bid_id	contract_year	version	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_h0066	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	2011	5	h.6.	h.7.	h.8.								OP Facility - Other	OP Facility - Other	OP Facility - Other								Urgent Care	PT/OT/ST/CORF/Cardiac Rehab/Pain Clinic	Hospital-based Clinic Visits								A		D	Coin	T	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	V	V	V	V	V	V	Coin	P			V		V		V		V	V	V																																																0	NO	243.1227571		1491.783198		142.7935695	27.39275044	7.020252626	307.2878083	482.6144438		893.5242272			0.154927597	4300.714945	4187.929928	189.6831053	1001.186462	2578.709609	941.9741842	51.89193109	76.53079776			102.1910793		77.87294235		0		0.288418305	798.0643096	578.4175866									$550/admit (PBP #1A/1B)		$100/admit; $0/day for 1st 15 days; $75/day for days 16 - 100 (#2)	0% coinsurance (#6)	$75 copay/day (#10A)	15% coinsurance (#11A/11C)	Prosthetics: 15% coinsurance; Medical Supplies: 0% coinsurance (#11B)	$50/visit (#4A)	"$100/visit, except $0 copay for Preventive Services (#9A/9B/14F)"	0% coinsurance (#8A)	"$0 copay for Preventive Radiology services; $50 copay/day for MRI, MRA, PET, & SPECT; all other diagnostic radiology $25 copay/day; Therapeutic Radiology $25 copay (#8B/14H)"	0% coinsurance	0% coinsurance (#12)	Partial Hospitalization: 20% coinsurance (#5)	"$10/visit, except $0 copay for Physical Exams (#7A/7G/14C)"	"$25/visit, except $0 copay for Physical Exams (#7D/7F/7G/14C/16B)"	$25/visit for individual therapy; $10/visit for group therapy (#7E/7H)	$25/visit (#7C/7I)	"$0 copay for Preventive Radiology services; $50 copay/day for MRI, MRA, PET, & SPECT; all other diagnostic radiology $25 copay/day; Therapeutic Radiology $25 copay (#8B/14H)"	Chiropractic Services: $25/visit (#7B)	10% coinsurance (#15)	Eyewear after cataract surgery or for Keratoconus: $25 copay (#17B)			$25/visit (#17A)		$25 copay ($10 if PCP provides exam) (#18A)		$0 copay (#14A)		$30 copay (#7A/7D/7F/7G/16B)	$25 copay (#3/7C/7I/9D)	$10/visit for PCPs; $25/visit for Specialists (#9A)								0	550		42.89	0	75	0.15	0.028	50	92.30927835	0	22.2	0	0	0.2	9.83	24.92	24.102889	25	19.64	25	0.1	25			25		24.38737624		0		30	25	15.95584125								NO	480.3032944		37.45492418	0	65.49590378	0.130991808	0.024451804	43.66393585	80.61172817	0	19.38678752	0	0	0.174655743	8.584329789	21.76210563	21.04853999	21.83196793	17.151194	21.83196793	0.087327872	21.83196793			21.83196793		21.29697663		0		26.19836151	21.83196793	13.93389658									9.7311	0	4.65621888	0	0.779366158	3.588225895	0.171657842	1.118116263	3.242032029	0	1.443547028	0	0	0.027058995	3.076562951	7.594847789	0.332712702	1.821489228	3.685662399	1.713762515	4.531611901	0.139234827	0	0	0.185919364	0	0.138204853	0	0	0	0.000629674	1.451942868	0.671634236	0	0	0	0	0	0	0	50.1015	0	7.27	9.7311	0	4.65621888	0	0.779366158	3.588225895	0.171657842	1.118116263	3.242032029	0	1.443547028	0	0	0.027058995	3.076562951	7.594847789	0.332712702	1.821489228	3.685662399	1.713762515	4.531611901	0.139234827	0	0	0.185919364	0	0.138204853	0	0	0	0.000629674	1.451942868	0.671634236	0	0	0	0	0	0	0	50.1015	YES	$550/admit		$100/admit; $0/day for 1st 15 days; $75/day for days 16 - 100	0% coinsurance	$75 copay/day	15% coinsurance	Prosthetics: 15% coinsurance; Medical Supplies: 0% coinsurance	$50/visit	"$100/visit, except $0 copay for Preventive Services"	0% coinsurance	"$0 copay for Preventive Radiology services; $50 copay/day for MRI, MRA, PET, & SPECT; all other diagnostic radiology $25 copay/day; Therapeutic Radiology $25 copay"	0% coinsurance	0% coinsurance	Partial Hospitalization: 20% coinsurance	"$10/visit, except $0 copay for Physical Exams"	"$25/visit, except $0 copay for Physical Exams"	$25/visit for individual therapy; $10/visit for group therapy	$25/visit	"$0 copay for Preventive Radiology services; $50 copay/day for MRI, MRA, PET, & SPECT; all other diagnostic radiology $25 copay/day; Therapeutic Radiology $25 copay"	Chiropractic Services: $25/visit	10% coinsurance	Eyewear after cataract surgery or for Keratoconus: $25 copay			$25/visit		$25 copay ($10 if PCP provides exam)		$0 copay		$30 copay	$25 copay	$10/visit for PCPs; $25/visit for Specialists								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	9.7311	0	4.65621888	0	0.779366158	3.588225895	0.171657842	1.118116263	3.242032029	0	1.443547028	0	0	0.027058995	3.076562951	7.594847789	0.332712702	1.821489228	3.685662399	1.713762515	4.531611901	0.139234827	0	0	0.185919364	0	0.138204853	0	0	0	0.000629674	1.451942868	0.671634236	0	0	0	0	0	0	0	50.1015
E6036_801_0	2011	4																															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	YES						12.48452874	6.138495938	440.8583151																5.719264015																	6700						11a (DME) - 20%	11b (Prosthetics/Med Supplies) - 20%	4a (ER) - $25; 4b (Urgent Care) - $25																"16a (Dental) - $10 Deductible, 20% Preventive/30% Basic/50% Major"																							0.2	0.2	25																0.311612355																	NO						0.199953572	0.199953572	24.99419646																0.311540017																		0	0	0	0	0	2.496326112	1.227414188	0.918241612	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.781779608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4238	0	0.001491568	0	0	0	0	0	2.496326112	1.227414188	0.918241612	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.781779608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4238	NO																																																																																		0	0	0	0	0	0	0	0	2.496326112	1.227414188	0.918241612	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.781779608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4238
H0084_001_0	2011	5																															D	A	D	Coin	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	Coin	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	1218.585248	3.57428628	384.6772876	0	308.5532906	7.595019649	6.593253389	275.4447643	306.7665503	3.258408281	21.18146678	873.8607883	0.324508897	459.5173379	2834.945685	3421.731153	107.9451374	381.0591986	18.51173434	12.92328581	7.010637522	0	0	241.8461538	278.6707454	0	0	0	0	0												$220/Days 1-15 for IP Medical; $220/Days 1-15 for IP Surgical; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse; PBP 1b	$130/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"35% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 35% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $35/Visit for PCP Urgent Care; $35/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$175/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$50/Visit for OP Fac - Other; PBP 9c	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$50/Visit for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $50/Visit for OP Fac - Physical/Speech Therapy; $50/Visit for OP Fac - CORF; $50/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35/Visit for PCP Office Visits; $35/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $15/Visit for Chiropractor; $50/Visit for Vision Exams; $50/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $50/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$10/Visit for Dental - Preventive; PBP 16a, 16b"	$10/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	Not Covered; PBP 18a	Not Covered; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											0	220	1000	130	0	150	0.2	0.244830269	49.0903758	175	0.2	0.2	50	0.2	50	35	45.85962104	39.75	50	0.2	0.2	0.2	0	0	10	10	0	0	0	0	0											NO	198.0607803	900.276274	117.0359156	0	135.0414411	0.180055255	0.220414882	44.19490061	157.5483479	0.180055255	0.180055255	45.0138137	0.180055255	45.0138137	31.61110907	41.36911938	35.78598189	45.0138137	0.180055255	0.180055255	0.180055255	0	0	10	10	0	0	0	0	0												20.1128	0.268153761	3.751754881	0	3.472290085	1.367523198	1.453251167	1.014437832	4.027546933	0.586693533	3.813834398	3.277983894	0.058429532	1.723718987	7.467981438	11.79616704	0.321910228	1.429410648	3.333135043	2.32690552	1.262302125	0	0	0.201538462	0.232225621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3	0	8.018564044	20.1128	0.268153761	3.751754881	0	3.472290085	1.367523198	1.453251167	1.014437832	4.027546933	0.586693533	3.813834398	3.277983894	0.058429532	1.723718987	7.467981438	11.79616704	0.321910228	1.429410648	3.333135043	2.32690552	1.262302125	0	0	0.201538462	0.232225621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3	YES	$220/Days 1-15 for IP Medical; $220/Days 1-15 for IP Surgical; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse; PBP 1b	$130/Days 21-100 for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$150/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; PBP 11a	"35% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 35% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Worldwide; ; PBP 4a, 4b"	"$175/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$50/Visit for OP Fac - Other; PBP 9c	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$50/Visit for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $50/Visit for OP Fac - Physical/Speech Therapy; $50/Visit for OP Fac - CORF; $50/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35/Visit for PCP Office Visits; $35/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $15/Visit for Chiropractor; $50/Visit for Vision Exams; $50/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $50/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$10/Visit for Dental - Preventive; PBP 16a, 16b"	$10/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	Not Covered; PBP 18a	Not Covered; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											3400	0	0	0	5.8321	0	1.4727	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											7.3083	0	0.809150248	20.1128	0.268153761	3.751754881	5.832051587	3.472290085	2.840240488	1.453251167	1.017984941	4.027546933	0.586693533	3.813834398	3.277983894	0.058429532	1.723718987	7.467981438	11.79616704	0.321910228	1.429410648	3.333135043	2.32690552	1.262302125	0	0	0.201538462	0.232225621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6083
H0104_010_1	2011	4																															D	D	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	YES	1011.748425	39.27910275	348.1171553	37.38486159	157.4734295	34.1906309	5.965725887	285.410923	671.4641941	6.178157922	1550.236214	0	0.064547499	441.6874602	4924.304825	5562.057586	251.4965555	341.013671	45.09646442	45.98868846	13.2038323	0	0	1204.9024	0	0	0	0	0	0											3400	1a:  Acute - $195/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $195/$0/day for 1-7/8-190	2:  Skilled Nursing Services - $0/$90/day for 1-5/6-35/36-100	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) - $195/visit/9b:  Ambulatory Surgical Center Services - $195/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $35/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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		9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit/7g:  Other Health Care Professional Services - $30/visit/18a:  Hearing Exams - $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																				195	195	90	0	150	0.2	0.057185225	25.84310572	195	0	21.90158958	0	0.2	62.72178148	15.000919	29.45284457	30	30	0	0.000998891	0	0	0	0	0	0	0	0	0	0											NO	158.3084644	158.3084644	73.06544512	0	121.7757419	0.162367656	0.046425154	20.98042247	158.3084644	0	17.7805488	0	0.162367656	50.91994314	12.17832027	23.91094665	24.35514837	24.35514837	0	0.000810938	0	0	0	0	0	0	0	0	0	0												13.3474	0.518184537	2.119611242	0	1.598036975	5.551452591	0.276959745	0.499003479	8.858205456	0	2.29700422	0	0.010480426	1.87422503	4.997480105	11.08283852	0.510436327	0.69211988	0	0.037293969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2707	0	12.57845	13.3474	0.518184537	2.119611242	0	1.598036975	5.551452591	0.276959745	0.499003479	8.858205456	0	2.29700422	0	0.010480426	1.87422503	4.997480105	11.08283852	0.510436327	0.69211988	0	0.037293969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2707	YES	1a:  Acute - 30.0% for 1-100/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-100/1b:  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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%							14c:  Routine Exams - 30.0%/												5100	0.9174	0.0181	0.114	0.1091	0.0196	0.1136	0.0184	0.004	0.286	0.029	0.0742	0	0.0003	0.0611	0.21	0.5925	0.0073	0.0343	0.1712	0.1756	0.0435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.9992	2000	1.57365	14.2647	0.536235765	2.233611185	0.109107303	1.617684076	5.665049422	0.295365245	0.503027042	9.144170155	0.029035653	2.371163019	0	0.010762597	1.93534039	5.207516936	11.67538102	0.517743328	0.726370013	0.171218932	0.212856995	0.043497134	2.54E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.2699
H0104_010_2	2011	4																															D	D	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	YES	698.5067308	27.11831842	182.5096528	19.1008271	104.8173637	24.31332365	4.242291543	202.2074811	495.57024	6.069059744	1115.329437	0	0.039219185	331.99398	3756.362739	4129.578027	166.8913261	226.2942475	31.59644002	26.22683774	6.807565438	0	0	1204.9024	0	0	0	0	0	0											3400	1a:  Acute - $195/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $195/$0/day for 1-7/8-190	2:  Skilled Nursing Services - $0/$90/day for 1-5/6-35/36-100	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) - $195/visit/9b:  Ambulatory Surgical Center Services - $195/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $35/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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		9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit/7g:  Other Health Care Professional Services - $30/visit/18a:  Hearing Exams - $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																				195	195	90	0	150	0.2	0.057185225	25.84310572	195	0	21.89570795	0	0.2	44.49537566	15.00091902	29.51095445	30	30	0	0.001301215	0	0	0	0	0	0	0	0	0	0											NO	173.028397	173.028397	79.85926016	0	133.0987669	0.177465023	0.050741886	22.9312367	173.028397	0	19.42861153	0	0.177465023	39.48186423	13.31069216	26.18581099	26.61975339	26.61975339	0	0.0011546	0	0	0	0	0	0	0	0	0	0												10.0718	0.39101993	1.214590487	0	1.162588488	4.314764531	0.215261874	0.386405634	7.145643686	0	1.805775196	0	0.006960034	1.09231177	4.166649006	9.011362474	0.370217162	0.501991422	0	0.030281517	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8876	0	5.319	10.0718	0.39101993	1.214590487	0	1.162588488	4.314764531	0.215261874	0.386405634	7.145643686	0	1.805775196	0	0.006960034	1.09231177	4.166649006	9.011362474	0.370217162	0.501991422	0	0.030281517	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8876	YES	1a:  Acute - 30.0% for 1-100/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-100/1b:  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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%							14c:  Routine Exams - 30.0%/												5100	0.8364	0.0164	0.106	0.1014	0.0183	0.1056	0.0171	0.0037	0.2642	0.0268	0.0685	0	0.0003	0.0564	0.1957	0.5527	0.0068	0.0318	0.1594	0.1632	0.0402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.7709	2000	1.14195	10.9082	0.407468496	1.320545439	0.101407586	1.180853331	4.420344819	0.232368495	0.390082948	7.409840368	0.02682612	1.874289233	0	0.007222294	1.148755839	4.362355494	9.564098585	0.377008507	0.533824519	0.159385884	0.193466148	0.04017326	2.35E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6586
H0104_010_3	2011	5																															D	D	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	YES	945.9300903	55.25744663	324.4989983	39.25400214	152.883952	32.95612727	5.143281236	317.8818781	618.037747	4.295783422	1418.970777	0	0.110117251	164.3157819	4122.9428	5182.501881	156.180439	363.2083087	49.29265967	70.73670669	1.549720278	0	0	1204.9024	0	0	0	0	0	0											3400	1a:  Acute - $195/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $195/$0/day for 1-7/8-190	2:  Skilled Nursing Services - $0/$90/day for 1-5/6-35/36-100	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) - $195/visit/9b:  Ambulatory Surgical Center Services - $195/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $35/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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		9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit/7g:  Other Health Care Professional Services - $30/visit/18a:  Hearing Exams - $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																				195	195	90	0	150	0.2	0.101476685	25.84310572	195	0	20.66312447	0	0.2	91.79507696	15.00110348	29.31257258	30	30	0	0.000446262	0	0	0	0	0	0	0	0	0	0											NO	162.4867201	162.4867201	74.99387083	0	124.9897847	0.166653046	0.084556993	21.53416147	162.4867201	0	17.2178632	0	0.166653046	76.48964605	12.49989797	24.42514757	24.99795694	24.99795694	0	0.000371854	0	0	0	0	0	0	0	0	0	0												12.8084	0.748216772	2.027952997	0	1.59241102	5.492239003	0.434900397	0.570443308	8.368577202	0	2.035970393	0	0.018351375	1.047371333	4.294697026	10.54861444	0.325349324	0.756622139	0	0.026303756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0964	0	10.2243	12.8084	0.748216772	2.027952997	0	1.59241102	5.492239003	0.434900397	0.570443308	8.368577202	0	2.035970393	0	0.018351375	1.047371333	4.294697026	10.54861444	0.325349324	0.756622139	0	0.026303756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0964	YES	1a:  Acute - 30.0% for 1-100/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-100/1b:  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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%							14c:  Routine Exams - 30.0%/												5100	0.958	0.0361	0.1055	0.1351	0.0218	0.1311	0.0194	0.0048	0.3121	0.0421	0.0658	0	0.0003	0.0674	0.1653	0.5165	0.0025	0.0229	0.1785	0.175	0.0093	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.9696	2000	1.50435	13.7665	0.784357164	2.133411901	0.135052579	1.614248638	5.623311675	0.454348501	0.575269838	8.680700923	0.042081972	2.10179161	0	0.018626313	1.11475656	4.459997154	11.0650732	0.327821624	0.779528675	0.178512893	0.201286428	0.009342162	4.09E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.066
H0104_010_4	2011	4																															D	D	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	YES	1138.572231	73.88848454	263.411597	45.17948676	208.9069098	28.08997357	6.167172056	325.8662116	677.1008546	5.99070642	1150.075998	0	0.086784224	361.0978795	4343.04544	4896.226295	286.6835676	275.4888267	45.82618909	60.16469625	3.780727305	0	0	1204.9024	0	0	0	0	0	0											3400	1a:  Acute - $195/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $195/$0/day for 1-7/8-190	2:  Skilled Nursing Services - $0/$90/day for 1-5/6-35/36-100	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) - $195/visit/9b:  Ambulatory Surgical Center Services - $195/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $35/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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		9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit/7g:  Other Health Care Professional Services - $30/visit/18a:  Hearing Exams - $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																				195	195	90	0	150	0.2	0.108446805	25.84310572	195	0	24.87896013	0	0.2	68.08171253	15.00104883	29.58359765	30	30	0	0.001705119	0	0	0	0	0	0	0	0	0	0											NO	159.179059	159.179059	73.467258	0	122.44543	0.163260573	0.088525438	21.09580128	159.179059	0	20.30876648	0	0.163260573	55.57529711	12.24539916	24.14917557	24.489086	24.489086	0	0.001391893	0	0	0	0	0	0	0	0	0	0												15.1031	0.980124953	1.612677313	0	2.131641367	4.58598519	0.545951605	0.572867404	8.981689741	0	1.946385406	0	0.014168442	1.672343495	4.431860416	9.853319036	0.585051545	0.562205797	0	0.083742844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6631	0	12.0761	15.1031	0.980124953	1.612677313	0	2.131641367	4.58598519	0.545951605	0.572867404	8.981689741	0	1.946385406	0	0.014168442	1.672343495	4.431860416	9.853319036	0.585051545	0.562205797	0	0.083742844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6631	YES	1a:  Acute - 30.0% for 1-100/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-100/1b:  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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%							14c:  Routine Exams - 30.0%/												5100	0.9261	0.0417	0.0863	0.1367	0.03	0.1023	0.0214	0.0043	0.2708	0.0237	0.0816	0	0.0003	0.0724	0.1829	0.4951	0.0078	0.0298	0.1586	0.2042	0.0214	0.0006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.8983	2000	1.36725	16.0292	1.021836066	1.698960437	0.136728799	2.161682391	4.688308209	0.567388315	0.57715048	9.252484017	0.023727248	2.027979987	0	0.014510417	1.744782655	4.614762332	10.34844033	0.5928217	0.591966066	0.158624293	0.28798402	0.021410376	0.000631554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5614
H0104_010_5	2011	4																															D	D	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	YES	928.9540948	53.23940572	354.6524903	35.19362032	160.9724269	30.20707855	5.682932363	385.4042322	658.7145083	9.178988635	1342.030358	0	0.070892429	440.8510556	4374.560203	5045.835948	239.5874738	297.0766562	36.04872663	49.88490342	5.737729344	0	0	1204.9024	0	0	0	0	0	0											3400	1a:  Acute - $195/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $195/$0/day for 1-7/8-190	2:  Skilled Nursing Services - $0/$90/day for 1-5/6-35/36-100	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) - $195/visit/9b:  Ambulatory Surgical Center Services - $195/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $35/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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		9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit/7g:  Other Health Care Professional Services - $30/visit/18a:  Hearing Exams - $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																				195	195	90	0	150	0.2	0.0938992	25.84310572	195	0	22.96080366	0	0.2	63.50190032	15.00054121	29.38066719	30	30	0	0.000800725	0	0	0	0	0	0	0	0	0	0											NO	161.5111294	161.5111294	74.54359819	0	124.2393303	0.16565244	0.077773158	21.40486765	161.5111294	0	19.0175658	0	0.16565244	52.5962238	12.42438129	24.33489611	24.84786606	24.84786606	0	0.00066321	0	0	0	0	0	0	0	0	0	0												12.503	0.716563046	2.203089395	0	1.66659221	5.00387628	0.441979596	0.687460549	8.86581035	0	2.126845886	0	0.011743504	1.932258399	4.529266997	10.23249113	0.496103122	0.615143414	0	0.033084164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0653	0	10.7956	12.503	0.716563046	2.203089395	0	1.66659221	5.00387628	0.441979596	0.687460549	8.86581035	0	2.126845886	0	0.011743504	1.932258399	4.529266997	10.23249113	0.496103122	0.615143414	0	0.033084164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0653	YES	1a:  Acute - 30.0% for 1-100/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-100/1b:  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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%							14c:  Routine Exams - 30.0%/												5100	1.0157	0.0276	0.0878	0.1194	0.0204	0.0972	0.0173	0.0051	0.3077	0.0361	0.0749	0	0.0003	0.0823	0.1917	0.5488	0.0058	0.0263	0.139	0.1726	0.0314	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0076	2000	1.5861	13.5187	0.744120038	2.290897404	0.11939793	1.68700412	5.101075625	0.459295851	0.692575179	9.17354971	0.036109558	2.201789412	0	0.012009971	2.014568437	4.720997602	10.78133087	0.501900703	0.64149215	0.138990835	0.205676418	0.031394052	3.62E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0729
H0104_011_1	2011	5																															D	D	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	YES	1067.033479	28.53195667	258.9921846	54.74445115	153.6924397	26.99209806	4.674843657	312.7157351	715.9089313	9.870110194	1224.836685	0	0.05630088	461.7288985	4232.471067	4864.89708	207.945513	333.984897	36.77058583	38.45975114	44.51979661	0	0	0	0	0	0	0	0	0											3400	1a:  Acute - $260/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $260/$0/day for 1-7/8-190	2:  Skilled Nursing Services - $0/$90/day for 1-5/6-35/36-100	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 - $20/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 - $35/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $40/visit/3:  Rehab Services (CORF) - $40/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $40/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $40/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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		9c:  Outpatient Substance Abuse Svcs - Individual - $40/visit/9c:  Outpatient Substance Abuse Svcs - Group - $40/visit/7g:  Other Health Care Professional Services - $40/visit/18a:  Hearing Exams - $40/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																				260	260	90	0	150	0.2	0.056682514	29.49110512	300	0	28.37984538	0	0.2	91.54051092	20.00129582	38.61052172	40	40	0	0.001804935	0	0	0	0	0	0	0	0	0	0											NO	195.4784796	195.4784796	67.66562755	0	112.7760459	0.150368061	0.042616199	22.1726015	225.5520918	0	21.33711163	0	0.150368061	68.82384575	15.03778037	29.02894647	30.07361224	30.07361224	0	0.001357023	0	0	0	0	0	0	0	0	0	0												17.3818	0.464781959	1.460405725	0	1.444402136	4.058749453	0.199224067	0.577810115	13.45622975	0	2.17787309	0	0.008465854	2.648163207	5.303914195	11.76856974	0.521139394	0.837011024	0	0.052190752	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3608	0	20.5834	17.3818	0.464781959	1.460405725	0	1.444402136	4.058749453	0.199224067	0.577810115	13.45622975	0	2.17787309	0	0.008465854	2.648163207	5.303914195	11.76856974	0.521139394	0.837011024	0	0.052190752	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3608	YES	1a:  Acute - 30.0% for 1-100/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-100/1b:  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 - $20/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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%							14c:  Routine Exams - 30.0%/												5100	1.7879	0.0219	0.1387	0.2141	0.0454	0.2029	0.0326	0.0123	0.4731	0.052	0.23	0	0.0006	0.163	0.4231	1.1445	0.0165	0.0914	0.2672	0.384	0.4126	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.1138	2000	3.4125	19.1697	0.486656099	1.59909373	0.214149852	1.489782098	4.261609143	0.231840305	0.590150186	13.92933063	0.051976326	2.407907528	0	0.009106486	2.811116482	5.727034225	12.91308322	0.537618359	0.928402489	0.267195436	0.436197739	0.412598957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4746
H0104_011_2	2011	6																															D	D	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	YES	1341.289154	73.37033707	398.5625118	46.02313062	195.7229992	24.86348471	6.479077027	336.5694264	720.3386356	7.927769424	1250.383794	0	0.072490526	279.0420755	4386.59974	4990.775522	172.3434041	208.7193212	37.83598208	52.19734817	3.237766112	0	0	0	0	0	0	0	0	0											3400	1a:  Acute - $260/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $260/$0/day for 1-7/8-190	2:  Skilled Nursing Services - $0/$90/day for 1-5/6-35/36-100	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 - $20/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 - $35/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $40/visit/3:  Rehab Services (CORF) - $40/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $40/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $40/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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		9c:  Outpatient Substance Abuse Svcs - Individual - $40/visit/9c:  Outpatient Substance Abuse Svcs - Group - $40/visit/7g:  Other Health Care Professional Services - $40/visit/18a:  Hearing Exams - $40/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																				260	260	90	0	150	0.2	0.096439285	29.49110512	300	0	28.40661528	0	0.2	85.48485116	20.00107409	38.93504255	40	40	0	0.001189192	0	0	0	0	0	0	0	0	0	0											NO	189.3819394	189.3819394	65.55528672	0	109.2588112	0.145678415	0.070245611	21.48108724	218.5176224	0	20.69115344	0	0.145678415	62.26648809	14.56862385	28.35997642	29.13568299	29.13568299	0	0.000866198	0	0	0	0	0	0	0	0	0	0												21.168	1.157918061	2.177323311	0	1.782038518	3.622073042	0.455126726	0.602489767	13.11722383	0	2.155990244	0	0.010560305	1.447914173	5.325560134	11.79485634	0.418445232	0.506764998	0	0.045213248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7875	0	24.5313	21.168	1.157918061	2.177323311	0	1.782038518	3.622073042	0.455126726	0.602489767	13.11722383	0	2.155990244	0	0.010560305	1.447914173	5.325560134	11.79485634	0.418445232	0.506764998	0	0.045213248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7875	YES	1a:  Acute - 30.0% for 1-100/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-100/1b:  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 - $20/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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%							14c:  Routine Exams - 30.0%/												5100	1.9683	0.0527	0.2815	0.2915	0.0497	0.1581	0.0391	0.0109	0.5203	0.0626	0.2011	0	0.0006	0.144	0.3605	0.9516	0.0077	0.0428	0.3215	0.3863	0.0503	0.0003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9015	2000	2.9553	23.1363	1.210654664	2.458807463	0.291549234	1.831779671	3.780188544	0.494195928	0.613422279	13.63754889	0.062591424	2.357124734	0	0.011134876	1.591876748	5.686017038	12.74648762	0.426176374	0.54952246	0.321468898	0.431523525	0.050346988	0.000276072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.689
H0104_011_3	2011	6																															D	D	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	YES	780.9301016	40.80314369	188.3063472	26.95067307	146.9906757	26.78518721	5.797665569	393.7245961	644.717746	7.748898691	1471.701398	0	0.059748741	538.0182323	4093.048453	4758.183919	117.7783584	188.1808649	35.21784014	44.26690566	6.339617102	0	0	0	0	0	0	0	0	0											3400	1a:  Acute - $260/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $260/$0/day for 1-7/8-190	2:  Skilled Nursing Services - $0/$90/day for 1-5/6-35/36-100	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 - $20/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 - $35/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $40/visit/3:  Rehab Services (CORF) - $40/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $40/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $40/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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		9c:  Outpatient Substance Abuse Svcs - Individual - $40/visit/9c:  Outpatient Substance Abuse Svcs - Group - $40/visit/7g:  Other Health Care Professional Services - $40/visit/18a:  Hearing Exams - $40/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																				260	260	90	0	150	0.2	0.086575011	29.49110512	300	0	26.79152587	0	0.2	70.21064121	20.00129257	38.64404759	40	40	0	0.001074079	0	0	0	0	0	0	0	0	0	0											NO	203.7094687	203.7094687	70.51481608	0	117.5246935	0.156699591	0.067831344	23.10622059	235.0493869	0	20.99110577	0	0.156699591	55.00989391	15.67097186	30.27753231	31.33991826	31.33991826	0	0.000841539	0	0	0	0	0	0	0	0	0	0												13.2569	0.69266556	1.106532286	0	1.439586175	4.197227889	0.393263448	0.758123947	12.62837591	0	2.574386642	0	0.009362603	2.46636049	5.345170592	12.00550561	0.307597011	0.49146441	0	0.037252319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7098	0	15.9468	13.2569	0.69266556	1.106532286	0	1.439586175	4.197227889	0.393263448	0.758123947	12.62837591	0	2.574386642	0	0.009362603	2.46636049	5.345170592	12.00550561	0.307597011	0.49146441	0	0.037252319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7098	YES	1a:  Acute - 30.0% for 1-100/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-100/1b:  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 - $20/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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%							14c:  Routine Exams - 30.0%/												5100	1.7977	0.0372	0.116	0.1689	0.0509	0.1942	0.0397	0.0107	0.6662	0.0677	0.1757	0	0.0005	0.164	0.3971	1.0541	0.0071	0.0392	0.3059	0.3805	0.0623	0.0003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.7359	2000	2.6229	15.0546	0.729908622	1.222502678	0.16888976	1.490534039	4.391434002	0.43291548	0.76884507	13.29454429	0.06770972	2.750119456	0	0.009911896	2.630402507	5.742222611	13.05959058	0.314682007	0.530623582	0.305913196	0.417730735	0.062340499	0.000301383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4457
H0104_011_4	2011	6																															D	D	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	YES	725.8347484	37.67051831	241.8169591	25.7604053	128.9555552	26.22121292	6.07187272	332.7219921	618.1438311	8.080999555	1272.774989	0	0.061123815	380.135369	4202.840955	4930.435789	193.994903	287.6677275	35.21265753	43.99203337	3.315075298	0	0	0	0	0	0	0	0	0											3400	1a:  Acute - $260/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $260/$0/day for 1-7/8-190	2:  Skilled Nursing Services - $0/$90/day for 1-5/6-35/36-100	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 - $20/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 - $35/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $40/visit/3:  Rehab Services (CORF) - $40/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $40/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $40/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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		9c:  Outpatient Substance Abuse Svcs - Individual - $40/visit/9c:  Outpatient Substance Abuse Svcs - Group - $40/visit/7g:  Other Health Care Professional Services - $40/visit/18a:  Hearing Exams - $40/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																				260	260	90	0	150	0.2	0.107773298	29.49110512	300	0	25.91360191	0	0.2	71.3402438	20.00103259	38.58756025	40	40	0	0.001115032	0	0	0	0	0	0	0	0	0	0											NO	205.4239793	205.4239793	71.10830052	0	118.5138342	0.158018446	0.085150845	23.30069295	237.0276684	0	20.47413546	0	0.158018446	56.36537217	15.8026604	30.48773145	31.60368912	31.60368912	0	0.000880978	0	0	0	0	0	0	0	0	0	0												12.4253	0.644868981	1.43293275	0	1.273584774	4.143435307	0.517025095	0.646054415	12.20976592	0	2.171580629	0	0.00965869	1.785539296	5.534672361	12.52648352	0.510912884	0.757613452	0	0.038756004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.6282	0	15.0447	12.4253	0.644868981	1.43293275	0	1.273584774	4.143435307	0.517025095	0.646054415	12.20976592	0	2.171580629	0	0.00965869	1.785539296	5.534672361	12.52648352	0.510912884	0.757613452	0	0.038756004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.6282	YES	1a:  Acute - 30.0% for 1-100/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-100/1b:  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 - $20/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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%							14c:  Routine Exams - 30.0%/												5100	1.8082	0.0485	0.1333	0.1952	0.0361	0.1878	0.0415	0.0111	0.6241	0.0714	0.1572	0	0.0005	0.1591	0.398	1.0472	0.0106	0.0575	0.3064	0.3388	0.0407	0.0001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.6733	2000	2.4987	14.2335	0.693392332	1.566204686	0.195184652	1.309661544	4.331240571	0.558508502	0.657178466	12.83391522	0.071373138	2.328759988	0	0.010174344	1.944646104	5.93264552	13.5737108	0.521517107	0.815101199	0.306438686	0.377585998	0.040718473	9.97E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3015
H0104_011_5	2011	6																															D	D	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	YES	682.1806311	40.54843655	286.2275514	29.02551615	123.0189729	26.57794779	4.79664634	266.7115912	529.9641633	3.589470409	1275.180905	0	0.091611876	171.2479486	3865.087002	4916.4286	127.9515361	314.8212611	40.92835869	59.71210168	1.416665699	0	0	0	0	0	0	0	0	0											3400	1a:  Acute - $260/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $260/$0/day for 1-7/8-190	2:  Skilled Nursing Services - $0/$90/day for 1-5/6-35/36-100	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 - $20/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 - $35/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $40/visit/3:  Rehab Services (CORF) - $40/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $40/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $40/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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		9c:  Outpatient Substance Abuse Svcs - Individual - $40/visit/9c:  Outpatient Substance Abuse Svcs - Group - $40/visit/7g:  Other Health Care Professional Services - $40/visit/18a:  Hearing Exams - $40/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																				260	260	90	0	150	0.2	0.078320749	29.49110512	300	0	24.19420975	0	0.2	82.51153649	20.0015724	38.38507144	40	40	0	0.00068522	0	0	0	0	0	0	0	0	0	0											NO	210.4654694	210.4654694	72.85343172	0	121.4223862	0.161896515	0.063399282	23.8725357	242.8447724	0	19.5847912	0	0.161896515	66.79165099	16.19092433	31.07204646	32.37930299	32.37930299	0	0.000554674	0	0	0	0	0	0	0	0	0	0												11.9646	0.711170478	1.737721614	0	1.244771437	4.302877121	0.304103934	0.530590165	10.72491888	0	2.081179315	0	0.014831643	0.953161101	5.214944264	12.73029149	0.345248463	0.849474417	0	0.033120742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.743	0	12.6488	11.9646	0.711170478	1.737721614	0	1.244771437	4.302877121	0.304103934	0.530590165	10.72491888	0	2.081179315	0	0.014831643	0.953161101	5.214944264	12.73029149	0.345248463	0.849474417	0	0.033120742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.743	YES	1a:  Acute - 30.0% for 1-100/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-100/1b:  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 - $20/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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%							14c:  Routine Exams - 30.0%/												5100	1.7555	0.0554	0.1951	0.222	0.0384	0.235	0.0398	0.0101	0.5867	0.0782	0.1309	0	0.0005	0.1277	0.3454	1.05	0.0047	0.0436	0.3323	0.3309	0.019	0.0002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.6014	2000	2.3814	13.7201	0.766582718	1.932816083	0.222006392	1.283193821	4.537875038	0.343934825	0.540727943	11.31157494	0.0781719	2.212126927	0	0.015340151	1.080835558	5.560300521	13.78028399	0.349949163	0.893054565	0.332325493	0.363977691	0.018985724	0.000202914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3444
H0104_011_6	2011	6																															D	D	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	YES	616.9044823	19.85035023	134.4738621	20.83561694	99.78269427	20.01140088	4.103408429	221.9941421	594.4000171	4.726575908	1153.229773	0	0.051447685	323.0906587	4177.081037	4776.788818	194.9369682	282.9871958	37.54050044	41.91641491	3.982758355	0	0	0	0	0	0	0	0	0											3400	1a:  Acute - $260/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $260/$0/day for 1-7/8-190	2:  Skilled Nursing Services - $0/$90/day for 1-5/6-35/36-100	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 - $20/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 - $35/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $40/visit/3:  Rehab Services (CORF) - $40/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $40/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $40/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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		9c:  Outpatient Substance Abuse Svcs - Individual - $40/visit/9c:  Outpatient Substance Abuse Svcs - Group - $40/visit/7g:  Other Health Care Professional Services - $40/visit/18a:  Hearing Exams - $40/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																				260	260	90	0	150	0.2	0.066639972	29.49110512	300	0	26.2124751	0	0.2	68.76585939	20.00164235	38.91291967	40	40	0	0.002157689	0	0	0	0	0	0	0	0	0	0											NO	212.7788365	212.7788365	73.65421262	0	122.757021	0.163676028	0.054536829	24.13493474	245.5140421	0	21.45176905	0	0.163676028	56.27661365	16.36894687	31.84556066	32.73520561	32.73520561	0	0.00176581	-4.36E-19	0	0	0	0	0	0	0	0	0												10.9387	0.351977869	0.825380536	0	1.020752192	3.275386611	0.223786885	0.446484511	12.16112923	0	2.061568228	0	0.008420753	1.515204015	5.697868132	12.6766265	0.531775145	0.771970337	0	0.074016408	-1.73E-18	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.581	0	11.6691	10.9387	0.351977869	0.825380536	0	1.020752192	3.275386611	0.223786885	0.446484511	12.16112923	0	2.061568228	0	0.008420753	1.515204015	5.697868132	12.6766265	0.531775145	0.771970337	0	0.074016408	-1.73E-18	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.581	YES	1a:  Acute - 30.0% for 1-100/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-100/1b:  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 - $20/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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%							14c:  Routine Exams - 30.0%/												5100	1.4542	0.0281	0.1054	0.1515	0.0333	0.1709	0.0327	0.0081	0.6123	0.0478	0.1628	0	0.0005	0.1326	0.4066	1.0311	0.0135	0.0739	0.331	0.3631	0.0438	0.0001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.2035	2000	1.7709	12.3929	0.380049283	0.930797579	0.15154415	1.054027835	3.446298229	0.256496046	0.454580463	12.77338358	0.04784949	2.224401454	0	0.008935208	1.647846124	6.104465042	13.70775193	0.545285414	0.845841865	0.330985516	0.43707542	0.043816746	0.000146296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7845
H0104_801_0	2011	2																															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	YES	237.5782079	6.857785225	25.65470571	42.92402009	8.799430823	26.93165374	1.747903827	13.11590822	49.49099902	3.601098103	16.24305172	0	0.112693889	6.973335581	59.87451783	173.8772586	2.016174307	9.620580141	39.77263184	69.18166423	4.838687477	0.503420864	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS												0.090598562	0.090598562	0.175089694	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.232915724	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.07200225	0.07200225	0.139150683	0	0.185174287	0.185174287	0.185174287	0.185174287	0.185174287	0.185174287	0.185174287	0	0.185174287	0.185174287	0.185107309	0.185174287	0.185174287	0.185174287	0.185174287	0.185174287	0.185174287	0.185174287	0	0	0	0	0	0	0	0												17.1062	0.493775963	3.569869833	0	1.629428328	4.987049778	0.323666845	2.428728951	9.164460453	0.666830773	3.007795519	0	0.02086801	1.291282444	11.0832109	32.19759738	0.37334364	1.781484067	7.36486874	12.81066534	0.896000503	0.093220599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2903	0	28.7434	17.1062	0.493775963	3.569869833	0	1.629428328	4.987049778	0.323666845	2.428728951	9.164460453	0.666830773	3.007795519	0	0.02086801	1.291282444	11.0832109	32.19759738	0.37334364	1.781484067	7.36486874	12.81066534	0.896000503	0.093220599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2903	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	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS											10000	0.3967	0.0119	0.1341	0	0.0354	0.1086	0.007	0.0508	0.2347	0.033	0.07	0	0.0003	0.0786	0.2289	0.6301	0.0053	0.0259	0.1671	0.2029	0.0299	0.0033	0	0	0	0	0	0	0	0											2.4544	0	0.2978	17.5029	0.505660343	3.70393843	0	1.664863749	5.095605307	0.330712258	2.47953462	9.399187006	0.699805144	3.07780887	0	0.021157312	1.36986242	11.31211196	32.82768162	0.378596604	1.807353503	7.531962278	13.01360882	0.925878395	0.096470879	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7447
H0104_802_0	2011	3																															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	YES	261.4075497	7.545508883	32.00558334	51.89656854	10.17819027	31.15149705	2.021777847	16.22920913	60.85228062	7.1863009	16.95447219	0	0.082960204	10.74624436	55.60978862	158.6871278	1.484247768	7.082185545	40.47051467	54.70343132	6.037519537	0.628148461	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS												0.08992322	0.08992322	0.176149247	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.232917147	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.071207673	0.071207673	0.139487643	0	0.184506158	0.184506158	0.184506158	0.184506158	0.184506158	0.184506158	0.184506158	0	0.184506158	0.184506158	0.184440549	0.184506158	0.184506158	0.184506158	0.184506158	0.184506158	0.184506158	0.184506158	0	0	0	0	0	0	0	0												18.6142	0.537298131	4.464383381	0	1.877938785	5.747643044	0.373030463	2.994389029	11.22762052	1.325916771	3.128204528	0	0.015306668	1.982748263	10.25669997	29.27875231	0.273852854	1.306706847	7.467059183	10.09311996	1.113959535	0.115897259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.1948	0	29.4882	18.6142	0.537298131	4.464383381	0	1.877938785	5.747643044	0.373030463	2.994389029	11.22762052	1.325916771	3.128204528	0	0.015306668	1.982748263	10.25669997	29.27875231	0.273852854	1.306706847	7.467059183	10.09311996	1.113959535	0.115897259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.1948	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	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS											10000	0.412	0.0123	0.1405	0	0.0369	0.1131	0.0073	0.0525	0.2431	0.0342	0.0725	0	0.0003	0.0814	0.2384	0.6563	0.0055	0.027	0.1741	0.2114	0.0309	0.0034	0	0	0	0	0	0	0	0											2.5531	0	0.3402	19.0262	0.549637498	4.604889062	0	1.914851795	5.860726368	0.380369737	3.046889202	11.47073591	1.360072523	3.200725333	0	0.015608036	2.064152131	10.49512059	29.9350773	0.279318747	1.333667053	7.641117367	10.30452895	1.144903406	0.119264036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.7479
H0104_804_0	2011	2																															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	YES	261.4075497	7.545508883	32.00558334	51.89656854	10.17819027	31.15149705	2.021777847	16.22920913	60.85228062	7.1863009	16.95447219	0	0.082960204	10.74624436	55.60978862	158.6871278	1.484247768	7.082185545	40.47051467	54.70343132	6.037519537	0.628148461	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS												0.08992322	0.08992322	0.176149247	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.232917147	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.071207673	0.071207673	0.139487643	0	0.184506158	0.184506158	0.184506158	0.184506158	0.184506158	0.184506158	0.184506158	0	0.184506158	0.184506158	0.184440549	0.184506158	0.184506158	0.184506158	0.184506158	0.184506158	0.184506158	0.184506158	0	0	0	0	0	0	0	0												18.6142	0.537298131	4.464383381	0	1.877938785	5.747643044	0.373030463	2.994389029	11.22762052	1.325916771	3.128204528	0	0.015306668	1.982748263	10.25669997	29.27875231	0.273852854	1.306706847	7.467059183	10.09311996	1.113959535	0.115897259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.1948	0	29.4882	18.6142	0.537298131	4.464383381	0	1.877938785	5.747643044	0.373030463	2.994389029	11.22762052	1.325916771	3.128204528	0	0.015306668	1.982748263	10.25669997	29.27875231	0.273852854	1.306706847	7.467059183	10.09311996	1.113959535	0.115897259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.1948	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	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS											10000	0.412	0.0123	0.1405	0	0.0369	0.1131	0.0073	0.0525	0.2431	0.0342	0.0725	0	0.0003	0.0814	0.2384	0.6563	0.0055	0.027	0.1741	0.2114	0.0309	0.0034	0	0	0	0	0	0	0	0											2.5531	0	0.3402	19.0262	0.549637498	4.604889062	0	1.914851795	5.860726368	0.380369737	3.046889202	11.47073591	1.360072523	3.200725333	0	0.015608036	2.064152131	10.49512059	29.9350773	0.279318747	1.333667053	7.641117367	10.30452895	1.144903406	0.119264036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.7479
H0108_004_0	2011	5	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	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	YES	1667.656768	70.978097	692.734634	1720.70344	232.217956	9.32734	1.405139	403.691168	336.337831	1556.176117	1559.014574	78.953787	0.480426	3.190828	4820.562791	4997.997775	76.071785	751.038855		1903.685622	31.617015	0							1.42	0.15	7690.373074	1.719689	583.632826								5000	$225/Day(Days 1-5):1a.IP Acute	$225/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$200/Visit:8b, 9a. $200 DMAM -- OP,8b. $150 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $200 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,8b, 9a. $200 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$200/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$30/Visit:7b. $15 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"	$0/Proc:12.Dialysis -- Dialysis Center	"$30-$200/Visit:9d. $30 Cardiac Rehab,8b. $200 Nuclear Medicine,9a. $200 OP Other,5. $200 Partial Hospitalization,7h. $200 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"									139.3002	112.142475	45.243839	0	100	0.2	0.2	50	200	0	120.796066	200	0.2	0.2	15	29.678133	30	30		0	0.2	0							0	0	0	0	175.688085								NO	124.563075	100.278474	33.26128	0	88.8412	0.177682	0.177682	44.4206	177.6824	0	107.316675	177.6824	0.177682	0.177682	13.32618	26.36641	26.65236	26.65236		0	0.177682	0							0	0	0	0	156.083403									17.3107	0.593131271	1.920103386	0	1.719210156	1.657300426	0.249667908	1.494350325	4.980109419	0	13.94235503	1.169058197	0.085363053	0.566952701	5.353307288	10.98160488	0.168957717	1.668079828	0	0	5.617774459	0	0	0	0	0	0	0	0	0	0	0	7.591283132	0	0	0	0	0	0	0	77.0693	0	10.00018422	17.3107	0.593131271	1.920103386	0	1.719210156	1.657300426	0.249667908	1.494350325	4.980109419	0	13.94235503	1.169058197	0.085363053	0.566952701	5.353307288	10.98160488	0.168957717	1.668079828	0	0	5.617774459	0	0	0	0	0	0	0	0	0	0	0	7.591283132	0	0	0	0	0	0	0	77.0693	NO																																																																																		0	0	0	17.3107	0.593131271	1.920103386	0	1.719210156	1.657300426	0.249667908	1.494350325	4.980109419	0	13.94235503	1.169058197	0.085363053	0.566952701	5.353307288	10.98160488	0.168957717	1.668079828	0	0	5.617774459	0	0	0	0	0	0	0	0	0	0	0	7.591283132	0	0	0	0	0	0	0	77.0693
H0108_005_0	2011	5	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V					O	O	O	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	YES	1599.422127	68.073923	664.390373	1650.298316	222.716415	10.618718	1.599682	387.173547	322.576072	1492.502872	1495.225189	75.723276	0.54694	3.632602	4623.322342	4793.497309	72.959195	720.308991		1825.793512	35.994416	0		2.61					1.42	0.15	7375.710095	1.649326	559.752626								3400	$100/Day(Days 1-5):1a.IP Acute	$100/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $75(Days 21-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $5 Advanced Imaging -- Office,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0-$5/Visit:7b. $0 Chiropractic,7f. $5 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $5 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $5 Spec Cap"	"$5/Visit:7e, 7h.Psych -- Other Provider"	"$5-$15/Visit:7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $5 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"	$0/Proc:12.Dialysis -- Dialysis Center	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $100 OP Other,5. $100 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"									61.9112	49.8411	24.768525	0	100	0.2	0.2	50	78.964225	0	14.816946	100	0.2	0.2	0	4.892711	5	7.147484		0	0.2	0		0					0	0	0	0	86.241653								NO	59.543901	47.935326	22.361123	0	95.625	0.19125	0.19125	47.8125	75.50954	0	14.168705	95.625	0.19125	0.19125	0	4.678655	4.78125	6.834782		0	0.19125	0		0					0	0	0	0	82.468581									7.9363	0.271928808	1.238042904	0	1.774771432	2.030829818	0.305939183	1.542644601	2.029797568	0	1.765450384	0.603419856	0.104602275	0.694735133	0	1.868926679	0.029069679	0.410262911	0	0	6.88393206	0	0	0	0	0	0	0	0	0	0	0	3.846833731	0	0	0	0	0	0	0	33.3375	0	1.552686939	7.9363	0.271928808	1.238042904	0	1.774771432	2.030829818	0.305939183	1.542644601	2.029797568	0	1.765450384	0.603419856	0.104602275	0.694735133	0	1.868926679	0.029069679	0.410262911	0	0	6.88393206	0	0	0	0	0	0	0	0	0	0	0	3.846833731	0	0	0	0	0	0	0	33.3375	NO																																																																																		0	0	0	7.9363	0.271928808	1.238042904	0	1.774771432	2.030829818	0.305939183	1.542644601	2.029797568	0	1.765450384	0.603419856	0.104602275	0.694735133	0	1.868926679	0.029069679	0.410262911	0	0	6.88393206	0	0	0	0	0	0	0	0	0	0	0	3.846833731	0	0	0	0	0	0	0	33.3375
H0108_006_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other						Prosthetics/Supplies	Radiology	Renal Dialysis	Other	Other						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O		V					O	O	O	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	NO	1601.824364	68.176166	665.388247	1257.547691	169.712658	6.963032	1.048962	387.755058	323.06056	1494.744522	466.386493	75.837008	0.546609	3.630394	4655.430785	4826.787598	73.465888	724.46951		1838.473439	36.157435	0		2.61					3.27	0.15	5620.382152	1032.076652	1.651803	163.746771	396.846571							$100/Day(Days 1-5):1a.IP Acute	$100/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $75(Days 21-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$5/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $5 Advanced Imaging -- Office"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0-$5/Visit:7b. $0 Chiropractic,7f. $0 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $5 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $5 Spec Cap"	"$5/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$0-$100/Visit:8b, 9a. $100 DMAM -- OP,8b. $0 Radiology -- FSR,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$15-$100/Visit:9d. $15 Cardiac Rehab,5. $100 Partial Hospitalization,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$5-$100/Visit:8b. $50 Nuclear Medicine,9a. $100 OP Other,7h. $5 Psych -- OP"							61.9112	49.8411	24.768525	0	100	0.2	0.2	50	78.964225	0	1.967899	100	0.2	0.2	0	4.754749	5	15		0	0.2	0		0					0	0	0	20.613882	0	58.383613	95.956775						NO	60.532871	48.731488	23.856622	0	97.6233	0.195247	0.195247	48.81165	77.087482	0	1.921128	97.6233	0.195247	0.195247	0	4.641743	4.881165	14.643495		0	0.195247	0		0					0	0	0	20.123952	0	56.99601	93.67617							8.0803	0.276860501	1.322826324	0	1.380659144	1.359511109	0.204806684	1.577247015	2.075327092	0	0.074665679	0.616954915	0.106723767	0.708823537	0	1.867058962	0.02988326	0.884063804	0	0	7.059630711	0	0	0	0	0	0	0	0	0	0	1.730788417	0	0.777742716	3.097922237	0	0	0	0	0	33.2317	0	0.814237945	8.0803	0.276860501	1.322826324	0	1.380659144	1.359511109	0.204806684	1.577247015	2.075327092	0	0.074665679	0.616954915	0.106723767	0.708823537	0	1.867058962	0.02988326	0.884063804	0	0	7.059630711	0	0	0	0	0	0	0	0	0	0	1.730788417	0	0.777742716	3.097922237	0	0	0	0	0	33.2317	YES	$225/Day(Days 1-5)	$225/Day(Days 1-5)	$0/Day(Days 1-20) $120(Days 21-100)	$0/Visit	$100/Trip	20% Coins	20% Coins	$50/Visit	25% Coins	25% Coins	$20-$35/Visit	25% Coins	20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	$35/Visit		$20/Visit	20%-25% Coins	$0/Service									20% Coins	20%-25% Coins	$0/Proc	$35-$100/Visit	25% Coins						5000	1.3954	0.0478	0.1316	0	0.5203	0.7882	0.1187	0.1206	1.0526	0.1153	0.0724	0.1108	0.0083	0.0553	0.9451	0.9798	0.0149	0.1493		0.2133	0.5446	0									0.1595	0.4167	0	0.0694	0.1271						8.1572	0	1.374322684	9.4756	0.32467217	1.454451493	0	1.900953306	2.147701387	0.323545522	1.6978453	3.127940368	0.115256457	0.147114147	0.727716544	0.115051679	0.7641351	0.945059055	2.846903692	0.044796938	1.033411021	0	0.213264408	7.604200044	0	0	0	0	0	0	0	0	0	0.159532008	2.147533628	0	0.847183735	3.225015255	0	0	0	0	0	41.3889
H0108_008_0	2011	6	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V					O	O	O	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	YES	1701.544422	72.420409	706.811362	1755.669029	236.936746	10.818263	1.629743	411.894382	343.17239	1587.798426	1590.694563	80.558169	0.557218	3.700865	4918.519136	5099.559691	77.617603	766.300356		1942.369504	36.670815	0		2.61					3.27	0.15	7846.645457	1.754634	595.492549								3400	$125/Day(Days 1-5):1a.IP Acute	$125/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $84(Days 21-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$25/Visit:7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"	$0/Proc:12.Dialysis -- Dialysis Center	"$25-$100/Visit:9d. $25 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $100 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF"									77.389	62.301375	27.740748	0	100	0.2	0.2	50	100	0	71.969255	100	0.2	0.2	10	24.678133	25	25		0	0.2	0		0					0	0	0	0	89.274155								NO	69.219895	55.724904	20.751245	0	88.3127	0.176625	0.176625	44.15635	88.3127	0	63.557992	88.3127	0.176625	0.176625	8.83127	21.793926	22.078175	22.078175		0	0.176625	0		0					0	0	0	0	78.840417									9.8151	0.336301695	1.222267978	0	1.743710314	1.910775702	0.287853357	1.515646041	2.525540027	0	8.425112692	0.592859118	0.098418629	0.653665281	3.619730874	9.261618878	0.142804585	1.409876114	0	0	6.476982699	0	0	0	0	0	0	0	0	0	0	0	3.91240674	0	0	0	0	0	0	0	53.9506	0	7.244360731	9.8151	0.336301695	1.222267978	0	1.743710314	1.910775702	0.287853357	1.515646041	2.525540027	0	8.425112692	0.592859118	0.098418629	0.653665281	3.619730874	9.261618878	0.142804585	1.409876114	0	0	6.476982699	0	0	0	0	0	0	0	0	0	0	0	3.91240674	0	0	0	0	0	0	0	53.9506	NO																																																																																		0	0	0	9.8151	0.336301695	1.222267978	0	1.743710314	1.910775702	0.287853357	1.515646041	2.525540027	0	8.425112692	0.592859118	0.098418629	0.653665281	3.619730874	9.261618878	0.142804585	1.409876114	0	0	6.476982699	0	0	0	0	0	0	0	0	0	0	0	3.91240674	0	0	0	0	0	0	0	53.9506
H0108_009_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Radiology	Renal Dialysis	Other	Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V					O	O	O	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	NO	1612.997619	68.651718	670.02955	1266.319502	170.89646	6.717763	1.012013	390.459778	325.314014	1505.170859	469.639693	76.365996	0.527354	3.502515	4687.903955	4860.456039	73.978337	155.998154		1851.297399	34.883802	0		2.61					3.27	0.15	5659.586176	1039.275727	1.663324	564.503667	573.524771							$125/Day(Days 1-5):1a.IP Acute	$125/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $84(Days 21-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$25/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $25 Advanced Imaging -- Office"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$25/Visit:7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$0-$100/Visit:8b, 9a. $100 DMAM -- OP,8b. $100 Radiology -- FSR,8b. $100 Advanced Imaging -- FSR,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$25-$100/Visit:9d. $25 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $100 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF"	"$25/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							77.389	62.301375	27.740748	0	100	0.2	0.2	50	100	0	9.839495	100	0.2	0.2	10	24.678133	25	25		0	0.2	0		0					0	0	0	100	0	89.274155	25						NO	72.913749	58.698611	24.210349	0	92.7981	0.185596	0.185596	46.39905	92.7981	0	9.130865	92.7981	0.185596	0.185596	9.27981	22.900839	23.199525	23.199525		0	0.185596	0		0					0	0	0	92.7981	0	82.84472	23.199525							9.8008	0.335813374	1.351804104	0	1.321572232	1.246789942	0.187825565	1.509746897	2.5157102	0	0.357351386	0.590551611	0.097874793	0.650052774	3.625238167	9.275710101	0.143021857	0.301590256	0	0	6.474294116	0	0	0	0	0	0	0	0	0	0	8.03690107	0	3.897179019	1.108791855	0	0	0	0	0	52.8286	0	4.027623643	9.8008	0.335813374	1.351804104	0	1.321572232	1.246789942	0.187825565	1.509746897	2.5157102	0	0.357351386	0.590551611	0.097874793	0.650052774	3.625238167	9.275710101	0.143021857	0.301590256	0	0	6.474294116	0	0	0	0	0	0	0	0	0	0	8.03690107	0	3.897179019	1.108791855	0	0	0	0	0	52.8286	YES	$225/Day(Days 1-5)	$225/Day(Days 1-5)	$0/Day(Days 1-20) $128(Days 21-100)	$0/Visit	20% Coins	40% Coins	40% Coins	$50/Visit	25% Coins	20%-25% Coins	$20-$35/Visit	25% Coins	20% Coins	20% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$20/Visit	20% Coins	0% Coins									40% Coins	20%-25% Coins	20% Coins	20%-25% Coins	$35/Visit						5000	1.3932	0.0477	0.1375	0	0.4478	1.5107	0.2276	0.1206	1.0087	0.1082	0.0725	0.1061	0.008	0.053	0.4051	0.9681	0.0149	0.0248		0.2133	0.4948	0									0.3058	0.3994	0.0006	0.1372	0.1156						8.3211	0	1.475975786	11.194	0.383548722	1.489303543	0	1.769358541	2.757458786	0.415404078	1.63037322	3.524445116	0.108164485	0.429816694	0.696696234	0.105855672	0.70305877	4.030357642	10.24376538	0.157939002	0.326353576	0	0.213313991	6.969095817	0	0	0	0	0	0	0	0	0	0.305763841	8.436274396	0.000593621	4.034354809	1.224438593	0	0	0	0	0	61.1497
H0108_010_0	2011	5	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery					Prosthetics/Supplies	Radiology	Renal Dialysis	Other	Other						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	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	0					0	NO	1533.730175	65.277971	637.102329	1204.088839	162.498105	5.599609	0.843566	371.271437	0	1431.202339	446.560219	72.613146	0.439577	2.91953	4457.526575	4621.598944	70.342824	693.672024		1760.319204	29.077486	0							3.27	0.15	5381.457476	988.202663	1.581584	76.763056	459.99924	309.327128						$150/Day(Days 1-5):1a.IP Acute	$150/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $50(Days 21-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$50/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	$0/Visit:9a.Surgery OP -- Physician	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$10/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $10 Advanced Imaging -- Office"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$10/Visit:7b. $5 Chiropractic,7f. $10 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $10 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $10 Spec Cap"	"$10/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$0-$100/Visit:8b, 9a. $100 DMAM -- OP,8b. $100 Radiology -- FSR,8b. $100 Advanced Imaging -- FSR,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$10/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 9d.Cardiac Rehab"	"$100/Visit:5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 9a.OP Other"	"$0-$75/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $75 Surgery OP -- Facility"						92.8668	74.76165	16.51235	0	50	0.2	0.2	50	0	10.377806	3.935798	100	0.2	0.2	5	9.892711	10	10		0	0.2	0							0	0	0	100	0	10	100	75					NO	90.959966	73.226569	16.175168	0	48.85435	0.195417	0.195417	48.85435	0	10.140019	3.845617	97.7087	0.195417	0.195417	4.885435	9.666039	9.77087	9.77087		0	0.195417	0							0	0	0	97.7087	0	9.77087	97.7087	73.281525						11.6257	0.398340154	0.858769767	0	0.661561608	1.094258792	0.164847137	1.511518727	0	1.209368243	0.143108297	0.591244675	0.085900819	0.570525794	1.814746362	3.72271297	0.057275882	0.564814931	0	0	5.682235082	0	0	0	0	0	0	0	0	0	0	8.046333128	0	0.062503487	3.745493978	1.888996972	0	0	0	0	44.5002	0	1.011405806	11.6257	0.398340154	0.858769767	0	0.661561608	1.094258792	0.164847137	1.511518727	0	1.209368243	0.143108297	0.591244675	0.085900819	0.570525794	1.814746362	3.72271297	0.057275882	0.564814931	0	0	5.682235082	0	0	0	0	0	0	0	0	0	0	8.046333128	0	0.062503487	3.745493978	1.888996972	0	0	0	0	44.5002	YES	$230/Day(Days 1-6)	$230/Day(Days 1-6)	$0/Day(Days 1-20) $50(Days 21-100)	$0/Visit	$50/Trip	35% Coins	35% Coins	$50/Visit	30% Coins	20%-25% Coins	$20-$25/Visit	25% Coins	20% Coins	20% Coins	$25/Visit	$25/Visit	$25/Visit	$25/Visit		$20/Visit	20%-25% Coins	$0/Service									35% Coins	20%-30% Coins	20% Coins	$25/Visit	25% Coins	$0-$125/Visit					6700	1.6373	0.0581	0.0697	0	0.2725	1.2135	0.1828	0.1263	0.164	0.0993	0.0647	0.0974	0.0073	0.0487	0.7071	0.7331	0.0112	0.1117		0.2234	0.4791	0									0.2456	0.378	0.0005	0.0131	0.1225	0.2631					7.3298	0	0.457323807	13.2629	0.456400533	0.928445018	0	0.934052363	2.307723389	0.347652511	1.637839261	0.163965939	1.308664681	0.207842618	0.68868676	0.093227334	0.619185986	2.521818506	4.45581098	0.068433965	0.67655319	0	0.223383555	6.161318305	0	0	0	0	0	0	0	0	0	0.245609205	8.424311103	0.000545028	0.075562328	3.867960967	2.152108833	0	0	0	0	51.83
H0108_801_0	2011	3																															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	YES	330.436307	4.635289	33.96052	18.351157	8.305073	10.576913	3.734184	30.112902	55.854712	6.031736	32.691246	5.796517	0.585313	11.235339	43.571474	78.918334	0.543546	6.028307		8.572224	35.852709	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.070192	0.070192	0.142621	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.063615	0.063615	0.101764	0	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881		0.209881	0.209881	0																				21.0207	0.29487391	3.455958357	0	1.743077026	2.219893077	0.783734272	6.320125985	11.72284281	1.265946783	6.861271402	1.216578784	0.122846078	2.358084185	9.144824535	16.56345886	0.114079978	1.265227101	0	1.799146945	7.524802418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7975	0	11.41509208	21.0207	0.29487391	3.455958357	0	1.743077026	2.219893077	0.783734272	6.320125985	11.72284281	1.265946783	6.861271402	1.216578784	0.122846078	2.358084185	9.144824535	16.56345886	0.114079978	1.265227101	0	1.799146945	7.524802418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7975	NO																																																																																		0	0	0	21.0207	0.29487391	3.455958357	0	1.743077026	2.219893077	0.783734272	6.320125985	11.72284281	1.265946783	6.861271402	1.216578784	0.122846078	2.358084185	9.144824535	16.56345886	0.114079978	1.265227101	0	1.799146945	7.524802418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7975
H0108_802_0	2011	3																															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	YES	330.436307	4.635289	33.96052	18.351157	8.305073	10.576913	3.734184	30.112902	55.854712	6.031736	32.691246	5.796517	0.585313	11.235339	43.571474	78.918334	0.543546	6.028307		8.572224	35.852709	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.070192	0.070192	0.142621	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.063615	0.063615	0.101764	0	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881		0.209881	0.209881	0																				21.0207	0.29487391	3.455958357	0	1.743077026	2.219893077	0.783734272	6.320125985	11.72284281	1.265946783	6.861271402	1.216578784	0.122846078	2.358084185	9.144824535	16.56345886	0.114079978	1.265227101	0	1.799146945	7.524802418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7975	0	11.41509208	21.0207	0.29487391	3.455958357	0	1.743077026	2.219893077	0.783734272	6.320125985	11.72284281	1.265946783	6.861271402	1.216578784	0.122846078	2.358084185	9.144824535	16.56345886	0.114079978	1.265227101	0	1.799146945	7.524802418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7975	NO																																																																																		0	0	0	21.0207	0.29487391	3.455958357	0	1.743077026	2.219893077	0.783734272	6.320125985	11.72284281	1.265946783	6.861271402	1.216578784	0.122846078	2.358084185	9.144824535	16.56345886	0.114079978	1.265227101	0	1.799146945	7.524802418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7975
H0108_803_0	2011	3																															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	YES	330.436307	4.635289	33.96052	18.351157	8.305073	10.576913	3.734184	30.112902	55.854712	6.031736	32.691246	5.796517	0.585313	11.235339	43.571474	78.918334	0.543546	6.028307		8.572224	35.852709	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.070192	0.070192	0.142621	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.063615	0.063615	0.101764	0	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881	0.209881		0.209881	0.209881	0																				21.0207	0.29487391	3.455958357	0	1.743077026	2.219893077	0.783734272	6.320125985	11.72284281	1.265946783	6.861271402	1.216578784	0.122846078	2.358084185	9.144824535	16.56345886	0.114079978	1.265227101	0	1.799146945	7.524802418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7975	0	11.41509208	21.0207	0.29487391	3.455958357	0	1.743077026	2.219893077	0.783734272	6.320125985	11.72284281	1.265946783	6.861271402	1.216578784	0.122846078	2.358084185	9.144824535	16.56345886	0.114079978	1.265227101	0	1.799146945	7.524802418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7975	NO																																																																																		0	0	0	21.0207	0.29487391	3.455958357	0	1.743077026	2.219893077	0.783734272	6.320125985	11.72284281	1.265946783	6.861271402	1.216578784	0.122846078	2.358084185	9.144824535	16.56345886	0.114079978	1.265227101	0	1.799146945	7.524802418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7975
H0117_005_0	2011	6																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1659.041355	175.4749135	627.8874594	127.3257707	728.8173897	6.525229058	8.22087044	694.1180594	322.6566922	6243.509439	1666.059256	55.49468613	0.13565061	1540.423429	11244.76613	14544.3185	169.4874107	526.3912017	3794.56361	2685.708928	17.41166074	0.019093688	0	415.7142857	331.2	198.72	16.2	12.34285714	0	0											3800	"(1a) $200 days 1 - 8, $0 after day 8, unlimited coverage"	"(1b) $200 days 1 - 8, $0 after day 8, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $200.00 copayment	(12) 20% coinsurance	"(9a) $150.00 copayment , (9d) Copay between $35.00 and $150.00"	"(14b) , (14c) $0.00 copayment ; (7a) $10.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	"(16) $0.00 copayment, $500 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											0	174.1716548	91.72438204	31.56196351	0	43.6077415	0.2	0.074883733	43.90635443	119.1049567	0	17.53257666	58.69107403	0.2	35.28393494	3.435701606	6.227656584	24.78143045	13.91853001	1.928547055	3.511611912	0.2	0	0	0	0	0	0	0	0	0											NO	165.1285023	86.96196777	29.92323733	0	41.34358746	0.189615816	0.070995701	41.62669613	112.9209178	0	16.62226916	55.64377949	0.189615816	33.45196059	3.257316819	5.904310927	23.49475579	13.19586713	1.828415118	3.329285792	0.189615816	0	0	0	0	0	0	0	0	0												22.8296	1.271636981	1.565702122	0	2.510993791	1.237286633	0.583646461	2.407820128	3.036224152	0	2.307807115	0.25732784	0.025721501	4.294181988	3.052313819	7.156181554	0.331838777	0.57884903	0.578169789	0.745124381	3.30152626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0719	0	3.180270958	22.8296	1.271636981	1.565702122	0	2.510993791	1.237286633	0.583646461	2.407820128	3.036224152	0	2.307807115	0.25732784	0.025721501	4.294181988	3.052313819	7.156181554	0.331838777	0.57884903	0.578169789	0.745124381	3.30152626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0719	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	22.8296	1.271636981	1.565702122	0	2.510993791	1.237286633	0.583646461	2.407820128	3.036224152	0	2.307807115	0.25732784	0.025721501	4.294181988	3.052313819	7.156181554	0.331838777	0.57884903	0.578169789	0.745124381	3.30152626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0719
H0117_007_0	2011	6																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	P	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	Yes	2484.579871	578.1328132	1274.344328	471.789733	22.1465977	12.93277097	12.76433215	46.70934676	34.46674978	7867.295923	15.67979834	0.806644621	0.387325313	24.34985011	10111.72797	97.39606727	7.454112544	1.023289214	15.76703171	9.636669761	18.9956511	0.055551205	0	415.7142857	331.2	198.72	0	0	0	0											6700	FFS	FFS	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) $0.00 copayment	(8b) 20% coinsurance	(5) 45% coinsurance	(12) 20% coinsurance	"(9a) , (9d) 20% coinsurance"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) 20% coinsurance"	"(7e) , (7h) 45% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) 20% coinsurance"	(15) 20% coinsurance	(13a) 20% coinsurance	Not Covered	"(16) $0.00 copayment, $500 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	Not Covered	Not Covered	Not Covered	Not Covered											0	134.8466686	48.50480647	34.41710706	0	0.173067871	0.187400224	0.187400062	0.159080153	0.167411144	0	0.173074597	0.370233387	0.1874	0.135974505	0	0.062172949	0.33276145	0.156011635	0.133406876	0.119130577	0.187401303	0.166403457	0	0	0	0	0	0	0	0											NO	131.4943099	47.29895158	33.56147975	0	0.168765313	0.182741357	0.182741199	0.155125337	0.163249216	0	0.168771872	0.361029191	0.182741138	0.132594107	0	0.060627297	0.324488826	0.152133104	0.130090311	0.116168928	0.182742409	0.16226658	0	0	0	0	0	0	0	0												27.2257	2.278756328	3.564073447	0	3.737577498	2.363352111	2.332569356	7.245803172	5.626669868	0	2.64630892	0.291222255	0.070780268	3.228646637	0	5.904860328	2.418776228	0.155676164	2.051138062	1.119481597	3.471311035	0.009014104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7417	0	1.930983427	27.2257	2.278756328	3.564073447	0	3.737577498	2.363352111	2.332569356	7.245803172	5.626669868	0	2.64630892	0.291222255	0.070780268	3.228646637	0	5.904860328	2.418776228	0.155676164	2.051138062	1.119481597	3.471311035	0.009014104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7417	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	27.2257	2.278756328	3.564073447	0	3.737577498	2.363352111	2.332569356	7.245803172	5.626669868	0	2.64630892	0.291222255	0.070780268	3.228646637	0	5.904860328	2.418776228	0.155676164	2.051138062	1.119481597	3.471311035	0.009014104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7417
H0141_001_0	2011	8																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	369.8966173	5.288584707	52.44820901	0	13.20935065	17.57765888	9.306979819	35.4685946	49.30148694	12.98036565	26.51319171	0	0.354776759	32.1510991	3.461556282	56.41600995	35.61056066	4.435183711	40.36719742	97.62665249	54.57449619	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing for PCP Office Visits and Consults; PBP 7a, No Cost-Sharing for PBP 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, No Cost-Sharing for 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, No Cost-Sharing for 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	0.074049233	0.074049233	0.166674563	0	0.233	0.233	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	0.074049233	0.074049233	0.166674563	0	0.233	0.233	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												27.3906	0.391615639	8.741782308	0	3.077778701	4.095594519	2.168526298	8.264182541	11.48724646	3.024425197	6.177573669	0	0.082662985	7.491206091	0.806542614	13.14493032	8.297260635	1.033397805	9.405556999	22.74701003	12.71585761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.5437	0	1.14E-13	27.3906	0.391615639	8.741782308	0	3.077778701	4.095594519	2.168526298	8.264182541	11.48724646	3.024425197	6.177573669	0	0.082662985	7.491206091	0.806542614	13.14493032	8.297260635	1.033397805	9.405556999	22.74701003	12.71585761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.5437	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	27.3906	0.391615639	8.741782308	0	3.077778701	4.095594519	2.168526298	8.264182541	11.48724646	3.024425197	6.177573669	0	0.082662985	7.491206091	0.806542614	13.14493032	8.297260635	1.033397805	9.405556999	22.74701003	12.71585761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.5437
H0150_001_0	2011	8																															D	D	D	V	T	COIN		P	P		P	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	YES	1227.510215	87.39501851	508.5112861	846.4027283	271.7700122	10.75669251		531.7462398	665.4632507		558.5822949	2.926215756	2.158609207	226.3744175	4758.031036	3615.714057	0.17161582	185.1375234	1223.218617		32.55857445																				3400	1a. $195 per day for 1st 6 days	1b. $195 per day for 1st 10 days	2a. $75/day days 1-30	6a. $20 copay per PT/OT/ST visit	10a. $95 copay per Trip	11a. 20% Coinsurance	11b. 20% Coinsurance	4a. $50 copay per visit	9a/b. $200 copay per visit	"8a, 9a. Zero cost share for lab services"	"8a/b, 9a. $25/Xray; $100/MRI,MRA, CT, PET, and  Nuc Scan"	1a. $50 copay per Observation Stay	"9a, 12. 20% Coinsurance"	"3, 7c/i, 9a.  $20 copay per PT/OT/ST visit"	"7, 17, 18a. $10 copay per visit; 9d, 14b/c/d/e/f/g/h/i/j. Zero cost share for preventive services"	"4b/b1, 7b/d/f/g, 17a, 18a. $35 copay per visit"	"5, 7e/h, 9c. 20% Coinsurance"	"3, 7c/i. $20 copay per PT/OT/ST visit"	"8a/b. $25/Xray; $100/MRI,MRA, CT, PET, and  Nuc Scan"		"11c, 15. 20% coinsurance per Script"																					195	195	75	20	95	0.2		50	200		67.85890945	50	0.2	20	10	35	0.2	20	32.73323401		0.2																				NO	189.54	189.54	72.89287449	19.43809986	92.33097435	0.194380999	0	48.59524966	194.4	0	65.95241293	48.59524966	0.194380999	19.43809986	9.719049932	34.02	0.194380999	19.43809986	31.81359358	0	0.194380999																					19.3885	1.380404317	3.088904113	1.371038396	2.091065835	2.090896632	0	2.153361773	10.78050466	0	3.069987514	0.011850015	0.419592613	0.366690711	3.853628435	10.25054935	0.033358855	0.299893472	3.242914995	0	6.328768216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2219		2.111308756	19.3885	1.380404317	3.088904113	1.371038396	2.091065835	2.090896632	0	2.153361773	10.78050466	0	3.069987514	0.011850015	0.419592613	0.366690711	3.853628435	10.25054935	0.033358855	0.299893472	3.242914995	0	6.328768216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2219	NO																																																																																		0			19.3885	1.380404317	3.088904113	1.371038396	2.091065835	2.090896632	0	2.153361773	10.78050466	0	3.069987514	0.011850015	0.419592613	0.366690711	3.853628435	10.25054935	0.033358855	0.299893472	3.242914995	0	6.328768216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2219
H0150_007_0	2011	9																															D	D	D	V	COIN	COIN		V	V		COIN	V	COIN	COIN	V	V	COIN	V	COIN		COIN																																																												0	YES	2826.949611	0	1338.670199	1669.128666	14.92749906	20.6407279		960.7731877	684.2440136		19.42478734	5.915928777	5.424567945	23.58765456	7976.89135	13765.16914	0.270812267	215.156416	12.43801547		56.50485728																				6700	1a. $125 per day for 1st 6 days	1b. $125 per day for 1st 10 days	2a. $30 days 1-30	6a. $0 Copay per PT/OT/ST visit	10a. 20% Coinsurance	11a. 20% Coinsurance	11b. 20% Coinsurance	4a. $50 copay per visit	9a/b. $50 copay per visit	8a./9a. Zero cost share	8a/b. 9a. 20% Coinsurance	1a. $50 copay per Observation Stay	"9a., 12. 20% Coinsurance"	9a. 20% Coinsurance	"7, 17, 18a $0 copay per visit; 9d, 14b/c/d/e/f/g/h/i/j. Zero cost share for preventive services"	"4b/4b1, 7b/d/f/g, 17a., 18a. $0 copay per visit"	"5, 7e/h. 20% Coinsurance"	"3, 7c/i. $10 copay per PT/OT/ST visit"	8a/b. 20% Coinsurance		"11c., 15. 20% Coinsurance"																					125	125	30	0	0.2	0.2		50	50		0.2	50	0.2	0.2	0	0	0.2	10	0.2		0.2																				NO	116.9419559	116.9419559	28.0660694	0	0.187107129	0.187107129	0	46.77678234	46.77678234	0	0.187107129	46.77678234	0.187107129	0.187107129	0	0	0.187107129	9.355356468	0.187107129	0	0.187107129																					27.5491	0	3.130934227	0	2.793041497	3.862027345	0	3.745156523	2.667227774	0	3.634516198	0.023060676	1.014975336	4.413418333	0	0	0.050670906	0.167738747	2.32724137	0	10.57246164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9516		4.544481407	27.5491	0	3.130934227	0	2.793041497	3.862027345	0	3.745156523	2.667227774	0	3.634516198	0.023060676	1.014975336	4.413418333	0	0	0.050670906	0.167738747	2.32724137	0	10.57246164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9516	NO																																																																																		0			27.5491	0	3.130934227	0	2.793041497	3.862027345	0	3.745156523	2.667227774	0	3.634516198	0.023060676	1.014975336	4.413418333	0	0	0.050670906	0.167738747	2.32724137	0	10.57246164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9516
H0150_010_0	2011	8																															D	D	D	V	T	Coin	Coin	P	P	O	V	V	Coin	V	V	V	COIN	V	V		Coin	Coin	T	V	V	V			V																																																				0	YES	1249.598206	108.5369869	651.3471468	1089.828541	305.9735415	10.90451517		634.1598228	663.4436391		639.6733643	8.384849789	1.89234198	246.5136005	5922.409726	4016.69767	0.183442289	228.3489485	1388.298397		35.458544																				3400	1a. $205 per day; days 1-6	1b. $205 per day; days 1-7	2a. $65 per day; days 1 to 30	6a. $20 copay for PT/ST/OT per visit	10a. $85 copay per trip	11a. 20% coinsurance	11b. 20% coinsurance	4a. $50 copay per visit	9a/b. $175 copay per visit	"8a, 9a. Zero cost share for lab services"	"8a/b, 9a. $25/Xray; $100/MRI,MRA,CT,PET, and NUC Scans"	1a. $50 copay per Observation Stay	"9a, 12. 20% Coinsurance"	"3, 7c/i, 9a. $20 copay per PT/OT/ST visit"	"7, 17, 18a. $10 copay per visit; 9d, 14b/c/d/e/f/g/h/i/j. Zero cost share for preventive services"	"4b/b1, 7b/d/f/g, 17a, 18a. $40 copay per visit"	"5, 7e/h, 9c. 20% coinsurance"	"3, 7c/i. $20 copay per PT/OT/ST visit"	"8a/b. $25/Xray; $100/MRI,MRA,CT,PET, and NUC Scans"		"11c, 15. 20% per script"																					205	205	65	20	85	0.2		50	175		63.97562835	50	0.2	20	10	40	0.2	20	34.39612235		0.2																				NO	198.9255247	198.9255247	63.07394685	19.40736826	82.48131511	0.194073683	0	48.51842065	169.8144723	0	62.07992896	48.51842065	0.194073683	19.40736826	9.70368413	38.81473652	0.194073683	19.40736826	33.37691066	0	0.194073683																					20.7147	1.799231422	3.423586276	1.762558653	2.103091674	2.116279416	0	2.564036087	9.388527622	0	3.309239751	0.033901639	0.367253777	0.398681686	4.789099439	12.99225514	0.035601321	0.369304345	3.861425963	0	6.881570213	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.9104		2.348568812	20.7147	1.799231422	3.423586276	1.762558653	2.103091674	2.116279416	0	2.564036087	9.388527622	0	3.309239751	0.033901639	0.367253777	0.398681686	4.789099439	12.99225514	0.035601321	0.369304345	3.861425963	0	6.881570213	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.9104	NO																																																																																		0			20.7147	1.799231422	3.423586276	1.762558653	2.103091674	2.116279416	0	2.564036087	9.388527622	0	3.309239751	0.033901639	0.367253777	0.398681686	4.789099439	12.99225514	0.035601321	0.369304345	3.861425963	0	6.881570213	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.9104
H0150_012_0	2011	6																															D	D	D	V	T	Coin	Coin	P	P	O	V	V	COIN	O	V	V	COIN	V	P		Coin																																																												0	YES	1010.899897	38.98137313	485.9267318	710.1454068	226.4927784	7.514919469		575.1107323	676.2158984		458.9128397	4.745121126	1.120723069	254.7687393	4217.667947	3340.858298	0.097942153	169.6567513	1065.511236		22.3305854																				3400	1a. $180 per day/days 1-6	1b. $180 per day/days 1-10	2a. $65/day; days 1-30	6a. $20 copay per PT/OT/ST visit	10a. $100 copay per trip	11a. 20% coinsurance	11b. 20% coinsurance	4a. $50 copay per visit	9a/b. $100 copay per visit	"8a, 9a. Zero cost share for lab services"	"8a/b. $25/Xray; $100/MRI,MRA,CT,PET, and NUC Scans"	1a. $50 copay per Observation Stay	"9a, 12. 20% coinsurance"	"3, 7c/I, 9a. $20 copay per PT/ST/OT visit"	"7, 17, 18a. $5 copay per visit; 9d, 14b/c/d/e/f/g/h/i/j. Zero cost share for preventive services"	"4b/b1, 7b/d/f/g, 17a, 18a. $15 copay per visit"	"5, 7e/h, 9c. 20% coinsurance"	"3, 7c/i. $20 copay per PT/OT/ST visit"	"8a/b. $25/Xray; $100/MRI,MRA, CT, PET, and  Nuc Scan"		"11c, 15. 20% per script"																					180	180	65	20	100	0.2		50	100		59.04627202	50	0.2	20	5	15	0.2	20	27.93414895		0.2																				NO	176.8307951	176.8307951	63.85556491	19.64786613	98.23933064	0.196478661	0	49.11966532	98.23933064	0	58.0066624	49.11966532	0.196478661	19.64786613	4.911966532	14.7358996	0.196478661	19.64786613	27.44232095	0	0.196478661																					14.8965	0.5744256	2.585760497	1.162736824	1.854208245	1.476521317	0	2.354103891	5.535916436	0	2.218333514	0.01942323	0.220198168	0.417138507	1.726420316	4.102546037	0.019243543	0.277782761	2.436675109	0	4.387483525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2654		0.834930944	14.8965	0.5744256	2.585760497	1.162736824	1.854208245	1.476521317	0	2.354103891	5.535916436	0	2.218333514	0.01942323	0.220198168	0.417138507	1.726420316	4.102546037	0.019243543	0.277782761	2.436675109	0	4.387483525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2654	NO																																																																																		0			14.8965	0.5744256	2.585760497	1.162736824	1.854208245	1.476521317	0	2.354103891	5.535916436	0	2.218333514	0.01942323	0.220198168	0.417138507	1.726420316	4.102546037	0.019243543	0.277782761	2.436675109	0	4.387483525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2654
H0150_023_0	2011	9																															D	D	D	V	T	COIN		P	P		P	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	YES	1178.518556	76.09072015	359.5614135	1076.979803	292.0912732	11.98596746		630.9540961	758.4767004		645.6169491	3.686605312	2.566102212	285.4154125	6029.922366	4498.148591	0.225494725	241.364448	1561.244139		44.91313581																				3400	1a. $195 per day for 1st 6 days	1b. $195 per day for 1st 10 days	2a. $75/day days 1-30	6a. $20 copay per PT/OT/ST visit	10a. $90 copay per Trip	11a. 20% Coinsurance	11b. 20% Coinsurance	4a. $50 copay per visit	9a/b. $225 copay per visit	"8a, 9a. Zero cost share for lab services"	"8a/b, 9a. $25/Xray; $100/MRI,MRA, CT, PET, and  Nuc Scan"	1a. $50 copay per Observation Stay	"9a, 12. 20% Coinsurance"	"3, 7c/i, 9a.  $20 copay per PT/OT/ST visit"	"7, 17, 18a. $5 copay per visit; 9d, 14b/c/d/e/f/g/h/i/j. Zero cost share for preventive services"	"4b/b1, 7b/d/f/g, 17a, 18a. $40 copay per visit"	"5, 7e/h, 9c. 20% Coinsurance"	"3, 7c/i. $20 copay per PT/OT/ST visit"	"8a/b. $25/Xray; $100/MRI,MRA, CT, PET, and  Nuc Scan"		"11c, 15. 20% coinsurance per Script"																					195	195	75	20	90	0.2		50	225		67.2973534	50	0.2	20	5	40	0.2	20	33.1685072		0.2																				NO	189.0406373	189.0406373	72.70793741	19.38878331	87.24952489	0.193887833	0	48.47195827	218.1238122	0	65.24069012	48.47195827	0.193887833	19.38878331	4.847195827	38.77756662	0.193887833	19.38878331	32.15484994	0	0.193887833																					18.5657	1.198686519	2.178580729	1.740110669	2.123735401	2.323933258	0	2.548631718	13.78681912	0	3.510041276	0.014891415	0.497535997	0.461154799	2.435684544	14.53560472	0.043720684	0.389980248	4.18346425	0	8.708110581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.2463		2.498180903	18.5657	1.198686519	2.178580729	1.740110669	2.123735401	2.323933258	0	2.548631718	13.78681912	0	3.510041276	0.014891415	0.497535997	0.461154799	2.435684544	14.53560472	0.043720684	0.389980248	4.18346425	0	8.708110581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.2463	NO	30% Coinsurance	Included in Line a1	30% Coinsurance	30% Coinsurance	$100 Copay	30% Coinsurance	Included in Line e1	30% Coinsurance	30% Coinsurance	30% Coinsurance	Included in line h1	Included in line h1	Included in line h1	Included in line h1	30% Coinsurance	Include in line i1	Include in line i1	Include in line i1	Include in line i1	Include in line i1	30% Coinsurance																					0.7058		0.1054	0.0303	0.0246	0.0363		0.0788	0.2144	0.1933					0.6543						0.1361																				2.1792			19.2714	1.198686519	2.283985669	1.770387676	2.148322208	2.360254372	0	2.627401976	14.00119012	0.193329716	3.510041276	0.014891415	0.497535997	0.461154799	3.089945742	14.53560472	0.043720684	0.389980248	4.18346425	0	8.844210992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.4255
H0150_802_0	2011	3																															COIN	COIN	COIN		COIN	COIN		COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN		COIN																																																												0	YES	345.226384	8.127130841	41.24555491		14.75463465	12.02749212		30.40191661	82.33488665	17.25821046	22.02943768	0.231745322	0.504386878	21.33420171	87.2124973	201.9103427	0.228049115	0.825320607	13.18341075		53.24892545																				6700	1a. FFS	1b. FFS	2a. FFS	6a. FFS	10a. FFS	11a. FFS	11b. FFS	4a. FFS	9a/b. FFS	"8a, 9a. FFS"	"8a/b, 9a. FFS"	1a. FFS	"9a, 12. FFS"	"3, 7c/I, 9a. FFS"	"7, 17, 18a. FFS; 9d, 14b/c/d/e/f/g/h/i/j. Zero cost share for preventive services"	"4b/b1, 7b/d/f/g, 17a, 18a. FFS"	"5, 7e/h, 9c. FFS"	"3, 7c/i. FFS"	8a/b. FFS		"11c, 15. FFS"																					0.08496	0.08496	0.1842		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233																				NO	0.077118192	0.077118192	0.16719834		0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941		0.2114941																					26.6232	0.626749637	6.896188313	0	3.120518177	2.543743622	0	6.429825991	17.41334275	3.650009689	4.659096095	0.049012768	0.106674849	4.51205779	18.44492863	42.70284621	0.048231042	0.174550439	2.788213591	0	11.26183356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.0511		15.44928541	26.6232	0.626749637	6.896188313	0	3.120518177	2.543743622	0	6.429825991	17.41334275	3.650009689	4.659096095	0.049012768	0.106674849	4.51205779	18.44492863	42.70284621	0.048231042	0.174550439	2.788213591	0	11.26183356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.0511	NO																																																																																		0			26.6232	0.626749637	6.896188313	0	3.120518177	2.543743622	0	6.429825991	17.41334275	3.650009689	4.659096095	0.049012768	0.106674849	4.51205779	18.44492863	42.70284621	0.048231042	0.174550439	2.788213591	0	11.26183356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.0511
H0150_804_0	2011	3																															COIN	COIN	COIN		COIN	COIN		COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN		COIN																																																												0	YES	345.226384	8.127130841	41.24555491		14.75463465	12.02749212		30.40191661	82.33488665	17.25821046	22.02943768	0.231745322	0.504386878	21.33420171	87.2124973	201.9103427	0.228049115	0.825320607	13.18341075		53.24892545																				6700	1a. FFS	1b. FFS	2a. FFS	6a. FFS	10a. FFS	11a. FFS	11b. FFS	4a. FFS	9a/b. FFS	"8a, 9a. FFS"	"8a/b, 9a. FFS"	1a. FFS	"9a, 12. FFS"	"3, 7c/I, 9a. FFS"	"7, 17, 18a. FFS; 9d, 14b/c/d/e/f/g/h/i/j. Zero cost share for preventive services"	"4b/b1, 7b/d/f/g, 17a, 18a. FFS"	"5, 7e/h, 9c. FFS"	"3, 7c/i. FFS"	8a/b. FFS		"11c, 15. FFS"																					0.08496	0.08496	0.1842		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233																				NO	0.077118192	0.077118192	0.16719834		0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941		0.2114941																					26.6232	0.626749637	6.896188313	0	3.120518177	2.543743622	0	6.429825991	17.41334275	3.650009689	4.659096095	0.049012768	0.106674849	4.51205779	18.44492863	42.70284621	0.048231042	0.174550439	2.788213591	0	11.26183356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.0511		15.44928541	26.6232	0.626749637	6.896188313	0	3.120518177	2.543743622	0	6.429825991	17.41334275	3.650009689	4.659096095	0.049012768	0.106674849	4.51205779	18.44492863	42.70284621	0.048231042	0.174550439	2.788213591	0	11.26183356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.0511	NO																																																																																		0			26.6232	0.626749637	6.896188313	0	3.120518177	2.543743622	0	6.429825991	17.41334275	3.650009689	4.659096095	0.049012768	0.106674849	4.51205779	18.44492863	42.70284621	0.048231042	0.174550439	2.788213591	0	11.26183356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.0511
H0151_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1585.866818	106.7264557	705.5676298	2200.174732	237.8125562	10.88741798	12.71760891	448.8078377	48.63756771	16.37944934	39.69657654	0	0.159926175	14.06137559	6549.5307	120.2857585	535.8967442	429.5462527	0	0	35.0524518	1122.794339	728.5948098	0	232.6894474	258.7957985	19.98913796	6	0	0											3950	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-50 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$15 (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	61.43352945	0	200	0.2	0.121645249	48.80150593	0.2	0.144507685	0.168870747	0	0.2	0.160400648	11.65585525	0.093029389	38.5	35	0	0	0.2	34.70344828	0	0	35	15	0	0	0	0											NO	136.3524429	91.20666959	44.97532514	0	146.4194733	0.146419473	0.089056166	35.74203297	0.146419473	0.105793695	0.123629829	0	0.146419473	0.117428892	11.1197115	0.088750345	36.72908452	33.39007684	0	0	0.146419473	25.4063031	0	0	35	15	0	0	0	0												18.0197	0.811180381	2.644427796	0	2.901699103	1.594130006	1.132581495	1.336775377	7.121487048	1.732842475	4.90768098	0	0.023416306	1.651211751	6.06907432	10.67540258	1.640249734	1.195215199	0	0	5.132361532	2.377171107	0	0	0.678677555	0.323494748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9688	0	19.74767444	18.0197	0.811180381	2.644427796	0	2.901699103	1.594130006	1.132581495	1.336775377	7.121487048	1.732842475	4.90768098	0	0.023416306	1.651211751	6.06907432	10.67540258	1.640249734	1.195215199	0	0	5.132361532	2.377171107	0	0	0.678677555	0.323494748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9688	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	18.0197	0.811180381	2.644427796	0	2.901699103	1.594130006	1.132581495	1.336775377	7.121487048	1.732842475	4.90768098	0	0.023416306	1.651211751	6.06907432	10.67540258	1.640249734	1.195215199	0	0	5.132361532	2.377171107	0	0	0.678677555	0.323494748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9688
H0151_015_0	2011	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	320.3168674	6.5001	38.82182982	4402.129837	18.73239172	22.96547434	24.8119567	31.32838	68.61719844	22.11139004	58.09589246	0	0.020018027	20.11389585	45.14224932	159.6241213	3.1451	6.511928922	0	0	59.32579431	8.29369244	830.0665551	981.4342446	288.0633971	371.7332635	0	4.353724291	0	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (16b, 17a, 18a); $0 (17b)"	$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 n/c (18a1, 18a2)"	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.086580228	0.087631243	0.180027525	0	0.233	0.233	0.233	0.111384831	0.233	0.233	0.233	0	0.233	0.233	0.232141263	0.23299909	0.233167769	0.233	0	0	0.233	0.230873577	0	0	0	0	0	0	0	0											NO	0.070004242	0.070854038	0.145560837	0	0.188391609	0.188391609	0.188391609	0.090073274	0.188391609	0.188391609	0.188391609	0	0.188391609	0.188391609	0.187697279	0.188390873	0.188527258	0.188391609	0	0	0.188391609	0.187905957	0	0	0	0	0	0	0	0												22.4235	0.460558334	5.650938062	0	3.529025414	4.32650266	4.674364443	2.821849757	12.92690441	4.165600345	10.94477865	0	0.003771228	3.7892892	8.473077383	30.07172759	0.59293708	1.226792767	0	0	11.17648184	1.558434214	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.8166	0	30.48871892	22.4235	0.460558334	5.650938062	0	3.529025414	4.32650266	4.674364443	2.821849757	12.92690441	4.165600345	10.94477865	0	0.003771228	3.7892892	8.473077383	30.07172759	0.59293708	1.226792767	0	0	11.17648184	1.558434214	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.8166	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.4235	0.460558334	5.650938062	0	3.529025414	4.32650266	4.674364443	2.821849757	12.92690441	4.165600345	10.94477865	0	0.003771228	3.7892892	8.473077383	30.07172759	0.59293708	1.226792767	0	0	11.17648184	1.558434214	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.8166
H0151_801_0	2011	1																															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	236.94997	6.3957	25.4044857	2373.564967	9.465443574	11.66313358	13.62047867	19.59617238	58.05326877	18.7197727	45.31514257	0	0.13150378	14.97212041	40.08991989	133.780852	3.0157	4.029629463	0	0	52.06530344	8.101617463	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.08483993	0.08483993	0.184324547	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.067325197	0.067325197	0.146271767	0	0.184898443	0.184898443	0.184898443	0.184898443	0.184898443	0.184898443	0.184898443	0	0.184898443	0.184898443	0.184898443	0.184898443	0.184898443	0.184898443	0	0	0.184898443	0.184898443	0	0	0	0	0	0	0	0												15.9527	0.430591763	3.71595902	0	1.75014578	2.15649524	2.518405301	3.623301764	10.73395901	3.461256828	8.378699311	0	0.024314844	2.768321753	7.412563772	24.73587125	0.557598235	0.745072214	0	0	9.626793545	1.497976456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.09	0	26.03854402	15.9527	0.430591763	3.71595902	0	1.75014578	2.15649524	2.518405301	3.623301764	10.73395901	3.461256828	8.378699311	0	0.024314844	2.768321753	7.412563772	24.73587125	0.557598235	0.745072214	0	0	9.626793545	1.497976456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.09	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.9527	0.430591763	3.71595902	0	1.75014578	2.15649524	2.518405301	3.623301764	10.73395901	3.461256828	8.378699311	0	0.024314844	2.768321753	7.412563772	24.73587125	0.557598235	0.745072214	0	0	9.626793545	1.497976456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.09
H0151_804_0	2011	1																															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	230.6132324	6.415	24.72509519	2341.332083	9.212309831	11.35122716	13.2562271	19.07211322	56.50075397	18.21915104	44.10328266	0	0.127986982	14.57195309	39.01779777	130.2031594	3.0187	3.921865343	0	0	50.67292441	7.884956433	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.087706163	0.087706163	0.179907815	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.070012484	0.070012484	0.143613547	0	0.185995014	0.185995014	0.185995014	0.185995014	0.185995014	0.185995014	0.185995014	0	0.185995014	0.185995014	0.185995014	0.185995014	0.185995014	0.185995014	0	0	0.185995014	0.185995014	0	0	0	0	0	0	0	0												16.1458	0.449130088	3.550858624	0	1.713443691	2.111271648	2.465592138	3.547317955	10.5088585	3.388671243	8.202990653	0	0.023804941	2.710310613	7.257115823	24.21713838	0.561463147	0.729447398	0	0	9.42491126	1.466562578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4747	0	24.88669764	16.1458	0.449130088	3.550858624	0	1.713443691	2.111271648	2.465592138	3.547317955	10.5088585	3.388671243	8.202990653	0	0.023804941	2.710310613	7.257115823	24.21713838	0.561463147	0.729447398	0	0	9.42491126	1.466562578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4747	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.1458	0.449130088	3.550858624	0	1.713443691	2.111271648	2.465592138	3.547317955	10.5088585	3.388671243	8.202990653	0	0.023804941	2.710310613	7.257115823	24.21713838	0.561463147	0.729447398	0	0	9.42491126	1.466562578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4747
H0151_805_0	2011	1																															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	236.8933388	6.3965	25.398414	2372.997765	9.463181324	11.66034608	13.61722337	19.59148888	58.03939398	18.71529866	45.30431221	0	0.13147235	14.96814769	40.08033836	133.7488783	3.0147	4.028666377	0	0	52.05285978	8.099681169	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.084839935	0.084839935	0.184324539	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.067329454	0.067329454	0.146281001	0	0.184910123	0.184910123	0.184910123	0.184910123	0.184910123	0.184910123	0.184910123	0	0.184910123	0.184910123	0.184910123	0.184910123	0.184910123	0.184910123	0	0	0.184910123	0.184910123	0	0	0	0	0	0	0	0												15.9499	0.430672855	3.715305416	0	1.749838023	2.156116028	2.517962448	3.62266462	10.73207148	3.460648178	8.377225946	0	0.024310568	2.767762032	7.411260299	24.73152154	0.557448548	0.744941196	0	0	9.625100708	1.497713042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0725	0	26.02600827	15.9499	0.430672855	3.715305416	0	1.749838023	2.156116028	2.517962448	3.62266462	10.73207148	3.460648178	8.377225946	0	0.024310568	2.767762032	7.411260299	24.73152154	0.557448548	0.744941196	0	0	9.625100708	1.497713042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0725	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	15.9499	0.430672855	3.715305416	0	1.749838023	2.156116028	2.517962448	3.62266462	10.73207148	3.460648178	8.377225946	0	0.024310568	2.767762032	7.411260299	24.73152154	0.557448548	0.744941196	0	0	9.625100708	1.497713042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0725
H0154_001_0	2011	6																															D	D	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	YES	908.6139592	24.94608285	620.2404215	30.60805595	145.9774043	20.78148413	5.596664301	251.2468949	317.3929158	13.16128761	1708.593257	0	0.024030865	773.5650934	3121.395447	4133.463917	117.9509934	166.9154468	19.93691789	35.12627255	21.87087093	0	0	0	216.0094289	0	58.19579589	0	0	0											6700	1a:  Acute - $200/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/day for 1-6/7-90	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 - $185/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $7/service	4a:  Emergency Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $350/visit/9b:  Ambulatory Surgical Center Services - $350/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 - $15/visit		12:  Renal Dialysis - $50/service with $750 OOP Max	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $40/visit/14c:  Routine Exams - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $40/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $35/visit/7i:  Physical/Speech Therapy - $35/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/18a:  Hearing Exams - PCP -$20; SCP-$40/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 - $40/visit		18a:  Routine Hearing Test - PCP -$20; SCP-$40/visit		14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													200	200	50	0	185	0.2	0.11470516	50	350	0	22.01470108	0	0.195	35	20.00246135	37.71271436	40	35	0	26.99449857	0.190159304	0	0	0	40	0	26.66666667	0	0	0											NO	188.7783195	188.7783195	47.19457988	0	174.6199456	0.18877832	0.108269236	47.19457988	330.3620592	0	20.77949137	0	0.184058862	33.03620592	18.8801552	35.5967142	37.75566391	33.03620592	0	25.47988039	0.179489769	0	0	0	37.75566391	0	25.1704426	0	0	0												14.2939	0.392439967	2.439332177	0	2.124213866	3.923093651	0.605946571	0.988124304	8.737881436	0	2.95864157	0	0.004423094	2.129637976	4.911035873	12.26147781	0.371109839	0.459521089	0	0.074584435	3.925597572	0	0	0	0.679631617	0	0.122067828	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4026	0	3.65	14.2939	0.392439967	2.439332177	0	2.124213866	3.923093651	0.605946571	0.988124304	8.737881436	0	2.95864157	0	0.004423094	2.129637976	4.911035873	12.26147781	0.371109839	0.459521089	0	0.074584435	3.925597572	0	0	0	0.679631617	0	0.122067828	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4026	YES																																									6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.2939	0.392439967	2.439332177	0	2.124213866	3.923093651	0.605946571	0.988124304	8.737881436	0	2.95864157	0	0.004423094	2.129637976	4.911035873	12.26147781	0.371109839	0.459521089	0	0.074584435	3.925597572	0	0	0	0.679631617	0	0.122067828	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4026
H0154_008_0	2011	3																															D	D	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	YES	895.6419911	24.58993623	844.6600695	30.86779244	139.4201864	19.49286272	5.209798305	244.5499274	325.9074468	13.20255433	468.0020169	0	0.024149777	749.4210025	3085.269843	4049.726014	118.1057225	163.3358986	20.11413467	34.79349196	26.80115704	0	0	51.61702259	403.9227084	0	45.18823638	0	0	0											6700	1a:  Acute - $150/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $150/day for 1-6/7-90	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 - $6/service	4a:  Emergency 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 with $750 OOP Max	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $25/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $25/visit/14c:  Routine Exams - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $30/visit/7i:  Physical/Speech Therapy - $30/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/18a:  Hearing Exams - PCP -$15; SCP-$25/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 - $25/visit	17b:  Eye Glasses & Contact Lenses - $100 Per Year	18a:  Routine Hearing Test - PCP -$15; SCP-$25/visit		14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													150	150	50	0	150	0.2	0.105763628	50	250	0	40	0	0.195	30	15.00122078	24.44063239	25	30	0	18.49903414	0.190159304	0	0	0	25	0	18.33333333	0	0	0											NO	144.9204559	144.9204559	48.31382214	0	144.9202971	0.193219609	0.10217765	48.30601382	241.5469834	0	38.64631504	0	0.188399665	28.98468511	14.4933482	23.61321598	24.15384848	28.98461817	0	17.87275338	0.183733375	0	0	0	24.16024986	0	17.7102498	0	0	0												10.8164	0.296965397	3.400729697	0	1.68373457	3.766403314	0.532324946	0.984436014	6.560163387	0	1.507212782	0	0.00454981	1.810144314	3.726324177	7.968921253	0.237725644	0.394519054	0	0.051821292	4.924267039	0	0	0	0.813239463	0	0.066691246	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5466	0	1.735155488	10.8164	0.296965397	3.400729697	0	1.68373457	3.766403314	0.532324946	0.984436014	6.560163387	0	1.507212782	0	0.00454981	1.810144314	3.726324177	7.968921253	0.237725644	0.394519054	0	0.051821292	4.924267039	0	0	0	0.813239463	0	0.066691246	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5466	YES																																									6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.8164	0.296965397	3.400729697	0	1.68373457	3.766403314	0.532324946	0.984436014	6.560163387	0	1.507212782	0	0.00454981	1.810144314	3.726324177	7.968921253	0.237725644	0.394519054	0	0.051821292	4.924267039	0	0	0	0.813239463	0	0.066691246	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5466
H0154_011_0	2011	6																															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	1041.193895	28.58607761	656.5891168	27.30606395	263.3400986	26.41693062	7.821269576	322.4559751	353.8912436	15.10828215	49.81947034	0	0.029888393	850.1115098	3750.324072	4721.405467	128.5707252	177.8086149	24.00056965	41.49987836	38.14660586	0	0	74.23362601	408.4468658	0	87.58261739	0	0	0											6700	1a:  Acute - $100/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/day for 1-6/7-90	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 - $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 with $750 OOP Max	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 - $20/visit/14c:  Routine Exams - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/7f:  Podiatry Services - $20/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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/18a:  Hearing Exams - PCP -$10; SCP-$20/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 - $20/visit	17b:  Eye Glasses & Contact Lenses - $100 Per Year	18a:  Routine Hearing Test - PCP -$10; SCP-$20/visit		14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													100	100	50	0	100	0.2	0.050690067	50	150	0	0	0	0.195	20	10.00117563	20	20	20	0	13.48456647	0.190159304	0	0	0	20	0	13.33333333	0	0	0											NO	97.35563526	97.35563526	48.6710786	0	97.30551118	0.194668039	0.04933868	48.67191747	146.0282624	0	0	0	0.189821512	19.47093803	9.73640696	19.47120454	19.47267258	19.47267258	0	13.12792385	0.185059287	0	0	0	19.45880169	0	12.97674187	0	0	0												8.4472	0.231917979	2.663075043	0	2.135370243	5.142532088	0.385891118	1.307879217	4.306510281	0	0	0	0.00567346	1.379372377	3.042890116	7.660954299	0.208634636	0.288534078	0	0.045400604	7.059383676	0	0	0	0.66232388	0	0.094711418	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0682	0	1.230531261	8.4472	0.231917979	2.663075043	0	2.135370243	5.142532088	0.385891118	1.307879217	4.306510281	0	0	0	0.00567346	1.379372377	3.042890116	7.660954299	0.208634636	0.288534078	0	0.045400604	7.059383676	0	0	0	0.66232388	0	0.094711418	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0682	YES																																									6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.4472	0.231917979	2.663075043	0	2.135370243	5.142532088	0.385891118	1.307879217	4.306510281	0	0	0	0.00567346	1.379372377	3.042890116	7.660954299	0.208634636	0.288534078	0	0.045400604	7.059383676	0	0	0	0.66232388	0	0.094711418	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0682
H0154_012_0	2011	4																															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	YES	281.7940305	3.224245436	39.67887918	36.06996135	16.17425899	29.67173768	7.377956114	29.24266258	42.48912974	15.08774173	52.57054411	0	0.028538505	0	0	0	1.520841248	6.016581455	24.14956783	27.9812535	29.36588225	5.707149589	12000	566.2835199	0	0	0	0	0	0											6700	1a:  Acute - /$0/admit for 1-90/1a:  Additional Days - /$0/admit for 91-999	1b:  Psych - /$0/admit for 1-90	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 - $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	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14c:  Routine Exams - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/9c:  Outpatient Substance Abuse Svcs - Group - $0/visit/7g:  Other Health Care Professional Services - $0/visit/18a:  Hearing Exams - PCP -$0; SCP-$0/visit	15:  Medicare Part B Rx Drugs - Chemo - 0.0%/Medicare Part B Rx Drugs - Non-Chemo - 0.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service	10b:  Transportation - $0/trip		17a:  Routine Eye Exams - $0/visit	17b:  Eye Glasses & Contact Lenses - $120 Per Year	18a:  Routine Hearing Test - PCP -$0; SCP-$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	YES																																									6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2011	3																															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	YES	218.856223	2.516304503	28.01301692	26.4166331	6.651610333	27.49162751	6.81417205	10.32245297	35.62360917	12.99993048	47.28138725	0	0.022241491	29.43231898	36.17243827	99.55198694	1.04172664	4.171860342	17.58609411	20.28040546	23.91387065	4.496956411	0	0	0	0	0	0	0	0											6700	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	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	0.233	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	0.075846597	0.075846589	0.149282645	0	0.196841384	0.198673771	0.198671331	0.197498699	0.197752461	0.197660658	0.197730158	0	0.197681717	0.197691648	0.19765268	0.197656321	0.197681487	0.197681262	0.197640625	0.197663854	0.196873406	0.197396983	0	0	0	0	0	0	0	0												16.5995	0.190853114	4.181857274	0	1.309312183	5.461865315	1.353780634	2.038671036	7.044656388	2.569574814	9.348956176	0	0.004396736	5.818523639	7.149579373	19.67707951	0.205930071	0.824698617	3.475726627	4.008703113	4.70800517	0.887685627	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8594	0	17.33968512	16.5995	0.190853114	4.181857274	0	1.309312183	5.461865315	1.353780634	2.038671036	7.044656388	2.569574814	9.348956176	0	0.004396736	5.818523639	7.149579373	19.67707951	0.205930071	0.824698617	3.475726627	4.008703113	4.70800517	0.887685627	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8594	YES																																									6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.5995	0.190853114	4.181857274	0	1.309312183	5.461865315	1.353780634	2.038671036	7.044656388	2.569574814	9.348956176	0	0.004396736	5.818523639	7.149579373	19.67707951	0.205930071	0.824698617	3.475726627	4.008703113	4.70800517	0.887685627	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8594
H0154_802_0	2011	3																															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	YES	228.2037394	2.62378586	32.16941155	30.32937289	7.632694278	23.0341488	5.757953777	10.72775997	35.53233527	13.16339199	47.33410999	0	0.022442259	29.6518758	36.66485026	100.866939	1.051169537	4.209748307	17.86386102	20.52303296	27.31838227	4.749001967	0	0	0	0	0	0	0	0											6700	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	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	0.233	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	0.075563377	0.075563377	0.14920834	0	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0	0	0	0	0	0	0	0												17.2438	0.198262119	4.799944499	0	1.501647798	4.531712862	1.132813433	2.110567586	6.990592191	2.589751125	9.312460247	0	0.004415265	5.833677124	7.213401933	19.8444496	0.206805928	0.828221208	3.514516184	4.037678718	5.374588197	0.934313374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2037	0	18.1	17.2438	0.198262119	4.799944499	0	1.501647798	4.531712862	1.132813433	2.110567586	6.990592191	2.589751125	9.312460247	0	0.004415265	5.833677124	7.213401933	19.8444496	0.206805928	0.828221208	3.514516184	4.037678718	5.374588197	0.934313374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2037	YES																																									6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.2438	0.198262119	4.799944499	0	1.501647798	4.531712862	1.132813433	2.110567586	6.990592191	2.589751125	9.312460247	0	0.004415265	5.833677124	7.213401933	19.8444496	0.206805928	0.828221208	3.514516184	4.037678718	5.374588197	0.934313374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2037
H0154_803_0	2011	3																															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	YES	228.2037394	2.62378586	32.16941155	30.32937289	7.632694278	23.0341488	5.757953777	10.72775997	35.53233527	13.16339199	47.33410999	0	0.022442259	29.6518758	36.66485026	100.866939	1.051169537	4.209748307	17.86386102	20.52303296	27.31838227	4.749001967	0	0	0	0	0	0	0	0											6700	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	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	0.233	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	0.075563377	0.075563377	0.14920834	0	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0.19673889	0	0	0	0	0	0	0	0												17.2438	0.198262119	4.799944499	0	1.501647798	4.531712862	1.132813433	2.110567586	6.990592191	2.589751125	9.312460247	0	0.004415265	5.833677124	7.213401933	19.8444496	0.206805928	0.828221208	3.514516184	4.037678718	5.374588197	0.934313374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2037	0	18.1	17.2438	0.198262119	4.799944499	0	1.501647798	4.531712862	1.132813433	2.110567586	6.990592191	2.589751125	9.312460247	0	0.004415265	5.833677124	7.213401933	19.8444496	0.206805928	0.828221208	3.514516184	4.037678718	5.374588197	0.934313374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2037	YES																																									6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.2438	0.198262119	4.799944499	0	1.501647798	4.531712862	1.132813433	2.110567586	6.990592191	2.589751125	9.312460247	0	0.004415265	5.833677124	7.213401933	19.8444496	0.206805928	0.828221208	3.514516184	4.037678718	5.374588197	0.934313374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2037
H0248_001_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O		V	V				O	O	O	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	YES	810.9682646	21.44351911	264.4123394	161.9428268	23.94157664	4.520520543	1.163806931	258.9291378	263.0872341	2512.451861	1061.361106	7.29503101	0.009052597	9.863845051	4333.44057	3244.880727	48.9701465	871.424254		1706.629385	10.63769979	0		3.91	2.01				4.01	0.51	744.4153201	0.086106844	1800.036471								3400	$195/Day(Days 1-5):1a.IP Acute	$195/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$20/Visit:7b. $5 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$20/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS751: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center	"$20-$125/Visit:9d. $20 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $45 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF"									120.72684	97.190145	45.243839	0	100	0.2	0.2	50	125	14.060096	88.28219	125	0.2	0.2	5	18.980073	20	20		0	0.2	0		0	0				0	0	0	0	51.625147								NO	110.922734	89.297431	37.288298	0	90.3104	0.180621	0.180621	45.1552	112.888	12.697729	79.727999	112.888	0.180621	0.180621	4.51552	17.14098	18.06208	18.06208		0	0.180621	0		0	0				0	0	0	0	46.622877									7.4962	0.159570931	0.821623842	0	0.180181114	0.816500941	0.210207972	0.974333084	2.474949307	2.658536071	7.051683098	0.068626788	0.001635089	1.781617557	1.630644797	4.635036304	0.073708559	1.311644549	0	0	1.921391974	0	0	0	0	0	0	0	0	0	0	0	6.993573247	0	0	0	0	0	0	0	41.2617	0	4.369462838	7.4962	0.159570931	0.821623842	0	0.180181114	0.816500941	0.210207972	0.974333084	2.474949307	2.658536071	7.051683098	0.068626788	0.001635089	1.781617557	1.630644797	4.635036304	0.073708559	1.311644549	0	0	1.921391974	0	0	0	0	0	0	0	0	0	0	0	6.993573247	0	0	0	0	0	0	0	41.2617	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	20% Coins	20% Coins	25% Coins	25% Coins	25% Coins	25% Coins		25% Coins	20%-25% Coins	$0/Service		0.5	"VIS751: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	$0/Proc	25% Coins								5000	1.569	0.0304	0.4382	0.8966	0.6725	1.0046	0.2586	0.1358	1.6172	0.4935	0.9581	0.1009	0.0002	0.2535	1.5439	1.5222	0.0261	0.3315		0.2085	0.3503	0		0	0				0	0	0.231	0	0.8785								13.5211	0	2.884839826	9.0653	0.189937191	1.25978726	0.896589871	0.852654519	1.821121293	0.468847452	1.110176129	4.092188535	3.152006224	8.009780839	0.169558183	0.001867737	2.035119971	3.174519512	6.157220466	0.099808567	1.643114434	0	0.208498041	2.271693426	0	0	0	0	0	0	0	0	0	0.231025035	0	7.872029658	0	0	0	0	0	0	0	54.7828
H0248_002_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	Coin	V	V	V	V		V	Coin	O	T	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	YES	766.799244	38.855518	378.335046	432.88693	23.737266	6.32818	1.43289	239.249207	295.146367	1108.086734	870.032441	34.744293	7.895232	3.848859	2800.358876	2822.218799	67.82449	709.261304		1213.422775	14.241881	0	1.95	6.7					4.01	0.51	502.867547	696.03552									2500	$125/Day(Days 1-5):1a.IP Acute	$125/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $75(Days 21-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$50/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $50 Surgery OP -- Facility"	"$0-$45/Visit:8a. $0 Lab -- FSL,8a. $45 Lab -- OP"	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$5/Visit:7e, 7h.Psych -- Other Provider"	"$5/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN750: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$5-$50/Visit:9d. $5 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $45 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $5 Therapy (AT,PT,ST,OT) -- CORF"										77.389	62.301375	24.768525	0	100	0.2	0.2	50	50	26.915254	40.446427	50	0	0.2	5	5	5	5		0	0.2	0	0	0					0	0	0	46.086796									NO	71.144327	57.274152	19.720848	0	90.6444	0.181289	0.181289	45.3222	45.3222	24.39717	36.662421	45.3222	0	0.181289	4.53222	4.53222	4.53222	4.53222		0	0.181289	0	0	0					0	0	0	41.775099										4.5461	0.185451404	0.621757328	0	0.179304186	1.147229424	0.259767195	0.903608367	1.114723556	2.252848369	2.658124636	0.131223983	0	0.697755799	1.057653542	1.065909707	0.025616293	0.267877356	0	0	2.581896365	0	0	0	0	0	0	0	0	0	0	2.423079396	0	0	0	0	0	0	0	0	22.1199	0	2.30497247	4.5461	0.185451404	0.621757328	0	0.179304186	1.147229424	0.259767195	0.903608367	1.114723556	2.252848369	2.658124636	0.131223983	0	0.697755799	1.057653542	1.065909707	0.025616293	0.267877356	0	0	2.581896365	0	0	0	0	0	0	0	0	0	0	2.423079396	0	0	0	0	0	0	0	0	22.1199	YES	$125/Day(Days 1-5)	$125/Day(Days 1-5)	$0/Day(Days 1-20) $75(Days 21-100)	25% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	$0-$50/Visit	$0-$45/Visit	$0-$50/Visit	$50/Visit	$0/Proc	20% Coins	$5/Visit	$5/Visit	$5/Visit	$5/Visit		$0/Visit	20% Coins	$0/Service	0.5	50%-55%					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	$5-$50/Visit									2500	1.897	0.0774	0.2469	1.9196	0.8957	1.6493	0.3735	0.3755	0.4633	0.9363	1.1191	0.0545	0	0.2959	0.4736	0.4773	0.0115	0.1177		0	1.1859	0	0	0					0	0	0.1581	1.007									13.7349	0	2.204046567	6.4431	0.262835303	0.868616343	1.919641761	1.074974578	2.796567283	0.633227039	1.279137018	1.57798911	3.18910477	3.77719296	0.185759074	0	0.99369601	1.531222232	1.543175128	0.037086092	0.385547121	0	0	3.76783078	0	0	0	0	0	0	0	0	0	0.158057622	3.430081737	0	0	0	0	0	0	0	0	35.8548
H0251_002_0	2011	5																															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	237.7338283	42.0962	7.715601781	1411.590476	12.09930511	25.1903291	7.080500306	35.04813445	52.02450833	16.93159509	43.99795904	0	0.131033013	45.98513562	27.8847535	103.0013474	20.6245	5.647840619	0	0	27.32119823	2.134698212	0	1611.168082	123.7072625	121.950694	17.46434425	0	520.1378368	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a); $0 n/c (13a1); FFS (16b, 18a); $0 (17a, 17b)"	$0 n/c (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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.086478224	0.086478224	0.196615552	0	0.233	0.233	0.233	0.12154875	0.233	0.233	0.233	0	0.233	0.233	0.227300858	0.232746192	0.233	0.233	0	0	0.233	0.041782439	0	0	0	0	0	0	0	0											NO	0.070394608	0.070394608	0.160048093	0	0.189665594	0.189665594	0.189665594	0.098950802	0.189665594	0.189665594	0.189665594	0	0.189665594	0.189665594	0.185026405	0.18945899	0.189665594	0.189665594	0	0	0.189665594	0.039952787	0	0	0	0	0	0	0	0												16.7352	2.963345517	1.23486735	0	2.294821894	4.77773874	1.342927299	3.468041015	9.867259293	3.211341046	8.344899052	0	0.024852454	8.721798079	5.159415701	19.51453129	3.911758051	1.071201048	0	0	5.1818913	0.085287143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9112	0	22.35460448	16.7352	2.963345517	1.23486735	0	2.294821894	4.77773874	1.342927299	3.468041015	9.867259293	3.211341046	8.344899052	0	0.024852454	8.721798079	5.159415701	19.51453129	3.911758051	1.071201048	0	0	5.1818913	0.085287143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9112	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.7352	2.963345517	1.23486735	0	2.294821894	4.77773874	1.342927299	3.468041015	9.867259293	3.211341046	8.344899052	0	0.024852454	8.721798079	5.159415701	19.51453129	3.911758051	1.071201048	0	0	5.1818913	0.085287143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9112
H0302_001_0	2011	6																															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	YES	1283.37642	372.1825038	748.6583413		411.2107578	6.839178118	9.970145942	371.8954024	228.0958468		1084.075098	44.40205713	38.71093052	45.13457838	4863.7717	5820.162169	251.1436157	804.3832489		306.4192724	13.57906295	60.11193847			851.0081786		0.478027344														6700	"(1a) $125/day for days 1-4, $0/day for days 5+"	"(1b) $145/day for days 1-10, $0/day for days 11+"	(2) $0/day for days 1-15; $50/day days 16-100	(6) $0/visit	(10a) $125/trip land; 20% air/water	(11a) 15%	"(11b) 20%, (11c) 0%"	"(4a) $50/visit, (4b) $25/visit"	"(9a, 9b) $150 per visit"	(8a) $0 screening; $0 lab; 20% genetic testing	"(8b) $15 Radiation Therapy,$25 ultrasound, $5 diagnostic, $150-$275 complex radiology"	(9a) $150/visit	(12) $25/session	"(3) $10/visit, (5) $20/day, (9c) $20/visit, (9d) $10/visit, (9a) $0 chemotherapy"	"(7a) $10/visit, (14b) $0/visit, (14c) $0 for initial preventative exam, $10 per routine physical, Section C: Travel Program"	"(7b, 7d, 7f, ) $30/visit, (17a)$0/glaucoma testing, $20 Medicare covered vision screening with Optometrist, $30 Medicare covered vision screening with Ophthalmologist, (18a) $0 Medicare Covered hearing exam"	"(7e, 7h) $20/Visit"	"(7c, 7i) $10/visit"	(8a): $0	"(7g) Min of $10, Max of $75 per visit, (14d, 14e, 14f, 14g, 14h, 14i, 14j) $0"	(15) 20%	"(13a) $0, (17b) $20 Medicare Covered Eyewear"		(16a) $0	(17a) $20/exam		(18a) $20/exam		(14a) $0	"(13e) $0, (14a) $0"												82.27203668	80.32054732	14.64417132		61.00478036	0.15	0.151348334	43.19945303	150		67.61528837	150	25	14.49438202	10	26.38408509	20	10		28.60114564	0.2	20			20		20														NO	79.17421671	77.29620751	14.09276882		58.70774439	0.144351994	0.145649559	41.57284776	144.3519935		65.06934446	144.3519935	24.05866559	13.9486196	9.623466235	25.3906352	19.24693247	9.623466235		27.52421594	0.192469325	19.24693247			19.24693247		19.24693247															8.4675	2.397358004	0.879222411	0	2.011771339	0.987248995	1.452147356	1.288395912	2.74384085	0	5.878337997	0.534127122	0.077611111	0.052463755	3.900528561	12.3148012	0.402812018	0.645079586	0	0.702829185	2.613553076	0.096414202	0	0	1.364941412	0	0.000766713	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8118	0	1.909840176	8.4675	2.397358004	0.879222411	0	2.011771339	0.987248995	1.452147356	1.288395912	2.74384085	0	5.878337997	0.534127122	0.077611111	0.052463755	3.900528561	12.3148012	0.402812018	0.645079586	0	0.702829185	2.613553076	0.096414202	0	0	1.364941412	0	0.000766713	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8118	NO																																																																																		0	0	0	8.4675	2.397358004	0.879222411	0	2.011771339	0.987248995	1.452147356	1.288395912	2.74384085	0	5.878337997	0.534127122	0.077611111	0.052463755	3.900528561	12.3148012	0.402812018	0.645079586	0	0.702829185	2.613553076	0.096414202	0	0	1.364941412	0	0.000766713	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8118
H0302_004_0	2011	7																															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	YES	2245.440509	346.4570822	1101.222414		619.3307772	13.95910468	27.33452367	603.6601188	395.3565994		1568.490747	69.98953128	52.03170217	1936.764527	10376.77843	14953.99242	320.0165694	1378.812063		52.24047493	30.78635139	87.20360889			1426.663045		0.165366117														6700	"(1a) $120/day for days 1-4, $0/day for days 5+"	"(1b) $135/day for days 1-10, $0/day for days 11+"	(2) $0/day for days 1-20; $50/day days 16-100	(6) $0/visit	(10a) $75/trip land; 20% air/water	(11a) 10%	"(11b) 20%, (11c) 0%"	"(4a) $50/visit, (4b) $15/visit"	"(9a, 9b) $100 per visit"	(8a) $0 screening; $0 lab; 20% genetic testing	"(8b) $20 Radiation Therapy,$0 ultrasound, $0 diagnostic, $125-$250 complex radiology"	(9a) $100/visit	(12) $25/session	"(3) $10/visit, (5) $20/day, (9c) $20/visit, (9d) $10/visit, (9a) $0 chemotherapy"	"(7a) $10/visit, (14b) $0/visit, (14c) $0 for initial preventative exam, $10 per routine physical, Section C: Travel Program"	"(7b, 7f) $30/visit, (7d) $10 for PCP, Cardiologist, Pulmonologist; $20 for Specialty OV (excluding Chiropractic and Podiatrist), (17a)$0/glaucoma testing, $20 Medicare covered vision screening with Optometrist, $30 Medicare covered vision screening with Ophthalmologist, (18a) $0 Medicare Covered hearing exam"	"(7e, 7h) $20/Visit"	"(7c, 7i) $10/visit"	(8a): $0	"(7g) Min of $0, Max of $75 per visit, (14d, 14e, 14f, 14g, 14h, 14i, 14j) $0"	(15) 20%	"(13a) $0, (17b) $10 Medicare Covered Eyewear"		(16a) $0	(17a) $10/exam		(18a) $20 routine hearing exam		(14a) $0	"(13e) $0, (14a) $0"												83.06165297	93.29625824	10.98406265		77	0.1	0.170775653	31.76789707	100		72.65314218	100	25	13.18551438	10	15.28547623	20	10		80.80435484	0.2	10			10		20														NO	75.2818573	84.5578597	9.955263436		69.78795635	0.09063371	0.154780309	28.79242356	90.63370954		65.84823785	90.63370954	22.65842739	11.9505208	9.063370954	13.85379413	18.12674191	9.063370954		73.23598426	0.181267419	9.063370954			9.063370954		18.12674191															14.0867	2.441305779	0.913579936	0	3.601819104	1.265165439	4.230846016	1.448403152	2.986052933	0	8.606862646	0.528617571	0.098246379	1.928778731	7.837382687	17.2641277	0.483404813	1.041390434	0	0.31882355	5.58056246	0.065863221	0	0	1.077531367	0	0.000249796	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8058	0	7.833936752	14.0867	2.441305779	0.913579936	0	3.601819104	1.265165439	4.230846016	1.448403152	2.986052933	0	8.606862646	0.528617571	0.098246379	1.928778731	7.837382687	17.2641277	0.483404813	1.041390434	0	0.31882355	5.58056246	0.065863221	0	0	1.077531367	0	0.000249796	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8058	NO																																																																																		0	0	0	14.0867	2.441305779	0.913579936	0	3.601819104	1.265165439	4.230846016	1.448403152	2.986052933	0	8.606862646	0.528617571	0.098246379	1.928778731	7.837382687	17.2641277	0.483404813	1.041390434	0	0.31882355	5.58056246	0.065863221	0	0	1.077531367	0	0.000249796	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8058
H0302_006_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	O																																																			0	YES	1003.693709	291.0737893	585.5052778		321.5967227	5.524768375	8.05400094	290.849255	178.3875431	652.1633523	847.8255785	34.72563833	2.814120595	35.29852323	3803.823244	4585.810701	196.4125748	629.0862087		84.34628396	10.96932647	47.01190822																			6700	"(1a) $175/day for days 1-5, $0/day for days 6+"	"(1b) $145/day for days 1-10, $0/day for days 11+"	(2) $0/day for days 1-15; $50/day days 16-20; $100/day days 21-100	(6) $0/visit	(10a) $150/trip land; 20% air/water	(11a) 20%	"(11b) 20%, (11c) 0%"	"(4a) $50/visit, (4b) $25/visit"	"(9a, 9b) $200 per visit"	(8a) $0 screening; $5 lab; 20% genetic testing	"(8b) $20 Radiation Therapy, $5 diagnostic, $175-$300 complex radiology"	(9a) $200/visit	(12) 20%	"(3) $10/visit, (5) $20/day, (9c) $20/visit, (9d) $15/visit, (9a) $0 chemotherapy"	"(7a) $15/visit, (14b) $0/visit, (14c) $0 for initial preventative exam, $10 per routine physical, Section C: Travel Program"	"(7b, 7d, 7f, ) $40/visit, (17a)$0/glaucoma testing, $20 Medicare covered vision screening with Optometrist, $40 Medicare covered vision screening with Ophthalmologist"	"(7e, 7h) $20/Visit"	"(7c, 7i) $10/visit"	(8a): $0	"(7g) Min of $10, Max of $75 per visit, (14d, 14e, 14f, 14g, 14h, 14i, 14j) $0"	(15) 20%	"(13a) $0, (17b) $30 Medicare Covered Eyewear"		(16a) $0					(14a) $0	"(13e) $0, (14a) $0"												126.7205223	80.32054732	29.02147639		72.94121879	0.2	0.151348334	43.19945303	200	5	77.05253595	200	0.2	17.24719101	14.5583396	35.3652648	20	10		67.81367816	0.2	30																			NO	122.0237963	77.34357408	27.94583433		70.23775046	0.192587269	0.145738812	41.59832331	192.5872685	4.814681714	74.19668716	192.5872685	0.192587269	16.60794703	14.05149339	34.059998	19.25872685	9.629363427		65.30025524	0.192587269	28.88809028																				10.2062	1.876057265	1.363536125	0	1.88235253	1.064000051	1.173780526	1.008236779	2.862930806	0.261663247	5.242154101	0.557309653	0.541963799	0.048853	4.454116429	13.01605861	0.315221344	0.504808311	0	0.458986156	2.112552622	0.113173687	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.064	0	1.875524412	10.2062	1.876057265	1.363536125	0	1.88235253	1.064000051	1.173780526	1.008236779	2.862930806	0.261663247	5.242154101	0.557309653	0.541963799	0.048853	4.454116429	13.01605861	0.315221344	0.504808311	0	0.458986156	2.112552622	0.113173687	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.064	NO																																																																																		0	0	0	10.2062	1.876057265	1.363536125	0	1.88235253	1.064000051	1.173780526	1.008236779	2.862930806	0.261663247	5.242154101	0.557309653	0.541963799	0.048853	4.454116429	13.01605861	0.315221344	0.504808311	0	0.458986156	2.112552622	0.113173687	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.064
H0302_007_0	2011	6																															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	YES	1573.514427	456.3232815	917.9105078		504.174808	8.437429521	12.30007499	455.9712739	279.6623813		1329.156263	54.44020664	47.46246442	55.33833188	5963.343897	7135.949361	307.9206509	986.2333666		375.6926951	16.75236185	73.70168328			1043.398979		0.586096885														6700	"(1a) $50/day for days 1-3, $0/day for days 4+"	"(1b) $145/day for days 1-10, $0/day for days 11+"	(2) $0/day for days 1-20; $50/day days 21-100	(6) $0/visit	(10a) $100/trip land; 20% air/water	(11a) 10%	"(11b) 20%, (11c) 0%"	"(4a) $50/visit, (4b) $15/visit"	"(9a, 9b) $100 per visit"	(8a) $0 screening; $0 lab; 20% genetic testing	"(8b) $10 Radiation Therapy,$0 basic ultrasound, $25 complex ultrasound, $0 diagnostic, $125-$250 complex radiology"	(9a) $100/visit	(12) $25/session	"(3) $10/visit, (5) $20/day, (9c) $20/visit, (9d) $10/visit, (9a) $0 chemotherapy"	"(7a) $5/visit, (14b) $0/visit, (14c) $0 for initial preventative exam, $10 per routine physical, Section C: Travel Program"	"(7b) $15/visit, (7f, 7d) $25, (17a)$0/glaucoma testing, $15 Medicare covered vision screening with Optometrist, $15 Medicare covered vision screening with Ophthalmologist, (18a) $0 Medicare Covered hearing exam"	"(7e, 7h) $20/Visit"	"(7c, 7i) $10/visit"	(8a): $0	"(7g) Min of $10, Max of $75 per visit, (14d, 14e, 14f, 14g, 14h, 14i, 14j) $0"	(15) 20%	"(13a) $0, (17b) $10 Medicare Covered Eyewear"		(16a) $0	(17a) $10/exam		(18a) $20 routine hearing exam		(14a) $0	"(13e) $0, (14a) $0"												28.51378737	80.32054732	10.26950362		49.06834192	0.1	0.151348334	40.48111364	100		59.40189939	100	25	14.49438202	5.441660404	13.06542476	20	10		28.60114564	0.2	10			10		20														NO	27.84227568	78.42896464	10.02765249		47.91276183	0.097644958	0.147784017	39.52776638	97.64495792		58.00295966	97.64495792	24.41123948	14.15303323	5.334309589	12.75772851	19.52899158	9.764495792		27.92757663	0.195289916	9.764495792			9.764495792		19.52899158															3.6509	2.982413542	0.767040632	0	2.013033958	0.823872451	1.817754497	1.501960499	2.275635121	0	6.424583094	0.442984307	0.096551465	0.065267104	2.650860211	7.586542051	0.501114983	0.802505963	0	0.874348878	3.271567336	0.059971648	0	0	0.849022079	0	0.000953823	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4588	0	0.941097682	3.6509	2.982413542	0.767040632	0	2.013033958	0.823872451	1.817754497	1.501960499	2.275635121	0	6.424583094	0.442984307	0.096551465	0.065267104	2.650860211	7.586542051	0.501114983	0.802505963	0	0.874348878	3.271567336	0.059971648	0	0	0.849022079	0	0.000953823	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4588	NO																																																																																		0	0	0	3.6509	2.982413542	0.767040632	0	2.013033958	0.823872451	1.817754497	1.501960499	2.275635121	0	6.424583094	0.442984307	0.096551465	0.065267104	2.650860211	7.586542051	0.501114983	0.802505963	0	0.874348878	3.271567336	0.059971648	0	0	0.849022079	0	0.000953823	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4588
H0303_013_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1281.118927	70.59583983	1149.731346	1083.203676	430.177567	7.077211764	12.94374512	314.4448705	331.4677706	15.08967595	43.73399171	0	4.468878289	602.0556288	6505.930184	128.8359989	350.5815113	702.0814823	0	0	24.57914651	3668.217165	0	0	378.2032661	426.8735199	17.46434425	6	0	0											5400	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-64 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$215 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); $215 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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, 18a); $0/$40 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490891	124.5827041	66.09204312	0	200	0.2	0.105752193	49.57583836	215	0.134707822	0.162601172	0	0.2	83.95313396	9.018207679	0.15750483	38.5	40	0	0	0.2	37.92275513	0	0	40	30	0	0	0	0											NO	145.8438866	97.55551482	51.75391993	0	156.6116509	0.156611651	0.082810128	38.83969308	168.3575248	0.105484072	0.12732619	0	0.156611651	65.74019455	8.85991914	0.154740288	37.82424391	39.29791575	0	0	0.156611651	29.69572644	0	0	40	30	0	0	0	0												15.5703	0.573917791	4.958592003	0	5.614234913	1.108373818	1.071873185	1.017745188	4.650424449	1.591720468	5.568482547	0	0.699878407	3.298271181	4.80350128	19.93611962	1.10504005	2.299194912	0	0	3.849380714	9.077531123	0	0	1.260677554	1.0671838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.1224	0	16.75101383	15.5703	0.573917791	4.958592003	0	5.614234913	1.108373818	1.071873185	1.017745188	4.650424449	1.591720468	5.568482547	0	0.699878407	3.298271181	4.80350128	19.93611962	1.10504005	2.299194912	0	0	3.849380714	9.077531123	0	0	1.260677554	1.0671838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.1224	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.5703	0.573917791	4.958592003	0	5.614234913	1.108373818	1.071873185	1.017745188	4.650424449	1.591720468	5.568482547	0	0.699878407	3.298271181	4.80350128	19.93611962	1.10504005	2.299194912	0	0	3.849380714	9.077531123	0	0	1.260677554	1.0671838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.1224
H0303_015_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1368.604071	79.33725908	725.4283586	705.166494	395.3612335	7.20969015	14.70111724	287.0606866	251.3952354	17.56874875	57.2124697	0	4.749542961	761.543585	6373.616449	158.8448394	351.9978436	802.8372298	0	0	30.15333984	3474.253466	0	0	321.4466723	326.7845192	17.46434425	6	0	0											6700	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$75 Days 21-96 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$175 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $175 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												185.965914	119.8302997	59.09849435	0	200	0.2	0.113975374	49.90373206	175	0.091135667	0.158807012	0	0.2	68.54737909	6.457996643	0.126485037	38.5	35	0	0	0.2	33.5846759	0	0	35	30	0	0	0	0											NO	156.6120336	100.9156276	49.77006368	0	168.4309024	0.168430902	0.095984875	42.04162586	147.3770396	0.076750313	0.133740042	0	0.168430902	57.72748459	6.381098687	0.12497895	38.04156506	34.58324096	0	0	0.168430902	28.28348635	0	0	35	30	0	0	0	0												17.8617	0.667197441	3.008717967	0	5.549254112	1.214334618	1.411084904	1.005708165	3.087490464	1.348406964	7.651598101	0	0.799969807	3.663499631	3.389222963	19.8522613	1.115879072	2.313726114	0	0	5.07875424	8.188666707	0	0	0.937552794	0.816961298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.9619	0	11.66734127	17.8617	0.667197441	3.008717967	0	5.549254112	1.214334618	1.411084904	1.005708165	3.087490464	1.348406964	7.651598101	0	0.799969807	3.663499631	3.389222963	19.8522613	1.115879072	2.313726114	0	0	5.07875424	8.188666707	0	0	0.937552794	0.816961298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.9619	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.8617	0.667197441	3.008717967	0	5.549254112	1.214334618	1.411084904	1.005708165	3.087490464	1.348406964	7.651598101	0	0.799969807	3.663499631	3.389222963	19.8522613	1.115879072	2.313726114	0	0	5.07875424	8.188666707	0	0	0.937552794	0.816961298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.9619
H0303_034_0	2011	4																															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	YES	403.0354842	5.201806684	35.56218098	1182.157727	30.50580628	10.61489494	24.95455269	34.02403229	45.26669166	19.31939808	68.2773912	0	6.168811585	16.14614108	34.96431649	215.6729246	2.172936513	5.013644739	0	0	32.88594634	14.85105078	0	137.828538	402.1588154	737.6260872	0	0	12.7416766	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (16b, 17a, 18a); $0 (17b)"	$0 n/c (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 (14a1); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.07575991	0.076675323	0.136781135	0	0.233	0.233	0.233	0.089951684	0.233	0.233	0.233	0	0.233	0.233	0.220863617	0.23298748	0.228534374	0.233	0	0	0.233	0.218706234	0	0	0	0	0	0	0	0											NO	0.058555805	0.059263339	0.105719891	0	0.180088684	0.180088684	0.180088684	0.069541825	0.180088684	0.180088684	0.180088684	0	0.180088684	0.180088684	0.170708318	0.180079007	0.176637144	0.180088684	0	0	0.180088684	0.170388289	0	0	0	0	0	0	0	0												23.6001	0.308276434	3.759629885	0	5.493750498	1.911622458	4.494032545	2.366093297	8.152018916	3.479204969	12.29598551	0	1.110933158	2.907737294	5.968699651	38.83816609	0.383821299	0.902900681	0	0	5.922386787	2.53044514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.4258	0	36.53052371	23.6001	0.308276434	3.759629885	0	5.493750498	1.911622458	4.494032545	2.366093297	8.152018916	3.479204969	12.29598551	0	1.110933158	2.907737294	5.968699651	38.83816609	0.383821299	0.902900681	0	0	5.922386787	2.53044514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.4258	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.6001	0.308276434	3.759629885	0	5.493750498	1.911622458	4.494032545	2.366093297	8.152018916	3.479204969	12.29598551	0	1.110933158	2.907737294	5.968699651	38.83816609	0.383821299	0.902900681	0	0	5.922386787	2.53044514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.4258
H0303_801_0	2011	1																															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	246.0204926	6.644676637	20.35789785	908.9129689	15.91909642	8.535492061	18.04299058	15.52307183	46.81622449	18.47619328	70.44194922	0	4.556717833	20.96581538	33.56101941	160.1623374	2.562303073	8.279539202	0	0	45.50127559	26.6487706	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.074439865	0.074439865	0.141364625	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.057770408	0.057770408	0.109708582	0	0.180823878	0.180823878	0.180823878	0.180823878	0.180823878	0.180823878	0.180823878	0	0.180823878	0.180823878	0.180823878	0.180823878	0.180823878	0.180823878	0	0	0.180823878	0.180823878	0	0	0	0	0	0	0	0												14.2127	0.383865679	2.233436105	0	2.878552744	1.543420772	3.262603521	2.806942041	8.465491251	3.340936913	12.73758641	0	0.823963388	3.791120037	6.068633669	28.96117491	0.463325577	1.497138384	0	0	8.227717092	4.818734036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5173	0	30.73522249	14.2127	0.383865679	2.233436105	0	2.878552744	1.543420772	3.262603521	2.806942041	8.465491251	3.340936913	12.73758641	0	0.823963388	3.791120037	6.068633669	28.96117491	0.463325577	1.497138384	0	0	8.227717092	4.818734036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5173	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.2127	0.383865679	2.233436105	0	2.878552744	1.543420772	3.262603521	2.806942041	8.465491251	3.340936913	12.73758641	0	0.823963388	3.791120037	6.068633669	28.96117491	0.463325577	1.497138384	0	0	8.227717092	4.818734036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5173
H0303_804_0	2011	1																															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	273.1826969	7.025183801	22.22127136	869.7742862	16.5616194	9.129908741	17.59507409	16.8209829	43.97902312	18.04881183	69.09344688	0	4.642761325	19.56317905	33.82321806	163.6187074	2.607264198	8.691301465	0	0	44.68261161	26.8292483	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.076134647	0.076134647	0.13789286	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.058658216	0.058658216	0.106240055	0	0.179515697	0.179515697	0.179515697	0.179515697	0.179515697	0.179515697	0.179515697	0	0.179515697	0.179515697	0.179515697	0.179515697	0.179515697	0.179515697	0	0	0.179515697	0.179515697	0	0	0	0	0	0	0	0												16.0244	0.412084746	2.360789091	0	2.973070648	1.638961929	3.158591985	3.019630465	7.89492498	3.240045032	12.40335826	0	0.833448534	3.511897719	6.071798558	29.37212626	0.468044849	1.560225038	0	0	8.021230158	4.816271204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.7809	0	32.11188169	16.0244	0.412084746	2.360789091	0	2.973070648	1.638961929	3.158591985	3.019630465	7.89492498	3.240045032	12.40335826	0	0.833448534	3.511897719	6.071798558	29.37212626	0.468044849	1.560225038	0	0	8.021230158	4.816271204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.7809	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.0244	0.412084746	2.360789091	0	2.973070648	1.638961929	3.158591985	3.019630465	7.89492498	3.240045032	12.40335826	0	0.833448534	3.511897719	6.071798558	29.37212626	0.468044849	1.560225038	0	0	8.021230158	4.816271204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.7809
H0303_805_0	2011	1																															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	271.3478423	7.020023758	22.19215495	869.7119302	16.55851721	9.109640086	17.57669449	16.69882962	43.77267625	17.91559667	68.87921545	0	4.641805706	19.50478401	33.68600553	162.936688	2.606797855	8.677881739	0	0	44.61143514	26.66673712	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.076134647	0.076134647	0.13789286	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.058739672	0.058739672	0.106387586	0	0.179764983	0.179764983	0.179764983	0.179764983	0.179764983	0.179764983	0.179764983	0	0.179764983	0.179764983	0.179764983	0.179764983	0.179764983	0.179764983	0	0	0.179764983	0.179764983	0	0	0	0	0	0	0	0												15.9389	0.412353892	2.360969796	0	2.976641561	1.637594293	3.159674182	3.001864819	7.868794393	3.220596927	12.38207098	0	0.834434123	3.506277162	6.055564205	29.29031091	0.468610972	1.559979261	0	0	8.019573871	4.793745539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4879	0	31.83112892	15.9389	0.412353892	2.360969796	0	2.976641561	1.637594293	3.159674182	3.001864819	7.868794393	3.220596927	12.38207098	0	0.834434123	3.506277162	6.055564205	29.29031091	0.468610972	1.559979261	0	0	8.019573871	4.793745539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4879	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.9389	0.412353892	2.360969796	0	2.976641561	1.637594293	3.159674182	3.001864819	7.868794393	3.220596927	12.38207098	0	0.834434123	3.506277162	6.055564205	29.29031091	0.468610972	1.559979261	0	0	8.019573871	4.793745539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4879
H0307_008_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							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	YES	1537.100064	94.316507	632.67724	15.713188	223.015163	4.175687	2.373746	380.214424	265.045292	833.006742	1523.14908	81.979832	0.325831	1.760865	4011.328561	5151.315739	37.982632	542.215122		1485.866558	30.051703	0							4.86	0.51	168.408013	430.123706									5000	$240/Day(Days 1-7):1a.IP Acute	$240/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $35 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										172.4688	147.65736	43.922851	0	100	0.2	0.2	50	150	7.039572	60.344896	150	0.2	0.2	15	34.836194	35	35		0	0.2	0							0	0	0	117.331103									NO	157.797397	135.096591	34.166136	0	91.272	0.182544	0.182544	45.636	136.908	6.425159	55.077994	136.908	0.182544	0.182544	13.6908	31.795691	31.9452	31.9452		0	0.182544	0							0	0	0	107.090444										20.2125	1.061819881	1.801344719	0	1.69625333	0.762246608	0.43331309	1.445955454	3.023901736	0.44601673	6.990999657	0.935307903	0.059478494	0.321435341	4.576524755	13.64913696	0.101113565	1.443430876	0	0	5.485758072	0	0	0	0	0	0	0	0	0	0	3.838511554	0	0	0	0	0	0	0	0	68.2851	0	6.815617178	20.2125	1.061819881	1.801344719	0	1.69625333	0.762246608	0.43331309	1.445955454	3.023901736	0.44601673	6.990999657	0.935307903	0.059478494	0.321435341	4.576524755	13.64913696	0.101113565	1.443430876	0	0	5.485758072	0	0	0	0	0	0	0	0	0	0	3.838511554	0	0	0	0	0	0	0	0	68.2851	NO																																																																																		0	0	0	20.2125	1.061819881	1.801344719	0	1.69625333	0.762246608	0.43331309	1.445955454	3.023901736	0.44601673	6.990999657	0.935307903	0.059478494	0.321435341	4.576524755	13.64913696	0.101113565	1.443430876	0	0	5.485758072	0	0	0	0	0	0	0	0	0	0	3.838511554	0	0	0	0	0	0	0	0	68.2851
H0307_009_0	2011	7	r.	s.	t.	u.	v.	w.	x.	y.			DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional	Professional			Prosthetics/Supplies	Lab	Radiology	Other	Other		Specialist excl. MH	Therapy (PT/OT/ST)			D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O		V					O		O	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	NO	1052.361567	111.510363	440.1971044	703.0984759	143.0886405	8.125064286	1.5632492	415.2077054	149.1805866	216.9356545	217.2510656	54.1307553	0.138307791	3.988458605	4518.464768	493.5765828	71.52445041	158.2882301		1983.593654	18.32782687	0		2.53					3.55		204.7857628	866.7086183	1162.72826	158.7697251	474.5315031	164.4627122	3393.463942	381.6384911				$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility"	$50/Visit:8a.Lab -- OP	"$0-$150/Visit:8b, 9a. $50 DMAM -- OP,14h. $0 SMAM -- OP,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a		$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$150/Visit:8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,8b. $150 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office"	"$35-$40/Visit:5. $40 Partial Hospitalization,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$35-$150/Visit:9d. $35 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,7h. $150 Psych -- OP"	"$0-$150/Visit:9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"				161.6895	138.428775	45.243839	0	100	0.2	0.071171	50	150	50	81.607021	150	0.18836	0.2	10	32.890275	35	35		0	0.2	0		0					0		0	0	58.540017	40	138.488412	150	35	35			NO	151.352852	129.579162	38.591818	0	92.5913	0.185183	0.065898	46.29565	138.88695	46.29565	75.561002	138.88695	0.174405	0.185183	9.25913	30.453533	32.406955	32.406955		0	0.185183	0		0					0		0	0	54.202963	37.03652	128.228221	138.88695	32.406955	32.406955				13.2732	1.204118282	1.415667211	0	1.104063603	1.50462378	0.103014996	1.601859217	1.726603056	0.836931428	1.367975683	0.626504625	0.02412157	0.73859473	3.486421057	1.252595896	0.19315747	0.427469962	0	0	3.394001964	0	0	0	0	0	0	0	0	0	0	0	5.251943072	0.490023175	5.070694204	1.903477041	9.164319439	1.030645117	0	0	57.192	0	4.537287877	13.2732	1.204118282	1.415667211	0	1.104063603	1.50462378	0.103014996	1.601859217	1.726603056	0.836931428	1.367975683	0.626504625	0.02412157	0.73859473	3.486421057	1.252595896	0.19315747	0.427469962	0	0	3.394001964	0	0	0	0	0	0	0	0	0	0	0	5.251943072	0.490023175	5.070694204	1.903477041	9.164319439	1.030645117	0	0	57.192	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)			$100/Trip			$50/Visit		$50/Visit	$0-$150/Visit	$150/Visit	20% Coins	20% Coins				$35/Visit		$0/Visit	20% Coins	$0/Service													$35-$150/Visit	$0-$150/Visit	15% Coins				5000	1.1584	0.1051			0.4722			0.139		0.0726	0.1187	0.0544	0.0023	0.0654				0		0	0.2817	0													0.44	0.1652	0				3.075	0	0.230377477	14.4315	1.309203864	1.415667211	0	1.576264291	1.50462378	0.103014996	1.740865943	1.726603056	0.909558968	1.486686376	0.680871672	0.026389781	0.804006283	3.486421057	1.252595896	0.19315747	0.427469962	0	0	3.675725233	0	0	0	0	0	0	0	0	0	0	0	5.251943072	0.490023175	5.510720766	2.068657669	9.164319439	1.030645117	0	0	60.267
H0307_010_0	2011	7	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							Prosthetics/Supplies	Radiology	Other	Therapy (PT/OT/ST)							D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	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	1395.468143	84.860644	572.266725	12.269556	153.178776	2.462562	1.402215	344.361088	239.347554	751.635803	340.75805	73.765101	0.293371	1.585478	3646.768117	4682.034819	34.648452	54.183131		1349.89427	27.612326	0							4.86	0.51	115.293651	1035.086012	394.859789	439.393609								$240/Day(Days 1-7):1a.IP Acute	$240/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$150/Visit:8b, 9a. $100 DMAM -- OP,8b. $35 Radiology -- FSR,8b. $150 Advanced Imaging -- FSR,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	"$35-$150/Visit:9d. $35 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								172.4688	147.65736	43.922851	0	100	0.2	0.2	50	150	7.048022	10.477555	150	0.2	0.2	15	34.83719	35	35		0	0.2	0							0	0	0	76.683329	118.7531	35							NO	164.320339	140.68114	38.844008	0	94.7077	0.189415	0.189415	47.35385	142.06155	6.675019	9.923052	142.06155	0.189415	0.189415	14.206155	32.993501	33.147695	33.147695		0	0.189415	0							0	0	0	72.625017	112.46833	33.147695								19.1086	0.994857678	1.85242777	0	1.20893413	0.466446181	0.265600554	1.358901942	2.833507042	0.418098606	0.281779987	0.873265382	0.055568868	0.300313315	4.31721276	12.87306004	0.095709693	0.149670492	0	0	5.230188729	0	0	0	0	0	0	0	0	0	0	6.264428268	3.700768421	1.213740445	0	0	0	0	0	0	63.8631	0	3.580904479	19.1086	0.994857678	1.85242777	0	1.20893413	0.466446181	0.265600554	1.358901942	2.833507042	0.418098606	0.281779987	0.873265382	0.055568868	0.300313315	4.31721276	12.87306004	0.095709693	0.149670492	0	0	5.230188729	0	0	0	0	0	0	0	0	0	0	6.264428268	3.700768421	1.213740445	0	0	0	0	0	0	63.8631	YES	$240/Day(Days 1-7)	$240/Day(Days 1-7)	$0/Day(Days 1-20) $133(Days 21-100)	$0/Visit	$100/Trip	25% Coins	25% Coins	$50/Visit	20%-25% Coins	$0-$50/Visit	$0-$40/Visit	25% Coins	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins	$0/Service									25% Coins	20%-25% Coins	20%-25% Coins	$40/Visit							6700	1.7204	0.0896	0.1587	0	0.5792	0.4298	0.2447	0.1321	0.8328	0.0406	0.0292	0.0795	0.0055	0.0298	1.0435	1.3398	0.0099	0.0118		0	0.4863	0									0.0148	0.4395	0.1362	0.1257							7.9795	149	0.586262979	20.8291	1.084428618	2.011113643	0	1.788142472	0.896211352	0.510314404	1.491000854	3.666295956	0.458741991	0.310969748	0.952716514	0.061081578	0.330107232	5.360732498	14.21282051	0.10562432	0.161477429	0	0	5.71651672	0	0	0	0	0	0	0	0	0	0.014832586	6.703962861	3.836982318	1.339472567	0	0	0	0	0	0	71.8426
H0307_011_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	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	YES	398.034791	7.206642	27.950824	4.204486	9.682694	4.079518	2.463727	33.528457	40.516902	6.624085	28.691803	3.676528	0.318881	8.159343	40.719595	98.28148	0.364113	4.81171		6.872175	29.859905	0							0.11												6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0% Coins:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d												0.07894	0.07894	0.132708	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0							0												NO	0.070857	0.070857	0.096819	0	0.209221	0.209221	0.209221	0.209221	0.209221	0.209221	0.209221	0.209221	0.209221	0.209221	0.209221	0.209221	0.209221	0.209221		0.209221	0.209221	0							0													28.2036	0.510641032	2.706170829	0	2.025822921	0.853520835	0.515463427	7.014857302	8.476986753	1.385897688	6.002927715	0.769206865	0.066716602	1.707105902	8.519394385	20.56254953	0.076180086	1.006710778	0	1.437803326	6.247319184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0888	0	11.85569942	28.2036	0.510641032	2.706170829	0	2.025822921	0.853520835	0.515463427	7.014857302	8.476986753	1.385897688	6.002927715	0.769206865	0.066716602	1.707105902	8.519394385	20.56254953	0.076180086	1.006710778	0	1.437803326	6.247319184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0888	NO																																																																																		0	0	0	28.2036	0.510641032	2.706170829	0	2.025822921	0.853520835	0.515463427	7.014857302	8.476986753	1.385897688	6.002927715	0.769206865	0.066716602	1.707105902	8.519394385	20.56254953	0.076180086	1.006710778	0	1.437803326	6.247319184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0888
H0307_801_0	2011	3																															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	YES	301.18651	4.224978	30.954379	16.726735	7.569919	9.640658	3.403637	27.447347	50.910526	5.497815	29.797459	5.283417	0.533501	10.240803	39.714583	71.932585	0.495432	5.494689		7.813422	32.679072	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.076922	0.076922	0.136364	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.070637	0.070637	0.102885	0	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563		0.212563	0.212563	0																				21.2749	0.298439771	3.184741283	0	1.609084692	2.049247186	0.723487292	5.83429042	10.82169414	1.16863205	6.333837277	1.123058968	0.113402573	2.176815808	8.441850906	15.29020607	0.105310512	1.167967578	0	1.660844421	6.946361582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3242	0	9.259656096	21.2749	0.298439771	3.184741283	0	1.609084692	2.049247186	0.723487292	5.83429042	10.82169414	1.16863205	6.333837277	1.123058968	0.113402573	2.176815808	8.441850906	15.29020607	0.105310512	1.167967578	0	1.660844421	6.946361582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3242	NO																																																																																		0	0	0	21.2749	0.298439771	3.184741283	0	1.609084692	2.049247186	0.723487292	5.83429042	10.82169414	1.16863205	6.333837277	1.123058968	0.113402573	2.176815808	8.441850906	15.29020607	0.105310512	1.167967578	0	1.660844421	6.946361582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3242
H0307_802_0	2011	3																															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	YES	301.18651	4.224978	30.954379	16.726735	7.569919	9.640658	3.403637	27.447347	50.910526	5.497815	29.797459	5.283417	0.533501	10.240803	39.714583	71.932585	0.495432	5.494689		7.813422	32.679072	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.076922	0.076922	0.136364	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.070637	0.070637	0.102885	0	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563		0.212563	0.212563	0																				21.2749	0.298439771	3.184741283	0	1.609084692	2.049247186	0.723487292	5.83429042	10.82169414	1.16863205	6.333837277	1.123058968	0.113402573	2.176815808	8.441850906	15.29020607	0.105310512	1.167967578	0	1.660844421	6.946361582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3242	0	9.259656096	21.2749	0.298439771	3.184741283	0	1.609084692	2.049247186	0.723487292	5.83429042	10.82169414	1.16863205	6.333837277	1.123058968	0.113402573	2.176815808	8.441850906	15.29020607	0.105310512	1.167967578	0	1.660844421	6.946361582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3242	NO																																																																																		0	0	0	21.2749	0.298439771	3.184741283	0	1.609084692	2.049247186	0.723487292	5.83429042	10.82169414	1.16863205	6.333837277	1.123058968	0.113402573	2.176815808	8.441850906	15.29020607	0.105310512	1.167967578	0	1.660844421	6.946361582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3242
H0307_803_0	2011	3																															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	YES	301.18651	4.224978	30.954379	16.726735	7.569919	9.640658	3.403637	27.447347	50.910526	5.497815	29.797459	5.283417	0.533501	10.240803	39.714583	71.932585	0.495432	5.494689		7.813422	32.679072	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.076922	0.076922	0.136364	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.070637	0.070637	0.102885	0	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563	0.212563		0.212563	0.212563	0																				21.2749	0.298439771	3.184741283	0	1.609084692	2.049247186	0.723487292	5.83429042	10.82169414	1.16863205	6.333837277	1.123058968	0.113402573	2.176815808	8.441850906	15.29020607	0.105310512	1.167967578	0	1.660844421	6.946361582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3242	0	9.259656096	21.2749	0.298439771	3.184741283	0	1.609084692	2.049247186	0.723487292	5.83429042	10.82169414	1.16863205	6.333837277	1.123058968	0.113402573	2.176815808	8.441850906	15.29020607	0.105310512	1.167967578	0	1.660844421	6.946361582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3242	NO																																																																																		0	0	0	21.2749	0.298439771	3.184741283	0	1.609084692	2.049247186	0.723487292	5.83429042	10.82169414	1.16863205	6.333837277	1.123058968	0.113402573	2.176815808	8.441850906	15.29020607	0.105310512	1.167967578	0	1.660844421	6.946361582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3242
H0316_002_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	951.9419406	89.54235355	504.3247253	603.5252616	131.2974104	5.747528868	7.068567245	332.23891	28.43124981	15.67254363	40.22253423	0	0.011105517	7.739643778	5302.988151	92.50116199	449.9762238	307.8518043	0	0	25.28357361	1151.169827	0	0	175.178873	0	14.91715928	6	589.0878852	0											4200	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$75 Days 21-40 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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, 18a); $0/$40 (17a)"	$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												190.7019303	117.8997596	49.34743764	0	200	0.2	0.114513361	49.17174336	0.2	0.119560882	0.158463355	0	0.2	0.161149705	9.043334717	0.109551714	38.5	40	0	0	0.2	39.8651884	0	0	40	0	0	0	0	0											NO	153.8496097	95.11614261	39.81125944	0	161.3508678	0.161350868	0.092384151	39.68306051	0.161350868	0.096456261	0.127840999	0	0.161350868	0.130008224	8.751554955	0.106017985	37.25781211	38.70941518	0	0	0.161350868	32.16141372	0	0	40	0	0	0	0	0												12.2047	0.709743606	1.673150207	0	1.765412593	0.927368771	0.653023582	1.098688064	4.58740683	1.511714954	5.142088952	0	0.001791885	1.006217341	3.867449353	9.806786798	1.397094134	0.993063609	0	0	4.079526544	3.085270756	0	0	0.583929577	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0944	0	9.744206042	12.2047	0.709743606	1.673150207	0	1.765412593	0.927368771	0.653023582	1.098688064	4.58740683	1.511714954	5.142088952	0	0.001791885	1.006217341	3.867449353	9.806786798	1.397094134	0.993063609	0	0	4.079526544	3.085270756	0	0	0.583929577	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0944	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"$125 Days 1-40 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $50 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												3.522	0.0953	0.4575	0.3622	0.3862	0.3043	0.3742	0.2402	1.5052	0.3307	1.6648	0	0.0004	0.3282	1.3398	2.1387	0.2766	0.2175	0	0	1.2864	0.8075	0	0	0.1238	0	0.0105	0	0	0											15.772	0	0	15.7267	0.805080606	2.130677907	0.362152892	2.151581447	1.231649711	1.027241848	1.338934629	6.092590644	1.842389627	6.806840296	0	0.002183844	1.334409216	5.207277057	11.94544993	1.673724254	1.210600215	0	0	5.365883798	3.892778224	0	0	0.707715817	0	0.010540878	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8664
H0316_014_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	866.5831921	107.0131893	428.4994833	473.0816277	109.9224265	5.256934592	6.086610058	364.142035	25.99456166	13.22821019	32.35039755	0	0.007155864	7.484203287	4822.385677	83.99290453	446.7289976	331.8078239	0	0	24.12213479	1028.79356	0	0	141.2143568	170.4334003	14.93201433	6	145.8912983	0											3380	"$175 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-12 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$75 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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, 18a); $0/$40 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												163.3672933	116.8098224	53.43988392	0	200	0.2	0.107086716	49.00684054	0.2	0.123363445	0.161297323	0	0.2	0.161257863	6.454294102	0.111939402	38.5	40	0	0	0.2	39.86805118	0	0	40	30	0	0	0	0											YES	128.9431956	92.19612729	42.17924692	0	157.8568059	0.157856806	0.084521835	38.69355196	0.157856806	0.097368797	0.127309401	0	0.157856806	0.127278256	6.225419179	0.108010433	37.13475627	38.58156496	0	0	0.157856806	31.46721609	0	0	40	30	0	0	0	0											3380	9.3117	0.822183469	1.506148793	0	1.446000262	0.829842904	0.514451449	1.174162396	4.103418475	1.288014912	4.118509744	0	0.001129602	0.952576339	2.501781024	9.072110025	1.382431037	1.066805426	0	0	3.807843149	2.697772439	0	0	0.470714523	0.426083501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4936	0	9.207758553	9.3117	0.822183469	1.506148793	0	1.446000262	0.829842904	0.514451449	1.174162396	4.103418475	1.288014912	4.118509744	0	0.001129602	0.952576339	2.501781024	9.072110025	1.382431037	1.066805426	0	0	3.807843149	2.697772439	0	0	0.470714523	0.426083501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4936	NO	"$225 Days 1-16 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-16 (1b); $0 n/c (1b1, 1b2)"	"$125 Days 1-28 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.5761	0.0581	0.2309	0.1778	0.2184	0.188	0.2177	0.1774	0.9296	0.1945	0.9181	0	0.0002	0.2142	0.7612	1.6861	0.2591	0.1991	0	0	0.829	0.4399	0	0	0.0898	0	0.0095	0	0	0											8.3745	0	2.752195027	9.8878	0.880246135	1.737032107	0.177846402	1.664379362	1.017830781	0.732108504	1.351536267	5.032983486	1.482534612	5.036627203	0	0.001300198	1.166732821	3.263012295	10.75821658	1.641544166	1.265898042	0	0	4.636820308	3.137629335	0	0	0.560521899	0.426083501	0.009496237	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8681
H0316_801_0	2011	1																															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	226.8277498	5.2825	14.97880388	754.6358621	14.67190897	7.272586053	8.944150563	21.19447769	35.97523659	19.83111784	50.89523658	0	0.01405227	9.779711948	36.84612997	116.3571147	2.5399	4.337512381	0	0	31.8052619	8.234405185	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.071443515	0.071443515	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	0.059213612	0.059213612	0.123051385	0	0.193114403	0.193114403	0.193114403	0.193114403	0.193114403	0.193114403	0.193114403	0	0.193114403	0.193114403	0.193114403	0.193114403	0.193114403	0.193114403	0	0	0.193114403	0.193114403	0	0	0	0	0	0	0	0												13.4313	0.312795907	1.843162563	0	2.833356942	1.404441114	1.727244297	4.092958907	6.94733634	3.829674483	9.828603231	0	0.002713696	1.888603235	7.115518395	22.47023475	0.490491272	0.837636114	0	0	6.142054166	1.590182242	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7883	0	17.9251419	13.4313	0.312795907	1.843162563	0	2.833356942	1.404441114	1.727244297	4.092958907	6.94733634	3.829674483	9.828603231	0	0.002713696	1.888603235	7.115518395	22.47023475	0.490491272	0.837636114	0	0	6.142054166	1.590182242	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7883	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.4313	0.312795907	1.843162563	0	2.833356942	1.404441114	1.727244297	4.092958907	6.94733634	3.829674483	9.828603231	0	0.002713696	1.888603235	7.115518395	22.47023475	0.490491272	0.837636114	0	0	6.142054166	1.590182242	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7883
H0316_804_0	2011	1																															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	226.8277498	5.2832	14.97880388	754.6358621	14.67190897	7.272586053	8.944150563	21.19447769	35.97523659	19.83111784	50.89523658	0	0.01405227	9.779011948	36.84612997	116.3571147	2.5391	4.337512381	0	0	31.8052619	8.234405185	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.071443515	0.071443515	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	0.059213661	0.059213661	0.123051486	0	0.193114561	0.193114561	0.193114561	0.193114561	0.193114561	0.193114561	0.193114561	0	0.193114561	0.193114561	0.193114561	0.193114561	0.193114561	0.193114561	0	0	0.193114561	0.193114561	0	0	0	0	0	0	0	0												13.4313	0.312837613	1.843164073	0	2.833359263	1.404442265	1.727245712	4.09296226	6.947342031	3.82967762	9.828611283	0	0.002713698	1.888469602	7.115524224	22.47025316	0.490337183	0.8376368	0	0	6.142059198	1.590183545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7881	0	17.92501953	13.4313	0.312837613	1.843164073	0	2.833359263	1.404442265	1.727245712	4.09296226	6.947342031	3.82967762	9.828611283	0	0.002713698	1.888469602	7.115524224	22.47025316	0.490337183	0.8376368	0	0	6.142059198	1.590183545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7881	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.4313	0.312837613	1.843164073	0	2.833359263	1.404442265	1.727245712	4.09296226	6.947342031	3.82967762	9.828611283	0	0.002713698	1.888469602	7.115524224	22.47025316	0.490337183	0.8376368	0	0	6.142059198	1.590183545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7881
H0316_806_0	2011	1																															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	226.8277498	5.2832	14.97880388	754.6358621	14.67190897	7.272586053	8.944150563	21.19447769	35.97523659	19.83111784	50.89523658	0	0.01405227	9.779011948	36.84612997	116.3571147	2.5391	4.337512381	0	0	31.8052619	8.234405185	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.071443515	0.071443515	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	0.059213661	0.059213661	0.123051486	0	0.193114561	0.193114561	0.193114561	0.193114561	0.193114561	0.193114561	0.193114561	0	0.193114561	0.193114561	0.193114561	0.193114561	0.193114561	0.193114561	0	0	0.193114561	0.193114561	0	0	0	0	0	0	0	0												13.4313	0.312837613	1.843164073	0	2.833359263	1.404442265	1.727245712	4.09296226	6.947342031	3.82967762	9.828611283	0	0.002713698	1.888469602	7.115524224	22.47025316	0.490337183	0.8376368	0	0	6.142059198	1.590183545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7881	0	17.92501953	13.4313	0.312837613	1.843164073	0	2.833359263	1.404442265	1.727245712	4.09296226	6.947342031	3.82967762	9.828611283	0	0.002713698	1.888469602	7.115524224	22.47025316	0.490337183	0.8376368	0	0	6.142059198	1.590183545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7881	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.4313	0.312837613	1.843164073	0	2.833359263	1.404442265	1.727245712	4.09296226	6.947342031	3.82967762	9.828611283	0	0.002713698	1.888469602	7.115524224	22.47025316	0.490337183	0.8376368	0	0	6.142059198	1.590183545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7881
H0317_001_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	283.4052125	11.85837249	469.7481498	606.646595	38.04386898	11.74095195	3.319166482	324.9338205	410.5353895	1485.248321	1421.274376	68.62746969	0.157414645	6.210033368	3946.608062	5095.171642	118.1215656	1257.339028		1585.785514	32.83597163	0		4.04					4.86	0.51	471.3581052	877.1072982									3400	$300/Admit:1a.IP Acute	$300/Admit:1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $150 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $15 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$15/Visit:7b. $5 Chiropractic,7f. $15 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Spec Cap"	"$15/Visit:7e, 7h.Psych -- Other Provider"	"$15-$30/Visit:7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN749: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $25 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"										300	300	42.271616	0	100	0.2	0.2	50	150	54.145561	67.623729	100	0.174847	0.2	5	13.703736	15	16.806312		0	0.2	0		0					0	0	0	110.456876									NO	257.1168	257.1168	28.156278	0	84.0544	0.168109	0.168109	42.0272	126.0816	45.511726	56.840719	84.0544	0.146966	0.168109	4.20272	11.518593	12.60816	14.126445		0	0.168109	0		0					0	0	0	92.843865										6.0724	0.254082232	1.102196625	0	0.266479548	1.973759691	0.557981758	1.138004888	4.31341323	5.633017886	6.732188119	0.480703399	0.023134601	1.043962499	1.382207386	4.890767367	0.124107967	1.480144219	0	0	5.520022355	0	0	0	0	0	0	0	0	0	0	6.786169298	0	0	0	0	0	0	0	0	49.7747	0	9.64099678	6.0724	0.254082232	1.102196625	0	0.266479548	1.973759691	0.557981758	1.138004888	4.31341323	5.633017886	6.732188119	0.480703399	0.023134601	1.043962499	1.382207386	4.890767367	0.124107967	1.480144219	0	0	5.520022355	0	0	0	0	0	0	0	0	0	0	6.786169298	0	0	0	0	0	0	0	0	49.7747	YES	$600/Admit	$600/Admit	25% Coins(Days 1-20) 25%(Days 21-100)	25% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	15% Coins	15% Coins	15%-20% Coins	15% Coins	0%-20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	15%-20% Coins		20% Coins	20% Coins	$0/Service		50%-80%					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	15%-20% Coins									3400	1.4236	0.0596	0.2491	2.333	0.9185	1.4018	0.3963	0.1465	1.2177	0.1679	0.6993	0.0721	0.003	0.1372	1.0341	1.9672	0.0246	0.3161		0.1925	0.8611	0		0					0	0	0.0878	0.2895									13.9983	0	5.949085075	7.4959	0.313648775	1.351288653	2.332950096	1.184989175	3.375518988	0.954258909	1.284535396	5.531068045	5.800908567	7.431515552	0.55277639	0.026174652	1.181147395	2.416336068	6.858008929	0.148697648	1.796214745	0	0.192464886	6.381125749	0	0	0	0	0	0	0	0	0	0.087764917	7.075632338	0	0	0	0	0	0	0	0	63.773
H0317_002_0	2011	5	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery							Prosthetics/Supplies	Other	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O		V					O	O	O	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	897.947077	33.377431	318.793143	206.586986	29.970756	8.107364	3.293512	297.914546	0	1112.295532	1383.153625	58.427743	0.117124	2.312177	3673.605577	4633.649159	77.38574	1043.812321		1504.52564	25.185603	0		3.17					4.86	0.51	613.701952	0	549.50066	379.02788							6700	$255/Day(Days 1-7):1a.IP Acute	$255/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	$0/Visit:9a.Surgery OP -- Physician	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $35 Partial Hospitalization,7h. $100 Psych -- OP"	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $150 Surgery OP -- Facility"								183.2481	156.885945	45.243839	0	100	0.2	0.2	50	0	22.857932	60.248808	100	0.181647	0.2	15	32.391853	35	44.768783		0	0.2	0		0					0	0	0	0	71.091635	118.694148							NO	175.861003	150.561559	42.050846	0	94.8975	0.189795	0.189795	47.44875	0	21.691606	57.174613	94.8975	0.172378	0.189795	14.234625	30.739059	33.214125	42.484456		0	0.189795	0		0					0	0	0	0	67.464184	112.637779								13.1595	0.418779837	1.11712678	0	0.237012485	1.53873715	0.62509211	1.177972735	0	2.010623036	6.590106102	0.462053895	0.020189601	0.438839634	4.357699816	11.86950124	0.214191637	3.695483219	0	0	4.780101521	0	0	0	0	0	0	0	0	0	0	0	3.089301136	3.557738215	0	0	0	0	0	0	59.36	0	3.056737553	13.1595	0.418779837	1.11712678	0	0.237012485	1.53873715	0.62509211	1.177972735	0	2.010623036	6.590106102	0.462053895	0.020189601	0.438839634	4.357699816	11.86950124	0.214191637	3.695483219	0	0	4.780101521	0	0	0	0	0	0	0	0	0	0	0	3.089301136	3.557738215	0	0	0	0	0	0	59.36	YES	$265/Day(Days 1-7)	$265/Day(Days 1-7)	30% Coins(Days 1-20) 30%(Days 21-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	$0/Visit	30% Coins	$0-$100/Visit	$100/Visit	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	$40-$100/Visit		$0/Visit	20%-30% Coins	$0/Service		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	30% Coins	$40-$100/Visit	30% Coins							10000	2.149	0.0684	0.6119	1.5054	1.0232	1.3687	0.556	0.19	0	0.305	1.0856	0.0745	0.0033	0.0722	2.2132	2.7916	0.0466	0.7344		0	1.0289	0		0					0	0	0.1579	0	0.5923	2.9331							19.5111	149	1.287356879	15.3085	0.48716757	1.729045715	1.505401993	1.260190118	2.907424193	1.18110369	1.367940168	0	2.315648561	7.675657529	0.536567666	0.023512437	0.51106473	6.570887265	14.66107316	0.260813176	4.429888354	0	0	5.80899928	0	0	0	0	0	0	0	0	0	0.157884156	0	3.681593248	6.490803862	0	0	0	0	0	0	78.8711
H0317_004_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery						Prosthetics/Supplies	Lab	Other	Other							D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O		V					O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0					0	0	0	0	0	0	0						0	YES	801.2047183	72.23264368	358.2104933	368.0576173	27.83431333	8.743271494	1.776009649	290.27274	0	595.5361218	1060.341611	39.10163876	0.203567669	3.783640427	3274.97638	3571.46393	80.27849287	730.5916687		1631.273269	27.56836254	0		3.17					4.86	0.51	480.0932431	624.0436775	0	782.7029755	342.4139583						5000	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	$0/Visit:9a.Surgery OP -- Physician	$0/Visit:8a.Lab -- FSL	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$100/Visit:8a.Lab -- OP	"$35/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP"	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $150 Surgery OP -- Facility"							161.6895	138.428775	45.243839	0	100	0.2	0.2	50	0	0	62.528776	100	0.174846	0.2	15	32.409644	35	50.684996		0	0.2	0		0					0	0	0	100	0	84.316773	129.633976						NO	150.834152	129.135082	38.808582	0	91.776	0.183552	0.183552	45.888	0	0	57.386409	91.776	0.160467	0.183552	13.7664	29.744274	32.1216	46.516662		0	0.183552	0		0					0	0	0	91.776	0	77.382561	118.972878							10.0708	0.77731403	1.158470108	0	0.212876828	1.604844969	0.325990123	1.110002958	0	0	5.070766449	0.299049333	0.032665893	0.694494768	3.757052903	8.852550142	0.21488947	2.832057143	0	0	5.06022808	0	0	0	0	0	0	0	0	0	0	4.772686046	0	5.047296729	3.394831174	0	0	0	0	0	55.2888	0	4.851323122	10.0708	0.77731403	1.158470108	0	0.212876828	1.604844969	0.325990123	1.110002958	0	0	5.070766449	0.299049333	0.032665893	0.694494768	3.757052903	8.852550142	0.21488947	2.832057143	0	0	5.06022808	0	0	0	0	0	0	0	0	0	0	4.772686046	0	5.047296729	3.394831174	0	0	0	0	0	55.2888	YES	$255/Day(Days 1-7)	$255/Day(Days 1-7)	30% Coins(Days 1-20) 30%(Days 21-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	$0/Visit	30% Coins	$0-$100/Visit	$100/Visit	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	$40-$100/Visit		$0/Visit	20%-30% Coins	$0/Service		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	$100/Visit	30% Coins	$40-$100/Visit	30% Coins						7500	1.6685	0.1288	0.5853	1.7891	0.837	1.3001	0.2641	0.163	0	0.0733	0.7653	0.0439	0.0049	0.1041	1.7379	1.8952	0.0426	0.4922		0	0.9835	0		0					0	0	0.1131	0.701	0	0.776	2.0458						16.5148	0	1.963902801	11.7393	0.906100114	1.743770699	1.789070153	1.049877818	2.904986193	0.590086232	1.273039828	0	0.073288921	5.836038349	0.342973605	0.03756247	0.798599162	5.494957646	10.74778949	0.257490196	3.32424105	0	0	6.043712315	0	0	0	0	0	0	0	0	0	0.113074618	5.473696604	0	5.823345263	5.440667201	0	0	0	0	0	71.8037
H0317_006_0	2011	3	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery						Prosthetics/Supplies	Lab	Other	Other							D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	YES	895.138921	45.358791	441.657224	505.339491	27.710187	8.61245	1.950119	279.292499	0	519.855235	1015.650327	40.559468	0.265593	4.936482	3269.056724	3294.575357	79.176318	827.97082		1416.514118	18.281127	0							4.86	0.51	587.032809	773.692681	0	812.531429	344.545201						3400	$175/Day(Days 1-7):1a.IP Acute	$175/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	$0/Visit:9a.Surgery OP -- Physician	$0/Visit:8a.Lab -- FSL	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$100/Visit:8a.Lab -- OP	"$35/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $35 Partial Hospitalization,7h. $100 Psych -- OP"	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $150 Surgery OP -- Facility"							125.7585	107.666825	57.868692	0	100	0.2	0.2	50	0	0	65.906229	100	0.174846	0.2	15	32.803424	35	52.149664		0	0.2	0							0	0	0	100	0	81.200337	130.267352						NO	108.61246	92.987422	37.755213	0	85.716	0.171432	0.171432	42.858	0	0	56.492183	85.716	0.149871	0.171432	12.8574	28.117783	30.0006	44.700606		0	0.171432	0							0	0	0	85.716	0	69.601681	111.659963							8.1019	0.351483087	1.38957188	0	0.197933866	1.476449528	0.3343128	0.99749316	0	0	4.781358678	0.28971628	0.039804689	0.846270982	3.502630827	7.71967958	0.197944754	3.084233117	0	0	3.133970164	0	0	0	0	0	0	0	0	0	0	5.52648682	0	4.71279611	3.205992033	0	0	0	0	0	49.8901	0	8.748343726	8.1019	0.351483087	1.38957188	0	0.197933866	1.476449528	0.3343128	0.99749316	0	0	4.781358678	0.28971628	0.039804689	0.846270982	3.502630827	7.71967958	0.197944754	3.084233117	0	0	3.133970164	0	0	0	0	0	0	0	0	0	0	5.52648682	0	4.71279611	3.205992033	0	0	0	0	0	49.8901	YES	$175/Day(Days 1-7)	$175/Day(Days 1-7)	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	$0/Visit	30% Coins	$0-$100/Visit	$100/Visit	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	$40-$100/Visit		$0/Visit	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	$100/Visit	30% Coins	$40-$100/Visit	30% Coins						5100	1.5808	0.0686	0.4564	2.3524	1.0213	1.5697	0.3554	0.1923	0	0.0732	0.9449	0.0558	0.0078	0.1665	2.1263	2.1429	0.0515	0.6972		0	0.837	0							0	0	0.1504	1.0653	0	0.9809	2.4138						19.3106	500	3.417857795	9.6827	0.420060232	1.846018849	2.352377876	1.219270405	3.046187939	0.689749336	1.189768149	0	0.073245479	5.726297939	0.345561477	0.047635054	1.012750293	5.628929161	9.862576047	0.249443545	3.781464381	0	0	3.970998639	0	0	0	0	0	0	0	0	0	0.150429306	6.591762483	0	5.693709741	5.61974677	0	0	0	0	0	69.2007
H0317_007_0	2011	3	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery						Prosthetics/Supplies	Lab	Other	Other							D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O		V					O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0					0	0	0	0	0	0	0						0	YES	932.352026	47.244466	460.017991	526.347684	28.862167	10.311912	2.334928	290.903369	0	541.466884	1057.873386	42.245624	0.318001	5.910578	3404.959375	3431.53888	82.467871	862.391584		1475.40206	21.88847	0		3.17					4.86	0.51	611.437192	805.85697	0	846.31034	358.868784						4500	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	$0/Visit:9a.Surgery OP -- Physician	$0/Visit:8a.Lab -- FSL	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$100/Visit:8a.Lab -- OP	"$35/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP"	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $150 Surgery OP -- Facility"							161.6895	138.428775	45.243839	0	100	0.2	0.2	50	0	0	65.906229	100	0.174847	0.2	15	32.803424	35	52.149664		0	0.2	0		0					0	0	0	100	0	82.227062	130.267352						NO	145.927199	124.934046	34.79111	0	89.0618	0.178124	0.178124	44.5309	0	0	58.697274	89.0618	0.155722	0.178124	13.35927	29.21532	31.17163	46.445429		0	0.178124	0		0					0	0	0	89.0618	0	73.232901	116.018448							11.338	0.491870191	1.333711377	0	0.214209712	1.836799013	0.415906715	1.079515736	0	0	5.174523666	0.313539276	0.049519752	1.052815796	3.790647636	8.354458873	0.214221497	3.33784559	0	0	3.89886183	0	0	0	0	0	0	0	0	0	0	5.980922691	0	5.164813445	3.469616613	0	0	0	0	0	57.5118	0	7.125162398	11.338	0.491870191	1.333711377	0	0.214209712	1.836799013	0.415906715	1.079515736	0	0	5.174523666	0.313539276	0.049519752	1.052815796	3.790647636	8.354458873	0.214221497	3.33784559	0	0	3.89886183	0	0	0	0	0	0	0	0	0	0	5.980922691	0	5.164813445	3.469616613	0	0	0	0	0	57.5118	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	30% Coins(Days 1-20) 30%(Days 21-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	$0/Visit	30% Coins	$0-$100/Visit	$100/Visit	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	$40-$100/Visit		$0/Visit	20%-30% Coins	$0/Service		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	$100/Visit	30% Coins	$40-$100/Visit	30% Coins						6000	1.7957	0.0779	0.5487	2.4942	0.942	1.6644	0.3769	0.1773	0	0.0777	0.8716	0.0515	0.0083	0.1765	1.9612	1.9765	0.0475	0.6431		0	0.8875	0		0					0	0	0.1595	0.9826	0	0.9048	2.5593						19.3846	250	3.594233577	13.1336	0.569771807	1.882409706	2.494190693	1.156247761	3.501168596	0.792770505	1.256862135	0	0.077660897	6.046096063	0.365048544	0.057822185	1.229331266	5.751856163	10.33097682	0.261721824	3.980942509	0	0	4.786350825	0	0	0	0	0	0	0	0	0	0.159497734	6.963488345	0	6.069567092	6.028883832	0	0	0	0	0	76.8963
H0318_002_0	2011	3																															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	1327.44435	196.0614641	902.9633341	659.5750417	191.9042516	10.63617261	0	340.8532934	398.2745435	2596.014002	2691.618837	25.60548391	0.755232216	318.1534475	3543.485477	5064.583936	335.901182	672.7368425	0	0	292.5526878	0	0	0	815.8347899	0	47.73801578	5.602314369	0	0											3400	$300/day 1-7	$300/day 1-7	"$0/d 1-20, $130/d 21-100"	$0 per visit	$200 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$25 per visit	$50 X-ray; $250 Complex Radiology	$50 per visit	$25 per visit	$50 per visit	"$25 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$50 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$50 per visit	$50 per visit	$50 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$500.00 Every 3 Yrs	Not Covered	0											0	216.8565234	216.8565234	52.43074037	0	200	0.05	0.05	48.5	250	3.75	30	50	25	50	25	50	40	37.5	50	50	$50 	0	0	0	0	0	0	0	0	0											NO	178.6675233	178.6675233	43.19755005	0	164.7794777	0.041194869	0.041194869	39.95902333	205.9743471	3.089615206	24.71692165	41.19486941	20.59743471	41.19486941	20.59743471	41.19486941	32.95589553	30.89615206	41.19486941	41.19486941	41.19486941	0	0	0	0	0	0	0	0	0												19.7643	2.91915135	3.250483652	0	2.635156861	0.438155742	0	1.135013725	6.836194922	0.668390361	5.544044326	0.087901214	0.001296321	1.09219081	6.082225896	17.38623949	0.922493689	1.732081648	0	0	1.004305814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.4996	0	15.28256439	19.7643	2.91915135	3.250483652	0	2.635156861	0.438155742	0	1.135013725	6.836194922	0.668390361	5.544044326	0.087901214	0.001296321	1.09219081	6.082225896	17.38623949	0.922493689	1.732081648	0	0	1.004305814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.4996	NO																																																																																		0			19.7643	2.91915135	3.250483652	0	2.635156861	0.438155742	0	1.135013725	6.836194922	0.668390361	5.544044326	0.087901214	0.001296321	1.09219081	6.082225896	17.38623949	0.922493689	1.732081648	0	0	1.004305814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.4996
H0318_801_0	2011	1																															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	YES	315.1399298	6.433343623	40.25883556	7.993344862	9.373155928	12.12042906	0	15.02464047	41.46725515	18.57652188	60.02801393	1.062840551	0.091134019	27.64483678	28.21601233	135.023924	3.651172571	8.600511537	0	0	71.7323917	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.078940951	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	0.066645973	0.066645973	0.112039223	0	0.19671047	0.19671047	0.19671047	0.19671047	0.19671047	0.19671047	0.19671047	0.19671047	0.19671047	0.19671047	0.19671047	0.19671047	0.19671047	0.19671047	0.19671047	0.19671047	0.19671047	0.19671047	0	0	0	0	0	0	0	0												21.0028	0.428756442	4.51056864	0	1.84379791	2.3842153	0	2.955504091	8.157043258	3.654196354	11.80813885	0.209071864	0.017927016	5.438028842	5.550385052	26.56061958	0.718223873	1.691810669	0	0	14.1105125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0416	0	20.48514716	21.0028	0.428756442	4.51056864	0	1.84379791	2.3842153	0	2.955504091	8.157043258	3.654196354	11.80813885	0.209071864	0.017927016	5.438028842	5.550385052	26.56061958	0.718223873	1.691810669	0	0	14.1105125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0416	NO																																																																																		0			21.0028	0.428756442	4.51056864	0	1.84379791	2.3842153	0	2.955504091	8.157043258	3.654196354	11.80813885	0.209071864	0.017927016	5.438028842	5.550385052	26.56061958	0.718223873	1.691810669	0	0	14.1105125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0416
H0318_802_0	2011	1																															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	YES	288.3924195	4.997199183	34.44254756	6.54977784	7.961568493	12.84203336	0	14.38172766	48.86956893	17.82860671	66.22620807	2.090433517	0.062633334	32.57971283	31.61707071	133.5809306	3.337197887	8.8114601	0	0	61.0274576	0.011841565																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.078940951	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	0.066966967	0.066966967	0.11257885	0	0.197657909	0.197657909	0.197657909	0.197657909	0.197657909	0.197657909	0.197657909	0.197657909	0.197657909	0.197657909	0.197657909	0.197657909	0.197657909	0.197657909	0.197657909	0.197657909	0.197657909	0.197657909	0	0	0	0	0	0	0	0												19.3128	0.334647274	3.877502396	0	1.573666985	2.538329467	0	2.842662224	9.659456832	3.523965132	13.09013384	0.413190719	0.012379974	6.43963793	6.2493641	26.4033275	0.659623558	1.741654783	0	0	12.06255969	0.002340579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7372	0	19.80034275	19.3128	0.334647274	3.877502396	0	1.573666985	2.538329467	0	2.842662224	9.659456832	3.523965132	13.09013384	0.413190719	0.012379974	6.43963793	6.2493641	26.4033275	0.659623558	1.741654783	0	0	12.06255969	0.002340579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7372	NO																																																																																		0			19.3128	0.334647274	3.877502396	0	1.573666985	2.538329467	0	2.842662224	9.659456832	3.523965132	13.09013384	0.413190719	0.012379974	6.43963793	6.2493641	26.4033275	0.659623558	1.741654783	0	0	12.06255969	0.002340579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7372
H0319_001_0	2011	4																															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	YES	478.4316036	44.75493	6411.790184	117.0810072	35.28572712	57.16872361	4.547620385	11.94504869	2.95136052	35.54624191	18.10800159	0	4.409873835	12.91316227	1.655317101	181.9403176	20.687424	31.48655417	0	0	3.631641085	8.774319528	2770.828884	0	50.59699417	57.3140732	0	2.900859603	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.07496266	0.075872813	0	0	0.2	0.2	0.041506826	0.048622432	0.2	0	0.088984678	0	0.2	0.160744823	0.000994559	0.028146965	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.068644388	0.069477829	0	0	0.183142882	0.183142882	0.038008399	0.044524262	0.183142882	0	0.081484552	0	0.183142882	0.14719635	0.000907339	0.025678548	0.182460512	0	0	0	0.183142882	0.183244565	0	0	0	0	0	0	0	0												32.8416	3.109475354	0	0	6.462329753	10.47004479	0.172847769	0.531844473	0.540520671	0	1.475522391	0	0.807637003	1.900770356	0.001501933	4.671963261	3.774637976	0	0	0	0.665109214	1.607846366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0337	0	6.387633488	32.8416	3.109475354	0	0	6.462329753	10.47004479	0.172847769	0.531844473	0.540520671	0	1.475522391	0	0.807637003	1.900770356	0.001501933	4.671963261	3.774637976	0	0	0	0.665109214	1.607846366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0337	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.3117	0.1242	0	0.074	1.3848	2.2436	0.1785	0.076	0.1158	0	0.5049	0	0.1154	0.4073	0.0172	2.075	0.2359	0.0026	0	0	0.0416	0.1005	0	0	0.0032	0	0	0	0	0											9.012	0	0.838475845	34.1533	3.233665458	0	0.074001818	7.8471147	12.71362582	0.351318691	0.607822255	0.656346529	0	1.980421905	0	0.923013717	2.308078289	0.018685747	6.746939211	4.010552849	0.002587304	0	0	0.70667854	1.708336764	0	0	0.003165603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0457
H0320_005_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	1603.209446	14.4437591	408.1491695		177.2969395	9.284116677	4.811996725	364.8167485	160.4608426		15.42053701	0.621051967	0.071250911	6.404902085	4146.914688	4907.469127	29.48043617	831.6044207	20.65923513		6.548450712			11.76442105	159.1037094																4950	"1a (IP Acute) 225 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 225 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 350 copay, 9b (OP ASC) 200 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 35 copay, 7i (PT/ST) 35 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 7 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 35 copay, 7f (Podiatry) 35 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 35 copay, 18a (Hearing Exam) 35 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 35 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 35 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0%coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 14"												163.0846274	172.0337627	49.94161658		225	0.2	0.2	49.8	348.5638298		0.2	0.2	0.2	0.198896582	7	32.31315048	39.65975474	35	0.181		0.2			0.321428571	25																NO	150.291051	158.5381493	46.02382312		207.3493193	0.184310506	0.184310506	45.893316	321.2198792		0.184310506	0.184310506	0.184310506	0.183293649	6.450867711	29.77943256	36.5769068	32.25433855	0.166801008		0.184310506			0.321428571	25																	20.079	0.190823903	1.565382099	0	3.06353331	1.711160243	0.886901551	1.39522086	4.295267706	0	2.842166979	0.114466402	0.013132292	1.173977872	2.229266505	12.17847049	0.089858597	2.235237544	3.445981244	0	1.206948264	0	0	3.781421048	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8297	0	4.997693807	20.079	0.190823903	1.565382099	0	3.06353331	1.711160243	0.886901551	1.39522086	4.295267706	0	2.842166979	0.114466402	0.013132292	1.173977872	2.229266505	12.17847049	0.089858597	2.235237544	3.445981244	0	1.206948264	0	0	3.781421048	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8297	NO																																																																																		0	0	0	20.079	0.190823903	1.565382099	0	3.06353331	1.711160243	0.886901551	1.39522086	4.295267706	0	2.842166979	0.114466402	0.013132292	1.173977872	2.229266505	12.17847049	0.089858597	2.235237544	3.445981244	0	1.206948264	0	0	3.781421048	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8297
H0320_006_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	953.7059779	8.872292964	391.8035384		131.8511588	7.839124901	6.801421034	299.7605769	204.001701		10.44539233	1.786039531	0.385396354	9.185037847	4054.015702	4333.319378	146.3447337	1058.101184	29.36205702		18.46196288				159.1037094																6700	"1a (IP Acute) 250 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 225 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 400 copay, 9b (OP ASC) 200 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 40 copay, 7i (PT/ST) 40 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 15 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 40 copay, 7f (Podiatry) 40 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 40 copay, 18a (Hearing Exam) 40 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 40 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 40 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 70 allowance, 0%coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												181.2051416	172.0337627	49.94161658		225	0.2	0.2	48.28607089	306.1968031		0.2	0.2	0.2	0.197412978	15	38.19984619	39.45405356	40	0.181		0.2				25																NO	171.9562962	163.2530313	47.39255926		213.5158324	0.189791851	0.189791851	45.82151385	290.5682902		0.189791851	0.189791851	0.189791851	0.187336873	14.23438882	36.26242051	37.49776813	37.9583702	0.171761625		0.189791851				25																	13.6663	0.120702393	1.547381034	0	2.346025826	1.487802025	1.290854287	1.144623619	4.93970212	0	1.982450344	0.338975749	0.073145087	1.720696265	4.808869651	13.09472079	0.457300074	3.346983039	5.043274632	0	3.503930109	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.2452	0	3.270880414	13.6663	0.120702393	1.547381034	0	2.346025826	1.487802025	1.290854287	1.144623619	4.93970212	0	1.982450344	0.338975749	0.073145087	1.720696265	4.808869651	13.09472079	0.457300074	3.346983039	5.043274632	0	3.503930109	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.2452	NO																																																																																		0	0	0	13.6663	0.120702393	1.547381034	0	2.346025826	1.487802025	1.290854287	1.144623619	4.93970212	0	1.982450344	0.338975749	0.073145087	1.720696265	4.808869651	13.09472079	0.457300074	3.346983039	5.043274632	0	3.503930109	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.2452
H0321_002_0	2011	6																															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	424.704654	15.98000298	25.16025841	884.9981709	23.92597995	15.82329664	6.037691891	57.3317519	41.37532979	11.1717161	48.58739895	0	18.31302322	16.15350067	31.52948944	128.4832907	1.628755649	21.05212347	0	0	50.8424309	12.60794268	0	1121.639137	584.8867947	0	15.77416561	2.623955939	132	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7f1); $0 n/c (7b1); FFS (7d, 7f)"	"FFS (7e, 7h)"	$0 (7c); FFS (7i)	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a); $0 n/c (13a1); FFS (16b, 17a, 18a); $0 (17b)"	$0 n/c (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 (14a1); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.073737794	0.073737794	0.143195166	0	0.233	0.233	0.233	0.095672023	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232126962	0.233	0.230986981	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.059754952	0.059754952	0.116041176	0	0.188816388	0.188816388	0.188816388	0.077539867	0.188816388	0.188816388	0.188816388	0	0.188816388	0.188816388	0.188816388	0.188136152	0.188816388	0.187272682	0	0	0.188816388	0.188816388	0	0	0	0	0	0	0	0												25.3782	0.954884312	2.919625985	0	4.517617116	2.987697719	1.140015175	4.445496405	7.812340326	2.109403082	9.174097175	0	3.457798899	3.050045652	5.953284314	24.1723519	0.307535759	3.942487622	0	0	9.599884163	2.380586197	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3034	0	26.74002812	25.3782	0.954884312	2.919625985	0	4.517617116	2.987697719	1.140015175	4.445496405	7.812340326	2.109403082	9.174097175	0	3.457798899	3.050045652	5.953284314	24.1723519	0.307535759	3.942487622	0	0	9.599884163	2.380586197	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3034	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.3782	0.954884312	2.919625985	0	4.517617116	2.987697719	1.140015175	4.445496405	7.812340326	2.109403082	9.174097175	0	3.457798899	3.050045652	5.953284314	24.1723519	0.307535759	3.942487622	0	0	9.599884163	2.380586197	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3034
H0332_001_0	2011	5																															A	A	D		T	Coin	Coin	V	V		P		V	V		V	V	V	P		Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	158.2892927	1.092922033	315.4725647	0	176.1008865	5.172559314	1.97369448	286.080645	339.5618604	0	776.0483263	0	0	434.9197593	0	0	113.7573276	0	165.1831381	0	0.618426572	0	0	0	0	0	0	0	0	0											3400	$375/Admit for IP Medical; $375/Admit for IP Surgical; PBP 1a	$375/Admit for IP Psych; $375/Admit for IP Substance Abuse; PBP 1b	$125/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $50/Visit for PCP Urgent Care; $50/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$150/Visit for OP Fac - Surgery and ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0/Service for X-Rays/Lab Tests; $100/Service for OP Fac - CT/MRI/PET; $25/Service for Cardiac Stress Test/Rad Therapy; PBP 8b	No Cost-Sharing;	$25/Visit for Renal Dialysis - Fac; PBP 12	"$10/Visit for OP Fac - CORF; $25/Visit for Partial Hospital; $150/Visit for Outpatient Hospital; $20-35/Visit for OP Substance Abuse; $15/Visit for OP Fac - Cardiovascular; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$50/Visit for Urgent Care Visit; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$20-35/Day for OP Psych; $20-35/Day for OP Substance Abuse; PBP 7e, 7h"	"$0/Visit for Occ Therapy; $0/Visit for PT/ST; PBP 7c, 7i"	$0/Service for Prof Radiology (Office); $100/Service for Prof Radiology (Office); PBP 14g-h	"No Cost-Sharing; PBP 7d, 7g, 14f, 14i"	10% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"Not Offered; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	Every Two Years $150; PBP 17b	No Cost-Sharing; PBP 18a	Every Two Years $1000; PBP 18b	No Cost-Sharing; PBP 14a	Not Offered; PBP 13b											0	375	375	125	0	100	0.1	0.2	50	150	0	43.4826493	0	0	49.10363461	0	0	32	0	15.8202547	0	0.1	0	0	0	0	0	0	0	0	0											NO	371.3505021	371.3505021	123.7835007	0	99.02680055	0.099026801	0.198053601	49.51340027	148.5402008	0	43.0594764	0	0	48.6257583	0	0	31.68857618	0	15.66629207	0	0.099026801	0	0	0	0	0	0	0	0	0												4.8984	0.033821429	3.254191536	0	1.453225614	0.512221999	0.390897299	1.180402124	4.203215577	0	2.784686216	0	0	1.762358591	0	0	0.300400645	0	0.215650607	0	0.061240805	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.0507	0	0.206878768	4.8984	0.033821429	3.254191536	0	1.453225614	0.512221999	0.390897299	1.180402124	4.203215577	0	2.784686216	0	0	1.762358591	0	0	0.300400645	0	0.215650607	0	0.061240805	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.0507	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.8984	0.033821429	3.254191536	0	1.453225614	0.512221999	0.390897299	1.180402124	4.203215577	0	2.784686216	0	0	1.762358591	0	0	0.300400645	0	0.215650607	0	0.061240805	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.0507
H0332_002_0	2011	6																															A	A	D		T	Coin	Coin	V	V		P		V	V		V	V	V	P	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	206.3369298	3.054258648	452.8199734	0	208.8646028	7.055997862	0.583812331	347.7619722	337.637208	0	876.0572903	0	9.299475902	424.2125832	0	5005.236832	185.8094847	37.65833458	65.56827795	0	0.897758519	0	0	0	0	0	0	0	0	0											3400	$500/Admit for IP Medical; $500/Admit for IP Surgical; PBP 1a	$500/Admit for IP Psych; $500/Admit for IP Substance Abuse; PBP 1b	$125/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $50/Visit for PCP Urgent Care; $50/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$175/Visit for OP Fac - Surgery and ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0/Service for X-Rays/Lab Tests; $100/Service for OP Fac - CT/MRI/PET; $25/Service for Cardiac Stress Test/Rad Therapy; PBP 8b	No Cost-Sharing;	$25/Visit for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - CORF; $35/Visit for Partial Hospital; $150/Visit for Outpatient Hospital; $20-35/Visit for OP Substance Abuse ; $25/Visit for OP Fac - Cardiovascular; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$15/Visit for Speclst Office Visits; $15/Visit for Speclst Consults; $15/Visit for Cardio; $15/Visit for Chiropractor; $15/Exam for Vision Exams; $10/Visit for Diabetes Self-Management Training; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$20-35/Day for OP Psych; $20-35/Day for OP Substance Abuse; PBP 7e, 7h"	"$15/Visit for Occ Therapy; $15/Visit for PT/ST; PBP 7c, 7i"	$0/Service for Prof Radiology (Office); $100/Service for Prof Radiology (Office); PBP 14g-h	"$15/Visit for Specialty Services; PBP 7d, 7g, 14f, 14i"	10% Coinsurance for Part B Rx; $11/Other for Tx Injections; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"Not Offered; PBP 16a, 16b"	$15/Exam for Vision (Refractions); PBP 17a	Not Offered; PBP 17b	$15/Visit for Routine Hearing Exams; PBP 18a	Every Two Years $600; PBP 18b	No Cost-Sharing; PBP 14a	Not Offered; PBP 13b											0	500	500	125	0	100	0.1	0.2	50	175	0	40.89909826	0	25	43.525584	0	15	32	15	7.1058145	0	0.078726571	0	0	0	0	0	0	0	0	0											NO	486.2677126	486.2677126	121.5669281	0	97.25354251	0.097253543	0.194507085	48.62677126	170.1936994	0	39.77582192	0	24.31338563	42.33017234	0	14.58803138	31.1211336	14.58803138	6.910656326	0	0.07656438	0	0	0	0	0	0	0	0	0												8.3612	0.123765614	4.587327764	0	1.69273521	0.686220788	0.113555635	1.409211823	4.78864379	0	2.903824897	0	0.018841812	1.49641598	0	6.084712663	0.481883483	0.045780081	0.037759986	0	0.068736324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.9007	0	0.929120675	8.3612	0.123765614	4.587327764	0	1.69273521	0.686220788	0.113555635	1.409211823	4.78864379	0	2.903824897	0	0.018841812	1.49641598	0	6.084712663	0.481883483	0.045780081	0.037759986	0	0.068736324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.9007	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	8.3612	0.123765614	4.587327764	0	1.69273521	0.686220788	0.113555635	1.409211823	4.78864379	0	2.903824897	0	0.018841812	1.49641598	0	6.084712663	0.481883483	0.045780081	0.037759986	0	0.068736324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.9007
H0332_003_0	2011	5																															A	A	D		T	Coin	Coin	V	V		P		V	V		V	V	V	P		Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	169.7132634	0.961114978	359.7486383	0	156.4959473	7.483486576	3.049020345	285.1879809	331.6411074	0	970.5613567	0	0.830818235	346.4760836	0	0	119.6759315	0	152.4674236	0	1.604996351	0	0	0	0	0	0	0	0	0											3400	$375/Admit for IP Medical; $375/Admit for IP Surgical; PBP 1a	$375/Admit for IP Psych; $375/Admit for IP Substance Abuse; PBP 1b	$125/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $50/Visit for PCP Urgent Care; $50/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$150/Visit for OP Fac - Surgery and ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0/Service for X-Rays/Lab Tests; $100/Service for OP Fac - CT/MRI/PET; $25/Service for Cardiac Stress Test/Rad Therapy; PBP 8b	No Cost-Sharing;	$25/Visit for Renal Dialysis - Fac; PBP 12	"$15/Visit for OP Fac - Cardiovascular; $10/Visit for OP Fac - CORF; $20-35/Visit for OP Fac - Other; $150/Visit for OP Hosp; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$0/Visit for Speclst Office Visits; $0/Visit for Speclst Consults; $0/Visit for Cardio; $0/Visit for Chiropractor; $0/Exam for Vision Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$20-35/Day for OP Psych; $20-35/Day for OP Substance Abuse; PBP 7e, 7h"	"$0/Visit for Occ Therapy; $0/Visit for PT/ST; PBP 7c, 7i"	$0/Service for Prof Radiology (Office); $100/Service for Prof Radiology (Office); PBP 14g-h	"No Cost-Sharing; PBP 7d, 7g, 14f, 14i"	10% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	375	375	125	0	100	0.1	0.2	50	150	0	40.00940056	0	25	46.99674506	0	0	32	0	10.9975896	0	0.1	0	0	0	0	0	0	0	0	0											NO	369.6917168	369.6917168	123.2305723	0	98.58445781	0.098584458	0.197168916	49.29222891	147.8766867	0	39.44305061	0	24.64611445	46.33148631	0	0	31.5470265	0	10.84191408	0	0.098584458	0	0	0	0	0	0	0	0	0												5.2285	0.029609687	3.694335881	0	1.285672343	0.737755467	0.601172035	1.171462603	4.086832345	0	3.190158393	0	0.00170637	1.337729327	0	0	0.314618315	0	0.137753226	0	0.158227695	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9755	0	0.315539052	5.2285	0.029609687	3.694335881	0	1.285672343	0.737755467	0.601172035	1.171462603	4.086832345	0	3.190158393	0	0.00170637	1.337729327	0	0	0.314618315	0	0.137753226	0	0.158227695	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9755	NO	$1000/Admit for IP Medical; $1000/Admit for IP Surgical; PBP 1a	Not Covered	Not Covered	Not Covered	20% Coinsurance for Ambulance; PBP 10a	Not Covered	Not Covered	Not Covered	"20% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"20% Coinsurance for OP Fac - Cardiovascular; 20% Coinsurance for OP Fac - Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"20% Coinsurance for PCP Office Visits; 20% Coinsurance for PCP Consults; 20% Coinsurance for Medical Nutrition Therapy; 20% Coinsurance for Hepatitis B (HBV) Vaccine; PBP 4b, 7a, 14b-c"	"20% Coinsurance for Speclst Office Visits; 20% Coinsurance for Speclst Consults; 20% Coinsurance for Cardio; 20% Coinsurance for Chiropractor; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing/Speech Exams; 20% Coinsurance for Diabetes Self-Management Training; 20% Coinsurance for Prostate Cancer Screening; 20% Coinsurance for Pneumococcal Vaccine; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	Not Covered	Not Covered	"20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Initial Preventive Physical Examination (IPPE); 20% Coinsurance for Glaucoma Screening; PBP 7d, 14g-h"	"20% Coinsurance for Prof - Primary Surgeon (IP); 20% Coinsurance for Prof - Asst Surgeon (IP); 20% Coinsurance for Prof - Anesthesia (IP); 20% Coinsurance for Prof - Primary Surgeon (OP); 20% Coinsurance for Prof - PCP Asst Surgeon (OP); 20% Coinsurance for Prof - Speclst Asst Surgeon (OP); 20% Coinsurance for Prof - Anesthesia (OP); 20% Coinsurance for Prof - IP Visits; 20% Coinsurance for Allergy Testing; 20% Coinsurance for Allergy Tx; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for PCP Immunizations; 20% Coinsurance for Speclst Immunizations; 20% Coinsurance for Cardio Screenings; 20% Coinsurance for Diabetes Screening Tests; 20% Coinsurance for Pelvic Tests; 20% Coinsurance for Colorectal Cancer Screening; 20% Coinsurance for Influenza Virus Vaccine; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.5463	0	0	0	0.1989	0	0	0	1.4353	0.0179	0.446	0	0	0.1274	0	0.0006	0	0	0	0.0025	0.0213	0	0	0	0	0	0	0	0	0											2.7963	0	0	5.7747	0.029609687	3.694335881	0	1.484615589	0.737755467	0.601172035	1.171462603	5.522163473	0.017881777	3.636183338	0	0.00170637	1.465178142	0	0.000576657	0.314618315	0	0.137753226	0.002504193	0.179525457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.7718
H0332_004_0	2011	5																															A	A	D		T	Coin	Coin	V	V		P		V	V		V	V	V	P	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	206.0889106	4.735033526	336.8815512	0	203.5527263	9.08681599	0.848847445	337.2046979	335.6817542	0	712.5442008	0	2.385559835	486.4272768	0	4496.980324	254.4980256	134.0746129	152.0202638	30.64461998	2.876195668	0	0	0	0	0	0	0	0	0											3400	$500/Admit for IP Medical; $500/Admit for IP Surgical; PBP 1a	$500/Admit for IP Psych; $500/Admit for IP Substance Abuse; PBP 1b	$125/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $50/Visit for PCP Urgent Care; $50/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$175/Visit for OP Fac - Surgery and ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0/Service for X-Rays/Lab Tests; $100/Service for OP Fac - CT/MRI/PET; $25/Service for Cardiac Stress Test/Rad Therapy; PBP 8b	No Cost-Sharing;	$25/Visit for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $15/Visit for OP Fac - Occ Therapy; $15/Visit for OP Fac - Physical/Speech Therapy; $15/Visit for OP Fac - CORF; $20-35/Visit for OP Fac - Other; ; $175/Visit for Hosp OP; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$15/Visit for Speclst Office Visits; $15/Visit for Speclst Consults; $15/Visit for Cardio; $15/Visit for Chiropractor; $15/Exam for Vision Exams; $10/Visit for Diabetes Self-Management Training; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$20-35/Day for OP Psych; $20-35/Day for OP Substance Abuse; PBP 7e, 7h"	"$15/Visit for Occ Therapy; $15/Visit for PT/ST; PBP 7c, 7i"	$0/Service for Prof Radiology (Office); $100/Service for Prof Radiology (Office); PBP 14g-h	"$15/Visit for Specialty Services; PBP 7d, 7g, 14f, 14i"	10% Coinsurance for Part B Rx; $0-15/Other for Tx Injections; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$15/Exam for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	$15/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	500	500	125	0	100	0.1	0.2	50	175	0	47.32846152	0	25	43.89882421	0	15	32	15	9.214726907	11.90404654	0.069785829	0	0	0	0	0	0	0	0	0											NO	484.4286541	484.4286541	121.1071635	0	96.88573083	0.096885731	0.193771462	48.44286541	169.5500289	0	45.85452583	0	24.22143271	42.53169666	0	14.53285962	31.00343386	14.53285962	8.927755507	11.53332249	0.06761251	0	0	0	0	0	0	0	0	0												8.3196	0.191148827	3.399897426	0	1.643446221	0.880382808	0.16448241	1.361263483	4.742904261	0	2.722781372	0	0.00481514	1.724048115	0	5.446165315	0.657526059	0.162373961	0.113099979	0.029452857	0.194466809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7579	0	1.020816514	8.3196	0.191148827	3.399897426	0	1.643446221	0.880382808	0.16448241	1.361263483	4.742904261	0	2.722781372	0	0.00481514	1.724048115	0	5.446165315	0.657526059	0.162373961	0.113099979	0.029452857	0.194466809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7579	NO	$1000/Admit for IP Medical; $1000/Admit for IP Surgical; PBP 1a	Not Covered	Not Covered	Not Covered	20% Coinsurance for Ambulance; PBP 10a	Not Covered	Not Covered	Not Covered	"20% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"20% Coinsurance for OP Fac - Cardiovascular; 20% Coinsurance for OP Fac - Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"20% Coinsurance for PCP Office Visits; 20% Coinsurance for PCP Consults; 20% Coinsurance for Medical Nutrition Therapy; 20% Coinsurance for Hepatitis B (HBV) Vaccine; PBP 4b, 7a, 14b-c"	"20% Coinsurance for Speclst Office Visits; 20% Coinsurance for Speclst Consults; 20% Coinsurance for Cardio; 20% Coinsurance for Chiropractor; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing/Speech Exams; 20% Coinsurance for Diabetes Self-Management Training; 20% Coinsurance for Prostate Cancer Screening; 20% Coinsurance for Pneumococcal Vaccine; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	Not Covered	Not Covered	"20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Initial Preventive Physical Examination (IPPE); 20% Coinsurance for Glaucoma Screening; PBP 7d, 14g-h"	"20% Coinsurance for Prof - Primary Surgeon (IP); 20% Coinsurance for Prof - Asst Surgeon (IP); 20% Coinsurance for Prof - Anesthesia (IP); 20% Coinsurance for Prof - Primary Surgeon (OP); 20% Coinsurance for Prof - PCP Asst Surgeon (OP); 20% Coinsurance for Prof - Speclst Asst Surgeon (OP); 20% Coinsurance for Prof - Anesthesia (OP); 20% Coinsurance for Prof - IP Visits; 20% Coinsurance for Allergy Testing; 20% Coinsurance for Allergy Tx; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for PCP Immunizations; 20% Coinsurance for Speclst Immunizations; 20% Coinsurance for Cardio Screenings; 20% Coinsurance for Diabetes Screening Tests; 20% Coinsurance for Pelvic Tests; 20% Coinsurance for Colorectal Cancer Screening; 20% Coinsurance for Influenza Virus Vaccine; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.5104	0	0	0	0.1953	0	0	0	0.8405	0.009	0.1386	0	0	0.1468	0	0.0507	0	0	0	0.0006	0.0469	0	0	0	0	0	0	0	0	0											1.9387	0	0	8.83	0.191148827	3.399897426	0	1.838704348	0.880382808	0.16448241	1.361263483	5.58343839	0.008972694	2.861402803	0	0.00481514	1.870823473	0	5.496867422	0.657526059	0.162373961	0.113099979	0.030007025	0.241360746	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6965
H0332_801_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	248.9771821	1.84633485	47.29700835	0	9.203940928	13.54946972	6.688840306	17.32691635	55.31358797	7.095946033	45.4104738	0	0.836864732	36.61455613	50.80963748	79.11870897	1.122692725	5.789073867	35.0776711	163.6397609	80.53869008	16.97151082	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.069413561	0.069413561	0.17986366	0	0.233	0.233	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	0.060956552	0.060956552	0.157949951	0	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0	0	0	0	0	0	0	0												15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648	0	20.90298365	15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648
H0332_803_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	248.9771821	1.84633485	47.29700835	0	9.203940928	13.54946972	6.688840306	17.32691635	55.31358797	7.095946033	45.4104738	0	0.836864732	36.61455613	50.80963748	79.11870897	1.122692725	5.789073867	35.0776711	163.6397609	80.53869008	16.97151082	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.069413561	0.069413561	0.17986366	0	0.233	0.233	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	0.060956552	0.060956552	0.157949951	0	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0	0	0	0	0	0	0	0												15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648	0	20.90298365	15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648
H0332_804_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	248.9771821	1.84633485	47.29700835	0	9.203940928	13.54946972	6.688840306	17.32691635	55.31358797	7.095946033	45.4104738	0	0.836864732	36.61455613	50.80963748	79.11870897	1.122692725	5.789073867	35.0776711	163.6397609	80.53869008	16.97151082	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.069413561	0.069413561	0.17986366	0	0.233	0.233	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											YES	0.060956552	0.060956552	0.157949951	0	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0	0	0	0	0	0	0	0											0	15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648	0	20.90298365	15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648
H0332_805_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	248.9771821	1.84633485	47.29700835	0	9.203940928	13.54946972	6.688840306	17.32691635	55.31358797	7.095946033	45.4104738	0	0.836864732	36.61455613	50.80963748	79.11870897	1.122692725	5.789073867	35.0776711	163.6397609	80.53869008	16.97151082	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.069413561	0.069413561	0.17986366	0	0.233	0.233	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	0.060956552	0.060956552	0.157949951	0	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0	0	0	0	0	0	0	0												15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648	0	20.90298365	15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648
H0332_806_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	248.9771821	1.84633485	47.29700835	0	9.203940928	13.54946972	6.688840306	17.32691635	55.31358797	7.095946033	45.4104738	0	0.836864732	36.61455613	50.80963748	79.11870897	1.122692725	5.789073867	35.0776711	163.6397609	80.53869008	16.97151082	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.069413561	0.069413561	0.17986366	0	0.233	0.233	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	0.060956552	0.060956552	0.157949951	0	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0	0	0	0	0	0	0	0												15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648	0	20.90298365	15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648
H0332_807_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	245.9020994	1.823531024	46.71722681	0	9.116847156	13.42125568	6.625546078	17.43536036	55.67226581	7.141959294	45.70493546	0	0.842291334	36.85198115	50.32884311	78.37003545	1.112069064	5.734293824	34.74574299	162.0912933	80.08305347	16.81091517	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.069413561	0.069413561	0.17986366	0	0.233	0.233	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	0.061010557	0.061010557	0.158089888	0	0.204793697	0.204793697	0.204793697	0.204793697	0.204793697	0.204793697	0.204793697	0	0.204793697	0.204793697	0.204793697	0.204793697	0.204793697	0.204793697	0.204793697	0.204793697	0.204793697	0.204793697	0	0	0	0	0	0	0	0												15.0026	0.111254644	7.385521173	0	1.867072838	2.748588574	1.356870078	3.570651913	11.40132916	1.46262825	9.360082721	0	0.172495957	7.547053475	10.30702987	16.04968932	0.227744735	1.174347234	7.115709176	33.19527527	16.40050462	3.442769474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.8992	0	20.64567148	15.0026	0.111254644	7.385521173	0	1.867072838	2.748588574	1.356870078	3.570651913	11.40132916	1.46262825	9.360082721	0	0.172495957	7.547053475	10.30702987	16.04968932	0.227744735	1.174347234	7.115709176	33.19527527	16.40050462	3.442769474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.8992	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.0026	0.111254644	7.385521173	0	1.867072838	2.748588574	1.356870078	3.570651913	11.40132916	1.46262825	9.360082721	0	0.172495957	7.547053475	10.30702987	16.04968932	0.227744735	1.174347234	7.115709176	33.19527527	16.40050462	3.442769474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.8992
H0332_808_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	248.9771821	1.84633485	47.29700835	0	9.203940928	13.54946972	6.688840306	17.32691635	55.31358797	7.095946033	45.4104738	0	0.836864732	36.61455613	50.80963748	79.11870897	1.122692725	5.789073867	35.0776711	163.6397609	80.53869008	16.97151082	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.069413561	0.069413561	0.17986366	0	0.233	0.233	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											YES	0.060956552	0.060956552	0.157949951	0	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0	0	0	0	0	0	0	0											0	15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648	0	20.90298365	15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648
H0332_809_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	248.9771821	1.84633485	47.29700835	0	9.203940928	13.54946972	6.688840306	17.32691635	55.31358797	7.095946033	45.4104738	0	0.836864732	36.61455613	50.80963748	79.11870897	1.122692725	5.789073867	35.0776711	163.6397609	80.53869008	16.97151082	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.069413561	0.069413561	0.17986366	0	0.233	0.233	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	0.060956552	0.060956552	0.157949951	0	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0.204612419	0	0	0	0	0	0	0	0												15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648	0	20.90298365	15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.1768	0.112546207	7.470560139	0	1.883240613	2.772389769	1.368619792	3.54530226	11.31784701	1.45191868	9.291546872	0	0.171232917	7.491792883	10.39628281	16.18867039	0.229716874	1.184516405	7.177327121	33.48272724	16.47921616	3.472581875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6648
H0351_014_0	2011	4																															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	1031.641893	40.51667683	405.9875422	8.596235171	307.6496182	17.80615637	3.35083901	455.011758	331.5783694	5.722386793	58.54332525	0	0.465775815	526.8577109	3599.504557	5018.841965	247.5245686	194.3703031	6.309246834	99.62428055	18.27364367	0	0	0	0	0	0	0	20800	0											3400	1a:  Acute - $150/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $150/$0/day for 1-8/9-90	2:  Skilled Nursing Services - $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 - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - Copay Range: $0-$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 - Variable Copay: $125 CT Scan; $150 MRI; $200 PET/visit/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $35/visit		12:  Renal Dialysis - 20.0%	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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $25/visit/7i:  Physical/Speech Therapy - $25/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/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							14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													150	150	100	0	300	0.2	0.068791613	48.95347858	150	0	0.237871074	0	0.2	25	5.004430937	33.05888953	35	25	0	35	0.2	0	0	0	0	0	0	0	0	0											NO	120.6815527	120.6815527	80.45436846	0	241.3631054	0.160908737	0.055345858	39.38521203	120.6815527	0	0.191377671	0	0.160908737	20.11359211	4.026283305	26.59732079	28.15902896	20.11359211	0	28.15902896	0.160908737	0	0	0	0	0	0	0	0	0												10.375	0.407467956	2.721955943	0	6.187938934	2.865166131	0.185455059	1.493394547	3.334616038	0	11.20388522	0	0.074947398	0.883083425	1.207718759	11.12397914	0.580837625	0.325790416	0	0.233776917	2.940388922	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1454	0	13.64	10.375	0.407467956	2.721955943	0	6.187938934	2.865166131	0.185455059	1.493394547	3.334616038	0	11.20388522	0	0.074947398	0.883083425	1.207718759	11.12397914	0.580837625	0.325790416	0	0.233776917	2.940388922	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1454	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.375	0.407467956	2.721955943	0	6.187938934	2.865166131	0.185455059	1.493394547	3.334616038	0	11.20388522	0	0.074947398	0.883083425	1.207718759	11.12397914	0.580837625	0.325790416	0	0.233776917	2.940388922	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1454
H0351_029_0	2011	4																															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	YES	396.7791328	25.7481853	57.24693215	12.1255364	34.05821032	23.43177065	4.532111878	32.27779332	43.19604104	7.552304569	63.18204717	0	0.428123785	21.99402635	64.05004587	153.2459493	6.481340784	8.796694286	8.561644311	35.1341427	16.13102845	0.193395515	706.0465116	2118.974457	551.25	0	0	0	20800	0											6700	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	10b:  Transportation - $0/trip	16a:  Preventive Dental - Oral Exams - $101/service/16a:  Preventive Dental - Prophylaxis - $101/service/16a:  Preventive Dental - X-Rays - $101/service	17a:  Routine Eye Exams - $10/visit	17b:  Eye Glasses & Contact Lenses - $0 Per Year			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/													0.075347615	0.075347615	0.13952685	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.223041681	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	101.4402463	5.714285714	0	0	0	0	0											NO	0.057528257	0.057528257	0.106529403	0	0.17789659	0.17789659	0.17789659	0.17789659	0.17789659	0.17789659	0.17789659	0	0.17789659	0.17789659	0.170293367	0.17789659	0.17789659	0.17789659	0.17789659	0.17789659	0.17789659	0.17789659	0	101.4402463	5.714285714	0	0	0	0	0												22.826	1.48124822	6.098481492	0	6.058839488	4.168432104	0.80624725	5.742109374	7.684428416	1.343529232	11.23987076	0	0.076161762	3.912662294	10.90729798	27.26193186	1.153008426	1.564901919	1.52308733	6.25024419	2.86965496	0.034404403	0	17.91244091	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.1775	0	38.1	22.826	1.48124822	6.098481492	0	6.058839488	4.168432104	0.80624725	5.742109374	7.684428416	1.343529232	11.23987076	0	0.076161762	3.912662294	10.90729798	27.26193186	1.153008426	1.564901919	1.52308733	6.25024419	2.86965496	0.034404403	0	17.91244091	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.1775	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.826	1.48124822	6.098481492	0	6.058839488	4.168432104	0.80624725	5.742109374	7.684428416	1.343529232	11.23987076	0	0.076161762	3.912662294	10.90729798	27.26193186	1.153008426	1.564901919	1.52308733	6.25024419	2.86965496	0.034404403	0	17.91244091	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.1775
H0351_030_0	2011	3																															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	855.8336632	35.0391741	198.0838451	5.199082554	266.0149455	10.77581943	2.299687504	404.0099315	233.6845709	3.077537708	38.11263116	0	0.185737233	476.8661121	2563.26805	3651.739985	206.255457	145.6443844	4.751702042	59.59840305	7.644391096	0	0	0	0	0	0	0	20800	0											3400	1a:  Acute - $175/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-8/9-90	2:  Skilled Nursing Services - $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 - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - Copay Range: $0-$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 - Variable Copay: $125 CT Scan; $150 MRI; $200 PET/visit/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $25/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $5/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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 - $30/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							14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													175	175	100	0	250	0.2	0.084301839	48.95206265	150	0	0.222418798	0	0.2	20	5.003612687	28.53440373	30	20	0	30	0.2	0	0	0	0	0	0	0	0	0											NO	154.9974766	155.107791	88.0628004	0	221.4217742	0.176077869	0.074811354	43.38744828	132.5969003	0	0.196354237	0	0.17439414	17.74377821	4.423644625	25.23270453	26.58237059	17.70715255	0	26.45831415	0.174871905	0	0	0	0	0	0	0	0	0												11.0543	0.452904074	1.453651509	0	4.908458433	1.897383324	0.172042735	1.460746667	2.582154146	0	7.483576623	0	0.032391485	0.705117211	0.944915578	7.67860634	0.456896583	0.214912278	0	0.131406106	1.336789235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9663	0	5.633759359	11.0543	0.452904074	1.453651509	0	4.908458433	1.897383324	0.172042735	1.460746667	2.582154146	0	7.483576623	0	0.032391485	0.705117211	0.944915578	7.67860634	0.456896583	0.214912278	0	0.131406106	1.336789235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9663	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.0543	0.452904074	1.453651509	0	4.908458433	1.897383324	0.172042735	1.460746667	2.582154146	0	7.483576623	0	0.032391485	0.705117211	0.944915578	7.67860634	0.456896583	0.214912278	0	0.131406106	1.336789235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9663
H0351_035_0	2011	4																															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											2.805316636	0.055241969	0.599000236	0.160647915	0.379446356	0.401042291	0.022138739	0	0.744948961	0	1.30510945	0	0.008902952	0.187033975	0	0	0.036334609	0	0	0.00026605	0.444569861	0	0	0	0	0	0	0	0	0											7.15	YES	800.6427992	31.33931038	329.7684063	5.748994217	246.2114413	14.35181909	2.600345175	381.7884016	230.1278608	5.763464728	46.7050362	0	0.318603714	446.4520567	2518.414762	3574.189758	170.2396713	129.809669	4.200143441	69.18438545	15.90950972	0	0	0	0	0	0	0	20800	0											3400	1a:  Acute - $250/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $250/$0/day for 1-8/9-90	2:  Skilled Nursing Services - $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 - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - Copay Range: $0-$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 - Variable Copay: $125 CT Scan; $150 MRI; $200 PET/visit/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $35/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $45/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $45/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $40/visit/9c:  Outpatient Substance Abuse Svcs - Group - $40/visit/7g:  Other Health Care Professional Services - $45/visit/18a:  Hearing Exams - $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							14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													250	250	100	0	300	0.2	0.060935259	48.95344655	250	0	0.243854913	0	0.2	35	10.00537953	41.7644737	40	35	0	44.90991227	0.2	0	0	0	0	0	0	0	0	0											NO	199.9615881	199.9615881	79.98463523	0	239.9539057	0.15996927	0.048738844	39.15523565	199.9615881	0	0.195046462	0	0.15996927	27.99462233	8.002766317	33.40516194	31.99385409	27.99462233	0	35.92102951	0.15996927	0	0	0	0	0	0	0	0	0												13.3415	0.522221523	2.198033808	0	4.92328308	2.29585003	0.126737819	1.245751236	3.834727708	0	9.109652091	0	0.050966804	1.041521393	1.679523736	9.949698971	0.453885267	0.302831055	0	0.207097863	2.545032663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8283	120	13.47	16.1468	0.577463492	2.797034043	0.160647915	5.302729435	2.696892321	0.148876558	1.245751236	4.579676669	0	10.41476154	0	0.059869756	1.228555368	1.679523736	9.949698971	0.490219875	0.302831055	0	0.207363913	2.989602524	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9783	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.1468	0.577463492	2.797034043	0.160647915	5.302729435	2.696892321	0.148876558	1.245751236	4.579676669	0	10.41476154	0	0.059869756	1.228555368	1.679523736	9.949698971	0.490219875	0.302831055	0	0.207363913	2.989602524	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9783
H0351_036_0	2011	4																															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											6.684463436	0.131630683	2.035837584	0.456739937	0.810430098	0.856555184	0.047284419	0	1.991330338	0	2.701263867	0	0.025041551	0.392156429	0	0	0.101127511	0	0	0.000740478	0.765398485	0	0	0	0	0	0	0	0	0											17	YES	802.3366682	31.40561297	276.0307009	7.023247735	237.1610587	13.17116977	2.490291047	364.3905143	252.1070017	3.693582476	41.53708442	0	0.385061613	364.5793163	2810.066917	4171.274611	195.0304335	158.0212583	5.427060236	79.61597972	11.76946165	0	0	0	0	0	0	0	20800	0											5200	1a:  Acute - $200/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-8/9-90	2:  Skilled Nursing Services - $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 - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - Copay Range: $0-$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 - Variable Copay: $125 CT Scan; $150 MRI; $200 PET/visit/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $35/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $45/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $45/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $40/visit/9c:  Outpatient Substance Abuse Svcs - Group - $40/visit/7g:  Other Health Care Professional Services - $45/visit/18a:  Hearing Exams - $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							14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													200	200	100	0	300	0.2	0.058393828	48.9535715	200	0	0.237343628	0	0.2	35	15.00475593	41.62508972	40	35	0	44.91031597	0.2	0	0	0	0	0	0	0	0	0											NO	179.2540169	179.2540169	89.62700844	0	268.8810253	0.179254017	0.052336641	43.87562166	179.2540169	0	0.212723994	0	0.179254017	31.36945295	13.44831387	37.30732267	35.85080337	31.36945295	0	40.25177269	0.179254017	0	0	0	0	0	0	0	0	0												11.9852	0.469131856	2.061650497	0	5.314009052	2.360985088	0.13033347	1.332321695	3.765932729	0	8.835934477	0	0.069023841	0.953054476	3.149221824	12.96825732	0.582666477	0.413086702	0	0.267057027	2.109723276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7676	315	6.57	18.6696	0.600762539	4.097488081	0.456739937	6.12443915	3.217540272	0.177617889	1.332321695	5.757263067	0	11.53719834	0	0.094065392	1.345210904	3.149221824	12.96825732	0.683793988	0.413086702	0	0.267797505	2.875121761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7676	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.6696	0.600762539	4.097488081	0.456739937	6.12443915	3.217540272	0.177617889	1.332321695	5.757263067	0	11.53719834	0	0.094065392	1.345210904	3.149221824	12.96825732	0.683793988	0.413086702	0	0.267797505	2.875121761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7676
H0351_038_0	2011	4																															D	D	D	coin	T	coin	coin	V	V	coin	coin	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	YES	1716.885778	42.27669736	710.3760968	14.73650289	502.0189562	28.75769709	5.339680621	633.4143769	386.2733882	6.445168573	61.38946207	0	0.839687154	29.98849472	0.675773317	7169.047098	262.6363828	216.9816532	8.770591437	98.05890048	22.86944672	0	706.0465116	0	0	0	0	0	20800	0											3400	1a:  Acute - $175/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-8/9-90	2:  Skilled Nursing Services - $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 - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - Copay Range: $0-$175/visit/9b:  Ambulatory Surgical Center Services - $175/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - Variable Copay: $125 CT Scan; $150 MRI; $200 PET/visit/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $25/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $10/day/5:  Partial Hospitalization - $20/day	7a:  Primary Care - $0/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $20/visit/1-6 Additional Visits/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/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	10b:  Transportation - $0/trip						14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													175	175	100	0	300	0.2	0.067020774	48.95353842	175	0	0.219841621	0	0.2	0.011517316	20	20	20	10	0	20	0.2	0	0	0	0	0	0	0	0	0											NO	129.3033944	129.3033944	73.88765393	0	221.6629618	0.147775308	0.049520078	36.17062105	129.3033944	0	0.162435816	0	0.147775308	0.008509874	14.77753079	14.77753079	14.77753079	7.388765393	0	14.77753079	0.147775308	0	0	0	0	0	0	0	0	0												18.4999	0.455543373	4.374001934	0	9.273250726	4.249677541	0.264421399	1.909249283	4.162205021	0	9.971847395	0	0.124085028	0.255198324	0.000832188	8.828401183	0.323426436	0.133602211	0	0.120755702	3.37953953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.326	0	23.44	18.4999	0.455543373	4.374001934	0	9.273250726	4.249677541	0.264421399	1.909249283	4.162205021	0	9.971847395	0	0.124085028	0.255198324	0.000832188	8.828401183	0.323426436	0.133602211	0	0.120755702	3.37953953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.326	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.4999	0.455543373	4.374001934	0	9.273250726	4.249677541	0.264421399	1.909249283	4.162205021	0	9.971847395	0	0.124085028	0.255198324	0.000832188	8.828401183	0.323426436	0.133602211	0	0.120755702	3.37953953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.326
H0351_801_0	2011	1																															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	YES	251.1681209	4.895202834	26.43520594	11.26872623	12.4919711	15.14099988	2.192501688	15.35040263	42.15277269	4.652573557	54.88885761	0	0.171211423	22.51009089	48.87884368	120.6387565	1.558797577	5.647096287	5.362527581	28.74259825	13.37813046	0.145955594	0	0	0	0	0	0	0	0											6700	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare																				0.077254793	0.077254793	0.135701646	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.228269342	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.065448726	0.06545027	0.115054876	0	0.197552706	0.197333535	0.197514866	0.197444658	0.197275677	0.197321293	0.197326718	0	0.198486791	0.197170244	0.193287218	0.197302174	0.197517694	0.196996152	0.197429285	0.197310129	0.197489243	0.197144862	0	0	0	0	0	0	0	0												16.4386	0.320392346	3.041499341	0	2.467822698	2.987827036	0.433051676	3.030855001	8.315716779	0.918051832	10.83103814	0	0.033983206	4.438320115	9.447655697	23.80228894	0.307890102	1.112456239	1.058719987	5.671205758	2.642036854	0.028774395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3282	0	17.58962351	16.4386	0.320392346	3.041499341	0	2.467822698	2.987827036	0.433051676	3.030855001	8.315716779	0.918051832	10.83103814	0	0.033983206	4.438320115	9.447655697	23.80228894	0.307890102	1.112456239	1.058719987	5.671205758	2.642036854	0.028774395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3282	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.4386	0.320392346	3.041499341	0	2.467822698	2.987827036	0.433051676	3.030855001	8.315716779	0.918051832	10.83103814	0	0.033983206	4.438320115	9.447655697	23.80228894	0.307890102	1.112456239	1.058719987	5.671205758	2.642036854	0.028774395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3282
H0351_803_0	2011	1																															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	YES	251.1681209	4.895202834	26.43520594	11.26872623	12.4919711	15.14099988	2.192501688	15.35040263	42.15277269	4.652573557	54.88885761	0	0.171211423	22.51009089	48.87884368	120.6387565	1.558797577	5.647096287	5.362527581	28.74259825	13.37813046	0.145955594	0	0	0	0	0	0	0	0											6700	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare																				0.077254793	0.077254793	0.135701646	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.228269342	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.065448726	0.06545027	0.115054876	0	0.197552706	0.197333535	0.197514866	0.197444658	0.197275677	0.197321293	0.197326718	0	0.198486791	0.197170244	0.193287218	0.197302174	0.197517694	0.196996152	0.197429285	0.197310129	0.197489243	0.197144862	0	0	0	0	0	0	0	0												16.4386	0.320392346	3.041499341	0	2.467822698	2.987827036	0.433051676	3.030855001	8.315716779	0.918051832	10.83103814	0	0.033983206	4.438320115	9.447655697	23.80228894	0.307890102	1.112456239	1.058719987	5.671205758	2.642036854	0.028774395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3282	0	17.58962351	16.4386	0.320392346	3.041499341	0	2.467822698	2.987827036	0.433051676	3.030855001	8.315716779	0.918051832	10.83103814	0	0.033983206	4.438320115	9.447655697	23.80228894	0.307890102	1.112456239	1.058719987	5.671205758	2.642036854	0.028774395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3282	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.4386	0.320392346	3.041499341	0	2.467822698	2.987827036	0.433051676	3.030855001	8.315716779	0.918051832	10.83103814	0	0.033983206	4.438320115	9.447655697	23.80228894	0.307890102	1.112456239	1.058719987	5.671205758	2.642036854	0.028774395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3282
H0351_804_0	2011	1																															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	YES	251.1681209	4.895202834	26.43520594	11.26872623	12.4919711	15.14099988	2.192501688	15.35040263	42.15277269	4.652573557	54.88885761	0	0.171211423	22.51009089	48.87884368	120.6387565	1.558797577	5.647096287	5.362527581	28.74259825	13.37813046	0.145955594	0	0	0	0	0	0	0	0											6700	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare																				0.077254793	0.077254793	0.135701646	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.228269342	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.065448726	0.06545027	0.115054876	0	0.197552706	0.197333535	0.197514866	0.197444658	0.197275677	0.197321293	0.197326718	0	0.198486791	0.197170244	0.193287218	0.197302174	0.197517694	0.196996152	0.197429285	0.197310129	0.197489243	0.197144862	0	0	0	0	0	0	0	0												16.4386	0.320392346	3.041499341	0	2.467822698	2.987827036	0.433051676	3.030855001	8.315716779	0.918051832	10.83103814	0	0.033983206	4.438320115	9.447655697	23.80228894	0.307890102	1.112456239	1.058719987	5.671205758	2.642036854	0.028774395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3282	0	17.58962351	16.4386	0.320392346	3.041499341	0	2.467822698	2.987827036	0.433051676	3.030855001	8.315716779	0.918051832	10.83103814	0	0.033983206	4.438320115	9.447655697	23.80228894	0.307890102	1.112456239	1.058719987	5.671205758	2.642036854	0.028774395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3282	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.4386	0.320392346	3.041499341	0	2.467822698	2.987827036	0.433051676	3.030855001	8.315716779	0.918051832	10.83103814	0	0.033983206	4.438320115	9.447655697	23.80228894	0.307890102	1.112456239	1.058719987	5.671205758	2.642036854	0.028774395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3282
H0354_001_0	2011	9																															D	D	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	YES	884.6152827	25.20736755	266.5202116	18.10158703	255.0033661	19.44183755	1.936808565	247.9791303	244.0134948	5.488073411	248.3907336	0	0.042967606	1166.006974	3850.538408	5280.922609	158.0167474	93.0012064	57.05894055	26.44830704	13.29512981	0	0	0	303.1748088	0	92.00805385	0	81.43671579	0											6700	1a:  Acute - $230/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $230/$0/day for 1-5/6-90	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%	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/visitCMG, $25/visit non-CMG/4a:  Worldwide Coverage - $50/visit"	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit/9b:  Ambulatory Surgical Center Services - $150 CMG / $250 non-CMG contracted/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $150 CMG / $250 non-CMG/visit/8b:  Outpatient Therapeutic Radiological Services - $45/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $45/visit/3:  Rehab Services (CORF) - $45/day/5:  Partial Hospitalization - $40/day/9a:  Other Outpatient Hospital Services - $150/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10 optamologist / $30 opthomologist / $45 non-CMG/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $30 CMG / $45 non-CMG contracted/visit/7b:  Chiropractic Services - $30 CMG / $45 non-CMG contracted/visit/7-12 Additional Visits/7f:  Podiatry Services - $10 Nail CMG / $30 Podiatrist CMG / $45 non-CMG/visit/7-12 Additional Visits/17a:  Vision Exams - $10 optamologist / $30 opthomologist / $45 non-CMG/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $45/visit/7i:  Physical/Speech Therapy - $45/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $40/visit/9c:  Outpatient Substance Abuse Svcs - Group - $40/visit/7g:  Other Health Care Professional Services - $30 CMG / $45 non-CMG contracted/visit/18a:  Hearing Exams - $10 CMG / $45 non-CMG/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 - $10/visit		18a:  Routine Hearing Test - $10/visit		14c:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													230	230	125	0	150	0.2	0.153812267	49.54166018	240.8996018	0	181.1428126	0	0.2	54.75084852	10.0006264	34.82166727	40	45	0	15.3621094	0.2	0	0	0	10	0	10	0	0	0											NO	217.1238916	217.1238916	118.002115	0	141.602538	0.188803384	0.145201383	46.76816546	227.4133001	0	171.00188	0	0.188803384	51.68572739	9.440760533	32.87224308	37.7606768	42.4807614	0	14.5020912	0.188803384	0	0	0	9.4401692	0	9.4401692	0	0	0												16.0059	0.456093478	2.620829055	0	3.009093653	3.67068472	0.281227282	0.96646075	4.624326176	0	3.539606868	0	0.008112429	5.022159885	3.029334253	14.46631431	0.497234944	0.329230172	0	0.03196298	2.510165498	0	0	0	0.238501791	0	0.072380966	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3796	0	3.64	16.0059	0.456093478	2.620829055	0	3.009093653	3.67068472	0.281227282	0.96646075	4.624326176	0	3.539606868	0	0.008112429	5.022159885	3.029334253	14.46631431	0.497234944	0.329230172	0	0.03196298	2.510165498	0	0	0	0.238501791	0	0.072380966	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3796	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.0059	0.456093478	2.620829055	0	3.009093653	3.67068472	0.281227282	0.96646075	4.624326176	0	3.539606868	0	0.008112429	5.022159885	3.029334253	14.46631431	0.497234944	0.329230172	0	0.03196298	2.510165498	0	0	0	0.238501791	0	0.072380966	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3796
H0354_012_0	2011	4																															D	D	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	YES	1691.976339	42.07779853	510.5510307	26.51890097	487.6378132	22.03489832	2.201713129	542.7859762	336.3097959	4.907238104	253.1807487	0	0.049747904	2123.082824	0.409749227	6254.932306	212.1164728	148.9768193	61.07223701	36.76850749	20.58801925	0	27.93798699	0	0	0	0	0	81.43671579	0											6700	1a:  Acute - $125/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $125/$0/day for 1-5/6-90	2:  Skilled Nursing Services - $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 - $0/visitCMG, $25/visit non-CMG"	9a:  Outpatient Hospital Services (Hospital Surgery) - $50/visit/9b:  Ambulatory Surgical Center Services - $0 CMG / $50 non-CMG contracted/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $0 CMG / $25 non-CMG contracted/visit/8b:  Outpatient Therapeutic Radiological Services - $25/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $0/service	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $25/day/9a:  Other Outpatient Hospital Services - $25/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0 CMG / $25 non-CMG contracted/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $0 CMG / $25 non-CMG contracted/visit/7b:  Chiropractic Services - $0 CMG / $25 non-CMG contracted/visit/7-12 Additional Visits/7f:  Podiatry Services - $0 CMG / $25 non-CMG contracted/visit/7-12 Additional Visits/17a:  Vision Exams - $0 CMG / $25 non-CMG contracted/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0 CMG / $25 non-CMG contracted/visit/18a:  Hearing Exams - $0 CMG / $25 non-CMG contracted/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		17a:  Routine Eye Exams - $0/visit		18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit		14c:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													125	125	50	0	100	0.2	0.132515503	49.70550049	44.33086327	0	43.64367764	0	0	25	6.527665003	13.20536828	25	25	0	6.070918977	0.2	0	0	0	0	0	0	0	0	0											NO	121.1157624	121.1157624	48.44630498	0	96.89260995	0.19378522	0.12839773	48.16095671	42.95333044	0	42.28749835	0	0	24.22315249	6.32482499	12.79502598	24.22315249	24.22315249	0	5.882271845	0.19378522	0	0	0	0	0	0	0	0	0												17.0771	0.424690388	2.061192578	0	3.937375036	4.270037617	0.282694967	2.178424325	1.20380215	0	0.892198374	0	0	4.285646582	0.000215966	6.669335111	0.428177472	0.300724018	0	0.01802353	3.989653837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0193	0	1.54	17.0771	0.424690388	2.061192578	0	3.937375036	4.270037617	0.282694967	2.178424325	1.20380215	0	0.892198374	0	0	4.285646582	0.000215966	6.669335111	0.428177472	0.300724018	0	0.01802353	3.989653837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0193	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.0771	0.424690388	2.061192578	0	3.937375036	4.270037617	0.282694967	2.178424325	1.20380215	0	0.892198374	0	0	4.285646582	0.000215966	6.669335111	0.428177472	0.300724018	0	0.01802353	3.989653837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0193
H0354_801_0	2011	5																															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	YES	327.7096825	5.396767943	26.20359111	21.37173878	9.903890017	27.86011012	2.155326799	17.76880873	44.24520762	6.401491674	21.30790807	0	0.055647507	50.11984525	113.1699195	234.7335496	1.421204064	3.483793454	78.89728119	72.85378014	19.7400626	0.498022216	0	0	0	0	0	0	81.43671579	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS												0.078890514	0.078890514	0.132803349	0	0.233	0.233	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	0.056256731	0.056256731	0.094701909	0	0.16615202	0.16615202	0.16615202	0.16615202	0.16615202	0.16615202	0.16615202	0	0.16615202	0.16615202	0.16615202	0.16615202	0.16615202	0.16615202	0.16615202	0.16615202	0.16615202	0.16615202	0	0	0	0	0	0	0	0												18.4359	0.30360452	2.481530096	0	1.645551331	4.629013571	0.358111901	2.952323462	7.351430617	1.063620772	3.540351966	0	0.009245946	8.327513525	18.80341073	39.00145341	0.236135926	0.578839319	13.10894263	12.10480273	3.279851274	0.082747397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.2944	0	55.64	18.4359	0.30360452	2.481530096	0	1.645551331	4.629013571	0.358111901	2.952323462	7.351430617	1.063620772	3.540351966	0	0.009245946	8.327513525	18.80341073	39.00145341	0.236135926	0.578839319	13.10894263	12.10480273	3.279851274	0.082747397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.2944	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.4359	0.30360452	2.481530096	0	1.645551331	4.629013571	0.358111901	2.952323462	7.351430617	1.063620772	3.540351966	0	0.009245946	8.327513525	18.80341073	39.00145341	0.236135926	0.578839319	13.10894263	12.10480273	3.279851274	0.082747397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.2944
H0354_804_0	2011	4																															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	YES	284.5601314	4.686175224	22.75472595	18.55409943	8.601704773	24.19698826	1.871939691	15.43080736	38.41199637	5.562708695	18.50214286	0	0.048314237	43.53464426	98.26570912	203.8160902	1.233916732	3.024696553	68.50702132	63.25803212	17.14414374	0.432529756	0	0	0	0	0	0	81.43671579	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS												0.078891463	0.078891463	0.132801582	0	0.233	0.233	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	0.059323245	0.059323245	0.099861513	0	0.175206741	0.175206741	0.175206741	0.175206741	0.175206741	0.175206741	0.175206741	0	0.175206741	0.175206741	0.175206741	0.175206741	0.175206741	0.175206741	0.175206741	0.175206741	0.175206741	0.175206741	0	0	0	0	0	0	0	0												16.881	0.277999123	2.272321352	0	1.507076664	4.239475465	0.327976453	2.703581474	6.730040714	0.974624064	3.241700159	0	0.00846498	7.627563158	17.21681469	35.70995301	0.21619053	0.529947227	12.00289197	11.08323367	3.003769558	0.075782129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6304	0	41.77	16.881	0.277999123	2.272321352	0	1.507076664	4.239475465	0.327976453	2.703581474	6.730040714	0.974624064	3.241700159	0	0.00846498	7.627563158	17.21681469	35.70995301	0.21619053	0.529947227	12.00289197	11.08323367	3.003769558	0.075782129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6304	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.881	0.277999123	2.272321352	0	1.507076664	4.239475465	0.327976453	2.703581474	6.730040714	0.974624064	3.241700159	0	0.00846498	7.627563158	17.21681469	35.70995301	0.21619053	0.529947227	12.00289197	11.08323367	3.003769558	0.075782129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6304
H0354_805_0	2011	6																															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	YES	313.7718664	6.569702193	33.16119652	22.31461327	10.70373374	22.48628626	2.882097251	15.00972545	35.0789379	4.401271785	16.97257947	0	0.048602016	36.618876	104.6388936	217.4422625	0.684541037	3.324254758	64.51784979	54.22176012	16.71046315	0.302859331	0	0	0	0	0	0	81.43671579	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS												0.078891382	0.078891382	0.13280173	0	0.233	0.233	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	0.059043089	0.059076135	0.099453554	0	0.174431676	0.17429436	0.174509346	0.174318489	0.174284549	0.174200055	0.174287144	0	0.174335474	0.174237582	0.174363245	0.174364125	0.173927844	0.174377923	0.174301361	0.17424851	0.174319593	0.174116878	0	0	0	0	0	0	0	0												18.5261	0.388112615	3.297998833	0	1.867070221	3.919232868	0.502952908	2.616472656	6.113716857	0.766701787	2.95810241	0	0.008473056	6.380384404	18.24517707	37.91412991	0.119060747	0.579676641	11.24554905	9.448060906	2.912961141	0.052732921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8626	0	43.02190971	18.5261	0.388112615	3.297998833	0	1.867070221	3.919232868	0.502952908	2.616472656	6.113716857	0.766701787	2.95810241	0	0.008473056	6.380384404	18.24517707	37.91412991	0.119060747	0.579676641	11.24554905	9.448060906	2.912961141	0.052732921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8626	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.5261	0.388112615	3.297998833	0	1.867070221	3.919232868	0.502952908	2.616472656	6.113716857	0.766701787	2.95810241	0	0.008473056	6.380384404	18.24517707	37.91412991	0.119060747	0.579676641	11.24554905	9.448060906	2.912961141	0.052732921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8626
H0370_001_0	2011	10																															D	D	D	COIN	T	COIN	COIN	V	V	O	COIN	COIN	COIN	COIN	P	COIN	P	P	COIN	COIN	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	723.7397738	26.05754639	441.57003	0	88.21367688	5.383052418	4.108477345	221.9444652	286.4380833	1117.151923	16.35090209	0.782780371	0.096288939	8.48867827	2686.324863	76.92217592	118.9270872	600.3310986	6.684747166	5.250911015	12.69211907	0	0	0	0	0	0	0	0	0											6700	1a $175 days 1-9	1b $175 days 1-9	2 $50 days 1-50	6 $0	"10a $150,"	11a 20%	11b 20%	"4a $50, 4b $40"	"9a $300, 9b $300"	"8a $0 -20%, 8b 20%, 11c $0, 11c 20%"	8b 20%/$300 Adv. Imaging; 14h $0	5 20%	12 20%	"3 20%, 9d 20%, 13a $0 , 9a 20%, 9b 20%"	"7a $15, 14c $0"	"17a $0 - 20%, 18a 20%, 7b $30,7d $45,7f $45, 14d - 14g $0, 14i - 14j $0, 17b 20%"	"7e $40, 7h $40, 9c $40"	"7c $45,7i $45"	"8b 20% Ther., $300 Adv. Imaging, 14h $0"	"7g $45, 14b $0, 14a $0"	"15 20%, 11c 20%"	15 20%							14a $0													156.4797723	110.6321839	48.82880638	0	150	0.2	0.2	49.50584485	300	6.222775324	0.476400126	0.2	0.2	0.189954575	14.5082955	0.14006153	40	45	0.269806152	0.000462412	0.224885577	0	0	0	0	0	0	0	0	0											NO	144.2634181	101.9951446	45.0167482	0	138.2895207	0.184386028	0.184386028	45.64093036	276.5790414	5.736964112	0.439207634	0.184386028	0.184386028	0.175124847	13.37563487	0.129126946	36.87720551	41.4868562	0.248742423	0.000426312	0.207328791	0	0	0	0	0	0	0	0	0												8.7008	0.221478601	1.656503904	0	1.016585591	0.992559652	0.757545817	0.84414599	6.60189754	0.534088374	7.181441021	0.144333763	0.017754335	1.486578487	2.994275044	9.932725651	0.365474886	2.075487497	1.662780206	0.002238524	2.631441706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8201	0	4.218810365	8.7008	0.221478601	1.656503904	0	1.016585591	0.992559652	0.757545817	0.84414599	6.60189754	0.534088374	7.181441021	0.144333763	0.017754335	1.486578487	2.994275044	9.932725651	0.365474886	2.075487497	1.662780206	0.002238524	2.631441706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8201	YES	0.2	0.2	0.2	0.2	150	0.2	0.2	$50/$40	0.2	0.2	"20%, 14h $0"	0.2	0.2	0.2	"20%, 14c $0"	"20%, 14d-14g $0, 14i-14j $0"	0.2	0.2	"20%, 14h $0"	"20% , 14a-14b $0"	0.2	0.2							14a $50												10000	4.9733	0.0497	0.5378	0.3153	0.1946	0.19	0.145	0.1616	1.4159	0.2688	0.5322	0.0276	0.0034	0.2846	0.6726	2.6837	0.0143	0.1466	0.2308	0.179	0.5037	0	0	0	0	0	0	0	0.8667	0											14.397	0	0	13.674	0.271195976	2.194311442	0.315321058	1.211174584	1.182549737	0.9025509	1.005727582	8.017763642	0.802924158	7.71361674	0.171961306	0.021152768	1.771130829	3.666855126	12.61647226	0.379739837	2.222071665	1.893556991	0.181190179	3.13513721	0	0	0	0	0	0	0	0.866666667	0	0	0	0	0	0	0	0	0	0	0	64.2171
H0370_801_0	2011	5																															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	YES	163.9051292	3.05478241	18.08639328	0	4.27515344	5.91829258	4.516985736	12.45803923	48.10626191	8.860092124	19.01932976	0.910528234	0.112003061	9.874010027	22.61877537	91.30172341	1.061767101	4.929605331	7.934369114	6.232496928	14.28836015	0	0	0	0	0	0	0	0	0											6700	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	0.075688551	0.075688551	0.110359574	0	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0	0	0	0	0	0	0	0	0												12.4057	0.231212055	1.996006662	0	0.856789106	1.186092775	0.905255033	2.496731977	9.641039022	1.775662679	3.811688813	0.182480157	0.02244668	1.978863295	4.533058428	18.29789809	0.212790137	0.987948668	1.590137317	1.249062881	2.863548992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2245	0	10.93130334	12.4057	0.231212055	1.996006662	0	0.856789106	1.186092775	0.905255033	2.496731977	9.641039022	1.775662679	3.811688813	0.182480157	0.02244668	1.978863295	4.533058428	18.29789809	0.212790137	0.987948668	1.590137317	1.249062881	2.863548992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2245	YES	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%																			10000	2.5452	0.0377	0.4095	0	0.1758	0.2433	0.1857	0.5122	1.978	0.3643	0.782	0.0374	0.0046	0.406	0.93	3.7541	0.0197	0.2027	0.3262	0.2563	0.6826	0	0	0	0	0	0	0	0	0											13.8535	0	0	14.951	0.268869518	2.405519962	0	1.032573356	1.429439041	1.090982859	3.008977237	11.61905532	2.13996882	4.593718902	0.219918936	0.027051983	2.384859355	5.463089251	22.05201013	0.232515436	1.19064244	1.916379906	1.50532849	3.546119454	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.078
H0370_802_0	2011	5																															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	YES	163.9051292	3.05478241	18.08639328	0	4.27515344	5.91829258	4.516985736	12.45803923	48.10626191	8.860092124	19.01932976	0.910528234	0.112003061	9.874010027	22.61877537	91.30172341	1.061767101	4.929605331	7.934369114	6.232496928	14.28836015	0	0	0	0	0	0	0	0	0											6700	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	0.075688551	0.075688551	0.110359574	0	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0	0	0	0	0	0	0	0	0												12.4057	0.231212055	1.996006662	0	0.856789106	1.186092775	0.905255033	2.496731977	9.641039022	1.775662679	3.811688813	0.182480157	0.02244668	1.978863295	4.533058428	18.29789809	0.212790137	0.987948668	1.590137317	1.249062881	2.863548992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2245	0	10.93130334	12.4057	0.231212055	1.996006662	0	0.856789106	1.186092775	0.905255033	2.496731977	9.641039022	1.775662679	3.811688813	0.182480157	0.02244668	1.978863295	4.533058428	18.29789809	0.212790137	0.987948668	1.590137317	1.249062881	2.863548992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2245	YES	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%																			10000	2.5452	0.0377	0.4095	0	0.1758	0.2433	0.1857	0.5122	1.978	0.3643	0.782	0.0374	0.0046	0.406	0.93	3.7541	0.0197	0.2027	0.3262	0.2563	0.6826	0	0	0	0	0	0	0	0	0											13.8535	0	0	14.951	0.268869518	2.405519962	0	1.032573356	1.429439041	1.090982859	3.008977237	11.61905532	2.13996882	4.593718902	0.219918936	0.027051983	2.384859355	5.463089251	22.05201013	0.232515436	1.19064244	1.916379906	1.50532849	3.546119454	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.078
H0370_803_0	2011	5																															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	YES	163.9051292	3.05478241	18.08639328	0	4.27515344	5.91829258	4.516985736	12.45803923	48.10626191	8.860092124	19.01932976	0.910528234	0.112003061	9.874010027	22.61877537	91.30172341	1.061767101	4.929605331	7.934369114	6.232496928	14.28836015	0	0	0	0	0	0	0	0	0											6700	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	0.075688551	0.075688551	0.110359574	0	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0.200411311	0	0	0	0	0	0	0	0	0												12.4057	0.231212055	1.996006662	0	0.856789106	1.186092775	0.905255033	2.496731977	9.641039022	1.775662679	3.811688813	0.182480157	0.02244668	1.978863295	4.533058428	18.29789809	0.212790137	0.987948668	1.590137317	1.249062881	2.863548992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2245	0	10.93130334	12.4057	0.231212055	1.996006662	0	0.856789106	1.186092775	0.905255033	2.496731977	9.641039022	1.775662679	3.811688813	0.182480157	0.02244668	1.978863295	4.533058428	18.29789809	0.212790137	0.987948668	1.590137317	1.249062881	2.863548992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2245	YES	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%																			10000	2.5452	0.0377	0.4095	0	0.1758	0.2433	0.1857	0.5122	1.978	0.3643	0.782	0.0374	0.0046	0.406	0.93	3.7541	0.0197	0.2027	0.3262	0.2563	0.6826	0	0	0	0	0	0	0	0	0											13.8535	0	0	14.951	0.268869518	2.405519962	0	1.032573356	1.429439041	1.090982859	3.008977237	11.61905532	2.13996882	4.593718902	0.219918936	0.027051983	2.384859355	5.463089251	22.05201013	0.232515436	1.19064244	1.916379906	1.50532849	3.546119454	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.078
H0401_002_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1206.074822	75.46693742	628.9659002	800.3446172	129.1115383	9.271144783	8.731077699	282.1956126	262.7559207	13.85321199	27.3916771	0	0.126552875	486.3500731	5366.363924	88.25715971	411.2850068	277.4843444	0	0	22.74883376	1214.25415	0	0	164.7610015	0	15.02763993	6	139.57018	0											3350	"$175 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-28 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$125 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $125 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												163.2026629	111.9031178	68.99815588	0	200	0.2	0.106157433	49.14854757	125	0.139627905	0.168673267	0	0.2	49.46252742	6.866823874	0.104656054	38.5	30	0	0	0.2	29.84838514	0	0	30	0	0	0	0	0											YES	125.6488558	86.15361091	53.12131058	0	153.9789286	0.153978929	0.081730039	37.85785224	96.23683036	0.107498776	0.129860644	0	0.153978929	38.08093488	6.598812834	0.100608043	36.99735115	28.82910479	0	0	0.153978929	22.98011182	0	0	30	0	0	0	0	0											3750	12.6285	0.54181243	2.784291078	0	1.656704694	1.42756094	0.713591318	0.89027665	2.10723308	1.489203333	3.557100841	0	0.019486476	1.543388789	2.950969261	8.879380151	1.268037985	0.666635437	0	0	3.502841049	2.325308012	0	0	0.411902504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3642	0	11.07187029	12.6285	0.54181243	2.784291078	0	1.656704694	1.42756094	0.713591318	0.89027665	2.10723308	1.489203333	3.557100841	0	0.019486476	1.543388789	2.950969261	8.879380151	1.268037985	0.666635437	0	0	3.502841049	2.325308012	0	0	0.411902504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3642	NO	"$250 Days 1-15 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-15 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-22 (2a); $0 n/c (2a1, 2a2)"	20% (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $10 (8a2)	"$21 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 20% (9a); $45/$35 (9c)"	"$20 (7a, 14c); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 20% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 20% (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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9193	0.0469	0.3577	0.1983	0.2648	0.2281	0.2149	0.1423	0.7551	0.238	0.6011	0	0.0031	0.2728	1.0493	1.9593	0.2396	0.1486	0	0	0.538	0.4759	0	0	0.0931	0	0.0085	0	0	0											8.7547	0	2.4692452	13.5478	0.588747811	3.141968932	0.19831794	1.921466534	1.655702783	0.928443334	1.032585586	2.862292971	1.72719639	4.15816714	0	0.022600655	1.816174264	4.000268339	10.83870202	1.507618032	0.815269034	0	0	4.040813792	2.801255707	0	0	0.505042251	0	0.008495157	0	0	0	0	0	0	0	0	0	0	0	0	0	58.119
H0401_008_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1214.449603	65.85291498	768.0586925	1218.701737	146.9623283	9.955615048	10.31423863	339.4968542	264.9629382	14.68595898	33.18287948	0	0.115540236	487.6950437	5987.21227	84.29716195	302.5044026	325.2122356	0	0	15.26837167	1354.227745	0	0	103.1690287	0	14.93201433	6	210.4196854	0											3350	"$175 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-28 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$125 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $125 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												163.2026629	111.9031178	74.41853241	0	200	0.2	0.114663452	48.92762714	125	0.151661553	0.166292919	0	0.2	49.49803833	6.85647951	0.118083963	38.5	30	0	0	0.2	29.78896301	0	0	30	0	0	0	0	0											YES	122.6968819	84.12953186	55.94836334	0	150.3613724	0.150361372	0.08620477	36.80053044	93.97585777	0.114020196	0.125020158	0	0.150361372	37.21296488	6.566142075	0.113125386	36.86971857	28.72965083	0	0	0.150361372	22.39554681	0	0	30	0	0	0	0	0											3750	12.4174	0.461681242	3.580968899	0	1.841454781	1.496939942	0.889136568	1.041138693	2.075009949	1.674495922	4.148528826	0	0.017372788	1.512381544	3.276073867	9.536149023	0.929437683	0.778602831	0	0	2.295773319	2.527389238	0	0	0.257922572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7579	0	12.51569916	12.4174	0.461681242	3.580968899	0	1.841454781	1.496939942	0.889136568	1.041138693	2.075009949	1.674495922	4.148528826	0	0.017372788	1.512381544	3.276073867	9.536149023	0.929437683	0.778602831	0	0	2.295773319	2.527389238	0	0	0.257922572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7579	NO	"$250 Days 1-15 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-15 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-22 (2a); $0 n/c (2a1, 2a2)"	20% (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	20% (8a1a); $10 (8a2)	"$21 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 20% (9a); $45/$35 (9c)"	"$20 (7a, 14c); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 20% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 20% (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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.8943	0.0396	0.4786	0.2361	0.2911	0.2367	0.2452	0.1646	0.7898	0.2647	0.6896	0	0.0027	0.3717	1.1226	2.1099	0.1754	0.1734	0	0	0.3488	0.5107	0	0	0.0583	0	0.0084	0	0	0											9.2124	0	2.911129815	13.3117	0.501247513	4.059606653	0.2361131	2.132595435	1.733611555	1.134333623	1.205780827	2.864785719	1.939239777	4.83817871	0	0.020119489	1.884040752	4.398691469	11.64605435	1.10483135	0.951991144	0	0	2.644592495	3.038055513	0	0	0.316244245	0	0.0084411	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9703
H0401_801_0	2011	1																															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	229.380149	4.3071	21.22590891	996.3736113	6.119406332	11.62884576	10.95143678	14.04257592	38.4988708	17.38155599	34.36820064	0	0.158785261	17.27745666	35.83378088	111.1530558	2.0526	4.06595173	0	0	28.36711669	8.970642606	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.068942246	0.068942246	0.159928348	0	0.194232177	0.194232177	0.194232177	0.194232177	0.194232177	0.194232177	0.194232177	0	0.194232177	0.194232177	0.194232177	0.194232177	0.194232177	0.194232177	0	0	0.194232177	0.194232177	0	0	0	0	0	0	0	0												15.814	0.296941149	3.394624545	0	1.188585616	2.258696032	2.12712141	2.727520097	7.4777195	3.376057464	6.67541044	0	0.030841207	3.355838025	6.960073281	21.58950005	0.398680967	0.789738657	0	0	5.509806839	1.742387445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.7135	0	17.10801373	15.814	0.296941149	3.394624545	0	1.188585616	2.258696032	2.12712141	2.727520097	7.4777195	3.376057464	6.67541044	0	0.030841207	3.355838025	6.960073281	21.58950005	0.398680967	0.789738657	0	0	5.509806839	1.742387445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.7135	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.814	0.296941149	3.394624545	0	1.188585616	2.258696032	2.12712141	2.727520097	7.4777195	3.376057464	6.67541044	0	0.030841207	3.355838025	6.960073281	21.58950005	0.398680967	0.789738657	0	0	5.509806839	1.742387445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.7135
H0401_804_0	2011	1																															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	229.380149	4.3071	21.22590891	996.3736113	6.119406332	11.62884576	10.95143678	14.04257592	38.4988708	17.38155599	34.36820064	0	0.158785261	17.27745666	35.83378088	111.1530558	2.0526	4.06595173	0	0	28.36711669	8.970642606	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.068942246	0.068942246	0.159928348	0	0.194232177	0.194232177	0.194232177	0.194232177	0.194232177	0.194232177	0.194232177	0	0.194232177	0.194232177	0.194232177	0.194232177	0.194232177	0.194232177	0	0	0.194232177	0.194232177	0	0	0	0	0	0	0	0												15.814	0.296941149	3.394624545	0	1.188585616	2.258696032	2.12712141	2.727520097	7.4777195	3.376057464	6.67541044	0	0.030841207	3.355838025	6.960073281	21.58950005	0.398680967	0.789738657	0	0	5.509806839	1.742387445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.7135	0	17.10801373	15.814	0.296941149	3.394624545	0	1.188585616	2.258696032	2.12712141	2.727520097	7.4777195	3.376057464	6.67541044	0	0.030841207	3.355838025	6.960073281	21.58950005	0.398680967	0.789738657	0	0	5.509806839	1.742387445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.7135	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.814	0.296941149	3.394624545	0	1.188585616	2.258696032	2.12712141	2.727520097	7.4777195	3.376057464	6.67541044	0	0.030841207	3.355838025	6.960073281	21.58950005	0.398680967	0.789738657	0	0	5.509806839	1.742387445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.7135
H0401_805_0	2011	1																															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	229.380149	4.3071	21.22590891	996.3736113	6.119406332	11.62884576	10.95143678	14.04257592	38.4988708	17.38155599	34.36820064	0	0.158785261	17.27745666	35.83378088	111.1530558	2.0526	4.06595173	0	0	28.36711669	8.970642606	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.068942246	0.068942246	0.159928348	0	0.194232177	0.194232177	0.194232177	0.194232177	0.194232177	0.194232177	0.194232177	0	0.194232177	0.194232177	0.194232177	0.194232177	0.194232177	0.194232177	0	0	0.194232177	0.194232177	0	0	0	0	0	0	0	0												15.814	0.296941149	3.394624545	0	1.188585616	2.258696032	2.12712141	2.727520097	7.4777195	3.376057464	6.67541044	0	0.030841207	3.355838025	6.960073281	21.58950005	0.398680967	0.789738657	0	0	5.509806839	1.742387445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.7135	0	17.10801373	15.814	0.296941149	3.394624545	0	1.188585616	2.258696032	2.12712141	2.727520097	7.4777195	3.376057464	6.67541044	0	0.030841207	3.355838025	6.960073281	21.58950005	0.398680967	0.789738657	0	0	5.509806839	1.742387445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.7135	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.814	0.296941149	3.394624545	0	1.188585616	2.258696032	2.12712141	2.727520097	7.4777195	3.376057464	6.67541044	0	0.030841207	3.355838025	6.960073281	21.58950005	0.398680967	0.789738657	0	0	5.509806839	1.742387445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.7135
H0401_807_0	2011	1																															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	216.7642408	4.075029	19.31557711	846.9175696	5.201495382	9.8845189	9.308721259	11.93618954	32.72404018	14.77432259	29.21297054	0	0.134967471	14.68592316	30.63788265	95.03586273	1.768824	3.476388729	0	0	24.25388477	7.669899428	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.069381155	0.069381155	0.160946505	0	0.195468724	0.195468724	0.195468724	0.195468724	0.195468724	0.195468724	0.195468724	0	0.195468724	0.195468724	0.195468724	0.195468724	0.195468724	0.195468724	0	0	0.195468724	0.195468724	0	0	0	0	0	0	0	0												15.0394	0.28273022	3.108774622	0	1.016729663	1.932114293	1.819563863	2.333151734	6.396526368	2.887917979	5.710222066	0	0.026381919	2.870638656	5.988747818	18.57653879	0.34574977	0.679525268	0	0	4.7408759	1.499225452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2548	0	14.44940876	15.0394	0.28273022	3.108774622	0	1.016729663	1.932114293	1.819563863	2.333151734	6.396526368	2.887917979	5.710222066	0	0.026381919	2.870638656	5.988747818	18.57653879	0.34574977	0.679525268	0	0	4.7408759	1.499225452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2548	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0434	0.0196	0.3665	0	0.2139	0.4064	0.3828	0.4908	1.3455	0.6075	1.2012	0	0.0055	0.6039	1.2106	3.7553	0.0699	0.1374	0	0	0.9584	0.3031	0	0	0	0	0	0	0	0											13.1216	0	0	16.0827	0.302344924	3.47527042	0	1.230602915	2.338542453	2.202316579	2.823939762	7.742061902	3.495403361	6.911390679	0	0.031931464	3.474489261	7.199392105	22.33184478	0.415644178	0.816893447	0	0	5.699258938	1.802298612	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.3764
H0401_808_0	2011	1																															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	216.7642408	4.075029	19.31557711	846.9175696	5.201495382	9.8845189	9.308721259	11.93618954	32.72404018	14.77432259	29.21297054	0	0.134967471	14.68592316	30.63788265	95.03586273	1.768824	3.476388729	0	0	24.25388477	7.669899428	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.069381155	0.069381155	0.160946505	0	0.195468724	0.195468724	0.195468724	0.195468724	0.195468724	0.195468724	0.195468724	0	0.195468724	0.195468724	0.195468724	0.195468724	0.195468724	0.195468724	0	0	0.195468724	0.195468724	0	0	0	0	0	0	0	0												15.0394	0.28273022	3.108774622	0	1.016729663	1.932114293	1.819563863	2.333151734	6.396526368	2.887917979	5.710222066	0	0.026381919	2.870638656	5.988747818	18.57653879	0.34574977	0.679525268	0	0	4.7408759	1.499225452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2548	0	14.44940876	15.0394	0.28273022	3.108774622	0	1.016729663	1.932114293	1.819563863	2.333151734	6.396526368	2.887917979	5.710222066	0	0.026381919	2.870638656	5.988747818	18.57653879	0.34574977	0.679525268	0	0	4.7408759	1.499225452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2548	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0434	0.0196	0.3665	0	0.2139	0.4064	0.3828	0.4908	1.3455	0.6075	1.2012	0	0.0055	0.6039	1.2106	3.7553	0.0699	0.1374	0	0	0.9584	0.3031	0	0	0	0	0	0	0	0											13.1216	0	0	16.0827	0.302344924	3.47527042	0	1.230602915	2.338542453	2.202316579	2.823939762	7.742061902	3.495403361	6.911390679	0	0.031931464	3.474489261	7.199392105	22.33184478	0.415644178	0.816893447	0	0	5.699258938	1.802298612	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.3764
H0401_809_0	2011	1																															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	216.7642408	4.075029	19.31557711	846.9175696	5.201495382	9.8845189	9.308721259	11.93618954	32.72404018	14.77432259	29.21297054	0	0.134967471	14.68592316	30.63788265	95.03586273	1.768824	3.476388729	0	0	24.25388477	7.669899428	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.069381155	0.069381155	0.160946505	0	0.195468724	0.195468724	0.195468724	0.195468724	0.195468724	0.195468724	0.195468724	0	0.195468724	0.195468724	0.195468724	0.195468724	0.195468724	0.195468724	0	0	0.195468724	0.195468724	0	0	0	0	0	0	0	0												15.0394	0.28273022	3.108774622	0	1.016729663	1.932114293	1.819563863	2.333151734	6.396526368	2.887917979	5.710222066	0	0.026381919	2.870638656	5.988747818	18.57653879	0.34574977	0.679525268	0	0	4.7408759	1.499225452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2548	0	14.44940876	15.0394	0.28273022	3.108774622	0	1.016729663	1.932114293	1.819563863	2.333151734	6.396526368	2.887917979	5.710222066	0	0.026381919	2.870638656	5.988747818	18.57653879	0.34574977	0.679525268	0	0	4.7408759	1.499225452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2548	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0434	0.0196	0.3665	0	0.2139	0.4064	0.3828	0.4908	1.3455	0.6075	1.2012	0	0.0055	0.6039	1.2106	3.7553	0.0699	0.1374	0	0	0.9584	0.3031	0	0	0	0	0	0	0	0											13.1216	0	0	16.0827	0.302344924	3.47527042	0	1.230602915	2.338542453	2.202316579	2.823939762	7.742061902	3.495403361	6.911390679	0	0.031931464	3.474489261	7.199392105	22.33184478	0.415644178	0.816893447	0	0	5.699258938	1.802298612	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.3764
H0408_002_0	2011	4																															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	YES	209.0190313	45.10796	9962.138269	26.55137964	23.04774191	21.18001013	10.36028056	10.49557293	3.654384823	40.42400093	7.909049901	0	0	3.740395932	0.549025008	100.8326405	20.109948	12.9203954	0	0	3.147412856	6.792102635	1990.715579	0	112.2189435	206.4670984	0	0	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.100537234	0.10175746	0	0	0.2	0.2	0.097925108	0.06336277	0.2	0	0.110080243	0	0	0.161861203	0.013515198	0.029852988	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.094713987	0.095863537	0	0	0.188415742	0.188415742	0.092253159	0.059692717	0.188415742	0	0.103704253	0	0	0.152485993	0.01273238	0.028123864	0.188415742	0	0	0	0.188415742	0.188809889	0	0	0	0	0	0	0	0												19.797	4.324208576	0	0	4.342557387	3.990647319	0.955768614	0.626509261	0.688543627	0	0.820202114	0	0	0.570357987	0.006990395	2.835803507	3.789030769	0	0	0	0.593022128	1.282416143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6231	0	2.740694079	19.797	4.324208576	0	0	4.342557387	3.990647319	0.955768614	0.626509261	0.688543627	0	0.820202114	0	0	0.570357987	0.006990395	2.835803507	3.789030769	0	0	0	0.593022128	1.282416143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6231	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												2.2743	0.4908	0	0.0072	0.9429	0.8665	0.4238	0.0907	0.1495	0	0.2369	0	0	0.1238	0.0097	2.2769	0.4541	0.0045	0	0	0.0711	0.1534	0	0	0.016	0	0	0	0	0											8.5919	0	0	22.0713	4.815020576	0	0.007206949	5.285419556	4.857102279	1.379598273	0.717194976	0.838041188	0	1.05707302	0	0	0.694194915	0.016641215	5.112669582	4.243126369	0.004454608	0	0	0.664092741	1.435786203	0	0	0.01599494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.2149
H0423_001_0	2011	8																															Coin	Coin	Coin	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	V	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	526.7894352		11.82477134					501.7637814								1137.654148	162.5220211	325.0440422																							6700	FFS (Includes Mental Health)		FFS					$50 copay per visit								10	"$20 individal, $10 group, $25 Psychiatrist"	25																							0	0.061567114		0.144638709					50								10	17.5	25																							NO	0.058654675		0.137796559					47.63474464								9.526948928	16.67216062	23.81737232																								30.8987	0	1.629412804	0	0	0	0	1.991782466	0	0	0	0	0	0	0	0.903197747	0.225799437	0.645141248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.294	0	1.81	30.8987	0	1.629412804	0	0	0	0	1.991782466	0	0	0	0	0	0	0	0.903197747	0.225799437	0.645141248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.294	NO																																																																																		0			30.8987	0	1.629412804	0	0	0	0	1.991782466	0	0	0	0	0	0	0	0.903197747	0.225799437	0.645141248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.294
H0423_002_0	2011	9																															Coin	Coin	D	Coin	p	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	V	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	518.5203506		485.6621047		1796.157988			5254.383178	1180.170416							907.5012064	129.6430295	259.286059																							6700	FFS (Includes Mental Health)		$50 per day copay for days 1 to 30		$20 copay per visit			$50 copay per visit	$20 copay per visit							10	"$20 individal, $10 group, $25 Psychiatrist"	25																							0	0.061567114	0.061567114	33.33333333		20			50	20							10	17.5	25																							NO	0.058651365	0.058651365	31.75470417		19.0528225			47.63205625	19.0528225							9.52641125	16.67121969	23.81602812																								30.4119	0	1.285171372	0	2.851823277	0	0	20.85642292	1.873798122	0	0	0	0	0	0	0.720435809	0.180108952	0.514597006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6943	0	2.92	30.4119	0	1.285171372	0	2.851823277	0	0	20.85642292	1.873798122	0	0	0	0	0	0	0.720435809	0.180108952	0.514597006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6943	NO																																																																																		0	0	0	30.4119	0	1.285171372	0	2.851823277	0	0	20.85642292	1.873798122	0	0	0	0	0	0	0.720435809	0.180108952	0.514597006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6943
H0423_003_0	2011	8																															Coin	Coin	D	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	V	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	429.6441828		9.256418224					520.8430804										290.119552																							6700	FFS (Includes Mental Health)		FFS					$50 copay per visit										$2.50 per visit																							0	0.061567114		0.144638709					50										2.5																							NO	0.058512831		0.137463328					47.51955037										2.375977519																								25.1397	0	0.000106035	0	0	0	0	2.062519083	0	0	0	0	0	0	0	0	0	0.057443128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.2598	0	1.42	25.1397	0	0.000106035	0	0	0	0	2.062519083	0	0	0	0	0	0	0	0	0	0.057443128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.2598	NO																																																																																		0	0	0	25.1397	0	0.000106035	0	0	0	0	2.062519083	0	0	0	0	0	0	0	0	0	0.057443128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.2598
H0423_004_0	2011	9																															D	D	D		p	Coin	Coin	p	p	p	coin	p	p	p	p	p	p	p	p	p	Coin				p		p			v																																																			0	YES	2150.352402	621.7919864	467.2640511		1847.212896	8.814418579	5.402385581	422.4523923	935.4457609		30.25337543		164.4226195	899.0951162		1891.623064	135.1159332	270.2318663	135.1159332		27.17518307				298.77		303.12			18.05568											6700	$125 per day copay for days 1 to 5	$125 per day copay for days 1 to 5	$50 per day copay for days 1 to 30		$75 copay per trip	"11a), 10% copayment"	"11b) 10% copayment, 11c) $0 copay"	"4a), $50 copay per visit, 4b) $10 copay per visit"	"9a), 9b) $50 copay per visit"		10% coinsurance		$50 copay per visit	"3) $25 copay per visit, 5) $0 copay,  9c) $40 copay per visit, 9d) $0 copay"	"7a) $0 copay, 14b0 through 14j) $0 copay"	"$15 copay per visit for 7b, 7d, 7f, 7g"	7e) and 7h) 40 copay per visit	"7c) $25 copay, 7i) $15 copay"	$15 copay per visit		10% copayment				$5 copay per visit		$2.50 copay per visit			13b) $10 copay per visit											0	85.22727273	107.9545455	33.33333333		75	0.1	0.07	44	50		0.1		50	9.75		15	40	17	15		0.1				5		2.5			10											NO	62.71944132	79.44462567	24.53027038		55.19310836	0.073590811	0.051513568	32.37995691	36.79540558		0.073590811		36.79540558	7.175104087		11.03862167	29.43632446	12.5104379	11.03862167		0.073590811				3.679540558		1.839770279			7.359081115												11.2391	4.116502634	0.955176126	0	8.496118462	0.648660213	0.278296156	1.139915855	2.86834218	0	2.226370438	0	0.504166414	0.537591754	0	1.740075946	0.331443037	0.281726582	0.124291139	0	1.999843765	0	0	0	0.091611361	0	0.046472597	0	0	0.011072768	0	0	0	0	0	0	0	0	0	0	37.6368	0	13.5	11.2391	4.116502634	0.955176126	0	8.496118462	0.648660213	0.278296156	1.139915855	2.86834218	0	2.226370438	0	0.504166414	0.537591754	0	1.740075946	0.331443037	0.281726582	0.124291139	0	1.999843765	0	0	0	0.091611361	0	0.046472597	0	0	0.011072768	0	0	0	0	0	0	0	0	0	0	37.6368	NO																																																																																		0			11.2391	4.116502634	0.955176126	0	8.496118462	0.648660213	0.278296156	1.139915855	2.86834218	0	2.226370438	0	0.504166414	0.537591754	0	1.740075946	0.331443037	0.281726582	0.124291139	0	1.999843765	0	0	0	0.091611361	0	0.046472597	0	0	0.011072768	0	0	0	0	0	0	0	0	0	0	37.6368
H0423_005_0	2011	7																															D	D	D		p	Coin	Coin	p	p	p	coin	p	p	p	p	p	p	p	p	p	Coin				p		p			v																																																			0	YES	2150.352402	621.7919864	467.2640511		1847.212896	8.814418579	5.402385581	422.4523923	935.4457609		30.25337543		164.4226195	899.0951162		1891.623064	135.1159332	270.2318663	135.1159332		27.17518307				298.77		303.12			18.05568											6700	$125 per day copay for days 1 to 5	$125 per day copay for days 1 to 5	$50 per day copay for days 1 to 30	$0 copayment	$75 copay per trip	"11a), 10% copayment"	"11b) 10% copayment, 11c) $0 copay"	"4a), $50 copay per visit, 4b) $10 copay per visit"	"9a), 9b) $50 copay per visit"	$0 copay	10% coinsurance		$50 copay per visit	"3) $25 copay per visit, 5) $0 copay,  9c) $40 copay per visit, 9d) $0 copay"	"7a) $0 copay, 14b0 through 14j) $0 copay"	"$15 copay per visit for 7b, 7d, 7f, 7g"	7e) and 7h) 40 copay per visit	"7c) $25 copay, 7i) $15 copay"	$15 copay per visit		20% copayment	$0 copay	$0 copay		$10 copay per visit		$10 copay per visit		$0 Copay	13b) $10 copay per visit												85.22727273	107.9545455	33.33333333		75	0.1	0.07	44	50		0.1		50	9.75		15	40	17	15		0.2				10		10			10											NO	62.71944132	79.44462567	24.53027038		55.19310836	0.073590811	0.051513568	32.37995691	36.79540558		0.073590811		36.79540558	7.175104087		11.03862167	29.43632446	12.5104379	11.03862167		0.147181622				7.359081115		7.359081115			7.359081115												11.2391	4.116502634	0.955176126	0	8.496118462	0.648660213	0.278296156	1.139915855	2.86834218	0	2.226370438	0	0.504166414	0.537591754	0	1.740075946	0.331443037	0.281726582	0.124291139	0	3.999687531	0	0	0	0.183222722	0	0.185890389	0	0	0.011072768	0	0	0	0	0	0	0	0	0	0	39.8676		14.3	11.2391	4.116502634	0.955176126	0	8.496118462	0.648660213	0.278296156	1.139915855	2.86834218	0	2.226370438	0	0.504166414	0.537591754	0	1.740075946	0.331443037	0.281726582	0.124291139	0	3.999687531	0	0	0	0.183222722	0	0.185890389	0	0	0.011072768	0	0	0	0	0	0	0	0	0	0	39.8676	NO																																																																																		0			11.2391	4.116502634	0.955176126	0	8.496118462	0.648660213	0.278296156	1.139915855	2.86834218	0	2.226370438	0	0.504166414	0.537591754	0	1.740075946	0.331443037	0.281726582	0.124291139	0	3.999687531	0	0	0	0.183222722	0	0.185890389	0	0	0.011072768	0	0	0	0	0	0	0	0	0	0	39.8676
H0474_001_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	Coin	V	Coin											0.92	0	0.02	0.16	0.15	0.16	0.1	1.08	0.14	4.43	1.54	0	0	0.58	0	6.05	0.06	0.11	0	0.27	0.18	0.01	0	0.13	0.09	0.51	0.02	0	0	0											16.71	YES	837.533042	8.60433536	820.4846302	1417.395412	292.0204017	6.635460166	0.862972994	884.6473896	113.4650334	16.50612472	27.99169152	16.30238855	0.258997505	1366.10281	3840.085984	4997.537081	96.15537082	607.0226114	0	3536.118605	26.08343416	28.00555978	150.7235699	388.0063359	155.1448703	169.4463587	22.3784767	0	0	0											3400	1a: $300 Days 1-1	1b: $300 Days 1-1	2: $75 Days 8-52	6: none	10a: $100	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $35	9b: $75	8a: 20%	8b: 20%	5: none	12: 20%	3: $30; 9a: 20%; 9a: $200; 9c: $25; 9c: $35; 9d: $30	7a: $10	16b: $25; 7d: $30	7h: $25; 7h: $35	7c: $30; 7i: $30	7d: $0	7b: $15; 7f: $30	15: 20%	13a: none	10b: none	16b: $25	17a: $20	17b: $20	18a: $20	18b: 100%	14a: $0	20: 100%												71.95799603	69.99996703	41.55639176	0.00155388	69.07078501	0.204580974	0.196996258	14.65273108	73.9336503	0.00755408	0.183683125	0	0.2	35.00088682	8.564090571	21.77229015	32.33762617	28.06735727	0	1.974580448	0.146480178	0.00473389	0	24.87219476	16.2001416	17.37767555	18.85462483	0	0	0											NO	70.4650352	0	35.8740345	0.00155388	66.05843415	0.1973927	0.196482375	14.3839818	73.33879623	0.007415106	0.17145968	0	0.2	32.70360772	8.520891574	21.42368918	32.33762617	28.0457778	0	1.960668233	0.080850852	0.00473389	0	24.87219476	16.2001416	17.37767555	18.85462483	0	0	0												4.9181	0	2.452841161	0.000183539	1.607534206	1.309791397	0.169558983	1.060395996	0.693449081	0.122394665	4.799446467	0	0.051799501	3.723040867	2.726746359	8.922140091	0.259119703	1.418701773	0	0.577762951	2.10886787	1.10E-05	0	0.804214096	0.209447406	0.245381987	0.035161482	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2161	250	3.178874385	5.8381	0	2.472841161	0.160183539	1.757534206	1.469791397	0.269558983	2.140395996	0.833449081	4.552394665	6.339446467	0	0.051799501	4.303040867	2.726746359	14.97214009	0.319119703	1.528701773	0	0.847762951	2.28886787	0.010011048	0	0.934214096	0.299447406	0.755381987	0.055161482	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9261	NO																																																																																		0		0	5.8381	0	2.472841161	0.160183539	1.757534206	1.469791397	0.269558983	2.140395996	0.833449081	4.552394665	6.339446467	0	0.051799501	4.303040867	2.726746359	14.97214009	0.319119703	1.528701773	0	0.847762951	2.28886787	0.010011048	0	0.934214096	0.299447406	0.755381987	0.055161482	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9261
H0474_002_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	Coin	V	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1197.73309	12.30482523	1173.352619	2026.978314	417.61027	9.341713755	1.214934079	1265.109926	162.2632639	23.2380764	39.40798197	23.31362969	0.364628519	1953.626609	5491.605766	7146.841715	137.5090679	868.086385	0	5056.906232	36.72142881	40.04998734	215.5456114	554.8770608	221.8684914	242.3205101	32.00284954	0	0	0											2900	1a: $250 Days 1-1	1b: $250 Days 1-1	2: $75 Days 8-45	6: none	10a: $100	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $30	9b: $50	8a: 20%	8b: 20%	5: none	12: 20%	3: $25; 9a: 20%; 9a: $175; 9c: $25; 9c: $35; 9d: $25	7a: $5	16b: $25; 7d: $25	7h: $25; 7h: $35	7c: $25; 7i: $25	7d: $0	7b: $15; 7f: $25	15: 20%	13a: none	10b: none	16b: $25	17a: $20	17b: $20	18a: $20	18b: 100%	14a: $0	20: 100%												59.96327094	58.33336936	48.18175849	0	69.06590144	0.2	0.2	14.60298026	49.39847993	0.008956811	0.188524729	0	0.2	31.99064491	4.282045682	14.17013892	32.32620205	23.48277636	0	1.677148119	0.149412419	0	0	24.85537265	16.16958588	17.37862608	18.83710824	0	0	0											NO	56.9029309	0	35.17754722	0	63.57649746	0.187575038	0.199486117	14.17948715	49.00191045	0.008817837	0.161390243	0	0.2	28.85039645	4.235189078	13.65475409	31.93582986	23.23020925	0	1.637568763	0.067578032	0	0	24.85537265	16.16958588	17.37862608	18.83710824	0	0	0												5.6795	0	3.43963893	0	2.212516522	1.752272309	0.242362482	1.494884161	0.662600827	0.204909569	6.360063791	0	0.072925704	4.696908515	1.93816573	8.132363844	0.365955516	1.680485697	0	0.690085973	2.481561877	0	0	1.149306343	0.298960136	0.350933128	0.050236762	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9567	0	6.980806491	5.6795	0	3.43963893	0	2.212516522	1.752272309	0.242362482	1.494884161	0.662600827	0.204909569	6.360063791	0	0.072925704	4.696908515	1.93816573	8.132363844	0.365955516	1.680485697	0	0.690085973	2.481561877	0	0	1.149306343	0.298960136	0.350933128	0.050236762	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9567	NO																																																																																		0		0	5.6795	0	3.43963893	0	2.212516522	1.752272309	0.242362482	1.494884161	0.662600827	0.204909569	6.360063791	0	0.072925704	4.696908515	1.93816573	8.132363844	0.365955516	1.680485697	0	0.690085973	2.481561877	0	0	1.149306343	0.298960136	0.350933128	0.050236762	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9567
H0474_801_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	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	156.1843334	0.921332927	20.33719189	7.469958504	5.867667701	6.635460166	0.862972994	13.44668524	6.614075447	16.50612472	27.99169152	0.327071144	0.258997505	29.38980835	22.72543141	57.65428798	0.450315868	2.722881509	0	11.71429835	26.08343416	0.778307509	0.532145943	1.095360008	0.361891084	1.241818317	0.101627081	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare 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	0.089490042	0.089490042	0.187986045	0	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0	0.223275934	0.223275934	0.223275934	0	0	0	0	0	0	0	0												13.9769	0.082450122	3.823108267	0	1.310108983	1.481538563	0.192681101	3.0023212	1.47676387	3.685420406	6.249871054	0.073027115	0.05782791	6.562036896	5.074041911	12.87281497	0.100544696	0.607953911	0	2.615520899	5.82380311	0.173777336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2426	0	3.015637188	13.9769	0.082450122	3.823108267	0	1.310108983	1.481538563	0.192681101	3.0023212	1.47676387	3.685420406	6.249871054	0.073027115	0.05782791	6.562036896	5.074041911	12.87281497	0.100544696	0.607953911	0	2.615520899	5.82380311	0.173777336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2426	NO																																																																																		0		0	13.9769	0.082450122	3.823108267	0	1.310108983	1.481538563	0.192681101	3.0023212	1.47676387	3.685420406	6.249871054	0.073027115	0.05782791	6.562036896	5.074041911	12.87281497	0.100544696	0.607953911	0	2.615520899	5.82380311	0.173777336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2426
H0474_802_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	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	156.1843334	0.921332927	20.33719189	7.469958504	5.867667701	6.635460166	0.862972994	13.44668524	6.614075447	16.50612472	27.99169152	0.327071144	0.258997505	29.38980835	22.72543141	57.65428798	0.450315868	2.722881509	0	11.71429835	26.08343416	0.778307509	0.532145943	1.095360008	0.361891084	1.241818317	0.101627081	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare 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	0.089490042	0.089490042	0.187986045	0	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0.223275934	0	0.223275934	0.223275934	0.223275934	0	0	0	0	0	0	0	0												13.9769	0.082450122	3.823108267	0	1.310108983	1.481538563	0.192681101	3.0023212	1.47676387	3.685420406	6.249871054	0.073027115	0.05782791	6.562036896	5.074041911	12.87281497	0.100544696	0.607953911	0	2.615520899	5.82380311	0.173777336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2426	0	3.015637188	13.9769	0.082450122	3.823108267	0	1.310108983	1.481538563	0.192681101	3.0023212	1.47676387	3.685420406	6.249871054	0.073027115	0.05782791	6.562036896	5.074041911	12.87281497	0.100544696	0.607953911	0	2.615520899	5.82380311	0.173777336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2426	NO																																																																																		0		0	13.9769	0.082450122	3.823108267	0	1.310108983	1.481538563	0.192681101	3.0023212	1.47676387	3.685420406	6.249871054	0.073027115	0.05782791	6.562036896	5.074041911	12.87281497	0.100544696	0.607953911	0	2.615520899	5.82380311	0.173777336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2426
H0490_001_0	2011	9																															D	D	D		T	Coin	Coin	V	V		Coin		Coin	V	V	V	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	837.4005731	16.22620326	798.5491457	0	190.6599525	7.683373948	5.264503405	252.1741348	297.8629895	0	21.70512898	0	0.310569904	930.5962754	4640.303906	4672.095388	98.74841968	359.8843425	14.78142932	77.59905179	9.239491049	0	0	0	461.0144137	0	197.5776059	0	0	0											3400	$200/Days 1-10 for IP Medical; $200/Days 1-10 for IP Surgical; PBP 1a	$200/Days 1-10 for IP Psych; $200/Days 1-10 for IP Substance Abuse; PBP 1b	$75 /Days 11-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$150/Run for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for ER - Facility; $35/Visit for PCP Urgent Care; PBP 4a, 4b"	"$150/Case for OP Hospital Services; $150/Case for Ambulatory Surgery Center Services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	20% Coinsurance for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET; PBP 8b		20% Coinsurance for Renal Dialysis - Fac; PBP 12	"20% Coinsurance for OP Fac - Cardiovascular; $35/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy; $35/Case for OP Fac - CORF; $150/Case for OP Fac - Other; $35/Visit for Prof - CORF; $35/Visit for OP Substance Abuse; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"$10/Visit for Prof - Asst Surgeon (OP); $10/Visit for PCP Office Visits; $10/Consult for PCP Consults; PBP 7a, 14b, 14c"	"$35/Visit for Prof - Asst Surgeon (OP); $35/Visit for Speclst Office Visits; $35/Consult for Speclst Consults; $25/Visit for Chiropractor; $30/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; $35/Visit for Podiatry; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; PBP 7e, 7h"	"$35/Visit for Occ Therapy; $35/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); $33/Procedure for Prof Radiology (Office); PBP 8b	"$10/Visit for Allergy Testing; $10/Visit for Allergy Tx; PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; PBP 15				$30/Exam for Vision Exams (Refractions); PBP 17a		$35/Exam for Hearing Exam; PBP 18a														0	200	200	75	0	150	0.2	0.2	48.80004815	150	0	0.187313817	0	0.2	90.04398346	10	33.96698059	35	35	0.181926462	10	0.2	0	0	0	30	0	35	0	0	0											NO	191.9373902	191.9373902	71.97652133	0	143.9530427	0.19193739	0.19193739	46.83276942	143.9530427	0	0.179762626	0	0.19193739	86.41403595	9.62002049	32.61492454	33.58904329	33.58904329	0.174592451	9.596869511	0.19193739	0	0	0	30	0	35	0	0	0												13.394	0.259534592	4.789732468	0	2.287173356	1.474726744	1.010455044	0.984167759	3.573190303	0	3.901770973	0	0.059609977	6.701381666	3.719984888	12.69833655	0.276405412	1.007347563	2.580725979	0.062058998	1.773403799	0	0	0	1.152536034	0	0.576268017	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2829	0	2.527331703	13.394	0.259534592	4.789732468	0	2.287173356	1.474726744	1.010455044	0.984167759	3.573190303	0	3.901770973	0	0.059609977	6.701381666	3.719984888	12.69833655	0.276405412	1.007347563	2.580725979	0.062058998	1.773403799	0	0	0	1.152536034	0	0.576268017	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2829	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.394	0.259534592	4.789732468	0	2.287173356	1.474726744	1.010455044	0.984167759	3.573190303	0	3.901770973	0	0.059609977	6.701381666	3.719984888	12.69833655	0.276405412	1.007347563	2.580725979	0.062058998	1.773403799	0	0	0	1.152536034	0	0.576268017	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2829
H0490_004_0	2011	7																															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	291.4060375	2.902089648	78.41188326	0	9.737663434	11.23441404	7.342454998	16.24271029	47.93390855	7.42673075	29.87357791	0	0.319115782	23.43768135	35.48930802	60.89586974	1.258897994	4.73722143	23.54636291	87.931594	45.31579977	0	0	0	0	0	0	0	0	0											6700	8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical; PBP 1a	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse; PBP 1b	16% Coinsurance for SNF; PBP 2	No Cost-Sharing; PBP 6	23% Coinsurance for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for DME / Medical Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"23% Coinsurance for ER - Facility; 23% Coinsurance for PCP Urgent Care; PBP 4a, 4b"	"23% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	23% Coinsurance for OP Fac - Pathology; PBP 8a	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	23% Coinsurance; PBP 9a	23% Coinsurance for Renal Dialysis - Fac; PBP 12	"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 OP Substance Abuse; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"23% Coinsurance for Prof - Asst Surgeon (OP); 23% Coinsurance for PCP Office Visits; 23% Coinsurance for PCP Consults; 23% Coinsurance for PCP Immunizations; PBP 7a, 14b, 14c"	"23% Coinsurance for Prof - Asst Surgeon (OP); 23% Coinsurance for Speclst Office Visits; 23% Coinsurance for Speclst Consults; 23% Coinsurance for Cardio; 23% Coinsurance for Chiropractor; 23% Coinsurance for Speclst Immunizations; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; PBP 7e, 7h"	"23% Coinsurance for Occ Therapy; 23% Coinsurance for PT/ST; PBP 7c, 7i"	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office); 23% Coinsurance for Prof Radiology (Office); PBP 8b	"23% Coinsurance for Prof - Primary Surgeon (IP); 23% Coinsurance for Prof - Asst Surgeon (IP); 23% Coinsurance for Prof - Anesthesia (IP); 23% Coinsurance for Prof - Primary Surgeon (OP); 23% Coinsurance for Prof - Anesthesia (OP); 23% Coinsurance for Prof - IP Visits; 23% Coinsurance for Allergy Testing; 23% Coinsurance for Allergy Tx; 23% Coinsurance for Renal Dialysis - Prof; 23% Coinsurance for Prof - ER Visits; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14d-j"	23% Coinsurance for Part B Rx; 23% Coinsurance for Tx Injections; PBP 15	23% Coinsurance																			0	0.077285827	0.077285827	0.16239838	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.184091985	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.075956978	0.075956978	0.159606109	0	0.228993808	0.228993808	0.228993808	0.228993808	0.228993808	0.228993808	0.228993808	0	0.228993808	0.180926715	0.229197199	0.228993808	0.228993808	0.228993808	0.228993808	0.228993808	0.228993808	0	0	0	0	0	0	0	0	0												22.1343	0.22043396	12.51501561	0	2.229864635	2.572611257	1.681376733	3.71948009	10.97656827	1.700675359	6.840864378	0	0.073075538	4.240502698	8.134049996	13.94477713	0.288279846	1.084794377	5.391971318	20.13579059	10.37703757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.2615	0	2.236559436	22.1343	0.22043396	12.51501561	0	2.229864635	2.572611257	1.681376733	3.71948009	10.97656827	1.700675359	6.840864378	0	0.073075538	4.240502698	8.134049996	13.94477713	0.288279846	1.084794377	5.391971318	20.13579059	10.37703757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.2615	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	22.1343	0.22043396	12.51501561	0	2.229864635	2.572611257	1.681376733	3.71948009	10.97656827	1.700675359	6.840864378	0	0.073075538	4.240502698	8.134049996	13.94477713	0.288279846	1.084794377	5.391971318	20.13579059	10.37703757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.2615
H0490_005_0	2011	7																															D	D	D		T	Coin	Coin	V	V	V	V		V	V	V	V	V	V	P	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	916.2908479	20.36215377	911.9369059	0	187.5253132	7.286924413	4.495065939	248.3320705	314.8813366	0	778.7551957	0	14.58479653	865.0536816	4407.577982	4536.419418	95.7067301	359.8589974	1414.075458	78.9594607	9.341228813	0	0	0	461.0144137	0	197.5776059	0	0	0											3400	$110/Days 1-16 for IP Medical; $110/Days 1-16 for IP Surgical; PBP 1a	$110/Days 1-16 for IP Psych; $110/Days 1-16 for IP Substance Abuse; PBP 1b	$75/Days 11-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$150/Run for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for ER - Facility; $35/Visit for PCP Urgent Care; PBP 4a, 4b"	"$35/Case for OP Hospital Services; $35/Case for Ambulatory Surgery Center Services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$35/Case for Outpatient Diagnostic Radiological Services; $50/Case for Therapeutic Radiological Services; $0/Case for Outpatient X-Ray Services; PBP 8b		$35/Case for Renal Dialysis - Fac; PBP 12	"20% Coinsurance for OP Fac - Cardiovascular; $35/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy; $35/Case for OP Fac - Other; $35/Visit for OP Substance Abuse; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"$5/Visit for Prof - Asst Surgeon (OP); $5/Visit for PCP Office Visits; $5/Consult for PCP Consults; PBP 7a, 14b, 14c"	"$35/Visit for Prof - Asst Surgeon (OP); $35/Visit for Speclst Office Visits; $35/Consult for Speclst Consults; $25/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; $35/Visit for Podiatry; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; PBP 7e, 7h"	"$35/Visit for Occ Therapy; $35/Visit for PT/ST; PBP 7c, 7i"	$35/Case for Outpatient Diagnostic Radiological Services; $50/Case for Therapeutic Radiological Services; $0/Case for Outpatient X-Ray Services; PBP 8b	"$5/Visit for Allergy Testing; $5/Visit for Allergy Tx; PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; PBP 15				$35/Exam for Vision Exams (Refractions); PBP 17a		$35/Exam for Hearing Exam; PBP 18a														0	110	110	75	0	150	0.2	0.2	48.8302278	35	0	27.41428584	0	35	37.79060149	5	34.51390811	35	35	7.592481191	5	0.2	0	0	0	35	0	35	0	0	0											NO	107.523975	107.523975	73.31180114	0	146.6236023	0.195498136	0.195498136	47.73109267	34.21217386	0	26.79720896	0	34.21217386	36.93996082	4.894118255	33.74726462	34.21217386	34.21217386	7.421579616	4.887453409	0.195498136	0	0	0	35	0	35	0	0	0												8.2103	0.182451643	5.571311424	0	2.291303078	1.424580143	0.878777014	0.987763423	0.897731253	0	1.739038809	0	0.041581466	2.662920758	1.797600655	12.75764554	0.272861274	1.025963215	0.874556133	0.032159224	1.826192824	0	0	0	1.344625373	0	0.576268017	0	0	0	0	0	0	0	0	0	0	0	0	0	45.3956	0	0.994655582	8.2103	0.182451643	5.571311424	0	2.291303078	1.424580143	0.878777014	0.987763423	0.897731253	0	1.739038809	0	0.041581466	2.662920758	1.797600655	12.75764554	0.272861274	1.025963215	0.874556133	0.032159224	1.826192824	0	0	0	1.344625373	0	0.576268017	0	0	0	0	0	0	0	0	0	0	0	0	0	45.3956	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.2103	0.182451643	5.571311424	0	2.291303078	1.424580143	0.878777014	0.987763423	0.897731253	0	1.739038809	0	0.041581466	2.662920758	1.797600655	12.75764554	0.272861274	1.025963215	0.874556133	0.032159224	1.826192824	0	0	0	1.344625373	0	0.576268017	0	0	0	0	0	0	0	0	0	0	0	0	0	45.3956
H0504_015_0	2011	6																															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	YES	1070.59797	2.688852785	952.5323817	1015.20757	246.448707	12.87128898	0.853228038	209.8367814	167.6297866	899.1656877	1.749306603	19.2382056	0.105816898	1442.487365	4423.471086	5386.118163	325.8558635	4079.323721	2386.71347	12726.68439	35.20142563	0	0	3859.05206	348.3567494	97.45222085	0	0	0	0											6700	"$50 copay per day for days 1-10, $0 copay per day for days 11-90, $500 annual out-of-pocket max"	$900.00 per Admit	"$0 copay per day for days 1-20, $85 copay per day for days 21-100"	$0 Copay	$100 Copay per trip (1-way)	20% Coinsurance of medicare-allowable	20% Coinsurance of medicare-allowable for prosthetics and diabetes monitoring supplies.  $0.00 copay for medical supplies.	"4a.) ER: $50 Copay, 4b.) Urgent Care: $15 Copay"	$0 Copay per visit	$0 Copay	"$0 copay for simple x-ray and lab and 20% up to $500 for diagnostic radiology services (i.e., MRI, CAT scan, etc.), 20% for therapeutic radiology services"	$0 Copay	10% Coinsurance of medicare allowable	"$0 copay for other Outpatient Services except 3.) CORF - $10 copay, 5.) Partial Hospitalization: $30 copay, 9c.) OP Substance Abuse:  $30 copay, 9d.) Cardiac Rehab: $10"	$0 Copay per visit	$10 Copay per visit	$30 Copay per visit	$20 copay per visit	$10 Copay	$0 Copay	20% Coinsurance of Medicare allowable	$0 Copay	Not covered	"Oral Exams: $15, Prophylaxis: $20, Fluoride Treatment: $15, Dental X-Rays: $10, Emergency Dental: $5, Diagnostic Services: $15, Restorative Services: $430, EPE: $373, POO:  $525"	$10 Copay per Exam	"$20 Copay for Frames, $75 Maximum Allowable per 24 months; $20 copay for Lenses every 12 months"	$0 Copay.  Office visit copay may apply.	Not covered	No copay	Not covered												34.50052235	130.9521236	19.76816686	0	100	0.180515499	0.192766319	50	0	0	0.174	0	0.1	0	0	10	30	20	10	0	0.19960229	0	0	10	10	20	0	0	0	0											NO	34.49284284	130.8456732	19.56788148	0	99.91871038	0.180368758	0.19260962	49.95935519	0	0	0.173858556	0	0.09991871	0	0	9.991871038	29.97561311	19.98	9.991871038	0	0.199440034	0	0	10	10	20	0	0	0	0												3.0773	0.029318729	1.553253396	0	2.052069748	2.321578409	0.164339928	0.873609191	0	0	0.30413192	0	0.010573088	0	0	4.484783174	0.813977441	6.792073996	1.9873111	0	7.020573526	0	0	3.215876717	0.290297291	0.162420368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1535		0.03614697	3.0773	0.029318729	1.553253396	0	2.052069748	2.321578409	0.164339928	0.873609191	0	0	0.30413192	0	0.010573088	0	0	4.484783174	0.813977441	6.792073996	1.9873111	0	7.020573526	0	0	3.215876717	0.290297291	0.162420368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1535	NO																																																																																		0			3.0773	0.029318729	1.553253396	0	2.052069748	2.321578409	0.164339928	0.873609191	0	0	0.30413192	0	0.010573088	0	0	4.484783174	0.813977441	6.792073996	1.9873111	0	7.020573526	0	0	3.215876717	0.290297291	0.162420368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1535
H0504_017_0	2011	5																															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	YES	1298.062706	0.903845533	782.6585791	725.8750796	222.4504707	12.13292394	0.149334474	331.8870352	125.3807342	1543.951451	2.469941007	61.63365717	0.096202513	2322.062126	4382.103327	5335.747847	322.8084994	4041.174386	2364.393219	12607.666	34.40592023	0	0	3822.962678	345.0989598	96.54085962	0	0	0	0											6700	"Standard network hospitals: $175 copay per day for days 1-10 and $0 copay per day for days 11-90 with $1,750 copay max per admission. Select network hospitals: $50 copay per day for days 1-10 and $0 copay per day for days 11-90 with $500 copay max per year."	$900.00 per Admit	"$0 copay per day for days 1-20, $95 copay per day for days 21-100"	$0 Copay	$150 Copay per trip (1-way)	20% Coinsurance of medicare-allowable	20% Coinsurance of medicare-allowable for prosthetics and diabetes monitoring supplies.  $0.00 copay for medical supplies.	"4a.) ER: $50 Copay, 4b.) Urgent Care: $15 Copay"	$0 Copay per visit	$0 Copay	"$0 copay for simple x-ray and lab and 20% for diagnostic radiology services (i.e., MRI, CAT scan, etc.), 20% for therapeutic radiology services"	$0 Copay	10% Coinsurance of medicare allowable	"$0 copay for other Outpatient Services except 3.) CORF - $10 copay, 5.) Partial Hospitalization: $30 copay, 9c.) OP Substance Abuse:  $30 copay, 9d.) Cardiac Rehab: $10"	$0 Copay per visit	$10 Copay per visit	$30 Copay per visit	$20 Copay per visit	$10 Copay	$0 Copay per visit	20% Coinsurance of Medicare allowable	$0 Copay	Not covered	"Oral Exams: $15, Prophylaxis: $20, Fluoride Treatment: $15, Dental X-Rays: $10, Emergency Dental: $5, Diagnostic Services: $15, Restorative Services: $430, EPE: $373, POO:  $525"	$10 Copay per Exam	"$20 Copay for Frames, $75 Maximum Allowable per 24 months; $20 copay for Lenses every 12 months"	$0 Copay	Not covered	No copay	Not covered												118.7650153	130.9521236	20.05401129	0	150	0.180647132	0.2	50	0	0	0.077682787	0	0.1	0	0	10	30	20	10	0	0.2	0	0	10	10	20	0	0	0	0											NO	118.7559825	129.8542144	19.79071723	0	148.7423925	0.179132578	0.19832319	49.58079748	0	0	0.077031491	0	0.099161595	0	0	9.916159497	29.74847849	19.83	9.916159497	0	0.19832319	0	0	10	10	20	0	0	0	0												12.8461	0.009780679	1.290781219	0	2.757317934	2.173401939	0.029616489	1.371268657	0	0	0.190263238	0	0.009539595	0	0	4.409177224	0.800255142	6.678040673	1.953808356	0	6.823491854	0	0	3.185802232	0.287582466	0.160901433	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9771		0.226084279	12.8461	0.009780679	1.290781219	0	2.757317934	2.173401939	0.029616489	1.371268657	0	0	0.190263238	0	0.009539595	0	0	4.409177224	0.800255142	6.678040673	1.953808356	0	6.823491854	0	0	3.185802232	0.287582466	0.160901433	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9771	NO																																																																																		0			12.8461	0.009780679	1.290781219	0	2.757317934	2.173401939	0.029616489	1.371268657	0	0	0.190263238	0	0.009539595	0	0	4.409177224	0.800255142	6.678040673	1.953808356	0	6.823491854	0	0	3.185802232	0.287582466	0.160901433	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9771
H0504_021_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	P	P	P	V	P	P	P	Coin	O	T	V	P	P	P	P	O	O																																																			0	YES	1081.68661	6.010258011	589.1418081	403.1428359	281.7998774	17.0780758	5.25871323	217.0595903	21.46686308	793.5089893	0.047445981	6.458169346	3.506802184	1592.037885	4475.636016	5449.635359	329.6986032	4127.430204	2414.859408	12876.76712	35.61654757	0	0	3904.560932	352.4648367	98.60145143	0	0	0	0											6700	$0.00 per day	$900.00 Per Admit	"$0 copay per day for days 1-20, $60 copay per day for days 21-100."	$0 Copay	$60 Copay per trip (1-way)	"Tier 1: Purchase or rental for $0-$499, $0 copay; Tier 2: Purchase or rental for $500 or more, 20% of medicare-allowable"	0% Coinsurance of medicare-allowable for prosthetics.  $0.00 copay for medical supplies.	"4a.) ER: $50 Copay, 4b.) Urgent Care: $0 Copay"	$0 Copay per visit	$0 Copay	"$0 copay for simple x-ray and lab and 20% up to $500 for diagnostic radiology services (i.e., MRI, CAT scan, etc.), 20% for therapeutic radiology services"	$0 Copay	$25 Copay	"$0 copay for other Outpatient Services except 3.) CORF - $0 copay, 5.) Partial Hospitalization: $30 copay, 9c.) OP Substance Abuse:  $30 copay, 9d.) Cardiac Rehab: $0"	$0 Copay per visit	$0 Copay per visit	$30 Copay per visit	$10 Copay per visit	$0 Copay	$0 Copay per visit	20% Coinsurance of Medicare allowable	$0 Copay	$0 copay for up to 5 one-way trip(s) to plan-approved location every 3 months	"Oral Exams: $15, Prophylaxis: $20, Fluoride Treatment: $15, Dental X-Rays: $10, Emergency Dental: $5, Diagnostic Services: $15, Restorative Services: $430, EPE: $373, POO:  $525"	$10 Copay per Exam	"$0 Copay for Frames, $90 Maximum Allowable per 24 months; $15 copay for Lenses every 12 months"	$0 Copay.  Office visit copay may apply.	Not covered	No copay	Not covered												0	130.9521236	13.95400013	0	60	0.02753952	0.006342489	50	0	0	0.077682787	0	25	0	0	0	30	10	0	0	0.2	0	0	10	10	15	0	0	0	0											NO	0	130.297363	13.88423013	0	59.7	0.02753952	0.006342489	49.75	0	0	0.077682787	0	24.875	0	0	0	29.85	9.95	0	0	0.2	0	0	10	10	15	0	0	0	0												0	0.065260064	0.68164837	0	1.40195439	0.470322018	0.033353332	0.899892885	0	0	0.003685736	0	0.007269309	0	0	0	0.820125276	3.422327544	0	0	7.123309514	0	0	3.253800777	0.293720697	0.123251814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.5999		0.02	0	0.065260064	0.68164837	0	1.40195439	0.470322018	0.033353332	0.899892885	0	0	0.003685736	0	0.007269309	0	0	0	0.820125276	3.422327544	0	0	7.123309514	0	0	3.253800777	0.293720697	0.123251814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.5999	NO																																																																																		0			0	0.065260064	0.68164837	0	1.40195439	0.470322018	0.033353332	0.899892885	0	0	0.003685736	0	0.007269309	0	0	0	0.820125276	3.422327544	0	0	7.123309514	0	0	3.253800777	0.293720697	0.123251814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.5999
H0504_026_0	2011	6																															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	YES	1185.148749	0.878671401	1027.261251	1421.403381	304.4431646	10.95946588	1.105647617	331.8870352	122.1961001	1570.191672	0.305446817	50.3635196	0.091942576	2044.390644	4425.624064	5388.739678	326.014463	4081.309197	2387.875124	12732.87868	34.5270828	0	0	3860.930326	348.5263005	97.49965249	0	0	0	0											6700	"$250 copay per day for days 1-7, $0 copay per day for days 11-90, $1750 annual out-of-pocket max"	$900.00 per Admission	"$0 copay per day for days 1-10, $50 copay per day for days 11-20, $90 per day for days 21-100"	$0 Copay	$200 Copay per trip (1-way)	20% Coinsurance of medicare-allowable	20% Coinsurance of medicare-allowable for prosthetics and diabetes monitoring supplies.  $0.00 copay for medical supplies.	"4a.) ER: $50 Copay, 4b.) Urgent Care: $15 Copay"	$250 Copay per visit	$0 Copay	"$0 copay for simple x-ray and lab and 20% for diagnostic radiology services (i.e., MRI, CAT scan, etc.), 20% for therapeutic radiology services"	$0 Copay	10% Coinsurance of medicare allowable	"$0 copay for other Outpatient Services except 3.) CORF - $12 copay, 5.) Partial Hospitalization: $30 copay, 9c.) OP Substance Abuse:  $30 copay, 9d.) Cardiac Rehab: $12"	"$5 Copay per visit.  $0 copay for Preventive/Wellness Screenings including 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j"	$12 Copay	$30 Copay per visit	$22 Copay	$12 Copay	$0 Copay per visit	20% Coinsurance of Medicare allowable	$0 Copay	Not covered	Not Covered	$10 Copay per Exam	"$20 Copay for Frames, $75 Maximum Allowable per 24 months; $20 copay for Lenses every 12 months"	$0 Copay	Not covered	Not covered	Not covered												148.6815087	130.9521236	34.21012971	0	200	0.190198085	0.199332243	50	250	0	0.077682787	0	0.1	0	4.872185702	12	30	22	12	0	0.2	0	0	0	10	20	0	0	0	0											NO	148.4379577	130.1766342	31.93599087	0	198.8156138	0.189071745	0.198151811	49.70390344	248.5195172	0	0.077222755	0	0.099407807	0	4.843332954	11.93	29.82234206	21.87	11.93	0	0.198815614	0	0	0	10	20	0	0	0	0												14.6601	0.009531874	2.733883829	0	5.044004552	2.072125343	0.219086078	1.374673429	2.530676317	0	0.023587445	0	0.00913981	0	1.786230906	5.357305363	0.810209569	7.438186012	2.373945852	0	6.864523157	0	0	0	0.290438584	0.162499421	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7601		0.417109866	14.6601	0.009531874	2.733883829	0	5.044004552	2.072125343	0.219086078	1.374673429	2.530676317	0	0.023587445	0	0.00913981	0	1.786230906	5.357305363	0.810209569	7.438186012	2.373945852	0	6.864523157	0	0	0	0.290438584	0.162499421	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7601	NO																																																																																		0			14.6601	0.009531874	2.733883829	0	5.044004552	2.072125343	0.219086078	1.374673429	2.530676317	0	0.023587445	0	0.00913981	0	1.786230906	5.357305363	0.810209569	7.438186012	2.373945852	0	6.864523157	0	0	0	0.290438584	0.162499421	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7601
H0504_803_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											20.30118881	0	0	0	0.080384369	0.089021398	0.001564216	0.13426855	0.137250749	0.000105101	0.006848747	0	0	0.264584256	0.83570734	3.170477822	0.269070455	0.766433267	1.357537274	5.001653344	1.450195144	0.037106415	0	0	0	0	0	0	0	0											33.9034	YES	322.5557784	0	40.33189641	11.55693532	11.40507259	12.63050911	0.221933681	19.05025282	19.47337241	0.014911952	0.971711951	0	0	37.53966946	25.26555134	95.85158148	8.134681929	23.17122051	41.04179307	151.2126594	43.84307535	1.121820989	0	0	0.064900014	0	0	0	1.299013057	0											6700	"$1100 Deductible to days 1-60, $275 days 61-90 and $550 days 91+"	"$1100 Deductible to days 1-60, $275 days 61-90 and $550 days 91+"	$0 days 1-20 and $137.50/day for days 21-100	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 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	0.003673451	0.003673451	0.125155069	0	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.158342077	0.158342077	0.158342077	0.158342077	0.158342077	0.158342077	0.158342077	0.158342077	0	0	0	0	0	0	0	0												1.1849	0	5.047741279	0	2.200453471	2.436884762	0.042819082	3.675486904	3.757122068	0.002877058	0.187478591	0	0	7.242768104	4.000599886	15.17733853	1.288062436	3.668979192	6.498642774	23.94332662	6.942203631	0.177631466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.4753		17.22173226	21.4861	0	5.047741279	0	2.28083784	2.52590616	0.044383298	3.809755454	3.894372817	0.002982159	0.194327337	0	0	7.50735236	4.836307226	18.34781636	1.557132891	4.435412459	7.856180049	28.94497997	8.392398775	0.214737881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.3787	NO																																																																																		0			21.4861	0	5.047741279	0	2.28083784	2.52590616	0.044383298	3.809755454	3.894372817	0.002982159	0.194327337	0	0	7.50735236	4.836307226	18.34781636	1.557132891	4.435412459	7.856180049	28.94497997	8.392398775	0.214737881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.3787
H0504_804_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											15.66797623	0	0	0	0.058483357	0.09101938	0.001599323	0.117845714	0.10853109	7.91E-05	0.005155546	0	0	0.199171686	0.784691452	2.976935499	0.252645006	0.719646226	1.274666196	4.69632662	1.361667751	0	0	0	0	0	0	0	0	0											28.3164	YES	248.9409027	0	21.05129091	7.952024945	8.297719372	12.91398621	0.226914725	16.7201527	15.39857771	0.011225304	0.731477792	0	0	28.25882144	23.72321174	90.00030645	7.638098977	21.75672967	38.53639029	141.9818586	41.16666785	0	0	0	0	0	0	0	2.884850973	0											6700	"$1100 Deductible to days 1-60, $275 days 61-90 and $550 days 91+"	"$1100 Deductible to days 1-60, $275 days 61-90 and $550 days 91+"	$0 days 1-20 and $137.50/day for days 21-100	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 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	0.003673451	0.003673451	0.125155069	0	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.158342077	0.158342077	0.158342077	0.158342077	0.158342077	0.158342077	0.158342077	0.158342077	0	0	0	0	0	0	0	0												0.9145	0	2.634675767	0	1.600931976	2.491577809	0.043780107	3.225925812	2.970945912	0.002165769	0.141128681	0	0	5.452154842	3.75638263	14.25083549	1.209432459	3.445005774	6.101932093	22.48170244	6.518415707	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2415	"$1100 Deductible to days 1-60 for IP Facility Services, $155 Deductible for Professional Services"	15.20694077	16.5824	0	2.634675767	0	1.659415334	2.582597189	0.04537943	3.343771526	3.079477001	0.002244887	0.146284227	0	0	5.651326528	4.541074082	17.22777099	1.462077466	4.164652	7.376598289	27.17802906	7.880083458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5579	NO																																																																																		0			16.5824	0	2.634675767	0	1.659415334	2.582597189	0.04537943	3.343771526	3.079477001	0.002244887	0.146284227	0	0	5.651326528	4.541074082	17.22777099	1.462077466	4.164652	7.376598289	27.17802906	7.880083458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5579
H0504_805_0	2011	2																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											16.33149147	0.030581722	0	0	0.07440168	0.09261976	0.00811651	0.135350415	0.088214076	0.001384434	0.009113679	0.000446909	0.000495989	0.144085182	0.787734349	2.988479535	0.25362472	0.722436889	1.279609129	4.714538155	1.366948061	0	0	0	0	0	0	0	0	0											29.0297	YES	259.4831757	0.485898205	26.35330212	10.86764104	10.5562384	13.14105096	1.151584465	19.20374971	12.51596489	0.196425821	1.293064454	0.063408218	0.070371751	20.44305353	23.81520622	90.34931193	7.667718192	21.84109847	38.68582768	142.5324395	41.326305	0	0	0	0	0	0	0	0	0											6700	"$1100 Deductible to days 1-60, $275 days 61-90 and $550 days 91+"	"$1100 Deductible to days 1-60, $275 days 61-90 and $550 days 91+"	$0 days 1-20 and $137.50/day for days 21-100	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 Deductible and 20% Coins	$155 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	0.003673451	0.003673451	0.125155069	0	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.192936385	0.158342077	0.158342077	0.158342077	0.158342077	0.158342077	0.158342077	0.158342077	0.158342077	0	0	0	0	0	0	0	0												0.9532	0.001784923	3.298249345	0	2.036682472	2.535386861	0.222182543	3.705102039	2.414785015	0.037897688	0.249479181	0.012233752	0.013577271	3.944208838	3.770949226	14.30609774	1.214122427	3.458364905	6.125594321	22.56888256	6.543692985	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.4125	"$1100 Deductible to days 1-60 for IP Facility Services, $155 Deductible for Professional Services"	15.2406079	17.2847	0.032366646	3.298249345	0	2.111084152	2.628006622	0.230299054	3.840452454	2.502999091	0.039282121	0.25859286	0.012680661	0.01407326	4.08829402	4.558683575	17.29457728	1.467747147	4.180801794	7.405203449	27.28342072	7.910641046	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.4421	NO																																																																																		0			17.2847	0.032366646	3.298249345	0	2.111084152	2.628006622	0.230299054	3.840452454	2.502999091	0.039282121	0.25859286	0.012680661	0.01407326	4.08829402	4.558683575	17.29457728	1.467747147	4.180801794	7.405203449	27.28342072	7.910641046	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.4421
H0523_002_0	2011	4																															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	1527.669986	101.7543645	1084.04069	842.4537093	228.3522682	9.340288101	0	274.7861828	393.1111117	2489.534947	2542.622086	63.36280651	2.557062311	0	3317.462666	5478.091671	286.99427	540.6269202	0	0	79.55836641	0	0	0	1254.317139	98.77882277	61.09633167	14.18391423	4.026349406	0											3400	$100/day 1-5	$100/day 1-5	"$0/d 1-20, $75/d 21-100"	$0 per visit	$100 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $25 Urgent Care Ctr	$100 per procedure	$0 per visit	$0 X-ray; $100 Complex Radiology	$10 per visit	$25 per visit	$10 per visit	"$5 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$10 per visit; Chiropractic Visits $10 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness Only	0											0	61.28387407	61.28387407	30.24850406	0	100	0.05	0.05	47.5	100	0	2.5	10	25	10	5	10	10	7.5	10	10	$50 	0	0	0	0	0	0	0	0	0											NO	55.91253703	55.91253703	27.59731869	0	91.23531741	0.045617659	0.045617659	43.33677577	91.23531741	0	2.280882935	9.123531741	22.80882935	9.123531741	4.561765871	9.123531741	9.123531741	6.842648806	9.123531741	9.123531741	45.61765871	0	0	0	0	0	0	0	0	0												7.118	0.474112056	2.493051366	0	1.736149306	0.426082075	0	0.992362266	2.988801422	0	0.483285277	0.048174381	0.0048603	0	1.261123997	4.164961937	0.218200111	0.308276679	0	0	0.302438867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.0199	0	2.211444842	7.118	0.474112056	2.493051366	0	1.736149306	0.426082075	0	0.992362266	2.988801422	0	0.483285277	0.048174381	0.0048603	0	1.261123997	4.164961937	0.218200111	0.308276679	0	0	0.302438867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.0199	NO																																																																																		0			7.118	0.474112056	2.493051366	0	1.736149306	0.426082075	0	0.992362266	2.988801422	0	0.483285277	0.048174381	0.0048603	0	1.261123997	4.164961937	0.218200111	0.308276679	0	0	0.302438867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.0199
H0523_022_0	2011	5																															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	1514.594829	100.8834602	1074.762506	835.2432416	226.3978265	11.04777393	0	272.4343184	389.7465174	2468.227294	2520.860066	62.82049129	2.535176699	0	3289.068872	5431.205293	284.5379179	535.9997544	0	0	90.6984235	0	0	0	1243.581578	0	60.57341496	14.06251569	3.991888328	0											3400	$75/day 1-5	$75/day 1-5	"$0/d 1-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $25 Urgent Care Ctr	$75 per procedure	$0 per visit	$0 X-ray; $100 Complex Radiology	$10 per visit	$25 per visit	$10 per visit	"$5 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$10 per visit; Chiropractic Visits $10 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$300.00 Every 3 Yrs	Fitness Only	0											0	45.96290555	45.96290555	40.33133874	0	100	0.05	0.05	47.5	75	0	2.5	10	25	10	5	10	10	7.5	10	10	$50 	0	0	0	0	0	0	0	0	0											NO	41.36804946	41.36804946	36.29946357	0	90.00312091	0.04500156	0.04500156	42.75148243	67.50234068	0	2.250078023	9.000312091	22.50078023	9.000312091	4.500156046	9.000312091	9.000312091	6.750234068	9.000312091	9.000312091	45.00156046	0	0	0	0	0	0	0	0	0												5.2213	0.347779331	3.251108537	0	1.698042579	0.497167066	0	0.970580915	2.192400183	0	0.472677653	0.047117002	0.004753621	0	1.233443597	4.073545223	0.213410839	0.301510317	0	0	0.340130882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.865	0	2.317528019	5.2213	0.347779331	3.251108537	0	1.698042579	0.497167066	0	0.970580915	2.192400183	0	0.472677653	0.047117002	0.004753621	0	1.233443597	4.073545223	0.213410839	0.301510317	0	0	0.340130882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.865	NO																																																																																		0			5.2213	0.347779331	3.251108537	0	1.698042579	0.497167066	0	0.970580915	2.192400183	0	0.472677653	0.047117002	0.004753621	0	1.233443597	4.073545223	0.213410839	0.301510317	0	0	0.340130882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.865
H0523_031_0	2011	4																															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	1518.766986	101.1604939	1077.724645	837.441295	227.0221476	9.580436991	0	273.1835395	390.7721871	2600.156679	2527.790337	62.99354098	2.542041804	0	3297.724493	5445.498231	285.2867172	588.7350193	0	0	147.6275495	0	0	0	1246.854228	98.1911105	60.73282194	14.09952306	4.002393512	0											3400	$50/day 1-5	$50/day 1-5	"$0/d 1-20, $50/d 21-100"	$0 per visit	$75 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $25 Urgent Care Ctr	$50 per procedure	$0 per visit	$0 X-ray; $150 Complex Radiology	$0 per visit	$25 per visit	$0 per visit	"$0 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$0 per visit; Chiropractic Visits $0 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$0 per visit	$0 per visit	$0 per visit	$0 per visit	$50 per script	0	Not Covered	0	$0 per visit	$150.00 Every 2 Years	$0 per visit	$1000.00 Every 3 Yrs	Fitness Only	0											0	30.64193704	30.64193704	20.16566937	0	75	0.05	0.05	47.5	50	0	3.75	0	25	0	0	0	0	0	0	0	$50 	0	0	0	0	0	0	0	0	0											NO	30.33514736	30.33514736	19.96376897	0	74.24909362	0.049499396	0.049499396	47.02442596	49.49939575	0	3.712454681	0	24.74969787	0	0	0	0	0	0	0	49.49939575	0	0	0	0	0	0	0	0	0												3.8393	0.255726541	1.79295382	0	1.404682391	0.474225842	0	1.070524927	1.611915595	0	0.782025589	0	0.005242897	0	0	0	0	0	0	0	0.608956208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.8456	0	0.119798475	3.8393	0.255726541	1.79295382	0	1.404682391	0.474225842	0	1.070524927	1.611915595	0	0.782025589	0	0.005242897	0	0	0	0	0	0	0	0.608956208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.8456	NO																																																																																		0			3.8393	0.255726541	1.79295382	0	1.404682391	0.474225842	0	1.070524927	1.611915595	0	0.782025589	0	0.005242897	0	0	0	0	0	0	0	0.608956208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.8456
H0523_032_0	2011	4																															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	1529.022799	101.8434434	1085.00251	843.0773441	228.5552904	9.134350808	0	275.0280442	393.4021162	2640.807777	2544.857263	63.41891933	2.559185662	0	3319.918452	5482.146884	287.2067204	602.1704572	0	0	152.7389546	0	0	0	1255.24566	98.85194479	61.14155885	14.19441402	4.029329952	0											3400	$250/day 1-5	$250/day 1-5	"$0/d 1-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $25 Urgent Care Ctr	$250 per procedure	$0 per visit	$0 X-ray; $200 Complex Radiology	$10 per visit	$25 per visit	$10 per visit	"$5 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$10 per visit; Chiropractic Visits $10 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness Only	0											0	153.2096852	153.2096852	40.33133874	0	100	0.05	0.05	47.5	250	0	5	10	25	10	5	10	10	7.5	10	10	$50 	0	0	0	0	0	0	0	0	0											NO	140.7306781	140.7306781	37.04633061	0	91.85494895	0.045927474	0.045927474	43.63110075	229.6373724	0	4.592747447	9.185494895	22.96373724	9.185494895	4.592747447	9.185494895	9.185494895	6.889121171	9.185494895	9.185494895	45.92747447	0	0	0	0	0	0	0	0	0												17.9317	1.194374738	3.349613474	0	1.749494545	0.419517664	0	0.999981359	7.528319021	0	0.973990558	0.048544513	0.004897372	0	1.270628916	4.196352685	0.219844655	0.345702104	0	0	0.584576203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8175	0	3.619412383	17.9317	1.194374738	3.349613474	0	1.749494545	0.419517664	0	0.999981359	7.528319021	0	0.973990558	0.048544513	0.004897372	0	1.270628916	4.196352685	0.219844655	0.345702104	0	0	0.584576203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8175	NO																																																																																		0			17.9317	1.194374738	3.349613474	0	1.749494545	0.419517664	0	0.999981359	7.528319021	0	0.973990558	0.048544513	0.004897372	0	1.270628916	4.196352685	0.219844655	0.345702104	0	0	0.584576203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8175
H0523_052_0	2011	4																															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	1555.1065	103.5787588	1103.515322	857.2168876	232.4558301	11.09056626	0	279.7168469	400	2981.297336	2588.237616	64.50079188	2.602563472	0	3375.597959	5574.089877	292.0235642	733.4678385	0	0	278	0	0	0	1276.297822	0	62.16698521	0	4.096907246	0											3400	$300/day 1-7	$300/day 1-7	"$0/d 1-20, $130/d 21-100"	$0 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $25 Urgent Care Ctr	$250 per procedure	$0 per visit	$0 X-ray; $250 Complex Radiology	$10 per visit	$25 per visit	$10 per visit	"$5 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$10 per visit; Chiropractic Visits $10 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Fitness Only	0											0	216.8565234	216.8565234	52.43074037	0	150	0.05	0.05	47.5	250	0	6.25	10	25	10	5	10	10	7.5	10	10	$50 	0	0	0	0	0	0	0	0	0											NO	194.1214783	194.1214783	46.93394816	0	134.2741334	0.044758044	0.044758044	42.52014223	223.7902223	0	5.594755557	8.95160889	22.37902223	8.95160889	4.475804445	8.95160889	8.95160889	6.713706668	8.95160889	8.95160889	44.75804445	0	0	0	0	0	0	0	0	0												25.1566	1.675571815	4.316027578	0	2.601067094	0.496392058	0	0.991133343	7.459674075	0	1.206713065	0.048115489	0.004853569	0	1.259043029	4.158089375	0.217840061	0.410357327	0	0	1.036894696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0384	0	5.977496255	25.1566	1.675571815	4.316027578	0	2.601067094	0.496392058	0	0.991133343	7.459674075	0	1.206713065	0.048115489	0.004853569	0	1.259043029	4.158089375	0.217840061	0.410357327	0	0	1.036894696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0384	NO																																																																																		0			25.1566	1.675571815	4.316027578	0	2.601067094	0.496392058	0	0.991133343	7.459674075	0	1.206713065	0.048115489	0.004853569	0	1.259043029	4.158089375	0.217840061	0.410357327	0	0	1.036894696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0384
H0523_054_0	2011	4																															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	1555.1065	103.5787588	1103.515322	857.2168876	232.4558301	11.14513947	0	279.7168469	400	2981.297336	2588.237616	64.50079188	2.602563472	0	3375.597959	5574.089877	292.0235642	733.4678385	0	0	278	0	0	0	1276.297822	100.5098252	62.16698521	14.43247347	4.096907246	0											3400	$150/day 1-5	$150/day 1-5	"$0/d 1-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $25 Urgent Care Ctr	$100 per procedure	$0 per visit	$0 X-ray; $150 Complex Radiology	$10 per visit	$25 per visit	$10 per visit	"$5 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$10 per visit; Chiropractic Visits $10 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$50 per script	0	Not Covered	0	$0 per visit	$200.00 Every 2 Years	$0 per visit	$1000.00 Every 3 Yrs	Fitness Only	0											0	91.92581111	91.92581111	40.33133874	0	100	0.05	0.05	47.5	100	0	3.75	10	25	10	5	10	10	7.5	10	10	$50 	0	0	0	0	0	0	0	0	0											NO	83.9660788	83.9660788	36.83910238	0	91.34113454	0.045670567	0.045670567	43.38703891	91.34113454	0	3.425292545	9.134113454	22.83528363	9.134113454	4.567056727	9.134113454	9.134113454	6.85058509	9.134113454	9.134113454	45.67056727	0	0	0	0	0	0	0	0	0												10.8813	0.724758519	3.387709495	0	1.769398271	0.509004842	0	1.011340477	3.044704485	0	0.738789251	0.049096463	0.004952523	0	1.284712281	4.242864112	0.222281364	0.418723653	0	0	1.058034808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3477	0	2.782075802	10.8813	0.724758519	3.387709495	0	1.769398271	0.509004842	0	1.011340477	3.044704485	0	0.738789251	0.049096463	0.004952523	0	1.284712281	4.242864112	0.222281364	0.418723653	0	0	1.058034808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3477	NO																																																																																		0			10.8813	0.724758519	3.387709495	0	1.769398271	0.509004842	0	1.011340477	3.044704485	0	0.738789251	0.049096463	0.004952523	0	1.284712281	4.242864112	0.222281364	0.418723653	0	0	1.058034808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3477
H0523_056_0	2011	4																															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	1512.508456	100.744492	1073.282008	834.0926839	226.0859607	11.03255548	0	272.0590369	389.2096368	2464.82728	2517.387551	62.7339553	2.531684462	0	3284.53814	5423.723742	284.1459635	535.2614083	0	0	278	0	0	0	1241.868529	97.79848137	60.48997434	14.0431444	3.986389454	0											3400	$100 per stay	$100 per stay	"$0/d 1-20, $20/d 21-100"	$0 per visit	$75 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $25 Urgent Care Ctr	$50 per procedure	$0 per visit	$0 X-ray; $100 Complex Radiology	$10 per visit	$25 per visit	$10 per visit	"$5 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$10 per visit; Chiropractic Visits $10 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$50 per script	0	Not Covered	0	$0 per visit	$200.00 Every 2 Years	$0 per visit	$1000.00 Every 3 Yrs	Fitness Only	0											0	16.9076929	16.9076929	8.066267748	0	75	0.05	0.05	47.5	50	0	2.5	10	25	10	5	10	10	7.5	10	10	$50 	0	0	0	0	0	0	0	0	0											NO	15.71218479	15.71218479	7.495918585	0	69.69690462	0.046464603	0.046464603	44.14137292	46.46460308	0	2.323230154	9.292920616	23.23230154	9.292920616	4.646460308	9.292920616	9.292920616	6.969690462	9.292920616	9.292920616	46.46460308	0	0	0	0	0	0	0	0	0												1.9804	0.131909673	0.670436212	0	1.313124303	0.512623311	0	1.00075495	1.507039274	0	0.487372556	0.048581806	0.004901405	0	1.271789675	4.200186181	0.22004549	0.310883861	0	0	1.076429971	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.7365	0	1.121268697	1.9804	0.131909673	0.670436212	0	1.313124303	0.512623311	0	1.00075495	1.507039274	0	0.487372556	0.048581806	0.004901405	0	1.271789675	4.200186181	0.22004549	0.310883861	0	0	1.076429971	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.7365	NO																																																																																		0			1.9804	0.131909673	0.670436212	0	1.313124303	0.512623311	0	1.00075495	1.507039274	0	0.487372556	0.048581806	0.004901405	0	1.271789675	4.200186181	0.22004549	0.310883861	0	0	1.076429971	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.7365
H0523_057_0	2011	4																															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	1524.481866	101.5420117	1081.778388	840.6955786	227.875716	9.320795699	0	274.212727	392.2907216	2484.339495	2537.315846	63.23057362	2.551725935	0	3310.539398	5466.659351	286.3953369	539.4986769	0	0	278	0	0	0	1251.699484	98.5726796	60.96882872	14.15431359	4.01794675	0											3400	$100 per stay	$100 per stay	"$0/d 1-20, $20/d 21-100"	$0 per visit	$75 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $25 Urgent Care Ctr	$50 per procedure	$0 per visit	$0 X-ray; $100 Complex Radiology	$10 per visit	$25 per visit	$10 per visit	"$5 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$10 per visit; Chiropractic Visits $10 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$50 per script	0	Not Covered	0	$0 per visit	$200.00 Every 2 Years	$0 per visit	$1000.00 Every 3 Yrs	Fitness Only	0											0	16.9076929	16.9076929	8.066267748	0	75	0.05	0.05	47.5	50	0	2.5	10	25	10	5	10	10	7.5	10	10	$50 	0	0	0	0	0	0	0	0	0											NO	15.7654679	15.7654679	7.52133872	0	69.93326054	0.046622174	0.046622174	44.29106501	46.62217369	0	2.331108685	9.324434739	23.31108685	9.324434739	4.662217369	9.324434739	9.324434739	6.993326054	9.324434739	9.324434739	46.62217369	0	0	0	0	0	0	0	0	0												2.0028	0.133404777	0.678035139	0	1.328007652	0.434555756	0	1.01209781	1.524120513	0	0.492896584	0.049132446	0.004956959	0	1.286204524	4.247792363	0.222539552	0.314407513	0	0	1.080080357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.8111	0	1.073078533	2.0028	0.133404777	0.678035139	0	1.328007652	0.434555756	0	1.01209781	1.524120513	0	0.492896584	0.049132446	0.004956959	0	1.286204524	4.247792363	0.222539552	0.314407513	0	0	1.080080357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.8111	NO																																																																																		0			2.0028	0.133404777	0.678035139	0	1.328007652	0.434555756	0	1.01209781	1.524120513	0	0.492896584	0.049132446	0.004956959	0	1.286204524	4.247792363	0.222539552	0.314407513	0	0	1.080080357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.8111
H0523_058_0	2011	4																															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	1555.1065	103.5787588	1103.515322	857.2168876	232.4558301	10.78701052	0	279.7168469	400	2981.297336	2588.237616	64.50079188	2.602563472	0	3375.597959	5574.089877	292.0235642	733.4678385	0	0	278	0	0	0	1276.297822	0	62.16698521	14.43247347	0	0											3400	$250/day 1-8	$250/day 1-8	"$0/d 1-20, $130/d 21-100"	$0 per visit	$200 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $25 Urgent Care Ctr	$250 per procedure	$10 per visit	$10 X-ray; $250 Complex Radiology	$10 per visit	$25 per visit	$10 per visit	"$5 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$10 per visit; Chiropractic Visits $10 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$500.00 Every 3 Yrs	Not Covered	0											0	190.46	190.46	52.43074037	0	200	0.05	0.05	47.5	250	1.5	11	10	25	10	5	10	10	7.5	10	10	$50 	0	0	0	0	0	0	0	0	0											NO	170.5864129	170.5864129	46.95984418	0	179.1309596	0.04478274	0.04478274	42.54360291	223.9136995	1.343482197	9.85220278	8.956547982	22.39136995	8.956547982	4.478273991	8.956547982	8.956547982	6.717410986	8.956547982	8.956547982	44.78273991	0	0	0	0	0	0	0	0	0												22.1067	1.472427409	4.318408966	0	3.470002993	0.483071886	0	0.991680205	7.463789985	0.333776658	2.124986819	0.048142036	0.004856247	0	1.259737712	4.16038362	0.217960255	0.410583743	0	0	1.037466808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9039	0	5.813888628	22.1067	1.472427409	4.318408966	0	3.470002993	0.483071886	0	0.991680205	7.463789985	0.333776658	2.124986819	0.048142036	0.004856247	0	1.259737712	4.16038362	0.217960255	0.410583743	0	0	1.037466808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9039	NO																																																																																		0			22.1067	1.472427409	4.318408966	0	3.470002993	0.483071886	0	0.991680205	7.463789985	0.333776658	2.124986819	0.048142036	0.004856247	0	1.259737712	4.16038362	0.217960255	0.410583743	0	0	1.037466808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9039
H0523_059_0	2011	4																															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	1555.1065	103.5787588	1103.515322	857.2168876	232.4558301	10.74469377	0	279.7168469	400	2981.297336	2588.237616	64.50079188	2.602563472	0	3375.597959	5574.089877	292.0235642	733.4678385	0	0	278	0	0	0	1276.297822	100.5098252	62.16698521	14.43247347	4.096907246	0											3400	$150/day 1-5	$150/day 1-5	"$0/d 1-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $25 Urgent Care Ctr	$100 per procedure	$0 per visit	$0 X-ray; $200 Complex Radiology	$10 per visit	$25 per visit	$10 per visit	"$5 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$10 per visit; Chiropractic Visits $10 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$50 per script	0	Not Covered	0	$0 per visit	$150.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Fitness Only	0											0	91.92581111	91.92581111	40.33133874	0	100	0.05	0.05	47.5	100	0	5	10	25	10	5	10	10	7.5	10	10	$50 	0	0	0	0	0	0	0	0	0											NO	84.31153466	84.31153466	36.99066696	0	91.71693308	0.045858467	0.045858467	43.56554321	91.71693308	0	4.585846654	9.171693308	22.92923327	9.171693308	4.585846654	9.171693308	9.171693308	6.878769981	9.171693308	9.171693308	45.85846654	0	0	0	0	0	0	0	0	0												10.9261	0.727740343	3.401647315	0	1.776677985	0.49273518	0	1.015501365	3.057231103	0	0.989105068	0.049298457	0.004972899	0	1.289997884	4.260320235	0.223195881	0.420446379	0	0	1.062387808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6974	0	2.682005856	10.9261	0.727740343	3.401647315	0	1.776677985	0.49273518	0	1.015501365	3.057231103	0	0.989105068	0.049298457	0.004972899	0	1.289997884	4.260320235	0.223195881	0.420446379	0	0	1.062387808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6974	NO																																																																																		0			10.9261	0.727740343	3.401647315	0	1.776677985	0.49273518	0	1.015501365	3.057231103	0	0.989105068	0.049298457	0.004972899	0	1.289997884	4.260320235	0.223195881	0.420446379	0	0	1.062387808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6974
H0523_801_0	2011	1																															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	YES	260.8664816	4.128929479	31.49721896	8.440807677	7.495361666	8.710259739	0	13.85830313	40.08108122	17.05578471	54.15923127	0.682132642	0.058489948	18.05580052	28.45421686	122.4108804	4.602723333	5.782605423	0	0	60.63783346	0.990868818																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.065687951	0.065687951	0.152819344	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.055338112	0.055338112	0.128741022	0	0.196288359	0.196288359	0.196288359	0.196288359	0.196288359	0.196288359	0.196288359	0.196288359	0.196288359	0.196288359	0.196288359	0.196288359	0.196288359	0.196288359	0.196288359	0.196288359	0.196288359	0.196288359	0	0	0	0	0	0	0	0												14.4359	0.228487163	4.054984175	0	1.471252241	1.70972259	0	2.720223578	7.867449655	3.347851991	10.63082662	0.133894697	0.011480896	3.544143451	5.585231531	24.02783082	0.903461009	1.135058128	0	0	11.90250081	0.194496014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9048	0	17.5629245	14.4359	0.228487163	4.054984175	0	1.471252241	1.70972259	0	2.720223578	7.867449655	3.347851991	10.63082662	0.133894697	0.011480896	3.544143451	5.585231531	24.02783082	0.903461009	1.135058128	0	0	11.90250081	0.194496014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9048	NO																																																																																		0			14.4359	0.228487163	4.054984175	0	1.471252241	1.70972259	0	2.720223578	7.867449655	3.347851991	10.63082662	0.133894697	0.011480896	3.544143451	5.585231531	24.02783082	0.903461009	1.135058128	0	0	11.90250081	0.194496014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9048
H0523_805_0	2011	1																															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	YES	260.2370347	2.812377313	31.93392877	10.16763082	7.596734282	6.133063944	0	11.23484655	43.08471925	16.36044059	51.72833469	0.464627545	0.039839819	12.97978704	28.91077252	117.7085166	5.277360467	3.882713301	0	0	56.91729045	1.970633672																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.06648052	0.06648052	0.150677063	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.055880046	0.055880046	0.126651254	0	0.195847607	0.195847607	0.195847607	0.195847607	0.195847607	0.195847607	0.195847607	0.195847607	0.195847607	0.195847607	0.195847607	0.195847607	0.195847607	0.195847607	0.195847607	0.195847607	0.195847607	0.195847607	0	0	0	0	0	0	0	0												14.5421	0.157155775	4.044472136	0	1.487802228	1.201145895	0	2.200317809	8.438039152	3.204153135	10.13087055	0.090996193	0.007802533	2.542060227	5.662105606	23.05293126	1.033558417	0.760420108	0	0	11.14711512	0.385943888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0889	0	17.08992041	14.5421	0.157155775	4.044472136	0	1.487802228	1.201145895	0	2.200317809	8.438039152	3.204153135	10.13087055	0.090996193	0.007802533	2.542060227	5.662105606	23.05293126	1.033558417	0.760420108	0	0	11.14711512	0.385943888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0889	NO																																																																																		0			14.5421	0.157155775	4.044472136	0	1.487802228	1.201145895	0	2.200317809	8.438039152	3.204153135	10.13087055	0.090996193	0.007802533	2.542060227	5.662105606	23.05293126	1.033558417	0.760420108	0	0	11.14711512	0.385943888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0889
H0524_002_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	955.6677924	55.06810931	932.091353	0	240.4361941	7.847135921	0	525.3682643	61.48637474	4039.254827	1489.617518	0	0	57.89602012	10475.17796	3.198620036	287.7238524	974.6268966	0	0	885.1317042	56.05782117	0	0	616.3279967	0	0	0	178.4427744	0											3400	"$125/days 1-10, $0 after day 10, Unlimited Coverage"	"$125/days 1-10, $0 after day 10, Unlimited Coverage"	$100/days 21-100	0	$200/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"	0	0	$0 to $5/visit	$0 to $5/visit	$0 to $5/visit	$5 Individual & $2 Group Visit	$0 to $5/visit	0	0	"$8/generic, $45/brand"	0	0	0	0	0	0	0	$0 to $5/visit	0												125	125	100	0	200	0.176	0	40.8375	49.5	10.05	18.15	0	0	5	4.8	4.8	4.85	5	0	0	11.7	0	0	0	0	0	0	0	4.75	0											NO	93	93	9.8	0	189.6	0.166848	0	38.71395	46.926	9.5274	17.2062	0	0	4.74	4.5504	4.5504	4.5978	4.74	0	0	11.0916	0	0	0	0	0	0	0	4.503	0												7.4064	0.426777847	0.761207938	0	3.798891867	1.309278934	0	1.694923393	0.240442468	3.20696637	2.135888078	0	0	0.022868928	3.972187483	0.001212917	0.110241394	0.384977624	0	0	0.818127234	0	0	0	0	0	0	0	0.066960651	0	0	0	0	0	0	0	0	0	0	0	26.3574		10.67585572	7.4064	0.426777847	0.761207938	0	3.798891867	1.309278934	0	1.694923393	0.240442468	3.20696637	2.135888078	0	0	0.022868928	3.972187483	0.001212917	0.110241394	0.384977624	0	0	0.818127234	0	0	0	0	0	0	0	0.066960651	0	0	0	0	0	0	0	0	0	0	0	26.3574	NO																																																																																		0			7.4064	0.426777847	0.761207938	0	3.798891867	1.309278934	0	1.694923393	0.240442468	3.20696637	2.135888078	0	0	0.022868928	3.972187483	0.001212917	0.110241394	0.384977624	0	0	0.818127234	0	0	0	0	0	0	0	0.066960651	0	0	0	0	0	0	0	0	0	0	0	26.3574
H0524_003_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	911.7894771	52.53972458	564.9520134	0	215.570555	7.407581238	0	540.4680493	64.71846705	4077.625501	1503.768056	0	0	58.4460001	10719.84854	3.273330768	294.4442692	997.3914291	0	0	885.1317042	56.05782117	0	0	602.3279967	0	0	0	175.5308104	0											3400	"$125/days 1-10, $0 after day 10, Unlimited Coverage"	"$125/days 1-10, $0 after day 10, Unlimited Coverage"	$100/days 21-100	0	$200/trip	0% to 20% coinsurance	0	"$50/ER visit,$5U/R OOA"	$0 to $50/procedure	$0 to $20/routine lab	"$0 to $20/x-ray, $100/MRI,PET, CAT Scans"	0	0	$0 to $5/visit	$0 to $5/visit	$0 to $5/visit	$5 Individual & $2 Group Visit	$0 to $5/visit	0	0	"$5/generic, $35/brand"	0	0	0	0	0	0	0	$0 to $5/visit	0												125	125	100	0	200	0.176	0	42.975	49.5	13.4	27.2	0	0	5	4.8	4.8	4.85	5	0	0	8	0	0	0	0	0	0	0	4.75	0											NO	91.75	91.75	9.5	0	188.2	0.165616	0	40.439475	46.5795	12.6094	25.5952	0	0	4.705	4.5168	4.5168	4.56385	4.705	0	0	7.528	0	0	0	0	0	0	0	4.46975	0												6.9714	0.401709977	0.447253677	0	3.380864871	1.226813974	0	1.821353681	0.25121282	4.284700916	3.207437012	0	0	0.022915703	4.034950991	0.001232082	0.11198329	0.391060556	0	0	0.555272622	0	0	0	0	0	0	0	0.06538157	0	0	0	0	0	0	0	0	0	0	0	27.1755		8.146230657	6.9714	0.401709977	0.447253677	0	3.380864871	1.226813974	0	1.821353681	0.25121282	4.284700916	3.207437012	0	0	0.022915703	4.034950991	0.001232082	0.11198329	0.391060556	0	0	0.555272622	0	0	0	0	0	0	0	0.06538157	0	0	0	0	0	0	0	0	0	0	0	27.1755	NO																																																																																		0			6.9714	0.401709977	0.447253677	0	3.380864871	1.226813974	0	1.821353681	0.25121282	4.284700916	3.207437012	0	0	0.022915703	4.034950991	0.001232082	0.11198329	0.391060556	0	0	0.555272622	0	0	0	0	0	0	0	0.06538157	0	0	0	0	0	0	0	0	0	0	0	27.1755
H0524_008_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	998.633484	46.03197477	803.1213452	0	303.1328701	13.03663735	0	524.854996	112.2632642	3762.177929	1326.188214	0	0	48.84334976	10087.68593	2.397491304	314.631598	903.632938	0	0	140.0089705	39.44737444	0	0	627.7822114	0	0	0	182.7129706	0											3400	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	$100/days 21-100	0	$200/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"	0	0	$0 to $30/visit	$0 to $30/visit	$0 to $30/visit	$30 Individual & $15 Group Visit	$0 to $30/visit	0	0	"$10/generic, $45/brand"	0	0	0	$0 to $30/visit	0	0	0	$0 to $30/visit	0												225	225	100	0	200	0.184	0	44.1	173.25	18.75	31.75	0	0	30	28.512	28.512	27.8364	30	0	0	12.5	0	0	0	16.8	0	0	0	28.5	0											NO	126	126	8.4	0	183.2	0.168544	0	40.3956	158.697	17.175	29.083	0	0	27.48	26.116992	26.116992	25.4981424	27.48	0	0	11.45	0	0	0	15.3888	0	0	0	26.106	0												10.4857	0.483335735	0.562184942	0	4.627828483	2.197247006	0	1.766819373	1.484653603	5.384617161	3.214127652	0	0	0.111851271	21.95500106	0.005217938	0.668543441	2.069319428	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.397492068	0	0	0	0	0	0	0	0	0	0	0	56.3526		18.85924037	10.4857	0.483335735	0.562184942	0	4.627828483	2.197247006	0	1.766819373	1.484653603	5.384617161	3.214127652	0	0	0.111851271	21.95500106	0.005217938	0.668543441	2.069319428	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.397492068	0	0	0	0	0	0	0	0	0	0	0	56.3526	NO																																																																																		0			10.4857	0.483335735	0.562184942	0	4.627828483	2.197247006	0	1.766819373	1.484653603	5.384617161	3.214127652	0	0	0.111851271	21.95500106	0.005217938	0.668543441	2.069319428	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.397492068	0	0	0	0	0	0	0	0	0	0	0	56.3526
H0524_010_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	1050.739949	48.4338204	810.3433348	0	247.4197218	9.091400566	0	514.193942	97.70037069	3548.303306	1250.796244	0	0	46.06667273	8980.169101	2.13427316	280.0885133	804.4239922	0	0	140.0089705	39.44737444	0	0	627.7822114	0	0	0	150.0677846	0											3400	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	$100/days 21-100	0	$200/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"	0	0	$0 to $30/visit	$0 to $30/visit	$0 to $30/visit	$30 Individual & $15 Group Visit	$0 to $30/visit	0	0	"$10/generic, $45/brand"	0	0	0	$0 to $30/visit	0	0	0	$0 to $30/visit	0												225	225	100	0	200	0.184	0	44.1	173.25	18.75	31.75	0	0	30	28.512	28.512	27.8364	30	0	0	12.5	0	0	0	16.8	0	0	0	28.5	0											NO	126	126	8.4	0	183.2	0.168544	0	40.3956	158.697	17.175	29.083	0	0	27.48	26.116992	26.116992	25.4981424	27.48	0	0	11.45	0	0	0	15.3888	0	0	0	26.106	0												11.0328	0.508555114	0.567240334	0	3.777274419	1.532301017	0	1.730931067	1.292062977	5.078509106	3.031408931	0	0	0.105492681	19.54458371	0.004645066	0.595144733	1.842130942	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.326472465	0	0	0	0	0	0	0	0	0	0	0	51.9082		18.90355092	11.0328	0.508555114	0.567240334	0	3.777274419	1.532301017	0	1.730931067	1.292062977	5.078509106	3.031408931	0	0	0.105492681	19.54458371	0.004645066	0.595144733	1.842130942	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.326472465	0	0	0	0	0	0	0	0	0	0	0	51.9082	NO																																																																																		0			11.0328	0.508555114	0.567240334	0	3.777274419	1.532301017	0	1.730931067	1.292062977	5.078509106	3.031408931	0	0	0.105492681	19.54458371	0.004645066	0.595144733	1.842130942	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.326472465	0	0	0	0	0	0	0	0	0	0	0	51.9082
H0524_013_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	824.5067456	38.00560898	714.4204069	0	227.5633784	10.51162406	0	509.7267367	115.4062488	3525.61482	1242.798429	0	0	45.77211419	8516.112334	2.023983043	265.6147357	762.8547976	0	0	140.0089705	39.44737444	0	0	627.7822114	0	0	0	152.7948093	0											3400	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	$100/days 21-100	0	$200/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"	0	0	$0 to $30/visit	$0 to $30/visit	$0 to $30/visit	$30 Individual & $15 Group Visit	$0 to $30/visit	0	0	"$10/generic, $45/brand"	0	0	0	$0 to $30/visit	0	0	0	$0 to $30/visit	0												225	225	100	0	200	0.184	0	44.1	173.25	18.75	31.75	0	0	30	28.512	28.512	27.8364	30	0	0	12.5	0	0	0	16.8	0	0	0	28.5	0											NO	126	126	8.4	0	183.2	0.168544	0	40.3956	158.697	17.175	29.083	0	0	27.48	26.116992	26.116992	25.4981424	27.48	0	0	11.45	0	0	0	15.3888	0	0	0	26.106	0												8.6573	0.399058894	0.500094285	0	3.474134244	1.771671166	0	1.715893114	1.526218788	5.046036211	3.01202556	0	0	0.104818141	18.53460314	0.004405029	0.564390196	1.746937486	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.332405108	0	0	0	0	0	0	0	0	0	0	0	48.3287		16.1246651	8.6573	0.399058894	0.500094285	0	3.474134244	1.771671166	0	1.715893114	1.526218788	5.046036211	3.01202556	0	0	0.104818141	18.53460314	0.004405029	0.564390196	1.746937486	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.332405108	0	0	0	0	0	0	0	0	0	0	0	48.3287	NO																																																																																		0			8.6573	0.399058894	0.500094285	0	3.474134244	1.771671166	0	1.715893114	1.526218788	5.046036211	3.01202556	0	0	0.104818141	18.53460314	0.004405029	0.564390196	1.746937486	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.332405108	0	0	0	0	0	0	0	0	0	0	0	48.3287
H0524_015_0	2011	9																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	983.7220307	56.68466883	551.5846415	0	249.401601	9.259307579	0	445.3804771	118.4021306	4122.570373	1520.343061	0	0	59.09021032	10358.12128	3.162876505	284.5086326	963.7357603	0	0	885.1317042	56.05782117	0	0	602.3279967	0	0	0	190.8239746	0											3400	"$200/days 1-10, $0 after Day 10, Unlimited Coverage"	"$200/days 1-10, $0 after Day 10, Unlimited Coverage"	$100/days 21-100	0	$200/trip	0% to 20% coinsurance	0	"$50/ER visit,$15U/R OOA"	$0 to $150/procedure	$0 to $25/routine lab	"$0 to $25/x-ray, $100/MRI,PET, CAT Scans"	0	0	$0 to $15/visit	$0 to $15/visit	$0 to $15/visit	$15 Individual & $7 Group Visit	$0 to $15/visit	0	0	"$10/generic, $45/brand"	0	0	0	0	0	0	0	$0 to $15/visit	0												200	200	100	0	200	0.176	0	43.425	148.5	16.75	31.75	0	0	15	14.4	14.4	14.6	15	0	0	13.5	0	0	0	0	0	0	0	14.25	0											NO	124	124	5.6	0	182.6	0.160688	0	39.647025	135.5805	15.29275	28.98775	0	0	13.695	13.1472	13.1472	13.3298	13.695	0	0	12.3255	0	0	0	0	0	0	0	13.01025	0												10.1651	0.585741578	0.257406166	0	3.795061028	1.487859616	0	1.471500909	1.337751673	5.253786506	3.67261038	0	0	0.067436703	11.34835767	0.003465247	0.316036931	1.099863436	0	0	0.909140902	0	0	0	0	0	0	0	0.206888968	0	0	0	0	0	0	0	0	0	0	0	41.978		13.87949117	10.1651	0.585741578	0.257406166	0	3.795061028	1.487859616	0	1.471500909	1.337751673	5.253786506	3.67261038	0	0	0.067436703	11.34835767	0.003465247	0.316036931	1.099863436	0	0	0.909140902	0	0	0	0	0	0	0	0.206888968	0	0	0	0	0	0	0	0	0	0	0	41.978	NO																																																																																		0			10.1651	0.585741578	0.257406166	0	3.795061028	1.487859616	0	1.471500909	1.337751673	5.253786506	3.67261038	0	0	0.067436703	11.34835767	0.003465247	0.316036931	1.099863436	0	0	0.909140902	0	0	0	0	0	0	0	0.206888968	0	0	0	0	0	0	0	0	0	0	0	41.978
H0524_029_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	1578.449843	90.95446052	1165.427566	0	444.0853814	20.06159715	0	978.8110442	71.62555074	4892.106132	1804.136482	0	0	70.12022939	12404.40172	3.787713013	340.7142355	1154.124885	0	0	885.1317042	56.05782117	0	273	790.3279967	0	0	0	202.8831061	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 to $650	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.03	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	47.03	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0699325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0699		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0699325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0699	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0699325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0699
H0524_030_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	1683.651105	77.60783752	1554.168976	0	613.9337088	30.73626079	0	1064.218678	95.68252993	4630.462386	1632.263215	0	0	60.11605463	12050.2561	2.863925822	375.8435145	1079.4357	0	0	142.7844787	39.44737444	0	245	801.7822114	0	0	0	197.0622278	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 to $923	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.39	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	55.39	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.130879167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1309		1.130879167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.130879167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1309	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.130879167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1309
H0524_031_0	2011	9																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	890.6548779	41.05470478	475.28041	0	180.3627962	8.886835554	0	497.3376323	79.43954069	3502.215895	1234.550181	0	0	45.46833221	8978.268225	2.133821388	280.0292256	804.2537159	0	0	140.0089705	39.44737444	0	0	602.7822114	0	0	0	161.086741	0											3400	"$235/days 1-9, $0 after Day 9, Unlimited Coverage"	"$235/days 1-9, $0 after Day 9, Unlimited Coverage"	$100/days 21-100	0	$200/trip	0% to 20% coinsurance	0	"$50/ER visit, $30/UR OOA"	$0 to $200/procedure	$0 to $25/routine lab	"$0 to $25/x-ray, $125/MRI,PET, CAT Scans"	0	0	$0 to $30/visit	$0 to $30/visit	$0 to $30/visit	$30 Individual & $15 Group Visit	$0 to $30/visit	0	0	"$10/generic, $45/brand"	0	0	0	$0 to $30/visit	0	0	0	$0 to $30/visit	0												235	235	100	0	200	0.184	0	44.1	198	18.75	34	0	0	30	28.512	28.512	27.8364	30	0	0	12.5	0	0	0	16.8	0	0	0	28.5	0											NO	134.185	134.185	7.4	0	181.8	0.167256	0	40.0869	179.982	17.04375	30.906	0	0	27.27	25.917408	25.917408	25.3032876	27.27	0	0	11.3625	0	0	0	15.2712	0	0	0	25.9065	0												9.9594	0.45907713	0.293089586	0	2.732496362	1.486376567	0	1.661393661	1.191473951	4.974241014	3.179583991	0	0	0.103326785	19.39112006	0.004608593	0.590471669	1.827666569	0	0	0.132570994	0	0	0	0.767100642	0	0	0	0.347766138	0	0	0	0	0	0	0	0	0	0	0	49.1017		15.33834867	9.9594	0.45907713	0.293089586	0	2.732496362	1.486376567	0	1.661393661	1.191473951	4.974241014	3.179583991	0	0	0.103326785	19.39112006	0.004608593	0.590471669	1.827666569	0	0	0.132570994	0	0	0	0.767100642	0	0	0	0.347766138	0	0	0	0	0	0	0	0	0	0	0	49.1017	NO																																																																																		0			9.9594	0.45907713	0.293089586	0	2.732496362	1.486376567	0	1.661393661	1.191473951	4.974241014	3.179583991	0	0	0.103326785	19.39112006	0.004608593	0.590471669	1.827666569	0	0	0.132570994	0	0	0	0.767100642	0	0	0	0.347766138	0	0	0	0	0	0	0	0	0	0	0	49.1017
H0524_032_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	979.8594588	45.16658674	708.0900437	0	259.6801163	9.691071586	0	484.3381009	84.2983237	3194.039489	1125.916319	0	0	41.46736036	8800.482416	2.091567899	274.4841448	788.3280503	0	0	140.0089705	39.44737444	0	0	627.7822114	0	0	0	158.8274007	0											3400	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	$100/days 21-100	0	$200/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"	0	0	$0 to $30/visit	$0 to $30/visit	$0 to $30/visit	$30 Individual & $15 Group Visit	$0 to $30/visit	0	0	"$10/generic, $45/brand"	0	0	0	$0 to $30/visit	0	0	0	$0 to $30/visit	0												225	225	100	0	200	0.184	0	44.1	173.25	18.75	31.75	0	0	30	28.512	28.512	27.8364	30	0	0	12.5	0	0	0	16.8	0	0	0	28.5	0											NO	126	126	8.4	0	183.2	0.168544	0	40.3956	158.697	17.175	29.083	0	0	27.48	26.116992	26.116992	25.4981424	27.48	0	0	11.45	0	0	0	15.3888	0	0	0	26.106	0												10.2885	0.474249161	0.495663031	0	3.964449776	1.633371969	0	1.630427349	1.114824256	4.571469019	2.728752025	0	0	0.094960255	19.15351074	0.004552122	0.583236318	1.805271235	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.34552901	0	0	0	0	0	0	0	0	0	0	0	49.8275		17.39844868	10.2885	0.474249161	0.495663031	0	3.964449776	1.633371969	0	1.630427349	1.114824256	4.571469019	2.728752025	0	0	0.094960255	19.15351074	0.004552122	0.583236318	1.805271235	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.34552901	0	0	0	0	0	0	0	0	0	0	0	49.8275	NO																																																																																		0			10.2885	0.474249161	0.495663031	0	3.964449776	1.633371969	0	1.630427349	1.114824256	4.571469019	2.728752025	0	0	0.094960255	19.15351074	0.004552122	0.583236318	1.805271235	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.34552901	0	0	0	0	0	0	0	0	0	0	0	49.8275
H0524_033_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	1042.859527	48.07057262	789.1651031	0	247.162101	11.20338674	0	519.4858988	54.77473302	3772.896006	1329.966394	0	0	48.98249969	9352.790866	2.222832365	291.7104633	837.8026385	0	0	140.0089705	39.44737444	0	0	627.7822114	0	0	0	167.80637	0											3400	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	$100/days 21-100	0	$200/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"	0	0	$0 to $30/visit	$0 to $30/visit	$0 to $30/visit	$30 Individual & $15 Group Visit	$0 to $30/visit	0	0	"$10/generic, $45/brand"	0	0	0	$0 to $30/visit	0	0	0	$0 to $30/visit	0												225	225	100	0	200	0.184	0	44.1	173.25	18.75	31.75	0	0	30	28.512	28.512	27.8364	30	0	0	12.5	0	0	0	16.8	0	0	0	28.5	0											NO	126	126	8.4	0	183.2	0.168544	0	40.3956	158.697	17.175	29.083	0	0	27.48	26.116992	26.116992	25.4981424	27.48	0	0	11.45	0	0	0	15.3888	0	0	0	26.106	0												10.95	0.504741013	0.552415572	0	3.773341409	1.888263614	0	1.748745381	0.724382151	5.399957408	3.223284387	0	0	0.112169924	20.35556369	0.004837808	0.619839578	1.918568042	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.365062758	0	0	0	0	0	0	0	0	0	0	0	53.0799		18.79062354	10.95	0.504741013	0.552415572	0	3.773341409	1.888263614	0	1.748745381	0.724382151	5.399957408	3.223284387	0	0	0.112169924	20.35556369	0.004837808	0.619839578	1.918568042	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.365062758	0	0	0	0	0	0	0	0	0	0	0	53.0799	NO																																																																																		0			10.95	0.504741013	0.552415572	0	3.773341409	1.888263614	0	1.748745381	0.724382151	5.399957408	3.223284387	0	0	0.112169924	20.35556369	0.004837808	0.619839578	1.918568042	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.365062758	0	0	0	0	0	0	0	0	0	0	0	53.0799
H0524_034_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	1036.334389	59.71633225	462.4968203	0	265.6129789	7.040158456	0	468.622575	31.31573489	3962.143621	1461.180044	0	0	56.79075885	12002.3848	3.664956209	329.6719547	1116.720603	0	0	885.1317042	56.05782117	0	0	602.3279967	0	0	0	173.5762885	0											3400	"$125/days 1-10, $0 after day 10, Unlimited Coverage"	"$125/days 1-10, $0 after day 10, Unlimited Coverage"	$100/days 21-100	0	$200/trip	0% to 20% coinsurance	0	"$50/ER visit,$10U/R OOA"	$0 to $50/procedure	$0 to $20/routine lab	"$0 to $20/x-ray, $125/MRI,PET, CAT Scans"	0	0	$0 to $10/visit	$0 to $10/visit	$0 to $10/visit	$10 Individual & $5 Group Visit	$0 to $10/visit	0	0	"$5/generic, $35/brand"	0	0	0	0	0	0	0	$0 to $10/visit	0												125	125	100	0	200	0.176	0	43.2	47	13.4	29.45	0	0	10	9.6	9.6	9.75	10	0	0	8	0	0	0	0	0	0	0	9.5	0											NO	90.875	90.875	9.2	0	187.6	0.165088	0	40.5216	44.086	12.5692	27.6241	0	0	9.38	9.0048	9.0048	9.1455	9.38	0	0	7.504	0	0	0	0	0	0	0	8.911	0												7.8481	0.452226808	0.354580896	0	4.152416237	1.162245679	0	1.582444711	0.115048791	4.1500813	3.363648639	0	0	0.044391443	9.006589557	0.002750183	0.251251238	0.872903272	0	0	0.553502359	0	0	0	0	0	0	0	0.128894859	0	0	0	0	0	0	0	0	0	0	0	34.041		8.294430519	7.8481	0.452226808	0.354580896	0	4.152416237	1.162245679	0	1.582444711	0.115048791	4.1500813	3.363648639	0	0	0.044391443	9.006589557	0.002750183	0.251251238	0.872903272	0	0	0.553502359	0	0	0	0	0	0	0	0.128894859	0	0	0	0	0	0	0	0	0	0	0	34.041	NO																																																																																		0			7.8481	0.452226808	0.354580896	0	4.152416237	1.162245679	0	1.582444711	0.115048791	4.1500813	3.363648639	0	0	0.044391443	9.006589557	0.002750183	0.251251238	0.872903272	0	0	0.553502359	0	0	0	0	0	0	0	0.128894859	0	0	0	0	0	0	0	0	0	0	0	34.041
H0524_035_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	946.8462807	54.55979044	728.1840506	0	257.0536106	9.352432019	0	418.2844471	6.419713337	3626.781259	1337.503359	0	0	51.98389548	13191.67767	4.028109562	362.3385048	1227.374267	0	0	896.4553507	56.05782117	0	0	602.3279967	0	0	0	273.8004313	0											3400	"$150/days 1-5, $0 after day 5, Unlimited Coverage"	"$150/days 1-5, $0 after day 5, Unlimited Coverage"	$100/days 21-100	0	$100/trip	0% to 20% coinsurance	0	"$50/ER visit,$10U/R OOA"	$0 to $100/procedure	$05/routine lab	"$5/x-ray, $75/MRI,PET, CAT Scans"	0	0	$0 to $10/visit	$0 to $10/visit	$0 to $10/visit	$10 Individual & $5 Group Visit	$0 to $10/visit	0	0	"$10/generic, $45/brand"	0	0	0	0	0	0	0	$0 to $10/visit	0												150	150	100	0	100	0.176	0	43.2	99	3.35	11.3	0	0	10	9.6	9.6	9.75	10	0	0	13.635	0	0	0	0	0	0	0	9.5	0											NO	96.9	96.9	12.3	0	97	0.17072	0	41.904	96.03	3.2495	10.961	0	0	9.7	9.312	9.312	9.4575	9.7	0	0	13.22595	0	0	0	0	0	0	0	9.215	0												7.6458	0.440570308	0.746388652	0	2.077850019	1.596647194	0	1.460649289	0.051373756	0.982102142	1.221697859	0	0	0.042020316	10.23674187	0.003125813	0.285568034	0.992127532	0	0	0.98803947	0	0	0	0	0	0	0	0.210255915	0	0	0	0	0	0	0	0	0	0	0	28.9809		10.37617382	7.6458	0.440570308	0.746388652	0	2.077850019	1.596647194	0	1.460649289	0.051373756	0.982102142	1.221697859	0	0	0.042020316	10.23674187	0.003125813	0.285568034	0.992127532	0	0	0.98803947	0	0	0	0	0	0	0	0.210255915	0	0	0	0	0	0	0	0	0	0	0	28.9809	NO																																																																																		0			7.6458	0.440570308	0.746388652	0	2.077850019	1.596647194	0	1.460649289	0.051373756	0.982102142	1.221697859	0	0	0.042020316	10.23674187	0.003125813	0.285568034	0.992127532	0	0	0.98803947	0	0	0	0	0	0	0	0.210255915	0	0	0	0	0	0	0	0	0	0	0	28.9809
H0524_036_0	2011	9																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	680.0638586	39.1870807	520.6119854	0	182.6294157	6.747926502	0	301.7987942	4.596475542	2400.962731	885.4395917	0	0	34.41381952	8923.127347	2.724697759	245.0933612	830.2216866	0	0	626.381135	40.44659789	0	0	424.2832498	0	0	0	197.5513089	0											3400	"$250/days 1-7, $0 after day 7, Unlimited Coverage"	"$250/days 1-7, $0 after day 7, Unlimited Coverage"	$125/days 21-100	0	$200/trip	0% to 20% coinsurance	0	"$50/ER visit,$20U/R OOA"	$0 to $150/procedure	$0 to $30/routine lab	"$0 to $30/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $20/visit	$0 to $20/visit	$0 to $20/visit	$20 Individual & $10 Group Visit	$0 to $20/visit	0	0	"$10/generic, $45/brand"	0	0	0	0	0	0	0	$0 to $20/visit	0												250	250	125	0	200	0.176	0	43.65	148.5	20.1	31.8	0	0	20	19.008	19.008	19.5	20	0	0	13.5	0	0	0	0	0	0	0	19	0											NO	136.75	136.75	5.125	0	180.4	0.158752	0	39.3723	133.947	18.1302	28.6836	0	0	18.04	17.145216	17.145216	17.589	18.04	0	0	12.177	0	0	0	0	0	0	0	17.138	0												7.7499	0.446569441	0.222344702	0	2.745528882	1.071246828	0	0.990209389	0.051307009	3.627494543	2.116466256	0	0	0.051735442	12.74907881	0.003892961	0.359245594	1.248099936	0	0	0.635620257	0	0	0	0	0	0	0	0.282136194	0	0	0	0	0	0	0	0	0	0	0	34.3509		14.80607998	7.7499	0.446569441	0.222344702	0	2.745528882	1.071246828	0	0.990209389	0.051307009	3.627494543	2.116466256	0	0	0.051735442	12.74907881	0.003892961	0.359245594	1.248099936	0	0	0.635620257	0	0	0	0	0	0	0	0.282136194	0	0	0	0	0	0	0	0	0	0	0	34.3509	NO																																																																																		0			7.7499	0.446569441	0.222344702	0	2.745528882	1.071246828	0	0.990209389	0.051307009	3.627494543	2.116466256	0	0	0.051735442	12.74907881	0.003892961	0.359245594	1.248099936	0	0	0.635620257	0	0	0	0	0	0	0	0.282136194	0	0	0	0	0	0	0	0	0	0	0	34.3509
H0524_037_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	910.3503775	52.45679984	515.63186	0	215.5071271	7.154427513	0	486.5534107	62.28768832	4031.905278	1486.907113	0	0	57.79067652	9481.218599	2.895112225	260.4225676	882.1473672	0	0	885.1317042	56.05782117	0	0	588.0443791	0	0	0	204.1056417	0											3400	"$200/days 1-10, $0 after Day 10, Unlimited Coverage"	"$200/days 1-10, $0 after Day 10, Unlimited Coverage"	$100/days 21-100	0	$200/trip	0% to 20% coinsurance	0	"$50/ER visit,$15U/R OOA"	$0 to $150/procedure	$0 to $25/routine lab	"$0 to $25/x-ray, $125/MRI,PET, CAT Scans"	0	0	$0 to $15/visit	$0 to $15/visit	$0 to $15/visit	$15 Individual & $7 Group Visit	$0 to $15/visit	0	0	"$10/generic, $45/brand"	0	0	0	0	0	0	0	$0 to $15/visit	0												200	200	100	0	200	0.176	0	43.425	148.5	16.75	34	0	0	15	14.4	14.4	14.6	15	0	0	13.5	0	0	0	0	0	0	0	14.25	0											NO	124	124	5.5	0	182.2	0.160336	0	39.560175	135.2835	15.25925	30.974	0	0	13.665	13.1184	13.1184	13.3006	13.665	0	0	12.2985	0	0	0	0	0	0	0	12.98175	0												9.407	0.542053598	0.236331269	0	3.272116547	1.14711229	0	1.604011506	0.70220804	5.126987551	3.837955076	0	0	0.065809133	10.36486817	0.003164937	0.288648034	1.004545314	0	0	0.907149355	0	0	0	0	0	0	0	0.220804035	0	0	0	0	0	0	0	0	0	0	0	38.7307		12.94711604	9.407	0.542053598	0.236331269	0	3.272116547	1.14711229	0	1.604011506	0.70220804	5.126987551	3.837955076	0	0	0.065809133	10.36486817	0.003164937	0.288648034	1.004545314	0	0	0.907149355	0	0	0	0	0	0	0	0.220804035	0	0	0	0	0	0	0	0	0	0	0	38.7307	NO																																																																																		0			9.407	0.542053598	0.236331269	0	3.272116547	1.14711229	0	1.604011506	0.70220804	5.126987551	3.837955076	0	0	0.065809133	10.36486817	0.003164937	0.288648034	1.004545314	0	0	0.907149355	0	0	0	0	0	0	0	0.220804035	0	0	0	0	0	0	0	0	0	0	0	38.7307
H0524_038_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	960.9863945	44.29663352	609.2758481	0	246.1112229	11.14910179	0	461.061886	140.9758225	4033.921881	1421.979437	0	0	52.3713288	10393.92851	2.470274491	324.1832032	931.0654818	0	0	148.3354951	39.44737444	0	0	627.7822114	0	0	0	173.7932053	0											3400	"$150/days 1-7, $0 after Day 7, Unlimited Coverage"	"$150/days 1-7, $0 after Day 7, Unlimited Coverage"	$100/days 21-100	0	$200/trip	0% to 20% coinsurance	0	"$50/ER visit, $15/UR OOA"	$0 to $100/procedure	$0 to $10/routine lab	"$0 to $10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $15/visit	$0 to $15/visit	$0 to $15/visit	$15 Individual & $7 Group Visit	$15/visit	0	0	"$7/generic, $45/brand"	0	0	0	$0 to $15/visit	0	0	0	$0 to $15/visit	0												150	150	100	0	200	0.184	0	43.425	99	7.5	13.6	0	0	15	14.4	14.4	14.6	15	0	0	10.8	0	0	0	8.4	0	0	0	14.25	0											NO	98.55	98.55	13	0	191.8	0.176456	0	41.644575	94.941	7.1925	13.0424	0	0	14.385	13.8096	13.8096	14.0014	14.385	0	0	10.3572	0	0	0	8.0556	0	0	0	13.66575	0												7.8921	0.363786103	0.660048835	0	3.933677713	1.967325905	0	1.600060524	1.115365464	2.417831927	1.545502051	0	0	0.06278013	11.96133293	0.002842792	0.378251558	1.116114746	0	0	0.128028366	0	0	0	0.421430198	0	0	0	0.197917875	0	0	0	0	0	0	0	0	0	0	0	35.7644		9.87524963	7.8921	0.363786103	0.660048835	0	3.933677713	1.967325905	0	1.600060524	1.115365464	2.417831927	1.545502051	0	0	0.06278013	11.96133293	0.002842792	0.378251558	1.116114746	0	0	0.128028366	0	0	0	0.421430198	0	0	0	0.197917875	0	0	0	0	0	0	0	0	0	0	0	35.7644	NO																																																																																		0			7.8921	0.363786103	0.660048835	0	3.933677713	1.967325905	0	1.600060524	1.115365464	2.417831927	1.545502051	0	0	0.06278013	11.96133293	0.002842792	0.378251558	1.116114746	0	0	0.128028366	0	0	0	0.421430198	0	0	0	0.197917875	0	0	0	0	0	0	0	0	0	0	0	35.7644
H0524_039_0	2011	9																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	938.4205146	43.25646009	545.203734	0	192.8826278	9.538337161	0	448.5104766	107.8815787	3665.90833	1292.252656	0	0	47.59350731	9303.734055	2.211173271	290.1803975	833.4082361	0	0	140.0089705	39.44737444	0	0	627.7822114	0	0	0	166.9262001	0											3400	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	$100/days 21-100	0	$200/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"	0	0	$0 to $30/visit	$0 to $30/visit	$0 to $30/visit	$30 Individual & $15 Group Visit	$0 to $30/visit	0	0	"$10/generic, $45/brand"	0	0	0	$0 to $30/visit	0	0	0	$0 to $30/visit	0												225	225	100	0	200	0.184	0	44.1	173.25	18.75	31.75	0	0	30	28.512	28.512	27.8364	30	0	0	12.5	0	0	0	16.8	0	0	0	28.5	0											NO	126	126	8.4	0	183.2	0.168544	0	40.3956	158.697	17.175	29.083	0	0	27.48	26.116992	26.116992	25.4981424	27.48	0	0	11.45	0	0	0	15.3888	0	0	0	26.106	0												9.8534	0.454192831	0.381642614	0	2.944674784	1.607629498	0	1.509820817	1.426706909	5.246831297	3.131881999	0	0	0.108989132	20.24879566	0.004812433	0.616588425	1.908504861	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.363147948	0	0	0	0	0	0	0	0	0	0	0	50.7463		15.93391022	9.8534	0.454192831	0.381642614	0	2.944674784	1.607629498	0	1.509820817	1.426706909	5.246831297	3.131881999	0	0	0.108989132	20.24879566	0.004812433	0.616588425	1.908504861	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.363147948	0	0	0	0	0	0	0	0	0	0	0	50.7463	NO																																																																																		0			9.8534	0.454192831	0.381642614	0	2.944674784	1.607629498	0	1.509820817	1.426706909	5.246831297	3.131881999	0	0	0.108989132	20.24879566	0.004812433	0.616588425	1.908504861	0	0	0.133591893	0	0	0	0.805067908	0	0	0	0.363147948	0	0	0	0	0	0	0	0	0	0	0	50.7463
H0524_040_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	1181.197776	54.44726931	973.0882677	0	366.8712532	10.92215983	0	646.9442042	101.4064061	3779.382829	1332.253035	0	0	49.06671638	9401.615507	2.23443628	293.2332877	842.1762435	0	0	148.2510765	38.72396141	0	0	609.6795851	0	0	0	152.2885561	0											3400	"$150/days 1-7, $0 after Day 7, Unlimited Coverage"	"$150/days 1-7, $0 after Day 7, Unlimited Coverage"	$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"	0	0	$0 to $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	0	$0 to $10/visit	0	0	0	$0 to $10/visit	0												150	150	100	0	200	0.184	0	43.2	99	15	22.7	0	0	10	9.6	9.6	9.75	10	0	0	9.8	0	0	0	5.6	0	0	0	9.5	0											NO	97.2	97.2	12.6	0	190.6	0.175352	0	41.1696	94.347	14.295	21.6331	0	0	9.53	9.1488	9.1488	9.29175	9.53	0	0	9.3394	0	0	0	5.3368	0	0	0	9.0535	0												9.5677	0.441022881	1.021742681	0	5.827138405	1.91522257	0	2.219536176	0.797282516	4.502189795	2.401730261	0	0	0.038967151	7.167791662	0.001703534	0.2270542	0.6688283	0	0	0.115381342	0	0	0	0.271144834	0	0	0	0.11489537	0	0	0	0	0	0	0	0	0	0	0	37.2993		13.81969087	9.5677	0.441022881	1.021742681	0	5.827138405	1.91522257	0	2.219536176	0.797282516	4.502189795	2.401730261	0	0	0.038967151	7.167791662	0.001703534	0.2270542	0.6688283	0	0	0.115381342	0	0	0	0.271144834	0	0	0	0.11489537	0	0	0	0	0	0	0	0	0	0	0	37.2993	NO																																																																																		0			9.5677	0.441022881	1.021742681	0	5.827138405	1.91522257	0	2.219536176	0.797282516	4.502189795	2.401730261	0	0	0.038967151	7.167791662	0.001703534	0.2270542	0.6688283	0	0	0.115381342	0	0	0	0.271144834	0	0	0	0.11489537	0	0	0	0	0	0	0	0	0	0	0	37.2993
H0524_041_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	908.2370284	41.86515338	744.8671916	0	283.1642648	8.430110918	0	499.3345169	77.37056935	2799.417769	986.8100131	0	0	36.34409213	6551.259631	1.557006047	204.3316278	586.8475712	0	0	105.8724337	29.88852893	0	0	432.0877888	0	0	0	117.541717	0											3400	"$225/days 1-9, $0 after Day 9, Unlimited Coverage"	"$225/days 1-9, $0 after Day 9, Unlimited Coverage"	$125/days 21-100	0	$200/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, $125/MRI,PET, CAT Scans"	0	0	$0 to $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	0	$0 to $30/visit	0	0	0	$0 to $30/visit	0												225	225	125	0	200	0.184	0	44.1	173.25	22.5	38.55	0	0	30	28.512	28.512	29.25	30	0	0	12.5	0	0	0	16.8	0	0	0	28.5	0											NO	128.7	128.7	8.125	0	181.2	0.166704	0	39.9546	156.9645	20.385	34.9263	0	0	27.18	25.831872	25.831872	26.5005	27.18	0	0	11.325	0	0	0	15.2208	0	0	0	25.821	0												9.7408	0.44900377	0.504337161	0	4.275780399	1.405333211	0	1.662559241	1.012036061	4.755510936	2.872135213	0	0	0.082319369	14.10260835	0.003351698	0.451240858	1.329209749	0	0	0.099917109	0	0	0	0.548060151	0	0	0	0.25292039	0	0	0	0	0	0	0	0	0	0	0	43.5472		18.28785371	9.7408	0.44900377	0.504337161	0	4.275780399	1.405333211	0	1.662559241	1.012036061	4.755510936	2.872135213	0	0	0.082319369	14.10260835	0.003351698	0.451240858	1.329209749	0	0	0.099917109	0	0	0	0.548060151	0	0	0	0.25292039	0	0	0	0	0	0	0	0	0	0	0	43.5472	NO																																																																																		0			9.7408	0.44900377	0.504337161	0	4.275780399	1.405333211	0	1.662559241	1.012036061	4.755510936	2.872135213	0	0	0.082319369	14.10260835	0.003351698	0.451240858	1.329209749	0	0	0.099917109	0	0	0	0.548060151	0	0	0	0.25292039	0	0	0	0	0	0	0	0	0	0	0	43.5472
H0524_042_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	1102.528504	50.821012	1080.698846	0	363.6105493	8.430110918	0	438.2754918	107.562117	3374.026737	1189.362804	0	0	43.80408666	9249.114758	2.198192168	288.4768396	828.5155585	0	0	138.7785288	39.00972224	0	0	616.8304398	0	0	0	165.9462288	0											3400	"$100/days 1-7, $0 after Day 7, Unlimited Coverage"	"$100/days 1-7, $0 after Day 7, Unlimited Coverage"	$50/days 21-100	0	$200/trip	0% to 20% coinsurance	0	"$50/ER visit, $15/UR OOA"	$0 to $50/procedure	$0 to $10/routine lab	"$0 to $10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$0 to $15/visit	$0 to $15/visit	$0 to $15/visit	$15 Individual & $7 Group Visit	$15/visit	0	0	"$7/generic, $45/brand"	0	0	0	$0 to $15/visit	0	0	0	$0 to $15/visit	0												100	100	50	0	200	0.184	0	43.425	49.5	7.5	13.6	0	0	15	14.4	14.4	14.6	15	0	0	10.8	0	0	0	8.4	0	0	0	14.25	0											NO	68.6	68.6	8.05	0	194	0.17848	0	42.12225	48.015	7.275	13.192	0	0	14.55	13.968	13.968	14.162	14.55	0	0	10.476	0	0	0	8.148	0	0	0	13.8225	0												6.3028	0.290526785	0.724968809	0	5.878370546	1.504606197	0	1.538429153	0.430382921	2.045503709	1.307506176	0	0	0.053112455	10.76596958	0.002558696	0.34045075	1.004575115	0	0	0.121153656	0	0	0	0.418827869	0	0	0	0.191149312	0	0	0	0	0	0	0	0	0	0	0	32.9209		7.587707151	6.3028	0.290526785	0.724968809	0	5.878370546	1.504606197	0	1.538429153	0.430382921	2.045503709	1.307506176	0	0	0.053112455	10.76596958	0.002558696	0.34045075	1.004575115	0	0	0.121153656	0	0	0	0.418827869	0	0	0	0.191149312	0	0	0	0	0	0	0	0	0	0	0	32.9209	NO																																																																																		0			6.3028	0.290526785	0.724968809	0	5.878370546	1.504606197	0	1.538429153	0.430382921	2.045503709	1.307506176	0	0	0.053112455	10.76596958	0.002558696	0.34045075	1.004575115	0	0	0.121153656	0	0	0	0.418827869	0	0	0	0.191149312	0	0	0	0	0	0	0	0	0	0	0	32.9209
H0524_043_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	777.3038678	35.82979401	761.9135373	0	256.3524528	8.430110918	0	308.9926779	75.83336783	2378.753949	838.5237249	0	0	30.88272626	6520.804359	1.549767891	203.3817379	584.1194543	0	0	97.84154043	27.50260684	0	0	399.5187423	0	0	0	116.9952931	0											3400	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	$100/days 21-100	0	$200/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"	0	0	$0 to $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	0	$0 to $30/visit	0	0	0	$0 to $30/visit	0												225	225	100	0	200	0.184	0	44.1	173.25	18.75	31.75	0	0	30	28.512	28.512	29.25	30	0	0	13.5	0	0	0	16.8	0	0	0	28.5	0											NO	125.775	125.775	8.4	0	183.2	0.168544	0	40.3956	158.697	17.175	29.083	0	0	27.48	26.116992	26.116992	26.793	27.48	0	0	12.366	0	0	0	15.3888	0	0	0	26.106	0												8.1471	0.375541028	0.533339476	0	3.913647446	1.420844615	0	1.040162052	1.002877331	3.404591589	2.032232124	0	0	0.070721443	14.19198294	0.00337294	0.454100575	1.33763355	0	0	0.100825707	0	0	0	0.512342835	0	0	0	0.25452326	0	0	0	0	0	0	0	0	0	0	0	38.7959		15.26677489	8.1471	0.375541028	0.533339476	0	3.913647446	1.420844615	0	1.040162052	1.002877331	3.404591589	2.032232124	0	0	0.070721443	14.19198294	0.00337294	0.454100575	1.33763355	0	0	0.100825707	0	0	0	0.512342835	0	0	0	0.25452326	0	0	0	0	0	0	0	0	0	0	0	38.7959	NO																																																																																		0			8.1471	0.375541028	0.533339476	0	3.913647446	1.420844615	0	1.040162052	1.002877331	3.404591589	2.032232124	0	0	0.070721443	14.19198294	0.00337294	0.454100575	1.33763355	0	0	0.100825707	0	0	0	0.512342835	0	0	0	0.25452326	0	0	0	0	0	0	0	0	0	0	0	38.7959
H0524_046_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	651.0134185	30.00844027	410.9005194	0	167.3602431	8.430110918	0	313.5307216	94.76569596	2603.898167	917.8882884	0	0	33.80571343	6586.981643	1.565495924	205.4457856	590.0474713	0	0	96.0475667	26.82495376	0	0	392.4952076	0	0	0	118.182636	0											3400	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	"$225/days 1-7, $0 after day 7, Unlimited Coverage"	$100/days 21-100	0	$200/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"	0	0	$0 to $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	0	$0 to $30/visit	0	0	0	$0 to $30/visit	0												225	225	100	0	200	0.184	0	44.1	173.25	18.75	31.75	0	0	30	28.512	28.512	29.25	30	0	0	13.5	0	0	0	16.8	0	0	0	28.5	0											NO	125.775	125.775	8.4	0	183.2	0.168544	0	40.3956	158.697	17.175	29.083	0	0	27.48	26.116992	26.116992	26.793	27.48	0	0	12.366	0	0	0	15.3888	0	0	0	26.106	0												6.8234	0.314525965	0.287630364	0	2.555033045	1.420844615	0	1.055438468	1.253252638	3.726829252	2.224578758	0	0	0.077415084	14.33601224	0.00340717	0.458709078	1.351208709	0	0	0.098977017	0	0	0	0.503335854	0	0	0	0.257106325	0	0	0	0	0	0	0	0	0	0	0	36.7477		11.45667075	6.8234	0.314525965	0.287630364	0	2.555033045	1.420844615	0	1.055438468	1.253252638	3.726829252	2.224578758	0	0	0.077415084	14.33601224	0.00340717	0.458709078	1.351208709	0	0	0.098977017	0	0	0	0.503335854	0	0	0	0.257106325	0	0	0	0	0	0	0	0	0	0	0	36.7477	NO																																																																																		0			6.8234	0.314525965	0.287630364	0	2.555033045	1.420844615	0	1.055438468	1.253252638	3.726829252	2.224578758	0	0	0.077415084	14.33601224	0.00340717	0.458709078	1.351208709	0	0	0.098977017	0	0	0	0.503335854	0	0	0	0.257106325	0	0	0	0	0	0	0	0	0	0	0	36.7477
H0524_801_0	2011	3																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	1165.820958	67.17769133	837.514544	0	336.9511814	12.98604321	0	635.1987309	71.97777929	4277.42509	1577.451193	0	0	61.30979591	10665.16017	3.256631548	292.9421327	992.303138	0	0	720.0615807	56.05782117	0	0	0	0	0	0	217.4237733	0											3400	$250/day 1-4	$250/day 1-4	$100/days 21-100	0	$150/trip	20% coinsurance	0	"$50/ER visit, $25/UR OOA"	$250/procedure	$10/routine lab	"$0 to $10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$25/visit	$25/visit	$25/visit	$25 Individual & $12 Group Visit	$25/visit	0	0	"$11/generic, $50/brand"	0	0	0	0	0	0	0	$0 to $25/visit	0												250	250	100	0	150	0.2	0	43.875	250	10	13.6	0	0	25	24.5	24.5	24.35	25	0	0	14.9	0	0	0	0	0	0	0	23.75	0											NO	128.5	128.5	7	0	140.55	0.1874	0	41.110875	234.25	9.37	12.7432	0	0	23.425	22.9565	22.9565	22.81595	23.425	0	0	13.9613	0	0	0	0	0	0	0	22.25375	0												12.484	0.719361111	0.488550151	0	3.946540712	2.433584497	0	2.176131302	1.405066233	3.339956091	1.675148003	0	0	0.119681831	20.40289579	0.006230072	0.556979421	1.937058417	0	0	0.837749646	0	0	0	0	0	0	0	0.403207858	0	0	0	0	0	0	0	0	0	0	0	52.9321		20.48280577	12.484	0.719361111	0.488550151	0	3.946540712	2.433584497	0	2.176131302	1.405066233	3.339956091	1.675148003	0	0	0.119681831	20.40289579	0.006230072	0.556979421	1.937058417	0	0	0.837749646	0	0	0	0	0	0	0	0.403207858	0	0	0	0	0	0	0	0	0	0	0	52.9321	NO																																																																																		0			12.484	0.719361111	0.488550151	0	3.946540712	2.433584497	0	2.176131302	1.405066233	3.339956091	1.675148003	0	0	0.119681831	20.40289579	0.006230072	0.556979421	1.937058417	0	0	0.837749646	0	0	0	0	0	0	0	0.403207858	0	0	0	0	0	0	0	0	0	0	0	52.9321
H0524_802_0	2011	3																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	1103.620979	50.87136959	856.5790417	0	265.3384041	15.19806714	0	514.0919469	93.38068639	3751.005935	1322.250025	0	0	48.69830675	9996.733126	2.375874993	311.79481	895.4855838	0	0	121.3746991	39.41246123	0	0	0	0	0	0	201.2838207	0											3400	$250/day 1-4	$250/day 1-4	$100/days 21-100	0	$150/trip	20% coinsurance	0	"$50/ER visit, $25/UR OOA"	$250/procedure	$10/routine lab	"$0 to $10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$25/visit	$25/visit	$25/visit	$25 Individual & $12 Group Visit	$25/visit	0	0	"$11/generic, $50/brand"	0	0	0	0	0	0	0	$0 to $25/visit	0												250	250	100	0	150	0.196	0	43.875	250	9.6	13.6	0	0	25	24.5	24.5	24.35	25	0	0	14.9	0	0	0	0	0	0	0	23.75	0											NO	124	124	10	0	141.75	0.18522	0	41.461875	236.25	9.072	12.852	0	0	23.625	23.1525	23.1525	23.01075	23.625	0	0	14.0805	0	0	0	0	0	0	0	22.44375	0												11.4041	0.525670819	0.713815868	0	3.134309898	2.814985996	0	1.776268003	1.838432263	2.835760487	1.416129777	0	0	0.095874791	19.28744697	0.004583954	0.597886035	1.762987243	0	0	0.142418038	0	0	0	0	0	0	0	0.376463646	0	0	0	0	0	0	0	0	0	0	0	48.7271		20.48277793	11.4041	0.525670819	0.713815868	0	3.134309898	2.814985996	0	1.776268003	1.838432263	2.835760487	1.416129777	0	0	0.095874791	19.28744697	0.004583954	0.597886035	1.762987243	0	0	0.142418038	0	0	0	0	0	0	0	0.376463646	0	0	0	0	0	0	0	0	0	0	0	48.7271	NO																																																																																		0			11.4041	0.525670819	0.713815868	0	3.134309898	2.814985996	0	1.776268003	1.838432263	2.835760487	1.416129777	0	0	0.095874791	19.28744697	0.004583954	0.597886035	1.762987243	0	0	0.142418038	0	0	0	0	0	0	0	0.376463646	0	0	0	0	0	0	0	0	0	0	0	48.7271
H0524_803_0	2011	2																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	1008.257709	58.09847962	670.7003154	0	257.481514	10.85538769	0	527.5970524	70.81786359	4131.858634	1523.768434	0	0	59.22334214	10339.1264	3.157076374	283.9868964	961.968447	0	0	720.0615807	56.05782117	0	0	0	0	0	0	248.753688	0											3400	$250/day 1-4	$250/day 1-4	$100/days 21-100	0	$150/trip	20% coinsurance	0	"$50/ER visit, $25/UR OOA"	$250/procedure	$10/routine lab	"$0 to $10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$25/visit	$25/visit	$25/visit	$25 Individual & $12 Group Visit	$25/visit	0	0	"$11/generic, $50/brand"	0	0	0	0	0	0	0	$0 to $25/visit	0												250	250	100	0	150	0.2	0	43.875	250	10	13.6	0	0	25	24.5	24.5	24.35	25	0	0	14.9	0	0	0	0	0	0	0	23.75	0											NO	128.5	128.5	7	0	140.55	0.1874	0	41.110875	234.25	9.37	12.7432	0	0	23.425	22.9565	22.9565	22.81595	23.425	0	0	13.9613	0	0	0	0	0	0	0	22.25375	0												10.7968	0.622137886	0.391241851	0	3.015752232	2.034299653	0	1.807498039	1.382423712	3.22629295	1.618140492	0	0	0.115608899	19.7791796	0.006039619	0.539952569	1.877842573	0	0	0.837749646	0	0	0	0	0	0	0	0.461308532	0	0	0	0	0	0	0	0	0	0	0	48.5122		17.48486166	10.7968	0.622137886	0.391241851	0	3.015752232	2.034299653	0	1.807498039	1.382423712	3.22629295	1.618140492	0	0	0.115608899	19.7791796	0.006039619	0.539952569	1.877842573	0	0	0.837749646	0	0	0	0	0	0	0	0.461308532	0	0	0	0	0	0	0	0	0	0	0	48.5122	NO																																																																																		0			10.7968	0.622137886	0.391241851	0	3.015752232	2.034299653	0	1.807498039	1.382423712	3.22629295	1.618140492	0	0	0.115608899	19.7791796	0.006039619	0.539952569	1.877842573	0	0	0.837749646	0	0	0	0	0	0	0	0.461308532	0	0	0	0	0	0	0	0	0	0	0	48.5122
H0524_804_0	2011	2																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		V	V	V	V		V	O																																																			0	YES	1025.781306	47.28335267	743.5274563	0	242.7275393	13.94248126	0	507.4239726	91.94146884	3822.785683	1347.552777	0	0	49.63020402	9395.100097	2.232887794	293.0300742	841.5926073	0	0	121.3746991	39.41246123	0	0	0	0	0	0	222.5357928	0											3400	$250/day 1-4	$250/day 1-4	$100/days 21-100	0	$150/trip	20% coinsurance	0	"$50/ER visit, $25/UR OOA"	$250/procedure	$10/routine lab	"$0 to $10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$25/visit	$25/visit	$25/visit	$25 Individual & $12 Group Visit	$25/visit	0	0	"$11/generic, $50/brand"	0	0	0	0	0	0	0	$0 to $25/visit	0												250	250	100	0	150	0.196	0	43.875	250	9.6	13.6	0	0	25	24.5	24.5	24.35	25	0	0	14.9	0	0	0	0	0	0	0	23.75	0											NO	124	124	10	0	141.75	0.18522	0	41.461875	236.25	9.072	12.852	0	0	23.625	23.1525	23.1525	23.01075	23.625	0	0	14.0805	0	0	0	0	0	0	0	22.44375	0												10.5997	0.488594644	0.619606214	0	2.867219058	2.582426378	0	1.75322911	1.810097668	2.890025976	1.443229024	0	0	0.097709464	18.12667125	0.004308078	0.561903482	1.656885446	0	0	0.142418038	0	0	0	0	0	0	0	0.416211475	0	0	0	0	0	0	0	0	0	0	0	46.0603		18.69267711	10.5997	0.488594644	0.619606214	0	2.867219058	2.582426378	0	1.75322911	1.810097668	2.890025976	1.443229024	0	0	0.097709464	18.12667125	0.004308078	0.561903482	1.656885446	0	0	0.142418038	0	0	0	0	0	0	0	0.416211475	0	0	0	0	0	0	0	0	0	0	0	46.0603	NO																																																																																		0			10.5997	0.488594644	0.619606214	0	2.867219058	2.582426378	0	1.75322911	1.810097668	2.890025976	1.443229024	0	0	0.097709464	18.12667125	0.004308078	0.561903482	1.656885446	0	0	0.142418038	0	0	0	0	0	0	0	0.416211475	0	0	0	0	0	0	0	0	0	0	0	46.0603
H0524_805_0	2011	3																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	1018.714813	58.70104561	664.9912787	0	247.0027654	11.21284361	0	524.3075674	73.42922083	4126.012152	1521.612338	0	0	59.13954252	10385.46709	3.171226611	285.2597455	966.280057	0	0	720.0615807	56.05782117	0	0	0	0	0	0	258.2679227	0											3400	$250/day 1-4	$250/day 1-4	$100/days 21-100	0	$150/trip	20% coinsurance	0	"$50/ER visit, $25/UR OOA"	$250/procedure	$10/routine lab	"$0 to $10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$25/visit	$25/visit	$25/visit	$25 Individual & $12 Group Visit	$25/visit	0	0	"$11/generic, $50/brand"	0	0	0	0	0	0	0	$0 to $25/visit	0												250	250	100	0	150	0.2	0	43.875	250	10	13.6	0	0	25	24.5	24.5	24.35	25	0	0	14.9	0	0	0	0	0	0	0	23.75	0											NO	128.5	128.5	7	0	140.55	0.1874	0	41.110875	234.25	9.37	12.7432	0	0	23.425	22.9565	22.9565	22.81595	23.425	0	0	13.9613	0	0	0	0	0	0	0	22.25375	0												10.9087	0.628590363	0.387911579	0	2.89301989	2.101286892	0	1.796228572	1.433399582	3.221727822	1.615850862	0	0	0.115445315	19.86783127	0.006066689	0.542372674	1.886259195	0	0	0.837749646	0	0	0	0	0	0	0	0.478952482	0	0	0	0	0	0	0	0	0	0	0	48.7214		17.5487835	10.9087	0.628590363	0.387911579	0	2.89301989	2.101286892	0	1.796228572	1.433399582	3.221727822	1.615850862	0	0	0.115445315	19.86783127	0.006066689	0.542372674	1.886259195	0	0	0.837749646	0	0	0	0	0	0	0	0.478952482	0	0	0	0	0	0	0	0	0	0	0	48.7214	NO																																																																																		0			10.9087	0.628590363	0.387911579	0	2.89301989	2.101286892	0	1.796228572	1.433399582	3.221727822	1.615850862	0	0	0.115445315	19.86783127	0.006066689	0.542372674	1.886259195	0	0	0.837749646	0	0	0	0	0	0	0	0.478952482	0	0	0	0	0	0	0	0	0	0	0	48.7214
H0524_806_0	2011	3																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		V	V	V	V		V	O																																																			0	YES	993.0416104	45.77421755	728.7056393	0	245.0704683	14.70601765	0	481.0933297	98.19128945	3672.359151	1294.526605	0	0	47.67725659	9610.765037	2.284143832	299.7565926	860.9114029	0	0	121.3746991	39.41246123	0	0	0	0	0	0	236.055171	0											3400	$250/day 1-4	$250/day 1-4	$100/days 21-100	0	$150/trip	20% coinsurance	0	"$50/ER visit, $25/UR OOA"	$250/procedure	$10/routine lab	"$0 to $10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$25/visit	$25/visit	$25/visit	$25 Individual & $12 Group Visit	$25/visit	0	0	"$11/generic, $50/brand"	0	0	0	0	0	0	0	$0 to $25/visit	0												250	250	100	0	150	0.196	0	43.875	250	10	13.6	0	0	25	24.5	24.5	24.35	25	0	0	14.9	0	0	0	0	0	0	0	23.75	0											NO	124	124	10	0	141.75	0.18522	0	41.461875	236.25	9.45	12.852	0	0	23.625	23.1525	23.1525	23.01075	23.625	0	0	14.0805	0	0	0	0	0	0	0	22.44375	0												10.2614	0.473000248	0.607254699	0	2.894894907	2.72384859	0	1.662252625	1.933141011	2.891982831	1.386437994	0	0	0.093864599	18.54276979	0.00440697	0.574802001	1.694919325	0	0	0.142418038	0	0	0	0	0	0	0	0.441496937	0	0	0	0	0	0	0	0	0	0	0	46.3289		18.25062175	10.2614	0.473000248	0.607254699	0	2.894894907	2.72384859	0	1.662252625	1.933141011	2.891982831	1.386437994	0	0	0.093864599	18.54276979	0.00440697	0.574802001	1.694919325	0	0	0.142418038	0	0	0	0	0	0	0	0.441496937	0	0	0	0	0	0	0	0	0	0	0	46.3289	NO																																																																																		0			10.2614	0.473000248	0.607254699	0	2.894894907	2.72384859	0	1.662252625	1.933141011	2.891982831	1.386437994	0	0	0.093864599	18.54276979	0.00440697	0.574802001	1.694919325	0	0	0.142418038	0	0	0	0	0	0	0	0.441496937	0	0	0	0	0	0	0	0	0	0	0	46.3289
H0524_807_0	2011	2																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	821.7203044	47.34970029	636.7168232	0	207.4755302	12.13174933	0	474.1249156	65.75448381	3590.013843	1323.944079	0	0	51.45689555	9181.868451	2.803704959	252.200256	854.2953625	0	0	720.0615807	56.05782117	0	0	0	0	0	0	209.305147	0											3400	$250/day 1-4	$250/day 1-4	$100/days 21-100	0	$150/trip	20% coinsurance	0	"$50/ER visit, $25/UR OOA"	$250/procedure	$10/routine lab	"$0 to $10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$25/visit	$25/visit	$25/visit	$25 Individual & $12 Group Visit	$25/visit	0	0	"$11/generic, $50/brand"	0	0	0	0	0	0	0	$0 to $25/visit	0												250	250	100	0	150	0.2	0	43.875	250	10	13.6	0	0	25	24.5	24.5	24.35	25	0	0	14.9	0	0	0	0	0	0	0	23.75	0											NO	128.5	128.5	7	0	140.55	0.1874	0	41.110875	234.25	9.37	12.7432	0	0	23.425	22.9565	22.9565	22.81595	23.425	0	0	13.9613	0	0	0	0	0	0	0	22.25375	0												8.7993	0.507036374	0.371418147	0	2.430057147	2.273489825	0	1.624307512	1.283582319	2.803202476	1.405940349	0	0	0.100448148	17.56529693	0.005363604	0.479515703	1.667655739	0	0	0.837749646	0	0	0	0	0	0	0	0.388152035	0	0	0	0	0	0	0	0	0	0	0	42.5425		15.14682988	8.7993	0.507036374	0.371418147	0	2.430057147	2.273489825	0	1.624307512	1.283582319	2.803202476	1.405940349	0	0	0.100448148	17.56529693	0.005363604	0.479515703	1.667655739	0	0	0.837749646	0	0	0	0	0	0	0	0.388152035	0	0	0	0	0	0	0	0	0	0	0	42.5425	NO																																																																																		0			8.7993	0.507036374	0.371418147	0	2.430057147	2.273489825	0	1.624307512	1.283582319	2.803202476	1.405940349	0	0	0.100448148	17.56529693	0.005363604	0.479515703	1.667655739	0	0	0.837749646	0	0	0	0	0	0	0	0.388152035	0	0	0	0	0	0	0	0	0	0	0	42.5425
H0524_808_0	2011	2																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		V	V	V	V		V	O																																																			0	YES	872.4652897	40.21625636	1110.651461	0	266.7799027	14.73319514	0	479.1227519	100.4425713	3639.602769	1282.979802	0	0	47.25198925	9616.455979	2.285496371	299.9340912	861.4211851	0	0	121.3746991	39.41246123	0	0	0	0	0	0	227.2690902	0											3400	$250/day 1-4	$250/day 1-4	$100/days 21-100	0	$150/trip	20% coinsurance	0	"$50/ER visit, $25/UR OOA"	$250/procedure	$10/routine lab	"$0 to $10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$25/visit	$25/visit	$25/visit	$25 Individual & $12 Group Visit	$25/visit	0	0	"$11/generic, $50/brand"	0	0	0	0	0	0	0	$0 to $25/visit	0												250	250	100	0	150	0.196	0	43.875	250	10	13.6	0	0	25	24.5	24.5	24.35	25	0	0	14.9	0	0	0	0	0	0	0	23.75	0											NO	124	124	10	0	141.75	0.18522	0	41.461875	236.25	9.45	12.852	0	0	23.625	23.1525	23.1525	23.01075	23.625	0	0	14.0805	0	0	0	0	0	0	0	22.44375	0												9.0155	0.415567982	0.925542884	0	3.151337601	2.728882404	0	1.655443971	1.977463122	2.866187181	1.374071368	0	0	0.093027354	18.55374975	0.00440958	0.575142366	1.695922958	0	0	0.142418038	0	0	0	0	0	0	0	0.42506422	0	0	0	0	0	0	0	0	0	0	0	45.5997		19.80540522	9.0155	0.415567982	0.925542884	0	3.151337601	2.728882404	0	1.655443971	1.977463122	2.866187181	1.374071368	0	0	0.093027354	18.55374975	0.00440958	0.575142366	1.695922958	0	0	0.142418038	0	0	0	0	0	0	0	0.42506422	0	0	0	0	0	0	0	0	0	0	0	45.5997	NO																																																																																		0			9.0155	0.415567982	0.925542884	0	3.151337601	2.728882404	0	1.655443971	1.977463122	2.866187181	1.374071368	0	0	0.093027354	18.55374975	0.00440958	0.575142366	1.695922958	0	0	0.142418038	0	0	0	0	0	0	0	0.42506422	0	0	0	0	0	0	0	0	0	0	0	45.5997
H0524_809_0	2011	3																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	1297.466109	74.76343359	1019.220596	0	340.3931162	10.60094791	0	612.0401171	79.16457693	4516.360266	1665.566957	0	0	64.73453546	11007.6539	3.361212806	302.3494777	1024.169288	0	0	699.4883927	56.05782117	0	0	0	0	0	0	300.6803849	0											2000	$500/admit	$500/admit	0	0	$150/trip	0% to 20% coinsurance	0	"$50/ER visit, $30/UR OOA"	$200/procedure	$10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$30/visit	$30/visit	$30/visit	$30 Individual & $15 Group Visit	$30/visit	0	0	"$15/generic, $35/brand"	0	0	0	0	0	0	0	$0 to $30/visit	0												500	500	0	0	150	0.1996	0	49	200	9.1	13.6	0	0	30	29.1	29.1	29.25	30	0	0	17	0	0	0	0	0	0	0	28.5	0											NO	72.5	72.5	0	0	127.5	0.16966	0	41.65	170	7.735	11.56	0	0	25.5	24.735	24.735	24.8625	25.5	0	0	14.45	0	0	0	0	0	0	0	24.225	0												7.8389	0.451695745	0	0	3.61667686	1.798556822	0	2.12428924	1.121498173	2.911170555	1.604496168	0	0	0.137560888	22.6895266	0.0069283	0.626430324	2.176359738	0	0	0.842300606	0	0	0	0	0	0	0	0.606998527	0	0	0	0	0	0	0	0	0	0	0	48.5533		9.81007427	7.8389	0.451695745	0	0	3.61667686	1.798556822	0	2.12428924	1.121498173	2.911170555	1.604496168	0	0	0.137560888	22.6895266	0.0069283	0.626430324	2.176359738	0	0	0.842300606	0	0	0	0	0	0	0	0.606998527	0	0	0	0	0	0	0	0	0	0	0	48.5533	NO																																																																																		0			7.8389	0.451695745	0	0	3.61667686	1.798556822	0	2.12428924	1.121498173	2.911170555	1.604496168	0	0	0.137560888	22.6895266	0.0069283	0.626430324	2.176359738	0	0	0.842300606	0	0	0	0	0	0	0	0.606998527	0	0	0	0	0	0	0	0	0	0	0	48.5533
H0524_810_0	2011	3																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		V	V	V	V		V	O																																																			0	YES	1284.05992	59.18869615	1317.662545	0	370.400283	14.65930105	0	628.2386682	89.67542217	3897.774985	1373.986915	0	0	50.60377008	9541.983354	2.267796824	297.6113146	854.7500896	0	0	117.9068505	39.41246123	0	0	0	0	0	0	257.4305645	0											2000	$500/admit	$500/admit	0	0	$150/trip	0% to 20% coinsurance	0	"$50/ER visit, $30/UR OOA"	$200/procedure	$10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$30/visit	$30/visit	$30/visit	$30 Individual & $15 Group Visit	$30/visit	0	0	"$15/generic, $35/brand"	0	0	0	0	0	0	0	$0 to $30/visit	0												500	500	0	0	150	0.196	0	44.1	200	9.2	13.6	0	0	30	29.1	29.1	29.25	30	0	0	17	0	0	0	0	0	0	0	28.5	0											NO	68	68	0	0	130.65	0.170716	0	38.4111	174.2	8.0132	11.8456	0	0	26.13	25.3461	25.3461	25.47675	26.13	0	0	14.807	0	0	0	0	0	0	0	24.8235	0												7.2763	0.335402612	0	0	4.032733081	2.502577238	0	2.010944859	1.301788212	2.602804209	1.356308283	0	0	0.110189709	20.15433869	0.004789984	0.631847422	1.86121832	0	0	0.145487228	0	0	0	0	0	0	0	0.532527302	0	0	0	0	0	0	0	0	0	0	0	44.8593		10.28932179	7.2763	0.335402612	0	0	4.032733081	2.502577238	0	2.010944859	1.301788212	2.602804209	1.356308283	0	0	0.110189709	20.15433869	0.004789984	0.631847422	1.86121832	0	0	0.145487228	0	0	0	0	0	0	0	0.532527302	0	0	0	0	0	0	0	0	0	0	0	44.8593	NO																																																																																		0			7.2763	0.335402612	0	0	4.032733081	2.502577238	0	2.010944859	1.301788212	2.602804209	1.356308283	0	0	0.110189709	20.15433869	0.004789984	0.631847422	1.86121832	0	0	0.145487228	0	0	0	0	0	0	0	0.532527302	0	0	0	0	0	0	0	0	0	0	0	44.8593
H0524_811_0	2011	2																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	1143.102174	65.86857478	1673.770234	0	315.7389361	12.64822175	0	610.4961416	69.40012407	4252.738164	1568.347019	0	0	60.95594976	10769.30326	3.288431882	295.8026521	1001.992773	0	0	699.4883927	56.05782117	0	0	0	0	0	0	221.9618131	0											2000	$500/admit	$500/admit	0	0	$150/trip	0% to 20% coinsurance	0	"$50/ER visit, $30/UR OOA"	$200/procedure	$10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$30/visit	$30/visit	$30/visit	$30 Individual & $15 Group Visit	$30/visit	0	0	"$15/generic, $35/brand"	0	0	0	0	0	0	0	$0 to $30/visit	0												500	500	0	0	150	0.1996	0	49	200	9.1	13.6	0	0	30	29.1	29.1	29.25	30	0	0	17	0	0	0	0	0	0	0	28.5	0											NO	72.5	72.5	0	0	127.5	0.16966	0	41.65	170	7.735	11.56	0	0	25.5	24.735	24.735	24.8625	25.5	0	0	14.45	0	0	0	0	0	0	0	24.225	0												6.9062	0.397955973	0	0	3.354726196	2.145897303	0	2.118930358	0.983168424	2.741244141	1.510840962	0	0	0.129531393	22.19822635	0.00677828	0.61286612	2.129234643	0	0	0.842300606	0	0	0	0	0	0	0	0.44808541	0	0	0	0	0	0	0	0	0	0	0	46.526		9.304566784	6.9062	0.397955973	0	0	3.354726196	2.145897303	0	2.118930358	0.983168424	2.741244141	1.510840962	0	0	0.129531393	22.19822635	0.00677828	0.61286612	2.129234643	0	0	0.842300606	0	0	0	0	0	0	0	0.44808541	0	0	0	0	0	0	0	0	0	0	0	46.526	NO																																																																																		0			6.9062	0.397955973	0	0	3.354726196	2.145897303	0	2.118930358	0.983168424	2.741244141	1.510840962	0	0	0.129531393	22.19822635	0.00677828	0.61286612	2.129234643	0	0	0.842300606	0	0	0	0	0	0	0	0.44808541	0	0	0	0	0	0	0	0	0	0	0	46.526
H0524_812_0	2011	2																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		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	1332.849742	61.43766126	1823.952567	0	429.6863634	16.13949522	0	616.0997927	100.3989383	3893.297399	1372.408541	0	0	50.54563877	9332.659472	2.218047834	291.0825717	835.999312	0	0	117.9068505	39.41246123	0	0	0	0	0	0	179.5430327	0											2000	$500/admit	$500/admit	0	0	$150/trip	0% to 20% coinsurance	0	"$50/ER visit, $30/UR OOA"	$200/procedure	$10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"	0	0	$30/visit	$30/visit	$30/visit	$30 Individual & $15 Group Visit	$30/visit	0	0	"$15/generic, $35/brand"	0	0	0	0	0	0	0	$0 to $30/visit	0												500	500	0	0	150	0.196	0	49	200	9.2	13.6	0	0	30	29.1	29.1	29.25	30	0	0	17	0	0	0	0	0	0	0	28.5	0											NO	68	68	0	0	130.65	0.170716	0	42.679	174.2	8.0132	11.8456	0	0	26.13	25.3461	25.3461	25.47675	26.13	0	0	14.807	0	0	0	0	0	0	0	24.8235	0												7.5528	0.348146747	0	0	4.678210282	2.755270066	0	2.191210254	1.45745792	2.599814226	1.354750218	0	0	0.110063128	19.71221002	0.004684905	0.617986492	1.820388502	0	0	0.145487228	0	0	0	0	0	0	0	0.371407206	0	0	0	0	0	0	0	0	0	0	0	45.7199		10.5319532	7.5528	0.348146747	0	0	4.678210282	2.755270066	0	2.191210254	1.45745792	2.599814226	1.354750218	0	0	0.110063128	19.71221002	0.004684905	0.617986492	1.820388502	0	0	0.145487228	0	0	0	0	0	0	0	0.371407206	0	0	0	0	0	0	0	0	0	0	0	45.7199	NO																																																																																		0			7.5528	0.348146747	0	0	4.678210282	2.755270066	0	2.191210254	1.45745792	2.599814226	1.354750218	0	0	0.110063128	19.71221002	0.004684905	0.617986492	1.820388502	0	0	0.145487228	0	0	0	0	0	0	0	0.371407206	0	0	0	0	0	0	0	0	0	0	0	45.7199
H0540_001_0	2011	5	G.	H.6	H.7	I.7							OP Facility - Surgery	OP Facility - Other	OP Facility - Other	Professional								Lab	Radiology	Radiology							D	D	D	V	T	Coin	Coin	V	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	V		V	V	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	0	0	0	0	0	0	0	0	0	0	NO	1408.257404	37.9584206	532.0505287	37.9584206	166.3844103	19.42202594	6.504894647	336.9786201	39.02562548	7541.415396	295.296386	3.293681363	0	97.0259554	2624.744152	2895.605324	7.765515243	1116.991713	657.2732101	1467.682381	23.95576545	1.589984503	0	0	302.4	0	162	0	9.318618291	0	819.3663458	5.475456011	20.02217001	21.14172178	0	0	0	0	0	0		1A: $225/day (days1-7) no yrly max	1B: $225/day (days1-7) no yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: N/A	9A: 20% coin; 9B: 20% coin	8A: $0 -$75 copay	8B: $75 copay	9A: 20% coin	12: 20% coin	3: $35 copay; 5: $40 copay; 9C: $40 copay; 9D: $35 copay	7A: $20 copay; 7G: $20 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35-$50 copay; 7I: $35-$50 copay	8B: $75 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0-$35; 17B: $0; 18A: $35	15: 20% coin	13A: $0 copay	10B: Not covered	-	17A: $35 copay	-	18A: $35 copay	-	14A: $0 copay or not covered	0	9A: $35 copay	8A: 20% coin	8B: 20% coin	8B: 20% coin	0	0	0	0	0	0		225	225	128	0	125	0.2	0.2	50	0.2	42.49311532	75	0.2	0.2	35.16722408	16.24852071	28.36247586	40	41.74082314	75	7.725925926	0.2	0	0	0	35	0	35	0	0	0	35	0.2	0.2	0.2	0	0	0	0	0	0	NO	162.8745527	104.824859	115.4200598	0	112.7149021	0.180343843	0.180343843	45.08596086	0.180343843	38.31685868	67.62894128	0.180343843	0	31.71096177	14.65160337	25.57498953	36.06876868	37.63850236	67.62894128	6.966615877	0.180343843	0	0	0	35	0	35	0	0	0	31.5601726	0.180343843	0.180343843	0.180343843	0	0	0	0	0	0		19.1141	0.331582174	5.117441986	0	1.562833544	3.502642805	1.173117702	1.266083739	7.038031291	24.080279	1.664215162	0.593995156	0	0.256398863	3.204725856	6.17125632	0.023341048	3.503491267	3.704224278	0.852064948	4.320274813	0	0	0	0.882	0	0.4725	0	0	0	2.154945274	0.987464782	3.610875094	3.812779362	0	0	0	0	0	0	99.4007		10.68631387	19.1141	0.331582174	5.117441986	0	1.562833544	3.502642805	1.173117702	1.266083739	7.038031291	24.080279	1.664215162	0.593995156	0	0.256398863	3.204725856	6.17125632	0.023341048	3.503491267	3.704224278	0.852064948	4.320274813	0	0	0	0.882	0	0.4725	0	0	0	2.154945274	0.987464782	3.610875094	3.812779362	0	0	0	0	0	0	99.4007	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	0	0	0	0	0	5000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	19.1141	0.331582174	5.117441986	0	1.562833544	3.502642805	1.173117702	1.266083739	7.038031291	24.080279	1.664215162	0.593995156	0	0.256398863	3.204725856	6.17125632	0.023341048	3.503491267	3.704224278	0.852064948	4.320274813	0	0	0	0.882	0	0.4725	0	0	0	2.154945274	0.987464782	3.610875094	3.812779362	0	0	0	0	0	0	99.4007
H0540_020_0	2011	10	G.	H.6	H.7	I.7							OP Facility - Surgery	OP Facility - Other	OP Facility - Other	Professional								Lab	Radiology	Radiology							D	D	D	V	T	Coin	Coin	V	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	V		V	V	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	0	0	0	0	0	0	0	0	0	0	YES	1495.390711	64.1386762	545.9362911	45.45260518	156.0539445	19.16142092	8.104389	422.6576576	44.66453935	7693.652678	331.5782972	7.45513657	1.026065887	74.08702579	2851.096782	2830.267757	16.36566252	1119.808059	706.6990632	1656.403418	30.91795137	0	0	0	302.4	0	162	0	8.430795842	0	677.1450539	6.558704712	27.35169062	17.93939274	0	0	0	0	0	0	5000	1A: $225/day (days1-7) no yrly max	1B: $225/day (days1-7) no yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: N/A	9A: 20% coin; 9B: 20% coin	8A: $0 -$75 copay	8B: $75 copay	9A: 20% coin	12: 20% coin	3: $35 copay; 5: $40 copay; 9C: $40 copay; 9D: $35 copay	7A: $20 copay; 7G: $20 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35-$50 copay; 7I: $35-$50 copay	8B: $75 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0-$35; 17B: $0; 18A: $35	15: 20% coin	13A: $0 copay	10B: Not covered	-	17A: $35 copay	-	18A: $35 copay	-	14A: $0 copay or not covered		9A: $35 copay	8A: 20% coin	8B: 20% coin	8B: 20% coin								225	225	128	0	125	0.2	0.2	50	0.2	41.87609428	75	0.2	0.2	37.55244755	16.38545834	28.32398808	40	43.39016829	75	8.226047904	0.2	0	0	0	35	0	35	0	0	0	35	0.2	0.2	0.2	0	0	0	0	0	0	NO	153.4211789	133.3046737	114.6561257	0	111.9688728	0.179150196	0.179150196	44.78754912	0.179150196	37.51055258	67.18132367	0.179150196	0.179150196	33.63764178	14.6772904	25.37124015	35.83003929	38.86678587	67.18132367	7.368490491	0.179150196	0	0	0	35	0	35	0	0	0	31.35128438	0.179150196	0.179150196	0.179150196	0	0	0	0	0	0		19.1187	0.712498775	5.216245004	0	1.456098688	3.432772323	1.451902882	1.577483383	8.001661	24.04943028	1.856322409	1.335589181	0.183819905	0.20767607	3.487197953	5.983950246	0.048865194	3.626945005	3.956414875	1.017099403	5.538957062	0	0	0	0.882	0	0.4725	0	0	0	1.769113929	1.174993238	4.900060748	3.213845734	0	0	0	0	0	0	104.6722		12.02428445	19.1187	0.712498775	5.216245004	0	1.456098688	3.432772323	1.451902882	1.577483383	8.001661	24.04943028	1.856322409	1.335589181	0.183819905	0.20767607	3.487197953	5.983950246	0.048865194	3.626945005	3.956414875	1.017099403	5.538957062	0	0	0	0.882	0	0.4725	0	0	0	1.769113929	1.174993238	4.900060748	3.213845734	0	0	0	0	0	0	104.6722	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	0	0	0	0	0	0	0	0		0	19.1187	0.712498775	5.216245004	0	1.456098688	3.432772323	1.451902882	1.577483383	8.001661	24.04943028	1.856322409	1.335589181	0.183819905	0.20767607	3.487197953	5.983950246	0.048865194	3.626945005	3.956414875	1.017099403	5.538957062	0	0	0	0.882	0	0.4725	0	0	0	1.769113929	1.174993238	4.900060748	3.213845734	0	0	0	0	0	0	104.6722
H0540_090_0	2011	5	G.	H.6	H.7	I.7							OP Facility - Surgery	OP Facility - Other	OP Facility - Other	Professional								Lab	Radiology	Radiology							D	D	D	V	T	Coin	Coin	V	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	V		V	V	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	0	0	0	0	0	0	0	0	0	0	YES	1264.914164	43.7217053	684.4708347	44.22425364	156.2925327	12.46955628	3.099021522	387.6065201	62.02566017	7253.736735	422.7479831	2.860310831	0	54.13236369	2678.187889	3063.60612	6.908905555	901.1186817	598.607317	1470.609897	33.94608117	1.010424423	0	0	302.4	0	162	0	4.934932539	0	861.4779022	6.104941649	27.93791043	28.3592923	0	0	0	0	0	0	5000	1A: $225/day (days1-7) no yrly max	1B: $225/day (days1-7) no yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: N/A	9A: 20% coin; 9B: 20% coin	8A: $0 -$75 copay	8B: $75 copay	9A: 20% coin	12: 20% coin	3: $35 copay; 5: $40 copay; 9C: $40 copay; 9D: $35 copay	7A: $20 copay; 7G: $20 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35-$50 copay; 7I: $35-$50 copay	8B: $75 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0-$35; 17B: $0; 18A: $35	15: 20% coin	13A: $0 copay	10B: Not covered	-	17A: $35 copay	-	18A: $35 copay	-	14A: $0 copay or not covered	0	9A: $35 copay	8A: 20% coin	8B: 20% coin	8B: 20% coin	0	0	0	0	0	0		225	225	128	0	125	0.2	0.2	50	0.2	43.78358209	75	0.2	0.2	35.23809524	16.5726921	28.69362113	40	43.16538883	75	7.927852349	0.2	0	0	0	35	0	35	0	0	0	35	0.2	0.2	0.2	0	0	0	0	0	0	NO	164.5894765	141.140123	114.516314	0	111.8323379	0.178931741	0.178931741	44.73293514	0.178931741	39.17136276	67.09940272	0.178931741	0	31.52606858	14.82690321	25.67099786	35.78634812	38.61829078	67.09940272	7.092722099	0.178931741	0	0	0	35	0	35	0	0	0	31.3130546	0.178931741	0.178931741	0.178931741	0	0	0	0	0	0		17.3493	0.514240572	6.531923084	0	1.456546611	2.23119941	0.554513315	1.44489811	11.09835934	23.67822942	2.363844764	0.511800396	0	0.142215051	3.309102718	6.553818848	0.020603708	2.899971939	3.347182786	0.869218943	6.074031389	0	0	0	0.882	0	0.4725	0	0	0	2.247958716	1.092367835	4.998978942	5.074377532	0	0	0	0	0	0	105.7192		12.28838521	17.3493	0.514240572	6.531923084	0	1.456546611	2.23119941	0.554513315	1.44489811	11.09835934	23.67822942	2.363844764	0.511800396	0	0.142215051	3.309102718	6.553818848	0.020603708	2.899971939	3.347182786	0.869218943	6.074031389	0	0	0	0.882	0	0.4725	0	0	0	2.247958716	1.092367835	4.998978942	5.074377532	0	0	0	0	0	0	105.7192	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	-	-	-	-	-	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	17.3493	0.514240572	6.531923084	0	1.456546611	2.23119941	0.554513315	1.44489811	11.09835934	23.67822942	2.363844764	0.511800396	0	0.142215051	3.309102718	6.553818848	0.020603708	2.899971939	3.347182786	0.869218943	6.074031389	0	0	0	0.882	0	0.4725	0	0	0	2.247958716	1.092367835	4.998978942	5.074377532	0	0	0	0	0	0	105.7192
H0540_091_0	2011	9	G.	H.6	H.7	I.7							OP Facility - Surgery	OP Facility - Other	OP Facility - Other	Professional								Lab	Radiology	Radiology							D	D	D	V	T	Coin	Coin	V	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	V		V	V	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	0	0	0	0	0	0	0	0	0	0	YES	1053.217661	41.97606621	307.8244855	25.12203963	121.4761916	14.631051	3.302498071	351.1437908	49.99920679	7362.579096	380.7049407	4.160739156	0	67.85486517	2780.457983	2958.764531	3.747247955	763.8140415	649.8352495	1610.067538	37.96959384	1.598430688	0	0	302.4	0	162	0	6.869954584	0	353.954465	8.311252068	17.54620264	30.5565291	0	0	0	0	0	0	5000	1A: $225/day (days1-7) no yrly max	1B: $225/day (days1-7) no yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: N/A	9A: 20% coin; 9B: 20% coin	8A: $0 -$75 copay	8B: $75 copay	9A: 20% coin	12: 20% coin	3: $35 copay; 5: $40 copay; 9C: $40 copay; 9D: $35 copay	7A: $20 copay; 7G: $20 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35-$50 copay; 7I: $35-$50 copay	8B: $75 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0-$35; 17B: $0; 18A: $35	15: 20% coin	13A: $0 copay	10B: Not covered	-	17A: $35 copay	-	18A: $35 copay	-	14A: $0 copay or not covered		9A: $35 copay	8A: 20% coin	8B: 20% coin	8B: 20% coin								225	225	128	0	125	0.2	0.2	50	0.2	42.22406841	75	0.2	0.2	36.29807692	16.61725067	30.51451187	40	42.50613246	75	6.89681924	0.2	0	0	0	35	0	35	0	0	0	35	0.2	0.2	0.2	0	0	0	0	0	0	NO	156.0480234	143.8115993	116.1214233	0	113.3998274	0.181439724	0.181439724	45.35993096	0.181439724	38.30561656	68.03989645	0.181439724	0	32.92956527	15.07514687	27.68272304	36.28794477	38.56150468	68.03989645	6.256784892	0.181439724	0	0	0	35	0	35	0	0	0	31.75195167	0.181439724	0.181439724	0.181439724	0	0	0	0	0	0		13.696	0.503053768	2.978751448	0	1.147948264	2.654653853	0.599204338	1.327321509	9.071842274	23.50234432	2.158593728	0.754923364	0	0.186202601	3.492984371	6.825554921	0.011331661	2.454484895	3.684560257	0.839487187	6.889192621	0	0	0	0.882	0	0.4725	0	0	0	0.936562089	1.50799128	3.183578162	5.544168201	0	0	0	0	0	0	95.3053		9.61064301	13.696	0.503053768	2.978751448	0	1.147948264	2.654653853	0.599204338	1.327321509	9.071842274	23.50234432	2.158593728	0.754923364	0	0.186202601	3.492984371	6.825554921	0.011331661	2.454484895	3.684560257	0.839487187	6.889192621	0	0	0	0.882	0	0.4725	0	0	0	0.936562089	1.50799128	3.183578162	5.544168201	0	0	0	0	0	0	95.3053	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	13.696	0.503053768	2.978751448	0	1.147948264	2.654653853	0.599204338	1.327321509	9.071842274	23.50234432	2.158593728	0.754923364	0	0.186202601	3.492984371	6.825554921	0.011331661	2.454484895	3.684560257	0.839487187	6.889192621	0	0	0	0.882	0	0.4725	0	0	0	0.936562089	1.50799128	3.183578162	5.544168201	0	0	0	0	0	0	95.3053
H0543_001_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1066.344094	28.14526991	734.6825621	418.2238555	337.6028585	8.351363057	8.489414664	168.9789216	167.2686344	33.0970437	64.0596986	0	8.990338869	911.9315023	6642.386737	6291.604204	136.7043008	678.4271092	0	0	26.48090493	1060.823544	0	0	505.3666998	529.0639758	17.46434425	6	388.1378368	0											6700	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$75 Days 21-96 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$0 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 9a, 9d); $150 (5); $30 (9c)"	"$0 (7a, 14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$30 (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 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0	0	60.19295527	0	200	0.2	0.13064005	50	0	0.102763698	0.138595815	0	0	0.316786052	0.002014888	0	30	0	0	0	0.2	0	0	0	0	30	0	0	0	0											NO	0	0	54.09451435	0	179.7370277	0.179737028	0.117404271	44.95080771	0	0.092352208	0.124553999	0	0	0.284690917	0.00181075	0	26.96055416	0	0	0	0.179737028	0	0	0	0	30	0	0	0	0												0	0	3.311858033	0	5.056644529	1.501049173	0.996693541	0.632978251	0	3.056585072	7.978891642	0	0	0.021634885	0.001002308	0	0.307135309	0	0	0	4.759599144	0	0	0	0	1.322659939	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9467	0	3.113989349	0	0	3.311858033	0	5.056644529	1.501049173	0.996693541	0.632978251	0	3.056585072	7.978891642	0	0	0.021634885	0.001002308	0	0.307135309	0	0	0	4.759599144	0	0	0	0	1.322659939	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9467	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	3.311858033	0	5.056644529	1.501049173	0.996693541	0.632978251	0	3.056585072	7.978891642	0	0	0.021634885	0.001002308	0	0.307135309	0	0	0	4.759599144	0	0	0	0	1.322659939	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9467
H0543_004_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	O	O	V	Coin	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	1017.494878	24.73989391	683.9018628	401.6148155	298.7973354	7.346018246	6.623568074	153.193867	143.3010504	33.60811746	64.11579842	0	10.99652636	954.9861173	6540.896833	149.5006236	141.3454563	664.2345352	0	0	24.66972392	1026.830591	0	0	489.6002403	506.2225225	17.46434425	6	94.47336285	0											5900	"$150 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$75 Days 21-86 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$125 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$10 (3, 9d); $150 (5); $125 (9a); $30 (9c)"	"$5 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $10 (7d); $5/$30 (7f)"	"$30 (7e, 7h)"	"$10 (7c, 7i)"	Included in h.2.	$5/$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $0/$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												96.96708319	59.94903028	59.17825332	0	200	0.2	0.136701542	50	125	0.098987743	0.138879607	0	0	48.8242597	3.053718096	0.036336886	30	10	0	0	0.2	29.69112308	0	0	30	30	0	0	0	0											NO	89.87039033	55.56156352	54.84719712	0	185.3626764	0.185362676	0.126696819	46.35405055	115.8516728	0.091743165	0.128715478	0	0	45.25097727	3.047335803	0.036260941	29.93729979	9.97909993	0	0	0.185362676	27.5181302	0	0	30	30	0	0	0	0												7.6202	0.114548932	3.12584169	0	4.615489483	1.361677603	0.839185002	0.591763021	1.3834722	3.083315056	8.252695636	0	0	3.601171257	1.661025759	5.421033367	0.352625108	0.5523719	0	0	4.572846053	2.354704826	0	0	1.224000601	1.265556306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9935	0	3.294964021	7.6202	0.114548932	3.12584169	0	4.615489483	1.361677603	0.839185002	0.591763021	1.3834722	3.083315056	8.252695636	0	0	3.601171257	1.661025759	5.421033367	0.352625108	0.5523719	0	0	4.572846053	2.354704826	0	0	1.224000601	1.265556306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9935	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.6202	0.114548932	3.12584169	0	4.615489483	1.361677603	0.839185002	0.591763021	1.3834722	3.083315056	8.252695636	0	0	3.601171257	1.661025759	5.421033367	0.352625108	0.5523719	0	0	4.572846053	2.354704826	0	0	1.224000601	1.265556306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9935
H0543_007_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	O	O	V	Coin	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	991.7231027	28.27395928	693.181424	380.1973436	318.4144729	7.698699451	6.856990091	184.3740881	170.1807763	36.27546932	69.66021464	0	7.552584427	777.9452323	6226.230674	160.2204954	125.8835371	631.2202143	0	0	25.68860408	1002.834914	0	0	500.5249506	527.0838557	17.46434425	6	94.46726604	0											5900	"$200 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$175 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$10 (3, 9d); $150 (5); $175 (9a); $30 (9c)"	"$0 (7a, 14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $10 (7d); $0/$30 (7f)"	"$30 (7e, 7h)"	"$10 (7c, 7i)"	Included in h.2.	$0/$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $0/$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												148.9992442	99.66616326	50	0	200	0.2	0.13996115	50	175	0.0880923	0.138746507	0	0	68.08385502	0.004245728	0.032337942	30	10	0	0	0.2	29.71178484	0	0	30	30	0	0	0	0											NO	136.3962086	91.23594465	45.77077198	0	183.0830879	0.183083088	0.128122598	45.78344265	160.1977019	0.080641052	0.127010695	0	0	62.32501207	0.00422553	0.032184106	29.8572853	9.952428434	0	0	0.183083088	27.19862658	0	0	30	30	0	0	0	0												11.2723	0.214966782	2.643954075	0	4.858025411	1.409501668	0.878535385	0.703440041	2.271880773	2.925291992	8.847592285	0	0	4.040453833	0.002192427	5.156553331	0.313211724	0.523514501	0	0	4.70314896	2.272977696	0	0	1.251312376	1.317709639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6065	0	4.37513863	11.2723	0.214966782	2.643954075	0	4.858025411	1.409501668	0.878535385	0.703440041	2.271880773	2.925291992	8.847592285	0	0	4.040453833	0.002192427	5.156553331	0.313211724	0.523514501	0	0	4.70314896	2.272977696	0	0	1.251312376	1.317709639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6065	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.2723	0.214966782	2.643954075	0	4.858025411	1.409501668	0.878535385	0.703440041	2.271880773	2.925291992	8.847592285	0	0	4.040453833	0.002192427	5.156553331	0.313211724	0.523514501	0	0	4.70314896	2.272977696	0	0	1.251312376	1.317709639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6065
H0543_013_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	O	O	V	Coin	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	881.5209634	25.40150923	562.9840055	353.5000711	248.2831491	5.863032282	5.037731171	202.9606793	121.0837663	39.73308062	61.22680847	0	7.917322246	877.4707264	5808.268635	129.962346	129.4322862	589.5101711	0	0	21.60951123	903.2077321	0	0	534.8288044	548.7116324	17.46434425	6	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)"	"$50 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$200 (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $40 (7d); $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); $0/$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												155.7924926	107.839202	50	0	200	0.2	0.140061041	50	200	0.074064392	0.148088249	0	0	78.48248741	12.15507851	0.141929852	30	30	0	0	0.2	39.60250871	0	0	30	30	0	0	0	0											NO	131.3897647	90.94769035	42.16819519	0	168.6727807	0.168672781	0.118122426	42.1893321	168.6727807	0.062463235	0.124892284	0	0	66.18929695	12.01154924	0.14025392	29.6457548	29.6457548	0	0	0.168672781	33.39932635	0	0	30	30	0	0	0	0												9.6519	0.192517383	1.978334953	0	3.489884097	0.988933959	0.595069029	0.713564625	1.701961297	2.481856733	7.64675595	0	0	4.839930873	5.813858726	18.22772847	0.319759818	1.456372832	0	0	3.64493635	2.513877484	0	0	1.337072011	1.371779081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9661	0	7.818821899	9.6519	0.192517383	1.978334953	0	3.489884097	0.988933959	0.595069029	0.713564625	1.701961297	2.481856733	7.64675595	0	0	4.839930873	5.813858726	18.22772847	0.319759818	1.456372832	0	0	3.64493635	2.513877484	0	0	1.337072011	1.371779081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9661	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.6519	0.192517383	1.978334953	0	3.489884097	0.988933959	0.595069029	0.713564625	1.701961297	2.481856733	7.64675595	0	0	4.839930873	5.813858726	18.22772847	0.319759818	1.456372832	0	0	3.64493635	2.513877484	0	0	1.337072011	1.371779081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9661
H0543_019_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	O	O	V	Coin	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	984.8143351	22.404044	597.9565015	371.1811045	279.1752108	6.171314531	5.303434053	152.6033891	128.8959315	35.27288704	66.90784277	0	8.130882845	874.9511928	5974.968917	129.5868849	128.2704085	611.1409241	0	0	21.41349219	936.2321589	0	0	416.5939956	431.5116248	17.46434425	6	22.51104436	0											6700	"$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 21-76 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$185 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$20 (3, 9d); $150 (5); $185 (9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $20 (7d); $10/$20 (7f)"	"$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 18a); $0/$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												148.9992442	99.66616326	45.84506178	0	200	0.2	0.141008926	50	185	0.086138355	0.138801502	0	0	72.3773653	6.105468896	0.07287603	30	20	0	0	0.2	19.81228207	0	0	30	30	0	0	0	0											NO	137.451635	91.94192334	42.29201785	0	184.4997747	0.184499775	0.130080575	46.13847824	170.6622916	0.079462535	0.128044229	0	0	66.76803797	6.086997511	0.072655552	29.90923849	19.93949233	0	0	0.184499775	18.27680789	0	0	30	30	0	0	0	0												11.2804	0.171655908	2.10739892	0	4.292313625	1.138606141	0.689873751	0.586740679	1.833139588	2.802873033	8.567163168	0	0	4.868231205	3.030801744	9.415206673	0.319705853	1.015486647	0	0	3.950784484	1.425944609	0	0	1.041484989	1.078779062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6166	0	3.714232392	11.2804	0.171655908	2.10739892	0	4.292313625	1.138606141	0.689873751	0.586740679	1.833139588	2.802873033	8.567163168	0	0	4.868231205	3.030801744	9.415206673	0.319705853	1.015486647	0	0	3.950784484	1.425944609	0	0	1.041484989	1.078779062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6166	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.2804	0.171655908	2.10739892	0	4.292313625	1.138606141	0.689873751	0.586740679	1.833139588	2.802873033	8.567163168	0	0	4.868231205	3.030801744	9.415206673	0.319705853	1.015486647	0	0	3.950784484	1.425944609	0	0	1.041484989	1.078779062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6166
H0543_022_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	O	O	V	Coin	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	1282.806458	28.79352941	952.2379462	643.1360466	359.8422226	6.151050587	5.127399061	357.7399192	296.2165552	31.22207431	53.68619634	0	11.67719232	306.0524346	6095.139015	171.2391853	78.27918143	607.5082413	0	0	27.50894126	1078.384615	0	0	452.4734595	513.2261154	17.46434425	6	0	0											5900	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-69 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$260 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$20 (3, 9d); $150 (5); $260 (9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $20 (7d); $10/$20 (7f)"	"$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 18a); $0/$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												190.7019303	117.8997596	68.32087923	0	200	0.2	0.158159086	50	260	0.103483025	0.137030566	0	0	100.0662635	6.501246213	0.061810232	30	20	0	0	0.2	19.56780876	0	0	30	30	0	0	0	0											NO	164.3951238	101.6358122	58.89620194	0	172.4105504	0.17241055	0.136341475	43.11335673	224.1337155	0.089207826	0.118127576	0	0	86.26239781	6.434345211	0.061174174	29.69128534	19.79419022	0	0	0.17241055	16.86848339	0	0	30	30	0	0	0	0												17.5739	0.243871146	4.673599865	0	5.170049637	1.060506017	0.69907715	1.285280729	5.532676425	2.785253385	6.341820262	0	0	2.200068072	3.268185711	10.47541576	0.193684126	1.002094474	0	0	4.742831703	1.515892747	0	0	1.131183649	1.283065289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.1785	0	8.768112297	17.5739	0.243871146	4.673599865	0	5.170049637	1.060506017	0.69907715	1.285280729	5.532676425	2.785253385	6.341820262	0	0	2.200068072	3.268185711	10.47541576	0.193684126	1.002094474	0	0	4.742831703	1.515892747	0	0	1.131183649	1.283065289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.1785	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.5739	0.243871146	4.673599865	0	5.170049637	1.060506017	0.69907715	1.285280729	5.532676425	2.785253385	6.341820262	0	0	2.200068072	3.268185711	10.47541576	0.193684126	1.002094474	0	0	4.742831703	1.515892747	0	0	1.131183649	1.283065289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.1785
H0543_028_0	2011	6																															A	A	D	V	T	Coin	Coin	V	V	Coin	Coin	V	O	O	V	Coin	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	256.8321893	4.794794063	667.7927556	428.8661014	306.5930236	7.532828096	11.01308927	147.1513074	150.5022822	39.48970468	76.35178816	0	9.456669015	1040.470975	6937.499358	155.7470684	163.2772025	701.2466493	0	0	38.67501282	1076.339104	0	0	0	0	17.46434425	6	6.265192393	0											6700	"$200 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$40 (4a, 4a1, 4b)"	$0 (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $20 (7d); $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); $0/$20 (17a)"	$0 n/c (10b)	"$0 n/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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												200	200	0	0	200	0.2	0.106505195	40	0	0.088734555	0.139122572	0	0	0.014699463	6.053548491	0.069325494	10	0	0	0	0.2	19.80421792	0	0	0	0	0	0	0	0											NO	186.9599984	186.9599984	0	0	186.9599984	0.186959998	0.099561055	37.40195631	0	0.082949061	0.13005178	0	0	0.013741058	6.041794872	0.069190891	9.980583918	0	0	0	0.186959998	18.51298276	0	0	0	0	0	0	0	0												4.0014	0.074702891	0	0	4.776719268	1.408337529	1.096474789	0.458645564	0	3.275633917	9.929685931	0	0	0.001191431	3.492912337	10.77627837	0.135800152	0	0	0	7.230680336	1.660520607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.319	0	2.393313644	4.0014	0.074702891	0	0	4.776719268	1.408337529	1.096474789	0.458645564	0	3.275633917	9.929685931	0	0	0.001191431	3.492912337	10.77627837	0.135800152	0	0	0	7.230680336	1.660520607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.319	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.0014	0.074702891	0	0	4.776719268	1.408337529	1.096474789	0.458645564	0	3.275633917	9.929685931	0	0	0.001191431	3.492912337	10.77627837	0.135800152	0	0	0	7.230680336	1.660520607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.319
H0543_029_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	O	O	V	Coin	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	1419.304839	30.02012194	1208.43414	589.7679821	365.231328	10.25827107	13.73332821	303.1918473	318.4497151	39.52226132	76.41213663	0	16.0384058	404.3145056	6636.410695	194.9279697	188.2879238	668.9888755	0	0	42.63479061	1170.920038	0	0	0	0	17.46434425	6	0	0											6700	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-77 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$300 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$20 (3, 9d); $150 (5); $300 (9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $20 (7d); $10/$20 (7f)"	"$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 18a); $0/$20 (17a)"	$0 n/c (10b)	"$0 n/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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												206.8631108	127.8912646	68.01720315	0	200	0.2	0.116475318	50	300	0.090449082	0.138518337	0	0	112.1156724	6.42867539	0.055977249	30	20	0	0	0.2	19.48449231	0	0	0	0	0	0	0	0											NO	175.6796861	108.6123917	57.76400081	0	169.8511498	0.16985115	0.098917334	42.47619983	254.7767247	0.076814403	0.117637494	0	0	95.21487931	6.355860831	0.055343221	29.66020422	19.77346948	0	0	0.16985115	16.54731711	0	0	0	0	0	0	0	0												20.7786	0.271713104	5.816999221	0	5.169580083	1.742379136	1.35846421	1.073203124	6.761131282	3.035878899	8.988932236	0	0	3.208063071	3.515008566	10.78794168	0.465388189	1.102352593	0	0	7.241568206	1.614632099	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9318	0	12.08487783	20.7786	0.271713104	5.816999221	0	5.169580083	1.742379136	1.35846421	1.073203124	6.761131282	3.035878899	8.988932236	0	0	3.208063071	3.515008566	10.78794168	0.465388189	1.102352593	0	0	7.241568206	1.614632099	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9318	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.7786	0.271713104	5.816999221	0	5.169580083	1.742379136	1.35846421	1.073203124	6.761131282	3.035878899	8.988932236	0	0	3.208063071	3.515008566	10.78794168	0.465388189	1.102352593	0	0	7.241568206	1.614632099	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9318
H0543_032_0	2011	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	O	Coin	V	Coin	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	1153.103712	10.88795217	1257.463323	468.9101852	268.4404656	7.113920799	8.102455825	449.4467171	39.15506112	37.77563179	70.46248067	0	4.779078786	13.37377459	5782.090235	172.1670644	155.7048465	577.7800866	0	0	29.19854124	1016.687447	0	0	0	0	17.46434425	6	0	0											6700	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$75 Days 21-96 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	20% (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$20 (3, 9d); $150 (5); 20% (9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $20 (7d); $10/$20 (7f)"	"$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 18a); $0/$20 (17a)"	$0 n/c (10b)	"$0 n/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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												206.8631108	127.8912646	59.38888154	0	200	0.2	0.147399261	50	0.2	0.081195451	0.138007417	0	0	0.159486417	6.546588867	0.058312069	30	20	0	0	0.2	19.50057534	0	0	0	0	0	0	0	0											NO	182.9474781	113.105639	52.52287882	0	176.8778178	0.176877818	0.130358298	44.22653367	0.176877818	0.071808371	0.122052254	0	0	0.141048047	6.491047059	0.057817345	29.74547749	19.83031833	0	0	0.176877818	17.24609606	0	0	0	0	0	0	0	0												17.5798	0.102624066	5.503799477	0	3.956763646	1.258294787	1.056222349	1.656455864	6.925661766	2.712606565	8.600104556	0	0	1.886344789	3.127651651	9.954242526	0.385959584	0.95479692	0	0	5.164574256	1.461157448	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.287	0	7.687377357	17.5798	0.102624066	5.503799477	0	3.956763646	1.258294787	1.056222349	1.656455864	6.925661766	2.712606565	8.600104556	0	0	1.886344789	3.127651651	9.954242526	0.385959584	0.95479692	0	0	5.164574256	1.461157448	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.287	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	17.5798	0.102624066	5.503799477	0	3.956763646	1.258294787	1.056222349	1.656455864	6.925661766	2.712606565	8.600104556	0	0	1.886344789	3.127651651	9.954242526	0.385959584	0.95479692	0	0	5.164574256	1.461157448	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.287
H0543_035_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	O	O	V	Coin	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	1657.811498	46.16963799	1252.171689	439.476633	428.8016514	9.81978821	11.4538119	305.7980999	276.046252	32.94674443	64.10690664	0	6.206214166	1073.117675	6022.990678	148.7771802	129.1981202	601.364149	0	0	22.05409578	1049.527421	0	0	0	0	17.46434425	6	81.51182128	0											4900	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-59 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$225 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$10 (3, 9d); $150 (5); $225 (9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $10 (7d); $10/$30 (7f)"	"$30 (7e, 7h)"	"$10 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $0/$30 (17a)"	$0 n/c (10b)	"$0 n/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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	66.64561965	0	200	0.2	0.127305737	50	225	0.096707676	0.136695597	0	0	88.50072359	6.392747208	0.033594891	30	10	0	0	0.2	29.32737448	0	0	0	0	0	0	0	0											NO	148.2740633	99.18108698	53.05700377	0	159.2212783	0.159221278	0.101348911	39.82347691	179.1239381	0.076989599	0.108824239	0	0	70.4559917	6.288879921	0.033049052	29.51256971	9.837523238	0	0	0.159221278	23.34771027	0	0	0	0	0	0	0	0												20.4842	0.38159624	5.53637317	0	5.689528922	1.563519231	1.160831365	1.014828631	4.12054098	2.53655664	6.976385311	0	0	6.300630836	3.156488762	4.916944788	0.317747377	0.492994482	0	0	3.511481322	2.042005178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2027	0	15.85064211	20.4842	0.38159624	5.53637317	0	5.689528922	1.563519231	1.160831365	1.014828631	4.12054098	2.53655664	6.976385311	0	0	6.300630836	3.156488762	4.916944788	0.317747377	0.492994482	0	0	3.511481322	2.042005178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2027	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.4842	0.38159624	5.53637317	0	5.689528922	1.563519231	1.160831365	1.014828631	4.12054098	2.53655664	6.976385311	0	0	6.300630836	3.156488762	4.916944788	0.317747377	0.492994482	0	0	3.511481322	2.042005178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2027
H0543_036_0	2011	5																															A	A	D	V	T	Coin	Coin	V	V	Coin	Coin	V	O	O	V	Coin	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	254.87072	5.626295951	625.0135017	408.1480801	353.8703528	8.094450857	14.74836391	186.7448458	133.5400117	40.90993032	82.81547622	0	9.420646744	974.5156257	6793.94101	151.5538378	183.4692835	669.0283313	0	0	37.03994156	994.88096	0	0	0	0	17.46434425	6	0	0											6700	"$200 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$40 (4a, 4a1, 4b)"	$0 (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $10 (7d, 7f)"	"$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, 18a); $0/$10 (17a)"	$0 n/c (10b)	"$0 n/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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												200	200	0	0	200	0.2	0.104165665	40	0	0.079561909	0.139762857	0	0	0.02318739	5.687479526	0.033109498	10	0	0	0	0.2	9.892226945	0	0	0	0	0	0	0	0											NO	188.6050279	188.6050279	0	0	188.6050279	0.188605028	0.098230841	37.72755268	0	0.075028881	0.131799887	0	0	0.021866291	5.683827615	0.033088238	9.993579033	0	0	0	0.188605028	9.328618697	0	0	0	0	0	0	0	0												4.0058	0.088428975	0	0	5.561810648	1.52665413	1.448744186	0.587118834	0	3.069426285	10.91507045	0	0	0.001775754	3.217965794	5.014649517	0.152792899	0	0	0	6.985919214	0.773405427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3496	0	2.117714548	4.0058	0.088428975	0	0	5.561810648	1.52665413	1.448744186	0.587118834	0	3.069426285	10.91507045	0	0	0.001775754	3.217965794	5.014649517	0.152792899	0	0	0	6.985919214	0.773405427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3496	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.0058	0.088428975	0	0	5.561810648	1.52665413	1.448744186	0.587118834	0	3.069426285	10.91507045	0	0	0.001775754	3.217965794	5.014649517	0.152792899	0	0	0	6.985919214	0.773405427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3496
H0543_060_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	O	O	V	Coin	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	965.8141205	23.99768034	617.2963707	390.8097386	269.8371082	5.949910186	5.204836215	238.1922142	132.2688183	34.14474292	64.01033871	0	8.660489249	964.162539	6345.34508	134.3682241	140.7605954	643.3699345	0	0	21.37943025	987.4843223	0	0	603.3531376	618.3883483	17.46434425	3.6	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)"	"$50 Days 1-80 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	15% (11a)	"15% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$125 (9b)	$0/15% (8a1a); $0/$10 (8a2)	"$10 (8b1); 15% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$10 (3, 9d); $20 (5, 9c); $125 (9a)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $30 (7d); $10/$30 (7f)"	"$20 (7e, 7h)"	"$10 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"15% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $0/$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												116.8443694	80.87940148	49.46227585	0	200	0.15	0.103337309	50	125	0.09421247	0.113107766	0	0	48.74979436	6.076052439	0.112298575	20	10	0	0	0.15	29.70308333	0	0	30	30	0	0	0	0											NO	98.50072261	68.1819717	41.69708764	0	168.6015733	0.12645118	0.087114165	42.16877864	105.3759833	0.079421853	0.095350736	0	0	41.09646015	6.004127943	0.110969255	19.76325255	9.881626276	0	0	0.12645118	25.03993291	0	0	30	30	0	0	0	0												7.9278	0.136350763	2.144955073	0	3.791246748	0.752373164	0.453414959	0.837022896	1.1614964	2.711838766	6.10343292	0	0	3.30197228	3.174855309	14.91074166	0.231823933	0.529795104	0	0	2.703454182	2.060545099	0	0	1.508382844	1.545970871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9875	0	6.573106274	7.9278	0.136350763	2.144955073	0	3.791246748	0.752373164	0.453414959	0.837022896	1.1614964	2.711838766	6.10343292	0	0	3.30197228	3.174855309	14.91074166	0.231823933	0.529795104	0	0	2.703454182	2.060545099	0	0	1.508382844	1.545970871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9875	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.9278	0.136350763	2.144955073	0	3.791246748	0.752373164	0.453414959	0.837022896	1.1614964	2.711838766	6.10343292	0	0	3.30197228	3.174855309	14.91074166	0.231823933	0.529795104	0	0	2.703454182	2.060545099	0	0	1.508382844	1.545970871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9875
H0543_070_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	O	Coin	V	Coin	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	1780.174012	20.18354565	1334.76149	593.8588288	444.1740232	11.23190605	13.17960727	330.1341942	50.43807524	47.80047786	90.25232728	0	6.064706956	22.6702932	6500.940277	196.4223665	239.8975418	675.5128586	0	0	37.83522365	1176.824884	0	0	0	0	17.46434425	6	0	0											6700	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-77 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	20% (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$15 (3, 9d); $150 (5); 20% (9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $15 (7d); $10/$15 (7f)"	"$30 (7e, 7h)"	"$15 (7c, 7i)"	Included in h.2.	$10/$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $15 (16b, 18a); $0/$15 (17a)"	$0 n/c (10b)	"$0 n/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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												206.8631108	127.8912646	67.87192492	0	200	0.2	0.1285242	50	0.2	0.073535728	0.138936895	0	0	0.159091498	6.443556923	0.039909422	30	15	0	0	0.2	14.21888649	0	0	0	0	0	0	0	0											NO	171.7256225	106.1678273	56.34329152	0	166.0282704	0.16602827	0.106693253	41.52105562	0.16602827	0.061045049	0.115337262	0	0	0.132068431	6.359822847	0.039390798	29.61014975	14.80507488	0	0	0.16602827	11.80368566	0	0	0	0	0	0	0	0												25.4751	0.178570266	6.267071311	0	6.145453736	1.864813935	1.406175171	1.142293353	8.374146396	2.917982503	10.40945634	0	0	2.99403005	3.445402375	7.737233848	0.591950178	0.833418204	0	0	6.281716744	1.157572584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.2224	0	15.43269636	25.4751	0.178570266	6.267071311	0	6.145453736	1.864813935	1.406175171	1.142293353	8.374146396	2.917982503	10.40945634	0	0	2.99403005	3.445402375	7.737233848	0.591950178	0.833418204	0	0	6.281716744	1.157572584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.2224	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.4751	0.178570266	6.267071311	0	6.145453736	1.864813935	1.406175171	1.142293353	8.374146396	2.917982503	10.40945634	0	0	2.99403005	3.445402375	7.737233848	0.591950178	0.833418204	0	0	6.281716744	1.157572584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.2224
H0543_078_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	2908.12453	129.552846	1393.406745	767.0890603	756.6509019	15.96142724	17.58397224	650.3557869	459.8144748	36.51027546	90.24815109	0	29.20751159	2249.095912	16794.11214	18211.35731	328.2595245	1923.622144	0	0	31.76821948	2802.331922	918.3731753	265.2688658	887.4105336	1607.35406	0	0	41.0558516	0											6700	"$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/$100 Days 21-87 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$175 (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 9d); $150 (5); $175 (9a); $30 (9c)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$30 (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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												146.0649625	88.23565662	23.99196977	0	150	0.2	0.133462142	49.9554728	175	0	0.13745339	0	0	53.39049098	0.004961152	0	30	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	129.8468158	78.43851702	21.32805038	0	133.3449311	0.177793241	0.118643334	44.41356284	155.5690863	0	0.122191419	0	0	47.46234228	0.004410296	0	26.66898622	0	0	0	0.177793241	0	0	0	0	0	0	0	0	0												31.4676	0.84682776	2.476554105	0	8.407963532	2.837833887	2.086221096	2.407051468	5.961076475	0	11.02754961	0	0	8.895613333	0.006172251	0	0.729529061	0	0	0	5.648174718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.7981	0	10.3413694	31.4676	0.84682776	2.476554105	0	8.407963532	2.837833887	2.086221096	2.407051468	5.961076475	0	11.02754961	0	0	8.895613333	0.006172251	0	0.729529061	0	0	0	5.648174718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.7981	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	31.4676	0.84682776	2.476554105	0	8.407963532	2.837833887	2.086221096	2.407051468	5.961076475	0	11.02754961	0	0	8.895613333	0.006172251	0	0.729529061	0	0	0	5.648174718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.7981
H0543_079_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	2037.231745	69.06822167	790.8765227	596.2200221	477.0376356	11.0897771	11.79956696	431.2878005	330.1861944	33.30385519	77.55817811	0	22.00435725	1742.981735	12477.77599	13230.8765	247.67408	1416.39543	0	0	21.47154593	2036.484406	756.2378326	322.9189987	593.6597368	1057.060881	0	0	99.69520301	0											6700	"$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/$100 Days 21-87 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$175 (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 9d); $150 (5); $175 (9a); $30 (9c)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$30 (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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												146.0649625	88.23565662	25.26639207	0	150	0.2	0.135553203	49.98161972	175	0	0.138443309	0	0	66.33162326	0.002749311	0	30	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	131.681842	79.54702891	22.77839251	0	135.2293936	0.180305858	0.122205183	45.06561255	157.7676258	0	0.124810698	0	0	59.79990125	0.002478584	0	27.04587871	0	0	0	0.180305858	0	0	0	0	0	0	0	0	0												22.3555	0.457847652	1.501241322	0	5.375792515	1.999551776	1.441968239	1.61968741	4.341057664	0	9.680090383	0	0	8.685844638	0.002577268	0	0.558213594	0	0	0	3.871445514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8909	0	6.759881039	22.3555	0.457847652	1.501241322	0	5.375792515	1.999551776	1.441968239	1.61968741	4.341057664	0	9.680090383	0	0	8.685844638	0.002577268	0	0.558213594	0	0	0	3.871445514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8909	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.3555	0.457847652	1.501241322	0	5.375792515	1.999551776	1.441968239	1.61968741	4.341057664	0	9.680090383	0	0	8.685844638	0.002577268	0	0.558213594	0	0	0	3.871445514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8909
H0543_081_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	2330.012356	123.4487847	1159.370644	699.1210051	659.1529755	11.27621954	12.80862032	604.0554892	370.085051	35.73811856	82.5859313	0	23.53611121	1787.437277	14096.31869	15637.0274	290.744152	1563.07439	0	0	29.23141907	2408.278258	833.4947865	268.5162527	732.8417862	1355.205215	0	0	54.30351842	0											6700	"$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/$100 Days 21-87 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$175 (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 9d); $150 (5); $175 (9a); $30 (9c)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$30 (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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												146.0649625	88.23565662	22.09651892	0	150	0.2	0.135854376	49.96718228	175	0	0.137755924	0	0	61.29906743	0.004723096	0	30	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	130.8379713	79.03725923	19.79299935	0	134.3627887	0.179150385	0.121691819	44.76300923	156.7565868	0	0.123395134	0	0	54.90875762	0.004230723	0	26.87255774	0	0	0	0.179150385	0	0	0	0	0	0	0	0	0												25.4045	0.8130878	1.9122852	0	7.380469329	2.02013907	1.558704305	2.253278453	4.834439119	0	10.19070208	0	0	8.178830018	0.004969801	0	0.651086584	0	0	0	5.236819977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4393	0	8.197494373	25.4045	0.8130878	1.9122852	0	7.380469329	2.02013907	1.558704305	2.253278453	4.834439119	0	10.19070208	0	0	8.178830018	0.004969801	0	0.651086584	0	0	0	5.236819977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4393	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.4045	0.8130878	1.9122852	0	7.380469329	2.02013907	1.558704305	2.253278453	4.834439119	0	10.19070208	0	0	8.178830018	0.004969801	0	0.651086584	0	0	0	5.236819977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4393
H0543_085_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	O	Coin	V	Coin	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	YES	1108.284806	18.88272769	826.7556705	373.0384656	297.9253942	8.331549427	9.240998858	244.8972779	42.56813537	33.49572248	61.19481527	0	4.298260271	16.37089603	4869.626994	137.4936714	325.6250085	5.710177988	0	0	28.95888971	882.5059513	0	0	0	0	17.46434425	6	112.3830787	0											6700	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$75 Days 21-96 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $10 (7d); $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); $0/$10 (17a)"	$0 n/c (10b)	"$0 n/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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												206.8631108	127.8912646	59.80569823	0	200	0.2	0.119705914	50	0.2	0.078478094	0.138348629	0	0	0.16075974	3.236666476	0.028739266	30	0.2	0	0	0.2	9.49240574	0	0	0	0	0	0	0	0											NO	187.0556767	115.645496	54.07921843	0	180.8497184	0.180849718	0.108243904	45.22310966	0.180849718	0.070963706	0.125101553	0	0	0.145366768	3.216103617	0.028556683	29.80940706	0.19872938	0	0	0.180849718	8.583494527	0	0	0	0	0	0	0	0												17.2759	0.181975201	3.725858375	0	4.489976971	1.506758368	1.000281796	0.922918038	7.698435297	2.376980613	7.655566426	0	0	2.379784248	1.305102082	3.926363134	0.808890702	1.134780133	0	0	5.237207051	0.63124875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.258	0	5.878395491	17.2759	0.181975201	3.725858375	0	4.489976971	1.506758368	1.000281796	0.922918038	7.698435297	2.376980613	7.655566426	0	0	2.379784248	1.305102082	3.926363134	0.808890702	1.134780133	0	0	5.237207051	0.63124875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.258	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.2759	0.181975201	3.725858375	0	4.489976971	1.506758368	1.000281796	0.922918038	7.698435297	2.376980613	7.655566426	0	0	2.379784248	1.305102082	3.926363134	0.808890702	1.134780133	0	0	5.237207051	0.63124875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.258
H0543_086_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	O	O	V	Coin	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	1135.217744	12.29728871	970.1254147	358.241232	306.9471685	7.804277009	10.81233425	340.0403156	364.3993712	32.95399535	65.14758112	0	7.993677731	517.9984022	5708.286758	158.4358185	293.7506424	750.3079437	0	0	33.95536324	1034.717022	0	0	0	0	17.46434425	6	75.45529073	0											6300	"$240 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$240 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-73 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$185 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$30 (3, 9c, 9d); $150 (5); $185 (9a)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $30 (7d); $10/$30 (7f)"	"$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $0/$30 (17a)"	$0 n/c (10b)	"$0 n/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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												178.7990931	119.5993959	71.8587003	0	200	0.2	0.130747164	50	185	0.090329582	0.138547807	0	0	72.15614432	6.429651105	0.087135328	30	30	0	0	0.2	29.38619731	0	0	0	0	0	0	0	0											NO	154.9239576	103.6292266	62.26337083	0	173.2938964	0.173293896	0.113288428	43.33427013	160.2968542	0.078267826	0.120047447	0	0	62.52109699	6.365765308	0.086269541	29.70191634	29.70191634	0	0	0.173293896	25.46224316	0	0	0	0	0	0	0	0												14.656	0.106196543	5.033606537	0	4.432672568	1.352433571	1.224912347	1.227949907	4.867672738	2.57923758	7.820800763	0	0	2.698819029	3.028134484	13.66818533	0.727079751	1.857131981	0	0	5.8842572	2.195518034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3606	0	8.527361075	14.656	0.106196543	5.033606537	0	4.432672568	1.352433571	1.224912347	1.227949907	4.867672738	2.57923758	7.820800763	0	0	2.698819029	3.028134484	13.66818533	0.727079751	1.857131981	0	0	5.8842572	2.195518034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3606	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.656	0.106196543	5.033606537	0	4.432672568	1.352433571	1.224912347	1.227949907	4.867672738	2.57923758	7.820800763	0	0	2.698819029	3.028134484	13.66818533	0.727079751	1.857131981	0	0	5.8842572	2.195518034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3606
H0543_089_0	2011	5																															A	A	D	V	T	Coin	Coin	V	V	Coin	Coin	V	O	O	V	Coin	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	245.3559131	9.19783408	622.3723549	406.3636072	517.9701135	8.20483482	13.74169039	157.5690466	135.5932492	36.57543023	82.49765391	0	11.73372042	1192.439527	6725.222229	132.2560717	216.2538041	667.982643	0	0	26.00912817	1005.317901	0	0	0	0	17.46434425	6	0	0											6700	"$200 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$40 (4a, 4a1, 4b)"	$0 (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $10 (7d, 7f)"	"$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, 18a); $0/$10 (17a)"	$0 n/c (10b)	"$0 n/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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												200	200	0	0	200	0.2	0.117235557	40	0	0.090092278	0.141383017	0	0	0.016896757	5.809223342	0.038945287	10	0	0	0	0.2	9.874579946	0	0	0	0	0	0	0	0											NO	188.4313123	188.4313123	0	0	188.4313123	0.188431312	0.110454249	37.69427858	0	0.084881031	0.133204937	0	0	0.015919391	5.805097153	0.038917625	9.992897176	0	0	0	0.188431312	9.303400286	0	0	0	0	0	0	0	0												3.8527	0.144429995	0	0	8.13348235	1.546047792	1.517828095	0.494954295	0	3.104560212	10.98909482	0	0	0.001581909	3.253380701	5.147092198	0.180083502	0	0	0	4.900934151	0.779406237	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0456	0	2.183353934	3.8527	0.144429995	0	0	8.13348235	1.546047792	1.517828095	0.494954295	0	3.104560212	10.98909482	0	0	0.001581909	3.253380701	5.147092198	0.180083502	0	0	0	4.900934151	0.779406237	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0456	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.8527	0.144429995	0	0	8.13348235	1.546047792	1.517828095	0.494954295	0	3.104560212	10.98909482	0	0	0.001581909	3.253380701	5.147092198	0.180083502	0	0	0	4.900934151	0.779406237	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0456
H0543_121_0	2011	2																															A	A	D	V	T	Coin	Coin	V	V	Coin	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	198.9459561	3.053580104	524.1446438	312.3147162	240.0006368	5.911993476	5.066708425	178.9895263	119.2783755	27.55619534	51.36183009	0	6.891798338	762.909295	5222.777088	6439.513266	112.1078034	542.5915869	0	0	16.22873187	821.7375584	0	0	431.9965925	398.2255635	23.26082487	6.119620072	145.469848	776.8339574											6700	"$50 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$50 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$0 (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$10 (3, 9d); $150 (5); $0 (9a); $30 (9c)"	"$5 (7a); $30 (7a1); $0 (14b, 14c, 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)"	"$10 (7c, 7i)"	Included in h.2.	$5/$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $10 (16b, 18a); $0/$10 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$10 (13b); $0 n/c (13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												49.93689118	50	50	0	200	0.2	0.140975764	50	0	0	0.138837815	0	0	0.399809879	3.060061407	9.99968313	30	10	0	0	0.2	9.885306387	0	0	10	0	0	0	0	10											NO	49.25052294	49.31276435	49.31276435	0	197.2510574	0.197251057	0.139038093	49.31492677	0	0	0.136929529	0	0	0.394314607	3.060061407	9.99968313	30	10	0	0	0.197251057	9.749435687	0	0	10	0	0	0	0	10												0.8165	0.012548373	2.153918442	0	3.945031614	1.166146964	0.704465475	0.735571282	0	0	7.032951193	0	0	0.025068857	1.331834884	5.366091015	0.280269509	0.452159656	0	0	3.201134522	0.667623123	0	0	0.35999716	0	0	0	0	0.647361631	0	0	0	0	0	0	0	0	0	0	28.8987	0	0.285116837	0.8165	0.012548373	2.153918442	0	3.945031614	1.166146964	0.704465475	0.735571282	0	0	7.032951193	0	0	0.025068857	1.331834884	5.366091015	0.280269509	0.452159656	0	0	3.201134522	0.667623123	0	0	0.35999716	0	0	0	0	0.647361631	0	0	0	0	0	0	0	0	0	0	28.8987	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0.8165	0.012548373	2.153918442	0	3.945031614	1.166146964	0.704465475	0.735571282	0	0	7.032951193	0	0	0.025068857	1.331834884	5.366091015	0.280269509	0.452159656	0	0	3.201134522	0.667623123	0	0	0.35999716	0	0	0	0	0.647361631	0	0	0	0	0	0	0	0	0	0	28.8987
H0543_125_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	O	Coin	V	Coin	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	1238.730385	14.09032003	813.3612182	355.5528795	274.7175912	7.769765873	11.31390073	277.2073024	40.10000111	27.94033365	56.0253109	0	9.043012492	17.47177797	5007.472203	128.4623794	106.1192808	495.2318679	0	0	19.73528773	863.0232703	0	0	0	0	17.46434425	6	72.75576957	0											6700	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-77 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	20% (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$35 (3, 9d); $150 (5); 20% (9a); $30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $35 (7d); $15/$35 (7f)"	"$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 18a); $0/$35 (17a)"	$0 n/c (10b)	"$0 n/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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												206.8631108	127.8912646	70.39585683	0	200	0.2	0.121425358	50	0.2	0.094726228	0.137091092	0	0	0.160998886	9.529693987	0.106601277	30	35	0	0	0.2	34.24058088	0	0	0	0	0	0	0	0											NO	180.7643767	111.7559561	61.51441468	0	174.7671453	0.174767145	0.106105816	43.70349122	0.174767145	0.082775162	0.119795094	0	0	0.140686578	9.440603068	0.105604686	29.71953689	34.67279304	0	0	0.174767145	29.92064286	0	0	0	0	0	0	0	0												18.6599	0.131223099	4.169453272	0	4.000967431	1.357899801	1.200470669	1.009577242	7.008162719	2.312765646	6.711557399	0	0	2.458044658	3.93946312	13.56622923	0.26281799	1.430922672	0	0	3.449079898	2.151850921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.8203	0	8.067034941	18.6599	0.131223099	4.169453272	0	4.000967431	1.357899801	1.200470669	1.009577242	7.008162719	2.312765646	6.711557399	0	0	2.458044658	3.93946312	13.56622923	0.26281799	1.430922672	0	0	3.449079898	2.151850921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.8203	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.6599	0.131223099	4.169453272	0	4.000967431	1.357899801	1.200470669	1.009577242	7.008162719	2.312765646	6.711557399	0	0	2.458044658	3.93946312	13.56622923	0.26281799	1.430922672	0	0	3.449079898	2.151850921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.8203
H0543_138_0	2011	6																															A	A	D	V	T	Coin	Coin	V	V	Coin	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	235.3372258	3.49150339	646.686878	382.2102811	279.564346	6.907536668	5.994244568	145.2407752	133.9824129	31.44963385	60.20975783	0	9.09508413	919.8294527	6221.189942	6077.449717	135.5951634	651.0853448	0	0	24.42223418	972.0398854	710.947328	0	333.4288504	356.0389398	17.46434425	6	258.0481313	0											6700	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$120 Days 21-76 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$0 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 9a, 9d); $150 (5); $30 (9c)"	"$0 (7a, 14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$30 (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 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0	0	42.40756177	0	200	0.2	0.139274966	50	0	0.100354625	0.138930166	0	0	0.102198044	0.001268813	0	30	0	0	0	0.2	0	0	0	0	30	0	0	0	0											NO	0	0	39.19234222	0	184.8365744	0.184836574	0.128715538	46.22362661	0	0.092746025	0.12839688	0	0	0.094449682	0.001172615	0	27.72548616	0	0	0	0.184836574	0	0	0	0	30	0	0	0	0												0	0	2.112097786	0	4.306143002	1.276765415	0.771552414	0.559462947	0	2.916828533	7.730745022	0	0	0.0072398	0.000607922	0	0.313286819	0	0	0	4.514122104	0	0	0	0	0.89009735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.3989	0	2.010441351	0	0	2.112097786	0	4.306143002	1.276765415	0.771552414	0.559462947	0	2.916828533	7.730745022	0	0	0.0072398	0.000607922	0	0.313286819	0	0	0	4.514122104	0	0	0	0	0.89009735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.3989	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	2.112097786	0	4.306143002	1.276765415	0.771552414	0.559462947	0	2.916828533	7.730745022	0	0	0.0072398	0.000607922	0	0.313286819	0	0	0	4.514122104	0	0	0	0	0.89009735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.3989
H0543_140_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1213.81968	41.41131067	806.2051218	364.3942048	313.4673298	8.372565217	9.081854367	302.4385188	257.1894712	31.28397096	57.52060606	0	0.080833274	837.9358827	5610.054048	131.4063644	265.8930628	659.0054194	0	0	25.87222619	872.5290849	0	0	0	0	42.07644495	6	129.8646005	0											6700	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$75 Days 21-96 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$200 (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	59.53427248	0	200	0.2	0.132170164	49.96231293	200	0.091786622	0.151854851	0	0.2	78.94587143	12.88974277	0.111693979	38.5	25	0	0	0.2	33.6839811	0	0	0	0	35	0	0	0											NO	161.6476781	108.126749	51.67047371	0	173.5822798	0.17358228	0.114711992	43.37402038	173.5822798	0.079662655	0.131796557	0	0.17358228	68.5180217	12.76315532	0.110602253	38.12189961	24.75448027	0	0	0.17358228	29.23471115	0	0	0	0	35	0	0	0												16.3509	0.373139199	3.471416712	0	4.534364478	1.453328958	1.041797601	1.09316454	3.720294561	2.492164201	7.581017807	0	0.014031224	4.78447575	5.966832597	14.53383997	0.844695721	1.359444721	0	0	4.490960004	2.125677981	0	0	0	0	0.122722964	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3543	0	8.370486539	16.3509	0.373139199	3.471416712	0	4.534364478	1.453328958	1.041797601	1.09316454	3.720294561	2.492164201	7.581017807	0	0.014031224	4.78447575	5.966832597	14.53383997	0.844695721	1.359444721	0	0	4.490960004	2.125677981	0	0	0	0	0.122722964	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3543	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.3509	0.373139199	3.471416712	0	4.534364478	1.453328958	1.041797601	1.09316454	3.720294561	2.492164201	7.581017807	0	0.014031224	4.78447575	5.966832597	14.53383997	0.844695721	1.359444721	0	0	4.490960004	2.125677981	0	0	0	0	0.122722964	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3543
H0543_141_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	O	O	V	Coin	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	886.4487411	25.54350585	566.1311344	355.4761668	249.6710732	6.184677015	5.314658346	204.0724099	121.7606349	41.92239477	64.57677208	0	7.961580757	882.375863	5829.895657	137.0782649	130.1558237	592.8055835	0	0	22.46017288	908.2567408	639.2392537	981.4342446	120.6655306	198.3337391	0	0	598.5575223	0											6700	"$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 21-76 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$200 (9b)	$0/20% (8a1a); $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, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	50% (7b); $0 n/c (7b1); $40 (7d); $20/$40 (7f); $0 (7f1)	"$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); $0/$40 (17a)"	$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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												153.1332946	96.65372527	31.14707451	0	150	0.2	0.14004318	50	200	0	0.147641296	0	0	78.48248741	12.17768298	0.135350994	30	30	0	0	0.2	39.60250871	0	0	0	0	0	0	0	0											NO	138.1585049	87.20203023	28.10122554	0	135.3316129	0.180442151	0.126348463	45.1231879	180.4421505	0	0.133203565	0	0	70.80774403	12.13621347	0.134890074	29.89783891	29.89783891	0	0	0.180442151	35.72980919	0	0	0	0	0	0	0	0												10.2059	0.185620464	1.325748224	0	2.815699085	1.115976421	0.671498913	0.767366475	1.830895901	0	8.60185627	0	0	5.206587021	5.896071515	18.49049727	0.324281488	1.476967153	0	0	4.052761896	2.704320004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.672	0	4.368877697	10.2059	0.185620464	1.325748224	0	2.815699085	1.115976421	0.671498913	0.767366475	1.830895901	0	8.60185627	0	0	5.206587021	5.896071515	18.49049727	0.324281488	1.476967153	0	0	4.052761896	2.704320004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.672	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.2059	0.185620464	1.325748224	0	2.815699085	1.115976421	0.671498913	0.767366475	1.830895901	0	8.60185627	0	0	5.206587021	5.896071515	18.49049727	0.324281488	1.476967153	0	0	4.052761896	2.704320004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.672
H0543_142_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1084.379905	24.33970026	804.9442587	543.654735	304.1812525	6.180060162	5.14121143	302.4621595	250.397305	31.32709973	53.43255421	0	0.115777734	258.7117548	5152.33317	169.8859931	66.17083253	513.5378956	0	0	25.55838872	911.5783589	0	0	120.6655306	0	17.46434425	6	210.4196854	0											6700	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$75 Days 21-96 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$200 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (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, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	59.22574202	0	200	0.2	0.158203773	49.99686689	200	0.087182838	0.150384972	0	0.2	77.61452314	9.75108834	0.079402118	38.5	30	0	0	0.2	29.35171314	0	0	30	0	0	0	0	0											NO	167.1133824	111.7827795	53.1407478	0	179.4515222	0.179451522	0.141949539	44.86903686	179.4515222	0.078225465	0.134934061	0	0.179451522	69.64022163	9.682134653	0.078844676	38.22775173	29.78785849	0	0	0.179451522	26.33604802	0	0	30	0	0	0	0	0												15.1012	0.226729946	3.564611654	0	4.548815733	1.109021204	0.729792593	1.130932149	3.744514795	2.45057694	7.209871504	0	0.020776491	1.501395329	4.157131961	13.39460601	0.210796846	1.27476618	0	0	4.586491761	2.000614286	0	0	0.301663827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2643	0	5.622428956	15.1012	0.226729946	3.564611654	0	4.548815733	1.109021204	0.729792593	1.130932149	3.744514795	2.45057694	7.209871504	0	0.020776491	1.501395329	4.157131961	13.39460601	0.210796846	1.27476618	0	0	4.586491761	2.000614286	0	0	0.301663827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2643	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.1012	0.226729946	3.564611654	0	4.548815733	1.109021204	0.729792593	1.130932149	3.744514795	2.45057694	7.209871504	0	0.020776491	1.501395329	4.157131961	13.39460601	0.210796846	1.27476618	0	0	4.586491761	2.000614286	0	0	0.301663827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2643
H0543_144_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	991.5086127	28.26784419	693.0315026	380.1151145	318.3456062	7.463262243	6.659149031	184.3099368	170.1439696	35.11633794	67.53997995	0	7.550950954	777.7769782	6224.884065	5973.715764	125.856311	631.0836939	0	0	25.07099862	1002.618021	0	0	120.6655306	162.6571429	17.46434425	6	598.5575223	0											6700	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$0 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 9a, 9d); $150 (5); $30 (9c)"	"$0 (7a, 14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$30 (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 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0	0	50	0	200	0.2	0.139773234	50	0	0.090980398	0.138760522	0	0	0.101410027	0.004245728	0	30	0	0	0	0.2	0	0	0	0	30	0	0	0	0											NO	0	0	45.42789428	0	181.7115771	0.181711577	0.126992074	45.44099184	0	0.082660958	0.126071967	0	0	0.09213688	0.003857489	0	27.25673657	0	0	0	0.181711577	0	0	0	0	30	0	0	0	0												0	0	2.623580153	0	4.82059018	1.356161152	0.845659148	0.697935528	0	2.902750121	8.514898105	0	0	0.005971829	0.002001035	0	0.28586936	0	0	0	4.555690699	0	0	0	0	0.406642857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0178	0	2.678062447	0	0	2.623580153	0	4.82059018	1.356161152	0.845659148	0.697935528	0	2.902750121	8.514898105	0	0	0.005971829	0.002001035	0	0.28586936	0	0	0	4.555690699	0	0	0	0	0.406642857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0178	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	2.623580153	0	4.82059018	1.356161152	0.845659148	0.697935528	0	2.902750121	8.514898105	0	0	0.005971829	0.002001035	0	0.28586936	0	0	0	4.555690699	0	0	0	0	0.406642857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0178
H0543_145_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	O	O	V	Coin	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	877.3291782	21.7990861	560.741561	355.004943	245.1154558	5.699937433	4.985989472	216.3909771	120.1507528	32.71052838	61.29049908	0	7.867041653	875.8289095	5764.003928	128.5663459	127.8645392	584.4263445	0	0	20.19398272	897.0140222	0	0	120.6655306	132.8571429	17.46434425	6	598.5575223	0											6700	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$275 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$10 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$45 (3, 9d); $150 (5); $275 (9a); $30 (9c)"	"$25 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $45 (7d); $25/$45 (7f)"	"$30 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25/$45 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $45 (16b, 18a); $0/$45 (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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												190.7019303	117.8997596	50	0	200	0.2	0.137775853	50	275	0.089333367	0.146908679	0	0	107.9467513	15.1874439	0.159618562	30	45	0	0	0.2	44.554625	0	0	30	30	0	0	0	0											NO	167.2113368	103.3769106	43.84101842	0	175.3640737	0.175364074	0.120804675	43.85604613	241.1256013	0.078329315	0.128812522	0	0	94.64991021	15.04905451	0.158164103	29.72663724	44.58995586	0	0	0.175364074	39.0664027	0	0	30	30	0	0	0	0												12.2249	0.187793515	2.048623426	0	3.582037071	0.999564248	0.602330836	0.790837723	2.41428521	2.562193293	7.89498377	0	0	6.90809397	7.228567444	20.33458073	0.316748564	2.171628742	0	0	3.541299074	2.920259252	0	0	0.301663827	0.332142857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3626	0	6.833469377	12.2249	0.187793515	2.048623426	0	3.582037071	0.999564248	0.602330836	0.790837723	2.41428521	2.562193293	7.89498377	0	0	6.90809397	7.228567444	20.33458073	0.316748564	2.171628742	0	0	3.541299074	2.920259252	0	0	0.301663827	0.332142857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3626	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.2249	0.187793515	2.048623426	0	3.582037071	0.999564248	0.602330836	0.790837723	2.41428521	2.562193293	7.89498377	0	0	6.90809397	7.228567444	20.33458073	0.316748564	2.171628742	0	0	3.541299074	2.920259252	0	0	0.301663827	0.332142857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3626
H0543_802_0	2011	1																															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	391.7841101	3.559826627	23.5196434	406.4475721	13.59117414	7.83122244	7.983759223	14.34505301	28.14736102	35.30413448	72.12202576	0	0.282729379	12.5796047	31.76270676	151.4950723	0.847183048	6.064319552	0	0	29.27209211	15.47535125	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.066241946	0.066241946	0.145596259	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.052185284	0.052185284	0.114700467	0	0.183556973	0.183556973	0.183556973	0.183556973	0.183556973	0.183556973	0.183556973	0	0.183556973	0.183556973	0.183556973	0.183556973	0.183556973	0.183556973	0	0	0.183556973	0.183556973	0	0	0	0	0	0	0	0												20.4454	0.185770563	2.697714073	0	2.49475479	1.437475489	1.465474679	2.633134513	5.166644398	6.480320072	13.23850076	0	0.051896949	2.309074165	5.83026632	27.80797695	0.155506356	1.113148143	0	0	5.373096632	2.840608637	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7267	0	27.40117824	20.4454	0.185770563	2.697714073	0	2.49475479	1.437475489	1.465474679	2.633134513	5.166644398	6.480320072	13.23850076	0	0.051896949	2.309074165	5.83026632	27.80797695	0.155506356	1.113148143	0	0	5.373096632	2.840608637	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7267	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.4454	0.185770563	2.697714073	0	2.49475479	1.437475489	1.465474679	2.633134513	5.166644398	6.480320072	13.23850076	0	0.051896949	2.309074165	5.83026632	27.80797695	0.155506356	1.113148143	0	0	5.373096632	2.840608637	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7267
H0543_805_0	2011	1																															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	391.5212127	3.70898822	23.35422348	407.1135058	13.99728116	8.679037083	9.454374858	14.36519141	29.63080374	36.27728355	76.47612586	0	0.177606602	14.39134567	32.81228419	155.7967911	1.042994921	6.285487656	0	0	33.97109134	15.95714329	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.065210726	0.065210726	0.141354822	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.050927268	0.050927268	0.110393111	0	0.18196475	0.18196475	0.18196475	0.18196475	0.18196475	0.18196475	0.18196475	0	0.18196475	0.18196475	0.18196475	0.18196475	0.18196475	0.18196475	0	0	0.18196475	0.18196475	0	0	0	0	0	0	0	0												19.9391	0.188888638	2.578145376	0	2.54701176	1.579278809	1.720362953	2.613958458	5.391761782	6.601186817	13.91595909	0	0.032318141	2.61871761	5.970679076	28.34952409	0.18978831	1.143737187	0	0	6.181541128	2.903637582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.4656	0	29.29923627	19.9391	0.188888638	2.578145376	0	2.54701176	1.579278809	1.720362953	2.613958458	5.391761782	6.601186817	13.91595909	0	0.032318141	2.61871761	5.970679076	28.34952409	0.18978831	1.143737187	0	0	6.181541128	2.903637582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.4656	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.9391	0.188888638	2.578145376	0	2.54701176	1.579278809	1.720362953	2.613958458	5.391761782	6.601186817	13.91595909	0	0.032318141	2.61871761	5.970679076	28.34952409	0.18978831	1.143737187	0	0	6.181541128	2.903637582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.4656
H0543_806_0	2011	1																															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	360.8052637	4.533049502	21.62034815	337.6246476	12.73236178	8.482881663	8.984693288	13.82773477	31.86570233	33.42242883	70.21173461	0	0.20002646	15.77508282	30.54114814	145.9339417	1.197493263	6.115733727	0	0	31.01353279	14.82309576	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.06532666	0.06532666	0.147318289	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.051839233	0.051839233	0.116902764	0	0.184894517	0.184894517	0.184894517	0.184894517	0.184894517	0.184894517	0.184894517	0	0.184894517	0.184894517	0.184894517	0.184894517	0.184894517	0.184894517	0	0	0.184894517	0.184894517	0	0	0	0	0	0	0	0												18.7039	0.234989807	2.527478454	0	2.354143885	1.56843831	1.661220528	2.556672344	5.891793647	6.179623842	12.98176477	0	0.036983796	2.916726323	5.646890841	26.98238569	0.221409939	1.130765635	0	0	5.734232172	2.740709135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0701	0	26.03603615	18.7039	0.234989807	2.527478454	0	2.354143885	1.56843831	1.661220528	2.556672344	5.891793647	6.179623842	12.98176477	0	0.036983796	2.916726323	5.646890841	26.98238569	0.221409939	1.130765635	0	0	5.734232172	2.740709135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0701	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.7039	0.234989807	2.527478454	0	2.354143885	1.56843831	1.661220528	2.556672344	5.891793647	6.179623842	12.98176477	0	0.036983796	2.916726323	5.646890841	26.98238569	0.221409939	1.130765635	0	0	5.734232172	2.740709135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0701
H0544_002_0	2011	7																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	0	0	885.5627149	0	346.2527508	1462.900445	44.50131854	315.4167048	0	0	0	0	4.35775818	35.07327404	0	0	0	0	0	0	17.46612063	0	0	1415.016988	0	664.8252121	0	0	0	0											3400	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	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	3:$0; 5:$15; 9c:$15; 9d:$0	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits; Self Referral	7e:$0; 7h:$0	7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	10b:$0 34 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	13c:OTC $25 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0											0	0	0	1.071223087	0	13.69654605	1.227103214	0	50	0	0	0	0	25	15	0	0	0	0	0	0	0.17841593	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	0	0	1.069193188	0	13.67059198	1.224777932	0	49.90525321	0	0	0	0	24.95262661	14.97157596	0	0	0	0	0	0	0.165958217	0	0	20.10884354	0	19.01237072	0	0	0	0												0	0	0.078903135	0	0.394456673	0.149310682	0	1.311745877	0	0	0	0	0.009061459	0.043758516	0	0	0	0	0	0	2.898646239	0	0	2.371196269	0	1.053325283	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.3104	0	0.221360744	0	0	0.078903135	0	0.394456673	0.149310682	0	1.311745877	0	0	0	0	0.009061459	0.043758516	0	0	0	0	0	0	2.898646239	0	0	2.371196269	0	1.053325283	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.3104	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0.078903135	0	0.394456673	0.149310682	0	1.311745877	0	0	0	0	0.009061459	0.043758516	0	0	0	0	0	0	2.898646239	0	0	2.371196269	0	1.053325283	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.3104
H0544_003_0	2011	5																															D	D	D	V	Coin	Coin	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	0	0	0	0	24.12860094	15.47452149	0	719.0270326	0	0	0	0	0	0	0	0	0	0	0	0	17.61246578	0	0	1415.016988	0	682.7656281	0	0	0	0											3400	1a:$0; 100 Add'l Days	1b:$0; 60 Add'l Days	2:$0; 3 Day Waiver	6:$0	10a: 20% Coins (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	3:$0; 5:$0; 9c:$0; 9d:$0	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits; Self Referral	7e:$0; 7h:$0	7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	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	0	7g:Consult with Nutritionist $0 7g:Consult with Exercise Coach $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0 14c:Annual CCC Visit $0	13c:OTC $30 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0											0	0	0	0	0	0.054786184	0.035542077	0	50	0	0	0	0	0	0	0	0	0	0	0	0	0.178953174	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	0	0	0	0	0.054675112	0.03547002	0	49.89863163	0	0	0	0	0	0	0	0	0	0	0	0	0.165720539	0	0	20.10884354	0	19.01237072	0	0	0	0												0	0	0	0	1.319233971	0.548881592	0	2.989872086	0	0	0	0	0	0	0	0	0	0	0	0	2.918747321	0	0	2.371196269	0	1.081749436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.2297	0	0.242928271	0	0	0	0	1.319233971	0.548881592	0	2.989872086	0	0	0	0	0	0	0	0	0	0	0	0	2.918747321	0	0	2.371196269	0	1.081749436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.2297	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	1.319233971	0.548881592	0	2.989872086	0	0	0	0	0	0	0	0	0	0	0	0	2.918747321	0	0	2.371196269	0	1.081749436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.2297
H0544_004_0	2011	6																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	0	0	1274.056071	0	495.8409892	2704.700256	0	404.6576117	0	0	0	0	0	37.09058326	0	0	0	0	0	0	18.7398733	0	0	1415.016988	0	668.7264459	0	0	0	0											3400	1a:$0; 125 Add'l Days	1b:$0; 60 Add'l Days	"2:$0 Days 1-31, $25 Days 32-100; 3 Day Waiver"	6:$0	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	3:$0; 5:$15; 9c:$15; 9d:$0	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits; Self Referral	7e:$0; 7h:$0	7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	"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 14c:Annual CCC Visit $0	13c:OTC $25 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0 13e:Electronic Health Monitoring $0											0	0	0	1.071223087	0	13.69654605	1.227103214	0	50	0	0	0	0	0	15	0	0	0	0	0	0	0.178612193	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	0	0	1.068932099	0	13.66725372	1.224478851	0	49.89306674	0	0	0	0	0	14.96792002	0	0	0	0	0	0	0.164542567	0	0	20.10884354	0	19.01237072	0	0	0	0												0	0	0.113489953	0	0.564732051	0.275987355	0	1.682467435	0	0	0	0	0	0.046264074	0	0	0	0	0	0	3.08350685	0	0	2.371196269	0	1.059506258	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.1972	0	0.26941322	0	0	0.113489953	0	0.564732051	0.275987355	0	1.682467435	0	0	0	0	0	0.046264074	0	0	0	0	0	0	3.08350685	0	0	2.371196269	0	1.059506258	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.1972	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0.113489953	0	0.564732051	0.275987355	0	1.682467435	0	0	0	0	0	0.046264074	0	0	0	0	0	0	3.08350685	0	0	2.371196269	0	1.059506258	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.1972
H0544_005_0	2011	6																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	0	0	0	0	1621.152309	7083.255011	0	337.5377258	0	0	0	0	0	0	0	0	0	0	0	0	8.869152255	0	0	0	0	544.785442	0	0	0	0											3400	1a:$0; 150 Add'l Days	1b:$0; 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; 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	3:$0; 5:$0; 9c:$0; 9d:$0	"7a:$0; 14b,14c (ippe/ppps), 14c:Comprehensive Health Assessment $0, 14d,14e,14f,14i,14j:$0"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 6 Routine Footcare Visits	7e:$0; 7h:$0; 7g: NP Psych Services $0	7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	10b:$0 12 Plan Approved Location Trips	0	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	13c:OTC $40 per month Allowance 13e:Incontinence Care Program $0; Acupuncture $0											0	0	0	0	0	13.69654605	1.227103214	0	50	0	0	0	0	0	0	0	0	0	0	0	0	0.182770643	0	0	0	0	19.01237072	0	0	0	0											NO	0	0	0	0	13.68626637	1.226182235	0	49.96247344	0	0	0	0	0	0	0	0	0	0	0	0	0.178718899	0	0	0	0	19.01237072	0	0	0	0												0	0	0	0	1.848960194	0.723780122	0	1.405351638	0	0	0	0	0	0	0	0	0	0	0	0	1.585085126	0	0	0	0	0.863138565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4263	0	0.03892346	0	0	0	0	1.848960194	0.723780122	0	1.405351638	0	0	0	0	0	0	0	0	0	0	0	0	1.585085126	0	0	0	0	0.863138565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4263	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	1.848960194	0.723780122	0	1.405351638	0	0	0	0	0	0	0	0	0	0	0	0	1.585085126	0	0	0	0	0.863138565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4263
H0544_007_0	2011	5																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	405.2190653	17.31755934	300.7152721	0	120.5128809	389.7554666	17.18532735	280.0094365	234.8717233	0	322.5668987	7.113416127	0.404430876	26.74517472	3171.255826	2505.718465	126.8756288	823.548787	0	0	8.982889281	0	0	1415.016988	0	645.6210904	0	0	0	0											3400	1a:$100 Days 1-4	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	3:$20; 5:$30; 9c:$30; 9d:$20	"7a:$5; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$20; 7d:$20; 7f:$20; 16b:$0-$20; 17a:$0-$20	7e:$20; 7h:$20	7c:$20; 7i:$20	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	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	0	7g:Consult with Nutritionist $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0	0											0	76.40007321	56.38397018	5.149441298	0	13.69654605	1.227103214	0	35.7533689	75	0	10	75	25	24.95056853	5	19.9997911	20	20	0	0	0.177400294	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	75.99415635	56.08439973	5.122082097	0	13.62377572	1.220583562	0	35.56340973	74.60152179	0	9.946869572	74.60152179	24.86717393	24.81800509	4.973434786	19.89353136	19.89373914	19.89373914	0	0	0.172541434	0	0	20.10884354	0	19.01237072	0	0	0	0												2.5662	0.080937077	0.128357359	0	0.136820038	0.039644093	0	0.82984086	1.460148998	0	0.267377572	0.044222639	0.000838088	0.05531349	1.31433617	4.153965738	0.210335889	1.365288728	0	0	1.549920601	0	0	2.371196269	0	1.022898959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.5976	0	0.111234904	2.5662	0.080937077	0.128357359	0	0.136820038	0.039644093	0	0.82984086	1.460148998	0	0.267377572	0.044222639	0.000838088	0.05531349	1.31433617	4.153965738	0.210335889	1.365288728	0	0	1.549920601	0	0	2.371196269	0	1.022898959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.5976	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.5662	0.080937077	0.128357359	0	0.136820038	0.039644093	0	0.82984086	1.460148998	0	0.267377572	0.044222639	0.000838088	0.05531349	1.31433617	4.153965738	0.210335889	1.365288728	0	0	1.549920601	0	0	2.371196269	0	1.022898959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.5976
H0544_008_0	2011	7																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	712.2612188	24.311522	612.4733423	0	250.1362193	1148.612178	4577.828477	295.7467736	289.697487	0	513.0493172	22.55778496	2.202755886	36.29356989	0	3064.012546	237.3907041	1055.859424	0	0	10.25210915	0	0	1415.016988	0	678.0497793	0	0	0	688.6811828											3400	1a:$75 Days 1-4; 75 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	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	3:$10; 5:$30; 9c:$30; 9d:$10	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$10; 7d:$10; 7f:$10; 16b:$0-$10; 17a:$0-$10; 6 Routine Footcare Visits	7e:$10; 7h:$10	7c:$10; 7i:$10	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	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											0	57.3000549	42.28797763	1.285467704	0	24.65378289	1.227103214	0.238306404	50	75	0	10	75	25	21.92477051	0	10	10	10	0	0	0.179417115	0	0	20.10884354	0	19.01237072	0	0	0	2											NO	57.07261207	42.12012269	1.280365259	0	24.55592389	1.222232436	0.237360487	49.8015335	74.70230024	0	9.960306699	74.70230024	24.90076675	21.83774386	0	9.960306699	9.960306699	9.960306699	0	0	0.173470208	0	0	20.10884354	0	19.01237072	0	0	0	2												3.3876	0.085333691	0.065349132	0	0.511860497	0.116989255	0.090549633	1.227386904	1.803422388	0	0.425844046	0.140426535	0.004570859	0.066047474	0	2.543208724	0.197040352	0.876390308	0	0	1.778435508	0	0	2.371196269	0	1.074277814	0	0	0	0.114780197	0	0	0	0	0	0	0	0	0	0	16.8807	0	0.106964804	3.3876	0.085333691	0.065349132	0	0.511860497	0.116989255	0.090549633	1.227386904	1.803422388	0	0.425844046	0.140426535	0.004570859	0.066047474	0	2.543208724	0.197040352	0.876390308	0	0	1.778435508	0	0	2.371196269	0	1.074277814	0	0	0	0.114780197	0	0	0	0	0	0	0	0	0	0	16.8807	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.3876	0.085333691	0.065349132	0	0.511860497	0.116989255	0.090549633	1.227386904	1.803422388	0	0.425844046	0.140426535	0.004570859	0.066047474	0	2.543208724	0.197040352	0.876390308	0	0	1.778435508	0	0	2.371196269	0	1.074277814	0	0	0	0.114780197	0	0	0	0	0	0	0	0	0	0	16.8807
H0544_009_0	2011	4																															D	D	D	V	Coin	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	0	0	0	0	18.50590461	9.538543584	5.218257481	581.5609701	0	0	0	0	0	0	0	0	0	0	0	0	17.0329274	0	0	1415.016988	0	622.0820702	0	0	0	0											3400	1a:$0; 100 Add'l Days	1b:$0; 60 Add'l Days	2:$0; 3 Day Waiver	6:$0	10a: 20% Coins (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	3:$0; 5:$0; 9c:$0; 9d:$0	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 9 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	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	0	7g:Consult with Nutritionist $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0 14c:Annual CCC Visit $0	13c:OTC $35 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0											0	0	0	0	0	0.054786184	0.035542077	0.052507883	50	0	0	0	0	0	0	0	0	0	0	0	0	0.177476706	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	0	0	0	0	0.054683509	0.035475468	0.052409478	49.9062948	0	0	0	0	0	0	0	0	0	0	0	0	0.16534212	0	0	20.10884354	0	19.01237072	0	0	0	0												0	0	0	0	1.011967805	0.338384295	0.27348615	2.418629435	0	0	0	0	0	0	0	0	0	0	0	0	2.816260323	0	0	2.371196269	0	0.985604578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.2155	0	0.214277755	0	0	0	0	1.011967805	0.338384295	0.27348615	2.418629435	0	0	0	0	0	0	0	0	0	0	0	0	2.816260323	0	0	2.371196269	0	0.985604578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.2155	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	1.011967805	0.338384295	0.27348615	2.418629435	0	0	0	0	0	0	0	0	0	0	0	0	2.816260323	0	0	2.371196269	0	0.985604578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.2155
H0544_010_0	2011	5																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	1184.800227	34.16475575	972.5693195	0	436.0548025	3995.418297	7104.228155	394.1093936	0	0	0	0	0	20.76794913	0	0	0	0	0	0	12.66173024	0	0	1415.016988	0	688.3210151	0	0	0	0											3400	1a:$75 Days 1-4; 125 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	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	3:$0; 5:$30; 9c:$30; 9d:$0	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	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 14c:Annual CCC Visit $0	13c:OTC $30 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0 13e:Electronic Health Monitoring $0											0	57.3000549	42.28797763	1.285467704	0	24.65378289	1.227103214	0.238683821	50	0	0	0	0	0	30	0	0	0	0	0	0	0.179858319	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	57.16640488	42.18934266	1.282469404	0	24.59627896	1.224241046	0.2381271	49.88337705	0	0	0	0	0	29.93002623	0	0	0	0	0	0	0.171741465	0	0	20.10884354	0	19.01237072	0	0	0	0												5.6442	0.120115716	0.103940866	0	0.89377713	0.407612923	0.140975771	1.63829229	0	0	0	0	0	0.051798772	0	0	0	0	0	0	2.174544105	0	0	2.371196269	0	1.090551193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.637	0	0.123816358	5.6442	0.120115716	0.103940866	0	0.89377713	0.407612923	0.140975771	1.63829229	0	0	0	0	0	0.051798772	0	0	0	0	0	0	2.174544105	0	0	2.371196269	0	1.090551193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.637	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.6442	0.120115716	0.103940866	0	0.89377713	0.407612923	0.140975771	1.63829229	0	0	0	0	0	0.051798772	0	0	0	0	0	0	2.174544105	0	0	2.371196269	0	1.090551193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.637
H0544_012_0	2011	5																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	737.2167783	18.79502322	745.6835769	0	295.4250077	1163.925587	3861.569165	468.7146893	321.9529119	0	576.8807749	48.03482658	0	19.59766037	0	3414.387355	120.2624761	55.73942718	0	0	15.60701266	0	0	0	315.7128283	512.5646177	0	0	0	0											3400	1a:$100 Days 1-5; 25 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	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:$50	8a:$0	8b: X-Rays $0; Diagnostic $25; Therapeutic $25	9a:$100	12:$0	3:$20; 5:$15; 9c:$30; 9d:$20	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$20; 7d:$20; 7f:$0; 16b:$0-$20; 17a:$0-$20; 6 Routine Footcare Visits	7e:$20; 7h:$20	7c:$20; 7i: PT $0 ST $20	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0	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 52 Weeks $0											0	82.11627623	67.47437092	2.142446174	0	20.54481908	1.227103214	0.346637686	34.25322784	74.63985047	0	25	100	0	20.6057158	0	20	20	20	0	0	0.181361659	0	0	0	20	19.01237072	0	0	0	0											NO	81.08665741	66.62834033	2.115583011	0	20.28721689	1.211717122	0.342291353	33.82374212	73.70397517	0	24.68653632	98.74614526	0	20.34735006	0	19.74922905	19.74922905	19.74922905	0	0	0.167853932	0	0	0	20	19.01237072	0	0	0	0												4.9815	0.104356767	0.131462959	0	0.499445934	0.117529047	0.110148478	1.321140398	1.977434119	0	1.186765683	0.395271164	0	0.033230038	0	5.619293163	0.197924266	0.091734226	0	0	2.619698438	0	0	0	0.526188047	0.812089044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.7252	0	0.42372206	4.9815	0.104356767	0.131462959	0	0.499445934	0.117529047	0.110148478	1.321140398	1.977434119	0	1.186765683	0.395271164	0	0.033230038	0	5.619293163	0.197924266	0.091734226	0	0	2.619698438	0	0	0	0.526188047	0.812089044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.7252	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.9815	0.104356767	0.131462959	0	0.499445934	0.117529047	0.110148478	1.321140398	1.977434119	0	1.186765683	0.395271164	0	0.033230038	0	5.619293163	0.197924266	0.091734226	0	0	2.619698438	0	0	0	0.526188047	0.812089044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.7252
H0544_013_0	2011	3																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	0	0	2104.285732	0	779.7409329	4243.279904	0	506.2142802	0	0	0	0	0	24.14129495	0	0	0	0	0	0	24.39995591	0	0	1415.016988	0	660.8804323	0	0	0	0											3400	1a:$0; 175 Add'l Days	1b:$0; 60 Add'l Days	"2:$0 Days 1-31, $25 Days 32-100; 3 Day Waiver"	6:$0	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	3:$0; 5:$15; 9c:$15; 9d:$0	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits; Self Referral	7e:$0; 7h:$0	7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	"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 14c:Annual CCC Visit $0	13c:OTC $25 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0 13e:Electronic Health Monitoring $0											0	0	0	1.071223087	0	13.69654605	1.227103214	0	50	0	0	0	0	0	15	0	0	0	0	0	0	0.179352481	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	0	0	1.067960427	0	13.65483002	1.223365784	0	49.84771332	0	0	0	0	0	14.954314	0	0	0	0	0	0	0.159647137	0	0	20.10884354	0	19.01237072	0	0	0	0												0	0	0.187274491	0	0.887269158	0.432590287	0	2.102802027	0	0	0	0	0	0.030084709	0	0	0	0	0	0	3.895383107	0	0	2.371196269	0	1.047075315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.9537	0	0.491929918	0	0	0.187274491	0	0.887269158	0.432590287	0	2.102802027	0	0	0	0	0	0.030084709	0	0	0	0	0	0	3.895383107	0	0	2.371196269	0	1.047075315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.9537	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0.187274491	0	0.887269158	0.432590287	0	2.102802027	0	0	0	0	0	0.030084709	0	0	0	0	0	0	3.895383107	0	0	2.371196269	0	1.047075315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.9537
H0544_014_0	2011	3																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	0	0	1972.332887	0	796.972068	6806.899455	0	494.5078224	0	0	0	0	0	45.71596125	0	0	0	0	0	0	23.61600903	0	0	1415.016988	0	664.7280019	0	0	0	0											3400	1a:$0; 175 Add'l Days	1b:$0; 60 Add'l Days	"2:$0 Days 1-31, $25 Days 32-100; 3 Day Waiver"	6:$0	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	3:$0; 5:$15; 9c:$15; 9d:$0	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits; Self Referral	7e:$0; 7h:$0	7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	"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 14c:Annual CCC Visit $0	13c:OTC $25 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0											0	0	0	1.071223087	0	13.69654605	1.227103214	0	50	0	0	0	0	0	15	0	0	0	0	0	0	0.179486527	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	0	0	1.068068975	0	13.65621791	1.223490128	0	49.85277988	0	0	0	0	0	14.95583396	0	0	0	0	0	0	0.160385862	0	0	20.10884354	0	19.01237072	0	0	0	0												0	0	0.175548964	0	0.906968686	0.694014524	0	2.054382468	0	0	0	0	0	0.056976694	0	0	0	0	0	0	3.787673957	0	0	2.371196269	0	1.053171266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.0999	0	0.462562807	0	0	0.175548964	0	0.906968686	0.694014524	0	2.054382468	0	0	0	0	0	0.056976694	0	0	0	0	0	0	3.787673957	0	0	2.371196269	0	1.053171266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.0999	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0.175548964	0	0.906968686	0.694014524	0	2.054382468	0	0	0	0	0	0.056976694	0	0	0	0	0	0	3.787673957	0	0	2.371196269	0	1.053171266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.0999
H0544_016_0	2011	4																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	363.4891975	13.60279928	267.6350066	0	107.6972746	349.6131725	891.0717626	250.7110943	209.2441002	0	192.8582686	6.369145081	0.366728056	20.05362064	3496.658289	2298.385835	124.4969926	733.705636	0	0	7.680753372	0	0	0	0	580.3187763	0	0	0	0											3400	1a:$150 Days 1-6	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	3:$15; 5:$30; 9c:$30; 9d:$30	"7a:$5; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$20; 7d:$20; 7f:$20; 16b:$0-$20; 17a:$0-$20	7e:$20; 7h:$20	7c:$15; 7i:$15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	0	7g:Consult with Nutritionist $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0	0											0	129.2459736	115.4706431	2.142446174	0	24.65378289	1.227103214	0.4449042	35.68937223	150	0	50	150	25	29.98430775	5	19.99976167	20	15	0	0	0.177704976	0	0	0	0	19.01237072	0	0	0	0											NO	128.1441275	114.4862342	2.12418142	0	24.44360478	1.216641929	0.441111308	35.38511366	148.7212219	0	49.57374065	148.7212219	24.78687032	29.72868592	4.957374065	19.82925996	19.82949626	14.87212219	0	0	0.173617182	0	0	0	0	19.01237072	0	0	0	0												3.8816	0.129777772	0.047375442	0	0.219375801	0.03544617	0.032755153	0.739286714	2.593253189	0	0.796725483	0.078935587	0.000757503	0.049680649	1.44452026	3.797940852	0.205726054	0.909313323	0	0	1.333510756	0	0	0	0	0.919436309	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.2154	0	0.160051859	3.8816	0.129777772	0.047375442	0	0.219375801	0.03544617	0.032755153	0.739286714	2.593253189	0	0.796725483	0.078935587	0.000757503	0.049680649	1.44452026	3.797940852	0.205726054	0.909313323	0	0	1.333510756	0	0	0	0	0.919436309	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.2154	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.8816	0.129777772	0.047375442	0	0.219375801	0.03544617	0.032755153	0.739286714	2.593253189	0	0.796725483	0.078935587	0.000757503	0.049680649	1.44452026	3.797940852	0.205726054	0.909313323	0	0	1.333510756	0	0	0	0	0.919436309	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.2154
H0544_019_0	2011	3																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	1777.211652	44.68410206	1462.803346	0	666.5001137	9466.028117	6780.430135	478.9978395	0	0	0	0	0	34.30962174	0	0	0	0	0	0	16.53565276	0	0	1415.016988	0	705.8501416	0	0	0	0											3400	1a:$75 Days 1-4; 175 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	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	3:$0; 5:$30; 9c:$30; 9d:$0	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 9 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	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 14c:Annual CCC Visit $0	13c:OTC $30 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0											0	57.3000549	42.28797763	1.285467704	0	24.65378289	1.227103214	0.216139987	50	0	0	0	0	0	30	0	0	0	0	0	0	0.179821501	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	56.87151194	41.97170891	1.275853784	0	24.46939904	1.217925798	0.214523491	49.62605362	0	0	0	0	0	29.77563217	0	0	0	0	0	0	0.166143401	0	0	20.10884354	0	19.01237072	0	0	0	0												8.4227	0.15628901	0.155526932	0	1.359071437	0.96074332	0.121213462	1.980897706	0	0	0	0	0	0.085132556	0	0	0	0	0	0	2.747289582	0	0	2.371196269	0	1.118323714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.4784	0	0.325955524	8.4227	0.15628901	0.155526932	0	1.359071437	0.96074332	0.121213462	1.980897706	0	0	0	0	0	0.085132556	0	0	0	0	0	0	2.747289582	0	0	2.371196269	0	1.118323714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.4784	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.4227	0.15628901	0.155526932	0	1.359071437	0.96074332	0.121213462	1.980897706	0	0	0	0	0	0.085132556	0	0	0	0	0	0	2.747289582	0	0	2.371196269	0	1.118323714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.4784
H0544_021_0	2011	6																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	364.6917143	13.64780088	268.5204129	0	108.0535652	350.7691462	894.6210486	251.495241	209.9363341	0	290.303755	6.39021587	0.367941287	20.11996324	3486.4668	2123.65748	121.6443864	736.1329252	0	0	7.863344279	0	0	0	319.7401788	0	0	0	0	0											3400	1a:$200 Days 1-5	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:$75	8a:$0	8b: X-Rays $0; Diagnostic $50; Therapeutic $25	9a:$150	12:$15	3:$30; 5:$30; 9c:$30; 9d:$30	"7a:$15; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$30; 7d:$30; 7f:$0; 16b:$0-$30; 17a:$0-$30	7e:$30; 7h:$30	7c:$30; 7i:$30	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $20 copay	0	18a:$0	0	14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0	0											0	164.2325525	134.9487418	5.149441298	0	27.39309211	1.227103214	0.471124129	41.82462655	110.8293984	0	41.66326138	150	15	30	15	29.99947251	30	30	0	0	0.177635496	0	0	0	20	0	0	0	0	0											NO	161.2686222	132.513301	5.056508536	0	26.89872474	1.204957492	0.462621679	41.06981105	108.8292431	0	40.91135806	147.2929268	14.72929268	29.45858536	14.72929268	29.45806739	29.45858536	29.45858536	0	0	0.17260993	0	0	0	20	0	0	0	0	0												4.9011	0.150709596	0.11314798	0	0.242208592	0.035221826	0.034489258	0.860738502	1.903934362	0	0.989726739	0.078436133	0.000451626	0.049392138	4.279432494	5.213237097	0.298622628	1.807119551	0	0	1.357291309	0	0	0	0.532900298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.8482	0	0.424701107	4.9011	0.150709596	0.11314798	0	0.242208592	0.035221826	0.034489258	0.860738502	1.903934362	0	0.989726739	0.078436133	0.000451626	0.049392138	4.279432494	5.213237097	0.298622628	1.807119551	0	0	1.357291309	0	0	0	0.532900298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.8482	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.9011	0.150709596	0.11314798	0	0.242208592	0.035221826	0.034489258	0.860738502	1.903934362	0	0.989726739	0.078436133	0.000451626	0.049392138	4.279432494	5.213237097	0.298622628	1.807119551	0	0	1.357291309	0	0	0	0.532900298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.8482
H0544_022_0	2011	3																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	2677.959959	169.0643838	0	0	1241.416633	7610.65806	33360.88021	94.4021552	62.62600152	0	0	4.038465726	0	0	0	0	0	0	0	0	6.293632897	0	0	0	310	493.1	0	0	0	0											3400	1a:$100 Days 1-5; 150 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:$50	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	9a:$100	12:$0	3:$0; 5:$0; 9c:$0; 9d:$0	"7a:$0; 14b,14c (ippe/ppps), 14c:Comprehensive Health Assessment $0, 14d,14e,14f,14i,14j:$0"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 6 Routine Footcare Visits	7e:$0; 7h:$0; 7g: NP Psych Services $0	7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0	0	14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Comprehensive Health Assessment $0	13c:OTC $40 per month Allowance											0	82.11627623	67.47437092	0	0	13.69654605	1.227103214	0.106948599	50	76.59574468	0	0	100	0	0	0	0	0	0	0	0	0.182784036	0	0	0	20	19.01237072	0	0	0	0											NO	80.46942293	66.12116306	0	0	13.42185992	1.202493489	0.10480373	48.99724307	75.05960641	0	0	97.99448614	0	0	0	0	0	0	0	0	0.178524794	0	0	0	20	19.01237072	0	0	0	0												17.9578	0.931561141	0	0	1.388510012	0.76264723	0.291362058	0.385453779	0.391723585	0	0	0.032978948	0	0	0	0	0	0	0	0	1.123569516	0	0	0	0.516666667	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5635	0	0.479956198	17.9578	0.931561141	0	0	1.388510012	0.76264723	0.291362058	0.385453779	0.391723585	0	0	0.032978948	0	0	0	0	0	0	0	0	1.123569516	0	0	0	0.516666667	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5635	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.9578	0.931561141	0	0	1.388510012	0.76264723	0.291362058	0.385453779	0.391723585	0	0	0.032978948	0	0	0	0	0	0	0	0	1.123569516	0	0	0	0.516666667	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5635
H0544_024_0	2011	3																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	2225.697514	59.63571458	2049.082085	0	827.9845647	7071.641964	6762.4379	701.8433156	401.1009334	0	1003.533626	29.0158122	0	88.91355159	0	4952.699282	457.825028	80.13552146	0	0	23.72765237	0	0	0	327.1881939	554.189017	0	0	0	0											3400	1a:$100 Days 1-5; 150 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	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:$50	8a:$0	8b: X-Rays $0; Diagnostic $25; Therapeutic $25	9a:$100	12:$0	3:$20; 5:$15; 9c:$30; 9d:$15	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$15; 7d:$15; 7f:$0; 16b:$0-$15; 17a:$0-$15; 9 Routine Footcare Visits	7e:$15; 7h:$15	7c:$20; 7i: PT $0 ST $20	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0	0	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 14c:Annual CCC Visit $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0											0	82.11627623	67.47437092	2.142446174	0	20.54481908	1.227103214	0.261763967	40.62006235	80.4964539	0	25	100	0	15.07166624	0	14.99919327	15	20	0	0	0.179491225	0	0	0	20	19.01237072	0	0	0	0											NO	78.38451568	64.40800933	2.045083063	0	19.61116318	1.171337712	0.249868147	38.77409035	76.83830591	0	23.86387915	95.45551659	0	14.38673687	0	14.31755742	14.31832749	19.09110332	0	0	0.155014718	0	0	0	20	19.01237072	0	0	0	0												14.5384	0.320084805	0.349211922	0	1.353145034	0.69027341	0.140809819	2.267778011	2.568326352	0	1.995683765	0.230809945	0	0.106597989	0	5.909213028	0.546274057	0.127489627	0	0	3.678135338	0	0	0	0.545313656	0.878037253	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2455	0	2.063488091	14.5384	0.320084805	0.349211922	0	1.353145034	0.69027341	0.140809819	2.267778011	2.568326352	0	1.995683765	0.230809945	0	0.106597989	0	5.909213028	0.546274057	0.127489627	0	0	3.678135338	0	0	0	0.545313656	0.878037253	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2455	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.5384	0.320084805	0.349211922	0	1.353145034	0.69027341	0.140809819	2.267778011	2.568326352	0	1.995683765	0.230809945	0	0.106597989	0	5.909213028	0.546274057	0.127489627	0	0	3.678135338	0	0	0	0.545313656	0.878037253	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2455
H0544_025_0	2011	3																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	1275.71152	46.34176363	1140.003886	0	452.8143977	2151.407315	4308.276488	475.7181373	343.180153	0	566.7300242	14.51916032	0	74.54048912	0	3843.721735	298.6234896	51.44428601	0	0	17.22305144	0	0	0	333.8325205	552.08927	0	0	0	0											3400	1a:$100 Days 1-5; 125 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	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:$50	8a:$0	8b: X-Rays $0; Diagnostic $25; Therapeutic $25	9a:$100	12:$0	3:$20; 5:$15; 9c:$30; 9d:$15	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$15; 7d:$15; 7f:$0; 16b:$0-$15; 17a:$0-$15; 12 Routine Footcare Visits	7e:$15; 7h:$15	7c:$20; 7i: PT $0 ST $20	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0	0	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 14c:Annual CCC Visit $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0 13e:Electronic Health Monitoring $0											0	82.11627623	67.47437092	2.142446174	0	20.54481908	1.227103214	0.461281082	40.50774771	75.96153846	0	25	100	0	15.09916185	0	15	15	20	0	0	0.178883478	0	0	0	20	19.01237072	0	0	0	0											NO	80.58291131	66.21441567	2.102440076	0	20.16118375	1.2041894	0.452667537	39.75134274	74.54310153	0	24.53317266	98.13269063	0	14.81721378	0	14.71990359	14.71990359	19.62653813	0	0	0.163394033	0	0	0	20	19.01237072	0	0	0	0												8.5667	0.255707733	0.199732488	0	0.760772856	0.215891824	0.162518076	1.57586956	2.131809416	0	1.158640461	0.118733689	0	0.092040197	0	4.714934449	0.366309081	0.084139437	0	0	2.814143831	0	0	0	0.556387534	0.874710489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.6491	0	0.65502766	8.5667	0.255707733	0.199732488	0	0.760772856	0.215891824	0.162518076	1.57586956	2.131809416	0	1.158640461	0.118733689	0	0.092040197	0	4.714934449	0.366309081	0.084139437	0	0	2.814143831	0	0	0	0.556387534	0.874710489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.6491	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.5667	0.255707733	0.199732488	0	0.760772856	0.215891824	0.162518076	1.57586956	2.131809416	0	1.158640461	0.118733689	0	0.092040197	0	4.714934449	0.366309081	0.084139437	0	0	2.814143831	0	0	0	0.556387534	0.874710489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.6491
H0544_027_0	2011	5																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	876.5377389	35.19627766	807.7497554	0	315.8280832	1334.370663	5063.608774	416.1130919	290.4430716	0	562.7510421	15.65830319	0	51.55114093	0	3572.006842	276.7254135	72.21089768	0	0	15.54158138	0	0	0	323.5859775	548.274081	0	0	0	0											3400	1a:$100 Days 1-5; 25 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	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:$50	8a:$0	8b: X-Rays $0; Diagnostic $25; Therapeutic $25	9a:$100	12:$0	3:$20; 5:$15; 9c:$30; 9d:$20	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$20; 7d:$20; 7f:$0; 16b:$0-$20; 17a:$0-$20; 6 Routine Footcare Visits	7e:$20; 7h:$20	7c:$20; 7i: PT $0 ST $20	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0	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 52 Weeks $0											0	82.11627623	67.47437092	2.142446174	0	20.54481908	1.227103214	0.235866847	39.19908064	76.06643674	0	25	100	0	16.97075066	0	20	20	20	0	0	0.178539702	0	0	0	20	19.01237072	0	0	0	0											NO	80.94906726	66.51528346	2.111993229	0	20.25279296	1.209661046	0.232514212	38.64190098	74.98522079	0	24.6446475	98.57858999	0	16.72952672	0	19.715718	19.715718	19.715718	0	0	0.165387503	0	0	0	20	19.01237072	0	0	0	0												5.9129	0.195090865	0.142163501	0	0.533033398	0.134511351	0.098113417	1.339950075	1.814911487	0	1.155733422	0.128631121	0	0.071868849	0	5.868723299	0.454653351	0.118640808	0	0	2.570383344	0	0	0	0.539309963	0.86866584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9473	0	0.463500996	5.9129	0.195090865	0.142163501	0	0.533033398	0.134511351	0.098113417	1.339950075	1.814911487	0	1.155733422	0.128631121	0	0.071868849	0	5.868723299	0.454653351	0.118640808	0	0	2.570383344	0	0	0	0.539309963	0.86866584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9473	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.9129	0.195090865	0.142163501	0	0.533033398	0.134511351	0.098113417	1.339950075	1.814911487	0	1.155733422	0.128631121	0	0.071868849	0	5.868723299	0.454653351	0.118640808	0	0	2.570383344	0	0	0	0.539309963	0.86866584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9473
H0544_028_0	2011	7																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	349.6515965	13.08495691	257.4464606	0	103.5973675	336.3239743	858.4613134	242.5981156	201.2784264	0	278.3314439	6.126679311	0.352767155	19.29020318	4051.49315	2052.780824	119.1567689	705.774336	0	0	7.579228983	0	0	0	319.5305224	0	0	0	0	0											3400	1a:$200 Days 1-5	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:$75	8a:$0	8b: X-Rays $0; Diagnostic $50; Therapeutic $25	9a:$150	12:$15	3:$30; 5:$30; 9c:$30; 9d:$30	"7a:$15; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$30; 7d:$30; 7f:$0; 16b:$0-$30; 17a:$0-$30	7e:$30; 7h:$30	7c:$30; 7i:$30	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $20 copay	0	18a:$0	0	14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0	0											0	164.2325525	134.9487418	5.149441298	0	27.39309211	1.227103214	0.463331542	41.75274737	110.8293984	0	41.66326138	150	15	30	15	29.99946509	30	30	0	0	0.17783542	0	0	0	20	0	0	0	0	0											NO	161.2578705	132.5044664	5.056171421	0	26.89693141	1.204877158	0.454939393	40.99649569	108.8219875	0	40.90863052	147.2831069	14.72831069	29.45662137	14.72831069	29.45609616	29.45662137	29.45662137	0	0	0.173026435	0	0	0	20	0	0	0	0	0												4.6987	0.144484603	0.108474453	0	0.232204274	0.03376909	0.032545656	0.82880605	1.825293201	0	0.948846517	0.075196364	0.000432972	0.047352018	4.972637488	5.038909111	0.292496319	1.732477283	0	0	1.311406968	0	0	0	0.532550871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.8566	0	0.424062327	4.6987	0.144484603	0.108474453	0	0.232204274	0.03376909	0.032545656	0.82880605	1.825293201	0	0.948846517	0.075196364	0.000432972	0.047352018	4.972637488	5.038909111	0.292496319	1.732477283	0	0	1.311406968	0	0	0	0.532550871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.8566	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.6987	0.144484603	0.108474453	0	0.232204274	0.03376909	0.032545656	0.82880605	1.825293201	0	0.948846517	0.075196364	0.000432972	0.047352018	4.972637488	5.038909111	0.292496319	1.732477283	0	0	1.311406968	0	0	0	0.532550871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.8566
H0544_031_0	2011	5																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	2035.283999	54.53374276	1873.778425	0	757.1485909	6466.919423	6185.647234	643.8435664	366.7858309	0	917.6790288	26.53344309	0	81.30679383	0	4597.074583	438.2733701	73.27974427	0	0	21.25972332	0	0	0	326.3477791	551.6930348	0	0	0	0											3400	1a:$100 Days 1-5; 150 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	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:$50	8a:$0	8b: X-Rays $0; Diagnostic $25; Therapeutic $25	9a:$100	12:$0	3:$20; 5:$15; 9c:$30; 9d:$15	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$15; 7d:$15; 7f:$0; 16b:$0-$15; 17a:$0-$15; 9 Routine Footcare Visits	7e:$15; 7h:$15	7c:$20; 7i: PT $0 ST $20	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0	0	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 14c:Annual CCC Visit $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0											0	82.11627623	67.47437092	2.142446174	0	20.54481908	1.227103214	0.241596165	40.53870477	80.4964539	0	25	100	0	15.07166624	0	14.99898274	15	20	0	0	0.179686466	0	0	0	20	19.01237072	0	0	0	0											NO	78.95964926	64.88059257	2.060088526	0	19.75505689	1.179932211	0.232308981	38.98035879	77.40209442	0	24.03897646	96.15590584	0	14.4922972	0	14.42240772	14.42338588	19.23118117	0	0	0.158021283	0	0	0	20	19.01237072	0	0	0	0												13.3921	0.294848462	0.321679119	0	1.246459457	0.635877211	0.11974845	2.091437768	2.365832626	0	1.838338714	0.212612271	0	0.098193518	0	5.525073665	0.526782161	0.117438003	0	0	3.359488764	0	0	0	0.543912965	0.874082708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5639	0	1.61141174	13.3921	0.294848462	0.321679119	0	1.246459457	0.635877211	0.11974845	2.091437768	2.365832626	0	1.838338714	0.212612271	0	0.098193518	0	5.525073665	0.526782161	0.117438003	0	0	3.359488764	0	0	0	0.543912965	0.874082708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5639	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.3921	0.294848462	0.321679119	0	1.246459457	0.635877211	0.11974845	2.091437768	2.365832626	0	1.838338714	0.212612271	0	0.098193518	0	5.525073665	0.526782161	0.117438003	0	0	3.359488764	0	0	0	0.543912965	0.874082708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5639
H0544_032_0	2011	6																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	1237.621365	44.9580927	1105.965686	0	439.2942796	2087.275198	4180.70176	462.716321	332.9334907	0	549.8086169	14.08564768	0	72.31486152	0	3754.064316	294.6042085	49.90826412	0	0	16.94188452	0	0	0	333.4389175	551.0720613	0	0	0	0											3400	1a:$100 Days 1-5; 125 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	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:$50	8a:$0	8b: X-Rays $0; Diagnostic $25; Therapeutic $25	9a:$100	12:$0	3:$20; 5:$15; 9c:$30; 9d:$15	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$15; 7d:$15; 7f:$0; 16b:$0-$15; 17a:$0-$15; 12 Routine Footcare Visits	7e:$15; 7h:$15	7c:$20; 7i: PT $0 ST $20	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0	0	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 14c:Annual CCC Visit $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0 13e:Electronic Health Monitoring $0											0	82.11627623	67.47437092	2.142446174	0	20.54481908	1.227103214	0.449564723	40.44147726	75.96153846	0	25	100	0	15.09916185	0	15	15	20	0	0	0.179049123	0	0	0	20	19.01237072	0	0	0	0											NO	80.67595273	66.29086715	2.104867563	0	20.18446195	1.205579763	0.441679336	39.73213177	74.62916936	0	24.56149878	98.24599511	0	14.83432181	0	14.73689927	14.73689927	19.64919902	0	0	0.16392627	0	0	0	20	19.01237072	0	0	0	0												8.3205	0.248359246	0.193992608	0	0.738909889	0.209698062	0.153877465	1.53205882	2.070545822	0	1.125343639	0.115321539	0	0.089395161	0	4.610272306	0.361796045	0.081721451	0	0	2.777219943	0	0	0	0.555731529	0.87309886	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.0579	0	0.610627948	8.3205	0.248359246	0.193992608	0	0.738909889	0.209698062	0.153877465	1.53205882	2.070545822	0	1.125343639	0.115321539	0	0.089395161	0	4.610272306	0.361796045	0.081721451	0	0	2.777219943	0	0	0	0.555731529	0.87309886	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.0579	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.3205	0.248359246	0.193992608	0	0.738909889	0.209698062	0.153877465	1.53205882	2.070545822	0	1.125343639	0.115321539	0	0.089395161	0	4.610272306	0.361796045	0.081721451	0	0	2.777219943	0	0	0	0.555731529	0.87309886	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.0579
H0544_034_0	2011	4																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	929.431776	37.32683962	856.6458609	0	334.9463351	1415.130663	5370.094837	438.482086	160.5821136	0	596.8164617	16.60615868	0	54.67172377	0	4048.281721	282.9446292	76.58209266	0	0	16.64129539	0	0	1415.016988	0	664.1792411	0	0	0	0											3400	1a:$45 Days 1-5; Unlimited Add'l Days	1b:$45 Days 1-5; 60 Add'l Days	"2:$0 Days 1-31, $30 Days 32-100; 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:$10; Worldwide Coverage	9a:$45; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $25; Therapeutic $25	9a:$45	12:$0	3:$10; 5:$30; 9c:$30; 9d:$10	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$10; 7d:$10; 7f:$10; 16b:$0-$10; 17a:$0-$10; 4 Routine Footcare Visits	7e:Visits 1-10:$0; Visits 11+:$10; 7h:$10	7c:$10; 7i: PT $0 ST $10	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20%	14a:$0; 17b:$0; First 3 Pints of Blood	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 $20 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0											0	36.9523243	30.36346692	1.285467704	0	27.39309211	1.227103214	0.25087996	37.80844583	45	0	25	45	0	22.4115361	0	10	9.915880096	10	0	0	0.2	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	36.77154711	30.21492355	1.279178973	0	27.25908034	1.221100011	0.249652611	37.62348034	44.77985217	0	24.87769565	44.77985217	0	22.30189497	0	9.951078261	9.867369886	9.951078261	0	0	0.182792863	0	0	20.10884354	0	19.01237072	0	0	0	0												2.8481	0.093985634	0.091316948	0	0.760860755	0.144001339	0.111721517	1.374768512	0.599236942	0	1.237284858	0.061968444	0	0.10160692	0	3.357064019	0.232659943	0.0635062	0	0	3.041910032	0	0	2.371196269	0	1.052301829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.5434	0	0.340811161	2.8481	0.093985634	0.091316948	0	0.760860755	0.144001339	0.111721517	1.374768512	0.599236942	0	1.237284858	0.061968444	0	0.10160692	0	3.357064019	0.232659943	0.0635062	0	0	3.041910032	0	0	2.371196269	0	1.052301829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.5434	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.8481	0.093985634	0.091316948	0	0.760860755	0.144001339	0.111721517	1.374768512	0.599236942	0	1.237284858	0.061968444	0	0.10160692	0	3.357064019	0.232659943	0.0635062	0	0	3.041910032	0	0	2.371196269	0	1.052301829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.5434
H0544_035_0	2011	5																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	1477.141952	53.65896768	1320.006553	0	524.3122236	2491.096512	4988.06666	401.4426712	206.3252308	0	656.2147331	16.81168547	0	41.12240155	0	0	0	0	0	0	20.37790304	0	0	1415.016988	0	673.418615	0	0	0	0											3400	1a:$45 Days 1-5; 125 Add'l Days	1b:$45 Days 1-5; 60 Add'l Days	"2:$0 Days 1-31, $30 Days 32-100; 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; 11c:$0	4a:$50 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$45; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $25; Therapeutic $25	9a:$45	12:$0	3:$0; 5:$30; 9c:$30; 9d:$0	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits	7e:$0; 7h:$0	7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20%	14a:$0; 17b:$0; First 3 Pints of Blood	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: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 14c:Annual CCC Visit $0	13c:OTC $30 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0 13e:Electronic Health Monitoring $0											0	36.9523243	30.36346692	1.285467704	0	27.39309211	1.227103214	0.501208543	50	45	0	25	45	0	30	0	0	0	0	0	0	0.2	0	0	20.10884354	0	19.01237072	0	0	0	0											NO	36.77016116	30.21378473	1.27913076	0	27.25805292	1.221053987	0.498737746	49.75351599	44.77816439	0	24.87675799	44.77816439	0	29.85210959	0	0	0	0	0	0	0.178536321	0	0	20.10884354	0	19.01237072	0	0	0	0												4.5262	0.135103375	0.140705082	0	1.190977528	0.253480277	0.207311427	1.66443203	0.769905425	0	1.360374592	0.062733035	0	0.102299203	0	0	0	0	0	0	3.638195833	0	0	2.371196269	0	1.066940363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.4899	0	0.488974572	4.5262	0.135103375	0.140705082	0	1.190977528	0.253480277	0.207311427	1.66443203	0.769905425	0	1.360374592	0.062733035	0	0.102299203	0	0	0	0	0	0	3.638195833	0	0	2.371196269	0	1.066940363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.4899	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.5262	0.135103375	0.140705082	0	1.190977528	0.253480277	0.207311427	1.66443203	0.769905425	0	1.360374592	0.062733035	0	0.102299203	0	0	0	0	0	0	3.638195833	0	0	2.371196269	0	1.066940363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.4899
H0545_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	P	V	Ded	V	P	P	P	P	P	P	Coin	Coin	P	Coin	P	P	P	P	P	P																																																			0	YES	884.9305047	52.05852913	770.3804936		640.574975	5.44457382	9.665449705	813.0745321	443.6798276		1268.363168	29.19822231		1614.760797		6026.209474	114.0979714	642.0117709			21.47295004			3.08																	6700	"(1a) $200/admit with $1,000 MOOP/year"	(1b) $75 days 1-6; $0 after day 6	(2) $0 days 1-15; $40 days 16-100	(6) $0/visit	(10a) $50/trip	(11a) 20%	"(11b) 20%, (11c) 0%"	"(4a) $50/visit, (4b) $30/visit"	(9a) $50/visit; (9b) $50/visit	(8a) 0%	"(8b) $15 Radiation Therapy (MOOP of $1,000/year), $0 standard radiology, $60 complex radiology"	(9a) $50/visit	(12) $0/visit	"(3) $10/visit, (5) $10/visit, (9a) $50/visit, (9c) $10/visit, (9d) $10/visit"	"(7a) $0/visit, (14c) $0"	"(7b) $10/visit Medicare covered, $25/visit Non-Medicare Covered; (7d) $10/visit; (7f) $10/visit; (7g) $10/visit, (17a) $10/ Medicare covered exam; (18a) $10/ Medicare covered exam"	(7e) $10/visit; (7h) $10/visit	(7c) $10/visit; (7i) $10/visit	(7d) $0	"(14a) $0, (14b) $0, (14d) $0, (14e) $0, (14f) $0, (14g) $0, (14h) $0, (14i) $0, (14j) $0,"	"(15) 10% (MOOP $1,500/year)"	(13a) 0%		"(16a) $4/exam, $10/cleaning,$20/fluoride (16b) min of $4/procedure, max of $580/procedure"	(17a) $0/ Non-Medicare covered exam	(17b) $0 (max benefit of $125 every other year)			(14a) $0													60.00694143	20.49418605	6.019493177		50	0.2	0.2	49.00338534	50		59.48416586	50		32.24912399		10.2058566	10	10			0.092733019			0.375860468																	NO	58.98438733	20.14495289	5.916917421		49.14797016	0.196591881	0.196591881	48.16833841	49.14797016		58.47052018	49.14797016		31.69957967		10.03778925	9.829594032	9.829594032			0.091152793			0.375860468																		4.3498	0.087393051	0.37985648	0	2.62357998	1.070359007	1.900148935	3.263704101	1.817163577	0	6.18015452	0.119586113	0	4.26560321	0	5.040818388	0.093461395	0.525892923	0	0	1.957319369	0	0	1.157650241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8324	0	0.580799795	4.3498	0.087393051	0.37985648	0	2.62357998	1.070359007	1.900148935	3.263704101	1.817163577	0	6.18015452	0.119586113	0	4.26560321	0	5.040818388	0.093461395	0.525892923	0	0	1.957319369	0	0	1.157650241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8324	NO								"(4a) $50 World Wide coverage ($20,000 Max benefit)"																																									0.0008																																	0.0008	0	0	4.3498	0.087393051	0.37985648	0	2.62357998	1.070359007	1.900148935	3.26452003	1.817163577	0	6.18015452	0.119586113	0	4.26560321	0	5.040818388	0.093461395	0.525892923	0	0	1.957319369	0	0	1.157650241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8333
H0545_009_0	2011	2																															D	D	D	V	T	Coin	Coin	V	V	Coin	P	V	P	V	P	P	P	P	P	P	Coin	Coin	P	Coin	P	P	P	P	P	P																																																			0	YES	1499.310206	45.20698082	1168.121068		956.723313	11.962174	29.69780154	1286.118709	659.5198481		1966.675389	54.85462635		2476.097411		9676.187456	206.8309634	1154.211527			33.77061311																				6700	"(1a) $75/day days 1-6, $0/day days 7+ with $1,000 MOOP/year"	(1b) $75 days 1-6; $0 after day 6	(2) $0 days 1-15; $40 days 16-100	(6) $0/visit	(10a) $50/trip	"(11a) 0% for items under $2,000; 20% for items over $2,000"	"(11b)  0% for items under $2,000; 20% for items over $2,000, (11c) 0%"	"(4a) $50/visit, (4b) $30/visit"	(9a) $50/visit; (9b) $50/visit	(8a) 0%	"(8b) $15 Radiation Therapy (MOOP of $1,000/year), $0 standard radiology, $60 complex radiology"	(9a) $50/visit	(12) $0/visit	"(3) $10/visit, (5) $10/visit, (9a) $50/visit, (9c) $10/visit, (9d) $10/visit"	"(7a) $0/visit, (13e) $0, (14c) $0"	"(7b) $10/visit; (7d) $10/visit; (7f) $10/visit; (7g) $10/visit, (17a) $10/ Medicare covered exam; (18a) $10/ Medicare covered exam"	(7e) $10/visit; (7h) $10/visit	(7c) $10/visit; (7i) $10/visit	(7d) $0/visit	"(14b) $0, (14d) $0, (14e) $0, (14f) $0, (14g) $0, (14h) $0, (14i) $0, (14j) $0,"	"(15) 10% (MOOP $1,500/year)"	(13a) 0%	(10b) $0/trip for trips up to 20 miles; $3/mile for miles 21+	"(16a) $4/exam, $10/cleaning,$20/fluoride (16b) min of $4/procedure, max of $580/procedure"	(17a) $0/ Non-Medicare covered exam	(17b) $0 (max benefit of $125 every other year)			(14a) $0	(13e) $0												65.1871575	47.62280982	6.082949309		50	0.022499563	0.09244872	48.99413747	50		59.81964299	50		33.24453033		10	10	10			0.081584297																				NO	62.49701533	45.65751277	5.831918292		47.93660111	0.021571052	0.088633548	46.97224849	47.93660111		57.35100729	47.93660111		31.8749504		9.587320222	9.587320222	9.587320222			0.078217478																					7.8085	0.172003192	0.567698885	0	3.821838652	0.258036673	2.632221519	5.034323967	2.63459499	0	9.399234546	0.219128695	0	6.577123513	0	7.730725639	0.165246223	0.922149626	0	0	2.641452182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5843	0	2.176861095	7.8085	0.172003192	0.567698885	0	3.821838652	0.258036673	2.632221519	5.034323967	2.63459499	0	9.399234546	0.219128695	0	6.577123513	0	7.730725639	0.165246223	0.922149626	0	0	2.641452182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5843	NO								"(4a) $50 World Wide coverage ($20,000 Max benefit)"																																									0.0011																																	0.0011	0	0	7.8085	0.172003192	0.567698885	0	3.821838652	0.258036673	2.632221519	5.03543705	2.63459499	0	9.399234546	0.219128695	0	6.577123513	0	7.730725639	0.165246223	0.922149626	0	0	2.641452182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5854
H0545_011_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	P	V	P	V	P	P	P	P	P	P	Coin	Coin	P	Coin	P	P	P	P	P	P																																																			0	YES	519.9429765	20.27748632	350.5994274		364.7138257	2.531844291	7.659063188	573.4521931	277.3067781		644.9060506	22.82253999		1123.563849		4644.358137	91.29204262	592.3639818		29.40248168	18.90808261			2.980407086						28.10268771											6700	"(1a) $75/day days 1-6; $0/day days 7+ with $1,000 MOOP/year"	(1b) $912/admit	(2) $0 days 1-15; $40 days 16-100	(6) $0/visit	(10a) $50/trip	(11a) 20%	"(11b) 20%, (11c) 0%"	"(4a) $50/visit, (4b) $30/visit"	(9a) $50/visit; (9b) $50/visit	(8a) 0%	"(8b) $15 Radiation Therapy (MOOP of $1,000/year), $0 standard radiology, $75 complex radiology"	(9a) $50/visit	(12) $0/visit	"(3) $10/visit, (5) $10/visit, (9a) $50/visit, (9c) $10/visit, (9d) $10/visit"	"(7a) $0/visit, (14c) $0"	"(7b) $10/visit Medicare covered, $20/visit Non-Medicare Covered; (7d) $10/visit; (7f) $10/visit; (7g) $10/visit, (17a) $10/ Medicare covered exam; (18a) $10/ Medicare covered exam"	(7e) $10/visit; (7h) $10/visit	(7c) $10/visit; (7i) $10/visit	(7d) $0/visit	"(14a) $0, (14b) $0, (14d) $0, (14e) $0, (14f) $0, (14g) $0, (14h) $0, (14i) $0, (14j) $0,"	"(15) 10% (MOOP $1,500/year)"	(13a) 0%		"(16a) $4/exam, $10/cleaning,$20/fluoride (16b) min of $4/procedure, max of $580/procedure"	(17a) $0/ Non-Medicare covered exam	(17b) $0 (max benefit of $125 every other year)			(14a) $0	(13b) $20/treatment												60.8783376	57	4.565784157		50	0.2	0.2	46.6753612	50		74.47577561	50		26.31283504		10.18666727	10	10		10	0.097165877			0.375860468						20											NO	60.46812172	56.61591748	4.535018581		49.66308551	0.198652342	0.198652342	46.3608491	49.66308551		73.97393625	49.66308551		26.13553153		10.12054219	9.932617102	9.932617102		9.932617102	0.096511146			0.375860468						20												2.62	0.095669041	0.13249791	0	1.509401159	0.502956798	1.52149084	2.215477549	1.147659186	0	3.975519923	0.094453146	0	2.447078199	0	3.916951874	0.075564075	0.490310385	0	0.024336966	1.824840713	0	0	1.120217201	0	0	0	0	0	0.046837813	0	0	0	0	0	0	0	0	0	0	23.7613	0	0.152298913	2.62	0.095669041	0.13249791	0	1.509401159	0.502956798	1.52149084	2.215477549	1.147659186	0	3.975519923	0.094453146	0	2.447078199	0	3.916951874	0.075564075	0.490310385	0	0.024336966	1.824840713	0	0	1.120217201	0	0	0	0	0	0.046837813	0	0	0	0	0	0	0	0	0	0	23.7613	NO								"(4a) $50 World Wide coverage ($20,000 Max benefit)"																																									0.0008																																	0.0008	0	0	2.62	0.095669041	0.13249791	0	1.509401159	0.502956798	1.52149084	2.216237494	1.147659186	0	3.975519923	0.094453146	0	2.447078199	0	3.916951874	0.075564075	0.490310385	0	0.024336966	1.824840713	0	0	1.120217201	0	0	0	0	0	0.046837813	0	0	0	0	0	0	0	0	0	0	23.762
H0545_012_0	2011	5																															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	YES	0	2.962962963	0	0	301.8996037	0.879325473	2.051759437	658.6177494	0	0	4.654770563	0	0	0	0	0	117.3540934	0	0	0	12.28729825	0	0	0	0	0	0	0	0	0											6700	1a: $0	1b: $912/stay	2: $0	6: $0	10a: $100/trip	"11a: $0 items <$500, 10% items >$500"	"11b: 0% items <$500, 20% items >$500; 11c: $0"	4a: $50/visit; 4b: $0 (see also 7a)	"9a, 9b: $0"	8a: $0	"8b: therapeutic rad $15/visit, other $0"	5: $0	12: $0	"3,5,9a,9c,9d: $0"	"7a,14b-j:$0 (In Network Urgent Care $0)"	"7b,7d,7f,7g,14b-j: $0"	"7e,7h: $20/visit"	"7c,7i: $0"	7d: $0	"7b,7d,7f,7g,14b-j: $0"	15: 20%	"13a,14a: $0"	10b: $0	"16a,16b: $0"	17a: $0	17b: $0	18a: $0	18b: $0	14a: $0	"13b,13c,13d,13e: $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											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	0.225185185	0	0	2.515830031	0.087932547	0.410351887	2.744240622	0	0	0.005818463	0	0	0	0	0	0.195590156	0	0	0	2.45745965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.6424	0	0	0	0.225185185	0	0	2.515830031	0.087932547	0.410351887	2.744240622	0	0	0.005818463	0	0	0	0	0	0.195590156	0	0	0	2.45745965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.6424	NO	0	0	0	0	0	0	0	"4a: $50/visit (worldwide max $20,000/year);  4b: $50/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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.225185185	0	0	2.515830031	0.087932547	0.410351887	2.744240622	0	0	0.005818463	0	0	0	0	0	0.195590156	0	0	0	2.45745965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.6424
H0545_801_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	251.8231933	7.797890589	72.88388562		14.76483713	5.44457382	14.28177742	23.56668215	59.69738402	0.9701234	34.78124071	1.346504128	0.853890725	12.00312603	25.73994885	47.39946513	0.899005748	9.176212329	11.17275234	73.42563762	21.47295004	0.076849059																			6700	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												0.067122833	0.067122833	0.147602422		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.057246279	0.057246279	0.12588398		0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603																				14.4159	0.446400221	9.174913622	0	2.934009822	1.081924097	2.838018114	4.683077526	11.86282718	0.192779071	6.911590085	0.267571955	0.169681775	2.385213556	5.114940456	9.419033551	0.178646853	1.823460488	2.220204994	14.59085123	4.267019392	0.01527114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9934	0	16.38896475	14.4159	0.446400221	9.174913622	0	2.934009822	1.081924097	2.838018114	4.683077526	11.86282718	0.192779071	6.911590085	0.267571955	0.169681775	2.385213556	5.114940456	9.419033551	0.178646853	1.823460488	2.220204994	14.59085123	4.267019392	0.01527114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9934	NO																																																																																		0	0	0	14.4159	0.446400221	9.174913622	0	2.934009822	1.081924097	2.838018114	4.683077526	11.86282718	0.192779071	6.911590085	0.267571955	0.169681775	2.385213556	5.114940456	9.419033551	0.178646853	1.823460488	2.220204994	14.59085123	4.267019392	0.01527114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9934
H0545_802_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	251.8231933	7.797890589	72.88388562		14.76483713	5.44457382	14.28177742	23.56668215	59.69738402	0.9701234	34.78124071	1.346504128	0.853890725	12.00312603	25.73994885	47.39946513	0.899005748	9.176212329	11.17275234	73.42563762	21.47295004	0.076849059																			6700	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												0.067122833	0.067122833	0.147602422		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.057246279	0.057246279	0.12588398		0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603	0.19871603																				14.4159	0.446400221	9.174913622	0	2.934009822	1.081924097	2.838018114	4.683077526	11.86282718	0.192779071	6.911590085	0.267571955	0.169681775	2.385213556	5.114940456	9.419033551	0.178646853	1.823460488	2.220204994	14.59085123	4.267019392	0.01527114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9934	0	16.38896475	14.4159	0.446400221	9.174913622	0	2.934009822	1.081924097	2.838018114	4.683077526	11.86282718	0.192779071	6.911590085	0.267571955	0.169681775	2.385213556	5.114940456	9.419033551	0.178646853	1.823460488	2.220204994	14.59085123	4.267019392	0.01527114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9934	NO																																																																																		0	0	0	14.4159	0.446400221	9.174913622	0	2.934009822	1.081924097	2.838018114	4.683077526	11.86282718	0.192779071	6.911590085	0.267571955	0.169681775	2.385213556	5.114940456	9.419033551	0.178646853	1.823460488	2.220204994	14.59085123	4.267019392	0.01527114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9934
H0562_009_0	2011	4																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	944.7829496	25.54908129	543.0089357	30.12215415	302.9223508	12.69597397	3.441037677	356.0225414	323.8040478	0.524428075	2.829648259	0	5.340172102	14.1836013	3165.797956	5260.289444	151.0144266	2.114986744	49.82621424	37.30319589	17.03777374	0	0	0	799.5025791	0	126.9612722	0	800	0											3400	1a:  Acute - $250/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $10/visit/7-12 Additional Visits/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/18a:  Hearing Exams - $10/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			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													250	900	75	0	280	0.2	0.0553107	44.20692136	180.1905789	0	0.034248344	0	25	0	10	10	25	0	0	0.000817876	0.2	0	0	0	10	0	10	0	0	0											NO	219.513065	897.6412733	65.85391949	0	245.8546328	0.175610452	0.048565685	38.8159872	158.216745	0	0.030071835	0	21.9513065	0	8.780522599	8.780522599	24.97952066	0	0	0.000718137	0.175610452	0	0	0	8.780522599	0	8.780522599	0	0	0												17.2827	1.911159155	2.979938895	0	6.20623861	2.229545727	0.167116353	1.151613868	4.269268539	0	0.085092717	0	0.009768646	0	2.316446708	3.849007528	0.314355666	0	0	0.026788824	2.992011147	0	0	0	0.585004205	0	0.09289886	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4689	0	6.15	17.2827	1.911159155	2.979938895	0	6.20623861	2.229545727	0.167116353	1.151613868	4.269268539	0	0.085092717	0	0.009768646	0	2.316446708	3.849007528	0.314355666	0	0	0.026788824	2.992011147	0	0	0	0.585004205	0	0.09289886	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4689	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.2827	1.911159155	2.979938895	0	6.20623861	2.229545727	0.167116353	1.151613868	4.269268539	0	0.085092717	0	0.009768646	0	2.316446708	3.849007528	0.314355666	0	0	0.026788824	2.992011147	0	0	0	0.585004205	0	0.09289886	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4689
H0562_011_0	2011	4																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	991.5955695	26.38347588	538.9467672	22.88938389	313.6680903	13.0218184	2.956298631	395.0219583	342.1160703	0.552795204	8.883589784	0	11.00374533	10.6168479	3510.211844	5404.237132	162.4146584	3.272291598	53.4484751	44.16121934	22.95275684	0	0	0	632.0699888	0	65.78788618	0	800	0											3400	1a:  Acute - $250/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $20/visit/7-12 Additional Visits/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $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/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			17a:  Routine Eye Exams - $20/visit		18a:  Routine Hearing Test - $20/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													250	900	75	0	280	0.2	0.027263883	45.62125251	184.2413203	0	0.034248344	0	25	0	10.00260347	19.22696164	25	0	0	0.00073441	0.2	0	0	0	20	0	20	0	0	0											NO	211.4418196	892.7212197	63.43254588	0	236.8148379	0.169153456	0.0230589	38.58496257	155.82528	0	0.028966128	0	21.14418196	0	8.459874712	16.26153502	24.70526882	0	0	0.00062114	0.169153456	0	0	0	16.91534557	0	16.91534557	0	0	0												17.4721	1.962757397	2.848897128	0	6.190104831	2.202685582	0.068168996	1.270158956	4.442527705	0	0.257323201	0	0.019388766	0	2.474662701	7.323432613	0.334374816	0	0	0.027430308	3.882538137	0	0	0	0.890973524	0	0.092735402	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7602	0	9.04	17.4721	1.962757397	2.848897128	0	6.190104831	2.202685582	0.068168996	1.270158956	4.442527705	0	0.257323201	0	0.019388766	0	2.474662701	7.323432613	0.334374816	0	0	0.027430308	3.882538137	0	0	0	0.890973524	0	0.092735402	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7602	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.4721	1.962757397	2.848897128	0	6.190104831	2.202685582	0.068168996	1.270158956	4.442527705	0	0.257323201	0	0.019388766	0	2.474662701	7.323432613	0.334374816	0	0	0.027430308	3.882538137	0	0	0	0.890973524	0	0.092735402	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7602
H0562_012_0	2011	4																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	658.703374	25.53608638	543.5524732	7.714110797	222.0213081	10.1762302	4.061327824	290.2227361	218.5516841	1.27455852	4.116731779	0	39.77797591	6.591596802	2688.156279	4306.701438	154.6570098	6.710991892	47.29298064	32.85199675	14.61803539	0	0	0	406.6035256	0	66.06295054	0	1800	0											3400	1a:  Acute - $150/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $150/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $25/visit/7-12 Additional Visits/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/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			17a:  Routine Eye Exams - $25/visit		18a:  Routine Hearing Test - $25/visit		14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													150	900	75	0	280	0.2	0.101739562	46.8554553	109.8509193	0	0.034248344	0	25	0	10.00333486	14.72125197	25	0	0	0.00125457	0.2	0	0	0	25	0	25	0	0	0											NO	141.0811962	898.87659	70.54059808	0	263.3515662	0.188108262	0.095690261	44.0694912	103.3193272	0	0.032211982	0	23.51353269	0	9.408549648	13.84594558	24.95523971	0	0	0.001179975	0.188108262	0	0	0	23.51353269	0	23.51353269	0	0	0												7.7442	1.912815854	3.195209712	0	4.872471601	1.914232971	0.388629518	1.065830693	1.881717747	0	0.132608089	0	0.077943395	0	2.107637651	4.969196146	0.321625229	0	0	0.038764535	2.749773225	0	0	0	0.796723774	0	0.129447779	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2988	0	2.03	7.7442	1.912815854	3.195209712	0	4.872471601	1.914232971	0.388629518	1.065830693	1.881717747	0	0.132608089	0	0.077943395	0	2.107637651	4.969196146	0.321625229	0	0	0.038764535	2.749773225	0	0	0	0.796723774	0	0.129447779	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2988	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.7442	1.912815854	3.195209712	0	4.872471601	1.914232971	0.388629518	1.065830693	1.881717747	0	0.132608089	0	0.077943395	0	2.107637651	4.969196146	0.321625229	0	0	0.038764535	2.749773225	0	0	0	0.796723774	0	0.129447779	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2988
H0562_017_0	2011	6																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	646.2554677	25.23080617	634.2500582	22.10370632	233.2623382	10.09610061	2.546751422	395.0874888	337.4849521	3.116415053	3.003908017	0	5.038005946	7.149134803	3348.126765	5672.215565	156.0594551	13.66685118	44.39691146	29.51592163	13.68355377	0	0	0	702.2615449	0	85.89222037	0	800	0											3400	1a:  Acute - $200/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $180/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 - $0/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $15/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $15/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $15/visit/7-12 Additional Visits/17a:  Vision Exams - $15/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/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			17a:  Routine Eye Exams - $15/visit		18a:  Routine Hearing Test - $15/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													200	900	100	0	180	0.2	0.04453704	46.12075619	143.1132488	0	0.034248344	0	25	0	10.00149968	14.57086976	25	0	0	0.00106107	0.2	0	0	0	15	0	15	0	0	0											NO	180.7329832	899.6637272	90.18338296	0	163.3743393	0.1805289	0.041523155	41.94730547	129.5161207	0	0.032545758	0	23.65720153	0	9.101367238	13.24233665	24.96057269	0	0	0.000966323	0.181258435	0	0	0	13.5466906	0	13.65842494	0	0	0												9.7333	1.891603427	4.766567991	0	3.175756698	1.822637939	0.105749154	1.381071298	3.642478482	0	0.097764462	0	0.009932093	0	2.539377604	6.259449006	0.324611114	0	0	0.028521903	2.48025954	0	0	0	0.792776656	0	0.097762704	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1496	0	3.84363415	9.7333	1.891603427	4.766567991	0	3.175756698	1.822637939	0.105749154	1.381071298	3.642478482	0	0.097764462	0	0.009932093	0	2.539377604	6.259449006	0.324611114	0	0	0.028521903	2.48025954	0	0	0	0.792776656	0	0.097762704	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1496	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.7333	1.891603427	4.766567991	0	3.175756698	1.822637939	0.105749154	1.381071298	3.642478482	0	0.097764462	0	0.009932093	0	2.539377604	6.259449006	0.324611114	0	0	0.028521903	2.48025954	0	0	0	0.792776656	0	0.097762704	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1496
H0562_036_0	2011	5																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	833.6463819	25.87804084	556.3704142	12.29952386	215.1979968	5.867340817	2.284974341	340.2643402	318.3082544	3.24999758	14.80017507	0	19.54888568	12.96277857	3334.817944	5079.264236	358.5078854	7.006204165	43.72980816	37.31168917	34.51510781	0	0	0	572.1471361	0	155.9573392	0	800	0											3400	1a:  Acute - $250/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $15/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $10/visit/7-12 Additional Visits/17a:  Vision Exams - $15/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/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			17a:  Routine Eye Exams - $15/visit		18a:  Routine Hearing Test - $15/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													250	900	75	0	280	0.2	0.09930224	42.83668433	177.9828052	0	0.034248344	0	25	0	10.00119348	10.97393689	25	0	0	0.001563682	0.2	0	0	0	15	0	15	0	0	0											NO	220.2801602	896.3697855	66.08404807	0	246.7137795	0.176224128	0.087497254	37.74428675	156.8243234	0	0.030176922	0	22.02801602	0	8.81225801	9.669362307	23.27149661	0	0	0.001377793	0.176224128	0	0	0	13.21680961	0	13.21680961	0	0	0												15.303	1.933024493	3.0639341	0	4.42435926	1.03396702	0.19992898	1.070252902	4.159873052	0	0.446623735	0	0.035885264	0	2.448939678	4.092770512	0.695251253	0	0	0.051407776	6.082394784	0	0	0	0.630163314	0	0.171771538	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8435	0	5.89	15.303	1.933024493	3.0639341	0	4.42435926	1.03396702	0.19992898	1.070252902	4.159873052	0	0.446623735	0	0.035885264	0	2.448939678	4.092770512	0.695251253	0	0	0.051407776	6.082394784	0	0	0	0.630163314	0	0.171771538	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8435	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.303	1.933024493	3.0639341	0	4.42435926	1.03396702	0.19992898	1.070252902	4.159873052	0	0.446623735	0	0.035885264	0	2.448939678	4.092770512	0.695251253	0	0	0.051407776	6.082394784	0	0	0	0.630163314	0	0.171771538	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8435
H0562_037_0	2011	4																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	536.1880667	26.54337751	397.5399921	5.124261392	208.9082205	6.887447945	2.411206315	301.1120647	320.346314	3.229127242	12.43598882	0	12.890486	11.30761075	3350.477479	5076.90182	393.362661	7.607737838	46.18969256	39.86869909	28.97789486	0	0	0	548.0948166	0	162.8895384	0	800	0											3400	1a:  Acute - $100/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $0/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $20/visit/7-12 Additional Visits/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $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/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			17a:  Routine Eye Exams - $25/visit		18a:  Routine Hearing Test - $25/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													100	900	75	0	280	0.2	0.087983041	45.34004001	71.15903816	0	0.034248344	0	25	0	15.00235032	20.1467559	25	0	0	0.002580368	0.2	0	0	0	25	0	25	0	0	0											NO	92.71700652	896.1887414	69.53775489	0	259.6076182	0.185434013	0.081575242	42.03792785	65.97653004	0	0.031754039	0	23.17925163	0	13.90973013	18.67946898	23.87355305	0	0	0.00239244	0.185434013	0	0	0	23.17925163	0	23.17925163	0	0	0												4.1428	1.982323007	2.303669877	0	4.519513795	1.277167112	0.196694739	1.054843938	1.761278184	0	0.394892873	0	0.024899318	0	3.883686461	7.902819172	0.782580363	0	0	0.095383462	5.373487332	0	0	0	1.058702306	0	0.314638133	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0694	0	2.74	4.1428	1.982323007	2.303669877	0	4.519513795	1.277167112	0.196694739	1.054843938	1.761278184	0	0.394892873	0	0.024899318	0	3.883686461	7.902819172	0.782580363	0	0	0.095383462	5.373487332	0	0	0	1.058702306	0	0.314638133	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0694	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1428	1.982323007	2.303669877	0	4.519513795	1.277167112	0.196694739	1.054843938	1.761278184	0	0.394892873	0	0.024899318	0	3.883686461	7.902819172	0.782580363	0	0	0.095383462	5.373487332	0	0	0	1.058702306	0	0.314638133	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0694
H0562_039_0	2011	4																															D	A	coin	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	512.9004863	26.24624713	58.16527511	2.470280678	163.3305334	5.175524316	2.445076332	262.2641035	244.0638298	4.721285626	15.73707207	0	4.878155834	14.11226409	2791.354746	4445.173676	202.3336892	5.427356903	50.97180903	33.47417939	10.66392253	0	0	0	611.0057689	0	81.19340166	0	800	0											3400	1a:  Acute - $175/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - 0/day	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $0/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $20/visit/7-12 Additional Visits/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $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/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			17a:  Routine Eye Exams - $20/visit		18a:  Routine Hearing Test - $20/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													175	900	0	0	280	0.2	0.116991656	44.21232998	148.3235471	0	0.034248344	0	25	0	15.00144493	19.1470422	25	0	0	0.00110934	0.2	0	0	0	20	0	20	0	0	0											NO	166.2086702	897.8531782	0	0	265.9338723	0.189952766	0.111114443	41.99127185	140.8723402	0	0.032527838	0	23.74409575	0	14.24782979	18.18516813	24.67515986	0	0	0.001053611	0.189952766	0	0	0	18.9952766	0	18.9952766	0	0	0												7.104	1.963773034	0	0	3.619593434	0.983105159	0.271683295	0.917733606	2.865153571	0	0.51189293	0	0.009652283	0	3.314228941	6.736352557	0.416051344	0	0	0.035268767	2.025641581	0	0	0	0.967185298	0	0.12852426	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8699	0	1.57	7.104	1.963773034	0	0	3.619593434	0.983105159	0.271683295	0.917733606	2.865153571	0	0.51189293	0	0.009652283	0	3.314228941	6.736352557	0.416051344	0	0	0.035268767	2.025641581	0	0	0	0.967185298	0	0.12852426	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8699	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.104	1.963773034	0	0	3.619593434	0.983105159	0.271683295	0.917733606	2.865153571	0	0.51189293	0	0.009652283	0	3.314228941	6.736352557	0.416051344	0	0	0.035268767	2.025641581	0	0	0	0.967185298	0	0.12852426	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8699
H0562_040_0	2011	4																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	399.8448599	25.65077812	294.7496469	2.663624638	269.1300474	3.892805032	3.455176159	419.7212323	406.3809545	7.637225665	29.9268476	0	5.014924859	23.99959008	3011.805746	4810.257342	160.5713858	7.501605111	68.22797755	37.76046927	11.72425518	0	0	0	407.4307944	0	86.6097759	0	800	0											5000	1a:  Acute - $225/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $0/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: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $25/visit/7-12 Additional Visits/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/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			17a:  Routine Eye Exams - $25/visit		18a:  Routine Hearing Test - $25/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													225	900	75	0	280	0.2	0.155817297	47.77324007	200	0	0.034248344	0	25	0	15.00198837	23.67331608	25	0	0	0.001432767	0.2	0	0	0	25	0	25	0	0	0											NO	215.5394137	899.0326822	71.87434193	0	266.8451939	0.192636644	0.148159368	45.52847603	190.276092	0	0.032528179	0	24.12522205	0	14.32550936	22.60195046	24.93342667	0	0	0.001366896	0.191520693	0	0	0	23.8794076	0	23.85021611	0	0	0												7.1819	1.921740655	1.765411409	0	5.984671641	0.749896895	0.511916716	1.592439005	6.44371499	0	0.973465862	0	0.010082181	0	3.595470951	9.060099847	0.333632906	0	0	0.051614616	2.245437477	0	0	0	0.810767167	0	0.172138489	0	0	0	0	0	0	0	0	0	0	0	0	0	43.4044	0	1.952269955	7.1819	1.921740655	1.765411409	0	5.984671641	0.749896895	0.511916716	1.592439005	6.44371499	0	0.973465862	0	0.010082181	0	3.595470951	9.060099847	0.333632906	0	0	0.051614616	2.245437477	0	0	0	0.810767167	0	0.172138489	0	0	0	0	0	0	0	0	0	0	0	0	0	43.4044	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.1819	1.921740655	1.765411409	0	5.984671641	0.749896895	0.511916716	1.592439005	6.44371499	0	0.973465862	0	0.010082181	0	3.595470951	9.060099847	0.333632906	0	0	0.051614616	2.245437477	0	0	0	0.810767167	0	0.172138489	0	0	0	0	0	0	0	0	0	0	0	0	0	43.4044
H0562_044_0	2011	3																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	395.7866919	25.49121733	220.9631324	3.917633063	155.0707128	5.151819575	1.795363537	213.9084289	160.2228188	1.735973933	6.318126889	0	11.03510268	6.29827077	2236.176457	3252.474074	159.3578382	6.058393758	31.25581323	30.5630947	8.288773072	0	0	1622.925194	537.1680863	0	72.5879082	0	800	0											3400	1a:  Acute - $100/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - $0/$75/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 - $10/visit/4a:  Worldwide Coverage - $0/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $7/visit/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	"7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $10/visit / Routine Chiro/Acupuncture: $10, 30 visits per year, combined/7f:  Podiatry Services - $10/visit/7-12 Additional Visits/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/18a:  Hearing Exams - $10/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		16a:  Preventive Dental - Oral Exams - $25/service/16a:  Preventive Dental - Prophylaxis - $25/service/16a:  Preventive Dental - X-Rays - $25/service/16b:  Comprehensive Dental - Restorative Svcs - $25/visit	17a:  Routine Eye Exams - $10/visit	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year	18a:  Routine Hearing Test - $10/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													100	900	75	0	125	0.2	0.087470066	45.24665413	73.04482229	0	0.034248344	0	25	0	7.33597128	10	25	0	0	0.000599635	0.2	0	0	25.38224874	5.420427865	0	10	0	0	0											NO	99.08441242	899.8377063	74.30139562	0	123.8523882	0.19816185	0.086662287	44.83267428	72.37544857	0	0.033935577	0	24.77396535	0	7.278785387	9.908082595	24.98632772	0	0	0.000594207	0.198168143	0	0	25.38224874	5.370629263	0	9.909497296	0	0	0												3.268	1.911496544	1.36815576	0	1.600489843	1.020894098	0.15559031	0.79917391	0.966349865	0	0.214409284	0	0.022781938	0	1.356387377	2.685481814	0.331813931	0	0	0.018160792	1.642570768	0	0	3.432790913	0.240410887	0	0.059942473	0	0	0	0	0	0	0	0	0	0	0	0	0	21.0949	0	0.141535368	3.268	1.911496544	1.36815576	0	1.600489843	1.020894098	0.15559031	0.79917391	0.966349865	0	0.214409284	0	0.022781938	0	1.356387377	2.685481814	0.331813931	0	0	0.018160792	1.642570768	0	0	3.432790913	0.240410887	0	0.059942473	0	0	0	0	0	0	0	0	0	0	0	0	0	21.0949	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.268	1.911496544	1.36815576	0	1.600489843	1.020894098	0.15559031	0.79917391	0.966349865	0	0.214409284	0	0.022781938	0	1.356387377	2.685481814	0.331813931	0	0	0.018160792	1.642570768	0	0	3.432790913	0.240410887	0	0.059942473	0	0	0	0	0	0	0	0	0	0	0	0	0	21.0949
H0562_045_0	2011	3																															D	A	coin	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	758.376126	25.42688377	55.64059159	16.59631979	240.2338798	8.8193466	2.25891377	299.8480128	257.6676327	1.311613064	7.031652586	0	2.943293404	11.39528286	2587.897687	4259.988859	180.2123539	6.594488679	44.70766143	31.99999747	24.15242435	0	0	0	537.7397814	0	70.64088845	0	800	0											3400	1a:  Acute - $250/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - 0/day	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 - $10/visit/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $10/visit/7-12 Additional Visits/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/18a:  Hearing Exams - $10/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			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													250	900	0	0	125	0.2	0.04689246	44.00265605	181.2731341	0	0.034248344	0	25	0	10	10	25	0	0	0.000542018	0.2	0	0	0	10	0	10	0	0	0											NO	232.6901492	899.0434031	0	0	116.3211935	0.186082592	0.043815513	40.95954737	168.7944596	0	0.03192514	0	23.51742846	0	9.316222496	9.314819518	24.73663632	0	0	0.000505339	0.185697188	0	0	0	9.31378339	0	9.32197997	0	0	0												14.7056	1.904989343	0	0	2.328690968	1.641126874	0.098975465	1.023469907	3.624405735	0	0.224486491	0	0.005768224	0	2.00911922	3.306752281	0.371487288	0	0	0.016170858	4.485037274	0	0	0	0.417365987	0	0.054876079	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2183	0	2.536116875	14.7056	1.904989343	0	0	2.328690968	1.641126874	0.098975465	1.023469907	3.624405735	0	0.224486491	0	0.005768224	0	2.00911922	3.306752281	0.371487288	0	0	0.016170858	4.485037274	0	0	0	0.417365987	0	0.054876079	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2183	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.7056	1.904989343	0	0	2.328690968	1.641126874	0.098975465	1.023469907	3.624405735	0	0.224486491	0	0.005768224	0	2.00911922	3.306752281	0.371487288	0	0	0.016170858	4.485037274	0	0	0	0.417365987	0	0.054876079	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2183
H0562_053_0	2011	4																															D	A	coin	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	524.4118564	26.75270041	66.37376867	18.75022972	242.9002153	8.48686186	2.378459951	372.9377279	301.1174538	2.150909987	8.458110171	0	2.005682257	10.51002232	2886.339825	4467.942024	166.9320126	5.488655389	36.1388888	33.08923379	27.32062639	0	0	0	509.2296841	0	64.079835	0	800	0											3400	1a:  Acute - $150/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - 0/day	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $150/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $20/visit/7-12 Additional Visits/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $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/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			17a:  Routine Eye Exams - $25/visit		18a:  Routine Hearing Test - $25/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													150	900	0	0	280	0.2	0.060069911	45.94348646	107.4334896	0	0.034248344	0	25	0	10.00367774	20.18226327	25	0	0	0.001148155	0.2	0	0	0	25	0	25	0	0	0											NO	140.5313774	896.2548698	0	0	262.3164999	0.187375218	0.056284877	43.03794761	100.6449793	0	0.032082887	0	23.46293889	0	9.371762094	18.90722836	24.84383486	0	0	0.001075797	0.187302475	0	0	0	23.42164288	0	23.42423323	0	0	0												6.1414	1.998103169	0	0	5.30972786	1.59022759	0.133871326	1.337539533	2.525496658	0	0.271360589	0	0.0039216	0	2.25417418	7.039700013	0.345602613	0	0	0.035597312	5.117220938	0	0	0	0.993916317	0	0.125085083	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2229	0	2.229034825	6.1414	1.998103169	0	0	5.30972786	1.59022759	0.133871326	1.337539533	2.525496658	0	0.271360589	0	0.0039216	0	2.25417418	7.039700013	0.345602613	0	0	0.035597312	5.117220938	0	0	0	0.993916317	0	0.125085083	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2229	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.1414	1.998103169	0	0	5.30972786	1.59022759	0.133871326	1.337539533	2.525496658	0	0.271360589	0	0.0039216	0	2.25417418	7.039700013	0.345602613	0	0	0.035597312	5.117220938	0	0	0	0.993916317	0	0.125085083	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2229
H0562_055_0	2011	2																															coin	A	D	coin	T	coin	coin	V	coin	coin	coin	O	V	coin	V	V	V	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	YES	336.2377112	237.6904777	426.752381	6.997092011	315.1958763	9.753383163	2.645554074	374.8524033	33.62726296	2.496678296	10.04663099	0	7.127848522	9.257246369	0	0	744.5832026	11.40121979	55.66365862	52.3953599	7.428094641	0.358283286	6000	1500	0	246	0	0	500	0											3400	1a:  Acute - 0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $900/$0/admit for 1-90	2:  Skilled Nursing Services - $0/$50/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $50/trip	11a:  Durable Medical Equipment - 15.0%	11b:  Prosthetics Devices - 15.0%/11b:  Medical Supplies - 15.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $20/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 - $25/service	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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/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 - $0/service/13a:  3-Pints Deductible Waived	"10b:  Transportation - $0/trip, 48 one-way trip limit"	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 - Restorative Svcs - $0/visit	17a:  Routine Eye Exams - $0/visit	17b:  Eye Glasses & Contact Lenses - $0 Per Year	18a:  Routine Hearing Test - $0/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													0	900	50	0	50	0.15	0.052410693	20	0	0	0	0	25	0	0	0	10	0	0	4.07E-06	0.2	0	0	0	0	0	0	0	0	0											NO	0	899.9995781	49.99275804	0	49.99232215	0.149974113	0.052392124	19.9964416	0	0	0	0	24.99790111	0	0	0	9.999968241	0	0	4.07E-06	0.199970661	0	0	0	0	0	0	0	0	0												0	17.82677747	1.777877377	0	1.313114482	1.462754993	0.138606198	0.624642849	0	0	0	0	0.014848438	0	0	0	0.620484032	0	0	0.000213319	1.485400992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.2647	0	0.001101498	0	17.82677747	1.777877377	0	1.313114482	1.462754993	0.138606198	0.624642849	0	0	0	0	0.014848438	0	0	0	0.620484032	0	0	0.000213319	1.485400992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.2647	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.82677747	1.777877377	0	1.313114482	1.462754993	0.138606198	0.624642849	0	0	0	0	0.014848438	0	0	0	0.620484032	0	0	0.000213319	1.485400992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.2647
H0562_058_0	2011	3																															D	A	coin	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	493.8977017	25.94837667	60.46020214	5.997696048	209.5113279	3.874522533	2.174408442	334.3700982	282.8124221	3.785203752	13.99301477	0	3.47328653	13.46642994	3209.39649	5238.17139	320.3000068	13.43778306	64.88371927	38.43806811	8.586978253	0	0	0	705.0508052	0	56.29084325	0	800	0											3400	1a:  Acute - $100/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - 0/day	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $0/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $15/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $15/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $15/visit/7-12 Additional Visits/17a:  Vision Exams - $15/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/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			17a:  Routine Eye Exams - $15/visit		18a:  Routine Hearing Test - $15/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													100	900	0	0	280	0.2	0.130122576	43.79002379	78.01779142	0	0.034248344	0	25	0	10.00149837	14.59870318	25	0	0	0.000575463	0.2	0	0	0	15	0	15	0	0	0											NO	96.70186681	898.9151208	0	0	270.7652271	0.193403734	0.12583096	42.34577048	75.44466074	0	0.033118788	0	24.1754667	0	9.671635629	14.11721851	24.56160467	0	0	0.000556483	0.193403734	0	0	0	14.50528002	0	14.50528002	0	0	0												3.9801	1.943782346	0	0	4.727365189	0.749347124	0.273607903	1.179929953	1.77805727	0	0.463431684	0	0.00699736	0	2.58667612	6.162367507	0.655590179	0	0	0.021390134	1.660753655	0	0	0	0.852246613	0	0.06804287	0	0	0	0	0	0	0	0	0	0	0	0	0	27.1097	0	0.85	3.9801	1.943782346	0	0	4.727365189	0.749347124	0.273607903	1.179929953	1.77805727	0	0.463431684	0	0.00699736	0	2.58667612	6.162367507	0.655590179	0	0	0.021390134	1.660753655	0	0	0	0.852246613	0	0.06804287	0	0	0	0	0	0	0	0	0	0	0	0	0	27.1097	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.9801	1.943782346	0	0	4.727365189	0.749347124	0.273607903	1.179929953	1.77805727	0	0.463431684	0	0.00699736	0	2.58667612	6.162367507	0.655590179	0	0	0.021390134	1.660753655	0	0	0	0.852246613	0	0.06804287	0	0	0	0	0	0	0	0	0	0	0	0	0	27.1097
H0562_062_0	2011	4																															D	A	coin	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	656.1376126	25.49921103	65.8270287	14.22757828	285.8997303	13.25329244	3.951973466	329.783643	352.8717847	1.605456184	4.762497708	0	3.221472703	6.958380896	3183.692811	5117.477445	176.7751259	11.01973366	39.85304085	30.27212148	8.318665033	0	0	0	624.0730638	0	62.17480385	0	800	0											3400	1a:  Acute - $150/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - 0/day	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 - $20/visit/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $150/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $20/visit/7-12 Additional Visits/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $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/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			17a:  Routine Eye Exams - $20/visit		18a:  Routine Hearing Test - $20/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													150	900	0	0	200	0.2	0.068486729	45.13889098	108.4072088	0	0.034248344	0	25	0	10.0027931	19.1817562	25	0	0	0.00100552	0.2	0	0	0	20	0	20	0	0	0											NO	141.0222617	898.9454624	0	0	188.0297245	0.188029627	0.064387665	42.43724714	101.9188206	0	0.032198521	0	23.50380381	0	9.404107968	18.03369319	24.77337899	0	0	0.000945338	0.188029648	0	0	0	18.80296227	0	18.8029805	0	0	0												7.7108	1.910200004	0	0	4.479803959	2.49201163	0.254458345	1.166259163	2.997023009	0	0.153345382	0	0.006309739	0	2.494982577	7.690584846	0.364943099	0	0	0.028617394	1.564155658	0	0	0	0.977868523	0	0.097422635	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3888	0	2.05	7.7108	1.910200004	0	0	4.479803959	2.49201163	0.254458345	1.166259163	2.997023009	0	0.153345382	0	0.006309739	0	2.494982577	7.690584846	0.364943099	0	0	0.028617394	1.564155658	0	0	0	0.977868523	0	0.097422635	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3888	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.7108	1.910200004	0	0	4.479803959	2.49201163	0.254458345	1.166259163	2.997023009	0	0.153345382	0	0.006309739	0	2.494982577	7.690584846	0.364943099	0	0	0.028617394	1.564155658	0	0	0	0.977868523	0	0.097422635	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3888
H0562_068_0	2011	3																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	1042.56362	25.47692333	579.947617	18.8967587	311.0474302	11.58488759	3.201747918	344.2207545	296.6184719	0.963720904	8.387809393	0	10.24852518	9.133214997	3492.018322	5100.173089	175.7850311	10.00797836	48.64632922	35.25565284	9.911557045	0	0	0	524.394311	0	96.68790368	0	800	0											3400	1a:  Acute - $250/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $20/visit/7-12 Additional Visits/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $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/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			17a:  Routine Eye Exams - $20/visit		18a:  Routine Hearing Test - $20/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													250	900	75	0	280	0.2	0.058105844	44.97070245	175.1325492	0	0.034248344	0	25	0	10.0021707	19.18409233	25	0	0	0.001354949	0.2	0	0	0	20	0	20	0	0	0											NO	214.7071457	897.6215673	64.41214371	0	240.4720032	0.171765717	0.04990296	38.62212465	150.408839	0	0.029413456	0	21.47071457	0	8.590150087	16.47584683	24.48230669	0	0	0.001163669	0.171765717	0	0	0	17.17657165	0	17.17657165	0	0	0												18.6538	1.905719654	3.112972437	0	6.233183218	1.989886518	0.159776698	1.107878074	3.717836665	0	0.246714465	0	0.01833693	0	2.499746791	7.002472552	0.358635254	0	0	0.041025902	1.702465698	0	0	0	0.750608038	0	0.138397225	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6395	0	7.8	18.6538	1.905719654	3.112972437	0	6.233183218	1.989886518	0.159776698	1.107878074	3.717836665	0	0.246714465	0	0.01833693	0	2.499746791	7.002472552	0.358635254	0	0	0.041025902	1.702465698	0	0	0	0.750608038	0	0.138397225	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6395	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.6538	1.905719654	3.112972437	0	6.233183218	1.989886518	0.159776698	1.107878074	3.717836665	0	0.246714465	0	0.01833693	0	2.499746791	7.002472552	0.358635254	0	0	0.041025902	1.702465698	0	0	0	0.750608038	0	0.138397225	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6395
H0562_070_0	2011	3																															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	YES	321.671074	13.35404259	58.11551763	7.032556824	16.96702394	11.31427676	4.1979615	25.27695614	37.06762939	2.343705141	8.367017453	0	0.100480102	8.145884801	107.0750685	237.9230487	15.13195092	10.83698069	48.3596213	46.95397561	8.542627246	0.284617073	6000	1500	0	246	0	0	500	0											3400	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS + Routine Podiatry: 7-12 Additional Visits	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, 48 one-way trip limit"	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 - Restorative Svcs - $0/visit	17a:  Routine Eye Exams - $0/visit	17b:  Eye Glasses & Contact Lenses - $0 Per Year	18a:  Routine Hearing Test - $0/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/													0.065668555	0.065668555	0.144893527	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.215648632	0.229460933	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.037848501	0.062928595	0.083510331	0	0.134291073	0.134291073	0.134291073	0.134291073	0.134291073	0.134291073	0.134291073	0	0.134291073	0.134291073	0.124290498	0.132251308	0.22995563	0.134291073	0.134291073	0.134291073	0.134291073	0.134291073	0	0	0	0	0	0	0	0												12.1748	0.840351141	4.853246106	0	2.278519843	1.519406362	0.563748752	3.394469552	4.977851708	0.314738677	1.123615748	0	0.013493581	1.093919607	13.30841363	31.46563449	3.479677311	1.455309761	6.494265414	6.305499746	1.147198575	0.038221532	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8423	0	68.09	12.1748	0.840351141	4.853246106	0	2.278519843	1.519406362	0.563748752	3.394469552	4.977851708	0.314738677	1.123615748	0	0.013493581	1.093919607	13.30841363	31.46563449	3.479677311	1.455309761	6.494265414	6.305499746	1.147198575	0.038221532	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8423	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.1748	0.840351141	4.853246106	0	2.278519843	1.519406362	0.563748752	3.394469552	4.977851708	0.314738677	1.123615748	0	0.013493581	1.093919607	13.30841363	31.46563449	3.479677311	1.455309761	6.494265414	6.305499746	1.147198575	0.038221532	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8423
H0562_071_0	2011	4																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	718.7223597	25.80014704	387.8643022	6.089148212	205.8323985	7.312410239	2.638568749	268.9783292	212.7139659	2.378757592	8.697328913	0	9.248248434	8.726615107	2793.21033	3392.872804	170.9343379	10.67092187	43.32593302	40.51452072	13.45901199	0	0	0	380.5587725	0	69.91302462	0	1800	0											3400	1a:  Acute - $250/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $15/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/7-12 Additional Visits/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/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			17a:  Routine Eye Exams - $30/visit		18a:  Routine Hearing Test - $30/visit		14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													250	900	75	0	280	0.2	0.091319419	44.7648544	181.2236709	0	0.034248344	0	25	0	10.0040901	18.13888254	25	0	0	0.001324909	0.2	0	0	0	30	0	30	0	0	0											NO	229.7462439	897.7387129	68.92387316	0	257.3157931	0.183796995	0.083921174	41.13822862	166.5418308	0	0.031473713	0	22.97462439	0	9.193608495	16.66936053	24.75195214	0	0	0.001217571	0.183796995	0	0	0	27.56954926	0	27.56954926	0	0	0												13.7603	1.930149233	2.227759164	0	4.413660573	1.343999029	0.221431786	0.922107667	2.952147776	0	0.273737235	0	0.017706253	0	2.139973518	4.713085	0.352579879	0	0	0.049329319	2.47372596	0	0	0	0.874319486	0	0.160622548	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8266	0	3.23	13.7603	1.930149233	2.227759164	0	4.413660573	1.343999029	0.221431786	0.922107667	2.952147776	0	0.273737235	0	0.017706253	0	2.139973518	4.713085	0.352579879	0	0	0.049329319	2.47372596	0	0	0	0.874319486	0	0.160622548	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8266	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.7603	1.930149233	2.227759164	0	4.413660573	1.343999029	0.221431786	0.922107667	2.952147776	0	0.273737235	0	0.017706253	0	2.139973518	4.713085	0.352579879	0	0	0.049329319	2.47372596	0	0	0	0.874319486	0	0.160622548	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8266
H0562_077_0	2011	4																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	785.2128258	25.9988801	562.5550191	15.35156622	300.2534467	14.04076188	3.85093897	419.0330585	337.8358486	4.07171783	42.83011782	0	23.11429971	5.917432874	4017.104539	6248.055536	162.7903305	12.59559505	52.22328279	55.34777104	12.83223557	0	0	1215.694541	553.9896202	0	159.7454601	0	800	0											3400	1a:  Acute - $100/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $0/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $25/visit/7-12 Additional Visits/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/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		"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Diagnostic Svcs - Copay range: $0-$15/visit/16b:  Comprehensive Dental - Restorative Svcs - Copay range: $0-$300/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - Copay range: $0-$375/visit/16b:  Comprehensive Dental - Prosthodontics, Other - Copay range: $0-$2250/visit"	17a:  Routine Eye Exams - $30/visit		18a:  Routine Hearing Test - $30/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													100	900	75	0	280	0.2	0.05701718	47.12298641	78.5810854	0	0.034248344	0	25	0	10.00405404	15.62535656	25	0	0	0.00216057	0.2	0	0	63.54196533	30	0	30	0	0	0											NO	89.73750112	896.8549023	67.72522546	0	251.9445294	0.178775107	0.052672771	42.60455358	70.51203458	0	0.030094957	0	22.27774724	0	9.051327943	14.13436108	24.86438997	0	0	0.001924129	0.185009588	0	0	63.54196533	27.12407368	0	26.7149891	0	0	0												5.8719	1.943101923	3.174930458	0	6.303934444	2.510138708	0.202839626	1.487726366	1.98512442	0	1.288970536	0	0.042911211	0	3.03001088	7.35935608	0.337306855	0	0	0.106496271	2.374086612	0	0	6.437301696	1.252204606	0	0.355633185	0	0	0	0	0	0	0	0	0	0	0	0	0	46.064	0	4.083217032	5.8719	1.943101923	3.174930458	0	6.303934444	2.510138708	0.202839626	1.487726366	1.98512442	0	1.288970536	0	0.042911211	0	3.03001088	7.35935608	0.337306855	0	0	0.106496271	2.374086612	0	0	6.437301696	1.252204606	0	0.355633185	0	0	0	0	0	0	0	0	0	0	0	0	0	46.064	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.8719	1.943101923	3.174930458	0	6.303934444	2.510138708	0.202839626	1.487726366	1.98512442	0	1.288970536	0	0.042911211	0	3.03001088	7.35935608	0.337306855	0	0	0.106496271	2.374086612	0	0	6.437301696	1.252204606	0	0.355633185	0	0	0	0	0	0	0	0	0	0	0	0	0	46.064
H0562_079_0	2011	3																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	593.4415144	25.78000298	364.8975238	1.692614328	145.6869149	3.073602295	1.642564061	251.4988101	206.6362233	3.229669198	11.2856621	0	0	10.74512192	3221.814056	4796.290673	152.4925203	7.202007423	36.11697925	40.78599138	3.297045012	0	0	0	366.5508332	0	26.89510815	0	800	0											3400	1a:  Acute - $100/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $0/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $5/visit/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $10/visit/7-12 Additional Visits/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/18a:  Hearing Exams - $10/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			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													100	900	75	0	280	0.2	0.126618738	41.91532666	72.87007945	0	0.034248344	0	0	0	5.00080578	10	25	0	0	0.000159245	0.2	0	0	0	10	0	10	0	0	0											NO	98.08493267	899.4785174	73.56369951	0	274.6378115	0.196169865	0.124193904	41.11261993	71.47456837	0	0.033592465	0	0	0	4.905036982	9.808493267	24.99217446	0	0	0.000156195	0.196169865	0	0	0	9.808493267	0	9.808493267	0	0	0												4.8506	1.932379905	2.236934316	0	3.334261288	0.602948148	0.203996444	0.861647916	1.230769572	0	0.379113206	0	0	0	1.316926424	3.920365398	0.317593306	0	0	0.00637057	0.646780876	0	0	0	0.299609282	0	0.021983374	0	0	0	0	0	0	0	0	0	0	0	0	0	22.1623	0	0.39	4.8506	1.932379905	2.236934316	0	3.334261288	0.602948148	0.203996444	0.861647916	1.230769572	0	0.379113206	0	0	0	1.316926424	3.920365398	0.317593306	0	0	0.00637057	0.646780876	0	0	0	0.299609282	0	0.021983374	0	0	0	0	0	0	0	0	0	0	0	0	0	22.1623	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.8506	1.932379905	2.236934316	0	3.334261288	0.602948148	0.203996444	0.861647916	1.230769572	0	0.379113206	0	0	0	1.316926424	3.920365398	0.317593306	0	0	0.00637057	0.646780876	0	0	0	0.299609282	0	0.021983374	0	0	0	0	0	0	0	0	0	0	0	0	0	22.1623
H0562_081_0	2011	5																															D	A	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	813.8265892	144.6743981	399.4702318	5.234101978	590.0102109	10.08627858	6.522890252	843.7202835	659.4745114	11.71363816	47.76043735	0	0.612009776	1186.592415	3540.269991	5348.179452	788.2755262	298.4091157	72.72147041	65.80396919	12.91385389	0	6000	1500	455.9257655	0	0	0	500	0											3400	1a:  Acute - $50/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - $0/$20/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/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 - $25/visit/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $25/visit/9b:  Ambulatory Surgical Center Services - $25/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 - $20/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $0/service	9d:  Cardiac Rehabilitation Services - $10/visit/3:  Rehab Services (CORF) - $10/day/5:  Partial Hospitalization - $5/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	"7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $10/visit / Routine Chiro/Acupuncture: $10, 30 visits per year, combined/7f:  Podiatry Services - $0/visit/7-12 Additional Visits/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $10/visit/7i:  Physical/Speech Therapy - $10/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/18a:  Hearing Exams - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 10.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived	"10b:  Transportation - $0/trip, 48 one-way trip limit"	"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 - Diagnostic Svcs - Copay range: $0-$15/visit/16b:  Comprehensive Dental - Restorative Svcs - Copay range: $0-$300/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - Copay range: $0-$375/visit/16b:  Comprehensive Dental - Prosthodontics, Other - Copay range: $0-$2250/visit"	17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $0/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													50	900	20	0	150	0.1	0.072712533	48.56104939	25	0	0.039858835	0	0	10	10	10	25	10	0	4.02E-06	0.1	0	0	0	10	0	0	0	0	0											NO	48.48299458	899.8732789	19.39068759	0	141.9993745	0.097010959	0.068532287	45.94480607	23.37023042	0	0.037045661	0	0	9.297354679	9.511708786	9.574298341	24.97931008	9.494578043	0	3.87E-06	0.094333821	0	0	0	9.518644963	0	0	0	0	0												3.2881	10.84905208	0.645500205	0	6.981756742	0.978479562	0.447028587	3.2303804	1.284339274	0	1.76931699	0	0	0.919347545	2.806168098	4.267088804	1.640881567	0.23610572	0	0.000254662	1.21821318	0	0	0	0.361649624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.9236	0	1.492014184	3.2881	10.84905208	0.645500205	0	6.981756742	0.978479562	0.447028587	3.2303804	1.284339274	0	1.76931699	0	0	0.919347545	2.806168098	4.267088804	1.640881567	0.23610572	0	0.000254662	1.21821318	0	0	0	0.361649624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.9236	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	3.2881	10.84905208	0.645500205	0	6.981756742	0.978479562	0.447028587	3.2303804	1.284339274	0	1.76931699	0	0	0.919347545	2.806168098	4.267088804	1.640881567	0.23610572	0	0.000254662	1.21821318	0	0	0	0.361649624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.9236
H0562_082_0	2011	4																															coin	A	D	coin	T	coin	coin	V	coin	coin	coin	O	V	coin	V	V	V	coin	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	228.5863016	27.04935622	341.0475422	5.552150561	186.364869	6.478250132	2.253630042	267.560455	29.95430842	1.628040742	5.520401595	0	4.38380874	6.935728736	0.515854756	641.1672119	159.6621393	9.799223762	45.09289945	39.99549448	8.440299561	0	0	0	350.346809	0	68.09967415	0	1800	0											3400	1a:  Acute - $0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $900/$0/admit for 1-90	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	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 - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $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 - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/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			17a:  Routine Eye Exams - $30/visit		18a:  Routine Hearing Test - $30/visit		14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													0	900	75	0	280	0.2	0.087271194	44.7455583	0	0	0.034248344	0	25	0	30	30	25	0	0	0.001278434	0.2	0	0	0	30	0	30	0	0	0											NO	0	899.5530859	74.50843347	0	278.1648183	0.198689156	0.086699199	44.45228605	0	0	0.034023872	0	24.83614449	0	29.80337339	29.80337339	24.99008409	0	0	0.001270055	0.198689156	0	0	0	29.80337339	0	29.80337339	0	0	0												0	2.027694321	2.117576509	0	4.320012493	1.287158051	0.195387919	0.99113949	0	0	0.187825439	0	0.009073076	0	0.001281184	1.592412152	0.332497524	0	0	0.050796474	1.676995996	0	0	0	0.870126397	0	0.169133335	0	0	0	0	0	0	0	0	0	0	0	0	0	15.8291	0	0.09	0	2.027694321	2.117576509	0	4.320012493	1.287158051	0.195387919	0.99113949	0	0	0.187825439	0	0.009073076	0	0.001281184	1.592412152	0.332497524	0	0	0.050796474	1.676995996	0	0	0	0.870126397	0	0.169133335	0	0	0	0	0	0	0	0	0	0	0	0	0	15.8291	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.027694321	2.117576509	0	4.320012493	1.287158051	0.195387919	0.99113949	0	0	0.187825439	0	0.009073076	0	0.001281184	1.592412152	0.332497524	0	0	0.050796474	1.676995996	0	0	0	0.870126397	0	0.169133335	0	0	0	0	0	0	0	0	0	0	0	0	0	15.8291
H0562_083_0	2011	3																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	567.8289381	25.74540444	439.1860839	5.7022359	204.2903464	6.023288046	2.180305678	234.0245543	177.3064624	2.308623063	7.764292789	0	12.4086539	8.03582372	2760.138253	4496.554887	172.9948746	9.642368672	49.50787383	44.93264673	13.46410409	0	0	0	380.9532214	0	64.1680962	0	800	0											3400	1a:  Acute - $100/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $0/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $8/visit/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $10/visit/7-12 Additional Visits/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/18a:  Hearing Exams - $10/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			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													100	900	75	0	280	0.2	0.091663184	44.52682461	72.73561754	0	0.034248344	0	25	0	8.000416718	10	25	0	0	0.000373207	0.2	0	0	0	10	0	10	0	0	0											NO	97.03909179	899.2284578	72.77931884	0	271.709457	0.194078184	0.088949122	43.20842621	70.58198267	0	0.033234282	0	24.25977295	0	7.763531722	9.703909179	24.90160733	0	0	0.000362157	0.194078184	0	0	0	9.703909179	0	9.703909179	0	0	0												4.5918	1.929250027	2.663638669	0	4.625634924	1.168988803	0.193936275	0.842652724	1.042886805	0	0.258040692	0	0.025085927	0	1.78570174	3.63618002	0.358987536	0	0	0.016272655	2.613088866	0	0	0	0.308061289	0	0.051890115	0	0	0	0	0	0	0	0	0	0	0	0	0	26.1121	0	0.73	4.5918	1.929250027	2.663638669	0	4.625634924	1.168988803	0.193936275	0.842652724	1.042886805	0	0.258040692	0	0.025085927	0	1.78570174	3.63618002	0.358987536	0	0	0.016272655	2.613088866	0	0	0	0.308061289	0	0.051890115	0	0	0	0	0	0	0	0	0	0	0	0	0	26.1121	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.5918	1.929250027	2.663638669	0	4.625634924	1.168988803	0.193936275	0.842652724	1.042886805	0	0.258040692	0	0.025085927	0	1.78570174	3.63618002	0.358987536	0	0	0.016272655	2.613088866	0	0	0	0.308061289	0	0.051890115	0	0	0	0	0	0	0	0	0	0	0	0	0	26.1121
H0562_084_0	2011	3																															D	A	coin	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	629.7543011	25.78269998	64.05510626	9.716767617	240.3129723	8.666542035	2.584873773	315.5453067	274.5119474	2.896429142	9.443193542	0	8.890636671	9.944588147	2967.976253	4963.176503	227.9637411	5.631127597	61.91183326	39.46899179	12.36951539	0	0	0	724.0768959	0	64.12445255	0	800	0											3400	1a:  Acute - $100/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - 0/day	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $0/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $15/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $15/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $15/visit/7-12 Additional Visits/17a:  Vision Exams - $15/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/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			17a:  Routine Eye Exams - $15/visit		18a:  Routine Hearing Test - $15/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													100	900	0	0	280	0.2	0.068517992	43.97322304	76.45267693	0	0.034248344	0	25	0	10.00168455	14.60800087	25	0	0	0.000600544	0.2	0	0	0	15	0	15	0	0	0											NO	96.03292553	898.9161235	0	0	268.8921915	0.192065851	0.065799832	42.22877253	73.4197423	0	0.032889686	0	24.00823138	0	9.604910272	14.02849059	24.66081452	0	0	0.000576719	0.192065851	0	0	0	14.40493883	0	14.40493883	0	0	0												5.0398	1.931373726	0	0	5.384856813	1.664546772	0.170084261	1.110424248	1.679549703	0	0.310583673	0	0.017787372	0	2.375595466	5.802156241	0.468480961	0	0	0.022762537	2.375761501	0	0	0	0.869190283	0	0.076975735	0	0	0	0	0	0	0	0	0	0	0	0	0	29.2999	0	1.12	5.0398	1.931373726	0	0	5.384856813	1.664546772	0.170084261	1.110424248	1.679549703	0	0.310583673	0	0.017787372	0	2.375595466	5.802156241	0.468480961	0	0	0.022762537	2.375761501	0	0	0	0.869190283	0	0.076975735	0	0	0	0	0	0	0	0	0	0	0	0	0	29.2999	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	0	0	0	0	0	0	0	0	0	0	0	5.0398	1.931373726	0	0	5.384856813	1.664546772	0.170084261	1.110424248	1.679549703	0	0.310583673	0	0.017787372	0	2.375595466	5.802156241	0.468480961	0	0	0.022762537	2.375761501	0	0	0	0.869190283	0	0.076975735	0	0	0	0	0	0	0	0	0	0	0	0	0	29.2999
H0562_085_0	2011	4																															coin	A	D	coin	T	coin	coin	V	coin	coin	coin	O	V	coin	V	V	V	coin	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	284.8732143	25.74966513	431.5404097	5.626277894	203.9933836	6.037363377	2.185400657	229.8574407	30.92637446	2.387439155	7.619077459	0	11.82812517	7.554310157	0.511392164	635.6205588	171.9190782	9.031215849	51.07013036	45.26389899	13.03956747	0	100	1215.694541	339.0171821	0	57.08573636	0	1800	0											3400	1a:  Acute - $0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $900/$0/admit for 1-90	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	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 - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $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 - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/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	10b:  Transportation - $0/trip	"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Diagnostic Svcs - Copay range: $0-$15/visit/16b:  Comprehensive Dental - Restorative Svcs - Copay range: $0-$300/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - Copay range: $0-$375/visit/16b:  Comprehensive Dental - Prosthodontics, Other - Copay range: $0-$2250/visit"	17a:  Routine Eye Exams - $25/visit		18a:  Routine Hearing Test - $25/visit		14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													0	900	75	0	280	0.2	0.091663184	44.52680398	0	0	0.034248344	0	25	0	25	25	25	0	0	0.000813486	0.2	0	0	63.54196533	25	0	25	0	0	0											NO	0	899.7713955	74.3456536	0	277.5571068	0.198255076	0.090863458	44.1383246	0	0	0.03394954	0	24.78188453	0	24.78188453	24.78188453	24.97219104	0	0	0.000806388	0.198255076	0	0	63.54196533	24.78188453	0	24.78188453	0	0	0												0	1.930734344	2.673596152	0	4.718317779	1.196937937	0.198573061	0.845460194	0	0	0.258664173	0	0.024426936	0	0.001056105	1.312656275	0.357766339	0	0	0.036500278	2.585160443	0	0	6.437301696	0.700123722	0	0.117891011	0	0	0	0	0	0	0	0	0	0	0	0	0	23.3952	0	0.13	0	1.930734344	2.673596152	0	4.718317779	1.196937937	0.198573061	0.845460194	0	0	0.258664173	0	0.024426936	0	0.001056105	1.312656275	0.357766339	0	0	0.036500278	2.585160443	0	0	6.437301696	0.700123722	0	0.117891011	0	0	0	0	0	0	0	0	0	0	0	0	0	23.3952	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	1.930734344	2.673596152	0	4.718317779	1.196937937	0.198573061	0.845460194	0	0	0.258664173	0	0.024426936	0	0.001056105	1.312656275	0.357766339	0	0	0.036500278	2.585160443	0	0	6.437301696	0.700123722	0	0.117891011	0	0	0	0	0	0	0	0	0	0	0	0	0	23.3952
H0562_086_0	2011	4																															D	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	505.8656729	25.80580596	388.5273542	4.991308414	188.9025035	7.704981918	2.785572582	299.4356516	207.9233831	1.993766372	10.22782511	0	10.4403757	8.385039678	2757.944084	4309.12057	165.3486947	9.64126464	41.45102608	40.20303393	15.19621887	0	0	0	385.7395429	0	70.32394036	0	800	0											5000	1a:  Acute - $275/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $275/visit/9b:  Ambulatory Surgical Center Services - $225/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	"8b:  Outpatient Diagnostic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $25/visit/7-12 Additional Visits/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/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			17a:  Routine Eye Exams - $25/visit		18a:  Routine Hearing Test - $25/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													275	900	75	0	280	0.2	0.091528171	46.95201011	247.8158138	0	0.034248344	0	25	0	15.00205579	23.69990148	25	0	0	0.00109524	0.2	0	0	0	25	0	25	0	0	0											NO	263.7772285	898.8531068	71.93924413	0	268.5731781	0.191837984	0.087792899	45.0358949	237.7024311	0	0.032850666	0	23.97974804	0	14.38982072	22.73270664	24.90529386	0	0	0.001050543	0.191837984	0	0	0	23.97974804	0	23.97974804	0	0	0												11.1197	1.932969072	2.329197016	0	4.227845476	1.478108201	0.244553492	1.123779378	4.118657803	0	0.335990866	0	0.020863132	0	3.307193409	8.163164484	0.343171486	0	0	0.042235032	2.915211999	0	0	0	0.770828087	0	0.140529198	0	0	0	0	0	0	0	0	0	0	0	0	0	42.614	0	1.72	11.1197	1.932969072	2.329197016	0	4.227845476	1.478108201	0.244553492	1.123779378	4.118657803	0	0.335990866	0	0.020863132	0	3.307193409	8.163164484	0.343171486	0	0	0.042235032	2.915211999	0	0	0	0.770828087	0	0.140529198	0	0	0	0	0	0	0	0	0	0	0	0	0	42.614	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.1197	1.932969072	2.329197016	0	4.227845476	1.478108201	0.244553492	1.123779378	4.118657803	0	0.335990866	0	0.020863132	0	3.307193409	8.163164484	0.343171486	0	0	0.042235032	2.915211999	0	0	0	0.770828087	0	0.140529198	0	0	0	0	0	0	0	0	0	0	0	0	0	42.614
H0562_087_0	2011	3																															D	A	coin	coin	T	coin	coin	V	V	coin	coin	O	V	coin	V	V	V	coin	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	712.2666834	25.76228983	61.87826462	13.65807208	264.7241087	9.158920339	2.696300546	358.9637998	306.9022869	1.683948741	5.480260812	0	8.902781032	10.63357807	3043.002875	5038.468133	221.8296509	6.339532621	66.60255774	39.53116706	17.34074862	0	0	0	621.1943902	0	89.88809754	0	800	0											3400	1a:  Acute - $250/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $900/$0/day for 1-90	2:  Skilled Nursing Services - 0/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $280/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 - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/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 - Tiered Copays: $0-$200, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $0-$200, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		12:  Renal Dialysis - $25/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $25/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $30/visit/7-12 Additional Visits/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $30/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			17a:  Routine Eye Exams - $30/visit		18a:  Routine Hearing Test - $30/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													250	900	0	0	280	0.2	0.066790315	47.01703143	182.5363118	0	0.034248344	0	25	0	25.00140095	28.27496135	25	0	0	0.001614627	0.2	0	0	0	30	0	30	0	0	0											NO	217.098481	896.4952737	0	0	243.1502988	0.173678785	0.058000304	40.82930443	158.5134241	0	0.029741053	0	21.7098481	0	21.71106468	24.55380464	23.93463087	0	0	0.001402132	0.173678785	0	0	0	26.05181772	0	26.05181772	0	0	0												12.886	1.924647589	0	0	5.363978842	1.590710155	0.15638625	1.221353522	4.054011031	0	0.16298873	0	0.016106502	0	5.505569353	10.30946352	0.442450901	0	0	0.055427921	3.011720148	0	0	0	1.348603585	0	0.195145694	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2446	0	6.98	12.886	1.924647589	0	0	5.363978842	1.590710155	0.15638625	1.221353522	4.054011031	0	0.16298873	0	0.016106502	0	5.505569353	10.30946352	0.442450901	0	0	0.055427921	3.011720148	0	0	0	1.348603585	0	0.195145694	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2446	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.886	1.924647589	0	0	5.363978842	1.590710155	0.15638625	1.221353522	4.054011031	0	0.16298873	0	0.016106502	0	5.505569353	10.30946352	0.442450901	0	0	0.055427921	3.011720148	0	0	0	1.348603585	0	0.195145694	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2446
H0562_801_0	2011	2																															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	YES	247.164839	0.719591315	43.56332601	8.895569153	8.59886429	7.523949092	2.373741134	16.86043168	46.04616852	2.754977598	12.17202395	0	0.937305262	12.6247321	81.36228308	217.9980214	0.502019927	9.933612997	59.15489853	47.58593769	21.1689124	0.360140206	0	0	0	0	0	0	500	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS							14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/													0.062447247	0.062447247	0.132059391	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.23285839	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.049005361	0.049005361	0.103633361	0	0.182846316	0.182846316	0.182846316	0.182846316	0.182846316	0.182846316	0.182846316	0	0.182846316	0.182846316	0.182735188	0.182846316	0.182846316	0.182846316	0.182846316	0.182846316	0.182846316	0.182846316	0	0	0	0	0	0	0	0												12.1124	0.035263832	4.514613907	0	1.572270658	1.375726374	0.434029822	3.082867819	8.419372283	0.503737505	2.225609739	0	0.171382814	2.308385756	14.86775209	39.86013512	0.091792494	1.816324542	10.81625527	8.700913404	3.870657647	0.06585031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.8453	0	32.05	12.1124	0.035263832	4.514613907	0	1.572270658	1.375726374	0.434029822	3.082867819	8.419372283	0.503737505	2.225609739	0	0.171382814	2.308385756	14.86775209	39.86013512	0.091792494	1.816324542	10.81625527	8.700913404	3.870657647	0.06585031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.8453	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.1124	0.035263832	4.514613907	0	1.572270658	1.375726374	0.434029822	3.082867819	8.419372283	0.503737505	2.225609739	0	0.171382814	2.308385756	14.86775209	39.86013512	0.091792494	1.816324542	10.81625527	8.700913404	3.870657647	0.06585031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.8453
H0562_803_0	2011	3																															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	YES	283.5235292	1.234301847	52.46471791	7.545189573	10.63597263	5.714211186	2.453545547	18.3731311	46.53294996	3.528886196	13.63864273	0	2.149461788	14.51226284	91.39650268	267.4052353	0.815807466	11.15453474	58.5458037	56.42439202	20.39358692	0.553489713	0	0	0	0	0	0	500	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS							14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/													0.063806338	0.063806338	0.142241169	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.232875571	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.047726616	0.047726616	0.106395225	0	0.174282084	0.174282084	0.174282084	0.174282084	0.174282084	0.174282084	0.174282084	0	0.174282084	0.174282084	0.174189012	0.174282084	0.174282084	0.174282084	0.174282084	0.174282084	0.174282084	0.174282084	0	0	0	0	0	0	0	0												13.5316	0.05890905	5.581995459	0	1.853659473	0.995884633	0.427609031	3.202107575	8.109859485	0.61502164	2.376971076	0	0.374612679	2.529227409	15.92026648	46.60394163	0.142180625	1.944035559	10.20348467	9.83376062	3.554236825	0.096463341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.9558	0	43.11	13.5316	0.05890905	5.581995459	0	1.853659473	0.995884633	0.427609031	3.202107575	8.109859485	0.61502164	2.376971076	0	0.374612679	2.529227409	15.92026648	46.60394163	0.142180625	1.944035559	10.20348467	9.83376062	3.554236825	0.096463341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.9558	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.5316	0.05890905	5.581995459	0	1.853659473	0.995884633	0.427609031	3.202107575	8.109859485	0.61502164	2.376971076	0	0.374612679	2.529227409	15.92026648	46.60394163	0.142180625	1.944035559	10.20348467	9.83376062	3.554236825	0.096463341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.9558
H0562_804_0	2011	2																															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	YES	293.0178951	0.870509961	47.67547636	11.72783746	10.10924986	7.902372823	2.483714025	16.49483222	54.82291994	3.118935768	15.73787392	0	2.018891553	12.46032523	85.36798541	230.6812216	0.553097383	11.9425468	64.9724908	45.71798752	32.2590125	0.395006601	0	0	0	0	0	0	500	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS							14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/													0.063530295	0.063530295	0.129773533	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.232867283	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.048209228	0.048209228	0.098477143	0	0.176809352	0.176809352	0.176809352	0.176809352	0.176809352	0.176809352	0.176809352	0	0.176809352	0.176809352	0.176708641	0.176809352	0.176809352	0.176809352	0.176809352	0.176809352	0.176809352	0.176809352	0	0	0	0	0	0	0	0												14.1262	0.041966614	4.694944688	0	1.787409915	1.397213417	0.439143867	2.916440594	9.693204941	0.551457012	2.782603287	0	0.356958907	2.203102028	15.08526071	40.78659728	0.09779279	2.111553959	11.48774399	8.083367742	5.703695092	0.069840861	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.4165	0	39.54	14.1262	0.041966614	4.694944688	0	1.787409915	1.397213417	0.439143867	2.916440594	9.693204941	0.551457012	2.782603287	0	0.356958907	2.203102028	15.08526071	40.78659728	0.09779279	2.111553959	11.48774399	8.083367742	5.703695092	0.069840861	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.4165	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.1262	0.041966614	4.694944688	0	1.787409915	1.397213417	0.439143867	2.916440594	9.693204941	0.551457012	2.782603287	0	0.356958907	2.203102028	15.08526071	40.78659728	0.09779279	2.111553959	11.48774399	8.083367742	5.703695092	0.069840861	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.4165
H0564_006_0	2011	8	H.6	I.7									OP Facility - Other	Professional	0	0	0	0	0	0	0	0	Radiology	Radiology	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	V	V	V	V	V	V	V	0	Coin	Coin	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1462.295353	98.87645673	238.1352809	384.4911429	195.1228543	8.636115532	5.819510498	293.2030752	644.1005244	23933.26322	616.1946706	117.8661896	1.004181314	175.9638098	4606.721339	4772.946542	18.35092108	2143.430258	1453.030199	1547.452089	43.78793188	19.0772596	0				162	0	5580.318009	0	8.893420908	9.479451365	0	0	0	0	0	0	0	0	3400	1A: $150/day (days1-5) $1500 yrly max	1B: $150/day (days 1-5) no yrly max	2: $130/day (for days 21-100)	6: $0 copay	10A: $100 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $30 copay	9A: $30 - $125 copay; 9B: $75 copay	8A: $0 -$150 copay	8B: $30 - $150 copay	9A: $125 copay	12: 10% coin	3: $30 copay; 5: $30 copay; 9C: $40 copay; 9D: $30 copay	7A: $5 copay; 7G: $5 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $30 copay; 7F: $30 copay; 7G: $30 copay	7E: $40 copay; 7H: $40 copay	7C: $30-$50 copay; 7I: $30-$50 copay	8B: $30 - $150 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $30	15: 20% coinsurance	13A: $0 copay	10B: Not covered			-	18A: $30 copay	-	14A: $0 copay or not covered;  Silver Sneakers	0	8B: 20% coinsurance	8B: 20% coinsurance	0	0	0	0	0	0	0	0		150	150	130	0	100	0.2	0.2	49.89589358	69.71525493	5.131229156	65.81977472	125	0.1	33.97370343	4.491407661	26.79273963	40	34.53658537	66.68110728	0.918367347	0.2	0	0		0	0	30	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	68.46189059	60.11893339	116.7553676	0	89.81182122	0.179623642	0.179623642	44.81241074	62.61254013	4.608450356	59.1139384	112.2647765	0.089811821	30.51240179	4.033815019	24.06304742	35.92472849	31.01793631	59.88751686	0.82480244	0.179623642	0	0		0	0	30	0	0	0	0.179623642	0.179623642	0	0	0	0	0	0	0	0		8.3426	0.49536226	2.316964355	0	1.460361575	1.551250528	1.045321673	1.094928053	3.360730827	9.191271282	3.035474483	1.10268512	0.090187353	0.447423205	1.548555144	9.570969914	0.054937655	5.540398602	7.251530876	0.106361855	7.865347819	0	0	0	0	0	0.405	0	0	0	1.597468657	1.702733583	0	0	0	0	0	0	0	0	69.1779		7.801539827	8.3426	0.49536226	2.316964355	0	1.460361575	1.551250528	1.045321673	1.094928053	3.360730827	9.191271282	3.035474483	1.10268512	0.090187353	0.447423205	1.548555144	9.570969914	0.054937655	5.540398602	7.251530876	0.106361855	7.865347819	0	0	0	0	0	0.405	0	0	0	1.597468657	1.702733583	0	0	0	0	0	0	0	0	69.1779	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	8.3426	0.49536226	2.316964355	0	1.460361575	1.551250528	1.045321673	1.094928053	3.360730827	9.191271282	3.035474483	1.10268512	0.090187353	0.447423205	1.548555144	9.570969914	0.054937655	5.540398602	7.251530876	0.106361855	7.865347819	0	0	0	0	0	0.405	0	0	0	1.597468657	1.702733583	0	0	0	0	0	0	0	0	69.1779
H0564_047_0	2011	8	H.6	I.7									OP Facility - Other	Professional	0	0	0	0	0	0	0	0	Radiology	Radiology	0	0	0	0	0	0	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	V	V	V	V	V	V	V	0	Coin	Coin	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1388.25856	92.8115522	238.3016624	451.6888004	215.5585962	11.83106443	5.583707239	398.8704499	601.9319909	23751.88586	761.1163423	64.3196909	0.534470682	165.9192026	4919.625112	4651.372563	20.20988571	1804.877527	1577.718411	1526.115836	48.68823931	30.97445238	0	0	0	0	162	0	5580.616509	0	11.15408853	14.40820515	0	0	0	0	0	0	0	0	3400	1A: $175/day (days1-7) no yrly max	1B: $175/day (days1-7) no yrly max	2: $130/day (for days 21-100)	6: $0 copay	10A: $170 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $35 copay	9A: $35 - $150 copay; 9B: $75 copay	8A: $0 -$150 copay	8B: $35 - $150 copay	9A: $150 copay	12: 10% coin	3: $35 copay; 5: $35 copay; 9C: $40 copay; 9D: $35 copay	7A: $10 copay; 7G: $10 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35-$50 copay; 7I: $35-$50 copay	8B: $35 - $150 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $35	15: 20% coinsurance	13A: $0 copay	10B: Not covered	0	0	-	18A: $35 copay	-	14A: $0 copay or not covered;  Silver Sneakers	0	8B: 20% coinsurance	8B: 20% coinsurance	0	0	0	0	0	0	0	0		175	175	130	0	170	0.2	0.2	49.40660991	87.22888356	5.850185248	63.45385747	150	0.1	37.43490839	9.057347867	30.9961475	40	39.43527919	74.93082835	1.078396751	0.2	0	0	0	0	0	35	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	117.1362697	86.99349319	114.9090838	0	150.2657249	0.176783206	0.176783206	43.67129444	77.10300837	5.171072513	56.08788172	132.5874044	0.088391603	33.08931557	8.00593496	27.39799161	35.35664116	34.85747538	66.23256025	0.953212174	0.176783206	0	0	0	0	0	35	0	0	0	0.176783206	0.176783206	0	0	0	0	0	0	0	0		13.5513	0.672833428	2.281918807	0	2.699255727	2.091533498	0.987105666	1.451599072	3.867563945	10.23522701	3.557450282	0.710665072	0.04724272	0.457512738	3.282183223	10.61985554	0.05954614	5.242789496	8.708027477	0.121226016	8.60726303	0	0	0	0	0	0.4725	0	0	0	1.971855528	2.547128697	0	0	0	0	0	0	0	0	84.2436		10.85561923	13.5513	0.672833428	2.281918807	0	2.699255727	2.091533498	0.987105666	1.451599072	3.867563945	10.23522701	3.557450282	0.710665072	0.04724272	0.457512738	3.282183223	10.61985554	0.05954614	5.242789496	8.708027477	0.121226016	8.60726303	0	0	0	0	0	0.4725	0	0	0	1.971855528	2.547128697	0	0	0	0	0	0	0	0	84.2436	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	-	-	-	-	-	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	13.5513	0.672833428	2.281918807	0	2.699255727	2.091533498	0.987105666	1.451599072	3.867563945	10.23522701	3.557450282	0.710665072	0.04724272	0.457512738	3.282183223	10.61985554	0.05954614	5.242789496	8.708027477	0.121226016	8.60726303	0	0	0	0	0	0.4725	0	0	0	1.971855528	2.547128697	0	0	0	0	0	0	0	0	84.2436
H0564_801_0	2011	9																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	348.761886	4.175832579	25.81277859	5.399655309	7.979999915	4.937141053	1.246208985	18.6859909	39.2450929	3.197719148	13.35146761	0	0.011740931	16.33499897	86.31298834	237.6588377	2.298879389	9.141242169	35.92131254	43.37118212	19.64979373	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.065783206	0.065783206	0.154569415	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.050306994	0.050306994	0.118205286	0	0.178184227	0.178184227	0.178184227	0.178184227	0.178184227	0.178184227	0.178184227	0.178184227	0.178184227	0.178184227	0.178184227	0.178184227	0.178184227	0.178184227	0.178184227	0.178184227	0.178184227	0.178184227																				17.5452	0.210073585	3.051206889	0	1.421910114	0.879720661	0.222054784	3.32954884	6.992856533	0.569783114	2.379020933	0	0.002092049	2.910639161	15.37961309	42.34705624	0.409624046	1.628825168	6.400611301	7.728060551	3.501283302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.9091		35.96538908	17.5452	0.210073585	3.051206889	0	1.421910114	0.879720661	0.222054784	3.32954884	6.992856533	0.569783114	2.379020933	0	0.002092049	2.910639161	15.37961309	42.34705624	0.409624046	1.628825168	6.400611301	7.728060551	3.501283302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.9091	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	17.5452	0.210073585	3.051206889	0	1.421910114	0.879720661	0.222054784	3.32954884	6.992856533	0.569783114	2.379020933	0	0.002092049	2.910639161	15.37961309	42.34705624	0.409624046	1.628825168	6.400611301	7.728060551	3.501283302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.9091
H0564_810_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	386.6737106	4.629762434	32.99280253	8.884086902	16.28288219	13.07770904	3.301011321	21.97952931	60.57227093	6.230444083	26.01403329	0	0.02287606	31.82715334	63.55550692	174.9971609	1.692751551	6.731041191	26.45021649	31.93583629	48.18617414	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.065783206	0.065783206	0.154569415	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.050055181	0.050055181	0.117613605	0	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319																				19.355	0.231743595	3.880402457	0	2.88682994	2.31857736	0.585243951	3.896801717	10.73899837	1.104609878	4.612088283	0	0.00405575	5.642709816	11.26790319	31.02565243	0.300111848	1.193361901	4.689420214	5.661978467	8.543038545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9386		37.05791205	19.355	0.231743595	3.880402457	0	2.88682994	2.31857736	0.585243951	3.896801717	10.73899837	1.104609878	4.612088283	0	0.00405575	5.642709816	11.26790319	31.02565243	0.300111848	1.193361901	4.689420214	5.661978467	8.543038545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9386	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	19.355	0.231743595	3.880402457	0	2.88682994	2.31857736	0.585243951	3.896801717	10.73899837	1.104609878	4.612088283	0	0.00405575	5.642709816	11.26790319	31.02565243	0.300111848	1.193361901	4.689420214	5.661978467	8.543038545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9386
H0564_811_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	386.6737106	4.629762434	32.99280253	8.884086902	16.28288219	13.07770904	3.301011321	21.97952931	60.57227093	6.230444083	26.01403329	0	0.02287606	31.82715334	63.55550692	174.9971609	1.692751551	6.731041191	26.45021649	31.93583629	48.18617414	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.065783206	0.065783206	0.154569415	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.050055181	0.050055181	0.117613605	0	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319	0.177292319																				19.355	0.231743595	3.880402457	0	2.88682994	2.31857736	0.585243951	3.896801717	10.73899837	1.104609878	4.612088283	0	0.00405575	5.642709816	11.26790319	31.02565243	0.300111848	1.193361901	4.689420214	5.661978467	8.543038545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9386		37.05791205	19.355	0.231743595	3.880402457	0	2.88682994	2.31857736	0.585243951	3.896801717	10.73899837	1.104609878	4.612088283	0	0.00405575	5.642709816	11.26790319	31.02565243	0.300111848	1.193361901	4.689420214	5.661978467	8.543038545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9386	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	19.355	0.231743595	3.880402457	0	2.88682994	2.31857736	0.585243951	3.896801717	10.73899837	1.104609878	4.612088283	0	0.00405575	5.642709816	11.26790319	31.02565243	0.300111848	1.193361901	4.689420214	5.661978467	8.543038545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9386
H0571_001_0	2011	9																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	V	V					V		V			V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	594.7887986	45.3927433	213.4235574	0	74.63659548	4.935514166	0.026623889	114.2421851	139.6284884	0	91.80666434	0	0	11.18879075	3798.963348	2117.553345	101.9667873	189.3401628	363.7177486	67.57995079	0	0	0	0	70.71835613	0	30.8342063	0	0	97.17160655											3400	$195/Days 1-6 for IP Med/Surg at Chinese Hospital and $270/Days 1-6 for IP Med/Surg Everywhere Else; PBP 1a	$270/Days 1-6 for IP MH/SA; PBP 1b	$135/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; $15/Visit for Urgent Care; PBP 4a, 4b"	"$195/Visit for OP Surg and ASC at Chinese Hospital and $270/Visit for OP Surg and ASC Everywhere Else; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$100/Case for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"$25/Day for CORF; $25/Case for OP - PT/OT/ST; $15/Visit for OP Substance Abuse; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP OV; $15/Visit for PCP - IP Visit; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $15/Visit for SCP OV; $15/Visit for SCP - IP Visit; $15/Visit for SCP - Office Surg; $15/Visit for Podiatry; $15/Visit for Vision Exams; $15/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$15/Visit for MH - Non Phys; $15/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	"$100/Case for OP Rad - PET/CAT/MRI; PBP 7d, 8b"	"$15/Visit for SCP - IP/OP Surg; $15/Visit for SCP - Other; PBP 7d, 7g, 14d-j"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$15/Visit for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	$15/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	$15/Visit for Acupuncture; PBP 13b-f											0	232.5	270	135	0	150	0.2	0.2	49.84227613	217.5	0	100	0	0	24.79294523	15	15	15	25	33.33333333	15	0	0	0	0	15	0	15	0	0	15											NO	227.7032898	264.4296268	132.2148134	0	146.9053482	0.195873798	0.195873798	48.81397954	213.0127549	0	97.93689883	0	0	24.28144168	14.69053482	14.69053482	14.69053482	24.48422471	32.64563294	14.69053482	0	0	0	0	14.69053482	0	14.69053482	0	0	14.69053482												11.2863	1.000265514	2.351479651	0	0.913709587	0.966737903	0.005214922	0.464717974	2.478554082	0	0.749271666	0	0	0.022639998	4.650733613	2.592332596	0.124828887	0.386320591	0.98948301	0.082732135	0	0	0	0	0.086574206	0	0.037747582	0	0	0.118958572	0	0	0	0	0	0	0	0	0	0	29.3086	0	0.617403376	11.2863	1.000265514	2.351479651	0	0.913709587	0.966737903	0.005214922	0.464717974	2.478554082	0	0.749271666	0	0	0.022639998	4.650733613	2.592332596	0.124828887	0.386320591	0.98948301	0.082732135	0	0	0	0	0.086574206	0	0.037747582	0	0	0.118958572	0	0	0	0	0	0	0	0	0	0	29.3086	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.2863	1.000265514	2.351479651	0	0.913709587	0.966737903	0.005214922	0.464717974	2.478554082	0	0.749271666	0	0	0.022639998	4.650733613	2.592332596	0.124828887	0.386320591	0.98948301	0.082732135	0	0	0	0	0.086574206	0	0.037747582	0	0	0.118958572	0	0	0	0	0	0	0	0	0	0	29.3086
H0571_002_0	2011	9																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	V	V					V		V			V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	915.2497667	69.84949583	237.0828343	0	82.91050816	7.391245278	0.029575306	135.4301659	163.5610627	0	101.9839818	0	0	12.42913508	4388.476531	2727.978781	113.270415	319.0328758	404.0380349	239.6787682	0	0	0	0	78.55790856	0	41.68583004	0	0	147.4637537											3400	$195/Days 1-6 for IP Med/Surg at Chinese Hospital and $270/Days 1-6 for IP Med/Surg Everywhere Else; PBP 1a	$270/Days 1-6 for IP MH/SA; PBP 1b	$135/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; $15/Visit for Urgent Care; PBP 4a, 4b"	"$195/Visit for OP Surg and ASC at Chinese Hospital and $270/Visit for OP Surg and ASC Everywhere Else; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$100/Case for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"$25/Day for CORF; $25/Case for OP - PT/OT/ST; $15/Visit for OP Substance Abuse; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP OV; $15/Visit for PCP - IP Visit; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $15/Visit for SCP OV; $15/Visit for SCP - IP Visit; $15/Visit for SCP - Office Surg; $15/Visit for Podiatry; $15/Visit for Vision Exams; $15/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$15/Visit for MH - Non Phys; $15/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	"$100/Case for OP Rad - PET/CAT/MRI; PBP 7d, 8b"	"$15/Visit for SCP - IP/OP Surg; $15/Visit for SCP - Other; PBP 7d, 7g, 14d-j"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$15/Visit for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	$15/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	$15/Visit for Acupuncture; PBP 13b-f											0	232.5	270	135	0	150	0.2	0.2	49.85220278	217.5	0	100	0	0	24.79294523	15	15	15	25	33.33333333	15	0	0	0	0	15	0	15	0	0	15											NO	229.7855048	266.847683	133.4238415	0	148.2487128	0.19766495	0.19766495	49.27016593	214.9606335	0	98.83247518	0	0	24.50348144	14.82487128	14.82487128	14.82487128	24.70811879	32.94415839	14.82487128	0	0	0	0	14.82487128	0	14.82487128	0	0	14.82487128												17.5259	1.553264677	2.636041875	0	1.024281342	1.460990131	0.005846001	0.556055562	2.929932471	0	0.839944112	0	0	0.025379757	5.421549972	3.370161189	0.139934944	0.65689185	1.109224418	0.296100574	0	0	0	0	0.097050907	0	0.051498922	0	0	0.182177597	0	0	0	0	0	0	0	0	0	0	39.8823	0	0.471135841	17.5259	1.553264677	2.636041875	0	1.024281342	1.460990131	0.005846001	0.556055562	2.929932471	0	0.839944112	0	0	0.025379757	5.421549972	3.370161189	0.139934944	0.65689185	1.109224418	0.296100574	0	0	0	0	0.097050907	0	0.051498922	0	0	0.182177597	0	0	0	0	0	0	0	0	0	0	39.8823	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.5259	1.553264677	2.636041875	0	1.024281342	1.460990131	0.005846001	0.556055562	2.929932471	0	0.839944112	0	0	0.025379757	5.421549972	3.370161189	0.139934944	0.65689185	1.109224418	0.296100574	0	0	0	0	0.097050907	0	0.051498922	0	0	0.182177597	0	0	0	0	0	0	0	0	0	0	39.8823
H0571_005_0	2011	5																																																																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	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											0	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"No Cost Sharing; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b, 14c"	"No Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	No Cost Sharing; PBP 7d	"No Cost Sharing; PBP 7d, 7g, 14d-j"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											0	0	0	0	0	0	0	0	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
H0571_006_0	2011	8																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	V	V					V		V			V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	762.819875	46.49310339	157.8066755	0	59.42166314	4.585373976	0.191917784	105.0851132	201.1762488	0	113.4628173	0	0	12.47286628	4398.458195	2643.598996	82.18132545	185.7341562	434.7119402	294.6540963	0	0	0	0	86.30228767	0	40.40345823	0	0	104.5377779											3400	$270/Days 1-6 for IP Med/Surg; PBP 1a	$270/Days 1-6 for IP MH/SA; PBP 1b	$135/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; $15/Visit for Urgent Care; PBP 4a, 4b"	"$270/Visit for OP Surg and ASC; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$100/Case for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"$25/Day for CORF; $25/Case for OP - PT/OT/ST; $15/Visit for OP Substance Abuse; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP OV; $15/Visit for PCP - IP Visit; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $15/Visit for SCP OV; $15/Visit for SCP - IP Visit; $15/Visit for SCP - Office Surg; $15/Visit for Podiatry; $15/Visit for Vision Exams; $15/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$15/Visit for MH - Non Phys; $15/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	"$100/Case for OP Rad - PET/CAT/MRI; PBP 7d, 8b"	"$15/Visit for SCP - IP/OP Surg; $15/Visit for SCP - Other; PBP 7d, 7g, 14d-j"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$15/Visit for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	$15/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	$15/Visit for Acupuncture; PBP 13b-f											0	270	270	135	0	150	0.2	0.2	49.87321562	270	0	100	0	0	24.86266376	15	15	15	25	33.33333333	15	0	0	0	0	15	0	15	0	0	15											NO	260.262797	260.262797	130.1313985	0	144.5904428	0.192787257	0.192787257	48.0746022	260.262797	0	96.39362853	0	0	23.96602375	14.45904428	14.45904428	14.45904428	24.09840713	32.13120951	14.45904428	0	0	0	0	14.45904428	0	14.45904428	0	0	14.45904428												16.5445	1.008368761	1.711300282	0	0.715983715	0.884001671	0.036999303	0.420993751	4.363224433	0	0.911424388	0	0	0.024910417	5.299791816	3.185326245	0.099021952	0.372991443	1.163985036	0.355034719	0	0	0	0	0.103987383	0	0.048682949	0	0	0.125959697	0	0	0	0	0	0	0	0	0	0	37.3765	0	1.398364104	16.5445	1.008368761	1.711300282	0	0.715983715	0.884001671	0.036999303	0.420993751	4.363224433	0	0.911424388	0	0	0.024910417	5.299791816	3.185326245	0.099021952	0.372991443	1.163985036	0.355034719	0	0	0	0	0.103987383	0	0.048682949	0	0	0.125959697	0	0	0	0	0	0	0	0	0	0	37.3765	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.5445	1.008368761	1.711300282	0	0.715983715	0.884001671	0.036999303	0.420993751	4.363224433	0	0.911424388	0	0	0.024910417	5.299791816	3.185326245	0.099021952	0.372991443	1.163985036	0.355034719	0	0	0	0	0.103987383	0	0.048682949	0	0	0.125959697	0	0	0	0	0	0	0	0	0	0	37.3765
H0571_801_0	2011	4																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	V	V					V		V			V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	786.736146	56.77474456	191.5148031	0	71.56497097	2.974097102	0.023890844	108.4947554	158.1835109	0	98.83051389	0	0	10.04021808	3747.584766	1994.971008	91.49950188	169.9036622	368.7920232	413.3323248	0	0	0	0	64.68283029	0	27.66895568	0	0	87.19656504											3400	$175/Days 1-6 for IP Med/Surg at Chinese Hospital and $250/Days 1-6 for IP Med/Surg Everywhere Else; PBP 1a	$250/Days 1-6 for IP MH/SA; PBP 1b	$135/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; $15/Visit for Urgent Care; PBP 4a, 4b"	"$175/Visit for OP Surg and ASC at Chinese Hospital and $250/Visit for OP Surg and ASC Everywhere Else; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$100/Case for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"$25/Day for CORF; $25/Case for OP - PT/OT/ST; $15/Visit for OP Substance Abuse; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP OV; $15/Visit for PCP - IP Visit; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $15/Visit for SCP OV; $15/Visit for SCP - IP Visit; $15/Visit for SCP - Office Surg; $15/Visit for Podiatry; $15/Visit for Vision Exams; $15/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$15/Visit for MH - Non Phys; $15/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	"$100/Case for OP Rad - PET/CAT/MRI; PBP 7d, 8b"	"$15/Visit for SCP - IP/OP Surg; $15/Visit for SCP - Other; PBP 7d, 7g, 14d-j"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$15/Visit for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	$15/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	$15/Visit for Acupuncture; PBP 13b-f											0	212.5	250	135	0	150	0.2	0.2	48.18533596	197.5	0	100	0	0	24.79294523	15	15	15	25	33.33333333	15	0	0	0	0	15	0	15	0	0	15											NO	210.9345766	248.1583255	134.0054958	0	148.8949953	0.19852666	0.19852666	47.83036914	196.0450771	0	99.26333019	0	0	24.61030308	14.88949953	14.88949953	14.88949953	24.81583255	33.08777673	14.88949953	0	0	0	0	14.88949953	0	14.88949953	0	0	14.88949953												13.8292	1.174093795	2.138669678	0	0.887972168	0.590437565	0.004742969	0.43244535	2.584258217	0	0.817520494	0	0	0.020591067	4.6499718	2.475343324	0.113531816	0.351358403	1.016875677	0.512859288	0	0	0	0	0.080257914	0	0.034331409	0	0	0.108192768	0	0	0	0	0	0	0	0	0	0	31.8226	0	0.236167323	13.8292	1.174093795	2.138669678	0	0.887972168	0.590437565	0.004742969	0.43244535	2.584258217	0	0.817520494	0	0	0.020591067	4.6499718	2.475343324	0.113531816	0.351358403	1.016875677	0.512859288	0	0	0	0	0.080257914	0	0.034331409	0	0	0.108192768	0	0	0	0	0	0	0	0	0	0	31.8226	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.8292	1.174093795	2.138669678	0	0.887972168	0.590437565	0.004742969	0.43244535	2.584258217	0	0.817520494	0	0	0.020591067	4.6499718	2.475343324	0.113531816	0.351358403	1.016875677	0.512859288	0	0	0	0	0.080257914	0	0.034331409	0	0	0.108192768	0	0	0	0	0	0	0	0	0	0	31.8226
H0609_002_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1320.844638	155.8564013	1430.509899	531.3227747	230.2054632	18.91176817	16.07365251	294.5965781	358.4012138	22.30699539	45.56212415	0	0.043003597	1285.905123	6715.106015	135.4302588	807.6935147	856.1655553	0	0	22.64474006	4487.224772	0	0	329.8591827	357.9080011	17.46434425	6	87.57451375	0											5900	"$200 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$75 Days 21-86 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$175 (9b)	$0/20% (8a1a); $0 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $175 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												140.336857	90.43796201	59.66926121	0	200	0.2	0.100938307	49.89246616	175	0	0.159912315	0	0.2	65.77250938	6.389047849	0.108020471	38.5	30	0	0	0.2	28.72881274	0	0	30	30	0	0	0	0											NO	116.6455835	75.17047964	49.59606437	0	166.2365626	0.166236563	0.083898186	41.48562939	145.4569922	0	0.132916368	0	0.166236563	54.66897935	6.306636204	0.106627127	38.00339262	29.61303321	0	0	0.166236563	23.87889538	0	0	30	30	0	0	0	0												12.8392	0.976316703	5.912305086	0	3.189047074	3.143827333	1.348550294	1.018460371	4.344330214	0	6.055952055	0	0.00714877	5.858260051	3.529144226	14.44053939	2.557924479	2.112804918	0	0	3.764383747	8.92916424	0	0	0.824647957	0.894770003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.7468	0	11.95095068	12.8392	0.976316703	5.912305086	0	3.189047074	3.143827333	1.348550294	1.018460371	4.344330214	0	6.055952055	0	0.00714877	5.858260051	3.529144226	14.44053939	2.557924479	2.112804918	0	0	3.764383747	8.92916424	0	0	0.824647957	0.894770003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.7468	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.8392	0.976316703	5.912305086	0	3.189047074	3.143827333	1.348550294	1.018460371	4.344330214	0	6.055952055	0	0.00714877	5.858260051	3.529144226	14.44053939	2.557924479	2.112804918	0	0	3.764383747	8.92916424	0	0	0.824647957	0.894770003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.7468
H0609_007_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1305.283561	154.060706	1501.751005	765.1981527	381.9569896	18.82931041	12.51219714	308.5903591	403.7434199	32.82413208	57.81000421	0	0.050830921	814.1494482	7385.992779	158.0537713	808.3581389	740.6636742	0	0	41.06451347	4285.319772	0	0	341.1273315	313.1929433	17.46434425	6	87.5623813	0											5500	"$200 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-65 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$150 (9b)	$0/20% (8a1a); $0 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$20 (3, 9d); $60 (5); $150 (9a); $40/$30 (9c)"	"$10 (7a); $20 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $20 (7d, 7f, 7f1)"	"$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, 18a); $0/$20 (17a)"	$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												129.2894442	79.93204038	66.80005558	0	200	0.2	0.105263675	49.96876807	150	0	0.155692825	0	0.2	57.50987488	5.876302704	0.068289819	38.5	20	0	0	0.2	19.10187754	0	0	20	30	0	0	0	0											NO	106.5031638	65.84462666	55.02705422	0	164.7515223	0.164751522	0.086711754	41.17777124	123.5636417	0	0.12825315	0	0.164751522	47.37419716	5.796452045	0.067361877	37.97683935	19.72822823	0	0	0.164751522	15.73531702	0	0	20	30	0	0	0	0												11.5847	0.845339139	6.886411163	0	5.243999624	3.102157554	1.084954558	1.058921934	4.15733394	0	7.414315113	0	0.008374472	3.214139707	3.567712746	10.64679865	2.558240598	1.217665167	0	0	6.765441106	5.619238761	0	0	0.568545553	0.782982358	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3273	0	12.43932144	11.5847	0.845339139	6.886411163	0	5.243999624	3.102157554	1.084954558	1.058921934	4.15733394	0	7.414315113	0	0.008374472	3.214139707	3.567712746	10.64679865	2.558240598	1.217665167	0	0	6.765441106	5.619238761	0	0	0.568545553	0.782982358	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3273	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	11.5847	0.845339139	6.886411163	0	5.243999624	3.102157554	1.084954558	1.058921934	4.15733394	0	7.414315113	0	0.008374472	3.214139707	3.567712746	10.64679865	2.558240598	1.217665167	0	0	6.765441106	5.619238761	0	0	0.568545553	0.782982358	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3273
H0609_012_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	841.8626522	167.18955	679.8175873	391.9470482	206.3690417	13.9904674	11.38137276	252.7220223	363.5770907	23.38444922	44.52085136	0	0.119411134	699.9824955	5712.710932	111.7991768	812.7410151	565.884507	0	0	26.44977009	4234.806507	0	0	265.9918524	244.8711793	17.46434425	6	88.40009379	0											6700	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-77 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$250 (9b)	$0/20% (8a1a); $0 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $250 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												185.9463355	119.8302997	69.14892241	0	200	0.2	0.109319875	49.9472598	250	0	0.156504468	0	0.2	94.15424423	8.566732989	0.104988674	38.5	30	0	0	0.2	28.79131324	0	0	30	30	0	0	0	0											NO	162.7190544	104.8618302	60.51126115	0	175.0172209	0.175017221	0.095664304	43.72120758	218.7715262	0	0.136954885	0	0.175017221	82.39307082	8.487494776	0.104017601	38.14389328	29.72251424	0	0	0.175017221	25.19487815	0	0	30	30	0	0	0	0												11.4156	1.460983517	3.42805163	0	3.00984468	2.448572724	1.088791102	0.920776	6.628359585	0	6.097348073	0	0.020899005	4.806142277	4.040550349	11.62908217	2.583425545	1.40162586	0	0	4.629165256	8.891286161	0	0	0.664979631	0.612177948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7777	0	8.012125333	11.4156	1.460983517	3.42805163	0	3.00984468	2.448572724	1.088791102	0.920776	6.628359585	0	6.097348073	0	0.020899005	4.806142277	4.040550349	11.62908217	2.583425545	1.40162586	0	0	4.629165256	8.891286161	0	0	0.664979631	0.612177948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7777	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	11.4156	1.460983517	3.42805163	0	3.00984468	2.448572724	1.088791102	0.920776	6.628359585	0	6.097348073	0	0.020899005	4.806142277	4.040550349	11.62908217	2.583425545	1.40162586	0	0	4.629165256	8.891286161	0	0	0.664979631	0.612177948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7777
H0609_015_0	2011	1																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1132.469473	137.7374295	1064.367639	438.7588907	187.0032519	17.09266923	13.28829303	250.3173652	308.7196006	19.28776709	40.4848777	0	0.02368532	1018.705654	5833.852547	121.4853772	759.4818077	776.1012809	0	0	19.83990244	3686.657112	0	372.6760938	208.1543071	211.6529996	19.8343154	2.924106724	401.626899	0											5900	"$150 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$100 (9b)	$0/20% (8a1a); $0 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $100 (9a); $40/$30 (9c)"	"$10 (7a); $25 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$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, 18a); $0/$25 (17a)"	$0 n/c (10b)	"$20 (16a1); $0 n/c (16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												105.2526427	67.8284715	50	0	200	0.2	0.111287999	49.80238133	100	0	0.159994913	0	0.2	38.6843514	6.412613738	0.088042209	38.5	25	0	0	0.2	23.81019085	0	20	25	0	0	0	0	0											NO	94.56338857	60.93994356	44.92209703	0	179.6883881	0.179688388	0.099985806	44.75563838	89.84419405	0	0.14374614	0	0.179688388	34.75564374	6.368063617	0.087433399	38.23253033	24.8263184	0	0	0.179688388	21.39207407	0	20	25	0	0	0	0	0												8.9242	0.699475932	3.984468863	0	2.800192742	3.071354183	1.328640691	0.93359279	2.311388642	0	5.81954489	0	0.004255977	2.950480899	3.095862013	10.62187946	2.419742604	1.605644792	0	0	3.565000089	6.572103502	0	0.621126823	0.433654807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7626	0	4.980163721	8.9242	0.699475932	3.984468863	0	2.800192742	3.071354183	1.328640691	0.93359279	2.311388642	0	5.81954489	0	0.004255977	2.950480899	3.095862013	10.62187946	2.419742604	1.605644792	0	0	3.565000089	6.572103502	0	0.621126823	0.433654807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7626	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.9242	0.699475932	3.984468863	0	2.800192742	3.071354183	1.328640691	0.93359279	2.311388642	0	5.81954489	0	0.004255977	2.950480899	3.095862013	10.62187946	2.419742604	1.605644792	0	0	3.565000089	6.572103502	0	0.621126823	0.433654807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7626
H0609_018_0	2011	1																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	923.1173421	165.2947491	849.5006807	427.7497707	221.9099321	13.85797056	9.939267952	244.6131208	356.237176	24.04905449	46.73865377	0	0.093911493	678.5697212	5825.755457	117.8175562	808.2939514	594.4945657	0	0	25.87778387	4294.230293	0	0	220.7078845	217.365889	0	0	313.4713692	0											5900	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-69 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$250 (9b)	$0/20% (8a1a); $0 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $250 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												185.9463355	119.8302997	67.47948827	0	200	0.2	0.125326289	49.95026681	250	0	0.156879633	0	0.2	93.63499024	8.624017574	0.106645191	38.5	30	0	0	0.2	28.67207622	0	0	30	30	0	0	0	0											NO	158.1045853	101.8881055	57.37578256	0	170.0539943	0.170053994	0.10656118	42.48817028	212.5674928	0	0.133390041	0	0.170053994	79.61502047	8.52704989	0.105450182	38.06710943	29.66268268	0	0	0.170053994	24.37900543	0	0	30	30	0	0	0	0												12.1624	1.403464069	4.061730528	0	3.144722527	2.356603246	1.059140126	0.866096994	6.31037028	0	6.234470963	0	0.015970024	4.50202852	4.139708952	12.42388273	2.564117859	1.469525305	0	0	4.400620509	8.724088635	0	0	0.551769711	0.543414722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.9341	0	9.961237354	12.1624	1.403464069	4.061730528	0	3.144722527	2.356603246	1.059140126	0.866096994	6.31037028	0	6.234470963	0	0.015970024	4.50202852	4.139708952	12.42388273	2.564117859	1.469525305	0	0	4.400620509	8.724088635	0	0	0.551769711	0.543414722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.9341	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.1624	1.403464069	4.061730528	0	3.144722527	2.356603246	1.059140126	0.866096994	6.31037028	0	6.234470963	0	0.015970024	4.50202852	4.139708952	12.42388273	2.564117859	1.469525305	0	0	4.400620509	8.724088635	0	0	0.551769711	0.543414722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.9341
H0609_020_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1070.24712	167.8130513	647.0012387	429.3840306	142.8104597	16.07458373	15.79431857	283.5711559	304.5149587	16.8645384	35.49543844	0	0.018133144	919.7250411	5849.702416	101.4167872	811.8687995	641.9969088	0	0	17.68183869	4234.685172	0	0	258.3544004	271.5652266	17.46434425	6	388.1378368	0											6700	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$75 Days 21-96 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$250 (9b)	$0/20% (8a1a); $0 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $250 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												185.9463355	119.8302997	60.23985315	0	200	0.2	0.101800877	49.8955756	250	0	0.159137048	0	0.2	94.71895471	8.747757847	0.103321058	38.5	30	0	0	0.2	28.70983945	0	0	30	30	0	0	0	0											NO	163.0630236	105.0834959	52.82649197	0	175.3871871	0.175387187	0.089272848	43.76659646	219.2339838	0	0.139552996	0	0.175387187	83.06245514	8.668127508	0.102380533	38.1495367	29.72691172	0	0	0.175387187	25.17668991	0	0	30	30	0	0	0	0												14.5431	1.469531841	2.848233812	0	2.087260401	2.819276024	1.410003796	1.034245362	5.563335628	0	4.953494769	0	0.003180321	6.366218331	4.225497203	10.38310471	2.581034881	1.590382119	0	0	3.101167951	8.884612954	0	0	0.645886001	0.678913066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1885	0	7.90234277	14.5431	1.469531841	2.848233812	0	2.087260401	2.819276024	1.410003796	1.034245362	5.563335628	0	4.953494769	0	0.003180321	6.366218331	4.225497203	10.38310471	2.581034881	1.590382119	0	0	3.101167951	8.884612954	0	0	0.645886001	0.678913066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1885	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.5431	1.469531841	2.848233812	0	2.087260401	2.819276024	1.410003796	1.034245362	5.563335628	0	4.953494769	0	0.003180321	6.366218331	4.225497203	10.38310471	2.581034881	1.590382119	0	0	3.101167951	8.884612954	0	0	0.645886001	0.678913066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1885
H0609_801_0	2011	1																															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	223.4245227	12.32886753	42.25435896	651.6623043	8.993226185	17.05167576	13.71685863	13.01446038	47.87658761	25.17955211	57.05621204	0	0.050381149	25.83794008	33.69208267	132.9965137	6.014183555	6.647015526	0	0	45.99845318	33.78681255	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.076331619	0.076331619	0.148152342	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.059628595	0.059628595	0.115733377	0	0.182014517	0.182014517	0.182014517	0.182014517	0.182014517	0.182014517	0.182014517	0	0.182014517	0.182014517	0.182014517	0.182014517	0.182014517	0.182014517	0	0	0.182014517	0.182014517	0	0	0	0	0	0	0	0												13.3225	0.735153052	4.890239668	0	1.636897722	3.103652531	2.496667401	2.368820722	8.714233979	4.58304402	10.38505889	0	0.009170101	4.702880189	6.132448161	24.20729623	1.094668716	1.209853322	0	0	8.372386248	6.149690374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1147	0	29.16435386	13.3225	0.735153052	4.890239668	0	1.636897722	3.103652531	2.496667401	2.368820722	8.714233979	4.58304402	10.38505889	0	0.009170101	4.702880189	6.132448161	24.20729623	1.094668716	1.209853322	0	0	8.372386248	6.149690374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1147	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.3225	0.735153052	4.890239668	0	1.636897722	3.103652531	2.496667401	2.368820722	8.714233979	4.58304402	10.38505889	0	0.009170101	4.702880189	6.132448161	24.20729623	1.094668716	1.209853322	0	0	8.372386248	6.149690374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1147
H0609_804_0	2011	1																															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	236.6774813	12.63652027	47.71003634	611.7126025	9.856762341	16.31313448	15.09004651	13.76791375	49.74992012	25.08150256	58.8780132	0	0.037202411	26.6457619	34.41433592	135.4758748	6.054425311	7.004228265	0	0	44.89170285	34.19485502	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.075699444	0.075699444	0.148553617	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.058629074	0.058629074	0.115054491	0	0.180458052	0.180458052	0.180458052	0.180458052	0.180458052	0.180458052	0.180458052	0	0.180458052	0.180458052	0.180458052	0.180458052	0.180458052	0.180458052	0	0	0.180458052	0.180458052	0	0	0	0	0	0	0	0												13.8762	0.740867484	5.489253932	0	1.778732133	2.943836473	2.723120401	2.484530897	8.977773681	4.526159098	10.62501158	0	0.006713475	4.808442292	6.210344027	24.44771249	1.092569799	1.26396939	0	0	8.101069255	6.170736931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.267	0	30.94057823	13.8762	0.740867484	5.489253932	0	1.778732133	2.943836473	2.723120401	2.484530897	8.977773681	4.526159098	10.62501158	0	0.006713475	4.808442292	6.210344027	24.44771249	1.092569799	1.26396939	0	0	8.101069255	6.170736931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.267	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.8762	0.740867484	5.489253932	0	1.778732133	2.943836473	2.723120401	2.484530897	8.977773681	4.526159098	10.62501158	0	0.006713475	4.808442292	6.210344027	24.44771249	1.092569799	1.26396939	0	0	8.101069255	6.170736931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.267
H0609_805_0	2011	1																															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	235.0014637	12.63117526	47.70321781	611.625179	9.855353651	15.66568084	14.953263	13.72941154	49.49310627	23.82185085	57.11983729	0	0.034700374	26.20206795	33.25423014	130.3597241	6.053531373	6.905434035	0	0	43.73019829	33.34197235	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.075699444	0.075699444	0.148553617	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.059013383	0.059013383	0.115808663	0	0.181640938	0.181640938	0.181640938	0.181640938	0.181640938	0.181640938	0.181640938	0	0.181640938	0.181640938	0.181640938	0.181640938	0.181640938	0.181640938	0	0	0.181640938	0.181640938	0	0	0	0	0	0	0	0												13.8682	0.745408377	5.524445853	0	1.790135686	2.84552897	2.716124724	2.493823198	8.989974271	4.327023345	10.37530085	0	0.006303008	4.759368212	6.04032957	23.67866263	1.09956912	1.254309519	0	0	7.943194257	6.056267148	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.514	0	29.55138309	13.8682	0.745408377	5.524445853	0	1.790135686	2.84552897	2.716124724	2.493823198	8.989974271	4.327023345	10.37530085	0	0.006303008	4.759368212	6.04032957	23.67866263	1.09956912	1.254309519	0	0	7.943194257	6.056267148	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.514	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.8682	0.745408377	5.524445853	0	1.790135686	2.84552897	2.716124724	2.493823198	8.989974271	4.327023345	10.37530085	0	0.006303008	4.759368212	6.04032957	23.67866263	1.09956912	1.254309519	0	0	7.943194257	6.056267148	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.514
H0609_806_0	2011	1																															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	213.5079967	12.49750054	42.72292143	684.8708631	11.38723669	15.54647654	14.38452117	13.44653522	47.35328269	22.62048154	51.7197377	0	0.031318266	23.63836396	31.7769137	121.3707782	6.028318366	6.77170781	0	0	38.31082863	34.16918173	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.075699444	0.075699444	0.148553617	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.060159451	0.060159451	0.118057723	0	0.185168494	0.185168494	0.185168494	0.185168494	0.185168494	0.185168494	0.185168494	0	0.185168494	0.185168494	0.185168494	0.185168494	0.185168494	0.185168494	0	0	0.185168494	0.185168494	0	0	0	0	0	0	0	0												12.8445	0.751842775	5.04377084	0	2.108557473	2.878717653	2.663560126	2.48987468	8.768336055	4.188600508	9.576865955	0	0.005799156	4.377080262	5.884083263	22.47404425	1.116254635	1.253906939	0	0	7.093958453	6.327055932	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8468	0	25.79177616	12.8445	0.751842775	5.04377084	0	2.108557473	2.878717653	2.663560126	2.48987468	8.768336055	4.188600508	9.576865955	0	0.005799156	4.377080262	5.884083263	22.47404425	1.116254635	1.253906939	0	0	7.093958453	6.327055932	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8468	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.8445	0.751842775	5.04377084	0	2.108557473	2.878717653	2.663560126	2.48987468	8.768336055	4.188600508	9.576865955	0	0.005799156	4.377080262	5.884083263	22.47404425	1.116254635	1.253906939	0	0	7.093958453	6.327055932	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8468
H0620_002_0	2011	4																															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	1754.600816	617.6544897	6945.389109	48.34486663	608.7213957	1961.124391	413.0595577	168.4751275	80.51519569	26274.69962	2716.627032	0	4.198229926	243.546638	177.7250123	7094.281198	2136.25143	154.0233226	0	0	458.5813873	658.1765867	613.8752425	165.7250287	228.7668194	150.2289457	16.76102297	33.39202271	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 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$75 (10a)	$0 (11a)	"$0 (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $10 (4b)	$25 (9b)	"$0 (8a1a, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$25 (3, 5, 9a); $0 (9c, 9d)"	"$0 (7a, 14b, 14c, 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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												62.73917766	45.12154871	0	0	75	0	0	49.96329535	25	0	0	0	0	9.413227275	0.030475233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	53.18974004	38.25366438	0	0	63.5843607	0	0	42.35845591	21.1947869	0	0	0	0	7.980453845	0.027424131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												7.7772	1.968962296	0	0	3.225430066	0	0	0.594695522	0.142208535	0	0	0	0	0.161967725	0.000406163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.8709	0	2.490288976	7.7772	1.968962296	0	0	3.225430066	0	0	0.594695522	0.142208535	0	0	0	0	0.161967725	0.000406163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.8709	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $10 (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.3733	0.1685	0.249	0.0086	0.333	0.5181	0.1294	0.0517	0.1384	0	0.2513	0	0	0.0866	0.0068	1.1485	0.1167	0.0055	0	0	0.0234	0.0355	0	0	0.0049	0	0.0008	0	0	0											4.6501	0	0.745641365	9.1505	2.137439233	0.249023117	0.008609133	3.558439098	0.518127078	0.12942018	0.646408176	0.280635099	0	0.251339452	0	0	0.248540663	0.007194721	1.148549596	0.116744242	0.005486548	0	0	0.023352435	0.035537503	0	0	0.004888032	0	0.000777047	0	0	0	0	0	0	0	0	0	0	0	0	0	18.521
H0621_001_0	2011	7																															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	257.8101689	51.93774451	38.04149958	5.120857937	28.83104551	63.80252082	8.029197759	115.2126113	33.26187626	25.74199291	28.47753974	8.392554154	0.384042898	19.16856438	72.24761151	36.2887293	32.60216841	7.183665364	19.77021584	85.34482955	80.60738555	2.499518666	4.537228956	0	0	0	0	0	0	0											6700	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	PBP(10B) 24 trips per year	PBP (16A) & (16B) $250 per year	Every 2 years	$150 every 2 years	Every 3 years	$500 every 3 years													0	0.075911341	0.075911341	0.109015305	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.075048361	0.075425629	0.106166648	0	0.230756538	0.231757151	0.228895189	0.231401373	0.231032443	0.229531741	0.229531741	0.229531741	0.229531741	0.231463018	0.232008077	0.230839107	0.231792708	0.232494289	0.231077106	0.232434452	0.221983595	0.225993282	0	0	0	0	0	0	0	0												19.3482	3.917437064	4.03873851	0	6.652952258	14.78669047	1.837844741	26.66035645	7.684572546	5.90860446	6.536499285	1.926357569	0.088150035	4.436813754	16.76202942	8.37685785	7.556944899	1.670161173	4.568444265	19.83707868	17.89351724	0.564874427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	181.0532	0	2.642395143	19.3482	3.917437064	4.03873851	0	6.652952258	14.78669047	1.837844741	26.66035645	7.684572546	5.90860446	6.536499285	1.926357569	0.088150035	4.436813754	16.76202942	8.37685785	7.556944899	1.670161173	4.568444265	19.83707868	17.89351724	0.564874427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	181.0532	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.3482	3.917437064	4.03873851	0	6.652952258	14.78669047	1.837844741	26.66035645	7.684572546	5.90860446	6.536499285	1.926357569	0.088150035	4.436813754	16.76202942	8.37685785	7.556944899	1.670161173	4.568444265	19.83707868	17.89351724	0.564874427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	181.0532
H0621_006_0	2011	6																															A	A	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	V	T	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	196.7234794	68.32454265	558.3981544	406.8511923	18.26650578	40.38562349	5.646365461	1229.442777	27.57930815	20.1262447	21.5520318	5.749830191	0.030103752	14.23165951	7083.356321	2629.561892	4515.605648	779.8342849	15.55598219	58.60302171	20.88837588	36.90798653	2583.662128	0			0	0	0	0											6700	PBP(1A)-1075 per admit	PBP(1B)-1075 per admit	PBP(2)-50 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(11C)-0% of allowed cost	PBP(4A)-50 per visit & PBP(4B)-25 per visit	PBP(9A)-30% of allowed cost & PBP(9B)-30% of allowed cost	PBP(8A)-20% of allowed cost	PBP(8B)-20% of allowed cost	PBP(9A)-20% of allowed cost	PBP(12)-20% of allowed cost	PBP(9A)-20% of allowed cost PBP(9D)-40 PBP(3)-40	PBP(7A)-25 per visit PBP(14 B - J) $0 cost	PBP(7D)-40 per visit	PBP(7E) &PBP(5)&PBP(9C)-25 per visit & PBP(7H)-25 per visit	PBP(7C)-40 per visit & PBP(7I)-40 per visit	PBP(11A)-20% of allowed cost excl IPF/SNF svcs	PBP(7B)-50% of allowed cost & PBP(7F)-40per visit all prof svcs are 20% when fac coins applies PBP(7G) from 0 to SCP copay	PBP(15)-20% of allowed cost	PBP(14A)-0 per visit	PBP(10B) 24 trips per year	PBP (16A) & (16B) $240 per year			Every 3 years	$500 every 3 years													0	1075	1075	50	0	0.2	0.2	0.079910563	47.8481849	0.3	0.2	0.2	0.2	0.2	0.203133049	22.63589372	40	25	40	0.163514132	0.058567732	0.2	0	0	0			0	0	0	0											NO	975.7643232	1003.621238	44.82342085	0	0.18378535	0.18668709	0.079910563	44.34708189	0.270354923	0.193495951	0.193495951	0.193495951	0.193495951	0.181599904	22.27740333	38.45824822	24.69824337	38.74246177	0.152233273	0.058427493	0.151592008	0	0	0			0	0	0	0												15.9963	5.714330175	2.08577629	0	3.357116151	7.539474515	0.451204241	4.543516626	7.456201725	3.89434685	4.170230881	1.112568859	0.005824954	2.584468002	13.14989881	8.427361997	9.293960604	2.517724998	2.368138091	3.424027668	3.166510844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.259	0	5.903057862	15.9963	5.714330175	2.08577629	0	3.357116151	7.539474515	0.451204241	4.543516626	7.456201725	3.89434685	4.170230881	1.112568859	0.005824954	2.584468002	13.14989881	8.427361997	9.293960604	2.517724998	2.368138091	3.424027668	3.166510844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.259	NO																																																																																		0	0	0	15.9963	5.714330175	2.08577629	0	3.357116151	7.539474515	0.451204241	4.543516626	7.456201725	3.89434685	4.170230881	1.112568859	0.005824954	2.584468002	13.14989881	8.427361997	9.293960604	2.517724998	2.368138091	3.424027668	3.166510844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.259
H0621_009_0	2011	4																															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	YES	303.4363792	55.29758915	47.44628083	7.242727275	33.11022522	69.74346117	9.033655181	129.3559213	35.53459435	27.87663986	31.30754637	9.811341326	0.697886831	21.24751717	71.60499323	39.49551214	33.54972696	7.429964016	21.74577163	97.11941632	104.973807	3.988226845																			6700	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	PBP(10B) 24 trips per year	PBP (16A) & (16B) $770 per year	Every 2 years	$200 every 2 years	Every 3 years	$500 every 3 years													0	0.076598024	0.076598024	0.113138642	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.076419714	0.076486353	0.112557917	0	0.23253184	0.232728885	0.232207848	0.232673096	0.232606925	0.232335126	0.232335126	0.232335126	0.232335126	0.232674726	0.232792243	0.232563774	0.232737331	0.232887317	0.23261071	0.232881693	0.231063182	0.231666609																				23.1885	4.229510904	5.340454521	0	7.699181578	16.23131794	2.097685632	30.09764269	8.265592705	6.476722644	7.27384274	2.279519226	0.162143625	4.943760239	16.66908699	9.185225365	7.808273907	1.730344387	5.058299373	22.61733406	24.25558187	0.923938991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	206.534	0	2.212861118	23.1885	4.229510904	5.340454521	0	7.699181578	16.23131794	2.097685632	30.09764269	8.265592705	6.476722644	7.27384274	2.279519226	0.162143625	4.943760239	16.66908699	9.185225365	7.808273907	1.730344387	5.058299373	22.61733406	24.25558187	0.923938991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	206.534	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.1885	4.229510904	5.340454521	0	7.699181578	16.23131794	2.097685632	30.09764269	8.265592705	6.476722644	7.27384274	2.279519226	0.162143625	4.943760239	16.66908699	9.185225365	7.808273907	1.730344387	5.058299373	22.61733406	24.25558187	0.923938991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	206.534
H0623_001_0	2011	5	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							Prosthetics/Supplies	Lab	Radiology	Therapy (PT/OT/ST)							D	D	D	V	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	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	1004.507494	47.224737	373.951932	322.207028	1.184864	11.260089	3.38591	273.557587	299.760913	6.055377	18.029425	6.840492	0.071926	16.326316	2911.595117	3197.471676	75.563718	1.254773		1018.508218	22.207887	0							6.42	1.23	372.660603	439.824474	272.843473	606.448652							3400	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $175 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								161.6895	138.428775	46.371	0	0.2	0.2	0.2	50	185.909799	0.25	0.238479	0.25	0.2	0.229649	15	31.400979	35	0.25		0	0.2	0							0	0	0	0	11.937624	35							NO	140.585625	120.360913	32.680843	0	0.174157	0.174157	0.174157	43.53935	161.887836	0.217697	0.207664	0.217697	0.174157	0.199975	13.061805	27.343565	30.477545	0.217697		0	0.174157	0							0	0	0	0	10.395128	30.477545								11.7683	0.473667705	1.018422032	0	0.20635236	1.96102332	0.589679928	0.992543294	4.04397046	1.318237407	3.744062513	1.489154587	0.012526416	3.264855042	3.169223971	7.285856217	0.191916385	0.273160318	0	0	3.867658976	0	0	0	0	0	0	0	0	0	0	0	0.236353569	1.540255507	0	0	0	0	0	0	47.4472	0	7.337175726	11.7683	0.473667705	1.018422032	0	0.20635236	1.96102332	0.589679928	0.992543294	4.04397046	1.318237407	3.744062513	1.489154587	0.012526416	3.264855042	3.169223971	7.285856217	0.191916385	0.273160318	0	0	3.867658976	0	0	0	0	0	0	0	0	0	0	0	0.236353569	1.540255507	0	0	0	0	0	0	47.4472	YES	$250/Day(Days 1-15)	$250/Day(Days 1-15)	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		30% Coins	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins	30% Coins	30% Coins	30% Coins							5100	2.4857	0.1096	0.3863	1.6315	0.9869	2.3189	0.6973	0.1773	2.7665	0.2884	0.8588	0.3258	0.0023	0.7777	1.5789	2.607	0.0402	0.0598		0.2426	1.1867	0							0	0	0.0979	0.043	0.4001	0.2567							20.3257	500	4.774807192	14.254	0.58322506	1.404725	1.631451834	1.193226741	4.279892234	1.286964072	1.16986623	6.81048066	1.606659189	4.602816554	1.814971949	0.014810647	4.042601776	4.748124971	9.892895794	0.232082089	0.332926156	0	0.24256341	5.054334391	0	0	0	0	0	0	0	0	0	0.097857307	0.043021096	0.636410503	1.796954076	0	0	0	0	0	0	67.7728
H0623_009_0	2011	4	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							Prosthetics/Supplies	Lab	Radiology	Therapy (PT/OT/ST)							D	D	D	V	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	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	881.0304507	20.67327621	371.4974546	388.4067184	1.465100124	5.431066186	1.182837756	307.2142294	238.8256473	4.320607399	10.00131476	3.578726969	0.039112569	8.06031028	1952.68451	2210.337207	17.5034907	0.897817367		820.3332738	9.989802063	0							6.42	1.23	425.5679723	205.4523404	161.8104396	386.9417734							3400	$200/Day(Days 1-7):1a.IP Acute	$200/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$175/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $175 Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								143.724	123.0478	46.371	0	0.2	0.2	0.2	50	165.023623	0.25	0.234018	0.25	0.2	0.233078	10	32.083909	35	0.25		0	0.2	0							0	0	0	0	17.897245	35							NO	135.153307	115.710091	38.405251	0	0.187115	0.187115	0.187115	46.77865	154.391646	0.233893	0.218941	0.233893	0.187115	0.218061	9.35573	30.016839	32.745055	0.233893		0	0.187115	0							0	0	0	0	16.744179	32.745055								9.9228	0.199342223	1.188954416	0	0.27414221	1.016233949	0.221326687	1.19758891	3.072723733	1.010559826	2.189697855	0.837039187	0.007318548	1.75763932	1.522399088	5.528944674	0.04776273	0.209993197	0	0	1.869241813	0	0	0	0	0	0	0	0	0	0	0	0.225781914	1.055869138	0	0	0	0	0	0	33.3554	0	2.406547922	9.9228	0.199342223	1.188954416	0	0.27414221	1.016233949	0.221326687	1.19758891	3.072723733	1.010559826	2.189697855	0.837039187	0.007318548	1.75763932	1.522399088	5.528944674	0.04776273	0.209993197	0	0	1.869241813	0	0	0	0	0	0	0	0	0	0	0	0.225781914	1.055869138	0	0	0	0	0	0	33.3554	YES	$225/Day(Days 1-15)	$225/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 14-100)	20% Coins	20% Coins	20% Coins	20% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	20% Coins	30% Coins	30% Coins	30% Coins							5100	2.3516	0.0517	0.5099	1.46	1.5166	0.9267	0.2018	0.2475	2.5394	0.2558	0.592	0.2118	0.0015	0.4772	1.2713	2.0709	0.0115	0.0531		0.2337	0.702	0							0	0	0.107	0.0252	0.3776	0.2334							16.4294	500	2.071291483	12.2745	0.251074912	1.69888911	1.460004026	1.790715496	1.942916704	0.423149452	1.445080397	5.612137354	1.266320532	2.781731865	1.048884189	0.008861994	2.234793954	2.793733237	7.599871891	0.059217011	0.263140351	0	0.233686344	2.571245258	0	0	0	0	0	0	0	0	0	0.107016475	0.02524694	0.603357669	1.289220169	0	0	0	0	0	0	49.7848
H0624_001_0	2011	4																															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	YES	351.4379012	22.8156	53.43214881	2397.855377	13.39294299	35.53498486	21.38234075	36.81610663	50.76339821	21.50617965	47.27150519	0	0.082195491	24.59100166	50.32949368	153.7929501	11.2126	12.17730974	0	0	31.93815402	9.155114033	881.9531624	475.2708206	304.4556344	238.2491797	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.076962232	0.077896443	0.148899945	0	0.233	0.233	0.233	0.097084	0.233	0.233	0.233	0	0.233	0.233	0.225663917	0.232957802	0.231835679	0.233	0	0	0.233	0.23047408	0	0	0	0	0	0	0	0											NO	0.059862021	0.06058866	0.11581592	0	0.181229813	0.181229813	0.181229813	0.075526817	0.181229813	0.181229813	0.181229813	0	0.181229813	0.181229813	0.175523732	0.181196991	0.180324192	0.181229813	0	0	0.181229813	0.180875742	0	0	0	0	0	0	0	0												21.0378	1.382366627	6.18829345	0	2.427200559	6.439998672	3.875117623	2.780603358	9.199841182	3.897560923	8.567006061	0	0.014896274	4.456622641	8.834020576	27.86681985	2.021903039	2.206891571	0	0	5.788145691	1.655938047	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.641	0	33.87142754	21.0378	1.382366627	6.18829345	0	2.427200559	6.439998672	3.875117623	2.780603358	9.199841182	3.897560923	8.567006061	0	0.014896274	4.456622641	8.834020576	27.86681985	2.021903039	2.206891571	0	0	5.788145691	1.655938047	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.641	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.0378	1.382366627	6.18829345	0	2.427200559	6.439998672	3.875117623	2.780603358	9.199841182	3.897560923	8.567006061	0	0.014896274	4.456622641	8.834020576	27.86681985	2.021903039	2.206891571	0	0	5.788145691	1.655938047	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.641
H0630_013_0	2011	5	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	470.8194418	35.72613651	332.9391921	238.7354672	6.179848217	9.448616091	0.588999051	210.8582563	67.03289268	0	321.2955891	0.241347097	0.256831006	160.519379	3129.597512	3916.015314	283.4995518	631.0317893	1511.481217	4131.14101	0	6.360156199	0	0	0	0	59.10315892	0	42.58524551	0	192.2324998	4.201803274	0.173565113								3400	$250/day days 1-6; $0 after day 6; unlimited coverage	$250/day days 1-6; $0 days 7-90; $0 for lifetime reserve days.	"$0 days 1-20, $100/day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance (0% for Diabetic Supplies)	"$50/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	$275/visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $250/procedure, Radiation Therapy $40/visit"	20% coin	$0 Copay	"Pulmonary Rehab $5; $0-$275/visit; OP Substance Abuse, $10/Group Visit, $20/Individual Visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$40/visit	"$10/Group Visit, $20/Individual Visit"	$20/visit	$0 Copay	$0 Copay		$0 Copay			$20 copay		$20 copay		$0 copay	"$0-$3 copay, Acupuncture Not Covered"	$10 Generic copay	$45 Brand copay	20% coinsurance								0	250	250	100	0	0.2	0.129835082	0.2	45.35	275	0	242.7882257	0.2	0	19.52970297	18.8288967	38.22915975	18.56614246	20	0	0	0	0	0	0	20	0	20	0	0	0	10	45	0.2								NO	143.31	143.31	9.5	0	0.19	0.12	0.19	42.48	257.65	0	227.47	0.19	0	18.3	17.64	35.82	17.39	18.74	0	0	0	0	0	0	18.74	0	18.74	0	0	0	9.37	42.16	0.19									5.6228	0.426659385	0.26357686	0	1.174171161	1.133833931	0.11190982	0.746438227	1.439252067	0	6.090425637	0.045855948	0	0.244792053	4.600508342	11.68930571	0.410838101	0.985461311	0	0	0	0	0	0	0	0	0.092299433	0	0	0	0.150101544	0.014762336	0.032977372	0	0	0	0	0	0	0	35.2759	0	8.960825358	5.6228	0.426659385	0.26357686	0	1.174171161	1.133833931	0.11190982	0.746438227	1.439252067	0	6.090425637	0.045855948	0	0.244792053	4.600508342	11.68930571	0.410838101	0.985461311	0	0	0	0	0	0	0	0	0.092299433	0	0	0	0.150101544	0.014762336	0.032977372	0	0	0	0	0	0	0	35.2759	NO																																																																																		0	0	0	5.6228	0.426659385	0.26357686	0	1.174171161	1.133833931	0.11190982	0.746438227	1.439252067	0	6.090425637	0.045855948	0	0.244792053	4.600508342	11.68930571	0.410838101	0.985461311	0	0	0	0	0	0	0	0	0.092299433	0	0	0	0.150101544	0.014762336	0.032977372	0	0	0	0	0	0	0	35.2759
H0630_014_0	2011	2	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	1538.860315	144.4116271	1298.118901	1798.492357	24.80632468	44.23179891	2.483454353	631.9052122	83.05755431	0	469.96385	1.010344255	3.756371803	208.6873224	5261.281606	6637.967542	1576.412393	790.5139602	2653.08905	7003.433391	0	6.360156199	0	0	0	0	86.40145186	0	82.62663115	0	771.3544369	15.77581733	0.386833074								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"	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	$0 Copay		$0 Copay			$0-$15/visit; $0-$30/specialty visit		$0-$15/visit		$0 copay	$0-$3 copay	0%-20% coinsurance	0%-20% coinsurance	0%-20% coinsurance								0	190	190	100	0	0.2	0.161371215	0.2	0.04	0	0	1	0.2	0	2	2	2	2	2	0	0	0	0	0	0	2	0	2	0	0	0	1	3	0								NO	112.2	112.2	14.17	0	0.19	0.16	0.19	0.04	0	0	0.96	0.19	0	1.93	1.93	1.93	1.93	1.93	0	0	0	0	0	0	1.93	0	1.93	0	0	0	0.96	2.89	0									14.3883	1.350248713	1.532862068	0	4.71320169	7.077087825	0.471856327	0.002106351	0	0	0.037597108	0.191965408	0	0.033563878	0.846189458	1.067606446	0.25353966	0.127140995	0	0	0	0	0	0	0	0	0.013896234	0	0	0	0.061708355	0.003799343	0	0	0	0	0	0	0	0	32.1727	0	20.63088412	14.3883	1.350248713	1.532862068	0	4.71320169	7.077087825	0.471856327	0.002106351	0	0	0.037597108	0.191965408	0	0.033563878	0.846189458	1.067606446	0.25353966	0.127140995	0	0	0	0	0	0	0	0	0.013896234	0	0	0	0.061708355	0.003799343	0	0	0	0	0	0	0	0	32.1727	NO																																																																																		0	0	0	14.3883	1.350248713	1.532862068	0	4.71320169	7.077087825	0.471856327	0.002106351	0	0	0.037597108	0.191965408	0	0.033563878	0.846189458	1.067606446	0.25353966	0.127140995	0	0	0	0	0	0	0	0	0.013896234	0	0	0	0.061708355	0.003799343	0	0	0	0	0	0	0	0	32.1727
H0630_015_0	2011	5	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	860.8692858	42.9736651	689.46	719.6673147	9.469894912	18.53102448	0.868570727	276.9214832	78.79976975	0	454.2013952	1.054350261	1.748097739	214.8260113	3825.342638	5357.371329	225.7864853	673.3862251	1983.941148	5571.615812	0	6.360156199	0	0	0	0	69.23623463	0	56.78669658	0	336.5819053	12.9396371	0.44008658								3400	$200/day days 1-5; $0 after day 5; unlimited coverage	$200/day days 1-5; $0 days 6-90; $0 for lifetime reserve days.	"$0 days 1-20, $100/day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance (0% for Diabetic Supplies)	"$50/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	$125 per visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $150/procedure, Radiation Therapy $35/visit"	20% coin	$0 Copay	"Pulmonary Rehab $5; $0-$150/visit; OP Substance Abuse, $10/Group Visit, $15/Individual Visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$35/visit	"$10/Group Visit, $15/Individual Visit"	$15/visit	$0 Copay	$0 Copay		$0 Copay			$15 copay		$15 copay		$0 copay	"$0-$3 copay, Acupuncture Not Covered"	$10 Generic copay	$45 Brand copay	20% coinsurance								0	200	200	100	0	0.2	0.149081542	0.2	43.02	125	0	146.4862205	0.2	0	14.54238833	14.36010743	33.46873495	14.43144676	15	0	0	0	0	0	0	15	0	15	0	0	0	10	45	0.2								NO	115.47	115.47	13	0	0.19	0.14	0.19	41.5	120.58	0	141.31	0.19	0	14.03	13.85	32.29	13.92	14.47	0	0	0	0	0	0	14.47	0	14.47	0	0	0	8.68	43.41	0.19									8.2837	0.413514092	0.746915	0	1.799280033	2.594343427	0.165028438	0.957686796	0.791806353	0	5.348599929	0.20032655	0	0.251167412	4.415082961	14.41579335	0.261912323	0.811991556	0	0	0	0	0	0	0	0	0.08348736	0	0	0	0.243460912	0.046809137	0.08361645	0	0	0	0	0	0	0	41.9145	0	12.69123493	8.2837	0.413514092	0.746915	0	1.799280033	2.594343427	0.165028438	0.957686796	0.791806353	0	5.348599929	0.20032655	0	0.251167412	4.415082961	14.41579335	0.261912323	0.811991556	0	0	0	0	0	0	0	0	0.08348736	0	0	0	0.243460912	0.046809137	0.08361645	0	0	0	0	0	0	0	41.9145	NO																																																																																		0	0	0	8.2837	0.413514092	0.746915	0	1.799280033	2.594343427	0.165028438	0.957686796	0.791806353	0	5.348599929	0.20032655	0	0.251167412	4.415082961	14.41579335	0.261912323	0.811991556	0	0	0	0	0	0	0	0	0.08348736	0	0	0	0.243460912	0.046809137	0.08361645	0	0	0	0	0	0	0	41.9145
H0630_016_0	2011	5	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	T		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	1400.88895	33.96216218	1143.421224	1323.153631	15.95295891	37.5905171	0.71308008	434.2735649	90.82705428	0	564.0934274	1.532339158	5.626867106	293.8028467	4977.157743	7367.349058	424.0564256	771.342274	2548.37911	7428.563492	0	6.360156199	0	0	0	0	84.61559395	0	60.38201096	0	678.2798956	34.67137928	0.897307358								2350	$110/day days 1-5; $0 after day 5; unlimited coverage	$110/day days 1-5; $0 days 6-90; $0 for lifetime reserve days.	"$0 days 1-20, $100 /day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance (0% for Diabetic Supplies)	"$50/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	$90 per visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $125/procedure, Radiation Therapy $25/visit"	20% coin	$0 Copay	"Pulmonary Rehab $5; $0-$150/visit; OP Substance Abuse, $10/Group Visit, $15/Individual Visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$25/visit	"$10/Group Visit, $15/Individual Visit"	$15/visit	$0 Copay	$0 Copay		$0 Copay	$0 per trip		$15 copay		$15 copay		$0 copay	"$0-$3 copay, Acupuncture Not Covered"	$8 Generic copay	$30 Brand copay	20% coinsurance								0	110	110	100	0	0.2	0.161040165	0.2	42	90	0	121.5379009	0.2	0	14.27413672	14.53644567	24.29828715	14.41747573	15	0	0	0	0	0	0	15	0	15	0	0	0	8	30	0.2								NO	64.17	64.17	11.24	0	0.19	0.15	0.19	40.39	86.55	0	116.88	0.19	0	13.73	13.98	23.37	13.87	14.43	0	0	0	0	0	0	14.43	0	14.43	0	0	0	7.69	28.85	0.19									7.4913	0.181612662	1.071004547	0	3.031062193	5.638577564	0.135485215	1.46169244	0.655090129	0	5.494269983	0.29114444	0	0.336159424	5.79838877	14.34791229	0.490138552	0.927539084	0	0	0	0	0	0	0	0	0.101750252	0	0	0	0.434664366	0.083355774	0.170488398	0	0	0	0	0	0	0	48.1416	0	15.74162213	7.4913	0.181612662	1.071004547	0	3.031062193	5.638577564	0.135485215	1.46169244	0.655090129	0	5.494269983	0.29114444	0	0.336159424	5.79838877	14.34791229	0.490138552	0.927539084	0	0	0	0	0	0	0	0	0.101750252	0	0	0	0.434664366	0.083355774	0.170488398	0	0	0	0	0	0	0	48.1416	NO																														"Travel Benefit for certain routine, follow-up and diag care"																																									0.0314											0.0314	0	0	7.4913	0.181612662	1.071004547	0	3.031062193	5.638577564	0.135485215	1.46169244	0.655090129	0	5.494269983	0.29114444	0	0.336159424	5.79838877	14.34791229	0.490138552	0.927539084	0	0	0	0	0	0	0	0	0.101750252	0	0	0.031375622	0.434664366	0.083355774	0.170488398	0	0	0	0	0	0	0	48.173
H0630_017_0	2011	4	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	691.9416438	31.56874789	419.6145449	366.4925424	6.107144386	17.65401851	0.404312412	209.7844873	140.49153	0	387.9950131	0.677463166	5.620731286	283.6031243	3136.564047	5016.862177	111.7412976	346.0102591	1578.267999	3972.269478	0	6.360156199	0	0	0	0	46.9620252	0	26.13284624	0	192.2324998	4.201803274	0.173565113								3350	$210/day days 1-5; $0 after day 5; unlimited coverage	$210/day days 1-5; $0 days 8-90; $0 for lifetime reserve days.	"$0 days 1-20, $100/day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance (0% for Diabetic Supplies)	"$50/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	$275/visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $250/procedure, Radiation Therapy $35/visit"	20% Coinsurance	$0 Copay	"Pulmonary Rehab $5; $0-$275/visit; OP Substance Abuse, $10/Group Visit, $15/Individual Visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$40/visit	"$10/Group Visit, $20/Individual Visit"	$20/visit	$0 Copay	$0 Copay		$0 Copay			$20 copay		$20 copay		$0 copay	"$0-$3 copay, Acupuncture Not Covered"	$9 Generic copay	$45 Brand copay	20% coinsurance								0	210	210	100	0	0.2	0.129835082	0.2	45.35	275	0	248.5	0.2	0	16.40410959	17.14804723	39.16870416	20	20	0	0	0	0	0	0	20	0	20	0	0	0	9	45	0.2								NO	117.32	117.32	11.62	0	0.19	0.12	0.19	42.89	260.13	0	235.06	0.19	0	15.52	16.22	37.05	18.92	18.92	0	0	0	0	0	0	18.92	0	18.92	0	0	0	8.51	42.57	0.19									6.7649	0.308637125	0.406326751	0	1.160357433	2.118482221	0.076819358	0.749804722	3.045505142	0	7.600175648	0.128718001	0	0.366793374	4.239589071	15.48956197	0.176178779	0.545542842	0	0	0	0	0	0	0	0	0.07404346	0	0	0	0.136324881	0.014905897	0.032977372	0	0	0	0	0	0	0	43.4356	0	10.78064241	6.7649	0.308637125	0.406326751	0	1.160357433	2.118482221	0.076819358	0.749804722	3.045505142	0	7.600175648	0.128718001	0	0.366793374	4.239589071	15.48956197	0.176178779	0.545542842	0	0	0	0	0	0	0	0	0.07404346	0	0	0	0.136324881	0.014905897	0.032977372	0	0	0	0	0	0	0	43.4356	NO																																																																																		0	0	0	6.7649	0.308637125	0.406326751	0	1.160357433	2.118482221	0.076819358	0.749804722	3.045505142	0	7.600175648	0.128718001	0	0.366793374	4.239589071	15.48956197	0.176178779	0.545542842	0	0	0	0	0	0	0	0	0.07404346	0	0	0	0.136324881	0.014905897	0.032977372	0	0	0	0	0	0	0	43.4356
H0630_018_0	2011	4	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	1100.349325	33.13191365	775.4768998	518.6156213	8.672936538	18.39620893	0.549858489	258.2923834	142.2666391	0	410.3394154	0.633258887	1.03394764	317.9411921	3753.889568	6042.507213	165.823343	437.000096	1980.869832	4710.028971	0	6.360156199	0	0	0	0	64.14048151	0	35.64581707	0	336.5819053	12.9396371	0.44008658								2850	$155/day days 1-5; $0 after day 5; unlimited coverage	$155/day days 1-5; $0 days 6-90; $0 for lifetime reserve days.	"$0 days 1-20, $100/day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance (0% for Diabetic Supplies)	"$50/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	$225 per visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $150/procedure, Radiation Therapy $30/visit"	20% Coinsurance	$0 Copay	"Pulmonary Rehab $5; $0-$225/visit; OP Substance Abuse, $10/Group Visit, $15/Individual Visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10/Group Visit, $15/Individual Visit"	$15/visit	$0 Copay	$0 Copay		$0 Copay	$0 per trip		$15 copay		$15 copay		$0 copay	"$0-$3 copay, Acupuncture Not Covered"	$8 Generic copay	$45 Brand copay	20% coinsurance								0	155	155	100	0	0.2	0.149081542	0.2	43.02	225	0	146.5714286	0.2	0	12.04761905	13.29545455	29.49427481	15	15	0	0	0	0	0	0	15	0	15	0	0	0	8	45	0.2								NO	89.02	89.02	11.76	0	0.19	0.14	0.19	41.14	215.16	0	140.16	0.19	0	11.52	12.71	28.2	14.34	14.34	0	0	0	0	0	0	14.34	0	14.34	0	0	0	7.65	43.03	0.19									8.1628	0.245783579	0.759967362	0	1.647857942	2.57546925	0.104473113	0.885512388	2.55084084	0	4.792764372	0.120319189	0	0.305223544	3.975994701	14.19989195	0.198158895	0.522215115	0	0	0	0	0	0	0	0	0.076647875	0	0	0	0.214570965	0.046399382	0.08361645	0	0	0	0	0	0	0	41.4685	0	13.47845805	8.1628	0.245783579	0.759967362	0	1.647857942	2.57546925	0.104473113	0.885512388	2.55084084	0	4.792764372	0.120319189	0	0.305223544	3.975994701	14.19989195	0.198158895	0.522215115	0	0	0	0	0	0	0	0	0.076647875	0	0	0	0.214570965	0.046399382	0.08361645	0	0	0	0	0	0	0	41.4685	NO																																																																																		0	0	0	8.1628	0.245783579	0.759967362	0	1.647857942	2.57546925	0.104473113	0.885512388	2.55084084	0	4.792764372	0.120319189	0	0.305223544	3.975994701	14.19989195	0.198158895	0.522215115	0	0	0	0	0	0	0	0	0.076647875	0	0	0	0.214570965	0.046399382	0.08361645	0	0	0	0	0	0	0	41.4685
H0630_019_0	2011	5	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	864.3418379	43.14701115	689.46	719.6673147	9.469894912	18.53102448	0.868570727	276.9214832	77.93887641	0	454.2013952	1.054350261	1.748097739	214.8260113	3825.342638	5357.371329	225.7864853	673.3862251	1983.941148	5571.615812	0	6.360156199	0	0	0	0	69.23623463	0	56.78669658	0	336.5819053	12.9396371	0.44008658								3400	$175/day days 1-5; $0 after day 5; unlimited coverage	$175/day days 1-5; $0 days 6-90; $0 for lifetime reserve days.	"$0 days 1-20, $100/day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance (0% for Diabetic Supplies)	"$50/ER visit, waived if admitted to hospital; $30/Urgent Care visit"	$150 per visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $150/procedure, Radiation Therapy $35/visit"	20% coin	$0 Copay	"Pulmonary Rehab $5; $0-$150/visit; OP Substance Abuse, $10/Group Visit, $15/Individual Visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$35/visit; $0 copay for Routine Care	"$10/Group Visit, $15/Individual Visit"	$15/visit	$0 Copay	$0 Copay		$0 Copay			$15 copay		$15 copay		$0 copay	"$0-$5 copay, 30% coinsurance OON"	$10 Generic copay	$35 Brand copay	20% coinsurance								0	175	175	100	0	0.2	0.149081542	0.2	43.02	150	0	146.4862205	0.2	0	14.54238833	14.36010743	33.46873495	14.43144676	15	0	0	0	0	0	0	15	0	15	0	0	0	10	35	0.2								NO	102.82	102.82	14.26	0	0.19	0.14	0.19	41.7	145.38	0	85.182	0.19	0	14.09	13.92	19.464	13.99	14.54	0	0	0	0	0	0	14.54	0	14.54	0	0	0	9.69	33.92	0.19									7.406	0.369697974	0.8193083	0	1.799280033	2.594343427	0.165028438	0.962302154	0.944229488	0	3.224148604	0.20032655	0	0.252241542	4.43739746	8.689656295	0.263229411	0.815919643	0	0	0	0	0	0	0	0	0.083891238	0	0	0	0.271789889	0.036576041	0.08361645	0	0	0	0	0	0	0	33.419	0	19.49960499	7.406	0.369697974	0.8193083	0	1.799280033	2.594343427	0.165028438	0.962302154	0.944229488	0	3.224148604	0.20032655	0	0.252241542	4.43739746	8.689656295	0.263229411	0.815919643	0	0	0	0	0	0	0	0	0.083891238	0	0	0	0.271789889	0.036576041	0.08361645	0	0	0	0	0	0	0	33.419	NO																														30% coinsurance OON Physician Benefits																																									4.3243											4.3243	0	0	7.406	0.369697974	0.8193083	0	1.799280033	2.594343427	0.165028438	0.962302154	0.944229488	0	3.224148604	0.20032655	0	0.252241542	4.43739746	8.689656295	0.263229411	0.815919643	0	0	0	0	0	0	0	0	0.083891238	0	0	4.324285714	0.271789889	0.036576041	0.08361645	0	0	0	0	0	0	0	37.7432
H0630_805_0	2011	2	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									Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	YES	719.057023	7.761878914	552.0857034	501.9196352	7.057734247	12.18970731	0.902543688	220.1092363	59.85343167	0	400.3532583	0.644945585	0.788979782	199.0427918	3319.413441	5151.262493	114.1693936	709.6367507	1806.406354	5028.392927	0	6.360156199	0	0	0	0	0	0	0	0	0.567786066	0.998766314	0.260314024								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"	20% coin	$0 Copay	Pulmonary Rehab $5; all other services $0-$200 copay	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	$0 Copay		$0 Copay									20% Generic coinsurance	20% Brand coinsurance	20% coinsurance								0	250	250	100	0	0.2	0.141318724	0.2	44	200	0	97.88756945	0.2	0	19.26349052	18.99844852	28.92776981	18.63328424	25	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	77.84	77.84	10.99	0	0.19	0.13	0.19	41.8	190	0	92.99	0.19	0	18.3	18.05	27.48	17.7	19	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									4.6643	0.050348721	0.50561849	0	1.340969507	1.584661951	0.171483301	0.76671384	0.947679335	0	3.102404124	0.122539661	0	0.303540258	4.992951051	11.79639111	0.168399856	1.123591522	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0.049459665	0	0	0	0	0	0	0	31.9887	0	16.28196842	4.6643	0.050348721	0.50561849	0	1.340969507	1.584661951	0.171483301	0.76671384	0.947679335	0	3.102404124	0.122539661	0	0.303540258	4.992951051	11.79639111	0.168399856	1.123591522	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0.049459665	0	0	0	0	0	0	0	31.9887	NO																																																																																		0	0	0	4.6643	0.050348721	0.50561849	0	1.340969507	1.584661951	0.171483301	0.76671384	0.947679335	0	3.102404124	0.122539661	0	0.303540258	4.992951051	11.79639111	0.168399856	1.123591522	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0.049459665	0	0	0	0	0	0	0	31.9887
H0630_806_0	2011	2	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									Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	YES	783.2209195	16.88865854	566.309016	611.7685328	8.026092715	16.45209647	0.658939269	243.041687	81.59120694	0	439.0683588	0.810688498	1.716699046	219.7374779	3573.296273	5495.370763	166.8678686	771.4007851	1942.749592	5403.95529	0	6.360156199	0	0	0	0	0	0	0	0	0.567786066	0.998766314	0.260314024								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"	20% coin	$0 Copay	Pulmonary Rehab $5; all other services $0-$200 copay	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	$0 Copay		$0 Copay									20% Generic coinsurance	20% Brand coinsurance	20% coinsurance								0	250	250	100	0	0.2	0.141318724	0.2	44	200	0	97.88756945	0.2	0	19.26349052	18.99844852	28.92776981	18.63328424	25	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	77.84	77.84	10.99	0	0.19	0.13	0.19	41.8	190	0	92.99	0.19	0	18.3	18.05	27.48	17.7	19	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									5.0805	0.109551098	0.518644674	0	1.524957616	2.138772541	0.125198461	0.84659521	1.291860777	0	3.40241389	0.154030815	0	0.335099654	5.374833143	12.58439905	0.246130106	1.221384576	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0.049459665	0	0	0	0	0	0	0	35.3015	0	17.63244063	5.0805	0.109551098	0.518644674	0	1.524957616	2.138772541	0.125198461	0.84659521	1.291860777	0	3.40241389	0.154030815	0	0.335099654	5.374833143	12.58439905	0.246130106	1.221384576	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0.049459665	0	0	0	0	0	0	0	35.3015	NO																																																																																		0	0	0	5.0805	0.109551098	0.518644674	0	1.524957616	2.138772541	0.125198461	0.84659521	1.291860777	0	3.40241389	0.154030815	0	0.335099654	5.374833143	12.58439905	0.246130106	1.221384576	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0.049459665	0	0	0	0	0	0	0	35.3015
H0630_807_0	2011	3	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									Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	YES	796.6204173	17.37985476	584.0055539	627.0106029	8.236120421	16.95589535	0.666675088	244.7008627	83.12691928	0	434.702473	0.751201153	1.847619729	211.7272338	3570.237779	5513.149489	171.0085537	769.6873673	1950.02354	5417.983713	0	6.360156199	0	0	0	0	0	0	0	0	0.567786066	0.998766314	0.260314024								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"	20% coin	$0 Copay	Pulmonary Rehab $5; all other services $0-$200 copay	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	$0 Copay		$0 Copay									20% Generic coinsurance	20% Brand coinsurance	20% coinsurance								0	250	250	100	0	0.2	0.141318724	0.2	44	200	0	97.88756945	0.2	0	19.26349052	18.99844852	28.92776981	18.63328424	25	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	77.84	77.84	10.99	0	0.19	0.13	0.19	41.8	190	0	92.99	0.19	0	18.3	18.05	27.48	17.7	19	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									5.1674	0.112737325	0.534851753	0	1.56486288	2.204266396	0.126668267	0.852374672	1.316176222	0	3.368581914	0.142728219	0	0.322884032	5.370232659	12.62511233	0.252237617	1.218671665	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0.049459665	0	0	0	0	0	0	0	35.5269	0	17.97080247	5.1674	0.112737325	0.534851753	0	1.56486288	2.204266396	0.126668267	0.852374672	1.316176222	0	3.368581914	0.142728219	0	0.322884032	5.370232659	12.62511233	0.252237617	1.218671665	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0.049459665	0	0	0	0	0	0	0	35.5269	NO																																																																																		0	0	0	5.1674	0.112737325	0.534851753	0	1.56486288	2.204266396	0.126668267	0.852374672	1.316176222	0	3.368581914	0.142728219	0	0.322884032	5.370232659	12.62511233	0.252237617	1.218671665	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0.049459665	0	0	0	0	0	0	0	35.5269
H0630_808_0	2011	3	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									Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	YES	636.7659805	16.77437042	318.1949444	473.7644617	5.701595321	12.38045654	0.356717649	236.5313346	75.96224508	0	533.0291828	1.81036301	0.519052802	353.0891654	3812.815597	5501.180385	147.1051339	844.3959645	1941.978597	5488.357409	0	6.360156199	0	0	0	0	0	0	0	0	0.567786066	0.998766314	0.260314024								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"	20% coin	$0 Copay	Pulmonary Rehab $5; all other services $0-$200 copay	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	$0 Copay		$0 Copay									20% Generic coinsurance	20% Brand coinsurance	20% coinsurance								0	250	250	100	0	0.2	0.141318724	0.2	44	200	0	97.88756945	0.2	0	19.26349052	18.99844852	28.92776981	18.63328424	25	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	77.84	77.84	10.99	0	0.19	0.13	0.19	41.8	190	0	92.99	0.19	0	18.3	18.05	27.48	17.7	19	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									4.1305	0.108809749	0.291413537	0	1.083303111	1.609459351	0.067776353	0.823917482	1.202735547	0	4.130531976	0.343968972	0	0.538460977	5.735110127	12.59770308	0.216980073	1.336960277	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0.049459665	0	0	0	0	0	0	0	34.5647	0	13.72468177	4.1305	0.108809749	0.291413537	0	1.083303111	1.609459351	0.067776353	0.823917482	1.202735547	0	4.130531976	0.343968972	0	0.538460977	5.735110127	12.59770308	0.216980073	1.336960277	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0.049459665	0	0	0	0	0	0	0	34.5647	NO																																																																																		0	0	0	4.1305	0.108809749	0.291413537	0	1.083303111	1.609459351	0.067776353	0.823917482	1.202735547	0	4.130531976	0.343968972	0	0.538460977	5.735110127	12.59770308	0.216980073	1.336960277	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0.049459665	0	0	0	0	0	0	0	34.5647
H0630_809_0	2011	2	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	Coin	V	V	V	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	0	0								0	YES	1000.132089	55.79459082	1036.128381	911.3589949	11.19918182	22.65555682	1.545067927	306.3079311	23.19882126	0	11.66485819	0.349871397	0.100396887	188.4886579	4026.858083	5910.493489	220.7158784	814.8496742	2090.43826	5809.259471	0	6.360156199	0	0	0	0	0	0	0	0	0.567786066	0.998766314	0.260314024								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, other diagnostic x-ray 20%/procedure; colonoscopies 0%"	20% coin	20% coin	Pulmonary Rehab $5; 20% coin or $0-$45 copay for other services	Primary Care OV $0-$40/visit	Specialty Care OV $0-$45/visit	"$10 Group Visit, $25 OV"	Therapies=Primary Care OV	$0 Copay	$0 Copay		$0 Copay									20% Generic coinsurance	20% Brand coinsurance	0% coinsurance								0	250	250	100	0	0.2	0.141318724	0.2	44	0.2	0	0.2	0.2	0.2	23.96296296	24.02845709	42.63423328	23.98734177	25	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0								NO	102.08	102.08	10.72	0	0.19	0.13	0.19	41	0.19	0	0.19	0.19	0.19	22.33	22.39	39.73	22.35	23.29	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0									8.5078	0.474625986	0.92560802	0	2.127844546	2.945222386	0.293562906	1.046552098	4.407776039	0	2.216323056	0.066475565	0.019075408	0.350745977	7.51344604	19.56865886	0.411083323	1.581487409	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0	0	0	0	0	0	0	0	52.7539	0	23.70626294	8.5078	0.474625986	0.92560802	0	2.127844546	2.945222386	0.293562906	1.046552098	4.407776039	0	2.216323056	0.066475565	0.019075408	0.350745977	7.51344604	19.56865886	0.411083323	1.581487409	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0	0	0	0	0	0	0	0	52.7539	NO																																																																																		0	0	0	8.5078	0.474625986	0.92560802	0	2.127844546	2.945222386	0.293562906	1.046552098	4.407776039	0	2.216323056	0.066475565	0.019075408	0.350745977	7.51344604	19.56865886	0.411083323	1.581487409	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0	0	0	0	0	0	0	0	52.7539
H0630_810_0	2011	3	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	Coin	V	V	V	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	0	0								0	YES	1003.143463	47.58333211	1035.665664	906.0937965	11.20529373	22.77778913	1.541961938	305.7910202	23.32508359	0	11.66052064	0.347270066	0.100978312	188.6575351	4028.173108	5915.894435	212.7058981	816.8436045	2096.609381	5819.403897	0	6.360156199	0	0	0	0	0	0	0	0	0.567786066	0.998766314	0.260314024								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, other diagnostic x-ray 20%/procedure; colonoscopies 0%"	20% coin	20% coin	Pulmonary Rehab $5; 20% coin or $0-$45 copay for other services	Primary Care OV $0-$40/visit	Specialty Care OV $0-$45/visit	"$10 Group Visit, $25 OV"	Therapies=Primary Care OV	$0 Copay	$0 Copay		$0 Copay									20% Generic coinsurance	20% Brand coinsurance	0% coinsurance								0	250	250	100	0	0.2	0.141318724	0.2	44	0.2	0	0.2	0.2	0.2	23.96296296	24.02845709	42.63423328	23.98734177	25	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0								NO	102.08	102.08	10.72	0	0.19	0.13	0.19	41	0.19	0	0.19	0.19	0.19	22.33	22.39	39.73	22.35	23.29	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0									8.5334	0.404775545	0.92519466	0	2.129005809	2.961112587	0.292972768	1.044785986	4.431765882	0	2.215498922	0.065981313	0.019185879	0.35106023	7.515899657	19.58654049	0.396164735	1.585357296	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0	0	0	0	0	0	0	0	52.7564	0	23.64190736	8.5334	0.404775545	0.92519466	0	2.129005809	2.961112587	0.292972768	1.044785986	4.431765882	0	2.215498922	0.065981313	0.019185879	0.35106023	7.515899657	19.58654049	0.396164735	1.585357296	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0	0	0	0	0	0	0	0	52.7564	NO																																																																																		0	0	0	8.5334	0.404775545	0.92519466	0	2.129005809	2.961112587	0.292972768	1.044785986	4.431765882	0	2.215498922	0.065981313	0.019185879	0.35106023	7.515899657	19.58654049	0.396164735	1.585357296	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0	0	0	0	0	0	0	0	52.7564
H0630_811_0	2011	2	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									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	978.1265599	21.09142525	709.7043238	765.1173098	9.214366636	18.81865689	0.753977746	303.5229567	101.8447429	0	548.0584896	0.787500381	2.143902046	274.4194619	4292.784664	6607.949303	200.512354	926.2236745	2345.296917	6490.891862	0	6.360156199	0	0	0	0	0	0	0	0	0.567786066	0.998766314	0.260314024								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"	20% Coinsurance	$0 Copay	Pulmonary Rehab $5; all other services $0-$200 copay	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	$0 Copay		$0 Copay									20% Generic coinsurance	20% Brand coinsurance	20% coinsurance								0	250	250	100	0	0.2	0.141318724	0.2	44	200	0	97.88756945	0.2	0	19.26349052	18.99844852	28.92776981	18.63328424	25	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	77.84	77.84	10.99	0	0.19	0.13	0.19	41.8	190	0	92.99	0.19	0	18.3	18.05	27.48	17.7	19	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									6.3448	0.136813045	0.649970877	0	1.750729661	2.446425396	0.143255772	1.057271632	1.612541763	0	4.246996579	0.149625072	0	0.418489679	6.457063599	15.1322039	0.295755722	1.466520818	0	0	0	0	0	0	0	0	0	0	0	0	8.99E-06	1.58E-05	0.049459665	0	0	0	0	0	0	0	42.3579	0	21.92430399	6.3448	0.136813045	0.649970877	0	1.750729661	2.446425396	0.143255772	1.057271632	1.612541763	0	4.246996579	0.149625072	0	0.418489679	6.457063599	15.1322039	0.295755722	1.466520818	0	0	0	0	0	0	0	0	0	0	0	0	8.99E-06	1.58E-05	0.049459665	0	0	0	0	0	0	0	42.3579	NO																																																																																		0	0	0	6.3448	0.136813045	0.649970877	0	1.750729661	2.446425396	0.143255772	1.057271632	1.612541763	0	4.246996579	0.149625072	0	0.418489679	6.457063599	15.1322039	0.295755722	1.466520818	0	0	0	0	0	0	0	0	0	0	0	0	8.99E-06	1.58E-05	0.049459665	0	0	0	0	0	0	0	42.3579
H0630_812_0	2011	2	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									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	978.1265599	21.09142525	709.7043238	765.1173098	9.214366636	18.81865689	0.753977746	303.5229567	101.8447429	0	548.0584896	0.787500381	2.143902046	274.4194619	4292.784664	6607.949303	200.512354	926.2236745	2345.296917	6490.891862	0	6.360156199	0	0	0	0	0	0	0	0	0.567786066	0.998766314	0.260314024								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"	20% Coinsurance	$0 Copay	Pulmonary Rehab $5; all other services $0-$200 copay	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	$0 Copay		$0 Copay									20% Generic coinsurance	20% Brand coinsurance	20% coinsurance								0	250	250	100	0	0.2	0.141318724	0.2	44	200	0	97.88756945	0.2	0	19.26349052	18.99844852	28.92776981	18.63328424	25	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	77.84	77.84	10.99	0	0.19	0.13	0.19	41.8	190	0	92.99	0.19	0	18.3	18.05	27.48	17.7	19	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									6.3448	0.136813045	0.649970877	0	1.750729661	2.446425396	0.143255772	1.057271632	1.612541763	0	4.246996579	0.149625072	0	0.418489679	6.457063599	15.1322039	0.295755722	1.466520818	0	0	0	0	0	0	0	0	0	0	0	0	8.99E-06	1.58E-05	0.049459665	0	0	0	0	0	0	0	42.3579	0	21.92430399	6.3448	0.136813045	0.649970877	0	1.750729661	2.446425396	0.143255772	1.057271632	1.612541763	0	4.246996579	0.149625072	0	0.418489679	6.457063599	15.1322039	0.295755722	1.466520818	0	0	0	0	0	0	0	0	0	0	0	0	8.99E-06	1.58E-05	0.049459665	0	0	0	0	0	0	0	42.3579	NO																																																																																		0	0	0	6.3448	0.136813045	0.649970877	0	1.750729661	2.446425396	0.143255772	1.057271632	1.612541763	0	4.246996579	0.149625072	0	0.418489679	6.457063599	15.1322039	0.295755722	1.466520818	0	0	0	0	0	0	0	0	0	0	0	0	8.99E-06	1.58E-05	0.049459665	0	0	0	0	0	0	0	42.3579
H0630_813_0	2011	3	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									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	853.5180881	15.09951751	570.7664275	583.5726591	7.3138034	17.0296043	1.108392687	272.5428122	178.0615128	0	556.3221946	0.798776934	1.534836366	374.6794938	3961.910919	6568.94515	143.548374	679.215933	2159.18639	5673.512427	0	6.360156199	0	0	0	0	0	0	0	0	0.567786066	0.998766314	0.260314024								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"	20% Coinsurance	$0 Copay	Pulmonary Rehab $5; all other services $0-$200 copay	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	$0 Copay		$0 Copay									20% Generic coinsurance	20% Brand coinsurance	20% coinsurance								0	250	250	100	0	0.2	0.141318724	0.2	44	200	0	97.88756945	0.2	0	19.26349052	18.99844852	28.92776981	18.63328424	25	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	77.84	77.84	10.99	0	0.19	0.13	0.19	41.8	190	0	92.99	0.19	0	18.3	18.05	27.48	17.7	19	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									5.5365	0.097945537	0.52272692	0	1.389622646	2.213848558	0.210594611	0.949357462	2.819307287	0	4.311033406	0.151767618	0	0.571386228	5.95937434	15.04288439	0.211733852	1.075425227	0	0	0	0	0	0	0	0	0	0	0	0	8.99E-06	1.58E-05	0.049459665	0	0	0	0	0	0	0	41.113	0	18.89491913	5.5365	0.097945537	0.52272692	0	1.389622646	2.213848558	0.210594611	0.949357462	2.819307287	0	4.311033406	0.151767618	0	0.571386228	5.95937434	15.04288439	0.211733852	1.075425227	0	0	0	0	0	0	0	0	0	0	0	0	8.99E-06	1.58E-05	0.049459665	0	0	0	0	0	0	0	41.113	NO																																																																																		0	0	0	5.5365	0.097945537	0.52272692	0	1.389622646	2.213848558	0.210594611	0.949357462	2.819307287	0	4.311033406	0.151767618	0	0.571386228	5.95937434	15.04288439	0.211733852	1.075425227	0	0	0	0	0	0	0	0	0	0	0	0	8.99E-06	1.58E-05	0.049459665	0	0	0	0	0	0	0	41.113
H0630_814_0	2011	3	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									Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	YES	978.1265599	21.09142525	709.7043238	765.1173098	9.214366636	18.81865689	0.753977746	303.5229567	101.8447429	0	548.0584896	0.787500381	2.143902046	274.4194619	4292.784664	6607.949303	200.512354	926.2236745	2345.296917	6490.891862	0	6.360156199	0	0	0	0	0	0	0	0	0.567786066	0.998766314	0.260314024								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"	20% Coinsurance	$0 Copay	Pulmonary Rehab $5; all other services $0-$200 copay	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	$0 Copay		$0 Copay									20% Generic coinsurance	20% Brand coinsurance	20% coinsurance								0	250	250	100	0	0.2	0.141318724	0.2	44	200	0	97.88756945	0.2	0	19.26349052	18.99844852	28.92776981	18.63328424	25	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0.2								NO	77.84	77.84	10.99	0	0.19	0.13	0.19	41.8	190	0	92.99	0.19	0	18.3	18.05	27.48	17.7	19	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0.19									6.3448	0.136813045	0.649970877	0	1.750729661	2.446425396	0.143255772	1.057271632	1.612541763	0	4.246996579	0.149625072	0	0.418489679	6.457063599	15.1322039	0.295755722	1.466520818	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0.049459665	0	0	0	0	0	0	0	42.6555	0	21.93996821	6.3448	0.136813045	0.649970877	0	1.750729661	2.446425396	0.143255772	1.057271632	1.612541763	0	4.246996579	0.149625072	0	0.418489679	6.457063599	15.1322039	0.295755722	1.466520818	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0.049459665	0	0	0	0	0	0	0	42.6555	NO																																																																																		0	0	0	6.3448	0.136813045	0.649970877	0	1.750729661	2.446425396	0.143255772	1.057271632	1.612541763	0	4.246996579	0.149625072	0	0.418489679	6.457063599	15.1322039	0.295755722	1.466520818	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0.049459665	0	0	0	0	0	0	0	42.6555
H0630_815_0	2011	2	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	Coin	V	V	V	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	0	0								0	YES	1249.016382	69.67915414	1298.486818	1139.56773	12.84673211	25.9156029	1.767912291	382.5330956	93.87612256	0	539.3388013	0.339817426	0.097553461	235.3943286	4837.584997	7107.399173	265.706904	978.7020651	2523.986196	6977.64327	0	6.360156199	0	0	0	0	0	0	0	0	0.567786066	0.998766314	0.260314024								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, other diagnostic x-ray 20%/procedure; colonoscopies 0%"	20% Coinsurance	20% coin	Pulmonary Rehab $5; 20% coin or $0-$45 copay for other services	Primary Care OV $0-$30/visit	Specialty Care OV $0-$45/visit	"$10 Group Visit, $25 OV"	Therapies=Primary Care OV	$0 Copay	$0 Copay		$0 Copay									20% Generic coinsurance	20% Brand coinsurance	0% coinsurance								0	250	250	100	0	0.2	0.141318724	0.2	44	0.2	0	0.2	0.2	0.2	23.96296296	24.02845709	42.63423328	23.98734177	25	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0								NO	102.08	102.08	10.72	0	0.19	0.13	0.19	41	0.19	0	0.19	0.19	0.19	22.33	22.39	39.73	22.35	23.29	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0									10.625	0.592737338	1.159981557	0	2.440879101	3.369028377	0.335903335	1.306988077	0.001486372	0	0.008539531	0.064565311	0.018535158	0.438029613	9.02612734	23.53141409	0.494879109	1.899497591	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0	0	0	0	0	0	0	0	55.6112	0	29.05993578	10.625	0.592737338	1.159981557	0	2.440879101	3.369028377	0.335903335	1.306988077	0.001486372	0	0.008539531	0.064565311	0.018535158	0.438029613	9.02612734	23.53141409	0.494879109	1.899497591	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0	0	0	0	0	0	0	0	55.6112	NO																																																																																		0	0	0	10.625	0.592737338	1.159981557	0	2.440879101	3.369028377	0.335903335	1.306988077	0.001486372	0	0.008539531	0.064565311	0.018535158	0.438029613	9.02612734	23.53141409	0.494879109	1.899497591	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0	0	0	0	0	0	0	0	55.6112
H0630_816_0	2011	3	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	Coin	V	V	V	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	0	0								0	YES	1249.016382	69.67915414	1298.486818	1139.56773	12.84673211	25.9156029	1.767912291	382.5330956	93.87612256	0	539.3388013	0.339817426	0.097553461	235.3943286	4837.584997	7107.399173	265.706904	978.7020651	2523.986196	6977.64327	0	6.360156199	0	0	0	0	0	0	0	0	0.567786066	0.998766314	0.260314024								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, other diagnostic x-ray 20%/procedure; colonoscopies 0%"	20% Coinsurance	20% coin	Pulmonary Rehab $5; 20% coin or $0-$45 copay for other services	Primary Care OV $0-$30/visit	Specialty Care OV $0-$45/visit	"$10 Group Visit, $25 OV"	Therapies=Primary Care OV	$0 Copay	$0 Copay		$0 Copay									20% Generic coinsurance	20% Brand coinsurance	0% coinsurance								0	250	250	100	0	0.2	0.141318724	0.2	44	0.2	0	0.2	0.2	0.2	23.96296296	24.02845709	42.63423328	23.98734177	25	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0.2	0								NO	102.08	102.08	10.72	0	0.19	0.13	0.19	41	0.19	0	0.19	0.19	0.19	22.33	22.39	39.73	22.35	23.29	0	0	0	0	0	0	0	0	0	0	0	0	0.19	0.19	0									10.625	0.592737338	1.159981557	0	2.440879101	3.369028377	0.335903335	1.306988077	0.001486372	0	0.008539531	0.064565311	0.018535158	0.438029613	9.02612734	23.53141409	0.494879109	1.899497591	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0	0	0	0	0	0	0	0	55.6112	0	29.05993578	10.625	0.592737338	1.159981557	0	2.440879101	3.369028377	0.335903335	1.306988077	0.001486372	0	0.008539531	0.064565311	0.018535158	0.438029613	9.02612734	23.53141409	0.494879109	1.899497591	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0	0	0	0	0	0	0	0	55.6112	NO																																																																																		0	0	0	10.625	0.592737338	1.159981557	0	2.440879101	3.369028377	0.335903335	1.306988077	0.001486372	0	0.008539531	0.064565311	0.018535158	0.438029613	9.02612734	23.53141409	0.494879109	1.899497591	0	0	0	0	0	0	0	0	0	0	0	0	0.107879352	0.1897656	0	0	0	0	0	0	0	0	55.6112
H0710_001_0	2011	5																															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	YES	432.964268	44.064818	8117.123247	326.8308639	37.15070605	35.31777232	8.1002147	20.65321458	12.04040477	23.31570479	17.29905483	0	0	19.21120883	9.880498355	148.8663963	20.0973	308.3091363	0	0	4.318703661	8.360861069	668.0125448	134.3234157	80.97711044	44.11400583	0	0	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.067897015	0.068716003	0	0	0.2	0.2	0.101600828	0.057874684	0.2	0	0.123477137	0	0	0.160594285	0.001329388	0.025132274	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.062826945	0.063584776	0	0	0.185065409	0.185065409	0.094013995	0.05355301	0.185065409	0	0.114256735	0	0	0.148602236	0.001214872	0.022967335	0.182771644	0	0	0	0.185065409	0.186401101	0	0	0	0	0	0	0	0												27.2018	2.8018516	0	0	6.875310627	6.536097996	0.761533541	1.106041814	2.228262438	0	1.976533516	0	0	2.854828587	0.012003538	3.419064387	3.673216569	0	0	0	0.799242661	1.558473712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8043	0	5.071827106	27.2018	2.8018516	0	0	6.875310627	6.536097996	0.761533541	1.106041814	2.228262438	0	1.976533516	0	0	2.854828587	0.012003538	3.419064387	3.673216569	0	0	0	0.799242661	1.558473712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8043	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	2.4236	0.2496	0	0.1119	1.749	1.6627	0.3813	0.1876	0.5668	0	0.6139	0	0	0.7262	0.1892	3.0743	0.4147	0.1726	0	0	0.0902	0.176	0	0	0.007	0	0	0	0	0											12.7968	0	1.080358317	29.6254	3.051490587	0	0.111944517	8.624293155	8.198789591	1.142875795	1.293616157	2.795101129	0	2.590392268	0	0	3.581056911	0.201162522	6.493394988	4.087934568	0.172585689	0	0	0.889479736	1.734430422	0	0	0.007039231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.601
H0710_002_0	2011	4																															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	YES	404.0006073	21.86377	57.93717681	2284.391938	22.4319037	12.48558568	21.24023817	31.12543324	27.27307798	20.5885492	36.47964206	0	0.056451791	18.64234721	37.51775959	140.764094	10.08348	7.223128427	0	0	15.11090626	12.4205223	800.7178726	451.5072796	330.808524	200.9668979	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.068300962	0.069130126	0.164888494	0	0.233	0.233	0.233	0.104671501	0.233	0.233	0.233	0	0.233	0.233	0.22080553	0.232917793	0.231965063	0.233	0	0	0.233	0.232008273	0	0	0	0	0	0	0	0											NO	0.052410687	0.053046945	0.12652705	0	0.178792358	0.178792358	0.178792358	0.080333824	0.178792358	0.178792358	0.178792358	0	0.178792358	0.178792358	0.169291258	0.178577711	0.177847255	0.178640739	0	0	0.178792358	0.17868256	0	0	0	0	0	0	0	0												21.1739	1.15980621	7.330620081	0	4.010652954	2.232327303	3.797592264	2.500425079	4.876217918	3.681075256	6.522281218	0	0.010093149	3.333109213	6.351428726	25.13732972	1.793319238	1.290345001	0	0	2.70171456	2.219330724	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1216	0	30.38276348	21.1739	1.15980621	7.330620081	0	4.010652954	2.232327303	3.797592264	2.500425079	4.876217918	3.681075256	6.522281218	0	0.010093149	3.333109213	6.351428726	25.13732972	1.793319238	1.290345001	0	0	2.70171456	2.219330724	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1216	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h, 14h1); $0 (14b)"	"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)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	4.3298	0.2372	1.0039	0.6023	0.7425	0.4133	0.6816	0.3245	0.9028	0	0.9581	0	0.0013	0.5104	1.0787	4.8858	0.35	0.2507	0	0	0.5249	0.4318	0	0.1	0.0633	0	0	0	0	0											18.3926	0	5.531316361	25.5037	1.396970052	8.334511416	0.602293646	4.753169461	2.645611595	4.479153853	2.824914168	5.778981716	3.681075256	7.480337826	0	0.011398862	3.843486512	7.430129367	30.02311989	2.143285341	1.541037233	0	0	3.226612051	2.651125348	0	0.1	0.06331509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.5142
H0712_001_0	2011	5																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1304.586657	161.9248478	574.3520851	1217.376386	651.8126674	3.161351183	7.533265187	550.0971871	271.9251601	4471.203623	1014.037214	10.97271108	0.174134239	1062.072749	9880.273094	20856.71406	207.4157258	486.1817061	2818.304578	2590.465327	21.95621742	0.021023763	0	278.5714286	331.2	198.72	16.2	12.34285714	1552.941176	0											3250	"(1a) $200 days 1 - 7, $0 after day 7, unlimited coverage"	"(1b) $200 days 1 - 7, $0 after day 7, unlimited coverage"	"(2) $0 days 1 - 7, $85 days 8 - 100"	(6) Copay between $0.00 and $25.00	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $200.00 copayment	(12) 20% coinsurance	"(9a) $150.00 copayment , (9d) Copay between $30.00 and $150.00"	"(14b) , (14c) $0.00 copayment ; (7a) $10.00 copayment"	"(7b) , (7d) , (7g) $30.00 copayment"	"(7e) , (7h) $30.00 copayment"	"(7c) , (7i) $30.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $30.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	"(16) $0.00 copayment,   benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	132.6043904	83.85632439	60.99325838	3.814109951	47.68703441	0.2	0.089677915	46.53135976	92.92799998	0	21.37177932	42.07089391	0.2	17.01066702	3.374104781	3.780211122	20.72310486	10.12693131	4.243594069	6.05584235	0.2	0	0	0	0	0	0	0	0	0											NO	127.1267347	80.39236611	58.47373342	3.656555732	45.71716632	0.191738349	0.085973477	44.60923057	89.08930663	0	20.48894845	40.33301877	0.191738349	16.30798608	3.234726407	3.624057204	19.8670696	9.70860547	4.068298611	5.805686081	0.191738349	0	0	0	0	0	0	0	0	0												13.8207	1.084793471	2.798709226	0.370950384	2.483252343	0.606152258	0.647661001	2.044951021	2.018801997	0	1.731379685	0.036880213	0.033388212	1.443355634	2.66333169	6.29882707	0.343395222	0.393345531	0.955475383	1.253285708	4.209848886	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2384	0	1.949240591	13.8207	1.084793471	2.798709226	0.370950384	2.483252343	0.606152258	0.647661001	2.044951021	2.018801997	0	1.731379685	0.036880213	0.033388212	1.443355634	2.66333169	6.29882707	0.343395222	0.393345531	0.955475383	1.253285708	4.209848886	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2384	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												1.5712	0	0.1438	0.0687	0.0883	0.0215	0.0513	0	0.2266	0.0313	0.1608	0	0	0.0692	0	0.5725	0	0.0094	0.132	0.1041	0.1494	0.0001	0	0	0	0	0	0	0	0											3.4003	0	0	15.3918	1.084793471	2.942538556	0.439667738	2.571596441	0.627662482	0.698918269	2.044951021	2.245431556	0.031284519	1.892198249	0.036880213	0.033388212	1.512520209	2.66333169	6.871324788	0.343395222	0.402742004	1.087486264	1.357401951	4.359241705	0.000143048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6387
H0712_005_0	2011	5																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	P	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	Yes	2011.970315	403.9364076	1504.23946	1618.479298	33.64775221	11.16239176	12.94308128	58.28141476	42.34830909	8493.671351	24.86443449	0.89671044	0.024083683	24.96000975	9516.136773	104.1363445	8.40317028	2.008606865	21.36655585	12.46543147	20.37639532	0.062620051	1400	278.5714286	331.2	198.72	16.2	12.34285714	1466.666667	2984.458018											6700	FFS	FFS	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) $0.00 copayment	(8b) 20% coinsurance	(5) 45% coinsurance	(12) 20% coinsurance	"(9a) , (9d) 20% coinsurance"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) 20% coinsurance"	"(7e) , (7h) 45% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) 20% coinsurance"	(15) 20% coinsurance	(13a) 20% coinsurance	(10b) $0.00 copayment	"(16) $0.00 copayment,   benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	"(13b) , (13c) $0.00 copayment"											0	136.8237601	54.27241488	37.36683643	0	0.155801748	0.190800134	0.08963247	0.170423822	0.155952324	0	0.142117453	0.402304344	0.1908	0.134271316	0	0.065715262	0.287538686	0.177824137	0.147344912	0.120709202	0.190801401	0.190221635	0	0	0	0	0	0	0	0											NO	133.2099393	52.83895932	36.37989491	0	0.151686677	0.185760677	0.087265076	0.165922548	0.151833275	0	0.138363814	0.391678589	0.185760546	0.130724911	0	0.063979576	0.279944147	0.173127405	0.143453204	0.117521003	0.185761911	0.185197457	0	0	0	0	0	0	0	0												22.3345	1.778631617	4.560339457	0	5.103915706	2.073533449	1.129478975	9.670200845	6.429882471	0	3.440337995	0.35122228	0.004473798	3.262895057	0	6.662599113	2.35241834	0.347744894	3.065100896	1.464950005	3.785158125	0.011597074	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.829	0	2.111404902	22.3345	1.778631617	4.560339457	0	5.103915706	2.073533449	1.129478975	9.670200845	6.429882471	0	3.440337995	0.35122228	0.004473798	3.262895057	0	6.662599113	2.35241834	0.347744894	3.065100896	1.464950005	3.785158125	0.011597074	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.829	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	22.3345	1.778631617	4.560339457	0	5.103915706	2.073533449	1.129478975	9.670200845	6.429882471	0	3.440337995	0.35122228	0.004473798	3.262895057	0	6.662599113	2.35241834	0.347744894	3.065100896	1.464950005	3.785158125	0.011597074	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.829
H0712_018_0	2011	8																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1770.994028	88.33330196	1246.635347	1559.178686	711.8193425	6.433863949	9.549221665	566.6299371	354.489978	5807.911313	1460.541678	53.46052624	0.05601426	1808.07449	9790.306877	24818.36978	554.4385438	2192.32555	3442.649009	3492.344279	31.90028039	0.026197228	0	278.5714286	331.2	198.72	16.2	12.34285714	1389.473684	0											1750	"(1a) $50 days 1 - 7, $0 after day 7, unlimited coverage"	"(1b) $50 days 1 - 7, $0 after day 7, unlimited coverage"	"(2) $0 days 1 - 7, $85 days 8 - 100"	(6) Copay between $0.00 and $15.00	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) , (9b) $25.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $50.00 copayment	(12) 20% coinsurance	"(9a) $25.00 copayment , (9d) Copay between $15.00 and $25.00"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) $15.00 copayment"	"(7e) , (7h) $15.00 copayment"	"(7c) , (7i) $15.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $15.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	"(16) $0.00 copayment,   benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	33.11048152	20.41045977	61.08088379	3.609326561	46.54911096	0.2	0.103164387	44.05896799	17.47631564	0	14.15400726	8.650837016	0.2	6.135409183	0	2.460442622	10.53768241	4.531107356	4.595618452	6.024748646	0.2	0	0	0	0	0	0	0	0	0											NO	30.01239495	18.50069076	55.36565836	3.271608544	42.19359666	0.18128637	0.093511486	39.93645177	15.84108907	0	12.82964295	7.841394181	0.18128637	5.561330283	0	2.230223553	9.551690936	4.107140013	4.165614926	5.461024048	0.18128637	0	0	0	0	0	0	0	0	0												4.4293	0.136185592	5.751732227	0.425085193	2.502851519	1.166371838	0.892961908	1.885765763	0.467958943	0	1.561519021	0.034933755	0.010154622	0.837941618	0	4.612542736	0.441318801	0.750348999	1.195062508	1.589314674	5.78308602	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4745	0	3.558690705	4.4293	0.136185592	5.751732227	0.425085193	2.502851519	1.166371838	0.892961908	1.885765763	0.467958943	0	1.561519021	0.034933755	0.010154622	0.837941618	0	4.612542736	0.441318801	0.750348999	1.195062508	1.589314674	5.78308602	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4745	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												2.0583	0	0.2756	0.1407	0.0892	0.0438	0.065	0	0.3139	0.0325	0.1822	0	0	0.0964	0	0.7213	0	0.0362	0.1467	0.1156	0.2171	0.0002	0	0	0	0	0	0	0	0											4.5347	0	0	6.4876	0.136185592	6.027370522	0.565791265	2.592039096	1.210148644	0.957935994	1.885765763	0.781853344	0.032519868	1.743750691	0.034933755	0.010154622	0.934325633	0	5.33383841	0.441318801	0.786570072	1.34175544	1.70494654	6.000139474	0.000178249	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.0091
H0752_002_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1148.929435	91.70902436	1256.285595	3317.218093	236.3265377	5.483732434	8.714943056	336.4572933	532.4054825	15.63431404	37.78061905	0	0.055928707	479.1636053	5764.916444	91.92514934	391.7671924	514.7940514	0	0	21.17635404	1409.019388	0	0	78.28490809	58.63772864	22.91664488	10.94342622	115.4875858	0											3950	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-50 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$150 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $150 (9a); $40 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0/$30 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	60.01589057	0	200	0.2	0.093902569	49.35074793	150	0.126994267	0.152494006	0	0.2	58.04460289	9.399184438	0.120686994	40	30	0	0	0.2	29.76516917	0	0	0	0	0	0	0	0											NO	116.4503201	77.89406369	37.5243228	0	125.0479579	0.125047958	0.058711623	30.88190357	93.78596845	0.079401869	0.09534532	0	0.125047958	36.29179531	8.794200794	0.112945328	37.42537814	28.0690336	0	0	0.125047958	18.61036811	0	0	0	0	0	0	0	0												11.1494	0.595299049	3.928438851	0	2.462679246	0.685729543	0.511668448	0.86587014	4.161013649	1.241393756	3.602205221	0	0.006993771	1.44914229	4.224819397	10.3825161	1.221836276	1.204147627	0	0	2.648059829	2.185197457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5264	0	22.4421217	11.1494	0.595299049	3.928438851	0	2.462679246	0.685729543	0.511668448	0.86587014	4.161013649	1.241393756	3.602205221	0	0.006993771	1.44914229	4.224819397	10.3825161	1.221836276	1.204147627	0	0	2.648059829	2.185197457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5264	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, 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 (8a1a, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"50% (7b); $0 n/c (7b1); 30% (7d, 7f, 7f1)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												3.5562	0.1166	0	0	0	0	0	0.1537	0	0	0.9602	0	0.0012	0	1.3076	4.4976	0.2987	0	0	0	1.0342	0.3942	0	0	0	0	0	0	0	0											12.3202	0	0	14.7056	0.711852199	3.928438851	0	2.462679246	0.685729543	0.511668448	1.019614762	4.161013649	1.241393756	4.562424879	0	0.008236631	1.44914229	5.532428171	14.88009471	1.520505276	1.204147627	0	0	3.682253864	2.579392851	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.8466
H0752_801_0	2011	1																															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	234.120933	6.9765	33.58589506	3484.196651	10.94072786	5.75976666	9.153626488	17.27389249	46.00060296	16.41800209	44.08268468	0	0.065257998	15.15435644	43.5197918	126.6833918	3.2915	5.338805699	0	0	28.99455963	11.40013607	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.04513265	0.04513265	0.110450533	0	0.159477613	0.159477613	0.159477613	0.159477613	0.159477613	0.159477613	0.159477613	0	0.159477613	0.159477613	0.159477613	0.159477613	0.159477613	0.159477613	0	0	0.159477613	0.159477613	0	0	0	0	0	0	0	0												10.5665	0.314867931	3.709580012	0	1.744801169	0.918553841	1.459798507	2.754799149	7.336066378	2.618303791	7.030201347	0	0.01040719	2.416780599	6.940432534	20.20316499	0.524920565	0.851419992	0	0	4.623983173	1.818066493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8426	0	34.9649847	10.5665	0.314867931	3.709580012	0	1.744801169	0.918553841	1.459798507	2.754799149	7.336066378	2.618303791	7.030201347	0	0.01040719	2.416780599	6.940432534	20.20316499	0.524920565	0.851419992	0	0	4.623983173	1.818066493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8426	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.5665	0.314867931	3.709580012	0	1.744801169	0.918553841	1.459798507	2.754799149	7.336066378	2.618303791	7.030201347	0	0.01040719	2.416780599	6.940432534	20.20316499	0.524920565	0.851419992	0	0	4.623983173	1.818066493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8426
H0752_802_0	2011	1																															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	234.120933	6.9767	33.58589506	3484.196651	10.94072786	5.75976666	9.153626488	17.27389249	46.00060296	16.41800209	44.08268468	0	0.065257998	15.15485644	43.5197918	126.6833918	3.2914	5.338805699	0	0	28.99455963	11.40013607	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.045132636	0.045132636	0.1104505	0	0.159477565	0.159477565	0.159477565	0.159477565	0.159477565	0.159477565	0.159477565	0	0.159477565	0.159477565	0.159477565	0.159477565	0.159477565	0.159477565	0	0	0.159477565	0.159477565	0	0	0	0	0	0	0	0												10.5665	0.314876863	3.709578892	0	1.744800643	0.918553564	1.459798066	2.754798318	7.336064164	2.618303001	7.030199226	0	0.010407187	2.416859609	6.94043044	20.2031589	0.524904459	0.851419735	0	0	4.623981778	1.818065945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8427	0	34.96504116	10.5665	0.314876863	3.709578892	0	1.744800643	0.918553564	1.459798066	2.754798318	7.336064164	2.618303001	7.030199226	0	0.010407187	2.416859609	6.94043044	20.2031589	0.524904459	0.851419735	0	0	4.623981778	1.818065945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8427	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.5665	0.314876863	3.709578892	0	1.744800643	0.918553564	1.459798066	2.754798318	7.336064164	2.618303001	7.030199226	0	0.010407187	2.416859609	6.94043044	20.2031589	0.524904459	0.851419735	0	0	4.623981778	1.818065945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8427
H0752_803_0	2011	1																															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	234.120933	6.9767	33.58589506	3484.196651	10.94072786	5.75976666	9.153626488	17.27389249	46.00060296	16.41800209	44.08268468	0	0.065257998	15.15485644	43.5197918	126.6833918	3.2914	5.338805699	0	0	28.99455963	11.40013607	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.045132636	0.045132636	0.1104505	0	0.159477565	0.159477565	0.159477565	0.159477565	0.159477565	0.159477565	0.159477565	0	0.159477565	0.159477565	0.159477565	0.159477565	0.159477565	0.159477565	0	0	0.159477565	0.159477565	0	0	0	0	0	0	0	0												10.5665	0.314876863	3.709578892	0	1.744800643	0.918553564	1.459798066	2.754798318	7.336064164	2.618303001	7.030199226	0	0.010407187	2.416859609	6.94043044	20.2031589	0.524904459	0.851419735	0	0	4.623981778	1.818065945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8427	0	34.96504116	10.5665	0.314876863	3.709578892	0	1.744800643	0.918553564	1.459798066	2.754798318	7.336064164	2.618303001	7.030199226	0	0.010407187	2.416859609	6.94043044	20.2031589	0.524904459	0.851419735	0	0	4.623981778	1.818065945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8427	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.5665	0.314876863	3.709578892	0	1.744800643	0.918553564	1.459798066	2.754798318	7.336064164	2.618303001	7.030199226	0	0.010407187	2.416859609	6.94043044	20.2031589	0.524904459	0.851419735	0	0	4.623981778	1.818065945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8427
H0755_030_0	2011	3																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	Coin	O	V	Coin	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	1448.1853	95.7766747	1470.654484	981.2040773	296.0926834	11.09014068	5.467947945	283.2243152	288.0970086	5920.561686	4587.060354	0	0.155167183	469.1153279	7284.998598	152.0577233	608.2642084	346.1357853	0	0	44.47427492	2132.422677	0	0	383.3173192	0	17.28956335	6	78.4196854	0											2900	"$100 Days 1-10 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$100 Days 1-10 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$100 Days 21-49 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$125 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $20 (4b)"	$0/$75 (9b)	"$0 (8a1a, 8a2)"	"$20 (8b1, 8b3); $50 (8b2)"	Included in h.5.	20% (12)	"$20 (3, 5, 9c); $0/$75 (9a); $0 (9d)"	"$10 (7a, 7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $20 (7d, 7f)"	"$20 (7e, 7h)"	"$10 (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 18a); $0/$20 (17a)"	$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												82.9218824	60.92023687	35.76796471	0	125	0.2	0.183999728	48.84978948	73.5	0	11.42592695	0	0.2	0.506397448	6.199574743	0.0593419	20	10	0	0	0.2	19.89327665	0	0	20	0	0	0	0	0											NO	65.17826156	47.88452719	28.11433715	0	98.25250536	0.157204009	0.144627474	38.41738861	57.77247315	0	8.981007588	0	0.157204009	0.398038544	5.975998424	0.057201843	19.2787366	9.639368298	0	0	0.157204009	15.63651417	0	0	20	0	0	0	0	0												7.8659	0.382185065	3.445539666	0	2.424320664	1.743414571	0.790815499	0.906728215	1.387006391	0	3.43303532	0	0.024392903	0.015560498	3.627928345	8.697982011	0.977213788	0.278044193	0	0	6.991534297	2.778638117	0	0	0.638862199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4091	0	9.270376732	7.8659	0.382185065	3.445539666	0	2.424320664	1.743414571	0.790815499	0.906728215	1.387006391	0	3.43303532	0	0.024392903	0.015560498	3.627928345	8.697982011	0.977213788	0.278044193	0	0	6.991534297	2.778638117	0	0	0.638862199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4091	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.8659	0.382185065	3.445539666	0	2.424320664	1.743414571	0.790815499	0.906728215	1.387006391	0	3.43303532	0	0.024392903	0.015560498	3.627928345	8.697982011	0.977213788	0.278044193	0	0	6.991534297	2.778638117	0	0	0.638862199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4091
H0755_031_0	2011	3																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	946.6583993	104.5541152	747.5935774	533.2119893	174.8903246	7.2764557	4.136403243	249.3735936	254.0651374	20.61428514	43.2696765	0	0.017521513	438.5866811	5940.240203	110.9551957	659.5115176	214.3183429	0	0	23.41100387	1634.08953	0	0	299.6943386	0	16.7162814	6	78.4196854	0											4900	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$100 Days 21-69 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$125 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $30 (4b)"	$150 (9b)	$0/20% (8a1a); $0 (8a2)	"$20 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 5, 9c); $150 (9a); $0 (9d)"	"$15 (7a); $20 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $30 (7d, 7f)"	"$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $0/$30 (17a)"	$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	43.72632898	0	125	0.2	0.185536977	49.36324168	150	0	0.159531721	0	0.2	56.97958621	8.592643485	0.086799081	30	30	0	0	0.2	29.94517308	0	0	30	0	0	0	0	0											NO	161.0456985	107.7240825	37.80925053	0	108.0849096	0.172935855	0.160429979	42.69624951	129.7018916	0	0.137943773	0	0.172935855	49.26906741	8.404694139	0.0849005	29.34380143	29.34380143	0	0	0.172935855	25.89297061	0	0	30	0	0	0	0	0												12.7046	0.938583011	2.355496072	0	1.575250411	1.258360091	0.663603085	0.887276431	2.746060741	0	5.968782452	0	0.003030098	1.80072973	4.160491835	9.420151554	1.612714584	0.524076241	0	0	4.048601979	3.52595268	0	0	0.749235846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.943	0	6.37264595	12.7046	0.938583011	2.355496072	0	1.575250411	1.258360091	0.663603085	0.887276431	2.746060741	0	5.968782452	0	0.003030098	1.80072973	4.160491835	9.420151554	1.612714584	0.524076241	0	0	4.048601979	3.52595268	0	0	0.749235846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.943	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.7046	0.938583011	2.355496072	0	1.575250411	1.258360091	0.663603085	0.887276431	2.746060741	0	5.968782452	0	0.003030098	1.80072973	4.160491835	9.420151554	1.612714584	0.524076241	0	0	4.048601979	3.52595268	0	0	0.749235846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.943
H0755_032_0	2011	2																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1333.240547	102.8756287	1151.641633	742.483883	247.755601	6.158469798	4.040676349	257.569825	233.8405539	21.93734423	43.08423846	0	0.201598162	391.1962094	5236.041237	128.2183207	474.3701661	219.0930523	0	0	29.76079812	1619.9529	0	0	207.5792284	0	17.72781666	0	78.4196854	0											4500	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$100 Days 21-65 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$125 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $30 (4b)"	$150 (9b)	$0/20% (8a1a); $0 (8a2)	"$20 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 5, 9c); $150 (9a); $0 (9d)"	"$15 (7a); $20 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1, 7f1); $30 (7d, 7f)"	"$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $0/$30 (17a)"	$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	41.19762614	0	125	0.2	0.184327094	49.4345883	150	0	0.161591282	0	0.2	55.64252415	9.737966762	0.085125775	30	30	0	0	0.2	29.86280325	0	0	30	0	30	0	0	0											NO	155.8811346	104.269486	34.4803505	0	104.6187418	0.167389987	0.154272549	41.39162315	125.5424902	0	0.135243813	0	0.167389987	46.57000694	9.4765076	0.082840194	29.19451616	29.19451616	0	0	0.167389987	24.99367122	0	0	30	0	30	0	0	0												17.3189	0.893899077	3.30908393	0	2.159989937	1.030866179	0.62336544	0.888436094	2.446410453	0	5.826876696	0	0.033745514	1.518167515	4.134948715	10.62163052	1.154083957	0.533026305	0	0	4.981659607	3.374047516	0	0	0.518948071	0	0.044319542	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4124	0	9.104074088	17.3189	0.893899077	3.30908393	0	2.159989937	1.030866179	0.62336544	0.888436094	2.446410453	0	5.826876696	0	0.033745514	1.518167515	4.134948715	10.62163052	1.154083957	0.533026305	0	0	4.981659607	3.374047516	0	0	0.518948071	0	0.044319542	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4124	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.3189	0.893899077	3.30908393	0	2.159989937	1.030866179	0.62336544	0.888436094	2.446410453	0	5.826876696	0	0.033745514	1.518167515	4.134948715	10.62163052	1.154083957	0.533026305	0	0	4.981659607	3.374047516	0	0	0.518948071	0	0.044319542	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4124
H0755_807_0	2011	1																															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	241.6640535	6.6409875	41.75863851	689.6923625	9.892933461	10.16042781	4.708384263	11.58439861	35.05407512	24.03919087	45.78249251	0	0.01231855	20.37064789	33.83028716	137.7191472	2.8918665	4.425299526	0	0	39.26323869	13.28366728	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.068189191	0.068189191	0.160723405	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.053656144	0.053656144	0.126468697	0	0.183341104	0.183341104	0.183341104	0.183341104	0.183341104	0.183341104	0.183341104	0	0.183341104	0.183341104	0.183341104	0.183341104	0.183341104	0.183341104	0	0	0.183341104	0.183341104	0	0	0	0	0	0	0	0												12.9668	0.35632978	5.281160591	0	1.813781338	1.862824048	0.863240367	2.123896424	6.426852815	4.407371782	8.393812699	0	0.002258497	3.734777063	6.20248218	25.24958043	0.530197995	0.811339299	0	0	7.198565509	2.435442218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6607	0	24.55591762	12.9668	0.35632978	5.281160591	0	1.813781338	1.862824048	0.863240367	2.123896424	6.426852815	4.407371782	8.393812699	0	0.002258497	3.734777063	6.20248218	25.24958043	0.530197995	0.811339299	0	0	7.198565509	2.435442218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6607	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9591	0.0264	0.6638	0	0.4068	0.4178	0.1936	0.4763	1.4413	0.9884	1.8825	0	0.0005	0.8376	1.3368	5.4419	0.1143	0.1749	0	0	1.5515	0.5249	0	0	0	0	0	0	0	0											17.4383	0	0	13.9258	0.382685754	5.944944272	0	2.220555484	2.280596932	1.056838049	2.600219637	7.868193903	5.395806748	10.27628107	0	0.002765006	4.572370173	7.539273117	30.69150019	0.644469001	0.986203327	0	0	8.750037461	2.960341282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0989
H0755_808_0	2011	1																															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	241.6640535	6.6409875	41.75863851	689.6923625	9.892933461	10.16042781	4.708384263	11.58439861	35.05407512	24.03919087	45.78249251	0	0.01231855	20.37064789	33.83028716	137.7191472	2.8918665	4.425299526	0	0	39.26323869	13.28366728	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.068189191	0.068189191	0.160723405	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.053656144	0.053656144	0.126468697	0	0.183341104	0.183341104	0.183341104	0.183341104	0.183341104	0.183341104	0.183341104	0	0.183341104	0.183341104	0.183341104	0.183341104	0.183341104	0.183341104	0	0	0.183341104	0.183341104	0	0	0	0	0	0	0	0												12.9668	0.35632978	5.281160591	0	1.813781338	1.862824048	0.863240367	2.123896424	6.426852815	4.407371782	8.393812699	0	0.002258497	3.734777063	6.20248218	25.24958043	0.530197995	0.811339299	0	0	7.198565509	2.435442218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6607	0	24.55591762	12.9668	0.35632978	5.281160591	0	1.813781338	1.862824048	0.863240367	2.123896424	6.426852815	4.407371782	8.393812699	0	0.002258497	3.734777063	6.20248218	25.24958043	0.530197995	0.811339299	0	0	7.198565509	2.435442218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6607	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9591	0.0264	0.6638	0	0.4068	0.4178	0.1936	0.4763	1.4413	0.9884	1.8825	0	0.0005	0.8376	1.3368	5.4419	0.1143	0.1749	0	0	1.5515	0.5249	0	0	0	0	0	0	0	0											17.4383	0	0	13.9258	0.382685754	5.944944272	0	2.220555484	2.280596932	1.056838049	2.600219637	7.868193903	5.395806748	10.27628107	0	0.002765006	4.572370173	7.539273117	30.69150019	0.644469001	0.986203327	0	0	8.750037461	2.960341282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0989
H0755_809_0	2011	1																															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	241.6640535	6.6409875	41.75863851	689.6923625	9.892933461	10.16042781	4.708384263	11.58439861	35.05407512	24.03919087	45.78249251	0	0.01231855	20.37064789	33.83028716	137.7191472	2.8918665	4.425299526	0	0	39.26323869	13.28366728	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.068189191	0.068189191	0.160723405	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.053656144	0.053656144	0.126468697	0	0.183341104	0.183341104	0.183341104	0.183341104	0.183341104	0.183341104	0.183341104	0	0.183341104	0.183341104	0.183341104	0.183341104	0.183341104	0.183341104	0	0	0.183341104	0.183341104	0	0	0	0	0	0	0	0												12.9668	0.35632978	5.281160591	0	1.813781338	1.862824048	0.863240367	2.123896424	6.426852815	4.407371782	8.393812699	0	0.002258497	3.734777063	6.20248218	25.24958043	0.530197995	0.811339299	0	0	7.198565509	2.435442218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6607	0	24.55591762	12.9668	0.35632978	5.281160591	0	1.813781338	1.862824048	0.863240367	2.123896424	6.426852815	4.407371782	8.393812699	0	0.002258497	3.734777063	6.20248218	25.24958043	0.530197995	0.811339299	0	0	7.198565509	2.435442218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6607	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9591	0.0264	0.6638	0	0.4068	0.4178	0.1936	0.4763	1.4413	0.9884	1.8825	0	0.0005	0.8376	1.3368	5.4419	0.1143	0.1749	0	0	1.5515	0.5249	0	0	0	0	0	0	0	0											17.4383	0	0	13.9258	0.382685754	5.944944272	0	2.220555484	2.280596932	1.056838049	2.600219637	7.868193903	5.395806748	10.27628107	0	0.002765006	4.572370173	7.539273117	30.69150019	0.644469001	0.986203327	0	0	8.750037461	2.960341282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0989
H0755_810_0	2011	1																															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	255.4291403	7.0188	45.83477805	810.4508563	11.62509088	11.93942092	5.532777025	13.61271529	41.19170624	28.24822179	53.79856626	0	0.014475409	23.93708275	39.52116734	160.8860557	3.35	5.169716778	0	0	45.86804183	15.51822588	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.068189191	0.068189191	0.160723405	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.053372136	0.053372136	0.125799284	0	0.182370659	0.182370659	0.182370659	0.182370659	0.182370659	0.182370659	0.182370659	0	0.182370659	0.182370659	0.182370659	0.182370659	0.182370659	0.182370659	0	0	0.182370659	0.182370659	0	0	0	0	0	0	0	0												13.6328	0.374608348	5.765982278	0	2.120075489	2.177400066	1.009016194	2.482559864	7.512158628	5.151646834	9.811280001	0	0.00263989	4.365421565	7.207501346	29.34089606	0.610941709	0.942804657	0	0	8.364985033	2.830069085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7028	0	28.78973892	13.6328	0.374608348	5.765982278	0	2.120075489	2.177400066	1.009016194	2.482559864	7.512158628	5.151646834	9.811280001	0	0.00263989	4.365421565	7.207501346	29.34089606	0.610941709	0.942804657	0	0	8.364985033	2.830069085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7028	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.6328	0.374608348	5.765982278	0	2.120075489	2.177400066	1.009016194	2.482559864	7.512158628	5.151646834	9.811280001	0	0.00263989	4.365421565	7.207501346	29.34089606	0.610941709	0.942804657	0	0	8.364985033	2.830069085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7028
H0755_811_0	2011	1																															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	294.2980688	7.0099	51.25174719	994.6776704	11.70990466	13.53098063	7.760782876	13.80834484	35.93491591	26.86409567	56.83460959	0	0.052159701	28.10104356	41.39558907	174.8796981	3.3335	5.712145131	0	0	56.84888173	15.80414033	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.068189191	0.068189191	0.160723405	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.052050845	0.052050845	0.122684973	0	0.177855856	0.177855856	0.177855856	0.177855856	0.177855856	0.177855856	0.177855856	0	0.177855856	0.177855856	0.177855856	0.177855856	0.177855856	0.177855856	0	0	0.177855856	0.177855856	0	0	0	0	0	0	0	0												15.3185	0.364871219	6.287819231	0	2.082675122	2.406564147	1.380300685	2.455894997	6.391235244	4.777936743	10.10836816	0	0.009276908	4.997935168	7.362447946	31.10337848	0.592882497	1.015938464	0	0	10.11090655	2.810858914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5778	0	33.97454267	15.3185	0.364871219	6.287819231	0	2.082675122	2.406564147	1.380300685	2.455894997	6.391235244	4.777936743	10.10836816	0	0.009276908	4.997935168	7.362447946	31.10337848	0.592882497	1.015938464	0	0	10.11090655	2.810858914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5778	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.3185	0.364871219	6.287819231	0	2.082675122	2.406564147	1.380300685	2.455894997	6.391235244	4.777936743	10.10836816	0	0.009276908	4.997935168	7.362447946	31.10337848	0.592882497	1.015938464	0	0	10.11090655	2.810858914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5778
H0755_812_0	2011	1																															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	250.7377902	7.0212	38.43282411	695.9963914	10.77157337	11.87904945	5.157994556	14.01624043	39.20410825	27.56892459	50.61706978	0	0.011956718	24.85486087	39.16971285	156.7259091	3.3549	4.676527625	0	0	43.47527131	14.72193365	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.068189191	0.068189191	0.160723405	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.053956375	0.053956375	0.12717635	0	0.184366985	0.184366985	0.184366985	0.184366985	0.184366985	0.184366985	0.184366985	0	0.184366985	0.184366985	0.184366985	0.184366985	0.184366985	0.184366985	0	0	0.184366985	0.184366985	0	0	0	0	0	0	0	0												13.5289	0.378838503	4.887746275	0	1.985922503	2.190104528	0.950963903	2.584131985	7.227943223	5.082799497	9.332116527	0	0.002204424	4.582415753	7.221601847	28.89508328	0.618532797	0.862197297	0	0	8.015404678	2.714238515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.0611	0	26.658289	13.5289	0.378838503	4.887746275	0	1.985922503	2.190104528	0.950963903	2.584131985	7.227943223	5.082799497	9.332116527	0	0.002204424	4.582415753	7.221601847	28.89508328	0.618532797	0.862197297	0	0	8.015404678	2.714238515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.0611	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.5289	0.378838503	4.887746275	0	1.985922503	2.190104528	0.950963903	2.584131985	7.227943223	5.082799497	9.332116527	0	0.002204424	4.582415753	7.221601847	28.89508328	0.618532797	0.862197297	0	0	8.015404678	2.714238515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.0611
H0838_020_0	2011	9																															Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	V	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	172.7793673	80.30950404	12.62279141	73.15222546	30.23194181	3.46148008	0	1127.322345	9.462921611	1391.924421	7.774241002	3084.195746	0.273210553	2436.700636	12175.05422	23939.43786	24355.75134	212.3128253	0.369962621	0	1.97973831	3.452417437	6823.563536	337.4512694	385.6585936	0	0	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0 	10a: 20.0%	11a: 20.0%	"11b: 20.0%,11c: 20.0%"	"4a1: $50,4a2: 20.0%"	"9a1: 20.0%,9b: 20.0%"	$0 	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	$0 	12: 20.0%	$0 	$0 	$0 	$0 	$0 	7d2: 20.0%	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0.065969708	0.065969708	0.153741144	0	0.2	0.2	0	49.76833977	0.2	0	0.2	0	0.2	0	0	0	0	0	0.2	0	0.2	0	0	0	0	0	0	0	0	0											NO	0.06442909	0.06442909	0.150150763	0	0.195329316	0.195329316	0	48.60607894	0.195329316	0	0.195329316	0	0.195329316	0	0	0	0	0	0.195329316	0	0.195329316	0	0	0	0	0	0	0	0	0												11.132	5.17426826	1.895321764	0	5.905184528	0.676128538	0	4.566226574	1.84838601	0	1.518537181	0	0.053366031	0	0	0	0	0	0.072264546	0	0.386700931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2284		0.79455226	11.132	5.17426826	1.895321764	0	5.905184528	0.676128538	0	4.566226574	1.84838601	0	1.518537181	0	0.053366031	0	0	0	0	0	0.072264546	0	0.386700931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2284	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	11.132	5.17426826	1.895321764	0	5.905184528	0.676128538	0	4.566226574	1.84838601	0	1.518537181	0	0.053366031	0	0	0	0	0	0.072264546	0	0.386700931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2284
H0901_004_0	2011	3																															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	1443.406507	313.2230795	1141.742898	765.3689551	229.4175786	10.80348781	0	302.5308677	401.6976592	2661.803038	2357.983353	143.0328559	2.12179314	0	3218.094764	5060.414101	442.3825984	700.1268732	0	0	249.8156512	0	0	0	1173.538606	92.5835469	53.3431208	11.7663694	202.8561134	0											3400	$250/day 1-7	$250/day 1-7	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$15 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 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; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$35 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$35 per visit	$35 per visit	$50 per visit	$35 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	180.7137695	180.7137695	47.8866492	15	150	0.05	0.05	49	250	0	25.125	35	25	35	0	35	35	26.25	50	35	$50 	0	0	0	0	0	0	0	0	0											NO	152.5832517	152.5832517	40.4324511	12.66504917	126.6504917	0.042216831	0	41.37249394	211.0841528	0	21.21395735	29.55178139	21.10841528	0	0	29.55178139	29.55178139	22.16383604	0	0	42.21683055	0	0	0	0	0	0	0	0	0												18.3533	3.982716332	3.846955325	0.807786287	2.42132076	0.456089014	0	1.043038041	7.066000839	0	4.16851319	0.352239641	0.003732308	0	0	12.46202094	1.08943282	1.293124769	0	0	0.878868752	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2251	0	10.73449036	18.3533	3.982716332	3.846955325	0.807786287	2.42132076	0.456089014	0	1.043038041	7.066000839	0	4.16851319	0.352239641	0.003732308	0	0	12.46202094	1.08943282	1.293124769	0	0	0.878868752	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2251	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			18.3533	3.982716332	3.846955325	0.807786287	2.42132076	0.456089014	0	1.043038041	7.066000839	0	4.16851319	0.352239641	0.003732308	0	0	12.46202094	1.08943282	1.293124769	0	0	0.878868752	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2251
H0901_801_0	2011	1																															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	YES	345.3343776	7.049740467	44.11614844	8.759209837	10.2712245	13.28172165	0	16.46419375	45.44035012	20.35639097	65.77946769	1.164674309	0.099865827	30.29356676	30.91946825	147.960948	4.00100174	9.424550868	0	0	78.60527499	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.066973886	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	0.05772792	0.05772792	0.125231615	0	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0	0	0	0	0	0	0	0												19.9354	0.406966855	5.524736531	0	2.062806796	2.667415718	0	3.306562987	9.125948229	4.088246892	13.21072604	0.233905712	0.020056412	6.083965489	6.209667527	29.71552701	0.803535506	1.892766298	0	0	15.78657885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.0748	0	19.39189803	19.9354	0.406966855	5.524736531	0	2.062806796	2.667415718	0	3.306562987	9.125948229	4.088246892	13.21072604	0.233905712	0.020056412	6.083965489	6.209667527	29.71552701	0.803535506	1.892766298	0	0	15.78657885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.0748	NO																																																																																		0			19.9354	0.406966855	5.524736531	0	2.062806796	2.667415718	0	3.306562987	9.125948229	4.088246892	13.21072604	0.233905712	0.020056412	6.083965489	6.209667527	29.71552701	0.803535506	1.892766298	0	0	15.78657885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.0748
H0901_802_0	2011	1																															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	YES	345.3343829	7.049740575	44.11614912	8.759209971	10.27122466	13.28172185	0	16.46419401	45.44035081	20.35639128	65.7794687	1.164674327	0.099865828	30.29356723	30.91946873	147.9609503	4.001001801	9.424551012	0	0	78.60527619	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.066973886	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	0.05772792	0.05772792	0.125231615	0	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0	0	0	0	0	0	0	0												19.9354	0.406966862	5.524736615	0	2.062806828	2.667415759	0	3.306563038	9.125948368	4.088246954	13.21072624	0.233905716	0.020056412	6.083965582	6.209667622	29.71552746	0.803535519	1.892766327	0	0	15.78657909	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.0749	0	19.39189833	19.9354	0.406966862	5.524736615	0	2.062806828	2.667415759	0	3.306563038	9.125948368	4.088246954	13.21072624	0.233905716	0.020056412	6.083965582	6.209667622	29.71552746	0.803535519	1.892766327	0	0	15.78657909	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.0749	NO																																																																																		0			19.9354	0.406966862	5.524736615	0	2.062806828	2.667415759	0	3.306563038	9.125948368	4.088246954	13.21072624	0.233905716	0.020056412	6.083965582	6.209667622	29.71552746	0.803535519	1.892766327	0	0	15.78657909	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.0749
H0908_001_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	209.6232787	18.04371879	54.60336205	0	14.60663437	13.52488901	6.43906025	51.39911471	19.38181902	9.702945687	15.44034606	0	2.010672435	29.4236103	24.42641296	37.5280889	3.594516431	2.184643893	13.63624649	39.2133208	17.66959154	16.13044294	0	0	0	0	0	0	0	0											3400	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a; No Cost-Sharing PBP; 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, No Cost-Sharing PBP; 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, No Cost-Sharing PBP; 14a"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											0	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	0.079441842	0.079441842	0.169398439	0	0.23233692	0.23233692	0.23233692	0.23233692	0.23233692	0.23233692	0.23233692	0	0.23233692	0.23233692	0.232360278	0.23233692	0.23233692	0.23233692	0.23233692	0.23233692	0.23233692	0.23233692	0	0	0	0	0	0	0	0												16.6529	1.433426262	9.249724298	0	3.393660444	3.142331058	1.496031427	11.94191201	4.503112137	2.254352517	3.58736245	0	0.467153441	6.836190996	5.675728095	8.719160594	0.835138877	0.507573434	3.168203512	9.110702185	4.10529848	3.747697432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.8276	0	0.287185638	16.6529	1.433426262	9.249724298	0	3.393660444	3.142331058	1.496031427	11.94191201	4.503112137	2.254352517	3.58736245	0	0.467153441	6.836190996	5.675728095	8.719160594	0.835138877	0.507573434	3.168203512	9.110702185	4.10529848	3.747697432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.8276	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.6529	1.433426262	9.249724298	0	3.393660444	3.142331058	1.496031427	11.94191201	4.503112137	2.254352517	3.58736245	0	0.467153441	6.836190996	5.675728095	8.719160594	0.835138877	0.507573434	3.168203512	9.110702185	4.10529848	3.747697432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.8276
H0913_002_0	2011	5																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	2063.951075	174.273915	853.7621765	368.3735776	411.1183726	2.264417434	9.514343243	417.5685828	245.5249026	2897.136814	832.0173072	32.64247061	0.12531526	463.5967483	9943.991865	11714.70389	195.7544402	1141.21059	3326.650787	3799.901228	11.89124375	8.87E-05	0	0	0	0	16.2	12.34285714	0	0											4000	"(1a) $200 days 1 - 8, $0 after day 8, unlimited coverage"	"(1b) $200 days 1 - 8, $0 after day 8, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $200.00 copayment	(12) 20% coinsurance	"(9a) $150.00 copayment , (9d) Copay between $35.00 and $150.00"	"(14b) , (14c) $0.00 copayment ; (7a) $15.00 copayment"	"(7d) , (7g) $35.00 copayment ; (7b) $0.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											0	124.9824654	72.64533465	42.62738291	0	42.44529325	0.2	0.084922112	49.16394711	104.3320925	0	21.71731244	44.06494498	0.2	23.42154709	6.823545112	6.882106999	26.42825312	4.37872318	5.627221054	4.626444967	0.2	0	0	0	0	0	0	0	0	0											NO	120.7699884	70.19685678	41.19064641	0	41.014694	0.193259091	0.082059851	47.5068987	100.8156269	0	20.98534033	42.5797561	0.193259091	22.63213452	6.593560636	6.650148721	25.5375009	4.231140312	5.437558135	4.470512749	0.193259091	0	0	0	0	0	0	0	0	0												20.7719	1.019456754	2.930584661	0	1.405157854	0.437619255	0.780745593	1.653115697	2.062728915	0	1.455013862	0.115825703	0.024218313	0.874348664	5.463859443	6.49204359	0.416589933	0.402385178	1.507404754	1.415625574	2.29809096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5268	0	1.797261851	20.7719	1.019456754	2.930584661	0	1.405157854	0.437619255	0.780745593	1.653115697	2.062728915	0	1.455013862	0.115825703	0.024218313	0.874348664	5.463859443	6.49204359	0.416589933	0.402385178	1.507404754	1.415625574	2.29809096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5268	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	20.7719	1.019456754	2.930584661	0	1.405157854	0.437619255	0.780745593	1.653115697	2.062728915	0	1.455013862	0.115825703	0.024218313	0.874348664	5.463859443	6.49204359	0.416589933	0.402385178	1.507404754	1.415625574	2.29809096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5268
H0913_003_0	2011	6																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	P	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	Yes	2285.653897	502.7465801	1118.421374	349.1115471	18.38897934	6.710455492	10.38165127	26.44579604	38.50688811	3542.682816	12.07788628	0.030804779	0.074200002	14.37030463	10512.29652	115.9915278	11.15871033	6.781306384	25.87853646	28.60165145	12.63703472	0.004828723	530	0	342	205.2	16.2	12.34285714	1257.142857	3669.745112											6700	FFS	FFS	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) $0.00 copayment	(8b) 20% coinsurance	(5) 45% coinsurance	(12) 20% coinsurance	"(9a) , (9d) 20% coinsurance"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7d) , (7g) 20% coinsurance ; (7b) $0.00 copayment"	"(7e) , (7h) 45% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) 20% coinsurance"	(15) 20% coinsurance	(13a) 20% coinsurance	(10b) $0.00 copayment	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	"(13b) , (13c) $0.00 copayment"											0	101.9101905	38.88572258	36.65131054	0	0.137084866	0.183601001	0.183600179	0.127566797	0.120866695	0	0.142243261	0.387058512	0.1836	0.116221009	0	0.052895378	0.323447771	0.116849335	0.12253065	0.109305072	0.183601581	0.163029214	0	0	0	0	0	0	0	0											NO	100.3783695	38.30122787	36.10040146	0	0.135024331	0.180841278	0.180840469	0.125649329	0.119049937	0	0.14010519	0.381240601	0.180840292	0.114474081	0	0.052100303	0.318585999	0.115092962	0.120688881	0.107662098	0.180841849	0.160578707	0	0	0	0	0	0	0	0												19.1192	1.604650944	3.364621718	0	2.482959641	1.213527346	1.877422679	3.322896521	4.584242595	0	1.692174555	0.011744032	0.01341835	1.645027411	0	6.043193782	3.555008878	0.780480639	3.123251602	3.079313805	2.285304724	0.00077539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.7992	0	0.912563846	19.1192	1.604650944	3.364621718	0	2.482959641	1.213527346	1.877422679	3.322896521	4.584242595	0	1.692174555	0.011744032	0.01341835	1.645027411	0	6.043193782	3.555008878	0.780480639	3.123251602	3.079313805	2.285304724	0.00077539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.7992	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	19.1192	1.604650944	3.364621718	0	2.482959641	1.213527346	1.877422679	3.322896521	4.584242595	0	1.692174555	0.011744032	0.01341835	1.645027411	0	6.043193782	3.555008878	0.780480639	3.123251602	3.079313805	2.285304724	0.00077539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.7992
H0979_021_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	O	V	V	V	V	P	P	Coin	O	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	1546.84683	74.38750449	1044.441905	164.3824072	379.3984409	8.699434757	18.42078238	346.0528908	328.8502616	792.5211292	21.04524594	68.41045588	0	454.8695224	5123.118104	11908.63144	316.0126279	718.9501384	0	0	40.15692618	20.035648	0	425	468.4931309	43.05532868	30.69290757	0	0	0											3400	1a1: $225.36	1b1: $157.64	21: $40.74	6: $10	10a: $100	11a: 20.0%	"11b: 20.0%,11c: 20.0%"	"4a1: $50,4a2: $500,4b: $22.5"	"9a1: $250,9b: $100"	"8a1: $15,8a2: $15"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: $300,9a2: $250"	12: 20.0%	"3: $35,9a3: $250,9c: $35,9d1: $35"	7a: $10	"7b1: $35,7d1: $35,7f1: $35,7g: $35,17b1: $10"	"7c: $35,7i: $35"	"7e: $35,7h: $35"	7d2: $35	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16a1: $1.225	$0 	17b2: $10	$0 	$0 	$0 	$0 												225.36	157.64	40.74	10	100	0.2	0.2	48.98265896	181.5693431	15	0.2	250	0	146.9818617	6.586262029	31.75734509	35	35	0	0	0.2	0	0	1.225	0	10	0	0	0	0											NO	186.9489167	130.7713313	33.79614335	8.295567832	82.95567832	0.165911357	0.165911357	40.633897	150.6220802	12.44335175	0.165911357	207.3891958	0	121.9298004	5.463678343	26.34452104	29.03448741	29.03448741	0	0	0.165911357	0	0	1.016207059	0	8.295567832	0	0	0	0												24.0984	0.810646083	2.941509028	0.113637117	2.622771251	1.443335023	3.056216995	1.171789794	4.127675872	0.821801598	3.491645304	1.182299119	0	4.62184584	2.332589119	26.14393263	0.764605389	1.739529062	0	0	6.662490102	0	0	0.035990667	0	0.029764033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2125		18.13440787	24.0984	0.810646083	2.941509028	0.113637117	2.622771251	1.443335023	3.056216995	1.171789794	4.127675872	0.821801598	3.491645304	1.182299119	0	4.62184584	2.332589119	26.14393263	0.764605389	1.739529062	0	0	6.662490102	0	0	0.035990667	0	0.029764033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2125	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			24.0984	0.810646083	2.941509028	0.113637117	2.622771251	1.443335023	3.056216995	1.171789794	4.127675872	0.821801598	3.491645304	1.182299119	0	4.62184584	2.332589119	26.14393263	0.764605389	1.739529062	0	0	6.662490102	0	0	0.035990667	0	0.029764033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2125
H0979_022_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	O	V	V	V	V	P	P	Coin	O	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	1361.142367	65.45702004	919.05294	144.6477147	333.8503088	7.655036678	16.20930195	304.5080107	289.3706182	697.3761493	18.55233047	60.19753737	0	400.2608186	4507.692762	10478.95789	278.0741881	632.6376176	0	0	35.33594439	17.63029721	0	0	412.2488645	37.88638336	27.00811487	0	0	0											3400	1a1: $206.58	1b1: $144.51	21: $40.74	6: $10	10a: $100	11a: 20.0%	"11b: 20.0%,11c: 20.0%"	"4a1: $50,4a2: $500,4b: $22.5"	"9a1: $250,9b: $100"	"8a1: $15,8a2: $15"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: $275,9a2: $250"	12: 20.0%	"3: $35,9a3: $250,9c: $35,9d1: $35"	7a: $10	"7b1: $35,7d1: $35,7f1: $35,7g: $35,17b1: $10"	"7c: $35,7i: $35"	"7e: $35,7h: $35"	7d2: $35	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16a1: $1.225	$0 	17b2: $10	$0 	$0 	$0 	$0 												206.58	144.51	40.74	10	100	0.2	0.2	48.98265896	181.5693431	15	0.2	250	0	147.2455146	6.58681257	31.75977239	35	35	0	0	0.2	0	0	1.225	0	10	0	0	0	0											NO	176.4088925	123.4042456	34.78990357	8.53949523	85.3949523	0.170789905	0.170789905	41.82871825	155.0510539	12.80924284	0.170789905	213.4873807	0	125.7402369	5.624805452	27.12124248	29.8882333	29.8882333	0	0	0.170789905	0	0	1.016207059	0	8.53949523	0	0	0	0												20.0098	0.673139515	2.664480263	0.102934872	2.375760933	1.307402984	2.768385133	1.061431649	3.738934944	0.744405037	3.168550751	1.070951215	0	4.194074181	2.112907902	23.68352982	0.692595517	1.575701726	0	0	6.035022571	0	0	0	0	0.026960882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.007		13.34148573	20.0098	0.673139515	2.664480263	0.102934872	2.375760933	1.307402984	2.768385133	1.061431649	3.738934944	0.744405037	3.168550751	1.070951215	0	4.194074181	2.112907902	23.68352982	0.692595517	1.575701726	0	0	6.035022571	0	0	0	0	0.026960882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.007	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			20.0098	0.673139515	2.664480263	0.102934872	2.375760933	1.307402984	2.768385133	1.061431649	3.738934944	0.744405037	3.168550751	1.070951215	0	4.194074181	2.112907902	23.68352982	0.692595517	1.575701726	0	0	6.035022571	0	0	0	0	0.026960882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.007
H1013_011_0	2011	6																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	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	1416.96931	0	804.3107389	0	512.2315029	0	0	249.9846673	388.2682315	0	1842.132271	106.3333176	0.841035343	84.05767216	8307.598359	13412.94137	0	0	0	0	790.7722112	0	0	701.3173445	0	0	0	0	0	0											3400	$0 	$0 	(2) $15 days 11-100	0	$0 	0	0	(4a) $50	(9a) $100 @ Hospital	0	"(8a,8b) $50 @ Hosp (Diag); (8b) $25 @ Hosp (Therapy)"	(9a) $100 copay	(12) 20%	"(7c, 7i, 8b) $25 @ Hospital"	0	0	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20% chemo; $50 Part B Rx	0	0	"Various copays L. 16 a,b"	0	0	Not covered	0	0	0											0	0	0	7.138659195	0	0	0	0	50	31.59966045	0	3.119863607	50	0.2	12.34313648	0	0	0	0	0	0	82.77529066	0	0	79.65242276	0	0	0	0	0	0											NO	0	0	7.127015207	0	0	0	0	49.91844415	31.54811771	0	3.114774745	49.91844415	0.199673777	12.32300338	0	0	0	0	0	0	82.64027448	0	0	79.65242276	0	0	0	0	0	0												0	0	0.477694572	0	0	0	0	1.039903805	1.020760989	0	0.478152256	0.442332815	0.167932703	0.086320248	0	0	0	0	0	0	5.445802715	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.814	0	0.014963645	0	0	0.477694572	0	0	0	0	1.039903805	1.020760989	0	0.478152256	0.442332815	0.167932703	0.086320248	0	0	0	0	0	0	5.445802715	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.814	NO																																																																																		0	0	0	0	0	0.477694572	0	0	0	0	1.039903805	1.020760989	0	0.478152256	0.442332815	0.167932703	0.086320248	0	0	0	0	0	0	5.445802715	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.814
H1013_021_0	2011	7																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	YES	1205.213134	0	904.3316468	0	537.4552082	0	0	340.6534247	260.914462	0	1370.382975	98.14515057	0.114052742	86.36399384	14491.88778	13327.50673	0	0	0	0	848.686047	0	0	144.6015143	0	0	0	0	0	0											6700	(1a) $100 (days 1-10)	0	"(2) $35 days 1-20, $100 days 21-100"	0	(10a) $50	0	0	(4a) $50	"(9a,9b) $150 @ Hospital; $50 ASC"	0	"$150 (L.8a Diag, 8b. MRI/CT @ Hosp); $25 (L.8a diag @ freest.), $55 (Therapy) L.8b"	(9a) $150 copay	(12) 20%	"(7c,7i) $50 @ Hospital; (8b) $55 @ Hospital"	0	"(7b,7c,7d,7g,7i) $10"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20% chemo; $50 Part B Rx	0	Not covered	0	0	0	Not covered	Not covered	0	0											0	88.86258831	0	48.44273218	0	50	0	0	50	98.60770996	0	33.52798263	50	0.2	46.05058007	0	5.357417207	0	0	0	0	107.3585432	0	0	0	0	0	0	0	0	0											NO	87.64683988	0	47.77997661	0	49.31593911	0	0	49.31593911	97.2586364	0	33.069279	49.31593911	0.197263756	45.42055205	0	5.284121216	0	0	0	0	105.8897476	0	0	0	0	0	0	0	0	0												8.8028	0	3.600745411	0	2.208759027	0	0	1.399970296	2.114682066	0	3.776464745	0.403343356	0.022498472	0.32689169	0	5.868680089	0	0	0	0	7.488929278	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.0137	0	0.499546008	8.8028	0	3.600745411	0	2.208759027	0	0	1.399970296	2.114682066	0	3.776464745	0.403343356	0.022498472	0.32689169	0	5.868680089	0	0	0	0	7.488929278	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.0137	NO																																																																																		0	0	0	8.8028	0	3.600745411	0	2.208759027	0	0	1.399970296	2.114682066	0	3.776464745	0.403343356	0.022498472	0.32689169	0	5.868680089	0	0	0	0	7.488929278	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.0137
H1013_024_0	2011	6																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	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	1828.824092	0	971.8915509	0	1639.866886	0	0	554.2452325	288.6390942	0	1707.471394	125.3549496	0	125.9072482	9919.510605	14759.01579	0	0	0	0	802.5482892	0	0	2320.763854	0	0	0	0	0	0											3400	0	0	0	0	0	0	0	0	0	0	0	0	(12) 20%	0	0	0	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0.2	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
H1013_802_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	334.5695868	0	24.84801756	5.2	11.19886443	10.38665075	0	22.49299773	69.16933138	0	0	0	0	79.24925932	0	0	0	0	0	423.1217872	53.77343551	0	0	0	0	0	0	0	0	0											6700	FFS	included in a.1	FFS	FFS	FFS	FFS	included in e.1.	FFS	FFS	included in h.5	included in h.5	included in h.5	included in h.5	FFS	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	FFS	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered											0	0.076066257	0	0.159529212	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	0	0	0	0	0	0	0	0	0	0	NO	0.055957505	0	0.117356328	0	0.171404498	0.171404498	0	0.171404498	0.171404498	0	0	0	0	0.171404498	0	0	0	0	0	0.171404498	0.171404498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		18.7217	0	2.916072102	0	1.919535737	1.780318659	0	3.855400988	11.85593453	0	0	0	0	13.58367953	0	0	0	0	0	72.5249776	9.217008728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.3746	0	49.00724574	18.7217	0	2.916072102	0	1.919535737	1.780318659	0	3.855400988	11.85593453	0	0	0	0	13.58367953	0	0	0	0	0	72.5249776	9.217008728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.3746	NO																																																																																		0	0	0	18.7217	0	2.916072102	0	1.919535737	1.780318659	0	3.855400988	11.85593453	0	0	0	0	13.58367953	0	0	0	0	0	72.5249776	9.217008728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.3746
H1013_803_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	334.5695868	0	24.84801756	5.2	11.19886443	10.38665075	0	22.49299773	69.16933138	0	0	0	0	79.24925932	0	0	0	0	0	423.1217872	53.77343551	0	0	0	0	0	0	0	0	0											6700	FFS	included in a.1	FFS	FFS	FFS	FFS	included in e.1.	FFS	FFS	included in h.5	included in h.5	included in h.5	included in h.5	FFS	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	FFS	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered											0	0.076066257	0	0.159529212	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	0	0	0	0	0	0	0	0	0	0	NO	0.055957505	0	0.117356328	0	0.171404498	0.171404498	0	0.171404498	0.171404498	0	0	0	0	0.171404498	0	0	0	0	0	0.171404498	0.171404498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		18.7217	0	2.916072102	0	1.919535737	1.780318659	0	3.855400988	11.85593453	0	0	0	0	13.58367953	0	0	0	0	0	72.5249776	9.217008728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.3746	0	49.00724574	18.7217	0	2.916072102	0	1.919535737	1.780318659	0	3.855400988	11.85593453	0	0	0	0	13.58367953	0	0	0	0	0	72.5249776	9.217008728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.3746	NO																																																																																		0	0	0	18.7217	0	2.916072102	0	1.919535737	1.780318659	0	3.855400988	11.85593453	0	0	0	0	13.58367953	0	0	0	0	0	72.5249776	9.217008728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.3746
H1013_805_0	2011	2																															Coin	Coin	Coin	Coin	Coin	Coin	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	334.5695868	0	24.84801756	5.2	11.19886443	10.38665075	0	22.49299773	69.16933138	0	0	0	0	79.24925932	0	0	0	0	0	423.1217872	53.77343551	0	0	0	0	0	0	0	0	0											6700	FFS	included in a.1	FFS	FFS	FFS	FFS	included in e.1.	FFS	FFS	included in h.5	included in h.5	included in h.5	included in h.5	FFS	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	FFS	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered											0	0.076066257	0	0.159529212	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	0	0	0	0	0	0	0	0	0	0	NO	0.055957505	0	0.117356328	0	0.171404498	0.171404498	0	0.171404498	0.171404498	0	0	0	0	0.171404498	0	0	0	0	0	0.171404498	0.171404498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		18.7217	0	2.916072102	0	1.919535737	1.780318659	0	3.855400988	11.85593453	0	0	0	0	13.58367953	0	0	0	0	0	72.5249776	9.217008728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.3746	0	49.00724574	18.7217	0	2.916072102	0	1.919535737	1.780318659	0	3.855400988	11.85593453	0	0	0	0	13.58367953	0	0	0	0	0	72.5249776	9.217008728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.3746	NO																																																																																		0	0	0	18.7217	0	2.916072102	0	1.919535737	1.780318659	0	3.855400988	11.85593453	0	0	0	0	13.58367953	0	0	0	0	0	72.5249776	9.217008728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.3746
H1016_001_0	2011	10																															D	Coin	D	P	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	P	P	Coin	V	T	V	V	P	V	P	P	V																																																			0	YES	1384.745783	0.243387679	620.8800021		222.3913088	0.328736389		204.9793946	447.004442		64.67266183	119.1946336	0.732014904	1.516894132	0.093670384	6137.74815	2.06074844	1418.347355	3970.968574		103.3118937				0.281011151	926.8584156															3400	(1a) $100/day for days 6 - 23	(1b) $150/day for days 1 - 10	(2) $135/day for days 21 - 100	(6) $0.00	(10a) $100/Trip	(11a) 20%	(11b) $0.00; (11c) 20%	(4a) $50/visit (waived if admitted); (4b) $25/visit (waived if admitted)	(9a) $100/visit	"(8a) $0.00 Lab, $25-$100 for Diagnostic Tests"	"(8b) $25/X-ray, 20% for Therapeutic Services, 20% for Diagnostic Services, $50/proc for Radiation Therapy"	"(9a) $25/visit to ASC, $100/visit to Hospital"	(12) 20%	"(3) $5/visit; (5) $15/day; (9b) $25/visit to ASC, $100/visit to Hospital (9c) $15/visit; (9d) $5/visit; (13e) $0.00"	(7a) $0/visit; (8b) 20%; (14b) $0.00; (14c) $0.00; (14d) $0.00; (14e) $0.00; (14f) $0.00; (14g) $0.00; (14h) $0.00; (17a1) $5/visit	(7b) $5/visit; (7d) $0-5/visit; (7f) $5/visit; (8b) 20%; (14i) $0.00 (14j) $0.00	(7e) $15/visit; (7h) $15/visit	(7c) $5/visit; (7i) $5/visit	"(8b) $25/X-ray, 20% forTherapeutic Services, 20% fo Diagnostic Services"	"(7g) $0.00, (16b) $5/visit"	(15) 20%	(13a) $0.00; (13b) $5/visit	(10b) Not Covered	"(16a) $0.00, 2exams, 2 cleanings, 2 flouride treatments, 1 x-ray"	(17a) $5/visit	(17b) $10/one Pair/year	(18a) $5/Visit	(18b) Not Covered	(14a) $0.00	"(13b) not covered, (13c) not covered, (13d) not covered"												42.1	0.023190125	38.01		99.9527826	0.2		49.72435283	62.5		0.12255042	62.5	0.2	0.005290363	5	4.045904947	15	5	18.40142386		0.2				5	10															NO	36.94061753	0.02034816	33.3518497		87.70418633	0.175489869		43.63060094	54.84058422		0.107531786	54.84058422	0.175489869	0.004642025	4.387246737	3.550076656	13.16174021	4.387246737	16.14631736		0.175489869				5	10																4.2628	0.004952491	1.725624709	0	1.625387399	0.057689906	0	0.745281181	2.042832062	0	6.954366858	0.544725278	0.1284612	0.007041461	3.42E-05	1.815789702	0.002260253	0.518553317	5.343043235	0	18.13019074	0	0	0	0.000117088	0.772382013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6815	0	6.132622623	4.2628	0.004952491	1.725624709	0	1.625387399	0.057689906	0	0.745281181	2.042832062	0	6.954366858	0.544725278	0.1284612	0.007041461	3.42E-05	1.815789702	0.002260253	0.518553317	5.343043235	0	18.13019074	0	0	0	0.000117088	0.772382013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6815	NO																																																																																		0	0	0	4.2628	0.004952491	1.725624709	0	1.625387399	0.057689906	0	0.745281181	2.042832062	0	6.954366858	0.544725278	0.1284612	0.007041461	3.42E-05	1.815789702	0.002260253	0.518553317	5.343043235	0	18.13019074	0	0	0	0.000117088	0.772382013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6815
H1016_002_0	2011	9																															D	D	D	P	T	Coin	P	V	V	Coin	Coin	V	Coin	V	V	V	V	V	P	P	Coin	V	T	V	V	P	V	P	P	V																																																			0	YES	1335.850892	1.560695021	742.0420568		297.7353488	0.000361092		193.3361987	457.9898422		43.76399077	142.2753056	0.295791002	50.69727267		5625.390134	0.119861252	677.3359325	4297.900341		121.743042					974.2867335															3400	(1a) $100/day for days 6 - 23	(1b) $150/day for days 1-10	(2) $135/day for days 21 - 100	(6) $0.00	(10a) $100/Trip	(11a) 20%	(11b) $0.00; (11c) 20%	(4a) $50/visit (waived if admitted); (4b) $25/visit (waived if admitted)	"(9a) $100/visit to Hospital Facility, $25/visit to ASC"	"(8a) $0.00 Lab, $25-$100 for Diagnostic Tests"	"(8b) $25/X-ray, $25-$100,20% forTherapeutic Services; $25-$100, 20% fo Diagnostic Services, $50/proc for Radiation Therapy"	"(9a) $100/visit to Hospital Facility, $25/visit to ASC"	(12) 20%	"(3) $5/visit; (5) $15/day; (9b) $25/visit to ASC, $100/visit to Hospital Facility(9c) $15/vistit; (9d) $5/visit; (13e) $0.00"	(7a) $0/visit; (14b) $0.00; (14c) $0.00; (14d) $0.00; (14e) $0.00; (14f) $0.00; (14g) $0.00; (14h) $0.00	(7b) $5/visit; (7d) $0-$5/visit; (7f) $5/visit; (14i) $0.00 (14j) $0.00	(7e) $15/visit; (7h) $15/visit	(7c) $5/visit; (7i) $5/visit	"(8b) $25/X-ray, $25-$100,20% forTherapeutic Services; $25-$100, 20% fo Diagnostic Services, $50/proc for Radiation Therapy"	(7g) $0.00	(15) 20%	(13a) $0.00; (13b) $0.00	(10b) Not Covered	(16a) $0.00; (16b) $0.00	(17a) $5/visit	(17b) $10/one Pair/year	(18a) $5/Visit	(18b) Not Covered	(14a) $0.00	(13c) $0.00; (13d) $0.00; (13e) $0.00												42.1	58.98	38.01		100	0.2		48.62058277	62.5		0.15016239	62.5	0.2	5.022846301		4.050279915	15	5	15.80815253		0.2					10															NO	36.59640533	51.2697384	33.04107759		86.92732858	0.173854657		42.26457374	54.32958036		0.130532154	54.32958036	0.173854657	4.366226108		3.52080013	13.03909929	4.346366429	13.74160469		0.173854657					10																4.0739	0.006668035	2.043155765	0	2.156778208	6.28E-05	0	0.680939336	2.073532995	0	5.712608002	0.644146471	0.051424643	0.018446313	0	1.650489526	0.00013024	0.24532918	4.921670625	0	21.16559482	0	0	0	0	0.811905611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2568	0	6.834289547	4.0739	0.006668035	2.043155765	0	2.156778208	6.28E-05	0	0.680939336	2.073532995	0	5.712608002	0.644146471	0.051424643	0.018446313	0	1.650489526	0.00013024	0.24532918	4.921670625	0	21.16559482	0	0	0	0	0.811905611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2568	NO																																																																																		0	0	0	4.0739	0.006668035	2.043155765	0	2.156778208	6.28E-05	0	0.680939336	2.073532995	0	5.712608002	0.644146471	0.051424643	0.018446313	0	1.650489526	0.00013024	0.24532918	4.921670625	0	21.16559482	0	0	0	0	0.811905611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2568
H1019_001_0	2011	3																															D	D	D	V	T	Coin	O	V	V	V	V		Coin	V	V	V	V	V		V	Coin	Coin	T	V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0		0	0											0	YES	1847.645684	31.165029	2517.990541	1947.20373	969.62388	1.664922	461.72149	620.58101	1020.733375	4735.397072	2103.193583		0.008477	619.523049	7734.737564	12586.59271	328.321996	664.810532		414.555726	27.076868	0	1.8	4.17	2.5		0.4		2.37	3.8											5000	$25/Day(Days 1-5):1a.IP Acute	$25/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$75/Visit:9b. $0 Surgery ASC -- Physician,9b. $25 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $75 Surgery OP -- Facility"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0-$125/Visit:8b, 9a. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $25 Radiology OP -- Facility"		"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$10/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN863: Dental 16a, 16b"	"VIS841: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c												15.4778	12.460275	34.44565	0	150	0.044921971	0	50	11.187406	0	13.3371		0	12.221999	0	10	10	10		0	0.155166	0	0	0	0		0		0	0											NO	14.72496	11.854207	24.062904	0	143.61015	0.04300834	0	47.87005	10.710834	0	12.768953		0	11.701354	0	9.57401	9.57401	9.57401		0	0.148556	0	0	0	0		0		0	0												2.2672	0.030786392	5.049180388	0	11.6039859	0.071605531	0	2.475603665	0.911075478	0	2.237965001	0	0	0.604104876	0	10.04201371	0.261946506	0.530408557	0	0	4.022431203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1083	0	3.750629025	2.2672	0.030786392	5.049180388	0	11.6039859	0.071605531	0	2.475603665	0.911075478	0	2.237965001	0	0	0.604104876	0	10.04201371	0.261946506	0.530408557	0	0	4.022431203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1083	NO																																																																																		0	0	0	2.2672	0.030786392	5.049180388	0	11.6039859	0.071605531	0	2.475603665	0.911075478	0	2.237965001	0	0	0.604104876	0	10.04201371	0.261946506	0.530408557	0	0	4.022431203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1083
H1019_004_0	2011	3																															D	D	D	V	T	Coin	O	V	V	V	V		Coin	V	V	V	V	V		V	Coin	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	YES	1105.75831	13.42342722	1233.108222	1049.204614	384.8387172	1.070536504	208.2603399	393.5250793	816.6997434	3367.357219	1439.983163		0.00169958	355.2108952	5244.039208	7934.920731	129.1267664	481.05299		309.1130924	25.14170896	0			1.3				2.37	0.58											5000	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $45(Days 8-100):2. $0 SNF 1,2. $45 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"		"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$25-$100/Visit:9d. $25 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $25 OP Other,5. $25 Partial Hospitalization,7h. $25 Psych -- OP,8b. $50 Rad therapy,3, 7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"			"VIS842: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d												165.92202	145.11002	31.001085	0	150	0.044921971	0	50	24.323456	0	10.4786		0	26.705484	0	25	25	25		0	0.1698	0			0				0	0											NO	158.701591	138.795267	25.920038	0	143.52165	0.042981836	0	47.84055	23.272951	0	10.02604		0	25.552101	0	23.920275	23.920275	23.920275		0	0.162467	0			0				0	0												14.6238	0.155259014	2.663517664	0	4.602723974	0.046013624	0	1.568871353	1.583917759	0	1.203110733	0	0	0.756365389	0	15.81712383	0.257395647	0.958909984	0	0	4.084698029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3217	0	2.586284423	14.6238	0.155259014	2.663517664	0	4.602723974	0.046013624	0	1.568871353	1.583917759	0	1.203110733	0	0	0.756365389	0	15.81712383	0.257395647	0.958909984	0	0	4.084698029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3217	NO																																																																																		0	0	0	14.6238	0.155259014	2.663517664	0	4.602723974	0.046013624	0	1.568871353	1.583917759	0	1.203110733	0	0	0.756365389	0	15.81712383	0.257395647	0.958909984	0	0	4.084698029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3217
H1019_006_0	2011	5	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin	T	V	V		V		O	O	O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0	0										0	YES	431.572705	9.529315	1466.792232	1574.491028	774.215449	0.906122	6.561365	391.702269	1157.486599	5232.709039	2270.684025	0	0.012859	1184.6016	6816.681001	17472.20679	385.02513	302.225266		218.056778	13.163785	0	1.25	11.52	3.44		0.4		2.37	6.12	124.733414										3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	"$0/Day(Days 1-7) $15(Days 8-100):2. $0 SNF 1,2. $15 SNF 2"	$0/Visit:6.Home Health	$25/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	0% Coins:11c.Diabetic Monitoring Supplies	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$25/Visit:8b, 9a. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $25 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $25 Radiology OP -- Facility"	$0/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$25/Visit:9d. $0 Cardiac Rehab,8b. $25 Nuclear Medicine,9a. $0 OP Other,5. $0 Partial Hospitalization,7h. $0 Psych -- OP,8b. $0 Rad therapy,3, 7c, 7d, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN871: Dental 16a, 16b"	"VIS841: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	"$0/Service:11b.Prosthetics, 11b.Supplies"											0	0	10.333695	0	25	0.044921971	0	50	2.120942	0	1.922048	0	0.076631	0.095909	0	0	0	0		0	0.147797	0	0	0	0		0		0	0	0										NO	0	0	10.325407	0	24.963375	0.04485616	0	49.92675	2.117835	0	1.919232	0	0.076519	0.095768	0	0	0	0		0	0.147581	0	0	0	0		0		0	0	0											0	0	1.262102232	0	1.610585882	0.040645153	0	1.629701772	0.204280469	0	0.36316412	0	0.000983958	0.009453911	0	0	0	0	0	0	1.942724554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.0636	0	0.009465107	0	0	1.262102232	0	1.610585882	0.040645153	0	1.629701772	0.204280469	0	0.36316412	0	0.000983958	0.009453911	0	0	0	0	0	0	1.942724554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.0636	NO																																																																																		0	0	0	0	0	1.262102232	0	1.610585882	0.040645153	0	1.629701772	0.204280469	0	0.36316412	0	0.000983958	0.009453911	0	0	0	0	0	0	1.942724554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.0636
H1019_010_0	2011	4																															D	D	D	V	T	Coin	O	V	V	V	V		Coin	V	V	V	V	V		V	Coin	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	YES	1654.834591	23.870392	1879.309578	1273.500668	651.887041	1.580542	316.523323	545.313372	1217.308491	5090.522815	2804.441575		0	810.69475	6509.314033	13364.74472	247.301661	774.187467		696.629521	50.793859	0			2.45				0.07	0.58											6700	$125/Day(Days 1-10):1a.IP Acute	$125/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0-$125/Visit:8b, 9a. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"		"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$20-$125/Visit:9d. $20 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $75 OP Other,5. $20 Partial Hospitalization,7h. $20 Psych -- OP,8b. $25 Rad therapy,3, 7c, 7d, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$20/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$20/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"			"VIS841: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d												101.003875	91.082625	34.44565	0	150	0.044921971	0	50	31.783219	0	19.191567		0	50.738864	0	20	20	20		0	0.107566	0			0				0	0											NO	96.113166	86.672313	27.529687	0	142.51755	0.042681128	0	47.50585	30.197777	0	18.234234		0	48.207858	0	19.00234	19.00234	19.00234		0	0.1022	0			0				0	0												13.2543	0.172408507	4.311400372	0	7.742111997	0.067459316	0	2.158797938	3.063334196	0	4.26140366	0	0	3.256821449	0	21.16345193	0.391609187	1.225947789	0	0	5.19113239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.2602	0	4.310280588	13.2543	0.172408507	4.311400372	0	7.742111997	0.067459316	0	2.158797938	3.063334196	0	4.26140366	0	0	3.256821449	0	21.16345193	0.391609187	1.225947789	0	0	5.19113239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.2602	NO																																																																																		0	0	0	13.2543	0.172408507	4.311400372	0	7.742111997	0.067459316	0	2.158797938	3.063334196	0	4.26140366	0	0	3.256821449	0	21.16345193	0.391609187	1.225947789	0	0	5.19113239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.2602
H1019_014_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	Part B Rx								Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	Coin	V	V	V	V		V	Coin	Coin			V				O	O	O	V	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	YES	1905.092843	66.47144	1603.902085	1002.963276	473.090038	2.028281	3.198558	680.514149	1559.945717	4407.251963	2764.861139		0	17.255652	8145.172731	15014.83411	238.433625	645.750224		640.264841	25.061338	0			2				0.07	0.58	124.965701	665.300023	119.565118								6700	$170/Day(Days 1-10):1a.IP Acute	$170/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$125/Visit:8b, 9a. $125 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $125 Radiology OP -- Facility"		"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$35/Visit:7b. $25 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS842: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$125/Visit:9d. $35 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $35 Partial Hospitalization,7h. $35 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	$0/Script:15.Part B Rx - Chemo									137.36527	123.87237	34.44565	0	150	0	0.2	50	30.393564	0	24.869284		0	0.2	0	34.966079	35	35		0	0.2	0			0				0	0	0	114.984935	0								NO	124.673269	112.427059	24.957079	0	135.10035	0	0.180134	45.03345	27.374541	0	22.398993		0	0.180134	0	31.492863	31.523415	31.523415		0	0.180134	0			0				0	0	0	103.563366	0									19.7928	0.622765709	3.33572592	0	5.326219143	0	0.576169047	2.553824992	3.558566499	0	5.160842108	0	0	3.108329617	0	39.40500946	0.626353509	1.696354358	0	0	4.514399059	0	0	0	0	0	0	0	0	0	0	5.741725815	0	0	0	0	0	0	0	0	96.0191	0	11.31669087	19.7928	0.622765709	3.33572592	0	5.326219143	0	0.576169047	2.553824992	3.558566499	0	5.160842108	0	0	3.108329617	0	39.40500946	0.626353509	1.696354358	0	0	4.514399059	0	0	0	0	0	0	0	0	0	0	5.741725815	0	0	0	0	0	0	0	0	96.0191	NO																																																																																		0	0	0	19.7928	0.622765709	3.33572592	0	5.326219143	0	0.576169047	2.553824992	3.558566499	0	5.160842108	0	0	3.108329617	0	39.40500946	0.626353509	1.696354358	0	0	4.514399059	0	0	0	0	0	0	0	0	0	0	5.741725815	0	0	0	0	0	0	0	0	96.0191
H1019_023_0	2011	4																															A	A	A	V	T	O	O	V	V	V	V		P	V	V	V	V	V		V	S	Coin	T	V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0		0	0											0	YES	551.6560646	0.855775632	170.2008895	1877.181791	2604.555994	221.3238293	576.0390347	1163.944079	1228.111412	5184.138351	2175.239304		4.705891629	706.4045246	8417.939128	14475.16815	26.64373875	53.95020239		448.2149441	488.8620465	0	6.55	4.17	2.5		0.4		43.37	6.72											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-1) $0(Days 1-100):2.SNF	$0/Visit:6.Home Health	$25/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"		"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN863: Dental 16a, 16b"	"VIS841: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a$0: Nutritional Training/Nutritional benefit 13b	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$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											NO	0	0	0	0	24.9033	0	0	49.8066	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	5.405169941	0	0	4.831008098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.2362	0	0.039747279	0	0	0	0	5.405169941	0	0	4.831008098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.2362	NO																																																																																		0	0	0	0	0	0	0	5.405169941	0	0	4.831008098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.2362
H1019_024_0	2011	5																															A	A	A	V	T	O	O	V	V	V	V		P	V	V	V	V	V		V	S	Coin	T	V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0		0	0											0	YES	456.947797	19.949129	93.373202	1717.596607	1107.351486	1990.632896	552.99356	544.95107	1204.401711	5492.684676	2584.582087		10.005786	1122.837926	8761.070575	14750.75221	0	312.683756		320.255043	346.49636	0	4.65	11.76	5.86		0.4		71.37	8.46											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-1) $0(Days 1-100):2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$25/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"		"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN869: Dental 16a, 16b"	"VIS843: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a$0: Nutritional Training/Nutritional benefit 13b	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$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											NO	0	0	0	0	0	0	0	24.98135	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	0	0	0	1.134467784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1345	0	0.000846945	0	0	0	0	0	0	0	1.134467784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1345	NO																																																																																		0	0	0	0	0	0	0	0	0	0	1.134467784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1345
H1019_025_0	2011	5																															A	A	A	V	T	O	O	V	V	V	V		P	V	V	V	V	V		V	S	Coin	T	V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0		0	0											0	YES	503.8084909	4.82366191	48.0483062	1051.869114	1244.926303	783.186843	249.038789	933.1432963	1479.711184	4815.777684	2894.957948		0	1223.143803	6763.39599	13423.69204	112.4785628	352.1185156		623.6313024	1214.051001	0	3.93	3.75	1.25		0.4		2.37	3.69											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-1) $0(Days 1-100):2.SNF	$0/Visit:6.Home Health	$25/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$25/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"		"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN862: Dental 16a, 16b"	"VIS842: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$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	24.969725	0	0	24.969725	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	2.590455618	0	0	1.941694291	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.5321	0	0.005495088	0	0	0	0	2.590455618	0	0	1.941694291	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.5321	NO																																																																																		0	0	0	0	0	0	0	2.590455618	0	0	1.941694291	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.5321
H1019_026_0	2011	4																															A	A	A	V	T	O	O	V	V	V	V		P	V	V	V	V	V		V	S	Coin	T		V				O	O											0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0	0	0	0		0				0	0											0	YES	668.3897073	70.49565556	163.8970439	1164.382579	1728.585095	2611.446454	312.2651893	1407.213365	1559.98002	4309.794295	2704.020646		0	1073.622203	9693.265294	16754.81186	21.8971398	735.0870697		511.4469087	1343.329698	0	3.84		2				2.37	2.84											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-100) $0(Days 100-100):2.SNF	$0/Visit:6.Home Health	$25/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$25/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"		"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b		"VIS842: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$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											NO	0	0	0	0	24.959375	0	0	24.959375	0	0	0		0	0	0	0	0	0		0	0	0	0		0				0	0												0	0	0	0	3.595366967	0	0	2.926930508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.5223	0	0.010615984	0	0	0	0	3.595366967	0	0	2.926930508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.5223	NO																																																																																		0	0	0	0	0	0	0	3.595366967	0	0	2.926930508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.5223
H1019_027_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	Coin	V	V	V	V		V	Coin	Coin	T								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	YES	1775.098486	53.76755441	1252.494909	995.3887308	670.593114	2.571791742	3.2942961	711.2870452	1108.351083	3967.258948	2193.238079		0	10.47673656	7103.62031	12359.07613	80.17986315	488.4077397		562.3302735	18.51192097	0	0.09								96.78379941	508.4616142									6700	$150/Day(Days 1-10):1a.IP Acute	$150/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$150/Visit:8b, 9a. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"		"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$40/Visit:7b. $25 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b								$0/Service:11c.Diabetic Monitoring Supplies	"$40-$150/Visit:9d. $40 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $40 OP Other,5. $40 Partial Hospitalization,7h. $40 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"										121.20465	109.29915	34.44565	0	150	0	0.2	50	37.744242	0	35.949926		0	0.2	0	39.960913	40	40		0	0.2	0	0								0	41.141435									NO	112.650632	101.585362	27.659409	0	137.83785	0	0.183784	45.94595	34.683901	0	33.03507		0	0.183784	0	36.720842	36.75676	36.75676		0	0.183784	0	0								0	37.805646										16.6638	0.455166373	2.886939081	0	7.702759421	0	0.605438914	2.723396584	3.203494937	0	6.037814457	0	0	1.925456552	0	37.81964014	0.245595999	1.496023839	0	0	3.402194884	0	0	0	0	0	0	0	0	0	0	1.601893316	0	0	0	0	0	0	0	0	86.7696	0	7.899134232	16.6638	0.455166373	2.886939081	0	7.702759421	0	0.605438914	2.723396584	3.203494937	0	6.037814457	0	0	1.925456552	0	37.81964014	0.245595999	1.496023839	0	0	3.402194884	0	0	0	0	0	0	0	0	0	0	1.601893316	0	0	0	0	0	0	0	0	86.7696	NO																																																																																		0	0	0	16.6638	0.455166373	2.886939081	0	7.702759421	0	0.605438914	2.723396584	3.203494937	0	6.037814457	0	0	1.925456552	0	37.81964014	0.245595999	1.496023839	0	0	3.402194884	0	0	0	0	0	0	0	0	0	0	1.601893316	0	0	0	0	0	0	0	0	86.7696
H1019_028_0	2011	6																															A	A	A	V	T	O	O	V	V	V	V		P	V	V	V	V	V		V	S	Coin	T	V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0		0	0											0	YES	637.3421076	15.54468969	200.479724	972.4349733	1509.997066	487.2012715	253.1949088	984.8031466	1298.488794	4073.27723	2537.973504		0	802.1664232	7676.879177	14695.13962	72.68774189	597.6080266		583.035959	902.488122	0	1.63	1.77	1.05		0.4		2.37	0.58											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-1) $0(Days 2-100):2.SNF	$0/Visit:6.Home Health	$25/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$25/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"		"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN860: Dental 16a, 16b"	"VIS842: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d												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	24.96655	0	0	24.96655	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	3.141618103	0	0	2.048928083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.1905	0	0.006954256	0	0	0	0	3.141618103	0	0	2.048928083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.1905	NO																																																																																		0	0	0	0	0	0	0	3.141618103	0	0	2.048928083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.1905
H1019_032_0	2011	3																															D	D	D	V	T	Coin	O	V	V	V	V		Coin	V	V	V	V	V		V	Coin	Coin		V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0	0	0		0	0		0		0	0											0	YES	2755.712231	47.05504832	3789.872733	3262.731228	1392.315306	3.805392927	854.0225986	862.4346938	1410.371128	6474.531935	2782.355679		0.008548235	837.047089	10817.90829	17752.85744	331.0827478	672.2495248		526.0888054	35.03456129	0		2.88	1.3		0.4		0.07	2.36											5000	$25/Day(Days 1-5):1a.IP Acute	$25/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$125/Visit:8b, 9a. $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,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"		"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$10/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"		"DEN861: Dental 16a, 16b"	"VIS842: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: OTC items 13c												15.4778	12.460275	34.44565	0	150	0.044921971	0	50	16.937919	0	11.271346		0	11.658395	0	10	10	10		0	0.154022	0		0	0		0		0	0											NO	14.18949	11.423132	18.566136	0	138.6516	0.041523354	0	46.2172	15.656463	0	10.418601		0	10.776367	0	9.24344	9.24344	9.24344		0	0.142369	0		0	0		0		0	0												3.2585	0.044793002	5.863607715	0	16.08722874	0.158012678	0	3.321609727	1.840118615	0	2.415687805	0	0	0.751693886	0	13.67478938	0.255028626	0.517824846	0	0	4.987835456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1767	0	8.904226491	3.2585	0.044793002	5.863607715	0	16.08722874	0.158012678	0	3.321609727	1.840118615	0	2.415687805	0	0	0.751693886	0	13.67478938	0.255028626	0.517824846	0	0	4.987835456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1767	NO																																																																																		0	0	0	3.2585	0.044793002	5.863607715	0	16.08722874	0.158012678	0	3.321609727	1.840118615	0	2.415687805	0	0	0.751693886	0	13.67478938	0.255028626	0.517824846	0	0	4.987835456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1767
H1019_035_0	2011	3																															A	A	D	V	T	Coin	O	V	V	V	V		Coin	V	V	V	V	V		V	Coin	Coin	T	V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0		0	0											0	YES	635.9475432	8.319591456	1585.130046	3229.840143	1334.566448	1.152775161	700.2727768	617.1683673	1556.157427	6310.733364	3189.150857		0.012218062	1116.104337	8729.352394	15141.02405	238.4395895	748.2329916		458.629798	17.6252039	0	1.67	9.43	2.4		0.4		2.37	4.39											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$25/Visit:8b, 9a. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,8b, 9a. $25 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $25 Radiology OP -- Facility"		"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$0-$25/Visit:9d. $0 Cardiac Rehab,8b. $25 Nuclear Medicine,9a. $0 OP Other,5. $0 Partial Hospitalization,7h. $0 Psych -- OP,8b. $25 Rad therapy,3, 7c, 7d, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN865: Dental 16a, 16b"	"VIS841: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: OTC items 13c												0	0	34.44565	0	100	0.044921971	0	50	1.73178	0	1.608305		0.2	6.960576	0	0	0	0		0	0.146682	0	0	0	0		0		0	0											NO	0	0	26.05314	0	97.3285	0.04372188	0	48.66425	1.685516	0	1.565339		0.194657	6.774624	0	0	0	0		0	0.142763	0	0	0	0		0		0	0												0	0	3.441467918	0	10.82427922	0.050401498	0	2.50283631	0.218577353	0	0.416008518	0	0.002378331	0.630098936	0	0	0	0	0	0	2.516226984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.6023	0	1.578253161	0	0	3.441467918	0	10.82427922	0.050401498	0	2.50283631	0.218577353	0	0.416008518	0	0.002378331	0.630098936	0	0	0	0	0	0	2.516226984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.6023	NO																																																																																		0	0	0	0	0	3.441467918	0	10.82427922	0.050401498	0	2.50283631	0.218577353	0	0.416008518	0	0.002378331	0.630098936	0	0	0	0	0	0	2.516226984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.6023
H1019_039_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	Coin	V	V	V	V		V	Coin	Coin			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	YES	845.6604533	15.69196332	394.6693108	116.0740466	170.5258151	1.797839611	1.059507871	212.0177221	283.2130305	411.5265283	1223.852031		0.072217783	6.650654476	4942.066638	5093.819786	3.744680508	265.9178278		302.9821938	7.391543454	0			2				2.37	0.58	21.86216155	125.1143313									6700	$275/Day(Days 1-5):1a.IP Acute	$275/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$150/Visit:8b, 9a. $150 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"		"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$35/Visit:7b. $25 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35/Visit:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS842: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $35 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $35 OP Other,5. $35 Partial Hospitalization,7h. $35 Psych -- OP,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										170.2558	137.063025	34.44565	0	150	0	0.2	50	81.795029	0	31.457724		0.2	0.2	5	34.979528	35	35		0	0.2	0			0				0	0	0	41.987965									NO	167.774492	135.065468	34.026894	0	147.93675	0	0.197249	49.31225	80.669938	0	31.025023		0.197249	0.197249	4.931225	34.498385	34.518575	34.518575		0	0.197249	0			0				0	0	0	41.41042										11.8234	0.176620197	1.119114234	0	2.102252907	0	0.208986868	0.87125591	1.903898134	0	3.164169784	0	0.014244885	1.311834945	2.030870213	14.64404634	0.010771753	0.764925373	0	0	1.457974555	0	0	0	0	0	0	0	0	0	0	0.431753084	0	0	0	0	0	0	0	0	42.0361	0	0.594547165	11.8234	0.176620197	1.119114234	0	2.102252907	0	0.208986868	0.87125591	1.903898134	0	3.164169784	0	0.014244885	1.311834945	2.030870213	14.64404634	0.010771753	0.764925373	0	0	1.457974555	0	0	0	0	0	0	0	0	0	0	0.431753084	0	0	0	0	0	0	0	0	42.0361	NO																																																																																		0	0	0	11.8234	0.176620197	1.119114234	0	2.102252907	0	0.208986868	0.87125591	1.903898134	0	3.164169784	0	0.014244885	1.311834945	2.030870213	14.64404634	0.010771753	0.764925373	0	0	1.457974555	0	0	0	0	0	0	0	0	0	0	0.431753084	0	0	0	0	0	0	0	0	42.0361
H1019_043_0	2011	4	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	V		V	Coin	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	YES	1659.451055	14.81533183	1143.160708	791.2455986	321.5601197	1.040748173	1.757804969	602.1473949	1637.779219	4185.561463	2597.775494		0	973.3291656	7702.173594	15499.35339	191.5936031	833.7272489		650.935925	18.03323109	0							2.37	2.1	105.8465858										6700	$150/Day(Days 1-10):1a.IP Acute	$150/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$150/Visit:8b, 9a. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"		"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 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. $75 Rad therapy,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$35/Visit:7b. $25 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"20% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies											121.20465	109.29915	32.5726	0	150	0.2	0.2	50	26.666112	0	42.606475		0	50.787875	0	34.961493	35	35		0	0.2	0							0	0	0										NO	112.793653	101.714335	26.813536	0	137.6175	0.18349	0.18349	45.8725	24.464824	0	39.08931		0	46.595336	0	32.075422	32.11075	32.11075		0	0.18349	0							0	0	0											15.598	0.125577635	2.554348399	0	3.687691648	0.190966882	0.322539634	2.301833865	3.338998362	0	8.462104301	0	0	3.779383293	0	41.42902506	0.512684524	2.230967271	0	0	3.308917572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.843	0	7.980434412	15.598	0.125577635	2.554348399	0	3.687691648	0.190966882	0.322539634	2.301833865	3.338998362	0	8.462104301	0	0	3.779383293	0	41.42902506	0.512684524	2.230967271	0	0	3.308917572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.843	NO																																																																																		0	0	0	15.598	0.125577635	2.554348399	0	3.687691648	0.190966882	0.322539634	2.301833865	3.338998362	0	8.462104301	0	0	3.779383293	0	41.42902506	0.512684524	2.230967271	0	0	3.308917572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.843
H1019_044_0	2011	5	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	V		V	Coin	Coin							O		O										0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0	0	0							0		0										0	YES	1792.58253	62.545793	1509.179391	943.730618	445.150451	1.84667	2.912161	640.32458	1467.818984	4146.970002	2601.574926		0	982.740123	7664.137939	14128.09323	224.352295	607.61373		602.452301	37.200296	0							0.07		117.58552										6700	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$150/Visit:8b, 9a. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"		"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$40/Visit:7b. $25 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a		$0/Service:11c.Diabetic Monitoring Supplies											161.6895	138.428775	34.44565	0	150	0.2	0.2	50	33.595703	0	29.660922		0	54.164155	10	39.949118	40	40		0	0.2	0							0		0										NO	144.447417	123.667146	24.372605	0	133.10415	0.177472	0.177472	44.36805	29.811517	0	26.319945		0	48.063159	8.87361	35.449289	35.49444	35.49444		0	0.177472	0							0		0											21.5778	0.644571643	3.065219431	0	4.937614367	0.327732218	0.516827037	2.367496082	3.64649255	0	5.70610908	0	0	3.936132899	5.667380921	41.735905	0.663604923	1.797242424	0	0	6.602010932	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.1922	0	13.80840629	21.5778	0.644571643	3.065219431	0	4.937614367	0.327732218	0.516827037	2.367496082	3.64649255	0	5.70610908	0	0	3.936132899	5.667380921	41.735905	0.663604923	1.797242424	0	0	6.602010932	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.1922	NO																																																																																		0	0	0	21.5778	0.644571643	3.065219431	0	4.937614367	0.327732218	0.516827037	2.367496082	3.64649255	0	5.70610908	0	0	3.936132899	5.667380921	41.735905	0.663604923	1.797242424	0	0	6.602010932	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.1922
H1019_045_0	2011	6	r.										Skilled Nursing Facility																				A	A	A	V	T	O	O	V	V	V	V		P	V	V	V	V	V		V	S	Coin		V	V		V		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	YES	496.162044	11.522118	114.419389	1379.314952	706.051882	1865.034733	342.823025	590.623081	1317.5732	5504.853493	3034.194154		0	878.016191	7050.168405	14475.21205	267.849784	838.514164		754.511984	1228.713044	0		1.77	1.05		0.4		2.34	4.37	2035.460103										3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-1) $0(Days 1-100):2.SNF	$0/Visit:6.Home Health	$25/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$25/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"		"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN860: Dental 16a, 16b"	"VIS842: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: OTC items 13c	$0/Day(Days 1-2) $0(Days 2-100):2.SNF											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	24.975525	0	0	24.975525	0	0	0		0	0	0	0	0	0		0	0	0		0	0		0		0	0	0											0	0	0	0	1.469501369	0	0	1.229260127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.6988	0	0.002644677	0	0	0	0	1.469501369	0	0	1.229260127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.6988	NO																																																																																		0	0	0	0	0	0	0	1.469501369	0	0	1.229260127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.6988
H1019_046_0	2011	4																															A	A	A	V	T	O	O	V	V	V	V		P	V	V	V	V	V		V	S	Coin	T		V		V		O	O											0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0	0	0	0		0		0		0	0											0	YES	682.072154	75.195722	154.392359	1174.184076	1845.296773	2635.981117	315.736334	1472.5214	1551.366501	4276.187072	2682.965783		0	1070.628388	9795.407253	16837.24458	0	740.010859		495.667104	1314.123528	0	1.09		2		0.4		2.37	2.84											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-1) $0(Days 1-100):2.SNF	$0/Visit:6.Home Health	$25/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$25/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"		"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b		"VIS842: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$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											NO	0	0	0	0	24.954225	0	0	24.954225	0	0	0		0	0	0	0	0	0		0	0	0	0		0		0		0	0												0	0	0	0	3.837329239	0	0	3.062135861	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.8995	0	0.012656094	0	0	0	0	3.837329239	0	0	3.062135861	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.8995	NO																																																																																		0	0	0	0	0	0	0	3.837329239	0	0	3.062135861	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.8995
H1019_047_0	2011	4																															A	A	A	V	T	O	O	V	V	V	V		P	V	V	V	V	V		V	S	Coin	T	V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0		0	0											0	YES	556.209946	0	167.986615	1844.906572	2710.616553	0	577.96174	1195.032669	1229.04533	5150.925168	2151.179902		5.050089	704.119968	8360.049103	14437.78244	0	0		444.895876	483.131441	0	6.55	4.17	2.5		0.4		43.37	6.72											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-1) $0(Days 1-100):2.SNF	$0/Visit:6.Home Health	$25/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"		"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN863: Dental 16a, 16b"	"VIS841: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a$0: Nutritional Training/Nutritional benefit 13b	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$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											NO	0	0	0	0	24.896475	0	0	49.79295	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	5.623733104	0	0	4.958683495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.5824	0	0.044004008	0	0	0	0	5.623733104	0	0	4.958683495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.5824	NO																																																																																		0	0	0	0	0	0	0	5.623733104	0	0	4.958683495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.5824
H1019_048_0	2011	5																															A	A	A	V	T	O	O	V	V	V	V		P	V	V	V	V	V		V	S	Coin	T	V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0		0	0											0	YES	456.947797	19.949129	93.373202	1717.596607	1107.351486	1990.632896	552.99356	544.95107	1204.401711	5492.684676	2584.582087		10.005786	1122.837926	8761.070575	14750.75221	0	312.683756		320.255043	346.49636	0	4.65	11.76	5.86		0.4		71.37	8.77											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-1) $0(Days 1-100):2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$25/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"		"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN869: Dental 16a, 16b"	"VIS843: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a$0: Nutritional Training/Nutritional benefit 13b	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$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											NO	0	0	0	0	0	0	0	24.98135	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	0	0	0	1.134467784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1345	0	0.000846945	0	0	0	0	0	0	0	1.134467784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1345	NO																																																																																		0	0	0	0	0	0	0	0	0	0	1.134467784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1345
H1019_049_0	2011	6																															A	A	A	V	T	O	O	V	V	V	V		P	V	V	V	V	V		V	S	Coin	T	V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0		0	0											0	YES	624.798187	15.293742	208.560423	763.065423	1622.442716	0	201.326717	1022.902509	1186.383999	3268.479213	2158.356077		0	712.433435	7172.779643	13435.33775	0	459.633418		480.615741	724.721444	0	1.64	1.77	1.05		0.4		2.37	1.09											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-1) $0(Days 1-100):2.SNF	$0/Visit:6.Home Health	$25/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$25/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"		"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN860: Dental 16a, 16b"	"VIS842: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$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	24.965225	0	0	24.965225	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	3.375387288	0	0	2.128082608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.5035	0	0.00766599	0	0	0	0	3.375387288	0	0	2.128082608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.5035	NO																																																																																		0	0	0	0	0	0	0	3.375387288	0	0	2.128082608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.5035
H1019_050_0	2011	5																															A	A	A	V	T	O	O	V	V	V	V		P	V	V	V	V	V		V	S	Coin	T	V	V		V		O	O											0	0	0	0	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	1557.846668	0	223.717104	1546.72984	1613.772145	3899.406861	2287.436663		0	0	5812.024029	13327.83183	0	0		333.548061	1634.547735	0	3.93	3.75	1.25		0.4		2.37	3.69											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-1) $0(Days 1-100):2.SNF	$0/Visit:6.Home Health	$25/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$25/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"		"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN862: Dental 16a, 16b"	"VIS842: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$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	24.97425	0	0	24.97425	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	3.242171012	0	0	3.219034809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4612	0	0.003319024	0	0	0	0	3.242171012	0	0	3.219034809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4612	NO																																																																																		0	0	0	0	0	0	0	3.242171012	0	0	3.219034809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4612
H1019_054_0	2011	3	r.										OP Facility - Other										Other										D	D	D	V	T	Coin	O	V	V	V	V		Coin	Coin	V	V	V	V		V	Coin	Coin		V	V		V		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	YES	1918.609625	66.94306	1615.281895	1010.079378	476.446649	2.03921	262.446278	685.34245	1571.013654	4438.521758	2784.478043		0	17.34863	8202.963364	15121.36552	240.12533	650.331871		644.80757	41.078921	0		2.88	2.75		0.4		3.34	0.58	670.020378										5000	$100/Day(Days 1-7):1a.IP Acute	$100/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"		"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN861: Dental 16a, 16b"	"VIS841: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	"$25-$100/Visit:9d. $25 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $25 OP Other,5. $25 Partial Hospitalization,7h. $25 Psych -- OP,3, 7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF"											71.862	61.5239	34.44565	0	150	0.044921971	0	50	22.397136	0	24.520481		0	0.2	0	25	25	25		0	0.2	0		0	0		0		0	0	26.561943										NO	65.151526	55.778798	23.462069	0	134.6802	0.040334	0	44.8934	20.109671	0	22.016155		0	0.179574	0	22.4467	22.4467	22.4467		0	0.179574	0		0	0		0		0	0	23.849119											10.4167	0.311166952	3.158154606	0	5.347327498	0.082249496	0	2.563946062	2.632713977	0	5.108625016	0	0	3.115362884	0	28.28539629	0.449168437	1.216483701	0	0	7.37670616	0	0	0	0	0	0	0	0	0	1.331616311	0	0	0	0	0	0	0	0	0	71.3956	0	9.11573976	10.4167	0.311166952	3.158154606	0	5.347327498	0.082249496	0	2.563946062	2.632713977	0	5.108625016	0	0	3.115362884	0	28.28539629	0.449168437	1.216483701	0	0	7.37670616	0	0	0	0	0	0	0	0	0	1.331616311	0	0	0	0	0	0	0	0	0	71.3956	NO																																																																																		0	0	0	10.4167	0.311166952	3.158154606	0	5.347327498	0.082249496	0	2.563946062	2.632713977	0	5.108625016	0	0	3.115362884	0	28.28539629	0.449168437	1.216483701	0	0	7.37670616	0	0	0	0	0	0	0	0	0	1.331616311	0	0	0	0	0	0	0	0	0	71.3956
H1019_055_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	Coin	V	V	V	V		V	Coin	Coin							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	YES	1654.834591	23.870392	1879.309578	1273.500668	651.887041	1.580542	3.022372	545.313372	1217.308491	5090.522815	2804.441575		0	20.518891	6509.314033	13364.74472	247.301661	774.187467		696.629521	50.793859	0							2.37		153.671198	446.599387									6700	$225/Day(Days 1-5):1a.IP Acute	$225/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$125/Visit:8b, 9a. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"		"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$45/Visit:7b. $25 Chiropractic,7f. $45 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $45 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $45 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$45/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a		$0/Service:11c.Diabetic Monitoring Supplies	"$40-$125/Visit:9d. $45 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $75 OP Other,5. $45 Partial Hospitalization,7h. $40 Psych -- OP,3, 7c, 7d, 7i. $45 Therapy (AT,PT,ST,OT) -- CORF"										139.3002	112.142475	34.44565	0	150	0	0.2	50	33.82602	0	20.263961		0	0.2	10	44.907186	40	45		0	0.107566	0							0		0	73.22261									NO	124.99602	100.627013	23.603882	0	133.2687	0	0.177692	44.4229	30.052999	0	18.003679		0	0.177692	8.88458	39.898149	35.53832	39.98061		0	0.095568	0							0		0	65.055214										17.2373	0.200167187	3.69658346	0	7.239678208	0	0.537051325	2.018700116	3.048647572	0	4.207522158	0	0	3.64604278	4.819376773	44.43571467	0.732390464	2.579373932	0	0	4.854267517	0	0	0	0	0	0	0	0	0	0	2.421134891	0	0	0	0	0	0	0	0	101.674	0	13.8048413	17.2373	0.200167187	3.69658346	0	7.239678208	0	0.537051325	2.018700116	3.048647572	0	4.207522158	0	0	3.64604278	4.819376773	44.43571467	0.732390464	2.579373932	0	0	4.854267517	0	0	0	0	0	0	0	0	0	0	2.421134891	0	0	0	0	0	0	0	0	101.674	NO																																																																																		0	0	0	17.2373	0.200167187	3.69658346	0	7.239678208	0	0.537051325	2.018700116	3.048647572	0	4.207522158	0	0	3.64604278	4.819376773	44.43571467	0.732390464	2.579373932	0	0	4.854267517	0	0	0	0	0	0	0	0	0	0	2.421134891	0	0	0	0	0	0	0	0	101.674
H1019_056_0	2011	3	r.										OP Facility - Other										Other										D	D	D	V	T	Coin	O	V	V	V	V		Coin	Coin	V	V	V	V		V	Coin	Coin							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	YES	1105.733239	29.941332	951.775925	1244.670658	775.382587	0.880416	282.689663	335.388968	848.419487	3547.91704	1814.274127		0.010291	5.314306	4786.13176	8189.900868	200.818695	485.418808		298.868668	10.621753	0							2.37	0.36	390.291603										6700	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $45(Days 8-100):2. $0 SNF 1,2. $45 SNF 2"	$0/Visit:6.Home Health	$125/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$220/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $220 Surgery OP -- Facility"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0-$220/Visit:8b, 9a. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $220 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"		"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$40/Visit:7b. $25 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a	"$40-$220/Visit:9d. $40 Cardiac Rehab,8b. $220 Nuclear Medicine,9a. $40 OP Other,5. $40 Partial Hospitalization,7h. $40 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"											165.92202	145.11002	31.001085	0	125	0.044921971	0	50	35.970348	0	18.739686		0.2	0.2	0	39.920152	40	40		0	0.144095	0							0	0	41.647314										NO	160.091354	140.010709	28.460019	0	119.88525	0.043083854	0	47.9541	34.498513	0	17.972895		0.191816	0.191816	0	38.286699	38.36328	38.36328		0	0.138199	0							0	0	39.943189											14.7515	0.34934226	2.257296742	0	7.746411274	0.037931714	0	1.340273009	2.439100892	0	2.717313199	0	0.001973978	1.01936892	0	26.13035578	0.642005319	1.551854804	0	0	1.467915643	0	0	0	0	0	0	0	0	0	1.299124272	0	0	0	0	0	0	0	0	0	63.7518	0	2.729236638	14.7515	0.34934226	2.257296742	0	7.746411274	0.037931714	0	1.340273009	2.439100892	0	2.717313199	0	0.001973978	1.01936892	0	26.13035578	0.642005319	1.551854804	0	0	1.467915643	0	0	0	0	0	0	0	0	0	1.299124272	0	0	0	0	0	0	0	0	0	63.7518	NO																																																																																		0	0	0	14.7515	0.34934226	2.257296742	0	7.746411274	0.037931714	0	1.340273009	2.439100892	0	2.717313199	0	0.001973978	1.01936892	0	26.13035578	0.642005319	1.551854804	0	0	1.467915643	0	0	0	0	0	0	0	0	0	1.299124272	0	0	0	0	0	0	0	0	0	63.7518
H1019_057_0	2011	3	r.										OP Facility - Other										Other										D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin	T		V		V		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	YES	1530.663959	59.752612	700.359745	988.769744	216.314967	4.420611	4283.884903	283.917546	327.639535	124.120172	1771.61861	89.057715	0.620924	3.363625	6229.148534	5909.970265	92.202669	591.275032		631.151997	25.238053	0	0.09		1.05		0.4		0.07	1.09	343.768731										6700	$150/Day(Days 1-10):1a.IP Acute	$150/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$150/Visit:8b, 9a. $100 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$30/Visit:7b. $25 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b		"VIS842: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	"$30-$150/Visit:9d. $30 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $100 OP Other,5. $30 Partial Hospitalization,7h. $30 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"											121.20465	109.29915	34.44565	0	150	0.044921971	0	50	124.614039	0	54.078905	150	0.2	0.2	0	29.97445	30	30		0	0.2	0	0		0		0		0	0	74.87608										NO	117.94376	106.358566	32.629744	0	145.4622	0.043562991	0	48.4874	120.844215	0	52.44291	145.4622	0.19395	0.19395	0	29.067663	29.09244	29.09244		0	0.19395	0	0		0		0		0	0	72.610929											15.0444	0.529600177	1.904379932	0	2.622137583	0.192575039	0	1.147201968	3.299445201	0	7.742402943	1.079544263	0.12042821	0.652375069	0	14.315752	0.223533385	1.433469449	0	0	4.894920379	0	0	0	0	0	0	0	0	0	2.08011391	0	0	0	0	0	0	0	0	0	57.2822	0	1.772272404	15.0444	0.529600177	1.904379932	0	2.622137583	0.192575039	0	1.147201968	3.299445201	0	7.742402943	1.079544263	0.12042821	0.652375069	0	14.315752	0.223533385	1.433469449	0	0	4.894920379	0	0	0	0	0	0	0	0	0	2.08011391	0	0	0	0	0	0	0	0	0	57.2822	NO																																																																																		0	0	0	15.0444	0.529600177	1.904379932	0	2.622137583	0.192575039	0	1.147201968	3.299445201	0	7.742402943	1.079544263	0.12042821	0.652375069	0	14.315752	0.223533385	1.433469449	0	0	4.894920379	0	0	0	0	0	0	0	0	0	2.08011391	0	0	0	0	0	0	0	0	0	57.2822
H1019_058_0	2011	4	r.										OP Facility - Other										Other										A	A	D	V	T	Coin	O	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin			V				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	YES	251.213306	1.682989	574.321723	22.135866	256.248406	3.438538	1908.64393	234.66964	173.866773	105.099873	1241.341752	35.431898	0.912934	1.966829	6058.46431	5397.264396	0.171798	364.424132		252.490125	39.774064	0			1.25				2.37	0.58	64.785101										6700	$1000/Admit:1a.IP Acute	$1000/Admit:1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$220/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $220 Surgery OP -- Facility"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0-$220/Visit:8b, 9a. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $220 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$220/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$40/Visit:7b. $25 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"			"VIS842: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	"$40-$220/Visit:9d. $40 Cardiac Rehab,8b. $220 Nuclear Medicine,9a. $40 OP Other,5. $40 Partial Hospitalization,7h. $40 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"											1000	1000	34.44565	0	150	0.044921971	0	50	137.579992	0	19.01726	220	0.185836	0.2	0	39.996489	40	40		0	0.067717	0			0				0	0	60.424738										NO	977.591	977.591	33.042748	0	146.6889	0.043930363	0	48.8963	134.543052	0	18.597473	215.14372	0.181733	0.195585	0	39.113607	39.11704	39.11704		0	0.066222	0			0				0	0	59.090922											20.4653	0.137106242	1.581430664	0	3.132399734	0.151056223	0	0.956206427	1.949380523	0	1.92381831	0.635245862	0.165910235	0.38468225	0	17.59220654	0.000560019	1.187932779	0	0	2.633918066	0	0	0	0	0	0	0	0	0	0.319017612	0	0	0	0	0	0	0	0	0	53.2162	0	1.236465906	20.4653	0.137106242	1.581430664	0	3.132399734	0.151056223	0	0.956206427	1.949380523	0	1.92381831	0.635245862	0.165910235	0.38468225	0	17.59220654	0.000560019	1.187932779	0	0	2.633918066	0	0	0	0	0	0	0	0	0	0.319017612	0	0	0	0	0	0	0	0	0	53.2162	NO																																																																																		0	0	0	20.4653	0.137106242	1.581430664	0	3.132399734	0.151056223	0	0.956206427	1.949380523	0	1.92381831	0.635245862	0.165910235	0.38468225	0	17.59220654	0.000560019	1.187932779	0	0	2.633918066	0	0	0	0	0	0	0	0	0	0.319017612	0	0	0	0	0	0	0	0	0	53.2162
H1026_001_0	2011	9	g.2.	h.6.	h.7.	h.8.	h.9.	f.2.	i.7.	i.8.	i.9.	e.3.	OP Facility - Surgery	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Emergency	Professional	Professional	Professional	DME/Prosthetics/Supplies	ASC	AIXIDTF	IDTF	MH/SA	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine	DME Scooter	D	D	D		T			V	V	V	V		V	V	V	V	V	V			Coin			V						O	V	V	V	V	V	V	V	O	O	Coin																																									0	YES	1592.792433	20.77023689	610.1868845	284.7866849	185.9018593	262.8378152	48.65192415	260.3913232	237.6996865	19.0332187	37.63304571	0	26.32763417	841.2167219	4623.19579	15689.0954	4.314315242	1696.08178	0	0	52.9715103	0	0	2314.627185	0	0	0	0	0	325.7095986	168.6034794	7.434405573	639.4749723	80.13481284	255.0228748	17.30330451	887.1036867	107.9849509	0	0	3400	200 Copay for 8 days (#1A)	200 Copay for 8 days (#1B)	75 Copay for days 7 to 25 (#2)	0 Copay (#6)	175 Copay (#10A)	0 Copay (#11A)	0 Copay (#11A)	50 Copay (#4A)	125 Copay (#9A)	15 Copay (#8A)	50 Copay (#9A)		15 Copay (#9A)	125 Copay (#9A)	0 Copay PCP/0 Copay Immunizations (#7A)	0 Copay (multiple)	15 Copay (#7H)	0 Copay (#7I)			0.2 Coins (#15)			Copay Varies						(multiple)	100 Copay (#9B)	100 Copay (#8B)	75 Copay (#8B)	15 Copay (#7E)	0 Copay (#3)	25 Copay (#4B)	100 Copay (#8B)	5 Copay (#7G)	5 Copay (#7G)	0.2 Coins (#11A)		130.954197	71.28169841	34.28259816	0	157.3775	0	0	48.87540828	88.8891209	12.11538462	9.090909091	0	4.259259259	74.73338541	0	0	15	0	0	0	0.138079451	0	0	0.518442023	0	0	0	0	0	5.266296959	98.81656805	82.60869565	42.89551338	0	0	11.70172757	22.06925323	5	0	0	NO	116.3624423	71.28169841	26.77068174	0	157.3775	0	0	48.87540828	84.63151532	10.38461538	9.090909091	0	4.259259259	71.41584142	0	0	15	0	0	0	0.086041946	0	0	0.518442023	0	0	0	0	0	4.005054277	97.83037475	82.06504952	42.40714801	0	0	11.3673925	21.81894034	4.98630137	0	0		15.4451	0.123378147	1.361259907	0	2.438064154	0	0	1.06056102	1.676407055	0.016471055	0.028509883	0	0.009344685	5.006350001	0	0	0.005392894	0	0	0	4.55777183	0	0	0.1	0	0	0	0	0	0.108707052	1.374545131	0.050842072	2.25985915	0	0	0.016391121	1.612971868	0.044870459	0	0	37.2968	0	5.489827946	15.4451	0.123378147	1.361259907	0	2.438064154	0	0	1.06056102	1.676407055	0.016471055	0.028509883	0	0.009344685	5.006350001	0	0	0.005392894	0	0	0	4.55777183	0	0	0.1	0	0	0	0	0	0.108707052	1.374545131	0.050842072	2.25985915	0	0	0.016391121	1.612971868	0.044870459	0	0	37.2968	NO																																																																																		0			15.4451	0.123378147	1.361259907	0	2.438064154	0	0	1.06056102	1.676407055	0.016471055	0.028509883	0	0.009344685	5.006350001	0	0	0.005392894	0	0	0	4.55777183	0	0	0.1	0	0	0	0	0	0.108707052	1.374545131	0.050842072	2.25985915	0	0	0.016391121	1.612971868	0.044870459	0	0	37.2968
H1026_038_0	2011	8	g.2.	h.6.	h.7.	h.8.	h.9.	f.2.	i.7.	i.8.	i.9.	e.3.	OP Facility - Surgery	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Emergency	Professional	Professional	Professional	DME/Prosthetics/Supplies	ASC	AIXIDTF	IDTF	MH/SA	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine	DME Scooter	D	D	D		T			V	V	V	V		V	V	V	V	V	V			Coin			V						O	V	V	V	V	V	V	V	O	O	Coin																																									0	YES	1458.85639	31.21239026	1030.49988	325.6314845	286.237132	204.4456752	73.91630179	223.9951368	183.2092462	7.222926015	82.85750907	0	10.89437716	574.4627805	7718.894016	15578.56577	2.620851717	1518.973117	0	0	59.29842338	0	0	7237.562901	0	0	0	0	0	445.1478207	311.9032009	26.60062145	1485.761502	70.62477613	116.1222842	105.5295331	571.9039025	115.0958203	0	0.221229744	3400	250 Copay for 8 days (#1A)	250 Copay for 8 days (#1B)	75 Copay for days 7 to 25 (#2)	0 Copay (#6)	175 Copay (#10A)	0 Copay (#11A)	0 Copay (#11A)	50 Copay (#4A)	150 Copay (#9A)	15 Copay (#8A)	50 Copay (#9A)		15 Copay (#9A)	150 Copay (#9A)	0 Copay (#7A)	40 Copay (multiple)	40 Copay (#7H)	40 Copay (#7I)			0.2 Coins (#15)			Copay varies						(multiple)	100 Copay (#9B)	125 Copay (#8B)	75 Copay (#8B)	40 Copay (#7E)	40 Copay (#3)	25 Copay (#4B)	125 Copay (#8B)	5 Copay (#7G)	5 Copay (#7G)	0.2 Coins (#11A)		186.466115	109.0004995	36.02235678	0	172.1888383	0	0	48.80342882	128.5955724	8.278097875	2.372479241	0	6.98630137	60.10043645	0.000215707	19.06361909	36.52173913	16.69474464	0	0	0.16751791	0	0	0.165801668	0	0	0	0	0	38.5520487	99.49077021	108.5271318	46.06430035	0	39.39945009	21.38353589	15.81973205	4.995579134	0	0.19299541	NO	155.708069	83.5696943	25.51295835	0	172.1888383	0	0	48.80342882	115.3645544	7.174376808	2.372479241	0	6.98630137	53.14999956	0.000215707	18.10208902	36.52173913	15.23216598	0	0	0.098128504	0	0	0.165801668	0	0	0	0	0	34.51188489	97.38584323	93.53725022	44.51812505	0	36.23869574	21.02465881	15.13442229	4.882184923	0	0.19299541		18.9296	0.217367493	2.190925044	0	4.107236604	0	0	0.91097756	1.761321087	0.004318333	0.016381477	0	0.006342617	2.544391378	0.000138751	23.50038204	0.007976505	1.928104219	0	0	5.81886555	0	0	0.1	0	0	0	0	0	1.280240862	2.531246352	0.207345749	5.511943027	0	0.350676677	0.184893536	0.721286264	0.04682659	0	0.042696325	72.9215	0	11.25136059	18.9296	0.217367493	2.190925044	0	4.107236604	0	0	0.91097756	1.761321087	0.004318333	0.016381477	0	0.006342617	2.544391378	0.000138751	23.50038204	0.007976505	1.928104219	0	0	5.81886555	0	0	0.1	0	0	0	0	0	1.280240862	2.531246352	0.207345749	5.511943027	0	0.350676677	0.184893536	0.721286264	0.04682659	0	0.042696325	72.9215	NO																																																																																		0			18.9296	0.217367493	2.190925044	0	4.107236604	0	0	0.91097756	1.761321087	0.004318333	0.016381477	0	0.006342617	2.544391378	0.000138751	23.50038204	0.007976505	1.928104219	0	0	5.81886555	0	0	0.1	0	0	0	0	0	1.280240862	2.531246352	0.207345749	5.511943027	0	0.350676677	0.184893536	0.721286264	0.04682659	0	0.042696325	72.9215
H1026_040_0	2011	9	g.2.	h.6.	h.7.	h.8.	h.9.	f.2.	i.7.	i.8.	i.9.	e.3.	OP Facility - Surgery	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Emergency	Professional	Professional	Professional	DME/Prosthetics/Supplies	ASC	AIXIDTF	IDTF	MH/SA	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine	DME Scooter	D	D	D		T			V	V	V	V		V	V	V	V	V	V			Coin									O	V	V	V	V	V	V	V	O	O	O																																									0	YES	1289.736091	29.5875135	624.5436902	268.6589362	250.1455531	189.9667689	66.6082926	324.2392544	267.6738758	7.742418206	29.10867813	0	18.36978075	955.3866914	6223.373099	15220.48988	1.185405514	1258.649045	0	0	42.20112571	0	0	0	0	0	0	0	0	184.9151562	177.1806039	21.96885623	937.2710223	107.8483681	332.0566481	48.43567164	750.9390892	157.2288865	0	0.116497833	3400	225 Copay for 8 days (#1A)	225 Copay for 8 days (#1B)	75 Copay for days 7 to 25 (#2)	0 Copay (#6)	175 Copay (#10A)	0 Copay (#11A)	0 Copay (#11A)	50 Copay (#4A)	200 Copay (#9A)	15 Copay (#8A)	50 Copay (#9A)		15 Copay (#9A)	200 Copay (#9A)	15 Copay PCP/0 Copay Immunizations (#7A)	45 Copay (multiple)/Spec Chiro 40 Copay	40 Copay (#7H)	45 Copay (#7I)			0.2 Coins (#15)									(multiple)	125 Copay (#9B)	150 Copay (#8B)	75 Copay (#8B)	40 Copay (#7E)	45 Copay (#3)	25 Copay (#4B)	150 Copay (#8B)	5 Copay (#7G)	5 Copay (#7G)	0.2 Coins (#11A)		157.148266	69.0086731	32.43141519	0	173.0374296	0	0	49.25243724	90.86032896	12.14290836	45.16908213	0	9.076923077	90.68076604	14.36535068	19.57126426	40	30.32280168	0	0	0.155425093	0	0	0	0	0	0	0	0	44.89105869	117.3992674	130.3977273	41.43034252	0	44.82091277	20.56485318	24.71364562	4.97102649	0	0.184796858	NO	138.5547238	69.0086731	26.32988504	0	173.0374296	0	0	49.25243724	80.81657194	9.239682549	37.1040381	0	9.076923077	79.28441414	13.8521366	18.88528719	15	29.06376997	0	0	0.092366435	0	0	0	0	0	0	0	0	41.03993582	115.1917292	125.2840909	40.42727834	0	39.5963806	20.30895145	24.22298552	4.772350993	0	0.159570908		14.8916	0.170149587	1.370346964	0	3.607045295	0	0	1.330797794	1.802707087	0.005961457	0.090004125	0	0.013895091	6.312272842	7.183917856	23.95361021	0.001481757	3.04842386	0	0	3.89796752	0	0	0	0	0	0	0	0	0.632408845	1.700811678	0.229362348	3.157609708	0	1.095686785	0.081973142	1.515832224	0.062529286	0	1.55E-06	76.1564	0	7.764053338	14.8916	0.170149587	1.370346964	0	3.607045295	0	0	1.330797794	1.802707087	0.005961457	0.090004125	0	0.013895091	6.312272842	7.183917856	23.95361021	0.001481757	3.04842386	0	0	3.89796752	0	0	0	0	0	0	0	0	0.632408845	1.700811678	0.229362348	3.157609708	0	1.095686785	0.081973142	1.515832224	0.062529286	0	1.55E-06	76.1564	NO																																																																																		0		0	14.8916	0.170149587	1.370346964	0	3.607045295	0	0	1.330797794	1.802707087	0.005961457	0.090004125	0	0.013895091	6.312272842	7.183917856	23.95361021	0.001481757	3.04842386	0	0	3.89796752	0	0	0	0	0	0	0	0	0.632408845	1.700811678	0.229362348	3.157609708	0	1.095686785	0.081973142	1.515832224	0.062529286	0	1.55E-06	76.1564
H1026_801_0	2011	9	g.2.	h.6.	h.7.	h.8.	h.9.	f.2.	i.7.	i.8.	i.9.	e.3.	OP Facility - Surgery	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Emergency	Professional	Professional	Professional	DME/Prosthetics/Supplies	ASC	AIXIDTF	IDTF	MH/SA	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine	DME Scooter	Coin		Coin		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin								Coin											0		0		0	0		0	0					0						0	0	0								0											0	YES	280.667566		25.83220827		7.762967773	5.593301685		24.82796317	69.79687688					73.92048215						335.5091267	51.9184303	0								5.278202132											3400	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								23.3% coinsurance												0.076066257		0.159529212		0.233	0.233		0.233	0.233					0.233						0.233	0.233	0.233								0.233											NO	0.051371844		0.074935262		0.180272108	0.180272108		0.180272108	0.180272108					0.180272108						0.180272108	0.180272108	0.180272108								0.180272108												14.4184	0	1.935743282	0	1.399446561	1.008316283	0	4.475789246	12.58243009	0	0	0	0	13.32580111	0	0	0	0	0	60.48293735	9.359444849	0	0	0	0	0	0	0	0	0.951512622	0	0	0	0	0	0	0	0	0	0	119.9398	0	39.24454623	14.4184	0	1.935743282	0	1.399446561	1.008316283	0	4.475789246	12.58243009	0	0	0	0	13.32580111	0	0	0	0	0	60.48293735	9.359444849	0	0	0	0	0	0	0	0	0.951512622	0	0	0	0	0	0	0	0	0	0	119.9398	NO																																																																																		0			14.4184	0	1.935743282	0	1.399446561	1.008316283	0	4.475789246	12.58243009	0	0	0	0	13.32580111	0	0	0	0	0	60.48293735	9.359444849	0	0	0	0	0	0	0	0	0.951512622	0	0	0	0	0	0	0	0	0	0	119.9398
H1026_802_0	2011	8	g.2.	h.6.	h.7.	h.8.	h.9.	f.2.	i.7.	i.8.	i.9.	e.3.	OP Facility - Surgery	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Emergency	Professional	Professional	Professional	DME/Prosthetics/Supplies	ASC	AIXIDTF	IDTF	MH/SA	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine	DME Scooter	Coin		Coin		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin								Coin											0		0		0	0		0	0					0						0	0	0								0											0	YES	280.667566		25.83220827		7.762967773	5.593301685		24.82796317	69.79687688					73.92048215						335.5091267	51.9184303	0								5.278202132											3400	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								23.3% coinsurance												0.076066257		0.159529212		0.233	0.233		0.233	0.233					0.233						0.233	0.233	0.233								0.233											NO	0.051371844		0.074935262		0.180272108	0.180272108		0.180272108	0.180272108					0.180272108						0.180272108	0.180272108	0.180272108								0.180272108												14.4184	0	1.935743282	0	1.399446561	1.008316283	0	4.475789246	12.58243009	0	0	0	0	13.32580111	0	0	0	0	0	60.48293735	9.359444849	0	0	0	0	0	0	0	0	0.951512622	0	0	0	0	0	0	0	0	0	0	119.9398	0	39.24454623	14.4184	0	1.935743282	0	1.399446561	1.008316283	0	4.475789246	12.58243009	0	0	0	0	13.32580111	0	0	0	0	0	60.48293735	9.359444849	0	0	0	0	0	0	0	0	0.951512622	0	0	0	0	0	0	0	0	0	0	119.9398	NO																																																																																		0			14.4184	0	1.935743282	0	1.399446561	1.008316283	0	4.475789246	12.58243009	0	0	0	0	13.32580111	0	0	0	0	0	60.48293735	9.359444849	0	0	0	0	0	0	0	0	0.951512622	0	0	0	0	0	0	0	0	0	0	119.9398
H1032_002_0	2011	5																															D	D	D	P	P	P	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1761.831828	104.7228374	795.3345587	443.583897	572.0994813	766.630654	7.940999271	501.5481677	402.4636546	4604.874679	826.6352791	62.35207207	0.016135221	566.9168805	14493.36622	14373.68651	437.8290456	139.7409072	4512.429	3822.167855	18.97934013	0.004842185	0	287.1428571	0	0	13.8	10.51428571	1200	0											3400	"(1a) $50 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $50 days 1 - 5, $0 after day 5, unlimited coverage"	"(2) $0 days 1 - 7, $85 days 8 - 100"	(6) Copay between $0.00 and $20.00	(10a) $100.00 copayment	(11a) $0.00 copayment	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) , (9b) $25.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $50.00 copayment	(12) 20% coinsurance	"(9a) $25.00 copayment , (9d) Copay between $20.00 and $25.00"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) $20.00 copayment"	"(7e) , (7h) $20.00 copayment"	"(7c) , (7i) $20.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $20.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	"(16) $0.00 copayment,   benefit limit"	Not Covered	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	32.39050529	26.5381425	53.74801595	1.9477053	48.43109177	0	0.099444002	34.70063469	19.04619263	0	10.02972269	13.01194443	0.2	11.26612682	0	5.259072617	17.46644398	7.51507442	6.583446883	6.221539868	0.2	0	0	0	0	0	0	0	0	0											NO	31.91979463	26.15248052	52.96693014	1.919400535	47.72727346	0	0.097998846	34.19635239	18.7694064	0	9.883967099	12.8228501	0.197093527	11.10240335	0	5.182645853	17.21261524	7.405862613	6.487773828	6.131126178	0.197093527	0	0	0	0	0	0	0	0	0												4.6864	0.228230164	3.510535835	0.070951264	2.275395699	0	0.778208762	1.429259824	0.629500325	0	0.680869658	0.066627606	0.003180148	0.524511656	0	6.207810567	0.628015242	0.08624183	2.439634897	1.95284945	3.740705086	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.939	0	0.441500097	4.6864	0.228230164	3.510535835	0.070951264	2.275395699	0	0.778208762	1.429259824	0.629500325	0	0.680869658	0.066627606	0.003180148	0.524511656	0	6.207810567	0.628015242	0.08624183	2.439634897	1.95284945	3.740705086	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.939	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.8663	0	0.0629	0.0084	0.0287	0.007	0.0156	0	0.141	0.0017	0.0288	0	0	0.0334	0	0.2515	0	0.0005	0.079	0.0352	0.0507	0	0	0	0	0	0	0	0	0											1.6109	0	0	5.5527	0.228230164	3.573436525	0.079399572	2.304140925	0.007015657	0.7938508	1.429259824	0.77048965	0.001724145	0.709708889	0.066627606	0.003180148	0.557930395	0	6.459315686	0.628015242	0.08669627	2.518664817	1.988001232	3.791419112	1.29E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.5499
H1032_008_0	2011	5																															D	D	D	P	P	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1663.418572	117.477488	619.9929526	1634.838631	562.1712112	651.0967056	1836.22607	475.8985841	238.1772823	4950.207639	983.9285084	14.3507497	4.038146646	1031.926881	14061.61452	16676.40304	816.3539187	1192.470705	4424.818355	6607.213716	9.167815222	0.025496659	0	420	342	205.2	13.8	10.51428571	1147.826087	2278.142929											3400	"(1a) $0 per admission, unlimited coverage"	"(1b) $0 per admission, unlimited coverage"	"(2) $0 days 1 - 7, $85 days 8 - 100"	(6) $0.00 copayment	(10a) $0.00 copayment	(11a) $0.00 copayment	"(11b) , (11c) $0.00 copayment"	"(4a) , (4b) $0.00 copayment"	"(9a) , (9b) $0.00 copayment"	(8a) $0.00 copayment	(8b) $0.00 copayment	(5) $0.00 copayment	(12) 20% coinsurance	"(9a) , (9d) $0.00 copayment"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) $0.00 copayment"	"(7e) , (7h) $0.00 copayment"	"(7c) , (7i) $0.00 copayment"	(8b) $0.00 copayment	"(7g) , (8a) $0.00 copayment"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	"(16) $0.00 copayment, $500 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	"(13b) , (13c) $0.00 copayment"											0	0	0	60.70446262	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	60.58418855	0	0	0	0	0	0	0	0	0	0.199603739	0	0	0	0	0	0	0	0.199603739	0	0	0	0	0	0	0	0	0												0	0	3.130147495	0	0	0	0	0	0	0	0	0	0.806029169	0	0	0	0	0	0	0	1.829930196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.7661	0	0.011447098	0	0	3.130147495	0	0	0	0	0	0	0	0	0	0.806029169	0	0	0	0	0	0	0	1.829930196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.7661	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	3.130147495	0	0	0	0	0	0	0	0	0	0.806029169	0	0	0	0	0	0	0	1.829930196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.7661
H1032_012_0	2011	5																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1365.108388	118.8149664	874.7907088	299.8823315	552.9960505	5.066604334	9.506295697	419.7154178	234.3927068	4615.111665	526.4983156	17.47210894	0.221806585	240.3327115	13373.7173	10771.86484	522.9211144	59.32397285	3984.934844	2872.378201	18.72465455	0.028035112	0	0	0	0	13.8	10.51428571	1100	0											5000	"(1a) $175 days 1 - 7, $0 after day 7, unlimited coverage"	"(1b) $175 days 1 - 7, $0 after day 7, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $125.00 copayment , (9b) $75.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $175.00 copayment	(12) 20% coinsurance	"(9a) $125.00 copayment , (9d) Copay between $35.00 and $125.00"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	144.5050763	99.23634421	33.5188477	0	48.09546778	0.200000054	0.090173604	44.68249235	102.1957354	0	10.43016678	74.1670684	0.2	42.1741401	0	9.392542663	31.33727917	17.26913387	6.959331079	4.396678218	0.2	0	0	0	0	0	0	0	0	0											NO	142.3052703	97.72566576	33.00858907	0	47.36330874	0.196955446	0.088800888	44.00228916	100.640006	0	10.27138797	73.03802044	0.196955393	41.53212165	0	9.249559647	30.86023063	17.00624522	6.853388931	4.329747426	0.196955393	0	0	0	0	0	0	0	0	0												16.1885	0.967605975	2.406300586	0	2.182643556	0.997895316	0.844167503	1.539036598	1.965773619	0	0.450655705	0.106344021	0.043686003	0.831793951	0	8.302917196	1.344788849	0.084073169	2.275859029	1.036389343	3.687921692	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2564	0	0.699589102	16.1885	0.967605975	2.406300586	0	2.182643556	0.997895316	0.844167503	1.539036598	1.965773619	0	0.450655705	0.106344021	0.043686003	0.831793951	0	8.302917196	1.344788849	0.084073169	2.275859029	1.036389343	3.687921692	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2564	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.6168	0	0.0711	0.002	0.0257	0.0033	0.0176	0	0.1332	0.0014	0.0158	0	0	0.0229	0	0.2338	0	0.0001	0.07	0.0281	0.05	0.0001	0	0	0	0	0	0	0	0											1.292	0	0	16.8053	0.967605975	2.477427971	0.001990421	2.208377284	1.001176046	0.861784549	1.539036598	2.099012562	0.00139144	0.466424351	0.106344021	0.043686003	0.854688182	0	8.536754573	1.344788849	0.084136517	2.345878626	1.064465581	3.737955182	7.49E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5483
H1032_014_0	2011	5																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1786.474917	121.5823812	1476.805663	426.0417139	606.5481569	7.056493426	8.702464732	536.2199859	201.8681293	4583.612838	600.8431545	5.547663812	0.089588539	559.5742517	11693.74121	13316.59872	475.3361757	353.9618625	4151.524437	2958.645872	14.25912834	0.001971039	0	0	0	0	13.8	10.51428571	1056	0											5000	"(1a) $175 days 1 - 7, $0 after day 7, unlimited coverage"	"(1b) $175 days 1 - 7, $0 after day 7, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $125.00 copayment , (9b) $75.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $175.00 copayment	(12) 20% coinsurance	"(9a) $125.00 copayment , (9d) Copay between $35.00 and $125.00"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	136.9698714	77.53690622	36.55093472	0	47.07589586	0.200000033	0.115075821	38.66979088	100.7298177	0	9.047773995	78.71982963	0.2	36.23759276	0	7.972609323	30.59489327	9.552931047	5.266105555	7.721680249	0.2	0	0	0	0	0	0	0	0	0											NO	134.2098581	75.97449771	35.81441459	0	46.12729237	0.19596993	0.112756984	37.89057472	98.70006007	0	8.865456699	77.13358461	0.195969897	35.50738664	0	7.811957148	29.97839045	9.360434576	5.159990821	7.566084423	0.195969897	0	0	0	0	0	0	0	0	0												19.9802	0.769763362	4.407577524	0	2.331535347	1.382860521	0.981263681	1.693140287	1.660366374	0	0.443895747	0.035659266	0.017556657	1.655751609	0	8.669058211	1.187484456	0.276103071	1.785152333	1.865447037	2.794359914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9372	0	1.068083453	19.9802	0.769763362	4.407577524	0	2.331535347	1.382860521	0.981263681	1.693140287	1.660366374	0	0.443895747	0.035659266	0.017556657	1.655751609	0	8.669058211	1.187484456	0.276103071	1.785152333	1.865447037	2.794359914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9372	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.6991	0	0.1171	0.0101	0.0291	0.0086	0.0184	0	0.1046	0.0018	0.0158	0	0	0.0275	0	0.2461	0	0.0017	0.067	0.0311	0.0381	0	0	0	0	0	0	0	0	0											1.4159	0	0	20.6793	0.769763362	4.524648526	0.010104968	2.360605426	1.3914637	0.999664301	1.693140287	1.764943743	0.001810549	0.459648009	0.035659266	0.017556657	1.683286257	0	8.915122794	1.187484456	0.277796319	1.852120774	1.896518469	2.832461229	5.27E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3531
H1032_025_0	2011	5																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1382.038376	210.9466749	589.2627465	657.4050953	512.0630569	9.63980839	12.1561076	1020.658211	333.4297411	12145.73211	1619.965283	4.477369544	0.07564383	2646.405931	10040.8015	20435.03256	806.1754106	1342.168778	4486.181018	3990.405645	14.94817516	0.048691849	0	0	0	0	13.8	10.51428571	1015.384615	0											5000	"(1a) $150 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $150 days 1 - 5, $0 after day 5, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $100.00 copayment , (9b) $50.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $150.00 copayment	(12) 20% coinsurance	"(9a) $100.00 copayment , (9d) Copay between $35.00 and $100.00"	"(14b) , (14c) $0.00 copayment ; (7a) $10.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	136.6476706	63.53436941	39.27	0	33.07214493	0.2	0.076030645	49.81091111	16.18394829	0	14.78651638	39.0358333	0.2	12.52665489	3.901023114	13.35912197	29.26676158	14.88471105	5.879559847	8.685644033	0.2	0	0	0	0	0	0	0	0	0											NO	131.4540936	61.11961447	37.77746254	0	31.81516975	0.192398587	0.073140944	47.91774455	15.5688439	0	14.22452429	37.55219582	0.192398587	12.05055349	3.752756673	12.85138095	28.15441785	14.31898687	5.656095031	8.355528191	0.192398587	0	0	0	0	0	0	0	0	0												15.1396	1.074414954	1.855070944	0	1.357614423	1.854685512	0.889109181	4.075636619	0.432592966	0	1.920269625	0.014011255	0.014553766	2.657554686	3.140057071	21.88486568	1.891449948	1.601541425	2.11452218	2.778495572	2.876007777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.572	0	2.669680286	15.1396	1.074414954	1.855070944	0	1.357614423	1.854685512	0.889109181	4.075636619	0.432592966	0	1.920269625	0.014011255	0.014553766	2.657554686	3.140057071	21.88486568	1.891449948	1.601541425	2.11452218	2.778495572	2.876007777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.572	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.5967	0	0.0413	0.023	0.0199	0.0258	0.0325	0	0.1535	0.0162	0.0419	0	0	0.0412	0	0.3482	0	0.0071	0.0832	0.0473	0.0399	0.0001	0	0	0	0	0	0	0	0											1.5178	0	0	15.7362	1.074414954	1.896378458	0.023018641	1.377494129	1.880442905	0.9215907	4.075636619	0.586100305	0.016196161	1.962150844	0.014011255	0.014553766	2.698799488	3.140057071	22.2330719	1.891449948	1.608661814	2.197734441	2.825763869	2.915950269	0.000130108	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0898
H1032_032_0	2011	7																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	779.9583021	110.3932686	316.3305114	273.3548229	265.036965	4.307422528	5.131999434	317.6183696	158.8060242	4452.996423	333.4098401	11.84607232	0.022901797	130.090097	15014.0726	8604.248763	354.015804	144.4777328	3121.179619	2706.545134	8.939144985	0.012286681	0	0	0	0	13.8	10.51428571	977.7777778	0											5000	"(1a) $100 days 1 - 10, $0 after day 10, unlimited coverage"	"(1b) $100 days 1 - 10, $0 after day 10, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $75.00 copayment , (9b) $50.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $100.00 copayment	(12) 20% coinsurance	"(9a) $75.00 copayment , (9d) Copay between $25.00 and $75.00"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) $25.00 copayment"	"(7e) , (7h) $25.00 copayment"	"(7c) , (7i) $25.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $25.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	90.71798456	54.89293968	28.31931833	0	46.5541016	0.2	0.128650058	40.31665722	60.95187305	0	12.94040413	37.8565384	0.2	30.90479797	0	7.027906679	22.04682511	5.906368688	6.913828598	6.005231956	0.2	0	0	0	0	0	0	0	0	0											NO	90.15789008	54.55402968	28.14447435	0	46.26667573	0.198765196	0.127855771	40.06774145	60.57555509	0	12.86050984	37.62281144	0.198765196	30.71399119	0	6.984516256	21.91070761	5.869902661	6.871142495	5.968155545	0.198765196	0	0	0	0	0	0	0	0	0												5.8599	0.501866471	0.741912997	0	1.021864943	0.856165685	0.656155742	1.060520893	0.801646922	0	0.357318377	0.037140212	0.00455208	0.332965508	0	5.008042947	0.646394731	0.070672519	1.787172493	1.346090196	1.776790908	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.8672	0	0.14205973	5.8599	0.501866471	0.741912997	0	1.021864943	0.856165685	0.656155742	1.060520893	0.801646922	0	0.357318377	0.037140212	0.00455208	0.332965508	0	5.008042947	0.646394731	0.070672519	1.787172493	1.346090196	1.776790908	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.8672	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	5.8599	0.501866471	0.741912997	0	1.021864943	0.856165685	0.656155742	1.060520893	0.801646922	0	0.357318377	0.037140212	0.00455208	0.332965508	0	5.008042947	0.646394731	0.070672519	1.787172493	1.346090196	1.776790908	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.8672
H1032_035_0	2011	4																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1364.605332	123.1741012	853.5247376	278.1100178	530.9555738	5.889825992	8.163528223	470.6041707	300.8472695	4785.382285	514.2442968	11.45986625	0.061037572	312.8340699	12849.32263	12142.28633	386.0882154	67.50438849	4316.26332	2937.107453	15.00357291	0.011758102	0	0	0	0	13.8	10.51428571	942.8571429	0											5500	"(1a) $0 per admission, unlimited coverage"	"(1b) $0 per admission, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) , (9b) $0.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $0.00 copayment	(12) 20% coinsurance	"(9a) , (9d) $0.00 copayment"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) $0.00 copayment"	"(7e) , (7h) $0.00 copayment"	"(7c) , (7i) $0.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $0.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	0	0	34.2717046	0	49.10056469	0.200000046	0.106218203	35.71366291	0	0	10.67756836	0	0.2	0	0	0	0	0	5.773469084	13.48614538	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	34.13929233	0	48.91085959	0.199227326	0.105807818	35.57567949	0	0	10.63631447	0	0.199227279	0	0	0	0	0	5.75116269	13.43404027	0.199227279	0	0	0	0	0	0	0	0	0												0	0	2.428227544	0	2.16412446	1.173414281	0.86376511	1.395171929	0	0	0.455805338	0	0.012160349	0	0	0	0	0	2.068627714	3.288101649	2.989121011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.8385	0	0.065309689	0	0	2.428227544	0	2.16412446	1.173414281	0.86376511	1.395171929	0	0	0.455805338	0	0.012160349	0	0	0	0	0	2.068627714	3.288101649	2.989121011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.8385	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.6249	0	0.0656	0.002	0.0258	0.0042	0.0149	0	0.1452	0.0011	0.0152	0	0	0.0238	0	0.2617	0	0.0002	0.0733	0.03	0.0401	0	0	0	0	0	0	0	0	0											1.3279	0	0	0.6249	0	2.493790815	0.002004984	2.189970351	1.177603943	0.878687842	1.395171929	0.145157615	0.001083444	0.471028556	0	0.012160349	0.02377258	0	0.261727471	0	0.000165364	2.141900132	3.318073952	3.02921153	3.14E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.1664
H1032_037_0	2011	4																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1475.99707	64.31012053	625.035777	373.5227212	424.3854641	5.472302114	4.780912468	416.1350086	256.0861793	3828.391484	847.0008089	84.42346939	0.052652145	673.0350413	14477.55816	14608.0818	223.8169344	387.8685683	4547.626127	3670.149346	16.4823713	0.006815723	0	287.1428571	342	205.2	13.8	10.51428571	910.3448276	0											6700	"(1a) $0 per admission, unlimited coverage"	"(1b) $0 per admission, unlimited coverage"	(2) $0 days 1 - 100	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) , (9b) $0.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $0.00 copayment	(12) 20% coinsurance	"(9a) $0.00 copayment , (9d) $20.00 copayment"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) $20.00 copayment"	"(7e) , (7h) $20.00 copayment"	"(7c) , (7i) $20.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $20.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	"(16) $0.00 copayment,   benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	0	0	0	0	48.16095459	0.2	0.130508507	36.84797793	0	0	10.11189266	0	0.2	5.392600259	0	4.692003623	17.85707908	5.457848056	6.46416127	7.680438538	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	47.98697206	0.199277496	0.130037042	36.71486378	0	0	10.07536322	0	0.199277496	5.37311937	0	4.675053654	17.79256999	5.438131457	6.440809343	7.652692782	0.199277496	0	0	0	0	0	0	0	0	0												0	0	0	0	1.697081117	1.09050666	0.621695714	1.273195013	0	0	0.7111534	0	0.010492388	0.301358135	0	5.691130515	0.331856539	0.175773355	2.440866071	2.340543784	3.284565674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.9702	0	0.072404424	0	0	0	0	1.697081117	1.09050666	0.621695714	1.273195013	0	0	0.7111534	0	0.010492388	0.301358135	0	5.691130515	0.331856539	0.175773355	2.440866071	2.340543784	3.284565674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.9702	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	1.697081117	1.09050666	0.621695714	1.273195013	0	0	0.7111534	0	0.010492388	0.301358135	0	5.691130515	0.331856539	0.175773355	2.440866071	2.340543784	3.284565674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.9702
H1032_040_0	2011	4																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1245.313228	118.1005659	413.8481003	1541.642901	385.3737561	5.520780225	7.275129333	318.4674818	205.4070581	6921.921089	677.7661304	16.18516705	0.177447	1025.103746	14440.07175	12776.42996	811.4398286	913.2847769	3730.83508	6519.640797	11.9748684	0.025567178	0	420	0	0	0	0	880	0											6700	"(1a) $0 per admission, unlimited coverage"	"(1b) $0 per admission, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $0.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $0.00 copayment"	"(9a) , (9b) $0.00 copayment"	(8a) $0.00 copayment	(8b) $0.00 copayment	(5) $0.00 copayment	(12) 20% coinsurance	"(9a) , (9d) $0.00 copayment"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) $0.00 copayment"	"(7e) , (7h) $0.00 copayment"	"(7c) , (7i) $0.00 copayment"	(8b) $0.00 copayment	"(7g) , (8a) $0.00 copayment"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	"(16) $0.00 copayment, $500 benefit limit"	Not Covered	Not Covered	Not Covered	Not Covered	(14a) $0.00 copayment	Not Covered											0	0	0	40.29859446	0	0	0.2	0.111220022	30.92980832	0	0	0	0	0.2	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	40.26719899	0	0	0.199844186	0.111133374	30.9057118	0	0	0	0	0.199844186	0	0	0	0	0	0	0	0.199844186	0	0	0	0	0	0	0	0	0												0	0	1.388708651	0	0	1.103295829	0.808509669	0.820205351	0	0	0	0	0.035461751	0	0	0	0	0	0	0	2.393107826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.5493	0	0.005106339	0	0	1.388708651	0	0	1.103295829	0.808509669	0.820205351	0	0	0	0	0.035461751	0	0	0	0	0	0	0	2.393107826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.5493	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	1.388708651	0	0	1.103295829	0.808509669	0.820205351	0	0	0	0	0.035461751	0	0	0	0	0	0	0	2.393107826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.5493
H1032_061_0	2011	6																															D	D	D	P	P	P	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	2066.511304	281.8005603	757.9188903	450.7661218	756.7573862	699.1678508	19.69175312	751.08566	345.81594	4933.462235	783.6689059	43.69555956	0.626036372	494.5299218	18341.8416	15501.16956	956.2078721	222.8409271	5491.161317	4677.789222	8.895209743	0.001926673	0	420	342	205.2	13.8	10.51428571	851.6129032	0											6700	"(1a) $0 per admission, unlimited coverage"	"(1b) $0 per admission, unlimited coverage"	(2) $0 days 1 - 100	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) $0.00 copayment	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) , (9b) $0.00 copayment"	(8a) $0.00 copayment	(8b) $0.00 copayment	(5) $0.00 copayment	(12) 20% coinsurance	"(9a) , (9d) $0.00 copayment"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) $0.00 copayment"	"(7e) , (7h) $0.00 copayment"	"(7c) , (7i) $0.00 copayment"	(8b) $0.00 copayment	"(7g) , (8a) $0.00 copayment"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	"(16) $0.00 copayment, $500 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	0	0	0	0	48.87680892	0	0.125328123	39.04725959	0	0	0	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	48.80607254	0	0.125146743	38.99074891	0	0	0	0	0.199710552	0	0	0	0	0	0	0	0.199710552	0	0	0	0	0	0	0	0	0												0	0	0	0	3.077862991	0	2.464358765	2.440449365	0	0	0	0	0.12502607	0	0	0	0	0	0	0	1.776467251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.8842	0	0.014325472	0	0	0	0	3.077862991	0	2.464358765	2.440449365	0	0	0	0	0.12502607	0	0	0	0	0	0	0	1.776467251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.8842	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.846	0	0.0634	0.0042	0.0367	0.0086	0.046	0	0.1382	0.0031	0.0263	0	0	0.0442	0	0.3056	0	0.0004	0.0925	0.046	0.0238	0	0	0	0	0	0	0	0	0											1.685	0	0	0.846	0	0.063439842	0.004156674	3.114591987	0.008588719	2.510386158	2.440449365	0.138220903	0.003082259	0.026320793	0	0.12502607	0.044164992	0	0.30559121	0	0.000415081	0.092456378	0.046037863	1.800235828	5.15E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.5692
H1032_073_0	2011	7																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1914.992485	176.0696055	866.2544596	493.1008194	531.415711	5.750897742	10.652299	445.1891728	235.9797012	5378.507515	791.881688	0.053278168	0.04500509	349.6356959	14543.00603	15055.50067	632.5393701	294.9102032	5387.652446	4590.507704	31.33332434	0.013375485	0	0	0	0	0	0	825	0											6700	"(1a) $200 days 1 - 8, $0 after day 8, unlimited coverage"	"(1b) $200 days 1 - 8, $0 after day 8, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $200.00 copayment	(12) 20% coinsurance	"(9a) $150.00 copayment , (9d) Copay between $35.00 and $150.00"	"(14b) , (14c) $0.00 copayment ; (7a) $5.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	(14a) $0.00 copayment	Not Covered											0	162.6239402	94.54584211	39.98331505	0	49.31005376	0.200000041	0.074417588	47.34348054	112.3123718	0	15.68617801	52.04777773	0.2	82.87115623	1.763477606	8.712886436	30.6285047	9.559644304	6.811072281	6.291665941	0.2	0	0	0	0	0	0	0	0	0											NO	159.5416437	92.75386536	39.22549039	0	48.37545454	0.196209335	0.073007113	46.44615482	110.1836567	0	15.38886968	51.061289	0.196209295	81.3004559	1.730053494	8.547746547	30.04798664	9.37845537	6.681978469	6.172416708	0.196209295	0	0	0	0	0	0	0	0	0												25.4601	1.36092804	2.831604665	0	2.142289714	1.128379824	0.777693593	1.723110437	2.166758865	0	1.015513675	0.000226704	0.008830417	2.368795123	2.096681532	10.72421699	1.583877879	0.230483515	3.000014803	2.361210538	6.147889494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.1286	0	1.296904208	25.4601	1.36092804	2.831604665	0	2.142289714	1.128379824	0.777693593	1.723110437	2.166758865	0	1.015513675	0.000226704	0.008830417	2.368795123	2.096681532	10.72421699	1.583877879	0.230483515	3.000014803	2.361210538	6.147889494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.1286	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.7929	0	0.079	0.0023	0.025	0.0095	0.0247	0	0.1288	0.0013	0.0305	0	0	0.0629	0	0.2969	0	0	0.1185	0.0563	0.0837	0	0	0	0	0	0	0	0	0											1.7124	0	0	26.253	1.36092804	2.910615821	0.002257455	2.167261051	1.137926983	0.802411271	1.723110437	2.295535444	0.001323804	1.045971484	0.000226704	0.008830417	2.431685957	2.096681532	11.0210791	1.583877879	0.230523453	3.118560613	2.417526938	6.231614167	3.57E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.841
H1032_079_0	2011	5																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1420.183636	202.0067089	481.1519141	516.3704441	567.9149099	9.46152356	10.92066703	850.571761	326.1839425	8286.71704	1260.831148	10.00775238	0.048435392	1751.914135	9751.897323	15976.41421	760.9533433	1057.670051	3939.544308	3485.978386	16.44669615	0.027093866	0	0	0	0	13.8	10.51428571	800	0											5000	"(1a) $200 days 1 - 8, $0 after day 8, unlimited coverage"	"(1b) $200 days 1 - 8, $0 after day 8, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $200.00 copayment	(12) 20% coinsurance	"(9a) $150.00 copayment , (9d) Copay between $35.00 and $150.00"	"(14b) , (14c) $0.00 copayment ; (7a) $15.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	159.4953973	117.1664115	31.23958806	0	47.89551822	0.2	0.064244349	48.91269552	116.8758175	0	15.12696901	90.61506745	0.2	21.4366331	5.457457947	8.931803071	31.51476449	5.886620748	4.607503117	4.920301007	0.2	0	0	0	0	0	0	0	0	0											NO	154.7221742	113.6599692	30.30468006	0	46.46214774	0.194014595	0.062321707	47.44888395	113.3780717	0	14.6742638	87.90322786	0.194014595	20.7950984	5.294132454	8.664500757	30.57162128	5.710451688	4.469614246	4.773051024	0.194014595	0	0	0	0	0	0	0	0	0												18.3112	1.913339692	1.215096235	0	2.198878871	1.835673657	0.680594606	3.363223398	3.081842203	0	1.541814073	0.073309478	0.009397173	3.035935569	4.302319675	11.53563775	1.938631452	0.503314477	1.467353613	1.386562725	3.190899085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.585	0	1.899914222	18.3112	1.913339692	1.215096235	0	2.198878871	1.835673657	0.680594606	3.363223398	3.081842203	0	1.541814073	0.073309478	0.009397173	3.035935569	4.302319675	11.53563775	1.938631452	0.503314477	1.467353613	1.386562725	3.190899085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.585	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	18.3112	1.913339692	1.215096235	0	2.198878871	1.835673657	0.680594606	3.363223398	3.081842203	0	1.541814073	0.073309478	0.009397173	3.035935569	4.302319675	11.53563775	1.938631452	0.503314477	1.467353613	1.386562725	3.190899085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.585
H1032_091_0	2011	6																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1483.93934	123.777733	645.8149832	376.9835979	495.9883873	5.871383423	8.779876894	508.3185166	308.6164134	4746.815795	716.6386541	40.338927	0.04449314	332.4939637	16243.65335	12817.63835	467.6293456	351.5875923	4582.130193	3975.72094	11.04630697	0.017179595	0	0	0	0	13.8	10.51428571	776.4705882	0											4000	"(1a) $75 days 1 - 8, $0 after day 8, unlimited coverage"	"(1b) $75 days 1 - 8, $0 after day 8, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $50.00 copayment , (9b) $25.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $75.00 copayment	(12) 20% coinsurance	"(9a) $50.00 copayment , (9d) Copay between $25.00 and $50.00"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) $25.00 copayment"	"(7e) , (7h) $25.00 copayment"	"(7c) , (7i) $25.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $25.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	57.56210026	41.28313588	36.57268306	0	47.62160053	0.200000042	0.102194774	37.03331928	39.86370051	0	11.93887938	4.181106356	0.2	24.63691902	0	7.085977306	21.42225414	7.040581276	7.420832215	7.955589992	0.2	0	0	0	0	0	0	0	0	0											NO	56.7997849	40.73640863	36.08833801	0	46.99093074	0.19735137	0.100841372	36.54287386	39.33577134	0	11.78076856	4.125734478	0.197351329	24.31064354	0	6.992135189	21.13855161	6.947340354	7.322555495	7.850231285	0.197351329	0	0	0	0	0	0	0	0	0												7.024	0.420188359	1.942199117	0	1.94224633	1.158725561	0.885374833	1.54795162	1.011638722	0	0.703546177	0.013868975	0.00878078	0.673595186	0	7.468555013	0.823750588	0.203549889	2.796075219	2.600860742	2.18000336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4049	0	0.448329878	7.024	0.420188359	1.942199117	0	1.94224633	1.158725561	0.885374833	1.54795162	1.011638722	0	0.703546177	0.013868975	0.00878078	0.673595186	0	7.468555013	0.823750588	0.203549889	2.796075219	2.600860742	2.18000336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4049	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.7296	0	0.0517	0.0026	0.0245	0.0051	0.0167	0	0.1158	0.0016	0.0279	0	0	0.0262	0	0.234	0	0.0003	0.0888	0.0358	0.0295	0	0	0	0	0	0	0	0	0											1.3902	0	0	7.7535	0.420188359	1.993925586	0.002554138	1.966776097	1.163818178	0.902092685	1.54795162	1.127432403	0.001630678	0.73142947	0.013868975	0.00878078	0.699806599	0	7.702584739	0.823750588	0.203837352	2.884876114	2.636665628	2.209519807	4.59E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.795
H1032_101_0	2011	7																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1644.05802	150.7127701	751.7807823	562.6843142	520.8413695	9.102430166	9.921553132	1216.878417	347.795215	8272.744159	1789.171677	3.832739225	0.110575328	2557.061659	11536.29666	20612.70114	671.7817137	1259.050846	4702.752332	4082.281395	13.85524217	0.031895045	0	0	342	0	13.8	10.51428571	0	0											3400	"(1a) $100 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $100 days 1 - 5, $0 after day 5, unlimited coverage"	"(2) $0 days 1 - 7, $85 days 8 - 100"	(6) Copay between $0.00 and $25.00	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $75.00 copayment , (9b) $50.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $100.00 copayment	(12) 20% coinsurance	"(9a) $75.00 copayment , (9d) Copay between $25.00 and $75.00"	"(14b) , (14c) $0.00 copayment ; (7a) $5.00 copayment"	"(7b) , (7d) , (7g) $25.00 copayment"	"(7e) , (7h) $25.00 copayment"	"(7c) , (7i) $25.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $25.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											0	70.093626	43.03081526	60.32800767	10.24095124	44.58501327	0.200000002	0.07362755	44.69334711	57.50002422	0	11.5510779	26.02388886	0.2	10.10084091	1.842399962	6.226398394	21.93074206	6.815280195	5.049415657	5.998052389	0.2	0	0	0	0	0	0	0	0	0											NO	67.09362482	41.18910005	57.74597411	9.802639406	42.67677852	0.191440019	0.070476297	42.78047569	55.03902811	0	11.05669275	24.91006865	0.191440017	9.668525782	1.763545401	5.959909076	20.99210818	6.523586787	4.8333011	5.74133626	0.191440017	0	0	0	0	0	0	0	0	0												9.1922	0.51731028	3.617692799	0.459649286	1.852319314	1.742569402	0.699234329	4.338219794	1.595192551	0	1.648526793	0.00795615	0.021168543	2.060251381	1.695398577	10.23748538	1.175176201	0.684460622	1.894151502	1.95314585	2.652447799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0445	0	2.148245531	9.1922	0.51731028	3.617692799	0.459649286	1.852319314	1.742569402	0.699234329	4.338219794	1.595192551	0	1.648526793	0.00795615	0.021168543	2.060251381	1.695398577	10.23748538	1.175176201	0.684460622	1.894151502	1.95314585	2.652447799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0445	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.7298	0	0.0559	0.0193	0.0216	0.0239	0.0263	0	0.1606	0.0143	0.043	0	0	0.0421	0	0.3683	0	0.0068	0.0854	0.0496	0.037	0.0001	0	0	0	0	0	0	0	0											1.684	0	0	9.9219	0.51731028	3.673569125	0.478986387	1.873950958	1.766422589	0.72554051	4.338219794	1.755806474	0.014262797	1.691556055	0.00795615	0.021168543	2.10233956	1.695398577	10.60577095	1.175176201	0.691267121	1.979548272	2.002724631	2.689469904	8.52E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7285
H1032_124_0	2011	6																															D	D	D	P	Coin	P	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	P	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	Yes	1888.73509	462.5367847	562.1949787	1344.341699	16.52048035	535.1409226	11.80058207	64.55573834	38.14300681	10881.42358	9.374573747	0.789886654	0.097140278	15.43574062	11058.94992	110.414349	8.336092673	0.849667457	31.06732371	26.4743737	14.25389658	0.008056509	0	510	342	205.2	13.8	10.51428571	733.3333333	0											6700	FFS	FFS	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) $0.00 copayment	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) $0.00 copayment	(8b) 20% coinsurance	(5) 45% coinsurance	(12) 20% coinsurance	"(9a) , (9d) 20% coinsurance"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) 20% coinsurance"	"(7e) , (7h) 45% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) 20% coinsurance"	(15) 20% coinsurance	(13a) 20% coinsurance	Not Covered	"(16) $0.00 copayment, $750 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	150.4597441	58.30016858	32.12059497	0	0.184114776	0	0.099239484	0.185531061	0.182511392	0	0.188574599	0.407681521	0.1908	0.17911165	0	0.084533644	0.41215466	0.138449746	0.172999274	0.155843872	0.19080033	0.188488109	0	0	0	0	0	0	0	0											NO	146.4088076	56.730511	31.25578897	0	0.179157721	0	0.096567587	0.180535874	0.177597506	0	0.183497469	0.396705216	0.185662954	0.174289297	0	0.082257683	0.401057922	0.134722164	0.16834149	0.151647975	0.185663275	0.183413307	0	0	0	0	0	0	0	0												23.044	2.186662346	1.464320634	0	2.959771609	0	1.139553742	11.65462667	6.774102874	0	1.720210557	0.313352156	0.018035351	2.690284387	0	9.082428539	3.343256009	0.114469038	5.22991955	4.014785157	2.646425119	0.001477671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.3976	0	2.169158036	23.044	2.186662346	1.464320634	0	2.959771609	0	1.139553742	11.65462667	6.774102874	0	1.720210557	0.313352156	0.018035351	2.690284387	0	9.082428539	3.343256009	0.114469038	5.22991955	4.014785157	2.646425119	0.001477671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.3976	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	23.044	2.186662346	1.464320634	0	2.959771609	0	1.139553742	11.65462667	6.774102874	0	1.720210557	0.313352156	0.018035351	2.690284387	0	9.082428539	3.343256009	0.114469038	5.22991955	4.014785157	2.646425119	0.001477671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.3976
H1032_131_0	2011	6																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1031.172518	113.2747554	476.4543177	492.3098502	371.5895801	5.632493746	5.959039996	585.9291582	221.28915	3109.843766	688.6140971	7.822146883	0.026010091	822.5133059	15559.34056	13822.18721	612.9024564	867.5481307	3898.665449	3756.148336	10.11805619	0.007240947	0	0	342	205.2	0	0	0	0											5000	"(1a) $250 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $250 days 1 - 5, $0 after day 5, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $250.00 copayment	(12) 20% coinsurance	"(9a) $150.00 copayment , (9d) Copay between $35.00 and $150.00"	"(14b) , (14c) $0.00 copayment ; (7a) $15.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	Not Covered	Not Covered	Not Covered	Not Covered											0	149.8133065	99.01199558	38.44834504	0	46.3305259	0.2	0.10158988	42.5690805	115.0780982	0	11.45328062	77.47734801	0.2	19.90246332	4.75509724	7.587595658	31.65271252	9.558816545	6.898376688	7.445813492	0.2	0	0	0	0	0	0	0	0	0											NO	147.2825542	97.33941493	37.7988484	0	45.5478779	0.196621459	0.099873752	41.84997349	113.1341176	0	11.2598037	76.16854585	0.196621459	19.56625684	4.674770775	7.459420626	31.11801251	9.397342256	6.781844431	7.320033545	0.196621459	0	0	0	0	0	0	0	0	0												12.6561	0.918841535	1.500785377	0	1.410426402	1.107469136	0.59515168	2.043426645	2.086279393	0	0.646138297	0.049650129	0.005114142	1.34112555	6.061362543	8.592125698	1.589358859	0.679387226	2.203345214	2.291260985	1.989426966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7668	0	0.820776019	12.6561	0.918841535	1.500785377	0	1.410426402	1.107469136	0.59515168	2.043426645	2.086279393	0	0.646138297	0.049650129	0.005114142	1.34112555	6.061362543	8.592125698	1.589358859	0.679387226	2.203345214	2.291260985	1.989426966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7668	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	12.6561	0.918841535	1.500785377	0	1.410426402	1.107469136	0.59515168	2.043426645	2.086279393	0	0.646138297	0.049650129	0.005114142	1.34112555	6.061362543	8.592125698	1.589358859	0.679387226	2.203345214	2.291260985	1.989426966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7668
H1032_132_0	2011	6																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1438.856995	158.0898098	360.8098739	287.1884937	394.3357654	6.390094648	7.781595596	609.7035844	198.3816824	725.93125	590.5864931	29.13879495	0.02362422	454.3088336	16858.06938	9907.241408	599.1905346	57.20111909	4936.579177	3158.301055	9.208454856	0.007832493	0	0	0	0	13.8	10.51428571	694.7368421	0											6700	"(1a) $100 days 1 - 7, $0 after day 7, unlimited coverage"	"(1b) $100 days 1 - 7, $0 after day 7, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $75.00 copayment , (9b) $50.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $100.00 copayment	(12) 20% coinsurance	"(9a) $75.00 copayment , (9d) Copay between $35.00 and $75.00"	"(14b) , (14c) $0.00 copayment ; (7a) $5.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	76.76535389	57.5645289	29.13980967	0	49.77723671	0.200000069	0.090715704	38.14621361	53.28841024	0	11.48406992	26.02388886	0.2	35.92697254	1.562676256	9.411255632	31.29524672	33.80140131	4.876514989	4.903691945	0.2	0	0	0	0	0	0	0	0	0											NO	76.19747462	57.13868962	28.92424506	0	49.40900469	0.198520549	0.090044626	37.86402324	52.89420397	0	11.39911538	25.83137458	0.19852048	35.66119922	1.551116205	9.341634942	31.06373705	33.55135211	4.840440489	4.867416401	0.19852048	0	0	0	0	0	0	0	0	0												9.1364	0.752753715	0.869679434	0	1.623644807	1.268565098	0.700690863	1.923819224	0.874436764	0	0.561013631	0.062724594	0.004689891	1.350099818	2.179068716	7.712486043	1.551091434	0.159931241	1.991268144	1.281063863	1.828066881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8315	0	0.267042773	9.1364	0.752753715	0.869679434	0	1.623644807	1.268565098	0.700690863	1.923819224	0.874436764	0	0.561013631	0.062724594	0.004689891	1.350099818	2.179068716	7.712486043	1.551091434	0.159931241	1.991268144	1.281063863	1.828066881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8315	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.6299	0	0.0301	0.0007	0.0214	0.0037	0.0165	0	0.0913	0.0018	0.0224	0	0	0.0667	0	0.2162	0	0.0003	0.0778	0.0319	0.0246	0	0	0	0	0	0	0	0	0											1.2354	0	0	9.7664	0.752753715	0.899790627	0.000712806	1.645012438	1.272285748	0.717164577	1.923819224	0.965782442	0.001790565	0.583420593	0.062724594	0.004689891	1.416757296	2.179068716	7.928696838	1.551091434	0.160244041	2.069031177	1.312981903	1.852672469	2.09E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0669
H1032_133_0	2011	6																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1478.819669	142.9744132	499.2838138	297.3238844	436.2187197	4.197297022	10.68631759	429.2995023	249.0543161	2883.308723	780.4868524	21.37953288	1.692194717	506.6399808	18494.17299	16933.59749	529.7561596	152.7445223	4905.243669	4181.17397	11.47231034	0.013416442	0	0	0	0	13.8	10.51428571	676.9230769	0											5000	"(1a) $175 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $175 days 1 - 5, $0 after day 5, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $125.00 copayment , (9b) $75.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $175.00 copayment	(12) 20% coinsurance	"(9a) $125.00 copayment , (9d) Copay between $25.00 and $125.00"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) $25.00 copayment"	"(7e) , (7h) $25.00 copayment"	"(7c) , (7i) $25.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $25.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	125.7158228	78.14932284	30.83556305	0	48.02990591	0.20000005	0.08509358	46.34572163	112.4425896	0	16.31908252	79.08263657	0.2	44.10566823	0	6.076938197	22.6742303	6.894710918	6.411066737	11.39838157	0.2	0	0	0	0	0	0	0	0	0											NO	123.7041596	76.89880309	30.34214251	0	47.26134716	0.196799715	0.08373194	45.60411265	110.6433203	0	16.05794993	77.81718224	0.196799666	43.39990383	0	5.979697031	22.31140472	6.784384022	6.308478956	11.21598842	0.196799666	0	0	0	0	0	0	0	0	0												15.2447	0.916213437	1.262445053	0	1.718023696	0.826026856	0.894786105	1.631485239	2.296349706	0	1.044418233	0.138641251	0.333023355	1.83234387	0	8.438148552	0.984967007	0.086356458	2.578718872	3.907999901	2.25774684	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.3924	0	0.754427593	15.2447	0.916213437	1.262445053	0	1.718023696	0.826026856	0.894786105	1.631485239	2.296349706	0	1.044418233	0.138641251	0.333023355	1.83234387	0	8.438148552	0.984967007	0.086356458	2.578718872	3.907999901	2.25774684	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.3924	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.5885	0	0.0406	0.0024	0.022	0.0059	0.0255	0	0.1316	0.0059	0.0325	0	0	0.0282	0	0.3035	0	0.0005	0.1051	0.0561	0.0307	0	0	0	0	0	0	0	0	0											1.3791	0	0	15.8332	0.916213437	1.302996404	0.002406612	1.740060004	0.831940577	0.920305052	1.631485239	2.427902136	0.005948117	1.076881077	0.138641251	0.333023355	1.860588304	0	8.741656753	0.984967007	0.086884785	2.683805608	3.964081504	2.288401597	3.58E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7714
H1035_002_0	2011	9	e.3.	f.2	h.6.	h.7.	h.8	g.2.	i.7.				DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional				Diabetic supplies	Urgent Care ER	AIXIDTF	Ultrasound	Chemo	ASC	Immunizations				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	V	V	V	V	V	Coin	V	V																																												0	YES	1351.630882	44.74700337	1214.949881	85.29594707	130.8016918	10.98372857	0.349064754	372.8573784	490.3418914	6447.530302	372.1046671	40.6714969	0.411465123	70.97747192	3660.522565	12482.70179	276.5310416	1440.575414	3039.118312	0	18.33536386	0	0	0	0	0	0	0	0	485.4603309	1294.249371	0	728.3975212	848.3916136	19.68037681	358.7524695	558.1570007	0	0	0	6700	200 Copay for 8 days (#1A)	200 Copay for 8 days (#1B)	50 Copay for days 8 to 20 (#2)	0 Copay (#6)	150 Copay (#10A)	0.2 Coins (#11A)	0.2 Coins (#11B)	50 Copay (#4A)	150 Copay (#9A)	0 Copay (#8A)	200 Copay (#8B)	200 Copay (#9A)	0.2 Coins (#12)	200 Copay (#9A)	10 Copay (#7A)	40 Copay Spec/20 Copay Endo & Chiro/0 Copay Dental & Hearing/35 Copay Podiatry (multiple)	40 Copay (#7E/#9C)	"30 Copay (#9D,#7C,#7I)"	25 Copay (#8B)		0.2 Coins (#15)		0 Copay (#10B)							(multiple)	10 Copay Lancets/10 Copay Test Strips (#11C)	40 Copay (#4B)	100 Copay (#8B)	25 Copay (#8B)	0.2 Coins (#15)	100 Copay (#9B)	0 Copay (#14B)					143.6742138	124.291498	19.8101057	0	137.158299	0.194537479	0.191071756	49.05548682	82.67920691	0	141.2829833	58.23906713	0.054405802	44.71129518	9.682449493	29.07480178	39.14386746	19.08367261	17.04216382	0	0.194081376	0	0	0	0	0	0	0	0	32.14433344	10	0	76.22225312	19.73975782	0.073389261	98.5978904	0	0	0	0	NO	142.2430566	123.2995012	18.70890785	0	137.158299	0.190065796	0.191071756	49.05548682	80.1935987	0	137.045462	57.8061667	0.054405802	44.46110887	9.642848269	28.63660041	38.07546869	18.8338048	16.91394476	0	0.16044975	0	0	0	0	0	0	0	0	31.86278718	9.866709479	0	75.363129	19.55035318	0.048108315	98.0784183	0	0	0	0		16.0217	0.4597736	1.894198781	0	1.495044796	2.087631113	0.066696416	1.524225018	3.276856739	0	4.249604669	0.195921944	0.02238609	0.262978092	2.94148864	29.78851193	0.877420751	2.26095968	4.283623271	0	2.941904552	0	0	0	0	0	0	0	0	1.289009934	1.064165212	0	4.574526363	1.382196307	0.946789776	2.93215623	0	0	0	0	86.8397	0	2.805265001	16.0217	0.4597736	1.894198781	0	1.495044796	2.087631113	0.066696416	1.524225018	3.276856739	0	4.249604669	0.195921944	0.02238609	0.262978092	2.94148864	29.78851193	0.877420751	2.26095968	4.283623271	0	2.941904552	0	0	0	0	0	0	0	0	1.289009934	1.064165212	0	4.574526363	1.382196307	0.946789776	2.93215623	0	0	0	0	86.8397	NO																																																																																		0			16.0217	0.4597736	1.894198781	0	1.495044796	2.087631113	0.066696416	1.524225018	3.276856739	0	4.249604669	0.195921944	0.02238609	0.262978092	2.94148864	29.78851193	0.877420751	2.26095968	4.283623271	0	2.941904552	0	0	0	0	0	0	0	0	1.289009934	1.064165212	0	4.574526363	1.382196307	0.946789776	2.93215623	0	0	0	0	86.8397
H1035_006_0	2011	8	e.3.	f.2	h.6.	h.7.	h.8	g.2.	i.7.				DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional				Diabetic supplies	Urgent Care ER	AIXIDTF	Ultrasound	Chemo	ASC	Immunizations				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	V	V	V	V	V	Coin	V	V																																												0	YES	1197.335958	29.20331605	846.9242944	87.75289563	104.0679589	9.984064891	0.797530836	313.047586	421.0231001	4792.362363	308.1012975	32.1243059	0.050958871	64.24861181	3275.874926	10188.21754	270.4153982	962.2568825	2627.181808	0	17.45459341	0	0	0	0	0	0	0	0	0	841.617078	0	636.1586033	720.3632233	24.35489664	330.9776972	504.8766891	0	0	0	6700	200 Copay for 8 days (#1A)	200 Copay for 8 days (#1B)	50 Copay for days 8 to 20 (#2)	0 Copay (#6)	150 Copay (#10A)	0.2 Coins (#11A)	0.2 Coins (#11B)	50 Copay (#4A)	150 Copay (#9A)	0 Copay (#8A)	200 Copay (#8B)	200 Copay (#9A)	0.2 Coins (#12)	200 Copay (#9A)	10 Copay (#7A)	40 Copay Spec/20 Copay Endo & Chiro/0 Copay Dental & Hearing/35 Copay Podiatry (multiple)	40 Copay (#7E/#9C)	"30 Copay (#9D,#7C,#7I)"	25 Copay (#8B)		0.2 Coins (#15)		0 Copay (#10B)								10 Copay Lancets/10 Copay Test Strips (#11C)	40 Copay (#4B)	100 Copay (#8B)	25 Copay (#8B)	0.2 Coins (#15)	100 Copay (#9B)	0 Copay (#14B)					134.2627583	158.1818182	19.12168344	0	136.9127517	0.193369055	0.2	48.72268517	83.47591522	0	143.5641596	62.40315794	0.2	28.88963924	9.897253529	28.44224206	10.51702534	27.42589254	17.03362488	0	0.195755418	0	0	0	0	0	0	0	0	0	10	0	76.68345834	19.51287751	0.061113571	98.70571797	0	0	0	0	NO	132.8465423	158.1818182	18.53717382	0	136.9127517	0.189644612	0.2	48.72268517	78.62069613	0	138.4247241	62.40315794	0.2	28.88963924	9.862434341	27.95298054	10.48908262	26.55488446	16.87485881	0	0.131434681	0	0	0	0	0	0	0	0	0	9.793786046	0	75.29990521	19.30955496	0.036732117	97.2788892	0	0	0	0		13.2552	0.384952802	1.308298572	0	1.187352551	1.89342411	0.159506167	1.271043248	2.758427435	0	3.554069759	0.167054845	0.010191774	0.154676601	2.692341781	23.73258722	0.236367454	2.129385028	3.694443507	0	2.294138925	0	0	0	0	0	0	0	0	0	0.6868848	0	3.991890211	1.159157771	0.894606925	2.683095228	0	0	0	0	70.2991	0	3.628043313	13.2552	0.384952802	1.308298572	0	1.187352551	1.89342411	0.159506167	1.271043248	2.758427435	0	3.554069759	0.167054845	0.010191774	0.154676601	2.692341781	23.73258722	0.236367454	2.129385028	3.694443507	0	2.294138925	0	0	0	0	0	0	0	0	0	0.6868848	0	3.991890211	1.159157771	0.894606925	2.683095228	0	0	0	0	70.2991	NO																																																																																		0			13.2552	0.384952802	1.308298572	0	1.187352551	1.89342411	0.159506167	1.271043248	2.758427435	0	3.554069759	0.167054845	0.010191774	0.154676601	2.692341781	23.73258722	0.236367454	2.129385028	3.694443507	0	2.294138925	0	0	0	0	0	0	0	0	0	0.6868848	0	3.991890211	1.159157771	0.894606925	2.683095228	0	0	0	0	70.2991
H1035_007_0	2011	9	e.3.	f.2	h.6.	h.7.	h.8	g.2.	i.7.				DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional				Diabetic supplies	Urgent Care ER	AIXIDTF	Ultrasound	Chemo	ASC	Immunizations				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	V	V	V	V	V	Coin	V	V																																												0	YES	1166.617903	46.41164413	1095.423795	66.64400308	121.1843483	9.341952577	0.298897611	534.8348974	486.7467916	5845.936634	337.0819522	33.43749641	0.657330818	58.73719891	3393.087859	12001.83608	224.551727	1238.818231	2738.538456	0	15.85685931	0	92.4584337	0	0	0	0	0	0	366.2682041	923.4621012	0	670.8872494	793.6899594	17.47547944	355.0069128	515.4243612	0	0	0	6700	200 Copay for 8 days (#1A)	200 Copay for 8 days (#1B)	50 Copay for days 8 to 20 (#2)	0 Copay (#6)	150 Copay (#10A)	0.2 Coins (#11A)	0.2 Coins (#11B)	50 Copay (#4A)	150 Copay (#9A)	0 Copay (#8A)	200 Copay (#8B)	200 Copay (#9A)	0.2 Coins (#12)	200 Copay (#9A)	10 Copay (#7A)	40 Copay Spec/20 Copay Endo & Chiro/0 Copay Dental & Hearing/35 Copay Podiatry (multiple)	40 Copay (#7E/#9C)	"30 Copay (#9D,#7C,#7I)"	25 Copay (#8B)		0.2 Coins (#15)		0 Copay (#10B)							(multiple)	10 Copay Lancets/10 Copay Test Strips (#11C)	40 Copay (#4B)	100 Copay (#8B)	25 Copay (#8B)	0.2 Coins (#15)	100 Copay (#9B)	0 Copay (#14B)					149.0963151	150.7894737	21.18464951	0	139.6336636	0.192259794	0.178363973	49.07735075	84.42255567	0	144.8419642	37.85539364	0.05827892	36.84011965	9.696577479	29.12823058	39.44351385	24.80294309	16.55884532	0	0.194530403	0	0	0	0	0	0	0	0	33.20822033	10	0	78.86142236	19.28141002	0.06789658	98.55107143	0	0	0	0	NO	149.0963151	150.7894737	21.18464951	0	139.6336636	0.192259794	0.178363973	49.07735075	84.42255567	0	144.8419642	37.85539364	0.05827892	36.84011965	9.696577479	29.12823058	39.44351385	24.80294309	16.55884532	0	0.194530403	0	0	0	0	0	0	0	0	33.20822033	9.89248154	0	78.86142236	19.28141002	0.06789658	98.55107143	0	0	0	0		14.4949	0.583198949	1.93384743	0	1.410117877	1.79608188	0.053312565	2.187356654	3.424367343	0	4.068634338	0.105482466	0.03830853	0.180323786	2.741778277	29.13268739	0.738092429	2.560528174	3.778919557	0	3.084641227	0	0	0	0	0	0	0	0	1.013592935	0.761277649	0	4.408926894	1.275288461	1.186525287	2.915525968	0	0	0	0	83.8737	0	0.179311733	14.4949	0.583198949	1.93384743	0	1.410117877	1.79608188	0.053312565	2.187356654	3.424367343	0	4.068634338	0.105482466	0.03830853	0.180323786	2.741778277	29.13268739	0.738092429	2.560528174	3.778919557	0	3.084641227	0	0	0	0	0	0	0	0	1.013592935	0.761277649	0	4.408926894	1.275288461	1.186525287	2.915525968	0	0	0	0	83.8737	NO																																																																																		0			14.4949	0.583198949	1.93384743	0	1.410117877	1.79608188	0.053312565	2.187356654	3.424367343	0	4.068634338	0.105482466	0.03830853	0.180323786	2.741778277	29.13268739	0.738092429	2.560528174	3.778919557	0	3.084641227	0	0	0	0	0	0	0	0	1.013592935	0.761277649	0	4.408926894	1.275288461	1.186525287	2.915525968	0	0	0	0	83.8737
H1035_801_0	2011	6																															Coin		D		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin																			0		0		0	0		0	0					0						0	0	0																			0	YES	240.6508551		1178.474363		5.427505019	21.6336936		21.92600318	47.87217869					126.6374198						234.7860401	18.3494226	0																			6700	8.8% coinsurance		"$50/day, days 1-20"		23.3% coinsurance	23.3% coinsurance		23.3% coinsurance	23.3% coinsurance					23.3% coinsurance						23.3% coinsurance	23.3% coinsurance	23.3% coinsurance																				0.085410574		45.34459101		0.233	0.233		0.233	0.233					0.233						0.233	0.233	0.233																			NO	0.08296055		40.42997508		0.215230233	0.215230233		0.215230233	0.215230233					0.215230233						0.215230233	0.215230233	0.215230233																				19.9645	0	3.970474093	0	1.168163168	4.656224905	0	4.719138765	10.30354015	0	0	0	0	27.25620133	0	0	0	0	0	50.53305401	3.949350494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.5207	0	10.16540245	19.9645	0	3.970474093	0	1.168163168	4.656224905	0	4.719138765	10.30354015	0	0	0	0	27.25620133	0	0	0	0	0	50.53305401	3.949350494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.5207	NO																																																																																		0			19.9645	0	3.970474093	0	1.168163168	4.656224905	0	4.719138765	10.30354015	0	0	0	0	27.25620133	0	0	0	0	0	50.53305401	3.949350494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.5207
H1035_802_0	2011	6																															Coin		D		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin																			0		0		0	0		0	0					0						0	0	0																			0	YES	240.6508551		1178.474363		5.427505019	21.6336936		21.92600318	47.87217869					126.6374198						234.7860401	18.3494226	0																			6700	8.8% coinsurance		"$50/day, days 1-20"		23.3% coinsurance	23.3% coinsurance		23.3% coinsurance	23.3% coinsurance					23.3% coinsurance						23.3% coinsurance	23.3% coinsurance	23.3% coinsurance																				0.085410574		45.34459101		0.233	0.233		0.233	0.233					0.233						0.233	0.233	0.233																			NO	0.08296055		40.42997508		0.215230233	0.215230233		0.215230233	0.215230233					0.215230233						0.215230233	0.215230233	0.215230233																				19.9645	0	3.970474093	0	1.168163168	4.656224905	0	4.719138765	10.30354015	0	0	0	0	27.25620133	0	0	0	0	0	50.53305401	3.949350494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.5207	0	10.16540245	19.9645	0	3.970474093	0	1.168163168	4.656224905	0	4.719138765	10.30354015	0	0	0	0	27.25620133	0	0	0	0	0	50.53305401	3.949350494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.5207	NO																																																																																		0			19.9645	0	3.970474093	0	1.168163168	4.656224905	0	4.719138765	10.30354015	0	0	0	0	27.25620133	0	0	0	0	0	50.53305401	3.949350494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.5207
H1036_011_0	2011	5																															D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin							O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0											0	YES	1593.922007	8.645695	927.294648	85.090984	414.61334	5.357388	2996.823795	365.430211	198.834054	151.981863	1411.398441	81.843201	5.191376	170.80496	5974.965085	5837.044386	0	239.04644		314.011241	52.521272	0							3.78	0.36											6700	$150/Day(Days 1-8):1a.IP Acute	$150/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$195/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$30/Visit:7b. $25 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a												113.12865	98.93865	34.44565	0	150	0.044921971	0	50	144.045603	15.218401	18.384531	195	0.187737	54.634533	0	30	0	32.706188		0	0.080092	0							0	0											NO	110.561874	96.693831	32.563126	0	146.65245	0.043919447	0	48.88415	140.830937	14.878772	17.974244	190.648185	0.183547	53.415254	0	29.33049	0	31.976284		0	0.078304	0							0	0												14.6856	0.069665448	2.516301038	0	5.067005176	0.235293519	0	1.488645437	2.333498844	0.188441957	2.11406833	1.300271477	0.952861491	0.760299194	0	14.26694767	0	0.636984738	0	0	4.112625683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7285	0	1.246356896	14.6856	0.069665448	2.516301038	0	5.067005176	0.235293519	0	1.488645437	2.333498844	0.188441957	2.11406833	1.300271477	0.952861491	0.760299194	0	14.26694767	0	0.636984738	0	0	4.112625683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7285	NO																																																																																		0	0	0	14.6856	0.069665448	2.516301038	0	5.067005176	0.235293519	0	1.488645437	2.333498844	0.188441957	2.11406833	1.300271477	0.952861491	0.760299194	0	14.26694767	0	0.636984738	0	0	4.112625683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7285
H1036_025_0	2011	6	r.										OP Facility - Other										Other										D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V				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	YES	1088.419065	45.483055	611.73281	652.320655	190.256389	2.653934	5051.433383	214.039259	177.715336	50.510323	1836.695583	26.225144	0.53106	0.779015	5345.118532	3619.004074	66.216778	328.471262		229.876991	24.297218	0		1.8	2.3				4.39	2.15	166.754564										5000	$100/Day(Days 1-7):1a.IP Acute	$100/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN848: Dental 16a, 16b"	"VIS855: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	"$25-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $25 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF"											71.862	61.5239	34.44565	0	150	0.044921971	0	50	67.72979	71.117926	12.189212	100	0.196147	0.2	0	25	25	27.984497		0	0.2	0		0	0				0	0	54.285637										NO	70.828768	60.639309	33.713094	0	148.11465	0.044357347	0	49.37155	66.878494	70.224045	12.036006	98.7431	0.193682	0.197486	0	24.685775	24.685775	27.63276		0	0.197486	0		0	0				0	0	53.60332											6.4243	0.229838419	1.718617144	0	2.348313206	0.11772147	0	0.880620831	0.990444503	0.2955866	1.842206588	0.215796001	0.102856763	0.153844556	0	7.444826691	0.136217707	0.756380629	0	0	4.798360394	0	0	0	0	0	0	0	0	0	0.744883188	0	0	0	0	0	0	0	0	0	29.2008	0	0.398034378	6.4243	0.229838419	1.718617144	0	2.348313206	0.11772147	0	0.880620831	0.990444503	0.2955866	1.842206588	0.215796001	0.102856763	0.153844556	0	7.444826691	0.136217707	0.756380629	0	0	4.798360394	0	0	0	0	0	0	0	0	0	0.744883188	0	0	0	0	0	0	0	0	0	29.2008	NO																																																																																		0	0	0	6.4243	0.229838419	1.718617144	0	2.348313206	0.11772147	0	0.880620831	0.990444503	0.2955866	1.842206588	0.215796001	0.102856763	0.153844556	0	7.444826691	0.136217707	0.756380629	0	0	4.798360394	0	0	0	0	0	0	0	0	0	0.744883188	0	0	0	0	0	0	0	0	0	29.2008
H1036_034_0	2011	4																															D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	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	YES	2040.15362	1.772522	970.398007	103.194756	409.356294	8.703684	4501.019262	289.711533	285.264084	179.289469	1704.946605	70.349587	1.720789	266.991507	6408.15821	5869.387294	0.890695	795.531332		395.388394	39.592056	0		3.36	2.15				3.78	2.98											5000	$75/Day(Days 1-5):1a.IP Acute	$75/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $10 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $25 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$5-$50/Visit:9d. $40 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $25 OP Other,5. $5 Partial Hospitalization,7h. $25 Psych -- OP,8b. $25 Rad therapy,3, 7c, 7d, 7i. $5 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$5/Visit:7e, 7h.Psych -- Other Provider"	"$5-$40/Visit:7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $5 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"		"DEN849: Dental 16a, 16b"	"VIS829: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: OTC items 13c												46.4334	37.380825	34.44565	0	100	0.044921971	0	50	71.880266	10.718114	5.061628	150	0.2	26.225846	0	5	5	8.45745		0	0.027764	0		0	0				0	0											NO	45.775949	36.85155	32.935449	0	99.2349	0.044578273	0	49.61745	71.33031	10.636109	5.022901	148.85235	0.19847	26.025192	0	4.961745	4.961745	8.392742		0	0.027551	0		0	0				0	0												7.7825	0.005443349	2.663374506	0	3.385202575	0.387995199	0	1.197895625	1.695664629	0.158911861	0.713648167	0.872641779	0.341524993	0.579042103	0	2.426866922	0.000368283	0.556390769	0	0	1.090800735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.8583	0	0.334353957	7.7825	0.005443349	2.663374506	0	3.385202575	0.387995199	0	1.197895625	1.695664629	0.158911861	0.713648167	0.872641779	0.341524993	0.579042103	0	2.426866922	0.000368283	0.556390769	0	0	1.090800735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.8583	NO																																																																																		0	0	0	7.7825	0.005443349	2.663374506	0	3.385202575	0.387995199	0	1.197895625	1.695664629	0.158911861	0.713648167	0.872641779	0.341524993	0.579042103	0	2.426866922	0.000368283	0.556390769	0	0	1.090800735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.8583
H1036_035_0	2011	4																															D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin							O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0											0	YES	1622.784322	1.558215429	1171.614458	1.185902979	384.090825	8.049084584	2449.389447	286.4963948	273.3406926	116.3163743	1735.789211	70.40381074	1.432779412	225.2754708	7301.504611	5514.948181	0.58664966	369.2605639		416.1544583	54.38853646	0							3.16	0.36											6000	$175/Day(Days 1-8):1a.IP Acute	$175/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$195/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$35-$150/Visit:9d. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$35/Visit:7b. $25 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"							$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a												131.983425	115.428425	34.44565	0	150	0.044921971	0	50	135.497979	24.884132	17.35851	195	0.199981	56.404527	0	34.996817	35	36.413924		0	0.052986	0							0	0											NO	127.258022	111.295741	30.07863	0	144.76725	0.043354868	0	48.25575	130.771132	24.016049	16.752958	188.197425	0.193005	54.436855	0	33.775953	33.779025	35.143624		0	0.051138	0							0	0												17.2094	0.014451895	2.936713148	0	4.633647707	0.348966998	0	1.152091533	2.978755982	0.232788312	2.423300312	1.104151324	0.27653359	1.021940678	0	15.52271921	0.001651371	1.081429535	0	0	2.781320978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7198	0	2.266353281	17.2094	0.014451895	2.936713148	0	4.633647707	0.348966998	0	1.152091533	2.978755982	0.232788312	2.423300312	1.104151324	0.27653359	1.021940678	0	15.52271921	0.001651371	1.081429535	0	0	2.781320978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7198	NO																																																																																		0	0	0	17.2094	0.014451895	2.936713148	0	4.633647707	0.348966998	0	1.152091533	2.978755982	0.232788312	2.423300312	1.104151324	0.27653359	1.021940678	0	15.52271921	0.001651371	1.081429535	0	0	2.781320978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7198
H1036_040_0	2011	7	r.										OP Facility - Other										Other										D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V				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	YES	1113.17563	65.260731	702.10925	573.680719	215.663542	4.570805	8446.127608	255.872418	261.556707	72.642189	1762.757669	50.888451	0.664663	0.66914	7192.582653	4574.210995	92.235434	473.006113		278.672749	36.775429	0		1.8	2.3				4.39	2.15	255.572177										5000	$125/Day(Days 1-7):1a.IP Acute	$125/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN848: Dental 16a, 16b"	"VIS855: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	"$25-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $25 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF"											89.8275	76.904875	34.44565	0	150	0.044921971	0	50	66.052355	67.30871	17.905809	100	0.18044	0.2	0	25	25	27.516205		0	0.2	0		0	0				0	0	68.10806										NO	87.741975	75.119375	32.620306	0	146.27235	0.043805615	0	48.75745	64.410888	65.636021	17.460832	97.5149	0.175956	0.19503	0	24.378725	24.378725	26.8324		0	0.19503	0		0	0				0	0	66.415506											8.1394	0.408528777	1.908584882	0	2.628801091	0.200226923	0	1.039640552	1.40392498	0.397328687	2.564934626	0.413531851	0.116951443	0.130502374	0	9.292785995	0.187381857	1.057657436	0	0	7.172311918	0	0	0	0	0	0	0	0	0	1.414496288	0	0	0	0	0	0	0	0	0	38.4769	0	1.01895214	8.1394	0.408528777	1.908584882	0	2.628801091	0.200226923	0	1.039640552	1.40392498	0.397328687	2.564934626	0.413531851	0.116951443	0.130502374	0	9.292785995	0.187381857	1.057657436	0	0	7.172311918	0	0	0	0	0	0	0	0	0	1.414496288	0	0	0	0	0	0	0	0	0	38.4769	NO																																																																																		0	0	0	8.1394	0.408528777	1.908584882	0	2.628801091	0.200226923	0	1.039640552	1.40392498	0.397328687	2.564934626	0.413531851	0.116951443	0.130502374	0	9.292785995	0.187381857	1.057657436	0	0	7.172311918	0	0	0	0	0	0	0	0	0	1.414496288	0	0	0	0	0	0	0	0	0	38.4769
H1036_044_0	2011	5	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin			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	1272.12667	38.650454	959.269995	1178.379657	179.33348	3.952889	2.145549	429.782566	275.359345	188.770477	2311.931699	57.969874	0.48838	547.443458	5596.301159	5572.286248	38.546711	187.115624		566.040622	19.609626	0			2.3		0.4		5.66	1.48	122.005729										4000	$150/Day(Days 1-10):1a.IP Acute	$150/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% Coins:11a.DME	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$30/Visit:7b. $25 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS855: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies											121.20465	109.29915	34.44565	0	150	0	0.137708	50	128.925664	0	48.61615	150	0.193268	54.571421	5	29.987319	30	36.700206		0	0.2	0			0		0		0	0	0										NO	111.928131	100.93383	25.949803	0	137.733	0	0.126446	45.911	118.382124	0	44.640321	137.733	0.177462	50.10857	4.5911	27.534956	27.5466	33.698864		0	0.183644	0			0		0		0	0	0											11.8656	0.325094863	2.074405616	0	2.05834485	0	0.271296089	1.644312282	2.716468677	0	8.600447764	0.665363721	0.086668892	2.285967403	2.141098188	12.78605472	0.088485902	0.52546533	0	0	3.601190157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7362	0	5.026821246	11.8656	0.325094863	2.074405616	0	2.05834485	0	0.271296089	1.644312282	2.716468677	0	8.600447764	0.665363721	0.086668892	2.285967403	2.141098188	12.78605472	0.088485902	0.52546533	0	0	3.601190157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7362	NO																																																																																		0	0	0	11.8656	0.325094863	2.074405616	0	2.05834485	0	0.271296089	1.644312282	2.716468677	0	8.600447764	0.665363721	0.086668892	2.285967403	2.141098188	12.78605472	0.088485902	0.52546533	0	0	3.601190157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7362
H1036_047_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							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	YES	1514.515259	60.800043	697.510027	971.981731	213.950284	4.798422	0.23838	282.79245	327.229547	123.551555	1770.05951	90.268902	0.56883	3.606565	6193.087222	5883.286888	92.800097	597.767537		627.681342	25.360929	0							3.8	0.36	3919.866674	343.440651									6700	$175/Day(Days 1-10):1a.IP Acute	$175/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	0% Coins:11c.Diabetic Monitoring Supplies	"$50/Visit:4a, 4b.Emergency Room"	"$0-$175/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $175 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$150/Visit:8b, 9a. $100 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$40/Visit:7b. $25 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0/Service:11b.Prosthetics, 11b.Supplies"	"$40-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"										141.405425	127.515675	34.44565	0	150	0.044921971	0	50	149.53523	75.258729	53.987001	150	0.2	0.2	0	39.914809	40	46.482862		0	0.2	0							0	0	0	82.440831									NO	136.256005	122.872064	31.761886	0	143.6253	0.043012877	0	47.8751	143.180282	72.060384	51.692661	143.6253	0.1915	0.1915	0	38.21851	38.30008	44.507433		0	0.1915	0							0	0	0	78.937261										17.1968	0.622552231	1.846186163	0	2.56072281	0.206393935	0	1.128226402	3.904401568	0.741931041	7.62492385	1.080408178	0.108930945	0.690657198	0	18.73753823	0.296187595	2.21709155	0	0	4.856617904	0	0	0	0	0	0	0	0	0	0	2.259188692	0	0	0	0	0	0	0	0	66.0788	0	2.88028537	17.1968	0.622552231	1.846186163	0	2.56072281	0.206393935	0	1.128226402	3.904401568	0.741931041	7.62492385	1.080408178	0.108930945	0.690657198	0	18.73753823	0.296187595	2.21709155	0	0	4.856617904	0	0	0	0	0	0	0	0	0	0	2.259188692	0	0	0	0	0	0	0	0	66.0788	NO																																																																																		0	0	0	17.1968	0.622552231	1.846186163	0	2.56072281	0.206393935	0	1.128226402	3.904401568	0.741931041	7.62492385	1.080408178	0.108930945	0.690657198	0	18.73753823	0.296187595	2.21709155	0	0	4.856617904	0	0	0	0	0	0	0	0	0	0	2.259188692	0	0	0	0	0	0	0	0	66.0788
H1036_052_0	2011	6	r.										OP Facility - Other										Other										D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V				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	YES	1251.821141	59.510939	836.285075	457.729445	230.181442	3.96287	5206.275702	237.333228	263.182235	152.549106	1815.347722	40.603687	0.500866	2.297152	6572.146298	3990.573373	109.32542	499.23959		204.363791	50.716307	0		1.8	2.3				4.39	2.15	219.628868										5000	$100/Day(Days 1-7):1a.IP Acute	$100/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN848: Dental 16a, 16b"	"VIS855: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	"$25-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $25 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF"											71.862	61.5239	34.44565	0	150	0.044921971	0	50	66.031081	32.679762	18.069401	100	0.2	0.2	0	25	25	28.195721		0	0.2	0		0	0				0	0	62.42825										NO	69.99905	59.928954	32.010756	0	145.8093	0.043666941	0	48.6031	64.186305	31.766755	17.564578	97.2062	0.194412	0.194412	0	24.30155	24.30155	27.407989		0	0.194412	0		0	0				0	0	60.68413											7.3022	0.29720236	2.230843124	0	2.796882911	0.173046409	0	0.961260884	1.407724601	0.403832506	2.657151388	0.328910843	0.097374361	0.446593915	0	8.081426529	0.221398097	1.140262766	0	0	9.859858676	0	0	0	0	0	0	0	0	0	1.110665565	0	0	0	0	0	0	0	0	0	39.5166	0	1.220181171	7.3022	0.29720236	2.230843124	0	2.796882911	0.173046409	0	0.961260884	1.407724601	0.403832506	2.657151388	0.328910843	0.097374361	0.446593915	0	8.081426529	0.221398097	1.140262766	0	0	9.859858676	0	0	0	0	0	0	0	0	0	1.110665565	0	0	0	0	0	0	0	0	0	39.5166	NO																																																																																		0	0	0	7.3022	0.29720236	2.230843124	0	2.796882911	0.173046409	0	0.961260884	1.407724601	0.403832506	2.657151388	0.328910843	0.097374361	0.446593915	0	8.081426529	0.221398097	1.140262766	0	0	9.859858676	0	0	0	0	0	0	0	0	0	1.110665565	0	0	0	0	0	0	0	0	0	39.5166
H1036_053_0	2011	3																															D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O			V		V		O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0		0		0	0											0	YES	1128.099343	13.760485	491.595119	8.603614	235.049233	5.750288	2089.749837	236.753118	218.754705	206.756955	1331.3902	52.059305	0.018821	115.117715	6813.313795	6474.513195	0	410.003875		280.643137	25.503721	0			1.05		0.4		3.78	0.58											5000	$25/Day(Days 1-10):1a.IP Acute	$25/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$10/Visit:7e, 7h.Psych -- Other Provider"	"$10-$25/Visit:7c, 7i. $25 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"$0/Service:7g, 13a.Other Part B"			"VIS830: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d												20.200775	18.216525	34.44565	0	150	0.044921971	0	50	55.68883	10.927692	4.767384	100	0.2	31.682555	0	10	0	11.098997		0	0.134977	0			0		0		0	0											NO	20.060056	18.089629	34.358778	0	149.24685	0.044696418	0	49.74895	55.409216	10.872824	4.743447	99.4979	0.198996	31.523477	0	9.94979	0	11.043269		0	0.134299	0			0		0		0	0												1.8858	0.020743506	1.40755063	0	2.923363135	0.257017273	0	0.981518252	1.010085558	0.187335999	0.526281571	0.431649294	0.003745304	0.30240922	0	5.36833722	0	0.377315257	0	0	3.425124227	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1083	0	0.095338825	1.8858	0.020743506	1.40755063	0	2.923363135	0.257017273	0	0.981518252	1.010085558	0.187335999	0.526281571	0.431649294	0.003745304	0.30240922	0	5.36833722	0	0.377315257	0	0	3.425124227	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1083	NO																																																																																		0	0	0	1.8858	0.020743506	1.40755063	0	2.923363135	0.257017273	0	0.981518252	1.010085558	0.187335999	0.526281571	0.431649294	0.003745304	0.30240922	0	5.36833722	0	0.377315257	0	0	3.425124227	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1083
H1036_054_0	2011	4																															A	A	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin	T	V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0											0	YES	320.128452	1.09799	605.602632	5.242527	349.648182	7.867903	1823.388063	263.787591	337.635885	205.270875	2232.761642	36.754694	1.695646	272.084103	11175.10895	6663.037284	0.204954	1027.043107		408.86271	43.637023	0	2.35	12.72	2.15		0.4		3.75	6.12											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$75/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $15 Radiology OP -- Facility"	$20/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7d, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0-$15/Visit:7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN859: Dental 16a, 16b"	"VIS829: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c												0	0	34.44565	0	75	0.044921971	0	50	9.306233	4.503528	1.845096	20	0.188195	20.887865	0	0	0	0.66576		0	0.04398	0	0	0	0		0		0	0											NO	0	0	34.221581	0	74.839425	0.044825793	0	49.89295	9.286309	4.493886	1.841146	19.95718	0.187792	20.843144	0	0	0	0.664335		0	0.043886	0	0	0	0		0		0	0												0	0	1.727056627	0	2.180622408	0.35268499	0	1.096761757	0.261282596	0.076871993	0.342570014	0.06112667	0.318428754	0.472590678	0	0	0	0.05685839	0	0	1.915054391	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.8619	0	0.025859814	0	0	1.727056627	0	2.180622408	0.35268499	0	1.096761757	0.261282596	0.076871993	0.342570014	0.06112667	0.318428754	0.472590678	0	0	0	0.05685839	0	0	1.915054391	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.8619	NO																																																																																		0	0	0	0	0	1.727056627	0	2.180622408	0.35268499	0	1.096761757	0.261282596	0.076871993	0.342570014	0.06112667	0.318428754	0.472590678	0	0	0	0.05685839	0	0	1.915054391	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.8619
H1036_056_0	2011	3	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin			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	849.122982	21.200206	639.393921	890.044305	145.014186	3.72761	2.10462	334.839976	218.540405	80.587146	1720.600381	8.570085	0	219.508921	4526.302198	5042.688383	19.188632	173.618592		529.521917	9.357891	0			1.21		0.4		5.66	1.48	7445.959772										4500	$125/Day(Days 1-10):1a.IP Acute	$125/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$75/Visit:8b, 9a. $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,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $25 Radiology OP -- Facility"	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$50/Visit:7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS846: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"											101.003875	91.082625	34.44565	0	150	0	0.2	50	75	0	33.303238	100	0	37.186083	0	25	25	25		0	0.2	0			0		0		0	0	0										NO	98.951577	89.231917	32.895527	0	146.93295	0	0.195911	48.97765	73.466475	0	32.622287	97.9553	0	36.425739	0	24.488825	24.488825	24.488825		0	0.195911	0			0		0		0	0	0											7.0018	0.157644585	1.752766666	0	1.775613512	0	0.412318209	1.366639596	1.337949433	0	4.677493287	0.069957104	0	0.666314555	0	10.29079278	0.039158921	0.35430961	0	0	1.833313784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7361	0	0.70750642	7.0018	0.157644585	1.752766666	0	1.775613512	0	0.412318209	1.366639596	1.337949433	0	4.677493287	0.069957104	0	0.666314555	0	10.29079278	0.039158921	0.35430961	0	0	1.833313784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7361	NO																																																																																		0	0	0	7.0018	0.157644585	1.752766666	0	1.775613512	0	0.412318209	1.366639596	1.337949433	0	4.677493287	0.069957104	0	0.666314555	0	10.29079278	0.039158921	0.35430961	0	0	1.833313784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7361
H1036_062_0	2011	5																															D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin		V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0		0		0	0											0	YES	1464.805363	4.361853	1082.171303	9.216853	338.024092	9.723004	2507.354487	268.153784	307.133825	147.242469	2158.616565	38.576938	0.802843	203.397984	9937.022693	7643.938647	0.118702	464.309261		493.518996	59.032433	0		3.36	1.65		0.4		3.78	2.4											5000	$95/Day(Days 1-10):1a.IP Acute	$95/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$75/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7d, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$20/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$20-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"		"DEN849: Dental 16a, 16b"	"VIS871: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c												76.762945	69.222795	34.44565	0	150	0.044921971	0	50	91.701663	7.745093	15.752211	75	0.191863	37.882868	0	20	20	23.519497		0	0.044657	0		0	0		0		0	0											NO	74.537127	67.215611	30.691487	0	145.8165	0.043669097	0	48.6055	89.144103	7.529082	15.312882	72.90825	0.186512	36.826315	0	19.4422	19.4422	22.863538		0	0.043411	0		0	0		0		0	0												9.0985	0.024432051	2.767787206	0	4.107457501	0.424594805	0	1.086145729	2.281597444	0.092383385	2.754553395	0.23438142	0.149739854	0.624199852	0	12.384582	0.000192319	0.884646036	0	0	2.562656949	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4779	0	1.39028069	9.0985	0.024432051	2.767787206	0	4.107457501	0.424594805	0	1.086145729	2.281597444	0.092383385	2.754553395	0.23438142	0.149739854	0.624199852	0	12.384582	0.000192319	0.884646036	0	0	2.562656949	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4779	NO																																																																																		0	0	0	9.0985	0.024432051	2.767787206	0	4.107457501	0.424594805	0	1.086145729	2.281597444	0.092383385	2.754553395	0.23438142	0.149739854	0.624199852	0	12.384582	0.000192319	0.884646036	0	0	2.562656949	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4779
H1036_063_0	2011	3																															D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin		V	V				O	O											3.63	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0				0	0											3.63	YES	1141.050053	0	688.616571	0	236.904891	7.066201	746.851759	214.960904	252.119569	53.205719	1621.47132	25.782546	0.590159	188.678685	7256.831105	6886.586347	0	474.331674		387.096259	15.400264	0		3.36	1.05				3.78	2.28											6700	$95/Day(Days 1-10); $250 Deductible Before Copays Applied:1a.IP Acute	$95/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $25 Radiology OP -- Facility"	$95/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$15/Visit:7e, 7h.Psych -- Other Provider"	"$15-$25/Visit:7c, 7i. $25 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"		"DEN849: Dental 16a, 16b"	"VIS830: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c												76.762945	0	34.44565	0	150	0.044921971	0	50	14.640272	15.906168	1.267842	95	0.2	25.394705	0	15	0	16.712348		0	0.127337	0		0	0				0	0											NO	75.99608395	0	34.185516	0	149.25525	0.044698933	0	49.75175	14.567583	15.827194	1.261547	94.528325	0.199007	25.26862	0	14.925525	0	16.629371		0	0.126705	0		0	0				0	0												7.2263	0	1.961726067	0	2.946608228	0.315851646	0	0.89122343	0.306064396	0.07017477	0.170463523	0.203098407	0.117445772	0.397304166	0	8.565493057	0	0.657319782	0	0	1.95129045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.7803	0	0.204884351	10.8563	0	1.961726067	0	2.946608228	0.315851646	0	0.89122343	0.306064396	0.07017477	0.170463523	0.203098407	0.117445772	0.397304166	0	8.565493057	0	0.657319782	0	0	1.95129045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.4103	NO																																																																																		0	0	0	10.8563	0	1.961726067	0	2.946608228	0.315851646	0	0.89122343	0.306064396	0.07017477	0.170463523	0.203098407	0.117445772	0.397304166	0	8.565493057	0	0.657319782	0	0	1.95129045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.4103
H1036_065_0	2011	4																															D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin		V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0		0		0	0											0	YES	1473.650922	6.590304	786.749712	26.81898	351.481885	7.662173	2664.245697	323.731668	246.165421	145.131672	1755.296071	46.994665	1.350201	124.370126	8647.862107	7671.956895	0.263883	533.57553		355.828307	63.860121	0		4.98	2.1		0.4		3.78	4.22											5000	$25/Day(Days 1-5):1a.IP Acute	$25/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$75/Visit:9b. $0 Surgery ASC -- Physician,9b. $25 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $75 Surgery OP -- Facility"	"$0-$25/Visit:8a. $0 Lab -- FSL,8a. $25 Lab -- OP"	"$0-$125/Visit:8b, 9a. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $25 Radiology OP -- Facility"	$75/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$10/Visit:7e, 7h.Psych -- Other Provider"	"$10-$25/Visit:7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"		"DEN847: Dental 16a, 16b"	"VIS829: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c												15.4778	12.460275	34.44565	0	150	0.044921971	0	50	46.464464	7.990093	15.695771	75	0.186989	30.883383	0	10	10	11.398471		0	0.07642	0		0	0		0		0	0											NO	15.297762	12.315337	33.718123	0	148.34565	0.044426526	0	49.44855	45.952008	7.901971	15.522662	74.172825	0.184927	30.54277	0	9.88971	9.88971	11.272757		0	0.075577	0		0	0		0		0	0												1.8786	0.006763485	2.21064363	0	4.345067391	0.340403731	0	1.334005131	0.942649616	0.095568855	2.270572302	0.290477255	0.24968862	0.316550679	0	6.322785735	0.000217477	0.501238941	0	0	4.826356365	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.9316	0	0.309601817	1.8786	0.006763485	2.21064363	0	4.345067391	0.340403731	0	1.334005131	0.942649616	0.095568855	2.270572302	0.290477255	0.24968862	0.316550679	0	6.322785735	0.000217477	0.501238941	0	0	4.826356365	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.9316	NO																																																																																		0	0	0	1.8786	0.006763485	2.21064363	0	4.345067391	0.340403731	0	1.334005131	0.942649616	0.095568855	2.270572302	0.290477255	0.24968862	0.316550679	0	6.322785735	0.000217477	0.501238941	0	0	4.826356365	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.9316
H1036_067_0	2011	6	r.										OP Facility - Other										Other										D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V				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	YES	1146.228157	81.462849	436.474013	488.862805	169.809042	3.487078	8150.677979	310.660728	300.753958	78.887455	1884.485508	28.921865	0	2.652167	7466.346454	4343.763305	51.95799	406.497348		282.992477	28.867283	0		1.8	2.3				4.39	2.15	516.050811										5000	$100/Day(Days 1-7):1a.IP Acute	$100/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN848: Dental 16a, 16b"	"VIS855: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	"$25-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $25 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF"											71.862	61.5239	34.44565	0	150	0.044921971	0	50	63.692248	65.16746	16.100443	100	0	0.2	0	25	25	36.130396		0	0.2	0		0	0				0	0	63.841655										NO	70.542829	60.394506	33.659084	0	146.904	0.043994781	0	48.968	62.37764	63.822404	15.768129	97.936	0	0.195872	0	24.484	24.484	35.384664		0	0.195872	0		0	0				0	0	62.523963											6.7382	0.409992377	1.224276289	0	2.078802292	0.153413234	0	1.267702877	1.563360177	0.419565585	2.476234216	0.236040981	0	0.519485255	0	8.862725063	0.106011619	1.198647673	0	0	5.654292456	0	0	0	0	0	0	0	0	0	2.688795151	0	0	0	0	0	0	0	0	0	35.5975	0	0.732817485	6.7382	0.409992377	1.224276289	0	2.078802292	0.153413234	0	1.267702877	1.563360177	0.419565585	2.476234216	0.236040981	0	0.519485255	0	8.862725063	0.106011619	1.198647673	0	0	5.654292456	0	0	0	0	0	0	0	0	0	2.688795151	0	0	0	0	0	0	0	0	0	35.5975	NO																																																																																		0	0	0	6.7382	0.409992377	1.224276289	0	2.078802292	0.153413234	0	1.267702877	1.563360177	0.419565585	2.476234216	0.236040981	0	0.519485255	0	8.862725063	0.106011619	1.198647673	0	0	5.654292456	0	0	0	0	0	0	0	0	0	2.688795151	0	0	0	0	0	0	0	0	0	35.5975
H1036_068_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	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	YES	1367.320379	62.386631	383.717856	723.205689	162.217027	5.190069	1.670675	284.339753	350.001508	137.287559	1805.407432	46.571121	0	293.829723	6998.901587	4212.358325	47.598983	565.279496		433.066073	33.091437	0			1.21				4.42	0.58											6700	$150/Day(Days 1-10):1a.IP Acute	$150/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $50 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$30-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $30 Partial Hospitalization,7h. $100 Psych -- OP,8b. $50 Rad therapy,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$30/Visit:7b. $25 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS856: Vision 17a, 17b"				$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d												121.20465	109.29915	34.44565	0	150	0.2	0.055385	50	100	95.02272	40.452136	125	0	77.122143	0	29.975169	30	39.078844		0	0.2	0			0				0	0											NO	118.842008	107.168582	33.687777	0	146.77005	0.195693	0.054192	48.92335	97.8467	92.976596	39.58108	122.308375	0	75.461471	0	29.329714	29.35401	38.237359		0	0.195693	0			0				0	0												13.5413	0.557157232	1.077216797	0	1.984050097	1.015660173	0.09053722	1.159237771	2.853874379	1.063710826	5.954998	0.474669844	0	1.84773526	0	10.29560541	0.116435085	1.801232919	0	0	6.475762581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3091	0	1.077697179	13.5413	0.557157232	1.077216797	0	1.984050097	1.015660173	0.09053722	1.159237771	2.853874379	1.063710826	5.954998	0.474669844	0	1.84773526	0	10.29560541	0.116435085	1.801232919	0	0	6.475762581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3091	NO																																																																																		0	0	0	13.5413	0.557157232	1.077216797	0	1.984050097	1.015660173	0.09053722	1.159237771	2.853874379	1.063710826	5.954998	0.474669844	0	1.84773526	0	10.29560541	0.116435085	1.801232919	0	0	6.475762581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3091
H1036_074_0	2011	6	r.										OP Facility - Other										Other										D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V				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	YES	1280.50924	108.2575127	1015.73772	510.2080767	207.8693646	6.230952884	2968.406756	336.7388442	259.3284782	86.5404745	2449.555826	11.28819559	0.06199846	0.149149527	7151.572803	5053.988406	160.9937714	369.2256329		332.3404176	39.56773345	0		1.8	2.3				4.39	2.15	561.4822629										5000	$100/Day(Days 1-7):1a.IP Acute	$100/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN848: Dental 16a, 16b"	"VIS855: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	"$25-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $25 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF"											71.862	61.5239	34.44565	0	150	0.044921971	0	50	65.59648	58.17454	11.300234	100	0.190556	0.2	0	25	25	26.98332		0	0.2	0		0	0				0	0	83.649504										NO	69.649153	59.629395	30.852693	0	145.14435	0.043467802	0	48.38145	63.473057	56.291372	10.934435	96.7629	0.184387	0.193526	0	24.190725	24.190725	26.109843		0	0.193526	0		0	0				0	0	80.941686											7.4322	0.537944166	2.611520336	0	2.514255318	0.270845824	0	1.357659463	1.371697607	0.405956837	2.232042413	0.091023212	0.01143171	0.028864311	0	10.18830364	0.324546337	0.803368609	0	0	7.657385185	0	0	0	0	0	0	0	0	0	3.787276751	0	0	0	0	0	0	0	0	0	41.6263	0	1.586852119	7.4322	0.537944166	2.611520336	0	2.514255318	0.270845824	0	1.357659463	1.371697607	0.405956837	2.232042413	0.091023212	0.01143171	0.028864311	0	10.18830364	0.324546337	0.803368609	0	0	7.657385185	0	0	0	0	0	0	0	0	0	3.787276751	0	0	0	0	0	0	0	0	0	41.6263	NO																																																																																		0	0	0	7.4322	0.537944166	2.611520336	0	2.514255318	0.270845824	0	1.357659463	1.371697607	0.405956837	2.232042413	0.091023212	0.01143171	0.028864311	0	10.18830364	0.324546337	0.803368609	0	0	7.657385185	0	0	0	0	0	0	0	0	0	3.787276751	0	0	0	0	0	0	0	0	0	41.6263
H1036_077_0	2011	6																															A	A	A	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V		V	S	Coin	T	V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0											0	YES	558.490854	0	77.237681	0	859.203677	925.275636	1943.775387	530.443438	398.634941	199.182849	2981.545295	55.517209	70.426381	94.103153	25693.46522	8154.285811	0	1058.552358		459.916727	10960.18977	0	3.04	16.22	4.8		0.4		72.78	10.01											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-100) $0(Days 100-100):2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$25/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN859 + Partial Dentures: Dental 16a, 16b"	"VIS833: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a$0: Nutritional Training/Nutritional benefit 13b	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$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											NO	0	0	0	0	0	0	0	24.981625	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	0	0	0	1.104278254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1043	0	0.000812242	0	0	0	0	0	0	0	1.104278254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1043	NO																																																																																		0	0	0	0	0	0	0	0	0	0	1.104278254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1043
H1036_081_0	2011	7	r.										OP Facility - Other										Other										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							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	YES	2009.386065	151.284855	963.381035	780.384037	296.068969	4.785357	2.179095	398.35136	304.511597	221.104632	1346.660572	101.839586	0.622482	7.703437	6777.017108	3180.941337	97.15902	336.984321		1194.204992	23.580213	0							4.45	0.36	1012.30704										6700	$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $175 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$200/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$40/Visit:7b. $25 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$75/Visit:7c, 7d, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$40-$150/Visit:9d. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $40 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"											147.067245	128.620245	34.44565	0	150	0.2	0.106771	50	189.524181	68.782437	81.156703	200	0.171458	0.2	5	39.970457	40	53.061851		0	0.2	0							0	0	77.063161										NO	139.210177	121.748708	29.394471	0	141.40335	0.188538	0.100652	47.13445	178.66236	64.840447	76.505532	188.5378	0.161632	0.188538	4.713445	37.67971	37.70756	50.020823		0	0.188538	0							0	0	72.646594											23.3106	1.534894636	2.359839658	0	3.488762004	0.902221638	0.21933027	1.564672688	4.533730047	1.194710264	8.585581957	1.600050958	0.100613011	1.452390605	2.661924784	9.988078925	0.305302465	1.40468609	0	0	4.445766199	0	0	0	0	0	0	0	0	0	6.128388212	0	0	0	0	0	0	0	0	0	75.7815	0	4.761006035	23.3106	1.534894636	2.359839658	0	3.488762004	0.902221638	0.21933027	1.564672688	4.533730047	1.194710264	8.585581957	1.600050958	0.100613011	1.452390605	2.661924784	9.988078925	0.305302465	1.40468609	0	0	4.445766199	0	0	0	0	0	0	0	0	0	6.128388212	0	0	0	0	0	0	0	0	0	75.7815	NO																																																																																		0	0	0	23.3106	1.534894636	2.359839658	0	3.488762004	0.902221638	0.21933027	1.564672688	4.533730047	1.194710264	8.585581957	1.600050958	0.100613011	1.452390605	2.661924784	9.988078925	0.305302465	1.40468609	0	0	4.445766199	0	0	0	0	0	0	0	0	0	6.128388212	0	0	0	0	0	0	0	0	0	75.7815
H1036_102_0	2011	6																															A	A	A	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V		V	S	Coin	T	V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0											0	YES	491.422045	87.155908	96.384888	819.198251	510.53815	491.495781	4800.184138	864.235157	324.712327	110.063329	2697.361307	105.322292	0	833.193247	9616.64727	5706.969499	485.122369	884.605529		340.55115	4479.38132	0	1.64	5.1	5.65		0.4		4.39	4.41											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-100) $0(Days 100-100):2.SNF	$0/Visit:6.Home Health	$25/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$25/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN851: Dental 16a, 16b"	"VIS848: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$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	0											NO	0	0	0	0	24.9751	0	0	24.9751	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	1.062561779	0	0	1.798696622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.8613	0	0.002852655	0	0	0	0	1.062561779	0	0	1.798696622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.8613	NO																																																																																		0	0	0	0	0	0	0	1.062561779	0	0	1.798696622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.8613
H1036_103_0	2011	6																															A	A	A	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V		V	S	Coin	T	V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0											0	YES	545.2057918	0.029796587	88.39475779	0.39190579	502.4670678	597.1038387	2915.075657	757.6090323	234.3284782	71.16527889	2249.933793	82.48279388	0.526267323	106.0866004	11432.71088	7435.296172	0.003041598	688.0847389		403.1586308	6432.545256	0	0.77	11	4.8		0.4		35.2	5.45											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-100) $0(Days 100-100):2.SNF	$0/Visit:6.Home Health	$25/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN853: Dental 16a, 16b"	"VIS833: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a$0: Nutritional Training/Nutritional benefit 13b	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$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											NO	0	0	0	0	24.9712	0	0	49.9424	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	1.04560047	0	0	3.153067778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1987	0	0.004842444	0	0	0	0	1.04560047	0	0	3.153067778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1987	NO																																																																																		0	0	0	0	0	0	0	1.04560047	0	0	3.153067778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1987
H1036_104_0	2011	6																															A	A	A	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V		V	S	Coin	T	V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0											0	YES	494.9987027	0.381590578	129.9831854	2.230769154	490.4207445	1084.529152	1589.845521	557.9715186	398.4560699	125.8062902	2372.359046	10.49127464	5.340866263	142.505916	12403.14564	8486.659477	0.035563112	770.2046849		549.567765	5477.779198	0	1.07	11	1.05		0.4		3.78	3											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-100) $0(Days 100-100):2.SNF	$0/Visit:6.Home Health	$25/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$25/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN853: Dental 16a, 16b"	"VIS830: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$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	0											NO	0	0	0	0	24.976525	0	0	24.976525	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	1.020750499	0	0	1.161349132	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.1821	0	0.002050917	0	0	0	0	1.020750499	0	0	1.161349132	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.1821	NO																																																																																		0	0	0	0	0	0	0	1.020750499	0	0	1.161349132	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.1821
H1036_119_0	2011	3	r.										OP Facility - Other										Other										D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin			V				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	YES	598.6265203	27.40492045	320.1388319	231.4829122	113.0713337	2.221786172	2279.304376	143.9257837	133.8319135	48.28324917	976.9147672	24.69557376	0.123117925	16.90400901	3739.895636	2212.472661	33.13958825	193.9770525		125.3276521	10.75915913	0			1.21				4.38	0.58	115.83659										6700	$275/Day(Days 1-5):1a.IP Acute	$275/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $150 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$225/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$35/Visit:7b. $25 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS846: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"											170.2558	137.063025	34.44565	0	150	0.044921971	0	50	116.353801	80.487352	30.31043	225	0.190556	0.2	10	34.996629	35	39.303882		0	0.2	0			0				0	0	89.12385										NO	168.496887	135.647027	34.31238	0	148.8588	0.044580204	0	49.6196	115.468582	79.875004	30.079828	223.2882	0.189106	0.198478	9.92392	34.730374	34.73372	39.004859		0	0.198478	0			0				0	0	88.445796											8.4056	0.309782999	0.915393771	0	1.402638587	0.099047682	0	0.595128318	1.287781773	0.321385393	2.448785681	0.459519184	0.023282338	3.355073901	3.092868759	6.403333582	0.095921765	0.630503965	0	0	2.135456386	0	0	0	0	0	0	0	0	0	0.853771617	0	0	0	0	0	0	0	0	0	32.8352	0	0.271667499	8.4056	0.309782999	0.915393771	0	1.402638587	0.099047682	0	0.595128318	1.287781773	0.321385393	2.448785681	0.459519184	0.023282338	3.355073901	3.092868759	6.403333582	0.095921765	0.630503965	0	0	2.135456386	0	0	0	0	0	0	0	0	0	0.853771617	0	0	0	0	0	0	0	0	0	32.8352	NO																																																																																		0	0	0	8.4056	0.309782999	0.915393771	0	1.402638587	0.099047682	0	0.595128318	1.287781773	0.321385393	2.448785681	0.459519184	0.023282338	3.355073901	3.092868759	6.403333582	0.095921765	0.630503965	0	0	2.135456386	0	0	0	0	0	0	0	0	0	0.853771617	0	0	0	0	0	0	0	0	0	32.8352
H1036_121_0	2011	4																															D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin		V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0		0		0	0											0	YES	2313.18637	5.905845267	1126.015287	27.22657875	501.1237064	9.065183111	2710.373424	412.9236929	342.1277619	224.9070196	2270.741586	54.65289095	1.12288668	198.4987185	11591.7321	10326.07487	0.211307011	517.4717792		455.5476914	83.94316409	0		3.36	1.05		0.4		3.78	0.92											5000	$25/Day(Days 1-5):1a.IP Acute	$25/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $25 Radiology OP -- Facility"	$175/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$10/Visit:7e, 7h.Psych -- Other Provider"	"$10-$25/Visit:7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"		"DEN849: Dental 16a, 16b"	"VIS830: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: Nutritional benefit 13d												15.4778	12.460275	34.44565	0	150	0.044921971	0	50	68.450468	5.219911	24.028403	175	0.185836	30.141343	0	10	10	11.382621		0	0.053305	0		0	0		0		0	0											NO	15.11127	12.165203	31.457249	0	146.3205	0.043820035	0	48.7735	66.771378	5.091866	23.438986	170.70725	0.181277	29.401976	0	9.7547	9.7547	11.103405		0	0.051997	0		0	0		0		0	0												2.9129	0.005987151	2.951778604	0	6.110389274	0.39723664	0	1.678311145	1.903695176	0.095433034	4.435323354	0.777470393	0.203553529	0.486354547	0	8.393980213	0.00017177	0.478808228	0	0	4.364792703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1962	0	1.078670254	2.9129	0.005987151	2.951778604	0	6.110389274	0.39723664	0	1.678311145	1.903695176	0.095433034	4.435323354	0.777470393	0.203553529	0.486354547	0	8.393980213	0.00017177	0.478808228	0	0	4.364792703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1962	NO																																																																																		0	0	0	2.9129	0.005987151	2.951778604	0	6.110389274	0.39723664	0	1.678311145	1.903695176	0.095433034	4.435323354	0.777470393	0.203553529	0.486354547	0	8.393980213	0.00017177	0.478808228	0	0	4.364792703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1962
H1036_125_0	2011	3																															A	A	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin		V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0		0		0	0											0	YES	471.2817675	0.977672693	811.8465465	14.40025026	476.5118976	8.120633827	2135.184494	344.4074535	464.1244491	241.798692	2735.310597	75.7473981	1.188960638	372.2772821	14340.40161	8690.64883	0.258636559	1170.233458		566.8220749	50.38197603	0		11	2.15		0.4		3.78	4.39											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $15 Radiology OP -- Facility"	$20/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7d, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0-$15/Visit:7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $0 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"		"DEN853: Dental 16a, 16b"	"VIS829: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: OTC items 13c												0	0	34.44565	0	100	0.044921971	0	50	9.209127	6.7435	1.861797	20	0.187741	20.987663	0	0	0	0.636554		0	0.025741	0		0	0		0		0	0											NO	0	0	33.152629	0	99.5107	0.044702168	0	49.75535	9.164067	6.710504	1.852687	19.90214	0.186822	20.884971	0	0	0	0.63344		0	0.025615	0		0	0		0		0	0												0	0	2.242903947	0	3.951502707	0.363009934	0	1.428009449	0.354438962	0.135215924	0.422306199	0.125627943	0.222124004	0.647916687	0	0	0	0.061772723	0	0	1.290534316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.2454	0	0.129958451	0	0	2.242903947	0	3.951502707	0.363009934	0	1.428009449	0.354438962	0.135215924	0.422306199	0.125627943	0.222124004	0.647916687	0	0	0	0.061772723	0	0	1.290534316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.2454	NO																																																																																		0	0	0	0	0	2.242903947	0	3.951502707	0.363009934	0	1.428009449	0.354438962	0.135215924	0.422306199	0.125627943	0.222124004	0.647916687	0	0	0	0.061772723	0	0	1.290534316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.2454
H1036_130_0	2011	3																															D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin		V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0		0		0	0											0	YES	2418.579528	3.688025837	1396.822318	7.648592067	442.066013	12.09278814	2961.962995	350.6401533	457.4922118	173.0862299	2731.678422	100.8540795	0.545249964	218.8977519	13434.39937	11267.73861	0.12193403	644.5337806		616.4546059	78.1207634	0		3.36	1.65		0.4		0.66	0.92											6700	$95/Day(Days 1-10):1a.IP Acute	$95/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$75/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7d, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$20/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$20-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"		"DEN849: Dental 16a, 16b"	"VIS871: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: Nutritional benefit 13d												76.762945	69.222795	34.44565	0	150	0.044921971	0	50	95.000049	10.318223	17.661379	75	0.191186	40.434506	0	20	20	22.305419		0	0.023695	0		0	0		0		0	0											NO	74.320348	67.020126	30.421468	0	145.36995	0.043535364	0	48.45665	92.067683	9.99973	17.116225	72.684975	0.185285	39.186414	0	19.38266	19.38266	21.616917		0	0.022964	0		0	0		0		0	0												14.9791	0.020597663	3.541115453	0	5.355259518	0.526463937	0	1.415903932	3.510020661	0.14423463	3.896335209	0.610881354	0.10102664	0.714818161	0	18.19989554	0.00019695	1.161069437	0	0	1.793965211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9709	0	2.136784853	14.9791	0.020597663	3.541115453	0	5.355259518	0.526463937	0	1.415903932	3.510020661	0.14423463	3.896335209	0.610881354	0.10102664	0.714818161	0	18.19989554	0.00019695	1.161069437	0	0	1.793965211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9709	NO																																																																																		0	0	0	14.9791	0.020597663	3.541115453	0	5.355259518	0.526463937	0	1.415903932	3.510020661	0.14423463	3.896335209	0.610881354	0.10102664	0.714818161	0	18.19989554	0.00019695	1.161069437	0	0	1.793965211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9709
H1036_136_0	2011	4	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	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	YES	266.034981	8.114364	601.158091	1493.233835	201.51974	9.210445	2.802051	350.324929	291.875414	1350.456318	1352.919545	68.516435	0.509694	546.838808	4183.305095	4337.283935	66.015421	651.754744		1652.026559	31.220773	0		2.29					3.85	0.73	341.691571										3400	$0/Admit:1a.IP Acute	$100/Admit:1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$75/Visit:8b, 9a. $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,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$0/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0-$75/Visit:9d. $5 Cardiac Rehab,8b. $75 Nuclear Medicine,9a. $20 OP Other,5. $20 Partial Hospitalization,7h. $20 Psych -- OP,8b. $0 Rad therapy,3, 7c, 7d, 7i. $5 Therapy (AT,PT,ST,OT) -- CORF"	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$20/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$5/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											0	100	66.51235	0	0	0.2	0.2	50	100	0	29.102481	0	0.2	18.169582	5	20	20	5		0	0.2	0		0					0	0	0										NO	0	96.2437	53.804966	0	0	0.191911	0.191911	47.97785	95.9557	0	27.92549	0	0.191911	17.43475	4.797785	19.19114	19.19114	4.797785		0	0.191911	0		0					0	0	0											0	0.065079701	2.695440887	0	0	1.76758571	0.537744409	1.400653075	2.333925805	0	3.148411769	0	0.097815885	0.794499826	1.67254987	6.936451935	0.105575932	0.260581595	0	0	5.991609767	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.8079	0	1.694823681	0	0.065079701	2.695440887	0	0	1.76758571	0.537744409	1.400653075	2.333925805	0	3.148411769	0	0.097815885	0.794499826	1.67254987	6.936451935	0.105575932	0.260581595	0	0	5.991609767	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.8079	NO																																																																																		0	0	0	0	0.065079701	2.695440887	0	0	1.76758571	0.537744409	1.400653075	2.333925805	0	3.148411769	0	0.097815885	0.794499826	1.67254987	6.936451935	0.105575932	0.260581595	0	0	5.991609767	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.8079
H1036_137_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	NO	1504.299186	64.025341	624.876872	1180.98339	159.379904	5.938474	0.894615	364.147051	303.391401	291.35457	265.606651	71.219761	0.500857	568.414416	4371.9904	4532.914357	68.993004	680.361043		1726.540163	30.837139	0							4.31	0.41	5278.191846	1112.384203	1141.624341									$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$0-$195/Visit:9b. $0 Surgery ASC -- Physician,9b. $195 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $195 Surgery OP -- Facility"	$0/Visit:8a.Lab -- OP	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"	$0/Visit:8a.Lab -- FSL	"$0-$150/Visit:8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"									140.1309	119.971605	34.44565	0	150	0.2	0.2	50	195	0	0	50	0.2	41.908507	10	35	35	10		0	0.2	0							0	0	0	0	71.821666								NO	121.829104	104.302714	23.728816	0	130.8981	0.174531	0.174531	43.6327	170.16753	0	0	43.6327	0.174531	36.571627	8.72654	30.54289	30.54289	8.72654		0	0.174531	0							0	0	0	0	62.675464									15.2723	0.556501403	1.23563236	0	1.738543884	1.036447806	0.156138051	1.324059919	4.302280444	0	0	0.258959205	0.087415073	1.73232	3.179362425	11.53735872	0.175603811	0.494766488	0	0	5.382036707	0	0	0	0	0	0	0	0	0	0	0	5.96265294	0	0	0	0	0	0	0	54.4324	0	8.389026528	15.2723	0.556501403	1.23563236	0	1.738543884	1.036447806	0.156138051	1.324059919	4.302280444	0	0	0.258959205	0.087415073	1.73232	3.179362425	11.53735872	0.175603811	0.494766488	0	0	5.382036707	0	0	0	0	0	0	0	0	0	0	0	5.96265294	0	0	0	0	0	0	0	54.4324	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Day(Days 1-20) $137(Days 20-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	20% Coins	$0/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		$0/Visit	20% Coins	$0/Service									20% Coins	$0/Visit	20% Coins								3900	1.6993	0.0238	0.1115	0	0.4327	0.7299	0.11	0.1056	0.7798	0.0765	0	0.0821	0.0083	0.1591	0.5811	1.0524	0.0072	0.0815		0	0.4781	0									0.1477	0	0.4285								7.0949	0	1.994699986	16.9716	0.580338625	1.347105454	0	2.171231545	1.766313701	0.26609037	1.429612824	5.082058425	0.07654065	0	0.341011676	0.095700418	1.891373542	3.760414399	12.58978324	0.18285237	0.576266266	0	0	5.860154709	0	0	0	0	0	0	0	0	0	0.147726993	0	6.391160461	0	0	0	0	0	0	0	61.5273
H1036_138_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	NO	1504.752872	64.044651	625.06533	1181.339566	159.427972	5.649831	0.851132	364.256875	303.482902	291.44244	265.686757	71.241241	0.476511	568.585846	4373.308959	4534.281449	69.013812	680.566235		1727.060874	29.338284	0							4.31	0.41	5279.783708	1112.719689	1141.968647									$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$0-$195/Visit:9b. $0 Surgery ASC -- Physician,9b. $195 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $195 Surgery OP -- Facility"	$0/Visit:8a.Lab -- OP	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"	$0/Visit:8a.Lab -- FSL	"$0-$150/Visit:8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"									140.1309	119.971605	34.44565	0	150	0.2	0.2	50	195	0	0	50	0.2	41.908507	10	35	35	10		0	0.2	0							0	0	0	0	71.821666								NO	121.992637	104.44272	23.784067	0	131.0622	0.17475	0.17475	43.6874	170.38086	0	0	43.6874	0.17475	36.617474	8.73748	30.58118	30.58118	8.73748		0	0.17475	0							0	0	0	0	62.754037									15.2974	0.557416463	1.238882974	0	1.741248396	0.987307967	0.148735317	1.32611965	4.308973153	0	0	0.259362049	0.083270297	1.735014786	3.184308297	11.55530643	0.175876984	0.495536156	0	0	5.126865129	0	0	0	0	0	0	0	0	0	0	0	5.971928561	0	0	0	0	0	0	0	54.1936	0	8.273426296	15.2974	0.557416463	1.238882974	0	1.741248396	0.987307967	0.148735317	1.32611965	4.308973153	0	0	0.259362049	0.083270297	1.735014786	3.184308297	11.55530643	0.175876984	0.495536156	0	0	5.126865129	0	0	0	0	0	0	0	0	0	0	0	5.971928561	0	0	0	0	0	0	0	54.1936	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Day(Days 1-20) $137(Days 20-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	20% Coins	$0/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		$0/Visit	20% Coins	$0/Service									20% Coins	$0/Visit	20% Coins								3900	1.6612	0.0233	0.1155	0	0.4179	0.7049	0.1062	0.1072	0.7531	0.0739	0	0.0792	0.008	0.1536	0.5612	1.0164	0.007	0.0787		0	0.4618	0									0.1427	0	0.4139								6.8858	0	1.779133564	16.9586	0.58072004	1.354407604	0	2.159140963	1.692217346	0.254928031	1.43330382	5.062087885	0.073923289	0	0.338608731	0.091272417	1.88863039	3.74549194	12.57174479	0.182877514	0.574249211	0	0	5.588634434	0	0	0	0	0	0	0	0	0	0.142675703	0	6.385784304	0	0	0	0	0	0	0	61.0793
H1036_140_0	2011	4	r.										OP Facility - Other										Other										D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							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	YES	1178.587834	57.598307	725.975757	577.172357	213.386787	1.960804	6117.711019	242.304625	236.12739	96.780781	1849.743044	39.39787	0.319833	0.76942	6416.176319	4096.37116	89.575803	434.154392		241.379024	24.576609	0							4.38	0.36	229.609041										6700	$150/Day(Days 1-10):1a.IP Acute	$150/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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-$150/Visit:8b, 9a. $100 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$125/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$30/Visit:7b. $25 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$30-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $30 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"											121.20465	109.29915	34.44565	0	150	0.044921971	0	50	66.513001	47.189625	33.577596	125	0.190556	0.2	0	29.997539	30	33.16381		0	0.2	0							0	0	65.644914										NO	119.234832	107.52282	33.583544	0	147.79905	0.044262831	0	49.26635	65.537056	46.497212	33.084912	123.165875	0.18776	0.197065	0	29.557385	29.55981	32.677197		0	0.197065	0							0	0	64.681706											11.7107	0.516094366	2.031736565	0	2.628197033	0.086790735	0	0.994788705	1.289591165	0.375003041	5.099882153	0.404372761	0.060051844	0.151625752	0	10.08983496	0.220653643	1.182245716	0	0	4.843189453	0	0	0	0	0	0	0	0	0	1.237625374	0	0	0	0	0	0	0	0	0	42.9224	0	0.679704297	11.7107	0.516094366	2.031736565	0	2.628197033	0.086790735	0	0.994788705	1.289591165	0.375003041	5.099882153	0.404372761	0.060051844	0.151625752	0	10.08983496	0.220653643	1.182245716	0	0	4.843189453	0	0	0	0	0	0	0	0	0	1.237625374	0	0	0	0	0	0	0	0	0	42.9224	NO																																																																																		0	0	0	11.7107	0.516094366	2.031736565	0	2.628197033	0.086790735	0	0.994788705	1.289591165	0.375003041	5.099882153	0.404372761	0.060051844	0.151625752	0	10.08983496	0.220653643	1.182245716	0	0	4.843189453	0	0	0	0	0	0	0	0	0	1.237625374	0	0	0	0	0	0	0	0	0	42.9224
H1036_141_0	2011	5	r.										OP Facility - Other										Other										A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							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	YES	212.139786	1.916457	504.291399	116.135405	189.597948	2.521004	1.52948	224.587893	212.521531	124.40794	1375.760647	34.474383	0.105062	3.31948	5773.730117	5439.839726	2.335012	340.302056		304.465199	10.899144	0							0.11	0.36	96.068009										6700	$1450/Admit:1a.IP Acute	$1450/Admit:1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% Coins:11a.DME	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $150 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$40/Visit:7b. $25 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$40-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"											1450	1450	34.44565	0	150	0	0.114486	50	118.789212	51.993037	43.945677	150	0.2	0.2	10	39.995802	40	51.68193		0	0.2	0							0	0	141.097307										NO	1400.1461	1400.1461	32.038622	0	144.40215	0	0.110213	48.13405	114.356118	50.052709	42.305668	144.40215	0.192536	0.192536	9.62681	38.503199	38.50724	49.753212		0	0.192536	0							0	0	135.831697											24.7522	0.223609983	1.346400126	0	2.281529277	0	0.168568579	0.900860406	2.02526144	0.518912868	4.850206098	0.414847919	0.020228217	0.639119401	4.631883569	17.45426929	0.007492906	1.410926695	0	0	2.098477589	0	0	0	0	0	0	0	0	0	1.087423391	0	0	0	0	0	0	0	0	0	64.8322	0	2.483315899	24.7522	0.223609983	1.346400126	0	2.281529277	0	0.168568579	0.900860406	2.02526144	0.518912868	4.850206098	0.414847919	0.020228217	0.639119401	4.631883569	17.45426929	0.007492906	1.410926695	0	0	2.098477589	0	0	0	0	0	0	0	0	0	1.087423391	0	0	0	0	0	0	0	0	0	64.8322	NO																																																																																		0	0	0	24.7522	0.223609983	1.346400126	0	2.281529277	0	0.168568579	0.900860406	2.02526144	0.518912868	4.850206098	0.414847919	0.020228217	0.639119401	4.631883569	17.45426929	0.007492906	1.410926695	0	0	2.098477589	0	0	0	0	0	0	0	0	0	1.087423391	0	0	0	0	0	0	0	0	0	64.8322
H1036_143_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							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	YES	1509.731238	58.93546	690.781918	975.247742	213.356734	3.847393	2.532501	280.034808	323.158874	122.422756	1747.390694	87.839799	0.540409	2.927465	6143.961301	5829.147981	90.941744	583.189001		622.520626	21.965451	0							4.52	0.36	229.081354	339.067493									3400	$150/Day(Days 1-7):1a.IP Acute	$150/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$125/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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-$175/Visit:8b, 9a. $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,8b, 9a. $175 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$200/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$30/Visit:7b. $25 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30-$75/Visit:7c, 7d, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11c.Diabetic Monitoring Supplies	"$30-$150/Visit:9d. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $30 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"										107.793	92.28585	34.44565	0	125	0.2	0.2	50	124.614039	56.261331	78.747105	200	0.2	0.2	5	29.97445	30	34.924953		0	0.2	0							0	0	0	63.444138									NO	94.79144	81.1547	24.088084	0	109.504625	0.175207	0.175207	43.80185	109.166509	49.287008	68.985378	175.2074	0.175207	0.175207	4.380185	26.258727	26.28111	30.595551		0	0.175207	0							0	0	0	55.579413										11.9258	0.398574131	1.386634406	0	1.946962429	0.674090185	0.443711903	1.022170221	2.939843844	0.502820946	10.04536729	1.282515233	0.09468344	0.51291236	2.242640594	12.75550046	0.199170831	1.486915735	0	0	3.848500773	0	0	0	0	0	0	0	0	0	0	1.570431019	0	0	0	0	0	0	0	0	55.2792	0	8.168727712	11.9258	0.398574131	1.386634406	0	1.946962429	0.674090185	0.443711903	1.022170221	2.939843844	0.502820946	10.04536729	1.282515233	0.09468344	0.51291236	2.242640594	12.75550046	0.199170831	1.486915735	0	0	3.848500773	0	0	0	0	0	0	0	0	0	0	1.570431019	0	0	0	0	0	0	0	0	55.2792	NO																																																																																		0	0	0	11.9258	0.398574131	1.386634406	0	1.946962429	0.674090185	0.443711903	1.022170221	2.939843844	0.502820946	10.04536729	1.282515233	0.09468344	0.51291236	2.242640594	12.75550046	0.199170831	1.486915735	0	0	3.848500773	0	0	0	0	0	0	0	0	0	0	1.570431019	0	0	0	0	0	0	0	0	55.2792
H1036_144_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V		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	1509.731238	58.93546	690.781918	975.247742	213.356734	3.847393	2.532501	280.034808	323.158874	122.422756	1747.390694	87.839799	0.540409	2.927465	6143.961301	5829.147981	90.941744	583.189001		622.520626	21.965451	0		3.36	2.3		0.4		4.52	1.09	229.081354	339.067493									3400	$100/Day(Days 1-7):1a.IP Acute	$100/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$125/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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-$175/Visit:8b, 9a. $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,8b, 9a. $175 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$200/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$75/Visit:7c, 7d, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN849: Dental 16a, 16b"	"VIS855: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	"$25-$150/Visit:9d. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $25 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF"										71.862	61.5239	34.44565	0	125	0.2	0.2	50	124.614039	56.261331	78.747105	200	0.2	0.2	0	25	25	30.472169		0	0.2	0		0	0		0		0	0	0	61.843101									NO	65.769755	56.308088	26.363082	0	112.92775	0.180684	0.180684	45.1711	112.579064	50.827724	71.141867	180.6844	0.180684	0.180684	0	22.58555	22.58555	27.529228		0	0.180684	0		0	0		0		0	0	0	55.870418										8.2746	0.276545256	1.517595029	0	2.00782466	0.695162357	0.457582411	1.05412336	3.03174363	0.518539171	10.35938636	1.322606782	0.09764326	0.528946086	0	10.97120943	0.171164109	1.337895248	0	0	3.968805548	0	0	0	0	0	0	0	0	0	0	1.578653547	0	0	0	0	0	0	0	0	48.17	0	5.330482839	8.2746	0.276545256	1.517595029	0	2.00782466	0.695162357	0.457582411	1.05412336	3.03174363	0.518539171	10.35938636	1.322606782	0.09764326	0.528946086	0	10.97120943	0.171164109	1.337895248	0	0	3.968805548	0	0	0	0	0	0	0	0	0	0	1.578653547	0	0	0	0	0	0	0	0	48.17	NO																																																																																		0	0	0	8.2746	0.276545256	1.517595029	0	2.00782466	0.695162357	0.457582411	1.05412336	3.03174363	0.518539171	10.35938636	1.322606782	0.09764326	0.528946086	0	10.97120943	0.171164109	1.337895248	0	0	3.968805548	0	0	0	0	0	0	0	0	0	0	1.578653547	0	0	0	0	0	0	0	0	48.17
H1036_146_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin			V		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	YES	1542.52919	60.215795	705.788716	996.434379	217.991774	4.454878	0.263991	286.118387	330.179295	125.082313	1785.351647	89.748062	0.625737	3.389698	6277.434957	5955.782516	92.917395	595.858412		636.044491	25.433691	0			1.21		0.4		4.35	1.09	4083.034246	346.433519									4700	$150/Day(Days 1-10):1a.IP Acute	$150/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	0% Coins:11c.Diabetic Monitoring Supplies	"$50/Visit:4a, 4b.Emergency Room"	"$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-$150/Visit:8b, 9a. $100 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$30/Visit:7b. $25 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS856: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	"$0/Service:11b.Prosthetics, 11b.Supplies"	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $100 OP Other,5. $30 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"										121.20465	109.29915	34.44565	0	150	0.044921971	0	50	124.614039	75.015108	54.078905	150	0.2	0.2	0	29.97445	30	37.661037		0	0.2	0			0		0		0	0	0	79.487793									NO	113.935522	102.744043	28.970583	0	139.92735	0.041905415	0	46.64245	116.246081	69.977768	50.447452	139.92735	0.18657	0.18657	0	27.961635	27.98547	35.132061		0	0.18657	0			0		0		0	0	0	74.150108										14.6457	0.515567853	1.703925881	0	2.541917605	0.186683514	0	1.112105213	3.198504089	0.72941509	7.505536793	1.046517374	0.116743752	0.632415956	0	13.87778474	0.216694748	1.74447784	0	0	4.74516373	0	0	0	0	0	0	0	0	0	0	2.140673571	0	0	0	0	0	0	0	0	56.6599	0	4.140489109	14.6457	0.515567853	1.703925881	0	2.541917605	0.186683514	0	1.112105213	3.198504089	0.72941509	7.505536793	1.046517374	0.116743752	0.632415956	0	13.87778474	0.216694748	1.74447784	0	0	4.74516373	0	0	0	0	0	0	0	0	0	0	2.140673571	0	0	0	0	0	0	0	0	56.6599	NO																																																																																		0	0	0	14.6457	0.515567853	1.703925881	0	2.541917605	0.186683514	0	1.112105213	3.198504089	0.72941509	7.505536793	1.046517374	0.116743752	0.632415956	0	13.87778474	0.216694748	1.74447784	0	0	4.74516373	0	0	0	0	0	0	0	0	0	0	2.140673571	0	0	0	0	0	0	0	0	56.6599
H1036_149_0	2011	5	r.	s.	t.	u.	v.	w.	x.				DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional				Prosthetics/Supplies	Lab	Radiology	Other	Other		Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	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	1219.760669	51.914934	506.681277	1710.000226	129.23316	8.862413	2.69617	295.268558	140.622357	236.24479	226.467358	57.748528	0.35901	2.219345	4790.577664	4966.908956	75.598599	117.966953		1891.844213	30.041046	0							3.68	0.49	391.293479	1225.511537	1241.616894	86.469203	363.240496	142.506798	586.086018					$150/Day(Days 1-5):1a.IP Acute	$150/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$75/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility"	$50/Visit:8a.Lab -- OP	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,14h. $0 SMAM -- OP,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$20/Visit:7b. $10 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$50/Visit:8b. $30 Radiology -- FSR,14h. $0 SMAM -- FSR,8b. $50 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office"	"$30-$50/Visit:5. $50 Partial Hospitalization,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$30-$50/Visit:9d. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,7h. $50 Psych -- OP"	"$0-$125/Visit:9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$20/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"					92.8668	74.76165	42.271616	0	100	0.2	0.2	50	75	50	40.071376	50	0.2	0.2	10	19.785422	20	30		0	0.2	0							0	0	0	0	32.486915	50	46.638651	125	20				NO	75.527547	60.802828	22.073392	0	83.2421	0.166484	0.166484	41.62105	62.431575	41.62105	33.356255	41.62105	0.166484	0.166484	8.32421	16.469801	16.64842	24.97263		0	0.166484	0							0	0	0	0	27.04279	41.62105	38.822992	104.052625	16.64842					7.6771	0.2630479	0.932014537	0	0.896469969	1.475449966	0.448869166	1.024115618	0.731606269	0.819396351	0.629508579	0.200296198	0.059769421	0.369485433	3.323147875	6.817000174	0.104883102	0.245495422	0	0	5.001353502	0	0	0	0	0	0	0	0	0	0	0	2.79806541	0.299911585	1.175173573	1.235683868	0.813117182	0	0	0	37.341	0	8.406909658	7.6771	0.2630479	0.932014537	0	0.896469969	1.475449966	0.448869166	1.024115618	0.731606269	0.819396351	0.629508579	0.200296198	0.059769421	0.369485433	3.323147875	6.817000174	0.104883102	0.245495422	0	0	5.001353502	0	0	0	0	0	0	0	0	0	0	0	2.79806541	0.299911585	1.175173573	1.235683868	0.813117182	0	0	0	37.341	YES	$150/Day(Days 1-5)	$150/Day(Days 1-5)	$0/Day(Days 1-20) $128(Days 21-100)		$100/Trip			$50/Visit		$50/Visit	$0-$50/Visit	$50/Visit	20% Coins	20% Coins				$30/Visit																	$30-$50/Visit	$0-$125/Visit					2500	2.7724	0.095	0.3378		0.7083			0.3694		0.2956	0.2271	0.0722	0.022	0.136				0.0886																	0.4239	0.4457					5.9939	0	1.479806414	10.4495	0.358040354	1.269803696	0	1.60477731	1.475449966	0.448869166	1.393515235	0.731606269	1.114953509	0.856573009	0.272543255	0.08177177	0.505499406	3.323147875	6.817000174	0.104883102	0.334045889	0	0	5.001353502	0	0	0	0	0	0	0	0	0	0	0	2.79806541	0.299911585	1.599059966	1.68139638	0.813117182	0	0	0	43.3349
H1036_151_0	2011	3	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	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	1447.199706	61.595097	601.158091	1493.233835	201.51974	9.210445	1.38753	350.324929	291.875414	1350.456318	1352.919545	68.516435	0.509694	546.838808	4183.305095	4337.283935	66.015421	651.754744		1652.026559	31.220773	0							3.85	0.73	6673.738785										4900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$150/Visit:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"											140.1309	119.971605	66.51235	0	100	0.2	0.2	50	250	0	79.359846	50	0.2	46.261065	15	35	35	15		0	0.2	0							0	0	0										NO	129.475206	110.848844	50.130092	0	92.0334	0.184067	0.184067	46.0167	230.0835	0	73.037565	46.0167	0.184067	42.575631	13.80501	32.21169	32.21169	13.80501		0	0.184067	0							0	0	0											15.6147	0.568978775	2.511342534	0	1.54554557	1.69533898	0.255398485	1.343399763	5.596309735	0	8.234495767	0.262741686	0.093817845	1.940167275	4.812547389	11.6426038	0.17720569	0.749790063	0	0	5.746714024	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7911	0	5.969642875	15.6147	0.568978775	2.511342534	0	1.54554557	1.69533898	0.255398485	1.343399763	5.596309735	0	8.234495767	0.262741686	0.093817845	1.940167275	4.812547389	11.6426038	0.17720569	0.749790063	0	0	5.746714024	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7911	NO																																																																																		0	0	0	15.6147	0.568978775	2.511342534	0	1.54554557	1.69533898	0.255398485	1.343399763	5.596309735	0	8.234495767	0.262741686	0.093817845	1.940167275	4.812547389	11.6426038	0.17720569	0.749790063	0	0	5.746714024	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7911
H1036_801_0	2011	2																															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	YES	444.571272	6.670371	46.517577	24.887583	11.523986	14.616652	5.020758	41.130855	73.382732	8.06498	43.167336	7.74684	0.770888	14.837521	51.878767	88.338448	0.772124	7.916154		11.173337	47.406236	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.08228	0.08228	0.16103	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.067713	0.067713	0.08626	0	0.196875	0.196875	0.196875	0.196875	0.196875	0.196875	0.196875	0.196875	0.196875	0.196875	0.196875	0.196875	0.196875	0.196875		0.196875	0.196875	0																				30.1033	0.451670832	4.012606192	0	2.268784744	2.877653363	0.988461731	8.097637078	14.44722536	1.587792938	8.498569275	1.525159125	0.151768575	2.921136947	10.21363225	17.39163195	0.152011913	1.558492819	0	2.199750722	9.333102713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.7803	0	25.50360369	30.1033	0.451670832	4.012606192	0	2.268784744	2.877653363	0.988461731	8.097637078	14.44722536	1.587792938	8.498569275	1.525159125	0.151768575	2.921136947	10.21363225	17.39163195	0.152011913	1.558492819	0	2.199750722	9.333102713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.7803	NO																																																																																		0	0	0	30.1033	0.451670832	4.012606192	0	2.268784744	2.877653363	0.988461731	8.097637078	14.44722536	1.587792938	8.498569275	1.525159125	0.151768575	2.921136947	10.21363225	17.39163195	0.152011913	1.558492819	0	2.199750722	9.333102713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.7803
H1036_806_0	2011	3																															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	YES	410.635947	5.880630083	42.43224127	22.85997092	10.41788831	13.25113404	4.639602041	37.59252621	68.92194188	7.481782398	40.39955424	7.189009893	0.722770608	13.88501612	52.27746641	93.12723145	0.686789354	7.437541986		10.55303283	44.32429737	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.080689	0.080689	0.160663	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.068061	0.068061	0.09182	0	0.199654	0.199654	0.199654	0.199654	0.199654	0.199654	0.199654	0.199654	0.199654	0.199654	0.199654	0.199654	0.199654	0.199654		0.199654	0.199654	0																				27.9483	0.400241564	3.896128394	0	2.079973072	2.645641916	0.926315106	7.505498227	13.76054138	1.493767783	8.065932602	1.435314581	0.144304043	2.772199009	10.43740528	18.59322427	0.137120242	1.484935008	0	2.106955216	8.849523267	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.6833	0	21.94984203	27.9483	0.400241564	3.896128394	0	2.079973072	2.645641916	0.926315106	7.505498227	13.76054138	1.493767783	8.065932602	1.435314581	0.144304043	2.772199009	10.43740528	18.59322427	0.137120242	1.484935008	0	2.106955216	8.849523267	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.6833	NO																																																																																		0	0	0	27.9483	0.400241564	3.896128394	0	2.079973072	2.645641916	0.926315106	7.505498227	13.76054138	1.493767783	8.065932602	1.435314581	0.144304043	2.772199009	10.43740528	18.59322427	0.137120242	1.484935008	0	2.106955216	8.849523267	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.6833
H1036_807_0	2011	2																															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	YES	417.837642	5.861335	42.943173	23.205089	10.501789	13.374537	4.721885	38.07785	70.628442	7.627148	41.338172	7.329712	0.74013	14.207116	55.096251	99.792459	0.687315	7.622811		10.839601	45.335851	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.081862	0.081862	0.16402	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.068191	0.068191	0.091141	0	0.197972	0.197972	0.197972	0.197972	0.197972	0.197972	0.197972	0.197972	0.197972	0.197972	0.197972	0.197972	0.197972	0.197972		0.197972	0.197972	0																				28.4928	0.399690295	3.91388373	0	2.079060172	2.647783839	0.934801017	7.53834812	13.98245392	1.509961744	8.183800587	1.451077744	0.146525016	2.812611169	10.907515	19.75611269	0.136069125	1.509103139	0	2.145937489	8.975229094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5227	0	23.91151324	28.4928	0.399690295	3.91388373	0	2.079060172	2.647783839	0.934801017	7.53834812	13.98245392	1.509961744	8.183800587	1.451077744	0.146525016	2.812611169	10.907515	19.75611269	0.136069125	1.509103139	0	2.145937489	8.975229094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5227	NO																																																																																		0	0	0	28.4928	0.399690295	3.91388373	0	2.079060172	2.647783839	0.934801017	7.53834812	13.98245392	1.509961744	8.183800587	1.451077744	0.146525016	2.812611169	10.907515	19.75611269	0.136069125	1.509103139	0	2.145937489	8.975229094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5227
H1045_001_0	2011	5																																						V													Coin																											0													0																				0	YES								492.8401085													41.9475765																				3400								"4a1: $50,4a2: $50"													$0 																												44.77497044													0.2																				NO								44.77497044													0.2																					0	0	0	0	0	0	0	1.838908441	0	0	0	0	0	0	0	0	0	0	0	0	8.389515301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.2284		0	0	0	0	0	0	0	0	1.838908441	0	0	0	0	0	0	0	0	0	0	0	0	8.389515301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.2284	NO								"4a1: $50,4a2: $50"																																									0																																	0			0	0	0	0	0	0	0	1.838908441	0	0	0	0	0	0	0	0	0	0	0	0	8.389515301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.2284
H1045_005_0	2011	6																																	D		T			V	V		P	V		O							Coin																						0		0			0	0		0	0		0							0																				0	YES			853.8909285		702.3484425			629.6047359	387.2557955		217.1489776	191.8902159		123.5326425							58.03829682																				3400	$0.00 copay	$0.00 copay	21: $25 days 7 - 21	$0.00 copay	10a: $100	$0.00 copay	$0.00 copay	"4a1: $50,4a2: $50"	"9a1: $100,9b: $25"	$0.00 copay	"8b3: $40,8b4: $40"	9a2: $100	$0.00 copay	9a3: $100	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	"151: 20.0%,153: 20.0%"	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay														13.59281081		100			49.08568395	57.10220564		22.83612222	100		73.28437333							0.196466608																				NO			13.59281081		100			49.08568395	57.10220564		22.83612222	100		73.28437333							0.196466608																					0	0	0.967231487	0	5.852903687	0	0	2.57538159	1.842763339	0	0.413236716	1.599085133	0	0.754417691	0	0	0	0	0	0	11.40258732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.4076		0	0	0	0.967231487	0	5.852903687	0	0	2.57538159	1.842763339	0	0.413236716	1.599085133	0	0.754417691	0	0	0	0	0	0	11.40258732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.4076	NO																																																																																		0			0	0	0.967231487	0	5.852903687	0	0	2.57538159	1.842763339	0	0.413236716	1.599085133	0	0.754417691	0	0	0	0	0	0	11.40258732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.4076
H1045_010_0	2011	6																															D	D	D	Coin	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	O	T	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	YES	1096.369196	0	252.7151583	7.286691978	326.4629565	5.367421928	0.174295647	336.9866205	359.0052519	88.55147135	194.8947972	154.0399526	0	57.83914936	7098.276409	3049.492098	0.022932974	76.78117793	0.321061633	0	26.31528472	25.10181562	215.5897095	875.9448412																	6700	1a: $175 days 1 - 7	$0 	21: $50 days 11 - 20	$0 	10a: $150	11a: 20.0%	$0 	"4a1: $50,4a2: $50"	"9a1: $200,9b: $150"	8a2: $25	"8b1: $25,8b2: $100,8b3: $25,8b4: $25,8b5: $25,8b6: $25"	9a2: $200	$0 	9a3: $200	$0 	"7b1: $25,7b2: $25,7d1: $25,7f1: $25"	$0 	"7c: $25,7i: $25"	7d2: $25	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16a1: $12																		131.4623006	0	20.83348212	0	132.0794535	0.2	0	45.65422317	168.6717739	4.068862455	33.75711482	200	0	143.9157791	0	24.16992156	0	25	25	0	0.198095303	0	0	12																	NO	131.4623006	0	20.83000784	0	132.0574274	0.2	0	45.65367276	168.6561006	4.068183914	33.75592378	199.9666472	0	143.8917791	0	24.16992156	0	25	24.99583089	0	0.198062268	0	0	12																		12.0109	0	0.438671561	0	3.592654848	1.073484386	0	1.282056408	5.045702158	0.030020306	0.548237827	2.566904404	0	0.693548175	0	6.142165402	0	0.159960787	0.000668767	0	5.21206498	0	0	0.875944841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.673		0	12.0109	0	0.438671561	0	3.592654848	1.073484386	0	1.282056408	5.045702158	0.030020306	0.548237827	2.566904404	0	0.693548175	0	6.142165402	0	0.159960787	0.000668767	0	5.21206498	0	0	0.875944841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.673	NO	"1a1: 20.0%,1a2: 20.0%"	"1b1: 20.0%,1b2: 20.0%"	"21: 20.0%,22: 20.0%,23: 20.0%"	6: 20.0%	10a: 20.0%	11a: 20.0%	"11b: 20.0%,11c: 20.0%"	"4a1: 20.0%,4a2: 20.0%,4b: 20.0%"	"9a1: 20.0%,9b: 20.0%"	"8a1: 20.0%,8a2: 20.0%"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: 20.0%,9a2: 20.0%"	12: 20.0%	"3: 20.0%,9a3: 20.0%,9c: 20.0%,9d1: 20.0%"	7a: 20.0%	"7b1: 20.0%,7b2: 20.0%,7d1: 20.0%,7f1: 20.0%,7f2: 20.0%,7g: 20.0%"	"7e: 20.0%,7h: 20.0%"	"7c: 20.0%,7i: 20.0%"	7d2: 20.0%	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	"13a1: 20.0%,13a2: 20.0%"	$0 																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																		0			12.0109	0	0.438671561	0	3.592654848	1.073484386	0	1.282056408	5.045702158	0.030020306	0.548237827	2.566904404	0	0.693548175	0	6.142165402	0	0.159960787	0.000668767	0	5.21206498	0	0	0.875944841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.673
H1045_012_0	2011	6																																																																																																															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	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2011	6																																						V																																								0																																	0	YES								607.992857																																	3400	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	"4a1: $50,4a2: $50"	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay																			44.49803292																																	NO								44.49803292																																		0	0	0	0	0	0	0	2.254540514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.2545		0	0	0	0	0	0	0	0	2.254540514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.2545	NO								"4a1: $50,4a2: $50"																																									0																																	0			0	0	0	0	0	0	0	2.254540514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.2545
H1045_018_0	2011	4																																																																																																															0	YES																																									3400																																																																																		NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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_019_0	2011	5																																	D		T	Coin		V	V	P	P	V		O							Coin																						0		0	0		0	0	0	0	0		0							0																				0	YES			363.110323		528.5554533	5.453893906		291.1930884	255.5746309	79.1900775	264.8939807	143.7424327		87.04565512							35.01109165																				3400	$0.00 copay	$0.00 copay	21: $75 days 11 - 100	$0.00 copay	10a: $100	11a: 20.0%	$0.00 copay	"4a1: $50,4a2: $50"	9a1: $150	8a2: $25	"8b1: $25,8b2: $100,8b3: $25,8b4: $25,8b5: $25,8b6: $25"	9a2: $150	$0.00 copay	9a3: $150	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	"151: 20.0%,153: 20.0%"	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay	$0.00 copay														27.35136583		100	0.2		44.52077748	58.79152348	6.654343808	33.44078099	150		94.42264574							0.197224878																				NO			27.35136583		100	0.2		44.52077748	58.79152348	6.654343808	33.44078099	150		94.42264574							0.197224878																					0	0	0.827630273	0	4.404628777	1.090778781	0	1.080345224	1.252135159	0.043913167	0.738188466	1.796780409	0	0.684923421	0	0	0	0	0	0	6.905058287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.8244		0	0	0	0.827630273	0	4.404628777	1.090778781	0	1.080345224	1.252135159	0.043913167	0.738188466	1.796780409	0	0.684923421	0	0	0	0	0	0	6.905058287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.8244	NO																																																																																		0			0	0	0.827630273	0	4.404628777	1.090778781	0	1.080345224	1.252135159	0.043913167	0.738188466	1.796780409	0	0.684923421	0	0	0	0	0	0	6.905058287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.8244
H1076_003_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	V	V	Coin	Coin	V	P	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	382.437613	0	27.36512423	0	11.9299075	9.56697266	0	16.29860899	65.31465017	0	39.06891212	24.2547886	0.035271682	5.28795478	13510.49395	14625.40913	0	0	0	0	60.34586705	0	0	144.6015143	0	0	0	0	0	0											6700	FFS	included in a.1	FFS	FFS	FFS	FFS	included in e.1.	FFS	FFS	included in h.5	included in h.5	included in h.5	included in h.5	FFS	0	"(7b,7d,7g) $15"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	FFS	0	Not covered	0	0	0	Not covered	Not covered	0	0											0	0.076066257	0	0.159529212	0	0.233	0.233	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	7.866592512	0	0	0	0	0.233	0	0	0	0	0	0	0	0	0											NO	0.067598325	0	0.141769925	0	0.207061717	0.207061717	0	0.207061717	0.207061717	0	0.207061717	0.207061717	0.207061717	0.207061717	0	6.990859019	0	0	0	0	0.207061717	0	0	0	0	0	0	0	0	0												25.8521	0	3.8795516	0	2.470227129	1.980953784	0	3.374817961	13.5241636	0	8.089676021	5.02223817	0.007303415	1.094932996	0	8.520347777	0	0	0	0	12.49531884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3117	0	10.81212238	25.8521	0	3.8795516	0	2.470227129	1.980953784	0	3.374817961	13.5241636	0	8.089676021	5.02223817	0.007303415	1.094932996	0	8.520347777	0	0	0	0	12.49531884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3117	NO																																																																																		0	0	0	25.8521	0	3.8795516	0	2.470227129	1.980953784	0	3.374817961	13.5241636	0	8.089676021	5.02223817	0.007303415	1.094932996	0	8.520347777	0	0	0	0	12.49531884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3117
H1076_010_0	2011	6																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	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	755.2334073	0	400.5658928	0	234.2852177	0	0	207.8801419	270.1021256	0	1273.838509	40.3406454	0.025841128	60.07945565	10599.1139	9790.839219	0	0	0	0	519.5242253	0	0	144.6015143	0	0	0	0	0	0											6700	$150 copay (days 1-10) PBP L.1a	0	"(2) $35 days 1-20, $100 days 21-100"	0	(10a) $100	0	0	(4a) $50	"(9a,9b) $150 @ Hospital; $50 ASC"	0	"$100 (L.8a Diag, 8b. MRI/CT @ Hosp); $10 (L.8a diag @ freest.) $55 (Therapy) L.8b"	(9a) $150 copay	(12) 20%	(8b) $55 @ Hospital	0	"(7b,7d,7g) $25"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20% chemo; $50 Part B Rx	0	Not covered	0	0	0	Not covered	Not covered	0	0											0	133.4235294	0	48.44273218	0	100	0	0	50	93.67217549	0	16.76899915	50	0.2	30.3915785	0	13.29569276	0	0	0	0	136.4405247	0	0	0	0	0	0	0	0	0											NO	131.9093565	0	47.89297403	0	98.86513801	0	0	49.43256901	92.60912558	0	16.57869415	49.43256901	0.197730276	30.04667603	0	13.144805	0	0	0	0	134.8921131	0	0	0	0	0	0	0	0	0												8.3019	0	1.598690992	0	1.930220032	0	0	0.856337455	2.084493473	0	1.759881588	0.166178478	0.005109573	0.150432328	0	10.72488936	0	0	0	0	5.839976713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4181	0	0.383602361	8.3019	0	1.598690992	0	1.930220032	0	0	0.856337455	2.084493473	0	1.759881588	0.166178478	0.005109573	0.150432328	0	10.72488936	0	0	0	0	5.839976713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4181	NO																																																																																		0	0	0	8.3019	0	1.598690992	0	1.930220032	0	0	0.856337455	2.084493473	0	1.759881588	0.166178478	0.005109573	0.150432328	0	10.72488936	0	0	0	0	5.839976713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4181
H1076_011_0	2011	6																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	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	1441.242469	0	805.7034028	0	1425.735433	0	0	480.9135825	308.123804	0	1651.940965	106.0194034	0.050216618	113.2250931	11780.23856	13489.14309	0	0	0	0	984.8761242	0	0	2100.591872	0	0	0	0	0	0											3400	0	0	0	0	0	0	0	0	0	0	0	0	(12) 20%	0	0	0	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0.2	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	0.2	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	0.010043324	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	4.1423	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.010043324	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	4.1423	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.010043324	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	4.1423
H1076_016_0	2011	7																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	V	V	Coin	Coin	V	P	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	304.5831017	0	34.39971373	0	8.997583698	9.504914039	0	29.15328302	57.38106651	0	35.86189258	16.61429563	0	3.56924572	11110.77828	13934.55689	0	0	0	0	60.52697959	0	0	144.6015143	0	0	0	0	0	0											6700	FFS	included in a.1	FFS	FFS	FFS	FFS	included in e.1.	FFS	FFS	included in h.5	included in h.5	included in h.5	included in h.5	FFS	0	"(7b,7d,7g) $25"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	FFS	0	Not covered	0	0	0	Not covered	Not covered	0	0											0	0.076066257	0	0.159529212	0	0.233	0.233	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	11.58550923	0	0	0	0	0.233	0	0	0	0	0	0	0	0	0											NO	0.068114113	0	0.142851656	0	0.208641637	0.208641637	0	0.208641637	0.208641637	0	0.208641637	0.208641637	0.208641637	0.208641637	0	10.37433309	0	0	0	0	0.208641637	0	0	0	0	0	0	0	0	0												20.7464	0	4.914056069	0	1.87727059	1.983120823	0	6.082588688	11.97207964	0	7.482283967	3.466433836	0	0.744693269	0	12.04681122	0	0	0	0	12.62844809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.9442	0	9.800264209	20.7464	0	4.914056069	0	1.87727059	1.983120823	0	6.082588688	11.97207964	0	7.482283967	3.466433836	0	0.744693269	0	12.04681122	0	0	0	0	12.62844809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.9442	NO																																																																																		0	0	0	20.7464	0	4.914056069	0	1.87727059	1.983120823	0	6.082588688	11.97207964	0	7.482283967	3.466433836	0	0.744693269	0	12.04681122	0	0	0	0	12.62844809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.9442
H1076_802_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	333.4646997	0	24.97075029	5.2	11.24363608	10.42673641	0	22.44459845	69.09767016	0	0	0	0	78.58617624	0	0	0	0	0	421.1003328	53.67526804	0	0	0	0	0	0	0	0	0											6700	FFS	included in a.1	FFS	FFS	FFS	FFS	included in e.1.	FFS	FFS	included in h.5	included in h.5	included in h.5	included in h.5	FFS	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	FFS	FFS	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered											0	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	0	0	0	0	0	0	0	0	0	0	NO	0.056212057	0	0.117174737	0	0.171643694	0.171643694	0	0.171643694	0.171643694	0	0	0	0	0.171643694	0	0	0	0	0	0.171643694	0.171643694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		18.7447	0	2.925941101	0	1.929899234	1.789683556	0	3.852473794	11.86017937	0	0	0	0	13.48882161	0	0	0	0	0	72.27921676	9.213021295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.084	0	48.64501382	18.7447	0	2.925941101	0	1.929899234	1.789683556	0	3.852473794	11.86017937	0	0	0	0	13.48882161	0	0	0	0	0	72.27921676	9.213021295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.084	NO																																																																																		0	0	0	18.7447	0	2.925941101	0	1.929899234	1.789683556	0	3.852473794	11.86017937	0	0	0	0	13.48882161	0	0	0	0	0	72.27921676	9.213021295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.084
H1076_803_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	333.4646997	0	24.97075029	5.2	11.24363608	10.42673641	0	22.44459845	69.09767016	0	0	0	0	78.58617624	0	0	0	0	0	421.1003328	53.67526804	0	0	0	0	0	0	0	0	0											6700	FFS	included in a.1	FFS	FFS	FFS	FFS	included in e.1.	FFS	FFS	included in h.5	included in h.5	included in h.5	included in h.5	FFS	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	FFS	FFS	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered											0	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	0	0	0	0	0	0	0	0	0	0	NO	0.056212057	0	0.117174737	0	0.171643694	0.171643694	0	0.171643694	0.171643694	0	0	0	0	0.171643694	0	0	0	0	0	0.171643694	0.171643694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		18.7447	0	2.925941101	0	1.929899234	1.789683556	0	3.852473794	11.86017937	0	0	0	0	13.48882161	0	0	0	0	0	72.27921676	9.213021295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.084	0	48.64501382	18.7447	0	2.925941101	0	1.929899234	1.789683556	0	3.852473794	11.86017937	0	0	0	0	13.48882161	0	0	0	0	0	72.27921676	9.213021295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.084	NO																																																																																		0	0	0	18.7447	0	2.925941101	0	1.929899234	1.789683556	0	3.852473794	11.86017937	0	0	0	0	13.48882161	0	0	0	0	0	72.27921676	9.213021295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.084
H1076_805_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	333.4646997	0	24.97075029	5.2	11.24363608	10.42673641	0	22.44459845	69.09767016	0	0	0	0	78.58617624	0	0	0	0	0	421.1003328	53.67526804	0	0	0	0	0	0	0	0	0											6700	FFS	included in a.1	FFS	FFS	FFS	FFS	included in e.1.	FFS	FFS	included in h.5	included in h.5	included in h.5	included in h.5	FFS	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	FFS	FFS	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered											0	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	0	0	0	0	0	0	0	0	0	0	NO	0.056212057	0	0.117174737	0	0.171643694	0.171643694	0	0.171643694	0.171643694	0	0	0	0	0.171643694	0	0	0	0	0	0.171643694	0.171643694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		18.7447	0	2.925941101	0	1.929899234	1.789683556	0	3.852473794	11.86017937	0	0	0	0	13.48882161	0	0	0	0	0	72.27921676	9.213021295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.084	0	48.64501382	18.7447	0	2.925941101	0	1.929899234	1.789683556	0	3.852473794	11.86017937	0	0	0	0	13.48882161	0	0	0	0	0	72.27921676	9.213021295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.084	NO																																																																																		0	0	0	18.7447	0	2.925941101	0	1.929899234	1.789683556	0	3.852473794	11.86017937	0	0	0	0	13.48882161	0	0	0	0	0	72.27921676	9.213021295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.084
H1080_004_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1219.164003	77.94130834	915.8402147	2010.523772	154.0372161	8.611960231	7.695035409	223.4302605	44.16324794	19.43025662	51.57288917	0	0.263305352	11.56703699	5696.856583	126.2879465	378.4803512	482.2586223	0	0	26.44139846	2046.935274	0	267.6467843	215.8231982	0	15.08433879	6	0	0											4950	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-60 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												187.4696942	115.9014585	65.65729764	0	200	0.2	0.130123278	49.20216024	0.2	0.116995868	0.159474613	0	0.2	0.159273088	10.57265523	0.12209918	38.5	35	0	0	0.2	34.85419322	0	0	34.97760649	0	0	0	0	0											NO	146.2267594	90.40338373	51.21283155	0	156.0004246	0.156000425	0.101496433	38.40046523	0.156000425	0.091257025	0.124390537	0	0.156000425	0.124233347	10.17958633	0.11756506	37.06865165	33.69877423	0	0	0.156000425	27.1863447	0	0	34.97760649	0	0	0	0	0												14.8562	0.587179834	3.90856422	0	2.00248926	1.343469453	0.781018649	0.714985496	6.889485431	1.773147423	6.415179379	0	0.041075747	1.437011717	4.832636949	14.84704996	1.169146358	1.354293703	0	0	4.124869387	4.637390663	0	0	0.629081575	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.3443	0	14.82087605	14.8562	0.587179834	3.90856422	0	2.00248926	1.343469453	0.781018649	0.714985496	6.889485431	1.773147423	6.415179379	0	0.041075747	1.437011717	4.832636949	14.84704996	1.169146358	1.354293703	0	0	4.124869387	4.637390663	0	0	0.629081575	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.3443	NO	"$375 Days 1-Unlimited (1a); $375 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-80 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												2.2174	0.1409	1.3037	0.9958	0.4531	0.4559	0.4074	0.1617	2.3381	0.4012	2.1489	0	0.0093	0.4852	2.3918	2.9829	0.2327	0.2726	0	0	1.3453	1.1523	0	0.047	0.1067	0	0.0085	0	0	0											20.0582	0	0	17.0736	0.728119853	5.21224521	0.995845106	2.455539896	1.799396759	1.188402877	0.876650959	9.227539733	2.174310907	8.564054881	0	0.050368877	1.922181446	7.224434439	17.82991493	1.401823241	1.626915536	0	0	5.470133519	5.78972459	0	0.046955576	0.735767924	0	0.008527209	0	0	0	0	0	0	0	0	0	0	0	0	0	92.4024
H1080_036_0	2011	4																															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	YES	519.7914241	22.9181	70.80942989	3804.510644	17.94742604	27.83209943	26.67634511	44.95286047	64.01171042	29.25602208	66.91366952	0	0.476229959	38.13583223	44.04119261	192.9381864	11.0497	8.027703457	0	0	46.19484162	10.13317338	666.773802	386.6214151	180.126123	192.6296441	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.084593097	0.085620102	0.159541363	0	0.233	0.233	0.233	0.068565661	0.233	0.233	0.233	0	0.233	0.233	0.227015383	0.232890172	0.229406285	0.233	0	0	0.233	0.23032116	0	0	0	0	0	0	0	0											NO	0.064034658	0.064812073	0.120768444	0	0.176374621	0.176374621	0.176374621	0.051913117	0.176374621	0.176374621	0.176374621	0	0.176374621	0.176374621	0.171844429	0.176291484	0.173654277	0.176374621	0	0	0.176374621	0.176115802	0	0	0	0	0	0	0	0												33.2847	1.485369578	8.551544654	0	3.165470461	4.908875982	4.705030251	2.333643115	11.29004115	5.160019798	11.80187308	0	0.083994878	6.726192947	7.568233614	34.01335919	1.918827667	1.415883153	0	0	8.147597671	1.784611957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.3452	0	47.60217503	33.2847	1.485369578	8.551544654	0	3.165470461	4.908875982	4.705030251	2.333643115	11.29004115	5.160019798	11.80187308	0	0.083994878	6.726192947	7.568233614	34.01335919	1.918827667	1.415883153	0	0	8.147597671	1.784611957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.3452	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	33.2847	1.485369578	8.551544654	0	3.165470461	4.908875982	4.705030251	2.333643115	11.29004115	5.160019798	11.80187308	0	0.083994878	6.726192947	7.568233614	34.01335919	1.918827667	1.415883153	0	0	8.147597671	1.784611957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.3452
H1080_042_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1239.436171	74.08984571	895.3676399	2142.625187	179.0186108	9.519434225	9.229528803	274.0265803	379.9009699	18.68816715	48.44677084	0	0.209357209	264.7852898	6832.348074	146.2848937	439.4546191	688.0025697	0	0	30.30924078	2305.489559	0	180.6029118	135.2981389	0	17.5408954	6	174.532604	0											3200	"$175 Days 1-19 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-42 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$175 (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$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, 18a); $0/$25 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												162.2902655	111.9031178	56.6815979	0	200	0.2	0.124510637	49.17878207	175	0.14456723	0.163242595	0	0.2	67.93033439	7.244523429	0.086717378	38.5	25	0	0	0.2	24.90801794	0	0	25	0	0	0	0	0											NO	118.942866	82.01402285	41.54205849	0	146.5804072	0.146580407	0.091254099	36.06914976	128.2578563	0.105953617	0.11964083	0	0.146580407	49.78628036	6.912373977	0.082764714	36.73483849	23.85379123	0	0	0.146580407	18.25513706	0	0	25	0	0	0	0	0												12.2852	0.506367192	3.099617906	0	2.186718405	1.395362545	0.842232339	0.823658814	4.060440333	1.980078902	5.796211888	0	0.030687665	1.098556223	3.935645419	12.10722733	1.345274538	1.367622472	0	0	4.442740854	3.507252324	0	0	0.281871123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0927	0	16.223391	12.2852	0.506367192	3.099617906	0	2.186718405	1.395362545	0.842232339	0.823658814	4.060440333	1.980078902	5.796211888	0	0.030687665	1.098556223	3.935645419	12.10722733	1.345274538	1.367622472	0	0	4.442740854	3.507252324	0	0	0.281871123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0927	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.2852	0.506367192	3.099617906	0	2.186718405	1.395362545	0.842232339	0.823658814	4.060440333	1.980078902	5.796211888	0	0.030687665	1.098556223	3.935645419	12.10722733	1.345274538	1.367622472	0	0	4.442740854	3.507252324	0	0	0.281871123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0927
H1080_801_0	2011	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	216.3454017	4.485	24.82043053	2305.526555	6.93041575	9.431308358	9.805582204	15.53547687	44.49122703	21.1675574	53.1626429	0	0.178038625	10.01866587	37.12224711	159.1184465	2.1181	7.082788828	0	0	29.09927917	12.29824741	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.085475693	0.085475693	0.160019889	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.068756458	0.068756458	0.128719644	0	0.187424683	0.187424683	0.187424683	0.187424683	0.187424683	0.187424683	0.187424683	0	0.187424683	0.187424683	0.187424683	0.187424683	0.187424683	0.187424683	0	0	0.187424683	0.187424683	0	0	0	0	0	0	0	0												14.8751	0.308372712	3.194876979	0	1.298930978	1.767659983	1.83780814	2.911731834	8.33875414	3.967322744	9.963991515	0	0.033368833	1.877745278	6.957625413	29.82272447	0.396984222	1.327489454	0	0	5.453923185	2.304995127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6394	0	23.49943123	14.8751	0.308372712	3.194876979	0	1.298930978	1.767659983	1.83780814	2.911731834	8.33875414	3.967322744	9.963991515	0	0.033368833	1.877745278	6.957625413	29.82272447	0.396984222	1.327489454	0	0	5.453923185	2.304995127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6394	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.8751	0.308372712	3.194876979	0	1.298930978	1.767659983	1.83780814	2.911731834	8.33875414	3.967322744	9.963991515	0	0.033368833	1.877745278	6.957625413	29.82272447	0.396984222	1.327489454	0	0	5.453923185	2.304995127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6394
H1080_804_0	2011	1																															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	216.2990121	4.4854	24.81510844	2305.03218	6.928929704	9.429286062	9.803479654	15.53214569	44.48168705	21.16301857	53.15124357	0	0.178000449	10.01552123	37.11428722	159.0843278	2.117	7.08127011	0	0	29.09303959	12.29561037	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.085475693	0.085475693	0.160019884	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.068760548	0.068760548	0.128727297	0	0.187435832	0.187435832	0.187435832	0.187435832	0.187435832	0.187435832	0.187435832	0	0.187435832	0.187435832	0.187435832	0.187435832	0.187435832	0.187435832	0	0	0.187435832	0.187435832	0	0	0	0	0	0	0	0												14.8728	0.308418561	3.194381827	0	1.298729707	1.767386083	1.83752337	2.911280658	8.337462042	3.966708003	9.962447585	0	0.033363662	1.877267559	6.956547322	29.81810341	0.396801657	1.327283758	0	0	5.453078095	2.304637966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6243	0	23.48859289	14.8728	0.308418561	3.194381827	0	1.298729707	1.767386083	1.83752337	2.911280658	8.337462042	3.966708003	9.962447585	0	0.033363662	1.877267559	6.956547322	29.81810341	0.396801657	1.327283758	0	0	5.453078095	2.304637966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6243	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	14.8728	0.308418561	3.194381827	0	1.298729707	1.767386083	1.83752337	2.911280658	8.337462042	3.966708003	9.962447585	0	0.033363662	1.877267559	6.956547322	29.81810341	0.396801657	1.327283758	0	0	5.453078095	2.304637966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6243
H1080_807_0	2011	1																															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	216.2990121	4.4854	24.81510844	2305.03218	6.928929704	9.429286062	9.803479654	15.53214569	44.48168705	21.16301857	53.15124357	0	0.178000449	10.01552123	37.11428722	159.0843278	2.117	7.08127011	0	0	29.09303959	12.29561037	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.085475693	0.085475693	0.160019884	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.068760548	0.068760548	0.128727297	0	0.187435832	0.187435832	0.187435832	0.187435832	0.187435832	0.187435832	0.187435832	0	0.187435832	0.187435832	0.187435832	0.187435832	0.187435832	0.187435832	0	0	0.187435832	0.187435832	0	0	0	0	0	0	0	0												14.8728	0.308418561	3.194381827	0	1.298729707	1.767386083	1.83752337	2.911280658	8.337462042	3.966708003	9.962447585	0	0.033363662	1.877267559	6.956547322	29.81810341	0.396801657	1.327283758	0	0	5.453078095	2.304637966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6243	0	23.48859289	14.8728	0.308418561	3.194381827	0	1.298729707	1.767386083	1.83752337	2.911280658	8.337462042	3.966708003	9.962447585	0	0.033363662	1.877267559	6.956547322	29.81810341	0.396801657	1.327283758	0	0	5.453078095	2.304637966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6243	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	14.8728	0.308418561	3.194381827	0	1.298729707	1.767386083	1.83752337	2.911280658	8.337462042	3.966708003	9.962447585	0	0.033363662	1.877267559	6.956547322	29.81810341	0.396801657	1.327283758	0	0	5.453078095	2.304637966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6243
H1080_808_0	2011	1																															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	216.2990121	4.4854	24.81510844	2305.03218	6.928929704	9.429286062	9.803479654	15.53214569	44.48168705	21.16301857	53.15124357	0	0.178000449	10.01552123	37.11428722	159.0843278	2.117	7.08127011	0	0	29.09303959	12.29561037	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.085475693	0.085475693	0.160019884	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.068760548	0.068760548	0.128727297	0	0.187435832	0.187435832	0.187435832	0.187435832	0.187435832	0.187435832	0.187435832	0	0.187435832	0.187435832	0.187435832	0.187435832	0.187435832	0.187435832	0	0	0.187435832	0.187435832	0	0	0	0	0	0	0	0												14.8728	0.308418561	3.194381827	0	1.298729707	1.767386083	1.83752337	2.911280658	8.337462042	3.966708003	9.962447585	0	0.033363662	1.877267559	6.956547322	29.81810341	0.396801657	1.327283758	0	0	5.453078095	2.304637966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6243	0	23.48859289	14.8728	0.308418561	3.194381827	0	1.298729707	1.767386083	1.83752337	2.911280658	8.337462042	3.966708003	9.962447585	0	0.033363662	1.877267559	6.956547322	29.81810341	0.396801657	1.327283758	0	0	5.453078095	2.304637966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6243	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	14.8728	0.308418561	3.194381827	0	1.298729707	1.767386083	1.83752337	2.911280658	8.337462042	3.966708003	9.962447585	0	0.033363662	1.877267559	6.956547322	29.81810341	0.396801657	1.327283758	0	0	5.453078095	2.304637966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6243
H1080_809_0	2011	1																															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	203.9324034	4.2431445	22.52980656	1957.022709	5.87604312	7.996457442	8.313790389	13.1719561	37.72246542	17.94718881	45.07463814	0	0.150952363	8.493727045	31.65972456	135.7042362	1.8270495	6.040559526	0	0	24.81733287	10.48856564	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.085068992	0.085068992	0.157055458	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.068859814	0.068859814	0.127129867	0	0.188603818	0.188603818	0.188603818	0.188603818	0.188603818	0.188603818	0.188603818	0	0.188603818	0.188603818	0.188603818	0.188603818	0.188603818	0.188603818	0	0	0.188603818	0.188603818	0	0	0	0	0	0	0	0												14.0427	0.292182141	2.864211319	0	1.108244167	1.508162404	1.568012609	2.48428121	7.114601001	3.384908332	8.501248846	0	0.028470192	1.601949349	5.971144928	25.59433706	0.344588511	1.139272589	0	0	4.68064373	1.978183525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2072	0	19.82185592	14.0427	0.292182141	2.864211319	0	1.108244167	1.508162404	1.568012609	2.48428121	7.114601001	3.384908332	8.501248846	0	0.028470192	1.601949349	5.971144928	25.59433706	0.344588511	1.139272589	0	0	4.68064373	1.978183525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2072	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0097	0.021	0.35	0	0.2416	0.3288	0.3418	0.5416	1.5511	0.7379	1.8534	0	0.0062	0.3492	1.251	5.3623	0.0722	0.2387	0	0	0.9806	0.4145	0	0	0	0	0	0	0	0											15.6516	0	0	15.0524	0.313190397	3.214165845	0	1.349853234	1.836957918	1.909856108	3.025881051	8.665660021	4.122854507	10.35461191	0	0.034676998	1.95119142	7.222166909	30.95663837	0.416783678	1.377963003	0	0	5.661291205	2.392635209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8588
H1080_810_0	2011	1																															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	203.9324034	4.2431445	22.52980656	1957.022709	5.87604312	7.996457442	8.313790389	13.1719561	37.72246542	17.94718881	45.07463814	0	0.150952363	8.493727045	31.65972456	135.7042362	1.8270495	6.040559526	0	0	24.81733287	10.48856564	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.085068992	0.085068992	0.157055458	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.068859814	0.068859814	0.127129867	0	0.188603818	0.188603818	0.188603818	0.188603818	0.188603818	0.188603818	0.188603818	0	0.188603818	0.188603818	0.188603818	0.188603818	0.188603818	0.188603818	0	0	0.188603818	0.188603818	0	0	0	0	0	0	0	0												14.0427	0.292182141	2.864211319	0	1.108244167	1.508162404	1.568012609	2.48428121	7.114601001	3.384908332	8.501248846	0	0.028470192	1.601949349	5.971144928	25.59433706	0.344588511	1.139272589	0	0	4.68064373	1.978183525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2072	0	19.82185592	14.0427	0.292182141	2.864211319	0	1.108244167	1.508162404	1.568012609	2.48428121	7.114601001	3.384908332	8.501248846	0	0.028470192	1.601949349	5.971144928	25.59433706	0.344588511	1.139272589	0	0	4.68064373	1.978183525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2072	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0097	0.021	0.35	0	0.2416	0.3288	0.3418	0.5416	1.5511	0.7379	1.8534	0	0.0062	0.3492	1.251	5.3623	0.0722	0.2387	0	0	0.9806	0.4145	0	0	0	0	0	0	0	0											15.6516	0	0	15.0524	0.313190397	3.214165845	0	1.349853234	1.836957918	1.909856108	3.025881051	8.665660021	4.122854507	10.35461191	0	0.034676998	1.95119142	7.222166909	30.95663837	0.416783678	1.377963003	0	0	5.661291205	2.392635209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8588
H1080_811_0	2011	1																															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	203.9324034	4.2431445	22.52980656	1957.022709	5.87604312	7.996457442	8.313790389	13.1719561	37.72246542	17.94718881	45.07463814	0	0.150952363	8.493727045	31.65972456	135.7042362	1.8270495	6.040559526	0	0	24.81733287	10.48856564	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.085068992	0.085068992	0.157055458	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.068859814	0.068859814	0.127129867	0	0.188603818	0.188603818	0.188603818	0.188603818	0.188603818	0.188603818	0.188603818	0	0.188603818	0.188603818	0.188603818	0.188603818	0.188603818	0.188603818	0	0	0.188603818	0.188603818	0	0	0	0	0	0	0	0												14.0427	0.292182141	2.864211319	0	1.108244167	1.508162404	1.568012609	2.48428121	7.114601001	3.384908332	8.501248846	0	0.028470192	1.601949349	5.971144928	25.59433706	0.344588511	1.139272589	0	0	4.68064373	1.978183525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2072	0	19.82185592	14.0427	0.292182141	2.864211319	0	1.108244167	1.508162404	1.568012609	2.48428121	7.114601001	3.384908332	8.501248846	0	0.028470192	1.601949349	5.971144928	25.59433706	0.344588511	1.139272589	0	0	4.68064373	1.978183525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2072	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0097	0.021	0.35	0	0.2416	0.3288	0.3418	0.5416	1.5511	0.7379	1.8534	0	0.0062	0.3492	1.251	5.3623	0.0722	0.2387	0	0	0.9806	0.4145	0	0	0	0	0	0	0	0											15.6516	0	0	15.0524	0.313190397	3.214165845	0	1.349853234	1.836957918	1.909856108	3.025881051	8.665660021	4.122854507	10.35461191	0	0.034676998	1.95119142	7.222166909	30.95663837	0.416783678	1.377963003	0	0	5.661291205	2.392635209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8588
H1099_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	O	V	V	V	V	V	V	Coin	V	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	1414.069747	100.6319761	1865.667351	2854.390815	197.6157694	13.4043634	9.928612178	222.2313503	419.2347773	4251.196482	822.6313871	131.2394454	0.286636907	3622.0208	4590.155635	12529.64331	226.3828693	459.5170543	231.6564538	336.657444	61.60787224	0.257482885	0	357.4302486	197.7115518	194.8224963	5.569780315	23.22639946	12000	0											5000	1a1: $200 days 1-6	1b1: $200 days 1-6	21: $25 days 15-20; $75 21+	$0 	10a: $150	11a: 20.0%	"11b: 20.0%,11c: 0%"	"4a1: $50,4a2: $50"	"9a1: $300,9b: $300"	8a1 OP Lab: 0%	"8b1: $0,8b2: $175"	9a2: $200	$0 	"3: $25,5: $15,9a3: $0,9c: $25,9d1: $25,9d2: $25"	"4b: $10,7a: $10"	"7b1: $25,7d1: $25,7f1: $25,17a1: $15 (excluding glaucoma screening),18a1: $15"	"7e: $25,7h: $25"	"7c: $25,7i: $25"	7d2: $25	7g: $10-$25	"152: 20.0%,153: 20.0%"	$0 	$0 	16b: $100 limit/year	$0 	17b2: $100 limit/year	18a2: $15	18b: $250 limit/year	"14a: Newsletter, Health Club membership"	$0 											0	141.2016597	96.47529629	10.97631375	0	126.3090016	0.2	0.023296984	50	300	0	143.3479052	200	0	1.116340591	10	23.64886192	25	25	25	21.25	0.2	0	0	0	0	0	15	0	0	0											YES	125.5920523	85.81011359	9.762900621	0	112.3457526	0.177890334	0.020721541	44.47782117	266.8355016	0	127.501034	177.8903344	0	1.116340591	8.922784598	21.03451977	22.2362918	22.2362918	22.2362918	18.90084803	0.177890334	0	0	0	0	0	13.34177508	0	0	0											10000	14.7997	0.719603442	1.517860412	0	1.850107695	2.384506687	0.205736148	0.823697188	9.32222684	0	8.740529371	1.945519069	0	0.336950737	3.413080834	21.96291917	0.419492962	0.851496276	0.429265042	0.530259266	10.95944499	0	0	0	0	0	0.006192563	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2185		10.04036069	14.7997	0.719603442	1.517860412	0	1.850107695	2.384506687	0.205736148	0.823697188	9.32222684	0	8.740529371	1.945519069	0	0.336950737	3.413080834	21.96291917	0.419492962	0.851496276	0.429265042	0.530259266	10.95944499	0	0	0	0	0	0.006192563	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2185	NO	1a1: 20.0%	1b1: 20.0%	21: 20.0%	6: 20.0%	10a: 20.0%	11a: 20.0%	"11b: 20.0%,11c: 20.0%"	4a1: $50	"9a1: 20.0%,9b: 20.0%"	"8a1: 20.0%,8a2: 20.0%"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%"	9a2: 20.0%	$0 	"3: 20.0%,5: 20.0%,9a3: 20.0%,9c: 20.0%,9d1: 20.0%"	"7a: 20.0%,14b1: 20.0%,14c1: 20.0%,14d1: 20.0%,14e1: 20.0%,14f1: 20.0%,14g1: 20.0%,14h1: 20.0%,14h2: 20.0%,14i: 20.0%,14j: 20.0%"	"7b1: 20.0%,7d1: 20.0%,7f1: 20.0%,17a1: 20.0%,18a1: 20.0%"	"7c: 20.0%,7i: 20.0%"	"7e: 20.0%,7h: 20.0%"	7d2: 20.0%	7g: 20.0%	"152: 20.0%,153: 20.0%"	13a2: 20.0%	$0 	$0 	17a2: 20.0%	$0 	18a2: 20.0%	$0 	$0 	$0 												2.179	0.1442	0.214	0.0222	0.903	0.1198	0.0065	0.076	0.1073	0.0549	0.0481	0.116	0	0.0311	0.0504	2.3591	0.0089	0.0433	0.1543	0.6895	0.2113	0	0	0	0.0004	0	0.0014	0	0	0											7.5406		0	16.9786	0.863816033	1.731837369	0.022229757	2.753071045	2.504315867	0.212255234	0.899667895	9.429495544	0.054901667	8.788659257	2.061502176	0	0.368065296	3.463454949	24.32203283	0.428398062	0.894750733	0.583578761	1.219718255	11.17077983	0	0	0	0.000362398	0	0.007590458	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7591
H1099_006_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	O	V	V	V	V	V	V	Coin	V	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	1182.03227	80.90539038	1362.150394	2009.623255	124.7549264	10.13405705	7.681787106	202.8370984	357.4857887	3744.384179	421.3364255	104.3208564	0.041653174	2786.006566	3942.346007	9822.193661	181.4011046	275.3797606	505.6239382	109.4823781	39.3355099	0.257482885	0	0	0	0	0	0	12000	0											6000	1a1: $235 days 1-6	1b1: $235 days 1-6	21: $50 days 15-20; $75 21+	$0 	10a: $150	11a: 20.0%	"11b: 20.0%,11c: 0%"	"4a1: $50,4a2: $50"	"9a1: $450,9b: $450"	8a1 OP Lab: 0%	"8b1: $35,8b2: $200"	9a2: $235	$0 	"3: $30,5: $15,9a3: $0,9c: $30,9d1: $30,9d2: $30"	"4b: $10,7a: $10"	"7b1: $30,7d1: $30,7f1: $30,17a1: $30 (excluding glaucoma screening),18a1: $30"	"7e: $30,7h: $30"	"7c: $30,7i: $30"	7d2: $35	7g: $10-$30	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"14a: Newsletter, Health Club membership"	$0 											0	165.9119502	113.3584731	16.75415104	0	150	0.2	0.026645321	50	450	0	175.7624288	235	0	1.17957671	10	24.21506758	30	30	35	25	0.2	0	0	0	0	0	0	0	0	0											NO	157.0850159	107.3275164	15.86278794	0	142.0196216	0.189359495	0.025227722	47.3414005	426.0588648	0	166.4114241	222.4974071	0	1.17957671	9.483813935	22.9267649	28.40392432	28.40392432	33.1379117	23.66993693	0.189359495	0	0	0	0	0	0	0	0	0												15.4733	0.723614551	1.800625237	0	1.47647062	1.91897993	0.193793993	0.800216026	12.69249911	0	5.842932885	1.934260006	0	0.273859038	3.115706333	18.76592707	0.429375271	0.651822157	1.396276785	0.215953415	7.448552308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1542		4.202156905	15.4733	0.723614551	1.800625237	0	1.47647062	1.91897993	0.193793993	0.800216026	12.69249911	0	5.842932885	1.934260006	0	0.273859038	3.115706333	18.76592707	0.429375271	0.651822157	1.396276785	0.215953415	7.448552308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1542	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	15.4733	0.723614551	1.800625237	0	1.47647062	1.91897993	0.193793993	0.800216026	12.69249911	0	5.842932885	1.934260006	0	0.273859038	3.115706333	18.76592707	0.429375271	0.651822157	1.396276785	0.215953415	7.448552308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1542
H1099_009_0	2011	2																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	O	V	V	V	V	V	V	Coin	V	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	1174.923386	59.44084777	1598.034045	2225.483666	167.8675097	10.74087417	5.764255695	193.2572876	358.8951096	4928.061551	1035.859626	116.6365416	0.040219699	2934.426903	4221.951331	10307.84109	112.9588338	366.6786073	277.1206686	193.5009545	47.69201061	0.260678562	0	194.527238	117.5626877	110.8414164	2.694719847	12.21490916	12000	0											3400	1a1: $200 days 1-10	1b1: $200 days 1-10	"21: $75, 15+"	$0 	10a: $150	11a: 20.0%	"11b: 20.0%,11c: 0%"	"4a1: $50,4a2: $50"	"9a1: $300,9b: $300"	8a1 OP Lab: 0%	"8b1: $0,8b2: $75"	9a2: $200	$0 	"3: $25,5: $15,9a3: $0,9c: $25,9d1: $25,9d2: $25"	"4b: $10,7a: $10"	"7b1: $25,7d1: $25,7f1: $25,17a1: $15 (excluding glaucoma screening),18a1: $15"	"7e: $25,7h: $25"	"7c: $25,7i: $25"	$0 	7g: $10-$25	"152: 20.0%,153: 20.0%"	$0 	$0 	16b: $100 limit/year	$0 	17b2: $100 limit/year	18a2: $15	18b: $250 limit/year	"14a: Newsletter, Health Club membership"	$0 											0	167.824463	125.3501616	17.33351187	0	150	0.2	0.024900176	50	300	0	50.9947753	200	0	0.901147138	10	22.28261486	25	25	0	21.25	0.2	0	0	0	0	0	15	0	0	0											NO	140.4558813	104.9082303	14.50678669	0	125.5382071	0.167384276	0.02083949	41.85396384	251.0764143	0	42.67861776	167.3842762	0	0.901147138	8.41511199	18.6487968	20.92303452	20.92303452	0	17.78457934	0.167384276	0	0	0	0	0	12.55382071	0	0	0												13.7521	0.519652846	1.931861584	0	1.75614885	1.797853448	0.120124148	0.674048627	7.509174768	0	3.684088086	1.626926925	0	0.220362534	2.960682772	16.0190695	0.196953465	0.639335763	0	0.286777757	7.982892675	0	0	0	0	0	0.002819086	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6808		11.95645831	13.7521	0.519652846	1.931861584	0	1.75614885	1.797853448	0.120124148	0.674048627	7.509174768	0	3.684088086	1.626926925	0	0.220362534	2.960682772	16.0190695	0.196953465	0.639335763	0	0.286777757	7.982892675	0	0	0	0	0	0.002819086	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6808	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	13.7521	0.519652846	1.931861584	0	1.75614885	1.797853448	0.120124148	0.674048627	7.509174768	0	3.684088086	1.626926925	0	0.220362534	2.960682772	16.0190695	0.196953465	0.639335763	0	0.286777757	7.982892675	0	0	0	0	0	0.002819086	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6808
H1099_014_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	O	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	747.7262302	48.04122252	875.1944338	1105.296903	41.24796491	6.551284684	5.101188461	142.9743492	251.8399235	2908.597523	738.4479272	70.96013839	0	1927.812621	2758.95317	6592.14223	111.314996	165.1654059	271.8862364	18.68119088	25.75907924	0.186664285	0	0	0	0	0	0	12000	0											6700	1a1: $266 days 1-6	1b1: $266 days 1-6	21: $48/day	$0 	10a: $200	11a: 20.0%	"11b: 20.0%,11c: 0%"	"4a1: $50,4a2: $50"	"9a1: $450,9b: $450"	8a1 OP Lab: 0%	"8b1: $0,8b2: $275"	9a2: $266	$0 	"3: $35,5: 20.0%,9a3: $0,9c: $35,9d1: $35,9d2: $35"	"4b: $10,7a: $10"	"7b1: $35,7d1: $35,7f1: $35,17a1: $20 (excluding glaucoma screening),18a1: $20"	"7e: $35,7h: $35"	"7c: $35,7i: $35"	7d2: $35	7g: $10-$35	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	14a: 0	$0 											0	187.7982074	128.3121441	48	0	200	0.2	0.026504622	50	450	0	160.7334157	266	0	1.36583877	10	25.62941615	35	35	35	28.75	0.2	0	0	0	0	0	0	0	0	0											YES	176.6051672	120.6645578	45.13913173	0	188.0797155	0.188079716	0.024924909	47.02328839	423.1793599	0	151.1534755	250.1460216	0	1.36583877	9.422018244	24.1018665	32.91395022	32.91395022	32.91395022	27.03645911	0.188079716	0	0	0	0	0	0	0	0	0											10000	11.0044	0.483072739	3.292126403	0	0.646492125	1.23216376	0.127146659	0.560260338	8.881121469	0	9.301580891	1.479199693	0	0.219423435	2.166242259	13.24024433	0.30531802	0.453020496	0.745737504	0.042089438	4.844760296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.0244		3.722540628	11.0044	0.483072739	3.292126403	0	0.646492125	1.23216376	0.127146659	0.560260338	8.881121469	0	9.301580891	1.479199693	0	0.219423435	2.166242259	13.24024433	0.30531802	0.453020496	0.745737504	0.042089438	4.844760296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.0244	NO	1a1: 20.0%	1b1: 20.0%	21: 20.0%	6: 20.0%	10a: 20.0%	11a: 20.0%	"11b: 20.0%,11c: 20.0%"	4a1: $50	"9a1: 20.0%,9b: 20.0%"	"8a1: 20.0%,8a2: 20.0%"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%"	9a2: 20.0%	$0 	"3: 20.0%,5: 20.0%,9a3: 20.0%,9c: 20.0%,9d1: 20.0%"	"7a: 20.0%,14b1: 20.0%,14c1: 20.0%,14c2: 20.0%,14d1: 20.0%,14e1: 20.0%,14f1: 20.0%,14g1: 20.0%,14h1: 20.0%,14i: 20.0%,14j: 20.0%"	"7b1: 20.0%,7d1: 20.0%,7f1: 20.0%"	"7c: 20.0%,7i: 20.0%"	"7e: 20.0%,7h: 20.0%"	7d2: 20.0%	7g: 20.0%	"152: 20.0%,153: 20.0%"	13a2: 20.0%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												1.493	0.0643	0.1506	0.4493	0.3639	0.0412	0.0093	0	0.0313	0.0329	0.0493	0.06	0	0.0226	0.0427	0.4866	0.0073	0.0221	1.39	2.3459	0.1377	0	0	0	0	0	0	0	0	0											7.2		0	12.4973	0.547361287	3.442774307	0.449293001	1.010425647	1.273372589	0.136400239	0.560260338	8.912390084	0.032914602	9.350917673	1.539185041	0	0.242060978	2.208975995	13.72679878	0.312604226	0.475104306	2.135694033	2.388010325	4.982493614	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.2244
H1099_802_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	256.1096144	3.366920093	45.29855207	18.39138158	6.016077468	14.16246727	8.46079611	8.95874017	28.31996553	39.6669615	38.85403501	30.96640739	0.000819929	31.95376265	28.3510814	209.8452309	0.836144747	3.463909234	35.60759302	28.58078212	62.90996493	0	0	0	0	0	0	0	0	0											3000	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0.087895759	0.087895759	0.147650495	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233077851	0.233	0	0	0	0	0	0	0	0	0											NO	0.054716563	0.054716563	0.091914874	0	0.145046352	0.145046352	0.145046352	0.145046352	0.145046352	0.172366329	0.145046352	0.145046352	0.145046352	0.156832178	0.145046352	0.153602568	0.145046352	0.145046352	0.145046352	0.145094815	0.145046352	0	0	0	0	0	0	0	0	0												14.0134	0.184226295	4.163610696	0	0.87261009	2.054214212	1.22720761	1.29943258	4.107707688	6.837248521	5.635636036	4.491564426	0.000118928	5.011378191	4.11222093	32.2327663	0.121279745	0.502427398	5.164751469	4.146923307	9.124860914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3036		58.62429663	14.0134	0.184226295	4.163610696	0	0.87261009	2.054214212	1.22720761	1.29943258	4.107707688	6.837248521	5.635636036	4.491564426	0.000118928	5.011378191	4.11222093	32.2327663	0.121279745	0.502427398	5.164751469	4.146923307	9.124860914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3036	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	14.0134	0.184226295	4.163610696	0	0.87261009	2.054214212	1.22720761	1.29943258	4.107707688	6.837248521	5.635636036	4.491564426	0.000118928	5.011378191	4.11222093	32.2327663	0.121279745	0.502427398	5.164751469	4.146923307	9.124860914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3036
H1099_803_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	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	202.5210853	2.806059832	35.79090399	16.45913751	4.754097614	11.18898086	6.684823185	7.080168977	22.37722235	30.9860126	30.69813553	24.46847049	0.000650174	25.24476958	22.40506496	165.7921746	0.660746009	2.736225358	28.13747099	22.58093932	49.70124111	0	0	0	0	0	0	0	0	0											2000	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																					0.087895759	0.087895759	0.147650495	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.23307795	0.233	0	0	0	0	0	0	0	0	0											NO	0.050519811	0.050519811	0.084865017	0	0.133921319	0.133921319	0.133921319	0.133921319	0.133921319	0.163915194	0.133921319	0.133921319	0.133921319	0.147195556	0.133921319	0.14356519	0.133921319	0.133921319	0.133921319	0.133966122	0.133921319	0	0	0	0	0	0	0	0	0												10.2313	0.141761612	3.037395672	0	0.636675022	1.498443072	0.895240336	0.948185566	2.996787127	5.079078277	4.111134794	3.276849836	8.71E-05	3.7159179	3.000515847	23.80198508	0.088487977	0.366438908	3.768207222	3.025080871	6.656055752	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2757		52.18888133	10.2313	0.141761612	3.037395672	0	0.636675022	1.498443072	0.895240336	0.948185566	2.996787127	5.079078277	4.111134794	3.276849836	8.71E-05	3.7159179	3.000515847	23.80198508	0.088487977	0.366438908	3.768207222	3.025080871	6.656055752	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2757	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	10.2313	0.141761612	3.037395672	0	0.636675022	1.498443072	0.895240336	0.948185566	2.996787127	5.079078277	4.111134794	3.276849836	8.71E-05	3.7159179	3.000515847	23.80198508	0.088487977	0.366438908	3.768207222	3.025080871	6.656055752	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2757
H1099_804_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	185.6695057	2.519813102	32.89194687	15.1612404	3.964384266	10.25822284	6.158847765	6.436390016	20.56881775	28.5365493	28.27432635	22.50061766	0.000599311	23.24655383	20.62850645	151.7212987	0.604934975	2.50306105	25.86485394	20.49540523	45.71528967	0	0	0	0	0	0	0	0	0											3000	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0.087895759	0.087895759	0.147650495	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233060125	0.233	0	0	0	0	0	0	0	0	0											YES	0.061292665	0.061292665	0.10296165	0	0.162478727	0.162478727	0.162478727	0.162478727	0.162478727	0.162478727	0.162478727	0.162478727	0.162478727	0.171909404	0.162478727	0.162478727	0.162478727	0.162478727	0.162478727	0.162520654	0.162478727	0	0	0	0	0	0	0	0	0											10000	11.3802	0.154446061	3.386609116	0	0.64412811	1.66674299	1.000681746	1.045776458	3.341995328	4.636582209	4.593976558	3.655871719	9.74E-05	3.996301216	3.351693473	24.6514835	0.098289065	0.406694174	4.202488547	3.330926663	7.427762079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9727		35.69858977	11.3802	0.154446061	3.386609116	0	0.64412811	1.66674299	1.000681746	1.045776458	3.341995328	4.636582209	4.593976558	3.655871719	9.74E-05	3.996301216	3.351693473	24.6514835	0.098289065	0.406694174	4.202488547	3.330926663	7.427762079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9727	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																					0.0886	0.0059	0.0146	0	0.0973	0.0129	0.0007	0.0209	0.0116	0.0059	0.0052	0.0125	0	0.0034	0.0055	0.2543	0.001	0.0045	0.0166	0.0743	0.0228	0	0	0	0	0	0	0	0	0											0.6586		0	11.4688	0.16031103	3.401227406	0	0.741474691	1.679659365	1.001384555	1.066721217	3.353559742	4.642501042	4.59916534	3.668375614	9.74E-05	3.999655611	3.357237086	24.90581459	0.099249105	0.411146153	4.219124785	3.405255788	7.450545644	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6313
H1108_001_0	2011	5																															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	YES	448.4344103	44.0938415	12311.45699	23.8930623	31.87888504	29.85227742	27.12056666	14.26904152	7.330375624	26.88577981	9.209370811	0	0.097012799	7.742040732	1.071658453	165.1565498	20.386107	87.71534031	0	0	9.431995954	10.55683676	811.134218	134.3234157	0	88.17944264	0	0	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.079573606	0.080539738	0	0	0.2	0.2	0.08905901	0.065583354	0.2	0	0.067651648	0	0.2	0.161054837	0	0.028922268	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.073704389	0.074599261	0	0	0.185248331	0.185248331	0.082490165	0.060746035	0.185248331	0	0.062661775	0	0.185248331	0.149175699	0	0.026596681	0.183918365	0	0	0	0.185248331	0.185513479	0	0	0	0	0	0	0	0												33.0516	3.289367976	0	0	5.905510248	5.530084569	2.237180026	0.866787691	1.35793985	0	0.57707552	0	0.017971459	1.154924336	0	4.39261611	3.749379461	0	0	0	1.747261508	1.958435518	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8361	0	5.303196077	33.0516	3.289367976	0	0	5.905510248	5.530084569	2.237180026	0.866787691	1.35793985	0	0.57707552	0	0.017971459	1.154924336	0	4.39261611	3.749379461	0	0	0	1.747261508	1.958435518	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8361	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	4.4652	0.4444	0.7086	0.0061	1.1511	1.0779	0.9793	0.1126	0.2647	0	0.2276	0	0.0023	0.2251	0.0172	2.6525	0.3273	0.009	0	0	0.1525	0.171	0	0	0	0	0	0	0	0											12.9945	0	1.057276397	37.5168	3.733757928	0.708647528	0.006108255	7.056584279	6.607982408	3.216442003	0.97942112	1.622623041	0	0.804713386	0	0.020306733	1.380036707	0.017206939	7.045079552	4.076706239	0.009002959	0	0	1.899800211	2.129410048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8306
H1108_002_0	2011	4																															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	YES	385.4520687	21.5400125	33.02204354	2412.470205	14.90249907	22.2630011	30.70715855	34.21844774	32.67490545	18.11375522	50.05070139	0	0.106924114	42.24394258	28.52786017	121.7263707	9.075385	10.04171765	0	0	10.64969508	6.119972358	834.8613169	451.5072796	185.2279557	200.0100568	0	0	598.5575223	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.07925967	0.080221828	0.174504777	0	0.233	0.233	0.233	0.107089669	0.233	0.233	0.233	0	0.233	0.233	0.226349406	0.232960462	0.233407334	0.233	0	0	0.233	0.229399345	0	0	0	0	0	0	0	0											NO	0.062151572	0.062906049	0.136838144	0	0.182707248	0.182707248	0.182707248	0.083987853	0.182707248	0.182707248	0.182707248	0	0.182707248	0.182707248	0.176235993	0.181383372	0.181731308	0.181414156	0	0	0.182707248	0.182159477	0	0	0	0	0	0	0	0												23.9565	1.354997076	4.518675159	0	2.722794595	4.067611666	5.610420436	2.873933964	5.969942058	3.30951437	9.144625917	0	0.019535811	7.718274497	5.027635779	22.0791396	1.649281582	1.821709737	0	0	1.945776481	1.114810962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.9051	0	29.13622476	23.9565	1.354997076	4.518675159	0	2.722794595	4.067611666	5.610420436	2.873933964	5.969942058	3.30951437	9.144625917	0	0.019535811	7.718274497	5.027635779	22.0791396	1.649281582	1.821709737	0	0	1.945776481	1.114810962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.9051	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	7.2639	0.4109	0.8155	1.0087	0.6081	0.9084	1.2275	0.4483	1.3332	0	1.6107	0	0.0031	1.4191	1.8952	8.6548	0.6452	0.7139	0	0	0.7626	0.4391	0	0.1	0.086	0	0	0	0	0											30.3541	0	8.404579311	31.2204	1.765850198	5.334130313	1.00868816	3.330862063	4.976010093	6.837944789	3.322203909	7.303177976	3.30951437	10.75533261	0	0.022590082	9.137369012	6.922860365	30.73390599	2.294526011	2.535658772	0	0	2.708348702	1.553893691	0	0.1	0.086004336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.2592
H1109_001_0	2011	3																															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	1612.63981	198.0747304	989.5910272	655.8006277	237.3016645	9.398050629	0	328.3009939	398.9896	2829.526531	2405.160095	75.5149105	1.297924423	46.35063314	2881.765236	4689.43982	416.702818	739.7340815	0	0	238.8227783	0	0	0	1051.67732	81.91358319	43.52597192	12.01403223	74.28936984	0											3400	$300/day 1-7	$300/day 1-7	"$0/d 1-8, $75/d 9-14, $100/d 15-100"	$15 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$300 per procedure	$0 per visit	$40 X-ray; $175 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$15 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$50 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	$100.00 Every 2 Years	$0 per visit	Not Covered	Fitness Only	0											0	216.8565234	216.8565234	65.3345749	15	150	0.05	0.05	49	300	0	23.375	40	25	40	15	40	40	30	50	40	$50 	0	0	0	0	0	0	0	0	0											NO	186.7028956	186.7028956	56.24988414	12.9142688	129.142688	0.043047563	0.043047563	42.18661141	258.285376	0	20.12473555	34.43805013	21.52378133	34.43805013	12.9142688	34.43805013	34.43805013	25.8285376	43.04756266	34.43805013	43.04756266	0	0	0	0	0	0	0	0	0												25.0904	3.081760475	4.638698385	0.705765465	2.553814568	0.404563173	0	1.154158871	8.587764903	0	4.033600905	0.216715523	0.00232802	0.133018786	3.101324239	13.4579303	1.195869378	1.592187461	0	0	0.85672821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8066	0	11.43568782	25.0904	3.081760475	4.638698385	0.705765465	2.553814568	0.404563173	0	1.154158871	8.587764903	0	4.033600905	0.216715523	0.00232802	0.133018786	3.101324239	13.4579303	1.195869378	1.592187461	0	0	0.85672821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8066	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			25.0904	3.081760475	4.638698385	0.705765465	2.553814568	0.404563173	0	1.154158871	8.587764903	0	4.033600905	0.216715523	0.00232802	0.133018786	3.101324239	13.4579303	1.195869378	1.592187461	0	0	0.85672821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8066
H1109_003_0	2011	3																															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	1379.944709	138.5952553	774.3390015	1015.714357	196.4899113	11.63379998	0	308.1639013	399.1647693	3843.082379	2793.630403	49.39172723	1.244089325	306.5975127	3313.887842	5253.988866	326.6667735	890.6756606	0	0	314.4419331	0	0	0	1026.745965	76.81225004	53.84373914	9.682891589	71.55378336	0											3400	$125/day 1-5	$125/day 1-5	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$15 per visit	$125 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$35 per visit	$35 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	"$0 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$35 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$35 per visit	$35 per visit	$50 per visit	$35 per visit	$50 per script	0	Not Covered	0	$0 per visit	$100.00 Every 2 Years	$0 per visit	Not Covered	Fitness Only	0											0	76.60484259	76.60484259	72.96419583	15	125	0.05	0.05	49	200	5.25	21	35	25	35	0	35	35	26.25	50	35	$50 	0	0	0	0	0	0	0	0	0											NO	65.85533155	65.85533155	62.72555552	12.89513743	107.4594786	0.042983791	0.042983791	42.12411561	171.9351658	4.513298101	18.05319241	30.08865401	21.49189572	30.08865401	0	30.08865401	30.08865401	22.56649051	42.98379144	30.08865401	42.98379144	0	0	0	0	0	0	0	0	0												7.5731	0.760603041	4.047570336	1.091481352	1.759558618	0.500064832	0	1.081760984	5.719205065	1.4454147	4.202828931	0.123844216	0.002228153	0.768758873	0	13.17378776	0.819080294	1.674951987	0	0	1.126325539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8705	0	7.487407577	7.5731	0.760603041	4.047570336	1.091481352	1.759558618	0.500064832	0	1.081760984	5.719205065	1.4454147	4.202828931	0.123844216	0.002228153	0.768758873	0	13.17378776	0.819080294	1.674951987	0	0	1.126325539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8705	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			7.5731	0.760603041	4.047570336	1.091481352	1.759558618	0.500064832	0	1.081760984	5.719205065	1.4454147	4.202828931	0.123844216	0.002228153	0.768758873	0	13.17378776	0.819080294	1.674951987	0	0	1.126325539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8705
H1109_801_0	2011	2																															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	YES	258.6126878	5.7954288	29.8013325	6.586841987	7.501475506	9.286239342	0	15.6767423	36.79352105	17.26814761	59.44256689	0.786760575	0.067461345	24.52901331	26.8535563	122.7381297	2.91934474	8.327061702	0	0	56.51006629	0.00079165																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.079588951	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	0.067581531	0.067581531	0.144172047	0	0.197847774	0.197847774	0.197847774	0.197847774	0.197847774	0.197847774	0.197847774	0.197847774	0.197847774	0.197847774	0.197847774	0.197847774	0.197847774	0.197847774	0.197847774	0.197847774	0.197847774	0.197847774	0	0	0	0	0	0	0	0												17.4774	0.391663954	4.296519102	0	1.484150229	1.83726178	0	3.101608562	7.279516227	3.416464562	11.76057952	0.155658828	0.013347077	4.853010674	5.31291633	24.28346571	0.577585857	1.647490619	0	0	11.18039081	0.000156626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.0692	0	17.60193633	17.4774	0.391663954	4.296519102	0	1.484150229	1.83726178	0	3.101608562	7.279516227	3.416464562	11.76057952	0.155658828	0.013347077	4.853010674	5.31291633	24.28346571	0.577585857	1.647490619	0	0	11.18039081	0.000156626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.0692	NO																																																																																		0			17.4774	0.391663954	4.296519102	0	1.484150229	1.83726178	0	3.101608562	7.279516227	3.416464562	11.76057952	0.155658828	0.013347077	4.853010674	5.31291633	24.28346571	0.577585857	1.647490619	0	0	11.18039081	0.000156626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.0692
H1109_802_0	2011	2																															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	YES	246.0012019	3.741536796	27.85674841	6.396197704	6.94569382	11.14351862	0	15.11148909	36.13805126	20.66199778	74.13044636	0.613785069	0.052629437	24.09203442	30.34383285	121.1429533	2.512444589	8.389419274	0	0	72.96089528	0.001525771																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.079588951	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	0.067932891	0.067932891	0.144921604	0	0.198876394	0.198876394	0.198876394	0.198876394	0.198876394	0.198876394	0.198876394	0.198876394	0.198876394	0.198876394	0.198876394	0.198876394	0.198876394	0.198876394	0.198876394	0.198876394	0.198876394	0.198876394	0	0	0	0	0	0	0	0												16.7116	0.254173412	4.037044663	0	1.381334538	2.216182796	0	3.005318454	7.187005308	4.109183605	14.74279583	0.122067361	0.010466753	4.791336922	6.034672046	24.09247368	0.499665919	1.66845745	0	0	14.51019973	0.00030344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3743	0	18.08032375	16.7116	0.254173412	4.037044663	0	1.381334538	2.216182796	0	3.005318454	7.187005308	4.109183605	14.74279583	0.122067361	0.010466753	4.791336922	6.034672046	24.09247368	0.499665919	1.66845745	0	0	14.51019973	0.00030344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3743	NO																																																																																		0			16.7116	0.254173412	4.037044663	0	1.381334538	2.216182796	0	3.005318454	7.187005308	4.109183605	14.74279583	0.122067361	0.010466753	4.791336922	6.034672046	24.09247368	0.499665919	1.66845745	0	0	14.51019973	0.00030344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3743
H1110_001_0	2011	4																															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	1220.804034	242.4975302	841.3409677	614.3487668	198.3134689	11.17678872	0	278.3928205	348.8307544	3147.139218	2271.313722	153.2623666	1.377271305	266.3014786	2678.476048	4887.773395	399.3139958	849.3799705	0	0	251.4332991	0	0	0	1042.91495	67.79971634	54.25189603	15.50462386	86.45723428	0											6700	$265/day 1-6	$265/day 1-6	"$0/d 1-4, $50/d 5-20, $105/d 21-100"	$0 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$250 per procedure	$40 per visit	$40 X-ray; $175 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$10 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$50 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	$100.00 Every 2 Years	$0 per visit	Not Covered	Fitness Only	0											0	178.5937298	178.5937298	63.87227671	0	150	0.05	0.05	49	250	6	23.375	40	25	40	10	40	40	30	50	40	$50 	0	0	0	0	0	0	0	0	0											NO	162.0943383	162.0943383	57.97143294	0	136.1422418	0.045380747	0.045380747	44.47313232	226.9037363	5.445689672	21.21549935	36.30459781	22.69037363	36.30459781	9.076149453	36.30459781	36.30459781	27.22844836	45.38074727	36.30459781	45.38074727	0	0	0	0	0	0	0	0	0												16.4905	3.275623058	4.064478457	0	2.249903353	0.507211024	0	1.031750062	6.595916794	1.428195295	4.015587898	0.463677381	0.002604233	0.805664007	2.025854077	14.78738728	1.208077835	1.927274889	0	0	0.950852583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8305	0	6.293654684	16.4905	3.275623058	4.064478457	0	2.249903353	0.507211024	0	1.031750062	6.595916794	1.428195295	4.015587898	0.463677381	0.002604233	0.805664007	2.025854077	14.78738728	1.208077835	1.927274889	0	0	0.950852583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8305	YES	$0 ded; 35% coinsurance; $10000 max OOP	$0 ded; 35% coinsurance; $10000 max OOP	$0 ded; 35% coinsurance; $10000 max OOP	$0 ded; 35% coinsurance; $10000 max OOP	$150 copay	$0 ded; 35% coinsurance; $10000 max OOP	$0 ded; 35% coinsurance; $10000 max OOP	$50 Emer Rm; $40 Urgent Care Ctr	$0 ded; 35% coinsurance; $10000 max OOP	$0 ded; 35% coinsurance; $10000 max OOP	$0 ded; 35% coinsurance; $10000 max OOP	$0 ded; 35% coinsurance; $10000 max OOP	$25 copay	$0 ded; 35% coinsurance; $10000 max OOP	$0 ded; 35% coinsurance; $10000 max OOP	$0 ded; 35% coinsurance; $10000 max OOP	$0 ded; 35% coinsurance; $10000 max OOP	$0 ded; 35% coinsurance; $10000 max OOP	$0 ded; 35% coinsurance; $10000 max OOP	$0 ded; 35% coinsurance; $10000 max OOP	$0 ded; 35% coinsurance; $10000 max OOP		0	0	$0 ded; 35% coinsurance; $10000 max OOP	$100.00 Every 2 Years	$0 ded; 35% coinsurance; $10000 max OOP	Not Covered	0	0	0	0	0	0	0	0	0	0	0	0	10000	8.0414	0.5428	0.8179	0.2389	0.2458	0.3879	0	0.115	1.2347	0.6996	1.4854	0.1662	0.1106	0.8232	0.8928	3.9504	0.1636	0.3077	0	0	1.7051	0	0	0	0.2317	0	0.0144	0	0	0	0	0	0	0	0	0	0	0	0	0	22.1751	0	9.135087978	24.5318	3.818404471	4.882400761	0.238929569	2.495696681	0.895087062	0	1.146765107	7.830651537	2.12779782	5.500998181	0.629923357	0.113203731	1.628820466	2.918653084	18.73775487	1.371657629	2.234980132	0	0	2.655916395	0	0	0	0.231700035	0	0.014413324	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0056
H1110_801_0	2011	2																															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	YES	249.2973109	5.089216294	31.84750169	6.32328433	7.414809572	9.588091155	0	11.88552167	32.80344451	14.69530362	47.48627844	0.840779813	0.072093263	21.86896302	22.32080207	106.8131899	2.888328065	6.803594836	0	0	56.74524447	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.080321609	0.080321609	0.180963732	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.066034337	0.066034337	0.14877466	0	0.191554934	0.191554934	0.191554934	0.191554934	0.191554934	0.191554934	0.191554934	0.191554934	0.191554934	0.191554934	0.191554934	0.191554934	0.191554934	0.191554934	0.191554934	0.191554934	0.191554934	0.191554934	0	0	0	0	0	0	0	0												16.4622	0.336063025	4.738101249	0	1.420343361	1.836646172	0	2.276730325	6.283661663	2.814957922	9.096230954	0.161055522	0.01380982	4.189107778	4.275659778	20.46059359	0.553273493	1.303262163	0	0	10.86983158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.0915	0	18.84322843	16.4622	0.336063025	4.738101249	0	1.420343361	1.836646172	0	2.276730325	6.283661663	2.814957922	9.096230954	0.161055522	0.01380982	4.189107778	4.275659778	20.46059359	0.553273493	1.303262163	0	0	10.86983158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.0915	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	2.9281	0.0598	0.8428	0	0.2526	0.3267	0	0.405	1.1177	0.5007	1.6179	0.0286	0.0025	0.7451	0.7605	3.6393	0.0984	0.2318	0	0	1.9334	0	0	0	0	0	0	0	0	0											15.4909	0	1.754282965	19.3903	0.395838324	5.58086406	0	1.672978858	2.163329164	0	2.681690782	7.401332242	3.315652552	10.7141713	0.189702357	0.016266164	4.934221497	5.036168442	24.09990531	0.651683869	1.535072508	0	0	12.80324105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5824
H1110_802_0	2011	3																															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	YES	260.1705975	5.311186226	33.23655403	6.599079052	7.738211975	10.00628284	0	12.40391749	34.234191	15.33625016	49.55742759	0.877451046	0.075237664	22.82279402	23.29434036	111.4719262	3.01430463	7.100338656	0	0	59.22023027	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.080001134	0.080001134	0.173407216	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.065727456	0.065727456	0.14246817	0	0.191428502	0.191428502	0.191428502	0.191428502	0.191428502	0.191428502	0.191428502	0.191428502	0.191428502	0.191428502	0.191428502	0.191428502	0.191428502	0.191428502	0.191428502	0.191428502	0.191428502	0.191428502	0	0	0	0	0	0	0	0												17.1004	0.349090758	4.735151036	0	1.48131433	1.915487739	0	2.37446335	6.553399916	2.935795401	9.48670415	0.16796914	0.014402633	4.36893328	4.459200691	21.3389039	0.577023821	1.359207196	0	0	11.33644	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5538	0	19.66508977	17.1004	0.349090758	4.735151036	0	1.48131433	1.915487739	0	2.37446335	6.553399916	2.935795401	9.48670415	0.16796914	0.014402633	4.36893328	4.459200691	21.3389039	0.577023821	1.359207196	0	0	11.33644	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5538	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	3.0426	0.0621	0.8425	0	0.2636	0.3408	0	0.4225	1.166	0.5224	1.6879	0.0299	0.0026	0.7773	0.7934	3.7967	0.1027	0.2418	0	0	2.017	0	0	0	0	0	0	0	0	0											16.1118	0	1.830797314	20.1429	0.411202836	5.577654206	0	1.744877627	2.256301471	0	2.796940455	7.719415565	3.458147679	11.17462883	0.197855099	0.016965226	5.146277046	5.252605314	25.13563478	0.679690958	1.601044544	0	0	13.35347949	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6657
H1110_805_0	2011	2																															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	YES	232.3751297	4.743762746	29.68570864	5.894062839	6.911495874	8.937256151	0	11.07873819	30.57676252	13.6977935	44.26293276	0.783708085	0.067199607	20.38450836	20.80567679	99.5627621	2.692269749	6.3417701	0	0	52.89340464	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0	0	0	0	0	0	0	0												0	0	0	0	1.229826721	1.590289081	0	1.971342892	5.440807643	2.437375753	7.876115163	0.139452466	0.011957451	3.627205098	3.702147513	17.71612795	0.479060588	1.128450117	0	0	9.411815266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.762	0	17.56415917	0	0	0	0	1.229826721	1.590289081	0	1.971342892	5.440807643	2.437375753	7.876115163	0.139452466	0.011957451	3.627205098	3.702147513	17.71612795	0.479060588	1.128450117	0	0	9.411815266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.762	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	0	0	0	0	0.2267	0.2932	0	0.3634	1.003	0.4493	1.452	0.0257	0.0022	0.6687	0.6825	3.2661	0.0883	0.208	0	0	1.7351	0	0	0	0	0	0	0	0	0											10.4644	0	1.635203084	0	0	0	0	1.456552429	1.883468122	0	2.334771418	6.443852172	2.886720147	9.328122795	0.165161339	0.014161876	4.295901451	4.384659937	20.98219916	0.567378193	1.336486458	0	0	11.14693814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2264
H1110_806_0	2011	2																															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	YES	242.7403659	4.955361213	31.00985801	6.156971152	7.219787416	9.335907981	0	11.57291215	31.94065789	14.30879204	46.23730822	0.818665868	0.070197087	21.29377194	21.73372686	104.0038206	2.812360104	6.624648672	0	0	55.25274762	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0	0	0	0	0	0	0	0												0	0	0	0	1.284683901	1.661224908	0	2.059275859	5.683498229	2.546096404	8.227434144	0.145672829	0.01249082	3.788998821	3.86728409	18.50636678	0.500429381	1.178785331	0	0	9.831635099	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2939	0	18.34761934	0	0	0	0	1.284683901	1.661224908	0	2.059275859	5.683498229	2.546096404	8.227434144	0.145672829	0.01249082	3.788998821	3.86728409	18.50636678	0.500429381	1.178785331	0	0	9.831635099	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2939	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	0	0	0	0	0.2368	0.3063	0	0.3796	1.0478	0.4694	1.5168	0.0269	0.0023	0.6985	0.713	3.4118	0.0923	0.2173	0	0	1.8125	0	0	0	0	0	0	0	0	0											10.9312	0	1.708142327	0	0	0	0	1.521522849	1.96748138	0	2.438915339	6.731284178	3.015484082	9.744209474	0.172528463	0.014793576	4.487522788	4.580240401	21.91812311	0.592686448	1.396101262	0	0	11.6441542	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.225
H1111_002_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1314.29294	95.85057823	488.4052571	942.8607354	148.9315761	9.238289229	10.57485396	343.3402785	34.98815844	14.93726389	34.56109814	0	0.09008232	15.54683367	5706.455075	91.92228613	477.3831582	326.7606175	0	0	18.19495236	1309.778935	0	0	176.9441586	203.5045662	14.93737389	6	110.9626343	0											3380	"$295 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-34 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												219.7738852	147.0075908	78.64751525	0	200	0.2	0.103448039	49.2579213	0.2	0.14101832	0.166537192	0	0.2	0.160555524	6.904783066	0.128522259	38.5	35	0	0	0.2	34.40111688	0	0	35	30	0	0	0	0											NO	155.1938922	103.8097869	55.53714442	0	141.2305125	0.141230512	0.073050098	34.80292536	0.141230512	0.099580448	0.117600665	0	0.141230512	0.113376695	6.55398907	0.122045771	36.54402706	33.22184278	0	0	0.141230512	24.29243683	0	0	35	30	0	0	0	0												16.9975	0.829185675	2.260386108	0	1.752806901	1.304728322	0.772494118	0.995770507	4.941395546	1.487459426	4.064408113	0	0.012722372	1.762648612	3.116670349	11.2187263	1.453791921	0.904632488	0	0	2.569682446	2.651476837	0	0	0.516087129	0.508761416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.1214	0	18.53239772	16.9975	0.829185675	2.260386108	0	1.752806901	1.304728322	0.772494118	0.995770507	4.941395546	1.487459426	4.064408113	0	0.012722372	1.762648612	3.116670349	11.2187263	1.453791921	0.904632488	0	0	2.569682446	2.651476837	0	0	0.516087129	0.508761416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.1214	NO	"$325 Days 1-Unlimited (1a); $325 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-40 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$15 (7a, 14c); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$15 (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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												2.0717	0.1502	0.595	0.5527	0.438	0.4891	0.5598	0.2487	1.8523	0.3717	1.4925	0	0.0032	0.6569	0.9833	2.2795	0.2935	0.1847	0	0	0.9257	0.7271	0	0	0.1	0	0.0084	0	0	0											14.9843	0	0	19.0692	0.979400731	2.855422508	0.552712086	2.190840949	1.793814223	1.332339328	1.244479748	6.793709816	1.859181988	5.55689575	0	0.015901748	2.41956056	4.099989529	13.49822232	1.747270895	1.089350966	0	0	3.495390549	3.378618447	0	0	0.616114041	0.508761416	0.008444129	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1056
H1111_004_0	2011	4																															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	YES	268.0543284	21.583068	38.86095909	1884.48129	10.59528677	17.65756911	18.26377612	23.71417512	43.58517906	16.15882966	31.68781515	0	0.166897569	22.65586279	30.73939872	93.71541294	9.386766	5.261096632	0	0	17.27544564	6.292308316	610.824921	475.2708206	105.7786023	186.242061	0	0	598.5575223	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.07660055	0.077530301	0.190116493	0	0.233	0.233	0.233	0.108958607	0.233	0.05825	0.178772177	0	0.233	0.187021503	0.226374057	0.232774045	0.236179148	0.233	0	0	0.233	0.231108168	0	0	0	0	0	0	0	0											NO	0.062980935	0.063745375	0.156313687	0	0.191572485	0.191572485	0.191572485	0.089597793	0.191572485	0.047893121	0.146986396	0	0.191572485	0.153768988	0.186124638	0.191386705	0.194186379	0.191572485	0	0	0.191572485	0.19083787	0	0	0	0	0	0	0	0												16.8823	1.375820768	6.074499799	0	2.029765417	3.382704396	3.498836981	2.124737742	8.34972107	0.773896789	4.65767774	0	0.031972982	3.48376909	5.721359465	17.93588407	1.822782105	1.007881357	0	0	3.309500053	1.20081072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6639	0	18.08567973	16.8823	1.375820768	6.074499799	0	2.029765417	3.382704396	3.498836981	2.124737742	8.34972107	0.773896789	4.65767774	0	0.031972982	3.48376909	5.721359465	17.93588407	1.822782105	1.007881357	0	0	3.309500053	1.20081072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6639	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												6.0528	0.4874	1.2238	0.8601	0.6534	1.0889	1.0912	0.4732	2.6877	0	1.5482	0	0.0072	1.1511	2.2359	7.3893	0.7402	0.4149	0	0	1.3623	0.4928	0	0	0.0461	0	0	0	0	0											30.0065	0	0	22.9352	1.863180368	7.298297959	0.860087457	2.683134346	4.471576011	4.590011984	2.597902104	11.03744462	0.773896789	6.20589853	0	0.039203452	4.634842479	7.957259847	25.32521387	2.562992784	1.422754798	0	0	4.671787059	1.693628233	0	0	0.046144327	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.6704
H1111_801_0	2011	1																															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	238.8053988	6.3809	14.66945842	1159.571813	7.084082908	11.30919034	12.9453661	15.99802614	42.7453068	18.24897212	42.2235639	0	0.110054275	18.98157324	39.2990337	127.4085198	3.0414	4.474686713	0	0	25.04905968	10.14598258	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078896549	0.078896549	0.190183676	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064286001	0.064286001	0.154964294	0	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0	0	0.189851628	0.189851628	0	0	0	0	0	0	0	0												15.3518	0.410202545	2.273242273	0	1.344924673	2.147068197	2.457698829	3.037251308	8.115266086	3.464597067	8.016212346	0	0.020893983	3.603682581	7.460985526	24.18871491	0.577414741	0.849526557	0	0	4.755604759	1.926231311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0014	0	20.4549852	15.3518	0.410202545	2.273242273	0	1.344924673	2.147068197	2.457698829	3.037251308	8.115266086	3.464597067	8.016212346	0	0.020893983	3.603682581	7.460985526	24.18871491	0.577414741	0.849526557	0	0	4.755604759	1.926231311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0014	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.3518	0.410202545	2.273242273	0	1.344924673	2.147068197	2.457698829	3.037251308	8.115266086	3.464597067	8.016212346	0	0.020893983	3.603682581	7.460985526	24.18871491	0.577414741	0.849526557	0	0	4.755604759	1.926231311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0014
H1111_804_0	2011	1																															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	238.8053988	6.3809	14.66945842	1159.571813	7.084082908	11.30919034	12.9453661	15.99802614	42.7453068	18.24897212	42.2235639	0	0.110054275	18.98157324	39.2990337	127.4085198	3.0414	4.474686713	0	0	25.04905968	10.14598258	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078896549	0.078896549	0.190183676	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064286001	0.064286001	0.154964294	0	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0	0	0.189851628	0.189851628	0	0	0	0	0	0	0	0												15.3518	0.410202545	2.273242273	0	1.344924673	2.147068197	2.457698829	3.037251308	8.115266086	3.464597067	8.016212346	0	0.020893983	3.603682581	7.460985526	24.18871491	0.577414741	0.849526557	0	0	4.755604759	1.926231311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0014	0	20.4549852	15.3518	0.410202545	2.273242273	0	1.344924673	2.147068197	2.457698829	3.037251308	8.115266086	3.464597067	8.016212346	0	0.020893983	3.603682581	7.460985526	24.18871491	0.577414741	0.849526557	0	0	4.755604759	1.926231311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0014	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.3518	0.410202545	2.273242273	0	1.344924673	2.147068197	2.457698829	3.037251308	8.115266086	3.464597067	8.016212346	0	0.020893983	3.603682581	7.460985526	24.18871491	0.577414741	0.849526557	0	0	4.755604759	1.926231311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0014
H1111_805_0	2011	1																															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	238.8053988	6.3809	14.66945842	1159.571813	7.084082908	11.30919034	12.9453661	15.99802614	42.7453068	18.24897212	42.2235639	0	0.110054275	18.98157324	39.2990337	127.4085198	3.0414	4.474686713	0	0	25.04905968	10.14598258	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078896549	0.078896549	0.190183676	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064286001	0.064286001	0.154964294	0	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0	0	0.189851628	0.189851628	0	0	0	0	0	0	0	0												15.3518	0.410202545	2.273242273	0	1.344924673	2.147068197	2.457698829	3.037251308	8.115266086	3.464597067	8.016212346	0	0.020893983	3.603682581	7.460985526	24.18871491	0.577414741	0.849526557	0	0	4.755604759	1.926231311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0014	0	20.4549852	15.3518	0.410202545	2.273242273	0	1.344924673	2.147068197	2.457698829	3.037251308	8.115266086	3.464597067	8.016212346	0	0.020893983	3.603682581	7.460985526	24.18871491	0.577414741	0.849526557	0	0	4.755604759	1.926231311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0014	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.3518	0.410202545	2.273242273	0	1.344924673	2.147068197	2.457698829	3.037251308	8.115266086	3.464597067	8.016212346	0	0.020893983	3.603682581	7.460985526	24.18871491	0.577414741	0.849526557	0	0	4.755604759	1.926231311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0014
H1111_807_0	2011	1																															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	238.8053988	6.3809	14.66945842	1159.571813	7.084082908	11.30919034	12.9453661	15.99802614	42.7453068	18.24897212	42.2235639	0	0.110054275	18.98157324	39.2990337	127.4085198	3.0414	4.474686713	0	0	25.04905968	10.14598258	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078896549	0.078896549	0.190183676	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064286001	0.064286001	0.154964294	0	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0.189851628	0	0	0.189851628	0.189851628	0	0	0	0	0	0	0	0												15.3518	0.410202545	2.273242273	0	1.344924673	2.147068197	2.457698829	3.037251308	8.115266086	3.464597067	8.016212346	0	0.020893983	3.603682581	7.460985526	24.18871491	0.577414741	0.849526557	0	0	4.755604759	1.926231311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0014	0	20.4549852	15.3518	0.410202545	2.273242273	0	1.344924673	2.147068197	2.457698829	3.037251308	8.115266086	3.464597067	8.016212346	0	0.020893983	3.603682581	7.460985526	24.18871491	0.577414741	0.849526557	0	0	4.755604759	1.926231311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0014	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.3518	0.410202545	2.273242273	0	1.344924673	2.147068197	2.457698829	3.037251308	8.115266086	3.464597067	8.016212346	0	0.020893983	3.603682581	7.460985526	24.18871491	0.577414741	0.849526557	0	0	4.755604759	1.926231311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0014
H1111_808_0	2011	1																															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	225.6711018	6.037038	13.34920716	985.6360413	6.021470472	9.612811788	11.00356118	13.59832222	36.33351078	15.5116263	35.89002931	0	0.093546134	16.13442225	33.60067381	108.9342845	2.622456	3.82585714	0	0	21.41694602	8.674815108	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078896549	0.078896549	0.190183676	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064687214	0.064687214	0.155931436	0	0.191036503	0.191036503	0.191036503	0.191036503	0.191036503	0.191036503	0.191036503	0	0.191036503	0.191036503	0.191036503	0.191036503	0.191036503	0.191036503	0	0	0.191036503	0.191036503	0	0	0	0	0	0	0	0												14.598	0.390519169	2.081561039	0	1.150320664	1.836397952	2.102081853	2.597775929	6.941026855	2.963286851	6.856305706	0	0.017870726	3.082263611	6.418955236	20.8104248	0.500984824	0.73087837	0	0	4.091418481	1.657206346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8273	0	17.31538023	14.598	0.390519169	2.081561039	0	1.150320664	1.836397952	2.102081853	2.597775929	6.941026855	2.963286851	6.856305706	0	0.017870726	3.082263611	6.418955236	20.8104248	0.500984824	0.73087837	0	0	4.091418481	1.657206346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8273	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0363	0.0277	0.2511	0	0.2476	0.3953	0.4524	0.5591	1.4939	0.6378	1.4757	0	0.0038	0.6634	1.3277	4.3045	0.1036	0.1512	0	0	0.8463	0.3428	0	0	0	0	0	0	0	0											14.3203	0	0	15.6343	0.418240418	2.332651277	0	1.397909362	2.231654154	2.554522399	3.156906943	8.434975328	3.601088427	8.332019264	0	0.021717123	3.745673091	7.746673089	25.11492165	0.604610176	0.882055661	0	0	4.937700962	1.999988367	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1476
H1111_809_0	2011	1																															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	225.6711018	6.037038	13.34920716	985.6360413	6.021470472	9.612811788	11.00356118	13.59832222	36.33351078	15.5116263	35.89002931	0	0.093546134	16.13442225	33.60067381	108.9342845	2.622456	3.82585714	0	0	21.41694602	8.674815108	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078896549	0.078896549	0.190183676	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064687214	0.064687214	0.155931436	0	0.191036503	0.191036503	0.191036503	0.191036503	0.191036503	0.191036503	0.191036503	0	0.191036503	0.191036503	0.191036503	0.191036503	0.191036503	0.191036503	0	0	0.191036503	0.191036503	0	0	0	0	0	0	0	0												14.598	0.390519169	2.081561039	0	1.150320664	1.836397952	2.102081853	2.597775929	6.941026855	2.963286851	6.856305706	0	0.017870726	3.082263611	6.418955236	20.8104248	0.500984824	0.73087837	0	0	4.091418481	1.657206346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8273	0	17.31538023	14.598	0.390519169	2.081561039	0	1.150320664	1.836397952	2.102081853	2.597775929	6.941026855	2.963286851	6.856305706	0	0.017870726	3.082263611	6.418955236	20.8104248	0.500984824	0.73087837	0	0	4.091418481	1.657206346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8273	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0363	0.0277	0.2511	0	0.2476	0.3953	0.4524	0.5591	1.4939	0.6378	1.4757	0	0.0038	0.6634	1.3277	4.3045	0.1036	0.1512	0	0	0.8463	0.3428	0	0	0	0	0	0	0	0											14.3203	0	0	15.6343	0.418240418	2.332651277	0	1.397909362	2.231654154	2.554522399	3.156906943	8.434975328	3.601088427	8.332019264	0	0.021717123	3.745673091	7.746673089	25.11492165	0.604610176	0.882055661	0	0	4.937700962	1.999988367	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1476
H1111_810_0	2011	1																															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	225.6711018	6.037038	13.34920716	985.6360413	6.021470472	9.612811788	11.00356118	13.59832222	36.33351078	15.5116263	35.89002931	0	0.093546134	16.13442225	33.60067381	108.9342845	2.622456	3.82585714	0	0	21.41694602	8.674815108	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078896549	0.078896549	0.190183676	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064687214	0.064687214	0.155931436	0	0.191036503	0.191036503	0.191036503	0.191036503	0.191036503	0.191036503	0.191036503	0	0.191036503	0.191036503	0.191036503	0.191036503	0.191036503	0.191036503	0	0	0.191036503	0.191036503	0	0	0	0	0	0	0	0												14.598	0.390519169	2.081561039	0	1.150320664	1.836397952	2.102081853	2.597775929	6.941026855	2.963286851	6.856305706	0	0.017870726	3.082263611	6.418955236	20.8104248	0.500984824	0.73087837	0	0	4.091418481	1.657206346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8273	0	17.31538023	14.598	0.390519169	2.081561039	0	1.150320664	1.836397952	2.102081853	2.597775929	6.941026855	2.963286851	6.856305706	0	0.017870726	3.082263611	6.418955236	20.8104248	0.500984824	0.73087837	0	0	4.091418481	1.657206346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8273	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0363	0.0277	0.2511	0	0.2476	0.3953	0.4524	0.5591	1.4939	0.6378	1.4757	0	0.0038	0.6634	1.3277	4.3045	0.1036	0.1512	0	0	0.8463	0.3428	0	0	0	0	0	0	0	0											14.3203	0	0	15.6343	0.418240418	2.332651277	0	1.397909362	2.231654154	2.554522399	3.156906943	8.434975328	3.601088427	8.332019264	0	0.021717123	3.745673091	7.746673089	25.11492165	0.604610176	0.882055661	0	0	4.937700962	1.999988367	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1476
H1112_003_0	2011	5																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1273.994418	113.4936504	289.5133855	492.8995453	510.9618363	6.658065552	5.068238829	459.7579478	239.5022157	1854.336645	1177.673283	7.23776984	0.069445115	1288.179997	8438.225186	17963.39668	254.5573871	1229.61754	3117.380194	2769.382278	24.32886243	0.065895235	0	620.6666667	331.2	198.72	15.6	11.88571429	660	0											3150	"(1a) $250 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $250 days 1 - 5, $0 after day 5, unlimited coverage"	"(2) $0 days 1 - 7, $85 days 8 - 100"	(6) Copay between $0.00 and $25.00	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $250.00 copayment	(12) 20% coinsurance	"(9a) $150.00 copayment , (9d) Copay between $35.00 and $150.00"	"(14b) , (14c) $0.00 copayment ; (7a) $10.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	"(16) $0.00 copayment, $750 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	139.5779076	93.16353813	61.1	7.683997126	43.76837666	0.2	0.100957974	46.41949311	107.6224523	0	12.11021328	39.70556157	0.2	13.42805858	3.274709396	6.994744088	29.56243019	7.766873474	3.160944639	5.379534498	0.2	0	0	0	0	0	0	0	0	0											NO	132.866429	88.68385286	58.16206124	7.314519008	41.66381348	0.190383179	0.0961035	44.18745337	102.4475231	0	11.52790453	37.79635522	0.190383179	12.78238242	3.117247928	6.658408085	28.14094722	7.393410321	3.008953448	5.120864401	0.190383179	0	0	0	0	0	0	0	0	0												14.1059	0.838754516	1.403224605	0.300443591	1.774051554	1.267583687	0.487075492	1.692961073	2.044700732	0	1.131342098	0.022796777	0.013221182	1.372167445	2.192003332	9.967302142	0.596957166	0.757588917	0.78167099	1.181802593	4.631806175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5634	0	2.352054769	14.1059	0.838754516	1.403224605	0.300443591	1.774051554	1.267583687	0.487075492	1.692961073	2.044700732	0	1.131342098	0.022796777	0.013221182	1.372167445	2.192003332	9.967302142	0.596957166	0.757588917	0.78167099	1.181802593	4.631806175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5634	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	14.1059	0.838754516	1.403224605	0.300443591	1.774051554	1.267583687	0.487075492	1.692961073	2.044700732	0	1.131342098	0.022796777	0.013221182	1.372167445	2.192003332	9.967302142	0.596957166	0.757588917	0.78167099	1.181802593	4.631806175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5634
H1112_006_0	2011	6																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	P	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	Yes	2247.160092	400.1130206	631.2449532	747.2890317	20.94380753	10.76846653	10.62809189	34.06707796	41.55489599	3004.356661	21.46705465	0.209632414	0.112839604	11.8991084	13360.36267	110.1806264	5.6584913	1.951471723	22.27157102	17.06905651	15.78165331	0.051856755	0	702	331.2	198.72	15.6	11.88571429	643.902439	0											6700	FFS	FFS	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) $0.00 copayment	(8b) 20% coinsurance	(5) 45% coinsurance	(12) 20% coinsurance	"(9a) , (9d) 20% coinsurance"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) 20% coinsurance"	"(7e) , (7h) 45% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) 20% coinsurance"	(15) 20% coinsurance	(13a) 20% coinsurance	Not Covered	"(16) $0.00 copayment, $1,000 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	131.6783589	55.14975867	34.82438318	0	0.174465384	0.183000905	0.104097783	0.15572552	0.152889547	0	0.134753101	0.407278887	0.183	0.135214312	0	0.071136607	0.379425518	0.136442989	0.148351107	0.15054763	0.183003586	0.181305001	0	0	0	0	0	0	0	0											NO	129.0454162	54.04702505	34.12806067	0	0.170976904	0.179341754	0.102016321	0.152611748	0.149832481	0	0.132058678	0.399135241	0.179340868	0.132510667	0	0.069714212	0.371838807	0.133714777	0.145384788	0.147537392	0.179344382	0.177679761	0	0	0	0	0	0	0	0												24.1655	1.802076537	1.795263839	0	3.580907365	1.931235679	1.084238832	5.19903631	6.226273164	0	2.834910856	0.083671684	0.020236753	1.576758796	0	7.681155552	2.104046655	0.260940606	3.237947632	2.518324076	2.830350867	0.009213896	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9421	0	1.406640473	24.1655	1.802076537	1.795263839	0	3.580907365	1.931235679	1.084238832	5.19903631	6.226273164	0	2.834910856	0.083671684	0.020236753	1.576758796	0	7.681155552	2.104046655	0.260940606	3.237947632	2.518324076	2.830350867	0.009213896	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9421	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	24.1655	1.802076537	1.795263839	0	3.580907365	1.931235679	1.084238832	5.19903631	6.226273164	0	2.834910856	0.083671684	0.020236753	1.576758796	0	7.681155552	2.104046655	0.260940606	3.237947632	2.518324076	2.830350867	0.009213896	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9421
H1112_027_0	2011	6																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1384.632729	198.9839251	366.1865778	606.5159192	501.8725495	5.695993553	8.662922348	509.4773272	276.9258043	2041.847456	1045.151883	10.05683843	0.507044111	587.2297134	13092.05473	17501.19171	477.9146938	399.3139612	3244.939474	2504.065743	21.54809622	0.050490386	0	499.3333333	0	0	15.6	11.88571429	628.5714286	0											4000	"(1a) $200 days 1 - 7, $0 after day 7, unlimited coverage"	"(1b) $200 days 1 - 7, $0 after day 7, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $200.00 copayment	(12) 20% coinsurance	"(9a) $150.00 copayment , (9d) Copay between $25.00 and $150.00"	"(14b) , (14c) $0.00 copayment ; (7a) $10.00 copayment"	"(7b) , (7d) , (7g) $25.00 copayment"	"(7e) , (7h) $25.00 copayment"	"(7c) , (7i) $25.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $25.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	"(16) $0.00 copayment, $500 benefit limit"	Not Covered	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	139.1623886	88.81046682	33.88993847	0	46.30379825	0.2	0.068973328	46.44859573	112.4140824	0	14.64013411	38.32101309	0.2	17.04989112	3.21772157	4.044182178	20.8036421	4.072859699	3.661231904	5.459114088	0.2	0	0	0	0	0	0	0	0	0											NO	135.8512871	86.69739252	33.08359255	0	45.2020884	0.195241385	0.06733224	45.3434407	109.7394055	0	14.29180027	37.40923826	0.195241385	16.64422174	3.141162072	3.947958639	20.30865943	3.975953833	3.574119931	5.329224965	0.195241385	0	0	0	0	0	0	0	0	0												15.6753	1.437615621	1.009563961	0	1.890473946	1.112093668	0.583293966	1.925121248	2.53247276	0	1.244758496	0.031351555	0.098995994	0.814498464	3.427022146	5.757831751	0.80881723	0.13230449	0.966483571	1.112060806	4.20708014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7672	0	1.091109948	15.6753	1.437615621	1.009563961	0	1.890473946	1.112093668	0.583293966	1.925121248	2.53247276	0	1.244758496	0.031351555	0.098995994	0.814498464	3.427022146	5.757831751	0.80881723	0.13230449	0.966483571	1.112060806	4.20708014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7672	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												1.4311	0	0.1744	0.049	0.0654	0.0388	0.0589	0	0.2844	0.015	0.1262	0	0	0.0417	0	0.6164	0	0.0086	0.1483	0.1009	0.1466	0.0003	0	0	0	0	0	0	0	0											3.306	0	0	17.1065	1.437615621	1.183938192	0.048971567	1.955844982	1.150849912	0.642237561	1.925121248	2.816825589	0.01504627	1.370929667	0.031351555	0.098995994	0.856185578	3.427022146	6.374270729	0.80881723	0.140924588	1.114824706	1.212935577	4.353696052	0.000343543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0732
H1170_002_0	2011	5																															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	1237.062067	171.3479843	1090.85153	458.2821139	292.1172261	10.65759034	1.101794468	260.9675465	246.6346139	553.7666741	680.7261862	0.811298072	31.9110575	315.1670481	8672.113687	4081.090461	363.1067623	421.0201907	1911.459656	0	871.041175	0.552548146	0	0	168.2846796	0	7.799719815	0	22.62607402	0											3400	"$175 per Day, days 1-9, $0 per Day, days 10-365"	"$175 per Day, days 1-9, $0 per Day, days 10-365"	$125/day for days 21-100	$0 per visit	$200 per trip	"20% coinsurance, 0% diabetic monitoring supplies"	20% coinsurance	$50 per visit	$175 per visit	$0-50 per visit	$0-50 per visit	$50 per visit	$0 per visit	$30-$175 per visit	"$15 per visit, $0 per preventive service visit"	$30 per visit; chiropractic services 20% coinsurance	$15 Group Therapy & $30 Individual Therapy	$30 per visit	$0-125 per visit		"$8 generic Kaiser retail, $40 brand Kaiser retail, $24 Generic community pharmacy, $50 Brand community pharmacy"	20% coinsurance Medicare covered Optical; $0 Blood		$30 per visit	$0 per visit		$30 per visit		$0 - $75 copay (varies by class)													175	175	125	0	200	0.147611053	0.2	50	175	5.335238258	6.873678959	50	0	34.74507976	13.46964638	30	27.75	30	25.29821214	0	24	0.059713974	0	0	0	0	30	0	7.5	0											NO	118.8224363	118.8224363	12.06814013	0	189.9585422	0.140199902	0.189958542	47.48963554	166.2137244	5.067370408	6.528570172	47.48963554	0	33.00062349	12.79337194	28.49378133	26.35674773	28.49378133	24.02805749	0	24	0.056715897	0	0	0	0	28.49378133	0	7.123445331	0												12.2492	1.696665413	1.09704576	0	4.624180201	1.494193123	0.209295271	1.032771139	3.416171479	0.233845071	0.37034739	0.003210687	0	0.866725757	9.245464663	9.69047493	0.797526111	0.999704771	3.827388542	0	1.74208235	0.031338264	0	0	0	0	0.018520293	0	0.0134313	0	0	0	0	0	0	0	0	0	0	0	53.6596	0	19.07627074	12.2492	1.696665413	1.09704576	0	4.624180201	1.494193123	0.209295271	1.032771139	3.416171479	0.233845071	0.37034739	0.003210687	0	0.866725757	9.245464663	9.69047493	0.797526111	0.999704771	3.827388542	0	1.74208235	0.031338264	0	0	0	0	0.018520293	0	0.0134313	0	0	0	0	0	0	0	0	0	0	0	53.6596	NO																																																																																		0			12.2492	1.696665413	1.09704576	0	4.624180201	1.494193123	0.209295271	1.032771139	3.416171479	0.233845071	0.37034739	0.003210687	0	0.866725757	9.245464663	9.69047493	0.797526111	0.999704771	3.827388542	0	1.74208235	0.031338264	0	0	0	0	0.018520293	0	0.0134313	0	0	0	0	0	0	0	0	0	0	0	53.6596
H1170_008_0	2011	2																															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	0	0	0	0	0	0	0	0	0	0	YES	2268.773481	138.3934873	1815.755458	985.0828823	585.9241159	26.85436463	2.830786908	368.4625453	275.9362048	765.0408073	1013.552376	0.447333531	33.96341948	424.476187	11027.591	4806.614607	708.7952377	482.2724153	2460.444727	0	1075.519078	0.552548146	0	0	231.3899155	0	10.25001775	0	26.47920263	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"	$50/day for days 21-100	$0 per visit	$100 per trip	0	0	$50.00 per visit	$75 per visit	$0-3 per visit	$0-3 per visit	$50 per visit	$0 per visit	$3 per visit	$0 per visit	$3 per visit	$3 per visit	$3 per visit	$0-25 per visit	0	$3 per script	20% coinsurance Medicare covered Optical	0	$3 per visit	$0 per visit	0	$3 per visit	0	$0 - $75 copay (varies by class)	0												150	150	50	0	100	0	0	50	75	0.341339555	0.469765093	50	0	3	0	3	2.55	3	1.311560017	0	3	0	0	0	0	0	3	0	2	0											NO	100.4282229	100.4282229	8.363995579	0	96.12064207	0	0	48.06032103	72.09048155	0.328097772	0.451541224	48.06032103	0	2.883619262	0	2.883619262	2.451076373	2.883619262	1.260679909	0	3	0	0	0	0	0	2.883619262	0	1.922412841	0												18.9874	1.158217666	1.265580885	0	4.693283519	0	0	1.475702351	1.657697823	0.020917349	0.03813839	0.001791583	0	0.102002309	0	1.155037205	0.144775938	0.115890836	0.258486103	0	0.26887977	0	0	0	0	0	0.002463096	0	0.004241997	0	0	0	0	0	0	0	0	0	0	0	31.3505	0	16.63432022	18.9874	1.158217666	1.265580885	0	4.693283519	0	0	1.475702351	1.657697823	0.020917349	0.03813839	0.001791583	0	0.102002309	0	1.155037205	0.144775938	0.115890836	0.258486103	0	0.26887977	0	0	0	0	0	0.002463096	0	0.004241997	0	0	0	0	0	0	0	0	0	0	0	31.3505	NO																																																																																		0			18.9874	1.158217666	1.265580885	0	4.693283519	0	0	1.475702351	1.657697823	0.020917349	0.03813839	0.001791583	0	0.102002309	0	1.155037205	0.144775938	0.115890836	0.258486103	0	0.26887977	0	0	0	0	0	0.002463096	0	0.004241997	0	0	0	0	0	0	0	0	0	0	0	31.3505
H1170_009_0	2011	5																															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	866.4108862	89.07401988	416.7108879	239.0092222	207.0976152	7.093396014	0.349347223	208.0005531	148.843691	409.9018633	480.9307878	0.179134614	20.64405522	274.9331118	6698.077181	2818.912383	316.1966292	293.0100182	1454.245057	0	605.6884137	0.552548146	0	0	66.47066319	0	0	0	21.0574948	0											3400	"$265 per Day, days 1-8, $0 per Day, days 10-365"	"$265 per Day, days 1-8, $0 per Day, days 10-365"	$125/day for days 21-100	$0 per visit	$200 per trip	"20% coinsurance, 0% diabetic monitoring supplies"	20% coinsurance	$50 per visit	$225 per visit	$0-50 per visit	$0-50 per visit	$50 per visit	$0 per visit	$40-$225 per visit	"$30 per visit, $0 per preventive service visit"	$40 per visit; chiropractic services 20% coinsurance	$20 Group Therapy & $40 Individual Therapy	$40 per visit	$0-225 per visit	0	"$10 generic Kaiser retail, $40 brand Kaiser retail, $24 Generic community pharmacy, $50 Brand community pharmacy"	20% coinsurance Medicare covered Optical; $0 Blood	0	$40 per visit	$0 per visit	0		0	$0 - $75 copay (varies by class)	0											0	265	265	125	0	200	0.146293177	0.2	50	225	5.700966833	7.378895495	50	0	41.752908	27.98866061	40	37	40	42.2843445	0	25	0.059713974	0	0	0	0	0	0	15	0											NO	152.3241255	152.3241255	8.171428151	0	184.2118662	0.134744695	0.184211866	46.05296656	207.2383495	5.250928699	6.796400549	46.05296656	0	38.45690552	25.77921702	36.84237325	34.07919525	36.84237325	38.94639007	0	25	0.055000113	0	0	0	0	0	0	13.81588997	0												10.9979	1.130676848	0.283760257	0	3.179153183	0.955797486	0.064353904	0.798253543	2.570510071	0.179363788	0.272383189	0.000687473	0	0.881089725	14.38926544	8.654618513	0.897977222	0.899598705	4.719799605	0	1.261850862	0.030390211	0	0	0	0	0	0	0.024244003	0	0	0	0	0	0	0	0	0	0	0	52.1917	0	14.39468272	10.9979	1.130676848	0.283760257	0	3.179153183	0.955797486	0.064353904	0.798253543	2.570510071	0.179363788	0.272383189	0.000687473	0	0.881089725	14.38926544	8.654618513	0.897977222	0.899598705	4.719799605	0	1.261850862	0.030390211	0	0	0	0	0	0	0.024244003	0	0	0	0	0	0	0	0	0	0	0	52.1917	NO																																																																																		0			10.9979	1.130676848	0.283760257	0	3.179153183	0.955797486	0.064353904	0.798253543	2.570510071	0.179363788	0.272383189	0.000687473	0	0.881089725	14.38926544	8.654618513	0.897977222	0.899598705	4.719799605	0	1.261850862	0.030390211	0	0	0	0	0	0	0.024244003	0	0	0	0	0	0	0	0	0	0	0	52.1917
H1170_801_0	2011	3	i.2.										Professional										Professional - IP										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										6.69	0.04	0.54	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										7.27	YES	186.4863939	2.441998355	13.1588423	486.8468759	201.3874766	13.44107964	3.114726567	269.6749037	279.2594525	596.8731172	750.3510098	0	1.733943958	353.354513	9509.45911	3967.422796	297.2720909	459.4632351	1970.844091	0	674.7322114	0.552548146	0	0	156.6622931	0	6.047745968	0	0	0	27.2885175										2000	10% Coinsurance	10% Coinsurance	10% coinsurance	$0 per visit	$150 per trip	20% coinsurance	20% coinsurance	$50 per visit	$300 per visit	$0-$300 per visit	$0-$300 per visit	$50 per visit	$0 per visit	$50-$300 per visit	"$35 per visit, $0 per preventive service visit"	$50 per visit	$17 Group Therapy & $35 Individual Therapy	$50 per visit	$0-$300 per visit	0	"$20 generic Kaiser retail, $40 brand Kaiser retail"	20% coinsurance Medicare covered Optical	0	$50 per visit	$50 per visit	0	$50 per visit	0	0	0	10% coinsurance										0	0.1	0.1	0.1	0	150	0.147280283	0.2	50	300	41.23054974	46.38537859	50	0	95.8520662	32.52735901	50	46.25	50	79.22768022	0	30	0.059713974	0	0	50	0	50	0	0	0	0.1										NO	0.012959532	0.012959532	0.001510311	0	80.16681072	0.078713271	0.106889081	26.72227024	160.3336214	22.03547785	24.79045244	26.72227024	0	51.22769632	17.38409755	26.72227024	24.71809997	26.72227024	42.34286963	0	30	0.031913859	0	0	17.7	0	26.72227024	0	0	0	0.012959532											2.4168	0.031647156	0.019873944	0	1.345382643	1.057991338	0.33293026	0.600527138	3.731223279	1.096032029	1.550128419	0	0	1.508461474	13.77611374	8.834878676	0.612333438	1.023158395	6.954266199	0	1.686830529	0.017633944	0	0	0.231076882	0	0.013467459	0	0	0	0.35364642	0	0	0	0	0	0	0	0	0	47.1944	500	57.51939035	9.1068	0.071647156	0.559873944	0	1.345382643	1.057991338	0.33293026	0.600527138	3.731223279	1.096032029	1.550128419	0	0	1.508461474	13.77611374	8.834878676	0.612333438	1.023158395	6.954266199	0	1.686830529	0.017633944	0	0	0.231076882	0	0.013467459	0	0	0	0.35364642	0	0	0	0	0	0	0	0	0	54.4644	NO																																																																																		0	500	0	9.1068	0.071647156	0.559873944	0	1.345382643	1.057991338	0.33293026	0.600527138	3.731223279	1.096032029	1.550128419	0	0	1.508461474	13.77611374	8.834878676	0.612333438	1.023158395	6.954266199	0	1.686830529	0.017633944	0	0	0.231076882	0	0.013467459	0	0	0	0.35364642	0	0	0	0	0	0	0	0	0	54.4644
H1170_802_0	2011	3	i.2.										Professional										Professional - IP										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										10.24	0.08	0.89	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										11.21	YES	183.9281317	0.951063146	20.41914511	414.2102818	195.8402346	14.39028089	1.832440437	218.4892564	288.7826489	712.5769583	675.9742776	0	8.33375273	352.2588262	9150.403304	4052.128371	332.3377355	569.7397218	2126.14337	0	814.0015637	0.552548146	0	0	195.7359873	0	2.162828589	0	0	0	25.31248956										2000	10% Coinsurance	10% Coinsurance	10% coinsurance	$0 per visit	$150 per trip	20% coinsurance	20% coinsurance	$50 per visit	$300 per visit	$0-$300 per visit	$0-$300 per visit	$50 per visit	$0 per visit	$50-$300 per visit	"$35 per visit, $0 per preventive service visit"	$50 per visit	$17 Group Therapy & $35 Individual Therapy	$50 per visit	$0-$300 per visit	0	"$20 generic Kaiser retail, $40 brand Kaiser retail"	20% coinsurance Medicare covered Optical	0	$50 per visit	$50 per visit	0	$50 per visit	0	0	0	10% coinsurance										0	0.1	0.1	0.1	0	150	0.152463263	0.2	50	300	25.32271937	43.73939411	50	0	122.2598772	32.05575404	50	46.25	50	75.1747923	0	30	0.059713974	0	0	50	0	50	0	0	0	0.1										NO	0.012959532	0.012959532	0.001510311	0	80.16681072	0.08148329	0.106889081	26.72227024	160.3336214	13.53361101	23.37631819	26.72227024	0	65.34122958	17.13205044	26.72227024	24.71809997	26.72227024	40.1768223	0	30	0.031913859	0	0	17.7	0	26.72227024	0	0	0	0.012959532											2.3836	0.012325333	0.030839259	0	1.308323918	1.172567437	0.195867874	0.486544079	3.858463993	0.803644947	1.316815817	0	0	1.918085403	13.06376425	9.023505782	0.684563114	1.268728234	7.118473696	0	2.035003909	0.017633944	0	0	0.288710581	0	0.004816308	0	0	0	0.328038022	0	0	0	0	0	0	0	0	0	47.3203	500	57.62988177	12.6236	0.092325333	0.920839259	0	1.308323918	1.172567437	0.195867874	0.486544079	3.858463993	0.803644947	1.316815817	0	0	1.918085403	13.06376425	9.023505782	0.684563114	1.268728234	7.118473696	0	2.035003909	0.017633944	0	0	0.288710581	0	0.004816308	0	0	0	0.328038022	0	0	0	0	0	0	0	0	0	58.5303	NO																																																																																		0	500	0	12.6236	0.092325333	0.920839259	0	1.308323918	1.172567437	0.195867874	0.486544079	3.858463993	0.803644947	1.316815817	0	0	1.918085403	13.06376425	9.023505782	0.684563114	1.268728234	7.118473696	0	2.035003909	0.017633944	0	0	0.288710581	0	0.004816308	0	0	0	0.328038022	0	0	0	0	0	0	0	0	0	58.5303
H1170_805_0	2011	3																															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											14.55	0.04	1.73	0	0	0.78	0.12	0	2.78	0.31	1.64	0	0	0.79	0	0	0	0.32	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	23.06	YES	1275.442744	12.82700444	992.0606782	610.3708669	284.2180894	12.43773651	1.724565728	271.5066404	42.39766372	0	-2.152614972	0	3.666851201	321.0276801	9730.871013	4416.983109	330.5604837	3.493252672	4477.074671	0	816.9689218	0.552548146	0	0	228.107771	0	3.726928584	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 per visit	$0 per visit	$125 per trip	20% coinsurance	20% coinsurance	$50 per visit	20% coinsurance	20% coinsurance	20% coinsurance	$50 per visit	$20 per visit	$15 - 20% coinsurance	"$20 per visit, $0 per preventive service visit"	$30 per visit	$10 Group Therapy & $20 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 per visit	$30 per visit	0	$30 per visit	0	0	0											0	250	250	0	0	125	0.09561142	0.2	50	0.2	0.020562075	0.028479937	50	0	77.16363291	17.97165724	30	27.75	0.2	0	0	25	0.059713974	0	0	30	0	30	0	0	0											NO	96.27627504	96.27627504	0	0	115.9172564	0.088664108	0.18546761	46.36690256	0.18546761	0.019067994	0.026410529	46.36690256	0	71.55677298	16.66580161	27.82014154	25.73363092	0.18546761	0	0	25	0.055375041	0	0	17.73	0	27.82014154	0	0	0												10.2329	0.102911351	0	0	2.745481762	1.102780811	0.319851084	1.049076829	7.863393371	0	-0.0568517	0	0	1.914308735	13.51439715	10.24009127	0.70887679	0.647885225	0	0	1.702018587	0.030597376	0	0	0.337029232	0	0.008640307	0	0	0	0	0	0	0	0	0	0	0	0	0	52.4634	500	17.40150747	24.7829	0.142911351	1.73	0	2.745481762	1.882780811	0.439851084	1.049076829	10.64339337	0.31	1.5831483	0	0	2.704308735	13.51439715	10.24009127	0.70887679	0.967885225	0	0	1.702018587	0.030597376	0	0	0.337029232	0	0.008640307	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5234	NO																																																																																		0	500	0	24.7829	0.142911351	1.73	0	2.745481762	1.882780811	0.439851084	1.049076829	10.64339337	0.31	1.5831483	0	0	2.704308735	13.51439715	10.24009127	0.70887679	0.967885225	0	0	1.702018587	0.030597376	0	0	0.337029232	0	0.008640307	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5234
H1216_001_0	2011	7																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1751.725294	144.8565308	545.084329	432.259152	601.6557423	7.932079059	15.24668063	756.2641216	266.0393029	2728.102274	1354.172775	82.76468378	0.319723437	1553.226151	9426.060379	16498.25529	374.7702646	813.6788544	3517.26584	2659.785791	11.81530756	0.002384906	1930	395.1428571	331.2	198.72	16.2	12.34285714	0	0											3000	"(1a) $200 days 1 - 7, $0 after day 7, unlimited coverage"	"(1b) $200 days 1 - 7, $0 after day 7, unlimited coverage"	"(2) $0 days 1 - 7, $85 days 8 - 100"	(6) Copay between $0.00 and $25.00	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $200.00 copayment	(12) 20% coinsurance	"(9a) $150.00 copayment , (9d) Copay between $35.00 and $150.00"	"(14b) , (14c) $0.00 copayment ; (7a) $5.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	(10b) $0.00 copayment	"(16) $0.00 copayment, $500 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											0	143.4996389	108.9863441	55.88559493	6.904048458	40.16386602	0.2	0.143963797	39.31516279	108.2991372	0	11.86537544	55.03365058	0.2	18.84844098	1.689628691	5.907302063	25.1676979	8.173363755	2.222563356	4.890224817	0.2	0	0	0	0	0	0	0	0	0											NO	133.8482728	101.6562413	52.12689323	6.439702345	37.46256183	0.186548585	0.134281213	36.6709399	101.0152539	0	11.06734498	51.33224816	0.186548585	17.58074995	1.575989206	5.509994199	23.47499213	7.623647207	2.073080243	4.561322594	0.186548585	0	0	0	0	0	0	0	0	0												19.5388	1.22713087	2.367796051	0.231968356	1.87829712	1.479718123	2.04734277	2.311076346	2.23950231	0	1.248924772	0.354041441	0.059643955	2.275573382	1.237947451	7.57544091	0.733144084	0.516933377	0.607631194	1.011011752	2.204128904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.146	0	3.687975333	19.5388	1.22713087	2.367796051	0.231968356	1.87829712	1.479718123	2.04734277	2.311076346	2.23950231	0	1.248924772	0.354041441	0.059643955	2.275573382	1.237947451	7.57544091	0.733144084	0.516933377	0.607631194	1.011011752	2.204128904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.146	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												2.0297	0	0.134	0.0536	0.0655	0.054	0.1037	0	0.1924	0.0206	0.1108	0	0	0.0773	0	0.5941	0	0.0118	0.0989	0.0762	0.0804	0	0	0	0	0	0	0	0	0											3.7031	0	0	21.5685	1.22713087	2.501805796	0.285583549	1.943845096	1.53368897	2.151083071	2.311076346	2.431942049	0.020602794	1.359765585	0.354041441	0.059643955	2.35283262	1.237947451	8.169530558	0.733144084	0.528741941	0.706509496	1.08719729	2.284521718	1.62E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8491
H1216_003_0	2011	6																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	P	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	Yes	1996.28786	645.162916	525.6596853	628.5146729	17.03718975	9.91991023	9.80139595	40.95188837	21.05946913	3259.950036	10.5827762	0.434817395	0.065847521	14.4232161	7786.069772	79.10008662	19.16468294	0.961562457	11.1720668	9.239370847	7.142143237	0.00012684	1930	623.4	331.2	198.72	16.2	12.34285714	600	2851.621115											6700	FFS	FFS	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) $0.00 copayment	(8b) 20% coinsurance	(5) 45% coinsurance	(12) 20% coinsurance	"(9a) , (9d) 20% coinsurance"	"(14b) , (14c) $0.00 copayment ; (7a) $10.00 copayment"	"(7b) , (7d) , (7g) 20% coinsurance"	"(7e) , (7h) 45% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) 20% coinsurance"	(15) 20% coinsurance	(13a) 20% coinsurance	(10b) $0.00 copayment	"(16) $0.00 copayment, $1,000 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	"(13b) , (13c) $0.00 copayment"											0	153.5766059	58.83913555	36.23278943	0	0.166257762	0.189600361	0.189600117	0.150324467	0.153087583	0	0.144818488	0.332628534	0.1896	0.150173915	2.912065258	0.064766338	0.30627472	0.166732149	0.128593028	0.137274019	0.189602964	0.168356966	0	0	0	0	0	0	0	0											NO	150.765647	57.76218513	35.56960977	0	0.163214696	0.186130048	0.186129809	0.147573033	0.150285575	0	0.142167831	0.326540334	0.186129694	0.147425237	2.85876485	0.063580901	0.300668881	0.1636804	0.126239351	0.134761451	0.186132604	0.165275477	0	0	0	0	0	0	0	0												25.081	3.10550165	1.558125823	0	2.780719741	1.846393367	1.82433196	6.043394374	3.164934425	0	1.504530341	0.141985417	0.012256179	2.126346053	1.854878549	5.029254738	5.762223782	0.157388928	1.410354464	1.245111021	1.329385719	2.10E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9781	0	1.230132648	25.081	3.10550165	1.558125823	0	2.780719741	1.846393367	1.82433196	6.043394374	3.164934425	0	1.504530341	0.141985417	0.012256179	2.126346053	1.854878549	5.029254738	5.762223782	0.157388928	1.410354464	1.245111021	1.329385719	2.10E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9781	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	25.081	3.10550165	1.558125823	0	2.780719741	1.846393367	1.82433196	6.043394374	3.164934425	0	1.504530341	0.141985417	0.012256179	2.126346053	1.854878549	5.029254738	5.762223782	0.157388928	1.410354464	1.245111021	1.329385719	2.10E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9781
H1216_005_0	2011	6																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1608.67899	124.4254258	637.2216549	428.1486543	603.1800131	7.732062515	7.123762656	619.8161609	279.357182	2772.91864	1328.590873	10.17563165	0.066986559	2251.750988	8377.80998	20395.68668	758.1300635	1450.907066	3411.73691	3102.827811	11.13487821	0.003898879	0	222	331.2	198.72	0	0	0	0											6700	"(1a) $250 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $250 days 1 - 5, $0 after day 5, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $250.00 copayment	(12) 20% coinsurance	"(9a) $150.00 copayment , (9d) Copay between $35.00 and $150.00"	"(14b) , (14c) $0.00 copayment ; (7a) $10.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	"(16) $0.00 copayment,   benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	Not Covered	Not Covered	Not Covered	Not Covered											0	141.2910184	97.61132387	39.27	0	38.49091192	0.2	0.120471447	41.80801747	104.2560714	0	10.82615045	50.62157916	0.2	17.18542847	3.014099896	6.501198604	25.50787894	8.677956267	3.369208372	5.620046334	0.2	0	0	0	0	0	0	0	0	0											NO	139.4470499	96.33741271	38.75749296	0	37.98857264	0.197389829	0.118899191	41.26238713	102.8954406	0	10.68485994	49.96092431	0.197389829	16.96114394	2.974763318	6.416352409	25.17497933	8.564701525	3.325237325	5.546699929	0.197389829	0	0	0	0	0	0	0	0	0												18.6938	0.998901966	2.058092817	0	1.909495645	1.526230499	0.84700962	2.131257865	2.395381694	0	1.18298395	0.04236533	0.013222465	3.182689386	2.076833485	10.90549278	1.59049239	1.03554883	0.94540291	1.434204567	2.197911707	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1673	0	0.72950117	18.6938	0.998901966	2.058092817	0	1.909495645	1.526230499	0.84700962	2.131257865	2.395381694	0	1.18298395	0.04236533	0.013222465	3.182689386	2.076833485	10.90549278	1.59049239	1.03554883	0.94540291	1.434204567	2.197911707	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1673	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	18.6938	0.998901966	2.058092817	0	1.909495645	1.526230499	0.84700962	2.131257865	2.395381694	0	1.18298395	0.04236533	0.013222465	3.182689386	2.076833485	10.90549278	1.59049239	1.03554883	0.94540291	1.434204567	2.197911707	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1673
H1230_001_0	2011	4																															D	D	D	V	Coin	Coin	Coin	V	V	O	O	Coin	O	V	V	V	Coin	V	O	O	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	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1332.31745	29.97296743	567.6750389	341.8306815	14.9870849	6.374175729	1.983382308	283.8109016	154.8207953	0	248.8689116	0.604423483	2.065610788	190.2661236	13173.60542	3669.301618	4.813803503	395.9536785	3315.505108	4017.079308	1132.373916	1.497356738	0	0	367.3752736	0	53.92349998	0	0	0	0	0	0	0	0	0	0	0	0	0	3000	$50/day days 1-4	$50/day days 1-4 for up to 190 days	$50/day 21 to 100	0	0.2	0.2	0-20%	$15-$50/visit	$15-$50/visit	$0-$15/test	$15/$50 (routine/advanced)	0.2	0	$0-$15/visit	$0-$15/visit	$0-$15/visit	"SMI $15/visit, NON-SMI 20%"	$15/visit	$15/$50 (routine/advanced)	$0-$15/test	"$10/generic & $40/brand, 0-20% DMS"	0-20%			$20/visit		$20/visit		$0-$15/visit	$0-$15/visit											0	50	50	7.546417482	0	0.2	0.2	0.2	45.86541492	30.8854897	0	16.30558685	0.2	0	14.995	8.263710085	12.3403817	0.123815665	15	18.53124224	0	2.644750313	0	0	0	20	0	20	0	15	0	0	0	0	0	0	0	0	0	0	0	NO	27.23175762	27.23175762	2.077872972	0	0.196547051	0.196547051	0.196547051	45.07356014	30.35225954	0	16.02407502	0.196547051	0	14.73611512	8.121039222	12.12732813	0.121678019	14.7410288	18.21130504	0	2.599089368	0	0	0	19.65470506	0	19.65470506	0	14.7410288	0	0	0	0	0	0	0	0	0	0	0		3.0234	0.068018049	0.098296385	0	2.945667334	1.25282544	0.389827943	1.066030645	0.391596747	0	0.332324509	0.118797653	0	0.233648625	8.915280529	3.708235395	0.585734075	0.486397048	5.031639573	0	0.245261751	0	0	0	0.601721054	0	0.088320874	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5831	0	3.307121993	3.0234	0.068018049	0.098296385	0	2.945667334	1.25282544	0.389827943	1.066030645	0.391596747	0	0.332324509	0.118797653	0	0.233648625	8.915280529	3.708235395	0.585734075	0.486397048	5.031639573	0	0.245261751	0	0	0	0.601721054	0	0.088320874	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5831	NO																																																																																		0	0	0	3.0234	0.068018049	0.098296385	0	2.945667334	1.25282544	0.389827943	1.066030645	0.391596747	0	0.332324509	0.118797653	0	0.233648625	8.915280529	3.708235395	0.585734075	0.486397048	5.031639573	0	0.245261751	0	0	0	0.601721054	0	0.088320874	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5831
H1230_003_0	2011	4																															D	D	D	V	Coin	Coin	Coin	V	V	O	O	Coin	O	V	V	V	Coin	V	O	O	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	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	799.8053431	8.64751781	351.4929143	163.103407	10.06197513	2.836115459	1.274914071	179.442661	87.40665699	0	189.7971647	0.370195677	2.72438952	115.2329524	8999.891694	2412.901396	5.126289169	210.6739337	2133.510797	2505.659833	821.0297125	1.288597027	0	0	263.1392805	0	26.11143587	0	0	0	0	0	0	0	0	0	0	0	0	0	3400	$250/day days 1-8	"SMI $250/day days 1-8, NON-SMI $250/day days 1-8, 20% days 191-220"	$50/day 21 to 100	0	0.25	0.2	0-20%	$29-$50/visit	$29-250/visit	"$0-$29/test, $15/day"	"$29/$150 (routine/advanced), 20% rad therapy"	0.2	0	$0-$29/visit	$0-$29/visit	$0-$29/visit	"SMI $29/visit, NON-SMI 20%"	$29/visit	"$29/$150 (routine/advanced), 20% rad therapy"	"$0-$29/test, $15/day"	"$10/generic & $40/brand, 0-20% DMS"	0-20%			$35/visit		$35/visit		$0-$29/visit	$0-$29/visit											0	250	250	9.703161988	0	0.25	0.2	0.2	45.11014977	129.3055207	0	33.78360383	0.2	0	28.995	15.92997687	24.06734824	0.145341693	29	42.71492186	14.63176587	2.6570856	0	0	0	35	0	35	0	29	0	0	0	0	0	0	0	0	0	0	0	NO	138.9089326	138.9089326	1.039152364	0	0.227084983	0.181667986	0.181667986	40.97535034	117.4533678	0	30.68699638	0.181667986	0	26.33731631	14.46983409	21.86133345	0.132019664	26.34185801	38.79966918	13.2906172	2.413536951	0	0	0	31.79189759	0	31.79189759	0	26.34185801	0	0	0	0	0	0	0	0	0	0	0		9.2583	0.100101456	0.030437891	0	2.284923449	0.515231384	0.231611072	0.612727158	0.855517186	0	0.485358742	0.067252703	0	0.25291056	10.85224497	4.395770167	0.676770973	0.462461904	6.89829276	2.77514714	0.165132129	0	0	0	0.697141421	0	0.069177675	0	0	0	0	0	0	0	0	0	0	0	0	0	41.6866	0	10.99724219	9.2583	0.100101456	0.030437891	0	2.284923449	0.515231384	0.231611072	0.612727158	0.855517186	0	0.485358742	0.067252703	0	0.25291056	10.85224497	4.395770167	0.676770973	0.462461904	6.89829276	2.77514714	0.165132129	0	0	0	0.697141421	0	0.069177675	0	0	0	0	0	0	0	0	0	0	0	0	0	41.6866	NO																																																																																		0	0	0	9.2583	0.100101456	0.030437891	0	2.284923449	0.515231384	0.231611072	0.612727158	0.855517186	0	0.485358742	0.067252703	0	0.25291056	10.85224497	4.395770167	0.676770973	0.462461904	6.89829276	2.77514714	0.165132129	0	0	0	0.697141421	0	0.069177675	0	0	0	0	0	0	0	0	0	0	0	0	0	41.6866
H1230_801_0	2011	6																															D	D	D	V	Coin	Coin	Coin	V	V	Coin	O	Coin	O	V	V	V	Coin	V	O	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	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1201.91052	21.87982543	367.6193328	322.0270055	10.99282069	4.943190583	1.573012025	266.1159157	144.4944419	2.643595722	292.9837324	0.529341188	8.196402681	196.6061773	11942.22019	3381.278631	2.014796682	327.9001383	3058.85589	28.93581064	1173.242593	1.408864352	0	0	318.9316524	0	57.73829186	0	0	0	0	0	0	0	0	0	0	0	0	0	3000	$75/day	$75/day days 1-30 $0/day days 31-190	0	0	0.2	0.2	0-20%	$20-$50/visit	$20-75/visit	0% OP Lab	"$20/$50 (routine/advanced), 20% rad therapy"	0.2	0	$0-$20/visit	$0-$20/visit	$0-$200/visit	"SMI $20/visit, NON-SMI 20%"	$20/visit	"$20/$50 (routine/advanced), 20% rad therapy"	0% OP Lab	"$10/generic & $40/brand, 20% DMS"	0-20%			$20/visit		$20/visit		$0-$20/visit	$0-$20/visit											0	75	75	0	0	0.2	0.2	0.2	46.05464712	44.96291239	0	21.18601748	0.2	0	19.995	11.39380378	18.97124222	0.142820355	20	28.54241159	0	6.916997097	0	0	0	20	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	NO	64.07387953	64.07387953	0	0	0.194001281	0.194001281	0.194001281	44.67330273	43.61431304	0	20.55057267	0.194001281	0	19.39527808	11.05206266	18.40222648	0.13853666	19.40012812	27.68632208	0	6.709531493	0	0	0	19.40012812	0	19.40012812	0	19.40012812	0	0	0	0	0	0	0	0	0	0	0		6.4176	0.116827108	0	0	2.132621297	0.958985306	0.305166348	0.990689739	0.525168819	0	0.501748624	0.102692869	0	0.31776929	10.99884715	5.185254595	0.279123202	0.530108724	7.057372447	0	0.655992344	0	0	0	0.515609576	0	0.093344188	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6849	0	2.077478675	6.4176	0.116827108	0	0	2.132621297	0.958985306	0.305166348	0.990689739	0.525168819	0	0.501748624	0.102692869	0	0.31776929	10.99884715	5.185254595	0.279123202	0.530108724	7.057372447	0	0.655992344	0	0	0	0.515609576	0	0.093344188	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6849	NO																																																																																		0	0	0	6.4176	0.116827108	0	0	2.132621297	0.958985306	0.305166348	0.990689739	0.525168819	0	0.501748624	0.102692869	0	0.31776929	10.99884715	5.185254595	0.279123202	0.530108724	7.057372447	0	0.655992344	0	0	0	0.515609576	0	0.093344188	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6849
H1230_802_0	2011	3																															D	D	D	V	Coin	Coin	Coin	V	V	Coin	O	Coin	O	V	V	V	Coin	V	O	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	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1203.290409	12.17463506	449.9922409	374.0456573	12.58707836	5.847411389	1.538356	276.5838558	150.4879432	2.027114326	217.6450584	0.725124915	2.27304642	188.0975541	12423.65271	3500.312796	2.569205574	386.0709069	3062.216006	30.3597506	1272.696358	1.421246517	0	0	356.3060965	0	57.60379635	0	0	0	0	0	0	0	0	0	0	0	0	0	3000	$75/day	$75/day	0	0	0.2	0.2	0-20%	$20-$50/visit	$20-75/visit	0% OP Lab	"$20/$50 (routine/advanced), 20% rad therapy"	0.2	0	$0-$20/visit	$0-$20/visit	$0-$200/visit	"SMI $20/visit, NON-SMI 20%"	$20/visit	"$20/$50 (routine/advanced), 20% rad therapy"	0% OP Lab	"$10/generic & $40/brand, 20% DMS"	0-20%			$20/visit		$20/visit		$0-$20/visit	$0-$20/visit											0	75	75	0	0	0.2	0.2	0.2	45.85057751	44.96291239	0	21.18601748	0.2	0	19.995	11.40545294	18.97124222	0.13658697	20	28.04609329	0	7.018531041	0	0	0	20	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	NO	64.07387953	64.07387953	0	0	0.194001281	0.194001281	0.194001281	44.4753539	43.61431304	0	20.55057267	0.194001281	0	19.39527808	11.06336241	18.40222648	0.132490235	19.40012812	27.20489015	0	6.80802007	0	0	0	19.40012812	0	19.40012812	0	19.40012812	0	0	0	0	0	0	0	0	0	0	0		6.425	0.065006342	0	0	2.441909328	1.134405301	0.298443035	1.025097073	0.546952355	0	0.372727549	0.140675163	0	0.304017031	11.4539477	5.367795734	0.340394652	0.624152088	6.942270839	0	0.722045196	0	0	0	0.576031993	0	0.093126752	0	0	0	0	0	0	0	0	0	0	0	0	0	38.874	0	2.108039407	6.425	0.065006342	0	0	2.441909328	1.134405301	0.298443035	1.025097073	0.546952355	0	0.372727549	0.140675163	0	0.304017031	11.4539477	5.367795734	0.340394652	0.624152088	6.942270839	0	0.722045196	0	0	0	0.576031993	0	0.093126752	0	0	0	0	0	0	0	0	0	0	0	0	0	38.874	NO																																																																																		0	0	0	6.425	0.065006342	0	0	2.441909328	1.134405301	0.298443035	1.025097073	0.546952355	0	0.372727549	0.140675163	0	0.304017031	11.4539477	5.367795734	0.340394652	0.624152088	6.942270839	0	0.722045196	0	0	0	0.576031993	0	0.093126752	0	0	0	0	0	0	0	0	0	0	0	0	0	38.874
H1230_803_0	2011	5																															D	D	D	V	Coin	Coin	Coin	V	V	Coin	O	Coin	O	V	V	V	Coin	V	O	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	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1164.983076	8.947593201	449.5658241	343.0816737	12.50193196	5.805805974	1.54216528	267.7313461	146.7677403	1.959056292	214.5192905	0.652206508	1.344064875	177.9325007	12415.81043	3490.139091	2.769548277	391.6099904	2984.098639	30.30948868	1273.258646	1.411517457	0	0	354.4085196	0	57.66946931	0	0	0	0	0	0	0	0	0	0	0	0	0	3000	$75/day	$75/day days 1-30 $0/day days 31-190	0	0	0.2	0.2	0-20%	$20-$50/visit	$20-75/visit	0% OP Lab	"$20/$50 (routine/advanced), 20% rad therapy"	0.2	0	$0-$20/visit	$0-$20/visit	$0-$200/visit	"SMI $20/visit, NON-SMI 20%"	$20/visit	"$20/$50 (routine/advanced), 20% rad therapy"	0% OP Lab	"$10/generic & $40/brand, 20% DMS"	0-20%			$20/visit		$20/visit		$0-$20/visit	$0-$20/visit											0	75	75	0	0	0.2	0.2	0.2	45.9346327	44.96291239	0	21.14113185	0.2	0	19.995	11.39196053	18.97124222	0.136134049	20	28.15422194	0	6.975150754	0	0	0	20	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	NO	64.07387953	64.07387953	0	0	0.194001281	0.194001281	0.194001281	44.55688797	43.61431304	0	20.50703332	0.194001281	0	19.39527808	11.05027468	18.40222648	0.132050899	19.40012812	27.30977563	0	6.765940913	0	0	0	19.40012812	0	19.40012812	0	19.40012812	0	0	0	0	0	0	0	0	0	0	0		6.2204	0.047775584	0	0	2.425390818	1.126333797	0.29918204	0.994106299	0.533431181	0	0.366596186	0.126528898	0	0.287587528	11.4331763	5.352194166	0.365721341	0.633106999	6.791255359	0	0.717899397	0	0	0	0.572964224	0	0.093232924	0	0	0	0	0	0	0	0	0	0	0	0	0	38.3869	0	2.062019078	6.2204	0.047775584	0	0	2.425390818	1.126333797	0.29918204	0.994106299	0.533431181	0	0.366596186	0.126528898	0	0.287587528	11.4331763	5.352194166	0.365721341	0.633106999	6.791255359	0	0.717899397	0	0	0	0.572964224	0	0.093232924	0	0	0	0	0	0	0	0	0	0	0	0	0	38.3869	NO																																																																																		0	0	0	6.2204	0.047775584	0	0	2.425390818	1.126333797	0.29918204	0.994106299	0.533431181	0	0.366596186	0.126528898	0	0.287587528	11.4331763	5.352194166	0.365721341	0.633106999	6.791255359	0	0.717899397	0	0	0	0.572964224	0	0.093232924	0	0	0	0	0	0	0	0	0	0	0	0	0	38.3869
H1230_804_0	2011	3																															D	D	D	V	Coin	Coin	Coin	V	V	Coin	O	Coin	O	V	V	V	Coin	V	O	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	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1203.290409	12.17463506	449.9922409	374.0456573	12.58707836	5.847411389	1.538356	276.5838558	150.4879432	2.027114326	217.6450584	0.725124915	2.27304642	188.0975541	12423.65271	3500.312796	2.569205574	386.0709069	3062.216006	30.3597506	1272.696358	1.421246517	0	0	356.3060965	0	57.60379635	0	0	0	0	0	0	0	0	0	0	0	0	0	3000	$75/day	$75/day	0	0	0.2	0.2	0-20%	$20-$50/visit	$20-75/visit	0% OP Lab	"$20/$50 (routine/advanced), 20% rad therapy"	0.2	0	$0-$20/visit	$0-$20/visit	$0-$200/visit	"SMI $20/visit, NON-SMI 20%"	$20/visit	"$20/$50 (routine/advanced), 20% rad therapy"	0% OP Lab	"$10/generic & $40/brand, 20% DMS"	0-20%			$20/visit		$20/visit		$0-$20/visit	$0-$20/visit											0	75	75	0	0	0.2	0.2	0.2	45.85057751	44.96291239	0	21.18601748	0.2	0	19.995	11.40545294	18.97124222	0.13658697	20	28.04609329	0	7.018531041	0	0	0	20	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	NO	64.07387953	64.07387953	0	0	0.194001281	0.194001281	0.194001281	44.4753539	43.61431304	0	20.55057267	0.194001281	0	19.39527808	11.06336241	18.40222648	0.132490235	19.40012812	27.20489015	0	6.80802007	0	0	0	19.40012812	0	19.40012812	0	19.40012812	0	0	0	0	0	0	0	0	0	0	0		6.425	0.065006342	0	0	2.441909328	1.134405301	0.298443035	1.025097073	0.546952355	0	0.372727549	0.140675163	0	0.304017031	11.4539477	5.367795734	0.340394652	0.624152088	6.942270839	0	0.722045196	0	0	0	0.576031993	0	0.093126752	0	0	0	0	0	0	0	0	0	0	0	0	0	38.874	0	2.108039407	6.425	0.065006342	0	0	2.441909328	1.134405301	0.298443035	1.025097073	0.546952355	0	0.372727549	0.140675163	0	0.304017031	11.4539477	5.367795734	0.340394652	0.624152088	6.942270839	0	0.722045196	0	0	0	0.576031993	0	0.093126752	0	0	0	0	0	0	0	0	0	0	0	0	0	38.874	NO																																																																																		0	0	0	6.425	0.065006342	0	0	2.441909328	1.134405301	0.298443035	1.025097073	0.546952355	0	0.372727549	0.140675163	0	0.304017031	11.4539477	5.367795734	0.340394652	0.624152088	6.942270839	0	0.722045196	0	0	0	0.576031993	0	0.093126752	0	0	0	0	0	0	0	0	0	0	0	0	0	38.874
H1230_805_0	2011	3																															Coin	D	D	V	Coin	Coin	Coin	V	V	Coin	V	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	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	328.9258673	29.0667454	444.8428049	525.9853582	13.39229425	6.22593274	1.507588342	327.0773552	173.6246423	2.305846547	96.68244892	1.106634221	0.572085497	248.6160382	12590.62234	3594.459325	75.54885444	370.6537688	38.04780515	31.02498974	1292.876209	1.481871625	0	0	378.0824732	0	57.65777603	0	0	0	0	0	0	0	0	0	0	0	0	0	2500	10% Room & Board	$125/day days 1-15	0	0	0.25	0.2	0-20%	$25-$50/visit	$25/visit	50% OP Lab	"$25/visit Radiation Therapy, 50% OP Radiology"	10% Room & Board	$25/visit	$0-$25/visit	$0-$25/visit	$0-$25/visit	$25/visit	$25/visit	"$25/visit Radiation Therapy, 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	0.071634071	125	0	0	0.25	0.2	0.2	45.36492961	25	0.5	25	0.1	25	25	14.37070227	20.90286307	25	25	0.450787346	0.481104713	7.275884683	0	0	0	25	0	25	0	25	0	0	0	0	0	0	0	0	0	0	0	NO	0.030779071	53.70885375	0	0	0.204257217	0.163405774	0.163405774	37.06445713	20.42572172	0.408514434	20.42572172	0.081702887	20.42572172	20.42572172	11.74127862	17.07824257	20.42572172	20.42572172	0.368306275	0.393076439	5.944607833	0	0	0	20.42572172	0	20.42572172	0	20.42572172	0	0	0	0	0	0	0	0	0	0	0		10.124	0.130095131	0	0	2.735472756	1.017353357	0.24634864	1.010245384	0.295534052	0.941971598	0.1645674	0.090415211	0.000973772	0.423180168	12.31916708	5.115587357	0.12859499	0.630905895	14.0132454	12.1951925	0.64047017	0	0	0	0.643550616	0	0.098141807	0	0	0	0	0	0	0	0	0	0	0	0	0	62.965	0	25.41539973	10.124	0.130095131	0	0	2.735472756	1.017353357	0.24634864	1.010245384	0.295534052	0.941971598	0.1645674	0.090415211	0.000973772	0.423180168	12.31916708	5.115587357	0.12859499	0.630905895	14.0132454	12.1951925	0.64047017	0	0	0	0.643550616	0	0.098141807	0	0	0	0	0	0	0	0	0	0	0	0	0	62.965	NO																																																																																		0	0	0	10.124	0.130095131	0	0	2.735472756	1.017353357	0.24634864	1.010245384	0.295534052	0.941971598	0.1645674	0.090415211	0.000973772	0.423180168	12.31916708	5.115587357	0.12859499	0.630905895	14.0132454	12.1951925	0.64047017	0	0	0	0.643550616	0	0.098141807	0	0	0	0	0	0	0	0	0	0	0	0	0	62.965
H1230_806_0	2011	4																															Coin	Coin	D	V	Coin	Coin	Coin	V	V	Coin	V	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	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	327.1707414	0.403196523	440.0256125	564.5097952	13.468109	6.355988721	1.515817587	331.0964813	173.857356	2.280876588	95.63547692	1.094650505	0.565890396	245.9237809	12615.4134	3581.718142	74.73073765	370.4484235	37.93764513	31.04047928	1301.598226	1.481870148	0	0	377.392541	0	57.03340131	0	0	0	0	0	0	0	0	0	0	0	0	0	2500	10% Room & Board	10% Room & Board	0	0	0.25	0.2	0-20%	$25-$50/visit	$25/visit	50% OP Lab	"$25/visit Radiation Therapy, 50% OP Radiology"	10% Room & Board	$25/visit	$0-$25/visit	$0-$25/visit	$0-$25/visit	$25/visit	$25/visit	"$25/visit Radiation Therapy, 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	0.071634071	0.071634071	0	0	0.25	0.2	0.2	45.85057751	25	0.5	25	0.1	25	24.995	14.25681617	20.90286307	25	25	0.450975876	0.481104713	7.291541282	0	0	0	25	0	25	0	25	0	0	0	0	0	0	0	0	0	0	0	NO	0.030779071	0.030779071	0	0	0.204257217	0.163405774	0.163405774	37.46124549	20.42572172	0.408514434	20.42572172	0.081702887	20.42572172	20.42163658	11.64823039	17.07824257	20.42572172	20.42572172	0.36846031	0.393076439	5.957399727	0	0	0	20.42572172	0	20.42572172	0	20.42572172	0	0	0	0	0	0	0	0	0	0	0		10.07	0.012410014	0	0	2.750958467	1.038605255	0.247693346	1.033607214	0.295930164	0.93177101	0.162785303	0.089436106	0.000963227	0.41851384	12.24560348	5.097454272	0.127202438	0.630556368	13.97851648	12.20128107	0.64617841	0	0	0	0.642376252	0	0.097079032	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7189	0	25.17082009	10.07	0.012410014	0	0	2.750958467	1.038605255	0.247693346	1.033607214	0.295930164	0.93177101	0.162785303	0.089436106	0.000963227	0.41851384	12.24560348	5.097454272	0.127202438	0.630556368	13.97851648	12.20128107	0.64617841	0	0	0	0.642376252	0	0.097079032	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7189	NO																																																																																		0	0	0	10.07	0.012410014	0	0	2.750958467	1.038605255	0.247693346	1.033607214	0.295930164	0.93177101	0.162785303	0.089436106	0.000963227	0.41851384	12.24560348	5.097454272	0.127202438	0.630556368	13.97851648	12.20128107	0.64617841	0	0	0	0.642376252	0	0.097079032	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7189
H1264_004_0	2011	5																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	2211.704379	183.5721781	359.5526151	245.3607767	398.0303386	9.421703048	13.22140687	444.7286307	316.6322455	4284.612469	1063.390676	28.05595861	0.351248904	1881.352863	14270.05437	17049.91402	217.3504443	405.8375734	4096.148108	3639.775029	11.02869351	0.015871254	0	234.8571429	331.2	198.72	16.2	12.34285714	0	0											5500	"(1a) $125 days 1 - 6, $0 after day 6, unlimited coverage"	"(1b) $125 days 1 - 6, $0 after day 6, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $100.00 copayment , (9b) $75.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $125.00 copayment	(12) 20% coinsurance	"(9a) $100.00 copayment , (9d) Copay between $35.00 and $100.00"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	"(16) $0.00 copayment,   benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											0	84.64266427	59.32322929	35.20664077	0	46.48468926	0.2	0.2	42.16342313	96.44086969	0	14.90964657	57.23408425	0.2	25.85785994	0	4.870597008	24.34903295	7.465730675	3.744415812	5.729777366	0.2	0	0	0	0	0	0	0	0	0											NO	83.5112301	58.5302447	34.73602708	0	45.86331981	0.197326563	0.197326563	41.59981684	95.15172672	0	14.71034657	56.46902564	0.197326563	25.51221313	0	4.805490836	24.02355492	7.365934871	3.694363513	5.653186371	0.197326563	0	0	0	0	0	0	0	0	0												15.3918	0.895377042	1.040785781	0	1.521249393	1.85915228	2.608934776	1.541719132	2.510675408	0	1.303570449	0.132024387	0.069310739	3.999789601	0	6.827767131	0.435127528	0.249114428	1.26105501	1.714693882	2.176254184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5384	0	0.616967984	15.3918	0.895377042	1.040785781	0	1.521249393	1.85915228	2.608934776	1.541719132	2.510675408	0	1.303570449	0.132024387	0.069310739	3.999789601	0	6.827767131	0.435127528	0.249114428	1.26105501	1.714693882	2.176254184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5384	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												2.4343	0	0.1345	0.0994	0.0683	0.0641	0.09	0	0.3166	0.0378	0.1149	0	0	0.1388	0	0.7174	0	0.0104	0.1885	0.1445	0.075	0.0001	0	0	0	0	0	0	0	0											4.6345	0	0	17.8261	0.895377042	1.175255555	0.099410012	1.58952997	1.923258713	2.698894864	1.541719132	2.827279017	0.037828549	1.418453907	0.132024387	0.069310739	4.138602958	0	7.54519618	0.435127528	0.259476355	1.449565076	1.859156973	2.251294779	0.00010799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.173
H1264_007_0	2011	5																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	P	P	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	Yes	2569.119426	398.1134523	597.9359942	921.4680192	16.15990617	10.83691269	13.73371001	38.82116777	45.76344494	5558.261806	16.57963728	1.058154081	0.104159818	22.94504354	13419.49039	22512.56641	8.979689675	3.078898504	23.3183419	19.44694005	48.66972223	0.055035033	1800	341.3333333	331.2	198.72	16.2	12.34285714	0	3099.485502											6700	FFS	FFS	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) $0.00 copayment	(8b) 20% coinsurance	(5) 45% coinsurance	(12) 20% coinsurance	"(9a) , (9d) 20% coinsurance"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) $0.00 copayment"	"(7e) , (7h) 45% coinsurance"	"(7c) , (7i) $0.00 copayment"	(8b) 20% coinsurance	"(7g) $0.00 copayment , (8a) 20% coinsurance"	(15) 20% coinsurance	(13a) 20% coinsurance	(10b) $0.00 copayment	"(16) $0.00 copayment, $500 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	Not Covered	"(13b) , (13c) $0.00 copayment"											0	123.7622552	53.04555495	36.46129056	0	0.138024325	0.192600311	0.192600073	0.135218315	0.15701003	0	0.125990856	0.430353859	0.1926	0.126321326	0	0	0.320780432	0	0.108718726	0.125870932	0.192600482	0.067948691	0	0	0	0	0	0	0	0											NO	121.1403879	51.92180033	35.68886875	0	0.13510032	0.188520129	0.188519897	0.132353755	0.153683818	0	0.123321776	0.421236938	0.188519825	0.123645246	0	0	0.313984792	0	0.106415552	0.123204393	0.188520297	0.066509217	0	0	0	0	0	0	0	0												25.9353	1.722563932	1.778304935	0	2.183208492	2.042976182	2.589077595	5.138127316	7.03310095	0	2.044630316	0.445733585	0.019636191	2.837045542	0	0	2.819485993	0	2.481434215	2.395948453	9.175230486	0.003660337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6455	0	1.528995825	25.9353	1.722563932	1.778304935	0	2.183208492	2.042976182	2.589077595	5.138127316	7.03310095	0	2.044630316	0.445733585	0.019636191	2.837045542	0	0	2.819485993	0	2.481434215	2.395948453	9.175230486	0.003660337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6455	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	25.9353	1.722563932	1.778304935	0	2.183208492	2.042976182	2.589077595	5.138127316	7.03310095	0	2.044630316	0.445733585	0.019636191	2.837045542	0	0	2.819485993	0	2.481434215	2.395948453	9.175230486	0.003660337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6455
H1264_008_0	2011	6																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1534.440684	119.9245839	274.7734284	462.2829036	278.686639	4.358269097	7.179981645	292.243607	256.8508935	2682.862007	1143.118032	7.281056857	0.13850131	1452.678783	11143.1412	17522.32597	391.3076722	648.3561584	3697.825075	3265.72523	10.49886871	0.138573624	0	0	331.2	198.72	16.2	12.34285714	0	0											5500	"(1a) $150 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $150 days 1 - 5, $0 after day 5, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $100.00 copayment , (9b) $50.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $150.00 copayment	(12) 20% coinsurance	"(9a) $100.00 copayment , (9d) Copay between $35.00 and $100.00"	"(14b) , (14c) $0.00 copayment ; (7a) $15.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											0	85.17724165	64.36584368	42.0602811	0	42.96387672	0.2	0.090555154	45.26469566	73.20699262	0	18.36392932	33.89850664	0.2	16.3511335	5.521311565	4.635688398	25.28527013	7.978746373	4.530199813	4.238693429	0.2	0	0	0	0	0	0	0	0	0											NO	84.2870727	63.69317015	41.62071819	0	42.51487052	0.197909843	0.089608781	44.79164411	72.44192215	0	18.17201186	33.54424067	0.197909843	16.18025133	5.46360953	4.58724182	25.02101924	7.895362219	4.482855674	4.19439576	0.197909843	0	0	0	0	0	0	0	0	0												10.7778	0.63653141	0.953022286	0	0.987360531	0.862544354	0.643389406	1.090839303	1.550564369	0	1.73106287	0.020353127	0.027410773	1.958725651	5.073481038	6.698262207	0.815909733	0.426583893	1.381401343	1.141478671	2.077829459	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8545	0	0.410348906	10.7778	0.63653141	0.953022286	0	0.987360531	0.862544354	0.643389406	1.090839303	1.550564369	0	1.73106287	0.020353127	0.027410773	1.958725651	5.073481038	6.698262207	0.815909733	0.426583893	1.381401343	1.141478671	2.077829459	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8545	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	10.7778	0.63653141	0.953022286	0	0.987360531	0.862544354	0.643389406	1.090839303	1.550564369	0	1.73106287	0.020353127	0.027410773	1.958725651	5.073481038	6.698262207	0.815909733	0.426583893	1.381401343	1.141478671	2.077829459	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8545
H1264_014_0	2011	6																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1383.114024	118.487613	306.1678215	951.7509573	312.6550518	8.947498723	6.41083442	504.2226394	217.4796112	3057.887878	951.220569	3.100155394	0.100098676	1566.496478	10309.9735	18533.37723	484.4130819	742.7164532	3668.558712	3042.699989	18.0006676	0.074831661	0	234.8571429	331.2	198.72	16.2	12.34285714	0	0											5500	"(1a) $225 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $225 days 1 - 5, $0 after day 5, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $225.00 copayment	(12) 20% coinsurance	"(9a) $150.00 copayment , (9d) Copay between $35.00 and $150.00"	"(14b) , (14c) $0.00 copayment ; (7a) $15.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	"(16) $0.00 copayment,   benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											0	171.4672221	94.17481128	36.83341003	0	43.24677228	0.2	0.093970767	45.59871685	118.4675821	0	14.72153251	57.88513	0.2	17.99335912	5.066077158	4.642866637	25.58478195	6.828324138	3.848386469	4.155463627	0.2	0	0	0	0	0	0	0	0	0											NO	168.6759527	92.64176452	36.23380872	0	42.54276955	0.196744253	0.092441042	44.85642744	116.5390798	0	14.48188459	56.94283333	0.196744253	17.70045001	4.983607833	4.567286643	25.16829407	6.717167661	3.785739607	4.087817937	0.196744253	0	0	0	0	0	0	0	0	0												19.4415	0.914741795	0.924468857	0	1.108434318	1.760368953	0.592624216	1.884802186	2.112072813	0	1.147955542	0.014710969	0.019693839	2.310641049	4.281738723	7.053937188	1.015987575	0.415745912	1.157350668	1.036500299	3.541527903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7348	0	0.839565559	19.4415	0.914741795	0.924468857	0	1.108434318	1.760368953	0.592624216	1.884802186	2.112072813	0	1.147955542	0.014710969	0.019693839	2.310641049	4.281738723	7.053937188	1.015987575	0.415745912	1.157350668	1.036500299	3.541527903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7348	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	19.4415	0.914741795	0.924468857	0	1.108434318	1.760368953	0.592624216	1.884802186	2.112072813	0	1.147955542	0.014710969	0.019693839	2.310641049	4.281738723	7.053937188	1.015987575	0.415745912	1.157350668	1.036500299	3.541527903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7348
H1286_002_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	830.6321175	90.64551958	513.1622737	176.2444272	73.77684819	7.0335634	9.159082535	297.319879	35.99970351	15.39758443	32.7716265	0	0.027115467	9.79694217	5901.059242	97.69229477	505.5792733	799.2911194	0	0	17.89583236	1215.068716	0	0	498.2284622	251.4772874	58.50318529	1.139184661	18.14573791	0											3400	"$275 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-34 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												214.2146773	137.0409745	78.45021486	0	200	0.2	0.117598029	49.37190276	0.2	0.128990664	0.162115463	0	0.2	0.159601719	6.466247271	0.106506086	38.5	30	0	0	0.2	29.84200814	0	0	30	0	0	0	0	0											YES	162.1129694	103.7096038	59.36940196	0	151.3556134	0.151355613	0.088995609	37.38055975	0.151355613	0.097617306	0.122685427	0	0.151355613	0.12078308	6.19834897	0.102096877	36.90493501	28.75709222	0	0	0.151355613	22.58377724	0	0	30	0	0	0	0	0											4500	11.2214	0.78340091	2.538844775	0	0.930545009	1.064569303	0.81511813	0.926165292	5.448757207	1.503070707	4.02060099	0	0.004104078	1.183304854	3.048068706	9.974078199	1.554864185	1.915440702	0	0	2.708634685	2.286736768	0	0	1.245571156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1732	0	12.10048877	11.2214	0.78340091	2.538844775	0	0.930545009	1.064569303	0.81511813	0.926165292	5.448757207	1.503070707	4.02060099	0	0.004104078	1.183304854	3.048068706	9.974078199	1.554864185	1.915440702	0	0	2.708634685	2.286736768	0	0	1.245571156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1732	NO	"$275 Days 1-10/$375 Days 1-12 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-12 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-26 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	25% (9b)	30% (8a1a); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 25% (9a); $45/$35 (9c)"	"$25 (7a, 14c); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9334	0.0923	0.3067	0.3859	0.2026	0.3476	0.4527	0.2017	1.4828	0.3272	1.2925	0	0.0009	0.3227	1.0881	1.742	0.2149	0.3514	0	0	0.4661	0.3935	0	0	0.2309	0	0.0271	0	0	0											10.863	0	3.238061215	12.1547	0.875724103	2.845567367	0.385898834	1.133130725	1.412214821	1.26782095	1.127826692	6.931544671	1.830299	5.313127614	0	0.004997563	1.506002374	4.136146856	11.71612801	1.769714458	2.266818966	0	0	3.174700476	2.68020816	0	0	1.476491651	0	0.02711524	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0362
H1286_003_0	2011	1																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	812.5839927	84.23833914	410.7534238	144.966254	72.14893877	6.791644206	8.633565791	307.5882129	32.74165949	14.32907086	31.08434962	0	0.02007308	9.486088938	5438.202138	93.04478618	522.1060636	719.8078527	0	0	17.77695545	1159.968411	0	0	499.6957233	256.4379277	58.55396789	1.309891359	13.46780371	0											3300	"$275 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-33 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												214.2146773	137.0409745	76.31360228	0	200	0.2	0.126199019	49.39036345	0.2	0.128288672	0.162617488	0	0.2	0.159761374	6.4394437	0.109384336	38.5	30	0	0	0.2	29.77406525	0	0	30	0	0	0	0	0											YES	165.1212782	105.6341291	58.82416515	0	154.1642994	0.154164299	0.097276916	38.08711316	0.154164299	0.098887666	0.125349056	0	0.154164299	0.123147501	6.189200887	0.105145326	37.00385394	28.8341719	0	0	0.154164299	22.95048955	0	0	30	0	0	0	0	0											3900	11.1812	0.741536966	2.013518936	0	0.926899216	1.047029071	0.839846658	0.976262256	5.047594995	1.416968379	3.896393878	0	0.003094552	1.168188152	2.804843791	9.783224392	1.60999471	1.729588614	0	0	2.740571882	2.218486907	0	0	1.249239308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3945	0	10.81581137	11.1812	0.741536966	2.013518936	0	0.926899216	1.047029071	0.839846658	0.976262256	5.047594995	1.416968379	3.896393878	0	0.003094552	1.168188152	2.804843791	9.783224392	1.60999471	1.729588614	0	0	2.740571882	2.218486907	0	0	1.249239308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3945	NO	"$275 Days 1-10/$375 Days 1-11 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-23 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	25% (9b)	30% (8a1a); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 25% (9a); $45/$35 (9c)"	"$25 (7a, 14c); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.8853	0.0783	0.2114	0.3231	0.1942	0.3291	0.4184	0.2046	1.3222	0.2969	1.2063	0	0.0006	0.3065	0.9899	1.6833	0.2213	0.3156	0	0	0.4539	0.3674	0	0	0.2316	0	0.0271	0	0	0											10.067	0	3.166108284	12.0665	0.81983258	2.224961167	0.323061925	1.121131677	1.37613772	1.258210914	1.180883435	6.369754378	1.713895219	5.102677528	0	0.003743018	1.474666281	3.794707432	11.46653569	1.8312702	2.045172203	0	0	3.194467354	2.585887342	0	0	1.480839854	0	0.027138777	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4615
H1286_004_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	893.2777339	92.60878299	508.0264012	130.2004626	98.25072988	6.351727363	8.023365225	335.5480139	32.72585199	14.02691508	27.95068703	0	0.015707438	11.62052461	5334.619976	89.36657916	492.7190226	620.2875679	0	0	14.74184731	1103.036924	0	0	174.0094534	0	15.21697297	6	134.0174453	0											3900	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$50 Days 11-88 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$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, 18a); $0/$25 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												185.9463355	119.8302997	30.09102386	0	200	0.2	0.112283648	49.52167972	0.2	0.117963187	0.163165349	0	0.2	0.159689035	9.698913868	0.08562693	38.5	25	0	0	0.2	24.89507539	0	0	25	0	0	0	0	0											NO	152.3541672	98.18233558	24.6549246	0	163.8689645	0.163868964	0.091999025	40.58673859	0.163868964	0.096652527	0.133688684	0	0.163868964	0.130840384	9.406267738	0.083059132	37.33833632	24.24567293	0	0	0.163868964	20.39765113	0	0	25	0	0	0	0	0												11.3412	0.757712217	1.043779384	0	1.341687114	1.040850986	0.738141782	1.13489996	5.362751477	1.355736784	3.73669056	0	0.002573962	1.520433905	4.181571981	7.422710511	1.533109048	1.253274125	0	0	2.415731252	1.874946863	0	0	0.362519695	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4203	0	7.869053212	11.3412	0.757712217	1.043779384	0	1.341687114	1.040850986	0.738141782	1.13489996	5.362751477	1.355736784	3.73669056	0	0.002573962	1.520433905	4.181571981	7.422710511	1.533109048	1.253274125	0	0	2.415731252	1.874946863	0	0	0.362519695	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4203	YES	"$390 Days 1-22 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$390 Days 1-22 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-48 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											8400	1.5619	0.1424	0.4851	0.3465	0.3147	0.3662	0.4626	0.2662	1.8869	0.318	1.2899	0	0.0006	0.534	1.0223	1.3941	0.2141	0.2478	0	0	0.4479	0.3711	0	0	0.0717	0	0.0063	0	0	0											11.7505	0	2.027898232	12.9032	0.900129097	1.528876151	0.346544744	1.656403844	1.407076332	1.200749753	1.401111062	7.249645515	1.673749116	5.026633335	0	0.00317773	2.054444803	5.203868437	8.816843808	1.747202928	1.501112603	0	0	2.863591541	2.246013545	0	0	0.434208982	0	0.006269165	0	0	0	0	0	0	0	0	0	0	0	0	0	60.1708
H1286_008_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	807.1698622	95.01898382	441.6928975	194.0775983	68.2743178	7.452084537	8.941591397	279.2545564	308.3293121	16.30051933	33.82812539	0	0.023634054	344.2287602	5919.295618	93.85069345	487.4339115	719.3566389	0	0	15.1618542	1192.654844	0	0	154.5073167	0	15.53995544	6	164.7671672	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 1-33 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$200 (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	78.50191393	0	200	0.2	0.117065575	49.01158041	200	0.117996398	0.160814769	0	0.2	77.42546375	9.750119363	0.107072681	38.5	30	0	0	0.2	29.87268102	0	0	30	0	0	0	0	0											YES	144.2297369	96.47582161	60.79123664	0	154.8783554	0.154878355	0.090654619	37.97152875	154.8783554	0.091375441	0.124533635	0	0.154878355	59.95764247	9.377555641	0.103016476	37.02886895	28.85366412	0	0	0.154878355	23.13315854	0	0	30	0	0	0	0	0											3800	9.7015	0.763919544	2.237588121	0	0.881184505	1.154166598	0.810596558	0.883643535	3.979461399	1.489467135	4.212739424	0	0.003660403	1.719928744	4.625710334	9.668167751	1.504093869	1.729672903	0	0	2.348243044	2.299156133	0	0	0.386268292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3992	0	10.15652998	9.7015	0.763919544	2.237588121	0	0.881184505	1.154166598	0.810596558	0.883643535	3.979461399	1.489467135	4.212739424	0	0.003660403	1.719928744	4.625710334	9.668167751	1.504093869	1.729672903	0	0	2.348243044	2.299156133	0	0	0.386268292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3992	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 1-24 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	$250 (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.7933	0.0747	0.2195	0.3491	0.1852	0.3639	0.4367	0.1858	1.0457	0.3131	1.3086	0	0.0008	0.452	0.9095	1.5119	0.2068	0.2806	0	0	0.3902	0.3399	0	0	0.0637	0	0.0064	0	0	0											9.4375	0	3.009116647	10.4948	0.838654194	2.457047298	0.349091361	1.066426091	1.518107945	1.247281731	1.069445666	5.025158605	1.802581191	5.52137769	0	0.004429889	2.17195318	5.535244798	11.180035	1.710894018	2.010313242	0	0	2.738400615	2.639030836	0	0	0.449922991	0	0.006402229	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8366
H1286_801_0	2011	1																															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	193.4325285	5.6832105	16.55453199	180.9411813	3.198126751	7.060721968	9.194448331	14.90289673	35.93467221	15.36976962	32.71242652	0	0.027066485	9.76957521	32.61750301	97.13341257	2.603873	8.727702192	0	0	17.76946905	7.472721461	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078338418	0.078338418	0.142616418	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.06620606	0.06620606	0.120529253	0	0.196915028	0.196915028	0.196915028	0.196915028	0.196915028	0.196915028	0.196915028	0	0.196915028	0.196915028	0.196915028	0.196915028	0.196915028	0.196915028	0	0	0.196915028	0.196915028	0	0	0	0	0	0	0	0												12.8064	0.376262973	1.995305382	0	0.62975922	1.390362267	1.810525055	2.934604334	7.076077001	3.026538622	6.4415684	0	0.005329798	1.923776181	6.422876534	19.1270287	0.512741726	1.718615726	0	0	3.499075504	1.471491159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1683	0	13.40820776	12.8064	0.376262973	1.995305382	0	0.62975922	1.390362267	1.810525055	2.934604334	7.076077001	3.026538622	6.4415684	0	0.005329798	1.923776181	6.422876534	19.1270287	0.512741726	1.718615726	0	0	3.499075504	1.471491159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1683	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0534	0.031	0.2053	0	0.1748	0.3859	0.5025	0.8145	1.964	0.84	1.7879	0	0.0015	0.5339	0.9393	2.7972	0.075	0.2513	0	0	0.5117	0.2152	0	0	0	0	0	0	0	0											13.0845	0	0	13.8598	0.40721366	2.200605213	0	0.804550666	1.776261232	2.313041385	3.749112035	9.04006211	3.866562944	8.22944386	0	0.006809098	2.45772568	7.362187323	21.92425271	0.587727417	1.969953936	0	0	4.010796281	1.686688745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2528
H1286_803_0	2011	1																															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	193.4325285	5.6832105	16.55453199	180.9411813	3.198126751	7.060721968	9.194448331	14.90289673	35.93467221	15.36976962	32.71242652	0	0.027066485	9.76957521	32.61750301	97.13341257	2.603873	8.727702192	0	0	17.76946905	7.472721461	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078338418	0.078338418	0.142616418	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.06620606	0.06620606	0.120529253	0	0.196915028	0.196915028	0.196915028	0.196915028	0.196915028	0.196915028	0.196915028	0	0.196915028	0.196915028	0.196915028	0.196915028	0.196915028	0.196915028	0	0	0.196915028	0.196915028	0	0	0	0	0	0	0	0												12.8064	0.376262973	1.995305382	0	0.62975922	1.390362267	1.810525055	2.934604334	7.076077001	3.026538622	6.4415684	0	0.005329798	1.923776181	6.422876534	19.1270287	0.512741726	1.718615726	0	0	3.499075504	1.471491159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1683	0	13.40820776	12.8064	0.376262973	1.995305382	0	0.62975922	1.390362267	1.810525055	2.934604334	7.076077001	3.026538622	6.4415684	0	0.005329798	1.923776181	6.422876534	19.1270287	0.512741726	1.718615726	0	0	3.499075504	1.471491159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1683	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0534	0.031	0.2053	0	0.1748	0.3859	0.5025	0.8145	1.964	0.84	1.7879	0	0.0015	0.5339	0.9393	2.7972	0.075	0.2513	0	0	0.5117	0.2152	0	0	0	0	0	0	0	0											13.0845	0	0	13.8598	0.40721366	2.200605213	0	0.804550666	1.776261232	2.313041385	3.749112035	9.04006211	3.866562944	8.22944386	0	0.006809098	2.45772568	7.362187323	21.92425271	0.587727417	1.969953936	0	0	4.010796281	1.686688745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2528
H1286_804_0	2011	1																															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	193.4325285	5.6832105	16.55453199	180.9411813	3.198126751	7.060721968	9.194448331	14.90289673	35.93467221	15.36976962	32.71242652	0	0.027066485	9.76957521	32.61750301	97.13341257	2.603873	8.727702192	0	0	17.76946905	7.472721461	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078338418	0.078338418	0.142616418	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.06620606	0.06620606	0.120529253	0	0.196915028	0.196915028	0.196915028	0.196915028	0.196915028	0.196915028	0.196915028	0	0.196915028	0.196915028	0.196915028	0.196915028	0.196915028	0.196915028	0	0	0.196915028	0.196915028	0	0	0	0	0	0	0	0												12.8064	0.376262973	1.995305382	0	0.62975922	1.390362267	1.810525055	2.934604334	7.076077001	3.026538622	6.4415684	0	0.005329798	1.923776181	6.422876534	19.1270287	0.512741726	1.718615726	0	0	3.499075504	1.471491159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1683	0	13.40820776	12.8064	0.376262973	1.995305382	0	0.62975922	1.390362267	1.810525055	2.934604334	7.076077001	3.026538622	6.4415684	0	0.005329798	1.923776181	6.422876534	19.1270287	0.512741726	1.718615726	0	0	3.499075504	1.471491159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1683	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0534	0.031	0.2053	0	0.1748	0.3859	0.5025	0.8145	1.964	0.84	1.7879	0	0.0015	0.5339	0.9393	2.7972	0.075	0.2513	0	0	0.5117	0.2152	0	0	0	0	0	0	0	0											13.0845	0	0	13.8598	0.40721366	2.200605213	0	0.804550666	1.776261232	2.313041385	3.749112035	9.04006211	3.866562944	8.22944386	0	0.006809098	2.45772568	7.362187323	21.92425271	0.587727417	1.969953936	0	0	4.010796281	1.686688745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2528
H1291_001_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1174.465194	80.983225	459.401	316.692735	39.941868	9.336381	3.902204	355.209299	30.144463	13.207899	11.702051	2.943394	0.227151	18.545399	3009.90542	2401.177347	100.660114	1.433742		1351.459084	9.042467	0							3.41	0.56	1022.919654	410.312149	266.789489	0	278.598512							$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							140.1309	119.971605	32.5726	0	150	0.2	0.2	50	0.245449	0.25	0.24242	0.25	0.2	0.230495	15	34.153049	35	0.25		0	0.2	0							0	0	0	0	38.569492	0	35						NO	126.062739	107.927296	25.153148	0	133.7043	0.178272	0.178272	44.5681	0.218784	0.222841	0.216084	0.222841	0.178272	0.205454	13.37043	30.44273	31.19767	0.222841		0	0.178272	0							0	0	0	0	34.379379	0	31.19767							12.338	0.728358375	0.962948445	0	0.445033292	1.664415314	0.695653711	1.319250297	6.595126193	2.943261421	2.528625988	0.655908862	0.040494663	3.810226406	3.353644144	6.091532805	0.261696752	0.319496501	0	0	1.612018677	0	0	0	0	0	0	0	0	0	0	0	0.76433808	0	0.724302037	0	0	0	0	0	47.8544	0	5.864754289	12.338	0.728358375	0.962948445	0	0.445033292	1.664415314	0.695653711	1.319250297	6.595126193	2.943261421	2.528625988	0.655908862	0.040494663	3.810226406	3.353644144	6.091532805	0.261696752	0.319496501	0	0	1.612018677	0	0	0	0	0	0	0	0	0	0	0	0.76433808	0	0.724302037	0	0	0	0	0	47.8544	YES	$195/Day(Days 1-7)	$195/Day(Days 1-7)	$0/Day(Days 1-8) $50(Days 9-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$35/Visit						5000	5.3503	0.3158	0.4152	0	2.32	1.9978	0.835	0.5722	2.9191	1.3027	1.1192	0.2903	0.0179	1.6867	1.5671	2.8464	0.1223	0.1414		0	0.7727	0									0	0	0.3572	0	0.3384						25.2877	0	3.301158707	17.6883	1.044203888	1.37816045	0	2.764994399	3.662173238	1.530630276	1.891414187	9.514263085	4.246005949	3.647847024	0.946226715	0.058418615	5.496953059	4.920708907	8.937936888	0.383980374	0.460911645	0	0	2.384741653	0	0	0	0	0	0	0	0	0	0	0	1.121492039	0	1.062748261	0	0	0	0	0	73.1421
H1291_003_0	2011	4	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin		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	NO	203.604702	4.533663	24.983794	318.538737	1.77737	9.390802	3.92495	357.279814	39.684804	15.10788	20.043139	2.960551	0.228476	18.6535	25.137876	31.356041	0.858045	3.381448		1359.336739	9.095174	0		3.57	1.82				3.41	0.56	1028.882253											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit:14b-j.Preventive Services	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											0.0886	0.0886	0.1854	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0		0	0				0	0	0										NO	0.072954	0.072954	0.087646	0	0.19683	0.19683	0.19683	42.2383	0.19683	0.19683	0.19683	0.19683	0.19683	0.19683	0.19683	0.19683	0.19683	0.19683		0	0.19683	0		0	0				0	0	0											14.8538	0.330748851	2.189729609	0	0.349839737	1.848391558	0.772547909	1.257574331	7.811159971	2.97368402	3.945091049	0.582725253	0.044970931	3.671568405	4.947888133	6.17180955	0.168888997	0.66557041	0	0	1.790203098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3762	0	12.498302	14.8538	0.330748851	2.189729609	0	0.349839737	1.848391558	0.772547909	1.257574331	7.811159971	2.97368402	3.945091049	0.582725253	0.044970931	3.671568405	4.947888133	6.17180955	0.168888997	0.66557041	0	0	1.790203098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3762	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	$50/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		0.5							$0/Service										5000	6.5609	0.1461	0.9525	0	1.8235	2.2183	0.9272	0.5454	3.5247	1.3161	1.7963	0.2579	0.0199	1.6252	2.3715	2.9581	0.0809	0.3086		0	0.858	0		0							0										28.291	0	6.608447471	21.4147	0.476840207	3.142254323	0	2.173347221	4.06671235	1.699710173	1.802925178	11.33583539	4.289745972	5.741343613	0.840621617	0.064873542	5.296758379	7.319386428	9.12992764	0.249836702	0.974150082	0	0	2.648238845	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.6672
H1291_007_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Radiology									Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin							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	NO	203.604702	4.533663	24.983794	318.538737	1.77737	9.390802	3.92495	357.279814	39.684804	15.10788	18.725178	2.960551	0.228476	18.6535	25.137876	31.356041	0.858045	3.381448		1359.336739	9.095174	0							3.41	0.56	1028.882253	130.345739										Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"0%-20% Coins:8a. 0% Lab -- FSL,8a. 20% Lab -- OP"	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"20% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"										0.0886	0.0886	0.1854	0	0.2	0.2	0.2	50	0.2	0.175867	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0							0	0	0	0									NO	0.080825	0.080825	0.120338	0	0.183347	0.183347	0.183347	45.83665	0.183347	0.161223	0.183347	0.183347	0.183347	0.183347	0.183347	0.183347	0.183347	0.183347		0	0.183347	0							0	0	0	0										16.4564	0.366433312	3.006499802	0	0.325875457	1.721775374	0.719627808	1.364709149	7.276089759	2.435737737	3.433205211	0.542808144	0.041890389	3.420063265	4.608954151	5.749036049	0.157319977	0.619978346	0	0	1.667572867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9139	0	6.339764168	16.4564	0.366433312	3.006499802	0	0.325875457	1.721775374	0.719627808	1.364709149	7.276089759	2.435737737	3.433205211	0.542808144	0.041890389	3.420063265	4.608954151	5.749036049	0.157319977	0.619978346	0	0	1.667572867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9139	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	0%-20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		$0/Visit	20% Coins	20% Coins									$0/Service	$0/Visit									6700	7.3118	0.1628	1.3165	0	1.7032	2.0719	0.866	0.5934	3.2921	1.0809	1.5705	0.2409	0.0186	1.5179	2.215	2.7629	0.0756	0.2882		0	0.8014	0									0	0									27.8894	0	3.33813865	23.7681	0.529244064	4.323001812	0	2.029034846	3.79369113	1.585599091	1.958112043	10.56814317	3.51662005	5.003676621	0.783683829	0.060479464	4.937993729	6.823937979	8.511923859	0.232925284	0.908192336	0	0	2.468979854	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8033
H1291_801_0	2011	4																															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	260.889819	2.327638	54.611388	18.860357	2.1421	9.533202	3.886731	17.802482	56.813103	14.683555	25.834592	5.592563	0.357847	19.676852	31.622895	61.559036	0.554493	9.364296		6.434126	26.087184	0																				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.088575	0.088575	0.185408	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.07554	0.07554	0.083221	0	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538		0.201538	0.201538	0																				19.7076	0.175829775	4.544814321	0	0.43171455	1.921302465	0.783323992	3.587876617	11.44999915	2.959294308	5.206652002	1.127113962	0.072119769	3.965633398	6.373215013	12.406485	0.11175141	1.887261487	0	1.296720886	5.257558889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2663	0	18.19655024	19.7076	0.175829775	4.544814321	0	0.43171455	1.921302465	0.783323992	3.587876617	11.44999915	2.959294308	5.206652002	1.127113962	0.072119769	3.965633398	6.373215013	12.406485	0.11175141	1.887261487	0	1.296720886	5.257558889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2663	YES	8% Coins	8% Coins	18% Coins	0% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins		23% Coins	23% Coins	23% Coins																			6700	3.0367	0.0271	0.6979	0	1.7444	1.2796	0.5217	0.5527	1.8487	0.4559	0.8526	0.1736	0.0111	0.6109	1.1655	2.2687	0.0204	0.3264		0.2371	0.9614	0																			16.7925	0	3.228513723	22.7443	0.202923041	5.242665679	0	2.176081793	3.200939335	1.305038433	4.140565564	13.29867276	3.41515423	6.059273587	1.300738376	0.083229614	4.576549685	7.538668561	14.67522708	0.132187117	2.2136819	0	1.533849063	6.21899515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0588
H1291_802_0	2011	3																															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	260.889819	2.327638	54.611388	18.860357	2.1421	9.533202	3.886731	17.802482	56.813103	14.683555	25.834592	5.592563	0.357847	19.676852	31.622895	61.559036	0.554493	9.364296		6.434126	26.087184	0																				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.088575	0.088575	0.185408	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.07554	0.07554	0.083221	0	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538		0.201538	0.201538	0																				19.7076	0.175829775	4.544814321	0	0.43171455	1.921302465	0.783323992	3.587876617	11.44999915	2.959294308	5.206652002	1.127113962	0.072119769	3.965633398	6.373215013	12.406485	0.11175141	1.887261487	0	1.296720886	5.257558889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2663	0	18.19655024	19.7076	0.175829775	4.544814321	0	0.43171455	1.921302465	0.783323992	3.587876617	11.44999915	2.959294308	5.206652002	1.127113962	0.072119769	3.965633398	6.373215013	12.406485	0.11175141	1.887261487	0	1.296720886	5.257558889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2663	YES	8% Coins	8% Coins	18% Coins(Days 1-7) 18%(Days 8-100)	0% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins		23% Coins	23% Coins	23% Coins																			6700	3.0367	0.0271	0.6979	0	1.7444	1.2796	0.5217	0.5527	1.8487	0.4559	0.8526	0.1736	0.0111	0.6109	1.1655	2.2687	0.0204	0.3264		0.2371	0.9614	0																			16.7925	0	3.228513723	22.7443	0.202923041	5.242665679	0	2.176081793	3.200939335	1.305038433	4.140565564	13.29867276	3.41515423	6.059273587	1.300738376	0.083229614	4.576549685	7.538668561	14.67522708	0.132187117	2.2136819	0	1.533849063	6.21899515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0588
H1291_803_0	2011	3																															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	260.889819	2.327638	54.611388	18.860357	2.1421	9.533202	3.886731	17.802482	56.813103	14.683555	25.834592	5.592563	0.357847	19.676852	31.622895	61.559036	0.554493	9.364296		6.434126	26.087184	0																				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.088575	0.088575	0.185408	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.07554	0.07554	0.083221	0	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538	0.201538		0.201538	0.201538	0																				19.7076	0.175829775	4.544814321	0	0.43171455	1.921302465	0.783323992	3.587876617	11.44999915	2.959294308	5.206652002	1.127113962	0.072119769	3.965633398	6.373215013	12.406485	0.11175141	1.887261487	0	1.296720886	5.257558889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2663	0	18.19655024	19.7076	0.175829775	4.544814321	0	0.43171455	1.921302465	0.783323992	3.587876617	11.44999915	2.959294308	5.206652002	1.127113962	0.072119769	3.965633398	6.373215013	12.406485	0.11175141	1.887261487	0	1.296720886	5.257558889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2663	YES	8% Coins	8% Coins	18% Coins(Days 1-7) 18%(Days 8-100)	0% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins		23% Coins	23% Coins	23% Coins																			6700	3.0367	0.0271	0.6979	0	1.7444	1.2796	0.5217	0.5527	1.8487	0.4559	0.8526	0.1736	0.0111	0.6109	1.1655	2.2687	0.0204	0.3264		0.2371	0.9614	0																			16.7925	0	3.228513723	22.7443	0.202923041	5.242665679	0	2.176081793	3.200939335	1.305038433	4.140565564	13.29867276	3.41515423	6.059273587	1.300738376	0.083229614	4.576549685	7.538668561	14.67522708	0.132187117	2.2136819	0	1.533849063	6.21899515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0588
H1302_001_0	2011	7																															D	D	D		T	Coin	Coin	V	V	Coin	Coin		Coin	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	0	0	0	0	0	0	0											0	YES	269.4064441	31.19520496	98.62521945	0	43.23844769	9.410056636	1.186004775	161.3165553	153.4823399	4.895179909	8.14574514	0	0.0694766	450.699462	727.6003488	7116.77394	130.4547617	532.3447275	12.67763238	0	5.072009971	0	0	0	110.8435263	0	0	0	0	0											3000	$125/Days 1-5 for IP Med/Surg; $125/Days 1-5 for IP Med/Surg; PBP 1a	$125/Days 1-5 for IP MH/SA; PBP 1b	$50/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics; 10% Coinsurance for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"$175/Case for OP Surg; $175/Case for ASC services; PBP 9a, 9b"	10% Coinsurance for OP Lab; PBP 8a	10% Coinsurance for OP Rad - General; 10% Coinsurance for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for Renal Dialysis; PBP 12	"$25/Visit for CORF; $20/Day for Partial Hosp; $25/Case for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5,7c, 7i,  9c, 9d, 13a"	"$20/Visit for PCP OV; PBP 4b, 7a, 14b-j"	"$20/Visit for Chiro - cvd; $20/Visit for SCP OV; $20/Visit for SCP - Office Surg; $25/Visit for Podiatry; $25/Exam for Vision Exams; 10% Coinsurance for Hearing Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	10% Coinsurance for Phys Rad - General; 10% Coinsurance for Phys Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing;	10% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing;	PBP 10b	"10% Coinsurance for Comprehensive Dental; PBP 16a, 16b"	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b											0	125	125	50	0	148.6872159	0.1	0.1	49.1129909	175	0.1	0.1	0	0.2	21.63559779	20	16.92002865	25	25	0.1	0	0.1	0	0	0	25	0	0	0	0	0											NO	116.3997177	116.3997177	46.55988707	0	138.4571996	0.093119774	0.093119774	45.7339062	162.9596047	0.093119774	0.093119774	0	0.186239548	20.14701979	18.6527106	15.75589246	23.27994353	23.27994353	0.093119774	0	0.093119774	0	0	0	23.95563386	0	0	0	0	0												2.6132	0.302592754	0.382664923	0	0.498889532	0.876262349	0.110440497	0.614803018	2.08428512	0.455838048	0.758529948	0	0.012939291	0.756687582	1.130976562	9.344260404	0.253081624	1.032746266	1.180538264	0	0.472304423	0	0	0	0.221277244	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.1024	0	1.698360274	2.6132	0.302592754	0.382664923	0	0.498889532	0.876262349	0.110440497	0.614803018	2.08428512	0.455838048	0.758529948	0	0.012939291	0.756687582	1.130976562	9.344260404	0.253081624	1.032746266	1.180538264	0	0.472304423	0	0	0	0.221277244	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.1024	YES	$150/Days 1-10 for IP Med/Surg; $150/Days 1-10 for IP Med/Surg; PBP 1a	$150/Days 1-10 for IP MH/SA; PBP 1b	$100/Days 1-12 for SNF; PBP 2	10% Coinsurance for HH; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; 20% Coinsurance for DMS; PBP 11b, 11c"	"$50/Case for OP ER; $50/Case for OP ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Surg; 20% Coinsurance for ASC services; PBP 9a, 9b"	20% Coinsurance for OP Lab; PBP 8a	25% Coinsurance for OP Rad - General; 25% Coinsurance for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for Renal Dialysis; PBP 12	"$30/Visit for CORF; 25% Coinsurance for Partial Hosp; $30/Visit for OP - PT/OT/ST; 25% Coinsurance for OP - Other; 25% Coinsurance for OP Substance Abuse; 25% Coinsurance for Cardiac Rehab; PBP 3, 5,7c, 7i,  9c, 9d, 13a"	"$30/Visit for PCP OV; 25% Coinsurance for PCP - IP Visit; PBP 4b, 7a, 14b-j"	"$30/Visit for Chiro - cvd; $30/Visit for SCP OV; 25% Coinsurance for SCP - Office Surg; 17% Coinsurance for SCP - IP/OP Surg; $30/Visit for SCP - Other; $30/Visit for Podiatry; $30/Visit for Vision Exams; $30/Visit for Hearing Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"25% Coinsurance for MH - Non Phys; 25% Coinsurance for Psych Services ; PBP 7e, 7h"	"$30/Visit for OP PT/OT/ST; $30/Visit for PT/ST; PBP 7c, 7i"	25% Coinsurance for Phys Rad - General; 25% Coinsurance for Phys Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing;	20% Coinsurance for Medicare Part B Drugs; PBP 15	25% Coinsurance for Blood;	No Cost Sharing; PBP 10b	"25% Coinsurance for Comprehensive Dental; PBP 16a, 16b"	$30/Visit for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	25% Coinsurance for Other Non-Covered; PBP 13b											3000	0.4025	0.0064	0.1012	0.1168	0.9222	0.3672	0.0329	0.1757	0.8923	0.1845	0.4052	0	0.0032	1.022	0.1634	2.4681	0.1026	0.2332	0.4121	0	0.1472	0	0	0	0.0153	0	0	0	0	0											8.1739	0	0.602115618	3.0157	0.309012404	0.483909333	0.116761229	1.421099635	1.243461152	0.143322074	0.79045894	2.976599719	0.640381277	1.163695178	0	0.016101206	1.778679221	1.294406931	11.81235977	0.35564071	1.26596958	1.592643961	0	0.619545955	0	0	0	0.236546974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.2763
H1302_004_0	2011	5																															D	D			T	Coin	Coin	V	V	Coin	Coin			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	0	0	0	0	0	0	0											0	YES	357.0089531	78.07269592	0	0	83.19282663	8.925894728	1.562938037	206.3456396	174.8038325	8.059393311	10.97774158	0	0	1368.830792	0	7036.293195	116.9232584	389.8081113	7.713082673	0	0.633431488	0	0	0	21.62482943	0	0	0	0	0											3000	$125/Days 1-5 for IP Med/Surg; $125/Days 1-5 for IP Med/Surg; PBP 1a	$125/Days 1-5 for IP MH/SA; PBP 1b	$50/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics; 10% Coinsurance for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"$175/Case for OP Surg; $175/Case for ASC services; PBP 9a, 9b"	10% Coinsurance for OP Lab; PBP 8a	10% Coinsurance for OP Rad - General; 10% Coinsurance for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for Renal Dialysis; PBP 12	"$25/Visit for CORF; $20/Day for Partial Hosp; $25/Case for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5,7c, 7i,  9c, 9d, 13a"	"$20/Visit for PCP OV; PBP 4b, 7a, 14b-j"	"$20/Visit for Chiro - cvd; $20/Visit for SCP OV; $20/Visit for SCP - Office Surg; $25/Visit for Podiatry; $25/Exam for Vision Exams; 10% Coinsurance for Hearing Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	10% Coinsurance for Phys Rad - General; 10% Coinsurance for Phys Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing;	10% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing;	PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b											0	125	125	0	0	150	0.1	0.1	49.67806058	175	0.1	0.1	0	0	25	0	20.85948567	25	25	0.1	0	0.1	0	0	0	25	0	0	0	0	0											NO	114.3177733	114.3177733	0	0	137.1813279	0.091454219	0.091454219	45.43268213	160.0448826	0.091454219	0.091454219	0	0	22.86355465	0	19.07687962	22.86355465	22.86355465	0.091454219	0	0.091454219	0	0	0	22.86355465	0	0	0	0	0												3.401	0.743758063	0	0	0.951041869	0.816310728	0.142937277	0.781236321	2.331371571	0.737065518	1.003960778	0	0	2.608028135	0	11.18587652	0.222773442	0.742699921	0.705393949	0	0.057929982	0	0	0	0.041201706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.4726	0	2.473688671	3.401	0.743758063	0	0	0.951041869	0.816310728	0.142937277	0.781236321	2.331371571	0.737065518	1.003960778	0	0	2.608028135	0	11.18587652	0.222773442	0.742699921	0.705393949	0	0.057929982	0	0	0	0.041201706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.4726	YES	$150/Days 1-10 for IP Med/Surg; $150/Days 1-10 for IP Med/Surg; PBP 1a	$150/Days 1-10 for IP MH/SA; PBP 1b	$100/Days 1-12 for SNF; PBP 2	10% Coinsurance for HH; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; 20% Coinsurance for DMS; PBP 11b, 11c"	"$50/Case for OP ER; $50/Case for OP ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Surg; 20% Coinsurance for ASC services; PBP 9a, 9b"	20% Coinsurance for OP Lab; PBP 8a	25% Coinsurance for OP Rad - General; 25% Coinsurance for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for Renal Dialysis; PBP 12	"$30/Visit for CORF; 25% Coinsurance for Partial Hosp; $30/Visit for OP - PT/OT/ST; 25% Coinsurance for OP - Other; 25% Coinsurance for OP Substance Abuse; 25% Coinsurance for Cardiac Rehab; PBP 3, 5,7c, 7i,  9c, 9d, 13a"	"$30/Visit for PCP OV; 25% Coinsurance for PCP - IP Visit; PBP 4b, 7a, 14b-j"	"$30/Visit for Chiro - cvd; $30/Visit for SCP OV; 25% Coinsurance for SCP - Office Surg; 17% Coinsurance for SCP - IP/OP Surg; $30/Visit for SCP - Other; $30/Visit for Podiatry; $30/Visit for Vision Exams; $30/Visit for Hearing Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"25% Coinsurance for MH - Non Phys; 25% Coinsurance for Psych Services ; PBP 7e, 7h"	"$30/Visit for OP PT/OT/ST; $30/Visit for PT/ST; PBP 7c, 7i"	25% Coinsurance for Phys Rad - General; 25% Coinsurance for Phys Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing;	20% Coinsurance for Medicare Part B Drugs; PBP 15	25% Coinsurance for Blood;	No Cost Sharing; PBP 10b	"25% Coinsurance for Comprehensive Dental; PBP 16a, 16b"	$30/Visit for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	25% Coinsurance for Other Non-Covered; PBP 13b											3000	0.1791	0	0.0417	0.0676	1.0931	1.7561	0	0.1044	0.2492	0.1197	0.218	0	0.1293	0.9621	0	2.3952	0.0827	0.2113	0.334	0	0.0047	0	0	0	0	0	0	0	0	0											7.9482	0	0.742155732	3.5801	0.743758063	0.041709144	0.067602593	2.044170682	2.572402882	0.142937277	0.885629297	2.580621565	0.856758233	1.221994965	0	0.129279549	3.570169874	0	13.58110704	0.305431016	0.953958527	1.039417974	0	0.062600356	0	0	0	0.041201706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4209
H1303_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	827.5991679	82.46737911	841.1166079	351.6956758	110.6449098	9.651604517	10.88914862	531.7789596	476.0848024	16.09679544	33.98449805	0	0.023429448	1771.487146	4713.346005	76.03034982	415.5882155	689.7716459	0	0	8.657989883	1011.587384	0	0	403.122893	0	14.65773254	6.434100353	859.1017717	0											3200	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-42 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$195 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $195 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												167.6241497	112.1244337	57.21006449	0	200	0.2	0.121377106	49.82124009	195	0.113053309	0.166856626	0	0.2	77.2980418	9.883915764	0.118459145	38.5	30	0	0	0.2	29.8471594	0	0	30	0	30	0	0	0											NO	122.0242394	81.62247959	41.64683083	0	145.5926722	0.145592672	0.088358086	36.28182969	141.9528554	0.082298667	0.12146551	0	0.145592672	56.27014231	9.439012089	0.113137654	36.76700349	28.64961311	0	0	0.145592672	21.72763847	0	0	30	0	30	0	0	0												8.4156	0.560932664	2.919153423	0	1.342424007	1.405202893	0.962144328	1.607826137	5.631799759	1.324744809	4.127944393	0	0.003411156	8.306819485	3.70744416	8.601895379	1.273327781	1.646807566	0	0	1.260539883	1.83161708	0	0	1.007807232	0	0.036644331	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9741	0	15.5519135	8.4156	0.560932664	2.919153423	0	1.342424007	1.405202893	0.962144328	1.607826137	5.631799759	1.324744809	4.127944393	0	0.003411156	8.306819485	3.70744416	8.601895379	1.273327781	1.646807566	0	0	1.260539883	1.83161708	0	0	1.007807232	0	0.036644331	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9741	YES	"$350 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$350 Days 1-20 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-40 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											7000	0.5094	0.044	1.4542	0.19	0.1328	0.2085	0.2352	0.159	0.9085	0.131	0.5994	0	0.0003	0.4525	2.1892	3.4454	0.442	0.6745	0	0	0.5808	0.7507	0	0	0.4128	0	0.015	0	0	0											13.5351	0	2.692352429	8.925	0.604959706	4.373362328	0.189993931	1.475191216	1.613667058	1.197338101	1.766841909	6.540313042	1.455763527	4.727307504	0	0.003748523	8.759357591	5.896627643	12.0472519	1.715279848	2.321316983	0	0	1.841376888	2.582271551	0	0	1.420591023	0	0.051653339	0	0	0	0	0	0	0	0	0	0	0	0	0	69.5092
H1303_004_0	2011	4																															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	YES	317.4841559	21.725265	35.07630108	1512.143926	9.774071546	19.15607677	21.58294553	28.58632496	37.57959258	17.91617342	33.86954824	0	0.19095083	35.30847509	32.08233099	107.7865815	9.342702	5.750819021	0	0	15.16188109	6.703162294	740.940931	451.5072796	141.5470691	193.159256	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.083022693	0.084030481	0.166717839	0	0.233	0.233	0.233	0.116234723	0.233	0.233	0.233	0	0.233	0.233	0.226628959	0.232855263	0.232818838	0.233	0	0	0.233	0.231801132	0	0	0	0	0	0	0	0											NO	0.063823241	0.064597973	0.128163426	0	0.179117475	0.179117475	0.179117475	0.089368719	0.179117475	0.179117475	0.179117475	0	0.179117475	0.179117475	0.17352731	0.178294723	0.178266832	0.178405546	0	0	0.179117475	0.178824844	0	0	0	0	0	0	0	0												20.2629	1.403408077	4.495498929	0	1.750707019	3.43118811	3.865882715	2.554723247	6.731161749	3.209099752	6.066627973	0	0.034202631	6.324364918	5.567160601	19.21777868	1.665493892	1.025978008	0	0	2.715757863	1.19869195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5206	0	27.66805901	20.2629	1.403408077	4.495498929	0	1.750707019	3.43118811	3.865882715	2.554723247	6.731161749	3.209099752	6.066627973	0	0.034202631	6.324364918	5.567160601	19.21777868	1.665493892	1.025978008	0	0	2.715757863	1.19869195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5206	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	5.445	0.3771	0.8492	0.71	0.4587	0.899	0.9847	0.4681	1.7637	0	1.254	0	0.0063	1.3616	1.784	6.4438	0.5585	0.3438	0	0	0.9099	0.402	0	0.1	0.0624	0	0	0	0	0											25.1818	0	7.570324499	25.7079	1.780531465	5.344663973	0.710049093	2.209419378	4.330212546	4.850578238	3.022846317	8.494830398	3.209099752	7.320650459	0	0.040471608	7.685928801	7.351182344	25.66156931	2.223965898	1.369740598	0	0	3.625695454	1.600674943	0	0.1	0.062399298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7024
H1304_001_0	2011	4																															D	D	D	Coin	T	Coin	Coin	V	V		Coin		Coin	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	0	0	0	0	0	0	0											0	NO	547.9330627	7.498876459	520.8911466	10.58064681	1.18138677	11.28456186	2.565243475	361.0020056	497.5851301	0	18.00122129	0	0.020215894	416.0005483	3473.402135	3824.647935	93.76480521	1691.031752	17.73892235	0	10.21339988	0	0	0	61.42330844	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; $200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$10/Days 1-5, $35/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	10% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $15/Visit for Urgent Care; PBP 4a, 7a"	"$175/Case for OP Surg; $175/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$35/Visit for OP - PT/OT/ST; $35/Visit for OP Substance Abuse; $35/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP OV; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $35/Visit for SCP OV; $35/Visit for Podiatry - cvd; $35/Visit for Vision Exams; $35/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for MH - Non Phys; $35/Visit for Psych Services ; PBP 7e, 7h"	"$35/Visit for OT; $35/Visit for PT/ST; PBP 7c, 7i"	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											0	200	200	24.97374256	0.1	100	0.2	0.2	47.24713546	175	0	0.109973093	0	0.1	35	15	31.39988238	35	35	0.101701998	0	0.1984	0	0	0	35	0	0	0	0	0											NO	180.2354163	180.2354163	22.50576443	0.090117708	90.11770815	0.180235416	0.180235416	42.57803565	157.7059893	0	0.099105231	0	0.090117708	31.54119785	13.51765622	28.29685437	31.54119785	31.54119785	0.091651509	0	0.178793533	0	0	0	31.54119785	0	0	0	0	0												8.2297	0.11263026	0.97692112	0.953503641	0.008871989	2.033877705	0.462347726	1.280896355	6.539346266	0	1.784015188	0	0.00182181	1.093429633	3.912687999	9.018792135	0.246454523	4.444763922	1.625799009	0	1.826089849	0	0	0	0.16144706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7134	0	4.903268042	8.2297	0.11263026	0.97692112	0.953503641	0.008871989	2.033877705	0.462347726	1.280896355	6.539346266	0	1.784015188	0	0.00182181	1.093429633	3.912687999	9.018792135	0.246454523	4.444763922	1.625799009	0	1.826089849	0	0	0	0.16144706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7134	YES	$300/Days 1-5 for IP Med/Surg; $300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$30/Days 1-5, $50/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	20% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $35/Visit for Urgent Care; PBP 4a, 4b"	"$225/Case for OP Surg; $225/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$35/Visit for OP - PT/OT/ST; $35/Visit for OP Substance Abuse; $35/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$35/Visit for PCP OV; PBP 7a, 14b, 14c"	"$35/Visit for Chiro - cvd; $35/Visit for SCP OV; $35/Visit for Podiatry - cvd; $35/Visit for Vision Exams; $35/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for MH - Non Phys; $35/Visit for Psych Services ; PBP 7e, 7h"	"$35/Visit for OT; $35/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											2500	0.8728	0.0603	0.2536	0.0378	1.0442	0.0915	0.6156	0.0988	0.4479	0	0.1376	0	0	0.3366	0.829	0.9936	0.281	0.0672	0.3041	0	0.1949	0	0	1.4537	0.0026	0	0	0	0	0											8.1228	0	0.890740975	9.1025	0.172976468	1.230559527	0.991306616	1.053068725	2.125351421	1.077926335	1.379649734	6.98728268	0	1.921656422	0	0.00182181	1.430007572	4.741731259	10.012417	0.527414354	4.511992431	1.929888741	0	2.020959853	0	0	1.453654769	0.163997271	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8362
H1304_002_0	2011	6																															D	D	D	Coin	T	Coin	Coin	V	V		Coin		Coin	V	V	V	V	V	Coin		Coin				V																1.263318064	0.009866275	0.207850028	0.079461444	7.19E-05	0.115787673	0.0067422	0.122239829	0.381105479	0.02929933	0.133681006	0	0.000519142	0.360213228	0.194748519	0.635953509	0.004826246	0.098427574	0.124879056	0	0	0.006847711	0	0	0	0	0	0	0	0											3.7758	NO	549.1085644	9.870964775	681.1028605	12.41939898	3.042648961	13.63919875	0.663875764	361.0371472	465.0916862	0	20.53353207	0	0.076026453	497.733592	3552.560941	3814.100087	111.9889658	1989.295361	19.43096792	0	9.766519181	0	0	0	66.83465733	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; $200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$10/Days 1-5, $35/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	10% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $15/Visit for Urgent Care; PBP 4a, 7a"	"$175/Case for OP Surg; $175/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$35/Visit for OP - PT/OT/ST; $35/Visit for OP Substance Abuse; $35/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP OV; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $35/Visit for SCP OV; $35/Visit for Podiatry - cvd; $35/Visit for Vision Exams; $35/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for Psych Services ; PBP 7e, 7h"	"$35/Visit for OT; $35/Visit for PT/ST; PBP 7c, 7i"	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											50	198.684645	198.8547147	24.82868974	0.099373668	99.97776257	0.198711568	0.199153878	47.16341617	173.8558223	0	0.100240211	0	0.099317156	34.78815432	14.91437447	30.71396482	34.85656955	34.76785958	0.104358993	0	0.1984	0	0	0	35	0	0	0	0	0											NO	184.900721	185.0589919	23.1061773	0.092479532	93.04171635	0.184925777	0.1853374	43.89141221	161.7944199	0	0.093285958	0	0.09242694	32.37469517	13.87967648	28.58315619	32.43836402	32.35580839	0.097118995	0	0.184635823	0	0	0	32.57184386	0	0	0	0	0												8.4609	0.152225899	1.311473621	1.148540203	0.023591107	2.522239421	0.123041008	1.320535854	6.270769965	0	1.915490203	0	0.007026892	1.34283111	4.109033043	9.084918209	0.302728237	5.363771628	1.887116075	0	1.803249312	0	0	0	0.181410669	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3309	50	3.528407873	9.7242	0.162092174	1.519323649	1.228001646	0.023663043	2.638027094	0.129783208	1.442775683	6.651875444	0.02929933	2.049171208	0	0.007546035	1.703044337	4.303781561	9.720871717	0.307554482	5.462199202	2.01199513	0	1.803249312	0.006847711	0	0	0.181410669	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1067	YES	$300/Days 1-5 for IP Med/Surg; $300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$30/Days 1-5, $50/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	20% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $35/Visit for Urgent Care; PBP 4a, 4b"	"$225/Case for OP Surg; $225/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$35/Visit for OP - PT/OT/ST; $35/Visit for OP Substance Abuse; $35/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$35/Visit for PCP OV; PBP 7a, 14b, 14c"	"$35/Visit for Chiro - cvd; $35/Visit for SCP OV; $35/Visit for Podiatry - cvd; $35/Visit for Vision Exams; $35/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for Psych Services ; PBP 7e, 7h"	"$35/Visit for OT; $35/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											3400	0.3435	0.0725	0.4038	0.1237	1.8508	0.1408	0.0185	0.0637	0.3358	0.0304	0.2514	0	0	0.5256	0.9061	1.094	0.2535	0.1135	0.3006	0	0.0218	0	0	1.4885	0.0033	0	0	0	0	0											8.3416	50	0.547430289	10.0677	0.234592124	1.923157336	1.351655331	1.874481869	2.778816639	0.148239	1.506429283	6.987632053	0.059673063	2.300561056	0	0.007546035	2.228625199	5.209857046	10.81486813	0.561086378	5.575737868	2.312594123	0	1.825022763	0.006847711	0	1.488505871	0.184718441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.4483
H1304_004_0	2011	5																															D	D	D		T	Coin	Coin	V	V		Coin			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	0	0	0	0	0	0	0											0	NO	587.6233664	17.73959356	559.3774591	0	1.658211578	13.7139763	1.013905256	358.9590928	547.0755066	0	22.59592368	0	0	612.364835	4021.121256	4199.948268	176.0093084	1860.957606	20.85123993	0	13.09911475	0	0	0	65.53670164	0	0	0	0	0												$100/Days 1-5 for IP Med/Surg; $100/Days 1-5 for IP Med/Surg; PBP 1a	$100/Days 1-5 for IP MH/SA; PBP 1b	"$0/Days 1-5, $30/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $10/Visit for Urgent Care; PBP 4a, 7a"	"$100/Case for OP Surg; $100/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$25/Visit for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$10/Visit for PCP OV; PBP 7a, 14b, 14c"	"$10/Visit for Chiro - cvd; $25/Visit for SCP OV; $25/Visit for Podiatry - cvd; $25/Visit for Vision Exams; $25/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OT; $25/Visit for PT/ST; PBP 7c, 7i"	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	10% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											0	100	100	17.96849107	0	100	0.1	0.1	46.97592387	100	0	0.101974013	0	0	25	10	22.2074284	25	25	0.104249349	0	0.0989	0	0	0	25	0	0	0	0	0											NO	95.87129765	95.87129765	17.22662556	0	95.87129765	0.095871298	0.095871298	45.0364278	95.87129765	0	0.09776381	0	0	23.96782441	9.587129765	21.29054978	23.96782441	23.96782441	0.099945203	0	0.094816713	0	0	0	23.96782441	0	0	0	0	0												4.6947	0.141726488	0.803015503	0	0.013247908	1.314776704	0.097204413	1.347186272	4.370736561	0	2.209063581	0	0	1.223087737	3.212584274	7.451600639	0.351546683	3.716925429	2.083981417	0	1.242015008	0	0	0	0.13089768	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4043	0	1.48162212	4.6947	0.141726488	0.803015503	0	0.013247908	1.314776704	0.097204413	1.347186272	4.370736561	0	2.209063581	0	0	1.223087737	3.212584274	7.451600639	0.351546683	3.716925429	2.083981417	0	1.242015008	0	0	0	0.13089768	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4043	YES	$250/Days 1-5 for IP Med/Surg; $250/Days 1-5 for IP Med/Surg; PBP 1a	$250/Days 1-5 for IP MH/SA; PBP 1b	"$20/Days 1-5, $40/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	10% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"$200/Case for OP Surg; $200/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	10% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$25/Visit for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$25/Visit for PCP OV; PBP 7a, 14b, 14c"	"$25/Visit for Chiro - cvd; $25/Visit for SCP OV; $25/Visit for Podiatry - cvd; $25/Visit for Vision Exams; $25/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OT; $25/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	10% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											2500	1.8422	0.1683	0.2717	0.0181	1.0954	0.1875	0.0222	0.1263	0.3848	0	0.205	0	0	0.1406	0.8551	1.2365	0.2837	0.1126	0.4092	0	0.0987	0	0	1.7044	0.0058	0	0	0	0	0											9.1678	0	0.394810721	6.5368	0.309994082	1.074668661	0.018104067	1.108623016	1.502226753	0.11943364	1.473452521	4.755522146	0	2.414037661	0	0	1.363668366	4.067646575	8.688087821	0.63526722	3.82952001	2.493143856	0	1.340679685	0	0	1.704421585	0.136715354	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5721
H1304_803_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	196.6404206	2.065157693	31.75901315	0	0.665328425	17.80217401	2.112869758	18.9252384	59.19473	6.646197454	20.33137296	0	0.035836652	60.923235	34.2832499	109.5994352	1.477747466	15.06060225	19.43046505	3.428922688	16.52987916	1.384179909	0	0	0	0	0	0	0	0												Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 7a"	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 14d-j	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											0	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	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.07702788	0.07702788	0.152824564	0	0.213583164	0.213583164	0.213583164	0.213583164	0.213583164	0.213583164	0.213583164	0	0.213583164	0.213583164	0.213583164	0.213583164	0.213583164	0.213583164	0.213583164	0.213583164	0.213583164	0.213583164	0	0	0	0	0	0	0	0												15.1468	0.159074719	4.853557348	0	0.14210295	3.802244656	0.451273409	4.042112302	12.64299774	1.419515883	4.342438972	0	0.007654106	13.01217731	7.322324996	23.40859418	0.31562198	3.216691084	4.150020209	0.732360158	3.530503896	0.295637525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9937	0	9.3631524	15.1468	0.159074719	4.853557348	0	0.14210295	3.802244656	0.451273409	4.042112302	12.64299774	1.419515883	4.342438972	0	0.007654106	13.01217731	7.322324996	23.40859418	0.31562198	3.216691084	4.150020209	0.732360158	3.530503896	0.295637525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9937	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 14d-j	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											6700	0.9033	0.063	0.859	0	1.6913	0.2279	0.1124	0.3474	0.8165	0.4727	0.2157	0	0	1.4317	0.6836	2.985	0.1938	0.0806	0.3266	0.0685	0.1438	0.0024	0	0	0	0	0	0	0	0											11.6252	0	1.0568476	16.0501	0.222061284	5.712523685	0	1.833429617	4.030169079	0.563682515	4.389489599	13.4594545	1.892239875	4.558144847	0	0.007654106	14.44388101	8.005892979	26.39362936	0.509428472	3.297304833	4.476666161	0.80085701	3.674265418	0.298038274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.6189
H1304_804_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	196.5873826	2.064600677	31.75044708	0	0.665148972	17.79737239	2.112299873	18.92013387	59.17876395	6.644404836	20.32588917	0	0.035826986	60.90680273	34.27400299	109.569874	1.477348887	15.05654009	19.42522425	3.427997836	16.52542071	1.383806567	0	0	0	0	0	0	0	0												Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 7a"	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 14d-j	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											0	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	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077025991	0.077025991	0.152820816	0	0.213577926	0.213577926	0.213577926	0.213577926	0.213577926	0.213577926	0.213577926	0	0.213577926	0.213577926	0.213577926	0.213577926	0.213577926	0.213577926	0.213577926	0.213577926	0.213577926	0.213577926	0	0	0	0	0	0	0	0												15.1423	0.159027913	4.852129231	0	0.142061138	3.801125879	0.451140625	4.040922946	12.63927765	1.419098203	4.341161247	0	0.007651853	13.00834859	7.320170467	23.4017064	0.315529111	3.215744601	4.148799102	0.732144667	3.529465076	0.295550536	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9634	0	9.3631524	15.1423	0.159027913	4.852129231	0	0.142061138	3.801125879	0.451140625	4.040922946	12.63927765	1.419098203	4.341161247	0	0.007651853	13.00834859	7.320170467	23.4017064	0.315529111	3.215744601	4.148799102	0.732144667	3.529465076	0.295550536	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9634	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 14d-j	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											6700	0.903	0.063	0.8587	0	1.6908	0.2279	0.1124	0.3473	0.8162	0.4726	0.2156	0	0	1.4313	0.6834	2.9842	0.1937	0.0806	0.3265	0.0685	0.1437	0.0024	0	0	0	0	0	0	0	0											11.6218	0	1.0568476	16.0454	0.221995945	5.710842825	0	1.832890147	4.028983237	0.563516657	4.388198031	13.45549417	1.8916831	4.556803653	0	0.007651853	14.43963103	8.003537316	26.38586326	0.509278577	3.29633463	4.475348942	0.800621365	3.673184298	0.297950579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.5852
H1350_001_0	2011	6																															A	A	D		T			V	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	0	0	0	0	0	0	0											0	YES	204.0938012	9.0795172	103.8057517	0	282.2435422	0	0	387.9917178	338.6281086	0	0	0	0	1316.836312	3139.220632	5338.128975	271.5412337	1520.438097	0	0	13.56161535	0	0	0	195.7004159	0	0	0	0	0											3000	$100/Admit for IP Med/Surg; $100/Admit for IP Med/Surg; PBP 1a	$100/Admit for IP MH/SA; PBP 1b	$50/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"$175/Case for OP Surg; $175/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"$15/Visit for CORF; $25/Day for Partial Hosp; $15/Case for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $15/Visit for Cardiac Rehab; PBP 3, 5,7c, 7i,  9c, 9d, 13a"	"$15/Visit for PCP OV; PBP 4b, 7a, 14b-j"	"$20/Visit for Chiro - cvd; $25/Visit for SCP OV; $25/Visit for SCP - Office Surg; $25/Visit for Podiatry; $25/Exam for Vision Exams; $25/Visit for Hearing Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$15/Visit for OP PT/OT/ST; $15/Visit for PT/ST; PBP 7c, 7i"	No Cost Sharing; PBP 8b	No Cost Sharing;	10% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing;	PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b											0	100	100	50	0	150	0	0	49.57977388	175	0	0	0	0	15	15	24.78929428	25	15	0	0	0.1	0	0	0	25	0	0	0	0	0											NO	98.3187965	98.3187965	49.15939825	0	147.4781948	0	0	48.74623699	172.0578939	0	0	0	0	14.74781948	14.74781948	24.3725358	24.57969913	14.74781948	0	0	0.098318797	0	0	0	24.57969913	0	0	0	0	0												1.6722	0.0743906	0.425252357	0	3.468730673	0	0	1.576094685	4.855303264	0	0	0	0	1.618372017	3.858054931	10.84197829	0.556200152	1.868595548	0	0	1.333361699	0	0	0	0.400854778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5494	0	0.556578482	1.6722	0.0743906	0.425252357	0	3.468730673	0	0	1.576094685	4.855303264	0	0	0	0	1.618372017	3.858054931	10.84197829	0.556200152	1.868595548	0	0	1.333361699	0	0	0	0.400854778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5494	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	1.6722	0.0743906	0.425252357	0	3.468730673	0	0	1.576094685	4.855303264	0	0	0	0	1.618372017	3.858054931	10.84197829	0.556200152	1.868595548	0	0	1.333361699	0	0	0	0.400854778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5494
H1350_006_0	2011	4																															A	A	D		T			V	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	0	0	0	0	0	0	0											0	YES	161.9305133	3.451415078	103.4494597	0	213.3651032	0	0	296.5717662	235.2131976	0	0	0	0	893.6639356	2207.972432	4194.35117	134.4503733	1086.669246	0	0	4.510976109	0	0	0	195.2999957	0	0	0	0	0											3000	$100/Admit for IP Med/Surg; $100/Admit for IP Med/Surg; PBP 1a	$100/Admit for IP MH/SA; PBP 1b	$50/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"$175/Case for OP Surg; $175/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"$15/Visit for CORF; $25/Day for Partial Hosp; $15/Case for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $15/Visit for Cardiac Rehab; PBP 3, 5,7c, 7i,  9c, 9d, 13a"	"$15/Visit for PCP OV; PBP 4b, 7a, 14b-j"	"$20/Visit for Chiro - cvd; $25/Visit for SCP OV; $25/Visit for SCP - Office Surg; $25/Visit for Podiatry; $25/Exam for Vision Exams; $25/Visit for Hearing Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$15/Visit for OP PT/OT/ST; $15/Visit for PT/ST; PBP 7c, 7i"	No Cost Sharing; PBP 8b	No Cost Sharing;	10% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing;	PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b											0	100	100	50	0	150	0	0	49.58356436	175	0	0	0	0	15	15	24.78935388	25	15	0	0	0.1	0	0	0	25	0	0	0	0	0											NO	99.12586661	99.12586661	49.56293331	0	148.6887999	0	0	49.15013787	173.4702666	0	0	0	0	14.86887999	14.86887999	24.57266186	24.78146665	14.86887999	0	0	0.099125867	0	0	0	24.78146665	0	0	0	0	0												1.3376	0.028510376	0.427271556	0	2.643750094	0	0	1.214711933	3.400208007	0	0	0	0	1.107315151	2.735839759	8.588864418	0.277656453	1.346462884	0	0	0.447154416	0	0	0	0.403318361	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.9587	0	0.211277746	1.3376	0.028510376	0.427271556	0	2.643750094	0	0	1.214711933	3.400208007	0	0	0	0	1.107315151	2.735839759	8.588864418	0.277656453	1.346462884	0	0	0.447154416	0	0	0	0.403318361	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.9587	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	1.3376	0.028510376	0.427271556	0	2.643750094	0	0	1.214711933	3.400208007	0	0	0	0	1.107315151	2.735839759	8.588864418	0.277656453	1.346462884	0	0	0.447154416	0	0	0	0.403318361	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.9587
H1350_009_0	2011	5																																																																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	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; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"No Cost Sharing; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5,7c, 7i,  9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-j"	"No Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 15	No Cost Sharing;	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	0	0	0	0	0	0	0	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
H1350_010_0	2011	4																															A	A	D		T			V	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	0	0	0	0	0	0	0											0	YES	183.5327468	8.164817948	93.34803226	0	253.8094359	0	0	348.9042062	304.5136429	0	0	0	0	1184.174061	2822.965626	4800.348994	244.1853118	1367.264359	0	0	12.19537536	0	0	0	175.9849376	0	0	0	0	0											3000	$100/Admit for IP Med/Surg; $100/Admit for IP Med/Surg; PBP 1a	$100/Admit for IP MH/SA; PBP 1b	$50/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"$175/Case for OP Surg; $175/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"$15/Visit for CORF; $25/Day for Partial Hosp; $15/Case for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $15/Visit for Cardiac Rehab; PBP 3, 5,7c, 7i,  9c, 9d, 13a"	"$15/Visit for PCP OV; PBP 4b, 7a, 14b-j"	"$20/Visit for Chiro - cvd; $25/Visit for SCP OV; $25/Visit for SCP - Office Surg; $25/Visit for Podiatry; $25/Exam for Vision Exams; $25/Visit for Hearing Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$15/Visit for OP PT/OT/ST; $15/Visit for PT/ST; PBP 7c, 7i"	No Cost Sharing; PBP 8b	No Cost Sharing;	10% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing;	PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b											0	100	100	50	0	150	0	0	49.57977388	175	0	0	0	0	15	15	24.78929428	25	15	0	0	0.1	0	0	0	25	0	0	0	0	0											NO	98.63376258	98.63376258	49.31688129	0	147.9506439	0	0	48.90239645	172.6090845	0	0	0	0	14.79506439	14.79506439	24.45061366	24.65844064	14.79506439	0	0	0.098633763	0	0	0	24.65844064	0	0	0	0	0												1.5085	0.06711056	0.383636152	0	3.129272455	0	0	1.421854318	4.38015176	0	0	0	0	1.459994289	3.480496516	9.780956559	0.501769085	1.685730352	0	0	1.202875758	0	0	0	0.361626178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.364	0	0.406739223	1.5085	0.06711056	0.383636152	0	3.129272455	0	0	1.421854318	4.38015176	0	0	0	0	1.459994289	3.480496516	9.780956559	0.501769085	1.685730352	0	0	1.202875758	0	0	0	0.361626178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.364	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	1.5085	0.06711056	0.383636152	0	3.129272455	0	0	1.421854318	4.38015176	0	0	0	0	1.459994289	3.480496516	9.780956559	0.501769085	1.685730352	0	0	1.202875758	0	0	0	0.361626178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.364
H1355_001_0	2011	4																															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	722.927135	5.28629049	1115.906753	65.931505	183.7922883	11.15622739	2.816000325	183.9283249	263.6243715	1.652338528	19.03159944	0	0.019790384	858.3445124	0	3043.899004	188.6002561	127.4107837	18.20822874	28.51251004	6.075057722	0.604862843	0	0	0	0	0	0	0	0												1a:  Acute - $150/$0/day for 1-5/6-90	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	2:  Skilled Nursing Services - $0/$50/$110/day for 1-10/11-20/21-100 /2:  Non-Medicare Covered Stay - $0/$50/$110/day for 1-10/11-20/21-100	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) - $225/visit/9b:  Ambulatory Surgical Center Services - $175/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 - $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) - $225/visit	"7a:  Primary Care - $0/visit/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  OP Phys (Surgery, ER, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $35/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/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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/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:  Eye Glasses & Contact Lenses - $0/service			14a:  Written health education materials - $0/service/14c:  Routine Exams - $0/visit													150	0.077403451	46	0	50	0.2	0.2	40.04208922	220.9051822	0	0.169308798	0	0.2	60.81563261	0	32.52008889	20	35	0	35	0.2	0	0	0	0	0	0	0	0	0											NO	138.7262101	0.071585916	42.54270442	0	46.24207002	0.18496828	0.18496828	37.04423495	204.302258	0	0.156583785	0	0.18496828	56.24481483	0	30.07592455	18.49682801	32.36944901	0	32.36944901	0.18496828	0	0	0	0	0	0	0	0	0												8.3574	0.378423948	3.956140929	0	0.708244655	2.063548192	0.520870737	0.56779034	4.488254531	0	2.980039884	0	0.003660593	4.023119013	0	7.629006399	0.290708875	0.343684739	0	0.076911187	1.123692978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5115	0	3.048234927	8.3574	0.378423948	3.956140929	0	0.708244655	2.063548192	0.520870737	0.56779034	4.488254531	0	2.980039884	0	0.003660593	4.023119013	0	7.629006399	0.290708875	0.343684739	0	0.076911187	1.123692978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5115	YES	1a:  Acute - 20.0%	1b:  Psych - 30.0%	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 - $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 - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	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%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/14c:  Routine Exams - 20.0%/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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/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/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 - 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:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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%		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:  Eye Glasses & Contact Lenses - $0/service			14c:  Routine Exams - 20.0%												4000	4.0854	0	0.8691	0.5317	0.1278	0.308	0.0777	0.0648	0.6361	0.0939	0.3326	0	0.0004	0.351	0.459	1.3288	0	0.0701	0.2786	0.323	0.1309	0.0133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.082	0	6.279	12.4428	0.378423948	4.825226623	0.531650709	0.836044539	2.371499492	0.598602297	0.632607263	5.124392767	0.093863196	3.312595369	0	0.004040942	4.374161604	0.459011885	8.957794671	0.290708875	0.413748492	0.278569442	0.399866524	1.254587703	0.013328709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5935
H1355_002_0	2011	4																															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	343.6684543	5.09600745	417.3998527	7.230371122	42.07786606	5.464861151	8.925172682	92.50677896	11.40190378	3.615364052	9.724440597	0	0.056205604	62.35324041	0	0	1.998441113	0.702588451	12.69542701	0	2.499531844	0.618971267	0	0	0	0	0	0	0	0												"1a:  Acute - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/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 - 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  OP Phys (Surgery, ER, Rad & Path) - $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/17a:  Vision Exams - $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/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/7f:  Routine Podiatry - $0/visit/12 Visits	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/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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 - Non-Routine 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:  Eye Glasses & Contact Lenses - $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													0.077403451	0.077403451	0	0	0.2	0.2	0.2	50	0.2	0	0.136850958	0	0.2	0.02887273	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.075486327	0.075486327	0	0	0.195046411	0.195046411	0.195046411	48.76160278	0.195046411	0	0.133461441	0	0.195046411	0.028157612	0	0	0	0	0	0	0.195046411	0.195046411	0	0	0	0	0	0	0	0												25.9423	0.384678883	0	0	8.207136762	1.065901555	1.7408229	0.375898234	2.223900413	0	1.297837859	0	0.010962701	1.75571835	0	0	0	0	0	0	0.487524716	0.120728124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.6134	0	1.107647931	25.9423	0.384678883	0	0	8.207136762	1.065901555	1.7408229	0.375898234	2.223900413	0	1.297837859	0	0.010962701	1.75571835	0	0	0	0	0	0	0.487524716	0.120728124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.6134	YES	1a:  Acute - 20.0%	1b:  Psych - 30.0%	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 - $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 - 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 - 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%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/14c:  Routine Exams - 20.0%/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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/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/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/7f:  Routine Footcare - 50.0%/12 Visits	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:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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%	10b:  Transportation - 50.0%	"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 - Non-Routine 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:  Eye Glasses & Contact Lenses - $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%												6700	1.7324	0	2.0693	0.0163	0.2117	0.0413	0.0674	0.011	0.0573	0.0557	0.0457	0	0.0003	0.3665	0.0345	0.2846	0	0.0031	0.0182	0.0288	0.0125	0.0039	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.0606	0	6.9062	27.6747	0.384678883	2.069338155	0.016349106	8.418885085	1.107163667	1.808211891	0.386905994	2.281201893	0.055667111	1.343570816	0	0.0112611	2.122216138	0.034546173	0.284559601	0	0.003065548	0.018152536	0.028800311	0.500025605	0.124662684	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.674
H1355_801_0	2011	2																															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	287.9289624	3.314694238	55.11179619	43.16254314	7.676116175	12.38941423	3.127275314	8.297960518	39.14689055	5.185473752	22.4457781	0	0.024792744	18.19739665	53.42312245	114.6885592	1.142978114	4.521721733	19.13577892	21.67965112	7.140137391	0.729540239	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																				0.072386386	0.072386386	0.159191608	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.176091146	0.222770147	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.06112759	0.06112759	0.134431346	0	0.196759766	0.196759766	0.196759766	0.196759766	0.196759766	0.196759766	0.196759766	0	0.196759766	0.196759766	0.148702372	0.188121039	0.196759766	0.196759766	0.196759766	0.196759766	0.196759766	0.196759766	0	0	0	0	0	0	0	0												17.6004	0.20261927	7.408752942	0	1.510350824	2.437738249	0.61532196	1.632704772	7.702533034	1.020292603	4.416426052	0	0.004878214	3.580515511	7.944145023	21.57533089	0.224892107	0.889692911	3.765151387	4.265683087	1.404891764	0.143544167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.3459	0	16.272	17.6004	0.20261927	7.408752942	0	1.510350824	2.437738249	0.61532196	1.632704772	7.702533034	1.020292603	4.416426052	0	0.004878214	3.580515511	7.944145023	21.57533089	0.224892107	0.889692911	3.765151387	4.265683087	1.404891764	0.143544167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.3459	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	Similar to Medicare FFS																			6700	2.0092	0.0231	0.9358	0	0.2006	0.3236	0.0817	0.2315	1.0026	0.1475	0.5225	0	0.0006	0.5154	0.9141	2.5965	0.0277	0.1094	0.4838	0.5197	0.2057	0.021	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.8719	0	2.53	19.6096	0.225749859	8.344571283	0	1.710912864	2.761298739	0.696993516	1.864238378	8.705106492	1.167761124	4.938904166	0	0.005478233	4.095925537	8.858207296	24.17183054	0.252553767	0.999124867	4.248929296	4.785407064	1.610639328	0.164550623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2178
H1355_802_0	2011	2																															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	287.9289624	3.314694238	55.11179619	43.16254314	7.676116175	12.38941423	3.127275314	8.297960518	39.14689055	5.185473752	22.4457781	0	0.024792744	18.19739665	53.42312245	114.6885592	1.142978114	4.521721733	19.13577892	21.67965112	7.140137391	0.729540239	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																				0.072386386	0.072386386	0.159191608	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.176091146	0.222770147	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.06112759	0.06112759	0.134431346	0	0.196759766	0.196759766	0.196759766	0.196759766	0.196759766	0.196759766	0.196759766	0	0.196759766	0.196759766	0.148702372	0.188121039	0.196759766	0.196759766	0.196759766	0.196759766	0.196759766	0.196759766	0	0	0	0	0	0	0	0												17.6004	0.20261927	7.408752942	0	1.510350824	2.437738249	0.61532196	1.632704772	7.702533034	1.020292603	4.416426052	0	0.004878214	3.580515511	7.944145023	21.57533089	0.224892107	0.889692911	3.765151387	4.265683087	1.404891764	0.143544167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.3459	0	16.272	17.6004	0.20261927	7.408752942	0	1.510350824	2.437738249	0.61532196	1.632704772	7.702533034	1.020292603	4.416426052	0	0.004878214	3.580515511	7.944145023	21.57533089	0.224892107	0.889692911	3.765151387	4.265683087	1.404891764	0.143544167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.3459	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	Similar to Medicare FFS																			6700	2.0092	0.0231	0.9358	0	0.2006	0.3236	0.0817	0.2315	1.0026	0.1475	0.5225	0	0.0006	0.5154	0.9141	2.5965	0.0277	0.1094	0.4838	0.5197	0.2057	0.021	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.8719	0	2.53	19.6096	0.225749859	8.344571283	0	1.710912864	2.761298739	0.696993516	1.864238378	8.705106492	1.167761124	4.938904166	0	0.005478233	4.095925537	8.858207296	24.17183054	0.252553767	0.999124867	4.248929296	4.785407064	1.610639328	0.164550623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2178
H1365_001_0	2011	9																															D	D	D		T	Coin	Coin	V	V		Coin	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	YES	417.7076864	8.883730834	5.653262523	0	6.679907992	5.562154246	0.702680165	208.5130231	358.0201306	0	8.925630114	2.036485264	0	591.1150495	2873.800587	2759.885992	277.1439147	751.7211772	3.282030075	0	4.550095856	0	0	0	0	0	0	0	0	0											3000	$182/Days Custom for IP Medical; $182/Days Custom for IP Medical; $182/Days Custom for IP Surg; $182/Days Custom for IP Surg; PBP 1a	$182/Days Custom for IP Psych; $182/Days Custom for IP Psych; $182/Days Custom for IP S/A; $182/Days Custom for IP S/A; PBP 1b	$135/Days Custom for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; PBP 4a, 4b"	"$175/Visit for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad; 20% Coinsurance for OP Rad; 20% Coinsurance for OP Rad; PBP 8b	$50/Visit for Partial Hospitalization; PBP 5	$100/Service for Renal Dialysis; PBP 12	"$25/Visit for OP PT/OT/ST; PBP 3, 9c, 9d, 13a"	"$20/Visit for OV; $20/Visit for OV; $20/Visit for OV; $20/Visit for Consult; PBP 4b, 7a, 14b-c"	"$25/Visit for OV; $25/Visit for OV; $25/Visit for OV; $25/Visit for Consult; $25/Visit for Chiro; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$24/Visit for OP Psych; PBP 7e, 7h"	"$25/Visit for PT/OT/ST; $25/Visit for PT/OT/ST; PBP 7c, 7i"	"20% Coinsurance for Office Rad; 20% Coinsurance for Office Rad; 20% Coinsurance for Office Rad; 20% Coinsurance for Office Rad; 20% Coinsurance for Office Rad; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	No Cost Sharing; PBP 13b											0	182	182	135	0	150	0.2	0.2	50	175	0	0.2	50	0	25.0368514	20	25	24	25	0.2	0	0.2	0	0	0	0	0	0	0	0	0											NO	174.4839992	174.4839992	129.4249445	0	143.8054939	0.191740658	0.191740658	47.93516462	167.7730762	0	0.191740658	47.93516462	0	24.00291187	19.17406585	23.96758231	23.00887902	23.96758231	0.191740658	0	0.191740658	0	0	0	0	0	0	0	0	0												6.0736	0.129172407	0.060972766	0	0.080050622	1.066491118	0.134732358	0.832925508	5.005511553	0	1.711406195	0.008134938	0	1.182373537	4.591870141	5.512316224	0.531397567	1.501411599	0.629298608	0	0.872438376	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.9241	0	1.288998727	6.0736	0.129172407	0.060972766	0	0.080050622	1.066491118	0.134732358	0.832925508	5.005511553	0	1.711406195	0.008134938	0	1.182373537	4.591870141	5.512316224	0.531397567	1.501411599	0.629298608	0	0.872438376	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.9241	YES	30% Coinsurance for IP Medical; 30% Coinsurance for IP Medical; 30% Coinsurance for IP Surg; 30% Coinsurance for IP Surg; PBP 1a	30% Coinsurance for IP Psych; 30% Coinsurance for IP Psych; PBP 1b	30% Coinsurance for SNF; PBP 2	20% Coinsurance for HH; PBP 6	$150/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosthetics; PBP 11b, 11c"	"30% Coinsurance for OP ER; 30% Coinsurance for OP ER; PBP 4a, 4b"	"30% Coinsurance for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	30% Coinsurance for OP Rad; 30% Coinsurance for OP Rad; 30% Coinsurance for OP Rad; PBP 8b	No Cost Sharing; PBP 5	20% Coinsurance; PBP 12	"30% Coinsurance for OP PT/OT/ST; PBP 3, 9c, 9d, 13a"	"30% Coinsurance for IP Visit; 30% Coinsurance for IP Visit; $25/Visit for OV; 30% Coinsurance for OV; 30% Coinsurance for Immunization; $25/Visit for Consult; PBP 4b, 7a, 14b-c"	"30% Coinsurance for IP Visit; 30% Coinsurance for IP Visit; 30% Coinsurance for IP Visit; 30% Coinsurance for OV; 30% Coinsurance for OV; 30% Coinsurance for OV; 30% Coinsurance for OV; 30% Coinsurance for Immunization; 30% Coinsurance for Consult; 30% Coinsurance for Chiro; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"30% Coinsurance for OP Psych; 30% Coinsurance for OP Psych; PBP 7e, 7h"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	"30% Coinsurance for Office Rad; 30% Coinsurance for Office Rad; 30% Coinsurance for Office Rad; 30% Coinsurance for Office Rad; 30% Coinsurance for Office Rad; PBP 7d, 14g-h"	"30% Coinsurance; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	30% Coinsurance for Professional; PBP 13b											5000	2.3697	0.0633	0.0251	0.5166	1.1012	0.3049	0.0176	0.1019	0.1211	0	0.2401	0	0	0.1546	0.1306	2.0183	0.1368	0.0617	1.4331	0.558	1.4873	0	0	0	0	0	0	0	0	0.0347											10.8765	0	0.205945123	8.4434	0.192468686	0.086026094	0.516556065	1.18129548	1.371403403	0.152348955	0.934785469	5.126637384	0	1.951523333	0.008134938	0	1.337002775	4.722464202	7.530589547	0.668191694	1.563085861	2.062354233	0.55800689	2.359727459	0	0	0	0	0	0	0	0	0.034691173	0	0	0	0	0	0	0	0	0	0	40.8006
H1406_013_0	2011	7	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							O	O	O	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	YES	1611.136954	138.363732	697.343176	1184.484967	549.313605	3.743641	1.748279	494.652029	416.317625	1196.720682	780.260959	59.718227	0.576316	5.873196	6643.227179	3883.342394	161.535532	384.462178		1273.739215	19.592427	0							4.51	0.36	115.916962	0	474.468069								3400	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$35/Visit:7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $100 OP Other,5. $35 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"									161.6895	138.428775	49.091	0	100	0.2	0.2	50	97.69381	15.756255	23.777971	100	0.2	0.2	5	34.905193	35	42.068123		0	0.2	0							0	0	0	0	76.721025								NO	135.493376	116.001237	29.098396	0	86.6534	0.173307	0.173307	43.3267	84.655008	13.653331	20.60442	86.6534	0.173307	0.173307	4.33267	30.246537	30.32869	36.453459		0	0.173307	0							0	0	0	0	66.481377									18.1915	1.337530339	1.69096399	0	3.966657628	0.648799191	0.302988989	1.785970005	2.936947656	1.361601965	1.339735376	0.431232284	0.099879597	1.017865979	2.398575925	9.788138284	0.408263423	1.167914687	0	0	3.395504746	0	0	0	0	0	0	0	0	0	0	0	2.628607547	0	0	0	0	0	0	0	54.8987	0	10.12481838	18.1915	1.337530339	1.69096399	0	3.966657628	0.648799191	0.302988989	1.785970005	2.936947656	1.361601965	1.339735376	0.431232284	0.099879597	1.017865979	2.398575925	9.788138284	0.408263423	1.167914687	0	0	3.395504746	0	0	0	0	0	0	0	0	0	0	0	2.628607547	0	0	0	0	0	0	0	54.8987	NO																																																																																		0	0	0	18.1915	1.337530339	1.69096399	0	3.966657628	0.648799191	0.302988989	1.785970005	2.936947656	1.361601965	1.339735376	0.431232284	0.099879597	1.017865979	2.398575925	9.788138284	0.408263423	1.167914687	0	0	3.395504746	0	0	0	0	0	0	0	0	0	0	0	2.628607547	0	0	0	0	0	0	0	54.8987
H1406_022_0	2011	6	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin			V				O	O	O	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	NO	1627.353755	0	745.702296	972.327951	312.016955	1.846623	5.560598	837.92041	211.336957	1619.217584	1121.785572	119.1429	0	0	7195.663501	3282.298561	324.002059	95.791262		1900.647974	9.122084	0			1.65				4.51	0.6	953.357223	0	300.225035									$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$35/Visit:7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS734: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $100 OP Other,5. $35 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"									161.6895	0	45.243839	0	100	0.2	0.2	50	104.361779	23.050138	20.494636	100	0	0	5	34.874885	35	37.635051		0	0.2	0			0				0	0	0	0	67.849712								NO	155.451519	0	39.782953	0	96.2232	0.192446	0.192446	48.1116	100.420243	22.17958	19.720594	96.2232	0	0	4.81116	33.55773	33.67812	36.21365		0	0.192446	0			0				0	0	0	0	65.287164									21.0812	0	2.472186616	0	2.501939155	0.35537521	1.070114843	3.3594743	1.768542381	2.992797162	1.843523152	0.955359258	0	0	2.884957367	9.178874074	0.909315019	0.28907927	0	0	1.755508577	0	0	0	0	0	0	0	0	0	0	0	1.633403425	0	0	0	0	0	0	0	55.0517	0	2.421619738	21.0812	0	2.472186616	0	2.501939155	0.35537521	1.070114843	3.3594743	1.768542381	2.992797162	1.843523152	0.955359258	0	0	2.884957367	9.178874074	0.909315019	0.28907927	0	0	1.755508577	0	0	0	0	0	0	0	0	0	0	0	1.633403425	0	0	0	0	0	0	0	55.0517	YES	30% Coins	30% Coins	30% Coins(Days 1-20) 30%(Days 21-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	30% Coins									30% Coins	$0/Proc	30% Coins								6700	4.4038	0	0.2405	1.0662	0.7892	0.2587	0.7789	0.215	0.7716	0.2532	0.4064	0.1687	0	0	1.2143	0.9838	0.0431	0.0145		0.1605	0.1112	0									0.1604	0	0.0795								12.1196	0	8.391862168	25.4851	0	2.712690691	1.066236377	3.291101352	0.614050676	1.849045504	3.574474961	2.540132715	3.245964302	2.249963122	1.124087354	0	0	4.099235927	10.16265106	0.952434926	0.303605256	0	0.160473361	1.866698918	0	0	0	0	0	0	0	0	0	0.160404738	0	1.712904798	0	0	0	0	0	0	0	67.1712
H1406_025_0	2011	6	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							O	O	O	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	YES	1542.910932	65.668718	640.915961	1591.98955	214.847342	9.150732	2.783885	373.493831	311.178731	1439.769376	1442.395508	73.047802	0.471329	3.130413	4459.969924	4624.132225	70.381382	694.858848		1761.284104	31.018364	0							4.51	0.6	364.289502	1.591051	539.975302								3400	$150/Day(Days 1-10):1a.IP Acute	$150/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$50/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$50/Visit:8b, 9a. $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,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $20 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$20/Visit:7b. $10 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$20/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $20 Nuclear Medicine,9a. $100 OP Other,5. $20 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF"									121.20465	109.29915	45.243839	0	50	0.2	0.2	50	100	0	24.206079	100	0.2	0.2	10	19.785422	20	20		0	0.2	0							0	0	0	0	73.353484								NO	109.660877	98.88928	31.930206	0	45.3693	0.181477	0.181477	45.3693	90.7386	0	21.964257	90.7386	0.181477	0.181477	9.07386	17.953015	18.14772	18.14772		0	0.181477	0							0	0	0	0	66.559924									14.0997	0.54116102	1.705381555	0	0.812289459	1.660647391	0.505211098	1.412096139	2.352993533	0	2.640095469	0.552354607	0.085535373	0.56809796	3.372428558	6.918092933	0.106438468	1.050841984	0	0	5.629119644	0	0	0	0	0	0	0	0	0	0	0	2.995059589	0	0	0	0	0	0	0	47.0076	0	5.381797175	14.0997	0.54116102	1.705381555	0	0.812289459	1.660647391	0.505211098	1.412096139	2.352993533	0	2.640095469	0.552354607	0.085535373	0.56809796	3.372428558	6.918092933	0.106438468	1.050841984	0	0	5.629119644	0	0	0	0	0	0	0	0	0	0	0	2.995059589	0	0	0	0	0	0	0	47.0076	NO																																																																																		0	0	0	14.0997	0.54116102	1.705381555	0	0.812289459	1.660647391	0.505211098	1.412096139	2.352993533	0	2.640095469	0.552354607	0.085535373	0.56809796	3.372428558	6.918092933	0.106438468	1.050841984	0	0	5.629119644	0	0	0	0	0	0	0	0	0	0	0	2.995059589	0	0	0	0	0	0	0	47.0076
H1406_026_0	2011	6	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							O	O	O	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	YES	1595.607455	67.911565	662.805781	1646.362302	222.18523	9.05674	2.755289	386.250126	321.806717	1488.943206	1491.659033	75.542673	0.466487	3.098258	4612.295573	4782.064668	72.785185	718.591032		1821.438937	30.699756	0							4.51	0.6	376.731432	1.645392	558.417599								3400	$175/Day(Days 1-10):1a.IP Acute	$175/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $20 Advanced Imaging -- Office,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$20/Visit:7b. $10 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$20-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $100 OP Other,5. $35 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"									141.405425	127.515675	45.243839	0	100	0.2	0.2	50	115.8569	10.377806	13.608423	100	0.2	0.2	10	19.785422	20	26.442453		0	0.2	0							0	0	0	0	76.55118								NO	123.941855	111.767489	29.801393	0	88.8615	0.177723	0.177723	44.43075	102.952179	9.221874	12.092649	88.8615	0.177723	0.177723	8.88615	17.581623	17.7723	23.49716		0	0.177723	0							0	0	0	0	68.024527									16.4802	0.632525425	1.64604463	0	1.645309401	1.609591003	0.489678227	1.430115232	2.760891894	1.14423722	1.503175759	0.559402936	0.082905469	0.550631707	3.415462526	7.006371513	0.107796679	1.407070704	0	0	5.456052736	0	0	0	0	0	0	0	0	0	0	0	3.165507753	0	0	0	0	0	0	0	51.093	0	7.31713931	16.4802	0.632525425	1.64604463	0	1.645309401	1.609591003	0.489678227	1.430115232	2.760891894	1.14423722	1.503175759	0.559402936	0.082905469	0.550631707	3.415462526	7.006371513	0.107796679	1.407070704	0	0	5.456052736	0	0	0	0	0	0	0	0	0	0	0	3.165507753	0	0	0	0	0	0	0	51.093	NO																																																																																		0	0	0	16.4802	0.632525425	1.64604463	0	1.645309401	1.609591003	0.489678227	1.430115232	2.760891894	1.14423722	1.503175759	0.559402936	0.082905469	0.550631707	3.415462526	7.006371513	0.107796679	1.407070704	0	0	5.456052736	0	0	0	0	0	0	0	0	0	0	0	3.165507753	0	0	0	0	0	0	0	51.093
H1406_801_0	2011	3																															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	YES	363.1543291	5.437817938	37.97764629	20.3247754	9.40467861	11.93005314	4.101357413	33.58273505	59.98831156	6.589258061	35.28245681	6.329425877	0.63013195	12.12727549	42.54828596	72.61128852	0.629689778	6.471332539		9.13619047	38.74543323	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.071907	0.071907	0.162897	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.064021	0.064021	0.105302	0	0.207418	0.207418	0.207418	0.207418	0.207418	0.207418	0.207418	0.207418	0.207418	0.207418	0.207418	0.207418	0.207418	0.207418		0.207418	0.207418	0																				23.2495	0.348134542	3.999122109	0	1.950699628	2.474507763	0.850695352	6.965663738	12.44265561	1.366730729	7.318216627	1.312836857	0.130700709	2.515415227	8.825280376	15.06088824	0.130608994	1.342270852	0	1.895010355	8.036500271	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2154	0	14.05057565	23.2495	0.348134542	3.999122109	0	1.950699628	2.474507763	0.850695352	6.965663738	12.44265561	1.366730729	7.318216627	1.312836857	0.130700709	2.515415227	8.825280376	15.06088824	0.130608994	1.342270852	0	1.895010355	8.036500271	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2154	NO																																																																																		0	0	0	23.2495	0.348134542	3.999122109	0	1.950699628	2.474507763	0.850695352	6.965663738	12.44265561	1.366730729	7.318216627	1.312836857	0.130700709	2.515415227	8.825280376	15.06088824	0.130608994	1.342270852	0	1.895010355	8.036500271	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2154
H1406_802_0	2011	3																															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	YES	359.594126	5.044308	36.957208	19.97047	9.037916	11.510224	4.063689	32.770075	60.783354	6.563981	35.575931	6.308004	0.63696	12.226749	47.416237	85.882119	0.591508	6.560247		9.32864	39.016366	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.073117	0.073117	0.165037	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.064637	0.064637	0.105706	0	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969		0.205969	0.205969	0																				23.2431	0.326048936	3.906598629	0	1.861530521	2.370749327	0.83699396	6.749619578	12.51948664	1.351976603	7.327538932	1.299253276	0.131194014	2.518331265	9.766274919	17.68905417	0.121832311	1.351207514	0	1.921410652	8.036161889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.3283	0	15.23944525	23.2431	0.326048936	3.906598629	0	1.861530521	2.370749327	0.83699396	6.749619578	12.51948664	1.351976603	7.327538932	1.299253276	0.131194014	2.518331265	9.766274919	17.68905417	0.121832311	1.351207514	0	1.921410652	8.036161889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.3283	NO																																																																																		0	0	0	23.2431	0.326048936	3.906598629	0	1.861530521	2.370749327	0.83699396	6.749619578	12.51948664	1.351976603	7.327538932	1.299253276	0.131194014	2.518331265	9.766274919	17.68905417	0.121832311	1.351207514	0	1.921410652	8.036161889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.3283
H1406_803_0	2011	3																															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	YES	359.594126	5.044308	36.957208	19.97047	9.037916	11.510224	4.063689	32.770075	60.783354	6.563981	35.575931	6.308004	0.63696	12.226749	47.416237	85.882119	0.591508	6.560247		9.32864	39.016366	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.073117	0.073117	0.165037	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.064637	0.064637	0.105706	0	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969	0.205969		0.205969	0.205969	0																				23.2431	0.326048936	3.906598629	0	1.861530521	2.370749327	0.83699396	6.749619578	12.51948664	1.351976603	7.327538932	1.299253276	0.131194014	2.518331265	9.766274919	17.68905417	0.121832311	1.351207514	0	1.921410652	8.036161889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.3283	0	15.23944525	23.2431	0.326048936	3.906598629	0	1.861530521	2.370749327	0.83699396	6.749619578	12.51948664	1.351976603	7.327538932	1.299253276	0.131194014	2.518331265	9.766274919	17.68905417	0.121832311	1.351207514	0	1.921410652	8.036161889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.3283	NO																																																																																		0	0	0	23.2431	0.326048936	3.906598629	0	1.861530521	2.370749327	0.83699396	6.749619578	12.51948664	1.351976603	7.327538932	1.299253276	0.131194014	2.518331265	9.766274919	17.68905417	0.121832311	1.351207514	0	1.921410652	8.036161889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.3283
H1415_005_0	2011	11																															COIN	D	COIN		COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																																																												0	YES	379.4935545	605.4971167	49.49906889		20.10481954	18.17728348	1.206043227	394.7913687	31.24614164		26.23645598	7.221500572	7.993052074	23.89318744	51.52323152	82.0870226	7.988613248	0.680348565	12.95851393	0.451524698	31.38266866																				6700	1a. Standard Medicare FFS	1b. $100 Days 1-7	2a. 10% Coinsurance	6a. No Cost Share	10a. 20% Coinsurance	11a. 20% Coinsurance	11b./c. 20% Coinsurance	4a./4b. $50/Visit	9a/b. 20% Coinsurance	8a.  No Cost Share	8a/b. 20% Coinsurance	1a. 20% Coinsurance	12.  20% Coinsurance	3./5.  20% Coinsurance	7a. 20% Coinsurance	"7b/d/f/g, 17a, 18a. 20% Coinsurance"	"7e/h, 5, 9c. 20% Coinsurance"	7c/i. 20% Coinsurance	7g. 20% Coinsurance	9d. 20% Coinsurance	15. 20% Coinsurance																				0	0.072	100	0.1		0.2	0.2	0.2	50	0.2		0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2																				NO	0.067464	93.7	0.0937		0.1874	0.1874	0.1874	46.85	0.1874		0.1874	0.1874	0.1874	0.1874	0.1874	0.1874	0.1874	0.1874	0.1874	0.1874	0.1874																					25.6022	4.727923319	4.638062755	0	3.767643183	3.406422925	0.226012501	1.541331302	5.855526943	0	4.916711852	1.353309207	1.497897959	4.477583326	9.655453587	15.38310804	1.497066123	0.127497321	2.42842551	0.084615728	5.881112107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0679	0	6.52	25.6022	4.727923319	4.638062755	0	3.767643183	3.406422925	0.226012501	1.541331302	5.855526943	0	4.916711852	1.353309207	1.497897959	4.477583326	9.655453587	15.38310804	1.497066123	0.127497321	2.42842551	0.084615728	5.881112107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0679	NO																																																																																		0	0	0	25.6022	4.727923319	4.638062755	0	3.767643183	3.406422925	0.226012501	1.541331302	5.855526943	0	4.916711852	1.353309207	1.497897959	4.477583326	9.655453587	15.38310804	1.497066123	0.127497321	2.42842551	0.084615728	5.881112107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0679
H1415_013_0	2011	6																															D	D	D	V	T	COIN	COIN	V	V	V	V	V	V	V	V	V	COIN	V	V	V	COIN																																																												0	YES	560.5076399	82.87869561	747.0102141		242.1476561	3.403830172	1.215613041	138.1457473	157.4716834		999.811948	17.54056049	199.9623896		1471.429196	3633.176997	0.34	9.100319491	49.35102684		14.70973228																				3400	1a. $175/day 1-3	1b. $275 days 1-5	2a. $0/days 0-3; $100/days 4-20; $0 days 21-100	6a. No Cost Sharing	10a. $100 COPAY per one-way trip; 20% air ambulance	11a. 20% Coinsurance	11b./c. 20% Coinsurance	4a./4b. $50 COPAY; waived if admitted	9a/b.$100 COPAY	8a. No Cost Sharing	8a/b. $0- $100 Copay	1a. $100 COPAY	12. $30 Copay	3./5.No Cost Sharing	7a. $5 Copay	"7b/d/f/g, 17a, 18a. $30 Copay"	"7e/h, 9c, 5. 20% Coinsurance"	7c/i. $15 Copay	i5. $30 Copay	i6. No Cost Sharing	15. 20% Coinsurance																				0	175	275	100		100	0.2	0.2	50	100		4.252284394	100	30		5	30	0.2	15	30		0.2																				NO	171.675	269.775	98.1		98.1	0.1962	0.1962	49.05	98.1		4.17149099	98.1	29.43		4.905	29.43	0.1962	14.715	29.43		0.1962																					8.0188	1.863216676	6.1068085	0	1.979557089	0.66783148	0.238503279	0.564670742	1.287331012	0	0.347558878	0.143394082	0.49040776	0	0.601446684	8.910366584	0.066708	0.011159267	0.121033393	0	2.886049474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3048	0	0.67	8.0188	1.863216676	6.1068085	0	1.979557089	0.66783148	0.238503279	0.564670742	1.287331012	0	0.347558878	0.143394082	0.49040776	0	0.601446684	8.910366584	0.066708	0.011159267	0.121033393	0	2.886049474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3048	NO																																																																																		0	0	0	8.0188	1.863216676	6.1068085	0	1.979557089	0.66783148	0.238503279	0.564670742	1.287331012	0	0.347558878	0.143394082	0.49040776	0	0.601446684	8.910366584	0.066708	0.011159267	0.121033393	0	2.886049474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3048
H1415_021_0	2011	8																															D	D	D	V	T	COIN	COIN	V	V	P	P	V	V	V	V	V	COIN	V	P	V	COIN																																																												0	YES	1082.468849	49.43535428	768.7043958		296.652484	7.430032084	1.836477134	144.3921766	246.099445		1433.887489	240.5996313	86.31376909		3627.578054	4230.012128	1.6915	48.70166501	377.661126		21.87806445																				3400	1a. $215/days 1-5	1b. $275 days 1-5	2a. $0/days 0-3; $100/days 4-20; 21 - 100 $0	6a. No Cost Sharing	10a. $100 COPAY per one way trip; 20% Coinsurance one way air ambulance	11a. 20% Coinsurance	11b./c. 20% Coinsurance	4a./4b. $50 COPAY; waived if admitted	9a/b. $200 COPAY	8a.  No Cost Sharing	8a/b. $25 Xray; $30 radiation $100/$200 Hi-tech	1a. $200 COPAY	12.   $30 Copay	3./5.   No Cost Share	7a  $7 Copay	"7b/d/f/g, 17a, 18a. $40 Copay"	"7e/h, 9c, 5. 20% Coinsurance"	7c/i. $15 Copay	7g. $40 Copay	9d. No Cost Sharing	15. 20% Coinsurance																				0	215	275	100		100	0.2	0.2	50	200		35.84342429	200	30		7	40	0.2	15	40		0.2																				NO	207.26	265.1	96.4		96.4	0.1928	0.1928	48.2	192.8		34.55306101	192.8	28.92		6.748	38.56	0.1928	14.46	38.56		0.1928																					18.696	1.092109368	6.175258646	0	2.383108288	1.432510186	0.354072791	0.579975243	3.95399775	0	4.128766824	3.865634077	0.208016184	0	2.039908059	13.59243897	0.3261212	0.058685506	1.213551085	0	4.218090826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3183	0	2.4	18.696	1.092109368	6.175258646	0	2.383108288	1.432510186	0.354072791	0.579975243	3.95399775	0	4.128766824	3.865634077	0.208016184	0	2.039908059	13.59243897	0.3261212	0.058685506	1.213551085	0	4.218090826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3183	NO	30% Coinsurance	Included in Line a1	30% Coinsurance		$100 COPAY per one way trip; 20% Coinsurance one way air ambulance	30% Coinsurance	Included in Line e1	30% Coinsurance	30% Coinsurance	30% Coinsurance	Included in line h1	Included in line h1	Included in line h1	Included in line h1	30% Coinsurance	Include in line i1	Include in line i1	Include in line i1	Include in line i1	Include in line i1	30% Coinsurance																					0.4183		0.0738		0.01	0.0138		0.0099	0.0262	0.0848					0.2885						0.033																				0.9583	0	0	19.1143	1.092109368	6.249103788	0	2.393108288	1.446354224	0.354072791	0.589847306	3.980190622	0.084803875	4.128766824	3.865634077	0.208016184	0	2.328361749	13.59243897	0.3261212	0.058685506	1.213551085	0	4.251072833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2766
H1415_802_0	2011	4																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																																																												0	Yes	269.9533715	8.917964875	49.23009487	34.96839455	11.36110955	7.430032084	1.799326974	6.581375482	17.46191448	5.857520155	24.7751408	0.824391726	0.565359168	24.5135049	55.37829303	107.0613557	1.237316934	1.538285917	27.00360605	0.083602496	21.98800447																				6700	1a. Equiv to Medicare FFS	1b. Equiv to Medicare FFS	2a. Equiv to Medicare FFS	6a. Equiv to Medicare FFS	10a. Equiv to Medicare FFS	11a. Equiv to Medicare FFS	11b./c. Equiv to Medicare FFS	4a./4b. Equiv to Medicare FFS	9a/b. Equiv to Medicare FFS	8a.  Equiv to Medicare FFS	8a/b. Equiv to Medicare FFS	1a. Equiv to Medicare FFS	12. Equiv to Medicare FFS	3./5.  Equiv to Medicare FFS	7a  Equiv to Medicare FFS	"7b/d/f/g, 17a, 18a. Equiv to Medicare FFS"	"7e/h, 5, 9c. Equiv to Medicare FFS"	7c/i. Equiv to Medicare FFS	7g. Equiv to Medicare FFS	9d. Equiv to Medicare FFS	15. Equiv to Medicare FFS																				0	0.072	0.072	0.163	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.066996	0.066996	0.1516715	0	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065																					18.0858	0.597467975	7.466802334	0	2.463162399	1.610879251	0.390105784	1.426884983	3.785856562	1.269948444	5.371411565	0.178733485	0.122573542	5.314687201	12.00637389	23.21159783	0.268258354	0.333510386	5.854557315	0.018125564	4.767142292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5439	0	7.07	18.0858	0.597467975	7.466802334	0	2.463162399	1.610879251	0.390105784	1.426884983	3.785856562	1.269948444	5.371411565	0.178733485	0.122573542	5.314687201	12.00637389	23.21159783	0.268258354	0.333510386	5.854557315	0.018125564	4.767142292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5439	NO																																																																																		0	0	0	18.0858	0.597467975	7.466802334	0	2.463162399	1.610879251	0.390105784	1.426884983	3.785856562	1.269948444	5.371411565	0.178733485	0.122573542	5.314687201	12.00637389	23.21159783	0.268258354	0.333510386	5.854557315	0.018125564	4.767142292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5439
H1415_804_0	2011	4																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																																																												0	Yes	269.9533715	8.917964875	49.23009487	34.96839455	11.36110955	7.430032084	1.799326974	6.581375482	17.46191448	5.857520155	24.7751408	0.824391726	0.565359168	24.5135049	55.37829303	107.0613557	1.237316934	1.538285917	27.00360605	0.083602496	21.98800447																				6700	1a. Equiv to Medicare FFS	1b. Equiv to Medicare FFS	2a. Equiv to Medicare FFS	6a. Equiv to Medicare FFS	10a. Equiv to Medicare FFS	11a. Equiv to Medicare FFS	11b./c. Equiv to Medicare FFS	4a./4b. Equiv to Medicare FFS	9a/b. Equiv to Medicare FFS	8a.  Equiv to Medicare FFS	8a/b. Equiv to Medicare FFS	5. Equiv to Medicare FFS	12. Equiv to Medicare FFS	3./5.  Equiv to Medicare FFS	7a  Equiv to Medicare FFS	"7b/d/f/g, 17a, 18a. Equiv to Medicare FFS"	"7e/h, 9c. Equiv to Medicare FFS"	7c/i. Equiv to Medicare FFS	7g. Equiv to Medicare FFS	9d. Equiv to Medicare FFS	15. Equiv to Medicare FFS																				0	0.072	0.072	0.163	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.066996	0.066996	0.1516715	0	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065	0.2168065																					18.0858	0.597467975	7.466802334	0	2.463162399	1.610879251	0.390105784	1.426884983	3.785856562	1.269948444	5.371411565	0.178733485	0.122573542	5.314687201	12.00637389	23.21159783	0.268258354	0.333510386	5.854557315	0.018125564	4.767142292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5439	0	7.07	18.0858	0.597467975	7.466802334	0	2.463162399	1.610879251	0.390105784	1.426884983	3.785856562	1.269948444	5.371411565	0.178733485	0.122573542	5.314687201	12.00637389	23.21159783	0.268258354	0.333510386	5.854557315	0.018125564	4.767142292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5439	NO																																																																																		0	0	0	18.0858	0.597467975	7.466802334	0	2.463162399	1.610879251	0.390105784	1.426884983	3.785856562	1.269948444	5.371411565	0.178733485	0.122573542	5.314687201	12.00637389	23.21159783	0.268258354	0.333510386	5.854557315	0.018125564	4.767142292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5439
H1416_007_0	2011	5																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	P	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	Yes	2004.009448	850.3886879	534.9507225	442.0643784	19.85735455	5.978813338	8.920516172	34.83891279	24.38399302	5188.131736	14.2004714	0.051542358	0.352542525	12.8567668	7927.661276	78.0456599	12.04478348	2.089076553	15.09279499	8.394669329	9.064879545	0.003829125	870	227.1428571	331.2	198.72	15.6	11.88571429	528	0											6700	FFS	FFS	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) $0.00 copayment	(8b) 20% coinsurance	(5) 45% coinsurance	(12) 20% coinsurance	"(9a) , (9d) 20% coinsurance"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) 20% coinsurance"	"(7e) , (7h) 45% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) 20% coinsurance"	(15) 20% coinsurance	(13a) 20% coinsurance	(10b) $0.00 copayment	"(16) $0.00 copayment,   benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	142.3508561	63.29039397	19.25316161	0	0.180619233	0.1924	0.070711137	0.16031438	0.168258507	0	0.168346901	0.432343043	0.192403472	0.178975259	0	0.063729271	0.300102998	0.106302195	0.120135132	0.124124728	0.1924	0.190895367	0	0	0	0	0	0	0	0											NO	140.0950872	62.28746005	18.94806557	0	0.177757043	0.189351125	0.06959061	0.157773952	0.165592192	0	0.165679185	0.425491901	0.189354542	0.17613912	0	0.062719382	0.295347403	0.104617673	0.118231405	0.12215778	0.189351125	0.187870335	0	0	0	0	0	0	0	0												23.396	4.414045952	0.844690114	0	3.529784625	1.132095033	0.620784164	5.496672938	4.03779885	0	2.352722527	0.021930856	0.066755528	2.264579595	0	4.894975557	3.55739552	0.218554327	1.784442359	1.02547417	1.716445142	0.000719379	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3759	0	0.988255552	23.396	4.414045952	0.844690114	0	3.529784625	1.132095033	0.620784164	5.496672938	4.03779885	0	2.352722527	0.021930856	0.066755528	2.264579595	0	4.894975557	3.55739552	0.218554327	1.784442359	1.02547417	1.716445142	0.000719379	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3759	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	23.396	4.414045952	0.844690114	0	3.529784625	1.132095033	0.620784164	5.496672938	4.03779885	0	2.352722527	0.021930856	0.066755528	2.264579595	0	4.894975557	3.55739552	0.218554327	1.784442359	1.02547417	1.716445142	0.000719379	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3759
H1416_009_0	2011	5																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1795.080878	312.2508511	871.7026573	698.237275	464.4619895	5.672502641	11.08308677	424.7128838	290.3231436	4382.984673	1385.778895	9.917849655	0.7806421	2234.572343	9222.056867	17154.81239	943.1465808	1743.645924	3347.453788	3040.219364	12.75494174	0.041860135	1000	387.4285714	331.2	198.72	15.6	11.88571429	0	0											3000	"(1a) $200 days 1 - 7, $0 after day 7, unlimited coverage"	"(1b) $200 days 1 - 7, $0 after day 7, unlimited coverage"	"(2) $0 days 1 - 7, $85 days 8 - 100"	(6) Copay between $0.00 and $25.00	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $200.00 copayment	(12) 20% coinsurance	"(9a) $150.00 copayment , (9d) Copay between $35.00 and $150.00"	"(14b) , (14c) $0.00 copayment ; (7a) $5.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	(10b) $3.00 copayment	"(16) $0.00 copayment, $500 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											0	137.65946	105.5660551	40.17096639	5.786693827	47.04919937	0.2	0.069126287	41.77666972	144.7798132	0	16.98816681	55.81770872	0.2	35.18392161	1.680907288	5.546876755	14.71956781	6.761207434	1.764130319	1.935405777	0.2	0	3	0	0	0	0	0	0	0											NO	126.9737455	97.37156761	37.05272462	5.337505968	43.39703981	0.184475147	0.06376041	38.53378641	133.5413865	0	15.66947283	51.48490006	0.184475147	32.45279553	1.550428094	5.11630452	13.57697217	6.236373672	1.627190998	1.785171325	0.184475147	0	3	0	0	0	0	0	0	0												18.994	2.533696239	2.691579876	0.310570469	1.679689621	1.046435758	0.706662156	1.363816296	3.230846262	0	1.809535395	0.042551625	0.144009066	6.043176613	1.191511337	7.314103682	1.067089573	0.906168961	0.453912223	0.452276036	2.352969751	0	0.25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5846	0	4.572631596	18.994	2.533696239	2.691579876	0.310570469	1.679689621	1.046435758	0.706662156	1.363816296	3.230846262	0	1.809535395	0.042551625	0.144009066	6.043176613	1.191511337	7.314103682	1.067089573	0.906168961	0.453912223	0.452276036	2.352969751	0	0.25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5846	NO	25% coinsurance	Not covered OON	25% coinsurance	25% coinsurance	25% coinsurance	25% coinsurance	25% coinsurance	Same as in-network	25% coinsurance	25% coinsurance	25% coinsurance	Not covered OON	Not covered OON	25% coinsurance	Not covered OON	25% coinsurance	Not covered OON	25% coinsurance	25% coinsurance	25% coinsurance	25% coinsurance	25% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												1.3218	0	0.1446	0.0475	0.0372	0.0238	0.0464	0	0.1455	0.018	0.0715	0	0	0.0546	0	0.4064	0	0.0163	0.0767	0.053	0.0534	0.0002	0	0	0	0	0	0	0	0											2.5169	0	0	20.3158	2.533696239	2.836162337	0.358030399	1.716905736	1.070191162	0.753076098	1.363816296	3.376323661	0.017992936	1.881050412	0.042551625	0.144009066	6.097812035	1.191511337	7.72053855	1.067089573	0.922422751	0.530576777	0.505304737	2.406385116	0.000175303	0.25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1015
H1416_018_0	2011	6																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1440.537391	135.6395911	625.8694446	223.0710659	625.9199636	7.890571723	7.260859496	682.8666337	306.6084815	2834.280658	1234.753561	10.52525099	0.108662878	1703.524729	10795.90353	17637.42479	342.4750392	844.1477093	4276.273956	2974.537297	9.731686372	0.0576739	1380	387.4285714	331.2	198.72	15.6	11.88571429	0	0											3000	"(1a) $200 days 1 - 7, $0 after day 7, unlimited coverage"	"(1b) $200 days 1 - 7, $0 after day 7, unlimited coverage"	"(2) $0 days 1 - 7, $85 days 8 - 100"	(6) Copay between $0.00 and $25.00	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $200.00 copayment	(12) 20% coinsurance	"(9a) $150.00 copayment , (9d) Copay between $35.00 and $150.00"	"(14b) , (14c) $0.00 copayment ; (7a) $5.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	(10b) $0.00 copayment	"(16) $0.00 copayment, $500 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											0	156.2978511	99.00087362	61.72781116	7.962768919	40.81225231	0.2	0.096339527	45.41123725	94.5077539	0	16.16307572	36.17866176	0.2	18.43517859	1.662698306	6.48827498	25.24441383	9.422684856	4.119482649	3.198184821	0.2	0	0	0	0	0	0	0	0	0											NO	146.2217919	92.61858071	57.74840212	7.449432807	38.18120736	0.187106593	0.090128804	42.48370937	88.4151191	0	15.12109014	33.84633066	0.187106593	17.24671726	1.555509074	6.069995122	23.61698129	8.81523229	3.853911812	2.992007324	0.187106593	0	0	0	0	0	0	0	0	0												17.5532	1.046895535	3.011913364	0.13847941	1.99153166	1.47637799	0.654412579	2.417558967	2.259068784	0	1.555901658	0.02968676	0.020331541	2.448350779	1.399427158	8.921590202	0.674018883	0.620113179	1.373365226	0.741653115	1.820862679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1547	0	3.456131597	17.5532	1.046895535	3.011913364	0.13847941	1.99153166	1.47637799	0.654412579	2.417558967	2.259068784	0	1.555901658	0.02968676	0.020331541	2.448350779	1.399427158	8.921590202	0.674018883	0.620113179	1.373365226	0.741653115	1.820862679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1547	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												1.674	0	0.1228	0.0221	0.063	0.0537	0.0494	0	0.2342	0.0204	0.0976	0	0	0.0748	0	0.6017	0	0.0129	0.2417	0.0868	0.0662	0.0004	0	0	0	0	0	0	0	0											3.4216	0	0	19.2272	1.046895535	3.134678766	0.160611489	2.054530167	1.530066416	0.703816365	2.417558967	2.493272911	0.02040062	1.65348774	0.02968676	0.020331541	2.523139576	1.399427158	9.523245754	0.674018883	0.633050168	1.615044588	0.828424195	1.887078277	0.00039242	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5763
H1416_019_0	2011	5																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	2034.086538	307.4632686	916.3777778	674.0740552	504.8397441	6.403940627	9.840754227	439.0063732	297.9068449	4353.234726	1594.063339	9.319658505	1.214660056	2266.140143	9915.846185	17730.69932	883.2010577	1536.035674	3658.370216	3160.056528	11.95880546	0.040773133	1080	387.4285714	331.2	198.72	15.6	11.88571429	498.1132075	2851.621115											3000	"(1a) $175 days 1 - 7, $0 after day 7, unlimited coverage"	"(1b) $175 days 1 - 7, $0 after day 7, unlimited coverage"	"(2) $0 days 1 - 7, $85 days 8 - 100"	(6) Copay between $0.00 and $25.00	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $125.00 copayment , (9b) $75.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $175.00 copayment	(12) 20% coinsurance	"(9a) $125.00 copayment , (9d) Copay between $35.00 and $125.00"	"(14b) , (14c) $0.00 copayment ; (7a) $5.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	(10b) $3.00 copayment	"(16) $0.00 copayment, $500 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	"(13b) , (13c) $0.00 copayment"											0	139.62693	89.64305385	49.55127993	4.808105465	44.50497781	0.2	0.062495934	43.86912606	116.0445781	0	15.62053484	33.50265941	0.2	35.70567777	2.170486414	5.509031774	22.07623971	5.967769294	1.300264893	2.805901781	0.2	0	3	0	0	0	0	0	0	0											NO	127.2925524	81.72415689	45.17401407	4.383366569	40.57349268	0.18233238	0.056975162	39.99381087	105.7934207	0	14.24064649	30.54309817	0.18233238	32.55150608	1.978749771	5.02237438	20.12606666	5.4405879	1.185401964	2.558033752	0.18233238	0	3	0	0	0	0	0	0	0												21.577	2.093931367	3.449705219	0.24622614	1.706925972	1.167645737	0.560678567	1.463128155	2.626382014	0	1.891707708	0.023720937	0.221471859	6.147189552	1.63508153	7.420850832	1.48128028	0.696411425	0.361386603	0.673627605	2.180477463	0	0.27	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8948	0	5.583723889	21.577	2.093931367	3.449705219	0.24622614	1.706925972	1.167645737	0.560678567	1.463128155	2.626382014	0	1.891707708	0.023720937	0.221471859	6.147189552	1.63508153	7.420850832	1.48128028	0.696411425	0.361386603	0.673627605	2.180477463	0	0.27	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8948	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	21.577	2.093931367	3.449705219	0.24622614	1.706925972	1.167645737	0.560678567	1.463128155	2.626382014	0	1.891707708	0.023720937	0.221471859	6.147189552	1.63508153	7.420850832	1.48128028	0.696411425	0.361386603	0.673627605	2.180477463	0	0.27	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8948
H1416_022_0	2011	6																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1364.104792	88.68734804	819.9796711	273.2973318	408.1285673	6.7817585	7.455682703	493.3036996	290.3992416	3355.890633	1279.361698	7.855351646	0.156450465	2214.780466	8153.624956	18152.33996	726.4845516	2165.788285	3280.814624	3233.415348	8.150617796	0.038570323	0	0	331.2	198.72	0	0	0	0											6700	"(1a) $250 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $250 days 1 - 5, $0 after day 5, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $250.00 copayment	(12) 20% coinsurance	"(9a) $150.00 copayment , (9d) Copay between $35.00 and $150.00"	"(14b) , (14c) $0.00 copayment ; (7a) $10.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	Not Covered	Not Covered	Not Covered	Not Covered											0	148.6954368	109.1887432	39.27	0	38.88741578	0.2	0.107002045	42.66521906	107.9328809	0	14.3543275	45.2233272	0.2	16.66839763	3.422360079	6.416526324	25.79265302	8.458582848	1.852549583	2.72410528	0.2	0	0	0	0	0	0	0	0	0											NO	147.0137769	107.9538813	38.82587888	0	38.44762147	0.197738115	0.105791913	42.18269996	106.7122221	0	14.19198831	44.71187737	0.197738115	16.47988764	3.383655155	6.3439591	25.50095294	8.362921139	1.831598312	2.693297215	0.197738115	0	0	0	0	0	0	0	0	0												16.7118	0.797845287	2.653035949	0	1.307631055	1.341012142	0.788750939	1.734073496	2.582429029	0	1.513057189	0.02926896	0.03093622	3.041611102	2.299087926	9.596475189	1.543837364	1.509359719	0.500761211	0.725712379	1.611687799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3184	0	0.575581932	16.7118	0.797845287	2.653035949	0	1.307631055	1.341012142	0.788750939	1.734073496	2.582429029	0	1.513057189	0.02926896	0.03093622	3.041611102	2.299087926	9.596475189	1.543837364	1.509359719	0.500761211	0.725712379	1.611687799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3184	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	16.7118	0.797845287	2.653035949	0	1.307631055	1.341012142	0.788750939	1.734073496	2.582429029	0	1.513057189	0.02926896	0.03093622	3.041611102	2.299087926	9.596475189	1.543837364	1.509359719	0.500761211	0.725712379	1.611687799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3184
H1417_001_0	2011	4																															A	A	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	257.0161768	4.003454999	1090.468656	0	164.0118105	11.64390467	2.413818324	354.2093152	406.667762	0	0	0	0	791.1697635	4157.616401	8407.160886	188.6866669	270.8161007	1225.168073	3312.285944	0	0	0	0	35.5195736	0	0.345384531	0	0	0											1500	$100/Day (Days 1-5) for IP Acute; PBP 1a	$100/Day (Days 1-5) for IP Psych; PBP 1b	$50/Day (Days 21-100) for SNF; PBP 2	No Cost Sharing for Home Health; PBP 6	$50/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b-c"	"$50/Visit for ER, $20/Visit for Urgent Care; PBP 4a-b"	$100/Visit for ASC Services; PBP 9b	No Cost Sharing for OP Diagnostic Procedures/Tests; PBP 8a	No Cost Sharing for OP Radiology; PBP 8b	$100/Visit for OP Hospital; PBP 9a	No Cost Sharing for Renal Dialysis; PBP 12	"$20/Visit for CORF, Partial Hosp, OP Substance Abuse, Cardiac Rehab; PBP 3, 5, 9c-d"	"$20/Visit for PCP, No Cost Sharing for Immunizations, Routine Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7a, 14b-j"	"$20/Visit for Chiropractic, Physician Specialist (excl. Radiology), Podiatry; PBP 7b, 7d, 7f"	"$20/Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$20/Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$20/Visit for Physician Specialist (Radiology); PBP 7d	"$20/Visit for Other Health Care, Hearing Exams (Medicare Covered); PBP 7g, 18a"	No Cost Sharing for Part B Drugs; PBP 15	"No Cost Sharing for Blood, $20/Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); PBP 13a, 16b, 17a"	No Coverage for Transportation; PBP 10b	"No Coverage for Preventive Dental Services, Comprehensive Dental (Non-Medicare Covered); PBP 16a-b"	$20/Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing for Eye Wear (Medicare Covered); PBP 17b	$20/Visit for Routine Hearing Exams (Non-Medicare Covered); PBP 18a	No Coverage for Hearing Aids (Non-Medicare Covered); PBP 18b	No Cost Sharing for Health Education/Wellness Program; PBP 14a	No Coverage for Acupuncture; PBP 13b											0	294.884335	399.8308	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	7.26217676	0	0	0											NO	221.2532512	299.99513	17.6321723	0	37.51526021	0.07503052	0.07503052	36.59238481	75.03052042	0	0	0	0	15.00610408	15.00610408	15.00610408	15.00610408	15.00610408	15.00610408	15.00610408	0	0	0	0	15.00610408	0	5.448849017	0	0	0												4.7388	0.10008475	1.602277603	0	0.512745479	0.873648227	0.181110045	1.08011363	2.542707818	0	0	0	0	0.989364652	5.199135372	10.51322761	0.235954314	0.338657883	1.532083302	4.142042302	0	0	0	0	0.044417535	0	0.000156829	0	0	0	0	0	0	0	0	0	0	0	0	0	34.6265	0	11.52339738	4.7388	0.10008475	1.602277603	0	0.512745479	0.873648227	0.181110045	1.08011363	2.542707818	0	0	0	0	0.989364652	5.199135372	10.51322761	0.235954314	0.338657883	1.532083302	4.142042302	0	0	0	0	0.044417535	0	0.000156829	0	0	0	0	0	0	0	0	0	0	0	0	0	34.6265	YES	$175/Day (Days 1-5) for IP Acute; PBP 1a	$175/Day (Days 1-5) for IP Psych; PBP 1b	$100/Day (Days 21-100) for SNF; PBP 2	$30/Visit for Home Health; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b-c"	"$50/Visit for ER, $20/Visit for Urgent Care; PBP 4a-b"	$200/Visit for ASC Services; PBP 9b	$30/Visit for OP Diagnostic Procedures/Tests; PBP 8a	$30/Visit for OP Radiology; PBP 8b	$200/Visit for OP Hospital; PBP 9a	No Cost Sharing for Renal Dialysis; PBP 12	"$30/Visit for CORF, Partial Hosp, OP Substance Abuse, Cardiac Rehab; PBP 3, 5, 9c-d"	"$30/Visit for PCP, Immunizations, Routine Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7a, 14b-j"	"$30/Visit for Chiropractic, Physician Specialist (excl. Radiology), Podiatry; PBP 7b, 7d, 7f"	"$30/Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$30/Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$30/Visit for Physician Specialist (Radiology); PBP 7d	"$30/Visit for Other Health Care, Hearing Exams (Medicare Covered); PBP 7g, 18a"	$30/Script for Part B Drugs; PBP 15	"No Cost Sharing for Blood, $30/Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); PBP 13a, 16b, 17a"	No Coverage for Transportation; PBP 10b	"No Coverage for Preventive Dental Services, Comprehensive Dental (Non-Medicare Covered); PBP 16a-b"	$30/Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing for Eye Wear (Medicare Covered); PBP 17b	$30/Visit for Routine Hearing Exams (Non-Medicare Covered); PBP 18a	No Coverage for Hearing Aids (Non-Medicare Covered); PBP 18b	No Cost Sharing for Health Education/Wellness Program; PBP 14a	No Coverage for Acupuncture; PBP 13b											5100	0.6434	0.0199	0.5556	0.1423	0.0939	0.1606	0.0158	0.0818	0.2855	0.2206	0.0854	0	0	0.144	0.3413	2.8363	0.0412	0.2942	0.1644	0.3417	0.2756	0	0	0	0.0008	0.0001	0	0	0	0											6.7444	110	1.434899976	5.3822	0.120019262	2.157887566	0.142264152	0.60668376	1.034207143	0.196916973	1.16189848	2.828182489	0.220574757	0.085435312	0	0	1.133370864	5.540474607	13.34952204	0.277161793	0.632865791	1.696479781	4.483755178	0.275602848	0	0	0	0.045188501	0.000120897	0.000156829	0	0	0	0	0	0	0	0	0	0	0	0	0	41.371
H1417_002_0	2011	5																															A	A	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	293.6250133	8.056579037	1295.784686	0	217.2170344	13.29228617	2.222827992	436.7760451	444.6147302	0	0	0	0	888.405712	4710.951119	9271.771563	242.3285027	280.5908978	1345.515813	3744.684601	0	0	0	0	50.59138915	0	0.850275448	0	0	0											1500	$100/Day (Days 1-5) for IP Acute; PBP 1a	$100/Day (Days 1-5) for IP Psych; PBP 1b	$50/Day (Days 21-100) for SNF; PBP 2	No Cost Sharing for Home Health; PBP 6	$50/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b-c"	"$50/Visit for ER, $20/Visit for Urgent Care; PBP 4a-b"	$100/Visit for ASC Services; PBP 9b	No Cost Sharing for OP Diagnostic Procedures/Tests; PBP 8a	No Cost Sharing for OP Radiology; PBP 8b	$100/Visit for OP Hospital; PBP 9a	No Cost Sharing for Renal Dialysis; PBP 12	"$20/Visit for CORF, Partial Hosp, OP Substance Abuse, Cardiac Rehab; PBP 3, 5, 9c-d"	"$20/Visit for PCP, No Cost Sharing for Immunizations, Routine Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7a, 14b-j"	"$20/Visit for Chiropractic, Physician Specialist (excl. Radiology), Podiatry; PBP 7b, 7d, 7f"	"$20/Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$20/Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$20/Visit for Physician Specialist (Radiology); PBP 7d	"$20/Visit for Other Health Care, Hearing Exams (Medicare Covered); PBP 7g, 18a"	No Cost Sharing for Part B Drugs; PBP 15	"No Cost Sharing for Blood, $20/Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); PBP 13a, 16b, 17a"	No Coverage for Transportation; PBP 10b	"No Coverage for Preventive Dental Services, Comprehensive Dental (Non-Medicare Covered); PBP 16a-b"	$20/Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing for Eye Wear (Medicare Covered); PBP 17b	$20/Visit for Routine Hearing Exams (Non-Medicare Covered); PBP 18a	No Coverage for Hearing Aids (Non-Medicare Covered); PBP 18b	No Cost Sharing for Health Education/Wellness Program; PBP 14a	No Coverage for Acupuncture; PBP 13b											0	294.884335	399.8308	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	7.238574328	0	0	0											NO	214.1217503	290.3255974	17.06384685	0	36.30605714	0.072612114	0.072612114	35.41292813	72.61211427	0	0	0	0	14.52242285	14.52242285	14.52242285	14.52242285	14.52242285	14.52242285	14.52242285	0	0	0	0	14.52242285	0	5.256081863	0	0	0												5.2393	0.19491926	1.842589286	0	0.657191172	0.965181002	0.16140424	1.288959891	2.690367966	0	0	0	0	1.075150285	5.701202017	11.2207156	0.293266415	0.339571639	1.628345799	4.531824436	0	0	0	0	0.061225796	0	0.000372426	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8916	0	14.29197108	5.2393	0.19491926	1.842589286	0	0.657191172	0.965181002	0.16140424	1.288959891	2.690367966	0	0	0	0	1.075150285	5.701202017	11.2207156	0.293266415	0.339571639	1.628345799	4.531824436	0	0	0	0	0.061225796	0	0.000372426	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8916	YES	$175/Day (Days 1-5) for IP Acute; PBP 1a	$175/Day (Days 1-5) for IP Psych; PBP 1b	$100/Day (Days 21-100) for SNF; PBP 2	$30/Visit for Home Health; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b-c"	"$50/Visit for ER, $20/Visit for Urgent Care; PBP 4a-b"	$200/Visit for ASC Services; PBP 9b	$30/Visit for OP Diagnostic Procedures/Tests; PBP 8a	$30/Visit for OP Radiology; PBP 8b	$200/Visit for OP Hospital; PBP 9a	No Cost Sharing for Renal Dialysis; PBP 12	"$30/Visit for CORF, Partial Hosp, OP Substance Abuse, Cardiac Rehab; PBP 3, 5, 9c-d"	"$30/Visit for PCP, Immunizations, Routine Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7a, 14b-j"	"$30/Visit for Chiropractic, Physician Specialist (excl. Radiology), Podiatry; PBP 7b, 7d, 7f"	"$30/Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$30/Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$30/Visit for Physician Specialist (Radiology); PBP 7d	"$30/Visit for Other Health Care, Hearing Exams (Medicare Covered); PBP 7g, 18a"	$30/Script for Part B Drugs; PBP 15	"No Cost Sharing for Blood, $30/Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); PBP 13a, 16b, 17a"	No Coverage for Transportation; PBP 10b	"No Coverage for Preventive Dental Services, Comprehensive Dental (Non-Medicare Covered); PBP 16a-b"	$30/Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing for Eye Wear (Medicare Covered); PBP 17b	$30/Visit for Routine Hearing Exams (Non-Medicare Covered); PBP 18a	No Coverage for Hearing Aids (Non-Medicare Covered); PBP 18b	No Cost Sharing for Health Education/Wellness Program; PBP 14a	No Coverage for Acupuncture; PBP 13b											5100	0.4124	0.0461	0.3736	0.0865	0.0932	0.1919	0.0194	0.0729	0.1878	0.1451	0.0577	0	0	0.1575	0.3379	2.5428	0.0778	0.3031	0.1316	0.2592	0.2956	0	0	0	0.0009	0.0003	0	0	0	0											5.7931	110	1.550405853	5.6517	0.241067017	2.216152567	0.086535808	0.750430511	1.157039198	0.180823269	1.361835716	2.878192005	0.145066602	0.057665268	0	0	1.232625337	6.039112233	13.76352913	0.37103062	0.642687229	1.759925251	4.791028576	0.295560467	0	0	0	0.062114502	0.000269645	0.000372426	0	0	0	0	0	0	0	0	0	0	0	0	0	43.6847
H1417_003_0	2011	4																															A	A	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	254.4927091	6.00432959	1055.404054	0	179.367678	11.5036904	1.954127609	369.4841309	387.2314848	1409.45561	496.309134	0	0	759.7682068	4108.734345	7799.917292	232.8989198	290.1170164	1170.418687	3179.880467	2210.084214	0	0	0	38.91813635	0	0	0	0	0											3000	$150/Day (Days 1-5) for IP Acute; PBP 1a	$150/Day (Days 1-5) for IP Psych; PBP 1b	$140/Day (Days 21-100) for SNF; PBP 2	No Cost Sharing for Home Health; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b-c"	"$50/Visit for ER, $40/Visit for Urgent Care; PBP 4a-b"	$150/Visit for ASC Services; PBP 9b	$40/Visit for OP Diagnostic Procedures/Tests; PBP 8a	$40/Visit for OP Radiology; PBP 8b	$150/Visit for OP Hospital; PBP 9a	No Cost Sharing for Renal Dialysis; PBP 12	"$40/Visit for CORF, Partial Hosp, OP Substance Abuse, Cardiac Rehab; PBP 3, 5, 9c-d"	"$20/Visit for PCP, No Cost Sharing for Immunizations, Routine Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7a, 14b-j"	"$40/Visit for Chiropractic, Physician Specialist (excl. Radiology), Podiatry; PBP 7b, 7d, 7f"	"$40/Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$40/Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$40/Visit for Physician Specialist (Radiology); PBP 7d	"$40/Visit for Other Health Care, Hearing Exams (Medicare Covered); PBP 7g, 18a"	$40/Script for Part B Drugs; PBP 15	"No Cost Sharing for Blood, $40/Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); PBP 13a, 16b, 17a"	No Coverage for Transportation; PBP 10b	"No Coverage for Preventive Dental Services, Comprehensive Dental (Non-Medicare Covered); PBP 16a-b"	$40/Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing for Eye Wear (Medicare Covered); PBP 17b	No Coverage for Routine Hearing Exams (Non-Medicare Covered); PBP 18a	No Coverage for Hearing Aids (Non-Medicare Covered); PBP 18b	No Cost Sharing for Health Education/Wellness Program; PBP 14a	No Coverage for Acupuncture; PBP 13b											0	442.3265025	599.7462	65.8	0	100	0.2	0.2	49.59	150	40	40	0	0	40	20	40	40	40	40	40	40	0	0	0	40	0	0	0	0	0											NO	333.3723352	452.0163049	49.5920989	0	75.36793146	0.150735863	0.150735863	37.37495721	113.0518972	30.14717258	30.14717258	0	0	30.14717258	15.07358629	30.14717258	30.14717258	30.14717258	30.14717258	30.14717258	30.14717258	0	0	0	30.14717258	0	0	0	0	0												7.0701	0.22617124	4.36164185	0	1.126547572	1.7340187	0.294557111	1.150787799	3.648104501	3.540925127	1.24685976	0	0	1.908738605	5.161113474	19.5954544	0.585103661	0.728850647	2.94040118	7.988700437	5.552315852	0	0	0	0.097772648	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9581	0	22.53719109	7.0701	0.22617124	4.36164185	0	1.126547572	1.7340187	0.294557111	1.150787799	3.648104501	3.540925127	1.24685976	0	0	1.908738605	5.161113474	19.5954544	0.585103661	0.728850647	2.94040118	7.988700437	5.552315852	0	0	0	0.097772648	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9581	YES	$200/Day (Days 1-5) for IP Acute; PBP 1a	$200/Day (Days 1-5) for IP Psych; PBP 1b	$200/Day (Days 21-100) for SNF; PBP 2	$50/Visit for Home Health; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b-c"	"$50/Visit for ER, $40/Visit for Urgent Care; PBP 4a-b"	$200/Visit for ASC Services; PBP 9b	$50/Visit for OP Diagnostic Procedures/Tests; PBP 8a	$50/Visit for OP Radiology; PBP 8b	$200/Visit for OP Hospital; PBP 9a	No Cost Sharing for Renal Dialysis; PBP 12	"$50/Visit for CORF, Partial Hosp, OP Substance Abuse, Cardiac Rehab; PBP 3, 5, 9c-d"	"$50/Visit for PCP, Immunizations, Routine Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7a, 14b-j"	"$50/Visit for Chiropractic, Physician Specialist (excl. Radiology), Podiatry; PBP 7b, 7d, 7f"	"$50/Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$50/Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$50/Visit for Physician Specialist (Radiology); PBP 7d	"$50/Visit for Other Health Care, Hearing Exams (Medicare Covered); PBP 7g, 18a"	$50/Script for Part B Drugs; PBP 15	"No Cost Sharing for Blood, $50/Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); PBP 13a, 16b, 17a"	No Coverage for Transportation; PBP 10b	"No Coverage for Preventive Dental Services, Comprehensive Dental (Non-Medicare Covered); PBP 16a-b"	$50/Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing for Eye Wear (Medicare Covered); PBP 17b	No Coverage for Routine Hearing Exams (Non-Medicare Covered); PBP 18a	No Coverage for Hearing Aids (Non-Medicare Covered); PBP 18b	No Cost Sharing for Health Education/Wellness Program; PBP 14a	No Coverage for Acupuncture; PBP 13b											5100	0.5722	0.0335	0.7116	0.1453	0.1644	0.1541	0.0177	0.0764	0.2506	0.2083	0.0976	0	0	0.2416	0.5102	3.821	0.0855	0.4388	0.2235	0.4594	0.4304	0	0	0	0.0016	0.0003	0	0	0	0											8.644	200	3.508309129	7.6422	0.259700739	5.073225627	0.145256747	1.290961777	1.888105917	0.312298137	1.227170778	3.898700103	3.749269421	1.344463432	0	0	2.150312406	5.671348723	23.41643879	0.670577584	1.167619157	3.163904	8.448106067	5.982715227	0	0	0	0.099372636	0.000338806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6021
H1417_004_0	2011	5																															A	A	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	194.2112916	6.561250483	663.8217872	0	129.0431058	8.400650784	1.372050949	292.3052659	318.5612737	1106.600493	457.8785237	0	0	558.710621	3201.013839	6150.405052	254.0671493	183.6316163	1004.815607	2514.3694	1692.497675	0	0	0	32.4046948	0	0	0	0	0											3000	$150/Day (Days 1-5) for IP Acute; PBP 1a	$150/Day (Days 1-5) for IP Psych; PBP 1b	$140/Day (Days 21-100) for SNF; PBP 2	No Cost Sharing for Home Health; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b-c"	"$50/Visit for ER, $40/Visit for Urgent Care; PBP 4a-b"	$150/Visit for ASC Services; PBP 9b	$40/Visit for OP Diagnostic Procedures/Tests; PBP 8a	$40/Visit for OP Radiology; PBP 8b	$150/Visit for OP Hospital; PBP 9a	No Cost Sharing for Renal Dialysis; PBP 12	"$40/Visit for CORF, Partial Hosp, OP Substance Abuse, Cardiac Rehab; PBP 3, 5, 9c-d"	"$20/Visit for PCP, No Cost Sharing for Immunizations, Routine Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7a, 14b-j"	"$40/Visit for Chiropractic, Physician Specialist (excl. Radiology), Podiatry; PBP 7b, 7d, 7f"	"$40/Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$40/Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$40/Visit for Physician Specialist (Radiology); PBP 7d	"$40/Visit for Other Health Care, Hearing Exams (Medicare Covered); PBP 7g, 18a"	$40/Script for Part B Drugs; PBP 15	"No Cost Sharing for Blood, $40/Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); PBP 13a, 16b, 17a"	No Coverage for Transportation; PBP 10b	"No Coverage for Preventive Dental Services, Comprehensive Dental (Non-Medicare Covered); PBP 16a-b"	$40/Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing for Eye Wear (Medicare Covered); PBP 17b	No Coverage for Routine Hearing Exams (Non-Medicare Covered); PBP 18a	No Coverage for Hearing Aids (Non-Medicare Covered); PBP 18b	No Cost Sharing for Health Education/Wellness Program; PBP 14a	No Coverage for Acupuncture; PBP 13b											0	442.3265025	599.7462	65.8	0	100	0.2	0.2	49.59	150	40	40	0	0	40	20	40	40	40	40	40	40	0	0	0	40	0	0	0	0	0											NO	357.6662178	484.956144	53.20602994	0	80.86022787	0.161720456	0.161720456	40.098587	121.2903418	32.34409115	32.34409115	0	0	32.34409115	16.17204557	32.34409115	32.34409115	32.34409115	32.34409115	32.34409115	32.34409115	0	0	0	32.34409115	0	0	0	0	0												5.7886	0.265159894	2.943276824	0	0.869537912	1.358557073	0.221888705	0.976752345	3.219867148	2.9826656	1.234138725	0	0	1.505915604	4.313911807	16.57743847	0.684797586	0.494949811	2.708320632	6.777082755	4.561858257	0	0	0	0.0873417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.572	0	13.62741048	5.7886	0.265159894	2.943276824	0	0.869537912	1.358557073	0.221888705	0.976752345	3.219867148	2.9826656	1.234138725	0	0	1.505915604	4.313911807	16.57743847	0.684797586	0.494949811	2.708320632	6.777082755	4.561858257	0	0	0	0.0873417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.572	YES	$200/Day (Days 1-5) for IP Acute; PBP 1a	$200/Day (Days 1-5) for IP Psych; PBP 1b	$200/Day (Days 21-100) for SNF; PBP 2	$50/Visit for Home Health; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b-c"	"$50/Visit for ER, $40/Visit for Urgent Care; PBP 4a-b"	$200/Visit for ASC Services; PBP 9b	$50/Visit for OP Diagnostic Procedures/Tests; PBP 8a	$50/Visit for OP Radiology; PBP 8b	$200/Visit for OP Hospital; PBP 9a	No Cost Sharing for Renal Dialysis; PBP 12	"$50/Visit for CORF, Partial Hosp, OP Substance Abuse, Cardiac Rehab; PBP 3, 5, 9c-d"	"$50/Visit for PCP, Immunizations, Routine Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7a, 14b-j"	"$50/Visit for Chiropractic, Physician Specialist (excl. Radiology), Podiatry; PBP 7b, 7d, 7f"	"$50/Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$50/Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$50/Visit for Physician Specialist (Radiology); PBP 7d	"$50/Visit for Other Health Care, Hearing Exams (Medicare Covered); PBP 7g, 18a"	$50/Script for Part B Drugs; PBP 15	"No Cost Sharing for Blood, $50/Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); PBP 13a, 16b, 17a"	No Coverage for Transportation; PBP 10b	"No Coverage for Preventive Dental Services, Comprehensive Dental (Non-Medicare Covered); PBP 16a-b"	$50/Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing for Eye Wear (Medicare Covered); PBP 17b	No Coverage for Routine Hearing Exams (Non-Medicare Covered); PBP 18a	No Coverage for Hearing Aids (Non-Medicare Covered); PBP 18b	No Cost Sharing for Health Education/Wellness Program; PBP 14a	No Coverage for Acupuncture; PBP 13b											5100	0.3707	0.0215	0.5124	0.0946	0.1231	0.1123	0.0109	0.0834	0.1978	0.2005	0.0601	0	0	0.2249	0.4874	3.7619	0.0515	0.6818	0.1695	0.395	0.3372	0	0	0	0.001	0.0003	0	0	0	0											7.8975	200	2.929747582	6.1592	0.286623309	3.455716222	0.094554329	0.992682266	1.470869298	0.232790553	1.060145962	3.417657372	3.183115649	1.294278898	0	0	1.730770832	4.801285215	20.33930558	0.736254058	1.176758294	2.877832558	7.172094057	4.899048343	0	0	0	0.088305424	0.000254066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.4696
H1417_005_0	2011	6																															A	A	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	309.1879161	6.196519005	1349.673789	0	203.2374675	17.54246399	2.70482568	437.8716852	446.4650873	0	0	0	0	926.727704	5045.481249	9809.898248	417.8468904	423.5863919	1464.059087	4048.365875	0	0	0	0	46.73472983	0	0.349223565	0	0	0											1500	$100/Day (Days 1-5) for IP Acute; PBP 1a	$100/Day (Days 1-5) for IP Psych; PBP 1b	$50/Day (Days 21-100) for SNF; PBP 2	No Cost Sharing for Home Health; PBP 6	$50/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b-c"	"$50/Visit for ER, $20/Visit for Urgent Care; PBP 4a-b"	$100/Visit for ASC Services; PBP 9b	No Cost Sharing for OP Diagnostic Procedures/Tests; PBP 8a	No Cost Sharing for OP Radiology; PBP 8b	$100/Visit for OP Hospital; PBP 9a	No Cost Sharing for Renal Dialysis; PBP 12	"$20/Visit for CORF, Partial Hosp, OP Substance Abuse, Cardiac Rehab; PBP 3, 5, 9c-d"	"$20/Visit for PCP, No Cost Sharing for Immunizations, Routine Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7a, 14b-j"	"$20/Visit for Chiropractic, Physician Specialist (excl. Radiology), Podiatry; PBP 7b, 7d, 7f"	"$20/Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$20/Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$20/Visit for Physician Specialist (Radiology); PBP 7d	"$20/Visit for Other Health Care, Hearing Exams (Medicare Covered); PBP 7g, 18a"	No Cost Sharing for Part B Drugs; PBP 15	"No Cost Sharing for Blood, $20/Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); PBP 13a, 16b, 17a"	No Coverage for Transportation; PBP 10b	"No Coverage for Preventive Dental Services, Comprehensive Dental (Non-Medicare Covered); PBP 16a-b"	$20/Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing for Eye Wear (Medicare Covered); PBP 17b	$20/Visit for Routine Hearing Exams (Non-Medicare Covered); PBP 18a	No Coverage for Hearing Aids (Non-Medicare Covered); PBP 18b	No Cost Sharing for Health Education/Wellness Program; PBP 14a	No Coverage for Acupuncture; PBP 13b											0	294.884335	399.8308	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	7.240298947	0	0	0											NO	209.325697	283.8226754	16.68163851	0	35.4928479	0.070985696	0.070985696	34.61972384	70.9856958	0	0	0	0	14.19713916	14.19713916	14.19713916	14.19713916	14.19713916	14.19713916	14.19713916	0	0	0	0	14.19713916	0	5.139576586	0	0	0												5.3934	0.146559384	1.876230855	0	0.601123043	1.245264013	0.192003933	1.263249735	2.641052906	0	0	0	0	1.096406848	5.969283285	11.60604088	0.494352538	0.501142913	1.732120884	4.789601141	0	0	0	0	0.055291622	0	0.000149572	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6033	0	16.18723094	5.3934	0.146559384	1.876230855	0	0.601123043	1.245264013	0.192003933	1.263249735	2.641052906	0	0	0	0	1.096406848	5.969283285	11.60604088	0.494352538	0.501142913	1.732120884	4.789601141	0	0	0	0	0.055291622	0	0.000149572	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6033	YES	$175/Day (Days 1-5) for IP Acute; PBP 1a	$175/Day (Days 1-5) for IP Psych; PBP 1b	$100/Day (Days 21-100) for SNF; PBP 2	$30/Visit for Home Health; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b-c"	"$50/Visit for ER, $20/Visit for Urgent Care; PBP 4a-b"	$200/Visit for ASC Services; PBP 9b	$30/Visit for OP Diagnostic Procedures/Tests; PBP 8a	$30/Visit for OP Radiology; PBP 8b	$200/Visit for OP Hospital; PBP 9a	No Cost Sharing for Renal Dialysis; PBP 12	"$30/Visit for CORF, Partial Hosp, OP Substance Abuse, Cardiac Rehab; PBP 3, 5, 9c-d"	"$30/Visit for PCP, Immunizations, Routine Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7a, 14b-j"	"$30/Visit for Chiropractic, Physician Specialist (excl. Radiology), Podiatry; PBP 7b, 7d, 7f"	"$30/Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$30/Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$30/Visit for Physician Specialist (Radiology); PBP 7d	"$30/Visit for Other Health Care, Hearing Exams (Medicare Covered); PBP 7g, 18a"	$30/Script for Part B Drugs; PBP 15	"No Cost Sharing for Blood, $30/Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); PBP 13a, 16b, 17a"	No Coverage for Transportation; PBP 10b	"No Coverage for Preventive Dental Services, Comprehensive Dental (Non-Medicare Covered); PBP 16a-b"	$30/Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing for Eye Wear (Medicare Covered); PBP 17b	$30/Visit for Routine Hearing Exams (Non-Medicare Covered); PBP 18a	No Coverage for Hearing Aids (Non-Medicare Covered); PBP 18b	No Cost Sharing for Health Education/Wellness Program; PBP 14a	No Coverage for Acupuncture; PBP 13b											5100	0.4769	0.018	0.4438	0.1626	0.0985	0.1686	0.0216	0.0728	0.2942	0.1262	0.0734	0	0	0.1606	0.3142	3.4083	0.0638	0.3531	0.1851	0.329	0.3871	0	0	0	0.0007	0.0001	0	0	0	0											7.1585	110	2.387610073	5.8703	0.16457598	2.320013528	0.162606337	0.699602645	1.413894057	0.213632199	1.336046816	2.935206243	0.126238909	0.073351377	0	0	1.257016931	6.283443212	15.01431774	0.558103656	0.854289408	1.917248179	5.118586455	0.38713719	0	0	0	0.055997645	0.000100561	0.000149572	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7618
H1417_801_0	2011	2																															Coin	Coin	Coin	Coin	Coin	Coin	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	229.6602057	2.664094585	41.32635041	0	7.78772243	11.0671747	1.879976849	18.53820145	45.47571178	7.155661029	14.21552634	0	2.024767407	29.45568422	25.91041312	69.49442174	1.638170587	1.688200518	27.87127818	58.63145721	32.23577817	0	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Sharing; PBP 1a	Medicare FFS Cost Sharing; PBP 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	Medicare FFS Cost Sharing; PBP 11b-c	Medicare FFS Cost Sharing; PBP 4a-b	Medicare FFS Cost Sharing; PBP 9b	Medicare FFS Cost Sharing; PBP 8a	Medicare FFS Cost Sharing; PBP 8b	Medicare FFS Cost Sharing; PBP 9a	Medicare FFS Cost Sharing; PBP 12	"Medicare FFS Cost Sharing; PBP 3, 5, 9c-d"	"Medicare FFS Cost Sharing; PBP 7a, 14b-j"	"Medicare FFS Cost Sharing; PBP 7b, 7d, 7f"	"Medicare FFS Cost Sharing; PBP 7e, 7h"	"Medicare FFS Cost Sharing; PBP 7c, 7i"	Medicare FFS Cost Sharing; PBP 7d	"Medicare FFS Cost Sharing; PBP 7g, 18a"	Medicare FFS Cost Sharing; PBP 15	"Medicare FFS Cost Sharing; PBP 13a, 16b, 17a"	No Coverage; PBP 10b	No Coverage; PBP 16a-b	No Coverage; PBP 17a	No Coverage; PBP 17b	No Coverage; PBP 18a	No Coverage; PBP 18b	No Coverage; PBP 14a	No Coverage; PBP 13b											0	0.084509523	0.084509523	0.186379137	0	0.233	0.233	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	0.071867347	0.071867347	0.158497808	0	0.198144437	0.198144437	0.198144437	0.198144437	0.198144437	0.198144437	0.198144437	0	0.198144437	0.198144437	0.198144437	0.198144437	0.198144437	0.198144437	0.198144437	0.198144437	0.198144437	0	0	0	0	0	0	0	0	0												16.5051	0.191461411	6.550135937	0	1.543093877	2.192899102	0.372506955	3.673241492	9.010759313	1.417854427	2.816727466	0	0.401196398	5.83647997	5.134004223	13.76993308	0.324594389	0.334507541	5.522538726	11.61749709	6.38734012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.6018	0	16.46548807	16.5051	0.191461411	6.550135937	0	1.543093877	2.192899102	0.372506955	3.673241492	9.010759313	1.417854427	2.816727466	0	0.401196398	5.83647997	5.134004223	13.76993308	0.324594389	0.334507541	5.522538726	11.61749709	6.38734012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.6018	YES	Medicare FFS Cost Sharing; PBP 1a	Medicare FFS Cost Sharing; PBP 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	Medicare FFS Cost Sharing; PBP 11b-c	Medicare FFS Cost Sharing; PBP 4a-b	Medicare FFS Cost Sharing; PBP 9b	Medicare FFS Cost Sharing; PBP 8a	Medicare FFS Cost Sharing; PBP 8b	Medicare FFS Cost Sharing; PBP 9a	Medicare FFS Cost Sharing; PBP 12	"Medicare FFS Cost Sharing; PBP 3, 5, 9c-d"	"Medicare FFS Cost Sharing; PBP 7a, 14b-j"	"Medicare FFS Cost Sharing; PBP 7b, 7d, 7f"	"Medicare FFS Cost Sharing; PBP 7e, 7h"	"Medicare FFS Cost Sharing; PBP 7c, 7i"	Medicare FFS Cost Sharing; PBP 7d	"Medicare FFS Cost Sharing; PBP 7g, 18a"	Medicare FFS Cost Sharing; PBP 15	"Medicare FFS Cost Sharing; PBP 13a, 16b, 17a"	No Coverage; PBP 10b	No Coverage; PBP 16a-b	No Coverage; PBP 17a	No Coverage; PBP 17b	No Coverage; PBP 18a	No Coverage; PBP 18b	No Coverage; PBP 14a	No Coverage; PBP 13b											10000	0.6274	0.0317	0.7005	0	0.1941	0.1989	0.0229	0.1737	0.5448	0.069	0.133	0	0	0.468	0.263	1.9207	0.0446	0.1697	0.2413	0.7797	0.5323	0	0	0	0	0	0	0	0	0											7.1153	0	0.734610677	17.1324	0.223151508	7.2506216	0	1.73722382	2.391819326	0.395409885	3.846922323	9.555527512	1.486827635	2.949708014	0	0.401196398	6.304515806	5.397046854	15.69065876	0.369158827	0.504203506	5.7638413	12.39722534	6.919644071	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.7171
H1417_802_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	284.1671338	2.084936335	49.94231558	0	10.49160603	11.49744209	1.618558773	21.27918819	50.44609422	7.988262243	17.26471355	0	1.584677401	34.1202725	28.74648964	80.5932554	1.607766276	3.606747343	28.23840091	65.31605907	29.39047814	0	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Sharing; PBP 1a	Medicare FFS Cost Sharing; PBP 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	Medicare FFS Cost Sharing; PBP 11b-c	Medicare FFS Cost Sharing; PBP 4a-b	Medicare FFS Cost Sharing; PBP 9b	Medicare FFS Cost Sharing; PBP 8a	Medicare FFS Cost Sharing; PBP 8b	Medicare FFS Cost Sharing; PBP 9a	Medicare FFS Cost Sharing; PBP 12	"Medicare FFS Cost Sharing; PBP 3, 5, 9c-d"	"Medicare FFS Cost Sharing; PBP 7a, 14b-j"	"Medicare FFS Cost Sharing; PBP 7b, 7d, 7f"	"Medicare FFS Cost Sharing; PBP 7e, 7h"	"Medicare FFS Cost Sharing; PBP 7c, 7i"	Medicare FFS Cost Sharing; PBP 7d	"Medicare FFS Cost Sharing; PBP 7g, 18a"	Medicare FFS Cost Sharing; PBP 15	"Medicare FFS Cost Sharing; PBP 13a, 16b, 17a"	No Coverage; PBP 10b	No Coverage; PBP 16a-b	No Coverage; PBP 17a	No Coverage; PBP 17b	No Coverage; PBP 18a	No Coverage; PBP 18b	No Coverage; PBP 14a	No Coverage; PBP 13b											0	0.084779567	0.084779567	0.185575414	0	0.233	0.233	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	0.069694313	0.069694313	0.15255505	0	0.191541142	0.191541142	0.191541142	0.191541142	0.191541142	0.191541142	0.191541142	0	0.191541142	0.191541142	0.191541142	0.191541142	0.191541142	0.191541142	0.191541142	0.191541142	0.191541142	0	0	0	0	0	0	0	0	0												19.8048	0.145308206	7.618952457	0	2.009574204	2.202233191	0.310020596	4.075840012	9.662502509	1.530080875	3.306902954	0	0.303530919	6.535435969	5.506135461	15.4369242	0.307953389	0.690840506	5.408815565	12.51071256	5.629485755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9961	0	22.29338243	19.8048	0.145308206	7.618952457	0	2.009574204	2.202233191	0.310020596	4.075840012	9.662502509	1.530080875	3.306902954	0	0.303530919	6.535435969	5.506135461	15.4369242	0.307953389	0.690840506	5.408815565	12.51071256	5.629485755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9961	YES	Medicare FFS Cost Sharing; PBP 1a	Medicare FFS Cost Sharing; PBP 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	Medicare FFS Cost Sharing; PBP 11b-c	Medicare FFS Cost Sharing; PBP 4a-b	Medicare FFS Cost Sharing; PBP 9b	Medicare FFS Cost Sharing; PBP 8a	Medicare FFS Cost Sharing; PBP 8b	Medicare FFS Cost Sharing; PBP 9a	Medicare FFS Cost Sharing; PBP 12	"Medicare FFS Cost Sharing; PBP 3, 5, 9c-d"	"Medicare FFS Cost Sharing; PBP 7a, 14b-j"	"Medicare FFS Cost Sharing; PBP 7b, 7d, 7f"	"Medicare FFS Cost Sharing; PBP 7e, 7h"	"Medicare FFS Cost Sharing; PBP 7c, 7i"	Medicare FFS Cost Sharing; PBP 7d	"Medicare FFS Cost Sharing; PBP 7g, 18a"	Medicare FFS Cost Sharing; PBP 15	"Medicare FFS Cost Sharing; PBP 13a, 16b, 17a"	No Coverage; PBP 10b	No Coverage; PBP 16a-b	No Coverage; PBP 17a	No Coverage; PBP 17b	No Coverage; PBP 18a	No Coverage; PBP 18b	No Coverage; PBP 14a	No Coverage; PBP 13b											10000	0.633	0.0239	0.8198	0	0.2851	0.2332	0.0304	0.2341	0.5833	0.0798	0.1685	0	0	0.645	0.3689	2.2322	0.0563	0.1722	0.3147	0.8866	0.4351	0	0	0	0	0	0	0	0	0											8.2021	0	1.209069975	20.4379	0.169230643	8.438800665	0	2.294707721	2.435404641	0.340378881	4.309949068	10.24577678	1.609877619	3.475427819	0	0.303530919	7.180386291	5.875080678	17.66909755	0.364210039	0.863072952	5.723558663	13.39726537	6.064580478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1982
H1418_002_0	2011	6	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Radiology	Renal Dialysis	Other	Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V					O	O	O	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	YES	1335.661904	76.242923	636.756007	657.94385	46.997268	8.687887	2.55367	273.69315	306.835759	1214.238222	128.098858	72.566641	1.222357	12.162781	3417.350815	3293.274946	149.401927	301.415996		1264.228196	17.475951	0		3.2					4.51	0.6	654.589136	960.254456	5.494661	909.736594	707.809663						4500	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	45.243839	0	100	0.2	0.2	50	138.42896	40.447224	35	50	0.2	0.2	10	32.148439	35	50		0	0.2	0		0					0	0	0	39.315394	0	43.110273	35						NO	143.389644	122.761545	31.066863	0	88.8625	0.177725	0.177725	44.43125	123.011435	35.942415	31.101875	44.43125	0.177725	0.177725	8.88625	28.567907	31.101875	44.43125		0	0.177725	0		0					0	0	0	34.936642	0	38.308866	31.101875							15.96	0.779974919	1.648500969	0	0.348024561	1.544054717	0.453851001	1.013377398	3.145358919	3.63688784	0.332009556	0.268685547	0.217243398	2.161630253	2.530619473	7.840164365	0.387223338	1.116024123	0	0	3.105913391	0	0	0	0	0	0	0	0	0	0	2.79567218	0	2.904248106	1.834517305	0	0	0	0	0	54.024	0	7.355027611	15.96	0.779974919	1.648500969	0	0.348024561	1.544054717	0.453851001	1.013377398	3.145358919	3.63688784	0.332009556	0.268685547	0.217243398	2.161630253	2.530619473	7.840164365	0.387223338	1.116024123	0	0	3.105913391	0	0	0	0	0	0	0	0	0	0	2.79567218	0	2.904248106	1.834517305	0	0	0	0	0	54.024	YES	$250/Day(Days 1-10)	$250/Day(Days 1-10)	30% Coins(Days 1-20) 30%(Days 20-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$40/Visit	30% Coins	20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins		$40/Visit	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$0/Proc	30% Coins	$40/Visit						6000	2.5969	0.1337	0.5776	2.4789	1.2561	1.3779	0.405	0.1366	2.3811	0.4198	0.0604	0.2186	0.0299	0.2974	1.6119	1.5533	0.0705	0.1563		0.5963	0.5578	0		0					0	0	0.1676	1.0756	0	0.6253	0.3339						19.1186	0	5.852513598	18.5569	0.913653241	2.226120378	2.478869294	1.604159694	2.921994614	0.858875019	1.150012347	5.526480036	4.056701865	0.392429643	0.487324783	0.247136769	2.459077682	4.14247329	9.393495608	0.457691394	1.272340814	0	0.59629554	3.663742143	0	0	0	0	0	0	0	0	0	0.167557375	3.871283397	0	3.529532189	2.168368222	0	0	0	0	0	73.1426
H1418_007_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Radiology	Renal Dialysis	Other	Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V			V		O	O	O	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	1065.921148	44.09561973	386.0460667	463.2918831	30.02285119	9.839920084	1.961497989	358.836126	391.374608	1543.46952	180.8425027	77.04501895	0.221970264	8.100799644	3374.318997	3395.93951	110.2305054	330.2475811		1488.391085	18.33716928	0		3.2			0.28		4.51	0.6	713.2220846	863.6805734	1.020257379	837.1739226	441.8156485						4500	$175/Day(Days 1-10):1a.IP Acute	$175/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	$30/Visit:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"			"HER724: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30-$50/Visit:9d. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							141.405425	127.515675	45.243839	0	100	0.2	0.2	50	100	0	30	50	0.2	0.2	10	28.002385	30	30		0	0.2	0		0			0		0	0	0	38.611233	0	43.613876	30						NO	132.993216	119.929767	38.599465	0	93.1873	0.186375	0.186375	46.59365	93.1873	0	27.95619	46.59365	0.186375	0.186375	9.31873	26.094667	27.95619	27.95619		0	0.186375	0		0			0		0	0	0	35.980766	0	40.642594	27.95619							11.8134	0.440698117	1.241764303	0	0.233145703	1.833915106	0.365574188	1.393290405	3.039261917	0	0.421305614	0.299150721	0.041369708	1.509786534	2.620363973	7.384659222	0.256802079	0.76937201	0	0	3.417589925	0	0	0	0	0	0	0	0	0	0	2.589657384	0	2.835409987	1.029290185	0	0	0	0	0	43.5358	0	3.185004764	11.8134	0.440698117	1.241764303	0	0.233145703	1.833915106	0.365574188	1.393290405	3.039261917	0	0.421305614	0.299150721	0.041369708	1.509786534	2.620363973	7.384659222	0.256802079	0.76937201	0	0	3.417589925	0	0	0	0	0	0	0	0	0	0	2.589657384	0	2.835409987	1.029290185	0	0	0	0	0	43.5358	YES	$200/Day(Days 1-10)	$200/Day(Days 1-10)	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	20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins		$35/Visit	20%-30% Coins	0% Coins		0.5			"HER724: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$0/Proc	30% Coins	$35/Visit						6000	2.2042	0.0822	0.4498	3.0482	1.0769	2.0944	0.4175	0.2404	3.4645	0.4169	0.1002	0.3195	0.0073	0.2659	1.8689	1.8809	0.0611	0.1195		0.8244	0.832	0		0			0		0	0	0.2656	1.1055	0	0.6863	0.2447						22.0766	500	3.809761397	14.0176	0.522925783	1.691609694	3.048207028	1.310023341	3.928309024	0.783072477	1.63369607	6.503774849	0.416924583	0.521465845	0.618675309	0.048654624	1.775648313	4.489241964	9.265511808	0.317853617	0.888835105	0	0.824350436	4.24963641	0	0	0	0	0	0	0	0	0	0.265553984	3.695143026	0	3.521724462	1.273991275	0	0	0	0	0	65.6124
H1418_008_0	2011	6	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							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		V	Coin	Coin		V					O	O	O	V	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	YES	1181.182094	63.274182	360.090628	674.978835	33.726339	8.765335	2.425674	321.522726	354.88227	1632.591459	212.681754	81.174534	0.437306	868.72464	3380.803529	3339.277101	92.623203	204.707752		1545.677892	17.535289	0		3.14					5.25	0.48	801.273955	807.113145	1.371325	413.808526							3400	$200/Day(Days 1-7):1a.IP Acute	$200/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								143.724	123.0478	46.371	0	100	0.2	0.2	50	150	18.365847	30	50	0.2	46.491501	10	28.105289	30	50		0	0.2	0		0					0	0	0	39.480931	0	30							NO	125.339832	107.308387	32.479918	0	87.3998	0.1748	0.1748	43.6999	131.0997	16.051714	26.21994	43.6999	0.1748	40.633478	8.73998	24.563966	26.21994	43.6999		0	0.1748	0		0					0	0	0	34.506255	0	26.21994								12.3374	0.565820867	0.974642839	0	0.245639607	1.532180558	0.424007815	1.170875914	3.877079928	2.183824265	0.464708569	0.295609918	0.076441089	2.941608629	2.462346269	6.835490764	0.202381235	0.745475691	0	0	3.065168517	0	0	0	0	0	0	0	0	0	0	2.320871	0	0.90416956	0	0	0	0	0	0	43.6258	0	6.598088505	12.3374	0.565820867	0.974642839	0	0.245639607	1.532180558	0.424007815	1.170875914	3.877079928	2.183824265	0.464708569	0.295609918	0.076441089	2.941608629	2.462346269	6.835490764	0.202381235	0.745475691	0	0	3.065168517	0	0	0	0	0	0	0	0	0	0	2.320871	0	0.90416956	0	0	0	0	0	0	43.6258	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		$35/Visit	20%-30% Coins	0% Coins		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$0/Proc	$35/Visit							5100	5.049	0.0899	0.2299	1.6252	0.7903	1.2189	0.3373	0.1407	1.8943	0.2094	0.077	0.1574	0.0094	0.4868	1.2233	1.2083	0.0335	0.0458		0.5593	0.6158	0		0					0	0	0.1547	0.6318	0	0.1497							16.9377	0	10.40238492	17.3864	0.655756956	1.204567933	1.625204899	1.035959027	2.751042052	0.761309407	1.311603499	5.771353194	2.393228686	0.541664852	0.453022713	0.085817408	3.4284012	3.685648511	8.043767178	0.235895804	0.791261594	0	0.559284566	3.680980949	0	0	0	0	0	0	0	0	0	0.15473943	2.952647835	0	1.053901092	0	0	0	0	0	0	60.5635
H1418_009_0	2011	4	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							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		V	Coin	Coin		V					O	O	O	V	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	YES	1028.531266	33.535331	365.604654	449.960105	32.88927	4.719312	1.582796	274.432419	267.780903	822.715923	117.632266	54.561875	0.025905	525.046636	2189.78235	2426.601908	28.393437	158.757666		902.930258	9.596216	0		3.14					1.42	0.48	504.468586	559.481227	0.397489	316.021108							3400	$200/Day(Days 1-7):1a.IP Acute	$200/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								143.724	123.0478	46.371	0	100	0.2	0.2	50	150	34.094012	30	50	0.2	48.041608	10	28.303497	30	50		0	0.2	0		0					0	0	0	42.120406	0	30							NO	132.851998	113.739849	36.480529	0	92.1173	0.184235	0.184235	46.05865	138.17595	31.406483	27.63519	46.05865	0.184235	44.254632	9.21173	26.072417	27.63519	46.05865		0	0.184235	0		0					0	0	0	38.800181	0	27.63519								11.3869	0.317858624	1.111454265	0	0.252472563	0.869462446	0.291606421	1.053332228	3.083406722	2.153217804	0.270899168	0.209420525	0.004772608	1.936312138	1.680973647	5.272281403	0.065388169	0.609346981	0	0	1.767958855	0	0	0	0	0	0	0	0	0	0	1.808997739	0	0.72777528	0	0	0	0	0	0	34.8738	0	3.146718815	11.3869	0.317858624	1.111454265	0	0.252472563	0.869462446	0.291606421	1.053332228	3.083406722	2.153217804	0.270899168	0.209420525	0.004772608	1.936312138	1.680973647	5.272281403	0.065388169	0.609346981	0	0	1.767958855	0	0	0	0	0	0	0	0	0	0	1.808997739	0	0.72777528	0	0	0	0	0	0	34.8738	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		$35/Visit	20%-30% Coins	0% Coins		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$0/Proc	$35/Visit							5100	5.3518	0.0538	0.2714	2.1976	1.2063	1.0272	0.3445	0.188	2.3169	0.2632	0.0666	0.1809	0.0009	0.5414	1.2402	1.3743	0.0161	0.0687		0.5114	0.5735	0		0					0	0	0.1538	0.7105	0	0.179							18.8379	500	7.573688628	16.7387	0.371702039	1.382817337	2.197634655	1.458789593	1.896622787	0.636102451	1.24134041	5.400319217	2.416373104	0.337520617	0.39035141	0.005641879	2.47775599	2.921164608	6.646595958	0.08146889	0.678004816	0	0.511377739	2.341421066	0	0	0	0	0	0	0	0	0	0.153767682	2.51948777	0	0.906754951	0	0	0	0	0	0	53.7117
H1418_016_0	2011	4	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Radiology	Renal Dialysis	Other	Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							O	O	O	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	YES	1179.098884	60.637503	466.727574	604.438498	37.861264	9.562846	2.794818	350.512651	385.133384	1532.649734	178.994478	76.873389	0.366951	6.304153	3643.853456	3634.352373	95.119682	214.462185		1650.032252	20.161178	0							4.51	0.6	961.863906	894.73868	1.857807	797.405295	525.072447						4500	$175/Day(Days 1-10):1a.IP Acute	$175/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	$30/Visit:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30-$50/Visit:9d. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							141.405425	127.515675	45.243839	0	100	0.2	0.2	50	100	0	30	50	0.2	0.2	10	28.321154	30	30		0	0.2	0							0	0	0	39.396913	0	44.780835	30						NO	131.476643	118.562162	36.647691	0	92.3365	0.184673	0.184673	46.16825	92.3365	0	27.70095	46.16825	0.184673	0.184673	9.23365	26.150763	27.70095	27.70095		0	0.184673	0							0	0	0	36.377731	0	41.349055	27.70095							12.9187	0.599109454	1.425373993	0	0.291331384	1.765999459	0.516127425	1.348546308	2.963489059	0	0.41319309	0.295759153	0.067765942	1.164206847	2.803838955	7.92009063	0.219575463	0.495067189	0	0	3.723225225	0	0	0	0	0	0	0	0	0	0	2.712380251	0	2.74766295	1.2120838	0	0	0	0	0	45.6035	0	3.899832017	12.9187	0.599109454	1.425373993	0	0.291331384	1.765999459	0.516127425	1.348546308	2.963489059	0	0.41319309	0.295759153	0.067765942	1.164206847	2.803838955	7.92009063	0.219575463	0.495067189	0	0	3.723225225	0	0	0	0	0	0	0	0	0	0	2.712380251	0	2.74766295	1.2120838	0	0	0	0	0	45.6035	YES	$200/Day(Days 1-10)	$200/Day(Days 1-10)	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	20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins		$35/Visit	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$0/Proc	30% Coins	$35/Visit						6000	2.3533	0.1091	0.508	2.8755	1.3543	2.0298	0.5932	0.2342	3.136	0.4354	0.0989	0.2134	0.012	0.2063	2.0126	2.0074	0.0525	0.0798		0.9114	0.881	0							0	0	0.3083	1.0715	0	0.5573	0.29						22.3313	500	4.139021398	15.272	0.708247147	1.933367669	2.875535732	1.645632583	3.7958298	1.109361083	1.582730707	6.099465602	0.435375164	0.512057545	0.509186141	0.079775896	1.370536009	4.816457377	9.927461295	0.27211315	0.5748774	0	0.911366317	4.604188811	0	0	0	0	0	0	0	0	0	0.308297126	3.783859325	0	3.304913105	1.50209834	0	0	0	0	0	67.9347
H1418_017_0	2011	9	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Radiology									Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin		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	YES	216.831708	3.862348	16.848092	674.978835	1.51528	8.765335	2.425674	321.522726	56.260851	6.511001	22.880528	4.894428	0.506844	15.134324	28.402824	45.542933	0.724724	4.587078		1545.677892	17.535289	0		3.14					1.42	0.48	801.273955	169.801577									6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $155 plan year deductible	"8a. $0 Lab -- FSL,8a. 20% coinsurance after $155 plan year deductible Lab -- OP"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit:14b-j.Preventive Services	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"										0.085413	0.085413	0.158887	0	0.233	0.233	0.233	50	0.233	0.204591	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0		0					0	0	0	0									NO	0.079653	0.079653	0.129885	0	0.215271	0.215271	0.215271	46.19545	0.215271	0.189024	0.215271	0.215271	0.215271	0.215271	0.215271	0.215271	0.215271	0.215271		0	0.215271	0		0					0	0	0	0										17.2713	0.307647605	2.188314429	0	0.326195841	1.886922431	0.522177268	1.237740584	12.11132966	1.230735453	4.925514143	1.05362841	0.109108815	3.257981062	6.114304325	9.80407273	0.15601206	0.987464868	0	0	3.774839198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2653	0	5.671607895	17.2713	0.307647605	2.188314429	0	0.326195841	1.886922431	0.522177268	1.237740584	12.11132966	1.230735453	4.925514143	1.05362841	0.109108815	3.257981062	6.114304325	9.80407273	0.15601206	0.987464868	0	0	3.774839198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2653	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	$50/Visit	20% coinsurance after $155 plan year deductible	"8a. $0 Lab -- FSL,8a. 20% coinsurance after $155 plan year deductible Lab -- OP"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	$0/Visit									8000	2.6959	0.048	0.3603	0	1.3359	1.2738	0.3525	0.1894	1.9797	0.1922	0.8226	0.1645	0.017	0.5087	1.1333	1.8172	0.0289	0.1741		0	0.6997	0		0					0	0	0.1388	0									13.9327	0	0.802003258	19.9672	0.355667873	2.548628455	0	1.662137438	3.160757078	0.874691853	1.427107135	14.09103853	1.422900961	5.748109817	1.218140844	0.126144877	3.766728977	7.247621439	11.62130644	0.184929636	1.16154295	0	0	4.474524266	0	0	0	0	0	0	0	0	0	0.138814159	0	0	0	0	0	0	0	0	0	81.1979
H1419_001_0	2011	3																															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	1386.308123	221.7459756	854.0082778	464.1560385	201.8596212	9.765007469	0	313.4889591	399.6457679	2630.638692	2088.870137	90.31785804	1.0662609	190.2263626	2884.790972	4126.902855	277.9924448	511.4232555	0	0	205.2184027	0	0	0	756.1990855	49.62392425	39.19338188	10.13563758	45.95125774	0											3400	$225/day 1-8	$225/day 1-8	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$15 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$250 per procedure	$0 per visit	$50 X-ray; $250 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$10 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$50 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness Only	0											0	171.4121744	171.4121744	72.96419583	15	150	0.05	0.05	49	250	0	30	40	25	40	10	40	40	30	50	40	$50 	0	0	0	0	0	0	0	0	0											NO	139.1082248	139.1082248	59.21352898	12.17313402	121.7313402	0.040577113	0.040577113	39.76557114	202.8855671	0	24.34626805	32.46169073	20.28855671	32.46169073	8.115422682	32.46169073	32.46169073	24.34626805	40.57711341	32.46169073	40.57711341	0	0	0	0	0	0	0	0	0												16.0706	2.570557418	4.214070326	0.470852805	2.047720185	0.396235816	0	1.038838959	6.756863187	0	4.238016023	0.244322531	0.001802741	0.514589113	1.950941507	11.16385368	0.752008731	1.037603972	0	0	0.693930867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1628	0	12.57777322	16.0706	2.570557418	4.214070326	0.470852805	2.047720185	0.396235816	0	1.038838959	6.756863187	0	4.238016023	0.244322531	0.001802741	0.514589113	1.950941507	11.16385368	0.752008731	1.037603972	0	0	0.693930867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1628	NO																																																																																		0			16.0706	2.570557418	4.214070326	0.470852805	2.047720185	0.396235816	0	1.038838959	6.756863187	0	4.238016023	0.244322531	0.001802741	0.514589113	1.950941507	11.16385368	0.752008731	1.037603972	0	0	0.693930867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1628
H1419_801_0	2011	1																															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	YES	354.4128717	7.235071066	45.27591769	8.98948067	10.54124468	13.63088477	0	16.89702088	46.63493131	20.89154005	67.50874386	1.195292427	0.102491199	31.08995422	31.73231003	151.8506928	4.106184058	9.672312848	0	0	80.67172876	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.071907457	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	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.057584861	0.057584861	0.130451379	0	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0	0	0	0	0	0	0	0												20.4088	0.416630565	5.906305888	0	1.966899681	2.543398216	0	3.152829289	8.701650923	3.89816997	12.5965131	0.223030616	0.019123919	5.801100619	5.920958328	28.33394805	0.766176325	1.804764962	0	0	15.05260549	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5129	0	29.22799567	20.4088	0.416630565	5.906305888	0	1.966899681	2.543398216	0	3.152829289	8.701650923	3.89816997	12.5965131	0.223030616	0.019123919	5.801100619	5.920958328	28.33394805	0.766176325	1.804764962	0	0	15.05260549	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5129	NO																																																																																		0			20.4088	0.416630565	5.906305888	0	1.966899681	2.543398216	0	3.152829289	8.701650923	3.89816997	12.5965131	0.223030616	0.019123919	5.801100619	5.920958328	28.33394805	0.766176325	1.804764962	0	0	15.05260549	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5129
H1419_802_0	2011	1																															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	YES	354.1916175	7.230554329	45.24765268	8.983868683	10.53466396	13.62237524	0	16.88647234	46.60581788	20.87849781	67.46659925	1.194546226	0.102427216	31.07054527	31.71250007	151.7558949	4.103620635	9.666274581	0	0	80.62136671	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.071907457	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	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.057584861	0.057584861	0.130451379	0	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0.186590838	0	0	0	0	0	0	0	0												20.3961	0.41637047	5.902618677	0	1.965671778	2.541810414	0	3.150861029	8.696218624	3.895736406	12.58864931	0.222891382	0.01911198	5.797479086	5.91726197	28.31625963	0.765698014	1.803638277	0	0	15.04320839	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.4396	0	29.20974911	20.3961	0.41637047	5.902618677	0	1.965671778	2.541810414	0	3.150861029	8.696218624	3.895736406	12.58864931	0.222891382	0.01911198	5.797479086	5.91726197	28.31625963	0.765698014	1.803638277	0	0	15.04320839	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.4396	NO																																																																																		0			20.3961	0.41637047	5.902618677	0	1.965671778	2.541810414	0	3.150861029	8.696218624	3.895736406	12.58864931	0.222891382	0.01911198	5.797479086	5.91726197	28.31625963	0.765698014	1.803638277	0	0	15.04320839	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.4396
H1463_001_0	2011	4																															A	A	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	271.7969994	2.12627106	1669.535211	0	235.2601629	12.12296141	0.817780948	442.7146777	370.9376042	0	0	0	0	1034.0633	4736.310293	3843.223669	94.362516	201.0027732	1191.452683	4112.029862	0	0	0	0	65.86294563	0	3.549244276	0	0	0											1500	$100/Day (Days 1-5) for IP Acute; PBP 1a	$100/Day (Days 1-5) for IP Psych; PBP 1b	$50/Day (Days 21-100) for SNF; PBP 2	No Cost Sharing for Home Health; PBP 6	$50/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b-c"	"$50/Visit for ER, $20/Visit for Urgent Care; PBP 4a-b"	$100/Visit for ASC Services; PBP 9b	No Cost Sharing for OP Diagnostic Procedures/Tests; PBP 8a	No Cost Sharing for OP Radiology; PBP 8b	$100/Visit for OP Hospital; PBP 9a	No Cost Sharing for Renal Dialysis; PBP 12	"$20/Visit for CORF, Partial Hosp, OP Substance Abuse, Cardiac Rehab; PBP 3, 5, 9c-d"	"$20/Visit for PCP, No Cost Sharing for Immunizations, Routine Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7a, 14b-j"	"$20/Visit for Chiropractic, Physician Specialist (excl. Radiology), Podiatry; PBP 7b, 7d, 7f"	"$20/Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$20/Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$20/Visit for Physician Specialist (Radiology); PBP 7d	"$20/Visit for Other Health Care, Hearing Exams (Medicare Covered); PBP 7g, 18a"	No Cost Sharing for Part B Drugs; PBP 15	"No Cost Sharing for Blood, $20/Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); PBP 13a, 16b, 17a"	No Coverage for Transportation; PBP 10b	"No Coverage for Preventive Dental Services, Comprehensive Dental (Non-Medicare Covered); PBP 16a-b"	$20/Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing for Eye Wear (Medicare Covered); PBP 17b	$20/Visit for Routine Hearing Exams (Non-Medicare Covered); PBP 18a	No Coverage for Hearing Aids (Non-Medicare Covered); PBP 18b	No Cost Sharing for Health Education/Wellness Program; PBP 14a	No Coverage for Acupuncture; PBP 13b											0	285.9100909	365.8104348	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	223.9705938	286.5613454	18.40896535	0	39.16801138	0.078336023	0.078336023	38.2044783	78.33602275	0	0	0	0	15.66720455	15.66720455	15.66720455	15.66720455	15.66720455	15.66720455	15.66720455	0	0	0	0	15.66720455	0	15.66720455	0	0	0												5.0729	0.050775591	2.56120132	0	0.767889395	0.949664581	0.064061707	1.409473608	2.421481384	0	0	0	0	1.350073436	6.183728515	5.01771428	0.123199737	0.262429297	1.555561074	5.368667747	0	0	0	0	0.085990687	0	0.004633895	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2494	0	9.195191996	5.0729	0.050775591	2.56120132	0	0.767889395	0.949664581	0.064061707	1.409473608	2.421481384	0	0	0	0	1.350073436	6.183728515	5.01771428	0.123199737	0.262429297	1.555561074	5.368667747	0	0	0	0	0.085990687	0	0.004633895	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2494	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.0729	0.050775591	2.56120132	0	0.767889395	0.949664581	0.064061707	1.409473608	2.421481384	0	0	0	0	1.350073436	6.183728515	5.01771428	0.123199737	0.262429297	1.555561074	5.368667747	0	0	0	0	0.085990687	0	0.004633895	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2494
H1463_003_0	2011	4																															A	A	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	343.3254461	4.251071447	2559.516707	0	364.4938186	16.2291906	3.006182953	564.9097735	363.9854366	0	0	0	0	1228.748735	5756.963931	4407.312887	194.8259059	231.3406349	1481.058077	4669.865887	0	0	0	0	51.64638341	0	4.992922584	0	0	0											1500	$100/Day (Days 1-5) for IP Acute; PBP 1a	$100/Day (Days 1-5) for IP Psych; PBP 1b	$50/Day (Days 21-100) for SNF; PBP 2	No Cost Sharing for Home Health; PBP 6	$50/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b-c"	"$50/Visit for ER, $20/Visit for Urgent Care; PBP 4a-b"	$100/Visit for ASC Services; PBP 9b	No Cost Sharing for OP Diagnostic Procedures/Tests; PBP 8a	No Cost Sharing for OP Radiology; PBP 8b	$100/Visit for OP Hospital; PBP 9a	No Cost Sharing for Renal Dialysis; PBP 12	"$20/Visit for CORF, Partial Hosp, OP Substance Abuse, Cardiac Rehab; PBP 3, 5, 9c-d"	"$20/Visit for PCP, No Cost Sharing for Immunizations, Routine Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7a, 14b-j"	"$20/Visit for Chiropractic, Physician Specialist (excl. Radiology), Podiatry; PBP 7b, 7d, 7f"	"$20/Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$20/Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$20/Visit for Physician Specialist (Radiology); PBP 7d	"$20/Visit for Other Health Care, Hearing Exams (Medicare Covered); PBP 7g, 18a"	No Cost Sharing for Part B Drugs; PBP 15	"No Cost Sharing for Blood, $20/Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); PBP 13a, 16b, 17a"	No Coverage for Transportation; PBP 10b	"No Coverage for Preventive Dental Services, Comprehensive Dental (Non-Medicare Covered); PBP 16a-b"	$20/Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing for Eye Wear (Medicare Covered); PBP 17b	$20/Visit for Routine Hearing Exams (Non-Medicare Covered); PBP 18a	No Coverage for Hearing Aids (Non-Medicare Covered); PBP 18b	No Cost Sharing for Health Education/Wellness Program; PBP 14a	No Coverage for Acupuncture; PBP 13b											0	285.9100909	365.8104348	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	210.8367952	269.7571795	17.32945022	0	36.87117067	0.073742341	0.073742341	35.96413988	73.74234135	0	0	0	0	14.74846827	14.74846827	14.74846827	14.74846827	14.74846827	14.74846827	14.74846827	0	0	0	0	14.74846827	0	14.74846827	0	0	0												6.0321	0.095563087	3.696251446	0	1.119942816	1.196778513	0.221682969	1.693041176	2.236761526	0	0	0	0	1.510180144	7.075533322	5.416759522	0.239448641	0.284326668	1.820278171	5.739447405	0	0	0	0	0.063475421	0	0.006136497	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4477	0	13.69020446	6.0321	0.095563087	3.696251446	0	1.119942816	1.196778513	0.221682969	1.693041176	2.236761526	0	0	0	0	1.510180144	7.075533322	5.416759522	0.239448641	0.284326668	1.820278171	5.739447405	0	0	0	0	0.063475421	0	0.006136497	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4477	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.0321	0.095563087	3.696251446	0	1.119942816	1.196778513	0.221682969	1.693041176	2.236761526	0	0	0	0	1.510180144	7.075533322	5.416759522	0.239448641	0.284326668	1.820278171	5.739447405	0	0	0	0	0.063475421	0	0.006136497	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4477
H1463_005_0	2011	6																															A	A	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	348.043957	2.367278351	2257.257604	0	323.2695744	20.48377946	2.099101483	506.1796034	410.2888048	0	0	0	0	1159.045748	5851.600022	4348.368623	231.12749	389.9099912	1445.175603	4884.636938	0	0	0	0	52.78865442	0	4.465234593	0	0	0											1500	$100/Day (Days 1-5) for IP Acute; PBP 1a	$100/Day (Days 1-5) for IP Psych; PBP 1b	$50/Day (Days 21-100) for SNF; PBP 2	No Cost Sharing for Home Health; PBP 6	$50/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics/Medical Supplies, Diabetes Monitoring Supplies; PBP 11b-c"	"$50/Visit for ER, $20/Visit for Urgent Care; PBP 4a-b"	$100/Visit for ASC Services; PBP 9b	No Cost Sharing for OP Diagnostic Procedures/Tests; PBP 8a	No Cost Sharing for OP Radiology; PBP 8b	$100/Visit for OP Hospital; PBP 9a	No Cost Sharing for Renal Dialysis; PBP 12	"$20/Visit for CORF, Partial Hosp, OP Substance Abuse, Cardiac Rehab; PBP 3, 5, 9c-d"	"$20/Visit for PCP, No Cost Sharing for Immunizations, Routine Physical Exams, Pap Smears/Pelvic Exams, Prostate Screening, Colorectal Screening, Bone Mass Measurement, Mammography, Diabetes Monitoring, Nutrition Therapy; PBP 7a, 14b-j"	"$20/Visit for Chiropractic, Physician Specialist (excl. Radiology), Podiatry; PBP 7b, 7d, 7f"	"$20/Visit for Mental Health, Psychiatric; PBP 7e, 7h"	"$20/Visit for Occupational Therapy, Physical and Speech Therapy; PBP 7c, 7i"	$20/Visit for Physician Specialist (Radiology); PBP 7d	"$20/Visit for Other Health Care, Hearing Exams (Medicare Covered); PBP 7g, 18a"	No Cost Sharing for Part B Drugs; PBP 15	"No Cost Sharing for Blood, $20/Visit for Comprehensive Dental (Medicare Covered), Eye Exams (Medicare Covered); PBP 13a, 16b, 17a"	No Coverage for Transportation; PBP 10b	"No Coverage for Preventive Dental Services, Comprehensive Dental (Non-Medicare Covered); PBP 16a-b"	$20/Visit for Routine Eye Exams (Non-Medicare Covered); PBP 17a	No Cost Sharing for Eye Wear (Medicare Covered); PBP 17b	$20/Visit for Routine Hearing Exams (Non-Medicare Covered); PBP 18a	No Coverage for Hearing Aids (Non-Medicare Covered); PBP 18b	No Cost Sharing for Health Education/Wellness Program; PBP 14a	No Coverage for Acupuncture; PBP 13b											0	285.9100909	365.8104348	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	210.4180056	269.2213551	17.29502836	0	36.79793269	0.073595865	0.073595865	35.89270354	73.59586537	0	0	0	0	14.71917307	14.71917307	14.71917307	14.71917307	14.71917307	14.71917307	14.71917307	0	0	0	0	14.71917307	0	14.71917307	0	0	0												6.1029	0.053110157	3.253277857	0	0.991304337	1.507521475	0.15448519	1.51401287	2.516296637	0	0	0	0	1.421682914	7.177559458	5.333699197	0.283500461	0.47826272	1.772649152	5.991484708	0	0	0	0	0.064750445	0	0.005477047	0	0	0	0	0	0	0	0	0	0	0	0	0	38.622	0	13.85647992	6.1029	0.053110157	3.253277857	0	0.991304337	1.507521475	0.15448519	1.51401287	2.516296637	0	0	0	0	1.421682914	7.177559458	5.333699197	0.283500461	0.47826272	1.772649152	5.991484708	0	0	0	0	0.064750445	0	0.005477047	0	0	0	0	0	0	0	0	0	0	0	0	0	38.622	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.1029	0.053110157	3.253277857	0	0.991304337	1.507521475	0.15448519	1.51401287	2.516296637	0	0	0	0	1.421682914	7.177559458	5.333699197	0.283500461	0.47826272	1.772649152	5.991484708	0	0	0	0	0.064750445	0	0.005477047	0	0	0	0	0	0	0	0	0	0	0	0	0	38.622
H1463_801_0	2011	1																															Coin	Coin	Coin	Coin	Coin	Coin	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	258.1699956	1.365845375	73.4740312	0	12.31990505	13.19619403	2.021674471	24.09521988	38.7194046	6.088018258	5.324341885	0	0.865396372	20.92280184	36.47917903	84.70510154	1.143561674	1.031529895	29.91061589	61.73411961	37.4756863	0	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Sharing; PBP 1a	Medicare FFS Cost Sharing; PBP 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	Medicare FFS Cost Sharing; PBP 11b-c	Medicare FFS Cost Sharing; PBP 4a-b	Medicare FFS Cost Sharing; PBP 9b	Medicare FFS Cost Sharing; PBP 8a	Medicare FFS Cost Sharing; PBP 8b	Medicare FFS Cost Sharing; PBP 9a	Medicare FFS Cost Sharing; PBP 12	"Medicare FFS Cost Sharing; PBP 3, 5, 9c-d"	"Medicare FFS Cost Sharing; PBP 7a, 14b-j"	"Medicare FFS Cost Sharing; PBP 7b, 7d, 7f"	"Medicare FFS Cost Sharing; PBP 7e, 7h"	"Medicare FFS Cost Sharing; PBP 7c, 7i"	Medicare FFS Cost Sharing; PBP 7d	"Medicare FFS Cost Sharing; PBP 7g, 18a"	Medicare FFS Cost Sharing; PBP 15	"Medicare FFS Cost Sharing; PBP 13a, 16b, 17a"	No Coverage; PBP 10b	No Coverage; PBP 16a-b	No Coverage; PBP 17a	No Coverage; PBP 17b	No Coverage; PBP 18a	No Coverage; PBP 18b	No Coverage; PBP 14a	No Coverage; PBP 13b											0	0.085193997	0.085193997	0.18432395	0	0.233	0.233	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	0.071529137	0.071529137	0.154758944	0	0.195627502	0.195627502	0.195627502	0.195627502	0.195627502	0.195627502	0.195627502	0	0.195627502	0.195627502	0.195627502	0.195627502	0.195627502	0.195627502	0.195627502	0.195627502	0.195627502	0	0	0	0	0	0	0	0	0												18.4667	0.097697741	11.37076345	0	2.410112251	2.581538475	0.395495127	4.713687677	7.574580403	1.190983804	1.041587703	0	0.169295331	4.09307546	7.136330671	16.57064743	0.223712114	0.201795617	5.851339073	12.07689161	7.331274899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.4975	0	19.77206441	18.4667	0.097697741	11.37076345	0	2.410112251	2.581538475	0.395495127	4.713687677	7.574580403	1.190983804	1.041587703	0	0.169295331	4.09307546	7.136330671	16.57064743	0.223712114	0.201795617	5.851339073	12.07689161	7.331274899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.4975	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.4667	0.097697741	11.37076345	0	2.410112251	2.581538475	0.395495127	4.713687677	7.574580403	1.190983804	1.041587703	0	0.169295331	4.09307546	7.136330671	16.57064743	0.223712114	0.201795617	5.851339073	12.07689161	7.331274899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.4975
H1463_802_0	2011	1																															Coin	Coin	Coin	Coin	Coin	Coin	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	306.8499345	1.674052052	77.1630704	0	14.60113675	17.29155512	2.117539148	25.63804219	43.89727125	7.055320929	5.808384401	0	0.762536332	22.33250169	43.11971328	102.8810647	1.161586724	0.998015632	35.67409359	72.90701225	45.39025646	0	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Sharing; PBP 1a	Medicare FFS Cost Sharing; PBP 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	Medicare FFS Cost Sharing; PBP 11b-c	Medicare FFS Cost Sharing; PBP 4a-b	Medicare FFS Cost Sharing; PBP 9b	Medicare FFS Cost Sharing; PBP 8a	Medicare FFS Cost Sharing; PBP 8b	Medicare FFS Cost Sharing; PBP 9a	Medicare FFS Cost Sharing; PBP 12	"Medicare FFS Cost Sharing; PBP 3, 5, 9c-d"	"Medicare FFS Cost Sharing; PBP 7a, 14b-j"	"Medicare FFS Cost Sharing; PBP 7b, 7d, 7f"	"Medicare FFS Cost Sharing; PBP 7e, 7h"	"Medicare FFS Cost Sharing; PBP 7c, 7i"	Medicare FFS Cost Sharing; PBP 7d	"Medicare FFS Cost Sharing; PBP 7g, 18a"	Medicare FFS Cost Sharing; PBP 15	"Medicare FFS Cost Sharing; PBP 13a, 16b, 17a"	No Coverage; PBP 10b	No Coverage; PBP 16a-b	No Coverage; PBP 17a	No Coverage; PBP 17b	No Coverage; PBP 18a	No Coverage; PBP 18b	No Coverage; PBP 14a	No Coverage; PBP 13b											0	0.085242735	0.085242735	0.184175321	0	0.233	0.233	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	0.068438859	0.068438859	0.147868893	0	0.187068778	0.187068778	0.187068778	0.187068778	0.187068778	0.187068778	0.187068778	0	0.187068778	0.187068778	0.187068778	0.187068778	0.187068778	0.187068778	0.187068778	0.187068778	0.187068778	0	0	0	0	0	0	0	0	0												21.0005	0.114570213	11.41001783	0	2.73141681	3.234710087	0.396125461	4.796077224	8.211808891	1.319830265	1.086567372	0	0.14264674	4.1777138	8.06635207	19.24583505	0.217296609	0.186697565	6.673509095	13.63862569	8.491099809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.1414	0	28.27079659	21.0005	0.114570213	11.41001783	0	2.73141681	3.234710087	0.396125461	4.796077224	8.211808891	1.319830265	1.086567372	0	0.14264674	4.1777138	8.06635207	19.24583505	0.217296609	0.186697565	6.673509095	13.63862569	8.491099809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.1414	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.0005	0.114570213	11.41001783	0	2.73141681	3.234710087	0.396125461	4.796077224	8.211808891	1.319830265	1.086567372	0	0.14264674	4.1777138	8.06635207	19.24583505	0.217296609	0.186697565	6.673509095	13.63862569	8.491099809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.1414
H1468_007_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V			V		O	O	O	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	YES	1500.408759	54.33113476	1614.441436	1275.587655	310.7426554	9.804036918	2.869994428	446.4752724	303.8430264	1560.472256	1091.765808	48.52570057	0.187484719	4.375852806	4350.004947	3319.590258	29.41462882	544.9184561		1905.508525	28.22765598	0		2.69			0.25		4.51	0.6	224.0341847	0.466621494	705.2877865								3400	$150/Day(Days 1-10):1a.IP Acute	$150/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-13) $75(Days 14-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6.Home Health	$50/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$50/Visit:8b, 9a. $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,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $20 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$20/Visit:7b. $10 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$20/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"			"HER834: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center	"$20-$100/Visit:9d. $20 Cardiac Rehab,8b. $20 Nuclear Medicine,9a. $100 OP Other,5. $20 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF"									121.20465	109.29915	36.81825	0	50	0.2	0.2	50	100	0	23.996566	100	0.2	0.2	10	19.870244	20	20		0	0.2	0		0			0		0	0	0	0	83.403551								NO	107.948982	97.345539	20.59797	0	45.1604	0.180642	0.180642	45.1604	90.3208	0	21.673891	90.3208	0.180642	0.180642	9.03208	17.946963	18.06416	18.06416		0	0.180642	0		0			0		0	0	0	0	75.330755									13.4973	0.440741133	2.771184689	0	1.169438551	1.771020837	0.518441533	1.680250158	2.286945435	0	1.971901093	0.365240008	0.033867615	0.790462803	3.274132723	4.964713627	0.044279213	0.820291181	0	0	5.099100231	0	0	0	0	0	0	0	0	0	0	0	4.427488454	0	0	0	0	0	0	0	45.9268	0	7.024845542	13.4973	0.440741133	2.771184689	0	1.169438551	1.771020837	0.518441533	1.680250158	2.286945435	0	1.971901093	0.365240008	0.033867615	0.790462803	3.274132723	4.964713627	0.044279213	0.820291181	0	0	5.099100231	0	0	0	0	0	0	0	0	0	0	0	4.427488454	0	0	0	0	0	0	0	45.9268	NO																																																																																		0	0	0	13.4973	0.440741133	2.771184689	0	1.169438551	1.771020837	0.518441533	1.680250158	2.286945435	0	1.971901093	0.365240008	0.033867615	0.790462803	3.274132723	4.964713627	0.044279213	0.820291181	0	0	5.099100231	0	0	0	0	0	0	0	0	0	0	0	4.427488454	0	0	0	0	0	0	0	45.9268
H1468_802_0	2011	3																															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	YES	280.018147	3.928034	28.778805	15.551127	7.03788	8.963082	3.164418	25.518259	47.33237	5.111412	27.703197	4.912082	0.496005	9.521045	36.923312	66.876932	0.460612	5.108505		7.264269	30.382281	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082682	0.082682	0.191585	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.075962	0.075962	0.136904	0	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593		0.213593	0.213593	0																				21.2707	0.298381319	3.93993352	0	1.503241903	1.914451574	0.675897534	5.450521495	10.10986291	1.091761823	5.917208957	1.049186331	0.105943196	2.033628565	7.88656098	14.28444454	0.098383499	1.091140908	0	1.551597009	6.489442546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7623	0	9.047106905	21.2707	0.298381319	3.93993352	0	1.503241903	1.914451574	0.675897534	5.450521495	10.10986291	1.091761823	5.917208957	1.049186331	0.105943196	2.033628565	7.88656098	14.28444454	0.098383499	1.091140908	0	1.551597009	6.489442546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7623	NO																																																																																		0	0	0	21.2707	0.298381319	3.93993352	0	1.503241903	1.914451574	0.675897534	5.450521495	10.10986291	1.091761823	5.917208957	1.049186331	0.105943196	2.033628565	7.88656098	14.28444454	0.098383499	1.091140908	0	1.551597009	6.489442546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7623
H1468_803_0	2011	3																															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	YES	280.018147	3.928034	28.778805	15.551127	7.03788	8.963082	3.164418	25.518259	47.33237	5.111412	27.703197	4.912082	0.496005	9.521045	36.923312	66.876932	0.460612	5.108505		7.264269	30.382281	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082682	0.082682	0.191585	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.075962	0.075962	0.136904	0	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593		0.213593	0.213593	0																				21.2707	0.298381319	3.93993352	0	1.503241903	1.914451574	0.675897534	5.450521495	10.10986291	1.091761823	5.917208957	1.049186331	0.105943196	2.033628565	7.88656098	14.28444454	0.098383499	1.091140908	0	1.551597009	6.489442546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7623	0	9.047106905	21.2707	0.298381319	3.93993352	0	1.503241903	1.914451574	0.675897534	5.450521495	10.10986291	1.091761823	5.917208957	1.049186331	0.105943196	2.033628565	7.88656098	14.28444454	0.098383499	1.091140908	0	1.551597009	6.489442546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7623	NO																																																																																		0	0	0	21.2707	0.298381319	3.93993352	0	1.503241903	1.914451574	0.675897534	5.450521495	10.10986291	1.091761823	5.917208957	1.049186331	0.105943196	2.033628565	7.88656098	14.28444454	0.098383499	1.091140908	0	1.551597009	6.489442546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7623
H1468_804_0	2011	3																															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	YES	280.018147	3.928034	28.778805	15.551127	7.03788	8.963082	3.164418	25.518259	47.33237	5.111412	27.703197	4.912082	0.496005	9.521045	36.923312	66.876932	0.460612	5.108505		7.264269	30.382281	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082682	0.082682	0.191585	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.075962	0.075962	0.136904	0	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593	0.213593		0.213593	0.213593	0																				21.2707	0.298381319	3.93993352	0	1.503241903	1.914451574	0.675897534	5.450521495	10.10986291	1.091761823	5.917208957	1.049186331	0.105943196	2.033628565	7.88656098	14.28444454	0.098383499	1.091140908	0	1.551597009	6.489442546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7623	0	9.047106905	21.2707	0.298381319	3.93993352	0	1.503241903	1.914451574	0.675897534	5.450521495	10.10986291	1.091761823	5.917208957	1.049186331	0.105943196	2.033628565	7.88656098	14.28444454	0.098383499	1.091140908	0	1.551597009	6.489442546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7623	NO																																																																																		0	0	0	21.2707	0.298381319	3.93993352	0	1.503241903	1.914451574	0.675897534	5.450521495	10.10986291	1.091761823	5.917208957	1.049186331	0.105943196	2.033628565	7.88656098	14.28444454	0.098383499	1.091140908	0	1.551597009	6.489442546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7623
H1509_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1052.302453	83.18854316	768.5645645	140.228781	107.6200153	8.665786177	10.47232876	324.1487273	36.06598562	12.22998876	29.88615709	0	0.045319207	15.9894949	5103.227281	78.25986861	425.5213139	387.6462023	0	0	20.81364952	1229.952894	0	0	418.4211835	0	15.22190315	10.45	1150.109543	0											3400	"$275 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-34 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												204.8739608	137.0409745	78.1598803	0	200	0.2	0.10308694	49.64219721	0.2	0.150216186	0.169606713	0	0.2	0.160430101	9.620930598	0.108306659	38.5	30	0	0	0.2	29.91811139	0	0	30	0	30	0	0	0											NO	149.127518	99.75196609	56.89248605	0	145.5797676	0.145579768	0.075036864	36.15689314	0.145579768	0.109342188	0.12345653	0	0.145579768	0.116776884	9.167468933	0.103211208	36.68538613	28.58601517	0	0	0.145579768	21.77735852	0	0	30	0	30	0	0	0												13.0773	0.691518395	3.64379573	0	1.305608069	1.261563138	0.785810704	0.976684241	5.250477805	1.337253724	3.689641237	0	0.00659756	1.867203396	3.898639797	8.077295606	1.300867809	0.923438352	0	0	3.03004626	2.232093762	0	0	1.046052959	0	0.038054758	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4399	0	15.3378317	13.0773	0.691518395	3.64379573	0	1.305608069	1.261563138	0.785810704	0.976684241	5.250477805	1.337253724	3.689641237	0	0.00659756	1.867203396	3.898639797	8.077295606	1.300867809	0.923438352	0	0	3.03004626	2.232093762	0	0	1.046052959	0	0.038054758	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4399	YES	"$300 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$300 Days 1-17 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-29 (2a); $0 n/c (2a1, 2a2)"	25% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	25% (9b)	25% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 25% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											5000	1.1196	0.0739	2.0958	0.1635	0.2125	0.3081	0.3723	0.159	1.0684	0.2177	0.7583	0	0.0011	0.38	1.6181	2.8955	0.4026	0.3372	0	0	1.2448	0.8153	0	0	0.382	0	0.0139	0	0	0											14.6396	0	3.619533919	14.1969	0.765443666	5.739569319	0.163541257	1.518148917	1.569619253	1.158086785	1.13567935	6.318888987	1.554946191	4.447914469	0	0.007671581	2.247246849	5.516701943	10.97282163	1.703427696	1.26066	0	0	4.274874182	3.047370165	0	0	1.428051067	0	0.051951612	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0795
H1509_004_0	2011	4																															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	YES	339.4103841	21.085052	62.17551698	1360.938736	10.13277053	25.0827498	26.66278009	26.43462327	40.84569448	15.33509392	40.53843579	0	0.117016372	26.32038067	27.89810643	101.0531417	8.761698	4.267923573	0	0	35.94893051	5.47869904	686.4027781	451.5072796	137.4534405	190.7085464	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.07766881	0.078611638	0.186671337	0	0.233	0.233	0.233	0.096549475	0.233	0.233	0.233	0	0.233	0.233	0.225189972	0.232887101	0.230458485	0.233	0	0	0.233	0.230660982	0	0	0	0	0	0	0	0											NO	0.057290869	0.057986328	0.137694438	0	0.171867864	0.171867864	0.171867864	0.071232262	0.171867864	0.171867864	0.171867864	0	0.171867864	0.171867864	0.165332163	0.170983316	0.169200251	0.171066205	0	0	0.171867864	0.17131512	0	0	0	0	0	0	0	0												19.4451	1.222644735	8.56122284	0	1.741497627	4.310918633	4.582475063	1.882998021	7.020062265	2.635609836	6.967254371	0	0.020111354	4.523627606	4.612454281	17.27840122	1.4824815	0.730097489	0	0	6.178465901	0.938583982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.134	0	33.62668493	19.4451	1.222644735	8.56122284	0	1.741497627	4.310918633	4.582475063	1.882998021	7.020062265	2.635609836	6.967254371	0	0.020111354	4.523627606	4.612454281	17.27840122	1.4824815	0.730097489	0	0	6.178465901	0.938583982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.134	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	7.7897	0.4898	2.5238	1.0864	0.5607	1.3879	1.4243	0.4268	2.26	0	1.7675	0	0.0045	1.195	1.9143	7.5324	0.653	0.3181	0	0	2.6918	0.4098	0	0.1	0.0723	0	0	0	0	0											34.608	0	12.30893236	27.2348	1.712434512	11.08501977	1.086412494	2.302155588	5.698776309	6.006726301	2.309802165	9.280101977	2.635609836	8.734765031	0	0.024626712	5.718597142	6.526723041	24.81076387	2.135491624	1.048186209	0	0	8.87029862	1.348390565	0	0.1	0.072316101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.742
H1509_006_0	2011	4																															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	YES	219.3331569	43.866198	10151.79835	27.05686717	23.93366547	21.99414064	10.75851553	10.97319388	3.820684536	42.26357177	8.268966218	0	0	3.904058004	0.592413325	108.7652531	20.102694	13.16637504	0	0	3.396146421	7.328868538	1990.715579	134.3234157	112.2189435	206.4670984	0	0	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.074567319	0.075472347	0	0	0.2	0.2	0.097925108	0.061761633	0.2	0	0.110080243	0	0	0.161797198	0.013515198	0.029862864	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.070259149	0.071111888	0	0	0.188444883	0.188444883	0.092267428	0.058193319	0.188444883	0	0.103720293	0	0	0.152449271	0.012608461	0.027859358	0.186581956	0	0	0	0.188444883	0.188838039	0	0	0	0	0	0	0	0												15.4102	3.119408173	0	0	4.510176792	4.144683263	0.992660554	0.638566571	0.719988451	0	0.857659597	0	0	0.595170796	0.00746942	3.03013016	3.750799967	0	0	0	0.639986415	1.38396916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8008	0	2.509395384	15.4102	3.119408173	0	0	4.510176792	4.144683263	0.992660554	0.638566571	0.719988451	0	0.857659597	0	0	0.595170796	0.00746942	3.03013016	3.750799967	0	0	0	0.639986415	1.38396916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8008	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	2.2217	0.4497	0	0.0071	0.9225	0.8478	0.4147	0.0871	0.1473	0	0.2333	0	0	0.1217	0.0097	2.2919	0.4235	0.0045	0	0	0.0723	0.1563	0	0	0.016	0	0	0	0	0											8.427	0	0.54358704	17.6318	3.569132452	0	0.007051583	5.432712954	4.992459385	1.40735339	0.725643831	0.867258816	0	1.091001629	0	0	0.716910277	0.01718428	5.322036658	4.174277383	0.004484168	0	0	0.712242946	1.540223743	0	0	0.01599494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2278
H1509_007_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1158.438048	83.96064749	1160.188438	120.2575814	144.5549716	10.73297215	12.84909362	366.8681765	35.87252197	14.89258087	33.73462919	0	0.101539273	19.37024648	5479.876024	86.34661909	423.1389441	377.9173602	0	0	15.94647469	1116.765699	0	0	153.2065036	0	15.04946786	10.45	584.6839148	0											4200	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-84 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												185.9463355	119.8302997	49.59550678	0	200	0.2	0.100773344	49.18143099	0.2	0.126118587	0.167170565	0	0.2	0.160596628	6.593384472	0.123571593	38.5	35	0	0	0.2	34.83189178	0	0	35	0	35	0	0	0											NO	144.4900952	93.1144535	38.53832063	0	155.4105327	0.155410533	0.078306195	38.23183517	0.155410533	0.098000784	0.129900333	0	0.155410533	0.124792038	6.345008819	0.118923741	37.0496883	33.68153482	0	0	0.155410533	27.06621427	0	0	35	0	35	0	0	0												13.9486	0.651495817	3.725976168	0	1.872113761	1.668016918	1.006163635	1.168836971	5.574967747	1.459484604	4.382139563	0	0.015780273	2.417252526	2.897488475	10.26866298	1.306430499	1.060736394	0	0	2.478250126	2.518884976	0	0	0.446852302	0	0.043894281	0	0	0	0	0	0	0	0	0	0	0	0	0	58.912	0	12.91196126	13.9486	0.651495817	3.725976168	0	1.872113761	1.668016918	1.006163635	1.168836971	5.574967747	1.459484604	4.382139563	0	0.015780273	2.417252526	2.897488475	10.26866298	1.306430499	1.060736394	0	0	2.478250126	2.518884976	0	0	0.446852302	0	0.043894281	0	0	0	0	0	0	0	0	0	0	0	0	0	58.912	YES	"$350 Days 1-24 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$350 Days 1-24 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-40 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											8400	1.5985	0.1038	3.5197	0.226	0.3048	0.4073	0.4876	0.1903	1.3613	0.2376	1.0457	0	0.0026	0.588	2.1226	3.575	0.4043	0.3735	0	0	1.0181	0.8858	0	0	0.1265	0	0.0155	0	0	0											18.5946	0	3.688961531	15.5471	0.755332754	7.245635276	0.225952298	2.176876466	2.075323375	1.493774962	1.359112757	6.936297081	1.697075121	5.427852935	0	0.018349154	3.005273446	5.020131958	13.84368432	1.710711787	1.434262312	0	0	3.496384731	3.404716572	0	0	0.573358126	0	0.059351139	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5066
H1509_009_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1084.394441	74.64546888	705.0374302	128.6501629	111.6438434	9.129647008	11.55440501	411.655256	40.02868351	13.81649312	33.94109113	0	0.057865677	16.9921392	5551.866369	87.62717409	432.2451151	452.7188236	0	0	21.56928896	1208.123122	0	0	134.8493338	0	14.25436808	10.45	144.6981432	0											4200	"$275 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												177.7729858	109.9065555	63.75759527	0	200	0.2	0.098113007	48.98158513	0.2	0.12424605	0.16751561	0	0.2	0.160800647	10.1372251	0.117171542	38.5	35	0	0	0.2	34.92940653	0	0	35	0	35	0	0	0											NO	134.2619383	83.00624029	48.15252601	0	151.0487521	0.151048752	0.074099236	37.00659459	0.151048752	0.093836054	0.12651512	0	0.151048752	0.121443686	9.707151723	0.112243163	36.86663141	33.51511947	0	0	0.151048752	26.38021634	0	0	35	0	35	0	0	0												12.1327	0.516336644	2.8291111	0	1.405305268	1.379021788	0.856172588	1.269496597	6.046282693	1.296485196	4.294061202	0	0.008740538	2.063588012	4.491067432	9.835551215	1.327951778	1.264410455	0	0	3.258014182	2.655879111	0	0	0.393310557	0	0.04157524	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3651	0	13.71174815	12.1327	0.516336644	2.8291111	0	1.405305268	1.379021788	0.856172588	1.269496597	6.046282693	1.296485196	4.294061202	0	0.008740538	2.063588012	4.491067432	9.835551215	1.327951778	1.264410455	0	0	3.258014182	2.655879111	0	0	0.393310557	0	0.04157524	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3651	YES	"$340 Days 1-18 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$340 Days 1-18 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-35 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											6000	1.3673	0.0796	2.2027	0.22	0.2288	0.3367	0.4262	0.2067	1.4764	0.2111	1.025	0	0.0014	0.5017	2.1968	3.4032	0.4109	0.4452	0	0	1.3385	0.9343	0	0	0.1385	0	0.0146	0	0	0											17.1657	0	3.705173219	13.5	0.595925372	5.031847398	0.219970124	1.634075893	1.715759666	1.282345235	1.476158834	7.52270056	1.507540926	5.319071854	0	0.010163417	2.565286565	6.687898626	13.23876715	1.738892931	1.709657813	0	0	4.596497715	3.590189614	0	0	0.531810271	0	0.056215475	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5308
H1509_801_0	2011	1																															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	259.7158095	4.13882	37.01100413	217.6894486	6.260478858	11.2143381	11.54304042	12.71926847	45.75395674	24.05283799	42.45828176	0	0.116849958	24.62091272	25.47619282	109.50166	1.6402575	9.426360823	0	0	26.30820201	8.249712144	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078819421	0.078819421	0.172378013	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.062648048	0.062648048	0.137011232	0	0.185195413	0.185195413	0.185195413	0.185195413	0.185195413	0.185195413	0.185195413	0	0.185195413	0.185195413	0.186048232	0.186048232	0.186048232	0.186048232	0	0	0.185195413	0.185195413	0	0	0	0	0	0	0	0												16.2707	0.259288994	5.070923288	0	1.159411965	2.07684397	2.137718133	2.355550171	8.473422892	4.454475254	7.863079004	0	0.021640076	4.559680087	4.739800622	20.3725902	0.305167007	1.753757761	0	0	4.872158324	1.527808844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.274	0	22.62951499	16.2707	0.259288994	5.070923288	0	1.159411965	2.07684397	2.137718133	2.355550171	8.473422892	4.454475254	7.863079004	0	0.021640076	4.559680087	4.739800622	20.3725902	0.305167007	1.753757761	0	0	4.872158324	1.527808844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.274	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.0386	0.0166	1.8283	0	0.1887	0.3381	0.348	0.3835	1.3794	0.7251	1.28	0	0.0035	0.7423	1.2982	5.5798	0.0836	0.4803	0	0	1.3344	0.4184	0	0	0	0	0	0	0	0											17.4667	0	4.465783022	17.3092	0.275839355	6.899215357	0	1.348153447	2.414934848	2.485718759	2.739011826	9.852817317	5.179622389	9.143115121	0	0.025162879	5.301953589	6.037962576	25.95234421	0.38874778	2.23408632	0	0	6.206571113	1.946253304	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.7408
H1509_803_0	2011	1																															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	258.4412556	1.083162	43.29758617	211.3593688	6.404933253	8.592334824	9.390242723	11.47987545	39.18805678	23.05595485	41.80654556	0	0.107810086	22.84696007	22.75159817	105.4654184	0.4305725	8.323334694	0	0	25.11315007	9.571789782	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.076598152	0.076598152	0.162543179	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.06176322	0.06176322	0.131063085	0	0.187874379	0.187874379	0.187874379	0.187874379	0.187874379	0.187874379	0.187874379	0	0.187874379	0.187874379	0.188677923	0.188677923	0.188677923	0.188677923	0	0	0.187874379	0.187874379	0	0	0	0	0	0	0	0												15.9622	0.066899573	5.674715204	0	1.203322856	1.614279567	1.764186018	2.156774468	7.362431822	4.331623194	7.854378775	0	0.020254753	4.29235843	4.292724293	19.89899611	0.081239525	1.570429504	0	0	4.718117468	1.798294059	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.6632	0	20.19878686	15.9622	0.066899573	5.674715204	0	1.203322856	1.614279567	1.764186018	2.156774468	7.362431822	4.331623194	7.854378775	0	0.020254753	4.29235843	4.292724293	19.89899611	0.081239525	1.570429504	0	0	4.718117468	1.798294059	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.6632	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.0189	0.0043	2.046	0	0.1959	0.2628	0.2872	0.3511	1.1985	0.7051	1.2786	0	0.0033	0.6988	1.1757	5.45	0.0223	0.4301	0	0	1.2922	0.4925	0	0	0	0	0	0	0	0											16.9133	0	4.025033316	16.981	0.071169758	7.720700958	0	1.399212623	1.877069264	2.051379091	2.507877288	8.560967235	5.036771155	9.132998575	0	0.023552038	4.991114454	5.46843859	25.34903962	0.103489841	2.000547139	0	0	6.010340723	2.290820457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5765
H1509_804_0	2011	1																															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	268.9859664	1.08147	38.31655604	221.6658664	6.498547517	11.64078829	11.98199026	13.20294699	47.4938529	24.96750075	44.07285253	0	0.121293438	25.54570637	26.55290974	114.1295999	0.4285315	9.824753246	0	0	27.42008267	8.598375098	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.076452586	0.076452586	0.164825044	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.060359023	0.060359023	0.130128738	0	0.183952603	0.183952603	0.183952603	0.183952603	0.183952603	0.183952603	0.183952603	0	0.183952603	0.183952603	0.184779335	0.184779335	0.184779335	0.184779335	0	0	0.183952603	0.183952603	0	0	0	0	0	0	0	0												16.2357	0.065276472	4.986085082	0	1.195424735	2.141353312	2.204118303	2.428716473	8.73661789	4.592836766	8.107315965	0	0.022312244	4.699199194	4.906429015	21.08879163	0.079183766	1.815411375	0	0	5.043995596	1.581693485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9305	0	23.82016805	16.2357	0.065276472	4.986085082	0	1.195424735	2.141353312	2.204118303	2.428716473	8.73661789	4.592836766	8.107315965	0	0.022312244	4.699199194	4.906429015	21.08879163	0.079183766	1.815411375	0	0	5.043995596	1.581693485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9305	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.0363	0.0042	1.7977	0	0.1946	0.3486	0.3588	0.3954	1.4222	0.7477	1.3198	0	0.0036	0.765	1.3438	5.7759	0.0217	0.4972	0	0	1.3815	0.4332	0	0	0	0	0	0	0	0											17.8472	0	4.7153182	17.2721	0.069443056	6.783789227	0	1.390028761	2.489945712	2.562928259	2.824088922	10.15885801	5.340507868	9.427111587	0	0.025944469	5.464185109	6.250228044	26.86470271	0.100871039	2.312625955	0	0	6.425472096	2.014896159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.7777
H1509_806_0	2011	1																															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	268.9859664	1.08147	38.31655604	221.6658664	6.498547517	11.64078829	11.98199026	13.20294699	47.4938529	24.96750075	44.07285253	0	0.121293438	25.54570637	26.55290974	114.1295999	0.4285315	9.824753246	0	0	27.42008267	8.598375098	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.076452586	0.076452586	0.164825044	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.060359023	0.060359023	0.130128738	0	0.183952603	0.183952603	0.183952603	0.183952603	0.183952603	0.183952603	0.183952603	0	0.183952603	0.183952603	0.184779335	0.184779335	0.184779335	0.184779335	0	0	0.183952603	0.183952603	0	0	0	0	0	0	0	0												16.2357	0.065276472	4.986085082	0	1.195424735	2.141353312	2.204118303	2.428716473	8.73661789	4.592836766	8.107315965	0	0.022312244	4.699199194	4.906429015	21.08879163	0.079183766	1.815411375	0	0	5.043995596	1.581693485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9305	0	23.82016805	16.2357	0.065276472	4.986085082	0	1.195424735	2.141353312	2.204118303	2.428716473	8.73661789	4.592836766	8.107315965	0	0.022312244	4.699199194	4.906429015	21.08879163	0.079183766	1.815411375	0	0	5.043995596	1.581693485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9305	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.0363	0.0042	1.7977	0	0.1946	0.3486	0.3588	0.3954	1.4222	0.7477	1.3198	0	0.0036	0.765	1.3438	5.7759	0.0217	0.4972	0	0	1.3815	0.4332	0	0	0	0	0	0	0	0											17.8472	0	4.7153182	17.2721	0.069443056	6.783789227	0	1.390028761	2.489945712	2.562928259	2.824088922	10.15885801	5.340507868	9.427111587	0	0.025944469	5.464185109	6.250228044	26.86470271	0.100871039	2.312625955	0	0	6.425472096	2.014896159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.7777
H1509_807_0	2011	1																															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	261.4933869	1.082786	43.85480141	212.7474083	6.489186096	8.705361551	9.513765423	11.63088594	39.70355087	23.35924134	42.35648421	0	0.109228259	23.14744986	23.04111835	106.807494	0.4302585	8.429251355	0	0	25.43272162	9.693593368	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.076452586	0.076452586	0.164825044	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.061433426	0.061433426	0.132445057	0	0.187226998	0.187226998	0.187226998	0.187226998	0.187226998	0.187226998	0.187226998	0	0.187226998	0.187226998	0.18803369	0.18803369	0.18803369	0.18803369	0	0	0.187226998	0.187226998	0	0	0	0	0	0	0	0												16.0644	0.066519253	5.808351653	0	1.214950832	1.62987871	1.78123374	2.17761586	7.43357664	4.373480633	7.930277386	0	0.020450479	4.33382755	4.332506503	20.08340721	0.080903093	1.584983236	0	0	4.761692121	1.814902386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.493	0	20.76195986	16.0644	0.066519253	5.808351653	0	1.214950832	1.62987871	1.78123374	2.17761586	7.43357664	4.373480633	7.930277386	0	0.020450479	4.33382755	4.332506503	20.08340721	0.080903093	1.584983236	0	0	4.761692121	1.814902386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.493	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.0254	0.0042	2.0942	0	0.1978	0.2653	0.29	0.3545	1.2101	0.712	1.291	0	0.0033	0.7055	1.1866	5.5006	0.0222	0.4341	0	0	1.3042	0.4971	0	0	0	0	0	0	0	0											17.0979	0	4.141938742	17.0898	0.070765163	7.902519256	0	1.412733526	1.895207802	2.071202023	2.532111465	8.643693768	5.085442597	9.221252774	0	0.023779627	5.03933436	5.519116564	25.58395823	0.103061265	2.019086924	0	0	6.065849836	2.311977562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5909
H1509_808_0	2011	1																															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	268.9859664	1.08147	38.31655604	221.6658664	6.498547517	11.64078829	11.98199026	13.20294699	47.4938529	24.96750075	44.07285253	0	0.121293438	25.54570637	26.55290974	114.1295999	0.4285315	9.824753246	0	0	27.42008267	8.598375098	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.076452586	0.076452586	0.164825044	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.060359023	0.060359023	0.130128738	0	0.183952603	0.183952603	0.183952603	0.183952603	0.183952603	0.183952603	0.183952603	0	0.183952603	0.183952603	0.184779335	0.184779335	0.184779335	0.184779335	0	0	0.183952603	0.183952603	0	0	0	0	0	0	0	0												16.2357	0.065276472	4.986085082	0	1.195424735	2.141353312	2.204118303	2.428716473	8.73661789	4.592836766	8.107315965	0	0.022312244	4.699199194	4.906429015	21.08879163	0.079183766	1.815411375	0	0	5.043995596	1.581693485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9305	0	23.82016805	16.2357	0.065276472	4.986085082	0	1.195424735	2.141353312	2.204118303	2.428716473	8.73661789	4.592836766	8.107315965	0	0.022312244	4.699199194	4.906429015	21.08879163	0.079183766	1.815411375	0	0	5.043995596	1.581693485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9305	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.0363	0.0042	1.7977	0	0.1946	0.3486	0.3588	0.3954	1.4222	0.7477	1.3198	0	0.0036	0.765	1.3438	5.7759	0.0217	0.4972	0	0	1.3815	0.4332	0	0	0	0	0	0	0	0											17.8472	0	4.7153182	17.2721	0.069443056	6.783789227	0	1.390028761	2.489945712	2.562928259	2.824088922	10.15885801	5.340507868	9.427111587	0	0.025944469	5.464185109	6.250228044	26.86470271	0.100871039	2.312625955	0	0	6.425472096	2.014896159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.7777
H1509_809_0	2011	1																															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	275.3333049	1.080718	39.25180194	223.7622711	6.693344501	11.98972633	12.34115599	13.59871147	48.91750322	25.7159132	45.39395677	0	0.124929266	26.3113451	26.83787679	115.3544441	0.4280605	9.93019295	0	0	27.71435626	8.690653255	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.075961555	0.075961555	0.163269757	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.059677708	0.059677708	0.128269688	0	0.183051888	0.183051888	0.183051888	0.183051888	0.183051888	0.183051888	0.183051888	0	0.183051888	0.183051888	0.183862669	0.183862669	0.183862669	0.183862669	0	0	0.183051888	0.183051888	0	0	0	0	0	0	0	0												16.4313	0.064494774	5.034816386	0	1.225229347	2.194742041	2.259071903	2.489269808	8.954441318	4.707346461	8.309449489	0	0.022868538	4.816341395	4.934483664	21.209376	0.078704346	1.825791782	0	0	5.073165237	1.590840486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2217	0	24.73360306	16.4313	0.064494774	5.034816386	0	1.225229347	2.194742041	2.259071903	2.489269808	8.954441318	4.707346461	8.309449489	0	0.022868538	4.816341395	4.934483664	21.209376	0.078704346	1.825791782	0	0	5.073165237	1.590840486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2217	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.0488	0.0041	1.8153	0	0.1995	0.3573	0.3678	0.4052	1.4577	0.7663	1.3527	0	0.0037	0.7841	1.3515	5.8089	0.0216	0.5001	0	0	1.3895	0.4357	0	0	0	0	0	0	0	0											18.0696	0	4.887413839	17.4801	0.068611461	6.850090321	0	1.424685288	2.552025629	2.626827794	2.894499777	10.41214107	5.473658676	9.662150568	0	0.026591323	5.600396971	6.28596645	27.01831337	0.100260314	2.325849404	0	0	6.462630875	2.02654839	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2913
H1509_810_0	2011	1																															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	267.6639209	1.08194	44.92522703	214.7594667	6.683702467	8.966308812	9.798944966	11.97952716	40.89368327	24.05944547	43.62613952	0	0.112502427	23.84119716	23.28839669	107.953757	0.4297875	8.519714469	0	0	25.70566676	9.797625458	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.075961555	0.075961555	0.163269757	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.060747202	0.060747202	0.130568429	0	0.18633239	0.18633239	0.18633239	0.18633239	0.18633239	0.18633239	0.18633239	0	0.18633239	0.18633239	0.187151416	0.187151416	0.187151416	0.187151416	0	0	0.18633239	0.18633239	0	0	0	0	0	0	0	0												16.2598	0.065724828	5.865816325	0	1.245390252	1.670713747	1.825860832	2.232173923	7.619817725	4.483053967	8.128962828	0	0.020962846	4.44238724	4.358456411	20.20369845	0.080435339	1.594476625	0	0	4.789798316	1.825614965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7132	0	21.5740465	16.2598	0.065724828	5.865816325	0	1.245390252	1.670713747	1.825860832	2.232173923	7.619817725	4.483053967	8.128962828	0	0.020962846	4.44238724	4.358456411	20.20369845	0.080435339	1.594476625	0	0	4.789798316	1.825614965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7132	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.0379	0.0042	2.1149	0	0.2027	0.272	0.2972	0.3634	1.2404	0.7298	1.3233	0	0.0034	0.7232	1.1937	5.5335	0.022	0.4367	0	0	1.3119	0.5	0	0	0	0	0	0	0	0											17.3102	0	4.296084203	17.2977	0.069920029	7.980702483	0	1.4481282	1.942690404	2.12309399	2.595551073	8.860253169	5.212853451	9.452282359	0	0.024375402	5.165566558	5.552173772	25.73719548	0.1024654	2.031180413	0	0	6.101653905	2.325624159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.0234
H1509_811_0	2011	1																															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	275.3333049	1.080718	39.25180194	223.7622711	6.693344501	11.98972633	12.34115599	13.59871147	48.91750322	25.7159132	45.39395677	0	0.124929266	26.3113451	26.83787679	115.3544441	0.4280605	9.93019295	0	0	27.71435626	8.690653255	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.075961555	0.075961555	0.163269757	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.059677708	0.059677708	0.128269688	0	0.183051888	0.183051888	0.183051888	0.183051888	0.183051888	0.183051888	0.183051888	0	0.183051888	0.183051888	0.183862669	0.183862669	0.183862669	0.183862669	0	0	0.183051888	0.183051888	0	0	0	0	0	0	0	0												16.4313	0.064494774	5.034816386	0	1.225229347	2.194742041	2.259071903	2.489269808	8.954441318	4.707346461	8.309449489	0	0.022868538	4.816341395	4.934483664	21.209376	0.078704346	1.825791782	0	0	5.073165237	1.590840486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2217	0	24.73360306	16.4313	0.064494774	5.034816386	0	1.225229347	2.194742041	2.259071903	2.489269808	8.954441318	4.707346461	8.309449489	0	0.022868538	4.816341395	4.934483664	21.209376	0.078704346	1.825791782	0	0	5.073165237	1.590840486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2217	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.0488	0.0041	1.8153	0	0.1995	0.3573	0.3678	0.4052	1.4577	0.7663	1.3527	0	0.0037	0.7841	1.3515	5.8089	0.0216	0.5001	0	0	1.3895	0.4357	0	0	0	0	0	0	0	0											18.0696	0	4.887413839	17.4801	0.068611461	6.850090321	0	1.424685288	2.552025629	2.626827794	2.894499777	10.41214107	5.473658676	9.662150568	0	0.026591323	5.600396971	6.28596645	27.01831337	0.100260314	2.325849404	0	0	6.462630875	2.02654839	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2913
H1509_812_0	2011	1																															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	253.8333068	1.085136	36.83517635	213.9931851	6.405887067	11.47480648	11.81114337	13.01469093	46.81665515	24.61149815	43.44443359	0	0.119563959	25.18159561	24.86773214	106.886377	0.429395	9.201226322	0	0	25.67987003	8.052680133	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.079787532	0.079787532	0.175637684	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.063530695	0.063530695	0.139851227	0	0.18552588	0.18552588	0.18552588	0.18552588	0.18552588	0.18552588	0.18552588	0	0.18552588	0.18552588	0.186400562	0.186400562	0.186400562	0.186400562	0	0	0.18552588	0.18552588	0	0	0	0	0	0	0	0												16.1262	0.068939445	5.151444599	0	1.188457834	2.128873568	2.191272766	2.414561985	8.685701138	4.566069849	8.060066767	0	0.022182209	4.671837682	4.635359234	19.92368069	0.080039469	1.715113753	0	0	4.764280483	1.493980567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8881	0	22.33432016	16.1262	0.068939445	5.151444599	0	1.188457834	2.128873568	2.191272766	2.414561985	8.685701138	4.566069849	8.060066767	0	0.022182209	4.671837682	4.635359234	19.92368069	0.080039469	1.715113753	0	0	4.764280483	1.493980567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8881	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.0293	0.0044	1.8573	0	0.1935	0.3466	0.3567	0.3931	1.414	0.7433	1.3121	0	0.0036	0.7605	1.2696	5.4568	0.0219	0.4697	0	0	1.3049	0.4092	0	0	0	0	0	0	0	0											17.3465	0	4.396238769	17.1555	0.073339835	7.008768162	0	1.381927715	2.475434382	2.547991589	2.807630215	10.09965249	5.309383545	9.372170659	0	0.025793266	5.432369398	5.904916222	25.38048495	0.101961107	2.184858284	0	0	6.069147112	1.903159958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.2345
H1509_813_0	2011	1																															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	273.8849528	1.078932	38.48876265	223.015995	6.574386152	11.77663734	12.12182116	13.35702657	48.04811044	25.25887374	44.58718669	0	0.122708944	25.84378591	27.01752475	116.1266061	0.4283745	9.996663888	0	0	27.89987122	8.748826936	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.073688766	0.073688766	0.15690342	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.058093783	0.058093783	0.12369746	0	0.183689484	0.183689484	0.183689484	0.183689484	0.183689484	0.183689484	0.183689484	0	0.183689484	0.183689484	0.184499783	0.184499783	0.184499783	0.184499783	0	0	0.183689484	0.183689484	0	0	0	0	0	0	0	0												15.911	0.062679241	4.760962197	0	1.207645598	2.163244432	2.226651071	2.453545315	8.8259326	4.639789476	8.190197302	0	0.022540343	4.747231691	4.98472746	21.42533366	0.079035002	1.844382321	0	0	5.124912939	1.607067503	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2769	0	24.07653499	15.911	0.062679241	4.760962197	0	1.207645598	2.163244432	2.226651071	2.453545315	8.8259326	4.639789476	8.190197302	0	0.022540343	4.747231691	4.98472746	21.42533366	0.079035002	1.844382321	0	0	5.124912939	1.607067503	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2769	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.0156	0.004	1.7165	0	0.1966	0.3522	0.3625	0.3994	1.4368	0.7553	1.3333	0	0.0037	0.7728	1.3652	5.8681	0.0216	0.5051	0	0	1.4036	0.4402	0	0	0	0	0	0	0	0											17.9525	0	4.776040828	16.9266	0.066680044	6.477499588	0	1.404239067	2.515400503	2.589129152	2.852959669	10.26271233	5.395104042	9.523485235	0	0.026209701	5.52003685	6.349971287	27.29341868	0.100681532	2.349531619	0	0	6.528551515	2.047219749	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.2294
H1509_814_0	2011	1																															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	274.4474218	1.080718	39.95095264	223.3679254	6.595612805	11.81466045	12.16095876	13.40015227	48.20324288	25.3404268	44.73114488	0	0.123105133	25.9272161	27.04610696	116.2494581	0.428139	10.0072395	0	0	27.92938688	8.758082443	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.075942758	0.075942758	0.166310252	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.059673443	0.059673443	0.130681393	0	0.18308411	0.18308411	0.18308411	0.18308411	0.18308411	0.18308411	0.18308411	0	0.18308411	0.18308411	0.183885619	0.183885619	0.183885619	0.183885619	0	0	0.18308411	0.18308411	0	0	0	0	0	0	0	0												16.3772	0.064490164	5.22084613	0	1.207551899	2.163076591	2.22647831	2.45335495	8.825247815	4.639429485	8.189561843	0	0.022538594	4.74686128	4.973390128	21.37660359	0.078728605	1.840187432	0	0	5.113426936	1.603465728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1225	0	24.68673713	16.3772	0.064490164	5.22084613	0	1.207551899	2.163076591	2.22647831	2.45335495	8.825247815	4.639429485	8.189561843	0	0.022538594	4.74686128	4.973390128	21.37660359	0.078728605	1.840187432	0	0	5.113426936	1.603465728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1225	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.0454	0.0041	1.8823	0	0.1966	0.3521	0.3624	0.3994	1.4367	0.7553	1.3332	0	0.0037	0.7727	1.3621	5.8547	0.0216	0.504	0	0	1.4005	0.4392	0	0	0	0	0	0	0	0											18.126	0	4.8989027	17.4226	0.068606558	7.103192013	0	1.404130116	2.515205338	2.588928268	2.852738314	10.26191606	5.394685448	9.522746329	0	0.026207667	5.51960614	6.335528825	27.23134215	0.100291217	2.344187812	0	0	6.513919664	2.042631501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2484
H1509_815_0	2011	1																															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	271.4251122	1.082692	38.13740967	222.2674583	6.721160747	12.03955332	12.39244345	13.65522509	49.12079491	25.82278357	45.58260529	0	0.125448447	26.42067531	25.94468236	111.5153197	0.4283745	9.599705067	0	0	26.79199162	8.401418634	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.077866217	0.077866217	0.162966859	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.061361564	0.061361564	0.128424133	0	0.183612933	0.183612933	0.183612933	0.183612933	0.183612933	0.183612933	0.183612933	0	0.183612933	0.183612933	0.184457007	0.184457007	0.184457007	0.184457007	0	0	0.183612933	0.183612933	0	0	0	0	0	0	0	0												16.6551	0.066435675	4.897763766	0	1.234092038	2.210617697	2.275412888	2.507275929	9.019213226	4.741397029	8.369555851	0	0.023033957	4.851177686	4.785678462	20.56978213	0.079016678	1.770732867	0	0	4.919356162	1.542609117	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5182	0	24.18905345	16.6551	0.066435675	4.897763766	0	1.234092038	2.210617697	2.275412888	2.507275929	9.019213226	4.741397029	8.369555851	0	0.023033957	4.851177686	4.785678462	20.56978213	0.079016678	1.770732867	0	0	4.919356162	1.542609117	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5182	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.0631	0.0042	1.7659	0	0.2009	0.3599	0.3704	0.4082	1.4682	0.7719	1.3625	0	0.0037	0.7897	1.3107	5.6338	0.0216	0.485	0	0	1.3473	0.4225	0	0	0	0	0	0	0	0											17.7895	0	4.741653386	17.7182	0.07067625	6.663624171	0	1.434990742	2.570485694	2.64582894	2.915437127	10.48745724	5.513252359	9.732041687	0	0.026783671	5.640904286	6.096405684	26.20354412	0.100658189	2.255710659	0	0	6.266695747	1.965107155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.3078
H1509_816_0	2011	1																															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	252.3336095	1.083162	35.39454829	214.7474854	6.040957706	10.82111188	11.13828839	12.27327248	44.1496128	23.20943498	40.96949932	0	0.112752662	23.74726101	25.14281938	108.0687558	0.4302585	9.303010431	0	0	25.96394116	8.141759006	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.076966714	0.076966714	0.157257397	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.061819946	0.061819946	0.126309717	0	0.187146453	0.187146453	0.187146453	0.187146453	0.187146453	0.187146453	0.187146453	0	0.187146453	0.187146453	0.188006213	0.188006213	0.188006213	0.188006213	0	0	0.187146453	0.187146453	0	0	0	0	0	0	0	0												15.5993	0.066961017	4.470675373	0	1.130543807	2.025132706	2.084491165	2.296899411	8.262443438	4.343563434	7.66729648	0	0.021101261	4.444215667	4.727006253	20.3175975	0.080891271	1.74902376	0	0	4.859059494	1.523701319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6699	0	20.83732447	15.5993	0.066961017	4.470675373	0	1.130543807	2.025132706	2.084491165	2.296899411	8.262443438	4.343563434	7.66729648	0	0.021101261	4.444215667	4.727006253	20.3175975	0.080891271	1.74902376	0	0	4.859059494	1.523701319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6699	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.9957	0.0043	1.6119	0	0.184	0.3297	0.3393	0.3739	1.345	0.7071	1.2482	0	0.0034	0.7235	1.2947	5.5647	0.0222	0.479	0	0	1.3308	0.4173	0	0	0	0	0	0	0	0											16.9747	0	4.117138652	16.5949	0.071235124	6.082551528	0	1.314585823	2.354805472	2.423826936	2.670813268	9.607492369	5.050655155	8.915461023	0	0.02453635	5.167692636	6.021664016	25.88228981	0.103046205	2.228055745	0	0	6.189884706	1.941020789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.6446
H1509_817_0	2011	1																															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	254.5276067	1.08429	35.84750503	215.4672997	6.094072554	10.91625602	11.23622129	12.38118467	44.53779628	23.41350289	41.3297218	0	0.113744035	23.95602597	25.40957307	109.2153153	0.4296305	9.401711071	0	0	26.23940657	8.228139306	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078601654	0.078601654	0.179107514	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.062791009	0.062791009	0.143080213	0	0.186132278	0.186132278	0.186132278	0.186132278	0.186132278	0.186132278	0.186132278	0	0.186132278	0.186132278	0.186981703	0.186981703	0.186981703	0.186981703	0	0	0.186132278	0.186132278	0	0	0	0	0	0	0	0												15.982	0.068083663	5.129068639	0	1.134303606	2.031867597	2.091423463	2.304538105	8.28992147	4.358008625	7.692795259	0	0.021171436	4.458989682	4.751125247	20.42126566	0.080333043	1.757947948	0	0	4.884000513	1.531522311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9884	0	21.74990031	15.982	0.068083663	5.129068639	0	1.134303606	2.031867597	2.091423463	2.304538105	8.28992147	4.358008625	7.692795259	0	0.021171436	4.458989682	4.751125247	20.42126566	0.080333043	1.757947948	0	0	4.884000513	1.531522311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9884	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.0201	0.0043	1.8493	0	0.1847	0.3308	0.3405	0.3752	1.3495	0.7094	1.2523	0	0.0034	0.7259	1.3013	5.5931	0.022	0.4815	0	0	1.3377	0.4195	0	0	0	0	0	0	0	0											17.3003	0	4.314118479	17.0022	0.072429428	6.978324679	0	1.318957681	2.362636741	2.431887748	2.679695471	9.63944357	5.06745189	8.945110767	0	0.024617949	5.184871723	6.05238885	26.01435115	0.102335086	2.239424137	0	0	6.221656705	1.950983836	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.2887
H1510_001_0	2011	6	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		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	YES	1194.269174	39.376833	880.345953	530.615007	36.555135	9.957313	3.945378	415.473101	416.40919	1545.388218	1095.11771	290.285769	0.01218	5.845294	3311.896838	3576.213323	87.560086	695.394141		1845.861376	20.533556	0		3.22					4.9	0.56	916.925423	777.13082									4900	$215/Day(Days 1-8):1a.IP Acute	$215/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										162.151065	141.812065	32.5726	0	150	0.2	0.2	50	182.103145	41.157517	113.436901	150	0.2	0.2	10	33.289148	35	95.693802		0	0.2	0		0					0	0	0	131.742906									NO	138.495333	121.123528	21.412804	0	127.39035	0.169854	0.169854	42.46345	154.654556	34.953803	96.338443	127.39035	0.169854	0.169854	8.49269	28.271442	29.724415	81.269779		0	0.169854	0		0					0	0	0	111.885166										13.7834	0.397455078	1.570889612	0	0.388064287	1.691289442	0.670138235	1.470201771	5.366631533	4.501432944	8.791827924	3.081633809	0.002068822	0.992846567	2.34390943	8.425392295	0.216889361	4.709544013	0	0	3.487706621	0	0	0	0	0	0	0	0	0	0	7.245784233	0	0	0	0	0	0	0	0	69.1371	0	12.71587481	13.7834	0.397455078	1.570889612	0	0.388064287	1.691289442	0.670138235	1.470201771	5.366631533	4.501432944	8.791827924	3.081633809	0.002068822	0.992846567	2.34390943	8.425392295	0.216889361	4.709544013	0	0	3.487706621	0	0	0	0	0	0	0	0	0	0	7.245784233	0	0	0	0	0	0	0	0	69.1371	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									6000	5.6252	0.0784	0.4095	3.2598	1.898	2.0453	0.8104	0.2686	3.5087	0.4738	1.3799	0.4182	0.0004	0.2777	1.6145	2.7566	0.0496	0.2521		0.3922	1.0785	0		0					0	0	0.3222	0.6627									27.5825	1000	15.51117644	19.4085	0.475872903	1.980425313	3.259847675	2.286070868	3.736568484	1.480537789	1.738819754	8.875340987	4.975225974	10.17174386	3.499870671	0.002454704	1.270542051	3.958407523	11.18203005	0.266475048	4.961687142	0	0.39224743	4.566199459	0	0	0	0	0	0	0	0	0	0.322170201	7.908530169	0	0	0	0	0	0	0	0	96.7196
H1510_004_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	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	YES	1470.969565	17.480171	541.771127	388.467727	31.030179	9.204601	2.186233	336.637375	396.511384	3264.366703	958.155476	81.281869	0.265893	1.854344	3780.026138	3191.594736	97.244422	712.961912		1679.586838	21.846109	0		3.22	3.1				4.9	0.56	1118.628437	820.851677									3500	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										165.92202	145.11002	32.5726	0	150	0.2	0.2	50	190.623286	29.858792	116.441183	150	0.2	0.2	10	33.816976	35	70.980583		0	0.2	0		0	0				0	0	0	131.86489									NO	123.531433	108.036587	18.493224	0	118.41735	0.15789	0.15789	39.47245	150.487363	23.571994	91.924375	118.41735	0.15789	0.15789	7.89449	26.696778	27.630715	56.03555		0	0.15789	0		0	0				0	0	0	104.100606										15.1426	0.157374835	0.834924567	0	0.306209297	1.453314452	0.345184328	1.107325163	4.972496048	6.412302695	7.339820274	0.802098628	0.041981846	0.292782374	2.486781546	7.100441344	0.223911076	3.329267739	0	0	3.44928215	0	0	0	0	0	0	0	0	0	0	7.120929751	0	0	0	0	0	0	0	0	62.919	0	18.36354476	15.1426	0.157374835	0.834924567	0	0.306209297	1.453314452	0.345184328	1.107325163	4.972496048	6.412302695	7.339820274	0.802098628	0.041981846	0.292782374	2.486781546	7.100441344	0.223911076	3.329267739	0	0	3.44928215	0	0	0	0	0	0	0	0	0	0	7.120929751	0	0	0	0	0	0	0	0	62.919	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									5200	5.0663	0.028	0.2878	2.352	1.6358	1.9196	0.4559	0.221	3.2073	0.5562	1.1839	0.5567	0.0085	0.0894	1.6893	2.5013	0.0405	0.3145		0.3717	1.1619	0		0	0				0	0	0.3844	0.5617									24.5937	1000	14.3431533	20.2088	0.185328814	1.122715266	2.3519964	1.942000881	3.3729099	0.801117137	1.328303079	8.179753889	6.968542107	8.523766382	1.358780855	0.050531773	0.38222576	4.176130247	9.601700782	0.264371143	3.643757635	0	0.371670682	4.611219055	0	0	0	0	0	0	0	0	0	0.384429783	7.682618959	0	0	0	0	0	0	0	0	87.5127
H1510_005_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V		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	1050.287916	72.333448	660.649415	361.897527	28.747001	7.947245	2.865322	330.774711	389.863522	1955.868838	1182.75444	67.800831	2.055351	2.496336	3238.197256	3240.497309	94.017082	660.356392		1518.216635	28.52171	0		3.22	3.1		0.28		4.9	0.56	1161.562813	594.236103									3900	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										161.6895	138.428775	32.5726	0	150	0.2	0.2	50	180.634174	24.21759	98.97949	150	0.1821	0.2	10	33.502121	35	71.361537		0	0.2	0		0	0		0		0	0	0	132.942771									NO	136.770399	117.094547	21.7612	0	127.2876	0.169717	0.169717	42.4292	153.28327	20.550659	83.992412	127.2876	0.154528	0.169717	8.48584	28.429364	29.70044	60.556259		0	0.169717	0		0	0		0		0	0	0	112.813108										11.9707	0.705821027	1.198043671	0	0.304928064	1.34878258	0.486293854	1.169542197	4.979962959	3.349532795	8.278533185	0.719183755	0.317609279	0.423670657	2.289901984	7.677106462	0.232695725	3.332392726	0	0	4.840619056	0	0	0	0	0	0	0	0	0	0	5.586468472	0	0	0	0	0	0	0	0	59.2118	0	10.99451728	11.9707	0.705821027	1.198043671	0	0.304928064	1.34878258	0.486293854	1.169542197	4.979962959	3.349532795	8.278533185	0.719183755	0.317609279	0.423670657	2.289901984	7.677106462	0.232695725	3.332392726	0	0	4.840619056	0	0	0	0	0	0	0	0	0	0	5.586468472	0	0	0	0	0	0	0	0	59.2118	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5	"VIS752: Vision 17a, 17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									5800	5.4756	0.1043	0.3925	1.735	1.3598	1.4871	0.5362	0.1948	2.7727	0.4353	1.0855	0.1701	0.054	0.108	1.2733	2.1495	0.0358	0.2484		0.2832	1.3969	0		0	0		0		0	0	0.3471	0.4674									22.1126	500	11.2139764	17.4463	0.810088036	1.590536149	1.734978427	1.664692856	2.835912419	1.022467526	1.364367963	7.752652973	3.784850116	9.364046886	0.889268199	0.371604999	0.531711572	3.563190077	9.826642041	0.268502469	3.580789911	0	0.283231324	6.237515709	0	0	0	0	0	0	0	0	0	0.347105121	6.053903051	0	0	0	0	0	0	0	0	81.3243
H1510_007_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V		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	1191.591105	55.212516	587.002631	520.445021	42.238321	9.067657	2.809311	368.57676	388.963558	1471.996306	976.826608	90.144679	0.365175	7.461636	3394.620004	3300.784829	94.292993	607.395563		1498.500381	17.936319	0		3.22	3.1		0.28		4.9	0.56	1070.550121	714.873863									4000	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										161.6895	138.428775	32.5726	0	150	0.2	0.2	50	184.085226	30.381622	106.990671	150	0.172843	0.2	10	33.428061	35	70.92209		0	0.2	0		0	0		0		0	0	0	128.277878									NO	136.505552	116.867801	22.172657	0	127.42035	0.169894	0.169894	42.47345	156.374693	25.808246	90.885258	127.42035	0.146825	0.169894	8.49469	28.396102	29.731415	60.246117		0	0.169894	0		0	0		0		0	0	0	108.968081										13.5549	0.537713778	1.084617333	0	0.448501804	1.540540518	0.477285083	1.304560549	5.068671414	3.165803565	7.398261524	0.957188879	0.053616819	1.267687187	2.403020383	7.810785224	0.233622009	3.049435346	0	0	3.04727298	0	0	0	0	0	0	0	0	0	0	6.491536084	0	0	0	0	0	0	0	0	59.895	0	11.0329422	13.5549	0.537713778	1.084617333	0	0.448501804	1.540540518	0.477285083	1.304560549	5.068671414	3.165803565	7.398261524	0.957188879	0.053616819	1.267687187	2.403020383	7.810785224	0.233622009	3.049435346	0	0	3.04727298	0	0	0	0	0	0	0	0	0	0	6.491536084	0	0	0	0	0	0	0	0	59.895	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5	"VIS752: Vision 17a, 17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									6000	5.7188	0.0893	0.3699	2.5034	2.0252	1.7199	0.5329	0.2201	2.5776	0.3815	1.0392	0.1903	0.0092	0.3273	1.3698	2.1304	0.0355	0.2254		0.256	0.858	0		0	0		0		0	0	0.3145	0.4699									23.3641	500	10.6090829	19.2737	0.626965731	1.454484697	2.503397948	2.473685697	3.260483063	1.010151992	1.524614223	7.646264233	3.547325976	8.43747301	1.147526333	0.062846732	1.595031762	3.7727881	9.941200529	0.269130014	3.274817353	0	0.255999172	3.90528362	0	0	0	0	0	0	0	0	0	0.314536792	6.961408928	0	0	0	0	0	0	0	0	83.2591
H1510_008_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		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	YES	1219.518051	56.506514	600.760027	532.642527	43.228247	9.714911	3.009842	377.214977	398.079575	1506.49502	999.720186	92.257371	0.39124	7.994252	3474.178645	3378.144284	96.502908	621.630902		1533.620263	19.216623	0		3.22					4.9	0.56	1095.640267	731.628137									4000	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										161.6895	138.428775	32.5726	0	150	0.2	0.2	50	184.085226	30.381622	106.990671	150	0.172844	0.2	10	33.428061	35	70.92209		0	0.2	0		0					0	0	0	128.277878									NO	135.115992	115.678144	21.752829	0	126.52185	0.168696	0.168696	42.17395	155.272022	25.62626	90.244384	126.52185	0.14579	0.168696	8.43479	28.195868	29.521765	59.821294		0	0.168696	0		0					0	0	0	108.199696										13.7314	0.544714055	1.089019178	0	0.455776482	1.638866626	0.507748306	1.325720465	5.150885044	3.217152756	7.51826103	0.972714438	0.05703888	1.348598335	2.441997274	7.93747586	0.237411348	3.098897079	0	0	3.241767434	0	0	0	0	0	0	0	0	0	0	6.596828501	0	0	0	0	0	0	0	0	61.1122	0	11.83848736	13.7314	0.544714055	1.089019178	0	0.455776482	1.638866626	0.507748306	1.325720465	5.150885044	3.217152756	7.51826103	0.972714438	0.05703888	1.348598335	2.441997274	7.93747586	0.237411348	3.098897079	0	0	3.241767434	0	0	0	0	0	0	0	0	0	0	6.596828501	0	0	0	0	0	0	0	0	61.1122	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									6000	5.7563	0.0898	0.3622	3.0615	2.3658	2.1034	0.6517	0.2571	3.1522	0.4666	1.2709	0.2328	0.0113	0.4003	1.6751	2.6053	0.0434	0.2756		0.3131	1.0493	0		0					0	0	0.3847	0.5746									27.1029	1000	12.67008376	19.4877	0.634552587	1.451216373	3.061462755	2.821591464	3.742223801	1.159403244	1.58278664	8.303082534	3.683725489	8.789136418	1.205482636	0.068326513	1.748915712	4.117117682	10.54280905	0.280834761	3.374521922	0	0.31306764	4.291048641	0	0	0	0	0	0	0	0	0	0.384654095	7.171446031	0	0	0	0	0	0	0	0	88.2151
H1517_003_0	2011	7	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	1158.50705	80.17393276	469.1852011	509.0699424	90.53553343	10.08620639	2.027247517	289.888733	582.101505	7082.071743	746.6061174	112.2758868	0.024835041	134.3191754	3292.092537	3633.473967	13.91744074	1288.451436	580.64511	1226.570663	35.12139239	2.081575528	0	745.9758882	302.4	239.2	129.6	0	5531.244773	0	4.915848118	5.482471374	144.791167	0	0	0	0	0	0	0		1A: $175/day (days1-5) w/$875 yrly max	1B: $175/day (days1-5) w/$875 yrly max	2: $115/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $15 copay	9A: $15-$150 copay; 9B: $150 copay	8A: $0-$125 copay	8B: $75-$125 copay	9A: $150 copay	12: 20% coin	3: $15 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $10 copay; 7G: $10 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $15 copay; 7F: $15 copay; 7G: $15 copay	7E: $40 copay; 7H: $40 copay	7C: $15-$30 copay; 7I: $15-$30 copay	8B: $75-$125 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$15; 17B: $0; 18A: $15	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $15 copay	17B: $15 copay	18A: $15 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay									175	175	115	0	125	0.2	0.08092947	49.44444444	104.1539935	18.03593564	95.74590997	150	0.2	6.970954357	8.667024892	14.71358007	40	25.86810066	87.76279582	7.379249158	0.2	0	0	0	15	15	15	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	74.2920157	46.58598834	103.8381895	0	112.8675972	0.180588156	0.073074519	44.64540513	94.04488794	16.28538176	86.45288643	135.4411167	0.180588156	6.29435895	7.825810198	13.28549144	36.11763112	23.35736293	79.24460712	6.663024975	0.180588156	0	0	0	15	15	15	0	0	0	0.180588156	0.180588156	0	0	0	0	0	0	0	0		7.1723	0.311248491	4.05994515	0	0.85154401	1.821449408	0.148140136	1.078516661	4.561972567	9.61118683	5.37885449	1.267230957	0.004484914	0.070454425	2.146940946	4.022707272	0.041888749	2.507902318	3.834416135	0.681055914	6.342507473	0	0	0	0.378	0.299	0.162	0	0	0	0.887743945	0.990069393	0	0	0	0	0	0	0	0	58.6316		6.212259856	7.1723	0.311248491	4.05994515	0	0.85154401	1.821449408	0.148140136	1.078516661	4.561972567	9.61118683	5.37885449	1.267230957	0.004484914	0.070454425	2.146940946	4.022707272	0.041888749	2.507902318	3.834416135	0.681055914	6.342507473	0	0	0	0.378	0.299	0.162	0	0	0	0.887743945	0.990069393	0	0	0	0	0	0	0	0	58.6316	YES	1A: $250/day (days1-5) no yrly max	1B: $250/day (days1-5) no yrly max	2: 25% coin (for days 1-100)	6: $0 copay	10A: $125 copay	11A: 25% coin	11B: 25% coin; 11C: 25% coin	4A: $50 copay; 4B: $15 copay	9A: $25-$225 copay; 9B: $225 copay	8A: 0% - 25%	8B: 25% coin	9A: $225 copay	12: 20% coin	3: $25 copay; 5: $50 copay; 9C: $50 copay; 9D: $0 copay	7A: $20 copay; 7G: $20 copay; 14B: $0 copay; 14C: $0 copay	7B: $25 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $50 copay; 7H: $50 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: 25% coin	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $25; 17B: $0; 18A: $25	15: 20% coinsurance	13A: $0 copay	10B: Not covered	$16A: 20% coinsurance	17A: $25 copay	17B: $25 copay	18A: $25 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin								3800	2.9979	0.2468	0.8404	0	1.0594	0.4244	0.3436	0.256	1.3545	0.8041	0.7291	0.2963	0.0001	0.0423	0.9161	1.3855	0.0132	0.6079	1.6262	0.1733	1.5457	0	0	0.1858	0.1575	0.1246	0.0675	0	0	0	0.1724	0.113	0.0298	0	0	0	0	0	0	0	16.5134		1.717511489	10.1702	0.558083415	4.900354821	0	1.910919519	2.245823474	0.491725424	1.334502739	5.916496724	10.41532709	6.107970976	1.563509998	0.004555119	0.112744775	3.063086724	5.408157468	0.05512917	3.115817025	5.460647881	0.854327168	7.888172037	0	0	0.18582996	0.5355	0.423583333	0.2295	0	0	0	1.060141994	1.103043782	0.029789284	0	0	0	0	0	0	0	75.145
H1517_004_0	2011	9	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	811.3411521	94.335359	284.7343832	264.6407952	58.62366135	7.031822367	1.269106766	213.1731283	470.8326751	4518.211666	546.1744884	72.84404433	0.011916537	105.2423047	2288.136217	2298.933796	10.31704161	883.065392	362.009276	852.0117041	19.1346459	0.902213716	0	0	0	0	129.6	0	5529.600004	0	4.299000841	3.147837883	85.00956328	0	0	0	0	0	0	0		1A: $255/day (days1-7) w/$1785 yrly max	1B: $255/day (days1-7) w/$1785 yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $40 copay	9A: $40-$200 copay; 9B: $200 copay	8A: $0-$150 copay	8B: $85-$150 copay	9A: $200 copay	12: 20% coin	3: $40 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $0 copay; 7G: $0 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $40 copay; 7F: $40 copay; 7G: $40 copay	7E: $40 copay; 7H: $40 copay	7C: $40-$50 copay; 7I: $40-$50 copay	8B: $85-$150 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$35; 17B: $0; 18A: $35	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	-	-	18A: $35 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay									255	255	128	0	125	0.2	0.2	49.08825482	148.0956616	20.67133971	112.0335225	200	0.2	4.482707046	0	37.74713012	40	48.3902598	99.43006258	16.89618756	0.2	0	0	0	0	0	35	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	133.2282571	88.28362664	114.1510575	0	111.4756421	0.178361027	0.178361027	43.77715778	132.0724717	18.43480693	99.91207078	178.3610273	0.178361027	3.997701168	0	33.66308453	35.67220546	43.15468224	88.67224052	15.06810685	0.178361027	0	0	0	0	0	35	0	0	0	0.178361027	0.178361027	0	0	0	0	0	0	0	0		9.0078	0.694022301	2.708560912	0	0.544592524	1.254203061	0.226359186	0.777676139	5.182002931	6.941029977	4.547452012	1.082711548	0.002125446	0.035060607	0	6.449100226	0.030669302	3.175700533	2.675014466	1.069850283	3.4128751	0	0	0	0	0	0.378	0	0	0	0.766774206	0.561451599	0	0	0	0	0	0	0	0	51.523		6.204976043	9.0078	0.694022301	2.708560912	0	0.544592524	1.254203061	0.226359186	0.777676139	5.182002931	6.941029977	4.547452012	1.082711548	0.002125446	0.035060607	0	6.449100226	0.030669302	3.175700533	2.675014466	1.069850283	3.4128751	0	0	0	0	0	0.378	0	0	0	0.766774206	0.561451599	0	0	0	0	0	0	0	0	51.523	YES	1A: 20% coin	1B: 20% coin	2: 30% coin (for days 1-100)	6: $0 copay	10A: $125 copay	11A: 25% coin	11B: 25% coin; 11C: 25% coin	4A: $50 copay; 4B: $40 copay	9A: $45-$275 copay; 9B: $275 copay	8A: 0% - 30%	8B: 30% coin	9A: $275 copay	12: 20% coin	3: $45 copay; 5: $50 copay; 9C: $50 copay; 9D: $0 copay	7A: $25 copay; 7G: $25 copay; 14B: $0 copay; 14C: $0 copay	7B: $45 copay; 7D: $45 copay; 7F: $45 copay; 7G: $45 copay	7E: $50 copay; 7H: $50 copay	7C: $45-$90 copay; 7I: $45-$90 copay	8B: 30% coin	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $45; 17B: $0; 18A: $45	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	-	-	18A: $45 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 30% coin; 14J: 30% coin								4500	15.9979	0.9583	1.183	0	1.1183	1.0385	0.3576	0.5046	2.2672	1.7247	1.7642	0.7695	0	0.1242	2.5653	5.8291	0.0308	2.9342	3.0822	0.9548	2.5182	0	0	0	0	0	0.1215	0		0	0.1695	0.2815	0.0358	0	0	0	0	0	0	0	46.331		5.606190477	25.0057	1.652351447	3.89156584	0	1.662929813	2.29266231	0.583977603	1.282311239	7.449156424	8.66576259	6.311633718	1.852212549	0.002125446	0.1592512	2.565281485	12.27822753	0.061451706	6.109908607	5.757260687	2.024650155	5.931070486	0	0	0	0	0	0.4995	0	0	0	0.936303769	0.842939736	0.035791717	0	0	0	0	0	0	0	97.854
H1517_801_0	2011	4																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	296.8291197	3.417467279	67.70956295	31.96076051	10.05978078	16.23103976	4.096959632	10.9896885	44.12954308	6.121506721	25.55918607	0	0.022353866	31.26723179	38.84455757	106.9562542	1.034599895	4.113973197	16.16621836	19.51899725	11.90595641	1.213718732	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.067554324	0.067554324	0.149631552	0	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0	0	0	0	0	0	0	0												20.0521	0.230864692	10.13148701	0	1.913118141	3.086736907	0.779139025	2.089963279	8.392332917	1.164157133	4.860716509	0	0.004251145	5.946243724	7.387261151	20.34039853	0.196754966	0.782374579	3.074409501	3.712024003	2.264214469	0.230818879	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6394	0	21.762	20.0521	0.230864692	10.13148701	0	1.913118141	3.086736907	0.779139025	2.089963279	8.392332917	1.164157133	4.860716509	0	0.004251145	5.946243724	7.387261151	20.34039853	0.196754966	0.782374579	3.074409501	3.712024003	2.264214469	0.230818879	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6394	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	Similar to Medicare FFS							0												10000	2.5495	0.0294	1.1964	0	0.2226	0.3592	0.0907	0.257	1.113	0.1631	0.5778	0	0.0007	0.5721	1.1621	3.0355	0.0312	0.1236	0.5451	0.5861	0.2284	0.0233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.8668	0	1.744	22.6016	0.260219567	11.32791172	0	2.13575728	3.445942959	0.869808059	2.34693393	9.505356492	1.327229742	5.438479607	0	0.004926011	6.518371116	8.549382476	23.37594515	0.227989666	0.905941791	3.619558773	4.298129023	2.492609462	0.254139546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5062
H1517_802_0	2011	4																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	296.8291197	3.417467279	67.70956295	31.96076051	10.05978078	16.23103976	4.096959632	10.9896885	44.12954308	6.121506721	25.55918607	0	0.022353866	31.26723179	38.84455757	106.9562542	1.034599895	4.113973197	16.16621836	19.51899725	11.90595641	1.213718732	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.067554324	0.067554324	0.149631552	0	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0	0	0	0	0	0	0	0												20.0521	0.230864692	10.13148701	0	1.913118141	3.086736907	0.779139025	2.089963279	8.392332917	1.164157133	4.860716509	0	0.004251145	5.946243724	7.387261151	20.34039853	0.196754966	0.782374579	3.074409501	3.712024003	2.264214469	0.230818879	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6394	0	21.762	20.0521	0.230864692	10.13148701	0	1.913118141	3.086736907	0.779139025	2.089963279	8.392332917	1.164157133	4.860716509	0	0.004251145	5.946243724	7.387261151	20.34039853	0.196754966	0.782374579	3.074409501	3.712024003	2.264214469	0.230818879	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6394	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	Similar to Medicare FFS							0												10000	2.5495	0.0294	1.1964	0	0.2226	0.3592	0.0907	0.257	1.113	0.1631	0.5778	0	0.0007	0.5721	1.1621	3.0355	0.0312	0.1236	0.5451	0.5861	0.2284	0.0233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.8668	0	1.744	22.6016	0.260219567	11.32791172	0	2.13575728	3.445942959	0.869808059	2.34693393	9.505356492	1.327229742	5.438479607	0	0.004926011	6.518371116	8.549382476	23.37594515	0.227989666	0.905941791	3.619558773	4.298129023	2.492609462	0.254139546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5062
H1517_803_0	2011	4																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	296.8291197	3.417467279	67.70956295	31.96076051	10.05978078	16.23103976	4.096959632	10.9896885	44.12954308	6.121506721	25.55918607	0	0.022353866	31.26723179	38.84455757	106.9562542	1.034599895	4.113973197	16.16621836	19.51899725	11.90595641	1.213718732	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.067554324	0.067554324	0.149631552	0	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0.190174933	0	0	0	0	0	0	0	0												20.0521	0.230864692	10.13148701	0	1.913118141	3.086736907	0.779139025	2.089963279	8.392332917	1.164157133	4.860716509	0	0.004251145	5.946243724	7.387261151	20.34039853	0.196754966	0.782374579	3.074409501	3.712024003	2.264214469	0.230818879	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6394	0	21.762	20.0521	0.230864692	10.13148701	0	1.913118141	3.086736907	0.779139025	2.089963279	8.392332917	1.164157133	4.860716509	0	0.004251145	5.946243724	7.387261151	20.34039853	0.196754966	0.782374579	3.074409501	3.712024003	2.264214469	0.230818879	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6394	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	Similar to Medicare FFS							0												10000	2.5495	0.0294	1.1964	0	0.2226	0.3592	0.0907	0.257	1.113	0.1631	0.5778	0	0.0007	0.5721	1.1621	3.0355	0.0312	0.1236	0.5451	0.5861	0.2284	0.0233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.8668	0	1.744	22.6016	0.260219567	11.32791172	0	2.13575728	3.445942959	0.869808059	2.34693393	9.505356492	1.327229742	5.438479607	0	0.004926011	6.518371116	8.549382476	23.37594515	0.227989666	0.905941791	3.619558773	4.298129023	2.492609462	0.254139546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5062
H1595_001_0	2011	9																															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	YES	243.0222182	5.306161968	541.8758028		126.8778039	10.03300835	13.39807748	231.3473743	431.8152332						3476.10268	4671.461029	388.7014497	568.9066572							143.3469894		247.8708359														6700	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: $0, 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														0	400	400	31		50	0.2	0.2	47	146.5627711						15.06077768	35	35	35							35		35														NO	385.7120045	385.7120045	29.89268035		48.21400056	0.192856002	0.192856002	45.32116053	141.3275506						14.52280687	33.74980039	33.74980039	33.74980039							33.74980039		33.74980039															7.8114	0.170554197	1.349843347	0	0.509773876	1.934925882	2.583899662	0.873744291	5.085615767	0	0	0	0	0	4.206897324	13.13840644	1.093216362	1.60004051	0	0	0	0	0	0	0.403161023	0	0.697132603	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4586	0	1.535757743	7.8114	0.170554197	1.349843347	0	0.509773876	1.934925882	2.583899662	0.873744291	5.085615767	0	0	0	0	0	4.206897324	13.13840644	1.093216362	1.60004051	0	0	0	0	0	0	0.403161023	0	0.697132603	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4586	YES	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%														6700	0.7217	0.0148	0.282		0.0269	0.2546	0.4038	0.0481	0.682	0.0996	0.207	0.0219	0.0006	0.1369	0.6111	1.0326	0.0421	0.164	0.4757	0.9078	0.3761	0.0096			0.0161		0.0214														6.5562	500	0.242863322	8.5331	0.185350687	1.631854307	0	0.536655172	2.189521392	2.987654934	0.921866368	5.76765159	0.099592441	0.206954371	0.021851057	0.000582857	0.136850852	4.818009301	14.17104326	1.135344913	1.763992178	0.475687752	0.907783218	0.376092746	0.009588783	0	0	0.419266712	0	0.718508226	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0148
H1595_002_0	2011	9																															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	YES	277.7776183	6.065013501	619.371229		145.0230125	11.46979269	15.31675902	264.433117	493.5705383						3973.231464	5339.54191	444.290912	650.2678541							143.3469894		247.8708359														6700	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: $0, 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														0	300	300	15.50829212		25	0.2	0.2	45	73.28138555						10.04558326	25	25	25							25		25														NO	292.8717535	292.8717535	15.13980236		24.40597946	0.195247836	0.195247836	43.93076302	71.54015961						9.806891945	24.40597946	24.40597946	24.40597946							24.40597946		24.40597946															6.7794	0.148022595	0.781429833	0	0.294952389	2.239452198	2.990564048	0.968062383	2.942509591	0	0	0	0	0	3.247087637	10.85972918	0.903612906	1.322535324	0	0	0	0	0	0	0.29154364	0	0.504127544	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2731	0	0.834176896	6.7794	0.148022595	0.781429833	0	0.294952389	2.239452198	2.990564048	0.968062383	2.942509591	0	0	0	0	0	3.247087637	10.85972918	0.903612906	1.322535324	0	0	0	0	0	0	0.29154364	0	0.504127544	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2731	YES	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%														6700	0.6535	0.0143	0.3263		0.0156	0.2947	0.4427	0.053	0.5263	0.0768	0.1597	0.0169	0.0004	0.1056	0.4701	0.7968	0.0325	0.1265	0.367	0.7004	0.2902	0.0065			0.0109		0.0144														5.501	0	0.133889204	7.4329	0.162291208	1.107769844	0	0.310505761	2.534116961	3.433262391	1.021060697	3.468761143	0.076844463	0.159683781	0.016860042	0.000449726	0.105592655	3.717152301	11.65650072	0.936118846	1.449038679	0.367035586	0.70043583	0.290189143	0.006471803	0	0	0.30241393	0	0.518554695	0	0	0	0	0	0	0	0	0	0	0	0	0	39.774
H1595_801_0	2011	6																															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	YES	247.3277029	5.400168186	551.4759046		133.4428759	10.55885137	18.50807633	238.2923237	444.778142	1451.058622	258.7668443	22.9347761	6.751539223	373.2330779	7613.218832	10222.55238	404.8231332	590.654718	4383.499355	13621.85553	1519.56856	3.694277055																			6700	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	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	812.6292957	460.5805576	77.88074903		144.134206	0.233	0.233	149.4264766	272.6486984	12.20340702	142.2019829	169.4016484	16.01704085	66.94146349	14.87844014	18.79018387	19.25127868	50.03228631	20.13372383	12.3642838	47.83287768	757.2236043																			NO	693.5996304	393.1171398	66.47318651		123.0221855	0.198871385	0.198871385	127.5392722	232.7125511	10.41591614	121.3729843	144.5885859	13.67094894	57.13622999	12.69912448	16.03789656	16.43145263	42.70382014	17.18464185	10.55322854	40.82656933	646.3094733																				14.2955	0.176908223	3.054863389	0	1.368036186	2.0998534	3.680726781	2.532635795	8.625454673	1.259508744	2.617275344	0.276342237	0.007691662	1.777094248	8.056767803	13.66235314	0.554319345	2.101934404	6.277405539	11.97954621	5.169897596	0.198970521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7731	0	15.4060986	14.2955	0.176908223	3.054863389	0	1.368036186	2.0998534	3.680726781	2.532635795	8.625454673	1.259508744	2.617275344	0.276342237	0.007691662	1.777094248	8.056767803	13.66235314	0.554319345	2.101934404	6.277405539	11.97954621	5.169897596	0.198970521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7731	YES	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																			6700	0.855	0.0106	0.1827		0.0722	0.1105	0.1937	0.1449	0.4934	0.0721	0.1497	0.0158	0.0004	0.1017	0.4416	0.7471	0.0305	0.1186	0.3442	0.6568	0.2721	0.0114																			5.0249	0	0.862336709	15.1505	0.187488858	3.237570529	0	1.440231118	2.210372	3.874449243	2.677523426	9.118901737	1.33156302	2.767005055	0.29215129	0.008113354	1.878758679	8.49835677	14.40945702	0.58479899	2.220552028	6.621561545	12.63631957	5.44199747	0.210353274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7981
H1595_802_0	2011	5																															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	YES	247.3277029	5.400168186	551.4759046		133.4428759	10.55885137	18.50807633	238.2923237	444.778142	1451.058622	258.7668443	22.9347761	6.751539223	373.2330779	7613.218832	10222.55238	404.8231332	590.654718	4383.499355	13621.85553	1519.56856	3.694277055																			6700	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	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	812.6292957	460.5805576	77.88074903		144.134206	0.233	0.233	149.4264766	272.6486984	12.20340702	142.2019829	169.4016484	16.01704085	66.94146349	14.87844014	18.79018387	19.25127868	50.03228631	20.13372383	12.3642838	47.83287768	757.2236043																			NO	693.5996304	393.1171398	66.47318651		123.0221855	0.198871385	0.198871385	127.5392722	232.7125511	10.41591614	121.3729843	144.5885859	13.67094894	57.13622999	12.69912448	16.03789656	16.43145263	42.70382014	17.18464185	10.55322854	40.82656933	646.3094733																				14.2955	0.176908223	3.054863389	0	1.368036186	2.0998534	3.680726781	2.532635795	8.625454673	1.259508744	2.617275344	0.276342237	0.007691662	1.777094248	8.056767803	13.66235314	0.554319345	2.101934404	6.277405539	11.97954621	5.169897596	0.198970521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7731	0	15.4060986	14.2955	0.176908223	3.054863389	0	1.368036186	2.0998534	3.680726781	2.532635795	8.625454673	1.259508744	2.617275344	0.276342237	0.007691662	1.777094248	8.056767803	13.66235314	0.554319345	2.101934404	6.277405539	11.97954621	5.169897596	0.198970521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7731	YES	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																			6700	0.855	0.0106	0.1827		0.0722	0.1105	0.1937	0.1449	0.4934	0.0721	0.1497	0.0158	0.0004	0.1017	0.4416	0.7471	0.0305	0.1186	0.3442	0.6568	0.2721	0.0114																			5.0249	0	0.862336709	15.1505	0.187488858	3.237570529	0	1.440231118	2.210372	3.874449243	2.677523426	9.118901737	1.33156302	2.767005055	0.29215129	0.008113354	1.878758679	8.49835677	14.40945702	0.58479899	2.220552028	6.621561545	12.63631957	5.44199747	0.210353274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7981
H1607_001_0	2011	10	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	833.0590574	52.50392412	498.2844486	273.5621126	23.57639896	10.20879468	1.524065363	286.5044656	364.9931294	5666.909815	655.0387178	194.2438344	0	136.071073	2637.228919	3022.995045	18.12104853	1120.639262	406.2551876	1132.39686	32.21018315	0.356510817	0	0	302.4	239.2	129.6	0	6420.118147	0	2.704183189	5.988021992	110.1164793	0	0	0	0	0	0	0		1A: $225/day (days1-7) w/$1575 yrly max	1B: $225/day (days1-7) w/$1575 yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $100 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $30 copay	9A: $30-$200 copay; 9B: $200 copay	8A: $0-$125 copay	8B: $75-$125 copay	9A: $200 copay	12: 20% coin	3: $30 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $15 copay; 7G: $15 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $30 copay; 7F: $30 copay; 7G: $30 copay	7E: $40 copay; 7H: $40 copay	7C: $30-$50 copay; 7I: $30-$50 copay	8B: $75-$125 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$30; 17B: $0; 18A: $30	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	17A: $30 copay	17B: $30 copay	18A: $30 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay									225	225	128	0	100	0.2	0.086811922	49.62025316	180.5666004	17.18075813	95.46799354	200	0.2	7.310704961	12.62023994	27.91312037	40	45.40104665	86.98380567	14.79526917	0.2	0	0	0	30	30	30	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	129.5626143	83.62092567	114.3124402	0	89.30659392	0.178613188	0.077528771	44.314158	161.2578806	15.3435499	85.25921332	178.6131878	0	6.528941592	11.27070644	24.92825706	35.72263757	40.54612837	77.6822741	13.21315096	0.178613188	0	0	0	30	30	30	0	0	0	0.178613188	0.178613188	0	0	0	0	0	0	0	0		8.9944	0.365868895	4.746675937	0	0.175460657	1.823425361	0.118158915	1.058017013	4.904834873	7.245876126	4.654007147	2.891209207	0	0.074033341	2.476952746	6.279833131	0.053944304	3.786465279	2.629902237	1.246877554	5.753163493	0	0	0	0.756	0.598	0.324	0	0	0	0.48300278	1.069539697	0	0	0	0	0	0	0	0	62.5097		7.283873982	8.9944	0.365868895	4.746675937	0	0.175460657	1.823425361	0.118158915	1.058017013	4.904834873	7.245876126	4.654007147	2.891209207	0	0.074033341	2.476952746	6.279833131	0.053944304	3.786465279	2.629902237	1.246877554	5.753163493	0	0	0	0.756	0.598	0.324	0	0	0	0.48300278	1.069539697	0	0	0	0	0	0	0	0	62.5097	YES	1A: $300/day (days1-10) no yrly max	1B: $300/day (days1-10) no yrly max	2: 30% coin (for days 1-100)	6: $0 copay	10A: $100 copay	11A: 25% coin	11B: 25% coin; 11C: 25% coin	4A: $50 copay; 4B: $30 copay	9A: $40-$275 copay; 9B: $275 copay	8A: 0% - 30%	8B: 30% coin	9A: $275 copay	12: 20% coin	3: $40 copay; 5: $50 copay; 9C: $50 copay; 9D: $0 copay	7A: $30 copay; 7G: $30 copay; 14B: $0 copay; 14C: $0 copay	7B: $40 copay; 7D: $40 copay; 7F: $40 copay; 7G: $40 copay	7E: $50 copay; 7H: $50 copay	7C: $40-$80 copay; 7I: $40-$80 copay	8B: 30% coin	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $40; 17B: $0; 18A: $40	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	17A: $40 copay	17B: $40 copay	18A: $40 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin								4000	4.5959	0.3195	0.8669	0	1.0699	0.4378	0.5968	0.2907	3.1065	1.2598	1.1245	0.1986	0	0.0523	2.0162	2.8481	0.0035	1.0537	2.3517	0.355	1.2754	0	0	0	0.252	0.1993	0.108	0	0	0	0.2991	0.0597	0.0565	0	0	0	0	0	0	0	24.7973		2.902208272	13.5904	0.685407153	5.613566902	0	1.24534989	2.26118489	0.714922358	1.348682361	8.011344662	8.505708667	5.778469739	3.089817637	0	0.126331485	4.493151678	9.127926102	0.05742892	4.840161631	4.981643442	1.601845591	7.028545574	0	0	0	1.008	0.797333333	0.432	0	0	0	0.782127485	1.129207448	0.056471862	0	0	0	0	0	0	0	87.307
H1607_004_0	2011	9	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	833.0590574	52.50392412	498.2844486	273.5621126	23.57639896	10.20879468	1.524065363	285.8968335	364.9931294	5666.909815	655.0387178	194.2438344	0	136.071073	2637.228919	3022.995045	18.12104853	1120.639262	406.2551876	1132.39686	32.21018315	0.356510817	0	1491.951776	302.4	239.2	129.6	0	6423.075344	0	2.704183189	5.988021992	0.192832014	0	0	0	0	0	0	0		1A: $185/day (days1-7) w/$1295 yrly max	1B: $185/day (days1-7) w/$1295 yrly max	2: $120/day (for days 21-100)	6: $0 copay	10A: $100 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $20 copay	9A: $20-$150 copay; 9B: $150 copay	8A: $0-$100 copay	8B: $50-$100 copay	9A: $150 copay	12: 20% coin	3: $20 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $10 copay; 7G: $10 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $20 copay; 7F: $20 copay; 7G: $20 copay	7E: $40 copay; 7H: $40 copay	7C: $20-$40 copay; 7I: $20-$40 copay	8B: $50-$100 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$20; 17B: $0; 18A: $20	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $20 copay	17B: $20 copay	18A: $20 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 0% coin; 14J: 0% coin									185	185	120	0	100	0.2	0.086811922	49.43037975	135.139165	11.624628	70.46799354	150	0.2	7.310704961	8.413493295	18.95656019	40	35.40104665	61.98380567	9.863512781	0.2	0	0	0	20	20	20	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	107.2417121	69.21480617	107.8846354	0	89.9038628	0.179807726	0.078047272	44.43982079	121.4953295	10.45098961	63.35344823	134.8557942	0	6.572606158	7.564055468	17.04267986	35.96154512	31.82690841	55.7258356	8.867678997	0.179807726	0	0	0	20	20	20	0	0	0	0.179807726	0.179807726	0	0	0	0	0	0	0	0		7.4449	0.302837411	4.47976967	0	0.176634111	1.835620152	0.118949143	1.058767004	3.695413377	4.9354013	3.458246791	2.18290888	0	0.074528464	1.662345486	4.293328064	0.054305075	2.972206928	1.886575816	0.836810988	5.791639773	0	0	0	0.504	0.398666667	0.216	0	0	0	0.486233029	1.076692615	0	0	0	0	0	0	0	0	49.9428		5.482910721	7.4449	0.302837411	4.47976967	0	0.176634111	1.835620152	0.118949143	1.058767004	3.695413377	4.9354013	3.458246791	2.18290888	0	0.074528464	1.662345486	4.293328064	0.054305075	2.972206928	1.886575816	0.836810988	5.791639773	0	0	0	0.504	0.398666667	0.216	0	0	0	0.486233029	1.076692615	0	0	0	0	0	0	0	0	49.9428	YES	1A: $225/day (days1-7) no yrly max	1B: $225/day (days1-7) no yrly max	2: 25% coin (for days 1-100)	6: $0 copay	10A: $100 copay	11A: 25% coin	11B: 25% coin; 11C: 25% coin	4A: $50 copay; 4B: $20 copay	9A: $30-$225 copay; 9B: $225 copay	8A: 0% - 25%	8B: 25% coin	9A: $225 copay	12: 20% coin	3: $30 copay; 5: $50 copay; 9C: $50 copay; 9D: $0 copay	7A: $20 copay; 7G: $20 copay; 14B: $0 copay; 14C: $0 copay	7B: $30 copay; 7D: $30 copay; 7F: $30 copay; 7G: $30 copay	7E: $50 copay; 7H: $50 copay	7C: $30-$60 copay; 7I: $30-$60 copay	8B: 25% coin	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $30; 17B: $0; 18A: $30	15: 20% coinsurance	13A: $0 copay	10B: Not covered	$16A: 20% coinsurance	17A: $30 copay	17B: $30 copay	18A: $30 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin								3400	3.1671	0.1951	0.7272	0	1.077	0.4407	0.5006	0.2768	2.5467	1.0569	0.9433	0.1636	0	0.0526	1.3531	2.1504	0.0035	0.7956	1.9729	0.268	1.2839	0	0	0.2354	0.189	0.1495	0.081	0	0	0	0.3011	0.0601	0.0568	0	0	0	0	0	0	0	20.0479		2.177825253	10.612	0.497895826	5.20701017	0	1.2536786	2.27630735	0.619577898	1.33554457	6.242067831	5.992283057	4.401565813	2.346493447	0	0.127176371	3.015467461	6.443683501	0.057812996	3.767764412	3.859466893	1.104817494	7.075551414	0	0	0.235384615	0.693	0.548166667	0.297	0	0	0	0.787358235	1.136759415	0.056849538	0	0	0	0	0	0	0	69.9907
H1607_804_0	2011	4																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	280.7750027	3.23236793	78.81016722	30.32994051	8.667628425	13.96383979	3.524684109	10.89905095	50.76851476	6.856051249	25.22511187	0	0.02512437	22.10706593	44.99812239	115.6623784	1.162826624	4.600244178	19.85822681	21.36539238	12.71864611	1.297552514	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.062177785	0.062177785	0.150142326	0	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0	0	0	0	0	0	0	0												17.458	0.200981479	11.83274183	0	1.635932198	2.63554158	0.665250509	2.057091917	9.582072956	1.294014284	4.760999281	0	0.004741985	4.172497847	8.492966431	21.8301708	0.219472435	0.868252214	3.748050912	4.032514039	2.400523148	0.244900662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.1367	0	23.013	17.458	0.200981479	11.83274183	0	1.635932198	2.63554158	0.665250509	2.057091917	9.582072956	1.294014284	4.760999281	0	0.004741985	4.172497847	8.492966431	21.8301708	0.219472435	0.868252214	3.748050912	4.032514039	2.400523148	0.244900662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.1367	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	Similar to Medicare FFS							0												10000	2.2967	0.0264	1.1747	0	0.2163	0.3488	0.0881	0.2498	1.0809	0.1584	0.5611	0	0.0006	0.5558	1.1206	2.9229	0.0301	0.1189	0.5251	0.5646	0.2219	0.0226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.2844	0	1.495	19.7547	0.227423463	13.007463	0	1.852199649	2.984380436	0.753302706	2.306855064	10.66297309	1.452380386	5.322087316	0	0.005391402	4.728302164	9.613552843	24.75311879	0.24952929	0.987159769	4.273163723	4.597157663	2.622383137	0.26754826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.4211
H1607_805_0	2011	4																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	280.7750027	3.23236793	78.81016722	30.32994051	8.667628425	13.96383979	3.524684109	10.89905095	50.76851476	6.856051249	25.22511187	0	0.02512437	22.10706593	44.99812239	115.6623784	1.162826624	4.600244178	19.85822681	21.36539238	12.71864611	1.297552514	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.062177785	0.062177785	0.150142326	0	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0	0	0	0	0	0	0	0												17.458	0.200981479	11.83274183	0	1.635932198	2.63554158	0.665250509	2.057091917	9.582072956	1.294014284	4.760999281	0	0.004741985	4.172497847	8.492966431	21.8301708	0.219472435	0.868252214	3.748050912	4.032514039	2.400523148	0.244900662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.1367	0	23.013	17.458	0.200981479	11.83274183	0	1.635932198	2.63554158	0.665250509	2.057091917	9.582072956	1.294014284	4.760999281	0	0.004741985	4.172497847	8.492966431	21.8301708	0.219472435	0.868252214	3.748050912	4.032514039	2.400523148	0.244900662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.1367	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	Similar to Medicare FFS							0												10000	2.2967	0.0264	1.1747	0	0.2163	0.3488	0.0881	0.2498	1.0809	0.1584	0.5611	0	0.0006	0.5558	1.1206	2.9229	0.0301	0.1189	0.5251	0.5646	0.2219	0.0226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.2844	0	1.495	19.7547	0.227423463	13.007463	0	1.852199649	2.984380436	0.753302706	2.306855064	10.66297309	1.452380386	5.322087316	0	0.005391402	4.728302164	9.613552843	24.75311879	0.24952929	0.987159769	4.273163723	4.597157663	2.622383137	0.26754826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.4211
H1607_806_0	2011	4																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	280.7750027	3.23236793	78.81016722	30.32994051	8.667628425	13.96383979	3.524684109	10.89905095	50.76851476	6.856051249	25.22511187	0	0.02512437	22.10706593	44.99812239	115.6623784	1.162826624	4.600244178	19.85822681	21.36539238	12.71864611	1.297552514	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.062177785	0.062177785	0.150142326	0	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0.188740462	0	0	0	0	0	0	0	0												17.458	0.200981479	11.83274183	0	1.635932198	2.63554158	0.665250509	2.057091917	9.582072956	1.294014284	4.760999281	0	0.004741985	4.172497847	8.492966431	21.8301708	0.219472435	0.868252214	3.748050912	4.032514039	2.400523148	0.244900662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.1367	0	23.013	17.458	0.200981479	11.83274183	0	1.635932198	2.63554158	0.665250509	2.057091917	9.582072956	1.294014284	4.760999281	0	0.004741985	4.172497847	8.492966431	21.8301708	0.219472435	0.868252214	3.748050912	4.032514039	2.400523148	0.244900662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.1367	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	Similar to Medicare FFS							0												10000	2.2967	0.0264	1.1747	0	0.2163	0.3488	0.0881	0.2498	1.0809	0.1584	0.5611	0	0.0006	0.5558	1.1206	2.9229	0.0301	0.1189	0.5251	0.5646	0.2219	0.0226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.2844	0	1.495	19.7547	0.227423463	13.007463	0	1.852199649	2.984380436	0.753302706	2.306855064	10.66297309	1.452380386	5.322087316	0	0.005391402	4.728302164	9.613552843	24.75311879	0.24952929	0.987159769	4.273163723	4.597157663	2.622383137	0.26754826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.4211
H1608_001_0	2011	11																															D	D	D	COIN	T	COIN	COIN	V	V	O	COIN	COIN	COIN	COIN	P	COIN	P	P	COIN	COIN	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	786.2017948	72.83097214	437.2238994	0	99.03596527	5.954503941	6.620250254	306.1038466	319.6616089	1163.911184	20.18455415	1.588536164	0.14897237	10.78806454	3131.492207	85.50643904	204.2419254	597.5945292	7.125915768	6.544179834	10.12341086	0	0	0	0	0	0	0	0	0											6700	1a $175 days 1-9	1b $175 days 1-9	2 $50 days 1-50	6 $0	"10a $150,"	11a 20%	11b 20%	"4a $50, 4b $40"	"9a $300, 9b $300"	"8a $0 -20%, 8b 20%, 11c $0, 11c 20%"	8b 20%/$300 Adv. Imaging; 14h $0	5 20%	12 20%	"3 20%, 9d 20%, 13a $0 , 9a 20%, 9b 20%"	"7a $15, 14c $0"	"17a $0 - 20%, 18a 20%, 7b $30,7d $45,7f $45, 14d - 14g $0, 14i - 14j $0, 17b 20%"	"7e $40, 7h $40, 9c $40"	"7c $45,7i $45"	"8b 20% Ther., $300 Adv. Imaging, 14h $0"	"7g $45, 14b $0, 14a $0"	"15 20%, 11c 20%"	15 20%							14a $0													156.4797723	110.6321839	48.82880638	0	150	0.2	0.2	49.64757839	300	5.802516247	0.468502308	0.2	0.2	0.193553692	14.47845572	0.148198525	40	45	0.277664762	0.000710038	0.232887678	0	0	0	0	0	0	0	0	0											NO	142.6254205	99.6500359	41.23711788	0	135.1099188	0.180146558	0.180146558	44.7192019	271.3460285	5.22651666	0.424472534	0.180146558	0.180146558	0.174340157	13.04121984	0.132668619	34.85423463	40.53297564	0.250101756	0.000639554	0.209769568	0	0	0	0	0	0	0	0	0												9.3444	0.604800749	1.50248779	0	1.115061769	1.072683392	1.192615299	1.140726643	7.228242338	0.506933433	8.567788848	0.286169323	0.02683686	1.880792871	3.403206525	11.34402119	0.593224666	2.018523708	1.782204047	0.004185359	2.123583523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7385	0	6.142776789	9.3444	0.604800749	1.50248779	0	1.115061769	1.072683392	1.192615299	1.140726643	7.228242338	0.506933433	8.567788848	0.286169323	0.02683686	1.880792871	3.403206525	11.34402119	0.593224666	2.018523708	1.782204047	0.004185359	2.123583523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7385	YES	0.2	0.2	0.2	0.2	150	0.2	0.2	$50/$40	0.2	0.2	"20%, 14h $0"	0.2	0.2	0.2	"20%, 14c $0"	"20%, 14d-14g $0, 14i-14j $0"	0.2	0.2	"20%, 14h $0"	"20% , 14a-14b $0"	0.2	0.2							14a $50												10000	3.8347	0.1187	0.3386	0.2044	0	0.1472	0.1636	0	1.0556	0.2104	0.4674	0.0393	0.0037	0.2581	0.533	2.0848	0.0263	0.0993	0.1737	0.157	0.2914	0	0	0	0	0	0	0	0.8667	0											11.0737	0	0	13.1791	0.723453655	1.841111556	0.204363294	1.115061769	1.219873377	1.356261934	1.140726643	8.283834029	0.717304951	9.035214382	0.325436509	0.030519323	2.138868904	3.936237992	13.42877405	0.619490946	2.117786432	1.955907329	0.161229334	2.414974468	0	0	0	0	0	0	0	0.866666667	0	0	0	0	0	0	0	0	0	0	0	66.8122
H1608_801_0	2011	7																															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	YES	176.0764765	3.251220073	19.42946152	0	4.592619877	6.357776047	4.852410273	13.38315441	51.67856025	9.518029181	20.43167646	0.978142685	0.120320239	10.6072391	24.29841147	98.08165147	1.112510744	5.295670377	8.523563379	6.695312736	15.4610217	0	0	0	0	0	0	0	0	0											6700	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	0.077133927	0.077133927	0.102369141	0	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0	0	0	0	0	0	0	0	0												13.5815	0.250779371	1.988977292	0	0.904142996	1.251646954	0.955287587	2.634723893	10.17388975	1.873801806	4.022357098	0.192565656	0.023687286	2.08823312	4.783596101	19.30920489	0.219018518	1.042551617	1.678022639	1.318097355	3.043790876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.3358	0	13.09227325	13.5815	0.250779371	1.988977292	0	0.904142996	1.251646954	0.955287587	2.634723893	10.17388975	1.873801806	4.022357098	0.192565656	0.023687286	2.08823312	4.783596101	19.30920489	0.219018518	1.042551617	1.678022639	1.318097355	3.043790876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.3358	YES	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%																			10000	1.9867	0.0294	0.2909	0	0.1323	0.1831	0.1397	0.3854	1.4882	0.2741	0.5884	0.0282	0.0035	0.3055	0.6997	2.8245	0.0148	0.1525	0.2455	0.1928	0.5136	0	0	0	0	0	0	0	0	0											10.4788	0	0	15.5682	0.280172855	2.279922899	0	1.036400128	1.434736617	1.095026099	3.020128665	11.66211615	2.147899657	4.610743466	0.220733967	0.027152239	2.393697769	5.483335748	22.13373604	0.233859503	1.195055023	1.923482111	1.510907317	3.557345483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8146
H1608_802_0	2011	7																															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	YES	176.0764765	3.251220073	19.42946152	0	4.592619877	6.357776047	4.852410273	13.38315441	51.67856025	9.518029181	20.43167646	0.978142685	0.120320239	10.6072391	24.29841147	98.08165147	1.112510744	5.295670377	8.523563379	6.695312736	15.4610217	0	0	0	0	0	0	0	0	0											6700	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	0.077133927	0.077133927	0.102369141	0	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0	0	0	0	0	0	0	0	0												13.5815	0.250779371	1.988977292	0	0.904142996	1.251646954	0.955287587	2.634723893	10.17388975	1.873801806	4.022357098	0.192565656	0.023687286	2.08823312	4.783596101	19.30920489	0.219018518	1.042551617	1.678022639	1.318097355	3.043790876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.3358	0	13.09227325	13.5815	0.250779371	1.988977292	0	0.904142996	1.251646954	0.955287587	2.634723893	10.17388975	1.873801806	4.022357098	0.192565656	0.023687286	2.08823312	4.783596101	19.30920489	0.219018518	1.042551617	1.678022639	1.318097355	3.043790876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.3358	YES	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%																			10000	1.9867	0.0294	0.2909	0	0.1323	0.1831	0.1397	0.3854	1.4882	0.2741	0.5884	0.0282	0.0035	0.3055	0.6997	2.8245	0.0148	0.1525	0.2455	0.1928	0.5136	0	0	0	0	0	0	0	0	0											10.4788	0	0	15.5682	0.280172855	2.279922899	0	1.036400128	1.434736617	1.095026099	3.020128665	11.66211615	2.147899657	4.610743466	0.220733967	0.027152239	2.393697769	5.483335748	22.13373604	0.233859503	1.195055023	1.923482111	1.510907317	3.557345483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8146
H1608_803_0	2011	6																															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	YES	176.0764765	3.251220073	19.42946152	0	4.592619877	6.357776047	4.852410273	13.38315441	51.67856025	9.518029181	20.43167646	0.978142685	0.120320239	10.6072391	24.29841147	98.08165147	1.112510744	5.295670377	8.523563379	6.695312736	15.4610217	0	0	0	0	0	0	0	0	0											6700	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	0.077133927	0.077133927	0.102369141	0	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0.196868676	0	0	0	0	0	0	0	0	0												13.5815	0.250779371	1.988977292	0	0.904142996	1.251646954	0.955287587	2.634723893	10.17388975	1.873801806	4.022357098	0.192565656	0.023687286	2.08823312	4.783596101	19.30920489	0.219018518	1.042551617	1.678022639	1.318097355	3.043790876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.3358	0	13.09227325	13.5815	0.250779371	1.988977292	0	0.904142996	1.251646954	0.955287587	2.634723893	10.17388975	1.873801806	4.022357098	0.192565656	0.023687286	2.08823312	4.783596101	19.30920489	0.219018518	1.042551617	1.678022639	1.318097355	3.043790876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.3358	YES	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%																			10000	1.9867	0.0294	0.2909	0	0.1323	0.1831	0.1397	0.3854	1.4882	0.2741	0.5884	0.0282	0.0035	0.3055	0.6997	2.8245	0.0148	0.1525	0.2455	0.1928	0.5136	0	0	0	0	0	0	0	0	0											10.4788	0	0	15.5682	0.280172855	2.279922899	0	1.036400128	1.434736617	1.095026099	3.020128665	11.66211615	2.147899657	4.610743466	0.220733967	0.027152239	2.393697769	5.483335748	22.13373604	0.233859503	1.195055023	1.923482111	1.510907317	3.557345483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8146
H1609_001_0	2011	11																															D	D	D	COIN	T	COIN	COIN	V	V	O	COIN	COIN	COIN	COIN	P	COIN	P	P	COIN	COIN	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	1050.258775	12.38911156	553.810181	0	120.3861298	7.893085854	4.562677916	291.9711837	421.9515536	1560.036315	21.43930006	1.125298266	0.136217099	11.22622522	3853.221945	110.2786971	67.51028444	873.4147989	10.6708385	7.091131237	16.2219875	0	0	0	0	0	0	0	0	0											6700	1a $160 days 1-9	1b $160 days 1-9	2 $50 days 1-50	6 $0	"10a $150,"	11a 20%	11b 20%	"4a $50, 4b $40"	"9a $300, 9b $300"	"8a $0 -20%, 8b 20%, 11c $0, 11c 20%"	8b 20%/$300 Adv. Imaging; 14h $0	5 20%	12 20%	"3 20%, 9d 20%, 13a $0 , 9a 20%, 9b 20%"	7a $10; 14c $0	"17a $0 - 20%, 18a 20%, 7b $20,7d $45,7f $45, 14d - 14g $0, 14i - 14j $0, 17b 20%"	"7e $40, 7h $40, 9c $40"	"7c $45,7i $45"	"8b 20% Ther., $300 Adv. Imaging, 14h $0"	"7g $45, 14b $0, 14a $0"	"15 20%, 11c 20%"	15 20%							14a $0													143.0672204	101.1494253	48.82880638	0	150	0.2	0.2	49.6659919	300	5.876902533	0.469307849	0.2	0.2	0.188117679	9.646992771	0.127550817	40	45	0.276189899	0.000429019	0.221512696	0	0	0	0	0	0	0	0	0											NO	125.9002876	88.76995328	42.85274828	0	131.6418057	0.175522408	0.175522408	43.58747238	263.2836114	5.15764041	0.411870218	0.175522408	0.175522408	0.16509434	8.466316988	0.111668094	35.10448152	39.49254171	0.24238758	0.000376512	0.194402208	0	0	0	0	0	0	0	0	0												11.019	0.091648405	1.97769069	0	1.320653959	1.385413433	0.800852213	1.060523826	9.257744074	0.670508861	8.830209187	0.197515061	0.023909153	1.853386243	2.718549867	12.31461196	0.197492794	2.874447532	2.586478726	0.002669898	3.153590194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3369	0	8.69323132	11.019	0.091648405	1.97769069	0	1.320653959	1.385413433	0.800852213	1.060523826	9.257744074	0.670508861	8.830209187	0.197515061	0.023909153	1.853386243	2.718549867	12.31461196	0.197492794	2.874447532	2.586478726	0.002669898	3.153590194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3369	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.019	0.091648405	1.97769069	0	1.320653959	1.385413433	0.800852213	1.060523826	9.257744074	0.670508861	8.830209187	0.197515061	0.023909153	1.853386243	2.718549867	12.31461196	0.197492794	2.874447532	2.586478726	0.002669898	3.153590194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3369
H1609_801_0	2011	5																															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	YES	198.1741326	3.579255788	21.86786537	0	5.16899519	7.155679044	5.461389368	15.06274471	58.16423666	10.71254499	22.99585861	1.100899915	0.135420469	11.93845111	27.34787014	110.3909312	1.178199978	5.960278761	9.593273402	7.535576699	17.6950663	0	0	0	0	0	0	0	0	0											6700	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	0.074785725	0.074785725	0.0992527	0	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0	0	0	0	0	0	0	0	0												14.8206	0.26767724	2.170444671	0	0.986633862	1.365842875	1.042444708	2.875106949	11.10212011	2.044760973	4.389342987	0.210134677	0.025848432	2.278756256	5.220034792	21.07090967	0.224889355	1.137670405	1.831119596	1.43835598	3.377552302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8802	0	17.18753195	14.8206	0.26767724	2.170444671	0	0.986633862	1.365842875	1.042444708	2.875106949	11.10212011	2.044760973	4.389342987	0.210134677	0.025848432	2.278756256	5.220034792	21.07090967	0.224889355	1.137670405	1.831119596	1.43835598	3.377552302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8802	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%																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.8206	0.26767724	2.170444671	0	0.986633862	1.365842875	1.042444708	2.875106949	11.10212011	2.044760973	4.389342987	0.210134677	0.025848432	2.278756256	5.220034792	21.07090967	0.224889355	1.137670405	1.831119596	1.43835598	3.377552302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8802
H1609_802_0	2011	5																															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	YES	198.1741326	3.579255788	21.86786537	0	5.16899519	7.155679044	5.461389368	15.06274471	58.16423666	10.71254499	22.99585861	1.100899915	0.135420469	11.93845111	27.34787014	110.3909312	1.178199978	5.960278761	9.593273402	7.535576699	17.6950663	0	0	0	0	0	0	0	0	0											6700	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	0.074785725	0.074785725	0.0992527	0	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0	0	0	0	0	0	0	0	0												14.8206	0.26767724	2.170444671	0	0.986633862	1.365842875	1.042444708	2.875106949	11.10212011	2.044760973	4.389342987	0.210134677	0.025848432	2.278756256	5.220034792	21.07090967	0.224889355	1.137670405	1.831119596	1.43835598	3.377552302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8802	0	17.18753195	14.8206	0.26767724	2.170444671	0	0.986633862	1.365842875	1.042444708	2.875106949	11.10212011	2.044760973	4.389342987	0.210134677	0.025848432	2.278756256	5.220034792	21.07090967	0.224889355	1.137670405	1.831119596	1.43835598	3.377552302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8802	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%																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.8206	0.26767724	2.170444671	0	0.986633862	1.365842875	1.042444708	2.875106949	11.10212011	2.044760973	4.389342987	0.210134677	0.025848432	2.278756256	5.220034792	21.07090967	0.224889355	1.137670405	1.831119596	1.43835598	3.377552302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8802
H1609_803_0	2011	4																															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	YES	198.1741326	3.579255788	21.86786537	0	5.16899519	7.155679044	5.461389368	15.06274471	58.16423666	10.71254499	22.99585861	1.100899915	0.135420469	11.93845111	27.34787014	110.3909312	1.178199978	5.960278761	9.593273402	7.535576699	17.6950663	0	0	0	0	0	0	0	0	0											6700	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	0.074785725	0.074785725	0.0992527	0	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0.190875369	0	0	0	0	0	0	0	0	0												14.8206	0.26767724	2.170444671	0	0.986633862	1.365842875	1.042444708	2.875106949	11.10212011	2.044760973	4.389342987	0.210134677	0.025848432	2.278756256	5.220034792	21.07090967	0.224889355	1.137670405	1.831119596	1.43835598	3.377552302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8802	0	17.18753195	14.8206	0.26767724	2.170444671	0	0.986633862	1.365842875	1.042444708	2.875106949	11.10212011	2.044760973	4.389342987	0.210134677	0.025848432	2.278756256	5.220034792	21.07090967	0.224889355	1.137670405	1.831119596	1.43835598	3.377552302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8802	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%																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.8206	0.26767724	2.170444671	0	0.986633862	1.365842875	1.042444708	2.875106949	11.10212011	2.044760973	4.389342987	0.210134677	0.025848432	2.278756256	5.220034792	21.07090967	0.224889355	1.137670405	1.831119596	1.43835598	3.377552302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8802
H1657_002_0	2011	8																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	2231.20286	134.0977525	313.0094047	492.8185111	773.9040532	9.955970946	11.30830211	554.7474042	348.5839309	5686.213221	1711.806508	2.524271915	0.287267994	1350.392278	10800.78817	14470.52648	295.9376561	816.6959337	3885.266038	3160.671435	18.69052163	0.068340676	0	0	331.2	198.72	16.2	12.34285714	0	0											4000	"(1a) $200 days 1 - 8, $0 after day 8, unlimited coverage"	"(1b) $200 days 1 - 8, $0 after day 8, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $200.00 copayment	(12) 20% coinsurance	"(9a) $150.00 copayment , (9d) Copay between $35.00 and $150.00"	"(14b) , (14c) $0.00 copayment ; (7a) $15.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											0	145.860876	109.2919727	36.67670459	0	37.11839994	0.2	0.125383972	45.13773135	93.67613692	0	13.02683617	8.54872282	0.2	18.88941605	6.020169327	6.25486254	27.16994098	8.907007558	2.173463745	3.679988928	0.2	0	0	0	0	0	0	0	0	0											NO	138.5209128	103.7922179	34.83107149	0	35.25053999	0.189935666	0.119074441	42.86632523	88.96219707	0	12.37130399	8.118536793	0.189935666	17.93886905	5.71722434	5.940107398	25.80270412	8.458792043	2.064091415	3.494805732	0.189935666	0	0	0	0	0	0	0	0	0												25.7557	1.159858596	0.908537746	0	2.273377981	1.890993968	1.346529755	1.981665221	2.584232696	0	1.764773223	0.001707783	0.054562438	2.018709187	5.145877419	7.163040116	0.636332648	0.575688422	0.668295356	0.920494387	3.549996665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4004	0	3.2005018	25.7557	1.159858596	0.908537746	0	2.273377981	1.890993968	1.346529755	1.981665221	2.584232696	0	1.764773223	0.001707783	0.054562438	2.018709187	5.145877419	7.163040116	0.636332648	0.575688422	0.668295356	0.920494387	3.549996665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4004	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												2.1546	0	0.0914	0.078	0.074	0.0677	0.0769	0	0.2727	0.034	0.1492	0	0	0.0729	0	0.6125	0	0.0114	0.1136	0.0981	0.1272	0.0005	0	0	0	0	0	0	0	0											4.0348	0	0	27.9103	1.159858596	0.999978999	0.077964549	2.347390072	1.958735626	1.423472841	1.981665221	2.856914724	0.034012102	1.913949768	0.001707783	0.054562438	2.09164653	5.145877419	7.775540388	0.636332648	0.587096369	0.781896875	1.018593456	3.677169287	0.000464998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4351
H1659_001_0	2011	6																															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	745.358058	20.46387653	261.5816507	22.83957403	247.2695865	12.75985328	3.477293005	227.0599615	351.0315723	1140.74221	626.1035779	0	0.019353567	331.0579024	3573.247169	4462.090245	114.5364205	149.8835723	13.75332465	19.94232784	4.530471656	0	0	0	0	0	0	0	0	0											3400	1a:  Acute - $175/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-5/6-90	2:  Skilled Nursing Services - $0/$100/day for 1-40/41-100	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 - $30/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 - $15/visit/8a:  Outpatient Lab Services - $15/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%	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $15/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $15/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $30/visit/7i:  Physical/Speech Therapy - $30/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $15/visit/9c:  Outpatient Substance Abuse Svcs - Group - $15/visit/7g:  Other Health Care Professional Services - $30/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							14c:  Routine Exams - $0/visit/													175	175	100	0	100	0.2	0.052463811	36.62016799	150	15	30	0	0.2	30	15.0018289	28.50742173	15	30	0	0.004813271	0.2	0	0	0	0	0	0	0	0	0											NO	156.6733524	156.6733524	89.52762993	0	89.52762993	0.17905526	0.046969607	32.78516848	134.2914449	13.42914449	26.85828898	0	0.17905526	26.85828898	13.43078186	25.52201903	13.42914449	26.85828898	0	0.004309207	0.17905526	0	0	0	0	0	0	0	0	0												9.7315	0.267178678	1.951565435	0	1.844788336	2.284718846	0.163327085	0.620349924	3.928378087	1.276599331	1.401339235	0	0.003465358	0.740970734	3.999291939	9.490129345	0.128177178	0.335468025	0	0.085935625	0.81120478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.0644	0	4.5695	9.7315	0.267178678	1.951565435	0	1.844788336	2.284718846	0.163327085	0.620349924	3.928378087	1.276599331	1.401339235	0	0.003465358	0.740970734	3.999291939	9.490129345	0.128177178	0.335468025	0	0.085935625	0.81120478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.0644	YES	1a:  Acute - 30.0% for 1-90/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-190/1b:  Non-Medicare Covered Stay - 30.0%	2:  Skilled Nursing Services - 30.0% for 1-20/21-100/2:  Non-Medicare Covered Stay - 30.0% for 1-20/21-100	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 - $0/service	4a:  Emergency Care / Post Stabilization Care - 30.0%/4b:  Urgently Needed Care / Urgent Care Centers - 30.0%/4a:  Worldwide Coverage - 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%	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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - $8/visit/14e:  Prostate Cancer Screening - $8/visit/14f:  Colorectal Screening - $8/visit/14g:  Bone Mass Measurement - $8/visit/14h:  Mammography - $8/visit/14i:  Diabetes Monitoring - $8/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $8/visit	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - $8/visit/14e:  Prostate Cancer Screening - $8/visit/14f:  Colorectal Screening - $8/visit/14g:  Bone Mass Measurement - $8/visit/14h:  Mammography - $8/visit/14i:  Diabetes Monitoring - $8/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $8/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 - 30.0%/7i:  Physical/Speech Therapy - 30.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 30.0%/7d:  IP Phys (Surgery, Visits, 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%							14c:  Routine Exams - 30.0%/												5100	2.8147	0.0323	0.5977	0.3656	0.0872	0.1412	0.0116	0.1008	0.4375	0.0637	0.2257	0	0.0003	0.2237	0.4672	1.1559	0.012	0.0475	0.2075	0.2238	0.0894	0.0092	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.3145	100	5.254	12.5462	0.299528496	2.549273795	0.365639517	1.93195927	2.425913258	0.174943879	0.721130454	4.365878261	1.340296568	1.627017316	0	0.003723142	0.964657448	4.466462768	10.64605835	0.140183509	0.382966121	0.207502184	0.309773258	0.900611651	0.009166738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.3789
H1659_002_0	2011	9																															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	907.0535189	24.90324081	645.0799055	22.83957403	245.5033752	12.75985328	3.477293005	219.5894103	348.3243879	1132.928908	620.694747	0	0.019353567	328.4373913	3383.465781	4371.74941	108.3785485	146.4771275	13.63679538	19.76614055	4.530471656	0	0	0	0	0	0	0	0	0											3400	1a:  Acute - $250/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $250/$0/day for 1-8/9-90	2:  Skilled Nursing Services - $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 - $40/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 - $25/visit/8a:  Outpatient Lab Services - $25/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%	9d:  Cardiac Rehabilitation Services - $45/visit/3:  Rehab Services (CORF) - $45/day/5:  Partial Hospitalization - $25/day	7a:  Primary Care - $25/visit/17a:  Vision Exams - $45/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $15/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $45/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $45/visit/7i:  Physical/Speech Therapy - $45/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $45/visit/18a:  Hearing Exams - $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							14c:  Routine Exams - $0/visit/													250	250	100	0	150	0.2	0.052463811	43.42269485	250	25	45	0	0.2	45	25.00251679	41.95315613	25	45	0	0.007124605	0.2	0	0	0	0	0	0	0	0	0											NO	198.8541425	198.8541425	79.54165699	0	119.3124855	0.159083314	0.041730585	34.539131	198.8541425	19.88541425	35.79374565	0	0.159083314	35.79374565	19.88741614	33.37023555	19.88541425	35.79374565	0	0.005667029	0.159083314	0	0	0	0	0	0	0	0	0												15.0309	0.41267605	4.275893715	0	2.440968157	2.029879746	0.14510947	0.632035617	5.772145622	1.87739672	1.851415825	0	0.00307883	0.979667037	5.607365999	12.1571923	0.179596028	0.436913754	0	0.112015293	0.720722445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.665	0	14.06	15.0309	0.41267605	4.275893715	0	2.440968157	2.029879746	0.14510947	0.632035617	5.772145622	1.87739672	1.851415825	0	0.00307883	0.979667037	5.607365999	12.1571923	0.179596028	0.436913754	0	0.112015293	0.720722445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.665	YES	1a:  Acute - 30.0% for 1-90/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-190/1b:  Non-Medicare Covered Stay - 30.0%	2:  Skilled Nursing Services - 30.0% for 1-20/21-100/2:  Non-Medicare Covered Stay - 30.0% for 1-20/21-100	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 - $0/service	4a:  Emergency Care / Post Stabilization Care - 30.0%/4b:  Urgently Needed Care / Urgent Care Centers - 30.0%/4a:  Worldwide Coverage - 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%	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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - $8/visit/14e:  Prostate Cancer Screening - $8/visit/14f:  Colorectal Screening - $8/visit/14g:  Bone Mass Measurement - $8/visit/14h:  Mammography - $8/visit/14i:  Diabetes Monitoring - $8/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $8/visit	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - $8/visit/14e:  Prostate Cancer Screening - $8/visit/14f:  Colorectal Screening - $8/visit/14g:  Bone Mass Measurement - $8/visit/14h:  Mammography - $8/visit/14i:  Diabetes Monitoring - $8/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $8/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 - 30.0%/7i:  Physical/Speech Therapy - 30.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 30.0%/7d:  IP Phys (Surgery, Visits, 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%							14c:  Routine Exams - 30.0%/												5100	2.9794	0.0342	0.6327	0.387	0.0923	0.1495	0.0144	0.1067	0.4631	0.0674	0.2389	0	0.0003	0.2368	0.4925	1.2236	0.0127	0.0503	0.2196	0.2369	0.0946	0.0097	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.7427	250	5.225	18.0104	0.44691936	4.908587017	0.387041053	2.533241363	2.179338521	0.159529189	0.738728738	6.235253465	1.944822271	2.090303248	0	0.003351702	1.216446535	6.099816016	13.3807799	0.19230511	0.487191998	0.219647659	0.348954545	0.81536246	0.009703284	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4077
H1681_001_0	2011	6	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1057.781582	76.58680432	316.1962786	410.4494305	39.79372596	9.675628921	3.040864014	364.1674522	378.3697085	1654.672913	961.3729737	37.89089587	0.216156567	2.642086026	3862.309729	3444.942614	71.62208718	658.8897789		1410.598367	24.97360175	0							3.62	0.58	1619.056588	591.2577597									4900	$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										147.067245	128.620245	34.44565	0	100	0.2	0.2	50	225	68.839957	91.975965	50	0.2	0.2	15	35	35	15		0	0.2	0							0	0	0	71.610608									NO	134.180184	117.349639	28.714066	0	89.607	0.179214	0.179214	44.8035	201.61575	61.68542	82.416903	44.8035	0.179214	0.179214	13.44105	31.36245	31.36245	13.44105		0	0.179214	0							0	0	0	64.168118										11.8278	0.74895282	0.756606734	0	0.2971497	1.734008162	0.544965403	1.359664704	6.357107712	8.505766131	6.602781927	0.141470396	0.038738283	0.473498805	4.326124848	9.003486707	0.187187011	0.738014205	0	0	4.475619063	0	0	0	0	0	0	0	0	0	0	3.161658141	0	0	0	0	0	0	0	0	61.2806	0	6.92005624	11.8278	0.74895282	0.756606734	0	0.2971497	1.734008162	0.544965403	1.359664704	6.357107712	8.505766131	6.602781927	0.141470396	0.038738283	0.473498805	4.326124848	9.003486707	0.187187011	0.738014205	0	0	4.475619063	0	0	0	0	0	0	0	0	0	0	3.161658141	0	0	0	0	0	0	0	0	61.2806	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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	30% Coins									7300	6.4529	0.1478	0.3422	2.346	1.0414	1.2521	0.3935	0.178	2.3117	0.3399	0.9857	0.0903	0.0052	0.0949	1.4865	2.2407	0.0247	0.224		0.224	1.0184	0							0	0	0.3727	0.3341									21.9065	0	7.512278367	18.2807	0.896789446	1.098769557	2.345974108	1.338524983	2.986119545	0.938479978	1.537667941	8.668767794	8.845633262	7.588466531	0.231796041	0.04391396	0.568394034	5.812590875	11.24416456	0.211898443	0.96201152	0	0.224026419	5.493970378	0	0	0	0	0	0	0	0	0	0.372675461	3.495786519	0	0	0	0	0	0	0	0	83.1871
H1681_002_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1186.649886	127.9017055	294.6680616	741.3541716	37.29044728	9.910600594	3.157115724	352.8542133	346.446982	1320.835488	881.784783	92.00403345	4.374122566	4.670251711	3481.828486	3336.015237	86.70435848	638.9318053		1792.882876	32.19279052	0							3.62	0.58	1371.677	606.0041721									4900	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										161.6895	138.428775	34.44565	0	100	0.2	0.2	50	250	46.251167	99.79945	50	0.2	0.2	15	35	35	15		0	0.2	0							0	0	0	69.6021									NO	146.004325	125.000076	28.172822	0	89.2719	0.178544	0.178544	44.63595	223.17975	41.289296	89.092865	44.63595	0.178544	0.178544	13.390785	31.245165	31.245165	13.390785		0	0.178544	0							0	0	0	62.135117										14.438	1.332310243	0.691802571	0	0.277415757	1.769478272	0.56368407	1.312498585	6.443329236	4.544697286	6.546727719	0.342223953	0.780973339	0.833845422	3.885368055	8.686195544	0.225757666	0.712983203	0	0	5.747829591	0	0	0	0	0	0	0	0	0	0	3.137845011	0	0	0	0	0	0	0	0	62.273	0	7.353471202	14.438	1.332310243	0.691802571	0	0.277415757	1.769478272	0.56368407	1.312498585	6.443329236	4.544697286	6.546727719	0.342223953	0.780973339	0.833845422	3.885368055	8.686195544	0.225757666	0.712983203	0	0	5.747829591	0	0	0	0	0	0	0	0	0	0	3.137845011	0	0	0	0	0	0	0	0	62.273	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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									7300	6.5936	0.2152	0.3128	3.3138	0.9308	1.4679	0.4676	0.1645	2.4021	0.3204	0.957	0.1823	0.0999	0.16	1.5713	2.2569	0.0302	0.2173		0.3102	1.1489	0							0	0	0.3653	0.3116									23.7996	0	10.29732116	21.0316	1.547545309	1.004618723	3.313843848	1.208207697	3.237415063	1.031309443	1.477005609	8.84539369	4.865082214	7.503717128	0.524521525	0.880871988	0.99383812	5.456655188	10.94312064	0.2559532	0.930284168	0	0.310204947	6.896696612	0	0	0	0	0	0	0	0	0	0.365269114	3.449466107	0	0	0	0	0	0	0	0	86.0726
H1681_003_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1141.611378	33.79668267	363.5168797	560.7796214	35.53289501	9.744515175	2.518132743	369.3174989	398.5058419	943.0040997	940.3799694	42.14002965	0.585016477	5.27823537	3438.293493	3692.309948	63.35931982	771.3989974		1725.427907	15.66838914	0							3.62	0.58	1270.380656	549.1929088									4900	$200/Day(Days 1-5):1a.IP Acute	$200/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										123.8224	99.6822	34.44565	0	100	0.2	0.2	50	175	64.545704	70.375281	50	0.2	0.2	15	35	35	15		0	0.2	0							0	0	0	59.632121									NO	115.158918	92.707736	29.739203	0	91.3701	0.18274	0.18274	45.68505	159.897675	58.975475	64.301964	45.68505	0.18274	0.18274	13.705515	31.979535	31.979535	13.705515		0	0.18274	0							0	0	0	54.485929										10.9556	0.261101161	0.900891857	0	0.270553681	1.780712703	0.460163577	1.406024034	5.310013132	4.634509559	5.039023245	0.16043078	0.106905911	0.964544732	3.926965254	9.839862933	0.168850132	0.881035044	0	0	2.863241432	0	0	0	0	0	0	0	0	0	0	2.493607153	0	0	0	0	0	0	0	0	52.424	0	4.793351263	10.9556	0.261101161	0.900891857	0	0.270553681	1.780712703	0.460163577	1.406024034	5.310013132	4.634509559	5.039023245	0.16043078	0.106905911	0.964544732	3.926965254	9.839862933	0.168850132	0.881035044	0	0	2.863241432	0	0	0	0	0	0	0	0	0	0	2.493607153	0	0	0	0	0	0	0	0	52.424	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 7-100)	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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	30% Coins									7300	6.623	0.123	0.3377	2.5058	0.916	1.2422	0.321	0.1778	2.6718	0.2863	0.9473	0.1257	0.0138	0.1867	1.4077	2.4154	0.0246	0.2911		0.2737	0.605	0							0	0	0.2895	0.3356									22.1207	0	8.300256004	17.5786	0.38409716	1.238548151	2.505751354	1.186552641	3.022924843	0.78117029	1.583851312	7.981834284	4.920775767	5.986273805	0.286169631	0.120704841	1.151293592	5.334659861	12.25523126	0.193416921	1.172143901	0	0.273743139	3.468261031	0	0	0	0	0	0	0	0	0	0.289519301	2.829161693	0	0	0	0	0	0	0	0	74.5447
H1681_004_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1109.005143	69.544005	335.068332	574.390488	37.785259	8.886163	3.119741	334.591443	351.577763	1025.706144	944.931843	74.527967	0.412781	5.404891	3445.816446	3631.864679	86.255416	705.094746		1856.242302	20.676272	0							3.62	0.58	1235.659619	641.908253									4900	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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-$150/Visit:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										161.6895	138.428775	34.44565	0	150	0.2	0.2	50	125	56.988071	94.655292	50	0.2	0.2	15	35	35	15		0	0.2	0							0	0	0	68.698733									NO	147.942012	126.659007	28.671181	0	135.23865	0.180318	0.180318	45.07955	112.698875	51.379932	85.34036	45.07955	0.180318	0.180318	13.523865	31.555685	31.555685	13.523865		0	0.180318	0							0	0	0	61.938159										13.6724	0.734031218	0.800567066	0	0.425835618	1.60233514	0.562545458	1.256935974	3.301868197	4.391725994	6.720068638	0.279973935	0.074431844	0.974599135	3.883396369	9.550498148	0.226820728	0.794633846	0	0	3.728304014	0	0	0	0	0	0	0	0	0	0	3.313217953	0	0	0	0	0	0	0	0	56.2942	0	5.984632787	13.6724	0.734031218	0.800567066	0	0.425835618	1.60233514	0.562545458	1.256935974	3.301868197	4.391725994	6.720068638	0.279973935	0.074431844	0.974599135	3.883396369	9.550498148	0.226820728	0.794633846	0	0	3.728304014	0	0	0	0	0	0	0	0	0	0	3.313217953	0	0	0	0	0	0	0	0	56.2942	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$150/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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	35% Coins	30% Coins									7300	6.467	0.131	0.3519	2.5273	1.4592	1.5839	0.5561	0.1609	2.1642	0.2565	0.8932	0.1513	0.0097	0.191	1.3553	2.2818	0.0313	0.2478		0.3117	0.8097	0							0	0	0.3644	0.3516									22.6567	0	8.432804279	20.1394	0.864985797	1.152487065	2.527333834	1.885036196	3.18618759	1.118602341	1.417833837	5.466094476	4.648261082	7.613222565	0.431321251	0.084155611	1.16558152	5.238688637	11.83227135	0.258113328	1.042414254	0	0.311749839	4.538026919	0	0	0	0	0	0	0	0	0	0.364386128	3.664772472	0	0	0	0	0	0	0	0	78.9509
H1681_005_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1086.34085	68.122763	328.220675	562.6519	37.013057	8.966787	3.148047	327.753532	344.39271	1004.7442	925.620651	73.004869	0.416525	5.453929	3375.39568	3557.641719	84.492648	690.685008		1818.307024	20.863864	0							3.62	0.58	1210.40694	628.789832									4900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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-$150/Visit:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	34.44565	0	150	0.2	0.2	50	125	56.988071	94.655292	50	0.2	0.2	15	35	35	15		0	0.2	0							0	0	0	68.698733									NO	129.620942	110.973615	29.477141	0	136.35585	0.181808	0.181808	45.45195	113.629875	51.804379	86.045352	45.45195	0.181808	0.181808	13.635585	31.816365	31.816365	13.635585		0	0.181808	0							0	0	0	62.449828										11.7344	0.629985773	0.806250593	0	0.420578904	1.630233611	0.572340129	1.241419762	3.261108382	4.337512445	6.637112894	0.276517805	0.075727577	0.991567924	3.835457892	9.432602289	0.224020744	0.784824511	0	0	3.793217386	0	0	0	0	0	0	0	0	0	0	3.272318071	0	0	0	0	0	0	0	0	53.9572	0	5.219644856	11.7344	0.629985773	0.806250593	0	0.420578904	1.630233611	0.572340129	1.241419762	3.261108382	4.337512445	6.637112894	0.276517805	0.075727577	0.991567924	3.835457892	9.432602289	0.224020744	0.784824511	0	0	3.793217386	0	0	0	0	0	0	0	0	0	0	3.272318071	0	0	0	0	0	0	0	0	53.9572	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$150/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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	35% Coins	30% Coins									7300	6.485	0.1313	0.3519	2.5438	1.4258	1.5942	0.5597	0.1572	2.1783	0.2582	0.899	0.1523	0.0098	0.1922	1.3641	2.2966	0.0315	0.2494		0.3138	0.815	0							0	0	0.3668	0.3538									22.7296	0	8.580108832	18.2194	0.761304569	1.158111458	2.543789032	1.846329253	3.224398598	1.132017526	1.398629256	5.439425692	4.595717813	7.536082145	0.428850712	0.085514636	1.183793737	5.199574505	11.72923147	0.255517248	1.034218153	0	0.313779848	4.60821183	0	0	0	0	0	0	0	0	0	0.366758682	3.626161393	0	0	0	0	0	0	0	0	76.6868
H1681_006_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1118.308462	70.127402	337.879183	579.208985	38.102235	8.643265	3.034466	337.398293	354.52711	1034.310678	952.85877	75.153174	0.401496	5.257151	3474.723013	3662.331983	86.979003	711.009706		1871.81411	20.111097	0							3.62	0.58	1246.025429	647.293148									4900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	34.44565	0	100	0.2	0.2	50	125	56.988071	71.22993	50	0.2	0.2	15	35	35	15		0	0.2	0							0	0	0	65.666512									NO	129.861127	111.179246	29.523091	0	91.1722	0.182344	0.182344	45.5861	113.96525	51.957278	64.941894	45.5861	0.182344	0.182344	13.67583	31.91027	31.91027	13.67583		0	0.182344	0							0	0	0	59.869604										12.1021	0.649725973	0.831269822	0	0.289488716	1.576047513	0.553316668	1.281722694	3.366980894	4.47833062	5.156704437	0.285495009	0.073210387	0.958609942	3.959976769	9.738833534	0.231293623	0.810303989	0	0	3.667137871	0	0	0	0	0	0	0	0	0	0	3.229432037	0	0	0	0	0	0	0	0	53.2399	0	4.986850967	12.1021	0.649725973	0.831269822	0	0.289488716	1.576047513	0.553316668	1.281722694	3.366980894	4.47833062	5.156704437	0.285495009	0.073210387	0.958609942	3.959976769	9.738833534	0.231293623	0.810303989	0	0	3.667137871	0	0	0	0	0	0	0	0	0	0	3.229432037	0	0	0	0	0	0	0	0	53.2399	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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	30% Coins									7300	6.5453	0.1325	0.361	2.5129	1.0028	1.1249	0.3949	0.1659	2.1519	0.2551	0.8881	0.1505	0.0097	0.1899	1.3476	2.2688	0.0311	0.2464		0.31	0.8051	0							0	0	0.2588	0.3495									21.5024	0	7.276145096	18.6473	0.782265936	1.192220306	2.512920564	1.292265883	2.700918857	0.948235313	1.447578614	5.518865061	4.733402979	6.044765093	0.435979503	0.082878802	1.148503162	5.307539973	12.00759329	0.262407894	1.056671648	0	0.309972136	4.472242771	0	0	0	0	0	0	0	0	0	0.258791537	3.578981782	0	0	0	0	0	0	0	0	74.7423
H1681_007_0	2011	4																															A	A	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	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	YES	209.66729	8.908988	344.979481	591.380663	38.902927	9.548655	9933.383653	344.488486	361.977253	1056.046004	972.88244	76.732466	0.443555	755.48989	3547.741924	3739.293367	88.806806	725.951086		1911.148995	22.217755	0							3.62	0.58											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Day(Days 1-20) $0(Days 21-100):2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$0/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d												0	0	0	0	0	0.2	0	0	0	0	0	0	0.2	0	0	0	0	0		0	0.2	0							0	0											NO	0	0	0	0	0	0.199487	0	0	0	0	0	0	0.199487	0	0	0	0	0		0	0.199487	0							0	0												0	0	0	0	0	1.90483254	0	0	0	0	0	0	0.088483456	0	0	0	0	0	0	0	4.432153292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4255	0	0.016536596	0	0	0	0	0	1.90483254	0	0	0	0	0	0	0.088483456	0	0	0	0	0	0	0	4.432153292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4255	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		30% Coins	20%-30% Coins	30% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d											5100	4.866	0.0985	0.2345	3.8033	0	2.043	1.1873	0	3.2569	0.3861	1.3441	0.2278	0.0146	0.8164	2.0395	3.4338	0.0471	0.3729		0.4691	1.2185	0							0	0											25.8595	1000	13.82866398	4.866	0.098535747	0.23454888	3.803318838	0	3.947831452	1.187272577	0	3.256888035	0.386052999	1.34408444	0.227759139	0.103116721	0.816449708	2.03954395	3.433780344	0.047091585	0.372878583	0	0.4691444	5.650684076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.285
H1689_012_0	2011	7	G.	H.6	H.7	I.7							OP Facility - Surgery	OP Facility - Other	OP Facility - Other	Professional								Lab	Radiology	Radiology							D	D	D	V	T	Coin	Coin	V	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	V		V	V	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	0	0	0	0	0	0	0	0	0	0	YES	1182.847584	55.36542604	270.1025845	44.60615296	149.733217	15.16666515	4.16370134	351.263063	47.65876598	7445.978905	465.416797	3.020486955	0.689207946	103.7070037	3150.913098	3014.663345	18.48946561	1162.635207	589.0215473	1743.512584	21.85963128	0.67601907	0	0	302.4	0	162	0	4.622366403	0	650.0658523	6.772306908	21.70726164	16.4802911	0	0	0	0	0	0	5000	1A: $225/day (days1-7) no yrly max	1B: $225/day (days1-7) no yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: N/A	9A: 20% coin; 9B: 20% coin	8A: $0 -$75 copay	8B: $75 copay	9A: 20% coin	12: 20% coin	3: $35 copay; 5: $40 copay; 9C: $40 copay; 9D: $35 copay	7A: $20 copay; 7G: $20 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35-$50 copay; 7I: $35-$50 copay	8B: $75 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0-$35; 17B: $0; 18A: $35	15: 20% coin	13A: $0 copay	10B: Not covered	-	17A: $35 copay	-	18A: $35 copay	-	14A: $0 copay or not covered	0	9A: $35 copay	8A: 20% coin	8B: 20% coin	8B: 20% coin	0	0	0	0	0	0		225	225	128	0	125	0.2	0.2	50	0.2	43.38362002	75	0.2	0.2	35.654102	15.99720573	30.48043224	40	41.1141613	75	6.177250347	0.2	0	0	0	35	0	35	0	0	0	35	0.2	0.2	0.2	0	0	0	0	0	0	NO	155.0645059	125.6372482	116.1446561	0	113.4225158	0.181476025	0.181476025	45.3690063	0.181476025	39.3654346	68.05350945	0.181476025	0.181476025	32.35182356	14.51554655	27.65733845	36.29520504	37.30617286	68.05350945	5.605114198	0.181476025	0	0	0	35	0	35	0	0	0	31.75830441	0.181476025	0.181476025	0.181476025	0	0	0	0	0	0		15.2848	0.579663314	2.61424765	0	1.415259847	2.752386107	0.755611969	1.32803801	8.648923417	24.42618297	2.639437199	0.548145967	0.125074719	0.279592557	3.811435479	6.948130371	0.055923245	3.614455833	3.340415286	0.814382262	3.966998996	0	0	0	0.882	0	0.4725	0	0	0	1.720415769	1.229011339	3.93934756	2.990777724	0	0	0	0	0	0	95.1832		9.57746239	15.2848	0.579663314	2.61424765	0	1.415259847	2.752386107	0.755611969	1.32803801	8.648923417	24.42618297	2.639437199	0.548145967	0.125074719	0.279592557	3.811435479	6.948130371	0.055923245	3.614455833	3.340415286	0.814382262	3.966998996	0	0	0	0.882	0	0.4725	0	0	0	1.720415769	1.229011339	3.93934756	2.990777724	0	0	0	0	0	0	95.1832	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	-	-	-	-	-	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	15.2848	0.579663314	2.61424765	0	1.415259847	2.752386107	0.755611969	1.32803801	8.648923417	24.42618297	2.639437199	0.548145967	0.125074719	0.279592557	3.811435479	6.948130371	0.055923245	3.614455833	3.340415286	0.814382262	3.966998996	0	0	0	0.882	0	0.4725	0	0	0	1.720415769	1.229011339	3.93934756	2.990777724	0	0	0	0	0	0	95.1832
H1689_013_0	2011	9	G.	H.6	H.7	I.7							OP Facility - Surgery	OP Facility - Other	OP Facility - Other	Professional								Lab	Radiology	Radiology							D	D	D	V	T	Coin	Coin	V	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	V		V	V	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	0	0	0	0	0	0	0	0	0	0	YES	1605.648885	75.15544337	366.6490253	45.03241141	141.4869683	14.12786432	3.503734637	344.5878664	46.73898985	7260.753973	466.6535054	3.408280146	0.861677438	119.5506974	3137.898432	2927.251089	17.03106176	1166.478335	579.0560998	1747.327178	20.61987057	0.611771841	0	0	302.4	0	162	0	4.780648915	0	638.3320526	7.440904362	19.96173782	17.25596117	0	0	0	0	0	0	5000	1A: $225/day (days1-7) no yrly max	1B: $225/day (days1-7) no yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: N/A	9A: 20% coin; 9B: 20% coin	8A: $0 -$75 copay	8B: $75 copay	9A: 20% coin	12: 20% coin	3: $35 copay; 5: $40 copay; 9C: $40 copay; 9D: $35 copay	7A: $20 copay; 7G: $20 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35-$50 copay; 7I: $35-$50 copay	8B: $75 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0-$35; 17B: $0; 18A: $35	15: 20% coin	13A: $0 copay	10B: Not covered	-	17A: $35 copay	-	18A: $35 copay	-	14A: $0 copay or not covered		9A: $35 copay	8A: 20% coin	8B: 20% coin	8B: 20% coin								225	225	128	0	125	0.2	0.2	50	0.2	43.4188126	75	0.2	0.2	35.77023499	15.89601981	31.11360621	40	40.61347336	75	6.086696306	0.2	0	0	0	35	0	35	0	0	0	35	0.2	0.2	0.2	0	0	0	0	0	0	NO	154.0527237	124.8174763	115.3868225	0	112.6824439	0.18029191	0.18029191	45.07297754	0.18029191	39.14030331	67.60946631	0.18029191	0.18029191	32.24541996	14.32961887	28.04765747	36.05838203	36.61140345	67.60946631	5.486910518	0.18029191	0	0	0	35	0	35	0	0	0	31.55108428	0.18029191	0.18029191	0.18029191	0	0	0	0	0	0		20.6129	0.781726064	3.525538834	0	1.328591447	2.547139645	0.63169501	1.294300097	8.426661759	23.68234273	2.629182871	0.614485338	0.155353471	0.32124687	3.747074049	6.84187799	0.051176044	3.558867413	3.262472823	0.798952323	3.717595852	0	0	0	0.882	0	0.4725	0	0	0	1.678339032	1.341534861	3.598939842	3.111110201	0	0	0	0	0	0	99.6136		10.74090847	20.6129	0.781726064	3.525538834	0	1.328591447	2.547139645	0.63169501	1.294300097	8.426661759	23.68234273	2.629182871	0.614485338	0.155353471	0.32124687	3.747074049	6.84187799	0.051176044	3.558867413	3.262472823	0.798952323	3.717595852	0	0	0	0.882	0	0.4725	0	0	0	1.678339032	1.341534861	3.598939842	3.111110201	0	0	0	0	0	0	99.6136	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	20.6129	0.781726064	3.525538834	0	1.328591447	2.547139645	0.63169501	1.294300097	8.426661759	23.68234273	2.629182871	0.614485338	0.155353471	0.32124687	3.747074049	6.84187799	0.051176044	3.558867413	3.262472823	0.798952323	3.717595852	0	0	0	0.882	0	0.4725	0	0	0	1.678339032	1.341534861	3.598939842	3.111110201	0	0	0	0	0	0	99.6136
H1716_001_0	2011	4	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	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	1076.407639	55.602619	592.688374	671.746877	32.62487	7.435121	1.836502	303.925461	468.021003	1172.380853	1045.333173	52.197713	0.794003	967.76809	3690.702076	3684.739202	133.12452	711.031158		1943.235637	17.058817	0							5.91	0.93	431.657248										5000	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $125(Days 21-100):2. $0 SNF 1,2. $125 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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. $50 Rad therapy,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies											161.6895	138.428775	41.280875	0	150	0.2	0.2	50	200	0	49.077012	100	0.174972	38.376782	10	31.47087	35	39.815367		0	0.2	0							0	0	0										NO	150.422329	128.782504	33.382151	0	138.45255	0.184603	0.184603	46.15085	184.6034	0	45.298917	92.3017	0.161502	35.422422	9.23017	29.048148	32.305595	36.75026		0	0.184603	0							0	0	0											13.493	0.596720375	1.648767733	0	0.37641637	1.372545642	0.339023779	1.168868197	7.199855702	0	3.946038387	0.401494804	0.128233073	2.85672414	2.838817298	8.919570807	0.358388902	2.177548327	0	0	3.149108795	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9711	0	4.384024082	13.493	0.596720375	1.648767733	0	0.37641637	1.372545642	0.339023779	1.168868197	7.199855702	0	3.946038387	0.401494804	0.128233073	2.85672414	2.838817298	8.919570807	0.358388902	2.177548327	0	0	3.149108795	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9711	YES	$250/Day(Days 1-15)	$250/Day(Days 1-15)	30% Coins(Days 1-20) 30%(Days 20-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	30% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins										6700	2.7916	0.1352	0.601	2.056	1.6993	1.532	0.3784	0.1971	3.5271	0.3952	1.521	0.2211	0.0221	0.9068	2.0383	3.2686	0.0544	0.3098		0.4754	0.8642	0							0	0	0.139										23.1336	500	4.714348578	16.2845	0.731909429	2.249793041	2.056022649	2.075687605	2.904561264	0.717436665	1.365985098	10.72697935	0.395157533	5.467047688	0.622549389	0.150302801	3.763552644	4.877146518	12.18816794	0.412784237	2.487347882	0	0.475413457	4.013273206	0	0	0	0	0	0	0	0	0	0.139048287	0	0	0	0	0	0	0	0	0	74.1047
H1716_002_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Surgery									Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin							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	YES	1001.86757	57.3220621	371.8966968	415.0337952	27.41119843	9.374084668	2.854138972	318.724862	0	1108.923797	961.5911738	129.1704909	0.219914316	935.9677161	3694.010676	3197.860904	126.9213716	671.1552937		1730.859538	25.8976842	0							5.91	0.93	731.2425944	372.179082									2500	$175/Day(Days 1-5):1a.IP Acute	$175/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $125(Days 21-100):2. $0 SNF 1,2. $125 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0-$75/Visit:8b, 9a. $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,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $35 Radiology OP -- Facility"	$50/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	"$175/Visit:9a.Surgery OP -- Facility, 9b.Surgery ASC -- Facility"										108.3446	87.221925	41.280875	0	150	0.2	0.2	50	0	0	38.636312	50	0.17256	46.155226	10	31.126856	35	41.256733		0	0.2	0							0	0	0	175									NO	88.795984	71.484473	25.116936	0	123.6759	0.164901	0.164901	41.2253	0	0	31.855871	41.2253	0.142277	38.055261	8.24506	25.664279	28.85771	34.016424		0	0.164901	0							0	0	0	144.28855										7.4135	0.341469783	0.778408794	0	0.28250872	1.545795936	0.470650371	1.094960671	0	0	2.552693699	0.443757686	0.031288749	2.968207977	2.538111639	6.839232871	0.305221678	1.902525253	0	0	4.270554021	0	0	0	0	0	0	0	0	0	0	4.47509834	0	0	0	0	0	0	0	0	38.254	0	8.534169159	7.4135	0.341469783	0.778408794	0	0.28250872	1.545795936	0.470650371	1.094960671	0	0	2.552693699	0.443757686	0.031288749	2.968207977	2.538111639	6.839232871	0.305221678	1.902525253	0	0	4.270554021	0	0	0	0	0	0	0	0	0	0	4.47509834	0	0	0	0	0	0	0	0	38.254	YES	$200/Day(Days 1-5)	$200/Day(Days 1-5)	30% Coins(Days 1-20) 30%(Days 21-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins	$200/Visit									3400	1.087	0.0501	0.2582	1.3271	1.0075	1.363	0.415	0.1459	0.6024	0.2235	0.867	0.3807	0.0043	0.3982	1.3341	1.8509	0.0366	0.1819		0.2512	0.9724	0							0	0	0.1808	0.6813									13.619	0	5.402653935	8.5004	0.391535972	1.036658078	1.327086376	1.289989519	2.90880504	0.88564727	1.240831196	0.602378758	0.22346904	3.419646219	0.824477924	0.035542691	3.36641156	3.872207901	8.69012604	0.341816853	2.084429557	0	0.251195362	5.242988379	0	0	0	0	0	0	0	0	0	0.180816691	5.156437816	0	0	0	0	0	0	0	0	51.8729
H1716_004_0	2011	6	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	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	YES	799.878891	24.670445	480.445353	319.525508	27.427948	8.013305	2.617573	297.272305	453.852865	1262.397047	967.382945	18.059562	1.059002	1633.238119	3064.267086	2515.994813	35.05341	565.624645		2393.103122	14.160339	0		3.11					4.56	0.93	782.366023										3400	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$75/Visit:8b, 9a. $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,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $35 Radiology OP -- Facility"	$50/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies											161.6895	138.428775	46.371	0	150	0.2	0.2	50	197.071114	0	40.912434	50	0.189062	42.521415	10	32.900125	35	47.063184		0	0.2	0		0					0	0	0										NO	145.440675	124.517514	33.42635	0	133.9923	0.178656	0.178656	44.6641	176.040079	0	36.54634	44.6641	0.168885	37.983615	8.93282	29.389089	31.26487	42.040695		0	0.178656	0		0					0	0	0											9.6946	0.255991873	1.338294544	0	0.306261153	1.431625018	0.467645122	1.106449996	6.658024517	0	2.946192168	0.06721784	0.178849553	5.16969066	2.281045526	6.161899624	0.091328359	1.981604432	0	0	2.529829524	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6665	0	5.378563514	9.6946	0.255991873	1.338294544	0	0.306261153	1.431625018	0.467645122	1.106449996	6.658024517	0	2.946192168	0.06721784	0.178849553	5.16969066	2.281045526	6.161899624	0.091328359	1.981604432	0	0	2.529829524	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6665	YES	$250/Day(Days 1-15)	$250/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 14-100)	25% Coins	$150/Trip	25% Coins	25% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	25% Coins										5100	2.4303	0.0703	0.46	1.6272	1.7079	1.645	0.5373	0.2305	4.7157	0.3682	1.6105	0.2163	0.038	1.6027	1.8792	2.2177	0.0271	0.2326		0.6583	0.855	0		0					0	0	0.241										23.3708	1000	5.026561526	12.1249	0.326265721	1.798248408	1.627247812	2.014180275	3.076623317	1.004989328	1.336950189	11.37369517	0.368186789	4.556719116	0.283469281	0.216874425	6.772414268	4.160219794	8.379647145	0.118388604	2.214159345	0	0.658337193	3.384857502	0	0	0	0	0	0	0	0	0	0.240985305	0	0	0	0	0	0	0	0	0	66.0374
H1716_006_0	2011	6	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	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	YES	1471.748331	133.3035091	392.2254961	558.4779827	46.27074236	9.441666689	1.477936512	404.1240874	319.6391533	1391.027379	1260.356329	174.7097927	0.490582085	1227.034504	3688.867241	3834.472596	99.77685034	570.7527405		1517.875059	18.15460843	0		3.11					4.56	0.93	1244.450756										4000	$150/Day(Days 1-7):1a.IP Acute	$150/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $125(Days 21-100):2. $0 SNF 1,2. $125 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0-$75/Visit:8b, 9a. $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,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $35 Radiology OP -- Facility"	$50/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies											107.793	92.28585	41.280875	0	150	0.2	0.2	50	150	0	38.66263	50	0.199827	40.208278	10	31.797371	35	39.485427		0	0.2	0		0					0	0	0										NO	97.655284	83.60655	32.050224	0	134.6715	0.179562	0.179562	44.8905	134.6715	0	34.711696	44.8905	0.179407	36.099394	8.9781	28.547998	31.42335	35.450411		0	0.179562	0		0					0	0	0											11.977	0.928753875	1.047576251	0	0.51927919	1.695364554	0.265381236	1.511777696	3.587190353	0	3.645758813	0.653567496	0.08801386	3.691266835	2.759918248	9.122209667	0.261276908	1.686118269	0	0	3.259877798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7003	0	5.368780177	11.977	0.928753875	1.047576251	0	0.51927919	1.695364554	0.265381236	1.511777696	3.587190353	0	3.645758813	0.653567496	0.08801386	3.691266835	2.759918248	9.122209667	0.261276908	1.686118269	0	0	3.259877798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7003	YES	$200/Day(Days 1-15)	$200/Day(Days 1-15)	30% Coins(Days 1-20) 30%(Days 20-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	25% Coins										5100	2.3916	0.2031	0.3416	1.6197	1.7854	1.4413	0.2256	0.1942	2.2775	0.3698	1.1405	0.2598	0.0115	0.7994	1.4229	2.3468	0.0511	0.1734		0.2592	0.6811	0		0					0	0	0.2189										18.2145	0	5.948220545	14.3686	1.13183267	1.389146869	1.619725836	2.304691299	3.136622682	0.490986465	1.705951035	5.864673667	0.369820813	4.786262836	0.913362392	0.099550945	4.490701567	4.182858604	11.46904655	0.312403733	1.85955522	0	0.259219301	3.940948347	0	0	0	0	0	0	0	0	0	0.218860484	0	0	0	0	0	0	0	0	0	64.9148
H1716_019_0	2011	3	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	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	261.979683	11.05832	422.909504	792.730891	39.609999	11.1186	3.076904	377.613316	416.792532	1917.40187	1197.701136	95.335671	0.642919	1020.276224	3970.594708	3921.823872	108.781595	726.418273		1815.325974	22.243059	0							4.56	1.53	941.058567										3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Day(Days 1-1) $0(Days 2-100):2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$0/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies											0	0	0	0	0	0.2	0.2	0	0	0	0	0	0.2	0	0	0	0	0		0	0.2	0							0	0	0										NO	0	0	0	0	0	0.199329	0.199329	0	0	0	0	0	0.199329	0	0	0	0	0		0	0.199329	0							0	0	0											0	0	0	0	0	2.216259419	0.613316197	0	0	0	0	0	0.128152401	0	0	0	0	0	0	0	4.433686707	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.3914	0	0.024896507	0	0	0	0	0	2.216259419	0.613316197	0	0	0	0	0	0.128152401	0	0	0	0	0	0	0	4.433686707	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.3914	YES	30% Coins	30% Coins	30% Coins(Days 1-1) 30%(Days 2-100)	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		30% Coins	20%-30% Coins	30% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	25% Coins										5100	5.0139	0.0893	0.218	3.0605	0	2.2953	0.6352	0	3.5672	0.3943	1.5701	0.2964	0.0205	0.9167	2.0421	3.2744	0.0521	0.3137		0.426	1.1597	0							0	0	0.2428										25.5881	1000	16.59262709	5.0139	0.089310402	0.217954208	3.060485267	0	4.511543844	1.248501399	0	3.567178349	0.394337268	1.570134732	0.296429863	0.148616936	0.916697953	2.042090204	3.274419842	0.052105946	0.313665447	0	0.425999031	5.593347239	0	0	0	0	0	0	0	0	0	0.24282967	0	0	0	0	0	0	0	0	0	32.9795
H1717_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1325.382031	84.31106222	1096.12098	1373.577763	166.8805369	9.911083187	10.75536164	351.1719605	30.46220166	13.45223314	31.10027216	0	0.099169718	16.81657802	5704.414664	100.567188	447.1576726	293.5531076	0	0	26.69383752	1379.050316	0	0	143.0740775	0	15.18920076	10.45	142.9340863	0											4500	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-55 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$25 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$25 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 18a); $0/$35 (17a)"	$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	63.40816336	0	200	0.2	0.10524803	49.26371067	0.2	0.162558822	0.16788032	0	0.2	0.160089273	16.78957412	0.11987032	38.5	35	0	0	0.2	34.73886954	0	0	35	0	35	0	0	0											NO	139.0091028	92.98371955	47.32540462	0	149.272277	0.149272277	0.078553066	36.78533691	0.149272277	0.121327628	0.125299388	0	0.149272277	0.119484451	16.06207244	0.114717604	36.83177337	33.48343033	0	0	0.149272277	25.92775078	0	0	35	0	35	0	0	0												15.3533	0.653296347	4.322864073	0	2.075886477	1.479449955	0.844866629	1.07649824	4.547162203	1.632127532	3.896845065	0	0.01480329	2.009319597	7.635393464	11.53682689	1.372467505	0.819097086	0	0	3.984649908	2.979639408	0	0	0.417299393	0	0.044301836	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6961	0	16.21121579	15.3533	0.653296347	4.322864073	0	2.075886477	1.479449955	0.844866629	1.07649824	4.547162203	1.632127532	3.896845065	0	0.01480329	2.009319597	7.635393464	11.53682689	1.372467505	0.819097086	0	0	3.984649908	2.979639408	0	0	0.417299393	0	0.044301836	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6961	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-45 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$35 (7a, 14c); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$35 (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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											7800	2.9363	0.0584	1.048	0.451	0.3663	0.3916	0.425	0.19	1.2037	0.288	1.008	0	0.0026	0.5303	1.9638	2.4891	0.263	0.1786	0	0	1.0136	0.6474	0	0	0.091	0	0.0097	0	0	0											15.5555	0	3.809063062	18.2897	0.711693901	5.370898813	0.451038421	2.442219385	1.87106906	1.26984592	1.266468517	5.750822787	1.920150038	4.904867743	0	0.017415635	2.539606687	9.599214882	14.02594999	1.635453417	0.997697202	0	0	4.998288919	3.627035275	0	0	0.508289486	0	0.053961634	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2517
H1717_007_0	2011	4																															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	YES	342.2133572	21.734286	37.57652621	2157.116958	11.10453058	25.56596981	23.41879543	27.96118214	39.7139292	17.52383848	37.95515975	0	0.204011954	26.49168677	36.13617894	112.8351218	9.307062	6.122274166	0	0	22.54417273	7.146474609	615.5708029	451.5072796	110.2674931	188.710525	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.08392923	0.084948024	0.171319404	0	0.233	0.233	0.233	0.091451907	0.233	0.233	0.233	0	0.233	0.233	0.225863889	0.232812332	0.231076781	0.233	0	0	0.233	0.231378735	0	0	0	0	0	0	0	0											NO	0.063966684	0.064743158	0.130571128	0	0.17758101	0.17758101	0.17758101	0.069713909	0.17758101	0.17758101	0.17758101	0	0.17758101	0.17758101	0.171492298	0.176768061	0.175450304	0.176910552	0	0	0.17758101	0.177220221	0	0	0	0	0	0	0	0												21.8903	1.407146315	4.906409398	0	1.971953754	4.540030735	4.158733341	1.94928332	7.05243965	3.111900933	6.740115596	0	0.036228649	4.704420487	6.197076352	19.94564575	1.632926862	1.083094904	0	0	4.003416958	1.266499812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.5976	0	30.28069506	21.8903	1.407146315	4.906409398	0	1.971953754	4.540030735	4.158733341	1.94928332	7.05243965	3.111900933	6.740115596	0	0.036228649	4.704420487	6.197076352	19.94564575	1.632926862	1.083094904	0	0	4.003416958	1.266499812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.5976	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	5.8188	0.374	0.9019	0.7819	0.514	1.1833	1.0553	0.3568	1.8382	0	1.3874	0	0.0066	1.0068	1.9667	6.6544	0.5488	0.361	0	0	1.3344	0.4229	0	0.1	0.0476	0	0	0	0	0											26.6608	0	8.316533962	27.7091	1.781189997	5.80829927	0.781891035	2.485931739	5.72336267	5.21399003	2.306100008	8.890615985	3.111900933	8.127527912	0	0.042819288	5.711266008	8.16375719	26.60001781	2.181718809	1.444095483	0	0	5.337774483	1.689402264	0	0.1	0.04762042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.2583
H1717_009_0	2011	4																															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	YES	225.8382499	44.3528475	10269.42096	27.37035837	24.4914876	22.50675825	11.00926433	11.23880503	3.913165945	43.28658077	8.469120311	0	0	3.995150711	0.604686552	111.0091463	20.10102	13.31892569	0	0	3.466505531	7.480703178	1990.715579	0	112.2189435	206.4670984	0	0	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.084992587	0.086024147	0	0	0.2	0.2	0.02987518	0.061002139	0.2	0	0.110080243	0	0	0.161764622	0.013515198	0.029865402	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.079730235	0.080697925	0	0	0.187616915	0.187616915	0.028025446	0.057225165	0.187616915	0	0.103264578	0	0	0.151748896	0.01254816	0.027728476	0.185689619	0	0	0	0.187616915	0.188038241	0	0	0	0	0	0	0	0												18.0061	3.579182777	0	0	4.595017338	4.222648543	0.308539539	0.643142473	0.734176121	0	0.874560134	0	0	0.60625971	0.007587704	3.07811442	3.732550749	0	0	0	0.650375072	1.406658269	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4449	0	2.873528579	18.0061	3.579182777	0	0	4.595017338	4.222648543	0.308539539	0.643142473	0.734176121	0	0.874560134	0	0	0.60625971	0.007587704	3.07811442	3.732550749	0	0	0	0.650375072	1.406658269	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4449	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	2.2775	0.4527	0	0.0072	0.9399	0.8637	0.4225	0.0877	0.1502	0	0.2379	0	0	0.124	0.0099	2.328	0.4214	0.0046	0	0	0.0734	0.1588	0	0	0.016	0	0	0	0	0											8.5755	0	0.59435032	20.2837	4.031898405	0	0.00718423	5.534907249	5.086372108	0.731033127	0.73084372	0.88434851	0	1.112500267	0	0	0.730267378	0.017456405	5.406152067	4.153967769	0.004555178	0	0	0.723804516	1.565474525	0	0	0.01599494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0204
H1777_007_0	2011	9																															Coin	Coin	Coin	Coin	Coin	Coin	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	614.0367527	34.37654423	914.5255896		44.13096431	32.19464559	17.31821724	7.393758904	13.46789943	19.05352611	39.57097828	5.554075943	2.938955302	102.4227272	248.5940971	153.5586468	60.98672592	5.287166484	19.82944093	75.45659441	72.75570763	12.18115203																			3400	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS 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	0.061406961	0.061406961	0.144262465		0.232393905	0.232393905	0.232393905	0.232393905	0.232393905	0.232393905	0.232393905	0.232393905	0.232393905	0.232393905	0.23239406	0.232393905	0.232393905	0.232393905	0.232393905	0.232393905	0.232393905	0.232393905																				37.7061	2.110959127	131.9317162	0	10.25576714	7.48183942	4.024648137	1.718264507	3.129857745	4.427923344	9.19605418	1.290733399	0.6829953	23.80241758	57.77179156	35.68609362	14.17294341	1.228705267	4.608241219	17.53565266	16.90798303	2.830825493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	388.5015	0	1.013192403	37.7061	2.110959127	131.9317162	0	10.25576714	7.48183942	4.024648137	1.718264507	3.129857745	4.427923344	9.19605418	1.290733399	0.6829953	23.80241758	57.77179156	35.68609362	14.17294341	1.228705267	4.608241219	17.53565266	16.90798303	2.830825493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	388.5015	NO																																																																																		0	0	0	37.7061	2.110959127	131.9317162	0	10.25576714	7.48183942	4.024648137	1.718264507	3.129857745	4.427923344	9.19605418	1.290733399	0.6829953	23.80241758	57.77179156	35.68609362	14.17294341	1.228705267	4.608241219	17.53565266	16.90798303	2.830825493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	388.5015
H1777_008_0	2011	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	YES	295.7868665	31.78691695	711.5220956		34.86704367	8.063778702	15.79383035	11.69001391	12.26945442	5.600545116	4.754096504	0.964622098	2.851169847	29.9585355	129.2157218	121.0475602	44.08442835	4.646222893	27.98174642	48.14340141	47.61824367	9.063460002																			3400	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS																				0.068432127	0.068432127	0.175039905		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.068340576	0.068340576	0.174805728		0.232688281	0.232688281	0.232688281	0.232688281	0.232688281	0.232688281	0.232688281	0.232688281	0.232688281	0.232688281	0.232688281	0.232688281	0.232688281	0.232688281	0.232688281	0.232688281	0.232688281	0.232688281																				20.2142	2.1723362	124.3781382	0	8.113152457	1.876346805	3.675039235	2.720129243	2.854958259	1.303181216	1.106222544	0.224456258	0.663433811	6.971000128	30.0669842	28.1663487	10.25792986	1.081121619	6.511024476	11.20240532	11.08020727	2.108960928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	276.7476	0	0.370742647	20.2142	2.1723362	124.3781382	0	8.113152457	1.876346805	3.675039235	2.720129243	2.854958259	1.303181216	1.106222544	0.224456258	0.663433811	6.971000128	30.0669842	28.1663487	10.25792986	1.081121619	6.511024476	11.20240532	11.08020727	2.108960928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	276.7476	NO																																																																																		0	0	0	20.2142	2.1723362	124.3781382	0	8.113152457	1.876346805	3.675039235	2.720129243	2.854958259	1.303181216	1.106222544	0.224456258	0.663433811	6.971000128	30.0669842	28.1663487	10.25792986	1.081121619	6.511024476	11.20240532	11.08020727	2.108960928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	276.7476
H1777_009_0	2011	9																															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	YES	495.5093154	10.17191708	85.80053397		10.85830799	15.06899553	24.87914484	10.62034872	48.48332423	7.643459622	15.69692144	3.677825613	0.615505662	27.7736931	12142.9028	157.5965813	7.379116583	23.56408777	59.71989994	125.7490851	44.68570088	21.69175276																			3400	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	Copay $7	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS																				0.061567114	0.061567114	0.144638709		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.218453171	0.233	7	0.233	0.231573514	0.228384187	0.22716638	0.233	0.233	0.232691451																			NO	0.033573453	0.033573453	0.078873616		0.127058328	0.127058328	0.127058328	0.127058328	0.127058328	0.127058328	0.127058328	0.127058328	0.119125729	0.127058328	3.817203002	0.127058328	0.126280445	0.124541258	0.12387717	0.127058328	0.127058328	0.126890072																				16.636	0.341506381	6.767398391	0	1.379638464	1.914641384	3.161102558	1.349403756	6.160210136	0.971165204	1.994424601	0.467298375	0.073322561	3.528879022	3.862660417	20.0239582	0.931838122	2.93470113	7.397932176	15.97746856	5.677690462	2.752468078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3037	0	86.96875623	16.636	0.341506381	6.767398391	0	1.379638464	1.914641384	3.161102558	1.349403756	6.160210136	0.971165204	1.994424601	0.467298375	0.073322561	3.528879022	3.862660417	20.0239582	0.931838122	2.93470113	7.397932176	15.97746856	5.677690462	2.752468078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3037	NO																																																																																		0	0	0	16.636	0.341506381	6.767398391	0	1.379638464	1.914641384	3.161102558	1.349403756	6.160210136	0.971165204	1.994424601	0.467298375	0.073322561	3.528879022	3.862660417	20.0239582	0.931838122	2.93470113	7.397932176	15.97746856	5.677690462	2.752468078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3037
H1777_010_0	2011	9																															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	YES	355.2900533	8.205150649	61.5238322		8.758826108	12.15536634	6.506425664	8.566876874	35.55625842	5.077533976	10.42743154	2.443171735	0.435914335	18.48675436	10905.97236	114.9664927	5.430817987	17.10711951	43.3556128	91.29165733	36.04560525	17.49759636																			3400	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	Copay $2	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS	CMS FFS																				0.061567114	0.061567114	0.152841145		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.212606068	0.233	2	0.233	0.231277257	0.226993377	0.225697261	0.233	0.233	0.232585794																			NO	0.039363669	0.039363669	0.097720809		0.14897133	0.14897133	0.14897133	0.14897133	0.14897133	0.14897133	0.14897133	0.14897133	0.135932226	0.14897133	1.27872386	0.14897133	0.147869873	0.145130923	0.144302237	0.14897133	0.14897133	0.148706502																				13.9855	0.322984832	6.012158673	0	1.304813971	1.810801086	0.969270882	1.276219039	5.296863095	0.756406988	1.553388342	0.363962542	0.059254806	2.753996379	1.162143922	17.12671128	0.803054366	2.48277205	6.256311893	13.59983958	5.369761742	2.602006349	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8682	0	48.43478405	13.9855	0.322984832	6.012158673	0	1.304813971	1.810801086	0.969270882	1.276219039	5.296863095	0.756406988	1.553388342	0.363962542	0.059254806	2.753996379	1.162143922	17.12671128	0.803054366	2.48277205	6.256311893	13.59983958	5.369761742	2.602006349	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8682	NO																																																																																		0	0	0	13.9855	0.322984832	6.012158673	0	1.304813971	1.810801086	0.969270882	1.276219039	5.296863095	0.756406988	1.553388342	0.363962542	0.059254806	2.753996379	1.162143922	17.12671128	0.803054366	2.48277205	6.256311893	13.59983958	5.369761742	2.602006349	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8682
H1804_128_0	2011	3	r.	s.	t.	u.	v.						OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						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		V	Coin	O							O	O	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	NO	1725.045714	113.46048	641.274532	2167.482097	7.104587	23.598952	15.829055	454.911372	45.928732	6.296081	15.864005	9.851638	0	38.562633	3604.860004	3482.71437	53.397285	4.623697		2120.592341	22.468313	0							3.85	0.73	869.641482	462.903204	0	0	391.971429							$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"20% Coins, up to $50 maximum:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							147.067245	128.620245	66.51235	0	0.2	0.2	0.2	50	0.238417	0.25	0.241595	0.25	0	0.223148	15	35	35	0.25		0	0.2	0							0	0	0	25.403044	0	0	15						NO	130.542181	114.16796	45.410642	0	0.177697	0.177697	0.177697	44.4243	0.21183	0.222122	0.214654	0.222122	0	0.198264	13.32729	31.09701	31.09701	0.222122		0	0.177697	0							0	0	0	22.570249	0	0	13.32729							18.7659	1.079462629	2.426724016	0	1.262463796	4.193462974	2.812775586	1.684093272	9.7290833	1.398498104	3.405272129	2.188265536	0	7.645581869	4.003584557	9.025166966	0.138374659	1.027024825	0	0	3.992551815	0	0	0	0	0	0	0	0	0	0	0.870653381	0	0	0.435326409	0	0	0	0	0	76.0843	0	10.39383114	18.7659	1.079462629	2.426724016	0	1.262463796	4.193462974	2.812775586	1.684093272	9.7290833	1.398498104	3.405272129	2.188265536	0	7.645581869	4.003584557	9.025166966	0.138374659	1.027024825	0	0	3.992551815	0	0	0	0	0	0	0	0	0	0	0.870653381	0	0	0.435326409	0	0	0	0	0	76.0843	YES																																									5000																																									0	0	0	18.7659	1.079462629	2.426724016	0	1.262463796	4.193462974	2.812775586	1.684093272	9.7290833	1.398498104	3.405272129	2.188265536	0	7.645581869	4.003584557	9.025166966	0.138374659	1.027024825	0	0	3.992551815	0	0	0	0	0	0	0	0	0	0	0.870653381	0	0	0.435326409	0	0	0	0	0	76.0843
H1806_001_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V			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	YES	1408.438084	80.969107	777.871291	465.856037	57.516106	12.034814	4.320916	352.120392	411.64416	1072.13371	951.803694	70.336665	0.333072	18.654551	3398.849532	3545.3318	132.616882	494.674328		1780.105576	13.55559	0		3.23			0.28		4.85	0.56	850.192505	559.179303									5000	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$40/Visit:7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"			"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$40-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"										161.6895	138.428775	32.5726	0	150	0.2	0.2	50	187.441609	29.42527	101.108392	150	0.2	0.2	15	38.158866	40	64.570543		0	0.2	0		0			0		0	0	0	123.224115									NO	142.294844	121.824243	23.475105	0	131.8236	0.175765	0.175765	43.9412	164.728184	25.859633	88.856481	131.8236	0.175765	0.175765	13.18236	33.534927	35.15296	56.746143		0	0.175765	0		0			0		0	0	0	108.29231										16.7011	0.822000014	1.521717519	0	0.631831679	2.115299083	0.759465801	1.289382714	5.650782911	2.310415356	7.047827238	0.772669366	0.0585424	3.278817157	3.733738176	9.907703592	0.388489662	2.339238346	0	0	2.382598276	0	0	0	0	0	0	0	0	0	0	5.046234869	0	0	0	0	0	0	0	0	66.7579	0	9.556984361	16.7011	0.822000014	1.521717519	0	0.631831679	2.115299083	0.759465801	1.289382714	5.650782911	2.310415356	7.047827238	0.772669366	0.0585424	3.278817157	3.733738176	9.907703592	0.388489662	2.339238346	0	0	2.382598276	0	0	0	0	0	0	0	0	0	0	5.046234869	0	0	0	0	0	0	0	0	66.7579	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5			"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									7500	7.4015	0.1316	0.4977	2.7426	3.1313	2.592	0.9306	0.2387	3.22	0.4434	1.3942	0.3339	0.0111	0.9293	1.7086	2.7057	0.055	0.2278		0.3834	0.6898	0		0			0		0	0	0.315	0.6237									30.707	1000	13.94635262	24.1026	0.953568078	2.01937754	2.742586887	3.763152294	4.707320554	1.690091523	1.528093523	8.870817239	2.753846578	8.441983265	1.10660028	0.069603592	4.208075174	5.442375098	12.61342844	0.443536583	2.567010631	0	0.383439725	3.072394007	0	0	0	0	0	0	0	0	0	0.315008443	5.669909094	0	0	0	0	0	0	0	0	97.4648
H1806_002_0	2011	7	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V			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	YES	1187.809347	63.839463	343.500673	609.810535	42.158137	11.186546	3.366608	427.928673	500.496073	1729.419483	1014.304793	28.381819	0.116636	5.032895	4129.994347	3751.787616	67.031976	795.194142		1535.266026	21.89449	0		3.23			0.28		4.85	0.56	1171.427167	808.828367									5000	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"			"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										161.6895	138.428775	32.5726	0	150	0.2	0.2	50	177.372193	23.006768	102.415762	150	0.2	0.2	10	33.315995	35	59.864858		0	0.2	0		0			0		0	0	0	118.512037									NO	144.974686	124.118562	26.239542	0	132.7428	0.17699	0.17699	44.2476	156.965877	20.359885	90.633034	132.7428	0.17699	0.17699	8.84952	29.483056	30.97332	52.977526		0	0.17699	0		0			0		0	0	0	104.877464										14.3502	0.660305196	0.751108361	0	0.466349096	1.979906777	0.59585595	1.577901396	6.546733753	2.934231816	7.660793399	0.313956844	0.020643406	0.890772086	3.045705631	9.217847032	0.173016904	3.510618194	0	0	3.875105785	0	0	0	0	0	0	0	0	0	0	7.068988995	0	0	0	0	0	0	0	0	65.64	0	8.396351511	14.3502	0.660305196	0.751108361	0	0.466349096	1.979906777	0.59585595	1.577901396	6.546733753	2.934231816	7.660793399	0.313956844	0.020643406	0.890772086	3.045705631	9.217847032	0.173016904	3.510618194	0	0	3.875105785	0	0	0	0	0	0	0	0	0	0	7.068988995	0	0	0	0	0	0	0	0	65.64	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5			"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									7500	6.9911	0.1183	0.3266	4.528	2.2997	2.414	0.7265	0.2907	3.9505	0.5483	1.5163	0.0958	0.0039	0.2512	2.1898	3.1807	0.0379	0.3914		0.3432	1.1893	0		0			0		0	0	0.4441	0.5301									32.3673	1000	11.70650531	21.3413	0.778593453	1.077753852	4.527973627	2.766041783	4.393952384	1.322366852	1.868573013	10.49718944	3.482561247	9.177082674	0.409735202	0.024524254	1.141971807	5.235493804	12.39851619	0.210931434	3.901969975	0	0.34316018	5.064396717	0	0	0	0	0	0	0	0	0	0.444051871	7.599106085	0	0	0	0	0	0	0	0	98.0073
H1806_005_0	2011	6	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		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	YES	1200.093646	55.606482	591.19116	524.158632	42.539711	10.231927	3.170022	371.206721	391.738989	1482.499664	983.796708	90.787902	0.412062	8.419696	3418.842151	3324.33742	94.965816	611.729605		1509.192858	20.23931	0		3.23					4.85	0.56	1078.188979	719.974811									6700	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										161.6895	138.428775	32.5726	0	150	0.2	0.2	50	184.085226	30.381622	106.990671	150	0.172843	0.2	15	33.742449	35	70.92209		0	0.2	0		0					0	0	0	128.277878									NO	152.295502	130.386202	28.673367	0	139.36065	0.185814	0.185814	46.45355	171.028245	28.226684	99.40193	139.36065	0.160584	0.185814	13.936065	31.349131	32.517485	65.891657		0	0.185814	0		0					0	0	0	119.179257										15.2307	0.604193166	1.412620091	0	0.494030148	1.901235284	0.589034468	1.436989165	5.583202649	3.487170795	8.149274292	1.054355086	0.066170564	1.564497393	3.97043387	8.684590772	0.257337458	3.358989776	0	0	3.760747148	0	0	0	0	0	0	0	0	0	0	7.150505253	0	0	0	0	0	0	0	0	68.7561	0	5.101211407	15.2307	0.604193166	1.412620091	0	0.494030148	1.901235284	0.589034468	1.436989165	5.583202649	3.487170795	8.149274292	1.054355086	0.066170564	1.564497393	3.97043387	8.684590772	0.257337458	3.358989776	0	0	3.760747148	0	0	0	0	0	0	0	0	0	0	7.150505253	0	0	0	0	0	0	0	0	68.7561	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	20% Coins	$150/Trip	20% Coins	20% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	30% Coins									10000	9.0094	0.1406	0.6867	2.5244	2.7341	1.7344	0.5373	0.2971	3.8989	0.5771	1.5719	0.2879	0.014	0.4951	2.0719	3.2225	0.0537	0.3409		0.3872	1.2978	0		0					0	0	0.3172	0.7107									32.9108	1000	6.800923743	24.2401	0.744801876	2.099276401	2.524418278	3.22811904	3.635619643	1.126375669	1.734071468	9.482056502	4.064259903	9.721179398	1.342258918	0.080131866	2.059637316	6.042337821	11.90704533	0.311046667	3.699901357	0	0.387222889	5.058570126	0	0	0	0	0	0	0	0	0	0.317177806	7.861231673	0	0	0	0	0	0	0	0	101.6669
H1807_001_0	2011	7																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																												0	YES	349.4568051	25.91598949	54.50480527		24.40159555	49.89638484		55.6150349	54.626338	29.36781993	27.49999863	4.240472237	2.333025338	14.09701914	134.6335207	60.50474392	6.795536485	2.341472908	24.19117088	21.20610591	11.11878902																				6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/day for days 1-25; $137.50/day for days 26+	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																					0.080006932	0.080006932	0.141524347		0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.080006932	0.080006932	0.141524347		0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					27.959	2.073458812	7.713756972	0	5.685571764	11.62585767	0	12.95830313	12.72793676	6.842702043	6.407499681	0.988030031	0.543594904	3.284605459	31.36961033	14.09760533	1.583360001	0.545563187	5.636542814	4.941022678	2.590677843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.5747	0	0	27.959	2.073458812	7.713756972	0	5.685571764	11.62585767	0	12.95830313	12.72793676	6.842702043	6.407499681	0.988030031	0.543594904	3.284605459	31.36961033	14.09760533	1.583360001	0.545563187	5.636542814	4.941022678	2.590677843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.5747	NO																																																																																		0	0	0	27.959	2.073458812	7.713756972	0	5.685571764	11.62585767	0	12.95830313	12.72793676	6.842702043	6.407499681	0.988030031	0.543594904	3.284605459	31.36961033	14.09760533	1.583360001	0.545563187	5.636542814	4.941022678	2.590677843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.5747
H1837_001_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	Coin	V	Coin											0.19	0	0.04	0.07	0.09	0.27	0.07	0.49	0.08	7.33	1.42	0	0	0.3	0	6.66	0.04	0.32	0	0.12	0.16	0	0	0.3	0.11	0.41	0.04	0	0	0											18.51	YES	763.1293271	22.80814988	652.0333333	791.7920787	150.2340977	7.346306318	3.426249125	939.1222989	166.2056589	27.86496712	36.31758075	0	0.393699882	1892.07207	4031.445132	6551.972082	133.3645246	873.5762665	0	3430.671232	24.1102946	18.98001591	124.9463512	296.8054466	116.9035167	151.3903162	30.28699256	0	0	0											3400	1a: $265 Days 1-7	1b: $265 Days 1-7	2: $100 Days 11-44	6: none	10a: $175	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $30	9b: $50	8a: 30%	8b: 20%	5: none	12: 20%	3: $40; 9a: 30%; 9a: $250; 9c: $30; 9d: $40	7a: $10	16b: $25; 7d: $40	7h: $30	7c: $40; 7i: $40	7d: $0	7b: $15; 7f: $40	15: 20%	13a: none	10b: none	16b: $25	17a: $20	17b: $20	18a: $20	18b: 100%	14a: $0	20: 100%												208.1140472	202.3227297	37.51187211	0	157.7301747	0.196373161	0.203323783	14.72090339	47.09306071	0.004037344	0.190760287	0	0.059849345	25.63957713	9.009942517	23.96318536	21.64797011	36.73521331	0	1.14090621	0.150503423	0	0	24.99511337	16.77531898	16.02646174	18.92400516	0	0	0											NO	174.6216384	0	22.68650592	0	131.4306784	0.12138615	0.19254198	13.86346219	46.69444179	0.004037344	0.150265901	0	0.00725298	21.30952908	8.81082847	22.84444726	21.61460991	36.16139581	0	1.139446823	0.062116108	0	0	24.99511337	16.77531898	16.02646174	18.92400516	0	0	0												11.1049	0	1.232696506	0	1.645447448	0.891739843	0.659696791	1.084957207	0.646740039	0.112500445	5.457294	0	0.002855497	3.359930399	2.960030962	12.47301505	0.240218514	2.632478095	0	0.32575562	1.497637673	0	0	0.618223816	0.163424482	0.202187593	0.0477626	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3595	275	9.163151869	11.2949	0	1.272696506	0.07	1.735447448	1.161739843	0.729696791	1.574957207	0.726740039	7.442500445	6.877294	0	0.002855497	3.659930399	2.960030962	19.13301505	0.280218514	2.952478095	0	0.44575562	1.657637673	0	0	0.918223816	0.273424482	0.612187593	0.0877626	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8695	NO																																																																																		0		0	11.2949	0	1.272696506	0.07	1.735447448	1.161739843	0.729696791	1.574957207	0.726740039	7.442500445	6.877294	0	0.002855497	3.659930399	2.960030962	19.13301505	0.280218514	2.952478095	0	0.44575562	1.657637673	0	0	0.918223816	0.273424482	0.612187593	0.0877626	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8695
H1837_002_0	2011	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	Coin	V	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	652.6501284	24.66160353	722.498872	878.5153771	144.1012545	9.341404967	2.121818621	920.9475605	193.079925	31.59214902	51.76095203	0	0.16438211	2957.259524	4974.410423	8314.284124	173.8431844	1388.596764	0	3464.305429	40.95649451	75.24518599	47.41799686	262.390508	114.4500418	251.4245698	24.93779086	0	0	0											3400	1a: $270 Days 1-5	1b: $270 Days 1-5	2: $100 Days 8-38	6: none	10a: $100	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $30	9b: $100	8a: 20%	8b: 20%	5: none	12: 20%	3: $35; 9a: 20%; 9a: $250; 9c: $30; 9d: $35	7a: $10	16b: $25; 7d: $35	7h: $30	7c: $35; 7i: $35	7d: $0	7b: $15; 7f: $35	15: 20%	13a: none	10b: none	16b: $25	17a: $20	17b: $20	18a: $20	18b: 100%	14a: $0	20: 100%												198.2213696	140.5246923	63.06994981	0	84.88965985	0.2	0.2	14.45972056	96.45526619	0.001287186	0.189292151	0	0.199999988	19.85385253	8.773803631	19.54904868	23.76369858	32.87329292	0	0.999411546	0.162183936	0	0	25	13.92109027	16.49453619	19.40022291	0	0	0											NO	178.9710865	0	36.74768218	0	73.43139464	0.178068795	0.185707224	13.76344373	93.59614535	0.001287186	0.132684226	0	0.179694295	17.01912048	8.537353989	18.59226956	22.4747107	31.54633755	0	0.957424852	0.082665288	0	0	25	13.92109027	16.49453619	18.30368845	0	0	0												9.7338	0	2.212513244	0	0.881796341	1.663412722	0.394037047	1.056284161	1.505961394	0.040664962	6.867861865	0	0.029538527	4.194163011	3.539025222	12.8817843	0.325589606	3.65042852	0	0.276401009	3.385680397	0	0	0.546646892	0.132772447	0.345594305	0.038037796	0	0	0	0	0	0	0	0	0	0	0	0	0	53.702	0	11.65044336	9.7338	0	2.212513244	0	0.881796341	1.663412722	0.394037047	1.056284161	1.505961394	0.040664962	6.867861865	0	0.029538527	4.194163011	3.539025222	12.8817843	0.325589606	3.65042852	0	0.276401009	3.385680397	0	0	0.546646892	0.132772447	0.345594305	0.038037796	0	0	0	0	0	0	0	0	0	0	0	0	0	53.702	NO																																																																																		0		0	9.7338	0	2.212513244	0	0.881796341	1.663412722	0.394037047	1.056284161	1.505961394	0.040664962	6.867861865	0	0.029538527	4.194163011	3.539025222	12.8817843	0.325589606	3.65042852	0	0.276401009	3.385680397	0	0	0.546646892	0.132772447	0.345594305	0.038037796	0	0	0	0	0	0	0	0	0	0	0	0	0	53.702
H1837_003_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	Coin	V	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	962.782376	30.55344768	1090.679365	1174.675269	216.1817473	9.030991125	2.531534369	1358.719124	227.442412	37.95528584	61.64719087	0	5.762892786	2860.33728	5562.765791	10134.67728	146.0107883	1462.394263	0	4324.33355	40.23646652	46.61180525	183.4979181	306.5113141	128.3018434	210.7262276	42.42516729	0	0	0											1950	1a: $200 Days 1-5	1b: $200 Days 1-5	2: $75 Days 8-33	6: none	10a: $125	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $25	9b: $50	8a: 20%	8b: 20%	5: none	12: 20%	3: $20; 9a: 20%; 9a: $150; 9c: $30; 9d: $20	7a: $10	16b: $25; 7d: $20	7h: $30	7c: $20; 7i: $20	7d: $0	7b: $15; 7f: $20	15: 20%	13a: none	10b: none	16b: $25	17a: $20	17b: $20	18a: $20	18b: 100%	14a: $0	20: 100%												135.1142493	93.47093334	41.6137599	0	117.3272481	0.2	0.2	14.06556204	45.55392626	0.000459933	0.192347666	0	0.2	14.18437805	8.934736742	12.12700559	15.14048697	19.00189653	0	0.724610442	0.158411762	0	0	25	14.55741281	17.42958611	19.78462586	0	0	0											NO	105.9193806	0	21.18966374	0	94.39641273	0.139782155	0.157188833	12.48454569	44.60569292	0.000459933	0.123149237	0	0.012801916	10.2651775	8.496969974	11.03727209	13.86020503	17.54340425	0	0.701103944	0.051036265	0	0	25	14.55741281	17.42958611	18.89544587	0	0	0												8.4981	0	1.925927417	0	1.700565121	1.262371399	0.397928934	1.413582582	0.845435532	0.017456893	7.591804521	0	0.073776067	2.44682249	3.938887825	9.321599224	0.168644955	2.13794781	0	0.252650609	2.053518952	0	0	0.638565238	0.155645242	0.306072577	0.066803538	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2141	0	17.38052437	8.4981	0	1.925927417	0	1.700565121	1.262371399	0.397928934	1.413582582	0.845435532	0.017456893	7.591804521	0	0.073776067	2.44682249	3.938887825	9.321599224	0.168644955	2.13794781	0	0.252650609	2.053518952	0	0	0.638565238	0.155645242	0.306072577	0.066803538	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2141	NO																																																																																		0		0	8.4981	0	1.925927417	0	1.700565121	1.262371399	0.397928934	1.413582582	0.845435532	0.017456893	7.591804521	0	0.073776067	2.44682249	3.938887825	9.321599224	0.168644955	2.13794781	0	0.252650609	2.053518952	0	0	0.638565238	0.155645242	0.306072577	0.066803538	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2141
H1837_005_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	Coin	V	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	731.817614	7.518275583	716.9210963	1238.488092	255.1608303	6.989239129	0.908983623	772.9849894	99.14321074	17.38618357	29.4841277	14.24468085	0.272806505	1193.67004	3561.918853	4366.735383	84.01838095	530.4027042	0	3089.780549	27.47410212	24.47062766	131.6988825	339.031041	135.5620993	148.0583171	19.55380902	0	0	0											3400	1a: $300 Days 1-7	1b: $300 Days 1-7	2: $75 Days 8-45	6: none	10a: $125	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $35	9b: $75	8a: 20%	8b: 20%	5: none	12: 20%	3: $35; 9a: 20%; 9a: $150; 9c: $30; 9d: $35	7a: none	16b: $25; 7d: $35	7h: $30	7c: $35; 7i: $35	7d: $0	7b: $15; 7f: $35	15: 20%	13a: none	10b: none	16b: $25	17a: $20	17b: $20	18a: $20	18b: 100%	14a: $0	20: 100%												274.1138276	300	37.48736539	0	86.32910374	0.2	0.2	19.00130557	74.0504472	0.008956811	0.188524729	0	0.200000001	32.46934445	0	19.11890115	27.97248244	32.77710549	0	2.271546093	0.149412419	0	0	24.98409317	16.37363644	17.37862601	19.04851308	0	0	0											NO	251.1690919	0	28.60908119	0	77.30210518	0.191748156	0.199455719	18.59155542	73.20519108	0.008817837	0.17500041	0	0.135924014	29.19179638	0	18.5752771	27.55422652	32.1267221	0	2.255315172	0.081415236	0	0	24.98409317	16.37363644	17.37862601	19.04851308	0	0	0												15.3175	0	1.709204488	0	1.643705778	1.340173718	0.181301982	1.197582772	0.604816474	0.153308533	5.159734423	0	0.037080955	2.903781062	0	6.759443313	0.192921792	1.420008356	0	0.580702413	2.236810505	0	0	0.70586526	0.184970377	0.214420843	0.031039249	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5744	0	5.430638557	15.3175	0	1.709204488	0	1.643705778	1.340173718	0.181301982	1.197582772	0.604816474	0.153308533	5.159734423	0	0.037080955	2.903781062	0	6.759443313	0.192921792	1.420008356	0	0.580702413	2.236810505	0	0	0.70586526	0.184970377	0.214420843	0.031039249	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5744	NO																																																																																		0		0	15.3175	0	1.709204488	0	1.643705778	1.340173718	0.181301982	1.197582772	0.604816474	0.153308533	5.159734423	0	0.037080955	2.903781062	0	6.759443313	0.192921792	1.420008356	0	0.580702413	2.236810505	0	0	0.70586526	0.184970377	0.214420843	0.031039249	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5744
H1837_006_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	Coin	V	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1046.269771	10.7487771	1024.972403	1770.649847	364.8000258	9.836055009	1.279225499	1105.126228	141.7437305	24.46778571	41.49336827	20.3654154	0.383923882	1706.574238	5092.426349	6243.062938	120.1199534	758.3095907	0	4417.418068	38.66463775	34.98533283	188.2880714	484.7082492	193.8113267	211.6771596	27.95582016	0	0	0											2800	1a: $150 Days 1-5	1b: $150 Days 1-5	2: $50 Days 8-53	6: none	10a: $125	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $30	9b: $50	8a: 20%	8b: 20%	5: none	12: 20%	3: $25; 9a: 20%; 9a: $100; 9c: $30; 9d: $25	7a: none	16b: $25; 7d: $25	7h: $30	7c: $25; 7i: $25	7d: $0	7b: $15; 7f: $25	15: 20%	13a: none	10b: none	16b: $25	17a: $20	17b: $20	18a: $20	18b: 100%	14a: $0	20: 100%												117.4144718	145.3472052	31.38705043	0	86.32595344	0.2	0.199999999	15.45061685	49.39848008	0.008956811	0.188524729	0	0.2	26.45994465	0	14.22390067	27.95970248	23.54449818	0	1.679317268	0.149412419	0	0	24.97820164	16.37363643	17.37862618	19.03046754	0	0	0											NO	109.1198635	0	23.84734901	0	77.27452988	0.187410835	0.199486116	14.99119179	49.00191054	0.008730129	0.159356548	0	0.183890922	22.87350451	0	13.649003	27.3741442	23.34387276	0	1.643344329	0.064313562	0	0	24.97820164	16.37363643	17.37862618	19.03046754	0	0	0												9.5141	0	2.036906219	0	2.349145875	1.843383279	0.255187727	1.380596604	0.578809467	0.213606923	6.612239935	0	0.070600117	3.25294446	0	7.100965399	0.274015077	1.475156883	0	0.604944911	2.486660559	0	0	1.008928366	0.264449683	0.306554852	0.044334361	0	0	0	0	0	0	0	0	0	0	0	0	0	41.6735	0	7.381052155	9.5141	0	2.036906219	0	2.349145875	1.843383279	0.255187727	1.380596604	0.578809467	0.213606923	6.612239935	0	0.070600117	3.25294446	0	7.100965399	0.274015077	1.475156883	0	0.604944911	2.486660559	0	0	1.008928366	0.264449683	0.306554852	0.044334361	0	0	0	0	0	0	0	0	0	0	0	0	0	41.6735	NO																																																																																		0		0	9.5141	0	2.036906219	0	2.349145875	1.843383279	0.255187727	1.380596604	0.578809467	0.213606923	6.612239935	0	0.070600117	3.25294446	0	7.100965399	0.274015077	1.475156883	0	0.604944911	2.486660559	0	0	1.008928366	0.264449683	0.306554852	0.044334361	0	0	0	0	0	0	0	0	0	0	0	0	0	41.6735
H1837_007_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	Coin	V	Coin											0.2	0	0.06	0.1	0.08	0.34	0.09	0.38	0.11	7.99	1.27	0	0	0.31	0	7.11	0.03	0.3	0	0.17	0.18	0	0	0.36	0.12	0.57	0.04	0	0	0											19.81	YES	923.5683633	31.46437802	1012.600124	1254.551046	211.23292	11.676344	3.632339627	1294.602878	264.0774055	42.73762883	65.96938117	0	2.029775144	3219.263316	6000.935954	10298.80472	211.0999302	1537.48766	0	4578.822942	48.25609609	69.67174799	128.9244972	354.5920561	148.0421028	257.3943973	36.31072521	0	0	0											3400	1a: $265 Days 1-7	1b: $265 Days 1-7	2: $100 Days 11-44	6: none	10a: $175	11a: 20%	11b: 20%	4a: $50; 4b: $30	9b: $50	8a: 30%	8b: 20%	5: none	12: 20%	3: $40; 9a: 30%; 9a: $250; 9c: $30; 9d: $40	7a: $5	16b: $25; 7d: $40	7h: $30	7c: $40; 7i: $40	7d: $0	7b: $15; 7f: $40	15: 20%	13a: none	10b: none	16b: $25	17a: $20	17b: $20	18a: $20	18b: 100%	14a: $0	20: 100%												197.1761488	160.5891063	51.70284205	0	161.0152526	0.198742141	0.197259576	14.21303007	47.11553276	0	0.190866049	0	0.202316887	26.42141633	4.453288819	23.35242664	20.4136039	37.03177684	0	1.225031004	0.164845853	0	0	25.00066725	15.31148667	16.75792573	19.63960753	0	0	0											NO	154.9863114	0	24.99386678	0	129.0392467	0.137863681	0.166844527	12.57410701	46.13615283	0	0.125142219	0	0.01841432	18.13278105	4.253010629	21.57010497	18.58846873	34.04421316	0	1.182172605	0.059795676	0	0	25.00066725	15.31148667	16.75792573	18.95212896	0	0	0												11.9284	0	2.109066051	0	2.271444739	1.609743768	0.606035988	1.356539594	1.015292962	0	8.255554734	0	0.037376929	4.864516405	2.126837033	18.51219157	0.327002038	4.361879801	0	0.451079921	2.885505895	0	0	0.738753167	0.18889539	0.359449683	0.057347129	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0629	275	20.99415415	12.1284	0	2.169066051	0.1	2.351444739	1.949743768	0.696035988	1.736539594	1.125292962	7.99	9.525554734	0	0.037376929	5.174516405	2.126837033	25.62219157	0.357002038	4.661879801	0	0.621079921	3.065505895	0	0	1.098753167	0.30889539	0.929449683	0.097347129	0	0	0	0	0	0	0	0	0	0	0	0	0	83.8729	NO																																																																																		0		0	12.1284	0	2.169066051	0.1	2.351444739	1.949743768	0.696035988	1.736539594	1.125292962	7.99	9.525554734	0	0.037376929	5.174516405	2.126837033	25.62219157	0.357002038	4.661879801	0	0.621079921	3.065505895	0	0	1.098753167	0.30889539	0.929449683	0.097347129	0	0	0	0	0	0	0	0	0	0	0	0	0	83.8729
H1837_009_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	Coin	V	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1036.139969	10.64470973	1015.048818	1753.506875	361.2680664	10.53819886	1.37054263	1094.426621	140.3713723	26.21440705	44.45535254	20.16824215	0.411330104	1690.051443	5043.123112	6182.619911	118.9568511	750.9678678	0	4374.649485	41.42474447	34.6466074	186.4651023	480.0154605	191.9348941	209.6276991	27.68515552	0	0	0											3400	1a: $290 Days 1-7	1b: $290 Days 1-7	2: $75 Days 8-45	6: none	10a: $125	11a: 20%	11b: 20%	4a: $50; 4b: $35	9b: $75	8a: 20%	8b: 20%	5: none	12: 20%	3: $35; 9a: 20%; 9a: $150; 9c: $30; 9d: $35	7a: none	16b: $25; 7d: $35	7h: $30	7c: $35; 7i: $35	7d: $0	7b: $15; 7f: $35	15: 20%	13a: none	10b: none	16b: $25	17a: $20	17b: $20	18a: $20	18b: 100%	14a: $0	20: 100%												247.9213297	290	46.29005616	0	86.33931322	0.2	0.181742682	18.03523949	74.07120734	0.008956811	0.188524729	0	0.2	33.44590693	0	19.14468416	28.02156729	32.82720823	0	2.272279515	0.149412419	0	0	24.99865639	16.3736365	17.37862613	19.07180388	0	0	0											NO	216.4165705	0	28.67719033	0	72.18234217	0.185531568	0.181142837	17.24513676	71.9919468	0.008771288	0.160738781	0	0.082706045	28.6139732	0	18.17945528	27.26870663	31.70798463	0	2.218674457	0.064680827	0	0	24.99865639	16.3736365	17.37862613	19.07180388	0	0	0												18.6865	0	2.425729012	0	2.173097932	1.955168559	0.248263981	1.572794729	0.842134031	0.229934108	7.145699173	0	0.034019486	4.029923892	0	9.366388516	0.270316623	1.984306468	0	0.808826923	2.679386731	0	0	0.999978463	0.261889349	0.303586784	0.044000488	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0619	0	11.5698791	18.6865	0	2.425729012	0	2.173097932	1.955168559	0.248263981	1.572794729	0.842134031	0.229934108	7.145699173	0	0.034019486	4.029923892	0	9.366388516	0.270316623	1.984306468	0	0.808826923	2.679386731	0	0	0.999978463	0.261889349	0.303586784	0.044000488	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0619	NO																																																																																		0		0	18.6865	0	2.425729012	0	2.173097932	1.955168559	0.248263981	1.572794729	0.842134031	0.229934108	7.145699173	0	0.034019486	4.029923892	0	9.366388516	0.270316623	1.984306468	0	0.808826923	2.679386731	0	0	0.999978463	0.261889349	0.303586784	0.044000488	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0619
H1837_801_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	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	192.8258314	1.91770571	26.39002305	8.151452475	5.939466293	7.744085168	2.40907149	13.98490812	14.02324491	28.3448426	43.7528188	0	1.346206112	34.24744557	28.55802844	77.57631006	0.927583521	6.762084817	0	19.98023867	32.00480323	0.94365199	0.809748544	1.216966427	0.311831851	1.690097098	0.149718548	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing												0.07254455	0.07254455	0.14709257	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.065965525	0.065965525	0.133752826	0	0.211869358	0.211869358	0.211869358	0.211869358	0.211869358	0.211869358	0.211869358	0	0.211869358	0.211869358	0.211869358	0.211869358	0.211869358	0.211869358	0	0.211869358	0.211869358	0.211869358	0	0	0	0	0	0	0	0												12.7199	0.126502463	3.529740156	0	1.258390913	1.640734357	0.510408431	2.962973511	2.971095903	6.005403619	9.269881651	0	0.285219825	7.255984323	6.050571164	16.43604305	0.196526526	1.432678572	0	4.233200349	6.780837129	0.199930942	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.866	0	8.364314552	12.7199	0.126502463	3.529740156	0	1.258390913	1.640734357	0.510408431	2.962973511	2.971095903	6.005403619	9.269881651	0	0.285219825	7.255984323	6.050571164	16.43604305	0.196526526	1.432678572	0	4.233200349	6.780837129	0.199930942	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.866	NO																																																																																		0		0	12.7199	0.126502463	3.529740156	0	1.258390913	1.640734357	0.510408431	2.962973511	2.971095903	6.005403619	9.269881651	0	0.285219825	7.255984323	6.050571164	16.43604305	0.196526526	1.432678572	0	4.233200349	6.780837129	0.199930942	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.866
H1837_803_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	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	192.8258314	1.91770571	26.39002305	8.151452475	5.939466293	7.744085168	2.40907149	13.98490812	14.02324491	28.3448426	43.7528188	0	1.346206112	34.24744557	28.55802844	77.57631006	0.927583521	6.762084817	0	19.98023867	32.00480323	0.94365199	0.809748544	1.216966427	0.311831851	1.690097098	0.149718548	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing												0.07254455	0.07254455	0.14709257	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.065965525	0.065965525	0.133752826	0	0.211869358	0.211869358	0.211869358	0.211869358	0.211869358	0.211869358	0.211869358	0	0.211869358	0.211869358	0.211869358	0.211869358	0.211869358	0.211869358	0	0.211869358	0.211869358	0.211869358	0	0	0	0	0	0	0	0												12.7199	0.126502463	3.529740156	0	1.258390913	1.640734357	0.510408431	2.962973511	2.971095903	6.005403619	9.269881651	0	0.285219825	7.255984323	6.050571164	16.43604305	0.196526526	1.432678572	0	4.233200349	6.780837129	0.199930942	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.866	0	8.364314552	12.7199	0.126502463	3.529740156	0	1.258390913	1.640734357	0.510408431	2.962973511	2.971095903	6.005403619	9.269881651	0	0.285219825	7.255984323	6.050571164	16.43604305	0.196526526	1.432678572	0	4.233200349	6.780837129	0.199930942	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.866	NO																																																																																		0		0	12.7199	0.126502463	3.529740156	0	1.258390913	1.640734357	0.510408431	2.962973511	2.971095903	6.005403619	9.269881651	0	0.285219825	7.255984323	6.050571164	16.43604305	0.196526526	1.432678572	0	4.233200349	6.780837129	0.199930942	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.866
H1846_001_0	2011	6																															A	A	D		T	Coin		V	V		V	V	V	V	V	V	V	V	V	V	Coin	V			V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	190.5422041	3.242335396	1414.338046	0	199.4581855	9.603034023	0	331.509691	443.4862711	0	1270.1962	42.83326966	26.30242468	1242.34539	3561.479551	3653.179066	33.63037425	274.3669898	785.1423949	285.8249005	36.06880572	792.7486042	0	0	311.9760822	0	133.7040352	0	0	0											3400	$300/Admit for Inpatient; PBP 1a	$300/Admit for Inpatient Mental Health; PBP 1b	$43/Day for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$30/Visit for Urgent Care; $50/Visit for Emergency Room; PBP 4a, 4b"	"$200/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$30/Visit for Radiology; $55/Visit for Therapuetic Radiology; PBP 8b	$30/Visit for Observation Room; PBP 9a	$30/Visit for OP Dialysis; PBP 12	"$30/Visit for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15/Visit for Primary Care Physician; PBP 4b, 7a, 14a-j"	"$30/Visit for Specialty Physician, Podiatrist, Vision Exam, Hearing Exam; $15/Visit for Chiropractor; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"$30/Visit for OP Mental Health; PBP 7e, 7h"	"$30/Visit for Therapy (PT/OT/ST); PBP 7c, 7i"	$30/Case for Radiology; PBP 7d	$30/Visit for Other Health Care; PBP 7g	20% Coinsurance for Part B Drugs; PBP 15	$30/Visit for Other Medicare Part C; PBP 7g	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$30/Visit for Routine Vision Exam; PBP 17a	No Cost Sharing; PBP 17b	$30/Visit for Routine Hearing Exam; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	300	300	42.5	0	100	0.2	0	43.77489596	200	0	36.16089613	30	30	30	15	28.21461244	30	30	30	30	0.2	30	0	0	30	0	30	0	0	0											NO	274.2829432	274.2829432	38.85675029	0	91.42764774	0.182855295	0	40.02235767	182.8552955	0	33.06105673	27.42829432	27.42829432	27.42829432	13.71414716	25.79595647	27.42829432	27.42829432	27.42829432	27.42829432	0.182855295	27.42829432	0	0	27.42829432	0	27.42829432	0	0	0												4.3552	0.074109775	4.579715024	0	1.51966606	1.755965624	0	1.105649952	6.757817762	0	3.499502385	0.097903627	0.06011922	2.839617918	4.070221223	7.853104015	0.07686865	0.627118212	1.794593058	0.653307458	6.595372126	1.811978503	0	0	0.713080984	0	0.305606136	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1465	0	4.795551811	4.3552	0.074109775	4.579715024	0	1.51966606	1.755965624	0	1.105649952	6.757817762	0	3.499502385	0.097903627	0.06011922	2.839617918	4.070221223	7.853104015	0.07686865	0.627118212	1.794593058	0.653307458	6.595372126	1.811978503	0	0	0.713080984	0	0.305606136	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1465	YES	$400/Admit for Inpatient; PBP 1a	$400/Admit for Inpatient Mental Health; PBP 1b	$43/Day for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$30/Visit for Urgent Care; $50/Visit for Emergency Room; PBP 4a, 4b"	"$250/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$45/Visit for Radiology; $100/Visit for Therapuetic Radiology; PBP 8b	$45/Visit for Observation Room; PBP 9a	$45/Visit for OP Dialysis; PBP 12	"$45/Visit for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$20/Visit for Primary Care Physician; $20/Visit for Preventive Services; PBP 4b, 7a, 14a-j"	"$40/Visit for Specialty Physician, Podiatrist, Vision Exam, Hearing Exam; $15/Visit for Chiropractor; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"$40/Visit for OP Mental Health; PBP 7e, 7h"	"$40/Visit for Therapy (PT/OT/ST); PBP 7c, 7i"	$45/Case for Radiology; PBP 7d	$40/Visit for Other Health Care; PBP 7g	20% Coinsurance for Part B Drugs; PBP 15	$40/Visit for Other Medicare Part C; PBP 7g	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$40/Visit for Routine Vision Exam; PBP 17a	No Cost Sharing; PBP 17b	$40/Visit for Routine Hearing Exam; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											5100	0.6479	0.0111	0.5126	0	0.1704	0.2064	0	0.1401	0.9494	0	0.6455	0.0163	0.01	0.4736	0.7137	1.2734	0.0115	0.1031	0.3324	0.1033	0.7328	0.2864	0	0	0.1145	0	0.0399	0	0	0											7.4943	0	0.702672892	5.0031	0.085163102	5.092321667	0	1.690050243	1.96238373	0	1.245778587	7.707224975	0	4.144984583	0.114229886	0.070139091	3.313251842	4.783950717	9.126553481	0.088333974	0.730264522	2.126961489	0.756557708	7.328191252	2.098347856	0	0	0.82756203	0	0.345476984	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6408
H1846_003_0	2011	7																															D	D	D		T	Coin		V	V		V	V	V	V	V	V	V	V	V	V	Coin	V			V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	803.8453895	8.709519358	1348.381109	0	204.5827446	8.322391569	0	314.628859	376.8583674	0	1056.869661	35.56697116	25.87163729	1016.494226	3327.976279	3028.37679	13.38136049	230.30965	616.7525764	230.5976091	19.96987139	639.5731527	0	0	326.5163745	0	139.9355891	0	0	0											3400	$200/Days 1-7 for Inpatient; PBP 1a	$200/Days 1-7 for Inpatient Mental Health; PBP 1b	$43/Day for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$40/Visit for Urgent Care; $50/Visit for Emergency Room; PBP 4a, 4b"	"$250/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$40/Visit for Radiology; $55/Visit for Diagnostic Radiology; PBP 8b	$40/Visit for Observation Room; PBP 9a	$40/Visit for OP Dialysis; PBP 12	"$40/Visit for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$20/Visit for Primary Care Physician; PBP 4b, 7a, 14a-j"	"$40/Visit for Specialty Physician, Podiatrist, Vision Exam, Hearing Exam; $15/Visit for Chiropractor; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"$40/Visit for OP Mental Health; PBP 7e, 7h"	"$40/Visit for Therapy (PT/OT/ST); PBP 7c, 7i"	$40/Case for Radiology; PBP 7d	$40/Visit for Other Health Care; PBP 7g	20% Coinsurance for Part B Drugs; PBP 15	$40/Visit for Other Medicare Part C; PBP 7g	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$40/Visit for Routine Vision Exam; PBP 17a	No Cost Sharing; PBP 17b	$40/Visit for Routine Hearing Exam; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	200	200	42.5	0	100	0.2	0	47.39517778	250	0	43.72689938	40	40	40	20	38.13329526	40	40	44.59358744	40	0.2	40	0	0	40	0	31.90181867	0	0	0											NO	178.7111647	178.7111647	37.9761225	0	89.35558236	0.178711165	0	42.35023712	223.3889559	0	39.07242559	35.74223294	35.74223294	35.74223294	17.87111647	34.07422806	35.74223294	35.74223294	39.84685975	35.74223294	0.178711165	35.74223294	0	0	35.74223294	0	28.50605586	0	0	0												11.9713	0.129707362	4.267190514	0	1.523384191	1.487304291	0	1.110383899	7.015499768	0	3.4412051	0.105936914	0.077059174	3.027647784	4.956220976	8.599133449	0.039856642	0.685981763	2.047971118	0.686839455	3.568838976	1.904981051	0	0	0.97253536	0	0.332417643	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9514	0	6.903422524	11.9713	0.129707362	4.267190514	0	1.523384191	1.487304291	0	1.110383899	7.015499768	0	3.4412051	0.105936914	0.077059174	3.027647784	4.956220976	8.599133449	0.039856642	0.685981763	2.047971118	0.686839455	3.568838976	1.904981051	0	0	0.97253536	0	0.332417643	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9514	YES	$200/Days 1-7 for Inpatient; PBP 1a	$200/Days 1-7 for Inpatient Mental Health; PBP 1b	$43/Day for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$40/Visit for Urgent Care; $50/Visit for Emergency Room; PBP 4a, 4b"	"$250/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$40/Visit for Radiology; $55/Visit for Therapuetic Radiology; PBP 8b	$40/Visit for Observation Room; PBP 9a	$40/Visit for OP Dialysis; PBP 12	"$40/Visit for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$20/Visit for Primary Care Physician; PBP 4b, 7a, 14a-j"	"$40/Visit for Specialty Physician, Podiatrist, Vision Exam, Hearing Exam; $15/Visit for Chiropractor; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"$40/Visit for OP Mental Health; PBP 7e, 7h"	"$40/Visit for Therapy (PT/OT/ST); PBP 7c, 7i"	$40/Case for Radiology; PBP 7d	$40/Visit for Other Health Care; PBP 7g	20% Coinsurance for Part B Drugs; PBP 15	$40/Visit for Other Medicare Part C; PBP 7g	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$40/Visit for Routine Vision Exam; PBP 17a	No Cost Sharing; PBP 17b	$40/Visit for Routine Hearing Exam; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											5100	1.3301	0.0144	0.4741	0	0.1693	0.1653	0	0.1234	0.7795	0	0.3824	0.0118	0.0086	0.3364	0.5507	0.9555	0.0044	0.0762	0.2276	0.0763	0.3965	0.2117	0	0	0.1081	0	0.0369	0	0	0											6.439	0	0.767046947	13.3015	0.144119292	4.741322793	0	1.692649101	1.652560323	0	1.233759887	7.794999742	0	3.823561222	0.117707682	0.085621304	3.364053093	5.506912195	9.554592721	0.044285158	0.762201959	2.275523464	0.76315495	3.96537664	2.116645612	0	0	1.080594844	0	0.369352937	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3905
H1846_801_0	2011	4																															Coin	Coin	Coin		Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	173.8770873	0.653489215	28.52231352	0	7.760070404	13.36535963	0	12.52872283	48.73373198	4.050146647	41.21964405	41.97563961	0.659645535	21.39338558	44.0627827	63.01475467	0.430890139	4.545456994	17.03096044	62.12667624	20.76641352	9.557950191	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.077395823	0.077395823	0.15774163	0	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	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070662503	0.070662503	0.144018345	0	0.21272935	0.21272935	0	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0	0	0	0	0	0	0	0												12.2866	0.046177183	4.107736402	0	1.650794732	2.843204265	0	2.665227063	10.36709512	0.861585063	8.76862808	8.929450523	0.140325966	4.551001007	9.373447117	13.40508779	0.091662979	0.966952111	3.622985143	13.21616744	4.417625646	2.03325653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.345	0	9.942873406	12.2866	0.046177183	4.107736402	0	1.650794732	2.843204265	0	2.665227063	10.36709512	0.861585063	8.76862808	8.929450523	0.140325966	4.551001007	9.373447117	13.40508779	0.091662979	0.966952111	3.622985143	13.21616744	4.417625646	2.03325653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.345	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											10000	1.3652	0.0051	0.4564	0	0.1834	0.3159	0	0.2961	1.1519	0.0957	0.9743	0.9922	0.0156	0.5057	1.0415	1.4895	0.0102	0.1074	0.4026	1.4685	0.4908	0.2259	0	0	0	0	0	0	0	0											11.5939	0	1.104763712	13.6518	0.051307981	4.564151558	0	1.834216369	3.15911585	0	2.961363403	11.51899458	0.957316737	9.742920088	9.921611692	0.15591774	5.056667785	10.41494124	14.89454199	0.101847755	1.074391235	4.025539047	14.68463049	4.90847294	2.259173922	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.9389
H1846_802_0	2011	3																															Coin	Coin	Coin		Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	173.8770873	0.653489215	28.52231352	0	7.760070404	13.36535963	0	12.52872283	48.73373198	4.050146647	41.21964405	41.97563961	0.659645535	21.39338558	44.0627827	63.01475467	0.430890139	4.545456994	17.03096044	62.12667624	20.76641352	9.557950191	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.077395823	0.077395823	0.15774163	0	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	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070662503	0.070662503	0.144018345	0	0.21272935	0.21272935	0	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0.21272935	0	0	0	0	0	0	0	0												12.2866	0.046177183	4.107736402	0	1.650794732	2.843204265	0	2.665227063	10.36709512	0.861585063	8.76862808	8.929450523	0.140325966	4.551001007	9.373447117	13.40508779	0.091662979	0.966952111	3.622985143	13.21616744	4.417625646	2.03325653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.345	0	9.942873406	12.2866	0.046177183	4.107736402	0	1.650794732	2.843204265	0	2.665227063	10.36709512	0.861585063	8.76862808	8.929450523	0.140325966	4.551001007	9.373447117	13.40508779	0.091662979	0.966952111	3.622985143	13.21616744	4.417625646	2.03325653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.345	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											10000	1.3652	0.0051	0.4564	0	0.1834	0.3159	0	0.2961	1.1519	0.0957	0.9743	0.9922	0.0156	0.5057	1.0415	1.4895	0.0102	0.1074	0.4026	1.4685	0.4908	0.2259	0	0	0	0	0	0	0	0											11.5939	0	1.104763712	13.6518	0.051307981	4.564151558	0	1.834216369	3.15911585	0	2.961363403	11.51899458	0.957316737	9.742920088	9.921611692	0.15591774	5.056667785	10.41494124	14.89454199	0.101847755	1.074391235	4.025539047	14.68463049	4.90847294	2.259173922	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.9389
H1849_005_0	2011	11	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	2592.817558	85.01727737	767.2495179	2303.842575	454.3115851	14.24229739	2.475233385	449.7597545	535.9517311	9420.98386	883.8579493	162.0626434	0.131809992	96.00450072	4340.312191	4641.089318	4.99937808	1888.900385	606.1745922	1215.324559	32.76837247	2.132763033	0	0	378	299	0	0	3666.919263	0	2.372029257	6.543353273	26.33840799	0	0	0	0	0	0	0	3400	1A: $260/day (days1-8) $2080 yrly max	1B: $260/day (days1-8) $2080 yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $150 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $40 copay	9A: $40-$200copay; 9B: $200 copay	8A: $0-$140 copay	8B: $85-$140 copay	9A: $200 copay	12: 20% coin	3: $35 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $20 copay; 7G: $20 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $40 copay; 7F: $40 copay; 7G: $40 copay	7E: $40 copay; 7H: $40 copay	7C: $40-$50 copay; 7I: $40-$50 copay	8B: $85-$140 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$40; 17B: $0; 18A: $40	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	17A: $40 copay	17B: $40 copay	-	-	14A: $0 copay;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay									260	260	128	0	150	0.2	0.067131918	49.98517787	167.9211175	23.81874569	105.3064275	200	0.2	1.28440367	17.67126157	39.74685817	40	48.5443076	98.9862543	19.0325812	0.2	0	0	0	40	40	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	123.7384552	99.0766131	110.017381	0	128.9266183	0.171902158	0.057700608	42.96279966	144.3300122	20.4724689	90.51201057	171.9021578	0.171902158	1.103958811	15.18863997	34.16285342	34.38043155	41.72435611	85.07975351	16.35870888	0.171902158	0	0	0	40	40	0	0	0	0	0.171902158	0.171902158	0	0	0	0	0	0	0	0		26.7359	0.701935325	7.034231876	0	4.881071361	2.448281653	0.142822471	1.610244852	6.446159989	16.07256659	6.666646671	2.321576508	0.022658422	0.008832085	5.493619938	13.21273784	0.014323398	6.567762694	4.297765408	1.656761722	5.632953934	0	0	0	1.26	0.996666667	0	0	0	0	0.407756947	1.124816547	0	0	0	0	0	0	0	0	115.7581		18.55210101	26.7359	0.701935325	7.034231876	0	4.881071361	2.448281653	0.142822471	1.610244852	6.446159989	16.07256659	6.666646671	2.321576508	0.022658422	0.008832085	5.493619938	13.21273784	0.014323398	6.567762694	4.297765408	1.656761722	5.632953934	0	0	0	1.26	0.996666667	0	0	0	0	0.407756947	1.124816547	0	0	0	0	0	0	0	0	115.7581	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	26.7359	0.701935325	7.034231876	0	4.881071361	2.448281653	0.142822471	1.610244852	6.446159989	16.07256659	6.666646671	2.321576508	0.022658422	0.008832085	5.493619938	13.21273784	0.014323398	6.567762694	4.297765408	1.656761722	5.632953934	0	0	0	1.26	0.996666667	0	0	0	0	0.407756947	1.124816547	0	0	0	0	0	0	0	0	115.7581
H1849_015_0	2011	11	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	2373.575764	93.83674471	832.0191364	1680.830111	447.8534159	15.20699036	3.256171189	414.0118387	573.3401432	10065.29946	634.2748444	64.05068025	0.012784051	43.27748666	4166.19377	5125.851213	10.80850416	1849.799671	807.6900378	1415.361821	33.76037752	1.006029633	0	0	378	299	0	0	3673.708318	0	11.28497418	5.254004839	10.53066716	0	0	0	0	0	0	0	3400	1A: $265/day (days1-8) $2120 yrly max	1B: $265/day (days1-8) $2120 yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $100 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $35 copay	9A: $40-$200copay; 9B: $200 copay	8A: $0-$150 copay	8B: $85-$150 copay	9A: $200 copay	12: 20% coin	3: $35 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $0 copay; 7G: $0 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $40 copay; 7F: $40 copay; 7G: $40 copay	7E: $40 copay; 7H: $40 copay	7C: $40-$50 copay; 7I: $40-$50 copay	8B: $85-$150 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$40; 17B: $0; 18A: $40	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	17A: $40 copay	17B: $40 copay	-	-	14A: $0 copay;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay									265	265	128	0	100	0.2	0.090292397	49.98733108	165.3140097	19.81993742	117.8902838	200	0.2	23	0	38.31309904	40	48.41174804	96.99310624	20.06797016	0.2	0	0	0	40	40	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	119.6368154	103.9066934	110.882439	0	86.62690546	0.173253811	0.07821751	43.30247804	143.2064109	17.16939845	102.1247047	173.2538109	0.173253811	19.92418826	0	33.18945209	34.65076219	41.93759921	84.02212645	17.38426154	0.173253811	0	0	0	40	40	0	0	0	0	0.173253811	0.173253811	0	0	0	0	0	0	0	0		23.6639	0.812522156	7.688025928	0	3.23301296	2.634669033	0.254689601	1.493978213	6.842165343	14.40126141	5.397927601	0.924752037	0.002214886	0.071855733	0	14.1770161	0.031210242	6.464679769	5.655319541	2.05041834	5.849114064	0	0	0	1.26	0.996666667	0	0	0	0	1.955164782	0.910276361	0	0	0	0	0	0	0	0	106.7709		16.13445842	23.6639	0.812522156	7.688025928	0	3.23301296	2.634669033	0.254689601	1.493978213	6.842165343	14.40126141	5.397927601	0.924752037	0.002214886	0.071855733	0	14.1770161	0.031210242	6.464679769	5.655319541	2.05041834	5.849114064	0	0	0	1.26	0.996666667	0	0	0	0	1.955164782	0.910276361	0	0	0	0	0	0	0	0	106.7709	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	23.6639	0.812522156	7.688025928	0	3.23301296	2.634669033	0.254689601	1.493978213	6.842165343	14.40126141	5.397927601	0.924752037	0.002214886	0.071855733	0	14.1770161	0.031210242	6.464679769	5.655319541	2.05041834	5.849114064	0	0	0	1.26	0.996666667	0	0	0	0	1.955164782	0.910276361	0	0	0	0	0	0	0	0	106.7709
H1849_801_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	331.4185133	3.968175081	70.53202245	11.62325791	11.66226726	12.36485938	3.121077299	15.66586209	48.28457948	6.764872811	28.24543871	0	0.0248383	34.5571907	44.95118402	123.7710147	1.197239864	4.760693225	18.70756141	22.58739995	38.91265497	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.07958819	0.07958819	0.18104765	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.063192749	0.063192749	0.143751211	0	0.185001199	0.185001199	0.185001199	0.185001199	0.185001199	0.185001199	0.185001199	0.185001199	0.185001199	0.185001199	0.185001199	0.185001199	0.185001199	0.185001199	0.185001199	0.185001199	0.185001199	0.185001199																				20.9432	0.250759893	10.13906366	0	2.157533424	2.287513808	0.577403042	2.898203265	8.932705083	1.251509579	5.225440021	0	0.004595115	6.393121703	8.316022927	22.89778608	0.22149081	0.880733953	3.460921287	4.178696067	7.198887814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.2156		28.07668692	20.9432	0.250759893	10.13906366	0	2.157533424	2.287513808	0.577403042	2.898203265	8.932705083	1.251509579	5.225440021	0	0.004595115	6.393121703	8.316022927	22.89778608	0.22149081	0.880733953	3.460921287	4.178696067	7.198887814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.2156	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	20.9432	0.250759893	10.13906366	0	2.157533424	2.287513808	0.577403042	2.898203265	8.932705083	1.251509579	5.225440021	0	0.004595115	6.393121703	8.316022927	22.89778608	0.22149081	0.880733953	3.460921287	4.178696067	7.198887814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.2156
H1849_803_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	379.2870842	4.5413201	66.63975113	15.54252842	15.01832493	13.41752536	3.386786095	20.53366233	47.40743093	6.839184259	28.55571202	0	0.025111146	34.93679796	47.02892268	129.4919724	1.25257882	4.980742521	19.57226441	23.63143728	33.84310815	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.07958819	0.07958819	0.18104765	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.062308294	0.062308294	0.141739248	0	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894																				23.6327	0.282961908	9.445468207	0	2.739521102	2.447516221	0.617790068	3.745584247	8.647679288	1.247548557	5.208901527	0	0.004580572	6.372887503	8.578634882	23.62087601	0.228485275	0.908546679	3.570213831	4.310655244	6.173385472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.784		31.00093431	23.6327	0.282961908	9.445468207	0	2.739521102	2.447516221	0.617790068	3.745584247	8.647679288	1.247548557	5.208901527	0	0.004580572	6.372887503	8.578634882	23.62087601	0.228485275	0.908546679	3.570213831	4.310655244	6.173385472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.784	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	23.6327	0.282961908	9.445468207	0	2.739521102	2.447516221	0.617790068	3.745584247	8.647679288	1.247548557	5.208901527	0	0.004580572	6.372887503	8.578634882	23.62087601	0.228485275	0.908546679	3.570213831	4.310655244	6.173385472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.784
H1849_804_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	379.2870842	4.5413201	66.63975113	15.54252842	15.01832493	13.41752536	3.386786095	20.53366233	47.40743093	6.839184259	28.55571202	0	0.025111146	34.93679796	47.02892268	129.4919724	1.25257882	4.980742521	19.57226441	23.63143728	33.84310815	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.07958819	0.07958819	0.18104765	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.062308294	0.062308294	0.141739248	0	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894	0.182411894																				23.6327	0.282961908	9.445468207	0	2.739521102	2.447516221	0.617790068	3.745584247	8.647679288	1.247548557	5.208901527	0	0.004580572	6.372887503	8.578634882	23.62087601	0.228485275	0.908546679	3.570213831	4.310655244	6.173385472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.784		31.00093431	23.6327	0.282961908	9.445468207	0	2.739521102	2.447516221	0.617790068	3.745584247	8.647679288	1.247548557	5.208901527	0	0.004580572	6.372887503	8.578634882	23.62087601	0.228485275	0.908546679	3.570213831	4.310655244	6.173385472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.784	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	23.6327	0.282961908	9.445468207	0	2.739521102	2.447516221	0.617790068	3.745584247	8.647679288	1.247548557	5.208901527	0	0.004580572	6.372887503	8.578634882	23.62087601	0.228485275	0.908546679	3.570213831	4.310655244	6.173385472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.784
H1903_005_0	2011	4																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1768.123245	153.4728951	401.8732357	1974.838732	530.2444996	8.958321883	7.509093779	556.8814848	364.849206	6602.83007	1562.72902	26.67624988	0.137750668	2313.662628	10338.67148	20613.66195	630.122058	2881.559265	4641.497762	4201.569741	27.73789679	0.104047162	0	0	331.2	198.72	0	0	0	0											3350	"(1a) $25 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $25 days 1 - 5, $0 after day 5, unlimited coverage"	(2) $0 days 1 - 100	(6) Copay between $0.00 and $25.00	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) , (9b) $25.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $25.00 copayment	(12) 20% coinsurance	"(9a) , (9d) $25.00 copayment"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) $25.00 copayment"	"(7e) , (7h) $25.00 copayment"	"(7c) , (7i) $25.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $25.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	Not Covered	Not Covered	Not Covered	Not Covered											0	15.0725	7.777418113	0	5.88587342	40.80794172	0.2	0.121574098	42.99999532	18.24103365	0	11.94824278	3.907145376	0.2	8.911367231	0	5.666603796	17.52570057	6.11241651	4.331837779	6.252794048	0.2	0	0	0	0	0	0	0	0	0											NO	14.77451585	7.623658132	0	5.769509381	40.00116648	0.196045989	0.119170571	42.14988306	17.88040742	0	11.71202537	3.829900899	0.196045989	8.735189014	0	5.554574729	17.17921652	5.991573701	4.246197109	6.129175968	0.196045989	0	0	0	0	0	0	0	0	0												2.1769	0.097502074	0	0.949487549	1.767533209	1.756243074	0.894862993	1.956040789	0.543637704	0	1.525226827	0.008513949	0.027005466	1.684190031	0	9.541677147	0.902083606	1.438756226	1.642392865	2.146013357	5.437903412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.496	0	0.69574269	2.1769	0.097502074	0	0.949487549	1.767533209	1.756243074	0.894862993	1.956040789	0.543637704	0	1.525226827	0.008513949	0.027005466	1.684190031	0	9.541677147	0.902083606	1.438756226	1.642392865	2.146013357	5.437903412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.496	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	2.1769	0.097502074	0	0.949487549	1.767533209	1.756243074	0.894862993	1.956040789	0.543637704	0	1.525226827	0.008513949	0.027005466	1.684190031	0	9.541677147	0.902083606	1.438756226	1.642392865	2.146013357	5.437903412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.496
H1903_011_0	2011	6																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	P	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	Yes	2432.143668	628.1639985	378.0917286	2251.477045	16.84413382	18.78924653	18.56878909	36.67389543	41.51262652	6811.871027	18.28024012	0.467294723	0.059978111	21.63111409	10981.05386	100.659168	38.50499013	4.310498251	30.89169959	17.44719551	33.03073879	0.102265872	0	625.2	331.2	198.72	16.2	12.34285714	0	3439.440935											6700	FFS	FFS	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) $0.00 copayment	(8b) 20% coinsurance	(5) 45% coinsurance	(12) 20% coinsurance	"(9a) , (9d) 20% coinsurance"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) 20% coinsurance"	"(7e) , (7h) 45% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) 20% coinsurance"	(15) 20% coinsurance	(13a) 20% coinsurance	Not Covered	"(16) $0.00 copayment, $1,000 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	Not Covered	"(13b) , (13c) $0.00 copayment"											0	122.8876791	55.47711107	36.6105396	0	0.1814733	0.19740001	0.118325874	0.16972357	0.172234857	0	0.184630567	0.436514386	0.1974	0.136376804	0	0.073128243	0.333711257	0.151018995	0.166167117	0.148422005	0.19740017	0.196041896	0	0	0	0	0	0	0	0											NO	118.2819441	53.39787193	35.23840494	0	0.174671822	0.19000161	0.113891112	0.163362462	0.165779628	0	0.177710757	0.420154165	0.190001601	0.131265507	0	0.070387453	0.321204017	0.14535892	0.159939302	0.142859263	0.190001764	0.188694397	0	0	0	0	0	0	0	0												23.9732	2.795218396	1.110279119	0	2.94219554	3.569987098	2.114820032	5.991137848	6.881947799	0	3.248595306	0.196335824	0.011395937	2.839419153	0	7.085142465	12.36795752	0.62656937	4.940796882	2.492493491	6.275898639	0.019296997	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4827	0	3.484332766	23.9732	2.795218396	1.110279119	0	2.94219554	3.569987098	2.114820032	5.991137848	6.881947799	0	3.248595306	0.196335824	0.011395937	2.839419153	0	7.085142465	12.36795752	0.62656937	4.940796882	2.492493491	6.275898639	0.019296997	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4827	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	23.9732	2.795218396	1.110279119	0	2.94219554	3.569987098	2.114820032	5.991137848	6.881947799	0	3.248595306	0.196335824	0.011395937	2.839419153	0	7.085142465	12.36795752	0.62656937	4.940796882	2.492493491	6.275898639	0.019296997	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4827
H1903_022_0	2011	5																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	2164.235106	169.4889489	118.0091695	1060.619929	500.7314362	12.0018312	13.55813765	629.2039921	421.4459557	7290.620304	1217.485898	57.28754281	1.854061237	1682.156912	12595.86426	17458.09922	240.8397033	1761.701886	4824.724709	3603.131361	28.8414439	0.019438798	0	209.1428571	0	0	16.2	12.34285714	0	0											4000	"(1a) $50 days 0 - 8, $0 after day 8, unlimited coverage"	"(1b) $50 days 0 - 8, $0 after day 8, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) , (9b) $25.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $50.00 copayment	(12) 20% coinsurance	"(9a) $25.00 copayment , (9d) Copay between $20.00 and $25.00"	"(14b) , (14c) $0.00 copayment ; (7a) $5.00 copayment"	"(7b) , (7d) , (7g) $20.00 copayment"	"(7e) , (7h) $20.00 copayment"	"(7c) , (7i) $20.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $20.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	"(16) $0.00 copayment,   benefit limit"	Not Covered	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											0	45.01860971	18.69073586	27.38366939	0	49.0614497	0.2	0.119325699	44.22293338	24.9209714	0	12.18940323	9.143578593	0.2	11.34143494	1.587954701	4.83193744	14.39136784	3.232946817	4.975187996	17.23634028	0.2	0	0	0	0	0	0	0	0	0											NO	44.05704065	18.29151355	26.79877151	0	48.01352813	0.195728126	0.116776977	43.27835946	24.38867519	0	11.92904528	8.94827753	0.195728126	11.09918905	1.554036992	4.728730309	14.08397732	3.163893115	4.868921123	16.86818294	0.195728126	0	0	0	0	0	0	0	0	0												7.9458	0.258350784	0.263541731	0	2.003490241	2.349095934	1.583278328	2.269243045	0.856542377	0	1.210287034	0.042718736	0.362891932	1.555881465	1.631203251	6.879553577	0.282665077	0.464486372	1.957600338	5.064856578	5.645081775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6266	0	0.930348578	7.9458	0.258350784	0.263541731	0	2.003490241	2.349095934	1.583278328	2.269243045	0.856542377	0	1.210287034	0.042718736	0.362891932	1.555881465	1.631203251	6.879553577	0.282665077	0.464486372	1.957600338	5.064856578	5.645081775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6266	NO	30% coinsurance	Not covered OON	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	Same as in-network	30% coinsurance	30% coinsurance	30% coinsurance	Not covered OON	Not covered OON	30% coinsurance	Not covered OON	30% coinsurance	Not covered OON	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.9753	0	0.0188	0.1594	0.0337	0.036	0.0406	0	0.1506	0.0454	0.0554	0	0	0.0405	0	0.2938	0	0.0139	0.0878	0.0418	0.0864	0.0001	0	0	0	0	0	0	0	0											2.0793	0	0	8.9211	0.258350784	0.282385836	0.159399722	2.037182857	2.385065095	1.623911697	2.269243045	1.007111978	0.045352964	1.265719233	0.042718736	0.362891932	1.596337364	1.631203251	7.173332372	0.282665077	0.478385622	2.045390064	5.106620616	5.731518797	5.83E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7059
H1903_024_0	2011	7																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1696.898446	183.304589	243.467968	2443.562271	532.1216564	9.600888197	9.131198809	659.2995757	322.2592314	6633.203252	1635.581655	26.24189257	0.092072449	2689.276057	7976.816576	19429.38186	956.4508585	2601.156312	4060.137479	3967.582368	26.09083356	0.056408364	0	0	331.2	198.72	0	0	0	0											6000	"(1a) $250 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $250 days 1 - 5, $0 after day 5, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $250.00 copayment	(12) 20% coinsurance	"(9a) $150.00 copayment , (9d) Copay between $35.00 and $150.00"	"(14b) , (14c) $0.00 copayment ; (7a) $10.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	Not Covered	Not Covered	Not Covered	Not Covered											0	149.7970511	72.79390788	39.27	0	35.87508706	0.2	0.120233592	43.33035695	107.0621206	0	11.45477459	39.07145376	0.2	15.26620314	3.200932851	7.680289011	24.24913054	8.560776776	4.648869977	6.261385735	0.2	0	0	0	0	0	0	0	0	0											NO	146.6326062	71.25614522	38.44042592	0	35.11723011	0.195775024	0.117693671	42.41500831	104.800446	0	11.21279384	38.24607395	0.195775024	14.94370642	3.133313525	7.518043818	23.73687054	8.379931383	4.550663151	6.129114706	0.195775024	0	0	0	0	0	0	0	0	0												20.7351	1.088464868	0.779917699	0	1.557219888	1.879614115	1.074684311	2.330349749	2.814409266	0	1.528286659	0.083637447	0.018025486	3.348979322	2.082822272	12.17257868	1.891929184	1.816459285	1.539693168	2.02648062	5.10793356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8765	0	1.378505053	20.7351	1.088464868	0.779917699	0	1.557219888	1.879614115	1.074684311	2.330349749	2.814409266	0	1.528286659	0.083637447	0.018025486	3.348979322	2.082822272	12.17257868	1.891929184	1.816459285	1.539693168	2.02648062	5.10793356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8765	NO	30% coinsurance	Not covered OON	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	Same as in-network	30% coinsurance	30% coinsurance	30% coinsurance	Not covered OON	Not covered OON	30% coinsurance	Not covered OON	30% coinsurance	Not covered OON	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.8023	0	0.0149	0.1249	0.021	0.0288	0.0274	0	0.1558	0.0207	0.0565	0	0	0.0489	0	0.3102	0	0.0161	0.0774	0.0546	0.0782	0.0002	0	0	0	0	0	0	0	0											1.838	0	0	21.5374	1.088464868	0.794841437	0.124945308	1.578221638	1.908387715	1.102050265	2.330349749	2.970234138	0.020688246	1.584825038	0.083637447	0.018025486	3.397832649	2.082822272	12.48276625	1.891929184	1.832576949	1.617141476	2.081080645	5.186127077	0.000169054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7145
H1906_001_0	2011	5	r.	s.	t.	u.	v.						OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						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		V	Coin	O							O	O	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	NO	1884.531798	116.89896	430.81808	2998.871836	13.523983	19.994521	10.917478	470.771222	58.532773	13.257792	19.628301	7.395922	0.323918	28.289659	3731.779051	4055.09833	62.377946	1.45642		1779.290667	19.260203	0							4.21	0.73	581.602382	350.894626	0	0	494.081103							$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"20% Coins, up to $50 maximum:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	66.51235	0	0.2	0.2	0.2	50	0.240065	0.25	0.242867	0.25	0.2	0.233434	15	35	35	0.25		0	0.2	0							0	0	0	16.289899	0	0	15						NO	140.806008	120.549591	47.036935	0	0.175351	0.175351	0.175351	43.83785	0.210479	0.219189	0.212935	0.219189	0.175351	0.204665	13.151355	30.686495	30.686495	0.219189		0	0.175351	0							0	0	0	14.282283	0	0	13.151355							22.1128	1.174343485	1.688696835	0	2.371443943	3.506059252	1.914390685	1.719799851	12.31991953	2.905962171	4.179552273	1.621104747	0.056799345	5.789903059	4.089829257	10.36972955	0.159513377	0.319231243	0	0	3.377295856	0	0	0	0	0	0	0	0	0	0	0.417631363	0	0	0.541486332	0	0	0	0	0	80.6355	0	11.97690728	22.1128	1.174343485	1.688696835	0	2.371443943	3.506059252	1.914390685	1.719799851	12.31991953	2.905962171	4.179552273	1.621104747	0.056799345	5.789903059	4.089829257	10.36972955	0.159513377	0.319231243	0	0	3.377295856	0	0	0	0	0	0	0	0	0	0	0.417631363	0	0	0.541486332	0	0	0	0	0	80.6355	YES																																									5000																																									0	0	0	22.1128	1.174343485	1.688696835	0	2.371443943	3.506059252	1.914390685	1.719799851	12.31991953	2.905962171	4.179552273	1.621104747	0.056799345	5.789903059	4.089829257	10.36972955	0.159513377	0.319231243	0	0	3.377295856	0	0	0	0	0	0	0	0	0	0	0.417631363	0	0	0.541486332	0	0	0	0	0	80.6355
H1906_010_0	2011	1	r.	s.									OP Facility - Other	OP Facility - Other									Lab	Radiology									Coin	Coin	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	O							O	O	V	V									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0									0	NO	338.45053	7.313071	439.128277	3056.718094	13.784852	20.380202	11.128069	479.852088	78.574491	13.513527	31.037047	7.538584	0.330167	28.835348	32.856103	59.205526	0.395388	5.250496		1813.61201	19.631717	0							4.21	0.73	592.821108	191.197534										Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	20% Coins:8a.Lab -- OP	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Visit:8a.Lab -- FSL	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"										0.079192	0.079192	45.408962	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	0.2	0							0	0	0	0									NO	0.073094	0.073094	38.11206	0	0.18271	0.18271	0.18271	45.67755	0.18271	0.18271	0.18271	0.18271	0.18271	0.18271	0.18271	0.18271	0.18271	0.18271		0	0.18271	0							0	0	0	0										24.7387	0.534541612	1.394673603	0	2.518630309	3.723666707	2.033209487	1.826538979	14.35634525	2.469056518	5.670778857	1.377374683	0.060324813	5.268506433	6.003138579	10.81744166	0.072241341	0.959318124	0	0	3.586911013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.4114	0	8.123554627	24.7387	0.534541612	1.394673603	0	2.518630309	3.723666707	2.033209487	1.826538979	14.35634525	2.469056518	5.670778857	1.377374683	0.060324813	5.268506433	6.003138579	10.81744166	0.072241341	0.959318124	0	0	3.586911013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.4114	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Day(Days 1-20) $137(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		$0/Visit	20% Coins	$0/Service									$0/Visit	$0/Visit									6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0									0	0									0	0	0	24.7387	0.534541612	1.394673603	0	2.518630309	3.723666707	2.033209487	1.826538979	14.35634525	2.469056518	5.670778857	1.377374683	0.060324813	5.268506433	6.003138579	10.81744166	0.072241341	0.959318124	0	0	3.586911013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.4114
H1944_001_0	2011	6																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1175.731493	125.0722207	768.9478877	934.2735035	152.8218133	8.616919204	9.593049206	328.0060361	39.02146604	18.08235664	39.68230435	0	0.090915415	25.43272302	5595.700187	100.4676492	564.2969048	410.2835528	0	0	14.69679838	1331.509914	0	0	123.3120543	0	15.00551274	6	134.9985469	0											3950	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-50 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												187.4696942	115.9014585	61.26941619	0	200	0.2	0.108800681	49.18061258	0.2	0.110080435	0.161831705	0	0.2	0.160613882	6.646096771	0.095411733	38.5	30	0	0	0.2	29.81516198	0	0	30	0	0	0	0	0											YES	143.9912023	89.02127054	47.05964311	0	153.6154448	0.153615445	0.083567325	37.79066625	0.153615445	0.084550275	0.124299247	0	0.153615445	0.123363865	6.384497699	0.091680408	36.98458959	28.81916072	0	0	0.153615445	22.90034685	0	0	30	0	0	0	0	0											6950	14.1079	0.927840666	3.01553443	0	1.956315903	1.323691876	0.801665462	1.032963886	5.994299863	1.528868223	4.932480534	0	0.013966012	3.137479007	2.977144581	9.210915072	1.739190786	0.985335637	0	0	2.25765522	2.541003239	0	0	0.308280136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7925	0	13.76449753	14.1079	0.927840666	3.01553443	0	1.956315903	1.323691876	0.801665462	1.032963886	5.994299863	1.528868223	4.932480534	0	0.013966012	3.137479007	2.977144581	9.210915072	1.739190786	0.985335637	0	0	2.25765522	2.541003239	0	0	0.308280136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7925	NO	"$395 Days 1-18 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$395 Days 1-18 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-40 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.5831	0.1423	0.7216	0.3666	0.3423	0.3475	0.3868	0.1808	1.5735	0.2675	1.2713	0	0.0024	0.8213	1.4123	2.0616	0.3328	0.2225	0	0	0.5695	0.57	0	0	0.0697	0	0.0085	0	0	0											13.254	0	3.031174203	15.691	1.070159585	3.737100886	0.366637581	2.298665045	1.671154762	1.188489161	1.213732131	7.567775356	1.796415364	6.203768451	0	0.01641002	3.958793786	4.389401949	11.27247128	2.072039679	1.20786857	0	0	2.827174842	3.110964014	0	0	0.377988704	0	0.008482649	0	0	0	0	0	0	0	0	0	0	0	0	0	72.0465
H1944_801_0	2011	1																															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	231.5838442	7.5946815	24.59388794	981.0837659	6.820405285	9.047680823	10.07260777	15.5622333	40.62371053	18.82482891	41.31168326	0	0.094648455	26.46595227	36.35798813	110.4090669	3.3067125	5.08319581	0	0	15.97463193	9.602752378	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.059588536	0.059588536	0.120250335	0	0.188055567	0.188055567	0.188055567	0.188055567	0.188055567	0.188055567	0.188055567	0	0.188055567	0.188055567	0.188055567	0.188055567	0.188055567	0.188055567	0	0	0.188055567	0.188055567	0	0	0	0	0	0	0	0												13.7997	0.452555951	2.957423262	0	1.282615182	1.701466746	1.894209964	2.926564606	7.639514912	3.540113871	7.768892013	0	0.017799169	4.977069657	6.837322068	20.76303966	0.621845694	0.95592327	0	0	3.004118463	1.805851042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9461	0	19.82373645	13.7997	0.452555951	2.957423262	0	1.282615182	1.701466746	1.894209964	2.926564606	7.639514912	3.540113871	7.768892013	0	0.017799169	4.977069657	6.837322068	20.76303966	0.621845694	0.95592327	0	0	3.004118463	1.805851042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9461	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9951	0.0326	0.3624	0	0.2804	0.372	0.4142	0.6399	1.6704	0.774	1.6986	0	0.0039	1.0882	1.4367	4.3628	0.1307	0.2009	0	0	0.6312	0.3794	0	0	0	0	0	0	0	0											15.4734	0	0	14.7949	0.485190145	3.31982004	0	1.563054199	2.073486093	2.308371895	3.566447022	9.309866304	4.314146542	9.467531225	0	0.021690891	6.065287341	8.273994149	25.12581196	0.752509181	1.15678382	0	0	3.635349971	2.185300152	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4195
H1944_802_0	2011	1																															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	231.5838442	7.5956265	24.59388794	981.0837659	6.820405285	9.047680823	10.07260777	15.5622333	40.62371053	18.82482891	41.31168326	0	0.094648455	26.46561227	36.35798813	110.4090669	3.3058575	5.08319581	0	0	15.97463193	9.602752378	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.059588571	0.059588571	0.120250406	0	0.188055679	0.188055679	0.188055679	0.188055679	0.188055679	0.188055679	0.188055679	0	0.188055679	0.188055679	0.188055679	0.188055679	0.188055679	0.188055679	0	0	0.188055679	0.188055679	0	0	0	0	0	0	0	0												13.7998	0.452612531	2.957425018	0	1.282615944	1.701467756	1.894211089	2.926566344	7.639519449	3.540115974	7.768896627	0	0.017799179	4.977008674	6.837326129	20.76305199	0.621685275	0.955923837	0	0	3.004120247	1.805852114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9459	0	19.82364694	13.7998	0.452612531	2.957425018	0	1.282615944	1.701467756	1.894211089	2.926566344	7.639519449	3.540115974	7.768896627	0	0.017799179	4.977008674	6.837326129	20.76305199	0.621685275	0.955923837	0	0	3.004120247	1.805852114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9459	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9951	0.0326	0.3624	0	0.2804	0.372	0.4142	0.6399	1.6704	0.774	1.6986	0	0.0039	1.0882	1.4367	4.3628	0.1306	0.2009	0	0	0.6312	0.3794	0	0	0	0	0	0	0	0											15.4734	0	0	14.7949	0.485250786	3.319821797	0	1.563054961	2.073487103	2.30837302	3.56644876	9.309870841	4.314148645	9.467535839	0	0.021690901	6.065212378	8.273998209	25.1258243	0.752314978	1.156784387	0	0	3.635351755	2.185301224	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4193
H1944_803_0	2011	1																															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	231.5838442	7.5956265	24.59388794	981.0837659	6.820405285	9.047680823	10.07260777	15.5622333	40.62371053	18.82482891	41.31168326	0	0.094648455	26.46561227	36.35798813	110.4090669	3.3058575	5.08319581	0	0	15.97463193	9.602752378	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.059588571	0.059588571	0.120250406	0	0.188055679	0.188055679	0.188055679	0.188055679	0.188055679	0.188055679	0.188055679	0	0.188055679	0.188055679	0.188055679	0.188055679	0.188055679	0.188055679	0	0	0.188055679	0.188055679	0	0	0	0	0	0	0	0												13.7998	0.452612531	2.957425018	0	1.282615944	1.701467756	1.894211089	2.926566344	7.639519449	3.540115974	7.768896627	0	0.017799179	4.977008674	6.837326129	20.76305199	0.621685275	0.955923837	0	0	3.004120247	1.805852114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9459	0	19.82364694	13.7998	0.452612531	2.957425018	0	1.282615944	1.701467756	1.894211089	2.926566344	7.639519449	3.540115974	7.768896627	0	0.017799179	4.977008674	6.837326129	20.76305199	0.621685275	0.955923837	0	0	3.004120247	1.805852114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9459	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9951	0.0326	0.3624	0	0.2804	0.372	0.4142	0.6399	1.6704	0.774	1.6986	0	0.0039	1.0882	1.4367	4.3628	0.1306	0.2009	0	0	0.6312	0.3794	0	0	0	0	0	0	0	0											15.4734	0	0	14.7949	0.485250786	3.319821797	0	1.563054961	2.073487103	2.30837302	3.56644876	9.309870841	4.314148645	9.467535839	0	0.021690901	6.065212378	8.273998209	25.1258243	0.752314978	1.156784387	0	0	3.635351755	2.185301224	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4193
H1951_001_0	2011	4	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O		V	V		V		O	O	O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0		0		0	0	0										0	YES	1593.814074	74.967028	351.127531	3035.698277	199.762431	11.186392	1.618994	419.884168	585.156546	3281.390772	1614.032146	139.041873	0.660935	840.9429	2537.752596	8153.610032	44.668894	1743.699233		893.284931	14.585083	0		2.33	1.65		0.31		4.6	0.73	12675.65134										6700	$50/Day(Days 1-10):1a.IP Acute	$50/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$20/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a, 17b"		"HER757: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"											40.40155	36.43305	66.51235	0	100	0.2	0.2	50	100	0	29.07127	50	0.2	32.537426	10	20	20	10		0	0.2	0		0	0		0		0	0	0										NO	39.732662	35.829864	65.19055	0	98.0645	0.196129	0.196129	49.03225	98.0645	0	28.508595	49.03225	0.196129	31.907664	9.80645	19.6129	19.6129	9.80645		0	0.196129	0		0	0		0		0	0	0											5.2772	0.223838201	1.907516406	0	1.63246691	2.193975877	0.317531674	1.715655458	4.781923675	0	3.834482397	0.56812799	0.129628521	2.236043625	2.073861995	13.32632818	0.073007213	1.424958279	0	0	2.860557744	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.5771	0	0.864881244	5.2772	0.223838201	1.907516406	0	1.63246691	2.193975877	0.317531674	1.715655458	4.781923675	0	3.834482397	0.56812799	0.129628521	2.236043625	2.073861995	13.32632818	0.073007213	1.424958279	0	0	2.860557744	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.5771	NO																																																																																		0	0	0	5.2772	0.223838201	1.907516406	0	1.63246691	2.193975877	0.317531674	1.715655458	4.781923675	0	3.834482397	0.56812799	0.129628521	2.236043625	2.073861995	13.32632818	0.073007213	1.424958279	0	0	2.860557744	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.5771
H1951_005_0	2011	5	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O		V	V		V		O	O	O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0		0		0	0	0										0	YES	1684.697297	79.513546	284.309018	3266.93857	199.613736	15.070077	2.538152	365.450881	569.819108	2078.169005	1072.351566	53.037436	0.345097	486.036786	3322.032696	9014.153041	46.860305	1676.845184		1607.19828	25.547744	0		2.33	1.65		0.31		4.6	0.73	18692.3575										6700	$25/Day(Days 1-10):1a.IP Acute	$25/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $5 Therapy (AT,PT,ST,OT) -- CORF"	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$15/Visit:7e, 7h.Psych -- Other Provider"	"$5/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a, 17b"		"HER757: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"											20.200775	18.216525	66.51235	0	100	0.2	0.2	50	100	0	52.596034	50	0.2	40.926153	5	15	15	5		0	0.2	0		0	0		0		0	0	0										NO	19.932145	17.974282	65.798273	0	98.3791	0.196758	0.196758	49.18955	98.3791	0	51.743505	49.18955	0.196758	40.262781	4.918955	14.756865	14.756865	4.918955		0	0.196758	0		0	0		0		0	0	0											2.7983	0.119099908	1.558920199	0	1.636484975	2.96515821	0.499401711	1.498030365	4.671524251	0	4.623935718	0.217407301	0.067900596	1.630766056	1.361744112	11.08505329	0.057625933	0.6873605	0	0	5.026723014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5054	0	0.649854714	2.7983	0.119099908	1.558920199	0	1.636484975	2.96515821	0.499401711	1.498030365	4.671524251	0	4.623935718	0.217407301	0.067900596	1.630766056	1.361744112	11.08505329	0.057625933	0.6873605	0	0	5.026723014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5054	NO																																																																																		0	0	0	2.7983	0.119099908	1.558920199	0	1.636484975	2.96515821	0.499401711	1.498030365	4.671524251	0	4.623935718	0.217407301	0.067900596	1.630766056	1.361744112	11.08505329	0.057625933	0.6873605	0	0	5.026723014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5054
H1951_013_0	2011	5	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	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	YES	1866.976383	61.649647	400.165889	2182.917382	146.574497	10.501782	1.581065	380.631594	526.651983	3388.074759	1320.047942	119.961733	0.376772	652.105047	4900.834857	4588.256727	33.837078	966.527072		1779.872685	17.368904	0		2.33					4.21	1.02	11674.92881										4900	$175/Day(Days 1-7):1a.IP Acute	$175/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$150/Visit:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"											125.7585	107.666825	66.51235	0	100	0.2	0.2	50	250	0	77.640562	50	0.2	42.081804	10	25	25	10		0	0.2	0		0					0	0	0										NO	116.817699	100.012252	53.760935	0	92.4124	0.184825	0.184825	46.2062	231.031	0	71.749506	46.2062	0.184825	38.888805	9.24124	23.1031	23.1031	9.24124		0	0.184825	0		0					0	0	0											18.1747	0.513810003	1.792774362	0	1.128775087	1.940991858	0.292220339	1.465628297	10.13941119	0	7.892732311	0.461914652	0.069636885	2.113298834	3.774149259	8.833579499	0.065145116	0.74432572	0	0	3.210207682	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6133	0	5.314855723	18.1747	0.513810003	1.792774362	0	1.128775087	1.940991858	0.292220339	1.465628297	10.13941119	0	7.892732311	0.461914652	0.069636885	2.113298834	3.774149259	8.833579499	0.065145116	0.74432572	0	0	3.210207682	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6133	NO																																																																																		0	0	0	18.1747	0.513810003	1.792774362	0	1.128775087	1.940991858	0.292220339	1.465628297	10.13941119	0	7.892732311	0.461914652	0.069636885	2.113298834	3.774149259	8.833579499	0.065145116	0.74432572	0	0	3.210207682	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6133
H1951_017_0	2011	6	r.	s.	t.	u.	v.						OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery						Lab	Radiology	Renal Dialysis	Other							Coin	Coin	D	V	T	O	O	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V		V	S	O	T	V	V				O	O	V	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						0	YES	498.3907555	13.09046214	312.6283213	4200.838706	348.3221589	11919.90372	25860.20222	902.6088061	95.24528016	23.86394965	31.73919855	8.880206588	0.316146002	37.05416305	5366.674694	8474.05115	107.204716	1870.787199		1157.895022	3260.960622	0	4.2	3.82	2.47				5.36	1.02	181.8025301	814.4031007	0.165699701	211.977182	182.5032524						3400	8% Coins:1a.IP Acute	2% Coins:1b.IP Psych	$0/Day(Days 1-100) $0(Days 100-100):2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$0/Visit:4a, 4b.Emergency Room"	"5% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician"	5% Coins:8a.Lab -- OP	"5% Coins:8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	5% Coins:9a.Observation	"5% Coins:9a, 12.Dialysis -- OP Hosp"	"5% Coins:7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN766: Dental 16a, 16b"	"VIS766: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Visit:8a.Lab -- FSL	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR"	$0/Proc:12.Dialysis -- Dialysis Center	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 9d.Cardiac Rehab"	"$0/Visit:9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"							0.08	0.02	0	0	0	0	0	0	0.05	0.05	0.05	0.05	0.05	0.05	0	0	0	0		0	0	0	0	0	0				0	0	0	0	0	0	0						NO	0.066329	0.016582	0	0	0	0	0	0	0.045013	0.045013	0.045013	0.045013	0.045013	0.045013	0	0	0	0		0	0	0	0	0	0				0	0	0	0	0	0	0							33.0578	0.217066043	0	0	0	0	0	0	4.287275796	1.074187966	1.428676544	0.399724739	0.01423068	1.667919041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1468	0	7.841110753	33.0578	0.217066043	0	0	0	0	0	0	4.287275796	1.074187966	1.428676544	0.399724739	0.01423068	1.667919041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1468	NO																																																																																		0	0	0	33.0578	0.217066043	0	0	0	0	0	0	4.287275796	1.074187966	1.428676544	0.399724739	0.01423068	1.667919041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1468
H1951_019_0	2011	7	r.	s.	t.	u.	v.						OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery						Lab	Radiology	Renal Dialysis	Other							Coin	Coin	D	V	T	O	O	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V		V	S	O	T	V	V		V		O	O	V	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	0						0	YES	423.714153	12.49456795	355.3599873	4399.119855	360.4146203	9633.341717	19734.35461	805.122501	74.28101484	13.17405974	19.05188343	5.305571017	0.146187558	16.65749238	6090.772786	9749.261911	98.08887527	2086.99503		1820.605265	6129.817739	0	4.2	3.82	2.47		0.31		5.36	1.02	51.03768129	1211.17403	0.216614797	152.9247652	304.185746						3400	8% Coins:1a.IP Acute	2% Coins:1b.IP Psych	$0/Day(Days 1-100) $0(Days 100-100):2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$0/Visit:4a, 4b.Emergency Room"	"5% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician"	5% Coins:8a.Lab -- OP	"5% Coins:8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	5% Coins:9a.Observation	"5% Coins:9a, 12.Dialysis -- OP Hosp"	"5% Coins:7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN766: Dental 16a, 16b"	"VIS766: Vision 17a, 17b"		"HER757: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Visit:8a.Lab -- FSL	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR"	$0/Proc:12.Dialysis -- Dialysis Center	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 9d.Cardiac Rehab"	"$0/Visit:9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"							0.08	0.02	0	0	0	0	0	0	0.05	0.05	0.05	0.05	0.05	0.05	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0	0	0						NO	0.07283	0.018208	0	0	0	0	0	0	0.047084	0.047084	0.047084	0.047084	0.047084	0.047084	0	0	0	0		0	0	0	0	0	0		0		0	0	0	0	0	0	0							30.8591	0.227501093	0	0	0	0	0	0	3.497447303	0.620287429	0.89703888	0.249807506	0.006883095	0.784301371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1424	0	3.435324851	30.8591	0.227501093	0	0	0	0	0	0	3.497447303	0.620287429	0.89703888	0.249807506	0.006883095	0.784301371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1424	NO																																																																																		0	0	0	30.8591	0.227501093	0	0	0	0	0	0	3.497447303	0.620287429	0.89703888	0.249807506	0.006883095	0.784301371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1424
H1951_024_0	2011	5	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							Prosthetics/Supplies	Lab	Radiology	Therapy (PT/OT/ST)							D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	O							O	O	O	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	1976.460459	92.965276	435.427001	3764.515392	9.922986	13.423398	4.316387	520.690882	119.086138	23.700367	39.310048	10.242702	0.788143	41.794213	5205.531004	10097.5433	55.393098	5.359434		1107.746744	17.840136	0							5.36	0.73	1846.093556	231.407868	353.006803	1486.762837							6700	$250/Day(Days 1-7):1a.IP Acute	$250/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 25% Advanced Imaging -- Office,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Physician,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								179.655	153.80975	66.51235	0	0.2	0.2	0.2	50	0.240556	0.25	0.238326	0.25	0.2	0.218462	15	35	35	0.25		0	0.2	0							0	0	0	0	0	35							NO	152.851372	130.862104	47.295735	0	0.170416	0.170416	0.170416	42.6041	0.204973	0.213021	0.203073	0.213021	0.170416	0.186148	12.78123	29.82287	29.82287	0.213021		0	0.170416	0							0	0	0	0	0	29.82287								25.1754	1.013802635	1.716153338	0	1.691035582	2.287561794	0.735581407	1.848630534	24.40944296	5.048675879	7.982809378	2.181910623	0.134312177	7.779909162	5.544424086	25.09481008	0.137665097	1.14167199	0	0	3.040244617	0	0	0	0	0	0	0	0	0	0	0	0	3.694961234	0	0	0	0	0	0	120.659	0	21.39141983	25.1754	1.013802635	1.716153338	0	1.691035582	2.287561794	0.735581407	1.848630534	24.40944296	5.048675879	7.982809378	2.181910623	0.134312177	7.779909162	5.544424086	25.09481008	0.137665097	1.14167199	0	0	3.040244617	0	0	0	0	0	0	0	0	0	0	0	0	3.694961234	0	0	0	0	0	0	120.659	NO																																																																																		0	0	0	25.1754	1.013802635	1.716153338	0	1.691035582	2.287561794	0.735581407	1.848630534	24.40944296	5.048675879	7.982809378	2.181910623	0.134312177	7.779909162	5.544424086	25.09481008	0.137665097	1.14167199	0	0	3.040244617	0	0	0	0	0	0	0	0	0	0	0	0	3.694961234	0	0	0	0	0	0	120.659
H1951_025_0	2011	3	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	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	1482.767252	67.720527	308.112569	2793.685292	179.60106	10.329715	1.591117	367.266868	532.42314	2680.407796	1302.184749	100.473828	0.447214	650.51178	4038.454551	7424.671032	40.890087	1518.235505		1094.238136	16.007113	0							4.21	0.73	13350.04223										4900	$175/Day(Days 1-7):1a.IP Acute	$175/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$150/Visit:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"											125.7585	107.666825	66.51235	0	100	0.2	0.2	50	250	0	77.66549	50	0.2	48.228433	15	35	35	15		0	0.2	0							0	0	0										NO	115.310861	98.722188	54.205503	0	90.406	0.180812	0.180812	45.203	226.015	0	70.214263	45.203	0.180812	43.601398	13.5609	31.6421	31.6421	13.5609		0	0.180812	0							0	0	0											14.2483	0.55712655	1.391783065	0	1.353084453	1.867736429	0.287693047	1.383463686	10.027968	0	7.619328537	0.378476537	0.080861658	2.363601919	4.563756527	19.57768194	0.107820685	1.715719988	0	0	2.894278116	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4186	0	7.411472231	14.2483	0.55712655	1.391783065	0	1.353084453	1.867736429	0.287693047	1.383463686	10.027968	0	7.619328537	0.378476537	0.080861658	2.363601919	4.563756527	19.57768194	0.107820685	1.715719988	0	0	2.894278116	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4186	NO																																																																																		0	0	0	14.2483	0.55712655	1.391783065	0	1.353084453	1.867736429	0.287693047	1.383463686	10.027968	0	7.619328537	0.378476537	0.080861658	2.363601919	4.563756527	19.57768194	0.107820685	1.715719988	0	0	2.894278116	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4186
H1951_028_0	2011	3	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O		V	V		V		O	O	O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0		0		0	0	0										0	YES	1667.528174	78.434262	367.367224	3176.099702	209.001468	11.407341	1.646372	439.303863	612.220111	3433.155511	1688.681329	145.472578	0.669772	879.836612	4391.876179	8519.238444	46.734834	1824.345538		934.599474	15.160731	0		2.33	1.65		0.31		5.36	1.02	13261.90189										6700	$150/Day(Days 1-10):1a.IP Acute	$150/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$20/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a, 17b"		"HER757: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"											121.20465	109.29915	66.51235	0	100	0.2	0.2	50	100	0	29.07127	50	0.2	32.537426	10	20	20	10		0	0.2	0		0	0		0		0	0	0										NO	117.740864	106.175599	62.596901	0	96.8131	0.193626	0.193626	48.40655	96.8131	0	28.144798	48.40655	0.193626	31.500491	9.68131	19.36262	19.36262	9.68131		0	0.193626	0		0	0		0		0	0	0											16.3614	0.693983729	1.916337479	0	1.686173335	2.208757808	0.318780425	1.772098701	4.939243902	0	3.960632908	0.586818802	0.129685273	2.309607106	3.543259564	13.74623139	0.075409069	1.471837892	0	0	2.935511701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6557	0	1.927935841	16.3614	0.693983729	1.916337479	0	1.686173335	2.208757808	0.318780425	1.772098701	4.939243902	0	3.960632908	0.586818802	0.129685273	2.309607106	3.543259564	13.74623139	0.075409069	1.471837892	0	0	2.935511701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6557	NO																																																																																		0	0	0	16.3614	0.693983729	1.916337479	0	1.686173335	2.208757808	0.318780425	1.772098701	4.939243902	0	3.960632908	0.586818802	0.129685273	2.309607106	3.543259564	13.74623139	0.075409069	1.471837892	0	0	2.935511701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6557
H1951_030_0	2011	3	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O		V	V		V		O	O	O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0		0		0	0	0										0	YES	1562.415622	73.742153	263.672798	3029.811864	185.125019	13.976234	2.353924	338.92508	528.459491	1927.32767	994.516251	49.187779	0.320049	450.758406	3080.907051	8359.871861	43.459007	1555.133445		1490.541775	23.693393	0		2.33	2.47		0.31		5.36	1.02	17335.59579										6700	$25/Day(Days 1-10):1a.IP Acute	$25/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7i. $5 Therapy (AT,PT,ST,OT) -- CORF"	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$15/Visit:7e, 7h.Psych -- Other Provider"	"$5/Visit:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"	"VIS766: Vision 17a, 17b"		"HER757: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"											20.200775	18.216525	66.51235	0	100	0.2	0.2	50	100	0	52.596034	50	0.2	40.926153	5	15	15	5		0	0.2	0		0	0		0		0	0	0										NO	19.965497	18.004357	66.02262	0	98.6413	0.197283	0.197283	49.32065	98.6413	0	51.881412	49.32065	0.197283	40.37009	4.932065	14.796195	14.796195	4.932065		0	0.197283	0		0	0		0		0	0	0											2.5995	0.110640004	1.450697412	0	1.521747711	2.757273372	0.464389188	1.393000437	4.343994266	0	4.29974228	0.202164436	0.063140227	1.516429785	1.266269486	10.30785785	0.053585662	0.63916827	0	0	4.674303651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6639	0	0.504174105	2.5995	0.110640004	1.450697412	0	1.521747711	2.757273372	0.464389188	1.393000437	4.343994266	0	4.29974228	0.202164436	0.063140227	1.516429785	1.266269486	10.30785785	0.053585662	0.63916827	0	0	4.674303651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6639	NO																																																																																		0	0	0	2.5995	0.110640004	1.450697412	0	1.521747711	2.757273372	0.464389188	1.393000437	4.343994266	0	4.29974228	0.202164436	0.063140227	1.516429785	1.266269486	10.30785785	0.053585662	0.63916827	0	0	4.674303651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6639
H1951_801_0	2011	3																															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	YES	401.332559	6.021615	41.993309	22.467034	10.403169	13.195045	4.532444	37.130494	66.245578	7.280584	38.968911	6.993387	0.695912	13.394434	46.833072	79.746708	0.697029	7.146234		10.086625	42.795536	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.077496	0.077496	0.209701	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.06614	0.06614	0.112657	0	0.201788	0.201788	0.201788	0.201788	0.201788	0.201788	0.201788	0.201788	0.201788	0.201788	0.201788	0.201788	0.201788	0.201788		0.201788	0.201788	0																				26.5441	0.398269616	4.730840212	0	2.099234666	2.66260174	0.91459281	7.492488123	13.36756269	1.469134484	7.863458613	1.411181576	0.140426691	2.702836048	9.450351933	16.09192871	0.140652088	1.442024266	0	2.035359886	8.635625618	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5927	0	20.75339852	26.5441	0.398269616	4.730840212	0	2.099234666	2.66260174	0.91459281	7.492488123	13.36756269	1.469134484	7.863458613	1.411181576	0.140426691	2.702836048	9.450351933	16.09192871	0.140652088	1.442024266	0	2.035359886	8.635625618	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5927	NO																																																																																		0	0	0	26.5441	0.398269616	4.730840212	0	2.099234666	2.66260174	0.91459281	7.492488123	13.36756269	1.469134484	7.863458613	1.411181576	0.140426691	2.702836048	9.450351933	16.09192871	0.140652088	1.442024266	0	2.035359886	8.635625618	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5927
H1951_804_0	2011	2																															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	YES	375.313876	5.264822	38.572802	20.843483	9.433011	12.013397	4.241334	34.202627	63.440513	6.850926	37.131141	6.58376	0.664806	12.761242	49.48905	89.636477	0.617367	6.847029		9.736444	40.721975	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.077968	0.077968	0.212612	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.067188	0.067188	0.119041	0	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797		0.202797	0.202797	0																				25.2166	0.353732861	4.591744923	0	1.912986332	2.436280871	0.860129811	6.936190148	12.86554571	1.38934724	7.530084001	1.335166777	0.134820662	2.587941594	10.03623087	18.17800863	0.125200175	1.38855694	0	1.974521634	8.258294364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1114	0	19.32104341	25.2166	0.353732861	4.591744923	0	1.912986332	2.436280871	0.860129811	6.936190148	12.86554571	1.38934724	7.530084001	1.335166777	0.134820662	2.587941594	10.03623087	18.17800863	0.125200175	1.38855694	0	1.974521634	8.258294364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1114	NO																																																																																		0	0	0	25.2166	0.353732861	4.591744923	0	1.912986332	2.436280871	0.860129811	6.936190148	12.86554571	1.38934724	7.530084001	1.335166777	0.134820662	2.587941594	10.03623087	18.17800863	0.125200175	1.38855694	0	1.974521634	8.258294364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1114
H1951_805_0	2011	2																															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	YES	375.313876	5.264822	38.572802	20.843483	9.433011	12.013397	4.241334	34.202627	63.440513	6.850926	37.131141	6.58376	0.664806	12.761242	49.48905	89.636477	0.617367	6.847029		9.736444	40.721975	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.077968	0.077968	0.212612	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.067188	0.067188	0.119041	0	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797	0.202797		0.202797	0.202797	0																				25.2166	0.353732861	4.591744923	0	1.912986332	2.436280871	0.860129811	6.936190148	12.86554571	1.38934724	7.530084001	1.335166777	0.134820662	2.587941594	10.03623087	18.17800863	0.125200175	1.38855694	0	1.974521634	8.258294364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1114	0	19.32104341	25.2166	0.353732861	4.591744923	0	1.912986332	2.436280871	0.860129811	6.936190148	12.86554571	1.38934724	7.530084001	1.335166777	0.134820662	2.587941594	10.03623087	18.17800863	0.125200175	1.38855694	0	1.974521634	8.258294364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1114	NO																																																																																		0	0	0	25.2166	0.353732861	4.591744923	0	1.912986332	2.436280871	0.860129811	6.936190148	12.86554571	1.38934724	7.530084001	1.335166777	0.134820662	2.587941594	10.03623087	18.17800863	0.125200175	1.38855694	0	1.974521634	8.258294364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1114
H1961_001_0	2011	7																															A	A	A		T	Coin	Coin	V	V		V			V	V	V	V	V	P	V	Coin		T	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	YES	299.793786	2.325492981	35.28722196	0	258.0965814	22.38264489	1.631708173	469.4800243	518.6724527	0	1562.596985	0	0	546.5915377	3803.164887	6787.459933	212.743468	714.0832813	742.4006614	54.9960298	47.50178783	0	143.0576223	1508.645629	1054.410057	0	0	0	0	0											6700	"$50/day for 10 days, $0 Copay afterwards; PBP 1a"	"$50/day for 10 days, $0 Copay afterwards; PBP 1b"	"$0 Copay days 1-20, $50 Copay 21+, Per Medicare Benefit Period; PBP 2"	- zero -; PBP 6	"$100 Copay, per Trip; PBP 10a"	"0% for Infusion Supplies, 20% otherwise; PBP 11a"	"0% for Diabetic Supplies, 20% otherwise; PBP 11b, 11c"	"ER: $50 Copay, Urgent Care: $25 Copay; PBP 4a, 4b"	"$50 Copay per visit; PBP 9a, 9b"	$0 Copay per visit; PBP 8a	"$75 Copay per visit --  for Advanced Imaging and Nuclear Medicine Only, $0 Otherwise; PBP 8b"	- zero -;	- zero -; PBP 12	"$10 Copay per visit for PT/OT/ST; PBP 3, 5, 9d, 7c, 7i"	"Office Visit:: $5, Routine Physical: $5 Copay; PBP 7a, 14b-c"	"Office Visit: $15 Copay; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"$15 Copay Days 1-20, 45% coins after; PBP 7e, 7h, 9c"	"$10 Copay per visit; PBP 7c, 7i"	"$75 Copay per visit --  for Advanced Imaging and Nuclear Medicine Only, $0 Otherwise; PBP 8b"	"Chiropractor $15 Copay; PBP 7b, 7d, 7g, 14d-j, 16b, 17b"	"Non-Chemo Drugs: 15%, Chemo Drugs: $50 Copay per Service; PBP 15"	- zero -; PBP 13a	"$5 Copay, 12 one-way trips; PBP 10b"	"Varies by Service; PBP 16a, 16b"	$15 Copay; PBP 17a	- zero -; PBP 17b	- zero -; PBP 18a	- zero -; PBP 18b	- zero -; PBP 14a	- zero -; PBP 13b											0	257.0075674	257.0075674	258.3960913	0	100	0.199535688	0.2	49.2042809	50	0	18.52775419	0	0	10	4.998407832	14.80920114	15	10	64.10957078	15	0.108412256	0	5	8.27519821	15	0	0	0	0	0											NO	251.5479497	251.5479497	252.9069771	0	97.87569767	0.195296947	0.195751395	48.15903321	48.93784884	0	18.13416867	0	0	9.787569767	4.892226538	14.49460894	14.68135465	9.787569767	62.74768967	14.68135465	0.106109252	0	4.893784884	8.099407982	14.68135465	0	0	0	0	0												6.2844	0.048747749	0.74369872	0	2.105115247	4.371262207	0.319409152	1.884142007	2.115226174	0	2.361366441	0	0	0.445816901	1.550495349	8.198464784	0.260280192	0.582428328	3.88199386	0.067284685	5.040379157	0	0.058341102	1.018261371	1.290014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6271	0	0.925182219	6.2844	0.048747749	0.74369872	0	2.105115247	4.371262207	0.319409152	1.884142007	2.115226174	0	2.361366441	0	0	0.445816901	1.550495349	8.198464784	0.260280192	0.582428328	3.88199386	0.067284685	5.040379157	0	0.058341102	1.018261371	1.290014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6271	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.2844	0.048747749	0.74369872	0	2.105115247	4.371262207	0.319409152	1.884142007	2.115226174	0	2.361366441	0	0	0.445816901	1.550495349	8.198464784	0.260280192	0.582428328	3.88199386	0.067284685	5.040379157	0	0.058341102	1.018261371	1.290014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6271
H1961_002_0	2011	8																															A	A	A		T	Coin	Coin	V	V		V			V	V	V	V	V	P	P	Coin		T	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	YES	287.9625483	2.223220423	24.71633601	0	194.6608966	20.98024898	1.577931544	453.439253	650.9541366	0	1288.638606	0	0	533.9560556	3992.387884	5814.484937	191.4622264	686.2890091	854.5750289	112.2344493	54.47043539	0	73.60737476	1007.912771	849.3954548	0	0	0	0	0											6700	"$50/day for 10 days, $0 Copay afterwards; PBP 1a"	"$50/day for 10 days, $0 Copay afterwards; PBP 1b"	"$0 Copay days 1-20, $50 Copay 21+, Per Medicare Benefit Period; PBP 2"	- zero -; PBP 6	"$100 Copay, per Trip; PBP 10a"	"0% for Infusion Supplies, 20% otherwise; PBP 11a"	"0% for Diabetic Supplies, 20% otherwise; PBP 11b, 11c"	"ER: $50 Copay, Urgent Care: $25 Copay; PBP 4a, 4b"	"$50 Copay per visit; PBP 9a, 9b"	$0 Copay per visit; PBP 8a	"$75 Copay per visit --  for Advanced Imaging and Nuclear Medicine Only, $0 Otherwise; PBP 8b"	- zero -;	- zero -; PBP 12	"$10 Copay per visit for PT/OT/ST; PBP 3, 5, 9d, 7c, 7i"	"Office Visit:: $5, Routine Physical: $5 Copay; PBP 7a, 14b-c"	"Office Visit: $15 Copay; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"$15 Copay Days 1-20, 45% coins after; PBP 7e, 7h, 9c"	"$10 Copay per visit; PBP 7c, 7i"	"$75 Copay per visit --  for Advanced Imaging and Nuclear Medicine Only, $0 Otherwise; PBP 8b"	"Chiropractor $15 Copay; PBP 7b, 7d, 7g, 14d-j, 16b, 17b"	"Non-Chemo Drugs: 15%, Chemo Drugs: $50 Copay per Service; PBP 15"	- zero - ; PBP 13a	"$5 Copay, 12 one-way trips; PBP 10b"	"Varies by Service; PBP 16a, 16b"	$15 Copay; PBP 17a	- zero - ; PBP 17b	- zero - ; PBP 18a	- zero - ; PBP 18b	- zero - ; PBP 14a	- zero - ; PBP 13b											0	241.4510941	241.4510941	283.0401031	0	100	0.196082727	0.2	49.99377756	51.57557233	0	19.65920405	0	0	9.9653908	5.284521031	15.46488068	15	10	60.28115752	15.68378994	0.108535581	0	5	10.60135486	15	0	0	0	0	0											NO	236.3400404	236.3400404	277.0486904	0	97.88319301	0.191932034	0.195766386	48.93550578	50.483817	0	19.24305664	0	0	9.75444271	5.17265792	15.13751901	14.68247895	9.788319301	59.00512176	15.35179438	0.106238093	0	4.89415965	10.37694463	14.68247895	0	0	0	0	0												5.6714	0.043786334	0.57063571	0	1.587835842	4.026781858	0.308905956	1.849106599	2.738554126	0	2.066445475	0	0	0.43403698	1.720938067	7.334739688	0.234261676	0.559801329	4.202025303	0.143583349	5.786835154	0	0.03002052	0.871587918	1.039269241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2206	0	0.891429853	5.6714	0.043786334	0.57063571	0	1.587835842	4.026781858	0.308905956	1.849106599	2.738554126	0	2.066445475	0	0	0.43403698	1.720938067	7.334739688	0.234261676	0.559801329	4.202025303	0.143583349	5.786835154	0	0.03002052	0.871587918	1.039269241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2206	NO	7% Coinsurance for Choice 1; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	20% Coinsurance for Choice 1; PBP 6	$100/Trip for Choice 1; PBP 10a	No Cost Sharing; PBP 11a	"20% Coinsurance for Choice 1; PBP 11b, 11c"	"$50/Case for Choice 1; PBP 4a, 4b"	"20% Coinsurance for Choice 1; PBP 9a, 9b"	20% Coinsurance for Choice 1; PBP 8a	20% Coinsurance for Choice 1; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"20% Coinsurance for Choice 1; PBP 3, 5, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"20% Coinsurance for Choice 1; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"20% Coinsurance for Choice 1; PBP 7e, 7h, 9c"	"20% Coinsurance for Choice 1; PBP 7c, 7i"	20% Coinsurance for Choice 1; PBP 8b	"20% Coinsurance for Choice 1; PBP 7b, 7d, 7g, 14d-j"	11% Coinsurance for Choice 1; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b												0.155	0	0	0.0344	0.14	0.3467	0.1756	0.0591	0.2913	0.038	0.1214	0	0	0.1034	0.3629	1.6804	0.0003	0.4298	0.2965	0.3266	0.1679	0.0011	0	0	0	0	0	0	0	0											4.7306	0	8.88E-16	5.8264	0.043786334	0.57063571	0.034396842	1.727835842	4.373512216	0.484505298	1.908228226	3.029817226	0.038007476	2.187796384	0	0	0.537437124	2.083863595	9.015174841	0.234568695	0.989597046	4.498520847	0.470218419	5.954760208	0.001144864	0.03002052	0.871587918	1.039269241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9511
H1961_003_0	2011	8																																	A		T			V									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	0	0	24.81680414	0	283.5527669	0	0	643.4508502	0	0	0	0	0	0	0	0	134.6582637	0	0	0	0	0	0	524.2926017	0	0	0	0	0	0											6700	- zero -; PBP 1a	- zero -; PBP 1b	"$0 Copay days 1-20, $50 Copay 21+; PBP 2"	- zero -; PBP 6	"$25 Copay, per Trip; PBP 10a"	- zero -; PBP 11a	"- zero -; PBP 11b, 11c"	"ER: $50 Copay, Urgent Care: $10 Copay; PBP 4a, 4b"	"- zero -; PBP 9a, 9b"	- zero -; PBP 8a	- zero -; PBP 8b	- zero -;	- zero -; PBP 12	"- zero -; PBP 3, 5, 9d, 7c, 7i"	"- zero -; PBP 7a, 14b-c"	"- zero -; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"$10 Copay Days 1-20, 45% coins after; PBP 7e, 7h, 9c"	"- zero -; PBP 7c, 7i"	- zero -; PBP 8b	"- zero -; PBP 7b, 7d, 7g, 14d-j, 16b, 17b"	- zero -; PBP 15	- zero -; PBP 13a	- zero -; PBP 10b	"Varies by Service; PBP 16a, 16b"	- zero -; PBP 17a	- zero -; PBP 17b	- zero -; PBP 18a	- zero -; PBP 18b	- zero -; PBP 14a	- zero -; PBP 13b											0	0	0	65.82054054	0	25	0	0	49.025643	0	0	0	0	0	0	0	0	10	0	0	0	0	0	0	5.721995677	0	0	0	0	0	0											NO	0	0	65.82054054	0	25	0	0	49.025643	0	0	0	0	0	0	0	0	10	0	0	0	0	0	0	5.721995677	0	0	0	0	0	0												0	0	0.136121289	0	0.590734931	0	0	2.628799306	0	0	0	0	0	0	0	0	0.11221522	0	0	0	0	0	0	0.25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.7179	0	0	0	0	0.136121289	0	0.590734931	0	0	2.628799306	0	0	0	0	0	0	0	0	0.11221522	0	0	0	0	0	0	0.25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.7179	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0.136121289	0	0.590734931	0	0	2.628799306	0	0	0	0	0	0	0	0	0.11221522	0	0	0	0	0	0	0.25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.7179
H1961_007_0	2011	6																															A	A	A		T	Coin	Coin	V	V		V			V	V	V	V	V	P	P	Coin		T	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	YES	325.4761203	2.512844682	27.9361924	0	220.0198386	24.52089309	1.844224572	512.5098723	735.7554937	0	1456.512649	0	0	603.515792	4512.485832	6571.95184	192.707135	775.6935249	964.2949615	126.8555003	63.5003609	0	75.96281075	929.6309704	847.1330287	0	0	0	0	0											6700	"$50/day for 10 days, $0 Copay afterwards; PBP 1a"	"$50/day for 10 days, $0 Copay afterwards; PBP 1b"	"$0 Copay days 1-20, $50 Copay 21+, Per Medicare Benefit Period; PBP 2"	- zero - ; PBP 6	"$100 Copay, per Trip; PBP 10a"	"0% for Infusion Supplies, 20% otherwise; PBP 11a"	"0% for Diabetic Supplies, 20% otherwise; PBP 11b, 11c"	"ER: $50 Copay, Urgent Care: $25 Copay; PBP 4a, 4b"	"$50 Copay per visit; PBP 9a, 9b"	$0 Copay per visit; PBP 8a	"$75 Copay per visit --  for Advanced Imaging and Nuclear Medicine Only, $0 Otherwise; PBP 8b"	- zero -;	- zero -; PBP 12	"$10 Copay per visit for PT/OT/ST; PBP 3, 5, 9d, 7c, 7i"	"Office Visit: $5 Copay, Routine Physical: $5 Copay; PBP 7a, 14b-c"	"Office Visit: $15 Copay; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"$15 Copay Days 1-20, 45% coins after; PBP 7e, 7h, 9c"	"$10 Copay per visit; PBP 7c, 7i"	"$75 Copay per visit, --  for Advanced Imaging and Nuclear Medicine Only, $0 Otherwise; PBP 8b"	"Chiropractor: $15 Copay; PBP 7b, 7d, 7g, 14d-j, 16b, 17b"	"Non-Chemo Drugs: 15% of MA, Chemo Drugs: $50 Copay per Service; PBP 15"	- zero - ; PBP 13a	"$5 Copay, 12 one-way trips; PBP 10b"	"Varies by Service; PBP 16a, 16b"	$15 Copay; PBP 17a	- zero - ; PBP 17b	- zero - ; PBP 18a	- zero - ; PBP 18b	- zero - ; PBP 14a	- zero - ; PBP 13b											0	241.4510941	241.4510941	283.0401031	0	100	0.19525856	0.2	49.99377756	51.57557233	0	19.65920405	0	0	9.9653908	5.284521031	15.46488068	15	10	61.50546779	15.68378994	0.11740207	0	5	9.714834712	15	0	0	0	0	0											NO	234.5326399	234.5326399	274.9299721	0	97.13463539	0.189663691	0.194269271	48.56127355	50.09774413	0	19.09589617	0	0	9.679846018	5.133100235	15.02175547	14.57019531	9.713463539	59.74311188	15.23439217	0.114038073	0	4.856731769	9.436469276	14.62660195	0	0	0	0	0												6.3612	0.049112008	0.640041383	0	1.780962233	4.650723082	0.358276163	2.074011009	3.071640872	0	2.317784527	0	0	0.486828328	1.930253507	8.226854456	0.233981716	0.627889231	4.800831814	0.161047203	7.241458769	0	0.03074425	0.731036174	1.032556467	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8073	0	1.38064521	6.3612	0.049112008	0.640041383	0	1.780962233	4.650723082	0.358276163	2.074011009	3.071640872	0	2.317784527	0	0	0.486828328	1.930253507	8.226854456	0.233981716	0.627889231	4.800831814	0.161047203	7.241458769	0	0.03074425	0.731036174	1.032556467	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8073	NO	7% Coinsurance for Choice 1; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	20% Coinsurance for Choice 1; PBP 6	$100/Trip for Choice 1; PBP 10a	No Cost Sharing; PBP 11a	"20% Coinsurance for Choice 1; PBP 11b, 11c"	"$50/Case for Choice 1; PBP 4a, 4b"	"20% Coinsurance for Choice 1; PBP 9a, 9b"	20% Coinsurance for Choice 1; PBP 8a	20% Coinsurance for Choice 1; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"20% Coinsurance for Choice 1; PBP 3, 5, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"20% Coinsurance for Choice 1; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"20% Coinsurance for Choice 1; PBP 7e, 7h, 9c"	"20% Coinsurance for Choice 1; PBP 7c, 7i"	20% Coinsurance for Choice 1; PBP 8b	"20% Coinsurance for Choice 1; PBP 7b, 7d, 7g, 14d-j"	12% Coinsurance for Choice 1; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b												0.1812	0	0	0.0402	0.16	0.4052	0.2052	0.0668	0.3404	0.0444	0.1418	0	0	0.1209	0.4242	1.964	0.0004	0.5023	0.3465	0.3818	0.2116	0.0013	0	0	0	0	0	0	0	0											5.5383	0	1.78E-15	6.5424	0.049112008	0.640041383	0.040201681	1.940962233	5.055967941	0.563509795	2.140834553	3.412057773	0.044421648	2.459614716	0	0	0.607678367	2.354426646	10.19088123	0.234340549	1.130217626	5.14736419	0.542805477	7.453032637	0.001338072	0.03074425	0.731036174	1.032556467	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3456
H1961_801_0	2011	2																															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	224.1088173	0.721854505	51.7780561	0	6.889244124	20.00068861	0.88754018	7.102404211	52.99357801	6.130057157	29.53370194	0.004509745	0.321445243	14.37086198	37.23122732	125.0602726	0.008989731	5.600110189	22.7942035	6.844890142	39.48617584	0.485932758	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 13a	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b											0	0.077921605	0.077921605	0.208691738	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.071125874	0.071125874	0.190491229	0	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0	0	0	0	0	0	0	0												15.9399	0.051342532	9.863265534	0	1.465201054	4.253736621	0.188761609	1.510535836	11.27064812	1.303737543	6.281213211	0.00095913	0.068364816	3.056387861	7.918319125	26.59775729	0.001911932	1.191028682	4.847859994	1.455767871	8.397900467	0.10334794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.768	0	10.1056158	15.9399	0.051342532	9.863265534	0	1.465201054	4.253736621	0.188761609	1.510535836	11.27064812	1.303737543	6.281213211	0.00095913	0.068364816	3.056387861	7.918319125	26.59775729	0.001911932	1.191028682	4.847859994	1.455767871	8.397900467	0.10334794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.768	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 13a	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b												0.0904	0	0	0	0.0961	0.3073	0.1141	0.0331	0.2738	0.0376	0.3845	0	0	0.1725	0.374	1.6143	0.0002	0.4258	0.2783	0.568	0.5195	0.0007	0	0	0	0	0	0	0	0											5.2902	0	0	16.0303	0.051342532	9.863265534	0	1.561304039	4.561035589	0.302906886	1.543662624	11.54442572	1.341351516	6.665715029	0.00095913	0.068364816	3.228859487	8.292308055	28.21209542	0.002109193	1.616797951	5.126152032	2.023766685	8.917368609	0.104092139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0582
H1961_802_0	2011	2																															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	224.1088173	0.721854505	51.7780561	0	6.889244124	20.00068861	0.88754018	7.102404211	52.99357801	6.130057157	29.53370194	0.004509745	0.321445243	14.37086198	37.23122732	125.0602726	0.008989731	5.600110189	22.7942035	6.844890142	39.48617584	0.485932758	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 13a	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b											0	0.077921605	0.077921605	0.208691738	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.071125874	0.071125874	0.190491229	0	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0.212679508	0	0	0	0	0	0	0	0												15.9399	0.051342532	9.863265534	0	1.465201054	4.253736621	0.188761609	1.510535836	11.27064812	1.303737543	6.281213211	0.00095913	0.068364816	3.056387861	7.918319125	26.59775729	0.001911932	1.191028682	4.847859994	1.455767871	8.397900467	0.10334794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.768	0	10.1056158	15.9399	0.051342532	9.863265534	0	1.465201054	4.253736621	0.188761609	1.510535836	11.27064812	1.303737543	6.281213211	0.00095913	0.068364816	3.056387861	7.918319125	26.59775729	0.001911932	1.191028682	4.847859994	1.455767871	8.397900467	0.10334794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.768	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 13a	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b												0.0904	0	0	0	0.0961	0.3073	0.1141	0.0331	0.2738	0.0376	0.3845	0	0	0.1725	0.374	1.6143	0.0002	0.4258	0.2783	0.568	0.5195	0.0007	0	0	0	0	0	0	0	0											5.2902	0	0	16.0303	0.051342532	9.863265534	0	1.561304039	4.561035589	0.302906886	1.543662624	11.54442572	1.341351516	6.665715029	0.00095913	0.068364816	3.228859487	8.292308055	28.21209542	0.002109193	1.616797951	5.126152032	2.023766685	8.917368609	0.104092139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0582
H1961_803_0	2011	2																															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	225.2690064	0.721854505	51.7780561	0	7.301703288	21.3195683	1.377434071	7.244579264	54.16858918	6.291490521	31.18392434	0.004509745	0.321445243	15.11108355	38.83633003	131.9887624	0.009836348	7.427446108	23.98858992	9.282653293	41.71565285	0.489126743	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 13a	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b											0	0.077921605	0.077921605	0.208691738	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.071193844	0.071193844	0.190673269	0	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0	0	0	0	0	0	0	0												16.0378	0.051391597	9.872691228	0	1.554406695	4.538568385	0.293231957	1.542245976	11.53155837	1.33934982	6.638519652	0.000960047	0.068430148	3.216889062	8.267584839	28.09813106	0.002093989	1.581175173	5.106757055	1.976116785	8.880543006	0.104126648	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7025	0	10.4613	16.0378	0.051391597	9.872691228	0	1.554406695	4.538568385	0.293231957	1.542245976	11.53155837	1.33934982	6.638519652	0.000960047	0.068430148	3.216889062	8.267584839	28.09813106	0.002093989	1.581175173	5.106757055	1.976116785	8.880543006	0.104126648	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7025	NO																																																																																		0	0	0	16.0378	0.051391597	9.872691228	0	1.554406695	4.538568385	0.293231957	1.542245976	11.53155837	1.33934982	6.638519652	0.000960047	0.068430148	3.216889062	8.267584839	28.09813106	0.002093989	1.581175173	5.106757055	1.976116785	8.880543006	0.104126648	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7025
H1961_804_0	2011	2																															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	225.2690064	0.721854505	51.7780561	0	7.301703288	21.3195683	1.377434071	7.244579264	54.16858918	6.291490521	31.18392434	0.004509745	0.321445243	15.11108355	38.83633003	131.9887624	0.009836348	7.427446108	23.98858992	9.282653293	41.71565285	0.489126743	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 13a	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b											0	0.077921605	0.077921605	0.208691738	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.071193844	0.071193844	0.190673269	0	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0.212882753	0	0	0	0	0	0	0	0												16.0378	0.051391597	9.872691228	0	1.554406695	4.538568385	0.293231957	1.542245976	11.53155837	1.33934982	6.638519652	0.000960047	0.068430148	3.216889062	8.267584839	28.09813106	0.002093989	1.581175173	5.106757055	1.976116785	8.880543006	0.104126648	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7025	0	10.4613	16.0378	0.051391597	9.872691228	0	1.554406695	4.538568385	0.293231957	1.542245976	11.53155837	1.33934982	6.638519652	0.000960047	0.068430148	3.216889062	8.267584839	28.09813106	0.002093989	1.581175173	5.106757055	1.976116785	8.880543006	0.104126648	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7025	NO																																																																																		0	0	0	16.0378	0.051391597	9.872691228	0	1.554406695	4.538568385	0.293231957	1.542245976	11.53155837	1.33934982	6.638519652	0.000960047	0.068430148	3.216889062	8.267584839	28.09813106	0.002093989	1.581175173	5.106757055	1.976116785	8.880543006	0.104126648	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7025
H2001_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1037.311629	126.743701	567.2928787	595.4934446	142.6428504	7.061888079	8.33251663	633.0209159	29.90753626	14.23199179	31.52427702	0	0.055983406	18.57191768	5189.753415	71.17401001	608.0797172	576.5454345	0	0	13.1888864	1232.37404	0	0	146.4041271	0	14.15730244	7.812477916	89.21761644	0											3375	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-44 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	56.63994233	0	200	0.2	0.108830284	49.62882534	0.2	0.125128887	0.163516996	0	0.2	0.161028103	12.43258113	0.129962674	38.5	35	0	0	0.2	34.88505088	0	0	35	0	35	0	0	0											NO	138.1322635	92.39719835	42.00721139	0	148.3306997	0.1483307	0.080714361	36.81763835	0.1483307	0.092802277	0.121272952	0	0.1483307	0.119427056	11.91420924	0.124568474	36.89475666	33.54068788	0	0	0.1483307	25.87262004	0	0	35	0	35	0	0	0												11.9405	0.975896907	1.98586599	0	1.763192818	1.0474948	0.672553754	1.942194596	4.436205781	1.320761242	3.823042141	0	0.008304058	2.217989451	5.152650673	8.86603784	1.869579433	1.611477539	0	0	1.956316749	2.657062106	0	0	0.427012037	0	0.041292132	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7154	0	13.55937446	11.9405	0.975896907	1.98586599	0	1.763192818	1.0474948	0.672553754	1.942194596	4.436205781	1.320761242	3.823042141	0	0.008304058	2.217989451	5.152650673	8.86603784	1.869579433	1.611477539	0	0	1.956316749	2.657062106	0	0	0.427012037	0	0.041292132	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7154	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											9375	0.7889	0.0383	0.1136	0.2	0.2404	0.2143	0.2528	0.2648	0.9074	0.1801	0.7668	0	0.0011	0.4512	2.4444	3.1848	0.5958	0.5844	0	0	0.8277	0.961	0	0	0.1549	0	0.015	0	0	0											13.1877	0	2.457411191	12.7294	1.014150653	2.099499791	0.200049737	2.003628202	1.2617551	0.925365394	2.207039313	5.343611509	1.500865048	4.589843586	0	0.009436429	2.669145985	7.597034617	12.05082343	2.465379472	2.195859503	0	0	2.783989219	3.618091521	0	0	0.581862556	0	0.056266202	0	0	0	0	0	0	0	0	0	0	0	0	0	67.9031
H2012_001_0	2011	5	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin							O		O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0		0										0	YES	1361.836702	54.097699	877.956261	1258.675317	195.844674	10.193376	2.534185	364.353112	295.005453	475.113743	785.67164	50.074192	0.770618	847.19818	3622.819234	3616.094961	83.33689	468.222174		2041.387168	22.579824	0							3.77		123.786456										3400	$150/Day(Days 1-5):1a.IP Acute	$150/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-14) $70(Days 15-100):2. $0 SNF 1,2. $70 SNF 2"	$5/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $35 Radiology OP -- Facility"	$50/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$35/Visit:7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a		$0/Service:11c.Diabetic Monitoring Supplies											92.8668	74.76165	32.4597	5	100	0.2	0.2	50	125	0	43.99894	50	0.175699	38.903052	5	34.008649	35	35		0	0.2	0							0		0										NO	86.192277	69.388381	24.69349	4.61741	92.3482	0.184696	0.184696	46.1741	115.43525	0	40.632229	46.1741	0.162255	35.926269	4.61741	31.406375	32.32187	32.32187		0	0.184696	0							0		0											9.7817	0.312812646	1.806650346	0.484318333	1.507158594	1.882675774	0.468053833	1.401973086	2.837835685	0	2.660299166	0.192677562	0.125036624	2.536389143	1.39400348	9.464036198	0.22446701	1.261151353	0	0	4.170403174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5116	0	3.886218888	9.7817	0.312812646	1.806650346	0.484318333	1.507158594	1.882675774	0.468053833	1.401973086	2.837835685	0	2.660299166	0.192677562	0.125036624	2.536389143	1.39400348	9.464036198	0.22446701	1.261151353	0	0	4.170403174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5116	NO																																																																																		0	0	0	9.7817	0.312812646	1.806650346	0.484318333	1.507158594	1.882675774	0.468053833	1.401973086	2.837835685	0	2.660299166	0.192677562	0.125036624	2.536389143	1.39400348	9.464036198	0.22446701	1.261151353	0	0	4.170403174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5116
H2012_002_0	2011	3	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	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	YES	1563.18732	66.531713	649.338651	1612.910912	217.670789	10.29291	1.5506	378.402155	315.268131	1458.690314	1461.350959	74.00777	0.569596	590.665883	4518.581267	4684.900931	71.306309	703.990436		1784.430275	34.890021	0		2.27					3.55	0.58	7208.61385										4900	$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$150/Visit:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"					$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"											147.067245	128.620245	34.44565	0	100	0.2	0.2	50	225	0	58.204962	50	0.2	42.570788	15	35	35	15		0	0.2	0		0					0	0	0										NO	136.203535	119.119196	28.239026	0	91.9431	0.183886	0.183886	45.97155	206.871975	0	53.515447	45.97155	0.183886	39.140902	13.791465	32.180085	32.180085	13.791465		0	0.183886	0		0					0	0	0											17.7426	0.66043368	1.528057587	0	1.66777726	1.892722048	0.285133632	1.449644466	5.435011743	0	6.517070816	0.283520992	0.10474073	1.92659962	5.193154616	12.56337585	0.191220257	0.809088288	0	0	6.415786402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.666	0	5.723774186	17.7426	0.66043368	1.528057587	0	1.66777726	1.892722048	0.285133632	1.449644466	5.435011743	0	6.517070816	0.283520992	0.10474073	1.92659962	5.193154616	12.56337585	0.191220257	0.809088288	0	0	6.415786402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.666	NO																																																																																		0	0	0	17.7426	0.66043368	1.528057587	0	1.66777726	1.892722048	0.285133632	1.449644466	5.435011743	0	6.517070816	0.283520992	0.10474073	1.92659962	5.193154616	12.56337585	0.191220257	0.809088288	0	0	6.415786402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.666
H2012_003_0	2011	4	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	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	YES	1566.672178	66.680034	650.78624	1616.50662	218.156049	9.762117	1.470637	379.245737	315.970967	1461.942214	1464.60879	74.172757	0.540224	591.98267	4528.654669	4695.345115	71.465274	705.559863		1788.408357	33.090779	0							3.62	0.36	7224.684219										3400	$150/Day(Days 1-5):1a.IP Acute	$150/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$150/Visit:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"											92.8668	74.76165	57.868692	0	100	0.2	0.2	50	175	0	58.204962	50	0.2	41.908507	10	35	35	10		0	0.2	0							0	0	0										NO	82.223615	66.193442	37.099734	0	88.3332	0.176666	0.176666	44.1666	154.5831	0	51.414306	44.1666	0.176666	37.019125	8.83332	30.91662	30.91662	8.83332		0	0.176666	0							0	0	0											10.7348	0.36781508	2.0119997	0	1.605868492	1.724634162	0.259811556	1.395832897	4.070314299	0	6.275153708	0.272996541	0.095439213	1.826223372	3.333587988	12.09701672	0.18412206	0.519369671	0	0	5.846015563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.621	0	7.781383041	10.7348	0.36781508	2.0119997	0	1.605868492	1.724634162	0.259811556	1.395832897	4.070314299	0	6.275153708	0.272996541	0.095439213	1.826223372	3.333587988	12.09701672	0.18412206	0.519369671	0	0	5.846015563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.621	NO																																																																																		0	0	0	10.7348	0.36781508	2.0119997	0	1.605868492	1.724634162	0.259811556	1.395832897	4.070314299	0	6.275153708	0.272996541	0.095439213	1.826223372	3.333587988	12.09701672	0.18412206	0.519369671	0	0	5.846015563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.621
H2012_006_0	2011	4	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	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	1600.648065	68.126101	664.89962	1651.563249	222.887125	9.764507	1.470998	387.470311	322.823322	1493.646857	1496.371262	75.781317	0.540355	604.820798	4626.866061	4797.171465	73.015117	720.861099		1827.19296	33.098883	0							1.42	0.41	7381.363486										3900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$0-$195/Visit:9b. $0 Surgery ASC -- Physician,9b. $195 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $195 Surgery OP -- Facility"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0-$175/Visit:8b, 9a. $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,8b, 9a. $175 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"											140.1309	119.971605	34.44565	0	150	0.2	0.2	50	195	0	67.90579	50	0.2	43.31285	15	35	35	15		0	0.2	0							0	0	0										NO	122.776108	105.113482	24.547934	0	131.76615	0.175688	0.175688	43.92205	171.295995	0	59.65123	43.92205	0.175688	38.047784	13.176615	30.745435	30.745435	13.176615		0	0.175688	0							0	0	0											16.3768	0.596747641	1.360159332	0	2.447414862	1.715506706	0.258436697	1.418207531	4.608195179	0	7.438365526	0.277372566	0.094933889	1.917674257	5.080536062	12.29092696	0.187073461	0.791542431	0	0	5.815076557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6749	0	9.08363933	16.3768	0.596747641	1.360159332	0	2.447414862	1.715506706	0.258436697	1.418207531	4.608195179	0	7.438365526	0.277372566	0.094933889	1.917674257	5.080536062	12.29092696	0.187073461	0.791542431	0	0	5.815076557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6749	NO																																																																																		0	0	0	16.3768	0.596747641	1.360159332	0	2.447414862	1.715506706	0.258436697	1.418207531	4.608195179	0	7.438365526	0.277372566	0.094933889	1.917674257	5.080536062	12.29092696	0.187073461	0.791542431	0	0	5.815076557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6749
H2012_007_0	2011	5	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	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	1601.719017	68.171682	665.344487	1652.668267	223.036253	9.102656	1.371291	387.729557	323.039314	1494.646217	1497.372445	75.83202	0.503729	605.225467	4629.961777	4800.381128	73.06397	721.343408		1828.415487	30.8554	0							3.76	0.41	7386.302164										3400	$150/Day(Days 1-5):1a.IP Acute	$150/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$150/Visit:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0-$150/Visit:9d. $5 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $0 Rad therapy,3, 7c, 7d, 7i. $5 Therapy (AT,PT,ST,OT) -- CORF"	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$30/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$5/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"											92.8668	74.76165	34.44565	0	100	0.2	0.2	50	175	0	58.204962	50	0.2	40.555821	5	30	30	5		0	0.2	0							0	0	0										NO	84.165831	67.757007	25.696076	0	89.9425	0.179885	0.179885	44.97125	157.399375	0	52.350998	44.97125	0.179885	36.476919	4.497125	26.98275	26.98275	4.497125		0	0.179885	0							0	0	0											11.2342	0.384925761	1.424728542	0	1.671703182	1.637431275	0.246674682	1.453056903	4.237182177	0	6.532411823	0.284188394	0.090613291	1.839730028	1.735126405	10.79395699	0.164288903	0.270330956	0	0	5.550423629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5509	0	5.768570869	11.2342	0.384925761	1.424728542	0	1.671703182	1.637431275	0.246674682	1.453056903	4.237182177	0	6.532411823	0.284188394	0.090613291	1.839730028	1.735126405	10.79395699	0.164288903	0.270330956	0	0	5.550423629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5509	NO																																																																																		0	0	0	11.2342	0.384925761	1.424728542	0	1.671703182	1.637431275	0.246674682	1.453056903	4.237182177	0	6.532411823	0.284188394	0.090613291	1.839730028	1.735126405	10.79395699	0.164288903	0.270330956	0	0	5.550423629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5509
H2012_008_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	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	YES	1611.25464	68.577534	669.305528	1662.50721	224.36407	9.046182	2.752077	390.037854	324.962486	1503.544396	1506.286855	76.283476	0.500604	3.094646	4657.525644	4828.959565	73.498947	725.637831		1839.300718	30.663966	0		3.08	2.71				2.41	0.36	380.425816	563.893672									3400	$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $150 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$35/Visit:7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN772: Dental 16a, 16b"	"VIS735: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										147.067245	128.620245	46.371	0	100	0.2	0.2	50	178.964225	10.377806	74.77137	150	0.186153	0.2	5	34.356266	35	59.696069		0	0.2	0		0	0				0	0	0	132.855318									NO	118.435753	103.58007	26.68818	0	83.1412	0.166282	0.166282	41.5706	148.793004	8.628232	62.165815	124.7118	0.15477	0.166282	4.15706	28.564212	29.09942	49.632028		0	0.166282	0		0	0				0	0	0	110.457505										15.9025	0.591938814	1.488545534	0	1.554491501	1.504217235	0.457620868	1.351175634	4.029345373	1.081077489	7.80329583	0.792787467	0.077478481	0.514583926	1.613467796	11.49461873	0.178231394	3.001239762	0	0	5.098865594	0	0	0	0	0	0	0	0	0	0	5.190524008	0	0	0	0	0	0	0	0	63.726	0	14.36076172	15.9025	0.591938814	1.488545534	0	1.554491501	1.504217235	0.457620868	1.351175634	4.029345373	1.081077489	7.80329583	0.792787467	0.077478481	0.514583926	1.613467796	11.49461873	0.178231394	3.001239762	0	0	5.098865594	0	0	0	0	0	0	0	0	0	0	5.190524008	0	0	0	0	0	0	0	0	63.726	NO																																																																																		0	0	0	15.9025	0.591938814	1.488545534	0	1.554491501	1.504217235	0.457620868	1.351175634	4.029345373	1.081077489	7.80329583	0.792787467	0.077478481	0.514583926	1.613467796	11.49461873	0.178231394	3.001239762	0	0	5.098865594	0	0	0	0	0	0	0	0	0	0	5.190524008	0	0	0	0	0	0	0	0	63.726
H2012_009_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	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	YES	1700.948939	72.395064	706.564002	1755.054604	236.853826	10.607446	3.227054	411.750233	343.052292	1587.24275	1590.137875	80.529976	0.587002	3.628745	4916.797821	5097.775016	77.590439	766.032176		1941.689741	35.956208	0		2.58	2.71				4.9	0.56	401.603118	595.284146									3900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $150 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$35/Visit:7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"	"VIS735: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	32.5726	0	100	0.2	0.2	50	178.964225	10.377806	74.77137	150	0.186153	0.2	5	34.356266	35	59.696069		0	0.2	0		0	0				0	0	0	132.855318									NO	118.098119	101.10847	21.840384	0	85.2635	0.170527	0.170527	42.63175	152.591162	8.848481	63.752687	127.89525	0.15872	0.170527	4.263175	29.293355	29.842225	50.898958		0	0.170527	0		0	0				0	0	0	113.277094										16.7399	0.609979513	1.285969094	0	1.682915516	1.808855944	0.550299837	1.46280275	4.362228989	1.17039061	8.447963519	0.858283451	0.093168957	0.618798999	1.746764129	12.44424444	0.192955945	3.249186629	0	0	6.131504282	0	0	0	0	0	0	0	0	0	0	5.61933818	0	0	0	0	0	0	0	0	69.0756	0	12.58650517	16.7399	0.609979513	1.285969094	0	1.682915516	1.808855944	0.550299837	1.46280275	4.362228989	1.17039061	8.447963519	0.858283451	0.093168957	0.618798999	1.746764129	12.44424444	0.192955945	3.249186629	0	0	6.131504282	0	0	0	0	0	0	0	0	0	0	5.61933818	0	0	0	0	0	0	0	0	69.0756	NO																																																																																		0	0	0	16.7399	0.609979513	1.285969094	0	1.682915516	1.808855944	0.550299837	1.46280275	4.362228989	1.17039061	8.447963519	0.858283451	0.093168957	0.618798999	1.746764129	12.44424444	0.192955945	3.249186629	0	0	6.131504282	0	0	0	0	0	0	0	0	0	0	5.61933818	0	0	0	0	0	0	0	0	69.0756
H2012_011_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V		V		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	YES	1619.471913	68.927274	672.718934	1670.985867	225.508309	9.049716	2.753153	392.027016	326.61977	1511.212355	1513.968799	76.672516	0.500799	3.095855	4681.278661	4853.586883	73.873786	729.338528		1848.681008	30.675946	0		2.5	1.65		0.28		4.78		382.365958	566.769485									3400	$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $150 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a, 17b"		"HER814: Hearing 18a, 18b"		$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a		$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										147.067245	128.620245	46.371	0	100	0.2	0.2	50	178.964225	10.377806	74.771371	150	0.186153	0.2	10	34.463555	35	59.696069		0	0.2	0		0	0		0		0		0	132.855318									NO	117.202741	102.501718	26.285123	0	82.5148	0.16503	0.16503	41.2574	147.671972	8.563226	61.697447	123.7722	0.153604	0.16503	8.25148	28.437534	28.88018	49.258092		0	0.16503	0		0	0		0		0		0	109.6253										15.8172	0.588763667	1.47354166	0	1.550647751	1.493474631	0.45435284	1.347834617	4.019382128	1.078404411	7.784000811	0.790827165	0.07692473	0.510908951	3.218956437	11.5020035	0.177790686	2.993818693	0	0	5.062451368	0	0	0	0	0	0	0	0	0	0	5.177689569	0	0	0	0	0	0	0	0	65.119	0	15.31664863	15.8172	0.588763667	1.47354166	0	1.550647751	1.493474631	0.45435284	1.347834617	4.019382128	1.078404411	7.784000811	0.790827165	0.07692473	0.510908951	3.218956437	11.5020035	0.177790686	2.993818693	0	0	5.062451368	0	0	0	0	0	0	0	0	0	0	5.177689569	0	0	0	0	0	0	0	0	65.119	NO																																																																																		0	0	0	15.8172	0.588763667	1.47354166	0	1.550647751	1.493474631	0.45435284	1.347834617	4.019382128	1.078404411	7.784000811	0.790827165	0.07692473	0.510908951	3.218956437	11.5020035	0.177790686	2.993818693	0	0	5.062451368	0	0	0	0	0	0	0	0	0	0	5.177689569	0	0	0	0	0	0	0	0	65.119
H2012_012_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V			V		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	YES	1700.243273	72.36503	706.270873	1754.326491	236.755563	10.715439	3.259908	411.579412	342.909971	1586.584257	1589.478178	80.496567	0.592978	3.665689	4914.758008	5095.660122	77.55825	765.714376		1940.8842	36.322269	0		2.5			0.28		3.54		401.436507	595.037184									3900	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $150 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"			"HER814: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a		$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										161.6895	138.428775	32.5726	0	100	0.2	0.2	50	178.964225	10.377806	74.77137	150	0.186153	0.2	10	34.463555	35	59.696069		0	0.2	0		0			0		0		0	132.855318									NO	131.986007	112.99844	20.812654	0	83.8043	0.167609	0.167609	41.90215	149.979716	8.697048	62.661624	125.70645	0.156004	0.167609	8.38043	28.881941	29.331505	50.027873		0	0.167609	0		0			0		0		0	111.338469										18.7007	0.681427958	1.224947609	0	1.653427852	1.796004015	0.54638992	1.437171855	4.285795005	1.149883287	8.299940329	0.843244806	0.09250694	0.614402468	3.432315454	12.26437958	0.189575016	3.19225513	0	0	6.087939185	0	0	0	0	0	0	0	0	0	0	5.520877422	0	0	0	0	0	0	0	0	72.0132	0	14.98863953	18.7007	0.681427958	1.224947609	0	1.653427852	1.796004015	0.54638992	1.437171855	4.285795005	1.149883287	8.299940329	0.843244806	0.09250694	0.614402468	3.432315454	12.26437958	0.189575016	3.19225513	0	0	6.087939185	0	0	0	0	0	0	0	0	0	0	5.520877422	0	0	0	0	0	0	0	0	72.0132	NO																																																																																		0	0	0	18.7007	0.681427958	1.224947609	0	1.653427852	1.796004015	0.54638992	1.437171855	4.285795005	1.149883287	8.299940329	0.843244806	0.09250694	0.614402468	3.432315454	12.26437958	0.189575016	3.19225513	0	0	6.087939185	0	0	0	0	0	0	0	0	0	0	5.520877422	0	0	0	0	0	0	0	0	72.0132
H2012_013_0	2011	6	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		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	YES	1553.35516	66.113241	645.25443	1602.765999	216.30168	8.153556	2.480518	376.022075	313.285152	1449.51542	1452.159328	73.542275	0.451207	2.789284	4490.160222	4655.433767	70.857806	699.562466		1773.206537	27.638222	0		2.68					2.34	0.58	366.75544	543.630487									3400	$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $150 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$35/Visit:7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"					$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										147.067245	128.620245	46.371	0	100	0.2	0.2	50	178.964225	10.377806	74.77137	150	0.186153	0.2	5	34.356266	35	59.696069		0	0.2	0		0					0	0	0	132.855318									NO	120.583228	105.458183	27.610731	0	84.1012	0.168202	0.168202	42.0506	150.511061	8.727859	62.88362	126.1518	0.156557	0.168202	4.20506	28.894032	29.43542	50.205111		0	0.168202	0		0					0	0	0	111.732916										15.609	0.581015189	1.484662208	0	1.515935904	1.371444426	0.417228089	1.317662822	3.929406719	1.05426385	7.609752947	0.773124197	0.070639614	0.469163147	1.573449429	11.20952102	0.173810773	2.926800938	0	0	4.648804217	0	0	0	0	0	0	0	0	0	0	5.061784962	0	0	0	0	0	0	0	0	61.7975	0	12.90576721	15.609	0.581015189	1.484662208	0	1.515935904	1.371444426	0.417228089	1.317662822	3.929406719	1.05426385	7.609752947	0.773124197	0.070639614	0.469163147	1.573449429	11.20952102	0.173810773	2.926800938	0	0	4.648804217	0	0	0	0	0	0	0	0	0	0	5.061784962	0	0	0	0	0	0	0	0	61.7975	NO																																																																																		0	0	0	15.609	0.581015189	1.484662208	0	1.515935904	1.371444426	0.417228089	1.317662822	3.929406719	1.05426385	7.609752947	0.773124197	0.070639614	0.469163147	1.573449429	11.20952102	0.173810773	2.926800938	0	0	4.648804217	0	0	0	0	0	0	0	0	0	0	5.061784962	0	0	0	0	0	0	0	0	61.7975
H2012_014_0	2011	3	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin		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	1562.272055	66.492758	648.958455	1611.966533	217.54334	9.595592	1.44555	378.180596	315.083537	1457.836234	1460.495319	73.964437	0.531008	590.320041	4515.935584	4682.157867	71.264558	703.578242		1783.38547	32.526311	0		2.27	1.65				3.62	0.58	7204.393121										3400	$150/Day(Days 1-5):1a.IP Acute	$150/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$150/Visit:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0-$150/Visit:9d. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $25 Partial Hospitalization,7h. $50 Psych -- OP,8b. $0 Rad therapy,3, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"											92.8668	74.76165	57.868692	0	100	0.2	0.2	50	175	0	58.204962	50	0.2	40.527697	10	25	25	10		0	0.2	0		0	0				0	0	0										NO	83.326594	67.081386	38.105029	0	89.5407	0.179081	0.179081	44.77035	156.696225	0	52.117131	44.77035	0.179081	36.288784	8.95407	22.385175	22.385175	8.95407		0	0.179081	0		0	0				0	0	0											10.8482	0.371702197	2.060715062	0	1.623248579	1.718388211	0.25887054	1.410939804	4.114366734	0	6.343068822	0.275951144	0.095093444	1.785166372	3.369666945	8.734243603	0.132939134	0.524990736	0	0	5.8248443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4924	0	6.583326771	10.8482	0.371702197	2.060715062	0	1.623248579	1.718388211	0.25887054	1.410939804	4.114366734	0	6.343068822	0.275951144	0.095093444	1.785166372	3.369666945	8.734243603	0.132939134	0.524990736	0	0	5.8248443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4924	NO																																																																																		0	0	0	10.8482	0.371702197	2.060715062	0	1.623248579	1.718388211	0.25887054	1.410939804	4.114366734	0	6.343068822	0.275951144	0.095093444	1.785166372	3.369666945	8.734243603	0.132939134	0.524990736	0	0	5.8248443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4924
H2012_015_0	2011	3	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O	T		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	292.081085	8.908799	660.014359	1639.42861	221.249492	9.30735	2.831531	384.623425	320.451421	1482.672487	1485.376877	75.224524	0.515057	600.376956	4592.870785	4761.924894	72.478649	715.564669		1813.767905	31.54925	0	6.98		1.65				3.72	0.58	375.144819										3400	$0/Admit:1a.IP Acute	$100/Admit:1b.IP Psych	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$75/Visit:8b, 9a. $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,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$0/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0-$75/Visit:9d. $10 Cardiac Rehab,8b. $75 Nuclear Medicine,9a. $20 OP Other,5. $20 Partial Hospitalization,7h. $20 Psych -- OP,8b. $0 Rad therapy,3, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$20/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"	$0: Other - Transportation 10b		"VIS734: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											0	100	68.8913	0	0	0.2	0.2	50	100	0	29.102481	0	0.2	18.831863	10	20	20	10		0	0.2	0	0		0				0	0	0										NO	0	95.1703	52.168557	0	0	0.189445	0.189445	47.36135	94.7227	0	27.566656	0	0.189445	17.838049	9.47227	18.94454	18.94454	9.47227		0	0.189445	0	0		0				0	0	0											0	0.070654423	2.869333059	0	0	1.763230921	0.53641939	1.518023721	2.529501985	0	3.41223945	0	0.097574973	0.892462797	3.625409346	7.517706386	0.114422889	0.564835146	0	0	5.976847666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4887	0	2.513894028	0	0.070654423	2.869333059	0	0	1.763230921	0.53641939	1.518023721	2.529501985	0	3.41223945	0	0.097574973	0.892462797	3.625409346	7.517706386	0.114422889	0.564835146	0	0	5.976847666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4887	NO																																																																																		0	0	0	0	0.070654423	2.869333059	0	0	1.763230921	0.53641939	1.518023721	2.529501985	0	3.41223945	0	0.097574973	0.892462797	3.625409346	7.517706386	0.114422889	0.564835146	0	0	5.976847666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4887
H2012_016_0	2011	3	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O	T						O	O	O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0						0	0	0										0	YES	292.081085	8.908799	660.014359	1639.42861	221.249492	9.30735	2.831531	384.623425	320.451421	1482.672487	1485.376877	75.224524	0.515057	600.376956	4592.870785	4761.924894	72.478649	715.564669		1813.767905	31.54925	0	6.98						3.65	0.58	375.144819										3400	$500/Admit:1a.IP Acute	$500/Admit:1b.IP Psych	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $25 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $25 OP Other,5. $20 Partial Hospitalization,7h. $25 Psych -- OP,8b. $25 Rad therapy,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$20/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"	$0: Other - Transportation 10b						$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											500	500	68.8913	0	100	0.2	0.2	50	100	5.188903	49.38075	100	0.2	25.211219	15	20	20	15		0	0.2	0	0						0	0	0										NO	448.5835	448.5835	43.052653	0	89.8638	0.179728	0.179728	44.9319	89.8638	4.662945	44.375419	89.8638	0.179728	22.655759	13.47957	17.97276	17.97276	13.47957		0	0.179728	0	0						0	0	0											10.9186	0.333028353	2.367947431	0	1.656860008	1.672791401	0.508905404	1.440155106	2.399748534	0.576135022	5.492851774	0.563330132	0.092570164	1.133499635	5.159160271	7.132077771	0.108553447	0.803792004	0	0	5.670283604	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0303	0	6.592169722	10.9186	0.333028353	2.367947431	0	1.656860008	1.672791401	0.508905404	1.440155106	2.399748534	0.576135022	5.492851774	0.563330132	0.092570164	1.133499635	5.159160271	7.132077771	0.108553447	0.803792004	0	0	5.670283604	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0303	NO																																																																																		0	0	0	10.9186	0.333028353	2.367947431	0	1.656860008	1.672791401	0.508905404	1.440155106	2.399748534	0.576135022	5.492851774	0.563330132	0.092570164	1.133499635	5.159160271	7.132077771	0.108553447	0.803792004	0	0	5.670283604	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0303
H2012_021_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin							O		O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0		0	0									0	YES	1569.23513	70.469598	594.799672	2902.520633	265.030023	10.170614	3.367038	375.147078	297.768505	1046.917106	2011.81666	84.117083	0.344907	397.426638	4565.115259	5028.109249	119.056715	1045.667907		1558.468151	43.000406	0							3.97		420.574789	0									3400	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $125(Days 21-100):2. $0 SNF 1,2. $125 SNF 2"	$5/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$175/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $175 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$50/Visit:8b, 9a. $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,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"$30-$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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a		$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										161.6895	138.428775	41.280875	5	100	0.2	0.2	50	163.272904	5.115879	38.673309	50	0.2	48.122561	10	34.073315	35	35.492791		0	0.2	0							0		0	0									NO	131.378216	112.478086	25.282059	4.198105	83.9621	0.167924	0.167924	41.98105	137.087359	4.2954	32.470922	41.98105	0.167924	40.404713	8.39621	28.608671	29.386735	29.800493		0	0.167924	0							0		0	0										17.1803	0.660523792	1.2531467	1.015423865	1.854373108	1.707890185	0.565406489	1.312422353	3.401691495	0.374743978	5.443795154	0.294276956	0.057918163	1.338159104	3.194138866	11.9872936	0.291557344	2.596784929	0	0	7.220800177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7506	0	13.05720221	17.1803	0.660523792	1.2531467	1.015423865	1.854373108	1.707890185	0.565406489	1.312422353	3.401691495	0.374743978	5.443795154	0.294276956	0.057918163	1.338159104	3.194138866	11.9872936	0.291557344	2.596784929	0	0	7.220800177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7506	NO																																																																																		0	0	0	17.1803	0.660523792	1.2531467	1.015423865	1.854373108	1.707890185	0.565406489	1.312422353	3.401691495	0.374743978	5.443795154	0.294276956	0.057918163	1.338159104	3.194138866	11.9872936	0.291557344	2.596784929	0	0	7.220800177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7506
H2012_022_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1519.146166	64.657252	631.044219	1567.468848	211.538144	8.260435	2.513034	367.741073	306.385784	1417.593253	1420.178937	71.922679	0.457121	2.825846	4391.275004	4552.908788	69.297329	684.156248		1734.155834	28.000511	0							5.38	0.49	358.678514	531.658305									3400	$150/Day(Days 1-5):1a.IP Acute	$150/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $100(Days 21-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	10% Coins:11a.DME	"10% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$50/Visit:8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$15/Visit:7b. $5 Chiropractic,7f. $15 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Spec Cap"	"$15/Visit:7e, 7h.Psych -- Other Provider"	"$15-$30/Visit:7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$30-$50/Visit:9d. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"										92.8668	74.76165	33.0247	0	100	0.1	0.1	50	64.482112	0	19.401654	50	0.2	0.2	5	14.785422	15	18.221226		0	0.2	0							0	0	0	47.139775									NO	88.081095	70.908958	27.740616	0	94.5549	0.094555	0.094555	47.27745	60.970997	0	18.345215	47.27745	0.18911	0.18911	4.727745	13.980341	14.183235	17.229062		0	0.18911	0							0	0	0	44.572967										11.1507	0.382064864	1.45879628	0	1.666830671	0.781065431	0.23761993	1.448821683	1.55672056	0	2.171123995	0.283360072	0.086446152	0.534395737	1.730069037	5.304268117	0.081905025	0.982280868	0	0	5.295176635	0	0	0	0	0	0	0	0	0	0	1.974799007	0	0	0	0	0	0	0	0	37.1264	0	2.294328343	11.1507	0.382064864	1.45879628	0	1.666830671	0.781065431	0.23761993	1.448821683	1.55672056	0	2.171123995	0.283360072	0.086446152	0.534395737	1.730069037	5.304268117	0.081905025	0.982280868	0	0	5.295176635	0	0	0	0	0	0	0	0	0	0	1.974799007	0	0	0	0	0	0	0	0	37.1264	NO																																																																																		0	0	0	11.1507	0.382064864	1.45879628	0	1.666830671	0.781065431	0.23761993	1.448821683	1.55672056	0	2.171123995	0.283360072	0.086446152	0.534395737	1.730069037	5.304268117	0.081905025	0.982280868	0	0	5.295176635	0	0	0	0	0	0	0	0	0	0	1.974799007	0	0	0	0	0	0	0	0	37.1264
H2012_023_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1529.101835	65.080981	635.179744	1577.741197	212.924452	7.911714	2.406944	370.151051	308.393671	1426.883398	1429.486027	72.394022	0.437823	2.706551	4420.053064	4582.74611	69.751467	688.639841		1745.520561	26.818445	0							5.38	0.49	361.0291	535.142508									3400	$150/Day(Days 1-5):1a.IP Acute	$150/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $100(Days 21-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	10% Coins:11a.DME	"10% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$50/Visit:8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$15/Visit:7b. $5 Chiropractic,7f. $15 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Spec Cap"	"$15/Visit:7e, 7h.Psych -- Other Provider"	"$15-$30/Visit:7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$30-$50/Visit:9d. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"										92.8668	74.76165	33.0247	0	100	0.1	0.1	50	64.482112	0	19.401654	50	0.2	0.2	5	14.785422	15	18.221226		0	0.2	0							0	0	0	47.139775									NO	88.089732	70.915911	27.71773	0	94.5851	0.094585	0.094585	47.29255	60.990471	0	18.351074	47.29255	0.18917	0.18917	4.729255	13.984806	14.187765	17.234565		0	0.18917	0							0	0	0	44.587203										11.2248	0.384606421	1.467145054	0	1.678290049	0.748329469	0.227660798	1.458782257	1.567422937	0	2.186050322	0.285308159	0.082822977	0.511998253	1.741963171	5.340734608	0.082468119	0.989034008	0	0	5.073245241	0	0	0	0	0	0	0	0	0	0	1.988375637	0	0	0	0	0	0	0	0	37.0391	0	2.282310514	11.2248	0.384606421	1.467145054	0	1.678290049	0.748329469	0.227660798	1.458782257	1.567422937	0	2.186050322	0.285308159	0.082822977	0.511998253	1.741963171	5.340734608	0.082468119	0.989034008	0	0	5.073245241	0	0	0	0	0	0	0	0	0	0	1.988375637	0	0	0	0	0	0	0	0	37.0391	NO																																																																																		0	0	0	11.2248	0.384606421	1.467145054	0	1.678290049	0.748329469	0.227660798	1.458782257	1.567422937	0	2.186050322	0.285308159	0.082822977	0.511998253	1.741963171	5.340734608	0.082468119	0.989034008	0	0	5.073245241	0	0	0	0	0	0	0	0	0	0	1.988375637	0	0	0	0	0	0	0	0	37.0391
H2012_024_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	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	YES	1611.25464	68.577534	669.305528	1662.50721	224.36407	9.046182	2.752077	390.037854	324.962486	1503.544396	1506.286855	76.283476	0.500604	3.094646	4657.525644	4828.959565	73.498947	725.637831		1839.300718	30.663966	0		3.08	2.71				3.72	0.56	380.425816	563.893672									3400	$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $150 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$35/Visit:7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN772: Dental 16a, 16b"	"VIS735: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										147.067245	128.620245	46.371	0	100	0.2	0.2	50	178.964225	10.377806	74.77137	150	0.186153	0.2	5	34.356266	35	59.696069		0	0.2	0		0	0				0	0	0	132.855318									NO	118.435753	103.58007	26.68818	0	83.1412	0.166282	0.166282	41.5706	148.793004	8.628232	62.165815	124.7118	0.15477	0.166282	4.15706	28.564212	29.09942	49.632028		0	0.166282	0		0	0				0	0	0	110.457505										15.9025	0.591938814	1.488545534	0	1.554491501	1.504217235	0.457620868	1.351175634	4.029345373	1.081077489	7.80329583	0.792787467	0.077478481	0.514583926	1.613467796	11.49461873	0.178231394	3.001239762	0	0	5.098865594	0	0	0	0	0	0	0	0	0	0	5.190524008	0	0	0	0	0	0	0	0	63.726	0	14.36076172	15.9025	0.591938814	1.488545534	0	1.554491501	1.504217235	0.457620868	1.351175634	4.029345373	1.081077489	7.80329583	0.792787467	0.077478481	0.514583926	1.613467796	11.49461873	0.178231394	3.001239762	0	0	5.098865594	0	0	0	0	0	0	0	0	0	0	5.190524008	0	0	0	0	0	0	0	0	63.726	NO																																																																																		0	0	0	15.9025	0.591938814	1.488545534	0	1.554491501	1.504217235	0.457620868	1.351175634	4.029345373	1.081077489	7.80329583	0.792787467	0.077478481	0.514583926	1.613467796	11.49461873	0.178231394	3.001239762	0	0	5.098865594	0	0	0	0	0	0	0	0	0	0	5.190524008	0	0	0	0	0	0	0	0	63.726
H2012_025_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		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	YES	1553.35516	66.113241	645.25443	1602.765999	216.30168	8.153556	2.480518	376.022075	313.285152	1449.51542	1452.159328	73.542275	0.451207	2.789284	4490.160222	4655.433767	70.857806	699.562466		1773.206537	27.638222	0		3.08					3.72	0.56	366.75544	543.630487									3400	$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $150 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$35/Visit:7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN772: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										147.067245	128.620245	46.371	0	100	0.2	0.2	50	178.964225	10.377806	74.77137	150	0.186153	0.2	5	34.356266	35	59.696069		0	0.2	0		0					0	0	0	132.855318									NO	120.583228	105.458183	27.610731	0	84.1012	0.168202	0.168202	42.0506	150.511061	8.727859	62.88362	126.1518	0.156557	0.168202	4.20506	28.894032	29.43542	50.205111		0	0.168202	0		0					0	0	0	111.732916										15.609	0.581015189	1.484662208	0	1.515935904	1.371444426	0.417228089	1.317662822	3.929406719	1.05426385	7.609752947	0.773124197	0.070639614	0.469163147	1.573449429	11.20952102	0.173810773	2.926800938	0	0	4.648804217	0	0	0	0	0	0	0	0	0	0	5.061784962	0	0	0	0	0	0	0	0	61.7975	0	12.90576721	15.609	0.581015189	1.484662208	0	1.515935904	1.371444426	0.417228089	1.317662822	3.929406719	1.05426385	7.609752947	0.773124197	0.070639614	0.469163147	1.573449429	11.20952102	0.173810773	2.926800938	0	0	4.648804217	0	0	0	0	0	0	0	0	0	0	5.061784962	0	0	0	0	0	0	0	0	61.7975	NO																																																																																		0	0	0	15.609	0.581015189	1.484662208	0	1.515935904	1.371444426	0.417228089	1.317662822	3.929406719	1.05426385	7.609752947	0.773124197	0.070639614	0.469163147	1.573449429	11.20952102	0.173810773	2.926800938	0	0	4.648804217	0	0	0	0	0	0	0	0	0	0	5.061784962	0	0	0	0	0	0	0	0	61.7975
H2012_026_0	2011	4	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	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	YES	1562.272055	66.492758	648.958455	1611.966533	217.54334	9.595592	2.919221	378.180596	315.083537	1457.836234	1460.495319	73.964437	0.531008	590.320041	4515.935584	4682.157867	71.264558	703.578242		1783.38547	32.526311	0							1.42	0.58	368.860766										4900	$195/Day(Days 1-9):1a.IP Acute	$195/Day(Days 1-9):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$175/Visit:8b, 9a. $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,8b, 9a. $175 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0-$175/Visit:9d. $17 Cardiac Rehab,8b. $175 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $0 Rad therapy,3, 7c, 7d, 7i. $17 Therapy (AT,PT,ST,OT) -- CORF"	"$17/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$17/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											152.7669	135.896085	34.44565	0	150	0.2	0.2	50	175	0	67.905789	100	0.2	43.577763	17	35	35	17		0	0.2	0							0	0	0										NO	140.694343	125.156761	27.871422	0	137.1897	0.18292	0.18292	45.7299	160.05465	0	62.106499	91.4598	0.18292	39.856135	15.548166	32.01093	32.01093	15.548166		0	0.18292	0							0	0	0											18.3169	0.693501518	1.507282913	0	2.487058796	1.755225689	0.533983905	1.44118007	4.20254877	0	7.558854256	0.563731051	0.097131983	1.960656271	5.851209675	12.49001898	0.190103731	0.911612608	0	0	5.949712808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.5107	0	6.281427214	18.3169	0.693501518	1.507282913	0	2.487058796	1.755225689	0.533983905	1.44118007	4.20254877	0	7.558854256	0.563731051	0.097131983	1.960656271	5.851209675	12.49001898	0.190103731	0.911612608	0	0	5.949712808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.5107	NO																																																																																		0	0	0	18.3169	0.693501518	1.507282913	0	2.487058796	1.755225689	0.533983905	1.44118007	4.20254877	0	7.558854256	0.563731051	0.097131983	1.960656271	5.851209675	12.49001898	0.190103731	0.911612608	0	0	5.949712808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.5107
H2012_801_0	2011	3																															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	YES	296.717228	4.162285	30.495049	16.478529	7.45759	9.497601	3.353132	27.040058	50.155069	5.416234	29.355297	5.205016	0.525585	10.088838	39.125261	70.865184	0.48808	5.413153		7.697479	32.194151	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082054	0.082054	0.181643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.074773	0.074773	0.127048	0	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854		0.211854	0.211854	0																				22.1864	0.311226536	3.874334985	0	1.579920272	2.012104762	0.710374427	5.728544448	10.62555199	1.147450838	6.219037091	1.10270346	0.111347285	2.137360686	8.288843044	15.01307269	0.1034017	1.146798116	0	1.630741716	6.820459666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7497	0	10.28149959	22.1864	0.311226536	3.874334985	0	1.579920272	2.012104762	0.710374427	5.728544448	10.62555199	1.147450838	6.219037091	1.10270346	0.111347285	2.137360686	8.288843044	15.01307269	0.1034017	1.146798116	0	1.630741716	6.820459666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7497	NO																																																																																		0	0	0	22.1864	0.311226536	3.874334985	0	1.579920272	2.012104762	0.710374427	5.728544448	10.62555199	1.147450838	6.219037091	1.10270346	0.111347285	2.137360686	8.288843044	15.01307269	0.1034017	1.146798116	0	1.630741716	6.820459666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7497
H2012_802_0	2011	3																															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	YES	296.717228	4.162285	30.495049	16.478529	7.45759	9.497601	3.353132	27.040058	50.155069	5.416234	29.355297	5.205016	0.525585	10.088838	39.125261	70.865184	0.48808	5.413153		7.697479	32.194151	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082054	0.082054	0.181643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.074773	0.074773	0.127048	0	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854		0.211854	0.211854	0																				22.1864	0.311226536	3.874334985	0	1.579920272	2.012104762	0.710374427	5.728544448	10.62555199	1.147450838	6.219037091	1.10270346	0.111347285	2.137360686	8.288843044	15.01307269	0.1034017	1.146798116	0	1.630741716	6.820459666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7497	0	10.28149959	22.1864	0.311226536	3.874334985	0	1.579920272	2.012104762	0.710374427	5.728544448	10.62555199	1.147450838	6.219037091	1.10270346	0.111347285	2.137360686	8.288843044	15.01307269	0.1034017	1.146798116	0	1.630741716	6.820459666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7497	NO																																																																																		0	0	0	22.1864	0.311226536	3.874334985	0	1.579920272	2.012104762	0.710374427	5.728544448	10.62555199	1.147450838	6.219037091	1.10270346	0.111347285	2.137360686	8.288843044	15.01307269	0.1034017	1.146798116	0	1.630741716	6.820459666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7497
H2012_803_0	2011	2																															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	YES	296.717228	4.162285	30.495049	16.478529	7.45759	9.497601	3.353132	27.040058	50.155069	5.416234	29.355297	5.205016	0.525585	10.088838	39.125261	70.865184	0.48808	5.413153		7.697479	32.194151	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082054	0.082054	0.181643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.074773	0.074773	0.127048	0	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854	0.211854		0.211854	0.211854	0																				22.1864	0.311226536	3.874334985	0	1.579920272	2.012104762	0.710374427	5.728544448	10.62555199	1.147450838	6.219037091	1.10270346	0.111347285	2.137360686	8.288843044	15.01307269	0.1034017	1.146798116	0	1.630741716	6.820459666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7497	0	10.28149959	22.1864	0.311226536	3.874334985	0	1.579920272	2.012104762	0.710374427	5.728544448	10.62555199	1.147450838	6.219037091	1.10270346	0.111347285	2.137360686	8.288843044	15.01307269	0.1034017	1.146798116	0	1.630741716	6.820459666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7497	NO																																																																																		0	0	0	22.1864	0.311226536	3.874334985	0	1.579920272	2.012104762	0.710374427	5.728544448	10.62555199	1.147450838	6.219037091	1.10270346	0.111347285	2.137360686	8.288843044	15.01307269	0.1034017	1.146798116	0	1.630741716	6.820459666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7497
H2029_001_0	2011	5	r.										Skilled Nursing Facility																				D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	S	O		V	V		V		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	YES	1016.837009	2.494737206	72.14099127	103.8706344	22.97318993	6.448556136	6442.441309	420.2764114	204.7737902	2688.586613	1780.068307	24.05682231	0.3396927	340.2322219	4625.668181	4719.439883	6.372521294	1159.128289		654.1459435	1808.175098	0		6.79	2.01		0.58		1.97	0.98	72.14099127										3400	$25/Day(Days 1-6):1a.IP Acute	$25/Day(Days 1-6):1b.IP Psych	$0/Day(Days 1-7) $25/Day(Days 8-100):2.SNF	$0/Visit:6.Home Health	$15/Trip:10a.Ambulance Emergency	0% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$25/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $10 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $10 Advanced Imaging -- FSR,8b. $10 Advanced Imaging -- Office,8b, 9a. $15 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $10 Radiology OP -- Facility"	$10/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$8-$15/Visit:9d. $10 Cardiac Rehab,8b. $15 Nuclear Medicine,9a. $10 OP Other,5. $8 Partial Hospitalization,7h. $10 Psych -- OP,8b. $10 Rad therapy,3, 7c, 7d, 7i. $8 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$8/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$8/Visit:7e, 7h.Psych -- Other Provider"	"$8-$10/Visit:7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $8 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN842: Dental 16a, 16b"	"VIS751: Vision 17a, 17b"		"HER810: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13dAssist America: Emergency Care 4a	$0/Day(Days 1-7) $25/Day(Days 8-100):2.SNF											16.85905	14.046725	0	0	15	0	0	25	7.964146	1.162584	4.789756	10	0.19925	10.585478	0	8	8	8.261187		0	0	0		0	0		0		0	0	17.222825										NO	16.746432	13.952893	0	0	14.952285	0	0	24.920475	7.938812	1.158886	4.77452	9.96819	0.198616	10.551806	0	7.974552	7.974552	8.234908		0	0	0		0	0		0		0	0	17.214903											1.419	0.002900733	0	0	0.02862514	0	0	0.87279065	0.135471719	0.259647116	0.708247644	0.019983581	0.067468405	0.299172033	0	3.136284896	0.004234834	0.795442902	0	0	0	0	0	0	0	0	0	0	0	0	0.103491681	0	0	0	0	0	0	0	0	0	7.8528	0	0.029801609	1.419	0.002900733	0	0	0.02862514	0	0	0.87279065	0.135471719	0.259647116	0.708247644	0.019983581	0.067468405	0.299172033	0	3.136284896	0.004234834	0.795442902	0	0	0	0	0	0	0	0	0	0	0	0	0.103491681	0	0	0	0	0	0	0	0	0	7.8528	YES	$300/Admit	$300/Admit	20% Coins(Days 1-7) 20%(Days 7-100)	$0/Visit	$15/Trip	20% Coins	20% Coins	$25/Visit	$0-$15/Visit	$10-$15/Visit	$0-$25/Visit	$15/Visit	0%-20% Coins	$10-$25/Visit	$10/Visit	$10/Visit	$10/Visit	$10-$15/Visit		$10/Visit	20% Coins	20% Coins		"DEN842: Dental 16a, 16b"	"VIS751: Vision 17a, 17b"		"HER810: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13dAssist America: Emergency Care 4a											5100	0.6728	0.0013	0.109	0	0.1116	0.8259	1.1778	0.1271	0.0346	0.3441	0.214	0.0044	0.01	0.0664	0.6607	0.6741	0.0009	0.1714		0.0934	1.1241	0		0	0		0		0	0											6.4237	0	0.184477508	2.0918	0.004191441	0.109041991	0	0.140191907	0.825935117	1.177795909	0.999866034	0.170100111	0.603718956	0.922283378	0.024347895	0.07749345	0.365583648	0.660707314	3.810386093	0.005145053	0.966847307	0	0.093434935	1.124131913	0	0	0	0	0	0	0	0	0	0.103491681	0	0	0	0	0	0	0	0	0	14.2765
H2029_801_0	2011	4																															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	YES	121.262784	2.05098	12.033046	6.416837	0.87397	5.088835	2.260161	11.525783	32.213566	4.645779	13.61159	2.304509	0.222208	9.290017	16.445319	26.035538	0.398998	3.11255		3.22797	10.636459	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.153183	0.153183	0.154629	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.148167	0.148167	0.142802	0	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479		0.22479	0.22479	0																				17.9671	0.303887554	1.718343035	0	0.196459716	1.14391922	0.508061591	2.590880761	7.241287501	1.044324661	3.059749316	0.518030578	0.049950136	2.088302921	3.696743258	5.852528587	0.08969076	0.699670115	0	0.725615376	2.390969619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8856	0	1.925832998	17.9671	0.303887554	1.718343035	0	0.196459716	1.14391922	0.508061591	2.590880761	7.241287501	1.044324661	3.059749316	0.518030578	0.049950136	2.088302921	3.696743258	5.852528587	0.08969076	0.699670115	0	0.725615376	2.390969619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8856	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	Medicare FFS Cost Sharing																			10000	2.7906	0.0472	0.279	0	0.8033	0.771	0.3424	0.4039	1.1809	0.1628	0.5059	0.0808	0.0078	0.3256	0.6841	1.0831	0.0166	0.1238		0.1343	0.4425	0																			10.1854	0	0.151134358	20.7577	0.351086348	1.997310022	0	0.999771907	1.914922252	0.850495834	2.994768215	8.422177302	1.207122568	3.565614763	0.59878555	0.057736514	2.413874148	4.380852523	6.935581641	0.106288831	0.823503964	0	0.859895633	2.833436236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.071
H2029_802_0	2011	4																															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	YES	121.262784	2.05098	12.033046	6.416837	0.87397	5.088835	2.260161	11.525783	32.213566	4.645779	13.61159	2.304509	0.222208	9.290017	16.445319	26.035538	0.398998	3.11255		3.22797	10.636459	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.153183	0.153183	0.154629	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.148167	0.148167	0.142802	0	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479		0.22479	0.22479	0																				17.9671	0.303887554	1.718343035	0	0.196459716	1.14391922	0.508061591	2.590880761	7.241287501	1.044324661	3.059749316	0.518030578	0.049950136	2.088302921	3.696743258	5.852528587	0.08969076	0.699670115	0	0.725615376	2.390969619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8856	0	1.925832998	17.9671	0.303887554	1.718343035	0	0.196459716	1.14391922	0.508061591	2.590880761	7.241287501	1.044324661	3.059749316	0.518030578	0.049950136	2.088302921	3.696743258	5.852528587	0.08969076	0.699670115	0	0.725615376	2.390969619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8856	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	Medicare FFS Cost Sharing																			10000	2.7906	0.0472	0.279	0	0.8033	0.771	0.3424	0.4039	1.1809	0.1628	0.5059	0.0808	0.0078	0.3256	0.6841	1.0831	0.0166	0.1238		0.1343	0.4425	0																			10.1854	0	0.151134358	20.7577	0.351086348	1.997310022	0	0.999771907	1.914922252	0.850495834	2.994768215	8.422177302	1.207122568	3.565614763	0.59878555	0.057736514	2.413874148	4.380852523	6.935581641	0.106288831	0.823503964	0	0.859895633	2.833436236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.071
H2029_803_0	2011	4																															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	YES	121.262784	2.05098	12.033046	6.416837	0.87397	5.088835	2.260161	11.525783	32.213566	4.645779	13.61159	2.304509	0.222208	9.290017	16.445319	26.035538	0.398998	3.11255		3.22797	10.636459	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.153183	0.153183	0.154629	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.148167	0.148167	0.142802	0	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479		0.22479	0.22479	0																				17.9671	0.303887554	1.718343035	0	0.196459716	1.14391922	0.508061591	2.590880761	7.241287501	1.044324661	3.059749316	0.518030578	0.049950136	2.088302921	3.696743258	5.852528587	0.08969076	0.699670115	0	0.725615376	2.390969619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8856	0	1.925832998	17.9671	0.303887554	1.718343035	0	0.196459716	1.14391922	0.508061591	2.590880761	7.241287501	1.044324661	3.059749316	0.518030578	0.049950136	2.088302921	3.696743258	5.852528587	0.08969076	0.699670115	0	0.725615376	2.390969619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8856	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	Medicare FFS Cost Sharing																			10000	2.7906	0.0472	0.279	0	0.8033	0.771	0.3424	0.4039	1.1809	0.1628	0.5059	0.0808	0.0078	0.3256	0.6841	1.0831	0.0166	0.1238		0.1343	0.4425	0																			10.1854	0	0.151134358	20.7577	0.351086348	1.997310022	0	0.999771907	1.914922252	0.850495834	2.994768215	8.422177302	1.207122568	3.565614763	0.59878555	0.057736514	2.413874148	4.380852523	6.935581641	0.106288831	0.823503964	0	0.859895633	2.833436236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.071
H2029_805_0	2011	6																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0																			0	YES				6.416837	0.87397	5.088835	2.260161	11.525783	32.213566	4.645779	13.61159	2.304509	0.222208	9.290017	16.445319	26.035538	0.398998	3.11255		3.22797	10.636459	0																			6700				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare 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	0																			NO				0	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479		0.22479	0.22479	0																				0	0	0	0	0.196459716	1.14391922	0.508061591	2.590880761	7.241287501	1.044324661	3.059749316	0.518030578	0.049950136	2.088302921	3.696743258	5.852528587	0.08969076	0.699670115	0	0.725615376	2.390969619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8962	0	1.1649	0	0	0	0	0.196459716	1.14391922	0.508061591	2.590880761	7.241287501	1.044324661	3.059749316	0.518030578	0.049950136	2.088302921	3.696743258	5.852528587	0.08969076	0.699670115	0	0.725615376	2.390969619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8962	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																			10000				0	0.8033	0.771	0.3424	0.4039	1.1809	0.1628	0.5059	0.0808	0.0078	0.3256	0.6841	1.0831	0.0166	0.1238		0.1343	0.4425	0																			7.0686	0	0.091418318	0	0	0	0	0.999771907	1.914922252	0.850495834	2.994768215	8.422177302	1.207122568	3.565614763	0.59878555	0.057736514	2.413874148	4.380852523	6.935581641	0.106288831	0.823503964	0	0.859895633	2.833436236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9648
H2029_806_0	2011	6																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0																			0	YES				6.416837	0.87397	5.088835	2.260161	11.525783	32.213566	4.645779	13.61159	2.304509	0.222208	9.290017	16.445319	26.035538	0.398998	3.11255		3.22797	10.636459	0																			6700				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare 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	0																			NO				0	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479		0.22479	0.22479	0																				0	0	0	0	0.196459716	1.14391922	0.508061591	2.590880761	7.241287501	1.044324661	3.059749316	0.518030578	0.049950136	2.088302921	3.696743258	5.852528587	0.08969076	0.699670115	0	0.725615376	2.390969619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8962	0	1.1649	0	0	0	0	0.196459716	1.14391922	0.508061591	2.590880761	7.241287501	1.044324661	3.059749316	0.518030578	0.049950136	2.088302921	3.696743258	5.852528587	0.08969076	0.699670115	0	0.725615376	2.390969619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8962	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																			10000				0	0.8033	0.771	0.3424	0.4039	1.1809	0.1628	0.5059	0.0808	0.0078	0.3256	0.6841	1.0831	0.0166	0.1238		0.1343	0.4425	0																			7.0686	0	0.091418318	0	0	0	0	0.999771907	1.914922252	0.850495834	2.994768215	8.422177302	1.207122568	3.565614763	0.59878555	0.057736514	2.413874148	4.380852523	6.935581641	0.106288831	0.823503964	0	0.859895633	2.833436236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9648
H2029_807_0	2011	6																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0																			0	YES				6.416837	0.87397	5.088835	2.260161	11.525783	32.213566	4.645779	13.61159	2.304509	0.222208	9.290017	16.445319	26.035538	0.398998	3.11255		3.22797	10.636459	0																			6700				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare 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	0																			NO				0	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479	0.22479		0.22479	0.22479	0																				0	0	0	0	0.196459716	1.14391922	0.508061591	2.590880761	7.241287501	1.044324661	3.059749316	0.518030578	0.049950136	2.088302921	3.696743258	5.852528587	0.08969076	0.699670115	0	0.725615376	2.390969619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8962	0	1.1649	0	0	0	0	0.196459716	1.14391922	0.508061591	2.590880761	7.241287501	1.044324661	3.059749316	0.518030578	0.049950136	2.088302921	3.696743258	5.852528587	0.08969076	0.699670115	0	0.725615376	2.390969619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8962	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																			10000				0	0.8033	0.771	0.3424	0.4039	1.1809	0.1628	0.5059	0.0808	0.0078	0.3256	0.6841	1.0831	0.0166	0.1238		0.1343	0.4425	0																			7.0686	0	0.091418318	0	0	0	0	0.999771907	1.914922252	0.850495834	2.994768215	8.422177302	1.207122568	3.565614763	0.59878555	0.057736514	2.413874148	4.380852523	6.935581641	0.106288831	0.823503964	0	0.859895633	2.833436236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9648
H2034_001_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	877.0317883	28.93258323	482.4806809	0	48.05469358	46.85298898	35.05605853	38.14568563	73.56172251	21.98809722	49.67110657	0	13.85496799	124.8475779	68.31084003	106.033023	7.371860518	12.40509877	33.64831722	149.1172658	172.6818014	18.8051642	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;																			0	0.079226433	0.079226433	0.152929923	0	0.233	0.233	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	0.079226433	0.079226433	0.152929923	0	0.233	0.233	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												69.4841	2.292225358	73.78573328	0	11.1967436	10.91674643	8.168061637	8.887944751	17.13988135	5.123226651	11.57336783	0	3.228207542	29.08948565	15.91642573	24.70569436	1.717643501	2.890388014	7.840057912	34.74432293	40.23485973	4.381603259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	383.3167	0	0	69.4841	2.292225358	73.78573328	0	11.1967436	10.91674643	8.168061637	8.887944751	17.13988135	5.123226651	11.57336783	0	3.228207542	29.08948565	15.91642573	24.70569436	1.717643501	2.890388014	7.840057912	34.74432293	40.23485973	4.381603259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	383.3167	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	69.4841	2.292225358	73.78573328	0	11.1967436	10.91674643	8.168061637	8.887944751	17.13988135	5.123226651	11.57336783	0	3.228207542	29.08948565	15.91642573	24.70569436	1.717643501	2.890388014	7.840057912	34.74432293	40.23485973	4.381603259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	383.3167
H2034_002_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	483.7064687	48.01203601	197.0224691	0	26.134653	28.43085932	22.09734094	30.64829898	44.96737205	13.56734338	33.63217033	0	7.881398467	83.43044626	51.54409263	57.92328676	12.90541927	6.43232552	20.99826341	95.54058485	360.2077331	10.42438932	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;																			0	0.07677964	0.07677964	0.155255841	0	0.233	0.233	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	0.07677964	0.07677964	0.155255841	0	0.233	0.233	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												37.1388	3.68634686	30.58888919	0	6.089374149	6.624390221	5.14868044	7.141053663	10.47739769	3.161191008	7.836295686	0	1.836365843	19.43929398	12.00977358	13.49612581	3.006962689	1.498731846	4.892595374	22.26095627	83.92840181	2.428882712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	282.6905	0	0	37.1388	3.68634686	30.58888919	0	6.089374149	6.624390221	5.14868044	7.141053663	10.47739769	3.161191008	7.836295686	0	1.836365843	19.43929398	12.00977358	13.49612581	3.006962689	1.498731846	4.892595374	22.26095627	83.92840181	2.428882712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	282.6905	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	37.1388	3.68634686	30.58888919	0	6.089374149	6.624390221	5.14868044	7.141053663	10.47739769	3.161191008	7.836295686	0	1.836365843	19.43929398	12.00977358	13.49612581	3.006962689	1.498731846	4.892595374	22.26095627	83.92840181	2.428882712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	282.6905
H2108_001_0	2011	5																															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	0.527119909	0.55738734	0.13886296	1.130565768	1.18518165	0.324943849	0.565785202	0	0.001177868	1.050854412	1.582420589	3.169918841	0.00032998	0.035060675	0.929809432	0.489264774	0.438371854	0.012944896	0	0	0	0	0	0	0	0											12.14	YES	756.4768318	19.24111128	119.1018617	14.78089365	22.20023732	23.47498359	5.883903646	47.97295601	49.91523451	19.4078692	23.82866882	0	0.049607223	44.25789449	108.4757781	135.8217818	2.830754449	1.476619068	39.15995145	20.6059265	19.15941065	0.545188608	0	0	0	0	0	0	0	0											6700	"Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	"Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	"Days 1-20, $0/day; days 21-100, $137.5/day"	$0 copay	20% coinsurance after deductible	20% coinsurance after deductible	20% coinsurance after deductible	"$50 for Emergency Room, 20% coinsurance for Urgent Care, and $0 Worldwide; after deductible"	20% coinsurance after deductible	0% coinsurance	20% coinsurance after deductible	$0 copay	12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	20% coinsurance after deductible	$0 for Preventive services and 20% coinsurance after deductible for all other	20% coinsurance after deductible and 7f:  Routine Footcare - $0/visit	20% coinsurance after deductible	20% coinsurance after deductible	20% coinsurance after deductible	20% coinsurance after deductible	20% coinsurance after deductible	20% coinsurance after deductible	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 - Non-Routine 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:  Eye Glasses & Contact Lenses - $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	13c:  Other: Over the Counter Benefit - $0/visit												0.059527502	0.059554173	0.146504221	0	0.2	0.2	0.2	0.127112055	0.2	0	0.2	0	0.2	0.2	0.124627362	0.196229974	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.04529188	0.045312173	0.11146867	0	0.152171275	0.152171275	0.152171275	0.096714017	0.152171275	0	0.152171275	0	0.152171275	0.152171275	0.094823523	0.149302827	0.152171275	0.152171275	0.152171275	0.152171275	0.152171275	0.152171275	0	0	0	0	0	0	0	0												34.2623	0.871856553	13.27612617	0	3.378238425	3.572218191	0.895361121	4.639657305	7.595664892	0	3.626038923	0	0.007548794	6.734780245	10.28605542	20.27857596	0.430759514	0.224699007	5.959019752	3.135630114	2.915511952	0.082962046	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.173	155	38.4	34.2623	0.871856553	13.27612617	0	3.905358334	4.129605531	1.034224082	5.770223073	8.780846542	0.324943849	4.191824125	0	0.008726663	7.785634657	11.86847601	23.4484948	0.431089495	0.259759682	6.888829184	3.624894888	3.353883806	0.095906942	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.313	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2623	0.871856553	13.27612617	0	3.905358334	4.129605531	1.034224082	5.770223073	8.780846542	0.324943849	4.191824125	0	0.008726663	7.785634657	11.86847601	23.4484948	0.431089495	0.259759682	6.888829184	3.624894888	3.353883806	0.095906942	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.313
H2108_020_0	2011	2																															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	YES	861.1609274	9.076194278	400.135734	2.422364442	54.19924637	31.37144813	8.141105682	97.29132447	56.97795795	40.40036365	8.372701949	0	0.063188397	112.3597083	0	0	2.781535083	0.409171761	46.3726099	0.032045488	2.093322739	0.474811508	0	0	0	0	0	0	0	0											6700	"1a:  Acute - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/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 - 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $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/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/7f:  Routine Podiatry - $0/visit/12 Visits	7e:  Mental Hlth Spec-Non-Physician - Individual - 20.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 20.0%/7h:  Psychiatric Services - Individual - 20.0%/7h:  Psychiatric Services - Group - 20.0%	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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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 - Non-Routine 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:  Eye Glasses & Contact Lenses - $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	13c:  Other: Over the Counter Benefit - $0/visit												0.059299483	0.059322821	0	0	0.2	0.2	0.2	50	0.2	0	0.2	0	0.2	0.020297328	0	0	0.2	0	0	10.61012115	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.053087761	0.053563476	0	0	0.179947972	0.179097381	0.179799534	45.19280395	0.178717026	0	0.180990575	0	0.180855893	0.018395341	0	0	0.180466563	0	0	9.938684296	0.182743184	0.184207945	0	0	0	0	0	0	0	0												45.7171	0.486152513	0	0	9.753044477	5.618544196	1.463767006	0.366405646	10.18293118	0	1.515380138	0	0.011427994	2.066895105	0	0	0.501974076	0	0	2.65E-05	0.382540462	0.087464052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.1537	0	9.032238695	45.7171	0.486152513	0	0	9.753044477	5.618544196	1.463767006	0.366405646	10.18293118	0	1.515380138	0	0.011427994	2.066895105	0	0	0.501974076	0	0	2.65E-05	0.382540462	0.087464052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.1537	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7171	0.486152513	0	0	9.753044477	5.618544196	1.463767006	0.366405646	10.18293118	0	1.515380138	0	0.011427994	2.066895105	0	0	0.501974076	0	0	2.65E-05	0.382540462	0.087464052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.1537
H2108_022_0	2011	6																															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	1468.22794	13.41893608	1433.496234	7.533558725	254.0973128	10.39904416	4.709539221	418.1804181	209.8888888	13.06924634	23.98275	0	0.033826934	1161.367415	3763.011346	3157.518374	222.3212926	156.0560902	32.83829469	29.94172173	8.589790309	0.205476778	0	0	0	0	0	0	0	0											6700	1a:  Acute - $250/$0/day for 1-7/8-90	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	2:  Skilled Nursing Services - $0/$50/$110/day for 1-10/11-20/21-100 /2:  Non-Medicare Covered Stay - $0/$50/$110/day for 1-10/11-20/21-100	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 - 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 - $5/visit/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/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/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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/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:  Eye Glasses & Contact Lenses - $0/service			14c:  Routine Exams - $0/visit													250	0.05913677	46	0	150	0.2	0.2	43.41994671	249.580843	0	0.2	0	0.2	64.38275089	5	39.75401659	20	40	0	39.9948042	0.2	0	0	0	0	0	0	0	0	0											NO	231.4971713	0.05475998	42.59547951	0	138.8983028	0.185197737	0.185197737	40.21880104	231.1090366	0	0.185197737	0	0.185197737	59.61769883	4.629943425	36.81176955	18.5197737	37.0395474	0	37.03473615	0.185197737	0	0	0	0	0	0	0	0	0												28.3242	0.734820668	5.088371622	0	2.941140457	1.925879445	0.872196006	1.401559586	4.04226824	0	4.441551027	0	0.006264672	5.76983773	1.45187747	9.686153226	0.343111669	0.481687246	0	0.09240698	1.590809727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1942	0	5.53	28.3242	0.734820668	5.088371622	0	2.941140457	1.925879445	0.872196006	1.401559586	4.04226824	0	4.441551027	0	0.006264672	5.76983773	1.45187747	9.686153226	0.343111669	0.481687246	0	0.09240698	1.590809727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1942	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.3242	0.734820668	5.088371622	0	2.941140457	1.925879445	0.872196006	1.401559586	4.04226824	0	4.441551027	0	0.006264672	5.76983773	1.45187747	9.686153226	0.343111669	0.481687246	0	0.09240698	1.590809727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1942
H2108_026_0	2011	3																															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	1349.953406	9.177762662	1598.169337	17.63161201	207.2801898	15.90308209	6.764904555	295.7190105	322.9446903	14.8781821	18.27167001	0	0.028737584	1320.632034	0	4065.039419	239.8097695	370.0417221	33.64787626	22.73616322	14.41561407	0.433476207	0	0	0	0	0	0	0	0												1a:  Acute - $200/$0/day for 1-7/8-90	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	2:  Skilled Nursing Services - $0/$50/$110/day for 1-10/11-20/21-100 /2:  Non-Medicare Covered Stay - $0/$50/$110/day for 1-10/11-20/21-100	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 - 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 - $0/visit/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/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/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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/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 - Non-Routine 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:  Eye Glasses & Contact Lenses - $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													200	0.059085197	46	0	150	0.2	0.2	43.42040073	247.9591914	0	0.2	0	0.2	64.87444562	0	38.54407285	20	40	0	37.9329243	0.2	0	0	0	0	0	0	0	0	0											NO	183.2880102	0.054190334	42.20931231	0	137.5870587	0.183309204	0.182997336	39.81327613	228.0168725	0	0.183524133	0	0.183467225	59.49279723	0	35.36786354	18.34876514	36.59444234	0	35.00229733	0.183129714	0	0	0	0	0	0	0	0	0												20.6192	0.49734602	5.621469054	0	2.376589303	2.915181315	1.237959509	0.981128552	6.136403189	0	3.353292399	0	0.005272405	6.547341152	0	11.98097995	0.366684428	1.128455872	0	0.066318162	2.639927284	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.4735	0	6.006750294	20.6192	0.49734602	5.621469054	0	2.376589303	2.915181315	1.237959509	0.981128552	6.136403189	0	3.353292399	0	0.005272405	6.547341152	0	11.98097995	0.366684428	1.128455872	0	0.066318162	2.639927284	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.4735	YES	1a:  Acute - 20.0%		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 - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	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%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/14c:  Routine Exams - 20.0%/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/Vision Exams:   - /visit"	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/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		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) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%"	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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%							14c:  Routine Exams - 20.0%												6700	6.4296	0	1.1119	0.4243	0.1541	0	0	0.1169	0.7748	0.1683	0.4445	0	0.0005	0.416	0.5602	1.3668	0	0.0881	0.4336	0.3091	0.2951	0.0091	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.1028	0	4.787283789	27.0488	0.49734602	6.733374523	0.424345437	2.530668974	2.915181315	1.237959509	1.098001543	6.911189856	0.168287563	3.797781435	0	0.005810903	6.963318286	0.560201059	13.34776142	0.366684428	1.2165451	0.433590041	0.375408254	2.934978107	0.009131624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.5764
H2108_028_0	2011	3																															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	704.2631533	11.49408849	829.4007278	17.54080231	187.6465176	6.895178018	3.937519253	251.990577	263.297282	10.62180671	13.49447347	0	0.021543702	716.5936593	3681.219305	3107.894357	249.004049	147.3445973	19.33451173	28.17772738	4.416927404	0.403608119	0	0	0	0	0	0	0	0											6700	1a:  Acute - $150/$0/day for 1-5/6-90	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	2:  Skilled Nursing Services - $0/$50/$110/day for 1-10/11-20/21-100 /2:  Non-Medicare Covered Stay - $0/$50/$110/day for 1-10/11-20/21-100	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 - $40/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 - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/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) - 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/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/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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/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:  Eye Glasses & Contact Lenses - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13c:  Other: Over the Counter Benefit - $0/visit												150	0.066973886	46	0	50	0.2	0.2	43.41874543	191.2705827	0	0.170928855	0	0.2	52.93577025	5	38.00146904	20	40	0	40	0.2	0	0	0	0	0	0	0	0	0											NO	146.5342159	0.065842394	44.68648816	0	49.05822741	0.194659618	0.19677678	42.54494145	186.6407201	0	0.166542304	0	0.195184144	51.73286777	4.884666939	37.09875013	19.59312745	39.15538864	0	38.9938897	0.194006973	0	0	0	0	0	0	0	0	0												8.5999	0.756798309	3.088583817	0	0.767133795	1.342212721	0.77481236	0.893410362	4.095166193	0	2.247400697	0	0.004204989	3.089287085	1.498460853	9.608249683	0.406564006	0.480777914	0	0.091563266	0.856914718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6014	0	0.939323383	8.5999	0.756798309	3.088583817	0	0.767133795	1.342212721	0.77481236	0.893410362	4.095166193	0	2.247400697	0	0.004204989	3.089287085	1.498460853	9.608249683	0.406564006	0.480777914	0	0.091563266	0.856914718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6014	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.5999	0.756798309	3.088583817	0	0.767133795	1.342212721	0.77481236	0.893410362	4.095166193	0	2.247400697	0	0.004204989	3.089287085	1.498460853	9.608249683	0.406564006	0.480777914	0	0.091563266	0.856914718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6014
H2108_029_0	2011	3																															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	1419.789932	12.51194753	1441.67194	9.762564522	79.44501383	10.65534775	9.897569539	406.4290556	164.1671468	10.38418203	13.92722725	0	0.028841214	577.0019283	3836.740092	3191.050365	208.8176169	56.54098114	27.34097672	29.29332063	6.055006843	0.256773184	0	0	0	0	0	0	0	0											6700	1a:  Acute - $150/$0/day for 1-5/6-90	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	2:  Skilled Nursing Services - $0/$50/$110/day for 1-10/11-20/21-100 /2:  Non-Medicare Covered Stay - $0/$50/$110/day for 1-10/11-20/21-100	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 - $40/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 - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/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) - 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/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/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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/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:  Eye Glasses & Contact Lenses - $0/service			14c:  Routine Exams - $0/visit													150	0.066973886	46	0	50	0.2	0.024354451	43.41874543	200	0	0.174342158	0	0.2	60.03894738	5	39.91796271	20	40	0	39.99873517	0.2	0	0	0	0	0	0	0	0	0											NO	145.118636	0.064794394	44.50304836	0	48.37287866	0.193491515	0.023561898	42.01095978	193.4915146	0	0.168668641	0	0.193491515	58.08513433	4.837287866	38.61893533	19.34915146	38.69830293	0	38.69707925	0.193491515	0	0	0	0	0	0	0	0	0												17.1698	0.810704052	5.346566338	0	0.320248668	2.061719375	0.233205528	1.422872892	2.647079158	0	2.349086489	0	0.00558053	2.79293621	1.546618024	10.26958064	0.336703642	0.182336668	0	0.094463829	1.171592445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.7611	0	1.64	17.1698	0.810704052	5.346566338	0	0.320248668	2.061719375	0.233205528	1.422872892	2.647079158	0	2.349086489	0	0.00558053	2.79293621	1.546618024	10.26958064	0.336703642	0.182336668	0	0.094463829	1.171592445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.7611	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.1698	0.810704052	5.346566338	0	0.320248668	2.061719375	0.233205528	1.422872892	2.647079158	0	2.349086489	0	0.00558053	2.79293621	1.546618024	10.26958064	0.336703642	0.182336668	0	0.094463829	1.171592445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.7611
H2108_030_0	2011	5																															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	1818.75018	13.78323242	1804.24356	10.27520596	97.60585814	12.58725966	11.68564621	414.5336823	226.9285058	13.0144361	14.44164958	0	0.032528747	885.7315542	4218.884056	3550.463346	225.9031933	64.70059958	34.53622229	32.42188059	7.525044179	0.327220802	0	0	0	0	0	0	0	0											6700	1a:  Acute - $250/$0/day for 1-7/8-90	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	2:  Skilled Nursing Services - $0/$50/$110/day for 1-10/11-20/21-100 /2:  Non-Medicare Covered Stay - $0/$50/$110/day for 1-10/11-20/21-100	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) - $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 - $5/visit/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/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/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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/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:  Eye Glasses & Contact Lenses - $0/service			14c:  Routine Exams - $0/visit													250	0.059827802	46	0	150	0.2	0.024257606	43.42013737	250	0	0.2	0	0.2	74.54327827	5	39.91562673	20	40	0	39.99865032	0.2	0	0	0	0	0	0	0	0	0											NO	229.1053058	0.054827467	42.15537627	0	137.4631835	0.183284245	0.022230185	39.80528352	229.1053058	0	0.183284245	0	0.183284245	68.31304225	4.582106116	36.57952747	18.32842446	36.65684893	0	36.65561205	0.183284245	0	0	0	0	0	0	0	0	0												34.7238	0.755699724	6.338213846	0	1.118100999	2.307046378	0.259774072	1.375052563	4.332543725	0	2.646926834	0	0.005962007	5.042251424	1.61094787	10.82285596	0.345037468	0.197643342	0	0.09903699	1.379222038	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3601	0	6.69	34.7238	0.755699724	6.338213846	0	1.118100999	2.307046378	0.259774072	1.375052563	4.332543725	0	2.646926834	0	0.005962007	5.042251424	1.61094787	10.82285596	0.345037468	0.197643342	0	0.09903699	1.379222038	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3601	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.7238	0.755699724	6.338213846	0	1.118100999	2.307046378	0.259774072	1.375052563	4.332543725	0	2.646926834	0	0.005962007	5.042251424	1.61094787	10.82285596	0.345037468	0.197643342	0	0.09903699	1.379222038	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3601
H2111_001_0	2011	4																															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	YES	544.7553165	43.741712	9891.135837	55.00697337	16.47442126	36.38216121	21.5758164	9.420377675	6.470000377	44.52288134	29.1732866	0	0.125056851	12.99243508	1.173457879	201.0415873	21.4301	36.11629158	0	0	7.061492795	3.279359286	918.1410863	168.9760389	105.0655755	131.0036395	16.39192898	12.47653709	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.060939087	0.061678991	0	0	0.2	0.2	0.092666726	0.063733983	0.2	0	0.110029517	0	0.2	0.160751289	0.081390918	0.026007048	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.055686425	0.056362554	0	0	0.182760945	0.182760945	0.084679292	0.058240415	0.182760945	0	0.100545493	0	0.182760945	0.146895287	0.075127323	0.024005626	0.184608615	0	0	0	0.182760945	0.185694674	0	0	0	0	0	0	0	0												30.3355	2.465394584	0	0	3.010880793	6.649238153	1.827024848	0.548646705	1.182463381	0	2.933242477	0	0.022855508	1.908527483	0.088158749	4.826129138	3.956181074	0	0	0	1.290565094	0.608959553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6537	0	5.707849632	30.3355	2.465394584	0	0	3.010880793	6.649238153	1.827024848	0.548646705	1.182463381	0	2.933242477	0	0.022855508	1.908527483	0.088158749	4.826129138	3.956181074	0	0	0	1.290565094	0.608959553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6537	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	3.0112	0.2447	0	0.013	0.5018	1.1082	0.6572	0.061	0.1971	0	0.643	0	0.0025	0.3181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											6.7578	0	0.63743335	33.3467	2.710117338	0	0.013034561	3.512694258	7.757444512	2.484227612	0.60960745	1.379540611	0	3.576193554	0	0.025395009	2.226615397	0.088158749	4.826129138	3.956181074	0	0	0	1.290565094	0.608959553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4115
H2111_008_0	2011	4																															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	YES	534.4547855	21.393441	78.98865155	2315.641292	25.71346868	30.16005356	23.58690783	39.22348562	40.61365544	17.42890973	44.54317639	0	0.042776865	28.80213652	35.38683962	143.1004711	9.364653	5.312310577	0	0	21.61094739	10.10526722	715.055796	451.5072796	139.1715962	195.5503009	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.066170535	0.066973886	0.14528928	0	0.233	0.233	0.233	0.103789539	0.233	0.233	0.233	0	0.233	0.233	0.227430181	0.232905496	0.229815681	0.233	0	0	0.233	0.230569869	0	0	0	0	0	0	0	0											NO	0.066170535	0.066973886	0.14528928	0	0.233	0.233	0.233	0.103789539	0.233	0.233	0.233	0	0.233	0.233	0.227430181	0.232905496	0.229815681	0.233	0	0	0.233	0.230569869	0	0	0	0	0	0	0	0												35.3652	1.432801886	11.47620432	0	5.991238202	7.02729248	5.495749525	4.070987485	9.462981719	4.060935967	10.3785601	0	0.00996701	6.710897808	8.04803534	33.32888624	2.152144107	1.237768364	0	0	5.035350743	2.32997014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.6149	0	0	35.3652	1.432801886	11.47620432	0	5.991238202	7.02729248	5.495749525	4.070987485	9.462981719	4.060935967	10.3785601	0	0.00996701	6.710897808	8.04803534	33.32888624	2.152144107	1.237768364	0	0	5.035350743	2.32997014	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.6149	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	11.9236	0.4831	2.4875	1.2158	1.5556	1.8246	1.3872	0.7459	2.4571	0	2.1176	0	0.0018	1.4294	2.5584	11.0704	0.7245	0.411	0	0	1.6719	0.7761	0	0.1	0.0588	0	0	0	0	0											45.0003	0	0	47.2887	1.915879586	13.96369224	1.215781807	7.546870513	8.851937549	6.882904078	4.816906801	11.92005647	4.060935967	12.49616347	0	0.011770291	8.140291437	10.60646903	44.39932979	2.876632733	1.648750874	0	0	6.707263796	3.106111339	0	0.1	0.058759543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	198.6152
H2112_001_0	2011	2																															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	1379.896761	60.70412004	859.6195229	544.6862569	164.4056122	10.58696009	0	267.0591254	406.1260764	2600.333076	2499.547146	33.97912439	1.371034764	200.1029552	3172.632991	5074.781705	226.2837333	716.0379961	0	0	265.2236579	0	0	0	1198.234159	104.104224	56.28119241	18.85725683	78.89147901	0											3400	$275/day 1-8	$300/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$15 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$300 per procedure	$0 per visit	$50 X-ray; $175 Complex Radiology	$50 per visit	$25 per visit	$50 per visit	"$25 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$50 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$50 per visit	$50 per visit	$50 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	209.5	216.8565234	72.96419583	15	175	0.05	0.05	49	300	0	28.125	50	25	50	25	50	40	37.5	50	50	$50 	0	0	0	0	0	0	0	0	0											NO	173.7473076	179.848387	60.51232734	12.44014136	145.1349825	0.041467138	0.041467138	40.6377951	248.8028271	0	23.32526504	41.46713786	20.73356893	41.46713786	20.73356893	41.46713786	33.17371028	31.10035339	41.46713786	41.46713786	41.46713786	0	0	0	0	0	0	0	0	0												19.9794	0.90979484	4.334798163	0.564664503	1.988417137	0.439010933	0	0.904391168	8.420442998	0	4.858549972	0.117418086	0.00236887	0.691474736	5.481667067	17.53638938	0.625555918	1.855752893	0	0	0.916505499	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.6266	0	14.32735939	19.9794	0.90979484	4.334798163	0.564664503	1.988417137	0.439010933	0	0.904391168	8.420442998	0	4.858549972	0.117418086	0.00236887	0.691474736	5.481667067	17.53638938	0.625555918	1.855752893	0	0	0.916505499	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.6266	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			19.9794	0.90979484	4.334798163	0.564664503	1.988417137	0.439010933	0	0.904391168	8.420442998	0	4.858549972	0.117418086	0.00236887	0.691474736	5.481667067	17.53638938	0.625555918	1.855752893	0	0	0.916505499	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.6266
H2112_007_0	2011	3																															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	1421.307269	144.0376239	1019.330017	317.0690924	163.9480277	9.658446675	0	320.3470464	438.1846818	2275.670786	2619.879377	116.1135285	0.019811512	349.2676933	3268.356	4488.106089	316.2657797	951.6417011	0	0	229.5088997	0	0	0	897.8603043	94.38866362	61.86572728	18.01600824	38.40149511	0											3400	$300/day 1-7	$300/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$15 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$300 per procedure	$0 per visit	$50 X-ray; $175 Complex Radiology	$50 per visit	$25 per visit	$50 per visit	"$25 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$50 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$50 per visit	$50 per visit	$50 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	216.8565234	216.8565234	72.96419583	15	175	0.05	0.05	49	300	0	28.125	50	25	50	25	50	40	37.5	50	50	$50 	0	0	0	0	0	0	0	0	0											NO	180.9297534	180.9297534	60.8761671	12.51493964	146.0076291	0.041716465	0.041716465	40.88213615	250.2987928	0	23.46551182	41.71646546	20.85823273	41.71646546	20.85823273	41.71646546	33.37317237	31.28734909	41.71646546	41.71646546	41.71646546	0	0	0	0	0	0	0	0	0												21.4297	2.171724314	5.171075371	0.330675046	1.994805236	0.402916257	0	1.091372631	9.139758072	0	5.123067542	0.403653833	3.44E-05	1.214184472	5.681010841	15.60232689	0.879566032	2.48119551	0	0	0.797858341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.915	0	14.67710852	21.4297	2.171724314	5.171075371	0.330675046	1.994805236	0.402916257	0	1.091372631	9.139758072	0	5.123067542	0.403653833	3.44E-05	1.214184472	5.681010841	15.60232689	0.879566032	2.48119551	0	0	0.797858341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.915	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			21.4297	2.171724314	5.171075371	0.330675046	1.994805236	0.402916257	0	1.091372631	9.139758072	0	5.123067542	0.403653833	3.44E-05	1.214184472	5.681010841	15.60232689	0.879566032	2.48119551	0	0	0.797858341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.915
H2112_014_0	2011	3																															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	1787.401403	48.01034152	1133.752409	574.5499887	184.1708183	14.08975545	0	367.9481092	430.9669295	2860.111872	3019.203515	45.2556498	0	731.3309302	3944.078451	5885.74777	285.2486627	1022.620274	0	0	315.1878921	0	0	0	1182.943333	115.6970525	49.97797847	14.56051341	29.51455422	0											3400	$185/day 1-10	$185/day 1-10	"$0/d 1-10, $75/d 11-20, $100/d 21-100"	$0 per visit	$125 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$250 per procedure	$0 per visit	$50 X-ray; $150 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	"$10 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$35 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$35 per visit	$35 per visit	$50 per visit	$35 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	151.63	151.63	57.64	0	125	0.05	0.05	49	250	0	27.5	35	25	35	10	35	35	26.25	50	35	$50 	0	0	0	0	0	0	0	0	0											NO	130.6291782	130.6291782	49.6568346	0	107.6874449	0.043074978	0.043074978	42.21347841	215.3748898	0	23.69123788	30.15248458	0	30.15248458	8.614995593	30.15248458	30.15248458	22.61436343	43.07497797	30.15248458	43.07497797	0	0	0	0	0	0	0	0	0												19.4572	0.522629288	4.691546322	0	1.652740404	0.606915906	0	1.29436413	7.73495458	0	5.960722391	0.11371419	0	1.837620383	2.831518206	14.7891599	0.716746325	1.927158878	0	0	1.131392626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2684	0	10.49298764	19.4572	0.522629288	4.691546322	0	1.652740404	0.606915906	0	1.29436413	7.73495458	0	5.960722391	0.11371419	0	1.837620383	2.831518206	14.7891599	0.716746325	1.927158878	0	0	1.131392626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2684	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			19.4572	0.522629288	4.691546322	0	1.652740404	0.606915906	0	1.29436413	7.73495458	0	5.960722391	0.11371419	0	1.837620383	2.831518206	14.7891599	0.716746325	1.927158878	0	0	1.131392626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2684
H2112_801_0	2011	1																															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	YES	289.8951998	5.305410718	36.94464697	7.142830563	7.897225023	11.95184584	0	14.41545286	41.00912856	20.04124686	60.53999067	0.876496886	0.075155849	27.3394196	31.48872253	138.1661596	3.368075353	9.7862091	0	0	80.92387977	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.063322473	0.063322473	0.149283641	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.054772236	0.054772236	0.129126335	0	0.201538734	0.201538734	0.201538734	0.201538734	0.201538734	0.201538734	0.201538734	0.201538734	0.201538734	0.201538734	0.201538734	0.201538734	0.201538734	0.201538734	0.201538734	0.201538734	0.201538734	0.201538734	0	0	0	0	0	0	0	0												15.8782	0.29058921	4.770526852	0	1.591596731	2.408759876	0	2.905272116	8.264927842	4.039087514	12.20115306	0.176648072	0.015146815	5.509952007	6.346197265	27.84583286	0.678797642	1.97230019	0	0	16.30929626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2043	0	17.35958048	15.8782	0.29058921	4.770526852	0	1.591596731	2.408759876	0	2.905272116	8.264927842	4.039087514	12.20115306	0.176648072	0.015146815	5.509952007	6.346197265	27.84583286	0.678797642	1.97230019	0	0	16.30929626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2043	NO																																																																																		0			15.8782	0.29058921	4.770526852	0	1.591596731	2.408759876	0	2.905272116	8.264927842	4.039087514	12.20115306	0.176648072	0.015146815	5.509952007	6.346197265	27.84583286	0.678797642	1.97230019	0	0	16.30929626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2043
H2112_802_0	2011	1																															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	YES	306.2080628	4.524161655	35.17304071	7.067029169	8.120204264	14.50935771	0	15.1099656	42.78644544	19.9716182	68.76201228	0.747428203	0.064088763	28.52429782	33.13664711	130.5458331	2.739791389	9.038679002	0	0	72.35747515	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.061180896	0.061180896	0.149104303	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.052772358	0.052772358	0.128611809	0	0.200977107	0.200977107	0.200977107	0.200977107	0.200977107	0.200977107	0.200977107	0.200977107	0.200977107	0.200977107	0.200977107	0.200977107	0.200977107	0.200977107	0.200977107	0.200977107	0.200977107	0.200977107	0	0	0	0	0	0	0	0												16.1593	0.238750678	4.523668393	0	1.631975159	2.916048733	0	3.036757168	8.599096011	4.013838042	13.81959028	0.150215958	0.012880374	5.732730848	6.659707462	26.23672384	0.550635346	1.816567554	0	0	14.54219601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6407	0	17.62904988	16.1593	0.238750678	4.523668393	0	1.631975159	2.916048733	0	3.036757168	8.599096011	4.013838042	13.81959028	0.150215958	0.012880374	5.732730848	6.659707462	26.23672384	0.550635346	1.816567554	0	0	14.54219601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6407	NO																																																																																		0			16.1593	0.238750678	4.523668393	0	1.631975159	2.916048733	0	3.036757168	8.599096011	4.013838042	13.81959028	0.150215958	0.012880374	5.732730848	6.659707462	26.23672384	0.550635346	1.816567554	0	0	14.54219601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6407
H2161_001_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	316.5956974	6.865358014	134.8808593	0	18.764137	22.83629848	17.0955613	28.47572338	41.79088563	17.24911777	35.10901453	0	10.4686952	65.49380644	39.81314944	51.52948565	2.479485128	5.159664558	14.73011079	66.4403633	42.17673153	8.512488737	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	No Cost-Sharing; PBP 18b	PBP 14a	PBP 13b											0	0.078722743	0.078722743	0.169378828	0	0.233	0.233	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	0.078722742	0.078722742	0.169378827	0	0.232999999	0.232999999	0.232999999	0.232999999	0.232999999	0.232999999	0.232999999	0	0.232999999	0.232999999	0.232999999	0.232999999	0.232999999	0.232999999	0.232999999	0.232999999	0.232999999	0.232999999	0	0	0	0	0	0	0	0												24.9233	0.54045981	22.84596176	0	4.372043911	5.320857534	3.983265774	6.634843532	9.73727633	4.019044431	8.180400367	0	2.439205975	15.26005686	9.276463798	12.00637013	0.577720033	1.202201839	3.432115806	15.48060461	9.827178424	1.983409871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	162.0428	0	3.70E-07	24.9233	0.54045981	22.84596176	0	4.372043911	5.320857534	3.983265774	6.634843532	9.73727633	4.019044431	8.180400367	0	2.439205975	15.26005686	9.276463798	12.00637013	0.577720033	1.202201839	3.432115806	15.48060461	9.827178424	1.983409871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	162.0428	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.9233	0.54045981	22.84596176	0	4.372043911	5.320857534	3.983265774	6.634843532	9.73727633	4.019044431	8.180400367	0	2.439205975	15.26005686	9.276463798	12.00637013	0.577720033	1.202201839	3.432115806	15.48060461	9.827178424	1.983409871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	162.0428
H2165_004_0	2011	3																															D	D	D	P	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	YES	652.3762797	22.8294134	335.3708382		201.1111627	4.671528026	1.783144464	285.1978736	349.9750697		276.5701258	3.486975516	6.24	62.11703804	3112.784244	3268.748345	2.180672977	331.3245458	105.9394785		22.08058401																				3400	1a; $150/days 1-4 Acute/Rehab/LTAC	1b; $225/days 1-7	2a; $0 (1-5 Days); $50 (6-20 Days); $0 (21-100)	6a; No Cost Sharing	10a; $100 Per one-way trip; 20% Air Ambulance Per one-way trip	11a; 20% Coins. On DME/Prosthetics/Supplies	11b; 20% Coins. On DME/Prosthetics/Supplies	4a; $50 CP Per ER Visit; Waived If Admitted	9a/b; $100 CP Per Surg	8a; No Cost Sharing	"8a/b; $100 CP Per MRI, CT, Test"	1a; $100 Per Admit	12; 20% Coins.	8b; 9a/b; $100 CP Per Surg; $30 per Radiation Therapy visit	7a; $15 CP Per Visit	"4b, 7b/d/f/g,17a,18a; $30 CP Per Visit; Urgent Care CP Waived if Admitted"	"5, 7e/h, 9c; 20% Coins."	"3, 7c/i, 9d; $15 CP Per Visit Per PT/OT/ST"	8a; $30 CP Per Visit	14; No Cost Sharing	15; 20% Coins.																				0	150	225	50	0	109.4067761	0.2	0.2	50	100	0	100	100	0.2	75	15	30	0.2	15	30	0	0.2																				NO	145.2	217.8	48.4	0	105.9057592	0.1936	0.1936	48.4	96.8	0	96.8	96.8	0.1936	72.6	14.52	29.04	0.1936	14.52	29.04	0	0.1936																					7.8938	0.414353853	1.352662381	0	1.774902532	0.904407826	0.345216768	1.15029809	2.823132229	0	2.230999015	0.028128269	1.208064	0.37580808	3.766468936	7.910370994	0.422178288	0.4009027	0.256373538	0	4.274801064	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5328	0	1.240826511	7.8938	0.414353853	1.352662381	0	1.774902532	0.904407826	0.345216768	1.15029809	2.823132229	0	2.230999015	0.028128269	1.208064	0.37580808	3.766468936	7.910370994	0.422178288	0.4009027	0.256373538	0	4.274801064	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5328	NO																																																																																		0	0	0	7.8938	0.414353853	1.352662381	0	1.774902532	0.904407826	0.345216768	1.15029809	2.823132229	0	2.230999015	0.028128269	1.208064	0.37580808	3.766468936	7.910370994	0.422178288	0.4009027	0.256373538	0	4.274801064	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5328
H2165_005_0	2011	6																															D	D	D	V	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	YES	766.6837663	43.2078934	490.9975181	1412.563491	223.5711131	7.05887042	2.707339709	377.3060427	517.4345663		350.0922319	4.859272451	7.195470894	228.3451933	4209.300391	4129.350011	0.540426083	448.9893377	90.64914783		42.74882836																				3400	1a; $300/days 1-4 Acute/Rehab/LTAC	1b; $225/days 1-7	2a; $0 (1-3 Days); $100 (4-20 Days); $0 (21-100)	6a; $10 CP Per Visit Per PT/OT/ST	10a; $100 Per one-way trip; 20% Coins Air Ambulance per one-way  trip	11a; 20% Coins. On DME/Prosthetics/Supplies	11b; 20% Coins. On DME/Prosthetics/Supplies	4a; $50 Per ER Visit; Waived if Admitted	9a/b; $240 CP Per Surg	8a; No Cost Sharing	"8a/b; $150 CP Per MRI, CT, Test"	1a; $200 Per Admit	12; 20% Coins.	8b; 9a/b; $240 CP Per Surg; $40 CP Per Radiation Therapy Visit	7a; $10 CP Per Visit	"4b, 7b/d/f/g,17a,18a; $40 CP Per Visit, Urgent Care CP Waived if Admitted"	"5; 7e/h, 9c; 20% Coins."	3; 7c/i; 9d; $10 CP Per Visit Per PT/OT/ST	8a; $40 CP Per Visit	14; No Cost Sharing	15; 20% Coins.																				0	300	225	100	10	104.5855258	0.2	0.2	50	240	0	150	200	0.2	215	10	40	0.2	10	40	0	0.2																				NO	278.7	209.025	92.9	9.29	97.15995346	0.1858	0.1858	46.45	222.96	0	139.35	185.8	0.1858	199.735	9.29	37.16	0.1858	9.29	37.16	0	0.1858																					17.8062	0.752627493	3.80113912	1.093559569	1.810179912	1.311538124	0.503023718	1.460488807	9.613934242	0	4.065446042	0.075237735	1.336918492	3.800710599	3.258700053	12.78722053	0.100411166	0.347592579	0.280710194	0	7.94273231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1484	0	6.05	17.8062	0.752627493	3.80113912	1.093559569	1.810179912	1.311538124	0.503023718	1.460488807	9.613934242	0	4.065446042	0.075237735	1.336918492	3.800710599	3.258700053	12.78722053	0.100411166	0.347592579	0.280710194	0	7.94273231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1484	NO																																																																																		0	0	0	17.8062	0.752627493	3.80113912	1.093559569	1.810179912	1.311538124	0.503023718	1.460488807	9.613934242	0	4.065446042	0.075237735	1.336918492	3.800710599	3.258700053	12.78722053	0.100411166	0.347592579	0.280710194	0	7.94273231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1484
H2165_011_0	2011	5																															D	D	D	V	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	YES	741.2229	41.52999086	508.6406561	1400.881033	220.0299986	6.9795	2.7027	376.1047488	491.5910671		342.1084823	4.536350404	6.568398859	222.3831952	4022.062998	4115.737108	0.359396492	456.3007519	92.67628486		42.5799																				3400	1a; $300/days 1-4 Acute/Rehab/LTAC	1b; $225/days 1-7	2a; $0 (1-3 Days); $100 (4-20 Days); $0 (21-100)	6a; $10 CP Per Visit Per PT/OT/ST	10a; $100 Per one-way trip; 20% Coins Air Ambulance per one-way trip	11a; 20% Coins. On DME/Prosthetics/Supplies	11b; 20% Coins. On DME/Prosthetics/Supplies	4a; $50 Per ER Visit; Waived if Admitted	9a/b; $275 CP Per Surg	8a; No Cost Sharing	"8a/b; $150 CP Per MRI, CT, Test"	1a; $200 Per Admit	12; 20% Coins.	"8b, 9a/b; $275 CP Per Surg; $40 CP Per Radiation Therapy Visit"	7a; $10 CP Per Visit	"4b, 7b/d/f/g, 17a, 18a; $40 CP Per Visit, Urgent Care CP Waived if Admitted"	"5, 7e/h, 9c; 20% Coins."	"3, 7c/i, 9d; $10 CP Per Visit Per PT/OT/ST"	8a; $40 CP Per Visit	14; No Cost Sharing	15; 20% Coins.																				0	300	225	100	10	104.5855258	0.2	0.2	50	275	0	150	200	0.2	250	10	40	0.2	10	40	0	0.2																				NO	280.5	210.375	93.5	9.35	97.78746662	0.187	0.187	46.75	257.125	0	140.25	187	0.187	233.75	9.35	37.4	0.187	9.35	37.4	0	0.187																					17.3261	0.728072652	3.963158445	1.091519805	1.793014679	1.3051665	0.5054049	1.465241417	10.53336276	0	3.998392886	0.07069146	1.228290587	4.331839323	3.133857419	12.82738065	0.067207144	0.355534336	0.288841088	0	7.9624413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9755	0	5.073205854	17.3261	0.728072652	3.963158445	1.091519805	1.793014679	1.3051665	0.5054049	1.465241417	10.53336276	0	3.998392886	0.07069146	1.228290587	4.331839323	3.133857419	12.82738065	0.067207144	0.355534336	0.288841088	0	7.9624413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9755	NO	30% Coinsurance	Included in Line a1	30% Coinsurance		$100 Copay; 20% Air	30% Coinsurance	Included in Line e1	30% Coinsurance	30% Coinsurance	30% Coinsurance	Included in line h1	Included in line h1	Included in line h1	Included in line h1	30% Coinsurance	Include in line i1	Include in line i1	Include in line i1	Include in line i1	Include in line i1	30% Coinsurance																					0.6973		0.0942		0.02	0.0293		0.0628	0.174	0.1562					0.7031						0.129																				2.066	0	0	18.0233	0.728072652	4.057351075	1.091519805	1.813014679	1.33450333	0.5054049	1.528065026	10.7073648	0.156227437	3.998392886	0.07069146	1.228290587	4.331839323	3.836924644	12.82738065	0.067207144	0.355534336	0.288841088	0	8.091484393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0415
H2169_002_0	2011	5																															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	287.7817121	12.50684661	1430.109303		319.3742245	25.71090363	0	1564.035901	1789.035785		11301.23257	2276.501707		432.7546351	24963.94189	7334.618342	93.63778472	921.9433801			381.2471503	721.9885676	0	0																	3400	1a $300/stay-$900 combined max (1a/1b)	1b $300/stay-$900 combined max (1a/1b)	"2 $25/days 1-10; $70/days 11-55; $0/days 56-100 - $3,400 max"	6 $0/vst	10a $100/trp	11a 20% coin	"11b 20% coin, 11c $10-$50/item"	"4a $50/vst, 4b $50 vst"	"9a $200/vst, 9b $200/vst -$400 combined max (9a/9b)"	8a $0/vst	8b $30/x-ray; $90/diag x-ray; $0-$25/thera x-ray-$100 max per year	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $40/vst, 9d $0/vst"	"7a $15/PCP; $40/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $40/vst, 7d $40/vst, 7f $40/vst, 7g $40/vst, 16b $40/vst, 17a $0/vst, 18a $40/vst"	"7e $40/vst, 7h $40/vst"	"7c $40/vst, 7i $40/vst"	0	0	"15 10% coin - $2,000 max"	13a $0/vst	10b not covrd	"16a not covrd, 16b not covrd"	17a $150 combined max-2yr (17a/17b)	17b $150 combined max-2yr (17a/17b)	18a not covrd	18b not covrd	14a $0 vst	13b not covrd												260.7137718	244.3708609	45.55799642		100	0.136381539	0	12.08161294	28.54290806		6.972697259	6.655788427		40	2.31025798	23.31704023	5.609149677	40			69.33378515	25.13326268	0	0																	NO	254.7778455	238.8070298	44.52073282		97.72320189	0.133276407	0	11.80653901	27.89304366		6.81394302	6.504249562		39.08928076	2.25765807	22.78615829	5.481440663	39.08928076			67.75519484	24.56102903	0	0																		6.11	0.248893574	5.30579285	0	2.600855985	3.42665685	0	1.538820906	4.158471107	0	6.417162897	1.233911269	0	1.409672286	4.696670405	13.92731455	0.042772497	3.003175302	0	0	2.152622913	1.477731847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7506	0	1.345592763	6.11	0.248893574	5.30579285	0	2.600855985	3.42665685	0	1.538820906	4.158471107	0	6.417162897	1.233911269	0	1.409672286	4.696670405	13.92731455	0.042772497	3.003175302	0	0	2.152622913	1.477731847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7506	NO																																																																																		0	0	0	6.11	0.248893574	5.30579285	0	2.600855985	3.42665685	0	1.538820906	4.158471107	0	6.417162897	1.233911269	0	1.409672286	4.696670405	13.92731455	0.042772497	3.003175302	0	0	2.152622913	1.477731847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7506
H2169_005_0	2011	5																															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	287.7817121	12.50684661	1430.109303		319.3742245	25.71090363	0	1564.035901	1789.035785		11301.23257	2276.501707		432.7546351	24963.94189	7334.618342	93.63778472	921.9433801			381.2471503	721.9885676	0	0																	3400	1a $300/stay-$900 combined max (1a/1b)	1b $300/stay-$900 combined max (1a/1b)	"2 $25/days 1-10; $70/days 11-55; $0/days 56-100 - $3,400 max"	6 $0/vst	10a $100/trp	11a 20% coin	"11b 20% coin, 11c $10-$50/item"	"4a $50/vst, 4b $50 vst"	"9a $200/vst, 9b $200/vst -$400 combined max (9a/9b)"	8a $0/vst	8b $30/x-ray; $90/diag x-ray; $0-$25/thera x-ray-$100 max per year	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $40/vst, 9d $0/vst"	"7a $15/PCP; $40/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $40/vst, 7d $40/vst, 7f $40/vst, 7g $40/vst, 16b $40/vst, 17a $0/vst, 18a $40/vst"	"7e $40/vst, 7h $40/vst"	"7c $40/vst, 7i $40/vst"	0	0	"15 10% coin - $2,000 max"	13a $0/vst	10b not covrd	"16a not covrd, 16b not covrd"	17a $150 combined max-2yr (17a/17b)	17b $150 combined max-2yr (17a/17b)	18a not covrd	18b not covrd	14a $0 vst	13b not covrd												260.7137718	244.3708609	45.55799642		100	0.136381539	0	12.08161294	28.54290806		6.972697259	6.655788427		40	2.31025798	23.31704023	5.609149677	40			69.33378515	25.13326268	0	0																	NO	254.7778455	238.8070298	44.52073282		97.72320189	0.133276407	0	11.80653901	27.89304366		6.81394302	6.504249562		39.08928076	2.25765807	22.78615829	5.481440663	39.08928076			67.75519484	24.56102903	0	0																		6.11	0.248893574	5.30579285	0	2.600855985	3.42665685	0	1.538820906	4.158471107	0	6.417162897	1.233911269	0	1.409672286	4.696670405	13.92731455	0.042772497	3.003175302	0	0	2.152622913	1.477731847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7506	0	1.345592763	6.11	0.248893574	5.30579285	0	2.600855985	3.42665685	0	1.538820906	4.158471107	0	6.417162897	1.233911269	0	1.409672286	4.696670405	13.92731455	0.042772497	3.003175302	0	0	2.152622913	1.477731847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7506	NO																																																																																		0	0	0	6.11	0.248893574	5.30579285	0	2.600855985	3.42665685	0	1.538820906	4.158471107	0	6.417162897	1.233911269	0	1.409672286	4.696670405	13.92731455	0.042772497	3.003175302	0	0	2.152622913	1.477731847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7506
H2169_801_0	2011	3																															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	340.1286318	3.082415726	1398.542954		359.4248702	25.87141734	0	1431.478106	1953.966298		12825.05761	2133.513405		267.3918231	46165.86287	9620.59467	68.11547678	1750.72206			470.9286911	887.0571937	0	387.9452223																	3400	1a $150/stay	1b $150/stay	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/vst	10a $75/trp	11a 20% coin	"11b 20% coin, 11c $25-$50/item"	"4a $50/vst, 4b $50 vst"	"9a $100/vst, 9b $100/vst"	8a $0/vst	8b $25/x-ray; $75/diag x-ray; $0/thera x-ray	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $25/vst, 9d $0/vst"	"7a $10/PCP; $25/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $25/vst, 7d $25/vst, 7f $25/vst, 7g $25/vst, 16b $25/vst, 17a $25/vst, 18a $25/vst"	"7e $25/vst, 7h $25/vst"	"7c $25/vst, 7i $25/vst"	0	0	15 20% coin	13a $0/vst	10b not covrd	"16a $25/vst-6 mo; $25/x-ray-1yr, 16b 20% coin"	17a $200 combined max-2yr (17a/17b)	17b $200 combined max-2yr (17a/17b)	"18a $25/vst - 1 yr, $25/fitting - 3yr"	"18b $1,000 max-3 yr"	14a $0/vst	13b not covrd												19.40625	31.03448276	36.96480056		22.21711132	0.138593354	0	9.520420997	1.191271435		22.0499906	0.793934804		25	0.290983802	14.0009929	1.941747573	21.4177789			239.8681881	53.98367331	0	0																	NO	18.89094827	30.21041203	35.98325978		21.62717169	0.134913231	0	9.267621543	1.15963914		21.4644886	0.772853143		24.33616524	0.283257196	13.62921908	1.890187592	20.84906426			233.4988745	52.55022377	0	0																		0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064	0	1.314780112	0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064	NO																																																																																		0	0	0	0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064
H2169_802_0	2011	3																															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	340.1286318	3.082415726	1398.542954		359.4248702	25.87141734	0	1431.478106	1953.966298		12825.05761	2133.513405		267.3918231	46165.86287	9620.59467	68.11547678	1750.72206			470.9286911	887.0571937	0	387.9452223																	3400	1a $150/stay	1b $150/stay	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/vst	10a $75/trp	11a 20% coin	"11b 20% coin, 11c $25-$50/item"	"4a $50/vst, 4b $50 vst"	"9a $100/vst, 9b $100/vst"	8a $0/vst	8b $25/x-ray; $75/diag x-ray; $0/thera x-ray	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $25/vst, 9d $0/vst"	"7a $10/PCP; $25/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $25/vst, 7d $25/vst, 7f $25/vst, 7g $25/vst, 16b $25/vst, 17a $25/vst, 18a $25/vst"	"7e $25/vst, 7h $25/vst"	"7c $25/vst, 7i $25/vst"	0	0	15 20% coin	13a $0/vst	10b not covrd	"16a $25/vst-6 mo; $25/x-ray-1yr, 16b 20% coin"	17a $200 combined max-2yr (17a/17b)	17b $200 combined max-2yr (17a/17b)	"18a $25/vst - 1 yr, $25/fitting - 3yr"	"18b $1,000 max-3 yr"	14a $0/vst	13b not covrd												19.40625	31.03448276	36.96480056		22.21711132	0.138593354	0	9.520420997	1.191271435		22.0499906	0.793934804		25	0.290983802	14.0009929	1.941747573	21.4177789			239.8681881	53.98367331	0	0																	NO	18.89094827	30.21041203	35.98325978		21.62717169	0.134913231	0	9.267621543	1.15963914		21.4644886	0.772853143		24.33616524	0.283257196	13.62921908	1.890187592	20.84906426			233.4988745	52.55022377	0	0																		0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064	0	1.314780112	0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064	NO																																																																																		0	0	0	0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064
H2169_803_0	2011	3																															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	340.1286318	3.082415726	1398.542954		359.4248702	25.87141734	0	1431.478106	1953.966298		12825.05761	2133.513405		267.3918231	46165.86287	9620.59467	68.11547678	1750.72206			470.9286911	887.0571937	0	387.9452223																	3400	1a $150/stay	1b $150/stay	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/vst	10a $75/trp	11a 20% coin	"11b 20% coin, 11c $25-$50/item"	"4a $50/vst, 4b $50 vst"	"9a $100/vst, 9b $100/vst"	8a $0/vst	8b $25/x-ray; $75/diag x-ray; $0/thera x-ray	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $25/vst, 9d $0/vst"	"7a $10/PCP; $25/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $25/vst, 7d $25/vst, 7f $25/vst, 7g $25/vst, 16b $25/vst, 17a $25/vst, 18a $25/vst"	"7e $25/vst, 7h $25/vst"	"7c $25/vst, 7i $25/vst"	0	0	15 20% coin	13a $0/vst	10b not covrd	"16a $25/vst-6 mo; $25/x-ray-1yr, 16b 20% coin"	17a $200 combined max-2yr (17a/17b)	17b $200 combined max-2yr (17a/17b)	"18a $25/vst - 1 yr, $25/fitting - 3yr"	"18b $1,000 max-3 yr"	14a $0/vst	13b not covrd												19.40625	31.03448276	36.96480056		22.21711132	0.138593354	0	9.520420997	1.191271435		22.0499906	0.793934804		25	0.290983802	14.0009929	1.941747573	21.4177789			239.8681881	53.98367331	0	0																	NO	18.89094827	30.21041203	35.98325978		21.62717169	0.134913231	0	9.267621543	1.15963914		21.4644886	0.772853143		24.33616524	0.283257196	13.62921908	1.890187592	20.84906426			233.4988745	52.55022377	0	0																		0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064	0	1.314780112	0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064	NO																																																																																		0	0	0	0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064
H2174_001_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	263.4012353	44.82759352	43.10003943	0	15.98726518	35.4862219	2.514216246	45.15424367	36.91663747	1.798439523	5.356131352	0	0	21.473501	43.17503899	56.11916047	6.358856206	3.343389539	31.62839126	68.72383046	18.57881987	0.289766521	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 4b, 7a"	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	0% Coinsurance for Transportation; PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	0.082225702	0.082225702	0.124309392	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	0.074355201	0.074355201	0.112410713	0	0.210697645	0.210697645	0.210697645	0.210697645	0.210697645	0.210697645	0.210697645	0	0	0.210697645	0.210697645	0.210697645	0.210697645	0.210697645	0.210697645	0.210697645	0.210697645	0.210697645	0	0	0	0	0	0	0	0												19.5853	3.333164708	4.844906173	0	3.36847912	7.476863379	0.529739442	9.513892796	7.778248571	0.378926972	1.128524261	0	0	4.524416088	9.096879033	11.82417494	1.339796027	0.704444302	6.664027549	14.47994922	3.914513592	0.061053124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.5473	0	11.70143146	19.5853	3.333164708	4.844906173	0	3.36847912	7.476863379	0.529739442	9.513892796	7.778248571	0.378926972	1.128524261	0	0	4.524416088	9.096879033	11.82417494	1.339796027	0.704444302	6.664027549	14.47994922	3.914513592	0.061053124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.5473	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.5853	3.333164708	4.844906173	0	3.36847912	7.476863379	0.529739442	9.513892796	7.778248571	0.378926972	1.128524261	0	0	4.524416088	9.096879033	11.82417494	1.339796027	0.704444302	6.664027549	14.47994922	3.914513592	0.061053124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.5473
H2174_002_0	2011	7																															D	D	D		T	Coin		V	V		V			V	V	V	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	YES	799.994612	5.88907812	301.7955526	0	235.7555007	14.65878124	0	392.7391198	355.2549415	0	99.31484431	0	0	321.5218545	4677.56142	5779.778388	229.2374131	649.7436077	0	124.1446942	55.94564634	0	0	0	0	0	0	0	0	0											2500	$250/Days Custom for IP Med/Surg; PBP 1a	$250/Days Custom for IP MH/SA; PBP 1b	$100/Days Custom for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"0% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; $50/Visit for Urgent Care; PBP 4a, 4b, 7a"	"$150/Case for OP Surg; $150/Visit for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$100/Case for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"$25/Visit for CORF; $25/Day for Partial Hosp; $25/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$25/Visit for PCP OV; $0/Visit for Physical Exams (Initial); $0/Visit for Routine Exams; PBP 7a, 14b, 14c"	"$10/Visit for Chiro - cvd; $25/Visit for SCP OV; $25/Visit for SCP - Office Surg; $25/Visit for Podiatry; $25/Visit for Vision Exams; $25/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	No Cost Sharing; PBP 7d	"No Cost Sharing; PBP 7d, 7g, 14d-j"	20% Coinsurance for Medicare Part B Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	250	250	100	0	100	0.2	0	50	150	0	100	0	0	25	25	24.36615905	25	25	0	10	0.2	0	0	0	0	0	0	0	0	0											NO	217.7983624	217.7983624	87.11934497	0	87.11934497	0.17423869	0	43.55967248	130.6790175	0	87.11934497	0	0	21.77983624	21.83153187	21.22763816	21.77983624	21.77983624	0	8.711934497	0.17423869	0	0	0	0	0	0	0	0	0												14.5198	0.106885964	2.191019238	0	1.711572066	2.554126839	0	1.425632286	3.868697225	0	0.721020348	0	0	0.583557778	8.509860935	10.22425369	0.416062777	1.179275781	0	0.09012837	9.747896126	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8498	0	8.53	14.5198	0.106885964	2.191019238	0	1.711572066	2.554126839	0	1.425632286	3.868697225	0	0.721020348	0	0	0.583557778	8.509860935	10.22425369	0.416062777	1.179275781	0	0.09012837	9.747896126	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8498	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.5198	0.106885964	2.191019238	0	1.711572066	2.554126839	0	1.425632286	3.868697225	0	0.721020348	0	0	0.583557778	8.509860935	10.22425369	0.416062777	1.179275781	0	0.09012837	9.747896126	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8498
H2174_003_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	668.0919293	19.91681137	277.7067811	0	17.0348025	31.20713005	11.46403587	51.62053011	120.7665201	13.58243864	49.0586184	0	1.46712353	80.77619591	75.76957299	94.64539692	2.415144672	7.012636769	43.95935179	148.6592325	77.31625814	0.264942948	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 4b, 7a"	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	0% Coinsurance for Transportation; PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	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	0.074359285	0.074359285	0.112416888	0	0.210709219	0.210709219	0.210709219	0.210709219	0.210709219	0.210709219	0.210709219	0	0.210709219	0.210709219	0.211307212	0.210709219	0.210709219	0.210709219	0.210709219	0.210709219	0.210709219	0.210709219	0	0	0	0	0	0	0	0												49.6788	1.480999854	31.21893214	0	3.589389927	6.575629995	2.415578043	10.87692158	25.44661912	2.861945036	10.33710316	0	0.309136453	17.02028914	16.01065719	19.94265765	0.508893247	1.477627216	9.262640677	31.32387075	16.29124836	0.055825922	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	256.6848	0	27.10440325	49.6788	1.480999854	31.21893214	0	3.589389927	6.575629995	2.415578043	10.87692158	25.44661912	2.861945036	10.33710316	0	0.309136453	17.02028914	16.01065719	19.94265765	0.508893247	1.477627216	9.262640677	31.32387075	16.29124836	0.055825922	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	256.6848	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	49.6788	1.480999854	31.21893214	0	3.589389927	6.575629995	2.415578043	10.87692158	25.44661912	2.861945036	10.33710316	0	0.309136453	17.02028914	16.01065719	19.94265765	0.508893247	1.477627216	9.262640677	31.32387075	16.29124836	0.055825922	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	256.6848
H2174_004_0	2011	4																															D	D	D		T	Coin		V	V		V			V	V	V	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	YES	657.3598121	7.064276915	244.4855157	0	174.089844	10.94218789	0	228.366025	283.7209925	0	89.327159	0	0	215.3730924	3885.855675	4613.338636	80.25088118	377.079759	0	148.918469	44.13382526	0	0	0	0	0	0	0	0	0											2500	$250/Days Custom for IP Med/Surg; PBP 1a	$250/Days Custom for IP MH/SA; PBP 1b	$100/Days Custom for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"0% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; $50/Visit for Urgent Care; PBP 4a, 4b, 7a"	"$150/Case for OP Surg; $150/Visit for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$100/Case for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"$25/Visit for CORF; $25/Day for Partial Hosp; $25/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$25/Visit for PCP OV; $0/Visit for Physical Exams (Initial); $0/Visit for Routine Exams; PBP 7a, 14b, 14c"	"$10/Visit for Chiro - cvd; $25/Visit for SCP OV; $25/Visit for SCP - Office Surg; $25/Visit for Podiatry; $25/Visit for Vision Exams; $25/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	No Cost Sharing; PBP 7d	"No Cost Sharing; PBP 7d, 7g, 14d-j"	20% Coinsurance for Medicare Part B Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	250	250	100	0	100	0.2	0	50	150	0	100	0	0	25	25	24.62127142	25	25	0	10	0.2	0	0	0	0	0	0	0	0	0											NO	225.4199471	225.4199471	90.16797885	0	90.16797885	0.180335958	0	45.08398942	135.2519683	0	90.16797885	0	0	22.54199471	22.59883014	22.2005028	22.54199471	22.54199471	0	9.016797885	0.180335958	0	0	0	0	0	0	0	0	0												12.3485	0.132702411	1.837063734	0	1.308110781	1.973269933	0	0.857970955	3.197818556	0	0.671204115	0	0	0.404578259	7.317982695	8.534869776	0.150751245	0.708344161	0	0.111897311	7.958915645	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.514	0	5.160568281	12.3485	0.132702411	1.837063734	0	1.308110781	1.973269933	0	0.857970955	3.197818556	0	0.671204115	0	0	0.404578259	7.317982695	8.534869776	0.150751245	0.708344161	0	0.111897311	7.958915645	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.514	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.3485	0.132702411	1.837063734	0	1.308110781	1.973269933	0	0.857970955	3.197818556	0	0.671204115	0	0	0.404578259	7.317982695	8.534869776	0.150751245	0.708344161	0	0.111897311	7.958915645	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.514
H2174_005_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	625.7683728	6.919170487	283.9208381	0	13.69882408	16.3793243	11.25539068	48.67886395	117.2436451	13.89441123	49.91128377	0	1.50205137	77.99515951	72.81099632	91.56822571	2.238998776	7.179586758	43.27749168	142.0931018	79.06519249	0.27125045	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 4b, 7a"	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	No Cost-Sharing; PBP 10b	"PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	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	0.074393924	0.074393924	0.112469256	0	0.210807374	0.210807374	0.210807374	0.210807374	0.210807374	0.210807374	0.210807374	0	0.210807374	0.210807374	0.211441675	0.210807374	0.210807374	0.210807374	0.210807374	0.210807374	0.210807374	0.210807374	0	0	0	0	0	0	0	0												46.5534	0.514744244	31.93236532	0	2.887813132	3.452882346	2.372719355	10.26186348	24.71582496	2.929044345	10.52166667	0	0.316643505	16.44195477	15.39527901	19.30325721	0.471997453	1.513509832	9.123214379	29.95427367	16.66752561	0.057181595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	245.3871	0	25.78194343	46.5534	0.514744244	31.93236532	0	2.887813132	3.452882346	2.372719355	10.26186348	24.71582496	2.929044345	10.52166667	0	0.316643505	16.44195477	15.39527901	19.30325721	0.471997453	1.513509832	9.123214379	29.95427367	16.66752561	0.057181595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	245.3871	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	46.5534	0.514744244	31.93236532	0	2.887813132	3.452882346	2.372719355	10.26186348	24.71582496	2.929044345	10.52166667	0	0.316643505	16.44195477	15.39527901	19.30325721	0.471997453	1.513509832	9.123214379	29.95427367	16.66752561	0.057181595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	245.3871
H2174_801_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	254.7475796	2.814495159	58.29818361	0	9.857867295	11.78679312	8.099538112	18.50925578	44.32000618	5.252313596	18.86727765	0	0.567799866	29.72916686	49.7597959	62.57868251	1.530155165	4.906604631	29.57629015	97.10791092	47.56510215	0.185375393	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 4b, 7a"	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	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	0.07480151	0.07480151	0.113085447	0	0.211962336	0.211962336	0.211962336	0.211962336	0.211962336	0.211962336	0.211962336	0	0.211962336	0.211962336	0.212563626	0.211962336	0.211962336	0.211962336	0.211962336	0.211962336	0.211962336	0.211962336	0	0	0	0	0	0	0	0												19.0555	0.210528488	6.592676147	0	2.089496576	2.498356199	1.716797016	3.923265087	9.394172026	1.113292657	3.999152238	0	0.120352186	6.301463644	10.57712264	13.26432371	0.324335263	1.040015378	6.26905954	20.58321961	10.08201015	0.039292601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.1944	0	11.79738431	19.0555	0.210528488	6.592676147	0	2.089496576	2.498356199	1.716797016	3.923265087	9.394172026	1.113292657	3.999152238	0	0.120352186	6.301463644	10.57712264	13.26432371	0.324335263	1.040015378	6.26905954	20.58321961	10.08201015	0.039292601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.1944	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.0555	0.210528488	6.592676147	0	2.089496576	2.498356199	1.716797016	3.923265087	9.394172026	1.113292657	3.999152238	0	0.120352186	6.301463644	10.57712264	13.26432371	0.324335263	1.040015378	6.26905954	20.58321961	10.08201015	0.039292601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.1944
H2174_802_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	254.7475796	2.814495159	58.29818361	0	9.857867295	11.78679312	8.099538112	18.50925578	44.32000618	5.252313596	18.86727765	0	0.567799866	29.72916686	49.7597959	62.57868251	1.530155165	4.906604631	29.57629015	97.10791092	47.56510215	0.185375393	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 4b, 7a"	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	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	0.07480151	0.07480151	0.113085447	0	0.211962336	0.211962336	0.211962336	0.211962336	0.211962336	0.211962336	0.211962336	0	0.211962336	0.211962336	0.212563626	0.211962336	0.211962336	0.211962336	0.211962336	0.211962336	0.211962336	0.211962336	0	0	0	0	0	0	0	0												19.0555	0.210528488	6.592676147	0	2.089496576	2.498356199	1.716797016	3.923265087	9.394172026	1.113292657	3.999152238	0	0.120352186	6.301463644	10.57712264	13.26432371	0.324335263	1.040015378	6.26905954	20.58321961	10.08201015	0.039292601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.1944	0	11.79738431	19.0555	0.210528488	6.592676147	0	2.089496576	2.498356199	1.716797016	3.923265087	9.394172026	1.113292657	3.999152238	0	0.120352186	6.301463644	10.57712264	13.26432371	0.324335263	1.040015378	6.26905954	20.58321961	10.08201015	0.039292601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.1944	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.0555	0.210528488	6.592676147	0	2.089496576	2.498356199	1.716797016	3.923265087	9.394172026	1.113292657	3.999152238	0	0.120352186	6.301463644	10.57712264	13.26432371	0.324335263	1.040015378	6.26905954	20.58321961	10.08201015	0.039292601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.1944
H2182_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1148.194233	102.6316253	509.7672377	635.9757009	130.9996097	6.404287636	10.8462035	313.9619437	34.57618258	16.33811742	40.67951329	0	0.0498353	15.52248106	5443.758544	100.4262147	474.6728032	745.3850931	0	0	15.88541385	1139.827845	0	0	212.4803627	207.900925	14.84625074	6	51.32860338	0											3380	"$295 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-34 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												219.7738852	147.0075908	77.72429458	0	200	0.2	0.110823597	49.17194105	0.2	0.12857472	0.161304388	0	0.2	0.160408103	6.765320386	0.126791254	38.5	35	0	0	0.2	34.7455371	0	0	35	30	0	0	0	0											NO	156.3185763	104.5620924	55.28296077	0	142.2540045	0.142254005	0.078825503	34.99281573	0.142254005	0.091451344	0.114730976	0	0.142254005	0.114093475	6.428059158	0.120482267	36.58071805	33.25519823	0	0	0.142254005	24.71345896	0	0	35	30	0	0	0	0												14.957	0.894281458	2.348453517	0	1.552934923	0.911035562	0.854957441	0.91553437	4.918600434	1.494142798	4.667200245	0	0.007089271	1.771013801	2.91606683	12.09957803	1.446989332	2.065660752	0	0	2.259763733	2.347424055	0	0	0.619734391	0.519752312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5672	0	17.16682202	14.957	0.894281458	2.348453517	0	1.552934923	0.911035562	0.854957441	0.91553437	4.918600434	1.494142798	4.667200245	0	0.007089271	1.771013801	2.91606683	12.09957803	1.446989332	2.065660752	0	0	2.259763733	2.347424055	0	0	0.619734391	0.519752312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5672	NO	"$325 Days 1-Unlimited (1a); $325 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-40 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$15 (7a, 14c); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$15 (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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.9849	0.1764	0.7309	0.7751	0.6339	0.5578	0.9447	0.3735	3.0115	0.6099	2.8132	0	0.0029	1.0794	1.0278	2.7589	0.3278	0.4733	0	0	0.9077	0.7185	0	0	0.1349	0	0.0094	0	0	0											20.0522	0	0	16.9419	1.070678967	3.079313704	0.775063559	2.186804002	1.468828356	1.799626778	1.28903723	7.930074401	2.104014406	7.480425683	0	0.009982934	2.850424013	3.943836173	14.8585258	1.774739601	2.538921129	0	0	3.167501668	3.065923469	0	0	0.754642558	0.519752312	0.009426191	0	0	0	0	0	0	0	0	0	0	0	0	0	79.6195
H2182_805_0	2011	1																															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	211.3123826	6.00707	16.17015088	670.6541297	5.866200636	6.77873787	11.48036668	12.40740219	34.10863345	16.11718867	40.12943315	0	0.049161413	15.30434273	33.01078985	116.3021072	2.57334	8.326158905	0	0	18.37859938	7.800528765	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.079888132	0.079888132	0.17196728	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.065129586	0.065129586	0.140198019	0	0.189955544	0.189955544	0.189955544	0.189955544	0.189955544	0.189955544	0.189955544	0	0.189955544	0.189955544	0.189955544	0.189955544	0.189955544	0.189955544	0	0	0.189955544	0.189955544	0	0	0	0	0	0	0	0												13.7627	0.391237982	2.267023114	0	1.114317335	1.287658842	2.180759303	2.356854837	6.479124035	3.061549348	7.622808321	0	0.009338483	2.907144755	6.270582558	22.09223009	0.488820201	1.581600048	0	0	3.49111685	1.481753688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8466	0	17.866861	13.7627	0.391237982	2.267023114	0	1.114317335	1.287658842	2.180759303	2.356854837	6.479124035	3.061549348	7.622808321	0	0.009338483	2.907144755	6.270582558	22.09223009	0.488820201	1.581600048	0	0	3.49111685	1.481753688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8466	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0775	0.0306	0.3262	0	0.3968	0.4585	0.7766	0.8393	2.3073	1.0902	2.7146	0	0.0033	1.0353	1.4651	5.1616	0.1142	0.3695	0	0	0.8157	0.3462	0	0	0	0	0	0	0	0											19.3286	0	0	14.8402	0.421869488	2.593254813	0	1.511137424	1.746207659	2.957350558	3.196155559	8.786408046	4.151799175	10.3373703	0	0.012664015	3.942409488	7.73563285	27.25382837	0.603027481	1.95112291	0	0	4.306776594	1.827948584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.1752
H2182_806_0	2011	1																															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	211.3123826	6.00707	16.17015088	670.6541297	5.866200636	6.77873787	11.48036668	12.40740219	34.10863345	16.11718867	40.12943315	0	0.049161413	15.30434273	33.01078985	116.3021072	2.57334	8.326158905	0	0	18.37859938	7.800528765	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.079888132	0.079888132	0.17196728	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.065129586	0.065129586	0.140198019	0	0.189955544	0.189955544	0.189955544	0.189955544	0.189955544	0.189955544	0.189955544	0	0.189955544	0.189955544	0.189955544	0.189955544	0.189955544	0.189955544	0	0	0.189955544	0.189955544	0	0	0	0	0	0	0	0												13.7627	0.391237982	2.267023114	0	1.114317335	1.287658842	2.180759303	2.356854837	6.479124035	3.061549348	7.622808321	0	0.009338483	2.907144755	6.270582558	22.09223009	0.488820201	1.581600048	0	0	3.49111685	1.481753688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8466	0	17.866861	13.7627	0.391237982	2.267023114	0	1.114317335	1.287658842	2.180759303	2.356854837	6.479124035	3.061549348	7.622808321	0	0.009338483	2.907144755	6.270582558	22.09223009	0.488820201	1.581600048	0	0	3.49111685	1.481753688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8466	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0775	0.0306	0.3262	0	0.3968	0.4585	0.7766	0.8393	2.3073	1.0902	2.7146	0	0.0033	1.0353	1.4651	5.1616	0.1142	0.3695	0	0	0.8157	0.3462	0	0	0	0	0	0	0	0											19.3286	0	0	14.8402	0.421869488	2.593254813	0	1.511137424	1.746207659	2.957350558	3.196155559	8.786408046	4.151799175	10.3373703	0	0.012664015	3.942409488	7.73563285	27.25382837	0.603027481	1.95112291	0	0	4.306776594	1.827948584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.1752
H2182_807_0	2011	1																															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	211.3123826	6.00707	16.17015088	670.6541297	5.866200636	6.77873787	11.48036668	12.40740219	34.10863345	16.11718867	40.12943315	0	0.049161413	15.30434273	33.01078985	116.3021072	2.57334	8.326158905	0	0	18.37859938	7.800528765	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.079888132	0.079888132	0.17196728	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.065129586	0.065129586	0.140198019	0	0.189955544	0.189955544	0.189955544	0.189955544	0.189955544	0.189955544	0.189955544	0	0.189955544	0.189955544	0.189955544	0.189955544	0.189955544	0.189955544	0	0	0.189955544	0.189955544	0	0	0	0	0	0	0	0												13.7627	0.391237982	2.267023114	0	1.114317335	1.287658842	2.180759303	2.356854837	6.479124035	3.061549348	7.622808321	0	0.009338483	2.907144755	6.270582558	22.09223009	0.488820201	1.581600048	0	0	3.49111685	1.481753688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8466	0	17.866861	13.7627	0.391237982	2.267023114	0	1.114317335	1.287658842	2.180759303	2.356854837	6.479124035	3.061549348	7.622808321	0	0.009338483	2.907144755	6.270582558	22.09223009	0.488820201	1.581600048	0	0	3.49111685	1.481753688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8466	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0775	0.0306	0.3262	0	0.3968	0.4585	0.7766	0.8393	2.3073	1.0902	2.7146	0	0.0033	1.0353	1.4651	5.1616	0.1142	0.3695	0	0	0.8157	0.3462	0	0	0	0	0	0	0	0											19.3286	0	0	14.8402	0.421869488	2.593254813	0	1.511137424	1.746207659	2.957350558	3.196155559	8.786408046	4.151799175	10.3373703	0	0.012664015	3.942409488	7.73563285	27.25382837	0.603027481	1.95112291	0	0	4.306776594	1.827948584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.1752
H2224_001_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	507.3004847	11.89617281	75.01258683	0	35.9292871	54.93401274	8.642098943	27.38285528	71.83923187	49.3859695	19.0146835	0	0.127575738	118.5438844	75.64046326	145.6455634	11.83707712	30.91415129	13.62909183	5.56247972	21.35039558	6.495202795	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.061367402	0.061367402	0.122712057	0	0.189479333	0.189479333	0.189479333	0.189479333	0.189479333	0.189479333	0.189479333	0	0.189479333	0.189479333	0.189479333	0.189479333	0.189479333	0.189479333	0.189479333	0.189479333	0.189479333	0.189479333	0	0	0	0	0	0	0	0											NO	0.056838831	0.056838831	0.113656594	0	0.175496819	0.175496819	0.175496819	0.175496819	0.175496819	0.175496819	0.175496819	0	0.175496819	0.175496819	0.175496819	0.175496819	0.175496819	0.175496819	0.175496819	0.175496819	0.175496819	0.175496819	0	0	0	0	0	0	0	0												28.8344	0.676164554	8.525675132	0	6.305475584	9.640744475	1.516660871	4.805603988	12.60755665	8.667080536	3.337016463	0	0.022389136	20.80407458	13.27466067	25.56033303	2.077369377	5.425335204	2.391862257	0.976197495	3.746926501	1.139887427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.3354	0	12.77454383	28.8344	0.676164554	8.525675132	0	6.305475584	9.640744475	1.516660871	4.805603988	12.60755665	8.667080536	3.337016463	0	0.022389136	20.80407458	13.27466067	25.56033303	2.077369377	5.425335204	2.391862257	0.976197495	3.746926501	1.139887427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.3354	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	28.8344	0.676164554	8.525675132	0	6.305475584	9.640744475	1.516660871	4.805603988	12.60755665	8.667080536	3.337016463	0	0.022389136	20.80407458	13.27466067	25.56033303	2.077369377	5.425335204	2.391862257	0.976197495	3.746926501	1.139887427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.3354
H2225_001_0	2011	4																															Coin		Coin	Coin	Coin	Coin		Coin	Coin	Coin					Coin						Coin	Coin																																																											0	YES	487.502716		168.5659498	196.1473881	52.53443109	111.2435212		30.85196082	26.20265547	126.2172931					394.2754408						25.3175604	0.405644531																			6700	FFS		FFS	FFS	FFS	FFS		FFS	FFS	FFS					FFS						FFS	FFS																			0	0.074485612		0.154070665	0	0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																			NO	0.074485612		0.154070665	0	0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																				36.3119	0	25.97106793	0	12.24052244	25.91974043	0	7.188506872	6.105218724	29.40862929	0	0	0	0	91.86617772	0	0	0	0	0	5.898991574	0.094515176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	241.0053	0	0	36.3119	0	25.97106793	0	12.24052244	25.91974043	0	7.188506872	6.105218724	29.40862929	0	0	0	0	91.86617772	0	0	0	0	0	5.898991574	0.094515176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	241.0053	NO																																																																																		0			36.3119	0	25.97106793	0	12.24052244	25.91974043	0	7.188506872	6.105218724	29.40862929	0	0	0	0	91.86617772	0	0	0	0	0	5.898991574	0.094515176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	241.0053
H2226_001_0	2011	5																															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	YES	354.4739506	22.726	124.9677607	1190.028603	12.9039069	11.14101787	24.89543051	61.94946597	18.08918007	24.09335754	44.57221836	0	0.037438166	32.91096986	35.9740376	125.9595806	11.3218	1.184752472	0	0	25.19272887	10.73096264	0	0	0	0	11.95999237	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); FFS (4b)	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.072208909	0.072208909	0.150083876	0	0.233	0.233	0.233	0.058158524	0.233	0.233	0.233	0	0.233	0.233	0.22804466	0.233	0.233350097	0.233	0	0	0.233	0.229669905	0	0	0	0	0	0	0	0											NO	0.055925078	0.055925078	0.116238462	0	0.180456171	0.180456171	0.180456171	0.045043195	0.180456171	0.180456171	0.180456171	0	0.180456171	0.180456171	0.17661831	0.180456171	0.180727317	0.180456171	0	0	0.180456171	0.177957085	0	0	0	0	0	0	0	0												19.824	1.270953324	14.52606027	0	2.328589632	2.010465429	4.49253407	2.790401893	3.264304175	4.347795053	8.043331865	0	0.006755948	5.93898761	6.353673711	22.73018364	2.046158543	0.213795895	0	0	4.546183393	1.909650834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6438	0	31.0506084	19.824	1.270953324	14.52606027	0	2.328589632	2.010465429	4.49253407	2.790401893	3.264304175	4.347795053	8.043331865	0	0.006755948	5.93898761	6.353673711	22.73018364	2.046158543	0.213795895	0	0	4.546183393	1.909650834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6438	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.824	1.270953324	14.52606027	0	2.328589632	2.010465429	4.49253407	2.790401893	3.264304175	4.347795053	8.043331865	0	0.006755948	5.93898761	6.353673711	22.73018364	2.046158543	0.213795895	0	0	4.546183393	1.909650834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6438
H2228_001_0	2011	6																															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	YES	245.9281778	44.0747775	10718.64423	31.16469956	29.10397919	26.74546498	13.08264346	16.09723286	5.604790124	61.99895527	12.13023995	0	0	5.669994136	0.692917859	129.1568767	20.481525	14.2005038	0	0	3.990925673	8.612399459	737.8943414	0	530.1521419	146.7385393	0	0	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.07172254	0.072593041	0	0	0.2	0.2	0.097925108	0.048519243	0.2	0	0.110080243	0	0	0.161412465	0.013292665	0.029552303	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.06719	0.068005488	0	0	0.187360903	0.187360903	0.091736684	0.045453046	0.187360903	0	0.103123669	0	0	0.151211926	0.012305035	0.027356601	0.185140231	0	0	0	0.187360903	0.187790941	0	0	0	0	0	0	0	0												16.5239	2.997326774	0	0	5.452947834	5.011054481	1.200158324	0.731668273	1.050118541	0	1.250914849	0	0	0.857370735	0.008526379	3.533293193	3.791954266	0	0	0	0.747743439	1.617330595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7743	0	3.110357034	16.5239	2.997326774	0	0	5.452947834	5.011054481	1.200158324	0.731668273	1.050118541	0	1.250914849	0	0	0.857370735	0.008526379	3.533293193	3.791954266	0	0	0	0.747743439	1.617330595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7743	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.751	0.3176	0	0.0026	0.3408	0.3132	0.1532	0.0305	0.0656	0	0.104	0	0	0.0536	0.0079	1.89	0.2994	0.0037	0	0	0.059	0.1277	0	0	0.0185	0	0	0	0	0											5.5382	0	0.397840515	18.2749	3.314937932	0	0.002605041	5.793757073	5.324245386	1.353356817	0.762154451	1.11575095	0	1.354905897	0	0	0.910956405	0.016447492	5.423296689	4.091319076	0.003656213	0	0	0.806775816	1.74501459	0	0	0.01849484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3125
H2228_002_0	2011	5																															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	YES	430.5451997	44.473455	12707.89824	7.423576219	53.16519578	41.69360696	25.12254436	38.94423345	13.10925485	69.73844959	22.84737098	0	0	5.07201879	1.723858218	133.1541697	20.500145	3.382625978	0	0	2.679235304	9.319616299	1159.726652	134.3234157	72.9614481	337.0040568	0	0	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.079887544	0.080857452	0	0	0.2	0.2	0.096614569	0.053207657	0.2	0	0.108143391	0	0	0.161543065	0.001048639	0.027463188	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.072707085	0.073589816	0	0	0.182023583	0.182023583	0.08793065	0.048425242	0.182023583	0	0.098423237	0	0	0.147023237	0.00094456	0.024737442	0.18014982	0	0	0	0.182023583	0.185102706	0	0	0	0	0	0	0	0												31.3037	3.272793354	0	0	9.677319416	7.589219719	2.20904165	1.885883917	2.386193536	0	2.24871222	0	0	0.745704622	0.001628288	3.29389349	3.693097428	0	0	0	0.487684009	1.725086197	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.5199	0	7.012797924	31.3037	3.272793354	0	0	9.677319416	7.589219719	2.20904165	1.885883917	2.386193536	0	2.24871222	0	0	0.745704622	0.001628288	3.29389349	3.693097428	0	0	0	0.487684009	1.725086197	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.5199	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	2.9781	0.3114	0	0.0006	0.6048	0.4743	0.2858	0.0786	0.1491	0	0.1889	0	0	0.0466	0.0241	1.8976	0.2916	0.0007	0	0	0.0385	0.1362	0	0	0.004	0	0	0	0	0											7.5108	0	0.759927759	34.2817	3.584147878	0	0.000563615	10.28215188	8.063545952	2.49484762	1.964462414	2.535330632	0	2.437600382	0	0	0.792311161	0.025724175	5.19148268	3.984657751	0.000698229	0	0	0.526185378	1.861277212	0	0	0.003979276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0307
H2230_002_0	2011	11																															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	1.400323077	0.34593222	0	0	6.952311437	3.991593676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											12.6902	NO	675.4961943	20.62919628	1161.36773	0	118.5266081	10.58337777	2.045094209	254.5148208	338.6505166	17.19256489	10.6949519	0	0	777.2668616	3472.164773	5532.6907	436.9969713	583.7639957	193.8804712	18.32430031	0	0	0	331.1380096	307.0257706	0	1.883954447	0	0	0												"(1a) $100/day, days 1-5; $0 days 5+, unlimited coverage ($500 annual max)"	"(1b) $100/day, days 1-5; $0 days 5+, unlimited coverage ($500 annual max)"	"(2) $30/day, days 1-20; $0 days 21-100 ($600 annual max)"	(6) $0 copay	(10a) $0-$100/day	(11a) 0-10% coinsurance after deductible	"(11b): 0-10% coinsurance after deductible, (11c) $0 copay"	"(4a) $0-50/visit, (4b) $15-30/visit"	(9a) (9b): $0-100/visit	(8a) 10% coinsurance after deductible for diagnostic labs; $0 for other labs and tests.	"(8b) $0 for most services; 10% after ded. for PET, CT, MRI, nuclear cardiology, waived if same day as ER/outpatient surgery visit"	(5) $0 copay	(12) $0 copay	"(3) $10/visit, (9c) $30/visit, (9d) $10/visit"	"(7a) (14b) (14c) (14d) $0-15/POC visit, $0-30 for non-POC visit"	(7d) (7g) (14e) (14g) (14h): $0-30/visit; (7b) (16b): $30/visit; (7f) $15-30/visit	(7e) (7h): $30/visit	(7c) (7i): $10/visit	(7d) $0-30/visit	"(7b) (7g): $0-30/visit, (14i) (14j): $0/visit, (7f) $15-30/visit"	(15) $0 copay	(13a) $0 copay	(10b) Not covered	(16a) $30/visit/6 mos.	(17a) $15-30/exam/12 mos.	(17b) $150 max benefit per 2 years	(18a) $15-30/exam/12 mos.	(18b) $400 max benefit per 3 years	(14a) Fitness benefit $150 max/year.  Weight loss benefit $150 max/year.	"(13b) (13c) (13d): not covered, (13e): All costs after $500 for covered wigs/CY"											0	100	100	30	0	100	0.1	0.1	50	100	0.1	0.1	0	0	10	15	30	30	10	30	30	0	0	0	30	30	0	30	0	0	0											NO	98.97648352	98.97648352	29.69294506	0	98.97648352	0.098976484	0.098976484	49.48824176	98.97648352	0.098976484	0.098976484	0	0	9.897648352	14.84647253	29.69294506	29.69294506	9.897648352	29.69294506	29.69294506	0	0	0	29.69294506	29.69294506	0	29.69294506	0	0	0												5.5715	0.170150442	2.87370235	0	0.97761224	1.047505516	0.202416233	1.049624249	2.793203107	1.701659615	1.05854873	0	0	0.641092839	4.295783244	13.69015675	1.081310588	0.481490896	0.479740182	0.04534187	0	0	0	0.819371894	0.759708278	0	0.00466168	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7446	250	0.41	5.5715	0.170150442	2.87370235	0	0.97761224	2.447828593	0.548348453	1.049624249	2.793203107	8.653971052	5.050142407	0	0	0.641092839	4.295783244	13.69015675	1.081310588	0.481490896	0.479740182	0.04534187	0	0	0	0.819371894	0.759708278	0	0.00466168	0	0	0	0	0	0	0	0	0	0	0	0	0	52.4348	YES	"(1a) deductible, then 20% coinsurance"	"(1b) deductible, then 20% coinsurance"	"(2) deductible, then 20% coinsurance"	"(6) deductible, then 20% coinsurance"	(10a) $0-100/day	"(11a) deductible, then 20% coinsurance"	"(11b) (11c): deductible, then 20% coinsurance"	"(4a) $0-50/visit, (4b): $40/visit"	"(9a) (9b): deductible, then 20% coinsurance"	"(8a) deductible, then 20% coinsurance"	"(8b) deductible, then 20% coinsurance"	"(5) deductible, then 20% coinsurance"	"(12) deductible, then 20% coinsurance"	"(3) (9c) (9d): deductible, then 20% coinsurance"	"(14b) (14d): 20% coinsurance after deductible, (7a) (14c): $0-40/visit"	"(7d) (7f) (16b): $0-40/visit, (7b) (14e) (14g) (14h): deductible, then 20% coinsurance"	"(7e) (7h): deductible, then 20% coinsurance"	"(7c) (7i): deductible, then 20% coinsurance"	(7d) $40/visit	"(7b) (7g): deductible, then 20% coins, (14i): deductible, then 0-20% coins, (7f) (14j): $40/visit"	(15) $0 copay	"(13a) deductible, then 20% coinsurance"	(10b) $0 copay	(16a) $40/visit every 6 mos.	(17a) $40/exam/12 mos.	(17b) $150 max benefit per 2 years	(18a) $40/exam/12 mos.	(18b) $400 max benefit per 3 years	(14a) $40/visit	"(13b) (13c) (13d): not covered, (13e): All costs after $500 for covered wigs/CY"											3400	2.0623	0.066	0.5497	0.1892	0.0321	0.0846	0.0169	0.034	0.2534	0.2109	0.1998	0.2454	0	0.2213	0.5058	0.7501	0.0258	0.0229	0.1124	0.0099	0	0	0	0.0352	0.0042	0	0.0002	0	0	0											5.6321	250	3.76	7.6338	0.236118425	3.42341808	0.189195653	1.00974051	2.53242936	0.565228269	1.083661685	3.04657598	8.864883342	5.249918597	0.245430572	0	0.862375667	4.801619014	14.44020754	1.107106134	0.504393984	0.592179173	0.05528454	0	0	0	0.854554413	0.763905787	0	0.004852518	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0669
H2230_801_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	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	329.9871703	5.156059191	61.78327498	0	15.7942303	12.44430016	2.780144705	10.29276121	41.39008176	35.85600607	39.82289096	37.74692108	0.845920712	48.65487739	36.58751806	115.8703789	3.590885716	4.346745183	18.06465779	1.378587118	11.92060059	0	0	0	0	0	0	0	0	0											6700	(1a) Medicare FFS Benefits	(1b) Medicare FFS Benefits	(2) Medicare FFS Benefits	(6) Medicare FFS Benefits	(10a) Medicare FFS Benefits	(11a) Medicare FFS Benefits	(11b) Medicare FFS Benefits	(4a) (4b) Medicare FFS Benefits	(9a) (9b) Medicare FFS Benefits	(8a) Medicare FFS Benefits	(8b) Medicare FFS Benefits	(5) Medicare FFS Benefits	(12) Medicare FFS Benefits	(3) (9c) (9d) Medicare FFS Benefits	(7a) (14c) (14d) (14b) Medicare FFS Benefits	(7d) (14e) (14g) (14h) (14f) Medicare FFS Benefits	(7e) (7h) Medicare FFS Benefits	(7c) (7i) Medicare FFS Benefits	(7d)  Medicare FFS Benefits	(7b) (7g) (14i) (7f) (14j)  Medicare FFS Benefits	(15)  Medicare FFS Benefits	(13a)  Medicare FFS Benefits	(10b) Not covered	(16a) Not covered	(17a) Not covered	(17b) Not covered	(18a) Not covered	(18b) Not covered	(14a) Not covered	(13b) (13c) (13d) (13e) Not covered											0	0.072796267	0.072796267	0.152717068	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.063187893	0.063187893	0.132559954	0	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0	0	0	0	0	0	0	0												20.8512	0.325800517	8.189988065	0	3.194325378	2.516814246	0.56227411	2.081673353	8.37099283	7.251746238	8.054034216	7.634176893	0.171084374	9.840271206	7.399691865	23.43436084	0.726243518	0.879113334	3.653511045	0.278814208	2.410897921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.827	0	17.92	20.8512	0.325800517	8.189988065	0	3.194325378	2.516814246	0.56227411	2.081673353	8.37099283	7.251746238	8.054034216	7.634176893	0.171084374	9.840271206	7.399691865	23.43436084	0.726243518	0.879113334	3.653511045	0.278814208	2.410897921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.827	YES	(1a) Medicare FFS Benefits	(1b) Medicare FFS Benefits	(2) Medicare FFS Benefits	(6) Medicare FFS Benefits	(10a) Medicare FFS Benefits	(11a) Medicare FFS Benefits	(11b) Medicare FFS Benefits	(4a) (4b) Medicare FFS Benefits	(9a) (9b) Medicare FFS Benefits	(8a) Medicare FFS Benefits	(8b) Medicare FFS Benefits	(5) Medicare FFS Benefits	(12) Medicare FFS Benefits	(3) (9c) (9d) Medicare FFS Benefits	(7a) (14c) (14d) (14b) Medicare FFS Benefits	(7d) (14e) (14g) (14h) (14f) Medicare FFS Benefits	(7e) (7h) Medicare FFS Benefits	(7c) (7i) Medicare FFS Benefits	(7d)  Medicare FFS Benefits	(7b) (7g) (14i) (7f) (14j)  Medicare FFS Benefits	(15)  Medicare FFS Benefits	(13a)  Medicare FFS Benefits	(10b) Not covered	(16a) (16b) Not covered	(17a) Not covered	(17b) Not covered	(18a) Not covered	(18b) Not covered	(14a) Not covered	(13b) (13c) (13d) (13e) Not covered											10000	1.1804	0.0184	0.4637	0	0.1808	0.1425	0.0318	0.1178	0.4739	0.4105	0.456	0.4322	0.0097	0.5571	0.4189	1.3267	0.0411	0.0498	0.2068	0.0158	0.1365	0	0	0	0	0	0	0	0	0											6.6704	0	0.47	22.0316	0.34424481	8.653641537	0	3.375163254	2.659296708	0.5941057	2.199521519	8.844893385	7.66228375	8.509991037	8.066364655	0.180769841	10.39735088	7.818604908	24.76103222	0.767357782	0.928881898	3.860344446	0.294598502	2.547384223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.4975
H2230_809_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	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	329.9871703	5.156059191	61.78327498	0	15.7942303	12.44430016	2.780144705	10.29276121	41.39008176	35.85600607	39.82289096	37.74692108	0.845920712	48.65487739	36.58751806	115.8703789	3.590885716	4.346745183	18.06465779	1.378587118	11.92060059	0	0	0	0	0	0	0	0	0											6700	(1a) Medicare FFS Benefits	(1b) Medicare FFS Benefits	(2) Medicare FFS Benefits	(6) Medicare FFS Benefits	(10a) Medicare FFS Benefits	(11a) Medicare FFS Benefits	(11b) Medicare FFS Benefits	(4a) (4b) Medicare FFS Benefits	(9a) (9b) Medicare FFS Benefits	(8a) Medicare FFS Benefits	(8b) Medicare FFS Benefits	(5) Medicare FFS Benefits	(12) Medicare FFS Benefits	(3) (9c) (9d) Medicare FFS Benefits	(7a) (14c) (14d) (14b) Medicare FFS Benefits	(7d) (14e) (14g) (14h) (14f) Medicare FFS Benefits	(7e) (7h) Medicare FFS Benefits	(7c) (7i) Medicare FFS Benefits	(7d)  Medicare FFS Benefits	(7b) (7g) (14i) (7f) (14j)  Medicare FFS Benefits	(15)  Medicare FFS Benefits	(13a)  Medicare FFS Benefits	(10b) Not covered	(16a) Not covered	(17a) Not covered	(17b) Not covered	(18a) Not covered	(18b) Not covered	(14a) Not covered	(13b) (13c) (13d) (13e) Not covered											0	0.072796267	0.072796267	0.152717068	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.063187893	0.063187893	0.132559954	0	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0	0	0	0	0	0	0	0												20.8512	0.325800517	8.189988065	0	3.194325378	2.516814246	0.56227411	2.081673353	8.37099283	7.251746238	8.054034216	7.634176893	0.171084374	9.840271206	7.399691865	23.43436084	0.726243518	0.879113334	3.653511045	0.278814208	2.410897921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.827	0	17.92	20.8512	0.325800517	8.189988065	0	3.194325378	2.516814246	0.56227411	2.081673353	8.37099283	7.251746238	8.054034216	7.634176893	0.171084374	9.840271206	7.399691865	23.43436084	0.726243518	0.879113334	3.653511045	0.278814208	2.410897921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.827	YES	(1a) Medicare FFS Benefits	(1b) Medicare FFS Benefits	(2) Medicare FFS Benefits	(6) Medicare FFS Benefits	(10a) Medicare FFS Benefits	(11a) Medicare FFS Benefits	(11b) Medicare FFS Benefits	(4a) (4b) Medicare FFS Benefits	(9a) (9b) Medicare FFS Benefits	(8a) Medicare FFS Benefits	(8b) Medicare FFS Benefits	(5) Medicare FFS Benefits	(12) Medicare FFS Benefits	(3) (9c) (9d) Medicare FFS Benefits	(7a) (14c) (14d) (14b) Medicare FFS Benefits	(7d) (14e) (14g) (14h) (14f) Medicare FFS Benefits	(7e) (7h) Medicare FFS Benefits	(7c) (7i) Medicare FFS Benefits	(7d)  Medicare FFS Benefits	(7b) (7g) (14i) (7f) (14j)  Medicare FFS Benefits	(15)  Medicare FFS Benefits	(13a)  Medicare FFS Benefits	(10b) Not covered	(16a) (16b) Not covered	(17a) Not covered	(17b) Not covered	(18a) Not covered	(18b) Not covered	(14a) Not covered	(13b) (13c) (13d) (13e) Not covered											10000	1.1804	0.0184	0.4637	0	0.1808	0.1425	0.0318	0.1178	0.4739	0.4105	0.456	0.4322	0.0097	0.5571	0.4189	1.3267	0.0411	0.0498	0.2068	0.0158	0.1365	0	0	0	0	0	0	0	0	0											6.6704	0	0.47	22.0316	0.34424481	8.653641537	0	3.375163254	2.659296708	0.5941057	2.199521519	8.844893385	7.66228375	8.509991037	8.066364655	0.180769841	10.39735088	7.818604908	24.76103222	0.767357782	0.928881898	3.860344446	0.294598502	2.547384223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.4975
H2237_001_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	349.1961868	39.24643739	24.73671383	0	21.42703247	22.1266642	10.02063819	26.63659445	3.607643081	17.37004433	6.572192171	0	0.238092214	74.72665877	122.0075037	67.06907052	17.62508712	5.194501714	13.40280112	2.77445924	87.74340273	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing											0	0.075508192	0.075508192	0.154012338	0	0.233	0.233	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	0.07159563	0.07159563	0.146031975	0	0.220926782	0.220926782	0.220926782	0.220926782	0.220926782	0.220926782	0.220926782	0	0.220926782	0.220926782	0.220926782	0.220926782	0.220926782	0.220926782	0.220926782	0.220926782	0.220926782	0	0	0	0	0	0	0	0	0												25.0009	2.809873422	3.612351187	0	4.733805334	4.888372722	2.213827351	5.8847371	0.797024977	3.837507999	1.451973268	0	0.052600947	16.50912026	26.95472519	14.81735393	3.893853783	1.147604549	2.961037724	0.612952352	19.38486762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.5645	0	7.73622446	25.0009	2.809873422	3.612351187	0	4.733805334	4.888372722	2.213827351	5.8847371	0.797024977	3.837507999	1.451973268	0	0.052600947	16.50912026	26.95472519	14.81735393	3.893853783	1.147604549	2.961037724	0.612952352	19.38486762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.5645	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.0009	2.809873422	3.612351187	0	4.733805334	4.888372722	2.213827351	5.8847371	0.797024977	3.837507999	1.451973268	0	0.052600947	16.50912026	26.95472519	14.81735393	3.893853783	1.147604549	2.961037724	0.612952352	19.38486762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.5645
H2237_007_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	669.336019	75.22720794	47.41510413	0	41.07113751	42.41218515	19.20746654	51.05677771	6.915096867	33.2947402	12.59751713	0	0.456372952	143.2353679	233.8628538	128.5573736	33.78360386	9.956772808	25.69036514	5.318057792	168.1857422	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing											0	0.075393538	0.075393538	0.153993856	0	0.233	0.233	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	0.075393538	0.075393538	0.153993856	0	0.233	0.233	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												50.4636	5.671645338	7.301634699	0	9.56957504	9.88203914	4.475339704	11.89622921	1.61121757	7.757674466	2.93522149	0	0.106334898	33.37384072	54.49004493	29.95386805	7.871579699	2.319928064	5.985855078	1.239107466	39.18727794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	286.092	0	0	50.4636	5.671645338	7.301634699	0	9.56957504	9.88203914	4.475339704	11.89622921	1.61121757	7.757674466	2.93522149	0	0.106334898	33.37384072	54.49004493	29.95386805	7.871579699	2.319928064	5.985855078	1.239107466	39.18727794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	286.092	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	50.4636	5.671645338	7.301634699	0	9.56957504	9.88203914	4.475339704	11.89622921	1.61121757	7.757674466	2.93522149	0	0.106334898	33.37384072	54.49004493	29.95386805	7.871579699	2.319928064	5.985855078	1.239107466	39.18727794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	286.092
H2241_001_0	2011	5																															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	P																																																					0	YES			769.225508		115.009657	9.05838255	8.627284021	194.4539773													33.48965203																				6700			"$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			Preventive and Comprehensive Dental		$150 every 2 years		$400 every 2 years																15.5		50	0.02	0.02	45													0.2																				NO			15.4906936		49.96997936	0.019987992	0.019987992	44.97298142													0.199879917																					0	0	0.992986388	0	0.478919182	0.181058876	0.172442082	0.728764592	0	0	0	0	0	0	0	0	0	0	0	0	6.693908884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.2481	0	0.005556001	0	0	0.992986388	0	0.478919182	0.181058876	0.172442082	0.728764592	0	0	0	0	0	0	0	0	0	0	0	0	6.693908884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.2481	NO																																																																																		0	0	0	0	0	0.992986388	0	0.478919182	0.181058876	0.172442082	0.728764592	0	0	0	0	0	0	0	0	0	0	0	0	6.693908884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.2481
H2256_001_1	2011	7																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	195.3131555	0	0	0	577.1221258	0	0	318.3211995	438.4101447	0	0	0	0	0	3255.132521	5564.713328	315.1764435	2088.955053	0	51.94693849	0	0	0	0	153.310645	0	41.58960398	0	0	0											3400	"$300 deductible, PBP 1a"	"No cost sharing, PBP 1b"	"No cost sharing, PBP 2"	"No cost sharing, PBP 6"	"$50 per day, PBP 10a"	"No cost sharing, PBP 11a"	"No cost sharing, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$50 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"No cost sharing, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$10 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$15 per visit may apply, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, 7b, 7d, 7f, (No copay for 14 b, d - j)"	"$15 per visit, PBP 7e,7h, 9c"	"$15 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$15 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$15 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$15 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												300	0	0	0	50	0	0	50	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	299.9826053	0	0	0	49.99710088	0	0	49.99710088	49.99710088	0	0	0	0	0	9.999420177	14.99913026	14.99913026	14.99913026	0	14.99913026	0	0	0	0	14.99913026	0	14.99913026	0	0	0												4.8825	0	0	0	2.404536095	0	0	1.326261427	1.82660302	0	0	0	0	0	2.712453151	6.955488342	0.393947711	2.611042413	0	0.064929908	0	0	0	0	0.191627195	0	0.051983991	0	0	0	0	0	0	0	0	0	0	0	0	0	23.4214		0.001358107	4.8825	0	0	0	2.404536095	0	0	1.326261427	1.82660302	0	0	0	0	0	2.712453151	6.955488342	0.393947711	2.611042413	0	0.064929908	0	0	0	0	0.191627195	0	0.051983991	0	0	0	0	0	0	0	0	0	0	0	0	0	23.4214	NO																																																																																		0			4.8825	0	0	0	2.404536095	0	0	1.326261427	1.82660302	0	0	0	0	0	2.712453151	6.955488342	0.393947711	2.611042413	0	0.064929908	0	0	0	0	0.191627195	0	0.051983991	0	0	0	0	0	0	0	0	0	0	0	0	0	23.4214
H2256_001_2	2011	7																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	182.0756687	0	0	0	574.5350053	0	0	297.585488	422.0802228	0	0	0	0	0	3555.569672	5116.97956	296.592661	2079.651799	0	32.77256156	0	0	0	0	190.3710834	0	56.94462344	0	0	0											3400	"$300 deductible, PBP 1a"	"No cost sharing, PBP 1b"	"No cost sharing, PBP 2"	"No cost sharing, PBP 6"	"$50 per day, PBP 10a"	"No cost sharing, PBP 11a"	"No cost sharing, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$50 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"No cost sharing, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$10 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$15 per visit may apply, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, 7b, 7d, 7f, (No copay for 14 b, d - j)"	"$15 per visit, PBP 7e,7h, 9c"	"$15 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$15 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$15 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$15 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												300	0	0	0	50	0	0	50	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	299.9819916	0	0	0	49.9969986	0	0	49.9969986	49.9969986	0	0	0	0	0	9.999399719	14.99909958	14.99909958	14.99909958	0	14.99909958	0	0	0	0	14.99909958	0	14.99909958	0	0	0												4.5516	0	0	0	2.393752154	0	0	1.239865102	1.758562025	0	0	0	0	0	2.962796865	6.395840496	0.370718571	2.599408702	0	0.040963243	0	0	0	0	0.23794957	0	0.071176506	0	0	0	0	0	0	0	0	0	0	0	0	0	22.6227		0.001358107	4.5516	0	0	0	2.393752154	0	0	1.239865102	1.758562025	0	0	0	0	0	2.962796865	6.395840496	0.370718571	2.599408702	0	0.040963243	0	0	0	0	0.23794957	0	0.071176506	0	0	0	0	0	0	0	0	0	0	0	0	0	22.6227	NO																																																																																		0			4.5516	0	0	0	2.393752154	0	0	1.239865102	1.758562025	0	0	0	0	0	2.962796865	6.395840496	0.370718571	2.599408702	0	0.040963243	0	0	0	0	0.23794957	0	0.071176506	0	0	0	0	0	0	0	0	0	0	0	0	0	22.6227
H2256_001_6	2011	7																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	193.3764089	0	0	0	610.194195	0	0	316.0554808	448.2771274	0	0	0	0	0	3776.250279	5434.570904	315.0010328	2208.72783	0	34.80662907	0	0	0	0	202.1866882	0	60.47895835	0	0	0											3400	"$300 deductible, PBP 1a"	"No cost sharing, PBP 1b"	"No cost sharing, PBP 2"	"No cost sharing, PBP 6"	"$50 per day, PBP 10a"	"No cost sharing, PBP 11a"	"No cost sharing, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$50 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"No cost sharing, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$10 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$15 per visit may apply, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, 7b, 7d, 7f, (No copay for 14 b, d - j)"	"$15 per visit, PBP 7e,7h, 9c"	"$15 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$15 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$15 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$15 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												300	0	0	0	50	0	0	50	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	299.983044	0	0	0	49.99717399	0	0	49.99717399	49.99717399	0	0	0	0	0	9.999434799	14.9991522	14.9991522	14.9991522	0	14.9991522	0	0	0	0	14.9991522	0	14.9991522	0	0	0												4.8341	0	0	0	2.542332111	0	0	1.316823405	1.867715795	0	0	0	0	0	3.146697371	6.792829677	0.393729036	2.76075374	0	0.043505827	0	0	0	0	0.252719076	0	0.075594425	0	0	0	0	0	0	0	0	0	0	0	0	0	24.0268		0.001358107	4.8341	0	0	0	2.542332111	0	0	1.316823405	1.867715795	0	0	0	0	0	3.146697371	6.792829677	0.393729036	2.76075374	0	0.043505827	0	0	0	0	0.252719076	0	0.075594425	0	0	0	0	0	0	0	0	0	0	0	0	0	24.0268	NO																																																																																		0			4.8341	0	0	0	2.542332111	0	0	1.316823405	1.867715795	0	0	0	0	0	3.146697371	6.792829677	0.393729036	2.76075374	0	0.043505827	0	0	0	0	0.252719076	0	0.075594425	0	0	0	0	0	0	0	0	0	0	0	0	0	24.0268
H2256_001_7	2011	7																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	170.3717016	0	0	0	537.6034434	0	0	278.4564589	394.9485742	0	0	0	0	0	3327.014858	4788.05609	277.5274516	1945.970146	0	30.66591553	0	0	0	0	178.1338805	0	53.28417827	0	0	0											3400	"$300 deductible, PBP 1a"	"No cost sharing, PBP 1b"	"No cost sharing, PBP 2"	"No cost sharing, PBP 6"	"$50 per day, PBP 10a"	"No cost sharing, PBP 11a"	"No cost sharing, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$50 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"No cost sharing, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$10 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$15 per visit may apply, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, 7b, 7d, 7f, (No copay for 14 b, d - j)"	"$15 per visit, PBP 7e,7h, 9c"	"$15 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$15 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$15 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$15 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												300	0	0	0	50	0	0	50	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	299.9807545	0	0	0	49.99679241	0	0	49.99679241	49.99679241	0	0	0	0	0	9.999358482	14.99903772	14.99903772	14.99903772	0	14.99903772	0	0	0	0	14.99903772	0	14.99903772	0	0	0												4.259	0	0	0	2.239870647	0	0	1.160160814	1.64551349	0	0	0	0	0	2.77233452	5.98468616	0.34688706	2.432306636	0	0.038329935	0	0	0	0	0.222653066	0	0.06660095	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1684		0.001358107	4.259	0	0	0	2.239870647	0	0	1.160160814	1.64551349	0	0	0	0	0	2.77233452	5.98468616	0.34688706	2.432306636	0	0.038329935	0	0	0	0	0.222653066	0	0.06660095	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1684	NO																																																																																		0			4.259	0	0	0	2.239870647	0	0	1.160160814	1.64551349	0	0	0	0	0	2.77233452	5.98468616	0.34688706	2.432306636	0	0.038329935	0	0	0	0	0.222653066	0	0.06660095	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1684
H2256_015_1	2011	5																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	192.4612124	0	0	0	577.1226186	0	0	307.6785855	401.1693919	0	0	0	0	0	3314.229228	5396.060506	279.3169926	2088.957585	0	63.48508033	0	0	0	0	132.0127464	0	49.50598775	0	0	0											3400	"$300 deductible, PBP 1a"	"No cost sharing, PBP 1b"	"No cost sharing, PBP 2"	"No cost sharing, PBP 6"	"$50 per day, PBP 10a"	"No cost sharing, PBP 11a"	"No cost sharing, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$50 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"No cost sharing, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$10 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$15 per visit may apply, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, 7b, 7d, 7f, (No copay for 14 b, d - j)"	"$15 per visit, PBP 7e,7h, 9c"	"$15 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$15 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$15 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$15 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												300	0	0	0	50	0	0	50	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	299.9822418	0	0	0	49.99704029	0	0	49.99704029	49.99704029	0	0	0	0	0	9.999408059	14.99911209	14.99911209	14.99911209	0	14.99911209	0	0	0	0	14.99911209	0	14.99911209	0	0	0												4.8112	0	0	0	2.404535235	0	0	1.28191822	1.671440188	0	0	0	0	0	2.761694204	6.744676363	0.349125573	2.611042413	0	0.079351653	0	0	0	0	0.165006165	0	0.061878822	0	0	0	0	0	0	0	0	0	0	0	0	0	22.9419		0.001358107	4.8112	0	0	0	2.404535235	0	0	1.28191822	1.671440188	0	0	0	0	0	2.761694204	6.744676363	0.349125573	2.611042413	0	0.079351653	0	0	0	0	0.165006165	0	0.061878822	0	0	0	0	0	0	0	0	0	0	0	0	0	22.9419	NO																																																																																		0			4.8112	0	0	0	2.404535235	0	0	1.28191822	1.671440188	0	0	0	0	0	2.761694204	6.744676363	0.349125573	2.611042413	0	0.079351653	0	0	0	0	0.165006165	0	0.061878822	0	0	0	0	0	0	0	0	0	0	0	0	0	22.9419
H2256_015_2	2011	5																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	186.7735977	0	0	0	570.1743512	0	0	296.5459462	379.9868369	0	0	0	0	0	3418.093629	5051.593105	398.7461298	2063.807907	0	60.76798797	0	0	0	0	180.3395442	0	65.3574812	0	0	0											3400	"$300 deductible, PBP 1a"	"No cost sharing, PBP 1b"	"No cost sharing, PBP 2"	"No cost sharing, PBP 6"	"$50 per day, PBP 10a"	"No cost sharing, PBP 11a"	"No cost sharing, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$50 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"No cost sharing, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$10 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$15 per visit may apply, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, 7b, 7d, 7f, (No copay for 14 b, d - j)"	"$15 per visit, PBP 7e,7h, 9c"	"$15 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$15 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$15 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$15 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												300	0	0	0	50	0	0	50	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	299.9818823	0	0	0	49.99698039	0	0	49.99698039	49.99698039	0	0	0	0	0	9.999396078	14.99909412	14.99909412	14.99909412	0	14.99909412	0	0	0	0	14.99909412	0	14.99909412	0	0	0												4.6691	0	0	0	2.375582988	0	0	1.235533488	1.583182869	0	0	0	0	0	2.848239336	6.314110035	0.498402561	2.579604086	0	0.075955398	0	0	0	0	0.225410816	0	0.081691918	0	0	0	0	0	0	0	0	0	0	0	0	0	22.4868		0.001358107	4.6691	0	0	0	2.375582988	0	0	1.235533488	1.583182869	0	0	0	0	0	2.848239336	6.314110035	0.498402561	2.579604086	0	0.075955398	0	0	0	0	0.225410816	0	0.081691918	0	0	0	0	0	0	0	0	0	0	0	0	0	22.4868	NO																																																																																		0			4.6691	0	0	0	2.375582988	0	0	1.235533488	1.583182869	0	0	0	0	0	2.848239336	6.314110035	0.498402561	2.579604086	0	0.075955398	0	0	0	0	0.225410816	0	0.081691918	0	0	0	0	0	0	0	0	0	0	0	0	0	22.4868
H2256_015_6	2011	5																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	214.4992817	0	0	0	654.8141186	0	0	340.5668318	436.39414	0	0	0	0	0	3925.493952	5801.478933	457.9381639	2370.170726	0	69.78871708	0	0	0	0	207.1101224	0	75.05949953	0	0	0											3400	"$300 deductible, PBP 1a"	"No cost sharing, PBP 1b"	"No cost sharing, PBP 2"	"No cost sharing, PBP 6"	"$50 per day, PBP 10a"	"No cost sharing, PBP 11a"	"No cost sharing, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$50 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"No cost sharing, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$10 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$15 per visit may apply, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, 7b, 7d, 7f, (No copay for 14 b, d - j)"	"$15 per visit, PBP 7e,7h, 9c"	"$15 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$15 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$15 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$15 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												300	0	0	0	50	0	0	50	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	299.9842242	0	0	0	49.9973707	0	0	49.9973707	49.9973707	0	0	0	0	0	9.99947414	14.99921121	14.99921121	14.99921121	0	14.99921121	0	0	0	0	14.99921121	0	14.99921121	0	0	0												5.3622	0	0	0	2.728248686	0	0	1.418953845	1.818213299	0	0	0	0	0	3.271072938	7.25146732	0.572392603	2.96255761	0	0.087231309	0	0	0	0	0.258874039	0	0.093819441	0	0	0	0	0	0	0	0	0	0	0	0	0	25.825		0.001358107	5.3622	0	0	0	2.728248686	0	0	1.418953845	1.818213299	0	0	0	0	0	3.271072938	7.25146732	0.572392603	2.96255761	0	0.087231309	0	0	0	0	0.258874039	0	0.093819441	0	0	0	0	0	0	0	0	0	0	0	0	0	25.825	NO																																																																																		0			5.3622	0	0	0	2.728248686	0	0	1.418953845	1.818213299	0	0	0	0	0	3.271072938	7.25146732	0.572392603	2.96255761	0	0.087231309	0	0	0	0	0.258874039	0	0.093819441	0	0	0	0	0	0	0	0	0	0	0	0	0	25.825
H2256_015_7	2011	5																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	178.1893274	0	0	0	543.9686623	0	0	282.9164471	362.5223248	0	0	0	0	0	3260.995194	4819.417671	380.4194249	1968.953574	0	57.97504054	0	0	0	0	172.0509883	0	62.35359683	0	0	0											3400	"$300 deductible, PBP 1a"	"No cost sharing, PBP 1b"	"No cost sharing, PBP 2"	"No cost sharing, PBP 6"	"$50 per day, PBP 10a"	"No cost sharing, PBP 11a"	"No cost sharing, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$50 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"No cost sharing, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$10 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$15 per visit may apply, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, 7b, 7d, 7f, (No copay for 14 b, d - j)"	"$15 per visit, PBP 7e,7h, 9c"	"$15 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$15 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$15 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$15 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												300	0	0	0	50	0	0	50	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	299.9810095	0	0	0	49.99683492	0	0	49.99683492	49.99683492	0	0	0	0	0	9.999366984	14.99905048	14.99905048	14.99905048	0	14.99905048	0	0	0	0	14.99905048	0	14.99905048	0	0	0												4.4545	0	0	0	2.266392618	0	0	1.178743908	1.510414069	0	0	0	0	0	2.717323973	6.023890742	0.47549418	2.46103617	0	0.072464213	0	0	0	0	0.215050121	0	0.077937062	0	0	0	0	0	0	0	0	0	0	0	0	0	21.4532		0.001358107	4.4545	0	0	0	2.266392618	0	0	1.178743908	1.510414069	0	0	0	0	0	2.717323973	6.023890742	0.47549418	2.46103617	0	0.072464213	0	0	0	0	0.215050121	0	0.077937062	0	0	0	0	0	0	0	0	0	0	0	0	0	21.4532	NO																																																																																		0			4.4545	0	0	0	2.266392618	0	0	1.178743908	1.510414069	0	0	0	0	0	2.717323973	6.023890742	0.47549418	2.46103617	0	0.072464213	0	0	0	0	0.215050121	0	0.077937062	0	0	0	0	0	0	0	0	0	0	0	0	0	21.4532
H2256_016_1	2011	4																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	172.6845196	0	0	0	577.1243006	0	0	238.2861293	451.9505618	0	0	0	0	0	2998.946157	5398.127069	133.4153602	2088.963673	0	16.40460039	0	0	0	0	145.0830357	0	33.85165855	0	0	0											3400	"$300 deductible, PBP 1a"	"No cost sharing, PBP 1b"	"No cost sharing, PBP 2"	"No cost sharing, PBP 6"	"$50 per day, PBP 10a"	"No cost sharing, PBP 11a"	"No cost sharing, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$50 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"No cost sharing, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$10 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$15 per visit may apply, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, 7b, 7d, 7f, (No copay for 14 b, d - j)"	"$15 per visit, PBP 7e,7h, 9c"	"$15 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$15 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$15 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$15 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												300	0	0	0	50	0	0	50	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	299.9813675	0	0	0	49.99689458	0	0	49.99689458	49.99689458	0	0	0	0	0	9.999378916	14.99906837	14.99906837	14.99906837	0	14.99906837	0	0	0	0	14.99906837	0	14.99906837	0	0	0												4.3168	0	0	0	2.404535235	0	0	0.992797207	1.883010383	0	0	0	0	0	2.498966581	6.74723975	0.166758842	2.611042413	0	0.020504477	0	0	0	0	0.181342531	0	0.042311945	0	0	0	0	0	0	0	0	0	0	0	0	0	21.8654		0.001358107	4.3168	0	0	0	2.404535235	0	0	0.992797207	1.883010383	0	0	0	0	0	2.498966581	6.74723975	0.166758842	2.611042413	0	0.020504477	0	0	0	0	0.181342531	0	0.042311945	0	0	0	0	0	0	0	0	0	0	0	0	0	21.8654	NO																																																																																		0			4.3168	0	0	0	2.404535235	0	0	0.992797207	1.883010383	0	0	0	0	0	2.498966581	6.74723975	0.166758842	2.611042413	0	0.020504477	0	0	0	0	0.181342531	0	0.042311945	0	0	0	0	0	0	0	0	0	0	0	0	0	21.8654
H2256_016_2	2011	4																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	173.4782572	0	0	0	576.1695245	0	0	264.7057675	374.7281107	0	0	0	0	0	2934.750367	4661.367387	151.4731454	2085.507758	0	21.17664693	0	0	0	0	195.2601997	0	49.16529273	0	0	0											3400	"$300 deductible, PBP 1a"	"No cost sharing, PBP 1b"	"No cost sharing, PBP 2"	"No cost sharing, PBP 6"	"$50 per day, PBP 10a"	"No cost sharing, PBP 11a"	"No cost sharing, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$50 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"No cost sharing, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$10 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$15 per visit may apply, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, 7b, 7d, 7f, (No copay for 14 b, d - j)"	"$15 per visit, PBP 7e,7h, 9c"	"$15 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$15 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$15 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$15 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												300	0	0	0	50	0	0	50	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	299.9804143	0	0	0	49.99673572	0	0	49.99673572	49.99673572	0	0	0	0	0	9.999347143	14.99902071	14.99902071	14.99902071	0	14.99902071	0	0	0	0	14.99902071	0	14.99902071	0	0	0												4.3367	0	0	0	2.40054962	0	0	1.102868692	1.561265193	0	0	0	0	0	2.445465641	5.826328834	0.189329071	2.606714505	0	0.026469081	0	0	0	0	0.244059315	0	0.061452604	0	0	0	0	0	0	0	0	0	0	0	0	0	20.8012		0.001358107	4.3367	0	0	0	2.40054962	0	0	1.102868692	1.561265193	0	0	0	0	0	2.445465641	5.826328834	0.189329071	2.606714505	0	0.026469081	0	0	0	0	0.244059315	0	0.061452604	0	0	0	0	0	0	0	0	0	0	0	0	0	20.8012	NO																																																																																		0			4.3367	0	0	0	2.40054962	0	0	1.102868692	1.561265193	0	0	0	0	0	2.445465641	5.826328834	0.189329071	2.606714505	0	0.026469081	0	0	0	0	0.244059315	0	0.061452604	0	0	0	0	0	0	0	0	0	0	0	0	0	20.8012
H2256_016_6	2011	4																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	177.1787465	0	0	0	588.4598783	0	0	270.3522437	382.7214891	0	0	0	0	0	2997.351943	4760.799676	154.7042406	2129.99402	0	21.62836899	0	0	0	0	199.4253227	0	50.21404456	0	0	0											3400	"$300 deductible, PBP 1a"	"No cost sharing, PBP 1b"	"No cost sharing, PBP 2"	"No cost sharing, PBP 6"	"$50 per day, PBP 10a"	"No cost sharing, PBP 11a"	"No cost sharing, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$50 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"No cost sharing, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$10 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$15 per visit may apply, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, 7b, 7d, 7f, (No copay for 14 b, d - j)"	"$15 per visit, PBP 7e,7h, 9c"	"$15 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$15 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$15 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$15 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												300	0	0	0	50	0	0	50	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	299.9808234	0	0	0	49.99680389	0	0	49.99680389	49.99680389	0	0	0	0	0	9.999360779	14.99904117	14.99904117	14.99904117	0	14.99904117	0	0	0	0	14.99904117	0	14.99904117	0	0	0												4.4292	0	0	0	2.451759428	0	0	1.126395676	1.594570936	0	0	0	0	0	2.497633622	5.950619194	0.193367939	2.662322332	0	0.027033733	0	0	0	0	0.249265719	0	0.062763543	0	0	0	0	0	0	0	0	0	0	0	0	0	21.2449		0.001358107	4.4292	0	0	0	2.451759428	0	0	1.126395676	1.594570936	0	0	0	0	0	2.497633622	5.950619194	0.193367939	2.662322332	0	0.027033733	0	0	0	0	0.249265719	0	0.062763543	0	0	0	0	0	0	0	0	0	0	0	0	0	21.2449	NO																																																																																		0			4.4292	0	0	0	2.451759428	0	0	1.126395676	1.594570936	0	0	0	0	0	2.497633622	5.950619194	0.193367939	2.662322332	0	0.027033733	0	0	0	0	0.249265719	0	0.062763543	0	0	0	0	0	0	0	0	0	0	0	0	0	21.2449
H2256_016_7	2011	4																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	171.5703141	0	0	0	569.8327149	0	0	261.7944888	370.6067877	0	0	0	0	0	2902.473488	4610.100883	149.8072183	2062.570992	0	20.9437426	0	0	0	0	193.1126951	0	48.62456455	0	0	0											3400	"$300 deductible, PBP 1a"	"No cost sharing, PBP 1b"	"No cost sharing, PBP 2"	"No cost sharing, PBP 6"	"$50 per day, PBP 10a"	"No cost sharing, PBP 11a"	"No cost sharing, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$50 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"No cost sharing, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$10 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$15 per visit may apply, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, 7b, 7d, 7f, (No copay for 14 b, d - j)"	"$15 per visit, PBP 7e,7h, 9c"	"$15 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$15 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$15 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$15 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												300	0	0	0	50	0	0	50	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	299.9801965	0	0	0	49.99669942	0	0	49.99669942	49.99669942	0	0	0	0	0	9.999339883	14.99900982	14.99900982	14.99900982	0	14.99900982	0	0	0	0	14.99900982	0	14.99900982	0	0	0												4.289	0	0	0	2.374146247	0	0	1.090738364	1.544093014	0	0	0	0	0	2.418568242	5.762245703	0.187246662	2.578043548	0	0.02617795	0	0	0	0	0.241374934	0	0.060776693	0	0	0	0	0	0	0	0	0	0	0	0	0	20.5724		0.001358107	4.289	0	0	0	2.374146247	0	0	1.090738364	1.544093014	0	0	0	0	0	2.418568242	5.762245703	0.187246662	2.578043548	0	0.02617795	0	0	0	0	0.241374934	0	0.060776693	0	0	0	0	0	0	0	0	0	0	0	0	0	20.5724	NO																																																																																		0			4.289	0	0	0	2.374146247	0	0	1.090738364	1.544093014	0	0	0	0	0	2.418568242	5.762245703	0.187246662	2.578043548	0	0.02617795	0	0	0	0	0.241374934	0	0.060776693	0	0	0	0	0	0	0	0	0	0	0	0	0	20.5724
H2256_018_1	2011	5																															D	D	D		T	COIN	COIN	V	V		V				V	V	V	V		V					V		V																																																						0	YES	643.7746449	0	562.8200875	0	275.1982173	2.479664372	0.641700804	220.4568482	295.0507129	0	384.1965477	0	0	0	2384.382115	4000.449638	418.4975353	2167.550708	0	29.52638973	0	0	0	0	185.0345972	0	54.08945901	0	0	0											3400	"$125 per day for days 1-5, PBP 1a"	"$125 per day for days 1-5, PBP 1b"	"$35 per day for days 1-20, PBP 2"	"No cost sharing, PBP 6"	"$100 per day, PBP 10a"	"10 % per item, PBP 11a"	"10 % per item, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$150 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"20% up to $100 /Day, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$15 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$20 per visit may apply, $15 for chiro, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, (7b at $15 per vst), 7d, 7f, (No copay for 14 b, d - j)"	"$20 per visit, PBP 7e,7h, 9c"	"$20 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$20 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$20 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$20 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												125	125	35	0	100	0.1	0.1	50	150	0	100	0	0	0	15	19.73830167	20	20	0	20	0	0	0	0	20	0	20	0	0	0											NO	122.7074129	122.7074129	34.35807562	0	98.16593035	0.09816593	0.09816593	49.08296518	147.2488955	0	98.16593035	0	0	0	14.72488955	19.37628747	19.63318607	19.63318607	0	19.63318607	0	0	0	0	19.63318607	0	19.63318607	0	0	0												6.583	0	1.611451261	0	2.25125742	0.24341856	0.062993156	0.901722984	3.620490967	0	3.142917628	0	0	0	2.925813608	6.459488516	0.684703332	3.546327197	0	0.048308092	0	0	0	0	0.30273489	0	0.088495701	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4731		0.606813966	6.583	0	1.611451261	0	2.25125742	0.24341856	0.062993156	0.901722984	3.620490967	0	3.142917628	0	0	0	2.925813608	6.459488516	0.684703332	3.546327197	0	0.048308092	0	0	0	0	0.30273489	0	0.088495701	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4731	NO																																																																																		0			6.583	0	1.611451261	0	2.25125742	0.24341856	0.062993156	0.901722984	3.620490967	0	3.142917628	0	0	0	2.925813608	6.459488516	0.684703332	3.546327197	0	0.048308092	0	0	0	0	0.30273489	0	0.088495701	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4731
H2256_018_7	2011	5																															D	D	D		T	COIN	COIN	V	V		V				V	V	V	V		V					V		V																																																						0	YES	597.7780704	0	522.6075748	0	255.5357851	2.299186593	0.594995799	204.7055913	273.9698546	0	356.746375	0	0	0	2214.022175	3714.624495	388.596617	2012.682994	0	27.41678073	0	0	0	0	171.8141982	0	50.22486159	0	0	0											3400	"$125 per day for days 1-5, PBP 1a"	"$125 per day for days 1-5, PBP 1b"	"$35 per day for days 1-20, PBP 2"	"No cost sharing, PBP 6"	"$100 per day, PBP 10a"	"10 % per item, PBP 11a"	"10 % per item, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$150 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"20% up to $100 /Day, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$15 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$20 per visit may apply, $15 for chiro, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, (7b at $15 per vst), 7d, 7f, (No copay for 14 b, d - j)"	"$20 per visit, PBP 7e,7h, 9c"	"$20 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$20 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$20 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$20 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												125	125	35	0	100	0.1	0.1	50	150	0	100	0	0	0	15	19.73830167	20	20	0	20	0	0	0	0	20	0	20	0	0	0											NO	122.5310078	122.5310078	34.30868217	0	98.0248062	0.098024806	0.098024806	49.0124031	147.0372093	0	98.0248062	0	0	0	14.70372093	19.34843196	19.60496124	19.60496124	0	19.60496124	0	0	0	0	19.60496124	0	19.60496124	0	0	0												6.1039	0	1.494164765	0	2.087403818	0.22537732	0.058324348	0.836092746	3.356980237	0	2.91416619	0	0	0	2.712863683	5.989346608	0.634868468	3.288214341	0	0.044792077	0	0	0	0	0.280700891	0	0.082054705	0	0	0	0	0	0	0	0	0	0	0	0	0	30.1092		0.606813966	6.1039	0	1.494164765	0	2.087403818	0.22537732	0.058324348	0.836092746	3.356980237	0	2.91416619	0	0	0	2.712863683	5.989346608	0.634868468	3.288214341	0	0.044792077	0	0	0	0	0.280700891	0	0.082054705	0	0	0	0	0	0	0	0	0	0	0	0	0	30.1092	NO																																																																																		0			6.1039	0	1.494164765	0	2.087403818	0.22537732	0.058324348	0.836092746	3.356980237	0	2.91416619	0	0	0	2.712863683	5.989346608	0.634868468	3.288214341	0	0.044792077	0	0	0	0	0.280700891	0	0.082054705	0	0	0	0	0	0	0	0	0	0	0	0	0	30.1092
H2256_018_8	2011	5																															D	D	D		T	COIN	COIN	V	V		V				V	V	V	V		V					V		V																																																						0	YES	666.3040692	0	582.5164404	0	284.8290058	2.568063574	0.664577222	228.1719173	305.3762558	0	397.6418225	0	0	0	2467.825532	4140.448671	433.1432016	2243.405932	0	30.55969008	0	0	0	0	191.5100354	0	55.98236422	0	0	0											3400	"$125 per day for days 1-5, PBP 1a"	"$125 per day for days 1-5, PBP 1b"	"$35 per day for days 1-20, PBP 2"	"No cost sharing, PBP 6"	"$100 per day, PBP 10a"	"10 % per item, PBP 11a"	"10 % per item, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$150 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"20% up to $100 /Day, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$15 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$20 per visit may apply, $15 for chiro, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, (7b at $15 per vst), 7d, 7f, (No copay for 14 b, d - j)"	"$20 per visit, PBP 7e,7h, 9c"	"$20 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$20 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$20 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$20 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												125	125	35	0	100	0.1	0.1	50	150	0	100	0	0	0	15	19.73830167	20	20	0	20	0	0	0	0	20	0	20	0	0	0											NO	122.7849311	122.7849311	34.37978071	0	98.22794488	0.098227945	0.098227945	49.11397244	147.3419173	0	98.22794488	0	0	0	14.73419173	19.38852808	19.64558898	19.64558898	0	19.64558898	0	0	0	0	19.64558898	0	19.64558898	0	0	0												6.8177	0	1.668898957	0	2.33151399	0.252255607	0.065280055	0.933869105	3.749560253	0	3.254961586	0	0	0	3.03011788	6.689767111	0.709112775	3.67275257	0	0.050030259	0	0	0	0	0.313527287	0	0.091650543	0	0	0	0	0	0	0	0	0	0	0	0	0	33.631		0.606813966	6.8177	0	1.668898957	0	2.33151399	0.252255607	0.065280055	0.933869105	3.749560253	0	3.254961586	0	0	0	3.03011788	6.689767111	0.709112775	3.67275257	0	0.050030259	0	0	0	0	0.313527287	0	0.091650543	0	0	0	0	0	0	0	0	0	0	0	0	0	33.631	NO																																																																																		0			6.8177	0	1.668898957	0	2.33151399	0.252255607	0.065280055	0.933869105	3.749560253	0	3.254961586	0	0	0	3.03011788	6.689767111	0.709112775	3.67275257	0	0.050030259	0	0	0	0	0.313527287	0	0.091650543	0	0	0	0	0	0	0	0	0	0	0	0	0	33.631
H2256_019_1	2011	4																															D	D	D		T	COIN	COIN	V	V		V				V	V	V	V		V					V		V																																																						0	YES	629.9305421	0	550.7168784	0	269.2801955	2.425343959	0.627643477	215.7160165	288.7057715	0	375.9345626	0	0	0	2333.106981	3914.421652	409.497922	2120.938442	0	28.89143714	0	0	0	0	181.055506	0	52.92628796	0	0	0											3400	"$125 per day for days 1-5, PBP 1a"	"$125 per day for days 1-5, PBP 1b"	"$35 per day for days 1-20, PBP 2"	"No cost sharing, PBP 6"	"$100 per day, PBP 10a"	"10 % per item, PBP 11a"	"10 % per item, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$150 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"20% up to $100 /Day, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$15 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$20 per visit may apply, $15 for chiro, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, (7b at $15 per vst), 7d, 7f, (No copay for 14 b, d - j)"	"$20 per visit, PBP 7e,7h, 9c"	"$20 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$20 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$20 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$20 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												125	125	35	0	100	0.1	0.1	50	150	0	100	0	0	0	15	19.73830167	20	20	0	20	0	0	0	0	20	0	20	0	0	0											NO	122.6570283	122.6570283	34.34396793	0	98.12562265	0.098125623	0.098125623	49.06281133	147.188434	0	98.12562265	0	0	0	14.7188434	19.36833141	19.62512453	19.62512453	0	19.62512453	0	0	0	0	19.62512453	0	19.62512453	0	0	0												6.4388	0	1.576150234	0	2.201940571	0.237988386	0.061587907	0.881969518	3.541179199	0	3.074067753	0	0	0	2.86171969	6.317984654	0.669703976	3.468640088	0	0.047249838	0	0	0	0	0.296103071	0	0.086557083	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7616		0.606813966	6.4388	0	1.576150234	0	2.201940571	0.237988386	0.061587907	0.881969518	3.541179199	0	3.074067753	0	0	0	2.86171969	6.317984654	0.669703976	3.468640088	0	0.047249838	0	0	0	0	0.296103071	0	0.086557083	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7616	NO																																																																																		0			6.4388	0	1.576150234	0	2.201940571	0.237988386	0.061587907	0.881969518	3.541179199	0	3.074067753	0	0	0	2.86171969	6.317984654	0.669703976	3.468640088	0	0.047249838	0	0	0	0	0.296103071	0	0.086557083	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7616
H2256_019_7	2011	4																															D	D	D		T	COIN	COIN	V	V		V				V	V	V	V		V					V		V																																																						0	YES	621.3905689	0	543.2508054	0	265.6295618	2.391835477	0.618971973	212.7915528	284.7917851	0	370.8380148	0	0	0	2301.477032	3861.353808	403.9463555	2092.184864	0	28.49975571	0	0	0	0	178.6009351	0	52.20876587	0	0	0											3400	"$125 per day for days 1-5, PBP 1a"	"$125 per day for days 1-5, PBP 1b"	"$35 per day for days 1-20, PBP 2"	"No cost sharing, PBP 6"	"$100 per day, PBP 10a"	"10 % per item, PBP 11a"	"10 % per item, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$150 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"20% up to $100 /Day, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$15 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$20 per visit may apply, $15 for chiro, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, (7b at $15 per vst), 7d, 7f, (No copay for 14 b, d - j)"	"$20 per visit, PBP 7e,7h, 9c"	"$20 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$20 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$20 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$20 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												125	125	35	0	100	0.1	0.1	50	150	0	100	0	0	0	15	19.73830167	20	20	0	20	0	0	0	0	20	0	20	0	0	0											NO	122.6248281	122.6248281	34.33495187	0	98.09986248	0.098099862	0.098099862	49.04993124	147.1497937	0	98.09986248	0	0	0	14.71497937	19.36324679	19.6199725	19.6199725	0	19.6199725	0	0	0	0	19.6199725	0	19.6199725	0	0	0												6.3498	0	1.554374188	0	2.171518623	0.234638731	0.060721065	0.869784253	3.49225437	0	3.031596521	0	0	0	2.822182254	6.230695561	0.660451365	3.420717457	0	0.046597035	0	0	0	0	0.29201212	0	0.085361213	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3227		0.606813966	6.3498	0	1.554374188	0	2.171518623	0.234638731	0.060721065	0.869784253	3.49225437	0	3.031596521	0	0	0	2.822182254	6.230695561	0.660451365	3.420717457	0	0.046597035	0	0	0	0	0.29201212	0	0.085361213	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3227	NO																																																																																		0			6.3498	0	1.554374188	0	2.171518623	0.234638731	0.060721065	0.869784253	3.49225437	0	3.031596521	0	0	0	2.822182254	6.230695561	0.660451365	3.420717457	0	0.046597035	0	0	0	0	0.29201212	0	0.085361213	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3227
H2256_019_8	2011	4																															D	D	D		T	COIN	COIN	V	V		V				V	V	V	V		V					V		V																																																						0	YES	554.7458631	0	484.9866606	0	237.1405488	2.130340168	0.551300818	189.9694645	254.2476062	0	331.0652992	0	0	0	2054.641519	3447.220087	360.6227401	1867.796127	0	25.44313089	0	0	0	0	159.4458218	0	46.60932807	0	0	0											3400	"$125 per day for days 1-5, PBP 1a"	"$125 per day for days 1-5, PBP 1b"	"$35 per day for days 1-20, PBP 2"	"No cost sharing, PBP 6"	"$100 per day, PBP 10a"	"10 % per item, PBP 11a"	"10 % per item, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$150 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"20% up to $100 /Day, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$15 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$20 per visit may apply, $15 for chiro, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, (7b at $15 per vst), 7d, 7f, (No copay for 14 b, d - j)"	"$20 per visit, PBP 7e,7h, 9c"	"$20 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$20 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$20 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$20 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												125	125	35	0	100	0.1	0.1	50	150	0	100	0	0	0	15	19.73830167	20	20	0	20	0	0	0	0	20	0	20	0	0	0											NO	122.3394855	122.3394855	34.25505594	0	97.87158839	0.097871588	0.097871588	48.93579419	146.8073826	0	97.87158839	0	0	0	14.68073826	19.31818936	19.57431768	19.57431768	0	19.57431768	0	0	0	0	19.57431768	0	19.57431768	0	0	0												5.6556	0	1.384437099	0	1.934110182	0.208499776	0.053956687	0.774692218	3.110452133	0	2.700157225	0	0	0	2.513637863	5.549504201	0.58824534	3.046736229	0	0.041502661	0	0	0	0	0.260086931	0	0.076028816	0	0	0	0	0	0	0	0	0	0	0	0	0	27.8977		0.606813966	5.6556	0	1.384437099	0	1.934110182	0.208499776	0.053956687	0.774692218	3.110452133	0	2.700157225	0	0	0	2.513637863	5.549504201	0.58824534	3.046736229	0	0.041502661	0	0	0	0	0.260086931	0	0.076028816	0	0	0	0	0	0	0	0	0	0	0	0	0	27.8977	NO																																																																																		0			5.6556	0	1.384437099	0	1.934110182	0.208499776	0.053956687	0.774692218	3.110452133	0	2.700157225	0	0	0	2.513637863	5.549504201	0.58824534	3.046736229	0	0.041502661	0	0	0	0	0.260086931	0	0.076028816	0	0	0	0	0	0	0	0	0	0	0	0	0	27.8977
H2256_026_1	2011	5																															D	D	D		T	COIN	COIN	V	V		V				V	V	V	V		V					V		V																																																						0	YES	720.598527	0	413.430126	0	236.6205762	2.713588224	0.746337844	250.3288888	262.4789042	0	382.2746122	0	0	0	1527.039928	3613.107867	420.9268014	839.9078539	0	14.17934248	0	0	0	0	217.0854041	0	35.3260793	0	0	0											3400	"$200 per day for days 1-10, PBP 1a"	"$200 per day for days 1-10, PBP 1b"	"$65 per day for days 1-20, PBP 2"	"No cost sharing, PBP 6"	"$150 per day, PBP 10a"	"20 % per item, PBP 11a"	"20 % per item, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$150 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"20% up to $100 /Day, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$20 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$30 per visit may apply, $15 for chiro, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, (7b at $15 per vst), 7d, 7f, (No copay for 14 b, d - j)"	"$30 per visit, PBP 7e,7h, 9c"	"$30 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$30 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$30 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$30 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												200	200	65	0	150	0.2	0.2	50	150	0	100	0	0	0	20	29.214905	30	30	0	30	0	0	0	0	30	0	30	0	0	0											NO	193.2538218	193.2538218	62.80749208	0	144.9403663	0.193253822	0.193253822	48.31345544	144.9403663	0	96.62691089	0	0	0	19.32538218	28.22946022	28.98807327	28.98807327	0	28.98807327	0	0	0	0	28.98807327	0	28.98807327	0	0	0												11.6049	0	2.16387578	0	2.857989417	0.524411295	0.144232641	1.007854468	3.170315711	0	3.078167907	0	0	0	2.459219185	8.499673735	1.016821413	2.028942534	0	0.034252652	0	0	0	0	0.5244073	0	0.085336248	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2004		1.369236245	11.6049	0	2.16387578	0	2.857989417	0.524411295	0.144232641	1.007854468	3.170315711	0	3.078167907	0	0	0	2.459219185	8.499673735	1.016821413	2.028942534	0	0.034252652	0	0	0	0	0.5244073	0	0.085336248	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2004	NO																																																																																		0			11.6049	0	2.16387578	0	2.857989417	0.524411295	0.144232641	1.007854468	3.170315711	0	3.078167907	0	0	0	2.459219185	8.499673735	1.016821413	2.028942534	0	0.034252652	0	0	0	0	0.5244073	0	0.085336248	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2004
H2256_026_2	2011	5																															D	D	D		T	COIN	COIN	V	V		V				V	V	V	V		V					V		V																																																						0	YES	693.3297089	0	397.7851442	0	227.6664038	2.607316238	0.71710909	240.8559678	252.5462035	0	367.8086142	0	0	0	1469.253835	3476.380997	404.998131	808.1241441	0	13.64276921	0	0	0	0	208.8704798	0	33.98927331	0	0	0											3400	"$200 per day for days 1-10, PBP 1a"	"$200 per day for days 1-10, PBP 1b"	"$65 per day for days 1-20, PBP 2"	"No cost sharing, PBP 6"	"$150 per day, PBP 10a"	"20 % per item, PBP 11a"	"20 % per item, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$150 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"20% up to $100 /Day, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$20 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$30 per visit may apply, $15 for chiro, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, (7b at $15 per vst), 7d, 7f, (No copay for 14 b, d - j)"	"$30 per visit, PBP 7e,7h, 9c"	"$30 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$30 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$30 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$30 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												200	200	65	0	150	0.2	0.2	50	150	0	100	0	0	0	20	29.214905	30	30	0	30	0	0	0	0	30	0	30	0	0	0											NO	192.988493	192.988493	62.72126023	0	144.7413698	0.192988493	0.192988493	48.24712326	144.7413698	0	96.49424651	0	0	0	19.2988493	28.19070245	28.94827395	28.94827395	0	28.94827395	0	0	0	0	28.94827395	0	28.94827395	0	0	0												11.1504	0	2.079132129	0	2.746062262	0.503182032	0.138393803	0.968383964	3.046156952	0	2.957617924	0	0	0	2.362909029	8.166801858	0.976999737	1.949483259	0	0.032911218	0	0	0	0	0.503869989	0	0.081994233	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6643		1.369236245	11.1504	0	2.079132129	0	2.746062262	0.503182032	0.138393803	0.968383964	3.046156952	0	2.957617924	0	0	0	2.362909029	8.166801858	0.976999737	1.949483259	0	0.032911218	0	0	0	0	0.503869989	0	0.081994233	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6643	NO																																																																																		0			11.1504	0	2.079132129	0	2.746062262	0.503182032	0.138393803	0.968383964	3.046156952	0	2.957617924	0	0	0	2.362909029	8.166801858	0.976999737	1.949483259	0	0.032911218	0	0	0	0	0.503869989	0	0.081994233	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6643
H2256_027_1	2011	4																															D	D	D		T	COIN	COIN	V	V		V				V	V	V	V		V					V		V																																																						0	YES	611.7286932	0	350.9680651	0	200.8713458	2.289300916	0.62964303	212.5085721	222.8229326	0	324.5196045	0	0	0	1296.330904	3067.230464	357.3321239	713.0124676	0	12.03709184	0	0	0	0	184.2875965	0	29.98892659	0	0	0											3400	"$200 per day for days 1-10, PBP 1a"	"$200 per day for days 1-10, PBP 1b"	"$65 per day for days 1-20, PBP 2"	"No cost sharing, PBP 6"	"$150 per day, PBP 10a"	"20 % per item, PBP 11a"	"20 % per item, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$150 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"20% up to $100 /Day, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$20 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$30 per visit may apply, $15 for chiro, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, (7b at $15 per vst), 7d, 7f, (No copay for 14 b, d - j)"	"$30 per visit, PBP 7e,7h, 9c"	"$30 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$30 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$30 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$30 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												200	200	65	0	150	0.2	0.2	50	150	0	100	0	0	0	20	29.214905	30	30	0	30	0	0	0	0	30	0	30	0	0	0											NO	192.0531992	192.0531992	62.41728973	0	144.0398994	0.192053199	0.192053199	48.01329979	144.0398994	0	96.02659958	0	0	0	19.20531992	28.05407984	28.80797987	28.80797987	0	28.80797987	0	0	0	0	28.80797987	0	28.80797987	0	0	0												9.7904	0	1.825539617	0	2.411124036	0.439667565	0.120924958	0.850269815	2.674616066	0	2.596876176	0	0	0	2.074704144	7.170694027	0.857834719	1.711704068	0	0.028897025	0	0	0	0	0.442412781	0	0.071993366	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0676		1.369236245	9.7904	0	1.825539617	0	2.411124036	0.439667565	0.120924958	0.850269815	2.674616066	0	2.596876176	0	0	0	2.074704144	7.170694027	0.857834719	1.711704068	0	0.028897025	0	0	0	0	0.442412781	0	0.071993366	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0676	NO																																																																																		0			9.7904	0	1.825539617	0	2.411124036	0.439667565	0.120924958	0.850269815	2.674616066	0	2.596876176	0	0	0	2.074704144	7.170694027	0.857834719	1.711704068	0	0.028897025	0	0	0	0	0.442412781	0	0.071993366	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0676
H2256_027_2	2011	5																															D	D	D		T	COIN	COIN	V	V		V				V	V	V	V		V					V		V																																																						0	YES	641.2953396	0	367.9313837	0	210.5800485	2.404527994	0.661334768	222.7797363	233.5926202	0	340.2045912	0	0	0	1358.986388	3215.478731	374.6030361	747.4744566	0	12.61887988	0	0	0	0	193.1947579	0	31.43837959	0	0	0											3400	"$200 per day for days 1-10, PBP 1a"	"$200 per day for days 1-10, PBP 1b"	"$65 per day for days 1-20, PBP 2"	"No cost sharing, PBP 6"	"$150 per day, PBP 10a"	"20 % per item, PBP 11a"	"20 % per item, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$150 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"20% up to $100 /Day, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$20 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$30 per visit may apply, $15 for chiro, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, (7b at $15 per vst), 7d, 7f, (No copay for 14 b, d - j)"	"$30 per visit, PBP 7e,7h, 9c"	"$30 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$30 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$30 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$30 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												200	200	65	0	150	0.2	0.2	50	150	0	100	0	0	0	20	29.214905	30	30	0	30	0	0	0	0	30	0	30	0	0	0											NO	192.419583	192.419583	62.53636448	0	144.3146873	0.192419583	0.192419583	48.10489575	144.3146873	0	96.2097915	0	0	0	19.2419583	28.10759919	28.86293745	28.86293745	0	28.86293745	0	0	0	0	28.86293745	0	28.86293745	0	0	0												10.2831	0	1.917424259	0	2.532482821	0.462678274	0.12725376	0.893066332	2.80923716	0	2.727584399	0	0	0	2.179129951	7.531615614	0.901012	1.797859041	0	0.030351495	0	0	0	0	0.464680684	0	0.075616999	0	0	0	0	0	0	0	0	0	0	0	0	0	34.7331		1.369236245	10.2831	0	1.917424259	0	2.532482821	0.462678274	0.12725376	0.893066332	2.80923716	0	2.727584399	0	0	0	2.179129951	7.531615614	0.901012	1.797859041	0	0.030351495	0	0	0	0	0.464680684	0	0.075616999	0	0	0	0	0	0	0	0	0	0	0	0	0	34.7331	NO																																																																																		0			10.2831	0	1.917424259	0	2.532482821	0.462678274	0.12725376	0.893066332	2.80923716	0	2.727584399	0	0	0	2.179129951	7.531615614	0.901012	1.797859041	0	0.030351495	0	0	0	0	0.464680684	0	0.075616999	0	0	0	0	0	0	0	0	0	0	0	0	0	34.7331
H2256_801_0	2011	4																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	168.9898898	0	0	0	579.5489528	0	0	241.0807966	433.3209059	0	0	0	0	0	3217.907292	5458.03481	389.6067156	2097.739664	0	38.35917977	0	0	0	0	205.796734	0	55.27222474	0	0	0											3400	"$300 deductible, PBP 1a"	"No cost sharing, PBP 1b"	"No cost sharing, PBP 2"	"No cost sharing, PBP 6"	"$50 per day, PBP 10a"	"No cost sharing, PBP 11a"	"No cost sharing, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$50 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"No cost sharing, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$10 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$15 per visit may apply, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, 7b, 7d, 7f, (No copay for 14 b, d - j)"	"$15 per visit, PBP 7e,7h, 9c"	"$15 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$15 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$15 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$15 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												300	0	0	0	50	0	0	50	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	299.9818413	0	0	0	49.99697355	0	0	49.99697355	49.99697355	0	0	0	0	0	9.99939471	14.99909207	14.99909207	14.99909207	0	14.99909207	0	0	0	0	14.99909207	0	14.99909207	0	0	0												4.2245	0	0	0	2.414641139	0	0	1.004442517	1.805394489	0	0	0	0	0	2.681427096	6.82213055	0.486978916	2.622015862	0	0.047946072	0	0	0	0	0.257230347	0	0.069086099	0	0	0	0	0	0	0	0	0	0	0	0	0	22.4358		0.001358107	4.2245	0	0	0	2.414641139	0	0	1.004442517	1.805394489	0	0	0	0	0	2.681427096	6.82213055	0.486978916	2.622015862	0	0.047946072	0	0	0	0	0.257230347	0	0.069086099	0	0	0	0	0	0	0	0	0	0	0	0	0	22.4358	NO																																																																																		0			4.2245	0	0	0	2.414641139	0	0	1.004442517	1.805394489	0	0	0	0	0	2.681427096	6.82213055	0.486978916	2.622015862	0	0.047946072	0	0	0	0	0.257230347	0	0.069086099	0	0	0	0	0	0	0	0	0	0	0	0	0	22.4358
H2256_802_0	2011	4																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	168.9898898	0	0	0	579.5489528	0	0	241.0807966	433.3209059	0	0	0	0	0	3217.907292	5458.03481	389.6067156	2097.739664	0	38.35917977	0	0	0	0	205.796734	0	55.27222474	0	0	0											3400	"$300 deductible, PBP 1a"	"No cost sharing, PBP 1b"	"No cost sharing, PBP 2"	"No cost sharing, PBP 6"	"$50 per day, PBP 10a"	"No cost sharing, PBP 11a"	"No cost sharing, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$50 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"No cost sharing, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$10 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$15 per visit may apply, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, 7b, 7d, 7f, (No copay for 14 b, d - j)"	"$15 per visit, PBP 7e,7h, 9c"	"$15 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$15 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$15 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$15 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												300	0	0	0	50	0	0	50	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	299.9818413	0	0	0	49.99697355	0	0	49.99697355	49.99697355	0	0	0	0	0	9.99939471	14.99909207	14.99909207	14.99909207	0	14.99909207	0	0	0	0	14.99909207	0	14.99909207	0	0	0												4.2245	0	0	0	2.414641139	0	0	1.004442517	1.805394489	0	0	0	0	0	2.681427096	6.82213055	0.486978916	2.622015862	0	0.047946072	0	0	0	0	0.257230347	0	0.069086099	0	0	0	0	0	0	0	0	0	0	0	0	0	22.4358		0.001358107	4.2245	0	0	0	2.414641139	0	0	1.004442517	1.805394489	0	0	0	0	0	2.681427096	6.82213055	0.486978916	2.622015862	0	0.047946072	0	0	0	0	0.257230347	0	0.069086099	0	0	0	0	0	0	0	0	0	0	0	0	0	22.4358	NO																																																																																		0			4.2245	0	0	0	2.414641139	0	0	1.004442517	1.805394489	0	0	0	0	0	2.681427096	6.82213055	0.486978916	2.622015862	0	0.047946072	0	0	0	0	0.257230347	0	0.069086099	0	0	0	0	0	0	0	0	0	0	0	0	0	22.4358
H2256_803_0	2011	4																															DED				T			V	V						V	V	V	V		V					V		V																																																						0	YES	150.6283228	0	0	0	516.5781626	0	0	214.8862047	386.2384985	0	0	0	0	0	2868.266137	4864.992991	347.274066	1869.810127	0	34.19126979	0	0	0	0	183.4359258	0	49.26663082	0	0	0											3400	"$300 deductible, PBP 1a"	"No cost sharing, PBP 1b"	"No cost sharing, PBP 2"	"No cost sharing, PBP 6"	"$50 per day, PBP 10a"	"No cost sharing, PBP 11a"	"No cost sharing, PBP 11b, (No cost sharing for 11c)"	"$50 per visit, PBP 4a"	"$50 per day, PBP 9a, 9b"	"No cost sharing, PBP 8a"	"No cost sharing, PBP 8b1, (No copay for 8b2)"	"No cost sharing, PBP 5"	"No cost sharing, PBP 12"	"No cost sharing, PBP 5, 9d"	"$10 per visit may apply, $0 for annual physical, no cost sharing for preventive services, PBP 4b, 7a, (No copay for 14 b - j)"	"$15 per visit may apply, no cost sharing for preventive services or respiration therapy, PBP 3, 4b, 7b, 7d, 7f, (No copay for 14 b, d - j)"	"$15 per visit, PBP 7e,7h, 9c"	"$15 per visit, PBP 7c, 7i"	"No cost sharing, PBP 7d"	"$15 per visit, PBP 7g, 4b, 16b"	"No cost sharing, PBP 15"	"No cost sharing, PBP 13a"	"No cost sharing, PBP 10b"	"No cost sharing, PBP 16a"	"$15 per visit, $0 for glaucoma, PBP 17a"	"No cost sharing, PBP 17b"	"$15 per visit, PBP 18a"	"No cost sharing, PBP 18b"	"No cost sharing, PBP 14a"	"No cost sharing, PBP 13e"												300	0	0	0	50	0	0	50	50	0	0	0	0	0	10	15	15	15	0	15	0	0	0	0	15	0	15	0	0	0											NO	299.9796278	0	0	0	49.99660463	0	0	49.99660463	49.99660463	0	0	0	0	0	9.999320925	14.99898139	14.99898139	14.99898139	0	14.99898139	0	0	0	0	14.99898139	0	14.99898139	0	0	0												3.7655	0	0	0	2.152262846	0	0	0.895298385	1.609217792	0	0	0	0	0	2.390059467	6.080828277	0.434063104	2.337103941	0	0.042736185	0	0	0	0	0.229279336	0	0.061579107	0	0	0	0	0	0	0	0	0	0	0	0	0	19.9979		0.001358107	3.7655	0	0	0	2.152262846	0	0	0.895298385	1.609217792	0	0	0	0	0	2.390059467	6.080828277	0.434063104	2.337103941	0	0.042736185	0	0	0	0	0.229279336	0	0.061579107	0	0	0	0	0	0	0	0	0	0	0	0	0	19.9979	NO																																																																																		0			3.7655	0	0	0	2.152262846	0	0	0.895298385	1.609217792	0	0	0	0	0	2.390059467	6.080828277	0.434063104	2.337103941	0	0.042736185	0	0	0	0	0.229279336	0	0.061579107	0	0	0	0	0	0	0	0	0	0	0	0	0	19.9979
H2261_005_0	2011	11																															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	839.2054797	25.63050352	1432.384491	0	146.5144744	14.21635823	2.89620904	317.5642326	416.3329488	28.00930074	15.66876902	0	0	979.6931227	4294.836543	6808.072775	524.7424669	738.1660431	0	20.86990542	0	0	0	404.3179203	361.8166452	0	2.204688372	0	0	0											3400	"(1a) $150/day, days 1-5; $0 days 5+, unlimited coverage ($750 annual max)"	"(1b) $150/day, days 1-5; $0 days 5+, unlimited coverage ($750 annual max)"	"(2) $50/day, days 1-20; $0 days 21-100; ($1,000 annual max)"	(6) $0 copay	(10a) $0-$100/day	(11a): 0-10% coinsurance	(11b) 10% coinsurance; (11c) $0 copay	"(4a) $0-$50/visit, (4b) $15-30/visit"	(9a) (9b) $0-$150/visit	(8a) 10% for diagnostic labs; $0 for other labs and tests	"(8b) $0 for most services; 10% for PET, CT, MRI, nuclear cardiology, waived if same day as ER/outpatient surgery visit"	(5) $0 copay	(12) $0 copay	"(9c) $30/visit, (3) (9d): $15/visit, (14f) $0-150/visit"	"(7a) (14b) (14c) (14d): $0-15/POC visit, $0-30/SPC visit; (14c) $15-30/visit"	"(7b) (7d) (14e) (14f) (14g) (14h) (16b): $0-30/visit, (7f) $15-30/visit"	(7e) (7h) $30/visit	(7c) (7i): $15/visit	(7d) $0-30/visit	(7b) (7g) (14i) (14j) $0-30/visit	(15) $0 copay	(13a) $0 copay	(10b) Not covered	(16a) $30/visit/6 mos.	(17a) $15-25/exam/12 mos.	(17b) $150 max benefit per 2 years	(18a) $30/exam/12 mos.	(18b) $400 max benefit per 3 years	(14a) Fitness benefit $150 max/year.  Weight loss benefit $150 max/year.	"(13b) (13c) (13d): not covered, (13e) All costs after $500 for covered wigs."											0	150	150	50	0	100	0.1	0.1	50	150	0.1	0.1	0	0	15	15	30	30	15	30	30	0	0	0	30	25	0	30	0	0	0											NO	148.2987303	148.2987303	49.43291009	0	98.86582018	0.09886582	0.09886582	49.43291009	148.2987303	0.09886582	0.09886582	0	0	14.82987303	14.82987303	29.65974605	29.65974605	14.82987303	29.65974605	29.65974605	0	0	0	29.65974605	24.71645505	0	29.65974605	0	0	0												10.3711	0.316747594	5.900577814	0	1.20710614	1.405511917	0.286336082	1.308177013	5.145137306	2.76916249	1.5491057	0	0	1.210727051	5.307656717	16.82714247	1.296977359	0.912242391	0	0.051583008	0	0	0	0.99933057	0.745235404	0	0.005449208	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6153	0	0.66	10.3711	0.316747594	5.900577814	0	1.20710614	1.405511917	0.286336082	1.308177013	5.145137306	2.76916249	1.5491057	0	0	1.210727051	5.307656717	16.82714247	1.296977359	0.912242391	0	0.051583008	0	0	0	0.99933057	0.745235404	0	0.005449208	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6153	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.3711	0.316747594	5.900577814	0	1.20710614	1.405511917	0.286336082	1.308177013	5.145137306	2.76916249	1.5491057	0	0	1.210727051	5.307656717	16.82714247	1.296977359	0.912242391	0	0.051583008	0	0	0	0.99933057	0.745235404	0	0.005449208	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6153
H2261_801_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	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	341.8218633	5.775140213	69.20150887	0	17.23928985	13.75638541	3.113952902	11.54006016	46.01104423	38.34913022	42.07190357	40.4006285	0.947489263	54.17005427	40.81186286	120.4136856	3.79617508	4.560803193	18.94598458	1.445961141	13.3518909	0	0	0	0	0	0	0	0	0											6700	(1a) Medicare FFS Benefits	(1b) Medicare FFS Benefits	(2) Medicare FFS Benefits	(6) Medicare FFS Benefits	(10a) Medicare FFS Benefits	(11a) Medicare FFS Benefits	(11b) Medicare FFS Benefits	(4a) (4b) Medicare FFS Benefits	(9a) (9b) Medicare FFS Benefits	(8a) Medicare FFS Benefits	(8b) Medicare FFS Benefits	(5) Medicare FFS Benefits	(12) Medicare FFS Benefits	(3) (9c) (9d) Medicare FFS Benefits	(7a) (14c) (14d) (14b) Medicare FFS Benefits	(7d) (14e) (14g) (14h) (14f) Medicare FFS Benefits	(7e) (7h) Medicare FFS Benefits	(7c) (7i) Medicare FFS Benefits	(7d)  Medicare FFS Benefits	(7b) (7g) (14i) (7f) (14j)  Medicare FFS Benefits	(15)  Medicare FFS Benefits	(13a)  Medicare FFS Benefits	(10b) Not covered	(16a) Not covered	(17a) Not covered	(17b) Not covered	(18a) Not covered	(18b) Not covered	(14a) Not covered	(13b) (13c) (13d) (13e) Not covered											0	0.072796267	0.072796267	0.152717068	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.063187893	0.063187893	0.132559954	0	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0	0	0	0	0	0	0	0												21.599	0.364918942	9.173348805	0	3.486583393	2.782178695	0.629785599	2.333935009	9.305565608	7.75597149	8.5088888	8.170879523	0.191626242	10.95569558	8.254050169	24.35322801	0.767762542	0.922405784	3.831756168	0.292440358	2.700371158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3804	0	19.22	21.599	0.364918942	9.173348805	0	3.486583393	2.782178695	0.629785599	2.333935009	9.305565608	7.75597149	8.5088888	8.170879523	0.191626242	10.95569558	8.254050169	24.35322801	0.767762542	0.922405784	3.831756168	0.292440358	2.700371158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3804	NO	(1a) Medicare FFS Benefits	(1b) Medicare FFS Benefits	(2) Medicare FFS Benefits	(6) Medicare FFS Benefits	(10a) Medicare FFS Benefits	(11a) Medicare FFS Benefits	(11b) Medicare FFS Benefits	(4a) (4b) Medicare FFS Benefits	(9a) (9b) Medicare FFS Benefits	(8a) Medicare FFS Benefits	(8b) Medicare FFS Benefits	(5) Medicare FFS Benefits	(12) Medicare FFS Benefits	(3) (9c) (9d) Medicare FFS Benefits	(7a) (14c) (14d) (14b) Medicare FFS Benefits	(7d) (14e) (14g) (14h) (14f) Medicare FFS Benefits	(7e) (7h) Medicare FFS Benefits	(7c) (7i) Medicare FFS Benefits	(7d)  Medicare FFS Benefits	(7b) (7g) (14i) (7f) (14j)  Medicare FFS Benefits	(15)  Medicare FFS Benefits	(13a)  Medicare FFS Benefits	(10b) Not covered	(16a) (16b) Not covered	(17a) Not covered	(17b) Not covered	(18a) Not covered	(18b) Not covered	(14a) Not covered	(13b) (13c) (13d) (13e) 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	21.599	0.364918942	9.173348805	0	3.486583393	2.782178695	0.629785599	2.333935009	9.305565608	7.75597149	8.5088888	8.170879523	0.191626242	10.95569558	8.254050169	24.35322801	0.767762542	0.922405784	3.831756168	0.292440358	2.700371158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3804
H2261_809_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	341.8218633	5.775140213	69.20150887	0	17.23928985	13.75638541	3.113952902	11.54006016	46.01104423	38.34913022	42.07190357	40.4006285	0.947489263	54.17005427	40.81186286	120.4136856	3.79617508	4.560803193	18.94598458	1.445961141	13.3518909	0	0	0	0	0	0	0	0	0											6700	(1a) Medicare FFS Benefits	(1b) Medicare FFS Benefits	(2) Medicare FFS Benefits	(6) Medicare FFS Benefits	(10a) Medicare FFS Benefits	(11a) Medicare FFS Benefits	(11b) Medicare FFS Benefits	(4a) (4b) Medicare FFS Benefits	(9a) (9b) Medicare FFS Benefits	(8a) Medicare FFS Benefits	(8b) Medicare FFS Benefits	(5) Medicare FFS Benefits	(12) Medicare FFS Benefits	(3) (9c) (9d) Medicare FFS Benefits	(7a) (14c) (14d) (14b) Medicare FFS Benefits	(7d) (14e) (14g) (14h) (14f) Medicare FFS Benefits	(7e) (7h) Medicare FFS Benefits	(7c) (7i) Medicare FFS Benefits	(7d)  Medicare FFS Benefits	(7b) (7g) (14i) (7f) (14j)  Medicare FFS Benefits	(15)  Medicare FFS Benefits	(13a)  Medicare FFS Benefits	(10b) Not covered	(16a) Not covered	(17a) Not covered	(17b) Not covered	(18a) Not covered	(18b) Not covered	(14a) Not covered	(13b) (13c) (13d) (13e) Not covered											0	0.072796267	0.072796267	0.152717068	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.063187893	0.063187893	0.132559954	0	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0.202246347	0	0	0	0	0	0	0	0												21.599	0.364918942	9.173348805	0	3.486583393	2.782178695	0.629785599	2.333935009	9.305565608	7.75597149	8.5088888	8.170879523	0.191626242	10.95569558	8.254050169	24.35322801	0.767762542	0.922405784	3.831756168	0.292440358	2.700371158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3804	0	19.22	21.599	0.364918942	9.173348805	0	3.486583393	2.782178695	0.629785599	2.333935009	9.305565608	7.75597149	8.5088888	8.170879523	0.191626242	10.95569558	8.254050169	24.35322801	0.767762542	0.922405784	3.831756168	0.292440358	2.700371158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3804	NO	(1a) Medicare FFS Benefits	(1b) Medicare FFS Benefits	(2) Medicare FFS Benefits	(6) Medicare FFS Benefits	(10a) Medicare FFS Benefits	(11a) Medicare FFS Benefits	(11b) Medicare FFS Benefits	(4a) (4b) Medicare FFS Benefits	(9a) (9b) Medicare FFS Benefits	(8a) Medicare FFS Benefits	(8b) Medicare FFS Benefits	(5) Medicare FFS Benefits	(12) Medicare FFS Benefits	(3) (9c) (9d) Medicare FFS Benefits	(7a) (14c) (14d) (14b) Medicare FFS Benefits	(7d) (14e) (14g) (14h) (14f) Medicare FFS Benefits	(7e) (7h) Medicare FFS Benefits	(7c) (7i) Medicare FFS Benefits	(7d)  Medicare FFS Benefits	(7b) (7g) (14i) (7f) (14j)  Medicare FFS Benefits	(15)  Medicare FFS Benefits	(13a)  Medicare FFS Benefits	(10b) Not covered	(16a) (16b) Not covered	(17a) Not covered	(17b) Not covered	(18a) Not covered	(18b) Not covered	(14a) Not covered	(13b) (13c) (13d) (13e) 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	21.599	0.364918942	9.173348805	0	3.486583393	2.782178695	0.629785599	2.333935009	9.305565608	7.75597149	8.5088888	8.170879523	0.191626242	10.95569558	8.254050169	24.35322801	0.767762542	0.922405784	3.831756168	0.292440358	2.700371158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3804
H2312_004_0	2011	13																															A	A	Coin		T	Coin		V	V		V		V	V	V	V	V	V		V					V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	306.5261714	5.634937867	42.63099757	0	352.7034004	10.26228359	0	452.3299515	225.309455	0	441.002043	0	0.638340937	1039.594483	3069.109901	3217.980031	134.7782868	8.294048416	0	0.831964733	0	0	0	0	29.95073039	0	0	0	0	0											3400	$350/Admit for IP Acute; PBP 1a	$350/Admit for IP Psych; PBP 1b	17% Coinsurance for SNF; PBP 2	No Cost Sharing; PBP 6	$75/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for ER; $35/Visit for Urgent Care; PBP 4a, 4b"	$50/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$50/Case for OP Radiology; $25/Visit for Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	$25/Case for Renal Dialysis; PBP 12	"$15/Visit for Cardiac Rehab; $50/Visit for OP Hospital; PBP 3, 5, 9d, 13a"	"$20/Visit for PCP; $20/Visit for Preventive Care; $20/Visit for Routine Physical Exams; PBP 7a, 14b-i"	"$35/Visit for Physician Specialist; $35/Visit for Chiropractic; $35/Visit for Podiatry; $35/Visit for Routine Eye Exams (Medicare Covered); PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for Mental Health; $35/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$15/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	$35/Visit for Other Health Care; PBP 7g	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 13c, 13d, 14j"	PBP 10b	"PBP 16a, 16b"	$35/Exam for Routine Eye Exams (Non Medicare Covered); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	350	350	0.165904628	0	75	0.2	0	49.13838841	50	0	43.39611725	0	25	49.74369108	20	35	35	15	0	35	0	0	0	0	35	0	0	0	0	0											NO	343.7127053	343.7127053	0.162924367	0	73.65272256	0.19640726	0	48.25568118	49.10181504	0	42.61656246	0	24.55090752	48.85011038	19.64072602	34.37127053	34.37127053	14.73054451	0	34.37127053	0	0	0	0	34.37127053	0	0	0	0	0												8.7797	0.161399978	6.945628288	0	2.164797141	2.015587003	0	1.818957494	0.921925265	0	1.566165926	0	0.001305987	4.232025437	5.023295556	9.21717185	0.386041746	0.010181321	0	0.002382974	0	0	0	0	0.085787055	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3324	0	0.792649074	8.7797	0.161399978	6.945628288	0	2.164797141	2.015587003	0	1.818957494	0.921925265	0	1.566165926	0	0.001305987	4.232025437	5.023295556	9.21717185	0.386041746	0.010181321	0	0.002382974	0	0	0	0	0.085787055	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3324	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.7797	0.161399978	6.945628288	0	2.164797141	2.015587003	0	1.818957494	0.921925265	0	1.566165926	0	0.001305987	4.232025437	5.023295556	9.21717185	0.386041746	0.010181321	0	0.002382974	0	0	0	0	0.085787055	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3324
H2312_006_0	2011	9																															A	A	Coin		T	Coin		V	V		V		V	V	V	V	V	V		V					V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	264.1456451	5.860012842	39.43705387	0	292.0096043	7.719379587	0	397.0831697	212.1826008	0	392.8103908	0	0.57667237	945.2570118	2677.087145	2988.431112	111.1371854	4.559929803	0	0.417672852	0	0	0	0	28.63945752	0	0	0	0	0											3400	$350/Admit for IP Acute; PBP 1a	$350/Admit for IP Psych; PBP 1b	17% Coinsurance for SNF; PBP 2	No Cost Sharing; PBP 6	$75/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for ER; $35/Visit for Urgent Care; PBP 4a, 4b"	$50/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$50/Case for OP Radiology; $25/Visit for Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	$25/Case for Renal Dialysis; PBP 12	"$15/Visit for Cardiac Rehab; $50/Visit for OP Hospital; PBP 3, 5, 9d, 13a"	"$20/Visit for PCP; $20/Visit for Preventive Care; $20/Visit for Routine Physical Exams; PBP 7a, 14b-i"	"$35/Visit for Physician Specialist; $35/Visit for Chiropractic; $35/Visit for Podiatry; $35/Visit for Routine Eye Exams (Medicare Covered); PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for Mental Health; $35/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$15/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	$35/Visit for Other Health Care; PBP 7g	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 13c, 13d, 14j"	PBP 10b	"PBP 16a, 16b"	$35/Exam for Routine Eye Exams (Non Medicare Covered); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	350	350	0.165904628	0	75	0.2	0	48.78424576	50	0	43.39611725	0	25	49.85410504	20	35	35	15	0	35	0	0	0	0	35	0	0	0	0	0											NO	344.8334123	344.8334123	0.163455597	0	73.89287406	0.197047664	0	48.06410837	49.26191604	0	42.75551769	0	24.63095802	49.11817473	19.70476642	34.48334123	34.48334123	14.77857481	0	34.48334123	0	0	0	0	34.48334123	0	0	0	0	0												7.5905	0.168394019	6.446207177	0	1.798119077	1.521085716	0	1.590454042	0.871043456	0	1.399567634	0	0.001183666	3.869108256	4.395948073	8.587590815	0.319365124	0.005615772	0	0.00120023	0	0	0	0	0.082298682	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6477	0	0.57905277	7.5905	0.168394019	6.446207177	0	1.798119077	1.521085716	0	1.590454042	0.871043456	0	1.399567634	0	0.001183666	3.869108256	4.395948073	8.587590815	0.319365124	0.005615772	0	0.00120023	0	0	0	0	0.082298682	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6477	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.5905	0.168394019	6.446207177	0	1.798119077	1.521085716	0	1.590454042	0.871043456	0	1.399567634	0	0.001183666	3.869108256	4.395948073	8.587590815	0.319365124	0.005615772	0	0.00120023	0	0	0	0	0.082298682	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6477
H2312_007_0	2011	11																															A	A	Coin		T	Coin		V	V		V		V	V	V	V	V	V		V					V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	252.9087791	7.388346355	27.07791135	0	260.6188387	7.654297463	0	362.1852502	234.5464582	0	361.0162855	0	0.491551393	690.1870212	4108.172174	3978.648655	265.9471707	105.6216843	0	22.76124434	0	0	0	0	40.13166765	0	0	0	0	0											3400	$300/Admit for IP Acute; PBP 1a	$300/Admit for IP Psych; PBP 1b	17% Coinsurance for SNF; PBP 2	No Cost Sharing; PBP 6	$75/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for ER; $35/Visit for Urgent Care; PBP 4a, 4b"	$75/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$75/Case for OP Radiology; $25/Visit for Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	$25/Case for Renal Dialysis; PBP 12	"$15/Visit for Cardiac Rehab; $75/Visit for OP Hospital; PBP 3, 5, 9d, 13a"	"$15/Visit for PCP; $15/Visit for Preventive Care; $15/Visit for Routine Physical Exams; PBP 7a, 14b-i"	"$30/Visit for Physician Specialist; $30/Visit for Chiropractic; $30/Visit for Podiatry; $30/Visit for Routine Eye Exams (Medicare Covered); PBP 7b, 7d, 7f, 17a, 18a"	"$30/Visit for Mental Health; $30/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$15/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	$30/Visit for Other Health Care; PBP 7g	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 13c, 13d, 14j"	PBP 10b	"PBP 16a, 16b"	$30/Exam for Routine Eye Exams (Non Medicare Covered); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	300	300	0.165904628	0	75	0.2	0	46.84988597	75	0	61.65737045	0	25	74.4048203	15	30	30	15	0	30	0	0	0	0	30	0	0	0	0	0											NO	295.5325207	295.5325207	0.163434043	0	73.88313017	0.19702168	0	46.15221632	73.88313017	0	60.7391937	0	24.62771006	73.29681365	14.77662603	29.55325207	29.55325207	14.77662603	0	29.55325207	0	0	0	0	29.55325207	0	0	0	0	0												6.2286	0.181958052	4.425452521	0	1.604611299	1.508062549	0	1.392971001	1.444085542	0	1.827319841	0	0.001008815	4.215709123	5.058743659	9.79850055	0.654966981	0.130061011	0	0.056055733	0	0	0	0	0.098835107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6269	0	0.583911721	6.2286	0.181958052	4.425452521	0	1.604611299	1.508062549	0	1.392971001	1.444085542	0	1.827319841	0	0.001008815	4.215709123	5.058743659	9.79850055	0.654966981	0.130061011	0	0.056055733	0	0	0	0	0.098835107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6269	NO	20% Coinsurance for IP Acute; PBP 1a	Not Covered OON; PBP 1b	20% Coinsurance for SNF; PBP 2	20% Coinsurance for Home Health; PBP 6	20% Coinsurance for Ambulance; PBP 10a	Not Covered OON; PBP 11a	"Not Covered OON; PBP 11b, 11c"	"20% Coinsurance for ER; 20% Coinsurance for Urgent Care; PBP 4a, 4b"	20% Coinsurance for ASC Services; PBP 9b	20% Coinsurance for OP Diagnostic Procedures/Tests; PBP 8a	20% Coinsurance for OP Radiology; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"20% Coinsurance for Cardiac Rehab; 20% Coinsurance for OP Hospital; PBP 3, 5, 9d, 13a"	"20% Coinsurance for PCP; 20% Coinsurance for Preventive Care; 20% Coinsurance for Routine Physical Exams; PBP 7a, 14b-i"	"20% Coinsurance for Physician Specialist; 20% Coinsurance for Chiropractic; 20% Coinsurance for Podiatry; 20% Coinsurance for Routine Eye Exams (Medicare Covered); 20% Coinsurance for Hearing Exams (Medicare Covered); PBP 7b, 7d, 7f, 17a, 18a"	"Not Covered; PBP 7e, 7h, 9c"	"20% Coinsurance for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	20% Coinsurance for Other Health Care; PBP 7g	20% Coinsurance for Part B Drugs; PBP 15	"20% Coinsurance for Other Medicare Part B; PBP 13a, 13c, 13d, 14j"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	20% Coinsurance for Routine Eye Exams (Non Medicare Covered); PBP 17a	20% Coinsurance for Eye Wear (Non Medicare Covered); PBP 17b	20% Coinsurance for Routine Hearing Exams (Non Medicare Covered); PBP 18a	20% Coinsurance for Hearing Aids (Non Medicare Covered); PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b												0.249	0	0.028	0	0.0168	0	0	0.0283	0.0426	0.0009	0.0202	0	0.0002	0.0594	0.0401	0.1458	0	0.0016	0	0.0554	0.0095	0.0001	0	0	0	0	0	0	0	0											0.6981	0	3.33E-16	6.4776	0.181958052	4.453441336	0	1.621427141	1.508062549	0	1.421233615	1.486706453	0.000931924	1.847568455	0	0.001253258	4.275138231	5.098857055	9.944337581	0.654966981	0.131638443	0	0.111411258	0.009519594	0.000144111	0	0	0.098835107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.325
H2312_008_0	2011	8																															A	A	Coin		T	Coin		V	V		V		V	V	V	V	V	V		V					V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	242.9449192	4.44409974	24.66518295	0	240.5243167	8.246256854	0	301.5869056	188.4956373	0	315.4790094	0	0.418421282	596.8494454	3507.615131	3618.589157	284.3058699	64.15612571	0	46.9115986	0	0	0	0	22.29892577	0	0	0	0	0											3400	$350/Admit for IP Acute; PBP 1a	$350/Admit for IP Psych; PBP 1b	17% Coinsurance for SNF; PBP 2	No Cost Sharing; PBP 6	$75/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for ER; $35/Visit for Urgent Care; PBP 4a, 4b"	$75/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$75/Case for OP Radiology; $25/Visit for Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	$25/Case for Renal Dialysis; PBP 12	"$15/Visit for Cardiac Rehab; $75/Visit for OP Hospital; PBP 3, 5, 9d, 13a"	"$20/Visit for PCP; $20/Visit for Preventive Care; $20/Visit for Routine Physical Exams; PBP 7a, 14b-i"	"$35/Visit for Physician Specialist; $35/Visit for Chiropractic; $35/Visit for Podiatry; $35/Visit for Routine Eye Exams (Medicare Covered); PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for Mental Health; $35/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$15/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	$35/Visit for Other Health Care; PBP 7g	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 13c, 13d, 14j"	PBP 10b	"PBP 16a, 16b"	$35/Exam for Routine Eye Exams (Non Medicare Covered); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	350	350	0.165904628	0	75	0.2	0	47.695752	75	0	61.65737045	0	25	74.44558652	20	35	35	15	0	35	0	0	0	0	35	0	0	0	0	0											NO	344.6715635	344.6715635	0.163378878	0	73.85819217	0.196955179	0	46.9696269	73.85819217	0	60.71869221	0	24.61939739	73.31221914	19.69551791	34.46715635	34.46715635	14.77163843	0	34.46715635	0	0	0	0	34.46715635	0	0	0	0	0												6.978	0.127646234	4.029769924	0	1.480390934	1.624142996	0	1.180452036	1.16016225	0	1.596289406	0	0.00085844	3.646363111	5.757024721	10.39353985	0.816601239	0.078974258	0	0.13474245	0	0	0	0	0.06404838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.069	0	0.603986034	6.978	0.127646234	4.029769924	0	1.480390934	1.624142996	0	1.180452036	1.16016225	0	1.596289406	0	0.00085844	3.646363111	5.757024721	10.39353985	0.816601239	0.078974258	0	0.13474245	0	0	0	0	0.06404838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.069	NO	20% Coinsurance for IP Acute; PBP 1a	Not Covered OON; PBP 1b	20% Coinsurance for SNF; PBP 2	20% Coinsurance for Home Health; PBP 6	20% Coinsurance for Ambulance; PBP 10a	Not Covered OON; PBP 11a	"Not Covered OON; PBP 11b, 11c"	"20% Coinsurance for ER; 20% Coinsurance for Urgent Care; PBP 4a, 4b"	20% Coinsurance for ASC Services; PBP 9b	20% Coinsurance for OP Diagnostic Procedures/Tests; PBP 8a	20% Coinsurance for OP Radiology; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"20% Coinsurance for Cardiac Rehab; 20% Coinsurance for OP Hospital; PBP 3, 5, 9d, 13a"	"20% Coinsurance for PCP; 20% Coinsurance for Preventive Care; 20% Coinsurance for Routine Physical Exams; PBP 7a, 14b-i"	"20% Coinsurance for Physician Specialist; 20% Coinsurance for Chiropractic; 20% Coinsurance for Podiatry; 20% Coinsurance for Routine Eye Exams (Medicare Covered); 20% Coinsurance for Hearing Exams (Medicare Covered); PBP 7b, 7d, 7f, 17a, 18a"	"Not Covered; PBP 7e, 7h, 9c"	"20% Coinsurance for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	20% Coinsurance for Other Health Care; PBP 7g	20% Coinsurance for Part B Drugs; PBP 15	"20% Coinsurance for Other Medicare Part B; PBP 13a, 13c, 13d, 14j"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	20% Coinsurance for Routine Eye Exams (Non Medicare Covered); PBP 17a	20% Coinsurance for Eye Wear (Non Medicare Covered); PBP 17b	20% Coinsurance for Routine Hearing Exams (Non Medicare Covered); PBP 18a	20% Coinsurance for Hearing Aids (Non Medicare Covered); PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b												0.2132	0	0.015	0	0.0123	0	0	0.0286	0.035	0.0006	0.0187	0	0.0003	0.0785	0.041	0.1831	0	0.0006	0	0.0534	0	0.0004	0	0	0	0	0	0	0	0											0.6806	0	0	7.1912	0.127646234	4.044734674	0	1.492689658	1.624142996	0	1.209074315	1.195121396	0.000579833	1.615027398	0	0.001119057	3.724867857	5.798055909	10.57665143	0.816601239	0.079537785	0	0.188103246	1.72E-05	0.000400233	0	0	0.06404838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7496
H2312_009_0	2011	11																															A	A	Coin		T	Coin		V	V		V		V	V	V	V	V	V		V					V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	366.2418946	13.43358301	46.05887064	0	382.1167558	16.84410413	0	498.6249451	282.4460757	0	559.2954656	0	0.845751911	1528.305175	3606.388523	4455.077246	330.5417729	9.385543372	0	1.478934107	0	0	0	0	40.30095442	0	0	0	0	0											3400	$300/Admit for IP Acute; PBP 1a	$300/Admit for IP Psych; PBP 1b	17% Coinsurance for SNF; PBP 2	No Cost Sharing; PBP 6	$75/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for ER; $35/Visit for Urgent Care; PBP 4a, 4b"	$50/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$50/Case for OP Radiology; $25/Visit for Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	$25/Case for Renal Dialysis; PBP 12	"$15/Visit for Cardiac Rehab; $50/Visit for OP Hospital; PBP 3, 5, 9d, 13a"	"$15/Visit for PCP; $15/Visit for Preventive Care; $15/Visit for Routine Physical Exams; PBP 7a, 14b-i"	"$35/Visit for Physician Specialist; $35/Visit for Chiropractic; $35/Visit for Podiatry; $35/Visit for Routine Eye Exams (Medicare Covered); PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for Mental Health; $35/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$15/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	$35/Visit for Other Health Care; PBP 7g	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 13c, 13d, 14j"	PBP 10b	"PBP 16a, 16b"	$35/Exam for Routine Eye Exams (Non Medicare Covered); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	300	300	0.165904628	0	75	0.2	0	48.83948724	50	0	43.39611725	0	25	49.54628627	15	35	35	15	0	35	0	0	0	0	35	0	0	0	0	0											NO	292.5238059	292.5238059	0.161770177	0	73.13095146	0.195015871	0	47.62237561	48.75396764	0	42.31465793	0	24.37698382	48.31156075	14.62619029	34.12777735	34.12777735	14.62619029	0	34.12777735	0	0	0	0	34.12777735	0	0	0	0	0												8.9279	0.327470236	7.450951656	0	2.328713494	3.28486763	0	1.978808702	1.147530569	0	1.972199692	0	0.001718073	6.152900692	4.395643734	12.67015703	0.940054669	0.011439562	0	0.004206061	0	0	0	0	0.114615167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7091	0	1.321559595	8.9279	0.327470236	7.450951656	0	2.328713494	3.28486763	0	1.978808702	1.147530569	0	1.972199692	0	0.001718073	6.152900692	4.395643734	12.67015703	0.940054669	0.011439562	0	0.004206061	0	0	0	0	0.114615167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7091	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.9279	0.327470236	7.450951656	0	2.328713494	3.28486763	0	1.978808702	1.147530569	0	1.972199692	0	0.001718073	6.152900692	4.395643734	12.67015703	0.940054669	0.011439562	0	0.004206061	0	0	0	0	0.114615167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7091
H2312_010_0	2011	10																															A	A	Coin		T	Coin		V	V		V		V	V	V	V	V	V		V					V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	360.4661539	7.811709756	43.38887225	0	380.3482025	15.98557567	0	389.0238938	228.5597677	0	420.7171698	0	0.543126911	784.1829461	4581.98304	4852.773545	388.2029935	92.49268306	0	48.14768768	0	0	0	0	21.8819043	0	0	0	0	0											3400	$300/Admit for IP Acute; PBP 1a	$300/Admit for IP Psych; PBP 1b	17% Coinsurance for SNF; PBP 2	No Cost Sharing; PBP 6	$75/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for ER; $35/Visit for Urgent Care; PBP 4a, 4b"	$75/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$75/Case for OP Radiology; $25/Visit for Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	$25/Case for Renal Dialysis; PBP 12	"$15/Visit for Cardiac Rehab; $75/Visit for OP Hospital; PBP 3, 5, 9d, 13a"	"$15/Visit for PCP; $15/Visit for Preventive Care; $15/Visit for Routine Physical Exams; PBP 7a, 14b-i"	"$35/Visit for Physician Specialist; $35/Visit for Chiropractic; $35/Visit for Podiatry; $35/Visit for Routine Eye Exams (Medicare Covered); PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for Mental Health; $35/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$15/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	$35/Visit for Other Health Care; PBP 7g	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 13c, 13d, 14j"	PBP 10b	"PBP 16a, 16b"	$35/Exam for Routine Eye Exams (Non Medicare Covered); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	300	300	0.165904628	0	75	0.2	0	47.88611034	75	0	61.65737045	0	25	74.35377967	15	35	35	15	0	35	0	0	0	0	35	0	0	0	0	0											NO	292.4314617	292.4314617	0.161719109	0	73.10786544	0.194954308	0	46.67801748	73.10786544	0	60.1018499	0	24.36928848	72.47794825	14.62157309	34.11700387	34.11700387	14.62157309	0	34.11700387	0	0	0	0	34.11700387	0	0	0	0	0												8.7843	0.190365809	7.016809774	0	2.317203767	3.116456839	0	1.513238676	1.392459728	0	2.107156682	0	0.001102968	4.736330916	5.582983325	13.79684115	1.103693586	0.112699044	0	0.136887904	0	0	0	0	0.062212084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9707	0	1.34507613	8.7843	0.190365809	7.016809774	0	2.317203767	3.116456839	0	1.513238676	1.392459728	0	2.107156682	0	0.001102968	4.736330916	5.582983325	13.79684115	1.103693586	0.112699044	0	0.136887904	0	0	0	0	0.062212084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9707	NO	20% Coinsurance for IP Acute; PBP 1a	Not Covered OON; PBP 1b	20% Coinsurance for SNF; PBP 2	20% Coinsurance for Home Health; PBP 6	20% Coinsurance for Ambulance; PBP 10a	Not Covered OON; PBP 11a	"Not Covered OON; PBP 11b, 11c"	"20% Coinsurance for ER; 20% Coinsurance for Urgent Care; PBP 4a, 4b"	20% Coinsurance for ASC Services; PBP 9b	20% Coinsurance for OP Diagnostic Procedures/Tests; PBP 8a	20% Coinsurance for OP Radiology; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"20% Coinsurance for Cardiac Rehab; 20% Coinsurance for OP Hospital; PBP 3, 5, 9d, 13a"	"20% Coinsurance for PCP; 20% Coinsurance for Preventive Care; 20% Coinsurance for Routine Physical Exams; PBP 7a, 14b-i"	"20% Coinsurance for Physician Specialist; 20% Coinsurance for Chiropractic; 20% Coinsurance for Podiatry; 20% Coinsurance for Routine Eye Exams (Medicare Covered); 20% Coinsurance for Hearing Exams (Medicare Covered); PBP 7b, 7d, 7f, 17a, 18a"	"Not Covered; PBP 7e, 7h, 9c"	"20% Coinsurance for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	20% Coinsurance for Other Health Care; PBP 7g	20% Coinsurance for Part B Drugs; PBP 15	"20% Coinsurance for Other Medicare Part B; PBP 13a, 13c, 13d, 14j"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	20% Coinsurance for Routine Eye Exams (Non Medicare Covered); PBP 17a	20% Coinsurance for Eye Wear (Non Medicare Covered); PBP 17b	20% Coinsurance for Routine Hearing Exams (Non Medicare Covered); PBP 18a	20% Coinsurance for Hearing Aids (Non Medicare Covered); PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b												0.3053	0	0.0322	0	0.0175	0	0	0.0236	0.0342	0.0008	0.0164	0	0.0002	0.0561	0.0306	0.1258	0	0.0008	0	0.0564	0.0355	0.0014	0	0	0	0	0	0	0	0											0.7369	0	0	9.0896	0.190365809	7.049021058	0	2.334698744	3.116456839	0	1.536873554	1.426679678	0.000821689	2.123600064	0	0.001314718	4.792415374	5.613600788	13.92261104	1.103693586	0.113477219	0	0.193296071	0.035519608	0.001374395	0	0	0.062212084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.7077
H2312_801_0	2011	7																															Coin	Coin	Coin		Coin	Coin		Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	269.1159497	0.80654472	60.92563611	0	12.19803848	23.85626767	0	34.30623116	33.25649491	1.868034222	26.64827351	0	0.008618238	161.8954334	23.40492756	92.53828386	1.309082924	0.458730299	0	46.61398525	0.641827187	0.318502784	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 4b"	Medicare-FFS Cost Sharing; PBP 9b	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 13c, 13d, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b											0	0.070147949	0.070147949	0.165749144	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	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.069583099	0.069583099	0.140490143	0	0.215529734	0.215529734	0	0.215529734	0.215529734	0.215529734	0.215529734	0	0.215529734	0.215529734	0.215529734	0.215529734	0.215529734	0.215529734	0	0.215529734	0.215529734	0.215529734	0	0	0	0	0	0	0	0												18.7259	0.056121881	8.559451319	0	2.629039987	5.141735023	0	7.394012872	7.167763499	0.402616919	5.743495299	0	0.001857487	34.89327968	5.044457809	19.94475169	0.282146294	0.098870019	0	10.04669984	0.138332843	0.06864682	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3392	0	9.715877033	18.7259	0.056121881	8.559451319	0	2.629039987	5.141735023	0	7.394012872	7.167763499	0.402616919	5.743495299	0	0.001857487	34.89327968	5.044457809	19.94475169	0.282146294	0.098870019	0	10.04669984	0.138332843	0.06864682	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3392	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.7259	0.056121881	8.559451319	0	2.629039987	5.141735023	0	7.394012872	7.167763499	0.402616919	5.743495299	0	0.001857487	34.89327968	5.044457809	19.94475169	0.282146294	0.098870019	0	10.04669984	0.138332843	0.06864682	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3392
H2312_803_0	2011	7																															Coin	Coin	Coin		Coin	Coin		Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	168.2738252	1.085455429	29.87902348	0	7.999677504	17.21205346	0	20.61368934	21.75698383	1.481718916	17.05538383	0	0.005741799	108.7216981	17.16891258	62.67145954	1.259890733	0.247366561	0	30.26333054	1.501935553	0.428644026	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 4b"	Medicare-FFS Cost Sharing; PBP 9b	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 13c, 13d, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b											0	0.070147949	0.070147949	0.165749144	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	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.069640376	0.069640376	0.143576842	0	0.223594711	0.223594711	0	0.223594711	0.223594711	0.223594711	0.223594711	0	0.223594711	0.223594711	0.223594711	0.223594711	0.223594711	0.223594711	0	0.223594711	0.223594711	0.223594711	0	0	0	0	0	0	0	0												11.7187	0.075591525	4.28993583	0	1.78868558	3.848524121	0	4.609111913	4.864746514	0.331304513	3.81349362	0	0.001283836	24.30959667	3.838878047	14.01300689	0.281704905	0.055309855	0	6.766720649	0.335824846	0.095842537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0382	0	3.648931786	11.7187	0.075591525	4.28993583	0	1.78868558	3.848524121	0	4.609111913	4.864746514	0.331304513	3.81349362	0	0.001283836	24.30959667	3.838878047	14.01300689	0.281704905	0.055309855	0	6.766720649	0.335824846	0.095842537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0382	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.7187	0.075591525	4.28993583	0	1.78868558	3.848524121	0	4.609111913	4.864746514	0.331304513	3.81349362	0	0.001283836	24.30959667	3.838878047	14.01300689	0.281704905	0.055309855	0	6.766720649	0.335824846	0.095842537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0382
H2312_805_0	2011	7																															Coin	Coin	Coin		Coin	Coin		Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin		Coin		Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	335.4071292	3.269603519	64.00281934	0	18.08647975	29.56293992	0	38.89497139	38.18951089	1.734093423	22.79678764	0	0.009065664	148.2123335	25.64616221	104.196872	2.268306321	0.396452545	0	60.81645366	0	1.264794585	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 4b"	Medicare-FFS Cost Sharing; PBP 9b	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 13c, 13d, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b											0	0.070537784	0.070537784	0.165788262	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	0.233	0	0.233	0	0	0	0	0	0	0	0											NO	0.069915932	0.069915932	0.138660934	0	0.213739037	0.213739037	0	0.213739037	0.213739037	0.213739037	0.213739037	0	0.213739037	0.213739037	0.213739037	0.213739037	0.213739037	0.213739037	0	0.213739037	0	0.213739037	0	0	0	0	0	0	0	0												23.4503	0.228597376	8.8746907	0	3.865786759	6.318754301	0	8.313373719	8.16258927	0.370643458	4.872563431	0	0.001937686	31.6787614	5.481586007	22.27093904	0.484825608	0.084737385	0	12.99885022	0	0.270335976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.7293	0	11.42467514	23.4503	0.228597376	8.8746907	0	3.865786759	6.318754301	0	8.313373719	8.16258927	0.370643458	4.872563431	0	0.001937686	31.6787614	5.481586007	22.27093904	0.484825608	0.084737385	0	12.99885022	0	0.270335976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.7293	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.4503	0.228597376	8.8746907	0	3.865786759	6.318754301	0	8.313373719	8.16258927	0.370643458	4.872563431	0	0.001937686	31.6787614	5.481586007	22.27093904	0.484825608	0.084737385	0	12.99885022	0	0.270335976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.7293
H2312_807_0	2011	8																															Coin	Coin	Coin		Coin	Coin		Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	312.3399745	2.275377295	68.9706422	0	18.38450705	22.98296199	0	34.48646147	36.16645045	2.064221186	25.43613056	0	0.009287869	135.1568478	28.25091214	123.7067275	3.136015124	0.699006016	0	60.91303537	15.03904581	1.02350172	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 4b"	Medicare-FFS Cost Sharing; PBP 9b	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 13c, 13d, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b											0	0.070626047	0.070626047	0.165827211	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	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070057353	0.070057353	0.144442683	0	0.213070443	0.213070443	0	0.213070443	0.213070443	0.213070443	0.213070443	0	0.213070443	0.213070443	0.213070443	0.213070443	0.213070443	0.213070443	0	0.213070443	0.213070443	0.213070443	0	0	0	0	0	0	0	0												21.8817	0.159406911	9.962304623	0	3.917195069	4.896989902	0	7.348045637	7.706001634	0.439824523	5.419687617	0	0.00197897	28.79792949	6.019434376	26.35824728	0.668192133	0.148937522	0	12.97876746	3.20437616	0.218077965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.1271	0	11.76717961	21.8817	0.159406911	9.962304623	0	3.917195069	4.896989902	0	7.348045637	7.706001634	0.439824523	5.419687617	0	0.00197897	28.79792949	6.019434376	26.35824728	0.668192133	0.148937522	0	12.97876746	3.20437616	0.218077965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.1271	NO																																																																																		0	0	0	21.8817	0.159406911	9.962304623	0	3.917195069	4.896989902	0	7.348045637	7.706001634	0.439824523	5.419687617	0	0.00197897	28.79792949	6.019434376	26.35824728	0.668192133	0.148937522	0	12.97876746	3.20437616	0.218077965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.1271
H2320_007_0	2011	7																															A	A	D		P	Coin		P	P	P	P	P	P	P	P	P	P		P	P	Coin				P		P			Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	541.532871	32.98066214	288.3033044	0	40.31280993	12.31243184	0	333.4641827	280.3717356	1165.576944	1083.064904	3.198633222	1.58197993	1218.700598	3597.082359	3764.589068	78.93595054	0	575.8935778	1284.033844	16.10300476	0	0	0	13.27452583	0	5.566560944	0	0	0.103937318											3400	"$75 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$75 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	20% coinsurance; PBP 11a	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$50 copay; PBP 9a, 9b"	$10 - $20 copay; PBP 8a	$15 - $20 copay; PBP 8b	$50 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $40 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$10 PCP, $0 Physical Exams/Immun/Screenings/Exams; PBP 7a, 14a-i"	"$30 Specialist, $0 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$40 copay; PBP 7e, 7h, 9c"	$20 copay; included in row i.2.	$15 - $20 copay; PBP 8b	"$0 - $30 copay; PBP 7d, 7g, 8a"	0% - 20% coinsurance; PBP 15	$30 copay; PBP 7g			$30 copay; PBP 17a	$100 every two years; PBP 17b	$30 copay; PBP 18a	$350 every three years; PBP 18b		"20% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											0	75	75	120	0	50	0.2	0	49.44501415	50	15	16.53667197	50	10	17.2014095	10	30	40	0	15.74440811	19.37373933	0.2	0	0	0	30	0	30	0	0	0.2											YES	72.20726718	72.20726718	115.5316275	0	48.13817812	0.192552712	0	47.60385796	48.13817812	14.44145344	15.92090521	48.13817812	9.627635624	16.56089029	9.627635624	28.88290687	38.5105425	0	15.15814244	18.6523303	0.192552712	0	0	0	28.88290687	0	28.88290687	0	0	0.192552712											3400	3.2586	0.198453624	2.775679164	0	0.161715435	2.370792147	0	1.322848466	1.124715379	1.402718764	1.436947806	0.012831365	0.001269227	1.681897241	2.885949855	9.061022955	0.25332219	0	0.727456407	1.995851947	3.100677245	0	0	0	0.031950574	0	0.013398205	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	33.8381	0	1.30874177	3.2586	0.198453624	2.775679164	0	0.161715435	2.370792147	0	1.322848466	1.124715379	1.402718764	1.436947806	0.012831365	0.001269227	1.681897241	2.885949855	9.061022955	0.25332219	0	0.727456407	1.995851947	3.100677245	0	0	0	0.031950574	0	0.013398205	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	33.8381	NO	"$175 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$175 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	30% coinsurance; PBP 11a	"30% coinsurance, $10 Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$75 copay; PBP 9a, 9b"	$20 - $25 copay; PBP 8a	$20 - $25 copay; PBP 8b	$75 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $50 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35 PCP, $15 Physical Exam, $10 Immun/Screenings/Exams; PBP 7a, 14a-i"	"$35 Specialist, $10 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$50 copay; PBP 7e, 7h, 9c"	$25 copay; included in row i.2.	$20 - $25 copay; PBP 8b	"$0 - $35 copay; PBP 7d, 7g, 8a"	20% coinsurance; PBP 15	$35 copay; PBP 7g			$35 copay; PBP 17a	$100 every two years; PBP 17b	$35 copay; PBP 18a	$350 every three years; PBP 18b		"30% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"												0.6806	0.0299	0.5074	0	0.3586	0.3152	0.0225	0.2272	0.0601	0.043	0.0548	0.0014	0	0.0791	0	1.8799	0.2122	0	0.0919	1.009	0.0244	0	0	0	0	0	0.0031	0	0	0.0024											5.6027	400	0.216693872	3.9391	0.22835095	3.283124889	0	0.520333755	2.685962382	0.022527643	1.550050519	1.184860014	1.445701174	1.491716384	0.014184037	0.001269227	1.760978464	2.885949855	10.94088423	0.465559311	0	0.819314491	3.00486569	3.125114918	0	0	0	0.031950574	0	0.016534755	0	0	0.022414803	0	0	0	0	0	0	0	0	0	0	39.4408
H2320_008_0	2011	5																															A	A	D		P	Coin		P	P	P	P	P	P	P	P	P	P		P	P	Coin				P		P			Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	586.315774	10.98180674	157.6779333	0	66.56998728	9.405459047	0	303.4860811	179.8826821	1037.408661	995.777945	4.910968976	2.059589986	1082.231334	3421.721753	3810.464854	90.5307648	0	554.817461	1347.619844	18.1243878	0	0	0	17.90098842	0	1.492360732	0	0	0.103937318											3400	"$75 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$75 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	20% coinsurance; PBP 11a	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$50 copay; PBP 9a, 9b"	$10 - $20 copay; PBP 8a	$15 - $20 copay; PBP 8b	$50 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $40 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$10 PCP, $0 Physical Exams/Immun/Screenings/Exams; PBP 7a, 14a-i"	"$30 Specialist, $0 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$40 copay; PBP 7e, 7h, 9c"	$20 copay; included in row i.2.	$15 - $20 copay; PBP 8b	"$0 - $30 copay; PBP 7d, 7g, 8a"	0% - 20% coinsurance; PBP 15	$30 copay; PBP 7g			$30 copay; PBP 17a	$100 every two years; PBP 17b	$30 copay; PBP 18a	$350 every three years; PBP 18b		"20% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											0	75	75	120	0	50	0.2	0	49.11737096	50	15	16.44444925	50	10	15.99991541	10	30	40	0	15.70341514	22.18757778	0.2	0	0	0	30	0	30	0	0	0.2											YES	72.20726718	72.20726718	115.5316275	0	48.13817812	0.192552712	0	47.28841504	48.13817812	14.44145344	15.83211654	48.13817812	9.627635624	15.40413555	9.627635624	28.88290687	38.5105425	0	15.11867591	21.36139142	0.192552712	0	0	0	28.88290687	0	28.88290687	0	0	0.192552712											3400	3.528	0.066080521	1.518065687	0	0.267046492	1.811046652	0	1.19594798	0.721602049	1.248474073	1.313772706	0.019700425	0.001652415	1.389236514	2.745257521	9.171441794	0.290532405	0	0.699008782	2.398919581	3.489900033	0	0	0	0.043086048	0	0.003591976	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	31.9424	0	1.235423922	3.528	0.066080521	1.518065687	0	0.267046492	1.811046652	0	1.19594798	0.721602049	1.248474073	1.313772706	0.019700425	0.001652415	1.389236514	2.745257521	9.171441794	0.290532405	0	0.699008782	2.398919581	3.489900033	0	0	0	0.043086048	0	0.003591976	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	31.9424	NO	"$175 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$175 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	30% coinsurance; PBP 11a	"30% coinsurance, $10 Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$75 copay; PBP 9a, 9b"	$20 - $25 copay; PBP 8a	$20 - $25 copay; PBP 8b	$75 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $50 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35 PCP, $15 Physical Exam, $10 Immun/Screenings/Exams; PBP 7a, 14a-i"	"$35 Specialist, $10 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$50 copay; PBP 7e, 7h, 9c"	$25 copay; included in row i.2.	$20 - $25 copay; PBP 8b	"$0 - $35 copay; PBP 7d, 7g, 8a"	20% coinsurance; PBP 15	$35 copay; PBP 7g			$35 copay; PBP 17a	$100 every two years; PBP 17b	$35 copay; PBP 18a	$350 every three years; PBP 18b		"30% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"												0.6902	0.0389	0.173	0	0.1747	0.3855	0.0343	0.1609	0.0292	0.0336	0.0353	0.0018	0	0.0324	0	1.7218	0.1155	0	0.1104	0.9084	0.0467	0	0	0	0	0	0.0039	0	0	0.0024											4.6988	400	0.181735096	4.2182	0.105004046	1.6910695	0	0.441698994	2.196577522	0.03428349	1.356824632	0.75078935	1.282078468	1.349037375	0.021461478	0.001652415	1.421660415	2.745257521	10.89328356	0.405991114	0	0.809439776	3.307278367	3.536580816	0	0	0	0.043086048	0	0.007521306	0	0	0.022414803	0	0	0	0	0	0	0	0	0	0	36.6412
H2320_011_0	2011	7																															A	A	D		P	Coin		P	P	P	P	P	P	P	P	P	P		P	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	YES	160.2649311	5.137432431	252.0128594	0	64.26947598	8.550411948	0	273.3446205	224.1018064	932.4711713	869.0705075	1.904092129	3.06350542	958.8553246	2943.438357	3183.504894	94.84750417	0	514.0208323	1159.016848	9.877782993	0	0	0	0	0	0	0	0	0.103937318											3400	"$600 copay per admit, unlimited coverage; PBP 1a"	$600 copay per admit; PBP 1b	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	20% coinsurance; PBP 11a	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$75 copay; PBP 9a, 9b"	$10 - $35 copay; PBP 8a	$15 - $35 copay; PBP 8b	$75 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $40 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15 PCP, $0  Physical Exam/Immun/Screenings/Exams; PBP 7a, 14a-i"	"$40 Specialist, $0 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$40 copay; PBP 7e, 7h, 9c"	$30 copay; included in row i.2.	$10 - $35 copay; PBP 8b	"$0 - $40 copay; PBP 7d, 7g, 8a"	0% - 20% coinsurance; PBP 15	$40 copay; PBP 7g								"20% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											0	600	600	120	0	50	0.2	0	49.44814522	75	10	21.15687432	75	10	24.88555708	15	40	40	0	17.7644503	20.40130967	0.2	0	0	0	0	0	0	0	0	0.2											YES	577.6581374	577.6581374	115.5316275	0	48.13817812	0.192552712	0	47.60687244	72.20726718	9.627635624	20.36906769	72.20726718	9.627635624	23.95890759	14.44145344	38.5105425	38.5105425	0	17.10296546	19.64163757	0.192552712	0	0	0	0	0	0	0	0	0.192552712											3400	7.7149	0.247306637	2.426287983	0	0.257817957	1.646405013	0	1.08442354	1.348481584	0.748124389	1.475179666	0.011457441	0.002457859	1.914427176	3.542293998	10.21654171	0.304385737	0	0.732606712	1.897082405	1.901993909	0	0	0	0	0	0	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	37.4921	0	1.450069486	7.7149	0.247306637	2.426287983	0	0.257817957	1.646405013	0	1.08442354	1.348481584	0.748124389	1.475179666	0.011457441	0.002457859	1.914427176	3.542293998	10.21654171	0.304385737	0	0.732606712	1.897082405	1.901993909	0	0	0	0	0	0	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	37.4921	NO	"$700 copay per admit, unlimited coverage; PBP 1a"	$700 copay per admit; PBP 1b	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	30% coinsurance; PBP 11a	"30% coinsurance, $10 Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$100 copay; PBP 9a, 9b"	$20 - $40 copay; PBP 8a	$25 - $40 copay; PBP 8b	$100 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $50 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$45 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams; PBP 7a, 14a-i"	"$45 Specialist, $10 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$50 copay; PBP 7e, 7h, 9c"	$35 copay; included in row i.2.	$25 - $40 copay; PBP 8b	"$0 - $45 copay; PBP 7d, 7g, 8a"	20% coinsurance; PBP 15	$45 copay; PBP 7g								"30% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"												0.3406	0.0737	0.223	0	0.1644	0.3951	0.0236	0.1819	0.1176	0.0381	0.0495	0.0034	0	0.077	0	1.8487	0.1736	0	0.1064	0.6065	0.0624	0	0	0	0	0	0	0	0	0.0024											4.4881	500	0.173583311	8.0555	0.32101609	2.649283514	0	0.422183503	2.041522449	0.023598951	1.26635123	1.466084744	0.786245361	1.524675386	0.014904683	0.002457859	1.99147385	3.542293998	12.06521018	0.478022366	0	0.838989881	2.503598183	1.964399069	0	0	0	0	0	0	0	0	0.022414803	0	0	0	0	0	0	0	0	0	0	41.9802
H2320_012_0	2011	5																															A	A	D		P	Coin		P	P	P	P	P	P	P	P	P	P		P	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	YES	112.6087156	5.067990961	225.7728646	0	60.84700037	7.633080193	0	224.6173398	172.1932884	759.1727143	689.470171	1.878354962	3.022096736	677.679413	2520.16251	2714.944481	86.68595568	0	413.0985952	1112.339162	8.114868073	0	0	0	0	0	0	0	0	0.103937318											3400	"$600 copay per admit, unlimited coverage; PBP 1a"	$600 copay per admit; PBP 1b	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	20% coinsurance; PBP 11a	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$75 copay; PBP 9a, 9b"	$10 - $35 copay; PBP 8a	$15 - $35 copay; PBP 8b	$75 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $40 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15 PCP, $0  Physical Exam/Immun/Screenings/Exams; PBP 7a, 14a-i"	"$40 Specialist, $0 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$40 copay; PBP 7e, 7h, 9c"	$30 copay; included in row i.2.	$10 - $35 copay; PBP 8b	"$0 - $40 copay; PBP 7d, 7g, 8a"	0% - 20% coinsurance; PBP 15	$40 copay; PBP 7g								"20% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											0	600	600	120	0	50	0.2	0	49.34077126	75	10	20.85305317	75	10	24.70394646	15	40	40	0	17.7192621	23.00980157	0.2	0	0	0	0	0	0	0	0	0.2											YES	577.6581374	577.6581374	115.5316275	0	48.13817812	0.192552712	0	47.50349671	72.20726718	9.627635624	20.07655975	72.20726718	9.627635624	23.7840595	14.44145344	38.5105425	38.5105425	0	17.0594599	22.15299853	0.192552712	0	0	0	0	0	0	0	0	0.192552712											3400	5.4208	0.243963852	2.173658874	0	0.244088645	1.469770296	0	0.889175755	1.036133898	0.609086522	1.153515757	0.011302573	0.002424637	1.343163956	3.032900795	8.712832068	0.278193598	0	0.58726991	2.053470651	1.562539859	0	0	0	0	0	0	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	30.8443	0	1.192952539	5.4208	0.243963852	2.173658874	0	0.244088645	1.469770296	0	0.889175755	1.036133898	0.609086522	1.153515757	0.011302573	0.002424637	1.343163956	3.032900795	8.712832068	0.278193598	0	0.58726991	2.053470651	1.562539859	0	0	0	0	0	0	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	30.8443	NO	"$700 copay per admit, unlimited coverage; PBP 1a"	$700 copay per admit; PBP 1b	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	30% coinsurance; PBP 11a	"30% coinsurance, $10 Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$100 copay; PBP 9a, 9b"	$20 - $40 copay; PBP 8a	$25 - $40 copay; PBP 8b	$100 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $50 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$45 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams; PBP 7a, 14a-i"	"$45 Specialist, $10 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$50 copay; PBP 7e, 7h, 9c"	$35 copay; included in row i.2.	$25 - $40 copay; PBP 8b	"$0 - $45 copay; PBP 7d, 7g, 8a"	20% coinsurance; PBP 15	$45 copay; PBP 7g								"30% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"												0.336	0.0727	0.2307	0	0.1335	0.2074	0.0171	0.206	0.0664	0.0341	0.0657	0.0237	0	0.0344	0	1.7099	0.1856	0	0.111	0.575	0.0408	0	0	0	0	0	0	0	0	0.0024											4.0523	500	0.156727799	5.7568	0.316676991	2.404353257	0	0.377580279	1.677161148	0.017125145	1.095173893	1.102540985	0.643152397	1.219194295	0.035012474	0.002424637	1.377530459	3.032900795	10.42268404	0.463759546	0	0.698250474	2.62847176	1.603334604	0	0	0	0	0	0	0	0	0.022414803	0	0	0	0	0	0	0	0	0	0	34.8965
H2320_013_0	2011	5																															A	A	D		P	Coin		P	P	P	P	P	P	P	P	P	P		P	P	Coin				P		P			Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	580.1139667	24.16166131	359.7565468	0	139.7108135	12.08543052	0	281.4650429	267.4956143	965.8758566	957.1565181	3.662283058	7.838243754	895.7859348	3449.852724	4289.878992	127.0294669	0	636.3591385	1790.414999	18.330525	0	0	0	16.82075309	0	6.0824519	0	0	0.103937318											3400	"$75 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$75 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	20% coinsurance; PBP 11a	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$50 copay; PBP 9a, 9b"	$10 - $20 copay; PBP 8a	$15 - $20 copay; PBP 8b	$50 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $40 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$10 PCP, $0 Physical Exams/Immun/Screenings/Exams; PBP 7a, 14a-i"	"$30 Specialist, $0 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$40 copay; PBP 7e, 7h, 9c"	$20 copay; included in row i.2.	$15 - $20 copay; PBP 8b	"$0 - $30 copay; PBP 7d, 7g, 8a"	0% - 20% coinsurance; PBP 15	$30 copay; PBP 7g			$30 copay; PBP 17a	$100 every two years; PBP 17b	$30 copay; PBP 18a	$350 every three years; PBP 18b		"20% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											0	75	75	120	0	50	0.2	0	49.49378681	50	15	16.57788872	50	10	18.57634672	10	30	40	0	15.70887053	18.3045723	0.2	0	0	0	30	0	30	0	0	0.2											YES	72.20726718	72.20726718	115.5316275	0	48.13817812	0.192552712	0	47.65081451	48.13817812	14.44145344	15.9605872	48.13817812	9.627635624	17.88462975	9.627635624	28.88290687	38.5105425	0	15.12392815	17.62297524	0.192552712	0	0	0	28.88290687	0	28.88290687	0	0	0.192552712											3400	3.4907	0.145387294	3.463604946	0	0.560452002	2.327082428	0	1.117669879	1.073062627	1.162387601	1.273065006	0.014691303	0.006288646	1.335066648	2.767827082	10.32534795	0.407664474	0	0.802020824	2.629369932	3.529592311	0	0	0	0.04048602	0	0.014639908	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	36.5064	0	1.411944979	3.4907	0.145387294	3.463604946	0	0.560452002	2.327082428	0	1.117669879	1.073062627	1.162387601	1.273065006	0.014691303	0.006288646	1.335066648	2.767827082	10.32534795	0.407664474	0	0.802020824	2.629369932	3.529592311	0	0	0	0.04048602	0	0.014639908	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	36.5064	NO	"$175 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$175 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	30% coinsurance; PBP 11a	"30% coinsurance, $10 Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$75 copay; PBP 9a, 9b"	$20 - $25 copay; PBP 8a	$20 - $25 copay; PBP 8b	$75 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $50 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35 PCP, $15 Physical Exam, $10 Immun/Screenings/Exams; PBP 7a, 14a-i"	"$35 Specialist, $10 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$50 copay; PBP 7e, 7h, 9c"	$25 copay; included in row i.2.	$20 - $25 copay; PBP 8b	"$0 - $35 copay; PBP 7d, 7g, 8a"	20% coinsurance; PBP 15	$35 copay; PBP 7g			$35 copay; PBP 17a	$100 every two years; PBP 17b	$35 copay; PBP 18a	$350 every three years; PBP 18b		"30% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"												0.5269	0	0.4181	0	0.0874	0.5041	0.0158	0.2587	0.0467	0.0523	0.0411	0	0	0.0103	0	1.7463	0.0888	0	0.1158	0.788	0.0981	0	0	0	0	0	0.0026	0	0	0.0024											4.8033	400	0.185776729	4.0176	0.145387294	3.881714826	0	0.647824354	2.831179951	0.015817368	1.376321441	1.119788253	1.214725421	1.314139468	0.014691303	0.006288646	1.345385349	2.767827082	12.07160869	0.496475257	0	0.917791565	3.41739348	3.627643862	0	0	0	0.04048602	0	0.017245536	0	0	0.022414803	0	0	0	0	0	0	0	0	0	0	41.3098
H2320_015_0	2011	5																															A	A	D		P	Coin		P	P	P	P	P	P	P	P	P	P		P	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	YES	148.4809912	10.77162128	212.9515526	0	97.63653572	8.015833279	0	242.3392063	205.8357883	842.7534576	775.1324536	2.260617897	2.033370673	654.4633762	2734.503084	3188.036045	83.69031747	0	485.9073447	1389.544431	8.471357825	0	0	0	0	0	0	0	0	0.103937318											3400	"$600 copay per admit, unlimited coverage; PBP 1a"	$600 copay per admit; PBP 1b	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	20% coinsurance; PBP 11a	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$75 copay; PBP 9a, 9b"	$10 - $35 copay; PBP 8a	$15 - $35 copay; PBP 8b	$75 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $40 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15 PCP, $0  Physical Exam/Immun/Screenings/Exams; PBP 7a, 14a-i"	"$40 Specialist, $0 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$40 copay; PBP 7e, 7h, 9c"	$30 copay; included in row i.2.	$10 - $35 copay; PBP 8b	"$0 - $40 copay; PBP 7d, 7g, 8a"	0% - 20% coinsurance; PBP 15	$40 copay; PBP 7g								"20% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											0	600	600	120	0	50	0.2	0	49.43814913	75	10	20.99895427	75	10	26.16849814	15	40	40	0	17.78507586	21.18436283	0.2	0	0	0	0	0	0	0	0	0.2											YES	577.6581374	577.6581374	115.5316275	0	48.13817812	0.192552712	0	47.59724857	72.20726718	9.627635624	20.21702802	72.20726718	9.627635624	25.19407649	14.44145344	38.5105425	38.5105425	0	17.122823	20.39553262	0.192552712	0	0	0	0	0	0	0	0	0.192552712											3400	7.1476	0.518526224	2.050219954	0	0.391670412	1.543470441	0	0.961223287	1.23856998	0.676143601	1.305906211	0.013602753	0.001631379	1.37405003	3.290849913	10.23108313	0.268579961	0	0.693342121	2.361708232	1.631182928	0	0	0	0	0	0	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	35.7194	0	1.381504718	7.1476	0.518526224	2.050219954	0	0.391670412	1.543470441	0	0.961223287	1.23856998	0.676143601	1.305906211	0.013602753	0.001631379	1.37405003	3.290849913	10.23108313	0.268579961	0	0.693342121	2.361708232	1.631182928	0	0	0	0	0	0	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	35.7194	NO	"$700 copay per admit, unlimited coverage; PBP 1a"	$700 copay per admit; PBP 1b	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	30% coinsurance; PBP 11a	"30% coinsurance, $10 Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$100 copay; PBP 9a, 9b"	$20 - $40 copay; PBP 8a	$25 - $40 copay; PBP 8b	$100 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $50 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$45 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams; PBP 7a, 14a-i"	"$45 Specialist, $10 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$50 copay; PBP 7e, 7h, 9c"	$35 copay; included in row i.2.	$25 - $40 copay; PBP 8b	"$0 - $45 copay; PBP 7d, 7g, 8a"	20% coinsurance; PBP 15	$45 copay; PBP 7g								"30% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"												0.3893	0.3754	0.1169	0	0.0914	0.2567	0.0338	0.2316	0.0391	0.0368	0.0716	0.0105	0	0.0168	0	2.201	0.0901	0	0.1483	0.6061	0.0401	0	0	0	0	0	0	0	0	0.0024											4.7578	500	0.184015788	7.5369	0.893891396	2.167096266	0	0.483039174	1.800159366	0.033843274	1.192838041	1.277694522	0.712961856	1.377547378	0.02413379	0.001631379	1.390825051	3.290849913	12.43205122	0.358649715	0	0.841603534	2.967787179	1.671250655	0	0	0	0	0	0	0	0	0.022414803	0	0	0	0	0	0	0	0	0	0	40.4772
H2320_016_0	2011	5																															A	A	D		P	Coin		P	P	P	P	P	P	P	P	P	P		P	P	Coin				P		P			Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	669.5843784	27.09069111	317.020088	0	105.132548	12.26625917	0	367.9690811	304.5707824	1219.465774	1301.19638	3.19889689	5.080741033	1132.937855	4381.641464	4981.731978	150.3006244	0	708.529052	2163.340706	21.75669947	0	0	0	15.01377739	0	5.972957408	0	0	0.103937318											3400	"$75 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$75 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	20% coinsurance; PBP 11a	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$50 copay; PBP 9a, 9b"	$10 - $20 copay; PBP 8a	$15 - $20 copay; PBP 8b	$50 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $40 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$10 PCP, $0 Physical Exams/Immun/Screenings/Exams; PBP 7a, 14a-i"	"$30 Specialist, $0 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$40 copay; PBP 7e, 7h, 9c"	$20 copay; included in row i.2.	$15 - $20 copay; PBP 8b	"$0 - $30 copay; PBP 7d, 7g, 8a"	0% - 20% coinsurance; PBP 15	$30 copay; PBP 7g			$30 copay; PBP 17a	$100 every two years; PBP 17b	$30 copay; PBP 18a	$350 every three years; PBP 18b		"20% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											0	75	75	120	0	50	0.2	0	49.54667737	50	15	16.42163236	50	10	17.79684947	10	30	40	0	15.71342297	20.66719383	0.2	0	0	0	30	0	30	0	0	0.2											YES	72.20726718	72.20726718	115.5316275	0	48.13817812	0.192552712	0	47.70173561	48.13817812	14.44145344	15.81014927	48.13817812	9.627635624	17.13415819	9.627635624	28.88290687	38.5105425	0	15.12831108	19.89762116	0.192552712	0	0	0	28.88290687	0	28.88290687	0	0	0.192552712											3400	4.0291	0.163012064	3.052153893	0	0.421740777	2.361901476	0	1.462730318	1.221790214	1.467571517	1.714342416	0.012832422	0.004076294	1.617661369	3.515403954	11.99057506	0.482346549	0	0.893237326	3.58711115	4.189311498	0	0	0	0.036136795	0	0.014376364	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	42.2574	0	1.634373137	4.0291	0.163012064	3.052153893	0	0.421740777	2.361901476	0	1.462730318	1.221790214	1.467571517	1.714342416	0.012832422	0.004076294	1.617661369	3.515403954	11.99057506	0.482346549	0	0.893237326	3.58711115	4.189311498	0	0	0	0.036136795	0	0.014376364	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	42.2574	NO	"$175 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$175 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	30% coinsurance; PBP 11a	"30% coinsurance, $10 Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$75 copay; PBP 9a, 9b"	$20 - $25 copay; PBP 8a	$20 - $25 copay; PBP 8b	$75 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $50 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35 PCP, $15 Physical Exam, $10 Immun/Screenings/Exams; PBP 7a, 14a-i"	"$35 Specialist, $10 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$50 copay; PBP 7e, 7h, 9c"	$25 copay; included in row i.2.	$20 - $25 copay; PBP 8b	"$0 - $35 copay; PBP 7d, 7g, 8a"	20% coinsurance; PBP 15	$35 copay; PBP 7g			$35 copay; PBP 17a	$100 every two years; PBP 17b	$35 copay; PBP 18a	$350 every three years; PBP 18b		"30% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"												0.543	0.096	0.292	0	0.2328	0.3571	0.0292	0.2996	0.1015	0.0505	0.0662	0.0043	0	0.0328	0	2.3288	0.1816	0	0.1536	1.1546	0.0556	0	0	0	0	0	0.0099	0	0	0.0024											5.9916	400	0.23173321	4.5721	0.259031345	3.344190305	0	0.654549538	2.71895347	0.029197788	1.762347699	1.323277223	1.51803579	1.780583743	0.017176711	0.004076294	1.650428989	3.515403954	14.31940871	0.663977027	0	1.04680489	4.741759915	4.244901038	0	0	0	0.036136795	0	0.02423082	0	0	0.022414803	0	0	0	0	0	0	0	0	0	0	48.249
H2320_018_0	2011	5																															A	A	D		P	Coin		P	P	P	P	P	P	P	P	P	P		P	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	YES	137.7449206	6.181951466	206.0588912	0	71.19707761	7.694187568	0	233.5772838	207.8091685	828.6580341	759.7702393	2.291223347	3.686363194	683.7990735	2749.182551	2957.668858	108.0325919	0	450.4349749	1271.623549	9.550929145	0	0	0	0	0	0	0	0	0.103937318											3400	"$600 copay per admit, unlimited coverage; PBP 1a"	$600 copay per admit; PBP 1b	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	20% coinsurance; PBP 11a	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$75 copay; PBP 9a, 9b"	$10 - $35 copay; PBP 8a	$15 - $35 copay; PBP 8b	$75 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $40 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15 PCP, $0  Physical Exam/Immun/Screenings/Exams; PBP 7a, 14a-i"	"$40 Specialist, $0 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$40 copay; PBP 7e, 7h, 9c"	$30 copay; included in row i.2.	$10 - $35 copay; PBP 8b	"$0 - $40 copay; PBP 7d, 7g, 8a"	0% - 20% coinsurance; PBP 15	$40 copay; PBP 7g								"20% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											0	600	600	120	0	50	0.2	0	49.30596079	75	10	21.04806113	75	10	25.98422994	15	40	40	0	17.84642778	22.39922339	0.2	0	0	0	0	0	0	0	0	0.2											YES	577.6581374	577.6581374	115.5316275	0	48.13817812	0.192552712	0	47.46998245	72.20726718	9.627635624	20.26430631	72.20726718	9.627635624	25.01666979	14.44145344	38.5105425	38.5105425	0	17.18189039	21.56515611	0.192552712	0	0	0	0	0	0	0	0	0.192552712											3400	6.6308	0.297587881	1.983859922	0	0.285608134	1.481536686	0	0.923992464	1.250444346	0.664834801	1.283018071	0.013786915	0.00295758	1.425531302	3.308515983	9.491786021	0.346699477	0	0.644943697	2.285230029	1.839057314	0	0	0	0	0	0	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	34.1802	0	1.321974256	6.6308	0.297587881	1.983859922	0	0.285608134	1.481536686	0	0.923992464	1.250444346	0.664834801	1.283018071	0.013786915	0.00295758	1.425531302	3.308515983	9.491786021	0.346699477	0	0.644943697	2.285230029	1.839057314	0	0	0	0	0	0	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	34.1802	NO	"$700 copay per admit, unlimited coverage; PBP 1a"	$700 copay per admit; PBP 1b	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	30% coinsurance; PBP 11a	"30% coinsurance, $10 Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$100 copay; PBP 9a, 9b"	$20 - $40 copay; PBP 8a	$25 - $40 copay; PBP 8b	$100 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $50 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$45 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams; PBP 7a, 14a-i"	"$45 Specialist, $10 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$50 copay; PBP 7e, 7h, 9c"	$35 copay; included in row i.2.	$25 - $40 copay; PBP 8b	"$0 - $45 copay; PBP 7d, 7g, 8a"	20% coinsurance; PBP 15	$45 copay; PBP 7g								"30% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"												0.4099	0.0887	0.2119	0	0.1297	0.2443	0.0218	0.1742	0.0556	0.0365	0.0458	0.0041	0	0.0304	0	1.8258	0.1045	0	0.1171	0.6476	0.04	0	0	0	0	0	0	0	0	0.0024											4.1905	500	0.162074133	7.0407	0.386283599	2.195748753	0	0.415330017	1.725881584	0.021818655	1.098218931	1.306059471	0.701382543	1.328798248	0.017935035	0.00295758	1.455943278	3.308515983	11.31757827	0.451172079	0	0.762056955	2.932815743	1.879101667	0	0	0	0	0	0	0	0	0.022414803	0	0	0	0	0	0	0	0	0	0	38.3707
H2320_019_0	2011	5																															A	A	D		P	Coin		P	P	P	P	P	P	P	P	P	P		P	P	Coin				P		P			Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	553.199908	27.12355421	284.345795	0	98.24662026	10.29974613	0	296.3897094	252.9906632	1008.562015	966.1053361	3.202777399	5.086904365	947.718016	3443.473612	3903.006875	107.9480869	0	586.8218312	1578.401942	13.14956792	0	0	0	12.30795925	0	3.685926022	0	0	0.078816179											3400	"$75 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$75 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	20% coinsurance; PBP 11a	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$50 copay; PBP 9a, 9b"	$10 - $20 copay; PBP 8a	$15 - $20 copay; PBP 8b	$50 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $40 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$10 PCP, $0 Physical Exams/Immun/Screenings/Exams; PBP 7a, 14a-i"	"$30 Specialist, $0 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$40 copay; PBP 7e, 7h, 9c"	$20 copay; included in row i.2.	$15 - $20 copay; PBP 8b	"$0 - $30 copay; PBP 7d, 7g, 8a"	0% - 20% coinsurance; PBP 15	$30 copay; PBP 7g			$30 copay; PBP 17a	$100 every two years; PBP 17b	$30 copay; PBP 18a	$350 every three years; PBP 18b		"20% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											0	75	75	120	0	50	0.2	0	49.43651531	50	15	16.54166375	50	10	17.36307328	10	30	40	0	15.71037684	19.31480179	0.2	0	0	0	30	0	30	0	0	0.2											YES	72.20726718	72.20726718	115.5316275	0	48.13817812	0.192552712	0	47.59567559	48.13817812	14.44145344	15.92571112	48.13817812	9.627635624	16.71653428	9.627635624	28.88290687	38.5105425	0	15.12537837	18.59558738	0.192552712	0	0	0	28.88290687	0	28.88290687	0	0	0.192552712											3400	3.3288	0.16320981	2.737577706	0	0.394117775	1.983244054	0	1.175572372	1.014875801	1.213758448	1.282159541	0.012847989	0.004081238	1.320213392	2.762709101	9.394182007	0.346428282	0	0.73965852	2.445942603	2.531984971	0	0	0	0.029624137	0	0.008871688	0	0	0.015176269	0	0	0	0	0	0	0	0	0	0	32.905	0	1.272653703	3.3288	0.16320981	2.737577706	0	0.394117775	1.983244054	0	1.175572372	1.014875801	1.213758448	1.282159541	0.012847989	0.004081238	1.320213392	2.762709101	9.394182007	0.346428282	0	0.73965852	2.445942603	2.531984971	0	0	0	0.029624137	0	0.008871688	0	0	0.015176269	0	0	0	0	0	0	0	0	0	0	32.905	NO	"$175 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$175 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	30% coinsurance; PBP 11a	"30% coinsurance, $10 Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$75 copay; PBP 9a, 9b"	$20 - $25 copay; PBP 8a	$20 - $25 copay; PBP 8b	$75 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $50 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35 PCP, $15 Physical Exam, $10 Immun/Screenings/Exams; PBP 7a, 14a-i"	"$35 Specialist, $10 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$50 copay; PBP 7e, 7h, 9c"	$25 copay; included in row i.2.	$20 - $25 copay; PBP 8b	"$0 - $35 copay; PBP 7d, 7g, 8a"	20% coinsurance; PBP 15	$35 copay; PBP 7g			$35 copay; PBP 17a	$100 every two years; PBP 17b	$35 copay; PBP 18a	$350 every three years; PBP 18b		"30% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"												2.2782	0.493	1.4994	0	0.7947	1.7291	0.1305	1.2329	0.2967	0.2285	0.2446	0.0223	0	0.1682	0	9.2025	0.7393	0	0.595	4.1036	0.2834	0	0	0	0	0	0.016	0	0	0.0093											24.0671	400	0.930833876	5.607	0.65619633	4.236964222	0	1.188818196	3.712299057	0.130457429	2.408449127	1.311543228	1.442254243	1.526796696	0.035152631	0.004081238	1.488450383	2.762709101	18.59671538	1.085706564	0	1.334622454	6.549507361	2.815350374	0	0	0	0.029624137	0	0.024906935	0	0	0.024514329	0	0	0	0	0	0	0	0	0	0	56.9721
H2320_021_0	2011	5																															A	A	D		P	Coin		P	P	P	P	P	P	P	P	P	P		P	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	YES	172.8727548	8.476002016	282.5249578	0	97.61748805	10.23379066	0	294.4917478	250.1010632	1015.254551	953.6214548	3.14146978	5.054329856	937.5489855	3314.50351	3818.807259	107.2568304	0	581.3015252	1556.918085	13.06536333	0	0	0	0	0	0	0	0	0.078816179											3400	"$600 copay per admit, unlimited coverage; PBP 1a"	$600 copay per admit; PBP 1b	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	20% coinsurance; PBP 11a	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$75 copay; PBP 9a, 9b"	$10 - $35 copay; PBP 8a	$15 - $35 copay; PBP 8b	$75 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $40 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15 PCP, $0  Physical Exam/Immun/Screenings/Exams; PBP 7a, 14a-i"	"$40 Specialist, $0 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$40 copay; PBP 7e, 7h, 9c"	$30 copay; included in row i.2.	$10 - $35 copay; PBP 8b	"$0 - $40 copay; PBP 7d, 7g, 8a"	0% - 20% coinsurance; PBP 15	$40 copay; PBP 7g								"20% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											0	600	600	120	0	50	0.2	0	49.43651531	75	10	21.07530521	75	10	25.98422735	15	40	40	0	17.78948203	21.36586937	0.2	0	0	0	0	0	0	0	0	0.2											YES	577.6581374	577.6581374	115.5316275	0	48.13817812	0.192552712	0	47.59567559	72.20726718	9.627635624	20.29053593	72.20726718	9.627635624	25.01666729	14.44145344	38.5105425	38.5105425	0	17.12706509	20.57028051	0.192552712	0	0	0	0	0	0	0	0	0.192552712											3400	8.3218	0.408019295	2.720047349	0	0.391594002	1.97054415	0	1.168044474	1.504926191	0.81454174	1.612457532	0.018903079	0.004055104	1.954529254	3.988854009	12.2553616	0.344209894	0	0.829665755	2.668853477	2.515771148	0	0	0	0	0	0	0	0	0.015176269	0	0	0	0	0	0	0	0	0	0	43.5073	0	1.682716487	8.3218	0.408019295	2.720047349	0	0.391594002	1.97054415	0	1.168044474	1.504926191	0.81454174	1.612457532	0.018903079	0.004055104	1.954529254	3.988854009	12.2553616	0.344209894	0	0.829665755	2.668853477	2.515771148	0	0	0	0	0	0	0	0	0.015176269	0	0	0	0	0	0	0	0	0	0	43.5073	NO	"$700 copay per admit, unlimited coverage; PBP 1a"	$700 copay per admit; PBP 1b	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	30% coinsurance; PBP 11a	"30% coinsurance, $10 Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$100 copay; PBP 9a, 9b"	$20 - $40 copay; PBP 8a	$25 - $40 copay; PBP 8b	$100 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $50 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$45 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams; PBP 7a, 14a-i"	"$45 Specialist, $10 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$50 copay; PBP 7e, 7h, 9c"	$35 copay; included in row i.2.	$25 - $40 copay; PBP 8b	"$0 - $45 copay; PBP 7d, 7g, 8a"	20% coinsurance; PBP 15	$45 copay; PBP 7g								"30% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"												2.8798	0.6232	1.4887	0	0.789	1.7167	0.1295	1.2241	0.3907	0.2269	0.3216	0.0291	0	0.2137	0	11.5894	0.734	0	0.7568	4.1126	0.2813	0	0	0	0	0	0	0	0	0.0093											27.5165	500	1.064246515	11.2016	1.03118232	4.208747002	0	1.180630203	3.68727533	0.129527595	2.392133913	1.895669845	1.041408934	1.934102298	0.048047159	0.004055104	2.168199306	3.988854009	23.8447196	1.078218977	0	1.586439197	6.781464174	2.797116867	0	0	0	0	0	0	0	0	0.024507526	0	0	0	0	0	0	0	0	0	0	71.0239
H2320_802_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	179.696862	2.475903964	45.68443125	0	3.287478448	12.93038625	1.767479064	7.168542225	32.56228098	16.11763366	35.15338064	0.052056029	0.080055576	30.06041546	35.22447721	63.68354406	1.524138093	0	17.71380185	72.01100261	45.9853663	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	Medicare-FFS Cost Sharing; included in row i.2.	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.077345137	0.077345137	0.169436349	0	0.233	0.233	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											YES	0.065484559	0.065484559	0.143453938	0	0.197270348	0.197270348	0.197270348	0.197270348	0.197270348	0.197270348	0.197270348	0.197270348	0.197270348	0.197270348	0.197270348	0.197270348	0.197270348	0	0.197270348	0.197270348	0.197270348	0	0	0	0	0	0	0	0	0											6700	11.7674	0.162133478	6.553611573	0	0.648522018	2.550781798	0.34867121	1.414140821	6.423572507	3.179531205	6.93471964	0.010269111	0.015792591	5.930028625	6.948744885	12.56287491	0.300667252	0	3.494407859	14.20563556	9.071549223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.523	0	16.75779182	11.7674	0.162133478	6.553611573	0	0.648522018	2.550781798	0.34867121	1.414140821	6.423572507	3.179531205	6.93471964	0.010269111	0.015792591	5.930028625	6.948744885	12.56287491	0.300667252	0	3.494407859	14.20563556	9.071549223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.523	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	Medicare-FFS Cost Sharing; included in row i.2.	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																				1.0907	0	0.3762	0	0.4951	0.1299	0.0286	0.1561	0.3785	0.1281	0.5808	0	0	0.1825	0	2.1443	0.0448	0	0.5195	2.1524	0.0203	0	0	0	0	0	0	0	0	0											8.4278	0	1.526447485	12.8581	0.162133478	6.929807623	0	1.143596491	2.680698521	0.377265997	1.570197432	6.802022691	3.307651947	7.51550394	0.010269111	0.015792591	6.112541352	6.948744885	14.70722463	0.34543796	0	4.013929164	16.35808032	9.09184244	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.9508
H2320_803_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	168.0357602	1.702748657	23.81883827	0	3.088628843	10.61236587	1.968989392	5.494437542	38.46192574	13.63552642	27.17278006	0.038032222	0.024923135	27.40649646	31.09851696	56.41729989	1.251966912	0	19.11715419	69.88892398	40.29452727	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	Medicare-FFS Cost Sharing; included in row i.2.	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.076900168	0.076900168	0.169464237	0	0.233	0.233	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											YES	0.067309687	0.067309687	0.148329776	0	0.203941779	0.203941779	0.203941779	0.203941779	0.203941779	0.203941779	0.203941779	0.203941779	0.203941779	0.203941779	0.203941779	0.203941779	0.203941779	0	0.203941779	0.203941779	0.203941779	0	0	0	0	0	0	0	0	0											6700	11.3104	0.114611479	3.533042953	0	0.629900461	2.164304775	0.401559199	1.120545367	7.843993558	2.780853515	5.541665103	0.007756359	0.005082868	5.589329643	6.342286871	11.5058445	0.255328359	0	3.898786434	14.25327148	8.217737573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5163	0	12.18461748	11.3104	0.114611479	3.533042953	0	0.629900461	2.164304775	0.401559199	1.120545367	7.843993558	2.780853515	5.541665103	0.007756359	0.005082868	5.589329643	6.342286871	11.5058445	0.255328359	0	3.898786434	14.25327148	8.217737573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5163	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	Medicare-FFS Cost Sharing; included in row i.2.	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																				0.7796	0	0.3209	0	0.1792	0.163	0.0186	0.1591	0.2112	0.0845	0.1621	0	0	0.0878	0	1.6102	0.0609	0	0.1957	1.917	0.0606	0	0	0	0	0	0	0	0	0											6.0103	0	0.856360737	12.09	0.114611479	3.853940297	0	0.809096632	2.327288532	0.420164599	1.27962841	8.055187434	2.86538505	5.703734866	0.007756359	0.005082868	5.677139573	6.342286871	13.11599921	0.316202215	0	4.094469777	16.17029687	8.278298652	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5266
H2320_804_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	216.3163764	1.811947693	38.0059366	0	5.396280697	15.40348383	2.449941845	9.037536441	42.93603203	18.84807369	35.8661178	0.039765213	0.036054372	42.02569983	37.6627661	79.33567706	2.151531498	0	22.54750425	90.06274444	43.0640395	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	Medicare-FFS Cost Sharing; included in row i.2.	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.077835714	0.077835714	0.169425721	0	0.233	0.233	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	0.06480845	0.06480845	0.141069155	0	0.194003089	0.194003089	0.194003089	0.194003089	0.194003089	0.194003089	0.194003089	0.194003089	0.194003089	0.194003089	0.194003089	0.194003089	0.194003089	0	0.194003089	0.194003089	0.194003089	0	0	0	0	0	0	0	0	0												14.0191	0.117429522	5.36146537	0	1.046895124	2.988323446	0.475296286	1.753309987	8.329722844	3.656584518	6.958137645	0.007714574	0.00699466	8.153115586	7.306692965	15.39136642	0.417403757	0	4.374285474	17.47245063	8.354556689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.1909	0	21.3456193	14.0191	0.117429522	5.36146537	0	1.046895124	2.988323446	0.475296286	1.753309987	8.329722844	3.656584518	6.958137645	0.007714574	0.00699466	8.153115586	7.306692965	15.39136642	0.417403757	0	4.374285474	17.47245063	8.354556689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.1909	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.0191	0.117429522	5.36146537	0	1.046895124	2.988323446	0.475296286	1.753309987	8.329722844	3.656584518	6.958137645	0.007714574	0.00699466	8.153115586	7.306692965	15.39136642	0.417403757	0	4.374285474	17.47245063	8.354556689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.1909
H2320_805_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	182.2880569	1.849244588	30.91372556	0	4.293413201	11.92738349	2.021755177	6.668547473	38.09634125	14.72308853	30.14787821	0.040583735	0.03679651	29.05204601	32.00740511	65.95350495	1.590338942	0	19.94072225	78.99260002	41.37148844	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	Medicare-FFS Cost Sharing; included in row i.2.	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.076963064	0.076963064	0.169466903	0	0.233	0.233	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	0.067019078	0.067019078	0.147570991	0	0.202895317	0.202895317	0.202895317	0.202895317	0.202895317	0.202895317	0.202895317	0.202895317	0.202895317	0.202895317	0.202895317	0.202895317	0.202895317	0	0.202895317	0.202895317	0.202895317	0	0	0	0	0	0	0	0	0												12.2168	0.123934667	4.561969131	0	0.871113431	2.420010251	0.410204657	1.353017052	7.729569227	2.987245712	6.1168633	0.00823425	0.00746584	5.894524078	6.4941526	13.38165728	0.322672323	0	4.045879157	16.0272286	8.394081253	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.3666	0	13.85331101	12.2168	0.123934667	4.561969131	0	0.871113431	2.420010251	0.410204657	1.353017052	7.729569227	2.987245712	6.1168633	0.00823425	0.00746584	5.894524078	6.4941526	13.38165728	0.322672323	0	4.045879157	16.0272286	8.394081253	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.3666	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.2168	0.123934667	4.561969131	0	0.871113431	2.420010251	0.410204657	1.353017052	7.729569227	2.987245712	6.1168633	0.00823425	0.00746584	5.894524078	6.4941526	13.38165728	0.322672323	0	4.045879157	16.0272286	8.394081253	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.3666
H2322_001_0	2011	10																															D	D	Coin		T	Coin		V	V		V		V	V	V	V	V	V		V					V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	728.1924459	51.96080769	22.82915382	0	98.55454525	7.848135934	0	264.625152	214.2301723	0	394.2635727	0	0.481854866	736.7670486	3302.931543	4790.321602	248.5315837	75.82338057	0	98.15377747	0	0	0	0	36.2702392	0	0	0	0	0											6700	$75/Days 1-5 for IP Acute; PBP 1a	$75/Days 1-5 for IP Psych; PBP 1b	17% Coinsurance for SNF; PBP 2	No Cost Sharing; PBP 6	$75/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for ER; $35/Visit for Urgent Care; PBP 4a, 4b"	$75/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$75/Case for OP Radiology; $25/Visit for Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	$25/Case for Renal Dialysis; PBP 12	"$15/Visit for Cardiac Rehab; $75/Visit for OP Hospital; PBP 3, 5, 9d, 13a"	"$20/Visit for PCP; $20/Visit for Preventive Care; $20/Visit for Routine Physical Exams; PBP 7a, 14b-i"	"$35/Visit for Physician Specialist; $35/Visit for Chiropractic; $35/Visit for Podiatry; $35/Visit for Routine Eye Exams (Medicare Covered); PBP 7b, 7d, 7f, 17a, 18a"	"$35/Visit for Mental Health; $35/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$15/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	$35/Visit for Other Health Care; PBP 7g	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 13c, 13d, 14j"	PBP 10b	"PBP 16a, 16b"	$35/Exam for Routine Eye Exams (Non Medicare Covered); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	75	75	0.165904628	0	75	0.2	0	47.86906235	75	0	61.65737045	0	25	74.03787831	20	35	35	15	0	35	0	0	0	0	35	0	0	0	0	0											NO	73.84618379	73.84618379	0.163352315	0	73.84618379	0.196923157	0	47.13263435	73.84618379	0	60.70882014	0	24.6153946	72.89886358	19.69231568	34.46155243	34.46155243	14.76923676	0	34.46155243	0	0	0	0	34.46155243	0	0	0	0	0												4.4812	0.319758946	3.729195127	0	0.606489755	1.545479703	0	1.039373377	1.318340056	0	1.99460636	0	0.000988421	4.475790047	5.42019755	13.75682659	0.713732017	0.093321122	0	0.281877629	0	0	0	0	0.104160729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8813	0	0.623129257	4.4812	0.319758946	3.729195127	0	0.606489755	1.545479703	0	1.039373377	1.318340056	0	1.99460636	0	0.000988421	4.475790047	5.42019755	13.75682659	0.713732017	0.093321122	0	0.281877629	0	0	0	0	0.104160729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8813	YES	$200/Days 1-5 for IP Acute; PBP 1a	No Cost Sharing; PBP 1b	$124/Day for SNF; PBP 2	No Cost Sharing; PBP 6	20% Coinsurance for Ambulance; PBP 10a	50% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for ER; $35/Visit for Urgent Care; PBP 4a, 4b"	20% Coinsurance for ASC Services; PBP 9b	20% Coinsurance for OP Diagnostic Procedures/Tests; PBP 8a	20% Coinsurance for OP Radiology; 20% Coinsurance for Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for Renal Dialysis; PBP 12	"20% Coinsurance for OP Hospital; 50% Coinsurance for Partial Hosp; PBP 3, 5, 9d, 13a"	"20% Coinsurance for PCP; 20% Coinsurance for Preventive Care; 20% Coinsurance for Routine Physical Exams; PBP 7a, 14b-i"	"20% Coinsurance for Physician Specialist; 20% Coinsurance for Chiropractic; 20% Coinsurance for Podiatry; 20% Coinsurance for Routine Eye Exams (Medicare Covered); 20% Coinsurance for Hearing Exams (Medicare Covered); PBP 7b, 7d, 7f, 17a, 18a"	"50% Coinsurance for Mental Health; 50% Coinsurance for OP Substance Abuse; PBP 7e, 7h, 9c"	"20% Coinsurance for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	20% Coinsurance for Other Health Care; PBP 7g	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 13c, 13d, 14j"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	20% Coinsurance for Routine Eye Exams (Non Medicare Covered); PBP 17a	20% Coinsurance for Eye Wear (Non Medicare Covered); PBP 17b	20% Coinsurance for Routine Hearing Exams (Non Medicare Covered); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											10000	0.6384	0	1.3191	0	1.1859	0.6764	0	0.1902	0.3037	0.0055	0.0459	0	0.001	0.2409	1.328	1.8085	0.5394	0.0015	0	1.0332	0	0	0	0	0.0032	0.0069	0	0	0	0											9.3277	0	0.103987409	5.1196	0.319758946	5.048289576	0	1.792381319	2.221926176	0	1.229540143	1.622063664	0.005524881	2.04054896	0	0.002022162	4.716735837	6.748209269	15.56531247	1.253131201	0.094784381	0	1.315037141	0	0	0	0	0.107326755	0.006888965	3.75E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2091
H2322_004_0	2011	12																															D	D	Coin		T	Coin		V	V		V		V	V	V	V	V	V		V					V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1417.313885	21.91257955	41.12349852	0	138.111344	13.45498874	0	354.0757642	251.8722063	0	449.4556119	0	0.570395377	851.4560313	4279.066023	6133.983708	305.1140133	102.6312053	0	35.7055723	0	0	0	0	17.81061606	0	0	0	0	0											6700	$75/Days 1-5 for IP Acute; PBP 1a	$75/Days 1-5 for IP Psych; PBP 1b	17% Coinsurance for SNF; PBP 2	No Cost Sharing; PBP 6	$75/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for ER; $35/Visit for Urgent Care; PBP 4a, 4b"	$75/Case for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$75/Case for OP Radiology; $25/Visit for Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	$25/Case for Renal Dialysis; PBP 12	"$15/Visit for Cardiac Rehab; $75/Visit for OP Hospital; PBP 3, 5, 9d, 13a"	"$15/Visit for PCP; $15/Visit for Preventive Care; $15/Visit for Routine Physical Exams; PBP 7a, 14b-i"	"$30/Visit for Physician Specialist; $30/Visit for Chiropractic; $30/Visit for Podiatry; $30/Visit for Routine Eye Exams (Medicare Covered); PBP 7b, 7d, 7f, 17a, 18a"	"$30/Visit for Mental Health; $30/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$15/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	$30/Visit for Other Health Care; PBP 7g	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 13c, 13d, 14j"	PBP 10b	"PBP 16a, 16b"	$30/Exam for Routine Eye Exams (Non Medicare Covered); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	75	75	0.165904628	0	75	0.2	0	48.8648027	75	0	61.65737045	0	25	74.09212295	15	30	30	15	0	30	0	0	0	0	30	0	0	0	0	0											NO	72.66069377	72.66069377	0.160729938	0	72.66069377	0.19376185	0	47.34067286	72.66069377	0	59.73423084	0	24.22023126	71.78113408	14.53213875	29.06427751	29.06427751	14.53213875	0	29.06427751	0	0	0	0	29.06427751	0	0	0	0	0												8.5819	0.132681936	6.609777366	0	0.836272173	2.60706351	0	1.396848744	1.525100771	0	2.237323773	0	0.001151259	5.093206629	5.181998431	14.85665039	0.738993196	0.124287576	0	0.086479722	0	0	0	0	0.043137724	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0529	0	1.611449509	8.5819	0.132681936	6.609777366	0	0.836272173	2.60706351	0	1.396848744	1.525100771	0	2.237323773	0	0.001151259	5.093206629	5.181998431	14.85665039	0.738993196	0.124287576	0	0.086479722	0	0	0	0	0.043137724	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0529	YES	$250/Days 1-5 for IP Acute; PBP 1a	No Cost Sharing; PBP 1b	$124/Day for SNF; PBP 2	No Cost Sharing; PBP 6	20% Coinsurance for Ambulance; PBP 10a	50% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for ER; $35/Visit for Urgent Care; PBP 4a, 4b"	20% Coinsurance for ASC Services; PBP 9b	20% Coinsurance for OP Diagnostic Procedures/Tests; PBP 8a	20% Coinsurance for OP Radiology; 20% Coinsurance for Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for Renal Dialysis; PBP 12	"20% Coinsurance for OP Hospital; 50% Coinsurance for Partial Hosp; PBP 3, 5, 9d, 13a"	"20% Coinsurance for PCP; 20% Coinsurance for Preventive Care; 20% Coinsurance for Routine Physical Exams; PBP 7a, 14b-i"	"20% Coinsurance for Physician Specialist; 20% Coinsurance for Chiropractic; 20% Coinsurance for Podiatry; 20% Coinsurance for Routine Eye Exams (Medicare Covered); 20% Coinsurance for Hearing Exams (Medicare Covered); PBP 7b, 7d, 7f, 17a, 18a"	"50% Coinsurance for Mental Health; 50% Coinsurance for OP Substance Abuse; PBP 7e, 7h, 9c"	"20% Coinsurance for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	20% Coinsurance for Other Health Care; PBP 7g	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 13c, 13d, 14j"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	20% Coinsurance for Routine Eye Exams (Non Medicare Covered); PBP 17a	20% Coinsurance for Eye Wear (Non Medicare Covered); PBP 17b	20% Coinsurance for Routine Hearing Exams (Non Medicare Covered); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											10000	2.2509	0	2.2071	0	2.2552	1.8453	0	0.1821	0.5628	0.0107	0.1233	0	0.0016	0.8564	1.5185	2.2835	0.8152	0.0151	0	1.5252	0	0	0	0	0.0035	0.0002	0.0007	0	0	0											16.4572	0	0.396790242	10.8329	0.132681936	8.816865071	0	3.091513705	4.452318022	0	1.578948038	2.087882159	0.010663203	2.360583589	0	0.00279159	5.9496361	6.700461402	17.14010673	1.554169785	0.139399844	0	1.611691848	0	0	0	0	0.046637564	0.000233812	0.00065161	0	0	0	0	0	0	0	0	0	0	0	0	0	66.5101
H2322_801_0	2011	9																															Coin	Coin	Coin		Coin	Coin		Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	360.2796566	3.206216579	67.29483658	0	18.62118173	31.43668465	0	42.35188195	40.16903574	1.869525873	25.30335859	0	0.009987437	152.3623406	31.19755461	124.028974	2.774430753	0.45669266	0	67.04129153	2.495014629	1.266128067	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 4b"	Medicare-FFS Cost Sharing; PBP 9b	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 13c, 13d, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b											0	0.070505029	0.070505029	0.165773809	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	0.233	0.233	0.233	0	0	0	0	0	0	0	0											YES	0.070009521	0.070009521	0.14499759	0	0.210772362	0.210772362	0	0.210772362	0.210772362	0.210772362	0.210772362	0	0.210772362	0.210772362	0.210772362	0.210772362	0.210772362	0.210772362	0	0.210772362	0.210772362	0.210772362	0	0	0	0	0	0	0	0											6700	25.223	0.224465688	9.757589148	0	3.924830451	6.625984266	0	8.92660618	8.466522529	0.394044383	5.333248648	0	0.002105076	32.11377035	6.575582264	26.14187978	0.584773322	0.09625819	0	14.13045135	0.525880126	0.266864803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.3139	0	13.61193188	25.223	0.224465688	9.757589148	0	3.924830451	6.625984266	0	8.92660618	8.466522529	0.394044383	5.333248648	0	0.002105076	32.11377035	6.575582264	26.14187978	0.584773322	0.09625819	0	14.13045135	0.525880126	0.266864803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.3139	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 4b"	Medicare-FFS Cost Sharing; PBP 9b	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 13c, 13d, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b												0	0	0.2177	0	0.1893	0.1925	0	0.0984	0.0547	0	0.0156	0	0	0.1038	0.1293	0.3118	0	0	0	0.1383	0	0	0	0	0	0	0	0	0	0											1.4515	0	0.459516477	25.223	0.224465688	9.97530526	0	4.11413675	6.818435113	0	9.025001601	8.521241743	0.394044383	5.348862969	0	0.002122723	32.21753691	6.704900596	26.45371655	0.584773322	0.09625819	0	14.26879264	0.525880126	0.266864803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.7653
H2322_803_0	2011	8																															Coin	Coin	Coin		Coin	Coin		Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	323.6909753	3.031861395	63.19733752	0	17.60855533	27.81181848	0	37.22752928	36.76728005	1.734005964	22.56188943	0	0.008848438	141.9421344	25.44257113	104.6382393	2.345796725	0.431857552	0	59.26256334	2.359334858	1.197275578	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 4b"	Medicare-FFS Cost Sharing; PBP 9b	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 13c, 13d, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b											0	0.070505029	0.070505029	0.165773809	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	0.233	0.233	0.233	0	0	0	0	0	0	0	0											YES	0.07003516	0.07003516	0.145596901	0	0.21429145	0.21429145	0	0.21429145	0.21429145	0.21429145	0.21429145	0	0.21429145	0.21429145	0.21429145	0.21429145	0.21429145	0.21429145	0	0.21429145	0.21429145	0.21429145	0	0	0	0	0	0	0	0											6700	22.6697	0.212336899	9.201336465	0	3.773362862	5.959834921	0	7.977541246	7.878913771	0.371582653	4.834820011	0	0.001896145	30.41698586	5.45212547	22.42308007	0.502684183	0.092543381	0	12.69946066	0.505585289	0.25656592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.2304	0	10.43381139	22.6697	0.212336899	9.201336465	0	3.773362862	5.959834921	0	7.977541246	7.878913771	0.371582653	4.834820011	0	0.001896145	30.41698586	5.45212547	22.42308007	0.502684183	0.092543381	0	12.69946066	0.505585289	0.25656592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.2304	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 4b"	Medicare-FFS Cost Sharing; PBP 9b	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 13c, 13d, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b												0	0	0.0053	0	0.0046	0.0047	0	0.0024	0.0013	0	0.0004	0	0	0.0025	0.0032	0.0076	0	0	0	0.0034	0	0	0	0	0	0	0	0	0	0											0.0356	0	0.009401149	22.6697	0.212336899	9.206677198	0	3.778006682	5.964555879	0	7.979954956	7.880256072	0.371582653	4.835203041	0	0.001896577	30.41953133	5.455297742	22.43072965	0.502684183	0.092543381	0	12.70285427	0.505585289	0.25656592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.266
H2323_005_0	2011	7																															Coin	Coin	Coin	Coin	Coin	Coin	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	397.1669075	2.864475476	0	0	71.61832646	24.6231362	2.938776694	54.47169919	112.6150755	29.83872558	62.45768073	17.33303289	0.562152418	5.026767692	0	89.18625508	10.92136103	54.07931635	31.2587536	68.23841176	55.91227304	30.88381886	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	Medicare-FFS Cost Sharing; PBP 10a	Medicare-FFS Cost Sharing; PBP 11a	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 4b"	Medicare-FFS Cost Sharing; PBP 9b	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14c; Medicare-FFS Cost Sharing; PBP 14b, 14d-j"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"5% Coinsurance for Occ Therapy; 5% Coinsurance for PT/ST; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7g, 18a"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 16b, 17a"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											0	0.072749987	0.072749987	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.207759773	0	0.233	0.233	0.05	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.067887954	0.067887954	0	0	0.217428125	0.217428125	0.217428125	0.217428125	0.217428125	0.217428125	0.217428125	0.217428125	0.217428125	0.193874754	0	0.217428125	0.217428125	0.046658396	0.217428125	0.217428125	0.217428125	0.217428125	0	0	0	0	0	0	0	0												26.9628	0.194463379	0	0	15.57183842	5.353762328	0.638972706	11.8436794	24.48568468	6.487778146	13.58005639	3.768688836	0.122227746	0.974563351	0	19.39160019	2.374611048	2.52325415	6.796532176	14.8369499	12.15690067	6.715010817	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	174.7794	0	12.51743943	26.9628	0.194463379	0	0	15.57183842	5.353762328	0.638972706	11.8436794	24.48568468	6.487778146	13.58005639	3.768688836	0.122227746	0.974563351	0	19.39160019	2.374611048	2.52325415	6.796532176	14.8369499	12.15690067	6.715010817	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	174.7794	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	26.9628	0.194463379	0	0	15.57183842	5.353762328	0.638972706	11.8436794	24.48568468	6.487778146	13.58005639	3.768688836	0.122227746	0.974563351	0	19.39160019	2.374611048	2.52325415	6.796532176	14.8369499	12.15690067	6.715010817	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	174.7794
H2323_006_0	2011	6																															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	1652.154191	37.29606017	0	0	591.8797365	30.17716923	0	671.193955	1932.285393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											750	$75/Days 1-10 for IP Medical; $75/Days 1-10 for IP Surgical; PBP 1a	$75/Days 1-10 for IP Psych; $75/Days 1-10 for IP Substance Abuse; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME / Medical Supplies; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"$50/Visit for ER - Facility; $20/Visit for PCP Urgent Care; PBP 4a, 4b"	$50/Visit for OP Fac - Surgery; $50/Visit for Prof - Primary Surgeon (OP); $50/Visit for Prof - Anesthesia (OP); PBP 9b	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14b-j"	"No Cost-Sharing; PBP 7b, 7d, 7f"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	No Cost-Sharing; PBP 7d	"No Cost-Sharing; PBP 7g, 18a"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 13a, 16b, 17a"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	75	75	0	0	50	0.2	0	48.16870234	50	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	61.29159316	61.29159316	0	0	40.8610621	0.163444248	0	39.36448676	40.8610621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												8.4386	0.190494579	0	0	2.015402889	4.932284744	0	2.201767129	6.579602789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.3581	0	5.447915438	8.4386	0.190494579	0	0	2.015402889	4.932284744	0	2.201767129	6.579602789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.3581	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.4386	0.190494579	0	0	2.015402889	4.932284744	0	2.201767129	6.579602789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.3581
H2323_007_0	2011	6																															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	1653.371882	37.32793927	0	0	591.8797365	0	0	1677.984888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											500	$65/Days 1-10 for IP Medical; $65/Days 1-10 for IP Surgical; PBP 1a	$65/Days 1-10 for IP Psych; $65/Days 1-10 for IP Substance Abuse; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"$50/Visit for ER - Facility; $20/Visit for PCP Urgent Care; PBP 4a, 4b"	No Cost-Sharing; PBP 9b	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14b-j"	"No Cost-Sharing; PBP 7b, 7d, 7f"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	No Cost-Sharing; PBP 7d	"No Cost-Sharing; PBP 7g, 18a"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 13a, 16b, 17a"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	65	65	0	0	50	0	0	48.16870234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	53.84312043	53.84312043	0	0	41.41778495	0	0	39.9008191	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												7.4186	0.167487727	0	0	2.042862303	0	0	5.579414287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.2083	0	3.151329718	7.4186	0.167487727	0	0	2.042862303	0	0	5.579414287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.2083	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.4186	0.167487727	0	0	2.042862303	0	0	5.579414287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.2083
H2354_001_0	2011	5																															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	YES	295.9568216	2.230105557	858.9657927		2648.232502	14.08103777	2.202246203	87.16882188	83.34351661					0.203622703	3762.349359	5093.992082	258.2566677	1063.818888							23.06373306		40.40861978														6700	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: $0, $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		36.52598623	0.2	0.2	48.54340322	165.2805532					35	15.00425846	35	35	25.23136422							35		35														NO	386.1968553	386.1968553	29.93025628		36.52497783	0.193098428	0.193098428	46.86827417	159.5770747					33.79222484	14.48649359	33.79222484	33.79222484	25.07001665							33.79222484		33.79222484															9.5248	0.071771646	2.142422193	0	8.060552784	2.719026252	0.425250279	0.340454354	1.108309548	0	0	0	0	0.000573405	4.541937488	14.34477715	0.727255615	2.222496437	0	0	0	0	0	0	0.064947904	0	0.11379143	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4084	0	1.305688959	9.5248	0.071771646	2.142422193	0	8.060552784	2.719026252	0.425250279	0.340454354	1.108309548	0	0	0	0	0.000573405	4.541937488	14.34477715	0.727255615	2.222496437	0	0	0	0	0	0	0.064947904	0	0.11379143	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4084	NO																																																																																		0	0	0	9.5248	0.071771646	2.142422193	0	8.060552784	2.719026252	0.425250279	0.340454354	1.108309548	0	0	0	0	0.000573405	4.541937488	14.34477715	0.727255615	2.222496437	0	0	0	0	0	0	0.064947904	0	0.11379143	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4084
H2354_013_0	2011	9																															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	YES	352.7831692	4.948724827	1260.772911		2814.298521	16.19469095	4.94545395	147.5373329	180.4556816					0.50603914	4244.81328	6082.792534	387.1466043	781.7307806							49.17456178		84.91875374														6700	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: $0, 4B Urgent Care: $25"	"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	15.5		25	0.2	0.2	46.41778734	80.08904723					25	10.00696382	25	25	25							25		25														NO	292.3852774	292.3852774	15.10657266		24.36543978	0.194923518	0.194923518	45.23959209	78.0561943					24.36543978	9.752962972	24.36543978	24.36543978	24.36543978							24.36543978		24.36543978															8.5957	0.120577857	1.587163133	0	5.714301761	3.156726137	0.963985283	0.55621073	1.173806978	0	0	0	0	0.001027489	3.449958895	12.35082627	0.786083106	1.587267855	0	0	0	0	0	0	0.099846652	0	0.172423565	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3159	0	1.049965895	8.5957	0.120577857	1.587163133	0	5.714301761	3.156726137	0.963985283	0.55621073	1.173806978	0	0	0	0	0.001027489	3.449958895	12.35082627	0.786083106	1.587267855	0	0	0	0	0	0	0.099846652	0	0.172423565	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3159	NO																																																																																		0	0	0	8.5957	0.120577857	1.587163133	0	5.714301761	3.156726137	0.963985283	0.55621073	1.173806978	0	0	0	0	0.001027489	3.449958895	12.35082627	0.786083106	1.587267855	0	0	0	0	0	0	0.099846652	0	0.172423565	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3159
H2354_801_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	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	274.81806	1.969097805	16.24332975		7.675014329	24.85339898	0.501489664	4.685690562	4.349184645	18.38155538	63.65104234	0.177131409	0.226168691	28.78973715	41.40499527	72.75049569	3.709866973	12.92259929	42.69597421	76.45425804	28.1005543	0.432394786																			6700	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																				0.069477565	0.069477565	0.162653016		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.057926526	0.057926526	0.135611029		0.194262428	0.194262428	0.194262428	0.194262428	0.194262428	0.194262428	0.194262428	0.194262428	0.194262428	0.194262428	0.194262428	0.194262428	0.194262428	0.194262428	0.194262428	0.194262428	0.194262428	0.194262428																				15.9193	0.114062995	2.202774662	0	1.490966918	4.828081629	0.0974206	0.910253625	0.844883169	3.570845578	12.36500603	0.034409978	0.043936079	5.592764239	8.043434911	14.13268793	0.720687766	2.510375513	8.294223615	14.8521898	5.458881907	0.083998061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1111	0	20.36182549	15.9193	0.114062995	2.202774662	0	1.490966918	4.828081629	0.0974206	0.910253625	0.844883169	3.570845578	12.36500603	0.034409978	0.043936079	5.592764239	8.043434911	14.13268793	0.720687766	2.510375513	8.294223615	14.8521898	5.458881907	0.083998061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1111	NO																																																																																		0	0	0	15.9193	0.114062995	2.202774662	0	1.490966918	4.828081629	0.0974206	0.910253625	0.844883169	3.570845578	12.36500603	0.034409978	0.043936079	5.592764239	8.043434911	14.13268793	0.720687766	2.510375513	8.294223615	14.8521898	5.458881907	0.083998061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.1111
H2354_802_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	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	274.81806	1.969097805	16.24332975		7.675014329	24.85339898	0.501489664	4.685690562	4.349184645	18.38155538	63.65104234	0.177131409	0.226168691	28.78973715	41.40499527	72.75049569	3.709866973	12.92259929	42.69597421	76.45425804	28.1005543	0.432394786																			6700	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																				0.069477565	0.069477565	0.162653016		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.058403164	0.058403164	0.13672688		0.195860882	0.195860882	0.195860882	0.195860882	0.195860882	0.195860882	0.195860882	0.195860882	0.195860882	0.195860882	0.195860882	0.195860882	0.195860882	0.195860882	0.195860882	0.195860882	0.195860882	0.195860882																				16.0502	0.115001542	2.2208998	0	1.503235074	4.867808637	0.098222208	0.917743485	0.851835139	3.600227644	12.46674927	0.034693114	0.044297599	5.638783301	8.109618879	14.24897623	0.726617816	2.53103169	8.362471154	14.97439839	5.503799342	0.084689224	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9513	0	19.52162219	16.0502	0.115001542	2.2208998	0	1.503235074	4.867808637	0.098222208	0.917743485	0.851835139	3.600227644	12.46674927	0.034693114	0.044297599	5.638783301	8.109618879	14.24897623	0.726617816	2.53103169	8.362471154	14.97439839	5.503799342	0.084689224	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9513	NO																																																																																		0	0	0	16.0502	0.115001542	2.2208998	0	1.503235074	4.867808637	0.098222208	0.917743485	0.851835139	3.600227644	12.46674927	0.034693114	0.044297599	5.638783301	8.109618879	14.24897623	0.726617816	2.53103169	8.362471154	14.97439839	5.503799342	0.084689224	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9513
H2406_001_0	2011	4																															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	YES	597.3671038	44.908578	6666.017564	99.31668193	34.92908638	18.79750131	10.11920764	20.41888586	7.601223739	37.98421956	16.7925095	0	0.381253943	3.391796308	5.098941036	171.2419737	19.818351	346.4278707	0	0	10.3232554	11.6354402	783.6679236	134.3234157	69.3585725	18.54770012	0	0	0	0											3300	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.07824765	0.079197757	0	0	0.2	0.2	0.094121808	0.066933348	0.2	0	0.10136042	0	0.2	0.162148621	0.025693	0.030059765	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.067603163	0.068424021	0	0	0.172792826	0.172792826	0.081317866	0.057828011	0.172792826	0	0.087571767	0	0.172792826	0.140090592	0.022237801	0.026017323	0.173103967	0	0	0	0.172792826	0.175674196	0	0	0	0	0	0	0	0												40.3839	3.072825478	0	0	6.035495541	3.248073372	0.822872371	1.180783565	1.31343693	0	1.470549726	0	0.065877946	0.475158752	0.113389236	4.455257685	3.430635183	0	0	0	1.783784472	2.044046608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8961	0	10.9500746	40.3839	3.072825478	0	0	6.035495541	3.248073372	0.822872371	1.180783565	1.31343693	0	1.470549726	0	0.065877946	0.475158752	0.113389236	4.455257685	3.430635183	0	0	0	1.783784472	2.044046608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8961	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.5452	0.1176	0	0.0089	0.4765	0.2564	0.138	0.0621	0.1037	0	0.1663	0	0.0035	0.0375	0.0954	4.1306	0.478	0.0598	0	0	0.2486	0.2848	0	0	0.0054	0	0	0	0	0											8.2183	0	1.277764426	41.9291	3.190399418	0	0.008895525	6.511982031	3.504500217	0.960913935	1.242930068	1.417129319	0	1.636803992	0	0.069345206	0.512671285	0.208740921	8.585865933	3.908674512	0.059833996	0	0	2.032344603	2.328872774	0	0	0.005375943	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.1144
H2410_016_0	2011	9																															A	A	D		Coin	Coin	Coin	V	Coin	Coin	Coin			V	V	V	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	YES	134.1875346	6.199519269	353.7969362	0	5.842556065	6.035353401	0.729022108	223.7116041	18.77591781	3.320366512	10.8376909	0	0	208.6836821	2661.654105	2024.323454	229.1191884	331.0896561	0	976.6967374	16.58640195	0	0	0	0	0	0	0	0	0											3350	$670/Admit for Inpatient Facility; PBP 1a	$670/Admit for Inpatient Psychiatric; $670/Admit for Inpatient Psychiatric; PBP 1b	$48/Day for Skilled Nursing Facility; PBP 2	No Cost Sharing; PBP 6	20% Coinsurance for Ambulance; PBP 10a	20% Coinsurance for DME/Supplies; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for OP Facility - Emergency; $15/Visit for PCP Urgent Care; $30/Visit for SPC Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Facility - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Facility - Pathology/Lab; PBP 8a	20% Coinsurance for OP Facility - Radiology; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$30/Case for OP Facility - Other; $30/Case for Partial Hospitalization; $30/Visit for Professional - Substance Abuse; $30/Visit for Cardiac Rehab Services; PBP 3, 5, 9c, 9d"	"$15/Visit for PCP Office Visits; PBP 7a, 14b-c"	"$30/Visit for SCP Office Visits; $30/Exam for Medicare-Covered Vision Exams; $30/Exam for Medicare-Covered Hearing Exams; $30/Consult for Consults; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for Professional - Psychiatric Services; PBP 7e, 7h"	"$30/Visit for Professional - Physical Therapy; PBP 7c, 7i"	$15 Copay for Radiology Services performed in Physician Setting; $30 Copay for Radiology Services performed in Specialty Physician Setting; Separate Office Visit cost share does not apply; PBP 8b	"$30/Visit for Professional - Chiropractic Services; 20% Coinsurance for Medicare-Covered Glasses; PBP 7b, 7d, 7g,14d-j, 17b"	20% Coinsurance for Part B Rx; PBP 15	No Cost Sharing; PBP 13a	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b											0	670	670	48	0	0.2	0.2	0.2	40.05509102	0.2	0.2	0.2	0	0	30	15.05099138	30	30	30	0	30.10065281	0.2	0	0	0	0	0	0	0	0	0											NO	629.4592045	629.4592045	45.0955848	0	0.18789827	0.18789827	0.18789827	37.63141154	0.18789827	0.18789827	0.18789827	0	0	28.1847405	14.14027621	28.1847405	28.1847405	28.1847405	0	28.27930294	0.18789827	0	0	0	0	0	0	0	0	0												7.0388	0.325195372	1.329556645	0	1.097806177	1.134032463	0.136981993	0.70154862	3.527962473	0.623891123	2.036383371	0	0	0.490141286	3.136377018	4.754585937	0.538138739	0.77763967	0	2.30169191	3.116556231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0673	0	2.129723612	7.0388	0.325195372	1.329556645	0	1.097806177	1.134032463	0.136981993	0.70154862	3.527962473	0.623891123	2.036383371	0	0	0.490141286	3.136377018	4.754585937	0.538138739	0.77763967	0	2.30169191	3.116556231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0673	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.0388	0.325195372	1.329556645	0	1.097806177	1.134032463	0.136981993	0.70154862	3.527962473	0.623891123	2.036383371	0	0	0.490141286	3.136377018	4.754585937	0.538138739	0.77763967	0	2.30169191	3.116556231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0673
H2410_017_0	2011	4																															A	A	D		Coin	Coin	Coin	V	Coin	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	0	0	0	0	0	0	0											0	YES	161.6331768	4.817355946	545.7698331	0	9.119872661	8.355035326	0.430707347	245.9199259	18.52617394	3.544242501	11.5472054	0	0	239.7244331	2720.102423	2127.58484	165.5923617	321.5045917	0	989.8659521	27.50025188	0	0	0	0	0	9.209121958	0	0	0											3350	$550/Admit for Inpatient Facility; PBP 1a	$550/Admit for Inpatient Psychiatric; $550/Admit for Inpatient Psychiatric; PBP 1b	$48/Day for Skilled Nursing Facility; PBP 2	No Cost Sharing; PBP 6	20% Coinsurance for Ambulance; PBP 10a	20% Coinsurance for DME/Supplies; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for OP Facility - Emergency; $15/Visit for PCP Urgent Care; $30/Visit for SPC Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Facility - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Facility - Pathology/Lab; PBP 8a	20% Coinsurance for OP Facility - Radiology; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$30/Case for OP Facility - Other; $30/Case for Partial Hospitalization; $30/Visit for Professional - Substance Abuse; $30/Visit for Cardiac Rehab Services; PBP 3, 5, 9c, 9d"	"$15/Visit for PCP Office Visits; PBP 7a, 14b-c"	"$30/Visit for SCP Office Visits; $30/Exam for Medicare-Covered Vision Exams; $30/Exam for Medicare-Covered Hearing Exams; $30/Consult for Consults; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for Professional - Psychiatric Services; PBP 7e, 7h"	"$30/Visit for Professional - Physical Therapy; PBP 7c, 7i"	$15 Copay for Radiology Services performed in Physician Setting; $30 Copay for Radiology Services performed in Specialty Physician Setting; Separate Office Visit cost share does not apply; PBP 8b	"$30/Visit for Professional - Chiropractic Services; 20% Coinsurance for Medicare-Covered Glasses; PBP 7b, 7d, 7g,14d-j, 17b"	20% Coinsurance for Part B Rx; PBP 15	No Cost Sharing; PBP 13a	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	$30/Exam for Hearing Exams (Non-Covered) - Limit 1 per year; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	PBP 13b											0	550	550	48	0	0.2	0.2	0.2	42.22281154	0.2	0.2	0.2	0	0	30	15.06112961	30	30	30	0	29.98142396	0.2	0	0	0	0	0	30	0	0	0											NO	507.6428452	507.6428452	44.30337558	0	0.184597398	0.184597398	0.184597398	38.97110578	0.184597398	0.184597398	0.184597398	0	0	27.68960974	13.90122671	27.68960974	27.68960974	27.68960974	0	27.67246429	0.184597398	0	0	0	0	0	27.68960974	0	0	0												6.8377	0.203791357	2.014953825	0	1.683504766	1.542317784	0.079507456	0.79864762	3.419883509	0.654257944	2.131584075	0	0	0.553156333	3.151063371	4.909332826	0.382098989	0.741861389	0	2.282669185	5.076474948	0	0	0	0	0	0.021249749	0	0	0	0	0	0	0	0	0	0	0	0	0	36.484	0	3.044185712	6.8377	0.203791357	2.014953825	0	1.683504766	1.542317784	0.079507456	0.79864762	3.419883509	0.654257944	2.131584075	0	0	0.553156333	3.151063371	4.909332826	0.382098989	0.741861389	0	2.282669185	5.076474948	0	0	0	0	0	0.021249749	0	0	0	0	0	0	0	0	0	0	0	0	0	36.484	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.8377	0.203791357	2.014953825	0	1.683504766	1.542317784	0.079507456	0.79864762	3.419883509	0.654257944	2.131584075	0	0	0.553156333	3.151063371	4.909332826	0.382098989	0.741861389	0	2.282669185	5.076474948	0	0	0	0	0	0.021249749	0	0	0	0	0	0	0	0	0	0	0	0	0	36.484
H2410_018_0	2011	6																															A	A	D		Coin	Coin	Coin	V	Coin	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	0	0	0	0	0	0	0											0	YES	134.0173817	6.191672366	352.4563007	0	5.795926998	5.98718563	0.723203829	222.8865601	18.58929919	3.287364546	10.72997234	0	0	207.9140608	2651.837977	2016.857789	228.2742014	329.868604	0	973.0946991	16.43124328	0	0	0	0	0	9.72916046	0	0	0											3350	$550/Admit for Inpatient Facility; PBP 1a	$550/Admit for Inpatient Psychiatric; $550/Admit for Inpatient Psychiatric; PBP 1b	$48/Day for Skilled Nursing Facility; PBP 2	No Cost Sharing; PBP 6	20% Coinsurance for Ambulance; PBP 10a	20% Coinsurance for DME/Supplies; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for OP Facility - Emergency; $15/Visit for PCP Urgent Care; $30/Visit for SPC Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Facility - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Facility - Pathology/Lab; PBP 8a	20% Coinsurance for OP Facility - Radiology; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$30/Case for OP Facility - Other; $30/Case for Partial Hospitalization; $30/Visit for Professional - Substance Abuse; $30/Visit for Cardiac Rehab Services; PBP 3, 5, 9c, 9d"	"$15/Visit for PCP Office Visits; PBP 7a, 14b-c"	"$30/Visit for SCP Office Visits; $30/Exam for Medicare-Covered Vision Exams; $30/Exam for Medicare-Covered Hearing Exams; $30/Consult for Consults; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for Professional - Psychiatric Services; PBP 7e, 7h"	"$30/Visit for Professional - Physical Therapy; PBP 7c, 7i"	$15 Copay for Radiology Services performed in Physician Setting; $30 Copay for Radiology Services performed in Specialty Physician Setting; Separate Office Visit cost share does not apply; PBP 8b	"$30/Visit for Professional - Chiropractic Services; 20% Coinsurance for Medicare-Covered Glasses; PBP 7b, 7d, 7g,14d-j, 17b"	20% Coinsurance for Part B Rx; PBP 15	No Cost Sharing; PBP 13a	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	$30/Exam for Hearing Exams (Non-Covered) - Limit 1 per year; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	PBP 13b											0	550	550	48	0	0.2	0.2	0.2	40.05509102	0.2	0.2	0.2	0	0	30	15.05099138	30	30	30	0	30.09682622	0.2	0	0	0	0	0	30	0	0	0											NO	519.263991	519.263991	45.31758467	0	0.188823269	0.188823269	0.188823269	37.81666622	0.188823269	0.188823269	0.188823269	0	0	28.32349042	14.209887	28.32349042	28.32349042	28.32349042	0	28.41490563	0.188823269	0	0	0	0	0	28.32349042	0	0	0												5.7992	0.267926042	1.33103902	0	1.094405885	1.130519965	0.136557712	0.702402221	3.510092249	0.620730921	2.026068458	0	0	0.490737659	3.140193167	4.760371022	0.538793513	0.778585854	0	2.304199504	3.102601077	0	0	0	0	0	0.022963649	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7574	0	1.879767094	5.7992	0.267926042	1.33103902	0	1.094405885	1.130519965	0.136557712	0.702402221	3.510092249	0.620730921	2.026068458	0	0	0.490737659	3.140193167	4.760371022	0.538793513	0.778585854	0	2.304199504	3.102601077	0	0	0	0	0	0.022963649	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7574	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.7992	0.267926042	1.33103902	0	1.094405885	1.130519965	0.136557712	0.702402221	3.510092249	0.620730921	2.026068458	0	0	0.490737659	3.140193167	4.760371022	0.538793513	0.778585854	0	2.304199504	3.102601077	0	0	0	0	0	0.022963649	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7574
H2411_801_0	2011	4																															A	A	D		T			V	V		V	V			V	V	V	V		V	S				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	30.63559044	0.162672158	257.3097077	0	52.2980853	0	0	657.7431664	658.3475813	0	482.180213	52.21337788	0	0	4860.463149	3609.762325	251.1676362	498.9429739	0	43.73188001	105.2448639	0	0	0	119.1034791	0	0	0	578.2575774	0											3400	$450/Admit for IP Acute; PBP 1a	$450/Admit for IP Psych; PBP 1b	$100/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$50/Trip for Ambulance; PBP 10a, 10b"	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$225/Visit for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$75/Visit for OP X-Ray; PBP 8b	$225/Visit for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"$25/Visit for Bone Mass Measurement; $25/Visit for Colorectal Screening; $25/Visit for Diabetes Monitoring; $25/Visit for Mammography; $25/Visit for PCP; $25/Visit for Pelvic Exams & Pap Smears; $25/Visit for Prostate Screening; $25/Visit for Nutritional Therapy; PBP 7a, 14b-j"	"$35/Visit for Chiropractic; $35/Visit for Podiatry; $35/Visit for Physician Specialist; $30/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$35/Visit for Mental Health; $35/Visit for Psychiatric; $35/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$35/Visit for Occupational Therapy; $35/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$35/Visit for Medicare Covered Hearing Exams; $25/Visit for Other Health Care; PBP 7g, 18a-b"	$10-50/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a		"PBP 16a, 16b"	$35/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			$25/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											0	450	450	100	0	50	0	0	47.27904302	225	0	75	225	0	0	25	33.73608521	35	35	0	35	11.66304348	0	0	0	35	0	0	0	25	0											NO	428.9910477	428.9910477	95.33134394	0	47.66567197	0	0	45.07174711	214.4955239	0	71.49850795	214.4955239	0	0	23.83283598	32.16106342	33.36597038	33.36597038	0	33.36597038	11.11853609	0	0	0	33.36597038	0	0	0	23.83283598	0												1.0952	0.005815408	2.044140021	0	0.207735282	0	0	2.470469472	11.76771744	0	2.872930483	0.933294653	0	0	9.65321842	9.674482924	0.698370993	1.387309707	0	0.121596384	0.097514068	0	0	0	0.33116693	0	0	0	1.148459833	0	0	0	0	0	0	0	0	0	0	0	44.5094	0	2.179757172	1.0952	0.005815408	2.044140021	0	0.207735282	0	0	2.470469472	11.76771744	0	2.872930483	0.933294653	0	0	9.65321842	9.674482924	0.698370993	1.387309707	0	0.121596384	0.097514068	0	0	0	0.33116693	0	0	0	1.148459833	0	0	0	0	0	0	0	0	0	0	0	44.5094	YES	7% Coinsurance for IP Acute; PBP 1a	7% Coinsurance for IP Psych; PBP 1b	15% Coinsurance for SNF; 15% Coinsurance for SNF; PBP 2	No Cost Sharing; PBP 6	"No Cost Sharing; PBP 10a, 10b"	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics / Medical Supplies; PBP 11b, 11c"	"No Cost Sharing; PBP 4a, 4b"	20% Coinsurance for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	20% Coinsurance for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"20% Coinsurance for Bone Mass Measurement; 20% Coinsurance for Colorectal Screening; 20% Coinsurance for Diabetes Monitoring; 20% Coinsurance for Immunizations; 20% Coinsurance for Mammography; 20% Coinsurance for PCP; 20% Coinsurance for Pelvic Exams & Pap Smears; 20% Coinsurance for Prostate Screening; PBP 7a, 14b-j"	"20% Coinsurance for Chiropractic; 20% Coinsurance for Podiatry; 20% Coinsurance for Physician Specialist; 20% Coinsurance for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"20% Coinsurance for Mental Health; 20% Coinsurance for Psychiatric; 20% Coinsurance for OP Substance Abuse; PBP 7e, 7h, 9c"	"20% Coinsurance for Occupational Therapy; 20% Coinsurance for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"20% Coinsurance for Non-Medicare Covered Routine Hearing Exams; PBP 7g, 18a-b"	$12/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing;	"No Cost Sharing; PBP 16a, 16b"	20% Coinsurance for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing;	No Cost Sharing;	$25/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											5100	0.1096	0.0019	0.0923	0.0128	0.0075	0.0194	0.012	0.0094	0.0884	0.0248	0.0148	0.0248	0.0002	0.0004	0.0963	0.079	0.0081	0.0059	0	0.0005	0.0026	0.0007	0	0	0.0007	0.0005	0	0	0.0253	0.0004											0.6384	500	0.016160089	1.2048	0.007758167	2.136483654	0.012818435	0.215226742	0.019399835	0.01201541	2.479855892	11.85614545	0.024823694	2.887766618	0.958050103	0.00016344	0.000383795	9.749541519	9.753440496	0.706442059	1.393249067	0	0.12212484	0.100068857	0.000728717	0	0	0.331884811	0.000547514	0	0	1.17374742	0.000369189	0	0	0	0	0	0	0	0	0	0	45.1478
H2411_803_0	2011	4																															A	A	D		T			V	V		V	V			V	V	V	V		V	S				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	69.38771243	0.169019055	344.4920462	0	111.4703883	0	0	906.2474203	850.1428521	0	912.97983	71.0973039	0	0	5710.086631	4604.667236	396.6982633	695.2869221	0	57.47828159	184.4259488	0	0	0	152.0579385	0	0	0	398.0947957	0											3400	$450/Admit for IP Acute; PBP 1a	$450/Admit for IP Psych; PBP 1b	$100/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$50/Trip for Ambulance; PBP 10a, 10b"	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$225/Visit for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$75/Visit for OP X-Ray; PBP 8b	$225/Visit for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"$25/Visit for Bone Mass Measurement; $25/Visit for Colorectal Screening; $25/Visit for Diabetes Monitoring; $25/Visit for Mammography; $25/Visit for PCP; $25/Visit for Pelvic Exams & Pap Smears; $25/Visit for Prostate Screening; $25/Visit for Nutritional Therapy; PBP 7a, 14b-j"	"$35/Visit for Chiropractic; $35/Visit for Podiatry; $35/Visit for Physician Specialist; $30/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$35/Visit for Mental Health; $35/Visit for Psychiatric; $35/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$35/Visit for Occupational Therapy; $35/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$35/Visit for Medicare Covered Hearing Exams; $25/Visit for Other Health Care; PBP 7g, 18a-b"	$10-50/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a		"PBP 16a, 16b"	$35/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			$25/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											0	450	450	100	0	50	0	0	47.12719282	225	0	75	225	0	0	25	33.77557091	35	34.85233661	0	35	11.66304348	0	0	0	35	0	0	0	25	0											NO	412.9615071	412.9615071	91.76922379	0	45.8846119	0	0	43.24825905	206.4807535	0	68.82691784	206.4807535	0	0	22.94230595	30.99557925	32.11922833	31.98371878	0	32.11922833	10.70308447	0	0	0	32.11922833	0	0	0	22.94230595	0												2.3879	0.00581653	2.63448064	0	0.426231292	0	0	3.266135266	14.62817806	0	5.236465646	1.223352074	0	0	10.91687954	11.89369402	1.061803508	1.853155116	0	0.153846504	0.164493876	0	0	0	0.406998637	0	0	0	0.76110105	0	0	0	0	0	0	0	0	0	0	0	57.0205	0	5.11416551	2.3879	0.00581653	2.63448064	0	0.426231292	0	0	3.266135266	14.62817806	0	5.236465646	1.223352074	0	0	10.91687954	11.89369402	1.061803508	1.853155116	0	0.153846504	0.164493876	0	0	0	0.406998637	0	0	0	0.76110105	0	0	0	0	0	0	0	0	0	0	0	57.0205	YES	7% Coinsurance for IP Acute; PBP 1a	7% Coinsurance for IP Psych; PBP 1b	15% Coinsurance for SNF; 15% Coinsurance for SNF; PBP 2	No Cost Sharing; PBP 6	"No Cost Sharing; PBP 10a, 10b"	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics / Medical Supplies; PBP 11b, 11c"	"No Cost Sharing; PBP 4a, 4b"	20% Coinsurance for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	20% Coinsurance for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"20% Coinsurance for Bone Mass Measurement; 20% Coinsurance for Colorectal Screening; 20% Coinsurance for Diabetes Monitoring; 20% Coinsurance for Immunizations; 20% Coinsurance for Mammography; 20% Coinsurance for PCP; 20% Coinsurance for Pelvic Exams & Pap Smears; 20% Coinsurance for Prostate Screening; PBP 7a, 14b-j"	"20% Coinsurance for Chiropractic; 20% Coinsurance for Podiatry; 20% Coinsurance for Physician Specialist; 20% Coinsurance for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"20% Coinsurance for Mental Health; 20% Coinsurance for Psychiatric; 20% Coinsurance for OP Substance Abuse; PBP 7e, 7h, 9c"	"20% Coinsurance for Occupational Therapy; 20% Coinsurance for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"20% Coinsurance for Non-Medicare Covered Routine Hearing Exams; PBP 7g, 18a-b"	$12/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing;	"No Cost Sharing; PBP 16a, 16b"	20% Coinsurance for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing;	No Cost Sharing;	$25/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											5100	0.0998	0.0018	0.0905	0.0117	0.0068	0.0191	0.0118	0.0086	0.0871	0.0226	0.0135	0.0228	0.0001	0.0003	0.0947	0.0778	0.0079	0.0058	0	0.0005	0.0024	0.0007	0	0	0.0007	0.0005	0	0	0.0253	0.0003											0.6134	500	0.029811969	2.4877	0.007591512	2.724943946	0.011678895	0.433056772	0.019107698	0.011834474	3.274687247	14.71527445	0.022616904	5.24998287	1.246185558	0.000148911	0.000349676	11.01157175	11.97146259	1.069753034	1.859005036	0	0.154328675	0.166923297	0.000663935	0	0	0.407705708	0.000498841	0	0	0.786434378	0.000336369	0	0	0	0	0	0	0	0	0	0	57.6339
H2416_001_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin		Coin	Coin	Coin	Coin		Coin																																																												0	YES	369.0289329	16.88782514	145.317859		22.11047781	36.99287818	6.300622211	46.68901762	46.79129382	44.06279893	56.90680608			78.01139326		138.2144134	4.763877962	1.162917897	15.54909479		6.049830174																				6700	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																				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																					30.033	1.374395207	19.98945815	0	5.151741329	8.619340615	1.468044975	10.87854111	10.90237146	10.26663215	13.25928582	0	0	18.17665463	0	32.20395831	1.109983565	0.27095987	3.622939086	0	1.409610431	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	168.7369		0	30.033	1.374395207	19.98945815	0	5.151741329	8.619340615	1.468044975	10.87854111	10.90237146	10.26663215	13.25928582	0	0	18.17665463	0	32.20395831	1.109983565	0.27095987	3.622939086	0	1.409610431	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	168.7369	NO																																																																																		0			30.033	1.374395207	19.98945815	0	5.151741329	8.619340615	1.468044975	10.87854111	10.90237146	10.26663215	13.25928582	0	0	18.17665463	0	32.20395831	1.109983565	0.27095987	3.622939086	0	1.409610431	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	168.7369
H2417_001_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin		Coin	Coin	Coin	Coin		Coin																																																												0	YES	355.3480371	19.19769361	96.73020753		16.45514256	41.62038664	14.50274598	29.03681708	86.25477111	30.7739694	46.63991459			71.00135857		179.6298398	3.871087612	2.218820606	17.89419446		13.13830721																				6700	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																				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																					28.9196	1.562381056	13.3058968	0	3.834048217	9.697550087	3.379139814	6.76557838	20.09736167	7.17033487	10.8671001	0	0	16.54331655	0	41.85375268	0.901963414	0.516985201	4.169347309	0	3.06122558	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	172.6456		0	28.9196	1.562381056	13.3058968	0	3.834048217	9.697550087	3.379139814	6.76557838	20.09736167	7.17033487	10.8671001	0	0	16.54331655	0	41.85375268	0.901963414	0.516985201	4.169347309	0	3.06122558	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	172.6456	NO																																																																																		0			28.9196	1.562381056	13.3058968	0	3.834048217	9.697550087	3.379139814	6.76557838	20.09736167	7.17033487	10.8671001	0	0	16.54331655	0	41.85375268	0.901963414	0.516985201	4.169347309	0	3.06122558	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	172.6456
H2419_001_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin		Coin	Coin	Coin	Coin		Coin																																																												0	YES	400.3315975	9.515681318	156.1523807		28.34740266	48.78800013	21.94612744	53.36843349	37.37488734	43.45393645	26.83023377			79.87299413		129.6524492	4.065267249	1.927432093	19.39755986		6.125252263																				6700	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																				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																					32.5805	0.774422205	21.47982016	0	6.60494482	11.36760403	5.113447693	12.434845	8.70834875	10.12476719	6.251444468	0	0	18.61040763	0	30.20902066	0.947207269	0.449091678	4.519631447	0	1.427183777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	171.6027		0	32.5805	0.774422205	21.47982016	0	6.60494482	11.36760403	5.113447693	12.434845	8.70834875	10.12476719	6.251444468	0	0	18.61040763	0	30.20902066	0.947207269	0.449091678	4.519631447	0	1.427183777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	171.6027	NO																																																																																		0			32.5805	0.774422205	21.47982016	0	6.60494482	11.36760403	5.113447693	12.434845	8.70834875	10.12476719	6.251444468	0	0	18.61040763	0	30.20902066	0.947207269	0.449091678	4.519631447	0	1.427183777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	171.6027
H2422_002_0	2011	8																															Coin		Coin	Coin	Coin	Coin		Coin	Coin	Coin					Coin						Coin	Coin																																																											0	NO	566.7856835		128.6097941	24.63799578	43.66346214	57.35012883		32.15478476	42.1700931	73.70837747					260.0907517						37.55121816	0.850381333																				Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		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. One additional prophylaxis (cleaning) and one additional exam per year. 16b. Dental crowns up to $2,000 per year"		17b. Additional pair of eyeglasses (lenses and frames) and tints and coating for all glasses				13e. Second pair of orthotics and orthotic shoes												0.080827514		0.127298432	0	0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																			NO	0.080827514		0.127298432	0	0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																				45.8119	0	16.37182517	0	10.17358668	13.36258002	0	7.492064848	9.825631692	17.17405195	0	0	0	0	60.60114514	0	0	0	0	0	8.749433831	0.198138851	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	189.7603			45.8119	0	16.37182517	0	10.17358668	13.36258002	0	7.492064848	9.825631692	17.17405195	0	0	0	0	60.60114514	0	0	0	0	0	8.749433831	0.198138851	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	189.7603	NO																																																																																		0			45.8119	0	16.37182517	0	10.17358668	13.36258002	0	7.492064848	9.825631692	17.17405195	0	0	0	0	60.60114514	0	0	0	0	0	8.749433831	0.198138851	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	189.7603
H2425_001_0	2011	9																															Coin		Coin	Coin	Coin	Coin		V	Coin					Coin						Coin	Coin	Coin																																																											0	YES	413.2500417		286.9563944	15.8188103	30.21155136	44.09256018		645	43.36336355					133.3541138						196.7055395	18.40780787	2.184289425																			6700	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																				0.08125732		0.135412412	0	0.233	0.233		50	0.233					0.233						0.233	0.233	0.233																			NO	0.081249687		0.135399693	0	0.232978115	0.232978115		50	0.232978115					0.232978115						0.232978115	0.232978115	0.232978115																				33.5764	0	38.85380756	0	7.038630279	10.27260154	0	2.6875	10.10271469	0	0	0	0	31.06859002	0	0	0	0	0	45.82808574	4.288616374	0.508891632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	184.2259		0.017305623	33.5764	0	38.85380756	0	7.038630279	10.27260154	0	2.6875	10.10271469	0	0	0	0	31.06859002	0	0	0	0	0	45.82808574	4.288616374	0.508891632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	184.2259	NO																																																																																		0			33.5764	0	38.85380756	0	7.038630279	10.27260154	0	2.6875	10.10271469	0	0	0	0	31.06859002	0	0	0	0	0	45.82808574	4.288616374	0.508891632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	184.2259
H2456_002_0	2011	9																															Coin		Coin		Coin	Coin		Coin	Coin	Coin					Coin						Coin																																																												0	YES	438.4590994		178.4110898		26.20848543	45.09245254		40.63395632	29.54708596	98.44784047					305.3269499						31.3127407																				6700	FFS		FFS		FFS	FFS		FFS	FFS	FFS					FFS						FFS																					0.081019561		0.131093039		0.233	0.233		0.233	0.233	0.233					0.233						0.233																				NO	0.081019561		0.131093039		0.233	0.233		0.233	0.233	0.233					0.233						0.233																					35.5238	0	23.38845194	0	6.106577105	10.50654144	0	9.467711822	6.884471029	22.93834683	0	0	0	0	71.14117933	0	0	0	0	0	7.295868582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	193.2529		0	35.5238	0	23.38845194	0	6.106577105	10.50654144	0	9.467711822	6.884471029	22.93834683	0	0	0	0	71.14117933	0	0	0	0	0	7.295868582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	193.2529	NO																																																																																		0		0	35.5238	0	23.38845194	0	6.106577105	10.50654144	0	9.467711822	6.884471029	22.93834683	0	0	0	0	71.14117933	0	0	0	0	0	7.295868582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	193.2529
H2457_002_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin		Coin	Coin	Coin	Coin		Coin																																																												0	YES	576.7402247	17.91970363	113.9239889		27.76480676	29.31471936	17.43129275	26.81045764	39.33847775	31.35110817	30.82732963			66.90271287		179.9822089	5.868571785	1.878764989	29.97044842		34.32767536																				6700	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																					0.080820393	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																				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																					46.6124	1.448277494	14.48566529	0	6.469199974	6.830329612	4.06149121	6.246836631	9.165865316	7.304808204	7.182767803	0	0	15.5883321	0	41.93585467	1.367377226	0.437752242	6.983114482	0	7.998348359	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	184.1184		0	46.6124	1.448277494	14.48566529	0	6.469199974	6.830329612	4.06149121	6.246836631	9.165865316	7.304808204	7.182767803	0	0	15.5883321	0	41.93585467	1.367377226	0.437752242	6.983114482	0	7.998348359	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	184.1184	NO																																																																																		0			46.6124	1.448277494	14.48566529	0	6.469199974	6.830329612	4.06149121	6.246836631	9.165865316	7.304808204	7.182767803	0	0	15.5883321	0	41.93585467	1.367377226	0.437752242	6.983114482	0	7.998348359	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	184.1184
H2458_002_0	2011	8																															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	427.2268967	20.68990845	195.6609698	0	44.99827756	47.57125667	1.394990709	19.97886347	38.64470903	45.57251775	60.02280812	5.070499091	0.105447882	88.66271772	88.81609948	120.4791296	4.19680715	3.797144435	23.86579124	10.8576298	62.04134486	4.724901847	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	0.081032136	0.081032136	0.131331547	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.081032136	0.081032136	0.131331547	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												34.6191	1.676547473	25.69645785	0	10.48459867	11.0841028	0.325032835	4.655075188	9.004217204	10.61839664	13.98531429	1.181426288	0.024569357	20.65841323	20.69415118	28.07163719	0.977856066	0.884734653	5.560729359	2.529827743	14.45563335	1.10090213	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	218.2887	0	0	34.6191	1.676547473	25.69645785	0	10.48459867	11.0841028	0.325032835	4.655075188	9.004217204	10.61839664	13.98531429	1.181426288	0.024569357	20.65841323	20.69415118	28.07163719	0.977856066	0.884734653	5.560729359	2.529827743	14.45563335	1.10090213	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	218.2887	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	34.6191	1.676547473	25.69645785	0	10.48459867	11.0841028	0.325032835	4.655075188	9.004217204	10.61839664	13.98531429	1.181426288	0.024569357	20.65841323	20.69415118	28.07163719	0.977856066	0.884734653	5.560729359	2.529827743	14.45563335	1.10090213	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	218.2887
H2459_001_0	2011	6																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	O																																																												0	YES	191.5498005	6.233869248	201.9184011		130.7995236	3.757684448	3.189997056	269.7349028	330.1279843	687.7927103	594.5432892			940.8303342	38.26792714	1200.896244	70.3229149	443.8758347		38.7995251	606.7150856																				3400	#1a $300	#1b $300	#2 $125/day days 21-100		#10a $100	#11a 20%	#11b 20%/10% #11C 0%	"#4a $50,"	"#9a $200, #9b $200"	#8a $25	#8b $25			"#4b $25, #9a $25, #9c $25, #9d $25"	#7a $0/$25	#7d $30	"#7e $30, #7h $30"	"#7c $30, #7I $30"		"#7f $30, #17a $30"	#15 $25/$25/$50																					300	300	125		100	0.2	0.1124217	50	200	25	25			25	25	30	30	30		30	44.59514474																				NO	295.5	295.5	123.125		98.5	0.197	0.110735375	49.25	197	24.625	24.625			24.625	24.625	29.55	29.55	29.55		29.55	43.92621756																					4.7169	0.15350903	2.071766928	0	1.07364609	0.740263836	0.353245519	1.107036997	5.419601075	1.411407958	1.220052375	0	0	1.930662248	0.078528975	2.957207	0.173170178	1.093044243	0	0.095543831	2.220891571	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.8165		0.40837297	4.7169	0.15350903	2.071766928	0	1.07364609	0.740263836	0.353245519	1.107036997	5.419601075	1.411407958	1.220052375	0	0	1.930662248	0.078528975	2.957207	0.173170178	1.093044243	0	0.095543831	2.220891571	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.8165	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.0412	0.0266							0.2656						0.1725																					0.5059		0	4.7169	0.15350903	2.071766928	0	1.07364609	0.781487379	0.379828828	1.107036997	5.419601075	1.411407958	1.220052375	0	0	2.196229278	0.078528975	2.957207	0.173170178	1.093044243	0	0.268075655	2.220891571	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.3224
H2459_002_0	2011	9																															A	A	D		T	Coin	Coin	V	V					V	V	V	V	V		V	O																																																												0	YES	273.2351479	8.936938906	495.8522745		186.2429265	8.837886451	8.202555722	322.4384232	420.8191519					0.106636059	72.81958336	2226.450695	278.6827132	996.5502181		102.8253084	1171.684751																				3400	#1a $150	#1b $150	#2 $75/day days 21-100		#10a $100	#11a 20%	#11b 10%/10% #11C 0%	#4a $50	"#9a $100, #9b $100"					#4b $20	#7a $0/$20	#7d $15	"#7e $15, #7h $15"	"#7c $15, #7I $15"		"#7f $15, #17a $15"	#15 $25/$25/$50																					150	150	75		100	0.2	0.04912449	50	100					20	20	15	15	15		15	42.8387183																				NO	149.25	149.25	74.625		99.5	0.199	0.048878867	49.75	99.5					19.9	19.9	14.925	14.925	14.925		14.925	42.6245247																					3.3984	0.111153178	3.083581332	0	1.544264266	1.758739404	0.400931632	1.336775963	3.489292135	0	0	0	0	0.000176838	0.120759142	2.769148052	0.346611625	1.239459334	0	0.127888977	4.161875469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.889		0.120045324	3.3984	0.111153178	3.083581332	0	1.544264266	1.758739404	0.400931632	1.336775963	3.489292135	0	0	0	0	0.000176838	0.120759142	2.769148052	0.346611625	1.239459334	0	0.127888977	4.161875469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.889	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.0814	0.0882							0.3635						0.1644																					0.6975			3.3984	0.111153178	3.083581332	0	1.544264266	1.840092333	0.48909398	1.336775963	3.489292135	0	0	0	0	0.363676477	0.120759142	2.769148052	0.346611625	1.239459334	0	0.292333354	4.161875469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5865
H2459_013_0	2011	7																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	O																																																												0	YES	216.124993	7.201049097	205.7095925		121.2461665	7.180714136	6.532105545	292.3746995	382.121649	1199.965254	895.9203527			1389.137158	60.26586731	1439.700251	163.9863521	635.7075281		56.69830289	939.3189046																				3400	#1a $300	#1b $300	#2 $125/day days 21-100		#10a $100	#11a 20%	#11b 20%/10% #11C 0%	#4a $50	"#9a $200, #9b $200"	#8a $25	#8b $25			"#4b $25, #9a $25, #9c $25, #9d $25"	#7a $0/$25	#7d $30	"#7e $30, #7h $30"	"#7c $30, #7i $30"		"#7f $30, #17a $30"	#15 $25/$25/$50																					300	300	125		100	0.2	0.094891458	50	200	25	25			25	25	30	30	30		30	42.03337123																				NO	294.6	294.6	122.75		98.2	0.1964	0.093183411	49.1	196.4	24.55	24.55			24.55	24.55	29.46	29.46	29.46		29.46	41.27677054																					5.3059	0.176785755	2.104237707	0	0.992197796	1.410292256	0.608683878	1.196299812	6.254057655	2.454928915	1.832903722	0	0	2.841943103	0.12329392	3.534464117	0.402586494	1.560661982	0	0.139194334	3.231004241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1694		0.626323092	5.3059	0.176785755	2.104237707	0	0.992197796	1.410292256	0.608683878	1.196299812	6.254057655	2.454928915	1.832903722	0	0	2.841943103	0.12329392	3.534464117	0.402586494	1.560661982	0	0.139194334	3.231004241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1694	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.0788	0.0544							0.44						0.1204																					0.6936			5.3059	0.176785755	2.104237707	0	0.992197796	1.489068023	0.663118091	1.196299812	6.254057655	2.454928915	1.832903722	0	0	3.281974238	0.12329392	3.534464117	0.402586494	1.560661982	0	0.259580908	3.231004241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.863
H2459_016_0	2011	9																															Coin		Coin		Coin	Coin		Coin	Coin	Coin					Coin						Coin																																																												0	YES	330.2374328		19.6356439		16.51867143	32.17183252		24.35512538	28.82422959	124.7776982					168.2221879						48.59838323																				6700	FFS		FFS		FFS	FFS		FFS	FFS	FFS					FFS						FFS																					0.081146448		0.133447111		0.233	0.233		0.233	0.233	0.233					0.233						0.233																				NO	0.081146448		0.133447111		0.233	0.233		0.233	0.233	0.233					0.233						0.233																					26.7976	0	2.620319948	0	3.848850443	7.496036977	0	5.674744212	6.716045494	29.07320367	0	0	0	0	39.19576978	0	0	0	0	0	11.32342329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.746		0	26.7976	0	2.620319948	0	3.848850443	7.496036977	0	5.674744212	6.716045494	29.07320367	0	0	0	0	39.19576978	0	0	0	0	0	11.32342329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.746	NO																																																																																		0		0	26.7976	0	2.620319948	0	3.848850443	7.496036977	0	5.674744212	6.716045494	29.07320367	0	0	0	0	39.19576978	0	0	0	0	0	11.32342329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.746
H2459_018_0	2011	7																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	O																																																												0	YES	216.124993	7.201049097	205.7095925		121.2461665	7.180714136	6.532105545	292.3746995	382.121649	1199.965254	895.9203527			1389.137158	60.26586731	1439.700251	163.9863521	635.7075281		56.69830289	939.3189046																				3400	#1a $500	#1b $500	#2 $125/day days 21-100		#10a $100	#11a 20%	#11b 20% #11C 20%	#4a $50	"#9a $250, #9b $250"	#8a $35	#8b $35			"#4b $25, #9a $35, #9c $35, #9d $35"	#7a $0/$25	#7d $35	"#7e $35, #7h $35"	"#7c $35, #7i $35"		"#7f $35, #17a $35, #18a $35"	#15 $25/$25/$50																					500	500	125		100	0.2	0.2	50	250	35	35			35	25	35	35	35		35	42.03337123																				NO	486	486	121.5		97.2	0.1944	0.1944	48.6	243	34.02	34.02			34.02	24.3	34.02	34.02	34.02		34.02	40.85643683																					8.7531	0.291642488	2.082809624	0	0.982093948	1.395930828	1.269841318	1.184117533	7.737963392	3.401901495	2.5399342	0	0	3.938203843	0.122038381	4.081550213	0.464901308	1.802230842	0	0.160739689	3.198101958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.4071		1.25040923	8.7531	0.291642488	2.082809624	0	0.982093948	1.395930828	1.269841318	1.184117533	7.737963392	3.401901495	2.5399342	0	0	3.938203843	0.122038381	4.081550213	0.464901308	1.802230842	0	0.160739689	3.198101958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.4071	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.0788	0.0544							0.44						0.1204																					0.6936		0	8.7531	0.291642488	2.082809624	0	0.982093948	1.474706595	1.324275531	1.184117533	7.737963392	3.401901495	2.5399342	0	0	4.378234979	0.122038381	4.081550213	0.464901308	1.802230842	0	0.281126264	3.198101958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1007
H2459_801_0	2011	4																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	O																																																												0	YES	262.5368364	8.178064392	202.3221287		179.4661283	8.681880347	9.288584914	310.5342942	433.9606766	958.9280479	753.0630311			1747.145599	7580.370919	1291.720837	289.6957039	764.0668566		52.69228701	1247.994914																				3400	#1a $300	#1b $300	#2 $125/day days 21-100		#10a $100	#11a 20%	#11b 20% #11C 20%	#4a $50	"#9a $200, #9b $200"	#8a $25	#8b $25			"#4b $25, #9a $25, #9c $25, #9d $25"	#7a $30/$25	#7d $30	"#7e $30, #7h $30"	"#7c $30, #7i $30"		"#7f $30, #17a $30"	#15 $25/$25/$50																					300	300	125		100	0.2	0.2	50	200	25	25			25	29.96610015	30	30	30		30	44.0183793																				NO	294.6	294.6	122.75		98.2	0.1964	0.1964	49.1	196.4	24.55	24.55			24.55	29.42671035	29.46	29.46	29.46		29.46	43.22604847																					6.4453	0.200771481	2.069586775	0	1.46863115	1.7051213	1.824278077	1.27060282	7.10248974	1.961806965	1.540641451	0	0	3.574368705	18.58878161	3.171174654	0.711202953	1.875784133	0	0.129359565	4.49549072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1354		1.065617806	6.4453	0.200771481	2.069586775	0	1.46863115	1.7051213	1.824278077	1.27060282	7.10248974	1.961806965	1.540641451	0	0	3.574368705	18.58878161	3.171174654	0.711202953	1.875784133	0	0.129359565	4.49549072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1354	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.0952	0.0774							0.4495						0.1125																					0.7346		0	6.4453	0.200771481	2.069586775	0	1.46863115	1.800365557	1.901682951	1.27060282	7.10248974	1.961806965	1.540641451	0	0	4.023867059	18.58878161	3.171174654	0.711202953	1.875784133	0	0.241836062	4.49549072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.87
H2459_804_0	2011	4																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	O																																																												0	YES	262.5368364	8.178064392	202.3221287		179.4661283	8.681880347	9.288584914	310.5342942	433.9606766	958.9280479	753.0630311			1747.145599	7580.370919	1291.720837	289.6957039	764.0668566		52.69228701	1247.994914																				3400	#1a $300	#1b $300	#2 $125/day days 21-100		#10a $100	#11a 20%	#11b 20% #11C 20%	#4a $50	"#9a $200, #9b $200"	#8a $25	#8b $25			"#4b $25, #9a $25, #9c $25, #9d $25"	#7a $30/$25	#7d $30	"#7e $30, #7h $30"	"#7c $30, #7i $30"		"#7f $30, #17a $30"	#15 $25/$25/$50																					300	300	125		100	0.2	0.2	50	200	25	25			25	29.96610015	30	30	30		30	44.0183793																				NO	294.6	294.6	122.75		98.2	0.1964	0.1964	49.1	196.4	24.55	24.55			24.55	29.42671035	29.46	29.46	29.46		29.46	43.22604847																					6.4453	0.200771481	2.069586775	0	1.46863115	1.7051213	1.824278077	1.27060282	7.10248974	1.961806965	1.540641451	0	0	3.574368705	18.58878161	3.171174654	0.711202953	1.875784133	0	0.129359565	4.49549072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1354		1.065617806	6.4453	0.200771481	2.069586775	0	1.46863115	1.7051213	1.824278077	1.27060282	7.10248974	1.961806965	1.540641451	0	0	3.574368705	18.58878161	3.171174654	0.711202953	1.875784133	0	0.129359565	4.49549072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1354	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.0952	0.0774							0.4495						0.1125																					0.7346		0	6.4453	0.200771481	2.069586775	0	1.46863115	1.800365557	1.901682951	1.27060282	7.10248974	1.961806965	1.540641451	0	0	4.023867059	18.58878161	3.171174654	0.711202953	1.875784133	0	0.241836062	4.49549072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.87
H2486_002_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1007.370999	35.24293281	604.0522212	1267.42287	136.6472376	9.561266189	1.799514375	329.6199438	270.8674892	812.2879729	909.2952415	46.93065421	0.230667169	3.216473897	3432.13792	2864.78276	39.64486158	517.697959		1454.840631	39.29420915	0							3.67	0.36	265.5040728	511.5698046									3400	$150/Day(Days 1-10):1a.IP Acute	$150/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$75/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 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-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $30 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11c.Diabetic Monitoring Supplies	"$30-$50/Visit:9d. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"										121.20465	109.29915	43.922851	0	150	0.2	0.2	50	75	17.741271	35.837429	50	0.2	0.2	10	29.436015	30	30		0	0.2	0							0	0	0	48.582854									NO	112.863225	101.777073	34.177161	0	138.813	0.185084	0.185084	46.271	69.4065	16.418127	33.164674	46.271	0.185084	0.185084	9.2542	27.240677	27.7626	27.7626		0	0.185084	0							0	0	0	44.959544										9.4746	0.298910212	1.720399168	0	1.580701082	1.769637391	0.333061319	1.270987035	1.566663699	1.111353925	2.513040021	0.180960692	0.042692802	0.595317855	2.646807562	6.503218486	0.09172037	1.197720113	0	0	7.272729407	0	0	0	0	0	0	0	0	0	0	1.916662095	0	0	0	0	0	0	0	0	42.0872	0	3.678434865	9.4746	0.298910212	1.720399168	0	1.580701082	1.769637391	0.333061319	1.270987035	1.566663699	1.111353925	2.513040021	0.180960692	0.042692802	0.595317855	2.646807562	6.503218486	0.09172037	1.197720113	0	0	7.272729407	0	0	0	0	0	0	0	0	0	0	1.916662095	0	0	0	0	0	0	0	0	42.0872	NO																																																																																		0	0	0	9.4746	0.298910212	1.720399168	0	1.580701082	1.769637391	0.333061319	1.270987035	1.566663699	1.111353925	2.513040021	0.180960692	0.042692802	0.595317855	2.646807562	6.503218486	0.09172037	1.197720113	0	0	7.272729407	0	0	0	0	0	0	0	0	0	0	1.916662095	0	0	0	0	0	0	0	0	42.0872
H2486_003_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	Professional								Prosthetics/Supplies	Other	Therapy (PT/OT/ST)								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	NO	1394.194783	59.339125	579.140162	1094.54349	147.714386	5.449798	1.657967	337.493979	281.185227	1300.994703	1304.231318	66.006962	0.459642	2.841422	4051.990628	4201.136054	63.943189	134.837032		1600.169241	28.299552	0							5.05	0.49	250.460628	487.928845	495.72624									$150/Day(Days 1-10):1a.IP Acute	$150/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$75/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 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-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $30 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$30-$50/Visit:9d. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"									121.20465	109.29915	43.922851	0	150	0.2	0.2	50	75	10.377806	34.003816	50	0.2	0.2	10	29.570844	30	30		0	0.2	0							0	0	0	47.139775	30								NO	110.814018	99.929152	32.783401	0	136.5249	0.182033	0.182033	45.5083	68.26245	9.445526	30.949117	45.5083	0.182033	0.182033	9.10166	26.914377	27.30498	27.30498		0	0.182033	0							0	0	0	42.90502	27.30498									12.8747	0.49414237	1.582182014	0	1.680557648	0.992043079	0.301804707	1.279898104	1.599532708	1.024048274	3.363733971	0.250322052	0.083670012	0.517232571	3.073320085	9.422579965	0.145497291	0.306810205	0	0	5.151452349	0	0	0	0	0	0	0	0	0	0	1.744549738	1.127982922	0	0	0	0	0	0	0	47.0161	0	4.955997781	12.8747	0.49414237	1.582182014	0	1.680557648	0.992043079	0.301804707	1.279898104	1.599532708	1.024048274	3.363733971	0.250322052	0.083670012	0.517232571	3.073320085	9.422579965	0.145497291	0.306810205	0	0	5.151452349	0	0	0	0	0	0	0	0	0	0	1.744549738	1.127982922	0	0	0	0	0	0	0	47.0161	YES	$175/Day(Days 1-10)	$175/Day(Days 1-10)	$0/Day(Days 1-20) $137(Days 21-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins		$40/Visit	20%-30% Coins	$0/Service									20% Coins	30% Coins	$40/Visit								4000	1.1524	0.0442	0.1124	0	0.6462	0.5869	0.1785	0.0999	0.9405	0.103	0.5488	0.099	0.0067	0.0412	0.8943	0.9272	0.0141	0.0231		0.3532	0.4265	0									0.0287	0.1301	0.1094								7.4661	0	1.746984476	14.0271	0.538372619	1.694603184	0	2.326760877	1.578901456	0.480341945	1.379753158	2.5400185	1.127027235	3.912521803	0.349285021	0.090332055	0.558415695	3.967613035	10.34978999	0.159609847	0.329897808	0	0.353164701	5.577949118	0	0	0	0	0	0	0	0	0	0.02865327	1.874609265	1.237391983	0	0	0	0	0	0	0	54.4821
H2486_801_0	2011	2																															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	YES	286.005824	4.012028	29.394187	15.883659	7.188372	9.154741	3.232085	26.06392	48.344485	5.22071	28.295579	5.017117	0.506611	9.724634	37.712851	68.306972	0.470461	5.217741		7.419602	31.031952	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082627	0.082627	0.165471	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.075943	0.075943	0.121612	0	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313		0.213313	0.213313	0																				21.7201	0.304685442	3.574685869	0	1.533373196	1.952825267	0.689445748	5.559772967	10.31250713	1.113645312	6.035814843	1.070216279	0.108066712	2.074390852	8.044641385	14.57076512	0.100355447	1.113011986	0	1.582697561	6.619518777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0806	0	8.994187518	21.7201	0.304685442	3.574685869	0	1.533373196	1.952825267	0.689445748	5.559772967	10.31250713	1.113645312	6.035814843	1.070216279	0.108066712	2.074390852	8.044641385	14.57076512	0.100355447	1.113011986	0	1.582697561	6.619518777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0806	NO																																																																																		0	0	0	21.7201	0.304685442	3.574685869	0	1.533373196	1.952825267	0.689445748	5.559772967	10.31250713	1.113645312	6.035814843	1.070216279	0.108066712	2.074390852	8.044641385	14.57076512	0.100355447	1.113011986	0	1.582697561	6.619518777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0806
H2486_802_0	2011	2																															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	YES	286.005824	4.012028	29.394187	15.883659	7.188372	9.154741	3.232085	26.06392	48.344485	5.22071	28.295579	5.017117	0.506611	9.724634	37.712851	68.306972	0.470461	5.217741		7.419602	31.031952	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082627	0.082627	0.165471	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.075943	0.075943	0.121612	0	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313		0.213313	0.213313	0																				21.7201	0.304685442	3.574685869	0	1.533373196	1.952825267	0.689445748	5.559772967	10.31250713	1.113645312	6.035814843	1.070216279	0.108066712	2.074390852	8.044641385	14.57076512	0.100355447	1.113011986	0	1.582697561	6.619518777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0806	0	8.994187518	21.7201	0.304685442	3.574685869	0	1.533373196	1.952825267	0.689445748	5.559772967	10.31250713	1.113645312	6.035814843	1.070216279	0.108066712	2.074390852	8.044641385	14.57076512	0.100355447	1.113011986	0	1.582697561	6.619518777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0806	NO																																																																																		0	0	0	21.7201	0.304685442	3.574685869	0	1.533373196	1.952825267	0.689445748	5.559772967	10.31250713	1.113645312	6.035814843	1.070216279	0.108066712	2.074390852	8.044641385	14.57076512	0.100355447	1.113011986	0	1.582697561	6.619518777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0806
H2486_803_0	2011	2																															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	YES	286.005824	4.012028	29.394187	15.883659	7.188372	9.154741	3.232085	26.06392	48.344485	5.22071	28.295579	5.017117	0.506611	9.724634	37.712851	68.306972	0.470461	5.217741		7.419602	31.031952	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082627	0.082627	0.165471	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.075943	0.075943	0.121612	0	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313	0.213313		0.213313	0.213313	0																				21.7201	0.304685442	3.574685869	0	1.533373196	1.952825267	0.689445748	5.559772967	10.31250713	1.113645312	6.035814843	1.070216279	0.108066712	2.074390852	8.044641385	14.57076512	0.100355447	1.113011986	0	1.582697561	6.619518777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0806	0	8.994187518	21.7201	0.304685442	3.574685869	0	1.533373196	1.952825267	0.689445748	5.559772967	10.31250713	1.113645312	6.035814843	1.070216279	0.108066712	2.074390852	8.044641385	14.57076512	0.100355447	1.113011986	0	1.582697561	6.619518777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0806	NO																																																																																		0	0	0	21.7201	0.304685442	3.574685869	0	1.533373196	1.952825267	0.689445748	5.559772967	10.31250713	1.113645312	6.035814843	1.070216279	0.108066712	2.074390852	8.044641385	14.57076512	0.100355447	1.113011986	0	1.582697561	6.619518777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0806
H2491_001_0	2011	7																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	P	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	Yes	2070.440802	196.3402948	909.895174	405.6637994	17.56042878	13.80452035	16.67317986	19.10295979	27.92288145	4099.838142	22.88906932	0.000988199	0.032648045	24.08209615	14332.3874	98.02114829	8.461878261	4.73287904	20.35891812	11.12622062	21.2273185	0.013801058	1200	720.6	331.2	198.72	16.2	12.34285714	356	2487.434625											6700	FFS	FFS	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) $0.00 copayment	(8b) 20% coinsurance	(5) 45% coinsurance	(12) 20% coinsurance	"(9a) , (9d) 20% coinsurance"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) 20% coinsurance"	"(7e) , (7h) 45% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) 20% coinsurance"	(15) 20% coinsurance	(13a) 20% coinsurance	(10b) $0.00 copayment	"(16) $0.00 copayment, $1,000 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	"(13b) , (13c) $0.00 copayment"											0	124.114957	44.19898063	40.1270008	0	0.180464574	0.2	0.2	0.178864677	0.179847797	0	0.18559908	0.421632366	0.2	0.157290722	0	0.076622381	0.345709196	0.156962935	0.12963796	0.13880392	0.2	0.196078867	0	0	0	0	0	0	0	0											NO	121.6176549	43.30965828	39.31961026	0	0.176833468	0.195975824	0.195975824	0.175265762	0.176229101	0	0.181864663	0.413148752	0.195975824	0.154125895	0	0.075080671	0.338753223	0.153804703	0.127029531	0.136011063	0.195975824	0.192133588	0	0	0	0	0	0	0	0												20.9835	0.708619256	2.981393635	0	3.105271527	2.705352253	3.267540164	3.348094808	4.920824308	0	4.162712874	0.000408273	0.006398228	3.711674612	0	7.359493576	2.866488532	0.727939055	2.586183813	1.513289099	4.160041238	0.002651647	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1179	0	1.41926967	20.9835	0.708619256	2.981393635	0	3.105271527	2.705352253	3.267540164	3.348094808	4.920824308	0	4.162712874	0.000408273	0.006398228	3.711674612	0	7.359493576	2.866488532	0.727939055	2.586183813	1.513289099	4.160041238	0.002651647	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1179	NO	Same as in-network	Not covered OON	Same as in-network	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	Same as in-network	30% coinsurance	30% coinsurance	30% coinsurance	Not covered OON	Not covered OON	30% coinsurance	Not covered OON	30% coinsurance	Not covered OON	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.9099	0	0.107	0.0414	0.0526	0.0414	0.05	0	0.0837	0.0095	0.0686	0	0	0.0722	0	0.2938	0	0.0142	0.0609	0.0328	0.0636	0	0	0	0	0	0	0	0	0											1.9015	0	0	21.8934	0.708619256	3.088399056	0.041351333	3.157899654	2.746724024	3.31750923	3.348094808	5.004508423	0.009451564	4.231310791	0.000408273	0.006398228	3.783847999	0	7.653260287	2.866488532	0.742123364	2.647133765	1.546069187	4.223658933	0.002693008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.0194
H2491_002_0	2011	8																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1528.37997	45.44672213	336.3611582	374.2629251	348.9255238	4.152247798	4.061724484	539.7109169	405.5140107	2115.046815	1470.688827	0.64763437	0.04599447	1545.022656	11865.47709	21351.48506	277.4366809	1932.877897	3144.766276	2448.705531	21.87888733	0.015260721	0	241.7142857	0	0	16.2	12.34285714	350.1639344	0											3900	"(1a) $175 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $175 days 1 - 5, $0 after day 5, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $125.00 copayment , (9b) $75.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $175.00 copayment	(12) 20% coinsurance	"(9a) $125.00 copayment , (9d) Copay between $35.00 and $125.00"	"(14b) , (14c) $0.00 copayment ; (7a) $5.00 copayment"	"(7b) , (7d) , (7g) $35.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	"(16) $0.00 copayment,   benefit limit"	Not Covered	Not Covered	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	Not Covered											0	88.85417213	49.5206926	38.69129133	0	42.35279917	0.2	0.113217337	43.14084221	92.46327967	0	14.13692775	28.72040595	0.2	24.63067356	2.571978971	5.477130066	27.16204529	9.990916072	3.533437402	6.528109072	0.2	0	0	0	0	0	0	0	0	0											NO	86.56154694	48.24295421	37.69297434	0	41.26000755	0.194839578	0.110296091	42.02771742	90.07753188	0	13.77216518	27.97935885	0.194839578	23.9951502	2.505616485	5.335808549	26.46120719	9.733129349	3.442267259	6.359670079	0.194839578	0	0	0	0	0	0	0	0	0												11.0249	0.182707011	1.056537709	0	1.199722479	0.809022208	0.447992332	1.890234826	3.043975102	0	1.687880787	0.001510033	0.008961543	3.08942089	2.477527916	9.493953043	0.611775791	1.567745882	0.902093832	1.297746608	4.262873172	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0566	0	1.193346035	11.0249	0.182707011	1.056537709	0	1.199722479	0.809022208	0.447992332	1.890234826	3.043975102	0	1.687880787	0.001510033	0.008961543	3.08942089	2.477527916	9.493953043	0.611775791	1.567745882	0.902093832	1.297746608	4.262873172	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0566	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												1.7179	0	0.1055	0.0373	0.0507	0.0283	0.0276	0	0.2568	0.012	0.1199	0	0	0.0641	0	0.6288	0	0.0334	0.1198	0.0766	0.1489	0.0001	0	0	0	0	0	0	0	0											3.4278	0	0	12.7428	0.182707011	1.162045551	0.037310155	1.250379166	0.837274616	0.475628808	1.890234826	3.300792698	0.012002458	1.807805242	0.001510033	0.008961543	3.153544569	2.477527916	10.12275455	0.611775791	1.601103619	1.021922511	1.374388707	4.411739828	0.000103836	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4844
H2491_004_0	2011	8																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	P	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	Yes	2279.437676	284.0575276	1266.65769	553.3347925	21.35502435	19.1913574	21.46691402	16.83901405	29.08513575	6203.117942	25.98306363	0.000758578	0.053718873	30.93068918	10609.26025	96.88832923	16.5347636	6.106068312	13.40018727	10.49515597	21.63140427	0.003843528	1200	720.6	331.2	198.72	16.2	12.34285714	338.7096774	2997.791352											6700	FFS	FFS	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) $0.00 copayment	(8b) 20% coinsurance	(5) 45% coinsurance	(12) 20% coinsurance	"(9a) , (9d) 20% coinsurance"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7b) , (7d) , (7g) 20% coinsurance"	"(7e) , (7h) 45% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) 20% coinsurance"	(15) 20% coinsurance	(13a) 20% coinsurance	(10b) $0.00 copayment	"(16) $0.00 copayment, $1,000 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	"(13b) , (13c) $0.00 copayment"											0	102.6952664	45.64825154	36.51785983	0	0.172752836	0.1908	0.1908	0.170408516	0.169700124	0	0.170515554	0.402237277	0.1908	0.146707092	0	0.07340463	0.332715127	0.154694489	0.145283607	0.139305669	0.1908	0.177095912	0	0	0	0	0	0	0	0											NO	100.4180221	44.63601188	35.70808454	0	0.168922081	0.186569053	0.186569053	0.166629746	0.165937062	0	0.16673441	0.393317756	0.186569053	0.143453895	0	0.071776899	0.325337244	0.151264173	0.142061976	0.136216598	0.186569053	0.17316885	0	0	0	0	0	0	0	0												19.0747	1.056599598	3.769159991	0	3.607335155	3.580513379	4.005061821	2.80588063	4.826301989	0	4.332270781	0.000298362	0.010022279	4.437127841	0	6.954343828	5.379374427	0.923629376	1.903657084	1.429614437	4.035750613	0.000665579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1323	0	1.635791332	19.0747	1.056599598	3.769159991	0	3.607335155	3.580513379	4.005061821	2.80588063	4.826301989	0	4.332270781	0.000298362	0.010022279	4.437127841	0	6.954343828	5.379374427	0.923629376	1.903657084	1.429614437	4.035750613	0.000665579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1323	NO	Same as in-network	Not covered OON	Same as in-network	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	Same as in-network	30% coinsurance	30% coinsurance	30% coinsurance	Not covered OON	Not covered OON	30% coinsurance	Not covered OON	30% coinsurance	Not covered OON	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.8706	0	0.136	0.0525	0.064	0.0575	0.0643	0	0.0872	0.0136	0.0779	0	0	0.0927	0	0.2904	0	0.0183	0.0401	0.0309	0.0648	0	0	0	0	0	0	0	0	0											1.9608	0	0	19.9453	1.056599598	3.905185455	0.052467848	3.671335581	3.638029354	4.069397578	2.80588063	4.913469348	0.013616526	4.410141315	0.000298362	0.010022279	4.529826274	0	7.244715511	5.379374427	0.941929096	1.943783563	1.460486521	4.100579342	0.000677098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0932
H2542_001_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	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	YES	1089.643308	38.05721329	448.6321217	323.9010856	24.82791268	7.778336416	1.748683667	377.3689154	369.9625388	1085.898191	789.2768281	13.56610529	0.031440836	5.649798936	3359.367506	2939.345595	147.5539579	540.1133663		1522.68391	12.28390105	0		3.4	3.1				3.72	0.56	1647.018322	705.6305358									3400	$215/Day(Days 1-7):1a.IP Acute	$215/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										154.5033	132.276385	46.371	0	150	0.2	0.2	50	187.641915	38.632981	101.968799	150	0.163934	0.2	10	33.675444	35	80.867542		0	0.2	0		0	0				0	0	0	128.981627									NO	128.824388	110.291653	29.731462	0	126.4536	0.168605	0.168605	42.1512	158.186638	32.56853	85.962145	126.4536	0.1382	0.168605	8.43024	28.389207	29.50584	68.173279		0	0.168605	0		0	0				0	0	0	108.734607										11.6977	0.349782747	1.11154074	0	0.261631578	1.311466411	0.29483681	1.325546052	4.876927517	2.947175651	5.653994095	0.142956904	0.004345124	0.95258435	2.36002286	6.953807546	0.362808623	3.068441601	0	0	2.071127136	0	0	0	0	0	0	0	0	0	0	6.393871583	0	0	0	0	0	0	0	0	52.1406	0	10.28213741	11.6977	0.349782747	1.11154074	0	0.261631578	1.311466411	0.29483681	1.325546052	4.876927517	2.947175651	5.653994095	0.142956904	0.004345124	0.95258435	2.36002286	6.953807546	0.362808623	3.068441601	0	0	2.071127136	0	0	0	0	0	0	0	0	0	0	6.393871583	0	0	0	0	0	0	0	0	52.1406	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$150/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									5100	5.0134	0.0563	0.2568	2.1377	1.1294	1.8664	0.4196	0.2138	2.4472	0.3141	0.8332	0.0625	0.0007	0.2352	1.5044	2.2533	0.0567	0.1972		0.3243	0.5549	0		0	0				0	0	0.7107	0.4188									21.0064	500	12.13094699	16.7111	0.406078066	1.368308362	2.137710049	1.391058293	3.177865002	0.714430026	1.539306238	7.324145034	3.261262477	6.487176697	0.205437833	0.005060297	1.18774478	3.864387305	9.207145949	0.41948488	3.265661478	0	0.32426434	2.626049505	0	0	0	0	0	0	0	0	0	0.710656447	6.812626608	0	0	0	0	0	0	0	0	73.147
H2542_002_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V		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	1249.510079	58.93731	585.088539	508.773874	36.313789	12.557201	2.842637	502.154605	371.60214	1520.089197	1009.618184	76.5307	0.561264	10.638639	4021.256731	3750.73156	158.195299	789.013336		2189.915128	21.528693	0		3.4	3.1		0.28		3.72	0.56	2201.574812	712.260683									3400	$215/Day(Days 1-7):1a.IP Acute	$215/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										154.5033	132.276385	46.371	0	150	0.2	0.2	50	189.445513	43.195412	112.387682	150	0.098207	0.2	10	33.794675	35	82.023233		0	0.2	0		0	0		0		0	0	0	130.109876									NO	115.929388	99.251734	24.294741	0	117.86505	0.157153	0.157153	39.28835	148.860032	33.941529	88.310532	117.86505	0.077167	0.157153	7.85767	26.55474	27.501845	64.45115		0	0.157153	0		0	0		0		0	0	0	102.236047										12.0712	0.487469185	1.184547876	0	0.356677213	1.973401809	0.446728932	1.644068823	4.609725538	4.29951263	7.429993245	0.751691232	0.043311059	1.671894035	2.633142365	8.299975115	0.362555216	4.237734739	0	0	3.383298691	0	0	0	0	0	0	0	0	0	0	6.068226389	0	0	0	0	0	0	0	0	61.9552	0	18.3997191	12.0712	0.487469185	1.184547876	0	0.356677213	1.973401809	0.446728932	1.644068823	4.609725538	4.29951263	7.429993245	0.751691232	0.043311059	1.671894035	2.633142365	8.299975115	0.362555216	4.237734739	0	0	3.383298691	0	0	0	0	0	0	0	0	0	0	6.068226389	0	0	0	0	0	0	0	0	61.9552	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$150/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5	"VIS752: Vision 17a, 17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									5100	4.5676	0.0693	0.279	3.165	1.4878	2.7137	0.6143	0.2562	2.4704	0.5895	0.9529	0.0725	0.0069	0.3988	1.5875	2.0523	0.056	0.2784		0.3588	0.9267	0		0	0		0		0	0	0.8312	0.3787									24.1134	500	16.24609185	16.6388	0.5567401	1.463552723	3.165037501	1.844445896	4.68706896	1.061035686	1.900248189	7.080106642	4.889060104	8.382872951	0.824145094	0.05019841	2.070701606	4.220659841	10.35226834	0.418550526	4.516162878	0	0.358824898	4.309961248	0	0	0	0	0	0	0	0	0	0.831238567	6.446904842	0	0	0	0	0	0	0	0	86.0686
H2542_003_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	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	YES	1142.410774	52.933739	562.775374	498.964785	40.495026	9.710582	3.008501	353.364556	372.909933	1411.242861	936.510216	86.424153	0.391066	7.99069	3254.514448	3164.552116	90.401255	582.326633		1436.653038	19.208061	0		3.4	3.1				3.72	0.56	1026.365493	685.369									4000	$215/Day(Days 1-7):1a.IP Acute	$215/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										154.5033	132.276385	32.5726	0	150	0.2	0.2	50	184.085226	30.381622	106.990671	150	0.172843	0.2	10	33.428061	35	70.92209		0	0.2	0		0	0				0	0	0	128.277878									NO	132.71509	113.622637	22.940719	0	128.73615	0.171648	0.171648	42.91205	157.989488	26.074753	91.823781	128.73615	0.148341	0.171648	8.58241	28.689333	30.038435	60.868246		0	0.171648	0		0	0				0	0	0	110.093335										12.6346	0.501205918	1.075872643	0	0.434431145	1.666801979	0.51640318	1.263633125	4.909654115	3.066484085	7.166159082	0.927159394	0.058011122	1.371585957	2.327631445	7.565740788	0.226292685	2.953766729	0	0	3.297025255	0	0	0	0	0	0	0	0	0	0	6.28787991	0	0	0	0	0	0	0	0	58.2503	0	9.882294839	12.6346	0.501205918	1.075872643	0	0.434431145	1.666801979	0.51640318	1.263633125	4.909654115	3.066484085	7.166159082	0.927159394	0.058011122	1.371585957	2.327631445	7.565740788	0.226292685	2.953766729	0	0	3.297025255	0	0	0	0	0	0	0	0	0	0	6.28787991	0	0	0	0	0	0	0	0	58.2503	YES	20% Coins	20% Coins	20% Coins(Days 1-8) 20%(Days 9-100)	20% Coins	$150/Trip	20% Coins	20% Coins	$50/Visit	20% Coins	20% Coins	20% Coins	20% Coins	0%-20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		20% Coins	20% Coins	20% Coins		0.5	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	20% Coins									6000	5.2103	0.0813	0.3905	1.5138	1.6445	1.0401	0.3222	0.1787	1.5587	0.2307	0.6284	0.1151	0.0084	0.1979	0.8283	1.2883	0.0215	0.1363		0.1548	0.5649	0		0	0				0	0	0.1902	0.2841									16.589	0	4.973975204	17.8449	0.582522922	1.466416776	1.5138086	2.078960493	2.706853884	0.838628545	1.442325403	6.468328387	3.297191563	7.794571853	1.042256636	0.066383251	1.569531849	3.155932111	8.854005959	0.24776451	3.090055583	0	0.154803087	3.861882359	0	0	0	0	0	0	0	0	0	0.190200954	6.572012485	0	0	0	0	0	0	0	0	74.8394
H2542_004_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V		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	1167.137027	54.079433	574.956042	509.764341	41.371498	8.800931	2.726675	361.012752	380.981168	1441.787694	956.779972	88.294711	0.354433	7.242151	3324.954913	3233.045443	92.357893	594.930467		1467.747848	17.408719	0		3.4	3.1		0.28		3.72	0.56	1048.580071	700.203074									4000	$215/Day(Days 1-7):1a.IP Acute	$215/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										154.5033	132.276385	32.5726	0	150	0.2	0.2	50	184.085226	30.381622	106.990671	150	0.172843	0.2	10	33.428061	35	70.92209		0	0.2	0		0	0		0		0	0	0	128.277878									NO	132.229023	113.206495	22.735479	0	128.47185	0.171296	0.171296	42.82395	157.66513	26.021221	91.635263	128.47185	0.148037	0.171296	8.56479	28.630432	29.976765	60.743281		0	0.171296	0		0	0		0		0	0	0	109.867309										12.8608	0.510178588	1.089325085	0	0.44292274	1.507564277	0.467068521	1.28833267	5.005620448	3.126423018	7.306232031	0.945282072	0.052469198	1.240551498	2.373128382	7.713623976	0.230715905	3.011502378	0	0	2.98204393	0	0	0	0	0	0	0	0	0	0	6.410785624	0	0	0	0	0	0	0	0	58.5646	0	10.11428721	12.8608	0.510178588	1.089325085	0	0.44292274	1.507564277	0.467068521	1.28833267	5.005620448	3.126423018	7.306232031	0.945282072	0.052469198	1.240551498	2.373128382	7.713623976	0.230715905	3.011502378	0	0	2.98204393	0	0	0	0	0	0	0	0	0	0	6.410785624	0	0	0	0	0	0	0	0	58.5646	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5	"VIS752: Vision 17a, 17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									6000	5.698	0.0889	0.373	2.4635	2.0112	1.6925	0.5244	0.2185	2.5365	0.3754	1.0226	0.1873	0.0091	0.3221	1.3479	2.0965	0.0349	0.2218		0.2519	0.8443	0		0	0		0		0	0	0.3095	0.4624									23.0924	500	10.02147028	18.5588	0.599106306	1.462327399	2.463492756	2.454084332	3.200090179	0.991441473	1.5068627	7.542125207	3.501864273	8.328878114	1.13258546	0.061551911	1.562678336	3.721061587	9.810079467	0.265658098	3.233291199	0	0.251918694	3.826377655	0	0	0	0	0	0	0	0	0	0.309523043	6.87316804	0	0	0	0	0	0	0	0	81.6569
H2593_001_0	2011	4																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	917.1729748	36.82793478	845.196063	0	330.4694935	1396.210673	5296.103562	301.0390485	303.9076632	0	1008.333387	16.3842033	0	53.94098985	0	3699.545604	282.1914503	75.55850809	0	0	16.15924297	0	0	0	388.8590398	734.5406315	0	0	0	0											3400	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	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:$25	8a:$0	8b: X-Rays $15; Diagnostic $50; Therapeutic $0	9a:$75	12:$0	3:$15; 5:$30; 9c:$25; 9d:$25	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	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	7c:$15; 7i: PT $0 ST $15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	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 52 Weeks $0											0	82.11627623	67.47437092	7.724161948	0	27.39309211	1.227103214	0.243346268	50	51.06643674	0	26.71831523	75	0	27.99652281	0	25	24.79195728	15	0	0	0.178399445	0	0	0	20	19.01622718	0	0	0	0											NO	80.50289736	66.14866877	7.572401539	0	26.85488655	1.202993713	0.238565124	49.01762541	50.06310934	0	26.19336735	73.52643811	0	27.44646135	0	24.5088127	24.3048575	14.70528762	0	0	0.164024149	0	0	0	20	19.01622718	0	0	0	0												6.1529	0.203009905	0.533346997	0	0.739560063	0.139969389	0.1052888	1.229684943	1.267880214	0	2.200970567	0.100389342	0	0.123374108	0	7.555955857	0.571551916	0.092592466	0	0	2.650506078	0	0	0	0.6480984	1.16401596	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.4791	0	0.653490833	6.1529	0.203009905	0.533346997	0	0.739560063	0.139969389	0.1052888	1.229684943	1.267880214	0	2.200970567	0.100389342	0	0.123374108	0	7.555955857	0.571551916	0.092592466	0	0	2.650506078	0	0	0	0.6480984	1.16401596	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.4791	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.1529	0.203009905	0.533346997	0	0.739560063	0.139969389	0.1052888	1.229684943	1.267880214	0	2.200970567	0.100389342	0	0.123374108	0	7.555955857	0.571551916	0.092592466	0	0	2.650506078	0	0	0	0.6480984	1.16401596	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.4791
H2593_003_0	2011	6																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	2678.020163	169.0681846	0	0	1060.197796	6367.555066	27911.81001	95.56033149	64.16454748	0	93.67926127	7.889185055	0	0	0	0	0	0	0	0	6.486655009	0	0	0	375	678.0455398	0	0	0	0											3400	1a:$100 Days 1-5; 125 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:$75; 9b:$25	8a:$0	8b: X-Rays $0; Diagnostic $50; Therapeutic $0	9a:$75	12:$0	3:$0; 5:$0; 9c:$0; 9d:$0	"7a:$0; 14b,14c (ippe/ppps), 14c:Comprehensive Health Assessment $0, 14d,14e,14f,14i,14j:$0"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 6 Routine Footcare Visits	7e:$0; 7h:$0; 7g: NP Psych Services $0	7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Comprehensive Health Assessment $0	13c:OTC $40 per month Allowance											0	82.11627623	67.47437092	0	0	13.69654605	1.227103214	0.121771143	50	51.59574468	0	50	75	0	0	0	0	0	0	0	0	0.182784036	0	0	0	20	19.01622718	0	0	0	0											NO	80.47584498	66.12644001	0	0	13.42293109	1.202589456	0.119338529	49.00115341	50.56502	0	49.00115341	73.50173011	0	0	0	0	0	0	0	0	0.178391144	0	0	0	20	19.01622718	0	0	0	0												17.9597	0.93165643	0	0	1.185913496	0.638129549	0.27757953	0.390213872	0.270373469	0	0.382532654	0.048322396	0	0	0	0	0	0	0	0	1.157161807	0	0	0	0.625	1.074489002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.941	0	0.478666424	17.9597	0.93165643	0	0	1.185913496	0.638129549	0.27757953	0.390213872	0.270373469	0	0.382532654	0.048322396	0	0	0	0	0	0	0	0	1.157161807	0	0	0	0.625	1.074489002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.941	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.9597	0.93165643	0	0	1.185913496	0.638129549	0.27757953	0.390213872	0.270373469	0	0.382532654	0.048322396	0	0	0	0	0	0	0	0	1.157161807	0	0	0	0.625	1.074489002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.941
H2593_005_0	2011	4																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	1994.051798	53.4289602	1835.818116	0	741.8097471	6335.627164	6058.59934	460.280526	359.3552279	0	1378.772172	25.9959101	0	79.65962414	0	4452.665849	414.6216524	71.79519214	0	0	21.05068103	0	0	0	390.5420911	733.395375	0	0	0	0											3400	1a:$100 Days 1-5; 125 Add'l Days	1b:$100 Days 1-5; 60 Add'l Days	"2:$0 Days 1-31, $75 Days 32-100; 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; 11c:$0	4a:$50 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$75; 9b:$25	8a:$0	8b: X-Rays $15; Diagnostic $50; Therapeutic $0	9a:$75	12:$0	3:$15; 5:$30; 9c:$25; 9d:$25	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	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	7c:$15; 7i: PT $0 ST $15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	10b:$0 24 Plan Approved Location Trips	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	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 14c:Annual CCC Visit $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0											0	82.11627623	67.47437092	3.213669261	0	27.39309211	1.227103214	0.256146793	50	55.4964539	0	27.40467957	75	0	27.60429997	0	24.99685082	24.86916909	15	0	0	0.179514673	0	0	0	20	19.01622718	0	0	0	0											NO	78.11370324	64.18548463	3.057026188	0	26.05787751	1.16729083	0.243661495	47.56286258	52.79140421	0	26.06890017	71.34429387	0	26.25879052	0	23.77843561	23.65697743	14.26885877	0	0	0.157172568	0	0	0	20	19.01622718	0	0	0	0												12.9802	0.285780309	0.467678671	0	1.610832294	0.616293291	0.123020614	1.82435495	1.580905591	0	2.995256176	0.154554987	0	0.174313782	0	8.823119014	0.817391256	0.085369621	0	0	3.30858959	0	0	0	0.650903485	1.162201089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6608	0	2.137631261	12.9802	0.285780309	0.467678671	0	1.610832294	0.616293291	0.123020614	1.82435495	1.580905591	0	2.995256176	0.154554987	0	0.174313782	0	8.823119014	0.817391256	0.085369621	0	0	3.30858959	0	0	0	0.650903485	1.162201089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6608	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.9802	0.285780309	0.467678671	0	1.610832294	0.616293291	0.123020614	1.82435495	1.580905591	0	2.995256176	0.154554987	0	0.174313782	0	8.823119014	0.817391256	0.085369621	0	0	3.30858959	0	0	0	0.650903485	1.162201089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6608
H2593_006_0	2011	4																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	1220.279075	44.32811306	1090.468234	0	433.1386259	2057.894073	4120.610201	331.6350814	328.2682278	0	1013.725169	13.88827118	0	71.30154251	0	3636.574519	277.8210443	49.20891973	0	0	16.58588607	0	0	0	397.2887245	733.2823603	0	0	0	0											3400	1a:$100 Days 1-5; 75 Add'l Days	1b:$100 Days 1-5; 60 Add'l Days	"2:$0 Days 1-31, $75 Days 32-100; 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; 11c:$0	4a:$50 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$75; 9b:$25	8a:$0	8b: X-Rays $15; Diagnostic $50; Therapeutic $0	9a:$75	12:$0	3:$15; 5:$30; 9c:$25; 9d:$25	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	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	7c:$15; 7i: PT $0 ST $15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	10b:$0 24 Plan Approved Location Trips	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	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 14c:Annual CCC Visit $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0 13e:Electronic Health Monitoring $0											0	82.11627623	67.47437092	3.213669261	0	27.39309211	1.227103214	0.484847726	50	50.96153846	0	26.1113365	75	0	27.29016645	0	25	24.75818242	15	0	0	0.178768966	0	0	0	20	19.01622718	0	0	0	0											NO	80.16582034	65.87169493	3.137337011	0	26.74244134	1.197956608	0.473331445	48.81238167	49.75108132	0	25.49113047	73.21857251	0	26.64196041	0	24.40619084	24.170117	14.6437145	0	0	0.163477014	0	0	0	20	19.01622718	0	0	0	0												8.1521	0.243330662	0.285097196	0	0.965265358	0.205438984	0.162534532	1.348991514	1.360974941	0	2.153416711	0.084739949	0	0.158301073	0	7.396244309	0.559580595	0.060050114	0	0	2.71141113	0	0	0	0.662147874	1.162021996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.6716	0	0.816536187	8.1521	0.243330662	0.285097196	0	0.965265358	0.205438984	0.162534532	1.348991514	1.360974941	0	2.153416711	0.084739949	0	0.158301073	0	7.396244309	0.559580595	0.060050114	0	0	2.71141113	0	0	0	0.662147874	1.162021996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.6716	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.1521	0.243330662	0.285097196	0	0.965265358	0.205438984	0.162534532	1.348991514	1.360974941	0	2.153416711	0.084739949	0	0.158301073	0	7.396244309	0.559580595	0.060050114	0	0	2.71141113	0	0	0	0.662147874	1.162021996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.6716
H2593_007_0	2011	5																															D	D	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	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	901.8062546	36.21737314	831.1837568	0	324.9907176	1373.061036	5210.312971	424.0997715	298.8692497	0	340.6325844	16.11257346	0.051887057	53.0467149	0	3960.034193	279.2279264	74.3058414	0	0	15.87122227	0	0	0	388.7123703	733.8920799	0	0	0	0											3400	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	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:$25; Worldwide Coverage	9a:$100; 9b:$50	8a:$0	8b: X-Rays $0; Diagnostic $150; Therapeutic 20% Coins	9a:$100	12:20% Coins	3:$15; 5:$30; 9c:$30; 9d:$25	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$25; 7d:$25; 7f:$25; 16b:$0-$25; 17a:$0-$25; 4 Routine Footcare Visits	7e:Visits 1-10:$0; Visits 11+:$25; 7h:$25	7c:$15; 7i: PT $0 ST $15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20%	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	7g:Consult with Nutritionist $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0	13c:OTC $13 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0											0	82.11627623	67.47437092	7.724161948	0	27.39309211	1.227103214	0.24320472	42.43557516	76.06643674	0	212.8159217	100	0.2	28.0210677	0	25	24.79323496	15	0	0	0.2	0	0	0	20	19.01622718	0	0	0	0											NO	79.68131681	65.47358176	7.49512062	0	26.58081626	1.190716438	0.235993072	41.17725089	73.81087066	0	206.5053806	97.03474203	0.194069484	27.19017076	0	24.25868551	24.05805158	14.5552113	0	0	0.18071829	0	0	0	20	19.01622718	0	0	0	0												5.9881	0.197606762	0.519151876	0	0.719876546	0.136243862	0.10246648	1.455271891	1.838316628	0	5.86187179	0.130289951	0.010069694	0.12019577	0	8.005435341	0.559806655	0.090128102	0	0	2.868220155	0	0	0	0.647853951	1.16298821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.4139	0	1.092447697	5.9881	0.197606762	0.519151876	0	0.719876546	0.136243862	0.10246648	1.455271891	1.838316628	0	5.86187179	0.130289951	0.010069694	0.12019577	0	8.005435341	0.559806655	0.090128102	0	0	2.868220155	0	0	0	0.647853951	1.16298821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.4139	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.9881	0.197606762	0.519151876	0	0.719876546	0.136243862	0.10246648	1.455271891	1.838316628	0	5.86187179	0.130289951	0.010069694	0.12019577	0	8.005435341	0.559806655	0.090128102	0	0	2.868220155	0	0	0	0.647853951	1.16298821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.4139
H2593_009_0	2011	5																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	2678.053598	169.0702954	0	0	1275.568527	7661.06256	33581.82543	101.8324834	64.16502051	0	113.8735263	9.491797028	0	349.3962796	0	0	0	0	0	0	7.405431782	0	0	0	375	678.0455398	0	0	0	0											3400	1a:$100 Days 1-5; 125 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: $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:$100; 9b:$50	8a:$0	8b: X-Rays $0; Diagnostic $150; Therapeutic 20% Coins	9a:$100	12:$0	3:$15; 5:$30; 9c:$30; 9d:$15	"7a:$0; 14b,14c (ippe/ppps), 14c:Comprehensive Health Assessment $0, 14d,14e,14f,14i,14j:$0"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 6 Routine Footcare Visits	7e:Visits 1-10:$0; Visits 11+:$25; 7h:$0; 7g: NP Psych Services $0	7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20%	14a:$0; 17b:$0; First 3 Pints of Blood	10b:$0 24 Plan Approved Location Trips	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Comprehensive Health Assessment $0	13c:OTC $40 per month Allowance											0	82.11627623	67.47437092	0	0	27.39309211	1.227103214	0.115547484	50	76.59574468	0	480.6810147	100	0	18.40779166	0	0	0	0	0	0	0.2	0	0	0	20	19.01622718	0	0	0	0											NO	79.3238162	65.17982601	0	0	26.46155796	1.185374133	0.111618157	48.29969151	73.99101678	0	464.3348945	96.59938302	0	17.78181317	0	0	0	0	0	0	0.192698762	0	0	0	20	19.01622718	0	0	0	0												17.7028	0.918331036	0	0	2.812794208	0.756768783	0.312361788	0.409873128	0.395636259	0	4.406287651	0.076408478	0	0.517741614	0	0	0	0	0	0	1.427017537	0	0	0	0.625	1.074489002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4355	0	1.050638626	17.7028	0.918331036	0	0	2.812794208	0.756768783	0.312361788	0.409873128	0.395636259	0	4.406287651	0.076408478	0	0.517741614	0	0	0	0	0	0	1.427017537	0	0	0	0.625	1.074489002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4355	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.7028	0.918331036	0	0	2.812794208	0.756768783	0.312361788	0.409873128	0.395636259	0	4.406287651	0.076408478	0	0.517741614	0	0	0	0	0	0	1.427017537	0	0	0	0.625	1.074489002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4355
H2593_011_0	2011	4																															D	D	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	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1285.178472	46.68566213	1148.463763	0	456.174697	2167.355271	4339.816165	479.0475666	345.7268653	0	347.5657304	14.62690584	0.668153313	75.0936481	0	3815.203314	289.7142653	51.82604992	0	0	17.66980674	0	0	0	398.2869586	735.7820991	0	0	0	0											3400	1a:$100 Days 1-5; 75 Add'l Days	1b:$100 Days 1-5; 60 Add'l Days	"2:$0 Days 1-31, $75 Days 32-100; 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; 11c:$0	4a:$50 (waived if admitted); 4b:$25; Worldwide Coverage	9a:$100; 9b:$50	8a:$0	8b: X-Rays $0; Diagnostic $150; Therapeutic 20% Coins	9a:$100	12:20% Coins	3:$15; 5:$30; 9c:$30; 9d:$25	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	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	7c:$15; 7i: PT $0 ST $15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20%	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	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 14c:Annual CCC Visit $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0 13e:Electronic Health Monitoring $0											0	82.11627623	67.47437092	3.213669261	0	27.39309211	1.227103214	0.494096177	43.22745831	75.96153846	0	210.2168663	100	0.2	27.31141542	0	25	24.75577653	15	0	0	0.2	0	0	0	20	19.01622718	0	0	0	0											NO	79.00558716	64.91833943	3.091930596	0	26.35540023	1.180618683	0.475379065	41.58993663	73.08400019	0	202.2535327	96.21184835	0.192423697	26.27681758	0	24.05296209	23.81799017	14.43177725	0	0	0.177630021	0	0	0	20	19.01622718	0	0	0	0												8.4614	0.252562972	0.295914187	0	1.001888893	0.213235011	0.171921479	1.660296495	2.105591857	0	5.858033067	0.117273471	0.12856853	0.164435174	0	7.647245055	0.575034294	0.062328501	0	0	3.138688137	0	0	0	0.663811598	1.165983296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6842	0	1.525896661	8.4614	0.252562972	0.295914187	0	1.001888893	0.213235011	0.171921479	1.660296495	2.105591857	0	5.858033067	0.117273471	0.12856853	0.164435174	0	7.647245055	0.575034294	0.062328501	0	0	3.138688137	0	0	0	0.663811598	1.165983296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6842	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.4614	0.252562972	0.295914187	0	1.001888893	0.213235011	0.171921479	1.660296495	2.105591857	0	5.858033067	0.117273471	0.12856853	0.164435174	0	7.647245055	0.575034294	0.062328501	0	0	3.138688137	0	0	0	0.663811598	1.165983296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6842
H2593_013_0	2011	4																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	1928.868637	35.50168133	1975.211884	0	731.9127502	3982.904408	6634.434004	475.1638274	388.8524233	0	1297.369883	25.86334757	0	90.10068524	0	4782.745265	342.0735367	83.33482579	0	0	22.16645119	0	0	0	394.457668	729.5969249	0	0	0	0											3400	1a:$100 Days 1-5; 125 Add'l Days	1b:$100 Days 1-5; 60 Add'l Days	"2:$0 Days 1-31, $75 Days 32-100; 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; 11c:$0	4a:$50 (waived if admitted); 4b:$0; Worldwide Coverage	9a:$75; 9b:$25	8a:$0	8b: X-Rays $15; Diagnostic $50; Therapeutic $0	9a:$75	12:$0	3:$15; 5:$30; 9c:$25; 9d:$25	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	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	7c:$15; 7i: PT $0 ST $15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	10b:$0 24 Plan Approved Location Trips	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	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 14c:Annual CCC Visit $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0 13e:Electronic Health Monitoring $0											0	82.11627623	67.47437092	3.213669261	0	27.39309211	1.227103214	0.42400658	50	53.4996133	0	26.94713265	75	0	26.15987984	0	24.99742327	24.73686002	15	0	0	0.179391282	0	0	0	20	19.01622718	0	0	0	0											NO	78.13692176	64.20456314	3.057934859	0	26.06562295	1.167637796	0.403459223	47.57700017	50.90702222	0	25.64127469	71.36550025	0	24.89217215	0	23.78604823	23.53811187	14.27310005	0	0	0.156055894	0	0	0	20	19.01622718	0	0	0	0												12.5597	0.189947495	0.503339106	0	1.589813482	0.387549144	0.223060299	1.883905791	1.649609913	0	2.772184797	0.153812561	0	0.186900147	0	9.48021746	0.670980431	0.099120526	0	0	3.459205358	0	0	0	0.657429447	1.15618174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6229	0	2.164787312	12.5597	0.189947495	0.503339106	0	1.589813482	0.387549144	0.223060299	1.883905791	1.649609913	0	2.772184797	0.153812561	0	0.186900147	0	9.48021746	0.670980431	0.099120526	0	0	3.459205358	0	0	0	0.657429447	1.15618174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6229	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.5597	0.189947495	0.503339106	0	1.589813482	0.387549144	0.223060299	1.883905791	1.649609913	0	2.772184797	0.153812561	0	0.186900147	0	9.48021746	0.670980431	0.099120526	0	0	3.459205358	0	0	0	0.657429447	1.15618174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6229
H2593_014_0	2011	4																															D	D	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	V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	2049.272432	37.71776649	2098.508517	0	777.6001916	4231.541435	7048.680965	665.4006756	413.1253606	0	482.7539859	27.47778887	1.152099159	95.72494821	0	5067.369929	360.5915331	88.53675043	0	0	23.71030164	0	0	0	395.5065484	732.4028394	0	0	0	0											3400	1a:$100 Days 1-5; 125 Add'l Days	1b:$100 Days 1-5; 60 Add'l Days	"2:$0 Days 1-31, $75 Days 32-100; 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; 11c:$0	4a:$50 (waived if admitted); 4b:$25; Worldwide Coverage	9a:$100; 9b:$50	8a:$0	8b: X-Rays $0; Diagnostic $150; Therapeutic 20% Coins	9a:$100	12:20% Coins	3:$15; 5:$30; 9c:$30; 9d:$25	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	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	7c:$15; 7i: PT $0 ST $15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20%	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	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 14c:Annual CCC Visit $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0 13e:Electronic Health Monitoring $0											0	82.11627623	67.47437092	3.213669261	0	27.39309211	1.227103214	0.431582872	43.96693646	78.4996133	0	211.6049998	100	0.2	26.18240988	0	24.99745372	24.73479126	15	0	0	0.2	0	0	0	20	19.01622718	0	0	0	0											NO	76.17425336	62.59185221	2.981124665	0	25.41089823	1.138308693	0.400353067	40.78544121	72.81929608	0	196.2930324	92.76389147	0.185527783	24.28782228	0	23.18861083	22.94495492	13.91458372	0	0	0.167738836	0	0	0	20	19.01622718	0	0	0	0												13.0085	0.196735405	0.521326292	0	1.646626611	0.401400033	0.23516342	2.261555012	2.506958163	0	7.896770315	0.212412219	0.213746403	0.193745878	0	9.79210577	0.689479706	0.102662669	0	0	3.977138409	0	0	0	0.659177581	1.160628232	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6761	0	3.875722956	13.0085	0.196735405	0.521326292	0	1.646626611	0.401400033	0.23516342	2.261555012	2.506958163	0	7.896770315	0.212412219	0.213746403	0.193745878	0	9.79210577	0.689479706	0.102662669	0	0	3.977138409	0	0	0	0.659177581	1.160628232	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6761	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.0085	0.196735405	0.521326292	0	1.646626611	0.401400033	0.23516342	2.261555012	2.506958163	0	7.896770315	0.212412219	0.213746403	0.193745878	0	9.79210577	0.689479706	0.102662669	0	0	3.977138409	0	0	0	0.659177581	1.160628232	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6761
H2610_005_0	2011	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	Coin	V	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	801.4336644	18.89424256	879.0132191	1536.87445	296.55225	7.786084355	0.922360385	921.5950813	118.37128	21.17794473	36.00112872	13.1812159	0.344956094	1605.069252	4109.30124	5380.114998	107.2029332	586.25256	0	4040.845935	32.84561168	34.30157458	159.4797542	442.8735516	167.5073411	197.7341734	24.18034507	0	0	0											2250	1a: $210 Days 1-10	1b: $210 Days 1-10	2: $100 Days 8-37	6: none	10a: $150	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $25	9b: $75	8a: 20%	8b: 20%	5: none	12: 20%	3: $30; 9a: 20%; 9a: $175; 9c: $25; 9c: $35; 9d: $30	7a: $5	16b: $25; 7d: $30	7h: $25; 7h: $35	7c: $30; 7i: $30	7d: $0	7b: $15; 7f: $30	15: 20%	13a: none	10b: none	16b: $25	17a: $20	17b: $20	18a: $20	18b: 100%	14a: $0	20: 100%												190.2681353	202.3537095	60.74202825	0	117.5274797	0.2	0.200000001	17.63031165	75.25646143	0.009182797	0.188448527	0	0.2	32.29144023	4.328788766	16.75410142	33.27447284	28.65422126	0	1.712960484	0.176269418	0	0	24.98336286	17.58567027	17.04569146	19.46932752	0	0	0											NO	145.8838068	0	20.99565141	0	90.23286349	0.147708226	0.196123002	15.8096133	74.44893988	0.008244652	0.13712245	0	0.058417497	26.48181936	4.177391979	15.42264935	30.66364627	26.75586954	0	1.694502429	0.057729573	0	0	24.98336286	17.58567027	17.04569146	19.46932752	0	0	0												9.743	0	1.537954595	0	2.229896558	1.150068711	0.180896088	1.214171822	0.734384692	0.174604779	4.936562974	0	0.020151472	3.542096165	1.430513503	6.914635591	0.273936069	1.307141418	0	0.570601938	1.896163137	0	0	0.92203922	0.245477406	0.280876309	0.039231255	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3444	0	14.71826954	9.743	0	1.537954595	0	2.229896558	1.150068711	0.180896088	1.214171822	0.734384692	0.174604779	4.936562974	0	0.020151472	3.542096165	1.430513503	6.914635591	0.273936069	1.307141418	0	0.570601938	1.896163137	0	0	0.92203922	0.245477406	0.280876309	0.039231255	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3444	NO																																																																																		0		0	9.743	0	1.537954595	0	2.229896558	1.150068711	0.180896088	1.214171822	0.734384692	0.174604779	4.936562974	0	0.020151472	3.542096165	1.430513503	6.914635591	0.273936069	1.307141418	0	0.570601938	1.896163137	0	0	0.92203922	0.245477406	0.280876309	0.039231255	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3444
H2610_006_0	2011	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	Coin	V	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1455.160431	23.21954581	1181.438065	2567.388052	507.5429582	15.13005894	1.695887527	1340.26917	183.3213532	28.11372999	49.84297438	41.71804525	0.242278997	3056.894672	5355.200847	7729.843117	265.2156676	992.1889621	0	3908.482707	54.58365521	27.10060114	184.1050622	501.4589348	191.3546427	226.3657312	32.9279125	0	0	0											1700	1a: $175 Days 1-6	1b: $175 Days 1-6	2: $50 Days 8-41	6: none	10a: $150	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $25	9b: $50	8a: 20%	8b: 20%	5: none	12: 20%	3: $15; 9a: 20%; 9a: $125; 9c: $25; 9c: $35; 9d: $15	7a: $5	16b: $25; 7d: $15	7h: $25; 7h: $35	7c: $15; 7i: $15	7d: $0	7b: $15; 7f: $15	15: 20%	13a: none	10b: none	16b: $25	17a: $20	17b: $20	18a: $20	18b: 100%	14a: $0	20: 100%												136.5289371	172.6099813	30.45791188	0	97.89138212	0.200000001	0.2	14.71329202	49.29276662	0.013370378	0.189053574	0	0.2	20.15375336	4.201187857	9.083186423	33.2011898	14.31354811	0	1.431690682	0.15224845	0	0	24.97396936	16.22592302	17.6956791	19.28565274	0	0	0											NO	106.3519285	0	12.01930799	0	66.56918837	0.142389145	0.195544255	12.05596052	46.84411806	0.0121594	0.131036898	0	0.14555242	15.81044388	3.996629109	8.115311424	31.29038094	13.48397227	0	1.35217244	0.043963845	0	0	24.97396936	16.22592302	17.6956791	19.22629871	0	0	0												12.8966	0	1.183338998	0	2.815560233	2.15435615	0.331621063	1.34651935	0.715627259	0.341846094	6.531268771	0	0.035264294	4.027571805	1.783562633	5.227507013	0.691558272	1.114887371	0	0.440411883	2.39970733	0	0	1.043618339	0.258742142	0.333807945	0.052756823	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7261	0	19.16703219	12.8966	0	1.183338998	0	2.815560233	2.15435615	0.331621063	1.34651935	0.715627259	0.341846094	6.531268771	0	0.035264294	4.027571805	1.783562633	5.227507013	0.691558272	1.114887371	0	0.440411883	2.39970733	0	0	1.043618339	0.258742142	0.333807945	0.052756823	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7261	NO																																																																																		0		0	12.8966	0	1.183338998	0	2.815560233	2.15435615	0.331621063	1.34651935	0.715627259	0.341846094	6.531268771	0	0.035264294	4.027571805	1.783562633	5.227507013	0.691558272	1.114887371	0	0.440411883	2.39970733	0	0	1.043618339	0.258742142	0.333807945	0.052756823	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7261
H2610_010_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	Coin	V	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1803.244014	15.21480053	1115.446453	2294.198684	447.1952876	18.77215011	3.313445448	1269.924384	135.6280609	28.93577995	44.21105249	18.12748694	0.463756413	3101.806778	5655.901399	7049.26795	98.25000426	663.6992015	0	3582.685452	47.33951762	43.91915641	323.9360542	359.9899691	144.6835051	175.8573255	29.63025827	0	0	0											2250	1a: $200 Days 1-10	1b: $200 Days 1-10	2: $100 Days 8-37	6: none	10a: $150	11a: 20%	11b: 20%	4a: $50; 4b: $25	9b: $75	8a: 20%	8b: 20%	5: none	12: 20%	3: $30; 9a: 20%; 9a: $175; 9c: $25; 9c: $35; 9d: $30	7a: none	16b: $25; 7d: $30	7h: $25; 7h: $35	7c: $30; 7i: $30	7d: $0	7b: $15; 7f: $30	15: 20%	13a: none	10b: none	16b: $25	17a: $20	17b: $20	18a: $20	18b: 100%	14a: $0	20: 100%												169.2522911	200	56.68159085	0	108.8810682	0.2	0.166582593	16.00198609	75.01127986	0.005928045	0.187017748	0	0.2	23.14405583	0	16.19535968	30.84591301	28.8581535	0	3.912490099	0.112013858	0	0	24.9767521	15.52225694	17.49145635	18.84468933	0	0	0											NO	119.703545	0	20.41202195	0	71.35692109	0.148241276	0.142133411	14.37927262	70.01581224	0.00497059	0.134220824	0	0.009631451	18.75820599	0	14.6060601	29.21088091	25.91251259	0	3.610340591	0.038968934	0	0	24.9767521	15.52225694	17.49145635	18.35857208	0	0	0												17.9879	0	1.897376457	0	2.659206571	2.78280748	0.470951304	1.521715744	0.791342404	0.1438279	5.934043898	0	0.004466647	4.848694206	0	8.580169277	0.239164098	1.433176159	0	1.077892893	1.844770518	0	0	0.749281685	0.187151212	0.256333394	0.045330769	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4556	0	22.16891775	17.9879	0	1.897376457	0	2.659206571	2.78280748	0.470951304	1.521715744	0.791342404	0.1438279	5.934043898	0	0.004466647	4.848694206	0	8.580169277	0.239164098	1.433176159	0	1.077892893	1.844770518	0	0	0.749281685	0.187151212	0.256333394	0.045330769	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4556	NO																																																																																		0		0	17.9879	0	1.897376457	0	2.659206571	2.78280748	0.470951304	1.521715744	0.791342404	0.1438279	5.934043898	0	0.004466647	4.848694206	0	8.580169277	0.239164098	1.433176159	0	1.077892893	1.844770518	0	0	0.749281685	0.187151212	0.256333394	0.045330769	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4556
H2610_011_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	Coin	V	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	711.9315466	7.313976697	697.4398075	1204.834031	248.2271869	6.177128584	0.803364803	751.980227	96.44913728	15.3659788	26.05819002	13.85761145	0.24110748	1161.234277	3264.203757	4248.076601	81.73523607	515.9898678	0	3005.820973	24.28175337	23.80567579	128.1201383	329.8184894	131.8784995	144.0350866	19.02246454	0	0	0											3400	1a: $300 Days 1-7	1b: $300 Days 1-7	2: $75 Days 9-53	6: none	10a: $150	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $25	9b: $100	8a: 20%	8b: 20%	5: none	12: 20%	3: $35; 9a: 20%; 9a: $200; 9c: $25; 9c: $35; 9d: $35	7a: $5	16b: $25; 7d: $35	7h: $25; 7h: $35	7c: $35; 7i: $35	7d: $0	7b: $15; 7f: $35	15: 20%	13a: none	10b: none	16b: $25	17a: $20	17b: $20	18a: $20	18b: 100%	14a: $0	20: 100%												275.3980641	300	32.94062793	0	103.4991877	0.2	0.2	18.53236679	98.35636715	0.008956811	0.188524729	0	0.2	36.38358472	4.282045207	19.08056219	32.40610578	32.69554248	0	2.270284829	0.149412419	0	0	24.94357993	16.36325779	17.37862609	18.94299882	0	0	0											NO	253.2030005	0	24.84801059	0	92.82600688	0.192132944	0.199455719	18.12945734	97.27470642	0.008947137	0.176773022	0	0.150739552	33.41008102	4.249949504	18.58612853	31.91814054	32.05294518	0	2.254053905	0.085989926	0	0	24.94357993	16.36325779	17.37862609	18.94299882	0	0	0												15.0219	0	1.444165977	0	1.920161547	1.186829903	0.160235704	1.136082787	0.781838459	0.137481524	4.606384988	0	0.036344434	3.233077607	1.156058428	6.579608141	0.217403063	1.378249579	0	0.564606875	2.087986171	0	0	0.685571154	0.179830157	0.208594326	0.030028544	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7525	0	4.827894778	15.0219	0	1.444165977	0	1.920161547	1.186829903	0.160235704	1.136082787	0.781838459	0.137481524	4.606384988	0	0.036344434	3.233077607	1.156058428	6.579608141	0.217403063	1.378249579	0	0.564606875	2.087986171	0	0	0.685571154	0.179830157	0.208594326	0.030028544	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7525	NO																																																																																		0		0	15.0219	0	1.444165977	0	1.920161547	1.186829903	0.160235704	1.136082787	0.781838459	0.137481524	4.606384988	0	0.036344434	3.233077607	1.156058428	6.579608141	0.217403063	1.378249579	0	0.564606875	2.087986171	0	0	0.685571154	0.179830157	0.208594326	0.030028544	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7525
H2610_803_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	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	189.0211629	1.147981079	25.52313479	9.208613348	7.117564412	7.442015731	0.881601096	17.04495403	8.246698019	20.24208317	34.4102251	0.292223788	0.329712353	35.59748988	28.26747818	70.16392817	0.575307687	3.476164485	0	14.72357714	31.39417896	1.161209432	0.670221075	1.394177093	0.479184619	1.609120642	0.129255159	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0	0.083537016	0.083537016	0.177299293	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.074501324	0.074501324	0.158121905	0	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0	0.207797805	0.207797805	0.207797805	0	0	0	0	0	0	0	0												14.0823	0.08552611	4.035766702	0	1.47901426	1.546434532	0.183194772	3.54190403	1.713645745	4.206260446	7.150369235	0.060723462	0.068513503	7.397080251	5.87391991	14.57991024	0.119547674	0.722339349	0	3.059527007	6.523641469	0.241296771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6709	0	9.29882808	14.0823	0.08552611	4.035766702	0	1.47901426	1.546434532	0.183194772	3.54190403	1.713645745	4.206260446	7.150369235	0.060723462	0.068513503	7.397080251	5.87391991	14.57991024	0.119547674	0.722339349	0	3.059527007	6.523641469	0.241296771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6709	NO																																																																																		0		0	14.0823	0.08552611	4.035766702	0	1.47901426	1.546434532	0.183194772	3.54190403	1.713645745	4.206260446	7.150369235	0.060723462	0.068513503	7.397080251	5.87391991	14.57991024	0.119547674	0.722339349	0	3.059527007	6.523641469	0.241296771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6709
H2610_804_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	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	189.0211629	1.147981079	25.52313479	9.208613348	7.117564412	7.442015731	0.881601096	17.04495403	8.246698019	20.24208317	34.4102251	0.292223788	0.329712353	35.59748988	28.26747818	70.16392817	0.575307687	3.476164485	0	14.72357714	31.39417896	1.161209432	0.670221075	1.394177093	0.479184619	1.609120642	0.129255159	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0	0.083537016	0.083537016	0.177299293	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.074501324	0.074501324	0.158121905	0	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0.207797805	0	0.207797805	0.207797805	0.207797805	0	0	0	0	0	0	0	0												14.0823	0.08552611	4.035766702	0	1.47901426	1.546434532	0.183194772	3.54190403	1.713645745	4.206260446	7.150369235	0.060723462	0.068513503	7.397080251	5.87391991	14.57991024	0.119547674	0.722339349	0	3.059527007	6.523641469	0.241296771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6709	0	9.29882808	14.0823	0.08552611	4.035766702	0	1.47901426	1.546434532	0.183194772	3.54190403	1.713645745	4.206260446	7.150369235	0.060723462	0.068513503	7.397080251	5.87391991	14.57991024	0.119547674	0.722339349	0	3.059527007	6.523641469	0.241296771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6709	NO																																																																																		0		0	14.0823	0.08552611	4.035766702	0	1.47901426	1.546434532	0.183194772	3.54190403	1.713645745	4.206260446	7.150369235	0.060723462	0.068513503	7.397080251	5.87391991	14.57991024	0.119547674	0.722339349	0	3.059527007	6.523641469	0.241296771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6709
H2611_001_0	2011	11																															D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	T	P	P	P	P	P	P	P											20.04615809	0.408791088	1.361919259	0.029221298	0.252779053	0.643328114	0.252610704	1.074570058	3.550804774	1.485407359	1.058872015	0.278743755	0.059184865	2.282170281	2.535935225	9.735010999	0.283841894	0.212921909	1.600752832	0.806275958	3.400087027	0.003691356	5.76E-09		0.044927082	0.011559052				0.171989505											51.5916	YES					3.285965988	8.362853934	3.28377755	286.1786064	46.15819056	19.30934543	13.76465883	3.623490495	0.769365379	29.66675372	5054.046815	8549.032468	491.6657265	2.767848612	19.78809489	10.48107167	44.19895628	0.000146583								160.4689019											3500	$0 copay	$0 copay	$0 copay	$0 copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	$50 Copay for ER and $50 for Urgent Care	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$15 Copay	$30 Copay	$30 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$30 Copay	$0 copay	N/A	$0 copay	$150 Limit Every Two Years	$30 Copay	N/A	$250 Limit	$30 Copay																0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.196956703	12.06796712	22.50064206	30	0.2	0.2	0.2	0.2	1								21.89211728											YES					0.14498917	0.14498917	0.14498917	36.24729241	0.14498917	0.14498917	0.14498917	0.14498917	0.14498917	0.142782944	8.748622661	16.31174705	21.74837545	0.14498917	0.14498917	0.14498917	0.14498917	1								21.74837545											6500	0	0	0	0	0.47642948	1.212523248	0.47611218	0.864433302	6.692437723	2.799645961	1.995726454	0.525366878	0.111549647	4.235906442	3.684662374	11.62080459	0.891077568	0.401308072	2.869059448	1.519641879	6.40836997	0.000146583	0	0	0	0	0	0	0	0.290828161	0	0	0	0	0	0	0	0	0	0	47.076	750	17.75279792	20.0462	0.408791088	1.361919259	0.029221298	0.729208534	1.855851362	0.728722884	1.93900336	10.2432425	4.28505332	3.054598469	0.804110633	0.170734512	6.518076723	6.220597599	21.35581559	1.174919462	0.614229981	4.46981228	2.325917837	9.808456997	0.003837939	5.76E-09	0	0.044927082	0.011559052	0	0	0	0.462817665	0	0	0	0	0	0	0	0	0	0	98.6676	NO	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	20% Coinsurance	40% Coinsurance	40% Coinsurance	$50 Copay for ER and $50 for Urgent Care	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	$150 Limit Every Two Years	40% Coinsurance	40% Coinsurance	$250 Limit	40% Coinsurance												6.3787	0.0265	0.1222		0.7532	0.073	0.0905	0.209	1.5967	0.2757	0.1317	0.0379	0.0169	0.3789	0.5873	2.592	0.1608	0.1633	0.2667	0.9058	0.3245	0.0011			0.0211	0.0151				0.0334											15.1618	1250	9.133798298	26.4249	0.435248246	1.484087317	0.029221298	1.482427301	1.928827496	0.819264487	2.147959628	11.8399923	4.560746417	3.18625343	0.841978946	0.187664582	6.896975194	6.807878354	23.94778231	1.335759912	0.777579342	4.736489358	3.231679228	10.13295023	0.004893866	5.76E-09	0	0.066000761	0.026636367	0	0	0	0.49617408	0	0	0	0	0	0	0	0	0	0	113.8294
H2611_002_0	2011	9																															D	D	D	V	T	Coin	Coin	V	P	P	Coin	Coin	Coin	P	P	P	P	P	P	P	Coin	P	T	V	V	P	P	P	P	P																																																			0	NO	2158.321819	34.87027063	1010.599536		150.6939852	12.16034394	2.271868212	336.6245069			14.87093508	1.406861344	7.815180357	471.4967947	4089.721752	4799.440772	403.971547	125.7095077			38.44450642									310.7304239												"$50/day, days 1-10"	"$175/day, days 1-10"	$0 days 1-20 $100 days 21-100	$0 Copay	$75 copayment	20% Coinsurance	20% Coinsurance	$50 Copay for ER	$0 Copay	$0 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	$5 copay for CORF; $15 copay Outpatient Rehab services	$5 Copay	$15 Copay; 20% coins for Dialysis	$15 Copay	$15 Copay	$0 Copay	$0 Copay	20% Coinsurance	$15 Copay	Not Covered	Not Covered	$0 Copay	$150 limit per 2 years	$0 Copay	Not Covered	$300 Limit	$15 Copay for Routine Foot Care and Non-Covered Chiro											0	26.48044549	117.7704216	42.22536209		75	0.2	0.2	49.99657586			0.2	0.2	0.2	15	5.000034964	15.07175204	15	13.46155047			0.2									5											NO	25.72009175	114.3887874	41.01291226		72.84646636	0.194257244	0.194257244	48.56098509			0.194257244	0.194257244	0.194257244	14.56929327	4.856465051	14.63898504	14.56929327	13.07501845			0.194257244									4.856431091												4.626	0.332397331	3.453969174	0	0.914793694	2.362234896	0.441326857	1.362234805	0	0	2.888786859	0.273293007	1.518155395	0.572447923	1.655132563	5.854911807	0.490464995	0.136971178	0	0	7.468123849	0	0	0	0	0	0	0	0	0.125753408	0	0	0	0	0	0	0	0	0	0	34.477	0	1.019231546	4.626	0.332397331	3.453969174	0	0.914793694	2.362234896	0.441326857	1.362234805	0	0	2.888786859	0.273293007	1.518155395	0.572447923	1.655132563	5.854911807	0.490464995	0.136971178	0	0	7.468123849	0	0	0	0	0	0	0	0	0.125753408	0	0	0	0	0	0	0	0	0	0	34.477	YES	$100/day for days 1-10	$175/day for days 1-10	20% Coinsurance	$0 Copay	$75 copayment	20% Coinsurance	20% Coinsurance	$50 Copay for ER	$150 Copay	$0 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	$25 copay	$15 Copay	$25 Copay	$25 Copay	$25 Copay	20% Coinsurance	$0 Copay	20% Coinsurance	$25 Copay	Not Covered	Not Covered	$25 Copay	$25 Copay; $150 limit per 2 years	$25 Copay	Not Covered	20% Coinsurance	$25 Copay for Routine Foot Care and Non-Covered Chiro											6700	1.304	0.0021	0.7191		0.5873	0.3574	0.0379	0.0959	0.3775		0.0773	1.1235	0.0013	0.0341	0.2696	1.5022	0.122	0.1906	0.3292		0.211				0.0792					0.0865											7.5079	0	0.221913536	5.9301	0.334499287	4.173036751	0	1.50205544	2.719657625	0.479276405	1.458094654	0.377521742	0	2.966124234	1.396781068	1.519469433	0.60656353	1.924764495	7.357136525	0.612485057	0.327579226	0.329232603	0	7.679096291	0	0	0	0.079223088	0	0	0	0	0.212285573	0	0	0	0	0	0	0	0	0	0	41.9849
H2611_008_0	2011	10																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	V	V	V	V	P	P	P	Coin	V	T	Coin	V	V	V	P	P	V																																																			0	NO	1512.571082	32.86229515	355.4782907		155.9025037	6.491201483	1.254026703	209.8377075	240.3462864		6.707273475	2.368679497	1.28662561	176.912154	2622.969344	3217.594252	146.5529125	284.7449433		191.1617109	33.02912206	0.3030175			162.8101563					87.71670512												$220/day days 1-8	$220/day days 1-8	"$0/day days 1-20, $130/day days 21-100"	$0 copay	$75/trip	20% coins	20% coins	"$50 copay ER, $25 copay Urgent Care"	$150 copay for ASC; $200 copay for OP Surgery	$0 copay	20% coinsurance	20% coins	20% coins	"$0 Copay for OP Rehab, $150 copay for OP Partial Hospitalization"	$10 copay	$35 copay	$35 copay	$35 copay	No cost sharing	$35 copay	20% coins	$35 copay	N/A	"$0 copay for Preventative Services, 2 visit limit"	$35 copay	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$35 copay	N/A	Fitness benefit limited to $500/year	$35 copay											0	103.5370853	132.7674214	54.89297072		75	0.2	0.2	47.42982732	200		0.2	0.2	0.2	35.59252803	10.00143706	34.96959506	35	34.62001944		31.35673071	0.2	9.707721752			28.83659315					22.90058082											NO	93.31536998	119.6599365	49.47365342		67.59561302	0.180254968	0.180254968	42.74731004	180.2549681		0.180254968	0.180254968	0.180254968	32.07865002	9.014043589	31.5172162	31.54461941	31.25429171		30.09761644	0.180254968	9.707721752			28.83659315					22.90058082												11.7622	0.327691679	1.465567479	0	0.878193776	1.170071316	0.226044543	0.747499795	3.610301015	0	1.209019366	0.426966247	0.231920658	0.472925256	1.970296667	8.450801139	0.385246321	0.741625127	0	0.479459321	5.953663341	0.000245134	0	0	0.391240853	0	0	0	0	0.167396958	0	0	0	0	0	0	0	0	0	0	41.0684	0	4.403550982	11.7622	0.327691679	1.465567479	0	0.878193776	1.170071316	0.226044543	0.747499795	3.610301015	0	1.209019366	0.426966247	0.231920658	0.472925256	1.970296667	8.450801139	0.385246321	0.741625127	0	0.479459321	5.953663341	0.000245134	0	0	0.391240853	0	0	0	0	0.167396958	0	0	0	0	0	0	0	0	0	0	41.0684	YES	30% coins	30% coins	30% coins	30% coins	$75/trip	30% coins	30% coins	$50 copay	30% coins	30% coins	30% coins	30% coins	20% coins	30% coins	30% coins	30% coins	30% coins	30% coins	30% coins	30% coins	30% coins	30% coins	N/A	N/A	30% coins	$150 max benefit every 2 years (combined with IN allowance)	30% coins	N/A	30% coins	30% coins											4800	3.9211	0.0387	1.1659		0.1919	0.1683	0.1298	0.0617	1.6281	0.5283	0.129	0.0388	0.0165	0.3393	0.9412	3.2601	0.1026	0.138	0.595	0.4489	0.5202	0.0015		0.0371	0.0119					0.0268											14.4407	0	1.581824344	15.6832	0.366374059	2.631460084	0	1.070094879	1.338388679	0.355856793	0.809234358	5.238407643	0.528306106	1.338066288	0.465801218	0.248422692	0.812176563	2.911452216	11.71086153	0.487875617	0.879626982	0.594990861	0.928326932	6.47389256	0.00178898	0	0.037064567	0.403145965	0	0	0	0	0.194181274	0	0	0	0	0	0	0	0	0	0	55.509
H2611_018_0	2011	9																															A	A	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	P	P	P	P	P	P	P	Coin	P	T	V	V	P	P	P	P	P																																																			0	NO	250.2324159	5.547791587	486.7459172		158.0607072	7.114784876	1.893504726	248.2707289	356.4362464		13.10990898	8.588825215	0.880871031	268.2665876	3091.289206	2839.6555	124.6637956	27.96944133			27.28274455									275.6987788												$650 per admit	$650 per admit	"$0 days 1-9, $50 days 10-20; $100 days 21-100"	$0 copay	$100 copay	20% Coinsurance	20% Coinsurance	"$50 Copay for ER, $35 Urgent Care"	"$200 Copay for OP Surgery, $150 for ASC"	$0 copay	20% Coinsurance	$35 Copay	20% Coinsurance	$35 copay	$10 Copay	$35 Copay	$35 Copay	$35 Copay	$0 copay	$0 copay	20% Coinsurance	"$35 Copay for eye exam, hearing screening, dental"	N/A	N/A	$0 Copay	$150 routine eyewear per 2 CY	$0 Copay	N/A	$300 Limit for fitness benefit; $10 copay for smoking cessation	$35 Copay											0	650	650	54.92167121		100	0.2	0.2	49.98378378	200		0.2	35	0.2	35	10	34.89031283	35	32.26190476			0.2									10											NO	574.6317847	574.6317847	48.55344299		88.40488996	0.17680978	0.17680978	44.18810905	176.8097799		0.17680978	30.94171149	0.17680978	30.94171149	8.840488996	30.85296595	30.94171149	28.5211014			0.17680978									8.840488996												11.9826	0.265661448	1.969432512	0	1.164444953	1.257963548	0.334790154	0.914217837	5.251784524	0	2.317960121	0.022146079	0.155746613	0.691718946	2.277375684	7.300982872	0.3214426	0.066476606	0	0	4.823856059	0	0	0	0	0	0	0	0	0.203109335	0	0	0	0	0	0	0	0	0	0	41.3217	0	5.417522367	11.9826	0.265661448	1.969432512	0	1.164444953	1.257963548	0.334790154	0.914217837	5.251784524	0	2.317960121	0.022146079	0.155746613	0.691718946	2.277375684	7.300982872	0.3214426	0.066476606	0	0	4.823856059	0	0	0	0	0	0	0	0	0.203109335	0	0	0	0	0	0	0	0	0	0	41.3217	YES	30% Coinsurance	30% Coinsurance	30% Coinsurance	25% Coinsurance	$100 copay	25% Coinsurance	25% Coinsurance	"$50 Copay for ER, $35 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	N/A	N/A	25% Coinsurance	$150 routine eyewear per 2 CY	25% Coinsurance	N/A	25% Coinsurance	25% Coinsurance											4000	3.4627	0.0424	0.2644		0.0839	0.1133	0.0311	0.0659	1.0919	0.1636	0.2254	0.0219	0.014	0.5209	0.4507	1.4083	0.0148	0.0033	0.2146	0.1028	0.3041				0.0148					0.0405											8.6554	0	1.135237734	15.4454	0.3080686	2.233810375	0	1.248322068	1.371230338	0.365931068	0.980070632	6.343726582	0.163630318	2.543316158	0.044087387	0.169770008	1.212568984	2.728112874	8.709238577	0.336271684	0.069797315	0.214594521	0.102848286	5.127982075	0	0	0	0.014789844	0	0	0	0	0.243623278	0	0	0	0	0	0	0	0	0	0	49.9772
H2611_807_0	2011	9																															A	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	P	P	P	P	P	P	P	Coin	P	T	V	V	P	P	P	P	P											13.27047714	0.172730257	0.957359764	0.015287949	0.382524612	0.408895592	0.156477477	0.779021396	2.781335787	0.870049703	1.280427107	0.17716973	0.110530968	1.245812502	1.963556432	6.639124941	0.089156538	0.14501213	1.173854249	0.589490187	3.691492355	0.006893809	1.08E-08		0.034186752	0.011465182				0.098760019											37.0511	YES						8.142158965	3.027042743	314.4580049			24.18295438		2.200954795	11.8930014	5118.975894	7008.448932	249.5971856				73.50707168	0.494197405								148.760755											3500	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	20% Coinsurance	20% Coinsurance	$50 copay for ER; $25 copay for Urgent Care	$0 copay	$0 copay	20% Coinsurance	$0 copay	20% Coinsurance	"$30 copay for OP Rehab, $25 copay for OP Partial Hospitalization"	$15 copay	$30 Copay for OV; $0 for Hepatitis B immun; $15 all other Immun.	$30 Copay	$0 copay	$0 copay	$0 copay	20% Coinsurance	$30 Copay	$0 copay	$30 Copay	$0 copay	$150 limit per 2 years	$30 Copay	N/A	$0 copay	$30 Copay																	0.2	0.2	46.92687847			0.2		0.2	29.375	15	28.37328993	30				0.2	10.18224403								24.45657393											YES						0.168269484	0.168269484	39.48180816			0.168269484		0.168269484	24.71458048	12.62021131	23.8717943	25.24042262				0.168269484	10.18224403								24.45657393											6500	0	0	0	0	0	1.370076889	0.509358921	1.034614219	0	0	4.069253258	0	0.370353528	0.024494212	5.383546456	13.94202094	0.524994871	0	0	0	12.36899703	0.000419337	0	0	0	0	0	0	0	0.303181534	0	0	0	0	0	0	0	0	0	0	39.9013	500	7.466925938	13.2705	0.172730257	0.957359764	0.015287949	0.382524612	1.77897248	0.665836398	1.813635615	2.781335787	0.870049703	5.349680366	0.17716973	0.480884496	1.270306713	7.347102888	20.58114588	0.614151409	0.14501213	1.173854249	0.589490187	16.06048939	0.007313145	1.08E-08	0	0.034186752	0.011465182	0	0	0	0.401941553	0	0	0	0	0	0	0	0	0	0	76.9524	YES	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	20% Coinsurance	40% Coinsurance	40% Coinsurance	$50 copay for ER; $25 copay for Urgent Care	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	N/A	40% Coinsurance	40% Coinsurance											10000	3.4168	0.0477	0.2203		0.1059	0.1111	0.028	0.0837	0.6777	0.205	0.1492	0.0479	0.0305	0.324	0.4583	1.7627	0.0235	0.0381	0.2789	0.2154	0.4991	0.0019			0.0188	0.0331				0.0241											8.8018	1000	11.39615772	16.6873	0.220429007	1.177612582	0.015287949	0.48840795	1.890070654	0.693821534	1.897361572	3.45904522	1.07504639	5.498905646	0.225056637	0.511407168	1.59433674	7.805443673	22.34385148	0.637618028	0.183077228	1.452799951	0.804922107	16.55957013	0.009216842	1.08E-08	0	0.052992247	0.044575407	0	0	0	0.426081329	0	0	0	0	0	0	0	0	0	0	85.7542
H2611_809_0	2011	8																															A	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	P	P	P	P	P	P	P	Coin	P	T	V	V	P	P	P	P	P											5.129159796	0.05010441	0.520283806	0.003096264	0.142235774	0.194759804	0.051694	0.417172158	1.930432837	0.280834542	0.35048096	0.031108609	0.019882511	0.846136067	0.78768061	2.674143556	0.021041733	0.006595888	0.381366612	0.184450027	0.882097366	0.001314407			0.029316335	0.000844349		7.67E-07		0.083329329											15.0196	YES						4.938035612	1.274853926	167.7179077			8.109803022		0.504110946	1.718856121		2403.337557	72.65527338				22.36512939	4.654138479																			3500	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	20% Coinsurance	20% Coinsurance	$40 copay for ER	$0 copay	$0 copay	20% Coinsurance	$0 copay	20% Coinsurance	$5 Copay	$0 copay	$30 OV Copay; $5 copay for Podiatry	$5 Copay	$0 copay	$0 copay	$0 copay	20% Coinsurance	$30 copay for eye and hearing exams; $5 copay for dental	$0 copay	$5 Copay	$0 copay	$150 limit per 2 years	$30 Copay	Not Covered	$0 copay	$5 Copay for Routine Foot Care and Non-Covered Chiro																	0.2	0.2	40			0.2		0.2	5		28.70760302	5				0.2	30																			YES						0.197303259	0.197303259	39.46065173			0.197303259		0.197303259	4.932581466		28.32051811	4.932581466				0.197303259	29.59548879																			6500	0	0	0	0	0	0.974290518	0.251532834	0.551521495	0	0	1.600090563	0	0.099462732	0.000706533	0	5.671980401	0.029864838	0	0	0	4.412712909	0.011478459	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.6036	200	0.185934599	5.1292	0.05010441	0.520283806	0.003096264	0.142235774	1.169050321	0.303226834	0.968693653	1.930432837	0.280834542	1.950571523	0.031108609	0.119345244	0.846842601	0.78768061	8.346123956	0.050906571	0.006595888	0.381366612	0.184450027	5.294810275	0.012792866	0	0	0.029316335	0.000844349	0	7.67E-07	0	0.083329329	0	0	0	0	0	0	0	0	0	0	28.6232	YES	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	20% Coinsurance	40% Coinsurance	40% Coinsurance	$40 copay for ER	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	Not Covered	40% Coinsurance	40% Coinsurance											10000	2.4609	0.0226	0.7326		0.0334	0.0724	0.0344	0.0695	1.101	0.1857	0.144	0.014	0.009	0.3853	0.305	1.1664	0.018	0.0216	0.1852	0.2229	0.1943				0.0094	0.0004				0.0353											7.4232	1000	6.352077866	7.5901	0.072680125	1.252898873	0.003096264	0.175647009	1.24140827	0.337672654	1.038209647	3.031408604	0.466569184	2.094535174	0.045125322	0.128303775	1.232111194	1.09267758	9.512484036	0.068868907	0.028227497	0.566587496	0.407312856	5.489094361	0.012792866	0	0	0.038764495	0.00120829	0	7.67E-07	0	0.118630592	0	0	0	0	0	0	0	0	0	0	36.0464
H2613_001_0	2011	6	G.	H.6	H.7	I.7							OP Facility - Surgery	OP Facility - Other	OP Facility - Other	Professional								Lab	Radiology	Radiology							D	D	D	V	T	Coin	Coin	V	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	V		V	V	V	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	0	0	0	0	0	0	0	0	0	0	YES	1348.963112	37.58908448	543.677605	40.62046226	163.9975379	17.02274784	5.267100442	364.4637659	48.11634516	7485.400237	371.6189229	2.842102048	0.036803906	88.1623135	2745.31452	2995.213305	9.97213732	1025.344089	623.4818393	1504.304357	28.78749849	1.218978523	0	0	302.4	0	162	0	7.144217781	0	800.1468524	5.587745296	23.42643927	22.29159727	0	0	0	0	0	0	5000	1A: $225/day (days1-7) no yrly max	1B: $225/day (days1-7) no yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: N/A	9A: 20% coin; 9B: 20% coin	8A: $0 -$75 copay	8B: $75 copay	9A: 20% coin	12: 20% coin	3: $35 copay; 5: $40 copay; 9C: $40 copay; 9D: $35 copay	7A: $20 copay; 7G: $20 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35-$50 copay; 7I: $35-$50 copay	8B: $75 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0-$35; 17B: $0; 18A: $35	15: 20% coin	13A: $0 copay	10B: Not covered	-	17A: $35 copay	-	18A: $35 copay	-	14A: $0 copay or not covered	0	9A: $35 copay	8A: 20% coin	8B: 20% coin	8B: 20% coin	0	0	0	0	0	0		225	225	128	0	125	0.2	0.2	50	0.2	43.09029725	75	0.2	0.2	35.13227513	16.41203578	28.61583184	40	42.31818842	75	7.524982685	0.2	0	0	0	35	0	35	0	0	0	35	0.2	0.2	0.2	0	0	0	0	0	0	NO	162.192009	119.0873945	115.0779376	0	112.3807985	0.179809278	0.179809278	44.95231939	0.179809278	38.7401761	67.42847909	0.179809278	0.179809278	31.58554505	14.75518149	25.72696025	35.96185551	38.04601444	67.42847909	6.765308502	0.179809278	0	0	0	35	0	35	0	0	0	31.46662357	0.179809278	0.179809278	0.179809278	0	0	0	0	0	0		18.2326	0.373032178	5.213774794	0	1.535847855	3.060847991	0.947073525	1.365290967	8.651765263	24.16547694	2.088141564	0.511036316	0.006617684	0.23205456	3.375634499	6.421477804	0.029884713	3.250854669	3.503369347	0.848090254	5.176259307	0	0	0	0.882	0	0.4725	0	0	0	2.098159984	1.004728445	4.212291121	4.008236	0	0	0	0	0	0	101.667		11.26406002	18.2326	0.373032178	5.213774794	0	1.535847855	3.060847991	0.947073525	1.365290967	8.651765263	24.16547694	2.088141564	0.511036316	0.006617684	0.23205456	3.375634499	6.421477804	0.029884713	3.250854669	3.503369347	0.848090254	5.176259307	0	0	0	0.882	0	0.4725	0	0	0	2.098159984	1.004728445	4.212291121	4.008236	0	0	0	0	0	0	101.667	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	-	-	-	-	-	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	18.2326	0.373032178	5.213774794	0	1.535847855	3.060847991	0.947073525	1.365290967	8.651765263	24.16547694	2.088141564	0.511036316	0.006617684	0.23205456	3.375634499	6.421477804	0.029884713	3.250854669	3.503369347	0.848090254	5.176259307	0	0	0	0.882	0	0.4725	0	0	0	2.098159984	1.004728445	4.212291121	4.008236	0	0	0	0	0	0	101.667
H2613_004_0	2011	10	G.	H.6	H.7	I.7							OP Facility - Surgery	OP Facility - Other	OP Facility - Other	Professional								Lab	Radiology	Radiology							D	D	D	V	T	Coin	Coin	V	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	V		V	V	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	0	0	0	0	0	0	0	0	0	0	YES	1201.61911	53.18324922	324.7938634	36.63734946	132.7969617	15.42157867	4.380044959	362.0338864	47.3920227	7299.414816	398.2240469	4.552005154	0.522551621	94.5685669	2940.107878	2852.222212	11.28903517	976.2377794	623.9565792	1650.414739	28.94638887	0.864083385	0	0	378	0	162	0	5.908280087	0	545.4776662	7.566501578	20.6929035	22.2633584	0	0	0	0	0	0	5000	1A: $225/day (days1-7) no yrly max	1B: $225/day (days1-7) no yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: N/A	9A: 20% coin; 9B: 20% coin	8A: $0 -$75 copay	8B: $75 copay	9A: 20% coin	12: 20% coin	3: $35 copay; 5: $40 copay; 9C: $40 copay; 9D: $35 copay	7A: $20 copay; 7G: $20 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35-$50 copay; 7I: $35-$50 copay	8B: $75 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0-$35; 17B: $0; 18A: $35	15: 20% coin	13A: $0 copay	10B: Not covered	-	17A: $35 copay	-	18A: $35 copay	-	14A: $0 copay or not covered		9A: $35 copay	8A: 20% coin	8B: 20% coin	8B: 20% coin								225	225	128	0	125	0.2	0.2	50	0.2	42.55322683	75	0.2	0.2	36.08974359	16.4079377	30.36232152	40	41.88479412	75	6.871124465	0.2	0	0	0	35	0	35	0	0	0	35	0.2	0.2	0.2	0	0	0	0	0	0	NO	152.9427685	135.9977677	116.0514284	0	113.3314731	0.181330357	0.181330357	45.33258923	0.181330357	38.58095905	67.99888385	0.181330357	0.181330357	32.72083043	14.876286	27.52805299	36.26607139	37.97492334	67.99888385	6.229717258	0.181330357	0	0	0	35	0	35	0	0	0	31.73281246	0.181330357	0.181330357	0.181330357	0	0	0	0	0	0		15.3149	0.602733598	3.141065983	0	1.254172941	2.796400365	0.794235116	1.367661122	8.593612391	23.46820201	2.256565892	0.825416719	0.094754472	0.257863503	3.644823806	6.54301035	0.034117413	3.089379569	3.535695913	0.856801432	5.248859025	0	0	0	1.1025	0	0.4725	0	0	0	1.442461707	1.372036432	3.752251578	4.037022726	0	0	0	0	0	0	95.8991		9.711537021	15.3149	0.602733598	3.141065983	0	1.254172941	2.796400365	0.794235116	1.367661122	8.593612391	23.46820201	2.256565892	0.825416719	0.094754472	0.257863503	3.644823806	6.54301035	0.034117413	3.089379569	3.535695913	0.856801432	5.248859025	0	0	0	1.1025	0	0.4725	0	0	0	1.442461707	1.372036432	3.752251578	4.037022726	0	0	0	0	0	0	95.8991	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	15.3149	0.602733598	3.141065983	0	1.254172941	2.796400365	0.794235116	1.367661122	8.593612391	23.46820201	2.256565892	0.825416719	0.094754472	0.257863503	3.644823806	6.54301035	0.034117413	3.089379569	3.535695913	0.856801432	5.248859025	0	0	0	1.1025	0	0.4725	0	0	0	1.442461707	1.372036432	3.752251578	4.037022726	0	0	0	0	0	0	95.8991
H2643_001_0	2011	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V																	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0																	0	YES	241.1110827	0	15.22000727	7.194360478	8.673258044	6.13556807	3.841412941	14.07989212	20.54915721	10.27408705	8.795535865	4.802055339	0	7.274364699	505.8956285	103.5117617	8.555772395	0.142289303	0	0	13.44986706	0.023830245		1573.333333																	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 - $2000																		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		13.84655694																	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		13.84655694																		15.7114	0	2.367425491	0	2.020869124	1.42958736	0.895049215	3.280614863	4.787953629	2.393862284	2.049359857	1.118878894	0	1.694926975	117.8736814	24.11824047	1.993494968	0.033153407	0	0	3.133819024	0.005552447	0	1.815437466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	186.7233		0	15.7114	0	2.367425491	0	2.020869124	1.42958736	0.895049215	3.280614863	4.787953629	2.393862284	2.049359857	1.118878894	0	1.694926975	117.8736814	24.11824047	1.993494968	0.033153407	0	0	3.133819024	0.005552447	0	1.815437466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	186.7233	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0			15.7114	0	2.367425491	0	2.020869124	1.42958736	0.895049215	3.280614863	4.787953629	2.393862284	2.049359857	1.118878894	0	1.694926975	117.8736814	24.11824047	1.993494968	0.033153407	0	0	3.133819024	0.005552447	0	1.815437466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	186.7233
H2649_004_0	2011	3	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	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	YES	1471.079016	58.437249	948.383188	1359.642345	211.554726	12.516717	3.111793	393.580388	318.669875	513.225892	848.695781	54.090988	0.94626	915.157788	3913.430551	3906.166877	90.021916	505.781504		2205.140912	27.726366	0		2.44	3.33				3.69		133.716221										3400	$200/Day(Days 1-7):1a.IP Acute	$200/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $70(Days 15-100):2. $0 SNF 1,2. $70 SNF 2"	$5/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $35 Radiology OP -- Facility"	$50/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"	"VIS993: Vision 17a, 17b"				$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a		$0/Service:11c.Diabetic Monitoring Supplies											143.724	123.0478	32.4597	5	100	0.2	0.2	50	200	0	43.99894	50	0.175699	38.903052	10	34.173874	35	35		0	0.2	0		0	0				0		0										NO	125.145517	107.142026	21.050667	4.40213	88.0426	0.176085	0.176085	44.0213	176.0852	0	38.737811	44.0213	0.15469	34.251259	8.80426	30.087567	30.81491	30.81491		0	0.176085	0		0	0				0		0											15.3416	0.521757104	1.66367489	0.498776863	1.552152343	2.204006113	0.54794007	1.443826695	4.676087389	0	2.739718063	0.198429634	0.146376959	2.612108869	2.871238339	9.793921469	0.231168103	1.29880096	0	0	4.882197157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.2238	0	8.104782418	15.3416	0.521757104	1.66367489	0.498776863	1.552152343	2.204006113	0.54794007	1.443826695	4.676087389	0	2.739718063	0.198429634	0.146376959	2.612108869	2.871238339	9.793921469	0.231168103	1.29880096	0	0	4.882197157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.2238	NO																																																																																		0	0	0	15.3416	0.521757104	1.66367489	0.498776863	1.552152343	2.204006113	0.54794007	1.443826695	4.676087389	0	2.739718063	0.198429634	0.146376959	2.612108869	2.871238339	9.793921469	0.231168103	1.29880096	0	0	4.882197157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.2238
H2649_012_0	2011	3	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin		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	1076.824021	56.77817341	654.1669409	1060.612308	176.82135	7.566835518	2.404964755	344.1411165	258.3009433	563.2329629	690.9694298	52.07737833	0.357117139	687.3544	3213.321726	3652.503898	63.88994158	550.9100376		1671.100854	12.91344994	0		2.44	3.33				4.56	0.93	121.3579511										3400	$200/Day(Days 1-7):1a.IP Acute	$200/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $70(Days 15-100):2. $0 SNF 1,2. $70 SNF 2"	$5/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0-$15/Visit:7b. $0 Chiropractic,7f. $15 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Spec Cap"	"$15/Visit:7e, 7h.Psych -- Other Provider"	"$15-$35/Visit:7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"	"VIS993: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies											143.724	123.0478	32.4597	5	100	0.2	0.2	50	200	0	42.680218	50	0.1757	35.832679	0	13.650036	15	22.481183		0	0.2	0		0	0				0	0	0										NO	136.791617	117.112712	27.30867	4.75772	95.1544	0.190309	0.190309	47.5772	190.3088	0	40.612105	47.5772	0.167186	34.096371	0	12.98861	14.27316	21.391835		0	0.190309	0		0	0				0	0	0											12.275	0.554120489	1.488702426	0.420508033	1.402110789	1.440036901	0.457686438	1.364439227	4.096411881	0	2.33847692	0.206474654	0.059704986	1.953024219	0	3.953412388	0.075992613	0.982081385	0	0	2.457545744	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5258	0	2.010946154	12.275	0.554120489	1.488702426	0.420508033	1.402110789	1.440036901	0.457686438	1.364439227	4.096411881	0	2.33847692	0.206474654	0.059704986	1.953024219	0	3.953412388	0.075992613	0.982081385	0	0	2.457545744	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5258	NO																																																																																		0	0	0	12.275	0.554120489	1.488702426	0.420508033	1.402110789	1.440036901	0.457686438	1.364439227	4.096411881	0	2.33847692	0.206474654	0.059704986	1.953024219	0	3.953412388	0.075992613	0.982081385	0	0	2.457545744	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5258
H2649_020_0	2011	4	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin							O		O										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0		0										0	YES	1433.790294	56.955989	924.343693	1325.178305	206.192264	10.502317	2.61099	383.603963	310.592272	500.216709	827.183148	52.719897	0.793973	891.960487	3814.233416	3807.15386	87.740052	492.96102		2149.245283	23.264174	0							3.69		130.326799										2900	$175/Day(Days 1-5):1a.IP Acute	$175/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-14) $70(Days 15-100):2. $0 SNF 1,2. $70 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $35 Radiology OP -- Facility"	$50/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a		$0/Service:11c.Diabetic Monitoring Supplies											108.3446	87.221925	32.4597	0	100	0.2	0.2	50	150	0	43.99894	50	0.175699	38.903052	10	34.173874	35	35		0	0.2	0							0		0										NO	94.911711	76.407889	20.671927	0	88.0542	0.176108	0.176108	44.0271	132.0813	0	38.742915	44.0271	0.154711	34.255771	8.80542	30.091532	30.81897	30.81897		0	0.176108	0							0		0											11.3403	0.36265724	1.592330445	0	1.513007904	1.849542042	0.459816227	1.40741417	3.418619255	0	2.670623866	0.193425348	0.122836357	2.546232849	2.798827267	9.546924351	0.225338169	1.266045907	0	0	4.097007155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4109	0	6.921264965	11.3403	0.36265724	1.592330445	0	1.513007904	1.849542042	0.459816227	1.40741417	3.418619255	0	2.670623866	0.193425348	0.122836357	2.546232849	2.798827267	9.546924351	0.225338169	1.266045907	0	0	4.097007155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4109	NO																																																																																		0	0	0	11.3403	0.36265724	1.592330445	0	1.513007904	1.849542042	0.459816227	1.40741417	3.418619255	0	2.670623866	0.193425348	0.122836357	2.546232849	2.798827267	9.546924351	0.225338169	1.266045907	0	0	4.097007155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4109
H2649_801_0	2011	3																															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	YES	240.664723	2.425	40.37665	11.528679	5.325575	10.064322	2.839654	25.285482	59.380604	3.731559	30.8816	2.932653	0.035344	9.902212	36.786619	88.809753	0.508453	6.290568		14.223711	34.198199	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.085992	0.085992	0.169632	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.077821	0.077821	0.111323	0	0.210224	0.210224	0.210224	0.210224	0.210224	0.210224	0.210224	0.210224	0.210224	0.210224	0.210224	0.210224	0.210224	0.210224		0.210224	0.210224	0																				18.7288	0.188715925	4.494849808	0	1.119563679	2.115762028	0.596963422	5.315615168	12.4832281	0.784463259	6.492053478	0.616514044	0.007430157	2.081682615	7.733430193	18.66994151	0.106889023	1.322428367	0	2.990165421	7.189282187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.0377	0	11.88382042	18.7288	0.188715925	4.494849808	0	1.119563679	2.115762028	0.596963422	5.315615168	12.4832281	0.784463259	6.492053478	0.616514044	0.007430157	2.081682615	7.733430193	18.66994151	0.106889023	1.322428367	0	2.990165421	7.189282187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.0377	NO																																																																																		0	0	0	18.7288	0.188715925	4.494849808	0	1.119563679	2.115762028	0.596963422	5.315615168	12.4832281	0.784463259	6.492053478	0.616514044	0.007430157	2.081682615	7.733430193	18.66994151	0.106889023	1.322428367	0	2.990165421	7.189282187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.0377
H2649_802_0	2011	5																															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	YES	314.89756	4.417314	32.363529	17.488195	7.914528	10.079535	3.558582	28.696845	53.228149	5.748095	31.153942	5.523936	0.557788	10.706998	41.522528	75.207205	0.517986	5.744825		8.169116	34.166738	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.085711	0.085711	0.170847	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.077142	0.077142	0.115932	0	0.20959	0.20959	0.20959	0.20959	0.20959	0.20959	0.20959	0.20959	0.20959	0.20959	0.20959	0.20959	0.20959	0.20959		0.20959	0.20959	0																				24.2918	0.340760437	3.751968644	0	1.658805924	2.112569741	0.745843201	6.014571744	11.15608775	1.204743231	6.529554704	1.157761746	0.116906787	2.244079711	8.702706644	15.7626781	0.108564686	1.204057872	0	1.712165022	7.161006617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9767	0	12.06297321	24.2918	0.340760437	3.751968644	0	1.658805924	2.112569741	0.745843201	6.014571744	11.15608775	1.204743231	6.529554704	1.157761746	0.116906787	2.244079711	8.702706644	15.7626781	0.108564686	1.204057872	0	1.712165022	7.161006617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9767	NO																																																																																		0	0	0	24.2918	0.340760437	3.751968644	0	1.658805924	2.112569741	0.745843201	6.014571744	11.15608775	1.204743231	6.529554704	1.157761746	0.116906787	2.244079711	8.702706644	15.7626781	0.108564686	1.204057872	0	1.712165022	7.161006617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9767
H2649_803_0	2011	2																															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	YES	302.984404	4.250199	31.139156	16.826584	7.615107	9.698207	3.423955	27.61119	51.214431	5.530634	29.97533	5.314956	0.536686	10.301931	39.951654	72.361978	0.49839	5.527488		7.860063	32.874148	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.084774	0.084774	0.174971	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.076891	0.076891	0.121368	0	0.210984	0.210984	0.210984	0.210984	0.210984	0.210984	0.210984	0.210984	0.210984	0.210984	0.210984	0.210984	0.210984	0.210984		0.210984	0.210984	0																				23.2968	0.326802051	3.779297085	0	1.606665735	2.046166506	0.722399722	5.825519311	10.80542551	1.166875284	6.324315025	1.121370677	0.113232159	2.17354261	8.429159768	15.26721957	0.105152316	1.166211528	0	1.658347532	6.935919242	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.8704	0	10.92242496	23.2968	0.326802051	3.779297085	0	1.606665735	2.046166506	0.722399722	5.825519311	10.80542551	1.166875284	6.324315025	1.121370677	0.113232159	2.17354261	8.429159768	15.26721957	0.105152316	1.166211528	0	1.658347532	6.935919242	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.8704	NO																																																																																		0	0	0	23.2968	0.326802051	3.779297085	0	1.606665735	2.046166506	0.722399722	5.825519311	10.80542551	1.166875284	6.324315025	1.121370677	0.113232159	2.17354261	8.429159768	15.26721957	0.105152316	1.166211528	0	1.658347532	6.935919242	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.8704
H2654_004_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1306.108252	85.37381989	1035.096394	1349.822014	223.646972	7.283689457	6.243912287	331.8860082	34.57533805	12.64949401	37.23393438	0	0.224995221	19.50082044	4956.06701	91.90312734	464.2871032	253.8357858	0	0	22.06443939	3158.139236	331.665322	0	196.0474689	167.3328132	17.32715291	5.546961044	0	0											4500	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-55 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												185.9463355	119.8302997	64.65974987	0	200	0.2	0.093902744	49.19719258	0.2	0.113330001	0.161660294	0	0.2	0.157835767	11.53807909	0.08700657	38.5	35	0	0	0.2	33.35140709	0	0	35	13.15279259	0	0	0	0											NO	148.6315744	95.78336704	51.68416145	0	159.8650213	0.159865021	0.075058821	39.34071621	0.159865021	0.090587515	0.129219131	0	0.159865021	0.126162091	11.15019006	0.08408459	37.2057007	33.82336427	0	0	0.159865021	26.65861703	0	0	35	13.15279259	0	0	0	0												16.1774	0.681449327	4.458174096	0	2.979443995	1.16440717	0.468660692	1.088052772	5.527387154	1.145886225	4.811336658	0	0.035968866	2.460264289	4.605090758	7.727636827	1.439510583	0.715465021	0	0	3.527332074	7.015968702	0	0	0.571805118	0.183407815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7847	0	13.44297997	16.1774	0.681449327	4.458174096	0	2.979443995	1.16440717	0.468660692	1.088052772	5.527387154	1.145886225	4.811336658	0	0.035968866	2.460264289	4.605090758	7.727636827	1.439510583	0.715465021	0	0	3.527332074	7.015968702	0	0	0.571805118	0.183407815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7847	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.1774	0.681449327	4.458174096	0	2.979443995	1.16440717	0.468660692	1.088052772	5.527387154	1.145886225	4.811336658	0	0.035968866	2.460264289	4.605090758	7.727636827	1.439510583	0.715465021	0	0	3.527332074	7.015968702	0	0	0.571805118	0.183407815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7847
H2654_010_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	787.7169009	77.4019644	720.5180638	590.3446664	22.72689017	7.893505089	6.009138914	415.1842128	37.60173642	15.60867616	33.60173577	0	0.043683562	32.97309779	4480.829732	75.12893849	434.3889851	352.533167	0	0	6.363973363	932.0379211	342.4080185	0	295.4209273	249.1262667	16.77772605	11	787.8949786	0											2975	"$220 Days 1-14 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$220 Days 1-9 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-30 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												194.7763335	126.6713695	71.73698308	0	200	0.2	0.085361996	48.90251693	0.2	0.097509699	0.16336842	0	0.2	0.160446242	11.94703477	0.110412915	38.5	35	0	0	0.2	34.57999349	0	0	35	13.08482096	0	0	0	0											YES	148.2990423	96.44520181	54.61919166	0	152.2762439	0.152276244	0.064993021	37.24846293	0.152276244	0.074242054	0.124385647	0	0.152276244	0.122160756	11.46215606	0.105937925	36.93745074	33.57950067	0	0	0.152276244	26.32855761	0	0	35	13.08482096	0	0	0	0											2975	9.7348	0.62208734	3.279509519	0	0.288397123	1.201993306	0.390552089	1.288747813	5.725851186	1.158820176	4.179573646	0	0.006651969	4.028018539	4.279997471	7.959003823	1.337101812	0.986490643	0	0	0.96908196	2.044934509	0	0	0.861644371	0.271647716	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6149	0	11.55857792	9.7348	0.62208734	3.279509519	0	0.288397123	1.201993306	0.390552089	1.288747813	5.725851186	1.158820176	4.179573646	0	0.006651969	4.028018539	4.279997471	7.959003823	1.337101812	0.986490643	0	0	0.96908196	2.044934509	0	0	0.861644371	0.271647716	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6149	NO	"$275 Days 1-11 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-20 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.2048	0.0151	0.0642	0.0643	0.009	0.0565	0.043	0.0404	0.2692	0.0363	0.1928	0	0.0002	0.1889	0.3548	0.5229	0.0779	0.0654	0	0	0.0661	0.1196	0	0	0.0583	0	0.0033	0	0	0											2.4533	0	0.777091863	9.9396	0.637187113	3.343750083	0.064295051	0.297436516	1.258505438	0.43357344	1.32915248	5.995054063	1.19514173	4.372418503	0	0.006860465	4.216936418	4.634814099	8.481928094	1.415024932	1.051910678	0	0	1.035197845	2.164519843	0	0	0.919951133	0.271647716	0.003311393	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0682
H2654_013_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	985.7561516	88.91488992	814.7623838	1064.111645	174.5921202	4.894007673	6.419322098	267.3192139	30.53505666	13.68023863	34.63618826	0	0.044233946	18.31932521	4200.357684	84.03012263	477.1410202	237.4663883	0	0	21.15557148	3149.541232	332.301552	0	196.9288634	165.7575167	17.60770171	11	0	0											2700	"$175 Days 1-12/$270 Days 1-8/$315 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-12 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-27 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												202.4294568	116.8098224	70.90351949	0	200	0.2	0.112817671	49.45775536	0.2	0.102131273	0.1614569	0	0.2	0.159311466	6.594212224	0.091552846	38.5	35	0	0	0.2	33.45310428	0	0	35	13.16026063	0	0	0	0											YES	142.5463219	82.2548793	49.92868168	0	140.8355524	0.140835552	0.079443695	34.85656819	0.140835552	0.071918571	0.113694358	0	0.140835552	0.112183592	6.256785755	0.086871367	36.52995132	33.20904666	0	0	0.140835552	23.55693211	0	0	35	13.16026063	0	0	0	0											2700	11.7097	0.609473628	3.390000976	0	2.049064809	0.689250274	0.509974667	0.776485867	4.300421573	0.983863215	3.937939204	0	0.006229712	2.055127701	2.19006151	7.29981159	1.452494854	0.657169364	0	0	2.979456597	6.182794082	0	0	0.574375852	0.181784343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5354	0	17.50368185	11.7097	0.609473628	3.390000976	0	2.049064809	0.689250274	0.509974667	0.776485867	4.300421573	0.983863215	3.937939204	0	0.006229712	2.055127701	2.19006151	7.29981159	1.452494854	0.657169364	0	0	2.979456597	6.182794082	0	0	0.574375852	0.181784343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5354	NO	"$365 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	35% (9b)	35% (8a1a); $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, 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 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												3.2858	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											3.2858	0	0.727514939	14.9955	0.609473628	3.390000976	0	2.049064809	0.689250274	0.509974667	0.776485867	4.300421573	0.983863215	3.937939204	0	0.006229712	2.055127701	2.19006151	7.29981159	1.452494854	0.657169364	0	0	2.979456597	6.182794082	0	0	0.574375852	0.181784343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8212
H2654_020_0	2011	2																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1220.1969	83.25086742	985.8350513	1307.52371	202.3318912	7.189217984	8.023180398	307.1161245	34.83783481	12.16376541	37.13556285	0	0.16244549	16.51789555	4846.486756	87.86711986	463.3412199	263.7070599	0	0	20.19146256	3157.37705	332.4774418	0	198.1880398	168.7099091	17.40136259	7.091117953	0	0											3800	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-48 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												185.9463355	119.8302997	61.40851873	0	200	0.2	0.132944308	48.97175682	0.2	0.115457923	0.161331702	0	0.2	0.158388917	11.49567177	0.087806965	38.5	35	0	0	0.2	33.38505242	0	0	35	13.14904955	0	0	0	0											NO	144.6450805	93.21433144	47.76883672	0	155.5772316	0.155577232	0.103415537	38.11337983	0.155577232	0.08981312	0.125497698	0	0.155577232	0.123208546	11.06376641	0.084524045	37.05351154	33.68501049	0	0	0.155577232	25.96977017	0	0	35	13.14904955	0	0	0	0												14.708	0.646681162	3.924349466	0	2.623186293	1.118478632	0.82972151	0.975436125	5.419973896	1.092465725	4.660427652	0	0.02527282	2.035145892	4.468366447	7.426884386	1.430701603	0.740247923	0	0	3.141331849	6.833029694	0	0	0.578048449	0.18486458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8626	0	14.26226295	14.708	0.646681162	3.924349466	0	2.623186293	1.118478632	0.82972151	0.975436125	5.419973896	1.092465725	4.660427652	0	0.02527282	2.035145892	4.468366447	7.426884386	1.430701603	0.740247923	0	0	3.141331849	6.833029694	0	0	0.578048449	0.18486458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8626	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.708	0.646681162	3.924349466	0	2.623186293	1.118478632	0.82972151	0.975436125	5.419973896	1.092465725	4.660427652	0	0.02527282	2.035145892	4.468366447	7.426884386	1.430701603	0.740247923	0	0	3.141331849	6.833029694	0	0	0.578048449	0.18486458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8626
H2654_024_0	2011	4																															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	YES	370.4705	22.9491	40.37012369	2195.340271	13.08682007	22.5626954	18.56855302	35.90144559	41.51292136	20.54739736	50.53230619	0	0.162904295	33.1269193	29.96695312	146.9575378	11.2615	5.851024653	0	0	24.29392504	9.510872768	271.1769002	981.4342446	113.9118244	165.9807193	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4, 16b1, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.082580936	0.083583381	0.176993281	0	0.233	0.233	0.233	0.093200646	0.233	0.233	0.233	0	0.233	0.233	0.226080207	0.232914599	0.235758038	0.233	0	0	0.233	0.222334336	0	0	0	0	0	0	0	0											NO	0.065807393	0.066606225	0.141043042	0	0.185673878	0.185673878	0.185673878	0.074280808	0.185673878	0.185673878	0.185673878	0	0.185673878	0.185673878	0.180159608	0.185605823	0.187871713	0.185673878	0	0	0.185673878	0.177872992	0	0	0	0	0	0	0	0												24.3797	1.528552917	5.693925064	0	2.429880628	4.189303143	3.44769524	2.66678839	7.707865077	3.815114942	9.382529232	0	0.030247072	6.150803558	5.398834517	27.27617477	2.115717297	1.086382435	0	0	4.510747264	1.691727399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.502	0	28.92152328	24.3797	1.528552917	5.693925064	0	2.429880628	4.189303143	3.44769524	2.66678839	7.707865077	3.815114942	9.382529232	0	0.030247072	6.150803558	5.398834517	27.27617477	2.115717297	1.086382435	0	0	4.510747264	1.691727399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.502	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.3797	1.528552917	5.693925064	0	2.429880628	4.189303143	3.44769524	2.66678839	7.707865077	3.815114942	9.382529232	0	0.030247072	6.150803558	5.398834517	27.27617477	2.115717297	1.086382435	0	0	4.510747264	1.691727399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.502
H2654_801_0	2011	1																															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	201.5117166	4.2706	30.89976847	1425.380575	6.909214451	7.85626562	8.169371235	12.82963088	45.12888825	17.68777478	56.41228783	0	0.115027578	28.70347036	139.6951476	181.0584854	1.9947	10.68051334	0	0	30.32667203	43.02594532	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	$0 n/c (8a1a); FFS (8a2)	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.08359662	0.08359662	0.176905767	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.061718502	0.061718502	0.130607661	0	0.172021441	0.172021441	0.172021441	0.172021441	0.172021441	0.172021441	0.172021441	0	0.172021441	0.172021441	0.172021441	0.172021441	0.172021441	0.172021441	0	0	0.172021441	0.172021441	0	0	0	0	0	0	0	0												12.437	0.263575035	4.035746472	0	1.188533025	1.351446132	1.405307011	2.20697159	7.763136383	3.042676503	9.704123037	0	0.01978721	4.93761233	24.03056058	31.14594155	0.343131168	1.837277295	0	0	5.216837821	7.401385109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.331	0	41.94626474	12.437	0.263575035	4.035746472	0	1.188533025	1.351446132	1.405307011	2.20697159	7.763136383	3.042676503	9.704123037	0	0.01978721	4.93761233	24.03056058	31.14594155	0.343131168	1.837277295	0	0	5.216837821	7.401385109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.331	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.437	0.263575035	4.035746472	0	1.188533025	1.351446132	1.405307011	2.20697159	7.763136383	3.042676503	9.704123037	0	0.01978721	4.93761233	24.03056058	31.14594155	0.343131168	1.837277295	0	0	5.216837821	7.401385109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.331
H2654_802_0	2011	1																															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	216.3204079	4.2676	30.08379727	1327.124278	7.911940837	8.251044075	6.168293234	13.48960275	46.60872136	18.98107126	60.61032	0	0.053417895	32.60989606	141.53375	182.843008	1.9901	10.07357619	0	0	36.68123074	42.88252993	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.083587429	0.083587429	0.176966528	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.061032675	0.061032675	0.129214892	0	0.170128612	0.170128612	0.170128612	0.170128612	0.170128612	0.170128612	0.170128612	0	0.170128612	0.170128612	0.170128612	0.170128612	0.170128612	0.170128612	0	0	0.170128612	0.170128612	0	0	0	0	0	0	0	0												13.2026	0.260463044	3.887274609	0	1.346047512	1.403738675	1.049403166	2.294967392	7.929477068	3.229223306	10.31154961	0	0.009087912	5.547876352	24.07894043	31.10682715	0.338572951	1.713803535	0	0	6.24052687	7.295545292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.2459	0	44.80669264	13.2026	0.260463044	3.887274609	0	1.346047512	1.403738675	1.049403166	2.294967392	7.929477068	3.229223306	10.31154961	0	0.009087912	5.547876352	24.07894043	31.10682715	0.338572951	1.713803535	0	0	6.24052687	7.295545292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.2459	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.2026	0.260463044	3.887274609	0	1.346047512	1.403738675	1.049403166	2.294967392	7.929477068	3.229223306	10.31154961	0	0.009087912	5.547876352	24.07894043	31.10682715	0.338572951	1.713803535	0	0	6.24052687	7.295545292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.2459
H2654_803_0	2011	1																															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	148.9131992	4.3108	19.92965525	594.9338436	1.361829648	7.52822	6.26372427	24.14605027	43.85619004	16.67873069	39.84212524	0	0.029804481	39.7175045	22.76004589	85.54912072	2.0693	5.839220528	0	0	8.218619244	6.923193083	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.070350848	0.070350848	0.165680359	0	0.201691285	0.201691285	0.201691285	0.201691285	0.201691285	0.201691285	0.201691285	0	0.201691285	0.201691285	0.201691285	0.201691285	0.201691285	0.201691285	0	0	0.201691285	0.201691285	0	0	0	0	0	0	0	0												10.4762	0.303268435	3.301952433	0	0.274669172	1.518376364	1.263338596	4.870047903	8.845411316	3.363954621	8.035809429	0	0.006011304	8.010674512	4.590502898	17.25451207	0.417359776	1.177719891	0	0	1.657623875	1.396347708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.7638	0	11.91610431	10.4762	0.303268435	3.301952433	0	0.274669172	1.518376364	1.263338596	4.870047903	8.845411316	3.363954621	8.035809429	0	0.006011304	8.010674512	4.590502898	17.25451207	0.417359776	1.177719891	0	0	1.657623875	1.396347708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.7638	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.4762	0.303268435	3.301952433	0	0.274669172	1.518376364	1.263338596	4.870047903	8.845411316	3.363954621	8.035809429	0	0.006011304	8.010674512	4.590502898	17.25451207	0.417359776	1.177719891	0	0	1.657623875	1.396347708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.7638
H2654_804_0	2011	1																															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	149.0730932	4.3107	19.95105451	595.5726475	1.363291899	7.536303348	6.270449879	24.17197684	43.90328016	16.6966393	39.8849053	0	0.029836483	39.76013293	22.78448425	85.6409782	2.0692	5.84549033	0	0	8.227443901	6.930626789	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.070334068	0.070334068	0.165640842	0	0.201643179	0.201643179	0.201643179	0.201643179	0.201643179	0.201643179	0.201643179	0	0.201643179	0.201643179	0.201643179	0.201643179	0.201643179	0.201643179	0	0	0.201643179	0.201643179	0	0	0	0	0	0	0	0												10.4849	0.303189068	3.304709471	0	0.274898513	1.519644166	1.264393448	4.874114257	8.852796987	3.366763429	8.042519105	0	0.006016323	8.017359607	4.594335839	17.26891911	0.417240066	1.178703254	0	0	1.659007945	1.397513619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.827	0	11.94710271	10.4849	0.303189068	3.304709471	0	0.274898513	1.519644166	1.264393448	4.874114257	8.852796987	3.366763429	8.042519105	0	0.006016323	8.017359607	4.594335839	17.26891911	0.417240066	1.178703254	0	0	1.659007945	1.397513619	0	0	0	0	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	10.4849	0.303189068	3.304709471	0	0.274898513	1.519644166	1.264393448	4.874114257	8.852796987	3.366763429	8.042519105	0	0.006016323	8.017359607	4.594335839	17.26891911	0.417240066	1.178703254	0	0	1.659007945	1.397513619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.827
H2654_805_0	2011	1																															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	201.3397047	4.2707	30.8733922	1424.163861	6.903316696	7.849559455	8.162397801	12.81867941	45.09036591	17.67267636	56.3641339	0	0.11492939	28.67898244	139.5759028	180.9039326	1.9948	10.67139638	0	0	30.30078497	42.98921806	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.08359662	0.08359662	0.176905767	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.061734687	0.061734687	0.130641911	0	0.172066551	0.172066551	0.172066551	0.172066551	0.172066551	0.172066551	0.172066551	0	0.172066551	0.172066551	0.172066551	0.172066551	0.172066551	0.172066551	0	0	0.172066551	0.172066551	0	0	0	0	0	0	0	0												12.4296	0.263650327	4.033358946	0	1.187829893	1.350646621	1.404475636	2.205665953	7.758543739	3.040876467	9.698382112	0	0.019775504	4.934693591	24.01634418	31.12751572	0.343238356	1.836190368	0	0	5.213751558	7.397006476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.2616	0	41.87964765	12.4296	0.263650327	4.033358946	0	1.187829893	1.350646621	1.404475636	2.205665953	7.758543739	3.040876467	9.698382112	0	0.019775504	4.934693591	24.01634418	31.12751572	0.343238356	1.836190368	0	0	5.213751558	7.397006476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.2616	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.4296	0.263650327	4.033358946	0	1.187829893	1.350646621	1.404475636	2.205665953	7.758543739	3.040876467	9.698382112	0	0.019775504	4.934693591	24.01634418	31.12751572	0.343238356	1.836190368	0	0	5.213751558	7.397006476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.2616
H2654_807_0	2011	1																															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	149.0730947	4.3112	19.95105471	595.5726504	1.363291912	7.536303422	6.27044994	24.17197708	43.90328059	16.69663946	39.88490569	0	0.029836483	39.75893332	22.78448447	85.64097903	2.068	5.845490387	0	0	8.227443982	6.930626857	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.070334159	0.070334159	0.165641056	0	0.201643439	0.201643439	0.201643439	0.201643439	0.201643439	0.201643439	0.201643439	0	0.201643439	0.201643439	0.201643439	0.201643439	0.201643439	0.201643439	0	0	0.201643439	0.201643439	0	0	0	0	0	0	0	0												10.4849	0.303224626	3.304713763	0	0.27489887	1.51964614	1.26439509	4.874120587	8.852808485	3.366767802	8.042529551	0	0.006016331	8.017128048	4.594341806	17.26894154	0.416998632	1.178704785	0	0	1.659010099	1.397515434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8267	0	11.94693401	10.4849	0.303224626	3.304713763	0	0.27489887	1.51964614	1.26439509	4.874120587	8.852808485	3.366767802	8.042529551	0	0.006016331	8.017128048	4.594341806	17.26894154	0.416998632	1.178704785	0	0	1.659010099	1.397515434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8267	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.4849	0.303224626	3.304713763	0	0.27489887	1.51964614	1.26439509	4.874120587	8.852808485	3.366767802	8.042529551	0	0.006016331	8.017128048	4.594341806	17.26894154	0.416998632	1.178704785	0	0	1.659010099	1.397515434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8267
H2654_809_0	2011	1																															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	171.5555916	3.641485	30.9485905	1425.897224	6.9201311	7.868678621	8.182278948	12.84990186	45.20019248	17.71572169	56.50141998	0	0.115209323	28.74789709	139.9158678	181.3445602	1.9905	10.69738869	0	0	30.37458857	43.09392687	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.083494308	0.083494308	0.177580506	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.061200788	0.061200788	0.130165363	0	0.170787494	0.170787494	0.170787494	0.170787494	0.170787494	0.170787494	0.170787494	0	0.170787494	0.170787494	0.170787494	0.170787494	0.170787494	0.170787494	0	0	0.170787494	0.170787494	0	0	0	0	0	0	0	0												10.4993	0.222861753	4.028434531	0	1.18187185	1.343871904	1.397430918	2.194602539	7.719627609	3.025623715	9.649735935	0	0.019676312	4.909781307	23.89588045	30.97138301	0.339952507	1.826980209	0	0	5.187599868	7.359903783	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7746	0	42.17302477	10.4993	0.222861753	4.028434531	0	1.18187185	1.343871904	1.397430918	2.194602539	7.719627609	3.025623715	9.649735935	0	0.019676312	4.909781307	23.89588045	30.97138301	0.339952507	1.826980209	0	0	5.187599868	7.359903783	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7746	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												2.5277	0.0537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											2.5814	0	0	13.0271	0.276516448	4.028434531	0	1.18187185	1.343871904	1.397430918	2.194602539	7.719627609	3.025623715	9.649735935	0	0.019676312	4.909781307	23.89588045	30.97138301	0.339952507	1.826980209	0	0	5.187599868	7.359903783	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.356
H2654_810_0	2011	1																															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	171.5555916	3.641485	30.9485905	1425.897224	6.9201311	7.868678621	8.182278948	12.84990186	45.20019248	17.71572169	56.50141998	0	0.115209323	28.74789709	139.9158678	181.3445602	1.9905	10.69738869	0	0	30.37458857	43.09392687	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.083494308	0.083494308	0.177580506	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.061200788	0.061200788	0.130165363	0	0.170787494	0.170787494	0.170787494	0.170787494	0.170787494	0.170787494	0.170787494	0	0.170787494	0.170787494	0.170787494	0.170787494	0.170787494	0.170787494	0	0	0.170787494	0.170787494	0	0	0	0	0	0	0	0												10.4993	0.222861753	4.028434531	0	1.18187185	1.343871904	1.397430918	2.194602539	7.719627609	3.025623715	9.649735935	0	0.019676312	4.909781307	23.89588045	30.97138301	0.339952507	1.826980209	0	0	5.187599868	7.359903783	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7746	0	42.17302477	10.4993	0.222861753	4.028434531	0	1.18187185	1.343871904	1.397430918	2.194602539	7.719627609	3.025623715	9.649735935	0	0.019676312	4.909781307	23.89588045	30.97138301	0.339952507	1.826980209	0	0	5.187599868	7.359903783	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7746	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												2.5277	0.0537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											2.5814	0	0	13.0271	0.276516448	4.028434531	0	1.18187185	1.343871904	1.397430918	2.194602539	7.719627609	3.025623715	9.649735935	0	0.019676312	4.909781307	23.89588045	30.97138301	0.339952507	1.826980209	0	0	5.187599868	7.359903783	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.356
H2654_811_0	2011	1																															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	128.8391942	3.6686	20.28596474	600.5506613	1.386176925	7.662812204	6.375709368	24.57774197	44.64026665	16.97691899	40.55443697	0	0.030337336	40.42609143	23.16695811	87.07859843	2.0631	5.943616196	0	0	8.365554652	7.046968399	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.069652552	0.069652552	0.164035831	0	0.199689315	0.199689315	0.199689315	0.199689315	0.199689315	0.199689315	0.199689315	0	0.199689315	0.199689315	0.199689315	0.199689315	0.199689315	0.199689315	0	0	0.199689315	0.199689315	0	0	0	0	0	0	0	0												8.974	0.255527351	3.327625077	0	0.276804721	1.530181724	1.273161039	4.907912471	8.914184291	3.390109331	8.098287759	0	0.006058042	8.072658527	4.626194007	17.38866571	0.411979027	1.18687665	0	0	1.670511882	1.407204296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7179	0	12.63069963	8.974	0.255527351	3.327625077	0	0.276804721	1.530181724	1.273161039	4.907912471	8.914184291	3.390109331	8.098287759	0	0.006058042	8.072658527	4.626194007	17.38866571	0.411979027	1.18687665	0	0	1.670511882	1.407204296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7179	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.8478	0.0526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											1.9004	0	0	10.8218	0.308142502	3.327625077	0	0.276804721	1.530181724	1.273161039	4.907912471	8.914184291	3.390109331	8.098287759	0	0.006058042	8.072658527	4.626194007	17.38866571	0.411979027	1.18687665	0	0	1.670511882	1.407204296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6184
H2654_812_0	2011	1																															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	128.8391942	3.6686	20.28596474	600.5506613	1.386176925	7.662812204	6.375709368	24.57774197	44.64026665	16.97691899	40.55443697	0	0.030337336	40.42609143	23.16695811	87.07859843	2.0631	5.943616196	0	0	8.365554652	7.046968399	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.069652552	0.069652552	0.164035831	0	0.199689315	0.199689315	0.199689315	0.199689315	0.199689315	0.199689315	0.199689315	0	0.199689315	0.199689315	0.199689315	0.199689315	0.199689315	0.199689315	0	0	0.199689315	0.199689315	0	0	0	0	0	0	0	0												8.974	0.255527351	3.327625077	0	0.276804721	1.530181724	1.273161039	4.907912471	8.914184291	3.390109331	8.098287759	0	0.006058042	8.072658527	4.626194007	17.38866571	0.411979027	1.18687665	0	0	1.670511882	1.407204296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7179	0	12.63069963	8.974	0.255527351	3.327625077	0	0.276804721	1.530181724	1.273161039	4.907912471	8.914184291	3.390109331	8.098287759	0	0.006058042	8.072658527	4.626194007	17.38866571	0.411979027	1.18687665	0	0	1.670511882	1.407204296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7179	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.8478	0.0526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											1.9004	0	0	10.8218	0.308142502	3.327625077	0	0.276804721	1.530181724	1.273161039	4.907912471	8.914184291	3.390109331	8.098287759	0	0.006058042	8.072658527	4.626194007	17.38866571	0.411979027	1.18687665	0	0	1.670511882	1.407204296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6184
H2654_813_0	2011	1																															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	171.5555916	3.641485	30.9485905	1425.897224	6.9201311	7.868678621	8.182278948	12.84990186	45.20019248	17.71572169	56.50141998	0	0.115209323	28.74789709	139.9158678	181.3445602	1.9905	10.69738869	0	0	30.37458857	43.09392687	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.083494308	0.083494308	0.177580506	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.061200788	0.061200788	0.130165363	0	0.170787494	0.170787494	0.170787494	0.170787494	0.170787494	0.170787494	0.170787494	0	0.170787494	0.170787494	0.170787494	0.170787494	0.170787494	0.170787494	0	0	0.170787494	0.170787494	0	0	0	0	0	0	0	0												10.4993	0.222861753	4.028434531	0	1.18187185	1.343871904	1.397430918	2.194602539	7.719627609	3.025623715	9.649735935	0	0.019676312	4.909781307	23.89588045	30.97138301	0.339952507	1.826980209	0	0	5.187599868	7.359903783	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7746	0	42.17302477	10.4993	0.222861753	4.028434531	0	1.18187185	1.343871904	1.397430918	2.194602539	7.719627609	3.025623715	9.649735935	0	0.019676312	4.909781307	23.89588045	30.97138301	0.339952507	1.826980209	0	0	5.187599868	7.359903783	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7746	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												2.5277	0.0537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											2.5814	0	0	13.0271	0.276516448	4.028434531	0	1.18187185	1.343871904	1.397430918	2.194602539	7.719627609	3.025623715	9.649735935	0	0.019676312	4.909781307	23.89588045	30.97138301	0.339952507	1.826980209	0	0	5.187599868	7.359903783	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.356
H2654_814_0	2011	1																															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	128.8391942	3.6686	20.28596474	600.5506613	1.386176925	7.662812204	6.375709368	24.57774197	44.64026665	16.97691899	40.55443697	0	0.030337336	40.42609143	23.16695811	87.07859843	2.0631	5.943616196	0	0	8.365554652	7.046968399	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.069652552	0.069652552	0.164035831	0	0.199689315	0.199689315	0.199689315	0.199689315	0.199689315	0.199689315	0.199689315	0	0.199689315	0.199689315	0.199689315	0.199689315	0.199689315	0.199689315	0	0	0.199689315	0.199689315	0	0	0	0	0	0	0	0												8.974	0.255527351	3.327625077	0	0.276804721	1.530181724	1.273161039	4.907912471	8.914184291	3.390109331	8.098287759	0	0.006058042	8.072658527	4.626194007	17.38866571	0.411979027	1.18687665	0	0	1.670511882	1.407204296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7179	0	12.63069963	8.974	0.255527351	3.327625077	0	0.276804721	1.530181724	1.273161039	4.907912471	8.914184291	3.390109331	8.098287759	0	0.006058042	8.072658527	4.626194007	17.38866571	0.411979027	1.18687665	0	0	1.670511882	1.407204296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7179	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.8478	0.0526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											1.9004	0	0	10.8218	0.308142502	3.327625077	0	0.276804721	1.530181724	1.273161039	4.907912471	8.914184291	3.390109331	8.098287759	0	0.006058042	8.072658527	4.626194007	17.38866571	0.411979027	1.18687665	0	0	1.670511882	1.407204296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6184
H2663_002_0	2011	13																															D	D	D	V	T	COIN	COIN	V	V	COIN	COIN	COIN	COIN	COIN	P	COIN	P	COIN	COIN	P	COIN	V	T	COIN	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	2119.985678	42.58246458	1670.82721	0	353.3067176	29.45013914	17.82470288	238.4179455	456.6489325	15.3116721	53.1624727	2.829514598	0.118197422	30.45210467	4149.859401	164.6413825	209.5652577	8.328311827	13.17996469	1912.827029	46.49508074	0	0	0	59.22334789	45.66538468	5.383609881	0	0	0											3400	1a $400 days 1-5	1b $400 days 1-5	2 $100 days 1-34	6 0%	10a $100	11a 20%	11b 20%	4a $50	"9a $350,9b $350"	8a $0	"8a 20%, 8b $15"	9a 20%	12 20%	"9a 20%,9d 20%, 4b $35, 3 20%"	"14c $0,7a $20"	"17a $25,17b $15,18a $35,7b $35,7d $35,7f $35,8a 20%, 14d-j $0"	"7h Ind.$30, Grp. $20,9c Ind.$30, Grp. $20, 7e Ind.$30, Grp. $20"	"7c 20%,7i 20%"	"8a 20%, 8b $15, 14h $0"	7g $35	15 20%				17a $25	17b $15	18a $35			7f $35												283.2390711	298.5074627	90.82600749	0	100	0.06737969	0.2	46.6194619	350	0.09897767	0.2	0.2	0.2	0.180759993	19.52835976	0.108060635	29.64904491	0.2	0.074508526	31.28039187	0.21439101	0	0	0	9.456455251	15	35	0	0	0											NO	164.0761116	172.92086	52.61413293	0	57.92848809	0.039032036	0.115856976	27.00594943	202.7497083	0.057336268	0.115856976	0.115856976	0.115856976	0.104711531	11.31248356	0.062597892	17.17524345	0.115856976	0.043161663	18.12025808	0.124193471	0	0	0	5.477981554	8.689273214	20.27497083	0	0	0												28.9866	0.613616366	7.325760412	0	1.705543665	1.149498878	2.065116177	0.536558582	7.715453156	0.87791413	6.159243333	0.327819005	0.013693996	3.188686505	3.912101354	10.30620352	0.299944527	0.964893025	0.568869188	2.888409952	5.774385444	0	0	0	0.027035367	0.033066584	0.009096044	0	0	0	0	0	0	0	0	0	0	0	0	0	85.4495	0	62.0590919	28.9866	0.613616366	7.325760412	0	1.705543665	1.149498878	2.065116177	0.536558582	7.715453156	0.87791413	6.159243333	0.327819005	0.013693996	3.188686505	3.912101354	10.30620352	0.299944527	0.964893025	0.568869188	2.888409952	5.774385444	0	0	0	0.027035367	0.033066584	0.009096044	0	0	0	0	0	0	0	0	0	0	0	0	0	85.4495	NO	30% Coins.	30% Coins.	30% Coins.	30% Coins.	30% Coins.	30% Coins.	30% Coins.	30% Coins.	30% Coins.	30% Coins.	30% Coins.	30% Coins.	30% Coins.	30% Coins.	30% Coins.	30% Coins.	30% Coins.	30% Coins.	30% Coins.	30% Coins.	30% Coins.																					0.9678	0.0029	0.1312	0.0512	0.0394	0.0804	0.0484	0.0256	0.1276	0.0402	0.1407	0.0077	0.0003	0.0831	0.0633	0.4289	0.0002	0.0226	0.0353	0.0278	0.0355	0	0	0	0	0.0004	0.0002	0	0.022	0											2.3829	0	0	29.9544	0.616521176	7.456998142	0.051158468	1.744905809	1.229932192	2.113534978	0.562172907	7.843020348	0.918138593	6.299931354	0.335546889	0.014016813	3.271829258	3.975358352	10.73514266	0.300109763	0.987531027	0.60421136	2.916239729	5.809887507	0	0	0	0.027077322	0.033500894	0.009272453	0	0.022032	0	0	0	0	0	0	0	0	0	0	0	87.8324
H2663_005_0	2011	10																															D	D	D	V	T	COIN	COIN	V	V	COIN	COIN	COIN	COIN	COIN	P	P	P	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	1573.751175	46.10061325	1063.726776	0	221.7069678	15.58721488	11.28164887	245.6691819	374.3147182	7.563928089	35.18452344	3.085226145	0.11431188	15.96269254	2830.552172	12296.4969	176.0653232	7.21942208	13.20910126	1671.701307	33.65139892	0	0	0	44.845912	34.56448997	1.575862889	0	0	0											2800	1a $390 days 1-5	1b $390 days 1-5	2 $100 days 1-25	6 0%	10a $150	11a 20%	11b 20%	4a $50	"9a $350,9b $350"	8a $0	"8a 20%, 8b $15"	9a 20%	12 20%	"9a 20%,9d 20%, 4b $35, 3 20%"	"14c $0,7a $5"	"17a $25,17b $15,18a $40,7b $40,7d $40,7f $40,8a 20%, 14d-j $0"	"7h Ind.$30, Grp. $20,9c Ind.$30, Grp. $20, 7e Ind.$30, Grp. $20"	"7c 20%,7i 20%"	"8a 20%, 8b $15, 14h $0"	7g $40	15 20%				17a $25	17b $15	18a $40			7f $40												264.7033285	362.1428571	81.57625384	0	150	0.096684831	0.2	47.01067974	350	0.124359457	0.188581441	0.2	0.2	0.191879386	4.856895005	12.02645505	29.98308475	0.2	0.199886566	37.29662968	0.221403353	0	0	0	8.746191827	15	40	0	0	0											NO	205.4803068	279.5412901	63.5470953	0	116.5801855	0.075428512	0.155353338	36.50218537	271.6455147	0.096452207	0.146233136	0.154738286	0.156127087	0.148991789	3.754967158	9.32698054	23.13869802	0.155303723	0.155892099	28.92073071	0.172233023	0	0	0	6.748835276	11.57446934	31.06839525	0	0	0												26.9479	1.073918742	5.633062237	0	2.15388662	1.175720423	1.75264181	0.747288501	8.473409522	0.729557558	5.145143186	0.477402607	0.017847181	2.378310124	0.885719204	9.557432271	0.339493529	1.12120313	2.059194515	4.028901944	5.795882156	0	0	0	0.025221473	0.033338802	0.004079961	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5566	0	0	26.9479	1.073918742	5.633062237	0	2.15388662	1.175720423	1.75264181	0.747288501	8.473409522	0.729557558	5.145143186	0.477402607	0.017847181	2.378310124	0.885719204	9.557432271	0.339493529	1.12120313	2.059194515	4.028901944	5.795882156	0	0	0	0.025221473	0.033338802	0.004079961	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5566	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	26.9479	1.073918742	5.633062237	0	2.15388662	1.175720423	1.75264181	0.747288501	8.473409522	0.729557558	5.145143186	0.477402607	0.017847181	2.378310124	0.885719204	9.557432271	0.339493529	1.12120313	2.059194515	4.028901944	5.795882156	0	0	0	0.025221473	0.033338802	0.004079961	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5566
H2663_006_0	2011	12																															D	D	D	V	T	COIN	COIN	V	V	COIN	COIN	COIN	COIN	COIN	P	P	P	COIN	COIN	P	COIN	V	T	COIN	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	1470.427548	117.192758	855.56021	0	269.42364	25.75716183	14.18151234	325.2423708	352.4651729	9.33561189	34.59909328	2.415554847	0.370388982	23.74971971	3075.565574	13852.86631	243.9690141	6.060889481	12.02395987	1524.993468	22.61467651	0	0	0	57.914822	44.071353	4.218139337	0	0	0											6700	1a $320 days 1-5	1b $320 days 1-5	"2 $50 days 1-20, $100 days 21-77"	6 0%	10a $100	11a 20%	11b 20%	4a $50	"9a $350,9b $350"	8a $0	"8a 20%, 8b $15"	9a 20%	12 20%	"9a 20%,9d 20%, 4b $35, 3 20%"	"14c $0,7a $20"	"17a $25,17b $15,18a $35,7b $35,7d $35,7f $35,8a 20%, 14d-j $0"	"7h Ind.$30, Grp. $20,9c Ind.$30, Grp. $20, 7e Ind.$30, Grp. $20"	"7c 20%,7i 20%"	"8a 20%, 8b $15, 14h $0"	7g $35	15 20%				17a $25	17b $15	18a $35			7f $35												226.5912569	238.8059701	62.10569588	0	100	0.059829578	0.2	47.44677999	350	0.112599586	0.193587157	0.2	0.065843909	0.189826953	19.49345135	11.21170296	29.37466119	0.2	0.19990184	31.89763456	0.220794651	0	0	0	9.903719518	15	35	0	0	0											NO	190.6560176	200.9335923	52.25631742	0	84.14094179	0.05034117	0.168281884	39.92216753	294.4932963	0.094742352	0.162886057	0.168281884	0.055401685	0.159722186	16.40197355	9.433632465	24.71611657	0.168281884	0.168199291	26.83897013	0.185778699	0	0	0	8.333082875	12.62114127	29.44932963	0	0	0												23.3622	1.962330154	3.725702159	0	1.889129901	1.29664567	2.386491608	1.082031701	8.649885883	0.884477832	5.63570989	0.40649412	0.020520174	3.793357146	4.203778767	10.89023745	0.502497216	1.019937898	2.022421525	3.410771179	4.20132518	0	0	0	0.040217418	0.046352564	0.010351781	0	0	0	0	0	0	0	0	0	0	0	0	0	81.4428	0	15.35051107	23.3622	1.962330154	3.725702159	0	1.889129901	1.29664567	2.386491608	1.082031701	8.649885883	0.884477832	5.63570989	0.40649412	0.020520174	3.793357146	4.203778767	10.89023745	0.502497216	1.019937898	2.022421525	3.410771179	4.20132518	0	0	0	0.040217418	0.046352564	0.010351781	0	0	0	0	0	0	0	0	0	0	0	0	0	81.4428	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.3622	1.962330154	3.725702159	0	1.889129901	1.29664567	2.386491608	1.082031701	8.649885883	0.884477832	5.63570989	0.40649412	0.020520174	3.793357146	4.203778767	10.89023745	0.502497216	1.019937898	2.022421525	3.410771179	4.20132518	0	0	0	0.040217418	0.046352564	0.010351781	0	0	0	0	0	0	0	0	0	0	0	0	0	81.4428
H2663_802_0	2011	4																															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	YES	287.8971932	2.857018572	34.6753766	0	9.679501377	31.73795993	18.85422612	7.36026412	45.10607887	14.18007355	44.8589799	3.049186372	0.109286576	23.62897162	30.2527243	151.8135813	1.731978587	9.954010493	12.77975734	8.461850112	32.70062497	0	0	0	0	0	0	0	0	0											6700	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%																				0.083594509	0.083594509	0.176964026	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.064006261	0.064006261	0.135497006	0	0.178402374	0.178402374	0.178402374	0.178402374	0.178402374	0.178402374	0.178402374	0.178402374	0.178402374	0.178402374	0.178402374	0.178402374	0.178402374	0.178402374	0.178402374	0.178402374	0.178402374	0	0	0	0	0	0	0	0	0												18.4272	0.182867078	4.698409711	0	1.726846028	5.66212741	3.363638707	1.313088595	8.047031569	2.529758789	8.002948526	0.543982089	0.019496985	4.21546464	5.397157847	27.08390336	0.308989092	1.775819107	2.279939053	1.509614152	5.833869138	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9222	0	31.4979349	18.4272	0.182867078	4.698409711	0	1.726846028	5.66212741	3.363638707	1.313088595	8.047031569	2.529758789	8.002948526	0.543982089	0.019496985	4.21546464	5.397157847	27.08390336	0.308989092	1.775819107	2.279939053	1.509614152	5.833869138	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9222	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.4272	0.182867078	4.698409711	0	1.726846028	5.66212741	3.363638707	1.313088595	8.047031569	2.529758789	8.002948526	0.543982089	0.019496985	4.21546464	5.397157847	27.08390336	0.308989092	1.775819107	2.279939053	1.509614152	5.833869138	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9222
H2663_804_0	2011	4																															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	YES	231.7408205	1.911118545	27.25734113	0	7.805147539	24.11096331	13.8998289	6.164611162	39.90964039	11.39302863	49.50968328	2.01244813	0.055266392	19.88668458	28.22910793	139.9376119	1.920831134	7.541372371	12.77446425	6.958260128	34.95387932	0	0	0	0	0	0	0	0	0											6700	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%																				0.083572349	0.083572349	0.177110311	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.066434598	0.066434598	0.140791211	0	0.185219889	0.185219889	0.185219889	0.185219889	0.185219889	0.185219889	0.185219889	0.185219889	0.185219889	0.185219889	0.185219889	0.185219889	0.185219889	0.185219889	0.185219889	0.185219889	0.185219889	0	0	0	0	0	0	0	0	0												15.3956	0.126964392	3.837594063	0	1.445668564	4.465829958	2.574524772	1.141808598	7.39205918	2.110215503	9.170178062	0.37274542	0.010236435	3.683409518	5.228592249	25.91922899	0.35577613	1.396812157	2.366084856	1.288808171	6.474153662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7563	0	24.44373796	15.3956	0.126964392	3.837594063	0	1.445668564	4.465829958	2.574524772	1.141808598	7.39205918	2.110215503	9.170178062	0.37274542	0.010236435	3.683409518	5.228592249	25.91922899	0.35577613	1.396812157	2.366084856	1.288808171	6.474153662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7563	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.3956	0.126964392	3.837594063	0	1.445668564	4.465829958	2.574524772	1.141808598	7.39205918	2.110215503	9.170178062	0.37274542	0.010236435	3.683409518	5.228592249	25.91922899	0.35577613	1.396812157	2.366084856	1.288808171	6.474153662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7563
H2663_805_0	2011	4																															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	325.4252892	3.750592722	51.81138284	0	12.16410822	31.21572051	23.85769302	10.20427618	50.24106792	17.09445334	50.37782706	2.858562742	0.087688706	30.0176389	35.14370437	171.0776531	1.675347851	9.652054842	20.65969679	9.34666166	35.93333288	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%																				0.083539439	0.083539439	0.177283316	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.060808526	0.060808526	0.129044882	0	0.169601168	0.169601168	0.169601168	0.169601168	0.169601168	0.169601168	0.169601168	0.169601168	0.169601168	0.169601168	0.169601168	0.169601168	0.169601168	0.169601168	0.169601168	0.169601168	0.169601168	0	0	0	0	0	0	0	0	0												19.7886	0.228068014	6.685993774	0	2.063046964	5.294222663	4.046292606	1.73065716	8.520943808	2.899239255	8.544138319	0.48481558	0.014872107	5.091026622	5.960413314	29.0149698	0.284140953	1.636999776	3.50390871	1.585204736	6.094335233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4719	0	42.4170856	19.7886	0.228068014	6.685993774	0	2.063046964	5.294222663	4.046292606	1.73065716	8.520943808	2.899239255	8.544138319	0.48481558	0.014872107	5.091026622	5.960413314	29.0149698	0.284140953	1.636999776	3.50390871	1.585204736	6.094335233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4719	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.7886	0.228068014	6.685993774	0	2.063046964	5.294222663	4.046292606	1.73065716	8.520943808	2.899239255	8.544138319	0.48481558	0.014872107	5.091026622	5.960413314	29.0149698	0.284140953	1.636999776	3.50390871	1.585204736	6.094335233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4719
H2667_001_0	2011	11																															A	A	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	P	P	P	P	P	Coin	P	Coin	V	T	V	V	P	P	P	P	P																																																			0	YES	269.8097834	30.68860635	512.0040341		170.1206884	7.328277121	1.950322829	267.2137057	383.6322175		13.50329598		0.907303192	245.9810491	4227.821651	3319.269329	134.3189532	30.10350072	12.98300358	113.6520328	27.53534305			125																	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	$0 copay	20% coins	$30 copay	$10 copay	$30 copay	$30 copay	$30 copay	20% coins	$30 copay for chiro; $10 copay for podiatry	20% coins	$30 copay	N/A	$30 copay; $500 limit for preventive	$0 copay	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay	N/A	Fitness benefit limited to $250/year; $10 copay for nutritional training and smoking cessation; $0 copay others	No cost sharing												321.209662	55.58444676	28.29719571		75	0.2	0.2	49.96216216	100		0.2		0.2	30	10	29.93334071	29.97865528	27.80952381	0.2	28.71346777	0.2			30																	NO	287.3265593	49.72106921	25.31223946		67.08855459	0.178902812	0.178902812	44.69185658	89.45140612		0.178902812		0.178902812	26.83542184	8.945140612	26.77579416	26.81632869	24.87601008	0.178902812	25.68460067	0.178902812			26.83542184																		6.4603	0.12715586	1.079997393	0	0.951095924	1.311049386	0.348918239	0.995189718	2.859703441	0	2.415777626	0	0.162319093	0.550083768	3.151538262	7.406339361	0.300161766	0.062404582	2.322695852	0.243258923	4.926150308	0	0	0.279535644	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.9537	0	4.239851119	6.4603	0.12715586	1.079997393	0	0.951095924	1.311049386	0.348918239	0.995189718	2.859703441	0	2.415777626	0	0.162319093	0.550083768	3.151538262	7.406339361	0.300161766	0.062404582	2.322695852	0.243258923	4.926150308	0	0	0.279535644	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.9537	NO																																																																																		0	0	0	6.4603	0.12715586	1.079997393	0	0.951095924	1.311049386	0.348918239	0.995189718	2.859703441	0	2.415777626	0	0.162319093	0.550083768	3.151538262	7.406339361	0.300161766	0.062404582	2.322695852	0.243258923	4.926150308	0	0	0.279535644	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.9537
H2667_003_0	2011	10																															D	D	D	V	T	Coin	Coin	V	Coin	P	Coin	P	Coin	P	P	P	P	Coin	P	P	Coin	P	T	V	V	P	P	P	P	P																																																			0	YES	2650.577236	66.57511476	668.8636389		356.9574714	9.990045338	2.506278045	325.9323549	53.97600188		11.99350359		2.744625493	294.2316632	4717.289454	5933.70027	297.204281	3.422847	3252.44726	369.901731	52.84344295	0.613877538								171.8857106											3400	$195/day days 1-20; $0/day days 21-90	"$195/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	$75 copay	20% coins	20% coins	$50 copay for ER and $35 for Urgent Care	20% coins for OP Surgery; $150 for ASC	0% coins	20% coins	$0 copay	20% coins	"20% coins for PT/OT/ST, $30 copay for other Outpatient Rehab"	$15 copay	$30 copay	$30 copay	20% coins	$30 copay	$30 copay for chiro; $30 copay for podiatry	20% coins	$30 copay	$0 copay	not covered	$0 copay	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay	N/A	Fitness benefit limited to $250/year	$30 copay												140.1733739	131.2298984	64.76115207		75	0.2	0.2	47.98866856	0.2		0.2		0.2	79.01420197	15	29.9862724	29.98458376	0.2	29.67599549	30	0.2	10.22196029								24.0666904											NO	100.9943401	94.55060276	46.66014406		54.03719193	0.144099178	0.144099178	34.57563858	0.144099178		0.144099178		0.144099178	56.92940796	10.80743839	21.60498609	21.60376944	0.144099178	21.38143286	21.61487677	0.144099178	10.22196029								21.61487677												22.3078	0.524559769	2.600772812	0	1.607414949	1.439557326	0.361152607	0.939109942	7.777897528	0	1.728254015	0	0.395498279	1.395869532	4.248484593	10.68312599	0.535061064	0.493229441	5.795165226	0.666281695	7.614696717	0.000522919	0	0	0	0	0	0	0	0.309607371	0	0	0	0	0	0	0	0	0	0	71.424	0	27.62254784	22.3078	0.524559769	2.600772812	0	1.607414949	1.439557326	0.361152607	0.939109942	7.777897528	0	1.728254015	0	0.395498279	1.395869532	4.248484593	10.68312599	0.535061064	0.493229441	5.795165226	0.666281695	7.614696717	0.000522919	0	0	0	0	0	0	0	0.309607371	0	0	0	0	0	0	0	0	0	0	71.424	NO																																																																																		0	0	0	22.3078	0.524559769	2.600772812	0	1.607414949	1.439557326	0.361152607	0.939109942	7.777897528	0	1.728254015	0	0.395498279	1.395869532	4.248484593	10.68312599	0.535061064	0.493229441	5.795165226	0.666281695	7.614696717	0.000522919	0	0	0	0	0	0	0	0.309607371	0	0	0	0	0	0	0	0	0	0	71.424
H2667_012_0	2011	7																															A	A	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	P	P	P	P	P	Coin	P	Coin	P	T	V	V	P	P	P	P	P																																																			0	YES	249.8368257	18.00152724	426.2034091		185.9537818	6.764079982	1.53970628	266.5945889	359.1535955		13.47112131		0.418368116	210.9102045	3765.810179	3184.51089	69.54751647	54.77937372	12.66935336		22.09165193			125																	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	$0 copay	20% coins	$30 copay	$10 copay	$30 copay	$30 copay	$30 copay	20% coins	$30 copay for chiro; $10 copay for podiatry	20% coins	$30 copay	N/A	$30 copay; $500 limit for preventive	$0 copay	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay	N/A	Fitness benefit limited to $250/year; $10 copay for nutritional training and smoking cessation; $0 copay others	$0 copay												321.209662	55.58444676	28.29719571		75	0.2	0.2	49.98313998	100		0.2		0.2	30	10	29.92771521	30	28.15060556	0.2		0.2			30																	NO	292.162006	50.55782994	25.73822161		68.25057793	0.181913585	0.181913585	45.46306095	90.95679258		0.181913585		0.181913585	27.28703777	9.095679258	27.22128985	27.28703777	25.60488791	0.181913585		0.181913585			27.28703777																		6.0827	0.075843179	0.914143149	0	1.05762109	1.23047804	0.28009349	1.01001717	2.722288257	0	2.450579974	0	0.076106844	0.479592893	2.854383461	7.223874497	0.158145476	0.116884977	2.304727491	0	4.018771604	0	0	0.284239977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.3405	0	3.314257057	6.0827	0.075843179	0.914143149	0	1.05762109	1.23047804	0.28009349	1.01001717	2.722288257	0	2.450579974	0	0.076106844	0.479592893	2.854383461	7.223874497	0.158145476	0.116884977	2.304727491	0	4.018771604	0	0	0.284239977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.3405	NO																																																																																		0	0	0	6.0827	0.075843179	0.914143149	0	1.05762109	1.23047804	0.28009349	1.01001717	2.722288257	0	2.450579974	0	0.076106844	0.479592893	2.854383461	7.223874497	0.158145476	0.116884977	2.304727491	0	4.018771604	0	0	0.284239977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.3405
H2667_803_0	2011	5																															A	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	P	P	P	P	P	P	P	Coin	P	T	V	V	P	P	P	P	P																																																			0	YES	282.3933872	22.20814126	337.4973305		138.3000523	6.538652314	1.952534486	255.9493566	418.2278806		12.99126902		0.584513732	239.4887356	4322.70047	3553.228967	96.33370507	129.0859025	2888.447595	229.611406	31.93248515																				6700	$150/day days 1-90; $750 max per stay	$175/day days 1-10	$0/day days 1-5; $50/day days 6-20; $100/day days 21-100	$0 copay	$75 copay	20% coins	20% coins	$50 copay for ER and $15 for urgent care	$150 copay	$0 copay	20% coins	$0 copay	20% coins	$30 copay	$15 copay	$30 copay for OV; $5 copay for immun.	$30 copay	$30 copay	$30 copay	$30 copay for chiro; $15 copay for podiatry	20% coins	$30 copay	N/A	N/A	$0 copay	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay	N/A	Fitness benefit limited to $200/year; $10 copay for nutritional training and smoking cessation; $0 copay others	$15 copay for routine foot care												519.4100182	117.7704216	61.14085602		75	0.2	0.2	49.97546151	150		0.2		0.2	30	15	28.97165546	30	29.38474543	30	29.7033239	0.2																				NO	496.0302847	112.4693281	58.38877795		71.62409281	0.190997581	0.190997581	47.72596125	143.2481856		0.190997581		0.190997581	28.64963713	14.32481856	27.66758053	28.64963713	28.06207645	28.64963713	28.36631504	0.190997581																					11.673	0.208144561	1.642171391	0	0.825467982	1.248866774	0.372929363	1.017952423	4.99253209	0	2.481300956	0	0.111640709	0.571772114	5.160158327	8.192437382	0.229993808	0.301868205	6.896081288	0.542769123	6.099027413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5681	0	2.477727457	11.673	0.208144561	1.642171391	0	0.825467982	1.248866774	0.372929363	1.017952423	4.99253209	0	2.481300956	0	0.111640709	0.571772114	5.160158327	8.192437382	0.229993808	0.301868205	6.896081288	0.542769123	6.099027413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5681	NO																																																																																		0	0	0	11.673	0.208144561	1.642171391	0	0.825467982	1.248866774	0.372929363	1.017952423	4.99253209	0	2.481300956	0	0.111640709	0.571772114	5.160158327	8.192437382	0.229993808	0.301868205	6.896081288	0.542769123	6.099027413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5681
H2667_807_0	2011	8																															A	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	P	P	P	P	P	P	P	Coin	P	T	V	V	P	P	P	P	P																																																			0	YES	278.0233556	24.68468798	485.6944532		167.3864757	7.885171017	1.707620713	245.3083773	440.8712703		12.86566241		0.479774903	272.7236922	4048.55143	3788.780574	127.7845884	182.4443759	3258.642364		37.53562961	1.056848969																			6700	$150/day days 1-90; $750 max per stay	$175/day days 1-10	$0/day days 1-5; $50/day days 6-20; $100/day days 21-100	$0 copay	$75 copay	20% coins	20% coins	$50 copay for ER and $15 for urgent care	$150 copay	$0 copay	20% coins	$0 copay	20% coins	$30 copay	$15 copay	$30 copay for OV; $5 copay for immun.	$30 copay	$30 copay	$30 copay	$30 copay for chiro; $15 copay for podiatry	20% coins	$30 copay	N/A	N/A	$0 copay	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay	N/A	Fitness benefit limited to $200/year; $10 copay for nutritional training and smoking cessation; $0 copay others	$15 copay for routine foot care												519.4100182	117.7704216	61.14085602		75	0.2	0.2	49.97916181	150		0.2		0.2	30	15	29.09781952	30	29.86295171	30		0.2	30																			NO	493.265466	111.8424364	58.06332528		71.22486794	0.189932981	0.189932981	47.463456	142.4497359		0.189932981		0.189932981	28.48994718	14.24497359	27.63317804	28.48994718	28.35979723	28.48994718		0.189932981	28.48994718																				11.4283	0.230066304	2.350086252	0	0.993506635	1.497654038	0.324333493	0.970265281	5.233499667	0	2.443613617	0	0.091125078	0.647490299	4.805959016	8.724670678	0.303381348	0.431173792	7.736545736	0	7.129254033	0.002509131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.3434	0	2.933367114	11.4283	0.230066304	2.350086252	0	0.993506635	1.497654038	0.324333493	0.970265281	5.233499667	0	2.443613617	0	0.091125078	0.647490299	4.805959016	8.724670678	0.303381348	0.431173792	7.736545736	0	7.129254033	0.002509131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.3434	NO																																																																																		0	0	0	11.4283	0.230066304	2.350086252	0	0.993506635	1.497654038	0.324333493	0.970265281	5.233499667	0	2.443613617	0	0.091125078	0.647490299	4.805959016	8.724670678	0.303381348	0.431173792	7.736545736	0	7.129254033	0.002509131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.3434
H2667_808_0	2011	5																															A	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	P	P	P	P	P	P	P	Coin	P	T	V	V	P	P	P	P	P																																																			0	YES	227.2956846	21.75096117	383.8005204		141.6190805	5.819418284	2.115489671	229.2487508	351.6193863		11.33278667		0.661620382	209.5107085	3978.564261	3294.828016	102.0793551	21.33625971	2880.079862		26.45801363																				6700	$150/day days 1-90; $750 max per stay	$175/day days 1-10	$0/day days 1-5; $50/day days 6-20; $100/day days 21-100	$0 copay	$75 copay	20% coins	20% coins	$50 copay for ER and $15 for urgent care	$150 copay	$0 copay	20% coins	$0 copay	20% coins	$30 copay	$15 copay	$30 copay for OV; $5 copay for immun.	$30 copay	$30 copay	$30 copay	$30 copay for chiro; $15 copay for podiatry	20% coins	$30 copay	N/A	N/A	$0 copay	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay	N/A	Fitness benefit limited to $200/year; $10 copay for nutritional training and smoking cessation; $0 copay others	$15 copay for routine foot care												519.4100182	117.7704216	61.14085602		75	0.2	0.2	49.96874069	150		0.2		0.2	30	15	29.10317863	30	28.35714286	30		0.2																				NO	500.8741525	113.5676211	58.95895992		72.32352116	0.192862723	0.192862723	48.185537	144.6470423		0.192862723		0.192862723	28.92940846	14.46470423	28.06459141	28.92940846	27.34517895	28.92940846		0.192862723																					9.4872	0.20585041	1.885706625	0	0.853532547	1.122348857	0.407999099	0.920539514	4.238392021	0	2.185672097	0	0.127601908	0.505085072	4.795729608	7.705666834	0.24609128	0.04862032	6.94325056	0	5.102764556	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7821	0	1.731265268	9.4872	0.20585041	1.885706625	0	0.853532547	1.122348857	0.407999099	0.920539514	4.238392021	0	2.185672097	0	0.127601908	0.505085072	4.795729608	7.705666834	0.24609128	0.04862032	6.94325056	0	5.102764556	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7821	NO																																																																																		0	0	0	9.4872	0.20585041	1.885706625	0	0.853532547	1.122348857	0.407999099	0.920539514	4.238392021	0	2.185672097	0	0.127601908	0.505085072	4.795729608	7.705666834	0.24609128	0.04862032	6.94325056	0	5.102764556	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7821
H2667_809_0	2011	5																															A	D	D	P	P	Coin	Coin	P	P	P	Coin	Coin	Coin	P	P	P	P	P	P	P	Coin	V	P	P	P	P	P	P	P	P																																																			0	YES	438.9367039	28.36933814	661.2118949		301.9170801	7.714645745	2.092862319	296.317372	406.1556233		11.93867642	5.374816623		287.7106433	4554.137357	7286.959146	193.613874	746.7963713		481.1874222	50.28484396	5.722253377								335.9780197											6700	$150/day days 1-90; maximum $750 per stay	$175/day days 1-10	$0/day days 1-5; $50/day days 6-20; $100/day days 21-100	$0 copay	$75/copay	20% coins	20% coins	"$50 copay for ER, $15 for Urgent Care"	$150/copay	$0 copay	20% coins	20% coins	20% coins	$30 Copay	$15 copay	$30 copay	$30 copay	$30 copay	$0 copay	$30 copay for chiro; $15 copay for podiatry	20% coins	$30 copay	N/A	N/A	$0 copay	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay	N/A	Fitness benefit limited to $200/year; $10 copay for nutritional training and smoking cessation; $0 copay others	$30 copay for chiro; $15 copay for podiatry												519.4100182	117.7704216	61.14085602		75	0.2	0.2	45.06224066	150		0.2	0.2		30	15	28.35476872	30	30		27.00760778	0.2	30								22.91691328											NO	479.2973488	108.6753218	56.41910854		69.20794729	0.184554526	0.184554526	41.58220235	138.4158946		0.184554526	0.184554526		27.68317891	13.84158946	26.16500452	27.68317891	27.68317891		24.92188127	0.184554526	27.68317891								22.91691328												17.5318	0.256920579	3.108748806	0	1.741255114	1.423772789	0.386247213	1.026794077	4.684866161	0	2.203336768	0.991946735	0	0.663728768	5.253041636	15.88860992	0.44665396	1.72280813	0	0.999341317	9.280295548	0.013200847	0	0	0	0	0	0	0	0.641631595	0	0	0	0	0	0	0	0	0	0	68.265	0	5.659435596	17.5318	0.256920579	3.108748806	0	1.741255114	1.423772789	0.386247213	1.026794077	4.684866161	0	2.203336768	0.991946735	0	0.663728768	5.253041636	15.88860992	0.44665396	1.72280813	0	0.999341317	9.280295548	0.013200847	0	0	0	0	0	0	0	0.641631595	0	0	0	0	0	0	0	0	0	0	68.265	NO																																																																																		0	0	0	17.5318	0.256920579	3.108748806	0	1.741255114	1.423772789	0.386247213	1.026794077	4.684866161	0	2.203336768	0.991946735	0	0.663728768	5.253041636	15.88860992	0.44665396	1.72280813	0	0.999341317	9.280295548	0.013200847	0	0	0	0	0	0	0	0.641631595	0	0	0	0	0	0	0	0	0	0	68.265
H2667_810_0	2011	5																															A	D	D	P	P	Coin	Coin	P	P	P	Coin	Coin	Coin	P	P	P	P	P	P	P	Coin	O	P	P	P	P	P	P	P	P																																																			0	YES	469.0055142	27.71085892	485.5134926		247.5680556	10.81271084	3.25062822	290.3207519	437.759063		13.66500427	5.17551043		215.6247103	5179.177549	6795.146784	196.5317752	652.4806405	3361.126664	496.2855626	63.02772767	1.249026917								284.6980689											6700	$150/day days 1-90; maximum $750 per stay	$175/day days 1-10	$0/day days 1-5; $50/day days 6-20; $100/day days 21-100	$0 copay	$75/copay	20% coins	20% coins	"$50 copay for ER, $15 for Urgent Care"	$150/copay	$0 copay	20% coins	20% coins	20% coins	$30 copay	$15 copay	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay for chiro; $15 copay for podiatry	20% coins	$30 copay	N/A	N/A	$0 copay	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay	N/A	Fitness benefit limited to $200/year; $10 copay for nutritional training and smoking cessation; $0 copay others	$30 copay for chiro; $15 copay for podiatry												519.4100182	117.7704216	61.14085602		75	0.2	0.2	45.63285384	150		0.2	0.2		30	14.9965623	28.29834344	30	29.93454572	30	28.08683807	0.2	30								24.65691031											NO	468.2592956	106.1725665	55.11979587		67.61411205	0.180304299	0.180304299	41.13899857	135.2282241		0.180304299	0.180304299		27.04564482	13.52282241	25.51156486	27.04564482	27.04564482	27.04564482	25.32088822	0.180304299	27.04564482								24.65691031												18.3013	0.245177751	2.23011705	0	1.394924521	1.949578246	0.586102242	0.995292083	4.933115056	0	2.463859012	0.933166779	0	0.485975777	5.836424852	14.44623566	0.442944049	1.470563305	7.57531983	1.047199271	11.36417024	0.002815062	0	0	0	0	0	0	0	0.584981229	0	0	0	0	0	0	0	0	0	0	77.2893	0	8.373823365	18.3013	0.245177751	2.23011705	0	1.394924521	1.949578246	0.586102242	0.995292083	4.933115056	0	2.463859012	0.933166779	0	0.485975777	5.836424852	14.44623566	0.442944049	1.470563305	7.57531983	1.047199271	11.36417024	0.002815062	0	0	0	0	0	0	0	0.584981229	0	0	0	0	0	0	0	0	0	0	77.2893	NO																																																																																		0	0	0	18.3013	0.245177751	2.23011705	0	1.394924521	1.949578246	0.586102242	0.995292083	4.933115056	0	2.463859012	0.933166779	0	0.485975777	5.836424852	14.44623566	0.442944049	1.470563305	7.57531983	1.047199271	11.36417024	0.002815062	0	0	0	0	0	0	0	0.584981229	0	0	0	0	0	0	0	0	0	0	77.2893
H2672_001_0	2011	9																															D	D	D	V	COIN	COIN	COIN	V	V	O	COIN	O	COIN	COIN	P	COIN	P	P	COIN	P	COIN	V	T	COIN	V	COIN	V	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	1632.563151	9.942528322	1820.079235	0	12.3948867	13.32586815	3.249682458	595.9132358	605.4603547	0	23.53028986	27.2224758	0	14.82339066	6263.55344	108.2562016	164.7398419	782.0363422	30.97097119	0	24.8334557	0	0	0	582.1534775	0	1.309681614	0	0	178.7715403											3900	1a $200 days 1-7	1b $195 days 1-9	2 $50 days 1-78	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $10"	"9a $250, 9b $250"	8a $0	"8b X-ray $0, Ther. 20%, CT $150, Other Diag. $250"	5 $40	12 $0	"3 $40, 4b $10, 9d $40, 13a $0, 14b $0"	"7a $10, 14b $0, 14c $0, 14d - 14g $0, 14i - 14j $0"	"17a $40, 18a $10, 7b $20, 7d $40, 7f $10, 14d - 14g $0, 14i - 14j $0, 16b $40-$250"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $250, 14h $0"	7g $40	15 20%				17a $40		18a $10		14a $0	7f $10												153.2835372	170.2023121	49.4384468	0	0.326284521	0.2	0.2	49.44367177	250	0	0.250446035	40	0	0.019769478	5.705499167	0.125547313	40	40	0.291397197	0	0.234287364	0	0	0	17.32283465	0	10	0	0	10											NO	116.7771424	129.6664991	37.6640613	0	0.248575774	0.152367494	0.152367494	37.66804187	190.4593678	0	0.190799174	30.47349885	0	0.015061129	4.346663057	0.095646647	30.47349885	30.47349885	0.221997304	0	0.178488893	0	0	0	17.32283465	0	10	0	0	10												15.8872	0.107434403	5.712631322	0	3.081068558	2.030429139	0.495145973	1.870573726	9.609633032	0	4.489559861	0.06913034	0	0.223257001	2.268796362	10.35434274	0.418349949	1.985948631	6.875472102	0	4.432496012	0	0	0	0.840379036	0	0.001091401	0	0	0.148976284	0	0	0	0	0	0	0	0	0	0	70.9019	0	21.85543	15.8872	0.107434403	5.712631322	0	3.081068558	2.030429139	0.495145973	1.870573726	9.609633032	0	4.489559861	0.06913034	0	0.223257001	2.268796362	10.35434274	0.418349949	1.985948631	6.875472102	0	4.432496012	0	0	0	0.840379036	0	0.001091401	0	0	0.148976284	0	0	0	0	0	0	0	0	0	0	70.9019	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.8872	0.107434403	5.712631322	0	3.081068558	2.030429139	0.495145973	1.870573726	9.609633032	0	4.489559861	0.06913034	0	0.223257001	2.268796362	10.35434274	0.418349949	1.985948631	6.875472102	0	4.432496012	0	0	0	0.840379036	0	0.001091401	0	0	0.148976284	0	0	0	0	0	0	0	0	0	0	70.9019
H2672_008_0	2011	10																															D	D	D	V	COIN	COIN	COIN	V	V	O	COIN	O	COIN	COIN	COIN	COIN	P	P	COIN	P	COIN	V	T	COIN	COIN	COIN	COIN	COIN	P	COIN											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1823.009033	21.49354066	1194.498515	0	9.817937668	11.78659225	3.739787072	656.7863871	660.1140072	0	27.09295171	41.1323555	0	21.4592305	39.94361756	105.0388989	149.3077436	795.3154785	27.53372049	0	16.52604325	0	0	0	0	0	0	0	0	0											6300	1a $250 days 1-7	1b $250 days 1-7	2 $50 days 1-100	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $20"	"9a $300, 9b $300"	8a $0	"8b X-ray $10, Ther. 20%, CT $150, Other Diag. $400"	5 $40	12 $0	"3 $40, 4b $20, 9d $40, 13a $0, 14b $0"	"7a $20, 14b $0, 14c $0, 14d - 14g $0, 14i - 14j $0"	"17a $40, 18a $20, 7b $20, 7d $40, 7f $20, 14d - 14g $0, 14i - 14j $0, 16b $40-$300"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $400, 14h $0"	7g $40	15 20%								14a $0	7f $20												191.6060998	204.4797688	50	0	0.326420287	0.2	0.2	49.33843178	300	0	0.20782086	40	0	0.006156346	0.156600864	0.126161824	40	40	0.359007648	0	0.252207475	0	0	0	0	0	0	0	0	0											NO	162.0136496	172.8990551	42.27779015	0	0.276006568	0.169111161	0.169111161	41.7183973	253.6667409	0	0.175724134	33.82223212	0	0.005205534	0.132414769	0.106676862	33.82223212	33.82223212	0.303561	0	0.213255494	0	0	0	0	0	0	0	0	0												24.6127	0.309684406	4.208396462	0	2.70981528	1.993244295	0.632439732	2.283339619	13.95408073	0	4.760885479	0.11593234	0	0.111706749	5.289124903	11.20522012	0.420826763	2.24161206	8.358163724	0	3.524269516	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7314	0	15.8418489	24.6127	0.309684406	4.208396462	0	2.70981528	1.993244295	0.632439732	2.283339619	13.95408073	0	4.760885479	0.11593234	0	0.111706749	5.289124903	11.20522012	0.420826763	2.24161206	8.358163724	0	3.524269516	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7314	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.6127	0.309684406	4.208396462	0	2.70981528	1.993244295	0.632439732	2.283339619	13.95408073	0	4.760885479	0.11593234	0	0.111706749	5.289124903	11.20522012	0.420826763	2.24161206	8.358163724	0	3.524269516	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7314
H2672_009_0	2011	8																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	COIN	COIN	COIN	COIN	P	P	COIN	P	COIN	V	T	COIN	COIN	COIN	COIN	COIN	P	COIN											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1378.342591	34.32085764	727.1499361	0	117.8895838	14.74098159	2.855434829	515.2327959	492.9348024	0	13.1037299	86.28300409	2.078714354	4.510324219	41.59346261	112.096215	273.2895291	1089.850879	31.74054744	0	31.75987137	0	0	0	0	0	0	0	0	0											5500	1a $250 days 1-7	1b $175 days 1-10	2 $50 days 1-95	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $40"	"9a $250, 9b $250"	8a $0	"8b X-ray $0, Ther. 20%, CT $250, Other Diag. $250"	5 $40	12 $0	"3 $40, 4b $40, 9d $40, 13a $0, 14b $0"	"7a $0, 14b $0, 14c $0, 14d - 14g $0, 14i - 14j $0"	"17a $0, 18a $0, 7b $20, 7d $40, 7f $40, 14d - 14g $0, 14i - 14j $0, 16b $40-$250"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $250, 14h $0"	7g $40	15 20%								14a $0	7f $40												191.4074915	157.2976879	49.93470312	0	150	0.2	0.2	49.72886762	250	0	0.408821091	40	0.2	0.085491686	0.000307521	0.167648359	40	40	0.355260376	0	0.218601212	0	0	0	0	0	0	0	0	0											NO	161.2545923	132.518191	42.06836488	0	126.3701261	0.168493502	0.168493502	41.89495516	210.6168769	0	0.344418485	33.6987003	0.168493502	0.072023968	0.000259076	0.141238296	33.6987003	33.6987003	0.299295324	0	0.184164418	0	0	0	0	0	0	0	0	0												18.522	0.379011497	2.549167403	0	1.241476798	2.483759604	0.481122213	1.798804573	8.651699049	0	4.513166805	0.242302091	0.35024986	0.324851446	0.010775883	15.83227834	0.767458495	3.060546513	9.499797418	0	5.849038243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5575	0	14.31544316	18.522	0.379011497	2.549167403	0	1.241476798	2.483759604	0.481122213	1.798804573	8.651699049	0	4.513166805	0.242302091	0.35024986	0.324851446	0.010775883	15.83227834	0.767458495	3.060546513	9.499797418	0	5.849038243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5575	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.522	0.379011497	2.549167403	0	1.241476798	2.483759604	0.481122213	1.798804573	8.651699049	0	4.513166805	0.242302091	0.35024986	0.324851446	0.010775883	15.83227834	0.767458495	3.060546513	9.499797418	0	5.849038243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5575
H2672_801_0	2011	4																															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	YES	236.1414344	6.631508277	37.76590281	0	9.811274506	16.87968653	5.165176637	17.65694186	74.29524899	5.108852969	26.39214231	0.817932725	0.097378938	15.35909398	36.77104188	122.5235417	1.9221439	8.548397434	33.35815249	3.382747459	40.2281529	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 17.0%	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%																				0.086	0.086	0.169	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.070223846	0.070223846	0.137998022	0	0.190257629	0.190257629	0.190257629	0.190257629	0.190257629	0.190257629	0.190257629	0.190257629	0.190257629	0.190257629	0.190257629	0.190257629	0.190257629	0.190257629	0.190257629	0.190257629	0.190257629	0	0	0	0	0	0	0	0	0												16.5828	0.465690014	5.211619904	0	1.866669821	3.211489131	0.982714258	3.359367887	14.13523789	0.971998251	5.02130641	0.155617941	0.018527086	2.922184799	6.99597123	23.3110385	0.36570254	1.626397824	6.346642987	0.64359351	7.653712974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8482	0	22.88074042	16.5828	0.465690014	5.211619904	0	1.866669821	3.211489131	0.982714258	3.359367887	14.13523789	0.971998251	5.02130641	0.155617941	0.018527086	2.922184799	6.99597123	23.3110385	0.36570254	1.626397824	6.346642987	0.64359351	7.653712974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8482	NO	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 17.0%	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	16.5828	0.465690014	5.211619904	0	1.866669821	3.211489131	0.982714258	3.359367887	14.13523789	0.971998251	5.02130641	0.155617941	0.018527086	2.922184799	6.99597123	23.3110385	0.36570254	1.626397824	6.346642987	0.64359351	7.653712974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8482
H2672_802_0	2011	4																															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	YES	319.1007862	15.2644623	48.15270446	0	0.657475135	18.31735725	4.363790768	23.78928266	89.13852578	11.04445337	38.03803557	1.05472066	0.211209587	15.61100427	48.69088498	130.1237997	3.120524339	8.037553867	39.0822161	3.530419771	40.40614735	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 17.0%	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%																				0.086	0.086	0.17	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.066867004	0.066867004	0.132178961	0	0.181162928	0.181162928	0.181162928	0.181162928	0.181162928	0.181162928	0.181162928	0.181162928	0.181162928	0.181162928	0.181162928	0.181162928	0.181162928	0.181162928	0.181162928	0.181162928	0.181162928	0	0	0	0	0	0	0	0	0												21.3373	1.020688855	6.364774424	0	0.119110121	3.318426077	0.790557114	4.309736108	16.14859635	2.000845513	6.89108191	0.191076283	0.038263347	2.828135246	8.820983304	23.57360859	0.565323327	1.456106795	7.080248713	0.639581184	7.320095975	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.8146	0	32.85247294	21.3373	1.020688855	6.364774424	0	0.119110121	3.318426077	0.790557114	4.309736108	16.14859635	2.000845513	6.89108191	0.191076283	0.038263347	2.828135246	8.820983304	23.57360859	0.565323327	1.456106795	7.080248713	0.639581184	7.320095975	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.8146	NO	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 17.0%	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	21.3373	1.020688855	6.364774424	0	0.119110121	3.318426077	0.790557114	4.309736108	16.14859635	2.000845513	6.89108191	0.191076283	0.038263347	2.828135246	8.820983304	23.57360859	0.565323327	1.456106795	7.080248713	0.639581184	7.320095975	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.8146
H2672_803_0	2011	3																															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	YES	251.1669247	6.816891035	37.04798021	0	10.11299316	15.99458103	4.107309458	20.69749375	71.01298879	15.59644658	19.65212841	1.075156983	0.311239852	13.49061906	38.13233694	117.6733542	2.200319446	7.445507312	34.99649142	2.977421711	23.61401033	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 17.0%	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%																				0.086	0.086	0.17	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.070728061	0.070728061	0.139811283	0	0.1916237	0.1916237	0.1916237	0.1916237	0.1916237	0.1916237	0.1916237	0.1916237	0.1916237	0.1916237	0.1916237	0.1916237	0.1916237	0.1916237	0.1916237	0.1916237	0.1916237	0	0	0	0	0	0	0	0	0												17.7645	0.482145485	5.179725661	0	1.937889169	3.064940799	0.787057836	3.966130337	13.60777168	2.988648805	3.765813563	0.206025559	0.059640932	2.585122343	7.307059501	22.54900354	0.421633354	1.426735661	6.70615718	0.570544565	4.525004036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9016	0	21.57122803	17.7645	0.482145485	5.179725661	0	1.937889169	3.064940799	0.787057836	3.966130337	13.60777168	2.988648805	3.765813563	0.206025559	0.059640932	2.585122343	7.307059501	22.54900354	0.421633354	1.426735661	6.70615718	0.570544565	4.525004036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9016	NO	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 17.0%	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	17.7645	0.482145485	5.179725661	0	1.937889169	3.064940799	0.787057836	3.966130337	13.60777168	2.988648805	3.765813563	0.206025559	0.059640932	2.585122343	7.307059501	22.54900354	0.421633354	1.426735661	6.70615718	0.570544565	4.525004036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9016
H2701_001_0	2011	12																															A	A	D	V	T	Coin	Coin	V	V	P	V	V	Coin	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	NO	272.3568445	0.483766811	693.6377968		24.5897714	13.17685357	2.199724966	364.2560604	541.0390509	2490.850051	867.865594	169.5938224		4802.158038	2970.91707	5780.275971	324.4917103	780.6635373		1928.550399	31.81331087			1.003664139																		$600 per Admission	$600 per Admission	"$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: 20% coinsurance"	ER - $50 per Visit; UC - $35 per Visit	$125 Per visit	"OP diag Procs/Tests/lab Services: $0 copay for Abdominal Aortic Anuerysm Screening, Cardiovascular Screening, EKG Screening, HIV Screening, $15 for lab"	"$50 Copay for CT/MRI/PET, $15 for Therapeutic Radiology, $25 Copay for X-ray services"	OP observation $25 Copay	OP Dialysis: 20% coinsurance	"OP Partial Hospitalization: $25 copay OP PT/OT/ST $15 copay, Cardiac Rehab: $15 copay"	"$15 copay for Primary physician services, no copay for immunizations, physical exams, pap smears, pelvic exams, prostate cancer screening, colorectal  screening, bone mass measurement, mammography screening, diabetes monitoring and nutrition therapy for diabetes or renal disease."	"Specialist: $25 copay, Immunizations: $0 copay, Physical Exam: $0 copay, Prostate Screening, Colorectal Screening, Bone Mass meas, Mammography, Pap & Pelvic: $0 copay, chiro $15"	"$15 copay for PCP,$25 Copay for specialist"	$15 copay	No cost sharing for test performing in physician's office	"$15 copay for PCP,$25 Copay for specialist"	20% Coinsurance	Medicare covered hearing exam: $0 copay in-network	not covered	$200 annual allowance	$0 Copay up to 1 routine eye exam per year	$100 annual allowance	$0 Copay for hearing routine	not covered	No cost sharing												0	600	600	35.61		100	0.2	0.2	46.31460686	125	15	31.74536026	25		19.44146303	14.9717153	23.67377002	24.16400624	15		21.87418599	0.2			25																	NO	467.0145924	467.0145924	27.71731606		77.83576539	0.155671531	0.155671531	36.04932874	97.29470674	11.67536481	24.70924414	19.45894135		15.13241155	11.67021273	18.42666009	18.80823921	11.67536481		17.02594009	0.155671531			25																		10.5996	0.01882718	1.60214817	0	0.159496973	2.051260966	0.342434553	1.094265539	4.386686316	2.423465252	1.787025237	0.275009687	0	6.055685981	2.889269517	8.875931714	0.508593142	0.759544299	0	2.736281962	4.952426802	0	0	0.002090967	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.52	0	14.66469079	10.5996	0.01882718	1.60214817	0	0.159496973	2.051260966	0.342434553	1.094265539	4.386686316	2.423465252	1.787025237	0.275009687	0	6.055685981	2.889269517	8.875931714	0.508593142	0.759544299	0	2.736281962	4.952426802	0	0	0.002090967	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.52	YES	$800 per Admission	$800 per Admission	$100 per day	$35 copay	$100 per segment	50% Coinsurance	50% Coinsurance	ER - $50 per Visit; UC - $35 per Visit	$200 Per Visit	$35 Copay	"$150 Copay for CT/MRI/PET, $35 Copay for other Radiology"	$35 Copay	20% Coinsurance	$35 Copay	$35 Copay	"Chiropractic: $15, $35 Copay all other specialist visits"	$35 Copay	$35 Copay	No cost share	$35 Copay	20% Coinsurance	Medicare covered hearing exam: $35 copay	not covered	$200 annual allowance	$35 copay	$100 annual allowance	$35 Copay for hearing routine	not covered	$35 Copay												3400					0.4883	0.5513	0.3712	0.1036	0.7532						1.1457	2.6184	0.3558	0.3148		2.168	0.3525			1.6627	0.2233		0.001														11.1099	0	2.613567531	10.5996	0.01882718	1.60214817	0	0.647753013	2.602580311	0.713654558	1.19785803	5.139911288	2.423465252	1.787025237	0.275009687	0	6.055685981	4.034951634	11.49437585	0.864415697	1.074310405	0	4.90429054	5.304887859	0	0	1.66482789	0.223295762	0	0.001026411	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6299
H2701_003_0	2011	12																															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	188.0279116	1.175683497	361.6051473		12.27960194	7.691084384	1.327473914	272.4699741	423.7522524	1762.320036	614.4667016	106.2071316		3312.409146	2130.350309	4024.454409	143.8544767	513.6899037		1336.040487	15.99659803																					$750 per admission	$750 per admission	"$0 per day for days 1-20, $125 per day for days 21-100"	No Cost Sharing	$100 per segment	20% Coinsurance	"Prosthetic Medical Supplies:20% Coinsurance, Diabetes Monitoring Supplies: 20% Coinsurance"	ER - $50 per Visit; UC - $45 per Visit	$225 copay per visit	"OP diag Procs/Tests/lab Services: $0 copay for Abdominal Aortic Aneurysm Screening, Cardiavascular Screening, EKG Screening, $20 for lab"	"$100 copay for CT/MRI/PET, $20 for Therapeutic Radiology, $40 copay for X-Rays"	$40 copay	20% Coinsurance	"OP Partial Hospitalization: $40 copay OP PT/OT/ST $20 copay, Cardiac Rehab: $20 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, mammography screening, diabetes monitoring and nutrition therapy for diabetes or renal disease."	"Specialist: $40 copay, Immunizations: $0 copay, Physical Exam: $0 copay, Prostate Screening, Colorectal Screening, Bone Mass meas, Mammography: $0 copay, Pap & Pelvic: $0 copay, chiro $20"	"$20 copay for PCP,$40 Copay for specialist"	$20 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: $0 copay	not covered	not covered	$0 copay for routine vision	not covered	$0 copay for Hearing routine; $40 copay for diagnostic hearing exams	not covered	No cost sharing												0	750	750	52.78		100	0.2	0.2	48.86766502	225	20	54.84445615	40		28.401791	19.90162577	37.11182505	38.59153307	20		33.76845671	0.2																				NO	661.8563859	661.8563859	46.57704007		88.24751812	0.176495036	0.176495036	43.12450155	198.5569158	17.64950362	48.39887138	35.29900725		25.06387566	17.58453677	32.80380088	34.05607014	17.64950362		29.79982496	0.176495036																					10.3706	0.064844469	1.403541453	0	0.0903037	1.357438217	0.234292557	0.979177652	7.011578358	2.592006156	2.478291238	0.312417192	0	6.918484247	3.121768611	11.00145009	0.408259846	0.755530985	0	3.317814388	2.823320149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2411	0	7.332072915	10.3706	0.064844469	1.403541453	0	0.0903037	1.357438217	0.234292557	0.979177652	7.011578358	2.592006156	2.478291238	0.312417192	0	6.918484247	3.121768611	11.00145009	0.408259846	0.755530985	0	3.317814388	2.823320149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2411	YES	"$1,000 per admission"	"$1,000 per admission"	$130 per day	$45 Copay	$100 per segment	50% Coinsurance	50% Coinsurance	ER - $50 per Visit; UC - $45 per Visit	$425 copay per visit	$45 Copay	"$200 copay for CT/MRI/PET, $45 copay for other radialogy"	$45 Copay	20% Coinsurance	$45 Copay	$45 Copay	"Chiropractic:$20,  $45 Copay all other specialist visits"	$45 Copay	$45 Copay	No cost sharing	$45 Copay	30% Coinsurance	Medicare covered hearing exam: $45 copay	not covered	not covered	$45 copay	not covered	$45 copay for Hearing routine	not covered	$45 Copay												5000	0.122	0.003	0.0917		0.2996	0.2036	0.4868	0.0726	0.7536	0.0603	0.0568	0.002		0.1023	0.9867	2.3848	0.2943	0.1993		1.6388	0.2389	0.0202			0.1559		0.0009														8.174	0	1.000223985	10.4926	0.067795952	1.495225304	0	0.389925997	1.561003686	0.721081338	1.05174211	7.765151305	2.652308877	2.53509537	0.314374084	0	7.020752829	4.108470742	13.38625553	0.702527483	0.954880178	0	4.956628194	3.062264379	0.020227265	0	0	0.155875222	0	0.000900691	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4151
H2701_806_0	2011	3																															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	1271.425406	7.314751287	755.2091777		31.68039871	14.16444851	2.446660597	382.0629641	478.0580121	2407.181698	843.5035702	150.2678878	0.421991661	4538.660187	4559.774822	7020.828944	280.8573642	876.4945767	1726.319222	3891.880733	35.95026262	10.57082064																				FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	not covered	not covered	not covered	not covered	FFS	not covered	not covered												0	185.2405571	25.54783962	66.78039646		344.523367	0.233	0.233	108.8712204	287.2679867	13.41616002	72.97285255	148.0564376	16.50290352	42.44621752	16.50665013	20.68748094	24.073857	20.07415093	17.40913768	31.96515965	0.233	147.0473563																			YES	153.3917944	21.15535077	55.29871536		285.2888065	0.192939865	0.192939865	90.15278352	237.8774531	11.109494	60.42649065	122.6008115	13.6655278	35.14835828	13.66863025	17.13064284	19.93479279	16.62276382	14.41595139	26.46932871	0.192939865	121.7652235																				16.2522	0.012895511	3.480174779	0	0.753171928	2.732886784	0.472058365	2.870336641	9.476601862	2.228547553	4.247496716	1.535247083	0.000480562	13.2938712	5.193823005	10.02260942	0.466569447	1.214146862	2.073877833	8.584622534	6.936238818	0.107263195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9551	0	19.09265324	16.2522	0.012895511	3.480174779	0	0.753171928	2.732886784	0.472058365	2.870336641	9.476601862	2.228547553	4.247496716	1.535247083	0.000480562	13.2938712	5.193823005	10.02260942	0.466569447	1.214146862	2.073877833	8.584622534	6.936238818	0.107263195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9551	YES	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	not covered	not covered	not covered	not covered	FFS	not covered	not covered												6700					0.702	0.2569	0.184	0.0767	0.3327				0.0014		1.306	2.5999	0.2959	0.1574	1.4939	3.4012	0.7656	1.0503																			12.624	0	2.62111972	16.2522	0.012895511	3.480174779	0	1.455165273	2.989834148	0.656063438	2.947066935	9.809324602	2.228547553	4.247496716	1.535247083	0.001922246	13.2938712	6.499793216	12.62247325	0.762511671	1.371564839	3.567770185	11.98579603	7.701860094	1.157524875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.5791
H2701_807_0	2011	3																															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	920.1345138	5.056006486	442.035219		14.27754503	8.509345506	1.578070096	322.7680075	541.3373098	2336.296423	709.1907053	148.7151084	0.291683544	4120.456571	4003.312698	6419.140401	241.4298079	795.7947564	1605.037903	3585.568751	24.38389379	5.017254026																				FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	not covered	not covered	not covered	not covered	not covered	not covered	not covered												0	186.0227092	21.94929936	49.22093385		202.1189982	0.233	0.233	90.98739982	227.8425798	10.81479902	59.63713824	87.55916187	14.17839514	34.91706759	14.92022551	17.89242853	24.20942556	18.5657787	16.3919166	28.75465952	0.233	86.37759062																			YES	164.5878591	19.4201461	43.54935029		178.82942	0.206152095	0.206152095	80.50318911	201.5889488	9.568641511	52.76532605	77.46997695	12.54466033	30.8936765	13.207618	15.83073657	21.41984459	16.42649858	14.50312422	25.4413446	0.206152095	76.42455469																				12.6202	0.008182365	1.604195549	0	0.212770425	1.7542194	0.325322456	2.165321162	9.093968271	1.862931911	3.1183899	0.960079668	0.000304923	10.60800436	4.406185405	8.46831006	0.43094908	1.089343453	1.939838674	7.601807517	5.026790781	0.03195345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3291	0	9.547415293	12.6202	0.008182365	1.604195549	0	0.212770425	1.7542194	0.325322456	2.165321162	9.093968271	1.862931911	3.1183899	0.960079668	0.000304923	10.60800436	4.406185405	8.46831006	0.43094908	1.089343453	1.939838674	7.601807517	5.026790781	0.03195345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3291	YES	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	not covered	not covered	not covered	not covered	not covered	not covered	not covered												6700					0.5224	0.1607	0.1422	0.0634	0.2889				0.0009		0.8984	1.6675	0.2026	0.1853	1.7787	2.6124	0.3863	1.1974																			10.107	0	1.315736872	12.6202	0.008182365	1.604195549	0	0.735147817	1.914872421	0.467512376	2.228730271	9.382866296	1.862931911	3.1183899	0.960079668	0.00121969	10.60800436	5.304623166	10.1358006	0.633507116	1.274626939	3.71849486	10.21425059	5.413072812	1.229367221	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.4361
H2773_001_0	2011	4																															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	YES	1993.743741	176.8590199	730.5430281		169.82057		11.19763739	199.0652602	274.278101	3141.197211	693.9688934	55.0877648	0.538853666	1209.175987		9140.288595	869.6479111	2679.687633	4977.128347	0.123068738	35.54108398				150.8915678		260.9166693														3400	"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; $100 CT; $200 MRI and PET;8b: 20% therapuetic radiation, $200 Nuclear Medicine"	9a: $200/visit	12a: 20%	3: $15/visit;5: $25/visit;7c: $15/visit;7e: $25/visit;7i: $15/visit;9a: $200/visit;9c: $25/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: $25/visit;7h: $25/visit	7c: $15/visit;7i: $15/visit	"8b: $5/visit;8b: $40 Ultrasounds; $100 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: $0 exam and $15/visit fitting/evaluation	18b: $1000 allowance every two years	14a: $0 copay	13c: $30/quarter allowance												75.06659695	44.11008635	24.24797264		100		0.2	43	156.8951963	10	66.15053457	200	0.2	129.2519911		14.99975085	24.88807065	15	6.065172574	0.2	0.2				30		15														NO	64.69875598	38.01781124	20.89895811		86.1884761		0.172376952	37.06104472	135.2255788	8.61884761	58.67304491	172.3769522	0.172376952	117.7234106		12.92805668	21.50567619	12.92827142	5.227479815	0.172376952	0.172376952				30		15															10.7494	0.560316069	1.272299012	0	1.219714678	0	1.930214606	0.614797209	3.090784579	2.256125007	3.39310567	0.79132175	0.092885953	11.86236011	0	9.84718075	1.558530531	2.886977419	2.168153164	0.021214214	6.126463735	0	0	0	0.37722892	0	0.326145837	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1452	0	8.830497738	10.7494	0.560316069	1.272299012	0	1.219714678	0	1.930214606	0.614797209	3.090784579	2.256125007	3.39310567	0.79132175	0.092885953	11.86236011	0	9.84718075	1.558530531	2.886977419	2.168153164	0.021214214	6.126463735	0	0	0	0.37722892	0	0.326145837	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1452	NO																																																																																		0	0	0	10.7494	0.560316069	1.272299012	0	1.219714678	0	1.930214606	0.614797209	3.090784579	2.256125007	3.39310567	0.79132175	0.092885953	11.86236011	0	9.84718075	1.558530531	2.886977419	2.168153164	0.021214214	6.126463735	0	0	0	0.37722892	0	0.326145837	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1452
H2773_002_0	2011	7																															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	YES	1807.024236	160.2956934	662.1256937		153.9164134		9.658395382	180.4222591	248.5912135	2847.01558	628.9768259	49.92864634	0.46478213	1095.933379		8284.275798	788.2030275	2428.727624	4511.006789	0.106151547	30.65555968				150.8915678		260.9166693														3400	"1a: Days 1-7, $150 copay, Days 8-90, $0 copay"	"1b: Days 1-7, $150 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; $100 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: $25/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; $100 CT; $250 MRI and PET;8b: 20% therapuetic radiation, $250 Nuclear Medicine"	7g: $25/visit;8a: $0 (stand alone facility) to $250 Hospital outpatient;12a: 20%;14b: $0/visit;14i: 20%	15: 20%	17b: $30/visit		16a: $0/visit	17a1: $30/visit	17b1: $75 allowance	18a1: $0 exam and $15/visit fitting/evaluations	18b: $500 allowance/two years	14a: $0 copay	13c: $30/quarter allowance												112.5998954	66.16512953	29.09756717		100		0.2	43	156.8951963	10	82.17495089	200	0.2	128.7230773		21.7528877	29.84669478	30	6.001672478	0.2	0.2				30		15														NO	94.99332807	55.8192868	24.54775587		84.36360239		0.168727205	36.27634903	132.3624396	8.436360239	71.11306402	168.7272048	0.168727205	115.4079538		18.35151969	25.25153511	25.30908072	5.063227107	0.168727205	0.168727205				30		15															14.3046	0.745632607	1.354474991	0	1.082078592	0	1.629634056	0.545421737	2.742011623	2.00153742	3.72737244	0.702026745	0.07842139	10.53995241	0	12.66908754	1.658611369	5.122405291	1.903354321	0.017910654	5.172426897	0	0	0	0.37722892	0	0.326145837	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7003	0	11.37810302	14.3046	0.745632607	1.354474991	0	1.082078592	0	1.629634056	0.545421737	2.742011623	2.00153742	3.72737244	0.702026745	0.07842139	10.53995241	0	12.66908754	1.658611369	5.122405291	1.903354321	0.017910654	5.172426897	0	0	0	0.37722892	0	0.326145837	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7003	NO																																																																																		0	0	0	14.3046	0.745632607	1.354474991	0	1.082078592	0	1.629634056	0.545421737	2.742011623	2.00153742	3.72737244	0.702026745	0.07842139	10.53995241	0	12.66908754	1.658611369	5.122405291	1.903354321	0.017910654	5.172426897	0	0	0	0.37722892	0	0.326145837	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7003
H2773_003_0	2011	6																															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	YES	3169.529409	193.6498673	1181.274844		268.9990451		17.40774641	246.5629057	312.5438656	4044.099385	779.4378512	76.1780904	1.362827425	1486.845338		10115.92254	752.0846192	2837.496876	5608.58823	0.222850315	43.16857791				150.8915678		260.9166693														3400	"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, $100 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, $100 CT; $250 MRI and PET;8b: 20% therapuetic radiation, $250 Nuclear Medicine"	7g: $30/visit;8a: $0 (stand alone facility) to $250 Hospital outpatient;12a: 20%;14b: $0/visit;14i: 20%	15: 20%	17b: $30/visit		16a: $0/visit	17a1: $30/visit	17b1: $75 allowance	18a1: $0 exam and $15/visit fitting/evaluations	18b: $500 allowance every two years	14a: $0 copay	13c: $30/quarter allowance												147.400503	90.96674229	24.39687176		100		0.2	43	174.2433294	10	84.2235606	300	0.2	144.142791		19.43642598	29.87244844	30	5.932575169	0.2	0.2				30		15														NO	111.153962	68.59755296	18.39755564		75.40948618		0.150818972	32.42607906	131.3959994	7.540948618	66.06045505	226.2284585	0.150818972	140.8165579		14.65690897	22.60588879	22.62284585	4.473724452	0.150818972	0.150818972				30		15															29.3588	1.106992253	1.811047472	0	1.690423315	0	2.625418424	0.66625569	3.422251132	2.541362139	4.290834927	1.436137664	0.205540232	17.44770355	0	12.35567965	1.416795105	5.349354537	2.090939859	0.033610055	6.510640558	0	0	0	0.37722892	0	0.326145837	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0632	0	25.26659174	29.3588	1.106992253	1.811047472	0	1.690423315	0	2.625418424	0.66625569	3.422251132	2.541362139	4.290834927	1.436137664	0.205540232	17.44770355	0	12.35567965	1.416795105	5.349354537	2.090939859	0.033610055	6.510640558	0	0	0	0.37722892	0	0.326145837	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0632	NO																																																																																		0	0	0	29.3588	1.106992253	1.811047472	0	1.690423315	0	2.625418424	0.66625569	3.422251132	2.541362139	4.290834927	1.436137664	0.205540232	17.44770355	0	12.35567965	1.416795105	5.349354537	2.090939859	0.033610055	6.510640558	0	0	0	0.37722892	0	0.326145837	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0632
H2773_004_0	2011	6																															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	YES	435.85049	3.783668194	27.31635036		4.071076652	14.91350982	16.73729164	16.23962819	28.56616935	5.226325509	13.66105099	3.110982826	9.184460348	59.21556567	65.00961944	123.8993043	0.725227752	25.27923816	32.25711714	18.79937791	14.75357265																				6700	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	(10b) $10/trip	"(16a) $0/visit, (16b1) $1500/year"	(17a1) $0/visit	(17b1) $0 copay	(18a) $0/visit	(18b) $1000/2 years	(14a) $0 copay	"(13b) 4 visits/year, (13c) $34/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																					26.8341	0.23294953	3.951001648	0	0.94856086	3.474847788	3.899788951	3.783833369	6.655917459	1.217733844	3.183024881	0.724858999	2.139979261	13.7972268	15.14724133	28.8685379	0.168978066	5.89006249	7.515908294	4.380255053	3.437582428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.2523	0	0	26.8341	0.23294953	3.951001648	0	0.94856086	3.474847788	3.899788951	3.783833369	6.655917459	1.217733844	3.183024881	0.724858999	2.139979261	13.7972268	15.14724133	28.8685379	0.168978066	5.89006249	7.515908294	4.380255053	3.437582428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.2523	NO																																																																																		0	0	0	26.8341	0.23294953	3.951001648	0	0.94856086	3.474847788	3.899788951	3.783833369	6.655917459	1.217733844	3.183024881	0.724858999	2.139979261	13.7972268	15.14724133	28.8685379	0.168978066	5.89006249	7.515908294	4.380255053	3.437582428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.2523
H2775_082_0	2011	10																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1603.47416	52.89975621	3233.90202	14.32897013	235.296709	19.67932219	1.289950113	251.4173778	320.8453425	10.22046057	17.05885769	0	23.90869321	9.934675811	5586.344428	91.83017882	0.897662975	774.4377779	37.8691256	38.18448903	16.64376784	73.10386872	0	0	0	0	0.470419028	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: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	128.8537736	92.6697687	35.01559476	0.15	150	0.2	0.2	49.68018596	135.8736014	0	0.2	0	50	0.105885791	4.04365693	0.084111465	0.45	0	0.131867094	0.040391297	0.2	0	0	0	0	0	20	0	0	0											NO	90.48457994	65.07520006	24.58889092	0.105334028	105.334028	0.140445371	0.140445371	34.88676065	95.41409152	0	0.140445371	0	35.11134266	0.074355846	2.839564481	0.05906533	0.316002084	0	0.092600615	0.028363854	0.140445371	0	0	0	0	0	20	0	0	0												12.0908	0.286871852	6.626505336	1.509328141	2.065395844	2.763869699	0.181167522	0.730928157	2.551097239	0	2.395837591	0	0.069955527	0.738701226	1.321898768	5.423979791	0.283663371	0	3.506704308	1.083059258	2.337540143	0	0	0	0	0	0.000784032	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9681	0	19.4920356	12.0908	0.286871852	6.626505336	1.509328141	2.065395844	2.763869699	0.181167522	0.730928157	2.551097239	0	2.395837591	0	0.069955527	0.738701226	1.321898768	5.423979791	0.283663371	0	3.506704308	1.083059258	2.337540143	0	0	0	0	0	0.000784032	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9681	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	1.3337	0.0316	0.7309	0.1753	0.2278	0.3211	0.021	0.0794	0.2814	0	0.2414	0	0.0077	0.0797	0.1458	0.5415	0.0308	0	0.3806	0.1195	0.2357	0	0	0	0	0	0.0001	0	0	0											4.9851	0	2.165781733	13.4245	0.318514977	7.357435678	1.684658223	2.29321736	3.084932753	0.202212724	0.810341453	2.832493584	0	2.637245045	0	0.077671904	0.818417533	1.467709549	5.965497937	0.314450752	0	3.887304173	1.202525075	2.573200269	0	0	0	0	0	0.000871146	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9532
H2775_083_0	2011	11																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1661.485312	56.46435965	1509.550327	11.88202305	178.8953396	22.37667646	0.765690011	253.6266053	362.8292627	13.27561674	22.35147776	0	11.13150025	10.32189749	5671.729577	86.93397069	0.75135729	569.0873502	22.432546	31.37441781	20.09410065	68.22019436	0	0	0	0	0.15383511	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: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	128.8537736	92.6697687	35.01559476	0.15	150	0.2	0.2	49.9386719	134.4909084	0	0.2	0	50	0.131620543	4.22819601	0.075244068	0.45	0	0.098759186	0.054654359	0.2	0	0	0	0	0	20	0	0	0											NO	93.63899295	67.34380824	25.44609242	0.109006113	109.0061125	0.145341483	0.145341483	36.29080326	97.73554064	0	0.145341483	0	36.33537085	0.095649625	3.072661401	0.054680422	0.327018338	0	0.071769033	0.039717728	0.145341483	0	0	0	0	0	20	0	0	0												12.965	0.316877084	3.201013094	1.295213142	1.625057126	3.25225935	0.111286522	0.767026103	2.955109513	0	3.248596934	0	0.033705599	0.987285623	1.452275379	4.753586232	0.245707612	0	1.609962139	1.246120593	2.920506395	0	0	0	0	0	0.000256392	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9868	0	16.16594412	12.965	0.316877084	3.201013094	1.295213142	1.625057126	3.25225935	0.111286522	0.767026103	2.955109513	0	3.248596934	0	0.033705599	0.987285623	1.452275379	4.753586232	0.245707612	0	1.609962139	1.246120593	2.920506395	0	0	0	0	0	0.000256392	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9868	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	1.4354	0.0351	0.3544	0.1482	0.1799	0.3722	0.0127	0.0847	0.3272	0	0.3566	0	0.0037	0.1093	0.1608	0.4729	0.0268	0	0.176	0.138	0.3206	0	0	0	0	0	0	0	0	0											4.7143	0	1.796216014	14.4004	0.351959628	3.555408187	1.443424088	1.804972751	3.62441465	0.124021014	0.851702845	3.28227978	0	3.605160858	0	0.037437261	1.096563615	1.613061746	5.226448166	0.272554215	0	1.785955119	1.38408286	3.241065468	0	0	0	0	0	0.00028488	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7012
H2775_084_0	2011	12																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1365.963128	67.00739526	4198.700802	18.92627833	206.6710562	19.57774148	1.303076746	268.5464281	286.211309	7.193146943	14.77747357	0	5.719670242	8.097483071	4494.789283	74.03920348	1.311406426	404.8594229	25.61895828	30.57742852	19.71900446	26.36179501	0	0	0	0	0.063076082	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	20.25	0	150	0.2	0.2	49.67268245	285.8526702	0.2	0.2	0	25	0.196207308	20.42010597	0.111994659	0.45	0.136713368	0.125388362	0.101678352	0.2	0	0	0	0	0	20	0	0	0											NO	151.6888974	114.9861936	16.54153739	0	122.5299066	0.163373209	0.163373209	40.5759276	233.5033399	0.163373209	0.163373209	0	20.4216511	0.160275087	16.68049118	0.091484634	0.36758972	0.111676508	0.102425496	0.083057593	0.163373209	0	0	0	0	0	20	0	0	0												17.2668	0.64207711	5.787747192	0	2.110282101	3.198478447	0.212887829	0.908043369	5.569274712	1.175167497	2.414243275	0	0.009733759	1.297824808	6.247941082	6.773449457	0.482059521	0.003767774	2.624034499	2.539687619	3.221557033	0	0	0	0	0	0.000105127	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4851	0	14.00857993	17.2668	0.64207711	5.787747192	0	2.110282101	3.198478447	0.212887829	0.908043369	5.569274712	1.175167497	2.414243275	0	0.009733759	1.297824808	6.247941082	6.773449457	0.482059521	0.003767774	2.624034499	2.539687619	3.221557033	0	0	0	0	0	0.000105127	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4851	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	1.8962	0.0705	0.6356	0	0.2317	0.3523	0.0234	0.099	0.6116	0	0.2592	0	0.0011	0.1409	0.6861	0.7054	0.0528	0	0.2874	0.1236	0.3459	0	0	0	0	0	0	0	0	0											6.5226	0	1.556508881	19.1629	0.712587197	6.423332153	0	2.342024007	3.55077244	0.236336199	1.007072799	6.180867986	1.175167497	2.67342804	0	0.010802678	1.43872103	6.934062513	7.478850427	0.534849214	0.003767774	2.911389009	2.663239525	3.567433881	0	0	0	0	0	0.000116808	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0078
H2775_085_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1749.288074	56.84220079	5418.672908	14.68301281	240.8765923	23.84645237	1.044449448	314.896948	417.297291	13.27602506	22.19387339	0	6.10358215	14.98321491	5425.212659	94.06218521	0.822245255	512.0954224	28.24888138	34.49243365	21.82492688	31.28321113	0	0	0	0	0.077992182	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: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $300; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	193.2806604	139.004653	35.01559476	0.2	150	0.2	0.2	49.90512387	223.4359757	0	0.2	0	50	0.094766591	16.0624726	0.124520614	0.45	0.011879408	0.108964182	0.050579731	0.2	0	0	0	0	0	20	0	0	0											NO	126.9495329	91.30026635	22.99874902	0.131362892	98.52216924	0.131362892	0.131362892	32.77840706	146.7559801	0	0.131362892	0	32.84072308	0.062244067	10.55006429	0.08178694	0.295566508	0.007802567	0.071569251	0.033221499	0.131362892	0	0	0	0	0	20	0	0	0												18.5059	0.432475673	10.38522485	1.92880303	1.977640366	3.132538955	0.1372019	0.860151695	5.103406078	0	2.9154514	0	0.016703838	0.932616239	4.769695196	7.693058317	0.243028159	0.000332972	2.021751271	1.145890334	2.866985519	0	0	0	0	0	0.000129987	0	0	0	0	0	0	0	0	0	0	0	0	0	65.069	0	33.99849733	18.5059	0.432475673	10.38522485	1.92880303	1.977640366	3.132538955	0.1372019	0.860151695	5.103406078	0	2.9154514	0	0.016703838	0.932616239	4.769695196	7.693058317	0.243028159	0.000332972	2.021751271	1.145890334	2.866985519	0	0	0	0	0	0.000129987	0	0	0	0	0	0	0	0	0	0	0	0	0	65.069	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $300; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	2.0506	0.0479	1.1507	0.2156	0.2191	0.3502	0.0153	0.0953	0.5655	0	0.3154	0	0.0019	0.1022	0.5285	0.8322	0.0262	0	0.2183	0.127	0.3102	0	0	0	0	0	0	0	0	0											7.1722	0	3.777610815	20.5565	0.480396242	11.53596216	2.144417841	2.196773277	3.48271561	0.152539268	0.955461008	5.668890201	0	3.230881678	0	0.01855471	1.034814107	5.298202405	8.525300734	0.269265767	0.000332972	2.24002194	1.272860985	3.177196636	0	0	0	0	0	0.00014443	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2412
H2775_088_0	2011	8																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	YES	1576.589967	52.20174198	3231.761658	14.31948649	235.1409776	19.66629741	1.289096358	251.250977	317.9055791	9.600874373	17.04756726	0	23.89286921	9.712159544	5131.160907	90.83028034	0.897068856	715.6727798	37.80603178	36.86450241	16.63275214	73.05548484	0	0	0	0	0.47010768	0	0	0											3400	1a: $335 Per Day (Days 1-6)	1b: $335 Per Day (Days 1-6)	2: $100 Per Day (Days 21-100)	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $335; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	234.7479911	177.948277	35.01559476	0.2	150	0.2	0.2	49.68018596	226.2298202	0	0.2	0	50	0.158896581	15.83803668	0.120824428	0.45	0	0.131999743	0.041809876	0.2	0	0	0	0	0	20	0	0	0											NO	141.4132204	107.1968233	21.093548	0.120480878	90.3606585	0.120480878	0.120480878	29.92756212	136.2818369	0	0.120480878	0	30.1202195	0.095719998	9.540902827	0.072785166	0.271081976	0	0.079517225	0.025186453	0.120480878	0	0	0	0	0	20	0	0	0												18.5792	0.466321742	5.68077664	1.725224304	1.770624465	2.369412778	0.155311461	0.626610768	3.610396356	0	2.053905872	0	0.059971539	0.929647891	4.079658967	6.611096994	0.243179198	0	3.006230721	0.928486045	2.003928582	0	0	0	0	0	0.000783513	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9008	0	36.23479821	18.5792	0.466321742	5.68077664	1.725224304	1.770624465	2.369412778	0.155311461	0.626610768	3.610396356	0	2.053905872	0	0.059971539	0.929647891	4.079658967	6.611096994	0.243179198	0	3.006230721	0.928486045	2.003928582	0	0	0	0	0	0.000783513	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9008	YES	1a: $335 Per Day (Days 1-6)	1b: $335 Per Day (Days 1-6)	2: $100 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%	9a: 20%	12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9c: 45%; 9d: 20%	7a : 20%; 14a: 20%; 14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 50%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%; 9a: 20%; 9b: 20%	7e: 45%; 7h: 45%	7c: 20%; 7i: 20%; 9d: 20%	8b: 20%	8a: 20%; 17a: 20%; 18a: 20%	15: 20%	13a: 20%	0	0	17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline												5100	1.0122	0.0254	0.3095	0.099	0.0578	0.1344	0.0089	0.0336	0.278	0.0563	0.113	0	0.0016	0.064	0.2129	0.347	0.013	0.0292	0.1781	0.2516	0.0998	0.0068	0	0	0	0	0	0	0	0											3.3322	0	1.907094643	19.5914	0.491726909	5.990264837	1.824207911	1.828434643	2.50386239	0.164222354	0.660235693	3.888408919	0.056341334	2.166881424	0	0.061522257	0.993684727	4.292592548	6.95807622	0.256215092	0.029226661	3.184349593	1.180051224	2.103711042	0.006768766	0	0	0	0	0.000783513	0	0	0	0	0	0	0	0	0	0	0	0	0	58.233
H2775_089_0	2011	10																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	YES	1667.733985	56.77610667	1513.031781	13.22063734	181.1350189	22.65682115	0.775276064	256.8018823	363.5818748	12.3664751	22.63130698	0	11.27086101	10.17947389	5095.232322	87.3466145	0.760763903	526.6454097	22.69178873	30.67647458	20.34566864	69.07427674	0	0	0	0	0.155761048	0	0	0											6700	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $500; 9b: $250	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $30; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.9386719	448.8247863	0.2	0.2	0	25	0.223366233	24.78068884	0.118823615	0.45	0	0.0988532	0.097772945	0.2	0	0	0	0	0	20	0	0	0											NO	148.2896962	112.4094643	37.74881302	0	119.7841301	0.159712173	0.159712173	39.87906913	358.4139106	0.159712173	0.159712173	0	19.96402168	0.178371532	19.78888837	0.094887889	0.35935239	0	0.078940297	0.078077648	0.159712173	0	0	0	0	0	20	0	0	0												20.609	0.531847645	4.759596148	0	1.808091722	3.618570149	0.123821025	0.853418335	10.85940013	1.975076615	3.614495225	0	0.018750976	1.815728356	8.402415304	8.288135861	0.273382327	0	1.791296544	2.395146984	3.249450958	0	0	0	0	0	0.000259602	0	0	0	0	0	0	0	0	0	0	0	0	0	74.9879	0	18.91582559	20.609	0.531847645	4.759596148	0	1.808091722	3.618570149	0.123821025	0.853418335	10.85940013	1.975076615	3.614495225	0	0.018750976	1.815728356	8.402415304	8.288135861	0.273382327	0	1.791296544	2.395146984	3.249450958	0	0	0	0	0	0.000259602	0	0	0	0	0	0	0	0	0	0	0	0	0	74.9879	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%	9a: 20%	12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9c: 45%; 9d: 20%	7a : 20%; 14a: 20%; 14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 50%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%; 9a: 20%; 9b: 20%	7e: 45%; 7h: 45%	7c: 20%; 7i: 20%; 9d: 20%	8b: 20%	8a: 20%; 17a: 20%; 18a: 20%	15: 20%	13a: 20%	0	0	17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline												10000	1.0558	0.0272	0.2438	0.1017	0.0638	0.1895	0.0066	0.0436	0.3953	0.1003	0.2029	0	0.001	0.0886	0.2656	0.4007	0.0138	0.0285	0.1002	0.2609	0.165	0.0104	0	0	0	0	0	0	0	0											3.7654	0	0.995569768	21.6648	0.559095263	5.003439775	0.101744724	1.871911655	3.808074072	0.130377562	0.897015376	11.25472779	2.075391776	3.817401732	0	0.019747868	1.904281954	8.668044993	8.688840342	0.287204688	0.028520365	1.891451835	2.656079199	3.414495419	0.010364514	0	0	0	0	0.000259602	0	0	0	0	0	0	0	0	0	0	0	0	0	78.7533
H2775_091_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	YES	1562.254394	50.69192986	4784.917779	14.39323011	214.8716318	21.27199694	0.931691017	280.9007734	372.0233187	11.71676291	19.79782986	0	5.444641358	13.34839785	4753.136786	83.94081426	0.733475918	451.5011767	25.20162912	30.68148882	19.4687147	27.90588558	0	0	0	0	0.069572171	0	0	0											6700	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.90512387	290.1423412	0.2	0.2	0	25	0.108551306	19.98865227	0.137973386	0.45	0.012019081	0.108953425	0.09413257	0.2	0	0	0	0	0	20	0	0	0											NO	146.0508566	110.7123352	37.17889116	0	117.9756601	0.15730088	0.15730088	39.25059955	228.1982282	0.15730088	0.15730088	0	19.66261002	0.08537608	15.72116297	0.108516676	0.35392698	0.00945306	0.085692348	0.07403568	0.15730088	0	0	0	0	0	20	0	0	0												19.014	0.467685161	14.82482811	0	2.112468551	3.346103842	0.146555817	0.918793648	7.074588515	1.843057119	3.114216063	0	0.008921322	1.139633882	6.227069838	9.108978114	0.259596917	0.000355672	2.159586774	2.271524897	3.062445958	0	0	0	0	0	0.000115954	0	0	0	0	0	0	0	0	0	0	0	0	0	77.1006	0	20.92881971	19.014	0.467685161	14.82482811	0	2.112468551	3.346103842	0.146555817	0.918793648	7.074588515	1.843057119	3.114216063	0	0.008921322	1.139633882	6.227069838	9.108978114	0.259596917	0.000355672	2.159586774	2.271524897	3.062445958	0	0	0	0	0	0.000115954	0	0	0	0	0	0	0	0	0	0	0	0	0	77.1006	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%	9a: 20%	12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9c: 45%; 9d: 20%	7a : 20%; 14a: 20%; 14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 50%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%; 9a: 20%; 9b: 20%	7e: 45%; 7h: 45%	7c: 20%; 7i: 20%; 9d: 20%	8b: 20%	8a: 20%; 17a: 20%; 18a: 20%	15: 20%	13a: 20%	0	0	17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline												10000	1.0011	0.0246	0.7806	0.1094	0.0709	0.1758	0.0078	0.0484	0.3689	0.0937	0.1774	0	0.0005	0.1148	0.2338	0.4115	0.0133	0.0268	0.123	0.2578	0.1575	0.0042	0	0	0	0	0	0	0	0											4.2019	0	1.101516827	20.0152	0.492310102	15.60539708	0.109441705	2.183388824	3.521893195	0.154340754	0.967170722	7.443527645	1.936792289	3.291610486	0	0.009405649	1.254460885	6.460876479	9.520485585	0.272914595	0.027140593	2.282587799	2.529316598	3.219902829	0.004195347	0	0	0	0	0.000115954	0	0	0	0	0	0	0	0	0	0	0	0	0	81.3025
H2775_094_0	2011	7																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	YES	1586.702021	52.5134422	3231.761658	14.31948649	235.1409776	19.66629741	1.289096358	251.250977	317.9055791	9.600874373	17.04756726	0	23.89286921	9.712159544	5131.160907	91.03605302	0.897068856	715.6727798	37.82092406	36.86741816	16.63275214	73.05548484	0	0	0	0	0.47010768	0	0	0											3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $300; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0			17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	193.2806604	139.004653	35.01559476	0.2	150	0.2	0.2	49.68018596	226.2298202	0	0.2	0	50	0.158896581	15.83803668	0.120551323	0.45	0	0.131947767	0.041806569	0.2	0	0	0	0	0	20	0	0	0											NO	119.7354466	86.11199992	21.69181266	0.123898011	92.92350799	0.123898011	0.123898011	30.77638105	140.1471234	0	0.123898011	0	30.97450266	0.098434851	9.811506189	0.074680345	0.278770524	0	0.081740329	0.025898754	0.123898011	0	0	0	0	0	20	0	0	0												15.832	0.376836461	5.841897372	1.774155889	1.820843709	2.436615125	0.159716474	0.644382984	3.712796035	0	2.11215967	0	0.061672478	0.956014981	4.195368083	6.798603889	0.250076355	0	3.091494784	0.954820182	2.060764902	0	0	0	0	0	0.000783513	0	0	0	0	0	0	0	0	0	0	0	0	0	53.081	0	34.31951201	15.832	0.376836461	5.841897372	1.774155889	1.820843709	2.436615125	0.159716474	0.644382984	3.712796035	0	2.11215967	0	0.061672478	0.956014981	4.195368083	6.798603889	0.250076355	0	3.091494784	0.954820182	2.060764902	0	0	0	0	0	0.000783513	0	0	0	0	0	0	0	0	0	0	0	0	0	53.081	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%	9a: 20%	12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9c: 45%; 9d: 20%	7a : 20%; 14a: 20%; 14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 50%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%; 9a: 20%; 9b: 20%	7e: 45%; 7h: 45%	7c: 20%; 7i: 20%; 9d: 20%	8b: 20%	8a: 20%; 17a: 20%; 18a: 20%	15: 20%	13a: 20%			17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline												5100	0.8726	0.0208	0.322	0.103	0.0601	0.1399	0.0093	0.035	0.2892	0.0586	0.1175	0	0.0016	0.0666	0.2215	0.361	0.0136	0.0304	0.1853	0.2617	0.1038	0.007	0	0	0	0	0	0	0	0											3.2805	0		16.7046	0.397605418	6.163867579	1.877131617	1.880985437	2.576487242	0.168986753	0.67936404	4.002021159	0.058613644	2.229691654	0	0.063285739	1.022634495	4.416889516	7.15957718	0.263638002	0.030405406	3.276797391	1.216531269	2.164571702	0.007041758	0	0	0	0	0.000783513	0	0	0	0	0	0	0	0	0	0	0	0	0	56.3615
H2775_095_0	2011	7																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	YES	1667.733985	56.77610667	1513.031781	13.22063734	181.1350189	22.65682115	0.775276064	256.8018823	364.009918	12.5008933	22.63130698	0	11.27086101	10.17947389	5159.982767	87.3466145	0.760763903	526.6454097	22.69178873	30.76166489	20.34566864	69.07427674	0	0	0	0	0.155761048	0	0	0											6700	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.9386719	291.686959	0.2	0.2	0	25	0.223366233	20.70515315	0.118823615	0.45	0	0.0988532	0.097948494	0.2	0	0	0	0	0	20	0	0	0											NO	153.0174691	115.9933035	38.95232089	0	123.6030884	0.164804118	0.164804118	41.15049385	240.3560599	0.164804118	0.164804118	0	20.60051473	0.184058375	17.0614725	0.097913105	0.370809265	0	0.081457072	0.080711576	0.164804118	0	0	0	0	0	20	0	0	0												21.266	0.548804015	4.91134162	0	1.865737312	3.733937423	0.127768688	0.880627023	7.290999137	2.060198694	3.729732583	0	0.019348795	1.873617418	7.336408672	8.552378257	0.282098304	0	1.848406671	2.482822454	3.353049972	0	0	0	0	0	0.000259602	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1636	0	15.41133497	21.266	0.548804015	4.91134162	0	1.865737312	3.733937423	0.127768688	0.880627023	7.290999137	2.060198694	3.729732583	0	0.019348795	1.873617418	7.336408672	8.552378257	0.282098304	0	1.848406671	2.482822454	3.353049972	0	0	0	0	0	0.000259602	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1636	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%	9a: 20%	12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9c: 45%; 9d: 20%	7a : 20%; 14a: 20%; 14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 50%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%; 9a: 20%; 9b: 20%	7e: 45%; 7h: 45%	7c: 20%; 7i: 20%; 9d: 20%	8b: 20%	8a: 20%; 17a: 20%; 18a: 20%	15: 20%	13a: 20%	0	0	17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline												10000	1.1059	0.0285	0.2554	0.1066	0.0668	0.1985	0.0069	0.0457	0.4141	0.1051	0.2125	0	0.001	0.0928	0.2782	0.4197	0.0145	0.0299	0.1049	0.2733	0.1729	0.0109	0	0	0	0	0	0	0	0											3.9441	0	0.811122893	22.372	0.577344466	5.166755038	0.106572265	1.932585348	3.93243285	0.134636316	0.926292639	7.705084134	2.165273566	3.942266513	0	0.020392987	1.96637267	7.614641847	8.972095197	0.296576502	0.029873587	1.953314088	2.756135272	3.525925394	0.010856285	0	0	0	0	0.000259602	0	0	0	0	0	0	0	0	0	0	0	0	0	76.1077
H2775_096_0	2011	7																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	YES	1478.198217	72.51309358	4443.851706	20.48136607	223.6522936	21.18635704	1.410144741	290.6116884	309.7280136	7.784175694	15.99167256	0	6.189629994	8.762817081	4864.106038	80.12267407	1.419158834	438.1249131	27.72395364	33.08983922	21.33922697	28.52782594	0	0	0	0	0.068258762	0	0	0											6700	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.67268245	285.8526702	0.2	0.2	0	25	0.196207308	20.42010597	0.111994659	0.45	0.136713368	0.125388362	0.101678352	0.2	0	0	0	0	0	20	0	0	0											NO	148.0788969	112.2496702	37.69515169	0	119.6138525	0.159485137	0.159485137	39.61027275	227.9462609	0.159485137	0.159485137	0	19.93564209	0.156460747	16.28351696	0.089307418	0.358841558	0.109018751	0.099987901	0.081080929	0.159485137	0	0	0	0	0	20	0	0	0												18.2408	0.67829757	13.95930534	0	2.229326038	3.378909048	0.224897127	0.959267354	5.883445217	1.241460325	2.550434084	0	0.010282854	1.371036904	6.600396097	7.155549128	0.509253166	0.003980319	2.772059921	2.682954917	3.40328953	0	0	0	0	0	0.000113765	0	0	0	0	0	0	0	0	0	0	0	0	0	73.8551	0	18.7617748	18.2408	0.67829757	13.95930534	0	2.229326038	3.378909048	0.224897127	0.959267354	5.883445217	1.241460325	2.550434084	0	0.010282854	1.371036904	6.600396097	7.155549128	0.509253166	0.003980319	2.772059921	2.682954917	3.40328953	0	0	0	0	0	0.000113765	0	0	0	0	0	0	0	0	0	0	0	0	0	73.8551	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%	9a: 20%	12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9c: 45%; 9d: 20%	7a : 20%; 14a: 20%; 14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 50%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%; 9a: 20%; 9b: 20%	7e: 45%; 7h: 45%	7c: 20%; 7i: 20%; 9d: 20%	8b: 20%	8a: 20%; 17a: 20%; 18a: 20%	15: 20%	13a: 20%	0	0	17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline												10000	0.9553	0.0355	0.7311	0.1561	0.0751	0.1755	0.0118	0.0499	0.3538	0.0629	0.1443	0	0.0005	0.0768	0.2665	0.3739	0.0266	0.0268	0.16	0.2846	0.1743	0.003	0	0	0	0	0	0	0	0											4.1442	0	0.987461832	19.1961	0.713820895	14.6903723	0.156139084	2.304401659	3.554446068	0.236710529	1.009158863	6.237231877	1.304337851	2.694757741	0	0.010742617	1.447850832	6.866894045	7.529422438	0.535848871	0.030745145	2.932074018	2.967595809	3.577543971	0.002961226	0	0	0	0	0.000113765	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9993
H2775_097_0	2011	8																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	YES	1562.254394	50.69192986	4784.917779	14.39323011	214.8716318	21.27199694	0.931691017	280.9007734	372.0233187	11.71676291	19.79782986	0	5.444641358	13.34839785	4753.136786	83.94081426	0.733475918	451.5011767	25.20162912	30.68148882	19.4687147	27.90588558	0	0	0	0	0.069572171	0	0	0											6700	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.90512387	290.1423412	0.2	0.2	0	25	0.108551306	19.98865227	0.137973386	0.45	0.012019081	0.108953425	0.09413257	0.2	0	0	0	0	0	20	0	0	0											NO	146.0508566	110.7123352	37.17889116	0	117.9756601	0.15730088	0.15730088	39.25059955	228.1982282	0.15730088	0.15730088	0	19.66261002	0.08537608	15.72116297	0.108516676	0.35392698	0.00945306	0.085692348	0.07403568	0.15730088	0	0	0	0	0	20	0	0	0												19.014	0.467685161	14.82482811	0	2.112468551	3.346103842	0.146555817	0.918793648	7.074588515	1.843057119	3.114216063	0	0.008921322	1.139633882	6.227069838	9.108978114	0.259596917	0.000355672	2.159586774	2.271524897	3.062445958	0	0	0	0	0	0.000115954	0	0	0	0	0	0	0	0	0	0	0	0	0	77.1006	0	20.92881971	19.014	0.467685161	14.82482811	0	2.112468551	3.346103842	0.146555817	0.918793648	7.074588515	1.843057119	3.114216063	0	0.008921322	1.139633882	6.227069838	9.108978114	0.259596917	0.000355672	2.159586774	2.271524897	3.062445958	0	0	0	0	0	0.000115954	0	0	0	0	0	0	0	0	0	0	0	0	0	77.1006	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%	9a: 20%	12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9c: 45%; 9d: 20%	7a : 20%; 14a: 20%; 14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 50%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%; 9a: 20%; 9b: 20%	7e: 45%; 7h: 45%	7c: 20%; 7i: 20%; 9d: 20%	8b: 20%	8a: 20%; 17a: 20%; 18a: 20%	15: 20%	13a: 20%	0	0	17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline												10000	1.0011	0.0246	0.7806	0.1094	0.0709	0.1758	0.0078	0.0484	0.3689	0.0937	0.1774	0	0.0005	0.1148	0.2338	0.4115	0.0133	0.0268	0.123	0.2578	0.1575	0.0042	0	0	0	0	0	0	0	0											4.2019	0	1.101516827	20.0152	0.492310102	15.60539708	0.109441705	2.183388824	3.521893195	0.154340754	0.967170722	7.443527645	1.936792289	3.291610486	0	0.009405649	1.254460885	6.460876479	9.520485585	0.272914595	0.027140593	2.282587799	2.529316598	3.219902829	0.004195347	0	0	0	0	0.000115954	0	0	0	0	0	0	0	0	0	0	0	0	0	81.3025
H2775_801_0	2011	6																															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	284.4263106	5.86692449	55.1798199	23.9107199	10.57694822	25.86325723	1.90952076	14.1783765	51.34597629	9.498702019	21.71870606	0	0.17918509	12.383668	36.75521823	96.1941689	1.050250921	3.254956506	38.01608312	40.57880281	18.10407363	0.784013215	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	0	0	0	0	0	0	0	0											0	0.081738963	0.081738963	0.177293583	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.064584892	0.064584892	0.140086032	0	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0	0	0	0	0	0	0	0												18.3696	0.378914684	7.729921996	0	1.947233872	4.761468951	0.351545968	2.610262847	9.452880186	1.748726942	3.998450143	0	0.032988275	2.279854008	6.766697204	17.70950752	0.193352953	0.599242941	6.99882454	7.470625524	3.332990262	0.144338145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8775	0	27.05144111	18.3696	0.378914684	7.729921996	0	1.947233872	4.761468951	0.351545968	2.610262847	9.452880186	1.748726942	3.998450143	0	0.032988275	2.279854008	6.766697204	17.70950752	0.193352953	0.599242941	6.99882454	7.470625524	3.332990262	0.144338145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8775	YES	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	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	0	0	0	0	0	0	0											6700	0.9668	0.0199	0.4068	0	0.1025	0.2506	0.0185	0.1374	0.4975	0.092	0.2104	0	0.0017	0.12	0.3561	0.9321	0.0102	0.0315	0.3684	0.3932	0.1754	0.0076	0	0	0	0	0	0	0	0											5.0988	0		19.3365	0.398857562	8.136759995	0	2.049719865	5.01207258	0.370048388	2.747645103	9.950400196	1.840765202	4.208894887	0	0.0347245	2.399846325	7.122839162	18.64158686	0.203529424	0.630782044	7.367183726	7.863816341	3.508410802	0.15193489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9763
H2775_802_0	2011	6																															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	284.4263106	5.86692449	55.1798199	23.9107199	10.57694822	25.86325723	1.90952076	14.1783765	51.34597629	9.498702019	21.71870606	0	0.17918509	12.383668	36.75521823	96.1941689	1.050250921	3.254956506	38.01608312	40.57880281	18.10407363	0.784013215	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	0	0	0	0	0	0	0	0											0	0.081738963	0.081738963	0.177293583	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.064584892	0.064584892	0.140086032	0	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0	0	0	0	0	0	0	0												18.3696	0.378914684	7.729921996	0	1.947233872	4.761468951	0.351545968	2.610262847	9.452880186	1.748726942	3.998450143	0	0.032988275	2.279854008	6.766697204	17.70950752	0.193352953	0.599242941	6.99882454	7.470625524	3.332990262	0.144338145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8775	0	27.05144111	18.3696	0.378914684	7.729921996	0	1.947233872	4.761468951	0.351545968	2.610262847	9.452880186	1.748726942	3.998450143	0	0.032988275	2.279854008	6.766697204	17.70950752	0.193352953	0.599242941	6.99882454	7.470625524	3.332990262	0.144338145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8775	YES	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	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	0	0	0	0	0	0	0											6700	0.9668	0.0199	0.4068	0	0.1025	0.2506	0.0185	0.1374	0.4975	0.092	0.2104	0	0.0017	0.12	0.3561	0.9321	0.0102	0.0315	0.3684	0.3932	0.1754	0.0076	0	0	0	0	0	0	0	0											5.0988	0		19.3365	0.398857562	8.136759995	0	2.049719865	5.01207258	0.370048388	2.747645103	9.950400196	1.840765202	4.208894887	0	0.0347245	2.399846325	7.122839162	18.64158686	0.203529424	0.630782044	7.367183726	7.863816341	3.508410802	0.15193489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9763
H2775_803_0	2011	6																															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	284.4263106	5.86692449	55.1798199	23.9107199	10.57694822	25.86325723	1.90952076	14.1783765	51.34597629	9.498702019	21.71870606	0	0.17918509	12.383668	36.75521823	96.1941689	1.050250921	3.254956506	38.01608312	40.57880281	18.10407363	0.784013215	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	0	0	0	0	0	0	0	0											0	0.081738963	0.081738963	0.177293583	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.064584892	0.064584892	0.140086032	0	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0.184101674	0	0	0	0	0	0	0	0												18.3696	0.378914684	7.729921996	0	1.947233872	4.761468951	0.351545968	2.610262847	9.452880186	1.748726942	3.998450143	0	0.032988275	2.279854008	6.766697204	17.70950752	0.193352953	0.599242941	6.99882454	7.470625524	3.332990262	0.144338145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8775	0	27.05144111	18.3696	0.378914684	7.729921996	0	1.947233872	4.761468951	0.351545968	2.610262847	9.452880186	1.748726942	3.998450143	0	0.032988275	2.279854008	6.766697204	17.70950752	0.193352953	0.599242941	6.99882454	7.470625524	3.332990262	0.144338145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8775	YES	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	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	0	0	0	0	0	0	0											6700	0.9668	0.0199	0.4068	0	0.1025	0.2506	0.0185	0.1374	0.4975	0.092	0.2104	0	0.0017	0.12	0.3561	0.9321	0.0102	0.0315	0.3684	0.3932	0.1754	0.0076	0	0	0	0	0	0	0	0											5.0988	0		19.3365	0.398857562	8.136759995	0	2.049719865	5.01207258	0.370048388	2.747645103	9.950400196	1.840765202	4.208894887	0	0.0347245	2.399846325	7.122839162	18.64158686	0.203529424	0.630782044	7.367183726	7.863816341	3.508410802	0.15193489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9763
H2802_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1523.800407	94.04112369	1618.829108	2066.27414	159.0279981	9.348825759	8.608569381	284.8432669	35.39775318	16.69577741	38.56243284	0	0.03615164	17.37090745	5844.22104	116.0676123	477.1129729	378.2692291	0	0	36.57172886	1664.840092	0	0	467.5476304	146.1680633	17.18712401	6.763428963	0	0											4500	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-55 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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, 18a); $0/$40 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												206.8631108	127.8912646	62.89470802	0	200	0.2	0.106602052	49.56010351	0.2	0.10802964	0.168722517	0	0.2	0.160341584	12.74207771	0.118182236	38.5	40	0	0	0.2	39.61387676	0	0	40	15	0	0	0	0											NO	155.5447351	96.16413866	47.2918572	0	150.3842173	0.150384217	0.080156331	37.2885106	0.150384217	0.081229764	0.126866018	0	0.150384217	0.120564218	12.20278298	0.113181872	36.87052892	38.30704303	0	0	0.150384217	29.78650926	0	0	40	15	0	0	0	0												19.7516	0.753615305	6.379786252	0	1.992941753	1.405915845	0.690031334	0.885115098	5.323263408	1.356194064	4.892262298	0	0.005436636	2.094309878	5.942980086	13.1367496	1.465950639	1.207531303	0	0	5.499810822	4.132481235	0	0	1.558492101	0.182710079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.6572	0	19.16011859	19.7516	0.753615305	6.379786252	0	1.992941753	1.405915845	0.690031334	0.885115098	5.323263408	1.356194064	4.892262298	0	0.005436636	2.094309878	5.942980086	13.1367496	1.465950639	1.207531303	0	0	5.499810822	4.132481235	0	0	1.558492101	0.182710079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.6572	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.7516	0.753615305	6.379786252	0	1.992941753	1.405915845	0.690031334	0.885115098	5.323263408	1.356194064	4.892262298	0	0.005436636	2.094309878	5.942980086	13.1367496	1.465950639	1.207531303	0	0	5.499810822	4.132481235	0	0	1.558492101	0.182710079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.6572
H2803_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1081.688188	82.35915591	920.1532507	949.2768902	91.73759795	7.777393739	8.185561852	230.0503815	32.13442749	14.77874982	34.92944259	0	0.018443568	20.52780437	5017.920124	95.37334998	445.6765831	377.268766	0	0	29.14753651	1365.616976	0	0	416.9731328	186.9891436	15.82884347	3.202705368	10.45564078	0											4500	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-55 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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, 18a); $0/$40 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												206.8631108	127.8912646	62.95550861	0	200	0.2	0.099374858	49.2239709	0.2	0.096311352	0.165382622	0	0.2	0.16019239	12.62266663	0.115034578	38.5	40	0	0	0.2	39.48774882	0	0	40	15	0	0	0	0											YES	163.3274106	100.9757081	49.70610838	0	157.9086866	0.157908687	0.078460766	38.88441155	0.157908687	0.076041995	0.130576763	0	0.157908687	0.12647885	12.17565915	0.110963402	37.13659648	38.58347686	0	0	0.157908687	31.17729276	0	0	40	15	0	0	0	0											7500	14.7224	0.69302284	3.811436434	0	1.2071803	1.22811803	0.642245456	0.745447809	5.074305239	1.123805624	4.560973548	0	0.0029124	2.596333088	5.091373757	10.58295141	1.379242619	1.213028392	0	0	4.602649206	3.548020022	0	0	1.389910443	0.233736429	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4491	0	12.5472743	14.7224	0.69302284	3.811436434	0	1.2071803	1.22811803	0.642245456	0.745447809	5.074305239	1.123805624	4.560973548	0	0.0029124	2.596333088	5.091373757	10.58295141	1.379242619	1.213028392	0	0	4.602649206	3.548020022	0	0	1.389910443	0.233736429	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4491	NO	"$425 Days 1-18 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$425 Days 1-18 (1b); $0 n/c (1b1, 1b2)"	"$125 Days 1-60 (2a); $0 n/c (2a1, 2a2)"	25% (6a); $0 n/c (6a2)	$200 (10a)	25% (11a)	"25% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	25% (9b)	25% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 25% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $43 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.5219	0.098	0.1526	0.3388	0.1786	0.2271	0.239	0.1103	0.9384	0.1663	0.8499	0	0.0004	0.4783	0.5809	0.9905	0.1362	0.114	0	0	0.5181	0.3429	0	0	0.1299	0	0.0049	0	0	0											8.1169	0	1.430819385	16.2443	0.791008346	3.96398934	0.338811155	1.385769027	1.455225816	0.881272165	0.855719182	6.012663115	1.290060007	5.41089376	0	0.003343256	3.074664022	5.672228747	11.573431	1.515471135	1.327021412	0	0	5.12073298	3.890958796	0	0	1.519836854	0.233736429	0.004932176	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5661
H2803_002_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1137.667937	84.63174935	785.2625974	801.1906568	103.1936424	7.430181319	7.765479986	292.4151326	34.00259641	16.20303684	36.29197151	0	0.009368804	21.78620361	4760.638524	92.37516638	435.6354602	366.8744382	0	0	31.45405276	1242.311718	0	0	274.0894393	182.4300249	16.04848154	5.354642865	107.5666843	0											4500	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-55 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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, 18a); $0/$40 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												206.8631108	127.8912646	62.52260786	0	200	0.2	0.094530917	49.29732209	0.2	0.08804402	0.163936246	0	0.2	0.160111913	12.65551512	0.117871583	38.5	40	0	0	0.2	39.43686903	0	0	40	15	0	0	0	0											YES	162.840768	100.6748456	49.21723086	0	157.4381893	0.157438189	0.074413882	38.82328311	0.157438189	0.069307455	0.129049129	0	0.157438189	0.126038648	12.20185387	0.11366902	37.11989355	38.56612317	0	0	0.157438189	31.04434626	0	0	40	15	0	0	0	0											7500	15.4382	0.710024025	3.220704212	0	1.353885017	1.169794293	0.577859514	0.946042957	5.35330721	1.122991254	4.683447314	0	0.001475008	2.745903652	4.840717967	10.50019463	1.347561826	1.179077064	0	0	4.952069112	3.213896262	0	0	0.913631464	0.228037531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4988	0	12.95926322	15.4382	0.710024025	3.220704212	0	1.353885017	1.169794293	0.577859514	0.946042957	5.35330721	1.122991254	4.683447314	0	0.001475008	2.745903652	4.840717967	10.50019463	1.347561826	1.179077064	0	0	4.952069112	3.213896262	0	0	0.913631464	0.228037531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4988	NO	"$425 Days 1-18 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$425 Days 1-18 (1b); $0 n/c (1b1, 1b2)"	"$125 Days 1-60 (2a); $0 n/c (2a1, 2a2)"	25% (6a); $0 n/c (6a2)	$200 (10a)	25% (11a)	"25% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	25% (9b)	25% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 25% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $43 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.6024	0.1008	0.1305	0.3299	0.2011	0.2172	0.227	0.1405	0.994	0.1668	0.8762	0	0.0002	0.508	0.551	0.9822	0.1332	0.1109	0	0	0.5597	0.3122	0	0	0.0854	0	0.005	0	0	0											8.2341	0	1.466474638	17.0406	0.81082282	3.351245878	0.329889879	1.554994103	1.386999094	0.804866025	1.086559291	6.34729738	1.289802867	5.559630336	0	0.001694108	3.253871035	5.391680156	11.48238543	1.480743073	1.289947692	0	0	5.511758174	3.526120913	0	0	0.999036145	0.228037531	0.005000614	0	0	0	0	0	0	0	0	0	0	0	0	0	72.733
H2803_010_0	2011	5																															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	YES	365.575426	22.018815	63.17755607	3853.417297	12.23303997	32.17891765	25.15918189	28.83275408	45.00193462	22.95709618	45.60444293	0	0.210398552	29.37592157	45.19472508	146.9036155	10.397288	7.611384964	0	0	24.79892551	9.166596074	667.1685971	0	155.0526898	198.1151463	0	0	132	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.080172539	0.081145721	0.159848505	0	0.233	0.233	0.233	0.096444321	0.233	0.233	0.233	0	0.233	0.233	0.226913017	0.232874243	0.228731256	0.233	0	0	0.233	0.231590808	0	0	0	0	0	0	0	0											NO	0.060407726	0.061140991	0.120441299	0	0.175558869	0.175558869	0.175558869	0.072682879	0.175558869	0.175558869	0.175558869	0	0.175558869	0.175558869	0.1709725	0.175464115	0.172342492	0.175558869	0	0	0.175558869	0.175285251	0	0	0	0	0	0	0	0												22.0836	1.346252174	7.609186921	0	2.147618662	5.649294388	4.416917517	2.095647585	7.900488745	4.030321841	8.006264421	0	0.036937332	5.157203567	7.727055144	25.77631285	1.791894521	1.336246136	0	0	4.353671314	1.606769089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.0717	0	36.98577698	22.0836	1.346252174	7.609186921	0	2.147618662	5.649294388	4.416917517	2.095647585	7.900488745	4.030321841	8.006264421	0	0.036937332	5.157203567	7.727055144	25.77631285	1.791894521	1.336246136	0	0	4.353671314	1.606769089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.0717	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												5.7722	0.3477	0.3868	1.1717	0.5745	1.5112	1.1462	0.3964	2.1134	0	1.6862	0	0.0069	1.1309	1.1947	4.1991	0.2972	0.2176	0	0	0.7089	0.2608	0	0	0	0	0	0	0	0											23.1223	0	0	27.8558	1.693917674	7.995988285	1.171658482	2.72210189	7.160468104	5.563155664	2.492071387	10.01385196	4.030321841	9.692453521	0	0.043812293	6.288114322	8.921767996	29.97540258	2.089104395	1.553820061	0	0	5.062556699	1.867619053	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.194
H2803_012_0	2011	5																															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	YES	400.9885416	22.280825	64.74047603	2100.37983	14.48807808	26.39216822	23.38738365	51.78842965	34.5366643	20.91277435	50.49823762	0	0.19356428	25.60475694	40.64361968	157.4712126	10.506308	5.045086721	0	0	26.98132159	10.1653864	715.8961239	0	257.1938682	212.4957441	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.090195395	0.091290323	0.121156958	0	0.233	0.233	0.233	0.080075631	0.233	0.233	0.233	0	0.233	0.233	0.223197875	0.232847266	0.233577053	0.233	0	0	0.233	0.226504505	0	0	0	0	0	0	0	0											NO	0.07118059	0.072044687	0.0956149	0	0.183879425	0.183879425	0.183879425	0.063203515	0.183879425	0.183879425	0.183879425	0	0.183879425	0.183879425	0.176143764	0.18375889	0.184334825	0.183879425	0	0	0.183879425	0.182722708	0	0	0	0	0	0	0	0												28.5426	1.605215061	6.190154166	0	2.664059471	4.852976724	4.300458663	3.27321081	6.350581981	3.845428927	9.285586909	0	0.035592489	4.708187991	7.159120134	28.93673529	1.936678444	0.927687647	0	0	4.961309907	1.857446934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.433	0	32.38723897	28.5426	1.605215061	6.190154166	0	2.664059471	4.852976724	4.300458663	3.27321081	6.350581981	3.845428927	9.285586909	0	0.035592489	4.708187991	7.159120134	28.93673529	1.936678444	0.927687647	0	0	4.961309907	1.857446934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.433	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												6.3314	0.3518	0.3964	0.7125	0.6904	1.2577	1.0827	0.5917	1.6458	0	1.8504	0	0.0065	1.0036	1.0769	4.5674	0.3048	0.1463	0	0	0.7826	0.2888	0	0	0	0	0	0	0	0											23.0876	0	0	34.874	1.957017561	6.586524427	0.712496832	3.354472383	6.110665536	5.383117874	3.864916646	7.996387507	3.845428927	11.13596733	0	0.042051371	5.71176116	8.235976459	33.50415416	2.241431771	1.074028965	0	0	5.743949014	2.146279029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.5206
H2803_801_0	2011	1																															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	211.6980819	4.20888	26.07780606	997.5222085	3.879320205	8.17754937	8.60671819	9.759874031	33.78777983	15.53913308	36.72660158	0	0.01939251	21.5734834	26.52636166	100.7345836	1.95086	5.462914167	0	0	30.64720995	9.458027688	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.081003487	0.081003487	0.160636939	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.067221648	0.067221648	0.133306357	0	0.193357651	0.193357651	0.193357651	0.193357651	0.193357651	0.193357651	0.193357651	0	0.193357651	0.193357651	0.193357651	0.193357651	0.193357651	0.193357651	0	0	0.193357651	0.193357651	0	0	0	0	0	0	0	0												14.2307	0.28292785	3.476337333	0	0.750096244	1.58119174	1.664174816	1.887146321	6.533125754	3.004610277	7.101369426	0	0.00374969	4.171398082	5.129074991	19.47780251	0.377213708	1.056296253	0	0	5.925872538	1.828782021	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.4819	0	16.09041777	14.2307	0.28292785	3.476337333	0	0.750096244	1.58119174	1.664174816	1.887146321	6.533125754	3.004610277	7.101369426	0	0.00374969	4.171398082	5.129074991	19.47780251	0.377213708	1.056296253	0	0	5.925872538	1.828782021	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.4819	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9025	0.0179	0.0855	0	0.1291	0.2722	0.2865	0.3249	1.1247	0.5172	1.2225	0	0.0006	0.7181	0.5374	2.041	0.0395	0.1107	0	0	0.6209	0.1916	0	0	0	0	0	0	0	0											9.1429	0	0	15.1332	0.300871742	3.561828332	0	0.879222188	1.853387312	1.950655578	2.212010699	7.65777614	3.52184142	8.323840593	0	0.004395184	4.889486886	5.666522145	21.51877277	0.416739828	1.166979644	0	0	6.546811662	2.020409886	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.6248
H2803_803_0	2011	1																															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	211.6980788	4.209355	26.07780568	997.5222013	3.879320149	8.177549252	8.606718066	9.75987389	33.78777934	15.53913285	36.72660105	0	0.019392509	21.57330808	26.52636128	100.7345822	1.949848	5.462914088	0	0	30.64720951	9.458027551	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.081003492	0.081003492	0.160636912	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.067221701	0.067221701	0.133306432	0	0.193357792	0.193357792	0.193357792	0.193357792	0.193357792	0.193357792	0.193357792	0	0.193357792	0.193357792	0.193357792	0.193357792	0.193357792	0.193357792	0	0	0.193357792	0.193357792	0	0	0	0	0	0	0	0												14.2307	0.282960002	3.476339225	0	0.750096779	1.581192868	1.664176003	1.887147667	6.533130414	3.00461242	7.101374492	0	0.003749693	4.17136722	5.12907865	19.4778164	0.377018304	1.056297007	0	0	5.925876765	1.828783325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.4817	0	16.09031997	14.2307	0.282960002	3.476339225	0	0.750096779	1.581192868	1.664176003	1.887147667	6.533130414	3.00461242	7.101374492	0	0.003749693	4.17136722	5.12907865	19.4778164	0.377018304	1.056297007	0	0	5.925876765	1.828783325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.4817	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9025	0.0179	0.0855	0	0.1291	0.2722	0.2865	0.3249	1.1247	0.5172	1.2225	0	0.0006	0.7181	0.5374	2.041	0.0395	0.1107	0	0	0.6209	0.1916	0	0	0	0	0	0	0	0											9.1429	0	0	15.1332	0.300905921	3.561830208	0	0.879222721	1.853388436	1.950656761	2.212012041	7.657780784	3.521843556	8.323845641	0	0.004395186	4.889450189	5.666525795	21.51878663	0.41652392	1.166980396	0	0	6.546815879	2.020411188	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.6246
H2803_804_0	2011	1																															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	210.6747309	4.213345	25.95174565	995.1082709	3.860567528	8.138019004	8.565113218	9.71269469	33.62444932	15.46401673	36.54906478	0	0.019298766	21.46909215	26.39813293	100.2476315	1.9504	5.436506378	0	0	30.49906099	9.412307475	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.081952679	0.081952679	0.155162328	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.068098271	0.068098271	0.128931555	0	0.193610477	0.193610477	0.193610477	0.193610477	0.193610477	0.193610477	0.193610477	0	0.193610477	0.193610477	0.193610477	0.193610477	0.193610477	0.193610477	0	0	0.193610477	0.193610477	0	0	0	0	0	0	0	0												14.3466	0.286921511	3.345998924	0	0.747446322	1.575605744	1.658295659	1.880479456	6.510045686	2.993995662	7.07628188	0	0.003736443	4.15664118	5.110955119	19.4089918	0.377617875	1.052564595	0	0	5.904937759	1.822321344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.2594	0	15.92166556	14.3466	0.286921511	3.345998924	0	0.747446322	1.575605744	1.658295659	1.880479456	6.510045686	2.993995662	7.07628188	0	0.003736443	4.15664118	5.110955119	19.4089918	0.377617875	1.052564595	0	0	5.904937759	1.822321344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.2594	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9087	0.0182	0.0822	0	0.1285	0.2709	0.2851	0.3233	1.1192	0.5147	1.2166	0	0.0006	0.7146	0.5348	2.0311	0.0395	0.1101	0	0	0.6179	0.1907	0	0	0	0	0	0	0	0											9.1068	0	0	15.2553	0.305094928	3.428177154	0	0.87594807	1.84648552	1.94339157	2.203773436	7.629259499	3.508726505	8.292843608	0	0.004378817	4.871255247	5.645804247	21.44009599	0.417134675	1.162712942	0	0	6.522875256	2.013022878	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3663
H2810_001_0	2011	7																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	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	398.407868	10.36125554	821.7082895	0	174.2834102	8.368495115	5.388712612	287.7823547	294.0188934	0	181.4890631	0	0	289.4186639	2593.354164	3235.378984	91.62057758	330.881957	246.8698063	0	0	0	0	0	0	0	97.92724914	0	0	0												$200/Days 1-5 for IP Medical; $200/Days 1-5 for IP Surgical; PBP 1a	$200/Days 1-5 for IP Psych; $200/Days 1-5 for IP Substance Abuse; PBP 1b	$50/Day for SNF; PBP 2	No Cost-Sharing; PBP 6	$150/Run for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for ER - Facility; $50/Case for ER - Worldwide; $20/Visit for PCP Urgent Care; $20/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$200/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$75/Case for OP Fac - Radiology (Diag); PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"$20/Case for OP Fac - Cardiovascular; $20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; PBP 7c, 7i, 9d"	"$20/Visit for PCP Office Visits; $20/Consult for PCP Consults; PBP 4b, 7a"	"$40/Visit for Speclst Office Visits; $40/Consult for Speclst Consults; $20/Procedure for Cardio; $20/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 9d, 17a, 18a"	"$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$20/Visit for Occ Therapy; $20/Visit for PT/ST; PBP 7c, 7i"	$75/Procedure for Prof Radiology (OP - Diag); $75/Procedure for Prof Radiology (Office - Diag); PBP 8b	"No Cost-Sharing; PBP 14f, 14i"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 14a, 14j"	No Cost Sharing;	No Cost Sharing;	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	$20/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing;											0	200	200	50	0	150	0.2	0.2	48.47052967	200	0	75	0	0	20	20	33.88389931	20	20	75	0	0	0	0	0	0	0	20	0	0	0											NO	197.7893168	197.7893168	49.4473292	0	148.3419876	0.197789317	0.197789317	47.93476475	197.7893168	0	74.1709938	0	0	19.77893168	19.78964354	33.50936648	19.77893168	19.77893168	74.1709938	0	0	0	0	0	0	0	20	0	0	0												6.5667	0.170778804	3.385940025	0	2.154462289	1.655198932	1.065829786	1.149564956	4.84614967	0	1.121768681	0	0	0.477032665	4.276796208	9.034625005	0.151013095	0.545374302	1.525881573	0	0	0	0	0	0	0	0.163212082	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2904	0	0.423804779	6.5667	0.170778804	3.385940025	0	2.154462289	1.655198932	1.065829786	1.149564956	4.84614967	0	1.121768681	0	0	0.477032665	4.276796208	9.034625005	0.151013095	0.545374302	1.525881573	0	0	0	0	0	0	0	0.163212082	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2904	YES	$400/Days 1-5 for IP Medical; $400/Days 1-5 for IP Surgical; PBP 1a	$400/Days 1-5 for IP Psych; $400/Days 1-5 for IP Substance Abuse; PBP 1b	$75/Day for SNF; PBP 2	20% Coinsurance for Home Health; PBP 6	$150/Run for Ambulance; PBP 10a	40% Coinsurance for DME; PBP 11a	"40% Coinsurance for DME / Medical Supplies; 40% Coinsurance for Diabetes Monitoring Supplies; 40% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for ER - Facility; $50/Case for ER - Worldwide; $20/Visit for PCP Urgent Care; $20/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$400/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$150/Case for OP Fac - Radiology (Diag); PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"$35/Case for OP Fac - Cardiovascular; $35/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy; PBP 7c, 7i, 9d"	"$35/Visit for PCP Office Visits; $35/Consult for PCP Consults; $35/Exam for Routine Physicals; PBP 4b, 7a"	"$55/Visit for Speclst Office Visits; $55/Consult for Speclst Consults; $35/Procedure for Cardio; $35/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 9d, 17a, 18a"	"$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$35/Visit for Occ Therapy; $35/Visit for PT/ST; PBP 7c, 7i"	$150/Procedure for Prof Radiology (OP - Diag); $150/Procedure for Prof Radiology (Office - Diag); PBP 8b	"No Cost-Sharing; PBP 14f, 14i"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 14a, 14j"	No Cost-Sharing; No Cost Sharing;	No Cost-Sharing; No Cost Sharing;	$35/Exam for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	$35/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; No Cost Sharing; PBP 14a	No Cost-Sharing; No Cost Sharing;											3200	1.4427	0.0431	0.5612	0.2612	0.2654	0.4161	0.2625	0.1474	1.2146	0	0.2777	0	0	0.0963	0.7789	1.4138	0.0303	0.1133	0.2416	0	0	0	0	0	0.0686	0	0.0294	0	0	0											7.6641	0	0.084188032	8.0094	0.213875199	3.947183571	0.261194894	2.419858541	2.071299007	1.328306931	1.296930504	6.060700327	0	1.399513364	0	0	0.573288252	5.055706556	10.44843454	0.181356708	0.658689424	1.767530305	0	0	0	0	0	0.068574069	0	0.192600969	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9544
H2810_002_0	2011	7																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	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	439.9797776	11.45606111	881.2452936	0	190.8002512	8.778281192	5.651735085	318.1462844	332.6324613	0	212.3095919	0	0	288.1595106	3069.639698	3720.037402	107.0399782	387.3697286	272.5000093	0	0	0	0	0	0	0	115.9598839	0	0	0												$100/Days 1-5 for IP Medical; $100/Days 1-5 for IP Surgical; PBP 1a	$100/Days 1-5 for IP Psych; $100/Days 1-5 for IP Substance Abuse; PBP 1b	$25/Day for SNF; PBP 2	No Cost-Sharing; PBP 6	$100/Run for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for ER - Facility; $50/Case for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$100/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$50/Case for OP Fac - Radiology (Diag); PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy; PBP 7c, 7i, 9d"	"$10/Visit for PCP Office Visits; $10/Consult for PCP Consults; PBP 4b, 7a"	"$30/Visit for Speclst Office Visits; $30/Consult for Speclst Consults; $10/Procedure for Cardio; $10/Visit for Chiropractor; $10/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$10/Visit for Occ Therapy; $10/Visit for PT/ST; PBP 7c, 7i"	$50/Procedure for Prof Radiology (OP - Diag); $50/Procedure for Prof Radiology (Office - Diag); PBP 8b	"No Cost-Sharing; PBP 14f, 14i"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 14a, 14j"	No Cost Sharing;	No Cost Sharing;	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	$10/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing;											0	100	100	25	0	100	0.2	0.2	47.80777237	100	0	50	0	0	10	10	23.7459298	10	10	50	0	0	0	0	0	0	0	10	0	0	0											NO	99.05248473	99.05248473	24.76312118	0	99.05248473	0.198104969	0.198104969	47.35478643	99.05248473	0	49.52624236	0	0	9.905248473	9.90965018	23.52093348	9.905248473	9.905248473	49.52624236	0	0	0	0	0	0	0	10	0	0	0												3.6318	0.09456261	1.818532	0	1.574936581	1.739021127	1.119636806	1.255479112	2.745672649	0	0.876241359	0	0	0.237857629	2.534921299	7.291562692	0.088354798	0.319749451	1.124658459	0	0	0	0	0	0	0	0.096633237	0	0	0	0	0	0	0	0	0	0	0	0	0	26.5496	0	0.251906567	3.6318	0.09456261	1.818532	0	1.574936581	1.739021127	1.119636806	1.255479112	2.745672649	0	0.876241359	0	0	0.237857629	2.534921299	7.291562692	0.088354798	0.319749451	1.124658459	0	0	0	0	0	0	0	0.096633237	0	0	0	0	0	0	0	0	0	0	0	0	0	26.5496	YES	$300/Days 1-5 for IP Medical; $300/Days 1-5 for IP Surgical; PBP 1a	$300/Days 1-5 for IP Psych; $300/Days 1-5 for IP Substance Abuse; PBP 1b	$50/Day for SNF; PBP 2	20% Coinsurance for Home Health; PBP 6	$100/Run for Ambulance; PBP 10a	40% Coinsurance for DME; PBP 11a	"40% Coinsurance for DME / Medical Supplies; 40% Coinsurance for Diabetes Monitoring Supplies; 40% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for ER - Facility; $50/Case for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$300/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$100/Case for OP Fac - Radiology (Diag); PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; PBP 7c, 7i, 9d"	"$25/Visit for PCP Office Visits; $25/Consult for PCP Consults; $25/Exam for Routine Physicals; PBP 4b, 7a"	"$45/Visit for Speclst Office Visits; $45/Consult for Speclst Consults; $25/Procedure for Cardio; $25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	$100/Procedure for Prof Radiology (OP - Diag); $100/Procedure for Prof Radiology (Office - Diag); PBP 8b	"No Cost-Sharing; PBP 14f, 14i"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 14a, 14j"	No Cost-Sharing; No Cost Sharing;	No Cost-Sharing; No Cost Sharing;	$25/Exam for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	$25/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; No Cost Sharing; PBP 14a	No Cost-Sharing; No Cost Sharing;											2500	1.2004	0.0359	0.3969	0.2665	0.1945	0.4378	0.2761	0.1616	1.0232	0	0.2191	0	0	0.0669	0.6462	1.2888	0.0245	0.0915	0.2154	0	0	0	0	0	0.0568	0	0.0243	0	0	0											6.6262	0	0.062341368	4.8321	0.130421093	2.215385695	0.266459719	1.769423441	2.176781035	1.395777037	1.417096085	3.768886034	0	1.095295223	0	0	0.304744037	3.181080047	8.580342453	0.112859538	0.411259897	1.340088905	0	0	0	0	0	0.056797103	0	0.120974852	0	0	0	0	0	0	0	0	0	0	0	0	0	33.1758
H2816_001_0	2011	6																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1673.042143	70.73508824	3356.027472	12.47065966	237.6231415	20.85347475	1.144622249	263.8327579	326.0568632	10.63167209	16.00679396	0	21.07087732	10.28168474	5646.365143	88.91267655	0.827650847	740.6894698	35.32340713	37.4710656	14.07487082	41.46992957	0	0	0	0	0.531747968	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: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0			17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	128.8537736	92.6697687	35.01559476	0.15	150	0.2	0.2	49.17838346	137.5182865	0	0.2	0	50	0.134885305	4.092380593	0.083913739	0.45	0	0.130173416	0.041529392	0.2	0	0	0	0	0	20	0	0	0											NO	87.13974647	62.66964425	23.67994328	0.101440273	101.440273	0.135253697	0.135253697	33.25779097	92.99928354	0	0.135253697	0	33.81342434	0.091218681	2.767548031	0.056748217	0.304320819	0	0.088032179	0.028085019	0.135253697	0	0	0	0	0	20	0	0	0												12.149	0.369411901	6.622545016	1.26502712	2.008713029	2.820509563	0.154814391	0.731207893	2.526921222	0	2.164978066	0	0.05937321	0.937881719	1.302215561	5.045635901	0.251871384	0	3.1095965	1.052375599	1.903678318	0	0	0	0	0	0.000886247	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4767	0	22.41124304	12.149	0.369411901	6.622545016	1.26502712	2.008713029	2.820509563	0.154814391	0.731207893	2.526921222	0	2.164978066	0	0.05937321	0.937881719	1.302215561	5.045635901	0.251871384	0	3.1095965	1.052375599	1.903678318	0	0	0	0	0	0.000886247	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4767	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0			17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	0.6356	0.0193	0.3465	0.0662	0.1051	0.1476	0.0081	0.0368	0.1322	0	0.1126	0	0.0031	0.049	0.0681	0.2378	0.0132	0	0.1627	0.0551	0.099	0	0	0	0	0	0	0	0	0											2.298	0		12.7846	0.388737868	6.969006747	1.331207642	2.113799849	2.968065921	0.162913583	0.767970173	2.659118361	0	2.27760906	0	0.062479349	0.986930851	1.370341615	5.28346298	0.26504816	0	3.272276585	1.107431151	2.002717946	0	0	0	0	0	0.000932891	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7747
H2816_002_0	2011	7																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1805.039348	70.2312623	2831.750082	12.75655578	224.1725616	21.22810674	0.622301696	290.9985555	342.7835607	12.50490469	18.51215169	0	5.283908564	11.73724499	5520.416112	91.79103627	0.710150387	473.7762763	27.18142722	30.19116614	16.59277132	73.17412769	0	0	0	0	0.154896341	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: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	128.8537736	92.6697687	35.01559476	0.15	150	0.2	0.2	49.5771232	132.9530844	0	0.2	0	50	0.123539635	4.238907726	0.074762782	0.45	0	0.119495449	0.052468104	0.2	0	0	0	0	0	20	0	0	0											NO	90.37213641	64.9943323	24.55833476	0.105203131	105.2031313	0.140270842	0.140270842	34.77112402	93.24720532	0	0.140270842	0	35.06771044	0.086645043	2.972975775	0.052435192	0.315609394	0	0.083808636	0.036798726	0.140270842	0	0	0	0	0	20	0	0	0												13.5938	0.380386167	5.79525554	1.342029613	1.96530462	2.977684401	0.087290783	0.843195572	2.663634089	0	2.596715101	0	0.015441215	1.016974098	1.367671947	4.813080611	0.224130133	0	2.278038343	1.110996442	2.327482	0	0	0	0	0	0.000258161	0	0	0	0	0	0	0	0	0	0	0	0	0	45.3993	0	19.33152286	13.5938	0.380386167	5.79525554	1.342029613	1.96530462	2.977684401	0.087290783	0.843195572	2.663634089	0	2.596715101	0	0.015441215	1.016974098	1.367671947	4.813080611	0.224130133	0	2.278038343	1.110996442	2.327482	0	0	0	0	0	0.000258161	0	0	0	0	0	0	0	0	0	0	0	0	0	45.3993	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	0.7124	0.0199	0.3037	0.0716	0.103	0.1589	0.0047	0.0433	0.1396	0	0.1358	0	0.0008	0.0532	0.0717	0.2269	0.0117	0	0.1185	0.0582	0.1217	0	0	0	0	0	0	0	0	0											2.3556	0	1.017448571	14.3062	0.40032094	6.098965602	1.413640829	2.068299696	3.136574786	0.091948652	0.88650517	2.80322629	0	2.732516837	0	0.016250437	1.070200685	1.439347084	5.039936992	0.235785719	0	2.3965377	1.169220069	2.449204517	0	0	0	0	0	0.000271748	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7549
H2816_007_0	2011	5																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1488.532622	31.31914378	5072.67384	14.38587361	228.9442779	19.57864596	0.816623828	278.1845514	275.9793754	8.21086067	17.23602407	0	7.276057996	6.376777115	4602.98805	74.65044261	0.448355017	315.1730641	36.89834941	33.65048048	11.00447359	50.19017197	0	0	0	0	0.09381202	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: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $300; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0			17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	193.2806604	139.004653	35.01559476	0.2	150	0.2	0.2	49.07069725	226.0958971	0	0.2	0	50	0.196507002	16.46170041	0.105151832	0.45	0.023216887	0.143344976	0.041358992	0.2	0	0	0	0	0	20	0	0	0											NO	106.7703068	76.78765908	19.34298956	0.110482142	82.8616065	0.110482142	0.110482142	27.10717871	124.897795	0	0.110482142	0	27.6205355	0.108552572	9.093619614	0.058086998	0.248584819	0.012825257	0.0791853	0.02284715	0.110482142	0	0	0	0	0	20	0	0	0												13.2443	0.200410311	8.176723096	1.589382131	1.580890889	2.163090743	0.09022235	0.628399862	2.872434622	0	1.904272859	0	0.016747385	0.69221556	3.488151868	4.336220135	0.111454251	0.000336848	2.921806865	0.768817571	1.215797814	0	0	0	0	0	0.000156353	0	0	0	0	0	0	0	0	0	0	0	0	0	46.0018	0	39.2344196	13.2443	0.200410311	8.176723096	1.589382131	1.580890889	2.163090743	0.09022235	0.628399862	2.872434622	0	1.904272859	0	0.016747385	0.69221556	3.488151868	4.336220135	0.111454251	0.000336848	2.921806865	0.768817571	1.215797814	0	0	0	0	0	0.000156353	0	0	0	0	0	0	0	0	0	0	0	0	0	46.0018	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $300; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0			17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	0.6952	0.0105	0.4292	0.0834	0.083	0.1135	0.0047	0.0319	0.1508	0	0.0994	0	0.0009	0.0362	0.1831	0.2219	0.0059	0	0.1534	0.0404	0.0635	0	0	0	0	0	0	0	0	0											2.407	0		13.9395	0.210930562	8.605948408	1.672814459	1.663877481	2.276639079	0.094958442	0.660320937	3.023218944	0	2.003678098	0	0.017626515	0.728437825	3.671257381	4.558162765	0.117304881	0.000336848	3.075182912	0.809175543	1.279265167	0	0	0	0	0	0.000164582	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4088
H2816_008_0	2011	8																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1595.445035	50.01828673	3356.608519	16.10508838	231.7236222	19.94877496	0.722741125	286.4668993	240.6262916	7.955424382	14.58600676	0	5.034994915	7.740224416	3937.079059	75.67537275	0.979933511	268.356912	20.49868804	24.67265081	12.21203523	38.94166235	0	0	0	0	0.084357182	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	40.5	0	150	0.2	0.2	49.33021057	288.7674496	0.2	0.2	0	25	0.185952946	20.69009456	0.096457428	0.45	0.024519064	0.112027076	0.101431882	0.2	0	0	0	0	0	20	0	0	0											NO	145.840036	110.5525249	31.80744864	0	117.8053653	0.15707382	0.15707382	38.74242319	226.7890327	0.15707382	0.15707382	0	19.63422756	0.146041698	16.24936099	0.075754683	0.353416096	0.019256515	0.087982604	0.079661466	0.15707382	0	0	0	0	0	20	0	0	0												19.39	0.460803991	8.897096091	0	2.274857165	3.133430296	0.11352371	0.924868487	4.547616992	1.249588901	2.291079807	0	0.008238186	1.13039552	5.331251572	5.732763906	0.346324276	0.000430635	1.803527957	1.965459533	1.918191029	0	0	0	0	0	0.000140595	0	0	0	0	0	0	0	0	0	0	0	0	0	61.5196	0	16.81243896	19.39	0.460803991	8.897096091	0	2.274857165	3.133430296	0.11352371	0.924868487	4.547616992	1.249588901	2.291079807	0	0.008238186	1.13039552	5.331251572	5.732763906	0.346324276	0.000430635	1.803527957	1.965459533	1.918191029	0	0	0	0	0	0.000140595	0	0	0	0	0	0	0	0	0	0	0	0	0	61.5196	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	1.0088	0.024	0.4629	0	0.1184	0.166	0.006	0.0471	0.2366	0	0.119	0	0.0004	0.0588	0.2774	0.289	0.0179	0	0.0931	0.047	0.0996	0	0	0	0	0	0	0	0	0											3.0719	0	0.884865208	20.3988	0.484778889	9.359997842	0	2.393214363	3.299424506	0.119537655	0.971970874	4.784222267	1.249588901	2.41003275	0	0.008666806	1.189154405	5.608628107	6.021768431	0.364209396	0.000430635	1.896667006	2.012477841	2.017784302	0	0	0	0	0	0.000147995	0	0	0	0	0	0	0	0	0	0	0	0	0	64.5915
H2816_009_0	2011	8																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1894.839554	66.49810387	4586.701052	17.32161019	261.8966508	22.65050768	1.523113648	361.4358048	331.8989005	16.27939195	22.48359697	0	3.771661456	17.47724322	5618.803317	93.70910434	1.427149887	441.9430411	31.24946115	37.15591024	9.996692577	93.34862103	0	0	0	0	0.45608157	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	29.7	0	150	0.2	0.2	49.94531938	304.8992464	0.2	0.2	0	25	0.255908806	20.86156266	0.108471338	0.45	0	0.116533997	0.088948095	0.2	0	0	0	0	0	20	0	0	0											NO	152.9101925	115.9119836	24.45625381	0	123.5164334	0.164688578	0.164688578	41.1271181	251.0671164	0.164688578	0.164688578	0	20.58607223	0.210726286	17.17830543	0.089319952	0.3705493	0	0.095959091	0.073243677	0.164688578	0	0	0	0	0	20	0	0	0												24.145	0.64232726	9.347793758	0	2.695711686	3.730279898	0.250839421	1.238734419	6.944074991	2.681029909	3.702791611	0	0.006470308	3.682914558	8.043459963	8.370092725	0.528829392	0	2.998669896	2.721435479	1.646341084	0	0	0	0	0	0.000760136	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3776	0	17.87709941	24.145	0.64232726	9.347793758	0	2.695711686	3.730279898	0.250839421	1.238734419	6.944074991	2.681029909	3.702791611	0	0.006470308	3.682914558	8.043459963	8.370092725	0.528829392	0	2.998669896	2.721435479	1.646341084	0	0	0	0	0	0.000760136	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3776	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	1.1811	0.0314	0.4573	0	0.1319	0.1851	0.0124	0.0604	0.3397	0	0.18	0	0.0003	0.1794	0.3935	0.3815	0.0256	0	0.145	0.0649	0.08	0	0	0	0	0	0	0	0	0											3.8495	0	0.940899969	25.3261	0.67374758	9.805053919	0	2.827576123	3.915354936	0.26328463	1.299174022	7.283753949	2.681029909	3.882807997	0	0.006786812	3.862339743	8.436916847	8.751546442	0.554388646	0	3.143662146	2.786315347	1.726383662	0	0	0	0	0	0.000798238	0	0	0	0	0	0	0	0	0	0	0	0	0	87.227
H2816_010_0	2011	8																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	2055.684427	37.34174373	3478.68275	20.11888451	295.3017791	24.739472	1.184653708	361.1424644	414.7056954	13.85544483	23.52705787	0	5.62347773	17.21613009	5505.16662	103.2849229	0.887425092	437.2110551	28.58102345	37.09008015	23.14308615	32.0983465	0	0	0	0	0.071032565	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	40.5	0	150	0.2	0.2	49.89788445	288.5009849	0.2	0.2	0	25	0.148260949	20.4911508	0.124664794	0.45	0.012672461	0.106053981	0.093071527	0.2	0	0	0	0	0	20	0	0	0											NO	156.969445	118.9890578	34.23475267	0	126.7953803	0.169060507	0.169060507	42.17880822	243.8706139	0.169060507	0.169060507	0	21.13256338	0.125325356	17.32122172	0.105379466	0.380386141	0.010712063	0.089647699	0.078673598	0.169060507	0	0	0	0	0	20	0	0	0												26.89	0.370271575	9.924320297	0	3.120241781	4.18246768	0.200278157	1.269379896	8.427877712	2.342408527	3.977496332	0	0.009903208	2.157617627	7.946350969	10.88411003	0.337564206	0.000390286	2.56222298	2.918010046	3.912581878	0	0	0	0	0	0.000118388	0	0	0	0	0	0	0	0	0	0	0	0	0	91.4336	0	16.73309191	26.89	0.370271575	9.924320297	0	3.120241781	4.18246768	0.200278157	1.269379896	8.427877712	2.342408527	3.977496332	0	0.009903208	2.157617627	7.946350969	10.88411003	0.337564206	0.000390286	2.56222298	2.918010046	3.912581878	0	0	0	0	0	0.000118388	0	0	0	0	0	0	0	0	0	0	0	0	0	91.4336	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	1.4033	0.0193	0.5179	0	0.1628	0.2203	0.0105	0.0662	0.4398	0	0.207	0	0.0005	0.1124	0.4147	0.5563	0.0175	0	0.133	0.0759	0.2037	0	0	0	0	0	0	0	0	0											4.5615	0	0.880689048	28.2933	0.389595193	10.44224762	0	3.283079984	4.402785823	0.210828127	1.335625897	8.86770916	2.342408527	4.184528212	0	0.010420034	2.270031966	8.361052651	11.44044789	0.355088729	0.000390286	2.695239853	2.993936737	4.116236231	0	0	0	0	0	0.000124619	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9951
H2816_013_0	2011	6																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1644.920154	112.4208135	1172.153503	14.4169094	200.7047959	22.12286993	1.695884895	261.6681856	390.544458	10.87995385	16.50868181	0	14.1132641	9.983290711	6422.323445	99.155541	0.882796846	945.4283186	46.51311741	43.9184659	17.55167118	96.30227267	0	0	0	0	0.26770538	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: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	128.8537736	92.6697687	35.01559476	0.15	150	0.2	0.2	48.86211665	137.0181679	0	0.2	0	50	0.141009472	3.987496781	0.088630347	0.45	0.056631555	0.139373469	0.038970617	0.2	0	0	0	0	0	20	0	0	0											NO	92.54376327	66.5561349	25.14846731	0.107731144	107.7311444	0.143641526	0.143641526	35.09314497	98.40749357	0	0.143641526	0	35.91038147	0.101274079	2.863850611	0.063654992	0.323193433	0.040673215	0.100099089	0.027988995	0.143641526	0	0	0	0	0	20	0	0	0												12.6856	0.623524569	2.456488672	1.553150149	1.801846446	3.177762794	0.243599494	0.765229964	3.202708436	0	2.371332245	0	0.042234391	1.011048569	1.532714577	6.311745145	0.285314144	0.003204467	4.655920657	1.229233708	2.521148831	0	0	0	0	0	0.000446176	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4742	0	18.23422846	12.6856	0.623524569	2.456488672	1.553150149	1.801846446	3.177762794	0.243599494	0.765229964	3.202708436	0	2.371332245	0	0.042234391	1.011048569	1.532714577	6.311745145	0.285314144	0.003204467	4.655920657	1.229233708	2.521148831	0	0	0	0	0	0.000446176	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4742	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	0.6638	0.0326	0.1285	0.0813	0.0943	0.1663	0.0127	0.0379	0.1676	0	0.1234	0	0.0022	0.0527	0.0802	0.2985	0.0149	0	0.2436	0.0643	0.1312	0	0	0	0	0	0	0	0	0											2.3959	0	0.959696235	13.3493	0.656149543	2.585020703	1.634416366	1.896125319	3.344034395	0.256345467	0.803093798	3.37028528	0	2.494717446	0	0.044444242	1.063749743	1.612911534	6.610216339	0.300242772	0.003204467	4.899534619	1.293551491	2.652333176	0	0	0	0	0	0.000469659	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8702
H2816_014_0	2011	7																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1631.082628	54.97214402	2140.193137	14.50203495	211.3268391	23.49271214	4.008595846	290.1348029	370.9384011	12.99091278	22.0808914	0	4.391987906	11.30805737	6199.490952	101.680219	0.94943789	670.3482726	34.69114663	34.9461765	24.6943541	40.05612126	0	0	0	0	0.035104103	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: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	128.8537736	92.6697687	35.01559476	0.15	150	0.2	0.2	49.48353902	131.1839176	0	0.2	0	50	0.104032216	4.203181148	0.079007827	0.45	0.004084623	0.125365966	0.048479673	0.2	0	0	0	0	0	20	0	0	0											NO	94.04029962	67.63242218	25.55514621	0.109473278	109.4732778	0.14596437	0.14596437	36.11416808	95.74088968	0	0.14596437	0	36.49109258	0.075924985	3.067573449	0.057661639	0.328419833	0.002981047	0.091494821	0.035381525	0.14596437	0	0	0	0	0	20	0	0	0												12.7823	0.309824938	4.557745711	1.5875853	1.927886813	3.429098936	0.585112169	0.873164753	2.959497711	0	3.22302341	0	0.013355703	0.858564082	1.58478282	5.863048052	0.311814234	0.000166528	3.174060257	1.236449012	3.604495847	0	0	0	0	0	5.85E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	48.882	0	18.09597717	12.7823	0.309824938	4.557745711	1.5875853	1.927886813	3.429098936	0.585112169	0.873164753	2.959497711	0	3.22302341	0	0.013355703	0.858564082	1.58478282	5.863048052	0.311814234	0.000166528	3.174060257	1.236449012	3.604495847	0	0	0	0	0	5.85E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	48.882	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	0.6699	0.0162	0.2389	0.0847	0.101	0.183	0.0312	0.0448	0.1551	0	0.1686	0	0.0007	0.045	0.0831	0.2764	0.0162	0	0.1651	0.0648	0.1885	0	0	0	0	0	0	0	0	0											2.5334	0	0.952419851	13.4522	0.326063414	4.796625275	1.672307717	2.028930792	3.612094803	0.616337021	0.918012048	3.114610253	0	3.391595937	0	0.014055699	0.903556503	1.667844108	6.139448214	0.328035816	0.000166528	3.339185113	1.301253505	3.793022485	0	0	0	0	0	6.16E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4154
H2816_019_0	2011	8																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1357.693616	53.73198444	7353.30243	14.13194029	204.6500692	20.05945835	1.942101233	269.6310089	282.0008944	7.070524757	14.80820519	0	9.013904123	8.375338416	4610.35211	72.01096696	0.626776819	398.1148777	29.19888393	30.76883408	11.84104933	28.9045471	0	0	0	0	0.15102052	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: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $300; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	193.2806604	139.004653	27	0.2	150	0.2	0.2	49.70267263	218.1667996	0	0.2	0	50	0.213806765	16.23991965	0.111168432	0.45	0.029588446	0.127628026	0.04148895	0.2	0	0	0	0	0	20	0	0	0											NO	94.73969732	68.13541889	13.23449446	0.098033292	73.5249692	0.098033292	0.098033292	24.36258316	106.9380481	0	0.098033292	0	24.50832307	0.104800905	7.960263946	0.054491037	0.220574908	0.014503264	0.062558978	0.020336492	0.098033292	0	0	0	0	0	20	0	0	0												10.719	0.305087606	8.109770019	1.385400632	1.253907503	1.966494743	0.190390578	0.54740899	2.513052102	0	1.451697107	0	0.01840964	0.877743047	3.05830164	3.923952263	0.138251239	0.000481164	1.826652334	0.625730144	1.160817049	0	0	0	0	0	0.000251701	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0728	0	41.68034426	10.719	0.305087606	8.109770019	1.385400632	1.253907503	1.966494743	0.190390578	0.54740899	2.513052102	0	1.451697107	0	0.01840964	0.877743047	3.05830164	3.923952263	0.138251239	0.000481164	1.826652334	0.625730144	1.160817049	0	0	0	0	0	0.000251701	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0728	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $300; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	0.5614	0.016	0.4247	0.0726	0.0657	0.103	0.01	0.0287	0.1316	0	0.0756	0	0.001	0.0458	0.1602	0.1965	0.0072	0	0.0957	0.0328	0.0605	0	0	0	0	0	0	0	0	0											2.0888	0	2.193702329	11.2803	0.321065575	8.534492805	1.457956477	1.319576824	2.069483499	0.200361664	0.576077752	2.644665019	0	1.527301512	0	0.019373784	0.923589546	3.218470226	4.120451027	0.145491697	0.000481164	1.9223173	0.658500722	1.221273483	0	0	0	0	0	0.000264948	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1615
H2816_020_0	2011	10																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1417.702874	88.2190269	2105.89534	14.17697457	171.2600048	17.80974044	0.918318814	277.6397989	340.4928824	9.765832707	17.93554384	0	7.145729255	8.179403718	4237.238925	79.34852586	0.792176726	329.7967093	24.09401001	26.61022546	29.19795887	65.36640156	0	0	0	0	0.102993385	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.65690275	290.2893428	0.2	0.2	0	25	0.219111741	20.38211125	0.10030804	0.45	0.024358897	0.118716191	0.104681659	0.2	0	0	0	0	0	20	0	0	0											NO	147.8510844	112.0769793	37.63715945	0	119.4298322	0.159239776	0.159239776	39.53677041	231.1280499	0.159239776	0.159239776	0	19.90497203	0.174456523	16.22821417	0.079865149	0.358289496	0.019394526	0.094521699	0.08334742	0.159239776	0	0	0	0	0	20	0	0	0												17.4674	0.823943504	6.604993226	0	1.704462802	2.836019082	0.146232882	0.914748415	6.558121327	1.555109015	2.856051988	0	0.011852962	1.426950333	5.730235064	6.337181874	0.2838286	0.000533021	2.277406752	2.217893626	4.649476436	0	0	0	0	0	0.000171656	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4026	0	16.4849407	17.4674	0.823943504	6.604993226	0	1.704462802	2.836019082	0.146232882	0.914748415	6.558121327	1.555109015	2.856051988	0	0.011852962	1.426950333	5.730235064	6.337181874	0.2838286	0.000533021	2.277406752	2.217893626	4.649476436	0	0	0	0	0	0.000171656	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4026	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0.9081	0.0428	0.3434	0	0.0886	0.1501	0.0077	0.0474	0.341	0	0.1482	0	0.0006	0.0741	0.2979	0.3197	0.0146	0	0.1175	0.0531	0.2412	0	0	0	0	0	0	0	0	0											3.1964	0	0.867628458	18.3756	0.866781218	6.94839397	0	1.793079668	2.986150078	0.153974046	0.96216807	6.89908515	1.555109015	3.004231921	0	0.01246921	1.501083357	6.028156185	6.656914934	0.298475759	0.000533021	2.394933802	2.271032296	4.890707222	0	0	0	0	0	0.00018069	0	0	0	0	0	0	0	0	0	0	0	0	0	67.599
H2816_021_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1251.70943	51.62492149	1479.83703	14.92383224	178.3768466	18.32113189	1.312262726	249.6400827	303.0838369	8.809426598	17.15754624	0	7.432280431	9.461180131	4529.816058	77.35348602	1.19070365	581.7481396	21.62139042	31.61835274	16.45704435	27.36571946	0	0	0	0	0.932496074	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.85341015	293.3618937	0.2	0.2	0	25	0.230663405	20.37244419	0.107668799	0.45	0.012808652	0.11051787	0.100487046	0.2	0	0	0	0	0	20	0	0	0											NO	147.6667706	111.937262	37.59024028	0	119.2809488	0.159041265	0.159041265	39.64374708	233.2832334	0.159041265	0.159041265	0	19.88015813	0.183424999	16.20029647	0.08561891	0.357842846	0.010185521	0.087884509	0.079907934	0.159041265	0	0	0	0	0	20	0	0	0												15.403	0.481562697	4.635619128	0	1.773079958	2.913815992	0.208703924	0.824722358	5.892031455	1.40106235	2.728757859	0	0.012312909	1.735416952	6.115363592	6.622921132	0.426084783	0.000493784	1.900185284	2.526557255	2.617349151	0	0	0	0	0	0.00155416	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2206	0	14.99345391	15.403	0.481562697	4.635619128	0	1.773079958	2.913815992	0.208703924	0.824722358	5.892031455	1.40106235	2.728757859	0	0.012312909	1.735416952	6.115363592	6.622921132	0.426084783	0.000493784	1.900185284	2.526557255	2.617349151	0	0	0	0	0	0.00155416	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2206	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0.7977	0.0249	0.2401	0	0.0918	0.1531	0.011	0.0427	0.3052	0	0.1405	0	0.0006	0.0896	0.3167	0.3245	0.0218	0	0.0973	0.0471	0.1347	0	0	0	0	0	0.0001	0	0	0											2.8394	0	0.789129153	16.2007	0.506503594	4.875705207	0	1.864910586	3.066880161	0.219667243	0.867436039	6.197189124	1.40106235	2.869217889	0	0.012950614	1.825013544	6.432087987	6.94738045	0.447897871	0.000493784	1.997463829	2.573658115	2.752077549	0	0	0	0	0	0.001635958	0	0	0	0	0	0	0	0	0	0	0	0	0	61.06
H2816_022_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1538.296117	117.3216383	5645.225699	20.61591556	239.1695578	26.58777108	1.13355368	300.9339845	356.6970705	8.817232101	19.31063558	0	12.27333284	10.36356533	5254.707128	94.58114511	1.036528912	568.1454504	37.64754514	36.45429968	30.477197	27.97520559	0	0	0	0	0.136377994	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	20.25	0	150	0.2	0.2	49.82640092	288.0914657	0.2	0.2	0	25	0.162821975	20.31595762	0.120329804	0.45	0.018723169	0.129655248	0.10028472	0.2	0	0	0	0	0	20	0	0	0											NO	151.5434396	114.8759307	16.52567534	0	122.4124099	0.163216547	0.163216547	40.66246543	235.1064706	0.163216547	0.163216547	0	20.40206832	0.132876202	16.57950221	0.098199075	0.36723723	0.015279655	0.105809409	0.081840628	0.163216547	0	0	0	0	0	20	0	0	0												19.4266	1.123119366	7.774263927	0	2.439776829	4.339564177	0.185014717	1.019726478	6.988482443	1.439118174	3.151815251	0	0.020866781	1.377071201	7.260035705	9.287780983	0.380652006	0.000723422	3.983464507	2.983442781	4.974382843	0	0	0	0	0	0.000227297	0	0	0	0	0	0	0	0	0	0	0	0	0	78.1561	0	17.61366998	19.4266	1.123119366	7.774263927	0	2.439776829	4.339564177	0.185014717	1.019726478	6.988482443	1.439118174	3.151815251	0	0.020866781	1.377071201	7.260035705	9.287780983	0.380652006	0.000723422	3.983464507	2.983442781	4.974382843	0	0	0	0	0	0.000227297	0	0	0	0	0	0	0	0	0	0	0	0	0	78.1561	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	1.0112	0.0585	0.4047	0	0.127	0.228	0.0097	0.0531	0.3638	0	0.1636	0	0.0011	0.0716	0.3779	0.4574	0.0197	0	0.2063	0.0675	0.2583	0	0	0	0	0	0	0	0	0											3.8793	0	0.927035262	20.4378	1.181581966	8.178943693	0	2.566776417	4.567571051	0.194735653	1.072807089	7.352259318	1.439118174	3.315448799	0	0.021952976	1.448671223	7.637947952	9.745146091	0.400362708	0.000723422	4.189733962	3.050985787	5.232641891	0	0	0	0	0	0.00023926	0	0	0	0	0	0	0	0	0	0	0	0	0	82.0354
H2816_801_0	2011	6																															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	286.1132647	5.902397119	55.51533131	25.02963353	11.06609254	27.07354079	1.998877702	13.6696163	49.3200676	9.122744602	20.85908244	0	0.172092967	11.90192588	33.07754164	96.20134919	1.0521924	3.270231026	38.0860748	41.45168002	17.39009842	0.752982072	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	0	0	0	0	0	0	0	0											0	0.082752392	0.082752392	0.16360035	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.065583033	0.065583033	0.12965676	0	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0	0	0	0	0	0	0	0												18.7642	0.387097102	7.197937983	0	2.043436541	4.999331277	0.369107679	2.524196627	9.107318413	1.684582847	3.851785183	0	0.03177825	2.197779403	6.108014825	17.7642968	0.194295176	0.603872555	7.032877837	7.654361948	3.211211404	0.139043757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8665	0	26.41461014	18.7642	0.387097102	7.197937983	0	2.043436541	4.999331277	0.369107679	2.524196627	9.107318413	1.684582847	3.851785183	0	0.03177825	2.197779403	6.108014825	17.7642968	0.194295176	0.603872555	7.032877837	7.654361948	3.211211404	0.139043757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8665	YES	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	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	0	0	0	0	0	0	0											6700	0.9876	0.0204	0.3788	0	0.1075	0.2631	0.0194	0.1329	0.4793	0.0887	0.2027	0	0.0017	0.1157	0.3215	0.935	0.0102	0.0318	0.3702	0.4029	0.169	0.0073	0	0	0	0	0	0	0	0											5.0456	0		19.7518	0.407470634	7.576776824	0	2.150985832	5.262453976	0.388534399	2.657049081	9.586650961	1.773245102	4.054510719	0	0.03345079	2.313452004	6.42948929	18.69925979	0.204521238	0.635655321	7.403029302	8.057223103	3.380222531	0.146361849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.9121
H2816_802_0	2011	6																															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	286.1132647	5.902397119	55.51533131	25.02963353	11.06609254	27.07354079	1.998877702	13.6696163	49.3200676	9.122744602	20.85908244	0	0.172092967	11.90192588	33.07754164	96.20134919	1.0521924	3.270231026	38.0860748	41.45168002	17.39009842	0.752982072	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	0	0	0	0	0	0	0	0											0	0.082752392	0.082752392	0.16360035	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.065583033	0.065583033	0.12965676	0	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0	0	0	0	0	0	0	0												18.7642	0.387097102	7.197937983	0	2.043436541	4.999331277	0.369107679	2.524196627	9.107318413	1.684582847	3.851785183	0	0.03177825	2.197779403	6.108014825	17.7642968	0.194295176	0.603872555	7.032877837	7.654361948	3.211211404	0.139043757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8665	0	26.41461014	18.7642	0.387097102	7.197937983	0	2.043436541	4.999331277	0.369107679	2.524196627	9.107318413	1.684582847	3.851785183	0	0.03177825	2.197779403	6.108014825	17.7642968	0.194295176	0.603872555	7.032877837	7.654361948	3.211211404	0.139043757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8665	YES	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	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	0	0	0	0	0	0	0											6700	0.9876	0.0204	0.3788	0	0.1075	0.2631	0.0194	0.1329	0.4793	0.0887	0.2027	0	0.0017	0.1157	0.3215	0.935	0.0102	0.0318	0.3702	0.4029	0.169	0.0073	0	0	0	0	0	0	0	0											5.0456	0		19.7518	0.407470634	7.576776824	0	2.150985832	5.262453976	0.388534399	2.657049081	9.586650961	1.773245102	4.054510719	0	0.03345079	2.313452004	6.42948929	18.69925979	0.204521238	0.635655321	7.403029302	8.057223103	3.380222531	0.146361849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.9121
H2816_803_0	2011	6																															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	286.1132647	5.902397119	55.51533131	25.02963353	11.06609254	27.07354079	1.998877702	13.6696163	49.3200676	9.122744602	20.85908244	0	0.172092967	11.90192588	33.07754164	96.20134919	1.0521924	3.270231026	38.0860748	41.45168002	17.39009842	0.752982072	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	0	0	0	0	0	0	0	0											0	0.082752392	0.082752392	0.16360035	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.065583033	0.065583033	0.12965676	0	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0.18465746	0	0	0	0	0	0	0	0												18.7642	0.387097102	7.197937983	0	2.043436541	4.999331277	0.369107679	2.524196627	9.107318413	1.684582847	3.851785183	0	0.03177825	2.197779403	6.108014825	17.7642968	0.194295176	0.603872555	7.032877837	7.654361948	3.211211404	0.139043757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8665	0	26.41461014	18.7642	0.387097102	7.197937983	0	2.043436541	4.999331277	0.369107679	2.524196627	9.107318413	1.684582847	3.851785183	0	0.03177825	2.197779403	6.108014825	17.7642968	0.194295176	0.603872555	7.032877837	7.654361948	3.211211404	0.139043757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8665	YES	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	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	0	0	0	0	0	0	0											6700	0.9876	0.0204	0.3788	0	0.1075	0.2631	0.0194	0.1329	0.4793	0.0887	0.2027	0	0.0017	0.1157	0.3215	0.935	0.0102	0.0318	0.3702	0.4029	0.169	0.0073	0	0	0	0	0	0	0	0											5.0456	0		19.7518	0.407470634	7.576776824	0	2.150985832	5.262453976	0.388534399	2.657049081	9.586650961	1.773245102	4.054510719	0	0.03345079	2.313452004	6.42948929	18.69925979	0.204521238	0.635655321	7.403029302	8.057223103	3.380222531	0.146361849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.9121
H2899_001_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1547.161787	43.20093321	686.0171195		207.2382379	5.477139026	6.057389516	385.9944685	211.2199203		12.05600248	2.701226776	0.128736206	11.39020528	4522.519176	3388.800526	140.5087553	403.2352014	23.94625553		10.73908554				159.1037094																6700	"1a (IP Acute) 250 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 400 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 40 copay, 7i (PT/ST) 40 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 10 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 40 copay, 7f (Podiatry) 40 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 40 copay, 18a (Hearing Exam) 40 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 40 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 40 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 12 trips/yr	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0%coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												181.2051416	172.0337627	49.94161658		150	0.2	0.2	49.35121979	354.8137574		0.2	0.2	0.2	0.196810521	10	39.23564975	40	40	0.181		0.2				25																NO	171.1180596	162.4572206	47.16153442		141.6500035	0.188866671	0.188866671	46.60400305	335.0624665		0.188866671	0.188866671	0.188866671	0.18585474	9.443333567	37.08758919	37.77333427	37.77333427	0.170924338		0.188866671				25																	22.0623	0.584858628	2.696135	0	2.446274761	1.034449016	1.144038995	1.499073949	5.897655623	0	2.276977058	0.51017171	0.024313979	2.116923639	3.558971428	10.47353681	0.442290348	1.269294838	4.092997864	0	2.02825534	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.49	0	3.771237946	22.0623	0.584858628	2.696135	0	2.446274761	1.034449016	1.144038995	1.499073949	5.897655623	0	2.276977058	0.51017171	0.024313979	2.116923639	3.558971428	10.47353681	0.442290348	1.269294838	4.092997864	0	2.02825534	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.49	NO																																																																																		0	0	0	22.0623	0.584858628	2.696135	0	2.446274761	1.034449016	1.144038995	1.499073949	5.897655623	0	2.276977058	0.51017171	0.024313979	2.116923639	3.558971428	10.47353681	0.442290348	1.269294838	4.092997864	0	2.02825534	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.49
H2899_002_0	2011	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin	T	Coin	P	P	P	P	O	V																																																			0	YES	262.3386153	29.85740604	30.89757749		23.44708577	12.06289953	7.148279217	25.23489046	34.73706308		10.92580316	1.813105707	0.245751949	12.2608605		4483.69686	2.202648917	457.3256084	28.97412539	14.95725048	57.59984485	1.292987858		13.93798932	159.1037094		112.6966327														3400	"1a (IP Acute) FFS, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 20% coin	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 20% coin, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 20% coin"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 0-20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 20% coin, 5 (Partial Hosp) 20% coin, 7c (OT) 8 copay, 7i (PT/ST) 8 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 20% coin, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 8 copay, 7b1 (Routine Chiro) 0% coin (5 visits), 7d (SPC w/Copay) 8 copay, 7f (Podiatry) 8 copay, 7f1 (Routine Podiatry) 0% coin (3 visits), 17a (Eye Exam) 8 copay, 18a (Hearing Exam) 8 copay"	"7e (MH Non-Phys) 45% coin, 7h (Psych) 45% coin"	7i (PT/ST) 8 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0-20% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 8 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 8 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												0.079248566	0.079248566	0.182319		0.2	0.2	0.2	0.2	0.2		0.2	0.2	0.2	0.2		8	0.45	8	0.181	0.07872	0.2	0.2		0.135384615	5		8														NO	0.066948095	0.066948095	0.154020576		0.168957241	0.168957241	0.168957241	0.168957241	0.168957241		0.168957241	0.168957241	0.168957241	0.168957241		6.758289636	0.380153792	6.758289636	0.152906303	0.06650157	0.168957241	0.168957241		0.135384615	5		6.758289636															17.5631	1.998896469	4.758862693	0	3.961554918	2.038114222	1.207753534	4.263617467	5.869078334	0	1.845993556	0.306337338	0.041521571	2.071561161	0	2.525176835	0.837345338	0.257561577	4.430326396	0.99468064	9.731910862	0.218459661	0	1.886989318	0.066293212	0	0.063469707	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9386	0	11.9398422	17.5631	1.998896469	4.758862693	0	3.961554918	2.038114222	1.207753534	4.263617467	5.869078334	0	1.845993556	0.306337338	0.041521571	2.071561161	0	2.525176835	0.837345338	0.257561577	4.430326396	0.99468064	9.731910862	0.218459661	0	1.886989318	0.066293212	0	0.063469707	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9386	NO																																																																																		0	0	0	17.5631	1.998896469	4.758862693	0	3.961554918	2.038114222	1.207753534	4.263617467	5.869078334	0	1.845993556	0.306337338	0.041521571	2.071561161	0	2.525176835	0.837345338	0.257561577	4.430326396	0.99468064	9.731910862	0.218459661	0	1.886989318	0.066293212	0	0.063469707	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9386
H2899_003_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1090.989356	47.60733444	377.228069		76.56142693	4.937961715	6.215935266	189.200851	259.8354992		11.0516639	2.929882209	0.034940964	16.28693455	4358.187867	4920.763511	336.0223426	668.6596719	22.69367486		12.37280554				159.1037094																3400	"1a (IP Acute) 165 days 1-5, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 250 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 35 copay, 7i (PT/ST) 35 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 5 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 35 copay, 7f (Podiatry) 35 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 35 copay, 18a (Hearing Exam) 35 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 35 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 35 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0% Coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												102.1273837	172.0337627	49.94161658		150	0.2	0.2	46	176.9076118		0.2	0.2	0.2	0.197343298	5	34.5081538	40	35	0.181		0.2				25																NO	92.35127204	155.5658849	45.16097105		135.6412972	0.180855063	0.180855063	41.59666448	159.9731863		0.180855063	0.180855063	0.180855063	0.178452672	4.521376574	31.20487163	36.17101259	31.64963602	0.163673832		0.180855063				25																	8.3962	0.617173093	1.419665492	0	0.865407605	0.893055377	1.124183364	0.655843693	3.463892727	0	1.998749371	0.529884031	0.00631925	2.906446998	1.642084044	12.79598281	1.012855699	1.763569603	3.714360726	0	2.237684524	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.3748	0	4.87405192	8.3962	0.617173093	1.419665492	0	0.865407605	0.893055377	1.124183364	0.655843693	3.463892727	0	1.998749371	0.529884031	0.00631925	2.906446998	1.642084044	12.79598281	1.012855699	1.763569603	3.714360726	0	2.237684524	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.3748	NO																																																																																		0	0	0	8.3962	0.617173093	1.419665492	0	0.865407605	0.893055377	1.124183364	0.655843693	3.463892727	0	1.998749371	0.529884031	0.00631925	2.906446998	1.642084044	12.79598281	1.012855699	1.763569603	3.714360726	0	2.237684524	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.3748
H2899_006_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1415.630054	37.79474857	596.2842233		190.4392973	6.560269828	7.235698119	318.5000753	233.4158451		11.60888259	4.196647411	0.057936252	13.78778831	4951.396447	4595.735296	239.2513548	706.3494309	21.1002924		14.9462765				159.1037094																6700	"1a (IP Acute) 250 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 400 copay, 9b (OP ASC) 250 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 40 copay, 7i (PT/ST) 40 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 10 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 40 copay, 7f (Podiatry) 40 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 40 copay, 18a (Hearing Exam) 40 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 40 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 40 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 12 trips/yr	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0%coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												181.2051416	172.0337627	49.94161658		150	0.2	0.2	48.28860007	345.586337		0.2	0.2	0.2	0.197831974	10	39.20588617	40	40	0.181		0.2				25																NO	170.0747311	161.4666984	46.87398458		140.7863455	0.187715127	0.187715127	45.32250355	324.3589162		0.187715127	0.187715127	0.187715127	0.185680271	9.385756367	36.8088865	37.54302547	37.54302547	0.16988219		0.187715127				25																	20.0636	0.508549439	2.329184791	0	2.234271059	1.231461886	1.358249994	1.202935066	6.309209212	0	2.179162873	0.787774203	0.010875511	2.560120268	3.872716727	14.09699157	0.748518309	2.209874556	3.584563887	0	2.805642197	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4251	0	4.451769677	20.0636	0.508549439	2.329184791	0	2.234271059	1.231461886	1.358249994	1.202935066	6.309209212	0	2.179162873	0.787774203	0.010875511	2.560120268	3.872716727	14.09699157	0.748518309	2.209874556	3.584563887	0	2.805642197	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4251	NO																																																																																		0	0	0	20.0636	0.508549439	2.329184791	0	2.234271059	1.231461886	1.358249994	1.202935066	6.309209212	0	2.179162873	0.787774203	0.010875511	2.560120268	3.872716727	14.09699157	0.748518309	2.209874556	3.584563887	0	2.805642197	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4251
H2899_009_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1253.394242	38.96927485	726.7975687		145.4587154	5.341806021	6.198679779	383.9838186	259.6420824		11.61123789	3.081754217	0.025289738	17.21255235	5009.580168	4399.552781	253.6643045	637.5172372	22.21516724		10.35106858				159.1037094																3900	"1a (IP Acute) 220 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 350 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 35 copay, 7i (PT/ST) 35 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 7 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 35 copay, 7f (Podiatry) 35 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 35 copay, 18a (Hearing Exam) 35 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 35 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 35 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0% Coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												159.4605246	172.0337627	49.94161658		150	0.2	0.2	48.50026901	264.9142487		0.2	0.2	0.2	0.19817784	7	34.51353996	40	35	0.181		0.2				25																NO	142.8873792	154.1538481	44.751055		134.4101114	0.179213482	0.179213482	43.45951042	237.3810246		0.179213482	0.179213482	0.179213482	0.177580704	6.272471867	30.93806091	35.84269638	31.36235934	0.162188201		0.179213482				25																	14.9245	0.500605306	2.710413164	0	1.629260179	0.957323657	1.110886987	1.39064573	5.136175295	0	2.080890372	0.552291904	0.004532262	3.056617159	2.618537556	11.34280266	0.757667721	1.66617039	3.603038013	0	1.855051043	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2289	0	6.478653883	14.9245	0.500605306	2.710413164	0	1.629260179	0.957323657	1.110886987	1.39064573	5.136175295	0	2.080890372	0.552291904	0.004532262	3.056617159	2.618537556	11.34280266	0.757667721	1.66617039	3.603038013	0	1.855051043	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2289	NO																																																																																		0	0	0	14.9245	0.500605306	2.710413164	0	1.629260179	0.957323657	1.110886987	1.39064573	5.136175295	0	2.080890372	0.552291904	0.004532262	3.056617159	2.618537556	11.34280266	0.757667721	1.66617039	3.603038013	0	1.855051043	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2289
H2899_801_0	2011	3																															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	Coin	V																																																			0	YES	227.4986081	4.816220376	21.64941773		4.741326104	5.229990481	7.824387067	13.03318274	40.20030768	5.648840767	15.12595614	3.349618633	0.355966845	19.73472283	54.44655332	110.0499444	2.815356025	11.27613634	28.04070881	15.28431242	15.72331121	0.717295013																			6700	"1a (IP Acute) FFS, 1a1 (Add'l Days) n/a"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) n/a"	6a (Home Health) FFS	10a (Ambulance) FFS	11a (DME) FFS	"11b (Prosthetics) FFS, 11b (Medical Supplies) FFS, 11c (Diabetic Supplies) FFS"	"4a (ER) FFS, 4a (ER) - Worldwide Coverage n/a, 4b (UC) FFS"	"9a (OP Surgery) FFS, 9b (OP ASC) FFS"	8a (OP Diag Proc/Test/Lab) FFS	"8b (X-Ray) FFS, 8b (OP Therap Rad) FFS, 8b (OP Diag) FFS"	9a (OP Observation) FFS	12 (Renal Dialysis) FFS	"3 (CORF) FFS, 5 (Partial Hosp) FFS, 7c (OT) FFS, 7i (PT/ST) FFS, 9a (OP Other) FFS, 9a (OP Chemo) FFS, 9c (OP SA) FFS, 9d (OP Cardiac Rehab) FFS"	"7a (PCP w/Copay) FFS, 14b (Immunizations) FFS, 14c (Routine Physical) FFS, 14d (Pap & Pelvic Exam) FFS, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) FFS, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) FFS, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) FFS, 14h (Mammography) FFS, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) FFS, 14j (Nutrition Therapy Diabetes) FFS"	"7b (Chiro) FFS, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) FFS, 7f (Podiatry) FFS, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) FFS, 18a (Hearing Exam) FFS"	"7e (MH Non-Phys) FFS, 7h (Psych) FFS"	7i (PT/ST) FFS	7g Physician Specialist Services Excluding Psychiatric (Radiology only) FFS	"8a (OP Diag Proc/Test/Lab) FFS, 7g (Prof. Other) FFS"	15 (Part B Rx) FFS	"13a (Blood) FFS, 13a1 (3 Pint Blood) n/a, 14a4-1 (Smoking Cessation - Mdcr Covered) FFS, 16b (Comp. Dental) FFS, 17b (MCR Eyewear) FFS"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive n/a"	17a1 (Routine Eye Exam) n/a	17b1 (Non MCR Covered) n/a	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) n/a, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												0.076653506	0.076653506	0.164633008		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069034452	0.069034452	0.148269141		0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725																				15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	0	10.31335866	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	NO																																																																																		0	0	0	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469
H2905_001_0	2011	3																															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	YES	920.9492962	57.73562441	1722.104436	1436.050224	217.7097416	9.599488288	24.44199139	209.3056092	223.064477	3471.785046	24.10695242	0	3.99952378	611.7512278	3979.33802	4921.867357	295.5656553	359.7947036	0	0	17.6259738	7.91600441	0	0	0	0	0	0	159.0668112	0											4250	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	$250 Days 1-7 (1b); $0 (1b1); $0 n/c (1b2)	"$50 Days 1-20/$75 Days 21-64 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$150/30% (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$50 (4a, 4a1); $40 (4b)"	$195 (9b)	$0/$15 (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$0 (3, 5); $195 (9a); $30 (9c, 9d)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$23 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $30 (16b, 18a); $0/$30 (17a); 20% (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	56.83817452	0	166.9991066	0.2	0.141335758	49.61766358	195	2.325	0.153596292	0	0.2	72.89605754	7.220054161	29.64335229	30	30	0	0	0.2	0.43940816	0	0	0	0	0	0	0	0											NO	150.8033485	100.8729355	46.02110344	0	135.2169246	0.161937303	0.114437658	40.1961367	157.8888704	1.882521147	0.124364847	0	0.161937303	59.02295479	6.991260817	28.71040766	29.04934227	29.04934227	0	0	0.161937303	0.355782862	0	0	0	0	0	0	0	0												11.5735	0.48533016	6.604428867	0	2.453170143	1.554515243	2.797084242	0.701106407	2.934949859	0.544642397	2.998057439	0	0.647672094	3.008947088	2.318382498	11.77573486	0.71549899	0.870983291	0	0	2.85430266	2.816378703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6547	0	10.37582172	11.5735	0.48533016	6.604428867	0	2.453170143	1.554515243	2.797084242	0.701106407	2.934949859	0.544642397	2.998057439	0	0.647672094	3.008947088	2.318382498	11.77573486	0.71549899	0.870983291	0	0	2.85430266	2.816378703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6547	YES	"$350 Days 1-15 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$350 Days 1-15 (1b); $0 n/c (1b1, 1b2)"	"40% (2a); $0 n/c (2a1, 2a2)"	40% (6a); $0 n/c (6a2)	$150/30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $0 n/c (4b)"	30% (9b)	"30% (8a1a, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$0 (3, 5); 30% (9a); $35 (9c, 9d)"	"$15 (7a, 14c); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b); 30% (14d, 14e, 14f, 14g, 14h, 14i, 14j)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $35 (16b, 17a, 18a); 40% (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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											8500	1.1413	0.0584	1.472	1.2007	0.3505	0.3331	0.8482	0.0971	0.8117	0.0959	0.6344	0	0.0925	0.2986	0.7074	2.3578	0.1416	0.1723	0	0	0.4841	0.5658	0	0	0	0	0	0	0	0											11.8633	0	2.104181963	12.7149	0.543710037	8.076435756	1.200696015	2.803623021	1.887625653	3.645242135	0.798178975	3.746685547	0.640587887	3.632475404	0	0.740196679	3.307499581	3.025749723	14.133507	0.85706458	1.043312344	0	0	3.338365685	3.382221545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.518
H2906_003_0	2011	11																															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	YES	1623.435033	40.90563504	1175.995375	939.7880712	9.639762013	10.29365135	5.458625874	516.1120324	686.4393047	255.0842921	1168.159085	0	0.002133421	704.1337143	4281.232817	13150.52727	276.2600973	780.8622007	2560.36952	3338.354207	19.02738474	213.3669764	0.83399205	62.92720814	205.3817106	234.1333333	0	0	12532.05801	100											2000	PBP: 1A IP Acute: $50 per admit	1B IP Psych: $50 per admit	2 SNF: $50 per day for days 35-100; $150 per day for days 101-125	6 Home Health: $0	10A Ambulance: 10%	11A DME: 10%	11B Prosthetic and Medical Supplies: 10%	"4A ER: $50, 4B Urgent Care: $10/$20"	"9B ASC Services including Colonoscopies: $50, 9A OP Hosp - Surgery including Colonoscopies $50"	8A OP Lab: $0	"8B: $10 Routine Imaging, $30 Radiation Theray, $30 CT, $50 PET, MRI, and Nuclear Medicine"	5 Partial Hosp: $20	12 Renal Dialysis: 20%	"3 CORF: 10%, 9D Cardiac Rehab: $10, 9A Colorectal Screening: $0, 9c Substance Abuse: $40"	"7A PCP: $10, 14B Immunizations: $0, separate office visit copay applies,  14C Phsycial Exams: $0, 14D Pap/Pelvic: $0, separate office visit copay applies, 14E Prostate Screening: $0, separate office visit copay applies, 14F Colorectal Screening: $0, 14G B"	"7B Chiropractic: $20, 7D Physician Specialist (Except Colonoscopies, Surgery, Anesthesia and Lab): $20, 7D Physcian Colonoscopies, Surgery, Anesthesia and Lab: $0, 7F Podiatry: $20"	"7E Mental Health: $20, 7H Psychiatric: $20, 9C OP Substance Abuse: $20"	"7C Occupational Therapy: $10, 7I Physical and Speech Therapy: $10"	7D Physician Specialist (Radiology): $0	"7G Allergy, Immunotherapy, Consultations: $0, 7G Dialysis: 10%"	15 Part B Drugs: 10%	"13A Blood: 10%, 17A Medicare Covered Eye Exams: $20, 17B Medicare Covered Lens/Frames: $0, 18A Medicare Covered Hearing Exams: $25"	10B Transportation: $0	"16A Preventive Dental Services: Not Covered, 16B Additional Comprehensive Dental Coverage: Covered"	17A Routine Eye Exams: $15	17B Eye Wear: $150 allowance	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: $800 allowance every 36 months	"14A Flu Shots: $0, Health Education/Wellness Programs: $0, Membership in Health Club $0"	"13B Accupuncture: $10, 13C Over the counter drugs: Not Covered"												9.405121673	3.603866145	33.52118528	0	0.1	0.1	0.1	29.73851264	50	0	25.44517248	0	0.1	0.784113633	7.284608987	10.88003804	20	4.175170924	0	0.00976547	0.1	35.40169304	0	0.37	15	0	0	0	0	10											YES	7.712199772	2.955170239	27.48737193	0	0.082	0.082	0.082	24.38558036	41	0	20.86504143	0	0.082	0.642973179	5.973379369	8.921631191	16.4	3.423640158	0	0.008007685	0.082	29.02938829	0	0.3034	12.3	0	0	0	0	8.2											5100	1.0434	0.010073593	2.693751855	0	0.790460485	0.84407941	0.447607322	1.04880762	2.345334291	0	2.031140642	0	0.000174941	0.037728258	2.131118982	9.777012855	0.377555466	0.222782599	0	0.002227707	1.560245549	0.516159401	0	19.09211495	0.210516253	0	0	0	0	0.068333333	0	0	0	0	0	0	0	0	0	0	45.2506		9.933054173	1.0434	0.010073593	2.693751855	0	0.790460485	0.84407941	0.447607322	1.04880762	2.345334291	0	2.031140642	0	0.000174941	0.037728258	2.131118982	9.777012855	0.377555466	0.222782599	0	0.002227707	1.560245549	0.516159401	0	19.09211495	0.210516253	0	0	0	0	0.068333333	0	0	0	0	0	0	0	0	0	0	45.2506	YES	"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											5100	1.8956	0	0.0163	1.6254	0	0.123	0.0666	0.37	0.6567	0.0642	0.1145	0	0	0.0128	1.0822	2.2561	0.1915	0.1241	0.1106	0.4565	0.0653	0.0023	0	0	0	0	0	0	0	0											9.2338		0.387820904	2.939	0.010073593	2.710101018	1.62539789	0.790460485	0.967122859	0.514214164	1.418829697	3.002031127	0.06416344	2.145615205	0	0.000174941	0.05055746	3.213282893	12.03308365	0.569086804	0.346888715	0.110615769	0.458709338	1.625539813	0.518499027	0	19.09211495	0.210516253	0	0	0	0	0.068333333	0	0	0	0	0	0	0	0	0	0	54.4844
H2906_801_0	2011	5																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																																																											0	YES	115.4535516	1.75	27.97	6.11	5.84	4.82678394	1.479313385	9.264529815	30.59427704	1.151337529	26.98178849	0	0	2.41233462	15.13557686	63.32063831	0.960796557	1.266884542	12.30495789	36.53503065	5.84	2.752751654																			3400	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0	0.072900439	0.072900439	0.150134603	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																			YES	0.065974897	0.065974897	0.135871816	0	0.210865	0.210865	0.210865	0.210865	0.210865	0.210865	0.210865	0	0	0.210865	0.210865	0.210865	0.210865	0.210865	0.210865	0.210865	0.210865	0.210865																			5100	7.617	0.11545607	3.800334697	0	1.2314516	1.017799796	0.311935417	1.953565079	6.451262228	0.242776788	5.689514829	0	0	0.50867694	3.191563415	13.3521064	0.202598366	0.267141609	2.594684946	7.703959238	1.2314516	0.580458978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0638	0	6.807633337	7.617	0.11545607	3.800334697	0	1.2314516	1.017799796	0.311935417	1.953565079	6.451262228	0.242776788	5.689514829	0	0	0.50867694	3.191563415	13.3521064	0.202598366	0.267141609	2.594684946	7.703959238	1.2314516	0.580458978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0638	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			5100	0.4528	0	0.009	0	0	0.0699	0.0443	0.1934	0.1771	0.035	0.0979	0	0	0.0117	0.6128	1.2768	0.0466	0.0909	0.0513	0.4334	0.0606	0																			3.6632	0	0	8.0698	0.11545607	3.809342773	0	1.2314516	1.087699796	0.356205417	2.146955079	6.628342228	0.277726788	5.787374829	0	0	0.52032694	3.804353415	14.6289464	0.249198366	0.358011609	2.645944946	8.137339238	1.2920316	0.580458978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.727
H2926_001_0	2011	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin		Coin	Coin	Coin	Coin		Coin																																																												0	YES	270.339474	42.90769424	85.43729694		14.13433223	36.33715687	8.729507857	34.52664242	43.14454379	30.3869888	45.31940161			63.4857975		121.4052317	19.20004137	1.293920342	14.37646998		4.677371372																				6700	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																				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																					22.0013	3.491990756	11.75248027	0	3.293299408	8.466557551	2.033975331	8.044707684	10.0526787	7.08016839	10.55942057	0	0	14.79219082	0	28.28741898	4.473609639	0.30148344	3.349717505	0	1.08982753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.0708		0	22.0013	3.491990756	11.75248027	0	3.293299408	8.466557551	2.033975331	8.044707684	10.0526787	7.08016839	10.55942057	0	0	14.79219082	0	28.28741898	4.473609639	0.30148344	3.349717505	0	1.08982753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.0708	NO																																																																																		0			22.0013	3.491990756	11.75248027	0	3.293299408	8.466557551	2.033975331	8.044707684	10.0526787	7.08016839	10.55942057	0	0	14.79219082	0	28.28741898	4.473609639	0.30148344	3.349717505	0	1.08982753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.0708
H2931_002_0	2011	4																															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	YES	994.7372227	69.91653885	2350.26654	2260.955736	313.9970303	14.423552	26.18329415	226.6085313	167.1079227	3334.725628	23.87543272	0	7.125051569	273.8288422	4654.767753	5525.699565	456.1276578	268.7064079	0	0	13.26425705	10.66266907	0	0	0.12273248	57.34061447	0	0	0	0											3200	"$125 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$50 Days 11-74 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$150/30% (10a)	20% (11a)	"20% (11b, 11b1); $0/$10 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$70 (9b)	$0/$5/$50 (8a1a); $0/$5/50%/50% (8a2)	$5 (8b1); $5/$200 (8b2); 20% (8b3)	Included in h.5.	20% (12)	"$0 (3, 5); $100 (9a); $25 (9c, 9d)"	"$5 (7a); $25 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"$30 (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$25 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$5/$25 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $25 (16b, 18a); $0/$25 (17a); 20% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b3, 17b4, 17b5); $0 (17b2)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14a1, 14a4, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a12, 14a13); $5/$25 (14a11)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												93.12452764	62.29135204	30.93638194	0	168.7862408	0.2	0.101992922	49.87334482	70	1.1625	0.038675831	0	0.2	33.56076068	3.630878846	25.16335348	25	25	0	0	0.2	0.33650654	0	0	25	0	0	0	0	0											NO	76.61420997	51.24753753	25.45158104	0	138.8616385	0.16454142	0.083910301	41.05191636	57.58949693	0.956397003	0.031818881	0	0.16454142	27.61067606	3.581183012	24.81894334	24.65782504	24.65782504	0	0	0.16454142	0.27684632	0	0	25	0	0	0	0	0												6.3509	0.298587537	4.984833275	0	3.633511843	2.373271725	2.197048094	0.775226206	0.801971767	0.2657768	0.759689543	0	1.172366101	0.630049955	1.389131267	11.42850204	0.937259665	0.552142966	0	0	2.182519688	2.951920689	0	0	0.000255693	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.685	0	6.528936106	6.3509	0.298587537	4.984833275	0	3.633511843	2.373271725	2.197048094	0.775226206	0.801971767	0.2657768	0.759689543	0	1.172366101	0.630049955	1.389131267	11.42850204	0.937259665	0.552142966	0	0	2.182519688	2.951920689	0	0	0.000255693	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.685	NO	"$325 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"20% (2a); $0 n/c (2a1, 2a2)"	20% (6a); $0 n/c (6a2)	$150/30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	30% (8a1a); 30%/50% (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a); $35 (9c, 9d)"	"$30 (7a, 14c); $0 n/c (7a1, 14b1, 14e1, 14f1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j)"	"$35 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$30/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 17b); $35 (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)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.1482	0.007	0.2137	0.2035	0.0999	0.0978	0.1776	0.0213	0.0773	0.0238	0.1215	0	0.0322	0.027	0.7316	1.277	0.1054	0.0621	0	0	0.1573	0.3015	0	0	0	0	0	0	0	0											3.8859	0	0	6.4991	0.305556085	5.198580123	0.203455965	3.733375752	2.471112686	2.374660284	0.796540239	0.879312093	0.289615221	0.881206671	0	1.204587563	0.657083056	2.120742928	12.70553126	1.042674385	0.614243149	0	0	2.339776753	3.253412128	0	0	0.000255693	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5709
H2931_004_0	2011	3																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	YES	1239.766118	104.4247034	1225.064606	433.8475744	209.0592812	15.5770092	5.314979051	340.6648684	414.5893898	10.11236299	42.81894376	0	0.061437939	759.9961606	4412.731071	4360.060723	195.1277478	628.0319551	0	0	17.08499844	6.525849624	0	0	0	0	0	0	110.8965248	0											3600	"$200 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-46 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$150/30% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	$150 (9b)	$0/20% (8a1a); $0/20%/50% (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$0 (3, 5); $150 (9a); $35 (9c, 9d)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"$17 (7b); $0 n/c (7b1, 7f1); $35 (7d, 7f)"	"$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $35 (16b, 18a); $0/$35 (17a); 20% (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 (14a1, 14a4, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a12, 14a13); $5/$25 (14a11)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												148.9992442	99.66616326	60.6698028	0	171.4866698	0.2	0.2	49.22649596	150	0.0465	0.151714943	0	0.2	58.66039805	11.53367436	34.623035	35	35	0	0	0.2	0.385418419	0	0	0	0	0	0	0	0											NO	112.810504	75.45937678	45.93440099	0	129.8362133	0.151424263	0.151424263	37.28911162	113.5681975	0.035206141	0.114866618	0	0.151424263	44.41303782	11.05655853	33.19077695	33.55214796	33.55214796	0	0	0.151424263	0.291808501	0	0	0	0	0	0	0	0												11.6549	0.65665192	4.689384072	0	2.261955452	2.358737144	0.804816788	1.058590859	3.923680809	0.35601728	4.918467238	0	0.009303195	2.812811519	4.065801615	12.05948358	0.545579589	1.75598509	0	0	2.587083304	1.904298396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4235	0	13.62508846	11.6549	0.65665192	4.689384072	0	2.261955452	2.358737144	0.804816788	1.058590859	3.923680809	0.35601728	4.918467238	0	0.009303195	2.812811519	4.065801615	12.05948358	0.545579589	1.75598509	0	0	2.587083304	1.904298396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4235	NO	"$350 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$350 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"20% (2a); $0 n/c (2a1, 2a2)"	20% (6a); $0 n/c (6a2)	$150/30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	30% (8a1a); 30%/50% (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a); $45 (9c, 9d)"	"$40 (7a, 14c); $0 n/c (7a1, 14b1, 14e1, 14f1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j)"	"$40 (7b); $0 n/c (7b1, 7f1); $45 (7d, 7f)"	"$45 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$40/$45 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 17b); $45 (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)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.1918	0.0108	0.1136	0.0335	0.0651	0.1019	0.0348	0.0305	0.2001	0.0268	0.2125	0	0.0003	0.0642	0.9384	1.2522	0.0563	0.1812	0	0	0.1953	0.2012	0	0	0	0	0	0	0	0											3.9105	0	0	11.8467	0.667460948	4.80301739	0.033492378	2.327100607	2.460635899	0.83958532	1.089083313	4.123738407	0.382808498	5.130947755	0	0.00957113	2.876994936	5.00416151	13.31168175	0.601882547	1.9372	0	0	2.782417597	2.10552243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.334
H2931_801_0	2011	1																															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	225.1442695	6.738432318	95.41758114	2686.702613	12.68790874	16.72798262	28.69385394	28.74491236	18.07276111	10.25228893	25.07775758	0	7.323359108	7.190658602	65.11854837	144.6288534	3.778497298	4.145616617	0	0	15.61714832	10.94251633	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.069949868	0.069949868	0.145510404	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.05582438	0.05582438	0.116126426	0	0.185948608	0.185948608	0.185948608	0.185948608	0.185948608	0.185948608	0.185948608	0	0.185948608	0.185948608	0.185948608	0.185948608	0.185948608	0.185948608	0	0	0.185948608	0.185948608	0	0	0	0	0	0	0	0												12.5685	0.376168809	11.08050264	0	2.359298975	3.110545091	5.335582213	5.345076455	3.36060478	1.906398861	4.663174126	0	1.361768436	1.337092961	12.10870346	26.89353405	0.702606315	0.770871641	0	0	2.903986998	2.034745685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2192	0	24.85283493	12.5685	0.376168809	11.08050264	0	2.359298975	3.110545091	5.335582213	5.345076455	3.36060478	1.906398861	4.663174126	0	1.361768436	1.337092961	12.10870346	26.89353405	0.702606315	0.770871641	0	0	2.903986998	2.034745685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2192	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.5685	0.376168809	11.08050264	0	2.359298975	3.110545091	5.335582213	5.345076455	3.36060478	1.906398861	4.663174126	0	1.361768436	1.337092961	12.10870346	26.89353405	0.702606315	0.770871641	0	0	2.903986998	2.034745685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2192
H2931_803_0	2011	1																															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	268.5867449	7.910676662	108.7331643	2387.844949	15.44714176	15.66589948	28.47452597	22.58914816	11.3446525	5.762312259	15.7051093	0	4.73221748	4.874698781	62.26026926	140.7669811	3.787013636	2.666641725	0	0	15.39485818	11.72793886	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.07054673	0.07054673	0.1465552	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.056633311	0.056633311	0.117651183	0	0.187047103	0.187047103	0.187047103	0.187047103	0.187047103	0.187047103	0.187047103	0	0.187047103	0.187047103	0.187047103	0.187047103	0.187047103	0.187047103	0	0	0.187047103	0.187047103	0	0	0	0	0	0	0	0												15.211	0.44800781	12.79258539	0	2.889343113	2.930261113	5.326077589	4.22523472	2.121984384	1.077823814	2.937595194	0	0.88514757	0.911798284	11.64560299	26.33005599	0.708349929	0.498787609	0	0	2.879563621	2.193676987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0129	0	23.58800899	15.211	0.44800781	12.79258539	0	2.889343113	2.930261113	5.326077589	4.22523472	2.121984384	1.077823814	2.937595194	0	0.88514757	0.911798284	11.64560299	26.33005599	0.708349929	0.498787609	0	0	2.879563621	2.193676987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0129	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.211	0.44800781	12.79258539	0	2.889343113	2.930261113	5.326077589	4.22523472	2.121984384	1.077823814	2.937595194	0	0.88514757	0.911798284	11.64560299	26.33005599	0.708349929	0.498787609	0	0	2.879563621	2.193676987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0129
H2931_804_0	2011	1																															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	211.2769091	4.786026817	71.00423419	2094.768759	11.90602005	12.82170998	23.07256706	23.58803246	19.44359757	9.119479237	21.4538011	0	5.383220882	6.351037997	50.07604569	115.6941347	2.809923585	3.997410449	0	0	13.63501265	8.548850076	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.070134716	0.070134716	0.145840738	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.059115028	0.059115028	0.122925989	0	0.196390637	0.196390637	0.196390637	0.196390637	0.196390637	0.196390637	0.196390637	0	0.196390637	0.196390637	0.196390637	0.196390637	0.196390637	0.196390637	0	0	0.196390637	0.196390637	0	0	0	0	0	0	0	0												12.4896	0.282926108	8.728265708	0	2.338230861	2.518063791	4.531236142	4.63246872	3.818540513	1.790980337	4.213325666	0	1.057214178	1.247284398	9.834466512	22.7212448	0.551842683	0.785053984	0	0	2.677788819	1.678914112	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8975	0	16.0122313	12.4896	0.282926108	8.728265708	0	2.338230861	2.518063791	4.531236142	4.63246872	3.818540513	1.790980337	4.213325666	0	1.057214178	1.247284398	9.834466512	22.7212448	0.551842683	0.785053984	0	0	2.677788819	1.678914112	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8975	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.4896	0.282926108	8.728265708	0	2.338230861	2.518063791	4.531236142	4.63246872	3.818540513	1.790980337	4.213325666	0	1.057214178	1.247284398	9.834466512	22.7212448	0.551842683	0.785053984	0	0	2.677788819	1.678914112	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8975
H2944_004_0	2011	8	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	1110.780318	50.011587	438.217334	528.210121	7.385437	8.338846	4.189887	388.957007	51.50273	15.278655	17.482147	7.64532	0.199977	21.820352	3183.358912	2945.151702	126.071387	3.123541		1629.185479	22.264661	0							5.25	0.48	932.156797	315.420945	312.954976	147.870244	0	341.886587						$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $50(Days 21-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,7h. 25% Psych -- OP,8b. 20% Rad therapy,3, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$35/Visit:5.Partial Hospitalization	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						161.6895	138.428775	16.51235	0	0.2	0.2	0.2	50	0.247157	0.25	0.248371	0.25	0.2	0.237734	15	32.294507	35	0.25		0	0.2	0							0	0	0	0	15.575792	35	0	35					NO	150.819762	129.122762	14.66366	0	0.183247	0.183247	0.183247	45.8118	0.226454	0.229059	0.227567	0.229059	0.183247	0.217821	13.74354	29.58939	32.06826	0.229059		0	0.183247	0							0	0	0	0	14.271101	32.06826	0	32.06826						13.9606	0.538136187	0.535489166	0	1.353359174	1.528068513	0.767784223	1.484901718	11.66299922	3.499713436	3.978359746	1.751229354	0.036645185	4.752930893	3.645885045	7.262103527	0.336907501	0.715475178	0	0	4.079932334	0	0	0	0	0	0	0	0	0	0	0	0.372184339	0.395161786	0	0.91364233	0	0	0	0	63.5715	0	5.549820585	13.9606	0.538136187	0.535489166	0	1.353359174	1.528068513	0.767784223	1.484901718	11.66299922	3.499713436	3.978359746	1.751229354	0.036645185	4.752930893	3.645885045	7.262103527	0.336907501	0.715475178	0	0	4.079932334	0	0	0	0	0	0	0	0	0	0	0	0.372184339	0.395161786	0	0.91364233	0	0	0	0	63.5715	YES						30% Coins																									30% Coins										5000						1.3288																									0										1.3288	0	0.20280248	13.9606	0.538136187	0.535489166	0	1.353359174	2.856891133	0.767784223	1.484901718	11.66299922	3.499713436	3.978359746	1.751229354	0.036645185	4.752930893	3.645885045	7.262103527	0.336907501	0.715475178	0	0	4.079932334	0	0	0	0	0	0	0	0	0	0	0	0.372184339	0.395161786	0	0.91364233	0	0	0	0	64.9004
H2944_009_0	2011	8	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1780.406799	122.30425	474.688268	1329.045802	11.482499	17.277692	8.390968	470.51312	49.469627	10.400246	15.462783	6.232775	0.151923	23.580437	3808.291541	3098.120895	86.497743	2.366579		1949.584176	23.883015	0							4.64	0.93	2384.95191	805.854261	458.416919	0	350.567395							$250/Day(Days 1-7):1a.IP Acute	$250/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $125(Days 21-100):2. $0 SNF 1,2. $125 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							179.655	153.80975	41.280875	0	0.2	0.2	0.2	50	0.240393	0.25	0.24132	0.25	0.2	0.232459	15	34.028473	35	0.25		0	0.2	0							0	0	0	0	24.109269	0	35						NO	156.755096	134.204236	30.286622	0	0.175557	0.175557	0.175557	43.8893	0.211014	0.219447	0.211827	0.219447	0.175557	0.204049	13.16679	29.869717	30.72251	0.219447		0	0.175557	0							0	0	0	0	21.162779	0	30.72251							23.2573	1.367812369	1.198058678	0	2.015833077	3.033219774	1.473093169	1.72087429	10.43878387	2.282302784	3.275434935	1.367763775	0.026671146	4.811564589	4.178581248	7.711666197	0.221452315	0.519338662	0	0	4.192830464	0	0	0	0	0	0	0	0	0	0	0	0.808447996	0	0.897525858	0	0	0	0	0	74.7986	0	10.85115193	23.2573	1.367812369	1.198058678	0	2.015833077	3.033219774	1.473093169	1.72087429	10.43878387	2.282302784	3.275434935	1.367763775	0.026671146	4.811564589	4.178581248	7.711666197	0.221452315	0.519338662	0	0	4.192830464	0	0	0	0	0	0	0	0	0	0	0	0.808447996	0	0.897525858	0	0	0	0	0	74.7986	YES						20% Coins																									20% Coins	$0/Visit									5000						1.9037																									0	0									1.9037	0	0.211891484	23.2573	1.367812369	1.198058678	0	2.015833077	4.936963891	1.473093169	1.72087429	10.43878387	2.282302784	3.275434935	1.367763775	0.026671146	4.811564589	4.178581248	7.711666197	0.221452315	0.519338662	0	0	4.192830464	0	0	0	0	0	0	0	0	0	0	0	0.808447996	0	0.897525858	0	0	0	0	0	76.7023
H2944_011_0	2011	8	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1403.643272	76.041577	602.642079	776.573843	7.588523	10.017204	7.767159	373.291691	42.245863	7.276171	14.449951	11.117793	0.205842	18.504437	3495.201046	3260.155742	179.317569	2.966262		1893.430771	41.946858	0							5.91	0.93	1534.41589	296.8867	491.220048	0	469.708913							$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $125(Days 21-100):2. $0 SNF 1,2. $125 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	41.280875	0	0.2	0.2	0.2	50	0.239515	0.25	0.243773	0.25	0.2	0.233883	15	32.085451	35	0.25		0	0.2	0							0	0	0	0	26.009009	0	35						NO	146.830558	125.707447	31.982523	0	0.179936	0.179936	0.179936	44.9839	0.215487	0.22492	0.219317	0.22492	0.179936	0.21042	13.49517	28.866575	31.48873	0.22492		0	0.179936	0							0	0	0	0	23.399733	0	31.48873							17.1748	0.796582709	1.606167846	0	1.365448475	1.802455619	1.397591522	1.399343008	9.10343428	1.636556381	3.169119903	2.500614002	0.037038386	3.893703634	3.930694358	7.842460853	0.47054021	0.667171649	0	0	7.547749841	0	0	0	0	0	0	0	0	0	0	0	0.957868164	0	1.232544762	0	0	0	0	0	68.5319	0	7.744463229	17.1748	0.796582709	1.606167846	0	1.365448475	1.802455619	1.397591522	1.399343008	9.10343428	1.636556381	3.169119903	2.500614002	0.037038386	3.893703634	3.930694358	7.842460853	0.47054021	0.667171649	0	0	7.547749841	0	0	0	0	0	0	0	0	0	0	0	0.957868164	0	1.232544762	0	0	0	0	0	68.5319	YES						20% Coins																									20% Coins	$0/Visit									5000						1.1232																									0	0									1.1232	0	0.103437648	17.1748	0.796582709	1.606167846	0	1.365448475	2.925614371	1.397591522	1.399343008	9.10343428	1.636556381	3.169119903	2.500614002	0.037038386	3.893703634	3.930694358	7.842460853	0.47054021	0.667171649	0	0	7.547749841	0	0	0	0	0	0	0	0	0	0	0	0.957868164	0	1.232544762	0	0	0	0	0	69.6551
H2944_013_0	2011	8	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1194.47714	32.215243	462.541196	427.219576	10.837181	11.011408	5.410554	368.652998	45.301913	13.290614	16.931352	5.411678	0.394707	31.171489	2950.458422	2458.157679	53.464191	2.928631		1541.620784	15.086951	0							4.56	0.77	1355.453333	870.483389	347.356634	0	231.412379							$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	46.371	0	0.2	0.2	0.2	50	0.242152	0.25	0.247158	0.25	0.2	0.233574	15	33.636804	35	0.25		0	0.2	0							0	0	0	0	17.820455	0	35						NO	135.944328	116.387315	29.998188	0	0.169159	0.169159	0.169159	42.28975	0.204811	0.211449	0.209045	0.211449	0.169159	0.197556	12.686925	28.449841	29.602825	0.211449		0	0.169159	0							0	0	0	0	15.072451	0	29.602825							13.5319	0.312453803	1.156283146	0	1.833206701	1.862678766	0.915243904	1.299186927	9.278330103	2.81028704	3.539414479	1.144293901	0.066768241	6.158114681	3.119353726	5.827849593	0.131890924	0.619256096	0	0	2.552093544	0	0	0	0	0	0	0	0	0	0	0	0.436292987	0	0.57087168	0	0	0	0	0	57.1657	0	10.94046035	13.5319	0.312453803	1.156283146	0	1.833206701	1.862678766	0.915243904	1.299186927	9.278330103	2.81028704	3.539414479	1.144293901	0.066768241	6.158114681	3.119353726	5.827849593	0.131890924	0.619256096	0	0	2.552093544	0	0	0	0	0	0	0	0	0	0	0	0.436292987	0	0.57087168	0	0	0	0	0	57.1657	YES						20% Coins																									20% Coins	$0/Visit									3400						1.178																									0	0									1.178	0	0.170378383	13.5319	0.312453803	1.156283146	0	1.833206701	3.040635983	0.915243904	1.299186927	9.278330103	2.81028704	3.539414479	1.144293901	0.066768241	6.158114681	3.119353726	5.827849593	0.131890924	0.619256096	0	0	2.552093544	0	0	0	0	0	0	0	0	0	0	0	0.436292987	0	0.57087168	0	0	0	0	0	58.3437
H2944_017_0	2011	8	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	1332.172021	46.333089	645.43127	394.729086	6.112624	9.422414	5.415823	282.045329	41.427127	14.822809	25.620115	14.864881	0.537918	23.596443	3356.774097	2953.579703	82.484312	3.423361		1863.965872	26.713699	0							1.42	0.48	987.551894	141.840076	370.34963	222.632655	0	401.138204						$250/Day(Days 1-7):1a.IP Acute	$250/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $50(Days 15-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,7h. 25% Psych -- OP,8b. 20% Rad therapy,3, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$35/Visit:5.Partial Hospitalization	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						179.655	153.80975	23.1855	0	0.2	0.2	0.2	50	0.240391	0.25	0.246343	0.25	0.2	0.238642	15	32.653294	35	0.25		0	0.2	0							0	0	0	0	17.350208	35	0	35					NO	163.253576	139.767843	18.845615	0	0.179626	0.179626	0.179626	44.9064	0.215902	0.224532	0.221247	0.224532	0.179626	0.214331	13.47192	29.326838	31.43448	0.224532		0	0.179626	0							0	0	0	0	15.582707	31.43448	0	31.43448						18.1235	0.539656326	1.013629102	0	1.097986199	1.692510537	0.972822622	1.05547003	8.944199574	3.32819495	5.668373583	3.337641461	0.096624059	5.057449225	3.768516008	7.218262789	0.216070955	0.768654092	0	0	4.798474897	0	0	0	0	0	0	0	0	0	0	0	0.480920814	0.583195145	0	1.050797571	0	0	0	0	69.8129	0	7.795231392	18.1235	0.539656326	1.013629102	0	1.097986199	1.692510537	0.972822622	1.05547003	8.944199574	3.32819495	5.668373583	3.337641461	0.096624059	5.057449225	3.768516008	7.218262789	0.216070955	0.768654092	0	0	4.798474897	0	0	0	0	0	0	0	0	0	0	0	0.480920814	0.583195145	0	1.050797571	0	0	0	0	69.8129	YES						30% Coins																									30% Coins	$0/Visit									5000						1.4927																									0	0									1.4927	0	0.237917304	18.1235	0.539656326	1.013629102	0	1.097986199	3.185240733	0.972822622	1.05547003	8.944199574	3.32819495	5.668373583	3.337641461	0.096624059	5.057449225	3.768516008	7.218262789	0.216070955	0.768654092	0	0	4.798474897	0	0	0	0	0	0	0	0	0	0	0	0.480920814	0.583195145	0	1.050797571	0	0	0	0	71.3057
H2944_019_0	2011	7	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	Lab	Radiology	Other		Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	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	1108.730751	125.68478	460.436353	190.706934	97.577195	7.436896	3.654688	320.926792	38.793435	14.211809	19.526132	6.168748	0.002919	33.04042	2781.912599	2600.772081	86.582538	3.301788		1711.468718	22.824326	0							4.62	0.48	827.396019	376.032843	271.16658	161.85248	0	292.719688						$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $50(Days 15-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$125/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,7h. 25% Psych -- OP,8b. 20% Rad therapy,3, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$35/Visit:5.Partial Hospitalization	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						161.6895	138.428775	23.1855	0	125	0.2	0.2	50	0.243411	0.25	0.246374	0.25	0.2	0.232494	15	32.07334	35	0.25		0	0.2	0							0	0	0	0	18.619497	35	0	35					NO	151.254383	129.494859	20.463128	0	115.20075	0.184321	0.184321	46.0803	0.224329	0.230402	0.22706	0.230402	0.184321	0.214268	13.82409	29.558983	32.25621	0.230402		0	0.184321	0							0	0	0	0	17.15984	32.25621	0	32.25621						13.975	1.356294405	0.785164002	0	0.936747171	1.370776108	0.673635747	1.232366904	8.70249248	3.274429217	4.433603532	1.421291877	0.000538033	7.079504713	3.204784178	6.406348144	0.232735377	0.760738559	0	0	4.207002593	0	0	0	0	0	0	0	0	0	0	0	0.387764594	0.435062299	0	0.786835644	0	0	0	0	61.6631	0	5.036478678	13.975	1.356294405	0.785164002	0	0.936747171	1.370776108	0.673635747	1.232366904	8.70249248	3.274429217	4.433603532	1.421291877	0.000538033	7.079504713	3.204784178	6.406348144	0.232735377	0.760738559	0	0	4.207002593	0	0	0	0	0	0	0	0	0	0	0	0.387764594	0.435062299	0	0.786835644	0	0	0	0	61.6631	YES						30% Coins																									30% Coins	$0/Visit									5000						1.209																									0	0									1.209	0	0.156989817	13.975	1.356294405	0.785164002	0	0.936747171	2.57974659	0.673635747	1.232366904	8.70249248	3.274429217	4.433603532	1.421291877	0.000538033	7.079504713	3.204784178	6.406348144	0.232735377	0.760738559	0	0	4.207002593	0	0	0	0	0	0	0	0	0	0	0	0.387764594	0.435062299	0	0.786835644	0	0	0	0	62.8721
H2944_022_0	2011	8	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1748.214897	108.528082	487.058795	3588.480016	13.508618	15.725919	7.34351	467.339058	47.636329	8.482617	15.511092	8.03167	0.418108	22.318456	4076.048518	3274.020015	116.503784	1.886678		1424.610002	27.806549	0							3.69	0.93	1951.05325	696.286934	344.368187	0	360.032848							$250/Day(Days 1-7):1a.IP Acute	$250/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							179.655	153.80975	46.371	0	0.2	0.2	0.2	50	0.243468	0.25	0.24281	0.25	0.2	0.229424	15	34.095191	35	0.25		0	0.2	0							0	0	0	0	22.272043	0	35						NO	129.38268	110.769629	23.855283	0	0.156828	0.156828	0.156828	39.20695	0.190912	0.196035	0.190397	0.196035	0.156828	0.1799	11.762085	26.735369	27.444865	0.196035		0	0.156828	0							0	0	0	0	17.464378	0	27.444865							18.8491	1.001801282	0.968243783	0	2.118529544	2.466264425	1.151667986	1.52691159	9.094346842	1.662889824	2.953265384	1.574488428	0.065571041	4.015090234	3.995235761	7.294344435	0.266452552	0.369854922	0	0	4.360845467	0	0	0	0	0	0	0	0	0	0	0	0.501181349	0	0.823421076	0	0	0	0	0	65.0595	0	20.80570106	18.8491	1.001801282	0.968243783	0	2.118529544	2.466264425	1.151667986	1.52691159	9.094346842	1.662889824	2.953265384	1.574488428	0.065571041	4.015090234	3.995235761	7.294344435	0.266452552	0.369854922	0	0	4.360845467	0	0	0	0	0	0	0	0	0	0	0	0.501181349	0	0.823421076	0	0	0	0	0	65.0595	YES						20% Coins																									20% Coins	$0/Visit									3400						1.5838																									0	0									1.5838	0	0.341782642	18.8491	1.001801282	0.968243783	0	2.118529544	4.050104583	1.151667986	1.52691159	9.094346842	1.662889824	2.953265384	1.574488428	0.065571041	4.015090234	3.995235761	7.294344435	0.266452552	0.369854922	0	0	4.360845467	0	0	0	0	0	0	0	0	0	0	0	0.501181349	0	0.823421076	0	0	0	0	0	66.6433
H2944_024_0	2011	7	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1868.703868	82.457986	485.36898	2420.486632	10.855697	13.711884	8.223841	391.642194	51.450578	10.009699	19.368277	7.857795	0.246057	19.39571	4085.629046	4259.716833	117.596413	2.696893		1753.598348	33.869568	0							4.14	1.48	1828.771969	1925.243225	457.552878	0	484.702037							$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $100(Days 21-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	33.0247	0	0.2	0.2	0.2	50	0.240164	0.25	0.234659	0.25	0.2	0.229965	15	34.398125	35	0.25		0	0.2	0							0	0	0	0	21.214021	0	35						NO	140.918705	120.646076	24.705844	0	0.174432	0.174432	0.174432	43.60805	0.209462	0.21804	0.20466	0.21804	0.174432	0.200566	13.082415	30.000703	30.525635	0.21804		0	0.174432	0							0	0	0	0	18.502042	0	30.525635							21.9446	0.82901937	0.999287525	0	1.893580939	2.39179135	1.434501033	1.423229365	10.77694097	2.18251477	3.963911571	1.713313622	0.042920215	3.890119972	4.454157893	10.64954163	0.299142098	0.58803055	0	0	5.907936485	0	0	0	0	0	0	0	0	0	0	0	0.70547188	0	1.232986455	0	0	0	0	0	77.323	0	11.54243885	21.9446	0.82901937	0.999287525	0	1.893580939	2.39179135	1.434501033	1.423229365	10.77694097	2.18251477	3.963911571	1.713313622	0.042920215	3.890119972	4.454157893	10.64954163	0.299142098	0.58803055	0	0	5.907936485	0	0	0	0	0	0	0	0	0	0	0	0.70547188	0	1.232986455	0	0	0	0	0	77.323	YES						20% Coins																									20% Coins	$0/Visit									5000						1.4819																									0	0									1.4819	0	0.197080092	21.9446	0.82901937	0.999287525	0	1.893580939	3.873717658	1.434501033	1.423229365	10.77694097	2.18251477	3.963911571	1.713313622	0.042920215	3.890119972	4.454157893	10.64954163	0.299142098	0.58803055	0	0	5.907936485	0	0	0	0	0	0	0	0	0	0	0	0.70547188	0	1.232986455	0	0	0	0	0	78.8049
H2944_031_0	2011	7																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin							O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0											0	NO	363.9331296	13.02555611	35.51924631	9.068110919	18.92349299	15.25716356	4.192422139	32.97635202	68.64827706	16.53947297	30.55268773	6.391207724	0.271373375	15.79555602	40.40917521	82.59559284	1.141932533	8.019657174		5.878159083	24.32146716	0							4.86	0.51												Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0% Coins:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d												0.070156	0.070156	0.151722	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0							0	0											NO	0.060996	0.060996	0.094501	0	0.202138	0.202138	0.202138	0.202138	0.202138	0.202138	0.202138	0.202138	0.202138	0.202138	0.202138	0.202138	0.202138	0.202138		0.202138	0.202138	0							0	0												22.1985	0.794506821	3.356604295	0	3.825157027	3.084052528	0.847447826	6.665773845	13.87642543	3.343255987	6.175859192	1.291905947	0.054854871	3.192882103	8.168229858	16.69570795	0.230827958	1.621077462	0	1.188199321	4.916292729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5275	0	16.96337564	22.1985	0.794506821	3.356604295	0	3.825157027	3.084052528	0.847447826	6.665773845	13.87642543	3.343255987	6.175859192	1.291905947	0.054854871	3.192882103	8.168229858	16.69570795	0.230827958	1.621077462	0	1.188199321	4.916292729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5275	YES	7% Coins	7% Coins	15% Coins(Days 1-100) 15%(Days 100-100)	0% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins		23% Coins	23% Coins	23% Coins																			6700	0	0	0	0	0	2.0778	0.571	0	0	0.183	0	0	0	0	0	0	0	0		0	0	0																			2.8318	0	0.134452384	22.1985	0.794506821	3.356604295	0	3.825157027	5.161880016	1.418401439	6.665773845	13.87642543	3.52629833	6.175859192	1.291905947	0.054854871	3.192882103	8.168229858	16.69570795	0.230827958	1.621077462	0	1.188199321	4.916292729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3593
H2944_041_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	O							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1506.94307	76.619419	727.363683	621.397138	10.917636	11.962735	4.705012	446.783231	49.053973	16.191665	18.999211	5.268895	0.358335	24.184294	3905.195638	3864.559566	118.996887	3.498152		1531.736736	25.872191	0							4.51	0.6	1739.592628	586.554733	355.906264	0	450.031695							$225/Day(Days 1-9):1a.IP Acute	$225/Day(Days 1-9):1b.IP Psych	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							176.2695	156.803175	57.868692	0	0.2	0.2	0.2	50	0.242124	0.25	0.245227	0.25	0.2	0.235597	15	33.329505	35	0.25		0	0.2	0							0	0	0	0	15.665741	0	35						NO	130.408935	116.007223	25.86256	0	0.15777	0.15777	0.15777	39.44255	0.191	0.197213	0.193448	0.197213	0.15777	0.185851	11.832765	26.292013	27.609785	0.197213		0	0.15777	0							0	0	0	0	12.357935	0	27.609785							16.3766	0.740700502	1.567623908	0	1.722475432	1.887360701	0.742309743	1.468522494	9.369308843	3.19320683	3.67535937	1.03909459	0.056534513	4.494675224	3.850771855	8.467254196	0.273789872	0.68988105	0	0	4.081855574	0	0	0	0	0	0	0	0	0	0	0	0.366522206	0	1.035439862	0	0	0	0	0	65.0993	0	20.3831584	16.3766	0.740700502	1.567623908	0	1.722475432	1.887360701	0.742309743	1.468522494	9.369308843	3.19320683	3.67535937	1.03909459	0.056534513	4.494675224	3.850771855	8.467254196	0.273789872	0.68988105	0	0	4.081855574	0	0	0	0	0	0	0	0	0	0	0	0.366522206	0	1.035439862	0	0	0	0	0	65.0993	YES						20% Coins																									20% Coins	$0/Visit									3400						1.2385																									0	0									1.2385	0	0.226312471	16.3766	0.740700502	1.567623908	0	1.722475432	3.12587283	0.742309743	1.468522494	9.369308843	3.19320683	3.67535937	1.03909459	0.056534513	4.494675224	3.850771855	8.467254196	0.273789872	0.68988105	0	0	4.081855574	0	0	0	0	0	0	0	0	0	0	0	0.366522206	0	1.035439862	0	0	0	0	0	66.3378
H2944_044_0	2011	6	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	O							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1329.925944	78.679824	571.698693	808.754225	9.711138	11.249523	6.1588	466.05384	44.599158	18.092078	17.38588	4.438443	0.175685	27.573269	3381.805436	3252.740629	132.609703	3.616204		1540.570343	22.124699	0							3.7	0.6	1808.887563	267.637602	372.363769	0	536.814405							$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$20/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$20-$40/Visit:7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$40/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $40 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$40/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	45.243839	0	0.2	0.2	0.2	50	0.242254	0.25	0.247498	0.25	0.2	0.236729	20	38.533967	40	0.25		0	0.2	0							0	0	0	0	7.344983	0	40						NO	150.763332	129.074451	38.07717	0	0.184195	0.184195	0.184195	46.04865	0.223109	0.230243	0.227939	0.230243	0.184195	0.218021	18.41946	35.488743	36.83892	0.230243		0	0.184195	0							0	0	0	0	6.764531	0	36.83892							16.7087	0.846296257	1.814055694	0	1.788743064	2.072105889	1.134420166	1.78842918	9.950473542	4.165574315	3.962920101	1.021920432	0.032360299	6.011551681	5.190919163	9.619639686	0.407099853	0.832605658	0	0	4.075258932	0	0	0	0	0	0	0	0	0	0	0	0.209905522	0	1.64797191	0	0	0	0	0	73.2809	0	6.239762012	16.7087	0.846296257	1.814055694	0	1.788743064	2.072105889	1.134420166	1.78842918	9.950473542	4.165574315	3.962920101	1.021920432	0.032360299	6.011551681	5.190919163	9.619639686	0.407099853	0.832605658	0	0	4.075258932	0	0	0	0	0	0	0	0	0	0	0	0.209905522	0	1.64797191	0	0	0	0	0	73.2809	YES						20% Coins																									20% Coins	$0/Visit									6000						1.2819																									0	0									1.2819	0	0.095617271	16.7087	0.846296257	1.814055694	0	1.788743064	3.353981218	1.134420166	1.78842918	9.950473542	4.165574315	3.962920101	1.021920432	0.032360299	6.011551681	5.190919163	9.619639686	0.407099853	0.832605658	0	0	4.075258932	0	0	0	0	0	0	0	0	0	0	0	0.209905522	0	1.64797191	0	0	0	0	0	74.5628
H2944_052_0	2011	8	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							Prosthetics/Supplies	Lab	Radiology	Therapy (PT/OT/ST)							D	D	D	V	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	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	1025.107195	66.782616	410.556966	395.462224	7.297399	11.071163	6.843887	317.342149	277.492567	0.699158	22.833475	8.843772	0.04134	34.445432	2745.495467	2758.906445	33.763187	3.54612		1214.893406	19.487038	0							5.21	0.49	851.802953	1901.670363	345.608534	594.652417								$250/Day(Days 1-7):1a.IP Acute	$250/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	0% Coins:8a.Lab -- FSL	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$30/Visit:7b. $15 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$100/Visit:8a.Lab -- OP	"$0-$30/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $30 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								179.655	153.80975	43.922851	0	0.2	0.2	0.2	50	125	0	0.24235	0.25	0.2	0.235263	15	28.481889	30	0.25		0	0.2	0							0	0	0	100	10.039902	30							NO	146.719927	125.612731	28.034462	0	0.164826	0.164826	0.164826	41.20645	103.016125	0	0.199727	0.206032	0.164826	0.193887	12.361935	23.472751	24.72387	0.206032		0	0.164826	0							0	0	0	82.4129	8.274174	24.72387								12.5336	0.699062232	0.959145305	0	1.202801088	1.824815513	1.128050519	1.08971195	2.382184081	0	4.560461461	1.822100033	0.006813907	6.678521474	2.828303042	5.396593668	0.069563054	0.730614196	0	0	3.211970525	0	0	0	0	0	0	0	0	0	0	13.06018079	0.238302096	1.225175754	0	0	0	0	0	0	61.648	0	13.6412682	12.5336	0.699062232	0.959145305	0	1.202801088	1.824815513	1.128050519	1.08971195	2.382184081	0	4.560461461	1.822100033	0.006813907	6.678521474	2.828303042	5.396593668	0.069563054	0.730614196	0	0	3.211970525	0	0	0	0	0	0	0	0	0	0	13.06018079	0.238302096	1.225175754	0	0	0	0	0	0	61.648	YES						20% Coins				0% Coins																															3400						1.1764				0																															1.1764	0	0.179271526	12.5336	0.699062232	0.959145305	0	1.202801088	3.001196786	1.128050519	1.08971195	2.382184081	0	4.560461461	1.822100033	0.006813907	6.678521474	2.828303042	5.396593668	0.069563054	0.730614196	0	0	3.211970525	0	0	0	0	0	0	0	0	0	0	13.06018079	0.238302096	1.225175754	0	0	0	0	0	0	62.8244
H2944_053_0	2011	6	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	NO	2437.925357	206.8541702	570.4432404	535.1944357	224.8029116	18.05249801	4.680433542	438.1106698	317.3751475	827.3346124	1354.222157	74.72799844	0.298279194	6.2195821	4013.568703	4958.475588	108.1181849	556.9468795		1062.628986	65.84400487	0							4.74	0.51	620.4771995	1126.144874	888.9932169									$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$125/Visit:8a.Lab -- OP	"$0-$125/Visit:8b, 9a. $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,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $125 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$125/Visit:7c, 7d, 7i. $125 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,3, 7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- CORF"									161.6895	138.428775	45.243839	0	100	0.2	0.2	50	98.897836	125	76.737188	125	0.2	0.2	15	34.631543	35	57.457066		0	0.2	0							0	0	0	0	108.563833								NO	125.33588	107.305003	26.780371	0	81.3244	0.162649	0.162649	40.6622	80.428072	101.6555	62.406057	101.6555	0.162649	0.162649	12.19866	28.163895	28.46354	46.726614		0	0.162649	0							0	0	0	0	88.288886									25.4633	1.849707279	1.273056801	0	1.523496825	2.936220749	0.761267835	1.484545307	2.127155935	7.008592808	7.042638759	0.63304267	0.048514813	1.011608809	4.080013333	11.63749882	0.25645219	2.168686821	0	0	10.70946155	0	0	0	0	0	0	0	0	0	0	0	6.540685065	0	0	0	0	0	0	0	88.5559	0	22.57149591	25.4633	1.849707279	1.273056801	0	1.523496825	2.936220749	0.761267835	1.484545307	2.127155935	7.008592808	7.042638759	0.63304267	0.048514813	1.011608809	4.080013333	11.63749882	0.25645219	2.168686821	0	0	10.70946155	0	0	0	0	0	0	0	0	0	0	0	6.540685065	0	0	0	0	0	0	0	88.5559	YES				$0/Visit		20% Coins	20% Coins																									$0/Visit									5000				0		2.0928	0.5426																									0									2.6354	0	0.148202946	25.4633	1.849707279	1.273056801	0	1.523496825	5.029041062	1.303868961	1.484545307	2.127155935	7.008592808	7.042638759	0.63304267	0.048514813	1.011608809	4.080013333	11.63749882	0.25645219	2.168686821	0	0	10.70946155	0	0	0	0	0	0	0	0	0	0	0	6.540685065	0	0	0	0	0	0	0	91.1914
H2944_065_0	2011	7	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	O							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1243.183238	56.948969	744.913175	317.855929	7.981603	7.358715	3.71785	373.427617	57.750141	19.296286	22.708247	6.127343	0.233932	29.622129	3263.097194	3792.684496	111.899775	3.646438		2235.199582	26.766224	0							6.04	0.6	776.400972	699.616979	376.055771	0	501.713052							$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	45.243839	0	0.2	0.2	0.2	50	0.244449	0.25	0.247976	0.25	0.2	0.235083	15	32.82716	35	0.25		0	0.2	0							0	0	0	0	20.031785	0	35						NO	144.96644	124.111502	32.666595	0	0.177388	0.177388	0.177388	44.3469	0.216811	0.221735	0.219939	0.221735	0.177388	0.208504	13.30407	29.115655	31.04283	0.221735		0	0.177388	0							0	0	0	0	17.766951	0	31.04283							15.0183	0.58900184	2.02781475	0	1.415840593	1.305347736	0.659501976	1.380029766	12.52086582	4.278661976	4.994429137	1.3586464	0.04149673	6.176332385	3.617706124	9.202207776	0.289473808	0.80854293	0	0	4.748006943	0	0	0	0	0	0	0	0	0	0	0	0.556780371	0	1.297882749	0	0	0	0	0	72.2869	0	9.54788098	15.0183	0.58900184	2.02781475	0	1.415840593	1.305347736	0.659501976	1.380029766	12.52086582	4.278661976	4.994429137	1.3586464	0.04149673	6.176332385	3.617706124	9.202207776	0.289473808	0.80854293	0	0	4.748006943	0	0	0	0	0	0	0	0	0	0	0	0.556780371	0	1.297882749	0	0	0	0	0	72.2869	YES						20% Coins																									20% Coins	$0/Visit									5000						0.8211																									0	0									0.8211	0	0.079918371	15.0183	0.58900184	2.02781475	0	1.415840593	2.126496766	0.659501976	1.380029766	12.52086582	4.278661976	4.994429137	1.3586464	0.04149673	6.176332385	3.617706124	9.202207776	0.289473808	0.80854293	0	0	4.748006943	0	0	0	0	0	0	0	0	0	0	0	0.556780371	0	1.297882749	0	0	0	0	0	73.108
H2944_071_0	2011	6	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1328.894858	49.918217	311.762976	251.791916	9.483615	19.665323	4.846337	377.699162	43.596508	13.237175	19.408274	8.050437	0	19.837267	2953.352604	3228.747075	69.626809	1.900744		980.293272	20.748808	0							3.43	0.49	1167.364516	177.83243	370.566603	0	787.007676							$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	43.922851	0	0.2	0.2	0.2	50	0.239219	0.25	0.241496	0.25	0	0.231167	15	33.867628	35	0.25		0	0.2	0							0	0	0	0	14.632715	0	35						NO	131.659233	112.718675	28.942699	0	0.165378	0.165378	0.165378	41.3446	0.197808	0.206723	0.199691	0.206723	0	0.19115	12.40338	28.00487	28.94122	0.206723		0	0.165378	0							0	0	0	0	12.099675	0	28.94122							14.5801	0.46889294	0.751938498	0	1.568381281	3.252211787	0.80147752	1.301318398	8.623738054	2.736428528	3.875657643	1.664210488	0	3.791893587	3.052629552	7.535053508	0.167923733	0.392927502	0	0	3.431396369	0	0	0	0	0	0	0	0	0	0	0	0.373644622	0	1.898080191	0	0	0	0	0	60.2679	0	13.13079455	14.5801	0.46889294	0.751938498	0	1.568381281	3.252211787	0.80147752	1.301318398	8.623738054	2.736428528	3.875657643	1.664210488	0	3.791893587	3.052629552	7.535053508	0.167923733	0.392927502	0	0	3.431396369	0	0	0	0	0	0	0	0	0	0	0	0.373644622	0	1.898080191	0	0	0	0	0	60.2679	YES						20% Coins																										$0/Visit									3400						2.0849																										0									2.0849	0	0.323131794	14.5801	0.46889294	0.751938498	0	1.568381281	5.337078993	0.80147752	1.301318398	8.623738054	2.736428528	3.875657643	1.664210488	0	3.791893587	3.052629552	7.535053508	0.167923733	0.392927502	0	0	3.431396369	0	0	0	0	0	0	0	0	0	0	0	0.373644622	0	1.898080191	0	0	0	0	0	62.3528
H2944_073_0	2011	5	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin							O	O	O	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	NO	307.06343	5.972964	43.617609	514.265344	10.396284	12.570703	6.19654	432.37429	64.807757	1.806574	28.279416	6.630333	0.266945	26.293688	36.233824	52.750782	0.923506	6.606449		1832.59536	25.001221	0							4.29	0.56	1835.737397	13.910587	188.508506									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	0% Coins:8a.Lab -- FSL	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"20% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	20% Coins:8a.Lab -- OP	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"									0.073	0.073	0.148853	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	0.2	0							0	0	0	0.2	0								NO	0.059909	0.059909	0.067671	0	0.168285	0.168285	0.168285	42.07115	0.168285	0	0.168285	0.168285	0.168285	0.168285	0.168285	0.168285	0.168285	0.168285		0	0.168285	0							0	0	0	0.168285	0									18.3959	0.3578343	2.951647219	0	1.749538653	2.115460754	1.042784734	1.515873634	10.90617339	0	4.759001522	1.115785589	0.044922839	4.424833285	6.097609072	8.877165349	0.155412207	1.11176627	0	0	4.207330476	0	0	0	0	0	0	0	0	0	0	2.340943133	0	0	0	0	0	0	0	0	72.1699	0	17.14967548	18.3959	0.3578343	2.951647219	0	1.749538653	2.115460754	1.042784734	1.515873634	10.90617339	0	4.759001522	1.115785589	0.044922839	4.424833285	6.097609072	8.877165349	0.155412207	1.11176627	0	0	4.207330476	0	0	0	0	0	0	0	0	0	0	2.340943133	0	0	0	0	0	0	0	0	72.1699	YES						20% Coins				0% Coins																															4500						1.5067				0																															1.5067	0	0.032581724	18.3959	0.3578343	2.951647219	0	1.749538653	3.62214883	1.042784734	1.515873634	10.90617339	0	4.759001522	1.115785589	0.044922839	4.424833285	6.097609072	8.877165349	0.155412207	1.11176627	0	0	4.207330476	0	0	0	0	0	0	0	0	0	0	2.340943133	0	0	0	0	0	0	0	0	73.6766
H2944_078_0	2011	7	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1582.750226	74.197363	713.034166	820.286957	217.834515	11.661434	5.676944	491.728291	41.012265	11.51641	14.458437	3.964882	0.27328	25.231735	3983.01863	3306.543513	185.966023	2.036265		1960.367197	23.671948	0							3.72	0.56	2605.133054	462.254559	293.760596	0	416.96876							$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.243802	0.25	0.245634	0.25	0.2	0.22903	15	34.277044	35	0.25		0	0.2	0							0	0	0	0	30.825428	0	35						NO	157.18158	137.465914	28.771768	0	140.8446	0.187793	0.187793	46.9482	0.228921	0.234741	0.230641	0.234741	0.187793	0.215051	14.08446	32.18491	32.86374	0.234741		0	0.187793	0							0	0	0	0	28.943968	0	32.86374							20.7316	0.84996736	1.709604467	0	2.556734594	2.189935675	1.066090345	1.923813179	9.388568716	2.7033736	3.334708368	0.930720366	0.051320071	5.426109843	4.674888881	8.868400448	0.509294919	0.477994882	0	0	4.445426131	0	0	0	0	0	0	0	0	0	0	0	0.708549774	0	1.14192941	0	0	0	0	0	73.689	0	4.701975817	20.7316	0.84996736	1.709604467	0	2.556734594	2.189935675	1.066090345	1.923813179	9.388568716	2.7033736	3.334708368	0.930720366	0.051320071	5.426109843	4.674888881	8.868400448	0.509294919	0.477994882	0	0	4.445426131	0	0	0	0	0	0	0	0	0	0	0	0.708549774	0	1.14192941	0	0	0	0	0	73.689	YES						20% Coins																										$0/Visit									6700						1.3531																										0									1.3531	0	0.074854988	20.7316	0.84996736	1.709604467	0	2.556734594	3.543011487	1.066090345	1.923813179	9.388568716	2.7033736	3.334708368	0.930720366	0.051320071	5.426109843	4.674888881	8.868400448	0.509294919	0.477994882	0	0	4.445426131	0	0	0	0	0	0	0	0	0	0	0	0.708549774	0	1.14192941	0	0	0	0	0	75.0421
H2944_085_0	2011	6	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	1476.084555	86.356018	443.688992	1973.523532	6.596235	11.586648	6.409187	423.565986	36.105899	7.897734	14.275476	7.046892	0.056972	25.150037	3197.387559	3039.968438	62.83844	3.065567		1884.594176	15.438657	0							3.85	0.73	2854.364482	393.161432	327.905561	0	0	427.071036						$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						161.6895	138.428775	66.51235	0	0.2	0.2	0.2	50	0.237343	0.25	0.240552	0.25	0.2	0.225056	15	35	35	0.25		0	0.2	0							0	0	0	0	19.199682	0	0	15					NO	148.552552	127.181714	51.463	0	0.182892	0.182892	0.182892	45.72295	0.217041	0.228615	0.219975	0.228615	0.182892	0.205804	13.716885	32.006065	32.006065	0.228615		0	0.182892	0							0	0	0	0	17.557322	0	0	13.716885						18.273	0.915242199	1.902797216	0	1.206398612	2.119105226	1.172189029	1.613890533	7.836460425	1.805540458	3.140247833	1.611025215	0.010419723	5.175978215	3.654849787	8.108118952	0.167600933	0.7008346	0	0	2.823606856	0	0	0	0	0	0	0	0	0	0	0	0.47976196	0	0	0.488173691	0	0	0	0	63.2053	0	6.192786827	18.273	0.915242199	1.902797216	0	1.206398612	2.119105226	1.172189029	1.613890533	7.836460425	1.805540458	3.140247833	1.611025215	0.010419723	5.175978215	3.654849787	8.108118952	0.167600933	0.7008346	0	0	2.823606856	0	0	0	0	0	0	0	0	0	0	0	0.47976196	0	0	0.488173691	0	0	0	0	63.2053	YES	$195/Day(Days 1-7)	$195/Day(Days 1-7)	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins										20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					5000	0	0	0	0	0	1.3077	0	0	0	0	0	0	0	0	0	0	0	0		0	0										0	0	0	0	0	0					1.3077	0	0.111118317	18.273	0.915242199	1.902797216	0	1.206398612	3.426760109	1.172189029	1.613890533	7.836460425	1.805540458	3.140247833	1.611025215	0.010419723	5.175978215	3.654849787	8.108118952	0.167600933	0.7008346	0	0	2.823606856	0	0	0	0	0	0	0	0	0	0	0	0.47976196	0	0	0.488173691	0	0	0	0	64.5129
H2944_090_0	2011	6	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	1701.104671	86.901859	673.009378	1050.476383	11.774913	15.374745	7.242752	390.490902	44.999009	9.353346	14.576607	5.374213	0.176126	23.12184	4423.305708	3981.779136	145.41218	2.542658		2148.508254	26.639496	0							4.23	0.58	1683.33274	555.636033	435.911378	0	0	426.847485						$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						147.067245	128.620245	34.44565	0	0.2	0.2	0.2	50	0.23796	0.25	0.246471	0.25	0.2	0.230367	15	35	35	0.25		0	0.2	0							0	0	0	0	22.120741	0	0	15					NO	130.855581	114.44205	25.827486	0	0.176744	0.176744	0.176744	44.186	0.21029	0.22093	0.217812	0.22093	0.176744	0.20358	13.2558	30.9302	30.9302	0.22093		0	0.176744	0							0	0	0	0	19.548541	0	0	13.2558						18.5499	0.828768908	1.448511691	0	2.081145223	2.71739393	1.280112959	1.437852583	9.462841603	2.066434732	3.174959924	1.187324878	0.031129214	4.707144187	4.88620465	10.26310209	0.374802317	0.561749432	0	0	4.708371081	0	0	0	0	0	0	0	0	0	0	0	0.710119287	0	0	0.471517074	0	0	0	0	70.9494	0	9.479246869	18.5499	0.828768908	1.448511691	0	2.081145223	2.71739393	1.280112959	1.437852583	9.462841603	2.066434732	3.174959924	1.187324878	0.031129214	4.707144187	4.88620465	10.26310209	0.374802317	0.561749432	0	0	4.708371081	0	0	0	0	0	0	0	0	0	0	0	0.710119287	0	0	0.471517074	0	0	0	0	70.9494	YES	$195/Day(Days 1-8)	$195/Day(Days 1-8)	$0/Day(Days 1-7) $50(Days 8-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins										20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					5000	0	0	0	0	0	1.8611	0	0	0	0	0	0	0	0	0	0	0	0		0	0										0	0	0	0	0	0					1.8611	0	0.021546607	18.5499	0.828768908	1.448511691	0	2.081145223	4.578469124	1.280112959	1.437852583	9.462841603	2.066434732	3.174959924	1.187324878	0.031129214	4.707144187	4.88620465	10.26310209	0.374802317	0.561749432	0	0	4.708371081	0	0	0	0	0	0	0	0	0	0	0	0.710119287	0	0	0.471517074	0	0	0	0	72.8105
H2944_106_0	2011	6	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1326.847186	103.7789065	650.2621816	413.1050255	271.3295009	6.848821865	2.424502191	657.5733056	51.61714035	24.77967105	21.63683586	4.781632229	0	61.15640181	3021.563553	3734.156355	336.9633243	4.569402245		1826.519186	8.360557606	0							4.29	0.56	994.7778999	539.547116	279.6410608	0	539.2274355							$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$40/Visit:7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$40/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.245073	0.25	0.24756	0.25	0	0.222874	15	37.989729	40	0.25		0	0.2	0							0	0	0	0	17.323521	0	40						NO	154.604479	135.212066	28.092532	0	137.5128	0.18335	0.18335	45.8376	0.224671	0.229188	0.226951	0.229188	0	0.20432	13.75128	34.82716	36.67008	0.229188		0	0.18335	0							0	0	0	0	15.881372	0	36.67008							17.0947	1.169346696	1.522292596	0	3.109273283	1.255731489	0.444532477	2.511798513	11.59687454	5.679203247	4.910501534	1.095892727	0	12.49547602	3.462530538	10.83750507	1.029706005	1.047252162	0	0	1.532908237	0	0	0	0	0	0	0	0	0	0	0	0.370090309	0	1.647792767	0	0	0	0	0	82.8134	0	7.303089387	17.0947	1.169346696	1.522292596	0	3.109273283	1.255731489	0.444532477	2.511798513	11.59687454	5.679203247	4.910501534	1.095892727	0	12.49547602	3.462530538	10.83750507	1.029706005	1.047252162	0	0	1.532908237	0	0	0	0	0	0	0	0	0	0	0	0.370090309	0	1.647792767	0	0	0	0	0	82.8134	YES						20% Coins																										$0/Visit									6700						0.8347																										0									0.8347	0	0.003979305	17.0947	1.169346696	1.522292596	0	3.109273283	2.09038329	0.444532477	2.511798513	11.59687454	5.679203247	4.910501534	1.095892727	0	12.49547602	3.462530538	10.83750507	1.029706005	1.047252162	0	0	1.532908237	0	0	0	0	0	0	0	0	0	0	0	0.370090309	0	1.647792767	0	0	0	0	0	83.6481
H2944_114_0	2011	6	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	1484.004778	90.965362	487.053358	526.906783	9.808974	12.879489	6.856544	412.496024	45.4901	11.373773	15.249904	6.676176	0.674483	23.234005	3681.501309	4040.006519	76.849317	2.237833		1657.055361	28.245896	0							3.9	0.41	2007.396517	597.444756	382.771758	0	0	452.604575						$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						147.067245	128.620245	34.44565	0	0.2	0.2	0.2	50	0.240934	0.25	0.239875	0.25	0.2	0.228328	15	35	35	0.25		0	0.2	0							0	0	0	0	19.619056	0	0	15					NO	137.325217	120.100183	29.921627	0	0.18411	0.18411	0.18411	46.02745	0.221792	0.230137	0.220816	0.230137	0.18411	0.210187	13.808235	32.219215	32.219215	0.230137		0	0.18411	0							0	0	0	0	18.060303	0	0	13.808235						16.9826	0.910413052	1.214452409	0	1.805930203	2.37124272	1.262358316	1.582178343	10.08934026	2.617525997	3.367422802	1.536435116	0.124179065	4.883485809	4.236252936	10.84715322	0.206335389	0.515008173	0	0	5.200351913	0	0	0	0	0	0	0	0	0	0	0	0.576081161	0	0	0.520805861	0	0	0	0	70.8496	0	5.918742471	16.9826	0.910413052	1.214452409	0	1.805930203	2.37124272	1.262358316	1.582178343	10.08934026	2.617525997	3.367422802	1.536435116	0.124179065	4.883485809	4.236252936	10.84715322	0.206335389	0.515008173	0	0	5.200351913	0	0	0	0	0	0	0	0	0	0	0	0.576081161	0	0	0.520805861	0	0	0	0	70.8496	YES	$195/Day(Days 1-8)	$195/Day(Days 1-8)	$0/Day(Days 1-7) $50(Days 8-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins										20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					5900	0	0	0	0	0	1.5624	0	0	0	0	0	0	0	0	0	0	0	0		0	0										0	0	0	0	0	0					1.5624	0	0.014630573	16.9826	0.910413052	1.214452409	0	1.805930203	3.933692347	1.262358316	1.582178343	10.08934026	2.617525997	3.367422802	1.536435116	0.124179065	4.883485809	4.236252936	10.84715322	0.206335389	0.515008173	0	0	5.200351913	0	0	0	0	0	0	0	0	0	0	0	0.576081161	0	0	0.520805861	0	0	0	0	72.412
H2944_124_0	2011	4	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1422.711983	72.036573	983.852335	645.423157	198.131362	11.589856	5.162414	427.360744	48.039423	14.023032	16.886072	8.102987	0.287108	23.309387	3500.592448	3479.899521	115.552922	2.481625		1534.937178	28.56862	0							4.9	0.56	1519.340434	1141.766551	369.917587	0	302.255316							$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.241444	0.25	0.246097	0.25	0.2	0.230301	15	33.94477	35	0.25		0	0.2	0							0	0	0	0	34.631501	0	35						NO	156.446379	136.822932	27.839573	0	140.11755	0.186823	0.186823	46.70585	0.225537	0.233529	0.229883	0.233529	0.186823	0.215128	14.011755	31.708387	32.694095	0.233529		0	0.186823	0							0	0	0	0	32.349873	0	32.694095							18.5482	0.821354594	2.282502408	0	2.313473418	2.165251667	0.964457671	1.6633539	10.83466735	3.27478464	3.88182089	1.892282451	0.053638378	5.014501807	4.087453645	9.195166728	0.314824851	0.579531405	0	0	5.337275294	0	0	0	0	0	0	0	0	0	0	0	0.997232247	0	0.823497001	0	0	0	0	0	75.0452	0	5.327034091	18.5482	0.821354594	2.282502408	0	2.313473418	2.165251667	0.964457671	1.6633539	10.83466735	3.27478464	3.88182089	1.892282451	0.053638378	5.014501807	4.087453645	9.195166728	0.314824851	0.579531405	0	0	5.337275294	0	0	0	0	0	0	0	0	0	0	0	0.997232247	0	0.823497001	0	0	0	0	0	75.0452	YES						20% Coins																										0% Coins									6700						1.3465																										0									1.3465	0	0.072651375	18.5482	0.821354594	2.282502408	0	2.313473418	3.511766492	0.964457671	1.6633539	10.83466735	3.27478464	3.88182089	1.892282451	0.053638378	5.014501807	4.087453645	9.195166728	0.314824851	0.579531405	0	0	5.337275294	0	0	0	0	0	0	0	0	0	0	0	0.997232247	0	0.823497001	0	0	0	0	0	76.3918
H2944_125_0	2011	4	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1546.60891	50.038208	1149.912082	756.438857	221.95483	14.744856	5.679745	442.848884	60.043913	15.126214	19.475493	9.896694	1.25224	23.094882	3421.683748	3627.622845	117.418052	2.820655		1595.079067	33.061928	0							4.9	0.56	1594.868967	901.305996	356.629162	0	277.956121							$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.242202	0.25	0.246851	0.25	0.2	0.235144	15	34.190623	35	0.25		0	0.2	0							0	0	0	0	37.782983	0	35						NO	153.98924	134.673998	26.274557	0	137.89575	0.183861	0.183861	45.96525	0.222658	0.229826	0.226931	0.229826	0.183861	0.216169	13.789575	31.431611	32.175675	0.229826		0	0.183861	0							0	0	0	0	34.734085	0	32.175675							19.8468	0.56157046	2.517785879	0	2.550552312	2.711003969	1.044283595	1.696304972	13.36925758	3.476397259	4.419593102	2.274517595	0.230238099	4.992397547	3.931963722	9.501835843	0.314833757	0.648259856	0	0	6.078799144	0	0	0	0	0	0	0	0	0	0	0	1.032265636	0	0.745285484	0	0	0	0	0	81.9439	0	7.365457509	19.8468	0.56157046	2.517785879	0	2.550552312	2.711003969	1.044283595	1.696304972	13.36925758	3.476397259	4.419593102	2.274517595	0.230238099	4.992397547	3.931963722	9.501835843	0.314833757	0.648259856	0	0	6.078799144	0	0	0	0	0	0	0	0	0	0	0	1.032265636	0	0.745285484	0	0	0	0	0	81.9439	YES						20% Coins																										0% Coins									6700						1.6851																										0									1.6851	0	0.120373997	19.8468	0.56157046	2.517785879	0	2.550552312	4.396122572	1.044283595	1.696304972	13.36925758	3.476397259	4.419593102	2.274517595	0.230238099	4.992397547	3.931963722	9.501835843	0.314833757	0.648259856	0	0	6.078799144	0	0	0	0	0	0	0	0	0	0	0	1.032265636	0	0.745285484	0	0	0	0	0	83.629
H2944_127_0	2011	7	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1828.766157	102.940674	607.135437	1305.469957	261.215974	14.217634	5.340231	460.618144	50.449527	11.043729	17.272887	10.022275	0.333565	21.725974	3914.14973	3576.210524	125.034214	2.266054		1568.556651	24.186525	0							4.85	0.56	1901.052088	1066.880274	334.005604	0	283.703356							$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$40/Visit:7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$40/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.24363	0.25	0.243536	0.25	0.2	0.232583	15	39.194578	40	0.25		0	0.2	0							0	0	0	0	43.386946	0	40						NO	154.669686	135.269094	27.942144	0	138.4488	0.184598	0.184598	46.1496	0.224868	0.230748	0.224782	0.230748	0.184598	0.214672	13.84488	36.176282	36.91968	0.230748		0	0.184598	0							0	0	0	0	40.045804	0	36.91968							23.5712	1.160390976	1.413722151	0	3.013753178	2.624546801	0.985795962	1.771445258	11.34448424	2.548318379	3.882634086	2.312619912	0.061575432	4.663958291	4.515911109	10.7811667	0.384685264	0.522887428	0	0	4.464784142	0	0	0	0	0	0	0	0	0	0	0	1.114626913	0	0.872853093	0	0	0	0	0	82.0114	0	6.694594273	23.5712	1.160390976	1.413722151	0	3.013753178	2.624546801	0.985795962	1.771445258	11.34448424	2.548318379	3.882634086	2.312619912	0.061575432	4.663958291	4.515911109	10.7811667	0.384685264	0.522887428	0	0	4.464784142	0	0	0	0	0	0	0	0	0	0	0	1.114626913	0	0.872853093	0	0	0	0	0	82.0114	YES						20% Coins				0% Coins																						0% Coins									6700						1.6341				0																						0									1.6341	0	0.10682897	23.5712	1.160390976	1.413722151	0	3.013753178	4.258652431	0.985795962	1.771445258	11.34448424	2.548318379	3.882634086	2.312619912	0.061575432	4.663958291	4.515911109	10.7811667	0.384685264	0.522887428	0	0	4.464784142	0	0	0	0	0	0	0	0	0	0	0	1.114626913	0	0.872853093	0	0	0	0	0	83.6455
H2944_128_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1948.740099	109.69397	646.965806	1391.113699	278.352725	16.246888	6.102429	490.836427	57.650087	12.619978	19.738212	11.452734	0.381173	24.82688	4170.932681	3810.823392	133.236929	2.589483		1671.45987	27.638619	0							4.85	0.56	2025.768259	1136.871634	355.917629	0	302.315363							$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.24363	0.25	0.243536	0.25	0.2	0.232583	15	34.355662	35	0.25		0	0.2	0							0	0	0	0	43.386946	0	35						NO	152.677958	133.527193	27.030144	0	136.73505	0.182313	0.182313	45.57835	0.222085	0.227892	0.221999	0.227892	0.182313	0.212015	13.673505	31.317488	31.904845	0.227892		0	0.182313	0							0	0	0	0	39.550108	0	31.904845							24.7941	1.220593992	1.457298242	0	3.171714481	2.962018892	1.112552138	1.864292872	12.80321957	2.875992026	4.381863326	2.609986457	0.069492793	5.263670963	4.752605739	9.945451321	0.354241964	0.59012246	0	0	5.038879546	0	0	0	0	0	0	0	0	0	0	0	1.173048389	0	0.803777066	0	0	0	0	0	87.245	0	8.354161213	24.7941	1.220593992	1.457298242	0	3.171714481	2.962018892	1.112552138	1.864292872	12.80321957	2.875992026	4.381863326	2.609986457	0.069492793	5.263670963	4.752605739	9.945451321	0.354241964	0.59012246	0	0	5.038879546	0	0	0	0	0	0	0	0	0	0	0	1.173048389	0	0.803777066	0	0	0	0	0	87.245	YES						20% Coins				0% Coins																						0% Coins									6700						1.8377				0																						0									1.8377	0	0.151676963	24.7941	1.220593992	1.457298242	0	3.171714481	4.799756729	1.112552138	1.864292872	12.80321957	2.875992026	4.381863326	2.609986457	0.069492793	5.263670963	4.752605739	9.945451321	0.354241964	0.59012246	0	0	5.038879546	0	0	0	0	0	0	0	0	0	0	0	1.173048389	0	0.803777066	0	0	0	0	0	89.0827
H2944_133_0	2011	6	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	1374.511974	89.343118	599.323007	706.961949	9.487689	14.787754	6.63686	444.842416	42.795672	10.250731	14.883827	9.026488	0.222953	20.537356	4306.415841	3416.976928	97.862581	2.857198		2113.888591	21.089592	0							4.38	0.41	2822.951754	369.128297	394.424099	0	0	307.612296						$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						147.067245	128.620245	34.44565	0	0.2	0.2	0.2	50	0.243318	0.25	0.246927	0.25	0.2	0.229949	15	35	35	0.25		0	0.2	0							0	0	0	0	19.895368	0	0	15					NO	138.569258	121.188181	30.169395	0	0.186113	0.186113	0.186113	46.52815	0.226423	0.232641	0.229781	0.232641	0.186113	0.213982	13.958445	32.569705	32.569705	0.232641		0	0.186113	0							0	0	0	0	18.513894	0	0	13.958445						15.8721	0.902277496	1.506767711	0	1.765782263	2.75219326	1.235205925	1.724807888	9.689924441	2.384740311	3.420020652	2.099931195	0.041494452	4.394624512	5.009239055	9.274160878	0.265612949	0.6647014	0	0	3.925047236	0	0	0	0	0	0	0	0	0	0	0	0.608527163	0	0	0.357815776	0	0	0	0	67.895	0	4.944381666	15.8721	0.902277496	1.506767711	0	1.765782263	2.75219326	1.235205925	1.724807888	9.689924441	2.384740311	3.420020652	2.099931195	0.041494452	4.394624512	5.009239055	9.274160878	0.265612949	0.6647014	0	0	3.925047236	0	0	0	0	0	0	0	0	0	0	0	0.608527163	0	0	0.357815776	0	0	0	0	67.895	YES	$195/Day(Days 1-8)	$195/Day(Days 1-8)	$0/Day(Days 1-7) $50(Days 8-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins										20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					5900	0	0	0	0	0	1.6769	0	0	0	0	0	0	0	0	0	0	0	0		0	0										0	0	0	0	0	0					1.6769	0	0.133803206	15.8721	0.902277496	1.506767711	0	1.765782263	4.429135254	1.235205925	1.724807888	9.689924441	2.384740311	3.420020652	2.099931195	0.041494452	4.394624512	5.009239055	9.274160878	0.265612949	0.6647014	0	0	3.925047236	0	0	0	0	0	0	0	0	0	0	0	0.608527163	0	0	0.357815776	0	0	0	0	69.5719
H2944_137_0	2011	4	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	1460.45532	91.029417	635.427287	440.724248	9.869167	14.328218	6.747836	450.048576	42.860566	9.914401	14.650061	8.906538	0.207024	20.130055	4424.753401	3594.334615	94.386683	2.578092		2120.508134	21.053533	0							4.38	0.41	2966.138428	499.661462	412.367962	0	0	337.961586						$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						147.067245	128.620245	34.44565	0	0.2	0.2	0.2	50	0.244015	0.25	0.246247	0.25	0.2	0.229197	15	35	35	0.25		0	0.2	0							0	0	0	0	20.618816	0	0	15					NO	137.683619	120.41363	29.592396	0	0.184945	0.184945	0.184945	46.2362	0.225646	0.231181	0.22771	0.231181	0.184945	0.211944	13.87086	32.36534	32.36534	0.231181		0	0.184945	0							0	0	0	0	19.066714	0	0	13.87086						16.7567	0.913431878	1.566984659	0	1.825253091	2.649932278	1.247978529	1.734044664	9.671315276	2.292021138	3.33596539	2.059022361	0.038288054	4.266444377	5.11459458	9.694321824	0.254571424	0.596005887	0	0	3.893745661	0	0	0	0	0	0	0	0	0	0	0	0.6552085	0	0	0.390651487	0	0	0	0	68.9565	0	5.50861785	16.7567	0.913431878	1.566984659	0	1.825253091	2.649932278	1.247978529	1.734044664	9.671315276	2.292021138	3.33596539	2.059022361	0.038288054	4.266444377	5.11459458	9.694321824	0.254571424	0.596005887	0	0	3.893745661	0	0	0	0	0	0	0	0	0	0	0	0.6552085	0	0	0.390651487	0	0	0	0	68.9565	YES	$195/Day(Days 1-8)	$195/Day(Days 1-8)	$0/Day(Days 1-7) $50(Days 8-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins										20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					5900	0	0	0	0	0	1.732	0	0	0	0	0	0	0	0	0	0	0	0		0	0										0	0	0	0	0	0					1.732	0	0.022469569	16.7567	0.913431878	1.566984659	0	1.825253091	4.381938309	1.247978529	1.734044664	9.671315276	2.292021138	3.33596539	2.059022361	0.038288054	4.266444377	5.11459458	9.694321824	0.254571424	0.596005887	0	0	3.893745661	0	0	0	0	0	0	0	0	0	0	0	0.6552085	0	0	0.390651487	0	0	0	0	70.6885
H2944_138_0	2011	7	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1621.584784	125.4986304	632.3983086	468.4279802	153.4706455	9.475018386	7.036923386	338.9033356	43.87375285	7.775790386	22.46621862	8.815538386	0.496386	19.66571523	3912.956365	5565.810961	105.5984672	2.087053731		1622.868783	31.74755881	0							3.32	0.58	1148.60919	748.4838397	416.534203	0	814.0010275							$255/Day(Days 1-7):1a.IP Acute	$255/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$35/Visit:7b. $25 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"20% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							183.2481	156.885945	34.44565	0	150	0.2	0.2	50	0.230772	0.25	0.222535	0.25	0.2	0.227352	15	34.628951	35	0.25		0	0.2	0							0	0	0	0	45.350256	0	35						NO	169.907822	145.464805	29.040335	0	137.6622	0.18355	0.18355	45.8874	0.21179	0.229437	0.204231	0.229437	0.18355	0.208652	13.76622	31.780651	32.12118	0.229437		0	0.18355	0							0	0	0	0	41.620107	0	32.12118							22.96	1.521302817	1.530421561	0	1.760592225	1.739139625	1.291627288	1.29594941	9.292022117	1.784054019	4.588298295	2.022610681	0.09111165	4.103290815	4.488884847	14.74042464	0.282662281	0.478847347	0	0	5.82726442	0	0	0	0	0	0	0	0	0	0	0	1.444683175	0	2.17888946	0	0	0	0	0	83.4221	0	7.352332808	22.96	1.521302817	1.530421561	0	1.760592225	1.739139625	1.291627288	1.29594941	9.292022117	1.784054019	4.588298295	2.022610681	0.09111165	4.103290815	4.488884847	14.74042464	0.282662281	0.478847347	0	0	5.82726442	0	0	0	0	0	0	0	0	0	0	0	1.444683175	0	2.17888946	0	0	0	0	0	83.4221	YES				$0/Visit		20% Coins																										$0/Visit									6700				0		1.15																										0									1.15	0	0.010256224	22.96	1.521302817	1.530421561	0	1.760592225	2.889089785	1.291627288	1.29594941	9.292022117	1.784054019	4.588298295	2.022610681	0.09111165	4.103290815	4.488884847	14.74042464	0.282662281	0.478847347	0	0	5.82726442	0	0	0	0	0	0	0	0	0	0	0	1.444683175	0	2.17888946	0	0	0	0	0	84.572
H2944_163_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Lab									Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin							O	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	NO	307.06343	5.972964	43.617609	514.265344	10.396284	12.570703	6.19654	432.37429	64.807757	1.806574	30.146021	6.630333	0.266945	26.293688	36.233824	52.750782	0.923506	6.606449		1832.59536	25.001221	0							4.29	0.56	1835.737397	13.910587										Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"$0/Visit:14b-j, 17a.Preventive Services"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	20% coinsurance after $155 plan year deductible										0.073	0.073	0.148853	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0							0	0	0	0.233									NO	0.065541	0.065541	0.094374	0	0.208771	0.208771	0.208771	44.80065	0.208771	0.208771	0.208771	0.208771	0.208771	0.208771	0.208771	0.208771	0.208771	0.208771		0	0.208771	0							0	0	0	0.208771										20.1252	0.391474034	4.116368232	0	2.170442607	2.624398236	1.293657852	1.61422077	13.52998024	0.377160261	6.29361495	1.384221251	0.055730375	5.489359537	7.56457167	11.01283351	0.192801271	1.379234964	0	0	5.219529909	0	0	0	0	0	0	0	0	0	0	2.904127159	0	0	0	0	0	0	0	0	87.739	0	12.03506755	20.1252	0.391474034	4.116368232	0	2.170442607	2.624398236	1.293657852	1.61422077	13.52998024	0.377160261	6.29361495	1.384221251	0.055730375	5.489359537	7.56457167	11.01283351	0.192801271	1.379234964	0	0	5.219529909	0	0	0	0	0	0	0	0	0	0	2.904127159	0	0	0	0	0	0	0	0	87.739	YES						20% coinsurance after $155 plan year deductible				20% coinsurance after $155 plan year deductible																															6700						1.7695				0.0565																															1.826	0	0.024518807	20.1252	0.391474034	4.116368232	0	2.170442607	4.393887	1.293657852	1.61422077	13.52998024	0.433628671	6.29361495	1.384221251	0.055730375	5.489359537	7.56457167	11.01283351	0.192801271	1.379234964	0	0	5.219529909	0	0	0	0	0	0	0	0	0	0	2.904127159	0	0	0	0	0	0	0	0	89.5649
H2944_166_0	2011	5	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	Lab	Radiology	Other		Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	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	1110.739771	125.91252	461.270664	191.052495	97.754005	7.450371	3.66131	321.508311	38.863729	14.237562	19.561513	6.179926	0.002924	33.100288	2786.953425	2605.484679	86.739425	3.30777		1714.569899	22.865684	0							4.62	0.48	828.895261	376.714214	271.657935	162.145757	0	293.250096						$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $50(Days 15-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$125/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9b.Surgery ASC -- Facility"	20% Coins:8a.Lab -- OP	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$35/Visit:5.Partial Hospitalization	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						161.6895	138.428775	23.1855	0	125	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	15	32.07334	35	0.2		0	0.2	0							0	0	0	0	18.619497	35	0	35					NO	152.634565	130.676487	20.813878	0	116.491875	0.186387	0.186387	46.59675	0.186387	0.186387	0.186387	0.186387	0.186387	0.186387	13.979025	29.890268	32.617725	0.186387		0	0.186387	0							0	0	0	0	17.352161	32.617725	0	32.617725						14.1281	1.371150482	0.800069277	0	0.948962278	1.3886523	0.682420587	1.248436866	7.243693857	2.653696468	3.646011724	1.151857867	0.000544996	6.169463379	3.2465743	6.489886277	0.235770226	0.616525327	0	0	4.261866244	0	0	0	0	0	0	0	0	0	0	0	0.392821019	0.440735476	0	0.797095916	0	0	0	0	57.9143	0	4.050048513	14.1281	1.371150482	0.800069277	0	0.948962278	1.3886523	0.682420587	1.248436866	7.243693857	2.653696468	3.646011724	1.151857867	0.000544996	6.169463379	3.2465743	6.489886277	0.235770226	0.616525327	0	0	4.261866244	0	0	0	0	0	0	0	0	0	0	0	0.392821019	0.440735476	0	0.797095916	0	0	0	0	57.9143	YES						30% Coins																									30% Coins	$0/Visit									5000						1.2108																									0	0									1.2108	0	0.157649255	14.1281	1.371150482	0.800069277	0	0.948962278	2.599438645	0.682420587	1.248436866	7.243693857	2.653696468	3.646011724	1.151857867	0.000544996	6.169463379	3.2465743	6.489886277	0.235770226	0.616525327	0	0	4.261866244	0	0	0	0	0	0	0	0	0	0	0	0.392821019	0.440735476	0	0.797095916	0	0	0	0	59.1251
H2944_169_0	2011	5	r.										OP Facility - Other										Lab										Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin							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	NO	311.624627	7.522083	37.015286	471.930044	6.793945	9.545856	8.931803	23.754751	64.963547	3.686141	36.386194	8.881446	0.500097	19.812739	46.213819	110.803639	1.09942	8.885047		7.188394	31.98491	0							4.63	0.58	7.833923											Medicare FFS Cost Sharing:1a.IP Acute	Medicare FFS Cost Sharing:1b.IP Psych	Medicare FFS Cost Sharing:2.SNF	$0/Visit:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% coinsurance after $155 plan year deductible											0.083003	0.083003	0.166836	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0							0	0	0.233										NO	0.071104	0.071104	0.097083	0	0.199719	0.199719	0.199719	0.199719	0.199719	0.199719	0.199719	0.199719	0.199719	0.199719	0.199719	0.199719	0.199719	0.199719		0.199719	0.199719	0							0	0	0.199719											22.1578	0.53485019	3.593555011	0	1.356879901	1.906488814	1.783850763	4.744275115	12.97445464	0.736192394	7.267014279	1.773793514	0.099878873	3.95698042	9.229777717	22.12959198	0.219575063	1.774512702	0	1.435658861	6.38799424	0	0	0	0	0	0	0	0	0	1.564583268	0	0	0	0	0	0	0	0	0	105.6277	0	19.60074061	22.1578	0.53485019	3.593555011	0	1.356879901	1.906488814	1.783850763	4.744275115	12.97445464	0.736192394	7.267014279	1.773793514	0.099878873	3.95698042	9.229777717	22.12959198	0.219575063	1.774512702	0	1.435658861	6.38799424	0	0	0	0	0	0	0	0	0	1.564583268	0	0	0	0	0	0	0	0	0	105.6277	YES				$0/Visit		20% coinsurance after $155 plan year deductible				20% coinsurance after $155 plan year deductible																															6700				0		1.3408				0.115																															1.4558	0	0.022687756	22.1578	0.53485019	3.593555011	0	1.356879901	3.247338493	1.783850763	4.744275115	12.97445464	0.851166246	7.267014279	1.773793514	0.099878873	3.95698042	9.229777717	22.12959198	0.219575063	1.774512702	0	1.435658861	6.38799424	0	0	0	0	0	0	0	0	0	1.564583268	0	0	0	0	0	0	0	0	0	107.0835
H2944_171_0	2011	5	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	Coin							O	O	O	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	1344.789022	46.77191	651.54415	398.467565	6.170516	9.511653	5.467117	284.716581	41.819484	14.963195	25.862764	15.005667	0.543011	23.819925	3388.566105	2981.553056	83.265521	3.455784		1881.619493	26.966704	0							1.42	0.48	996.904998	143.183443	373.857211	224.741209	0	404.937384						$250/Day(Days 1-7):1a.IP Acute	$250/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $50(Days 15-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,7h. 25% Psych -- OP,8b. 20% Rad therapy,3, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$35/Visit:5.Partial Hospitalization	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						179.655	153.80975	23.1855	0	0.2	0.2	0.2	50	0.240391	0.25	0.246343	0.25	0.2	0.238642	15	32.653294	35	0.25		0	0.2	0							0	0	0	0	17.350208	35	0	35					NO	168.279425	144.07067	20.348731	0	0.18495	0.18495	0.18495	46.2376	0.222302	0.231188	0.227806	0.231188	0.18495	0.220685	13.87128	30.196199	32.36632	0.231188		0	0.18495	0							0	0	0	0	16.044639	32.36632	0	32.36632						18.8584	0.561538368	1.104841387	0	1.141236934	1.759180222	1.011143289	1.097050949	9.296554932	3.459311126	5.891692816	3.469130142	0.100429884	5.256700149	3.916979103	7.502630784	0.224583208	0.798935791	0	0	4.987491905	0	0	0	0	0	0	0	0	0	0	0	0.499866999	0.606170491	0	1.092194413	0	0	0	0	72.636	0	5.707144835	18.8584	0.561538368	1.104841387	0	1.141236934	1.759180222	1.011143289	1.097050949	9.296554932	3.459311126	5.891692816	3.469130142	0.100429884	5.256700149	3.916979103	7.502630784	0.224583208	0.798935791	0	0	4.987491905	0	0	0	0	0	0	0	0	0	0	0	0.499866999	0.606170491	0	1.092194413	0	0	0	0	72.636	YES						30% Coins																									30% Coins	$0/Visit									6000						1.5545																									0	0									1.5545	0	0.192530609	18.8584	0.561538368	1.104841387	0	1.141236934	3.313687914	1.011143289	1.097050949	9.296554932	3.459311126	5.891692816	3.469130142	0.100429884	5.256700149	3.916979103	7.502630784	0.224583208	0.798935791	0	0	4.987491905	0	0	0	0	0	0	0	0	0	0	0	0.499866999	0.606170491	0	1.092194413	0	0	0	0	74.1905
H2944_178_0	2011	7	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	Coin							O	O	O	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	1110.780318	50.011587	438.217334	528.210121	7.385437	8.338846	4.189887	388.957007	51.50273	15.278655	17.482147	7.64532	0.199977	21.820352	3183.358912	2945.151702	126.071387	3.123541		1629.185479	22.264661	0							5.25	0.48	932.156797	315.420945	312.954976	147.870244	0	341.886587						$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $50(Days 15-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,7h. 25% Psych -- OP,8b. 20% Rad therapy,3, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$35/Visit:5.Partial Hospitalization	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						161.6895	138.428775	23.1855	0	0.2	0.2	0.2	50	0.247157	0.25	0.248371	0.25	0.2	0.237734	15	32.294507	35	0.25		0	0.2	0							0	0	0	0	15.575792	35	0	35					NO	150.597762	128.932699	20.35251	0	0.183093	0.183093	0.183093	45.77335	0.226264	0.228867	0.227376	0.228867	0.183093	0.217638	13.732005	29.564556	32.041345	0.228867		0	0.183093	0							0	0	0	0	14.259123	32.041345	0	32.041345						13.9401	0.537344074	0.743235223	0	1.352221817	1.526784331	0.76713898	1.483655435	11.6532137	3.496779934	3.975020656	1.749761452	0.036614389	4.748937769	3.642825041	7.256008535	0.336624734	0.714875458	0	0	4.076503576	0	0	0	0	0	0	0	0	0	0	0	0.371871958	0.394830125	0	0.912875507	0	0	0	0	63.7172	0	5.64784439	13.9401	0.537344074	0.743235223	0	1.352221817	1.526784331	0.76713898	1.483655435	11.6532137	3.496779934	3.975020656	1.749761452	0.036614389	4.748937769	3.642825041	7.256008535	0.336624734	0.714875458	0	0	4.076503576	0	0	0	0	0	0	0	0	0	0	0	0.371871958	0.394830125	0	0.912875507	0	0	0	0	63.7172	YES						30% Coins																									30% Coins										5000						1.3288																									0										1.3288	0	0.20280248	13.9401	0.537344074	0.743235223	0	1.352221817	2.855606951	0.76713898	1.483655435	11.6532137	3.496779934	3.975020656	1.749761452	0.036614389	4.748937769	3.642825041	7.256008535	0.336624734	0.714875458	0	0	4.076503576	0	0	0	0	0	0	0	0	0	0	0	0.371871958	0.394830125	0	0.912875507	0	0	0	0	65.046
H2944_180_0	2011	5	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin							O	O	O	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	NO	234.73855	5.445111	26.990723	395.462224	7.297399	11.071163	6.843887	317.342149	58.203081	0.699158	29.382	8.843772	0.04134	34.445432	25.66366	35.015218	0.294641	7.98486		1214.893406	19.487038	0							5.21	0.49	851.802953	18.484699	229.946012									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	0% Coins:8a.Lab -- FSL	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"20% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	20% Coins:8a.Lab -- OP	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"									0.091519	0.091519	0.146056	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	0.2	0							0	0	0	0.2	0								NO	0.084374	0.084374	0.10871	0	0.183746	0.183746	0.183746	45.93655	0.183746	0	0.183746	0.183746	0.183746	0.183746	0.183746	0.183746	0.183746	0.183746		0	0.183746	0							0	0	0	0.183746	0									19.8058	0.459425796	2.934161497	0	1.340867877	2.034281917	1.257536861	1.214800291	10.69458332	0	5.398824972	1.62500773	0.00759606	6.329210348	4.71559487	6.433906247	0.054139105	1.467186086	0	0	3.580665284	0	0	0	0	0	0	0	0	0	0	3.396489502	0	0	0	0	0	0	0	0	72.7501	0	7.107288884	19.8058	0.459425796	2.934161497	0	1.340867877	2.034281917	1.257536861	1.214800291	10.69458332	0	5.398824972	1.62500773	0.00759606	6.329210348	4.71559487	6.433906247	0.054139105	1.467186086	0	0	3.580665284	0	0	0	0	0	0	0	0	0	0	3.396489502	0	0	0	0	0	0	0	0	72.7501	YES						20% Coins				0% Coins																															6000						1.2783				0																															1.2783	0	0.077376595	19.8058	0.459425796	2.934161497	0	1.340867877	3.312558122	1.257536861	1.214800291	10.69458332	0	5.398824972	1.62500773	0.00759606	6.329210348	4.71559487	6.433906247	0.054139105	1.467186086	0	0	3.580665284	0	0	0	0	0	0	0	0	0	0	3.396489502	0	0	0	0	0	0	0	0	74.0284
H2944_184_0	2011	5	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin							O	O	O	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	NO	326.680326	3.753738	21.559536	251.791916	9.483615	19.665323	4.846337	377.699162	59.452008	0.394584	26.811492	8.050437	0	19.837267	24.229051	39.319233	0.683693	7.615377		980.293272	20.748808	0							3.43	0.49	1167.364516	13.237175	215.641021									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	0% Coins:8a.Lab -- FSL	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"20% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	20% Coins:8a.Lab -- OP	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"									0.078539	0.078539	0.158536	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0	0.2	0.2	0.2	0.2	0.2		0	0.2	0							0	0	0	0.2	0								NO	0.07207	0.07207	0.118999	0	0.183171	0.183171	0.183171	45.7927	0.183171	0	0.183171	0.183171	0	0.183171	0.183171	0.183171	0.183171	0.183171		0	0.183171	0							0	0	0	0.183171	0									23.5439	0.270531898	2.565563224	0	1.737123243	3.602116879	0.887708395	1.441322035	10.88988376	0	4.911087801	1.474606596	0	3.633612034	4.438059501	7.202143228	0.125232731	1.39491622	0	0	3.80057991	0	0	0	0	0	0	0	0	0	0	2.424666582	0	0	0	0	0	0	0	0	74.343	0	7.396695872	23.5439	0.270531898	2.565563224	0	1.737123243	3.602116879	0.887708395	1.441322035	10.88988376	0	4.911087801	1.474606596	0	3.633612034	4.438059501	7.202143228	0.125232731	1.39491622	0	0	3.80057991	0	0	0	0	0	0	0	0	0	0	2.424666582	0	0	0	0	0	0	0	0	74.343	YES						20% Coins				0% Coins																															6000						2.2677				0																															2.2677	0	0.140323734	23.5439	0.270531898	2.565563224	0	1.737123243	5.869792146	0.887708395	1.441322035	10.88988376	0	4.911087801	1.474606596	0	3.633612034	4.438059501	7.202143228	0.125232731	1.39491622	0	0	3.80057991	0	0	0	0	0	0	0	0	0	0	2.424666582	0	0	0	0	0	0	0	0	76.6107
H2944_185_0	2011	5	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin							O	O	O	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	NO	226.306273	5.421542	28.055255	568.64087	7.462177	12.437522	5.912767	342.600929	57.282057	1.045812	24.824449	6.722774	0.136242	27.091126	25.493371	36.460184	0.547777	6.798679		1101.46148	16.854431	0							5.05	0.49	919.665271	14.921088	188.874144									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	0% Coins:8a.Lab -- FSL	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"20% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	20% Coins:8a.Lab -- OP	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"									0.0835	0.0835	0.155465	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	0.2	0							0	0	0	0.2	0								NO	0.066475	0.066475	0.070831	0	0.164958	0.164958	0.164958	41.23945	0.164958	0	0.164958	0.164958	0.164958	0.164958	0.164958	0.164958	0.164958	0.164958		0	0.164958	0							0	0	0	0.164958	0									15.0437	0.360397004	1.987181767	0	1.230945794	2.051668754	0.975358219	1.17738949	9.449133559	0	4.094991458	1.108975353	0.022474208	4.468897963	4.205335493	6.014399032	0.090360198	1.12149649	0	0	2.780273229	0	0	0	0	0	0	0	0	0	0	2.461352834	0	0	0	0	0	0	0	0	58.6443	0	15.08298244	15.0437	0.360397004	1.987181767	0	1.230945794	2.051668754	0.975358219	1.17738949	9.449133559	0	4.094991458	1.108975353	0.022474208	4.468897963	4.205335493	6.014399032	0.090360198	1.12149649	0	0	2.780273229	0	0	0	0	0	0	0	0	0	0	2.461352834	0	0	0	0	0	0	0	0	58.6443	YES						20% Coins				0% Coins																															3400						1.332				0																															1.332	0	0.190973318	15.0437	0.360397004	1.987181767	0	1.230945794	3.383657236	0.975358219	1.17738949	9.449133559	0	4.094991458	1.108975353	0.022474208	4.468897963	4.205335493	6.014399032	0.090360198	1.12149649	0	0	2.780273229	0	0	0	0	0	0	0	0	0	0	2.461352834	0	0	0	0	0	0	0	0	59.9763
H2944_189_0	2011	5	r.	s.									OP Facility - Other	OP Facility - Other									Lab	Radiology									Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin							O	O	Coin	V									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0									0	NO	205.073836	7.079635	29.233434	458.820172	5.979454	10.957083	6.811243	347.201475	60.671048	0.950987	21.729123	4.799856	0.094432	28.241011	22.640159	35.117354	0.749862	6.428628		977.713325	10.792363	0							5.38	0.49	13.501753	180.662057										Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"0%-20% Coins:11b. 20% Supplies,11b. 20% Prosthetics,11c. 0% Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	0% Coins:8a.Lab -- FSL	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"20% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins:8a.Lab -- OP	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"										0.08403	0.08403	0.166717	0	0.2	0.2	0.123906	50	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0							0	0	0.2	0									NO	0.068612	0.068612	0.075379	0	0.167873	0.167873	0.104002	41.96825	0.167873	0	0.167873	0.167873	0.167873	0.167873	0.167873	0.167873	0.167873	0.167873		0	0.167873	0							0	0	0.167873	0										14.0705	0.485747917	2.203587021	0	1.003788881	1.839398394	0.708382894	1.214286525	10.18503084	0	3.647733065	0.805766226	0.015852583	4.74090324	3.800671412	5.895255568	0.125881584	1.079193068	0	0	1.811746354	0	0	0	0	0	0	0	0	0	2.266579781	0	0	0	0	0	0	0	0	0	55.9003	0	13.43161707	14.0705	0.485747917	2.203587021	0	1.003788881	1.839398394	0.708382894	1.214286525	10.18503084	0	3.647733065	0.805766226	0.015852583	4.74090324	3.800671412	5.895255568	0.125881584	1.079193068	0	0	1.811746354	0	0	0	0	0	0	0	0	0	2.266579781	0	0	0	0	0	0	0	0	0	55.9003	YES						20% Coins				0% Coins																															3400						1.1875				0																															1.1875	0	0.154135295	14.0705	0.485747917	2.203587021	0	1.003788881	3.026946699	0.708382894	1.214286525	10.18503084	0	3.647733065	0.805766226	0.015852583	4.74090324	3.800671412	5.895255568	0.125881584	1.079193068	0	0	1.811746354	0	0	0	0	0	0	0	0	0	2.266579781	0	0	0	0	0	0	0	0	0	57.0879
H2944_192_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	NO	306.844296	5.378333	673.009378	1050.476383	11.774913	15.374745	7.242752	390.490902	62.335133	9.353346	26.69271	5.374213	0.176126	23.12184	41.703385	58.509195	1.038219	6.669064		2148.508254	26.639496	0							4.23	0.58	1683.33274	555.636033	160.40616									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	20% Coins:8a.Lab -- OP	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"									0.085108	0.085108	45.408963	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	0.2	0							0	0	0	0	0								NO	0.078487	0.078487	36.721956	0	0.182943	0.182943	0.182943	45.73565	0.182943	0.182943	0.182943	0.182943	0.182943	0.182943	0.182943	0.182943	0.182943	0.182943		0	0.182943	0							0	0	0	0	0									24.0833	0.422129222	2.059518397	0	2.154137909	2.812701975	1.325010779	1.488279602	11.40377624	1.711129177	4.883244446	0.983174649	0.032221019	4.229978775	7.629342362	10.70384766	0.189934899	1.220058575	0	0	4.873509317	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2053	0	7.742265746	24.0833	0.422129222	2.059518397	0	2.154137909	2.812701975	1.325010779	1.488279602	11.40377624	1.711129177	4.883244446	0.983174649	0.032221019	4.229978775	7.629342362	10.70384766	0.189934899	1.220058575	0	0	4.873509317	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2053	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Day(Days 1-20) $137(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		$0/Visit	20% Coins	$0/Service									$0/Service	$0/Visit	$0/Visit								6700	0	0	0	0	0	1.8716	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0									0	0	0								1.8716	0	0.011058521	24.0833	0.422129222	2.059518397	0	2.154137909	4.684265254	1.325010779	1.488279602	11.40377624	1.711129177	4.883244446	0.983174649	0.032221019	4.229978775	7.629342362	10.70384766	0.189934899	1.220058575	0	0	4.873509317	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0768
H2944_193_0	2011	3	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	NO	292.407779	5.970243	493.862364	534.27294	9.946103	13.059545	6.952399	418.262719	61.63236	11.532778	25.06496	6.769509	0.683913	23.558817	36.123275	61.835001	0.622382	6.329998		1680.220995	28.640774	0							3.9	0.41	2035.459921	605.797034	170.562762									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	20% Coins:8a.Lab -- OP	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"									0.081595	0.081595	45.408962	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	0.2	0							0	0	0	0	0								NO	0.0761	0.0761	38.817398	0	0.184476	0.184476	0.184476	46.1191	0.184476	0.184476	0.184476	0.184476	0.184476	0.184476	0.184476	0.184476	0.184476	0.184476		0	0.184476	0							0	0	0	0	0									22.2522	0.454335492	1.597537662	0	1.834817297	2.409172623	1.282550758	1.60749168	11.36969124	2.127520754	4.623883561	1.248811942	0.126165535	4.346036325	6.663877279	11.40707364	0.114814542	1.167732711	0	0	5.283535424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.9173	0	6.590725	22.2522	0.454335492	1.597537662	0	1.834817297	2.409172623	1.282550758	1.60749168	11.36969124	2.127520754	4.623883561	1.248811942	0.126165535	4.346036325	6.663877279	11.40707364	0.114814542	1.167732711	0	0	5.283535424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.9173	YES	Medicare FFS CostSharing	Medicare FFS CostSharing	$0/Day(Days 1-20) $137(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		$0/Visit	20% Coins	$0/Service									$0/Service	$0/Visit	$0/Visit								6700	0	0	0	0	0	1.5877	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0									0	0	0								1.5877	0	0.011465748	22.2522	0.454335492	1.597537662	0	1.834817297	3.996834876	1.282550758	1.60749168	11.36969124	2.127520754	4.623883561	1.248811942	0.126165535	4.346036325	6.663877279	11.40707364	0.114814542	1.167732711	0	0	5.283535424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.5049
H2944_194_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	O							O	O	O	V	V								0.336124459	0.007451263	0.032476132	0	0.096520158	0.150438779	0.067518104	0.094280643	0.580856698	0.104282737	0.253935626	0.091828268	0.002268146	0.20893063	0.426120902	0.54921122	0.008147655	0.055971237		0	0.214548637	0							0	0	0	0	0								3.2809	NO	275.302597	6.102954	599.323007	706.961949	9.487689	14.787754	6.63686	444.842416	57.096754	10.250731	24.961234	9.026488	0.222953	20.537356	41.886614	53.986083	0.800894	5.501832		2113.888591	21.089592	0							4.38	0.41	2822.951754	369.128297	170.21802									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible		$0/Visit:14b-j.Preventive Services	20% coinsurance after payment of $50 plan year deductible	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"									0.08187	0.08187	45.408963	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	0.2	0							0	0	0	0	0								NO	0.076916	0.076916	38.892095	0	0.186185	0.186185	0.186185	46.5463	0.186185	0.186185	0.186185	0.186185	0.186185	0.186185	0.186185	0.186185	0.186185	0.186185		0	0.186185	0							0	0	0	0	0									21.1752	0.46941481	1.94241061	0	1.766465376	2.753257978	1.235683779	1.725480712	10.63055914	1.908532351	4.647407352	1.680596668	0.041510504	3.823747627	7.798659228	10.05139886	0.149114449	1.024358591	0	0	3.926565687	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.7503	50	5.664229079	21.5113	0.476866073	1.974886743	0	1.862985534	2.903696757	1.303201883	1.819761355	11.21141584	2.012815088	4.901342978	1.772424936	0.04377865	4.032678257	8.224780129	10.60061008	0.157262104	1.080329828	0	0	4.141114324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.0312	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Day(Days 1-20) $137(Days 21-100)	$0/Visit	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	$50/Visit	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible	20% coinsurance after payment of $50 plan year deductible		$0/Visit	20% coinsurance after payment of $50 plan year deductible	$0/Service									$0/Service	$0/Visit	$0/Visit								6700	0	0	0	0	0	1.7724	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0									0	0	0								1.7724	50	0.109617082	21.5113	0.476866073	1.974886743	0	1.862985534	4.676092185	1.303201883	1.819761355	11.21141584	2.012815088	4.901342978	1.772424936	0.04377865	4.032678257	8.224780129	10.60061008	0.157262104	1.080329828	0	0	4.141114324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8036
H2944_195_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							0	0	0	0	0								0	NO	278.873087	5.999127	635.427287	440.724248	9.869167	14.328218	6.747836	450.048576	57.175429	9.914401	24.767734	8.906538	0.207024	20.130055	42.247788	55.515211	0.769489	5.413822		2120.508134	21.053533	0							4.38	0.41	2966.138428	499.661462	169.438276									Medicare FFS CostSharing	Medicare FFS CostSharing	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible		$0/Visit:14b-j.Preventive Services	20% coinsurance after $50 plan year deductible	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"									0.079299	0.079299	45.408963	0	0.212331184	0.212331184	0.212331184	50	0.212331184	0.212331184	0.212331184	0.212331184	0.212331184	0.212331184	0.212331184	0.212331184	0.212331184	0.212331184		0	0.212331184	0							0	0	0	0	0								NO	0.074283	0.074283	38.478102	0	0.19699344	0.19699344	0.19699344	46.3883	0.19699344	0.19699344	0.19699344	0.19699344	0.19699344	0.19699344	0.19699344	0.19699344	0.19699344	0.19699344		0	0.19699344	0							0	0	0	0	0									20.7155	0.445633151	2.037502997	0	1.944161162	2.82256496	1.329279429	1.73974903	11.26318447	1.953071963	4.879081133	1.754529563	0.04078237	3.965488791	8.32253711	10.93613241	0.151584286	1.066487422	0	0	4.1474079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.5147	0	5.933915879	20.7155	0.445633151	2.037502997	0	1.944161162	2.82256496	1.329279429	1.73974903	11.26318447	1.953071963	4.879081133	1.754529563	0.04078237	3.965488791	8.32253711	10.93613241	0.151584286	1.066487422	0	0	4.1474079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.5147	YES	Medicare FFS CostSharing	Medicare FFS CostSharing	$0/Day(Days 1-20) $137(Days 21-100)	$0/Visit	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	$50/Visit	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible	20% coinsurance after $50 plan year deductible		$0/Visit	20% coinsurance after $50 plan year deductible	$0/Service									$0/Service	$0/Visit	$0/Visit								6700	0	0	0	0	0	1.9284	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0									0	0	0								1.9284	0	0.017032449	20.7155	0.445633151	2.037502997	0	1.944161162	4.750937163	1.329279429	1.73974903	11.26318447	1.953071963	4.879081133	1.754529563	0.04078237	3.965488791	8.32253711	10.93613241	0.151584286	1.066487422	0	0	4.1474079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.4431
H2944_197_0	2011	7	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Lab									Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin							O	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	NO	275.261551	4.924881	29.696004	26.322178	10.042235	13.858731	6.54593	398.799621	61.310397	1.042465	27.723198	6.421049	0.260489	23.636856	31.288444	44.635427	0.745253	6.205219		6.257918	23.765914	0							1.42	0.93	1575.466347	11.146913										Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0% Coins:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $155 plan year deductible	0% Coins:8a.Lab -- FSL	"8b, 9a. 20% coinsurance after $155 plan year deductibleDMAM -- OP,8b. 20% coinsurance after $155 plan year deductible Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% coinsurance after $155 plan year deductible Advanced Imaging -- FSR,8b. 20% coinsurance after $155 plan year deductible Advanced Imaging -- Office,8b, 9a. 20% coinsurance after $155 plan year deductible Advanced Imaging -- OP,8b. 20% coinsurance after $155 plan year deductible Radiology OP -- Physician,8b. 20% coinsurance after $155 plan year deductible Radiology OP -- Facility"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		0% Coins:14b-j.Preventive Services	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	20% coinsurance after $155 plan year deductible										0.08338	0.08338	0.17224	0	0.233	0.233	0.233	50	0.233	0	0.220092	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0							0	0	0	0.233									NO	0.071105	0.071105	0.095672	0	0.200725	0.200725	0.200725	43.07405	0.200725	0	0.189605	0.200725	0.200725	0.200725	0.200725	0.200725	0.200725	0.200725		0	0.200725	0							0	0	0	0.200725										19.5725	0.350183664	2.841076095	0	2.01572762	2.78179378	1.313931799	1.431492901	12.30652944	0	5.256456957	1.288865061	0.052286655	4.744507921	6.280372922	8.959446085	0.149590908	1.245542584	0	0	4.770413088	0	0	0	0	0	0	0	0	0	0	2.237464112	0	0	0	0	0	0	0	0	77.5982	0	14.52985579	19.5725	0.350183664	2.841076095	0	2.01572762	2.78179378	1.313931799	1.431492901	12.30652944	0	5.256456957	1.288865061	0.052286655	4.744507921	6.280372922	8.959446085	0.149590908	1.245542584	0	0	4.770413088	0	0	0	0	0	0	0	0	0	0	2.237464112	0	0	0	0	0	0	0	0	77.5982	YES						20% coinsurance after $155 plan year deductible				0% Coins																					20% Coins										5000						1.7649				0																					0										1.7649	0	0.212138994	19.5725	0.350183664	2.841076095	0	2.01572762	4.54664534	1.313931799	1.431492901	12.30652944	0	5.256456957	1.288865061	0.052286655	4.744507921	6.280372922	8.959446085	0.149590908	1.245542584	0	0	4.770413088	0	0	0	0	0	0	0	0	0	0	2.237464112	0	0	0	0	0	0	0	0	79.363
H2944_198_0	2011	5	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin							O	O	O	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	NO	291.74937	4.612628	48.536771	497.549694	8.776943	9.122839	4.487144	394.902305	66.460523	1.327752	28.370304	5.462658	0.24356	27.243373	30.668632	48.964913	0.926047	7.281119		1778.726369	24.943523	0							4.51	0.6	1209.568473	17.740307	201.335913									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	20% Coins after payment of Original Medicare Part B deductible:10a.Ambulance Emergency	20% Coins after payment of Original Medicare Part B deductible:11a.DME	"20% Coins after payment of Original Medicare Part B deductible:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"15%-20% Coins after payment of Original Medicare Part B deductible:9b. 15% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 15% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	0% Coins after payment of Original Medicare Part B deductible:8a.Lab -- FSL	"15%-20% Coins after payment of Original Medicare Part B deductible:8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 15% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 15% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	20% Coins after payment of Original Medicare Part B deductible:9a.Observation	"20% Coins after payment of Original Medicare Part B deductible:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"15%-20% Coins after payment of Original Medicare Part B deductible:9d. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a. 15% OP Other,5. 20% Partial Hospitalization,7h. 20% Psych -- OP,8b. 20% Rad therapy,3, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"15% Coins after payment of Original Medicare Part B deductible:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"15% Coins after payment of Original Medicare Part B deductible:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"15% Coins after payment of Original Medicare Part B deductible:7e, 7h.Psych -- Other Provider"	"15%-20% Coins after payment of Original Medicare Part B deductible:7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. 15% Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"20% Coins after payment of Original Medicare Part B deductible:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"20% Coins after payment of Original Medicare Part B deductible:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	23% Coins:8a.Lab -- OP	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"									0.076993	0.076993	0.163937	0	0.233	0.233	0.233	50	0.22136	0	0.217834	0.233	0.233	0.209234	0.183	0.183	0.183	0.206741		0	0.233	0							0	0	0	0.233	0								NO	0.065203	0.065203	0.075416	0	0.200934	0.200934	0.200934	43.1188	0.190896	0	0.187855	0.200934	0.200934	0.180438	0.157815	0.157815	0.157815	0.178288		0	0.200934	0							0	0	0	0.200934	0									19.0229	0.300757183	3.660449122	0	1.763586265	1.833088532	0.901619792	1.418976126	12.687048	0	5.329503458	1.097633723	0.048939485	4.915739737	4.839970159	7.727397745	0.146144107	1.298136144	0	0	5.01200185	0	0	0	0	0	0	0	0	0	0	3.564630847	0	0	0	0	0	0	0	0	75.5686	0	16.1823638	19.0229	0.300757183	3.660449122	0	1.763586265	1.833088532	0.901619792	1.418976126	12.687048	0	5.329503458	1.097633723	0.048939485	4.915739737	4.839970159	7.727397745	0.146144107	1.298136144	0	0	5.01200185	0	0	0	0	0	0	0	0	0	0	3.564630847	0	0	0	0	0	0	0	0	75.5686	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		20% Coins after payment of Original Medicare Part B deductible				0% Coins after payment of Original Medicare Part B deductible																					20% Coins										5000						1.0197				0																					0										1.0197	0	0.097355965	19.0229	0.300757183	3.660449122	0	1.763586265	2.852814966	0.901619792	1.418976126	12.687048	0	5.329503458	1.097633723	0.048939485	4.915739737	4.839970159	7.727397745	0.146144107	1.298136144	0	0	5.01200185	0	0	0	0	0	0	0	0	0	0	3.564630847	0	0	0	0	0	0	0	0	76.5883
H2949_009_0	2011	4	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other						Prosthetics/Supplies	Prosthetics/Supplies	Radiology	Renal Dialysis	Other						D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	Coin	V	V	V	V		V	Coin	O	T						O	O	O	O	V	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	YES	1583.22928	67.38473	657.663961	1633.590389	220.461593	11.592689	1.746409	383.25373	319.310251	1477.392495	5.348879	74.956639	0.597107	5.529596	4576.514967	4744.967051	72.220543	713.016449		1807.308839	39.295897	0	2.95						4.74	0.15	373.808879	6927.228156	1371.669756	1.632628	536.32837						3400	$50/Day(Days 1-5):1a.IP Acute	$50/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"20% Coins:8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"20% Coins:8b.Nuclear Medicine, 8b.Rad therapy"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0-$30/Visit:7b. $0 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"	$0: Other - Transportation 10b						$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Service:11b.Supplies	"$0-$65/Visit:8b. $15 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $65 Advanced Imaging -- FSR,8b. $65 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician,8b. $15 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30-$150/Visit:9d. $30 Cardiac Rehab,9a. $30 OP Other,5. $150 Partial Hospitalization,7h. $30 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"							30.9556	24.92055	42.271616	0	100	0.2	0.2	50	0	0	0.2	0	0.2	0.2	0	29.356266	30	30		0	0.2	0	0						0	0	0	0	29.412605	0	48.482424						NO	29.217041	23.520937	34.446717	0	93.2178	0.186436	0.186436	46.6089	0	0	0.186436	0	0.186436	0.186436	0	27.365266	27.96534	27.96534		0	0.186436	0	0						0	0	0	0	27.417783	0	45.194249							3.8548	0.132079332	1.887863695	0	1.712578724	2.161294566	0.325593508	1.488586231	0	0	0.997223605	0	0.111322241	1.03091576	0	10.82060713	0.168306003	1.661645618	0	0	7.326169853	0	0	0	0	0	0	0	0	0	0	0	3.134011976	0	2.019913158	0	0	0	0	0	38.8329	0	3.064002511	3.8548	0.132079332	1.887863695	0	1.712578724	2.161294566	0.325593508	1.488586231	0	0	0.997223605	0	0.111322241	1.03091576	0	10.82060713	0.168306003	1.661645618	0	0	7.326169853	0	0	0	0	0	0	0	0	0	0	0	3.134011976	0	2.019913158	0	0	0	0	0	38.8329	NO																																																																																		0	0	0	3.8548	0.132079332	1.887863695	0	1.712578724	2.161294566	0.325593508	1.488586231	0	0	0.997223605	0	0.111322241	1.03091576	0	10.82060713	0.168306003	1.661645618	0	0	7.326169853	0	0	0	0	0	0	0	0	0	0	0	3.134011976	0	2.019913158	0	0	0	0	0	38.8329
H2949_012_0	2011	5	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O	T						O	O	O	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	YES	1843.022912	78.441956	765.58068	1901.647824	256.63735	13.453366	2.026715	446.142207	371.706181	1719.819266	1722.956209	87.256347	0.692946	4.602319	5327.479757	5523.573308	84.071282	830.016011		2103.871903	45.603061	0	1.45						4.74	0.15	8499.0713	1.900527	645.00603								2500	$50/Day(Days 1-5):1a.IP Acute	$50/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $15 DMAM -- OP,8b. $15 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $15 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0-$30/Visit:7b. $0 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"	$0: Other - Transportation 10b						$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"	$0/Proc:12.Dialysis -- Dialysis Center	"$30-$50/Visit:9d. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $30 OP Other,5. $30 Partial Hospitalization,7h. $30 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"									30.9556	24.92055	42.271616	0	100	0.2	0.2	50	50	10.377806	25.748119	50	0.2	0.2	0	29.356266	30	30		0	0.2	0	0						0	0	0	0	30.640956								NO	27.1302	21.840943	25.770722	0	86.4647	0.172929	0.172929	43.23235	43.23235	8.973139	22.263034	43.23235	0.172929	0.172929	0	25.382808	25.93941	25.93941		0	0.172929	0	0						0	0	0	0	26.49361									4.1668	0.142770524	1.644130573	0	1.849172623	2.326477129	0.350477798	1.60731467	1.33914431	1.286014777	3.196519388	0.314358078	0.119830459	0.795874422	0	11.68365006	0.181729954	1.794177135	0	0	7.886091736	0	0	0	0	0	0	0	0	0	0	0	1.424044851	0	0	0	0	0	0	0	42.1086	0	7.320123456	4.1668	0.142770524	1.644130573	0	1.849172623	2.326477129	0.350477798	1.60731467	1.33914431	1.286014777	3.196519388	0.314358078	0.119830459	0.795874422	0	11.68365006	0.181729954	1.794177135	0	0	7.886091736	0	0	0	0	0	0	0	0	0	0	0	1.424044851	0	0	0	0	0	0	0	42.1086	NO																																																																																		0	0	0	4.1668	0.142770524	1.644130573	0	1.849172623	2.326477129	0.350477798	1.60731467	1.33914431	1.286014777	3.196519388	0.314358078	0.119830459	0.795874422	0	11.68365006	0.181729954	1.794177135	0	0	7.886091736	0	0	0	0	0	0	0	0	0	0	0	1.424044851	0	0	0	0	0	0	0	42.1086
H2949_013_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O	T						O	O	O	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	YES	1617.096739	68.826183	671.732301	1668.535141	225.177571	11.832544	1.782541	391.452056	326.140738	1508.995959	1511.748359	76.560065	0.609461	4.047844	4674.412935	4846.468442	73.76544	728.268854		1845.969668	40.10894	0	1.45						4.74	0.15	7457.216289	1.667552	565.938242								2500	$50/Day(Days 1-5):1a.IP Acute	$50/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $15 DMAM -- OP,8b. $15 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $15 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0-$10/Visit:7b. $0 Chiropractic,7f. $10 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $10 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $10 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"	$0: Other - Transportation 10b						$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"	$0/Proc:12.Dialysis -- Dialysis Center	"$0-$50/Visit:9d. $0 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $30 OP Other,5. $30 Partial Hospitalization,7h. $30 Psych -- OP,3, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"									30.9556	24.92055	42.271616	0	100	0.2	0.2	50	50	10.377806	25.748119	50	0.2	0.2	0	9.785422	30	10		0	0.2	0	0						0	0	0	0	26.350618								NO	28.715591	23.117249	30.476017	0	91.9658	0.183932	0.183932	45.9829	45.9829	9.544032	23.679464	45.9829	0.183932	0.183932	0	8.999242	27.58974	9.19658		0	0.183932	0	0						0	0	0	0	24.233556									3.8697	0.132589334	1.705977085	0	1.725719622	2.176383483	0.327866331	1.500008395	1.249741412	1.20015881	2.983115904	0.293371151	0.112099381	0.744528043	0	3.634545196	0.169597443	0.558131898	0	0	7.377317552	0	0	0	0	0	0	0	0	0	0	0	1.14289134	0	0	0	0	0	0	0	30.9037	0	3.17358581	3.8697	0.132589334	1.705977085	0	1.725719622	2.176383483	0.327866331	1.500008395	1.249741412	1.20015881	2.983115904	0.293371151	0.112099381	0.744528043	0	3.634545196	0.169597443	0.558131898	0	0	7.377317552	0	0	0	0	0	0	0	0	0	0	0	1.14289134	0	0	0	0	0	0	0	30.9037	NO																																																																																		0	0	0	3.8697	0.132589334	1.705977085	0	1.725719622	2.176383483	0.327866331	1.500008395	1.249741412	1.20015881	2.983115904	0.293371151	0.112099381	0.744528043	0	3.634545196	0.169597443	0.558131898	0	0	7.377317552	0	0	0	0	0	0	0	0	0	0	0	1.14289134	0	0	0	0	0	0	0	30.9037
H2949_014_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O	T						O	O	O	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	YES	1661.039585	70.696459	689.985896	1713.875769	231.296526	12.154081	1.83098	402.08934	335.003258	1550.001284	1552.828479	78.640502	0.626023	4.157841	4801.435026	4978.165954	75.769935	748.058769		1896.131887	41.198855	0	1.45						4.74	0.15	7659.858036	1.712866	581.316998								2500	$50/Day(Days 1-5):1a.IP Acute	$50/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $15 DMAM -- OP,8b. $15 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $15 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0-$10/Visit:7b. $0 Chiropractic,7f. $10 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $10 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $10 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"	$0: Other - Transportation 10b						$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"	$0/Proc:12.Dialysis -- Dialysis Center	"$0-$50/Visit:9d. $0 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $30 OP Other,5. $30 Partial Hospitalization,7h. $30 Psych -- OP,3, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"									30.9556	24.92055	42.271616	0	100	0.2	0.2	50	50	10.377806	25.748119	50	0.2	0.2	0	9.785422	30	10		0	0.2	0	0						0	0	0	0	26.350618								NO	28.60867	23.031174	29.972985	0	91.6159	0.183232	0.183232	45.80795	45.80795	9.50772	23.589371	45.80795	0.183232	0.183232	0	8.965003	27.48477	9.16159		0	0.183232	0	0						0	0	0	0	24.141356									3.96	0.135685204	1.723411409	0	1.76586995	2.22701657	0.335494127	1.534907365	1.278817708	1.228081517	3.052520591	0.300196682	0.114707446	0.761849522	0	3.719106059	0.17354327	0.571117311	0	0	7.548948599	0	0	0	0	0	0	0	0	0	0	0	1.169481716	0	0	0	0	0	0	0	31.6008	0	3.402520804	3.96	0.135685204	1.723411409	0	1.76586995	2.22701657	0.335494127	1.534907365	1.278817708	1.228081517	3.052520591	0.300196682	0.114707446	0.761849522	0	3.719106059	0.17354327	0.571117311	0	0	7.548948599	0	0	0	0	0	0	0	0	0	0	0	1.169481716	0	0	0	0	0	0	0	31.6008	NO																																																																																		0	0	0	3.96	0.135685204	1.723411409	0	1.76586995	2.22701657	0.335494127	1.534907365	1.278817708	1.228081517	3.052520591	0.300196682	0.114707446	0.761849522	0	3.719106059	0.17354327	0.571117311	0	0	7.548948599	0	0	0	0	0	0	0	0	0	0	0	1.169481716	0	0	0	0	0	0	0	31.6008
H2949_015_0	2011	6	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery						Prosthetics/Supplies	Radiology	Renal Dialysis	Other							D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	V	Coin	Coin	V	V	V	V		V	Coin	O	T	V					O	O	O	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	1526.633281	64.975916	634.154321	1198.517266	161.746192	7.317443	2.226151	369.553485	9.144075	1424.579863	32.546946	72.27715	0.57443	5.319589	4436.900658	4600.213827	70.017332	690.462258		1752.173834	37.997808	0	2.95	4.95					4.74	0.15	274.25259	269.550071	1.574265	517.156138	307.895806							$175/Day(Days 1-6):1a.IP Acute	$175/Day(Days 1-6):1b.IP Psych	"$0/Day(Days 1-10) $50(Days 11-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	20% Coins:9a.Surgery OP -- Physician	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$150/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"20% Coins:8b.Nuclear Medicine, 8b.Rad therapy"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$25/Visit:7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN749: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"	$0/Proc:12.Dialysis -- Dialysis Center	"$25-$35/Visit:9d. $35 Cardiac Rehab,9a. $25 OP Other,5. $25 Partial Hospitalization,7h. $25 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $150 Surgery OP -- Facility"							118.01335	98.327075	29.1123	0	100	0.2	0.2	50	0.2	10.377806	0.2	150	0.2	0.2	10	24.678133	25	35		0	0.2	0	0	0					0	0	0	0	0	26.477462	150						NO	104.927676	87.424274	21.593728	0	88.2548	0.17651	0.17651	44.1274	0.17651	9.158912	0.17651	132.3822	0.17651	0.17651	8.82548	21.779637	22.0637	30.88918		0	0.17651	0	0	0					0	0	0	0	0	23.367631	132.3822							13.3488	0.47337269	1.141146326	0	1.189573152	1.291601864	0.392937913	1.358952871	1.614020678	1.087300134	5.744861438	0.797350677	0.101392639	0.938960654	3.263148168	8.34924894	0.128736784	1.777317748	0	0	6.70699309	0	0	0	0	0	0	0	0	0	0	0	0	1.007059484	3.396660347	0	0	0	0	0	54.1095	0	7.330786568	13.3488	0.47337269	1.141146326	0	1.189573152	1.291601864	0.392937913	1.358952871	1.614020678	1.087300134	5.744861438	0.797350677	0.101392639	0.938960654	3.263148168	8.34924894	0.128736784	1.777317748	0	0	6.70699309	0	0	0	0	0	0	0	0	0	0	0	0	1.007059484	3.396660347	0	0	0	0	0	54.1095	YES	$275/Day(Days 1-6)	$275/Day(Days 1-6)	40% Coins(Days 1-10) 40%(Days 11-100)	40% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	20% Coins	30% Coins	$150/Visit	20% Coins	20%-30% Coins	$35/Visit	$35/Visit	$35/Visit	$40/Visit		$20/Visit	20% Coins	$0/Service		50%-80%							40% Coins	$20/Visit	20% Coins	$35-$40/Visit	20% Coins						4000	1.2407	0.044	0.2105	1.8894	0.4015	1.3414	0.4081	0.0931	0.1586	0.0785	0.5907	0.0546	0.0071	0.0749	0.7293	0.7562	0.0115	0.1317		0.1646	0.4394	0		0							0.0655	0.0272	0.0005	0.0931	0.6108						9.6227	0	5.467587521	14.5895	0.517368704	1.351621216	1.889415608	1.591091902	2.633003801	0.801026639	1.452020365	1.772616994	1.165760973	6.335519097	0.851957011	0.108479176	1.013866757	3.992464313	9.105409708	0.140245893	1.909036	0	0.16457932	7.146353384	0	0	0	0	0	0	0	0	0	0.065493854	0.027153146	0.000527282	1.100151305	4.007496294	0	0	0	0	0	63.7322
H2949_805_0	2011	2																															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	YES	356.427794	4.999892	36.63179	19.794623	8.958334	11.408873	4.027907	32.481525	60.248139	6.506182	35.262676	6.252459	0.631352	12.119087	46.998722	85.125902	0.586301	6.502481		9.246499	38.672814	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.069852	0.069852	0.145333	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.062312	0.062312	0.098028	0	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066		0.207066	0.207066	0																				22.2097	0.31155327	3.59094111	0	1.854966388	2.362389697	0.834042591	6.725819456	12.47534115	1.347209082	7.301701269	1.294671675	0.130731533	2.509450869	9.73183737	17.62668002	0.121403003	1.346442731	0	1.914635562	8.007824904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.6974	0	13.92478764	22.2097	0.31155327	3.59094111	0	1.854966388	2.362389697	0.834042591	6.725819456	12.47534115	1.347209082	7.301701269	1.294671675	0.130731533	2.509450869	9.73183737	17.62668002	0.121403003	1.346442731	0	1.914635562	8.007824904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.6974	NO																																																																																		0	0	0	22.2097	0.31155327	3.59094111	0	1.854966388	2.362389697	0.834042591	6.725819456	12.47534115	1.347209082	7.301701269	1.294671675	0.130731533	2.509450869	9.73183737	17.62668002	0.121403003	1.346442731	0	1.914635562	8.007824904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.6974
H2949_807_0	2011	2																															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	YES	356.427794	4.999892	36.63179	19.794623	8.958334	11.408873	4.027907	32.481525	60.248139	6.506182	35.262676	6.252459	0.631352	12.119087	46.998722	85.125902	0.586301	6.502481		9.246499	38.672814	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.069852	0.069852	0.145333	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.062312	0.062312	0.098028	0	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066		0.207066	0.207066	0																				22.2097	0.31155327	3.59094111	0	1.854966388	2.362389697	0.834042591	6.725819456	12.47534115	1.347209082	7.301701269	1.294671675	0.130731533	2.509450869	9.73183737	17.62668002	0.121403003	1.346442731	0	1.914635562	8.007824904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.6974	0	13.92478764	22.2097	0.31155327	3.59094111	0	1.854966388	2.362389697	0.834042591	6.725819456	12.47534115	1.347209082	7.301701269	1.294671675	0.130731533	2.509450869	9.73183737	17.62668002	0.121403003	1.346442731	0	1.914635562	8.007824904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.6974	NO																																																																																		0	0	0	22.2097	0.31155327	3.59094111	0	1.854966388	2.362389697	0.834042591	6.725819456	12.47534115	1.347209082	7.301701269	1.294671675	0.130731533	2.509450869	9.73183737	17.62668002	0.121403003	1.346442731	0	1.914635562	8.007824904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.6974
H2949_808_0	2011	2																															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	YES	356.427794	4.999892	36.63179	19.794623	8.958334	11.408873	4.027907	32.481525	60.248139	6.506182	35.262676	6.252459	0.631352	12.119087	46.998722	85.125902	0.586301	6.502481		9.246499	38.672814	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.069852	0.069852	0.145333	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.062312	0.062312	0.098028	0	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066	0.207066		0.207066	0.207066	0																				22.2097	0.31155327	3.59094111	0	1.854966388	2.362389697	0.834042591	6.725819456	12.47534115	1.347209082	7.301701269	1.294671675	0.130731533	2.509450869	9.73183737	17.62668002	0.121403003	1.346442731	0	1.914635562	8.007824904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.6974	0	13.92478764	22.2097	0.31155327	3.59094111	0	1.854966388	2.362389697	0.834042591	6.725819456	12.47534115	1.347209082	7.301701269	1.294671675	0.130731533	2.509450869	9.73183737	17.62668002	0.121403003	1.346442731	0	1.914635562	8.007824904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.6974	NO																																																																																		0	0	0	22.2097	0.31155327	3.59094111	0	1.854966388	2.362389697	0.834042591	6.725819456	12.47534115	1.347209082	7.301701269	1.294671675	0.130731533	2.509450869	9.73183737	17.62668002	0.121403003	1.346442731	0	1.914635562	8.007824904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.6974
H2960_004_0	2011	12																															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	YES	1721.572341	25.96671917	1232.446083	985.3108958	9.311891046	7.598179371	2.064909256	490.3443067	491.1375819	256.9323036	836.0691549	0	0	621.9259663	4666.666256	10856.08932	205.4830702	556.2165073	1950.686131	3149.718502	11.59280829	195.9677005	1.149782227	6.086693872	158.1344734	181.76	0	0	12512.02043	100											3000	PBP: 1A IP Acute: $150 per day (days 1-4)	1B IP Psych: $150 per day (days 1-4)	2 SNF: $50 per day for days 16-100; $150 per day for days 101-125	6 Home Health: $0	10A Ambulance: 20%	11A DME: 20%	11B Prosthetic and Medical Supplies: 20%	"4A ER: $50, 4B Urgent Care: $25/$50"	"9B ASC Services including Colonoscopies: $150, 9A OP Hosp - Surgery including Colonoscopies $150"	8A OP Lab: $0	"8B: $40 Routine Imaging, $55 Radiation Theray, $65 CT, $80 PET, MRI, and Nuclear Medicine"	5 Partial Hosp: $40	12 Renal Dialysis: 20%	"3 CORF: $50, 9D Cardiac Rehab: $15, 9A Colorectal Screening: $0, 9c Substance Abuse: $40"	"7A PCP: $10, 14B Immunizations: $0, separate office visit copay applies,  14C Phsycial Exams: $0, 14D Pap/Pelvic: $0, separate office visit copay applies, 14E Prostate Screening: $0, separate office visit copay applies, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, separate office visit copay applies, 14H Mammography: $0, 14I Diabetes Monitoring: $0, separate office visit copay may apply, 14j Nutrition Therapy: $0"	"7B Chiropractic: $40, 7D Physician Specialist (Except Colonoscopies, Surgery, Anesthesia and Lab): $40, 7D Physcian Colonoscopies, Surgery, Anesthesia and Lab: $0, 7F Podiatry: $40"	"7E Mental Health: $40, 7H Psychiatric: $40, 9C OP Substance Abuse: $40"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $0	"7G Allergy, Immunotherapy, Consultations: $0, 7G Dialysis: 20%"	15 Part B Drugs: 20%	"13A Blood: 20%, 17A Medicare Covered Eye Exams: $20, 17B Medicare Covered Lens/Frames: $0, 18A Medicare Covered Hearing Exams: $40"	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: $400 allowance every 36 months	"14A Flu Shots: $0, Health Education/Wellness Programs: $0, Membership in Health Club $0"	"13B Accupuncture: $20, 13C Over the counter drugs: Not Covered"												80.14890846	56.81397595	46.5169954	0	0.2	0.2	0.2	37.09227089	150	0	55.07790068	0	0	1.089719469	7.766730404	20.35583294	40	20	0	0.019559324	0.2	35.5315301	0	0	20	0	0	0	0	20											NO	71.65312417	50.7916945	41.58619389	0	0.1788	0.1788	0.1788	33.16049017	134.1	0	49.23964321	0	0	0.974209206	6.943456981	18.19811465	35.76	17.88	0	0.017486035	0.1788	31.76518791	0	0	17.88	0	0	0	0	17.88												10.2797	0.109907806	4.271061815	0	1.664966119	1.358554472	0.369205775	1.355004797	5.488462478	0	3.430645574	0	0	0.0504905	2.700233033	16.46336317	0.612339549	0.828762596	0	0.004589674	2.072794123	0.518745902	0	0	0.235620365	0	0	0	0	0.149	0	0	0	0	0	0	0	0	0	0	51.9634		6.161210573	10.2797	0.109907806	4.271061815	0	1.664966119	1.358554472	0.369205775	1.355004797	5.488462478	0	3.430645574	0	0	0.0504905	2.700233033	16.46336317	0.612339549	0.828762596	0	0.004589674	2.072794123	0.518745902	0	0	0.235620365	0	0	0	0	0.149	0	0	0	0	0	0	0	0	0	0	51.9634	NO																																																																																		0			10.2797	0.109907806	4.271061815	0	1.664966119	1.358554472	0.369205775	1.355004797	5.488462478	0	3.430645574	0	0	0.0504905	2.700233033	16.46336317	0.612339549	0.828762596	0	0.004589674	2.072794123	0.518745902	0	0	0.235620365	0	0	0	0	0.149	0	0	0	0	0	0	0	0	0	0	51.9634
H2960_009_0	2011	7																															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	YES	1286.437355	17.87890067	1129.842939	663.8773709	7.366051111	6.843647284	1.790037711	340.4859229	376.904791	149.1994767	549.5729935	0	0.001806593	408.5287933	3270.413335	7838.862665	154.7157287	436.6122267	1389.30276	2383.83189	5.026595725	130.1915607	0.706229124	0	439.876808	221.6	0	0	12452.79909	123.1559482											17.6555	PBP: 1A IP Acute: $150 per day (days 1-5)	1B IP Psych: $150 per day (days 1-5)	2 SNF: $50 per day for days 16-100 only	6 Home Health: $0	10A Ambulance: 20%	11A DME: 20%	11B Prosthetic and Medical Supplies: 20%	"4A ER: $50, 4B Urgent Care: $25/$50"	"9B ASC Services including Colonoscopies: $150, 9A OP Hosp - Surgery including Colonoscopies $150"	8A OP Lab: $0	"8B: $50 Routine Imaging, $55 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, 9A Colorectal Screening: $0, 9c Substance Abuse: $40"	"7A PCP: $10, 14B Immunizations: $0, separate office visit copay applies,  14C Phsycial Exams: $0, 14D Pap/Pelvic: $0, separate office visit copay applies, 14E Prostate Screening: $0, separate office visit copay applies, 14F Colorectal Screening: $0, 14G B"	"7B Chiropractic: $40, 7D Physician Specialist (Except Colonoscopies, Surgery, Anesthesia and Lab): $40, 7D Physcian Colonoscopies, Surgery, Anesthesia and Lab: $0, 7F Podiatry: $40"	"7E Mental Health: $40, 7H Psychiatric: $40, 9C OP Substance Abuse: $40"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $0	"7G Allergy, Immunotherapy, Consultations: $0, 7G Dialysis: 20%"	15 Part B Drugs: 20%	"13A Blood: 20%, 17A Medicare Covered Eye Exams: $20, 17B Medicare Covered Lens/Frames: $0, 18A Medicare Covered Hearing Exams: $40"	10B Transportation: $0	"16A Preventive Dental Services: Not Covered, 16B Additional Comprehensive Dental Coverage: Not Covered"	17A Routine Eye Exams: $20	17B Eye Wear: $100 allowance	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	"14A Flu Shots: $0, Health Education/Wellness Programs: $0, Membership in Health Club $0"	"13B Accupuncture: $20, 13C Over the counter drugs: $4"												91.07181152	58.89806229	27.8845626	0	0.2	0.2	0.2	37.32358705	150	0	65.09071391	0	0.2	0.731068864	7.738610454	20.45500492	40	20	0	0.023161337	0.2	39.26261404	0	0	20	0	0	0	0	16.99165833											NO	82.41998942	53.30274637	25.23552916	0	0.181	0.181	0.181	33.77784628	135.75	0	58.90709608	0	0.181	0.661617322	7.003442461	18.51177945	36.2	18.1	0	0.02096101	0.181	35.53266571	0	0	18.1	0	0	0	0	15.37745078												8.8357	0.079416209	2.37601537	0	1.333255251	1.238700158	0.323996826	0.958406764	4.263735448	0	2.697812428	0	0.000326993	0.022524144	1.908679301	12.09260806	0.466725782	0.658556775	0	0.00416396	0.909813826	0.385504434	0	0	0.663480852	0	0	0	0	0.157818711	0	0	0	0	0	0	0	0	0	0	39.3772		4.133520408	8.8357	0.079416209	2.37601537	0	1.333255251	1.238700158	0.323996826	0.958406764	4.263735448	0	2.697812428	0	0.000326993	0.022524144	1.908679301	12.09260806	0.466725782	0.658556775	0	0.00416396	0.909813826	0.385504434	0	0	0.663480852	0	0	0	0	0.157818711	0	0	0	0	0	0	0	0	0	0	39.3772	NO																																																																																		0			8.8357	0.079416209	2.37601537	0	1.333255251	1.238700158	0.323996826	0.958406764	4.263735448	0	2.697812428	0	0.000326993	0.022524144	1.908679301	12.09260806	0.466725782	0.658556775	0	0.00416396	0.909813826	0.385504434	0	0	0.663480852	0	0	0	0	0.157818711	0	0	0	0	0	0	0	0	0	0	39.3772
H2960_010_0	2011	12																															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	YES	1901.944107	48.7960701	1396.961474	1157.660439	10.78221885	10.17995699	5.662374366	508.8736444	657.1162983	261.3061014	1078.552371	0	0.017134102	707.6747179	5285.387075	13623.85692	294.0755477	871.5294884	2368.644253	3808.820775	11.68992528	253.7730412	3.156793647	63.91753849	206.2038085	280.96	0	0	12525.53096	100											2500	PBP: 1A IP Acute: $50 per day (days 1-3)	1B IP Psych: $50 per day (days 1-3)	2 SNF: $50 per day for days 21-100; $150 per day for days 101-125	6 Home Health: $0	10A Ambulance: 15%	11A DME: 10%	11B Prosthetic and Medical Supplies: 10%	"4A ER: $50, 4B Urgent Care: $15/$30"	"9B ASC Services including Colonoscopies: $50, 9A OP Hosp - Surgery including Colonoscopies $50"	8A OP Lab: $0	"8B: $20 Routine Imaging, $40 Radiation Theray, $40 CT, $60 PET, MRI, and Nuclear Medicine"	5 Partial Hosp: $30	12 Renal Dialysis: 20%	"3 CORF: $50, 9D Cardiac Rehab: $15, 9A Colorectal Screening: $0, 9c Substance Abuse: $40"	"7A PCP: $10, 14B Immunizations: $0, separate office visit copay applies,  14C Phsycial Exams: $0, 14D Pap/Pelvic: $0, separate office visit copay applies, 14E Prostate Screening: $0, separate office visit copay applies, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, separate office visit copay applies, 14H Mammography: $0, 14I Diabetes Monitoring: $0, separate office visit copay may apply, 14j Nutrition Therapy: $0"	"7B Chiropractic: $30, 7D Physician Specialist (Except Colonoscopies, Surgery, Anesthesia and Lab): $30, 7D Physcian Colonoscopies, Surgery, Anesthesia and Lab: $0, 7F Podiatry: $30"	"7E Mental Health: $30, 7H Psychiatric: $30, 9C OP Substance Abuse: $30"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $0	"7G Allergy, Immunotherapy, Consultations: $0, 7G Dialysis: 20%"	15 Part B Drugs: 20%	"13A Blood: 20%, 17A Medicare Covered Eye Exams: $20, 17B Medicare Covered Lens/Frames: $0, 18A Medicare Covered Hearing Exams: $35"	10B Transportation: $0	"16A Preventive Dental Services: Not Covered, 16B Additional Comprehensive Dental Coverage: Covered"	17A Routine Eye Exams: $15	17B Eye Wear: $125 allowance	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: $800 allowance every 36 months	"14A Flu Shots: $0, Health Education/Wellness Programs: $0, Membership in Health Club $0"	"13B Accupuncture: $20, 13C Over the counter drugs: Not Covered"												23.72901205	12.51780501	42.50887655	0	0.15	0.1	0.1	31.56536005	50	0	35.00271831	0	0.2	0.694354902	7.547889872	15.83703995	30	20	0	0.09652987	0.2	89.76622142	0	0.37	15	0	0	0	0	20											NO	20.50186641	10.81538353	36.72766934	0	0.1296	0.0864	0.0864	27.27247108	43.2	0	30.24234862	0	0.1728	0.599922635	6.521376849	13.68320251	25.92	17.28	0	0.083401808	0.1728	77.55801531	0	0.31968	12.96	0	0	0	0	17.28												3.2495	0.043979018	4.275594924	0	1.397375564	0.879548284	0.489229145	1.156520146	2.365618674	0	2.718163067	0	0.002960773	0.035379173	2.872333409	15.53483277	0.635203183	1.255002463	0	0.026471878	2.020019088	1.640177785	0	20.4331587	0.222700113	0	0	0	0	0.144	0	0	0	0	0	0	0	0	0	0	61.3977		9.66445569	3.2495	0.043979018	4.275594924	0	1.397375564	0.879548284	0.489229145	1.156520146	2.365618674	0	2.718163067	0	0.002960773	0.035379173	2.872333409	15.53483277	0.635203183	1.255002463	0	0.026471878	2.020019088	1.640177785	0	20.4331587	0.222700113	0	0	0	0	0.144	0	0	0	0	0	0	0	0	0	0	61.3977	NO																																																																																		0			3.2495	0.043979018	4.275594924	0	1.397375564	0.879548284	0.489229145	1.156520146	2.365618674	0	2.718163067	0	0.002960773	0.035379173	2.872333409	15.53483277	0.635203183	1.255002463	0	0.026471878	2.020019088	1.640177785	0	20.4331587	0.222700113	0	0	0	0	0.144	0	0	0	0	0	0	0	0	0	0	61.3977
H2960_012_0	2011	10																															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	YES	1382.400557	55.66908929	1167.793399	958.4442171	10.67044488	8.5757179	2.228725003	455.9145871	425.7595286	196.7589865	728.8201304	0	0.001371267	559.6757537	4161.866199	9380.208847	239.9937687	461.4197667	1671.162282	2719.502911	5.620187101	152.7470517	0.536052691	0	146.6256027	221.6	0	0	12500.38406	100											3250	PBP: 1A IP Acute: $150 per day (days 1-5)	1B IP Psych: $150 per day (days 1-5)	2 SNF: $50 per day for days 16-100; $150 per day for days 101-125	6 Home Health: $0	10A Ambulance: 20%	11A DME: 20%	11B Prosthetic and Medical Supplies: 20%	"4A ER: $50, 4B Urgent Care: $25/$50"	"9B ASC Services including Colonoscopies: $150, 9A OP Hosp - Surgery including Colonoscopies $150"	8A OP Lab: $0	"8B: $50 Routine Imaging, $55 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, 9A Colorectal Screening: $0, 9c Substance Abuse: $40"	"7A PCP: $10, 14B Immunizations: $0, separate office visit copay applies,  14C Phsycial Exams: $0, 14D Pap/Pelvic: $0, separate office visit copay applies, 14E Prostate Screening: $0, separate office visit copay applies, 14F Colorectal Screening: $0, 14G B"	"7B Chiropractic: $40, 7D Physician Specialist (Except Colonoscopies, Surgery, Anesthesia and Lab): $40, 7D Physcian Colonoscopies, Surgery, Anesthesia and Lab: $0, 7F Podiatry: $40"	"7E Mental Health: $40, 7H Psychiatric: $40, 9C OP Substance Abuse: $40"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $0	"7G Allergy, Immunotherapy, Consultations: $0, 7G Dialysis: 20%"	15 Part B Drugs: 20%	"13A Blood: 20%, 17A Medicare Covered Eye Exams: $20, 17B Medicare Covered Lens/Frames: $0, 18A Medicare Covered Hearing Exams: $40"	10B Transportation: $0	"16A Preventive Dental Services: $0, 16B Additional Comprehensive Dental Coverage: Not Covered"	17A Routine Eye Exams: $20	17B Eye Wear: $100 allowance	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	"14A Flu Shots: $0, Health Education/Wellness Programs: $0, Membership in Health Club $0"	"13B Accupuncture: $20, 13C Over the counter drugs: Not Covered"												96.188239	49.98082527	46.51693696	0	0.2	0.2	0.2	38.11018003	150	0	65.59931854	0	0.2	1.291047606	7.856443235	19.73990961	40	20	0	0.015410317	0.2	50.78227817	0	0	20	0	0	0	0	20											NO	87.0503563	45.23264687	42.09782795	0	0.181	0.181	0.181	34.48971292	135.75	0	59.36738328	0	0.181	1.168398083	7.110081128	17.8646182	36.2	18.1	0	0.013946337	0.181	45.95796175	0	0	18.1	0	0	0	0	18.1												10.0282	0.209838355	4.096797133	0	1.931350524	1.55220494	0.403399226	1.310363602	4.816404667	0	3.605678669	0	0.000248199	0.054493673	2.46593386	13.96448747	0.723981202	0.695974815	0	0.003160592	1.017253865	0.584995263	0	0	0.221160284	0	0	0	0	0.150833333	0	0	0	0	0	0	0	0	0	0	47.8368		5.021538842	10.0282	0.209838355	4.096797133	0	1.931350524	1.55220494	0.403399226	1.310363602	4.816404667	0	3.605678669	0	0.000248199	0.054493673	2.46593386	13.96448747	0.723981202	0.695974815	0	0.003160592	1.017253865	0.584995263	0	0	0.221160284	0	0	0	0	0.150833333	0	0	0	0	0	0	0	0	0	0	47.8368	NO																																																																																		0			10.0282	0.209838355	4.096797133	0	1.931350524	1.55220494	0.403399226	1.310363602	4.816404667	0	3.605678669	0	0.000248199	0.054493673	2.46593386	13.96448747	0.723981202	0.695974815	0	0.003160592	1.017253865	0.584995263	0	0	0.221160284	0	0	0	0	0.150833333	0	0	0	0	0	0	0	0	0	0	47.8368
H2960_018_0	2011	11																															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	YES	1728.311504	37.50955594	1303.022856	1023.509133	9.218568894	8.033280037	2.715813916	492.0330928	533.226245	243.128589	878.1019591	0	0.003771433	629.9235532	4744.892981	11367.34705	237.725539	620.4576361	2015.682079	3279.159528	9.527341352	200.8659776	1.474320073	57.10083495	167.6002693	192.64	0	0	12531.67922	100											3000	PBP: 1A IP Acute: $100 per day (days 1-3)	1B IP Psych: $100 per day (days 1-3)	2 SNF: $50 per day for days 21-100; $150 per day for days 101-125	6 Home Health: $0	10A Ambulance: 20%	11A DME: 15%	11B Prosthetic and Medical Supplies: 15%	"4A ER: $50, 4B Urgent Care: $20/$40"	"9B ASC Services including Colonoscopies: $100, 9A OP Hosp - Surgery including Colonoscopies $100"	8A OP Lab: $0	"8B: $30 Routine Imaging, $50 Radiation Theray, $50 CT, $70 PET, MRI, and Nuclear Medicine"	5 Partial Hosp: $40	12 Renal Dialysis: 20%	"3 CORF: $50, 9D Cardiac Rehab: $15, 9A Colorectal Screening: $0, 9c Substance Abuse: $40"	"7A PCP: $10, 14B Immunizations: $0, separate office visit copay applies,  14C Phsycial Exams: $0, 14D Pap/Pelvic: $0, separate office visit copay applies, 14E Prostate Screening: $0, separate office visit copay applies, 14F Colorectal Screening: $0, 14G B"	"7B Chiropractic: $35, 7D Physician Specialist (Except Colonoscopies, Surgery, Anesthesia and Lab): $35, 7D Physcian Colonoscopies, Surgery, Anesthesia and Lab: $0, 7F Podiatry: $35"	"7E Mental Health: $35, 7H Psychiatric: $35, 9C OP Substance Abuse: $35"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $0	"7G Allergy, Immunotherapy, Consultations: $0, 7G Dialysis: 20%"	15 Part B Drugs: 20%	"13A Blood: 20%, 17A Medicare Covered Eye Exams: $20, 17B Medicare Covered Lens/Frames: $0, 18A Medicare Covered Hearing Exams: $40"	10B Transportation: $0	"16A Preventive Dental Services: Not Covered, 16B Additional Comprehensive Dental Coverage: Covered"	17A Routine Eye Exams: $20	17B Eye Wear: $125 allowance	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: $600 allowance every 36 months	"14A Flu Shots: $0, Health Education/Wellness Programs: $0, Membership in Health Club $0"	"13B Accupuncture: $20, 13C Over the counter drugs: Not Covered"												45.7230968	25.17923966	42.5096518	0	0.2	0.15	0.15	34.85599177	100	0	44.61087223	0	0.2	0.989781353	7.724551687	17.98264099	35	20	0	0.0351498	0.2	48.71453252	0	0.37	20	0	0	0	0	20											NO	40.87644854	22.51024026	38.00362871	0	0.1788	0.1341	0.1341	31.16125664	89.4	0	39.88211977	0	0.1788	0.884864529	6.905749208	16.07648104	31.29	17.88	0	0.031423921	0.1788	43.55079207	0	0.33078	17.88	0	0	0	0	17.88												5.8873	0.070362426	4.126633069	0	1.648280118	1.077262853	0.364190646	1.277697457	3.972535526	0	2.918380626	0	0.000674332	0.046449751	2.730586745	15.22891161	0.619869343	0.924481878	0	0.008587004	1.703488634	0.728989369	0	18.88781418	0.249724401	0	0	0	0	0.149	0	0	0	0	0	0	0	0	0	0	62.6212		7.424883785	5.8873	0.070362426	4.126633069	0	1.648280118	1.077262853	0.364190646	1.277697457	3.972535526	0	2.918380626	0	0.000674332	0.046449751	2.730586745	15.22891161	0.619869343	0.924481878	0	0.008587004	1.703488634	0.728989369	0	18.88781418	0.249724401	0	0	0	0	0.149	0	0	0	0	0	0	0	0	0	0	62.6212	NO																																																																																		0			5.8873	0.070362426	4.126633069	0	1.648280118	1.077262853	0.364190646	1.277697457	3.972535526	0	2.918380626	0	0.000674332	0.046449751	2.730586745	15.22891161	0.619869343	0.924481878	0	0.008587004	1.703488634	0.728989369	0	18.88781418	0.249724401	0	0	0	0	0.149	0	0	0	0	0	0	0	0	0	0	62.6212
H2960_803_0	2011	6																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																																																											0	YES	129.5669671	1.52520843	25.0217299	6.222850394	5.429684709	5.241740488	1.583840535	10.58831681	36.79848898	1.259710779	30.19081036	0	0	2.487694104	19.99374684	72.03178231	1.076961953	1.603647721	12.02637048	38.11378839	5.934007279	2.429601337																			3400	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0	0.072900439	0.072900439	0.150134603	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																			NO	0.065974897	0.065974897	0.135871816	0	0.210865	0.210865	0.210865	0.210865	0.210865	0.210865	0.210865	0	0	0.210865	0.210865	0.210865	0.210865	0.210865	0.210865	0.210865	0.210865	0.210865																				8.5482	0.10062547	3.399747884	0	1.144930466	1.105299608	0.333976534	2.232705425	7.759513379	0.265628913	6.366185227	0	0	0.524567617	4.215981427	15.18898178	0.227093582	0.338153177	2.53594061	8.03686399	1.251274445	0.512317886	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.088	0	6.727464865	8.5482	0.10062547	3.399747884	0	1.144930466	1.105299608	0.333976534	2.232705425	7.759513379	0.265628913	6.366185227	0	0	0.524567617	4.215981427	15.18898178	0.227093582	0.338153177	2.53594061	8.03686399	1.251274445	0.512317886	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.088	NO																																																																																		0	0	0	8.5482	0.10062547	3.399747884	0	1.144930466	1.105299608	0.333976534	2.232705425	7.759513379	0.265628913	6.366185227	0	0	0.524567617	4.215981427	15.18898178	0.227093582	0.338153177	2.53594061	8.03686399	1.251274445	0.512317886	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.088
H2997_003_0	2011	8	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	V	Coin	Coin	V	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	1556.350071	76.8003143	290.4130786	292.896919	166.563025	15.32780205	2.778214358	280.2575767	392.6505317	52.53259508	14.65214753	72.1550822	0.010225045	91.5404674	3437.744352	3661.271754	10.75924241	1215.041791	32.59150984	1005.209241	30.38406164	0.253377012	0	0	0	0	129.6	0	5639.942574	0	3.522085909	14.65513553	162.8954625	0	0	0	0	0	0	0		1A: $268/day (days1-6) no yrly max	1B: $268/day (days1-6) no yrly max	2: $120/day (for days 21-100)	6: $0 copay	10A: $150 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $45 copay	9A: $40-$268 copay; 9B: $240 copay	8A: 0%-30% coin	8B: 30% coinsurance	9A: $268 copay	12: 20% coin	3: $40 copay; 5: $40 copay; 9C: $40 copay; 9D: $40 copay	7A: $0 copay; 7G: $0 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $40 copay; 7F: $40 copay; 7G: $40 copay	7E: $40 copay; 7H: $40 copay	7C: $40-$50 copay; 7I: $40-$50 copay	8B: 30% coinsurance	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$40; 18A: $40	15: 20% coinsurance	13A: 10% coin	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	18A: $40 copay	18B: OSB	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay; 17B: $0 copay									268	268	120	0	150	0.2	0.2	49.90319057	195.3722219	0.203026158	0.3	268	0.2	40	0	37.27504581	40	44.15516334	0.3	19.86495908	0.2	0.1	0	0	0	0	40	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	154.8196129	125.663622	109.4455622	0	136.8069527	0.18240927	0.18240927	45.51402288	178.1885221	0.185169266	0.273613905	244.4284222	0.18240927	36.48185406	0	33.99656953	36.48185406	40.27155562	0.273613905	18.11776345	0.18240927	0.091204635	0	0	0	0	40	0	0	0	0.18240927	0.18240927	0	0	0	0	0	0	0	0		20.0795	0.804250472	2.648701888	0	1.89891499	2.795933187	0.506772054	1.062970813	5.83048483	9.727422084	4.009031308	1.469729408	0.001865143	0.278297164	0	10.37255665	0.032709759	4.077635257	8.91749029	1.517678603	5.542334512	0.023109158	0	0	0	0	0.432	0	0	0	0.64246112	2.673232577	0	0	0	0	0	0	0	0	85.345		8.188631806	20.0795	0.804250472	2.648701888	0	1.89891499	2.795933187	0.506772054	1.062970813	5.83048483	9.727422084	4.009031308	1.469729408	0.001865143	0.278297164	0	10.37255665	0.032709759	4.077635257	8.91749029	1.517678603	5.542334512	0.023109158	0	0	0	0	0.432	0	0	0	0.64246112	2.673232577	0	0	0	0	0	0	0	0	85.345	YES	1A: $268/day (days1-6) no yrly max	1B: $268/day (days1-6) no yrly max	2: 25% coin (for days 1-100)	6: 10% coin	10A: $150 copay	11A: 30% coin	11B: 30% coin; 11C: 30% coin	4A: $50 copay; 4B: $45 copay	9A: $40-$290 copay; 9B: $240 copay	8A: 0%-30% coin	8B: 30% coin	9A: $290 copay	12: 20% coin	3: $40 copay; 5: $40 copay; 9C: $40 copay; 9D: $40 copay	7A: $30 copay; 7G: $30 copay; 14B: $0 copay; 14C: $40 copay	7B: $40 copay; 7D: $40 copay; 7F: $40 copay; 7G: $40 copay	7E: $40 copay; 7H: $40 copay	7C: $40-$80 copay; 7I: $40-$80 copay	8B: 30% coin	14D: $40; 14E: $40; 14F: $40; 14G: $40; 14H: $40; 17A: $40; 18A: $40	15: 25% coinsurance	13A: 20% coin	10B: Not covered	16A: OSB	17A: OSB	17B: OSB	18A: $40 copay	18B: OSB	14A: $0 copay or not covd;  Silver Sneakers		8B: 25% coinsurance	8B: 25% coinsurance	14I: 20% coin; 14J: 0% coin; 17B: 20% coin								6000	4.71	0.1887	1.3179	0.1205	0.4454	0.9838	0.1783	0.2493	1.4273	2.2817	0.9404	0.3731	0.0004	0.0653	1.7169	2.6109	0.0077	1.2265	2.0918	0.7168	1.6251	0.0108	0	0	0	0	0.108	0	0	0	0.1884	0.7838	0.0188	0	0	0	0	0	0	0	24.3875		2.341407745	24.7895	0.992901817	3.966562093	0.120507326	2.344339494	3.779687456	0.685080739	1.312309646	7.257758687	12.00916307	4.949421368	1.842781234	0.002302646	0.343576746	1.716865574	12.9834925	0.040382419	5.304143125	11.00924727	2.234516092	7.16740173	0.033950491	0	0	0	0	0.54	0	0	0	0.830837066	3.457050771	0.018825424	0	0	0	0	0	0	0	109.7326
H2997_803_0	2011	7																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	288.4839882	3.454106899	46.76333213	9.755274585	7.789721903	15.63702511	3.947021361	13.2686964	51.91134239	6.571245551	27.43698494	0	0.024127367	33.5680791	51.96032593	143.0703641	1.383922914	5.503017931	21.62459143	26.10940488	50.38481346	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.068453168	0.068453168	0.139110346	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.054306931	0.054306931	0.1103624	0	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643																				15.6667	0.187581945	5.160913566	0	1.295931633	2.601442741	0.656643447	2.207437391	8.63619415	1.093220668	4.5645348	0	0.004013932	5.584529988	8.644343263	23.80180101	0.230235367	0.915505727	3.59756002	4.343672872	8.382234233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5745		25.41686063	15.6667	0.187581945	5.160913566	0	1.295931633	2.601442741	0.656643447	2.207437391	8.63619415	1.093220668	4.5645348	0	0.004013932	5.584529988	8.644343263	23.80180101	0.230235367	0.915505727	3.59756002	4.343672872	8.382234233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5745	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.7407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.7407		2.824095625	17.4074	0.187581945	5.160913566	0	1.295931633	2.601442741	0.656643447	2.207437391	8.63619415	1.093220668	4.5645348	0	0.004013932	5.584529988	8.644343263	23.80180101	0.230235367	0.915505727	3.59756002	4.343672872	8.382234233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3152
H2997_804_0	2011	7																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	288.4839882	3.454106899	46.76333213	9.755274585	7.789721903	15.63702511	3.947021361	13.2686964	51.91134239	6.571245551	27.43698494	0	0.024127367	33.5680791	51.96032593	143.0703641	1.383922914	5.503017931	21.62459143	26.10940488	50.38481346	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.068453168	0.068453168	0.139110346	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.054306931	0.054306931	0.1103624	0	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643																				15.6667	0.187581945	5.160913566	0	1.295931633	2.601442741	0.656643447	2.207437391	8.63619415	1.093220668	4.5645348	0	0.004013932	5.584529988	8.644343263	23.80180101	0.230235367	0.915505727	3.59756002	4.343672872	8.382234233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5745		25.41686063	15.6667	0.187581945	5.160913566	0	1.295931633	2.601442741	0.656643447	2.207437391	8.63619415	1.093220668	4.5645348	0	0.004013932	5.584529988	8.644343263	23.80180101	0.230235367	0.915505727	3.59756002	4.343672872	8.382234233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5745	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.7407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.7407		2.824095625	17.4074	0.187581945	5.160913566	0	1.295931633	2.601442741	0.656643447	2.207437391	8.63619415	1.093220668	4.5645348	0	0.004013932	5.584529988	8.644343263	23.80180101	0.230235367	0.915505727	3.59756002	4.343672872	8.382234233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3152
H2997_805_0	2011	7																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	288.4839882	3.454106899	46.76333213	9.755274585	7.789721903	15.63702511	3.947021361	13.2686964	51.91134239	6.571245551	27.43698494	0	0.024127367	33.5680791	51.96032593	143.0703641	1.383922914	5.503017931	21.62459143	26.10940488	50.38481346	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.068453168	0.068453168	0.139110346	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.054306931	0.054306931	0.1103624	0	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643																				15.6667	0.187581945	5.160913566	0	1.295931633	2.601442741	0.656643447	2.207437391	8.63619415	1.093220668	4.5645348	0	0.004013932	5.584529988	8.644343263	23.80180101	0.230235367	0.915505727	3.59756002	4.343672872	8.382234233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5745		25.41686063	15.6667	0.187581945	5.160913566	0	1.295931633	2.601442741	0.656643447	2.207437391	8.63619415	1.093220668	4.5645348	0	0.004013932	5.584529988	8.644343263	23.80180101	0.230235367	0.915505727	3.59756002	4.343672872	8.382234233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5745	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.7407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.7407		2.824095625	17.4074	0.187581945	5.160913566	0	1.295931633	2.601442741	0.656643447	2.207437391	8.63619415	1.093220668	4.5645348	0	0.004013932	5.584529988	8.644343263	23.80180101	0.230235367	0.915505727	3.59756002	4.343672872	8.382234233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3152
H2997_806_0	2011	7																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	288.4839882	3.454106899	46.76333213	9.755274585	7.789721903	15.63702511	3.947021361	13.2686964	51.91134239	6.571245551	27.43698494	0	0.024127367	33.5680791	51.96032593	143.0703641	1.383922914	5.503017931	21.62459143	26.10940488	50.38481346	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.068453168	0.068453168	0.139110346	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.054306931	0.054306931	0.1103624	0	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643	0.1663643																				15.6667	0.187581945	5.160913566	0	1.295931633	2.601442741	0.656643447	2.207437391	8.63619415	1.093220668	4.5645348	0	0.004013932	5.584529988	8.644343263	23.80180101	0.230235367	0.915505727	3.59756002	4.343672872	8.382234233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5745		25.41686063	15.6667	0.187581945	5.160913566	0	1.295931633	2.601442741	0.656643447	2.207437391	8.63619415	1.093220668	4.5645348	0	0.004013932	5.584529988	8.644343263	23.80180101	0.230235367	0.915505727	3.59756002	4.343672872	8.382234233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5745	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.7407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.7407		2.824095625	17.4074	0.187581945	5.160913566	0	1.295931633	2.601442741	0.656643447	2.207437391	8.63619415	1.093220668	4.5645348	0	0.004013932	5.584529988	8.644343263	23.80180101	0.230235367	0.915505727	3.59756002	4.343672872	8.382234233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3152
H3028_001_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin		V	V				O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0				0	0	0	0									0	YES	1145.307328	38.0064181	340.0075241	759.7825515	196.0178698	10.00217215	1.316183084	390.1866219	293.6539808	2006.426097	1257.520224	130.8466462	0.164930995	1918.168597	3884.133303	3253.012424	55.29881296	591.2230731		1284.359062	19.40205994	0		2.5	1.65				3.15	1.48	644.9189004	0.638237169									2900	$125/Day(Days 1-5):1a.IP Acute	$125/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $100(Days 21-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$50/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$150/Visit:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"$20-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $100 OP Other,5. $20 Partial Hospitalization,7h. $100 Psych -- OP,8b. $50 Rad therapy,3, 7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$20/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$20-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										77.389	62.301375	33.0247	0	50	0.2	0.087955	50	90.738696	0	81.585577	100	0.2	93.395086	0	20	20	49.816623		0	0.2	0		0	0				0	0	0	0									NO	69.962519	56.322748	26.454964	0	44.272	0.177088	0.077879	44.272	80.343671	0	72.239134	88.544	0.177088	82.695745	0	17.7088	17.7088	44.10963		0	0.177088	0		0	0				0	0	0	0										6.6774	0.178385492	0.749573901	0	0.723175261	1.771264662	0.102503022	1.43952851	1.966103235	0	7.570180999	0.965473787	0.0292073	13.21869843	0	4.800578868	0.081606302	2.17321925	0	0	3.43587199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8828	0	5.866290451	6.6774	0.178385492	0.749573901	0	0.723175261	1.771264662	0.102503022	1.43952851	1.966103235	0	7.570180999	0.965473787	0.0292073	13.21869843	0	4.800578868	0.081606302	2.17321925	0	0	3.43587199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8828	NO																																																																																		0	0	0	6.6774	0.178385492	0.749573901	0	0.723175261	1.771264662	0.102503022	1.43952851	1.966103235	0	7.570180999	0.965473787	0.0292073	13.21869843	0	4.800578868	0.081606302	2.17321925	0	0	3.43587199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8828
H3028_801_0	2011	2																															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	YES	235.335381	3.301234	24.186543	13.069619	5.914839	7.532835	2.65947	21.446285	39.779497	4.295778	23.28257	4.128256	0.416858	8.001762	31.031425	56.205315	0.387112	4.293335		6.105103	25.534153	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07655	0.07655	0.168059	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.072507	0.072507	0.138523	0	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499		0.219499	0.219499	0																				17.0635	0.239362574	3.350392496	0	1.298301246	1.65344975	0.583751006	4.707438111	8.731559812	0.942918975	5.110500832	0.906148064	0.091499914	1.756378757	6.811366756	12.33701044	0.084970697	0.942382739	0	1.340064003	5.604721049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5557	0	4.933001132	17.0635	0.239362574	3.350392496	0	1.298301246	1.65344975	0.583751006	4.707438111	8.731559812	0.942918975	5.110500832	0.906148064	0.091499914	1.756378757	6.811366756	12.33701044	0.084970697	0.942382739	0	1.340064003	5.604721049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5557	NO																																																																																		0	0	0	17.0635	0.239362574	3.350392496	0	1.298301246	1.65344975	0.583751006	4.707438111	8.731559812	0.942918975	5.110500832	0.906148064	0.091499914	1.756378757	6.811366756	12.33701044	0.084970697	0.942382739	0	1.340064003	5.604721049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5557
H3028_803_0	2011	2																															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	YES	235.335381	3.301234	24.186543	13.069619	5.914839	7.532835	2.65947	21.446285	39.779497	4.295778	23.28257	4.128256	0.416858	8.001762	31.031425	56.205315	0.387112	4.293335		6.105103	25.534153	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07655	0.07655	0.168059	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.072507	0.072507	0.138523	0	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499		0.219499	0.219499	0																				17.0635	0.239362574	3.350392496	0	1.298301246	1.65344975	0.583751006	4.707438111	8.731559812	0.942918975	5.110500832	0.906148064	0.091499914	1.756378757	6.811366756	12.33701044	0.084970697	0.942382739	0	1.340064003	5.604721049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5557	0	4.933001132	17.0635	0.239362574	3.350392496	0	1.298301246	1.65344975	0.583751006	4.707438111	8.731559812	0.942918975	5.110500832	0.906148064	0.091499914	1.756378757	6.811366756	12.33701044	0.084970697	0.942382739	0	1.340064003	5.604721049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5557	NO																																																																																		0	0	0	17.0635	0.239362574	3.350392496	0	1.298301246	1.65344975	0.583751006	4.707438111	8.731559812	0.942918975	5.110500832	0.906148064	0.091499914	1.756378757	6.811366756	12.33701044	0.084970697	0.942382739	0	1.340064003	5.604721049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5557
H3028_804_0	2011	2																															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	YES	235.335381	3.301234	24.186543	13.069619	5.914839	7.532835	2.65947	21.446285	39.779497	4.295778	23.28257	4.128256	0.416858	8.001762	31.031425	56.205315	0.387112	4.293335		6.105103	25.534153	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07655	0.07655	0.168059	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.072507	0.072507	0.138523	0	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499	0.219499		0.219499	0.219499	0																				17.0635	0.239362574	3.350392496	0	1.298301246	1.65344975	0.583751006	4.707438111	8.731559812	0.942918975	5.110500832	0.906148064	0.091499914	1.756378757	6.811366756	12.33701044	0.084970697	0.942382739	0	1.340064003	5.604721049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5557	0	4.933001132	17.0635	0.239362574	3.350392496	0	1.298301246	1.65344975	0.583751006	4.707438111	8.731559812	0.942918975	5.110500832	0.906148064	0.091499914	1.756378757	6.811366756	12.33701044	0.084970697	0.942382739	0	1.340064003	5.604721049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5557	NO																																																																																		0	0	0	17.0635	0.239362574	3.350392496	0	1.298301246	1.65344975	0.583751006	4.707438111	8.731559812	0.942918975	5.110500832	0.906148064	0.091499914	1.756378757	6.811366756	12.33701044	0.084970697	0.942382739	0	1.340064003	5.604721049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5557
H3044_001_0	2011	9																															D	D	D		T	Coin	Coin	V	V	V	Coin			V	V	V	V	V	Coin	P	Coin	Coin			V	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	YES	1154.97129	18.85579146	734.2713512	0	223.0215501	6.220510317	3.133827656	211.2211247	305.4722157	734.0956224	8.525666861	0	0	893.2945335	4373.004073	3594.428232	157.7805013	462.8097976	27.89223158	4820.588974	24.57949935	0.022905532	0	0	119.5745031	110.9375593	90.47198995	0	0	0											3400	$150/Days 1-10 for IP Medical; $150/Days 1-10 for IP Surgical; PBP 1a	$150/Days 1-10 for IP Psych; $150/Days 1-10 for IP Substance Abuse; PBP 1b	$90/Days 11-50 for SNF; PBP 2	No Cost-Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; $15/Unit for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $50/Visit for PCP Urgent Care; $50/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$125/Case for OP Fac - Surgery; PBP 9a, 9b"	$15/Case for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"$125/Visit for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $35/Visit for OP Fac - Physical/Speech Therapy; $35/Visit for OP Fac - CORF; $50/Day for Partial Hosp; $35/Case for OP Fac - Other; $35/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP Office Visits; $15/Consult for PCP Consults; PBP 7a, 14b, 14c"	"$35/Visit for Speclst Office Visits; $35/Consult for Speclst Consults; $15/Visit for Chiropractor; $25/Visit for Vision Exams; $35/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $55/Visit for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $35/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d	"$5/Visit for Allergy Tx; $35/visit for Specialist Other - Prof; $35/Visit for Cardio; $15/Visit for Prof Path (OP); $15/Procedure for Prof Path (Office); PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"20% Coinsurance for Blood; PBP 13a, 14a"	PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$25/Exam for Vision (Refractions); PBP 17a	$25/Service for Vision Hardware; PBP 17b	$35/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b-f											0	150	150	90	0	150	0.2	0.213110456	50	125	15.41156335	0.2	0	0	43.73333443	15	32.46724304	35.69480477	42.43610563	0.2	16.69084691	0.2	0.2	0	0	25	25	35	0	0	0											NO	134.7010844	134.7010844	80.82065067	0	134.7010844	0.179601446	0.19137473	44.90036148	112.2509037	13.83969531	0.179601446	0	0	39.2728505	13.48747991	29.15581898	32.05419275	38.10792965	0.179601446	14.9885012	0.179601446	0.179601446	0	0	25	25	31.43025304	0	0	0												12.9647	0.211657963	4.945357365	0	2.503437055	1.117212647	0.599735422	0.790325404	2.857461022	0.846638312	1.531222096	0	0	2.923518555	4.915067049	8.733208239	0.42146055	1.469726934	5.009485121	6.021116968	4.414513624	0.004113867	0	0	0.249113548	0.231119915	0.236963128	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9971	0	7.093416351	12.9647	0.211657963	4.945357365	0	2.503437055	1.117212647	0.599735422	0.790325404	2.857461022	0.846638312	1.531222096	0	0	2.923518555	4.915067049	8.733208239	0.42146055	1.469726934	5.009485121	6.021116968	4.414513624	0.004113867	0	0	0.249113548	0.231119915	0.236963128	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9971	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.9647	0.211657963	4.945357365	0	2.503437055	1.117212647	0.599735422	0.790325404	2.857461022	0.846638312	1.531222096	0	0	2.923518555	4.915067049	8.733208239	0.42146055	1.469726934	5.009485121	6.021116968	4.414513624	0.004113867	0	0	0.249113548	0.231119915	0.236963128	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9971
H3044_002_0	2011	7																															D	D	D		T	Coin	Coin	V	V	V	Coin			V	V	V	V	V	Coin	P	Coin	Coin			V	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	YES	1163.169907	15.60757776	869.6770286	0	209.5093541	8.089365675	4.661163201	232.8497686	367.4216722	1027.888117	12.44614414	0	0	1246.168306	4394.872126	4280.296612	110.4010182	438.0307158	23.01134925	5509.936734	33.60751884	0	0	0	173.0714244	140.2758337	120.2998169	0	0	0											3400	$150/Days 1-10 for IP Medical; $150/Days 1-10 for IP Surgical; PBP 1a	$150/Days 1-10 for IP Psych; $150/Days 1-10 for IP Substance Abuse; PBP 1b	$90/Days 11-50 for SNF; PBP 2	No Cost-Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; $15/Unit for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $50/Visit for PCP Urgent Care; $50/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$125/Case for OP Fac - Surgery; PBP 9a, 9b"	$15/Case for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"$125/Visit for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $35/Visit for OP Fac - Physical/Speech Therapy; $35/Visit for OP Fac - CORF; $50/Day for Partial Hosp; $35/Case for OP Fac - Other; $35/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP Office Visits; $15/Consult for PCP Consults; PBP 7a, 14b, 14c"	"$35/Visit for Speclst Office Visits; $35/Consult for Speclst Consults; $15/Visit for Chiropractor; $25/Visit for Vision Exams; $35/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $55/Visit for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $35/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d	"$5/visit for Allergy Tx; $35/visit for Specialist Other - Prof; $35/Visit for Cardio; $15/Visit for Prof Path (OP); $15/Procedure for Prof Path (Office); PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"20% Coinsurance for Blood; PBP 13a, 14a"	PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$25/Exam for Vision (Refractions); PBP 17a	$25/Service for Vision Hardware; PBP 17b	$35/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b-f											0	150	150	90	0	150	0.2	0.205891019	50	125	15.01088719	0.2	0	0	44.00647851	15	32.42158932	36.38515163	42.44131837	0.2	17.20677081	0.2	0	0	0	25	25	35	0	0	0											NO	132.2881634	132.2881634	79.37289805	0	132.2881634	0.176384218	0.181579631	44.09605447	110.2401362	13.23841798	0.176384218	0	0	38.81024147	13.25959483	28.59328337	32.08883256	37.42989373	0.176384218	15.17501406	0.176384218	0	0	0	25	25	30.86723813	0	0	0												12.8228	0.17205815	5.752398843	0	2.309633972	1.426836438	0.846372296	0.85564634	3.375384598	1.133967711	2.195303399	0	0	4.030341073	4.856185311	10.19897783	0.295219982	1.366286929	4.058838839	6.967780618	5.927835925	0	0	0	0.360565468	0.29224132	0.309443591	0	0	0	0	0	0	0	0	0	0	0	0	0	69.5541	0	9.212297732	12.8228	0.17205815	5.752398843	0	2.309633972	1.426836438	0.846372296	0.85564634	3.375384598	1.133967711	2.195303399	0	0	4.030341073	4.856185311	10.19897783	0.295219982	1.366286929	4.058838839	6.967780618	5.927835925	0	0	0	0.360565468	0.29224132	0.309443591	0	0	0	0	0	0	0	0	0	0	0	0	0	69.5541	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.8228	0.17205815	5.752398843	0	2.309633972	1.426836438	0.846372296	0.85564634	3.375384598	1.133967711	2.195303399	0	0	4.030341073	4.856185311	10.19897783	0.295219982	1.366286929	4.058838839	6.967780618	5.927835925	0	0	0	0.360565468	0.29224132	0.309443591	0	0	0	0	0	0	0	0	0	0	0	0	0	69.5541
H3044_003_0	2011	11																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	P	V	Coin				V	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	YES	1127.295632	22.97103858	653.0608314	0	213.9226641	7.887932067	2.224165885	168.1484402	297.3426174	0	218.7062832	0	0	226.8787712	4895.842788	3935.871837	264.7158753	751.7274745	3911.007334	4942.852494	27.07882236	0	0	0	80.64962292	79.26362343	77.86668617	0	0	0											3200	$125/Days 1-8 for IP Medical; $125/Days 1-8 for IP Surgical; PBP 1a	$125/Days 1-8 for IP Psych; $125/Days 1-8 for IP Substance Abuse; PBP 1b	$50/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; $5/Service for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for ER - Facility; $50/Case for ER - Worldwide; $35/Visit for PCP Urgent Care; $35/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$95/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	"$15/Case for OP Fac - Radiology; $35/Case for OP Fac - Diag Radiology, $55/Case for OP Fac - Ther. Radiology; PBP 8b"	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"$95/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; $25/Day for OP Fac - CORF; $50/Day for Partial Hosp; $25/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; PBP 7a, 14b, 14c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; $15/Visit for Chiropractor; $25/Visit for Vision Exams; $25/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"$15/Procedure for Prof Radiology (OP); $35/Case for OP Fac - Diag Radiology, $55/Case for OP Fac - Ther. Radiology; $15/Procedure for Prof Radiology (Office); $35/Case for OP Fac - Diag Radiology, $55/Case for OP Fac - Ther. Radiology; PBP 7d"	"$5/Visit for Allergy Tx; $25/Visit for Specialist Other - Prof; $25/Visit for Cardio; PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"No Cost-Sharing; PBP 13a, 14a"	PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$25/Exam for Vision (Refractions); PBP 17a	$25/Service for Vision Hardware; PBP 17b	$25/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b-f											0	125	125	50	0	100	0.2	0.198106754	44.74805113	95	0	22.04066047	0	0	39.6250895	15	24.03776735	25	25	21.51989627	24.90381575	0.2	0	0	0	25	25	25	0	0	0											NO	114.3976408	114.3976408	45.75905633	0	91.51811267	0.183036225	0.181303562	40.95257185	86.94220703	0	20.17119648	0	0	36.26413405	13.73632486	21.99891101	22.87952817	22.87952817	19.69460292	22.79150216	0.183036225	0	0	0	25	25	22.87952817	0	0	0												10.7467	0.218986052	2.490287281	0	1.631483206	1.443777311	0.403249197	0.57384259	2.15430195	0	0.367630618	0	0	0.685630181	5.604240584	7.215407856	0.504714527	1.433264161	6.418811371	9.387919441	4.956405431	0	0	0	0.168020048	0.165132549	0.148462753	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7182	0	5.221924607	10.7467	0.218986052	2.490287281	0	1.631483206	1.443777311	0.403249197	0.57384259	2.15430195	0	0.367630618	0	0	0.685630181	5.604240584	7.215407856	0.504714527	1.433264161	6.418811371	9.387919441	4.956405431	0	0	0	0.168020048	0.165132549	0.148462753	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7182	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.7467	0.218986052	2.490287281	0	1.631483206	1.443777311	0.403249197	0.57384259	2.15430195	0	0.367630618	0	0	0.685630181	5.604240584	7.215407856	0.504714527	1.433264161	6.418811371	9.387919441	4.956405431	0	0	0	0.168020048	0.165132549	0.148462753	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7182
H3044_004_0	2011	11																															D	D	D					V			V			V		V	V	V	P	V	Coin				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	741.8179662	16.56697264	495.807131	0	0	0	0	386.2010048	0	0	623.9703319	0	0	505.976276	0	4755.231933	122.4437778	406.654059	1934.874651	951.5545065	48.84030637	0	0	0	307.16897	185.4340778	0	0	0	0											3200	$50/Days 1-5 for IP Medical; $50/Days 1-5 for IP Surgical; PBP 1a	$50/Days 1-5 for IP Psych; $50/Days 1-5 for IP Substance Abuse; PBP 1b	$20/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	No Cost-Sharing; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $25/Visit for PCP Urgent Care; $25/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"No Cost-Sharing; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$30/Case for OP Fac - Radiology; $30/Case for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"$10/Visit for OP Fac - Cardiovascular; $10/Visit for OP Fac - Occ Therapy; $10/Visit for OP Fac - Physical/Speech Therapy; $10/Day for Partial Hosp; $0/Visit for OP Fac - CORF; PBP 3, 5, 9a, 9d"	"No Cost-Sharing; PBP 7a, 14b, 14c"	"$10/Visit for Speclst Office Visits; $10/Consult for Speclst Consults; $10/Visit for Chiropractor; $10/Visit for Podiatry; $10/Visit for Other Health Care Prof; $25/Visit for Vision Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$10/Visit for Occ Therapy; $10/Visit for PT/ST; PBP 7c, 7i"	$30/Procedure for Prof Radiology (OP); $30/Procedure for Prof Radiology (OP); $30/Procedure for Prof Radiology (Office); $30/Procedure for Prof Radiology (Office); PBP 7d	"$5/Visit for Allergy Tx; $10/Visit for Specialist Other - Prof; $10/Visit for Cardio; PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"No Cost-Sharing; PBP 13a, 14a"	PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$25/Exam for Vision (Refractions); PBP 17a	$25/Service for Vision Hardware; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b-f											0	50	50	20	0	0	0	0	48.18221581	0	0	30	0	0	10	0	12.52038002	10	10	30	9.625570304	0.2	0	0	0	25	25	0	0	0	0											YES	46.11070732	46.11070732	18.44428293	0	0	0	0	44.43432103	0	0	27.66642439	0	0	9.222141464	0	11.54647157	9.222141464	9.222141464	27.66642439	8.876837101	0.184442829	0	0	0	25	25	0	0	0	0											3200	2.8505	0.063659569	0.76206725	0	0	0	0	1.430048286	0	0	1.438585667	0	0	0.388848733	0	4.575512527	0.094099487	0.312518438	4.460921938	0.703899529	9.00824429	0	0	0	0.639935354	0.386320995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.1151	0	2.200515135	2.8505	0.063659569	0.76206725	0	0	0	0	1.430048286	0	0	1.438585667	0	0	0.388848733	0	4.575512527	0.094099487	0.312518438	4.460921938	0.703899529	9.00824429	0	0	0	0.639935354	0.386320995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.1151	NO	20% Coinsurance for IP Medical; 20% Coinsurance for IP Surgical; PBP 1a	20% Coinsurance for IP Psych; 20% Coinsurance for IP Substance Abuse; PBP 1b	20% Coinsurance for SNF; PBP 2	No Cost-Sharing; PBP 6	20% Coinsurance for Ambulance; PBP 10a	15% Coinsurance for DME; PBP 11a	"15% Coinsurance for DME / Medical Supplies; 15% Coinsurance for Diabetes Monitoring Supplies; 15% Coinsurance for Prosthetics; PBP 11b, 11c"	"No Cost-Sharing; PBP 4a, 4b"	"20% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"20% Coinsurance for OP Fac - Cardiovascular; 15% Coinsurance for OP Fac - Occ Therapy; 15% Coinsurance for OP Fac - Physical/Speech Therapy; 20% Coinsurance for OP Fac - Other; PBP 3, 5, 9a, 9d"	"No Cost-Sharing; PBP 7a, 14b, 14c"	"15% Coinsurance for Prof - Office Surgery (Specialist); 15% Coinsurance for Speclst Office Visits; 15% Coinsurance for Speclst Consults; 15% Coinsurance for Chiropractor; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"15% Coinsurance for OP Psych - Non-Physician; 15% Coinsurance for OP Psych - Psychiatrist; 20% Coinsurance for OP Substance Abuse; PBP 7e, 7h, 9c"	"15% Coinsurance for Occ Therapy; 15% Coinsurance for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d	"20% Coinsurance for Prof - Primary Surgeon (IP); 20% Coinsurance for Prof - Asst Surgeon (IP); 20% Coinsurance for Prof - Anesthesia (IP); 20% Coinsurance for Prof - Primary Surgeon (OP); 20% Coinsurance for Prof - Anesthesia (OP); 20% Coinsurance for Prof - IP Visits; 15% Coinsurance for Allergy Testing; 15% Coinsurance for Allergy Tx; 15% Coinsurance for Renal Dialysis - Prof; 20% Coinsurance for Cardio; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14d-j"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 13a, 14a"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b-f												17.7166	0.2295	4.5786	0	0.8332	0.6444	0.3927	0	3.2071	0.5724	1.2822	0	0	1.714	0	2.6316	0.0812	0.2735	1.8044	5.7878	0	0	0	0	0	0	0	0	0	0											41.749	0	3.521397655	20.5671	0.293116868	5.340690648	0	0.833175423	0.644385055	0.392662493	1.430048286	3.207087125	0.572369196	2.720805532	0	0	2.102830734	0	7.207062678	0.175254912	0.586063676	6.265319281	6.491682943	9.00824429	0	0	0	0.639935354	0.386320995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.8642
H3044_801_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	181.275881	1.754075169	48.69498017	0	8.20372185	8.476320555	5.380155598	15.7274298	35.18220772	6.37678777	18.40196441	0	0.379865696	23.28880719	24.67489226	34.44349528	0.937637238	3.094540163	15.84933941	64.59947731	31.49728907	0	0	0	0	0	0	0	0	0											3400	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	0.079565027	0.079565027	0.181077582	0	0.233	0.233	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	0.056186488	0.056186488	0.127871677	0	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0	0	0	0	0	0	0	0	0												10.1853	0.098555323	6.22670876	0	1.349822057	1.394674838	0.885238777	2.587756146	5.788801821	1.049222407	3.027818093	0	0.062502253	3.831888281	4.05995162	5.667255726	0.154276735	0.509168722	2.607814881	10.62905361	5.182493543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2983	0	27.16983999	10.1853	0.098555323	6.22670876	0	1.349822057	1.394674838	0.885238777	2.587756146	5.788801821	1.049222407	3.027818093	0	0.062502253	3.831888281	4.05995162	5.667255726	0.154276735	0.509168722	2.607814881	10.62905361	5.182493543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2983	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f												6.7261	0.0871	4.3437	0	0.9496	1.0544	0.6395	1.6879	4.2274	0.769	2.1151	0	0.0407	2.5849	2.0754	4.0185	0.1049	0.364	1.7987	6.7785	3.3022	0	0	0	0	0	0	0	0	0											43.6678	0	0	16.9114	0.185669141	10.57039586	0	2.299421362	2.449075669	1.52473129	4.275609372	10.01619073	1.818237343	5.142959761	0	0.103204507	6.416834598	6.135336644	9.685732353	0.259225521	0.873190693	4.406500471	17.40760311	8.484715417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.966
H3044_802_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	181.275881	1.754075169	48.69498017	0	8.20372185	8.476320555	5.380155598	15.7274298	35.18220772	6.37678777	18.40196441	0	0.379865696	23.28880719	24.67489226	34.44349528	0.937637238	3.094540163	15.84933941	64.59947731	31.49728907	0	0	0	0	0	0	0	0	0											3400	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	0.079565027	0.079565027	0.181077582	0	0.233	0.233	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	0.056186488	0.056186488	0.127871677	0	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0	0	0	0	0	0	0	0	0												10.1853	0.098555323	6.22670876	0	1.349822057	1.394674838	0.885238777	2.587756146	5.788801821	1.049222407	3.027818093	0	0.062502253	3.831888281	4.05995162	5.667255726	0.154276735	0.509168722	2.607814881	10.62905361	5.182493543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2983	0	27.16983999	10.1853	0.098555323	6.22670876	0	1.349822057	1.394674838	0.885238777	2.587756146	5.788801821	1.049222407	3.027818093	0	0.062502253	3.831888281	4.05995162	5.667255726	0.154276735	0.509168722	2.607814881	10.62905361	5.182493543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2983	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f												6.7261	0.0871	4.3437	0	0.9496	1.0544	0.6395	1.6879	4.2274	0.769	2.1151	0	0.0407	2.5849	2.0754	4.0185	0.1049	0.364	1.7987	6.7785	3.3022	0	0	0	0	0	0	0	0	0											43.6678	0	0	16.9114	0.185669141	10.57039586	0	2.299421362	2.449075669	1.52473129	4.275609372	10.01619073	1.818237343	5.142959761	0	0.103204507	6.416834598	6.135336644	9.685732353	0.259225521	0.873190693	4.406500471	17.40760311	8.484715417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.966
H3044_803_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	181.275881	1.754075169	48.69498017	0	8.20372185	8.476320555	5.380155598	15.7274298	35.18220772	6.37678777	18.40196441	0	0.379865696	23.28880719	24.67489226	34.44349528	0.937637238	3.094540163	15.84933941	64.59947731	31.49728907	0	0	0	0	0	0	0	0	0											3400	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	0.079565027	0.079565027	0.181077582	0	0.233	0.233	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	0.056186488	0.056186488	0.127871677	0	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0	0	0	0	0	0	0	0	0												10.1853	0.098555323	6.22670876	0	1.349822057	1.394674838	0.885238777	2.587756146	5.788801821	1.049222407	3.027818093	0	0.062502253	3.831888281	4.05995162	5.667255726	0.154276735	0.509168722	2.607814881	10.62905361	5.182493543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2983	0	27.16983999	10.1853	0.098555323	6.22670876	0	1.349822057	1.394674838	0.885238777	2.587756146	5.788801821	1.049222407	3.027818093	0	0.062502253	3.831888281	4.05995162	5.667255726	0.154276735	0.509168722	2.607814881	10.62905361	5.182493543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2983	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f												6.7261	0.0871	4.3437	0	0.9496	1.0544	0.6395	1.6879	4.2274	0.769	2.1151	0	0.0407	2.5849	2.0754	4.0185	0.1049	0.364	1.7987	6.7785	3.3022	0	0	0	0	0	0	0	0	0											43.6678	0	0	16.9114	0.185669141	10.57039586	0	2.299421362	2.449075669	1.52473129	4.275609372	10.01619073	1.818237343	5.142959761	0	0.103204507	6.416834598	6.135336644	9.685732353	0.259225521	0.873190693	4.406500471	17.40760311	8.484715417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.966
H3044_804_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	181.275881	1.754075169	48.69498017	0	8.20372185	8.476320555	5.380155598	15.7274298	35.18220772	6.37678777	18.40196441	0	0.379865696	23.28880719	24.67489226	34.44349528	0.937637238	3.094540163	15.84933941	64.59947731	31.49728907	0	0	0	0	0	0	0	0	0											3400	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	0.079565027	0.079565027	0.181077582	0	0.233	0.233	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	0.056186488	0.056186488	0.127871677	0	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0.164537765	0	0	0	0	0	0	0	0	0												10.1853	0.098555323	6.22670876	0	1.349822057	1.394674838	0.885238777	2.587756146	5.788801821	1.049222407	3.027818093	0	0.062502253	3.831888281	4.05995162	5.667255726	0.154276735	0.509168722	2.607814881	10.62905361	5.182493543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2983	0	27.16983999	10.1853	0.098555323	6.22670876	0	1.349822057	1.394674838	0.885238777	2.587756146	5.788801821	1.049222407	3.027818093	0	0.062502253	3.831888281	4.05995162	5.667255726	0.154276735	0.509168722	2.607814881	10.62905361	5.182493543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2983	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f												6.7261	0.0871	4.3437	0	0.9496	1.0544	0.6395	1.6879	4.2274	0.769	2.1151	0	0.0407	2.5849	2.0754	4.0185	0.1049	0.364	1.7987	6.7785	3.3022	0	0	0	0	0	0	0	0	0											43.6678	0	0	16.9114	0.185669141	10.57039586	0	2.299421362	2.449075669	1.52473129	4.275609372	10.01619073	1.818237343	5.142959761	0	0.103204507	6.416834598	6.135336644	9.685732353	0.259225521	0.873190693	4.406500471	17.40760311	8.484715417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.966
H3107_004_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1528.328056	102.7718775	1324.749934	2351.731216	173.9593723	1.02155619	9.712869954	275.5948775	861.7327509	18.43301123	47.03073236	0	0.082819672	446.2930424	5424.087897	123.1488606	432.3247537	662.8875092	0	0	37.06506134	1815.17069	0	435.2068595	74.65446398	87.39632894	28.96614171	15.83621167	81.19658634	0											6700	"$195 Days 1-9 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$195 Days 1-9 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$75 Days 21-96 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$175 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $175 (9a); $40 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0/$35 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												157.2686053	112.2768957	57.03421397	0	200	0.2	0.095654508	49.5660643	175	0.088510437	0.153824079	0	0.2	69.07291037	10.21334085	0.139858498	40	35	0	0	0.2	34.74604826	0	0	0	0	0	0	0	0											NO	114.2096316	81.53631726	41.41867065	0	145.2414885	0.145241488	0.069465016	36.02031712	127.0863024	0.064276938	0.111708191	0	0.145241488	50.16126157	9.749826814	0.133512676	38.18467223	33.4115882	0	0	0.145241488	25.23283884	0	0	0	0	0	0	0	0												14.5458	0.698303367	4.572448435	0	2.105509847	0.148372342	0.674704664	0.82725124	9.126202414	1.184817523	5.253718015	0	0.012028852	1.865551836	4.406993135	16.44193391	1.375681585	1.84567704	0	0	5.383384679	3.816825789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2852	0	20.07522972	14.5458	0.698303367	4.572448435	0	2.105509847	0.148372342	0.674704664	0.82725124	9.126202414	1.184817523	5.253718015	0	0.012028852	1.865551836	4.406993135	16.44193391	1.375681585	1.84567704	0	0	5.383384679	3.816825789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2852	NO	"$295 Days 1-Unlimited (1a); $295 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	$225 (6a); $0 n/c (6a2)	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	$225 (9b)	"$0 n/c (8a1a, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$0 n/c (3, 5, 9c, 9d); $225 (9a)"	"30% (7a, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"50% (7b); $0 n/c (7b1); 30% (7d, 7f, 7f1)"	"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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.1888	0.0126	0	0.1772	0	0	0	0.0115	0.1632	0	0.1096	0	0.0002	0.0329	0.2881	1.5442	0.0839	0	0	0	0.4633	0.1016	0	0	0	0	0	0	0	0											3.1771	0	0	14.7346	0.710925935	4.572448435	0.177216935	2.105509847	0.148372342	0.674704664	0.838749686	9.289409374	1.184817523	5.363331031	0	0.012196165	1.898443688	4.69510321	17.98611613	1.459611585	1.84567704	0	0	5.846697945	3.918409788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.4624
H3107_008_0	2011	1																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1568.142297	49.33140774	1313.336719	1940.024351	155.8367789	1.032037398	8.015953124	246.9877865	789.9495286	18.2160833	41.62259527	0	0.053561753	439.9907439	5037.376306	115.6648092	414.9338041	598.0376918	0	0	35.49840095	1724.728569	0	435.2463792	76.14710378	87.4042651	29.16618846	17.1413304	38.70204297	0											6700	"$195 Days 1-9 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$195 Days 1-9 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$125 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $125 (9a); $40 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0/$30 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												157.2686053	112.2768957	50	0	200	0.2	0.109045977	49.54816655	125	0.084759327	0.154126807	0	0.2	49.45237936	10.45255247	0.120213738	40	30	0	0	0.2	29.79018585	0	0	0	0	0	0	0	0											NO	120.7271887	86.18931886	38.38248213	0	153.5299285	0.153529929	0.083709106	38.05997219	95.95620531	0.065065467	0.118315389	0	0.153529929	37.96210134	10.05816322	0.1156804	38.49074475	28.86805856	0	0	0.153529929	22.86842552	0	0	0	0	0	0	0	0												15.7765	0.354320036	4.200760261	0	1.993800794	0.158448628	0.671008266	0.783362357	6.316713263	1.185237974	4.92459353	0	0.008223332	1.391914434	4.222229425	13.38015146	1.330925928	1.438682259	0	0	5.45006696	3.286818902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.8737	0	14.87288029	15.7765	0.354320036	4.200760261	0	1.993800794	0.158448628	0.671008266	0.783362357	6.316713263	1.185237974	4.92459353	0	0.008223332	1.391914434	4.222229425	13.38015146	1.330925928	1.438682259	0	0	5.45006696	3.286818902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.8737	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, 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 (8a1a, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"50% (7b); $0 n/c (7b1); 30% (7d, 7f, 7f1)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.4839	0.0123	0	0	0	0	0	0.0103	0	0	0.0972	0	0.0001	0	0.2686	1.4506	0.083	0	0	0	0.4437	0.0972	0	0	0	0	0	0	0	0											2.9469	0	0	16.2603	0.366588586	4.200760261	0	1.993800794	0.158448628	0.671008266	0.793663529	6.316713263	1.185237974	5.021792889	0	0.008331538	1.391914434	4.490834929	14.83078322	1.413923928	1.438682259	0	0	5.893796972	3.383984156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8206
H3107_801_0	2011	1																															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	312.5194386	6.9347	38.96717243	2920.227336	7.494259871	1.020686385	9.601673195	8.950955181	63.67832315	19.79535981	52.80053223	0	0.104942346	11.20612844	28.51970991	139.0037397	3.2528	9.83625317	0	0	37.53547845	9.603725327	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.061658166	0.061658166	0.14449253	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.041957117	0.041957117	0.098324202	0	0.15855172	0.15855172	0.15855172	0.15855172	0.15855172	0.15855172	0.15855172	0	0.15855172	0.15855172	0.15855172	0.15855172	0.15855172	0.15855172	0	0	0.15855172	0.15855172	0	0	0	0	0	0	0	0												13.1124	0.290960017	3.831416149	0	1.188227792	0.161831582	1.522361799	1.419189339	10.09630765	3.138588344	8.371615196	0	0.016638789	1.776750937	4.521849058	22.039282	0.515737034	1.559554857	0	0	5.951314665	1.522687168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0367	0	38.05095871	13.1124	0.290960017	3.831416149	0	1.188227792	0.161831582	1.522361799	1.419189339	10.09630765	3.138588344	8.371615196	0	0.016638789	1.776750937	4.521849058	22.039282	0.515737034	1.559554857	0	0	5.951314665	1.522687168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0367	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.1124	0.290960017	3.831416149	0	1.188227792	0.161831582	1.522361799	1.419189339	10.09630765	3.138588344	8.371615196	0	0.016638789	1.776750937	4.521849058	22.039282	0.515737034	1.559554857	0	0	5.951314665	1.522687168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0367
H3107_803_0	2011	1																															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	312.5371503	6.9347	38.96938085	2920.392836	7.494684599	1.020744231	9.602217359	8.951462466	63.68193204	19.79648169	52.80352464	0	0.104948293	11.20666213	28.52132624	139.0116176	3.2533	9.836810629	0	0	37.53760573	9.604269607	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.061658166	0.061658166	0.14449253	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.041956332	0.041956332	0.098322365	0	0.158548756	0.158548756	0.158548756	0.158548756	0.158548756	0.158548756	0.158548756	0	0.158548756	0.158548756	0.158548756	0.158548756	0.158548756	0.158548756	0	0	0.158548756	0.158548756	0	0	0	0	0	0	0	0												13.1129	0.290954579	3.831561671	0	1.188272922	0.161837728	1.52241962	1.419243241	10.09669112	3.138707552	8.37193316	0	0.016639421	1.776802343	4.522020803	22.04011908	0.515806669	1.559614091	0	0	5.951540702	1.522745001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0398	0	38.05463821	13.1129	0.290954579	3.831561671	0	1.188272922	0.161837728	1.52241962	1.419243241	10.09669112	3.138707552	8.37193316	0	0.016639421	1.776802343	4.522020803	22.04011908	0.515806669	1.559614091	0	0	5.951540702	1.522745001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0398	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.1129	0.290954579	3.831561671	0	1.188272922	0.161837728	1.52241962	1.419243241	10.09669112	3.138707552	8.37193316	0	0.016639421	1.776802343	4.522020803	22.04011908	0.515806669	1.559614091	0	0	5.951540702	1.522745001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0398
H3107_804_0	2011	1																															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	312.5371503	6.9347	38.96938085	2920.392836	7.494684599	1.020744231	9.602217359	8.951462466	63.68193204	19.79648169	52.80352464	0	0.104948293	11.20666213	28.52132624	139.0116176	3.2533	9.836810629	0	0	37.53760573	9.604269607	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.061658166	0.061658166	0.14449253	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.041956332	0.041956332	0.098322365	0	0.158548756	0.158548756	0.158548756	0.158548756	0.158548756	0.158548756	0.158548756	0	0.158548756	0.158548756	0.158548756	0.158548756	0.158548756	0.158548756	0	0	0.158548756	0.158548756	0	0	0	0	0	0	0	0												13.1129	0.290954579	3.831561671	0	1.188272922	0.161837728	1.52241962	1.419243241	10.09669112	3.138707552	8.37193316	0	0.016639421	1.776802343	4.522020803	22.04011908	0.515806669	1.559614091	0	0	5.951540702	1.522745001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0398	0	38.05463821	13.1129	0.290954579	3.831561671	0	1.188272922	0.161837728	1.52241962	1.419243241	10.09669112	3.138707552	8.37193316	0	0.016639421	1.776802343	4.522020803	22.04011908	0.515806669	1.559614091	0	0	5.951540702	1.522745001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0398	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.1129	0.290954579	3.831561671	0	1.188272922	0.161837728	1.52241962	1.419243241	10.09669112	3.138707552	8.37193316	0	0.016639421	1.776802343	4.522020803	22.04011908	0.515806669	1.559614091	0	0	5.951540702	1.522745001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0398
H3113_001_0	2011	5																															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	YES	291.2417793	44.4091	13724.36207	21.36068783	24.87173779	46.2869047	22.81221425	15.71059549	3.264976834	52.45672088	12.64985775	0	0	3.510613251	0.97077911	161.4683648	21.4374	9.835663653	0	0	3.028615885	7.03830583	1328.609004	0	76.87735486	138.4657792	0	0	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.060828651	0.061567114	0	0	0.2	0.2	0.094847804	0.070045668	0.2	0	0.086530189	0	0	0.162164952	0.005709688	0.03040205	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.057712649	0.058413283	0	0	0.189754819	0.189754819	0.089989139	0.066457515	0.189754819	0	0.082097602	0	0	0.153857906	0.005417204	0.028844678	0.189754819	0	0	0	0.189754819	0.190025016	0	0	0	0	0	0	0	0												16.8083	2.594081308	0	0	4.719532093	8.783163207	2.052851524	1.044087135	0.619545087	0	1.038522984	0	0	0.540135602	0.005258908	4.657502968	4.067849949	0	0	0	0.574694458	1.337454178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.843	0	2.635111946	16.8083	2.594081308	0	0	4.719532093	8.783163207	2.052851524	1.044087135	0.619545087	0	1.038522984	0	0	0.540135602	0.005258908	4.657502968	4.067849949	0	0	0	0.574694458	1.337454178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.843	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.8083	2.594081308	0	0	4.719532093	8.783163207	2.052851524	1.044087135	0.619545087	0	1.038522984	0	0	0.540135602	0.005258908	4.657502968	4.067849949	0	0	0	0.574694458	1.337454178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.843
H3113_004_0	2011	5																															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	1445.162925	661.6310682	13621.68771	21.20088477	684.0238665	4498.552378	1476.214233	263.3839228	48.4591652	42165.83471	4100.266587	0	0	333.6180817	361.4250472	5568.817412	2193.39169	9.762081325	0	0	463.2487418	1129.061892	0	0	0	0	0	0	0	0											5000	"$50 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$50 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$0 (10a)	$0 (11a)	"$0 (11b, 11b1, 11c)"	"$0 (4a, 4b); $0 n/c (4a1)"	$0 (9b)	"$0 (8a1a, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 5, 9a, 9c, 9d)"	"$0 (7a, 7a1, 14b, 14c, 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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												36.26114675	22.23465932	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	36.26114675	22.23465932	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												4.3669	1.22592845	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.5929	0	1.24E-14	4.3669	1.22592845	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.5929	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.3669	1.22592845	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.5929
H3132_001_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	O	O	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	0	0	0	0	0	0	0	0	0	0	YES	2394.110943	421.4296261	1067.176005	137.2447637	4663.042597	42.44350443	2.017496311	897.2997177	260.3524404	30742.22757	213.6245547	910.8747283	0	46749.78622	14896.78626	26411.48245	2618.670216	106.0286373	8154.697165	0	372628.4308	566.331552	27.91742074	272.029856	37.71099832	2.245860524	20.06025498	8.358439577	642.1558124	0	0	0	0	0	0	0	0	0	0	0	0	1a1:$0	1b1:$0	"21:$0,22:$0"	6:$0	10a:$0	"11a:$0,17b1:$0"	"11b:$0,11c:$0"	"4a1:$0,4b:$0"	"9a1:$0,9b:$0"	"8a1:$0,8a2:$0"	"8b1:$0,8b2:$0,8b3:$0,8b4:$0,8b5:$0,8b6:$0"	"5:$0,9a2:$0"	12:$0	"3:$0,9a3:$0,9c:$0,9d1:$0,9d2:$0"	"7a:$0,14b1:$0,14c1:$0,14d1:$0,14e1:$0,14f1:$0,14g1:$0,14h1:$0,14i:$0,14j:$0"	"7b1:$0,7d1:$0,7d3:$0,7f1:$0,7g:$0,16b1:$0,17a1:$0,18a1:$0"	"7e:$0,7h:$0"	"7c:$0,7i:$0"	7d2:$0	$0 	"151:$0,152:$0,153:$0"	"13a1:$0,14a:$0"	10b:$0	"16a1:$0,16a2:$0,16a3:$0,16a4:$0,16b2:$0"	17a2:$0	17b2:$0 $100 allowance	18a2:$0	18b:$0 $400 allowance	"14a3:$0,14a4:$0"	VT:$0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	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	0	0	0
H3152_022_0	2011	3																															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	1668.132639	63.77054146	1359.191482	1328.280773	386.7391081	13.91245906	0	281.824651	385.7089201	1678.135818	1806.911048	33.47485901	1.870103855	249.5070834	2164.258202	5836.77571	170.9610943	777.0326616	0	0	270.968505	0	0	0	1170.842025	128.8486439	39.7943338	16.03363935	14.48822833	0											3400	$223/day 1-10	$275/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$15 per visit	$200 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$300 per procedure	$0 per visit	$50 X-ray; $175 Complex Radiology	$50 per visit	$25 per visit	$50 per visit	"$25 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$50 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$50 per visit	$50 per visit	$50 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	182.7813712	198.7851464	72.96419583	15	200	0.05	0.05	49	300	0	28.125	50	25	50	25	50	40	37.5	50	50	$50 	0	0	0	0	0	0	0	0	0											NO	152.7327162	166.1055235	60.96912253	12.53404944	167.1206592	0.041780165	0.041780165	40.9445615	250.6809888	0	23.5013427	41.7801648	20.8900824	41.7801648	20.8900824	41.7801648	33.42413184	31.3351236	41.7801648	41.7801648	41.7801648	0	0	0	0	0	0	0	0	0												21.2315	0.882719931	6.905726	1.38739474	5.386007891	0.581264832	0	0.961598896	8.057491124	0	3.538736314	0.11654876	0.003255552	0.868703922	3.767627682	20.32178759	0.476185513	2.029034541	0	0	0.943425733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.459	0	15.23930281	21.2315	0.882719931	6.905726	1.38739474	5.386007891	0.581264832	0	0.961598896	8.057491124	0	3.538736314	0.11654876	0.003255552	0.868703922	3.767627682	20.32178759	0.476185513	2.029034541	0	0	0.943425733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.459	NO																																																																																		0			21.2315	0.882719931	6.905726	1.38739474	5.386007891	0.581264832	0	0.961598896	8.057491124	0	3.538736314	0.11654876	0.003255552	0.868703922	3.767627682	20.32178759	0.476185513	2.029034541	0	0	0.943425733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.459
H3152_041_0	2011	2																															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	1397.408182	57.09797111	950.5416535	757.5571208	268.1312919	12.22892326	0	255.594965	388.1041322	2367.589584	2040.969205	49.20625003	1.434667645	73.60534784	2672.529363	5341.664417	200.8604305	725.1936963	0	0	244.6340076	0	0	0	1172.879084	105.7621912	53.40492937	13.99864314	77.79238992	0											3400	$223/day 1-10	$275/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$15 per visit	$200 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$300 per procedure	$0 per visit	$50 X-ray; $175 Complex Radiology	$50 per visit	$25 per visit	$50 per visit	"$25 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$50 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$50 per visit	$50 per visit	$50 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	182.7813712	198.7851464	72.96419583	15	200	0.05	0.05	49	300	0	28.125	50	25	50	25	50	40	37.5	50	50	$50 	0	0	0	0	0	0	0	0	0											NO	152.2160468	165.5436161	60.76287411	12.49164883	166.5553178	0.041638829	0.041638829	40.80605286	249.8329767	0	23.42184156	41.63882944	20.81941472	41.63882944	20.81941472	41.63882944	33.31106356	31.22912208	41.63882944	41.63882944	41.63882944	0	0	0	0	0	0	0	0	0												17.7257	0.787683718	4.813136903	0.788594794	3.72155771	0.50919805	0	0.869151804	8.080100884	0	3.983604779	0.170740888	0.002489078	0.255403377	4.636708097	18.53505447	0.55757288	1.88726354	0	0	0.848856143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1728	0	13.68924738	17.7257	0.787683718	4.813136903	0.788594794	3.72155771	0.50919805	0	0.869151804	8.080100884	0	3.983604779	0.170740888	0.002489078	0.255403377	4.636708097	18.53505447	0.55757288	1.88726354	0	0	0.848856143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1728	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			17.7257	0.787683718	4.813136903	0.788594794	3.72155771	0.50919805	0	0.869151804	8.080100884	0	3.983604779	0.170740888	0.002489078	0.255403377	4.636708097	18.53505447	0.55757288	1.88726354	0	0	0.848856143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1728
H3152_045_0	2011	2																															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	1607.890696	48.07962843	1010.140709	549.412629	226.1573324	8.675941058	0	261.7508494	404.463236	2418.017854	3100.004843	46.47598089	0.90639876	307.4348099	3006.409866	5931.958615	147.7720526	564.6982754	0	0	221.2426059	0	0	0	1166.695082	101.9029486	42.93679402	11.86828486	58.44238	0											3400	$275/day 1-7	$275/day 1-7	"$0/d 1-10, $75/d 11-20, $100/d 21-100"	$15 per visit	$200 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$250 per procedure	$45 per visit	$45 X-ray; $175 Complex Radiology	$45 per visit	$25 per visit	$45 per visit	"$20 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$45 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$45 per visit	$40 per visit	$45 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	198.7851464	198.7851464	57.64	15	200	0.05	0.05	49	250	6.75	25.75	45	25	45	20	45	40	33.75	40	45	$50 	0	0	0	0	0	0	0	0	0											NO	162.4322086	162.4322086	47.09905479	12.25686714	163.4248952	0.040856224	0.040856224	40.03909932	204.281119	5.515590212	21.04095525	36.77060141	20.4281119	36.77060141	16.34248952	36.77060141	32.68497903	27.57795106	32.68497903	36.77060141	40.85622379	0	0	0	0	0	0	0	0	0												21.7644	0.650806686	3.964722717	0.561173133	3.079978194	0.354466189	0	0.873355688	6.885350202	1.111399634	5.4355886	0.142412481	0.001543001	0.942046904	4.09435181	18.17680715	0.40249387	1.29776845	0	0	0.753261451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.492	0	15.77636576	21.7644	0.650806686	3.964722717	0.561173133	3.079978194	0.354466189	0	0.873355688	6.885350202	1.111399634	5.4355886	0.142412481	0.001543001	0.942046904	4.09435181	18.17680715	0.40249387	1.29776845	0	0	0.753261451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.492	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			21.7644	0.650806686	3.964722717	0.561173133	3.079978194	0.354466189	0	0.873355688	6.885350202	1.111399634	5.4355886	0.142412481	0.001543001	0.942046904	4.09435181	18.17680715	0.40249387	1.29776845	0	0	0.753261451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.492
H3152_046_0	2011	3																															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	1390.219737	65.83782193	1190.255225	554.8414015	214.8620046	8.488271464	0	241.2918727	411.3086862	2435.715467	3162.57523	85.03768313	1.565946127	503.9536648	3023.659185	5905.778641	216.6306436	523.9178538	0	0	259.6244616	0	0	0	1457.469083	78.41426855	61.00422831	13.12661764	5.181559596	0											3400	$275/day 1-7	$275/day 1-7	"$0/d 1-10, $75/d 11-20, $100/d 21-100"	$15 per visit	$225 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$250 per procedure	$45 per visit	$45 X-ray; $175 Complex Radiology	$45 per visit	$25 per visit	$45 per visit	"$20 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$45 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$45 per visit	$40 per visit	$45 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	198.7851464	198.7851464	57.64	15	225	0.05	0.05	49	250	6.75	25.75	45	25	45	20	45	40	33.75	40	45	$50 	0	0	0	0	0	0	0	0	0											NO	163.5724779	163.5724779	47.42968878	12.34290999	185.1436498	0.041143033	0.041143033	40.32017262	205.7151664	5.554309494	21.18866214	37.02872996	20.57151664	37.02872996	16.45721332	37.02872996	32.91442663	27.77154747	32.91442663	37.02872996	41.14303329	0	0	0	0	0	0	0	0	0												18.9501	0.897437973	4.704452909	0.570696456	3.315027977	0.349233235	0	0.810744163	7.051036237	1.127393128	5.584228171	0.262403117	0.002684491	1.555063681	4.146750351	18.22362354	0.594189452	1.212500796	0	0	0.890144822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2478	0	15.12241425	18.9501	0.897437973	4.704452909	0.570696456	3.315027977	0.349233235	0	0.810744163	7.051036237	1.127393128	5.584228171	0.262403117	0.002684491	1.555063681	4.146750351	18.22362354	0.594189452	1.212500796	0	0	0.890144822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2478	NO																																																																																		0			18.9501	0.897437973	4.704452909	0.570696456	3.315027977	0.349233235	0	0.810744163	7.051036237	1.127393128	5.584228171	0.262403117	0.002684491	1.555063681	4.146750351	18.22362354	0.594189452	1.212500796	0	0	0.890144822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2478
H3152_048_0	2011	3																															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	1872.491862	81.67472826	1490.511835	911.0998634	243.3817691	12.81692605	0	254.9997241	402.8247476	3378.198794	3757.727105	85.83120298	0.623471208	909.2213199	3355.5678	8222.732866	282.5674993	757.9844697	0	0	357.7416742	0	0	0	1694.18176	101.4442209	66.64526779	17.50492793	15.81770596	0											3400	$200/day 1-7	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100"	$15 per visit	$200 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$35 per visit	$35 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	"$15 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$35 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	144.5710156	144.5710156	71.93854446	15	200	0.05	0.05	49	200	5.25	21	35	25	35	15	35	35	26.25	35	35	$50 	0	0	0	0	0	0	0	0	0											NO	123.9045023	123.9045023	61.65488641	12.85574101	171.4098801	0.04285247	0.04285247	41.99542063	171.4098801	4.499509353	17.99803741	29.99672902	21.42623502	29.99672902	12.85574101	29.99672902	29.99672902	22.49754677	29.99672902	29.99672902	42.85247003	0	0	0	0	0	0	0	0	0												19.3342	0.843322213	7.65811149	0.97607199	3.476503322	0.54923694	0	0.892401723	5.754011808	1.266686423	5.635976085	0.214554611	0.00111322	2.272805463	3.594859215	20.5545908	0.706341726	1.421065921	0	0	1.277509531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4293	0	12.74794714	19.3342	0.843322213	7.65811149	0.97607199	3.476503322	0.54923694	0	0.892401723	5.754011808	1.266686423	5.635976085	0.214554611	0.00111322	2.272805463	3.594859215	20.5545908	0.706341726	1.421065921	0	0	1.277509531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4293	NO																																																																																		0			19.3342	0.843322213	7.65811149	0.97607199	3.476503322	0.54923694	0	0.892401723	5.754011808	1.266686423	5.635976085	0.214554611	0.00111322	2.272805463	3.594859215	20.5545908	0.706341726	1.421065921	0	0	1.277509531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4293
H3152_077_0	2011	3																															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	1555.1065	103.5787588	1103.515322	857.2168876	232.4558301	13.5196996	0	279.7168469	400	2981.297336	2588.237616	64.50079188	2.602563472	0	3375.597959	5574.089877	292.0235642	733.4678385	0	0	278	0	0	0	1276.297822	100.5098252	62.16698521	14.43247347	4.096907246	0											3400	$223/day 1-10	$275/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$15 per visit	$200 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$300 per procedure	$0 per visit	$50 X-ray; $175 Complex Radiology	$50 per visit	$25 per visit	$50 per visit	"$25 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$50 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$50 per visit	$50 per visit	$50 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	182.7813712	198.7851464	72.96419583	15	200	0.05	0.05	49	300	0	28.125	50	25	50	25	50	40	37.5	50	50	$50 	0	0	0	0	0	0	0	0	0											NO	149.6064399	162.70552	59.7211494	12.27749077	163.699877	0.040924969	0.040924969	40.10646985	245.5498154	0	23.0202952	40.92496924	20.46248462	0	20.46248462	40.92496924	32.73997539	30.69372693	40.92496924	40.92496924	40.92496924	0	0	0	0	0	0	0	0	0												19.3878	1.404402984	5.49193362	0.877039369	3.171082566	0.55329329	0	0.934871274	8.184993848	0	4.965166163	0.21997441	0.00443791	0	5.756093444	19.00995473	0.796737026	1.876071796	0	0	0.948095121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.582	0	16.31665735	19.3878	1.404402984	5.49193362	0.877039369	3.171082566	0.55329329	0	0.934871274	8.184993848	0	4.965166163	0.21997441	0.00443791	0	5.756093444	19.00995473	0.796737026	1.876071796	0	0	0.948095121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.582	NO																																																																																		0			19.3878	1.404402984	5.49193362	0.877039369	3.171082566	0.55329329	0	0.934871274	8.184993848	0	4.965166163	0.21997441	0.00443791	0	5.756093444	19.00995473	0.796737026	1.876071796	0	0	0.948095121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.582
H3152_801_0	2011	3																															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	YES	304.7476357	3.341182675	50.65556961	12.63628711	13.57973856	11.87178677	0	10.85381488	49.12713948	23.87576892	107.9628298	0.638790601	0.003849422	32.75142629	43.36393406	171.5775171	2.556978039	11.38564244	0	0	103.2385833	0.000586492																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.068568889	0.068568889	0.143967718	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.055664422	0.055664422	0.116873409	0	0.189150072	0.189150072	0.189150072	0.189150072	0.189150072	0.189150072	0.189150072	0.189150072	0.189150072	0.189150072	0.189150072	0.189150072	0.189150072	0.189150072	0.189150072	0.189150072	0.189150072	0.189150072	0	0	0	0	0	0	0	0												16.9636	0.185985002	5.920289091	0	2.568608522	2.245549319	0	2.052999862	9.292401955	4.516103404	20.42117701	0.120827288	0.000728118	6.194934632	8.202291238	32.45389967	0.48365258	2.153595084	0	0	19.52758543	0.000110935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.3043	0	30.90342871	16.9636	0.185985002	5.920289091	0	2.568608522	2.245549319	0	2.052999862	9.292401955	4.516103404	20.42117701	0.120827288	0.000728118	6.194934632	8.202291238	32.45389967	0.48365258	2.153595084	0	0	19.52758543	0.000110935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.3043	NO																																																																																		0			16.9636	0.185985002	5.920289091	0	2.568608522	2.245549319	0	2.052999862	9.292401955	4.516103404	20.42117701	0.120827288	0.000728118	6.194934632	8.202291238	32.45389967	0.48365258	2.153595084	0	0	19.52758543	0.000110935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.3043
H3152_804_0	2011	2																															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	YES	286.7815813	4.594103435	43.24797496	6.663576972	11.56320615	10.26502702	0	10.23346031	44.44185051	20.83779784	82.23012385	0.213284805	0	29.62790039	40.19875612	159.5633649	2.809202712	7.009841376	0	0	92.37647967	0.000561422																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.065408684	0.065408684	0.145439088	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.052908101	0.052908101	0.117643491	0	0.188470197	0.188470197	0.188470197	0.188470197	0.188470197	0.188470197	0.188470197	0.188470197	0.188470197	0.188470197	0.188470197	0.188470197	0.188470197	0.188470197	0.188470197	0.188470197	0.188470197	0.188470197	0	0	0	0	0	0	0	0												15.1731	0.243065288	5.087842775	0	2.179319741	1.934651665	0	1.928702281	8.375964321	3.927303864	15.49792764	0.040197829	0	5.583976224	7.576267486	30.07293883	0.529450989	1.321146185	0	0	17.41021332	0.000105811	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.8821	0	27.61571265	15.1731	0.243065288	5.087842775	0	2.179319741	1.934651665	0	1.928702281	8.375964321	3.927303864	15.49792764	0.040197829	0	5.583976224	7.576267486	30.07293883	0.529450989	1.321146185	0	0	17.41021332	0.000105811	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.8821	NO																																																																																		0			15.1731	0.243065288	5.087842775	0	2.179319741	1.934651665	0	1.928702281	8.375964321	3.927303864	15.49792764	0.040197829	0	5.583976224	7.576267486	30.07293883	0.529450989	1.321146185	0	0	17.41021332	0.000105811	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.8821
H3154_004_0	2011	6	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D		D		T	coin		V	V					V	V	V			V	V							V				P	V																																																	0	YES	1740.85594		1155.742101		335.5825319	11.66352002		254.0149381	122.5238381					1484.426739	6623.816165	3936.455527			676.7696025	2708.371765							10.28571429				168.2223843	156.4097412									6700	(1a.)&(1b.)$150/day for the first 10 days of each IP stay;		(2.)$0 copay each days 1-9; $50 copay days 10-30; $125 copay each day 31+		(10a.)$150 /Trip	(11a.)20% Coinsurance;(11b.)20% Coinsurance;(11c.)$0 copay. Prior auth if >$500		(4a.)$50 copay per visit; (4b.) $35-$50 copay per visit	(9a.)$125 Copay;					(3)$35;(5.)$125; (8a.)$0-$125; (8b.)$35-$125;(9a.)$35-$125;(9c.)$35;(9d.)$35;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $15; for Selected PCP visit	(7b.)$35;(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (17a.)$0-$35; (18a.) $35;			(7d.)$35 /visit	(4b.)$35;(7b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(17a.)$0-$35;							(18a.)$35 /visit; (18b.) Hearing Aids $750/3 yrs for first ear and $500/3 yrs for second ear				(9b.)$75 Copay	(8b.)$35 Copay (9a.) $35;									0	135.7136734		43.44726046		150	0.2		50	125					117.4011394	15	35			35	35							35				75	35									NO	125.6737569		40.23309011		138.9032002	0.185204267		46.30106673	115.7526668					108.7159598	13.89032002	32.41074671			32.41074671	32.41074671							32.41074671				69.45160009	32.41074671										18.2317	0	3.874923008	0	3.884457301	2.160133675	0	0.980096883	1.181871751	0	0	0	0	13.44840647	7.667243856	10.63195525	0	0	1.827884014	7.315029273	0	0	0	0	0	0	0.02778064	0	0	0	0.97360948	0.422446375	0	0	0	0	0	0	0	0	72.6275	0	5.790069601	18.2317	0	3.874923008	0	3.884457301	2.160133675	0	0.980096883	1.181871751	0	0	0	0	13.44840647	7.667243856	10.63195525	0	0	1.827884014	7.315029273	0	0	0	0	0	0	0.02778064	0	0	0	0.97360948	0.422446375	0	0	0	0	0	0	0	0	72.6275	NO																																																																																		0	0	0	18.2317	0	3.874923008	0	3.884457301	2.160133675	0	0.980096883	1.181871751	0	0	0	0	13.44840647	7.667243856	10.63195525	0	0	1.827884014	7.315029273	0	0	0	0	0	0	0.02778064	0	0	0	0.97360948	0.422446375	0	0	0	0	0	0	0	0	72.6275
H3154_005_0	2011	3	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D		D		T	coin		V	V					V	V	V			V	V							V				P	V									0		0		0	0		0	0					0	0	0			0	0							0				0	0									0	YES	1777.774122		957.3270938		296.2609635	13.17372581		213.7579104	134.796655					1416.302412	6531.529624	4652.047155			852.5315491	3579.299123							10.28571429				216.466344	158.1308518									6700	(1a.)&(1b.)$75/day for the first 10 days of each IP stay;		(2.)$0 copay each days 1-5; $50 copay days 6-22; $100 copay each day 23+		(10a.)$150 /Trip	(11a.)20% Coinsurance;(11b.)20% Coinsurance;(11c.)$0 copay. Prior auth if >$500		(4a.)$50 copay per visit; (4b.) $35-$50 copay per visit	(9a.)$125 Copay;					(3)$35;(5.)$125; (8a.)$0-$125; (8b.)$35-$125;(9a.)$35-$125;(9c.)$35;(9d.)$35;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $15; for Selected PCP visit	(7b.)$35;(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (17a.)$0-$35; (18a.) $35;			(7d.)$35 /visit	(4b.)$35;(7b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(17a.)$0-$35;							(18a.)$35 /visit; (18b.) Hearing Aids $750/3 yrs for first ear and $500/3 yrs for second ear				(9b.)$75 Copay	(8b.)$35 Copay (9a.) $35;									0	66.94510454		52.8010452		150	0.2		50	125					117.4011394	15	35			35	35							35				75	35									YES	63.41202433		50.01442878		142.0836328	0.189444844		47.36121092	118.4030273					111.2052025	14.20836328	33.15284765			33.15284765	33.15284765							33.15284765				71.04181639	33.15284765									6200	9.3944	0	3.990013979	0	3.507819496	2.495694427	0	0.84365279	1.330027669	0	0	0	0	13.12501638	7.733528804	12.85238422	0	0	2.355320713	9.88866321	0	0	0	0	0	0	0.028416727	0	0	0	1.281513522	0.436874003	0	0	0	0	0	0	0	0	69.2633	0	3.850491858	9.3944	0	3.990013979	0	3.507819496	2.495694427	0	0.84365279	1.330027669	0	0	0	0	13.12501638	7.733528804	12.85238422	0	0	2.355320713	9.88866321	0	0	0	0	0	0	0.028416727	0	0	0	1.281513522	0.436874003	0	0	0	0	0	0	0	0	69.2633	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										0.0607		0.0258	0	0.0227	0.0161			0.0086					0.0848	0.05	0.0831			0.0152	0.0639											0.0083	0.0028									0.4421	900	0.35686809	9.4551	0	4.015807428	0	3.530495798	2.511827846	0	0.84365279	1.338625634	0	0	0	0	13.20986306	7.783522208	12.93546847	0	0	2.370546686	9.952588483	0	0	0	0	0	0	0.028416727	0	0	0	1.289797867	0.439698176	0	0	0	0	0	0	0	0	69.7054
H3154_006_0	2011	6	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D		D		T	coin		V	V					V	V	V			V	V							V				P	V									0		0		0	0		0	0					0	0	0			0	0							0				0	0									0	YES	1827.821844		1119.809604		311.0410634	20.25613624		233.2035778	146.7792585					1764.686994	6730.702659	5629.132826			915.022886	3896.878117							10.28571429				220.5395425	148.4472046									6700	(1a.)&(1b.)$75/day for the first 10 days of each IP stay;		(2.)$0 copay each days 1-5; $50 copay days 6-22; $100 copay each day 23+		(10a.)$150 /Trip	(11a.)20% Coinsurance;(11b.)20% Coinsurance;(11c.)$0 copay. Prior auth if >$500		(4a.)$50 copay per visit; (4b.) $35-$50 copay per visit	(9a.)$125 Copay;					(3)$35;(5.)$125; (8a.)$0-$125; (8b.)$35-$125;(9a.)$35-$125;(9c.)$35;(9d.)$35;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $15; for Selected PCP visit	(7b.)$35;(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (17a.)$0-$35; (18a.) $35;			(7d.)$35 /visit	(4b.)$35;(7b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(17a.)$0-$35;							(18a.)$35 /visit; (18b.) Hearing Aids $750/3 yrs for first ear and $500/3 yrs for second ear				(9b.)$75 Copay	(8b.)$35 Copay (9a.) $35;									0	66.94510454		52.8010452		150	0.2		50	125					117.4011394	15	35			35	35							35				75	35									YES	63.41202433		50.01442878		142.0836328	0.189444844		47.36121092	118.4030273					111.2052025	14.20836328	33.15284765			33.15284765	33.15284765							33.15284765				71.04181639	33.15284765									6200	9.6588	0	4.667219807	0	3.682820352	3.837420563	0	0.92040032	1.448259046	0	0	0	0	16.35353121	7.969355707	15.55181525	0	0	2.527967861	10.76605054	0	0	0	0	0	0	0.028416727	0	0	0	1.305627473	0.41012063	0	0	0	0	0	0	0	0	79.1278	0	4.400119494	9.6588	0	4.667219807	0	3.682820352	3.837420563	0	0.92040032	1.448259046	0	0	0	0	16.35353121	7.969355707	15.55181525	0	0	2.527967861	10.76605054	0	0	0	0	0	0	0.028416727	0	0	0	1.305627473	0.41012063	0	0	0	0	0	0	0	0	79.1278	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										0.0547		0.0264	0	0.0208	0.0217			0.0082					0.0925	0.0451	0.088			0.0143	0.0609											0.0074	0.0023									0.4424	900	0.35686809	9.7135	0	4.693629726	0	3.703659951	3.859134982	0	0.92040032	1.456454161	0	0	0	0	16.44606926	8.014451085	15.63981671	0	0	2.542272614	10.82697129	0	0	0	0	0	0	0.028416727	0	0	0	1.313015494	0.412441337	0	0	0	0	0	0	0	0	79.5702
H3154_012_0	2011	6	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D		D		T	coin		V	V					V	V	V			V	V							V				P	V																																																	0	YES	2618.452372		1941.681505		498.869506	21.14818112		316.1743954	138.1665064					2040.539267	6852.284296	5426.098048			875.9777809	3705.142064							10.28571429				203.8941351	137.6338676									6700	(1a.)&(1b.)$75/day for the first 10 days of each IP stay;		(2.)$0 copay each days 1-5; $50 copay days 6-22; $100 copay each day 23+		(10a.)$150 /Trip	(11a.)20% Coinsurance;(11b.)20% Coinsurance;(11c.)$0 copay. Prior auth if >$500		(4a.)$50 copay per visit; (4b.) $35-$50 copay per visit	(9a.)$125 Copay;					(3)$35;(5.)$125; (8a.)$0-$125; (8b.)$35-$125;(9a.)$35-$125;(9c.)$35;(9d.)$35;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $15; for Selected PCP visit	(7b.)$35;(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (17a.)$0-$35; (18a.) $35;			(7d.)$35 /visit	(4b.)$35;(7b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(17a.)$0-$35;							(18a.)$35 /visit; (18b.) Hearing Aids $750/3 yrs for first ear and $500/3 yrs for second ear				(9b.)$75 Copay	(8b.)$35 Copay (9a.) $35;									0	66.94510454		52.8010452		150	0.2		50	125					117.4011394	15	35			35	35							35				75	35									YES	63.41202433		50.01442878		142.0836328	0.189444844		47.36121092	118.4030273					111.2052025	14.20836328	33.15284765			33.15284765	33.15284765							33.15284765				71.04181639	33.15284765									6200	13.8368	0	8.092674276	0	5.906765974	4.006413866	0	1.247866853	1.363277719	0	0	0	0	18.90988187	8.113312046	14.99088349	0	0	2.420096493	10.2363342	0	0	0	0	0	0	0.028416727	0	0	0	1.207084142	0.38024622	0	0	0	0	0	0	0	0	90.74	0	5.047108026	13.8368	0	8.092674276	0	5.906765974	4.006413866	0	1.247866853	1.363277719	0	0	0	0	18.90988187	8.113312046	14.99088349	0	0	2.420096493	10.2363342	0	0	0	0	0	0	0.028416727	0	0	0	1.207084142	0.38024622	0	0	0	0	0	0	0	0	90.74	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										0.0683		0.0399	0	0.0291	0.0198			0.0067					0.0933	0.04	0.074			0.0119	0.0505											0.006	0.0019									0.4415	900	0.35686809	13.9051	0	8.132607207	0	5.93591264	4.026183332	0	1.247866853	1.37000475	0	0	0	0	19.00319181	8.153346813	15.06485532	0	0	2.432038348	10.28684492	0	0	0	0	0	0	0.028416727	0	0	0	1.213040443	0.382122528	0	0	0	0	0	0	0	0	91.1815
H3154_013_0	2011	3	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D		D		T	coin		V	V					V	V	V			V	V							V				P	V																																																	0	YES	1529.365603	0	894.7255801		251.5867387	10.88561006	0	234.1472644	130.085091	0	0	0	0	1224.524784	7382.166506	4044.648961	0	0	740.2631575	2656.270449	0	0	0	0	0	0	11.93646703	0	0	0	194.1394563	162.013168									6700	(1a.)&(1b.)$175/day for the first 10 days of each IP stay;		(2.)$0 copay each days 1-9; $50 copay days 10-30; $125 copay each day 31+		(10a.)$150 /Trip	(11a.)20% Coinsurance;(11b.)20% Coinsurance;(11c.)$0 copay. Prior auth if >$500		(4a.)$50 copay per visit; (4b.) $35-$50 copay per visit	(9a.)$200 Copay;					(3)$35;(5.)$200; (8a.)$0-$200; (8b.)$35-$200;(9a.)$35-$200;(9c.)$35;(9d.)$35;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $15; for Selected PCP visit	(7b.)$35;(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (17a.)$0-$35; (18a.) $35;			(7d.)$35 /visit	(4b.)$35;(7b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(17a.)$0-$35;							(18a.)$35 /visit; (18b.) Hearing Aids $750/3 yrs for first ear and $500/3 yrs for second ear				(9b.)$100 Copay	(8b.)$35 Copay (9a.) $35;									0	158.3326189	0	43.44726046		150	0.2	0	50	200	0	0	0	0	187.841823	15	35	0	0	35	35	0	0	0	0	0	0	35	0	0	0	100	35									NO	140.4228513	0	38.53273087		133.0327751	0.177377034	0	44.34425838	177.3770335	0	0	0	0	166.5941267	13.30327751	31.04098087	0	0	31.04098087	31.04098087	0	0	0	0	0	0	31.04098087	0	0	0	88.68851676	31.04098087										17.8965	0	2.873018332	0	2.789106836	1.93085722	0	0.865257233	1.922842296	0	0	0	0	16.99988642	8.183917474	10.46248925	0	0	1.914874542	6.871103349	0	0	0	0	0	0	0.030876637	0	0	0	1.434828368	0.419087304	0	0	0	0	0	0	0	0	74.5946	0	8.473690364	17.8965	0	2.873018332	0	2.789106836	1.93085722	0	0.865257233	1.922842296	0	0	0	0	16.99988642	8.183917474	10.46248925	0	0	1.914874542	6.871103349	0	0	0	0	0	0	0.030876637	0	0	0	1.434828368	0.419087304	0	0	0	0	0	0	0	0	74.5946	NO																																																																																		0			17.8965	0	2.873018332	0	2.789106836	1.93085722	0	0.865257233	1.922842296	0	0	0	0	16.99988642	8.183917474	10.46248925	0	0	1.914874542	6.871103349	0	0	0	0	0	0	0.030876637	0	0	0	1.434828368	0.419087304	0	0	0	0	0	0	0	0	74.5946
H3154_016_0	2011	6	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D		D		T	coin		V	V					V	V	V			V	V							V				P	V																																																	0	YES	1318.453911		796.1518175		250.6608357	15.43960909		213.116922	142.4460256					1349.924545	6818.252813	4871.874922			848.0507571	3228.77658							10.28571429				214.2211548	234.6494608									6700	(1a.)&(1b.)$150/day for the first 10 days of each IP stay;		(2.)$0 copay each days 1-9; $50 copay days 10-30; $125 copay each day 31+		(10a.)$150 /Trip	(11a.)20% Coinsurance;(11b.)20% Coinsurance;(11c.)$0 copay. Prior auth if >$500		(4a.)$50 copay per visit; (4b.) $35-$50 copay per visit	(9a.)$125 Copay;					(3)$35;(5.)$125; (8a.)$0-$125; (8b.)$35-$125;(9a.)$35-$125;(9c.)$35;(9d.)$35;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $15; for Selected PCP visit	(7b.)$35;(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (17a.)$0-$35; (18a.) $35;			(7d.)$35 /visit	(4b.)$35;(7b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(17a.)$0-$35;							(18a.)$35 /visit; (18b.) Hearing Aids $750/3 yrs for first ear and $500/3 yrs for second ear				(9b.)$75 Copay	(8b.)$35 Copay (9a.) $35;									0	135.7136734		43.44726046		150	0.2		50	125					117.4011394	15	35			35	35							35				75	35									NO	125.6737569		40.23309011		138.9032002	0.185204267		46.30106673	115.7526668					108.7159598	13.89032002	32.41074671			32.41074671	32.41074671							32.41074671				69.45160009	32.41074671										13.8079	0	2.669303984	0	2.90146602	2.859481483	0	0.822295069	1.374042278	0	0	0	0	12.22986188	7.892309461	13.15842534	0	0	2.290496524	8.720588327	0	0	0	0	0	0	0.02778064	0	0	0	1.239833498	0.633763687	0	0	0	0	0	0	0	0	70.6276	0	5.630293757	13.8079	0	2.669303984	0	2.90146602	2.859481483	0	0.822295069	1.374042278	0	0	0	0	12.22986188	7.892309461	13.15842534	0	0	2.290496524	8.720588327	0	0	0	0	0	0	0.02778064	0	0	0	1.239833498	0.633763687	0	0	0	0	0	0	0	0	70.6276	NO																																																																																		0			13.8079	0	2.669303984	0	2.90146602	2.859481483	0	0.822295069	1.374042278	0	0	0	0	12.22986188	7.892309461	13.15842534	0	0	2.290496524	8.720588327	0	0	0	0	0	0	0.02778064	0	0	0	1.239833498	0.633763687	0	0	0	0	0	0	0	0	70.6276
H3154_801_0	2011	3	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D							V	V					V	V	V			V	V							V				P	V																																																	0	YES	1808.212284							184.1746983	157.5598575					2383.092845	6884.506778	6181.030627			1068.852007	5071.724063							10.28571429				264.5515176	237.9366768									6700	(1a.)&(1b.)$100/day for the first 10 days of each IP stay;							(4a.)$50 copay per visit; (4b.) $35-$50 copay per visit	(9a.)$200 Copay;					(3)$35;(5.)$200; (8a.)$0-$200; (8b.)$35-$200;(9a.)$35-$200;(9c.)$35;(9d.)$35;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $15; for Selected PCP visit	(7b.)$35;(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (17a.)$0-$35; (18a.) $35;			(7d.)$35 /visit	(4b.)$35;(7b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(17a.)$0-$35;							(18a.)$35 /visit; (18b.) Hearing Aids $750/3 yrs for first ear and $500/3 yrs for second ear				(9b.)$100 Copay	(8b.)$35 Copay (9a.) $35;									0	87.31545646							50	200					187.841823	15	35			35	35							35				100	35									YES	78.82385325							45.13739975	180.549599					169.5738291	13.54121992	31.59617982			31.59617982	31.59617982							31.59617982				90.2747995	31.59617982									6200	11.8775	0	0	0	0	0	0	0.692763915	2.370614091	0	0	0	0	33.67584824	7.768718363	16.27474627	0	0	2.81430335	13.35392546	0	0	0	0	0	0	0.02708244	0	0	0	1.9901946	0.626490835	0	0	0	0	0	0	0	0	91.4722	0	9.838351446	11.8775	0	0	0	0	0	0	0.692763915	2.370614091	0	0	0	0	33.67584824	7.768718363	16.27474627	0	0	2.81430335	13.35392546	0	0	0	0	0	0	0.02708244	0	0	0	1.9901946	0.626490835	0	0	0	0	0	0	0	0	91.4722	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										0.04		0	0	0	0			0.008					0.1135	0.0262	0.0548			0.0095	0.045											0.0067	0.0021									0.3058	900	0.245673033	11.9175	0	0	0	0	0	0	0.692763915	2.378602486	0	0	0	0	33.78932768	7.794897061	16.32958822	0	0	2.82378687	13.39892495	0	0	0	0	0	0	0.02708244	0	0	0	1.996901074	0.628601958	0	0	0	0	0	0	0	0	91.778
H3154_802_0	2011	3	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D							V	V					V	V	V			V	V							V				P	V																																																	0	YES	2004.010419							233.2839338	192.3071037					2811.375685	7166.339772	6640.072177			973.7068539	5244.831398							10.28571429				252.3523596	284.8092548									6700	(1a.)&(1b.)$100/day for the first 10 days of each IP stay;							(4a.)$50 copay per visit; (4b.) $35-$50 copay per visit	(9a.)$200 Copay;					(3)$35;(5.)$200; (8a.)$0-$200; (8b.)$35-$200;(9a.)$35-$200;(9c.)$35;(9d.)$35;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $15; for Selected PCP visit	(7b.)$35;(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (17a.)$0-$35; (18a.) $35;			(7d.)$35 /visit	(4b.)$35;(7b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(17a.)$0-$35;							(18a.)$35 /visit; (18b.) Hearing Aids $750/3 yrs for first ear and $500/3 yrs for second ear				(9b.)$100 Copay	(8b.)$35 Copay (9a.) $35;									0	87.31545646							50	200					187.841823	15	35			35	35							35				100	35									YES	78.82385325							45.13739975	180.549599					169.5738291	13.54121992	31.59617982			31.59617982	31.59617982							31.59617982				90.2747995	31.59617982									6200	13.1637	0	0	0	0	0	0	0.877485848	2.893414204	0	0	0	0	39.72797833	8.086748575	17.48340955	0	0	2.563784738	13.80971967	0	0	0	0	0	0	0.02708244	0	0	0	1.898421556	0.749907036	0	0	0	0	0	0	0	0	101.2816	0	10.89510627	13.1637	0	0	0	0	0	0	0.877485848	2.893414204	0	0	0	0	39.72797833	8.086748575	17.48340955	0	0	2.563784738	13.80971967	0	0	0	0	0	0	0.02708244	0	0	0	1.898421556	0.749907036	0	0	0	0	0	0	0	0	101.2816	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										0.0401		0	0	0	0			0.0088					0.1209	0.0246	0.0532			0.0078	0.042											0.0058	0.0023									0.3055	900	0.245673033	13.2037	0	0	0	0	0	0	0.877485848	2.902219985	0	0	0	0	39.84888596	8.111359685	17.53661834	0	0	2.571587328	13.85174799	0	0	0	0	0	0	0.02708244	0	0	0	1.904199188	0.752189294	0	0	0	0	0	0	0	0	101.5871
H3154_805_0	2011	4	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D							V	V					V	V	V			V	V							V				P	V																																																	0	YES	2004.010419							233.2839338	192.3071037					2811.375685	7166.339772	6640.072177			973.7068539	5244.831398							10.28571429				252.3523596	284.8092548									6700	(1a.)&(1b.)$100/day for the first 10 days of each IP stay;							(4a.)$50 copay per visit; (4b.) $35-$50 copay per visit	(9a.)$200 Copay;					(3)$35;(5.)$200; (8a.)$0-$200; (8b.)$35-$200;(9a.)$35-$200;(9c.)$35;(9d.)$35;	(7a.)$15 ;(7f.)$15; (7g.)$15; (17a.) $0-$15;(18a.) $15; for Selected PCP visit	(7b.)$35;(7c.)$35; (7d.)$35; (7f.)$35; (7g.)$35; (7i.)$35; (17a.)$0-$35; (18a.) $35;			(7d.)$35 /visit	(4b.)$35;(7b.)$35;(7d.)$35;(7e.)$35;(7f.)$35;(7g.)$35; (7h.)$35;(7i.)$35;(17a.)$0-$35;							(18a.)$35 /visit; (18b.) Hearing Aids $750/3 yrs for first ear and $500/3 yrs for second ear				(9b.)$100 Copay	(8b.)$35 Copay (9a.) $35;									0	87.31545646							50	200					187.841823	15	35			35	35							35				100	35									YES	78.82385325							45.13739975	180.549599					169.5738291	13.54121992	31.59617982			31.59617982	31.59617982							31.59617982				90.2747995	31.59617982									6200	13.1637	0	0	0	0	0	0	0.877485848	2.893414204	0	0	0	0	39.72797833	8.086748575	17.48340955	0	0	2.563784738	13.80971967	0	0	0	0	0	0	0.02708244	0	0	0	1.898421556	0.749907036	0	0	0	0	0	0	0	0	101.2816	0	10.89510627	13.1637	0	0	0	0	0	0	0.877485848	2.893414204	0	0	0	0	39.72797833	8.086748575	17.48340955	0	0	2.563784738	13.80971967	0	0	0	0	0	0	0.02708244	0	0	0	1.898421556	0.749907036	0	0	0	0	0	0	0	0	101.2816	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										0.0401		0	0	0	0			0.0088					0.1209	0.0246	0.0532			0.0078	0.042											0.0058	0.0023									0.3055	900	0.245673033	13.2037	0	0	0	0	0	0	0.877485848	2.902219985	0	0	0	0	39.84888596	8.111359685	17.53661834	0	0	2.571587328	13.85174799	0	0	0	0	0	0	0.02708244	0	0	0	1.904199188	0.752189294	0	0	0	0	0	0	0	0	101.5871
H3156_027_0	2011	4																															D	D	D	V	T	coin	coin	V	V	P	V			V	V	V	V	V	V	V	S	O		V	V		V		O												35.65718573	0.050113753	3.141275623	0	1.107619201	0.063855628	1.009875435	0	3.69098573		0.691754642	0		1.238092684	0	0	0	0	3.496435294	1.112113501	0	0	0	0	0	0	0	0	0												51.2593	YES						0.168601739	12.42028926	318.3811054	0			0		139.597522	4122.981956	4551.668727	114.7984238	316.7188342	0	76.01140402	0	0	0	809.1476997	234.8986269	0	0.00001	0	0												6700	$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	$0 copay	$0; PBP 12	"$15-40 copay; PBP 3, 5, 9a, 9c, 9d, 13a"	"$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"	$0; 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	0	0	0	0	0.1	0.1	50	0	0	0	0	0	15.12658228	10	39.59	25	15	0	40	0	0	0	10	40	0	40	0	0												NO	0	0	0	0	0	0.1	0.1	50	0	0	0	0	0	15.12658228	10	39.59	25	15	0	40	0	0	0	10	40	0	40	0	0													0	0	0	0	0	0.016860174	1.242028926	1.326587939	0	0	0	0	0	0.17596945	3.435818296	15.01671374	0.239163383	0.395898543	0	0.253371347	0	0	0	0.67428975	0.782995423	0	3.33E-08	0	0	0	0	0	0	0	0	0	0	0	0	0	23.5597	1500	0	35.6572	0.050113753	3.141275623	0	1.107619201	0.080715802	2.251904361	1.326587939	3.69098573	0	0.691754642	0	0	1.414062134	3.435818296	15.01671374	0.239163383	0.395898543	3.496435294	1.365484847	0	0	0	0.67428975	0.782995423	0	3.33E-08	0	0	0	0	0	0	0	0	0	0	0	0	0	74.819	NO																																																																																		0			35.6572	0.050113753	3.141275623	0	1.107619201	0.080715802	2.251904361	1.326587939	3.69098573	0	0.691754642	0	0	1.414062134	3.435818296	15.01671374	0.239163383	0.395898543	3.496435294	1.365484847	0	0	0	0.67428975	0.782995423	0	3.33E-08	0	0	0	0	0	0	0	0	0	0	0	0	0	74.819
H3156_028_0	2011	4																															D	D	D	V	T	coin	coin	V	V	P	V			V	V	V	V	V	V	V	S	V		V	V		V														34.42783505	0.048385985	3.03297405	0	1.06943188	0.061654082	0.975058019	0	3.563731834	0	0.667905059	0	0	1.195407036	0	0	0	0	3.375888902	1.073771229	0	0		0	0		0														49.492	YES						0.84941241	15.93706589	364.4477858	0	0	0	0	0	314.0883592	4340.181721	4988.483679	141.3406584	470.6289421	0	83.52115196	0	0		809.1476997	238.0513693		0														6700	$0; PBP 1a	$0; PBP 1b	$0; PBP 2	$0; PBP 6	$0; PBP 10a	10% coins; PBP 11a	10% coins; PBP 11b	"$40-50 copay; PBP 4a, 4b"	"$0; PBP 9a, 9b"	$0; PBP 8a	$0; PBP 8b	$0 copay	$0; PBP 12	"$15-40 copay; PBP 3, 5, 9a, 9c, 9d"	"$0-40 copay; PBP 4b, 7a"	"$0-40 copay; PBP 4b, 7b, 7d, 7f"	"$25 copay; PBP 7e, 7h"	"$15 copay; PBP 7c, 7i"	$0; PBP 8b	"$0-40; PBP 7d, 7g, 18a"	$0; PBP 15	$0; PBP 13a		"$10: PBP 16a, 16b"	$40 copay; PBP 17a		$40 copay; PBP 18a															0	0	0	0	0	0.1	0.1	50	0	0	0	0	0	15.12658228	10	39.59	25	15	0	40	0	0		10	40		0														NO	0	0	0	0	0	0.1	0.1	50	0	0	0	0	0	15.12658228	10	39.59	25	15	0	40	0	0		10	40		0															0	0	0	0	0	0.084941241	1.593706589	1.518532441	0	0	0	0	0	0.395923617	3.616818101	16.45783907	0.294459705	0.588286178	0	0.27840384	0	0	0	0.67428975	0.793504564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.2967	1500	0	34.4278	0.048385985	3.03297405	0	1.06943188	0.146595323	2.568764609	1.518532441	3.563731834	0	0.667905059	0	0	1.591330653	3.616818101	16.45783907	0.294459705	0.588286178	3.375888902	1.352175069	0	0	0	0.67428975	0.793504564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7887	NO																																																																																		0			34.4278	0.048385985	3.03297405	0	1.06943188	0.146595323	2.568764609	1.518532441	3.563731834	0	0.667905059	0	0	1.591330653	3.616818101	16.45783907	0.294459705	0.588286178	3.375888902	1.352175069	0	0	0	0.67428975	0.793504564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7887
H3156_801_0	2011	3																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																											0	YES	362.9226618	4.599866611	34.57620229	11.12659364	13.96525983	1.090569043	22.27855408	12.69352445	59.35718034	6.901881709	7.140108564	0	5.089940329	25.05142586	30.06502229	49.96056994	0.346260929	3.771930266	46.72190156	92.64127926	60.47805337	0.201490576																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.073046688	0.073046688	0.147528391	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.056105088	0.056105088	0.113312371	0	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689																				20.3618	0.258075922	3.91791147	0	2.499232526	0.195168988	3.986985396	2.271641887	10.62260191	1.235165509	1.277798751	0	0.91089923	4.483220442	5.380457116	8.940978039	0.061967095	0.675027241	8.361383712	16.5791472	10.82319412	0.036058892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8787		31.06545528	20.3618	0.258075922	3.91791147	0	2.499232526	0.195168988	3.986985396	2.271641887	10.62260191	1.235165509	1.277798751	0	0.91089923	4.483220442	5.380457116	8.940978039	0.061967095	0.675027241	8.361383712	16.5791472	10.82319412	0.036058892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8787	NO																																																																																		0			20.3618	0.258075922	3.91791147	0	2.499232526	0.195168988	3.986985396	2.271641887	10.62260191	1.235165509	1.277798751	0	0.91089923	4.483220442	5.380457116	8.940978039	0.061967095	0.675027241	8.361383712	16.5791472	10.82319412	0.036058892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8787
H3156_803_0	2011	3																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																											0	NO	514.5882797	0.284425371	51.5629663	14.10422456	20.15829545	0.909387318	20.89257855	13.19545612	66.40780392	5.556051207	6.339421749	0	0	37.54381146	30.98690267	51.01807636	0.338250534	4.407331115	42.75273381	91.37254589	71.80013914	0.389296856																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.072289739	0.072289739	0.144260532	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.055523697	0.055523697	0.110802422	0	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689																				28.5718	0.015792348	5.713301536	0	3.607542451	0.162744581	3.73895026	2.361467924	11.88438637	0.994314754	1.134507287	0	0	6.718866381	5.545437464	9.130230116	0.060533549	0.788739015	7.651058715	16.3520938	12.8494024	0.069668834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.3509		35.43549575	28.5718	0.015792348	5.713301536	0	3.607542451	0.162744581	3.73895026	2.361467924	11.88438637	0.994314754	1.134507287	0	0	6.718866381	5.545437464	9.130230116	0.060533549	0.788739015	7.651058715	16.3520938	12.8494024	0.069668834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.3509	NO																																																																																		0			28.5718	0.015792348	5.713301536	0	3.607542451	0.162744581	3.73895026	2.361467924	11.88438637	0.994314754	1.134507287	0	0	6.718866381	5.545437464	9.130230116	0.060533549	0.788739015	7.651058715	16.3520938	12.8494024	0.069668834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.3509
H3164_003_0	2011	5																															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	288.9456618	9.309934841	39.6904431	978.5269164	14.39820036	17.96028801	10.26744476	28.24649182	32.19275117	14.04666955	31.63241367	0	14.92013765	91.16727812	44.56636641	167.7060544	3.821171784	9.121855546	0	1.62780969	21.40070461	8.297817487	639.2392537	452.6954566	431.1227989	451.9606409	0	0	132	456.9911737											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a); $0 n/c (13a1); FFS (16b, 18a); $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 (14a1); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e2, 13f); $0 (13c1, 13e1)"												0.062461563	0.062461563	0.14321244	0	0.233	0.233	0.233	0.070900045	0.233	0.233	0.233	0	0.233	0.233	0.228584134	0.232972186	0.233	0.233	0	0.233	0.233	0.041577493	0	0	0	0	0	0	0	0											NO	0.051545418	0.051545418	0.118183804	0	0.19227957	0.19227957	0.19227957	0.058518235	0.19227957	0.19227957	0.19227957	0	0.19227957	0.19227957	0.188635446	0.192256616	0.19227957	0.19227957	0	0.19227957	0.19227957	0.04034471	0	0	0	0	0	0	0	0												14.8938	0.479884487	4.690767533	0	2.768479767	3.453396449	1.974219859	1.652934839	6.190008339	2.700887575	6.082266885	0	2.868837646	17.529605	8.406796391	32.24259858	0.734733266	1.753946458	0	0.312994546	4.114918271	0.334773044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1859	0	23.90920929	14.8938	0.479884487	4.690767533	0	2.768479767	3.453396449	1.974219859	1.652934839	6.190008339	2.700887575	6.082266885	0	2.868837646	17.529605	8.406796391	32.24259858	0.734733266	1.753946458	0	0.312994546	4.114918271	0.334773044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1859	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.8938	0.479884487	4.690767533	0	2.768479767	3.453396449	1.974219859	1.652934839	6.190008339	2.700887575	6.082266885	0	2.868837646	17.529605	8.406796391	32.24259858	0.734733266	1.753946458	0	0.312994546	4.114918271	0.334773044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1859
H3204_001_0	2011	5																															A	A	D		T	Coin	Coin	V	V		V			V	V	V	V	V			Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	156.2998787	4.2304155	166.5615075	0	217.7903921	15.31738379	1.362623005	609.1540367	279.0615167	0	144.795135	0	0	114.9166503	2666.702051	4077.735658	212.7014235	237.7145742	0	0	44.50793541	0	0	0	46.85919935	0	29.22616737	0	0	0											3000	$600/Ben Per for IP Med/Surg; PBP 1a	$600/Ben Per for IP MH/SA; PBP 1b	$40/Days 21-100 for SNF; PBP 2	$0/Visit for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	"20% Coinsurance for DME; 0% Coinsurance for Ostomy Supplies; PBP 11a, 17b"	"20% Coinsurance for Prosthetics; 0% Coinsurance for Ostomy Supplies; $0/Unit for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $10/Visit for Urgent Care (IN); $40/Visit for Urgent Care (OON); PBP 7a; PBP 4a, 4b"	"$375/Case for OP Surg; $375/Visit for ASC services; 0% Coinsurance for Polyp Removal; PBP 9a, 9b"	$0/Visit for OP Lab; PBP 8a	$0/Case for OP Rad - General; $100/Case for OP Rad - Advanced Imaging; PBP 8b	No Cost Sharing; PBP 9a	$0/Case for Renal Dialysis; PBP 12	"$25/Visit for CORF; $30/Day for Partial Hosp; $25/Visit for OP - PT/OT/ST; $30/Service for OP Substance Abuse; $0/Visit for Cardiac Rehab; PBP 3, 5, 9c, 9d"	"$10/Visit for PCP OV; $0/Visit for PCP - IP Visit; $0/Visit for Immunizations; $0/Visit for Immunizations (non-cvd); $0/Visit for Physical Exams (Initial); $0/Visit for Routine Exams; PBP 7a, 14b, 14c"	"$20/Visit for Chiro - cvd; $30/Visit for SCP OV; $0/Visit for SCP - IP Visit; $30/Visit for Podiatry; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $30/Exam for Vision Exams; $30/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"$30/Visit for MH - Non Phys; $30/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OP Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"$0/Procedure for Phys Rad - General; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 8b, 14g, 14h"	"$0/Visit for Other Health Care Professional; $0/Visit for Colorectal Screening; $0/Visit for Diabetes Monitoring; $0/Visit for Nutrition Therapy for Diabetes & Renal Dialysis; PBP 7g, 14f, 14j"	15% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Oral and Nebulized Inhaled Medications; PBP 15	"$0/Case for Blood; $0/Visit for Smoking Cessation; PBP 13a, 14a"	PBP 10b	PBP 16a	$30/Exam for Routine Eye Exams (non-cvd); PBP 17a	PBP 17b	$30/Exam for Routine Hearing Test (non-cvd); PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											0	600	600	40	0	100	0.2	0.2	33.64236377	375	0	100	0	0	25.08393623	10	29.41862029	30	25	0	0	0.15	0	0	0	30	0	30	0	0	0											NO	578.3088568	578.3088568	38.55392378	0	96.38480946	0.192769619	0.192769619	32.42612822	361.4430355	0	96.38480946	0	0	24.17710414	9.638480946	28.35508111	28.91544284	24.09620237	0	0	0.144577214	0	0	0	28.91544284	0	28.91544284	0	0	0												7.5325	0.203873896	0.535133305	0	1.749307121	2.952726236	0.262672317	1.646042242	8.405403472	0	1.163004291	0	0	0.231529318	2.141913075	9.635377111	0.512529654	0.477334874	0	0	6.434833312	0	0	0	0.112912875	0	0.070423964	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0675	0	1.652878212	7.5325	0.203873896	0.535133305	0	1.749307121	2.952726236	0.262672317	1.646042242	8.405403472	0	1.163004291	0	0	0.231529318	2.141913075	9.635377111	0.512529654	0.477334874	0	0	6.434833312	0	0	0	0.112912875	0	0.070423964	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0675	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.5325	0.203873896	0.535133305	0	1.749307121	2.952726236	0.262672317	1.646042242	8.405403472	0	1.163004291	0	0	0.231529318	2.141913075	9.635377111	0.512529654	0.477334874	0	0	6.434833312	0	0	0	0.112912875	0	0.070423964	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0675
H3204_007_0	2011	4																															A	A	D		T	Coin	Coin	V	V		V			V	V	V	V	V			Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	232.7184825	3.641016777	289.5931401	0	291.3545639	32.45228995	1.968420918	738.646588	363.033318	0	201.0506073	0	0	176.350878	3502.995458	6031.95832	352.8683708	385.1733064	0	0	65.52999336	0	0	0	66.94701549	0	40.33109864	0	0	0											2500	$400/Ben Per for IP Med/Surg; PBP 1a	$400/Ben Per for IP MH/SA; PBP 1b	$35/Days 21-100 for SNF; PBP 2	$0/Visit for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	"10% Coinsurance for DME; 0% Coinsurance for Ostomy Supplies; PBP 11a, 17b"	"10% Coinsurance for Prosthetics; 0% Coinsurance for Ostomy Supplies; $0/Unit for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $10/Visit for Urgent Care (IN); $40/Visit for Urgent Care (OON); PBP 7a; PBP 4a, 4b"	"$250/Case for OP Surg; $250/Visit for ASC services; 0% Coinsurance for Polyp Removal; PBP 9a, 9b"	$0/Visit for OP Lab; PBP 8a	"$0/Case for OP Rad - General; $100/Case for OP Rad - Advanced Imaging; PBP 8a, 8b"	No Cost Sharing; PBP 9a	$0/Case for Renal Dialysis; PBP 12	"$20/Visit for CORF; $25/Day for Partial Hosp; $20/Visit for OP - PT/OT/ST; $25/Service for OP Substance Abuse; $0/Visit for Cardiac Rehab; PBP 3, 5, 9c, 9d"	"$10/Visit for PCP OV; $0/Visit for PCP - IP Visit; $0/Visit for Immunizations; $0/Visit for Immunizations (non-cvd); $0/Visit for Physical Exams (Initial); $0/Visit for Routine Exams; PBP 7a, 14b, 14c"	"$20/Visit for Chiro - cvd; $25/Visit for SCP OV; $0/Visit for SCP - IP Visit; $25/Visit for Podiatry; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $25/Exam for Vision Exams; $25/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$20/Visit for OP Occ Therapy; $20/Visit for PT/ST; PBP 7c, 7i"	"$0/Procedure for Phys Rad - General; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 8b, 14g, 14h"	"$0/Visit for Other Health Care Professional; $0/Visit for Colorectal Screening; $0/Visit for Diabetes Monitoring; $0/Visit for Nutrition Therapy for Diabetes & Renal Dialysis; PBP 7g, 14f, 14j"	5% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Oral and Nebulized Inhaled Medications; PBP 15	"$0/Case for Blood; $0/Visit for Smoking Cessation; PBP 13a, 14a"	PBP 10b	PBP 16a	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	PBP 17b	$25/Exam for Routine Hearing Test (non-cvd); PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											0	400	400	35	0	100	0.1	0.1	35.34720257	250	0	100	0	0	20.01126717	10	24.7446313	25	20	0	0	0.05	0	0	0	25	0	25	0	0	0											NO	380.4621178	380.4621178	33.29043531	0	95.11552946	0.095115529	0.095115529	33.62067887	237.7888236	0	95.11552946	0	0	19.03382272	9.511552946	23.53598707	23.77888236	19.02310589	0	0	0.047557765	0	0	0	23.77888236	0	23.77888236	0	0	0												7.3784	0.11543908	0.803390141	0	2.309361967	3.086716741	0.187227398	2.069483311	7.193772136	0	1.593586247	0	0	0.279719279	2.77657723	11.83067442	0.699234623	0.610599383	0	0	3.116460007	0	0	0	0.132660434	0	0.079919038	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2632	0	2.273049495	7.3784	0.11543908	0.803390141	0	2.309361967	3.086716741	0.187227398	2.069483311	7.193772136	0	1.593586247	0	0	0.279719279	2.77657723	11.83067442	0.699234623	0.610599383	0	0	3.116460007	0	0	0	0.132660434	0	0.079919038	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2632	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	0	0	7.3784	0.11543908	0.803390141	0	2.309361967	3.086716741	0.187227398	2.069483311	7.193772136	0	1.593586247	0	0	0.279719279	2.77657723	11.83067442	0.699234623	0.610599383	0	0	3.116460007	0	0	0	0.132660434	0	0.079919038	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2632
H3204_008_0	2011	2																															A	A	D		T	Coin	Coin	V	V		V			V	V	V	V	V			Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	160.533753	2.206287283	253.8563123	0	198.4807553	17.87245682	2.307368658	634.5937339	349.4735504	0	178.1907028	0	0	196.0072591	2911.225635	5275.394467	329.059413	336.5949712	0	0	38.97261828	0	0	0	67.03303391	0	37.09399381	0	0	0											2500	$400/Ben Per for IP Med/Surg; PBP 1a	$400/Ben Per for IP MH/SA; PBP 1b	$35/Days 21-100 for SNF; PBP 2	$0/Visit for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	"10% Coinsurance for DME; 0% Coinsurance for Ostomy Supplies; PBP 11a, 17b"	"10% Coinsurance for Prosthetics; 0% Coinsurance for Ostomy Supplies; $0/Unit for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $10/Visit for Urgent Care (IN); $40/Visit for Urgent Care (OON); PBP 7a; PBP 4a, 4b"	"$250/Case for OP Surg; $250/Visit for ASC services; 0% Coinsurance for Polyp Removal; PBP 9a, 9b"	$0/Visit for OP Lab; PBP 8a	"$0/Case for OP Rad - General; $100/Case for OP Rad - Advanced Imaging; PBP 8a, 8b"	No Cost Sharing; PBP 9a	$0/Case for Renal Dialysis; PBP 12	"$20/Visit for CORF; $25/Day for Partial Hosp; $20/Visit for OP - PT/OT/ST; $25/Service for OP Substance Abuse; $0/Visit for Cardiac Rehab; PBP 3, 5, 9c, 9d"	"$10/Visit for PCP OV; $0/Visit for PCP - IP Visit; $0/Visit for Immunizations; $0/Visit for Immunizations (non-cvd); $0/Visit for Physical Exams (Initial); $0/Visit for Routine Exams; PBP 7a, 14b, 14c"	"$20/Visit for Chiro - cvd; $25/Visit for SCP OV; $0/Visit for SCP - IP Visit; $25/Visit for Podiatry; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $25/Exam for Vision Exams; $25/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$20/Visit for OP Occ Therapy; $20/Visit for PT/ST; PBP 7c, 7i"	"$0/Procedure for Phys Rad - General; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 8b, 14g, 14h"	"$0/Visit for Other Health Care Professional; $0/Visit for Colorectal Screening; $0/Visit for Diabetes Monitoring; $0/Visit for Nutrition Therapy for Diabetes & Renal Dialysis; PBP 7g, 14f, 14j"	5% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Oral and Nebulized Inhaled Medications; PBP 15	"$0/Case for Blood; $0/Visit for Smoking Cessation; PBP 13a, 14a"	PBP 10b	PBP 16a	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	PBP 17b	$25/Exam for Routine Hearing Test (non-cvd); PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											0	400	400	35	0	100	0.1	0.1	33.71852572	250	0	100	0	0	20.00491524	10	24.72838454	25	20	0	0	0.05	0	0	0	25	0	25	0	0	0											NO	385.9285795	385.9285795	33.7687507	0	96.48214487	0.096482145	0.096482145	32.53235683	241.2053622	0	96.48214487	0	0	19.3011713	9.648214487	23.8584758	24.12053622	19.29642897	0	0	0.048241072	0	0	0	24.12053622	0	24.12053622	0	0	0												5.1629	0.070955776	0.714367544	0	1.595820749	1.724372968	0.222619877	1.720402483	7.024574525	0	1.4326851	0	0	0.31526414	2.340677446	10.4885726	0.661424124	0.541256746	0	0	1.880080901	0	0	0	0.134739394	0	0.074560585	0	0	0	0	0	0	0	0	0	0	0	0	0	36.1053	0	1.316441062	5.1629	0.070955776	0.714367544	0	1.595820749	1.724372968	0.222619877	1.720402483	7.024574525	0	1.4326851	0	0	0.31526414	2.340677446	10.4885726	0.661424124	0.541256746	0	0	1.880080901	0	0	0	0.134739394	0	0.074560585	0	0	0	0	0	0	0	0	0	0	0	0	0	36.1053	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	5.1629	0.070955776	0.714367544	0	1.595820749	1.724372968	0.222619877	1.720402483	7.024574525	0	1.4326851	0	0	0.31526414	2.340677446	10.4885726	0.661424124	0.541256746	0	0	1.880080901	0	0	0	0.134739394	0	0.074560585	0	0	0	0	0	0	0	0	0	0	0	0	0	36.1053
H3204_801_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	152.6190264	1.103623773	7.915711722	0	5.10537564	21.618648	1.60437351	28.30516766	65.62276584	2.250640448	68.13790328	0	0	26.70452759	25.70110401	51.14039563	2.584933058	4.689930585	25.35671713	63.84446276	68.65796281	0.325393412	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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, 17b"	"Medicare-FFS Cost Sharing; PBP 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 8a, 8b"	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	PBP 10b	PBP 16a	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											0	0.076416775	0.076416775	0.166475229	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	0.07046253	0.07046253	0.153503808	0	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0	0	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0	0	0	0	0	0	0	0												10.7539	0.077764124	1.215091889	0	1.09686494	4.64466059	0.344691787	6.081226575	14.09872969	0.483539072	14.63909464	0	0	5.737336898	5.521756259	10.98726341	0.555360201	1.007608605	5.447766426	13.71666998	14.75082688	0.06990918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2301	0	9.399195315	10.7539	0.077764124	1.215091889	0	1.09686494	4.64466059	0.344691787	6.081226575	14.09872969	0.483539072	14.63909464	0	0	5.737336898	5.521756259	10.98726341	0.555360201	1.007608605	5.447766426	13.71666998	14.75082688	0.06990918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2301	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.7539	0.077764124	1.215091889	0	1.09686494	4.64466059	0.344691787	6.081226575	14.09872969	0.483539072	14.63909464	0	0	5.737336898	5.521756259	10.98726341	0.555360201	1.007608605	5.447766426	13.71666998	14.75082688	0.06990918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2301
H3204_802_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	152.6190264	1.103623773	7.915711722	0	5.10537564	21.618648	1.60437351	28.30516766	65.62276584	2.250640448	68.13790328	0	0	26.70452759	25.70110401	51.14039563	2.584933058	4.689930585	25.35671713	63.84446276	68.65796281	0.325393412	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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, 17b"	"Medicare-FFS Cost Sharing; PBP 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 8a, 8b"	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	PBP 10b	PBP 16a	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											0	0.076416775	0.076416775	0.166475229	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	0.07046253	0.07046253	0.153503808	0	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0	0	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0	0	0	0	0	0	0	0												10.7539	0.077764124	1.215091889	0	1.09686494	4.64466059	0.344691787	6.081226575	14.09872969	0.483539072	14.63909464	0	0	5.737336898	5.521756259	10.98726341	0.555360201	1.007608605	5.447766426	13.71666998	14.75082688	0.06990918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2301	0	9.399195315	10.7539	0.077764124	1.215091889	0	1.09686494	4.64466059	0.344691787	6.081226575	14.09872969	0.483539072	14.63909464	0	0	5.737336898	5.521756259	10.98726341	0.555360201	1.007608605	5.447766426	13.71666998	14.75082688	0.06990918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2301	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.7539	0.077764124	1.215091889	0	1.09686494	4.64466059	0.344691787	6.081226575	14.09872969	0.483539072	14.63909464	0	0	5.737336898	5.521756259	10.98726341	0.555360201	1.007608605	5.447766426	13.71666998	14.75082688	0.06990918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2301
H3204_803_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	152.6190264	1.103623773	7.915711722	0	5.10537564	21.618648	1.60437351	28.30516766	65.62276584	2.250640448	68.13790328	0	0	26.70452759	25.70110401	51.14039563	2.584933058	4.689930585	25.35671713	63.84446276	68.65796281	0.325393412	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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, 17b"	"Medicare-FFS Cost Sharing; PBP 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 8a, 8b"	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	PBP 10b	PBP 16a	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											0	0.076416775	0.076416775	0.166475229	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	0.07046253	0.07046253	0.153503808	0	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0	0	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0.2148451	0	0	0	0	0	0	0	0												10.7539	0.077764124	1.215091889	0	1.09686494	4.64466059	0.344691787	6.081226575	14.09872969	0.483539072	14.63909464	0	0	5.737336898	5.521756259	10.98726341	0.555360201	1.007608605	5.447766426	13.71666998	14.75082688	0.06990918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2301	0	9.399195315	10.7539	0.077764124	1.215091889	0	1.09686494	4.64466059	0.344691787	6.081226575	14.09872969	0.483539072	14.63909464	0	0	5.737336898	5.521756259	10.98726341	0.555360201	1.007608605	5.447766426	13.71666998	14.75082688	0.06990918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2301	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.7539	0.077764124	1.215091889	0	1.09686494	4.64466059	0.344691787	6.081226575	14.09872969	0.483539072	14.63909464	0	0	5.737336898	5.521756259	10.98726341	0.555360201	1.007608605	5.447766426	13.71666998	14.75082688	0.06990918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2301
H3206_001_0	2011	5																															A	A	D		T	Coin	Coin	V	V		V			V	V	V	V	V			Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	126.67065	0.677992928	141.6820017	0	40.14118652	19.34896571	1.666511667	373.752084	262.1059069	0	161.4161255	0	0	119.8061137	3351.789915	4461.320339	289.6125978	677.569954	0	0	31.93613172	0	0	0	22.12376264	0	0.845861595	0	0	0											3400	$650/Ben Per for IP Med/Surg; PBP 1a	$650/Ben Per for IP MH/SA; PBP 1b	$40/Days 21-100 for SNF; PBP 2	$0/Visit for HH; PBP 6	$150/Trip for Ambulance; PBP 10a	"20% Coinsurance for DME; 0% Coinsurance for Ostomy Supplies; PBP 11a, 17b"	"20% Coinsurance for Prosthetics; 0% Coinsurance for Ostomy Supplies; $0/Unit for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $10/Visit for Urgent Care (IN); $40/Visit for Urgent Care (OON); PBP 7a; PBP 4a, 4b"	"$375/Case for OP Surg; $375/Visit for ASC services; 0% Coinsurance for Polyp Removal; PBP 9a, 9b"	$0/Visit for OP Lab; PBP 8a	"$0/Case for OP Rad - General; $100/Case for OP Rad - Advanced Imaging; PBP 8a, 8b"	No Cost Sharing; PBP 9a	$0/Case for Renal Dialysis; PBP 12	"$20/Visit for CORF; $40/Day for Partial Hosp; $20/Visit for OP - PT/OT/ST; $40/Service for OP Substance Abuse; $0/Visit for Cardiac Rehab; PBP 3, 5, 9c, 9d"	"$10/Visit for PCP OV; $0/Visit for PCP - IP Visit; $0/Visit for Immunizations; $0/Visit for Immunizations (non-cvd); $0/Visit for Physical Exams (Initial); $0/Visit for Routine Exams; PBP 7a, 14b, 14c"	"$20/Visit for Chiro - cvd; $40/Visit for SCP OV; $0/Visit for SCP - IP Visit; $40/Visit for Podiatry; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $40/Exam for Vision Exams; $40/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$20/Visit for OP Occ Therapy; $20/Visit for PT/ST; PBP 7c, 7i"	"$0/Procedure for Phys Rad - General; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 8b, 14g, 14h"	"$0/Visit for Other Health Care Professional; $0/Visit for Colorectal Screening; $0/Visit for Diabetes Monitoring; $0/Visit for Nutrition Therapy for Diabetes & Renal Dialysis; PBP 7g, 14f, 14j"	10% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Oral and Nebulized Inhaled Medications; PBP 15	"$0/Case for Blood; $0/Visit for Smoking Cessation; PBP 13a, 14a"	PBP 10b	PBP 16a	$40/Exam for Routine Eye Exams (non-cvd); PBP 17a	PBP 17b	$40/Exam for Routine Hearing Test (non-cvd); PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											0	650	650	40	0	150	0.2	0.2	38.27165227	375	0	100	0	0	20.70951609	10	38.55762454	40	20	0	0	0.1	0	0	0	40	0	40	0	0	0											NO	625.5708458	625.5708458	38.49666744	0	144.3625029	0.192483337	0.192483337	36.83327674	360.9062572	0	96.24166859	0	0	19.93118384	9.624166859	37.10850122	38.49666744	19.24833372	0	0	0.096241669	0	0	0	38.49666744	0	38.49666744	0	0	0												6.6035	0.035344384	0.454523742	0	0.482906846	3.724353491	0.320775727	1.147209495	7.882971822	0	1.294579771	0	0	0.198989806	2.688182118	13.79607594	0.929093322	1.086841049	0	0	3.073586605	0	0	0	0.070974261	0	0.002713571	0	0	0	0	0	0	0	0	0	0	0	0	0	43.7926	0	1.710143036	6.6035	0.035344384	0.454523742	0	0.482906846	3.724353491	0.320775727	1.147209495	7.882971822	0	1.294579771	0	0	0.198989806	2.688182118	13.79607594	0.929093322	1.086841049	0	0	3.073586605	0	0	0	0.070974261	0	0.002713571	0	0	0	0	0	0	0	0	0	0	0	0	0	43.7926	YES	$1000/Ben Per for IP Med/Surg; PBP 1a	$1000/Ben Per for IP MH/SA; PBP 1b	$60/Days 21-100 for SNF; PBP 2	$0/Visit for HH; PBP 6	$150/Trip for Ambulance; PBP 10a	"25% Coinsurance for DME; PBP 11a, 17b"	"25% Coinsurance for Prosthetics; 25% Coinsurance for DMS; PBP 11b, 11c"	"$50/Case for OP ER; $40/Visit for Urgent Care (OON); PBP 4a, 4b"	"20% Coinsurance for OP Surg; 20% Coinsurance for ASC services; 0% Coinsurance for Polyp Removal; PBP 9a, 9b"	20% Coinsurance for OP Lab; PBP 8a	"10% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - Therapeutic; 20% Coinsurance for OP Rad - Advanced Imaging; PBP 8a, 8b"	No Cost Sharing; PBP 9a	$0/Case for Renal Dialysis; PBP 12	"$35/Visit for CORF; 50% Coinsurance for Partial Hosp; $35/Visit for OP - PT/OT/ST; 20% Coinsurance for OP - Other; 50% Coinsurance for OP Substance Abuse; $35/Visit for Cardiac Rehab; PBP 3, 5, 9c, 9d"	"$35/Visit for PCP OV; $0/Visit for PCP - IP Visit; $0/Visit for Immunizations; $0/Visit for Immunizations (non-cvd); $35/Visit for Physical Exams (Initial); $35/Visit for Routine Exams; PBP 7a, 14b, 14c"	"$55/Visit for Chiro - cvd; $55/Visit for SCP OV; $0/Visit for SCP - IP Visit; $55/Visit for Podiatry; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $55/Exam for Vision Exams; $55/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"50% Coinsurance for MH - Non Phys; 50% Coinsurance for Psych Services ; PBP 7e, 7h"	"$35/Visit for OP Occ Therapy; $35/Visit for PT/ST; PBP 7c, 7i"	"10% Coinsurance for Phys Rad - General; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 8b, 14g, 14h"	"20% Coinsurance for Other Health Care Professional; $0/Visit for Colorectal Screening; 25% Coinsurance for Diabetes Monitoring; 10% Coinsurance for Nutrition Therapy for Diabetes & Renal Dialysis; PBP 7g, 14f, 14j"	20% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Oral and Nebulized Inhaled Medications; PBP 15	"$0/Case for Blood; $0/Visit for Smoking Cessation; PBP 13a, 14a"	PBP 10b	PBP 16a	$55/Exam for Routine Eye Exams (non-cvd); PBP 17a	PBP 17b	$55/Exam for Routine Hearing Test (non-cvd); PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											7500	1.7429	0.0442	0.018	0	0.5759	0.113	0.0425	0.1747	0.7888	0.0952	0.86	0	0	0.134	0.6884	1.182	0.1475	0.0941	0.1341	0.2018	0.0899	0	0	0	0.0031	0	0.0064	0	0	0											7.1364	0	0.506531326	8.3463	0.079576177	0.472484145	0	1.058808428	3.837382446	0.363255552	1.321872157	8.671727399	0.095175326	2.154612989	0	0	0.332982385	3.376554197	14.97810428	1.076563535	1.180935074	0.13414035	0.201755129	3.16353162	0	0	0	0.074025151	0	0.009163116	0	0	0	0	0	0	0	0	0	0	0	0	0	50.929
H3206_002_0	2011	4																															A	A	D		T	Coin	O	V	V		V			V	V	V	V	V		V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	173.6095747	2.54848137	143.4849728	0	120.531092	22.64931048	556.904704	386.0963991	312.8372919	0	213.8032237	0	0	241.2461082	3569.33195	5093.077613	226.2507453	602.2384612	0	110.267655	36.46613662	0	0	0	104.1926199	0	71.46660148	0	0	0											3000	$500/Ben Per for IP Med/Surg; PBP 1a	$500/Ben Per for IP MH/SA; PBP 1b	$40/Days 21-100 for SNF; PBP 2	$0/Visit for HH; PBP 6	$150/Trip for Ambulance; PBP 10a	"10% Coinsurance for DME; 0% Coinsurance for Ostomy Supplies; PBP 11a, 17b"	"10% Coinsurance for Prosthetics; 0% Coinsurance for Ostomy Supplies; $0/Unit for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $10/Visit for Urgent Care (IN); $40/Visit for Urgent Care (OON); PBP 7a; PBP 4a, 4b"	"$350/Case for OP Surg; $350/Visit for ASC services; 0% Coinsurance for Polyp Removal; PBP 9a, 9b"	$0/Visit for OP Lab; PBP 8a	"$0/Case for OP Rad - General; $100/Case for OP Rad - Advanced Imaging; PBP 8a, 8b"	No Cost Sharing; PBP 9a	$0/Case for Renal Dialysis; PBP 12	"$20/Visit for CORF; $30/Day for Partial Hosp; $20/Visit for OP - PT/OT/ST; $30/Service for OP Substance Abuse; $0/Visit for Cardiac Rehab; PBP 3, 5, 9c, 9d"	"$10/Visit for PCP OV; $0/Visit for PCP - IP Visit; $0/Visit for Immunizations; $0/Visit for Immunizations (non-cvd); $0/Visit for Physical Exams (Initial); $0/Visit for Routine Exams; PBP 7a, 14b, 14c"	"$20/Visit for Chiro - cvd; $30/Visit for SCP OV; $0/Visit for SCP - IP Visit; $30/Visit for Podiatry; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $30/Exam for Vision Exams; $30/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"$30/Visit for MH - Non Phys; $30/Visit for Psych Services ; PBP 7e, 7h"	"$20/Visit for OP Occ Therapy; $20/Visit for PT/ST; PBP 7c, 7i"	"$0/Procedure for Phys Rad - General; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 8b, 14g, 14h"	"$0/Visit for Other Health Care Professional; $0/Visit for Colorectal Screening; $0/Visit for Diabetes Monitoring; $0/Visit for Nutrition Therapy for Diabetes & Renal Dialysis; PBP 7g, 14f, 14j"	10% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Oral and Nebulized Inhaled Medications; PBP 15	"$0/Case for Blood; $0/Visit for Smoking Cessation; PBP 13a, 14a"	PBP 10b	PBP 16a	$30/Exam for Routine Eye Exams (non-cvd); PBP 17a	PBP 17b	$30/Exam for Routine Hearing Test (non-cvd); PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											0	500	500	40	0	150	0.099674506	5.826317388	40.84728477	350	0	100	0	0	20.03645952	10	29.28825287	30	20	0	50	0.098308134	0	0	0	30	0	30	0	0	0											NO	476.0292781	476.0292781	38.08234225	0	142.8087834	0.094895966	5.546995321	38.88900697	333.2204947	0	95.20585562	0	0	19.07588272	9.526567611	27.88413175	28.56175669	19.04117112	0	47.60292781	0.0935951	0	0	0	29.52711988	0	29.27985324	0	0	0												6.8869	0.101095979	0.455353653	0	1.434408218	2.149328208	0.257428982	1.25124213	8.686983096	0	1.69627657	0	0	0.383498539	2.833623512	11.8346706	0.538509895	0.955610467	0	0.437421935	3.413051712	0	0	0	0.256375665	0	0.174377634	0	0	0	0	0	0	0	0	0	0	0	0	0	43.7462	0	2.187699169	6.8869	0.101095979	0.455353653	0	1.434408218	2.149328208	0.257428982	1.25124213	8.686983096	0	1.69627657	0	0	0.383498539	2.833623512	11.8346706	0.538509895	0.955610467	0	0.437421935	3.413051712	0	0	0	0.256375665	0	0.174377634	0	0	0	0	0	0	0	0	0	0	0	0	0	43.7462	YES	$1000/Ben Per for IP Med/Surg; PBP 1a	$1000/Ben Per for IP MH/SA; PBP 1b	$60/Days 21-100 for SNF; PBP 2	$0/Visit for HH; PBP 6	$150/Trip for Ambulance; PBP 10a	"25% Coinsurance for DME; PBP 11a, 17b"	"25% Coinsurance for Prosthetics; 25% Coinsurance for DMS; PBP 11b, 11c"	"$50/Case for OP ER; $40/Visit for Urgent Care (OON); PBP 4a, 4b"	"20% Coinsurance for OP Surg; 20% Coinsurance for ASC services; 0% Coinsurance for Polyp Removal; PBP 9a, 9b"	20% Coinsurance for OP Lab; PBP 8a	"10% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - Therapeutic; 20% Coinsurance for OP Rad - Advanced Imaging; PBP 8a, 8b"	No Cost Sharing; PBP 9a	$0/Case for Renal Dialysis; PBP 12	"$35/Visit for CORF; 50% Coinsurance for Partial Hosp; $35/Visit for OP - PT/OT/ST; 20% Coinsurance for OP - Other; 50% Coinsurance for OP Substance Abuse; $35/Visit for Cardiac Rehab; PBP 3, 5, 9c, 9d"	"$35/Visit for PCP OV; $0/Visit for PCP - IP Visit; $0/Visit for Immunizations; $0/Visit for Immunizations (non-cvd); $35/Visit for Physical Exams (Initial); $35/Visit for Routine Exams; PBP 7a, 14b, 14c"	"$55/Visit for Chiro - cvd; $55/Visit for SCP OV; $0/Visit for SCP - IP Visit; $55/Visit for Podiatry; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $55/Exam for Vision Exams; $55/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"50% Coinsurance for MH - Non Phys; 50% Coinsurance for Psych Services ; PBP 7e, 7h"	"$35/Visit for OP Occ Therapy; $35/Visit for PT/ST; PBP 7c, 7i"	"10% Coinsurance for Phys Rad - General; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 8b, 14g, 14h"	"20% Coinsurance for Other Health Care Professional; $0/Visit for Colorectal Screening; 25% Coinsurance for Diabetes Monitoring; 10% Coinsurance for Nutrition Therapy for Diabetes & Renal Dialysis; PBP 7g, 14f, 14j"	20% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Oral and Nebulized Inhaled Medications; PBP 15	"$0/Case for Blood; $0/Visit for Smoking Cessation; PBP 13a, 14a"	PBP 10b	PBP 16a	$55/Exam for Routine Eye Exams (non-cvd); PBP 17a	PBP 17b	$55/Exam for Routine Hearing Test (non-cvd); PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											7500	2.0986	0.0674	0.1554	0	0.7372	0.2742	0.1568	0.2182	1.1067	0.2313	0.7039	0	0	0.4645	1.0142	1.7008	0.2417	0.1116	0.1794	0.758	0.3677	0.0001	0	0	0.0707	0	0.0301	0	0	0											10.6884	0	1.0395491	8.9855	0.168490007	0.610733088	0	2.171595618	2.42350708	0.414270308	1.469432999	9.793728364	0.23127171	2.400185085	0	0	0.847964012	3.8477895	13.53544911	0.78023983	1.067168235	0.179384846	1.195429909	3.780753209	0.000109225	0	0	0.327125029	0	0.204482497	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4346
H3206_003_0	2011	2																															A	A	D		T	Coin	O	V	V		V			P	V	V	V	V		V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	107.9892338	0.726846591	123.9530498	0	118.825941	8.149854912	731.3832361	268.7098844	220.0635349	0	111.8785834	0	0	236.2512017	2168.462704	2824.555287	121.9566189	365.7969481	0	143.4944193	18.77720924	0	0	0	108.5452169	0	54.46382507	0	0	0											3000	$500/Ben Per for IP Med/Surg; PBP 1a	$500/Ben Per for IP MH/SA; PBP 1b	$40/Days 21-100 for SNF; PBP 2	$0/Visit for HH; PBP 6	$150/Trip for Ambulance; PBP 10a	"10% Coinsurance for DME; 0% Coinsurance for Ostomy Supplies; PBP 11a, 17b"	"10% Coinsurance for Prosthetics; 0% Coinsurance for Ostomy Supplies; $0/Unit for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $10/Visit for Urgent Care (IN); $40/Visit for Urgent Care (OON); PBP 7a; PBP 4a, 4b"	"$350/Case for OP Surg; $350/Visit for ASC services; 0% Coinsurance for Polyp Removal; PBP 9a, 9b"	$0/Visit for OP Lab; PBP 8a	"$0/Case for OP Rad - General; $100/Case for OP Rad - Advanced Imaging; PBP 8a, 8b"	No Cost Sharing; PBP 9a	$0/Case for Renal Dialysis; PBP 12	"$20/Visit for CORF; $30/Day for Partial Hosp; $20/Visit for OP - PT/OT/ST; $30/Service for OP Substance Abuse; $0/Visit for Cardiac Rehab; PBP 3, 5, 9c, 9d"	"$10/Visit for PCP OV; $0/Visit for PCP - IP Visit; $0/Visit for Immunizations; $0/Visit for Immunizations (non-cvd); $0/Visit for Physical Exams (Initial); $0/Visit for Routine Exams; PBP 7a, 14b, 14c"	"$20/Visit for Chiro - cvd; $30/Visit for SCP OV; $0/Visit for SCP - IP Visit; $30/Visit for Podiatry; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $30/Exam for Vision Exams; $30/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"$30/Visit for MH - Non Phys; $30/Visit for Psych Services ; PBP 7e, 7h"	"$20/Visit for OP Occ Therapy; $20/Visit for PT/ST; PBP 7c, 7i"	"$0/Procedure for Phys Rad - General; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 8b, 14g, 14h"	"$0/Visit for Other Health Care Professional; $0/Visit for Colorectal Screening; $0/Visit for Diabetes Monitoring; $0/Visit for Nutrition Therapy for Diabetes & Renal Dialysis; PBP 7g, 14f, 14j"	10% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Oral and Nebulized Inhaled Medications; PBP 15	"$0/Case for Blood; $0/Visit for Smoking Cessation; PBP 13a, 14a"	PBP 10b	PBP 16a	$30/Exam for Routine Eye Exams (non-cvd); PBP 17a	PBP 17b	$30/Exam for Routine Hearing Test (non-cvd); PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											0	500	500	40	0	150	0.098804266	5.61956257	41.7970624	350	0	100	0	0	21.27852047	10	29.3561988	30	20	0	50	0.09612856	0	0	0	30	0	30	0	0	0											NO	486.9591545	486.9591545	38.95673236	0	146.0877463	0.096227284	5.472994876	40.70692433	340.8714081	0	97.3918309	0	0	20.72354068	9.746324647	28.59053949	29.21754927	19.47836618	0	48.69591545	0.093621364	0	0	0	29.8724323	0	29.83233481	0	0	0												4.3822	0.029495383	0.402400482	0	1.446584495	0.784238399	0.333571392	0.911529411	6.251113918	0	0.908005006	0	0	0.407996782	1.761211791	6.729629957	0.29693946	0.593760575	0	0.582299343	1.757947947	0	0	0	0.270209137	0	0.135398589	0	0	0	0	0	0	0	0	0	0	0	0	0	27.9845	0	0.739157769	4.3822	0.029495383	0.402400482	0	1.446584495	0.784238399	0.333571392	0.911529411	6.251113918	0	0.908005006	0	0	0.407996782	1.761211791	6.729629957	0.29693946	0.593760575	0	0.582299343	1.757947947	0	0	0	0.270209137	0	0.135398589	0	0	0	0	0	0	0	0	0	0	0	0	0	27.9845	YES	$1000/Ben Per for IP Med/Surg; PBP 1a	$1000/Ben Per for IP MH/SA; PBP 1b	$60/Days 21-100 for SNF; PBP 2	$0/Visit for HH; PBP 6	$150/Trip for Ambulance; PBP 10a	"25% Coinsurance for DME; PBP 11a, 17b"	"25% Coinsurance for Prosthetics; 25% Coinsurance for DMS; PBP 11b, 11c"	"$50/Case for OP ER; $40/Visit for Urgent Care (OON); PBP 4a, 4b"	"20% Coinsurance for OP Surg; 20% Coinsurance for ASC services; 0% Coinsurance for Polyp Removal; PBP 9a, 9b"	20% Coinsurance for OP Lab; PBP 8a	"10% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - Therapeutic; 20% Coinsurance for OP Rad - Advanced Imaging; PBP 8a, 8b"	No Cost Sharing; PBP 9a	$0/Case for Renal Dialysis; PBP 12	"$35/Visit for CORF; 50% Coinsurance for Partial Hosp; $35/Visit for OP - PT/OT/ST; 20% Coinsurance for OP - Other; 50% Coinsurance for OP Substance Abuse; $35/Visit for Cardiac Rehab; PBP 3, 5, 9c, 9d"	"$35/Visit for PCP OV; $0/Visit for PCP - IP Visit; $0/Visit for Immunizations; $0/Visit for Immunizations (non-cvd); $35/Visit for Physical Exams (Initial); $35/Visit for Routine Exams; PBP 7a, 14b, 14c"	"$55/Visit for Chiro - cvd; $55/Visit for SCP OV; $0/Visit for SCP - IP Visit; $55/Visit for Podiatry; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $55/Exam for Vision Exams; $55/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"50% Coinsurance for MH - Non Phys; 50% Coinsurance for Psych Services ; PBP 7e, 7h"	"$35/Visit for OP Occ Therapy; $35/Visit for PT/ST; PBP 7c, 7i"	"10% Coinsurance for Phys Rad - General; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 8b, 14g, 14h"	"20% Coinsurance for Other Health Care Professional; $0/Visit for Colorectal Screening; 25% Coinsurance for Diabetes Monitoring; 10% Coinsurance for Nutrition Therapy for Diabetes & Renal Dialysis; PBP 7g, 14f, 14j"	20% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Oral and Nebulized Inhaled Medications; PBP 15	"$0/Case for Blood; $0/Visit for Smoking Cessation; PBP 13a, 14a"	PBP 10b	PBP 16a	$55/Exam for Routine Eye Exams (non-cvd); PBP 17a	PBP 17b	$55/Exam for Routine Hearing Test (non-cvd); PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											7500	2.2261	0.0203	0.2192	0	0.6607	0.4911	0.3166	0.2218	2.0531	0.2068	0.5877	0	0	0.8389	1.185	2.5017	0.1208	0.2857	0.276	1.3998	0.7777	0.0002	0	0	0.1645	0	0.0648	0	0	0											14.6186	0	1.134578461	6.6083	0.049812548	0.621641137	0	2.107267893	1.275316522	0.650144699	1.133336646	8.30419523	0.206847533	1.495742589	0	0	1.246882335	2.946194836	9.231293185	0.417746578	0.879497484	0.276021255	1.982139972	2.535639301	0.000244864	0	0	0.434711678	0	0.200233502	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6032
H3206_801_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	175.1035441	1.046461698	25.04448564	0	6.8903472	23.32605782	5.834808542	14.43709131	47.5752079	4.807119263	18.77645686	0	0.21049801	31.641578	30.84359718	62.35046074	2.176167622	5.496415804	26.66109802	72.47950072	46.56677583	0.239810139	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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, 17b"	"Medicare-FFS Cost Sharing; PBP 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 8a, 8b"	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	PBP 10b	PBP 16a	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											0	0.07647962	0.07647962	0.167208003	0	0.233	0.233	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	0.070838519	0.070838519	0.154874819	0	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0	0	0	0	0	0	0	0												12.4041	0.074129797	3.878760186	0	1.48703359	5.034090516	1.259233539	3.115726841	10.26739729	1.037443775	4.052222802	0	0.045428424	6.828696429	6.656480974	13.45610414	0.469647502	1.186203639	5.753838979	15.64209306	10.04976351	0.051754392	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7501	0	8.182325723	12.4041	0.074129797	3.878760186	0	1.48703359	5.034090516	1.259233539	3.115726841	10.26739729	1.037443775	4.052222802	0	0.045428424	6.828696429	6.656480974	13.45610414	0.469647502	1.186203639	5.753838979	15.64209306	10.04976351	0.051754392	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7501	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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, 17b"	"Medicare-FFS Cost Sharing; PBP 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 8a, 8b"	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	PBP 10b	PBP 16a	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											10000	0.6059	0.0017	0.1492	0	0.3208	0.2035	0.0378	0.1646	0.1377	0.0738	0.1733	0	0.0019	0.1861	0.3491	0.4182	0.0659	0.0225	0.2132	0.5179	0.1072	0.0008	0	0	0	0	0	0	0	0											3.7513	0	1.176517164	13.01	0.075845213	4.027976512	0	1.807877633	5.237562681	1.297004825	3.280363068	10.40511562	1.111281701	4.225530958	0	0.047350544	7.01483212	7.005630638	13.87430537	0.535524571	1.208753361	5.967005167	16.16003565	10.15694777	0.052522944	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5015
H3206_802_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	175.1035441	1.046461698	25.04448564	0	6.8903472	23.32605782	5.834808542	14.43709131	47.5752079	4.807119263	18.77645686	0	0.21049801	31.641578	30.84359718	62.35046074	2.176167622	5.496415804	26.66109802	72.47950072	46.56677583	0.239810139	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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, 17b"	"Medicare-FFS Cost Sharing; PBP 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 8a, 8b"	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	PBP 10b	PBP 16a	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											0	0.07647962	0.07647962	0.167208003	0	0.233	0.233	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	0.070838519	0.070838519	0.154874819	0	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0	0	0	0	0	0	0	0												12.4041	0.074129797	3.878760186	0	1.48703359	5.034090516	1.259233539	3.115726841	10.26739729	1.037443775	4.052222802	0	0.045428424	6.828696429	6.656480974	13.45610414	0.469647502	1.186203639	5.753838979	15.64209306	10.04976351	0.051754392	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7501	0	8.182325723	12.4041	0.074129797	3.878760186	0	1.48703359	5.034090516	1.259233539	3.115726841	10.26739729	1.037443775	4.052222802	0	0.045428424	6.828696429	6.656480974	13.45610414	0.469647502	1.186203639	5.753838979	15.64209306	10.04976351	0.051754392	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7501	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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, 17b"	"Medicare-FFS Cost Sharing; PBP 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 8a, 8b"	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	PBP 10b	PBP 16a	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											10000	0.6059	0.0017	0.1492	0	0.3208	0.2035	0.0378	0.1646	0.1377	0.0738	0.1733	0	0.0019	0.1861	0.3491	0.4182	0.0659	0.0225	0.2132	0.5179	0.1072	0.0008	0	0	0	0	0	0	0	0											3.7513	0	1.176517164	13.01	0.075845213	4.027976512	0	1.807877633	5.237562681	1.297004825	3.280363068	10.40511562	1.111281701	4.225530958	0	0.047350544	7.01483212	7.005630638	13.87430537	0.535524571	1.208753361	5.967005167	16.16003565	10.15694777	0.052522944	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5015
H3206_803_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	175.1035441	1.046461698	25.04448564	0	6.8903472	23.32605782	5.834808542	14.43709131	47.5752079	4.807119263	18.77645686	0	0.21049801	31.641578	30.84359718	62.35046074	2.176167622	5.496415804	26.66109802	72.47950072	46.56677583	0.239810139	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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, 17b"	"Medicare-FFS Cost Sharing; PBP 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 8a, 8b"	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	PBP 10b	PBP 16a	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											0	0.07647962	0.07647962	0.167208003	0	0.233	0.233	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	0.070838519	0.070838519	0.154874819	0	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0.215814029	0	0	0	0	0	0	0	0												12.4041	0.074129797	3.878760186	0	1.48703359	5.034090516	1.259233539	3.115726841	10.26739729	1.037443775	4.052222802	0	0.045428424	6.828696429	6.656480974	13.45610414	0.469647502	1.186203639	5.753838979	15.64209306	10.04976351	0.051754392	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7501	0	8.182325723	12.4041	0.074129797	3.878760186	0	1.48703359	5.034090516	1.259233539	3.115726841	10.26739729	1.037443775	4.052222802	0	0.045428424	6.828696429	6.656480974	13.45610414	0.469647502	1.186203639	5.753838979	15.64209306	10.04976351	0.051754392	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7501	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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, 17b"	"Medicare-FFS Cost Sharing; PBP 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 8a, 8b"	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 16b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 8b, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	PBP 10b	PBP 16a	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-d											10000	0.6059	0.0017	0.1492	0	0.3208	0.2035	0.0378	0.1646	0.1377	0.0738	0.1733	0	0.0019	0.1861	0.3491	0.4182	0.0659	0.0225	0.2132	0.5179	0.1072	0.0008	0	0	0	0	0	0	0	0											3.7513	0	1.176517164	13.01	0.075845213	4.027976512	0	1.807877633	5.237562681	1.297004825	3.280363068	10.40511562	1.111281701	4.225530958	0	0.047350544	7.01483212	7.005630638	13.87430537	0.535524571	1.208753361	5.967005167	16.16003565	10.15694777	0.052522944	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5015
H3209_001_0	2011	4																															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	YES	142.8698613	43.9249665	9026.706544	19.32832224	23.05440043	21.51389357	7.079601181	17.29337638	3.620639179	45.7324263	10.90425058	0	0	3.707749234	0.356102358	83.96147177	20.131152	9.405521264	0	0	2.0793414	4.507432001	2649.423457	142.1497666	87.02016743	206.4670984	17.75400078	8.103451354	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.075473458	0.076389233	0	0	0.2	0.2	0.02987518	0.06352699	0.2	0	0.079105894	0	0	0.161880676	0.013766127	0.029375818	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.071847913	0.072719696	0	0	0.190392529	0.190392529	0.028440056	0.060475321	0.190392529	0	0.075305856	0	0	0.154104357	0.013042508	0.027831672	0.189486963	0	0	0	0.190392529	0.190717951	0	0	0	0	0	0	0	0												10.2649	3.194210231	0	0	4.389385605	4.096084607	0.201344251	1.045822491	0.68934265	0	0.821153921	0	0	0.571380311	0.004644468	2.336788164	3.814590845	0	0	0	0.395891068	0.859648194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.6852	0	1.678703539	10.2649	3.194210231	0	0	4.389385605	4.096084607	0.201344251	1.045822491	0.68934265	0	0.821153921	0	0	0.571380311	0.004644468	2.336788164	3.814590845	0	0	0	0.395891068	0.859648194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.6852	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.4621	0.455	0	0.0047	0.8978	0.8378	0.2757	0.1426	0.141	0	0.2951	0	0	0.1169	0.0059	1.7968	0.4307	0.0028	0	0	0.0447	0.0971	0	0	0.0124	0	0.0017	0	0	0											7.0208	0	0.364047557	11.727	3.649191306	0	0.004688227	5.287214479	4.933920095	0.477051718	1.188434649	0.830344556	0	1.116257388	0	0	0.688253557	0.010543699	4.13357426	4.245270456	0.002788245	0	0	0.440588447	0.956705248	0	0	0.012403275	0	0.001702402	0	0	0	0	0	0	0	0	0	0	0	0	0	39.706
H3209_002_0	2011	4																															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	YES	322.6633271	21.579999	28.08320205	2250.047579	13.07053067	19.80852799	15.90656299	32.80536758	32.77463623	21.0017807	38.28219423	0	0.156617318	29.15737646	26.90831358	90.60336069	9.432288	3.731901161	0	0	12.38663554	5.163735387	0	932.3625324	0	0	0	0	598.5575223	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a4, 16b1, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.075629971	0.076548035	0.16803021	0	0.233	0.233	0.233	0.080537526	0.233	0.233	0.233	0	0.233	0.233	0.224318081	0.232766283	0.237959043	0.233	0	0	0.233	0.231719424	0	0	0	0	0	0	0	0											NO	0.06173095	0.062480296	0.137150187	0	0.190180048	0.190180048	0.190180048	0.06574787	0.190180048	0.190180048	0.190180048	0	0.190180048	0.190180048	0.182431169	0.189301839	0.193524954	0.189491914	0	0	0.190180048	0.189668733	0	0	0	0	0	0	0	0												19.9183	1.348324725	3.851616403	0	2.485754153	3.767186808	3.025110916	2.156883029	6.233081897	3.994119666	7.280509543	0	0.029785489	5.545151261	4.90891511	17.15138281	1.825383105	0.707165093	0	0	2.355690944	0.979399149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.5638	0	19.82099064	19.9183	1.348324725	3.851616403	0	2.485754153	3.767186808	3.025110916	2.156883029	6.233081897	3.994119666	7.280509543	0	0.029785489	5.545151261	4.90891511	17.15138281	1.825383105	0.707165093	0	0	2.355690944	0.979399149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.5638	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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, 16b1, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	5.8756	0.3977	0.7219	0.9785	0.6614	1.0023	0.7797	0.3947	1.6584	0	1.5293	0	0.0056	1.2165	1.5782	5.8419	0.6081	0.2406	0	0	0.8015	0.3335	0	0	0	0	0	0	0	0											24.6253	0	5.578557653	25.7939	1.746062462	4.573474675	0.978451956	3.147119313	4.769492729	3.804836973	2.551549374	7.891469232	3.994119666	8.809776913	0	0.035365384	6.761679091	6.487123384	22.99324863	2.433496355	0.947766159	0	0	3.157175289	1.312934956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.1891
H3240_010_0	2011	6																																	D		T	Coin	Coin	V					Coin	V	V	V	V	V			Coin	V																			29.39954224	2.337605236	0	0	0	0	0	0	15.13566459	5.286799526	6.870527291	0.25236788	0	5.454640709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											64.7371	YES	0	0	610.877929	0	294.5697196	2.756944826	1.62705021	486.0485314	0	0	0	0	0.121700993	28.39526502	5259.722868	5593.362387	166.8037148	443.5157592	0	0	32.88619194	1.639214842	0	0	0	0	0	0	0	0											3400	No Cost-Sharing; PBP 1a	No Cost-Sharing; PBP 1b	$50/$125 per day for SNF days 8-20/21-100; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; PBP 4a, 4b"	No Cost-Sharing; PBP 9b	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$20/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$5/Visit for PCP Office Visits; $5/Visit for PCP Consults; PBP 7a, 14b-c"	"$20/Visit for Speclst Office Visits; $20/Visit for Speclst Consults; $20/Visit for Chiropractor; $20/Visit for Vision Exams; $20/Visit for Hearing/Speech Exams; $20/Visit for Podiatrist (Routine); PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse; PBP 7e, 7h"	"$20/Visit for Occ Therapy; $20/Visit for PT/ST; PBP 7c, 7i"	"No Cost-Sharing; PBP 7d, 14g-h"	"No Cost-Sharing; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"$20/Visit for Bone Mass Measurements; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	"No Cost-Sharing; PBP 13b-f, 14a"											0	0	0	91.21879862	0	100	0.2	0.2	49.22381224	0	0	0	0	0.2	10.50480381	5	20	20	20	0	0	0.2	20	0	0	0	0	0	0	0	0											NO	0	0	72.70178323	0	100	0.2	0.2	49.22381224	0	0	0	0	0.2	10.50480381	5	20	20	20	0	0	0.2	20	0	0	0	0	0	0	0	0												0	0	3.700992898	0	2.454747663	0.551388965	0.325410042	1.993763471	0	0	0	0	0.024340199	0.024857224	2.191551195	9.322270645	0.278006191	0.739192932	0	0	6.577238388	0.002732025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.1865	1500	0.942636335	29.3995	2.337605236	3.700992898	0	2.454747663	0.551388965	0.325410042	1.993763471	15.13566459	5.286799526	6.870527291	0.25236788	0.024340199	5.479497933	2.191551195	9.322270645	0.278006191	0.739192932	0	0	6.577238388	0.002732025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9236	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	29.3995	2.337605236	3.700992898	0	2.454747663	0.551388965	0.325410042	1.993763471	15.13566459	5.286799526	6.870527291	0.25236788	0.024340199	5.479497933	2.191551195	9.322270645	0.278006191	0.739192932	0	0	6.577238388	0.002732025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9236
H3240_013_0	2011	4																															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	396.4985846	22.32540733	40.01626226	0	13.94753722	8.984611822	5.546065281	21.10107887	27.36400094	10.10369801	13.06582552	0.6049995	0.123362812	12.79862744	61.35337754	99.00982559	2.326346412	4.592369582	19.68184352	44.43805179	31.79742151	9.55845127	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 1b	Medicare-FFS Cost Sharing; PBP 2	No Cost-Sharing; PBP 6	20% Coinsurance for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"20% Coinsurance for ER - Facility; 20% Coinsurance for PCP Urgent Care; PBP 4a, 4b"	20% Coinsurance for OP Fac - Surgery; PBP 9b	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	20% Coinsurance for OP Fac - Observation; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"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; PBP 3, 5, 9a, 9c, 9d, 13a"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for PCP Office Visits; 20% Coinsurance for PCP Consults; 20% Coinsurance for PCP Immunizations; PBP 7a, 14b-c"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for Speclst Office Visits; 20% Coinsurance for Speclst Consults; 20% Coinsurance for Cardio; 20% Coinsurance for Chiropractor; 20% Coinsurance for Speclst Immunizations; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing/Speech Exams; 20% Coinsurance for Podiatrist (Routine); PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"20% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; 20% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"20% Coinsurance for Occ Therapy; 20% Coinsurance for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof - Primary Surgeon (IP); 20% Coinsurance for Prof - Asst Surgeon (IP); 20% Coinsurance for Prof - Anesthesia (IP); 20% Coinsurance for Prof - Primary Surgeon (OP); 20% Coinsurance for Prof - Anesthesia (OP); 20% Coinsurance for Prof - IP Visits; 20% Coinsurance for Allergy Testing; 20% Coinsurance for Allergy Tx; 20% Coinsurance for Prof - ER Visits; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"20% Coinsurance for Renal Dialysis - Prof; 20% Coinsurance for Bone Mass Measurements; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	PBP 14a	"No Cost-Sharing; PBP 13b-f, 14a"											0	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	0.2	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	0.061059834	0.061059834	0.121017378	0	0.190907726	0.190907726	0.190907726	0.190907726	0.190907726	0.190907726	0.190907726	0.190907726	0.190907726	0.190907726	0.190954584	0.190927375	0.190907726	0.190907726	0.190907726	0.190907726	0.190907726	0.192889845	0	0	0	0	0	0	0	0												24.2101	1.363185655	4.842663118	0	2.662692608	1.715231808	1.058786709	4.028358975	5.223999183	1.928874007	2.494367034	0.115499079	0.023550914	2.443356854	11.71570866	18.90368608	0.444117502	0.876718832	3.75741598	8.483567395	6.070373419	1.843728181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.206	0	4.647164262	24.2101	1.363185655	4.842663118	0	2.662692608	1.715231808	1.058786709	4.028358975	5.223999183	1.928874007	2.494367034	0.115499079	0.023550914	2.443356854	11.71570866	18.90368608	0.444117502	0.876718832	3.75741598	8.483567395	6.070373419	1.843728181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.206	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.2101	1.363185655	4.842663118	0	2.662692608	1.715231808	1.058786709	4.028358975	5.223999183	1.928874007	2.494367034	0.115499079	0.023550914	2.443356854	11.71570866	18.90368608	0.444117502	0.876718832	3.75741598	8.483567395	6.070373419	1.843728181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.206
H3251_002_0	2011	5																															D	D	D	V	T	O	P	V	P	O	P	P	P	O	V	V	V	P	P	V	S	O	T	V	V	P	V	P	O	O																																																			0	YES	1338.454213	60.9866327	1233.96589		225.8547969			292.1438677	255.6796202		192.0618716			43.96594821	3749.965538	5045.992029	403.3370525	756.5861904		268.3210617					313.0591446		266.8368941			228.9666577											3350	"$200 Copay / Day 1 to 3  $0 after day 3, unlimited coverage"	"$200 Copay / Day 1 to 3  $0 after day 3, unlimited coverage"	$0 Copay / Day 1 to 20  $50 Copay / Day 21 to 100	$0 copay for Medicare covered visits	$75 copay for Medicare covered visits	$0 copay for Medicare covered items	$0 copay for Medicare covered items	"(4a) $50 copay, worldwide coverage, (4b) $20 copay"	$150 copay for Medicare covered OP facility and ASC visits	"$0 copay for routine x-rays, Medicare covered labs"	"$50 copay for PET, CT, MRI, MRA and nuclear medicine services. $10 copay for the first five copayments within a calendar month for radiation and chemotherapy services."	$0 copay for Medicare covered services	$0 copay for dialysis	"(3) $10/visit, (5) $0/visit, (9C) $30/day,(9D) $10/visit"	"$10 copay/visit, urgent care $20 copay"	"$30 copay/visit, urgent care $20 copay"	$20 copay/session	$10 copay/visit	(7D) $30/visit	"(7B) $25/visit,36 visit limits (7D) $30/visit,(7F) $30/visit, (7G) $50 daytime study, $150 overnight sleep study, (14C) $0 Copay (14D) & (14E) $0 for screening test, $10 at PCP office, $30 at specialist office, (14F)-(14J) $0 copay except for $150 copay for colonoscopy procedures"	$0 copay	"(13A) $0 copay, 3 pint deductible waived, (14A)  $0 copay"	Not covered	Not covered	$30 copay eye exam every year	$150 eyewear benefit every two years	$30 copay rountine hearing tests every two years	Not covered	(14A) No cost sharing	"(13B) $15/treatment, 20 treatment limits, (13 C) & (13D) not covered, (13E) safety devices to prevent falls in the bathroom, installation costs is not included"												65.66564364	51.47679325	13.58947911		75			49.97958931	150		46.4624389			14.78036422	10.58835769	29.88992708	20	10		25					29.98821543		30			15											NO	61.43080899	48.1490853	12.7109897		70.15163863			46.75163415	140.3032773		43.45888298			13.82489026	9.903875234	27.95769818	18.70710363	9.353551817		23.38387954					29.98821543		30			15												6.8519	0.244704215	1.30707731	0	1.320340341	0	0	1.138183602	2.989390721	0	0.6955662	0	0	0.050652034	3.094932569	11.75619351	0.628772337	0.589730678	0	0.522865615	0	0	0	0	0.782340423	0	0.667092235	0	0	0.286208322	0	0	0	0	0	0	0	0	0	0	32.9259	0	2.154357619	6.8519	0.244704215	1.30707731	0	1.320340341	0	0	1.138183602	2.989390721	0	0.6955662	0	0	0.050652034	3.094932569	11.75619351	0.628772337	0.589730678	0	0.522865615	0	0	0	0	0.782340423	0	0.667092235	0	0	0.286208322	0	0	0	0	0	0	0	0	0	0	32.9259	NO																																																																																		0	0	0	6.8519	0.244704215	1.30707731	0	1.320340341	0	0	1.138183602	2.989390721	0	0.6955662	0	0	0.050652034	3.094932569	11.75619351	0.628772337	0.589730678	0	0.522865615	0	0	0	0	0.782340423	0	0.667092235	0	0	0.286208322	0	0	0	0	0	0	0	0	0	0	32.9259
H3251_021_0	2011	5																															D	D	D	V	T	O	P	V	P	O	P	P	P	O	V	V	V	P	P	V	S	O	T	V	V	P	V	P	O	O																																																			0	YES	2137.804037	54.67764808	2388.298932		335.75632			369.7455278	279.2697355		256.5176369			165.2461146	4911.189433	7233.980474	709.3413589	819.5485093		232.7370672					318.2412061		268.6559925			278.3161019											2750	"$150 Copay / Day 1 to 3  $0 after day 3, unlimited coverage"	"$150 Copay / Day 1 to 3  $0 after day 3, unlimited coverage"	$0 Copay / Day 1 to 20  $50 Copay / Day 21 to 100	$0 copay for Medicare covered visits	$75 copay for Medicare covered visits	$0 copay for Medicare covered items	$0 copay for Medicare covered items	"(4a) $50 copay, worldwide coverage, (4b) $20 copay"	$150 copay for Medicare covered OP facility and ASC visits	"$0 copay for routine x-rays, Medicare covered lab"	"$50 copay for PET, CT, MRI, MRA and nuclear medicine services. $10 copay for the first five copayments within a calendar month for radiation and chemotherapy services."	$0 copay for Medicare covered services	$0 copay for dialysis	"(3) $10/visit, (5) $0/visit, (9C) $30/day,(9D) $10/visit"	"$10 copay/visit, urgent care $20 copay"	"$30 copay/visit, urgent care $20 copay"	$20 copay/session	$10 copay/visit	(7D) $30/visit	"(7B) $25/visit,36 visit limits (7D) $30/visit,(7F) $30/visit, (7G) $50 daytime study, $150 overnight sleep study, (14C) $0 copay, (14D) & (14E) $0 for screening test, $10 at PCP office, $30 at specialist office, (14F)-(14J) $0 copay except for $150 copay for colonoscopy procedures"	$0 copay	"(13A) $0 copay, 3 pint deductible waived, (14A)  $0 copay"	Not covered	Not covered	$30 copay eye exam every year	$150 eyewear benefit every two years	$30 copay rountine hearing tests every two years	Not covered	(14A) No cost sharing	"(13B) $15/treatment, 20 treatment limits, (13 C) & (13D) not covered, (13E) safety devices to prevent falls in the bathroom, installation costs is not included"												48.41097869	42.77108434	15.09520532		75			49.95068883	150		46.80941823			17.84611126	10.54894374	29.90125505	20	10		25					29.99897601		30			15											YES	41.249564	36.44397672	12.86217827		63.90528313			42.56150549	127.8105663		39.88492167			15.20614391	8.988443156	25.4779756	17.04140883	8.520704417		21.30176104					29.99897601		30			15											3400	7.3486	0.166055911	2.559893885	0	1.788050225	0	0	1.311410526	2.974468586	0	0.852598821	0	0	0.20939635	3.678662254	15.3589315	1.007348008	0.58192755	0	0.413142449	0	0	0	0	0.795575859	0	0.671639981	0	0	0.347895127	0	0	0	0	0	0	0	0	0	0	40.0656	0	6.640743226	7.3486	0.166055911	2.559893885	0	1.788050225	0	0	1.311410526	2.974468586	0	0.852598821	0	0	0.20939635	3.678662254	15.3589315	1.007348008	0.58192755	0	0.413142449	0	0	0	0	0.795575859	0	0.671639981	0	0	0.347895127	0	0	0	0	0	0	0	0	0	0	40.0656	NO	20% coin	20% coin	20% coin	$0 copay for Medicare covered visits	$75 copay for Medicare covered visits	20% coin	20% coin	"$50 copay, worldwide coverage"	$250 copay for Medicare covered OP facility and ASC visits	20% coin	20% coin	20% coin	$0 copay for dialysis	"(3) 20% coin, (5) 20% coin, (9C) $40/day,(9D) 20% coin"	"$20 copay/visit, urgent care $50 copay"	"$40 copay/visit, urgent care $50 copay"	$40 copay/session	20% coin	(7D) $40/visit	"(7B) $40, (7D) $40/visit,(7F) $40/visit, (7G) $40 (14C) $0 copay, (14D) & (14E) $0 for screening test, $20 at PCP office, $40 at specialist office, (14F)-(14J) $0 copay"	$0 copay	"(13A) 20% coin, (14A) not covered"	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	"(13B), (13 C), (13D) & (13E) not covered"												0.9192	0.0075	0.1129		0.034	0.116	0.0173	0.0427	0.109	0.0187	0.0938	0.013		0.0167	0.1663	0.4187	0.0313	0.0309	0.0233	0.0151	0.0612	0.0039																			2.2515	500	0.989770949	8.2678	0.173558629	2.67277361	0	1.822011537	0.115999186	0.017284673	1.354085573	3.08349145	0.018682687	0.946407439	0.013039848	0	0.226145165	3.844967262	15.77761148	1.038666334	0.612813336	0.023343298	0.428237133	0.061215704	0.003877932	0	0	0.795575859	0	0.671639981	0	0	0.347895127	0	0	0	0	0	0	0	0	0	0	42.3171
H3251_023_0	2011	4																															D	D	D	V	T	O	P	V	P	O	P	P	P	O	V	V	V	P	P	V	S	O	T	V	V	P	V	P	O	O																																																			0	YES					187.0553244			240.0941041	207.7015182		142.2693209			31.57668126	3102.444232	4048.994614	341.4823578	600.8336272		241.0952935					268.122126		267.087194			355.7945835											2800	$0 Copay unlimited coverage	$0 Copay	"$0 Copay, 0 hospital days required prior to SNF admission"	$0 copay for Medicare covered visits	$50 copay for Medicare covered visits	$0 copay for Medicare covered items	$0 copay for Medicare covered items	"$50 copay, worldwide coverage"	$50 copay for Medicare covered OP facility and ASC visits	$0 copay for routine x-rays and Medicare covered Lab	"$50 copay for PET, CT, MRI, MRA and nuclear medicine services. $20 copay for the first five copayments within a calendar month for radiation and chemotherapy services."	$0 copay for Medicare covered services	$0 copay for dialysis	"(3) $5/visit, (5) $0/visit, (9C) $20/session,(9D) $5/visit"	"$5 copay/visit, urgent care $20"	"$20 copay/visit, urgent care $20"	$20 copay/session	$5 copay/visit	(7D) $20/visit	"(7B) $25/visit,36 visit limits (7D) $20/visit,(7F) $20/visit, (7G) $50 daytime study, $150 overnight sleep study, (14C) $0 Copay, (14D) & (14E) $0 for screening test, $5 at PCP office, $20 at specialist office, (14F)-(14J) $0 copay except for $50 copay for colonoscopy procedures"	$0 copay	"(13A) $0 copay, 3 pint deductible waived, (14A)  no cost sharing"	Not covered	Not covered	$30 copay eye exam every year	$150 eyewear every two years	$30 copay rountine hearing tests every two years	Not covered	(14A) No cost sharing	"(13B) $15/treatment, 20 treatment limits, (13 C) & (13D) not covered, (13E) safety devices to prevent falls in the bathroom, installation costs is not included"																50			49.98548442	50		47.11576978			10.15058064	5.995276738	20	20	5		25					29.97337135		30			17.1134938											NO					49.27993709			49.26563055	49.27993709		46.43724342			10.00439951	5.90893721	19.71197483	19.71197483	4.927993709		24.63996854					29.97337135		30			16.99174592												0	0	0	0	0.768172885	0	0	0.985698952	0.852959813	0	0.550549591	0	0	0.026325478	1.527679014	6.651139996	0.56094097	0.246742028	0	0.495048371	0	0	0	0	0.669710337	0	0.667717985	0	0	0.503797597	0	0	0	0	0	0	0	0	0	0	14.5065	0	0.188670516	0	0	0	0	0.768172885	0	0	0.985698952	0.852959813	0	0.550549591	0	0	0.026325478	1.527679014	6.651139996	0.56094097	0.246742028	0	0.495048371	0	0	0	0	0.669710337	0	0.667717985	0	0	0.503797597	0	0	0	0	0	0	0	0	0	0	14.5065	NO																																																																																		0	0	0	0	0	0	0	0.768172885	0	0	0.985698952	0.852959813	0	0.550549591	0	0	0.026325478	1.527679014	6.651139996	0.56094097	0.246742028	0	0.495048371	0	0	0	0	0.669710337	0	0.667717985	0	0	0.503797597	0	0	0	0	0	0	0	0	0	0	14.5065
H3251_024_0	2011	5																															D	D	D	V	T	O	P	V	P	O	P	P	P	O	V	V	V	P	P	V	S	O	T	V	V	P	V	P	O	O																																																			0	YES	1246.283163	57.45050081	1146.709103		210.9601088			272.848747	236.4248494		178.3696448			41.03184766	3480.820205	4674.536077	379.677718	700.6194273		246.8297594					289.396327		267.087194														3350	"$200 Copay / Day 1 to 3  $0 after day 3, unlimited coverage"	"$200 Copay / Day 1 to 3  $0 after day 3, unlimited coverage"	$0 Copay / Day 1 to 20  $50 Copay / Day 21 to 100	$0 copay for Medicare covered visits	$75 copay for Medicare covered visits	$0 copay for Medicare covered items	$0 copay for Medicare covered items	"(4A) $50 copay, worldwide coverage, (4B) $20 copay"	$150 copay for Medicare covered OP facility and ASC visits	$0 copay for routine x-rays and Medicared covered lab	"$50 copay for PET, CT, MRI, MRA and nuclear medicine services. $10 copay for the first five copayments within a calendar month for radiation and chemotherapy services."	$0 copay for Medicare covered services	$0 copay for dialysis	"(3) $10/visit, (5) $0/visit, (9C) $30/day,(9D) $10/visit"	"$10 copay/visit, urgent care $20 copay"	"$30 copay/visit, urgent care $20 copay"	$20 copay/session	$10 copay/visit	(7D) $30/visit	"(7B) $25/visit,36 visit limits (7D) $30/visit,(7F) $30/visit, (7G) $50 daytime study, $150 overnight sleep study, (14C) $0 copay, (14D) & (14E) $0 for screening test, $10 at PCP office, $30 at specialist office, (14F)-(14J) $0 copay except for $150 copay for colonoscopy procedures"	$0 copay	"(13A) $0 copay, 3 pint deductible waived, (14A)  $0 copay"	Not covered	Not covered	$30 copay eye exam every year	$150 eyewear benefit every two years	$30 copay rountine hearing tests every two years	Not covered	(14A) No cost sharing	"(13B) $15/treatment, 20 treatment limits, (13 C) & (13D) not covered, (13E) safety devices to prevent falls in the bathroom, installation costs is not included"												65.66574569	51.47679325	13.58947911		75			49.97998813	150		46.47531349			14.83873093	10.58738322	29.88992092	20	10		25					29.98861909		30														NO	61.98350836	48.58352201	12.82567767		70.78459866			47.17084535	141.5691973		43.86315218			14.00471484	9.992315626	28.20994742	18.87589298	9.437946488		23.59486622					29.98861909		30															6.4374	0.232595639	1.225610111	0	1.244393886	0	0	1.072542171	2.789206346	0	0.651987906	0	0	0.047886611	2.89845451	10.98903474	0.597229664	0.551034055	0	0.485326263	0	0	0	0	0.723216351	0	0.667717985	0	0	0	0	0	0	0	0	0	0	0	0	0	30.6137	0	1.739348048	6.4374	0.232595639	1.225610111	0	1.244393886	0	0	1.072542171	2.789206346	0	0.651987906	0	0	0.047886611	2.89845451	10.98903474	0.597229664	0.551034055	0	0.485326263	0	0	0	0	0.723216351	0	0.667717985	0	0	0	0	0	0	0	0	0	0	0	0	0	30.6137	NO																																																																																		0	0	0	6.4374	0.232595639	1.225610111	0	1.244393886	0	0	1.072542171	2.789206346	0	0.651987906	0	0	0.047886611	2.89845451	10.98903474	0.597229664	0.551034055	0	0.485326263	0	0	0	0	0.723216351	0	0.667717985	0	0	0	0	0	0	0	0	0	0	0	0	0	30.6137
H3251_025_0	2011	6																															D	D	D	V	T	O	P	V	P	O	P	P	P	O	V	V	V	P	P	V	S	O	T	V	V	P	V	P	O	O																																																			0	YES	1975.872656	50.5205012	2208.091589		310.6229333			341.9282044	258.1104467		237.1372698			152.731514	4542.25355	6688.152116	655.5684925	757.4947375		215.0420455					294.2301264		268.6856939			255.7935897											2750	"$150 Copay / Day 1 to 3  $0 after day 3, unlimited coverage"	"$150 Copay / Day 1 to 3  $0 after day 3, unlimited coverage"	$0 Copay / Day 1 to 20  $50 Copay / Day 21 to 100	$0 copay for Medicare covered visits	$75 copay for Medicare covered visits	$0 copay for Medicare covered items	$0 copay for Medicare covered items	"(4A) $50 copay, worldwide coverage, (4B) $20 Copay"	$150 copay for Medicare covered OP facility and ASC visits	$0 copay for routine x-rays and Medicare covered lab	"$50 copay for PET, CT, MRI, MRA and nuclear medicine services. $10 copay for the first five copayments within a calendar month for radiation and chemotherapy services."	$0 copay for Medicare covered services	$0 copay for dialysis	"(3) $10/visit, (5) $0/visit, (9C) $30/day,(9D) $10/visit"	"$10 copay/visit, urgent care $20 copay"	"$30 copay/visit, urgent care $20 copay"	$20 copay/session	$10 copay/visit	(7D) $30/visit	"(7B) $25/visit,36 visit limits (7D) $30/visit,(7F) $30/visit, (7G) $50 daytime study, $150 overnight sleep study, (14C) $0 copay, (14D) & (14E) $0 for screening test, $10 at PCP office, $30 at specialist office, (14F)-(14J) $0 copay except for $150 copay for colonoscopy procedures"	$0 copay	"(13A) $0 copay, 3 pint deductible waived, (14A)  $0 copay"	Not covered	Not covered	$30 copay eye exam every year	$150 eyewear benefit every two years	$30 copay rountine hearing tests every two years	Not covered	(14A) No cost sharing	"(13B) $15/treatment, 20 treatment limits, (13 C) & (13D) not covered, (13E) safety devices to prevent falls in the bathroom, installation costs is not included"												48.41097869	42.77108434	15.09520532		75			49.95073129	150		46.81106902			17.84359006	10.5488695	29.90123769	20	10		25					29.99895477		30														YES	42.06585364	37.16516837	13.11670854		65.16990791			43.40379411	130.3398158		40.67564076			15.50486828	9.166251388	25.98214542	17.37864211	8.689321055		21.72330264					29.99895477		30														3400	6.9264	0.156466911	2.413574484	0	1.686938997	0	0	1.236748449	2.803505673	0	0.8038092	0	0	0.197340167	3.469619826	14.48104507	0.949407517	0.548509581	0	0.389285286	0	0	0	0	0.735549688	0	0.671714235	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4699	0	5.439614212	6.9264	0.156466911	2.413574484	0	1.686938997	0	0	1.236748449	2.803505673	0	0.8038092	0	0	0.197340167	3.469619826	14.48104507	0.949407517	0.548509581	0	0.389285286	0	0	0	0	0.735549688	0	0.671714235	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4699	NO	20% coin	20% coin	20% coin	$0 copay for Medicare covered visits	$75 copay for Medicare covered visits	20% coin	20% coin	"$50 copay, worldwide coverage"	$250 copay for Medicare covered OP facility and ASC visits	20% coin	20% coin	20% coin	$0 copay for dialysis	"(3) 20% coin, (5) 20% coin, (9C) $40/day,(9D) 20% coin"	"$20 copay/visit, urgent care $50 copay"	"$40 copay/visit, urgent care $50 copay"	$40 copay/session	20% coin	(7D) $40/visit	"(7B) $40, (7D) $40/visit,(7F) $40/visit, (7G) $40 (14D) & (14E) $0 for screening test, $20 at PCP office, $40 at specialist office, (14F)-(14J) $0 copay"	$0 copay	(13A) 20% coin (14A)  not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	(14A) Not covered	(13B) (13 C) (13D) & (13E) not covered												0.878	0.0072	0.1078		0.0327	0.1107	0.0165	0.0417	0.1053	0.0178	0.0896	0.0124		0.0163	0.1607	0.4046	0.0299	0.0295	0.0232	0.0154	0.0608	0.0038																			2.1639	500	0.842720103	7.8044	0.163628995	2.521324917	0	1.719606577	0.110726725	0.016499725	1.278418436	2.908849123	0.017833749	0.893402988	0.012447821	0	0.21364718	3.630319804	14.88560902	0.979311778	0.577991802	0.023197303	0.404670344	0.060832844	0.003822581	0	0	0.735549688	0	0.671714235	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6338
H3251_804_0	2011	7																															A	A	D	V	T	Coin	Coin	V	P	O	P	P	P	O	V	V	V	P	P	V	S	O	T	V	V	P	V	P	O	O																																																			0	YES	208.5989126	3.86715626	805.7728845		187.3913821	18.7058949	3.344132215	224.1798617	251.5124487		211.1261929			38.52892612	3969.971253	5725.168593	300.9925977	737.2051428		192.7365886					375.125966		267.0328792			270.0724209											6700	"$400 Copay, unlimited coverage"	"$400 Copay, unlimited coverage"	$0 Copay / Day 1 to 20  $50 Copay / Day 21 to 100	$0 copay for Medicare covered visits	$95 copay for Medicare covered visits	20% coinsurance	20% coinsurance	"$50 copay, worldwide coverage"	$300 copay for Medicare covered OP facility and ASC visits	$0 copay for routine x-rays and Medicare covered lab	"$100 copay for PET, CT, MRI, MRA and nuclear medicine services. $20 copay for the first five copayments within a calendar month for radiation and chemotherapy services."	$0 copay for Medicare covered services	$0 copay for dialysis	"(3) $30/visit, (5) $0/visit, (9C) $40/visit,(9D) $30/visit"	"$30 copay/visit, urgent care $50 copay"	"$60 copay/visit, urgent care $50 copay"	$40 copay/session	$30 copay/visit	(7D) $60/visit	"(7B) $25/visit,36 visit limits (7D) $60/visit,(7F) $60/visit, (7G) $50 daytime study, $150 overnight sleep study, (14D) & (14E) $0 for screening test, $30 at PCP office, $60 at specialist office, (14F)-(14J) $0 copay except for $300 copay for colonoscopy procedures"	$0 copay	"(13A) $0 copay, 3 pint deductible waived, (14A)  no cost sharing"	Not covered	Not covered	$30 copay eye exam every year	Not covered	$30 copay rountine hearing tests every two years	Not covered	(14A) No cost sharing	"(13B) $30/treatment, 20 treatment limits, (13 C) & (13D) not covered, (13E) safety devices to prevent falls in the bathroom, installation costs is not included"												400	400	14.80351011		95	0.2	0.2	49.99700655	300		91.83054312			31.29785293	31.14217551	59.62944122	39.9607477	29.97686532		25					30		30			30											NO	375.4431636	375.4431636	13.89469167		89.16775134	0.187721582	0.187721582	46.93039544	281.5823727		86.19287405			29.415628	29.23029224	56.08630272	37.51086178	28.13652287		23.46519772					30		30			30												6.5264	0.120991448	0.932997149	0	1.392439013	3.51150018	0.627765789	0.876737463	5.901789339	0	1.516464446	0	0	0.094446046	9.670284992	26.75862824	0.940874311	1.728532447	0	0.376883513	0	0	0	0	0.937814915	0	0.667582198	0	0	0.675181052	0	0	0	0	0	0	0	0	0	0	63.2573	0	3.928266997	6.5264	0.120991448	0.932997149	0	1.392439013	3.51150018	0.627765789	0.876737463	5.901789339	0	1.516464446	0	0	0.094446046	9.670284992	26.75862824	0.940874311	1.728532447	0	0.376883513	0	0	0	0	0.937814915	0	0.667582198	0	0	0.675181052	0	0	0	0	0	0	0	0	0	0	63.2573	NO																																																																																		0	0	0	6.5264	0.120991448	0.932997149	0	1.392439013	3.51150018	0.627765789	0.876737463	5.901789339	0	1.516464446	0	0	0.094446046	9.670284992	26.75862824	0.940874311	1.728532447	0	0.376883513	0	0	0	0	0.937814915	0	0.667582198	0	0	0.675181052	0	0	0	0	0	0	0	0	0	0	63.2573
H3305_007_0	2011	7																															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	Coin																																																			0	YES	294.9950963	4.18600806	1436.194724		275.046345	5.756778593	2.297786836	309.7132033	275.9787055		443.6340739	47.38086498		646.6343809	3824.675049	5454.34378	95.52542455	737.2667231	2485.074382	9.062028961	1040.691001				5.566056476		2.897399261			0.193108886											3400	$300 per stay/$900 max	$300 per stay/$900 max	$0 days 1-20; $105/day days 21-100	$0 Copay	$50 Copay	20.00%	20.00%	$50 ER Copay;$25 UC Copay	$150 for OP Surgery;$75 for ASC	$0 Copay	"$40 Copay for MRI, CT, Other Imaging, and Diag Rad.;$25 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$25 Copay	$0 Copay	"$25 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$25 Copay for Chemotherapy;$40 Copay for Clinic"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$25 Copay	$25 Copay	$25 Copay	20% of the cost for diabetic related shoe inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 	$100 allowance	$25 exam	No coverage	No Cost Sharing	50.0% for Accupuncture												280.2132935	294.5619335	26.76		50	0.2	0.2	46.50383142	121.7137592		37.85632404	25		38.68462446	14.99067378	24.72670183	25	25	24.99130173	24.40547625	23.13124829				25		25			0.5											NO	250.3237209	263.1418315	23.90558524		44.66663909	0.178666556	0.178666556	41.54339708	108.7308911		33.81829526	22.33331954		34.55824318	13.39999173	22.08917333	22.33331954	22.33331954	22.32554909	21.80221199	20.66390238				22.33331954		22.33331954			0.5												6.1537	0.091792819	2.861089617	0	1.023782985	1.028543807	0.410537661	1.072211549	2.500617548	0	1.250245675	0.088181	0	1.862212349	4.270884501	10.04016209	0.177783319	1.372134443	4.62338751	0.016464356	1.792061438	0	0	0	0.010359043	0	0.005392379	0	0	0.096554443	0	0	0	0	0	0	0	0	0	0	40.7481	0	4.850970036	6.1537	0.091792819	2.861089617	0	1.023782985	1.028543807	0.410537661	1.072211549	2.500617548	0	1.250245675	0.088181	0	1.862212349	4.270884501	10.04016209	0.177783319	1.372134443	4.62338751	0.016464356	1.792061438	0	0	0	0.010359043	0	0.005392379	0	0	0.096554443	0	0	0	0	0	0	0	0	0	0	40.7481	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	No Cost Sharing																																									0.0775											0.0775	0	0	6.1537	0.091792819	2.861089617	0	1.023782985	1.028543807	0.410537661	1.072211549	2.500617548	0	1.250245675	0.088181	0	1.862212349	4.270884501	10.04016209	0.177783319	1.372134443	4.62338751	0.016464356	1.792061438	0	0	0	0.010359043	0	0.005392379	0	0	0.174066708	0	0	0	0	0	0	0	0	0	0	40.8256
H3305_011_0	2011	10																															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	Coin																																																			0	NO	279.6608025	3.512313969	1382.151213		266.6313935	7.774625086	3.780381737	330.5858529	289.0000064		486.6718089	52.52298598		798.5347621	4040.388323	5851.511193	232.8603864	999.1419755	2696.198409	10.54599355	1180.223198				7.441185684		3.665061605			0.264701365												$300 per stay/$900 max	$300 per stay/$900 max	$0 days 1-20; $105/day days 21-100	$0 Copay	$50 Copay	20.00%	20.00%	$50 ER Copay;$25 UC Copay	$150 for OP Surgery;$75 for ASC	$0 Copay	"$40 Copay for MRI, CT, Other Imaging, and Diag Rad.;$25 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$25 Copay	$0 Copay	"$25 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$25 Copay for Chemotherapy;$40 Copay for Clinic"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$25 Copay	$25 Copay	$25 Copay	20% of the cost for diabetic related shoe inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 	$100 allowance	$25 exam Copay	No coverage	No Cost Sharing	50.0% for Accupuncture												280.2132935	294.5619335	26.76		50	0.2	0.2	46.14485981	122.177678		37.78123413	25		37.84570146	15.00015001	24.68336009	25	25	24.99168259	25.94438837	26.0965797				25		25			0.5											NO	246.4747445	259.0957639	23.53801307		43.97984504	0.17591938	0.17591938	40.58887568	107.4671069		33.23225645	21.98992252		33.28896172	13.19408546	21.71140704	21.98992252	21.98992252	21.98260655	22.8206036	22.95447063				21.98992252		21.98992252			0.5												5.7441	0.075835473	2.711091109	0	0.977200614	1.367707226	0.665042412	1.118175674	2.588166216	0	1.347766863	0.096248033	0	2.215199427	4.442435736	10.58704511	0.426715155	1.830921219	4.939122402	0.020055495	2.257616561	0	0	0	0.013635925	0	0.006716202	0	0	0.132350682	0	0	0	0	0	0	0	0	0	0	43.5632	0	5.945000244	5.7441	0.075835473	2.711091109	0	0.977200614	1.367707226	0.665042412	1.118175674	2.588166216	0	1.347766863	0.096248033	0	2.215199427	4.442435736	10.58704511	0.426715155	1.830921219	4.939122402	0.020055495	2.257616561	0	0	0	0.013635925	0	0.006716202	0	0	0.132350682	0	0	0	0	0	0	0	0	0	0	43.5632	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	No Cost Sharing																																									0.1054											0.1054	0	0	5.7441	0.075835473	2.711091109	0	0.977200614	1.367707226	0.665042412	1.118175674	2.588166216	0	1.347766863	0.096248033	0	2.215199427	4.442435736	10.58704511	0.426715155	1.830921219	4.939122402	0.020055495	2.257616561	0	0	0	0.013635925	0	0.006716202	0	0	0.237766889	0	0	0	0	0	0	0	0	0	0	43.6686
H3305_015_0	2011	7																															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	Coin																																																			0	NO	213.9332367	3.035732676	1041.542011		199.4662134	4.54824957	1.815409056	224.6069472	200.1423701	4360.472803	321.7276305	34.36105186		468.9453751	2773.690555	3955.541748	69.27594227	534.6728077	1802.199469	6.571869197	754.7189667				3.994705954		2.079435976			0.152569253												$500 per stay/$1500 max per yr	$500 per stay/$1500 max per yr	$0 days 1-20; $105/day days 21-100	$0 Copay	$75 Copay	20.00%	20.00%	$50 ER Copay;$40 UC Copay	$250 for OP Surgery;$150 for ASC	$10 Copay	"$50 Copay for MRI, CT, Other Imaging, and Diag Rad.;$40 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$40 Copay	$0 Copay	"$40 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$40 Copay for Chemotherapy;$50 Copay for Clinic"	$20 Copay for Office Visits;$0 Copay for Preventive Services;$40 Copay for PCP Ophthalmology Services	$40 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$40 Copay	$40 Copay	$40 Copay	20% of the cost for diabetic related shoe inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$40 	No coverage	$40 Copay	No coverage	No Cost Sharing	50.0% for Accupuncture												467.0221558	490.9365559	26.76		75	0.2	0.2	48.60153257	212.2850123	9.6939159	48.57088269	40		49.12308297	19.96455068	38.9068073	40	40	39.98260346	26.58817829	32.56687917				40		40			0.5											NO	426.9547592	448.8174628	24.46416988		68.56549855	0.182841329	0.182841329	44.43184414	194.0723694	8.883028546	44.40382382	36.56826589		44.90864899	18.26054446	35.56886186	36.56826589	36.56826589	36.55236186	24.30708933	29.77285742				36.56826589		36.56826589			0.5												7.6117	0.11354082	2.123371725	0	1.139708364	0.831607998	0.331931805	0.831641739	3.236841997	3.227850366	1.190494752	0.10471034	0	1.75497527	4.220758308	11.72450984	0.211108423	1.629338116	5.489553929	0.013311918	1.872511682	0	0	0	0.012173289	0	0.006336781	0	0	0.076284626	0	0	0	0	0	0	0	0	0	0	47.7542	0	4.463824092	7.6117	0.11354082	2.123371725	0	1.139708364	0.831607998	0.331931805	0.831641739	3.236841997	3.227850366	1.190494752	0.10471034	0	1.75497527	4.220758308	11.72450984	0.211108423	1.629338116	5.489553929	0.013311918	1.872511682	0	0	0	0.012173289	0	0.006336781	0	0	0.076284626	0	0	0	0	0	0	0	0	0	0	47.7542	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	No Cost Sharing																																									0.0556											0.0556	0	0	7.6117	0.11354082	2.123371725	0	1.139708364	0.831607998	0.331931805	0.831641739	3.236841997	3.227850366	1.190494752	0.10471034	0	1.75497527	4.220758308	11.72450984	0.211108423	1.629338116	5.489553929	0.013311918	1.872511682	0	0	0	0.012173289	0	0.006336781	0	0	0.131846877	0	0	0	0	0	0	0	0	0	0	47.8098
H3305_016_0	2011	5																															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	Coin																																																			0	YES	272.2807528	3.863689398	1325.609089		253.8680366	5.571062487	2.223659264	285.8655795	254.7286062		409.4746698	43.73258319		596.8441451	3530.178687	5034.364467	88.1700572	680.4978827	2293.726005	8.364261301	960.5587782				5.282851904		2.749977703			0.186879112											3400	$300 per stay/$900 max	$300 per stay/$900 max	$0 days 1-20; $105/day days 21-100	$0 Copay	$50 Copay	20.00%	20.00%	$50 ER Copay;$25 UC Copay	$150 for OP Surgery;$75 for ASC	$0 Copay	"$40 Copay for MRI, CT, Other Imaging, and Diag Rad.;$25 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$25 Copay	$0 Copay	"$25 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$25 Copay for Chemotherapy;$40 Copay for Clinic"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$25 Copay	$25 Copay	$25 Copay	20% of the cost for diabetic related shoe inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 	$100 allowance	$25 exam Copay	No Coverage	No Cost Sharing	50.0% for Accupuncture												280.2132935	294.5619335	26.76		50	0.2	0.2	46.50383142	121.7137592		37.85632404	25		38.68462446	14.9952475	24.72670183	25	25	24.99130173	25.58843022	23.55305872				25		25			0.5											NO	254.6986464	267.7407799	24.32338485		45.44728111	0.181789124	0.181789124	42.26945398	110.6311886		34.40934	22.72364055		35.16222005	13.63418433	22.47522737	22.72364055	22.72364055	22.7157343	23.25849163	21.40844961				22.72364055		22.72364055			0.5												5.7791	0.086205601	2.686941669	0	0.961467668	1.012758572	0.404237071	1.006948497	2.348410706	0	1.174146095	0.082813625	0	1.748863764	4.010925579	9.429040507	0.166962057	1.288615774	4.34197254	0.016211675	1.71367285	0	0	0	0.010003802	0	0.005207459	0	0	0.093439556	0	0	0	0	0	0	0	0	0	0	38.368	0	3.832784912	5.7791	0.086205601	2.686941669	0	0.961467668	1.012758572	0.404237071	1.006948497	2.348410706	0	1.174146095	0.082813625	0	1.748863764	4.010925579	9.429040507	0.166962057	1.288615774	4.34197254	0.016211675	1.71367285	0	0	0	0.010003802	0	0.005207459	0	0	0.093439556	0	0	0	0	0	0	0	0	0	0	38.368	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	No Cost Sharing																																									0.0681											0.0681	0	0	5.7791	0.086205601	2.686941669	0	0.961467668	1.012758572	0.404237071	1.006948497	2.348410706	0	1.174146095	0.082813625	0	1.748863764	4.010925579	9.429040507	0.166962057	1.288615774	4.34197254	0.016211675	1.71367285	0	0	0	0.010003802	0	0.005207459	0	0	0.161496677	0	0	0	0	0	0	0	0	0	0	38.436
H3305_017_0	2011	7																															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	Coin																																																			0	NO	284.1060451	3.568142629	1404.120675		270.8695321	7.614639389	3.702589303	335.8405555	293.5936968		494.4075168	53.35784526		811.2275698	4104.61079	5944.521679	236.5617307	1015.023459	2739.054813	10.71362341	1198.98299				7.826508194		3.854847319			0.259254359												$300 per stay/$900 max	$300 per stay/$900 max	$0 days 1-20; $105/day days 21-100	$0 Copay	$50 Copay	20.00%	20.00%	$50 ER Copay;$25 UC Copay	$150 for OP Surgery;$75 for ASC	$0 Copay	"$40 Copay for MRI, CT, Other Imaging, and Diag Rad.;$25 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$25 Copay	$0 Copay	"$25 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$25 Copay for Chemotherapy;$40 Copay for Clinic"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$25 Copay	$25 Copay	$25 Copay	20% of the cost for diabetic related shoe inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 	$100 allowance	$25 exam Copay	No Coverage	No Cost Sharing	50.0% for Accupuncture												280.2132935	294.5619335	26.76		50	0.2	0.2	46.14485981	122.177678		37.78123413	25		37.84570146	14.99515493	24.68336009	25	25	24.99168259	25.01292307	25.61804101				25		25			0.5											NO	247.2231586	259.8825013	23.60948562		44.11338869	0.176453555	0.176453555	40.71212274	107.793428		33.33316532	22.05669434		33.39004277	13.23414895	21.77733316	22.05669434	22.05669434	22.04935616	22.06809595	22.60197201				22.05669434		22.05669434			0.5												5.8531	0.077274819	2.762547242	0	0.995747746	1.343630188	0.653335044	1.139398493	2.637289251	0	1.373347291	0.098074807	0	2.257243605	4.526752549	10.78798575	0.434814149	1.865671849	5.032866259	0.019702439	2.258281665	0	0	0	0.014385575	0	0.007085432	0	0	0.129627179	0	0	0	0	0	0	0	0	0	0	44.2682	0	5.888262605	5.8531	0.077274819	2.762547242	0	0.995747746	1.343630188	0.653335044	1.139398493	2.637289251	0	1.373347291	0.098074807	0	2.257243605	4.526752549	10.78798575	0.434814149	1.865671849	5.032866259	0.019702439	2.258281665	0	0	0	0.014385575	0	0.007085432	0	0	0.129627179	0	0	0	0	0	0	0	0	0	0	44.2682	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	No Cost Sharing																																									0.1032											0.1032	0	0	5.8531	0.077274819	2.762547242	0	0.995747746	1.343630188	0.653335044	1.139398493	2.637289251	0	1.373347291	0.098074807	0	2.257243605	4.526752549	10.78798575	0.434814149	1.865671849	5.032866259	0.019702439	2.258281665	0	0	0	0.014385575	0	0.007085432	0	0	0.232874139	0	0	0	0	0	0	0	0	0	0	44.3714
H3305_018_0	2011	6																															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	Coin																																																			0	NO	217.6629458	3.088657598	1059.70024		202.9437046	4.472809213	1.785297448	228.5227417	203.6316494	4436.493226	327.3366256	34.96010197		477.1209623	2822.047039	4024.502609	70.4836981	543.9942861	1833.61899	6.686443075	767.8767269				4.204953636		2.188879975			0.150038636												$500 per stay/$1500 max per yr	$500 per stay/$1500 max per yr	$0 days 1-20; $105/day days 21-100	$0 Copay	$75 Copay	20.00%	20.00%	$50 ER Copay;$40 UC Copay	$250 for OP Surgery;$150 for ASC	$10 Copay	"$50 Copay for MRI, CT, Other Imaging, and Diag Rad.;$40 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$40 Copay	$0 Copay	"$40 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$40 Copay for Chemotherapy;$50 Copay for Clinic"	$20 Copay for Office Visits;$0 Copay for Preventive Services;$40 Copay for PCP Ophthalmology Services	$40 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$40 Copay	$40 Copay	$40 Copay	20% of the cost for diabetic related shoe inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$40 	No coverage	$40 Copay	No Coverage	No Cost Sharing	50.0% for Accupuncture												467.0221558	490.9365559	26.76		75	0.2	0.2	48.60153257	212.2850123	9.685814542	48.57088269	40		49.12308297	19.9611133	38.9068073	40	40	39.98260346	25.69913041	32.24986796				40		40			0.5											NO	425.9180929	447.7277128	24.40476972		68.39901828	0.182397382	0.182397382	44.32396153	193.6011525	8.853947048	44.29600924	36.47947642		44.79960867	18.21301922	35.48249899	36.47947642	36.47947642	36.463611	23.43727055	29.41145744				36.47947642		36.47947642			0.5												7.7255	0.1152398	2.155145029	0	1.156762514	0.815828691	0.325633581	0.844086101	3.285276834	3.273373009	1.208308849	0.106277185	0	1.781236033	4.283166412	11.89995081	0.214267367	1.653718894	5.571697465	0.013059331	1.88203114	0	0	0	0.012782876	0	0.0066541	0	0	0.075019318	0	0	0	0	0	0	0	0	0	0	48.4051	0	4.653575486	7.7255	0.1152398	2.155145029	0	1.156762514	0.815828691	0.325633581	0.844086101	3.285276834	3.273373009	1.208308849	0.106277185	0	1.781236033	4.283166412	11.89995081	0.214267367	1.653718894	5.571697465	0.013059331	1.88203114	0	0	0	0.012782876	0	0.0066541	0	0	0.075019318	0	0	0	0	0	0	0	0	0	0	48.4051	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	No Cost Sharing																																									0.0546											0.0546	0	0	7.7255	0.1152398	2.155145029	0	1.156762514	0.815828691	0.325633581	0.844086101	3.285276834	3.273373009	1.208308849	0.106277185	0	1.781236033	4.283166412	11.89995081	0.214267367	1.653718894	5.571697465	0.013059331	1.88203114	0	0	0	0.012782876	0	0.0066541	0	0	0.129659976	0	0	0	0	0	0	0	0	0	0	48.4597
H3305_801_0	2011	4																															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	Coin																																																			0	YES	227.4885181	5.202440124	1180.059071		195.4079017	4.945560342	3.445070147	251.7462838			344.1209282	61.41391196		722.7554598	3752.712516	6041.279701	251.9066773	1172.909351	2331.381363	6.471910681	795.2467299				5.948958886		1.830448888			0.259913258											4000	$500 per stay/$1500 max	$500 per stay/$1500 max	$0 days 1-20; $105/day days 21-100	$0 Copay	$75 Copay	20.00%	20.00%	$50 ER Copay;$40 UC Copay	$0 for OP Surgery;$0 for ASC	$0 Copay	"$40 Copay for MRI, CT, Other Imaging, and Diag Rad.;$40 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$40 Copay	$0 Copay	"$40 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$40 Copay for Chemotherapy;$40 Copay for Clinic"	$20 Copay for Office Visits;$0 Copay for Preventive Services;$40 Copay for PCP Ophthalmology Services	$40 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$40 Copay	$40 Copay	$40 Copay	20% of the cost for diabetic related shoe inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$40 	No coverage	$40 Copay	No Coverage	No Cost Sharing	50.0% for Accupuncture												467.0221558	490.9365559	26.76		75	0.2	0.2	48.10483871			40	40		40	19.95115705	38.98475484	40	40	39.99145847	18.2287023	34.85970496				40		40			0.5											NO	408.2788953	429.1852801	23.39405766		65.56630509	0.17484348	0.17484348	42.05408708			34.96869605	34.96869605		34.96869605	17.4561963	34.08115107	34.96869605	34.96869605	34.96122889	15.93584875	30.47496068				34.96869605		40			0.5												7.7399	0.18606756	2.300530828	0	1.067681175	0.864698982	0.602348054	0.882246678	0	0	1.002788345	0.178963702	0	2.106151333	5.459007194	17.15781384	0.734070669	3.417925883	6.792329789	0.008594616	2.019592735	0	0	0	0.017335611	0	0.006101496	0	0	0.129956629	0	0	0	0	0	0	0	0	0	0	52.6741	0	7.553981701	7.7399	0.18606756	2.300530828	0	1.067681175	0.864698982	0.602348054	0.882246678	0	0	1.002788345	0.178963702	0	2.106151333	5.459007194	17.15781384	0.734070669	3.417925883	6.792329789	0.008594616	2.019592735	0	0	0	0.017335611	0	0.006101496	0	0	0.129956629	0	0	0	0	0	0	0	0	0	0	52.6741	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	No Cost Sharing																																									0.0527											0.0527	0	0	7.7399	0.18606756	2.300530828	0	1.067681175	0.864698982	0.602348054	0.882246678	0	0	1.002788345	0.178963702	0	2.106151333	5.459007194	17.15781384	0.734070669	3.417925883	6.792329789	0.008594616	2.019592735	0	0	0	0.017335611	0	0.006101496	0	0	0.182618426	0	0	0	0	0	0	0	0	0	0	52.7268
H3305_803_0	2011	6																															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	Coin																																																			0	YES	247.6691354	3.166152784	1224.609018		227.4085043	6.010306981	3.518349198	268.8073989			317.3552818	48.84689006		660.3436284	3746.577783	5859.026956	190.3150599	1033.40171	2460.098103	7.732049226	1113.401727				6.66465519		0.906589125			0.264500979											4000	$500 per stay/$1500 max	$500 per stay/$1500 max	$0 days 1-20; $105/day days 21-100	$0 Copay	$75 Copay	20.00%	20.00%	$50 ER Copay;$40 UC Copay	$0 for OP Surgery;$0 for ASC	$0 Copay	"$40 Copay for MRI, CT, Other Imaging, and Diag Rad.;$40 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$40 Copay	$0 Copay	"$40 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$40 Copay for Chemotherapy;$40 Copay for Clinic"	$20 Copay for Office Visits;$0 Copay for Preventive Services;$40 Copay for PCP Ophthalmology Services	$40 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$40 Copay	$40 Copay	$40 Copay	20% of the cost for diabetic related shoe inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$40 	No coverage	$40 Copay	No Coverage	No Cost Sharing	50.0% for Accupuncture												467.0221558	490.9365559	26.76		75	0.2	0.2	48.33754677			40	40		40	19.9291735	38.9476223	40	40	39.97724046	25.15802807	33.05810806				40		40			0.5											NO	406.9214302	427.7583044	23.31627598		65.34830712	0.174262152	0.174262152	42.11702469			34.85243047	34.85243047		34.85243047	17.38844938	33.93548245	34.85243047	34.85243047	34.83259983	21.9204606	28.80388531				34.85243047		40			0.5												8.3985	0.112862346	2.379443485	0	1.238396732	1.047369031	0.613115104	0.943447321	0	0	0.921716908	0.141869403	0	1.917881699	5.42893151	16.56907554	0.552745199	3.001380104	7.140967732	0.014124173	2.672524637	0	0	0	0.019356619	0	0.003021964	0	0	0.132250489	0	0	0	0	0	0	0	0	0	0	53.249	0	7.836107694	8.3985	0.112862346	2.379443485	0	1.238396732	1.047369031	0.613115104	0.943447321	0	0	0.921716908	0.141869403	0	1.917881699	5.42893151	16.56907554	0.552745199	3.001380104	7.140967732	0.014124173	2.672524637	0	0	0	0.019356619	0	0.003021964	0	0	0.132250489	0	0	0	0	0	0	0	0	0	0	53.249	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	No Cost Sharing																																									0.0746											0.0746	0	0	8.3985	0.112862346	2.379443485	0	1.238396732	1.047369031	0.613115104	0.943447321	0	0	0.921716908	0.141869403	0	1.917881699	5.42893151	16.56907554	0.552745199	3.001380104	7.140967732	0.014124173	2.672524637	0	0	0	0.019356619	0	0.003021964	0	0	0.206802209	0	0	0	0	0	0	0	0	0	0	53.3235
H3307_002_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1568.145298	92.50425692	1413.80555	3619.824652	195.5210019	0.46527466	8.421181569	206.0681577	551.7245569	17.44538224	54.63381532	0	0.149809923	377.3161494	5946.568348	170.8232473	587.3979245	1208.300928	0	0	51.68522247	3084.034607	0	362.3940007	120.6655306	2.200340809	17.46434425	1.8	790.1702171	0											5900	"$175 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-8 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$75 Days 21-86 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$190 (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0/$35 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												136.318431	94.35930172	56.79819179	0	200	0.2	0.09636036	49.30543941	190	0.086559048	0.152993295	0	0.2	74.19364707	10.00378739	0.128934445	40	35	0	0	0.2	34.87089889	0	0	0	0	0	0	0	0											NO	91.87898637	63.59842124	38.28213288	0	134.8005339	0.134800534	0.06494714	33.27287671	128.0605072	0.058341029	0.103117889	0	0.134800534	50.00671617	9.451773674	0.12182559	37.79278108	33.06868344	0	0	0.134800534	23.50307893	0	0	0	0	0	0	0	0												12.0066	0.490260391	4.510290995	0	2.196361286	0.062719273	0.546931658	0.571373367	5.887843881	1.017781556	5.633723715	0	0.020194458	1.572361799	4.683801514	20.81064294	1.849950097	3.329743409	0	0	6.967195582	6.040359067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.1982	0	24.77549695	12.0066	0.490260391	4.510290995	0	2.196361286	0.062719273	0.546931658	0.571373367	5.887843881	1.017781556	5.633723715	0	0.020194458	1.572361799	4.683801514	20.81064294	1.849950097	3.329743409	0	0	6.967195582	6.040359067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.1982	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.0066	0.490260391	4.510290995	0	2.196361286	0.062719273	0.546931658	0.571373367	5.887843881	1.017781556	5.633723715	0	0.020194458	1.572361799	4.683801514	20.81064294	1.849950097	3.329743409	0	0	6.967195582	6.040359067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.1982
H3307_012_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1224.609899	86.36756231	972.0099533	2081.021072	147.730102	0.678749574	6.355825114	257.0138786	809.1371923	21.01144417	49.50029576	0	0.115454942	380.1930153	5594.991575	119.3721006	569.6898094	852.1806038	0	0	28.02827419	2029.470193	0	797.8169518	72.92567649	89.68563446	29.93890198	16.82665008	38.66971398	0											5900	"$175 Days 1-10 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-10 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$175 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $175 (9a); $40 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0/$35 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												145.1132942	106.6104145	50	0	200	0.2	0.067263533	49.58190956	175	0.087530308	0.153186428	0	0.2	67.31253073	6.313400326	0.131604216	40	35	0	0	0.2	34.80783979	0	0	0	0	0	0	0	0											NO	106.4553737	78.20959192	36.68008997	0	146.7203599	0.14672036	0.049344649	36.39765033	128.3803149	0.064212392	0.112377839	0	0.14672036	49.38059367	6.035453945	0.125815839	38.23900677	33.45913092	0	0	0.14672036	25.53509391	0	0	0	0	0	0	0	0												10.8639	0.56289765	2.971117711	0	1.806251144	0.099586382	0.313625958	0.77955844	8.656440628	1.349195082	5.562736277	0	0.016939591	1.564513067	2.814026165	15.01890105	1.815364373	2.376101866	0	0	4.112318476	4.31855933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.002	0	16.61965134	10.8639	0.56289765	2.971117711	0	1.806251144	0.099586382	0.313625958	0.77955844	8.656440628	1.349195082	5.562736277	0	0.016939591	1.564513067	2.814026165	15.01890105	1.815364373	2.376101866	0	0	4.112318476	4.31855933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.002	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.8639	0.56289765	2.971117711	0	1.806251144	0.099586382	0.313625958	0.77955844	8.656440628	1.349195082	5.562736277	0	0.016939591	1.564513067	2.814026165	15.01890105	1.815364373	2.376101866	0	0	4.112318476	4.31855933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.002
H3307_015_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	Coin	O	V	Coin	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	906.3416495	73.75189869	728.1760544	1791.604543	107.9545076	0.313732999	7.681391316	109.2566391	360.8780687	6245.133112	3829.726149	0	0.098782992	218.9501354	8071.899568	160.0824832	4.849610924	6242.598053	0	0	41.43208673	3303.356668	0	0	70.8500143	87.50391464	28.97359696	15.83214575	768.1382156	637.3857142											2900	"$125 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$100 Days 21-49 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$0 (10a)	10% (11a)	"10% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$75 (9b)	"$0 (8a1a, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	10% (12)	"$15 (3, 9d); $0 (5); $75 (9a); $10 (9c)"	"$0 (7a, 14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $15 (7a1); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $15 (7d, 7f, 7f1)"	"45% (7e, 7h)"	"$15 (7c, 7i)"	Included in h.2.	$0 (7g)	"10% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $15 (16b, 18a); $0/$15 (17a)"	$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)"	$15/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0/$15 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$5 (13b); $0 n/c (13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												80.80590266	49.95752524	20.47499233	0	0	0.1	0.047733063	48.62508498	75	0	0	0	0.1	28.82232171	0.08153002	0.064557984	0.45	15	0	0	0.1	14.95471717	0	0	0	0	0	0	0	5											NO	59.22627916	36.61611638	15.00704245	0	0	0.073294496	0.034985708	35.70278739	54.97087206	0	0	0	0.073294496	21.12517546	0.077930861	0.061710764	0.430134662	14.33782207	0	0	0.073294496	10.96098459	0	0	0	0	0	0	0	5												4.4733	0.225042342	0.910647413	0	0	0.022994902	0.268738912	0.32506388	1.653148512	0	0	0	0.00724025	0.385446669	0.05242084	9.87881231	2.085985755	7.458771675	0	0	3.036743918	3.017336794	0	0	0	0	0	0	0	0.265577381	0	0	0	0	0	0	0	0	0	0	34.0672	0	6.117927282	4.4733	0.225042342	0.910647413	0	0	0.022994902	0.268738912	0.32506388	1.653148512	0	0	0	0.00724025	0.385446669	0.05242084	9.87881231	2.085985755	7.458771675	0	0	3.036743918	3.017336794	0	0	0	0	0	0	0	0.265577381	0	0	0	0	0	0	0	0	0	0	34.0672	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.4733	0.225042342	0.910647413	0	0	0.022994902	0.268738912	0.32506388	1.653148512	0	0	0	0.00724025	0.385446669	0.05242084	9.87881231	2.085985755	7.458771675	0	0	3.036743918	3.017336794	0	0	0	0	0	0	0	0.265577381	0	0	0	0	0	0	0	0	0	0	34.0672
H3307_018_0	2011	1																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1551.618837	126.9233616	1691.088707	4750.31783	198.9267831	0.438461915	7.278892511	210.7166053	631.2473131	18.2136324	51.13148019	0	0.052542918	434.1004042	6242.661298	181.5119101	511.40488	1482.268725	0	0	53.58254375	3391.167816	0	727.9075639	79.40548824	76.20036524	27.93785052	14.47279246	38.69463114	0											5900	"$175 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-8 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$75 Days 21-86 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$190 (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0/$30 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												136.318431	94.35930172	57.04278779	0	200	0.2	0.083503312	49.2753538	190	0.087409142	0.153317226	0	0.2	74.0977632	10.21785964	0.111445124	40	30	0	0	0.2	29.88743954	0	0	0	0	0	0	0	0											NO	91.45732575	63.30654874	38.27054629	0	134.1818932	0.134181893	0.056023162	33.09972063	127.4727985	0.058643621	0.102861978	0	0.134181893	49.71289074	9.648151198	0.105239553	37.76975429	28.32731572	0	0	0.134181893	20.05176611	0	0	0	0	0	0	0	0												11.8256	0.669589998	5.39324072	0	2.224364364	0.05883365	0.407786577	0.581221731	6.705571797	1.068113357	5.259485195	0	0.007050308	1.798365497	5.01917834	19.10223235	1.609636388	3.499057845	0	0	7.189807163	5.666575323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0857	0	25.68771252	11.8256	0.669589998	5.39324072	0	2.224364364	0.05883365	0.407786577	0.581221731	6.705571797	1.068113357	5.259485195	0	0.007050308	1.798365497	5.01917834	19.10223235	1.609636388	3.499057845	0	0	7.189807163	5.666575323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0857	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.8256	0.669589998	5.39324072	0	2.224364364	0.05883365	0.407786577	0.581221731	6.705571797	1.068113357	5.259485195	0	0.007050308	1.798365497	5.01917834	19.10223235	1.609636388	3.499057845	0	0	7.189807163	5.666575323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0857
H3307_020_0	2011	4																															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	428.1197932	7.041284067	37.93382676	6370.38675	11.36195994	0.777397908	18.97233067	11.6690746	60.42997151	17.73609928	70.49649009	0	0.14056429	11.17772829	37.03230773	201.4128645	3.453442717	11.22621206	0	9.4897	46.20424083	15.31407899	644.3497306	479.0704317	90.38181102	54.36197545	0	0	212.1019115	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.060806067	0.061567114	0.144638709	0	0.233	0.233	0.233	0.110084791	0.233	0.233	0.233	0	0.233	0.233	0.213450993	0.232932635	0.226289732	0.233	0	0.233	0.233	0.231586718	0	0	0	0	0	0	0	0											NO	0.036054844	0.036506105	0.085763253	0	0.138156915	0.138156915	0.138156915	0.065352849	0.138156915	0.138156915	0.138156915	0	0.138156915	0.138156915	0.126565368	0.138116972	0.134178075	0.138156915	0	0.138156915	0.138156915	0.138805589	0	0	0	0	0	0	0	0												15.4358	0.257049858	3.253328371	0	1.56973334	0.107402897	2.621158685	0.762607267	8.348818467	2.45036477	9.739577624	0	0.019419929	1.544280462	4.687007667	27.81853492	0.463376294	1.550978831	0	1.311067681	6.383435396	2.125679753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.4496	0	62.05265123	15.4358	0.257049858	3.253328371	0	1.56973334	0.107402897	2.621158685	0.762607267	8.348818467	2.45036477	9.739577624	0	0.019419929	1.544280462	4.687007667	27.81853492	0.463376294	1.550978831	0	1.311067681	6.383435396	2.125679753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.4496	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	15.4358	0.257049858	3.253328371	0	1.56973334	0.107402897	2.621158685	0.762607267	8.348818467	2.45036477	9.739577624	0	0.019419929	1.544280462	4.687007667	27.81853492	0.463376294	1.550978831	0	1.311067681	6.383435396	2.125679753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.4496
H3307_802_0	2011	1																															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	271.0404088	6.93028059	29.33737177	3254.242442	6.946727826	0.616063091	9.541012391	7.456238466	56.23128901	18.05622272	54.43068474	0	0.140284282	9.729431646	31.88311793	162.1177258	3.245765844	12.67563798	0	0	45.80006135	17.17506168	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.061646674	0.061646674	0.144997079	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.041321168	0.041321168	0.097190136	0	0.156177641	0.156177641	0.156177641	0.156177641	0.156177641	0.156177641	0.156177641	0	0.156177641	0.156177641	0.156177641	0.156177641	0.156177641	0.156177641	0	0	0.156177641	0.156177641	0	0	0	0	0	0	0	0												11.1997	0.286367286	2.851303155	0	1.084923566	0.09621528	1.490092809	1.164497735	8.782070076	2.819978273	8.500855949	0	0.021909268	1.519519684	4.979430151	25.319164	0.506916053	1.97965124	0	0	7.152945546	2.68236062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4379	0	40.55045536	11.1997	0.286367286	2.851303155	0	1.084923566	0.09621528	1.490092809	1.164497735	8.782070076	2.819978273	8.500855949	0	0.021909268	1.519519684	4.979430151	25.319164	0.506916053	1.97965124	0	0	7.152945546	2.68236062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4379	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.1997	0.286367286	2.851303155	0	1.084923566	0.09621528	1.490092809	1.164497735	8.782070076	2.819978273	8.500855949	0	0.021909268	1.519519684	4.979430151	25.319164	0.506916053	1.97965124	0	0	7.152945546	2.68236062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4379
H3307_804_0	2011	1																															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	271.2127087	6.9314	29.35602148	3256.311157	6.951143847	0.616454721	9.547077593	7.460978381	56.26703512	18.06770103	54.46528621	0	0.140373461	9.73523666	31.90338596	162.2207837	3.2464	12.68369586	0	0	45.82917635	17.18597983	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.061646674	0.061646674	0.144997079	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.041310202	0.041310202	0.097164344	0	0.156136195	0.156136195	0.156136195	0.156136195	0.156136195	0.156136195	0.156136195	0	0.156136195	0.156136195	0.156136195	0.156136195	0.156136195	0.156136195	0	0	0.156136195	0.156136195	0	0	0	0	0	0	0	0												11.2039	0.286337533	2.852358558	0	1.085325148	0.096250894	1.490644364	1.164928772	8.78532074	2.821022082	8.504002522	0	0.021917378	1.520022805	4.981273276	25.32853583	0.506880542	1.980384003	0	0	7.155593193	2.68335349	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.468	0	40.5979187	11.2039	0.286337533	2.852358558	0	1.085325148	0.096250894	1.490644364	1.164928772	8.78532074	2.821022082	8.504002522	0	0.021917378	1.520022805	4.981273276	25.32853583	0.506880542	1.980384003	0	0	7.155593193	2.68335349	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.468	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.2039	0.286337533	2.852358558	0	1.085325148	0.096250894	1.490644364	1.164928772	8.78532074	2.821022082	8.504002522	0	0.021917378	1.520022805	4.981273276	25.32853583	0.506880542	1.980384003	0	0	7.155593193	2.68335349	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.468
H3307_805_0	2011	1																															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	267.6119934	6.9342	28.96628061	3234.622965	6.858858016	0.608270452	9.420327233	7.361923809	55.52001417	17.82782787	53.74218592	0	0.138509813	9.606321471	31.47982539	160.0670835	3.2495	12.51530265	0	0	45.22073209	16.95781272	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.061931142	0.061931142	0.146277261	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.041716253	0.041716253	0.098531031	0	0.156946679	0.156946679	0.156946679	0.156946679	0.156946679	0.156946679	0.156946679	0	0.156946679	0.156946679	0.156946679	0.156946679	0.156946679	0.156946679	0	0	0.156946679	0.156946679	0	0	0	0	0	0	0	0												11.1638	0.289268844	2.854077492	0	1.076474984	0.095466027	1.47848907	1.155429489	8.713681815	2.79801837	8.434657576	0	0.021738655	1.507680248	4.940654035	25.12199709	0.509998232	1.964235181	0	0	7.097243701	2.661472381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8844	0	39.67957191	11.1638	0.289268844	2.854077492	0	1.076474984	0.095466027	1.47848907	1.155429489	8.713681815	2.79801837	8.434657576	0	0.021738655	1.507680248	4.940654035	25.12199709	0.509998232	1.964235181	0	0	7.097243701	2.661472381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8844	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.1638	0.289268844	2.854077492	0	1.076474984	0.095466027	1.47848907	1.155429489	8.713681815	2.79801837	8.434657576	0	0.021738655	1.507680248	4.940654035	25.12199709	0.509998232	1.964235181	0	0	7.097243701	2.661472381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8844
H3312_002_0	2011	3																															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	1948.678228	95.41034004	1524.414266	786.0839559	287.1176922	10.89591663	0	180.1887462	288.6782468	2953.076066	2501.461708	66.53371815	0.114539109	305.1916515	4794.083975	6078.730542	224.5245898	703.8205767	0	0	260.6357291	0	0	0	1708.856869	54.21235494	83.51593621	6.731775543	38.28406018	0											3400	$200/day 1-7	$300/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$0 per visit	$200 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$175 per procedure	$20 per visit	$20 X-ray; $175 Complex Radiology	$20 per visit	$25 per visit	$20 per visit	"$5 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$20 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	144.5710156	216.8565234	72.96419583	0	200	0.05	0.05	49	175	3	13.875	20	25	20	5	20	20	15	20	20	$50 	0	0	0	0	0	0	0	0	0											NO	125.6781353	188.5172029	63.42906313	0	174.3562066	0.043465882	0.043465882	42.59656477	152.1305885	2.607952945	12.06178237	17.38635297	21.73294121	17.38635297	4.346588242	17.38635297	17.38635297	13.03976472	17.38635297	17.38635297	43.46588242	0	0	0	0	0	0	0	0	0												20.4089	1.498874203	8.057680727	0	4.171729305	0.473600631	0	0.639618466	3.659732629	0.641790285	2.514340561	0.096398226	0.000207439	0.442180815	1.73649242	8.807246233	0.325305314	0.764804561	0	0	0.944063496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1829	0	8.1374	20.4089	1.498874203	8.057680727	0	4.171729305	0.473600631	0	0.639618466	3.659732629	0.641790285	2.514340561	0.096398226	0.000207439	0.442180815	1.73649242	8.807246233	0.325305314	0.764804561	0	0	0.944063496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1829	NO																																																																																		0			20.4089	1.498874203	8.057680727	0	4.171729305	0.473600631	0	0.639618466	3.659732629	0.641790285	2.514340561	0.096398226	0.000207439	0.442180815	1.73649242	8.807246233	0.325305314	0.764804561	0	0	0.944063496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1829
H3312_018_0	2011	3																															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	1652.253307	117.8108259	1569.55359	739.9577448	257.7280009	6.45504837	0	246.067932	289.1153114	3992.674366	2836.692978	82.98989215	20.02203692	632.2320484	4243.508645	6579.332954	260.6791748	640.0993696	0	0	293.330984	0	0	0	1727.466078	71.24188644	88.00468324	12.57209761	22.4501743	0											3400	$195/day 1-10	$300/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$15 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$40 per visit	$40 X-ray; $175 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$15 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	159.83	216.8565234	72.96419583	15	175	0.05	0.05	49	200	6	23.375	40	25	40	15	40	40	30	40	40	$50 	0	0	0	0	0	0	0	0	0											NO	130.718225	177.3578165	59.67434253	12.2678682	143.125129	0.040892894	0.040892894	40.07503613	163.571576	4.907147281	19.11742795	32.71431521	20.446447	32.71431521	12.2678682	32.71431521	32.71431521	24.5357364	32.71431521	32.71431521	40.89289401	0	0	0	0	0	0	0	0	0												17.9983	1.741222571	7.805173211	0.756475341	3.073946116	0.263965609	0	0.821765105	3.940920595	1.632720097	4.519189468	0.226246458	0.03411496	1.723586543	4.338233731	17.93653101	0.710661724	1.308775784	0	0	0.99959607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8314	0	15.5519	17.9983	1.741222571	7.805173211	0.756475341	3.073946116	0.263965609	0	0.821765105	3.940920595	1.632720097	4.519189468	0.226246458	0.03411496	1.723586543	4.338233731	17.93653101	0.710661724	1.308775784	0	0	0.99959607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8314	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			17.9983	1.741222571	7.805173211	0.756475341	3.073946116	0.263965609	0	0.821765105	3.940920595	1.632720097	4.519189468	0.226246458	0.03411496	1.723586543	4.338233731	17.93653101	0.710661724	1.308775784	0	0	0.99959607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8314
H3312_025_0	2011	3																															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	2062.315612	100.2789421	1674.834261	1029.860456	267.1341096	8.482681827	0	186.9234666	290.6989771	3118.529219	2984.119162	182.9650874	0	328.7837334	4194.739701	6819.668182	354.2899858	724.5000853	0	0	303.9527453	0	0	0	1766.05328	47.67039667	102.9860456	8.994414466	33.72905425	0											3400	$125/day 1-10	$300/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$15 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$175 per procedure	$25 per visit	$25 X-ray; $175 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	"$5 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$25 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$25 per visit	$25 per visit	$40 per visit	$25 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	102.4559256	216.8565234	72.96419583	15	150	0.05	0.05	49	175	3.75	16.25	25	25	25	5	25	25	18.75	40	25	$50 	0	0	0	0	0	0	0	0	0											NO	88.44999464	187.2118009	62.98984364	12.94946986	129.4946986	0.0431649	0	42.30160153	151.0771483	3.237367464	14.02859235	21.58244976	0	21.58244976	4.316489952	21.58244976	21.58244976	16.18683732	34.53191962	21.58244976	43.16489952	0	0	0	0	0	0	0	0	0												15.201	1.564450112	8.791462352	1.111345578	2.882704251	0.366154109	0	0.658930167	3.659831041	0.841318753	3.488582603	0.329069567	0	0.591329867	1.508879314	12.26542883	0.637203818	0.977280418	0	0	1.093340809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9683	0	8.8625	15.201	1.564450112	8.791462352	1.111345578	2.882704251	0.366154109	0	0.658930167	3.659831041	0.841318753	3.488582603	0.329069567	0	0.591329867	1.508879314	12.26542883	0.637203818	0.977280418	0	0	1.093340809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9683	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			15.201	1.564450112	8.791462352	1.111345578	2.882704251	0.366154109	0	0.658930167	3.659831041	0.841318753	3.488582603	0.329069567	0	0.591329867	1.508879314	12.26542883	0.637203818	0.977280418	0	0	1.093340809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9683
H3312_040_0	2011	2																															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	1514.951514	145.0210161	1434.869802	991.5939258	242.6312528	11.82594982	0	246.6168446	352.3133549	3412.045453	2753.825323	89.40967831	1.43623943	368.7497922	3601.892529	6143.103848	264.3623679	666.9789932	0	0	287.9403332	0	0	0	1422.128062	103.0180631	79.59400894	20.41851385	87.17366121	0											3400	$175/day 1-10	$300/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$15 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$30 per visit	$30 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	"$15 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$30 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$30 per visit	$30 per visit	$40 per visit	$30 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	143.4382958	216.8565234	72.96419583	15	175	0.05	0.05	49	200	4.5	18.625	30	25	30	15	30	30	22.5	40	30	$50 	0	0	0	0	0	0	0	0	0											NO	122.7109088	185.5199194	62.42058814	12.83244215	149.7118251	0.042774807	0.042774807	41.91931103	171.0992287	3.849732645	15.93361567	25.6648843	21.38740358	25.6648843	12.83244215	25.6648843	25.6648843	19.24866323	34.21984574	25.6648843	42.77480717	0	0	0	0	0	0	0	0	0												15.4918	2.242023935	7.463784744	1.060380974	3.027063973	0.505852723	0	0.861500684	5.023378606	1.094621897	3.65653286	0.191224087	0.002559786	0.788660063	3.85175646	13.13850413	0.565402466	1.069871168	0	0	1.026382686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0613	0	10.314	15.4918	2.242023935	7.463784744	1.060380974	3.027063973	0.505852723	0	0.861500684	5.023378606	1.094621897	3.65653286	0.191224087	0.002559786	0.788660063	3.85175646	13.13850413	0.565402466	1.069871168	0	0	1.026382686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0613	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			15.4918	2.242023935	7.463784744	1.060380974	3.027063973	0.505852723	0	0.861500684	5.023378606	1.094621897	3.65653286	0.191224087	0.002559786	0.788660063	3.85175646	13.13850413	0.565402466	1.069871168	0	0	1.026382686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0613
H3312_043_0	2011	3																															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	1353.532552	81.07215427	1071.34699	876.9010966	203.4495064	7.438608696	0	219.9885754	325.5326304	3029.742744	2552.911915	98.1926137	0.865786982	248.1296323	3437.265835	5601.856879	399.8324978	638.6360797	0	0	244.0443486	0	0	0	1467.997934	77.43134483	85.94021803	9.933962649	56.35670942	0											3400	$223/day 1-10	$300/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$15 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$40 per visit	$40 X-ray; $175 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$15 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	182.7813712	216.8565234	72.96419583	15	150	0.05	0.05	49	200	6	23.375	40	25	40	15	40	40	30	40	40	$50 	0	0	0	0	0	0	0	0	0											NO	148.1051587	175.7157724	59.12185545	12.15428775	121.5428775	0.040514293	0.040514293	39.70400666	162.05717	4.861715101	18.94043175	32.41143401	20.25714625	32.41143401	12.15428775	32.41143401	32.41143401	24.3085755	32.41143401	32.41143401	40.51429251	0	0	0	0	0	0	0	0	0												16.7054	1.187138018	5.278335157	0.888175688	2.060653204	0.301369969	0	0.727868989	4.396241403	1.227478838	4.029437823	0.265213618	0.001461531	0.670186433	3.481459836	15.13035121	1.079928718	1.293694447	0	0	0.823940344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5484	0	13.9422	16.7054	1.187138018	5.278335157	0.888175688	2.060653204	0.301369969	0	0.727868989	4.396241403	1.227478838	4.029437823	0.265213618	0.001461531	0.670186433	3.481459836	15.13035121	1.079928718	1.293694447	0	0	0.823940344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5484	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			16.7054	1.187138018	5.278335157	0.888175688	2.060653204	0.301369969	0	0.727868989	4.396241403	1.227478838	4.029437823	0.265213618	0.001461531	0.670186433	3.481459836	15.13035121	1.079928718	1.293694447	0	0	0.823940344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5484
H3312_048_0	2011	3																															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	1231.636973	74.88485682	935.7444171	940.6840241	210.2301924	13.03529496	0	288.2845839	297.6933772	4408.531309	2715.629587	91.07561046	0.488364397	825.4940549	3149.934334	5064.571515	246.399493	1468.781434	0	0	283.8007954	0	0	0	1093.372581	103.9011622	41.74791834	8.493301861	44.1569119	0											3400	$223/day 1-10	$300/day 1-7	"$0/d 1-10, $75/d 11-20, $100/d 21-100"	$15 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$30 per visit	$30 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	"$10 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$30 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$30 per visit	$30 per visit	$40 per visit	$30 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	182.7813712	216.8565234	57.64	15	175	0.05	0.05	49	200	4.5	18.625	30	25	30	10	30	30	22.5	40	30	$50 	0	0	0	0	0	0	0	0	0											NO	158.7177635	188.3068399	50.05155521	13.02521388	151.9608286	0.04341738	0.04341738	42.54903201	173.6695184	3.907564164	16.1729739	26.05042776	21.7086898	26.05042776	8.683475921	26.05042776	26.05042776	19.53782082	34.73390368	26.05042776	43.4173796	0	0	0	0	0	0	0	0	0												16.2902	1.175110895	3.90295528	1.021050884	2.662229519	0.565958349	0	1.022185833	4.308355455	1.43555158	3.65998387	0.197713218	0.000883479	1.792039437	2.279364911	10.9945212	0.534901016	2.39139904	0	0	1.026823905	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2613	0	8.3783	16.2902	1.175110895	3.90295528	1.021050884	2.662229519	0.565958349	0	1.022185833	4.308355455	1.43555158	3.65998387	0.197713218	0.000883479	1.792039437	2.279364911	10.9945212	0.534901016	2.39139904	0	0	1.026823905	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2613	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			16.2902	1.175110895	3.90295528	1.021050884	2.662229519	0.565958349	0	1.022185833	4.308355455	1.43555158	3.65998387	0.197713218	0.000883479	1.792039437	2.279364911	10.9945212	0.534901016	2.39139904	0	0	1.026823905	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2613
H3312_801_0	2011	2																															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	YES	307.1110765	1.619095533	43.21747571	6.463576939	6.784245611	12.9310412	0	9.613613113	35.26289847	22.86228103	64.92866865	0.339115239	0.020383623	23.50859876	42.77832666	167.7985462	3.794752312	6.74414229	0	0	51.08499699	0.00055139																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.065459671	0.065459671	0.154202002	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.052437534	0.052437534	0.123526021	0	0.186648438	0.186648438	0.186648438	0.186648438	0.186648438	0.186648438	0.186648438	0.186648438	0.186648438	0.186648438	0.186648438	0.186648438	0.186648438	0.186648438	0.186648438	0.186648438	0.186648438	0.186648438	0	0	0	0	0	0	0	0												16.1041	0.084901377	5.338482808	0	1.266268848	2.413558646	0	1.794365874	6.58176493	4.26720905	12.1188346	0.06329533	0.003804571	4.387843246	7.984507864	31.3193366	0.708284593	1.258783626	0	0	9.534934909	0.000102916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.2304	0	26.1325232	16.1041	0.084901377	5.338482808	0	1.266268848	2.413558646	0	1.794365874	6.58176493	4.26720905	12.1188346	0.06329533	0.003804571	4.387843246	7.984507864	31.3193366	0.708284593	1.258783626	0	0	9.534934909	0.000102916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.2304	NO																																																																																		0			16.1041	0.084901377	5.338482808	0	1.266268848	2.413558646	0	1.794365874	6.58176493	4.26720905	12.1188346	0.06329533	0.003804571	4.387843246	7.984507864	31.3193366	0.708284593	1.258783626	0	0	9.534934909	0.000102916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.2304
H3312_804_0	2011	2																															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	YES	322.3892893	2.638730815	43.89571793	9.945987765	7.028122919	9.855548724	0	9.424106135	37.52183782	23.0211567	70.4235379	0.562320194	0	25.01455863	46.40224453	184.7946572	2.156537454	6.13458326	0	0	68.49263113	0.000702717																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.062069732	0.062069732	0.145960041	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.049665185	0.049665185	0.116790137	0	0.186435286	0.186435286	0.186435286	0.186435286	0.186435286	0.186435286	0.186435286	0.186435286	0.186435286	0.186435286	0.186435286	0.186435286	0.186435286	0.186435286	0.186435286	0.186435286	0.186435286	0.186435286	0	0	0	0	0	0	0	0												16.0115	0.131053055	5.126586926	0	1.310290109	1.837422048	0	1.756985925	6.995394576	4.291955941	13.12943245	0.104836326	0	4.663596401	8.651015745	34.45224482	0.402054678	1.143702787	0	0	12.76944329	0.000131011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7777	0	28.16773591	16.0115	0.131053055	5.126586926	0	1.310290109	1.837422048	0	1.756985925	6.995394576	4.291955941	13.12943245	0.104836326	0	4.663596401	8.651015745	34.45224482	0.402054678	1.143702787	0	0	12.76944329	0.000131011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7777	NO																																																																																		0			16.0115	0.131053055	5.126586926	0	1.310290109	1.837422048	0	1.756985925	6.995394576	4.291955941	13.12943245	0.104836326	0	4.663596401	8.651015745	34.45224482	0.402054678	1.143702787	0	0	12.76944329	0.000131011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7777
H3327_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V		V			V	V	P	V	P		V	Coin						V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	2085.57081	381.8538296	1289.205868	326.6165393	358.5619508	11.62425737	0.130912094	305.5285846	205.2425862	0	555.0862104	0	0	197.4859021	7843.57434	6246.080763	514.5601616	1201.991119	0	122.7691137	17.36993033	0	0	0	0	0	3.021046054	0	0	0											3400	"1A IP Acute: $200 copay day 1, $100 copay days 2-7"	"1B IP Psych: $200 Day 1, $100 Days 2-7"	"2 SNF: $25 copay days 1-20, $100 copay days 21-100"	6 Home Health: $20 copay per visit	10A Ambulance: $75 copay	11A DME:  20% coins	"11B Prosthetic Medical Supplies: 20% coinsurance, 11C Diabetes Monitoring Supplies: $0 copay"	"4A ER: $50 copay,  4B Urgent Care: $20 copay, 13A Blood: $0 copay"	"9A Outpatient Hospital: $150 copay,   9B ASC Services: $150 copay"	8A OP C/D/T: $0-100 copay	"8B OP X-Ray: $10 copay, MRI/PET/CAT $100 copay, Chemo $25 copay"		12 Renal Dialysis: $0 copay	"3 CORF: $25 copay,  5  Partial Hosp:  $25 copay, 9C OP SA: $25 copay, 9D Cardiac Rehab: $25 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, 17A Medicare Covered Eye Exams: $0 copay, 18A Medicare Covered Hearing Exams: $25 copay"	"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	7G Other Health Care:  $25 copay	15 Part B Drugs: 20% coinsurance		10B Transportation: Not Covered	"16A Preventive Dental: $0 copay, 16B Comp Dental: $0 Copay"	17A Routine Eye Exams: $0 copay	17B Eye Wear:  $0 copay for eye wear	18A Routine Hearing Exams: $25 copay	18B Hearing Aids: $0 copay	14A Health Ed/Wellness: No Cost Sharing	"13B Acupuncture: Not covered, 13C Other1: $15 OTC"											0	71.79715906	58.01305654	55.00097788	20	75	0.2	0.196	48.67173636	150	0	44.43527095	0	0	25	5	25	25	25	0	25	0.2	0	0	0	0	0	25	0	0	0											NO	64.1707494	51.85081641	49.15868559	17.87556785	67.03337943	0.178755678	0.175180565	43.50174627	134.0667589	0	39.71528503	0	0	22.34445981	4.468891962	22.34445981	22.34445981	22.34445981	0	22.34445981	0.178755678	0	0	0	0	0	22.34445981	0	0	0												11.1527	1.649952734	5.281305495	0.486538009	2.002968274	2.077902013	0.022933255	1.107585581	2.293017359	0	1.837117255	0	0	0.367726317	2.921007193	11.63044171	0.958130738	2.238153521	0	0.228600794	3.104973682	0	0	0	0	0	0.005625304	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3667	0	5.867013814	11.1527	1.649952734	5.281305495	0.486538009	2.002968274	2.077902013	0.022933255	1.107585581	2.293017359	0	1.837117255	0	0	0.367726317	2.921007193	11.63044171	0.958130738	2.238153521	0	0.228600794	3.104973682	0	0	0	0	0	0.005625304	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3667	NO																							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	11.1527	1.649952734	5.281305495	0.486538009	2.002968274	2.077902013	0.022933255	1.107585581	2.293017359	0	1.837117255	0	0	0.367726317	2.921007193	11.63044171	0.958130738	2.238153521	0	0.228600794	3.104973682	0	0	0	0	0	0.005625304	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3667
H3327_002_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V		V			V		P	V	P		V	Coin						V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1915.879154	614.0797129	604.6443353	270.3387875	368.4363085	10.43674631	1.834328458	420.4369248	220.129818	0	596.9925308	0	0	234.5439585	0	5656.394095	785.8207256	1372.719296	0	187.8525636	12.51510761	0	0	0	0	0	0.512091772	0	0	0											3400	1A IP Acute: $50 copay days 1-7	"1B IP Psych: $50 copay days 1-7, 190-day lifetime limit"	"2 SNF: $0 copay days 1-20, $50 copay days 21-100"	6 Home Health: $10 copay per visit	10A Ambulance: $75 copay	11A DME:  20% coins	"11B Prosthetic Medical Supplies: 20% coinsurance, 11C Diabetes Monitoring Supplies: $0 copay"	"4A ER: $50 copay,  4B Urgent Care: $10 copay, 13A Blood: $0 copay"	"9A Outpatient Hospital: $50 copay,   9B ASC Services: $50 copay"	8A OP C/D/T: $0 copay	"8B OP X-Ray: $10 copay, MRI/PET/CAT $100 copay, Chemo $10 copay"		12 Renal Dialysis: $0 copay	"3 CORF: $10 copay,  5  Partial Hosp:  $10 copay, 9C OP SA: $10 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, 17A Medicare Covered Eye Exams: $0 copay, 18A Medicare Covered Hearing Exams: $10 copay"	"7E Mental Health: $10 copay, 7H Psychiatric: $10 copay"	"7C Occupational Therapy:  $10 copay, 7I Physical and Speech Therapy:  $10 copay"	7D Physician Specialist: $0 copay	7G Other Health Care:  $10 copay	15 Part B Drugs: 20% coinsurance		10B Transportation: 12 trips	"16A Preventive Dental: $0 copay, 16B Comp Dental: $0 Copay"	17A Routine Eye Exams: $0 copay	17B Eye Wear:  $0 copay for eye wear	18A Routine Hearing Exams: $10 copay	18B Hearing Aids: $0 copay	14A Health Ed/Wellness: No Cost Sharing	"13B Acupuncture: Not covered, 13C Other1: $28 OTC"											0	32.12724928	24.95791119	20.00065192	10	75	0.2	0.196	49.42727748	50	0	48.22350758	0	0	10	0	10	10	10	0	10	0.2	0	0	0	0	0	10	0	0	0											NO	31.27047905	24.29233304	19.46727407	9.733319769	72.99989827	0.194666395	0.190773067	48.1091497	48.66659885	0	46.93748196	0	0	9.733319769	0	9.733319769	9.733319769	9.733319769	0	9.733319769	0.194666395	0	0	0	0	0	9.733319769	0	0	0												4.9925	1.243119075	0.980898083	0.219274489	2.241317753	2.031683784	0.349940467	1.685571913	0.892747462	0	2.335110512	0	0	0.190240946	0	4.587957706	0.637387034	1.113426322	0	0.152369089	2.436270886	0	0	0	0	0	0.000415363	0	0	0	0	0	0	0	0	0	0	0	0	0	26.0903	0	0.714839249	4.9925	1.243119075	0.980898083	0.219274489	2.241317753	2.031683784	0.349940467	1.685571913	0.892747462	0	2.335110512	0	0	0.190240946	0	4.587957706	0.637387034	1.113426322	0	0.152369089	2.436270886	0	0	0	0	0	0.000415363	0	0	0	0	0	0	0	0	0	0	0	0	0	26.0903	NO																							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	4.9925	1.243119075	0.980898083	0.219274489	2.241317753	2.031683784	0.349940467	1.685571913	0.892747462	0	2.335110512	0	0	0.190240946	0	4.587957706	0.637387034	1.113426322	0	0.152369089	2.436270886	0	0	0	0	0	0.000415363	0	0	0	0	0	0	0	0	0	0	0	0	0	26.0903
H3327_021_0	2011	4																															A	A	D	V	T	Coin	Coin	V	V		V			V	V	P	V	P		V	Coin						V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	222.3710453	16.17148832	402.7418234	169.7905279	157.4112475	14.86719362	1.698185589	428.2517546	324.7405512	0	869.6938449	0	0	647.8581295	5366.832896	4543.136035	1035.885362	1158.097227	0	757.8645662	15.61436018	0	0	0	0	0	23.62448496	0	0	0											3400	1A IP Acute: $300 per admission	"1B IP Psych: $300 per admission, 190-day lifetime limit"	"2 SNF: $25 copay days 1-20, $35 copay days 21-100"	6 Home Health: $20 copay per visit	10A Ambulance: $100 copay	11A DME:  20% coins	"11B Prosthetic Medical Supplies: 20% coinsurance, 11C Diabetes Monitoring Supplies: $0 copay"	"4A ER: $50 copay,  4B Urgent Care: $20 copay, 13A Blood: $0 copay"	"9A Outpatient Hospital: $100 copay,   9B ASC Services: $100 copay"	8A OP C/D/T: $0 copay	"8B OP X-Ray: $10 copay, MRI/PET/CAT $100 copay, Chemo $30 copay"		12 Renal Dialysis: $0 copay	"3 CORF: $30 copay,  5  Partial Hosp:  $30 copay, 9C OP SA: $30 copay, 9D Cardiac Rehab: $30 copay"	"7A PCP: $15 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: $30 copay, 7B Chiropractic:  $30 copay, 7F Podiatry:  $30 copay for medically necessary services, 17A Medicare Covered Eye Exams: $0 copay, 18A Medicare Covered Hearing Exams: $30 copay"	"7E Mental Health: $30 copay, 7H Psychiatric: $30 copay"	"7C Occupational Therapy:  $30 copay, 7I Physical and Speech Therapy:  $30 copay"	7D Physician Specialist: $0 copay	7G Other Health Care:  $30 copay	15 Part B Drugs: 20% coinsurance		10B Transportation: Not Covered	"16A Preventive Dental: $0 copay, 16B Comp Dental: $0 Copay"	17A Routine Eye Exams: $0 copay	17B Eye Wear:  $0 copay for eye wear	18A Routine Hearing Exams: $30 copay	18B Hearing Aids: $0 copay	14A Health Ed/Wellness: No Cost Sharing	"13B Acupuncture: Not covered, 13C Other1: Not covered"											0	300	300	29.00013038	20	100	0.2	0.196	48.65615679	100	0	29.41938197	0	0	30	15	30	30	30	0	30	0.2	0	0	0	0	0	30	0	0	0											NO	274.042505	274.042505	26.49089459	18.26950034	91.34750168	0.182695003	0.179041103	44.44618364	91.34750168	0	26.87387044	0	0	27.4042505	13.70917369	27.4042505	27.4042505	27.4042505	0	27.4042505	0.182695003	0	0	0	0	0	30	0	0	0												5.0783	0.369306264	0.889082599	0.258499009	1.198260349	2.716161988	0.304045022	1.586179678	2.472019837	0	1.947669976	0	0	1.479505539	6.131237029	10.37510316	2.365638496	2.644732209	0	1.730725868	2.852665585	0	0	0	0	0	0.059061212	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4582	0	4.202061733	5.0783	0.369306264	0.889082599	0.258499009	1.198260349	2.716161988	0.304045022	1.586179678	2.472019837	0	1.947669976	0	0	1.479505539	6.131237029	10.37510316	2.365638496	2.644732209	0	1.730725868	2.852665585	0	0	0	0	0	0.059061212	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4582	NO																							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	5.0783	0.369306264	0.889082599	0.258499009	1.198260349	2.716161988	0.304045022	1.586179678	2.472019837	0	1.947669976	0	0	1.479505539	6.131237029	10.37510316	2.365638496	2.644732209	0	1.730725868	2.852665585	0	0	0	0	0	0.059061212	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4582
H3327_022_0	2011	3																															D	D	D	V	T	Coin	Coin	V	V		V			V	V	P	V	P		V	Coin						V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1260.90215	86.86512232	668.6431584	197.1924992	200.8913959	5.605690644	2.253913861	227.4251295	192.3773131	0	466.7403818	0	0	517.0148212	5346.343993	3926.736911	207.8948471	893.520836	0	1229.829914	11.65359047	0	0	0	0	0	38.18531908	0	0	0											3400	"1A IP Acute: $150 copay day 1, $25 copay days 2-5"	"1B IP Psych: $150 copay day 1, $25 copay days 2-5, 190-day lifetime limit"	"2 SNF: $25 copay days 1-20, $35 copay days 21-100"	6 Home Health: $20 copay per visit	10A Ambulance: $75 copay	11A DME:  20% coins	"11B Prosthetic Medical Supplies: 20% coinsurance, 11C Diabetes Monitoring Supplies: $0 copay"	"4A ER: $50 copay,  4B Urgent Care: $20 copay, 13A Blood: $0 copay"	"9A Outpatient Hospital: $100 copay,   9B ASC Services: $100 copay"	8A OP C/D/T: $0 copay	"8B OP X-Ray: $10 copay, MRI/PET/CAT $100 copay, Chemo $20 copay"		12 Renal Dialysis: $0 copay	"3 CORF: $20 copay,  5  Partial Hosp:  $20 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, 17A Medicare Covered Eye Exams: $0 copay, 18A Medicare Covered Hearing Exams: $20 copay"	"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% coinsurance		10B Transportation: Not Covered	"16A Preventive Dental: $0 copay, 16B Comp Dental: $0 copay"	17A Routine Eye Exams: $0 copay	17B Eye Wear:  $0 copay for eye wear	18A Routine Hearing Exams: $20 copay	18B Hearing Aids: $0 copay	14A Health Ed/Wellness: No Cost Sharing	"13B Acupuncture: Not covered, 13C Other1: Not covered"											0	41.51715909	32.47642857	29.00013038	20	75	0.2	0.196	49.30405916	100	0	38.1426403	0	0	20	5	20	20	20	0	20	0.2	0	0	0	0	0	20	0	0	0											NO	39.7536499	31.09693919	27.76830245	19.15046731	71.81425242	0.191504673	0.18767458	47.20978866	95.75233656	0	36.52246932	0	0	19.15046731	4.789183746	19.15046731	19.15046731	19.15046731	0	19.15046731	0.191504673	0	0	0	0	0	19.98358885	0	0	0												4.1771	0.225103286	1.547257121	0.314694042	1.202238785	1.073515954	0.423002337	0.894724358	1.535048102	0	1.420542606	0	0	0.825089619	2.133718646	6.266570571	0.331773623	1.42594513	0	1.962651463	2.231717033	0	0	0	0	0	0.063589976	0	0	0	0	0	0	0	0	0	0	0	0	0	28.0543	0	1.241017493	4.1771	0.225103286	1.547257121	0.314694042	1.202238785	1.073515954	0.423002337	0.894724358	1.535048102	0	1.420542606	0	0	0.825089619	2.133718646	6.266570571	0.331773623	1.42594513	0	1.962651463	2.231717033	0	0	0	0	0	0.063589976	0	0	0	0	0	0	0	0	0	0	0	0	0	28.0543	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	"$50/Visit for OP ER; $20/Visit for OP Urgent Care; PBP 4a, 4b"	20% Coinsurance	20% Coinsurance	20% Coinsurance		12 Renal Dialysis: Not Covered	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	15 Part B Drugs: Not Covered		Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											5100	4.8368	0.0353	0.4867	0.0834	0.1311	0.1809	0.0703	0.1051	0.7408	0.173	0.4955	0	0	0.2712	0.6653	1.4741	0.0219	0.0983	0.5446	1.0516	0	0	0	0	0.0051	0.0285	0.0125	0.0852	0	0											11.597	0	3.585866198	9.0139	0.260438124	2.033992882	0.398120891	1.333320673	1.25439287	0.493275395	0.999823726	2.275831704	0.172985255	1.916028048	0	0	1.096263125	2.798973224	7.740662573	0.353635882	1.524246287	0.544552958	3.014224832	2.231717033	0	0	0	0.005123362	0.02846658	0.076067658	0.085214781	0	0	0	0	0	0	0	0	0	0	0	0	39.6513
H3327_023_0	2011	5																															A	A	D	V	T	Coin	Coin	V	V		V			V	V	P	V	P		V	Coin						V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	200.1399667	26.72576075	418.484435	213.9144687	169.9704889	12.02664514	1.856950553	299.8866388	304.7058335	0	710.8230826	0	0	714.0439725	5409.808906	5011.482707	602.2016667	806.3482898	0	1211.884847	27.16146199	0	0	0	0	0	38.49685311	0	0	0											3400	1A IP Acute: $300 per admission	"1B IP Psych: $300 per admission, 190-day lifetime limit"	"2 SNF: $25 copay days 1-20, $35 copay days 21-100"	6 Home Health: $20 copay per visit	10A Ambulance: $75 copay	11A DME:  20% coins	"11B Prosthetic Medical Supplies: 20% coinsurance, 11C Diabetes Monitoring Supplies: $0 copay"	"4A ER: $50 copay,  4B Urgent Care: $20 copay, 13A Blood: $0 copay"	"9A Outpatient Hospital: $100 copay,   9B ASC Services: $100 copay"	8A OP C/D/T: $0 copay	"8B OP X-Ray: $10 copay, MRI/PET/CAT $100 copay, Chemo $20 copay"		12 Renal Dialysis: $0 copay	"3 CORF: $20 copay,  5  Partial Hosp:  $20 copay, 9C OP SA: $20 copay, 9D Cardiac Rehab: $20 copay"	"7A PCP: $10 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, 17A Medicare Covered Eye Exams: $0 copay, 18A Medicare Covered Hearing Exams: $20 copay"	"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% coinsurance		10B Transportation: Not Covered	"16A Preventive Dental: $0 copay, 16B Comp Dental: $0 Copay"	17A Routine Eye Exams: $0 copay	17B Eye Wear:  $0 copay for eye wear	18A Routine Hearing Exams: $20 copay	18B Hearing Aids: $0 copay	14A Health Ed/Wellness: No Cost Sharing	"13B Acupuncture: Not covered, 13C Other1: Not covered"											0	300	300	29.00013038	20	75	0.2	0.196	47.8066066	100	0	33.13719097	0	0	20	10	20	20	20	0	19.9459426	0.2	0	0	0	0	0	20	0	0	0											NO	275.3380049	275.3380049	26.61612681	18.355867	68.83450123	0.18355867	0.179887497	43.87658561	91.77933498	0	30.4130935	0	0	18.355867	9.184542493	18.355867	18.355867	18.355867	0	18.30625348	0.18355867	0	0	0	0	0	20	0	0	0												4.5922	0.613218137	0.928202899	0.327215461	0.974986153	2.207594986	0.334042186	1.096500148	2.330474897	0	1.801527406	0	0	1.092241349	4.140551648	7.665842502	0.921161142	1.233435163	0	1.848755933	4.985721836	0	0	0	0	0	0.064161422	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1578	0	3.319227875	4.5922	0.613218137	0.928202899	0.327215461	0.974986153	2.207594986	0.334042186	1.096500148	2.330474897	0	1.801527406	0	0	1.092241349	4.140551648	7.665842502	0.921161142	1.233435163	0	1.848755933	4.985721836	0	0	0	0	0	0.064161422	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1578	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	"$50/Visit for OP ER; $20/Visit for OP Urgent Care; PBP 4a, 4b"	20% Coinsurance	20% Coinsurance	20% Coinsurance		12 Renal Dialysis: Not Covered	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	15 Part B Drugs: Not Covered		Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											5100	5.1308	0.0412	0.3812	0.0774	0.1659	0.4277	0.0759	0.1764	1.1639	0.2769	0.5433	0	0	0.5906	1.0902	2.2634	0.0418	0.0977	0.6756	0.938	0	0	0	0	0.0134	0.0387	0.0123	0.0953	0	0											14.3175	0	4.915491782	9.723	0.654420637	1.309390342	0.404639084	1.140886116	2.635272405	0.409898271	1.272883569	3.494414426	0.276880501	2.344781097	0	0	1.682832617	5.230717302	9.929256597	0.962988606	1.331164946	0.675641876	2.786758889	4.985721836	0	0	0	0.013376822	0.03866356	0.076423995	0.095251384	0	0	0	0	0	0	0	0	0	0	0	0	51.4753
H3327_026_0	2011	4																																						V						V		P	V	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	YES	0	0	0	0	0	0	0	556.7650725	0	0	0	0	0	996.8381239	0	5661.482897	659.5623775	1125.333818	0	12094.20557	0	0	0	0	0	0	0	0	0	0											3400	1A IP Acute: $0 copay	"1B IP Psych: $0 copay, 190-day lifetime limit"	2 SNF: $0 copay days 1-100	6 Home Health: $0 copay	10A Ambulance: $0 copay	11A DME:  0% coins	"11B Prosthetic Medical Supplies: 0% coinsurance, 11C Diabetes Monitoring Supplies: $0 copay"	"4A ER: $50 copay,  4B Urgent Care: $10 copay, 13A Blood: $0 copay"	"9A Outpatient Hospital: $0 copay,   9B ASC Services: $0 copay"	8A OP C/D/T: $0 copay	"8B OP X-Ray: $0 copay, MRI/PET/CAT $0 copay, Chemo $0 copay"		12 Renal Dialysis: $0 copay	"3 CORF: $10 copay,  5  Partial Hosp:  $10 copay, 9C OP SA: $10 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, 17A Medicare Covered Eye Exams: $0 copay, 18A Medicare Covered Hearing Exams: $10 copay"	"7E Mental Health: $20 copay, 7H Psychiatric: $20 copay"	"7C Occupational Therapy:  $10 copay, 7I Physical and Speech Therapy:  $10 copay"	7D Physician Specialist: $0 copay	7G Other Health Care:  $10 copay	15 Part B Drugs: 0% coinsurance		10B Transportation: 15 trips	"16A Preventive Dental: $0 copay, 16B Comp Dental: $0 Copay"	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: No Cost Sharing	"13B Acupuncture: Not covered, 13C Other1: $41 OTC"											0	0	0	0	0	0	0	0	47.62385292	0	0	0	0	0	10	0	10	20	10	0	10	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	47.00594341	0	0	0	0	0	9.870252096	0	9.870252096	19.74050419	9.870252096	0	9.870252096	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	2.180938957	0	0	0	0	0	0.819920298	0	4.656688619	1.085007823	0.925610706	0	9.947738156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.6159	0	0.257857902	0	0	0	0	0	0	0	2.180938957	0	0	0	0	0	0.819920298	0	4.656688619	1.085007823	0.925610706	0	9.947738156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.6159	NO																							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	0	0	0	0	0	0	0	2.180938957	0	0	0	0	0	0.819920298	0	4.656688619	1.085007823	0.925610706	0	9.947738156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.6159
H3327_027_0	2011	4																																						V						V		P	V	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	YES	0	0	0	0	0	0	0	800.5141419	0	0	0	0	0	3963.922126	0	7443.422277	1261.556581	604.2415502	0	10483.55197	0	0	0	0	0	0	0	0	0	0											3400	1A IP Acute: $0 copay	"1B IP Psych: $0 copay, 190-day lifetime limit"	2 SNF: $0 copay days 1-100	6 Home Health: $0 copay	10A Ambulance: $0 copay	11A DME:  0% coins	"11B Prosthetic Medical Supplies: 0% coinsurance, 11C Diabetes Monitoring Supplies: $0 copay"	"4A ER: $50 copay,  4B Urgent Care: $10 copay, 13A Blood: $0 copay"	"9A Outpatient Hospital: $0 copay,   9B ASC Services: $0 copay"	8A OP C/D/T: $0 copay	"8B OP X-Ray: $0 copay, MRI/PET/CAT $0 copay, Chemo $0 copay"		12 Renal Dialysis: $0 copay	"3 CORF: $10 copay,  5  Partial Hosp:  $10 copay, 9C OP SA: $10 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, 17A Medicare Covered Eye Exams: $0 copay, 18A Medicare Covered Hearing Exams: $10 copay"	"7E Mental Health: $20 copay, 7H Psychiatric: $20 copay"	"7C Occupational Therapy:  $10 copay, 7I Physical and Speech Therapy:  $10 copay"	7D Physician Specialist: $0 copay	7G Other Health Care:  $10 copay	15 Part B Drugs: 0% coinsurance		10B Transportation: Not Covered	"16A Preventive Dental: Not covered, 16B Comp Dental: Not covered"	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: No Cost Sharing	"13B Acupuncture: Not covered, 13C Other1: $41 OTC"											0	0	0	0	0	0	0	0	49.77052688	0	0	0	0	0	10	0	10	20	10	0	10	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	48.77200428	0	0	0	0	0	9.799374718	0	9.799374718	19.59874944	9.799374718	0	9.799374718	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	3.253556597	0	0	0	0	0	3.236996522	0	6.078407006	2.060410944	0.493432448	0	8.561021173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.6838	0	0.484885429	0	0	0	0	0	0	0	3.253556597	0	0	0	0	0	3.236996522	0	6.078407006	2.060410944	0.493432448	0	8.561021173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.6838	NO																							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	0	0	0	0	0	0	0	3.253556597	0	0	0	0	0	3.236996522	0	6.078407006	2.060410944	0.493432448	0	8.561021173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.6838
H3327_036_0	2011	5																															A	A	D	V	T	Coin	Coin	V	V		V			V		P	V	P		V	Coin						V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	290.7412614	10.29413201	806.0574292	373.7955485	277.1024143	15.38457419	5.079241475	597.0197867	409.3122447	0	1138.304117	0	0	1972.546096	0	6316.136507	632.0048365	569.9187918	0	2932.673021	20.87861922	0	0	0	0	0	119.5359383	0	0	0											3400	1A IP Acute: $150 per admission	"1B IP Psych: $150 per admission, 190-day lifetime limit"	"2 SNF: $25 copay days 1-20, $35 copay days 21-100"	6 Home Health: $20 copay per visit	10A Ambulance: $75 copay	11A DME:  20% coins	"11B Prosthetic Medical Supplies: 20% coinsurance, 11C Diabetes Monitoring Supplies: $0 copay"	"4A ER: $50 copay,  4B Urgent Care: $20 copay, 13A Blood: $0 copay"	"9A Outpatient Hospital: $35 copay,   9B ASC Services: $35 copay"	8A OP C/D/T: $0 copay	"8B OP X-Ray: $10 copay, MRI/PET/CAT $100 copay, Chemo $10 copay"		12 Renal Dialysis: $0 copay	"3 CORF: $10 copay,  5  Partial Hosp:  $10 copay, 9C OP SA: $10 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, 17A Medicare Covered Eye Exams: $0 copay, 18A Medicare Covered Hearing Exams: $10 copay"	"7E Mental Health: $10 copay, 7H Psychiatric: $10 copay"	"7C Occupational Therapy:  $10 copay, 7I Physical and Speech Therapy:  $10 copay"	7D Physician Specialist: $0 copay	7G Other Health Care:  $10 copay	15 Part B Drugs: 20% coinsurance		10B Transportation: Not Covered	"16A Preventive Dental: $0 copay, 16B Comp Dental: $0 Copay"	17A Routine Eye Exams: $0 copay	17B Eye Wear:  $0 copay for eye wear	18A Routine Hearing Exams: $10 copay	18B Hearing Aids: $0 copay	14A Health Ed/Wellness: No Cost Sharing	"13B Acupuncture: Not covered, 13C Other1: Not covered"											0	150	150	29.00013038	20	75	0.2	0.196	48.84159914	35	0	30.07966606	0	0	10	0	10	10	10	0	10	0.2	0	0	0	0	0	10	0	0	0											NO	143.6700664	143.6700664	27.77633771	19.15600885	71.83503318	0.191560088	0.187728887	46.78050526	33.52301548	0	28.81031746	0	0	9.578004424	0	9.578004424	9.578004424	9.578004424	0	9.578004424	0.191560088	0	0	0	0	0	10	0	0	0												3.4809	0.123246552	1.865776947	0.59670257	1.658805094	2.947070393	0.953520347	2.327407273	1.143448393	0	2.732908582	0	0	1.574421269	0	5.04133195	0.504445427	0.454890392	0	2.340762931	3.999510145	0	0	0	0	0	0.099613282	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8448	0	1.398653843	3.4809	0.123246552	1.865776947	0.59670257	1.658805094	2.947070393	0.953520347	2.327407273	1.143448393	0	2.732908582	0	0	1.574421269	0	5.04133195	0.504445427	0.454890392	0	2.340762931	3.999510145	0	0	0	0	0	0.099613282	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8448	NO																							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	3.4809	0.123246552	1.865776947	0.59670257	1.658805094	2.947070393	0.953520347	2.327407273	1.143448393	0	2.732908582	0	0	1.574421269	0	5.04133195	0.504445427	0.454890392	0	2.340762931	3.999510145	0	0	0	0	0	0.099613282	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8448
H3327_801_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	293.9171565	20.55633072	32.15340078	0	10.26425744	12.65779936	0.228665597	13.64543436	26.56007941	6.860540356	16.27196465	0	0.048700732	18.74978969	65.47477735	105.3374564	5.11441065	3.412401626	23.63694454	26.66236491	15.9852682	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	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	0.082904911	0.082904911	0.176530184	0	0.233	0.233	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	0.071092636	0.071092636	0.151378198	0	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0	0	0	0	0	0	0	0	0												20.8953	1.46140373	4.867323859	0	2.050821269	2.529056221	0.04568789	2.726387873	5.30676243	1.37075109	3.251174416	0	0.009730514	3.746249323	13.08200488	21.04665605	1.021870525	0.681805369	4.722713637	5.327199297	3.193891832	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3368	0	16.17283612	20.8953	1.46140373	4.867323859	0	2.050821269	2.529056221	0.04568789	2.726387873	5.30676243	1.37075109	3.251174416	0	0.009730514	3.746249323	13.08200488	21.04665605	1.021870525	0.681805369	4.722713637	5.327199297	3.193891832	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3368	NO																							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	20.8953	1.46140373	4.867323859	0	2.050821269	2.529056221	0.04568789	2.726387873	5.30676243	1.37075109	3.251174416	0	0.009730514	3.746249323	13.08200488	21.04665605	1.021870525	0.681805369	4.722713637	5.327199297	3.193891832	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3368
H3327_802_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	293.9171565	20.55633072	32.15340078	0	10.26425744	12.65779936	0.228665597	13.64543436	26.56007941	6.860540356	16.27196465	0	0.048700732	18.74978969	65.47477735	105.3374564	5.11441065	3.412401626	23.63694454	26.66236491	15.9852682	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	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	0.082904911	0.082904911	0.176530184	0	0.233	0.233	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	0.071092636	0.071092636	0.151378198	0	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0	0	0	0	0	0	0	0	0												20.8953	1.46140373	4.867323859	0	2.050821269	2.529056221	0.04568789	2.726387873	5.30676243	1.37075109	3.251174416	0	0.009730514	3.746249323	13.08200488	21.04665605	1.021870525	0.681805369	4.722713637	5.327199297	3.193891832	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3368	0	16.17283612	20.8953	1.46140373	4.867323859	0	2.050821269	2.529056221	0.04568789	2.726387873	5.30676243	1.37075109	3.251174416	0	0.009730514	3.746249323	13.08200488	21.04665605	1.021870525	0.681805369	4.722713637	5.327199297	3.193891832	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3368	NO																							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	20.8953	1.46140373	4.867323859	0	2.050821269	2.529056221	0.04568789	2.726387873	5.30676243	1.37075109	3.251174416	0	0.009730514	3.746249323	13.08200488	21.04665605	1.021870525	0.681805369	4.722713637	5.327199297	3.193891832	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3368
H3327_803_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	293.9171565	20.55633072	32.15340078	0	10.26425744	12.65779936	0.228665597	13.64543436	26.56007941	6.860540356	16.27196465	0	0.048700732	18.74978969	65.47477735	105.3374564	5.11441065	3.412401626	23.63694454	26.66236491	15.9852682	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	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	0.082904911	0.082904911	0.176530184	0	0.233	0.233	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	0.071092636	0.071092636	0.151378198	0	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0.199802205	0	0	0	0	0	0	0	0	0												20.8953	1.46140373	4.867323859	0	2.050821269	2.529056221	0.04568789	2.726387873	5.30676243	1.37075109	3.251174416	0	0.009730514	3.746249323	13.08200488	21.04665605	1.021870525	0.681805369	4.722713637	5.327199297	3.193891832	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3368	0	16.17283612	20.8953	1.46140373	4.867323859	0	2.050821269	2.529056221	0.04568789	2.726387873	5.30676243	1.37075109	3.251174416	0	0.009730514	3.746249323	13.08200488	21.04665605	1.021870525	0.681805369	4.722713637	5.327199297	3.193891832	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3368	NO																							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	20.8953	1.46140373	4.867323859	0	2.050821269	2.529056221	0.04568789	2.726387873	5.30676243	1.37075109	3.251174416	0	0.009730514	3.746249323	13.08200488	21.04665605	1.021870525	0.681805369	4.722713637	5.327199297	3.193891832	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3368
H3327_805_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	264.5254408	19.15819837	28.9380607	0	9.237831696	11.39201942	0.205799037	12.28089092	23.90407147	6.17448632	15.3604972	0	0.043830659	16.87481072	61.83490687	94.80371077	4.903787867	3.071161464	21.27325008	23.99612841	14.38674138	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	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	0.082904911	0.082904911	0.176530184	0	0.233	0.233	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	0.070749964	0.070749964	0.150648545	0	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0	0	0	0	0	0	0	0	0												18.7152	1.355441851	4.359476725	0	1.836842554	2.265179399	0.040920904	2.441921849	4.753065128	1.227729579	3.054268126	0	0.008715251	3.355372932	12.2952	18.85068877	0.975064986	0.610667119	4.229954854	4.771369652	2.860647351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0077	0	15.11985	18.7152	1.355441851	4.359476725	0	1.836842554	2.265179399	0.040920904	2.441921849	4.753065128	1.227729579	3.054268126	0	0.008715251	3.355372932	12.2952	18.85068877	0.975064986	0.610667119	4.229954854	4.771369652	2.860647351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0077	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	2.7108	0.1175	0.6315	0	0.2661	0.3281	0.0059	0.3537	0.6885	0.1778	0.2363	0	0.0013	0.486	0.9435	2.4178	0.0477	0.0885	0.6127	0.6911	0.4144	0	0	0	0	0	0	0	0	0											11.219	0	0.882494076	21.426	1.47289684	4.990931611	0	2.102902744	2.593282676	0.046848154	2.795625648	5.44152991	1.405561895	3.290529935	0	0.009977624	3.841386911	13.23869215	21.26848111	1.022810281	0.699120105	4.842648951	5.462485781	3.275002068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2267
H3327_806_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	264.5254408	19.15819837	28.9380607	0	9.237831696	11.39201942	0.205799037	12.28089092	23.90407147	6.17448632	15.3604972	0	0.043830659	16.87481072	61.83490687	94.80371077	4.903787867	3.071161464	21.27325008	23.99612841	14.38674138	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	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	0.082904911	0.082904911	0.176530184	0	0.233	0.233	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	0.070749964	0.070749964	0.150648545	0	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0	0	0	0	0	0	0	0	0												18.7152	1.355441851	4.359476725	0	1.836842554	2.265179399	0.040920904	2.441921849	4.753065128	1.227729579	3.054268126	0	0.008715251	3.355372932	12.2952	18.85068877	0.975064986	0.610667119	4.229954854	4.771369652	2.860647351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0077	0	15.11985	18.7152	1.355441851	4.359476725	0	1.836842554	2.265179399	0.040920904	2.441921849	4.753065128	1.227729579	3.054268126	0	0.008715251	3.355372932	12.2952	18.85068877	0.975064986	0.610667119	4.229954854	4.771369652	2.860647351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0077	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	2.7108	0.1175	0.6315	0	0.2661	0.3281	0.0059	0.3537	0.6885	0.1778	0.2363	0	0.0013	0.486	0.9435	2.4178	0.0477	0.0885	0.6127	0.6911	0.4144	0	0	0	0	0	0	0	0	0											11.219	0	0.882494076	21.426	1.47289684	4.990931611	0	2.102902744	2.593282676	0.046848154	2.795625648	5.44152991	1.405561895	3.290529935	0	0.009977624	3.841386911	13.23869215	21.26848111	1.022810281	0.699120105	4.842648951	5.462485781	3.275002068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2267
H3327_807_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	264.5254408	19.15819837	28.9380607	0	9.237831696	11.39201942	0.205799037	12.28089092	23.90407147	6.17448632	15.3604972	0	0.043830659	16.87481072	61.83490687	94.80371077	4.903787867	3.071161464	21.27325008	23.99612841	14.38674138	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	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	0.082904911	0.082904911	0.176530184	0	0.233	0.233	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	0.070749964	0.070749964	0.150648545	0	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0.198839145	0	0	0	0	0	0	0	0	0												18.7152	1.355441851	4.359476725	0	1.836842554	2.265179399	0.040920904	2.441921849	4.753065128	1.227729579	3.054268126	0	0.008715251	3.355372932	12.2952	18.85068877	0.975064986	0.610667119	4.229954854	4.771369652	2.860647351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0077	0	15.11985	18.7152	1.355441851	4.359476725	0	1.836842554	2.265179399	0.040920904	2.441921849	4.753065128	1.227729579	3.054268126	0	0.008715251	3.355372932	12.2952	18.85068877	0.975064986	0.610667119	4.229954854	4.771369652	2.860647351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0077	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	2.7108	0.1175	0.6315	0	0.2661	0.3281	0.0059	0.3537	0.6885	0.1778	0.2363	0	0.0013	0.486	0.9435	2.4178	0.0477	0.0885	0.6127	0.6911	0.4144	0	0	0	0	0	0	0	0	0											11.219	0	0.882494076	21.426	1.47289684	4.990931611	0	2.102902744	2.593282676	0.046848154	2.795625648	5.44152991	1.405561895	3.290529935	0	0.009977624	3.841386911	13.23869215	21.26848111	1.022810281	0.699120105	4.842648951	5.462485781	3.275002068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2267
H3328_001_0	2011	5																															A	A	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	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	255.4411093	20.49171579	540.1796843	715.2701472	8.229299792	8.941395601	5.196078662	201.0390058	22.20545656	21.81089447	14.14561396	0.01850648	0.094969147	6.15935936	5870.899383	3404.830268	488.0630156	1270.422208	101.664585	2.426238216	14.6269184	85.91415531	0	0	0	0	0	0	0	0											6700	PBP(1A)-1100 per admit	PBP(1B)-1100 per admit	PBP(2)-50 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(11C)-0% of allowed cost	PBP(4A)-50 per visit & PBP(4B)-20 per visit	PBP(9A)-30% of allowed cost & PBP(9B)-20% of allowed cost	PBP(8A)-0% of allowed cost	PBP(8B)-20% of allowed cost	PBP(9A)-20% of allowed cost	PBP(12)-20% of allowed cost	PBP(9A)-20% of allowed costPBP(7D)-40 per visit	PBP(7A)-20 per visit	PBP(7D)-40 per visit	PBP(7E)-40 per visit & PBP(7H)-40 per visit	PBP(7C)-40 per visit & PBP(7I)-40 per visit	PBP(11A)-20% of allowed cost excl IPF/SNF svcs	PBP(7B)-50% of allowed cost & PBP(7F)-40per visit 20% when fac coins applies	PBP(15)-20% of allowed cost	PBP(14A)-0 per visit																			0	1100	1100	50	0	0.2	0.2	0.091457513	49.73072336	0.299317529	0	0.2	0.2	0.2	0.209520411	12.86260801	39.62175043	40	40	0.126897373	0.551317526	0.2	0	0	0	0	0	0	0	0	0											NO	1005.26564	1005.26564	45.10412546	0	0.180416502	0.180416502	0.082502223	44.86121571	0.270009107	0	0.180416502	0.180416502	0.180416502	0.189004698	11.60313371	35.74208805	36.08330037	36.08330037	0.1144719	0.497333897	0.180416502	0	0	0	0	0	0	0	0	0												21.3988	1.716634815	2.030361021	0	1.484701481	1.613175316	0.42868804	0.751571184	5.995675504	0	2.552102186	0.003338874	0.017134001	1.164147858	5.676735878	10.14131194	1.467577033	3.820085511	11.63773824	1.206650508	2.63893745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7454	0	8.108566189	21.3988	1.716634815	2.030361021	0	1.484701481	1.613175316	0.42868804	0.751571184	5.995675504	0	2.552102186	0.003338874	0.017134001	1.164147858	5.676735878	10.14131194	1.467577033	3.820085511	11.63773824	1.206650508	2.63893745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7454	NO	POS(1A)-1600 per admit	POS(1B)-1600 per admit	POS(2)-50 per day	POS(6)-%	POS(10A)-20% of allowed cost	POS(11A)-30% of allowed cost	POS(11B)-30% of allowed cost & POS(11C)-0% of allowed cost	POS(4A)-50 per visit & POS(4B)-20 per visit	POS(9A)-40% of allowed cost & POS(9B)-30% of allowed cost	POS(8A)-30% of allowed cost	POS(8B)-20% of allowed cost	POS(9A)-30% of allowed cost	POS(12)-20% of allowed cost	POS(9A)-20% of allowed costPOS(7D)-30%	POS(7A)-30%	POS(7D)-30%	POS(7E)-30% per visit & POS(7H)-30%	POS(7C)-30% & POS(7I)-30%	POS(11A)-30% of allowed cost excl IPF/SNF svcs	POS(7B)-50% of allowed cost & POS(7F)-30% 20% when fac coins applies	POS(15)-20% of allowed cost	POS(14A)-0 per visit																				0	0	0	0	0	0.133	0.2644	0	1.9613	1.2728	0.3762	0	0	0.2321	2.8274	2.4246	1.8317	0.7771	6.2278	0.4394	0.4499	0	0	0	0	0	0	0	0	0											19.2176	150	0	21.3988	1.716634815	2.030361021	0	1.484701481	1.746183073	0.693045635	0.751571184	7.956935152	1.272798437	2.928329355	0.003338874	0.017134001	1.39624733	8.504111235	12.56587582	3.29927263	4.597185904	17.86556664	1.646029047	3.088836101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.963
H3328_002_0	2011	7																															A	A	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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	362.2102422	35.60646096	467.9710842	1108.207144	11.57869199	10.97984344	10.42603499	3.675105677	23.17188444	23.15950685	14.03689478	0.035121226	0.145867844	6.834014585	69.23944861	34.1820456	10.3346767	13.46292163	137.1988565	5.598986466	16.57079286	1.389715189																			6700	PBP(1A)-625 per admit	PBP(1B)-625 per admit	PBP(2)-0 per day	PBP(6)-0 per visit	PBP(10A)-% of allowed cost	PBP(11A)-% of allowed cost	PBP(11B)-% of allowed cost & PBP(11C)-0% of allowed cost	PBP(4A)-% of allowed cost & PBP(4B)-% of allowed cost	PBP(9A)-% of allowed cost & PBP(9B)-% of allowed cost	PBP(8A)-0% of allowed cost	PBP(8B)-% of allowed cost	PBP(9A)-% of allowed cost	PBP(12)-% of allowed cost	PBP(9A)-% of allowed costPBP(7D)-% of allowed cost	PBP(7A)-% of allowed cost	PBP(7D)-% of allowed cost	PBP(7E)-% of allowed cost & PBP(7H)-% of allowed cost	PBP(7C)-% of allowed cost & PBP(7I)-% of allowed cost	PBP(11A)-% of allowed cost excl IPF/SNF svcs	PBP(7B)-% of allowed cost & PBP(7F)-0per visit 20% when fac coins applies	PBP(15)-% of allowed cost	PBP(14A)-% of allowed cost																			0	625	625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			NO	625	625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																				18.8651	1.854503175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.7196	0	0	18.8651	1.854503175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.7196	NO																																																																																		0			18.8651	1.854503175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.7196
H3328_003_0	2011	10																															A	A	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	V	T	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	YES	354.6822765	36.11956405	787.4977722	1165.638219	12.80245168	14.00747676	9.003872051	248.6204259	37.58896279	28.59335397	21.23952739	0.038822646	0.197531013	10.323468	9853.756966	4639.240111	905.0837934	1593.496012	125.5684358	3.365865028	21.97649657	239.2986696	0	0	0	0	0	0	0	0											6700	PBP(1A)-1100 per admit	PBP(1B)-1100 per admit	PBP(2)-50 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(11C)-0% of allowed cost	PBP(4A)-50 per visit & PBP(4B)-10 per visit	PBP(9A)-30% of allowed cost & PBP(9B)-20% of allowed cost	PBP(8A)-0% of allowed cost	PBP(8B)-20% of allowed cost	PBP(9A)-20% of allowed cost	PBP(12)-20% of allowed cost	PBP(9A)-20% of allowed costPBP(7D)-30 per visit	PBP(7A)-10 per visit	PBP(7D)-30 per visit	PBP(7E)-30 per visit & PBP(7H)-30 per visit	PBP(7C)-30 per visit & PBP(7I)-30 per visit	PBP(7D)-20% of allowed cost excl IPF/SNF svcs	PBP(7B)-50% of allowed cost & PBP(7F)-30per visit match fac coins when fac coins applies	PBP(15)-20% of allowed cost	PBP(14A)-0 per visit	$150 Non Medicare Benefit Allowance	$150 Non Medicare Benefit Allowance	$150 Non Medicare Benefit Allowance	$150 Non Medicare Benefit Allowance	$150 Non Medicare Benefit Allowance	$150 Non Medicare Benefit Allowance	$150 Non Medicare Benefit Allowance												0	1100	1100	50	0	0.2	0.2	0.075647214	48.79699248	0.299671048	0	0.2	0.2	0.2	0.203992598	4.888407493	29.77075197	30	30	0.122330567	0.505407191	0.2	0	0	0	0	0	0	0	0	0											NO	1010.958234	1010.958234	45.62682428	0	0.182507297	0.182507297	0.069030843	44.52903603	0.273460765	0	0.182507297	0.182507297	0.182507297	0.186150688	4.460850194	27.16689737	27.37609457	27.37609457	0.111631105	0.461202502	0.182507297	0	0	0	0	0	0	0	0	0												29.8807	3.042947557	2.994251873	0	2.336540853	2.556466723	0.621544878	0.922568992	10.27910651	0	3.876368736	0.007085416	0.036050851	1.921720673	3.66301114	10.50281333	2.06480496	3.635308127	14.01734329	1.552345374	4.01087099	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9219	0	9.385424023	29.8807	3.042947557	2.994251873	0	2.336540853	2.556466723	0.621544878	0.922568992	10.27910651	0	3.876368736	0.007085416	0.036050851	1.921720673	3.66301114	10.50281333	2.06480496	3.635308127	14.01734329	1.552345374	4.01087099	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9219	NO	POS(1A)-1600 per admit	POS(1B)-1600 per admit	POS(2)-50 per day	POS(6)-%	POS(10A)-20% of allowed cost	POS(11A)-30% of allowed cost	POS(11B)-30% of allowed cost & POS(11C)-0% of allowed cost	POS(4A)-50 per visit & POS(4B)-10 per visit	POS(9A)-40% of allowed cost & POS(9B)-30% of allowed cost	POS(8A)-30% of allowed cost	POS(8B)-20% of allowed cost	POS(9A)-30% of allowed cost	POS(12)-20% of allowed cost	POS(9A)-20% of allowed costPOS(7D)-30%	POS(7A)-30%	POS(7D)-30%	POS(7E)-30% per visit & POS(7H)-30%	POS(7C)-30% & POS(7I)-30%	POS(7D)-20% of allowed cost excl IPF/SNF svcs	POS(7B)-50% of allowed cost & POS(7F)-30% match when fac coins applies	POS(15)-20% of allowed cost	POS(14A)-0 per visit																				0	0	0	0	0	1.3167	0.0617	0	2.1536	2.2462	0.7603	0.0039	0	0.3349	3.8577	3.0114	1.4371	0.4589	7.1217	0.4237	0.6404	0.0107	0	0	0	0	0	0	0	0											23.839	150	0	29.8807	3.042947557	2.994251873	0	2.336540853	3.873122259	0.683274999	0.922568992	12.43272056	2.246220318	4.63662649	0.010998677	0.036050851	2.256663114	7.520744588	13.51425578	3.501951133	4.094159039	21.13907582	1.97602548	4.651229664	0.010738489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.7609
H3328_012_0	2011	11																															A	A	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	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	290.246115	18.6052414	490.0885106	785.4004817	7.147601405	9.359037941	8.16520382	176.8879378	22.17294687	22.00761387	13.05386302	0.054587253	0.202467375	6.790874734	8382.803195	3613.347255	774.8605029	1219.947525	116.2704293	3.623701114	15.04100566	49.59095046	0	0	0	0	0	0	0	0											6700	PBP(1A)-1100 per admit	PBP(1B)-1100 per admit	PBP(2)-50 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(11C)-0% of allowed cost	PBP(4A)-50 per visit & PBP(4B)-18 per visit	PBP(9A)-30% of allowed cost & PBP(9B)-20% of allowed cost	PBP(8A)-20% of allowed cost	PBP(8B)-20% of allowed cost	PBP(9A)-20% of allowed cost	PBP(12)-20% of allowed cost	PBP(9A)-20% of allowed costPBP(7D)-40 per visit	PBP(7A)-18 per visit	PBP(7D)-40 per visit	PBP(7E)-40 per visit & PBP(7H)-40 per visit	PBP(7C)-40 per visit & PBP(7I)-40 per visit	PBP(7D)-20% of allowed cost excl IPF/SNF svcs	PBP(7B)-50% of allowed cost & PBP(7F)-40per visit 20% when fac coins applies	PBP(15)-20% of allowed cost	PBP(14A)-0 per visit																			0	1100	1100	50	0	0.2	0.2	0.101401175	49.89809083	0.29967207	0.2	0.2	0.2	0.2	0.236320804	8.987414282	39.65688348	40	40	0.120316	0.582765849	0.2	0	0	0	0	0	0	0	0	0											NO	1007.087304	1007.087304	45.26732061	0	0.181069282	0.181069282	0.09180319	45.17505751	0.271307033	0.181069282	0.181069282	0.181069282	0.181069282	0.213952192	8.136723275	35.90321718	36.21385648	36.21385648	0.108927659	0.527604971	0.181069282	0	0	0	0	0	0	0	0	0												24.3586	1.561425199	1.848749478	0	1.294211057	1.694634284	0.74959176	0.66591023	6.015676434	3.984902851	2.363653609	0.009884075	0.036660622	1.452922537	5.684045822	10.81089927	2.338390587	3.681583715	12.66506565	1.91188272	2.723464102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8522	0	8.886590726	24.3586	1.561425199	1.848749478	0	1.294211057	1.694634284	0.74959176	0.66591023	6.015676434	3.984902851	2.363653609	0.009884075	0.036660622	1.452922537	5.684045822	10.81089927	2.338390587	3.681583715	12.66506565	1.91188272	2.723464102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8522	NO	POS(1A)-1600 per admit	POS(1B)-1600 per admit	POS(2)-50 per day	POS(6)-%	POS(10A)-20% of allowed cost	POS(11A)-30% of allowed cost	POS(11B)-30% of allowed cost & POS(11C)-0% of allowed cost	POS(4A)-50 per visit & POS(4B)-18 per visit	POS(9A)-40% of allowed cost & POS(9B)-30% of allowed cost	POS(8A)-30% of allowed cost	POS(8B)-20% of allowed cost	POS(9A)-30% of allowed cost	POS(12)-20% of allowed cost	POS(9A)-20% of allowed costPOS(7D)-30%	POS(7A)-30%	POS(7D)-30%	POS(7E)-30% per visit & POS(7H)-30%	POS(7C)-30% & POS(7I)-30%	POS(7D)-20% of allowed cost excl IPF/SNF svcs	POS(7B)-50% of allowed cost & POS(7F)-30% 20% when fac coins applies	POS(15)-20% of allowed cost	POS(14A)-0 per visit																				0	0	0	0	0	1.2723	0.0726	0	3.0343	2.4908	0.9413	0.0075	0.0061	0.3063	4.1841	2.9278	2.2101	0.7329	6.276	0.4213	2.2325	0.0153	0	0	0	0	0	0	0	0											27.1312	150	0	24.3586	1.561425199	1.848749478	0	1.294211057	2.966892206	0.822177583	0.66591023	9.0499875	6.47572138	3.304930261	0.017404813	0.042779404	1.759183463	9.868182188	13.73867001	4.548539052	4.414471354	18.94110522	2.333221847	4.955917153	0.015259549	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9833
H3328_013_0	2011	9																															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	YES	366.46232	33.22208015	11.37494509	10.40760879	15.34114883	8.776413219	8.564367044	5.068854535	23.84654912	24.28616642	15.13747234	0.034926716	0.123696532	5.496018948	67.36429677	31.71556503	11.82906735	10.41439952	141.3139027	4.109949926	12.24605911	1.469784602																			6700	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	$300 Non Medicare Benefit Allowance	$300 Non Medicare Benefit Allowance	$300 Non Medicare Benefit Allowance	$300 Non Medicare Benefit Allowance	$300 Non Medicare Benefit Allowance	$300 Non Medicare Benefit Allowance	$300 Non Medicare Benefit Allowance												0	0.067208047	0.067208047	0.153856777	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.067208047	0.067208047	0.153856777	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				24.6292	2.232791132	1.750112388	0	3.574487678	2.04490428	1.995497521	1.181043107	5.556245945	5.658676775	3.527031054	0.008137925	0.028821292	1.280572415	15.69588115	7.389726653	2.756172692	2.426555089	32.92613933	0.957618333	2.853331773	0.342459812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.8154	0	0	24.6292	2.232791132	1.750112388	0	3.574487678	2.04490428	1.995497521	1.181043107	5.556245945	5.658676775	3.527031054	0.008137925	0.028821292	1.280572415	15.69588115	7.389726653	2.756172692	2.426555089	32.92613933	0.957618333	2.853331773	0.342459812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.8154	NO																																																																																		0			24.6292	2.232791132	1.750112388	0	3.574487678	2.04490428	1.995497521	1.181043107	5.556245945	5.658676775	3.527031054	0.008137925	0.028821292	1.280572415	15.69588115	7.389726653	2.756172692	2.426555089	32.92613933	0.957618333	2.853331773	0.342459812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.8154
H3328_015_0	2011	9																															A	A	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	V	V	V	Coin	Coin	Coin	V	T	V																	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																	0	YES	329.6642625	33.09853984	571.074877	1024.904434	295.0494592	12.14738135	8.434825372	241.1872402	287.4671726	28.01702192	18.64536884	2.355802491	0.214864864	9.289031485	8439.358339	4534.165311	1533.611899	1555.774605	134.7735042	4.365543468	22.25066745	123.7177071	0	750																	6700	PBP(1A)-1100 per admit	PBP(1B)-1100 per admit	PBP(2)-50 per day	PBP(6)-0 per visit	PBP(10A)-150 per trip	PBP(11A)-20% of allowed cost	PBP(11B)-20% of allowed cost & PBP(11C)-0% of allowed cost	PBP(4A)-50 per visit & PBP(4B)-15 per visit	PBP(9A)-500 per visit & PBP(9B)-250 per visit	PBP(8A)-0% of allowed cost	PBP(8B)-20% of allowed cost	PBP(9A)-150 per visit	PBP(12)-20% of allowed cost	PBP(9A)-20% of allowed costPBP(7D)-35 per visit	PBP(7A)-15 per visit	PBP(7D)-35 per visit	PBP(7E)-35 per visit & PBP(7H)-35 per visit	PBP(7C)-35 per visit & PBP(7I)-35 per visit	PBP(7D)-20% of allowed cost excl IPF/SNF svcs	PBP(7B)-50% of allowed cost & PBP(7F)-35per visit 20% when fac coins applies	PBP(15)-20% of allowed cost	PBP(14A)-0 per visit		"1 exam, cleaning per year, x-rays every 2 years, $5 copaySCP Copay applies"																	0	1100	1100	50	0	150	0.2	0.081632962	49.40534635	496.1593084	0	0.2	150	0.2	0.573692628	9.89048645	34.72129522	35	35	0.132196687	0.525001626	0.2	0	0	0																	NO	1014.50787	1014.50787	45.97958431	0	137.9387529	0.183918337	0.075068994	45.43274576	456.2639751	0	0.183918337	137.9387529	0.183918337	0.527562971	9.095209112	31.92941442	32.18570902	32.18570902	0.121566974	0.48278713	0.183918337	0	0	0																		27.8706	2.79822743	2.188148788	0	3.391562871	2.23412618	0.633193851	0.91314988	10.93007624	0	3.429225235	0.027079705	0.039517588	4.900549049	6.396477406	12.06443694	4.113365527	4.172809061	16.38400713	2.107628203	4.09230576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.6865	0	9.635567464	27.8706	2.79822743	2.188148788	0	3.391562871	2.23412618	0.633193851	0.91314988	10.93007624	0	3.429225235	0.027079705	0.039517588	4.900549049	6.396477406	12.06443694	4.113365527	4.172809061	16.38400713	2.107628203	4.09230576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.6865	NO																																																																																		0			27.8706	2.79822743	2.188148788	0	3.391562871	2.23412618	0.633193851	0.91314988	10.93007624	0	3.429225235	0.027079705	0.039517588	4.900549049	6.396477406	12.06443694	4.113365527	4.172809061	16.38400713	2.107628203	4.09230576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.6865
H3328_801_0	2011	3																															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	YES	291.0771458	11.62245344	20.31517348	10.32968856	9.725714868	8.816631459	8.192124714	4.074239372	28.99657092	24.90412309	16.68456911	0.044445088	0.188754467	8.318111273	52.03464699	31.3957515	5.268458864	9.264901414	119.9233228	3.412290379	17.82408518	1.688710257																			6700	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	0.074586259	0.074586259	0.165605579	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069848093	0.069848093	0.137330288	0	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787																				20.3312	0.811806203	2.789888631	0	1.879181911	1.703530752	1.582864888	0.787215853	5.602655672	4.811921618	3.223756905	0.008587585	0.036470736	1.607207743	10.05402366	6.066220233	1.0179604	1.790144517	23.17132901	0.659315479	3.443931774	0.326288999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7055	0	15.9625372	20.3312	0.811806203	2.789888631	0	1.879181911	1.703530752	1.582864888	0.787215853	5.602655672	4.811921618	3.223756905	0.008587585	0.036470736	1.607207743	10.05402366	6.066220233	1.0179604	1.790144517	23.17132901	0.659315479	3.443931774	0.326288999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7055	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	0.0024	0	0	0.75	0.0464	0	1.2769	1.4103	0.6571	0.0034	0.0025	0.2493	3.2758	1.7936	1.1067	0.3716	5.2772	0.2278	1.2344	0.0076																			17.6928			20.3312	0.811806203	2.792262766	0	1.879181911	2.453539437	1.629281316	0.787215853	6.879600835	6.222190679	3.880850373	0.011949945	0.038930763	1.856475555	13.32984233	7.859787851	2.124636218	2.161720083	28.44856791	0.887099296	4.678300342	0.333864096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.3983
H3328_802_0	2011	3																															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	YES	291.0771458	11.62245344	20.31517348	10.32968856	9.725714868	8.816631459	8.192124714	4.074239372	28.99657092	24.90412309	16.68456911	0.044445088	0.188754467	8.318111273	52.03464699	31.3957515	5.268458864	9.264901414	119.9233228	3.412290379	17.82408518	1.688710257																			6700	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	0.074589007	0.074589007	0.165609913	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069850665	0.069850665	0.137333882	0	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787																				20.3319	0.811836105	2.789961644	0	1.879181911	1.703530752	1.582864888	0.787215853	5.602655672	4.811921618	3.223756905	0.008587585	0.036470736	1.607207743	10.05402366	6.066220233	1.0179604	1.790144517	23.171329	0.659315479	3.443931774	0.326288999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7063	0	15.96168535	20.3319	0.811836105	2.789961644	0	1.879181911	1.703530752	1.582864888	0.787215853	5.602655672	4.811921618	3.223756905	0.008587585	0.036470736	1.607207743	10.05402366	6.066220233	1.0179604	1.790144517	23.171329	0.659315479	3.443931774	0.326288999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7063	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	0.0024	0	0	0.75	0.0464	0	1.2769	1.4103	0.6571	0.0034	0.0025	0.2493	3.2758	1.7936	1.1067	0.3716	5.2772	0.2278	1.2344	0.0076																			17.6928			20.3319	0.811836105	2.792335841	0	1.879181911	2.453539437	1.629281316	0.787215853	6.879600834	6.222190679	3.880850372	0.011949945	0.038930763	1.856475554	13.32984233	7.859787851	2.124636218	2.161720083	28.44856791	0.887099296	4.678300342	0.333864096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.3991
H3328_803_0	2011	3																															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	YES	291.0771458	11.62245344	20.31517348	10.32968856	9.725714868	8.816631459	8.192124714	4.074239372	28.99657092	24.90412309	16.68456911	0.044445088	0.188754467	8.318111273	52.03464699	31.3957515	5.268458864	9.264901414	119.9233228	3.412290379	17.82408518	1.688710257																			6700	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	0.074589007	0.074589007	0.165609913	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069850665	0.069850665	0.137333882	0	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787	0.19321787																				20.3319	0.811836105	2.789961644	0	1.879181911	1.703530752	1.582864888	0.787215853	5.602655672	4.811921618	3.223756905	0.008587585	0.036470736	1.607207743	10.05402366	6.066220233	1.0179604	1.790144517	23.171329	0.659315479	3.443931774	0.326288999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7063	0	15.96168535	20.3319	0.811836105	2.789961644	0	1.879181911	1.703530752	1.582864888	0.787215853	5.602655672	4.811921618	3.223756905	0.008587585	0.036470736	1.607207743	10.05402366	6.066220233	1.0179604	1.790144517	23.171329	0.659315479	3.443931774	0.326288999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7063	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	0.0024	0	0	0.75	0.0464	0	1.2769	1.4103	0.6571	0.0034	0.0025	0.2493	3.2758	1.7936	1.1067	0.3716	5.2772	0.2278	1.2344	0.0076																			17.6928			20.3319	0.811836105	2.792335841	0	1.879181911	2.453539437	1.629281316	0.787215853	6.879600834	6.222190679	3.880850372	0.011949945	0.038930763	1.856475554	13.32984233	7.859787851	2.124636218	2.161720083	28.44856791	0.887099296	4.678300342	0.333864096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.3991
H3330_021_1	2011	6																															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	YES	2112.861994	130.5022792	1707.21813	276.4057079	580.5379312	7.736289274	7.736289274	201.4769416	155.2625056	82.71937196	113.6197846	0	11.13095098	1048.858071	15461.7448	20866.71978	243.0253703	73.44640714	664.9877403	1917.263161	8.28841659	0	0	41.18740984	1359.285118	15.69310357	155.1527408	3.128842973	0	0											6700	1A IP Acute: $225 days 1-7	1B IP Psych: $0	"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 - $30	9B ASC Services - $150; 9A Outpatient Hospital - $150	8A Outpatient C/D/T - $30	8B Outpatient X-Rays - $30; Outpatient Radiology Therapy - $55; High-tech Radiology - $75	5 Partial Hosp - $30	12 Renal Dialysis - $0	3 CORF - $30; 9D Cardiac Rehab Svcs - $30; 9C Outpatient Sub Abuse - $30	7A Primary Care - $20; 14B Immunizations - $0; 14C Routine Physical Exams - $0	7D Physician Specialist - $32; 7B Chiropractic - $30; 7F Podiatry - $30	7E Mental Health - $30; 7H Psychiatric Services - $30	7C Occupational Therapy - $30; 7I PT and ST Services - $30	7D Specialist Copays; X-Rays - $30; High-tech Radiology - $75	7G Other Health Care - $32; 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 Nutritional Training - $0; 14A Health Education/Wellness Programs - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"	13A Blood - $0	10B Transportation - NA	16A Preventative Dental; Exam - $5; Cleaning - $10; Fluoride - $19 - $23; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - $30; 18A Hearing Exams (Medicare Covered) - $30	18B Hearing Aids - NA		13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA												142.0942921	0	30.34463181	0	75	0.2	0.2	48	150	30	46.2	$30 	0	$30 	19	31.9	$30 	$30 	47.48	16	0.2	30	0	7.5	10	40	30	0	0	0											NO	134.9895775	0	28.82740022	0	71.25	0.19	0.19	45.6	142.5	28.5	43.89	28.5	0	28.5	18.05	30.305	28.5	28.5	45.106	15.2	0.1425	28.5	0	7.125	9.5	38	28.5	0	0	0												23.7679	0	4.10122169	0	3.446943966	1.469894962	1.469894962	0.765612378	1.843742254	0.196458508	0.415564362	0	0	2.491037919	23.25704113	52.69716191	0.577185255	0.174435217	2.499578084	2.428533337	1.181099364	0	0	0.024455025	1.076100718	0.049694828	0.368487759	0	0	0	0	0	0	0	0	0	0	0	0	0	124.302		6.956631669	23.7679	0	4.10122169	0	3.446943966	1.469894962	1.469894962	0.765612378	1.843742254	0.196458508	0.415564362	0	0	2.491037919	23.25704113	52.69716191	0.577185255	0.174435217	2.499578084	2.428533337	1.181099364	0	0	0.024455025	1.076100718	0.049694828	0.368487759	0	0	0	0	0	0	0	0	0	0	0	0	0	124.302	NO																																																																																		0			23.7679	0	4.10122169	0	3.446943966	1.469894962	1.469894962	0.765612378	1.843742254	0.196458508	0.415564362	0	0	2.491037919	23.25704113	52.69716191	0.577185255	0.174435217	2.499578084	2.428533337	1.181099364	0	0	0.024455025	1.076100718	0.049694828	0.368487759	0	0	0	0	0	0	0	0	0	0	0	0	0	124.302
H3330_021_2	2011	5																															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	YES	1910.57432	124.5849832	1665.818169	256.2638915	252.3217948	7.201748675	7.201748675	229.6686535	221.6754945	58.22523229	79.97568396	0	7.834950763	738.2793581	14922.85754	20139.45325	234.5552218	70.88658394	641.8109627	1850.440904	18.13973376	0	0	41.03891226	1477.560018	21.29697197	210.5564113	4.246125108	0	0											6700	1A IP Acute: $225 days 1-7	1B IP Psych: $0	"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 - $30	9B ASC Services - $200; 9A Outpatient Hospital - $200	8A Outpatient C/D/T - $30	8B Outpatient X-Rays - $30; Outpatient Radiology Therapy - $55; High-tech Radiology - $75	5 Partial Hosp - $30	12 Renal Dialysis - $0	3 CORF - $30; 9D Cardiac Rehab Svcs - $30; 9C Outpatient Sub Abuse - $30	7A Primary Care - $20; 14B Immunizations - $0; 14C Routine Physical Exams - $0	7D Physician Specialist - $30; 7B Chiropractic - $30; 7F Podiatry - $30	7E Mental Health - $30; 7H Psychiatric Services - $30	7C Occupational Therapy - $30; 7I PT and ST Services - $30	7D Specialist Copays; X-Rays - $30; High-tech Radiology - $75	7G Other Health Care - $30; 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 Nutritional Training - $0; 14A Health Education/Wellness Programs - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"	13A Blood - $0	10B Transportation - NA	16A Preventative Dental; Exam - $5; Cleaning - $10; Fluoride - $19 - $23; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - $30; 18A Hearing Exams (Medicare Covered) - $30	18B Hearing Aids - NA		13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA												142.0942921	0	30.34463181	0	75	0.2	0.2	48	200	30	46.2	30	0	30	19	30	30	30	46.2	15	0.2	30	0	7.5	10	40	30	0	0	0											NO	134.9895775	0	28.82740022	0	71.25	0.19	0.19	45.6	190	28.5	43.89	28.5	0	28.5	18.05	28.5	28.5	28.5	43.89	14.25	0.1425	28.5	0	7.125	9.5	38	28.5	0	0	0												21.4923	0	4.001767253	0	1.498160657	1.368332248	1.368332248	0.872740883	3.509861995	0.138284927	0.292511064	0	0	1.753413475	22.44646488	47.83120148	0.557068652	0.168355637	2.347423596	2.197398573	2.584912061	0	0	0.024366854	1.169735015	0.067440411	0.500071477	0	0	0	0	0	0	0	0	0	0	0	0	0	116.1901		7.022257482	21.4923	0	4.001767253	0	1.498160657	1.368332248	1.368332248	0.872740883	3.509861995	0.138284927	0.292511064	0	0	1.753413475	22.44646488	47.83120148	0.557068652	0.168355637	2.347423596	2.197398573	2.584912061	0	0	0.024366854	1.169735015	0.067440411	0.500071477	0	0	0	0	0	0	0	0	0	0	0	0	0	116.1901	NO																																																																																		0			21.4923	0	4.001767253	0	1.498160657	1.368332248	1.368332248	0.872740883	3.509861995	0.138284927	0.292511064	0	0	1.753413475	22.44646488	47.83120148	0.557068652	0.168355637	2.347423596	2.197398573	2.584912061	0	0	0.024366854	1.169735015	0.067440411	0.500071477	0	0	0	0	0	0	0	0	0	0	0	0	0	116.1901
H3330_021_3	2011	5																															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	YES	2156.629834	132.1433951	1573.310257	310.8098808	201.8100172	6.345838989	6.345838989	258.4402408	285.719917	83.6692025	114.9244311	0	11.25876284	1060.901652	15596.29777	21048.30855	245.1402537	74.08556091	670.7746731	1933.947789	10.57839315	0	0	41.83818204	1264.309405	14.83408361	146.6598827	2.957574202	0	0											6700	1A IP Acute: $225 days 1-7	1B IP Psych: $0	"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 - $30	9B ASC Services - $200; 9A Outpatient Hospital - $200	8A Outpatient C/D/T - $30	8B Outpatient X-Rays - $30; Outpatient Radiology Therapy - $55; High-tech Radiology - $75	5 Partial Hosp - $30	12 Renal Dialysis - $0	3 CORF - $30; 9D Cardiac Rehab Svcs - $30; 9C Outpatient Sub Abuse - $30	7A Primary Care - $20; 14B Immunizations - $0; 14C Routine Physical Exams - $0	7D Physician Specialist - $30; 7B Chiropractic - $30; 7F Podiatry - $30	7E Mental Health - $30; 7H Psychiatric Services - $30	7C Occupational Therapy - $30; 7I PT and ST Services - $30	7D Specialist Copays; X-Rays - $30; High-tech Radiology - $75	7G Other Health Care - $30; 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 Nutritional Training - $0; 14A Health Education/Wellness Programs - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"	13A Blood - $0	10B Transportation - NA	16A Preventative Dental; Exam - $5; Cleaning - $10; Fluoride - $19 - $23; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - $30; 18A Hearing Exams (Medicare Covered) - $30	18B Hearing Aids - NA		13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA												142.0942921	0	30.34463181	0	75	0.2	0.2	48	200	30	46.2	30	0	30	19	30	30	30	46.2	15	0.2	30		7.5	10	40	30		0												NO	134.9895775	0	28.82740022	0	71.25	0.19	0.19	45.6	190	28.5	43.89	28.5	0	28.5	18.05	28.5	28.5	28.5	43.89	14.25	0.1425	28.5	0	7.125	9.5	38	28.5	0	0	0												24.2602	0	3.779537038	0	1.198246977	1.205709408	1.205709408	0.982072915	4.523898686	0.198714356	0.420336107	0	0	2.519641423	23.45943123	49.9897328	0.582208102	0.175953207	2.453358367	2.296562999	1.507421024	0	0	0.024841421	1.000911612	0.046974598	0.348317221	0	0	0	0	0	0	0	0	0	0	0	0	0	122.1798		6.959434995	24.2602	0	3.779537038	0	1.198246977	1.205709408	1.205709408	0.982072915	4.523898686	0.198714356	0.420336107	0	0	2.519641423	23.45943123	49.9897328	0.582208102	0.175953207	2.453358367	2.296562999	1.507421024	0	0	0.024841421	1.000911612	0.046974598	0.348317221	0	0	0	0	0	0	0	0	0	0	0	0	0	122.1798	NO																																																																																		0			24.2602	0	3.779537038	0	1.198246977	1.205709408	1.205709408	0.982072915	4.523898686	0.198714356	0.420336107	0	0	2.519641423	23.45943123	49.9897328	0.582208102	0.175953207	2.453358367	2.296562999	1.507421024	0	0	0.024841421	1.000911612	0.046974598	0.348317221	0	0	0	0	0	0	0	0	0	0	0	0	0	122.1798
H3330_029_0	2011	4																															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	YES	2485.181331	138.2721071	1163.208491	282.8896722	808.7836996	10.14099985	10.14099985	357.9009363	230.4930196	104.4884	153.4813927	0	0	1822.617376	15663.50973	21139.01585	246.1966811	74.40483129	673.6653644	1942.282102	7.399334861	0	0	41.24425424	1443.690755	17.62554227	174.2581496	3.514126688	0	993.6074876											6700	1A IP Acute: $0 days 1-7	1B IP Psych: $0	2 SNF: $0 days 1-100	6 Home Health - $0	10A Ambulance - $0 per trip one way	11A DME - 0% coinsurance	11B Pros./Med Supp. - 0%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $0; 4B Urgent Care - $20	9B ASC Services - $0; 9A Outpatient Hospital - $0	8A Outpatient C/D/T - $0	8B Outpatient X-Rays - $0; Outpatient Radiology Therapy - $0; High-tech Radiology - $0	5 Partial Hosp - $0	12 Renal Dialysis - $0	3 CORF - $0; 9D Cardiac Rehab Svcs - $0; 9C Outpatient Sub Abuse - $0	7A Primary Care - $0; 14B Immunizations - $0; 14C Routine Physical Exams - $0	7D Physician Specialist - $0; 7B Chiropractic - $0; 7F Podiatry - $0	7E Mental Health - $0; 7H Psychiatric Services - $0	7C Occupational Therapy - $0; 7I PT and ST Services - $0	7D Specialist Copays; X-Rays - $0; High-tech Radiology - $0	7G Other Health Care - $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 Nutritional Training - $0	15 Medicare Part B Rx Drugs - 0%	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - $5 exam $10 cleaning $19-$23 fluoride - 2/year; 16B Comp Dental - NA	17A Eye Exams (Routine) - NA; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - NA; 18A Hearing Exams (Medicare Covered) - $0	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	"13B Acupunture - NA; 13C OTC - $125 per Quarter, $0 Cost Sharing; 13D Meal Benefit - NA; 13E Other - NA"												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	7.125	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.024488776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0245		7.139900974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.024488776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0245	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.024488776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0245
H3330_032_1	2011	5																															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	YES	2215.402669	131.1677698	1766.031784	270.5532814	609.0488192	7.676569995	7.676569995	198.8027204	149.1936884	83.119957	109.6113271	0	13.14462926	1036.164337	15484.85928	20897.91441	243.3886803	73.55620561	665.9818616	1920.129367	7.688114633	0	0	40.93787546	1357.605895	15.52246491	153.4656904	3.094821558	0	0											6700	1A IP Acute: $125 days 1-7	1B IP Psych: $0	"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 - $30	9B ASC Services - $75; 9A Outpatient Hospital - $75	8A Outpatient C/D/T - $10	8B Outpatient X-Rays - $10; Outpatient Radiology Therapy - $55; High-tech Radiology - $150	5 Partial Hosp - $30	12 Renal Dialysis - $0	3 CORF - $20; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $30	7A Primary Care - $5; 14B Immunizations - $0; 14C Routine Physical Exams - $0	7D Physician Specialist - $20; 7B Chiropractic - $30; 7F Podiatry - $30	7E Mental Health - $30; 7H Psychiatric Services - $30	7C Occupational Therapy - $30; 7I PT and ST Services - $30	7D Specialist Copays; X-Rays - $20; High-tech Radiology - $150	7G Other Health Care - $30; 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 Nutritional Training - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"	13A Blood - $0	10B Transportation - NA	16A Preventative Dental; Exam - $5; Cleaning - $10; Fluoride - $19 - $23; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - $30; 18A Hearing Exams (Medicare Covered) - $30	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA												78.94127341	0	30.34463181	0	75	0.2	0.2	48	75	10	60.4	30	0	30	4.75	20.5	30	20	66.8	10	0.2	10	0	7.5	10	40	30	0	0	0											NO	74.99420974	0	28.82740022	0	71.25	0.19	0.19	45.6	71.25	9.5	57.38	28.5	0	28.5	4.5125	19.475	28.5	19	63.46	9.5	0.1425	9.5	0	7.125	9.5	38	28.5	0	0	0												13.8452	0	4.242508752	0	3.616227364	1.458548299	1.458548299	0.755450337	0.885837525	0.065803299	0.524124829	0	0	2.4608903	5.822952293	33.9155736	0.578048116	0.116463992	3.521934078	1.520102416	1.095556335	0	0	0.024306864	1.074771334	0.049154472	0.364481015	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3965		4.457904743	13.8452	0	4.242508752	0	3.616227364	1.458548299	1.458548299	0.755450337	0.885837525	0.065803299	0.524124829	0	0	2.4608903	5.822952293	33.9155736	0.578048116	0.116463992	3.521934078	1.520102416	1.095556335	0	0	0.024306864	1.074771334	0.049154472	0.364481015	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3965	NO																																																																																		0			13.8452	0	4.242508752	0	3.616227364	1.458548299	1.458548299	0.755450337	0.885837525	0.065803299	0.524124829	0	0	2.4608903	5.822952293	33.9155736	0.578048116	0.116463992	3.521934078	1.520102416	1.095556335	0	0	0.024306864	1.074771334	0.049154472	0.364481015	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3965
H3330_032_2	2011	5																															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	YES	2502.390022	148.1594849	1810.516427	266.3713986	265.8366963	7.341841723	7.341841723	226.037549	210.7528056	49.74928318	65.60500207	0	7.867375142	620.1691492	14677.58527	19808.44096	230.7000693	69.72149119	631.26215	1820.027035	18.22794692	0	0	40.44763286	1445.136396	21.05253865	208.1397765	4.19739074	0	0											6700	1A IP Acute: $100 days 1-7	1B IP Psych: $0	"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 - $35	9B ASC Services - $75; 9A Outpatient Hospital - $75	8A Outpatient C/D/T - $10	8B Outpatient X-Rays - $10; Outpatient Radiology Therapy - $55; High-tech Radiology - $150	5 Partial Hosp - $35	12 Renal Dialysis - $0	3 CORF - $20; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $35	7A Primary Care - $5; 14B Immunizations - $0; 14C Routine Physical Exams - $0	7D Physician Specialist - $20; 7B Chiropractic - $35; 7F Podiatry - $35	7E Mental Health - $35; 7H Psychiatric Services - $35	7C Occupational Therapy - $35; 7I PT and ST Services - $35	7D Specialist Copays; X-Rays - $20; High-tech Radiology - $150	7G Other Health Care - $35; 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 Nutritional Training - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"	13A Blood - $0	10B Transportation - NA	16A Preventative Dental; Exam - $5; Cleaning - $10; Fluoride - $19 - $23; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - $30; 18A Hearing Exams (Medicare Covered) - $35	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA												63.15301873	0	30.34463181	0	75	0.2	0.2	48.5	75	10	60.4	35	0	35	4.75	20.75	35	20	66.8	10	0.2	10	0	7.5	10	40	32.5	0	0	0											NO	59.99536779	0	28.82740022	0	71.25	0.19	0.19	46.075	71.25	9.5	57.38	33.25	0	33.25	4.5125	19.7125	33.25	19	63.46	9.5	0.1425	9.5	0	7.125	9.5	38	30.875	0	0	0												12.511	0	4.349373469	0	1.578405384	1.394949927	1.394949927	0.867890006	1.251344783	0.039384849	0.313701252	0	0	1.718385351	5.519383629	32.53949103	0.639231442	0.110392361	3.33832467	1.440854736	2.597482436	0	0	0.024015782	1.144066313	0.066666372	0.5355263	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3748		4.773229144	12.511	0	4.349373469	0	1.578405384	1.394949927	1.394949927	0.867890006	1.251344783	0.039384849	0.313701252	0	0	1.718385351	5.519383629	32.53949103	0.639231442	0.110392361	3.33832467	1.440854736	2.597482436	0	0	0.024015782	1.144066313	0.066666372	0.5355263	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3748	NO																																																																																		0			12.511	0	4.349373469	0	1.578405384	1.394949927	1.394949927	0.867890006	1.251344783	0.039384849	0.313701252	0	0	1.718385351	5.519383629	32.53949103	0.639231442	0.110392361	3.33832467	1.440854736	2.597482436	0	0	0.024015782	1.144066313	0.066666372	0.5355263	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3748
H3330_032_3	2011	6																															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	YES	2533.264351	149.9874672	1685.407954	329.1756595	203.7012983	6.484156226	6.484156226	252.2174624	263.4338807	84.37553946	111.2670794	0	13.34318767	1051.816291	15451.57793	20852.99888	242.8655691	73.39811248	664.5504779	1916.002465	10.9675607	0	0	41.56404162	1297.966576	14.73767262	145.7066977	2.938352073	0	0											6700	1A IP Acute: $100 days 1-7	1B IP Psych: $0	"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 - $35	9B ASC Services - $75; 9A Outpatient Hospital - $75	8A Outpatient C/D/T - $10	8B Outpatient X-Rays - $10; Outpatient Radiology Therapy - $55; High-tech Radiology - $150	5 Partial Hosp - $35	12 Renal Dialysis - $0	3 CORF - $20; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $35	7A Primary Care - $5; 14B Immunizations - $0; 14C Routine Physical Exams - $0	7D Physician Specialist - $20; 7B Chiropractic - $35; 7F Podiatry - $35	7E Mental Health - $35; 7H Psychiatric Services - $35	7C Occupational Therapy - $35; 7I PT and ST Services - $35	7D Specialist Copays; X-Rays - $20; High-tech Radiology - $150	7G Other Health Care - $35; 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 Nutritional Training - $0; 14A Health Education/Wellness Programs - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"	13A Blood - $0	10B Transportation - NA	16A Preventative Dental; Exam - $5; Cleaning - $10; Fluoride - $19 - $23; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - $30; 18A Hearing Exams (Medicare Covered) - $35	18B Hearing Aids - NA		13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA												63.15301873	0	30.34463181	0	75	0.2	0.2	48.5	75	10	60.4	35	0	35	4.75	20.75	35	20	66.8	10	0.2	10	0	7.5	10	40	32.5	0	0	0											NO	59.99536779	0	28.82740022	0	71.25	0.19	0.19	46.075	71.25	9.5	57.38	33.25	0	33.25	4.5125	19.7125	33.25	19	63.46	9.5	0.1425	9.5	0	7.125	9.5	38	30.875	0	0	0												12.6653	0	4.048827468	0	1.209476459	1.231989683	1.231989683	0.968409965	1.564138667	0.066797302	0.532042085	0	0	2.91440764	5.810437119	34.25539503	0.672940014	0.116213678	3.514364444	1.516835285	1.5628774	0	0	0.02467865	1.027556873	0.046669297	0.374891191	0	0	0	0	0	0	0	0	0	0	0	0	0	75.3563		4.51449813	12.6653	0	4.048827468	0	1.209476459	1.231989683	1.231989683	0.968409965	1.564138667	0.066797302	0.532042085	0	0	2.91440764	5.810437119	34.25539503	0.672940014	0.116213678	3.514364444	1.516835285	1.5628774	0	0	0.02467865	1.027556873	0.046669297	0.374891191	0	0	0	0	0	0	0	0	0	0	0	0	0	75.3563	NO																																																																																		0			12.6653	0	4.048827468	0	1.209476459	1.231989683	1.231989683	0.968409965	1.564138667	0.066797302	0.532042085	0	0	2.91440764	5.810437119	34.25539503	0.672940014	0.116213678	3.514364444	1.516835285	1.5628774	0	0	0.02467865	1.027556873	0.046669297	0.374891191	0	0	0	0	0	0	0	0	0	0	0	0	0	75.3563
H3330_033_1	2011	7																															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	YES	2291.387505	135.6666185	1828.979403	280.3091057	630.533182	8.235830314	8.235830314	205.8155404	154.4565363	86.05203609	113.4778965	0	13.60830964	1072.715316	16015.96566	21614.68009	251.7365302	76.07906806	688.8239946	1985.986792	8.251150045	0	0	42.34198037	1404.169647	16.0548611	158.7293228	3.200969083	0	0											6700	1A IP Acute: $0 days 1-7	1B IP Psych: $0	2 SNF: $0 days 1-100	6 Home Health - $0	10A Ambulance - $0 per trip one way	11A DME - 0% coinsurance	11B Pros./Med Supp. - 0%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $0; 4B Urgent Care - $20	9B ASC Services - $0; 9A Outpatient Hospital - $0	8A Outpatient C/D/T - $0	8B Outpatient X-Rays - $0; Outpatient Radiology Therapy - $0; High-tech Radiology - $0	5 Partial Hosp - $0	12 Renal Dialysis - $0	3 CORF - $0; 9D Cardiac Rehab Svcs - $0; 9C Outpatient Sub Abuse - $0	7A Primary Care - $0; 14B Immunizations - $0; 14C Routine Physical Exams - $0	7D Physician Specialist - $0; 7B Chiropractic - $0; 7F Podiatry - $0	7E Mental Health - $0; 7H Psychiatric Services - $0	7C Occupational Therapy - $0; 7I PT and ST Services - $0	7D Specialist Copays; X-Rays - $0; High-tech Radiology - $0	7G Other Health Care - $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 Nutritional Training - $0; 14A Health Education/Wellness Programs - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"	13A Blood - $0	10B Transportation - NA	16A Preventative Dental; Exam - $5; Cleaning - $10; Fluoride - $19 - $23; 16B Comp Dental - NA	17A Eye Exams (Routine) - $0; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $0; 18A Hearing Exams (Medicare Covered) - $0	18B Hearing Aids - NA		13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.2	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	0.15	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	1.237672507	0	0	0.026463738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.2641		0.412557502	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.237672507	0	0	0.026463738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.2641	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.237672507	0	0	0.026463738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.2641
H3330_033_2	2011	7																															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	YES	2629.773102	155.7014793	1902.679981	279.9309192	279.3689981	8.128586736	8.128586736	237.5438925	221.4810859	52.28174888	68.94459627	0	8.267860464	651.7385909	15424.74139	20816.78106	242.4437564	73.27063349	663.3962762	1912.674722	20.08800759	0	0	42.50660209	1518.700438	22.124209	218.7350417	4.411057097	0	0											6700	1A IP Acute: $0 days 1-7	1B IP Psych: $0	2 SNF: $0 days 1-100	6 Home Health - $0	10A Ambulance - $0 per trip one way	11A DME - 0% coinsurance	11B Pros./Med Supp. - 0%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $0; 4B Urgent Care - $20	9B ASC Services - $0; 9A Outpatient Hospital - $0	8A Outpatient C/D/T - $0	8B Outpatient X-Rays - $0; Outpatient Radiology Therapy - $0; High-tech Radiology - $0	5 Partial Hosp - $0	12 Renal Dialysis - $0	3 CORF - $0; 9D Cardiac Rehab Svcs - $0; 9C Outpatient Sub Abuse - $0	7A Primary Care - $0; 14B Immunizations - $0; 14C Routine Physical Exams - $0	7D Physician Specialist - $0; 7B Chiropractic - $0; 7F Podiatry - $0	7E Mental Health - $0; 7H Psychiatric Services - $0	7C Occupational Therapy - $0; 7I PT and ST Services - $0	7D Specialist Copays; X-Rays - $0; High-tech Radiology - $0	7G Other Health Care - $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 Nutritional Training - $0; 14A Health Education/Wellness Programs - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"	13A Blood - $0	10B Transportation - NA	16A Preventative Dental; Exam - $5; Cleaning - $10; Fluoride - $19 - $23; 16B Comp Dental - NA	17A Eye Exams (Routine) - $0; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $0; 18A Hearing Exams (Medicare Covered) - $0	18B Hearing Aids - NA		13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.2	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	0.15	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	3.013201138	0	0	0.026566626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0398		1.004400379	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.013201138	0	0	0.026566626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0398	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.013201138	0	0	0.026566626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0398
H3330_033_3	2011	8																															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	YES	2626.913305	155.5321587	1747.542297	341.413053	211.2109617	6.96967144	6.96967144	261.5157253	273.1456488	87.48613277	115.3690577	0	13.83509836	1090.592609	16022.78722	21623.88626	251.8437503	76.11147181	689.1173799	1986.832668	11.79230306	0	0	43.1005686	1345.949414	15.28249046	151.0931391	3.046976187	0	0											6700	1A IP Acute: $0 days 1-7	1B IP Psych: $0	2 SNF: $0 days 1-100	6 Home Health - $0	10A Ambulance - $0 per trip one way	11A DME - 0% coinsurance	11B Pros./Med Supp. - 0%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $0; 4B Urgent Care - $20	9B ASC Services - $0; 9A Outpatient Hospital - $0	8A Outpatient C/D/T - $0	8B Outpatient X-Rays - $0; Outpatient Radiology Therapy - $0; High-tech Radiology - $0	5 Partial Hosp - $0	12 Renal Dialysis - $0	3 CORF - $0; 9D Cardiac Rehab Svcs - $0; 9C Outpatient Sub Abuse - $0	7A Primary Care - $0; 14B Immunizations - $0; 14C Routine Physical Exams - $0	7D Physician Specialist - $0; 7B Chiropractic - $0; 7F Podiatry - $0	7E Mental Health - $0; 7H Psychiatric Services - $0	7C Occupational Therapy - $0; 7I PT and ST Services - $0	7D Specialist Copays; X-Rays - $0; High-tech Radiology - $0	7G Other Health Care - $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 Nutritional Training - $0; 14A Health Education/Wellness Programs - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP Max"	13A Blood - $0	10B Transportation - NA	16A Preventative Dental; Exam - $5; Cleaning - $10; Fluoride - $19 - $23; 16B Comp Dental - NA	17A Eye Exams (Routine) - $0; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $0; 18A Hearing Exams (Medicare Covered) - $0	18B Hearing Aids - NA		13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.2	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	0.15	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	1.768845459	0	0	0.026937855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.7958		0.589615153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.768845459	0	0	0.026937855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.7958	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.768845459	0	0	0.026937855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.7958
H3330_808_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	376.6529008	17.55856061	43.16386366	10.85818414	19.23221669	9.657332635	9.657332635	5.886770449	4.924151495	3.712961886	6.607770122	0	0	48.85070548	189.7095253	256.0264418	2.981825677	0.901158518	8.159137937	23.52406464	0.198181203	0	0	0.197085641	12.01599006	0.147401972	1.457316573	0.029388554	0	0											6700	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.5	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	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0	0	0	0	0	0	0	0												0	0	0	0	4.257051163	2.137650579	2.137650579	1.303036639	1.089960933	0.821864113	1.462629916	0	0	10.81310366	41.99220343	56.67145288	0.660027114	0.199471438	1.806025182	5.207051709	0.043867409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.603		6.873844565	0	0	0	0	4.257051163	2.137650579	2.137650579	1.303036639	1.089960933	0.821864113	1.462629916	0	0	10.81310366	41.99220343	56.67145288	0.660027114	0.199471438	1.806025182	5.207051709	0.043867409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.603	NO																																																																																		0			0	0	0	0	4.257051163	2.137650579	2.137650579	1.303036639	1.089960933	0.821864113	1.462629916	0	0	10.81310366	41.99220343	56.67145288	0.660027114	0.199471438	1.806025182	5.207051709	0.043867409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.603
H3330_810_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	466.8389258	21.76279422	56.32447958	9.995413063	24.0267755	11.21922203	11.21922203	10.41957256	22.46026136	4.789443859	8.52353054	0	0	63.01376597	200.3371569	270.3691833	3.148869185	0.951641912	8.616217314	24.84189563	2.943692349	0	0	0.202284414	14.36864475	0.136077489	1.345355001	0.027130713	0	0											6700	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.5	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	0.058488758	0.058488758	0.137406773	0	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0	0	0	0	0	0	0	0												27.3048	1.272878807	7.739365005	0	5.318326757	2.483374795	2.483374795	2.306372385	4.971578853	1.060143398	1.886683485	0	0	13.9480971	44.34462967	59.84621872	0.697002194	0.210645937	1.907199702	5.498753598	0.651586301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	183.9311		9.680582133	27.3048	1.272878807	7.739365005	0	5.318326757	2.483374795	2.483374795	2.306372385	4.971578853	1.060143398	1.886683485	0	0	13.9480971	44.34462967	59.84621872	0.697002194	0.210645937	1.907199702	5.498753598	0.651586301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	183.9311	NO																																																																																		0			27.3048	1.272878807	7.739365005	0	5.318326757	2.483374795	2.483374795	2.306372385	4.971578853	1.060143398	1.886683485	0	0	13.9480971	44.34462967	59.84621872	0.697002194	0.210645937	1.907199702	5.498753598	0.651586301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	183.9311
H3330_814_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	317.0061349	21.78628577	37.13243882	9.882640289	15.04408679	8.47731288	8.47731288	7.38399808	26.89377721	2.972299954	4.766013242	0	0.007808054	48.29912427	161.0420312	217.3376279	2.531234332	0.764982138	6.926189625	19.96928275	18.05048457	0	0	0.170241435	9.955536995	0.134467658	1.329439113	0.02680975	0	0											6700	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.5	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	0.058488758	0.058488758	0.137406773	0	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0	0	0	0	0	0	0	0												18.5413	1.274252799	5.102248608	0	3.330008611	1.876453206	1.876453206	1.634447975	5.952937585	0.657918595	1.054957031	0	0.001728313	10.69101116	35.6466536	48.10768393	0.560288719	0.169328796	1.533112074	4.420200737	3.99547476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.4265		7.706655519	18.5413	1.274252799	5.102248608	0	3.330008611	1.876453206	1.876453206	1.634447975	5.952937585	0.657918595	1.054957031	0	0.001728313	10.69101116	35.6466536	48.10768393	0.560288719	0.169328796	1.533112074	4.420200737	3.99547476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.4265	NO																																																																																		0			18.5413	1.274252799	5.102248608	0	3.330008611	1.876453206	1.876453206	1.634447975	5.952937585	0.657918595	1.054957031	0	0.001728313	10.69101116	35.6466536	48.10768393	0.560288719	0.169328796	1.533112074	4.420200737	3.99547476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.4265
H3330_815_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	267.2040091	28.04519536	27.73326468	6.932497353	13.62608453	7.987046885	7.987046885	4.472840077	9.133768852	2.239088855	4.272134835	0	0	35.7057227	158.0286695	213.2708829	2.483870768	0.750668062	6.796589209	19.59562458	1.02261365	0	0	0.117332442	9.725580105	0.103312187	1.021414844	0.020598068	0	0											6700	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.5	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	0.058488758	0.058488758	0.137406773	0	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0	0	0	0	0	0	0	0												15.6284	1.640328648	3.810738417	0	3.01613381	1.767932828	1.767932828	0.990063151	2.021759735	0.495622318	0.945637046	0	0	7.903461719	34.979646	47.20750992	0.549804795	0.166160375	1.504425021	4.337491501	0.226355531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.9594		6.787338648	15.6284	1.640328648	3.810738417	0	3.01613381	1.767932828	1.767932828	0.990063151	2.021759735	0.495622318	0.945637046	0	0	7.903461719	34.979646	47.20750992	0.549804795	0.166160375	1.504425021	4.337491501	0.226355531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.9594	NO																																																																																		0			15.6284	1.640328648	3.810738417	0	3.01613381	1.767932828	1.767932828	0.990063151	2.021759735	0.495622318	0.945637046	0	0	7.903461719	34.979646	47.20750992	0.549804795	0.166160375	1.504425021	4.337491501	0.226355531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.9594
H3333_037_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1646.848767	90.11763059	2432.612005	16.24019544	240.1520048	20.73457447	2.047454752	292.9697388	357.0574044	7.912300406	23.52585439	0	8.480288981	13.66611212	4701.94652	93.13234573	1.152932482	470.0456051	28.10472129	35.72423061	17.91733326	35.73910806	0	0	0	0	0.142080239	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.52687422	278.1673196	0.2	0.2	0	25	0.138259222	20.55457458	0.108475294	0.45	0.023576986	0.110175296	0.104710787	0.2	0	0	0	0	0	20	0	0	0											NO	154.8013601	117.3455636	39.40643044	0	125.044064	0.166725419	0.166725419	41.28694418	231.887814	0.166725419	0.166725419	0	20.84067733	0.115256633	17.13485026	0.090427944	0.375132192	0.019654414	0.091845112	0.087289749	0.166725419	0	0	0	0	0	20	0	0	0												21.2445	0.881242012	7.988379646	0	2.502465221	3.456980608	0.341362751	1.007985438	6.899771749	1.319181597	3.922357922	0	0.014727914	1.575110071	6.713929128	8.421766543	0.432502089	0.000769873	2.581281272	3.118359119	2.987274888	0	0	0	0	0	0.0002368	0	0	0	0	0	0	0	0	0	0	0	0	0	75.4102	0	15.05010849	21.2445	0.881242012	7.988379646	0	2.502465221	3.456980608	0.341362751	1.007985438	6.899771749	1.319181597	3.922357922	0	0.014727914	1.575110071	6.713929128	8.421766543	0.432502089	0.000769873	2.581281272	3.118359119	2.987274888	0	0	0	0	0	0.0002368	0	0	0	0	0	0	0	0	0	0	0	0	0	75.4102	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		21.2445	0.881242012	7.988379646	0	2.502465221	3.456980608	0.341362751	1.007985438	6.899771749	1.319181597	3.922357922	0	0.014727914	1.575110071	6.713929128	8.421766543	0.432502089	0.000769873	2.581281272	3.118359119	2.987274888	0	0	0	0	0	0.0002368	0	0	0	0	0	0	0	0	0	0	0	0	0	75.4102
H3333_039_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1650.401799	36.70192635	3445.496324	16.25129728	239.2581941	21.46070567	1.32236719	339.2480018	364.0116091	14.27970269	21.11591865	0	8.098713655	13.2374831	5235.985127	88.24236572	0.962196909	530.4567016	24.02516531	32.55516304	17.76874529	26.59974812	0	0	0	0	0.84100745	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	33.75	0	150	0.2	0.2	49.84153391	294.1379513	0.2	0.2	0	25	0.133184234	20.70694324	0.108517846	0.45	0.012232302	0.095959082	0.099413362	0.2	0	0	0	0	0	20	0	0	0											NO	154.3532503	117.0058786	28.05347111	0	124.6820938	0.166242792	0.166242792	41.42897871	244.4915709	0.166242792	0.166242792	0	20.78034897	0.110704595	17.21190026	0.090201549	0.374046281	0.01016766	0.079762528	0.082633775	0.166242792	0	0	0	0	0	20	0	0	0												21.2287	0.357861762	8.054844299	0	2.485934384	3.567687624	0.219834013	1.171224854	7.416480846	2.373897641	3.510369266	0	0.014024508	1.465450201	7.510104482	7.959598038	0.359906176	0.000449459	1.916307924	2.690156005	2.953925823	0	0	0	0	0	0.001401679	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2582	0	15.28162128	21.2287	0.357861762	8.054844299	0	2.485934384	3.567687624	0.219834013	1.171224854	7.416480846	2.373897641	3.510369266	0	0.014024508	1.465450201	7.510104482	7.959598038	0.359906176	0.000449459	1.916307924	2.690156005	2.953925823	0	0	0	0	0	0.001401679	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2582	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		21.2287	0.357861762	8.054844299	0	2.485934384	3.567687624	0.219834013	1.171224854	7.416480846	2.373897641	3.510369266	0	0.014024508	1.465450201	7.510104482	7.959598038	0.359906176	0.000449459	1.916307924	2.690156005	2.953925823	0	0	0	0	0	0.001401679	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2582
H3333_055_0	2011	11																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1562.407101	57.11343918	2511.674094	22.31370237	206.7041712	20.43662688	1.255305185	287.5080096	322.204282	8.914902337	16.46175526	0	10.21363735	10.9868924	4471.897622	83.60022802	0.871046969	397.6538838	24.55332245	31.21494204	14.35531586	58.40690483	0	0	0	0	0.171121059	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.64610745	285.1357919	0.2	0.2	0	25	0.231151932	20.55477395	0.112621311	0.45	0.033565478	0.109942097	0.103618376	0.2	0	0	0	0	0	20	0	0	0											NO	154.1849746	116.878319	39.24952257	0	124.5461656	0.166061554	0.166061554	41.2215488	236.7504637	0.166061554	0.166061554	0	20.75769427	0.191927245	17.06678853	0.09351035	0.373638497	0.027869677	0.091285778	0.086035143	0.166061554	0	0	0	0	0	20	0	0	0												20.075	0.556276897	8.215167422	0	2.145350995	3.393738021	0.20845793	0.987627121	6.35683443	1.480422537	2.733664662	0	0.01766763	2.108683994	6.360077588	7.817486572	0.32545668	0.00092354	2.241369139	2.685581996	2.383866061	0	0	0	0	0	0.000285202	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0939	0	14.32522306	20.075	0.556276897	8.215167422	0	2.145350995	3.393738021	0.20845793	0.987627121	6.35683443	1.480422537	2.733664662	0	0.01766763	2.108683994	6.360077588	7.817486572	0.32545668	0.00092354	2.241369139	2.685581996	2.383866061	0	0	0	0	0	0.000285202	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0939	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		20.075	0.556276897	8.215167422	0	2.145350995	3.393738021	0.20845793	0.987627121	6.35683443	1.480422537	2.733664662	0	0.01766763	2.108683994	6.360077588	7.817486572	0.32545668	0.00092354	2.241369139	2.685581996	2.383866061	0	0	0	0	0	0.000285202	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0939
H3333_057_0	2011	11																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1645.750391	72.64378001	1959.956145	21.67262596	236.8040691	21.43739146	2.070182312	280.9271605	328.5221595	12.88933319	21.28356883	0	15.82597638	15.29497656	5333.674314	92.20570573	1.429662413	468.6434255	26.52162538	34.15989615	15.81909484	18.63226919	0	0	0	0	0.116694268	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.79190671	292.0395033	0.2	0.2	0	25	0.158530162	20.41729575	0.10447689	0.45	0.060068745	0.101281837	0.096704222	0.2	0	0	0	0	0	20	0	0	0											NO	156.8318283	118.8847389	39.92330899	0	126.6842174	0.16891229	0.16891229	42.05232491	246.6453063	0.16891229	0.16891229	0	21.11403624	0.133888464	17.2436609	0.088237153	0.380052652	0.050731746	0.085538735	0.081672658	0.16891229	0	0	0	0	0	20	0	0	0												21.5088	0.719686401	6.52066123	0	2.499944848	3.621038882	0.349679235	0.984470019	6.752370719	2.177166784	3.595056349	0	0.027845853	2.047820915	7.664339268	8.135969	0.543346992	0.001981258	2.268626297	2.789929505	2.672039535	0	0	0	0	0	0.00019449	0	0	0	0	0	0	0	0	0	0	0	0	0	74.881	0	13.78154847	21.5088	0.719686401	6.52066123	0	2.499944848	3.621038882	0.349679235	0.984470019	6.752370719	2.177166784	3.595056349	0	0.027845853	2.047820915	7.664339268	8.135969	0.543346992	0.001981258	2.268626297	2.789929505	2.672039535	0	0	0	0	0	0.00019449	0	0	0	0	0	0	0	0	0	0	0	0	0	74.881	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		21.5088	0.719686401	6.52066123	0	2.499944848	3.621038882	0.349679235	0.984470019	6.752370719	2.177166784	3.595056349	0	0.027845853	2.047820915	7.664339268	8.135969	0.543346992	0.001981258	2.268626297	2.789929505	2.672039535	0	0	0	0	0	0.00019449	0	0	0	0	0	0	0	0	0	0	0	0	0	74.881
H3335_002_0	2011	7																															A	A	D		T	Coin	Coin	V	V		Coin			O	V	V	Coin	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	225.303999	12.43093621	1507.057189	0	150.3712105	6.097730015	2.496716599	229.7347957	318.7540028	0	10.76163211	0	0	349.94333	3325.500722	3232.361139	2.961242364	651.9384909	7.196227537	1106.570952	57.84211549	0	0	0	82.43834502	0	50.01734585	0	0	0											4000	$500/Admit for IP Medical; PBP 1a	$500/Admit for IP Medical; PBP 1b	$50/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"$125/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	20% Coinsurance for OP Radiology; PBP 8b	$0-$125 Copay; PBP 9a	$0 Copay; PBP 12	"50% for Partial Hosp and Subs Abuse, $0-$125 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$20/Visit for PCP; PBP 7a	"$40/Visit for Specialist; PBP 7d, 17a, 18a"	"45% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"$40/Visit for PT/OT/ST; PBP 7c, 7i"	20% Coinsurance for Radiology; PBP 8b	"$20/Visit for Chiro; $40/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $40/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$40 Copay; PBP 7g			$40/Visit for Vision Exams; PBP 17a	$0 Copay;	$40/Visit for Hearing Exams; PBP 18a														0	500	500	50	0	100	0.2	0.2	50	125	0	0.2	0	0	40	20	40	0.453214927	40	0.2	35.56917535	0.2	0	0	0	40	0	40	0	0	0											NO	497.0032146	497.0032146	49.70032146	0	99.40064293	0.198801286	0.198801286	49.70032146	124.2508037	0	0.198801286	0	0	39.76025717	19.88012859	39.76025717	0.450498551	39.76025717	0.198801286	35.35598898	0.198801286	0	0	0	39.76025717	0	39.76025717	0	0	0												9.3314	0.514851271	6.241768898	0	1.245582917	1.212236568	0.49635047	0.9514911	3.300453418	0	2.139426301	0	0	1.1594864	5.50928183	10.70995918	1.334035395	2.160103505	1.430619288	3.260325865	11.49908694	0	0	0	0.273147483	0	0.165725211	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9353	0	0.379481822	9.3314	0.514851271	6.241768898	0	1.245582917	1.212236568	0.49635047	0.9514911	3.300453418	0	2.139426301	0	0	1.1594864	5.50928183	10.70995918	1.334035395	2.160103505	1.430619288	3.260325865	11.49908694	0	0	0	0.273147483	0	0.165725211	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9353	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$175/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; PBP 4a, 4b"	"30% Coinsurance for OP Surgery; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Radiology; PBP 8b	0% - 30% Coinsurance; PBP 9a	0% - 30% Coinsurance; PBP 12	"30% Coinsurance for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$25/Visit for PCP; PBP 7a	"$45/Visit for Specialist; PBP 7d, 17a, 18a"	"50% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); 30% Coinsurance for Path (IP); 30% Coinsurance for Path (OP); 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; $45/Visit for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-j"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance for Other Medicare Part B; PBP 7g			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance for Hearing Exams; PBP 18a														10000	1.6255	0.0288	0.2275	0.1048	0.6805	0.1659	0.1625	0.1077	0.2014	0.1655	0.1145	0	0	0.0761	0.3612	0.8095	0.103	0.0286	0.4674	0.4312	0.2255	0.0037	0	0	0.011	0	0.0053	0	0	0											6.107	0	0.2739263	10.9569	0.543700643	6.469256156	0.104761792	1.926061509	1.378105298	0.658865278	1.059204145	3.50188179	0.165474372	2.253891353	0	0	1.235585013	5.870448495	11.51944079	1.43701827	2.188672682	1.898058499	3.691533539	11.72462048	0.003719618	0	0	0.284166335	0	0.171020076	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0424
H3335_005_0	2011	8																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	V	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	149.762896	4.095351243	837.7299366	0	117.0791063	9.194468373	1.23048993	100.0376613	346.4500442	0	794.6655051	0	0	374.1290533	3951.048776	3659.831726	275.6784693	854.4923143	840.8792779	1598.976086	44.27326494	0	0	0	580.8604303	0	37.9692961	0	0	0											3500	$300/Admit for IP Medical; PBP 1a	$300/Admit for IP Medical; PBP 1b	$25/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$50/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$30/Visit for OP Radiology; PBP 8b	$0-$50 Copay; PBP 9a	$0 Copay; PBP 12	"$0-$50 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$15/Visit for PCP; PBP 7a	"$30/Visit for Specialist; PBP 7d, 17a, 18a"	"$30/Visit for MH; $30/Visit for SA; PBP 7e, 7h, 9c"	"$30/Visit for PT/OT/ST; PBP 7c, 7i"	$30/Visit for Radiology; PBP 8b	"$15/Visit for Chiro; $30/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $30/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$30 Copay; PBP 7g		"$0 Copay; PBP 16a, 16b"	$30/Visit for Vision Exams; PBP 17a		$30/Visit for Hearing Exam; PBP 18a														0	300	300	25	0	100	0.2	0.2	45.73045684	50	0	30	0	0	30	15	30	30	30	30	22.30457395	0.2	0	0	0	30	0	30	0	0	0											NO	298.0782744	298.0782744	24.8398562	0	99.35942481	0.19871885	0.19871885	45.43751888	49.67971241	0	29.80782744	0	0	29.80782744	14.90391372	29.80782744	29.80782744	29.80782744	29.80782744	22.16169638	0.19871885	0	0	0	29.80782744	0	29.80782744	0	0	0												3.7201	0.101727936	1.73409093	0	0.969409388	1.827114178	0.244521543	0.378788594	1.43429488	0	1.973937688	0	0	0.929331189	4.907174172	9.09096938	0.684781354	2.122546621	2.088732035	2.953001878	8.797932278	0	0	0	1.442848956	0	0.094315186	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4956	0	0.293312457	3.7201	0.101727936	1.73409093	0	0.969409388	1.827114178	0.244521543	0.378788594	1.43429488	0	1.973937688	0	0	0.929331189	4.907174172	9.09096938	0.684781354	2.122546621	2.088732035	2.953001878	8.797932278	0	0	0	1.442848956	0	0.094315186	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4956	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$175/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surgery; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Radiology; PBP 8b	0% - 30% Coinsurance; PBP 9a	0% - 30% Coinsurance; PBP 12	"30% Coinsurance for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	30% Coinsurance for PCP; PBP 7a	"30% Coinsurance for Specialist; PBP 7d, 17a, 18a"	"50% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; 30% Coinsurance for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-j"	30% Coinsurance for Part B Rx; PBP 15	0% - 30% Coinsurance; PBP 7g		"$0 Copay; PBP 16a, 16b"	30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance; PBP 18a														10000	3.7309	0.0013	0.4055	0.0159	0.5653	0.4126	0.3593	0.0268	0.1135	0.082	0.0924	0.0013	0	0.0203	0.2913	1.2788	0.1058	0.0827	0.7512	1.642	0.0793	0.0002	0	0	0.0235	0	0.0069	0	0	0											10.0886	0	0.065041824	7.451	0.103058687	2.139583343	0.015850306	1.534666844	2.239699473	0.603844201	0.405611431	1.547817549	0.082004748	2.066366131	0.001268088	0	0.949583415	5.198433432	10.36973459	0.790600798	2.20520664	2.839969925	4.595047845	8.877195251	0.000193348	0	0	1.466301535	0	0.101202637	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5842
H3335_006_0	2011	7																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	V	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	192.6208972	5.300225531	1074.923249	0	171.4403848	7.643197467	0.443272946	101.0053053	356.7997696	0	823.6194813	0	0	282.497811	4307.30062	4237.68163	188.4938046	887.2576663	902.0112121	2184.239198	54.30722159	0	0	0	703.2514385	0	39.26345923	0	0	0											3500	$100/Admit for IP Medical; PBP 1a	$100/Admit for IP Medical; PBP 1b	$25/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"$35/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$25/Visit for OP Radiology; PBP 8b	$0-$35 Copay; PBP 9a	$0 Copay; PBP 12	"$0-$35 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$10/Visit for PCP; PBP 7a	"$25/Visit for Specialist; PBP 7d, 17a, 18a"	"$25/Visit for MH; $25/Visit for SA; PBP 7e, 7h, 9c"	"$25/Visit for PT/OT/ST; PBP 7c, 7i"	$25/Visit for Radiology; PBP 8b	"$10/Visit for Chiro; $25/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $25/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$25 Copay; PBP 7g			$25/Visit for Vision Exams; PBP 17a		$25/Visit for Hearing Exam; PBP 18a														0	100	100	25	0	100	0.2	0.2	43.79508665	35	0	25	0	0	25	10	25	25	25	25	16.47690363	0.2	0	0	0	25	0	25	0	0	0											NO	99.47447399	99.47447399	24.8686185	0	99.47447399	0.198948948	0.198948948	43.56493207	34.8160659	0	24.8686185	0	0	24.8686185	9.947447399	24.8686185	24.8686185	24.8686185	24.8686185	16.39031322	0.198948948	0	0	0	24.8686185	0	24.8686185	0	0	0												1.5967	0.043936429	2.227654682	0	1.421161842	1.520606095	0.088188686	0.366690772	1.035197024	0	1.706856556	0	0	0.585444191	3.570553862	8.782107314	0.39063171	1.838739368	1.869314393	2.983363717	10.8043646	0	0	0	1.457407644	0	0.081368999	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3703	0	0.223843441	1.5967	0.043936429	2.227654682	0	1.421161842	1.520606095	0.088188686	0.366690772	1.035197024	0	1.706856556	0	0	0.585444191	3.570553862	8.782107314	0.39063171	1.838739368	1.869314393	2.983363717	10.8043646	0	0	0	1.457407644	0	0.081368999	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3703	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance; PBP 6	$175/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surgery; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Radiology; PBP 8b	0% - 30% Coinsurance; PBP 9a	0% - 30% Coinsurance; PBP 12	"30% Coinsurance for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	30% Coinsurance for PCP; PBP 7a	"30% Coinsurance for Specialist; PBP 7d, 17a, 18a"	"50% Coinsurance for MH; PBP 7e, 7h, 9c"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; 30% Coinsurance for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-j"	30% Coinsurance for Part B Rx; PBP 15	0% - 30% Coinsurance; PBP 7g			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance; PBP 18a														10000	2.3427	0	0.5055	0.0409	0.54	0.2739	0.372	0.0272	0.4269	0.0887	0.4993	0	0	0.0637	0.233	1.2677	0.1088	0.1203	0.2457	1.3195	0.1022	0.0003	0	0	0.0289	0	0.0058	0	0	0											8.6128	0	0.045501815	3.9394	0.043936429	2.733137471	0.040914886	1.961182349	1.794483086	0.460165615	0.393850719	1.46213091	0.08865071	2.206159372	0	0	0.649118465	3.803562558	10.04977011	0.499463846	1.959049748	2.114970659	4.302839845	10.90654725	0.000291986	0	0	1.48630579	0	0.087205672	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9832
H3335_008_0	2011	8																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	V	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	136.9520953	5.706914933	535.1277701	0	82.22534059	10.08897447	0.947619997	128.6619057	298.5524346	0	1166.22667	0	0	681.5574943	3688.329528	3688.467597	315.3716233	729.8494862	468.0577888	1432.311802	37.48921338	0	0	0	464.5733286	0	36.9865648	0	0	0											3500	$300/Admit for IP Medical; PBP 1a	$300/Admit for IP Medical; PBP 1b	$25/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$50/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$30/Visit for OP Radiology; PBP 8b	$0-$50 Copay; PBP 9a	$0 Copay; PBP 12	"$0-$50 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$15/Visit for PCP; PBP 7a	"$30/Visit for Specialist; PBP 7d, 17a, 18a"	"$30/Visit for MH; $30/Visit for SA; PBP 7e, 7h, 9c"	"$30/Visit for PT/OT/ST; PBP 7c, 7i"	$30/Visit for Radiology; PBP 8b	"$15/Visit for Chiro; $30/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $30/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$30 Copay; PBP 7g		"$0 Copay; PBP 16a, 16b"	$30/Visit for Vision Exams; PBP 17a		$30/Visit for Hearing Exam; PBP 18a														0	300	300	25	0	100	0.2	0.2	49.37435912	50	0	30	0	0	30	15	30	30	30	30	24.29199367	0.2	0	0	0	30	0	30	0	0	0											NO	298.5725431	298.5725431	24.88104526	0	99.52418104	0.199048362	0.199048362	49.13942656	49.76209052	0	29.85725431	0	0	29.85725431	14.92862716	29.85725431	29.85725431	29.85725431	29.85725431	24.17640776	0.199048362	0	0	0	29.85725431	0	29.85725431	0	0	0												3.4075	0.141994009	1.109544855	0	0.681950807	2.008193843	0.188622208	0.526864355	1.238049439	0	2.901693856	0	0	1.695786286	4.588474696	9.177292923	0.784677563	1.81594181	1.164576703	2.885679513	7.462166519	0	0	0	1.155907001	0	0.092026439	0	0	0	0	0	0	0	0	0	0	0	0	0	43.027	0	0.205709211	3.4075	0.141994009	1.109544855	0	0.681950807	2.008193843	0.188622208	0.526864355	1.238049439	0	2.901693856	0	0	1.695786286	4.588474696	9.177292923	0.784677563	1.81594181	1.164576703	2.885679513	7.462166519	0	0	0	1.155907001	0	0.092026439	0	0	0	0	0	0	0	0	0	0	0	0	0	43.027	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$175/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surgery; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Radiology; PBP 8b	0% - 30% Coinsurance; PBP 9a	0% - 30% Coinsurance; PBP 12	"30% Coinsurance for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	30% Coinsurance for PCP; PBP 7a	"30% Coinsurance for Specialist; PBP 7d, 17a, 18a"	"50% Coinsurance for MH; PBP 7e, 7h, 9c"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; 30% Coinsurance for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-j"	30% Coinsurance for Part B Rx; PBP 15	0% - 30% Coinsurance; PBP 7g		"$0 Copay; PBP 16a, 16b"	30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance; PBP 18a														10000	1.2893	0	0.0109	0.0167	0.3374	0.4872	0.2527	0.0199	0.698	0.0505	0.0734	0	0	0.1349	0.1417	0.8687	0.2531	0.0129	0.1858	1.2775	0.0231	0	0	0	0.0608	0	0.0043	0	0	0											6.1986	0	0.029635309	4.6968	0.141994009	1.120459917	0.01665923	1.019329423	2.495366399	0.441274565	0.546808506	1.936052234	0.050470643	2.9751077	0	0	1.830647821	4.730194658	10.04598027	1.037796779	1.828868036	1.35042201	4.163164623	7.485240923	0	0	0	1.216689769	0	0.096285459	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2256
H3335_009_0	2011	7																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	V	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	164.9306993	5.389892135	497.457411	0	122.4822966	8.319465803	0.608521902	135.6542564	297.9988283	0	1154.648043	0	0	803.9991243	4127.91741	4000.942472	291.0915222	802.3229639	479.6926056	1763.655392	48.55888223	0	0	0	505.4004486	0	37.06520424	0	0	0											3500	$100/Admit for IP Medical; PBP 1a	$100/Admit for IP Medical; PBP 1b	$25/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"$35/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$25/Visit for OP Radiology; PBP 8b	$0-$35 Copay; PBP 9a	$0 Copay; PBP 12	"$0-$35 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$10/Visit for PCP; PBP 7a	"$25/Visit for Specialist; PBP 7d, 17a, 18a"	"$25/Visit for MH; $25/Visit for SA; PBP 7e, 7h, 9c"	"$25/Visit for PT/OT/ST; PBP 7c, 7i"	$25/Visit for Radiology; PBP 8b	"$10/Visit for Chiro; $25/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $25/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$25 Copay; PBP 7g			$25/Visit for Vision Exams; PBP 17a		$25/Visit for Hearing Exam; PBP 18a														0	100	100	25	0	100	0.2	0.2	49.79354255	35	0	25	0	0	25	10	25	25	25	25	18.62732177	0.2	0	0	0	25	0	25	0	0	0											NO	99.53305961	99.53305961	24.8832649	0	99.53305961	0.199066119	0.199066119	49.56103639	34.83657086	0	24.8832649	0	0	24.8832649	9.953305961	24.8832649	24.8832649	24.8832649	24.8832649	18.54034329	0.199066119	0	0	0	24.8832649	0	24.8832649	0	0	0												1.368	0.044706038	1.031530378	0	1.015919811	1.656123771	0.121136094	0.560263795	0.865104775	0	2.394284427	0	0	1.667176933	3.423868747	8.296375949	0.603608955	1.663701237	0.994693181	2.724898033	9.666428239	0	0	0	1.048001104	0	0.076858608	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2227	0	0.184005754	1.368	0.044706038	1.031530378	0	1.015919811	1.656123771	0.121136094	0.560263795	0.865104775	0	2.394284427	0	0	1.667176933	3.423868747	8.296375949	0.603608955	1.663701237	0.994693181	2.724898033	9.666428239	0	0	0	1.048001104	0	0.076858608	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2227	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance; PBP 6	$175/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surgery; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Radiology; PBP 8b	0% - 30% Coinsurance; PBP 9a	0% - 30% Coinsurance; PBP 12	"30% Coinsurance for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	30% Coinsurance for PCP; PBP 7a	"30% Coinsurance for Specialist; PBP 7d, 17a, 18a"	"50% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; 30% Coinsurance for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-j"	30% Coinsurance for Part B Rx; PBP 15	0% - 30% Coinsurance; PBP 7g			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance; PBP 18a														10000	2.8153	0.1114	0.3612	0	0.4624	0.493	0.3406	0.022	0.9598	0.0895	0.2202	0.0097	0	0.1128	0.2026	1.1834	0.1001	0.0332	0.2317	1.7184	0.1652	0	0	0	0.0627	0	0.0067	0	0	0											9.7018	0	0.045514278	4.1833	0.15608141	1.39271841	0	1.478368858	2.149092187	0.46170556	0.582230477	1.824908983	0.089534709	2.614486393	0.009715484	0	1.780013293	3.626439749	9.479795329	0.703664144	1.696904575	1.226406439	4.443255212	9.831660874	0	0	0	1.110657998	0	0.083591605	0	0	0	0	0	0	0	0	0	0	0	0	0	48.9245
H3335_014_0	2011	8																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	V	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	145.5519764	4.229935887	633.4007802	0	59.72957065	9.442005024	1.098183229	181.4216755	330.2438254	0	479.0171184	0	0	473.005283	4004.031472	4282.177501	411.0772308	1033.1034	1138.19627	1537.026337	37.3992234	0	0	0	630.1212242	0	39.96855181	0	0	0											3500	$300/Admit for IP Medical; PBP 1a	$300/Admit for IP Medical; PBP 1b	$25/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$50/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$30/Visit for OP Radiology; PBP 8b	$0-$50 Copay; PBP 9a	$0 Copay; PBP 12	"$0-$50 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$15/Visit for PCP; PBP 7a	"$30/Visit for Specialist; PBP 7d, 17a, 18a"	"$30/Visit for MH; $30/Visit for SA; PBP 7e, 7h, 9c"	"$30/Visit for PT/OT/ST; PBP 7c, 7i"	$30/Visit for Radiology; PBP 8b	"$15/Visit for Chiro; $30/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $30/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$30 Copay; PBP 7g		"$0 Copay; PBP 16a, 16b"	$30/Visit for Vision Exams; PBP 17a		$30/Visit for Hearing Exam; PBP 18a														0	300	300	25	0	100	0.2	0.2	43.71813179	50	0	30	0	0	30	15	30	30	30	30	23.70484406	0.2	0	0	0	30	0	30	0	0	0											NO	297.9478042	297.9478042	24.82898369	0	99.31593474	0.198631869	0.198631869	43.41907124	49.65796737	0	29.79478042	0	0	29.79478042	14.89739021	29.79478042	29.79478042	29.79478042	29.79478042	23.54268746	0.198631869	0	0	0	29.79478042	0	29.79478042	0	0	0												3.6139	0.105025009	1.310558136	0	0.494341512	1.87548311	0.218134188	0.656430054	1.366603092	0	1.189350822	0	0	1.174424045	4.970801604	10.63221153	1.020662986	2.565090747	2.826025662	3.015477556	7.428677662	0	0	0	1.564526959	0	0.099237852	0	0	0	0	0	0	0	0	0	0	0	0	0	46.127	0	0.317711935	3.6139	0.105025009	1.310558136	0	0.494341512	1.87548311	0.218134188	0.656430054	1.366603092	0	1.189350822	0	0	1.174424045	4.970801604	10.63221153	1.020662986	2.565090747	2.826025662	3.015477556	7.428677662	0	0	0	1.564526959	0	0.099237852	0	0	0	0	0	0	0	0	0	0	0	0	0	46.127	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$175/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surgery; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Radiology; PBP 8b	0% - 30% Coinsurance; PBP 9a	0% - 30% Coinsurance; PBP 12	"30% Coinsurance for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	30% Coinsurance for PCP; PBP 7a	"30% Coinsurance for Specialist; PBP 7d, 17a, 18a"	"50% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; 30% Coinsurance for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-j"	30% Coinsurance for Part B Rx; PBP 15	0% - 30% Coinsurance; PBP 7g		"$0 Copay; PBP 16a, 16b"	30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance; PBP 18a														10000	1.9043	0	0.4663	0.0998	1.3051	0.687	0.2738	0.0339	0.1784	0.0642	0.1021	0	0	0.0858	0.3792	2.3453	0.5708	0.0736	0.4495	1.7971	0.1062	0	0	0	0.0719	0	0.0073	0	0	0											11.0015	0	0.075775974	5.5182	0.105025009	1.776866212	0.099753916	1.799488827	2.562435521	0.491970819	0.690376032	1.545046384	0.06418613	1.291441028	0	0	1.260227945	5.349956348	12.97756026	1.591439652	2.638684966	3.275528016	4.812528224	7.534855324	0	0	0	1.636420728	0	0.106532232	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1285
H3335_015_0	2011	7																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	V	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	151.5478826	3.654202126	735.551597	0	79.19972144	8.938148255	0.839309867	166.1197521	325.3023502	0	488.6901428	0	0	447.7378512	4127.145145	4352.732946	229.1086079	1140.514644	1139.697583	1810.419901	45.12417957	0	0	0	658.5651665	0	38.01301868	0	0	0											3500	$100/Admit for IP Medical; PBP 1a	$100/Admit for IP Medical; PBP 1b	$25/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"$35/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$25/Visit for OP Radiology; PBP 8b	$0-$35 Copay; PBP 9a	$0 Copay; PBP 12	"$0-$35 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$10/Visit for PCP; PBP 7a	"$25/Visit for Specialist; PBP 7d, 17a, 18a"	"$25/Visit for MH; $25/Visit for SA; PBP 7e, 7h, 9c"	"$25/Visit for PT/OT/ST; PBP 7c, 7i"	$25/Visit for Radiology; PBP 8b	"$10/Visit for Chiro; $25/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $25/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$25 Copay; PBP 7g			$25/Visit for Vision Exams; PBP 17a		$25/Visit for Hearing Exam; PBP 18a														0	100	100	25	0	100	0.2	0.2	42.06763025	35	0	25	0	0	25	10	25	25	25	25	18.10775709	0.2	0	0	0	25	0	25	0	0	0											NO	99.49533217	99.49533217	24.87383304	0	99.49533217	0.198990664	0.198990664	41.85532846	34.82336626	0	24.87383304	0	0	24.87383304	9.949533217	24.87383304	24.87383304	24.87383304	24.87383304	18.01637307	0.198990664	0	0	0	24.87383304	0	24.87383304	0	0	0												1.2565	0.030298005	1.524665635	0	0.656666883	1.778608059	0.167014828	0.579416399	0.944010241	0	1.012966419	0	0	0.928079713	3.421930643	9.022429383	0.474900772	2.364080904	2.362387283	2.718100028	8.979290471	0	0	0	1.365086667	0	0.078794123	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6653	0	0.201193122	1.2565	0.030298005	1.524665635	0	0.656666883	1.778608059	0.167014828	0.579416399	0.944010241	0	1.012966419	0	0	0.928079713	3.421930643	9.022429383	0.474900772	2.364080904	2.362387283	2.718100028	8.979290471	0	0	0	1.365086667	0	0.078794123	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6653	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance; PBP 6	$175/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surgery; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Radiology; PBP 8b	0% - 30% Coinsurance; PBP 9a	0% - 30% Coinsurance; PBP 12	"30% Coinsurance for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	30% Coinsurance for PCP; PBP 7a	"30% Coinsurance for Specialist; PBP 7d, 17a, 18a"	"50% Coinsurance for MH; PBP 7e, 7h, 9c"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; 30% Coinsurance for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-j"	30% Coinsurance for Part B Rx; PBP 15	0% - 30% Coinsurance; PBP 7g			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance; PBP 18a														10000	2.2779	0.0089	0.3823	0.0049	1.3101	0.5135	0.2038	0.0384	0.0395	0.0859	0.2179	0.0015	0	0.0479	0.3759	1.7854	0.3386	0.077	0.8899	1.7136	0.1942	0	0	0	0.051	0	0.0071	0	0	0											10.5651	0	0.053589223	3.5344	0.039236947	1.90691775	0.00492335	1.966717314	2.292142766	0.370796992	0.617777249	0.983533416	0.085884475	1.230817419	0.001523336	0	0.976013236	3.797807597	10.80787356	0.813513951	2.441110572	3.252284598	4.431650044	9.173442513	0	0	0	1.416073055	0	0.085914032	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2304
H3335_018_0	2011	7																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	V	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	156.3761823	4.479264079	371.4415152	0	45.6580096	9.357037071	0.763434052	158.0562249	294.58685	0	1175.794003	0	0	609.1677044	3980.602756	3251.91583	285.5565654	420.5625932	359.5973128	1379.203064	46.85763275	0	0	0	519.2848654	0	33.11504422	0	0	0											3500	$100/Admit for IP Medical; PBP 1a	$100/Admit for IP Medical; PBP 1b	$25/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"$35/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$25/Visit for OP Radiology; PBP 8b	$0-$35 Copay; PBP 9a	$0 Copay; PBP 12	"$0-$35 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$10/Visit for PCP; PBP 7a	"$25/Visit for Specialist; PBP 7d, 17a, 18a"	"$25/Visit for MH; $25/Visit for SA; PBP 7e, 7h, 9c"	"$25/Visit for PT/OT/ST; PBP 7c, 7i"	$25/Visit for Radiology; PBP 8b	"$10/Visit for Chiro; $25/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $25/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$25 Copay; PBP 7g			$25/Visit for Vision Exams; PBP 17a		$25/Visit for Hearing Exam; PBP 18a														0	100	100	25	0	100	0.2	0.2	47.20865046	35	0	25	0	0	25	10	25	25	25	25	16.74066365	0.2	0	0	0	25	0	25	0	0	0											NO	99.51237157	99.51237157	24.87809289	0	99.51237157	0.199024743	0.199024743	46.97844766	34.82933005	0	24.87809289	0	0	24.87809289	9.951237157	24.87809289	24.87809289	24.87809289	24.87809289	16.65903141	0.199024743	0	0	0	24.87809289	0	24.87809289	0	0	0												1.2968	0.037145183	0.770063043	0	0.378628068	1.8622819	0.151942266	0.618769674	0.855021885	0	2.437626035	0	0	1.262910895	3.300993505	6.741788675	0.592008563	0.871899605	0.745507946	1.914682264	9.325828321	0	0	0	1.076568093	0	0.068653262	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3091	0	0.168120729	1.2968	0.037145183	0.770063043	0	0.378628068	1.8622819	0.151942266	0.618769674	0.855021885	0	2.437626035	0	0	1.262910895	3.300993505	6.741788675	0.592008563	0.871899605	0.745507946	1.914682264	9.325828321	0	0	0	1.076568093	0	0.068653262	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3091	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance; PBP 6	$175/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surgery; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Radiology; PBP 8b	0% - 30% Coinsurance; PBP 9a	0% - 30% Coinsurance; PBP 12	"30% Coinsurance for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	30% Coinsurance for PCP; PBP 7a	"30% Coinsurance for Specialist; PBP 7d, 17a, 18a"	"50% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; 30% Coinsurance for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-j"	30% Coinsurance for Part B Rx; PBP 15	0% - 30% Coinsurance; PBP 7g			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance; PBP 18a														10000	5.6989	0.1707	0.3939	0.336	1.0604	0.4292	0.3691	0.0282	1.0041	0.1728	0.2104	0.0005	0	0.0583	0.3645	2.2961	0.6832	0.0797	0.4134	1.4107	0.05	0	0	0	0.0823	0	0.0103	0	0	0											15.3228	0	0.075084646	6.9957	0.20786355	1.163970627	0.335970403	1.439027137	2.291474106	0.520998687	0.646990406	1.8591316	0.172841729	2.64801616	0.000514183	0	1.321240862	3.66546198	9.037856124	1.275226316	0.9515767	1.158954696	3.325406792	9.375854281	2.33E-05	0	0	1.15888791	0	0.078932215	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6319
H3335_021_0	2011	7																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	V	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	191.4224162	2.808528596	412.6888741	0	61.13999446	10.05981453	1.099604362	131.1044455	326.7651998	0	1295.54251	0	0	739.3566791	3946.281946	3412.555592	266.9552583	500.062588	449.6390784	1410.291002	44.87060368	0	0	0	718.426035	0	35.05833049	0	0	0											3500	$100/Admit for IP Medical; PBP 1a	$100/Admit for IP Medical; PBP 1b	$25/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"$35/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$25/Visit for OP Radiology; PBP 8b	$0-$35 Copay; PBP 9a	$0 Copay; PBP 12	"$0-$35 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$10/Visit for PCP; PBP 7a	"$25/Visit for Specialist; PBP 7d, 17a, 18a"	"$25/Visit for MH; $25/Visit for SA; PBP 7e, 7h, 9c"	"$25/Visit for PT/OT/ST; PBP 7c, 7i"	$25/Visit for Radiology; PBP 8b	"$10/Visit for Chiro; $25/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $25/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$25 Copay; PBP 7g			$25/Visit for Vision Exams; PBP 17a		$25/Visit for Hearing Exam; PBP 18a														0	100	100	25	0	100	0.2	0.2	47.91855095	35	0	25	0	0	25	10	25	25	25	25	17.72832278	0.2	0	0	0	25	0	25	0	0	0											NO	99.53576223	99.53576223	24.88394056	0	99.53576223	0.199071524	0.199071524	47.69609493	34.83751678	0	24.88394056	0	0	24.88394056	9.953576223	24.88394056	24.88394056	24.88394056	24.88394056	17.64602121	0.199071524	0	0	0	24.88394056	0	24.88394056	0	0	0												1.5878	0.023295753	0.855777118	0	0.507134663	2.002622614	0.218899917	0.521097507	0.948640678	0	2.6865169	0	0	1.533175638	3.273301512	7.076485875	0.553574898	1.036960643	0.932399342	2.073835411	8.932459477	0	0	0	1.489772562	0	0.072699118	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3264	0	0.169427561	1.5878	0.023295753	0.855777118	0	0.507134663	2.002622614	0.218899917	0.521097507	0.948640678	0	2.6865169	0	0	1.533175638	3.273301512	7.076485875	0.553574898	1.036960643	0.932399342	2.073835411	8.932459477	0	0	0	1.489772562	0	0.072699118	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3264	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance; PBP 6	$175/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surgery; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Radiology; PBP 8b	0% - 30% Coinsurance; PBP 9a	0% - 30% Coinsurance; PBP 12	"30% Coinsurance for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	30% Coinsurance for PCP; PBP 7a	"30% Coinsurance for Specialist; PBP 7d, 17a, 18a"	"50% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; 30% Coinsurance for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-j"	30% Coinsurance for Part B Rx; PBP 15	0% - 30% Coinsurance; PBP 7g			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance; PBP 18a														10000	3.8344	0.0113	0.604	0.0231	0.7063	0.7346	0.2553	0.0229	0.5708	0.127	0.1682	0.0007	0	0.0517	0.4079	2.156	0.3442	0.0451	0.87	1.3657	0.1019	0	0	0	0.0979	0	0.0083	0	0	0											12.5072	0	0.058333836	5.4222	0.034590941	1.459756669	0.023053426	1.213413953	2.737267724	0.474157333	0.543997274	1.519391621	0.127012485	2.85472234	0.000686219	0	1.584889478	3.681185064	9.232478694	0.897805062	1.082027962	1.802445325	3.43955851	9.034330614	3.11E-05	0	0	1.587627652	0	0.081009097	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8336
H3335_032_0	2011	8																															A	A	D		T	Coin	Coin	V	V		Coin			O	V	V	Coin	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	204.7042356	9.675099576	900.883274	0	148.9338972	9.107392518	1.314981318	170.2870802	289.8855307	0	19.30535615	0	0	833.9422218	3320.768328	3411.367683	5.572664787	500.6787531	7.282079194	1468.747938	40.57477029	0	0	0	599.9152714	0	38.52184082	0	0	0											4000	$500/Admit for IP Medical; PBP 1a	$500/Admit for IP Medical; PBP 1b	$50/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"$125/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	20% Coinsurance for OP Radiology; PBP 8b	$0-$125 Copay; PBP 9a	$0 Copay; PBP 12	"50% for Partial Hosp and Subs Abuse, $0-$125 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$20/Visit for PCP; PBP 7a	"$40/Visit for Specialist; PBP 7d, 17a, 18a"	"45% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"$40/Visit for PT/OT/ST; PBP 7c, 7i"	20% Coinsurance for Radiology; PBP 8b	"$20/Visit for Chiro; $40/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $40/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$40 Copay; PBP 7g			$40/Visit for Vision Exams; PBP 17a	$0 Copay;	$40/Visit for Hearing Exams; PBP 18a														0	500	500	50	0	100	0.2	0.2	48.80009138	125	0	0.2	0	0	40	20	40	0.452367739	40	0.2	33.69897906	0.2	0	0	0	40	0	40	0	0	0											NO	493.6824828	493.6824828	49.36824828	0	98.73649656	0.197472993	0.197472993	48.18350055	123.4206207	0	0.197472993	0	0	39.49459862	19.74729931	39.49459862	0.446652057	39.49459862	0.197472993	33.2731913	0.197472993	0	0	0	39.49459862	0	39.49459862	0	0	0												8.4216	0.398035598	3.706252428	0	1.225434269	1.79846406	0.259673297	0.683752302	2.981487677	0	3.812286462	0	0	2.744684444	5.464683842	11.22754978	2.489042191	1.647842199	1.438013974	4.072494259	8.012421334	0	0	0	1.974451071	0	0.12678372	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4849	0	0.799602211	8.4216	0.398035598	3.706252428	0	1.225434269	1.79846406	0.259673297	0.683752302	2.981487677	0	3.812286462	0	0	2.744684444	5.464683842	11.22754978	2.489042191	1.647842199	1.438013974	4.072494259	8.012421334	0	0	0	1.974451071	0	0.12678372	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4849	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$175/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surgery; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Radiology; PBP 8b	30% Coinsurance for OP Observation; PBP 9a	No Cost Sharing; PBP 12	"30% Coinsurance for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$25/Visit for PCP; PBP 7a	"$45/Visit for Specialist; PBP 7d, 17a, 18a"	"50% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; $45/Visit for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-j"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance for Other Medicare Part B; PBP 7g			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance for Hearing Exams; PBP 18a														10000	2.7281	0.0822	0.3712	0.3109	0.8065	0.1069	0.0293	0.0297	0.7239	0.1103	0.3099	0.0383	0	0.1132	0.2857	0.8745	0.0775	0.1064	0.4047	0.5788	0.4015	0.0004	0	0	0.062	0	0.0065	0	0	0											8.5585	0	0.273935827	11.1497	0.480270137	4.077424655	0.310932517	2.031966755	1.905371818	0.288946363	0.713410874	3.705431588	0.110316682	4.122179467	0.038344861	0	2.857927913	5.750389606	12.10204697	2.566519676	1.754259672	1.842721538	4.651332693	8.413929869	0.000376502	0	0	2.036424326	0	0.133246956	0	0	0	0	0	0	0	0	0	0	0	0	0	71.0435
H3335_037_0	2011	7																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	Coin	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	102.7999074	1.710401953	548.6225336	0	73.43250976	6.044930776	0.629561293	99.97130492	248.4861032	0	596.393996	0	0	324.1999529	2755.21488	2495.943113	1.049786943	403.4774353	456.8859451	1064.73195	25.82586769	0	0	0	408.2529334	0	25.66847287	0	0	0											4000	$600/Admit for IP Medical; PBP 1a	$600/Admit for IP Medical; PBP 1b	$50/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"$100/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$40/Visit for OP Radiology; PBP 8b	$0-$100 Copay; PBP 9a	$0 Copay; PBP 12	"50% for Partial Hosp and Subs Abuse, $0-$100 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$20/Visit for PCP; PBP 7a	"$40/Visit for Specialist; PBP 7d, 17a, 18a"	"45% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"$40/Visit for PT/OT/ST; PBP 7c, 7i"	$40/Visit for Radiology; PBP 8b	"$20/Visit for Chiro; $40/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $40/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$40 Copay; PBP 7g			$40/Visit for Vision Exams; PBP 17a		$40/Visit for Hearing Exams; PBP 18a														0	600	600	50	0	100	0.2	0.2	48.72984079	100	0	40	0	0	40	20	40	0.452247034	40	40	30.6981224	0.2	0	0	0	40	0	40	0	0	0											NO	597.3263452	597.3263452	49.77719543	0	99.55439087	0.199108782	0.199108782	48.51269617	99.55439087	0	39.82175635	0	0	39.82175635	19.91087817	39.82175635	0.45023178	39.82175635	39.82175635	30.56132876	0.199108782	0	0	0	39.82175635	0	39.82175635	0	0	0												5.1171	0.085139012	2.275740923	0	0.609210732	1.203598803	0.125351182	0.404156462	2.06149022	0	1.979121366	0	0	1.075850961	4.571562318	8.282736542	0.472647444	1.338931677	1.516166732	2.711635263	5.142157053	0	0	0	1.35477907	0	0.085180306	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4125	0	0.180888055	5.1171	0.085139012	2.275740923	0	0.609210732	1.203598803	0.125351182	0.404156462	2.06149022	0	1.979121366	0	0	1.075850961	4.571562318	8.282736542	0.472647444	1.338931677	1.516166732	2.711635263	5.142157053	0	0	0	1.35477907	0	0.085180306	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4125	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$175/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surgery; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Radiology; PBP 8b	0% - 30% Coinsurance; PBP 9a	0% - 30% Coinsurance; PBP 12	"30% Coinsurance for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	30% Coinsurance for PCP; PBP 7a	"30% Coinsurance for Specialist; PBP 7d, 17a, 18a"	"50% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; 30% Coinsurance for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-j"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance for Other Medicare Part B; PBP 7g			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance for Hearing Exams; PBP 18a														10000	1.8133	0.0104	0.1316	0.0182	0.4589	0.2404	0.2608	0.022	0.2785	0.0506	0.1084	0.0006	0	0.0916	0.1918	1.6733	0.2463	0.0746	0.2994	1.068	0.7124	0	0	0	0.0475	0	0.0053	0	0	0											7.8037	0	0.034929439	6.9303	0.095540202	2.407297992	0.018181885	1.068081685	1.444006579	0.38615607	0.426170702	2.339954515	0.050593863	2.087473671	0.000631906	0	1.167454123	4.763330171	9.956050992	0.718923844	1.413555914	1.81554452	3.779608222	5.854537814	2.87E-05	0	0	1.402281632	0	0.090449174	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2162
H3335_038_0	2011	7																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	Coin	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	87.74923245	3.834220194	313.0394653	0	45.68044517	4.23552993	0.541064773	112.086647	220.7729889	0	372.3152777	0	0	310.0720607	2775.202415	2600.499837	0.790370346	530.6164654	675.6595725	1205.252533	28.02279328	0	0	0	463.3219786	0	25.12870746	0	0	0											4000	$600/Admit for IP Medical; PBP 1a	$600/Admit for IP Medical; PBP 1b	$50/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"$100/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$40/Visit for OP Radiology; PBP 8b	$0-$100 Copay; PBP 9a	$0 Copay; PBP 12	"50% for Partial Hosp and Subs Abuse, $0-$100 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$20/Visit for PCP; PBP 7a	"$40/Visit for Specialist; PBP 7d, 17a, 18a"	"45% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"$40/Visit for PT/OT/ST; PBP 7c, 7i"	$40/Visit for Radiology; PBP 8b	"$20/Visit for Chiro; $40/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $40/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$40 Copay; PBP 7g			$40/Visit for Vision Exams; PBP 17a		$40/Visit for Hearing Exams; PBP 18a														0	600	600	50	0	100	0.2	0.2	46.1569546	100	0	40	0	0	40	20	40	0.451614837	40	40	29.35777987	0.2	0	0	0	40	0	40	0	0	0											NO	597.6755837	597.6755837	49.80629865	0	99.61259729	0.199225195	0.199225195	45.9781413	99.61259729	0	39.84503892	0	0	39.84503892	19.92251946	39.84503892	0.449865269	39.84503892	39.84503892	29.24404704	0.199225195	0	0	0	39.84503892	0	39.84503892	0	0	0												4.3705	0.190968316	1.299278091	0	0.379195649	0.843824275	0.107793735	0.429461308	1.83264757	0	1.236243061	0	0	1.029569444	4.607418677	8.634751435	0.355560168	1.761869476	2.243473497	2.937205147	5.582846443	0	0	0	1.538423522	0	0.083437861	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4644	0	0.153480869	4.3705	0.190968316	1.299278091	0	0.379195649	0.843824275	0.107793735	0.429461308	1.83264757	0	1.236243061	0	0	1.029569444	4.607418677	8.634751435	0.355560168	1.761869476	2.243473497	2.937205147	5.582846443	0	0	0	1.538423522	0	0.083437861	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4644	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$175/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surgery; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Radiology; PBP 8b	0% - 30% Coinsurance; PBP 9a	0% - 30% Coinsurance; PBP 12	"30% Coinsurance for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	30% Coinsurance for PCP; PBP 7a	"30% Coinsurance for Specialist; PBP 7d, 17a, 18a"	"50% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; 30% Coinsurance for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-j"	30% Coinsurance for Part B Rx; PBP 15	30% Coinsurance for Other Medicare Part B; PBP 7g			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance for Hearing Exams; PBP 18a															0.7564	0.0056	0.0712	0.0098	0.7114	0.209	0.1455	0.0363	0.1016	0.0692	0.1606	0.0003	0	0.0159	0.3149	1.2298	0.5824	0.0763	0.3871	1.1311	0.1596	0	0	0	0.0449	0	0.0041	0	0	0											6.2231	0	0.024202328	5.1268	0.196599312	1.370500463	0.009843309	1.090590833	1.052833429	0.253275202	0.465748566	1.9342301	0.069247975	1.39681842	0.000342101	0	1.045502553	4.92233047	9.864528144	0.937943035	1.838160863	2.630563537	4.068300982	5.74247365	1.55E-05	0	0	1.583342868	0	0.087528924	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6876
H3335_041_0	2011	6																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	Coin	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	119.3148676	6.215229613	459.3626565	0	84.66731919	6.633318644	0.500657803	119.2522085	290.0984756	0	650.0209821	0	0	363.5680168	3055.888182	3249.086607	1.501683495	605.0197031	646.1837042	1460.826151	36.00304661	0	0	0	489.2096305	0	30.35201379	0	0	0											4000	$400/Admit for IP Medical; PBP 1a	$400/Admit for IP Medical; PBP 1b	$50/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$100/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$30/Visit for OP Radiology; PBP 8b	$0-$100 Copay; PBP 9a	$0 Copay; PBP 12	"50% for Partial Hosp and Subs Abuse, $0-$100 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$20/Visit for PCP; PBP 7a	"$30/Visit for Specialist; PBP 7d, 17a, 18a"	"45% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"$30/Visit for PT/OT/ST; PBP 7c, 7i"	$30/Visit for Radiology; PBP 8b	"$20/Visit for Chiro; $30/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $30/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$30 Copay; PBP 7g			$30/Visit for Vision Exams; PBP 17a		$30/Visit for Hearing Exam; PBP 18a														0	400	400	50	0	100	0.2	0.2	44.38651773	100	0	30	0	0	30	20	30	0.452925381	30	30	24.90236489	0.2	0	0	0	30	0	30	0	0	0											NO	398.2376536	398.2376536	49.77970669	0	99.55941339	0.199118827	0.199118827	44.19095667	99.55941339	0	29.86782402	0	0	29.86782402	19.91188268	29.86782402	0.450929853	29.86782402	29.86782402	24.79264841	0.199118827	0	0	0	29.86782402	0	29.86782402	0	0	0												3.9596	0.206261538	1.905578192	0	0.702452386	1.320818626	0.099690394	0.439155765	2.406836171	0	1.617892692	0	0	0.904915462	5.070707246	8.086928917	0.677153917	1.505885168	1.608341763	3.018145762	7.168884401	0	0	0	1.217635596	0	0.075545717	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9925	0	0.185831948	3.9596	0.206261538	1.905578192	0	0.702452386	1.320818626	0.099690394	0.439155765	2.406836171	0	1.617892692	0	0	0.904915462	5.070707246	8.086928917	0.677153917	1.505885168	1.608341763	3.018145762	7.168884401	0	0	0	1.217635596	0	0.075545717	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9925	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance; PBP 6	$175/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surgery; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Radiology; PBP 8b	0% - 30% Coinsurance; PBP 9a	0% - 30% Coinsurance; PBP 12	"30% Coinsurance for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$25/Visit for PCP; PBP 7a	"$35/Visit for Specialist; PBP 7d, 17a, 18a"	"50% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; $35/Visit for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-j"	30% Coinsurance for Part B Rx; PBP 15	0% - 30% Coinsurance; PBP 7g			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance; PBP 18a														10000	1.745	0.0194	0.245	0.0339	0.5272	0.3372	0.2091	0.02	0.382	0.1101	0.2395	0.0012	0	0.0538	0.1373	0.4499	0.222	0.1138	0.3189	0.7561	0.0955	0.0001	0	0	0.0383	0	0.005	0	0	0											6.06	0	0.026817581	5.7046	0.225632669	2.150589522	0.033861865	1.229640545	1.658020648	0.308794017	0.459174644	2.788820529	0.110058294	1.857423518	0.001176858	0	0.958666027	5.20801472	8.536838387	0.899150227	1.619675789	1.927208379	3.774206132	7.264383684	5.34E-05	0	0	1.255889136	0	0.080553627	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0524
H3335_042_0	2011	6																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	Coin	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	114.3889539	3.183272676	457.2214005	0	69.65702578	6.040078486	0.548918634	131.2246507	274.5477529	0	814.9161266	0	0	406.4934383	3096.650513	3089.119508	1.293541379	635.266749	564.4705343	1322.758409	30.65245566	0	0	0	456.6107975	0	29.61846092	0	0	0											4000	$400/Admit for IP Medical; PBP 1a	$400/Admit for IP Medical; PBP 1b	$50/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$100/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$30/Visit for OP Radiology; PBP 8b	$0-$100 Copay; PBP 9a	$0 Copay; PBP 12	"50% for Partial Hosp and Subs Abuse, $0-$100 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$20/Visit for PCP; PBP 7a	"$30/Visit for Specialist; PBP 7d, 17a, 18a"	"45% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"$30/Visit for PT/OT/ST; PBP 7c, 7i"	$30/Visit for Radiology; PBP 8b	"$20/Visit for Chiro; $30/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $30/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$30 Copay; PBP 7g			$30/Visit for Vision Exams; PBP 17a		$30/Visit for Hearing Exam; PBP 18a														0	400	400	50	0	100	0.2	0.2	47.22899835	100	0	30	0	0	30	20	30	0.45338027	30	30	25.6800307	0.2	0	0	0	30	0	30	0	0	0											NO	398.44337	398.44337	49.80542125	0	99.6108425	0.199221685	0.199221685	47.04520316	99.6108425	0	29.88325275	0	0	29.88325275	19.9221685	29.88325275	0.451615907	29.88325275	29.88325275	25.58009494	0.199221685	0	0	0	29.88325275	0	29.88325275	0	0	0												3.7981	0.105696158	1.897675371	0	0.578216252	1.203314614	0.109356495	0.514457529	2.278994414	0	2.029362048	0	0	1.012278847	5.140999442	7.692744918	0.584183863	1.581986402	1.405684637	2.819690473	6.106633866	0	0	0	1.137084656	0	0.073757996	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0702	0	0.156545573	3.7981	0.105696158	1.897675371	0	0.578216252	1.203314614	0.109356495	0.514457529	2.278994414	0	2.029362048	0	0	1.012278847	5.140999442	7.692744918	0.584183863	1.581986402	1.405684637	2.819690473	6.106633866	0	0	0	1.137084656	0	0.073757996	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0702	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance; PBP 6	$175/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surgery; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Radiology; PBP 8b	0% - 30% Coinsurance; PBP 9a	0% - 30% Coinsurance; PBP 12	"30% Coinsurance for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$25/Visit for PCP; PBP 7a	"$35/Visit for Specialist; PBP 7d, 17a, 18a"	"50% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; $35/Visit for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-j"	30% Coinsurance for Part B Rx; PBP 15	0% - 30% Coinsurance; PBP 7g			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance; PBP 18a														10000	1.7377	0.0193	0.244	0.0337	0.525	0.3515	0.2408	0.0199	0.3115	0.0595	0.1522	0.0012	0	0.0535	0.1473	0.4293	0.2094	0.0493	0.3123	0.67	0.0951	0.0001	0	0	0.0381	0	0.0047	0	0	0											5.7054	0	0.022289901	5.5359	0.124986953	2.141670589	0.033721433	1.103218055	1.554855235	0.350159133	0.534393386	2.590456659	0.059544793	2.181523008	0.001171978	0	1.065806497	5.288293127	8.122077643	0.7935447	1.631327639	1.717952592	3.48966341	6.201737094	5.32E-05	0	0	1.17517955	0	0.078491443	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7757
H3335_043_0	2011	6																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	Coin	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	123.0449519	3.307564594	555.4225787	0	80.27880169	6.591094854	0.630933061	116.7880984	289.3553536	0	780.9462583	0	0	398.7104529	3293.700778	3492.781451	1.364964404	735.2028114	661.1308489	1575.890861	37.29398683	0	0	0	557.5922951	0	32.83372807	0	0	0											4000	$400/Admit for IP Medical; PBP 1a	$400/Admit for IP Medical; PBP 1b	$50/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$100/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$30/Visit for OP Radiology; PBP 8b	$0-$100 Copay; PBP 9a	$0 Copay; PBP 12	"50% for Partial Hosp and Subs Abuse, $0-$100 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$20/Visit for PCP; PBP 7a	"$30/Visit for Specialist; PBP 7d, 17a, 18a"	"45% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"$30/Visit for PT/OT/ST; PBP 7c, 7i"	$30/Visit for Radiology; PBP 8b	"$20/Visit for Chiro; $30/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $30/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$30 Copay; PBP 7g			$30/Visit for Vision Exams; PBP 17a		$30/Visit for Hearing Exam; PBP 18a														0	400	400	50	0	100	0.2	0.2	46.23837247	100	0	30	0	0	30	20	30	0.453328472	30	30	24.90038485	0.2	0	0	0	30	0	30	0	0	0											NO	397.8194935	397.8194935	49.72743669	0	99.45487338	0.198909747	0.198909747	45.98631479	99.45487338	0	29.83646201	0	0	29.83646201	19.89097468	29.83646201	0.450857258	29.83646201	29.83646201	24.76464623	0.198909747	0	0	0	29.83646201	0	29.83646201	0	0	0												4.0791	0.109651139	2.301645093	0	0.665343171	1.311033008	0.125498735	0.447554521	2.398150005	0	1.941722781	0	0	0.99134244	5.459576564	8.684353425	0.615404108	1.827987563	1.643817122	3.252198307	7.418137476	0	0	0	1.386381778	0	0.081636857	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7406	0	0.245229591	4.0791	0.109651139	2.301645093	0	0.665343171	1.311033008	0.125498735	0.447554521	2.398150005	0	1.941722781	0	0	0.99134244	5.459576564	8.684353425	0.615404108	1.827987563	1.643817122	3.252198307	7.418137476	0	0	0	1.386381778	0	0.081636857	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7406	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance; PBP 6	$175/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surgery; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Radiology; PBP 8b	0% - 30% Coinsurance; PBP 9a	0% - 30% Coinsurance; PBP 12	"30% Coinsurance for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$25/Visit for PCP; PBP 7a	"$35/Visit for Specialist; PBP 7d, 17a, 18a"	"50% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; $35/Visit for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-j"	30% Coinsurance for Part B Rx; PBP 15	0% - 30% Coinsurance; PBP 7g			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance; PBP 18a														10000	1.999	0.02	0.2531	0.035	0.6727	0.4276	0.3418	0.0314	0.3231	0.0737	0.2138	0.0012	0	0.1374	0.1904	0.4654	0.2172	0.0512	0.3661	0.9908	0.0997	0.0001	0	0	0.0548	0	0.0057	0	0	0											6.9711	0	0.038209869	6.0781	0.129663765	2.554770223	0.034983235	1.338013645	1.738632195	0.467344567	0.478913318	2.72126667	0.073679215	2.155529581	0.001215831	0	1.128763783	5.649969011	9.14970582	0.832598894	1.87917507	2.009939294	4.243016571	7.517873353	5.51E-05	0	0	1.44117869	0	0.087298374	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7117
H3335_044_0	2011	6																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	Coin	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	90.25784282	2.435809053	349.8613345	0	52.61980598	6.332317097	0.420027159	74.796665	193.7332595	0	515.5710214	0	0	288.6461743	2179.692485	2246.165829	0.989805185	436.0493017	418.6190663	939.9232367	23.42023692	0	0	0	333.5008032	0	21.36719519	0	0	0											4000	$400/Admit for IP Medical; PBP 1a	$400/Admit for IP Medical; PBP 1b	$50/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$100/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$30/Visit for OP Radiology; PBP 8b	$0-$100 Copay; PBP 9a	$0 Copay; PBP 12	"50% for Partial Hosp and Subs Abuse, $0-$100 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$20/Visit for PCP; PBP 7a	"$30/Visit for Specialist; PBP 7d, 17a, 18a"	"45% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"$30/Visit for PT/OT/ST; PBP 7c, 7i"	$30/Visit for Radiology; PBP 8b	"$20/Visit for Chiro; $30/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $30/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$30 Copay; PBP 7g			$30/Visit for Vision Exams; PBP 17a		$30/Visit for Hearing Exam; PBP 18a														0	400	400	50	0	100	0.2	0.2	46.28003054	100	0	30	0	0	30	20	30	0.45338027	30	30	25.09086624	0.2	0	0	0	30	0	30	0	0	0											NO	399.3604109	399.3604109	49.92005137	0	99.84010274	0.199680205	0.199680205	46.20603004	99.84010274	0	29.95203082	0	0	29.95203082	19.96802055	29.95203082	0.452655328	29.95203082	29.95203082	25.05074663	0.199680205	0	0	0	29.95203082	0	29.95203082	0	0	0												3.0038	0.081063809	1.455424649	0	0.437797236	1.264438379	0.083871109	0.288004746	1.611862378	0	1.286866593	0	0	0.720461592	3.627012026	5.606435678	0.44804059	1.088380177	1.044874265	1.962148238	4.676557721	0	0	0	0.832418861	0	0.053332574	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5728	0	0.047361788	3.0038	0.081063809	1.455424649	0	0.437797236	1.264438379	0.083871109	0.288004746	1.611862378	0	1.286866593	0	0	0.720461592	3.627012026	5.606435678	0.44804059	1.088380177	1.044874265	1.962148238	4.676557721	0	0	0	0.832418861	0	0.053332574	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5728	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance; PBP 6	$175/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surgery; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Radiology; PBP 8b	0% - 30% Coinsurance; PBP 9a	0% - 30% Coinsurance; PBP 12	"30% Coinsurance for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$25/Visit for PCP; PBP 7a	"$35/Visit for Specialist; PBP 7d, 17a, 18a"	"50% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; $35/Visit for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-j"	30% Coinsurance for Part B Rx; PBP 15	0% - 30% Coinsurance; PBP 7g			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance; PBP 18a														10000	1.3328	0.0148	0.1871	0.0259	0.4027	0.245	0.1597	0.0153	0.2389	0.0457	0.1167	0.0009	0	0.0411	0.1049	0.334	0.1606	0.0378	0.2341	0.4727	0.0729	0	0	0	0.0292	0	0.0035	0	0	0											4.2763	0	0.006848592	4.3365	0.09585891	1.642557106	0.025862698	0.840448067	1.509477229	0.243578314	0.303294577	1.850738761	0.045667958	1.403566644	0.00089885	0	0.761514695	3.731883442	5.940426774	0.608610163	1.126222504	1.279020927	2.434825434	4.749497269	4.08E-05	0	0	0.861635791	0	0.056878878	0	0	0	0	0	0	0	0	0	0	0	0	0	33.849
H3335_045_0	2011	5																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	Coin	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	112.8608651	3.326348909	477.771797	0	71.85778129	6.271244581	0.573590479	98.17171221	230.4270618	0	622.9993797	0	0	368.0149302	2826.512014	2859.015904	1.351681239	595.4703703	558.9535356	1188.265332	32.11324382	0	0	0	448.5458462	0	27.07789343	0	0	0											4000	$400/Admit for IP Medical; PBP 1a	$400/Admit for IP Medical; PBP 1b	$50/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$100/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$30/Visit for OP Radiology; PBP 8b	$0-$100 Copay; PBP 9a	$0 Copay; PBP 12	"50% for Partial Hosp and Subs Abuse, $0-$100 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$20/Visit for PCP; PBP 7a	"$30/Visit for Specialist; PBP 7d, 17a, 18a"	"45% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"$30/Visit for PT/OT/ST; PBP 7c, 7i"	$30/Visit for Radiology; PBP 8b	"$20/Visit for Chiro; $30/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $30/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$30 Copay; PBP 7g			$30/Visit for Vision Exams; PBP 17a		$30/Visit for Hearing Exam; PBP 18a														0	400	400	50	0	100	0.2	0.2	46.12956477	100	0	30	0	0	30	20	30	0.45338027	30	30	25.31707696	0.2	0	0	0	30	0	30	0	0	0											NO	398.6113857	398.6113857	49.82642321	0	99.65284643	0.199305693	0.199305693	45.96942434	99.65284643	0	29.89585393	0	0	29.89585393	19.93056929	29.89585393	0.451806345	29.89585393	29.89585393	25.22918782	0.199305693	0	0	0	29.89585393	0	29.89585393	0	0	0												3.749	0.110493379	1.98380498	0	0.596736037	1.249894746	0.114319848	0.376074758	1.913559384	0	1.552091538	0	0	0.916843383	4.694499462	7.122726819	0.610698159	1.483507934	1.392532771	2.498247436	6.40035231	0	0	0	1.117471758	0	0.067459729	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9503	0	0.132204717	3.749	0.110493379	1.98380498	0	0.596736037	1.249894746	0.114319848	0.376074758	1.913559384	0	1.552091538	0	0	0.916843383	4.694499462	7.122726819	0.610698159	1.483507934	1.392532771	2.498247436	6.40035231	0	0	0	1.117471758	0	0.067459729	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9503	YES	30% Coinsurance for IP Medical; PBP 1a	30% Coinsurance for IP Medical; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance; PBP 6	$175/Trip for Ambulance; PBP 10a	30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"30% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Surgery; PBP 9a, 9b"	30% Coinsurance for OP Lab; PBP 8a	30% Coinsurance for OP Radiology; PBP 8b	0% - 30% Coinsurance; PBP 9a	0% - 30% Coinsurance; PBP 12	"30% Coinsurance for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$25/Visit for PCP; PBP 7a	"$35/Visit for Specialist; PBP 7d, 17a, 18a"	"50% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	30% Coinsurance for Radiology; PBP 8b	"30% Coinsurance for Path (Office); 30% Coinsurance for Chiro; 30% Coinsurance for Podiatry; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams; $35/Visit for Professional Other; PBP 7b, 7f, 7g, 8a, 14a-j"	30% Coinsurance for Part B Rx; PBP 15	0% - 30% Coinsurance; PBP 7g			30% Coinsurance for Vision Exams; PBP 17a		30% Coinsurance; PBP 18a														10000	1.8166	0.0202	0.2551	0.0353	0.5488	0.334	0.2177	0.0208	0.3256	0.0622	0.1591	0.0012	0	0.056	0.1429	0.4084	0.2189	0.0516	0.3192	0.6683	0.0994	0.0001	0	0	0.0398	0	0.0048	0	0	0											5.8059	0	0.020225705	5.5656	0.130659724	2.238874385	0.035251944	1.145566046	1.583893	0.332007482	0.396915441	2.239157935	0.062247346	1.711158612	0.00122517	0	0.972800488	4.83744361	7.531153401	0.829561237	1.535088617	1.711684515	3.166581605	6.49977198	5.56E-05	0	0	1.157295662	0	0.072247093	0	0	0	0	0	0	0	0	0	0	0	0	0	43.7562
H3335_801_0	2011	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	0																			0	YES	258.7813002	4.076597408	47.47976571	0	7.921724068	7.959468768	11.41363033	21.21530472	47.67546205	19.21583063	18.84961033	0	0.659799267	6.772664968	44.45131469	126.4485988	2.762362153	6.024413627	54.29696609	30.71194564	68.78329689	3.309874351																			6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.090790069	0.090790069	0.173520647	0	0.233	0.233	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																			NO	0.072287197	0.072287197	0.138157413	0	0.185514968	0.185514968	0.185514968	0.185514968	0.185514968	0.185514968	0.185514968	0	0.185514968	0.185514968	0.185514968	0.185514968	0.185514968	0.185514968	0.185514968	0.185514968	0.185514968	0.185514968																				18.7066	0.294685798	6.559681611	0	1.469598385	1.476600592	2.117399263	3.93575657	8.844511803	3.564824199	3.496884851	0	0.12240264	1.256430723	8.24638421	23.45810773	0.512459526	1.1176189	10.07289991	5.697525605	12.7603311	0.614031233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3247	0	29.26293538	18.7066	0.294685798	6.559681611	0	1.469598385	1.476600592	2.117399263	3.93575657	8.844511803	3.564824199	3.496884851	0	0.12240264	1.256430723	8.24638421	23.45810773	0.512459526	1.1176189	10.07289991	5.697525605	12.7603311	0.614031233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3247	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			10000	0.3261	0.0065	0.107	0	0.4103	0.0301	0.0528	0.3202	0.1615	0.1499	0.0559	0	0.0035	0.039	0.2533	0.8215	0.0294	0.0208	0.1919	0.326	0.1889	0.0124																			3.507	0	0.545178401	19.0327	0.301178484	6.666717583	0	1.879899718	1.506652002	2.170204844	4.255986103	9.006044005	3.714705644	3.552774686	0	0.12586811	1.295405609	8.499657952	24.27965156	0.541873038	1.138385864	10.26478083	6.023548088	12.94927186	0.626411131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.8317
H3335_811_0	2011	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	0																			0	YES	238.4627337	7.525456255	28.98149242	0	6.11603543	11.68316666	1.56109502	7.367652459	44.4262258	17.50642498	39.44764962	0.734393477	0.01013637	10.77553679	41.39182244	85.86751322	1.644252585	3.44244609	26.88302158	48.67753356	53.4721292	0																			6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.089102228	0.089102228	0.187434609	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0																			NO	0.074055113	0.074055113	0.15578164	0	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0																				17.6594	0.557298516	4.51478443	0	1.184383642	2.262470786	0.302309466	1.426762019	8.603235826	3.390157501	7.639123657	0.142216904	0.00196293	2.086706276	8.015616977	16.62843181	0.318413111	0.666637217	5.205955946	9.426510876	10.35499481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3874	0	20.39751227	17.6594	0.557298516	4.51478443	0	1.184383642	2.262470786	0.302309466	1.426762019	8.603235826	3.390157501	7.639123657	0.142216904	0.00196293	2.086706276	8.015616977	16.62843181	0.318413111	0.666637217	5.205955946	9.426510876	10.35499481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3874	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			10000	1.1725	0.1479	0.403	0	0.4516	0.512	0.1698	0.0616	0.3833	0.0733	0.1659	0.0069	0	0.2742	0.1881	1.1759	0.0896	0.0322	0.3215	1.3307	0.1116	0.0006																			7.0721	0	0.694711749	18.8319	0.705182624	4.917784781	0	1.635961303	2.774455692	0.472082389	1.488318129	8.986533101	3.463451467	7.805072695	0.149081254	0.00196293	2.360888747	8.203742112	17.80432911	0.40802417	0.698815776	5.527498052	10.75723226	10.46655339	0.000594215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4595
H3335_813_0	2011	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	0																			0	YES	281.1292613	6.194855295	53.43474394	0	10.21091709	7.050215462	12.37063371	22.78021607	51.67803741	20.28406293	20.17854657	0	1.288401912	8.057261218	54.04702619	137.5131032	2.671233708	5.615298866	47.25508634	33.81259619	70.06853388	4.602632065																			6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.091110119	0.091110119	0.170257033	0	0.233	0.233	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																			NO	0.070939677	0.070939677	0.132564627	0	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223	0	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223																				19.9432	0.439461032	7.083556917	0	1.852436222	1.27903051	2.244246012	4.132723535	9.375286028	3.679878364	3.66073588	0	0.233738297	1.461725954	9.805061395	24.94724529	0.484607801	1.018711926	8.572886528	6.134187297	12.71163883	0.834996727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.8954	0	34.09012791	19.9432	0.439461032	7.083556917	0	1.852436222	1.27903051	2.244246012	4.132723535	9.375286028	3.679878364	3.66073588	0	0.233738297	1.461725954	9.805061395	24.94724529	0.484607801	1.018711926	8.572886528	6.134187297	12.71163883	0.834996727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.8954	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			10000	0.5825	0.0128	0.2069	0	0.0541	0.0374	0.0656	0.1207	0.2738	0.1075	0.1069	0	0.0068	0.0427	0.2864	0.7287	0.0142	0.0298	0.2504	0.1792	0.3713	0.0244																			3.502	0	0.508734155	20.5257	0.452297258	7.290460664	0	1.906544066	1.316389736	2.309798236	4.253436334	9.649128934	3.787364	3.767662383	0	0.240565563	1.504421535	10.09145762	25.67592985	0.498762719	1.048467501	8.823292132	6.313360889	13.08293332	0.859386162	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.3974
H3335_819_0	2011	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	0																			0	YES	238.4627337	7.525456255	28.98149242	0	6.11603543	11.68316666	1.56109502	7.367652459	44.4262258	17.50642498	39.44764962	0.734393477	0.01013637	10.77553679	41.39182244	85.86751322	1.644252585	3.44244609	26.88302158	48.67753356	53.4721292	0																			6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.089102228	0.089102228	0.187434609	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0																			NO	0.074055113	0.074055113	0.15578164	0	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0																				17.6594	0.557298516	4.51478443	0	1.184383642	2.262470786	0.302309466	1.426762019	8.603235826	3.390157501	7.639123657	0.142216904	0.00196293	2.086706276	8.015616977	16.62843181	0.318413111	0.666637217	5.205955946	9.426510876	10.35499481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3874	0	20.39751227	17.6594	0.557298516	4.51478443	0	1.184383642	2.262470786	0.302309466	1.426762019	8.603235826	3.390157501	7.639123657	0.142216904	0.00196293	2.086706276	8.015616977	16.62843181	0.318413111	0.666637217	5.205955946	9.426510876	10.35499481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3874	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			10000	1.1725	0.1479	0.403	0	0.4516	0.512	0.1698	0.0616	0.3833	0.0733	0.1659	0.0069	0	0.2742	0.1881	1.1759	0.0896	0.0322	0.3215	1.3307	0.1116	0.0006																			7.0721	0	0.694711749	18.8319	0.705182624	4.917784781	0	1.635961303	2.774455692	0.472082389	1.488318129	8.986533101	3.463451467	7.805072695	0.149081254	0.00196293	2.360888747	8.203742112	17.80432911	0.40802417	0.698815776	5.527498052	10.75723226	10.46655339	0.000594215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4595
H3335_820_0	2011	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	0																			0	YES	238.4627337	7.525456255	28.98149242	0	6.11603543	11.68316666	1.56109502	7.367652459	44.4262258	17.50642498	39.44764962	0.734393477	0.01013637	10.77553679	41.39182244	85.86751322	1.644252585	3.44244609	26.88302158	48.67753356	53.4721292	0																			6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.089102228	0.089102228	0.187434609	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0																			NO	0.074055113	0.074055113	0.15578164	0	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0.193652188	0																				17.6594	0.557298516	4.51478443	0	1.184383642	2.262470786	0.302309466	1.426762019	8.603235826	3.390157501	7.639123657	0.142216904	0.00196293	2.086706276	8.015616977	16.62843181	0.318413111	0.666637217	5.205955946	9.426510876	10.35499481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3874	0	20.39751227	17.6594	0.557298516	4.51478443	0	1.184383642	2.262470786	0.302309466	1.426762019	8.603235826	3.390157501	7.639123657	0.142216904	0.00196293	2.086706276	8.015616977	16.62843181	0.318413111	0.666637217	5.205955946	9.426510876	10.35499481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3874	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			10000	1.1725	0.1479	0.403	0	0.4516	0.512	0.1698	0.0616	0.3833	0.0733	0.1659	0.0069	0	0.2742	0.1881	1.1759	0.0896	0.0322	0.3215	1.3307	0.1116	0.0006																			7.0721	0	0.694711749	18.8319	0.705182624	4.917784781	0	1.635961303	2.774455692	0.472082389	1.488318129	8.986533101	3.463451467	7.805072695	0.149081254	0.00196293	2.360888747	8.203742112	17.80432911	0.40802417	0.698815776	5.527498052	10.75723226	10.46655339	0.000594215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4595
H3335_822_0	2011	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	0																			0	YES	281.1292613	6.194855295	53.43474394	0	10.21091709	7.050215462	12.37063371	22.78021607	51.67803741	20.28406293	20.17854657	0	1.288401912	8.057261218	54.04702619	137.5131032	2.671233708	5.615298866	47.25508634	33.81259619	70.06853388	4.602632065																			6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.091110119	0.091110119	0.170257033	0	0.233	0.233	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																			NO	0.070939677	0.070939677	0.132564627	0	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223	0	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223	0.181417223																				19.9432	0.439461032	7.083556917	0	1.852436222	1.27903051	2.244246012	4.132723535	9.375286028	3.679878364	3.66073588	0	0.233738297	1.461725954	9.805061395	24.94724529	0.484607801	1.018711926	8.572886528	6.134187297	12.71163883	0.834996727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.8954	0	34.09012791	19.9432	0.439461032	7.083556917	0	1.852436222	1.27903051	2.244246012	4.132723535	9.375286028	3.679878364	3.66073588	0	0.233738297	1.461725954	9.805061395	24.94724529	0.484607801	1.018711926	8.572886528	6.134187297	12.71163883	0.834996727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.8954	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			10000	0.5825	0.0128	0.2069	0	0.0541	0.0374	0.0656	0.1207	0.2738	0.1075	0.1069	0	0.0068	0.0427	0.2864	0.7287	0.0142	0.0298	0.2504	0.1792	0.3713	0.0244																			3.502	0	0.508734155	20.5257	0.452297258	7.290460664	0	1.906544066	1.316389736	2.309798236	4.253436334	9.649128934	3.787364	3.767662383	0	0.240565563	1.504421535	10.09145762	25.67592985	0.498762719	1.048467501	8.823292132	6.313360889	13.08293332	0.859386162	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.3974
H3337_001_0	2011	5																															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	YES	0	0	103.8538412	0	344.335609	2.906573158	0.322952573	301.9181373	0	0	0	0	0.378488261	158.6114383	0	0	475.8343148	609.7014256	0	0	4.211442776	0	0	0	0	0	5.784643507	0	0	0											6700	1a: $0	1b: $0	"2: $0 for days 1-20 , $25/day for days 21-100"	6: $0	10a: $50/trip	11a: 20%	11b: 20%; 11c: $0	"4a,4b: $50/visit"	"9a, 9b: $0"	8a: $0	8b: $0	5: $0	12: 20%	"9c: $20/visit, 3,5,9a,9d: $0"	"7a,14b-j:$0 (In Network Urgent Care $0)"	"7b,7d,7f,7g,14b-j: $0"	"7e,7h: $20/visit"	"7c,7i: $20/visit"	7d: $0	"7b,7d,7f,7g,14b-j: $0"	15: 20%	"13a,14a: $0"	10b: $0	"16a,16b: $0"	17a: $0	17b: $0	18a: $20/visit	18b: $0	14a: $0	"13b,13c,13d,13e: $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	0.2	0	0	0	0	0	20	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	0.2	0	0	0	0	0	20	0	0	0												0	0	0.216362169	0	1.434731704	0.581314632	0.064590515	1.257992239	0	0	0	0	0.075697652	0.264352397	0	0	0.793057191	1.016169043	0	0	0.842288555	0	0	0	0	0	0.009641073	0	0	0	0	0	0	0	0	0	0	0	0	0	6.5562	0	0	0	0	0.216362169	0	1.434731704	0.581314632	0.064590515	1.257992239	0	0	0	0	0.075697652	0.264352397	0	0	0.793057191	1.016169043	0	0	0.842288555	0	0	0	0	0	0.009641073	0	0	0	0	0	0	0	0	0	0	0	0	0	6.5562	NO	0	0	0	0	0	0	0	"4a,4b: $50/visit (worldwide 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	0.216362169	0	1.434731704	0.581314632	0.064590515	1.257992239	0	0	0	0	0.075697652	0.264352397	0	0	0.793057191	1.016169043	0	0	0.842288555	0	0	0	0	0	0.009641073	0	0	0	0	0	0	0	0	0	0	0	0	0	6.5562
H3337_003_0	2011	5																															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	YES	0	0	0	0	0	0	0	374.8214752	0	0	0	0	0	158.6114383	0	14945.01846	475.8343148	931.8587606	0	111.4520931	10.16141407	0	0	0	0	0	0	0	0	0											6700	1a: $0	1b: $0	2: $0	6: $0	10a: $0	11a: $0	"11b,11c: $0"	"4a,4b: $50/visit"	"9a, 9b: $0"	8a: $0	8b: $0	5: $0	12: $0	"9c: $20/visit, 3,5,9a,9d: $0"	"7a,14b-j:$0 (In Network Urgent Care $0)"	"7b,7d: $10/visit; 7f,7g,14b-j: $0"	"7e,7h: $20/visit"	"7c,7i: $10/visit"	7d: $0	"7b,7d: $10/visit; 7f,7g,14b-j: $0"	15: 20%	"13a,14a: $0"	10b: $0	"16a,16b: $0"	17a: $0	17b: $0	18a: $0	18b: $0	14a: $0	"13b,13c,13d,13e: $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											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	1.561756147	0	0	0	0	0	0.264352397	0	12.45418205	0.793057191	0.776548967	0	0.092876744	2.032282814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.9751	0	0	0	0	0	0	0	0	0	1.561756147	0	0	0	0	0	0.264352397	0	12.45418205	0.793057191	0.776548967	0	0.092876744	2.032282814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.9751	NO	0	0	0	0	0	0	0	"4a,4b: $50/visit (worldwide 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	1.561756147	0	0	0	0	0	0.264352397	0	12.45418205	0.793057191	0.776548967	0	0.092876744	2.032282814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.9751
H3342_001_0	2011	6	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	1376.352537	84.780137	806.4048187	1142.544815	141.0794467	6.703754677	3.277076527	198.5297584	437.3416258	11185.78332	204.3347181	12.33992969	0.83910133	158.6043904	4491.067778	6299.117281	658.2367406	1362.524469	1766.749808	653.8509322	40.00715315	2.135893915	0	745.9758882	302.4	143.52	129.6	14.7	5786.047326	0	10.89295135	3.700790741	1805.393654	0	0	0	0	0	0	0		1A: $125/day (days1-6) no yrly max	1B: $125/day (days1-6) no yrly max	2: $40/day (days 1-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $50 copay; 4B: $20 copay	9A: $20-$75 copay; 9B: $75 copay	8A: $0 copay	8B: $75 copay	9A: $20 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $5 copay; 7G: $5 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $20 copay; 7F: $20 copay; 7G: $20 copay	7E: $40 copay; 7H: $40 copay	7C: $20-$40 copay; 7I: $20-$40 copay	8B: $35 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0;	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $0 copay	17B: $0 copay	18A: $0 copay	18B: $0 copay	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay; 17A: $0 copay; 17B: $0 copay; 18A: $0 copay									125	125	40	0	200	0.2	0.115514334	49.44029851	58.93360996	0	75	20	0.1	32.31121281	4.241129557	19.16318477	40	21.47532189	35	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	69.68934072	52.00210596	34.63424813	0	173.1712407	0.173171241	0.100018803	42.80818916	51.02803177	0	64.93921525	17.31712407	0.08658562	27.97686405	3.672208336	16.59256241	34.63424813	18.59454068	30.30496712	0	0.173171241	0	0	0	0	0	0	0	0	0	0.173171241	0.173171241	0	0	0	0	0	0	0	0		7.9931	0.367395472	2.327435382	0	2.035908568	1.160897514	0.32776927	0.708224954	1.859723531	0	1.10577802	0.017807674	0.072654109	0.369771122	1.374344711	8.709874719	1.89979455	2.111293055	4.461774569	0	6.928088346	0	0	0	0	0	0	0	0	0	1.8863459	0.640870524	0	0	0	0	0	0	0	0	46.3588		7.182198711	7.9931	0.367395472	2.327435382	0	2.035908568	1.160897514	0.32776927	0.708224954	1.859723531	0	1.10577802	0.017807674	0.072654109	0.369771122	1.374344711	8.709874719	1.89979455	2.111293055	4.461774569	0	6.928088346	0	0	0	0	0	0	0	0	0	1.8863459	0.640870524	0	0	0	0	0	0	0	0	46.3588	YES	1A: $125/day (days1-6) no yrly max	1B: $125/day (days1-6) no yrly max	2: $150/day (for days 1-100)	6: $50 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $20 copay	9A: $50-$75 copay; 9B: $75 copay	8A: $0 - $100 copay	8B: $150 copay	9A: $30 copay	12: 10% coin	3: $50 copay; 5: $100 copay; 9C: $100 copay; 9D: $100 copay	7A: $30 copay; 7G: $30 copay; 14B: $0 copay; 14C: $30 copay	7B: $50 copay; 7D: $50 copay; 7F: $50 copay; 7G: $50 copay	7E: $100 copay; 7H: $100 copay	7C: $50-$100 copay; 7I: $50-$100 copay	8B: $75 copay	14D: $50; 14E: $50; 14F: $50; 14G: $100; 14H: $100	15: 20% coinsurance	13A: 20% coin	10B: Not covered	$16A: 20% coinsurance	17A: $0 copay	17B: $0 copay	18A: 50% coinsurance	18B: $0 copay	14A: 50% coin or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin; 17A: 0% coin; 17B: 0% coin; 18A: 50% coin								2500	1.8749	0.0862	2.0473	0.9669	0.4776	0.2723	0.1331	0.1628	0.5011	8.3047	0.5188	0.0063	0.017	0.2684	2.059	5.3307	1.1141	1.2381	2.2427	0.879	1.6251	0.0137	0	0.2019	0	0	0	0	0.001	0	0.4425	0.1503	0.0978	0	0	0	0	0	0	0	31.0331		4.776565956	9.868	0.453574657	4.374716506	0.966888416	2.513467368	1.433206808	0.460885477	0.871009342	2.36082302	8.30470405	1.624538079	0.024073338	0.089696431	0.638211792	3.433314986	14.04055711	3.013871601	3.349397007	6.70446549	0.879013598	8.553195489	0.013694976	0	0.201862348	0	0	0	0	0.000958229	0	2.328822099	0.791198178	0.097782763	0	0	0	0	0	0	0	77.3919
H3342_002_0	2011	7	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	1184.849107	85.11098293	763.7772391	1308.552717	135.4403595	6.120915378	4.946295205	202.7962767	299.9272632	10272.67958	247.918503	9.591299635	1.649888534	132.0375389	4553.857509	5551.512465	647.1577467	1034.398285	1311.773264	676.0242462	20.87013214	0.16080823	0	745.9758882	302.4	143.52	129.6	14.7	5788.874504	0	9.028149729	5.025530296	1570.208244	0	0	0	0	0	0	0		1A: $125/day (days1-6) no yrly max	1B: $125/day (days1-6) no yrly max	2: $40/day (days 1-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $50 copay; 4B: $20 copay	9A: $20-$75 copay; 9B: $75 copay	8A: $0 copay	8B: $75 copay	9A: $20 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $5 copay; 7G: $5 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $20 copay; 7F: $20 copay; 7G: $20 copay	7E: $40 copay; 7H: $40 copay	7C: $20-$40 copay; 7I: $20-$40 copay	8B: $35 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0;	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $0 copay	17B: $0 copay	18A: $0 copay	18B: $0 copay	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay; 17A: $0 copay; 17B: $0 copay; 18A: $0 copay									125	125	40	0	200	0.2	0.116450722	48.9971572	68.17527414	0	75	20	0.1	24.75188512	4.122640289	19.24411562	40	23.29720414	35	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	71.40858975	21.96856345	35.01498116	0	175.0749058	0.175074906	0.101937996	42.89086341	59.67889849	0	65.65308968	17.50749058	0.087537453	21.66716979	3.608854302	16.84580865	35.01498116	20.3937791	30.63810852	0	0.175074906	0	0	0	0	0	0	0	0	0	0.175074906	0.175074906	0	0	0	0	0	0	0	0		7.0507	0.155813836	2.228637137	0	1.976017349	1.071618683	0.50421542	0.724842284	1.491610725	0	1.356384643	0.013993299	0.14442704	0.238406648	1.369517355	7.793309725	1.888351359	1.757940844	3.349187635	0	3.653836418	0	0	0	0	0	0	0	0	0	1.580602464	0.879844243	0	0	0	0	0	0	0	0	39.2293		5.58499764	7.0507	0.155813836	2.228637137	0	1.976017349	1.071618683	0.50421542	0.724842284	1.491610725	0	1.356384643	0.013993299	0.14442704	0.238406648	1.369517355	7.793309725	1.888351359	1.757940844	3.349187635	0	3.653836418	0	0	0	0	0	0	0	0	0	1.580602464	0.879844243	0	0	0	0	0	0	0	0	39.2293	YES	1A: $125/day (days1-6) no yrly max	1B: $125/day (days1-6) no yrly max	2: $150/day (for days 1-100)	6: $50 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $20 copay	9A: $50-$75 copay; 9B: $75 copay	8A: $0 - $100 copay	8B: $150 copay	9A: $30 copay	12: 10% coin	3: $50 copay; 5: $100 copay; 9C: $100 copay; 9D: $100 copay	7A: $30 copay; 7G: $30 copay; 14B: $0 copay; 14C: $30 copay	7B: $50 copay; 7D: $50 copay; 7F: $50 copay; 7G: $50 copay	7E: $100 copay; 7H: $100 copay	7C: $50-$100 copay; 7I: $50-$100 copay	8B: $75 copay	14D: $50; 14E: $50; 14F: $50; 14G: $100; 14H: $100	15: 20% coinsurance	13A: 20% coin	10B: Not covered	$16A: 20% coinsurance	17A: $0 copay	17B: $0 copay	18A: 50% coinsurance	18B: $0 copay	14A: 50% coin or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin; 17A: 0% coin; 17B: 0% coin; 18A: 50% coin								2500	1.6539	0.0365	1.9604	1.1195	0.4635	0.2514	0.2031	0.1667	0.369	7.7231	0.6363	0.0049	0.0339	0.2259	2.097	4.7497	1.1074	1.0309	1.6835	0.9084	0.8571	0.001	0	0.2019	0	0	0	0	0.001	0	0.3708	0.2064	0.0954	0	0	0	0	0	0	0	28.1585		3.980130046	8.7046	0.19236276	4.189012396	1.119547358	2.439527591	1.322986029	0.707344694	0.891518109	1.860599454	7.723109639	1.992713241	0.018916867	0.178304987	0.464339124	3.466490989	12.5429702	2.995717897	2.788832079	5.032641737	0.908412516	4.510909158	0.001026623	0	0.201862348	0	0	0	0	0.001000462	0	1.951361066	1.086227461	0.095416893	0	0	0	0	0	0	0	67.3877
H3342_012_0	2011	8	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	942.2975122	135.7599297	312.2314825	681.5275598	75.62218669	4.940891146	3.073882245	198.2191632	354.8923754	10262.13504	223.2059495	5.592859784	0	123.8055779	4942.403415	5708.109859	548.1034762	1084.430792	1501.204476	695.5614875	23.38913941	0.249296405	0	0	302.4	143.52	0	0	5788.874505	0	12.33428961	5.678318365	1549.62476	0	0	0	0	0	0	0		1A: $175/day (days1-7) no yrly max	1B: $175/day (days1-7) no yrly max	2: $45/day (days 1-100)	6: $0 copay	10A: $250 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $50 copay; 4B: $30 copay	9A: $30-$175 copay; 9B: $175 copay	8A: $0 copay	8B: $75 copay	9A: $30 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $15 copay; 7G: $15 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $30 copay; 7F: $30 copay; 7G: $30 copay	7E: $40 copay; 7H: $40 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: $35 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0;	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: OSB	17A: $0 copay	17B: $0 copay	18A: Not Covered	18B: $0 copay	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay; 17A: $0 copay; 17B: $0 copay; 18A: $30 copay									175	175	45	0	250	0.2	0.115930233	49.60732984	158.7965616	0	75	30	0.1	29.73305955	12.65591008	28.29535259	40	27.48465534	35	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0.740795505	0	0	0	0	0	0	0	NO	109.9100608	41.39425408	39.6313721	0	220.1742894	0.176139432	0.102099426	43.68903439	139.8516805	0	66.05228683	26.42091473	0	26.18582103	11.14602404	24.9196366	35.22788631	24.20565783	30.82440052	0	0.176139432	0	0	0	0	0	0	0	0	0	0.176139432	0.176139432	0.652416496	0	0	0	0	0	0	0		8.6307	0.468306752	1.031180172	0	1.387505102	0.870285758	0.313841614	0.721666987	4.13602459	0	1.228605283	0.012314039	0	0.270162559	4.590678938	11.85366862	1.609043912	2.187446724	3.856144004	0	4.11974972	0	0	0	0	0	0	0	0	0	2.17255476	1.000175769	0.084250063	0	0	0	0	0	0	0	50.5443		6.846933742	8.6307	0.468306752	1.031180172	0	1.387505102	0.870285758	0.313841614	0.721666987	4.13602459	0	1.228605283	0.012314039	0	0.270162559	4.590678938	11.85366862	1.609043912	2.187446724	3.856144004	0	4.11974972	0	0	0	0	0	0	0	0	0	2.17255476	1.000175769	0.084250063	0	0	0	0	0	0	0	50.5443	YES	1A: 20% coin	1B: 20% coin	2: $200/day (for days 1-100)	6: $50 copay	10A: $250 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $30 copay	9A: $60-$500 copay; 9B: $500 copay	8A: $0 - $100 copay	8B: $150 copay	9A: $60 copay	12: 10% coin	3: $50 copay; 5: $100 copay; 9C: $100 copay; 9D: $100 copay	7A: $30 copay; 7G: $30 copay; 14B: $0 copay; 14C: $30 copay	7B: $50 copay; 7D: $60 copay; 7F: $60 copay; 7G: $60 copay	7E: $100 copay; 7H: $100 copay	7C: $50-$100 copay; 7I: $50-$100 copay	8B: $125 copay	14D: $50; 14E: $50; 14F: $50; 14G: $100; 14H: $100	15: 20% coinsurance	13A: 20% coin	10B: Not covered	16A: OSB	17A: $0 copay	17B: $0 copay	18A: Not Covered	18B: $0 copay	14A: 50% coin or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin; 17A: 0% coin; 17B: 0% coin; 18A: 50% coin								3500	7.6146	0.4322	1.075	0.5866	0.3255	0.2041	0.127	0.1659	2.7544	7.7108	0.5764	0.0058	0	0.2131	2.3114	5.8122	0.9436	1.0262	3.2305	0.9535	0.9664	0.0015	0	0	0	0	0	0	0.0016	0	0.5096	0.2346	0.0966	0	0	0	0	0	0	0	37.8791		5.131257063	16.2453	0.900476579	2.106210255	0.586634172	1.712969261	1.074426861	0.440844151	0.887535668	6.890407522	7.710813028	1.804988009	0.018090996	0	0.483297249	6.902063405	17.665914	2.552619045	3.213656298	7.086599739	0.953491266	5.086110766	0.001453466	0	0	0	0	0	0	0.001634958	0	2.682166371	1.2347849	0.180882696	0	0	0	0	0	0	0	88.4234
H3342_013_0	2011	8	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	1376.352528	84.78013649	806.4048139	1142.544808	141.0794459	6.703754636	3.277076507	198.5297572	437.3416232	11185.78326	204.3347169	12.33992962	0.839101325	158.6043895	4491.067751	6299.117244	658.2367366	1362.524461	1766.749797	653.8509283	40.00715291	2.135893902	0	745.9758882	302.4	143.52	129.6	14.7	5788.874157	0	10.89295129	3.700790719	1805.393643	0	0	0	0	0	0	0		1A: $150/day (days1-6) no yrly max	1B: $150/day (days1-6) no yrly max	2: $45/day (days 1-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $50 copay; 4B: $25 copay	9A: $25-$125 copay; 9B: $125 copay	8A: $0 copay	8B: $75 copay	9A: $25 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $10 copay; 7G: $10 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: $35 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0;	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $0 copay	17B: $0 copay	18A: $0 copay	18B: $0 copay	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay; 17A: $0 copay; 17B: $0 copay; 18A: $0 copay									150	150	45	0	200	0.2	0.115514333	49.53358179	95.78838117	0	74.99999955	25	0.1	32.31121262	8.482259064	23.74477702	40	26.8441522	34.99999979	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	84.78976485	63.2700251	39.50518664	0	175.5786073	0.175578607	0.101409229	43.48518653	84.0919528	0	65.84197734	21.94732591	0.087789304	28.36578856	7.446516165	20.84537439	35.11572146	23.56629429	30.72625609	0	0.175578607	0	0	0	0	0	0	0	0	0	0.175578607	0.175578607	0	0	0	0	0	0	0	0		9.7251	0.447003447	2.65476439	0	2.064211052	1.177035903	0.332325801	0.719425294	3.064742594	0	1.12115015	0.022569038	0.073664121	0.374911548	2.786900717	10.94228811	1.926204825	2.675804368	4.52380056	0	7.024400189	0	0	0	0	0	0	0	0	0	1.912569216	0.64977968	0	0	0	0	0	0	0	0	54.2186		7.541316009	9.7251	0.447003447	2.65476439	0	2.064211052	1.177035903	0.332325801	0.719425294	3.064742594	0	1.12115015	0.022569038	0.073664121	0.374911548	2.786900717	10.94228811	1.926204825	2.675804368	4.52380056	0	7.024400189	0	0	0	0	0	0	0	0	0	1.912569216	0.64977968	0	0	0	0	0	0	0	0	54.2186	YES	1A: $150/day (days1-6) no yrly max	1B: $150/day (days1-6) no yrly max	2: $150/day (for days 1-100)	6: $50 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $25 copay	9A: $50-$125 copay; 9B: $125 copay	8A: $0 - $100 copay	8B: $150 copay	9A: $50 copay	12: 10% coin	3: $50 copay; 5: $100 copay; 9C: $100 copay; 9D: $100 copay	7A: $30 copay; 7G: $30 copay; 14B: $0 copay; 14C: $30 copay	7B: $50 copay; 7D: $50 copay; 7F: $50 copay; 7G: $50 copay	7E: $100 copay; 7H: $100 copay	7C: $50-$100 copay; 7I: $50-$100 copay	8B: $75 copay	14D: $50; 14E: $50; 14F: $50; 14G: $100; 14H: $100	15: 20% coinsurance	13A: 20% coin	10B: Not covered	$16A: 20% coinsurance	17A: $0 copay	17B: $0 copay	18A: 50% coinsurance	18B: $0 copay	14A: 50% coin or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin; 17A: 0% coin; 17B: 0% coin; 18A: 50% coin								3300	2.2812	0.1049	2.0757	0.9803	0.4842	0.2761	0.135	0.1654	0.7737	8.4202	0.526	0.0106	0.0173	0.2722	2.0876	5.4048	1.1296	1.2553	2.2739	0.8912	1.6477	0.0139	0	0.2019	0	0	0	0	0.001	0	0.4486	0.1524	0.0991	0	0	0	0	0	0	0	32.1296		4.440852928	12.0062	0.551856107	4.730506094	0.980329758	2.548408706	1.453130744	0.467292542	0.884784062	3.838441012	8.420153069	1.647121825	0.033156982	0.090943359	0.647083984	4.874494059	16.34707577	3.055769382	3.931119998	6.797668566	0.89123333	8.672098999	0.013885359	0	0.201862348	0	0	0	0	0.00097155	0	2.361196564	0.802197136	0.099142104	0	0	0	0	0	0	0	86.3482
H3342_014_0	2011	6	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	1139.494297	108.9410296	570.4689798	967.8094527	109.8294376	5.767121343	3.551968261	199.3280727	369.2475854	10561.04078	222.595199	8.640928993	0.633211017	136.7944252	4711.811282	5863.353154	605.3070781	1162.694523	1544.703465	677.8605889	28.1697396	0.835568283	0	745.9758882	302.4	143.52	129.6	14.7	5788.874157	0	11.14252056	4.89940759	1636.289866	0	0	0	0	0	0	0		1A: $150/day (days1-6) no yrly max	1B: $150/day (days1-6) no yrly max	2: $45/day (days 1-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $50 copay; 4B: $25 copay	9A: $25-$125 copay; 9B: $125 copay	8A: $0 copay	8B: $75 copay	9A: $25 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $10 copay; 7G: $10 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: $35 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0;	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $0 copay	17B: $0 copay	18A: $0 copay	18B: $0 copay	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay; 17A: $0 copay; 17B: $0 copay; 18A: $0 copay									150	150	45	0	200	0.2	0.115930162	49.43924937	106.6743509	0	74.9999955	25	0.1	29.64412634	8.410497336	23.75935463	40	27.5534926	34.9999979	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	86.94809424	38.91655049	39.90641636	0	177.3618505	0.177361851	0.10280794	43.84318378	94.59980137	0	66.51068995	22.17023131	0.088680925	26.28868552	7.458506856	21.07001552	35.4723701	24.43469218	31.03832198	0	0.177361851	0	0	0	0	0	0	0	0	0	0.177361851	0.177361851	0	0	0	0	0	0	0	0		8.2564	0.353300757	1.897114386	0	1.623296024	1.022867313	0.365170542	0.728264777	2.910895686	0	1.233746689	0.015964283	0.056153739	0.299678802	2.928589729	10.29507849	1.789306391	2.367506897	3.995416958	0	4.996237143	0	0	0	0	0	0	0	0	0	1.976258066	0.868967996	0	0	0	0	0	0	0	0	47.9802		6.12410943	8.2564	0.353300757	1.897114386	0	1.623296024	1.022867313	0.365170542	0.728264777	2.910895686	0	1.233746689	0.015964283	0.056153739	0.299678802	2.928589729	10.29507849	1.789306391	2.367506897	3.995416958	0	4.996237143	0	0	0	0	0	0	0	0	0	1.976258066	0.868967996	0	0	0	0	0	0	0	0	47.9802	YES	1A: $150/day (days1-6) no yrly max	1B: $150/day (days1-6) no yrly max	2: $150/day (for days 1-100)	6: $50 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $25 copay	9A: $50-$125 copay; 9B: $125 copay	8A: $0 - $100 copay	8B: $150 copay	9A: $50 copay	12: 10% coin	3: $50 copay; 5: $100 copay; 9C: $100 copay; 9D: $100 copay	7A: $30 copay; 7G: $30 copay; 14B: $0 copay; 14C: $30 copay	7B: $50 copay; 7D: $50 copay; 7F: $50 copay; 7G: $50 copay	7E: $100 copay; 7H: $100 copay	7C: $50-$100 copay; 7I: $50-$100 copay	8B: $75 copay	14D: $50; 14E: $50; 14F: $50; 14G: $100; 14H: $100	15: 20% coinsurance	13A: 20% coin	10B: Not covered	$16A: 20% coinsurance	17A: $0 copay	17B: $0 copay	18A: 50% coinsurance	18B: $0 copay	14A: 50% coin or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin; 17A: 0% coin; 17B: 0% coin; 18A: 50% coin								3300	1.9367	0.0829	1.4833	0.8388	0.3808	0.2399	0.1478	0.1674	0.7121	8.0155	0.5788	0.0075	0.0132	0.2371	2.2125	5.082	1.0493	1.1107	2.0083	0.9321	1.172	0.0054	0	0.2019	0	0	0	0	0.0013	0	0.4636	0.2038	0.0982	0	0	0	0	0	0	0	29.3828		3.72460113	10.1931	0.436173774	3.380454852	0.838836686	2.004069166	1.262799152	0.512944478	0.895669052	3.623023135	8.015522504	1.812541431	0.0234537	0.069325604	0.536808487	5.141073867	15.37706619	2.838591004	3.478189146	6.003695323	0.932119044	6.168194004	0.00540407	0	0.201862348	0	0	0	0	0.001293293	0	2.439824773	1.072799996	0.098179681	0	0	0	0	0	0	0	77.363
H3342_015_0	2011	6	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	1139.494297	108.9410296	570.4689798	967.8094527	109.8294376	5.767121343	3.551968261	199.3280727	369.2475854	10561.04078	222.595199	8.640928993	0.633211017	136.7944252	4711.811282	5863.353154	605.3070781	1162.694523	1544.703465	677.8605889	28.1697396	0.835568283	0	745.9758882	302.4	143.52	129.6	14.7	5788.874157	0	11.14252056	4.89940759	1636.289866	0	0	0	0	0	0	0		1A: $150/day (days1-6) no yrly max	1B: $150/day (days1-6) no yrly max	2: $45/day (days 1-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $50 copay; 4B: $25 copay	9A: $25-$125 copay; 9B: $125 copay	8A: $0 copay	8B: $75 copay	9A: $25 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $10 copay; 7G: $10 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: $35 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0;	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $0 copay	17B: $0 copay	18A: $0 copay	18B: $0 copay	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay; 17A: $0 copay; 17B: $0 copay; 18A: $0 copay									150	150	45	0	200	0.2	0.115930162	49.43924937	106.6743509	0	74.9999955	25	0.1	29.64412634	8.410497336	23.75935463	40	27.5534926	34.9999979	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	86.94809423	38.91655048	39.90641636	0	177.3618505	0.17736185	0.10280794	43.84318377	94.59980136	0	66.51068994	22.17023131	0.088680925	26.28868551	7.458506855	21.07001551	35.4723701	24.43469218	31.03832197	0	0.17736185	0	0	0	0	0	0	0	0	0	0.17736185	0.17736185	0	0	0	0	0	0	0	0		8.2564	0.353300757	1.897114385	0	1.623296024	1.022867313	0.365170541	0.728264777	2.910895686	0	1.233746688	0.015964283	0.056153739	0.299678802	2.928589729	10.29507849	1.789306391	2.367506897	3.995416957	0	4.996237142	0	0	0	0	0	0	0	0	0	1.976258066	0.868967996	0	0	0	0	0	0	0	0	47.9802		6.124109435	8.2564	0.353300757	1.897114385	0	1.623296024	1.022867313	0.365170541	0.728264777	2.910895686	0	1.233746688	0.015964283	0.056153739	0.299678802	2.928589729	10.29507849	1.789306391	2.367506897	3.995416957	0	4.996237142	0	0	0	0	0	0	0	0	0	1.976258066	0.868967996	0	0	0	0	0	0	0	0	47.9802	YES	1A: $150/day (days1-6) no yrly max	1B: $150/day (days1-6) no yrly max	2: $150/day (for days 1-100)	6: $50 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $25 copay	9A: $50-$125 copay; 9B: $125 copay	8A: $0 - $100 copay	8B: $150 copay	9A: $50 copay	12: 10% coin	3: $50 copay; 5: $100 copay; 9C: $100 copay; 9D: $100 copay	7A: $30 copay; 7G: $30 copay; 14B: $0 copay; 14C: $30 copay	7B: $50 copay; 7D: $50 copay; 7F: $50 copay; 7G: $50 copay	7E: $100 copay; 7H: $100 copay	7C: $50-$100 copay; 7I: $50-$100 copay	8B: $75 copay	14D: $50; 14E: $50; 14F: $50; 14G: $100; 14H: $100	15: 20% coinsurance	13A: 20% coin	10B: Not covered	$16A: 20% coinsurance	17A: $0 copay	17B: $0 copay	18A: 50% coinsurance	18B: $0 copay	14A: 50% coin or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin; 17A: 0% coin; 17B: 0% coin; 18A: 50% coin								3300	1.9367	0.0829	1.4833	0.8388	0.3808	0.2399	0.1478	0.1674	0.7121	8.0155	0.5788	0.0075	0.0132	0.2371	2.2125	5.082	1.0493	1.1107	2.0083	0.9321	1.172	0.0054	0	0.2019	0	0	0	0	0.0013	0	0.4636	0.2038	0.0982	0	0	0	0	0	0	0	29.3828		3.724601149	10.1931	0.436173774	3.380454851	0.838836686	2.004069166	1.262799152	0.512944478	0.895669052	3.623023134	8.015522503	1.812541431	0.0234537	0.069325604	0.536808487	5.141073866	15.37706618	2.838591003	3.478189145	6.003695442	0.932119044	6.168194003	0.00540407	0	0.201862348	0	0	0	0	0.001293293	0	2.439824773	1.072799996	0.098179681	0	0	0	0	0	0	0	77.363
H3342_808_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	287.3730022	3.440804724	46.58324099	9.717705866	8.15626733	16.37282546	4.132748483	13.89305501	54.35403103	6.880455563	28.72803249	0	0.02526268	35.14762533	54.40531949	149.8025413	1.449043418	5.761962484	22.64213675	27.33798314	52.75567127	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.066932932	0.066932932	0.145774666	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.052548852	0.052548852	0.11444727	0	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865																				15.1011	0.180810337	5.331324756	0	1.342805972	2.695537912	0.680394489	2.287281239	8.94856857	1.132762874	4.729635756	0	0.004159118	5.786524557	8.957012439	24.66272118	0.238563068	0.948619917	3.727685131	4.500785168	8.685422825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9417		27.35682888	15.1011	0.180810337	5.331324756	0	1.342805972	2.695537912	0.680394489	2.287281239	8.94856857	1.132762874	4.729635756	0	0.004159118	5.786524557	8.957012439	24.66272118	0.238563068	0.948619917	3.727685131	4.500785168	8.685422825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9417	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.6779	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.6779		3.039647654	16.779	0.180810337	5.331324756	0	1.342805972	2.695537912	0.680394489	2.287281239	8.94856857	1.132762874	4.729635756	0	0.004159118	5.786524557	8.957012439	24.66272118	0.238563068	0.948619917	3.727685131	4.500785168	8.685422825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.6196
H3342_809_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	287.3730022	3.440804724	46.58324099	9.717705866	8.15626733	16.37282546	4.132748483	13.89305501	54.35403103	6.880455563	28.72803249	0	0.02526268	35.14762533	54.40531949	149.8025413	1.449043418	5.761962484	22.64213675	27.33798314	52.75567127	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.066932932	0.066932932	0.145774666	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.052548852	0.052548852	0.11444727	0	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865																				15.1011	0.180810337	5.331324756	0	1.342805972	2.695537912	0.680394489	2.287281239	8.94856857	1.132762874	4.729635756	0	0.004159118	5.786524557	8.957012439	24.66272118	0.238563068	0.948619917	3.727685131	4.500785168	8.685422825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9417		27.35682888	15.1011	0.180810337	5.331324756	0	1.342805972	2.695537912	0.680394489	2.287281239	8.94856857	1.132762874	4.729635756	0	0.004159118	5.786524557	8.957012439	24.66272118	0.238563068	0.948619917	3.727685131	4.500785168	8.685422825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9417	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.6779	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.6779		3.039647654	16.779	0.180810337	5.331324756	0	1.342805972	2.695537912	0.680394489	2.287281239	8.94856857	1.132762874	4.729635756	0	0.004159118	5.786524557	8.957012439	24.66272118	0.238563068	0.948619917	3.727685131	4.500785168	8.685422825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.6196
H3342_810_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	287.3730022	3.440804724	46.58324099	9.717705866	8.15626733	16.37282546	4.132748483	13.89305501	54.35403103	6.880455563	28.72803249	0	0.02526268	35.14762533	54.40531949	149.8025413	1.449043418	5.761962484	22.64213675	27.33798314	52.75567127	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.066932932	0.066932932	0.145774666	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.052548852	0.052548852	0.11444727	0	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865																				15.1011	0.180810337	5.331324756	0	1.342805972	2.695537912	0.680394489	2.287281239	8.94856857	1.132762874	4.729635756	0	0.004159118	5.786524557	8.957012439	24.66272118	0.238563068	0.948619917	3.727685131	4.500785168	8.685422825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9417		27.35682888	15.1011	0.180810337	5.331324756	0	1.342805972	2.695537912	0.680394489	2.287281239	8.94856857	1.132762874	4.729635756	0	0.004159118	5.786524557	8.957012439	24.66272118	0.238563068	0.948619917	3.727685131	4.500785168	8.685422825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9417	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.6779	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.6779		3.039647654	16.779	0.180810337	5.331324756	0	1.342805972	2.695537912	0.680394489	2.287281239	8.94856857	1.132762874	4.729635756	0	0.004159118	5.786524557	8.957012439	24.66272118	0.238563068	0.948619917	3.727685131	4.500785168	8.685422825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.6196
H3342_811_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	287.3730022	3.440804724	46.58324099	9.717705866	8.15626733	16.37282546	4.132748483	13.89305501	54.35403103	6.880455563	28.72803249	0	0.02526268	35.14762533	54.40531949	149.8025413	1.449043418	5.761962484	22.64213675	27.33798314	52.75567127	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.066932932	0.066932932	0.145774666	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.052548852	0.052548852	0.11444727	0	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865	0.164634865																				15.1011	0.180810337	5.331324756	0	1.342805972	2.695537912	0.680394489	2.287281239	8.94856857	1.132762874	4.729635756	0	0.004159118	5.786524557	8.957012439	24.66272118	0.238563068	0.948619917	3.727685131	4.500785168	8.685422825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9417		27.35682888	15.1011	0.180810337	5.331324756	0	1.342805972	2.695537912	0.680394489	2.287281239	8.94856857	1.132762874	4.729635756	0	0.004159118	5.786524557	8.957012439	24.66272118	0.238563068	0.948619917	3.727685131	4.500785168	8.685422825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9417	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.6779	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.6779		3.039647654	16.779	0.180810337	5.331324756	0	1.342805972	2.695537912	0.680394489	2.287281239	8.94856857	1.132762874	4.729635756	0	0.004159118	5.786524557	8.957012439	24.66272118	0.238563068	0.948619917	3.727685131	4.500785168	8.685422825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.6196
H3344_003_0	2011	6																															A	A	D		T	Coin	Coin	V	V		V			V	V	V	Coin	V	P	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	226.982669	5.926440443	830.3290169	0	154.7719043	11.09739972	1.058607812	323.0935617	543.680146	0	658.4850104	0	0	1562.919527	3790.651171	8050.537558	1.582899687	1364.964968	1181.879884	294.9102516	5.714694283	592.5766737	0	0	0	0	59.38814682	0	0	0											3400	$200/Admit for IP Medical; $200/Admit for IP Surg; PBP 1a	$200/Admit for IP S/A; PBP 1b	$25/Day for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for Emergency Room and Worldwide Coverage; PBP 4a, 4b"	"$75/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$30/Case for Diagnostic Radiology; $20/Case for Non-Diagnostic Radiology; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$10/Visit for PT/OT/ST, CORF; $20/Visit for OP Hospital; 45% Coinsurance for OP Substance Abuse, Partial Hosptial; PBP 3, 5, 9a, 9c, 9d, 13a"	"$10/Visit for PCP and No Cost Sharing for Physical Exams and Preventive Tests; PBP 4b, 7a, 14a-f, 14i-j"	"$20/Visit for SCP; 50% Coinsurance for Chiropractor; $20/Case for Medicare Covered Vision Exam; $20/Visit for Medicare Covered Hearing Exam; $20/Visit for Podatrist; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"45% Coinsurance for OP MH; PBP 7e, 7h"	"$10/Visit for PT/OT/ST; PBP 7c, 7i"	"$20/Procedure for Radiology; PBP 7d, 14g-h"	"$20/Visit for Physician Specialist  Services; PBP 7d,"	20% Coinsurance for Part B Drugs; PBP 15	"$20/Visit for Other Health Care Professional Services; PBP 7d,"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$20/Exam for Routine Hearing Exam; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	200	200	25	0	100	0.2	0.2	50	75	0	22.62140048	0	0	14.37854566	10	19.26318155	0.45	10	20	20	0.2	20	0	0	0	0	20	0	0	0											NO	188.039677	188.039677	23.50495962	0	94.01983849	0.188039677	0.188039677	47.00991925	70.51487887	0	21.26860419	0	0	13.51868541	9.401983849	18.11121218	0.423089273	9.401983849	18.8039677	18.8039677	0.188039677	18.8039677	0	0	0	0	18.8039677	0	0	0												3.5568	0.092867162	1.626404168	0	1.212635787	2.086751459	0.199060271	1.265716854	3.19479497	0	1.167088088	0	0	1.760718117	2.969970091	12.15041616	0.669707878	1.069448215	1.852002596	0.46212357	1.074589267	0.928566053	0	0	0	0	0.093061066	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4327	0	2.380920868	3.5568	0.092867162	1.626404168	0	1.212635787	2.086751459	0.199060271	1.265716854	3.19479497	0	1.167088088	0	0	1.760718117	2.969970091	12.15041616	0.669707878	1.069448215	1.852002596	0.46212357	1.074589267	0.928566053	0	0	0	0	0.093061066	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4327	YES	30% Coinsurance for IP Medical; 30% Coinsurance for IP Surg; PBP 1a	30% Coinsurance for IP S/A; 30% Coinsurance for IP Psych; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$100/Trip for Ambulance; PBP 10a	50% Coinsurance for DME; PBP 11a	"50% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for Emergency Room and Worldwide Coverage; PBP 4a, 4b"	"30% Coinsurance for Outpatient Surgery; PBP 9a, 9b"	30% Coinsurance for Lab; PBP 8a	30% Coinsurance for Diagnostic Radiology; 30% Coinsurance for Non-Diagnostic Radiology; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"30% Coinsurance for PT/OT/ST, CORF; 30% Coinsurance for OP Hospital; 45% Coinsurance for OP Substance Abuse, Partial Hosptial; PBP 3, 5, 9a, 9c, 9d, 13a"	"$30/Visit for PCP and No Cost Sharing for Physical Exams and Preventive Tests; $30/Visit for Physical Exams and Preventive; PBP 4b, 7a, 14a-f, 14i-j"	"$30/Visit for SCP; 50% Coinsurance for Chiropractor; $30/Case for Medicare Covered Vision Exam; 30% Coinsurance for Medicare Covered Hearing Exam; $30/Visit for Podatrist; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"45% Coinsurance for OP MH; PBP 7e, 7h"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	"30% Coinsurance for Radiology; PBP 7d, 14g-h"	"30% Coinsurance for Physician Specialist  Services; PBP 7d,"	20% Coinsurance for Part B Drugs; PBP 15	"30% Coinsurance for Other Health Care Professional Services; PBP 7d,"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$35/Exam for Routine Vision Exam; PBP 17a	No Cost Sharing; PBP 17b	30% Coinsurance for Routine Hearing Exam; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											5100	7.3027	0.206	0.0984	0.1433	0.1257	0.6747	0.0642	0.1312	2.0256	0.8121	0.6416	0	0	0.9793	1.0279	1.9627	0.2358	0.1563	1.3231	2.79	0.5277	1.1311	0	0.2631	0.0987	0	0.0165	0	0	0											22.7376	0	1.446232437	10.8595	0.298821513	1.724843242	0.143348235	1.338323576	2.761401735	0.263239603	1.396906412	5.220393436	0.812054908	1.808686539	0	0	2.739987029	3.997859997	14.11315971	0.905554079	1.225710229	3.175092343	3.252080268	1.602287456	2.059689062	0	0.263144857	0.09871302	0	0.109557754	0	0	0	0	0	0	0	0	0	0	0	0	0	60.1703
H3344_005_0	2011	4																															A	A	D		T	Coin	Coin	V	V		V			V	V	V	Coin	V	P	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	151.0374782	3.444460006	986.6518962	0	166.3993821	6.483750816	0.743667834	273.5669877	433.2457515	0	538.8294721	0	0	1386.626514	4089.862559	5207.810237	1.786849808	720.7901486	1076.948198	268.5126395	3.047142053	468.365517	0	0	0	0	20.7643534	0	0	0											3400	$500/Admit for IP Medical; $500/Admit for IP Surg; PBP 1a	$500/Admit for IP S/A; $500/Admit for IP Psych; PBP 1b	$45/Day for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for Emergency Room and Worldwide Coverage; PBP 4a, 4b"	"$100/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$75/Case for Diagnostic Radiology; $30/Case for Non-Diagnostic Radiology; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$15/Visit for PT/OT/ST, CORF; $30/Visit for OP Hospital; 45% Coinsurance for OP Substance Abuse, Partial Hosptial; PBP 3, 5, 9a, 9c, 9d, 13a"	"$20/Visit for PCP and No Cost Sharing for Physical Exams and Preventive Tests; PBP 4b, 7a, 14a-f, 14i-j"	"$30/Visit for SCP; 50% Coinsurance for Chiropractor; $30/Case for Medicare Covered Vision Exam; $30/Visit for Medicare Covered Hearing Exam; $30/Visit for Podatrist; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"45% Coinsurance for OP MH; PBP 7e, 7h"	"$15/Visit for PT/OT/ST; PBP 7c, 7i"	"$30/Procedure for Radiology; PBP 7d, 14g-h"	"$30/Visit for Physician Specialist  Services; PBP 7d,"	20% Coinsurance for Part B Drugs; PBP 15	"$30/Visit for Other Health Care Professional Services; PBP 7d,"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$30/Exam for Routine Hearing Exam; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	500	500	45	0	150	0.3	0.3	50	100	0	41.67403546	0	0	21.1998392	20	28.31111523	0.45	15	30	30	0.2	30	0	0	0	0	30	0	0	0											NO	464.903554	464.903554	41.84131986	0	139.4710662	0.278942132	0.278942132	46.4903554	92.9807108	0	38.74881439	0	0	19.71176118	18.59614216	26.32387618	0.418413199	13.94710662	27.89421324	27.89421324	0.185961422	27.89421324	0	0	0	0	27.89421324	0	0	0												5.8515	0.133445142	3.440234798	0	1.933991603	1.808591279	0.207440291	1.059852207	3.35695816	0	1.739916934	0	0	2.277737558	6.337972131	11.42414599	0.747641543	0.837744754	2.503385223	0.624162402	0.566650868	1.088723967	0	0	0	0	0.048267108	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9884	0	3.471747289	5.8515	0.133445142	3.440234798	0	1.933991603	1.808591279	0.207440291	1.059852207	3.35695816	0	1.739916934	0	0	2.277737558	6.337972131	11.42414599	0.747641543	0.837744754	2.503385223	0.624162402	0.566650868	1.088723967	0	0	0	0	0.048267108	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9884	YES	30% Coinsurance for IP Medical; 30% Coinsurance for IP Surg; PBP 1a	30% Coinsurance for IP S/A; 30% Coinsurance for IP Psych; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$150/Trip for Ambulance; PBP 10a	50% Coinsurance for DME; PBP 11a	"50% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for Emergency Room and Worldwide Coverage; PBP 4a, 4b"	"30% Coinsurance for Outpatient Surgery; PBP 9a, 9b"	30% Coinsurance for Lab; PBP 8a	30% Coinsurance for Diagnostic Radiology; 30% Coinsurance for Non-Diagnostic Radiology; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"30% Coinsurance for PT/OT/ST, CORF; 30% Coinsurance for OP Hospital; 45% Coinsurance for OP Substance Abuse, Partial Hosptial; PBP 3, 5, 9a, 9c, 9d, 13a"	"30% Coinsurance for PCP and No Cost Sharing for Physical Exams and Preventive Tests; 30% Coinsurance for Immunizations; 30% Coinsurance for Physical Exams and Preventive; PBP 4b, 7a, 14a-f, 14i-j"	"30% Coinsurance for SCP; 50% Coinsurance for Chiropractor; 30% Coinsurance for Medicare Covered Vision Exam; 30% Coinsurance for Medicare Covered Hearing Exam; 30% Coinsurance for Podatrist; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"45% Coinsurance for OP MH; PBP 7e, 7h"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	"30% Coinsurance for Radiology; PBP 7d, 14g-h"	"30% Coinsurance for Physician Specialist  Services; PBP 7d,"	20% Coinsurance for Part B Drugs; PBP 15	"30% Coinsurance for Other Health Care Professional Services; PBP 7d,"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$35/Exam for Routine Vision Exam; PBP 17a	No Cost Sharing; PBP 17b	30% Coinsurance for Routine Hearing Exam; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											5100	7.4417	0.152	0.3047	0.1464	0.199	0.5385	0.0601	0.109	1.8488	0.462	0.5788	0	0	0.8743	1.5361	1.5313	0.097	0.0974	1.385	2.4872	0.4607	0.923	0	0.2766	0.0904	0	0.0087	0	0	0											21.6089	500	1.346974978	13.2932	0.285448427	3.744933705	0.146430553	2.132961936	2.347118855	0.267547525	1.168890465	5.205728764	0.461978934	2.318764313	0	0	3.15199082	7.874042988	12.95549062	0.84468854	0.935187086	3.888392068	3.11134601	1.027354828	2.011762297	0	0.27662746	0.090397921	0	0.056953896	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5972
H3344_006_0	2011	4																															A	A	D		T	Coin	Coin	V	V		V			V	V	V	Coin	V	P	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	170.5825663	3.948879348	1103.836293	0	187.3095745	7.124957268	0.715088849	314.1414561	420.494876	0	530.9901546	0	0	1518.945833	3906.500409	4650.944562	1.705169452	585.3423671	1004.998194	273.4887573	2.828148916	439.5644036	0	0	0	0	21.73739094	0	0	0											3400	$600/Admit for IP Medical; $600/Admit for IP Surg; PBP 1a	$600/Admit for IP S/A; $600/Admit for IP Psych; PBP 1b	$50/Day for SNF; PBP 2	No Cost Sharing; PBP 6	$180/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for Emergency Room and Worldwide Coverage; PBP 4a, 4b"	"$125/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$100/Case for Diagnostic Radiology; $35/Case for Non-Diagnostic Radiology; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$20/Visit for PT/OT/ST, CORF; $35/Visit for OP Hospital; 45% Coinsurance for OP Substance Abuse, Partial Hosptial; PBP 3, 5, 9a, 9c, 9d, 13a"	"$25/Visit for PCP and No Cost Sharing for Physical Exams and Preventive Tests; PBP 4b, 7a, 14a-f, 14i-j"	"$35/Visit for SCP; 50% Coinsurance for Chiropractor; $35/Case for Medicare Covered Vision Exam; $35/Visit for Medicare Covered Hearing Exam; $35/Visit for Podatrist; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"45% Coinsurance for OP MH; PBP 7e, 7h"	"$20/Visit for PT/OT/ST; PBP 7c, 7i"	"$35/Procedure for Radiology; PBP 7d, 14g-h"	"$35/Visit for Physician Specialist  Services; PBP 7d,"	20% Coinsurance for Part B Drugs; PBP 15	"$35/Visit for Other Health Care Professional Services; PBP 7d,"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$35/Exam for Routine Hearing Exam; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	600	600	50	0	180	0.3	0.3	50	125	0	51.75525422	0	0	25.5974575	25	32.92175538	0.45	20	35	35	0.2	35	0	0	0	0	35	0	0	0											NO	550.147177	550.147177	45.84559808	0	165.0441531	0.275073588	0.275073588	45.84559808	114.6139952	0	47.45501167	0	0	23.47061497	22.92279904	30.18635131	0.412610383	18.33823923	32.09191866	32.09191866	0.183382392	32.09191866	0	0	0	0	32.09191866	0	0	0												7.8205	0.181038735	4.217169587	0	2.576195841	1.959887563	0.196702056	1.200166911	4.016216475	0	2.099845332	0	0	2.970882734	7.462326986	11.6995872	0.70357062	0.894512363	2.687693358	0.731398246	0.518632714	1.175538757	0	0	0	0	0.058132882	0	0	0	0	0	0	0	0	0	0	0	0	0	53.17	0	4.818115269	7.8205	0.181038735	4.217169587	0	2.576195841	1.959887563	0.196702056	1.200166911	4.016216475	0	2.099845332	0	0	2.970882734	7.462326986	11.6995872	0.70357062	0.894512363	2.687693358	0.731398246	0.518632714	1.175538757	0	0	0	0	0.058132882	0	0	0	0	0	0	0	0	0	0	0	0	0	53.17	YES	30% Coinsurance for IP Medical; 30% Coinsurance for IP Surg; PBP 1a	30% Coinsurance for IP S/A; 30% Coinsurance for IP Psych; PBP 1b	30% Coinsurance for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$180/Trip for Ambulance; PBP 10a	50% Coinsurance for DME; PBP 11a	"50% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for Emergency Room and Worldwide Coverage; PBP 4a, 4b"	"30% Coinsurance for Outpatient Surgery; PBP 9a, 9b"	30% Coinsurance for Lab; PBP 8a	30% Coinsurance for Diagnostic Radiology; 30% Coinsurance for Non-Diagnostic Radiology; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"30% Coinsurance for PT/OT/ST, CORF; 30% Coinsurance for OP Hospital; 45% Coinsurance for OP Substance Abuse, Partial Hosptial; PBP 3, 5, 9a, 9c, 9d, 13a"	"$40/Visit for PCP and No Cost Sharing for Physical Exams and Preventive Tests; 30% Coinsurance for Immunizations; $40/Visit for Physical Exams and Preventive; PBP 4b, 7a, 14a-f, 14i-j"	"$40/Visit for SCP; 50% Coinsurance for Chiropractor; $40/Case for Medicare Covered Vision Exam; 30% Coinsurance for Medicare Covered Hearing Exam; $40/Visit for Podatrist; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"45% Coinsurance for OP MH; PBP 7e, 7h"	"30% Coinsurance for PT/OT/ST; PBP 7c, 7i"	"30% Coinsurance for Radiology; PBP 7d, 14g-h"	"30% Coinsurance for Physician Specialist  Services; PBP 7d,"	20% Coinsurance for Part B Drugs; PBP 15	"30% Coinsurance for Other Health Care Professional Services; PBP 7d,"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$35/Exam for Routine Vision Exam; PBP 17a	No Cost Sharing; PBP 17b	30% Coinsurance for Routine Hearing Exam; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											5100	6.7005	0.1202	0.2531	0.1492	0.2567	0.5241	0.0521	0.1196	1.6111	0.3923	0.5193	0	0	0.7993	1.2501	1.3522	0.083	0.0772	1.1722	2.0904	0.3556	0.7685	0	0	0.0863	0	0.0083	0	0	0											18.7414	250	1.522764082	14.5209	0.301222296	4.470248736	0.14924124	2.832916903	2.483979171	0.248828743	1.319765009	5.627357956	0.392328189	2.619107196	0	0	3.770162746	8.712434304	13.05174842	0.786527105	0.971700498	3.85989412	2.821838478	0.874260193	1.94406396	0	0	0.086345969	0	0.066471924	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9114
H3344_801_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	248.7879488	6.074631969	44.98672394	0	12.91438571	9.449264487	0.382045975	14.24721665	63.84714235	17.27064948	19.73869121	0	0	22.42912677	45.84511961	50.17881989	1.549050717	4.650978085	40.55557197	82.55052716	25.18806724	22.58154354	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-f, 14i-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.092374609	0.090272217	0.178381457	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	0.08182016	0.079957981	0.15800012	0	0.20637811	0.20637811	0.20637811	0.20637811	0.20637811	0.20637811	0.20637811	0	0	0.20637811	0.20637811	0.20637811	0.20637811	0.20637811	0.20637811	0.20637811	0.20637811	0.20637811	0	0	0	0	0	0	0	0												20.3559	0.485715305	7.107907786	0	2.665246519	1.950121348	0.078845926	2.940313648	13.17665258	3.564284002	4.07363379	0	0	4.628880798	9.46142915	10.35581002	0.31969016	0.959860068	8.369782303	17.0366218	5.198265718	4.660336283	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.3893	0	14.6207112	20.3559	0.485715305	7.107907786	0	2.665246519	1.950121348	0.078845926	2.940313648	13.17665258	3.564284002	4.07363379	0	0	4.628880798	9.46142915	10.35581002	0.31969016	0.959860068	8.369782303	17.0366218	5.198265718	4.660336283	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.3893	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-f, 14i-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											10000	2.2618	0.054	0.7898	0	0.2961	0.2167	0.0088	0.3267	1.4641	0.396	0.4526	0	0	0.5143	1.0513	1.1506	0.0355	0.1067	0.93	1.893	0.5776	0.5178	0	0	0	0	0	0	0	0											13.0433	0	1.624523466	22.6176	0.539683672	7.897675318	0	2.961385021	2.166801498	0.087606585	3.267015165	14.64072509	3.960315558	4.526259767	0	0	5.143200886	10.51269906	11.50645558	0.355211289	1.066511187	9.299758115	18.92957977	5.775850798	5.178151425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.4325
H3344_803_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	221.4973059	3.860093047	39.6090693	0	12.33076337	10.80298852	0.909708579	12.53906285	60.54455737	16.61965367	16.43642803	0	0	30.05484163	55.77710431	49.99282143	1.9346686	3.953475004	44.55478818	80.7450508	21.37131752	30.99313324	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-f, 14i-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.093548922	0.09113205	0.170240803	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	0.082856212	0.08071559	0.150782156	0	0.20636793	0.20636793	0.20636793	0.20636793	0.20636793	0.20636793	0.20636793	0	0	0.20636793	0.20636793	0.20636793	0.20636793	0.20636793	0.20636793	0.20636793	0.20636793	0.20636793	0	0	0	0	0	0	0	0												18.3524	0.311569689	5.972340852	0	2.544674116	2.229390382	0.187734677	2.587660448	12.49445499	3.42976353	3.391951633	0	0	6.202355462	11.51060557	10.31691509	0.399253555	0.815870454	9.19467942	16.66318901	4.410354564	6.395988759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.4112	0	14.62107682	18.3524	0.311569689	5.972340852	0	2.544674116	2.229390382	0.187734677	2.587660448	12.49445499	3.42976353	3.391951633	0	0	6.202355462	11.51060557	10.31691509	0.399253555	0.815870454	9.19467942	16.66318901	4.410354564	6.395988759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.4112	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-f, 14i-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											10000	2.0392	0.0346	0.6636	0	0.2827	0.2477	0.0209	0.2875	1.3883	0.3811	0.3769	0	0	0.6892	1.279	1.1463	0.0444	0.0907	1.0216	1.8515	0.49	0.7107	0	0	0	0	0	0	0	0											13.0457	0	1.624564091	20.3916	0.346188543	6.63593428	0	2.827415685	2.477100424	0.208594085	2.875178275	13.88272777	3.810848367	3.768835148	0	0	6.891506068	12.78956175	11.46323899	0.443615061	0.906522727	10.21631047	18.51465446	4.90039396	7.106654177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.4569
H3344_804_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	221.4973059	3.860093047	39.6090693	0	12.33076337	10.80298852	0.909708579	12.53906285	60.54455737	16.61965367	16.43642803	0	0	30.05484163	55.77710431	49.99282143	1.9346686	3.953475004	44.55478818	80.7450508	21.37131752	30.99313324	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-f, 14i-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.093548922	0.09113205	0.170240803	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	0.082856212	0.08071559	0.150782156	0	0.20636793	0.20636793	0.20636793	0.20636793	0.20636793	0.20636793	0.20636793	0	0	0.20636793	0.20636793	0.20636793	0.20636793	0.20636793	0.20636793	0.20636793	0.20636793	0.20636793	0	0	0	0	0	0	0	0												18.3524	0.311569689	5.972340852	0	2.544674116	2.229390382	0.187734677	2.587660448	12.49445499	3.42976353	3.391951633	0	0	6.202355462	11.51060557	10.31691509	0.399253555	0.815870454	9.19467942	16.66318901	4.410354564	6.395988759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.4112	0	14.62107682	18.3524	0.311569689	5.972340852	0	2.544674116	2.229390382	0.187734677	2.587660448	12.49445499	3.42976353	3.391951633	0	0	6.202355462	11.51060557	10.31691509	0.399253555	0.815870454	9.19467942	16.66318901	4.410354564	6.395988759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.4112	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-f, 14i-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											10000	2.0392	0.0346	0.6636	0	0.2827	0.2477	0.0209	0.2875	1.3883	0.3811	0.3769	0	0	0.6892	1.279	1.1463	0.0444	0.0907	1.0216	1.8515	0.49	0.7107	0	0	0	0	0	0	0	0											13.0457	0	1.624564091	20.3916	0.346188543	6.63593428	0	2.827415685	2.477100424	0.208594085	2.875178275	13.88272777	3.810848367	3.768835148	0	0	6.891506068	12.78956175	11.46323899	0.443615061	0.906522727	10.21631047	18.51465446	4.90039396	7.106654177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.4569
H3346_002_0	2011	7																															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	Coin																																																			0	NO			843.0772518		163.4104267	6.778463113	3.559472906	290.9422306			548.8584089	54.03307464		911.5153811	3941.437199	6190.712176	348.9166596	1180.845582	2612.145625	5.525936938	1194.980886				15.60269468		3.644122925			0.341559802												$0 Copay	$0 (190 day limit)	$0 days 1-20; $105/day days 21-100	$0 Copay	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	$0 for OP Surgery;$0 for ASC	$0 Copay	"$15 Copay for MRI, CT, Other Imaging, and Diag Rad.;$15 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$15 Copay	$0 Copay	"$15 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$15 Copay for Chemotherapy;$15 Copay for Clinic"	$10 Copay for Office Visits;$0 Copay for Preventive Services;$15 Copay for PCP Ophthalmology Services	$15 Copay for Office Visits;$15 Copay for Chiro Visits;$0 Copay for Preventive Services	$15 Copay	$15 Copay	$15 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$15 	$100 allowance	$15 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture											0			26.76		35	0.2	0.2	44.56214977			15	15		15	10.00001828	15	15	15	14.98886814	31.20787463	19.70311949				15		15			0.5											NO			25.66052347		33.56197016	0.191782687	0.191782687	42.73124402			14.3837015	14.3837015		14.3837015	9.589151861	14.3837015	14.3837015	14.3837015	14.373027	29.9256502	18.89358595				14.3837015		14.3837015			0.479456717												0	0	1.802816967	0	0.457031322	1.299991867	0.682645277	1.036026954	0	0	0.657884626	0.064766301	0	1.092580429	3.149586655	7.420446333	0.41822609	1.415410864	3.128703301	0.013780605	1.881456174	0	0	0	0.018702042	0	0.004367998	0	0	0.163763141	0	0	0	0	0	0	0	0	0	0	24.7082	0	1.058671764	0	0	1.802816967	0	0.457031322	1.299991867	0.682645277	1.036026954	0	0	0.657884626	0.064766301	0	1.092580429	3.149586655	7.420446333	0.41822609	1.415410864	3.128703301	0.013780605	1.881456174	0	0	0	0.018702042	0	0.004367998	0	0	0.163763141	0	0	0	0	0	0	0	0	0	0	24.7082	NO	20.00%	20.00%	20.00%	20.00%	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	20% for OP Surgery;$0 for ASC	20.00%	"$0 Copay for MRI, CT, Other Imaging, and Diag Rad.;$25 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$25 Copay	$0 Copay	"$25 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$25 Copay for Chemotherapy; 20% Copay for Clinic"	$25 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	2500.00%	$25 Copay	$25 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 	$100 allowance	$25 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture												2.4366	0.0018	0.3059	0.0008	0.2805	0.0462	0.1064	0.071	0.0868	0.1696	0.0716	0.0035		0.1077	0.2499	0.5451	0.0048	0.0922	0.1703	0.0001	0.0765				0.0083					0.0182											4.8539	0	0.207963827	2.4366	0.001828928	2.108754307	0.000772391	0.737526132	1.346213292	0.789043395	1.107034345	0.086816973	0.169626495	0.729466238	0.068250794	0	1.20029421	3.399472883	7.965511436	0.423061373	1.50764388	3.299026401	0.013889885	1.957906446	0	0	0	0.027039238	0	0.004367998	0	0	0.181988093	0	0	0	0	0	0	0	0	0	0	29.5621
H3346_007_0	2011	7																															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	Coin																																																			0	NO			1386.438344		267.4584258	7.546237076	3.66932894	331.6112579			488.1813584	52.68590079		801.0116423	4052.920724	5869.661301	233.5826684	1002.241095	2704.561427	10.57870492	1183.883992				7.699795542		3.79243661			0.256925476												$0 Copay	$0 (190 day limit)	$0 days 1-20; $105/day days 21-100	$0 Copay	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	$0 for OP Surgery;$0 for ASC	$0 Copay	"$15 Copay for MRI, CT, Other Imaging, and Diag Rad.;$15 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$15 Copay	$0 Copay	"$15 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$15 Copay for Chemotherapy;$15 Copay for Clinic"	$10 Copay for Office Visits;$0 Copay for Preventive Services;$15 Copay for PCP Ophthalmology Services	$15 Copay for Office Visits;$15 Copay for Chiro Visits;$0 Copay for Preventive Services	$15 Copay	$15 Copay	$15 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$15 	$100 allowance	$15 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture											0			26.76		35	0.2	0.2	44.60280374			15	15		15	10.000075	15	15	15	14.99584129	25.10437565	20.55794658				15		15			0.5											NO			25.91738469		33.89792467	0.193702427	0.193702427	43.1983566			14.527682	14.527682		14.527682	9.685193976	14.527682	14.527682	14.527682	14.52365424	24.31389242	19.9106207				14.527682		14.527682			0.484256067												0	0	2.994404658	0	0.755523797	1.461724434	0.71075792	1.193755114	0	0	0.591011961	0.063783668	0	0.969736868	3.271110282	7.106047736	0.282784561	1.213353327	3.273342921	0.021434124	1.964322093	0	0	0	0.009321682	0	0.004591276	0	0	0.124417721	0	0	0	0	0	0	0	0	0	0	26.0114	0	0.845672683	0	0	2.994404658	0	0.755523797	1.461724434	0.71075792	1.193755114	0	0	0.591011961	0.063783668	0	0.969736868	3.271110282	7.106047736	0.282784561	1.213353327	3.273342921	0.021434124	1.964322093	0	0	0	0.009321682	0	0.004591276	0	0	0.124417721	0	0	0	0	0	0	0	0	0	0	26.0114	NO	20.00%	20.00%	20.00%	20.00%	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	20% for OP Surgery;$0 for ASC	20.00%	"$0 Copay for MRI, CT, Other Imaging, and Diag Rad.;$25 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$25 Copay	$0 Copay	"$25 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$25 Copay for Chemotherapy; 20% Copay for Clinic"	$25 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	2500.00%	$25 Copay	$25 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 	$100 allowance	$25 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture												0.9281	0.0079	0.1804	0.0033	0.0124	0.0311	0.0151	0.0196	0.2373	0.0945	0.106	0.0017		0.0946	0.1465	0.1924	0.0078	0.0333	0.0898	0.0005	0.0463				0.0003		0.0001			0.0027											2.252	0	0.029153279	0.9281	0.007891472	3.174774339	0.003332717	0.76795717	1.492867986	0.725901353	1.213400295	0.237318299	0.094547391	0.697059622	0.065533108	0	1.064327056	3.417642158	7.298481789	0.290540693	1.246632829	3.363148116	0.021890801	2.010654926	0	0	0	0.009577354	0	0.004717204	0	0	0.127068569	0	0	0	0	0	0	0	0	0	0	28.2634
H3346_802_0	2011	4																															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	Coin																																																			0	NO					279.5939911	7.134800514	4.394919799	332.1104204			395.4805343	75.50372517		887.4759113	4490.807102	7204.328655	162.8909964	1244.029315	3006.701614	12.05541596	1409.185478				12.34607218		4.074693579			0.478271659												$0 Copay	$0 (190 day limit)	$0 (days 1-100)	$0 Copay	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	$0 for OP Surgery;$0 for ASC	$0 Copay	"$15 Copay for MRI, CT, Other Imaging, and Diag Rad.;$15 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$15 Copay	$0 Copay	"$15 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$15 Copay for Chemotherapy;$15 Copay for Clinic"	$10 Copay for Office Visits;$0 Copay for Preventive Services;$15 Copay for PCP Ophthalmology Services	$15 Copay for Office Visits;$15 Copay for Chiro Visits;$0 Copay for Preventive Services	$15 Copay	$15 Copay	$15 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$15 	$100 allowance	$15 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture											0					35	0.2	0.2	43.33438653			15	15		15	10.00005339	15	15	15	14.99245941	31.31600869	19.25307652				15		15			0.5											NO					33.75076434	0.192861511	0.192861511	41.78767622			14.46461329	14.46461329		14.46461329	9.643127008	14.46461329	14.46461329	14.46461329	14.45734184	30.19826369	18.5658871				14.46461329		15			0.5												0	0	0	0	0.786375909	1.376028404	0.847610871	1.156510226	0	0	0.476706083	0.091011016	0	1.069749655	3.608785271	8.683985666	0.196346273	1.49953358	3.622409419	0.030337719	2.18023154	0	0	0	0.014881763	0	0.005093367	0	0	0.23913583	0	0	0	0	0	0	0	0	0	0	25.8847	0	0.949046097	0	0	0	0	0.786375909	1.376028404	0.847610871	1.156510226	0	0	0.476706083	0.091011016	0	1.069749655	3.608785271	8.683985666	0.196346273	1.49953358	3.622409419	0.030337719	2.18023154	0	0	0	0.014881763	0	0.005093367	0	0	0.23913583	0	0	0	0	0	0	0	0	0	0	25.8847	YES	20.00%	20.00%	20.00%	20.00%	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	20% for OP Surgery;$0 for ASC	20.00%	"$0 Copay for MRI, CT, Other Imaging, and Diag Rad.;$25 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$25 Copay	$0 Copay	"$25 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$25 Copay for Chemotherapy; 20% Copay for Clinic"	$25 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	2500.00%	$25 Copay	$25 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 	$100 allowance	$25 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture											4000	0.6799	0.0044	0.198	0.0034	0.2398	0.0374	0.0854	0.0326	0.1654	0.1129	0.0907	0.0065		0.0684	0.1515	0.3466	0.0148	0.0982	0.1494	0.0011	0.0355				0.0002		0.0001			0.0023											2.5246	0	0.093321338	0.6799	0.004433781	0.197975507	0.003408644	1.026153593	1.413423846	0.93298507	1.189120493	0.165412641	0.11288583	0.567429446	0.097543324	0	1.138181195	3.760325748	9.030588129	0.211163071	1.597696545	3.771813645	0.031448102	2.215773102	0	0	0	0.015087009	0	0.005148891	0	0	0.241442243	0	0	0	0	0	0	0	0	0	0	28.4094
H3346_803_0	2011	5																															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	Coin																																																			0	NO	259.1116416	3.922595016	1316.555307		245.1971652	6.51061971	3.494025686	276.7454887			301.1989869	50.65705323		682.6640983	3839.953197	5956.058806	205.1989632	1002.102104	2523.441558	8.118882787	1152.90556				5.757793227		0.042968606			0.251877357												$300 Copay	$300 (190 day limit)	$0 days 1-20; $105/day days 21-100	$0 Copay	$50 Copay	20.00%	20.00%	$50 ER Copay;$40 UC Copay	$0 for OP Surgery;$0 for ASC	$0 Copay	"$40 Copay for MRI, CT, Other Imaging, and Diag Rad.;$40 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$40 Copay	$0 Copay	"$40 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$40 Copay for Chemotherapy;$40 Copay for Clinic"	$20 Copay for Office Visits;$0 Copay for Preventive Services;$40 Copay for PCP Ophthalmology Services	$40 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$40 Copay	$40 Copay	$40 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No Coverage	No coverage	$40 	No coverage	$40 Copay	No coverage	No Cost Sharing	50.0% for Accupuncture											0	300	300	26.76		50	0.2	0.2	48.60878482			40	40		40	19.93409871	39.01683271	40	40	39.97609943	25.85701421	33.48523081				40		9.96			0.5											NO	262.3616288	262.3616288	23.40265729		43.72693814	0.174907753	0.174907753	42.51026654			34.98155051	34.98155051		34.98155051	17.45525059	34.1217326	34.98155051	34.98155051	34.96064853	22.61296121	29.28413232				34.98155051		9.96			0.437269381												5.6651	0.085761535	2.567574388	0	0.893476773	1.138757861	0.61113218	0.980377041	0	0	0.878033964	0.147671856	0	1.990054053	5.58561211	16.9359205	0.598181491	2.921257114	7.351762782	0.015299332	2.81348658	0	0	0	0.016784711	0	3.57E-05	0	0	0.110138256	0	0	0	0	0	0	0	0	0	0	51.3064	0	7.352315598	5.6651	0.085761535	2.567574388	0	0.893476773	1.138757861	0.61113218	0.980377041	0	0	0.878033964	0.147671856	0	1.990054053	5.58561211	16.9359205	0.598181491	2.921257114	7.351762782	0.015299332	2.81348658	0	0	0	0.016784711	0	3.57E-05	0	0	0.110138256	0	0	0	0	0	0	0	0	0	0	51.3064	YES	$500 Copay	$500 (190 day limit)	20.00%	0.00%	$50 Copay	20.00%	20.00%	$50 ER Copay;$50 UC Copay	$0 for OP Surgery;$0 for ASC	0.00%	"$50 Copay for MRI, CT, Other Imaging, and Diag Rad.;$50 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$50 Copay	$0 Copay	"$50 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$50 Copay for Chemotherapy;$50 Copay for Clinic"	$25 Copay for Office Visits;$0 Copay for Preventive Services;$50 Copay for PCP Ophthalmology Services	$50 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	5000.00%	$50 Copay	$50 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No Coverage	No coverage	$50 	No coverage	$50 Copay	No coverage	No Cost Sharing	50.0% for Accupuncture											4000	0.1554	0.0024	0.1584		0.0147	0.0243	0.013	0.0166			0.0181	0.003		0.0409	0.127	0.3466	0.0123		0.1512	0.0003	0.0586				0.0003					0.0023											1.1456	0	0.164177731	5.8205	0.088113777	2.726023661	0	0.908180385	1.163020276	0.624152984	0.996972496	0	0	0.89609581	0.150709581	0	2.030991021	5.712628128	17.28254986	0.610486552	2.921257114	7.50299429	0.0156253	2.872103256	0	0	0	0.017129986	0	3.57E-05	0	0	0.112484865	0	0	0	0	0	0	0	0	0	0	52.452
H3346_804_0	2011	3																															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	Coin																																																			0	YES	294.9058986	4.15532555	1613.696572		301.858982	14.1622367	3.974429088	290.3171221			470.3307883	56.20098795		779.4690114	3139.767585	7621.970423	134.1148778	964.5979413	3184.601192	10.54908391	1458.90016				252.3503558		0.944690148			0.062610959												$300 Copay	$300 (190 day limit)	$0 days 1-20; $105/day days 21-100	$0 Copay	$50 Copay	20.00%	20.00%	$50 ER Copay;$40 UC Copay	$0 for OP Surgery;$0 for ASC	$0 Copay	"$40 Copay for MRI, CT, Other Imaging, and Diag Rad.;$40 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$40 Copay	$0 Copay	"$40 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$40 Copay for Chemotherapy;$40 Copay for Clinic"	$20 Copay for Office Visits;$0 Copay for Preventive Services;$40 Copay for PCP Ophthalmology Services	$40 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$40 Copay	$40 Copay	$40 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No Coverage	No coverage	$40 	No coverage	$40 Copay	No coverage	No Cost Sharing	50.0% for Accupuncture											0	300	300	26.76		50	0.2	0.2	49.73797154			40	40		40	20.01352127	38.84027883	40	40	38.83455533	25.71888109	35.40374023				33.47583996		38.771875			0.5											YES	251.2874336	251.2874336	22.41483908		41.88123894	0.167524956	0.167524956	41.66175741			33.50499115	33.50499115		33.50499115	16.76382132	32.53357996	33.50499115	33.50499115	32.52878582	21.54277208	29.65505008				33.47583996		33.50499115			0.418812389												6.1755	0.087015091	3.014229083	0	1.053519012	2.372528076	0.665816057	1.007926793	0	0	1.313202408	0.1569178	0	2.176341861	4.386208566	20.66416535	0.374459816	2.693237124	8.632600841	0.018938043	3.60531311	0	0	0	0.70397001	0	0.002637653	0	0	0.026222245	0	0	0	0	0	0	0	0	0	0	59.1308	0	11.32605242	6.1755	0.087015091	3.014229083	0	1.053519012	2.372528076	0.665816057	1.007926793	0	0	1.313202408	0.1569178	0	2.176341861	4.386208566	20.66416535	0.374459816	2.693237124	8.632600841	0.018938043	3.60531311	0	0	0	0.70397001	0	0.002637653	0	0	0.026222245	0	0	0	0	0	0	0	0	0	0	59.1308	YES	$300 Copay	$300 (190 day limit)	$0 days 1-20; $105/day days 21-100	0.00%	$50 Copay	20.00%	20.00%	$50 ER Copay;$40 UC Copay	$0 for OP Surgery;$0 for ASC	0.00%	"$40 Copay for MRI, CT, Other Imaging, and Diag Rad.;$40 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$40 Copay	$0 Copay	"$40 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$40 Copay for Chemotherapy;$40 Copay for Clinic"	$20 Copay for Office Visits;$0 Copay for Preventive Services;$40 Copay for PCP Ophthalmology Services	$40 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	4000.00%	$40 Copay	$40 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No Coverage	No coverage	$40 	No coverage	$40 Copay	No coverage	No Cost Sharing	50.0% for Accupuncture											4000	0.1016	0.0014	0.0496		0.0173	0.0505	0.0142	0.0166			0.0216	0.0026		0.0358	0.0722	0.3401	0.0062	0.0443	0.1421	0.0004	0.063				0.0116					0.0006											0.9917	0	0.192243866	6.2771	0.088447066	3.063833122	0	1.07085638	2.423077242	0.680001957	1.024513866	0	0	1.334813289	0.159500138	0	2.212157104	4.458390758	21.00422778	0.380622161	2.737558719	8.77466432	0.019341537	3.66830362	0	0	0	0.715563544	0	0.002637653	0	0	0.026780938	0	0	0	0	0	0	0	0	0	0	60.1224
H3346_805_0	2011	4																															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	Coin																																																			0	NO	252.7611153	3.675960505	1386.510698		258.9754386	12.07877268	3.401135535	249.5854259			406.8820289	49.00586502		674.3584849	2694.967555	6529.342323	114.93805	829.0363286	2723.85194	9.210303677	1247.017551				215.9887337		0.800143492			0.053064559												$100 (Rider $0) Copay	100	$0 days 1-20; $105/day days 21-100	$0 Copay	$35 Copay	20.00%	20.00%	$50 ER Copay;$20 UC Copay	$0 for OP Surgery;$0 for ASC	$0 Copay	"$20 Copay for MRI, CT, Other Imaging, and Diag Rad.;$20 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$20 Copay	$0 Copay	"$20 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$20 Copay for Chemotherapy;$20 Copay for Clinic"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$20 Copay for PCP Ophthalmology Services	$20 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$20 Copay	$20 Copay	$20 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No Coverage	No coverage	$20 	No coverage	$20 Copay	No coverage	No Cost Sharing	50.0% for Accupuncture											0	100	100	26.76		35	0.2	0.2	49.21861086			20	20		20	15.0033367	20	20	20	19.70838335	25.68764555	21.40266515				20		20			0.5											NO	94.82071547	94.82071547	25.37402346		33.18725041	0.189641431	0.189641431	46.66943897			18.96414309	18.96414309		18.96414309	14.22627121	18.96414309	18.96414309	18.96414309	18.6876301	24.3572093	20.29416022				18.96414309		18.96414309			0.474103577												1.9972	0.029046434	2.931779581	0	0.716223561	2.290635734	0.64499621	0.97066765	0	0	0.643014085	0.077446186	0	1.065719234	3.194944945	10.31861518	0.181641802	1.310163631	4.241861459	0.018694775	2.108931166	0	0	0	0.341336771	0	0.001264503	0	0	0.025158097	0	0	0	0	0	0	0	0	0	0	33.1094	0	1.808496713	1.9972	0.029046434	2.931779581	0	0.716223561	2.290635734	0.64499621	0.97066765	0	0	0.643014085	0.077446186	0	1.065719234	3.194944945	10.31861518	0.181641802	1.310163631	4.241861459	0.018694775	2.108931166	0	0	0	0.341336771	0	0.001264503	0	0	0.025158097	0	0	0	0	0	0	0	0	0	0	33.1094	YES	$100 (Rider $0)	10000.00%	$0 days 1-20; $105/day days 21-100	0.00%	$35 Copay	20.00%	20.00%	$50 ER Copay;$20 UC Copay	$0 for OP Surgery;$0 for ASC	0.00%	"$20 Copay for MRI, CT, Other Imaging, and Diag Rad.;$20 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$20 Copay	$0 Copay	"$20 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$20 Copay for Chemotherapy;$20 Copay for Clinic"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$20 Copay for PCP Ophthalmology Services	$20 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	2000.00%	$20 Copay	$20 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No Coverage	No coverage	$20 	No coverage	$20 Copay	No coverage	No Cost Sharing	50.0% for Accupuncture											4000	0.0329	0.0005	0.0482		0.0118	0.0377	0.0106	0.016			0.0106	0.0013		0.0175	0.0526	0.1698	0.003	0.0216	0.0698	0.0003	0.0347				0.0056					0.0004											0.5448	0	0.029761753	2.0301	0.02952444	2.980026779	0	0.728010184	2.328331869	0.655610671	0.986641564	0	0	0.653595927	0.078720689	0	1.083257376	3.247522957	10.48842476	0.184631013	1.331724503	4.311668184	0.019002427	2.143637056	0	0	0	0.346954023	0	0.001264503	0	0	0.025572115	0	0	0	0	0	0	0	0	0	0	33.6542
H3347_002_0	2011	5																															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																																																			0	YES	418.7731535	5.294335474	68.97110895		11.66882661	11.5566541	3.114648688	9.026436191	17.92836585	29.45310129	9.354292243		0.171355538	13.87052052	51.34939095	148.6323247	3.01011865	9.684329153	35.71893362	17.87785392	6.315768476	11.32637122																			3400	1a: FFS	1b: FFS	2: FFS	6: FFS	10a: FFS	11a: FFS	11b: FFS 11c: FFS	4a: FFS 4a1: $0 4b: FFS	9b: FFS	8a: FFS	8b: FFS		12: FFS	5: FFS 9a: FFS 9c: FFS 9d: FFS	7a: FFS 14b: FFS 14c: FFS 14d: FFS 14e: FFS 14f: FFS 14g: FFS 14h: FFS 14i: FFS	7b: FFS 7d: FFS 7f: FFS 7f1: $0	7e: FFS 7h: FFS	3: FFS 7c: FFS 7i: FFS	7d: FFS	7g: FFS 16b: FFS	15: FFS	13a: FFS 14j: FFS 17a: FFS 17b: FFS 18a: FFS				"17b1: $0,  up to $100"		"18b1: $0, up to $750 per ear every three years"	14a: $0	13b: $0 13c: $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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.040324169	0.040324169	0.094732972		0.15260633	0.15260633	0.15260633	0.15260633	0.15260633	0.15260633	0.15260633		0.15260633	0.15260633	0.15260633	0.15260633	0.15260633	0.15260633	0.15260633	0.15260633	0.15260633	0.15260633																				16.8867	0.213489676	6.533838143	0	1.780736803	1.763618567	0.475315105	1.377491298	2.735982112	4.494729689	1.427524207	0	0.02614994	2.116729229	7.83624209	22.68223355	0.459363159	1.477889929	5.450935363	2.728273671	0.963826247	1.728475941	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.1595	0	43.80879451	16.8867	0.213489676	6.533838143	0	1.780736803	1.763618567	0.475315105	1.377491298	2.735982112	4.494729689	1.427524207	0	0.02614994	2.116729229	7.83624209	22.68223355	0.459363159	1.477889929	5.450935363	2.728273671	0.963826247	1.728475941	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.1595	NO																																																																																		0	0	0	16.8867	0.213489676	6.533838143	0	1.780736803	1.763618567	0.475315105	1.377491298	2.735982112	4.494729689	1.427524207	0	0.02614994	2.116729229	7.83624209	22.68223355	0.459363159	1.477889929	5.450935363	2.728273671	0.963826247	1.728475941	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.1595
H3347_003_0	2011	7																															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																																																			0	YES	809.5329719	35.27675715	146.3636964		38.75328554	19.23816855	26.55464755	20.76738178	57.91836534	57.9364934	23.97684897		3.198007793	32.67173318	66.28039863	332.0079556	25.33136361	39.00630447	77.77870406	35.39921135	71.16829269	24.14463743																			3400	1a: FFS	1b: FFS	2: FFS	6: FFS	10a: FFS	11a: FFS	11b: FFS 11c: FFS	4a: FFS 4a1: $0 4b: FFS	9b: FFS	8a: FFS	8b: FFS		12: FFS	5: FFS 9a: FFS 9c: FFS 9d: FFS	7a: FFS 14b: FFS 14c: FFS 14d: FFS 14e: FFS 14f: FFS 14g: FFS 14h: FFS 14i: FFS	7b: FFS 7d: FFS 7f: FFS 7f1: $0	7e: FFS 7h: FFS	3: FFS 7c: FFS 7i: FFS	7d: FFS	7g: FFS 16b: FFS	15: FFS	13a: FFS 14j: FFS 17a: FFS 17b: FFS 18a: FFS				"17b1: $0,  up to $100"		"18b1: $0, up to $750 per ear every three years"	14a: $0	13b: $0 13c: $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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.060625588	0.06071582	0.142514697		0.227774406	0.229635005	0.229155089	0.229428575	0.229651246	0.229218017	0.229402086		0.22931192	0.229178903	0.229402756	0.229192111	0.230041952	0.229291293	0.229239734	0.229388331	0.229876235	0.229301697																				49.0784	2.141857255	20.85897782	0	8.827006588	4.417756939	6.085132627	4.764630807	13.30102474	13.28008812	5.500339171	0	0.733341307	7.487671981	15.20490612	76.09360427	5.827276326	8.943806002	17.82996943	8.120166009	16.3598992	5.536406345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	290.3923	0	4.636789031	49.0784	2.141857255	20.85897782	0	8.827006588	4.417756939	6.085132627	4.764630807	13.30102474	13.28008812	5.500339171	0	0.733341307	7.487671981	15.20490612	76.09360427	5.827276326	8.943806002	17.82996943	8.120166009	16.3598992	5.536406345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	290.3923	NO																																																																																		0	0	0	49.0784	2.141857255	20.85897782	0	8.827006588	4.417756939	6.085132627	4.764630807	13.30102474	13.28008812	5.500339171	0	0.733341307	7.487671981	15.20490612	76.09360427	5.827276326	8.943806002	17.82996943	8.120166009	16.3598992	5.536406345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	290.3923
H3347_005_0	2011	7																															D	D	D	P	T	Coin	Coin	V	V	V	Coin		Coin	V	P	P	Coin	P	P	P	Coin	P		P	P	P		P	P	P																																																			0	YES	1332.976848	85.77702497	586.4232504		303.4398673	2.325023552	0.922144878	166.9222944	137.8129367		7.386289564		2.052021437	289.3749427		13669.46109	1.050199048	2954.360235	4095.23599	111.711188	10.96199465	2463.34504								3.00E-28											3400	1a: $120/day days 1-7	1b: $120/day days 1-7	"2: $0/day days 1-14, $100/day days 15-100"	6: $0	10a: $120	11a: 20%	11b: 20% 11c: $0	4a: $50 4b: $50	9b: $75	8a: $0	"8b: $75 diag rad, $0 x-rays, 20% ther rad"		12: 20%	5: $20 9a: $100 9c: 20% 9d: $10	"7a: $0 PCP, $25 UC 14b: $0 14c: $0 14d: $0 14e: $0 14f: $0 14g: $0 14h: $0 14i: $0"	7b: $15 7d: $15 7f: $15 7f1: $0	7e: 20% 7h: 20%	3: $25 7c: $15 7i: $15	7d: $15	7g: $15 16b: $0 m/c	15: 20%	13a: $0 14j: $0 17a: $15 17b: $0 18a: $0		16a: $0 16b1: $400/$800	17a1: $0	"17b1: $0,  up to $100"	18a1: $0	"18b1: $0, up to $500 per ear every three years"	14a: $0													80.7419281	80.7419281	47.66540831		63.98418972	0.190425664	0.136146009	50.66546204	72.32757387		0.146174151		0.084566776	14.20814473		5.021466494	0.2	5.691310948	7.352275187	28.00133988	0.199919252	5.325946853								1.00E-28											NO	76.41317117	76.41317117	45.10995823		60.55385296	0.180216514	0.128846915	47.94917231	68.44992946		0.138337425		0.08003296	13.44641404		4.752254347	0.189277549	5.386186928	6.958103127	26.50012488	0.18920113	5.040410826								1.00E-28												8.4881	0.546207874	2.204460694	0	1.531204425	0.41900764	0.118815522	0.666982155	0.78610715	0	1.021800279	0	0.16422935	0.324254608	0	5.413396323	0.198779102	1.326061373	2.374589529	0.246696703	2.074021777	1.034689251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9394	0	1.639397583	8.4881	0.546207874	2.204460694	0	1.531204425	0.41900764	0.118815522	0.666982155	0.78610715	0	1.021800279	0	0.16422935	0.324254608	0	5.413396323	0.198779102	1.326061373	2.374589529	0.246696703	2.074021777	1.034689251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9394	NO																																																																																		0	0	0	8.4881	0.546207874	2.204460694	0	1.531204425	0.41900764	0.118815522	0.666982155	0.78610715	0	1.021800279	0	0.16422935	0.324254608	0	5.413396323	0.198779102	1.326061373	2.374589529	0.246696703	2.074021777	1.034689251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9394
H3347_007_0	2011	5																															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																																																			0	YES	947.3119724	13.21804615	229.2983225		51.20213722	47.52103847	30.43513933	21.15424312	24.92954499	32.66459962	15.6426315		4.308130906	21.68010472	56.88749814	291.8421485	9.327881806	15.04535657	44.21348	22.95568485	38.3127376	10.48107617																			3400	1a: FFS	1b: FFS	2: FFS	6: FFS	10a: FFS	11a: FFS	11b: FFS 11c: FFS	4a: FFS 4a1: $0 4b: FFS	9b: FFS	8a: FFS	8b: FFS		12: FFS	5: FFS 9a: FFS 9c: FFS 9d: FFS	7a: FFS 14b: FFS 14c: FFS 14d: FFS 14e: FFS 14f: FFS 14g: FFS 14h: FFS 14i: FFS	7b: FFS 7d: FFS 7f: FFS 7f1: $0	7e: FFS 7h: FFS	3: FFS 7c: FFS 7i: FFS	7d: FFS	7g: FFS 16b: FFS	15: FFS	13a: FFS 14j: FFS 17a: FFS 17b: FFS 18a: FFS				"17b1: $0,  up to $100"		"18b1: $0, up to $750 per ear every three years"	14a: $0	13b: $0 13c: $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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.059817002	0.060886743	0.141544634		0.225582049	0.225248342	0.222910428	0.221311493	0.216268253	0.221474661	0.225934471		0.228454815	0.213397332	0.221181572	0.223589195	0.229591103	0.222203232	0.221207865	0.216014702	0.226116785	0.219331736																				56.6654	0.80480378	32.45594713	0	11.55028301	10.7040351	6.784309922	4.681677137	5.391469153	7.23438112	3.534209675	0	0.984213249	4.626476509	12.58246626	65.25275102	2.141598668	3.343126854	9.780369531	4.958765432	8.663153043	2.298832628	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	254.4382	0	9.958842921	56.6654	0.80480378	32.45594713	0	11.55028301	10.7040351	6.784309922	4.681677137	5.391469153	7.23438112	3.534209675	0	0.984213249	4.626476509	12.58246626	65.25275102	2.141598668	3.343126854	9.780369531	4.958765432	8.663153043	2.298832628	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	254.4382	NO																																																																																		0	0	0	56.6654	0.80480378	32.45594713	0	11.55028301	10.7040351	6.784309922	4.681677137	5.391469153	7.23438112	3.534209675	0	0.984213249	4.626476509	12.58246626	65.25275102	2.141598668	3.343126854	9.780369531	4.958765432	8.663153043	2.298832628	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	254.4382
H3347_008_0	2011	5																															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																																																			0	YES	418.7731535	5.294335474	68.97110895		11.66882661	11.5566541	3.114648688	9.026436191	17.92836585	28.1181872	9.354292243		0.160923246	13.87052052	49.86904014	139.5128367	2.467373538	8.714499721	33.58309371	17.52826155	6.315768476	10.60049131																			3400	1a: FFS	1b: FFS	2: FFS	6: FFS	10a: FFS	11a: FFS	11b: FFS 11c: FFS	4a: FFS 4a1: $0 4b: FFS	9b: FFS	8a: FFS	8b: FFS		12: FFS	5: FFS 9a: FFS 9c: FFS 9d: FFS	7a: FFS 14b: FFS 14c: FFS 14d: FFS 14e: FFS 14f: FFS 14g: FFS 14h: FFS 14i: FFS	7b: FFS 7d: FFS 7f: FFS 7f1: $0	7e: FFS 7h: FFS	3: FFS 7c: FFS 7i: FFS	7d: FFS	7g: FFS 16b: FFS	15: FFS	13a: FFS 14j: FFS 17a: FFS 17b: FFS 18a: FFS				"17b1: $0,  up to $100"		"18b1: $0, up to $750 per ear every three years"	14a: $0	13b: $0 13c: $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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.040821042	0.040821042	0.095900269		0.154486741	0.154486741	0.154486741	0.154486741	0.154486741	0.154486741	0.154486741		0.154486741	0.154486741	0.154486741	0.154486741	0.154486741	0.154486741	0.154486741	0.154486741	0.154486741	0.154486741																				17.0948	0.21612029	6.614347924	0	1.802678995	1.785349829	0.481171925	1.39446471	2.769694811	4.343887103	1.445114123	0	0.024860508	2.142811511	7.704105487	21.55288346	0.381176497	1.346274661	5.1881427	2.707884003	0.975702489	1.637635355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6091	0	41.47536189	17.0948	0.21612029	6.614347924	0	1.802678995	1.785349829	0.481171925	1.39446471	2.769694811	4.343887103	1.445114123	0	0.024860508	2.142811511	7.704105487	21.55288346	0.381176497	1.346274661	5.1881427	2.707884003	0.975702489	1.637635355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6091	NO																																																																																		0	0	0	17.0948	0.21612029	6.614347924	0	1.802678995	1.785349829	0.481171925	1.39446471	2.769694811	4.343887103	1.445114123	0	0.024860508	2.142811511	7.704105487	21.55288346	0.381176497	1.346274661	5.1881427	2.707884003	0.975702489	1.637635355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6091
H3347_009_0	2011	8																															D	D	D	P	T	Coin	Coin	V	V	V	Coin		Coin	V	P	P	Coin	P	P	P	Coin	P		P	P	P		P	P	P																																																			0	YES	1332.976848	85.77702497	586.4232504		303.4398673	2.325023552	0.922144878	166.9222944	137.8129367		7.386289564		2.052021437	287.8711383		13669.46109	1.050199048	2954.360235	4095.23599	111.711188	10.96199465	2463.34504								282.7617147											3400	1a: $100/day days 1-7	1b: $100/day days 1-7	"2: $0/day days 1-14, $75/day days 15-100"	6: $0	10a: $75	11a: 20%	11b: 20% 11c: $0	4a: $50 4b: $50	9b: $50	8a: $0	"8b: $75 diag rad, $0 x-rays, 20% ther rad"		12: 20%	5: $0 9a: $75 9c: 20% 9d: $0	"7a: $0 PCP, $15 UC 14b: $0 14c: $0 14d: $0 14e: $0 14f: $0 14g: $0 14h: $0 14i: $0"	7b: $20 7d: $15 7f: $20 7f1: $0	7e: 20% 7h: 20%	3: $25 7c: $20 7i: $20	7d: $15	7g: $20 16b: $0 m/c	15: 20%	13a: $0 14j: $0 17a: $20 17b: $0 18a: $0		16a: $0 16b1: $400/$800	17a1: $0	"17b1: $0,  up to $100"	18a1: $0	"18b1: $0, up to $750 per ear every three years"	14a: $0	13b: $20 13c: $0												67.28494008	67.28494008	35.74905623		39.99011858	0.190425664	0.136146009	50.66546204	48.21838258		0.146174151		0.084566776	12.19026703		5.052141417	0.2	6.070731678	7.352275187	37.33511985	0.199919252	7.10126247								6.529281463											NO	64.23401485	64.23401485	34.12807392		38.17683225	0.181791124	0.129972692	48.36811978	46.03199913		0.139546124		0.080732234	11.63751937		4.823060352	0.190931328	5.795464309	7.01889833	35.64222009	0.190854242	6.779267373								6.529281463												7.1352	0.459150225	1.667791337	0	0.965364409	0.422668645	0.119853652	0.672809794	0.528650415	0	1.030728079	0	0.165664275	0.279175496	0	5.494052985	0.200515899	1.426824108	2.395337088	0.331802896	2.092143178	1.391639555	0	0	0	0	0	0	0	0.153852569	0	0	0	0	0	0	0	0	0	0	26.9332	0	1.271940977	7.1352	0.459150225	1.667791337	0	0.965364409	0.422668645	0.119853652	0.672809794	0.528650415	0	1.030728079	0	0.165664275	0.279175496	0	5.494052985	0.200515899	1.426824108	2.395337088	0.331802896	2.092143178	1.391639555	0	0	0	0	0	0	0	0.153852569	0	0	0	0	0	0	0	0	0	0	26.9332	NO																																																																																		0	0	0	7.1352	0.459150225	1.667791337	0	0.965364409	0.422668645	0.119853652	0.672809794	0.528650415	0	1.030728079	0	0.165664275	0.279175496	0	5.494052985	0.200515899	1.426824108	2.395337088	0.331802896	2.092143178	1.391639555	0	0	0	0	0	0	0	0.153852569	0	0	0	0	0	0	0	0	0	0	26.9332
H3347_010_0	2011	6																															D	D	Coin	P	T	Coin	Coin	V	V	V	Coin		Coin	V	P	P	Coin	P	P	P	Coin	P		P	P	P		P	P	P																																																			0	YES	1329.644406	85.56258241	20.64609798		318.6118607	2.44127473	0.968252122	175.2684091	137.4684044		7.36782384		2.154622509	287.1514604	3243.302114	13647.51309	1.047573551	2946.974334	4084.9979	111.43191	11.32847924	2586.512292								296.8998004											3400	1a: $150/day days 1-7	1b: $150/day days 1-7	2: FFS	6: $0	10a: $75	11a: 20%	11b: 20% 11c: $0	4a: $50 4b: $50	9b: $75	8a: $0	"8b: $75 diag rad, $0 x-rays, 20% ther rad"		12: 20%	5: $0 9a: $100 9c: 20% 9d: $0	"7a: $10 PCP, $20 UC 14b: $0 14c: $0 14d: $0 14e: $0 14f: $0 14g: $0 14h: $0 14i: $0"	7b: $20 7d: $15 7f: $20 7f1: $0	7e: 20% 7h: 20%	3: $20 7c: $20 7i: $20	7d: $15	7g: $20 16b: $0 m/c	15: 20%	13a: $0 14j: $0 17a: $20 17b: $0 18a: $0		16a: $0 16b1: $400/$800	17a1: $0	"17b1: $0,  up to $100"	18a1: $0	"18b1: $0, up to $750 per ear every three years"	14a: $0	13b: $20												100.9274101	100.9274101	0.144638709		39.99011858	0.190425664	0.136146009	50.66546204	72.32757387		0.146174626		0.084566776	14.23012758	10	5.052084087	0.2	6.070731678	7.352275187	37.33511985	0.199917958	7.10126247								6.529281463											NO	92.77592417	92.77592417	0.132956844		36.7602835	0.175045777	0.125150064	46.57342399	66.48597741		0.134368711		0.07773667	13.08081953	9.19234171	4.644048327	0.183846834	5.580424001	6.758462586	34.31971794	0.183771418	6.52772312								6.529281463												10.2799	0.661512305	2.745040022	0	0.97602186	0.427334832	0.121176815	0.680237494	0.761643436	0	0.990004994	0	0.167493179	0.313014703	2.484461775	5.28164253	0.192593081	1.370447192	2.300692123	0.318692643	2.081850698	1.407003007	0	0	0	0	0	0	0	0.161545197	0	0	0	0	0	0	0	0	0	0	33.7223	0	2.948719899	10.2799	0.661512305	2.745040022	0	0.97602186	0.427334832	0.121176815	0.680237494	0.761643436	0	0.990004994	0	0.167493179	0.313014703	2.484461775	5.28164253	0.192593081	1.370447192	2.300692123	0.318692643	2.081850698	1.407003007	0	0	0	0	0	0	0	0.161545197	0	0	0	0	0	0	0	0	0	0	33.7223	NO	0.2	0.2	0.2	0.2					0.2	0.2	0.2			0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2																				2.6889	0.0679	0.2173	0.3332					0.2372	0.3166	0.114			0.1171	0.4206	1.3264	0.011	0.0726	0.4454	0.1773	0.0363	0.0005																			6.5824	0	0	12.9688	0.729393627	2.962367369	0.333230726	0.97602186	0.427334832	0.121176815	0.680237494	0.998813188	0.316580204	1.104053164	0	0.167493179	0.430109507	2.905048286	6.608016393	0.203620171	1.443032992	2.746107203	0.495996385	2.118173724	1.407546918	0	0	0	0	0	0	0	0.161545197	0	0	0	0	0	0	0	0	0	0	40.3047
H3351_001_0	2011	6																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	V	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	305.6649761	6.879900708	2324.969739	0	256.4685571	5.942358853	2.411275625	297.9109163	363.539326	0	772.918173	0	0	317.5456411	4226.38064	4140.975563	165.4978617	653.9380756	718.0556901	1698.858815	48.06059744	0	0	0	227.9970995	0	41.64728661	0	0	0											3400	$100/Admit for IP Medical; PBP 1a	$100/Admit for IP Medical; PBP 1b	$25/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"$35/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$25/Visit for OP Radiology; PBP 8b	$0-$35 Copay; PBP 9a	$0 Copay; PBP 12	"$0-$35 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$10/Visit for PCP; PBP 7a	"$25/Visit for Specialist; PBP 7d, 17a, 18a"	"$25/Visit for MH; $25/Visit for SA; PBP 7e, 7h, 9c"	"$25/Visit for PT/OT/ST; PBP 7c, 7i"	$25/Visit for Radiology; PBP 8b	"$10/Visit for Chiro; $25/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $25/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$25 Copay; PBP 7g		"$0 Copay; PBP 16a, 16b"	$25/Visit for Vision Exams; PBP 17a	$0 Copay; PBP 17b	$25/Visit for Hearing Exams; PBP 18a														0	100	100	25	0	100	0.2	0.2	50	35	0	25	0	0	25	10	25	25	25	25	21.5588198	0.2	0	0	0	25	0	25	0	0	0											NO	99.04736949	99.04736949	24.76184237	0	99.04736949	0.198094739	0.198094739	49.52368475	34.66657932	0	24.76184237	0	0	24.76184237	9.904736949	24.76184237	24.76184237	24.76184237	24.76184237	21.3534439	0.198094739	0	0	0	24.76184237	0	24.76184237	0	0	0												2.5229	0.056786339	4.797544518	0	2.116877994	1.177150026	0.477661015	1.229470525	1.050222073	0	1.594906497	0	0	0.655251259	3.488432374	8.54484868	0.341502664	1.349392629	1.481698484	3.023040533	9.520551505	0	0	0	0.47046902	0	0.085938629	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9847	0	0.423041573	2.5229	0.056786339	4.797544518	0	2.116877994	1.177150026	0.477661015	1.229470525	1.050222073	0	1.594906497	0	0	0.655251259	3.488432374	8.54484868	0.341502664	1.349392629	1.481698484	3.023040533	9.520551505	0	0	0	0.47046902	0	0.085938629	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9847	NO	"30% Coinsurance, $1,500 annual max; PBP 1a"	"30% Coinsurance, $1,500 annual max; PBP 1b"	"30% Coinsurance, $1,500 annual max; PBP 2"	"30% Coinsurance, $1,500 annual max; PBP 6"	"30% Coinsurance, $1,500 annual max; PBP 10a"	"30% Coinsurance, $1,500 annual max; PBP 11a"	"30% Coinsurance, $1,500 annual max; PBP 11a, 11b, 11c"	"30% Coinsurance, $1,500 annual max; PBP 4a, 4b"	"30% Coinsurance, $1,500 annual max; PBP 9a, 9b"	"30% Coinsurance, $1,500 annual max; PBP 8a"	"30% Coinsurance, $1,500 annual max; PBP 8b"	"30% Coinsurance, $1,500 annual max; PBP 9a"	"30% Coinsurance, $1,500 annual max; PBP 12"	"30% Coinsurance, $1,500 annual max; PBP 3, 5, 9a, 9c, 9d, 13a"	"30% Coinsurance, $1,500 annual max; PBP 7a"	"30% Coinsurance, $1,500 annual max; PBP 7d, 17a, 18a"	"30% Coinsurance, $1,500 annual max; PBP 7e, 7h, 9c"	"30% Coinsurance, $1,500 annual max; PBP 7c, 7i"	"30% Coinsurance, $1,500 annual max; PBP 8b"	"30% Coinsurance, $1,500 annual max; PBP 7b, 7f, 7g, 8a, 14a-j"	"30% Coinsurance, $1,500 annual max; PBP 15"	"30% Coinsurance, $1,500 annual max; PBP 7g"		"30% Coinsurance, $1,500 annual max; PBP 16a, 16b"	"30% Coinsurance, $1,500 annual max; PBP 17a"	"30% Coinsurance, $1,500 annual max; PBP 17b"	"30% Coinsurance, $1,500 annual max; PBP 18a"			"30% Coinsurance, $1,500 annual max;"												0	0	0	0.0039	0.016	0.0343	0.0255	0.0011	0.0104	0.0327	0.0093	0	0	0.0196	0.033	0.0809	0	0.0092	0.0126	0.034	0.0027	0	0	0	0	0	0	0	0	0											0.325	0	1.67E-16	2.5229	0.056786339	4.797544518	0.00393506	2.132891596	1.211494693	0.503141892	1.230534768	1.060605568	0.032655559	1.60416476	0	0	0.674846829	3.521450411	8.625732741	0.341502664	1.358544452	1.494258491	3.057050103	9.523228428	0	0	0	0.47046902	0	0.085938629	0	0	0	0	0	0	0	0	0	0	0	0	0	44.3097
H3351_002_0	2011	7																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	V	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	309.9564364	7.511678457	2365.122055	0	264.6278198	6.575678352	3.570669865	306.8821261	352.3486501	0	775.1588308	0	0	369.6766822	4147.993563	4235.026235	263.2259552	766.281776	729.3261262	1457.429289	53.98692165	0	0	0	217.3835865	0	43.79699132	0	0	0											3400	$250/Admit for IP Medical; PBP 1a	$250/Admit for IP Medical; PBP 1b	$25/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$50/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$30/Visit for OP Radiology; PBP 8b	$0-$50 Copay; PBP 9a	$0 Copay; PBP 12	"$0-$50 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$15/Visit for PCP; PBP 7a	"$30/Visit for Specialist; PBP 7d, 17a, 18a"	"$30/Visit for MH; $30/Visit for SA; PBP 7e, 7h, 9c"	"$30/Visit for PT/OT/ST; PBP 7c, 7i"	$30/Visit for Radiology; PBP 8b	"$15/Visit for Chiro; $30/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $30/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$30 Copay; PBP 7g		"$0 Copay; PBP 16a, 16b"	$30/Visit for Vision Exams; PBP 17a	$0 Copay; PBP 17b	$30/Visit for Hearing Exams; PBP 18a														0	250	250	25	0	100	0.2	0.2	50	50	0	30	0	0	30	15	30	30	30	30	27.1383875	0.2	0	0	0	30	0	30	0	0	0											NO	246.3965866	246.3965866	24.63965866	0	98.55863466	0.197117269	0.197117269	49.27931733	49.27931733	0	29.5675904	0	0	29.5675904	14.7837952	29.5675904	29.5675904	29.5675904	29.5675904	26.74722419	0.197117269	0	0	0	29.5675904	0	29.5675904	0	0	0												6.3644	0.154237661	4.856316679	0	2.173446384	1.296179761	0.703840693	1.26024514	1.446958412	0	1.9099649	0	0	0.910870727	5.110257277	10.43496009	0.648579769	1.88809214	1.797034681	3.248515661	10.64175457	0	0	0	0.535625737	0	0.107914292	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4891	0	0.81149796	6.3644	0.154237661	4.856316679	0	2.173446384	1.296179761	0.703840693	1.26024514	1.446958412	0	1.9099649	0	0	0.910870727	5.110257277	10.43496009	0.648579769	1.88809214	1.797034681	3.248515661	10.64175457	0	0	0	0.535625737	0	0.107914292	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4891	NO	"30% Coinsurance, $1,500 annual max; PBP 1a"	"30% Coinsurance, $1,500 annual max; PBP 1b"	"30% Coinsurance, $1,500 annual max; PBP 2"	"30% Coinsurance, $1,500 annual max; PBP 6"	"30% Coinsurance, $1,500 annual max; PBP 10a"	"30% Coinsurance, $1,500 annual max; PBP 11a"	"30% Coinsurance, $1,500 annual max; PBP 11a, 11b, 11c"	"30% Coinsurance, $1,500 annual max; PBP 4a, 4b"	"30% Coinsurance, $1,500 annual max; PBP 9a, 9b"	"30% Coinsurance, $1,500 annual max; PBP 8a"	"30% Coinsurance, $1,500 annual max; PBP 8b"	"30% Coinsurance, $1,500 annual max; PBP 9a"	"30% Coinsurance, $1,500 annual max; PBP 12"	"30% Coinsurance, $1,500 annual max; PBP 3, 5, 9a, 9c, 9d, 13a"	"30% Coinsurance, $1,500 annual max; PBP 7a"	"30% Coinsurance, $1,500 annual max; PBP 7d, 17a, 18a"	"30% Coinsurance, $1,500 annual max; PBP 7e, 7h, 9c"	"30% Coinsurance, $1,500 annual max; PBP 7c, 7i"	"30% Coinsurance, $1,500 annual max; PBP 8b"	"30% Coinsurance, $1,500 annual max; PBP 7b, 7f, 7g, 8a, 14a-j"	"30% Coinsurance, $1,500 annual max; PBP 15"	"30% Coinsurance, $1,500 annual max; PBP 7g"		"30% Coinsurance, $1,500 annual max; PBP 16a, 16b"	"30% Coinsurance, $1,500 annual max; PBP 17a"	"30% Coinsurance, $1,500 annual max; PBP 17b"	"30% Coinsurance, $1,500 annual max; PBP 18a"			"30% Coinsurance, $1,500 annual max;"												0	0	0	0.0011	0.0007	0.0248	0.0321	0.0012	0.0058	0.04	0.0076	0	0	0.0119	0.024	0.1408	0	0.0102	0.0149	0.0388	0.0014	0	0	0	0.0001	0	0	0	0	0											0.3553	0	0	6.3644	0.154237661	4.856316679	0.001072521	2.17416495	1.321018001	0.735952471	1.261471701	1.452781375	0.039957952	1.917563288	0	0	0.922785957	5.134252307	10.57576235	0.648579769	1.898247423	1.811932485	3.287306504	10.64312548	0	0	0	0.535690455	0	0.107914292	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8445
H3351_006_0	2011	7																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	V	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	251.1407299	8.685678657	1280.729373	0	210.0194396	11.16055788	2.298492675	223.2735791	325.4052001	0	740.4943293	0	0	948.9525616	4102.995897	4162.620537	864.6865743	561.4549415	710.1189122	1784.96881	51.37041953	0	0	0	760.6576439	0	47.48624466	0	0	0											3400	$250/Admit for IP Medical; PBP 1a	$250/Admit for IP Medical; PBP 1b	$25/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$50/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$30/Visit for OP Radiology; PBP 8b	$0-$50 Copay; PBP 9a	$0 Copay; PBP 12	"$0-$50 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$15/Visit for PCP; PBP 7a	"$30/Visit for Specialist; PBP 7d, 17a, 18a"	"$30/Visit for MH; $30/Visit for SA; PBP 7e, 7h, 9c"	"$30/Visit for PT/OT/ST; PBP 7c, 7i"	$30/Visit for Radiology; PBP 8b	"$15/Visit for Chiro; $30/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $30/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$30 Copay; PBP 7g		"$0 Copay; PBP 16a, 16b"	$30/Visit for Vision Exams; PBP 17a	$0 Copay; PBP 17b	$30/Visit for Hearing Exams; PBP 18a														0	250	250	25	0	100	0.2	0.2	46.44240064	50	0	30	0	0	30	15	30	30	30	30	26.08808462	0.2	0	0	0	30	0	30	0	0	0											NO	243.9771848	243.9771848	24.39771848	0	97.59087392	0.195181748	0.195181748	45.32354465	48.79543696	0	29.27726218	0	0	29.27726218	14.63863109	29.27726218	29.27726218	29.27726218	29.27726218	25.45958977	0.195181748	0	0	0	29.27726218	0	29.27726218	0	0	0												5.1061	0.176592286	2.603906224	0	1.707998388	2.178337194	0.448623818	0.843295836	1.323190744	0	1.806637218	0	0	2.315227745	5.005186941	10.1558444	2.109637961	1.36982196	1.732528131	3.787047804	10.02656827	0	0	0	1.855831106	0	0.115855603	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6682	0	1.349537498	5.1061	0.176592286	2.603906224	0	1.707998388	2.178337194	0.448623818	0.843295836	1.323190744	0	1.806637218	0	0	2.315227745	5.005186941	10.1558444	2.109637961	1.36982196	1.732528131	3.787047804	10.02656827	0	0	0	1.855831106	0	0.115855603	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6682	NO	"30% Coinsurance, $3,000 annual max; PBP 1a"	"30% Coinsurance, $3,000 annual max; PBP 1b"	"30% Coinsurance, $3,000 annual max; PBP 2"	"30% Coinsurance, $3,000 annual max; PBP 6"	"30% Coinsurance, $3,000 annual max; PBP 10a"	"30% Coinsurance, $3,000 annual max; PBP 11a"	"30% Coinsurance, $3,000 annual max; PBP 11a, 11b, 11c"	"30% Coinsurance, $3,000 annual max; PBP 4a, 4b"	"30% Coinsurance, $3,000 annual max; PBP 9a, 9b"	"30% Coinsurance, $3,000 annual max; PBP 8a"	"30% Coinsurance, $3,000 annual max; PBP 8b"	"30% Coinsurance, $3,000 annual max; PBP 9a"	"30% Coinsurance, $3,000 annual max; PBP 12"	"30% Coinsurance, $3,000 annual max; PBP 3, 5, 9a, 9c, 9d, 13a"	"30% Coinsurance, $3,000 annual max; PBP 7a"	"30% Coinsurance, $3,000 annual max; PBP 7d, 17a, 18a"	"30% Coinsurance, $3,000 annual max; PBP 7e, 7h, 9c"	"30% Coinsurance, $3,000 annual max; PBP 7c, 7i"	"30% Coinsurance, $3,000 annual max; PBP 8b"	"30% Coinsurance, $3,000 annual max; PBP 7b, 7f, 7g, 8a, 14a-j"	"30% Coinsurance, $3,000 annual max; PBP 15"	"30% Coinsurance, $3,000 annual max; PBP 7g"		"30% Coinsurance, $3,000 annual max; PBP 16a, 16b"	"30% Coinsurance, $3,000 annual max; PBP 17a"	"30% Coinsurance, $3,000 annual max; PBP 17b"	"30% Coinsurance, $3,000 annual max; PBP 18a"			"30% Coinsurance, $3,000 annual max;"												0	0	0	0	0.2316	0.0801	0.0464	0.0054	0.0047	0.0058	0.0239	0	0	0.0091	0.0046	0.3053	0	0.023	0.1147	0.1406	0.0048	0	0	0	0.0146	0.0001	0	0	0	0											1.0147	0	0	5.1061	0.176592286	2.603906224	0	1.939595434	2.258472293	0.495034523	0.848670479	1.327871798	0.005790219	1.830543824	0	0	2.324285375	5.009825551	10.46110389	2.109637961	1.392836993	1.847240218	3.927611415	10.03137326	0	0	0	1.870438563	0.000114436	0.115855603	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6829
H3351_007_0	2011	6																															A	A	D		T	Coin	Coin	V	V		V			O	V	V	V	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	325.5949951	5.370525646	1794.987816	0	301.8760174	10.38534594	1.581355993	218.2295132	284.71238	0	812.7435593	0	0	874.2310043	4505.89476	4304.3457	315.449711	386.8237539	692.0470709	1927.300449	40.63181889	0	0	0	773.1766014	0	45.14765038	0	0	0											3400	$100/Admit for IP Medical; PBP 1a	$100/Admit for IP Medical; PBP 1b	$25/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"$35/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	$25/Visit for OP Radiology; PBP 8b	$0-$35 Copay; PBP 9a	$0 Copay; PBP 12	"$0-$35 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$10/Visit for PCP; PBP 7a	"$25/Visit for Specialist; PBP 7d, 17a, 18a"	"$25/Visit for MH; $25/Visit for SA; PBP 7e, 7h, 9c"	"$25/Visit for PT/OT/ST; PBP 7c, 7i"	$25/Visit for Radiology; PBP 8b	"$10/Visit for Chiro; $25/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $25/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$25 Copay; PBP 7g			$25/Visit for Vision Exams; PBP 17a	$0 Copay; PBP 17b	$25/Visit for Hearing Exams; PBP 18a														0	100	100	25	0	100	0.2	0.2	46.99488892	35	0	25	0	0	25	10	25	25	25	25	20.84952082	0.2	0	0	0	25	0	25	0	0	0											NO	98.31430835	98.31430835	24.57857709	0	98.31430835	0.196628617	0.196628617	46.2027	34.41000792	0	24.57857709	0	0	24.57857709	9.831430835	24.57857709	24.57857709	24.57857709	24.57857709	20.49806219	0.196628617	0	0	0	24.57857709	0	24.57857709	0	0	0												2.6676	0.04399996	3.676520534	0	2.473227655	2.042056206	0.310939841	0.840232727	0.816412938	0	1.664673352	0	0	1.790612844	3.691616057	8.816224384	0.646108753	0.792298121	1.417461023	3.292160373	7.989378343	0	0	0	1.583631725	0	0.092472084	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6476	0	0.765524932	2.6676	0.04399996	3.676520534	0	2.473227655	2.042056206	0.310939841	0.840232727	0.816412938	0	1.664673352	0	0	1.790612844	3.691616057	8.816224384	0.646108753	0.792298121	1.417461023	3.292160373	7.989378343	0	0	0	1.583631725	0	0.092472084	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6476	NO	"30% Coinsurance, $3,000 annual max; PBP 1a"	"30% Coinsurance, $3,000 annual max; PBP 1b"	"30% Coinsurance, $3,000 annual max; PBP 2"	"30% Coinsurance, $3,000 annual max; PBP 6"	"30% Coinsurance, $3,000 annual max; PBP 10a"	"30% Coinsurance, $3,000 annual max; PBP 11a"	"30% Coinsurance, $3,000 annual max; PBP 11a, 11b, 11c"	"30% Coinsurance, $3,000 annual max; PBP 4a, 4b"	"30% Coinsurance, $3,000 annual max; PBP 9a, 9b"	"30% Coinsurance, $3,000 annual max; PBP 8a"	"30% Coinsurance, $3,000 annual max; PBP 8b"	"30% Coinsurance, $3,000 annual max; PBP 9a"	"30% Coinsurance, $3,000 annual max; PBP 12"	"30% Coinsurance, $3,000 annual max; PBP 3, 5, 9a, 9c, 9d, 13a"	"30% Coinsurance, $3,000 annual max; PBP 7a"	"30% Coinsurance, $3,000 annual max; PBP 7d, 17a, 18a"	"30% Coinsurance, $3,000 annual max; PBP 7e, 7h, 9c"	"30% Coinsurance, $3,000 annual max; PBP 7c, 7i"	"30% Coinsurance, $3,000 annual max; PBP 8b"	"30% Coinsurance, $3,000 annual max; PBP 7b, 7f, 7g, 8a, 14a-j"	"30% Coinsurance, $3,000 annual max; PBP 15"	"30% Coinsurance, $3,000 annual max; PBP 7g"			"30% Coinsurance, $3,000 annual max; PBP 17a"	"30% Coinsurance, $3,000 annual max; PBP 17b"	"30% Coinsurance, $3,000 annual max; PBP 18a"			"30% Coinsurance, $3,000 annual max;"												0	0	0	0	0.2657	0.0486	0.0571	0.0031	0	0.0216	0.0008	0	0	0.0003	0.005	0.1759	0	0.0036	0.1033	0.0874	0.0029	0	0	0	0.0048	0	0	0	0	0											0.7803	0	0	2.6676	0.04399996	3.676520534	0	2.738913129	2.090609396	0.368000615	0.843339327	0.816412938	0.021610354	1.665484237	0	0	1.790957998	3.696638602	8.992136905	0.646108753	0.795944028	1.520807472	3.379556265	7.992309829	0	0	0	1.588467879	0	0.092472084	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4278
H3351_010_0	2011	7																															A	A	D		T	Coin	Coin	V	V		Coin			O	V	V	Coin	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	177.3859838	10.95310996	1443.925828	0	162.9327878	5.107634491	2.210935737	252.3541613	285.2045149	0	10.14412344	0	0	283.688811	3002.224081	2727.762931	2.002701878	476.8445615	13.13428752	940.8472503	31.58894875	0	0	0	177.109396	0	56.74368598	0	0	0											3400	$500/Admit for IP Medical; PBP 1a	$500/Admit for IP Medical; PBP 1b	$50/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"$125/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	20% Coinsurance for OP Radiology; PBP 8b	$0-$125 Copay; PBP 9a	$0 Copay; PBP 12	"50% for Partial Hosp and Subs Abuse, $0-$125 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$20/Visit for PCP; PBP 7a	"$40/Visit for Specialist; PBP 7d, 17a, 18a"	"45% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"$40/Visit for PT/OT/ST; PBP 7c, 7i"	20% Coinsurance for Radiology; PBP 8b	"$20/Visit for Chiro; $40/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $40/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$40 Copay; PBP 7g			$40/Visit for Vision Exams; PBP 17a	$0 Copay;	$40/Visit for Hearing Exams; PBP 18a														0	500	500	50	0	100	0.2	0.2	50	125	0	0.2	0	0	40	20	40	0.451066669	40	0.2	35.49759877	0.2	0	0	0	40	0	40	0	0	0											NO	493.5160175	493.5160175	49.35160175	0	98.7032035	0.197406407	0.197406407	49.35160175	123.3790044	0	0.197406407	0	0	39.4812814	19.7406407	39.4812814	0.445217252	39.4812814	0.197406407	35.03726715	0.197406407	0	0	0	39.4812814	0	39.4812814	0	0	0												7.2952	0.450461267	5.938337702	0	1.340165676	1.008279773	0.43645288	1.037840172	2.932354091	0	2.00251496	0	0	0.933366481	4.938818907	8.974631321	0.891637428	1.568869526	2.592792507	2.747059705	6.235860874	0	0	0	0.582708825	0	0.186692786	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0941	0	0.684429874	7.2952	0.450461267	5.938337702	0	1.340165676	1.008279773	0.43645288	1.037840172	2.932354091	0	2.00251496	0	0	0.933366481	4.938818907	8.974631321	0.891637428	1.568869526	2.592792507	2.747059705	6.235860874	0	0	0	0.582708825	0	0.186692786	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0941	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.2952	0.450461267	5.938337702	0	1.340165676	1.008279773	0.43645288	1.037840172	2.932354091	0	2.00251496	0	0	0.933366481	4.938818907	8.974631321	0.891637428	1.568869526	2.592792507	2.747059705	6.235860874	0	0	0	0.582708825	0	0.186692786	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0941
H3351_011_0	2011	8																															A	A	D		T	Coin	Coin	V	V		Coin			O	V	V	Coin	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	167.6870375	5.387322333	570.6603886	0	159.0997671	6.544809406	1.892539578	146.9792677	264.5244861	0	21.10588813	0	0	699.7824597	3095.072595	2736.493949	4.582757217	320.9248933	15.74070645	1155.262818	22.36605716	0	0	0	547.5042894	0	36.75946878	0	0	0											3400	$500/Admit for IP Medical; PBP 1a	$500/Admit for IP Medical; PBP 1b	$50/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"$125/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	20% Coinsurance for OP Radiology; PBP 8b	$0-$125 Copay; PBP 9a	$0 Copay; PBP 12	"50% for Partial Hosp and Subs Abuse, $0-$125 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$20/Visit for PCP; PBP 7a	"$40/Visit for Specialist; PBP 7d, 17a, 18a"	"45% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"$40/Visit for PT/OT/ST; PBP 7c, 7i"	20% Coinsurance for Radiology; PBP 8b	"$20/Visit for Chiro; $40/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $40/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$40 Copay; PBP 7g			$40/Visit for Vision Exams; PBP 17a	$0 Copay;	$40/Visit for Hearing Exams; PBP 18a														0	500	500	50	0	100	0.2	0.2	48.37754204	125	0	0.2	0	0	40	20	40	0.457503061	40	0.2	33.83791694	0.2	0	0	0	40	0	40	0	0	0											NO	489.1214641	489.1214641	48.91214641	0	97.82429282	0.195648586	0.195648586	47.32498838	122.280366	0	0.195648586	0	0	39.12971713	19.56485856	39.12971713	0.447549134	39.12971713	0.195648586	33.10170295	0.195648586	0	0	0	39.12971713	0	39.12971713	0	0	0												6.8349	0.219587916	2.326018706	0	1.296985183	1.280482704	0.370272692	0.579649345	2.695512582	0	4.129337162	0	0	2.281857475	5.046221465	8.92318618	2.051009026	1.046475024	3.079646953	3.186763886	4.375887449	0	0	0	1.785307331	0	0.119865635	0	0	0	0	0	0	0	0	0	0	0	0	0	51.629	0	1.14827929	6.8349	0.219587916	2.326018706	0	1.296985183	1.280482704	0.370272692	0.579649345	2.695512582	0	4.129337162	0	0	2.281857475	5.046221465	8.92318618	2.051009026	1.046475024	3.079646953	3.186763886	4.375887449	0	0	0	1.785307331	0	0.119865635	0	0	0	0	0	0	0	0	0	0	0	0	0	51.629	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.8349	0.219587916	2.326018706	0	1.296985183	1.280482704	0.370272692	0.579649345	2.695512582	0	4.129337162	0	0	2.281857475	5.046221465	8.92318618	2.051009026	1.046475024	3.079646953	3.186763886	4.375887449	0	0	0	1.785307331	0	0.119865635	0	0	0	0	0	0	0	0	0	0	0	0	0	51.629
H3351_012_0	2011	8																															A	A	D		T	Coin	Coin	V	V		Coin			O	V	V	Coin	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	220.3751937	7.660011689	1342.147328	0	187.9289262	4.4088704	4.086633014	236.4101906	277.6138508	0	12.49860867	0	0	318.4994896	2964.365133	2986.970255	1.458788425	500.962102	8.340595577	1113.654492	32.87033722	0	0	0	156.4950697	0	37.44094249	0	0	0											3400	$350/Admit for IP Medical; PBP 1a	$350/Admit for IP Medical; PBP 1b	$50/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $35/Visit for Urgent Care; PBP 4a, 4b"	"$100/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	10% Coinsurance for OP Radiology; PBP 8b	$0-$100 Copay; PBP 9a	$0 Copay; PBP 12	"50% for Partial Hosp and Subs Abuse, $0-$100 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$20/Visit for PCP; PBP 7a	"$35/Visit for Specialist; PBP 7d, 17a, 18a"	"45% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"$35/Visit for PT/OT/ST; PBP 7c, 7i"	10% Coinsurance for Radiology; PBP 8b	"$20/Visit for Chiro; $35/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $35/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$35 Copay; PBP 7g		"$0 Copay; PBP 16a, 16b"	$35/Visit for Vision Exams; PBP 17a	$0 Copay; PBP 17b	$35/Visit for Hearing Exams; PBP 18a														0	350	350	50	0	100	0.2	0.2	50	100	0	0.1	0	0	35	20	35	0.450826278	35	0.1	31.92493459	0.2	0	0	0	35	0	35	0	0	0											NO	346.1479753	346.1479753	49.44971076	0	98.89942152	0.197798843	0.197798843	49.44971076	98.89942152	0	0.098899422	0	0	34.61479753	19.7798843	34.61479753	0.445864581	34.61479753	0.098899422	31.57357562	0.197798843	0	0	0	34.61479753	0	34.61479753	0	0	0												6.3569	0.220958128	5.530733095	0	1.548838507	0.872069464	0.808331282	0.974201295	2.287987437	0	1.236105167	0	0	0.918732946	4.88623328	8.616114218	0.650422089	1.445058478	0.824880078	2.930171193	6.501714672	0	0	0	0.451420429	0	0.108000887	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1688	0	0.524907135	6.3569	0.220958128	5.530733095	0	1.548838507	0.872069464	0.808331282	0.974201295	2.287987437	0	1.236105167	0	0	0.918732946	4.88623328	8.616114218	0.650422089	1.445058478	0.824880078	2.930171193	6.501714672	0	0	0	0.451420429	0	0.108000887	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1688	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.3569	0.220958128	5.530733095	0	1.548838507	0.872069464	0.808331282	0.974201295	2.287987437	0	1.236105167	0	0	0.918732946	4.88623328	8.616114218	0.650422089	1.445058478	0.824880078	2.930171193	6.501714672	0	0	0	0.451420429	0	0.108000887	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1688
H3351_013_0	2011	8																															A	A	D		T	Coin	Coin	V	V		Coin			O	V	V	Coin	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	205.9963305	5.936952737	1001.966431	0	174.1106326	8.634222392	1.548337537	164.691463	273.9131441	0	24.8751666	0	0	634.7703442	3422.121086	3342.519974	4.934639793	389.4159232	9.518812218	1360.904219	35.27108013	0	0	0	593.7144134	0	38.8750494	0	0	0											3400	$350/Admit for IP Medical; PBP 1a	$350/Admit for IP Medical; PBP 1b	$50/Day for SNF; PBP 2	$0 Copay; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a, 11b, 11c"	"$50/Visit for ER; $35/Visit for Urgent Care; PBP 4a, 4b"	"$100/Visit for OP Surgery; PBP 9a, 9b"	$0 Copay; PBP 8a	10% Coinsurance for OP Radiology; PBP 8b	$0-$100 Copay; PBP 9a	$0 Copay; PBP 12	"50% for Partial Hosp and Subs Abuse, $0-$100 Copay for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	$20/Visit for PCP; PBP 7a	"$35/Visit for Specialist; PBP 7d, 17a, 18a"	"45% Coinsurance for MH; 50% Coinsurance for SA; PBP 7e, 7h, 9c"	"$35/Visit for PT/OT/ST; PBP 7c, 7i"	10% Coinsurance for Radiology; PBP 8b	"$20/Visit for Chiro; $35/Visit for Podiatry; $0 for Lab, Health Ed/Wellness, Immun, Phys Exams,Pap & Pelvic Exams, Prostate/Colorectal Screening, Bone Mass Meas, Mammography, Diabetes Screening, Nutrition Therapy; $35/Visit for Other; PBP 7b, 7f, 7g, 8a, 14a-j"	20% Coinsurance for Part B Rx; PBP 15	$0-$35 Copay; PBP 7g		"$0 Copay; PBP 16a, 16b"	$35/Visit for Vision Exams; PBP 17a	$0 Copay; PBP 17b	$35/Visit for Hearing Exams; PBP 18a														0	350	350	50	0	100	0.2	0.2	48.0632753	100	0	0.1	0	0	35	20	35	0.452649959	35	0.1	30.78335149	0.2	0	0	0	35	0	35	0	0	0											NO	342.2812157	342.2812157	48.89731653	0	97.79463307	0.195589266	0.195589266	47.00330372	97.79463307	0	0.097794633	0	0	34.22812157	19.55892661	34.22812157	0.442667366	34.22812157	0.097794633	30.10446564	0.195589266	0	0	0	34.22812157	0	34.22812157	0	0	0												5.8757	0.169342283	4.082789146	0	1.418923786	1.688761221	0.302838203	0.645086905	2.232269618	0	2.43265779	0	0	1.810583043	5.577751265	9.534015001	2.184404	1.110747963	0.930888748	3.414107857	6.898644679	0	0	0	1.693477427	0	0.110884993	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1139	0	1.175220574	5.8757	0.169342283	4.082789146	0	1.418923786	1.688761221	0.302838203	0.645086905	2.232269618	0	2.43265779	0	0	1.810583043	5.577751265	9.534015001	2.184404	1.110747963	0.930888748	3.414107857	6.898644679	0	0	0	1.693477427	0	0.110884993	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1139	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.8757	0.169342283	4.082789146	0	1.418923786	1.688761221	0.302838203	0.645086905	2.232269618	0	2.43265779	0	0	1.810583043	5.577751265	9.534015001	2.184404	1.110747963	0.930888748	3.414107857	6.898644679	0	0	0	1.693477427	0	0.110884993	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1139
H3351_801_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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	305.1124	5.882907932	58.33382952	0	11.90257981	6.19226862	14.5215121	25.67657196	54.87577304	22.27770745	18.34592211	0	0.553258056	10.01938728	55.30245471	140.3857991	2.366331465	5.664018627	46.20394645	32.92036221	66.68599061	6.99023217																			6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.091191312	0.091191312	0.169636895	0	0.233	0.233	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																			NO	0.070741298	0.070741298	0.131595147	0	0.180748824	0.180748824	0.180748824	0.180748824	0.180748824	0.180748824	0.180748824	0	0.180748824	0.180748824	0.180748824	0.180748824	0.180748824	0.180748824	0.180748824	0.180748824	0.180748824	0.180748824																				21.584	0.416164543	7.676448883	0	2.151377302	1.11924527	2.624746234	4.641010184	9.918731437	4.026669421	3.316003845	0	0.100000743	1.810992467	9.995853647	25.37456807	0.427711629	1.023764705	8.351308981	5.950316752	12.05341437	1.263476244	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.8259	0	35.79578697	21.584	0.416164543	7.676448883	0	2.151377302	1.11924527	2.624746234	4.641010184	9.918731437	4.026669421	3.316003845	0	0.100000743	1.810992467	9.995853647	25.37456807	0.427711629	1.023764705	8.351308981	5.950316752	12.05341437	1.263476244	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.8259	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0	0	21.584	0.416164543	7.676448883	0	2.151377302	1.11924527	2.624746234	4.641010184	9.918731437	4.026669421	3.316003845	0	0.100000743	1.810992467	9.995853647	25.37456807	0.427711629	1.023764705	8.351308981	5.950316752	12.05341437	1.263476244	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.8259
H3351_802_0	2011	3																															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	YES	201.7826412	7.721813609	33.03006129	0	6.061818328	9.334618608	1.987756463	14.68231767	52.8483352	6.379887291	25.84966932	3.229469951	0.079793522	8.782818144	32.90785816	93.57173714	3.120385966	5.033851994	26.14400934	65.9998996	44.12492269	0.03164266																			6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.093254991	0.093254991	0.195976007	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.078952144	0.078952144	0.165918477	0	0.19726397	0.19726397	0.19726397	0.19726397	0.19726397	0.19726397	0.19726397	0.19726397	0.19726397	0.19726397	0.19726397	0.19726397	0.19726397	0.19726397	0.19726397	0.19726397	0.19726397	0.19726397																				15.9312	0.609653743	5.480297458	0	1.195778347	1.841383922	0.392112731	2.896292266	10.42507239	1.258521893	5.099208384	0.637058062	0.015740387	1.732533572	6.491534732	18.45833231	0.615539723	0.992997627	5.157271064	13.01940219	8.704257409	0.006241957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.9604	0	18.28982765	15.9312	0.609653743	5.480297458	0	1.195778347	1.841383922	0.392112731	2.896292266	10.42507239	1.258521893	5.099208384	0.637058062	0.015740387	1.732533572	6.491534732	18.45833231	0.615539723	0.992997627	5.157271064	13.01940219	8.704257409	0.006241957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.9604	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0	0	15.9312	0.609653743	5.480297458	0	1.195778347	1.841383922	0.392112731	2.896292266	10.42507239	1.258521893	5.099208384	0.637058062	0.015740387	1.732533572	6.491534732	18.45833231	0.615539723	0.992997627	5.157271064	13.01940219	8.704257409	0.006241957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.9604
H3351_803_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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	276.6992158	8.009256676	47.40918716	0	8.686518321	7.307939842	12.63578655	19.69183954	47.53173292	18.96317739	22.7568236	0	1.971808997	6.472954203	51.15894678	137.3987785	2.672697174	4.920084469	41.32952487	34.28552377	76.78580195	2.019136762																			6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.091106356	0.091106356	0.170159385	0	0.233	0.233	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																			NO	0.072161499	0.072161499	0.134776066	0	0.184549465	0.184549465	0.184549465	0.184549465	0.184549465	0.184549465	0.184549465	0	0.184549465	0.184549465	0.184549465	0.184549465	0.184549465	0.184549465	0.184549465	0.184549465	0.184549465	0.184549465																				19.967	0.577959967	6.389623754	0	1.603092306	1.348676386	2.331927643	3.634118445	8.771955866	3.499644237	4.199759614	0	0.363896295	1.194580233	9.441356243	25.35687101	0.493244833	0.907998955	7.627341692	6.327375058	14.17077865	0.372630609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.5799	0	31.13126228	19.967	0.577959967	6.389623754	0	1.603092306	1.348676386	2.331927643	3.634118445	8.771955866	3.499644237	4.199759614	0	0.363896295	1.194580233	9.441356243	25.35687101	0.493244833	0.907998955	7.627341692	6.327375058	14.17077865	0.372630609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.5799	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0	0	19.967	0.577959967	6.389623754	0	1.603092306	1.348676386	2.331927643	3.634118445	8.771955866	3.499644237	4.199759614	0	0.363896295	1.194580233	9.441356243	25.35687101	0.493244833	0.907998955	7.627341692	6.327375058	14.17077865	0.372630609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.5799
H3351_804_0	2011	3																															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	YES	191.3341068	4.112350937	35.36635943	0	5.841206581	9.315159991	2.344551226	16.58745416	53.09076468	6.648741717	28.28365962	4.61029752	0.042495064	8.337715389	33.03771128	88.5851285	2.283854733	4.020606617	24.45788867	63.30757053	35.67012472	0.017308987																			6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.093275627	0.093275627	0.196006714	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.079673704	0.079673704	0.167424026	0	0.199022765	0.199022765	0.199022765	0.199022765	0.199022765	0.199022765	0.199022765	0.199022765	0.199022765	0.199022765	0.199022765	0.199022765	0.199022765	0.199022765	0.199022765	0.199022765	0.199022765	0.199022765																				15.2443	0.327646233	5.921178283	0	1.162533084	1.853928896	0.466619067	3.301280988	10.56627077	1.323250959	5.629092137	0.917554159	0.008457485	1.659395169	6.575256642	17.63045719	0.454539083	0.800192245	4.867676625	12.59964772	7.099166842	0.003444882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4119	0	16.80091111	15.2443	0.327646233	5.921178283	0	1.162533084	1.853928896	0.466619067	3.301280988	10.56627077	1.323250959	5.629092137	0.917554159	0.008457485	1.659395169	6.575256642	17.63045719	0.454539083	0.800192245	4.867676625	12.59964772	7.099166842	0.003444882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4119	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0	0	15.2443	0.327646233	5.921178283	0	1.162533084	1.853928896	0.466619067	3.301280988	10.56627077	1.323250959	5.629092137	0.917554159	0.008457485	1.659395169	6.575256642	17.63045719	0.454539083	0.800192245	4.867676625	12.59964772	7.099166842	0.003444882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4119
H3351_805_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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	289.527875	6.982410091	52.4788853	0	10.19122411	6.761941713	13.50052196	22.48372555	50.90338752	20.49066986	20.61244456	0	1.294610485	8.139455715	53.00461819	138.4955097	2.521216041	5.261380469	43.54462464	33.55848112	71.81833415	4.371507471																			6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.091144465	0.091144465	0.169923986	0	0.233	0.233	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																			NO	0.071557899	0.071557899	0.133408031	0	0.182929272	0.182929272	0.182929272	0.182929272	0.182929272	0.182929272	0.182929272	0	0.182929272	0.182929272	0.182929272	0.182929272	0.182929272	0.182929272	0.182929272	0.182929272	0.182929272	0.182929272																				20.718	0.499646599	7.001104732	0	1.864273209	1.236957076	2.469640657	4.112931552	9.311719631	3.748343325	3.770619482	0	0.236822154	1.48894471	9.696096228	25.3348828	0.461204216	0.9624605	7.965586494	6.138828528	13.1376756	0.79967668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.9554	0	33.10747304	20.718	0.499646599	7.001104732	0	1.864273209	1.236957076	2.469640657	4.112931552	9.311719631	3.748343325	3.770619482	0	0.236822154	1.48894471	9.696096228	25.3348828	0.461204216	0.9624605	7.965586494	6.138828528	13.1376756	0.79967668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.9554	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0	0	20.718	0.499646599	7.001104732	0	1.864273209	1.236957076	2.469640657	4.112931552	9.311719631	3.748343325	3.770619482	0	0.236822154	1.48894471	9.696096228	25.3348828	0.461204216	0.9624605	7.965586494	6.138828528	13.1376756	0.79967668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.9554
H3351_806_0	2011	3																															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	YES	201.1503873	7.484732365	33.1949701	0	6.049011359	9.336139323	2.012020454	14.81310268	52.88033158	6.399641215	26.01889525	3.322029516	0.077343638	8.755940732	32.92638204	93.26916905	3.065840672	4.968161969	26.040047	65.84120152	43.57742588	0.030701472																			6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.093255648	0.093255648	0.195976986	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.078991866	0.078991866	0.16600161	0	0.197361823	0.197361823	0.197361823	0.197361823	0.197361823	0.197361823	0.197361823	0.197361823	0.197361823	0.197361823	0.197361823	0.197361823	0.197361823	0.197361823	0.197361823	0.197361823	0.197361823	0.197361823																				15.8892	0.591232975	5.510418478	0	1.193843908	1.842597474	0.397096024	2.923540945	10.43655863	1.263044855	5.135136592	0.6556418	0.015264681	1.728088423	6.498410775	18.40777321	0.605079903	0.980525502	5.139311139	12.99453954	8.600520202	0.006059298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.8139	0	18.20425356	15.8892	0.591232975	5.510418478	0	1.193843908	1.842597474	0.397096024	2.923540945	10.43655863	1.263044855	5.135136592	0.6556418	0.015264681	1.728088423	6.498410775	18.40777321	0.605079903	0.980525502	5.139311139	12.99453954	8.600520202	0.006059298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.8139	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	0	0	15.8892	0.591232975	5.510418478	0	1.193843908	1.842597474	0.397096024	2.923540945	10.43655863	1.263044855	5.135136592	0.6556418	0.015264681	1.728088423	6.498410775	18.40777321	0.605079903	0.980525502	5.139311139	12.99453954	8.600520202	0.006059298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.8139
H3359_001_0	2011	5	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				V	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	338.7576413	16.05670669	533.1809267	0	221.7919637	8.668220561	2.388297841	393.2428846	7.150883577	445.8716442	18.96392395		0.562754841	7.214280853	4190.633912	5392.497912	1.793286089	1192.237735	36.43444932	644.9511361	8.350331467			7.205539167	137.5	137.5	115				0	532.4187367	2.183988945	772.7575516							6700	1A IP Acute: $125 per day; days 1-8	1B IP Psych: $125 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 - $100 per trip	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $0	9B ASC Services - $50;  9A Outpatient Hospital - 10%	8A Outpatient Lab - $0; D/T - $50	8B Outpatient X-Rays - $0; Diagnostic Radiology - $50; Therapeutic Radiology - 20%		12 Renal Dialysis - 20%	3 CORF - $20; 5 Partial Hosp - $0; 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; 14C Routine Physical Exams - $0	7D Physician Specialist - $20	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 - $50; Therapeutic Radiology - 20%	7G Other Health Care - $20	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 2 years	18A Hearing Exams (Routine) - $20	18B Hearing Aids - $0 ($500 max every 3 years)	14A Health Education & Wellness - $0		7B Chiropractic Services - $20	7F Podiatry Services - $20	18A Hearing Exams (Medicare Covered) - $20	17A Eye Exams (Medicare Covered) - $20							0	529.6899632	737.4794745	50	0	100	0.2	0.2	50	0.057908796	50	0.094251317		0.2	0.037355512	0	20	0.45	20	0.141568744	20	0.2			0.1	0	0	20				20	20	20	20							NO	511.900909	712.7120384	48.32080505	0	96.64161011	0.19328322	0.19328322	48.32080505	0.055963993	48.32080505	0.09108599		0.19328322	0.036100968	0	19.32832202	0.434887245	19.32832202	0.136814314	19.32832202	0.19328322			0.1	0	0	20				19.32832202	19.32832202	19.32832202	19.32832202								14.4509	0.95365068	2.146977635	0	1.786194373	1.675421583	0.461617898	1.583484397	0.400191998	1.7954064	1.727347794	0	0.108771068	0.260442524	0	8.685661344	0.779877247	1.920329573	4.984754174	1.038818604	1.613978956	0	0	0.720553917	0	0	0.191666667	0	0	0	0	0.857563399	0.003517737	1.244675567	0	0	0	0	0	0	49.3918	0	1.684711314	14.4509	0.95365068	2.146977635	0	1.786194373	1.675421583	0.461617898	1.583484397	0.400191998	1.7954064	1.727347794	0	0.108771068	0.260442524	0	8.685661344	0.779877247	1.920329573	4.984754174	1.038818604	1.613978956	0	0	0.720553917	0	0	0.191666667	0	0	0	0	0.857563399	0.003517737	1.244675567	0	0	0	0	0	0	49.3918	NO																																																																																		0			14.4509	0.95365068	2.146977635	0	1.786194373	1.675421583	0.461617898	1.583484397	0.400191998	1.7954064	1.727347794	0	0.108771068	0.260442524	0	8.685661344	0.779877247	1.920329573	4.984754174	1.038818604	1.613978956	0	0	0.720553917	0	0	0.191666667	0	0	0	0	0.857563399	0.003517737	1.244675567	0	0	0	0	0	0	49.3918
H3359_019_0	2011	5	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				V	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	366.9003639	22.35004837	543.1655222	0.554137259	280.3621373	9.820119454	2.622855713	485.6731253	8.523603716	421.8072176	18.60472707		1.654440353	10.24448489	4242.954443	6275.535613	2.663011901	1119.792811	32.62321199	610.0938647	8.958446738			8.058476863	137.5	137.5	115				0	577.5000854	1.858060921	813.0813861							6700	1A IP Acute: $135 per day; days 1-8	1B IP Psych: $135 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 - $100 per trip	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $0	9B ASC Services - $50;  9A Outpatient Hospital - 10%	8A Outpatient Lab - $0; D/T - $50	8B Outpatient X-Rays - $0; Diagnostic Radiology - $50; Therapeutic Radiology - 20%		12 Renal Dialysis - 20%	3 CORF - $20; 5 Partial Hosp - $0; 9D Cardiac Rehab Svcs - $0-$25	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; 14C Routine Physical Exams - $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 - $50; Therapeutic Radiology - 20%	7G Other Health Care - $25	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 2 years	18A Hearing Exams (Routine) - $25	18B Hearing Aids - $0 ($500 max every 3 years)	14A Health Education & Wellness - $0		7B Chiropractic Services - $25	7F Podiatry Services - $25	18A Hearing Exams (Medicare Covered) - $25	17A Eye Exams (Medicare Covered) - $25							0	572.0651603	796.4778325	50	0	100	0.2	0.2	50	0.058252977	50	0.094251317		0.2	0.048712341	0	25	0.45	25	0.141568744	25	0.2			0.1	0	0	25				25	25	25	25							NO	557.504083	776.2046607	48.72732354	0	97.45464708	0.194909294	0.194909294	48.72732354	0.056770234	48.72732354	0.091852288		0.194909294	0.04747244	0	24.36366177	0.438545912	24.36366177	0.13796532	24.36366177	0.194909294			0.1	0	0	25				24.36366177	24.36366177	24.36366177	24.36366177								17.0457	1.445684309	2.205583511	0	2.276882762	1.914032551	0.511218956	1.972129293	0.483886973	1.71279473	1.708886757	0	0.322465801	0.486330693	0	12.74125226	1.167852983	2.273521109	4.500871874	1.238676714	1.74608453	0	0	0.805847686	0	0	0.239583333	0	0	0	0	1.172501396	0.003772431	1.650803324	0	0	0	0	0	0	59.6264	0	1.530036424	17.0457	1.445684309	2.205583511	0	2.276882762	1.914032551	0.511218956	1.972129293	0.483886973	1.71279473	1.708886757	0	0.322465801	0.486330693	0	12.74125226	1.167852983	2.273521109	4.500871874	1.238676714	1.74608453	0	0	0.805847686	0	0	0.239583333	0	0	0	0	1.172501396	0.003772431	1.650803324	0	0	0	0	0	0	59.6264	NO																																																																																		0			17.0457	1.445684309	2.205583511	0	2.276882762	1.914032551	0.511218956	1.972129293	0.483886973	1.71279473	1.708886757	0	0.322465801	0.486330693	0	12.74125226	1.167852983	2.273521109	4.500871874	1.238676714	1.74608453	0	0	0.805847686	0	0	0.239583333	0	0	0	0	1.172501396	0.003772431	1.650803324	0	0	0	0	0	0	59.6264
H3359_021_0	2011	5	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					V	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	YES	450.8738853	34.03988492	22.24342291	0	13.11477413	3.712073	0.820442207	10.28962933	5.752334467	1.440659499	4.592388924		0.13296521	2.252144956	3509.834339	4134.495952	1.373245717	297.7927909	19.44511673	652.0142617	0.106177393				206.25	412.5					0	169.1752728	14.30128081	277.1712895							6700	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 - 20% coinsurance	11B Pros./Med Supp. - 20%; 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%; Lab - $0	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; 14C Routine Physical Exams - $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) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $0	18B Hearing Aids - $0	14A Health Education & Wellness - $0	13C OTC Rx Card - $0; 13E Home Safety - $0	7B Chiropractic Services - $0	7F Podiatry Services - $0	18A Hearing Exams (Medicare Covered) - $0	17A Eye Exams (Medicare Covered) - $0							0	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	0.2	0	0.2	0	0				0	0					0	0	0	0							NO	0.059470251	0.059470251	0.13971258	0	0.193188367	0.193188367	0.193188367	0.193188367	0.193188367	0.193188367	0.193188367		0.193188367	0.193188367	0	0	0.193188367	0	0.193188367	0	0				0	0					0	0	0	0								26.8136	2.024360498	3.107686001	0	2.533621798	0.717129321	0.15849989	1.987836687	1.111284103	0.278318656	0.887196117	0	0.025687332	0.435088207	0	0	0.265295098	0	3.756570348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1022	0	1.551510723	26.8136	2.024360498	3.107686001	0	2.533621798	0.717129321	0.15849989	1.987836687	1.111284103	0.278318656	0.887196117	0	0.025687332	0.435088207	0	0	0.265295098	0	3.756570348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1022	NO																																																																																		0			26.8136	2.024360498	3.107686001	0	2.533621798	0.717129321	0.15849989	1.987836687	1.111284103	0.278318656	0.887196117	0	0.025687332	0.435088207	0	0	0.265295098	0	3.756570348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1022
H3359_027_0	2011	4	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				V	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	281.4840589	13.33402086	428.9834517	0	217.8690648	7.434492293	4.29525993	329.2463245	4.214017653	198.7076913	15.63143788		0.578419353	4.830786135	2174.696412	3854.779333	0.951961969	457.0380616	17.08825089	348.1844494	1.244126579			5.751330686	137.5	137.5	115				0	227.5702276	0.959291541	437.0221002							6700	1A IP Acute: $125 per day; days 1-8	1B IP Psych: $125 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 - $100 per trip	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $0	9B ASC Services - $50;  9A Outpatient Hospital - 10%	8A Outpatient Lab - $0; D/T - $50	8B Outpatient X-Rays - $0; Diagnostic Radiology - $50; Therapeutic Radiology - 20%		12 Renal Dialysis - 20%	3 CORF - $20; 5 Partial Hosp - $0; 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; 14C Routine Physical Exams - $0	7D Physician Specialist - $20	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 - $50; Therapeutic Radiology - 20%	7G Other Health Care - $20	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 2 years	18A Hearing Exams (Routine) - $20	18B Hearing Aids - $0 ($500 max every 3 years)	14A Health Education & Wellness - $0		7B Chiropractic Services - $20	7F Podiatry Services - $20	18A Hearing Exams (Medicare Covered) - $20	17A Eye Exams (Medicare Covered) - $20							0	529.6899632	737.4794745	50	0	100	0.2	0.2	50	0.058638722	50	0.094251317		0.2	0.092295055	0	20	0.45	20	0.141568744	20	0.2			0.1	0	0	20				20	20	20	20							NO	524.985673	730.9297611	49.55593927	0	99.11187854	0.198223757	0.198223757	49.55593927	0.058117939	49.55593927	0.093414251		0.198223757	0.091475363	0	19.82237571	0.446003453	19.82237571	0.140311442	19.82237571	0.198223757			0.1	0	0	20				19.82237571	19.82237571	19.82237571	19.82237571								12.3146	0.812186057	1.77155649	0	1.799451024	1.473692994	0.851422561	1.359675905	0.244910021	0.820595524	1.46019906	0	0.114656457	0.441897913	0	6.367573684	0.424578326	0.754965014	2.397677116	0.575153581	0.246615445	0	0	0.575133069	0	0	0.191666667	0	0	0	0	0.375915213	0.00158462	0.721901355	0	0	0	0	0	0	36.0976	0	0.316592139	12.3146	0.812186057	1.77155649	0	1.799451024	1.473692994	0.851422561	1.359675905	0.244910021	0.820595524	1.46019906	0	0.114656457	0.441897913	0	6.367573684	0.424578326	0.754965014	2.397677116	0.575153581	0.246615445	0	0	0.575133069	0	0	0.191666667	0	0	0	0	0.375915213	0.00158462	0.721901355	0	0	0	0	0	0	36.0976	NO																																																																																		0			12.3146	0.812186057	1.77155649	0	1.799451024	1.473692994	0.851422561	1.359675905	0.244910021	0.820595524	1.46019906	0	0.114656457	0.441897913	0	6.367573684	0.424578326	0.754965014	2.397677116	0.575153581	0.246615445	0	0	0.575133069	0	0	0.191666667	0	0	0	0	0.375915213	0.00158462	0.721901355	0	0	0	0	0	0	36.0976
H3359_032_0	2011	6	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				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	214.1981447	15.32726433	80.93374306	0	122.041987	4.214961211	1.092630817	241.4890718	76.87327209	477.0107433	15.43578664		0.168659089	5.286604518	4356.979606	5799.299071	1.88337461	2682.035087	22.82520223	566.6860523	8.278904809			8.914939417	417.6	417.6	115				0	199.9545623	3.285478107	793.6643943	500						6700	1A IP Acute: $150 per day; days 3-10	1B IP Psych: $150 per day; days 3-10 (up to 190 days)	2 SNF: $0 days 1-20; $75 per day for days 21-100	6 Home Health - $0 per day	10A Ambulance - $100 per trip	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $0	9B ASC Services - $100;  9A Outpatient Hospital - $100	8A Outpatient Lab - $0; D/T - $50	8B Outpatient X-Rays - $0; Diagnostic Radiology - $50; Therapeutic Radiology - 20%		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; 14C Routine Physical Exams - $0	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 - $50; Therapeutic Radiology - 20%	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 2 years	18A Hearing Exams (Routine) - $15	18B Hearing Aids - $0 ($500 max every 3 years)	14A Health Education & Wellness - $0		7B Chiropractic Services - $15	7F Podiatry Services - $20	18A Hearing Exams (Medicare Covered) - $15	17A Eye Exams (Medicare Covered) - $15	13B Accupuncture - $5						0	324.1001051	625.9852217	75	0	100	0.2	0.2	50	100	50	0.094251317		0.2	0.098301479	0	15	0.45	20	0.141568744	15	0.2			0.1	0	0	15				15	20	15	15	5						NO	313.2155599	604.9621973	72.48120758	0	96.64161011	0.19328322	0.19328322	48.32080505	96.64161011	48.32080505	0.09108599		0.19328322	0.095000132	0	14.49624152	0.434887245	19.32832202	0.136814314	14.49624152	0.19328322			0.1	0	0	15				14.49624152	19.32832202	14.49624152	14.49624152	5							5.5908	0.772701292	0.488847953	0	0.982861177	0.814681276	0.211187203	0.972412197	0.619096399	1.920795261	1.405983913	0	0.032598972	0.502228126	0	7.005669996	0.819055596	4.319936486	3.122814375	0.684568157	1.600173381	0	0	0.891493942	0	0	0.14375	0	0	0	0	0.322065514	0.003968924	0.958762562	0.208333333	0	0	0	0	0	34.3948	0	1.152038444	5.5908	0.772701292	0.488847953	0	0.982861177	0.814681276	0.211187203	0.972412197	0.619096399	1.920795261	1.405983913	0	0.032598972	0.502228126	0	7.005669996	0.819055596	4.319936486	3.122814375	0.684568157	1.600173381	0	0	0.891493942	0	0	0.14375	0	0	0	0	0.322065514	0.003968924	0.958762562	0.208333333	0	0	0	0	0	34.3948	NO																																																																																		0			5.5908	0.772701292	0.488847953	0	0.982861177	0.814681276	0.211187203	0.972412197	0.619096399	1.920795261	1.405983913	0	0.032598972	0.502228126	0	7.005669996	0.819055596	4.319936486	3.122814375	0.684568157	1.600173381	0	0	0.891493942	0	0	0.14375	0	0	0	0	0.322065514	0.003968924	0.958762562	0.208333333	0	0	0	0	0	34.3948
H3359_033_0	2011	5	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					V	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	YES	2036.309095	267.0359867	606.08631	0	7.118002766	12.61185412	2.887424815	16.00166803	10.64121946	7.30862465	20.15923897		0.250999176	18.59396517	4394.948199	9323.710891	612.2857275	1517.500928	4746.308288	684.1441059	15.88132786				0	0					0	758.8451054	2.034711435	1065.6544							6700	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; 14C Routine Physical Exams - $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	14A Health Education & Wellness - $0	13C OTC Rx Card - $0; 13E Home Safety - $0	7B Chiropractic Services - $0	7F Podiatry Services - $0	18A Hearing Exams (Medicare Covered) - $0	17A Eye Exams (Medicare Covered) - $0							0	100	100	48.74593561	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	96.59418355	96.59418355	47.08573851	0	0.193188367	0.096594184	0.096594184	0	0	0	0		0	0	0	0	0	0	0	0	0.193188367				0	0					0	0	0	0								16.3913	2.149510259	2.378168459	0	1.375115331	1.218231752	0.278908443	0	0	0	0	0	0	0	0	0	0	0	0	0	3.068087796	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.8593	0	0.947033472	16.3913	2.149510259	2.378168459	0	1.375115331	1.218231752	0.278908443	0	0	0	0	0	0	0	0	0	0	0	0	0	3.068087796	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.8593	NO																																																																																		0			16.3913	2.149510259	2.378168459	0	1.375115331	1.218231752	0.278908443	0	0	0	0	0	0	0	0	0	0	0	0	0	3.068087796	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.8593
H3359_804_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	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	403.800325	16.78535155	24.11297538	10.19448917	11.78828698	8.899247389	2.354580439	9.243979357	26.2082496	9.726607676	18.8043996		0.529405892	9.050934091	36.99629258	97.35595318	2.116053253	5.759946276	35.63937654	49.44069787	15.78468429																				6700	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	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	0.051596454	0.051596454	0.119556188	0	0.196519867	0.196519867	0.196519867	0.196519867	0.196519867	0.196519867	0.196519867		0.196519867	0.196519867	0.196519867	0.196519867	0.196519867	0.196519867	0.196519867	0.196519867	0.196519867																					20.8347	0.866064626	2.882855417	0	2.316632593	1.748878915	0.462721835	1.816625596	5.150441731	1.911471649	3.695438113	0	0.104038776	1.778688366	7.270506505	19.13237899	0.415846504	1.131943877	7.003845545	9.716079382	3.102004062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3411	0	17.19058424	20.8347	0.866064626	2.882855417	0	2.316632593	1.748878915	0.462721835	1.816625596	5.150441731	1.911471649	3.695438113	0	0.104038776	1.778688366	7.270506505	19.13237899	0.415846504	1.131943877	7.003845545	9.716079382	3.102004062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3411	NO																																																																																		0			20.8347	0.866064626	2.882855417	0	2.316632593	1.748878915	0.462721835	1.816625596	5.150441731	1.911471649	3.695438113	0	0.104038776	1.778688366	7.270506505	19.13237899	0.415846504	1.131943877	7.003845545	9.716079382	3.102004062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3411
H3359_805_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	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	403.800325	16.78535155	24.11297538	10.19448917	11.78828698	8.899247389	2.354580439	9.243979357	26.2082496	9.726607676	18.8043996		0.529405892	9.050934091	36.99629258	97.35595318	2.116053253	5.759946276	35.63937654	49.44069787	15.78468429																				6700	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	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	0.051596454	0.051596454	0.119556188	0	0.196519867	0.196519867	0.196519867	0.196519867	0.196519867	0.196519867	0.196519867		0.196519867	0.196519867	0.196519867	0.196519867	0.196519867	0.196519867	0.196519867	0.196519867	0.196519867																					20.8347	0.866064626	2.882855417	0	2.316632593	1.748878915	0.462721835	1.816625596	5.150441731	1.911471649	3.695438113	0	0.104038776	1.778688366	7.270506505	19.13237899	0.415846504	1.131943877	7.003845545	9.716079382	3.102004062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3411	0	17.19058424	20.8347	0.866064626	2.882855417	0	2.316632593	1.748878915	0.462721835	1.816625596	5.150441731	1.911471649	3.695438113	0	0.104038776	1.778688366	7.270506505	19.13237899	0.415846504	1.131943877	7.003845545	9.716079382	3.102004062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3411	NO																																																																																		0			20.8347	0.866064626	2.882855417	0	2.316632593	1.748878915	0.462721835	1.816625596	5.150441731	1.911471649	3.695438113	0	0.104038776	1.778688366	7.270506505	19.13237899	0.415846504	1.131943877	7.003845545	9.716079382	3.102004062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3411
H3361_039_0	2011	4																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1324.970718	231.4212646	569.7509625	941.5064546	622.9223159	4.382616878	5.711982125	222.2787343	132.0004686	1837.416713	472.5338285	2.0410595	0.106347499	645.1828637	8268.327067	14683.09317	740.8251161	2667.833399	2370.655934	3331.096132	9.1245334	0.003080467	0	0	342	205.2	0	0	419.047619	7.858136736											6700	"(1a) $200 days 1 - 5, $0 after day 5, unlimited coverage"	"(1b) $200 days 1 - 5, $0 after day 5, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $150.00 copayment , (9b) $100.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $200.00 copayment	(12) 20% coinsurance	"(9a) $150.00 copayment , (9d) Copay between $20.00 and $150.00"	"(14b) , (14c) $0.00 copayment ; (7a) $5.00 copayment"	"(7d) , (7g) $20.00 copayment ; (7b) $0.00 copayment"	"(7e) , (7h) $20.00 copayment"	"(7c) , (7i) $20.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $20.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	Not Covered	Not Covered	(14a) $0.00 copayment	"(13b) , (13c) $0.00 copayment"											0	111.7631301	47.87353703	40.05243107	0	44.64662294	0.2	0.136006066	44.20057402	113.8713017	0	10.52395405	31.47878654	0.2	12.92302608	1.474225629	3.303574415	14.87022601	6.899996131	3.6715381	8.297903077	0.2	0	0	0	0	0	0	0	0	0											NO	110.9753852	47.53610792	39.7701278	0	44.33193823	0.198590331	0.135047449	43.88903322	113.0686977	0	10.44977761	31.25691326	0.198590331	12.83194016	1.463834781	3.280289689	14.76541556	6.851362593	3.64565984	8.239416611	0.198590331	0	0	0	0	0	0	0	0	0												12.2533	0.916738851	1.888255716	0	2.301279469	0.870345338	0.771388615	0.812966563	1.24376009	0	0.411489452	0.005316435	0.021119585	0.689912325	1.008622062	4.013733261	0.911549225	1.523191163	0.720217095	2.287190733	1.812044112	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4624	0	0.244626896	12.2533	0.916738851	1.888255716	0	2.301279469	0.870345338	0.771388615	0.812966563	1.24376009	0	0.411489452	0.005316435	0.021119585	0.689912325	1.008622062	4.013733261	0.911549225	1.523191163	0.720217095	2.287190733	1.812044112	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4624	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	12.2533	0.916738851	1.888255716	0	2.301279469	0.870345338	0.771388615	0.812966563	1.24376009	0	0.411489452	0.005316435	0.021119585	0.689912325	1.008622062	4.013733261	0.911549225	1.523191163	0.720217095	2.287190733	1.812044112	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4624
H3361_043_0	2011	7																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	P	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	Yes	2207.695955	484.1814652	752.1224673	1461.353326	18.89119325	5.891996357	9.008812423	12.52567045	21.5954441	3316.844379	6.75642077	0.033367146	0.440020737	11.11094868	11121.38827	87.37519523	12.5308968	11.92571432	21.48422685	29.78330959	8.689239087	0.0051659	2600	0	691.2	138.24	0	0	412.5	4167.594056											6700	FFS	FFS	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) $0.00 copayment	(8b) 20% coinsurance	(5) 45% coinsurance	(12) 20% coinsurance	"(9a) , (9d) 20% coinsurance"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7d) , (7g) 20% coinsurance ; (7b) $0.00 copayment"	"(7e) , (7h) 45% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) 20% coinsurance"	(15) 20% coinsurance	(13a) 20% coinsurance	(10b) $0.00 copayment	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $300 benefit limit"	Not Covered	Not Covered	(14a) $0.00 copayment	"(13b) , (13c) $0.00 copayment"											0	124.0917808	45.32626715	38.81336498	0	0.1422089	0.19	0.19	0.166497384	0.16217729	0	0.134745404	0.405677778	0.19	0.154968311	0	0.074825676	0.330437161	0.153961242	0.119395654	0.17094578	0.19001528	0.152402355	0	0	0	0	0	0	0	0											NO	122.102543	44.59967006	38.19117217	0	0.139929238	0.186954229	0.186954229	0.163828368	0.159577527	0	0.132585385	0.399174611	0.186954229	0.152484111	0	0.073626192	0.325140129	0.151493186	0.117481697	0.168205455	0.186969264	0.149959288	0	0	0	0	0	0	0	0												22.4638	1.7995278	2.39370322	0	2.64343028	1.101533634	1.684235578	2.052060151	3.446147565	0	0.895802647	0.013319318	0.082263738	1.694243129	0	6.433102887	4.074297401	1.806664457	2.52400342	5.009715139	1.624620635	0.000774675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7432	0	1.005891822	22.4638	1.7995278	2.39370322	0	2.64343028	1.101533634	1.684235578	2.052060151	3.446147565	0	0.895802647	0.013319318	0.082263738	1.694243129	0	6.433102887	4.074297401	1.806664457	2.52400342	5.009715139	1.624620635	0.000774675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7432	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	22.4638	1.7995278	2.39370322	0	2.64343028	1.101533634	1.684235578	2.052060151	3.446147565	0	0.895802647	0.013319318	0.082263738	1.694243129	0	6.433102887	4.074297401	1.806664457	2.52400342	5.009715139	1.624620635	0.000774675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7432
H3361_059_0	2011	4																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1606.972412	184.0205926	485.6827854	725.775418	676.8774027	6.825584673	5.4008638	455.0046941	254.2823633	4658.181894	1218.749778	6.804440771	0.089336313	1400.089466	8783.947333	15547.91304	541.6497958	1249.348096	2824.466192	2926.99058	11.56982191	0.007082572	0	407.1428571	342	205.2	15.6	11.88571429	406.1538462	5.838149695											6700	"(1a) $150 days 1 - 10, $0 after day 10, unlimited coverage"	"(1b) $150 days 1 - 10, $0 after day 10, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $100.00 copayment , (9b) $50.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $150.00 copayment	(12) 20% coinsurance	"(9a) $100.00 copayment , (9d) Copay between $35.00 and $100.00"	"(14b) , (14c) $0.00 copayment ; (7a) $10.00 copayment"	"(7d) , (7g) $35.00 copayment ; (7b) $0.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	"(16) $0.00 copayment, $500 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	"(13b) $10.00 copayment , (13c) $0.00 copayment"											0	116.6868976	59.93065376	37.17505557	0	42.89884902	0.2	0.09814858	41.9734827	71.78848333	0	13.06416344	35.66568938	0.2	20.10093204	3.258840754	6.539903	25.55334189	12.33717926	3.261066589	7.573406333	0.2	0	0	0	0	0	0	0	0	10											NO	115.4865162	59.31413517	36.79262836	0	42.45754	0.19794256	0.097138906	41.54169311	71.04998088	0	12.92976978	35.29878932	0.19794256	19.89414974	3.225316409	6.472625713	25.29046956	12.21026424	3.227519346	7.495497191	0.19794256	0	0	0	0	0	0	0	0	9.897128005												15.4653	0.909585192	1.489128852	0	2.394879117	1.351073704	0.524634003	1.575138781	1.505563088	0	1.313179504	0.02001571	0.017683459	2.321132458	2.360917456	8.386318479	1.141548139	1.271239198	0.759668273	1.828270806	2.290160168	0	0	0	0	0	0	0	0	0.004815076	0	0	0	0	0	0	0	0	0	0	46.9303	0	0.487798985	15.4653	0.909585192	1.489128852	0	2.394879117	1.351073704	0.524634003	1.575138781	1.505563088	0	1.313179504	0.02001571	0.017683459	2.321132458	2.360917456	8.386318479	1.141548139	1.271239198	0.759668273	1.828270806	2.290160168	0	0	0	0	0	0	0	0	0.004815076	0	0	0	0	0	0	0	0	0	0	46.9303	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	15.4653	0.909585192	1.489128852	0	2.394879117	1.351073704	0.524634003	1.575138781	1.505563088	0	1.313179504	0.02001571	0.017683459	2.321132458	2.360917456	8.386318479	1.141548139	1.271239198	0.759668273	1.828270806	2.290160168	0	0	0	0	0	0	0	0	0.004815076	0	0	0	0	0	0	0	0	0	0	46.9303
H3361_065_0	2011	5																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	P	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	Yes	1955.96765	547.939828	454.5700533	822.615682	26.12413457	10.24540907	9.157051227	48.98149938	34.64096014	10569.54269	21.93654278	0.212184549	0.0705054	23.30430037	9645.162615	85.6253295	12.63355459	1.844472662	18.10564894	11.37706605	15.10845863	0.012758222	2600	0	342	205.2	0	0	400	3228.943576											6700	FFS	FFS	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) $0.00 copayment	(8b) 20% coinsurance	(5) 45% coinsurance	(12) 20% coinsurance	"(9a) , (9d) 20% coinsurance"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7d) , (7g) 20% coinsurance ; (7b) $0.00 copayment"	"(7e) , (7h) 45% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) 20% coinsurance"	(15) 20% coinsurance	(13a) 20% coinsurance	(10b) $0.00 copayment	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	Not Covered	Not Covered	(14a) $0.00 copayment	"(13b) , (13c) $0.00 copayment"											0	138.7386757	58.30089316	38.5445791	0	0.180360032	0.19	0.19	0.163945304	0.170301174	0	0.186571411	0.425473617	0.19	0.166711725	0	0.080890046	0.373990557	0.168769865	0.153678522	0.153094816	0.190016723	0.176144843	0	0	0	0	0	0	0	0											NO	135.4053533	56.90016136	37.61851066	0	0.176026719	0.185435078	0.185435078	0.160006369	0.166209534	0	0.182088863	0.415251228	0.185435078	0.162706325	0	0.07894659	0.365005095	0.164715016	0.149986256	0.149416574	0.185451399	0.171912804	0	0	0	0	0	0	0	0												22.0707	2.598155386	1.425020699	0	4.59854569	1.899858228	1.698038507	7.837351886	5.757657853	0	3.994400142	0.088109894	0.013074174	3.791757065	0	6.75982774	4.611311787	0.303812344	2.715598494	1.699922234	2.801884785	0.002193302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.6672	0	1.838110074	22.0707	2.598155386	1.425020699	0	4.59854569	1.899858228	1.698038507	7.837351886	5.757657853	0	3.994400142	0.088109894	0.013074174	3.791757065	0	6.75982774	4.611311787	0.303812344	2.715598494	1.699922234	2.801884785	0.002193302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.6672	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	22.0707	2.598155386	1.425020699	0	4.59854569	1.899858228	1.698038507	7.837351886	5.757657853	0	3.994400142	0.088109894	0.013074174	3.791757065	0	6.75982774	4.611311787	0.303812344	2.715598494	1.699922234	2.801884785	0.002193302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.6672
H3361_098_0	2011	6																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	P	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	Yes	2098.920406	260.468763	639.4434599	712.5971204	14.97037964	9.910176206	9.915224297	19.98036175	44.02819279	7189.421252	24.88209024	0.765238035	0.116225194	21.01636061	11809.23407	115.9863562	6.21476484	6.35687261	26.90210422	19.95948385	20.08233506	0.011013237	2600	0	342	205.2	0	0	394.0298507	3304.169741											6700	FFS	FFS	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) $0.00 copayment	(8b) 20% coinsurance	(5) 45% coinsurance	(12) 20% coinsurance	"(9a) , (9d) 20% coinsurance"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7d) , (7g) 20% coinsurance ; (7b) $0.00 copayment"	"(7e) , (7h) 45% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) 20% coinsurance"	(15) 20% coinsurance	(13a) 20% coinsurance	(10b) $0.00 copayment	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	Not Covered	Not Covered	(14a) $0.00 copayment	"(13b) , (13c) $0.00 copayment"											0	162.9735437	63.08320577	59.44626181	0	0.140090283	0.19	0.19	0.16355693	0.168033989	0	0.131939553	0.082303819	0.19	0.151405848	0	0.082033914	0.360400874	0.171533916	0.113722725	0.129938763	0.190017747	0.152402355	0	0	0	0	0	0	0	0											NO	158.8349022	61.48123547	57.93665011	0	0.136532752	0.185175033	0.185175033	0.159403474	0.16376684	0	0.128589006	0.080213749	0.185175033	0.147560963	0	0.079950698	0.351248652	0.167177887	0.110834786	0.126639025	0.185192329	0.148532164	0	0	0	0	0	0	0	0												27.7818	1.334495113	3.087267667	0	2.043947131	1.835117211	1.836051991	3.184939071	7.210357993	0	3.19956325	0.061382612	0.021522004	3.101194402	0	9.273190191	2.182927774	1.062728532	2.981688965	2.527649583	3.719094409	0.00163582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4466	0	1.991910813	27.7818	1.334495113	3.087267667	0	2.043947131	1.835117211	1.836051991	3.184939071	7.210357993	0	3.19956325	0.061382612	0.021522004	3.101194402	0	9.273190191	2.182927774	1.062728532	2.981688965	2.527649583	3.719094409	0.00163582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4466	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	27.7818	1.334495113	3.087267667	0	2.043947131	1.835117211	1.836051991	3.184939071	7.210357993	0	3.19956325	0.061382612	0.021522004	3.101194402	0	9.273190191	2.182927774	1.062728532	2.981688965	2.527649583	3.719094409	0.00163582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4466
H3361_099_0	2011	6																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1958.709328	321.7594777	478.9610735	893.5515404	731.6534784	8.685653581	7.9674904	564.25911	302.2088707	5999.504505	1159.713968	6.833122114	0.077325972	1274.927029	11290.49662	14833.12766	720.3939458	359.0164233	3192.296265	2644.374526	13.40243071	0.006899364	0	0	342	205.2	15.6	11.88571429	0	22.69149096											6700	"(1a) $175 days 1 - 10, $0 after day 10, unlimited coverage"	"(1b) $175 days 1 - 10, $0 after day 10, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $125.00 copayment , (9b) $75.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $175.00 copayment	(12) 20% coinsurance	"(9a) $125.00 copayment , (9d) Copay between $35.00 and $125.00"	"(14b) , (14c) $0.00 copayment ; (7a) $10.00 copayment"	"(7d) , (7g) $35.00 copayment ; (7b) $0.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	Not Covered	"(13b) $30.00 copayment , (13c) $0.00 copayment"											0	141.8482591	67.05055366	38.27679581	0	48.74122055	0.2	0.070865321	43.34675574	96.03617866	0	15.15744289	19.07518969	0.2	49.81951865	3.597644626	6.178351062	24.12083011	11.74347218	4.042820452	4.796797844	0.2	0	0	0	0	0	0	0	0	14.6755029											NO	139.7201689	66.04462222	37.70254503	0	48.00997638	0.196999484	0.069802158	42.69644248	94.59538799	0	14.9300421	18.78901258	0.196999484	49.07209722	3.543670667	6.085659842	23.75895537	11.56728977	3.982167706	4.72483349	0.196999484	0	0	0	0	0	0	0	0	14.45533246												22.8059	1.770873596	1.50483762	0	2.927222184	1.71106927	0.556148024	2.007654719	2.382297115	0	1.442881531	0.010698968	0.015233177	5.213611924	3.334150139	7.522447446	1.426317301	0.346070584	1.059354924	1.041185777	2.640271929	0	0	0	0	0	0	0	0	0.02733442	0	0	0	0	0	0	0	0	0	0	59.7456	0	0.90999039	22.8059	1.770873596	1.50483762	0	2.927222184	1.71106927	0.556148024	2.007654719	2.382297115	0	1.442881531	0.010698968	0.015233177	5.213611924	3.334150139	7.522447446	1.426317301	0.346070584	1.059354924	1.041185777	2.640271929	0	0	0	0	0	0	0	0	0.02733442	0	0	0	0	0	0	0	0	0	0	59.7456	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	22.8059	1.770873596	1.50483762	0	2.927222184	1.71106927	0.556148024	2.007654719	2.382297115	0	1.442881531	0.010698968	0.015233177	5.213611924	3.334150139	7.522447446	1.426317301	0.346070584	1.059354924	1.041185777	2.640271929	0	0	0	0	0	0	0	0	0.02733442	0	0	0	0	0	0	0	0	0	0	59.7456
H3361_105_0	2011	7																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	P	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	Yes	3822.264218	705.4098329	2063.682523	2985.177361	30.82384869	17.65175728	18.88607719	16.12872754	33.29325602	5304.629372	13.7530726	0.067177155	1.958589799	23.43243887	16062.95269	149.4274599	21.54938204	29.59106257	43.92928189	51.06494351	19.65097143	0.01913415	2760	0	691.2	138.24	0	0	0	4178.986032											6700	FFS	FFS	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) $0.00 copayment	(8b) 20% coinsurance	(5) 45% coinsurance	(12) 20% coinsurance	"(9a) , (9d) 20% coinsurance"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7d) , (7g) 20% coinsurance ; (7b) $0.00 copayment"	"(7e) , (7h) 45% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) 20% coinsurance"	(15) 20% coinsurance	(13a) 20% coinsurance	(10b) $0.00 copayment	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $300 benefit limit"	Not Covered	Not Covered	Not Covered	"(13b) , (13c) $0.00 copayment"											0	122.8537997	47.81930782	43.31824585	0	0.189480277	0.2	0.2	0.170607145	0.179171051	0	0.186207461	0.425126258	0.2	0.169348624	0	0.077810225	0.329655425	0.163152131	0.156091953	0.168793808	0.2	0.160423532	0	0	0	0	0	0	0	0											NO	114.6744433	44.63559544	40.43420503	0	0.176865065	0.186684406	0.186684406	0.159248467	0.167242206	0	0.173810147	0.396822215	0.186684406	0.158073737	0	0.072629779	0.307707637	0.152289794	0.145699668	0.157555859	0.186684406	0.149742859	0	0	0	0	0	0	0	0												36.5263	2.62386566	6.953613522	0	5.451662006	3.295307827	3.525736105	2.568475144	5.568037593	0	2.390423568	0.026657387	0.365638174	3.704053167	0	10.85288332	6.630909418	4.506416811	6.400481769	8.045581063	3.668529933	0.002865202	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1075	0	8.067589521	36.5263	2.62386566	6.953613522	0	5.451662006	3.295307827	3.525736105	2.568475144	5.568037593	0	2.390423568	0.026657387	0.365638174	3.704053167	0	10.85288332	6.630909418	4.506416811	6.400481769	8.045581063	3.668529933	0.002865202	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1075	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	36.5263	2.62386566	6.953613522	0	5.451662006	3.295307827	3.525736105	2.568475144	5.568037593	0	2.390423568	0.026657387	0.365638174	3.704053167	0	10.85288332	6.630909418	4.506416811	6.400481769	8.045581063	3.668529933	0.002865202	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1075
H3361_106_0	2011	5																															D	D	D	P	P	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	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	1622.408911	296.0080262	439.0357134	804.9547713	600.5720502	1.799212998	5.740986556	309.8048918	146.7498173	1653.425347	548.4227276	2.673696831	0.445323352	384.7545543	12711.87391	12593.7814	545.6244947	1548.459557	2763.245987	4025.281884	6.281916706	0.000293678	2700	407.1428571	342	205.2	15.6	11.88571429	377.1428571	3833.801856											6700	"(1a) $100 days 0 - 9, $0 after day 9, unlimited coverage"	"(1b) $100 days 0 - 9, $0 after day 9, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $75.00 copayment , (9b) $50.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $100.00 copayment	(12) 20% coinsurance	"(9a) $75.00 copayment , (9d) Copay between $20.00 and $75.00"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7d) , (7g) $20.00 copayment ; (7b) $0.00 copayment"	"(7e) , (7h) $20.00 copayment"	"(7c) , (7i) $20.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $20.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	(10b) $0.00 copayment	"(16) $0.00 copayment, $500 benefit limit"	(17a) $0.00 copayment	"(17b) $0.00 copayment, $100 benefit limit"	(18a) $0.00 copayment	"(18b) $0.00 copayment, $350 benefit limit"	(14a) $0.00 copayment	"(13b) $15.00 copayment , (13c) $0.00 copayment"											0	85.67420392	36.89275396	42.39306295	0	48.70830105	0.2	0.066398087	45.23546623	67.26939424	0	10.69840961	57.54509944	0.2	38.3731848	0	3.329928691	14.4148589	6.490510465	5.965588638	12.73796579	0.2	0	0	0	0	0	0	0	0	0.006790793											NO	85.10338827	36.64695113	42.11061359	0	48.38377558	0.198667474	0.065955701	44.93407899	66.82120305	0	10.62713005	57.16169765	0.198667474	38.11751841	0	3.307742603	14.318818	6.447266586	5.925842119	12.65309742	0.198667474	0	0	0	0	0	0	0	0	0.006745549												11.506	0.903982639	1.54067194	0	2.421495275	0.357445101	0.37865079	1.160066457	0.817166612	0	0.485679971	0.012736087	0.088471265	1.222157401	0	3.471415606	0.651058153	0.831944297	1.364546621	4.244356984	1.248012522	0	0	0	0	0	0	0	0	0.002155091	0	0	0	0	0	0	0	0	0	0	32.7081	0	0.219383383	11.506	0.903982639	1.54067194	0	2.421495275	0.357445101	0.37865079	1.160066457	0.817166612	0	0.485679971	0.012736087	0.088471265	1.222157401	0	3.471415606	0.651058153	0.831944297	1.364546621	4.244356984	1.248012522	0	0	0	0	0	0	0	0	0.002155091	0	0	0	0	0	0	0	0	0	0	32.7081	NO	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Same as in-network	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	Not covered OON	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												1.9603	0	0.1008	0.0472	0.0763	0.0122	0.0391	0	0.1302	0.0076	0.0686	0	0	0.0243	0	0.4598	0	0.0254	0.1576	0.1409	0.0427	0	0	0	0	0	0	0	0	0											3.2932	0	0	13.4664	0.903982639	1.64144441	0.04721043	2.497761245	0.369687169	0.417713173	1.160066457	0.947413349	0.00763375	0.554293655	0.012736087	0.088471265	1.246475669	0	3.931251709	0.651058153	0.857383185	1.522171597	4.385218022	1.29075546	2.00E-06	0	0	0	0	0	0	0	0.002155091	0	0	0	0	0	0	0	0	0	0	36.0013
H3361_109_0	2011	5																															D	D	D	P	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	P	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	Yes	1721.740226	459.6198154	508.0889199	1098.848177	17.4480146	3.051777174	9.151702964	10.00298369	21.79688204	2212.605034	6.776681612	0.032962874	0.191102566	5.016727211	13748.29363	70.91714327	7.447602804	7.209741998	20.06364251	29.50291453	4.496654809	0.004872265	2600	0	691.2	138.24	0	0	371.8309859	4190.774782											6700	FFS	FFS	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) 20% coinsurance	(11a) 20% coinsurance	"(11b) , (11c) 20% coinsurance"	"(4a) , (4b) 20% coinsurance"	"(9a) , (9b) 20% coinsurance"	(8a) $0.00 copayment	(8b) 20% coinsurance	(5) 45% coinsurance	(12) 20% coinsurance	"(9a) , (9d) 20% coinsurance"	"(7a) , (14b) , (14c) $0.00 copayment"	"(7d) , (7g) 20% coinsurance ; (7b) $0.00 copayment"	"(7e) , (7h) 45% coinsurance"	"(7c) , (7i) 20% coinsurance"	(8b) 20% coinsurance	"(7g) , (8a) 20% coinsurance"	(15) 20% coinsurance	(13a) 20% coinsurance	(10b) $0.00 copayment	Not Covered	(17a) $0.00 copayment	"(17b) $0.00 copayment, $300 benefit limit"	Not Covered	Not Covered	(14a) $0.00 copayment	"(13b) , (13c) $0.00 copayment"											0	129.757944	45.48204897	41.11607484	0	0.181031333	0.19	0.19	0.166715602	0.176415408	0	0.17817252	0.396562339	0.19	0.167168034	0	0.086934094	0.440691585	0.172516366	0.165786328	0.163546284	0.190066326	0.094227585	0	0	0	0	0	0	0	0											NO	128.1190897	44.90760667	40.59677517	0	0.178744891	0.187600283	0.187600283	0.164609969	0.174187266	0	0.175922186	0.391553722	0.187600283	0.165056687	0	0.085836109	0.435125611	0.170337469	0.163692432	0.16148068	0.187665771	0.093037482	0	0	0	0	0	0	0	0												18.3823	1.720035491	1.718897637	0	3.118743474	0.572514262	1.716862068	1.646590839	3.79673929	0	1.19216864	0.012906736	0.035850895	0.828044375	0	6.087251612	3.240642721	1.228089205	3.284266433	4.764150686	0.843868193	0.000453303	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1904	0	0.693184422	18.3823	1.720035491	1.718897637	0	3.118743474	0.572514262	1.716862068	1.646590839	3.79673929	0	1.19216864	0.012906736	0.035850895	0.828044375	0	6.087251612	3.240642721	1.228089205	3.284266433	4.764150686	0.843868193	0.000453303	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1904	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	18.3823	1.720035491	1.718897637	0	3.118743474	0.572514262	1.716862068	1.646590839	3.79673929	0	1.19216864	0.012906736	0.035850895	0.828044375	0	6.087251612	3.240642721	1.228089205	3.284266433	4.764150686	0.843868193	0.000453303	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1904
H3361_127_0	2011	7																															A	A	D	P	P	Coin	Coin	P	P	P	P	P	Coin	Coin	P	P	P	P	P	P	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	288.190999	5.422786465	916.7514855	1103.326118	713.9223327	11.75378629	8.932641433	505.6546828	335.6411813	10560.71661	2047.358715	2.034536576	0.174289998	14.56320788	10807.31888	18911.67337	538.4327692	2256.236155	3467.720452	3636.004992	17.34369877	0.012122293	0	0	342	0	0	0	0	13.33333333											6700	"(1a) $1000 per admission, unlimited coverage"	"(1b) $1000 per admission, unlimited coverage"	"(2) $0 days 1 - 4, $50 days 5 - 100"	(6) $0.00 copayment	(10a) $100.00 copayment	(11a) 20% coinsurance	"(11b) 20% coinsurance , (11c) $0.00 copayment"	"(4a) $50.00 copayment , (4b) $25.00 copayment"	"(9a) $200.00 copayment , (9b) $150.00 copayment"	(8a) $0.00 copayment	(8b) Copay between $0.00 and $50.00	(5) $250.00 copayment	(12) 20% coinsurance	"(9a) $200.00 copayment , (9d) $35.00 copayment , 20% coinsurance"	"(14b) , (14c) $0.00 copayment ; (7a) $10.00 copayment"	"(7d) , (7g) $35.00 copayment ; (7b) $0.00 copayment"	"(7e) , (7h) $35.00 copayment"	"(7c) , (7i) $35.00 copayment"	(8b) Copay between $0.00 and $50.00	"(7g) $35.00 copayment , (8a) Copay between $20.00 and $50.00"	(15) 20% coinsurance	(13a) $0.00 copayment	Not Covered	Not Covered	(17a) $0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	"(13b) $30.00 copayment , (13c) $0.00 copayment"											0	1041.205482	1041.205482	39.27	0	41.15530977	0.2	0.124162387	43.31721987	148.2060637	0	11.0112936	39.34848318	0.2	0.146925293	2.79003634	7.960436545	26.67263534	11.82153925	2.631901671	6.875430385	0.2	0	0	0	0	0	0	0	0	30											NO	1021.032062	1021.032062	38.50914135	0	40.35792312	0.196124988	0.121756733	42.47794609	145.3345621	0	10.79794911	38.58610391	0.196124988	0.144078606	2.735979216	7.8062026	26.1558514	11.5924962	2.580908415	6.742218501	0.196124988	0	0	0	0	0	0	0	0	29.41874816												24.521	0.461403237	2.941942711	0	2.401035218	2.305211193	1.087609236	1.78993103	4.065022009	0	1.842272935	0.00654207	0.034182624	2.098246692	2.464049986	12.30236282	1.173597292	2.179617421	0.745822408	2.04289501	3.40153271	0	0	0	0	0	0	0	0	0.032687498	0	0	0	0	0	0	0	0	0	0	67.897	0	1.341499878	24.521	0.461403237	2.941942711	0	2.401035218	2.305211193	1.087609236	1.78993103	4.065022009	0	1.842272935	0.00654207	0.034182624	2.098246692	2.464049986	12.30236282	1.173597292	2.179617421	0.745822408	2.04289501	3.40153271	0	0	0	0	0	0	0	0	0.032687498	0	0	0	0	0	0	0	0	0	0	67.897	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	24.521	0.461403237	2.941942711	0	2.401035218	2.305211193	1.087609236	1.78993103	4.065022009	0	1.842272935	0.00654207	0.034182624	2.098246692	2.464049986	12.30236282	1.173597292	2.179617421	0.745822408	2.04289501	3.40153271	0	0	0	0	0	0	0	0	0.032687498	0	0	0	0	0	0	0	0	0	0	67.897
H3362_003_0	2011	8																															A	A	D		T	Coin	Coin	V	V		V			V	V	V	Coin	V	P	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	188.115905	3.524655608	1141.127052	0	185.1722574	7.125250054	0.614718722	330.4204855	477.7656129	0	607.0117862	0	0	1416.449679	4797.905009	5454.487685	1.39616423	731.2934774	1124.466071	307.8033051	3.113030486	508.4098341	0	0	0	0	23.76423622	0	0	0											3400	$425/Admit for IP Medical; $425/Admit for IP Surg; PBP 1a	$425/Admit for IP S/A; $425/Admit for IP Psych; PBP 1b	$40/Day for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	25% Coinsurance for DME; PBP 11a	"25% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for Emergency Room and Worldwide Coverage; PBP 4a, 4b"	"$100/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$50/Case for Diagnostic Radiology; $25/Case for Non-Diagnostic Radiology; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$10/Visit for PT/OT/ST, CORF; $25/Visit for OP Hospital; 45% Coinsurance for OP Substance Abuse, Partial Hosptial; PBP 3, 5, 9a, 9c, 9d, 13a"	"$10/Visit for PCP and No Cost Sharing for Physical Exams and Preventive Tests; PBP 4b, 7a, 14a-f, 14i-j"	"$25/Visit for SCP; 50% Coinsurance for Chiropractor; $25/Case for Medicare Covered Vision Exam; $25/Visit for Medicare Covered Hearing Exam; $25/Visit for Podatrist; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"45% Coinsurance for OP MH; PBP 7e, 7h"	"$10/Visit for PT/OT/ST; PBP 7c, 7i"	"$25/Procedure for Radiology; PBP 7d, 14g-h"	"$25/Visit for Physician Specialist  Services; PBP 7d,"	20% Coinsurance for Part B Drugs; PBP 15	"$25/Visit for Other Health Care Professional Services; PBP 7d,"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$25/Exam for Routine Hearing Exam; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	425	425	40	0	100	0.25	0.25	50	100	0	31.44686391	0	0	15.97299064	10	23.91802917	0.45	10	25	25	0.2	25	0	0	0	0	25	0	0	0											NO	396.7430963	396.7430963	37.34052671	0	93.35131677	0.233378292	0.233378292	46.67565838	93.35131677	0	29.35606154	0	0	14.91099709	9.335131677	22.32779518	0.420080925	9.335131677	23.33782919	23.33782919	0.186702634	23.33782919	0	0	0	0	23.33782919	0	0	0												6.2195	0.116531898	3.550857097	0	1.440506172	1.662878687	0.143462005	1.285216142	3.716670756	0	1.484956279	0	0	1.760056421	3.73242292	10.14889032	0.586501962	0.568893409	2.186883091	0.598621747	0.58121099	0.988765156	0	0	0	0	0.04621714	0	0	0	0	0	0	0	0	0	0	0	0	0	40.819	0	2.907218849	6.2195	0.116531898	3.550857097	0	1.440506172	1.662878687	0.143462005	1.285216142	3.716670756	0	1.484956279	0	0	1.760056421	3.73242292	10.14889032	0.586501962	0.568893409	2.186883091	0.598621747	0.58121099	0.988765156	0	0	0	0	0.04621714	0	0	0	0	0	0	0	0	0	0	0	0	0	40.819	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.2195	0.116531898	3.550857097	0	1.440506172	1.662878687	0.143462005	1.285216142	3.716670756	0	1.484956279	0	0	1.760056421	3.73242292	10.14889032	0.586501962	0.568893409	2.186883091	0.598621747	0.58121099	0.988765156	0	0	0	0	0.04621714	0	0	0	0	0	0	0	0	0	0	0	0	0	40.819
H3362_016_0	2011	2																															A	A	D		T	Coin	Coin	V	V		V			V	V	V	Coin	V	P	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	235.3974286	3.956605943	1417.466287	0	240.6170879	6.639004858	0.627255401	359.0295119	547.2596718	0	704.4437734	0	0	1713.491985	4879.575339	6457.029717	0.848154539	682.9857541	1299.060388	376.4011761	2.511191193	625.6076253	0	0	0	0	27.03462625	0	0	0											3400	$475/Admit for IP Medical; $475/Admit for IP Surg; PBP 1a	$475/Admit for IP S/A; $475/Admit for IP Psych; PBP 1b	$40/Day for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	25% Coinsurance for DME; PBP 11a	"25% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for Emergency Room and Worldwide Coverage; PBP 4a, 4b"	"$100/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$75/Case for Diagnostic Radiology; $30/Case for Non-Diagnostic Radiology; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$10/Visit for Cardiac Rehab; $10/Visit for PT/OT/ST, CORF; $30/Visit for OP Hospital; 45% Coinsurance for OP Substance Abuse, Partial Hosptial; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15/Visit for PCP and No Cost Sharing for Physical Exams and Preventive Tests; PBP 4b, 7a, 14a-f, 14i-j"	"$30/Visit for SCP; 50% Coinsurance for Chiropractor; $30/Case for Medicare Covered Vision Exam; $30/Visit for Medicare Covered Hearing Exam; $30/Visit for Podatrist; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"45% Coinsurance for OP MH; PBP 7e, 7h"	"$10/Visit for PT/OT/ST; PBP 7c, 7i"	"$30/Procedure for Radiology; PBP 7d, 14g-h"	"$30/Visit for Physician Specialist  Services; PBP 7d,"	20% Coinsurance for Part B Drugs; PBP 15	"$30/Visit for Other Health Care Professional Services; PBP 7d,"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$30/Exam for Routine Hearing Exam; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	475	475	40	0	150	0.25	0.25	50	100	0	41.67403546	0	0	18.31986923	15	28.60510432	0.45	10	30	30	0.2	30	0	0	0	0	30	0	0	0											NO	422.45524	422.45524	35.57517811	0	133.4069179	0.222344863	0.222344863	44.46897263	88.93794527	0	37.06403085	0	0	16.29331527	13.34069179	25.44079202	0.400220754	8.893794527	26.68138358	26.68138358	0.177875891	26.68138358	0	0	0	0	26.68138358	0	0	0												8.2871	0.139290743	4.202217968	0	2.674998674	1.476148627	0.139467016	1.330472795	4.056012561	0	2.175793813	0	0	2.32653876	5.424742555	13.68932918	0.339449049	0.50619458	2.888394042	0.83690868	0.44668037	1.391006419	0	0	0	0	0.060110103	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3908	0	6.516343686	8.2871	0.139290743	4.202217968	0	2.674998674	1.476148627	0.139467016	1.330472795	4.056012561	0	2.175793813	0	0	2.32653876	5.424742555	13.68932918	0.339449049	0.50619458	2.888394042	0.83690868	0.44668037	1.391006419	0	0	0	0	0.060110103	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3908	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.2871	0.139290743	4.202217968	0	2.674998674	1.476148627	0.139467016	1.330472795	4.056012561	0	2.175793813	0	0	2.32653876	5.424742555	13.68932918	0.339449049	0.50619458	2.888394042	0.83690868	0.44668037	1.391006419	0	0	0	0	0.060110103	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3908
H3362_017_0	2011	5																															A	A	D		T	Coin	Coin	V	V		V			V	V	V	Coin	V	P	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	108.2712152	4.989456924	553.198235	0	93.33458769	5.319708062	0.475738799	217.5189096	319.8320689	0	363.4592003	0	0	874.2330597	3573.360757	3209.869116	1.615809285	537.5602368	725.9556298	183.2301294	1.589894334	329.4927766	0	0	0	0	16.93194645	0	0	0											3400	$600/Admit for IP Medical; $600/Admit for IP Surg; PBP 1a	$600/Admit for IP S/A; $600/Admit for IP Psych; PBP 1b	$45/Day for SNF; PBP 2	No Cost Sharing; PBP 6	$180/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for Emergency Room and Worldwide Coverage; PBP 4a, 4b"	"$125/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$75/Case for Diagnostic Radiology; $30/Case for Non-Diagnostic Radiology; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$20/Visit for PT/OT/ST, CORF; $30/Visit for OP Hospital; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15/Visit for PCP and No Cost Sharing for Physical Exams and Preventive Tests; PBP 4b, 7a, 14a-f, 14i-j"	"$30/Visit for SCP; 50% Coinsurance for Chiropractor; $30/Case for Medicare Covered Vision Exam; $30/Visit for Medicare Covered Hearing Exam; $30/Visit for Podatrist; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"45% Coinsurance for OP MH; PBP 7e, 7h"	"$20/Visit for PT/OT/ST; PBP 7c, 7i"	"$30/Procedure for Radiology; PBP 7d, 14g-h"	"$30/Visit for Physician Specialist  Services; PBP 7d,"	20% Coinsurance for Part B Drugs; PBP 15	"$30/Visit for Other Health Care Professional Services; PBP 7d,"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$30/Exam for Routine Hearing Exam; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	600	600	45	0	180	0.3	0.3	50	125	0	41.67403546	0	0	24.17679773	15	28.12447515	0.45	20	30	30	0.2	30	0	0	0	0	30	0	0	0											NO	573.4275034	573.4275034	43.00706276	0	172.028251	0.286713752	0.286713752	47.78562529	119.4640632	0	39.82839685	0	0	23.10606794	14.33568759	26.87891262	0.430070628	19.11425011	28.67137517	28.67137517	0.191142501	28.67137517	0	0	0	0	28.67137517	0	0	0												5.1738	0.238424319	1.982619268	0	1.33801549	1.525233457	0.136400856	0.866189759	3.184036542	0	1.206333106	0	0	1.683340706	4.268881954	7.189815957	0.694912113	0.856255068	1.734512185	0.437788315	0.30389638	0.787250918	0	0	0	0	0.040455182	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6482	0	1.559248305	5.1738	0.238424319	1.982619268	0	1.33801549	1.525233457	0.136400856	0.866189759	3.184036542	0	1.206333106	0	0	1.683340706	4.268881954	7.189815957	0.694912113	0.856255068	1.734512185	0.437788315	0.30389638	0.787250918	0	0	0	0	0.040455182	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6482	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.1738	0.238424319	1.982619268	0	1.33801549	1.525233457	0.136400856	0.866189759	3.184036542	0	1.206333106	0	0	1.683340706	4.268881954	7.189815957	0.694912113	0.856255068	1.734512185	0.437788315	0.30389638	0.787250918	0	0	0	0	0.040455182	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6482
H3362_020_0	2011	5																															A	A			T	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	YES	169.7944163	24.25634518	0	0	413.1946705	1.069932067	0	101.6583471	74.3991088	0	0	0	0	0	0	0	0	0	0	0	3.070759237	0	0	0	0	0	0	0	0	0											3400	$100/Admit for IP Medical; $100/Admit for IP Surg; PBP 1a	$100/Admit for IP S/A; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	$25/Trip for Ambulance; PBP 10a	15% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for Emergency Room and Worldwide Coverage; PBP 4a, 4b"	"$50/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14a-f, 14i-j"	"No Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d,"	20% Coinsurance for Part B Drugs; PBP 15	"No Cost Sharing; PBP 7d,"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	100	100	0	0	25	0.15	0	50	50	0	0	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	100	100	0	0	25	0.15	0	50	50	0	0	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0												1.415	0.20213621	0	0	0.86082223	0.16048981	0	0.423576446	0.309996287	0	0	0	0	0	0	0	0	0	0	0	0.614151847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.9861	0	2.66E-15	1.415	0.20213621	0	0	0.86082223	0.16048981	0	0.423576446	0.309996287	0	0	0	0	0	0	0	0	0	0	0	0.614151847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.9861	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	1.415	0.20213621	0	0	0.86082223	0.16048981	0	0.423576446	0.309996287	0	0	0	0	0	0	0	0	0	0	0	0.614151847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.9861
H3362_801_0	2011	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	213.4443787	3.528576678	29.27739492	0	12.26517517	14.09825734	0.694280307	14.67475082	66.14494189	10.73450833	14.18961609	0	0	27.94373561	65.54006049	61.59422243	2.547720905	5.091696506	48.13503432	99.00461475	19.31899846	30.75305235	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-f, 14i-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.093952257	0.091162758	0.169677282	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	0.080483269	0.078093673	0.145352362	0	0.19959714	0.19959714	0.19959714	0.19959714	0.19959714	0.19959714	0.19959714	0	0	0.19959714	0.19959714	0.19959714	0.19959714	0.19959714	0.19959714	0.19959714	0.19959714	0.19959714	0	0	0	0	0	0	0	0												17.1787	0.275559512	4.255538492	0	2.448093885	2.813971845	0.138576364	2.929038295	13.20234123	2.142577162	2.832206789	0	0	5.577489708	13.08160863	12.29403064	0.508517806	1.01628806	9.607615184	19.76103795	3.856016841	6.138221295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.0574	0	19.49177867	17.1787	0.275559512	4.255538492	0	2.448093885	2.813971845	0.138576364	2.929038295	13.20234123	2.142577162	2.832206789	0	0	5.577489708	13.08160863	12.29403064	0.508517806	1.01628806	9.607615184	19.76103795	3.856016841	6.138221295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.0574	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.1787	0.275559512	4.255538492	0	2.448093885	2.813971845	0.138576364	2.929038295	13.20234123	2.142577162	2.832206789	0	0	5.577489708	13.08160863	12.29403064	0.508517806	1.01628806	9.607615184	19.76103795	3.856016841	6.138221295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.0574
H3362_807_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	228.9654476	4.032897803	42.92844567	0	12.66112235	10.34434987	0.981068027	12.3836032	60.84521311	18.35829653	17.35858902	0	0	31.29541838	55.02693184	53.15075932	1.84741995	3.800740635	44.89676785	93.16361686	22.37643908	32.1173278	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-f, 14i-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.093463791	0.091124424	0.170382099	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	0.078390787	0.076428692	0.142904398	0	0.195423844	0.195423844	0.195423844	0.195423844	0.195423844	0.195423844	0.195423844	0	0	0.195423844	0.195423844	0.195423844	0.195423844	0.195423844	0.195423844	0.195423844	0.195423844	0.195423844	0	0	0	0	0	0	0	0												17.9488	0.308229104	6.134663683	0	2.474285202	2.021532618	0.191724085	2.420051342	11.89060545	3.587648883	3.392282197	0	0	6.115870967	10.75357456	10.38692571	0.361029909	0.742755346	8.773898968	18.20639215	4.372889745	6.276491666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.3596	0	21.77366539	17.9488	0.308229104	6.134663683	0	2.474285202	2.021532618	0.191724085	2.420051342	11.89060545	3.587648883	3.392282197	0	0	6.115870967	10.75357456	10.38692571	0.361029909	0.742755346	8.773898968	18.20639215	4.372889745	6.276491666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.3596	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-f, 14i-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b												2.3778	0.0408	0.8127	0	0.3278	0.2678	0.0254	0.3206	1.5752	0.4753	0.4494	0	0	0.8102	1.4246	1.376	0.0478	0.0984	1.1623	2.4119	0.5793	0.8315	0	0	0	0	0	0	0	0											15.4148	0	7.11E-15	20.3266	0.349061936	6.947356869	0	2.802067592	2.289336343	0.217122846	2.74064907	13.46582041	4.062924782	3.84167678	0	0	6.926074576	12.17816068	11.76293981	0.408857558	0.841152298	9.936226403	20.61829468	4.95219089	7.107973597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7744
H3362_817_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	221.4973062	3.860093053	39.60906755	0	12.33076337	10.80298852	0.909708579	12.53906285	60.54455737	16.61965367	16.43642803	0	0	30.05484163	55.77710431	53.56959561	1.9346686	3.953475004	44.55478818	92.29699835	21.37131752	31.21500665	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-f, 14i-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.093548915	0.091132042	0.170240944	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	0.078781729	0.076746373	0.143367521	0	0.196219731	0.196219731	0.196219731	0.196219731	0.196219731	0.196219731	0.196219731	0	0	0.196219731	0.196219731	0.196219731	0.196219731	0.196219731	0.196219731	0.196219731	0.196219731	0.196219731	0	0	0	0	0	0	0	0												17.4499	0.29624814	5.678653815	0	2.419539075	2.119759504	0.178502773	2.460411542	11.88003677	3.261103976	3.225151489	0	0	5.897352945	10.94456841	10.51141165	0.379620153	0.775749803	8.742528559	18.11049221	4.19347418	6.125000215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.6495	0	20.89040311	17.4499	0.29624814	5.678653815	0	2.419539075	2.119759504	0.178502773	2.460411542	11.88003677	3.261103976	3.225151489	0	0	5.897352945	10.94456841	10.51141165	0.379620153	0.775749803	8.742528559	18.11049221	4.19347418	6.125000215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.6495	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-f, 14i-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b												2.3023	0.0391	0.7492	0	0.3192	0.2797	0.0236	0.3246	1.5674	0.4303	0.4255	0	0	0.7781	1.444	1.3869	0.0501	0.1024	1.1535	2.3895	0.5533	0.8081	0	0	0	0	0	0	0	0											15.1267	0	0	19.7523	0.335334603	6.427885489	0	2.738768838	2.399436873	0.202054117	2.785033946	13.44746809	3.691368343	3.650672348	0	0	6.675439401	12.38857567	11.89826896	0.429706573	0.878100878	9.89600252	20.49995894	4.746753844	6.933122054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.7762
H3362_819_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	204.1494716	2.129011539	36.11757096	0	9.017853068	7.733166101	0.549980748	9.936843814	51.00968486	12.02626948	13.15436034	0	0	23.83771234	46.34404839	44.84864155	1.312091634	3.148486162	33.38937728	75.65151153	12.41052864	20.8350227	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-f, 14i-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.093288273	0.091049204	0.170573628	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	0.082125335	0.080154195	0.150162671	0	0.205119061	0.205119061	0.205119061	0.205119061	0.205119061	0.205119061	0.205119061	0	0	0.205119061	0.205119061	0.205119061	0.205119061	0.205119061	0.205119061	0.205119061	0.205119061	0.205119061	0	0	0	0	0	0	0	0												16.7658	0.170649205	5.423510944	0	1.849733558	1.586219773	0.112811535	2.038236077	10.46305868	2.466817109	2.698210048	0	0	4.889569182	9.506047711	9.199311262	0.269135004	0.645814527	6.84879773	15.51756704	2.545635987	4.273660301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2706	0	12.711572	16.7658	0.170649205	5.423510944	0	1.849733558	1.586219773	0.112811535	2.038236077	10.46305868	2.466817109	2.698210048	0	0	4.889569182	9.506047711	9.199311262	0.269135004	0.645814527	6.84879773	15.51756704	2.545635987	4.273660301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2706	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-f, 14i-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b												2.1161	0.0215	0.6845	0	0.2335	0.2002	0.0142	0.2573	1.3206	0.3113	0.3406	0	0	0.6171	1.1998	1.1611	0.034	0.0815	0.8644	1.9585	0.3213	0.5394	0	0	0	0	0	0	0	0											12.2769	0	0	18.8819	0.192187517	6.108033734	0	2.083195754	1.786422851	0.127049925	2.295489922	11.78364275	2.778163863	3.038761821	0	0	5.506701068	10.70584363	10.36039276	0.303103599	0.727325335	7.713211608	17.47610062	2.866930784	4.813055889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5475
H3362_820_0	2011	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	246.108118	4.288992281	44.01007505	0	13.70084819	12.00332058	1.010787311	13.93229205	67.27173041	18.46628186	18.26269781	0	0	33.39426848	61.97456035	59.5217729	2.149631778	4.392750005	49.5053202	102.5522204	23.74590836	34.68334073	0	0	0	0	0	0	0	0											3400	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-f, 14i-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7d,"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.093548915	0.091132042	0.170240944	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	0.065717295	0.064019463	0.119592775	0	0.163680463	0.163680463	0.163680463	0.163680463	0.163680463	0.163680463	0.163680463	0	0	0.163680463	0.163680463	0.163680463	0.163680463	0.163680463	0.163680463	0.163680463	0.163680463	0.163680463	0	0	0	0	0	0	0	0												16.1736	0.274578983	5.263287014	0	2.242561179	1.964709072	0.165446135	2.280444017	11.01106799	3.022569568	2.989246837	0	0	5.465989333	10.14402475	9.742551359	0.351852725	0.719007356	8.103053741	16.78579494	3.88674128	5.676985276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.2635	0	44.4	16.1736	0.274578983	5.263287014	0	2.242561179	1.964709072	0.165446135	2.280444017	11.01106799	3.022569568	2.989246837	0	0	5.465989333	10.14402475	9.742551359	0.351852725	0.719007356	8.103053741	16.78579494	3.88674128	5.676985276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.2635	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.1736	0.274578983	5.263287014	0	2.242561179	1.964709072	0.165446135	2.280444017	11.01106799	3.022569568	2.989246837	0	0	5.465989333	10.14402475	9.742551359	0.351852725	0.719007356	8.103053741	16.78579494	3.88674128	5.676985276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.2635
H3366_022_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	422.7511584	37.4505586	29.15031426	0	18.89350636	13.80544447	14.05474317	17.42881244	21.60378481	6.16827663	16.78167221	0	3.483991059	36.09709196	53.37249394	67.24957934	5.36652772	4.301341946	25.57741425	72.76776771	19.63022222	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	"7A PCP: FFS Cost Sharing, 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"	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	10B Transportation: Not Covered	"16A Preventive Dental: Not covered, 16B Comp Dental: 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 Ed/Wellness: No Cost Sharing	"13B Acupuncture: Not covered, 13C Other1: $37 OTC"											0	0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.215861628	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.051630988	0.051630988	0.121295915	0	0.195396851	0.195396851	0.195396851	0.195396851	0.195396851	0.195396851	0.195396851	0	0.195396851	0.195396851	0.181530485	0.195396851	0.195396851	0.195396851	0.195396851	0.195396851	0.195396851	0	0	0	0	0	0	0	0	0												21.8271	1.933609339	3.535814054	0	3.691731654	2.697540381	2.746252562	3.405535074	4.221311528	1.205261832	3.279085911	0	0.680760883	7.053258112	9.688734726	13.14035606	1.048602619	0.840468673	4.99774621	14.21859269	3.835683613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.0474	0	19.99119397	21.8271	1.933609339	3.535814054	0	3.691731654	2.697540381	2.746252562	3.405535074	4.221311528	1.205261832	3.279085911	0	0.680760883	7.053258112	9.688734726	13.14035606	1.048602619	0.840468673	4.99774621	14.21859269	3.835683613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.0474	NO																							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	21.8271	1.933609339	3.535814054	0	3.691731654	2.697540381	2.746252562	3.405535074	4.221311528	1.205261832	3.279085911	0	0.680760883	7.053258112	9.688734726	13.14035606	1.048602619	0.840468673	4.99774621	14.21859269	3.835683613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.0474
H3370_001_0	2011	11	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1897.748765	90.0074898	1319.463767	2031.407263	269.0533443	6.866976403	4.617121552	230.6035489	411.5874536	11632.70371	199.4458606	6.416122826	0.342018737	129.4145625	6237.400083	6472.150136	448.1113789	1021.662387	1764.394725	2981.360741	39.23233709	0.353024339	120	1065.67984	378	179.4	162	14.7	5654.51734	0	9.445628985	8.750192014	0	0	0	0	0	0	0	0	3400	1A: $100/day (days1-7) no yrly max	1B: $100/day (days1-7) no yrly max	2: $50/day (days 1-100)	6: $0 copay	10A: $210 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $50 copay; 4B: $15 copay	9A: $15-$100 copay; 9B: $100 copay	8A: $0 copay	8B: $60 copay	9A: $15 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $0 copay; 7G: $0 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $15 copay; 7F: $15 copay; 7G: $15 copay	7E: $40 copay; 7H: $40 copay	7C: $15-$30 copay; 7I: $15-$30 copay	8B: $20 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $0	15: 20% coinsurance	13A: $0 copay	10B: $0 copay; 24 one-way trips/yr; $100 max/one-way trip	16A: $0 Co-Pay	17A: $0 copay	17B: $0 copay	18A: $0 copay	18B: $0 copay	14A: $0 copay;  NA;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										100	100	50	0	210	0.2	0.110118759	49.52189634	75.1907131	0	60	15	0.1	33.20675105	0	14.83941918	40	16.48712999	20	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	63.99904233	35.37534832	47.50099483	0	199.5041783	0.190003979	0.104615012	47.04678684	71.43267348	0	57.00119379	14.25029845	0.09500199	31.5470742	0	14.09774347	38.00079586	15.66310152	19.00039793	0	0.190003979	0	0	0	0	0	0	0	0	0	0.190003979	0.190003979	0	0	0	0	0	0	0	0		10.1212	0.265337192	5.222986798	0	4.473105531	1.304752842	0.483020227	0.904096334	2.450066015	0	0.947387679	0.007619305	0.032492461	0.340220901	0	7.603559361	1.419049086	1.333533474	2.79368349	0	7.454300164	0	0	0	0	0	0	0	0	0	1.794707094	1.662571302	0	0	0	0	0	0	0	0	50.6137		2.662761277	10.1212	0.265337192	5.222986798	0	4.473105531	1.304752842	0.483020227	0.904096334	2.450066015	0	0.947387679	0.007619305	0.032492461	0.340220901	0	7.603559361	1.419049086	1.333533474	2.79368349	0	7.454300164	0	0	0	0	0	0	0	0	0	1.794707094	1.662571302	0	0	0	0	0	0	0	0	50.6137	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	10.1212	0.265337192	5.222986798	0	4.473105531	1.304752842	0.483020227	0.904096334	2.450066015	0	0.947387679	0.007619305	0.032492461	0.340220901	0	7.603559361	1.419049086	1.333533474	2.79368349	0	7.454300164	0	0	0	0	0	0	0	0	0	1.794707094	1.662571302	0	0	0	0	0	0	0	0	50.6137
H3370_002_0	2011	7	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1936.574013	35.41680837	1249.829298	2300.129685	274.3735877	6.079758159	4.131072551	284.0377386	350.0641876	12578.26788	321.0204006	7.212861008	0.18489766	161.2795721	6095.326427	6409.439249	321.0601713	1021.260355	1599.650346	3023.6717	36.00431637	1.958514085	0	1065.67984	378	179.4	162	14.7	5652.124415	0	6.150644692	11.39392997	0	0	0	0	0	0	0	0	3300	1A: $175/day (days1-7) no yrly max	1B: $175/day (days1-7) no yrly max	2: $60/day (days 1-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $50 copay; 4B: $25 copay	9A: $25-$300 copay; 9B: $300 copay	8A: $0 copay	8B: $80 copay	9A: $25 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $15 copay; 7G: $15 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: $25 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $0	15: 20% coinsurance	13A: $0 copay	0	16A: $0 Co-Pay	17A: $0 copay	17B: $0 copay	18A: $0 copay	18B: $0 copay	14A: $0 copay;  NA;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										175	175	60	0	200	0.2	0.111044627	48.73754723	287.9876374	0	80	25	0.1	27.38223017	12.59847725	24.47117434	40	30.43310658	25	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	107.1746378	76.62922496	53.44727455	0	178.1575818	0.178157582	0.098917211	43.4148178	256.5359054	0	71.26303273	22.26969773	0.089078791	24.39175956	11.22257121	21.79862622	35.63151637	27.10944338	22.26969773	0	0.178157582	0	0	0	0	0	0	0	0	0	0.178157582	0.178157582	0	0	0	0	0	0	0	0		17.296	0.226163548	5.566664135	0	4.073477909	1.083155012	0.408634177	1.027620556	7.483669441	0	1.906407276	0.013385686	0.01647046	0.327824379	5.700436239	11.64308087	0.953321729	2.30714998	2.96864414	0	6.41444194	0	0	0	0	0	0	0	0	0	1.095783985	2.029915012	0	0	0	0	0	0	0	0	72.5422		8.893797115	17.296	0.226163548	5.566664135	0	4.073477909	1.083155012	0.408634177	1.027620556	7.483669441	0	1.906407276	0.013385686	0.01647046	0.327824379	5.700436239	11.64308087	0.953321729	2.30714998	2.96864414	0	6.41444194	0	0	0	0	0	0	0	0	0	1.095783985	2.029915012	0	0	0	0	0	0	0	0	72.5422	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	17.296	0.226163548	5.566664135	0	4.073477909	1.083155012	0.408634177	1.027620556	7.483669441	0	1.906407276	0.013385686	0.01647046	0.327824379	5.700436239	11.64308087	0.953321729	2.30714998	2.96864414	0	6.41444194	0	0	0	0	0	0	0	0	0	1.095783985	2.029915012	0	0	0	0	0	0	0	0	72.5422
H3370_003_0	2011	6	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1907.515028	83.23330894	1260.306811	1859.411714	187.0198518	7.10940563	4.952804586	228.9618572	405.4069434	13215.97068	100.2018782	13.63402605	0.236950468	157.5304938	5876.08146	7010.192554	437.4744941	903.5865591	2084.530365	2932.26575	39.55984943	7.168357322	0	1065.67984	378	179.4	0	0	5656.307095	0	25.86908514	7.739324576	0	0	0	0	0	0	0	0	3400	1A: $230/day (days1-6) no yrly max	1B: $230/day (days1-6) no yrly max	2: $60/day (days 1-100)	6: $0 copay	10A: $225 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $50 copay; 4B: $25 copay	9A: $25-$200 copay; 9B: $225 copay	8A: $0 copay	8B: $90 copay	9A: $25 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $15 copay; 7G: $15 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: $35 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $25	15: 20% coinsurance	13A: $0 copay	0	16A: $0 Co-Pay	17A: $0 copay	17B: $0 copay	18A: Not covered	18B: Not covered	14A: $0 copay;  NA;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										230	230	60	0	225	0.2	0.11208139	49.96347699	175.4659643	0	90	25	0.1	32.40875912	12.77174937	24.50607605	40	27.10120819	35	0.480224464	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	128.5731388	54.35474095	53.26640232	0	199.7490087	0.177554674	0.099502874	44.35624444	155.7740108	0	79.89960348	22.1943343	0.088777337	28.77163337	11.33841901	21.75584177	35.51093488	24.05973098	31.07206802	0.426330492	0.177554674	0	0	0	0	0	0	0	0	0	0.177554674	0.177554674	0	0	0	0	0	0	0	0		20.4379	0.377010412	5.594334137	0	3.113085833	1.262308202	0.49281829	0.846324009	5.262655466	0	0.667174195	0.025216511	0.021035832	0.377700801	5.55212281	12.70938666	1.294594023	1.811670794	5.397555775	0.104176192	7.024036185	0	0	0	0	0	0	0	0	0	4.59317699	1.374153255	0	0	0	0	0	0	0	0	78.3385		9.903047922	20.4379	0.377010412	5.594334137	0	3.113085833	1.262308202	0.49281829	0.846324009	5.262655466	0	0.667174195	0.025216511	0.021035832	0.377700801	5.55212281	12.70938666	1.294594023	1.811670794	5.397555775	0.104176192	7.024036185	0	0	0	0	0	0	0	0	0	4.59317699	1.374153255	0	0	0	0	0	0	0	0	78.3385	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	20.4379	0.377010412	5.594334137	0	3.113085833	1.262308202	0.49281829	0.846324009	5.262655466	0	0.667174195	0.025216511	0.021035832	0.377700801	5.55212281	12.70938666	1.294594023	1.811670794	5.397555775	0.104176192	7.024036185	0	0	0	0	0	0	0	0	0	4.59317699	1.374153255	0	0	0	0	0	0	0	0	78.3385
H3370_004_0	2011	6	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	2337.742866	51.24359187	1495.977576	2566.771836	148.8469625	7.406358303	6.111292702	288.0500308	384.0173346	13883.84897	252.3425138	5.996420412	0.072901585	85.67488342	7403.718646	7135.505236	394.3290951	981.7876687	1755.650606	2557.046955	36.54903991	4.142224775	0	1065.67984	378	179.4	162	14.7	5658.760637	0	18.81099839	6.810628609	0	0	0	0	0	0	0	0	3400	1A: $175/day (days1-7) no yrly max	1B: $175/day (days1-7) no yrly max	2: $60/day (days 1-100)	6: $0 copay	10A: $200 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $50 copay; 4B: $25 copay	9A: $30-$200 copay; 9B: $200 copay	8A: $0 copay	8B: $75 copay	9A: $30 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $15 copay; 7G: $15 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: $30 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $0	15: 20% coinsurance	13A: $0 copay	0	16A: $0 Co-Pay	17A: $0 copay	17B: $0 copay	18A: $0 copay	18B: $0 copay	14A: $0 copay;  NA;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										175	175	60	0	200	0.2	0.110870771	49.95660978	188.9454545	0	75	30	0.1	22.12847555	13.11428022	24.48542954	40	28.38262551	30	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	106.4213554	69.85240826	53.27982966	0	177.5994322	0.177599432	0.09845293	44.36132766	167.7830272	0	66.59978708	26.63991483	0.088799716	19.65002347	11.6454436	21.74299192	35.51988644	25.20369088	26.63991483	0	0.177599432	0	0	0	0	0	0	0	0	0	0.177599432	0.177599432	0	0	0	0	0	0	0	0		20.7321	0.298290692	6.642119203	0	2.202928002	1.315365029	0.601674672	1.064856816	5.369299243	0	1.400496474	0.013312011	0.00647364	0.140292789	7.184965662	12.92893606	1.16721039	2.062056076	3.897531885	0	6.491088736	0	0	0	0	0	0	0	0	0	3.340822633	1.209563774	0	0	0	0	0	0	0	0	78.0694		9.846875946	20.7321	0.298290692	6.642119203	0	2.202928002	1.315365029	0.601674672	1.064856816	5.369299243	0	1.400496474	0.013312011	0.00647364	0.140292789	7.184965662	12.92893606	1.16721039	2.062056076	3.897531885	0	6.491088736	0	0	0	0	0	0	0	0	0	3.340822633	1.209563774	0	0	0	0	0	0	0	0	78.0694	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	20.7321	0.298290692	6.642119203	0	2.202928002	1.315365029	0.601674672	1.064856816	5.369299243	0	1.400496474	0.013312011	0.00647364	0.140292789	7.184965662	12.92893606	1.16721039	2.062056076	3.897531885	0	6.491088736	0	0	0	0	0	0	0	0	0	3.340822633	1.209563774	0	0	0	0	0	0	0	0	78.0694
H3370_009_0	2011	3	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	2633.502478	39.34680594	1547.648556	2407.785885	150.7748185	5.133024366	4.553070735	282.4757702	392.3731271	14174.53402	251.9824776	2.616710952	0.007830709	57.86038102	7357.845755	7256.202588	259.5893467	954.7555233	1723.1441	2630.656357	29.78001177	1.720230313	120	1065.67984	378	179.4	162	14.7	5660.490101	0	18.84722554	3.315118732	0	0	0	0	0	0	0	0	3400	1A: $200/day (days1-7) no yrly max	1B: $200/day (days1-7) no yrly max	2: $60/day (days 1-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $50 copay; 4B: $25 copay	9A: $25-$200 copay; 9B: $200 copay	8A: $0 copay	8B: $75 copay	9A: $25 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $15 copay; 7G: $15 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: $25 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $0	15: 20% coinsurance	13A: $0 copay	10B: $0 copay; 24 one-way trips/yr; $100 limit/trip	16A: $0 Co-Pay	17A: $0 copay	17B: $0 copay	18A: $0 copay	18B: $0 copay	14A: $0 copay;  NA;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										200	200	60	0	125	0.2	0.109545188	49.99533925	192.6348626	0	75	25	0.1	6.719232211	13.17068729	24.5222725	40	28.09235174	25	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	118.1238626	131.3929573	53.20944699	0	110.8530146	0.177364823	0.097147314	44.33707256	170.8332418	0	66.51180874	22.17060291	0.088682412	5.958777169	11.68008312	21.74694265	35.47296466	24.91297501	22.17060291	0	0.177364823	0	0	0	0	0	0	0	0	0	0.177364823	0.177364823	0	0	0	0	0	0	0	0		25.9233	0.430824433	6.862460314	0	1.392820262	0.91041796	0.442318594	1.04367906	5.585864443	0	1.396650863	0.004834505	0.000694446	0.028731426	7.161687501	13.15001846	0.767366977	1.982150041	3.1835953	0	5.281926525	0	0	0	0	0	0	0	0	0	3.342834827	0.587985448	0	0	0	0	0	0	0	0	79.4802		10.14320228	25.9233	0.430824433	6.862460314	0	1.392820262	0.91041796	0.442318594	1.04367906	5.585864443	0	1.396650863	0.004834505	0.000694446	0.028731426	7.161687501	13.15001846	0.767366977	1.982150041	3.1835953	0	5.281926525	0	0	0	0	0	0	0	0	0	3.342834827	0.587985448	0	0	0	0	0	0	0	0	79.4802	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	25.9233	0.430824433	6.862460314	0	1.392820262	0.91041796	0.442318594	1.04367906	5.585864443	0	1.396650863	0.004834505	0.000694446	0.028731426	7.161687501	13.15001846	0.767366977	1.982150041	3.1835953	0	5.281926525	0	0	0	0	0	0	0	0	0	3.342834827	0.587985448	0	0	0	0	0	0	0	0	79.4802
H3370_014_0	2011	7	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1875.312983	48.46984948	842.2654475	1795.905387	231.1139483	8.937167536	4.779338407	365.8951862	495.9342768	11410.76578	413.6119656	4.976617095	0.050695794	117.3586115	5992.503645	6552.761387	395.3191745	1032.914761	1433.215769	2603.109271	36.17892175	1.387276563	0	1065.67984	378	179.4	162	14.7	5657.375985	0	8.813287867	5.373530538	0	0	0	0	0	0	0	0	3800	1A: $75/day (days1-7) no yrly max	1B: $75/day (days1-7) no yrly max	2: $25/day (days 1-100)	6: $0 copay	10A: $50 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $50 copay; 4B: $20 copay	9A: $20-$100 copay; 9B: $100 copay	8A: $0 copay	8B: $60 copay	9A: $20 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $10 copay; 7G: $10 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $20 copay; 7F: $20 copay; 7G: $20 copay	7E: $40 copay; 7H: $40 copay	7C: $20-$40 copay; 7I: $20-$40 copay	8B: $20 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $0	15: 20% coinsurance	13A: $0 copay	0	16A: $0 Co-Pay	17A: $0 copay	17B: $0 copay	18A: $0 copay	18B: $0 copay	14A: $0 copay;  NA;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										75	75	25	0	50	0.2	0.107293297	47.81632254	95.34722341	0	60	20	0.1	17.19047398	8.193859947	19.44998646	40	23.75606976	20	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	47.20988167	35.18601329	23.96626469	0	47.93252939	0.191730118	0.102856782	45.83914571	91.40467177	0	57.51903527	19.17301176	0.095865059	16.47965799	7.855048655	18.64574095	38.34602351	22.77377024	19.17301176	0	0.191730118	0	0	0	0	0	0	0	0	0	0.191730118	0.191730118	0	0	0	0	0	0	0	0		7.3778	0.142121731	1.682163055	0	0.923156343	1.713524182	0.491587371	1.397693563	3.777559149	0	1.98254677	0.007951395	0.004859955	0.161169148	3.922617308	10.18175761	1.263243197	1.960280287	2.289921898	0	6.93658892	0	0	0	0	0	0	0	0	0	1.689772719	1.030267642	0	0	0	0	0	0	0	0	48.9366		2.110777292	7.3778	0.142121731	1.682163055	0	0.923156343	1.713524182	0.491587371	1.397693563	3.777559149	0	1.98254677	0.007951395	0.004859955	0.161169148	3.922617308	10.18175761	1.263243197	1.960280287	2.289921898	0	6.93658892	0	0	0	0	0	0	0	0	0	1.689772719	1.030267642	0	0	0	0	0	0	0	0	48.9366	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	7.3778	0.142121731	1.682163055	0	0.923156343	1.713524182	0.491587371	1.397693563	3.777559149	0	1.98254677	0.007951395	0.004859955	0.161169148	3.922617308	10.18175761	1.263243197	1.960280287	2.289921898	0	6.93658892	0	0	0	0	0	0	0	0	0	1.689772719	1.030267642	0	0	0	0	0	0	0	0	48.9366
H3370_019_0	2011	3	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1940.025442	44.58301506	1300.203928	2164.238349	242.1847168	6.662017689	3.546454534	256.4490409	407.7250028	11160.24607	266.9381341	5.27400729	0.060355271	116.5520385	5592.031996	6404.702041	281.4110834	991.2661469	1544.402576	2726.183039	36.27009422	0.636585229	120	2131.35968	378	179.4	162	14.7	5657.257663	0	12.35978433	6.41213893	0	0	0	0	0	0	0	0	3400	1A: $110/day (days1-7) no yrly max	1B: $110/day (days1-7) no yrly max	2: $60/day (days 1-100)	6: $0 copay	10A: $100 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $50 copay; 4B: $25 copay	9A: $25-$100 copay; 9B: $100 copay	8A: $0 copay	8B: $75 copay	9A: $25 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $10 copay; 7G: $10 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: $25 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $0	15: 20% coinsurance	13A: $0 copay	10B: $0 copay; 24 one-way trips/yr; $100 limit/trip	16A: $0 Co-Pay	17A: $0 copay	17B: $0 copay	18A: $0 copay	18B: $0 copay	14A: $0 copay;  NA;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										110	110	60	0	100	0.2	0.111080676	49.23049082	87.25193752	0	75	25	0.1	21.47724693	8.561183158	24.55023127	40	28.11825255	25	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	68.31793757	39.63597706	55.29203232	0	92.15338721	0.184306774	0.102364605	45.36756483	80.40561583	0	69.1150404	23.0383468	0.092153387	19.79201053	7.889420265	22.62386969	36.86135488	25.91192215	23.0383468	0	0.184306774	0	0	0	0	0	0	0	0	0	0.184306774	0.184306774	0	0	0	0	0	0	0	0		11.0449	0.147257614	5.9909098	0	1.859845166	1.227854991	0.363031418	0.969539041	2.731948328	0	1.537453327	0.010125367	0.005561943	0.192233265	3.676490879	12.0749287	0.864432818	2.140467602	2.965040179	0	6.684824073	0	0	0	0	0	0	0	0	0	2.277991982	1.181800643	0	0	0	0	0	0	0	0	57.9466		4.933998262	11.0449	0.147257614	5.9909098	0	1.859845166	1.227854991	0.363031418	0.969539041	2.731948328	0	1.537453327	0.010125367	0.005561943	0.192233265	3.676490879	12.0749287	0.864432818	2.140467602	2.965040179	0	6.684824073	0	0	0	0	0	0	0	0	0	2.277991982	1.181800643	0	0	0	0	0	0	0	0	57.9466	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	11.0449	0.147257614	5.9909098	0	1.859845166	1.227854991	0.363031418	0.969539041	2.731948328	0	1.537453327	0.010125367	0.005561943	0.192233265	3.676490879	12.0749287	0.864432818	2.140467602	2.965040179	0	6.684824073	0	0	0	0	0	0	0	0	0	2.277991982	1.181800643	0	0	0	0	0	0	0	0	57.9466
H3370_022_0	2011	6	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1907.391898	83.22793625	1260.225459	1859.29169	187.0077797	7.10894672	4.952484884	228.9473413	405.3807745	13215.11759	100.1954102	13.63314598	0.236935173	157.5203253	5875.702161	7009.740048	437.4462553	903.5282328	2084.395809	2932.076473	39.55729585	7.167894607	0	2131.35968	378	179.4	162	14.7	5655.941982	0	25.8674153	7.738825005	0	0	0	0	0	0	0	0	3300	1A: $100/day (days1-7) no yrly max	1B: $100/day (days1-7) no yrly max	2: $60/day (days 1-100)	6: $0 copay	10A: $75 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $50 copay; 4B: $25 copay	9A: $25-$200 copay; 9B: $200 copay	8A: $0 copay	8B: $75 copay	9A: $25 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $15 copay; 7G: $15 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: $25 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $0	15: 20% coinsurance	13A: $0 copay	0	16A: $0 Co-Pay	17A: $0 copay	17B: $0 copay	18A: $0 copay	18B: $0 copay	14A: $0 copay;  NA;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										100	100	60	0	75	0.2	0.112074156	49.96025186	170.2078131	0	74.99515877	25	0.1	32.40666715	12.77092496	24.50449419	40	27.09945882	24.99838626	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	61.33534305	27.02288819	54.14408852	0	67.68011065	0.180480295	0.101135883	45.08420499	153.5957816	0	67.67574192	22.56003688	0.090240148	29.24382424	11.52450153	22.11289171	36.09605901	24.45459162	22.55858064	0	0.180480295	0	0	0	0	0	0	0	0	0	0.180480295	0.180480295	0	0	0	0	0	0	0	0		9.7492	0.187421601	5.686146565	0	1.054725602	1.283024802	0.500873934	0.860159072	5.18873141	0	0.56506656	0.025630356	0.021381065	0.383874726	5.64287821	12.91713521	1.315840487	1.841284496	3.918417579	0	7.139312427	0	0	0	0	0	0	0	0	0	4.668558746	1.39670542	0	0	0	0	0	0	0	0	64.3464		6.959332286	9.7492	0.187421601	5.686146565	0	1.054725602	1.283024802	0.500873934	0.860159072	5.18873141	0	0.56506656	0.025630356	0.021381065	0.383874726	5.64287821	12.91713521	1.315840487	1.841284496	3.918417579	0	7.139312427	0	0	0	0	0	0	0	0	0	4.668558746	1.39670542	0	0	0	0	0	0	0	0	64.3464	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	9.7492	0.187421601	5.686146565	0	1.054725602	1.283024802	0.500873934	0.860159072	5.18873141	0	0.56506656	0.025630356	0.021381065	0.383874726	5.64287821	12.91713521	1.315840487	1.841284496	3.918417579	0	7.139312427	0	0	0	0	0	0	0	0	0	4.668558746	1.39670542	0	0	0	0	0	0	0	0	64.3464
H3370_023_0	2011	8	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	2139.916073	53.7880183	1372.201523	2352.555215	205.6085823	6.937337857	5.111799063	274.3046591	379.2728843	13231.21457	247.2273751	8.272730699	0.135309026	132.8727823	6610.790068	6882.842952	389.1854872	995.5351891	1762.352267	2797.759125	36.59267242	3.702694574	0	1065.67984	378	179.4	162	14.7	5656.302331	0	15.60476991	8.32113055	0	0	0	0	0	0	0	0	4000	1A: $150/day (days1-7) no yrly max	1B: $150/day (days1-7) no yrly max	2: $50/day (days 1-100)	6: $0 copay	10A: $175 copay	11A: 20% coin	11B: 20% coin; 11C: 10% coin	4A: $50 copay; 4B: $25 copay	9A: $25-$200 copay; 9B: $200 copay	8A: $0 copay	8B: $75 copay	9A: $25 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $10 copay; 7G: $10 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: $25 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $0	15: 20% coinsurance	13A: $0 copay	0	16A: $0 Co-Pay	17A: $0 copay	17B: $0 copay	18A: $0 copay	18B: $0 copay	14A: $0 copay;  NA;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										150	150	50	0	175	0.2	0.111082793	49.52731702	185.2307047	0	75	25	0.1	27.33716475	8.599820127	24.48438457	40	28.90038173	25	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	94.03705801	58.18061159	45.8940228	0	160.6290798	0.183576091	0.101960724	45.46015633	170.0196437	0	68.84103421	22.9470114	0.091788046	25.09224925	7.893606821	22.47373807	36.71521824	26.52709556	22.9470114	0	0.183576091	0	0	0	0	0	0	0	0	0	0.183576091	0.183576091	0	0	0	0	0	0	0	0		16.7693	0.260784983	5.247987332	0	2.752226448	1.273529367	0.521202736	1.039161057	5.373653389	0	1.418282349	0.015819537	0.012419751	0.277839748	4.348581464	12.89026748	1.190752508	2.200721425	3.370059798	0	6.71753977	0	0	0	0	0	0	0	0	0	2.864662664	1.527560621	0	0	0	0	0	0	0	0	70.0723		6.269126112	16.7693	0.260784983	5.247987332	0	2.752226448	1.273529367	0.521202736	1.039161057	5.373653389	0	1.418282349	0.015819537	0.012419751	0.277839748	4.348581464	12.89026748	1.190752508	2.200721425	3.370059798	0	6.71753977	0	0	0	0	0	0	0	0	0	2.864662664	1.527560621	0	0	0	0	0	0	0	0	70.0723	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	16.7693	0.260784983	5.247987332	0	2.752226448	1.273529367	0.521202736	1.039161057	5.373653389	0	1.418282349	0.015819537	0.012419751	0.277839748	4.348581464	12.89026748	1.190752508	2.200721425	3.370059798	0	6.71753977	0	0	0	0	0	0	0	0	0	2.864662664	1.527560621	0	0	0	0	0	0	0	0	70.0723
H3370_801_0	2011	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	281.9307793	3.375643328	32.2104636	30.12215606	7.995240535	10.02289259	2.529929502	8.611711258	43.37461056	6.795761485	28.37440849	0	0.024951713	34.71498018	72.53740151	199.7283939	1.931977336	7.682296329	30.18825696	36.44912443	53.64587939	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.06419214	0.06419214	0.152588229	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.049419221	0.049419221	0.117472193	0	0.179378324	0.179378324	0.179378324	0.179378324	0.179378324	0.179378324	0.179378324	0.179378324	0.179378324	0.179378324	0.179378324	0.179378324	0.179378324	0.179378324	0.179378324	0.179378324	0.179378324	0.179378324																				13.9328	0.166821665	3.783833783	0	1.434172849	1.797889677	0.453814515	1.544754334	7.780464956	1.219012307	5.089753846	0	0.004475796	6.22711497	13.01163753	35.8269446	0.346554857	1.378037442	5.415118945	6.538182859	9.622907947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.5743		34.54869624	13.9328	0.166821665	3.783833783	0	1.434172849	1.797889677	0.453814515	1.544754334	7.780464956	1.219012307	5.089753846	0	0.004475796	6.22711497	13.01163753	35.8269446	0.346554857	1.378037442	5.415118945	6.538182859	9.622907947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.5743	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	13.9328	0.166821665	3.783833783	0	1.434172849	1.797889677	0.453814515	1.544754334	7.780464956	1.219012307	5.089753846	0	0.004475796	6.22711497	13.01163753	35.8269446	0.346554857	1.378037442	5.415118945	6.538182859	9.622907947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.5743
H3370_803_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	250.7639261	3.002473075	26.72984469	15.46482481	6.131028543	8.811215127	2.224083805	8.026511178	69.95744733	5.664792058	23.65226093	0	0.020799179	28.93761714	78.21497152	215.3613214	2.083195002	8.283596821	32.55111996	39.30203136	27.43348111	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.06419214	0.06419214	0.152588229	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.049425773	0.049425773	0.117487767	0	0.179402107	0.179402107	0.179402107	0.179402107	0.179402107	0.179402107	0.179402107	0.179402107	0.179402107	0.179402107	0.179402107	0.179402107	0.179402107	0.179402107	0.179402107	0.179402107	0.179402107	0.179402107																				12.3942	0.148399554	3.140429772	0	1.099919436	1.580750555	0.39900532	1.439973014	12.55051342	1.016275628	4.243265436	0	0.003731417	5.191469473	14.03193065	38.63627473	0.373729572	1.48609472	5.839739491	7.050867217	4.921624301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.5482		34.52099837	12.3942	0.148399554	3.140429772	0	1.099919436	1.580750555	0.39900532	1.439973014	12.55051342	1.016275628	4.243265436	0	0.003731417	5.191469473	14.03193065	38.63627473	0.373729572	1.48609472	5.839739491	7.050867217	4.921624301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.5482	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	12.3942	0.148399554	3.140429772	0	1.099919436	1.580750555	0.39900532	1.439973014	12.55051342	1.016275628	4.243265436	0	0.003731417	5.191469473	14.03193065	38.63627473	0.373729572	1.48609472	5.839739491	7.050867217	4.921624301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.5482
H3370_805_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	270.3688826	3.237209206	30.29527747	25.38067199	7.389826739	9.633168087	2.43155715	8.426436724	52.13064092	6.429994009	26.84721602	0	0.023608739	32.84651986	74.45700662	205.0139382	1.983104527	7.885598005	30.98714872	37.41370165	45.08727874	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.06419214	0.06419214	0.152588229	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.049422024	0.049422024	0.117478854	0	0.179388496	0.179388496	0.179388496	0.179388496	0.179388496	0.179388496	0.179388496	0.179388496	0.179388496	0.179388496	0.179388496	0.179388496	0.179388496	0.179388496	0.179388496	0.179388496	0.179388496	0.179388496																				13.3622	0.15998943	3.559054481	0	1.325649906	1.728079537	0.436193381	1.511605813	9.351637283	1.153466956	4.81608171	0	0.004235136	5.892287804	13.35673045	36.77714208	0.355746139	1.414585568	5.558738011	6.711587678	8.088139133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.5631		34.53684708	13.3622	0.15998943	3.559054481	0	1.325649906	1.728079537	0.436193381	1.511605813	9.351637283	1.153466956	4.81608171	0	0.004235136	5.892287804	13.35673045	36.77714208	0.355746139	1.414585568	5.558738011	6.711587678	8.088139133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.5631	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	13.3622	0.15998943	3.559054481	0	1.325649906	1.728079537	0.436193381	1.511605813	9.351637283	1.153466956	4.81608171	0	0.004235136	5.892287804	13.35673045	36.77714208	0.355746139	1.414585568	5.558738011	6.711587678	8.088139133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.5631
H3379_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1799.483531	158.8234254	1324.383734	1407.679325	210.7452666	3.450294263	6.83937313	196.2749181	26.13061618	30.55236379	59.01796341	0	0.243263339	16.61324217	6672.829152	141.4719611	941.463928	2216.256638	0	0	19.19441058	2601.016747	0	0	93.73775106	0	17.27559905	6	138.782471	0											4200	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												185.9463355	119.8302997	60.90675346	0	200	0.2	0.099009146	49.92686404	0.2	0.101081154	0.155822242	0	0.2	0.160803852	10.83744968	0.095175585	38.5	35	0	0	0.2	34.93487099	0	0	35	0	0	0	0	0											NO	134.810554	86.87661978	44.15721965	0	144.9994201	0.14499942	0.071781344	36.23905677	0.14499942	0.073283543	0.112970674	0	0.14499942	0.116582326	10.32476177	0.090680091	36.67867808	33.3442528	0	0	0.14499942	25.32768017	0	0	35	0	0	0	0	0												20.2158	1.149836862	4.873425288	0	2.54649512	0.500290667	0.490939395	0.592734825	3.788924192	2.238985477	6.667299102	0	0.035273043	1.936810422	5.741280943	12.82869032	2.877637695	6.158285134	0	0	2.783178402	5.489810025	0	0	0.273401774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1891	0	21.59005929	20.2158	1.149836862	4.873425288	0	2.54649512	0.500290667	0.490939395	0.592734825	3.788924192	2.238985477	6.667299102	0	0.035273043	1.936810422	5.741280943	12.82869032	2.877637695	6.158285134	0	0	2.783178402	5.489810025	0	0	0.273401774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1891	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.2158	1.149836862	4.873425288	0	2.54649512	0.500290667	0.490939395	0.592734825	3.788924192	2.238985477	6.667299102	0	0.035273043	1.936810422	5.741280943	12.82869032	2.877637695	6.158285134	0	0	2.783178402	5.489810025	0	0	0.273401774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1891
H3379_002_0	2011	4																															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	YES	579.4741928	44.4234	18063.57688	0	30.32434604	55.80811468	20.79990819	11.07238492	11.71727293	28.34659753	16.68136942	0	0	7.995776151	0.473417816	334.5319704	21.4518	0	0	0	3.659819887	6.478863745	134.4516646	0	226.102867	56.52571675	0	0	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.060972475	0.06171282	0	0	0.2	0.2	0.082600165	0.089092461	0.2	0	0.094983364	0	0	0.161114533	0	0.025148665	0.2	0	0	0	0.2	0.19529263	0	0	0	0	0	0	0	0											NO	0.05585178	0.056529949	0	0	0.18320326	0.18320326	0.075663098	0.081610146	0.18320326	0	0.087006309	0	0	0.147583539	0	0.023036587	0.18320326	0	0	0	0.18320326	0.178891232	0	0	0	0	0	0	0	0												32.3647	2.511252533	0	0	5.555519048	10.22422854	1.573785482	0.903618951	2.146642598	0	1.451384386	0	0	1.180044939	0	7.706474965	3.93003969	0	0	0	0.670490934	1.159011917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.3772	0	6.544117162	32.3647	2.511252533	0	0	5.555519048	10.22422854	1.573785482	0.903618951	2.146642598	0	1.451384386	0	0	1.180044939	0	7.706474965	3.93003969	0	0	0	0.670490934	1.159011917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.3772	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	32.3647	2.511252533	0	0	5.555519048	10.22422854	1.573785482	0.903618951	2.146642598	0	1.451384386	0	0	1.180044939	0	7.706474965	3.93003969	0	0	0	0.670490934	1.159011917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.3772
H3379_022_0	2011	4																															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	YES	262.4542934	45.854	8664.506754	4.167363198	21.40040581	24.12583993	8.460859263	6.217598012	9.726638592	37.28606337	12.00891972	0	0	2.347957607	2.063398603	96.00274017	21.4503	52.03687287	0	0	2.769908613	6.830953048	956.9937337	141.3930691	50.90932316	64.92688681	0	0	0	0											1800	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.089979264	0.091071472	0	0	0.2	0.2	0.08729849	0.173088281	0.2	0	0.097531358	0	0	0.163097402	0.000499709	0.032516597	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.071333593	0.072199473	0	0	0.158555628	0.158555628	0.069208335	0.137220605	0.158555628	0	0.077320729	0	0	0.129300055	0.000396158	0.025778448	0.158555628	0	0	0	0.158555628	0.161430492	0	0	0	0	0	0	0	0												18.7218	3.310634616	0	0	3.393154785	3.825287703	0.585561978	0.853182562	1.542213291	0	0.928538425	0	0	0.303591047	0.000817432	2.474801606	3.401065789	0	0	0	0.4391846	1.102724113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8826	0	10.66139796	18.7218	3.310634616	0	0	3.393154785	3.825287703	0.585561978	0.853182562	1.542213291	0	0.928538425	0	0	0.303591047	0.000817432	2.474801606	3.401065789	0	0	0	0.4391846	1.102724113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8826	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.7218	3.310634616	0	0	3.393154785	3.825287703	0.585561978	0.853182562	1.542213291	0	0.928538425	0	0	0.303591047	0.000817432	2.474801606	3.401065789	0	0	0	0.4391846	1.102724113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8826
H3379_037_0	2011	4																															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	1120.274158	661.6310682	12655.289	38.32868525	966.126225	4024.511951	1664.560045	232.7098747	87.60842342	40929.56032	4095.693795	0	0	524.4470107	173.545405	6367.645487	2193.39169	17.64868525	0	0	692.3933487	1570.835494	0	0	0	0	0	0	0	0											5000	"$50 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$50 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$0 (10a)	$0 (11a)	"$0 (11b, 11b1, 11c)"	"$0 (4a, 4b); $0 n/c (4a1)"	$0 (9b)	"$0 (8a1a, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 5, 9a, 9c, 9d)"	"$0 (7a, 7a1, 14b, 14c, 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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												36.26114675	22.23465932	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	36.25740084	22.2323624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												3.3849	1.225801807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.6107	0	0.000476347	3.3849	1.225801807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.6107	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	3.3849	1.225801807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.6107
H3384_013_0	2011	8	h.6.										OP Facility - Other										Cardiac Rehab and CORF										BP	BP	A	COIN	T	COIN	COIN	V	V	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									V										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0										0	YES	242.9823266	2.36978882	35.40295573	0	213.6297153	15.01259034	1.130647711	245.8348681	324.2128839	0	413.8011989	0.046385054	0	3.781534567	4466.406487	4513.206842	0.939128934	623.8555201	854.7274217	1069.659645	0.115416278	0.199382109									22.54362422										3400	$300 Copay	$300 Copay	$100/Day for 4 Days ($400 Max)	0% Coinsurance	$125 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$150 Copay	0% Coinsurance	$30 Copay	45% Coinsurance	0% Coinsurance	50% Coinsurance	$10 Copay	$30 Copay	45% Coinsurance	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	"$0 Copay for Blood, $30 Copay for other"									$30 Copay										0	300	300	385	0	125	0.2	0.2	50	150	0	30	0.45	0	0.5	10	30	0.45	30	30	30	0.2	30									30										NO	273.4496703	273.4496703	350.9270769	0	113.9373626	0.18229978	0.18229978	45.57494505	136.7248352	0	27.34496703	0.410174505	0	0.455749451	9.11498901	27.34496703	0.410174505	27.34496703	27.34496703	27.34496703	0.18229978	27.34496703									27.34496703											5.537	0.054001498	1.035321314	0	2.028367195	2.736791919	0.206116829	0.933659217	3.693996093	0	0.942948345	0.019025967	0	1.723432301	3.392603837	10.28445769	0.385206746	1.421609052	1.947707764	2.437483977	0.021040362	0.000454341	0	0	0	0	0	0	0	0	0.051371222	0	0	0	0	0	0	0	0	0	38.8525	0	3.772350422	5.537	0.054001498	1.035321314	0	2.028367195	2.736791919	0.206116829	0.933659217	3.693996093	0	0.942948345	0.019025967	0	1.723432301	3.392603837	10.28445769	0.385206746	1.421609052	1.947707764	2.437483977	0.021040362	0.000454341	0	0	0	0	0	0	0	0	0.051371222	0	0	0	0	0	0	0	0	0	38.8525	NO																																																																																		0	0	0	5.537	0.054001498	1.035321314	0	2.028367195	2.736791919	0.206116829	0.933659217	3.693996093	0	0.942948345	0.019025967	0	1.723432301	3.392603837	10.28445769	0.385206746	1.421609052	1.947707764	2.437483977	0.021040362	0.000454341	0	0	0	0	0	0	0	0	0.051371222	0	0	0	0	0	0	0	0	0	38.8525
H3384_015_0	2011	6	h.6.										OP Facility - Other										Cardiac Rehab and CORF										D	D	A	COIN	T	COIN	COIN	V	V	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									V										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0										0	YES	237.4269944	2.729708179	49.98382682	0	237.3234447	11.61942168	0.297906649	269.7916897	304.9242523	0	358.2536906	0.083854486	0	3.078893532	4248.202353	4175.093298	0.251924805	503.4932866	707.9771119	1127.4755	0.076738671	0									4.794039607										3400	$300/Day for 5 Days	$300/Day for 5 Days	$100/Day for 4 Days ($400 Max)	0% Coinsurance	$125 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$200 Copay	0% Coinsurance	$30 Copay	45% Coinsurance	0% Coinsurance	50% Coinsurance	$15 Copay	$30 Copay	45% Coinsurance	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	"$0 Copay for Blood, $30 Copay for other"									$30 Copay										0	1097	1097	385	0	125	0.2	0.2	50	200	0	30	0.45	0	0.5	15	30	0.45	30	30	30	0.2	30									30										NO	974.502321	974.502321	342.008563	0	111.0417412	0.177666786	0.177666786	44.41669649	177.666786	0	26.65001789	0.399750268	0	0.444166965	13.32500895	26.65001789	0.399750268	26.65001789	26.65001789	26.65001789	0.177666786	26.65001789									26.65001789											19.2811	0.22167558	1.424574732	0	2.196067378	2.064385304	0.052928117	0.998604633	4.514575989	0	0.795622272	0.033520853	0	1.367542795	4.717277863	9.272192592	0.100707008	1.118175425	1.572300225	2.503936853	0.013633913	0	0	0	0	0	0	0	0	0	0.01064677	0	0	0	0	0	0	0	0	0	52.2595	0	6.569161508	19.2811	0.22167558	1.424574732	0	2.196067378	2.064385304	0.052928117	0.998604633	4.514575989	0	0.795622272	0.033520853	0	1.367542795	4.717277863	9.272192592	0.100707008	1.118175425	1.572300225	2.503936853	0.013633913	0	0	0	0	0	0	0	0	0	0.01064677	0	0	0	0	0	0	0	0	0	52.2595	NO																																																																																		0	0	0	19.2811	0.22167558	1.424574732	0	2.196067378	2.064385304	0.052928117	0.998604633	4.514575989	0	0.795622272	0.033520853	0	1.367542795	4.717277863	9.272192592	0.100707008	1.118175425	1.572300225	2.503936853	0.013633913	0	0	0	0	0	0	0	0	0	0.01064677	0	0	0	0	0	0	0	0	0	52.2595
H3384_019_0	2011	9	h.6.										OP Facility - Other										Cardiac Rehab and CORF										BP	BP	D	COIN	T	COIN	COIN	V	V	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									V										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0										0	YES	174.5369847	2.418451782	49.15374038	0	166.7598288	12.2087644	0.335555916	286.0567206	307.8799773	0	442.8666296	0.042805401	0	5.648236433	3630.394869	3288.046858	1.106577764	360.031051	850.1158776	676.9609547	0.002151324	15.04930356									19.01444243										3400	$650 Copay	$650 Copay	$15/Day for 20 Days ($300 Max)	0% Coinsurance	$125 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$200 Copay	0% Coinsurance	$35 Copay	45% Coinsurance	0% Coinsurance	50% Coinsurance	$25 Copay	$35 Copay	45% Coinsurance	$35 Copay	$35 Copay	$35 Copay	20% Coinsurance	"$0 Copay for Blood, $35 Copay for other"									$35 Copay										0	650	650	218	0	125	0.2	0.2	50	200	0	35	0.45	0	0.5	25	35	0.45	35	35	35	0.2	35									35										NO	580.3204916	580.3204916	194.6305649	0	111.6000945	0.178560151	0.178560151	44.64003782	178.5601513	0	31.24802647	0.40176034	0	0.446400378	22.32001891	31.24802647	0.40176034	31.24802647	31.24802647	31.24802647	0.178560151	31.24802647									31.24802647											8.4406	0.116956427	0.797235021	0	1.550867722	2.179998819	0.059916915	1.064131902	4.581257943	0	1.153225681	0.017197513	0	2.52137488	6.752540176	8.562081271	0.444579059	0.937521651	2.213703621	1.762807819	0.000384141	0.03918842	0	0	0	0	0	0	0	0	0.04951365	0	0	0	0	0	0	0	0	0	43.2451	0	5.192470775	8.4406	0.116956427	0.797235021	0	1.550867722	2.179998819	0.059916915	1.064131902	4.581257943	0	1.153225681	0.017197513	0	2.52137488	6.752540176	8.562081271	0.444579059	0.937521651	2.213703621	1.762807819	0.000384141	0.03918842	0	0	0	0	0	0	0	0	0.04951365	0	0	0	0	0	0	0	0	0	43.2451	NO																																																																																		0	0	0	8.4406	0.116956427	0.797235021	0	1.550867722	2.179998819	0.059916915	1.064131902	4.581257943	0	1.153225681	0.017197513	0	2.52137488	6.752540176	8.562081271	0.444579059	0.937521651	2.213703621	1.762807819	0.000384141	0.03918842	0	0	0	0	0	0	0	0	0.04951365	0	0	0	0	0	0	0	0	0	43.2451
H3384_022_0	2011	4	h.6.										OP Facility - Other										Cardiac Rehab and CORF										BP	BP	D	COIN	T	COIN	COIN	V	V	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									V										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0										0	YES	208.3570593	2.202631283	68.7938593	0	163.6942885	11.61916276	0.453172638	277.9980798	294.074004	0	493.5336833	0.060067041	0	2.618932448	4489.241178	3383.91186	0.446656672	350.9131702	943.229306	838.9977862	0.001769377	16.62891196									7.863906824										3400	$400 Copay	$400 Copay	$35/Day for 20 Days ($700 Max)	0% Coinsurance	$125 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$200 Copay	0% Coinsurance	$35 Copay	45% Coinsurance	0% Coinsurance	50% Coinsurance	$10 Copay	$35 Copay	45% Coinsurance	$35 Copay	$35 Copay	$35 Copay	20% Coinsurance	"$0 Copay for Blood, $35 Copay for other"									$35 Copay										0	400	400	508	0	125	0.2	0.2	50	200	0	35	0.45	0	0.5	10	35	0.45	35	35	35	0.2	35									35										NO	374.447931	374.447931	475.5488724	0	117.0149784	0.187223966	0.187223966	46.80599138	187.2239655	0	32.76419397	0.421253922	0	0.468059914	9.361198276	32.76419397	0.421253922	32.76419397	32.76419397	32.76419397	0.187223966	32.76419397									32.76419397											6.5016	0.068730894	2.726236852	0	1.596223637	2.175385728	0.084844778	1.084331311	4.588141765	0	1.347519444	0.025303477	0	1.225817296	3.502056398	9.239262045	0.188155875	0.958115598	2.575345661	2.290757184	0.00033127	0.045402741	0	0	0	0	0	0	0	0	0.021471214	0	0	0	0	0	0	0	0	0	40.245	0	2.746291472	6.5016	0.068730894	2.726236852	0	1.596223637	2.175385728	0.084844778	1.084331311	4.588141765	0	1.347519444	0.025303477	0	1.225817296	3.502056398	9.239262045	0.188155875	0.958115598	2.575345661	2.290757184	0.00033127	0.045402741	0	0	0	0	0	0	0	0	0.021471214	0	0	0	0	0	0	0	0	0	40.245	NO																																																																																		0	0	0	6.5016	0.068730894	2.726236852	0	1.596223637	2.175385728	0.084844778	1.084331311	4.588141765	0	1.347519444	0.025303477	0	1.225817296	3.502056398	9.239262045	0.188155875	0.958115598	2.575345661	2.290757184	0.00033127	0.045402741	0	0	0	0	0	0	0	0	0.021471214	0	0	0	0	0	0	0	0	0	40.245
H3384_041_0	2011	8	h.6.										OP Facility - Other										Cardiac Rehab and CORF										BP	BP	D	COIN	T	COIN	COIN	V	V	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									V										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0										0	YES	151.9085205	2.718449647	46.1852586	0	138.2768762	13.28972321	1.176376777	272.3376452	342.3470443	0	653.344463	0.041651963	0	2.962441692	4575.041968	4305.587577	1.464323541	649.27676	1019.60534	987.7339358	0.004725418	22.56991182									36.26745717										3400	$400 Copay	$400 Copay	$35/Day for 20 Days ($700 Max)	0% Coinsurance	$50 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$125 Copay	0% Coinsurance	$25 Copay	45% Coinsurance	0% Coinsurance	50% Coinsurance	$10 Copay	$25 Copay	45% Coinsurance	$25 Copay	$25 Copay	$25 Copay	20% Coinsurance	"$0 Copay for Blood, $25 Copay for other"									$25 Copay										0	400	400	508	0	50	0.2	0.2	50	125	0	25	0.45	0	0.5	10	25	0.45	25	25	25	0.2	25									25										NO	379.2647925	379.2647925	481.6662865	0	47.40809906	0.189632396	0.189632396	47.40809906	118.5202477	0	23.70404953	0.426672892	0	0.474080991	9.481619813	23.70404953	0.426672892	23.70404953	23.70404953	23.70404953	0.189632396	23.70404953									23.70404953											4.8011	0.085917687	1.8538235	0	0.546286987	2.520162058	0.223079147	1.075917505	3.381254706	0	1.290575793	0.017771763	0	1.404437292	3.614900714	8.504988433	0.62478716	1.282540707	2.014064623	1.951107845	0.000896092	0.044583192	0	0	0	0	0	0	0	0	0.071640467	0	0	0	0	0	0	0	0	0	35.3099	0	1.930464926	4.8011	0.085917687	1.8538235	0	0.546286987	2.520162058	0.223079147	1.075917505	3.381254706	0	1.290575793	0.017771763	0	1.404437292	3.614900714	8.504988433	0.62478716	1.282540707	2.014064623	1.951107845	0.000896092	0.044583192	0	0	0	0	0	0	0	0	0.071640467	0	0	0	0	0	0	0	0	0	35.3099	NO																																																																																		0	0	0	4.8011	0.085917687	1.8538235	0	0.546286987	2.520162058	0.223079147	1.075917505	3.381254706	0	1.290575793	0.017771763	0	1.404437292	3.614900714	8.504988433	0.62478716	1.282540707	2.014064623	1.951107845	0.000896092	0.044583192	0	0	0	0	0	0	0	0	0.071640467	0	0	0	0	0	0	0	0	0	35.3099
H3384_051_0	2011	4	h.6.										OP Facility - Other										Cardiac Rehab and CORF										BP	BP	D	COIN	T	COIN	COIN	V	V	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									V										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0										0	YES	206.6377296	2.782965275	31.03448329	0	164.2562212	10.90573298	0.963660807	293.4869615	350.3524351	0	625.9109567	0.055275561	0	2.452200994	4987.791166	4737.560958	0.816431855	720.4083173	1087.676026	1116.003927	0.002084858	75.98354891									9.968191721										3400	$100 Copay	$100 Copay	$35/Day for 20 Days ($700 Max)	0% Coinsurance	$125 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$125 Copay	0% Coinsurance	$15 Copay	45% Coinsurance	0% Coinsurance	50% Coinsurance	$5 Copay	$15 Copay	45% Coinsurance	$15 Copay	$15 Copay	$15 Copay	20% Coinsurance	"$0 Copay for Blood, $15 Copay for other"									$15 Copay										0	100	100	508	0	125	0.2	0.2	50	125	0	15	0.45	0	0.5	5	15	0.45	15	15	15	0.2	15									15										NO	93.30641871	93.30641871	473.996607	0	116.6330234	0.186612837	0.186612837	46.65320936	116.6330234	0	13.99596281	0.419878884	0	0.466532094	4.665320936	13.99596281	0.419878884	13.99596281	13.99596281	13.99596281	0.186612837	13.99596281									13.99596281											1.6067	0.021639044	1.225853315	0	1.596474974	2.035149776	0.179831477	1.141009055	3.405221979	0	0.730018872	0.023209041	0	1.144030463	1.939137213	5.52556058	0.342802496	0.840234001	1.268589434	1.301629122	0.000389061	0.08862191	0	0	0	0	0	0	0	0	0.011626203	0	0	0	0	0	0	0	0	0	24.4277	0	1.752388655	1.6067	0.021639044	1.225853315	0	1.596474974	2.035149776	0.179831477	1.141009055	3.405221979	0	0.730018872	0.023209041	0	1.144030463	1.939137213	5.52556058	0.342802496	0.840234001	1.268589434	1.301629122	0.000389061	0.08862191	0	0	0	0	0	0	0	0	0.011626203	0	0	0	0	0	0	0	0	0	24.4277	NO																																																																																		0	0	0	1.6067	0.021639044	1.225853315	0	1.596474974	2.035149776	0.179831477	1.141009055	3.405221979	0	0.730018872	0.023209041	0	1.144030463	1.939137213	5.52556058	0.342802496	0.840234001	1.268589434	1.301629122	0.000389061	0.08862191	0	0	0	0	0	0	0	0	0.011626203	0	0	0	0	0	0	0	0	0	24.4277
H3384_053_0	2011	10	h.6.										OP Facility - Other										Cardiac Rehab and CORF										D	D	D	COIN	T	COIN	COIN	V	V	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									V										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0										0	YES	177.5971741	1.798950111	27.55419702	0	168.0165794	10.28478686	1.490951236	226.1975917	277.9574101	0	331.3879369	0.063573505	0	2.512526189	3937.718277	3768.463054	0.796714939	414.9182715	635.1295383	963.0767733	0.177457125	0.053442705									21.79949295										3400	$400/Day for 5 Days ($2000 Max)	$400/Day for 5 Days ($2000 Max)	$20/Day for 20 Days ($400 Max)	0% Coinsurance	$125 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$200 Copay	0% Coinsurance	$35 Copay	45% Coinsurance	0% Coinsurance	50% Coinsurance	$20 Copay	$35 Copay	45% Coinsurance	$35 Copay	$35 Copay	$35 Copay	20% Coinsurance	"$0 Copay for Blood, $35 Copay for other"									$35 Copay										0	1462	1462	290	0	125	0.2	0.2	50	200	0	35	0.45	0	0.5	20	35	0.45	35	35	35	0.2	35									35										NO	1315.9715	1315.9715	261.0340185	0	112.5146632	0.180023461	0.180023461	45.00586527	180.0234611	0	31.50410569	0.405052787	0	0.450058653	18.00234611	31.50410569	0.405052787	31.50410569	31.50410569	31.50410569	0.180023461	31.50410569									31.50410569											19.4761	0.19728059	0.599381898	0	1.575360737	1.851502926	0.268406202	0.848351528	4.169904582	0	0.870006716	0.025750625	0	1.130784151	5.907347274	9.893504861	0.322711607	1.089302423	1.667432342	2.528406038	0.031946446	0.000140305	0	0	0	0	0	0	0	0	0.057231127	0	0	0	0	0	0	0	0	0	52.5108	0	5.826931934	19.4761	0.19728059	0.599381898	0	1.575360737	1.851502926	0.268406202	0.848351528	4.169904582	0	0.870006716	0.025750625	0	1.130784151	5.907347274	9.893504861	0.322711607	1.089302423	1.667432342	2.528406038	0.031946446	0.000140305	0	0	0	0	0	0	0	0	0.057231127	0	0	0	0	0	0	0	0	0	52.5108	NO																																																																																		0	0	0	19.4761	0.19728059	0.599381898	0	1.575360737	1.851502926	0.268406202	0.848351528	4.169904582	0	0.870006716	0.025750625	0	1.130784151	5.907347274	9.893504861	0.322711607	1.089302423	1.667432342	2.528406038	0.031946446	0.000140305	0	0	0	0	0	0	0	0	0.057231127	0	0	0	0	0	0	0	0	0	52.5108
H3384_805_0	2011	3	h.6.										OP Facility - Other										Cardiac Rehab and CORF										BP	BP	A	V	T	COIN	COIN	V	COIN	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									V										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0										0	YES	169.5930095	1.99080781	24.11479181	26.68781759	220.414279	14.85039175	0.285668344	255.0693156	40.38255327	0	320.7484065	0.066556298	0	12.73771421	3756.197508	4227.713141	1.527318404	690.5890207	826.3502949	930.1324249	0.005271573	7.817461624									6.670117797										3400	$500 Copay	$500 Copay	$100/Day for 4 Days ($400 Max)	$20 Copay	$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	$30 Copay	45% Coinsurance	0% Coinsurance	50% Coinsurance	$20 Copay	$30 Copay	45% Coinsurance	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	"$0 Copay for Blood, $30 Copay for other"									$30 Copay										0	500	500	385	20	100	0.2	0.2	50	0.2	0	30	0.45	0	0.5	20	30	0.45	30	30	30	0.2	30									30										NO	478.7886242	478.7886242	368.6672407	19.15154497	95.75772485	0.19151545	0.19151545	47.87886242	0.19151545	0	28.72731745	0.430909762	0	0.478788624	19.15154497	28.72731745	0.430909762	28.72731745	28.72731745	28.72731745	0.19151545	28.72731745									28.72731745											6.7666	0.079431344	0.740861146	0.042592745	1.758864157	2.844079454	0.054709901	1.017702389	7.73388285	0	0.767853441	0.028679758	0	6.098672661	5.994748791	10.12090479	0.65813641	1.653230836	1.978235604	2.22668412	0.001009588	0.018714558	0	0	0	0	0	0	0	0	0.015967883	0	0	0	0	0	0	0	0	0	50.6016	0	2.241759112	6.7666	0.079431344	0.740861146	0.042592745	1.758864157	2.844079454	0.054709901	1.017702389	7.73388285	0	0.767853441	0.028679758	0	6.098672661	5.994748791	10.12090479	0.65813641	1.653230836	1.978235604	2.22668412	0.001009588	0.018714558	0	0	0	0	0	0	0	0	0.015967883	0	0	0	0	0	0	0	0	0	50.6016	NO																																																																																		0	0	0	6.7666	0.079431344	0.740861146	0.042592745	1.758864157	2.844079454	0.054709901	1.017702389	7.73388285	0	0.767853441	0.028679758	0	6.098672661	5.994748791	10.12090479	0.65813641	1.653230836	1.978235604	2.22668412	0.001009588	0.018714558	0	0	0	0	0	0	0	0	0.015967883	0	0	0	0	0	0	0	0	0	50.6016
H3384_806_0	2011	3	h.6.										OP Facility - Other										Cardiac Rehab and CORF										BP	BP	A	V	T	COIN	COIN	V	COIN	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									V										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0										0	YES	177.1749123	0.674969439	25.96263192	0.686033153	174.4912501	12.74596967	0.575328951	248.0547969	43.66672454	0	680.2820705	0.040688132	0	12.73589901	3676.226817	4416.561047	1.310118772	717.7554107	930.0512722	1097.80999	0.026629719	11.31487837									6.232034368										3400	$500 Copay	$500 Copay	$100/Day for 4 Days ($400 Max)	$20 Copay	$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	$30 Copay	45% Coinsurance	0% Coinsurance	50% Coinsurance	$20 Copay	$30 Copay	45% Coinsurance	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	"$0 Copay for Blood, $30 Copay for other"									$30 Copay										0	500	500	385	20	100	0.2	0.2	50	0.2	0	30	0.45	0	0.5	20	30	0.45	30	30	30	0.2	30									30										NO	480.5707468	480.5707468	370.039475	19.22282987	96.11414936	0.192228299	0.192228299	48.05707468	0.192228299	0	28.83424481	0.432513672	0	0.480570747	19.22282987	28.83424481	0.432513672	28.83424481	28.83424481	28.83424481	0.192228299	28.83424481									28.83424481											7.0954	0.027030881	0.80059989	0.001098958	1.397589839	2.450136065	0.110594506	0.993398992	8.39398017	0	1.634618313	0.017598173	0	6.120500499	5.888956889	10.6123502	0.566644281	1.724661269	2.234777172	2.637876834	0.005118986	0.027187998	0	0	0	0	0	0	0	0	0.014974667	0	0	0	0	0	0	0	0	0	52.7551	0	2.132865035	7.0954	0.027030881	0.80059989	0.001098958	1.397589839	2.450136065	0.110594506	0.993398992	8.39398017	0	1.634618313	0.017598173	0	6.120500499	5.888956889	10.6123502	0.566644281	1.724661269	2.234777172	2.637876834	0.005118986	0.027187998	0	0	0	0	0	0	0	0	0.014974667	0	0	0	0	0	0	0	0	0	52.7551	NO																																																																																		0	0	0	7.0954	0.027030881	0.80059989	0.001098958	1.397589839	2.450136065	0.110594506	0.993398992	8.39398017	0	1.634618313	0.017598173	0	6.120500499	5.888956889	10.6123502	0.566644281	1.724661269	2.234777172	2.637876834	0.005118986	0.027187998	0	0	0	0	0	0	0	0	0.014974667	0	0	0	0	0	0	0	0	0	52.7551
H3384_807_0	2011	3	h.6.										OP Facility - Other										Cardiac Rehab and CORF										BP	BP	A	V	T	COIN	COIN	V	COIN	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									V										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0										0	YES	178.9584115	0.681763897	26.22398004	0.697699136	177.5163718	13.04595598	0.588869766	252.2729649	45.83965959	0	691.8502566	0.042712847	0	13.36966034	3739.960864	4493.130128	1.340953437	730.1990001	946.1753946	1116.842514	0.027999048	11.5072877									6.338010016										3400	$500 Copay	$500 Copay	$100/Day for 4 Days ($400 Max)	$20 Copay	$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	$30 Copay	45% Coinsurance	0% Coinsurance	50% Coinsurance	$20 Copay	$30 Copay	45% Coinsurance	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	"$0 Copay for Blood, $30 Copay for other"									$30 Copay										0	500	500	385	20	100	0.2	0.2	50	0.2	0	30	0.45	0	0.5	20	30	0.45	30	30	30	0.2	30									30										NO	480.5707468	480.5707468	370.039475	19.22282987	96.11414936	0.192228299	0.192228299	48.05707468	0.192228299	0	28.83424481	0.432513672	0	0.480570747	19.22282987	28.83424481	0.432513672	28.83424481	28.83424481	28.83424481	0.192228299	28.83424481									28.83424481											7.1668	0.027302982	0.808658984	0.001117646	1.421819589	2.507801924	0.113197433	1.010291726	8.811679777	0	1.662414973	0.01847389	0	6.425067653	5.991052617	10.79633451	0.579980695	1.754561394	2.27352108	2.683609204	0.005382209	0.027650329	0	0	0	0	0	0	0	0	0.015229311	0	0	0	0	0	0	0	0	0	54.102	0	2.187318695	7.1668	0.027302982	0.808658984	0.001117646	1.421819589	2.507801924	0.113197433	1.010291726	8.811679777	0	1.662414973	0.01847389	0	6.425067653	5.991052617	10.79633451	0.579980695	1.754561394	2.27352108	2.683609204	0.005382209	0.027650329	0	0	0	0	0	0	0	0	0.015229311	0	0	0	0	0	0	0	0	0	54.102	NO																																																																																		0	0	0	7.1668	0.027302982	0.808658984	0.001117646	1.421819589	2.507801924	0.113197433	1.010291726	8.811679777	0	1.662414973	0.01847389	0	6.425067653	5.991052617	10.79633451	0.579980695	1.754561394	2.27352108	2.683609204	0.005382209	0.027650329	0	0	0	0	0	0	0	0	0.015229311	0	0	0	0	0	0	0	0	0	54.102
H3387_010_0	2011	5																															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	361.7455049	20.2827	39.1112797	2127.13472	14.12375204	21.12354773	20.43832456	26.90927322	35.99976373	20.19261523	44.39749131	0	0.215206601	33.15467531	48.11236823	142.4222856	10.2124	10.47340841	0	5.355701903	25.54906001	8.482377438	639.2392537	452.6954566	168.9191946	239.5463849	17.46434425	11	520.1378368	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a); $0 n/c (13a1); FFS (16b, 18a); $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); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a6); $0 n/c (14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.09035775	0.233	0.233	0.233	0	0.233	0.233	0.226868254	0.232894723	0.233	0.233	0	0.233	0.233	0.038695243	0	0	0	0	0	0	0	0											NO	0.048792449	0.048792449	0.114627379	0	0.184654436	0.184654436	0.184654436	0.071622811	0.184654436	0.184654436	0.184654436	0	0.184654436	0.184654436	0.179794977	0.184571003	0.184654436	0.184654436	0	0.184654436	0.184654436	0.036647643	0	0	0	0	0	0	0	0												17.6504	0.989642612	4.483223471	0	2.608013471	3.900556797	3.774027298	1.927317788	6.647516075	3.72865598	8.198193726	0	0.039738854	6.122157878	8.650362132	26.28702409	1.885764964	1.933961325	0	0.988954115	4.717747271	0.31085914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.8442	0	27.3854451	17.6504	0.989642612	4.483223471	0	2.608013471	3.900556797	3.774027298	1.927317788	6.647516075	3.72865598	8.198193726	0	0.039738854	6.122157878	8.650362132	26.28702409	1.885764964	1.933961325	0	0.988954115	4.717747271	0.31085914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.8442	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.6504	0.989642612	4.483223471	0	2.608013471	3.900556797	3.774027298	1.927317788	6.647516075	3.72865598	8.198193726	0	0.039738854	6.122157878	8.650362132	26.28702409	1.885764964	1.933961325	0	0.988954115	4.717747271	0.31085914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.8442
H3388_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	V	P	V	V	V	V	V	V	V	V	V	S	V	T	P	P	P	P	P	O	V																																																			0	YES	1981.130766	18.21723011	1525.24082		728.3464188	10.06996776		273.5406513	346.3063583		490.3775909		30.93155525	697.966715	2395.793829	9715.695929	137.1628774	1034.141381			1893.532518				3836.999536																4000	"1a (IP Acute): $150/day (days 1-5), 1a1 (Add'l Days): 0"	1b (IP Psych): $150/day (days 1-5) (190 day lifetime limit)	"2a (SNF): $20 - days 1-20 $80 days 21-100, 2a2 (Waiver 3 Day): 0"	6a (Home Health): $0	10a (Ambulance): 75	"11a (DME): Lesser of 20% - $200 max  per item, 11b (Prosthetics): Lesser of 20% - $200 max  per item, 11b (Medical Supplies): Lesser of 20% - $200 max  per item, 11c (Diabetic Supplies): Lesser of 20% or $10 max per item"		"4a (ER): $50 (waived if admit), 4a (ER) - Worldwide Coverage: $50 (waived if admit), 4b (UC): 35"	"9b (OP Surg): 125, 9b (OP ASC): 125"	8a (OP Diag Proc/Test/Lab): $0 - $20	8b (Radiology): $0 - $20	9a (OP Observation): 0	12 (Renal Dialysis): 20	"3 (CORF): 0, 5 (Partial Hosp): 20, 9a (OP Other): 0, 9a (OP Chemo): 0, 9c (OP SA): 20, 9d (OP Cardiac Rehab): 20, 7e (MH Non-Phys): 20, 7i (PT/ST): 20, 13a (Blood): 0"	"7a (PCP w/Copay): 20, 14b (Immunizations): 0, 14c (Routine Physical): 0, 14d (Pap & Pelvic Exam): 0, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): 0, 14f (Colorectal Screening): 0, 14g (Bone Mass): 0, 14h (Mammography): 0, 14i (Diabetes Educ.): 0, 14j (Nutrition Therapy Diabetes): 0"	"7b (Chiro): 20, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): 20, 7f (Podiatry): 20, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): 20, 17a (Eye Exam): 20,18a (Hearing Exam): 20"	"7e (MH Non-Phys): 20, 7h (Psych): 20"	"7c (OT): 20, 7i (PT/ST): 20"	8b (Radiology): $0 - $20		15 (Part B Rx): 15		10b (Transportation): 0	"16a (Preventive Dental): Prev Dental - $250 annual max to include up to 2 preventative office visits per year, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): 20, 17b1 (Non MCR Covered): $100 annual eyewear"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): Silver Sneakers, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"													92.84307611	85.48283863	38.68001065		37.5	0.174708793		50	125		0.269385951		20	20	20	20	20	20			15				1.191291191																NO	84.83299472	78.1077653	35.34287398		34.26466933	0.159635707		45.68622577	114.2155644		0.246144548		18.27449031	18.27449031	18.27449031	18.27449031	18.27449031	18.27449031			13.70586773				1.088511966																	14.0054	0.118575594	4.492199509	0	2.079712433	1.607526426	0	1.041419996	3.296131348	0	0.010058648	0	0.047104867	1.062915497	3.648492592	14.79578259	0.208881806	1.574867221	0	0	2.162708853	0	0	0	0.348051659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.4999	0	4.768286753	14.0054	0.118575594	4.492199509	0	2.079712433	1.607526426	0	1.041419996	3.296131348	0	0.010058648	0	0.047104867	1.062915497	3.648492592	14.79578259	0.208881806	1.574867221	0	0	2.162708853	0	0	0	0.348051659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.4999	NO																																																																																		0	0	0	14.0054	0.118575594	4.492199509	0	2.079712433	1.607526426	0	1.041419996	3.296131348	0	0.010058648	0	0.047104867	1.062915497	3.648492592	14.79578259	0.208881806	1.574867221	0	0	2.162708853	0	0	0	0.348051659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.4999
H3388_002_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	P	V	V	V	V	V	V	V	V	V	S	V	T	P	P	P	P	P	O	V																																																			0	YES	1587.025644	49.66026015	943.1723737		575.1748033	10.02532778		264.2309667	385.4784706		547.5195274		45.20777586	635.4935022	2392.73105	9602.463301	274.831846	1345.466717			3005.992581				4272.151373																4000	"1a (IP Acute): $150/day (days 1-5), 1a1 (Add'l Days): 0"	1b (IP Psych): $150/day (days 1-5) (190 day lifetime limit)	"2a (SNF): $20 - days 1-20 $80 days 21-100, 2a2 (Waiver 3 Day): 0"	6a (Home Health): $0	10a (Ambulance): 75	"11a (DME): Lesser of 20% - $200 max  per item, 11b (Prosthetics): Lesser of 20% - $200 max  per item, 11b (Medical Supplies): Lesser of 20% - $200 max  per item, 11c (Diabetic Supplies): Lesser of 20% or $10 max per item"		"4a (ER): $50 (waived if admit), 4a (ER) - Worldwide Coverage: $50 (waived if admit), 4b (UC): 35"	"9b (OP Surg): 125, 9b (OP ASC): 125"	8a (OP Diag Proc/Test/Lab): $0 - $20	8b (Radiology): $0 - $20	9a (OP Observation): 0	12 (Renal Dialysis): 20	"3 (CORF): 0, 5 (Partial Hosp): 20, 9a (OP Other): 0, 9a (OP Chemo): 0, 9c (OP SA): 20, 9d (OP Cardiac Rehab): 20, 7e (MH Non-Phys): 20, 7i (PT/ST): 20, 13a (Blood): 0"	"7a (PCP w/Copay): 20, 14b (Immunizations): 0, 14c (Routine Physical): 0, 14d (Pap & Pelvic Exam): 0, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): 0, 14f (Colorectal Screening): 0, 14g (Bone Mass): 0, 14h (Mammography): 0, 14i (Diabetes Educ.): 0, 14j (Nutrition Therapy Diabetes): 0"	"7b (Chiro): 20, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): 20, 7f (Podiatry): 20, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): 20, 17a (Eye Exam): 20,18a (Hearing Exam): 20"	"7e (MH Non-Phys): 20, 7h (Psych): 20"	"7c (OT): 20, 7i (PT/ST): 20"	8b (Radiology): $0 - $20		15 (Part B Rx): 15		10b (Transportation): 0	"16a (Preventive Dental): Prev Dental - $250 annual max to include up to 2 preventative office visits per year, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): 20, 17b1 (Non MCR Covered): $100 annual eyewear"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): Silver Sneakers, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"													92.84307611	85.48283863	38.68001065		37.5	0.174708793		50	125		0.30198373		20	20	20	20	20	20			15				1.077602615																NO	85.4036149	78.63314893	35.58060409		34.49514701	0.16070948		45.99352934	114.9838234		0.277785951		18.39741174	18.39741174	18.39741174	18.39741174	18.39741174	18.39741174			13.7980588				0.99125495																	11.2948	0.325411886	2.796553568	0	1.65339495	1.611165214	0	1.012742893	3.693649031	0	0.012674436	0	0.069308839	0.974286301	3.668338191	14.72170592	0.421349552	2.062758764	0	0	3.456405199	0	0	0	0.352899266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1275	0	4.192355697	11.2948	0.325411886	2.796553568	0	1.65339495	1.611165214	0	1.012742893	3.693649031	0	0.012674436	0	0.069308839	0.974286301	3.668338191	14.72170592	0.421349552	2.062758764	0	0	3.456405199	0	0	0	0.352899266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1275	NO																																																																																		0	0	0	11.2948	0.325411886	2.796553568	0	1.65339495	1.611165214	0	1.012742893	3.693649031	0	0.012674436	0	0.069308839	0.974286301	3.668338191	14.72170592	0.421349552	2.062758764	0	0	3.456405199	0	0	0	0.352899266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1275
H3388_003_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	V	P	V	V	V	V	V	V	V	V	V	S	V	T	P	P	P	P	P	O	V																																																			0	YES	991.1526776	25.54552929	624.2418918		348.9726923	6.243106361		170.0657743	304.317916		398.4550438		23.25514524	447.3034585	1651.463036	6705.855947	171.1644311	820.4253818			1867.392478				2348.084711																5000	"1a (IP Acute): $200/day (days 1-5), 1a1 (Add'l Days): 0"	1b (IP Psych): $200/day (days 1-5) (190 day lifetime limit)	"2a (SNF): $50 - days 1-20 $100 days 21-100, 2a2 (Waiver 3 Day): 0"	6a (Home Health): $0	10a (Ambulance): 125	"11a (DME): Lesser of 20% or $250 max per item, 11b (Prosthetics): Lesser of 20% or $250 max per item, 11b (Medical Supplies): Lesser of 20% or $250 max per item, 11c (Diabetic Supplies): Lesser of 20% or $10 max per item"		"4a (ER): $50 (waived if admit), 4a (ER) - Worldwide Coverage: $50 (waived if admit), 4b (UC): 35"	"9b (OP Surg): 175, 9b (OP ASC): 175"	8a (OP Diag Proc/Test/Lab): $0 - $30	8b (Radiology): $0 - $30	9a (OP Observation): 0	12 (Renal Dialysis): 25	"3 (CORF): 0, 5 (Partial Hosp): 30, 9a (OP Other): 0, 9a (OP Chemo): 0, 9c (OP SA): 30, 9d (OP Cardiac Rehab): 30, 7e (MH Non-Phys): 30, 7i (PT/ST): 30, 13a (Blood): 0"	"7a (PCP w/Copay): 30, 14b (Immunizations): 0, 14c (Routine Physical): 0, 14d (Pap & Pelvic Exam): 0, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): 0, 14f (Colorectal Screening): 0, 14g (Bone Mass): 0, 14h (Mammography): 0, 14i (Diabetes Educ.): 0, 14j (Nutrition Therapy Diabetes): 0"	"7b (Chiro): 30, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): 30, 7f (Podiatry): 30, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): 30, 17a (Eye Exam): 30,18a (Hearing Exam): 30"	"7e (MH Non-Phys): 30, 7h (Psych): 30"	"7c (OT): 30, 7i (PT/ST): 30"	8b (Radiology): $0 - $30		15 (Part B Rx): 15		10b (Transportation): 0	"16a (Preventive Dental): Prev Dental - $100 annual max to include up to 2 preventative office visits per year, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): 30, 17b1 (Non MCR Covered): n/a"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): Silver Sneakers, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"													123.7907681	113.9771182	65.56667554		62.5	0.178158123		50	175		0.468746705		25	30	30	30	30	30			15				1.711536911																NO	117.2128521	107.9206737	62.08263474		59.17891428	0.168691269		47.34313142	165.70096		0.443838738		23.67156571	28.40587885	28.40587885	28.40587885	28.40587885	28.40587885			14.20293943				1.620590338																	9.6813	0.229740894	3.229548447	0	1.72098542	1.053157532	0	0.670953859	4.202147569	0	0.014737482	0	0.045873808	1.058837321	3.909271577	15.87381097	0.405173008	1.942075334	0	0	2.210205188	0	0	0	0.31710695	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5649	0	2.613197198	9.6813	0.229740894	3.229548447	0	1.72098542	1.053157532	0	0.670953859	4.202147569	0	0.014737482	0	0.045873808	1.058837321	3.909271577	15.87381097	0.405173008	1.942075334	0	0	2.210205188	0	0	0	0.31710695	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5649	NO																																																																																		0	0	0	9.6813	0.229740894	3.229548447	0	1.72098542	1.053157532	0	0.670953859	4.202147569	0	0.014737482	0	0.045873808	1.058837321	3.909271577	15.87381097	0.405173008	1.942075334	0	0	2.210205188	0	0	0	0.31710695	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5649
H3388_004_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	P	V	V	V	V	V	V	V	V	V	S	V	T	P	P	P	P	P	O	V																																																			0	YES	1047.69172	42.31598578	505.3437855		360.2277329	7.203042594		263.9091985	375.3614237		556.8007825		40.25320532	674.400593	2121.720536	8196.653309	298.9522073	1106.629197			2691.929762				2659.527749																5000	"1a (IP Acute): $200/day (days 1-5), 1a1 (Add'l Days): 0"	1b (IP Psych): $200/day (days 1-5) (190 day lifetime limit)	"2a (SNF): $50 - days 1-20 $100 days 21-100, 2a2 (Waiver 3 Day): 0"	6a (Home Health): $0	10a (Ambulance): 125	"11a (DME): Lesser of 20% or $250 max per item, 11b (Prosthetics): Lesser of 20% or $250 max per item, 11b (Medical Supplies): Lesser of 20% or $250 max per item, 11c (Diabetic Supplies): Lesser of 20% or $10 max per item"		"4a (ER): $50 (waived if admit), 4a (ER) - Worldwide Coverage: $50 (waived if admit), 4b (UC): 35"	"9b (OP Surg): 175, 9b (OP ASC): 175"	8a (OP Diag Proc/Test/Lab): $0 - $30	8b (Radiology): $0 - $30	9a (OP Observation): 0	12 (Renal Dialysis): 25	"3 (CORF): 0, 5 (Partial Hosp): 30, 9a (OP Other): 0, 9a (OP Chemo): 0, 9c (OP SA): 30, 9d (OP Cardiac Rehab): 30, 7e (MH Non-Phys): 30, 7i (PT/ST): 30, 13a (Blood): 0"	"7a (PCP w/Copay): 30, 14b (Immunizations): 0, 14c (Routine Physical): 0, 14d (Pap & Pelvic Exam): 0, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): 0, 14f (Colorectal Screening): 0, 14g (Bone Mass): 0, 14h (Mammography): 0, 14i (Diabetes Educ.): 0, 14j (Nutrition Therapy Diabetes): 0"	"7b (Chiro): 30, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): 30, 7f (Podiatry): 30, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): 30, 17a (Eye Exam): 30,18a (Hearing Exam): 30"	"7e (MH Non-Phys): 30, 7h (Psych): 30"	"7c (OT): 30, 7i (PT/ST): 30"	8b (Radiology): $0 - $30		15 (Part B Rx): 15		10b (Transportation): 0	"16a (Preventive Dental): Prev Dental - $100 annual max to include up to 2 preventative office visits per year, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): 30, 17b1 (Non MCR Covered): n/a"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): Silver Sneakers, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"													123.7907681	113.9771182	65.56667554		62.5	0.178158123		50	175		0.393746486		25	30	30	30	30	30			15				1.662666959																NO	115.2741936	106.1357045	61.05581026		58.20011629	0.165901176		46.56009303	162.9603256		0.366657461		23.28004652	27.93605582	27.93605582	27.93605582	27.93605582	27.93605582			13.96802791				1.548278566																	10.0643	0.374269747	2.57118119	0	1.747107996	1.194993234	0	1.023969736	5.09741832	0	0.01701293	0	0.078091374	1.570007718	4.939375277	19.08184703	0.695962129	2.576237919	0	0	3.133412504	0	0	0	0.343140817	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5083	0	4.027131978	10.0643	0.374269747	2.57118119	0	1.747107996	1.194993234	0	1.023969736	5.09741832	0	0.01701293	0	0.078091374	1.570007718	4.939375277	19.08184703	0.695962129	2.576237919	0	0	3.133412504	0	0	0	0.343140817	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5083	NO																																																																																		0	0	0	10.0643	0.374269747	2.57118119	0	1.747107996	1.194993234	0	1.023969736	5.09741832	0	0.01701293	0	0.078091374	1.570007718	4.939375277	19.08184703	0.695962129	2.576237919	0	0	3.133412504	0	0	0	0.343140817	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5083
H3388_801_0	2011	3																															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	Coin	V																																																			0	YES	178.9716163	0.859792633	19.0804061		7.559061719	7.593143531		8.651925705	38.71219887	5.261753041	5.955034646	0.825657563	0.37822879	23.40563799	20.80657025	73.49760174	0.283712665	5.942021832	35.18658543	78.44595023	49.55058693																				6700	"1a (IP Acute): FFS, 1a1 (Add'l Days): n/a"	1b (IP Psych): FFS	"2a (SNF): FFS, 2a2 (Waiver 3 Day): n/a"	6a (Home Health): FFS	10a (Ambulance): FFS	"11a (DME): FFS, 11b (Prosthetics): FFS, 11b (Medical Supplies): FFS, 11c (Diabetic Supplies): FFS"		"4a (ER): FFS, 4a (ER) - Worldwide Coverage: n/a, 4b (UC): FFS"	"9b (OP Surg): FFS, 9b (OP ASC): FFS"	8a (OP Diag Proc/Test/Lab): FFS	8b (X-Ray): FFS	9a (OP Observation): FFS	12 (Renal Dialysis): FFS	"3 (CORF): FFS, 5 (Partial Hosp): FFS, 9a (OP Other): FFS, 9a (OP Chemo): FFS, 9c (OP SA): FFS, 9d (OP Cardiac Rehab): FFS, 7e (MH Non-Phys): FFS, 7i (PT/ST): FFS, 13a (Blood): FFS"	"7a (PCP w/Copay): FFS, 14b (Immunizations): FFS, 14c (Routine Physical): FFS, 14d (Pap & Pelvic Exam): FFS, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): FFS, 14f (Colorectal Screening): FFS, 14g (Bone Mass): FFS, 14h (Mammography): FFS, 14i (Diabetes Educ.): FFS, 14j (Nutrition Therapy Diabetes): FFS"	"7b (Chiro): FFS, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): FFS, 7f (Podiatry): FFS, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): FFS, 17a (Eye Exam): FFS,18a (Hearing Exam): FFS"	"7e (MH Non-Phys): FFS, 7h (Psych): FFS"	"7c (OT): FFS, 7i (PT/ST): FFS"	8b (X-Ray): FFS	7g (Prof. Other): FFS	15 (Part B Rx): FFS		10b (Transportation): n/a	"16a (Preventive Dental): n/a, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): n/a, 17b1 (Non MCR Covered): n/a"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): n/a, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"													0.092258776	0.092258776	0.198417053		0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.082945369	0.082945369	0.178387102		0.209478944	0.209478944		0.209478944	0.209478944	0.209478944	0.209478944	0.209478944	0.209478944	0.209478944	0.209478944	0.209478944	0.209478944	0.209478944	0.209478944	0.209478944	0.209478944																					14.8449	0.071315817	3.403698341	0	1.583464266	1.590603687	0	1.812396259	8.109390533	1.10222647	1.247454368	0.172957874	0.079230967	4.902988327	4.358538362	15.39619999	0.05943183	1.244728458	7.370848753	16.43277481	10.37980462	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.1629	0	10.57295448	14.8449	0.071315817	3.403698341	0	1.583464266	1.590603687	0	1.812396259	8.109390533	1.10222647	1.247454368	0.172957874	0.079230967	4.902988327	4.358538362	15.39619999	0.05943183	1.244728458	7.370848753	16.43277481	10.37980462	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.1629	NO																																																																																		0	0	0	14.8449	0.071315817	3.403698341	0	1.583464266	1.590603687	0	1.812396259	8.109390533	1.10222647	1.247454368	0.172957874	0.079230967	4.902988327	4.358538362	15.39619999	0.05943183	1.244728458	7.370848753	16.43277481	10.37980462	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.1629
H3388_803_0	2011	4																															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	Coin	V																																																			0	YES	209.586433	1.422291172	19.59983196		9.494835431	8.682879232		8.447596323	45.21997313	4.971203095	6.612453182	0.868052579	0.625675829	26.45545438	24.19573521	83.68660962	0.358225494	7.047803473	39.33848766	91.27347058	54.03294876																				6700	"1a (IP Acute): FFS, 1a1 (Add'l Days): n/a"	1b (IP Psych): FFS	"2a (SNF): FFS, 2a2 (Waiver 3 Day): n/a"	6a (Home Health): FFS	10a (Ambulance): FFS	"11a (DME): FFS, 11b (Prosthetics): FFS, 11b (Medical Supplies): FFS, 11c (Diabetic Supplies): FFS"		"4a (ER): FFS, 4a (ER) - Worldwide Coverage: n/a, 4b (UC): FFS"	"9b (OP Surg): FFS, 9b (OP ASC): FFS"	8a (OP Diag Proc/Test/Lab): FFS	8b (X-Ray): FFS	9a (OP Observation): FFS	12 (Renal Dialysis): FFS	"3 (CORF): FFS, 5 (Partial Hosp): FFS, 9a (OP Other): FFS, 9a (OP Chemo): FFS, 9c (OP SA): FFS, 9d (OP Cardiac Rehab): FFS, 7e (MH Non-Phys): FFS, 7i (PT/ST): FFS, 13a (Blood): FFS"	"7a (PCP w/Copay): FFS, 14b (Immunizations): FFS, 14c (Routine Physical): FFS, 14d (Pap & Pelvic Exam): FFS, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): FFS, 14f (Colorectal Screening): FFS, 14g (Bone Mass): FFS, 14h (Mammography): FFS, 14i (Diabetes Educ.): FFS, 14j (Nutrition Therapy Diabetes): FFS"	"7b (Chiro): FFS, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): FFS, 7f (Podiatry): FFS, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): FFS, 17a (Eye Exam): FFS,18a (Hearing Exam): FFS"	"7e (MH Non-Phys): FFS, 7h (Psych): FFS"	"7c (OT): FFS, 7i (PT/ST): FFS"	8b (X-Ray): FFS	7g (Prof. Other): FFS	15 (Part B Rx): FFS		10b (Transportation): n/a	"16a (Preventive Dental): n/a, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): n/a, 17b1 (Non MCR Covered): n/a"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): n/a, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"													0.092258776	0.092258776	0.198417053		0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.08136002	0.08136002	0.174977559		0.205475138	0.205475138		0.205475138	0.205475138	0.205475138	0.205475138	0.205475138	0.205475138	0.205475138	0.205475138	0.205475138	0.205475138	0.205475138	0.205475138	0.205475138	0.205475138																					17.052	0.115717639	3.429530759	0	1.95095262	1.784115808	0	1.73577102	9.291580216	1.021458642	1.35869473	0.178363223	0.128560827	5.435938137	4.971622029	17.19551766	0.073606433	1.448148391	8.083081177	18.75442896	11.1024276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1115	0	14.08043234	17.052	0.115717639	3.429530759	0	1.95095262	1.784115808	0	1.73577102	9.291580216	1.021458642	1.35869473	0.178363223	0.128560827	5.435938137	4.971622029	17.19551766	0.073606433	1.448148391	8.083081177	18.75442896	11.1024276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1115	NO																																																																																		0	0	0	17.052	0.115717639	3.429530759	0	1.95095262	1.784115808	0	1.73577102	9.291580216	1.021458642	1.35869473	0.178363223	0.128560827	5.435938137	4.971622029	17.19551766	0.073606433	1.448148391	8.083081177	18.75442896	11.1024276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1115
H3388_804_0	2011	3																															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	Coin	V																																																			0	YES	191.709738	1.010502124	15.77391338		8.395743348	6.790045864		7.367036947	47.781949	4.98777732	7.351285741	0.62349758	0.290940577	30.87810051	22.71265996	83.8880738	0.332316718	6.163987313	34.37327973	89.77579309	36.41162753																				6700	"1a (IP Acute): FFS, 1a1 (Add'l Days): n/a"	1b (IP Psych): FFS	"2a (SNF): FFS, 2a2 (Waiver 3 Day): n/a"	6a (Home Health): FFS	10a (Ambulance): FFS	"11a (DME): FFS, 11b (Prosthetics): FFS, 11b (Medical Supplies): FFS, 11c (Diabetic Supplies): FFS"		"4a (ER): FFS, 4a (ER) - Worldwide Coverage: n/a, 4b (UC): FFS"	"9b (OP Surg): FFS, 9b (OP ASC): FFS"	8a (OP Diag Proc/Test/Lab): FFS	8b (X-Ray): FFS	9a (OP Observation): FFS	12 (Renal Dialysis): FFS	"3 (CORF): FFS, 5 (Partial Hosp): FFS, 9a (OP Other): FFS, 9a (OP Chemo): FFS, 9c (OP SA): FFS, 9d (OP Cardiac Rehab): FFS, 7e (MH Non-Phys): FFS, 7i (PT/ST): FFS, 13a (Blood): FFS"	"7a (PCP w/Copay): FFS, 14b (Immunizations): FFS, 14c (Routine Physical): FFS, 14d (Pap & Pelvic Exam): FFS, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): FFS, 14f (Colorectal Screening): FFS, 14g (Bone Mass): FFS, 14h (Mammography): FFS, 14i (Diabetes Educ.): FFS, 14j (Nutrition Therapy Diabetes): FFS"	"7b (Chiro): FFS, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): FFS, 7f (Podiatry): FFS, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): FFS, 17a (Eye Exam): FFS,18a (Hearing Exam): FFS"	"7e (MH Non-Phys): FFS, 7h (Psych): FFS"	"7c (OT): FFS, 7i (PT/ST): FFS"	8b (X-Ray): FFS	7g (Prof. Other): FFS	15 (Part B Rx): FFS		10b (Transportation): n/a	"16a (Preventive Dental): n/a, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): n/a, 17b1 (Non MCR Covered): n/a"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): n/a, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"													0.092258776	0.092258776	0.198417053		0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.08222294	0.08222294	0.176833405		0.207654447	0.207654447		0.207654447	0.207654447	0.207654447	0.207654447	0.207654447	0.207654447	0.207654447	0.207654447	0.207654447	0.207654447	0.207654447	0.207654447	0.207654447	0.207654447																					15.7629	0.083086456	2.789354812	0	1.74341344	1.409983217	0	1.529797982	9.922134185	1.03573414	1.526527174	0.129472045	0.060415104	6.411974878	4.71638484	17.41973156	0.069007044	1.279979375	7.137764386	18.64234265	7.561036371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2311	0	12.11178767	15.7629	0.083086456	2.789354812	0	1.74341344	1.409983217	0	1.529797982	9.922134185	1.03573414	1.526527174	0.129472045	0.060415104	6.411974878	4.71638484	17.41973156	0.069007044	1.279979375	7.137764386	18.64234265	7.561036371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2311	NO																																																																																		0	0	0	15.7629	0.083086456	2.789354812	0	1.74341344	1.409983217	0	1.529797982	9.922134185	1.03573414	1.526527174	0.129472045	0.060415104	6.411974878	4.71638484	17.41973156	0.069007044	1.279979375	7.137764386	18.64234265	7.561036371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2311
H3404_001_0	2011	9																															D	D	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	872.9076134	0	544.5727197	8.961114445	21.57848107	17.82631989	0	854.8965779	1005.964175	18.23336332	32.4858453	0	0	1419.901364	4338.618808	4962.985343	351.4163535	353.0977715	0	1539.618378	0.749934803	1.62531601	0	0	55.03705169	0	0	0	0	0											3400	"(1a) 195 copay per day, days 1 - 6, unlimited days"	"(1b) 195 copay per day, days 1 - 6"	"(2) $0 copay for days 1-10, $100 per day after day 10"	(6) 0% coinsurance	(10a) $100 copay	(11a) 20% coinsurance	"(11b) 20% coinsurance, (11c) 20% coinsurance"	"(4a) $50 copay, (4b) $40 copay"	"(9a) $100 copay, (9b) $100 copay"	(8a) 20% coinsurance	(8b) 20% coinsurance	(5) 0% coinsurance	(12) 0% coinsurance	"(3) $40 copay for physician services, 20% coinsurance for supplies, (9a - non-surgery) 0% coinsurance, (9c) $40 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 (16b Medicare covered) $40 copay, (17a Medicare Covered) $40 copay, (17b Medicare Covered) 20% coinsurance, (18a Medicare Covered) $40 copay"	(15) 20% coinsurance	"(13a) 0% coinsurance, 3 pint deductible waived"	(10b) Non Covered	"(16a) Non Covered, (16b) Non Covered"	(17a Non Medicare Covered) $40 copay	(17b) Non Covered	(18a) Non Covered	(18b) Non Covered	(14a) 0% coinsurance	Non Covered											0	233.8519924	0	54.89820482	0	100	0.2	0.2	49.5412234	100	0.2	0.2	0	0	100	19.24299186	40	40	40	0	9.319257372	0.2	0.00798103	0	0	40	0	0	0	0	0											NO	180.4508188	0	42.3619483	0	77.16454197	0.154329084	0.154329084	38.22825812	77.16454197	0.154329084	0.154329084	0	0	77.16454197	14.84876653	30.86581679	30.86581679	30.86581679	0	7.191162266	0.154329084	0.006158525	0	0	30.86581679	0	0	0	0	0												13.1264	0	1.922430116	0	0.138757801	2.751119618	0	2.723433921	6.468730402	2.813938258	5.013510746	0	0	9.130503199	5.368594812	12.76554969	0.903896065	0.908220927	0	0.922637132	0.115736751	0.01000955	0	0	0.141563629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.225	0	19.30217734	13.1264	0	1.922430116	0	0.138757801	2.751119618	0	2.723433921	6.468730402	2.813938258	5.013510746	0	0	9.130503199	5.368594812	12.76554969	0.903896065	0.908220927	0	0.922637132	0.115736751	0.01000955	0	0	0.141563629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.225	YES	20% coinsurance	20% coinsurance	"(2) $0 copay for days 1-10, $100 per day after day 10"	20% coinsurance	$100 copay	20% coinsurance	20% coinsurance	"(4a) $50 copay, (4b) $40 copay"	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	0% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	0	20% coinsurance	20% coinsurance	20% coinsurance	(10b) Non Covered	"(16a) Non Covered, (16b) Non Covered"	20% coinsurance	(17b) Non Covered	(18a) Non Covered	(18b) Non Covered	0% coinsurance	Non Covered											5100	2.0521	0	0.858	0.0286	0.8371	0.2964	0	0.602	0.748	0.3075	0.3821	0	0	0.0164	0.0089	1.2641	0.0252	0.0752	0	0.3385	0.0001	0.0379	0	0	0	0	0	0	0	0											7.8781	0	1.162808689	15.1785	0	2.780381268	0.028579729	0.975826777	3.047475936	0	3.325435695	7.216722777	3.121427709	5.395610747	0	0	9.146879063	5.377509502	14.02969759	0.929112789	0.983438079	0	1.261171728	0.115847154	0.0478846	0	0	0.141563629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1031
H3404_002_0	2011	13																															D	D	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	1043.265216	0	333.1456623	7.97047413	34.18227001	16.49518626	0	911.0864395	1259.213465	21.10131066	44.18393077	0	0	1501.965085	4309.896231	5420.140568	399.3519864	449.2391689	0	1584.115226	9.276326322	1.206748242	0	0	66.12560133	0	0	0	0	0											3400	"(1a) 140 copay per day, days 1 - 6, unlimited days"	"(1b) 140 copay per day, days 1 - 6"	"(2) $0 copay for days 1-10, $100 per day after day 10"	(6) 0% coinsurance	(10a) $100 copay	(11a) 20% coinsurance	"(11b) 20% coinsurance, (11c) 20% coinsurance"	"(4a) $50 copay, (4b) $40 copay"	"(9a) $100 copay, (9b) $100 copay"	(8a) 20% coinsurance	(8b) 20% coinsurance	(5) 0% coinsurance	(12) 0% coinsurance	"(3) $40 copay for physician services, 20% coinsurance for supplies, (9a - non-surgery) 0% coinsurance, (9c) $40 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"	(7d) $40 copay	"(7b) $40 copay, (7f) $40 copay, (7g) 0% coinsurance, (14d - j) 0% coinsurance (16b Medicare covered) $40 copay, (17a Medicare Covered) $40 copay, (17b Medicare Covered) 20% coinsurance, (18a Medicare Covered) $40 copay"	(15) 20% coinsurance	"(13a) 0% coinsurance, 3 pint deductible waived"	(10b) Non Covered	"(16a) Non Covered, (16b) Non Covered"	(17a Non Medicare Covered) $40 copay	(17b) Non Covered	(18a) Non Covered	(18b) Non Covered	(14a) 0% coinsurance	Non Covered												154.4970414	0	54.89820482	0	100	0.2	0.2	49.39516129	100	0.2	0.2	0	0	100	19.31612827	40	40	40	0	10.17013834	0.2	0.046919366	0	0	40	0	0	0	0	0											NO	114.3686328	0	40.63917712	0	74.02642264	0.148052845	0.148052845	36.56547086	74.02642264	0.148052845	0.148052845	0	0	74.02642264	14.29903875	29.61056905	29.61056905	29.61056905	0	7.528589588	0.148052845	0.034732728	0	0	29.61056905	0	0	0	0	0												9.9431	0	1.128230465	0	0.210865931	2.442159259	0	2.776192054	7.767922346	3.124109082	6.541556666	0	0	9.265425181	5.135614434	13.37445388	0.985419964	1.108518953	0	0.993846117	1.373386506	0.041913659	0	0	0.163168057	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3759	0	23.28922875	9.9431	0	1.128230465	0	0.210865931	2.442159259	0	2.776192054	7.767922346	3.124109082	6.541556666	0	0	9.265425181	5.135614434	13.37445388	0.985419964	1.108518953	0	0.993846117	1.373386506	0.041913659	0	0	0.163168057	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3759	YES	"(1a) 140 copay per day, days 1 - 6, unlimited days"	"(1b) 140 copay per day, days 1 - 6"	"(2) $0 copay for days 1-10, $100 per day after day 10"	(6) 0% coinsurance	(10a) $100 copay	(11a) 20% coinsurance	"(11b) 20% coinsurance, (11c) 20% coinsurance"	"(4a) $50 copay, (4b) $40 copay"	"(9a) $100 copay, (9b) $100 copay"	(8a) 20% coinsurance	(8b) 20% coinsurance	(5) 0% coinsurance	(12) 0% coinsurance	"(3) $40 copay for physician services, 20% coinsurance for supplies, (9a - non-surgery) 0% coinsurance, (9c) $40 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 (16b Medicare covered) $40 copay, (17a Medicare Covered) $40 copay, (17b Medicare Covered) 20% coinsurance, (18a Medicare Covered) $40 copay"	(15) 20% coinsurance	"(13a) 0% coinsurance, 3 pint deductible waived"	(10b) Non Covered	"(16a) Non Covered, (16b) Non Covered"	(17a Non Medicare Covered) $40 copay	(17b) Non Covered	(18a) Non Covered	(18b) Non Covered	(14a) 0% coinsurance	Non Covered											5100	0.9163	0	0.585	0	0.6716	0.3388	0.0001	0.9084	0.9617	0.3951	0.4911	0	0	0.3426	0	2.9488	0.0055	0.2564	0	0.4686	0.1688	0.0025	0	0	0.0006	0	0	0	0	0											9.462	0	4.059941904	10.8594	0	1.713239662	0	0.882439903	2.78099468	0.000134416	3.684620249	8.729660972	3.519222415	7.032689697	0	0	9.608025362	5.135614434	16.32324627	0.99093975	1.364882351	0	1.462414624	1.542182488	0.044366897	0	0	0.163781367	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8378
H3404_801_0	2011	9																															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	YES	216.0416739	0	27.73355453	9.410354601	5.930294662	14.07692652	0	21.09131071	88.82706358	20.217772	36.68322701	0	0	16.60873215	35.18366687	76.86545811	2.412233297	4.338063324	0	9.772606398	0.814925438	2.420380201																			6700	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				0.080297509	0.080297509	0.183028063	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.071180033	0.071180033	0.162245924	0	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737																				15.3779	0	4.499656171	0	1.224865223	2.907501014	0	4.35627814	18.34667369	4.17585419	7.576690805	0	0	3.430429612	7.26696605	15.87607899	0.498231681	0.895999812	0	2.018470649	0.168317746	0.499914373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.1198		11.41538532	15.3779	0	4.499656171	0	1.224865223	2.907501014	0	4.35627814	18.34667369	4.17585419	7.576690805	0	0	3.430429612	7.26696605	15.87607899	0.498231681	0.895999812	0	2.018470649	0.168317746	0.499914373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.1198	YES	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			10000	1.6382	0	0.4794	0	0.1305	0.3097	0	0.4641	1.9545	0.4449	0.8071	0	0	0.3654	0.7742	1.6913	0.0531	0.0955	0	0.215	0.0179	0.0533																			9.494		0.05	17.0161	0	4.979007538	0	1.355350931	3.217239032	0	4.82035535	20.30115705	4.620710716	8.38384072	0	0	3.795875562	8.041120781	17.56736826	0.551308633	0.991451268	0	2.233499671	0.186248747	0.553170583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6138
H3404_803_0	2011	8																															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	YES	171.2626813	0	3.883397381	8.378069048	6.139078492	11.74999888	0	16.53392732	104.016706	21.4546537	39.62055035	0	0	17.88911772	49.24457308	83.80694111	1.056935123	4.082996515	0	13.74903016	0	0																			6700	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				0.080293095	0.080293095	0.183001243	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.07117612	0.07117612	0.162222149	0	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737																				12.1898	0	0.629973069	0	1.267988216	2.426888682	0	3.414979142	21.48399921	4.431324359	8.183376546	0	0	3.694885233	10.17115817	17.30979883	0.218303331	0.84331736	0	2.839776074	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.1056		11.4135664	12.1898	0	0.629973069	0	1.267988216	2.426888682	0	3.414979142	21.48399921	4.431324359	8.183376546	0	0	3.694885233	10.17115817	17.30979883	0.218303331	0.84331736	0	2.839776074	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.1056	YES	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			10000	1.1511	0	0.0595	0	0.1197	0.2292	0	0.3225	2.0288	0.4185	0.7728	0	0	0.3489	0.9605	1.6346	0.0206	0.0796	0	0.2682	0	0																			8.4146		0.05	13.341	0	0.689464269	0	1.387730067	2.656070736	0	3.737471039	23.51283024	4.849794323	8.956169735	0	0	4.043809925	11.13166655	18.94444128	0.2389187	0.922955625	0	3.107948948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5202
H3404_807_0	2011	8																															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	YES	216.0416739	0	27.73355453	9.410354601	5.930294662	14.07692652	0	21.09131071	88.82706358	20.217772	36.68322701	0	0	16.60873215	35.18366687	76.86545811	2.412233297	4.338063324	0	9.772606398	0.814925438	2.420380201																			6700	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				0.080297509	0.080297509	0.183028063	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.071180033	0.071180033	0.162245924	0	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737																				15.3779	0	4.499656171	0	1.224865223	2.907501014	0	4.35627814	18.34667369	4.17585419	7.576690805	0	0	3.430429612	7.26696605	15.87607899	0.498231681	0.895999812	0	2.018470649	0.168317746	0.499914373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.1198		11.41538532	15.3779	0	4.499656171	0	1.224865223	2.907501014	0	4.35627814	18.34667369	4.17585419	7.576690805	0	0	3.430429612	7.26696605	15.87607899	0.498231681	0.895999812	0	2.018470649	0.168317746	0.499914373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.1198	YES	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			10000	1.6382	0	0.4794	0	0.1305	0.3097	0	0.4641	1.9545	0.4449	0.8071	0	0	0.3654	0.7742	1.6913	0.0531	0.0955	0	0.215	0.0179	0.0533																			9.494		0.05	17.0161	0	4.979007538	0	1.355350931	3.217239032	0	4.82035535	20.30115705	4.620710716	8.38384072	0	0	3.795875562	8.041120781	17.56736826	0.551308633	0.991451268	0	2.233499671	0.186248747	0.553170583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6138
H3404_808_0	2011	8																															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	YES	216.0416739	0	27.73355453	9.410354601	5.930294662	14.07692652	0	21.09131071	88.82706358	20.217772	36.68322701	0	0	16.60873215	35.18366687	76.86545811	2.412233297	4.338063324	0	9.772606398	0.814925438	2.420380201																			6700	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				0.080297509	0.080297509	0.183028063	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.071180033	0.071180033	0.162245924	0	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737																				15.3779	0	4.499656171	0	1.224865223	2.907501014	0	4.35627814	18.34667369	4.17585419	7.576690805	0	0	3.430429612	7.26696605	15.87607899	0.498231681	0.895999812	0	2.018470649	0.168317746	0.499914373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.1198		11.41538532	15.3779	0	4.499656171	0	1.224865223	2.907501014	0	4.35627814	18.34667369	4.17585419	7.576690805	0	0	3.430429612	7.26696605	15.87607899	0.498231681	0.895999812	0	2.018470649	0.168317746	0.499914373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.1198	YES	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			10000	1.6382	0	0.4794	0	0.1305	0.3097	0	0.4641	1.9545	0.4449	0.8071	0	0	0.3654	0.7742	1.6913	0.0531	0.0955	0	0.215	0.0179	0.0533																			9.494		0.05	17.0161	0	4.979007538	0	1.355350931	3.217239032	0	4.82035535	20.30115705	4.620710716	8.38384072	0	0	3.795875562	8.041120781	17.56736826	0.551308633	0.991451268	0	2.233499671	0.186248747	0.553170583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6138
H3405_001_0	2011	7	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1000.505527	63.00568649	405.5703891	487.5609855	39.30009247	8.343566096	2.334999352	301.6281769	305.7580807	1149.085449	846.1970624	70.28554136	0.400127085	6.799113516	3718.531055	3438.627575	94.73793956	694.8115392		1788.380456	22.64211379	0							4.38	0.41	1221.894815	915.1108469									4900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$195/Visit:9b. $0 Surgery ASC -- Physician,9b. $195 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $195 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$150/Visit:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	34.44565	0	150	0.2	0.2	50	195	46.702042	93.661341	50	0.2	0.2	15	35	35	15		0	0.2	0							0	0	0	61.523701									NO	129.290794	110.690962	29.015155	0	135.8808	0.181174	0.181174	45.2936	176.64504	42.306072	84.845187	45.2936	0.181174	0.181174	13.58808	31.70552	31.70552	13.58808		0	0.181174	0							0	0	0	55.732598										10.7797	0.581180004	0.980640642	0	0.445010667	1.511637244	0.423041173	1.1384855	4.500887366	4.051107643	5.982979	0.265290433	0.072492625	1.231822592	4.210641455	9.085289613	0.250309636	0.786762898	0	0	4.102162324	0	0	0	0	0	0	0	0	0	0	4.250125413	0	0	0	0	0	0	0	0	54.6495	0	5.532240469	10.7797	0.581180004	0.980640642	0	0.445010667	1.511637244	0.423041173	1.1384855	4.500887366	4.051107643	5.982979	0.265290433	0.072492625	1.231822592	4.210641455	9.085289613	0.250309636	0.786762898	0	0	4.102162324	0	0	0	0	0	0	0	0	0	0	4.250125413	0	0	0	0	0	0	0	0	54.6495	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$150/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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									7300	6.4837	0.1217	0.3985	2.2064	1.5003	1.6801	0.4702	0.1434	1.9666	0.2877	0.7769	0.1999	0.0093	0.2375	1.5156	2.4053	0.0454	0.2482		0.3248	0.8822	0							0	0	0.407	0.3952									22.7059	0	9.115155359	17.2634	0.702868131	1.379143509	2.206434213	1.945325114	3.191757046	0.893233339	1.281870418	6.467536654	4.338849475	6.759876421	0.465194693	0.081810434	1.469317681	5.726236781	11.49059054	0.295681199	1.034963914	0	0.324771513	4.984347117	0	0	0	0	0	0	0	0	0	0.40697653	4.645339078	0	0	0	0	0	0	0	0	77.3555
H3405_002_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1355.511798	57.76766816	565.0262497	607.3839642	46.83266647	9.045092222	2.896310315	325.3186203	323.6106781	922.4042675	945.9020759	146.0550172	0.203449261	4.629492567	3732.280668	3388.499283	93.48464325	606.6932439		2016.009925	20.58989586	0			1.82				4.38	0.41	1715.848094	662.3258019									4900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$195/Visit:9b. $0 Surgery ASC -- Physician,9b. $195 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $195 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$150/Visit:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"			"VIS742: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	34.44565	0	150	0.2	0.2	50	195	54.475741	99.496485	50	0.2	0.2	15	35	35	15		0	0.2	0			0				0	0	0	68.299815									NO	126.67413	108.450732	26.735715	0	134.0655	0.178754	0.178754	44.6885	174.28515	48.688783	88.926973	44.6885	0.178754	0.178754	13.40655	31.28195	31.28195	13.40655		0	0.178754	0			0				0	0	0	61.044325										14.309	0.522078825	1.258865065	0	0.523220404	1.616846415	0.517727054	1.211500097	4.700044632	3.742561768	7.00968403	0.54391497	0.036367369	0.827540314	4.169750616	8.833238762	0.243698495	0.677805276	0	0	3.680526245	0	0	0	0	0	0	0	0	0	0	3.369269292	0	0	0	0	0	0	0	0	57.7937	0	6.895292932	14.309	0.522078825	1.258865065	0	0.523220404	1.616846415	0.517727054	1.211500097	4.700044632	3.742561768	7.00968403	0.54391497	0.036367369	0.827540314	4.169750616	8.833238762	0.243698495	0.677805276	0	0	3.680526245	0	0	0	0	0	0	0	0	0	0	3.369269292	0	0	0	0	0	0	0	0	57.7937	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$150/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		30% Coins	20%-30% Coins	$0/Service			"VIS742: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									7300	6.7447	0.107	0.4491	2.54	1.7602	1.7932	0.5742	0.1523	1.8813	0.2308	0.9224	0.1991	0.0047	0.1592	1.4118	2.027	0.0369	0.185		0.3451	0.7842	0			0				0	0	0.568	0.3722									23.2485	0	10.49963205	21.0537	0.629070381	1.707930249	2.540002648	2.283456624	3.410071942	1.091932003	1.363755894	6.5813269	3.973409959	7.932120603	0.742983408	0.041031899	0.986749789	5.581577219	10.86025456	0.280631708	0.862819594	0	0.345091715	4.464743492	0	0	0	0	0	0	0	0	0	0.567996168	3.741506877	0	0	0	0	0	0	0	0	81.0422
H3405_005_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1163.91298	72.987191	351.657865	602.829075	39.656041	9.273915	3.255874	351.157365	368.984693	1076.489773	991.716262	78.217913	0.430792	5.640736	3616.421903	3811.68155	90.525998	740.004618		1948.14652	21.578491	0							4.38	0.41	1296.838233	673.689706									3900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	34.44565	0	100	0.2	0.2	50	150	56.988071	94.655292	50	0.2	0.2	15	35	35	15		0	0.2	0							0	0	0	68.698733									NO	120.571149	103.225728	25.113635	0	85.3886	0.170777	0.170777	42.6943	128.0829	48.661316	80.824829	42.6943	0.170777	0.170777	12.80829	29.88601	29.88601	12.80829		0	0.170777	0							0	0	0	58.660886										11.6945	0.627846327	0.735950606	0	0.282181152	1.583771382	0.556028394	1.249368157	3.938385795	4.365284085	6.679608108	0.278288254	0.073569365	0.963307972	3.860015041	9.492996077	0.225455073	0.789849479	0	0	3.685109958	0	0	0	0	0	0	0	0	0	0	3.293269587	0	0	0	0	0	0	0	0	54.3748	0	9.342414926	11.6945	0.627846327	0.735950606	0	0.282181152	1.583771382	0.556028394	1.249368157	3.938385795	4.365284085	6.679608108	0.278288254	0.073569365	0.963307972	3.860015041	9.492996077	0.225455073	0.789849479	0	0	3.685109958	0	0	0	0	0	0	0	0	0	0	3.293269587	0	0	0	0	0	0	0	0	54.3748	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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									5800	5.3699	0.1087	0.2671	2.4025	0.9299	1.7207	0.6041	0.1538	2.0573	0.2439	0.849	0.1439	0.0092	0.1815	1.2883	2.169	0.0297	0.2355		0.2963	0.7697	0							0	0	0.3959	0.3342									20.5603	0	11.72063875	17.0644	0.736584626	1.003027544	2.402466204	1.212124566	3.30445636	1.160124508	1.403177622	5.995684731	4.609144656	7.528634194	0.422158249	0.082812744	1.144854355	5.148346707	11.6620338	0.255201812	1.025387844	0	0.296347329	4.454826745	0	0	0	0	0	0	0	0	0	0.395866484	3.627454969	0	0	0	0	0	0	0	0	74.9351
H3405_006_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1146.339408	71.88518	346.348289	593.72714	39.057286	9.25958	3.25084	345.855346	363.413504	1060.236178	976.742639	77.036924	0.430126	5.632017	3561.818636	3754.130115	89.159174	728.83151		1918.732042	21.545136	0							4.38	0.41	1277.257662	663.517868									3900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	34.44565	0	100	0.2	0.2	50	150	56.988071	94.655292	50	0.2	0.2	15	35	35	15		0	0.2	0							0	0	0	68.698733									NO	121.133494	103.707174	25.334948	0	85.6825	0.171365	0.171365	42.84125	128.52375	48.828804	81.103021	42.84125	0.171365	0.171365	12.852375	29.988875	29.988875	12.852375		0	0.171365	0							0	0	0	58.862792										11.5717	0.621250739	0.731226324	0	0.278877159	1.586767927	0.557080197	1.234739612	3.892272195	4.314172044	6.60139823	0.275029843	0.073708542	0.965130593	3.814819066	9.381844896	0.222815277	0.780601323	0	0	3.692082231	0	0	0	0	0	0	0	0	0	0	3.254709521	0	0	0	0	0	0	0	0	53.8502	0	9.013897772	11.5717	0.621250739	0.731226324	0	0.278877159	1.586767927	0.557080197	1.234739612	3.892272195	4.314172044	6.60139823	0.275029843	0.073708542	0.965130593	3.814819066	9.381844896	0.222815277	0.780601323	0	0	3.692082231	0	0	0	0	0	0	0	0	0	0	3.254709521	0	0	0	0	0	0	0	0	53.8502	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 7-100)	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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									5800	5.371	0.1088	0.2673	2.4006	0.9166	1.7193	0.6036	0.1516	2.0557	0.2437	0.8484	0.1438	0.0092	0.1814	1.2873	2.1673	0.0297	0.2354		0.2961	0.7691	0							0	0	0.3956	0.3339									20.5351	0	11.67503566	16.9426	0.73001128	0.998491081	2.400556266	1.195468345	3.306085231	1.160695881	1.386340666	5.947935164	4.557838763	7.44974943	0.418785194	0.082944509	1.146532791	5.102126504	11.54915791	0.252538339	1.015952462	0	0.296111839	4.461187139	0	0	0	0	0	0	0	0	0	0.395551644	3.58862936	0	0	0	0	0	0	0	0	74.3853
H3405_007_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1094.673935	68.645317	330.738385	566.967881	37.296976	8.007034	2.811098	330.267659	347.034472	1012.451375	932.720885	73.564873	0.371943	4.870171	3401.287609	3584.931617	85.140773	695.983103		1832.254864	18.630719	0			3.1				4.38	0.41	1219.691709	633.613142									3900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	34.44565	0	100	0.2	0.2	50	125	56.988071	71.22993	50	0.2	0.2	15	35	35	15		0	0.2	0			0				0	0	0	65.666512									NO	125.933117	107.816322	27.39962	0	88.8751	0.17775	0.17775	44.43755	111.093875	50.648205	63.305671	44.43755	0.17775	0.17775	13.331265	31.106285	31.106285	13.331265		0	0.17775	0			0				0	0	0	58.361178										11.488	0.616757133	0.755175506	0	0.276231039	1.423250294	0.49967267	1.223023801	3.212783688	4.273237066	4.920543457	0.272420227	0.066112868	0.865672895	3.778622205	9.292825382	0.220701096	0.773194598	0	0	3.311610302	0	0	0	0	0	0	0	0	0	0	3.081534114	0	0	0	0	0	0	0	0	50.3513	0	6.25186905	11.488	0.616757133	0.755175506	0	0.276231039	1.423250294	0.49967267	1.223023801	3.212783688	4.273237066	4.920543457	0.272420227	0.066112868	0.865672895	3.778622205	9.292825382	0.220701096	0.773194598	0	0	3.311610302	0	0	0	0	0	0	0	0	0	0	3.081534114	0	0	0	0	0	0	0	0	50.3513	YES	$195/Day(Days 1-7)	$195/Day(Days 1-7)	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		30% Coins	20%-30% Coins	$0/Service			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	35% Coins	30% Coins									5800	1.6397	0.088	0.4315	2.5044	1.056	1.5695	0.551	0.1747	2.1446	0.2542	0.885	0.15	0.0096	0.1892	1.343	2.261	0.031	0.2455		0.3089	0.8024	0			0				0	0	0.3611	0.3484									17.3486	0	3.297550404	13.1277	0.704789356	1.186653622	2.504372492	1.332206645	2.992713317	1.050677737	1.397678561	5.357347769	4.527441507	5.805583294	0.422392614	0.075748394	1.054919972	5.121601503	11.55386812	0.25170963	1.018723906	0	0.308917783	4.113976599	0	0	0	0	0	0	0	0	0	0.361075642	3.429894764	0	0	0	0	0	0	0	0	67.7
H3410_001_1	2011	7																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	475.1795519	13.57655863	150.008334	14.30924505	141.0441753	10.32949018	11.94052716	634.6367763	89.84376744	32.91182458	31.48852192	0	0	0	4441.786293	1590.165112	1.07436519	6.93462961	0	8.702410518	26.79749915	0.277048956																				$225 - days 1-5	$225 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	15% Coinsurance																				225	225	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	20	40	0.4	0.15	40	40	0.2	0.15																			NO	191.0598869	191.0598869	42.45775264	0	127.3732579	0.169831011	0.169831011	42.45775264	0.127373258	0	0.127373258	0.339662021	0.127373258	0.339662021	16.98310106	33.96620211	0.339662021	0.127373258	33.96620211	2.741405132	0.169831011	0.084915505																				7.5656	0.216161313	0.530751395	0	1.497104676	1.754267756	2.027871794	2.245437606	11.44369336	0	4.010795625	0	0	0	6.286275457	4.500989132	0.364921052	0.883286366	0	0.001988069	4.551046362	0.023525752	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9038		8.957561151	7.5656	0.216161313	0.530751395	0	1.497104676	1.754267756	2.027871794	2.245437606	11.44369336	0	4.010795625	0	0	0	6.286275457	4.500989132	0.364921052	0.883286366	0	0.001988069	4.551046362	0.023525752	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9038	YES	$225 - days 1-5	$225 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	15% Coinsurance																			5000	0.3982	0.0114	0.0279	0	0.0788	0.0923	0.1067	0.1182	0.6023	0	0.2111	0	0	0	0.3309	0.2369	0.0192	0.0465	0	0.0001	0.2395	0.0012																			2.5213		0	7.9638	0.227538224	0.558685679	0	1.575899659	1.846597637	2.134601889	2.363618532	12.04599301	0	4.221890131	0	0	0	6.61713206	4.737883297	0.384127423	0.929775122	0	0.002092705	4.790575118	0.02476395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.425
H3410_001_2	2011	7																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	488.2803859	13.95086817	120.5862589	14.07628628	106.7175195	8.444282702	9.820717734	566.9790864	83.64301536	37.53815857	35.91478577	0	0	0	3907.994936	1399.067131	0.979253544	6.118699596	0	7.831568774	26.39865575	0.272925468																				$225 - days 1-5	$225 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	15% Coinsurance																				225	225	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	20	40	0.4	0.15	40	40	0.2	0.15																			NO	193.8896527	193.8896527	43.08658948	0	129.2597685	0.172346358	0.172346358	43.08658948	0.129259768	0	0.129259768	0.344692716	0.129259768	0.344692716	17.23463579	34.46927159	0.344692716	0.129259768	34.46927159	2.719853241	0.172346358	0.086173179																				7.8894	0.225410749	0.432970886	0	1.149523488	1.455341369	1.692564934	2.035766262	10.8116768	0	4.642336892	0	0	0	5.612739118	4.018735409	0.337541564	0.790901693	0	0.00177506	4.549712173	0.023518855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6699		7.713590887	7.8894	0.225410749	0.432970886	0	1.149523488	1.455341369	1.692564934	2.035766262	10.8116768	0	4.642336892	0	0	0	5.612739118	4.018735409	0.337541564	0.790901693	0	0.00177506	4.549712173	0.023518855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6699	YES	$225 - days 1-5	$225 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	15% Coinsurance																			5000	0.4152	0.0119	0.0228	0	0.0605	0.0766	0.0891	0.1071	0.569	0	0.2443	0	0	0	0.2954	0.2115	0.0178	0.0416	0	0.0001	0.2395	0.0012																			2.4037		0	8.3046	0.237274472	0.455758828	0	1.210024724	1.531938283	1.781647299	2.142911854	11.38071242	0	4.886670413	0	0	0	5.90814644	4.230247799	0.355306909	0.832528098	0	0.001868484	4.789170709	0.02475669	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0736
H3410_001_3	2011	7																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	534.5490287	15.27282939	124.4821793	16.72756922	116.0663713	9.070292668	10.535673	499.6374177	81.10262035	30.22071888	28.9137956	0	0	0	4248.884728	1521.106108	1.058523445	6.653494201	0	8.681986787	22.79005018	0.235617494																				$225 - days 1-5	$225 - days 1-6	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	15% Coinsurance																				225	225	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	20	40	0.4	0.15	40	40	0.2	0.15																			NO	193.93864	193.93864	43.09747555	0	129.2924267	0.172389902	0.172389902	43.09747555	0.129292427	0	0.129292427	0.344779804	0.129292427	0.344779804	17.23899022	34.47798044	0.344779804	0.129292427	34.47798044	2.668122628	0.172389902	0.086194951																				8.6391	0.246832647	0.447072306	0	1.2505419	1.563626866	1.816243639	1.794425949	10.48595459	0	3.738334797	0	0	0	6.103873524	4.370388886	0.364957506	0.860246411	0	0.001930384	3.928774522	0.020309038	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6327		7.693221907	8.6391	0.246832647	0.447072306	0	1.2505419	1.563626866	1.816243639	1.794425949	10.48595459	0	3.738334797	0	0	0	6.103873524	4.370388886	0.364957506	0.860246411	0	0.001930384	3.928774522	0.020309038	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6327	YES	$225 - days 1-5	$225 - days 1-6	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	15% Coinsurance																			5000	0.4547	0.013	0.0235	0	0.0658	0.0823	0.0956	0.0944	0.5519	0	0.1968	0	0	0	0.3213	0.23	0.0192	0.0453	0	0.0001	0.2068	0.0011																			2.4017		0	9.0938	0.259823839	0.470602428	0	1.316359894	1.645923017	1.911835409	1.88886942	11.03784694	0	3.93508926	0	0	0	6.425130025	4.600409354	0.384165796	0.905522538	0	0.002031983	4.135552129	0.021377935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0344
H3410_001_4	2011	7																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	537.7103051	15.36315157	161.1261782	15.66103053	246.6837589	17.68724248	20.3923465	591.0029332	85.29401438	23.2436799	22.2384852	0	0	0	4489.230023	1607.150027	1.089983046	7.01338663	0	8.897312058	23.95456158	0.247656926																				$225 - days 1-5	$225 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	15% Coinsurance																				225	225	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	20	40	0.4	0.15	40	40	0.2	0.15																			NO	188.6299429	188.6299429	41.91776508	0	125.7532952	0.16767106	0.16767106	41.91776508	0.125753295	0	0.125753295	0	0	0	16.76710603	33.53421207	0.335342121	0.125753295	0	2.675526648	0.16767106	0.08383553																				8.4524	0.241495867	0.562837441	0	2.585107963	2.9656387	3.41920636	2.064460176	10.72600337	0	2.796562796	0	0	0	6.272616317	4.491209153	0.365517226	0.88195648	0	0.00198375	4.01648674	0.02076245	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8642		10.12042153	8.4524	0.241495867	0.562837441	0	2.585107963	2.9656387	3.41920636	2.064460176	10.72600337	0	2.796562796	0	0	0	6.272616317	4.491209153	0.365517226	0.88195648	0	0.00198375	4.01648674	0.02076245	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8642	YES	$225 - days 1-5	$225 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	15% Coinsurance																			5000	0.4449	0.0127	0.0296	0	0.1361	0.1561	0.18	0.1087	0.5645	0	0.1472	0	0	0	0.3301	0.2364	0.0192	0.0464	0	0.0001	0.2114																				2.6233		0	8.8972	0.254206176	0.592460464	0	2.721166277	3.121724948	3.599164589	2.173115975	11.29052987	0	2.943750311	0	0	0	6.602754018	4.727588582	0.384754975	0.928375242	0	0.002088158	4.227880778	0.02076245	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.4875
H3410_001_5	2011	7																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	580.9227785	16.59779367	106.7325168	15.25034183	125.2724207	11.03287663	12.73805123	583.3315635	91.06969114	32.93054985	31.5064374	0	0	0	4369.754076	1564.377487	1.078163258	6.838212849	0	9.504812362	30.0391566	0.310563195																				$225 - days 1-5	$225 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	15% Coinsurance																				225	225	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	20	40	0.4	0.15	40	40	0.2	0.15																			NO	189.2081351	189.2081351	42.04625225	0	126.1387567	0.168185009	0.168185009	42.04625225	0.126138757	0	0.126138757	0.336370018	0.126138757	0.336370018	16.8185009	33.6370018	0.336370018	0.126138757	33.6370018	2.445337825	0.168185009	0.084092504																				9.1596	0.261703132	0.373975194	0	1.31680895	1.855564456	2.142349261	2.043908839	11.48741762	0	3.974182843	0	0	0	6.124392738	4.385080695	0.362661794	0.862563667	0	0.001936873	5.052135823	0.026116037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4304		9.842719485	9.1596	0.261703132	0.373975194	0	1.31680895	1.855564456	2.142349261	2.043908839	11.48741762	0	3.974182843	0	0	0	6.124392738	4.385080695	0.362661794	0.862563667	0	0.001936873	5.052135823	0.026116037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4304	YES	$225 - days 1-5	$225 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	15% Coinsurance																			5000	0.4821	0.0138	0.0197	0	0.0693	0.0977	0.1128	0.1076	0.6046	0	0.2092	0	0	0	0.3223	0.2308	0.0191	0.0454	0	0.0001	0.2659	0.0014																			2.6016		0	9.6417	0.275476981	0.393658099	0	1.386114685	1.953225743	2.255104486	2.151482988	12.09201854	0	4.183350361	0	0	0	6.446729198	4.615874416	0.381749257	0.907961755	0	0.002038814	5.318037709	0.027490565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.032
H3410_002_1	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	665.2924972	19.9911393	420.9644758	29.22295221	250.8416086	13.32920827	13.27486628	642.0933256	95.8018284	30.64108234	33.55273706	0.010660576	0.106745825	0.012436681	4322.792184	1741.428775	1.800024089	7.467353871	0	5.517505583	22.6497107	0.630520115																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	111.9672199	111.9672199	44.78688797	0	89.57377594	0.179147552	0.179147552	44.78688797	0.089573776	0	0.089573776	0.358295104	0.089573776	0.358295104	8.957377594	22.39344399	0.358295104	0.089573776	22.39344399	0.471186205	0.179147552	0.089573776																				6.2076	0.186529358	1.571140735	0	1.872402504	2.38789503	2.378159795	2.39644682	8.581331512	0	3.005445352	0.003819632	0.009561627	0.004456002	3.226740154	3.249715644	0.644939818	0.668879083	0	0.000216648	4.057640222	0.056478068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5094		4.963386938	6.2076	0.186529358	1.571140735	0	1.872402504	2.38789503	2.378159795	2.39644682	8.581331512	0	3.005445352	0.003819632	0.009561627	0.004456002	3.226740154	3.249715644	0.644939818	0.668879083	0	0.000216648	4.057640222	0.056478068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5094	YES	$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																			3000	0.3267	0.0098	0.0827	0	0.0985	0.1257	0.1252	0.1261	0.4516	0	0.1582	0.0002	0.0005	0.0002	0.1698	0.171	0.0339	0.0352	0	0	0.2136	0.003																			2.1321		0	6.5343	0.196346692	1.653832353	0	1.970950004	2.513573716	2.5033261	2.5225756	9.032980539	0	3.163626686	0.004020666	0.01006487	0.004690528	3.396568583	3.420753309	0.678884019	0.704083245	0	0.00022805	4.271200234	0.059450597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6414
H3410_002_2	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	642.1623251	19.29610893	317.8692692	27.00325506	178.2792526	10.23549599	10.25264858	538.840985	83.78455832	32.82810154	35.94757676	0.010660576	0.097221808	0.010859447	3572.574973	1439.20517	1.524241681	6.190920999	0	4.664229465	20.95901494	0.583454715																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	114.2845036	114.2845036	45.71380143	0	91.42760286	0.182855206	0.182855206	45.71380143	0.091427603	0	0.091427603	0.365710411	0.091427603	0.365710411	9.142760286	22.85690072	0.365710411	0.091427603	0	0.470185124	0.182855206	0.091427603																				6.1158	0.183770519	1.210917721	0	1.358303726	1.871613725	1.874750165	2.052705816	7.660221325	0	3.286600772	0.003898684	0.008888757	0.003971413	2.721933049	2.74131414	0.557431052	0.566021066	0	0.000182754	3.832464989	0.053343866	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.1041		3.563345001	6.1158	0.183770519	1.210917721	0	1.358303726	1.871613725	1.874750165	2.052705816	7.660221325	0	3.286600772	0.003898684	0.008888757	0.003971413	2.721933049	2.74131414	0.557431052	0.566021066	0	0.000182754	3.832464989	0.053343866	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.1041	YES	$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																			3000	0.3219	0.0097	0.0637	0	0.0715	0.0985	0.0987	0.108	0.4032	0	0.173	0.0002	0.0005	0.0002	0.1433	0.1443	0.0293	0.0298	0	0	0.2017	0.0028																			1.9002		0	6.4376	0.193442652	1.274650233	0	1.429793395	1.970119711	1.973421227	2.160742964	8.063390868	0	3.45957976	0.004103878	0.009356586	0.004180435	2.865192683	2.885593831	0.586769529	0.595811649	0	0.000192373	4.034173673	0.056151438	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0043
H3410_002_3	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	697.8335222	20.96895306	325.7216637	31.85294587	192.4687516	10.91330188	10.91870985	471.3432332	80.63509816	26.23410995	28.72699416	0.010660576	0.083829552	0.010472471	3855.591801	1553.217971	1.641132746	6.681183671	0	5.132572149	17.96069244	0.499987749																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	114.426813	114.426813	45.7707252	0	91.54145041	0.183082901	0.183082901	45.7707252	0.09154145	0	0.09154145	0.366165802	0.09154145	0.366165802	9.154145041	22.8853626	0.366165802	0.09154145	22.8853626	0.461704261	0.183082901	0.09154145																				6.6542	0.199950873	1.242376397	0	1.468239057	1.998038965	1.999029073	1.797810134	7.381453839	0	2.629710711	0.003903538	0.007673879	0.003834661	2.941220547	2.962163039	0.600926688	0.611605244	0	0.000197478	3.288295672	0.045769604	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8364		3.485614424	6.6542	0.199950873	1.242376397	0	1.468239057	1.998038965	1.999029073	1.797810134	7.381453839	0	2.629710711	0.003903538	0.007673879	0.003834661	2.941220547	2.962163039	0.600926688	0.611605244	0	0.000197478	3.288295672	0.045769604	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8364	YES	$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																			3000	0.3502	0.0105	0.0654	0	0.0773	0.1052	0.1052	0.0946	0.3885	0	0.1384	0.0002	0.0004	0.0002	0.1548	0.1559	0.0316	0.0322	0	0	0.1731	0.0024																			1.8861		0	7.0045	0.210474603	1.307764628	0	1.545514797	2.103198911	2.104241129	1.89243172	7.76995141	0	2.768116538	0.004108988	0.008077767	0.004036485	3.096021628	3.118066357	0.632554408	0.643794993	0	0.000207871	3.461363865	0.04817853	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7226
H3410_002_4	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	749.3917283	22.51820739	450.0925452	31.83708934	436.7074816	22.71910663	22.57032344	595.2072464	90.53423997	21.54084231	23.58775092	0.010660576	0.096173911	0.011752086	4348.947951	1751.965577	1.815539629	7.517316022	0	5.615221008	20.15404729	0.561046116																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	110.2737461	110.2737461	44.10949844	0	88.21899688	0.176437994	0.176437994	44.10949844	0.088218997	0	0.088218997	0.352875988	0.088218997	0.352875988	8.821899688	22.05474922	0.352875988	0.088218997	0	0.458743136	0.176437994	0.088218997																				6.8865	0.20693059	1.654446368	0	3.210491329	4.008513593	3.982262586	2.187857759	7.986839833	0	2.080887725	0.003761861	0.008484366	0.004147029	3.197165214	3.21993012	0.640660339	0.663170079	0	0.000214662	3.55593967	0.049494926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5477		6.1215577	6.8865	0.20693059	1.654446368	0	3.210491329	4.008513593	3.982262586	2.187857759	7.986839833	0	2.080887725	0.003761861	0.008484366	0.004147029	3.197165214	3.21993012	0.640660339	0.663170079	0	0.000214662	3.55593967	0.049494926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5477	YES	$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																			3000	0.3624	0.0109	0.0871	0	0.169	0.211	0.2096	0.1152	0.4204	0	0.1095	0.0002	0.0004	0.0002	0.1683	0.1695	0.0337	0.0349	0	0	0.1872	0.0026																			2.292		0	7.249	0.217821674	1.741522493	0	3.379464557	4.219487993	4.191855353	2.303008167	8.407199824	0	2.190408131	0.003959854	0.008930911	0.004365294	3.365437067	3.389400126	0.674379305	0.698073767	0	0.00022596	3.74309439	0.052099922	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8397
H3410_002_5	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	774.2220921	23.26432622	285.1143541	29.64689508	212.0763122	13.55209697	13.48121607	561.7986202	92.43826674	29.18390454	31.95709162	0.010660576	0.109214297	0.011999481	4048.14412	1630.787314	1.711513423	7.009583015	0	5.736488915	24.16842781	0.672797992																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	112.2398028	112.2398028	44.89592112	0	89.79184225	0.179583684	0.179583684	44.89592112	0.089791842	0	0.089791842	0.359167369	0.089791842	0.359167369	8.979184225	22.44796056	0.359167369	0.089791842	22.44796056	0.425438508	0.179583684	0.089791842																				7.2415	0.217598616	1.066705963	0	1.586893564	2.433735507	2.421006453	2.101872212	8.300202265	0	2.86948613	0.003828931	0.009806553	0.004309822	3.029085985	3.05065411	0.614719773	0.629403372	0	0.000203377	4.340255315	0.060411771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9817		4.784630513	7.2415	0.217598616	1.066705963	0	1.586893564	2.433735507	2.421006453	2.101872212	8.300202265	0	2.86948613	0.003828931	0.009806553	0.004309822	3.029085985	3.05065411	0.614719773	0.629403372	0	0.000203377	4.340255315	0.060411771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9817	YES	$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																			3000	0.3811	0.0115	0.0561	0	0.0835	0.1281	0.1274	0.1106	0.4369	0	0.151	0.0002	0.0005	0.0002	0.1594	0.1606	0.0324	0.0331	0	0	0.2284	0.0032																			2.1043		0	7.6227	0.229051174	1.122848382	0	1.670414278	2.561826849	2.548427845	2.212497065	8.737055016	0	3.020511716	0.004030454	0.010322687	0.004536655	3.188511564	3.211214853	0.647073446	0.662529866	0	0.000214081	4.568689805	0.063591338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.086
H3410_003_1	2011	8																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	690.5565406	26.27572186	316.30473	26.09426235	216.1141271	14.95585391	14.81049988	575.0648255	81.84046009	34.41783005	39.03534243	0.009429393	0.120125578	0	4152.973903	1943.77543	1.978217522	7.729888197	0	4.675141883	35.33966721	0.624732737																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	177.3258921	177.3258921	44.33147303	0	132.9944191	0.177325892	0.177325892	44.33147303	0.132994419	0	0.132994419	0.354651784	0.132994419	0.354651784	13.29944191	26.59888382	0.354651784	0.132994419	26.59888382	1.247402391	0.177325892	0.132994419																				10.2045	0.388280485	1.168521217	0	2.395164399	2.652060138	2.626285104	2.1244559	10.88432445	0	5.191482691	0.003344151	0.015976032	0	4.602686265	4.308521402	0.701578374	1.02803199	0	0.000485982	6.266638016	0.083085968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6454		7.355089186	10.2045	0.388280485	1.168521217	0	2.395164399	2.652060138	2.626285104	2.1244559	10.88432445	0	5.191482691	0.003344151	0.015976032	0	4.602686265	4.308521402	0.701578374	1.02803199	0	0.000485982	6.266638016	0.083085968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6454	YES	$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																			4000	0.5371	0.0204	0.0615	0	0.1261	0.1396	0.1382	0.1118	0.5729	0	0.2732	0.0002	0.0008	0	0.2422	0.2268	0.0369	0.0541	0	0	0.3298	0.0044																			2.8761		0	10.7415	0.4087163	1.230022334	0	2.521225683	2.79164225	2.764510636	2.236269369	11.45718363	0	5.464718622	0.003520159	0.016816875	0	4.84493291	4.535285686	0.738503551	1.082138937	0	0.00051156	6.596461069	0.087458913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5215
H3410_003_2	2011	8																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	667.3565282	25.39295986	234.598244	24.15670088	151.5458859	11.37066969	11.32156488	482.1979418	71.44535257	36.86500401	41.8108304	0.009429393	0.109058997	0	3457.517453	1618.271058	1.694679478	6.455689241	0	4.005467508	32.2649079	0.570377307																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	181.1157676	181.1157676	45.27894189	0	135.8368257	0.181115768	0.181115768	45.27894189	0.135836826	0	0.135836826	0.362231535	0.135836826	0	13.58368257	27.16736513	0.362231535	0.135836826	0	1.238047881	0.181115768	0.135836826																				10.0724	0.383255451	0.885196688	0	1.71545934	2.059407568	2.050513913	1.819451049	9.704909902	0	5.67945048	0.003415623	0.014814228	0	3.913818296	3.663680061	0.613866349	0.876920334	0	0.000413247	5.843683559	0.077478243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3781		5.41943661	10.0724	0.383255451	0.885196688	0	1.71545934	2.059407568	2.050513913	1.819451049	9.704909902	0	5.67945048	0.003415623	0.014814228	0	3.913818296	3.663680061	0.613866349	0.876920334	0	0.000413247	5.843683559	0.077478243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3781	YES	$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																			4000	0.5301	0.0202	0.0466	0	0.0903	0.1084	0.1079	0.0958	0.5108	0	0.2989	0.0002	0.0008	0	0.206	0.1928	0.0323	0.0462	0	0	0.3076	0.0041																			2.5988		0	10.6025	0.403426791	0.931785988	0	1.805746673	2.16779744	2.158435698	1.91521163	10.21569463	0	5.978368926	0.003595393	0.015593924	0	4.119808733	3.856505327	0.646175104	0.923074036	0	0.000434997	6.151245851	0.081556045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.977
H3410_003_3	2011	8																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	730.9947041	27.81439665	242.4400768	28.52693393	164.8613	12.23088466	12.16451366	425.4734793	69.23077007	29.6243684	33.59878769	0.009429393	0.094848838	0	3754.126054	1757.096999	1.83329782	7.009386983	0	4.474114211	27.86106947	0.492526488																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	181.2199315	181.2199315	45.30498287	0	135.9149486	0.181219931	0.181219931	45.30498287	0.135914949	0	0.135914949	0.362439863	0.135914949	0	13.59149486	27.18298972	0.362439863	0.135914949	0	1.204142151	0.181219931	0.135914949																				11.0392	0.420043588	0.915311961	0	1.867259593	2.21648008	2.204452332	1.606339057	9.409496556	0	4.566577502	0.003417588	0.012891375	0	4.252015414	3.980262473	0.664460211	0.952680472	0	0.000448956	5.0489811	0.066941712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2273		5.369991151	11.0392	0.420043588	0.915311961	0	1.867259593	2.21648008	2.204452332	1.606339057	9.409496556	0	4.566577502	0.003417588	0.012891375	0	4.252015414	3.980262473	0.664460211	0.952680472	0	0.000448956	5.0489811	0.066941712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2273	YES	$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																			4000	0.581	0.0221	0.0482	0	0.0983	0.1167	0.116	0.0845	0.4952	0	0.2403	0.0002	0.0007	0	0.2238	0.2095	0.035	0.0501	0	0	0.2657	0.0035																			2.5909		0	11.6202	0.442151145	0.963486274	0	1.965536414	2.333136926	2.320476139	1.690883218	9.904733217	0	4.806923687	0.003597461	0.013569868	0	4.475805699	4.189749971	0.699431801	1.002821549	0	0.000472585	5.314716947	0.07046496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8182
H3410_003_4	2011	8																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	774.5797905	29.47281206	335.8856169	28.21837488	373.6269319	25.41514535	25.10916331	530.7677115	76.84527991	24.05259093	27.27949791	0.009429393	0.107528315	0	4153.419018	1943.983763	1.984442271	7.735649093	0	4.733556946	31.22669571	0.552023848																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	175.1894191	175.1894191	43.79735477	0	131.3920643	0.175189419	0.175189419	43.79735477	0.131392064	0	0.131392064	0.350378838	0.131392064	0	13.13920643	26.27841286	0.350378838	0.131392064	0	1.217295526	0.175189419	0.131392064																				11.3082	0.430277069	1.225908461	0	4.090967822	4.452464549	4.398859734	1.937185147	10.09685996	0	3.584309545	0.00330386	0.014128367	0	4.547719157	4.257067328	0.695306577	1.016402903	0	0.000480178	5.470586681	0.072531553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6025		8.587111371	11.3082	0.430277069	1.225908461	0	4.090967822	4.452464549	4.398859734	1.937185147	10.09685996	0	3.584309545	0.00330386	0.014128367	0	4.547719157	4.257067328	0.695306577	1.016402903	0	0.000480178	5.470586681	0.072531553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6025	YES	$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																			4000	0.5952	0.0226	0.0645	0	0.2153	0.2343	0.2315	0.102	0.5314	0	0.1886	0.0002	0.0007	0	0.2394	0.2241	0.0366	0.0535	0	0	0.2879	0.0038																			3.0317		0	11.9033	0.45292323	1.290429958	0	4.306281918	4.686804789	4.630378668	2.03914226	10.62827364	0	3.772957415	0.003477747	0.014871966	0	4.787072797	4.481123503	0.73190166	1.069897793	0	0.000505451	5.758512296	0.076349003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6343
H3410_003_5	2011	8																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	817.5179537	31.106612	217.671572	27.04119573	186.0236275	15.50003391	15.33260925	511.7868219	80.37514597	33.36627698	37.84271249	0.009429393	0.125090473	0	4014.049661	1878.752741	1.944858063	7.489103421	0	5.040743777	38.39198458	0.67869144																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	176.7034373	176.7034373	44.17585933	0	132.527578	0.176703437	0.176703437	44.17585933	0.132527578	0	0.132527578	0.353406875	0.132527578	0	13.2527578	26.5055156	0.353406875	0.132527578	0	1.114302561	0.176703437	0.132527578																				12.0382	0.458053772	0.801319062	0	2.0544384	2.73890927	2.709324759	1.884051888	10.65192343	0	5.015203032	0.003332412	0.016577937	0	4.433102329	4.149775841	0.68732621	0.992512738	0	0.000468076	6.78399564	0.089945333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5084		7.703397609	12.0382	0.458053772	0.801319062	0	2.0544384	2.73890927	2.709324759	1.884051888	10.65192343	0	5.015203032	0.003332412	0.016577937	0	4.433102329	4.149775841	0.68732621	0.992512738	0	0.000468076	6.78399564	0.089945333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5084	YES	$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																			4000	0.6336	0.0241	0.0422	0	0.1081	0.1442	0.1426	0.0992	0.5606	0	0.264	0.0002	0.0009	0	0.2333	0.2184	0.0362	0.0522	0	0	0.3571	0.0047																			2.9215		0	12.6718	0.482161865	0.84349375	0	2.162566737	2.883062389	2.851920799	1.983212513	11.21255097	0	5.279161086	0.003507802	0.01745046	0	4.666423505	4.368185096	0.723501273	1.04475025	0	0.000492712	7.141048043	0.094679298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4299
H3410_801_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	683.6986005	19.67870028	818.6037059	26.1411098	202.4907832	11.28614615	11.08013583	596.7970935	97.99661299	32.77903477	37.55767426	0.000334712	0.123043678	0.000694139	4939.115085	1842.147594	1.547401767	9.087050843	0	0	21.74001171	0.649380275																				$250 day for 1st 5 days	$250 day for 1st 5 days	$50 day	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $25 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	20% Coinsurance	$20 Per Visit	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Per Visit	$40 Per Visit	20% Coinsurance	20% Coinsurance																				250	250	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.2	20	40	0.4	0.2	40	40	0.2	0.2																			NO	223.6397111	223.6397111	44.72794222	0	134.1838267	0.178911769	0.178911769	44.72794222	0.178911769	0	0.178911769	0.357823538	0.178911769	0.178911769	17.89117689	35.78235377	0.357823538	0.178911769	35.78235377	35.78235377	0.178911769	0.178911769																				12.7418	0.366744904	3.051204938	0	2.264249013	2.019224371	1.982366701	2.224458826	17.53274737	0	6.719509936	0.000119768	0.022013962	0.00012419	7.363881804	5.493031408	0.553696775	1.62578034	0	0	3.889543951	0.116181774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.9667		8.432930586	12.7418	0.366744904	3.051204938	0	2.264249013	2.019224371	1.982366701	2.224458826	17.53274737	0	6.719509936	0.000119768	0.022013962	0.00012419	7.363881804	5.493031408	0.553696775	1.62578034	0	0	3.889543951	0.116181774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.9667	YES	$250 day for 1st 5 days	$250 day for 1st 5 days	$50 day	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $25 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	20% Coinsurance	$20 Per Visit	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Per Visit	$40 Per Visit	20% Coinsurance	20% Coinsurance																			5000	0.6706	0.0193	0.1606	0	0.1192	0.1063	0.1043	0.1171	0.9228	0	0.3537	0	0.0012	0	0.3876	0.2891	0.0291	0.0856	0	0	0.2047	0.0061																			3.5772		0	13.4125	0.386047267	3.211794672	0	2.383420014	2.125499338	2.086701791	2.341535606	18.45552355	0	7.073168354	0.000126071	0.023172592	0.000130726	7.75145453	5.782138325	0.58283871	1.711347726	0	0	4.094256791	0.122296604	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5439
H3410_802_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	683.6986005	19.67870028	818.6037059	26.1411098	202.4907832	11.28614615	11.08013583	596.7970935	97.99661299	32.77903477	37.55767426	0.000334712	0.123043678	0.000694139	4939.115085	1842.147594	1.547401767	9.087050843	0	0	21.74001171	0.649380275																				$250 day for 1st 5 days	$250 day for 1st 5 days	$50 day	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $25 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	20% Coinsurance	$20 Per Visit	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Per Visit	$40 Per Visit	20% Coinsurance	20% Coinsurance																				250	250	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.2	20	40	0.4	0.2	40	40	0.2	0.2																			NO	222.7823165	222.7823165	44.73	0	133.6693899	0.178225853	0.178225853	44.55646329	0.178225853	0	0.178225853	0.356451706	0.178225853	0.178225853	17.82258532	35.64517063	0.356451706	0.178225853	35.64517063	35.64517063	0.178225853	0.178225853																				12.693	0.365338869	3.051345314	0	2.255568288	2.011483026	1.974766662	2.215930649	17.46552996	0	6.693748538	0.000119309	0.021929564	0.000123713	7.335649999	5.471972109	0.551574	1.619547389	0	0	3.874632136	0.115736354	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.718		8.902662996	12.693	0.365338869	3.051345314	0	2.255568288	2.011483026	1.974766662	2.215930649	17.46552996	0	6.693748538	0.000119309	0.021929564	0.000123713	7.335649999	5.471972109	0.551574	1.619547389	0	0	3.874632136	0.115736354	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.718	YES	$250 day for 1st 5 days	$250 day for 1st 5 days	$50 day	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $25 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	20% Coinsurance	$20 Per Visit	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Per Visit	$40 Per Visit	20% Coinsurance	20% Coinsurance																			5000	0.6681	0.0192	0.16	0	0.1187	0.1059	0.1039	0.1166	0.9192	0	0.3523	0	0.0012	0	0.3861	0.288	0.029	0.0852	0	0	0.2039	0.0061																			3.5635		0	13.361	0.384567231	3.211345304	0	2.374282408	2.117350554	2.07870175	2.332558578	18.38476838	0	7.046051092	0.000125588	0.023083752	0.000130225	7.721736841	5.759970641	0.580604211	1.704786726	0	0	4.078560143	0.121827741	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.2815
H3421_001_0	2011	3																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	O	V	V	V	V	P	P	Coin	O	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	993.7512473	13.91703109	381.8749984	69.42394448	271.982488	6.988289872	10.12772327	246.8729218	282.9207378	767.1994782	14.64964897	38.96077084	0.159953028	288.3825281	3238.189254	7927.83558	181.225129	1163.348409	0	0	22.4277023	8.147834875	0	425	358.805999	24.40242311	29.37328707	0	500	0												1a1: $206.58	1b1: $144.51	21: $40.74	6: $10	10a: $100	11a: 20.0%	"11b: 20.0%,11c: 20.0%"	"4a1: $50,4a2: $500,4b: $25"	"9a1: $250,9b: $100"	"8a1: $15,8a2: $15"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: $275,9a2: $250"	12: 20.0%	"3: $35,9a3: $250,9c: $35,9d1: $35"	7a: $15	"7b1: $35,7d1: $35,7f1: $35,7g: $35,17b1: $10"	"7e: $35,7h: $35"	"7c: $35,7i: $35"	7d2: $35	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16a1: $1.225	$0 	17b2: $10	$0 	$0 	$0 	$0 												206.58	144.51	40.74	10	100	0.2	0.2	48.70943953	155.7915058	15	0.2	250	0.2	134.9881873	9.520055839	31.45086731	35	35	0	0	0.2	0	0	1.225	0	10	0	0	0	0											NO	180.8827372	126.5338578	35.67219824	8.756062405	87.56062405	0.175121248	0.175121248	42.65028922	136.4120147	13.13409361	0.175121248	218.9015601	0.175121248	118.1964992	8.335820303	27.53857568	30.64621842	30.64621842	0	0	0.175121248	0	0	1.072617645	0	8.756062405	0	0	0	0												14.9794	0.146747969	1.135193387	0.050656699	1.984579698	1.223798044	1.773579539	0.87743346	3.216148987	0.839705814	2.565464811	0.71071446	0.028011174	2.840483772	2.249413644	18.19344168	0.462822074	2.971019119	0	0	3.927567219	0	0	0.037988542	0	0.017805762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.2319		8.556903663	14.9794	0.146747969	1.135193387	0.050656699	1.984579698	1.223798044	1.773579539	0.87743346	3.216148987	0.839705814	2.565464811	0.71071446	0.028011174	2.840483772	2.249413644	18.19344168	0.462822074	2.971019119	0	0	3.927567219	0	0	0.037988542	0	0.017805762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.2319	YES	1a1: $206.58	1b1: $144.51	21: $40.74	6: $10	10a: $100	11a: 30.0%	"11b: 30.0%,11c: 20.0%"	"4a1: $50,4a2: $500,4b: $25"	"9a1: $250,9b: $100"	"8a1: $15,8a2: $15"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: $275,9a2: $250"	12: 20.0%	"3: $35,9a3: $250,9c: $35,9d1: $35"	7a: $15	"7b1: $35,7d1: $35,7f1: $35,7g: $35,17a1: 50.0%,17b1: 50.0%,18a1: 50.0%"	"7e: $35,7h: $35"	"7c: $35,7i: $35"	7d2: $35	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16b1: 50.0%	17a2: 50.0%	17b2: 50.0%	18a2: 50.0%	18b: 50.0%	$0 	$0 											3400	3.019	0.0296	0.2288	0.0102	0.4	0.3458	0.4247	0.1768	0.6482	0.1692	0.4832	0.1432	0.0053	0.5353	0.4533	3.6906	0.0933	0.5988	0	0	0.7398	0	0	0	0.0168	0.0012	0.001	0	0	0											12.2141	2000	1.735203108	17.9983	0.176323707	1.363981438	0.060866103	2.384553945	1.569562799	2.198260129	1.054272308	3.864334983	1.008940993	3.048685778	0.853952588	0.03328725	3.375825019	2.702762799	21.88400588	0.556099714	3.569801388	0	0	4.667348493	0	0	0.037988542	0.016831278	0.019010142	0.000997432	0	0	0	0	0	0	0	0	0	0	0	0	0	72.446
H3421_002_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	O	V	V	V	V	P	P	Coin	O	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	1049.238002	14.69409768	403.1972402	73.3002761	287.1688091	7.320829058	10.60965302	260.6572338	298.7178033	810.0365658	15.34675547	41.13617112	0.167564425	304.4845563	3418.995682	8370.491495	191.3439533	1228.304732	0	0	23.49492905	8.602774596	0.195926316	0	378.840168	25.76494845	31.01336388	0	500	0												1a1: $206.58	1b1: $144.51	21: $40.74	6: $10	10a: $100	11a: 20.0%	"11b: 20.0%,11c: 20.0%"	"4a1: $50,4a2: $500,4b: $22.5"	"9a1: $250,9b: $100"	"8a1: $15,8a2: $15"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: $275,9a2: $250"	12: 20.0%	"3: $35,9a3: $250,9c: $35,9d1: $35"	7a: $10	"7b1: $35,7d1: $35,7f1: $35,7g: $35,17b1: $10"	"7e: $35,7h: $35"	"7c: $35,7i: $35"	7d2: $35	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16a1: $1.225	$0 	17b2: $10	$0 	$0 	$0 	$0 												206.58	144.51	40.74	10	100	0.2	0.2	48.58038348	155.7915058	15	0.2	250	0.2	133.9423481	6.346703893	31.43697303	35	35	0	0	0.2	0	0	0	0	10	0	0	0	0											NO	183.6483594	128.4685081	36.21761139	8.889938976	88.89938976	0.17779878	0.17779878	43.18766446	138.497698	13.33490846	0.17779878	222.2484744	0.17779878	119.0739301	5.642181031	27.94727718	31.11478642	31.11478642	0	0	0.17779878	0	0	0	0	8.889938976	0	0	0	0												16.0576	0.157310734	1.216903413	0.054302915	2.127427658	1.301634472	1.886383359	0.938098096	3.447644008	0.900146955	2.728634393	0.761870939	0.02979275	3.02134773	1.607549382	19.4943705	0.49613552	3.18486995	0	0	4.17736971	0	0	0	0	0.019087402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6084		7.94260354	16.0576	0.157310734	1.216903413	0.054302915	2.127427658	1.301634472	1.886383359	0.938098096	3.447644008	0.900146955	2.728634393	0.761870939	0.02979275	3.02134773	1.607549382	19.4943705	0.49613552	3.18486995	0	0	4.17736971	0	0	0	0	0.019087402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6084	YES	1a1: $206.58	1b1: $144.51	21: $40.74	6: $10	10a: $100	11a: 30.0%	"11b: 30.0%,11c: 20.0%"	"4a1: $50,4b: $22.5"	"9a1: $250,9b: $100"	"8a1: $15,8a2: $15"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: $275,9a2: $250"	12: 20.0%	"3: $35,9a3: $250,9c: $35,9d1: $35"	7a: $10	"7b1: $35,7d1: $35,7f1: $35,7g: $35,17a1: 50.0%,17b1: 50.0%,18a1: 50.0%"	"7e: $35,7h: $35"	"7c: $35,7i: $35"	7d2: $35	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16b1: 50.0%	17a2: 50.0%	17b2: 50.0%	18a2: 50.0%	18b: 50.0%	$0 	$0 											3400	3.1875	0.0312	0.2416	0.0108	0.4223	0.3622	0.4449	0.1862	0.6844	0.1787	0.5062	0.1512	0.0055	0.5609	0.3191	3.8725	0.0985	0.6322	0	0	0.775	0	0	0	0.0079	0.0006	0.0005	0	0	0											12.6799	2000	1.583297164	19.2451	0.188537852	1.458465995	0.065082367	2.54973473	1.663852512	2.331272461	1.12431616	4.132021896	1.078831491	3.234849527	0.913106863	0.035319889	3.582203502	1.926657517	23.36688035	0.594621378	3.817085621	0	0	4.952353626	0	0	0	0.007899183	0.019652636	0.000468111	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2883
H3449_005_0	2011	10																															D	D	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	1478.693269	0	1143.569761	12.57452429	262.5971567	18.45383769	0.001975261	1537.356496	990.1870741	20.15024352	38.99397085	0	0	1923.229259	5475.233823	5451.535311	127.2697827	256.5259903	0	1971.22646	2.329673655	0.715709537	0	0	106.8334004	0	0	0	0	0											3400	"(1a) 170 copay per day, days 1 - 6, unlimited days"	"(1b) 170 copay per day, days 1 - 6"	"(2) $0 copay for days 1-10, $100 per day after day 10"	(6) 0% coinsurance	(10a) $100 copay	(11a) 20% coinsurance	"(11b) 20% coinsurance, (11c) 20% coinsurance"	"(4a) $50 copay, (4b) $35 copay"	"(9a) $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) 0% coinsurance, (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"	0	"(7b) $35 copay, (7f) $35 copay, (7g) 0% coinsurance, (14d - j) 0% coinsurance (16b Medicare covered) $35 copay, (17a Medicare Covered) $35 copay, (17b Medicare Covered) 20% coinsurance, (18a Medicare Covered) $35 copay"	(15) 20% coinsurance	"(13a) 0% coinsurance, 3 pint deductible waived"	(10b) Non Covered	"(16a) Non Covered, (16b) Non Covered"	(17a Medicare Non Covered) $35 copay	(17b) Non Covered	(18a) Non Covered	(18b) Non Covered	(14a) 0% coinsurance	Non Covered												179.7348194	0	54.89820482	0	100	0.2	0.2	49.76103386	100	0.2	0.2	0	0	100	14.44250856	35	35	35	0	7.90126784	0.2	0.01185119	0	0	35	0	0	0	0	0											NO	130.1286301	0	39.74648994	0	72.40034546	0.144800691	0.144800691	36.02716042	72.40034546	0.144800691	0.144800691	0	0	72.40034546	10.45642609	25.34012091	25.34012091	25.34012091	0	5.720545212	0.144800691	0.008580303	0	0	25.34012091	0	0	0	0	0												16.035	0	3.787740332	0	1.584343738	2.672128448	0.000286019	4.615549093	5.974157186	2.917769184	5.646353921	0	0	11.60353856	4.770948151	11.51188033	0.26875264	0.541699968	0	0.939707507	0.337338355	0.006141005	0	0	0.225597607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.439		27.99558343	16.035	0	3.787740332	0	1.584343738	2.672128448	0.000286019	4.615549093	5.974157186	2.917769184	5.646353921	0	0	11.60353856	4.770948151	11.51188033	0.26875264	0.541699968	0	0.939707507	0.337338355	0.006141005	0	0	0.225597607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.439	NO																																																																																		0			16.035	0	3.787740332	0	1.584343738	2.672128448	0.000286019	4.615549093	5.974157186	2.917769184	5.646353921	0	0	11.60353856	4.770948151	11.51188033	0.26875264	0.541699968	0	0.939707507	0.337338355	0.006141005	0	0	0.225597607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.439
H3449_012_0	2011	9																															D	D	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	1274.415889	0	812.6361062	7.850791139	179.6323388	10.39307749	0	1230.338089	943.7576121	17.48121933	33.97028975	0	0	10.62272325	4285.908899	5057.068241	56.14969387	297.8976369	0	1731.236128	0.626385484	1.884441991	0	0	88.44604378	0	0	0	0	0											3400	"(1a) 195 copay per day, days 1 - 6, unlimited days"	"(1b) 195 copay per day, days 1 - 6"	"(2) $0 copay for days 1-10, $100 per day after day 10"	(6) 0% coinsurance	(10a) $100 copay	(11a) 10% coinsurance	"(11b) 10% coinsurance, (11c) 10% coinsurance"	"(4a) $50 copay, (4b) $20 copay"	"(9a) 0% coinsurance, (9b) $100 copay"	(8a) 20% coinsurance	(8b) 20% coinsurance	(5) 0% coinsurance	(12) 0% coinsurance	"(3) $20 copay for physician services, 10% coinsurance for supplies, (9a - non-surgery) 0% coinsurance, (9c) $20 copay, (9d) 0% coinsurance"	"(7a) $10 copay, $20 copay for Urgent Care services, (14b) 0% coinsurance, (14c) 0% coinsurance"	(7d) $20 copay	"(7e) $20 copay, (7h) $20 copay"	"(7c) $20 copay, (7i) $20 copay"	0	"(7b) $20 copay, (7f) $20 copay, (7g) 0% coinsurance, (14d - j) 0% coinsurance (16b Medicare covered) $20 copay, (17a Medicare Covered) $20 copay, (17b Medicare Covered) 10% coinsurance, (18a Medicare Covered) $20 copay"	(15) 10% coinsurance	"(13a) 0% coinsurance, 3 pint deductible waived"	(10b) Non Covered	"(16a) Non Covered, (16b) Non Covered"	(17a Non Medicare Covered) $20 copay	(17b) Non Covered	(18a) Non Covered	(18b) Non Covered	(14a) 0% coinsurance	Non Covered												200.1419878	0	54.89820482	0	100	0.1	0.1	49.09512761	100	0.2	0.2	0	0	0	9.548241368	20	20	20	0	6.624061352	0.1	0.008550311	0	0	20	0	0	0	0	0											NO	158.4340204	0	43.45786408	0	79.16081085	0.079160811	0.079160811	38.86410111	79.16081085	0.158321622	0.158321622	0	0	0	7.558465289	15.83216217	15.83216217	15.83216217	0	5.243660677	0.079160811	0.006768495	0	0	15.83216217	0	0	0	0	0												16.8259	0	2.942952454	0	1.1849868	0.822724442	0	3.984665323	6.225718152	2.767654994	5.378231364	0	0	0	2.69957447	6.672027042	0.074080922	0.393030308	0	0.756501234	0.049585183	0.012754837	0	0	0.116691009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9071		13.40135711	16.8259	0	2.942952454	0	1.1849868	0.822724442	0	3.984665323	6.225718152	2.767654994	5.378231364	0	0	0	2.69957447	6.672027042	0.074080922	0.393030308	0	0.756501234	0.049585183	0.012754837	0	0	0.116691009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9071	NO																																																																																		0			16.8259	0	2.942952454	0	1.1849868	0.822724442	0	3.984665323	6.225718152	2.767654994	5.378231364	0	0	0	2.69957447	6.672027042	0.074080922	0.393030308	0	0.756501234	0.049585183	0.012754837	0	0	0.116691009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9071
H3449_013_0	2011	10																															D	D	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	1099.337666	0	1146.916887	9.456536475	246.50154	13.01600925	0.000876131	1394.045993	57.95034144	18.55455243	29.96738771	0	0	1051.783262	4416.545838	4201.935434	200.5585316	177.5645598	0	1581.474281	1.342692806	1.356800215	0	0	68.0737968	0	0	0	0	0											3400	"(1a) 195 copay per day, days 1 - 6, unlimited days"	"(1b) 195 copay per day, days 1 - 6"	"(2) $0 copay for days 1-10, $100 per day after day 10"	(6) 0% coinsurance	(10a) $100 copay	(11a) 20% coinsurance	"(11b) 20% coinsurance, (11c) 20% coinsurance"	"(4a) $50 copay, (4b) $40 copay"	"(9a) 30% coinsurance, (9b) 30% coinsurance"	(8a) 30% coinsurance	(8b) 20% coinsurance	(5) 0% coinsurance	(12) 0% coinsurance	"(3) $40 copay for physician services, 20% coinsurance for supplies, (9a - non-surgery) 0% coinsurance, (9c) $40 copay, (9d) 0% coinsurance"	"(7a) $20 copay, $40 copay for Urgent Care services, (14b) 0% coinsurance, (14c) 0% coinsurance"	(7d) $45 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 (16b Medicare covered) $40 copay, (17a Medicare Covered) $40 copay, (17b Medicare Covered) 20% coinsurance, (18a Medicare Covered) $40 copay"	(15) 20% coinsurance	"(13a) 0% coinsurance, 3 pint deductible waived"	(10b) Non Covered	"(16a) Non Covered, (16b) Non Covered"	(17a Medicare Non Covered) $40 copay	(17b) Non Covered	(18a) Non Covered	(18b) Non Covered	(14a) 0% coinsurance	Non Covered												204.8224608	0	54.89820482	0	100	0.2	0.2	49.62165488	0.3	0.3	0.2	0	0	30	19.2614732	45	40	40	0	7.119009155	0.2	0	0	0	40	0	0	0	0	0											NO	143.5668159	0	38.4799618	0	70.09329709	0.140186594	0.140186594	34.78145397	0.210279891	0.210279891	0.140186594	0	0	21.02798913	13.50100163	31.54198369	28.03731884	28.03731884	0	4.989948237	0.140186594	0	0	0	28.03731884	0	0	0	0	0												13.1524	0	3.677776501	0	1.439842139	1.824670007	0.000122822	4.040578879	12.1857915	3.901649268	4.201026019	0	0	1.843073916	4.968982714	11.04478158	0.468593625	0.414869515	0	0.6576229	0.188227531	0	0	0	0.159050562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.169		27.37899487	13.1524	0	3.677776501	0	1.439842139	1.824670007	0.000122822	4.040578879	12.1857915	3.901649268	4.201026019	0	0	1.843073916	4.968982714	11.04478158	0.468593625	0.414869515	0	0.6576229	0.188227531	0	0	0	0.159050562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.169	NO																																																																																		0			13.1524	0	3.677776501	0	1.439842139	1.824670007	0.000122822	4.040578879	12.1857915	3.901649268	4.201026019	0	0	1.843073916	4.968982714	11.04478158	0.468593625	0.414869515	0	0.6576229	0.188227531	0	0	0	0.159050562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.169
H3449_801_0	2011	6																															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	YES	236.4434644	0	30.35255928	10.29901687	6.490319158	15.40627424	0	23.08305839	97.21540418	22.12702748	40.14738973	0	0	18.17716971	38.50621936	84.12421031	2.640031377	4.747726227	0	10.69547774	0.891882526	2.64894763																			6700	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				0.080293248	0.080293248	0.183000808	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.071176255	0.071176255	0.162221763	0	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737																				16.8292	0	4.923845688	0	1.340534776	3.18206946	0	4.76766115	20.07923291	4.570198952	8.292191921	0	0	3.754380566	7.953218459	17.3753288	0.545281947	0.980613119	0	2.209083945	0.18421275	0.547123544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5341		12.49318334	16.8292	0	4.923845688	0	1.340534776	3.18206946	0	4.76766115	20.07923291	4.570198952	8.292191921	0	0	3.754380566	7.953218459	17.3753288	0.545281947	0.980613119	0	2.209083945	0.18421275	0.547123544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5341	NO																																																																																		0			16.8292	0	4.923845688	0	1.340534776	3.18206946	0	4.76766115	20.07923291	4.570198952	8.292191921	0	0	3.754380566	7.953218459	17.3753288	0.545281947	0.980613119	0	2.209083945	0.18421275	0.547123544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5341
H3449_805_0	2011	5																															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	YES	236.4434644	0	30.35255928	10.29901687	6.490319158	15.40627424	0	23.08305839	97.21540418	22.12702748	40.14738973	0	0	18.17716971	38.50621936	84.12421031	2.640031377	4.747726227	0	10.69547774	0.891882526	2.64894763																			6700	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				0.080297509	0.080297509	0.183028063	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.071180033	0.071180033	0.162245924	0	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737	0.206543737																				16.8301	0	4.924579016	0	1.340534776	3.18206946	0	4.76766115	20.07923291	4.570198952	8.292191921	0	0	3.754380566	7.953218459	17.3753288	0.545281947	0.980613119	0	2.209083945	0.18421275	0.547123544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5358		12.49339168	16.8301	0	4.924579016	0	1.340534776	3.18206946	0	4.76766115	20.07923291	4.570198952	8.292191921	0	0	3.754380566	7.953218459	17.3753288	0.545281947	0.980613119	0	2.209083945	0.18421275	0.547123544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5358	NO																																																																																		0			16.8301	0	4.924579016	0	1.340534776	3.18206946	0	4.76766115	20.07923291	4.570198952	8.292191921	0	0	3.754380566	7.953218459	17.3753288	0.545281947	0.980613119	0	2.209083945	0.18421275	0.547123544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5358
H3449_810_0	2011	5																															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	YES	230.2299764	0	22.97290444	9.373635647	6.625266387	18.07007183	0	24.25372811	117.20905	27.05153685	47.89176013	0	0	49.16457611	30.37799094	67.03092164	0.917049363	3.555142503	0	13.14986141	2.43756954	3.71917565																			6700	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				0.079335651	0.079335651	0.18461426	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069513243	0.069513243	0.161757493	0	0.20415268	0.20415268	0.20415268	0.20415268	0.20415268	0.20415268	0.20415268	0.20415268	0.20415268	0.20415268	0.20415268	0.20415268	0.20415268	0.20415268	0.20415268	0.20415268	0.20415268	0.20415268																				16.004	0	3.716039428	0	1.352565886	3.689053586	0	4.951463585	23.92854164	5.522643737	9.777231164	0	0	10.03707996	6.201748253	13.68454227	0.187218085	0.725791869	0	2.684579444	0.497636353	0.759279675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7194		14.65583566	16.004	0	3.716039428	0	1.352565886	3.689053586	0	4.951463585	23.92854164	5.522643737	9.777231164	0	0	10.03707996	6.201748253	13.68454227	0.187218085	0.725791869	0	2.684579444	0.497636353	0.759279675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7194	NO																																																																																		0			16.004	0	3.716039428	0	1.352565886	3.689053586	0	4.951463585	23.92854164	5.522643737	9.777231164	0	0	10.03707996	6.201748253	13.68454227	0.187218085	0.725791869	0	2.684579444	0.497636353	0.759279675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7194
H3456_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1154.202326	103.1270423	738.7921552	1144.435553	138.0066248	9.383186439	9.721189854	347.8217979	34.97626782	15.46144379	34.93508503	0	0.121641281	20.60295323	6026.785871	100.0977112	543.0057067	329.4749443	0	0	18.14700883	1371.978241	0	0	215.0320051	0	16.35298505	2.36464923	570.3841776	0											4750	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-58 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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, 18a); $0/$40 (17a)"	$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												187.4696942	115.9014585	66.74885623	0	200	0.2	0.114663452	48.92772237	0.2	0.147574131	0.1655549	0	0.2	0.160126844	13.10753332	0.133071568	38.5	40	0	0	0.2	39.71861734	0	0	36.99278503	0	0	0	0	0											YES	150.0545579	92.76988584	53.42714276	0	160.0840697	0.16008407	0.09177896	39.17682105	0.16008407	0.118121337	0.132513511	0	0.16008407	0.128168784	12.66950455	0.12863162	37.21340341	38.66327627	0	0	0.16008407	31.79158953	0	0	36.99278503	0	0	0	0	0											7500	14.4328	0.797256995	3.289296162	0	1.841055179	1.502098672	0.892200696	1.135546028	5.599143296	1.826326419	4.629370766	0	0.019472831	2.64065547	6.363032583	12.87573072	1.683924201	1.0615484	0	0	2.905047025	3.634780758	0	0	0.662886062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7921	0	12.01545292	14.4328	0.797256995	3.289296162	0	1.841055179	1.502098672	0.892200696	1.135546028	5.599143296	1.826326419	4.629370766	0	0.019472831	2.64065547	6.363032583	12.87573072	1.683924201	1.0615484	0	0	2.905047025	3.634780758	0	0	0.662886062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7921	NO	"$350 Days 1-22 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$350 Days 1-22 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-43 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.3836	0.0301	0.3049	0.1049	0.0859	0.1051	0.1089	0.053	0.3918	0.0852	0.3175	0	0.0009	0.184	0.4725	0.7595	0.1	0.0628	0	0	0.2271	0.2127	0	0	0.0349	0	0.0032	0	0	0											4.0284	0	0.72969642	14.8163	0.827370528	3.59420021	0.10487355	1.926950427	1.607220295	1.001109036	1.188526384	5.990989079	1.911534491	4.946830833	0	0.020381345	2.824670751	6.835486452	13.63520291	1.78391197	1.124309151	0	0	3.13212971	3.847530147	0	0	0.697774802	0	0.003227563	0	0	0	0	0	0	0	0	0	0	0	0	0	71.8206
H3456_010_0	2011	5																															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	YES	358.0921374	45.3891	8684.511033	411.4922412	16.93699807	29.39553424	5.621449071	13.1650247	18.91466497	24.93784667	17.9195091	0	0	21.3598317	1.644458655	161.4494303	21.4538	2.060995377	0	0	3.461480099	7.708748606	2430.663722	141.3930691	80.49619734	32.46552206	0	0	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.080702714	0.081682444	0	0	0.2	0.2	0.144768005	0.100529172	0.2	0	0.090085804	0	0	0.160602255	0.000691579	0.026018829	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.075036599	0.075947542	0	0	0.185958055	0.185958055	0.134603883	0.093471047	0.185958055	0	0.083760905	0	0	0.149326415	0.000643023	0.024192054	0.185958055	0	0	0	0.185958055	0.186027431	0	0	0	0	0	0	0	0												26.87	3.447190576	0	0	3.149571225	5.466336384	0.756668876	1.230548642	3.517334316	0	1.500954297	0	0	3.189587094	0.001057425	3.905793348	3.989506929	0	0	0	0.643690108	1.434038697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.1023	0	4.462319081	26.87	3.447190576	0	0	3.149571225	5.466336384	0.756668876	1.230548642	3.517334316	0	1.500954297	0	0	3.189587094	0.001057425	3.905793348	3.989506929	0	0	0	0.643690108	1.434038697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.1023	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	26.87	3.447190576	0	0	3.149571225	5.466336384	0.756668876	1.230548642	3.517334316	0	1.500954297	0	0	3.189587094	0.001057425	3.905793348	3.989506929	0	0	0	0.643690108	1.434038697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.1023
H3456_016_0	2011	4																															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	YES	381.0966877	22.8803	50.57007239	3046.479859	13.9939796	28.25895201	25.62525685	34.61127976	47.16662956	22.58409129	48.55849166	0	0.296316036	36.03683989	45.81847263	145.7345005	11.2165	6.181415854	0	0	31.48480081	9.650313597	869.5927007	475.2708206	340.7043855	244.1404883	0	0	598.5575223	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.080217963	0.081191696	0.185828871	0	0.233	0.233	0.233	0.096015621	0.233	0.233	0.233	0	0.233	0.233	0.226374986	0.232955451	0.233818772	0.233	0	0	0.233	0.231191898	0	0	0	0	0	0	0	0											NO	0.063145136	0.063911628	0.146278823	0	0.183410498	0.183410498	0.183410498	0.075592445	0.183410498	0.183410498	0.183410498	0	0.183410498	0.183410498	0.178195489	0.183375431	0.184055011	0.183410498	0	0	0.183410498	0.182860263	0	0	0	0	0	0	0	0												24.0644	1.462317228	7.397330684	0	2.566642771	5.18298847	4.699941129	2.616351269	8.650855032	4.142159438	8.906137154	0	0.054347472	6.609534762	8.164645156	26.7241268	2.064453032	1.133736562	0	0	5.774643007	1.764658887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.9793	0	32.96884575	24.0644	1.462317228	7.397330684	0	2.566642771	5.18298847	4.699941129	2.616351269	8.650855032	4.142159438	8.906137154	0	0.054347472	6.609534762	8.164645156	26.7241268	2.064453032	1.133736562	0	0	5.774643007	1.764658887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.9793	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.0644	1.462317228	7.397330684	0	2.566642771	5.18298847	4.699941129	2.616351269	8.650855032	4.142159438	8.906137154	0	0.054347472	6.609534762	8.164645156	26.7241268	2.064453032	1.133736562	0	0	5.774643007	1.764658887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.9793
H3456_020_0	2011	2																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	973.9241943	103.1950466	577.6596129	882.3607983	124.3081837	7.966583299	8.612784715	333.2404256	34.78988326	15.34974273	37.60855201	0	0.071039019	18.89678754	5757.453209	99.53264579	540.3361869	419.6211747	0	0	29.10985025	1412.138329	0	0	166.840569	0	16.76509792	0	124.7431124	0											4200	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												187.4696942	115.9014585	63.05380463	0	200	0.2	0.122713314	48.8909382	0.2	0.150336126	0.162770406	0	0.2	0.158036527	12.7695318	0.119329948	38.5	35	0	0	0.2	34.65068635	0	0	35	0	35	0	0	0											YES	149.7061271	92.55447159	50.35235658	0	159.71235	0.15971235	0.097994159	39.05814678	0.15971235	0.12005268	0.12998222	0	0.15971235	0.126201925	12.33846158	0.115326522	37.20032796	33.81847996	0	0	0.15971235	27.67071273	0	0	35	0	35	0	0	0											6600	12.1502	0.795930251	2.423876901	0	1.654462678	1.27236174	0.844002596	1.084646121	5.556374012	1.842777753	4.888443088	0	0.011345809	2.384810967	5.919842934	11.47875383	1.675056947	1.182579191	0	0	4.649202592	3.256239503	0	0	0.486618326	0	0.048898202	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6064	0	11.50464306	12.1502	0.795930251	2.423876901	0	1.654462678	1.27236174	0.844002596	1.084646121	5.556374012	1.842777753	4.888443088	0	0.011345809	2.384810967	5.919842934	11.47875383	1.675056947	1.182579191	0	0	4.649202592	3.256239503	0	0	0.486618326	0	0.048898202	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6064	NO	"$350 Days 1-19 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$350 Days 1-19 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-38 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.3201	0.0291	0.2318	0.0807	0.0776	0.0895	0.0968	0.0509	0.3909	0.0864	0.3377	0	0.0005	0.1669	0.4435	0.6868	0.0995	0.0711	0	0	0.3654	0.195	0	0	0.0293	0	0.0029	0	0	0											3.8524	0	0.696169084	12.4703	0.825007179	2.655668409	0.080679772	1.732062762	1.361879061	0.940781025	1.135520286	5.947294061	1.929210472	5.226135873	0	0.011877967	2.551707265	6.36331852	12.1655694	1.774597894	1.253662207	0	0	5.014555191	3.451250271	0	0	0.515888602	0	0.051839448	0	0	0	0	0	0	0	0	0	0	0	0	0	67.4588
H3456_023_0	2011	6																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1083.616459	102.7509326	639.9659407	691.5384121	169.0096266	7.927493207	9.697654645	299.5309807	39.06093563	17.5829157	34.33313419	0	0.014349978	18.25932714	6033.592661	107.7067622	542.2099353	709.7556486	0	0	42.57361503	1626.280002	0	0	299.103167	0	16.50402592	4.604686493	569.2933724	0											4750	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-58 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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, 18a); $0/$40 (17a)"	$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												187.4696942	115.9014585	64.90478591	0	200	0.2	0.107021182	48.49198869	0.2	0.14487801	0.161679805	0	0.2	0.16047058	13.24866862	0.128454685	38.5	40	0	0	0.2	39.588708	0	0	40	0	0	0	0	0											YES	147.9213596	91.45105509	51.21256648	0	157.8082903	0.15780829	0.084444149	38.28054032	0.15780829	0.114314755	0.127572068	0	0.15780829	0.12661794	12.77826692	0.123896941	37.13303507	38.5797767	0	0	0.15780829	31.23713163	0	0	40	0	0	0	0	0											7500	13.3575	0.783056766	2.731191524	0	2.222593351	1.251024149	0.81891019	0.955517315	6.16413947	2.009986704	4.379948933	0	0.002264545	2.311958382	6.424904792	13.34453835	1.677825045	2.281851203	0	0	6.718469401	4.233360206	0	0	0.997010557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6661	0	13.68984673	13.3575	0.783056766	2.731191524	0	2.222593351	1.251024149	0.81891019	0.955517315	6.16413947	2.009986704	4.379948933	0	0.002264545	2.311958382	6.424904792	13.34453835	1.677825045	2.281851203	0	0	6.718469401	4.233360206	0	0	0.997010557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6661	NO	"$350 Days 1-22 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$350 Days 1-22 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-43 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.3566	0.0297	0.2664	0.0778	0.1042	0.088	0.1076	0.0448	0.4334	0.0942	0.3018	0	0.0001	0.1619	0.4714	0.7875	0.0997	0.135	0	0	0.5276	0.2486	0	0	0.059	0	0.0033	0	0	0											4.3985	0	0.835381669	13.7141	0.81276893	2.997547857	0.077774733	2.326762716	1.338974375	0.926499171	1.000301418	6.597494381	2.104191539	4.681753769	0	0.002370681	2.473824195	6.896333695	14.1320863	1.777519404	2.416851657	0	0	7.246037913	4.482000697	0	0	1.056044077	0	0.003257374	0	0	0	0	0	0	0	0	0	0	0	0	0	77.0645
H3456_801_0	2011	1																															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	199.3374062	5.3008	15.72038393	997.6460397	5.189588353	8.585002783	8.416898477	12.36504118	48.91731022	17.61440365	40.20769355	0	0.046040258	21.6068482	35.91442368	116.382066	2.5264	5.578524095	0	0	32.40576036	11.47384197	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.081692849	0.081692849	0.190996971	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.068164056	0.068164056	0.159366804	0	0.194413896	0.194413896	0.194413896	0.194413896	0.194413896	0.194413896	0.194413896	0	0.194413896	0.194413896	0.194413896	0.194413896	0.194413896	0.194413896	0	0	0.194413896	0.194413896	0	0	0	0	0	0	0	0												13.5876	0.361324027	2.505307337	0	1.008928089	1.669043835	1.636362022	2.403935825	9.510204845	3.424484832	7.816934337	0	0.008950866	4.200671532	6.982263017	22.62629083	0.491167266	1.084542601	0	0	6.300130113	2.230674316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8489	0	17.43571536	13.5876	0.361324027	2.505307337	0	1.008928089	1.669043835	1.636362022	2.403935825	9.510204845	3.424484832	7.816934337	0	0.008950866	4.200671532	6.982263017	22.62629083	0.491167266	1.084542601	0	0	6.300130113	2.230674316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8489	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.5876	0.361324027	2.505307337	0	1.008928089	1.669043835	1.636362022	2.403935825	9.510204845	3.424484832	7.816934337	0	0.008950866	4.200671532	6.982263017	22.62629083	0.491167266	1.084542601	0	0	6.300130113	2.230674316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8489
H3456_803_0	2011	1																															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	199.5382556	5.3007	15.73622355	998.6512534	5.194817305	8.593652904	8.425379218	12.37750001	48.96659857	17.63215166	40.24820622	0	0.046086647	21.62859899	35.95061051	116.4993308	2.5262	5.584144932	0	0	32.43841192	11.48540284	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.081692849	0.081692849	0.190996971	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.068143641	0.068143641	0.159319075	0	0.194355671	0.194355671	0.194355671	0.194355671	0.194355671	0.194355671	0.194355671	0	0.194355671	0.194355671	0.194355671	0.194355671	0.194355671	0.194355671	0	0	0.194355671	0.194355671	0	0	0	0	0	0	0	0												13.5973	0.361209	2.507080577	0	1.009642202	1.670225174	1.637520229	2.405637316	9.516936109	3.426908661	7.822467115	0	0.008957201	4.203640864	6.98720502	22.64230558	0.490981295	1.085310234	0	0	6.304589306	2.232253173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.9101	0	17.47943906	13.5973	0.361209	2.507080577	0	1.009642202	1.670225174	1.637520229	2.405637316	9.516936109	3.426908661	7.822467115	0	0.008957201	4.203640864	6.98720502	22.64230558	0.490981295	1.085310234	0	0	6.304589306	2.232253173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.9101	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.5973	0.361209	2.507080577	0	1.009642202	1.670225174	1.637520229	2.405637316	9.516936109	3.426908661	7.822467115	0	0.008957201	4.203640864	6.98720502	22.64230558	0.490981295	1.085310234	0	0	6.304589306	2.232253173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.9101
H3456_804_0	2011	1																															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	199.53825	5.3017	15.73622311	998.6512394	5.194817159	8.593652663	8.425378982	12.37749966	48.9665972	17.63215116	40.24820509	0	0.046086646	21.62829838	35.95060951	116.4993275	2.5253	5.584144776	0	0	32.43841101	11.48540252	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.081692848	0.081692848	0.190996969	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.06814368	0.06814368	0.159319164	0	0.194355782	0.194355782	0.194355782	0.194355782	0.194355782	0.194355782	0.194355782	0	0.194355782	0.194355782	0.194355782	0.194355782	0.194355782	0.194355782	0	0	0.194355782	0.194355782	0	0	0	0	0	0	0	0												13.5973	0.361277346	2.507081912	0	1.009642749	1.67022608	1.637521117	2.405638621	9.516941271	3.42691052	7.822471358	0	0.008957206	4.203584837	6.98720881	22.64231786	0.490806655	1.085310822	0	0	6.304592726	2.232254384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.91	0	17.47935557	13.5973	0.361277346	2.507081912	0	1.009642749	1.67022608	1.637521117	2.405638621	9.516941271	3.42691052	7.822471358	0	0.008957206	4.203584837	6.98720881	22.64231786	0.490806655	1.085310822	0	0	6.304592726	2.232254384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.91	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.5973	0.361277346	2.507081912	0	1.009642749	1.67022608	1.637521117	2.405638621	9.516941271	3.42691052	7.822471358	0	0.008957206	4.203584837	6.98720881	22.64231786	0.490806655	1.085310822	0	0	6.304592726	2.232254384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.91
H3456_805_0	2011	1																															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	199.53825	5.3017	15.73622311	998.6512394	5.194817159	8.593652663	8.425378982	12.37749966	48.9665972	17.63215116	40.24820509	0	0.046086646	21.62829838	35.95060951	116.4993275	2.5253	5.584144776	0	0	32.43841101	11.48540252	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.081692848	0.081692848	0.190996969	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.06814368	0.06814368	0.159319164	0	0.194355782	0.194355782	0.194355782	0.194355782	0.194355782	0.194355782	0.194355782	0	0.194355782	0.194355782	0.194355782	0.194355782	0.194355782	0.194355782	0	0	0.194355782	0.194355782	0	0	0	0	0	0	0	0												13.5973	0.361277346	2.507081912	0	1.009642749	1.67022608	1.637521117	2.405638621	9.516941271	3.42691052	7.822471358	0	0.008957206	4.203584837	6.98720881	22.64231786	0.490806655	1.085310822	0	0	6.304592726	2.232254384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.91	0	17.47935557	13.5973	0.361277346	2.507081912	0	1.009642749	1.67022608	1.637521117	2.405638621	9.516941271	3.42691052	7.822471358	0	0.008957206	4.203584837	6.98720881	22.64231786	0.490806655	1.085310822	0	0	6.304592726	2.232254384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.91	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.5973	0.361277346	2.507081912	0	1.009642749	1.67022608	1.637521117	2.405638621	9.516941271	3.42691052	7.822471358	0	0.008957206	4.203584837	6.98720881	22.64231786	0.490806655	1.085310822	0	0	6.304592726	2.232254384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.91
H3456_806_0	2011	1																															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	199.53825	5.3017	15.73622311	998.6512394	5.194817159	8.593652663	8.425378982	12.37749966	48.9665972	17.63215116	40.24820509	0	0.046086646	21.62829838	35.95060951	116.4993275	2.5253	5.584144776	0	0	32.43841101	11.48540252	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.081692848	0.081692848	0.190996969	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.06814368	0.06814368	0.159319164	0	0.194355782	0.194355782	0.194355782	0.194355782	0.194355782	0.194355782	0.194355782	0	0.194355782	0.194355782	0.194355782	0.194355782	0.194355782	0.194355782	0	0	0.194355782	0.194355782	0	0	0	0	0	0	0	0												13.5973	0.361277346	2.507081912	0	1.009642749	1.67022608	1.637521117	2.405638621	9.516941271	3.42691052	7.822471358	0	0.008957206	4.203584837	6.98720881	22.64231786	0.490806655	1.085310822	0	0	6.304592726	2.232254384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.91	0	17.47935557	13.5973	0.361277346	2.507081912	0	1.009642749	1.67022608	1.637521117	2.405638621	9.516941271	3.42691052	7.822471358	0	0.008957206	4.203584837	6.98720881	22.64231786	0.490806655	1.085310822	0	0	6.304592726	2.232254384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.91	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.5973	0.361277346	2.507081912	0	1.009642749	1.67022608	1.637521117	2.405638621	9.516941271	3.42691052	7.822471358	0	0.008957206	4.203584837	6.98720881	22.64231786	0.490806655	1.085310822	0	0	6.304592726	2.232254384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.91
H3456_807_0	2011	1																															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	198.6212626	5.219909	15.26634548	958.7356823	5.013453449	8.293627332	8.131228495	11.94537102	47.25705411	17.01656985	38.84304229	0	0.044477649	20.87300514	34.51383447	111.843403	2.404545	5.360973043	0	0	31.14200186	11.02638556	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.080984743	0.080984743	0.181898825	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.067530499	0.067530499	0.151679414	0	0.194290994	0.194290994	0.194290994	0.194290994	0.194290994	0.194290994	0.194290994	0	0.194290994	0.194290994	0.194290994	0.194290994	0.194290994	0.194290994	0	0	0.194290994	0.194290994	0	0	0	0	0	0	0	0												13.413	0.352503059	2.315590337	0	0.974068852	1.611377096	1.579824464	2.320878006	9.181620002	3.306166265	7.546853284	0	0.008641607	4.05543691	6.705727195	21.7301659	0.467181437	1.04158878	0	0	6.050610486	2.142327407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.8036	0	16.89559174	13.413	0.352503059	2.315590337	0	0.974068852	1.611377096	1.579824464	2.320878006	9.181620002	3.306166265	7.546853284	0	0.008641607	4.05543691	6.705727195	21.7301659	0.467181437	1.04158878	0	0	6.050610486	2.142327407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.8036	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.245	0.0064	0.1157	0	0.055	0.0911	0.0893	0.1311	0.5188	0.1868	0.4265	0	0.0005	0.2292	0.4232	1.3716	0.0295	0.0657	0	0	0.3819	0.1352	0	0	0	0	0	0	0	0											4.5025	0	0	13.6579	0.358940617	2.431295767	0	1.029111846	1.702433308	1.66909769	2.452026922	9.700457921	3.492992166	7.973313283	0	0.009129929	4.284602835	7.128975797	23.10171921	0.496668752	1.107331239	0	0	6.432509772	2.277545714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3061
H3456_808_0	2011	1																															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	198.6212626	5.219909	15.26634548	958.7356823	5.013453449	8.293627332	8.131228495	11.94537102	47.25705411	17.01656985	38.84304229	0	0.044477649	20.87300514	34.51383447	111.843403	2.404545	5.360973043	0	0	31.14200186	11.02638556	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.080984743	0.080984743	0.181898825	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.067530499	0.067530499	0.151679414	0	0.194290994	0.194290994	0.194290994	0.194290994	0.194290994	0.194290994	0.194290994	0	0.194290994	0.194290994	0.194290994	0.194290994	0.194290994	0.194290994	0	0	0.194290994	0.194290994	0	0	0	0	0	0	0	0												13.413	0.352503059	2.315590337	0	0.974068852	1.611377096	1.579824464	2.320878006	9.181620002	3.306166265	7.546853284	0	0.008641607	4.05543691	6.705727195	21.7301659	0.467181437	1.04158878	0	0	6.050610486	2.142327407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.8036	0	16.89559174	13.413	0.352503059	2.315590337	0	0.974068852	1.611377096	1.579824464	2.320878006	9.181620002	3.306166265	7.546853284	0	0.008641607	4.05543691	6.705727195	21.7301659	0.467181437	1.04158878	0	0	6.050610486	2.142327407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.8036	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.245	0.0064	0.1157	0	0.055	0.0911	0.0893	0.1311	0.5188	0.1868	0.4265	0	0.0005	0.2292	0.4232	1.3716	0.0295	0.0657	0	0	0.3819	0.1352	0	0	0	0	0	0	0	0											4.5025	0	0	13.6579	0.358940617	2.431295767	0	1.029111846	1.702433308	1.66909769	2.452026922	9.700457921	3.492992166	7.973313283	0	0.009129929	4.284602835	7.128975797	23.10171921	0.496668752	1.107331239	0	0	6.432509772	2.277545714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3061
H3456_809_0	2011	1																															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	198.6212626	5.219909	15.26634548	958.7356823	5.013453449	8.293627332	8.131228495	11.94537102	47.25705411	17.01656985	38.84304229	0	0.044477649	20.87300514	34.51383447	111.843403	2.404545	5.360973043	0	0	31.14200186	11.02638556	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.080984743	0.080984743	0.181898825	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.067530499	0.067530499	0.151679414	0	0.194290994	0.194290994	0.194290994	0.194290994	0.194290994	0.194290994	0.194290994	0	0.194290994	0.194290994	0.194290994	0.194290994	0.194290994	0.194290994	0	0	0.194290994	0.194290994	0	0	0	0	0	0	0	0												13.413	0.352503059	2.315590337	0	0.974068852	1.611377096	1.579824464	2.320878006	9.181620002	3.306166265	7.546853284	0	0.008641607	4.05543691	6.705727195	21.7301659	0.467181437	1.04158878	0	0	6.050610486	2.142327407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.8036	0	16.89559174	13.413	0.352503059	2.315590337	0	0.974068852	1.611377096	1.579824464	2.320878006	9.181620002	3.306166265	7.546853284	0	0.008641607	4.05543691	6.705727195	21.7301659	0.467181437	1.04158878	0	0	6.050610486	2.142327407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.8036	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.245	0.0064	0.1157	0	0.055	0.0911	0.0893	0.1311	0.5188	0.1868	0.4265	0	0.0005	0.2292	0.4232	1.3716	0.0295	0.0657	0	0	0.3819	0.1352	0	0	0	0	0	0	0	0											4.5025	0	0	13.6579	0.358940617	2.431295767	0	1.029111846	1.702433308	1.66909769	2.452026922	9.700457921	3.492992166	7.973313283	0	0.009129929	4.284602835	7.128975797	23.10171921	0.496668752	1.107331239	0	0	6.432509772	2.277545714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3061
H3528_001_0	2011	7																															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	937.390343	19.19725063	488.1956275	87.10677626	186.2425835	8.754649071	1.255741274	409.4018484	665.329853	4378.982081	1596.957565	0	0	746.2147167	3293.423022	6910.466676	693.6444307	696.0759071	1127.570082	4498.618323	9.820844493	0	0	0	729.6041707	80.90515779	2.915501182	0	0	0											4900	$250 Days 1-7	$250 Days 1-7	"$50 Days 1-20, $100 days 21-100"	0	$150 copay	0.2	0.2	50	"$175, Colorectal exempt"	0	"$35 X-ray, $45 ther., $200 diag."	0	0	0	$15 copay	$30 copay	$30 copay	$30 copay	$30 copay	0	20% coinsurance	0	0	0	$30 copay	0	$30 copay	0	0	0												132.75	132.75	65.76	0	150	0.2	0.2	50	157.5	0	76.29	0	0	0	15	30	30	30	30	0	0.2	0	0	0	30	0	30	0	0	0											NO	131.7971576	131.7971576	65.28799311	0	148.9233419	0.198564456	0.198564456	49.64111398	156.369509	0	75.74241171	0	0	0	14.89233419	29.78466839	29.78466839	29.78466839	29.78466839	0	0.198564456	0	0	0	29.78466839	0	29.78466839	0	0	0												10.2954	0.210845256	2.656109397	0	2.311322329	1.73836213	0.249345583	1.693596985	8.669775205	0	10.07978478	0	0	0	4.087229691	17.1521632	1.721664112	1.727699172	2.798691748	0	1.950070643	0	0	0	1.81091819	0	0.007236436	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1603		0.5	10.2954	0.210845256	2.656109397	0	2.311322329	1.73836213	0.249345583	1.693596985	8.669775205	0	10.07978478	0	0	0	4.087229691	17.1521632	1.721664112	1.727699172	2.798691748	0	1.950070643	0	0	0	1.81091819	0	0.007236436	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1603	NO																																																																																		0			10.2954	0.210845256	2.656109397	0	2.311322329	1.73836213	0.249345583	1.693596985	8.669775205	0	10.07978478	0	0	0	4.087229691	17.1521632	1.721664112	1.727699172	2.798691748	0	1.950070643	0	0	0	1.81091819	0	0.007236436	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1603
H3528_002_0	2011	8																															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	1228.408704	18.4603483	1062.814732	139.1004488	247.0289899	9.536525714	0.627870637	418.8096646	873.4837823	5524.4665	2147.845003	0	0	807.6205577	3874.167395	9404.253856	667.0183158	1476.132725	1564.038086	5897.168644	20.8500438	0	0	0	963.1305892	146.2144435	2.061432235	0	0	0											2900	$200 Days 1-7	$200 Days 1-7	"$50 Days 1-20, $100 days 21-100"	0	$150 copay	0.2	0.2	50	"$125, Colorectal exempt"	0	"$35 X-ray, $45 ther., $150 diag."	0	0	0	$10 copay	$25 copay	$25 copay	$25 copay	$30 copay	0	20% coinsurance	0	0	0	$25 copay	0	$25 copay	0	0	0												106.2	106.2	65.76	0	150	0.2	0.2	50	90	0	64.36	0	0	0	10	25	25	25	30	0	0.2	0	0	0	25	0	25	0	0	0											NO	104.2147025	104.2147025	64.53068587	0	147.1959075	0.19626121	0.19626121	49.06530251	88.31754452	0	63.1568574	0	0	0	9.813060503	24.53265126	24.53265126	24.53265126	29.43918151	0	0.19626121	0	0	0	24.53265126	0	24.53265126	0	0	0												10.6682	0.160319976	5.715346967	0	3.030138029	1.871650076	0.123226651	1.712418574	6.428661903	0	11.30426171	0	0	0	3.168119921	19.22594001	1.363643977	3.017787447	3.837000091	0	4.092054825	0	0	0	1.969012238	0	0.004214367	0	0	0	0	0	0	0	0	0	0	0	0	0	77.692		1.48	10.6682	0.160319976	5.715346967	0	3.030138029	1.871650076	0.123226651	1.712418574	6.428661903	0	11.30426171	0	0	0	3.168119921	19.22594001	1.363643977	3.017787447	3.837000091	0	4.092054825	0	0	0	1.969012238	0	0.004214367	0	0	0	0	0	0	0	0	0	0	0	0	0	77.692	NO																																																																																		0			10.6682	0.160319976	5.715346967	0	3.030138029	1.871650076	0.123226651	1.712418574	6.428661903	0	11.30426171	0	0	0	3.168119921	19.22594001	1.363643977	3.017787447	3.837000091	0	4.092054825	0	0	0	1.969012238	0	0.004214367	0	0	0	0	0	0	0	0	0	0	0	0	0	77.692
H3528_003_0	2011	4																															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	1129.784017	18.2521067	755.1108377	106.4286352	223.1979848	11.64109654	0.569168143	378.790672	667.2537805	4303.639396	1595.291991	0	0	662.1693652	2850.470688	7799.290139	659.4940287	954.6417165	1120.488376	4765.19159	13.74818461	0	0	0	715.0506334	64.00252051	2.410808059	0	0	0											5500	$200 Days 1-7	$200 Days 1-7	"$50 Days 1-20,$100 days 21-100"	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	20% coinsurance	0	0	0	$30 copay	0	$30 copay	0	0	0												106.2	106.2	65.76	0	100	0.2	0.2	50	112.5	0	64.61	0	0	0	20	30	30	30	30	0	0.2	0	0	0	30	0	30	0	0	0											NO	105.6327242	105.6327242	65.4087377	0	99.465842	0.198931684	0.198931684	49.732921	111.8990723	0	64.26488052	0	0	0	19.8931684	29.8397526	29.8397526	29.8397526	29.8397526	0	0.198931684	0	0	0	29.8397526	0	29.8397526	0	0	0												9.9452	0.160668313	4.115903893	0	1.850047958	2.315782939	0.113225577	1.569863881	6.222089916	0	8.543437434	0	0	0	4.725407784	19.39407402	1.639928221	2.373856053	2.786257995	0	2.734949517	0	0	0	1.778077833	0	0.005994826	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2747		0.38	9.9452	0.160668313	4.115903893	0	1.850047958	2.315782939	0.113225577	1.569863881	6.222089916	0	8.543437434	0	0	0	4.725407784	19.39407402	1.639928221	2.373856053	2.786257995	0	2.734949517	0	0	0	1.778077833	0	0.005994826	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2747	NO																																																																																		0			9.9452	0.160668313	4.115903893	0	1.850047958	2.315782939	0.113225577	1.569863881	6.222089916	0	8.543437434	0	0	0	4.725407784	19.39407402	1.639928221	2.373856053	2.786257995	0	2.734949517	0	0	0	1.778077833	0	0.005994826	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2747
H3528_006_0	2011	6																															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	1231.082119	18.87633122	817.0151545	140.0563101	226.9460456	9.604635962	0.633927608	430.7250096	942.8485291	5936.951968	2015.185749	0	0	929.7244016	3561.441671	10572.34015	682.0488139	1843.50362	1668.609379	6062.962079	20.80860421	0	0	0	1025.096144	154.1679353	7.68189329	0	0	0												$200 Days 1-7	$200 Days 1-7	"$50 Days 1-20,100 days 21-100"	0	$150 copay	0.2	0.2	50	"$125, Colorectal exempt"	0	"$35 X-ray, $45 ther., $150 diag."	0	0	0	$15 copay	$25 copay	$25 copay	$25 copay	$30 copay	0	20% coinsurance	0	0	0	$25 copay	0	$25 copay	0	0	0												106.2	106.2	65.76	0	150	0.2	0.2	50	112.5	0	64.36	0	0	0	15	25	25	25	30	0	0.2	0	0	0	25	0	25	0	0	0											NO	105.7753416	105.7753416	65.49704765	0	149.4001999	0.199200267	0.199200267	49.80006664	112.05015	0	64.10264578	0	0	0	14.94001999	24.90003332	24.90003332	24.90003332	29.88003999	0	0.199200267	0	0	0	24.90003332	0	24.90003332	0	0	0												10.8515	0.166387532	4.459340042	0	2.825482049	1.913246044	0.126278548	1.787511182	8.803859922	0	10.76489486	0	0	0	4.434000815	21.93763517	1.415253183	3.82527513	4.154842913	0	4.145079505	0	0	0	2.127077345	0	0.01593995	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7536		0.36	10.8515	0.166387532	4.459340042	0	2.825482049	1.913246044	0.126278548	1.787511182	8.803859922	0	10.76489486	0	0	0	4.434000815	21.93763517	1.415253183	3.82527513	4.154842913	0	4.145079505	0	0	0	2.127077345	0	0.01593995	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7536	YES	$300 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	0.2	0	0	0	40	0	40	0	0	0											5500	0.8601	0	0	0	0.0995	0.1011	0.0067	0.0945	0.9124	0	0.3943	0	0	0.1007	0.6148	1.8448	0	0.3234	0.191	0	0.219	0	0	0	0.1798	0	0.0013	0	0	0											5.9436		0.02	11.7116	0.166387532	4.459340042	0	2.925019789	2.014347475	0.132951471	1.881968421	9.716255502	0	11.15915472	0	0	0.10073999	5.048815143	23.78243169	1.415253183	4.148696818	4.34585436	0	4.364117444	0	0	0	2.306918773	0	0.01728765	0	0	0	0	0	0	0	0	0	0	0	0	0	89.6972
H3528_008_0	2011	5																															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	1064.121584	19.27283036	568.5993036	104.9873151	205.1197255	9.062661082	1.848782861	433.3002484	674.8317595	4434.348621	1629.427405	0	0	775.5710329	3300.974113	7064.756421	696.3753143	615.3002951	1089.838651	4565.165621	11.56395554	0	0	0	719.8053712	79.44518542	4.265513311	0	0	0												$250 Days 1-7	$250 Days 1-7	"$50 Days 1-20, $100 days 21-100"	0	$150 copay	0.2	0.2	50	"$200, Colorectal exempt"	0	"$35 X-ray, $50 ther., $200 diag."	0	0	0	$25 copay	$40 copay	$40 copay	$40 copay	$30 copay	0	20% coinsurance	0	0	0	$40 copay	0	$40 copay	0	0	0												132.75	132.75	65.76	0	150	0.2	0.2	50	180	0	78.67	0	0	0	25	40	40	40	30	0	0.2	0	0	0	40	0	25	0	0	0											NO	132.3898195	132.3898195	65.58157839	0	149.5930164	0.199457355	0.199457355	49.8643388	179.5116197	0	78.45655067	0	0	0	24.9321694	39.89147104	39.89147104	39.89147104	29.91860328	0	0.199457355	0	0	0	39.89147104	0	24.9321694	0	0	0												11.7399	0.212627211	3.107469983	0	2.557039871	1.80761441	0.36875334	1.800519199	10.09501185	0	10.65327115	0	0	0	6.858370482	23.48529385	2.314952974	2.045436159	2.717204186	0	2.306515988	0	0	0	2.39284126	0	0.008862375	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4717		0.23	11.7399	0.212627211	3.107469983	0	2.557039871	1.80761441	0.36875334	1.800519199	10.09501185	0	10.65327115	0	0	0	6.858370482	23.48529385	2.314952974	2.045436159	2.717204186	0	2.306515988	0	0	0	2.39284126	0	0.008862375	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4717	YES	0.2	0	0	0	0.2	0.2	0.2	50	0.2	0	0.2	0	0	0	0.2	0.2	0	0.2	0.2	0	0.2	0	0	0	0.2	0	0.2	0	0	0											6700	1.9906	0	0	0	0.1226	0.0906	0.0185	0.095	0.7071	0	0.2434	0	0	0	0.3321	0.7655	0	0.0963	0.2186	0	0.1217	0	0	0	0.0978	0	0.0001	0	0	0											4.9		0.01	13.7305	0.212627211	3.107469983	0	2.679687884	1.898241021	0.387241168	1.895541183	10.80214108	0	10.8966338	0	0	0	7.190426384	24.25081597	2.314952974	2.141742037	2.935795572	0	2.428241836	0	0	0	2.490597164	0	0.008983211	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3717
H3528_801_0	2011	5																															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	YES	1476.158691	20.58595932	1094.155606	163.8665212	18.06318365	19.75534806	1.490716271	20.97746681	110.2592846	29.47857852	40.61194598	0	0	14.11480001	37.73923227	108.3873642	5.497665372	19.05632475	29.62041882	56.00053968	20.18862218	0	0	0	12.69618602	139.8726733	0.036137152	0	0	0											6700	2011 Mcare defined cost share	2011 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	147.7532305	147.7532305	45.26440183	0	0.232611505	0.232611505	0.232611505	0.232611505	0.232611505	0	0.232611505	0.232611505	0.232611505	0.232611505	0.232611505	0.232611505	0.499166319	0.232611505	0.232611505	0.232611505	0.232611505	0.232611505	0	0.232611505	0.232611505	0	0.232611505	0	0.232611505	0												18.1756	0.253470166	4.127191584	0	4.201704329	4.595321241	0.346757755	4.879600121	25.6475781	0	9.446805868	0	0	3.28326487	8.778579609	25.21214788	2.744249388	4.432720377	6.890050194	13.02636981	4.696105785	0	0	0	2.953278936	0	0.008405917	0	0	0	0	0	0	0	0	0	0	0	0	0	143.6992		0.24	18.1756	0.253470166	4.127191584	0	4.201704329	4.595321241	0.346757755	4.879600121	25.6475781	0	9.446805868	0	0	3.28326487	8.778579609	25.21214788	2.744249388	4.432720377	6.890050194	13.02636981	4.696105785	0	0	0	2.953278936	0	0.008405917	0	0	0	0	0	0	0	0	0	0	0	0	0	143.6992	NO																																																																																		0			18.1756	0.253470166	4.127191584	0	4.201704329	4.595321241	0.346757755	4.879600121	25.6475781	0	9.446805868	0	0	3.28326487	8.778579609	25.21214788	2.744249388	4.432720377	6.890050194	13.02636981	4.696105785	0	0	0	2.953278936	0	0.008405917	0	0	0	0	0	0	0	0	0	0	0	0	0	143.6992
H3528_805_0	2011	4																															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	YES	1476.158691	20.58595932	1094.155606	163.8665212	18.06318365	19.75534806	1.490716271	20.97746681	110.2592846	29.47857852	40.61194598	0	0	14.11480001	37.73923227	108.3873642	5.497665372	19.05632475	29.62041882	56.00053968	20.18862218	0	0	0	12.69618602	139.8726733	0.036137152	0	0	0											6700	2011 Mcare defined cost share	2011 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	147.7532305	147.7532305	45.26440183	0	0.232611505	0.232611505	0.232611505	0.232611505	0.232611505	0	0.232611505	0.232611505	0.232611505	0.232611505	0.232611505	0.232611505	0.499166319	0.232611505	0.232611505	0.232611505	0.232611505	0.232611505	0	0.232611505	0.232611505	0	0.232611505	0	0.232611505	0												18.1756	0.253470166	4.127191584	0	4.201704329	4.595321241	0.346757755	4.879600121	25.6475781	0	9.446805868	0	0	3.28326487	8.778579609	25.21214788	2.744249388	4.432720377	6.890050194	13.02636981	4.696105785	0	0	0	2.953278936	0	0.008405917	0	0	0	0	0	0	0	0	0	0	0	0	0	143.6992		0.24	18.1756	0.253470166	4.127191584	0	4.201704329	4.595321241	0.346757755	4.879600121	25.6475781	0	9.446805868	0	0	3.28326487	8.778579609	25.21214788	2.744249388	4.432720377	6.890050194	13.02636981	4.696105785	0	0	0	2.953278936	0	0.008405917	0	0	0	0	0	0	0	0	0	0	0	0	0	143.6992	NO																																																																																		0			18.1756	0.253470166	4.127191584	0	4.201704329	4.595321241	0.346757755	4.879600121	25.6475781	0	9.446805868	0	0	3.28326487	8.778579609	25.21214788	2.744249388	4.432720377	6.890050194	13.02636981	4.696105785	0	0	0	2.953278936	0	0.008405917	0	0	0	0	0	0	0	0	0	0	0	0	0	143.6992
H3528_806_0	2011	4																															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	1402.350757	19.55666135	1039.447826	155.6731952	17.16002446	18.76758066	1.416180458	19.92859347	104.7463203	28.00464959	38.58134868	0	0	13.40906001	35.85227066	102.967996	5.222782103	18.10350852	28.13939788	53.2005127	19.17919107	0	0	0	12.06137672	132.8790396	0.034330294	0	0	0												2011 Mcare defined cost share	2011 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	147.7510604	147.7510604	45.26373702	0	0.232608088	0.232608088	0.232608088	0.232608088	0.232608088	0	0.232608088	0.232608088	0.232608088	0.232608088	0.232608088	0.232608088	0.499158988	0.232608088	0.232608088	0.232608088	0.232608088	0.232608088	0	0.232608088	0.232608088	0	0.232608088	0	0.232608088	0												17.2666	0.240793121	3.920774419	0	3.991560487	4.36549106	0.329415029	4.63555203	24.36484133	0	8.974333763	0	0	3.119055815	8.339528141	23.9511887	2.606998628	4.211022508	6.545451547	12.37486956	4.461234971	0	0	0	2.805573782	0	0.007985504	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5122		0.23	17.2666	0.240793121	3.920774419	0	3.991560487	4.36549106	0.329415029	4.63555203	24.36484133	0	8.974333763	0	0	3.119055815	8.339528141	23.9511887	2.606998628	4.211022508	6.545451547	12.37486956	4.461234971	0	0	0	2.805573782	0	0.007985504	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5122	YES	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											6700	2.9067	0	0	0	0.2104	0.2301	0.0174	0.2444	1.2845	0.3434	0.4731	0	0	0.1644	0.4397	1.2527	0	0.222	0.3451	0.6524	0.2352	0	0	0	0.1479	0	0.0004	0	0	0											9.1699		0.01	20.1732	0.240793121	3.920774419	0	4.201996576	4.595640865	0.346781874	4.879939518	25.649362	0.34342544	9.447462934	0	0	3.283493235	8.779190197	25.2039015	2.606998628	4.433028692	6.890529427	13.02727585	4.696432419	0	0	0	2.95348435	0	0.008406502	0	0	0	0	0	0	0	0	0	0	0	0	0	145.6822
H3528_807_0	2011	4																															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	1402.350757	19.55666135	1039.447826	155.6731952	17.16002446	18.76758066	1.416180458	19.92859347	104.7463203	28.00464959	38.58134868	0	0	13.40906001	35.85227066	102.967996	5.222782103	18.10350852	28.13939788	53.2005127	19.17919107	0	0	0	12.06137672	132.8790396	0.034330294	0	0	0												2011 Mcare defined cost share	2011 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	147.7510604	147.7510604	45.26373702	0	0.232608088	0.232608088	0.232608088	0.232608088	0.232608088	0	0.232608088	0.232608088	0.232608088	0.232608088	0.232608088	0.232608088	0.499158988	0.232608088	0.232608088	0.232608088	0.232608088	0.232608088	0	0.232608088	0.232608088	0	0.232608088	0	0.232608088	0												17.2666	0.240793121	3.920774419	0	3.991560487	4.36549106	0.329415029	4.63555203	24.36484133	0	8.974333763	0	0	3.119055815	8.339528141	23.9511887	2.606998628	4.211022508	6.545451547	12.37486956	4.461234971	0	0	0	2.805573782	0	0.007985504	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5122		0.23	17.2666	0.240793121	3.920774419	0	3.991560487	4.36549106	0.329415029	4.63555203	24.36484133	0	8.974333763	0	0	3.119055815	8.339528141	23.9511887	2.606998628	4.211022508	6.545451547	12.37486956	4.461234971	0	0	0	2.805573782	0	0.007985504	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5122	YES	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											6700	2.9067	0	0	0	0.2104	0.2301	0.0174	0.2444	1.2845	0.3434	0.4731	0	0	0.1644	0.4397	1.2527	0	0.222	0.3451	0.6524	0.2352	0	0	0	0.1479	0	0.0004	0	0	0											9.1699		0.01	20.1732	0.240793121	3.920774419	0	4.201996576	4.595640865	0.346781874	4.879939518	25.649362	0.34342544	9.447462934	0	0	3.283493235	8.779190197	25.2039015	2.606998628	4.433028692	6.890529427	13.02727585	4.696432419	0	0	0	2.95348435	0	0.008406502	0	0	0	0	0	0	0	0	0	0	0	0	0	145.6822
H3533_001_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1059.678982	103.5583631	707.1535161		160.2527663	6.547602832	5.997752686	223.6653315	228.6032435		5.113325866	1.165094696	0.047005983	21.49911392	4172.491216	4851.64799	281.807721	1501.243866	27.25519674		11.47608957				159.1037094																3900	"1a (IP Acute) 250 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 350 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 29 copay, 7i (PT/ST) 29 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 5 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 29 copay, 7f (Podiatry) 29 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 29 copay, 18a (Hearing Exam) 29 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 29 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 29 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0% Coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												181.2051416	172.0337627	49.94161658		150	0.2	0.2	47.64790189	276.7162679		0.2	0.2	0.2	0.193991896	5	28.505831	40	29	0.181		0.2				25																NO	162.6679354	154.4347846	44.8326112		134.6550661	0.179540088	0.179540088	42.77354252	248.4083156		0.179540088	0.179540088	0.179540088	0.17414661	4.488502202	25.58993193	35.90801762	26.03331277	0.16248378		0.179540088				25																	14.3646	1.332751124	2.641961554	0	1.798237236	1.175557189	1.076837046	0.797246547	4.732245556	0	0.918046976	0.209181204	0.008439458	3.743997808	1.560686334	10.34611182	0.843263051	3.256862594	4.428527384	0	2.060418133	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6265	0	6.301167971	14.3646	1.332751124	2.641961554	0	1.798237236	1.175557189	1.076837046	0.797246547	4.732245556	0	0.918046976	0.209181204	0.008439458	3.743997808	1.560686334	10.34611182	0.843263051	3.256862594	4.428527384	0	2.060418133	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6265	NO																																																																																		0	0	0	14.3646	1.332751124	2.641961554	0	1.798237236	1.175557189	1.076837046	0.797246547	4.732245556	0	0.918046976	0.209181204	0.008439458	3.743997808	1.560686334	10.34611182	0.843263051	3.256862594	4.428527384	0	2.060418133	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6265
H3533_002_0	2011	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin	T	Coin	P	P	P	P	O	V																																																			0	YES	238.8860724	21.57247455	23.1054837		9.309911206	11.01432051	13.76167353	23.2276523	29.08492474		10.32602888	3.890985464	1.56028646	25.19836985		3736.490769	13.29363686	481.3580289	19.46195858	9.323594185	10.18992014	0.385908853		13.93798932	159.1037094		260.9166693														3400	"1a (IP Acute) FFS, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 20% coin	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 20% coin, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 20% coin"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 0-20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 20% coin, 5 (Partial Hosp) 20% coin, 7c (OT) 8 copay, 7i (PT/ST) 8 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 20% coin, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 8 copay, 7b1 (Routine Chiro) 0% coin (5 visits), 7d (SPC w/Copay) 8 copay, 7f (Podiatry) 8 copay, 7f1 (Routine Podiatry) 0% coin (3 visits), 17a (Eye Exam) 8 copay, 18a (Hearing Exam) 8 copay"	"7e (MH Non-Phys) 45% coin, 7h (Psych) 45% coin"	7i (PT/ST) 8 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0-20% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 8 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 8 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 87"												0.087322435	0.087322435	0.178524803		0.2	0.2	0.2	0.2	0.2		0.2	0.2	0.2	0.2		8	0.45	8	0.181	0.07872	0.2	0.199893776		0.135384615	5		8														NO	0.075602948	0.075602948	0.154565105		0.17315813	0.17315813	0.17315813	0.17315813	0.17315813		0.17315813	0.17315813	0.17315813	0.17315813		6.926325194	0.389605792	6.926325194	0.156708108	0.06815504	0.17315813	0.173066162		0.135384615	5		6.926325194															18.0605	1.630942668	3.571301522	0	1.612086813	1.90721914	2.382945652	4.022056834	5.036291174	0	1.78803585	0.673755766	0.270176285	4.363302599	0	2.156679179	5.179277921	0.277836854	3.049846697	0.635449934	1.764467515	0.066787764	0	1.886989318	0.066293212	0	0.150599475	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5528	0	9.083729064	18.0605	1.630942668	3.571301522	0	1.612086813	1.90721914	2.382945652	4.022056834	5.036291174	0	1.78803585	0.673755766	0.270176285	4.363302599	0	2.156679179	5.179277921	0.277836854	3.049846697	0.635449934	1.764467515	0.066787764	0	1.886989318	0.066293212	0	0.150599475	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5528	NO																																																																																		0	0	0	18.0605	1.630942668	3.571301522	0	1.612086813	1.90721914	2.382945652	4.022056834	5.036291174	0	1.78803585	0.673755766	0.270176285	4.363302599	0	2.156679179	5.179277921	0.277836854	3.049846697	0.635449934	1.764467515	0.066787764	0	1.886989318	0.066293212	0	0.150599475	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5528
H3533_801_0	2011	3																															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	Coin	V																																																			0	YES	227.4986081	4.816220376	21.64941773		4.741326104	5.229990481	7.824387067	13.03318274	40.20030768	5.648840767	15.12595614	3.349618633	0.355966845	19.73472283	54.44655332	110.0499444	2.815356025	11.27613634	28.04070881	15.28431242	15.72331121	0.717295013																			6700	"1a (IP Acute) FFS, 1a1 (Add'l Days) n/a"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) n/a"	6a (Home Health) FFS	10a (Ambulance) FFS	11a (DME) FFS	"11b (Prosthetics) FFS, 11b (Medical Supplies) FFS, 11c (Diabetic Supplies) FFS"	"4a (ER) FFS, 4a (ER) - Worldwide Coverage n/a, 4b (UC) FFS"	"9a (OP Surgery) FFS, 9b (OP ASC) FFS"	8a (OP Diag Proc/Test/Lab) FFS	"8b (X-Ray) FFS, 8b (OP Therap Rad) FFS, 8b (OP Diag) FFS"	9a (OP Observation) FFS	12 (Renal Dialysis) FFS	"3 (CORF) FFS, 5 (Partial Hosp) FFS, 7c (OT) FFS, 7i (PT/ST) FFS, 9a (OP Other) FFS, 9a (OP Chemo) FFS, 9c (OP SA) FFS, 9d (OP Cardiac Rehab) FFS"	"7a (PCP w/Copay) FFS, 14b (Immunizations) FFS, 14c (Routine Physical) FFS, 14d (Pap & Pelvic Exam) FFS, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) FFS, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) FFS, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) FFS, 14h (Mammography) FFS, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) FFS, 14j (Nutrition Therapy Diabetes) FFS"	"7b (Chiro) FFS, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) FFS, 7f (Podiatry) FFS, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) FFS, 18a (Hearing Exam) FFS"	"7e (MH Non-Phys) FFS, 7h (Psych) FFS"	7i (PT/ST) FFS	7g Physician Specialist Services Excluding Psychiatric (Radiology only) FFS	"8a (OP Diag Proc/Test/Lab) FFS, 7g (Prof. Other) FFS"	15 (Part B Rx) FFS	"13a (Blood) FFS, 13a1 (3 Pint Blood) n/a, 14a4-1 (Smoking Cessation - Mdcr Covered) FFS, 16b (Comp. Dental) FFS, 17b (MCR Eyewear) FFS"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive n/a"	17a1 (Routine Eye Exam) n/a	17b1 (Non MCR Covered) n/a	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) n/a, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												0.076653506	0.076653506	0.164633008		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069034452	0.069034452	0.148269141		0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725																				15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	0	10.31335866	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	NO																																																																																		0	0	0	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469
H3597_001_0	2011	3																															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	1246.307718	43.53508353	720.536422	513.781875	189.1238449	7.203910915	0	287.6128954	388.0642707	3642.927407	2344.095807	79.9398984	1.093880825	501.6930475	2948.117881	4696.280378	175.0763088	872.9099842	0	0	242.6707971	0	0	0	1190.64169	100.1169199	54.64585074	15.2920274	64.62602862	0											3400	$185/day 1-10	$300/day 1-7	"$0/d 1-10, $100/d 11-100"	$15 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 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; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$30 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$30 per visit	$30 per visit	$40 per visit	$30 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	151.63	216.8565234	63.41611249	15	150	0.05	0.05	49	175	4.5	18.625	30	25	30	10	30	30	22.5	40	30	$50 	0	0	0	0	0	0	0	0	0											NO	136.0959366	194.6401877	56.91931166	13.46329255	134.6329255	0.044877642	0.044877642	43.980089	157.0717464	4.038987765	16.71692158	26.9265851	22.43882092	26.9265851	8.975528367	26.9265851	26.9265851	20.19493883	35.90211347	26.9265851	44.87764184	0	0	0	0	0	0	0	0	0												14.1348	0.706139736	3.417703097	0.576432974	2.121858043	0.323294534	0	1.054103395	5.079494394	1.226144936	3.265505483	0.179375706	0.00204545	1.125740045	2.205076306	10.53789944	0.392850594	1.469030311	0	0	0.907541093	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.725	0	5.5615	14.1348	0.706139736	3.417703097	0.576432974	2.121858043	0.323294534	0	1.054103395	5.079494394	1.226144936	3.265505483	0.179375706	0.00204545	1.125740045	2.205076306	10.53789944	0.392850594	1.469030311	0	0	0.907541093	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.725	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			14.1348	0.706139736	3.417703097	0.576432974	2.121858043	0.323294534	0	1.054103395	5.079494394	1.226144936	3.265505483	0.179375706	0.00204545	1.125740045	2.205076306	10.53789944	0.392850594	1.469030311	0	0	0.907541093	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.725
H3597_002_0	2011	4																															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	1302.919102	52.79969888	779.1773628	669.869837	199.1764336	9.380080796	0	359.5202289	387.0184077	4397.235229	2649.345433	34.70488135	1.04527842	634.0680572	3297.070095	5575.009926	211.0543281	1053.029584	0	0	309.2094653	0	0	0	1471.444525	87.57760556	59.15452111	14.75008621	62.69212868	0											3400	$75/day 1-10	$300/day 1-7	"$0/d 1-10, $100/d 11-100"	$15 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$175 per procedure	$20 per visit	$20 X-ray; $175 Complex Radiology	$20 per visit	$25 per visit	$20 per visit	"$5 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$20 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$20 per visit	$20 per visit	$40 per visit	$20 per visit	$50 per script	0	Not Covered	0	$0 per visit	$75.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	61.47355533	216.8565234	63.41611249	15	150	0.05	0.05	49	175	3	13.875	20	25	20	5	20	20	15	40	20	$50 	0	0	0	0	0	0	0	0	0											NO	57.11879311	201.4944935	58.9237403	13.93740596	139.3740596	0.04645802	0.04645802	45.52885948	162.6030696	2.787481193	12.89210052	18.58320795	23.22900994	18.58320795	4.645801988	18.58320795	18.58320795	13.93740596	37.1664159	18.58320795	46.45801988	0	0	0	0	0	0	0	0	0												6.2018	0.886570715	3.826003714	0.778020655	2.313335678	0.43577998	0	1.364045499	5.244198423	1.021434208	2.846302303	0.053744002	0.002023399	0.981918214	1.276461233	8.633464066	0.326838872	1.223041733	0	0	1.197104957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6121	0	2.9438	6.2018	0.886570715	3.826003714	0.778020655	2.313335678	0.43577998	0	1.364045499	5.244198423	1.021434208	2.846302303	0.053744002	0.002023399	0.981918214	1.276461233	8.633464066	0.326838872	1.223041733	0	0	1.197104957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6121	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			6.2018	0.886570715	3.826003714	0.778020655	2.313335678	0.43577998	0	1.364045499	5.244198423	1.021434208	2.846302303	0.053744002	0.002023399	0.981918214	1.276461233	8.633464066	0.326838872	1.223041733	0	0	1.197104957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6121
H3597_801_0	2011	2																															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	YES	257.7461366	5.261692688	32.92683139	6.537583982	7.666101627	9.913036941	0	12.28832867	33.91517164	15.1933357	49.09561505	0.869274312	0.074536544	22.61011444	23.07726657	110.4331488	2.986215123	7.034172481	0	0	58.66837263	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.080349692	0.080349692	0.140225504	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.064563584	0.064563584	0.112675742	0	0.187223059	0.187223059	0.187223059	0.187223059	0.187223059	0.187223059	0.187223059	0.187223059	0.187223059	0.187223059	0.187223059	0.187223059	0.187223059	0.187223059	0.187223059	0.187223059	0.187223059	0.187223059	0	0	0	0	0	0	0	0												16.641	0.339713739	3.71005515	0	1.435270996	1.855949099	0	2.300658482	6.349702177	2.844542785	9.191831227	0.162748196	0.01395496	4.233134787	4.320596438	20.67563193	0.55908833	1.316959289	0	0	10.98407218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9349	0	21.25600836	16.641	0.339713739	3.71005515	0	1.435270996	1.855949099	0	2.300658482	6.349702177	2.844542785	9.191831227	0.162748196	0.01395496	4.233134787	4.320596438	20.67563193	0.55908833	1.316959289	0	0	10.98407218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9349	NO																																																																																		0			16.641	0.339713739	3.71005515	0	1.435270996	1.855949099	0	2.300658482	6.349702177	2.844542785	9.191831227	0.162748196	0.01395496	4.233134787	4.320596438	20.67563193	0.55908833	1.316959289	0	0	10.98407218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9349
H3597_802_0	2011	2																															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	YES	259.2994034	5.293401457	33.12525979	6.57698171	7.71230019	9.972776309	0	12.36238236	34.11955612	15.28489597	49.3914821	0.874512858	0.074985727	22.74637076	23.21633811	111.0986569	3.004211082	7.076562822	0	0	59.02192841	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.080225602	0.080225602	0.140033871	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.064458198	0.064458198	0.112511851	0	0.187206574	0.187206574	0.187206574	0.187206574	0.187206574	0.187206574	0.187206574	0.187206574	0.187206574	0.187206574	0.187206574	0.187206574	0.187206574	0.187206574	0.187206574	0.187206574	0.187206574	0.187206574	0	0	0	0	0	0	0	0												16.714	0.341203118	3.726984292	0	1.443793298	1.866969288	0	2.31431925	6.387405214	2.86143301	9.246410157	0.163714556	0.014037821	4.258270145	4.346251123	20.79839896	0.562408065	1.324779083	0	0	11.04929302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.4196	0	21.38410438	16.714	0.341203118	3.726984292	0	1.443793298	1.866969288	0	2.31431925	6.387405214	2.86143301	9.246410157	0.163714556	0.014037821	4.258270145	4.346251123	20.79839896	0.562408065	1.324779083	0	0	11.04929302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.4196	NO																																																																																		0			16.714	0.341203118	3.726984292	0	1.443793298	1.866969288	0	2.31431925	6.387405214	2.86143301	9.246410157	0.163714556	0.014037821	4.258270145	4.346251123	20.79839896	0.562408065	1.324779083	0	0	11.04929302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.4196
H3619_001_0	2011	8	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		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	YES	1192.801214	53.621152	635.478668	705.600143	51.091935	10.3413	3.15219	372.67525	399.811201	1368.012437	1034.989926	118.751006	0.429523	8.3903	3448.407387	3361.048035	66.206858	564.747876		1313.531625	23.376531	0		3.22					4.53	0.56	866.77149	813.259305									4700	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$40/Visit:7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$40-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"										165.92202	145.11002	32.5726	0	150	0.2	0.2	50	183.201041	26.171046	110.13909	150	0.171154	0.2	15	38.6338	40	73.859565		0	0.2	0		0					0	0	0	131.510695									NO	141.64066	123.874329	22.490631	0	127.42845	0.169905	0.169905	42.47615	155.633498	22.232905	93.56569	127.42845	0.145399	0.169905	12.742845	32.820302	33.98092	62.745399		0	0.169905	0		0					0	0	0	111.72136										14.0791	0.553523685	1.191026353	0	0.542547174	1.757038577	0.535572842	1.319150818	5.185334646	2.534574213	8.069962214	1.261021386	0.062452215	1.425553922	3.661876736	9.192550962	0.187480829	2.952944235	0	0	3.9717895	0	0	0	0	0	0	0	0	0	0	7.571536299	0	0	0	0	0	0	0	0	66.055	0	11.93990708	14.0791	0.553523685	1.191026353	0	0.542547174	1.757038577	0.535572842	1.319150818	5.185334646	2.534574213	8.069962214	1.261021386	0.062452215	1.425553922	3.661876736	9.192550962	0.187480829	2.952944235	0	0	3.9717895	0	0	0	0	0	0	0	0	0	0	7.571536299	0	0	0	0	0	0	0	0	66.055	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									6000	5.7045	0.097	0.3544	3.3368	2.6831	2.1484	0.6549	0.2437	3.3981	0.4074	1.3406	0.2538	0.0118	0.4032	1.7208	2.8207	0.0316	0.2706		0.2591	1.2113	0		0					0	0	0.317	0.684									28.3527	1000	14.66682269	19.7836	0.650494587	1.545438863	3.336839993	3.225612013	3.90543802	1.190438641	1.562848968	8.583478852	2.94194193	9.410571995	1.51481364	0.074226585	1.828707039	5.382679896	12.01325877	0.219077723	3.223541638	0	0.259050421	5.18312908	0	0	0	0	0	0	0	0	0	0.316983522	8.255558646	0	0	0	0	0	0	0	0	94.4078
H3619_004_0	2011	6	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	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	YES	1908.146368	103.7646093	1082.487569	626.6204759	67.0241884	14.21201293	5.729568208	455.2725925	377.0304837	2181.683762	1022.158396	155.1724596	0.245257779	6.782341311	3231.378255	3114.031701	128.7039437	582.9884531		1261.321691	17.24644866	0		3.22	3.1				4.53	0.56	1274.429437	1063.754856									6700	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										165.92202	145.11002	32.5726	0	150	0.2	0.2	50	186.154462	37.125794	111.854213	150	0.172843	0.2	15	33.760829	35	81.419141		0	0.2	0		0	0				0	0	0	133.218266									NO	147.748249	129.215829	23.800994	0	133.5267	0.178036	0.178036	44.5089	165.710607	33.048565	99.57016	133.5267	0.153861	0.178036	13.35267	30.053147	31.15623	72.477528		0	0.178036	0		0	0				0	0	0	118.58797										23.4938	1.117335835	2.147023344	0	0.745793225	2.530249935	1.020069405	1.688640191	5.206495859	6.008459801	8.481372916	1.726638871	0.037735607	1.207500918	3.595627291	7.798871038	0.334160806	3.521130161	0	0	3.070488733	0	0	0	0	0	0	0	0	0	0	10.51237741	0	0	0	0	0	0	0	0	84.2437	0	10.91059756	23.4938	1.117335835	2.147023344	0	0.745793225	2.530249935	1.020069405	1.688640191	5.206495859	6.008459801	8.481372916	1.726638871	0.037735607	1.207500918	3.595627291	7.798871038	0.334160806	3.521130161	0	0	3.070488733	0	0	0	0	0	0	0	0	0	0	10.51237741	0	0	0	0	0	0	0	0	84.2437	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	20% Coins	$150/Trip	20% Coins	20% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	30% Coins									10000	10.6439	0.1856	0.7034	2.553	3.9258	2.1954	0.8851	0.3321	3.7878	0.8622	1.5806	0.3023	0.0076	0.3635	1.9077	2.9362	0.0791	0.3372		0.289	0.9618	0		0	0				0	0	0.3355	0.8976									36.0721	1000	15.04922214	34.1376	1.302897238	2.850416957	2.553022915	4.671550758	4.725668493	1.905151906	2.020692318	8.994267459	6.870674259	10.06193031	2.028928728	0.045308488	1.570984922	5.503320273	10.73506277	0.413217566	3.858317019	0	0.288976894	4.032321524	0	0	0	0	0	0	0	0	0	0.33551942	11.41000724	0	0	0	0	0	0	0	0	120.3159
H3619_012_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V			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	YES	1103.580995	38.21761945	463.7610712	496.6719776	38.92557625	9.191963366	3.219121541	380.8770603	358.4048405	1460.762202	1021.483722	62.39735635	0.29195691	6.362794795	3595.826879	3434.685218	88.12677145	554.1760259		1539.061431	17.58189521	0		3.22			0.28		4.53	0.56	1061.274961	728.8414172									5000	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$40/Visit:7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"			"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$40-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"										165.92202	145.11002	32.5726	0	150	0.2	0.2	50	183.400232	33.548392	106.341415	150	0.172844	0.2	15	37.408975	40	76.122146		0	0.2	0		0			0		0	0	0	129.377977									NO	149.428542	130.685358	25.98629	0	133.2306	0.177641	0.177641	44.4102	162.89682	29.797816	94.45287	133.2306	0.15352	0.177641	13.32306	33.226801	35.52816	67.611994		0	0.177641	0		0			0		0	0	0	114.914036										13.7422	0.41620694	1.004285807	0	0.432173157	1.632869564	0.57184797	1.409568869	4.865250732	3.627293609	8.040172435	0.692769769	0.044821225	1.13029323	3.992284772	9.510300186	0.26091517	3.122412178	0	0	3.123265447	0	0	0	0	0	0	0	0	0	0	6.979509071	0	0	0	0	0	0	0	0	64.5984	0	8.039655403	13.7422	0.41620694	1.004285807	0	0.432173157	1.632869564	0.57184797	1.409568869	4.865250732	3.627293609	8.040172435	0.692769769	0.044821225	1.13029323	3.992284772	9.510300186	0.26091517	3.122412178	0	0	3.123265447	0	0	0	0	0	0	0	0	0	0	6.979509071	0	0	0	0	0	0	0	0	64.5984	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	20% Coins	$150/Trip	20% Coins	20% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5			"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	30% Coins									7500	7.2465	0.0801	0.4819	3.0818	2.3362	1.455	0.5095	0.2846	3.7473	0.6641	1.5978	0.2387	0.0092	0.3494	2.1248	3.1979	0.0493	0.2905		0.3883	1.0275	0		0			0		0	0	0.2638	0.6578									30.0821	1000	10.37746022	20.9887	0.496284649	1.486209008	3.081840497	2.768369477	3.08783395	1.081391722	1.694212818	8.612505842	4.291423125	9.637964269	0.931483889	0.054058311	1.479703311	6.117076313	12.70820735	0.310241231	3.412878233	0	0.388283225	4.150717718	0	0	0	0	0	0	0	0	0	0.263843864	7.637309172	0	0	0	0	0	0	0	0	94.6805
H3619_013_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							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	YES	1274.060921	59.033764	627.628982	556.464932	45.161628	11.219662	3.47604	394.085894	415.883659	1573.872917	1044.432611	96.383576	0.45184	9.232489	3629.561072	3529.231581	100.818995	649.433306		1602.211335	22.193101	0							4.53	0.56	1144.642711	764.350161									6000	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$40/Visit:7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$40-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"										165.92202	145.11002	32.5726	0	150	0.2	0.2	50	184.085226	30.381622	106.990671	150	0.172843	0.2	15	38.428061	40	74.36026		0	0.2	0							0	0	0	129.222318									NO	150.085593	131.259994	25.800431	0	133.6359	0.178181	0.178181	44.5453	164.002632	27.067169	95.318631	133.6359	0.153987	0.178181	13.36359	34.23579	35.63624	66.248002		0	0.178181	0							0	0	0	115.124939										15.9348	0.645730959	1.349424854	0	0.502934567	1.999130595	0.619364283	1.462889531	5.683834557	3.550023686	8.296157221	1.073358827	0.069577486	1.645054123	4.041997171	10.06883594	0.299400825	3.585304913	0	0	3.954388929	0	0	0	0	0	0	0	0	0	0	7.332980472	0	0	0	0	0	0	0	0	72.1152	0	8.738855493	15.9348	0.645730959	1.349424854	0	0.502934567	1.999130595	0.619364283	1.462889531	5.683834557	3.550023686	8.296157221	1.073358827	0.069577486	1.645054123	4.041997171	10.06883594	0.299400825	3.585304913	0	0	3.954388929	0	0	0	0	0	0	0	0	0	0	7.332980472	0	0	0	0	0	0	0	0	72.1152	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									7500	7.1881	0.1122	0.4662	3.5012	2.4476	2.4055	0.7453	0.2659	3.605	0.5336	1.4534	0.2662	0.0129	0.4578	1.9158	2.9796	0.0497	0.3152		0.358	1.2	0							0	0	0.4399	0.6572									31.3763	1000	13.25093363	23.1229	0.757914001	1.815597096	3.501247774	2.950507397	4.404639086	1.364630819	1.728839397	9.288851233	4.083620416	9.749595942	1.339564398	0.082486504	2.102877901	5.957751639	13.04843034	0.349062542	3.900523151	0	0.358040222	5.154401353	0	0	0	0	0	0	0	0	0	0.439910533	7.99014309	0	0	0	0	0	0	0	0	103.4915
H3619_014_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	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	YES	1273.658068	59.015098	627.430528	556.28898	45.147348	10.406591	3.224136	393.961286	415.752158	1573.375264	1044.102365	96.3531	0.419096	8.563425	3628.413418	3528.11565	100.787117	649.227958		1601.704722	20.584805	0		3.22	3.1				4.53	0.56	1144.280779	764.108475									4800	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$40/Visit:7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$40-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"										165.92202	145.11002	32.5726	0	150	0.2	0.2	50	184.085226	30.381622	106.990671	150	0.172843	0.2	15	38.428061	40	74.36026		0	0.2	0		0	0				0	0	0	129.222318									NO	143.4069	125.419026	23.382632	0	129.3453	0.17246	0.17246	43.1151	158.737058	26.198133	92.25827	129.3453	0.149043	0.17246	12.93453	33.136594	34.49208	64.121001		0	0.17246	0		0	0				0	0	0	111.428664										15.2209	0.616801343	1.222581428	0	0.486633106	1.794720684	0.556034495	1.415473354	5.499606202	3.434957869	8.027256491	1.038568385	0.062463325	1.476848276	3.910985184	9.74247799	0.289696442	3.469095545	0	0	3.55005547	0	0	0	0	0	0	0	0	0	0	7.095298877	0	0	0	0	0	0	0	0	68.9105	0	11.246834	15.2209	0.616801343	1.222581428	0	0.486633106	1.794720684	0.556034495	1.415473354	5.499606202	3.434957869	8.027256491	1.038568385	0.062463325	1.476848276	3.910985184	9.74247799	0.289696442	3.469095545	0	0	3.55005547	0	0	0	0	0	0	0	0	0	0	7.095298877	0	0	0	0	0	0	0	0	68.9105	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									7200	6.8642	0.1071	0.451	3.3218	2.5027	2.2822	0.7071	0.2719	3.4202	0.5062	1.3789	0.2526	0.0122	0.4344	1.8176	2.8269	0.0471	0.2991		0.3397	1.1385	0		0	0				0	0	0.4174	0.6235									30.0222	1000	12.0375393	22.0851	0.723929669	1.673573521	3.321770083	2.989376356	4.07692054	1.263098163	1.687417964	8.919825518	3.941202263	9.406191029	1.291127806	0.074710691	1.911203675	5.728535855	12.56933537	0.336812644	3.76815584	0	0.339686278	4.688554111	0	0	0	0	0	0	0	0	0	0.417360026	7.718774326	0	0	0	0	0	0	0	0	98.9327
H3619_015_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		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	YES	1286.548025	59.612356	633.78039	561.918859	45.604258	10.006504	3.100181	397.94834	419.959745	1589.298486	1054.669122	97.328234	0.402984	8.2342	3665.134493	3563.821671	101.807125	655.798419		1617.91465	19.79341	0		3.22					4.53	0.56	1155.861383	771.841576									5000	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$40/Visit:7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$40-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"										165.92202	145.11002	32.5726	0	150	0.2	0.2	50	184.085226	30.381622	106.990671	150	0.172844	0.2	15	38.428061	40	74.36026		0	0.2	0		0					0	0	0	129.222318									NO	145.021155	126.830801	23.872035	0	130.4271	0.173903	0.173903	43.4757	160.064681	26.417245	93.029886	130.4271	0.15029	0.173903	13.04271	33.413737	34.78056	64.657287		0	0.173903	0		0					0	0	0	112.360615										15.5481	0.630056905	1.260802304	0	0.49566926	1.740161065	0.539130776	1.441756887	5.601726885	3.498740624	8.176312349	1.057853276	0.060564465	1.431952083	3.983607192	9.923383336	0.295075735	3.533512216	0	0	3.442133379	0	0	0	0	0	0	0	0	0	0	7.227049513	0	0	0	0	0	0	0	0	69.8875	0	10.66200274	15.5481	0.630056905	1.260802304	0	0.49566926	1.740161065	0.539130776	1.441756887	5.601726885	3.498740624	8.176312349	1.057853276	0.060564465	1.431952083	3.983607192	9.923383336	0.295075735	3.533512216	0	0	3.442133379	0	0	0	0	0	0	0	0	0	0	7.227049513	0	0	0	0	0	0	0	0	69.8875	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 8-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									7500	7.0642	0.1103	0.4791	3.2787	2.5951	2.2526	0.6979	0.282	3.3759	0.4997	1.3611	0.2493	0.0121	0.4287	1.794	2.7902	0.0465	0.2952		0.3353	1.1237	0		0					0	0	0.4119	0.6154									30.0988	1000	10.71329769	22.6123	0.740307219	1.739922169	3.27870101	3.090731705	3.992770162	1.237026426	1.72373277	8.977600835	3.998421037	9.537367884	1.307138328	0.072652913	1.860675433	5.777592075	12.71358863	0.341580716	3.828694856	0	0.335282512	4.565870763	0	0	0	0	0	0	0	0	0	0.411948862	7.842441833	0	0	0	0	0	0	0	0	99.9863
H3619_016_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V		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	1286.983057	59.632513	633.994696	562.108866	45.619679	12.06412	3.737666	398.082902	420.101751	1589.83589	1055.025747	97.361145	0.485849	9.92738	3666.373819	3565.026738	101.84155	656.02017		1618.461731	23.863486	0		3.22	3.1		0.28		4.53	0.56	1156.252225	772.102566									4000	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$40/Visit:7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$40-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"										165.92202	145.11002	32.5726	0	150	0.2	0.2	50	184.085226	30.381622	106.990671	150	0.172843	0.2	10	38.113673	40	74.36026		0	0.2	0		0	0		0		0	0	0	129.222318									NO	133.434488	116.697478	20.370318	0	123.26835	0.164358	0.164358	41.08945	151.279214	24.967283	87.923757	123.26835	0.142041	0.164358	8.21789	31.321398	32.87156	61.108444		0	0.164358	0		0	0		0		0	0	0	106.19348										14.3107	0.579913656	1.076222797	0	0.46862188	1.982834635	0.614315308	1.363083958	5.296055224	3.307823549	7.730152284	1.000128975	0.069010478	1.631644322	2.510821395	9.305135112	0.278974218	3.340697652	0	0	3.922154832	0	0	0	0	0	0	0	0	0	0	6.8326882	0	0	0	0	0	0	0	0	65.6209	0	15.03798069	14.3107	0.579913656	1.076222797	0	0.46862188	1.982834635	0.614315308	1.363083958	5.296055224	3.307823549	7.730152284	1.000128975	0.069010478	1.631644322	2.510821395	9.305135112	0.278974218	3.340697652	0	0	3.922154832	0	0	0	0	0	0	0	0	0	0	6.8326882	0	0	0	0	0	0	0	0	65.6209	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5	"VIS752: Vision 17a, 17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									6000	5.7376	0.0895	0.3329	3.432	2.2539	2.3579	0.7305	0.2449	3.5337	0.523	1.4247	0.2609	0.0127	0.4488	1.8779	2.9207	0.0487	0.309		0.351	1.1763	0		0	0		0		0	0	0.4312	0.6442									29.1419	1000	18.155052	20.0483	0.669460457	1.409119365	3.43199858	2.722480369	4.340766142	1.344841833	1.607985093	8.829770135	3.830866662	9.154844935	1.261069524	0.081664189	2.080413036	4.388685077	12.22579788	0.327653754	3.649681592	0	0.350958472	5.098432685	0	0	0	0	0	0	0	0	0	0.431209837	7.476852998	0	0	0	0	0	0	0	0	94.7629
H3619_017_0	2011	6	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							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	YES	1277.96023	59.214439	629.549863	558.168013	45.299847	10.409848	3.225145	395.292008	417.156485	1578.689812	1047.629134	96.678562	0.419227	8.566105	3640.669474	3540.032922	101.127555	651.42092		1607.114961	20.591244	0							4.53	0.56	1148.145931	766.689481									5000	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$40/Visit:7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$40-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"										165.92202	145.11002	32.5726	0	150	0.2	0.2	50	184.085226	30.381622	106.990671	150	0.172843	0.2	10	38.113673	40	74.36026		0	0.2	0							0	0	0	129.222318									NO	145.834837	127.542421	24.110695	0	131.055	0.17474	0.17474	43.685	160.835262	26.544423	93.477749	131.055	0.151013	0.17474	8.737	33.299916	34.948	64.968559		0	0.17474	0							0	0	0	112.90154										15.5309	0.629362742	1.264907061	0	0.494730954	1.81901684	0.563561837	1.439027614	5.591122713	3.492117513	8.160834436	1.055850745	0.063308727	1.496841188	2.650710766	9.823566578	0.294517149	3.526823206	0	0	3.598113977	0	0	0	0	0	0	0	0	0	0	7.213368592	0	0	0	0	0	0	0	0	68.7087	0	10.08326208	15.5309	0.629362742	1.264907061	0	0.494730954	1.81901684	0.563561837	1.439027614	5.591122713	3.492117513	8.160834436	1.055850745	0.063308727	1.496841188	2.650710766	9.823566578	0.294517149	3.526823206	0	0	3.598113977	0	0	0	0	0	0	0	0	0	0	7.213368592	0	0	0	0	0	0	0	0	68.7087	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									7500	7.1138	0.111	0.475	3.3554	2.5359	2.3053	0.7142	0.2755	3.4549	0.5114	1.3929	0.2551	0.0124	0.4388	1.836	2.8555	0.0476	0.3021		0.3431	1.15	0							0	0	0.4216	0.6298									30.5374	1000	11.53974737	22.6448	0.740387821	1.739880567	3.355444172	3.030591474	4.124352249	1.277792892	1.714570699	9.046014266	4.003493819	9.553747691	1.310970595	0.075680185	1.935599608	4.486686701	12.67908045	0.342110878	3.828915077	0	0.343129957	4.748153782	0	0	0	0	0	0	0	0	0	0.42159109	7.843164611	0	0	0	0	0	0	0	0	99.2461
H3620_001_0	2011	8																															D	D	D		T	Coin	Coin	V	Coin	V	V			O	V	V	V	V	V	V	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1155.304123	24.83955694	745.4199878	0	102.6089695	10.08851739	2.89706503	317.4352147	40.63149823	2243.38303	771.047932	0	0	537.7732403	3416.919425	4867.318685	180.1221187	550.5148568	1624.672436	1587.819385	42.91544121	0	0	0	132.5002773	0	17.83927566	0	0	0											3400	$210/Days 1-15 for IP Med/Surg; PBP 1a	$210/Days 1-10 for IP MA/SA; PBP 1b	"$100/Days 11-30, $75/Days 31-100; PBP 2"	$0/Visit for Home Health; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; 20% Coinsurance for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Surg, $400 Max OOP; 20% Coinsurance for ASC services, $400 Max OOP; PBP 9a, 9b"	$35/Visit for OP Lab; PBP 8a	$35/Visit for OP Rad - General; 20% Coinsurance for OP Rad - Therapeutic Rad; $100/Visit for OP Rad - PET/CAT/MRI/MRA ; PBP 8b	No Cost Sharing; PBP 9a	$0/Case for Renal Dialysis; PBP 12	"$10/Visit for CORF (max $300); $35/Day for Partial Hosp; $10/Visit for OP PT/OT/ST (max $300); $35/Visit for OP Substance Abuse; $0/Visit for Cardiac Rehab; PBP 3, 5, 9c, 9d"	"$15/Visit for PCP OV; $0/Visit for Immunizations; $0/Visit for Physical Exams (Initial); $0/Visit for Routine Exams; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $35/Visit for SCP OV; $35/Visit for SCP - Office Surg; $35/Visit for Podiatry; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $35/Exam for Vision Exams; $35/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14d, 14e, 17a, 18a"	"$35/Visit for MH - Non Phys; $35/Visit for Psych Services ; PBP 7e, 7h"	"$10/Visit for OP PT/OT/ST (max $300); $10/Visit for PT/ST (max $300); PBP 7c, 7i"	"$35/Visit for Phys Rad - General; $100/Visit for Phys Rad - PET/CAT/MRI/MRA; $0/Visit for Colorectal Screening; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 7g, 14f, 14g, 14h"	"$0/Visit for Other Health Care Professional; $0/Visit for Diabetes Monitoring; $0/Visit for Nutrition Therapy for Diabetes & Renal Dialysis; PBP 7g, 14i, 14j"	20% Coinsurance for Medicare Part B Drugs; PBP 15	"$0/Case for Blood; $0/Visit for Smoking Cessation; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"$125 annual max; PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	$75 max every two years; PBP 17b	$35/Exam for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-d											0	210	210	84	0	150	0.2	0.2	48.05864248	0.2	35	59.15583962	0	0	10.08292594	15	33.76657704	35	10	39.43309855	26.1229703	0.2	0	0	0	35	0	35	0	0	0											NO	192.6196171	192.6196171	77.04784683	0	137.5854408	0.183447254	0.183447254	44.08113005	0.183447254	32.10326951	54.25988179	0	0	9.248425401	13.75854408	30.97192923	32.10326951	9.172362718	36.1694683	23.96093588	0.183447254	0	0	0	32.10326951	0	32.10326951	0	0	0												18.5445	0.398715496	4.786083754	0	1.176458359	1.850710815	0.531458625	1.166075248	7.453736791	6.001660837	3.486414137	0	0	0.414462975	3.917653043	12.56252082	0.481875743	0.420793496	4.896961515	3.170469874	7.872719859	0	0	0	0.354474343	0	0.047724923	0	0	0	0	0	0	0	0	0	0	0	0	0	79.5355	0	7.176617319	18.5445	0.398715496	4.786083754	0	1.176458359	1.850710815	0.531458625	1.166075248	7.453736791	6.001660837	3.486414137	0	0	0.414462975	3.917653043	12.56252082	0.481875743	0.420793496	4.896961515	3.170469874	7.872719859	0	0	0	0.354474343	0	0.047724923	0	0	0	0	0	0	0	0	0	0	0	0	0	79.5355	YES	$400/Days 1-15 for IP Med/Surg; PBP 1a	$400/Days 1-15 for IP MH/SA; PBP 1b	$200/Day for SNF; PBP 2	40% Coinsurance for HH; PBP 6	$150/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; PBP 11a	"40% Coinsurance for Prosthetics; 40% Coinsurance for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"40% Coinsurance for OP Surg; 40% Coinsurance for ASC services; PBP 9a, 9b"	40% Coinsurance for OP Lab; PBP 8a	40% Coinsurance for OP Rad - General; 40% Coinsurance for OP Rad - Therapeutic Rad; 40% Coinsurance for OP Rad - PET/CAT/MRI/MRA ; PBP 8b	No Cost Sharing; PBP 9a	$0/Case for Renal Dialysis; PBP 12	"$30/Visit for CORF; $60/Visit for Partial Hosp; $30/Visit for OP - PT/OT/ST; 40% Coinsurance for OP - Other; $60/Visit for OP Substance Abuse; 40% Coinsurance for Cardiac Rehab; PBP 3, 5, 9c, 9d"	"$30/Visit for PCP OV; $0/Visit for Immunizations; $30/Exam for Physical Exams (Initial); $30/Exam for Routine Exams; PBP 7a, 14b, 14c"	"$60/Visit for Chiro - cvd; $60/Visit for SCP OV; $60/Visit for SCP - Office Surg; $60/Visit for Podiatry; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $60/Visit for Vision Exams; $60/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14d, 14e, 17a, 18a"	"$60/Visit for MH - Non Phys; $60/Visit for Psych Services ; PBP 7e, 7h"	"$30/Visit for OP PT/OT/ST; $30/Visit for PT/ST; PBP 7c, 7i"	"40% Coinsurance for Phys Rad - General; 40% Coinsurance for Phys Rad - PET/CAT/MRI/MRA; $0/Visit for Colorectal Screening; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 7g, 14f, 14g, 14h"	"40% Coinsurance for SCP - IP/OP Surg; 40% Coinsurance for SCP - Other; $0/Visit for Diabetes Monitoring; $0/Visit for Nutrition Therapy for Diabetes & Renal Dialysis; PBP 7g, 14i, 14j"	40% Coinsurance for Medicare Part B Drugs; PBP 15	"40% Coinsurance for Blood; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"$0/Visit for Preventive Dental; PBP 16a, 16b"	$60/Visit for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	$60/Visit for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-d											5100	3.1306	0.0522	1.378	0.3921	0.7885	1.0964	0.1618	0.0939	1.0364	0.2124	0.7174	0	0	1.0857	0.4909	1.5892	0.1149	0.0522	0.5341	3.1688	1.4405	0.1426	0	0	0.0964	0	0.0285	0	0	0											17.8034	0	1.88172795	21.6751	0.450895531	6.164078832	0.39207761	1.964984137	2.947108004	0.693261845	1.259982237	8.490137625	6.214039755	4.203836984	0	0	1.500159468	4.4085162	14.15172469	0.59675505	0.473019668	5.431025663	6.339253357	9.313240817	0.142601596	0	0	0.45087432	0	0.076217865	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3389
H3620_801_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	268.50105	7.980283072	61.65388524	0	7.553422605	13.27551553	3.880423465	16.01909606	53.37967815	13.51750539	30.85841775	0	0.134902736	26.69624844	34.09562056	64.15562103	1.142800597	5.318228334	23.8478683	73.82931193	43.37184166	3.976150262	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14i, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-d											0	0.081673547	0.081673547	0.174879736	0	0.233	0.233	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	0.07331789	0.07331789	0.156988569	0	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0	0	0	0	0	0	0	0												19.6859	0.585097513	9.678955187	0	1.579895072	2.776744088	0.811640263	3.350599092	11.1650433	2.827359367	6.454433267	0	0.028216635	5.583862252	7.131535692	13.41896976	0.23903138	1.112375565	4.988087067	15.4423461	9.071776132	0.831662749	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7636	0	13.30693356	19.6859	0.585097513	9.678955187	0	1.579895072	2.776744088	0.811640263	3.350599092	11.1650433	2.827359367	6.454433267	0	0.028216635	5.583862252	7.131535692	13.41896976	0.23903138	1.112375565	4.988087067	15.4423461	9.071776132	0.831662749	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7636	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14i, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-d											10000	2.5475	0.0588	1.5395	0	0.4407	0.529	0.2634	0.4625	1.442	0.2117	0.6027	0	0.006	0.5085	0.6866	1.5703	0.0383	0.109	0.6434	2.0822	0.7661	0.1756	0	0	0	0	0	0	0	0											14.6837	0	1.627264556	22.2334	0.643898257	11.21847617	0	2.020613	3.305695557	1.074991502	3.813138903	12.60701943	3.039018439	7.057180294	0	0.034237768	6.092326379	7.818092189	14.98931613	0.277371338	1.221398356	5.631467437	17.52455643	9.837858378	1.007221715	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.4473
H3620_802_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	265.5926763	2.146803932	73.31558501	0	8.606738691	17.79837487	2.030860563	16.17824516	47.1988097	13.53761661	34.10851694	0	0.049134568	27.06871625	39.60747058	64.29971893	1.395854104	7.228654649	25.78629713	73.86429703	51.52579043	2.378282916	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14i, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-d											0	0.081720745	0.081720745	0.174437341	0	0.233	0.233	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	0.072954695	0.072954695	0.155725735	0	0.208006474	0.208006474	0.208006474	0.208006474	0.208006474	0.208006474	0.208006474	0	0.208006474	0.208006474	0.208006474	0.208006474	0.208006474	0.208006474	0.208006474	0.208006474	0.208006474	0.208006474	0	0	0	0	0	0	0	0												19.3762	0.156619427	11.41712335	0	1.790257367	3.702177198	0.422432145	3.365179731	9.817657979	2.815911896	7.094792339	0	0.010220308	5.630468219	8.238610295	13.37475781	0.29034669	1.503606965	5.363716741	15.36425197	10.71769798	0.494698243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.9468	0	14.53265339	19.3762	0.156619427	11.41712335	0	1.790257367	3.702177198	0.422432145	3.365179731	9.817657979	2.815911896	7.094792339	0	0.010220308	5.630468219	8.238610295	13.37475781	0.29034669	1.503606965	5.363716741	15.36425197	10.71769798	0.494698243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.9468	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14i, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-d											10000	1.9727	0.0242	1.2964	0	0.2104	0.2599	0.161	0.3522	0.9652	0.2308	0.5165	0	0.0049	0.4514	0.6206	1.3063	0.0269	0.0979	0.4554	1.5508	0.8395	0.2066	0	0	0	0	0	0	0	0											11.5496	0	0.715227502	21.349	0.180792103	12.71356454	0	2.000701126	3.962082293	0.58346618	3.717332127	10.78285326	3.04673651	7.611272607	0	0.015088402	6.081898247	8.85921565	14.68101379	0.317273954	1.601508151	5.819165266	16.91503521	11.55716376	0.701264417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.4964
H3620_803_0	2011	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	268.50105	7.980283072	61.65388524	0	7.553422605	13.27551553	3.880423465	16.01909606	53.37967815	13.51750539	30.85841775	0	0.134902736	26.69624844	34.09562056	64.15562103	1.142800597	5.318228334	23.8478683	73.82931193	43.37184166	3.976150262	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14i, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-d											0	0.081673547	0.081673547	0.174879736	0	0.233	0.233	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	0.07331789	0.07331789	0.156988569	0	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0	0	0	0	0	0	0	0												19.6859	0.585097513	9.678955187	0	1.579895072	2.776744088	0.811640263	3.350599092	11.1650433	2.827359367	6.454433267	0	0.028216635	5.583862252	7.131535692	13.41896976	0.23903138	1.112375565	4.988087067	15.4423461	9.071776132	0.831662749	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7636	0	13.30693356	19.6859	0.585097513	9.678955187	0	1.579895072	2.776744088	0.811640263	3.350599092	11.1650433	2.827359367	6.454433267	0	0.028216635	5.583862252	7.131535692	13.41896976	0.23903138	1.112375565	4.988087067	15.4423461	9.071776132	0.831662749	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7636	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14i, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-d											10000	2.5475	0.0588	1.5395	0	0.4407	0.529	0.2634	0.4625	1.442	0.2117	0.6027	0	0.006	0.5085	0.6866	1.5703	0.0383	0.109	0.6434	2.0822	0.7661	0.1756	0	0	0	0	0	0	0	0											14.6837	0	1.627264556	22.2334	0.643898257	11.21847617	0	2.020613	3.305695557	1.074991502	3.813138903	12.60701943	3.039018439	7.057180294	0	0.034237768	6.092326379	7.818092189	14.98931613	0.277371338	1.221398356	5.631467437	17.52455643	9.837858378	1.007221715	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.4473
H3620_805_0	2011	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	268.50105	7.980283072	61.65388524	0	7.553422605	13.27551553	3.880423465	16.01909606	53.37967815	13.51750539	30.85841775	0	0.134902736	26.69624844	34.09562056	64.15562103	1.142800597	5.318228334	23.8478683	73.82931193	43.37184166	3.976150262	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14i, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-d											0	0.081673547	0.081673547	0.174879736	0	0.233	0.233	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	0.07331789	0.07331789	0.156988569	0	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0	0	0	0	0	0	0	0												19.6859	0.585097513	9.678955187	0	1.579895072	2.776744088	0.811640263	3.350599092	11.1650433	2.827359367	6.454433267	0	0.028216635	5.583862252	7.131535692	13.41896976	0.23903138	1.112375565	4.988087067	15.4423461	9.071776132	0.831662749	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7636	0	13.30693356	19.6859	0.585097513	9.678955187	0	1.579895072	2.776744088	0.811640263	3.350599092	11.1650433	2.827359367	6.454433267	0	0.028216635	5.583862252	7.131535692	13.41896976	0.23903138	1.112375565	4.988087067	15.4423461	9.071776132	0.831662749	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7636	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14i, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-d											10000	2.5475	0.0588	1.5395	0	0.4407	0.529	0.2634	0.4625	1.442	0.2117	0.6027	0	0.006	0.5085	0.6866	1.5703	0.0383	0.109	0.6434	2.0822	0.7661	0.1756	0	0	0	0	0	0	0	0											14.6837	0	1.627264556	22.2334	0.643898257	11.21847617	0	2.020613	3.305695557	1.074991502	3.813138903	12.60701943	3.039018439	7.057180294	0	0.034237768	6.092326379	7.818092189	14.98931613	0.277371338	1.221398356	5.631467437	17.52455643	9.837858378	1.007221715	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.4473
H3620_806_0	2011	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	268.50105	7.980283072	61.65388524	0	7.553422605	13.27551553	3.880423465	16.01909606	53.37967815	13.51750539	30.85841775	0	0.134902736	26.69624844	34.09562056	64.15562103	1.142800597	5.318228334	23.8478683	73.82931193	43.37184166	3.976150262	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14i, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-d											0	0.081673547	0.081673547	0.174879736	0	0.233	0.233	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	0.07331789	0.07331789	0.156988569	0	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0.209162807	0	0	0	0	0	0	0	0												19.6859	0.585097513	9.678955187	0	1.579895072	2.776744088	0.811640263	3.350599092	11.1650433	2.827359367	6.454433267	0	0.028216635	5.583862252	7.131535692	13.41896976	0.23903138	1.112375565	4.988087067	15.4423461	9.071776132	0.831662749	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7636	0	13.30693356	19.6859	0.585097513	9.678955187	0	1.579895072	2.776744088	0.811640263	3.350599092	11.1650433	2.827359367	6.454433267	0	0.028216635	5.583862252	7.131535692	13.41896976	0.23903138	1.112375565	4.988087067	15.4423461	9.071776132	0.831662749	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7636	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d, 14e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14g, 14h"	"Medicare-FFS Cost Sharing; PBP 7g, 14i, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-d											10000	2.5475	0.0588	1.5395	0	0.4407	0.529	0.2634	0.4625	1.442	0.2117	0.6027	0	0.006	0.5085	0.6866	1.5703	0.0383	0.109	0.6434	2.0822	0.7661	0.1756	0	0	0	0	0	0	0	0											14.6837	0	1.627264556	22.2334	0.643898257	11.21847617	0	2.020613	3.305695557	1.074991502	3.813138903	12.60701943	3.039018439	7.057180294	0	0.034237768	6.092326379	7.818092189	14.98931613	0.277371338	1.221398356	5.631467437	17.52455643	9.837858378	1.007221715	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.4473
H3623_001_0	2011	3																															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	1204.467693	91.55451969	1252.699098	1075.637453	233.4771867	11.40369686	0	373.1851617	387.4280073	3522.863993	2503.731274	16.68384714	1.717742015	668.1184168	3377.721005	4872.32044	205.8685867	795.1601939	0	0	261.929245	0	0	0	861.949001	72.01061212	43.90177115	9.083425358	81.31429445	0											3400	$200/day 1-7	$200/day 1-7	"$0/d 1-10, $75/d 11-100"	$10 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$250 per procedure	$40 per visit	$50 X-ray; $175 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$15 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$50 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness Only	0											0	144.5710156	144.5710156	47.56208437	10	150	0.05	0.05	49	250	6	28.125	40	25	40	15	40	40	30	50	40	$50 	0	0	0	0	0	0	0	0	0											NO	127.0390854	127.0390854	41.79429516	8.787313615	131.8097042	0.043936568	0.043936568	43.05783671	219.6828404	5.272388169	24.71431954	35.14925446	21.96828404	35.14925446	13.18097042	35.14925446	35.14925446	26.36194085	43.93656808	35.14925446	43.93656808	0	0	0	0	0	0	0	0	0												12.7512	0.969250204	4.362972986	0.787663636	2.564546577	0.501039303	0	1.33904548	7.092607091	1.547825537	5.15650123	0.048868732	0.003144654	1.956988687	3.710136722	14.27153591	0.603010612	1.746830499	0	0	0.959022675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3722	0	8.331618078	12.7512	0.969250204	4.362972986	0.787663636	2.564546577	0.501039303	0	1.33904548	7.092607091	1.547825537	5.15650123	0.048868732	0.003144654	1.956988687	3.710136722	14.27153591	0.603010612	1.746830499	0	0	0.959022675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3722	NO																																																																																		0			12.7512	0.969250204	4.362972986	0.787663636	2.564546577	0.501039303	0	1.33904548	7.092607091	1.547825537	5.15650123	0.048868732	0.003144654	1.956988687	3.710136722	14.27153591	0.603010612	1.746830499	0	0	0.959022675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3722
H3623_003_0	2011	3																															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	1460.514271	139.3684624	1128.076828	1590.357965	223.4654138	16.31854224	0	291.151908	376.6967526	4223.376934	2786.08063	23.15520013	0.874012599	968.9610673	3727.866973	5686.149501	271.6316509	1123.312326	0	0	316.4041808	0	0	0	1120.415498	84.26145616	59.14063423	7.907882348	116.1655921	0											3400	$115/day 1-5	$115/day 1-5	"$0/d 1-10, $50/d 11-100"	$0 per visit	$100 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$150 per procedure	$25 per visit	$40 X-ray; $150 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	"$5 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$25 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$25 per visit	$25 per visit	$50 per visit	$25 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness Only	0											0	70.47645518	70.47645518	31.70805624	0	100	0.05	0.05	49	150	3.75	22.75	25	25	25	5	25	25	18.75	50	25	$50 	0	0	0	0	0	0	0	0	0											NO	63.9953454	63.9953454	28.79214066	0	90.80386525	0.045401933	0.045401933	44.49389397	136.2057979	3.405144947	20.65787934	22.70096631	22.70096631	22.70096631	4.540193262	22.70096631	22.70096631	17.02572473	45.40193262	22.70096631	45.40193262	0	0	0	0	0	0	0	0	0												7.7888	0.743244407	2.706645558	0	1.690960277	0.740893355	0	1.079540177	4.275690145	1.198434219	4.796209791	0.043803785	0.001653411	1.833029379	1.410436376	10.75675736	0.513858413	1.593767205	0	0	1.197113442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3709	0	4.291098436	7.7888	0.743244407	2.706645558	0	1.690960277	0.740893355	0	1.079540177	4.275690145	1.198434219	4.796209791	0.043803785	0.001653411	1.833029379	1.410436376	10.75675736	0.513858413	1.593767205	0	0	1.197113442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3709	NO																																																																																		0			7.7888	0.743244407	2.706645558	0	1.690960277	0.740893355	0	1.079540177	4.275690145	1.198434219	4.796209791	0.043803785	0.001653411	1.833029379	1.410436376	10.75675736	0.513858413	1.593767205	0	0	1.197113442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3709
H3623_004_0	2011	3																															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	1408.091716	127.8904394	1103.758027	715.8610994	218.3280612	12.28788302	0	361.159827	382.5416631	3434.995392	2513.21237	63.97217203	1.268069062	661.4894423	3046.282971	5420.612319	279.9454414	636.9576076	0	0	258.2421168	0	0	0	1063.08558	79.80381738	53.53841476	10.06525758	39.88836664	0											3400	$200/day 1-8	$200/day 1-8	"$0/d 1-10, $75/d 11-100"	$15 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$250 per procedure	$40 per visit	$50 X-ray; $175 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$10 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$50 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness Only	0											0	152.3663772	152.3663772	47.56208437	15	150	0.05	0.05	49	250	6	28.125	40	25	40	10	40	40	30	50	40	$50 	0	0	0	0	0	0	0	0	0											NO	132.5241356	132.5241356	41.36820888	13.0465925	130.465925	0.043488642	0.043488642	42.61886883	217.4432083	5.218637	24.46236094	34.79091333	21.74432083	34.79091333	8.697728334	34.79091333	34.79091333	26.093185	43.48864167	34.79091333	43.48864167	0	0	0	0	0	0	0	0	0												15.5505	1.412380828	3.805041051	0.778295671	2.373697705	0.534383342	0	1.282685275	6.931757211	1.493832838	5.12325901	0.185470858	0.002297775	1.917818488	2.207978476	15.71567112	0.811629799	1.385021058	0	0	0.93588324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4476	0	9.35	15.5505	1.412380828	3.805041051	0.778295671	2.373697705	0.534383342	0	1.282685275	6.931757211	1.493832838	5.12325901	0.185470858	0.002297775	1.917818488	2.207978476	15.71567112	0.811629799	1.385021058	0	0	0.93588324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4476	NO																																																																																		0			15.5505	1.412380828	3.805041051	0.778295671	2.373697705	0.534383342	0	1.282685275	6.931757211	1.493832838	5.12325901	0.185470858	0.002297775	1.917818488	2.207978476	15.71567112	0.811629799	1.385021058	0	0	0.93588324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4476
H3623_801_0	2011	1																															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	YES	298.2852076	6.089267201	38.10566034	7.565834432	8.871848654	11.47218857	0	14.22107317	39.24944966	17.58298826	56.81751789	1.005996335	0.086259871	26.16629979	26.70692698	127.8023995	3.455895827	8.140527832	0	0	67.89590695	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.078363825	0.078363825	0.163059245	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.063000471	0.063000471	0.131091219	0	0.187319976	0.187319976	0.187319976	0.187319976	0.187319976	0.187319976	0.187319976	0.187319976	0.187319976	0.187319976	0.187319976	0.187319976	0.187319976	0.187319976	0.187319976	0.187319976	0.187319976	0.187319976	0	0	0	0	0	0	0	0												18.7921	0.383626704	4.995317449	0	1.661874479	2.14897009	0	2.663891088	7.352205978	3.293644943	10.6430561	0.18844321	0.016158197	4.901470655	5.002740928	23.93994244	0.647358324	1.52488348	0	0	12.71825968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.874	0	24.59921592	18.7921	0.383626704	4.995317449	0	1.661874479	2.14897009	0	2.663891088	7.352205978	3.293644943	10.6430561	0.18844321	0.016158197	4.901470655	5.002740928	23.93994244	0.647358324	1.52488348	0	0	12.71825968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.874	NO																																																																																		0			18.7921	0.383626704	4.995317449	0	1.661874479	2.14897009	0	2.663891088	7.352205978	3.293644943	10.6430561	0.18844321	0.016158197	4.901470655	5.002740928	23.93994244	0.647358324	1.52488348	0	0	12.71825968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.874
H3623_802_0	2011	1																															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	YES	271.4448546	4.752707583	31.20553375	7.295761536	7.764692695	12.97850254	0	14.78800841	39.39041026	19.12813378	55.11266522	0.785185844	0.067326319	26.26027505	28.5861671	122.0098629	3.119066979	8.189582309	0	0	65.39941221	0.000315315																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.079470107	0.079470107	0.170053403	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.064227733	0.064227733	0.137437145	0	0.188310579	0.188310579	0.188310579	0.188310579	0.188310579	0.188310579	0.188310579	0.188310579	0.188310579	0.188310579	0.188310579	0.188310579	0.188310579	0.188310579	0.188310579	0.188310579	0.188310579	0.188310579	0	0	0	0	0	0	0	0												17.4343	0.305255635	4.288799456	0	1.462173776	2.443989326	0	2.784738424	7.41763096	3.602029946	10.37829789	0.147858801	0.012678258	4.945087597	5.383077674	22.97574791	0.587353308	1.542184986	0	0	12.31540117	5.94E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0267	0	23.26345321	17.4343	0.305255635	4.288799456	0	1.462173776	2.443989326	0	2.784738424	7.41763096	3.602029946	10.37829789	0.147858801	0.012678258	4.945087597	5.383077674	22.97574791	0.587353308	1.542184986	0	0	12.31540117	5.94E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0267	NO																																																																																		0			17.4343	0.305255635	4.288799456	0	1.462173776	2.443989326	0	2.784738424	7.41763096	3.602029946	10.37829789	0.147858801	0.012678258	4.945087597	5.383077674	22.97574791	0.587353308	1.542184986	0	0	12.31540117	5.94E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0267
H3653_004_0	2011	7																															D	D	D		T	Coin	Coin	V	V				Coin		V	V	V	V		V	Coin				V		V																																																						0	YES	841.367574	34.3761071	1097.999225		244.1279282	0.000397267	19.04623445	423.5004832	392.1934238				0		3937.837433	5469.62197	162.980638	33.62999076		4235.28178	1.599961913				248.3332386		27.99198193														3400	"$150 per day first 5 days, Unlimited days"	"$150 per day first 5 days, Unlimited days"	$90 per day after 15 days (100 day limit)	Zero cost sharing (06)	$50 per trip (10A)	20% Coinsurance (11A)	20% Coinsurance (11B-C)	$50 per visit if ER (04A)/$25 if UC (04B)	$125 per visit (09A and 09B)	Zero cost sharing (08A)	Zero cost sharing (08B)	Zero cost sharing (05)	5% Coinsurance (12)	"Covered in Full  (05, 09C and 09D)"	"$15 per visit (07A, 14B-J)"	"$25 per visit (07D, 07F, 07G, 14D-J)"	"$25 per visit (07E, 07H)"	"$25 per visit (03, 07C, 07I)"	Covered in Full (8B)	"$25 per visit (07B, 14A and 14D-J)"	20% Coinsurance (15)	Zero cost sharing (13A)	Zero cost sharing (10B)	Zero cost sharing (16A-B)	$25 per visit (17A)	Zero cost sharing (17B)	$25 per visit (18A)	Zero cost sharing (18B)														150	150	90		50	0.2	0.2	50	125				0.05		15	25	25	25		25	0.2				25		25														NO	134.8672518	134.8672518	80.92035107		44.95575059	0.179823002	0.179823002	44.95575059	112.3893765				0.044955751		13.48672518	22.4778753	22.4778753	22.4778753		22.4778753	0.179823002				22.4778753		22.4778753															9.4561	0.386350924	7.404206899	0	0.914579521	7.14E-05	3.424951063	1.586565175	3.673197863	0	0	0	0	0	4.425710938	10.24545671	0.305288205	0.062994228	0	7.933344642	0.287709955	0	0	0	0.465166964	0	0.052433357	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6241		5.680265844	9.4561	0.386350924	7.404206899	0	0.914579521	7.14E-05	3.424951063	1.586565175	3.673197863	0	0	0	0	0	4.425710938	10.24545671	0.305288205	0.062994228	0	7.933344642	0.287709955	0	0	0	0.465166964	0	0.052433357	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6241	NO																																																																																		0			9.4561	0.386350924	7.404206899	0	0.914579521	7.14E-05	3.424951063	1.586565175	3.673197863	0	0	0	0	0	4.425710938	10.24545671	0.305288205	0.062994228	0	7.933344642	0.287709955	0	0	0	0.465166964	0	0.052433357	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6241
H3653_015_0	2011	7																															D	D	D		T	Coin	Coin	V	V	V	V		Coin		V	V	V	V		V	Coin				V		V																																																						0	YES	1104.224864	35.83677963	1334.173902		299.5150791	0.000251957	17.89895487	469.9116074	337.318927	3512.913624	1234.295337		0		3909.527865	4903.283026	221.6797975	26.06159164		3913.147398	1.100506843				234.403252		27.21832811														3400	"$250 per day first 8 days, Unlimited days"	"$250 per day first 8 days, Unlimited days"	$100 per day after 10 days (100 day limit)	Zero cost sharing (06)	$175 per trip (10A)	20% Coinsurance (11A)	20% Coinsurance (11B-C)	$50 per visit if ER (04A)/$25 if UC (04B)	$200 per visit (09A and 09B)	$5 per visit  (08A)	$15 or $100 per visit routine or advanced respectively.  (08B)	Zero cost sharing (05)	5% Coinsurance (12)	"Covered in Full  (05, 09C and 09D)"	"$20 per visit (07A, 14B-J)"	"$40 per visit (07D, 07F, 07G, 14D-J)"	"$40 per visit (07E, 07H)"	"$40 per visit (03, 07C, 07I)"	Covered in Full (8B)	"$40 per visit (07B, 14A and 14D-J)"	20% Coinsurance (15)	Zero cost sharing (13A)	Zero cost sharing (10B)	Zero cost sharing (16A-B)	$40 per visit (17A)	Zero cost sharing (17B)	$40 per visit  (18A)	Zero cost sharing (18B)														250	250	100		175	0.2	0.2	50	200	5	15		0.05		20	40	40	40		40	0.2				40		40														NO	209.4141009	209.4141009	83.76564036		146.5898706	0.167531281	0.167531281	41.88282018	167.5312807	4.188282018	12.56484605		0.04188282		16.75312807	33.50625614	33.50625614	33.50625614		33.50625614	0.167531281				33.50625614		33.50625614															19.27	0.625393915	9.31316094	0	3.658823058	4.22E-05	2.998634832	1.640101946	4.709289321	1.226089413	1.292394241	0	0	0	5.458068418	13.69088808	0.618971673	0.072768864	0	10.92624325	0.184369321	0	0	0	0.65449795	0	0.075998689	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4158		14.80990159	19.27	0.625393915	9.31316094	0	3.658823058	4.22E-05	2.998634832	1.640101946	4.709289321	1.226089413	1.292394241	0	0	0	5.458068418	13.69088808	0.618971673	0.072768864	0	10.92624325	0.184369321	0	0	0	0.65449795	0	0.075998689	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4158	NO																																																																																		0			19.27	0.625393915	9.31316094	0	3.658823058	4.22E-05	2.998634832	1.640101946	4.709289321	1.226089413	1.292394241	0	0	0	5.458068418	13.69088808	0.618971673	0.072768864	0	10.92624325	0.184369321	0	0	0	0.65449795	0	0.075998689	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4158
H3653_018_0	2011	3																															D	D	D		T	Coin	Coin	V	V				Coin		V	V	V	V		V	Coin				V		V																																																						0	YES	951.177281	29.41155783	998.1199489		252.8991006	0.168477169	18.09537047	439.968289	439.3217353				0		4134.113573	5706.319838	159.0676113	29.98723634		4459.387303	1.336823798				238.7928431		31.23159033														3400	"$150 per day first 5 days, Unlimited days"	"$150 per day first 5 days, Unlimited days"	$90 per day after 15 days (100 day limit)	Zero cost sharing (06)	$50 per trip (10A)	20% Coinsurance (11A)	20% Coinsurance (11B-C)	$50 per visit if ER (04A)/$25 if UC (04B)	$125 per visit (09A and 09B)	Zero cost sharing (08A)	Zero cost sharing (08B)	Zero cost sharing (05)	5% Coinsurance (12)	"Covered in Full  (05, 09C and 09D)"	"$15 per visit (07A, 14B-J)"	"$25 per visit (07D, 07F, 07G, 14D-J)"	"$25 per visit (07E, 07H)"	"$25 per visit (03, 07C, 07I)"	Covered in Full (8B)	"$25 per visit (07B, 14A and 14D-J)"	20% Coinsurance (15)	Zero cost sharing (13A)	Zero cost sharing (10B)	Zero cost sharing (16A-B)	$25 per visit (17A)	Zero cost sharing (17B)	$25 per visit (18A)	Zero cost sharing (18B)														150	150	90		50	0.2	0.2	50	125				0.05		15	25	25	25		25	0.2				25		25														NO	134.8672518	134.8672518	80.92035107		44.95575059	0.179823002	0.179823002	44.95575059	112.3893765				0.044955751		13.48672518	22.4778753	22.4778753	22.4778753		22.4778753	0.179823002				22.4778753		22.4778753															10.6902	0.330554665	6.730684723	0	0.947439074	0.03029607	3.253963847	1.648258723	4.114591325	0	0	0	0	0	4.646304468	10.68882881	0.297958494	0.05617078	0	8.353129308	0.240391669	0	0	0	0.447296312	0	0.058501649	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5346		5.89463153	10.6902	0.330554665	6.730684723	0	0.947439074	0.03029607	3.253963847	1.648258723	4.114591325	0	0	0	0	0	4.646304468	10.68882881	0.297958494	0.05617078	0	8.353129308	0.240391669	0	0	0	0.447296312	0	0.058501649	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5346	NO																																																																																		0			10.6902	0.330554665	6.730684723	0	0.947439074	0.03029607	3.253963847	1.648258723	4.114591325	0	0	0	0	0	4.646304468	10.68882881	0.297958494	0.05617078	0	8.353129308	0.240391669	0	0	0	0.447296312	0	0.058501649	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5346
H3653_803_0	2011	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	268.7714484	4.324955927	51.25573894		7.366951217	6.39E-05	16.66833865	23.65105384	41.22516083	21.8855593	35.15956201	14.66670183	0	13.67893197	35.24933373	135.4354796	2.063213138	1.200605371	0	42.50576316	0.535100468	20.28390586																			6700	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing		Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				0.076366873	0.076366873	0.169992765		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.064926069	0.064926069	0.144525519		0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406																				17.4503	0.280802388	7.407762248	0	1.459344462	1.27E-05	3.301887984	4.685117823	8.166432541	4.335384994	6.964877409	2.905376927	0	2.709706231	6.982660596	26.82887551	0.408708919	0.237832008	0	8.42011142	0.105999875	4.018108009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6693		18.79649157	17.4503	0.280802388	7.407762248	0	1.459344462	1.27E-05	3.301887984	4.685117823	8.166432541	4.335384994	6.964877409	2.905376927	0	2.709706231	6.982660596	26.82887551	0.408708919	0.237832008	0	8.42011142	0.105999875	4.018108009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6693	NO																																																																																		0			17.4503	0.280802388	7.407762248	0	1.459344462	1.27E-05	3.301887984	4.685117823	8.166432541	4.335384994	6.964877409	2.905376927	0	2.709706231	6.982660596	26.82887551	0.408708919	0.237832008	0	8.42011142	0.105999875	4.018108009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6693
H3653_806_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	272.5171841	4.324955927	51.25573894		7.366951217	6.39E-05	16.66833865	23.65105384	41.22516083	21.8855593	35.15956201	14.66670183	0	13.67893197	35.24933373	135.4354796	2.063213138	1.200605371	0	42.50576316	0.535100468	20.28390586																			6700	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing		Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				0.076	0.076	0.17		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.064614158	0.064614158	0.14453167		0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406																				17.6085	0.279453387	7.408077544	0	1.459344462	1.27E-05	3.301887984	4.685117823	8.166432541	4.335384994	6.964877409	2.905376927	0	2.709706231	6.982660596	26.82887551	0.408708919	0.237832008	0	8.42011142	0.105999875	4.018108009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8264		18.82418537	17.6085	0.279453387	7.408077544	0	1.459344462	1.27E-05	3.301887984	4.685117823	8.166432541	4.335384994	6.964877409	2.905376927	0	2.709706231	6.982660596	26.82887551	0.408708919	0.237832008	0	8.42011142	0.105999875	4.018108009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8264	NO																																																																																		0			17.6085	0.279453387	7.408077544	0	1.459344462	1.27E-05	3.301887984	4.685117823	8.166432541	4.335384994	6.964877409	2.905376927	0	2.709706231	6.982660596	26.82887551	0.408708919	0.237832008	0	8.42011142	0.105999875	4.018108009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8264
H3653_809_0	2011	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	306.5965402	2.832732642	63.68537764		9.900795295	0.000314026	18.95114989	31.98342483	42.53405463	22.64314824	37.30095967	13.7850152	0	14.66514109	38.91436636	137.6893907	1.501820682	1.235358379	0	47.79199493	1.536603027	24.29545511																			6700	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing		Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				0.076366873	0.076366873	0.169992765		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.064926069	0.064926069	0.144525519		0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406	0.198093406																				19.9061	0.183918195	9.204162227	0	1.961282267	6.22E-05	3.754097839	6.335705575	8.425715773	4.485458369	7.389074167	2.730720619	0	2.905067755	7.708679394	27.27536045	0.297500775	0.244716349	0	9.467279078	0.304390928	4.812769464	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.3921		20.6859851	19.9061	0.183918195	9.204162227	0	1.961282267	6.22E-05	3.754097839	6.335705575	8.425715773	4.485458369	7.389074167	2.730720619	0	2.905067755	7.708679394	27.27536045	0.297500775	0.244716349	0	9.467279078	0.304390928	4.812769464	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.3921	NO																																																																																		0			19.9061	0.183918195	9.204162227	0	1.961282267	6.22E-05	3.754097839	6.335705575	8.425715773	4.485458369	7.389074167	2.730720619	0	2.905067755	7.708679394	27.27536045	0.297500775	0.244716349	0	9.467279078	0.304390928	4.812769464	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.3921
H3655_013_0	2011	8	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	2105.572892	69.07584772	987.6738389	959.9155527	384.8641109	12.41551859	2.225250139	401.6395929	898.4710452	9665.943631	884.4590972	122.054896	0.097103319	127.3544969	4638.232123	4782.724489	18.8999127	1984.265224	691.4474577	1724.417818	38.52210011	5.133111159	0.061563234	0	0	0	162	0	5689.757028	0	6.187097251	6.762208816	0	0	0	0	0	0	0	0	3400	1A: $225/day (days1-9) w/$2025 yrly max	1B: $225/day (days1-9) w/$2025 yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $150 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $40 copay	9A: $40-$200 copay; 9B: $200 copay	8A: $0-$125 copay	8B: $75-$125 copay	9A: $200 copay	12: 20% coin	3: $40 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $25 copay; 7G: $25 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $40 copay; 7F: $40 copay; 7G: $40 copay	7E: $40 copay; 7H: $40 copay	7C: $40-$50 copay; 7I: $40-$50 copay	8B: $75-$125 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0-$40; 17B: $0; 18A: $40	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	-	-	18A: $40 copay	-	14A: $0 copay;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										225	225	128	0	150	0.2	0.069150653	49.8997111	119.6961286	19.09864415	93.56472378	200	0.2	3.875289874	22.02072891	39.14494517	40	47.54136776	86.96411877	19.21616045	0.2	0	0	0	0	0	40	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	117.1531957	104.350119	110.2823165	0	129.2370896	0.172316119	0.059578861	42.99262291	103.127862	16.45502123	80.61355062	172.3161195	0.172316119	3.338874565	18.97263277	33.72652524	34.4632239	40.96072004	74.92659741	16.556271	0.172316119	0	0	0	0	0	40	0	0	0	0.172316119	0.172316119	0	0	0	0	0	0	0	0		20.5562	0.600672744	9.07691324	0	4.144893133	2.139393985	0.132577868	1.43896163	7.721449827	13.25444231	5.941615683	1.752668837	0.016732467	0.035435058	7.333289563	13.44205652	0.054279327	6.773077693	4.317317108	2.379160726	6.637978805	0	0	0	0	0	0.54	0	0	0	1.066136589	1.165237582	0	0	0	0	0	0	0	0	110.5205		17.66919552	20.5562	0.600672744	9.07691324	0	4.144893133	2.139393985	0.132577868	1.43896163	7.721449827	13.25444231	5.941615683	1.752668837	0.016732467	0.035435058	7.333289563	13.44205652	0.054279327	6.773077693	4.317317108	2.379160726	6.637978805	0	0	0	0	0	0.54	0	0	0	1.066136589	1.165237582	0	0	0	0	0	0	0	0	110.5205	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	20.5562	0.600672744	9.07691324	0	4.144893133	2.139393985	0.132577868	1.43896163	7.721449827	13.25444231	5.941615683	1.752668837	0.016732467	0.035435058	7.333289563	13.44205652	0.054279327	6.773077693	4.317317108	2.379160726	6.637978805	0	0	0	0	0	0.54	0	0	0	1.066136589	1.165237582	0	0	0	0	0	0	0	0	110.5205
H3655_030_0	2011	9	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	2105.572892	69.07584772	987.6738389	959.9155527	384.8641109	12.41551859	2.225250139	401.6395929	898.4710452	9665.943631	884.4590972	122.054896	0.097103319	127.3544969	4638.232123	4782.724489	18.8999127	1984.265224	691.4474577	1724.417818	38.52210011	5.133111159	0.061563234	1065.67984	378	299	162	0	5693.266133	0	6.187097251	6.762208816	0	0	0	0	0	0	0	0	3000	1A: $135/day (days1-7) w/$945 yrly max	1B: $135/day (days1-7) w/$945 yrly max	2: $100/day (for days 21-100)	6: $0 copay	10A: $150 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $20 copay	9A: $20-$105 copay; 9B: $105 copay	8A: $0-$100 copay	8B: $50-$100 copay	9A: $105 copay	12: 20% coin	3: $20 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $15 copay; 7G: $15 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $20 copay; 7F: $20 copay; 7G: $20 copay	7E: $40 copay; 7H: $40 copay	7C: $20-$40 copay; 7I: $20-$40 copay	8B: $50-$100 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0-$20; 17B: $0; 18A: $20	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $20 Co-Pay	17A: $20 copay	17B: $20 copay	18A: $20 copay	-	14A: $0 copay;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										135	135	100	0	150	0.2	0.069150653	49.69913331	62.3385683	12.84217605	68.56472378	105	0.2	3.875289874	13.21243734	19.71498172	40	35.08273553	61.96411877	9.608080225	0.2	0	0	20	20	20	20	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	63.10804805	52.90957726	88.11793861	0	132.1769079	0.176235877	0.06093413	43.79385178	54.93146135	11.31626081	60.41782121	92.52383555	0.176235877	3.414825552	11.64252743	17.37243549	35.24717545	30.91418336	54.60150414	8.466442234	0.176235877	0	0	20	20	20	20	0	0	0	0.176235877	0.176235877	0	0	0	0	0	0	0	0		11.0732	0.304564492	7.252648559	0	4.239179012	2.18805981	0.135593681	1.465778733	4.112860624	9.115194923	4.453090967	0.94108226	0.017113089	0.036241116	4.500062059	6.923964388	0.055514045	5.111828246	3.146172602	1.21664032	6.788976105	0	0	1.776133067	0.63	0.498333333	0.27	0	0	0	1.090388512	1.191743803	0	0	0	0	0	0	0	0	78.5344		10.16173476	11.0732	0.304564492	7.252648559	0	4.239179012	2.18805981	0.135593681	1.465778733	4.112860624	9.115194923	4.453090967	0.94108226	0.017113089	0.036241116	4.500062059	6.923964388	0.055514045	5.111828246	3.146172602	1.21664032	6.788976105	0	0	1.776133067	0.63	0.498333333	0.27	0	0	0	1.090388512	1.191743803	0	0	0	0	0	0	0	0	78.5344	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	11.0732	0.304564492	7.252648559	0	4.239179012	2.18805981	0.135593681	1.465778733	4.112860624	9.115194923	4.453090967	0.94108226	0.017113089	0.036241116	4.500062059	6.923964388	0.055514045	5.111828246	3.146172602	1.21664032	6.788976105	0	0	1.776133067	0.63	0.498333333	0.27	0	0	0	1.090388512	1.191743803	0	0	0	0	0	0	0	0	78.5344
H3655_031_0	2011	8	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1308.593704	31.10556914	615.8991754	942.2293266	395.428472	12.15880412	2.214422348	397.5507647	908.5595101	9865.946213	837.8274322	122.499249	0.121962758	115.8966518	4707.084982	4841.949091	18.95384268	2070.323053	713.8109398	1797.576183	39.52461653	5.420022536	0.087850951	0	0	0	162	0	5693.468731	0	6.482966305	6.452131745	0	0	0	0	0	0	0	0	3400	1A: $255/day (days1-8) w/$2040 yrly max	1B: $255/day (days1-8) w/$2040 yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $45 copay	9A: $45-$250copay; 9B: $250 copay	8A: $0-$140 copay	8B: $50-$140 copay	9A: $250 copay	12: 20% coin	3: $45 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $0 copay; 7G: $0 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $45 copay; 7F: $45 copay; 7G: $45 copay	7E: $40 copay; 7H: $40 copay	7C: $45-$50 copay; 7I: $45-$50 copay	8B: $50-$140 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0-$45; 17B: $0; 18A: $45	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	-	-	18A: $45 copay	-	14A: $0 copay;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										255	255	128	0	125	0.2	0.072391555	49.95864326	143.8310785	12.93974582	83.13128773	250	0.2	5.066666667	0	44.15810888	40	48.72715561	71.05104458	21.60692347	0.2	0	0	0	0	0	45	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	127.8886734	129.1453334	111.9428582	0	109.3191975	0.174910716	0.063310293	43.69151032	125.7879846	11.31650103	72.70276529	218.638395	0.174910716	4.431071472	0	38.61863221	34.9821432	42.61450838	62.1379454	18.89641228	0.174910716	0	0	0	0	0	45	0	0	0	0.174910716	0.174910716	0	0	0	0	0	0	0	0		13.9462	0.334761591	5.745459507	0	3.602326936	2.126705135	0.140195728	1.447466112	9.523822471	9.303999206	5.07603093	2.231919932	0.021332593	0.042795529	0	15.58245426	0.055253837	7.352149925	3.696228767	2.830645055	6.913278977	0	0	0	0	0	0.6075	0	0	0	1.133940278	1.128546983	0	0	0	0	0	0	0	0	92.843		13.23030898	13.9462	0.334761591	5.745459507	0	3.602326936	2.126705135	0.140195728	1.447466112	9.523822471	9.303999206	5.07603093	2.231919932	0.021332593	0.042795529	0	15.58245426	0.055253837	7.352149925	3.696228767	2.830645055	6.913278977	0	0	0	0	0	0.6075	0	0	0	1.133940278	1.128546983	0	0	0	0	0	0	0	0	92.843	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	13.9462	0.334761591	5.745459507	0	3.602326936	2.126705135	0.140195728	1.447466112	9.523822471	9.303999206	5.07603093	2.231919932	0.021332593	0.042795529	0	15.58245426	0.055253837	7.352149925	3.696228767	2.830645055	6.913278977	0	0	0	0	0	0.6075	0	0	0	1.133940278	1.128546983	0	0	0	0	0	0	0	0	92.843
H3655_801_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	334.9642122	4.010628817	69.49044683	10.77166792	12.02553747	12.57043218	3.17296698	16.38946657	53.75053462	6.896079951	28.79326915	0	0.025320048	35.22743983	49.77657759	137.0575136	1.325760473	5.271741354	20.71576984	25.01209903	57.35253178	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.081008776	0.081008776	0.1725445	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.062715648	0.062715648	0.133581083	0	0.180384726	0.180384726	0.180384726	0.180384726	0.180384726	0.180384726	0.180384726	0.180384726	0.180384726	0.180384726	0.180384726	0.180384726	0.180384726	0.180384726	0.180384726	0.180384726	0.180384726	0.180384726																				21.0075	0.251529183	9.282609153	0	2.16922328	2.267513963	0.572354779	2.956409433	9.695775452	1.243947491	5.193865962	0	0.00456735	6.354492076	8.978934302	24.72308202	0.23914694	0.950941619	3.736808464	4.511800626	10.34552072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.486		33.39369959	21.0075	0.251529183	9.282609153	0	2.16922328	2.267513963	0.572354779	2.956409433	9.695775452	1.243947491	5.193865962	0	0.00456735	6.354492076	8.978934302	24.72308202	0.23914694	0.950941619	3.736808464	4.511800626	10.34552072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.486	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	21.0075	0.251529183	9.282609153	0	2.16922328	2.267513963	0.572354779	2.956409433	9.695775452	1.243947491	5.193865962	0	0.00456735	6.354492076	8.978934302	24.72308202	0.23914694	0.950941619	3.736808464	4.511800626	10.34552072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.486
H3655_803_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	334.3812043	4.003648284	69.31947032	10.71504576	12.05626533	12.54932697	3.167639705	16.34413494	53.90025572	6.87835283	28.71925293	0	0.02525496	35.13688388	49.7019411	136.8520055	1.323772589	5.263836748	20.684708	24.97459514	57.0406449	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.081008776	0.081008776	0.1725445	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.06275541	0.06275541	0.133665775	0	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092																				20.9842	0.25125059	9.265640726	0	2.176144943	2.265142121	0.57175609	2.950101514	9.728947207	1.241536439	5.183799072	0	0.004558497	6.342175629	8.97115523	24.7016627	0.23893975	0.950117752	3.733571008	4.507891741	10.2957846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3644		33.26462797	20.9842	0.25125059	9.265640726	0	2.176144943	2.265142121	0.57175609	2.950101514	9.728947207	1.241536439	5.183799072	0	0.004558497	6.342175629	8.97115523	24.7016627	0.23893975	0.950117752	3.733571008	4.507891741	10.2957846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3644	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	20.9842	0.25125059	9.265640726	0	2.176144943	2.265142121	0.57175609	2.950101514	9.728947207	1.241536439	5.183799072	0	0.004558497	6.342175629	8.97115523	24.7016627	0.23893975	0.950117752	3.733571008	4.507891741	10.2957846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3644
H3655_804_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	334.3812043	4.003648284	69.31947032	10.71504576	12.05626533	12.54932697	3.167639705	16.34413494	53.90025572	6.87835283	28.71925293	0	0.02525496	35.13688388	49.7019411	136.8520055	1.323772589	5.263836748	20.684708	24.97459514	57.0406449	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.081008776	0.081008776	0.1725445	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.06275541	0.06275541	0.133665775	0	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092	0.180499092																				20.9842	0.25125059	9.265640726	0	2.176144943	2.265142121	0.57175609	2.950101514	9.728947207	1.241536439	5.183799072	0	0.004558497	6.342175629	8.97115523	24.7016627	0.23893975	0.950117752	3.733571008	4.507891741	10.2957846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3644		33.26462797	20.9842	0.25125059	9.265640726	0	2.176144943	2.265142121	0.57175609	2.950101514	9.728947207	1.241536439	5.183799072	0	0.004558497	6.342175629	8.97115523	24.7016627	0.23893975	0.950117752	3.733571008	4.507891741	10.2957846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3644	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	20.9842	0.25125059	9.265640726	0	2.176144943	2.265142121	0.57175609	2.950101514	9.728947207	1.241536439	5.183799072	0	0.004558497	6.342175629	8.97115523	24.7016627	0.23893975	0.950117752	3.733571008	4.507891741	10.2957846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3644
H3659_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1477.890576	112.2668746	1654.992624	2398.463969	316.6383117	10.22220545	9.955386911	349.2328991	42.65991302	13.96449705	37.70881652	0	0.045033503	16.00623728	5695.719267	122.1521406	594.1475995	355.4205576	0	0	31.57443651	1475.021948	0	0	327.7810331	0	16.44667593	6.187755469	0	0											4600	"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-56 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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, 18a); $0/$40 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												190.7019303	117.8997596	63.57531997	0	200	0.2	0.115268056	49.34547436	0.2	0.164202038	0.169208334	0	0.2	0.160442843	17.0688554	0.118861373	38.5	40	0	0	0.2	39.54025459	0	0	40	0	0	0	0	0											YES	141.372595	87.40234003	47.13013627	0	148.2655102	0.14826551	0.085451386	36.60008272	0.14826551	0.121727495	0.1254388	0	0.14826551	0.1189407	16.3130106	0.113600456	36.79513906	38.22871591	0	0	0.14826551	29.3122801	0	0	40	0	0	0	0	0											5900	17.4111	0.817698962	6.500002326	0	3.912211737	1.515600506	0.850701606	1.06516275	6.32499377	1.699863239	4.730148689	0	0.006676915	1.903793064	7.742860731	13.87653888	1.821811962	1.132272627	0	0	4.68139994	3.603021376	0	0	1.092603444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6885	0	20.33655437	17.4111	0.817698962	6.500002326	0	3.912211737	1.515600506	0.850701606	1.06516275	6.32499377	1.699863239	4.730148689	0	0.006676915	1.903793064	7.742860731	13.87653888	1.821811962	1.132272627	0	0	4.68139994	3.603021376	0	0	1.092603444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6885	NO	"$325 Days 1-19 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-19 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-34 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.5232	0.0338	0.3451	0.115	0.0935	0.0544	0.0529	0.0255	0.2269	0.0406	0.1659	0	0.0002	0.0678	0.3324	0.4774	0.063	0.039	0	0	0.2025	0.117	0	0	0.038	0	0.0019	0	0	0											3.0162	0	0.973259435	17.9343	0.851512101	6.845140151	0.114968026	4.005758144	1.56996067	0.903642869	1.09063595	6.551852824	1.740509325	4.896060595	0	0.00683657	1.971626705	8.075304229	14.35392337	1.884856459	1.171286461	0	0	4.88392832	3.72001805	0	0	1.130619285	0	0.001907475	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7047
H3659_003_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1600.470938	98.11036229	1621.448975	1198.741885	275.9878617	8.209585773	10.65775739	384.578317	383.5912217	15.46422173	38.75178187	0	0.013968362	956.3799474	6309.617461	127.0516656	592.4094735	770.553652	0	0	17.83923137	1478.250696	0	330.0214975	282.7052637	0	17.16198367	3.843936221	384.2577807	0											3350	"$185 Days 1-19 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$185 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-34 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$175 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $175 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$0 n/c (10b)	"$25 (16a1, 16a2); $0 n/c (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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												171.3602267	118.2975817	79.77557366	0	200	0.2	0.116047953	49.60099557	175	0.140568232	0.169553719	0	0.2	69.10940183	7.260824014	0.107852633	38.5	35	0	0	0.2	34.36843556	0	25	35	0	0	0	0	0											NO	117.6748163	81.23615646	54.78270047	0	137.3420408	0.137342041	0.079691314	34.08301083	120.1742857	0.096529639	0.116434269	0	0.137342041	47.45813144	6.865735749	0.101989314	36.40507273	33.09552066	0	0	0.137342041	23.6011554	0	25	35	0	0	0	0	0												15.6946	0.664175728	7.402279463	0	3.158728015	1.127521264	0.849330686	1.092298912	3.841483423	1.492755748	4.512035403	0	0.001918443	3.782333771	3.610013847	12.95791222	1.797225831	2.125156193	0	0	2.450076443	2.9073687	0	0.687544786	0.824557019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.9793	0	23.52155248	15.6946	0.664175728	7.402279463	0	3.158728015	1.127521264	0.849330686	1.092298912	3.841483423	1.492755748	4.512035403	0	0.001918443	3.782333771	3.610013847	12.95791222	1.797225831	2.125156193	0	0	2.450076443	2.9073687	0	0.687544786	0.824557019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.9793	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.6946	0.664175728	7.402279463	0	3.158728015	1.127521264	0.849330686	1.092298912	3.841483423	1.492755748	4.512035403	0	0.001918443	3.782333771	3.610013847	12.95791222	1.797225831	2.125156193	0	0	2.450076443	2.9073687	0	0.687544786	0.824557019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.9793
H3659_031_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1310.51175	110.3407852	1132.074228	1475.227282	216.5803441	8.700991957	9.215764012	336.6677339	40.77719598	16.44499551	39.71308256	0	0.074665049	16.28996658	5869.803468	112.9773384	590.5840843	319.7524584	0	0	25.92707561	1302.769495	0	0	300.8264868	0	16.93265658	6	384.5495571	0											3800	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-48 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	60.44724483	0	200	0.2	0.106301073	49.30371138	0.2	0.192036866	0.181626967	0	0.2	0.160704709	13.48167946	0.101730832	38.5	35	0	0	0.2	34.6942935	0	0	35	0	0	0	0	0											NO	137.0326935	91.66169182	44.47404452	0	147.1499475	0.147149948	0.078210987	36.29584733	0.147149948	0.141291074	0.133631994	0	0.147149948	0.118238448	12.87071527	0.097122896	36.75525287	33.41386625	0	0	0.147149948	25.52631734	0	0	35	0	0	0	0	0												14.9652	0.842835254	4.195659967	0	2.655815522	1.28035051	0.720773998	1.018303389	6.000362248	2.323531072	5.306938395	0	0.010986958	1.926100361	6.295714094	10.9726863	1.80892228	0.890347156	0	0	3.815167815	2.771242296	0	0	0.877410586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6784	0	18.12649872	14.9652	0.842835254	4.195659967	0	2.655815522	1.28035051	0.720773998	1.018303389	6.000362248	2.323531072	5.306938395	0	0.010986958	1.926100361	6.295714094	10.9726863	1.80892228	0.890347156	0	0	3.815167815	2.771242296	0	0	0.877410586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6784	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.9652	0.842835254	4.195659967	0	2.655815522	1.28035051	0.720773998	1.018303389	6.000362248	2.323531072	5.306938395	0	0.010986958	1.926100361	6.295714094	10.9726863	1.80892228	0.890347156	0	0	3.815167815	2.771242296	0	0	0.877410586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6784
H3659_054_0	2011	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1310.604817	124.1869721	1111.546014	1297.734745	212.8833815	7.911039205	8.024555585	341.6267937	40.16255842	15.74677841	37.69989454	0	0.061518868	15.31782674	5587.97782	113.5765727	583.4483141	429.6902572	0	0	33.47591065	1307.020648	0	0	298.6243103	0	17.32112705	0	0	0											3350	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-44 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	57.83303171	0	200	0.2	0.117123595	49.27070587	0.2	0.193325879	0.18291957	0	0.2	0.160860668	13.68250469	0.103250843	38.5	35	0	0	0.2	34.37827946	0	0	35	0	35	0	0	0											NO	133.4013596	89.23267869	41.42305606	0	143.2505087	0.143250509	0.083890073	35.31281198	0.143250509	0.138470153	0.131016608	0	0.143250509	0.115216863	13.01307557	0.098205467	36.6163521	33.28759281	0	0	0.143250509	24.62353011	0	0	35	0	35	0	0	0												14.5697	0.923461348	3.836969405	0	2.541304392	1.133260391	0.673180555	1.005316894	5.753306926	2.180458814	4.939312286	0	0.008812609	1.764871941	6.05973147	11.15384036	1.780312408	1.191946193	0	0	4.795441231	2.68195519	0	0	0.870987572	0	0.050519954	0	0	0	0	0	0	0	0	0	0	0	0	0	67.9147	0	19.5797681	14.5697	0.923461348	3.836969405	0	2.541304392	1.133260391	0.673180555	1.005316894	5.753306926	2.180458814	4.939312286	0	0.008812609	1.764871941	6.05973147	11.15384036	1.780312408	1.191946193	0	0	4.795441231	2.68195519	0	0	0.870987572	0	0.050519954	0	0	0	0	0	0	0	0	0	0	0	0	0	67.9147	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.5697	0.923461348	3.836969405	0	2.541304392	1.133260391	0.673180555	1.005316894	5.753306926	2.180458814	4.939312286	0	0.008812609	1.764871941	6.05973147	11.15384036	1.780312408	1.191946193	0	0	4.795441231	2.68195519	0	0	0.870987572	0	0.050519954	0	0	0	0	0	0	0	0	0	0	0	0	0	67.9147
H3659_056_0	2011	4																															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	YES	346.5638424	23.1694	58.29404951	3896.495127	20.11195278	18.60343294	16.68302512	38.07353669	56.5290462	20.83341321	55.68296401	0	0.259210671	31.54461708	37.7624157	148.254547	11.3336	6.182074319	0	0	23.72305764	6.647675847	815.1380072	475.2708206	275.8897989	209.8759509	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.078331415	0.079282255	0.170903425	0	0.233	0.233	0.233	0.099300507	0.233	0.233	0.233	0	0.233	0.233	0.22819708	0.23298705	0.230680599	0.233	0	0	0.233	0.230505381	0	0	0	0	0	0	0	0											NO	0.059571308	0.060294424	0.129972636	0	0.177197293	0.177197293	0.177197293	0.075531404	0.177197293	0.177197293	0.177197293	0	0.177197293	0.177197293	0.173544655	0.177187444	0.17543338	0.177197293	0	0	0.177197293	0.176765375	0	0	0	0	0	0	0	0												20.6453	1.396985635	7.576631267	0	3.563783582	3.29647795	2.956186885	2.875747699	10.01679394	3.691624417	9.866870469	0	0.045931429	5.589620743	6.553465418	26.26884429	1.988291756	1.095446832	0	0	4.203661587	1.175078911	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.8067	0	35.51145887	20.6453	1.396985635	7.576631267	0	3.563783582	3.29647795	2.956186885	2.875747699	10.01679394	3.691624417	9.866870469	0	0.045931429	5.589620743	6.553465418	26.26884429	1.988291756	1.095446832	0	0	4.203661587	1.175078911	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.8067	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.6453	1.396985635	7.576631267	0	3.563783582	3.29647795	2.956186885	2.875747699	10.01679394	3.691624417	9.866870469	0	0.045931429	5.589620743	6.553465418	26.26884429	1.988291756	1.095446832	0	0	4.203661587	1.175078911	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.8067
H3659_058_0	2011	4																															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	YES	390.9500989	40.8332995	10151.14279	19.38645967	38.69984145	22.29182792	9.338109014	16.94906892	3.498444771	38.95127825	12.67301382	0	0	6.143599315	1.781264766	137.5507848	18.63441	9.433812017	0	0	4.822977446	6.574812541	2244.970717	141.3930691	192.6328337	262.7731521	0	0	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.07909029	0.08005051	0	0	0.2	0.2	0.09475187	0.077142093	0.2	0	0.106989148	0	0	0.161181806	0.002900402	0.027901405	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.074732412	0.075639724	0	0	0.188979992	0.188979992	0.089531038	0.072891561	0.188979992	0	0.101094042	0	0	0.152300682	0.00274059	0.026364036	0.188979992	0	0	0	0.188979992	0.189249682	0	0	0	0	0	0	0	0												29.2166	3.088619492	0	0	7.313495718	4.212709456	0.836050592	1.235444086	0.661136064	0	1.28116619	0	0	0.935674363	0.004881716	3.626393885	3.521530648	0	0	0	0.911446238	1.244281181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0895	0	3.385500428	29.2166	3.088619492	0	0	7.313495718	4.212709456	0.836050592	1.235444086	0.661136064	0	1.28116619	0	0	0.935674363	0.004881716	3.626393885	3.521530648	0	0	0	0.911446238	1.244281181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0895	NO	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												4.2028	0.4443	0	0.0053	1.5832	0.9119	0.382	0.1783	0.1431	0	0.3791	0	0	0.2025	0.0364	3.106	0.4208	0.0031	0	0	0.1089	0.1485	0	0	0.0186	0	0	0	0	0											12.2749	0	0	33.4195	3.532919642	0	0.005345941	8.89667105	5.12464787	1.218064143	1.413737721	0.804254259	0	1.660235601	0	0	1.138222724	0.041291109	6.732379348	3.942307648	0.00310157	0	0	1.02035218	1.39274469	0	0	0.018648201	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3644
H3659_801_0	2011	1																															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	224.9433023	6.2096	32.4572084	1529.459877	7.88567607	8.448083066	10.5784804	38.02173523	42.75907094	17.75360989	45.89113903	0	0.039911935	18.52598136	34.33007405	123.5944244	2.9471	7.439962374	0	0	34.16095353	9.709075542	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.080328944	0.080328944	0.171802895	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.06475076	0.06475076	0.138485177	0	0.187814334	0.187814334	0.187814334	0.187814334	0.187814334	0.187814334	0.187814334	0	0.187814334	0.187814334	0.187814334	0.187814334	0.187814334	0.187814334	0	0	0.187814334	0.187814334	0	0	0	0	0	0	0	0												14.5652	0.402076318	4.494842253	0	1.481043001	1.586671096	1.986790252	7.141026885	8.030766439	3.33438242	8.619013721	0	0.007496034	3.479444854	6.447679999	23.21280452	0.553507624	1.397331579	0	0	6.415916742	1.823503558	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9795	0	22.85083347	14.5652	0.402076318	4.494842253	0	1.481043001	1.586671096	1.986790252	7.141026885	8.030766439	3.33438242	8.619013721	0	0.007496034	3.479444854	6.447679999	23.21280452	0.553507624	1.397331579	0	0	6.415916742	1.823503558	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9795	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.5652	0.402076318	4.494842253	0	1.481043001	1.586671096	1.986790252	7.141026885	8.030766439	3.33438242	8.619013721	0	0.007496034	3.479444854	6.447679999	23.21280452	0.553507624	1.397331579	0	0	6.415916742	1.823503558	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9795
H3659_802_0	2011	1																															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	224.8649225	6.2105	32.44589893	1528.926951	7.882928366	8.445139395	10.5747944	38.00848684	42.74417187	17.74742378	45.87514861	0	0.039898028	18.51883424	34.31811199	123.5513588	2.9463	7.437369975	0	0	34.14905041	9.705692488	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.080328943	0.080328943	0.171802894	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064756968	0.064756968	0.138498456	0	0.187832345	0.187832345	0.187832345	0.187832345	0.187832345	0.187832345	0.187832345	0	0.187832345	0.187832345	0.187832345	0.187832345	0.187832345	0.187832345	0	0	0.187832345	0.187832345	0	0	0	0	0	0	0	0												14.5616	0.402173152	4.493706912	0	1.480668917	1.586270332	1.986288426	7.139223194	8.028738016	3.333540217	8.616836718	0	0.00749414	3.478436053	6.446051435	23.20694139	0.553410437	1.396978639	0	0	6.414296201	1.823042975	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9557	0	22.8337931	14.5616	0.402173152	4.493706912	0	1.480668917	1.586270332	1.986288426	7.139223194	8.028738016	3.333540217	8.616836718	0	0.00749414	3.478436053	6.446051435	23.20694139	0.553410437	1.396978639	0	0	6.414296201	1.823042975	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9557	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.5616	0.402173152	4.493706912	0	1.480668917	1.586270332	1.986288426	7.139223194	8.028738016	3.333540217	8.616836718	0	0.00749414	3.478436053	6.446051435	23.20694139	0.553410437	1.396978639	0	0	6.414296201	1.823042975	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9557
H3659_803_0	2011	1																															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	224.8649225	6.2105	32.44589893	1528.926951	7.882928366	8.445139395	10.5747944	38.00848684	42.74417187	17.74742378	45.87514861	0	0.039898028	18.51883424	34.31811199	123.5513588	2.9463	7.437369975	0	0	34.14905041	9.705692488	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.080328943	0.080328943	0.171802894	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064756968	0.064756968	0.138498456	0	0.187832345	0.187832345	0.187832345	0.187832345	0.187832345	0.187832345	0.187832345	0	0.187832345	0.187832345	0.187832345	0.187832345	0.187832345	0.187832345	0	0	0.187832345	0.187832345	0	0	0	0	0	0	0	0												14.5616	0.402173152	4.493706912	0	1.480668917	1.586270332	1.986288426	7.139223194	8.028738016	3.333540217	8.616836718	0	0.00749414	3.478436053	6.446051435	23.20694139	0.553410437	1.396978639	0	0	6.414296201	1.823042975	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9557	0	22.8337931	14.5616	0.402173152	4.493706912	0	1.480668917	1.586270332	1.986288426	7.139223194	8.028738016	3.333540217	8.616836718	0	0.00749414	3.478436053	6.446051435	23.20694139	0.553410437	1.396978639	0	0	6.414296201	1.823042975	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9557	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.5616	0.402173152	4.493706912	0	1.480668917	1.586270332	1.986288426	7.139223194	8.028738016	3.333540217	8.616836718	0	0.00749414	3.478436053	6.446051435	23.20694139	0.553410437	1.396978639	0	0	6.414296201	1.823042975	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9557
H3659_807_0	2011	1																															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	220.95416	6.099479014	31.71895129	1492.686306	7.706312019	8.255926757	10.33786702	37.15690989	41.78649229	17.34979424	44.84731976	0	0.039004116	18.1045977	33.37717031	120.1638	2.865297013	7.233450499	0	0	33.21274409	9.439579637	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.079685114	0.079685114	0.168663628	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064257046	0.064257046	0.13600817	0	0.187888189	0.187888189	0.187888189	0.187888189	0.187888189	0.187888189	0.187888189	0	0.187888189	0.187888189	0.187888189	0.187888189	0.187888189	0.187888189	0	0	0.187888189	0.187888189	0	0	0	0	0	0	0	0												14.1979	0.391934504	4.314036531	0	1.447925011	1.551191129	1.942363116	6.981344518	7.851188373	3.259821424	8.426281704	0	0.007328413	3.401640079	6.271176093	22.57735879	0.538355467	1.359079916	0	0	6.240282348	1.773585526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.5328	0	22.21704369	14.1979	0.391934504	4.314036531	0	1.447925011	1.551191129	1.942363116	6.981344518	7.851188373	3.259821424	8.426281704	0	0.007328413	3.401640079	6.271176093	22.57735879	0.538355467	1.359079916	0	0	6.240282348	1.773585526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.5328	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.3593	0.0099	0.1372	0	0.046	0.0493	0.0618	0.222	0.2496	0.1037	0.2679	0	0.0002	0.1082	0.2405	0.8659	0.0206	0.0521	0	0	0.2393	0.068	0	0	0	0	0	0	0	0											3.1017	0	0	14.5572	0.40185364	4.451211747	0	1.493965286	1.600514999	2.004125245	7.203333236	8.100835878	3.363475323	8.694215692	0	0.007561437	3.509803444	6.511698176	23.44328144	0.559003329	1.411205503	0	0	6.479619546	1.841608888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6345
H3659_808_0	2011	1																															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	220.95416	6.099479014	31.71895129	1492.686306	7.706312019	8.255926757	10.33786702	37.15690989	41.78649229	17.34979424	44.84731976	0	0.039004116	18.1045977	33.37717031	120.1638	2.865297013	7.233450499	0	0	33.21274409	9.439579637	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.079685114	0.079685114	0.168663628	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064257046	0.064257046	0.13600817	0	0.187888189	0.187888189	0.187888189	0.187888189	0.187888189	0.187888189	0.187888189	0	0.187888189	0.187888189	0.187888189	0.187888189	0.187888189	0.187888189	0	0	0.187888189	0.187888189	0	0	0	0	0	0	0	0												14.1979	0.391934504	4.314036531	0	1.447925011	1.551191129	1.942363116	6.981344518	7.851188373	3.259821424	8.426281704	0	0.007328413	3.401640079	6.271176093	22.57735879	0.538355467	1.359079916	0	0	6.240282348	1.773585526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.5328	0	22.21704369	14.1979	0.391934504	4.314036531	0	1.447925011	1.551191129	1.942363116	6.981344518	7.851188373	3.259821424	8.426281704	0	0.007328413	3.401640079	6.271176093	22.57735879	0.538355467	1.359079916	0	0	6.240282348	1.773585526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.5328	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.3593	0.0099	0.1372	0	0.046	0.0493	0.0618	0.222	0.2496	0.1037	0.2679	0	0.0002	0.1082	0.2405	0.8659	0.0206	0.0521	0	0	0.2393	0.068	0	0	0	0	0	0	0	0											3.1017	0	0	14.5572	0.40185364	4.451211747	0	1.493965286	1.600514999	2.004125245	7.203333236	8.100835878	3.363475323	8.694215692	0	0.007561437	3.509803444	6.511698176	23.44328144	0.559003329	1.411205503	0	0	6.479619546	1.841608888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6345
H3659_809_0	2011	1																															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	220.95416	6.099479014	31.71895129	1492.686306	7.706312019	8.255926757	10.33786702	37.15690989	41.78649229	17.34979424	44.84731976	0	0.039004116	18.1045977	33.37717031	120.1638	2.865297013	7.233450499	0	0	33.21274409	9.439579637	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.079685114	0.079685114	0.168663628	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064257046	0.064257046	0.13600817	0	0.187888189	0.187888189	0.187888189	0.187888189	0.187888189	0.187888189	0.187888189	0	0.187888189	0.187888189	0.187888189	0.187888189	0.187888189	0.187888189	0	0	0.187888189	0.187888189	0	0	0	0	0	0	0	0												14.1979	0.391934504	4.314036531	0	1.447925011	1.551191129	1.942363116	6.981344518	7.851188373	3.259821424	8.426281704	0	0.007328413	3.401640079	6.271176093	22.57735879	0.538355467	1.359079916	0	0	6.240282348	1.773585526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.5328	0	22.21704369	14.1979	0.391934504	4.314036531	0	1.447925011	1.551191129	1.942363116	6.981344518	7.851188373	3.259821424	8.426281704	0	0.007328413	3.401640079	6.271176093	22.57735879	0.538355467	1.359079916	0	0	6.240282348	1.773585526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.5328	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.3593	0.0099	0.1372	0	0.046	0.0493	0.0618	0.222	0.2496	0.1037	0.2679	0	0.0002	0.1082	0.2405	0.8659	0.0206	0.0521	0	0	0.2393	0.068	0	0	0	0	0	0	0	0											3.1017	0	0	14.5572	0.40185364	4.451211747	0	1.493965286	1.600514999	2.004125245	7.203333236	8.100835878	3.363475323	8.694215692	0	0.007561437	3.509803444	6.511698176	23.44328144	0.559003329	1.411205503	0	0	6.479619546	1.841608888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6345
H3660_028_0	2011	8																															D	D	D		T	Coin	Coin	V	V	V	V		Coin	V		V	V	P		Coin	Coin				V																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1422.394271	47.17195564	87.872695	0	156.6506698	21.78257035	0.505504561	280.5200431	183.1268002	1440.044624	1420.924396	0	0.268631768	180.1900477	0	2636.049246	175.7472244	289.1141033	0	0.264549164	11.66669246	0	0	0	539.712112	0	0	0	0	0											3400	1A IP Acute: $195/$0 Per Day for days 1-6/7-90	1B IP Psych: $130/$0 Per Day for days 1-15/16-90	2 SNF: $0/$75 for days 1-10/11-100	6 Home Health: $0	10A Ambulance: min $0/ max $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $40"	9B ASC Services: min $0/ max $150	8A OP Diagnostic Procedures/Tests: min $10/ max $125	8B OP Radiology: min $0/ max $150	9A OP Hospital: min $0/ max $150	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"											0	195	130	75	0	100	0.2	0.2	49.62242972	150	10	106.3	0	0.2	25	0	25	25	25	0	0.2	0.2	0	0	0	25	0	0	0	0	0											NO	180.6833724	130	75	0	100	0.2	0.2	49.62242972	150	10	106.3	0	0.2	25	0	25	25	25	0	0.2	0.2	0	0	0	25	0	0	0	0	0												21.4169	0.511029519	0.549204344	0	1.305422248	4.356514069	0.101100912	1.160007177	2.289085002	1.200037187	12.58702194	0	0.053726354	0.375395933	0	5.491769262	0.366140051	0.602321049	0	0.052909833	2.333338491	0	0	0	1.124400233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8763	0	1.696990756	21.4169	0.511029519	0.549204344	0	1.305422248	4.356514069	0.101100912	1.160007177	2.289085002	1.200037187	12.58702194	0	0.053726354	0.375395933	0	5.491769262	0.366140051	0.602321049	0	0.052909833	2.333338491	0	0	0	1.124400233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8763	NO	1A IP Acute: 20%	1B IP Psych: 20%	2 SNF: $75 for days 1-100	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: $40"	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: 20%, 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"												2.5888	0.0184	1.1537	0.0177	3.2101	0.4393	0.0395	0.1014	0.3736	0.0618	0.0554	0	0	0.0777	0.1169	0.692	0.1053	0.4584	0	0	0.0415	0	0	0	0.0541	0	0.0038	0	0	0											9.6098	0	5.33E-15	24.0057	0.529446878	1.702902648	0.017712169	4.515564148	4.795854184	0.140602412	1.261428796	2.662723271	1.261805236	12.64244114	0	0.053726354	0.453119186	0.116939905	6.183814717	0.471451214	1.06075567	0	0.052909833	2.374881432	0	0	0	1.178476987	0	0.003833279	0	0	0	0	0	0	0	0	0	0	0	0	0	65.4861
H3660_029_0	2011	8																															D	D	D		T	Coin	Coin	V	V	V	V		Coin	V		V	V	P		Coin	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	808.5037001	44.84690137	165.4392606	0	74.64723236	14.77295943	0.760268875	244.254449	225.1827047	1269.49485	1100.4592	0	0.421489703	138.4903473	0	2324.450987	166.5473944	216.1446575	0	0.506759288	6.595048556	0	0	0	446.1009713	0	0.143419769	0	0	0											3400	1A IP Acute: $265/$0 Per Day for days 1-6/7-90	1B IP Psych: $140/$0 Per Day for days 1-15/16-90	2 SNF: $0/$100 for days 1-10/11-100	6 Home Health: $0	10A Ambulance: min $0/ max $200	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $40"	9B ASC Services: min $0/ max $250	8A OP Diagnostic Procedures/Tests: min $20/ max $125	8B OP Radiology: min $0/ max $250	9A OP Hospital: min $0/ max $250	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, 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: $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): $0, 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"											0	265	140	100	0	200	0.2	0.2	49.55898471	250	20	125.86	0	0.2	40	0	40	40	40	0	0.2	0.2	0	0	0	40	0	40	0	0	0											NO	228.2041329	140	100	0	200	0.2	0.2	49.55898471	250	20	125.86	0	0.2	40	0	40	40	40	0	0.2	0.2	0	0	0	40	0	40	0	0	0												15.3753	0.523213849	1.378660505	0	1.244120539	2.954591885	0.152053775	1.008750208	4.691306348	2.11582475	11.54198291	0	0.084297941	0.461634491	0	7.748169958	0.555157981	0.720482192	0	0.101351858	1.319009711	0	0	0	1.487003238	0	0.000478066	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4634	0	2.479132894	15.3753	0.523213849	1.378660505	0	1.244120539	2.954591885	0.152053775	1.008750208	4.691306348	2.11582475	11.54198291	0	0.084297941	0.461634491	0	7.748169958	0.555157981	0.720482192	0	0.101351858	1.319009711	0	0	0	1.487003238	0	0.000478066	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4634	NO	1A IP Acute: 25%	1B IP Psych: 25%	2 SNF: $100 for days 1-100	6 Home Health: 20%	10A Ambulance: $250	11A DME: 30%	"11B Prosthetics/Medical Supplies: 30%, 11C Diabetes Monitoring Supplies: 30%"	"4A ER: $50, 4B Urgent Care: $40"	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: $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: $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): $0	"7G Other Health Care: $55, 18A Hearing Exams (Medicare Covered): $55"	15 Part B Drugs: 20%	"13A Blood: 20%, 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): $55	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): $55	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"												3.8755	0.1081	0.8524	0.0537	2.9259	0.5267	0.016	0.1745	0.6423	0.0822	0.1257	0	0.0082	0.0683	0.2539	1.1829	0.1789	0.4509	0	0	0.1284	0	0	0	0.1	0	0.0075	0	0	0											11.762	0	5.33E-15	19.2508	0.631335855	2.231059805	0.053741581	4.170031982	3.481299316	0.168031617	1.183278542	5.333621018	2.197990014	11.66765222	0	0.092505263	0.5299301	0.253911305	8.931021291	0.734062279	1.171339353	0	0.101351858	1.447402865	0	0	0	1.587039383	0	0.007976186	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2254
H3660_032_0	2011	8																															D	D	D			Coin	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	YES	1803.588412	102.8139189	488.5480541	0	0	34.61913342	1.002666632	405.0977819	271.0926715	2133.265282	1842.365094	0	0.312950769	0	0	0	0	0	0	1.086391168	20.5692655	0	0	0	0	0	0	0	0	0											3400	1A IP Acute: $145/$0 Per Day for days 1-6/7-90	1B IP Psych: $100/$0 Per Day for days 1-15/16-90	2 SNF: $0/$50 for days 1-10/11-100	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: min $0/ max $100	8A OP Diagnostic Procedures/Tests: min $5/ max $100	8B OP Radiology: min $0/ max $100	9A OP Hospital: min $0/ max $100	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"											0	145	100	50	0	0	0.1	0.1	49.15682522	100	5	89.11	0	0.2	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	0											NO	137.4274627	100	50	0	0	0.1	0.1	49.15682522	100	5	89.11	0	0.2	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	0												20.6552	0.856782657	2.035616892	0	0	3.461913342	0.100266663	1.659443405	2.259105596	0.888860534	13.68109613	0	0.062590154	0	0	0	0	0	0	0.217278234	4.1138531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.992	0	1.138145049	20.6552	0.856782657	2.035616892	0	0	3.461913342	0.100266663	1.659443405	2.259105596	0.888860534	13.68109613	0	0.062590154	0	0	0	0	0	0	0.217278234	4.1138531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.992	NO	1A IP Acute: 20%	1B IP Psych: 20%	2 SNF: $75 for days 1-100	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: $150	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $150	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: 20%, 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"												5.3462	0.0174	2.3108	0.0606	2.5061	1.8409	0.0312	0.1576	0.5859	0.1833	0.374	0	0.0014	0.0977	0.2972	1.3112	0.2898	0.4016	0	0	0.425	0	0	0	0.1459	0	0.0058	0	0	0											16.3898	0	0	26.0015	0.874190689	4.346462924	0.060638266	2.506130613	5.302776682	0.131444447	1.817002654	2.845023439	1.072162399	14.05511876	0	0.063958999	0.09770617	0.297225059	1.311159392	0.289823471	0.401639779	0	0.217278234	4.538862095	0	0	0	0.145893882	0	0.005832103	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3818
H3660_043_0	2011	7																															D	D	D		T	Coin	Coin	V	V	V	V		Coin	V		V	V	P		Coin	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	808.5037001	44.84690137	165.4392606	0	74.64723236	14.77295943	0.760268875	244.254449	225.1827047	1269.49485	1100.4592	0	0.421489703	138.4903473	0	2324.450987	166.5473944	216.1446575	0	0.506759288	6.595048556	0	0	0	446.1009713	0	0.143419769	0	0	0											3400	1A IP Acute: $265/$0 Per Day for days 1-6/7-90	1B IP Psych: $140/$0 Per Day for days 1-15/16-90	2 SNF: $0/$100 for days 1-10/11-100	6 Home Health: $0	10A Ambulance: min $0/ max $200	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $40"	9B ASC Services: min $0/ max $250	8A OP Diagnostic Procedures/Tests: min $15/ max $100	8B OP Radiology: min $0/ max $200	9A OP Hospital: min $0/ max $250	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, 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: $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): $0, 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"											0	265	140	100	0	200	0.2	0.2	49.55898471	250	15	102.15	0	0.2	40	0	40	40	40	0	0.2	0.2	0	0	0	40	0	40	0	0	0											NO	228.2041329	140	100	0	200	0.2	0.2	49.55898471	250	15	102.15	0	0.2	40	0	40	40	40	0	0.2	0.2	0	0	0	40	0	40	0	0	0												15.3753	0.523213849	1.378660505	0	1.244120539	2.954591885	0.152053775	1.008750208	4.691306348	1.586868562	9.367658942	0	0.084297941	0.461634491	0	7.748169958	0.555157981	0.720482192	0	0.101351858	1.319009711	0	0	0	1.487003238	0	0.000478066	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7601	0	2.479132894	15.3753	0.523213849	1.378660505	0	1.244120539	2.954591885	0.152053775	1.008750208	4.691306348	1.586868562	9.367658942	0	0.084297941	0.461634491	0	7.748169958	0.555157981	0.720482192	0	0.101351858	1.319009711	0	0	0	1.487003238	0	0.000478066	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7601	NO	1A IP Acute: 25%	1B IP Psych: 25%	2 SNF: $100 for days 1-100	6 Home Health: 20%	10A Ambulance: $250	11A DME: 30%	"11B Prosthetics/Medical Supplies: 30%, 11C Diabetes Monitoring Supplies: 30%"	"4A ER: $50, 4B Urgent Care: $40"	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: $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: $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): $0	"7G Other Health Care: $55, 18A Hearing Exams (Medicare Covered): $55"	15 Part B Drugs: 20%	"13A Blood: 20%, 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): $55	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): $55	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"												3.8755	0.1081	0.8524	0.0537	2.9259	0.5267	0.016	0.1745	0.6423	0.0822	0.1257	0	0.0082	0.0683	0.2539	1.1829	0.1789	0.4509	0	0	0.1284	0	0	0	0.1	0	0.0075	0	0	0											11.762	0	1.78E-15	19.2508	0.631335855	2.231059805	0.053741581	4.170031982	3.481299316	0.168031617	1.183278542	5.333621018	1.669033827	9.493328251	0	0.092505263	0.5299301	0.253911305	8.931021291	0.734062279	1.171339353	0	0.101351858	1.447402865	0	0	0	1.587039383	0	0.007976186	0	0	0	0	0	0	0	0	0	0	0	0	0	62.5221
H3660_044_0	2011	8																															D	D	D		T	Coin	Coin	V	V	V	V		Coin	V		V	V	P		Coin	Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	874.9419823	53.17826077	267.7271766	0	213.3170768	16.52865086	0.813528349	287.5200644	257.1548584	1348.820017	1143.602234	0	0.467171755	153.3912074	0	2584.254069	217.5516435	313.5814844	0	0.517750068	6.997188977	0	0	0	468.1838166	0	1.763873203	0	0	0											3400	1A IP Acute: $315/$0 Per Day for days 1-6/7-90	1B IP Psych: $140/$0 Per Day for days 1-15/16-90	2 SNF: $0/$100 for days 1-10/11-100	6 Home Health: $0	10A Ambulance: min $0/ max $200	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $40"	9B ASC Services: min $0/ max $250	8A OP Diagnostic Procedures/Tests: min $20/ max $125	8B OP Radiology: min $0/ max $250	9A OP Hospital: min $0/ max $250	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, 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: $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): $0, 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"											0	315	140	100	0	200	0.2	0.2	49.38557083	250	20	125.86	0	0.2	40	0	40	40	40	0	0.2	0.2	0	0	0	40	0	40	0	0	0											NO	271.030173	140	100	0	200	0.2	0.2	49.38557083	250	20	125.86	0	0.2	40	0	40	40	40	0	0.2	0.2	0	0	0	40	0	40	0	0	0												19.7613	0.620413042	2.231059805	0	3.555284613	3.305730173	0.16270567	1.183278542	5.357392883	2.248033362	11.99448143	0	0.093434351	0.511304025	0	8.614180229	0.725172145	1.045271615	0	0.103550014	1.399437795	0	0	0	1.560612722	0	0.005879577	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4785	0	3.205920636	19.7613	0.620413042	2.231059805	0	3.555284613	3.305730173	0.16270567	1.183278542	5.357392883	2.248033362	11.99448143	0	0.093434351	0.511304025	0	8.614180229	0.725172145	1.045271615	0	0.103550014	1.399437795	0	0	0	1.560612722	0	0.005879577	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4785	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.7613	0.620413042	2.231059805	0	3.555284613	3.305730173	0.16270567	1.183278542	5.357392883	2.248033362	11.99448143	0	0.093434351	0.511304025	0	8.614180229	0.725172145	1.045271615	0	0.103550014	1.399437795	0	0	0	1.560612722	0	0.005879577	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4785
H3660_801_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	284.5421128	1.930967596	22.61140638	0	9.859559397	29.6240049	1.38419909	10.61362428	41.71995976	9.327269687	41.24799366	0	1.371876732	25.94493169	40.17218093	130.1719167	0.89880023	4.867033295	18.08872027	39.37352006	28.56435143	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	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	0.081294997	0.081294997	0.172105398	0	0.233	0.233	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	0.077874701	0.077874701	0.164864467	0	0.223197071	0.223197071	0.223197071	0.223197071	0.223197071	0.223197071	0.223197071	0	0.223197071	0.223197071	0.223197071	0.223197071	0.223197071	0.223197071	0.223197071	0.223197071	0.223197071	0	0	0	0	0	0	0	0	0												22.1586	0.150373524	3.727817456	0	2.200624779	6.611991127	0.308949183	2.368929853	9.311772824	2.081819275	9.206431373	0	0.306198868	5.790832763	8.966313121	29.05399055	0.200609579	1.086307576	4.037349384	8.788054355	6.375479576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.7325	0	5.390472844	22.1586	0.150373524	3.727817456	0	2.200624779	6.611991127	0.308949183	2.368929853	9.311772824	2.081819275	9.206431373	0	0.306198868	5.790832763	8.966313121	29.05399055	0.200609579	1.086307576	4.037349384	8.788054355	6.375479576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.7325	NO																																																																																		0	0	0	22.1586	0.150373524	3.727817456	0	2.200624779	6.611991127	0.308949183	2.368929853	9.311772824	2.081819275	9.206431373	0	0.306198868	5.790832763	8.966313121	29.05399055	0.200609579	1.086307576	4.037349384	8.788054355	6.375479576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.7325
H3660_802_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	348.5510375	2.119656514	30.07537076	0	11.42268663	30.56450402	1.420214488	13.08603402	54.66393985	12.70020936	48.22330479	0	4.294530246	33.85368032	48.88195204	152.3027321	1.102225438	5.231082919	23.94076638	48.83608664	40.50054772	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	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	0.081294997	0.081294997	0.172105398	0	0.233	0.233	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	0.076816847	0.076816847	0.162624939	0	0.220165151	0.220165151	0.220165151	0.220165151	0.220165151	0.220165151	0.220165151	0	0.220165151	0.220165151	0.220165151	0.220165151	0.220165151	0.220165151	0.220165151	0.220165151	0.220165151	0	0	0	0	0	0	0	0	0												26.7746	0.16282533	4.891005349	0	2.514877521	6.729238631	0.312681737	2.881088651	12.03509455	2.796143507	10.61709116	0	0.945505898	7.453400626	10.76210233	33.53175395	0.24267163	1.151702159	5.270922436	10.75200437	8.916809188	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.7415	0	8.671103861	26.7746	0.16282533	4.891005349	0	2.514877521	6.729238631	0.312681737	2.881088651	12.03509455	2.796143507	10.61709116	0	0.945505898	7.453400626	10.76210233	33.53175395	0.24267163	1.151702159	5.270922436	10.75200437	8.916809188	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.7415	NO																																																																																		0	0	0	26.7746	0.16282533	4.891005349	0	2.514877521	6.729238631	0.312681737	2.881088651	12.03509455	2.796143507	10.61709116	0	0.945505898	7.453400626	10.76210233	33.53175395	0.24267163	1.151702159	5.270922436	10.75200437	8.916809188	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.7415
H3660_805_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	246.9953625	1.148705933	20.32329039	0	1.554691873	19.90005597	0.978880068	9.845173741	39.17518256	9.964973092	36.59529382	0	1.785136284	22.485381	32.53721744	103.5062373	0.479143956	2.975149677	16.74775268	35.95808243	31.60544704	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	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	0.081294997	0.081294997	0.172105398	0	0.233	0.233	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	0.077693089	0.077693089	0.164479987	0	0.222676553	0.222676553	0.222676553	0.222676553	0.222676553	0.222676553	0.222676553	0	0.222676553	0.222676553	0.222676553	0.222676553	0.222676553	0.222676553	0.222676553	0.222676553	0.222676553	0	0	0	0	0	0	0	0	0												19.1898	0.089246513	3.342774532	0	0.346193428	4.431275878	0.21797364	2.192289357	8.723394635	2.218965864	8.148913902	0	0.397507995	5.006967145	7.24527544	23.04841218	0.106694125	0.662496076	3.729331845	8.007021865	7.037792019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1424	0	4.828115304	19.1898	0.089246513	3.342774532	0	0.346193428	4.431275878	0.21797364	2.192289357	8.723394635	2.218965864	8.148913902	0	0.397507995	5.006967145	7.24527544	23.04841218	0.106694125	0.662496076	3.729331845	8.007021865	7.037792019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1424	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												3.8906	0.0363	1.2515	0	1.8085	0.4803	0.008	0.3157	2.2563	0.4093	0.6644	0	0.8371	1.762	2.1393	5.1017	0.109	0.2259	1.1969	1.4955	1.6222	0	0	0	0	0	0	0	0	0											25.6106	0	3.55E-15	23.0804	0.125553457	4.594314941	0	2.154726177	4.911583537	0.226023489	2.507985848	10.97964969	2.628227676	8.81329996	0	1.234634429	6.768918972	9.384619773	28.1501253	0.215738375	0.888373451	4.926222303	9.502485865	8.660016145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.7529
H3660_806_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	235.4387431	1.27337131	19.03179375	0	1.988597099	20.41382005	1.027460336	9.052116754	36.22484453	8.864088273	35.02684209	0	1.284335229	20.46483546	31.63857747	101.908293	0.535796142	3.274384598	15.39768554	33.64317784	27.78374991	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	Medicare-FFS Cost Sharing	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	0.081294997	0.081294997	0.172105398	0	0.233	0.233	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	0.078118216	0.078118216	0.16538	0	0.223895011	0.223895011	0.223895011	0.223895011	0.223895011	0.223895011	0.223895011	0	0.223895011	0.223895011	0.223895011	0.223895011	0.223895011	0.223895011	0.223895011	0.223895011	0.223895011	0	0	0	0	0	0	0	0	0												18.3921	0.099473495	3.147478054	0	0.44523697	4.570552471	0.230043243	2.026723783	8.110561975	1.984625144	7.842335206	0	0.287556251	4.581974567	7.08371966	22.81675841	0.119962083	0.733118377	3.447464979	7.532539684	6.220643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6728	0	4.053327983	18.3921	0.099473495	3.147478054	0	0.44523697	4.570552471	0.230043243	2.026723783	8.110561975	1.984625144	7.842335206	0	0.287556251	4.581974567	7.08371966	22.81675841	0.119962083	0.733118377	3.447464979	7.532539684	6.220643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6728	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												2.7069	0.0245	0.8446	0	1.5805	0.5223	0.0054	0.254	1.5437	0.2813	0.4516	0	0.5649	1.3782	1.4932	3.5825	0.0755	0.1524	0.8472	1.0624	1.0979	0	0	0	0	0	0	0	0	0											18.469	0	7.11E-15	21.0989	0.123974422	3.992052019	0	2.025754634	5.092845293	0.235475503	2.280725104	9.654311135	2.265937462	8.29388821	0	0.852472242	5.960199966	8.57691057	26.39926963	0.195427986	0.885546655	4.294636237	8.594982072	7.318497617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.1419
H3664_012_0	2011	6																															D	D	D		T	Coin	Coin	V	Coin	V	V			V	V	V	V	V	V		Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1895.680671	26.81611803	2299.45526	0	308.2175486	21.55292783	1.439427833	464.3249257	26.10203258	3423.604088	952.9281541	0	0	640.3532349	4631.808451	6021.206167	198.8719271	462.6743841	1402.120487	0	67.71641288	0	0	0	174.2462362	0	9.420991542	0	0	0											3400	$175/Days 1-15 for IP Med/Surg; PBP 1a	$175/Days 1-10 for IP MA/SA; PBP 1b	$75/Days 11-100; PBP 2	$0/Visit for Home Health; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; 20% Coinsurance for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Surg, $300 Max OOP; 20% Coinsurance for ASC services, $300 Max OOP; PBP 9a, 9b"	$30/Visit for OP Lab; PBP 8a	$30/Visit for OP Rad - General; 15% Coinsurance for OP Rad - Therapeutic Rad; $50/Visit for OP Rad - PET/CAT/MRI/MRA ; PBP 8b	No Cost Sharing; PBP 9a	$0/Case for Renal Dialysis; PBP 12	"$10/Visit for CORF (max $300); $35/Visit for Partial Hosp; $10/Visit for OP PT/OT/ST (max $300); $35/Visit for OP Substance Abuse; $0/Visit for Cardiac Rehab; PBP 3, 5, 9c, 9d"	"$15/Visit for PCP OV; $0/Visit for Immunizations; $0/Visit for Physical Exams (Initial); $0/Visit for Routine Exams; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $35/Visit for SCP OV; $35/Visit for SCP - Office Surg; $35/Visit for Podiatry; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $35/Exam for Vision Exams; $35/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14d, 14e, 17a, 18a"	"$35/Visit for MH - Non Phys; $35/Visit for Psych Services ; PBP 7e, 7h"	"$10/Visit for OP PT/OT/ST (max $300); $10/Visit for PT/ST (max $300); PBP 7c, 7i"	"$30/Visit for Phys Rad - General; $50/Visit for Phys Rad - PET/CAT/MRI/MRA; $0/Visit for Colorectal Screening; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 7g, 14f, 14g, 14h"	"$0/Visit for Other Health Care Professional; $0/Visit for Diabetes Monitoring; $0/Visit for Nutrition Therapy for Diabetes & Renal Dialysis; PBP 7g, 14i, 14j"	15% Coinsurance for Medicare Part B Drugs; PBP 15	"$0/Case for Blood; $0/Visit for Smoking Cessation; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"$125 annual max; PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	$70 max every two years; PBP 17b	$35/Exam for Routine Hearing Test (non-cvd); PBP 18a	$500 max every three years; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-d											0	175	175	75	0	125	0.2	0.2	47.81434257	0.2	30	45.52534359	0	0	10.25789938	15	34.2970684	35	10	31.60132765	0	0.15	0	0	0	35	0	35	0	0	0											NO	159.1107981	159.1107981	68.19034206	0	113.6505701	0.181840912	0.181840912	43.47301834	0.181840912	27.27613682	41.39185002	0	0	9.3265289	13.63806841	31.18305101	31.82215963	9.092045608	28.73207123	0	0.136380684	0	0	0	31.82215963	0	31.82215963	0	0	0												25.1353	0.355561162	13.06672006	0	2.919091676	3.919204057	0.26174687	1.682133834	4.746417414	7.781891127	3.286954937	0	0	0.497689413	5.26407671	15.64663159	0.527377851	0.350554717	3.357152143	0	9.235210715	0	0	0	0.462074295	0	0.024983025	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5207	0	9.838527623	25.1353	0.355561162	13.06672006	0	2.919091676	3.919204057	0.26174687	1.682133834	4.746417414	7.781891127	3.286954937	0	0	0.497689413	5.26407671	15.64663159	0.527377851	0.350554717	3.357152143	0	9.235210715	0	0	0	0.462074295	0	0.024983025	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5207	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.1353	0.355561162	13.06672006	0	2.919091676	3.919204057	0.26174687	1.682133834	4.746417414	7.781891127	3.286954937	0	0	0.497689413	5.26407671	15.64663159	0.527377851	0.350554717	3.357152143	0	9.235210715	0	0	0	0.462074295	0	0.024983025	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5207
H3664_014_0	2011	5																															D	D	D		T	Coin	Coin	V	Coin	V	V			V	V	V	V	V	V		Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1263.173963	30.18687924	782.6054486	0	144.6293943	8.972236127	0.585962004	317.8724673	14.82161787	2262.109555	675.0603676	0	0	353.6673335	3130.324169	4439.316799	80.88797306	216.6223772	913.7163925	0	45.82496782	0	0	0	56.54387904	0	6.814681889	0	0	0											3400	$210/Days 1-15 for IP Med/Surg; PBP 1a	$210/Days 1-10 for IP MA/SA; PBP 1b	$75/Days 5-100; PBP 2	$0/Visit for Home Health; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; 20% Coinsurance for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Surg, $500 Max OOP; 20% Coinsurance for ASC services, $500 Max OOP; PBP 9a, 9b"	$35/Visit for OP Lab; PBP 8a	$35/Visit for OP Rad - General; 20% Coinsurance for OP Rad - Therapeutic Rad; $100/Visit for OP Rad - PET/CAT/MRI/MRA ; PBP 8b	No Cost Sharing; PBP 9a	$0/Case for Renal Dialysis; PBP 12	"$10/Visit for CORF (max $300); $35/Day for Partial Hosp; $15/Visit for OP PT/OT/ST (max $450); $35/Visit for OP Substance Abuse; $0/Visit for Cardiac Rehab; PBP 3, 5, 9c, 9d"	"$25/Visit for PCP OV; $0/Visit for Immunizations; $0/Visit for Physical Exams (Initial); $0/Visit for Routine Exams; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $35/Visit for SCP OV; $35/Visit for SCP - Office Surg; $40/Visit for Podiatry; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $35/Exam for Vision Exams; $35/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14d, 14e, 17a, 18a"	"$35/Visit for MH - Non Phys; $35/Visit for Psych Services ; PBP 7e, 7h"	"$15/Visit for OP PT/OT/ST (max $450); $15/Visit for PT/ST (max $450); PBP 7c, 7i"	"$35/Visit for Phys Rad - General; $100/Visit for Phys Rad - PET/CAT/MRI/MRA; $0/Visit for Colorectal Screening; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 7g, 14f, 14g, 14h"	"$0/Visit for Other Health Care Professional; $0/Visit for Diabetes Monitoring; $0/Visit for Nutrition Therapy for Diabetes & Renal Dialysis; PBP 7g, 14i, 14j"	20% Coinsurance for Medicare Part B Drugs; PBP 15	"$0/Case for Blood; $0/Visit for Smoking Cessation; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"$125 annual max; PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	$70 max every two years; PBP 17b	$35/Exam for Routine Hearing Test (non-cvd); PBP 18a	$500 max every three years; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-d											0	210	210	75	0	150	0.2	0.2	47.90254282	0.2	35	71.09156167	0	0	12.04381775	25	34.28486354	35	15	40.00663723	0	0.2	0	0	0	35	0	35	0	0	0											NO	196.3931761	196.3931761	70.14042002	0	140.28084	0.18704112	0.18704112	44.79872632	0.18704112	32.73219601	66.4852266	0	0	11.26344581	23.38014001	32.06339639	32.73219601	14.028084	37.41443118	0	0.18704112	0	0	0	32.73219601	0	32.73219601	0	0	0												20.6732	0.494041424	4.57435624	0	1.690727744	1.678177095	0.109598989	1.186690139	2.772252008	6.170317778	3.740128459	0	0	0.331959404	6.098951444	11.86163119	0.220636749	0.253233075	2.848848257	0	8.571153307	0	0	0	0.154233778	0	0.018588292	0	0	0	0	0	0	0	0	0	0	0	0	0	73.4488	0	5.088793248	20.6732	0.494041424	4.57435624	0	1.690727744	1.678177095	0.109598989	1.186690139	2.772252008	6.170317778	3.740128459	0	0	0.331959404	6.098951444	11.86163119	0.220636749	0.253233075	2.848848257	0	8.571153307	0	0	0	0.154233778	0	0.018588292	0	0	0	0	0	0	0	0	0	0	0	0	0	73.4488	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.6732	0.494041424	4.57435624	0	1.690727744	1.678177095	0.109598989	1.186690139	2.772252008	6.170317778	3.740128459	0	0	0.331959404	6.098951444	11.86163119	0.220636749	0.253233075	2.848848257	0	8.571153307	0	0	0	0.154233778	0	0.018588292	0	0	0	0	0	0	0	0	0	0	0	0	0	73.4488
H3664_017_0	2011	6																															D	D	D		T	Coin	Coin	V	Coin	V	V			V	V	V	V	V	V		Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1259.498514	28.5093332	1017.374766	0	174.1754482	10.95762407	1.184865618	349.6541003	37.61112838	2602.161587	751.5398704	0	0	404.2109852	3667.551421	4703.43246	119.2354505	315.5098301	1025.924661	0	46.7588169	0	0	0	151.9640982	0	7.029755943	0	0	0											3400	$210/Days 1-15 for IP Med/Surg; PBP 1a	$210/Days 1-10 for IP MA/SA; PBP 1b	"$100/Days 11-30, $75/Days 31-100; PBP 2"	$0/Visit for Home Health; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; 20% Coinsurance for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Surg, $400 Max OOP; 20% Coinsurance for ASC services, $400 Max OOP; PBP 9a, 9b"	$35/Visit for OP Lab; PBP 8a	$35/Visit for OP Rad - General; 20% Coinsurance for OP Rad - Therapeutic Rad; $100/Visit for OP Rad - PET/CAT/MRI/MRA ; PBP 8b	No Cost Sharing; PBP 9a	$0/Case for Renal Dialysis; PBP 12	"$10/Visit for CORF (max $300); $35/Day for Partial Hosp; $10/Visit for OP PT/OT/ST (max $300); $35/Visit for OP Substance Abuse; $0/Visit for Cardiac Rehab; PBP 3, 5, 9c, 9d"	"$15/Visit for PCP OV; $0/Visit for Immunizations; $0/Visit for Physical Exams (Initial); $0/Visit for Routine Exams; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $35/Visit for SCP OV; $35/Visit for SCP - Office Surg; $35/Visit for Podiatry; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $35/Exam for Vision Exams; $35/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14d, 14e, 17a, 18a"	"$35/Visit for MH - Non Phys; $35/Visit for Psych Services ; PBP 7e, 7h"	"$10/Visit for OP PT/OT/ST (max $300); $10/Visit for PT/ST (max $300); PBP 7c, 7i"	"$35/Visit for Phys Rad - General; $100/Visit for Phys Rad - PET/CAT/MRI/MRA; $0/Visit for Colorectal Screening; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 7g, 14f, 14g, 14h"	"$0/Visit for Other Health Care Professional; $0/Visit for Diabetes Monitoring; $0/Visit for Nutrition Therapy for Diabetes & Renal Dialysis; PBP 7g, 14i, 14j"	20% Coinsurance for Medicare Part B Drugs; PBP 15	"$0/Case for Blood; $0/Visit for Smoking Cessation; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"$125 annual max; PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	$70 max every two years; PBP 17b	$35/Exam for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-d											0	210	210	84	0	150	0.2	0.2	47.68261055	0.2	35	68.95968678	0	0	10.04821385	15	34.1420775	35	10	40.53488823	0	0.2	0	0	0	35	0	35	0	0	0											NO	194.6075973	194.6075973	77.8430389	0	139.0054266	0.185340569	0.185340569	44.18761081	0.185340569	32.43459954	63.90513787	0	0	9.311708349	13.90054266	31.63956032	32.43459954	9.267028441	37.56379621	0	0.185340569	0	0	0	32.43459954	0	32.43459954	0	0	0												20.4257	0.462344403	6.599628627	0	2.01761104	2.030892279	0.219603668	1.287531608	6.970867927	7.033339084	4.002271586	0	0	0.313657901	4.248412915	12.40121125	0.322279507	0.243653214	3.211468741	0	8.666305722	0	0	0	0.410741223	0	0.01900061	0	0	0	0	0	0	0	0	0	0	0	0	0	80.8865	0	6.397681235	20.4257	0.462344403	6.599628627	0	2.01761104	2.030892279	0.219603668	1.287531608	6.970867927	7.033339084	4.002271586	0	0	0.313657901	4.248412915	12.40121125	0.322279507	0.243653214	3.211468741	0	8.666305722	0	0	0	0.410741223	0	0.01900061	0	0	0	0	0	0	0	0	0	0	0	0	0	80.8865	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.4257	0.462344403	6.599628627	0	2.01761104	2.030892279	0.219603668	1.287531608	6.970867927	7.033339084	4.002271586	0	0	0.313657901	4.248412915	12.40121125	0.322279507	0.243653214	3.211468741	0	8.666305722	0	0	0	0.410741223	0	0.01900061	0	0	0	0	0	0	0	0	0	0	0	0	0	80.8865
H3664_018_0	2011	6																															D	D	D		T	Coin	Coin	V	Coin	V	V			V	V	V	V	V	V		Coin				V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1248.496805	28.38826804	1069.101263	0	168.6129015	10.59229945	1.098897019	341.8239842	34.10038285	2531.778712	733.779335	0	0	389.5703681	3390.831896	4584.165506	112.3779644	291.7834216	1000.719877	0	46.112331	0	0	0	137.603079	0	6.870459663	0	0	0											3400	$210/Days 1-15 for IP Med/Surg; PBP 1a	$210/Days 1-10 for IP MA/SA; PBP 1b	$100/Days 5-100; PBP 2	$0/Visit for Home Health; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; 20% Coinsurance for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"25% Coinsurance for OP Surg; 25% Coinsurance for ASC services; PBP 9a, 9b"	$40/Visit for OP Lab; PBP 8a	$35/Visit for OP Rad - General; 20% Coinsurance for OP Rad - Therapeutic Rad; $100/Visit for OP Rad - PET/CAT/MRI/MRA ; PBP 8b	No Cost Sharing; PBP 9a	$0/Case for Renal Dialysis; PBP 12	"$10/Visit for CORF (max $300); $40/Day for Partial Hosp; $15/Visit for OP PT/OT/ST (max $450); $40/Visit for OP Substance Abuse; $0/Visit for Cardiac Rehab; PBP 3, 5, 9c, 9d"	"$25/Visit for PCP OV; $0/Visit for Immunizations; $0/Visit for Physical Exams (Initial); $0/Visit for Routine Exams; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $40/Visit for SCP OV; $40/Visit for SCP - Office Surg; $45/Visit for Podiatry; $0/Visit for Pap Smears and Pelvic Exams Screening; $0/Visit for Prostate Cancer Screening; $40/Exam for Vision Exams; $40/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 14d, 14e, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$15/Visit for OP PT/OT/ST (max $450); $15/Visit for PT/ST (max $450); PBP 7c, 7i"	"$35/Visit for Phys Rad - General; $100/Visit for Phys Rad - PET/CAT/MRI/MRA; $0/Visit for Colorectal Screening; $0/Visit for Bone Mass Measurement; $0/Visit for Mammography Screening; PBP 7g, 14f, 14g, 14h"	"$0/Visit for Other Health Care Professional; $0/Visit for Diabetes Monitoring; $0/Visit for Nutrition Therapy for Diabetes & Renal Dialysis; PBP 7g, 14i, 14j"	20% Coinsurance for Medicare Part B Drugs; PBP 15	"$0/Case for Blood; $0/Visit for Smoking Cessation; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$40/Exam for Routine Eye Exams (non-cvd); PBP 17a	$70 max every two years; PBP 17b	$40/Exam for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-d											0	210	210	100	0	150	0.2	0.2	47.7073459	0.25	40	69.19348454	0	0	11.9156865	25	39.22389456	40	15	40.47656758	0	0.2	0	0	0	40	0	40	0	0	0											NO	193.2612793	193.2612793	92.0291806	0	138.0437709	0.184058361	0.184058361	43.90467951	0.230072951	36.81167224	63.67819685	0	0	10.96590865	23.00729515	36.09742877	36.81167224	13.80437709	37.25025348	0	0.184058361	0	0	0	36.81167224	0	36.81167224	0	0	0												20.1072	0.457196083	8.199042767	0	1.939663395	1.949601278	0.202261184	1.250639373	7.84557573	7.766584012	3.893812078	0	0	0.355999423	6.501155853	13.78971565	0.344735066	0.335657365	3.106422425	0	8.487360076	0	0	0	0.42211662	0	0.021076092	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9758	0	7.533135674	20.1072	0.457196083	8.199042767	0	1.939663395	1.949601278	0.202261184	1.250639373	7.84557573	7.766584012	3.893812078	0	0	0.355999423	6.501155853	13.78971565	0.344735066	0.335657365	3.106422425	0	8.487360076	0	0	0	0.42211662	0	0.021076092	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9758	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.1072	0.457196083	8.199042767	0	1.939663395	1.949601278	0.202261184	1.250639373	7.84557573	7.766584012	3.893812078	0	0	0.355999423	6.501155853	13.78971565	0.344735066	0.335657365	3.106422425	0	8.487360076	0	0	0	0.42211662	0	0.021076092	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9758
H3664_801_0	2011	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	239.6742027	2.698254054	42.47313374	0	7.05379392	14.83955504	1.970902098	16.50109253	46.46205091	18.01939732	37.15053706	0	0.014246789	24.42203731	40.41695292	67.15661834	1.42915356	4.285633688	24.55634931	74.36941616	49.23115541	1.080322012	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7g	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											0	0.081715653	0.081715653	0.174677626	0	0.233	0.233	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	0.074900902	0.074900902	0.160110227	0	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0	0	0	0	0	0	0	0												17.9518	0.202101663	6.800383091	0	1.506469981	3.169265285	0.420923106	3.524117778	9.922842341	3.848380242	7.934193926	0	0.003042669	5.215784087	8.631798292	14.34255533	0.305222546	0.915277449	5.244468935	15.88298358	10.51423654	0.230723026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.5666	0	10.60564278	17.9518	0.202101663	6.800383091	0	1.506469981	3.169265285	0.420923106	3.524117778	9.922842341	3.848380242	7.934193926	0	0.003042669	5.215784087	8.631798292	14.34255533	0.305222546	0.915277449	5.244468935	15.88298358	10.51423654	0.230723026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.5666	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.9518	0.202101663	6.800383091	0	1.506469981	3.169265285	0.420923106	3.524117778	9.922842341	3.848380242	7.934193926	0	0.003042669	5.215784087	8.631798292	14.34255533	0.305222546	0.915277449	5.244468935	15.88298358	10.51423654	0.230723026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.5666
H3664_802_0	2011	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	302.2346989	2.554646329	52.66661357	0	8.85576416	17.73043809	1.979841321	20.92969856	57.26833764	22.15536013	45.05195059	0	0.01348854	34.59906627	50.22315049	83.09048718	1.523829738	5.33106137	28.31310737	90.3948928	70.37326192	1.08915114	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7g	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											0	0.081861336	0.081861336	0.174970599	0	0.233	0.233	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	0.0726744	0.0726744	0.15533442	0	0.206851437	0.206851437	0.206851437	0.206851437	0.206851437	0.206851437	0.206851437	0	0.206851437	0.206851437	0.206851437	0.206851437	0.206851437	0.206851437	0.206851437	0.206851437	0.206851437	0.206851437	0	0	0	0	0	0	0	0												21.9647	0.185657388	8.180937865	0	1.831827546	3.667566605	0.409533023	4.329338232	11.84603796	4.58286809	9.319060739	0	0.002790124	7.156866593	10.38873087	17.18738671	0.315206372	1.102737708	5.856606957	18.69831351	14.55681038	0.225292479	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.8083	0	17.92631033	21.9647	0.185657388	8.180937865	0	1.831827546	3.667566605	0.409533023	4.329338232	11.84603796	4.58286809	9.319060739	0	0.002790124	7.156866593	10.38873087	17.18738671	0.315206372	1.102737708	5.856606957	18.69831351	14.55681038	0.225292479	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.8083	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.9647	0.185657388	8.180937865	0	1.831827546	3.667566605	0.409533023	4.329338232	11.84603796	4.58286809	9.319060739	0	0.002790124	7.156866593	10.38873087	17.18738671	0.315206372	1.102737708	5.856606957	18.69831351	14.55681038	0.225292479	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.8083
H3664_803_0	2011	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	239.6742027	2.698254054	42.47313374	0	7.05379392	14.83955504	1.970902098	16.50109253	46.46205091	18.01939732	37.15053706	0	0.014246789	24.42203731	40.41695292	67.15661834	1.42915356	4.285633688	24.55634931	74.36941616	49.23115541	1.080322012	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7g	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											0	0.081715653	0.081715653	0.174677626	0	0.233	0.233	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	0.074900902	0.074900902	0.160110227	0	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0	0	0	0	0	0	0	0												17.9518	0.202101663	6.800383091	0	1.506469981	3.169265285	0.420923106	3.524117778	9.922842341	3.848380242	7.934193926	0	0.003042669	5.215784087	8.631798292	14.34255533	0.305222546	0.915277449	5.244468935	15.88298358	10.51423654	0.230723026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.5666	0	10.60564278	17.9518	0.202101663	6.800383091	0	1.506469981	3.169265285	0.420923106	3.524117778	9.922842341	3.848380242	7.934193926	0	0.003042669	5.215784087	8.631798292	14.34255533	0.305222546	0.915277449	5.244468935	15.88298358	10.51423654	0.230723026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.5666	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.9518	0.202101663	6.800383091	0	1.506469981	3.169265285	0.420923106	3.524117778	9.922842341	3.848380242	7.934193926	0	0.003042669	5.215784087	8.631798292	14.34255533	0.305222546	0.915277449	5.244468935	15.88298358	10.51423654	0.230723026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.5666
H3664_805_0	2011	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	239.6742027	2.698254054	42.47313374	0	7.05379392	14.83955504	1.970902098	16.50109253	46.46205091	18.01939732	37.15053706	0	0.014246789	24.42203731	40.41695292	67.15661834	1.42915356	4.285633688	24.55634931	74.36941616	49.23115541	1.080322012	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7g	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											0	0.081715653	0.081715653	0.174677626	0	0.233	0.233	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	0.074900902	0.074900902	0.160110227	0	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0	0	0	0	0	0	0	0												17.9518	0.202101663	6.800383091	0	1.506469981	3.169265285	0.420923106	3.524117778	9.922842341	3.848380242	7.934193926	0	0.003042669	5.215784087	8.631798292	14.34255533	0.305222546	0.915277449	5.244468935	15.88298358	10.51423654	0.230723026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.5666	0	10.60564278	17.9518	0.202101663	6.800383091	0	1.506469981	3.169265285	0.420923106	3.524117778	9.922842341	3.848380242	7.934193926	0	0.003042669	5.215784087	8.631798292	14.34255533	0.305222546	0.915277449	5.244468935	15.88298358	10.51423654	0.230723026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.5666	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.9518	0.202101663	6.800383091	0	1.506469981	3.169265285	0.420923106	3.524117778	9.922842341	3.848380242	7.934193926	0	0.003042669	5.215784087	8.631798292	14.34255533	0.305222546	0.915277449	5.244468935	15.88298358	10.51423654	0.230723026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.5666
H3664_806_0	2011	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	239.6742027	2.698254054	42.47313374	0	7.05379392	14.83955504	1.970902098	16.50109253	46.46205091	18.01939732	37.15053706	0	0.014246789	24.42203731	40.41695292	67.15661834	1.42915356	4.285633688	24.55634931	74.36941616	49.23115541	1.080322012	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7g	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											0	0.081715653	0.081715653	0.174677626	0	0.233	0.233	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	0.074900902	0.074900902	0.160110227	0	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0.213568754	0	0	0	0	0	0	0	0												17.9518	0.202101663	6.800383091	0	1.506469981	3.169265285	0.420923106	3.524117778	9.922842341	3.848380242	7.934193926	0	0.003042669	5.215784087	8.631798292	14.34255533	0.305222546	0.915277449	5.244468935	15.88298358	10.51423654	0.230723026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.5666	0	10.60564278	17.9518	0.202101663	6.800383091	0	1.506469981	3.169265285	0.420923106	3.524117778	9.922842341	3.848380242	7.934193926	0	0.003042669	5.215784087	8.631798292	14.34255533	0.305222546	0.915277449	5.244468935	15.88298358	10.51423654	0.230723026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.5666	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.9518	0.202101663	6.800383091	0	1.506469981	3.169265285	0.420923106	3.524117778	9.922842341	3.848380242	7.934193926	0	0.003042669	5.215784087	8.631798292	14.34255533	0.305222546	0.915277449	5.244468935	15.88298358	10.51423654	0.230723026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.5666
H3668_005_0	2011	4																																	D		T	Coin		V	V		V	V	V	V	V	V	V	V	V	V	Coin	V			V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	0	0	1535.088452	0	230.175276	9.612418457	0	358.878626	435.6388112	0	1235.977615	41.38224903	29.33256566	1167.173701	4024.714546	3507.378552	15.28753404	267.1914113	717.9866243	267.1914113	23.0653363	741.0677586	0	0	378.8046698	0	162.3448585	0	0	0											3400	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	$38/Day for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$25/Visit for Urgent Care; $50/Visit for Emergency Room; PBP 4a, 4b"	"$125/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$15/Visit for Radiology; $50/Visit for Diagnostic Radiology; PBP 8b	$15/Visit for Observation Room; PBP 9a	$15/Visit for OP Dialysis; PBP 12	"$15/Visit for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$10/Visit for Primary Care Physician; PBP 4b, 7a, 14a-j"	"$25/Visit for Specialty Physician, Podiatrist, Vision Exam, Hearing Exam; $15/Visit for Chiropractor; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for OP Mental Health; PBP 7e, 7h"	"$25/Visit for Therapy (PT/OT/ST); PBP 7c, 7i"	$15/Case for Radiology; PBP 7d	$25/Visit for Other Health Care; PBP 7g	20% Coinsurance for Part B Drugs; PBP 15	$25/Visit for Other Medicare Part C; PBP 7g	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$25/Visit for Routine Vision Exam; PBP 17a	No Cost Sharing; PBP 17b	$25/Visit for Routine Hearing Exam; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	0	0	37.5	0	150	0.2	0	43.37662391	125	0	23.45388188	15	15	15	10	24.26904772	25	25	15	25	0.2	25	0	0	25	0	25	0	0	0											NO	0	0	35.43008366	0	141.7203346	0.188960446	0	40.98233104	118.1002789	0	22.15927993	14.17203346	14.17203346	14.17203346	9.448022309	22.92945043	23.62005577	23.62005577	14.17203346	23.62005577	0.188960446	23.62005577	0	0	23.62005577	0	23.62005577	0	0	0												0	0	4.532359358	0	2.718376429	1.81636688	0	1.225640221	4.28742209	0	2.282364496	0.048872552	0.034641842	1.378435395	3.168799402	6.70185522	0.030091034	0.525923003	0.847944205	0.525923003	4.358436239	1.458671816	0	0	0.745615619	0	0.319549551	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0073	0	2.162060686	0	0	4.532359358	0	2.718376429	1.81636688	0	1.225640221	4.28742209	0	2.282364496	0.048872552	0.034641842	1.378435395	3.168799402	6.70185522	0.030091034	0.525923003	0.847944205	0.525923003	4.358436239	1.458671816	0	0	0.745615619	0	0.319549551	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0073	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	4.532359358	0	2.718376429	1.81636688	0	1.225640221	4.28742209	0	2.282364496	0.048872552	0.034641842	1.378435395	3.168799402	6.70185522	0.030091034	0.525923003	0.847944205	0.525923003	4.358436239	1.458671816	0	0	0.745615619	0	0.319549551	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0073
H3668_011_0	2011	4																															D	D	D		T	Coin		V	V		V	V	V	V	V	V	V	V	V	V	Coin	V			V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	436.7906919	12.20265472	503.0001903	0	112.8703038	4.618586766	0	265.6602444	234.5129218	0	789.8458362	59.33131332	43.39965414	482.5534157	2549.09395	2304.017809	14.22245329	149.8900594	306.6801213	150.0257261	6.793611316	416.1033024	0	0	256.6079819	0	109.9748494	0	0	0											3400	$200/Days 1-7 for Inpatient; PBP 1a	$200/Days 1-7 for Inpatient Mental Health; PBP 1b	$43/Day for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$40/Visit for Urgent Care; $50/Visit for Emergency Room; PBP 4a, 4b"	"$250/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$40/Visit for Radiology; $55/Visit for Diagnostic Radiology; PBP 8b	$40/Visit for Observation Room; PBP 9a	$40/Visit for OP Dialysis; PBP 12	"$40/Visit for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$20/Visit for Primary Care Physician; PBP 4b, 7a, 14a-j"	"$40/Visit for Specialty Physician, Podiatrist, Vision Exam, Hearing Exam; $15/Visit for Chiropractor; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"$40/Visit for OP Mental Health; PBP 7e, 7h"	"$40/Visit for Therapy (PT/OT/ST); PBP 7c, 7i"	$40/Case for Radiology; PBP 7d	$40/Visit for Other Health Care; PBP 7g	20% Coinsurance for Part B Drugs; PBP 15	$40/Visit for Other Medicare Part C; PBP 7g	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$40/Visit for Routine Vision Exam; PBP 17a	No Cost Sharing; PBP 17b	$40/Visit for Routine Hearing Exam; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	200	200	42.5	0	150	0.2	0	47.1547462	250	0	43.72689938	40	40	40	20	37.86572165	40	40	40	40	0.2	40	0	0	40	0	32.47792757	0	0	0											NO	184.7908574	184.7908574	39.26805719	0	138.593143	0.184790857	0	43.56882989	230.9885717	0	40.40165613	36.95817147	36.95817147	36.95817147	18.47908574	34.98619584	36.95817147	36.95817147	36.95817147	36.95817147	0.184790857	36.95817147	0	0	36.95817147	0	30.0081204	0	0	0												6.7262	0.187911586	1.645986686	0	1.303587513	0.853472608	0	0.964542166	4.514150404	0	2.659256656	0.182731404	0.133664322	1.48619099	3.925410471	6.717401523	0.043802989	0.461638543	0.944528043	0.462056376	1.25539726	1.281534767	0	0	0.790313483	0	0.275011543	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8148	0	3.030031126	6.7262	0.187911586	1.645986686	0	1.303587513	0.853472608	0	0.964542166	4.514150404	0	2.659256656	0.182731404	0.133664322	1.48619099	3.925410471	6.717401523	0.043802989	0.461638543	0.944528043	0.462056376	1.25539726	1.281534767	0	0	0.790313483	0	0.275011543	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8148	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.7262	0.187911586	1.645986686	0	1.303587513	0.853472608	0	0.964542166	4.514150404	0	2.659256656	0.182731404	0.133664322	1.48619099	3.925410471	6.717401523	0.043802989	0.461638543	0.944528043	0.462056376	1.25539726	1.281534767	0	0	0.790313483	0	0.275011543	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8148
H3668_013_0	2011	3																																	D		T	Coin		V	V		V	V	V	V	V	V	V	V	V	V	Coin	V			V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	0	0	1351.529057	0	213.367015	8.289680792	0	295.3676091	405.1421026	0	1100.933314	39.69960203	129.9972348	1077.182198	3557.090645	3153.501085	16.70825983	237.3306368	623.6385569	247.41525	13.77422188	686.2176592	0	0	322.3687491	0	138.1580353	0	0	0											3400	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	$38/Day for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$25/Visit for Urgent Care; $50/Visit for Emergency Room; PBP 4a, 4b"	"$100/Case for Outpatient Surgery; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$15/Visit for Radiology; $50/Visit for Diagnostic Radiology; PBP 8b	$15/Visit for Observation Room; PBP 9a	$15/Visit for OP Dialysis; PBP 12	"$15/Visit for OP Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$10/Visit for Primary Care Physician; PBP 4b, 7a, 14a-j"	"$25/Visit for Specialty Physician, Podiatrist, Vision Exam, Hearing Exam; $15/Visit for Chiropractor; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for OP Mental Health; PBP 7e, 7h"	"$25/Visit for Therapy (PT/OT/ST); PBP 7c, 7i"	$15/Case for Radiology; PBP 7d	$25/Visit for Other Health Care; PBP 7g	20% Coinsurance for Part B Drugs; PBP 15	$25/Visit for Other Medicare Part C; PBP 7g	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$25/Visit for Routine Vision Exam; PBP 17a	No Cost Sharing; PBP 17b	$25/Visit for Routine Hearing Exam; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	0	0	37.5	0	50	0.2	0	43.51227063	100	0	23.45388188	15	15	15	10	23.5226049	25	25	15	25	0.2	25	0	0	25	0	25	0	0	0											NO	0	0	35.79483268	0	47.72644358	0.190905774	0	41.53371859	95.45288715	0	22.38740741	14.31793307	14.31793307	14.31793307	9.545288715	22.45300551	23.86322179	23.86322179	14.31793307	23.86322179	0.190905774	23.86322179	0	0	23.86322179	0	23.86322179	0	0	0												0	0	4.031479704	0	0.848604067	1.58254793	0	1.022309596	3.222665284	0	2.05392022	0.04736802	0.155107642	1.285251885	2.829454766	5.900464771	0.033226076	0.471956135	0.74410126	0.492010415	2.629578494	1.364613683	0	0	0.64106308	0	0.27474132	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6305	0	1.411513775	0	0	4.031479704	0	0.848604067	1.58254793	0	1.022309596	3.222665284	0	2.05392022	0.04736802	0.155107642	1.285251885	2.829454766	5.900464771	0.033226076	0.471956135	0.74410126	0.492010415	2.629578494	1.364613683	0	0	0.64106308	0	0.27474132	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6305	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	4.031479704	0	0.848604067	1.58254793	0	1.022309596	3.222665284	0	2.05392022	0.04736802	0.155107642	1.285251885	2.829454766	5.900464771	0.033226076	0.471956135	0.74410126	0.492010415	2.629578494	1.364613683	0	0	0.64106308	0	0.27474132	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6305
H3668_801_0	2011	2																															Coin	Coin	Coin		Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	193.1967637	0.726099128	31.69145947	0	8.622300449	14.85039959	0	13.92080315	54.14859109	4.500162941	45.7996045	46.83484907	0.732939483	23.77042843	48.95864745	70.01639407	0.478766822	5.050507771	18.92328938	69.02964027	23.07379279	10.61994466	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.077395823	0.077395823	0.15774163	0	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	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.064504088	0.064504088	0.131466785	0	0.194189453	0.194189453	0	0.194189453	0.194189453	0.194189453	0.194189453	0.194189453	0.194189453	0.194189453	0.194189453	0.194189453	0.194189453	0.194189453	0.194189453	0.194189453	0.194189453	0.194189453	0	0	0	0	0	0	0	0												12.462	0.046836362	4.166374287	0	1.674359806	2.883790969	0	2.703273145	10.51508527	0.873884179	8.893800133	9.094833709	0.142329117	4.615966488	9.507252955	13.59644525	0.092971467	0.98075534	3.674703209	13.40482807	4.480687195	2.062281241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8724	0	21.15958024	12.462	0.046836362	4.166374287	0	1.674359806	2.883790969	0	2.703273145	10.51508527	0.873884179	8.893800133	9.094833709	0.142329117	4.615966488	9.507252955	13.59644525	0.092971467	0.98075534	3.674703209	13.40482807	4.480687195	2.062281241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8724	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.462	0.046836362	4.166374287	0	1.674359806	2.883790969	0	2.703273145	10.51508527	0.873884179	8.893800133	9.094833709	0.142329117	4.615966488	9.507252955	13.59644525	0.092971467	0.98075534	3.674703209	13.40482807	4.480687195	2.062281241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8724
H3668_802_0	2011	2																															Coin	Coin	Coin		Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	178.1285474	0.473930401	25.30219917	0	7.919221341	14.91158348	0	12.59730218	46.265195	4.957454962	37.66418623	54.59397704	0.478376767	24.72872305	45.72917484	63.98462953	0.426712367	4.592922948	16.4637598	63.78230914	23.50489279	9.812662945	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14a-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.077206638	0.077206638	0.156618765	0	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	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.06546986	0.06546986	0.132809936	0	0.197579869	0.197579869	0	0.197579869	0.197579869	0.197579869	0.197579869	0.197579869	0.197579869	0.197579869	0.197579869	0.197579869	0.197579869	0.197579869	0.197579869	0.197579869	0.197579869	0.197579869	0	0	0	0	0	0	0	0												11.6621	0.031028157	3.360383449	0	1.564678713	2.946228706	0	2.488973312	9.141071157	0.979493301	7.441684973	10.78667082	0.094517619	4.885897854	9.035164362	12.64207471	0.084309773	0.907469113	3.2529075	12.60210027	4.644093632	1.938784657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4896	0	18.01476155	11.6621	0.031028157	3.360383449	0	1.564678713	2.946228706	0	2.488973312	9.141071157	0.979493301	7.441684973	10.78667082	0.094517619	4.885897854	9.035164362	12.64207471	0.084309773	0.907469113	3.2529075	12.60210027	4.644093632	1.938784657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4896	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.6621	0.031028157	3.360383449	0	1.564678713	2.946228706	0	2.488973312	9.141071157	0.979493301	7.441684973	10.78667082	0.094517619	4.885897854	9.035164362	12.64207471	0.084309773	0.907469113	3.2529075	12.60210027	4.644093632	1.938784657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4896
H3672_013_0	2011	4																															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	1663	39	2147.8	452.9	386.4	11.95481298	0	436.6	494	8828.8	1244	217.5	158	5571.1	4540.7	3946.4	200.1	356.9	1103.1	0	19.52581099	0	0	0.3	233.8	163.5	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-12	$100 / days 11-100	$0.00 	125	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$250.00 	$10.00 	"$25 X-Rays, $125 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	$0.00 	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												124.8770823	124.8770823	42.97701827	$0.00 	125	20%	20%	$50.00 	$250.00 	$10.00 	51.37419558	$0.00 	13.60710984	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	99.52703456	99.52703456	34.25268356	0	99.625	0.1594	0.1594	39.85	199.25	7.97	40.94523387	0	10.84486654	0	0	27.895	27.895	27.895	0	0	0.15143	0	0	0	27.895	11.955	0	0	0	0												13.7928	0.323462862	6.130659479	0	3.207925	1.905597189	0	1.449875833	8.202458333	5.863794667	4.244655912	0	0.142790743	0	0	9.173735667	0.465149125	0.829643792	0	0	2.956793559	0	0	0	0.543487583	0.162886875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3957		15.12839157	13.7928	0.323462862	6.130659479	0	3.207925	1.905597189	0	1.449875833	8.202458333	5.863794667	4.244655912	0	0.142790743	0	0	9.173735667	0.465149125	0.829643792	0	0	2.956793559	0	0	0	0.543487583	0.162886875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3957	NO																																																																																		0		0	13.7928	0.323462862	6.130659479	0	3.207925	1.905597189	0	1.449875833	8.202458333	5.863794667	4.244655912	0	0.142790743	0	0	9.173735667	0.465149125	0.829643792	0	0	2.956793559	0	0	0	0.543487583	0.162886875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3957
H3672_014_0	2011	3																															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	1711.7	25.2	1642.7	482.3	313.9	8.769747596	0	385.2	455.6	6728.6	1112.9	142.7	56.8	4026.2	3641.4	3542	107.5	255.9	822.1	0	8.098018306	0	0	0.1	178.8	140.9	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-12	$100 / days 11-100	$0.00 	$125.00 	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$250.00 	$10.00 	"$25 X-Rays, $125 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	$0.00 	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												124.8770823	124.8770823	42.97701827	$0.00 	$125.00 	20%	20%	$50.00 	$250.00 	$10.00 	51.37419558	$0.00 	13.60710984	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	99.52703456	99.52703456	34.25268356	0	99.625	0.1594	0.1594	39.85	199.25	7.97	40.94523387	0	10.84486654	0	0	27.895	27.895	27.895	0	0	0.15143	0	0	0	27.895	11.955	0	0	0	0												14.1967	0.209006773	4.68890694	0	2.606023958	1.397897767	0	1.279185	7.564858333	4.468911833	3.797329232	0	0.051332368	0	0	8.233674167	0.249892708	0.594860875	0	0	1.226282912	0	0	0	0.4156355	0.140371625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1209		13.0207491	14.1967	0.209006773	4.68890694	0	2.606023958	1.397897767	0	1.279185	7.564858333	4.468911833	3.797329232	0	0.051332368	0	0	8.233674167	0.249892708	0.594860875	0	0	1.226282912	0	0	0	0.4156355	0.140371625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1209	NO																																																																																		0		0	14.1967	0.209006773	4.68890694	0	2.606023958	1.397897767	0	1.279185	7.564858333	4.468911833	3.797329232	0	0.051332368	0	0	8.233674167	0.249892708	0.594860875	0	0	1.226282912	0	0	0	0.4156355	0.140371625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1209
H3672_016_0	2011	6																															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	1669.7	39.1	2161	452.9	386.4	11.95481298	0	436.6	497.5	8828.8	1244	217.5	158	5571.2	4540.8	3946.5	200.1	356.9	1103.1	0	19.52581099	0	0	0.3	233.8	163.5	0	0	0	0											3400	$100 / days 1-12	$100 / days 1-12	$75 / days 11-100	$0.00 	125	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$175.00 	$5.00 	"$20 X-Rays, $100 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	$0.00 	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												71.35833272	71.35833272	32.2327637	$0.00 	125	20%	20%	$50.00 	$175.00 	$5.00 	44.87419558	$0.00 	13.60710984	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	60.94001614	60.94001614	27.5267802	0	106.75	0.1708	0.1708	42.7	149.45	4.27	38.32256302	0	11.6204718	0	0	29.89	29.89	29.89	0	0	0.16226	0	0	0	29.89	12.81	0	0	0	0												8.4793	0.198562886	4.957114334	0	3.43735	2.041882057	0	1.553568333	6.195947917	3.141581333	3.972772367	0	0.153002879	0	0	9.83007375	0.49841575	0.888978417	0	0	3.168258092	0	0	0	0.582356833	0.17453625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2737		8.423840404	8.4793	0.198562886	4.957114334	0	3.43735	2.041882057	0	1.553568333	6.195947917	3.141581333	3.972772367	0	0.153002879	0	0	9.83007375	0.49841575	0.888978417	0	0	3.168258092	0	0	0	0.582356833	0.17453625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2737	NO																																																																																		0		0	8.4793	0.198562886	4.957114334	0	3.43735	2.041882057	0	1.553568333	6.195947917	3.141581333	3.972772367	0	0.153002879	0	0	9.83007375	0.49841575	0.888978417	0	0	3.168258092	0	0	0	0.582356833	0.17453625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2737
H3672_804_0	2011	3																															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	1384.6	32.5	1788.3	377.1	321.7	9.953637731	0	363.5	411.3	7350.9	1035.8	181.1	131.5	4638.6	3780.7	3285.9	166.6	297.1	918.5	0	16.25728896	0	0	0.3	194.7	136.2	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-12	$100 / days 11-100	$0.00 	125	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$250.00 	$10.00 	"$25 X-Rays, $125 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	$0.00 	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												124.8770823	124.8770823	42.97701827	$0.00 	125	20%	20%	$50.00 	$250.00 	$10.00 	51.37419558	$0.00 	13.60710984	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	99.52703456	99.52703456	34.25268356	0	99.625	0.1594	0.1594	39.85	199.25	7.97	40.94523387	0	10.84486654	0	0	27.895	27.895	27.895	0	0	0.15143	0	0	0	27.895	11.955	0	0	0	0												11.4838	0.269552385	5.104506167	0	2.670780208	1.586609854	0	1.207122917	6.82929375	4.88222275	3.534256104	0	0.118841663	0	0	7.638348375	0.387275583	0.690633708	0	0	2.461841267	0	0	0	0.452596375	0.13568925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4533		12.5960179	11.4838	0.269552385	5.104506167	0	2.670780208	1.586609854	0	1.207122917	6.82929375	4.88222275	3.534256104	0	0.118841663	0	0	7.638348375	0.387275583	0.690633708	0	0	2.461841267	0	0	0	0.452596375	0.13568925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4533	NO																																																																																		0		0	11.4838	0.269552385	5.104506167	0	2.670780208	1.586609854	0	1.207122917	6.82929375	4.88222275	3.534256104	0	0.118841663	0	0	7.638348375	0.387275583	0.690633708	0	0	2.461841267	0	0	0	0.452596375	0.13568925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4533
H3672_805_0	2011	4																															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	1485	18.4	1870.6	534	329.6	11.16008122	0	363.1	422.4	7111.5	1138.6	211.8	85.2	4775.9	3856.3	3414.7	155.4	250.8	911.7	0	19.78792759	0	0	0.2	200	153.2	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-12	$100 / days 11-100	$0.00 	125	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$250.00 	$10.00 	"$25 X-Rays, $125 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	$0.00 	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												124.8770823	124.8770823	42.97701827	$0.00 	125	20%	20%	$50.00 	$250.00 	$10.00 	51.37419558	$0.00 	13.60710984	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	99.52703456	99.52703456	34.25268356	0	99.625	0.1594	0.1594	39.85	199.25	7.97	40.94523387	0	10.84486654	0	0	27.895	27.895	27.895	0	0	0.15143	0	0	0	27.895	11.955	0	0	0	0												12.3165	0.15260812	5.339422489	0	2.736366667	1.778916947	0	1.205794583	7.0136	4.72322125	3.885020274	0	0.076998552	0	0	7.937754708	0.36124025	0.5830055	0	0	2.996485875	0	0	0	0.464916667	0.1526255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7244		13.17448297	12.3165	0.15260812	5.339422489	0	2.736366667	1.778916947	0	1.205794583	7.0136	4.72322125	3.885020274	0	0.076998552	0	0	7.937754708	0.36124025	0.5830055	0	0	2.996485875	0	0	0	0.464916667	0.1526255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7244	NO																																																																																		0		0	12.3165	0.15260812	5.339422489	0	2.736366667	1.778916947	0	1.205794583	7.0136	4.72322125	3.885020274	0	0.076998552	0	0	7.937754708	0.36124025	0.5830055	0	0	2.996485875	0	0	0	0.464916667	0.1526255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7244
H3706_001_0	2011	7																															D	D	D		T	Coin	Coin	V	V	Coin	Coin		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	YES	1126.435452	2.495742875	70.54015907	0	211.449298	9.01470718	0.578478036	407.3341973	211.6263873	2.183282356	12.74829731	0	0	16.3654689	0	1332.887453	59.6244948	66.75994469	2.255017067	10.53051197	7.637583032	0	0	0	0	0	0	0	0	0											3000	$270/Days 1-6 for IP Medical; $270/Days Custom for IP Surgical; PBP 1a	$270/Days 1-6 for IP Psych; $270/Days Custom for IP Substance Abuse; PBP 1b	$105/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 0%-20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $25/Visit for PCP Urgent Care; PBP 4a, 4b"	"$250/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; $25/Visit for OP Fac - CORF; PBP 3, 5, 9a, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14b, 14c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; 50% Coinsurance for Chiropractor; $25/Visit for Vision Exams; $25/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 13a, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	270	270	105	0	100	0.2	0.154166493	49.58287835	250	0.2	0.2	0	0	25	0	25.12105416	25	25	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											NO	251.9875921	251.9875921	97.99517471	0	93.32873782	0.186657476	0.143881642	46.27507454	233.3218446	0.186657476	0.186657476	0	0	23.33218446	0	23.44516277	23.33218446	23.33218446	0.186657476	0.186657476	0.186657476	0	0	0	0	0	0	0	0	0												23.654	0.05240802	0.576049601	0	1.644524675	1.682662486	0.08323237	1.570785028	4.114754921	0.407525973	2.379564995	0	0	0.031820178	0	2.604146941	0.115930809	0.129804612	0.420915793	1.965598781	1.425611969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8593	0	3.063640918	23.654	0.05240802	0.576049601	0	1.644524675	1.682662486	0.08323237	1.570785028	4.114754921	0.407525973	2.379564995	0	0	0.031820178	0	2.604146941	0.115930809	0.129804612	0.420915793	1.965598781	1.425611969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8593	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.654	0.05240802	0.576049601	0	1.644524675	1.682662486	0.08323237	1.570785028	4.114754921	0.407525973	2.379564995	0	0	0.031820178	0	2.604146941	0.115930809	0.129804612	0.420915793	1.965598781	1.425611969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8593
H3706_006_0	2011	7																															D	D	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin			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	YES	1459.823967	6.723798258	253.2727089	0	376.3163088	11.44007476	2.551135897	436.1525362	209.476473	5.899294351	23.21321923	0	0.043687379	197.1738889	2224.378483	2014.403778	26.6305395	194.6316691	6.076252751	9.977477545	9.385248758	0	0	479.7575511	63.80536833	63.80536833	0	0	0	0											3000	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical; PBP 1a	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse; PBP 1b	$105/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 0%-20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $25/Visit for PCP Urgent Care; PBP 4a, 4b"	"$200/Visit for OP Fac - Surgery; PBP 9a, 9b"	10% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; $25/Visit for OP Fac - CORF; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; $0/Visit for Routine Physicals; PBP 7a, 14b, 14c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; 50% Coinsurance for Chiropractor; $25/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d	"10% Coinsurance for Prof Path (OP); 10% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 13a, 14a"	PBP 10b	"$15/Procedure for Preventative Dental; PBP 16a, 16b"	$25/Exam for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	250	250	105	0	100	0.2	0.183889464	49.1706702	200	0.1	0.2	0	0.2	25	15	24.42008525	25	25	0.2	0.100955132	0.2	0	0	15	25	0	0	0	0	0											NO	223.9833155	223.9833155	94.07299253	0	89.59332622	0.179186652	0.164752687	44.05363896	179.1866524	0.089593326	0.179186652	0	0.179186652	22.39833155	13.44327116	21.87876664	22.39833155	22.39833155	0.179186652	0.090449061	0.179186652	0	0	15	25	0	0	0	0	0												27.248	0.125501552	1.985510138	0	2.809619151	2.0499087	0.420306494	1.60117553	3.127948997	0.528537403	4.159499047	0	0.007828195	0.368030511	2.49191026	3.672722514	0.049706638	0.363285388	1.08878339	0.902453471	1.681711307	0	0	0.599696939	0.132927851	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4151	0	6.350732996	27.248	0.125501552	1.985510138	0	2.809619151	2.0499087	0.420306494	1.60117553	3.127948997	0.528537403	4.159499047	0	0.007828195	0.368030511	2.49191026	3.672722514	0.049706638	0.363285388	1.08878339	0.902453471	1.681711307	0	0	0.599696939	0.132927851	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4151	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	27.248	0.125501552	1.985510138	0	2.809619151	2.0499087	0.420306494	1.60117553	3.127948997	0.528537403	4.159499047	0	0.007828195	0.368030511	2.49191026	3.672722514	0.049706638	0.363285388	1.08878339	0.902453471	1.681711307	0	0	0.599696939	0.132927851	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4151
H3706_009_0	2011	6																															D	D	D		T	Coin	Coin	V	V	Coin	Coin		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	YES	664.1668236	1.055148951	37.35765588	0	159.8085299	4.778862738	0.27729293	290.4059735	150.2408064	1.552829718	9.78732495	0	0	45.02917091	0	924.3427152	32.12030248	69.22950514	1.68626799	7.100766228	5.625413344	0	0	0	0	0	0	0	0	0											3000	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical; PBP 1a	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse; PBP 1b	$105/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 0%-20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $25/Visit for PCP Urgent Care; PBP 4a, 4b"	"$250/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; $25/Visit for OP Fac - CORF; PBP 3, 5, 9a, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14b, 14c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; 50% Coinsurance for Chiropractor; $25/Visit for Vision Exams; $25/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 13a, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	250	250	105	0	100	0.2	0.14882749	49.45899634	250	0.2	0.2	0	0	25	0	25.09919448	25	25	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											NO	243.278006	243.278006	102.1767625	0	97.3112024	0.194622405	0.14482582	48.12914404	243.278006	0.194622405	0.194622405	0	0	24.3278006	0	24.42432794	24.3278006	24.3278006	0.194622405	0.194622405	0.194622405	0	0	0	0	0	0	0	0	0												13.4648	0.021391211	0.318090361	0	1.295930017	0.930073758	0.040159176	1.164749244	3.045856983	0.302215454	1.904832718	0	0	0.091288391	0	1.881370801	0.065118026	0.140350133	0.328185531	1.381968199	1.094831473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.4712	0	0.759053755	13.4648	0.021391211	0.318090361	0	1.295930017	0.930073758	0.040159176	1.164749244	3.045856983	0.302215454	1.904832718	0	0	0.091288391	0	1.881370801	0.065118026	0.140350133	0.328185531	1.381968199	1.094831473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.4712	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.4648	0.021391211	0.318090361	0	1.295930017	0.930073758	0.040159176	1.164749244	3.045856983	0.302215454	1.904832718	0	0	0.091288391	0	1.881370801	0.065118026	0.140350133	0.328185531	1.381968199	1.094831473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.4712
H3706_010_0	2011	6																															D	D	D		T	Coin	Coin	V	V	Coin	Coin		Coin	V	V	V	V	V	Coin	Coin	Coin			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	YES	492.2522481	8.847875947	224.587366	0	199.7827941	5.681842497	3.356642891	254.8338961	170.7324017	2.0296035	14.14731192	0	0.17920159	283.4798349	2480.011276	2073.612694	56.90370343	189.2504978	8.820544037	8.316474671	4.466560157	0	0	436.3206152	57.53158406	57.53158406	0	0	0	0											3000	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical; PBP 1a	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse; PBP 1b	$105/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 0%-20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $25/Visit for PCP Urgent Care; PBP 4a, 4b"	"$200/Visit for OP Fac - Surgery; PBP 9a, 9b"	10% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; $25/Visit for OP Fac - CORF; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; $0/Visit for Routine Physicals; PBP 7a, 14b, 14c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; 50% Coinsurance for Chiropractor; $25/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d	"10% Coinsurance for Prof Path (OP); 10% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 13a, 14a"	PBP 10b	$15/Procedure for Preventative Dental Procedures; PBP 16a	$25/Exam for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	250	250	105	0	100	0.2	0.192021103	48.71574068	200	0.1	0.2	0	0.2	25	15	25.1314349	25	25	0.2	0.100040134	0.2	0	0	15	25	0	0	0	0	0											NO	239.5921938	239.5921938	100.6287214	0	95.83687751	0.191673755	0.184027029	46.68764473	191.673755	0.095836878	0.191673755	0	0.191673755	23.95921938	14.38517923	24.08518249	23.95921938	23.95921938	0.191673755	0.095875341	0.191673755	0	0	15	25	0	0	0	0	0												9.8283	0.176656834	1.88332829	0	1.595546597	1.089060087	0.617713018	0.991466201	2.727076711	0.194510862	2.711668399	0	0.034348242	0.565996296	2.972950559	4.161945012	0.113614026	0.377857849	1.690666797	0.797344842	0.856122357	0	0	0.545400769	0.119857467	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0514	0	1.448204642	9.8283	0.176656834	1.88332829	0	1.595546597	1.089060087	0.617713018	0.991466201	2.727076711	0.194510862	2.711668399	0	0.034348242	0.565996296	2.972950559	4.161945012	0.113614026	0.377857849	1.690666797	0.797344842	0.856122357	0	0	0.545400769	0.119857467	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0514	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.8283	0.176656834	1.88332829	0	1.595546597	1.089060087	0.617713018	0.991466201	2.727076711	0.194510862	2.711668399	0	0.034348242	0.565996296	2.972950559	4.161945012	0.113614026	0.377857849	1.690666797	0.797344842	0.856122357	0	0	0.545400769	0.119857467	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0514
H3706_017_0	2011	8																															A	A			T	Coin	Coin	V	V	Coin	Coin		Coin	V		V	V	V	Coin	Coin	Coin			P	V	P															0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	266.9404865	0.558222938	0	0	226.013344	10.86590713	0.637195165	436.909986	211.9989343	0.140011332	13.03223321	0	0	63.2410173	0	1641.753105	28.80153039	94.61853761	2.250069402	17.27640586	5.805068552	0	0	384.1244763	75.3280501	75.3280501	0	0	0	0											2500	$150/Admit for IP Medical; $150/Admit for IP Surgical; PBP 1a	$150/Admit for IP Psych; $150/Admit for IP Substance Abuse; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for DME / Medical Supplies; 0%-20% Coinsurance for Diabetes Monitoring Supplies; 10% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; PBP 4a, 4b"	"$200/Visit for OP Fac - Surgery; $150/Visit for ASC; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$15/Visit for OP Fac - Cardiovascular; $15/Visit for OP Fac - Occ Therapy; $15/Visit for OP Fac - Physical/Speech Therapy; $15/Visit for OP Fac - CORF; PBP 3, 5, 9a, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14b, 14c"	"$15/Visit for Speclst Office Visits; $15/Visit for Speclst Consults; $20/Visit for Chiropractor; $10/Visit for Vision Exams; $15/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse; PBP 7e, 7h"	"$15/Visit for Occ Therapy; $15/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 13a, 14a"	PBP 10b	"$15/Procedure for Preventative Dental; PBP 16a, 16b"	$10/Exam for Vision (Refractions); PBP 17a	$20/Service for Vision Hardware; PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	150	150	0	0	50	0.1	0.1	49.10424348	189.7322018	0.2	0.2	0	0	15	0	14.70411968	15	15	0.2	0.2	0.2	0	0	15	10	20	0	0	0	0											NO	147.1203013	147.1203013	0	0	49.04010045	0.098080201	0.098080201	48.16154066	186.0897247	0.196160402	0.196160402	0	0	14.71203013	0	14.42183013	14.71203013	14.71203013	0.196160402	0.196160402	0.196160402	0	0	15	10	20	0	0	0	0												3.2727	0.006843827	0	0	0.923643091	1.065730354	0.06249623	1.753521504	3.287568611	0.027464679	2.556408103	0	0	0.077533646	0	1.973090366	0.035310749	0.116002565	0.441374518	3.388946715	1.13872458	0	0	0.480155595	0.062773375	0.12554675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.7958	0	0.393968209	3.2727	0.006843827	0	0	0.923643091	1.065730354	0.06249623	1.753521504	3.287568611	0.027464679	2.556408103	0	0	0.077533646	0	1.973090366	0.035310749	0.116002565	0.441374518	3.388946715	1.13872458	0	0	0.480155595	0.062773375	0.12554675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.7958	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.2727	0.006843827	0	0	0.923643091	1.065730354	0.06249623	1.753521504	3.287568611	0.027464679	2.556408103	0	0	0.077533646	0	1.973090366	0.035310749	0.116002565	0.441374518	3.388946715	1.13872458	0	0	0.480155595	0.062773375	0.12554675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.7958
H3706_803_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	230.401676	0.143110154	10.75079206	0	6.889483923	11.01949641	1.107138229	12.39995185	49.47792275	2.611186518	24.62100913	0	0.016335647	12.66646219	40.16747391	79.41987215	6.51140024	1.46844075	27.06383758	106.1744675	26.63465801	0.548618021	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	0.081453601	0.081453601	0.189754825	0	0.233	0.233	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	0.072444695	0.072444695	0.16876762	0	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0	0	0	0	0	0	0	0												16.6914	0.010367572	1.814385592	0	1.427706416	2.283568101	0.22943204	2.569639613	10.25330032	0.541115675	5.102206941	0	0.003385233	2.624868501	8.323897819	16.45816468	1.349356207	0.304304691	5.608433806	22.00251427	5.519495007	0.113690006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.2312	0	12.83738293	16.6914	0.010367572	1.814385592	0	1.427706416	2.283568101	0.22943204	2.569639613	10.25330032	0.541115675	5.102206941	0	0.003385233	2.624868501	8.323897819	16.45816468	1.349356207	0.304304691	5.608433806	22.00251427	5.519495007	0.113690006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.2312	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.6914	0.010367572	1.814385592	0	1.427706416	2.283568101	0.22943204	2.569639613	10.25330032	0.541115675	5.102206941	0	0.003385233	2.624868501	8.323897819	16.45816468	1.349356207	0.304304691	5.608433806	22.00251427	5.519495007	0.113690006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.2312
H3706_804_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	230.401676	0.143110154	10.75079206	0	6.889483923	11.01949641	1.107138229	12.39995185	49.47792275	2.611186518	24.62100913	0	0.016335647	12.66646219	40.16747391	79.41987215	6.51140024	1.46844075	27.06383758	106.1744675	26.63465801	0.548618021	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	0.081453601	0.081453601	0.189754825	0	0.233	0.233	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	0.072444695	0.072444695	0.16876762	0	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0	0	0	0	0	0	0	0												16.6914	0.010367572	1.814385592	0	1.427706416	2.283568101	0.22943204	2.569639613	10.25330032	0.541115675	5.102206941	0	0.003385233	2.624868501	8.323897819	16.45816468	1.349356207	0.304304691	5.608433806	22.00251427	5.519495007	0.113690006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.2312	0	12.83738293	16.6914	0.010367572	1.814385592	0	1.427706416	2.283568101	0.22943204	2.569639613	10.25330032	0.541115675	5.102206941	0	0.003385233	2.624868501	8.323897819	16.45816468	1.349356207	0.304304691	5.608433806	22.00251427	5.519495007	0.113690006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.2312	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.6914	0.010367572	1.814385592	0	1.427706416	2.283568101	0.22943204	2.569639613	10.25330032	0.541115675	5.102206941	0	0.003385233	2.624868501	8.323897819	16.45816468	1.349356207	0.304304691	5.608433806	22.00251427	5.519495007	0.113690006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.2312
H3706_807_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	230.401676	0.143110154	10.75079206	0	6.889483923	11.01949641	1.107138229	12.39995185	49.47792275	2.611186518	24.62100913	0	0.016335647	12.66646219	40.16747391	79.41987215	6.51140024	1.46844075	27.06383758	106.1744675	26.63465801	0.548618021	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	0.081453601	0.081453601	0.189754825	0	0.233	0.233	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	0.072444695	0.072444695	0.16876762	0	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0.207229806	0	0	0	0	0	0	0	0												16.6914	0.010367572	1.814385592	0	1.427706416	2.283568101	0.22943204	2.569639613	10.25330032	0.541115675	5.102206941	0	0.003385233	2.624868501	8.323897819	16.45816468	1.349356207	0.304304691	5.608433806	22.00251427	5.519495007	0.113690006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.2312	0	12.83738293	16.6914	0.010367572	1.814385592	0	1.427706416	2.283568101	0.22943204	2.569639613	10.25330032	0.541115675	5.102206941	0	0.003385233	2.624868501	8.323897819	16.45816468	1.349356207	0.304304691	5.608433806	22.00251427	5.519495007	0.113690006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.2312	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.6914	0.010367572	1.814385592	0	1.427706416	2.283568101	0.22943204	2.569639613	10.25330032	0.541115675	5.102206941	0	0.003385233	2.624868501	8.323897819	16.45816468	1.349356207	0.304304691	5.608433806	22.00251427	5.519495007	0.113690006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.2312
H3708_001_0	2011	9																															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	V																																																			0	NO	633.1816159	28.62056382	665.1061684		62.41233422	70.14686954	17.95860664	36.19856321	18.80440069	53.81116621	71.1557612	2.358600227	2.447368474	16.25567407	12.04755652	285.3993782	48.20078296	87.19553102		13.87605439	31.68400264	8.771566046																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.082833778	0.082833778	0.182366773		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																			NO	0.082833778	0.082833778	0.182366773		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																				52.4488	2.370749442	121.2932656	0	14.54207387	16.3442206	4.184355347	8.434265227	4.38142536	12.53800173	16.57929236	0.549553853	0.570236855	3.787572059	2.80708067	66.49805513	11.23078243	20.31655873	0	3.233120673	7.382372615	2.043774889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	371.5356	0	0	52.4488	2.370749442	121.2932656	0	14.54207387	16.3442206	4.184355347	8.434265227	4.38142536	12.53800173	16.57929236	0.549553853	0.570236855	3.787572059	2.80708067	66.49805513	11.23078243	20.31655873	0	3.233120673	7.382372615	2.043774889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	371.5356	YES																																									6700																																									0	0	0	52.4488	2.370749442	121.2932656	0	14.54207387	16.3442206	4.184355347	8.434265227	4.38142536	12.53800173	16.57929236	0.549553853	0.570236855	3.787572059	2.80708067	66.49805513	11.23078243	20.31655873	0	3.233120673	7.382372615	2.043774889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	371.5356
H3749_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1304.572679	79.46533733	518.9281773	419.5306417	177.5885384	13.58549079	11.09124754	377.4578182	361.2919209	19.94410128	48.92469056	0	0.309558704	960.7352539	6398.877647	113.3123738	347.0696886	859.9957555	0	0	23.12353462	980.865357	0	0	222.0545418	179.5676676	17.07891534	6	87.71227613	0											4900	"$225 Days 1-4 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-59 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$225 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $225 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												129.3405023	76.65800612	73.06915998	0	200	0.2	0.112200699	49.99897972	225	0.136671465	0.159849592	0	0.2	87.01855278	5.944219421	0.157566876	38.5	35	0	0	0.2	34.36596631	0	0	35	30	0	0	0	0											NO	104.6029078	61.99643732	59.09399195	0	161.7481081	0.161748108	0.090741254	40.44948004	181.9666217	0.110531755	0.129276846	0	0.161748108	70.37543143	5.754574031	0.152539915	37.27168943	33.88335403	0	0	0.161748108	27.79315017	0	0	35	30	0	0	0	0												11.3718	0.410547317	2.555461461	0	2.393717509	2.197427434	1.006433712	1.27233104	5.47858919	2.204456512	6.324829675	0	0.050070535	5.634346499	3.068567928	17.28465989	1.07798947	2.428295054	0	0	3.740187978	2.27177818	0	0	0.64765908	0.448919169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.8681	0	11.88002552	11.3718	0.410547317	2.555461461	0	2.393717509	2.197427434	1.006433712	1.27233104	5.47858919	2.204456512	6.324829675	0	0.050070535	5.634346499	3.068567928	17.28465989	1.07798947	2.428295054	0	0	3.740187978	2.27177818	0	0	0.64765908	0.448919169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.8681	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.3718	0.410547317	2.555461461	0	2.393717509	2.197427434	1.006433712	1.27233104	5.47858919	2.204456512	6.324829675	0	0.050070535	5.634346499	3.068567928	17.28465989	1.07798947	2.428295054	0	0	3.740187978	2.27177818	0	0	0.64765908	0.448919169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.8681
H3749_004_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1700.675639	82.30737981	783.9314613	848.8515995	301.047898	13.68875074	11.5618069	340.9595728	306.5362319	18.77567875	50.66635496	0	0.137679044	1342.6	5776.607661	118.0890558	371.7795862	913.4783708	0	0	28.40016909	980.75829	0	330.0214975	195.5207424	174.0572135	17.27583116	6	75.94325609	0											4900	"$175 Days 1-10 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-10 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-59 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$165 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $165 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$0 n/c (10b)	"$25 (16a1, 16a2); $0 n/c (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												145.1132942	106.6104145	68.15208515	0	200	0.2	0.100053403	49.99609769	165	0.13867567	0.16210446	0	0.2	64.23493181	9.393547125	0.139019807	38.5	30	0	0	0.2	29.39123259	0	25	30	30	0	0	0	0											NO	114.7704468	84.3184284	53.90164496	0	158.1804719	0.158180472	0.079132473	39.55876047	130.4988893	0.109678915	0.1282088	0	0.158180472	50.80355914	9.063243238	0.134160375	37.14623028	28.94511451	0	0	0.158180472	23.24559521	0	25	30	30	0	0	0	0												16.2656	0.578335743	3.521266275	0	3.968324881	2.165293052	0.914914369	1.123994839	3.33355315	2.059296073	6.495872549	0	0.021778136	5.684071541	4.362900027	15.84287199	1.150850844	2.20339467	0	0	4.49235215	1.899859184	0	0.687544786	0.488801856	0.435143034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.696	0	14.74084897	16.2656	0.578335743	3.521266275	0	3.968324881	2.165293052	0.914914369	1.123994839	3.33355315	2.059296073	6.495872549	0	0.021778136	5.684071541	4.362900027	15.84287199	1.150850844	2.20339467	0	0	4.49235215	1.899859184	0	0.687544786	0.488801856	0.435143034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.696	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.2656	0.578335743	3.521266275	0	3.968324881	2.165293052	0.914914369	1.123994839	3.33355315	2.059296073	6.495872549	0	0.021778136	5.684071541	4.362900027	15.84287199	1.150850844	2.20339467	0	0	4.49235215	1.899859184	0	0.687544786	0.488801856	0.435143034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.696
H3749_011_0	2011	4																															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	YES	473.3831821	20.33326631	63.03404762	2488.473015	20.35827687	38.1461545	25.691548	45.38205468	53.27695662	25.59101097	56.30862218	0	0.222032352	31.37519756	46.33436587	186.2658631	9.259249289	5.46637324	0	0	33.53000494	8.542055516	775.0938957	475.2708206	179.4774764	213.24179	0	0	133.2072565	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.080097171	0.081069489	0.189760773	0	0.233	0.233	0.233	0.115002741	0.233	0.05825	0.179089845	0	0.233	0.186967064	0.226026178	0.232859649	0.229274093	0.233	0	0	0.233	0.231473764	0	0	0	0	0	0	0	0											NO	0.061120046	0.061861996	0.144801459	0	0.177796176	0.177796176	0.177796176	0.087769057	0.177796176	0.044449044	0.136658754	0	0.177796176	0.142669653	0.172474636	0.177689078	0.174953035	0.177796176	0	0	0.177796176	0.177451928	0	0	0	0	0	0	0	0												28.9332	1.257856445	9.127422036	0	3.619623778	6.782240401	4.567858991	3.983140133	9.472439159	1.137495973	7.69506612	0	0.039476503	4.476288542	7.991502883	33.09740946	1.619933762	0.971900259	0	0	5.961506662	1.515804219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.2502	0	41.05228628	28.9332	1.257856445	9.127422036	0	3.619623778	6.782240401	4.567858991	3.983140133	9.472439159	1.137495973	7.69506612	0	0.039476503	4.476288542	7.991502883	33.09740946	1.619933762	0.971900259	0	0	5.961506662	1.515804219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.2502	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	28.9332	1.257856445	9.127422036	0	3.619623778	6.782240401	4.567858991	3.983140133	9.472439159	1.137495973	7.69506612	0	0.039476503	4.476288542	7.991502883	33.09740946	1.619933762	0.971900259	0	0	5.961506662	1.515804219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.2502
H3749_017_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1285.706485	79.17860234	423.4295931	441.0979921	205.8925983	11.56460219	9.182706245	363.7122014	313.522192	17.98401614	42.7394742	0	0.208905788	1022.878296	5812.317816	103.2645347	348.5283692	654.4010947	0	0	26.75208699	837.1525068	0	0	143.1099799	160.8870109	17.36906076	6	149.1530787	0											6700	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-77 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$255 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $255 (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												185.9463355	119.8302997	76.83209664	0	200	0.2	0.107097054	49.99926774	255	0.136489119	0.161306917	0	0.2	99.38403398	11.96981658	0.162634019	38.5	35	0	0	0.2	34.28365934	0	0	35	30	0	0	0	0											NO	159.8279395	102.998695	66.04010596	0	171.9075981	0.171907598	0.092053987	42.98652599	219.1821876	0.117317583	0.138649423	0	0.171907598	85.42435286	11.69705513	0.158952766	37.62268366	34.20243969	0	0	0.171907598	29.46810766	0	0	35	30	0	0	0	0												17.1243	0.679607726	2.330277933	0	2.949541836	1.988042986	0.845304721	1.302893667	5.726539991	2.109841304	5.925803433	0	0.035912492	7.281559711	5.665583496	16.41418338	1.092714382	1.865176165	0	0	4.598887018	2.055775016	0	0	0.417404108	0.402217527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.8116	0	9.56126728	17.1243	0.679607726	2.330277933	0	2.949541836	1.988042986	0.845304721	1.302893667	5.726539991	2.109841304	5.925803433	0	0.035912492	7.281559711	5.665583496	16.41418338	1.092714382	1.865176165	0	0	4.598887018	2.055775016	0	0	0.417404108	0.402217527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.8116	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.1243	0.679607726	2.330277933	0	2.949541836	1.988042986	0.845304721	1.302893667	5.726539991	2.109841304	5.925803433	0	0.035912492	7.281559711	5.665583496	16.41418338	1.092714382	1.865176165	0	0	4.598887018	2.055775016	0	0	0.417404108	0.402217527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.8116
H3749_801_0	2011	1																															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	282.3417913	6.923798141	19.98091974	979.4232999	10.4278055	18.7024109	9.759005024	12.75725393	54.33879907	23.85207866	63.27227635	0	0.233064296	21.47720792	27.7237862	132.6476694	2.745354375	10.49162351	0	0	40.24963856	8.85658971	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.084561924	0.084561924	0.192352575	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.066361231	0.066361231	0.150951552	0	0.182850225	0.182850225	0.182850225	0.182850225	0.182850225	0.182850225	0.182850225	0	0.182850225	0.182850225	0.182850225	0.182850225	0.182850225	0.182850225	0	0	0.182850225	0.182850225	0	0	0	0	0	0	0	0												18.7365	0.459471767	3.016150854	0	1.906726584	3.419740046	1.784436267	2.332666754	9.935861649	4.361357955	11.56934998	0	0.042615859	3.927112304	5.06930055	24.25465622	0.501988666	1.918395722	0	0	7.359655476	1.619429423	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.2155	0	28.03432447	18.7365	0.459471767	3.016150854	0	1.906726584	3.419740046	1.784436267	2.332666754	9.935861649	4.361357955	11.56934998	0	0.042615859	3.927112304	5.06930055	24.25465622	0.501988666	1.918395722	0	0	7.359655476	1.619429423	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.2155	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.7365	0.459471767	3.016150854	0	1.906726584	3.419740046	1.784436267	2.332666754	9.935861649	4.361357955	11.56934998	0	0.042615859	3.927112304	5.06930055	24.25465622	0.501988666	1.918395722	0	0	7.359655476	1.619429423	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.2155
H3749_803_0	2011	1																															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	252.5495174	6.78749052	23.21181046	486.9938265	8.115568617	19.72057604	12.67342413	12.90023647	55.3333946	22.45828839	54.39431942	0	0.169825442	17.78765384	28.44545785	124.4369553	2.729768248	7.982920145	0	0	33.33980113	7.894011804	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.081728698	0.081728698	0.190264476	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.065651043	0.065651043	0.152835683	0	0.187164282	0.187164282	0.187164282	0.187164282	0.187164282	0.187164282	0.187164282	0	0.187164282	0.187164282	0.187164282	0.187164282	0.187164282	0.187164282	0	0	0.187164282	0.187164282	0	0	0	0	0	0	0	0												16.5801	0.445605833	3.547592895	0	1.518944576	3.690987462	2.372012332	2.4144635	10.35643509	4.203389428	10.18067376	0	0.031785257	3.329213465	5.323973704	23.29015343	0.510915115	1.49411752	0	0	6.240019952	1.477477054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0079	0	23.75681218	16.5801	0.445605833	3.547592895	0	1.518944576	3.690987462	2.372012332	2.4144635	10.35643509	4.203389428	10.18067376	0	0.031785257	3.329213465	5.323973704	23.29015343	0.510915115	1.49411752	0	0	6.240019952	1.477477054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0079	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.5801	0.445605833	3.547592895	0	1.518944576	3.690987462	2.372012332	2.4144635	10.35643509	4.203389428	10.18067376	0	0.031785257	3.329213465	5.323973704	23.29015343	0.510915115	1.49411752	0	0	6.240019952	1.477477054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0079
H3749_804_0	2011	1																															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	248.4207128	6.676525263	22.83233229	482.9804127	7.982891281	19.3981743	12.46623272	12.68933701	54.42877686	22.09112916	53.50505415	0	0.167049052	17.49685246	27.98041742	122.4025983	2.685140645	7.852411412	0	0	32.79474555	7.764956589	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.082882081	0.082882081	0.190636864	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.066833131	0.066833131	0.153722715	0	0.187882825	0.187882825	0.187882825	0.187882825	0.187882825	0.187882825	0.187882825	0	0.187882825	0.187882825	0.187882825	0.187882825	0.187882825	0.187882825	0	0	0.187882825	0.187882825	0	0	0	0	0	0	0	0												16.6027	0.446213089	3.5098481	0	1.499848165	3.644583784	2.342191018	2.384108483	10.22623235	4.150543752	10.05268072	0	0.031385648	3.287358067	5.257039865	22.99734594	0.504491809	1.475333238	0	0	6.161569434	1.458901979	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0324	0	23.06070842	16.6027	0.446213089	3.5098481	0	1.499848165	3.644583784	2.342191018	2.384108483	10.22623235	4.150543752	10.05268072	0	0.031385648	3.287358067	5.257039865	22.99734594	0.504491809	1.475333238	0	0	6.161569434	1.458901979	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0324	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.6027	0.446213089	3.5098481	0	1.499848165	3.644583784	2.342191018	2.384108483	10.22623235	4.150543752	10.05268072	0	0.031385648	3.287358067	5.257039865	22.99734594	0.504491809	1.475333238	0	0	6.161569434	1.458901979	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0324
H3755_001_0	2011	7																															D	D	D		T	O		V	V		V			V	V	V	V	V	P						V	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	YES	723.1896133	19.96688901	152.3360008	0	130.2080979	37.73084333	0	326.0776441	381.4992316	0	273.20466	0	0	508.8105215	3360.241285	3818.561377	110.2373491	107.9035693	51.88305694	0	0	0	0	0	5.619812016	160.406893	15.36440177	0	0	0											3400	$250/Days 1-5 for IP Med/Surg; $0/Day for IP Med/Surg; PBP 1a	$250/Days 1-5 for IP MH/SA; $0/Day for IP MH/SA; PBP 1b	$50/Days Custom for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	$46/Unit for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"$225/Case for OP Surg; $225/Case for ASC services; PBP 9a, 9b"	$0/Case for OP Lab; PBP 8a	$0/Case for OP Rad - General; $200/Case for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"$50/Day for Partial Hosp; $25/Case for OP - PT/OT/ST; $0/Case for OP - Other; $34/Visit for OP Substance Abuse; PBP 3, 5, 9a, 9c, 9d"	"$25/Visit for PCP OV; $0/Procedure for PCP - IP Visit; $0/Visit for Immunizations; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $40/Visit for SCP OV; $0/Visit for SCP - IP Visit; $40/Visit for SCP - Office Surg; $40/Visit for Podiatry; $40/Visit for Vision Exams; $25/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	$0/Procedure for Phys Rad - General; $200/Procedure for Phys Rad - PET/CAT/MRI; $0/Visit for Colorectal Screening; $0/Visit for Bone Mass Measurement; PBP 7d	"$0/Procedure for SCP - IP/OP Surg; $0/Procedure for SCP - Other; PBP 7d, 7g, 14d-j"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 14a"	PBP 10b	"PBP 16a, 16b"	$40/Exam for Routine Eye Exams (non-cvd); PBP 17a	$40/Service for Glasses/Contacts (non-cvd); PBP 17b	$25/Exam for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	PBP 14a	PBP 13b-f											0	250	250	50	0	100	46	0	47.31079612	225	0	200	0	0	25.42303916	25	39.48357782	25	25	200	0	0	0	0	0	40	40	25	0	0	0											NO	239.6046053	239.6046053	47.92092107	0	95.84184214	44.08724738	0	45.34353853	215.6441448	0	191.6836843	0	0	24.36590906	23.96046053	37.84178832	23.96046053	23.96046053	191.6836843	0	0	0	0	0	38.33673686	38.33673686	23.96046053	0	0	0												14.44	0.39867988	0.608340123	0	1.039948664	0.138620752	0	1.232126185	6.855672962	0	4.364072982	0	0	1.033135908	6.709410725	12.04176594	0.220111471	0.215451601	0.828761292	0	0	0	0	0	0.017953771	0.512456404	0.030678179	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6872	0	2.178478953	14.44	0.39867988	0.608340123	0	1.039948664	0.138620752	0	1.232126185	6.855672962	0	4.364072982	0	0	1.033135908	6.709410725	12.04176594	0.220111471	0.215451601	0.828761292	0	0	0	0	0	0.017953771	0.512456404	0.030678179	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6872	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.44	0.39867988	0.608340123	0	1.039948664	0.138620752	0	1.232126185	6.855672962	0	4.364072982	0	0	1.033135908	6.709410725	12.04176594	0.220111471	0.215451601	0.828761292	0	0	0	0	0	0.017953771	0.512456404	0.030678179	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6872
H3755_002_0	2011	5																															D	D			T	O		V	V		V			V	V	V	V	V	P						V	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	YES	695.3099168	11.79953647	0	0	106.4121991	38.59306617	0	291.2650463	382.4605682	0	282.8180511	0	0	595.5356389	2898.212252	3942.871297	35.30182479	90.77758678	59.94901988	0	0	0	0	0	4.744922422	130.7530422	7.504586528	0	0	0											3400	$150/Days 1-5 IP Med/Surg; PBP 1a	$150/Days 1-5 IP MH/SA; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	$50/Standard (non-powered) wheelchairs; 20% coinsurance for power wheelchairs and scooters; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$100/Case for OP Surg; $100/Case for ASC services; PBP 9a, 9b"	$0/Case for OP Lab; PBP 8a	$0/Case for OP Rad - General; $100/Case for OP Rad - PET/CAT/MRI/Other; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"$20/Case for OP - PT/OT/ST; $0/Case for OP - Other; $30/Visit for OP Substance Abuse; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP OV; $0/Procedure for PCP - IP Visit; $0/Visit for Immunizations; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $30/Visit for SCP OV; $0/Visit for SCP - IP Visit; $30/Visit for SCP - Office Surg; $30/Visit for Podiatry; $30/Visit for Vision Exams; $15/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$20/Visit for OP PT/OT/ST; $20/Visit for PT/ST; PBP 7c, 7i"	"$0/Procedure for Phys Rad - General; $100/Procedure for Phys Rad - PET/CAT/MRI/Other; PBP 7d, 8b"	"No Cost Sharing; PBP 7g, 14d-j"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	$30/Exam for Routine Eye Exams (non-cvd); PBP 17a	$30/Service for Glasses/Contacts (non-cvd) every 2 years; PBP 17b	$15/Exam for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											0	150	150	0	0	50	40	0	44.71161152	100	0	100	0	0	20.1952713	15	29.37049261	25	20	100	0	0	0	0	0	30	30	15	0	0	0											NO	147.7135608	147.7135608	0	0	49.2378536	39.39028288	0	44.03007564	98.47570719	0	98.47570719	0	0	19.88743623	14.77135608	28.9228003	24.6189268	19.69514144	98.47570719	0	0	0	0	0	29.54271216	29.54271216	14.77135608	0	0	0												8.5589	0.145245962	0	0	0.43662569	0.126682649	0	1.068701835	3.138589578	0	2.320892299	0	0	0.986973087	3.567543764	9.503239928	0.07242442	0.148989784	0.491960177	0	0	0	0	0	0.01168149	0.321899957	0.009237743	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9096	0	0.470802257	8.5589	0.145245962	0	0	0.43662569	0.126682649	0	1.068701835	3.138589578	0	2.320892299	0	0	0.986973087	3.567543764	9.503239928	0.07242442	0.148989784	0.491960177	0	0	0	0	0	0.01168149	0.321899957	0.009237743	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9096	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.5589	0.145245962	0	0	0.43662569	0.126682649	0	1.068701835	3.138589578	0	2.320892299	0	0	0.986973087	3.567543764	9.503239928	0.07242442	0.148989784	0.491960177	0	0	0	0	0	0.01168149	0.321899957	0.009237743	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9096
H3755_004_0	2011	8																															D	D			T	O		V	V		V			V	V	V	V	V	P						V	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	YES	823.2044176	28.0720568	0	0	123.3771887	46.58359151	0	368.3559824	552.4511502	0	382.434115	0	0	726.0092368	4113.794067	5118.628913	179.3210672	170.4858759	102.1569843	0	0	0	0	0	5.966066152	156.1515757	9.961628478	0	0	0											3400	$150/Days 1-5 for IP Med/Surg; $0/Day for IP Med/Surg; PBP 1a	$150/Days 1-5 for IP MH/SA; $0//Day for IP MH/SA; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	$45/Unit for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$125/Case for OP Surg; $125/Case for ASC services; PBP 9a, 9b"	$0/Case for OP Lab; PBP 8a	$0/Case for OP Rad - General; $100/Case for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"$20/Case for OP - PT/OT/ST; $0/Case for OP - Other; $30/Visit for OP Substance Abuse; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP OV; $0/Procedure for PCP - IP Visit; $0/Visit for Immunizations; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $30/Visit for SCP OV; $0/Visit for SCP - IP Visit; $30/Visit for SCP - Office Surg; $30/Visit for Podiatry; $30/Visit for Vision Exams; $15/Exam for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$20/Visit for OP PT/OT/ST; $20/Visit for PT/ST; PBP 7c, 7i"	$0/Procedure for Phys Rad - General; $100/Procedure for Phys Rad - PET/CAT/MRI; $0/Visit for Colorectal Screening; $0/Visit for Bone Mass Measurement; PBP 7d	"$0/Procedure for SCP - IP/OP Surg; $0/Procedure for SCP - Other; PBP 7d, 7g, 14d-j"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 13a, 14a"	PBP 10b	"PBP 16a, 16b"	$30/Exam for Routine Eye Exams (non-cvd); PBP 17a	$30/Service for Glasses/Contacts (non-cvd); PBP 17b	$15/Exam for Routine Hearing Test (non-cvd); PBP 18a	No Cost Sharing; PBP 18b	PBP 14a	PBP 13b-f											0	150	150	0	0	50	45	0	44.57430627	125	0	100	0	0	20.61442833	15	29.4460715	25	20	100	0	0	0	0	0	30	30	15	0	0	0											NO	145.7741364	145.7741364	0	0	48.59137879	43.73224091	0	43.31854	121.478447	0	97.18275758	0	0	20.03366991	14.57741364	28.61650428	24.29568939	19.43655152	97.18275758	0	0	0	0	0	29.15482727	29.15482727	14.57741364	0	0	0												10.0002	0.341014986	0	0	0.499588976	0.169767071	0	1.32972028	5.592575646	0	3.097166824	0	0	1.21205245	4.997373145	12.20643885	0.363060746	0.276138126	0.827324787	0	0	0	0	0	0.014494969	0.379381018	0.012101232	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3184	0	1.180110398	10.0002	0.341014986	0	0	0.499588976	0.169767071	0	1.32972028	5.592575646	0	3.097166824	0	0	1.21205245	4.997373145	12.20643885	0.363060746	0.276138126	0.827324787	0	0	0	0	0	0.014494969	0.379381018	0.012101232	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3184	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.0002	0.341014986	0	0	0.499588976	0.169767071	0	1.32972028	5.592575646	0	3.097166824	0	0	1.21205245	4.997373145	12.20643885	0.363060746	0.276138126	0.827324787	0	0	0	0	0	0.014494969	0.379381018	0.012101232	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3184
H3755_801_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	216.1368773	3.8789313	14.36166161	0	7.63031146	16.59728397	1.87354106	10.72333427	77.50430801	1.183870269	36.38054717	0	2.278347476	30.32173347	39.21706771	57.48366979	0.81179182	1.361477859	20.24914675	75.56286447	55.69498828	1.652751373	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Sharing; PBP 1a	Medicare FFS Cost Sharing; PBP 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	"Medicare FFS Cost Sharing; PBP 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 9a	Medicare FFS Cost Sharing; PBP 12	"Medicare FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare FFS Cost Sharing; PBP 7e, 7h"	"Medicare FFS Cost Sharing; PBP 7c, 7i"	Medicare FFS Cost Sharing; PBP 7d	"Medicare FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare FFS Cost Sharing; PBP 15	"Medicare FFS Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											0	0.085432841	0.085432841	0.193246891	0	0.233	0.233	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	0.078331978	0.078331978	0.177184922	0	0.213633899	0.213633899	0.213633899	0.213633899	0.213633899	0.213633899	0.213633899	0	0.213633899	0.213633899	0.213633899	0.213633899	0.213633899	0.213633899	0.213633899	0.213633899	0.213633899	0.213633899	0	0	0	0	0	0	0	0												16.9304	0.30384436	2.544669891	0	1.630093187	3.545742488	0.400251882	2.290867709	16.55754751	0.252914821	7.772118139	0	0.486732254	6.477750144	8.378095081	12.2804605	0.173426252	0.290857823	4.325904172	16.14278935	11.8983375	0.35308372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.0359	0	10.20022122	16.9304	0.30384436	2.544669891	0	1.630093187	3.545742488	0.400251882	2.290867709	16.55754751	0.252914821	7.772118139	0	0.486732254	6.477750144	8.378095081	12.2804605	0.173426252	0.290857823	4.325904172	16.14278935	11.8983375	0.35308372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.0359	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.9304	0.30384436	2.544669891	0	1.630093187	3.545742488	0.400251882	2.290867709	16.55754751	0.252914821	7.772118139	0	0.486732254	6.477750144	8.378095081	12.2804605	0.173426252	0.290857823	4.325904172	16.14278935	11.8983375	0.35308372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.0359
H3805_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1144.019754	86.85244403	1145.886055	340.8398342	324.3484517	12.154305	8.293926205	367.9485466	164.0951303	31.13421369	47.98147886	0	0.020538943	1261.875563	6650.789912	164.4580358	410.0064834	689.8717229	0	0	24.40758458	1305.737829	0	0	390.8902885	362.2307297	17.46434425	6	0	0											4900	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$75 Days 21-72 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$225 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $225 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	56.72909986	0	200	0.2	0.098962445	49.99668267	225	0.105543525	0.155450174	0	0.2	87.09486879	8.96371592	0.10279453	38.5	30	0	0	0.2	29.4918557	0	0	30	30	0	0	0	0											NO	146.9708798	98.30938259	44.76546583	0	157.8218796	0.15782188	0.078092195	39.46831556	177.5496145	0.083285388	0.122667193	0	0.15782188	68.72737946	8.811841788	0.10105355	37.84768637	29.49170366	0	0	0.15782188	23.27230049	0	0	30	30	0	0	0	0												14.0115	0.711534179	4.274676921	0	4.265773523	1.918215259	0.647690903	1.210192445	2.427918927	2.593025055	5.885753338	0	0.003241495	7.227116718	4.883809039	16.61906829	1.293149733	1.695457701	0	0	3.852050874	2.532293593	0	0	0.977225721	0.905576824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9352	0	14.20113679	14.0115	0.711534179	4.274676921	0	4.265773523	1.918215259	0.647690903	1.210192445	2.427918927	2.593025055	5.885753338	0	0.003241495	7.227116718	4.883809039	16.61906829	1.293149733	1.695457701	0	0	3.852050874	2.532293593	0	0	0.977225721	0.905576824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9352	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.0115	0.711534179	4.274676921	0	4.265773523	1.918215259	0.647690903	1.210192445	2.427918927	2.593025055	5.885753338	0	0.003241495	7.227116718	4.883809039	16.61906829	1.293149733	1.695457701	0	0	3.852050874	2.532293593	0	0	0.977225721	0.905576824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9352
H3805_007_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	883.2960268	85.6798539	881.9893736	205.4152689	191.6212459	10.28283334	8.305458982	310.2245662	142.8380587	26.93271775	40.79825221	0	0.062634881	1158.600636	6261.044226	124.146255	407.1896961	744.7555702	0	0	14.21380671	898.6388277	0	0	425.6590324	311.8580206	17.46434425	6	0	0											6700	"$195 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$195 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$175 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												145.2742631	97.17450918	50	0	200	0.2	0.085580418	49.9967271	175	0.10091892	0.155449191	0	0.2	67.53841095	8.86179796	0.124581517	38.5	30	0	0	0.2	28.79409054	0	0	30	30	0	0	0	0											NO	131.7503549	88.12831534	45.34538743	0	181.3815497	0.18138155	0.077613544	45.35044653	158.708856	0.09152415	0.140978076	0	0.18138155	61.25110821	8.807838703	0.123823067	38.2655745	29.81733078	0	0	0.18138155	26.11358382	0	0	30	30	0	0	0	0												9.6979	0.629235099	3.332845821	0	2.896379878	1.865116247	0.644616108	1.172401883	1.88913874	2.46499411	5.75165911	0	0.011360812	5.913797747	4.595522304	15.37217004	1.298445638	1.850551932	0	0	2.578122289	1.955556696	0	0	1.064147581	0.779645051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7636	0	4.329731389	9.6979	0.629235099	3.332845821	0	2.896379878	1.865116247	0.644616108	1.172401883	1.88913874	2.46499411	5.75165911	0	0.011360812	5.913797747	4.595522304	15.37217004	1.298445638	1.850551932	0	0	2.578122289	1.955556696	0	0	1.064147581	0.779645051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7636	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	9.6979	0.629235099	3.332845821	0	2.896379878	1.865116247	0.644616108	1.172401883	1.88913874	2.46499411	5.75165911	0	0.011360812	5.913797747	4.595522304	15.37217004	1.298445638	1.850551932	0	0	2.578122289	1.955556696	0	0	1.064147581	0.779645051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7636
H3805_801_0	2011	1																															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	287.9688505	8.721255352	31.18916376	299.4116235	15.07874695	14.15279846	10.57661029	26.13600251	42.08343553	32.40362536	48.61677615	0	0.016960703	21.81369169	44.87589868	173.2389132	3.182169196	7.869930596	0	0	27.35931418	14.73014234	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.083937137	0.083937137	0.130532053	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064549568	0.064549568	0.100382119	0	0.179182303	0.179182303	0.179182303	0.179182303	0.179182303	0.179182303	0.179182303	0	0.179182303	0.179182303	0.179182303	0.179182303	0.179182303	0.179182303	0	0	0.179182303	0.179182303	0	0	0	0	0	0	0	0												18.5883	0.562953268	3.130834355	0	2.7018446	2.535931017	1.895141385	4.683109112	7.540606884	5.806156206	8.7112659	0	0.003039058	3.908627506	8.04096686	31.04134739	0.570188404	1.410152286	0	0	4.902304914	2.639380824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.6721	0	32.63984725	18.5883	0.562953268	3.130834355	0	2.7018446	2.535931017	1.895141385	4.683109112	7.540606884	5.806156206	8.7112659	0	0.003039058	3.908627506	8.04096686	31.04134739	0.570188404	1.410152286	0	0	4.902304914	2.639380824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.6721	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.5883	0.562953268	3.130834355	0	2.7018446	2.535931017	1.895141385	4.683109112	7.540606884	5.806156206	8.7112659	0	0.003039058	3.908627506	8.04096686	31.04134739	0.570188404	1.410152286	0	0	4.902304914	2.639380824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.6721
H3805_803_0	2011	1																															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	280.08886	7.73522312	30.49734131	373.0818067	14.26700091	12.60901738	9.750351354	23.14627971	37.35003783	33.40104522	50.28676173	0	0.027457404	23.64893168	46.01888685	171.0090272	3.086650065	7.446602706	0	0	34.81252373	14.48995487	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.083703723	0.083703723	0.129773585	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064498907	0.064498907	0.099998591	0	0.179540943	0.179540943	0.179540943	0.179540943	0.179540943	0.179540943	0.179540943	0	0.179540943	0.179540943	0.179540943	0.179540943	0.179540943	0.179540943	0	0	0.179540943	0.179540943	0	0	0	0	0	0	0	0												18.0654	0.498913436	3.049691169	0	2.561510791	2.263834866	1.750587272	4.155704876	6.705860997	5.996855141	9.028532598	0	0.004929728	4.245951484	8.26227432	30.70312193	0.554180062	1.336970069	0	0	6.250273323	2.601540155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0362	0	32.16821227	18.0654	0.498913436	3.049691169	0	2.561510791	2.263834866	1.750587272	4.155704876	6.705860997	5.996855141	9.028532598	0	0.004929728	4.245951484	8.26227432	30.70312193	0.554180062	1.336970069	0	0	6.250273323	2.601540155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0362	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.0654	0.498913436	3.049691169	0	2.561510791	2.263834866	1.750587272	4.155704876	6.705860997	5.996855141	9.028532598	0	0.004929728	4.245951484	8.26227432	30.70312193	0.554180062	1.336970069	0	0	6.250273323	2.601540155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0362
H3805_804_0	2011	1																															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	264.1341156	7.337117963	28.80074132	363.2850108	13.45166118	11.81590274	9.191867122	21.85235153	35.29904606	31.18359579	47.06317404	0	0.025888609	22.32459884	42.97725306	159.8898706	2.927493184	6.968580072	0	0	32.89206422	13.49699375	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.082225703	0.082225703	0.124309396	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064580218	0.064580218	0.097632827	0	0.182998627	0.182998627	0.182998627	0.182998627	0.182998627	0.182998627	0.182998627	0	0.182998627	0.182998627	0.182998627	0.182998627	0.182998627	0.182998627	0	0	0.182998627	0.182998627	0	0	0	0	0	0	0	0												17.0578	0.473832675	2.811897807	0	2.461635522	2.162293974	1.68209906	3.998950319	6.459676953	5.706555205	8.612496217	0	0.00473758	4.085370928	7.864778289	29.25962674	0.535727232	1.275240583	0	0	6.019202581	2.469931321	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9419	0	28.12718351	17.0578	0.473832675	2.811897807	0	2.461635522	2.162293974	1.68209906	3.998950319	6.459676953	5.706555205	8.612496217	0	0.00473758	4.085370928	7.864778289	29.25962674	0.535727232	1.275240583	0	0	6.019202581	2.469931321	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9419	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.0578	0.473832675	2.811897807	0	2.461635522	2.162293974	1.68209906	3.998950319	6.459676953	5.706555205	8.612496217	0	0.00473758	4.085370928	7.864778289	29.25962674	0.535727232	1.275240583	0	0	6.019202581	2.469931321	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9419
H3810_001_0	2011	7																															D	D	D		T			V	V		V			V	V	V	V	V			Coin				V					V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	646.9135202	8.588180684	297.0399228	0	155.7998996	0	0	234.1015567	316.3267318	0	97.39640708	0	0	7.098008283	2531.800246	3990.216359	96.4403633	826.6948379	0	0	30.81017372	0	0	0	290.6549404	0	0	0	0	265.8071535											2000	$200/Days 1-10 for IP Medical; $200/Days 1-10 for IP Surg; PBP 1a	$200/Days 1-10 for IP Psych; PBP 1b	$100/Days Custom for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $25/Visit for Urgent; PBP 4a, 4b"	"$50/Visit for ASC; $100/Visit for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$50/Visit for OP MRI/CT/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$20/Visit for Outpatient Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$20/Visit for Consult; $20/Visit for OV; PBP 4b, 7a, 14b-c"	"$20/Visit for Consult; $20/Visit for Chiro; $20/Visit for OV; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$20/Visit for Mental Health; PBP 7e, 7h"	"$20/Visit for PT/OT/ST; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14g-h"	No Cost Sharing;	10% Coinsurance for Rx; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	$20/Visit for Routine Vision Exams; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	$20/Visit for Routine Chiro; $20/Visit for Acupuncture; $50/Visit for Worldwide ER; $20/Service for Counseling Support Services; PBP 13b											0	200	200	100	0	100	0	0	49.98837677	62.41732846	0	50	0	0	20	20	20	20	20	0	0	0.1	0	0	0	20	0	0	0	0	20.26438307											NO	185.5689745	185.5689745	92.78448724	0	92.78448724	0	0	46.38145907	57.91359815	0	46.39224362	0	0	18.55689745	18.55689745	18.55689745	18.55689745	18.55689745	0	0	0.092784487	0	0	0	18.55689745	0	0	0	0	18.80220392												10.0039	0.132808324	2.296724744	0	1.20465115	0	0	0.904830981	1.526634936	0	0.376536487	0	0	0.010976418	3.91519646	6.17050298	0.149136161	1.278407611	0	0	2.85870617	0	0	0	0.44947116	0	0	0	0	0.416480025	0	0	0	0	0	0	0	0	0	0	31.695	0	2.464804072	10.0039	0.132808324	2.296724744	0	1.20465115	0	0	0.904830981	1.526634936	0	0.376536487	0	0	0.010976418	3.91519646	6.17050298	0.149136161	1.278407611	0	0	2.85870617	0	0	0	0.44947116	0	0	0	0	0.416480025	0	0	0	0	0	0	0	0	0	0	31.695	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.0039	0.132808324	2.296724744	0	1.20465115	0	0	0.904830981	1.526634936	0	0.376536487	0	0	0.010976418	3.91519646	6.17050298	0.149136161	1.278407611	0	0	2.85870617	0	0	0	0.44947116	0	0	0	0	0.416480025	0	0	0	0	0	0	0	0	0	0	31.695
H3810_002_0	2011	12																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin								V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	385.3567507	0.807062551	73.71830365	0	68.54010179	21.73529806	3.539038794	63.11127425	52.1418645	6.56969046	15.84042022	0	0.153121732	29.4912893	27.46060281	100.662513	0.504756516	1.732449502	15.949386	40.12159444	19.99573933	3.36005442	0	0	0	0	0	0	0	109.8978937												Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	$50/Visit for Foreign Travel; PBP 13b											0	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	14.14893426											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	14.14893426												31.6862	0.066361285	9.163877526	0	15.96984372	5.064324448	0.824596039	14.7049269	12.14905443	1.530737877	3.690817911	0	0.035677363	6.871470408	6.398320455	23.45436554	0.117608268	0.403660734	3.716206937	9.348331504	4.659007264	0.78289268	0	0	0	0	0	0	0	0.129578173	0	0	0	0	0	0	0	0	0	0	150.7679	0	8.53E-14	31.6862	0.066361285	9.163877526	0	15.96984372	5.064324448	0.824596039	14.7049269	12.14905443	1.530737877	3.690817911	0	0.035677363	6.871470408	6.398320455	23.45436554	0.117608268	0.403660734	3.716206937	9.348331504	4.659007264	0.78289268	0	0	0	0	0	0	0	0.129578173	0	0	0	0	0	0	0	0	0	0	150.7679	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	31.6862	0.066361285	9.163877526	0	15.96984372	5.064324448	0.824596039	14.7049269	12.14905443	1.530737877	3.690817911	0	0.035677363	6.871470408	6.398320455	23.45436554	0.117608268	0.403660734	3.716206937	9.348331504	4.659007264	0.78289268	0	0	0	0	0	0	0	0.129578173	0	0	0	0	0	0	0	0	0	0	150.7679
H3810_003_0	2011	11																															D	D	D		T			V	V		V			V	V	V	V	V			Coin				V					V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	749.8365614	5.748641187	648.0218278	0	209.51596	0	0	270.4019143	335.3215319	0	151.5081142	0	0	11.81604314	3363.962633	5158.406704	262.6813379	1032.156173	0	0	41.22468745	0	0	0	348.5641638	0	0	0	0	330.8993741											2000	$200/Days 1-10 for IP Medical; $200/Days 1-10 for IP Surg; PBP 1a	$200/Days 1-10 for IP Psych; PBP 1b	$100/Days Custom for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $25/Visit for Urgent; PBP 4a, 4b"	"$50/Visit for ASC; $100/Visit for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$50/Visit for OP MRI/CT/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$20/Visit for Outpatient Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$20/Visit for Consult; $20/Visit for OV; PBP 4b, 7a, 14b-c"	"$20/Visit for Consult; $20/Visit for Chiro; $20/Visit for OV; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$20/Visit for Mental Health; PBP 7e, 7h"	"$20/Visit for PT/OT/ST; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14g-h"	No Cost Sharing;	10% Coinsurance for Rx; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	$20/Visit for Routine Vision Exams; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	$20/Visit for Routine Chiro; $20/Visit for Acupuncture; $50/Visit for Worldwide ER; $20/Service for Counseling Support Services; PBP 13b											0	200	200	100	0	100	0	0	49.95542479	62.70323111	0	50	0	0	20	20	20	20	20	0	0	0.1	0	0	0	20	0	0	0	0	20.24471468											NO	179.095113	179.095113	89.54755651	0	89.54755651	0	0	44.73386224	56.14921131	0	44.77377825	0	0	17.9095113	17.9095113	17.9095113	17.9095113	17.9095113	0	0	0.089547557	0	0	0	17.9095113	0	0	0	0	18.12864732												11.191	0.085796129	4.835730937	0	1.563470189	0	0	1.008010165	1.569003296	0	0.565299226	0	0	0.017634963	5.020577233	7.69871193	0.392041199	1.540451053	0	0	3.691570029	0	0	0	0.520217819	0	0	0	0	0.499896504	0	0	0	0	0	0	0	0	0	0	40.1994	0	4.692279057	11.191	0.085796129	4.835730937	0	1.563470189	0	0	1.008010165	1.569003296	0	0.565299226	0	0	0.017634963	5.020577233	7.69871193	0.392041199	1.540451053	0	0	3.691570029	0	0	0	0.520217819	0	0	0	0	0.499896504	0	0	0	0	0	0	0	0	0	0	40.1994	NO																																										0	0	0	0	0	0	0	0	0	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	0.085796129	4.835730937	0	1.563470189	0	0	1.008010165	1.569003296	0	0.565299226	0	0	0.017634963	5.020577233	7.69871193	0.392041199	1.540451053	0	0	3.691570029	0	0	0	0.520217819	0	0	0	0	0.499896504	0	0	0	0	0	0	0	0	0	0	40.1994
H3810_004_0	2011	6																															D	D			T			V	V		V			V	V	V	V	V			Coin				V					V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	494.7086812	8.850444704	0	0	183.157481	0	0	200.7391996	298.5189245	0	95.37340022	0	0	9.329573827	2505.484046	4496.707231	187.2660673	949.8945872	0	0	32.75101141	0	0	0	270.8767403	0	0	0	0	253.443543											500	$150/Days 1-3 for IP Medical; $150/Days 1-3 for IP Surg; PBP 1a	$150/Days 1-3 for IP Psych; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $25/Visit for Urgent; PBP 4a, 4b"	"$50/Visit for ASC; $100/Visit for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$50/Visit for OP MRI/CT/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$5/Visit for Outpatient Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$5/Visit for Consult; $5/Visit for OV; PBP 4b, 7a, 14b-c"	"$5/Visit for Consult; $5/Visit for Chiro; $5/Visit for OV; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$5/Visit for Mental Health; PBP 7e, 7h"	"$5/Visit for PT/OT/ST; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14g-h"	No Cost Sharing;	10% Coinsurance for Rx; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	$5/Visit for Routine Vision Exams; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	$5/Visit for Routine Chiro; $5/Visit for Acupuncture; $50/Visit for Worldwide ER; $5/Service for Counseling Support Services; PBP 13b											0	150	150	0	0	100	0	0	49.97196639	63.65391751	0	50	0	0	5	5	5	5	5	0	0	0.1	0	0	0	5	0	0	0	0	5.395620152											NO	124.8428332	124.8428332	0	0	83.22855549	0	0	41.59094577	52.97823606	0	41.61427775	0	0	4.161427775	4.161427775	4.161427775	4.161427775	4.161427775	0	0	0.083228555	0	0	0	4.161427775	0	0	0	0	4.490696712												5.1467	0.092076216	0	0	1.270327714	0	0	0.69574443	1.317917171	0	0.330741264	0	0	0.003235362	0.868865908	1.55939353	0.064941184	0.32940981	0	0	2.72581937	0	0	0	0.093936166	0	0	0	0	0.09484484	0	0	0	0	0	0	0	0	0	0	14.594	0	2.940844962	5.1467	0.092076216	0	0	1.270327714	0	0	0.69574443	1.317917171	0	0.330741264	0	0	0.003235362	0.868865908	1.55939353	0.064941184	0.32940981	0	0	2.72581937	0	0	0	0.093936166	0	0	0	0	0.09484484	0	0	0	0	0	0	0	0	0	0	14.594	NO	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $25/Visit for Urgent; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP MRI/CT/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"20% Coinsurance for OV; 20% Coinsurance for OV; PBP 4b, 7a, 14b-c"	"20% Coinsurance for Chiro; 20% Coinsurance for Professional; 20% Coinsurance for OV; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"20% Coinsurance for Mental Health; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"20% Coinsurance for Office MRI/CT/PET; PBP 7d, 14g-h"	20% Coinsurance for Office Other;	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	20% Coinsurance for Routine Vision Exams; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	20% Coinsurance for Routine Chiro; 20% Coinsurance for Acupuncture; PBP 13b												0	0	0	0	0	0	0	0.0581	0	0	0.0849	0	0	0	0.2729	0.3803	0.0209	0	0.1154	0.2009	0	0.0014	0	0	0.0506	0	0	0	0	0.0112											1.1965	0	0.738594276	5.1467	0.092076216	0	0	1.270327714	0	0	0.7538177	1.317917171	0	0.415623666	0	0	0.003235362	1.141769531	1.93967672	0.085816762	0.32940981	0.115391802	0.200861966	2.72581937	0.001393011	0	0	0.144505301	0	0	0	0	0.106076552	0	0	0	0	0	0	0	0	0	0	15.7905
H3810_005_0	2011	9																															D	D			T			V	V		V			V	V	V	V	V			Coin				V					V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	712.177628	8.159249511	0	0	186.0821005	0	0	304.4565737	367.8936591	0	117.7739929	0	0	8.46244946	2203.099734	6001.668169	291.7883157	833.7200951	0	0	36.53239325	0	0	0	354.6814829	0	0	0	0	241.6231453											500	$150/Days 1-3 for IP Medical; $150/Days 1-3 for IP Surg; PBP 1a	$150/Days 1-3 for IP Psych; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $25/Visit for Urgent; PBP 4a, 4b"	"$50/Visit for ASC; $100/Visit for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$50/Visit for OP MRI/CT/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$5/Visit for Outpatient Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$5/Visit for Consult; $5/Visit for OV; PBP 4b, 7a, 14b-c"	"$5/Visit for Consult; $5/Visit for Chiro; $5/Visit for OV; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$5/Visit for Mental Health; PBP 7e, 7h"	"$5/Visit for PT/OT/ST; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14g-h"	No Cost Sharing;	10% Coinsurance for Rx; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	$5/Visit for Routine Vision Exams; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	$5/Visit for Routine Chiro; $5/Visit for Acupuncture; $50/Visit for Worldwide ER; $5/Service for Counseling Support Services; PBP 13b											0	150	150	0	0	100	0	0	49.98295994	64.39394996	0	50	0	0	5	5	5	5	5	0	0	0.1	0	0	0	5	0	0	0	0	5.620728701											NO	120.0715687	120.0715687	0	0	80.04771245	0	0	40.01021605	51.5458839	0	40.02385623	0	0	4.002385623	4.002385623	4.002385623	4.002385623	4.002385623	0	0	0.080047712	0	0	0	4.002385623	0	0	0	0	4.499264748												7.126	0.081641157	0	0	1.241287206	0	0	1.015114441	1.580283653	0	0.392814113	0	0	0.002822499	0.734804558	2.001749199	0.09732078	0.278072443	0	0	2.92433451	0	0	0	0.118297672	0	0	0	0	0.090593875	0	0	0	0	0	0	0	0	0	0	17.6852	0	4.408113411	7.126	0.081641157	0	0	1.241287206	0	0	1.015114441	1.580283653	0	0.392814113	0	0	0.002822499	0.734804558	2.001749199	0.09732078	0.278072443	0	0	2.92433451	0	0	0	0.118297672	0	0	0	0	0.090593875	0	0	0	0	0	0	0	0	0	0	17.6852	NO	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $25/Visit for Urgent; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP MRI/CT/PET; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"20% Coinsurance for OV; 20% Coinsurance for OV; PBP 4b, 7a, 14b-c"	"20% Coinsurance for Chiro; 20% Coinsurance for Professional; 20% Coinsurance for OV; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"20% Coinsurance for Mental Health; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"20% Coinsurance for Office MRI/CT/PET; PBP 7d, 14g-h"	20% Coinsurance for Office Other;	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	20% Coinsurance for Routine Vision Exams; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	20% Coinsurance for Routine Chiro; 20% Coinsurance for Acupuncture; PBP 13b												0	0	0	0	0	0	0	0.0851	0	0	0.0995	0	0	0	0.2355	0.4817	0.0305	0	0.145	0.2411	0	0.0012	0	0	0.0623	0	0	0	0	0.01											1.3919	0	0.92934606	7.126	0.081641157	0	0	1.241287206	0	0	1.100180107	1.580283653	0	0.492346667	0	0	0.002822499	0.970344069	2.483421658	0.127779263	0.278072443	0.144979208	0.241088575	2.92433451	0.001245252	0	0	0.180566296	0	0	0	0	0.100634217	0	0	0	0	0	0	0	0	0	0	19.0771
H3810_006_0	2011	5																															D	D	D		T	Coin	Coin	V	V		V		Coin	V	V	V	V	V			Coin				V					V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	398.2903311	130.9447232	290.0375777	0	134.1537772	9.150398075	2.623980805	209.4973604	240.5394609	0	83.50464231	0	0.027730881	7.634030342	2094.989423	3325.180873	156.4451725	763.1486955	0	0	23.39630448	0	0	0	273.1157422	0	0	0	0	251.8710739											3400	$300/Days Custom for IP Medical; $300/Days Custom for IP Surg; PBP 1a	$300/Days Custom for IP Psych; PBP 1b	$100/Days Custom for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $25/Visit for Urgent; PBP 4a, 4b"	"$200/Visit for ASC; $200/Visit for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$50/Visit for OP MRI/CT/PET; PBP 8b	No Cost Sharing;	20% Coinsurance for Dialysis; PBP 12	"$20/Visit for Outpatient Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$20/Visit for Consult; $20/Visit for OV; PBP 4b, 7a, 14b-c"	"$30/Visit for Consult; $30/Visit for Chiro; $30/Visit for OV; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for Mental Health; PBP 7e, 7h"	"$20/Visit for PT/OT/ST; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14g-h"	No Cost Sharing;	10% Coinsurance for Rx; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	$30/Visit for Routine Vision Exams; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	$30/Visit for Routine Chiro; $30/Visit for Acupuncture; $50/Visit for Worldwide ER; $20/Service for Counseling Support Services; PBP 13b											0	300	300	100	0	100	0.2	0.2	49.97845178	192.2604609	0	50	0	0.2	20	20.94758706	30	30	20	0	0	0.1	0	0	0	30	0	0	0	0	26.75940198											NO	287.7780732	287.7780732	95.9260244	0	95.9260244	0.191852049	0.191852049	47.94234185	184.4278166	0	47.9630122	0	0.191852049	19.18520488	20.09418748	28.77780732	28.77780732	19.18520488	0	0	0.095926024	0	0	0	28.77780732	0	0	0	0	25.66923048												9.5516	3.140251679	2.318512647	0	1.072403209	1.755522618	0.503416093	0.836982839	3.696847299	0	0.333761181	0	0.005320226	0.012205036	3.508092519	7.97428454	0.375179086	1.220097006	0	0	2.244314474	0	0	0	0.654972684	0	0	0	0	0.538778054	0	0	0	0	0	0	0	0	0	0	39.7425	0	1.687864708	9.5516	3.140251679	2.318512647	0	1.072403209	1.755522618	0.503416093	0.836982839	3.696847299	0	0.333761181	0	0.005320226	0.012205036	3.508092519	7.97428454	0.375179086	1.220097006	0	0	2.244314474	0	0	0	0.654972684	0	0	0	0	0.538778054	0	0	0	0	0	0	0	0	0	0	39.7425	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	9.5516	3.140251679	2.318512647	0	1.072403209	1.755522618	0.503416093	0.836982839	3.696847299	0	0.333761181	0	0.005320226	0.012205036	3.508092519	7.97428454	0.375179086	1.220097006	0	0	2.244314474	0	0	0	0.654972684	0	0	0	0	0.538778054	0	0	0	0	0	0	0	0	0	0	39.7425
H3810_007_0	2011	7																															D	D	D		T	Coin	Coin	V	V		V		Coin	V	V	V	V	V			Coin				V					V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	518.7165317	22.84978059	303.701736	0	140.1575594	10.0817691	2.476754279	213.1735348	236.7950479	0	110.4888341	0	0.024085457	12.0668761	2145.149511	3693.52582	141.381689	816.9480181	0	0	37.23832316	0	0	0	303.3712985	0	0	0	0	218.4074701											3400	$300/Days Custom for IP Medical; $300/Days Custom for IP Surg; PBP 1a	$300/Days Custom for IP Psych; PBP 1b	$100/Days Custom for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $25/Visit for Urgent; PBP 4a, 4b"	"$200/Visit for ASC; $200/Visit for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$50/Visit for OP MRI/CT/PET; PBP 8b	No Cost Sharing;	20% Coinsurance for Dialysis; PBP 12	"$20/Visit for Outpatient Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$20/Visit for Consult; $20/Visit for OV; PBP 4b, 7a, 14b-c"	"$30/Visit for Consult; $30/Visit for Chiro; $30/Visit for OV; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for Mental Health; PBP 7e, 7h"	"$20/Visit for PT/OT/ST; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14g-h"	No Cost Sharing;	10% Coinsurance for Rx; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	$30/Visit for Routine Vision Exams; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	$30/Visit for Routine Chiro; $30/Visit for Acupuncture; $50/Visit for Worldwide ER; $20/Service for Counseling Support Services; PBP 13b											0	300	300	100	0	100	0.2	0.2	49.98151101	197.3457408	0	50	0	0.2	20	21.09918023	30	30	20	0	0	0.1	0	0	0	30	0	0	0	0	26.26410462											NO	286.1981437	286.1981437	95.39938124	0	95.39938124	0.190798762	0.190798762	47.68205224	188.2666156	0	47.69969062	0	0.190798762	19.07987625	20.12848739	28.61981437	28.61981437	19.07987625	0	0	0.095399381	0	0	0	28.61981437	0	0	0	0	25.05579329												12.3713	0.544963732	2.414413142	0	1.11424537	1.923589068	0.472561651	0.847045969	3.715050189	0	0.439190267	0	0.004595475	0.019186209	3.598217907	8.809001946	0.337193141	1.298938924	0	0	3.552512988	0	0	0	0.723535854	0	0	0	0	0.456031035	0	0	0	0	0	0	0	0	0	0	42.6416	0	2.056382956	12.3713	0.544963732	2.414413142	0	1.11424537	1.923589068	0.472561651	0.847045969	3.715050189	0	0.439190267	0	0.004595475	0.019186209	3.598217907	8.809001946	0.337193141	1.298938924	0	0	3.552512988	0	0	0	0.723535854	0	0	0	0	0.456031035	0	0	0	0	0	0	0	0	0	0	42.6416	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.3713	0.544963732	2.414413142	0	1.11424537	1.923589068	0.472561651	0.847045969	3.715050189	0	0.439190267	0	0.004595475	0.019186209	3.598217907	8.809001946	0.337193141	1.298938924	0	0	3.552512988	0	0	0	0.723535854	0	0	0	0	0.456031035	0	0	0	0	0	0	0	0	0	0	42.6416
H3811_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	V	V	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	0											0	YES	896.8258534	26.4638623	530.013899	709.1377668	165.9037968	8.192604117	6.856289018	388.8324642	2532.517201	3321.623028	1230.55865	0	3.639537155	248.6821931	3574.020629	3137.985131	111.3228802	316.9513171	1874.817946	7761.853591	8.969032331	22.85458342	0	0	571.3509313	182.8320191	35.64591101	10.66411653	0	85.42975241											3400	"$150 copay days 1-5, $0 days 6-90. $1500 OOP max"	$500 copay	"$40 copay days 1-100, offers additional 20 days ($40 copay)"		$50 copay	20% Coinsurance	20% Coinsurance	"$50 copay ER, $10 UC. Mandatory Worldwide"	$50 copay				20% Coinsurance	"$15 copay on CORF and Cardiac Rehab, 20% Subst Abuse"	$10 copay; preventative services covered at 100%	"$20 Chiro copay, Chiro routine care ($25 copay), $20 Specialist"	$20 copay	$15 copay			20% Coinsurance				$20 copay	"$125 max coverage, glasses(1) contacts (24) per 2 yrs"	$10 copay			$20 copay Acupuncture (limit 15 visits)												74.9009247	30.76923077	40	0	50	0.2	0.096137825	40.66751559	50	0	0	0	0.2	0	10	19.22383613	20	15	0	0.035352691	0.2	0	0	0	20	0	10	0	0	20											NO	65.48706132	26.90202437	34.97263169	0	43.71578961	0.174863158	0.084054819	35.55625111	43.71578961	0	0	0	0.174863158	0	8.743157922	16.80770352	17.48631584	13.11473688	0	0.030909416	0.174863158	0	0	0	17.48631584	0	8.743157922	0	0	17.48631584												4.8942	0.059327622	1.544665073	0	0.604384623	1.432584632	0.576304133	1.152118728	9.225915763	0	0	0	0.636420962	0	2.604018898	4.395193644	0.16221892	0.346394427	0	0.019992863	1.568353322	0	0	0	0.83256857	0	0.025971486	0	0	0.124487636	0	0	0	0	0	0	0	0	0	0	30.2051		4.342032611	4.8942	0.059327622	1.544665073	0	0.604384623	1.432584632	0.576304133	1.152118728	9.225915763	0	0	0	0.636420962	0	2.604018898	4.395193644	0.16221892	0.346394427	0	0.019992863	1.568353322	0	0	0	0.83256857	0	0.025971486	0	0	0.124487636	0	0	0	0	0	0	0	0	0	0	30.2051	NO																																																																																		0			4.8942	0.059327622	1.544665073	0	0.604384623	1.432584632	0.576304133	1.152118728	9.225915763	0	0	0	0.636420962	0	2.604018898	4.395193644	0.16221892	0.346394427	0	0.019992863	1.568353322	0	0	0	0.83256857	0	0.025971486	0	0	0.124487636	0	0	0	0	0	0	0	0	0	0	30.2051
H3811_002_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	V	V	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	0											0	YES	987.1642149	75.71609497	582.8885072	765.13749	193.2400111	10.66227415	11.00131772	436.2037479	2948.686924	4046.478998	1511.009618	0	0.229919977	307.5425871	4064.628032	3368.94739	276.7296193	427.5754667	2079.449416	8573.934814	10.844311	33.3888573	0	0.678709958	654.5084818	190.4980151	34.55100258	5.39061827	0	100.616099											3400	"$150 copay days 1-5, $0 days 6-90. $1500 OOP max"	$500 copay	"$40 copay days 1-100, offers additional 20 days ($40 copay)"		$50 copay	20% Coinsurance	20% Coinsurance	"$50 copay ER, $10 UC. Mandatory Worldwide"	$60 copay				20% Coinsurance	"$15 copay on CORF and Cardiac Rehab, 20% Subst Abuse"	$10 copay	"$15 Chiro copay, Chiro routine care ($25 copay), $20 Specialist"	$20 Copay	$15 copay			20% Coinsurance			$15 copay on Comprehensive	$20 copay	"$125 max coverage, glasses(1) contacts (24) per 2 yrs"	"$10 copay, Mandatory annual routine hearing exam"			$20 copay Acupuncture (limit 15 visits)												74.9009247	30.76923077	40	0	50	0.2	0.105596037	42.30039381	60	0	0	0	0.2	0	10	19.3716518	20	15	0	0.002433648	0.2	0	0	0	20	0	10	0	0	20											NO	66.21931921	27.20283524	35.36368582	0	44.20460727	0.176818429	0.093356626	37.39744591	53.40774787	0	0	0	0.176818429	0	8.840921454	17.1263252	17.68184291	13.26138218	0	0.002151569	0.176818429	0	0	0	17.68184291	0	8.840921454	0	0	17.68184291												5.4474	0.171641038	1.71775717	0	0.711841567	1.885286566	1.027045909	1.359408839	13.12356065	0	0	0	0.040654089	0	2.994588098	4.808140714	0.407757471	0.47252014	0	0.001537284	1.917474035	0	0	0	0.96440968	0	0.025455225	0	0	0.148256505	0	0	0	0	0	0	0	0	0	0	37.2248		4.880310757	5.4474	0.171641038	1.71775717	0	0.711841567	1.885286566	1.027045909	1.359408839	13.12356065	0	0	0	0.040654089	0	2.994588098	4.808140714	0.407757471	0.47252014	0	0.001537284	1.917474035	0	0	0	0.96440968	0	0.025455225	0	0	0.148256505	0	0	0	0	0	0	0	0	0	0	37.2248	NO																																																																																		0			5.4474	0.171641038	1.71775717	0	0.711841567	1.885286566	1.027045909	1.359408839	13.12356065	0	0	0	0.040654089	0	2.994588098	4.808140714	0.407757471	0.47252014	0	0.001537284	1.917474035	0	0	0	0.96440968	0	0.025455225	0	0	0.148256505	0	0	0	0	0	0	0	0	0	0	37.2248
H3811_003_0	2011	5																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	343.9360887	18.0480432	32.81482787	20.28209138	20.15709925	31.19504148	29.60418546	18.46996119	115.3756951	37.0236065	37.73626355	0	0.208013428	15.46530364	42.74543135	27.70694471	16.12084515	2.223923946	17.15289808	99.05015468	18.76104973	0.934301728	0	28.67169152	660.7072171	268.4004183	38.09534754	1.853459961	0	49.98985645											3400	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	FFS Cost Sharing		$15 copay	"24 pairs contacts every 2 years, 1 eye glasses every 2 years. Max at $150 every 2 years (combined)"	$10 copay		"Written health education materials, incl. newsletters, Nutritional Training, Additional Smoking Cessation, Membership in Health Club/Fitness Classes, Other"	$15 copay Limit 15 acupuncture visits												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	0.229174994	0.233	0.233	0	0	15	0	10	0	0	15											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	0.229174994	0.233	0.233	0	0	15	0	10	0	0	15												28.2804	1.48401302	4.079191309	0	4.696604126	7.268444665	6.897775211	4.303500957	26.88253695	8.626500314	8.792549408	0	0.048467129	3.603415749	9.959685504	6.455718119	3.756156919	0.518174279	3.996625253	22.69981864	4.371324588	0.217692303	0	0	0.825884021	0	0.031746123	0	0	0.062487321	0	0	0	0	0	0	0	0	0	0	157.8587		0	28.2804	1.48401302	4.079191309	0	4.696604126	7.268444665	6.897775211	4.303500957	26.88253695	8.626500314	8.792549408	0	0.048467129	3.603415749	9.959685504	6.455718119	3.756156919	0.518174279	3.996625253	22.69981864	4.371324588	0.217692303	0	0	0.825884021	0	0.031746123	0	0	0.062487321	0	0	0	0	0	0	0	0	0	0	157.8587	NO																																																																																		0			28.2804	1.48401302	4.079191309	0	4.696604126	7.268444665	6.897775211	4.303500957	26.88253695	8.626500314	8.792549408	0	0.048467129	3.603415749	9.959685504	6.455718119	3.756156919	0.518174279	3.996625253	22.69981864	4.371324588	0.217692303	0	0	0.825884021	0	0.031746123	0	0	0.062487321	0	0	0	0	0	0	0	0	0	0	157.8587
H3811_009_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	V	V	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	0											0	YES	1006.569758	43.99096004	538.2931227	755.3331006	184.5259192	12.07286474	11.44424032	430.3612254	2941.371232	4203.330801	1595.853677	0	0.100585043	346.1666652	4365.577041	3705.302697	178.6692121	496.0589388	2314.024278	9356.885339	13.42941824	10.71315905	0	599.9723013	684.0908098	240.7123013	46.79272102	39.61834036	0	160.5347579											3400	"$150 copay days 1-5, $0 days 6-90. $1500 OOP max"	$500 copay	"$40 copay days 1-100, offers additional 20 days ($40 copay)"		$50 copay	20% Coinsurance	20% Coinsurance	"$50 copay ER, $10 UC. Mandatory Worldwide"	$60 copay				20% Coinsurance	"$15 copay on CORF and Cardiac Rehab, 20% Subst Abuse"	$10 copay	"$20 Specialist, $15 Chiro copay, Mandatory Chiro routine care ($25 copay)"	$20 copay	$15 copay			20% Coinsurance			"$15 copay on Comprehensive, Mandatory Exam/Prophylaxis/X-Ray (1 each annually)"	$20 copay	$125 max coverage	$10 copay	$500 max on hearing aids		$20 copay Acupuncture (limit 15 visits)												74.9009247	30.76923077	40	0	50	0.2	0.095482388	44.31581108	60	0	0	0	0.2	0	10	20	20	15	0	0.001922233	0.2	0	0	0	20	0	10	0	0	20											NO	66.2391488	27.21098122	35.37427559	0	44.21784448	0.176871378	0.084440508	39.19099285	53.42259417	0	0	0	0.176871378	0	8.843568897	17.68713779	17.68713779	13.26535335	0	0.00169994	0.176871378	0	0	0	17.68713779	0	8.843568897	0	0	17.68713779												5.5562	0.099753099	1.586810772	0	0.679944867	2.135344223	0.966357463	1.405523642	13.09464013	0	0	0	0.017790615	0	3.217273444	5.461349948	0.263345581	0.548366425	0	0.001325512	2.37527971	0	0	0	1.008300701	0	0.034484554	0	0	0.236616699	0	0	0	0	0	0	0	0	0	0	38.6887		5.059135939	5.5562	0.099753099	1.586810772	0	0.679944867	2.135344223	0.966357463	1.405523642	13.09464013	0	0	0	0.017790615	0	3.217273444	5.461349948	0.263345581	0.548366425	0	0.001325512	2.37527971	0	0	0	1.008300701	0	0.034484554	0	0	0.236616699	0	0	0	0	0	0	0	0	0	0	38.6887	NO																																																																																		0			5.5562	0.099753099	1.586810772	0	0.679944867	2.135344223	0.966357463	1.405523642	13.09464013	0	0	0	0.017790615	0	3.217273444	5.461349948	0.263345581	0.548366425	0	0.001325512	2.37527971	0	0	0	1.008300701	0	0.034484554	0	0	0.236616699	0	0	0	0	0	0	0	0	0	0	38.6887
H3812_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	845.4037784	104.4656039	788.6027975	181.5911779	137.8433021	6.258147887	7.594308304	419.8481325	34.1876816	13.48311229	27.52801034	0	0.030746394	13.66457052	5186.215878	80.82375748	523.2730684	454.9306854	0	0	19.43094049	1043.886126	0	0	241.9734187	0	16.23806509	10.45	24.86949748	0											3900	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$50 Days 11-88 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$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, 18a); $0/$25 (17a)"	$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												185.9463355	119.8302997	28.00302675	0	200	0.2	0.095861337	49.47799138	0.2	0.113658081	0.164968739	0	0.2	0.161982984	10.04873815	0.091081069	38.5	25	0	0	0.2	24.76089316	0	0	25	0	25	0	0	0											NO	151.3290219	97.52169625	22.78975081	0	162.7663396	0.16276634	0.078014995	40.27708127	0.16276634	0.092498549	0.134256789	0	0.16276634	0.131826887	9.738193504	0.088270097	37.31020196	24.22740387	0	0	0.16276634	20.15119973	0	0	25	0	25	0	0	0												10.6612	0.848971907	1.49767177	0	1.869687477	1.018615824	0.592469921	1.409188113	5.564603795	1.247168326	3.695822278	0	0.005004478	1.801357797	4.208697814	7.13432092	1.626951988	0.918482454	0	0	3.16270306	1.752963151	0	0	0.504111289	0	0.033829302	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5538	0	8.477713959	10.6612	0.848971907	1.49767177	0	1.869687477	1.018615824	0.592469921	1.409188113	5.564603795	1.247168326	3.695822278	0	0.005004478	1.801357797	4.208697814	7.13432092	1.626951988	0.918482454	0	0	3.16270306	1.752963151	0	0	0.504111289	0	0.033829302	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5538	YES	"$390 Days 1-22 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$390 Days 1-22 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-48 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											8400	0.431	0.0468	0.3649	0.2117	0.4674	0.382	0.4635	0.3523	2.0867	0.3118	1.3571	0	0.0013	0.6752	1.3871	1.9828	0.3244	0.2593	0	0	0.8372	0.495	0	0	0.1423	0	0.0096	0	0	0											12.5896	0	2.06640109	11.0922	0.895815767	1.862609057	0.211675327	2.337109346	1.400596758	1.056006582	1.761485141	7.651330218	1.558960408	5.052927011	0	0.006255597	2.476585574	5.595841677	9.11716173	1.951348068	1.177818676	0	0	3.999889164	2.247949311	0	0	0.646448594	0	0.043381105	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1434
H3812_005_0	2011	4																															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	YES	224.7073826	44.2505575	8090.458925	17.86178564	28.00441013	21.61263047	7.409628349	16.33977519	2.486312964	33.16387874	8.882241364	0	0	5.256171971	1.810806179	100.6269532	20.105112	28.6352763	0	0	4.066682216	5.600633302	1419.689576	0	196.6895573	223.2120011	0	0	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.082791614	0.083796497	0	0	0.2	0.2	0.2	0.085605567	0.2	0	0.111745459	0	0	0.161413179	0.00289567	0.028079105	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.077685886	0.078628798	0	0	0.187666074	0.187666074	0.187666074	0.080326303	0.187666074	0	0.104854158	0	0	0.151458888	0.002696333	0.02614615	0.186232077	0	0	0	0.187666074	0.188025711	0	0	0	0	0	0	0	0												17.4566	3.479368153	0	0	5.255477701	4.055957506	1.390535861	1.312513733	0.466596592	0	0.931339935	0	0	0.796093963	0.004882537	2.631007436	3.744216771	0	0	0	0.763178285	1.053063061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3408	0	2.898686459	17.4566	3.479368153	0	0	5.255477701	4.055957506	1.390535861	1.312513733	0.466596592	0	0.931339935	0	0	0.796093963	0.004882537	2.631007436	3.744216771	0	0	0	0.763178285	1.053063061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3408	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	2.2667	0.4518	0	0.0045	1.075	0.8296	0.2844	0.179	0.0954	0	0.2511	0	0	0.1628	0.0326	2.1165	0.4227	0.0053	0	0	0.0862	0.1189	0	0	0.0367	0	0	0	0	0											8.4192	0	0.571064468	19.7233	3.93115804	0	0.00445822	6.330461776	4.885585177	1.674963651	1.491492879	0.562036804	0	1.182430092	0	0	0.958931364	0.037432606	4.747517889	4.166950923	0.005278834	0	0	0.849343575	1.171957277	0	0	0.036685201	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.76
H3813_001_0	2011	9																															A	A	D	V	T	Coin		V	P	Coin					V										V					Coin											1.129541314		0.105688172	0.025219324	0.036851634	0.680713531		0.068240665	0.23800582	0.292311737					0.660358623										0.007075772					0.000993409											3.245	NO	698.7797353		414.1621408	30.64818281	107.5838398	106.2137468		243.5133345	893.2971118	45.61026542					9399.773736										118.1834832					0.15500452												"$150/day, 1-5 days, $0/day, 6-90 days"		"$30/day, 1-100 days"	0	100	20% for DME and Diabetic Supplies; $10 for other Supplies		"Emergency Care $50, Urgent Care $30"	200	"$0 for Labs; 20% for Radiology and Renal Dialysis; $30 for Partial Hospitalization, CORF and Cardiac Rehab Services; $20 for Outpatient Substance Abuse-Group, $30 for Outpatient Substance Abuse-Individual; Other 20%"					"$20 PCP; $0 Routine Physicals, Immunizations and Preventive Care; $30 Specialists, Therapy (PT/OT/ST) and Other excluding MH;  $20 Mental Health-Group; $30 Mental Health-Individual"						0.2	0	0	Not Covered	"Medicare Covered Exam $30, Routine Eye Exam $20"	Not Covered	Medicare Covered Hearing Exam $30	Not Covered	0	0.2											40	402.8492647		30	0	100	0.187760289		50	200	0.133114016					21.24901625										20					0.2											NO	234.4664748	0	17.46061085	0	58.20203617	0.109280312	0	29.10101808	116.4040723	0.077475068	0	0	0	0	12.36736012	0	0	0	0	0					11.64040723					0.116404072												13.6534	0	0.602626997	0	0.521799878	11.60707134	0	0.590540496	8.665285135	3.533658394	0	0	0	0	9.687532237	0	0	0	0	0	0	0	0	0	0.114641989	0	0	0	0	0.018043157	0	0	0	0	0	0	0	0	0	0	48.9946	0	35.18559346	14.7829	0	0.70831517	0.025219324	0.558651511	12.28778487	0	0.658781161	8.903290955	3.825970131	0	0	0	0	10.34789086	0	0	0	0	0	0	0	0	0	0.121717761	0	0	0	0	0.019036566	0	0	0	0	0	0	0	0	0	0	52.2396	YES	"$300/day, 1-5 days, $0/day, 6-90 days"		"$30/day, 1-100 days"	0	100	20% for DME and Diabetic Supplies; $10 for other Supplies		"Emergency Care $50, Urgent Care $30"	300	"$0 for Labs; 20% for Radiology and Renal Dialysis; $30 for Partial Hospitalization, CORF and Cardiac Rehab Services; $20 for Outpatient Substance Abuse-Group, $30 for Outpatient Substance Abuse-Individual; Other 20%"					"$20 PCP; $0 Routine Physicals, Immunizations and Preventive Care; $30 Specialists, Therapy (PT/OT/ST) and Other excluding MH;  $20 Mental Health-Group; $30 Mental Health-Individual"						0.2	0	0	Not Covered	"Medicare Covered Exam $30, Routine Eye Exam $20"	Not Covered	Medicare Covered Hearing Exam $30	Not Covered	0	0.2											3400	3.2851		0.3036	0.0108	0.2394	5.2662		0.2823	1.4839	1.6397					4.4348										0					0.0082											16.954	0	12.17554034	18.068	0	1.011878814	0.036027605	0.798073587	17.55397838	0	0.941115944	10.38717278	5.465671616	0	0	0	0	14.78270123	0	0	0	0	0	0	0	0	0	0.121717761	0	0	0	0	0.027195095	0	0	0	0	0	0	0	0	0	0	69.1935
H3813_003_0	2011	10																															A	A	D	V	T	Coin		V	P	Coin					V										V					Coin											1.054684042		0.089514906	0.031264798	0.033290273	0.716667861		0.060835637	0.243255204	0.324827369					0.683808992										0.006332175					0.000518744											3.245	NO	495.6234896		469.2875707	54.08733703	119.2031143	134.3234047		284.9588625	1054.282057	60.88164477					11777.1727										129.3706636					0.097227039												"$150/day, 1-5 days, $0/day, 6-90 days"		"$30/day, 1-100 days"	0	100	20% for DME and Diabetic Supplies; $10 for other Supplies		"Emergency Care $50, Urgent Care $30"	200	"$0 for Labs; 20% for Radiology and Renal Dialysis; $30 for Partial Hospitalization, CORF and Cardiac Rehab Services; $20 for Outpatient Substance Abuse-Group, $30 for Outpatient Substance Abuse-Individual; Other 20%"					"$20 PCP; $0 Routine Physicals, Immunizations and Preventive Care; $30 Specialists, Therapy (PT/OT/ST) and Other excluding MH;  $20 Mental Health-Group; $30 Mental Health-Individual"						0.2	0	0	Not Covered	"Medicare Covered Exam $30, Routine Eye Exam $20"	Not Covered	Medicare Covered Hearing Exam $30	Not Covered	0	0.2											40	402.8492647		30	0	100	0.187760289		50	200	0.133114016					21.24901625										20					0.2											NO	250.1619252	0	18.62944385	0	62.09814616	0.116595659	0	31.04907308	124.1962923	0.082661336	0	0	0	0	13.19524517	0	0	0							12.41962923					0.124196292												10.3322	0	0.728547204	0	0.616857701	15.66152588	0	0.737309046	10.91149354	5.032558096	0	0	0	0	12.95022343	0	0	0	0	0	0	0	0	0	0.13389464	0	0	0	0	0.012075238	0	0	0	0	0	0	0	0	0	0	57.1167	0	34.86138487	11.3869	0	0.81806211	0.031264798	0.650147974	16.37819374	0	0.798144682	11.15474874	5.357385465	0	0	0	0	13.63403242	0	0	0	0	0	0	0	0	0	0.140226815	0	0	0	0	0.012593982	0	0	0	0	0	0	0	0	0	0	60.3617	YES	"$300/day, 1-5 days, $0/day, 6-90 days"		"$30/day, 1-100 days"	0	100	20% for DME and Diabetic Supplies; $10 for other Supplies		"Emergency Care $50, Urgent Care $30"	300	"$0 for Labs; 20% for Radiology and Renal Dialysis; $30 for Partial Hospitalization, CORF and Cardiac Rehab Services; $20 for Outpatient Substance Abuse-Group, $30 for Outpatient Substance Abuse-Individual; Other 20%"					"$20 PCP; $0 Routine Physicals, Immunizations and Preventive Care; $30 Specialists, Therapy (PT/OT/ST) and Other excluding MH;  $20 Mental Health-Group; $30 Mental Health-Individual"						0.2	0	0	Not Covered	"Medicare Covered Exam $30, Routine Eye Exam $20"	Not Covered	Medicare Covered Hearing Exam $30	Not Covered	0	0.2											3400	2.5304		0.3506	0.0134	0.2786	7.0192		0.3421	1.8591	2.296					5.8432										0.0396					0.0054											20.5776	0	12.55961312	13.9173	0	1.168660157	0.044663996	0.92878282	23.39741962	0	1.140206689	13.01387353	7.653407807	0	0	0	0	19.47718917	0	0	0	0	0	0	0	0	0	0.17977883	0	0	0	0	0.017991403	0	0	0	0	0	0	0	0	0	0	80.9392
H3813_802_0	2011	7																															A	A	D	V	T	Coin		V	P	Coin					V										V					Coin																																																			0	NO	355.1114457		12.32909365	25.49690115	43.44537763	32.66368557		169.2524557	698.1454119	49.77798063					10880.90489										231.7246562					0.105740613												"$100/day, 1-3 days, $0/day, 4-90 days"		"$0 1-20 days, $40/day 21-100 days"	0	50	10% for DME and for Prosthetics and other supplies; $10 Diabetic Supplies		"Emergency Care $50, Urgent Care $20"	125	"$0 Labs; 10% Radiology, Renal Dialysis, Observation, Other"					"$15 PCP; $0 Routine Physicals; $20 Specialists, Mental Health, Therapy (PT/OT/ST), Radiology, Other Professional"										$15 copay					0.1											0	190.5898876		38.26086957	0	50	0.1		50	125	0.065746401					12.77693335										15					0.1											NO	128.5721479	0	25.81082471	0	33.73005501	0.06746011	0	33.73005501	84.32513753	0.044352594	0	0	0	0	8.619333295	0	0	0							10.1190165					0.06746011												3.8048	0	0.026518673	0	0.122117915	2.203495822	0	0.47574122	4.90593399	2.207782576	0	0	0	0	7.815512151	0	0	0	0	0	0	0	0	0	0.195402135	0	0	0	0	0.007133273	0	0	0	0	0	0	0	0	0	0	21.7644	0	10.49823339	3.8048	0	0.026518673	0	0.122117915	2.203495822	0	0.47574122	4.90593399	2.207782576	0	0	0	0	7.815512151	0	0	0	0	0	0	0	0	0	0.195402135	0	0	0	0	0.007133273	0	0	0	0	0	0	0	0	0	0	21.7644	YES	"$100/day, 1-3 days, $0/day, 4-90 days"		"$0 1-20 days, $40/day 21-100 days"	0	50	10% for DME and for Prosthetics and other supplies; $10 Diabetic Supplies		"Emergency Care $50, Urgent Care $20"	125	"$0 Labs; 10% Radiology, Renal Dialysis, Observation, Other"					"$15 PCP; $0 Routine Physicals; $20 Specialists, Mental Health, Therapy (PT/OT/ST), Radiology, Other Professional"										$15 copay					0.1											2500	1.6306		0.0114	0	0.0523	0.9444		0.2039	2.1025	0.9462					3.3495															0.0031											9.2439	0	4.458848445	5.4354	0	0.037883818	0	0.174454164	3.147851175	0	0.679630314	7.008477128	3.153975108	0	0	0	0	11.16501736	0	0	0	0	0	0	0	0	0	0.195402135	0	0	0	0	0.010190391	0	0	0	0	0	0	0	0	0	0	31.0083
H3814_007_0	2011	10																															Coin	Coin	Coin		Coin	Coin	Coin	V	Coin		Coin	0	Coin	Coin					Coin	Coin					V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.965252806	1.237123199	0.33681783	1.328558916	1.052127947	0.520346242	0.537460691	0	0.02591451	1.009837827	1.002358596	1.150417631	0.107197357	0.039284522	0.481069645	2.87215377	0.813729783	0.080348729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.56	YES	357.5122212	8.550898853	40.73746236	0	32.78348597	42.01719052	11.43955506	2076.850368	35.73408084	0	18.25411428	0	0.880150734	29.03276854	0	0	0	0	16.33886985	14.52489813	0	0	0	0	303.4480011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3400	Medicare IP	Medicare IP	Medicare SNF		20% Ambul	20% Coin DME	20% Coin Prosthetics/$0 Copay Diabetic Supplies	$50 ER/$50 ER/$50 ER/$50 ER	20% Coin OP Hosp & Surg/20% Coin ASC		20% Coin MRI/CT/PET/20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad/20% Coin Rad	0	20% Coin Dialysis	$0 Copay CORF/20% Coin Urgent Care/$0 Copay Partial Hospitalization/$0 Copay Mental Health/$0 Copay PT & ST/20% Coin OP Hosp & Surg/$0 Copay OP Substance Abuse/$0 Copay Cardiac Rehab/$0 Copay Cardiac Rehab					20% Coin MRI/CT/PET/20% Coin Rad	$50 ER/$0 Copay Other/$0 Copay Other/$0 Copay Other/$0 Copay Other/$0 Copay Other/$0 Copay Other/$0 Copay Lab/20% Coin ASC/$0 Copay Pap & Pelvic/$0 Copay Prostate Screen/$0 Copay Colorectal Screen/$0 Copay Bone Mass/$0 Copay Mammogram/$0 Copay Diab Monitor/$0 Copay Nutrition Ther/0/0					$20 Copay Non-Covered Vision Exams						0	0	0	0	0	0	0	0	0	0	0	0.082225702	0.082225702	0.124309392	0	0.2	0.2	0.070501895	50	0.2	0	0.2	0	0.2	0.2	0	0	0	0	0.2	0.2	0	0	0	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0.082225702	0.082225702	0.124309392	0	0.2	0.2	0.070501895	50	0.2	0	0.2	0	0.2	0.2	0	0	0	0	0.2	0.2	0	0	0	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		29.3967	0.70310366	5.064049189	0	6.556697195	8.403438104	0.806510313	8.6535432	7.146816169	0	3.650822856	0	0.176030147	5.806553707	0	0	0	0	3.267773971	2.904979626	0	0	0	0	0.505746668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.0428	155	0	29.3967	0.70310366	5.064049189	0	7.52195	9.640561303	1.143328144	9.982102115	8.198944116	0.520346242	4.188283547	0	0.201944657	6.816391534	1.002358596	1.150417631	0.107197357	0.039284522	3.748843616	5.777133397	0.813729783	0.080348729	0	0	0.505746668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6028	NO												0																			0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3967	0.70310366	5.064049189	0	7.52195	9.640561303	1.143328144	9.982102115	8.198944116	0.520346242	4.188283547	0	0.201944657	6.816391534	1.002358596	1.150417631	0.107197357	0.039284522	3.748843616	5.777133397	0.813729783	0.080348729	0	0	0.505746668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6028
H3815_001_0	2011	6																															D	A	D		T	Coin	Coin	V	V				P	V			V				Coin			V						V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	24.14604206	34.27036566	268.4730074	0	206.1962923	8.78483727	0.500656283	240.9340671	253.3917836	0	0	0	14.5473556	79.88869306	0	0	122.4817273	0	0	0	2.881722591	0	0	439.3739165	0	0	0	0	0	24.09537623											6700	$100/Days Custom for IP Medical; $100/Days Custom for IP Surg; PBP 1a	$810/Admit for IP S/A; $810/Admit for IP Psych; PBP 1b	$100/Days Custom for SNF; PBP 2	No Cost Sharing; PBP 6	$75/Trip for Ambulance; PBP 10a	20% coinsurance on DME amounts over $350; PBP 11a	"20% coinsurance on amounts over $99.99; PBP 11b, 11c"	"$50/Visit for OP ER; $25/Visit for Urgent; PBP 4a, 4b"	"$50/Visit for OP Surg; $25/Visit for ASC; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	$30/Procedure for Renal Dialysis; PBP 12	"$50/Visit for Partial Hospitalization; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-c"	"No Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$35/Visit for OP Psych; $35/Visit for OP Psych; $35/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"Dental copays vary by service; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	"$50/Visit for Worldwide ER; $10/Visit for Reflexology; PBP 13e, 4a"											0	100	810	100	0	75	0.1	0.1	49.45426305	48.16004225	0	0	0	30	50	0	0	35	0	0	0	0.2	0	0	25.75	0	0	0	0	0	16.79860931											NO	99.99015466	809.9202527	99.99015466	0	74.99261599	0.099990155	0.099990155	49.4493941	48.15530073	0	0	0	29.9970464	49.99507733	0	0	34.99655413	0	0	0	0.199980309	0	0	25.74746482	0	0	0	0	0	16.79695543												0.2012	2.313021935	2.237054794	0	1.288599947	0.878397237	0.050060699	0.99283697	1.016846462	0	0	0	0.036364808	0.332836782	0	0	0.3572032	0	0	0	0.576287775	0	0	0.942730372	0	0	0	0	0	0.033727413	0	0	0	0	0	0	0	0	0	0	11.2572	0	0.001108416	0.2012	2.313021935	2.237054794	0	1.288599947	0.878397237	0.050060699	0.99283697	1.016846462	0	0	0	0.036364808	0.332836782	0	0	0.3572032	0	0	0	0.576287775	0	0	0.942730372	0	0	0	0	0	0.033727413	0	0	0	0	0	0	0	0	0	0	11.2572	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0.2012	2.313021935	2.237054794	0	1.288599947	0.878397237	0.050060699	0.99283697	1.016846462	0	0	0	0.036364808	0.332836782	0	0	0.3572032	0	0	0	0.576287775	0	0	0.942730372	0	0	0	0	0	0.033727413	0	0	0	0	0	0	0	0	0	0	11.2572
H3815_005_0	2011	6																															D	A	D		T	Coin	Coin	V	V				P	V			V				Coin			V						V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	19.96821795	28.34079925	222.0209635	0	170.5195615	6.75022216	0.384701621	199.2468973	208.5687028	0	0	0	12.03032639	65.21909893	0	0	101.2895538	0	0	0	2.214300287	0	0	438.0761496	0	0	0	0	0	23.38678136											6700	$100/Days Custom for IP Medical; $100/Days Custom for IP Surg; PBP 1a	$810/Admit for IP S/A; $810/Admit for IP Psych; PBP 1b	$100/Days Custom for SNF; PBP 2	No Cost Sharing; PBP 6	$75/Trip for Ambulance; PBP 10a	20% coinsurance on DME amounts over $350; PBP 11a	"20% coinsurance on amounts over $99.99; PBP 11b, 11c"	"$50/Visit for OP ER; $25/Visit for Urgent; PBP 4a, 4b"	"$75/Visit for OP Surg; $25/Visit for ASC; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	$30/Procedure for Renal Dialysis; PBP 12	"$75/Visit for Partial Hospitalization; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-c"	"No Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$35/Visit for OP Psych; $35/Visit for OP Psych; $35/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"Dental copays vary by service; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	"$50/Visit for Worldwide ER; $10/Visit for Reflexology; PBP 13e, 4a"											0	100	810	100	0	75	0.1	0.1	49.45426305	71.30278598	0	0	0	30	75	0	0	35	0	0	0	0.2	0	0	25.75	0	0	0	0	0	15.7926421											NO	99.99595687	809.9672507	99.99595687	0	74.99696766	0.099995957	0.099995957	49.45226355	71.29990312	0	0	0	29.99878706	74.99696766	0	0	34.99858491	0	0	0	0.199991914	0	0	25.7489589	0	0	0	0	0	15.79200359												0.1664	1.912926604	1.850099891	0	1.06570417	0.674994924	0.038468607	0.82110084	1.239244025	0	0	0	0.0300746	0.407602888	0	0	0.295415921	0	0	0	0.442842152	0	0	0.940000397	0	0	0	0	0	0.030777011	0	0	0	0	0	0	0	0	0	0	9.9156	0	0.000400918	0.1664	1.912926604	1.850099891	0	1.06570417	0.674994924	0.038468607	0.82110084	1.239244025	0	0	0	0.0300746	0.407602888	0	0	0.295415921	0	0	0	0.442842152	0	0	0.940000397	0	0	0	0	0	0.030777011	0	0	0	0	0	0	0	0	0	0	9.9156	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0.1664	1.912926604	1.850099891	0	1.06570417	0.674994924	0.038468607	0.82110084	1.239244025	0	0	0	0.0300746	0.407602888	0	0	0.295415921	0	0	0	0.442842152	0	0	0.940000397	0	0	0	0	0	0.030777011	0	0	0	0	0	0	0	0	0	0	9.9156
H3817_001_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	V		Coin			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	0	0	0	0	0	0	0											0	NO	551.5789432	2.726749232	559.7764447	15.72679575	4.109108549	10.7927787	0.86506674	302.9220516	405.8948053	0	15.09399033	0	0	631.6418614	3799.448849	3345.595489	69.83369946	852.5802817	20.55824531	0	15.41443145	0	0	0	16.00803781	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; $200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$10/Days 1-5, $35/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	10% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $15/Visit for Urgent Care; PBP 4a, 7a"	"$175/Case for OP Surg; $175/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$35/Visit for OP - PT/OT/ST; $35/Visit for OP Substance Abuse; $35/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP OV; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $35/Visit for SCP OV; $35/Visit for Podiatry - cvd; $35/Visit for Vision Exams; $35/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for Psych Services ; PBP 7e, 7h"	"$35/Visit for OT; $35/Visit for PT/ST; PBP 7c, 7i"	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											0	200	200	24.97374256	0.1	100	0.2	0.2	49.18120236	175	0	0.105064178	0	0	35	15	32.57929808	35	35	0.106673561	0	0.1984	0	0	0	35	0	0	0	0	0											NO	181.9644573	181.9644573	22.72166755	0.090982229	90.98222863	0.181964457	0.181964457	44.74615397	159.2189001	0	0.09558973	0	0	31.84378002	13.6473343	29.64137147	31.84378002	31.84378002	0.097053983	0	0.180508742	0	0	0	31.84378002	0	0	0	0	0												8.364	0.04134762	1.05992119	1.430858927	0.031154654	1.963902118	0.1574114	1.12954973	5.385510372	0	1.442830467	0	0	1.676155374	4.321029048	8.264003224	0.18531408	2.262448245	1.9952596	0	2.782439623	0	0	0	0.042479703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5356	0	4.215947247	8.364	0.04134762	1.05992119	1.430858927	0.031154654	1.963902118	0.1574114	1.12954973	5.385510372	0	1.442830467	0	0	1.676155374	4.321029048	8.264003224	0.18531408	2.262448245	1.9952596	0	2.782439623	0	0	0	0.042479703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5356	YES	$300/Days 1-5 for IP Med/Surg; $300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$30/Days 1-5, $50/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	20% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $35/Visit for Urgent Care; PBP 4a, 4b"	"$225/Case for OP Surg; $225/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$35/Visit for OP - PT/OT/ST; $35/Visit for OP Substance Abuse; $35/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$35/Visit for PCP OV; PBP 7a, 14b, 14c"	"$35/Visit for Chiro - cvd; $35/Visit for SCP OV; $35/Visit for Podiatry - cvd; $35/Visit for Vision Exams; $35/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for Psych Services ; PBP 7e, 7h"	"$35/Visit for OT; $35/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											2500	0.8429	0.0023	0.0545	0.0161	1.572	0.1661	0.033	0.0792	0.2843	0	0.4243	0	0.0001	0.2303	0.2002	0.5933	0.0366	0.069	0.4803	0	0.1167	0	0	1.6142	0.0017	0	0	0	0	0											6.8171	0	0.675682459	9.2069	0.043644167	1.114396442	1.446958623	1.603129505	2.129961552	0.190442683	1.208710665	5.66977358	0	1.867174789	0	0.000111967	1.90647359	4.521182446	8.857347424	0.221872977	2.331421573	2.475588165	0	2.899185235	0	0	1.61422021	0.044226626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3527
H3817_002_0	2011	8																															D	D	D	Coin	T	Coin	Coin	V	V		Coin			V	V	V	V	V	Coin		Coin				V																1.129778197	0.013438218	0.230574811	0.132279608	0.000162972	0.122801791	0.006322331	0.15888189	0.358849976	0.039396559	0.10747128	0	0	0.145359745	0.25689428	0.770813768	0.009285064	0.05783309	0.129771722	0	0	0.006972868	0	0	0	0	0	0	0	0											3.6769	NO	545.6600811	10.07165651	649.2323555	19.60645887	7.492785463	13.50028926	0.694364374	331.5515358	404.7015543	0	17.8791992	0	0	686.0427471	4133.493762	3464.729698	189.4026973	1092.543125	21.02853822	0	20.20183795	0	0	0	16.7165173	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; $200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$10/Days 1-5, $35/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	10% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $15/Visit for Urgent Care; PBP 4a, 7a"	"$175/Case for OP Surg; $175/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$35/Visit for OP - PT/OT/ST; $35/Visit for OP Substance Abuse; $35/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP OV; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $35/Visit for SCP OV; $35/Visit for Podiatry - cvd; $35/Visit for Vision Exams; $35/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for MH - Non Phys; $35/Visit for Psych Services ; PBP 7e, 7h"	"$35/Visit for OT; $35/Visit for PT/ST; PBP 7c, 7i"	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											50	198.8025915	198.8694961	24.8104391	0.099327874	99.96902853	0.198709976	0.199179066	48.91695105	173.9181964	0	0.104322496	0	0	34.81932851	14.91301641	32.88691725	34.82216413	34.76518567	0.104424381	0	0.1984	0	0	0	35	0	0	0	0	0											NO	184.4568019	184.5188786	23.02009354	0.092160278	92.75516561	0.184370869	0.184806109	45.38705599	161.3680892	0	0.096794483	0	0	32.30673169	13.83687856	30.51376512	32.30936269	32.25649586	0.096889016	0	0.184083262	0	0	0	32.47436575	0	0	0	0	0												8.3876	0.154867564	1.245449129	1.806936695	0.057916213	2.489060068	0.128322778	1.254012343	5.442159709	0	1.730607843	0	0	1.846983247	4.766220933	8.810162352	0.509956704	2.936801065	2.03743437	0	3.718820226	0	0	0	0.045238191	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3685	50	3.683998919	9.5173	0.168305782	1.476023941	1.939216302	0.058079185	2.611861859	0.13464511	1.412894233	5.801009685	0.039396559	1.838079122	0	0	1.992342991	5.023115213	9.58097612	0.519241768	2.994634155	2.167206092	0	3.718820226	0.006972868	0	0	0.045238191	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0454	YES	$300/Days 1-5 for IP Med/Surg; $300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$30/Days 1-5, $50/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	20% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $35/Visit for Urgent Care; PBP 4a, 4b"	"$225/Case for OP Surg; $225/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$35/Visit for OP - PT/OT/ST; $35/Visit for OP Substance Abuse; $35/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$35/Visit for PCP OV; PBP 7a, 14b, 14c"	"$35/Visit for Chiro - cvd; $35/Visit for SCP OV; $35/Visit for Podiatry - cvd; $35/Visit for Vision Exams; $35/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for MH - Non Phys; $35/Visit for Psych Services ; PBP 7e, 7h"	"$35/Visit for OT; $35/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											3400	1.3333	0.0582	0.0992	0.0204	2.4187	0.306	0.0119	0.1283	0.4717	0.0278	0.599	0	0.0014	0.4632	0.335	0.7102	0.1949	0.0624	0.5996	0	0.1494	0.0005	0	1.7657	0.0024	0	0	0	0	0											9.7593	50	0.679935242	10.8507	0.226544021	1.57519553	1.959615296	2.476782378	2.917877863	0.146522775	1.541212333	6.272690018	0.067196168	2.43704678	0	0.001408583	2.455578184	5.358104327	10.29116202	0.714107536	3.057063578	2.766834505	0	3.868195458	0.007482121	0	1.765747033	0.047653853	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.8047
H3817_003_0	2011	6																															D	D	D		T	Coin	Coin	V	V		Coin			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	0	0	0	0	0	0	0											0	NO	552.5632808	7.555426614	546.442256	0	5.140365637	15.12228558	1.050129257	319.5959326	494.94066	0	21.95541937	0	0	776.4721919	5022.511887	4063.100464	257.639365	1232.278816	24.54672841	0	24.72011994	0	0	0	18.3578225	0	0	0	0	0												$150/Days 1-5 for IP Med/Surg; $150/Days 1-5 for IP Med/Surg; PBP 1a	$150/Days 1-5 for IP MH/SA; PBP 1b	"$0/Days 1-5, $30/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $10/Visit for Urgent Care; PBP 4a, 7a"	"$100/Case for OP Surg; $100/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$25/Visit for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$10/Visit for PCP OV; PBP 7a, 14b, 14c"	"$10/Visit for Chiro - cvd; $25/Visit for SCP OV; $25/Visit for Podiatry - cvd; $25/Visit for Vision Exams; $25/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OT; $25/Visit for PT/ST; PBP 7c, 7i"	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	10% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											0	150	150	17.96849107	0	100	0.1	0.1	48.82456317	100	0	0.100897738	0	0	25	10	23.33469113	25	25	0.106789483	0	0.0989	0	0	0	25	0	0	0	0	0											NO	143.1637055	143.1637055	17.14957176	0	95.44247036	0.09544247	0.09544247	46.59936923	95.44247036	0	0.096299294	0	0	23.86061759	9.544247036	22.27120567	23.86061759	23.86061759	0.101922521	0	0.094392603	0	0	0	23.86061759	0	0	0	0	0												6.5923	0.090138573	0.780937557	0	0.0408841	1.443308293	0.10022693	1.241080739	3.936529939	0	2.114291375	0	0	1.543925503	3.994674516	7.540845507	0.512286197	2.450244465	2.501864439	0	2.333396472	0	0	0	0.036502415	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2534	0	1.778908463	6.5923	0.090138573	0.780937557	0	0.0408841	1.443308293	0.10022693	1.241080739	3.936529939	0	2.114291375	0	0	1.543925503	3.994674516	7.540845507	0.512286197	2.450244465	2.501864439	0	2.333396472	0	0	0	0.036502415	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2534	YES	$250/Days 1-5 for IP Med/Surg; $250/Days 1-5 for IP Med/Surg; PBP 1a	$250/Days 1-5 for IP MH/SA; PBP 1b	"$20/Days 1-5, $40/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	10% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"$200/Case for OP Surg; $200/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	10% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$25/Visit for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$25/Visit for PCP OV; PBP 7a, 14b, 14c"	"$25/Visit for Chiro - cvd; $25/Visit for SCP OV; $25/Visit for Podiatry - cvd; $25/Visit for Vision Exams; $25/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OT; $25/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	10% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											2500	1.2267	0.0301	0.0697	0.0077	1.6944	0.1908	0.0067	0.1369	0.7782	0	0.741	0	0.0025	0.2845	0.3678	0.751	0.2166	0.0839	0.7711	0	0.1146	0	0	2.174	0.0022	0	0	0	0	0											9.6503	0	0.460817741	7.819	0.120266101	0.85065732	0.007681438	1.735249144	1.634073072	0.106940268	1.377983852	4.714704141	0	2.855294348	0	0.002508527	1.828398046	4.362440255	8.291867146	0.728879072	2.534134755	3.272954165	0	2.448004726	0	0	2.173966286	0.038732378	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9037
H3817_801_0	2011	7																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	195.2256838	1.844813421	32.92575383	0	0.50270827	19.99961801	1.849833687	23.84244807	63.73189471	7.943503137	19.15486202	0	0	31.66796833	45.82282212	130.6678521	2.072719	9.541894547	22.76963473	3.583397214	37.90601921	1.344935584	0	0	0	0	0	0	0	0												Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 7a"	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 14d-j	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											0	0.082950639	0.082950639	0.127142921	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	0.075916779	0.075916779	0.116361744	0	0.213242594	0.213242594	0.213242594	0.213242594	0.213242594	0.213242594	0.213242594	0	0	0.213242594	0.213242594	0.213242594	0.213242594	0.213242594	0.213242594	0.213242594	0.213242594	0.213242594	0	0	0	0	0	0	0	0												14.8209	0.140052293	3.83129814	0	0.107198816	4.264770432	0.394463335	5.084225483	13.59035457	1.693893217	4.084632472	0	0	6.752959724	9.771377471	27.86395178	0.441991977	2.034738348	4.855455984	0.764132919	8.083177878	0.286797553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.8664	0	10.08671455	14.8209	0.140052293	3.83129814	0	0.107198816	4.264770432	0.394463335	5.084225483	13.59035457	1.693893217	4.084632472	0	0	6.752959724	9.771377471	27.86395178	0.441991977	2.034738348	4.855455984	0.764132919	8.083177878	0.286797553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.8664	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 14d-j	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											6700	2.3003	0.0325	0.2151	0	2.2398	0.2594	0.0179	0.4063	1.4291	0.5202	0.6719	0	0.0032	2.0794	0.4366	1.7094	0.1451	0.0613	0.5986	0.0936	0.2721	0.0349	0	0	0	0	0	0	0	0											13.5268	0	1.253285448	17.1212	0.172598057	4.04643765	0	2.347031734	4.524172092	0.412318089	5.490485415	15.01949266	2.21408665	4.756518256	0	0.003161275	8.832323784	10.20798063	29.57333401	0.587102816	2.096082198	5.454087885	0.857761415	8.355259927	0.321741962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.3931
H3817_802_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	195.2432058	1.844978997	32.92870899	0	0.502753389	20.00141303	1.849999714	23.84458799	63.73761479	7.944216085	19.15658121	0	0	31.6708106	45.82693483	130.6795799	2.072905031	9.542750955	22.77167836	3.583718832	37.90942136	1.345056295	0	0	0	0	0	0	0	0												Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 7a"	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 14d-j	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											0	0.082954373	0.082954373	0.127156707	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	0.075914695	0.075914695	0.116365928	0	0.213227143	0.213227143	0.213227143	0.213227143	0.213227143	0.213227143	0.213227143	0	0	0.213227143	0.213227143	0.213227143	0.213227143	0.213227143	0.213227143	0.213227143	0.213227143	0.213227143	0	0	0	0	0	0	0	0												14.8218	0.140061018	3.831779793	0	0.107200669	4.264844154	0.394470153	5.084313371	13.5905895	1.693922499	4.08470308	0	0	6.753076458	9.771546383	27.86443345	0.441999617	2.034773522	4.855539917	0.764146128	8.083317607	0.286802511	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.8693	0	10.09560994	14.8218	0.140061018	3.831779793	0	0.107200669	4.264844154	0.394470153	5.084313371	13.5905895	1.693922499	4.08470308	0	0	6.753076458	9.771546383	27.86443345	0.441999617	2.034773522	4.855539917	0.764146128	8.083317607	0.286802511	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.8693	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 14d-j	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											6700	2.3004	0.0325	0.2152	0	2.2399	0.2594	0.0179	0.4063	1.4292	0.5202	0.6719	0	0.0032	2.0794	0.4366	1.7094	0.1451	0.0613	0.5986	0.0936	0.2721	0.0349	0	0	0	0	0	0	0	0											13.5271	0	1.254390064	17.1222	0.172608809	4.04694635	0	2.347072306	4.524250298	0.412325217	5.490580325	15.01975229	2.214124924	4.756600479	0	0.00316133	8.832476463	10.20815709	29.57384523	0.587112965	2.096118432	5.454182167	0.857776243	8.355404359	0.321747524	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.3965
H3818_001_0	2011	9																															D	D		V	T	Coin	Coin	V	Coin		Coin	0	Coin	Coin	V	V	V	V	Coin	Coin	Coin			V			V				0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	YES	741.120075	22.96066286	0	34.30636692	166.6716681	12.31569504	2.824528829	248.6923908	27.35718679	0	25.77766858	0	1.185414028	56.69891202	4654.846752	5583.282026	14.10764357	1134.432399	18.02447832	4.487003156	30.05659253	0	0	983.943662	0	0	7.823079452	0	0	0	0	0	0	0	0	0	0	0	0		2500	$160/day (Days 1-5)	$160/day (Days 1-5)		$20 Copay HHC	$50 Ambul Waived	20% Coin DME	20% Coin Prosthetics/20% Coin Diabetic Supplies	$50 ER Waived/$50 ER Waived/$50 ER Waived/$50 ER Waived	10% Coin OP Hosp & Surg/10% Coin ASC		10% Coin MRI/CT/PET/10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad/10% Coin Rad	0	20% Coin Dialysis	$0 Copay CORF/$30 Copay Urgent Care/$0 Copay Partial Hospitalization/$30 Copay Mental Health/$30 Copay PT & ST/10% Coin OP Hosp & Surg/$0 Copay OP Substance Abuse/$0 Copay Cardiac Rehab/$0 Copay Cardiac Rehab	$15 Copay PCP/$15 Copay PCP/$0 Copay Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$30 Copay Chiro/$30 Copay Specialists/$30 Copay Specialists/$30 Copay Specialists/$30 Copay Podiatry/$12 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$20 Copay Medicare Covered Hearing Exams	$30 Copay Mental Health/$30 Copay Psychiatric	$30 Copay OT/$30 Copay PT & ST	10% Coin MRI/CT/PET/10% Coin Rad	$50 ER Waived/$0 Copay Other/$0 Copay Other/$0 Copay Other/$0 Copay Other/$0 Copay Other/$0 Copay Other/$0 Copay Lab/10% Coin ASC/$0 Copay Pap & Pelvic/$0 Copay Prostate Screen/$0 Copay Colorectal Screen/$0 Copay Bone Mass/$0 Copay Mammogram/20% Coin Diab Monitor/20% Coin Nutrition Ther/0/0	20% Coin Part B Rx			"$12 OV, $35 Prophy, $8-40 XRay/to 870 Restore, to 830 Perio/Endo, to 250 surg"			$20 Copay Non-Covered Hearing Exams				0	0	0	0	0	0	0	0	0		0	160	160	0	20	50	0.2	0.2	50	0.1	0	0.1	0	0.2	0.154764433	15	29.99343149	30	30	0.1	0.2	0.2	0	0	99.35528199	0	0	20	0	0	0	0	0	0	0	0	0	0	0	0		NO	144.8554783	144.8554783	0	18.10693479	45.26733697	0.181069348	0.181069348	45.26733697	0.090534674	0	0.090534674	0	0.181069348	0.140115475	13.58020109	27.15445541	27.16040218	27.16040218	0.090534674	0.181069348	0.181069348	0	0	99.35528199	0	0	18.10693479	0	0	0	0	0	0	0	0	0	0	0	0			8.9463	0.277164817	0	0.051765262	0.62873188	2.22999487	0.511435593	0.938136855	2.476773986	0	2.33377282	0	0.214642145	7.944394968	5.267812912	12.63424857	0.031930773	2.567636684	1.631840268	0.812458735	5.44232761	0	0	8.146666667	0	0	0.011804332	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0998	0	5.745306674	8.9463	0.277164817	0	0.051765262	0.62873188	2.22999487	0.511435593	0.938136855	2.476773986	0	2.33377282	0	0.214642145	7.944394968	5.267812912	12.63424857	0.031930773	2.567636684	1.631840268	0.812458735	5.44232761	0	0	8.146666667	0	0	0.011804332	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0998	NO												0																			0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.9463	0.277164817	0	0.051765262	0.62873188	2.22999487	0.511435593	0.938136855	2.476773986	0	2.33377282	0	0.214642145	7.944394968	5.267812912	12.63424857	0.031930773	2.567636684	1.631840268	0.812458735	5.44232761	0	0	8.146666667	0	0	0.011804332	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0998
H3818_002_0	2011	8																															Coin	Coin	Coin		Coin	Coin	Coin	V	Coin	Coin	Coin	0	Coin	Coin	Coin	Coin	Coin	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	YES	306.1662452	12.72078006	71.82799358	0	27.01937069	22.94875398	5.985062861	1718.384543	28.88363225	27.42755518	40.42481767	0	1.556376379	77.88888487	37.13139773	39.7359063	5.142803862	1367.090784	15.40272389	106.862098	51.08094184	0.705437706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		3400	Medicare IP	Medicare IP	Medicare SNF		Medicare Ambul	Medicare DME	Medicare Prosthetics/Medicare Diabetic Supplies	$50 ER/$50 ER/$50 ER/$50 ER	Medicare OP Hosp & Surg/Medicare ASC	Medicare Lab/Medicare Lab/Medicare Lab	Medicare MRI/CT/PET/Medicare Rad/Medicare MRI/CT/PET/Medicare Rad/Medicare MRI/CT/PET/Medicare Rad/Medicare Rad	0	Medicare Dialysis	Medicare CORF/Medicare Urgent Care/Medicare Partial Hospitalization/Medicare Mental Health/$10 Copay PT & ST/Medicare OP Hosp & Surg/Medicare OP Substance Abuse/Medicare Cardiac Rehab/Medicare Cardiac Rehab	Medicare PCP/Medicare PCP/Medicare Immunizations/Medicare Physical Exams/Medicare Supp Physical Exams	Medicare Chiro/Medicare Specialists/Medicare Specialists/Medicare Specialists/Medicare Podiatry/Medicare Preventive Dental/Medicare Medicare Covered Vision Exams/Medicare Medicare Covered Hearing Exams	Medicare Mental Health/Medicare Psychiatric	$10 Copay OT/$10 Copay PT & ST	Medicare MRI/CT/PET/Medicare Rad	$50 ER/Medicare Other/Medicare Other/Medicare Other/Medicare Other/Medicare Other/Medicare Other/Medicare Lab/Medicare ASC/Medicare Pap & Pelvic/Medicare Prostate Screen/Medicare Colorectal Screen/Medicare Bone Mass/Medicare Mammogram/Medicare Diab Monitor/Medicare Nutrition Ther/0/0	Medicare Part B Rx	Medicare Blood									0	0	0	0	0	0	0	0	0		0	0.083393113	0.083393113	0.128723883	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0	0.233	0.224138171	0.233	0.233	0.233	10	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		NO	0.083393113	0.083393113	0.128723883	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0	0.233	0.224138171	0.233	0.233	0.233	10	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			25.5322	1.060825455	9.245978216	0	6.295513371	5.347059678	1.394519647	7.159935597	6.729886315	6.390620356	9.418982516	0	0.362635696	17.45787222	8.65161567	9.258466169	1.1982733	1.13924232	3.588834665	24.89886883	11.90185945	0.164366986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.1975	0	0	25.5322	1.060825455	9.245978216	0	6.295513371	5.347059678	1.394519647	7.159935597	6.729886315	6.390620356	9.418982516	0	0.362635696	17.45787222	8.65161567	9.258466169	1.1982733	1.13924232	3.588834665	24.89886883	11.90185945	0.164366986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.1975	NO												0																			0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.5322	1.060825455	9.245978216	0	6.295513371	5.347059678	1.394519647	7.159935597	6.729886315	6.390620356	9.418982516	0	0.362635696	17.45787222	8.65161567	9.258466169	1.1982733	1.13924232	3.588834665	24.89886883	11.90185945	0.164366986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.1975
H3818_003_0	2011	12																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	0	Coin	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	YES	566.2015804	90.5951783	168.4816231	34.30972125	165.0943684	13.88073006	3.852900387	305.0893502	22.54886329	17.54023179	24.44740002	0	0.675916695	54.77486204	4093.514183	4755.779267	87.54878171	2.862557589	14.9887813	23.85920343	27.40675136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		3400	$300/day (Days 1-5)	$300/day (Days 1-5)	$25/day (Days 21-100)	$20 Copay HHC	$50 Ambul Waived	20% Coin DME	20% Coin Prosthetics/20% Coin Diabetic Supplies	$50 ER Waived/$50 ER Waived/$50 ER Waived/$50 ER Waived	20% Coin OP Hosp & Surg/20% Coin ASC	20% Coin Lab/20% Coin Lab/20% Coin Lab	20% Coin MRI/CT/PET/20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad/20% Coin Rad	0	20% Coin Dialysis	$0 Copay CORF/$35 Copay Urgent Care/$0 Copay Partial Hospitalization/$35 Copay Mental Health/20% Coin PT & ST/20% Coin OP Hosp & Surg/20% Coin OP Substance Abuse/20% Coin Cardiac Rehab/20% Coin Cardiac Rehab	$20 Copay PCP/$20 Copay PCP/$0 Copay Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$35 Copay Chiro/$35 Copay Specialists/$35 Copay Specialists/$35 Copay Specialists/$35 Copay Podiatry/$0 Copay Preventive Dental/$30 Copay Medicare Covered Vision Exams/$30 Copay Medicare Covered Hearing Exams	$35 Copay Mental Health/$35 Copay Psychiatric	20% Coin OT/20% Coin PT & ST	20% Coin MRI/CT/PET/20% Coin Rad	$50 ER Waived/$35 Copay Other/$35 Copay Other/$35 Copay Other/$35 Copay Other/$35 Copay Other/$35 Copay Other/20% Coin Lab/20% Coin ASC/$0 Copay Pap & Pelvic/$0 Copay Prostate Screen/$0 Copay Colorectal Screen/$0 Copay Bone Mass/$0 Copay Mammogram/20% Coin Diab Monitor/20% Coin Nutrition Ther/0/0	20% Coin Part B Rx										0	0	0	0	0	0	0	0	0		0	300	300	25	20	50	0.2	0.2	50	0.2	0.2	0.2	0	0.2	0.19929252	20	34.99506592	35	0.2	0.2	0.20764204	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	269.5187482	269.5187482	22.45989568	17.96791655	44.91979136	0.179679165	0.179679165	44.91979136	0.179679165	0.179679165	0.179679165	0	0.179679165	0.179043568	17.96791655	31.43942119	31.44385395	0.179679165	0.179679165	0.186544742	0.179679165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			12.7168	2.034758254	0.315339973	0.051372851	0.618000382	2.494077993	0.692285926	1.14204583	4.051560938	3.151614209	4.392688433	0	0.121448148	9.807086737	6.129326769	12.45991229	0.229405925	0.514341959	2.693171716	4.450808946	4.924422212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9905	0	8.254868215	12.7168	2.034758254	0.315339973	0.051372851	0.618000382	2.494077993	0.692285926	1.14204583	4.051560938	3.151614209	4.392688433	0	0.121448148	9.807086737	6.129326769	12.45991229	0.229405925	0.514341959	2.693171716	4.450808946	4.924422212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9905	NO												0																			0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.7168	2.034758254	0.315339973	0.051372851	0.618000382	2.494077993	0.692285926	1.14204583	4.051560938	3.151614209	4.392688433	0	0.121448148	9.807086737	6.129326769	12.45991229	0.229405925	0.514341959	2.693171716	4.450808946	4.924422212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9905
H3818_004_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	0	Coin	Coin	V	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	YES	532.1213951	42.78023291	116.7604626	30.72410573	142.1149005	10.47678884	3.360186152	289.3783698	21.18325025	15.65016203	25.51786947	0	0.800503862	45.28759505	3779.138747	4428.214249	26.07502985	4.354130747	13.19642787	21.79252659	29.55460129	0.530572598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		3400	$300/day (Days 1-5)	$300/day (Days 1-5)	$25/day (Days 21-100)	$20 Copay HHC	$50 Ambul Waived	20% Coin DME	20% Coin Prosthetics/20% Coin Diabetic Supplies	$50 ER Waived/$50 ER Waived/$50 ER Waived/$50 ER Waived	20% Coin OP Hosp & Surg/20% Coin ASC	20% Coin Lab/20% Coin Lab/20% Coin Lab	20% Coin MRI/CT/PET/20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad/20% Coin Rad	0	20% Coin Dialysis	$0 Copay CORF/$35 Copay Urgent Care/$0 Copay Partial Hospitalization/$35 Copay Mental Health/20% Coin PT & ST/20% Coin OP Hosp & Surg/20% Coin OP Substance Abuse/20% Coin Cardiac Rehab/20% Coin Cardiac Rehab	$20 Copay PCP/$20 Copay PCP/$0 Copay Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$35 Copay Chiro/$35 Copay Specialists/$35 Copay Specialists/$35 Copay Specialists/$35 Copay Podiatry/$0 Copay Preventive Dental/$30 Copay Medicare Covered Vision Exams/$30 Copay Medicare Covered Hearing Exams	$35 Copay Mental Health/$35 Copay Psychiatric	20% Coin OT/20% Coin PT & ST	20% Coin MRI/CT/PET/20% Coin Rad	$50 ER Waived/$35 Copay Other/$35 Copay Other/$35 Copay Other/$35 Copay Other/$35 Copay Other/$35 Copay Other/20% Coin Lab/20% Coin ASC/$0 Copay Pap & Pelvic/$0 Copay Prostate Screen/$0 Copay Colorectal Screen/$0 Copay Bone Mass/$0 Copay Mammogram/20% Coin Diab Monitor/20% Coin Nutrition Ther/0/0	20% Coin Part B Rx	20% Coin Blood									0	0	0	0	0	0	0	0	0		0	300	300	25	20	50	0.2	0.2	50	0.2	0.2	0.2	0	0.2	0.199501025	20	34.99411162	35	0.2	0.2	0.209225792	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	269.5187482	269.5187482	22.45989568	17.96791655	44.91979136	0.179679165	0.179679165	44.91979136	0.179679165	0.179679165	0.179679165	0	0.179679165	0.179230888	17.96791655	31.43856385	31.44385395	0.179679165	0.179679165	0.187967579	0.179679165	0.179679165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			11.9514	0.960839568	0.218535651	0.046004014	0.531980974	1.882460676	0.603755444	1.083234666	3.806188726	2.812008053	4.58502949	0	0.143833866	8.116935884	5.658604136	11.60139137	0.068324953	0.782346579	2.371123146	4.096288456	5.310346094	0.095332842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.726	0	7.546379128	11.9514	0.960839568	0.218535651	0.046004014	0.531980974	1.882460676	0.603755444	1.083234666	3.806188726	2.812008053	4.58502949	0	0.143833866	8.116935884	5.658604136	11.60139137	0.068324953	0.782346579	2.371123146	4.096288456	5.310346094	0.095332842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.726	NO												0																			0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.9514	0.960839568	0.218535651	0.046004014	0.531980974	1.882460676	0.603755444	1.083234666	3.806188726	2.812008053	4.58502949	0	0.143833866	8.116935884	5.658604136	11.60139137	0.068324953	0.782346579	2.371123146	4.096288456	5.310346094	0.095332842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.726
H3818_014_0	2011	10																															D	D		V	T	Coin	Coin	V	Coin		Coin	0	Coin	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	YES	595.3542275	55.28797728	0	36.15010611	169.8372719	13.3989365	3.522042611	316.062696	21.48733005	0	25.48085941	0	0.970682702	49.46886375	3709.228812	4557.809595	33.97040766	955.5875673	12.85883293	4.390017472	30.7678023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		2500	$160/day (Days 1-5)	$160/day (Days 1-5)		$20 Copay HHC	$50 Ambul Waived	20% Coin DME	20% Coin Prosthetics/20% Coin Diabetic Supplies	$50 ER Waived/$50 ER Waived/$50 ER Waived/$50 ER Waived	10% Coin OP Hosp & Surg/10% Coin ASC		10% Coin MRI/CT/PET/10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad/10% Coin Rad	0	20% Coin Dialysis	$0 Copay CORF/$30 Copay Urgent Care/$0 Copay Partial Hospitalization/$30 Copay Mental Health/$30 Copay PT & ST/10% Coin OP Hosp & Surg/$0 Copay OP Substance Abuse/$0 Copay Cardiac Rehab/$0 Copay Cardiac Rehab	$15 Copay PCP/$15 Copay PCP/$0 Copay Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$30 Copay Chiro/$30 Copay Specialists/$30 Copay Specialists/$30 Copay Specialists/$30 Copay Podiatry/$0 Copay Preventive Dental/$30 Copay Medicare Covered Vision Exams/$30 Copay Medicare Covered Hearing Exams	$30 Copay Mental Health/$30 Copay Psychiatric	$30 Copay OT/$30 Copay PT & ST	10% Coin MRI/CT/PET/10% Coin Rad	$50 ER Waived/$0 Copay Other/$0 Copay Other/$0 Copay Other/$0 Copay Other/$0 Copay Other/$0 Copay Other/$0 Copay Lab/10% Coin ASC/$0 Copay Pap & Pelvic/$0 Copay Prostate Screen/$0 Copay Colorectal Screen/$0 Copay Bone Mass/$0 Copay Mammogram/20% Coin Diab Monitor/20% Coin Nutrition Ther/0/0	20% Coin Part B Rx										0	0	0	0	0	0	0	0	0		0	160	160	0	20	50	0.2	0.2	50	0.1	0	0.1	0	0.2	0.152611332	15	30	30	30	0.1	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		NO	144.8554783	144.8554783	0	18.10693479	45.26733697	0.181069348	0.181069348	45.26733697	0.090534674	0	0.090534674	0	0.181069348	0.138166172	13.58020109	27.16040218	27.16040218	27.16040218	0.090534674	0.181069348	0.181069348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			7.1867	0.6673972	0	0.054547301	0.640673418	2.426136694	0.637733959	1.19227638	1.94534842	0	2.306901298	0	0.175760884	6.834923546	4.197672764	10.31599514	0.076887495	2.162845221	1.164170247	0.794897601	5.571105898	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.352	0	5.055158561	7.1867	0.6673972	0	0.054547301	0.640673418	2.426136694	0.637733959	1.19227638	1.94534842	0	2.306901298	0	0.175760884	6.834923546	4.197672764	10.31599514	0.076887495	2.162845221	1.164170247	0.794897601	5.571105898	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.352	NO												0																			0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.1867	0.6673972	0	0.054547301	0.640673418	2.426136694	0.637733959	1.19227638	1.94534842	0	2.306901298	0	0.175760884	6.834923546	4.197672764	10.31599514	0.076887495	2.162845221	1.164170247	0.794897601	5.571105898	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.352
H3818_015_0	2011	10																															D	D		V	T	Coin	Coin	V	Coin		Coin	0		Coin	V	V	V	V	Coin		Coin			V			V				0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	YES	989.2438619	91.86680742	0	60.06721533	282.202546	22.26374665	5.852245392	525.1715156	35.7034659	0	42.33913626	0	0	82.19773633	6163.275014	7573.281514	56.44541637	1587.809563	21.36630759	0	51.12394968	0	0	983.943662	0	0	7.823079452	0	0	0	0	0	0	0	0	0	0	0	0		2500	$100/day (Days 1-5)	$100/day (Days 1-5)		$20 Copay HHC	$50 Ambul Waived	20% Coin DME	20% Coin Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$50 ER Waived/$50 ER Waived/$50 ER Waived	10% Coin OP Hosp & Surg/10% Coin ASC		10% Coin MRI/CT/PET/10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad/10% Coin Rad	0		$0 Copay CORF/$30 Copay Urgent Care/$0 Copay Partial Hospitalization/$30 Copay Mental Health/$30 Copay PT & ST/10% Coin OP Hosp & Surg/$0 Copay OP Substance Abuse/$0 Copay Cardiac Rehab/$0 Copay Cardiac Rehab	$15 Copay PCP/$15 Copay PCP/$0 Copay Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$30 Copay Chiro/$30 Copay Specialists/$30 Copay Specialists/$30 Copay Specialists/$30 Copay Podiatry/$12 Copay Preventive Dental/$0 Copay Medicare Covered Vision Exams/$20 Copay Medicare Covered Hearing Exams	$30 Copay Mental Health/$30 Copay Psychiatric	$30 Copay OT/$30 Copay PT & ST	10% Coin MRI/CT/PET/10% Coin Rad		20% Coin Part B Rx			"$12 OV, $35 Prophy, $8-40 XRay/to 870 Restore, to 830 Perio/Endo, to 250 surg"			$20 Copay Non-Covered Hearing Exams				0	0	0	0	0	0	0	0	0		0	100	100	0	20	50	0.2	0.059048232	50	0.1	0	0.1	0	0	0.152611332	15	29.98509354	30	30	0.1	0	0.2	0	0	99.35528199	0	0	20	0	0	0	0	0	0	0	0	0	0	0	0		NO	92.14239025	92.14239025	0	18.42847805	46.07119512	0.18428478	0.054408452	46.07119512	0.09214239	0	0.09214239	0	0	0.140619729	13.82135854	27.6289819	27.64271707	27.64271707	0.09214239	0	0.18428478	0	0	99.35528199	0	0	18.42847805	0	0	0	0	0	0	0	0	0	0	0	0			7.5959	0.705402268	0	0.092245613	1.083450713	4.102869664	0.318411614	2.016273281	3.289802688	0	3.901229216	0	0	11.55862344	7.098736144	17.43683816	0.13002539	3.657614209	1.968742652	0	9.421365844	0	0	8.146666667	0	0	0.012013954	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5363	0	6.343707114	7.5959	0.705402268	0	0.092245613	1.083450713	4.102869664	0.318411614	2.016273281	3.289802688	0	3.901229216	0	0	11.55862344	7.098736144	17.43683816	0.13002539	3.657614209	1.968742652	0	9.421365844	0	0	8.146666667	0	0	0.012013954	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5363	NO												0																			0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.5959	0.705402268	0	0.092245613	1.083450713	4.102869664	0.318411614	2.016273281	3.289802688	0	3.901229216	0	0	11.55862344	7.098736144	17.43683816	0.13002539	3.657614209	1.968742652	0	9.421365844	0	0	8.146666667	0	0	0.012013954	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5363
H3832_001_0	2011	7																															D	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	V	V	V	V	P	P	P	Coin	P	T	V	V	P	P	P	P	P																																																			0	YES	1076.232236	48.18928684	542.5761515		92.61009755	4.848776253	6.57024967	259.1553361	258.4274783	2195.752094	20.95855487	6.641637953	0.041341002	1398.547728	4306.631965	6148.061083	335.4623598	765.4084312	3098.315449	11677.32296	14.16669773									0.208772604											3000	$195/day days 1-7	$195/day days 1-7	"$95/day days 1-30, $0/day days 31-100"	$0 copay	$150 copay/trip	20% coins	20% coins	"$50 copay ER, $40 copay Urgent Care"	20% coinsurance	$10 copay	20% coinsurance	20% coinsurance	20% coinsurance	"$30 Copay for OP PT/OT/ST, $40 Copay for OP Partial Hospitalization"	"$19 copay, $30 copay for medicare covered eye exam, services"	"$19 copay, $30 copay for medicare covered eye exam, services, chiro and podiatry"	$40 copay	$30 copay	20% coins	"$30 copay for chiro and podiatry, 20% coins for chemotherapy"	20% coins	"$30  copay for Medicare covered Dental, hearing screening"	N/A	N/A	N/A	N/A	N/A	N/A	$0 copay	Woldwide ER coverage $50 copay												102.2324752	109.450556	67.45826686		150	0.2	0.2	48	311.3064051	10	0.2	536.1218913	0.2	26.13941905	19.13350488	23.38122954	40	30	14.9987353	9.949927724	0.2									50											NO	78.39326568	83.92818917	51.72792526		115.0220596	0.153362746	0.153362746	36.80705906	238.7140258	7.668137304	0.153362746	411.1056274	0.153362746	20.04406543	14.67183425	17.92904785	30.67254922	23.00441191	11.50123617	7.668137304	0.153362746									50												7.0308	0.337036632	2.338861551	0	0.88768368	0.743621641	1.007631532	0.79489548	5.14085531	1.403110712	3.214261529	0.227534561	0.00634017	2.336048515	5.265515865	9.185740109	0.857457145	1.467314236	2.969538141	7.461942985	2.172643667	0	0	0	0	0	0	0	0	0.000869886	0	0	0	0	0	0	0	0	0	0	54.8497	0	16.63067058	7.0308	0.337036632	2.338861551	0	0.88768368	0.743621641	1.007631532	0.79489548	5.14085531	1.403110712	3.214261529	0.227534561	0.00634017	2.336048515	5.265515865	9.185740109	0.857457145	1.467314236	2.969538141	7.461942985	2.172643667	0	0	0	0	0	0	0	0	0.000869886	0	0	0	0	0	0	0	0	0	0	54.8497	YES	$375/day days 1-11	$375/day days 1-11	"$125/day days 1-32, $0/day days 33-100"	$0 copay	$150 copay/trip	30% coins	30% coins	"$50 copay ER, $40 copay Urgent Care"	30% coinsurance	$10 copay	30% coinsurance	30% coinsurance	20% coinsurance	"$45 Copay for OP PT/OT/ST,30% Coins for OP Partial Hospitalization"	$35 copay	$35 copay	$45 copay	$35 copay	30% coins	"$35 copay for chiro and podiatry, 30% coins for chemotherapy"	30% coins	"$45  copay for Medicare covered Dental, hearing screening"	N/A	N/A	N/A	N/A	N/A	N/A	$0 copay	N/A											4000	0.1501	0.0072	0.0281		0.0079	0.0099	0.0159	0.0071	0.0685	0.0125	0.0428	0.003	0.0001	0.0305	0.089	0.129	0.0086	0.0152	0.0395	0.0662	0.0289																				0.76	0	1.250776456	7.1809	0.344233655	2.366957113	0	0.89556454	0.753524456	1.023553079	0.801952566	5.20931612	1.415567536	3.257065875	0.230564641	0.006396458	2.366549169	5.354563806	9.314784334	0.866021218	1.482512197	3.009083504	7.528190154	2.20157678	0	0	0	0	0	0	0	0	0.000869886	0	0	0	0	0	0	0	0	0	0	55.6097
H3832_801_0	2011	4																															D	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	V	V	V	V	P	P	P	Coin	P	T	V	V	P	P	P	P	P																																																			0	YES	1072.773717	48.03442847	540.8325595		92.31249097	4.806291262	7.727458407	258.3225291	257.5970103	2188.695949	20.77491596	6.62029476	0.040978772	2682.013591	6939.068682	9929.639007	334.3843369	762.9487579	3088.358877	16421.69461	14.04256909	9.119300929																				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	Woldwide ER coverage $50 copay											0	162.7482519	60.59200617	75.21692846		238.5412196	0.233	0.233	147.8287835	360.653204	3.050547301	0.233	621.1053633	0.233	29.43651419	16.69157933	17.39496575	24.45203436	31.97878323	17.37626291	8.32607855	0.233	49.72665614																			YES	153.4509527	57.13057416	70.92002033		224.9141049	0.219689438	0.219689438	139.3837869	340.0502133	2.876279064	0.219689438	585.6235544	0.219689438	27.7548981	15.73804155	16.40884793	23.05516603	30.15193525	16.3836113	7.850435695	0.219689438	46.88592763																				13.7182	0.228686206	3.196321343	0	1.73019844	1.055891426	1.697640994	3.000497697	7.299659857	0.524608361	4.564029611	0.323083379	0.009002603	6.20325116	9.100612603	13.57782804	0.642440534	1.917031796	4.216539283	10.74312146	3.08500411	0.035630574	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8693	0	5.256570165	13.7182	0.228686206	3.196321343	0	1.73019844	1.055891426	1.697640994	3.000497697	7.299659857	0.524608361	4.564029611	0.323083379	0.009002603	6.20325116	9.100612603	13.57782804	0.642440534	1.917031796	4.216539283	10.74312146	3.08500411	0.035630574	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8693	YES	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	N/A											10000	0.1976	0.0033	0.046		0.0249	0.0152	0.0245	0.0432	0.1051	0.0076	0.0657	0.0047	0.0001	0.0894	0.1311	0.1956	0.0093	0.0276	0.0607	0.1547	0.0444	0.0005																			1.2513	0	0.075718499	13.9158	0.231980327	3.242362896	0	1.755121161	1.071101061	1.72209474	3.0437185	7.404808133	0.532165106	4.629772378	0.327737248	0.009132282	6.292606168	9.231702783	13.77341046	0.651694597	1.944645766	4.277276611	10.89787123	3.129442189	0.036143816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1206
H3832_802_0	2011	4																															D	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	V	V	V	V	P	P	P	Coin	P	T	V	V	P	P	P	P	P																																																			0	YES	1072.773717	48.03442847	540.8325595		92.31249097	4.806291262	7.727458407	258.3225291	257.5970103	2188.695949	20.77491596	6.62029476	0.040978772	2682.013591	6939.068682	9929.639007	334.3843369	762.9487579	3088.358877	16421.69461	14.04256909	9.119300929																				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	Woldwide ER coverage $50 copay											0	162.7482519	60.59200617	75.21692846		238.5412196	0.233	0.233	147.8287835	360.653204	3.050547301	0.233	621.1053633	0.233	29.43651419	16.69157933	17.39496575	24.45203436	31.97878323	17.37626291	8.32607855	0.233	49.72665614																			YES	153.4506959	57.13047853	70.91990162		224.9137285	0.21968907	0.21968907	139.3835536	340.0496441	2.87627425	0.21968907	585.6225742	0.21968907	27.75485164	15.73801521	16.40882068	23.05512744	30.15188479	16.38358388	7.850422555	0.21968907	46.88584916																				13.7182	0.228685824	3.196315993	0	1.730195544	1.055889659	1.697638153	3.000492675	7.299647639	0.524607483	4.564021971	0.323082838	0.009002588	6.203240777	9.10059737	13.57780549	0.642439458	1.917028587	4.216532226	10.74310348	3.084998946	0.035630514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8691	0	5.256715383	13.7182	0.228685824	3.196315993	0	1.730195544	1.055889659	1.697638153	3.000492675	7.299647639	0.524607483	4.564021971	0.323082838	0.009002588	6.203240777	9.10059737	13.57780549	0.642439458	1.917028587	4.216532226	10.74310348	3.084998946	0.035630514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8691	YES	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	N/A											10000	0.1976	0.0033	0.046		0.0249	0.0152	0.0245	0.0432	0.1051	0.0076	0.0657	0.0047	0.0001	0.0894	0.1311	0.1955	0.0093	0.0276	0.0607	0.1547	0.0444	0.0005																			1.2512	0	0.075811207	13.9158	0.231979939	3.242357469	0	1.755118223	1.071099268	1.722091857	3.043713405	7.404795739	0.532164215	4.629764629	0.327736699	0.009132267	6.292595635	9.231687331	13.77329698	0.651693506	1.944642511	4.277269452	10.89785299	3.129436951	0.036143755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1203
H3832_805_0	2011	4																															D	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	V	V	V	V	P	P	P	Coin	P	T	V	V	P	P	P	P	P																																																			0	YES	1072.773717	48.03442847	540.8325595		92.31249097	4.806291262	7.727458407	258.3225291	257.5970103	2188.695949	20.77491596	6.62029476	0.040978772	2682.013591	6939.068682	9929.639007	334.3843369	762.9487579	3088.358877	16421.69461	14.04256909	9.119300929																				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	Woldwide ER coverage $50 copay											0	162.7482519	60.59200617	75.21692846		238.5412196	0.233	0.233	147.8287835	360.653204	3.050547301	0.233	621.1053633	0.233	29.43651419	16.69157933	17.39496575	24.45203436	31.97878323	17.37626291	8.32607855	0.233	49.72665614																			YES	153.4506959	57.13047853	70.91990162		224.9137285	0.21968907	0.21968907	139.3835536	340.0496441	2.87627425	0.21968907	585.6225742	0.21968907	27.75485164	15.73801521	16.40882068	23.05512744	30.15188479	16.38358388	7.850422555	0.21968907	46.88584916																				13.7182	0.228685824	3.196315993	0	1.730195544	1.055889659	1.697638153	3.000492675	7.299647639	0.524607483	4.564021971	0.323082838	0.009002588	6.203240777	9.10059737	13.57780549	0.642439458	1.917028587	4.216532226	10.74310348	3.084998946	0.035630514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8691	0	5.256715383	13.7182	0.228685824	3.196315993	0	1.730195544	1.055889659	1.697638153	3.000492675	7.299647639	0.524607483	4.564021971	0.323082838	0.009002588	6.203240777	9.10059737	13.57780549	0.642439458	1.917028587	4.216532226	10.74310348	3.084998946	0.035630514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8691	YES	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	N/A											10000	0.1976	0.0033	0.046		0.0249	0.0152	0.0245	0.0432	0.1051	0.0076	0.0657	0.0047	0.0001	0.0894	0.1311	0.1955	0.0093	0.0276	0.0607	0.1547	0.0444	0.0005																			1.2512	0	0.075811207	13.9158	0.231979939	3.242357469	0	1.755118223	1.071099268	1.722091857	3.043713405	7.404795739	0.532164215	4.629764629	0.327736699	0.009132267	6.292595635	9.231687331	13.77329698	0.651693506	1.944642511	4.277269452	10.89785299	3.129436951	0.036143755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1203
H3832_806_0	2011	4																															D	D	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	V	V	V	V	P	P	P	Coin	P	T	V	V	P	P	P	P	P																																																			0	YES	1072.773717	48.03442847	540.8325595		92.31249097	4.806291262	7.727458407	258.3225291	257.5970103	2188.695949	20.77491596	6.62029476	0.040978772	2682.013591	6939.068682	9929.639007	334.3843369	762.9487579	3088.358877	16421.69461	14.04256909	9.119300929																				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	Woldwide ER coverage $50 copay											0	162.7482519	60.59200617	75.21692846		238.5412196	0.233	0.233	147.8287835	360.653204	3.050547301	0.233	621.1053633	0.233	29.43651419	16.69157933	17.39496575	24.45203436	31.97878323	17.37626291	8.32607855	0.233	49.72665614																			YES	153.4506959	57.13047853	70.91990162		224.9137285	0.21968907	0.21968907	139.3835536	340.0496441	2.87627425	0.21968907	585.6225742	0.21968907	27.75485164	15.73801521	16.40882068	23.05512744	30.15188479	16.38358388	7.850422555	0.21968907	46.88584916																				13.7182	0.228685824	3.196315993	0	1.730195544	1.055889659	1.697638153	3.000492675	7.299647639	0.524607483	4.564021971	0.323082838	0.009002588	6.203240777	9.10059737	13.57780549	0.642439458	1.917028587	4.216532226	10.74310348	3.084998946	0.035630514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8691	0	5.256715383	13.7182	0.228685824	3.196315993	0	1.730195544	1.055889659	1.697638153	3.000492675	7.299647639	0.524607483	4.564021971	0.323082838	0.009002588	6.203240777	9.10059737	13.57780549	0.642439458	1.917028587	4.216532226	10.74310348	3.084998946	0.035630514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8691	YES	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	N/A											10000	0.1976	0.0033	0.046		0.0249	0.0152	0.0245	0.0432	0.1051	0.0076	0.0657	0.0047	0.0001	0.0894	0.1311	0.1955	0.0093	0.0276	0.0607	0.1547	0.0444	0.0005																			1.2512	0	0.075811207	13.9158	0.231979939	3.242357469	0	1.755118223	1.071099268	1.722091857	3.043713405	7.404795739	0.532164215	4.629764629	0.327736699	0.009132267	6.292595635	9.231687331	13.77329698	0.651693506	1.944642511	4.277269452	10.89785299	3.129436951	0.036143755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1203
H3864_001_0	2011	5																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	713.6707356	16.34439389	808.9691913	193.6828746	129.570552	1810.626469	0	496.1323322	397.8977241	1710.806221	858.5582268	0	0	986.1439356	4408.615858	3159.490473	103.851415	1089.136337	3125.539096	17400.88537	540.1899604	66.53736825	0	0	142.8866659	49.79327253	0	0	99.9967835	0											3400	"$175 Copay per Day for Days 1-5, $0 Copay for Days After Day 5, Unlimited Coverage"	"$175 Copay per Day for Days 1-5, $0 Copay for Days After Day 5, Unlimited Coverage"	"$0 Copay per Day for Days 1-20, $25 Copay per Day for Days 21-100"	No Cost Sharing for Home Health	$50 Copay for Ambulance	0-20%; Max OOP $500/yr for DME/Prosthetics Combined	0-20%; Max OOP $500/yr for DME/Prosthetics Combined; $0 Copay for Diabetes Monitoring Supplies	$50 Copay for Emergency Care/Post Stabilization Care; $25 Urgently Needed Services; Worldwide Coverage	$175 Copay for Outpatient Hospital Services and ASC Services	$0-$10 Copay for OP Diagnostic Procedures and Tests and Lab  Services	"$10 Copay per Day for X-Ray, $50 Copay per CT, $75 Copay per MRI/Nuclear, $200 Copay per PET"	No Cost Sharing for Observation (Partial Hospitalization is covered in h5)	No Cost Sharing for Renal Dialysis	$25 Copay for Outpatient Substance Abuse Services; $25 Copay for CORF Visits; $175 Partial Hospitalization; $0 Copay for Cardiac Rehabilitation Services	$10 Copay for Primary Care Physician Services	$25 Copay for Physician Specialist Services (Excluding MH and Radiology)	$25 Copay for Mental Health Specialty Services; $25 Copay for Psychiatric Services	$25 Copay (Medicare FFS Benefit Limit) for Independent Occupational Therapy Services; $25 Copay (Medicare FFS Benefit Limit) for Physical/Speech Therapy	$10 X-Ray (per day) Copay for Specialist Services (Radiology Only); No Other Cost Sharing	"$10 Copay for Chiropractic Services; $25 Copay for Podiatry Services; $0 Copay for Other Health Care Professional Services; $0 Copay for Immunizations, (Routine) Physical Exams, Pap Smears and Pelvic Exams, Screening, Prostate Cancer Screening, Colorectal Screening, Bone Mass Measurement, Mammography Screening, Diabetes Monitoring, Nutritional Training (diabetes and renal, disease)"	15% Coinsurance for Medicare Part  B Drugs	"$25 Copay for Medicare Covered Dental, Hearing and Vision Services; $0 Copay for Blood"	Non-Covered	Non-Covered	$25 Copay for Exam Every 2 Years	$100 Benefit Every 2 Years	"$25 Copay for Routine Hearing Test (please note that, historically, services are covered under other services e.g., office visits, and are typically not charged a copay above that for the primary service)"	Non-Covered	$0 Copay for Nutrition Benefit	Non-Covered												144.162761	116.8036383	0.356486852	0	50	13.18437979	0	40.29655945	175	8.307632954	35.53966205	0	0	5.989407309	10	25	25	25	10	1.961255439	36.76310593	25	0	0	25	0	0	0	0	0											NO	140.9637964	114.2117713	0.348576427	0	48.89050245	12.89181904	0	39.40238077	171.1167586	8.123286985	34.75103869	0	0	5.856502654	9.778100489	24.44525122	24.44525122	24.44525122	9.778100489	1.917735277	35.94733441	24.44525122	0	0	24.44525122	0	0	0	0	0												8.3835	0.155560181	0.023498966	0	0.527897449	1.945189066	0	1.629066255	5.673914066	1.158114159	2.486315846	0	0	0.481279548	3.592324074	6.436211529	0.211556161	2.218684281	2.546819613	2.780857644	1.618199096	0.135543557	0	0	0.291075037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2956		0.954565989	8.3835	0.155560181	0.023498966	0	0.527897449	1.945189066	0	1.629066255	5.673914066	1.158114159	2.486315846	0	0	0.481279548	3.592324074	6.436211529	0.211556161	2.218684281	2.546819613	2.780857644	1.618199096	0.135543557	0	0	0.291075037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2956	NO				10% Coinsurance		10% Coinsurance		10% Coinsurance	10% Coinsurance	10% Coinsurance	10% Coinsurance			10% Coinsurance	10% Coinsurance	10% Coinsurance	10% Coinsurance	10% Coinsurance	10% Coinsurance	10% Coinsurance	10% Coinsurance	10% Coinsurance				10% Coinsurance																0	0	0	0.006	0	0.0563	0	0.0259	0.1733	0.0188	0.0756	0	0	0.0537	0.0468	0.0208	0.0068	0	0.0359	0.3314	0.0539	0.0006	0	0	0	0.0007	0	0	0	0											0.9064			8.3835	0.155560181	0.023498966	0.00597946	0.527897449	2.001488654	0	1.654932217	5.847226597	1.176921342	2.561901693	0	0	0.535013993	3.639134302	6.456975082	0.218306271	2.218714946	2.58273279	3.112229691	1.672138323	0.136119397	0	0	0.291075037	0.000707143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.202
H3864_002_0	2011	4																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	491.258567	32.52067697	477.7593072	136.645278	111.3476069	1866.361735	0	419.4048779	266.1279332	1521.436507	600.0576058	0	0	752.5718932	3162.510615	2232.279903	223.4333059	974.4429179	2173.011376	11447.10667	446.2246402	50.94778659	0	0	127.1063495	29.82594549	0	0	0	0											3400	"$225 Copay per Day for Days 1-6, $0 Copay for Days After Day 6, Unlimited Coverage"	"$225 Copay per Day for Days 1-6, $0 Copay for Days After Day 6, Unlimited Coverage"	"$0 Copay per Day for Days 1-20, $50 Copay per Day for Days 21-100"	No Cost Sharing for Home Health	$50 Copay for Ambulance	0-20%; Max OOP $500/yr for DME/Prosthetics Combined	0-20%; Max OOP $500/yr for DME/Prosthetics Combined; $0 Copay for Diabetes Monitoring Supplies	$50 Copay for Emergency Care/Post Stabilization Care; $30 Urgently Needed Services; Worldwide Coverage	$225 Copay for Outpatient Hospital Services and ASC Services	$0-$10 Copay for OP Diagnostic Procedures and Tests and Lab  Services	"$10 Copay per Day for X-Ray, $100 Copay per CT, $150 Copay per MRI/Nuclear, $300 Copay per PET"	No Cost Sharing for Observation (Partial Hospitalization is covered in h5)	No Cost Sharing for Renal Dialysis	$30 Copay for Outpatient Substance Abuse Services; $30 Copay for CORF Visits; $225 Partial Hospitalization; $0 Copay for Cardiac Rehabilitation Services	$15 Copay for Primary Care Physician Services	$30 Copay for Physician Specialist Services (Excluding MH and Radiology)	$30 Copay for Mental Health Specialty Services; $30 Copay for Psychiatric Services	$30 Copay (Medicare FFS Benefit Limit) for Independent Occupational Therapy Services; $30 Copay (Medicare FFS Benefit Limit) for Physical/Speech Therapy	$10 X-Ray (per day) Copay for Specialist Services (Radiology Only); No Other Cost Sharing	"$15 Copay for Chiropractic Services; $30 Copay for Podiatry Services; $0 Copay for Other Health Care Professional Services; $0 Copay for Immunizations, (Routine) Physical Exams, Pap Smears and Pelvic Exams, Screening, Prostate Cancer Screening, Colorectal Screening, Bone Mass Measurement, Mammography Screening, Diabetes Monitoring, Nutritional Training (diabetes and renal, disease)"	20% Coinsurance for Medicare Part  B Drugs	"$30 Copay for Medicare Covered Dental, Hearing and Vision Services; $0 Copay for Blood"	Non-Covered	Non-Covered	$30 Copay for Exam Every 2 Years	$100 Benefit Every 2 Years	"$30 Copay for Routine Hearing Test (please note that, historically, services are covered under other services e.g., office visits, and are typically not charged a copay above that for the primary service)"	Non-Covered	$0 Copay for Nutrition Benefit	Non-Covered												160.4329197	99.74723343	1.87139992	0	50	14.82614867	0	44.85196709	225	11.24508667	50.33348576	0	0	6.888148442	15	30	30	30	8.385627667	2.380034051	61.1598496	30	0	0	30	0	0	0	0	0											NO	150.2780854	93.43358765	1.752946948	0	46.8351775	13.88770609	0	42.0129968	210.7582988	10.5333126	47.1475548	0	0	6.452153098	14.05055325	28.1011065	28.1011065	28.1011065	7.854847205	2.229386344	57.28864824	28.1011065	0	0	28.1011065	0	0	0	0	0												6.1521	0.253210294	0.06979056	0	0.434582078	2.159956937	0	1.468371316	4.674055871	1.335480527	2.357604071	0	0	0.404642423	3.702918649	5.227461274	0.523226927	2.281910351	1.422389361	2.126668607	2.130300537	0.119307431	0	0	0.297652422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1416		2.509795486	6.1521	0.253210294	0.06979056	0	0.434582078	2.159956937	0	1.468371316	4.674055871	1.335480527	2.357604071	0	0	0.404642423	3.702918649	5.227461274	0.523226927	2.281910351	1.422389361	2.126668607	2.130300537	0.119307431	0	0	0.297652422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1416	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	6.1521	0.253210294	0.06979056	0	0.434582078	2.159956937	0	1.468371316	4.674055871	1.335480527	2.357604071	0	0	0.404642423	3.702918649	5.227461274	0.523226927	2.281910351	1.422389361	2.126668607	2.130300537	0.119307431	0	0	0.297652422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1416
H3864_006_0	2011	6																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	1010.330293	110.3691795	1019.994177	324.4814611	270.3009839	3843.944266	0	896.2420551	344.084773	2679.23382	939.4271713	0	0	1374.058967	3944.322986	3524.601538	614.7048693	1107.776628	3220.715252	14598.08755	778.2864192	57.99852268	0	0	166.2795752	28.22885812	0	0	94.64732415	0											3400	"$200 Copay per Day for Days 1-5, $0 Copay for Days After Day 5, Unlimited Coverage"	"$200 Copay per Day for Days 1-5, $0 Copay for Days After Day 5, Unlimited Coverage"	"$0 Copay per Day for Days 1-20, $50 Copay per Day for Days 21-100"	No Cost Sharing for Home Health	$50 Copay for Ambulance	0-20%; Max OOP $500/yr for DME/Prosthetics Combined	0-20%; Max OOP $500/yr for DME/Prosthetics Combined; $0 Copay for Diabetes Monitoring Supplies	$50 Copay for Emergency Care/Post Stabilization Care; $25 Urgently Needed Services; Worldwide Coverage	$200 Copay for Outpatient Hospital Services and ASC Services	$0-$10 Copay for OP Diagnostic Procedures and Tests and Lab  Services	"$10 Copay per Day for X-Ray, $100 Copay per CT, $150 Copay per MRI/Nuclear, $300 Copay per PET"	No Cost Sharing for Observation (Partial Hospitalization is covered in h5)	No Cost Sharing for Renal Dialysis	$25 Copay for Outpatient Substance Abuse Services; $25 Copay for CORF Visits; $200 Partial Hospitalization; $0 Copay for Cardiac Rehabilitation Services	$15 Copay for Primary Care Physician Services	$25 Copay for Physician Specialist Services (Excluding MH and Radiology)	$25 Copay for Mental Health Specialty Services; $25 Copay for Psychiatric Services	$25 Copay (Medicare FFS Benefit Limit) for Independent Occupational Therapy Services; $25 Copay (Medicare FFS Benefit Limit) for Physical/Speech Therapy	$10 X-Ray (per day) Copay for Specialist Services (Radiology Only); No Other Cost Sharing	"$15 Copay for Chiropractic Services; $25 Copay for Podiatry Services; $25 Copay for Other Health Care Professional Services; $0 Copay for Immunizations, (Routine) Physical Exams, Pap Smears and Pelvic Exams, Screening, Prostate Cancer Screening, Colorectal Screening, Bone Mass Measurement, Mammography Screening, Diabetes Monitoring, Nutritional Training (diabetes and renal, disease)"	20% Coinsurance for Medicare Part  B Drugs	"$25 Copay for Medicare Covered Dental, Hearing and Vision Services; $0 Copay for Blood"	Non-Covered	Non-Covered	$25 Copay for Exam Every 2 Years	$100 Benefit Every 2 Years	"$25 Copay for Routine Hearing Test (please note historically, services are covered under other services e.g., office visits and are typically not charged a copay above that for the primary service)"	Non-Covered	$0 Copay for Nutrition Benefit													132.0475264	82.14000033	1.860980861	0	50	17.31444111	0	45.62825159	200	10.60974427	42.25291028	0	0	7.526270748	15	25	25	25	8.279246723	2.198085622	61.02933976	25	0	0	25	0	0	0	0	0											NO	123.6893868	76.94082991	1.743187379	0	46.8351775	16.21849846	0	42.74014525	187.34071	9.938185119	39.57845105	0	0	7.049884528	14.05055325	23.41758875	23.41758875	23.41758875	7.755199797	2.058954605	57.16639921	23.41758875	0	0	23.41758875	0	0	0	0	0												10.4139	0.707658022	0.148170081	0	1.054966213	5.195250345	0	3.192126301	5.371757139	2.218893473	3.098422693	0	0	0.807246421	4.618326679	6.878139111	1.199575486	2.161788125	2.081440856	2.504733298	3.707652678	0.113182129	0	0	0.324488893	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7977		3.770455688	10.4139	0.707658022	0.148170081	0	1.054966213	5.195250345	0	3.192126301	5.371757139	2.218893473	3.098422693	0	0	0.807246421	4.618326679	6.878139111	1.199575486	2.161788125	2.081440856	2.504733298	3.707652678	0.113182129	0	0	0.324488893	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7977	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	10.4139	0.707658022	0.148170081	0	1.054966213	5.195250345	0	3.192126301	5.371757139	2.218893473	3.098422693	0	0	0.807246421	4.618326679	6.878139111	1.199575486	2.161788125	2.081440856	2.504733298	3.707652678	0.113182129	0	0	0.324488893	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7977
H3864_007_0	2011	7																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	723.510948	20.04660866	456.5808208	203.8691372	117.9888465	2405.742542	0	567.860503	406.1938957	1987.532077	831.718631	0	0	1102.665668	4564.604708	3842.169834	281.3696313	1531.411402	3503.479063	19845.51544	810.1656853	33.51955866	0	0	192.8045014	10.18994583	0	0	99.78456277	0											3400	"$175 Copay per Day for Days 1-5, $0 Copay for Days After Day 5, Unlimited Coverage"	"$175 Copay per Day for Days 1-5, $0 Copay for Days After Day 5, Unlimited Coverage"	"$0 Copay per Day for Days 1-20, $25 Copay per Day for Days 21-100"	No Cost Sharing for Home Health	$50 Copay for Ambulance	0-20%; Max OOP $500/yr for DME/Prosthetics Combined	0-20%; Max OOP $500/yr for DME/Prosthetics Combined; $0 Copay for Diabetes Monitoring Supplies	$50 Copay for Emergency Care/Post Stabilization Care; $25 Urgently Needed Services; Worldwide Coverage	$175 Copay for Outpatient Hospital Services and ASC Services	$0-$10 Copay for OP Diagnostic Procedures and Tests and Lab  Services	"$10 Copay per Day for X-Ray, $50 Copay per CT, $75 Copay per MRI/Nuclear, $200 Copay per PET"	No Cost Sharing for Observation (Partial Hospitalization is covered in h5)	No Cost Sharing for Renal Dialysis	$25 Copay for Outpatient Substance Abuse Services; $25 Copay for CORF Visits; $175 Partial Hospitalization; $0 Copay for Cardiac Rehabilitation Services	$10 Copay for Primary Care Physician Services	$25 Copay for Physician Specialist Services (Excluding MH and Radiology)	$25 Copay for Mental Health Specialty Services; $25 Copay for Psychiatric Services	$25 Copay (Medicare FFS Benefit Limit) for Independent Occupational Therapy Services; $25 Copay (Medicare FFS Benefit Limit) for Physical/Speech Therapy	$10 X-Ray (per day) Copay for Specialist Services (Radiology Only); No Other Cost Sharing	"$10 Copay for Chiropractic Services; $25 Copay for Podiatry Services; $25 Copay for Other Health Care Professional Services; $0 Copay for Immunizations, (Routine) Physical Exams, Pap Smears and Pelvic Exams, Screening, Prostate Cancer Screening, Colorectal Screening, Bone Mass Measurement, Mammography Screening, Diabetes Monitoring, Nutritional Training (diabetes and renal, disease)"	15% Coinsurance for Medicare Part  B Drugs	"$25 Copay for Medicare Covered Dental, Hearing and Vision Services; $0 Copay for Blood"	Non-Covered	Non-Covered	$25 Copay for Exam Every 2 Years	$100 Benefit Every 2 Years	"$25 Copay for Routine Hearing Test (please note that, historically, services are covered under other services e.g., office visits, and are typically not charged a copay above that for the primary service)"	Non-Covered	$0 Copay for Nutrition Benefit	Non-Covered												141.4233362	133.8523874	0.354441045	0	50	13.45241584	0	39.98185645	175	8.706999963	35.75006508	0	0	6.182873701	10	25	10	25	9.383688969	1.975879911	38.42607425	25	0	0	25	0	0	0	0	0											NO	138.2851593	130.8822095	0.346576016	0	48.89050245	13.15390739	0	39.09466101	171.1167586	8.51379206	34.95677289	0	0	6.045676036	9.778100489	24.44525122	9.778100489	24.44525122	9.17546537	1.932035232	37.57340155	24.44525122	0	0	24.44525122	0	0	0	0	0												8.3376	0.218645369	0.013186663	0	0.480711166	2.637076218	0	1.850026155	5.792215231	1.410119568	2.422849941	0	0	0.55552995	3.719430294	7.826900569	0.229271711	3.119644704	2.678837568	3.195186252	2.536723385	0.068282836	0	0	0.392762873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.485		1.077601061	8.3376	0.218645369	0.013186663	0	0.480711166	2.637076218	0	1.850026155	5.792215231	1.410119568	2.422849941	0	0	0.55552995	3.719430294	7.826900569	0.229271711	3.119644704	2.678837568	3.195186252	2.536723385	0.068282836	0	0	0.392762873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.485	NO				10% Coinsurance		10% Coinsurance		10% Coinsurance	10% Coinsurance	10% Coinsurance	10% Coinsurance			10% Coinsurance	10% Coinsurance	10% Coinsurance	10% Coinsurance	10% Coinsurance	10% Coinsurance	10% Coinsurance	10% Coinsurance	10% Coinsurance																				0	0	0	0.0054	0	0.1147	0	0.0338	0.1412	0.0188	0.0587	0	0	0.2359	0.0014	0.1429	0.0266	0.0002	0.0555	0.3866	0.0309	0.0007	0	0	0	0	0	0	0	0											1.2532			8.3376	0.218645369	0.013186663	0.005429285	0.480711166	2.751734038	0	1.883870514	5.933389424	1.428928708	2.481544869	0	0	0.791405801	3.720851532	7.969796645	0.255851626	3.11986052	2.734309708	3.581802424	2.567581643	0.068954908	0	0	0.392762873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.7382
H3864_014_0	2011	6																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V	V																																																				0	YES	620.9577956	70.80029306	648.0850713	206.1694033	171.7441495	2442.369721	0	569.4696678	198.4173826	1702.33466	596.8943146	0	0	879.5142648	2506.148467	2165.820352	406.4093542	711.2163698	2046.381754	9274.734266	494.5085186	36.85116792	0	0	105.6509074	17.93608428	0	0	100	0											3400	"$275 Copay per Day for Days 1-6, $0 Copay for Days After Day 6, Unlimited Coverage"	"$275 Copay per Day for Days 1-6, $0 Copay for Days After Day 6, Unlimited Coverage"	"$10 Copay per Day for Days 1-20, $75 Copay per Day for Days 21-100"	No Cost Sharing for Home Health	$100 Copay for Ambulance	0-20%; Max OOP $500/yr for DME/Prosthetics Combined	0-20%; Max OOP $500/yr for DME/Prosthetics Combined; $0 Copay for Diabetes Monitoring Supplies	$50 Copay for Emergency Care/Post Stabilization Care; $35 Urgently Needed Services; Worldwide Coverage	20% Coinsurance for Outpatient Hospital Services and ASC Services	$0-$10 Copay for OP Diagnostic Procedures and Tests and Lab  Services	"$10 Copay per Day for X-Ray, $125 Copay per CT, $175 Copay per MRI/Nuclear, $325 Copay per PET"	No Cost Sharing for Observation (Partial Hospitalization is covered in h5)	No Cost Sharing for Renal Dialysis	$35 Copay for Outpatient Substance Abuse Services; $35 Copay for CORF Visits; $275 Partial Hospitalization; $0 Copay for Cardiac Rehabilitation Services	$15 Copay for Primary Care Physician Services	$35 Copay for Physician Specialist Services (Excluding MH and Radiology)	$35 Copay for Mental Health Specialty Services; $35 Copay for Psychiatric Services	$35 Copay (Medicare FFS Benefit Limit) for Independent Occupational Therapy Services; $35 Copay (Medicare FFS Benefit Limit) for Physical/Speech Therapy	$10 X-Ray (per day) Copay for Specialist Services (Radiology Only); No Other Cost Sharing	"$15 Copay for Chiropractic Services; $35 Copay for Podiatry Services; $35 Copay for Other Health Care Professional Services; $0 Copay for Immunizations, (Routine) Physical Exams, Pap Smears and Pelvic Exams, Screening, Prostate Cancer Screening, Colorectal Screening, Bone Mass Measurement, Mammography Screening, Diabetes Monitoring, Nutritional Training (diabetes and renal, disease)"	20% Coinsurance for Medicare Part  B Drugs	"$35 Copay for Medicare Covered Dental, Hearing and Vision Services; $0 Copay for Blood"	Non-Covered	Non-Covered	$35 Copay for Exam Every 2 Years	$100 Benefit Every 2 Years	"$35 Copay for Routine Hearing Test (please note that, historically, services are covered under other services e.g., office visits, and are typically not charged a copay above that for the primary service)"	Non-Covered	$0 Copay for Nutrition Benefit	Non-Covered												195.9830872	122.3621377	1.854074417	0	100	17.31444111	0	47.26439802	467.1265259	10.60974427	42.25291028	0	0	10.71654676	15	35	35	35	7.641072133	2.501927152	61.02933976	35	0	0	35	0	0	0	0	0											NO	189.1494931	118.0955798	1.789426022	0	96.51317149	16.71071624	0	45.61636951	450.8386249	10.23980068	40.77962375	0	0	10.34287915	14.47697572	33.77961002	33.77961002	33.77961002	7.374641051	2.414689242	58.90135134	33.77961002	0	0	33.77961002	0	0	0	0	0												9.7878	0.696766805	0.096641691	0	1.381297713	3.401145613	0	2.164761566	7.45451833	1.452630634	2.028427131	0	0	0.758059146	3.023454209	6.096713906	1.144029124	2.002050968	1.257610908	1.866300088	2.427268333	0.10373484	0	0	0.297403871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4406		1.713935616	9.7878	0.696766805	0.096641691	0	1.381297713	3.401145613	0	2.164761566	7.45451833	1.452630634	2.028427131	0	0	0.758059146	3.023454209	6.096713906	1.144029124	2.002050968	1.257610908	1.866300088	2.427268333	0.10373484	0	0	0.297403871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4406	NO																																																																																		0		0	9.7878	0.696766805	0.096641691	0	1.381297713	3.401145613	0	2.164761566	7.45451833	1.452630634	2.028427131	0	0	0.758059146	3.023454209	6.096713906	1.144029124	2.002050968	1.257610908	1.866300088	2.427268333	0.10373484	0	0	0.297403871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4406
H3864_801_0	2011	3																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	617.5708207	12.60930787	527.5074974	160.0964245	100.512531	2009.042671	0	465.3104623	349.1182832	1966.236544	505.0960147	0	0	1070.251972	3552.50009	3750.174101	284.2901852	1450.102804	3357.01142	15933.22597	601.3884395	35.77309649	0	0	201.2717816	9.38530809	0	5.305390882	100	0											3400	"$125 Copay per Day for Days 1-4, $0 Copay for Days After Day 6, Unlimited Coverage"	"$125 Copay per Day for Days 1-4, $0 Copay for Days After Day 6, Unlimited Coverage"	No Cost Sharing for SNF	No Cost Sharing for Home Health	$50 Copay for Ambulance	No Cost Sharing for DME/Prosthetics Combined	No Cost Sharing for DME/Prosthetics Combined; No Cost Sharing for Diabetes Monitoring Supplies	$50 Copay for Emergency Care/Post Stabilization Care; $15 Urgently Needed Services; Worldwide Coverage	$125 Copay for Outpatient Hospital Services and ASC Services	No Cost Sharing for Lab	No Cost Sharing for Radiology	No Cost Sharing for Observation (Partial Hospitalization is covered in h5)	No Cost Sharing for Renal Dialysis	$15 Copay for Outpatient Substance Abuse Services; $15 Copay for CORF Visits; $125 Partial Hospitalization; $0 Copay for Cardiac Rehabilitation Services	$10 Copay for Primary Care Physician Services	$15 Copay for Physician Specialist Services (Excluding MH and Radiology)	$15 Copay for Mental Health Specialty Services; $15 Copay for Psychiatric Services	$15 Copay (Medicare FFS Benefit Limit) for Independent Occupational Therapy Services; $15 Copay (Medicare FFS Benefit Limit) for Physical/Speech Therapy	No Cost Sharing for Specialist Services (Radiology Only); No Other Cost Sharing	"$10 Copay for Chiropractic Services; $15 Copay for Podiatry Services; $0 Copay for Other Health Care Professional Services; $0 Copay for Immunizations, $15 for (Routine) non-covered, Physical Exams, Pap Smears and Pelvic Exams, Screening, Prostate Cancer Screening, Colorectal Screening, Bone Mass Measurement, Mammography Screening, Diabetes Monitoring, Nutritional Training (diabetes and renal, disease)"	10% Coinsurance for Medicare Part  B Drugs	"$15 Copay for Medicare Covered Dental, Hearing and Vision Services; $0 Copay for Blood"	Non-Covered	Non-Covered	$15 Copay for Exam Every Two Years	$100 Benefit Every 2 Years	"$15 Copay for Routine Hearing Test (please note historically, services are covered under other services e.g., office visits and are typically not charged a copay above that for the primary service)"	250 Hearing Aid Benefit Every Two Years	$0 Copay for Nutrition Benefit	Non-Covered												81.77301274	120.1285311	0	0	50	0	0	37.38487215	125	0	0	0	0	3.941468117	10	15	15	15	0	1.689778376	31.56571935	15	0	0	15	0	0	0	0	0											NO	80.95528261	118.9272458	0	0	49.5	0	0	37.01102342	123.75	0	0	0	0	3.902053436	9.9	14.85	14.85	14.85	0	1.672880592	31.25006216	14.85	0	0	14.85	0	0	0	0	0												4.1663	0.124965855	0	0	0.41461419	0	0	1.435134702	3.600282295	0	0	0	0	0.348015032	2.930812574	4.640840451	0.351809104	1.79450222	0	2.221198707	1.566118843	0.044269207	0	0	0.24907383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.8879		0.24129231	4.1663	0.124965855	0	0	0.41461419	0	0	1.435134702	3.600282295	0	0	0	0	0.348015032	2.930812574	4.640840451	0.351809104	1.79450222	0	2.221198707	1.566118843	0.044269207	0	0	0.24907383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.8879	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	4.1663	0.124965855	0	0	0.41461419	0	0	1.435134702	3.600282295	0	0	0	0	0.348015032	2.930812574	4.640840451	0.351809104	1.79450222	0	2.221198707	1.566118843	0.044269207	0	0	0.24907383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.8879
H3887_001_0	2011	4																															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	YES	532.2577691	43.7062975	12648.51252	67.62626696	39.59134346	21.51302648	8.552423469	15.62719466	3.02253437	43.27885319	10.38421564	0	0	9.089271294	1.609877102	166.9002218	20.113668	9.662473088	0	0	2.475175761	7.305666438	1660.604711	141.3930691	184.5022313	139.8701231	0	0	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.071044853	0.071907457	0	0	0.2	0.2	0.02987518	0.073723254	0.2	0	0.093432746	0	0	0.160939444	0.135045462	0.027289434	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.065793619	0.066592465	0	0	0.185217131	0.185217131	0.027666976	0.068274048	0.185217131	0	0.086526725	0	0	0.149043711	0.125063665	0.025272353	0.185217131	0	0	0	0.185217131	0.185575409	0	0	0	0	0	0	0	0												35.0192	2.91051007	0	0	7.332995044	3.984581042	0.236619693	1.066931833	0.559825144	0	0.898512174	0	0	1.354698722	0.201337131	4.217961328	3.725395878	0	0	0	0.458444953	1.355752039	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.3227	0	5.051196579	35.0192	2.91051007	0	0	7.332995044	3.984581042	0.236619693	1.066931833	0.559825144	0	0.898512174	0	0	1.354698722	0.201337131	4.217961328	3.725395878	0	0	0	0.458444953	1.355752039	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.3227	NO	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												5.7219	0.4756	0	0.0133	1.6196	0.8801	0.3499	0.1571	0.1236	0	0.303	0	0	0.2992	0.0082	3.7687	0.4542	0.0034	0	0	0.0559	0.165	0	0	0.0154	0	0	0	0	0											14.4141	0	0	40.7411	3.38607082	0	0.013265681	8.952640913	4.864659398	0.586491562	1.224034693	0.683474277	0	1.201538076	0	0	1.653912368	0.209502056	7.986676013	4.179575478	0.003413005	0	0	0.514336018	1.5207187	0	0	0.015412407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.7368
H3887_002_0	2011	4																															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	YES	391.0032023	21.467004	45.3589266	2046.942625	14.39302769	22.28907844	21.82051265	30.26402861	38.59955773	19.76447379	47.82377573	0	0.315149234	27.81667332	35.57567004	120.4327519	8.967672	6.160467505	0	0	20.79567213	7.002665094	632.6677333	475.2708206	103.2779416	184.1504095	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/20% (8a1a); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 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, 18a); $0/20% (17a); $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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.071045047	0.071907457	0.162897447	0	0.2	0.2	0.2	0.088263876	0.2	0	0.153007701	0	0.2	0.16050514	0.171683533	0.199893867	0.2	0.2	0	0	0.2	0.199673317	0	0	0	0	0	0	0	0											NO	0.058228669	0.058935502	0.133511087	0	0.163920417	0.163920417	0.163920417	0.072351489	0.163920417	0	0.12540543	0	0.163920417	0.131550347	0.140712181	0.16383343	0.163920417	0.163920417	0	0	0.163920417	0.164272444	0	0	0	0	0	0	0	0												22.7676	1.265168653	6.055919609	0	2.359311097	3.653635028	3.576827527	2.189647537	6.32725559	0	5.997361177	0	0.051659394	3.659293026	5.005930126	19.73091083	1.469984532	1.009826401	0	0	3.408835243	1.150344906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.6795	0	19.73316889	22.7676	1.265168653	6.055919609	0	2.359311097	3.653635028	3.576827527	2.189647537	6.32725559	0	5.997361177	0	0.051659394	3.659293026	5.005930126	19.73091083	1.469984532	1.009826401	0	0	3.408835243	1.150344906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.6795	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												8.8291	0.4847	1.4284	1.0602	0.792	1.2266	1.2008	0.49	2.1241	0	2.0134	0	0.0116	1.2285	2.3281	8.4749	0.6311	0.4335	0	0	1.4634	0.492	0	0	0.0464	0	0	0	0	0											34.7587	0	0	31.5967	1.749907453	7.484349894	1.060160199	3.151353448	4.880193782	4.7776013	2.679634723	8.451373264	0	8.010730274	0	0.063221082	4.887751222	7.334064069	28.20580819	2.101042932	1.443340781	0	0	4.872234393	1.642320128	0	0	0.046377518	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.4382
H3887_003_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1234.415989	80.00231171	830.0744759	415.6149348	116.0580463	5.233112106	7.11893433	196.9835105	30.94112106	12.50808107	30.10986977	0	0.057445164	15.27214044	4323.752946	84.85043732	405.6145688	600.4011979	0	0	11.2883069	871.0262794	0	0	151.4396081	0	13.93640794	6	151.7840521	0											3800	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-48 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$5 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$5 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 18a); $0/$40 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	61.56384915	0	200	0.2	0.093225668	49.68748573	0.2	0.11269187	0.161584097	0	0.2	0.16063201	3.602462264	0.113520933	38.5	40	0	0	0.2	39.66535066	0	0	40	0	0	0	0	0											NO	144.7987812	96.85645751	47.86263377	0	155.4894128	0.155489413	0.072478022	38.65123974	0.155489413	0.087611963	0.125623082	0	0.155489413	0.124882885	3.466819403	0.10925711	37.05036646	38.49388723	0	0	0.155489413	30.83771042	0	0	40	0	0	0	0	0												14.8952	0.645728375	3.310795887	0	1.503816455	0.813693528	0.51596628	0.634471407	4.811016745	1.09585754	3.782494629	0	0.008932115	1.907228953	1.249139217	9.270513534	1.252347368	1.925981334	0	0	1.755212211	2.238371347	0	0	0.504798694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1215	0	11.38922132	14.8952	0.645728375	3.310795887	0	1.503816455	0.813693528	0.51596628	0.634471407	4.811016745	1.09585754	3.782494629	0	0.008932115	1.907228953	1.249139217	9.270513534	1.252347368	1.925981334	0	0	1.755212211	2.238371347	0	0	0.504798694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1215	NO	"$325 Days 1-Unlimited (1a); $325 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $50 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												2.134	0.1375	0.7727	0.6398	0.6621	0.5374	0.731	0.2792	3.1772	0.4825	2.4524	0	0.0039	1.2549	1.6692	2.8075	0.3449	0.5868	0	0	0.7944	0.8418	0	0	0.148	0	0.0136	0	0	0											20.4707	0	0	17.0291	0.783231884	4.083471596	0.639800079	2.165892558	1.351053362	1.246970947	0.913648356	7.988192263	1.578324058	6.234941631	0	0.012864603	3.162095398	2.918339375	12.07801794	1.597244941	2.512793204	0	0	2.549574549	3.08019431	0	0	0.652810656	0	0.013620975	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5922
H3887_801_0	2011	1																															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	243.1344522	4.009006	27.33763424	439.2319461	4.760974219	5.56246212	7.566970044	10.93414607	33.36575645	13.48825034	32.46936592	0	0.061946732	16.45861521	31.66673611	106.8489116	1.673946	7.997467008	0	0	14.21652292	6.801661022	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.059141019	0.059141019	0.133976661	0	0.191633217	0.191633217	0.191633217	0.191633217	0.191633217	0.191633217	0.191633217	0	0.191633217	0.191633217	0.191633217	0.191633217	0.191633217	0.191633217	0	0	0.191633217	0.191633217	0	0	0	0	0	0	0	0												14.3792	0.237096699	3.662604944	0	0.912360807	1.065952512	1.450082814	2.095345589	6.393987255	2.584796807	6.222209052	0	0.011871052	3.154017383	6.068398519	20.47580069	0.320783657	1.532580332	0	0	2.724358026	1.303424184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5949	0	16.10237847	14.3792	0.237096699	3.662604944	0	0.912360807	1.065952512	1.450082814	2.095345589	6.393987255	2.584796807	6.222209052	0	0.011871052	3.154017383	6.068398519	20.47580069	0.320783657	1.532580332	0	0	2.724358026	1.303424184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5949	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.1159	0.0184	0.2842	0	0.3797	0.4436	0.6035	0.872	2.661	1.0757	2.5895	0	0.0049	1.3126	1.7307	5.8398	0.0915	0.4371	0	0	0.777	0.3717	0	0	0	0	0	0	0	0											20.6089	0	0	15.4952	0.255497386	3.946853721	0	1.292056489	1.509568199	2.053561372	2.967362084	9.054962315	3.660507403	8.811695463	0	0.016811407	4.466619561	7.799122479	26.3155554	0.412272039	1.969676461	0	0	3.501352433	1.675164349	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2038
H3887_802_0	2011	1																															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	240.8434179	4.01004	27.08003414	437.1576263	4.716111982	5.510047534	7.495667159	10.83111459	33.0513539	13.36115175	32.16340997	0	0.061363014	16.30267588	31.36834327	105.8420838	1.673865	7.922107588	0	0	14.08256189	6.737569575	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.059303353	0.059303353	0.134344408	0	0.192159224	0.192159224	0.192159224	0.192159224	0.192159224	0.192159224	0.192159224	0	0.192159224	0.192159224	0.192159224	0.192159224	0.192159224	0.192159224	0	0	0.192159224	0.192159224	0	0	0	0	0	0	0	0												14.2828	0.237808817	3.638051158	0	0.906244419	1.058806459	1.440361585	2.081298574	6.351122518	2.567468553	6.180495902	0	0.011791469	3.132709546	6.027716502	20.3385327	0.3216486	1.522306047	0	0	2.706094165	1.294686141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.1	0	15.74891915	14.2828	0.237808817	3.638051158	0	0.906244419	1.058806459	1.440361585	2.081298574	6.351122518	2.567468553	6.180495902	0	0.011791469	3.132709546	6.027716502	20.3385327	0.3216486	1.522306047	0	0	2.706094165	1.294686141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.1	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.1054	0.0184	0.2816	0	0.3761	0.4394	0.5978	0.8638	2.6359	1.0656	2.5651	0	0.0049	1.3002	1.7144	5.7847	0.0915	0.433	0	0	0.7697	0.3682	0	0	0	0	0	0	0	0											20.4157	0	0	15.3883	0.256214249	3.919621484	0	1.282362262	1.498241994	2.038153617	2.945098135	8.987023447	3.633042824	8.745581812	0	0.016685272	4.432875301	7.742132004	26.12325992	0.413132555	1.955283458	0	0	3.475767023	1.662923432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5157
H3887_803_0	2011	1																															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	240.8434179	4.01004	27.08003414	437.1576263	4.716111982	5.510047534	7.495667159	10.83111459	33.0513539	13.36115175	32.16340997	0	0.061363014	16.30267588	31.36834327	105.8420838	1.673865	7.922107588	0	0	14.08256189	6.737569575	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.059303353	0.059303353	0.134344408	0	0.192159224	0.192159224	0.192159224	0.192159224	0.192159224	0.192159224	0.192159224	0	0.192159224	0.192159224	0.192159224	0.192159224	0.192159224	0.192159224	0	0	0.192159224	0.192159224	0	0	0	0	0	0	0	0												14.2828	0.237808817	3.638051158	0	0.906244419	1.058806459	1.440361585	2.081298574	6.351122518	2.567468553	6.180495902	0	0.011791469	3.132709546	6.027716502	20.3385327	0.3216486	1.522306047	0	0	2.706094165	1.294686141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.1	0	15.74891915	14.2828	0.237808817	3.638051158	0	0.906244419	1.058806459	1.440361585	2.081298574	6.351122518	2.567468553	6.180495902	0	0.011791469	3.132709546	6.027716502	20.3385327	0.3216486	1.522306047	0	0	2.706094165	1.294686141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.1	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.1054	0.0184	0.2816	0	0.3761	0.4394	0.5978	0.8638	2.6359	1.0656	2.5651	0	0.0049	1.3002	1.7144	5.7847	0.0915	0.433	0	0	0.7697	0.3682	0	0	0	0	0	0	0	0											20.4157	0	0	15.3883	0.256214249	3.919621484	0	1.282362262	1.498241994	2.038153617	2.945098135	8.987023447	3.633042824	8.745581812	0	0.016685272	4.432875301	7.742132004	26.12325992	0.413132555	1.955283458	0	0	3.475767023	1.662923432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5157
H3907_002_0	2011	5																															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	299.3183124	4.752535036	1460.852853		302.800758	19.80103371	0	1349.808061	1466.996223		10087.26892	1806.00039		109.0840915	38896.10124	6675.358808	52.97828599	810.3118876			332.9576951	462.7475227	0	0																	3400	1a $300/stay-$900 combined max (1a/1b)	1b $300/stay-$900 combined max (1a/1b)	"2 $25/days 1-10; $70/days 11-55; $0/days 56-100 - $3,400 max"	6 $0/vst	10a $100/trp	11a 20% coin	"11b 20% coin, 11c $10-$50/item"	"4a $50/vst, 4b $50 vst"	"9a $200/vst, 9b $200/vst -$400 combined max (9a/9b)"	8a $0/vst	8b $30/x-ray; $90/diag x-ray; $0-$25/thera x-ray-$100 max per year	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $35/vst, 9d $0/vst"	"7a $15/PCP; $35/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $35/vst, 7d $35/vst, 7f $35/vst, 7g $35/vst, 16b $35/vst, 17a $0/vst, 18a $35/vst"	"7e $35/vst, 7h $35/vst"	"7c $35/vst, 7i $35/vst"	0	0	15 15% coin	13a $0/vst	10b not covrd	"16a not covrd, 16b not covrd"	17a $150 combined max-2yr (17a/17b)	17b $150 combined max-2yr (17a/17b)	18a not covrd	18b not covrd	14a $0 vst	13b not covrd												264.4580153	225	46.29563743		100	0.139871732	0	10.8493565	31.99314168		6.605641696	7.440683249		35	1.240534114	20.49295641	4.069767442	29.24853801			154.5729773	45.54806263	0	0																	NO	257.5764641	219.1451992	45.09096305		97.39786629	0.136232083	0	10.56704174	31.16063735		6.433754067	7.247066723		34.0892532	1.208253758	19.95970229	3.963866651	28.48745195			150.5507818	44.36284114	0	0																		6.4248	0.08679127	5.489271835	0	2.457678979	2.697536059	0	1.188623177	3.809378109	0	5.408250619	1.090683777	0	0.309882935	3.916363375	11.10318121	0.017499905	1.923643413	0	0	4.177253442	1.710732903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8116	0	1.384225207	6.4248	0.08679127	5.489271835	0	2.457678979	2.697536059	0	1.188623177	3.809378109	0	5.408250619	1.090683777	0	0.309882935	3.916363375	11.10318121	0.017499905	1.923643413	0	0	4.177253442	1.710732903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8116	NO																																																																																		0	0	0	6.4248	0.08679127	5.489271835	0	2.457678979	2.697536059	0	1.188623177	3.809378109	0	5.408250619	1.090683777	0	0.309882935	3.916363375	11.10318121	0.017499905	1.923643413	0	0	4.177253442	1.710732903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8116
H3907_006_0	2011	5																															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	375.8304333	11.864201	1665.097236		375.5900932	32.55808998	0	1642.941124	2059.136591		13416.52524	2396.293264		462.0144514	43825.98827	8967.289732	99.64220123	1361.539507			630.4176492	1030.711232	0	0																	3200	1a $100/stay-$200 combined max (1a/1b)	1b $100/stay-$200 combined max (1a/1b)	"2 $0/days 1-10; $60/days 11-60; $0/days 61-100 - $3,000 max"	6 $0/vst	10a $100/trp	11a 20% coin	"11b 20% coin, 11c $10-$30/item"	"4a $50/vst, 4b $50 vst"	"9a $60/vst, 9b $60/vst -$120 combined max (9a/9b)"	8a $0/vst	8b $20/x-ray; $50/diag x-ray; $0/thera x-ray-$250 max	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $20/vst, 9d $0/vst"	"7a $5/PCP; $20/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $20/vst, 7d $20/vst, 7f $20/vst, 7g $20/vst, 16b $20/vst, 17a $0/vst, 18a $20/vst"	"7e $20/vst, 7h $20/vst"	"7c $20/vst, 7i $20/vst"	0	0	15 $5-$38/vst or inj	13a $0/vst	10b not covrd	"16a not covrd, 16b not covrd"	17a $200 combined max-2yr (17a/17b)	17b $200 combined max-2yr (17a/17b)	"18a $20/vst-1yr, $20/fitting-3yr"	"18b $1,000 max-3 yr"	14a $0 vst	13b not covrd												80.85050874	71.07438017	33.54927624		100	0.130670764	0	10.09862591	8.615574264		3.913492255	2.838721147		20	0.570983558	11.84654341	3.979591837	20			5	10.63901011	0	0																	NO	79.10110553	69.53650798	32.82335364		97.8362496	0.127843375	0	9.880116849	8.429154742		3.828814051	2.777298307		19.56724992	0.558628899	11.59021378	3.893483402	19.56724992			4.89181248	10.40880848	0	0																		2.4774	0.068749592	4.554506284	0	3.062193842	4.162336117	0	1.35270419	1.446398413	0	4.280781697	0.554601769	0	0.753362686	2.040205299	8.661067084	0.032329605	2.220131984	0	0	0.25699041	0.894039652	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8178	0	0.814332801	2.4774	0.068749592	4.554506284	0	3.062193842	4.162336117	0	1.35270419	1.446398413	0	4.280781697	0.554601769	0	0.753362686	2.040205299	8.661067084	0.032329605	2.220131984	0	0	0.25699041	0.894039652	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8178	NO																																																																																		0	0	0	2.4774	0.068749592	4.554506284	0	3.062193842	4.162336117	0	1.35270419	1.446398413	0	4.280781697	0.554601769	0	0.753362686	2.040205299	8.661067084	0.032329605	2.220131984	0	0	0.25699041	0.894039652	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8178
H3907_020_0	2011	6																															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	YES	345.5001974	53.11378534	74.80587876		27.86902382	63.13162275	0	49.20896427	50.86836601	28.27569815	65.95228217	19.9069519	0.256836498	20.26119662	92.18663534	88.3626473	2.525680399	14.17735017	0	0	42.24709039	24.62860674																			3400	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing		Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																				0.086861296	0.086861296	0.174725796		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.086861296	0.086861296	0.174725796		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				30.0106	4.613532233	13.07051668	0	6.493482549	14.7096681	0	11.46568867	11.85232928	6.588237669	15.36688174	4.638319792	0.059842904	4.720858812	21.47948603	20.58849682	0.588483533	3.30332259	0	0	9.843572061	5.738465371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	185.1318	0	0	30.0106	4.613532233	13.07051668	0	6.493482549	14.7096681	0	11.46568867	11.85232928	6.588237669	15.36688174	4.638319792	0.059842904	4.720858812	21.47948603	20.58849682	0.588483533	3.30332259	0	0	9.843572061	5.738465371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	185.1318	NO																																																																																		0			30.0106	4.613532233	13.07051668	0	6.493482549	14.7096681	0	11.46568867	11.85232928	6.588237669	15.36688174	4.638319792	0.059842904	4.720858812	21.47948603	20.58849682	0.588483533	3.30332259	0	0	9.843572061	5.738465371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	185.1318
H3907_029_0	2011	6																															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	287.7817121	12.50684661	1430.109303		319.3742245	25.71090363	0	1564.035901	1789.035785		11301.23257	2276.501707		432.7546351	24963.94189	7334.618342	93.63778472	921.9433801			381.2471503	721.9885676	0	0																	3400	1a $300/stay-$900 combined max (1a/1b)	1b $300/stay-$900 combined max (1a/1b)	"2 $25/days 1-10; $70/days 11-55; $0/days 56-100 - $3,400 max"	6 $0/vst	10a $100/trp	11a 20% coin	"11b 20% coin, 11c $10-$50/item"	"4a $50/vst, 4b $50 vst"	"9a $200/vst, 9b $200/vst -$400 combined max (9a/9b)"	8a $0/vst	8b $30/x-ray; $90/diag x-ray; $0-$25/thera x-ray-$100 max per year	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $40/vst, 9d $0/vst"	"7a $15/PCP; $40/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $40/vst, 7d $40/vst, 7f $40/vst, 7g $40/vst, 16b $40/vst, 17a $0/vst, 18a $40/vst"	"7e $40/vst, 7h $40/vst"	"7c $40/vst, 7i $40/vst"	0	0	"15 10% coin - $2,000 max"	13a $0/vst	10b not covrd	"16a not covrd, 16b not covrd"	17a $150 combined max-2yr (17a/17b)	17b $150 combined max-2yr (17a/17b)	18a not covrd	18b not covrd	14a $0 vst	13b not covrd												260.7137718	244.3708609	45.55799642		100	0.136381539	0	12.08161294	28.54290806		6.972697259	6.655788427		40	2.31025798	23.31704023	5.609149677	40			69.33378515	25.13326268	0	0																	NO	254.7778455	238.8070298	44.52073282		97.72320189	0.133276407	0	11.80653901	27.89304366		6.81394302	6.504249562		39.08928076	2.25765807	22.78615829	5.481440663	39.08928076			67.75519484	24.56102903	0	0																		6.11	0.248893574	5.30579285	0	2.600855985	3.42665685	0	1.538820906	4.158471107	0	6.417162897	1.233911269	0	1.409672286	4.696670405	13.92731455	0.042772497	3.003175302	0	0	2.152622913	1.477731847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7506	0	1.345592763	6.11	0.248893574	5.30579285	0	2.600855985	3.42665685	0	1.538820906	4.158471107	0	6.417162897	1.233911269	0	1.409672286	4.696670405	13.92731455	0.042772497	3.003175302	0	0	2.152622913	1.477731847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7506	NO																																																																																		0	0	0	6.11	0.248893574	5.30579285	0	2.600855985	3.42665685	0	1.538820906	4.158471107	0	6.417162897	1.233911269	0	1.409672286	4.696670405	13.92731455	0.042772497	3.003175302	0	0	2.152622913	1.477731847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7506
H3907_801_0	2011	3																															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	340.1286318	3.082415726	1398.542954		359.4248702	25.87141734	0	1431.478106	1953.966298		12825.05761	2133.513405		267.3918231	46165.86287	9620.59467	68.11547678	1750.72206			470.9286911	887.0571937	0	387.9452223																	3400	1a $150/stay	1b $150/stay	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/vst	10a $75/trp	11a 20% coin	"11b 20% coin, 11c $25-$50/item"	"4a $50/vst, 4b $50 vst"	"9a $100/vst, 9b $100/vst"	8a $0/vst	8b $25/x-ray; $75/diag x-ray; $0/thera x-ray	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $25/vst, 9d $0/vst"	"7a $10/PCP; $25/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $25/vst, 7d $25/vst, 7f $25/vst, 7g $25/vst, 16b $25/vst, 17a $25/vst, 18a $25/vst"	"7e $25/vst, 7h $25/vst"	"7c $25/vst, 7i $25/vst"	0	0	15 20% coin	13a $0/vst	10b not covrd	"16a $25/vst-6 mo; $25/x-ray-1yr, 16b 20% coin"	17a $200 combined max-2yr (17a/17b)	17b $200 combined max-2yr (17a/17b)	"18a $25/vst - 1 yr, $25/fitting - 3yr"	"18b $1,000 max-3 yr"	14a $0/vst	13b not covrd												19.40625	31.03448276	36.96480056		22.21711132	0.138593354	0	9.520420997	1.191271435		22.0499906	0.793934804		25	0.290983802	14.0009929	1.941747573	21.4177789			239.8681881	53.98367331	0	0																	NO	18.89094827	30.21041203	35.98325978		21.62717169	0.134913231	0	9.267621543	1.15963914		21.4644886	0.772853143		24.33616524	0.283257196	13.62921908	1.890187592	20.84906426			233.4988745	52.55022377	0	0																		0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064	0	1.704191278	0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064	NO																																																																																		0	0	0	0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064
H3907_802_0	2011	4																															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	340.1286318	3.082415726	1398.542954		359.4248702	25.87141734	0	1431.478106	1953.966298		12825.05761	2133.513405		267.3918231	46165.86287	9620.59467	68.11547678	1750.72206			470.9286911	887.0571937	0	387.9452223																	3400	1a $150/stay	1b $150/stay	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/vst	10a $75/trp	11a 20% coin	"11b 20% coin, 11c $25-$50/item"	"4a $50/vst, 4b $50 vst"	"9a $100/vst, 9b $100/vst"	8a $0/vst	8b $25/x-ray; $75/diag x-ray; $0/thera x-ray	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $25/vst, 9d $0/vst"	"7a $10/PCP; $25/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $25/vst, 7d $25/vst, 7f $25/vst, 7g $25/vst, 16b $25/vst, 17a $25/vst, 18a $25/vst"	"7e $25/vst, 7h $25/vst"	"7c $25/vst, 7i $25/vst"	0	0	15 20% coin	13a $0/vst	10b not covrd	"16a $25/vst-6 mo; $25/x-ray-1yr, 16b 20% coin"	17a $200 combined max-2yr (17a/17b)	17b $200 combined max-2yr (17a/17b)	"18a $25/vst - 1 yr, $25/fitting - 3yr"	"18b $1,000 max-3 yr"	14a $0/vst	13b not covrd												19.40625	31.03448276	36.96480056		22.21711132	0.138593354	0	9.520420997	1.191271435		22.0499906	0.793934804		25	0.290983802	14.0009929	1.941747573	21.4177789			239.8681881	53.98367331	0	0																	NO	18.89094827	30.21041203	35.98325978		21.62717169	0.134913231	0	9.267621543	1.15963914		21.4644886	0.772853143		24.33616524	0.283257196	13.62921908	1.890187592	20.84906426			233.4988745	52.55022377	0	0																		0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064	0	1.314780112	0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064	NO																																																																																		0	0	0	0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064
H3907_803_0	2011	3																															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	340.1286318	3.082415726	1398.542954		359.4248702	25.87141734	0	1431.478106	1953.966298		12825.05761	2133.513405		267.3918231	46165.86287	9620.59467	68.11547678	1750.72206			470.9286911	887.0571937	0	387.9452223																	3400	1a $150/stay	1b $150/stay	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/vst	10a $75/trp	11a 20% coin	"11b 20% coin, 11c $25-$50/item"	"4a $50/vst, 4b $50 vst"	"9a $100/vst, 9b $100/vst"	8a $0/vst	8b $25/x-ray; $75/diag x-ray; $0/thera x-ray	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $25/vst, 9d $0/vst"	"7a $10/PCP; $25/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $25/vst, 7d $25/vst, 7f $25/vst, 7g $25/vst, 16b $25/vst, 17a $25/vst, 18a $25/vst"	"7e $25/vst, 7h $25/vst"	"7c $25/vst, 7i $25/vst"	0	0	15 20% coin	13a $0/vst	10b not covrd	"16a $25/vst-6 mo; $25/x-ray-1yr, 16b 20% coin"	17a $200 combined max-2yr (17a/17b)	17b $200 combined max-2yr (17a/17b)	"18a $25/vst - 1 yr, $25/fitting - 3yr"	"18b $1,000 max-3 yr"	14a $0/vst	13b not covrd												19.40625	31.03448276	36.96480056		22.21711132	0.138593354	0	9.520420997	1.191271435		22.0499906	0.793934804		25	0.290983802	14.0009929	1.941747573	21.4177789			239.8681881	53.98367331	0	0																	NO	18.89094827	30.21041203	35.98325978		21.62717169	0.134913231	0	9.267621543	1.15963914		21.4644886	0.772853143		24.33616524	0.283257196	13.62921908	1.890187592	20.84906426			233.4988745	52.55022377	0	0																		0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064	0	0.979633954	0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064	NO																																																																																		0	0	0	0.5354	0.007760087	4.193677869	0	0.647778615	3.490396496	0	1.105533111	0.18882465	0	22.94027523	0.137407712	0	0.542274299	1.089734404	10.92676603	0.010729252	3.041743061	0	0	9.163443279	3.884587835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9064
H3909_001_0	2011	9		h.5.5										OP Facility - Other										Other									A	A	D		T	coin	coin	V	V		V		V	V	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	YES	368.8074748	1.109751679	1104.996559		283.1473603	1.12894815	24.93085207	305.8290478	464.8450689		817.9837756		22.69260233	387.2582488	3310.191046	6217.388668	214.7818474	834.7788134	129.0225814	74.54249194	130.0408552											108.5677103									6700	$850 per Admission (PBP 1a)	$850 per Admission (PBP 1b)	$25 for days 1-100.  100 days per Medicare benefit period.  (PBP 2)	$0 copay per service (PBP 6)	$100 copay per trip (PBP 10a)	20% coinsurance (PBP 11a)	20% coinsurance (PBP 11b)	$50 copay per visit (PBP 4a)	"$125 copay per service in Ambulatory Surgical Facility/$250 per service in Outpatient Facility (PBP 9b, 9a)"	$0 copay per service (PBP 8a)	$40 copay per encounter for routine X-ray (PBP 8b)	$0 copay per service	$25 copay per visit (PBP 12)	"$40 copay per visit (PBP 3, 5, 9c, 9d)"	$20 copay per visit (PBP 7a)	"$10 - 40 copay per visit (PBP 4b, 7b, 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$40 copay per visit (PBP 7c, 7i)"	$40 copay per visit (PBP 8b)	"$40 copay per visit (PBP 7d, 18a)"	20% coinsurance (PBP 15)								$0 copay per service (PBP 14a)			$25 copay per visit (PBP 8b)										850	850	25		100	0.2	0.2	50	187.5		40		25	40	20	39.37869295	40	40	40	40	0.2											25									NO	717.145	717.145	21.0925		84.37	0.16874	0.16874	42.185	158.19375		33.748		21.0925	33.748	16.874	33.22380324	33.748	33.748	33.748	33.748	0.16874											21.0925										22.0407	0.066321072	1.942261661	0	1.990761899	0.190498711	4.206831978	1.075116532	6.127965385	0	2.300443038	0	0.039886976	1.089099282	4.654680309	17.21377481	0.604038149	2.347676283	0.362854506	0.209638335	21.9430939	0	0	0	0	0	0	0	0	0	0	0.190830369	0	0	0	0	0	0	0	0	88.5965		16.40907822	22.0407	0.066321072	1.942261661	0	1.990761899	0.190498711	4.206831978	1.075116532	6.127965385	0	2.300443038	0	0.039886976	1.089099282	4.654680309	17.21377481	0.604038149	2.347676283	0.362854506	0.209638335	21.9430939	0	0	0	0	0	0	0	0	0	0	0.190830369	0	0	0	0	0	0	0	0	88.5965	YES	$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	$100 copay per trip	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	"$50 per visit (PBP category 4A), 20-40 per Visit (PBP category 4B)"	$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	$25 copay per visit	$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									10000	0.5534	0	0.1065	0	0.7084	0.0072	0.0839	0.0094	0.0854	0	0.0048	0	0	0.0185	0.3309	0.4355	0.6304	0.2432	0.4241	0.8301	0.0084											0									4.4801	500	0	22.5941	0.066321072	2.048736884	0	2.6991495	0.197727581	4.290743024	1.084564525	6.213384484	0	2.305196398	0	0.039886976	1.10760362	4.985605375	17.64926849	1.234457643	2.590883776	0.786938648	1.039717923	21.95150955	0	0	0	0	0	0	0	0	0	0	0.190830369	0	0	0	0	0	0	0	0	93.0766
H3909_007_0	2011	8	h.5.										OP Facility - Other										Other										A	A	D		T	coin	coin	V	V		V		V	V	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	YES	378.5307558	1.139009295	1120.924523		252.8060978	1.552508452	21.19227598	313.1418633	426.2108872		839.544219		22.69260233	377.4055189	3797.512773	6446.628042	166.473815	726.0591656	112.6588387	91.38108017	125.9539491										212.613558										6700	$850 per Admission (PBP 1a)	$850 per Admission (PBP 1b)	$25 for days 1-100.  100 days per Medicare benefit period.  (PBP 2)	$0 copay per service (PBP 6)	$100 copay per trip (PBP 10a)	20% coinsurance (PBP 11a)	20% coinsurance (PBP 11b)	$50 copay per visit (PBP 4a)	"$125 copay per service in Ambulatory Surgical Facility/$250 per service in Outpatient Facility (PBP 9b, 9a)"	$0 copay per service (PBP 8a)	$40 copay per encounter for routine X-ray (PBP 8b)	$0 copay per service	$25 copay per visit (PBP 12)	"$40 copay per visit (PBP 3, 5, 9c, 9d)"	$20 copay per visit (PBP 7a)	"$10 - 40 copay per visit (PBP 4b, 7b, 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$40 copay per visit (PBP 7c, 7i)"	$40 copay per visit (PBP 8b)	"$40 copay per visit (PBP 7d, 18a)"	20% coinsurance (PBP 15)								$0 copay per service (PBP 14)		$25 copay per service - therapeutic radiology (PBP 8b)											850	850	25		100	0.2	0.2	50	187.5		40		25	40	20	39.37869295	40	40	40	40	0.2										25										NO	741.115	741.115	21.7975		87.19	0.17438	0.17438	43.595	163.48125		34.876		21.7975	34.876	17.438	34.33428238	34.876	34.876	34.876	34.876	0.17438										21.7975											23.3779	0.070344739	2.03611269	0	1.836846972	0.270726424	3.695509085	1.137618294	5.806457383	0	2.439995349	0	0.041220167	1.09686624	5.518418979	18.44502896	0.483828398	2.110169955	0.327424138	0.265583879	21.96384964	0	0	0	0	0	0	0	0	0	0.386203669	0	0	0	0	0	0	0	0	0	91.3101		13.41479252	23.3779	0.070344739	2.03611269	0	1.836846972	0.270726424	3.695509085	1.137618294	5.806457383	0	2.439995349	0	0.041220167	1.09686624	5.518418979	18.44502896	0.483828398	2.110169955	0.327424138	0.265583879	21.96384964	0	0	0	0	0	0	0	0	0	0.386203669	0	0	0	0	0	0	0	0	0	91.3101	YES	$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	$100 copay per trip	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	"$50 per visit (PBP category 4A), 20-40 per Visit (PBP category 4B)"	$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	$25 copay per visit	$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										10000	0.6164	0	0.0304	0	0.6247	0.0061	0.0081	0	0	0	0	0	0	0	0.1591	0.4746	0.3698	0.3016	1.0349	0.7624	0.0021										0										4.3902	500	0	23.9943	0.070344739	2.066544178	0	2.461590661	0.276803858	3.703599764	1.137618294	5.806457383	0	2.439995349	0	0.041220167	1.09686624	5.677497387	18.91962548	0.853610682	2.411771497	1.362333787	1.027977029	21.96595453	0	0	0	0	0	0	0	0	0	0.386203669	0	0	0	0	0	0	0	0	0	95.7003
H3909_801_0	2011	3																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																											0	YES	363.0660741	3.182546814	30.48958841	20.51197279	6.108621042	1.208132026	20.79843981	10.49401288	54.2454021	12.31324886	33.67053614	0	0	65.02323889	25.64564603	57.0420911	2.84786868	15.0556604	17.60138851	99.76836671	100.2327673	0																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0.056794541	0.056794541	0.114882953	0	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689																				20.6202	0.180751285	3.502733958	0	1.093203033	0.21620814	3.722103126	1.87801578	9.707794556	2.203587504	6.02570236	0	0	11.63660366	4.589562494	10.20829195	0.509656542	2.694371364	3.149956622	17.85461568	17.93772513	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.7311		35.55029336	20.6202	0.180751285	3.502733958	0	1.093203033	0.21620814	3.722103126	1.87801578	9.707794556	2.203587504	6.02570236	0	0	11.63660366	4.589562494	10.20829195	0.509656542	2.694371364	3.149956622	17.85461568	17.93772513	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.7311	YES																																									10000																																									0			20.6202	0.180751285	3.502733958	0	1.093203033	0.21620814	3.722103126	1.87801578	9.707794556	2.203587504	6.02570236	0	0	11.63660366	4.589562494	10.20829195	0.509656542	2.694371364	3.149956622	17.85461568	17.93772513	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.7311
H3909_802_0	2011	3																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																											0	YES	456.6217669	4.105286822	32.91139856	11.58071302	10.02232943	1.007449198	25.46574204	11.02578834	54.32665169	13.61632113	37.04065274	0	0	91.03812893	26.15284854	59.07801823	4.586648934	9.939942283	19.55775275	107.4777002	118.2638309	0.8928554																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0.056794541	0.056794541	0.114882953	0	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689																				25.9336	0.233157881	3.780958661	0	1.793602984	0.180293803	4.557366751	1.973182682	9.722335039	2.436786216	6.62882075	0	0	16.29224631	4.680331804	10.57264287	0.820829855	1.778858923	3.500068915	19.23428332	21.1645767	0.159786018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.4438		40.89885366	25.9336	0.233157881	3.780958661	0	1.793602984	0.180293803	4.557366751	1.973182682	9.722335039	2.436786216	6.62882075	0	0	16.29224631	4.680331804	10.57264287	0.820829855	1.778858923	3.500068915	19.23428332	21.1645767	0.159786018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.4438	YES																																									10000																																									0			25.9336	0.233157881	3.780958661	0	1.793602984	0.180293803	4.557366751	1.973182682	9.722335039	2.436786216	6.62882075	0	0	16.29224631	4.680331804	10.57264287	0.820829855	1.778858923	3.500068915	19.23428332	21.1645767	0.159786018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.4438
H3912_001_0	2011	4																															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	YES	298.5616724	44.841654	8441.829514	7.968148572	16.42214738	16.60852581	5.672613794	10.15323773	4.115627688	38.10190099	13.51006126	0	0	27.5077737	0.76327708	144.0547386	20.276082	47.75329471	0	0	4.452759615	7.388657094	922.3887904	134.3234157	42.92096585	122.0936852	0	0	0	0											1900	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.077105196	0.078041175	0	0	0.2	0.2	0.118993214	0.058061073	0.2	0	0.112145849	0	0	0.16052112	0.002700826	0.031540358	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.061853625	0.062604466	0	0	0.160439577	0.160439577	0.095456105	0.04657647	0.160439577	0	0.089963163	0	0	0.128769703	0.0022162	0.025880878	0.164112773	0	0	0	0.160439577	0.162861906	0	0	0	0	0	0	0	0												18.4671	2.807287798	0	0	2.634762388	2.664664864	0.541485617	0.472901977	0.660309567	0	1.215407844	0	0	3.542167851	0.001691575	3.728263184	3.327564047	0	0	0	0.714398871	1.20333078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9814	0	10.13233929	18.4671	2.807287798	0	0	2.634762388	2.664664864	0.541485617	0.472901977	0.660309567	0	1.215407844	0	0	3.542167851	0.001691575	3.728263184	3.327564047	0	0	0	0.714398871	1.20333078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9814	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.7171	0.109	0	0.0008	0.23	0.2326	0.0795	0.0275	0.0576	0	0.1398	0	0	0.3092	0.0115	2.2645	0.3186	0.009	0	0	0.0684	0.1152	0	0	0.0043	0	0	0	0	0											4.6945	0	1.080533789	19.1842	2.916293495	0	0.000753286	2.864781326	2.897294336	0.620939818	0.500425372	0.717955641	0	1.355203089	0	0	3.851404727	0.013153923	5.99276399	3.646160604	0.00896625	0	0	0.782798763	1.318543302	0	0	0.004268572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6759
H3912_005_0	2011	4																															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	YES	328.9615645	21.656724	29.7459439	2025.232481	12.01114744	21.13590513	23.98108532	27.86594836	46.78009125	20.97827971	44.82142658	0	0.145392797	23.49048772	34.01259479	119.0309984	9.366678	6.185268274	0	0	25.00452129	6.50726768	772.3063361	451.5072796	172.7398077	217.8016399	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.080053901	0.081025641	0.173043082	0	0.233	0.233	0.233	0.103893152	0.233	0.233	0.233	0	0.233	0.233	0.226209021	0.232876453	0.235079177	0.233	0	0	0.233	0.231802028	0	0	0	0	0	0	0	0											NO	0.063108255	0.063874299	0.136413676	0	0.183679036	0.183679036	0.183679036	0.081915718	0.183679036	0.183679036	0.183679036	0	0.183679036	0.183679036	0.177584006	0.182818233	0.184547468	0.182915223	0	0	0.183679036	0.183309961	0	0	0	0	0	0	0	0												20.7602	1.383308064	4.057753551	0	2.206195982	3.882222678	4.404822633	2.282659176	8.592522063	3.853270193	8.232756425	0	0.026705609	4.314710138	6.040092855	21.76103677	1.728596705	1.131379723	0	0	4.592806366	1.192846982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4439	0	27.12805276	20.7602	1.383308064	4.057753551	0	2.206195982	3.882222678	4.404822633	2.282659176	8.592522063	3.853270193	8.232756425	0	0.026705609	4.314710138	6.040092855	21.76103677	1.728596705	1.131379723	0	0	4.592806366	1.192846982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4439	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	5.7856	0.3855	0.7385	1.082	0.582	1.0241	1.1247	0.4182	2.2667	0	1.7164	0	0.0049	0.937	1.931	7.3452	0.578	0.3817	0	0	1.5493	0.4026	0	0.1	0.0646	0	0	0	0	0											28.4178	0	7.63770818	26.5457	1.768815517	4.796214791	1.082021779	2.788179382	4.906333488	5.529524419	2.700823257	10.85918615	3.853270193	9.949141741	0	0.031647984	5.251702478	7.971110644	29.10621555	2.306553722	1.513032557	0	0	6.142116054	1.595445634	0	0.1	0.06458404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.8617
H3916_001_0	2011	11																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	319.0891257	0	517.4927572	0	158.0682851	13.77506859	0	392.9559763	497.2251229	0	2111.971433	0	0	763.9054124	3782.841701	7665.721735	0	0	0	0	73.60424907	0	46.93293729	7.671428571	329.5090672	0			0	0											3400	"(1a), (1b) $100 per admit"		(2) $50 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) $50"	( 8a) $0	"( 8b) X-Ray and Diag. X-Ray $10 - $50, Therapeutic Services $0"			"(3) $25, (5) $0, (9c) $25, (9d) $0, (12) $0, (13a) $0"	"(7a) $10-$25, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $25, (14b-j) $0, (16b), (18a) $25, (17a) $0-$25"					(15) 0-10% ($300 quarterly max)		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $25, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												100	0	50	0	100	0.15	0	50	50	0	17.42819228	0	0	25	10	25	0	0	0	0	0.1	0	40	0.3	25	0		0	0	0											NO	97.66950516	0	40.58959704	0	86.96145716	0.139703899	0	49.0185168	49.03971228	0	17.27771919	0	0	23.93944139	9.948257734	24.86390647	0	0	0	0	0.041492363	0	34.78458286	0.3	25	0		0	0	0												2.5971	0	1.750401874	0	1.145487367	1.924430792	0	1.605176594	2.031981414	0	3.040837446	0	0	1.523955737	3.136057018	15.88331569	0	0	0	0	3.054014209	0	0.136045221	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8167		5.412678641	2.5971	0	1.750401874	0	1.145487367	1.924430792	0	1.605176594	2.031981414	0	3.040837446	0	0	1.523955737	3.136057018	15.88331569	0	0	0	0	3.054014209	0	0.136045221	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8167	YES	"(1a), (1b)  20%"		(2) 20%	(6) 20%	"(10a) $100 emergency, 20% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) 20%"	( 8a) 20%	( 8b) 20%			"(3), (5), (9c), (9d), (12), (13a) 20%"	"(7a) 20%, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 20%, (14b-j) $0, (16b) 20%, (18a) 20%-50%, (17a) 20%"					(15) 0-20%		(10b) 50%	"(16a), (16b) 50%"	"(17a) 20%, (17b) 20%"			"(18b) $0, $500 allowance/3 years"	"(14a) $500 deductible, 50%"	(13e) 20%											5100	1.0373	0	0.0424	0.0349	0.7195	0.0308	0	0.0034	0.1459	0.4538	0.1143	0	0	0.0437	0.346	0.8364	0	0	0	0	0.0985		0																		3.9068	500	0.56938469	3.6344	0	1.792851586	0.034871228	1.864940644	1.955256179	0	1.608622495	2.177890051	0.453771753	3.155109729	0	0	1.567641878	3.482012737	16.71967377	0	0	0	0	3.15254608	0	0.136045221	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7236
H3916_002_0	2011	11																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	264.430009	0	454.9527085	0	86.25405232	12.13224792	0	371.3500843	509.8905148	0	2117.469685	0	0	930.5099417	4032.407011	6496.076268	0	0	0	0	65.40573107	0	25.61017238	7.671428571	329.5090672	0			0	0											3400	"(1a), (1b) $100 per admit"		(2) $50 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) $50"	( 8a) $0	"( 8b) X-Ray and Diag. X-Ray $10 - $50, Therapeutic Services $0"			"(3) $25, (5) $0, (9c) $25, (9d) $0, (12) $0, (13a) $0"	"(7a) $10-$25, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $25, (14b-j) $0, (16b), (18a) $25, (17a) $0-$25"					(15) 0-10% ($300 quarterly max)		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $25, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												100	0	50	0	100	0.15	0	50	50	0	17.28674008	0	0	25	10	25	0	0	0	0	0.1	0	40	0.3	25	0		0	0	0											NO	98.3895059	0	40.42363022	0	84.10385248	0.141279002	0	49.12791005	49.80463445	0	17.10914014	0	0	24.05960034	9.960219648	24.85956801	0	0	0	0	0.043332277	0	33.64154099	0.3	25	0		0	0	0												2.1681	0	1.532570005	0	0.604524841	1.714031874	0	1.520304461	2.116242558	0	3.019007132	0	0	1.865641443	3.346971629	13.45747082	0	0	0	0	2.834179285	0	0.071797139	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2387		4.604070514	2.1681	0	1.532570005	0	0.604524841	1.714031874	0	1.520304461	2.116242558	0	3.019007132	0	0	1.865641443	3.346971629	13.45747082	0	0	0	0	2.834179285	0	0.071797139	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2387	YES	"(1a), (1b)  20%"		(2) 20%	(6) 20%	"(10a) $100 emergency, 20% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) 20%"	( 8a) 20%	( 8b) 20%			"(3), (5), (9c), (9d), (12), (13a) 20%"	"(7a) 20%, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 20%, (14b-j) $0, (16b) 20%, (18a) 20%-50%, (17a) 20%"					(15) 0-20%		(10b) 50%	"(16a), (16b) 50%"	"(17a) 20%, (17b) 20%"			"(18b) $0, $500 allowance/3 years"	"(14a) $500 deductible, 50%"	(13e) 20%											5100	2.4562	0	0	0.0822	0.8737	0.0541	0	0.0009	0.3065	0.5517	0.2625	0	0	0.1089	0.2293	0.6742	0	0	0	0	0.1004		0																		5.7005	500	1.789568943	4.6243	0	1.532570005	0.0821841	1.478206602	1.768157657	0	1.521232613	2.422738389	0.55171141	3.28147377	0	0	1.974521426	3.576222747	14.1316603	0	0	0	0	2.934580213	0	0.071797139	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9393
H3916_005_0	2011	11																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	0	0	404.2265619	0	50.19256641	12.95906038	0	346.56015	0	0	0	0	0	865.2261089	4711.889391	6948.571621	0	0	0	0	57.25648308	0	4.960355077	7.671428571	329.5090672	0			0	0											3400	"(1a), (1b) $0"		(2) $25 per day (days 16-75)	(6) $0	(10a)  $50	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) $0"	( 8a) $0	"( 8b) X-Ray and Diag. X-Ray, Therapeutic Services $0"			"(3) $25, (5) $0, (9c) $25, (9d) $0, (12) $0, (13a) $0"	"(7a) $10-$25, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $25, (14b-j) $0, (16b), (18a) $25, (17a) $0-$25"					(15) 0-10% ($300 quarterly max)		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $25, (17b) $0"			"(18b) $0, $1,000 allowance/3 years"	(14a) $0	(13e) $0												0	0	25	0	50	0.15	0	50	0	0	0	0	0	25	10	25	0	0	0	0	0.1	0	40	0.3	25	0		0	0	0											NO	0	0	23.76514454	0	48.02615029	0.138005779	0	49.28509111	0	0	0	0	0	24.50741778	9.966598898	24.85831575	0	0	0	0	0.043293749	0	38.42092023	0.3	25	0		0	0	0												0	0	0.800541889	0	0.200879645	1.788425218	0	1.423354048	0	0	0	0	0	1.767038144	3.913459301	14.39414895	0	0	0	0	2.478847798	0	0.015881784	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.7705		3.607026885	0	0	0.800541889	0	0.200879645	1.788425218	0	1.423354048	0	0	0	0	0	1.767038144	3.913459301	14.39414895	0	0	0	0	2.478847798	0	0.015881784	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.7705	YES	"(1a), (1b)  20%"		(2) 20%	(6) 20%	"(10a) $50 emergency, 20% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) 20%"	( 8a) 20%	( 8b) 20%			"(3), (5), (9c), (9d), (12), (13a) 20%"	"(7a) 20%, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 20%, (14b-j) $0, (16b) 20%, (18a) 20%-50%, (17a) 20%"					(15) 0-20%		(10b) 50%	"(16a), (16b) 50%"	"(17a) 20%, (17b) 20%"			"(18b) $0, $1,000 allowance/3 years"	"(14a) $500 deductible, 50%"	(13e) 20%											5100	2.3772	0	0.3658	0.0932	0.6675	0.0938	0	0.0016	1.024	1.0071	0.4312	0	0	0.1805	0.7371	1.8535	0	0	0	0	0.3008		0																		9.1335	500	1.408456887	2.3772	0	1.166330943	0.093236332	0.868389393	1.882252489	0	1.424909899	1.024037109	1.00712295	0.431235464	0	0	1.947564276	4.650579555	16.24768186	0	0	0	0	2.779626023	0	0.015881784	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.904
H3916_012_0	2011	9																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	251.6817922	0	567.345577	0	57.17150909	8.128335397	0	374.4642178	403.8816203	4280.619828	1309.028244	0	0	559.8803445	3909.198934	4994.493344	0	0	0	0	43.88700859	0	5.650059474	0	329.5090672	0			0	0											3400	"(1a), (1b) $250 per admit"		(2) $35 per day (days 16-75)	(6) $0	(10a)  $75	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) $50"	( 8a) $0-$50	"( 8b) X-Ray and Diag. X-Ray $15-$50, Therapeutic Services $0"			"(3) $25, (5) $0, (9c) $25, (9d) $0, (12) $0, (13a) $0"	"(7a) $15-$25, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $25, (14b-j) $0, (16b), (18a) $25, (17a) $0-$25"					(15) 0-10% ($300 quarterly max)		(10b) $40		"(17a) $25, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												250	0	35	0	75	0.15	0	50	50	15	21.10465272	0	0	25	15	25	0	0	0	0	0.1	0	40		25	0		0	0	0											NO	234.9280342	0	31.46941283	0	68.55484157	0.138796591	0	48.22608755	49.26528477	14.85012994	20.61400996	0	0	24.13274707	14.87938091	24.76910755	0	0	0	0	0.041512486	0	36.56258217		25	0		0	0	0												4.9273	0	1.487836015	0	0.326615312	1.128185243	0	1.504912013	1.65811192	5.29731339	2.248693439	0	0	1.125954229	4.847205001	10.30909524	0	0	0	0	1.821858851	0	0.017215064	0	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3867		3.564855675	4.9273	0	1.487836015	0	0.326615312	1.128185243	0	1.504912013	1.65811192	5.29731339	2.248693439	0	0	1.125954229	4.847205001	10.30909524	0	0	0	0	1.821858851	0	0.017215064	0	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3867	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $75 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) 30%"	( 8a) 30%	( 8b) 30%			"(3), (5), (9c), (9d), (12), (13a) 30%"	"(7a) 30%, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 30%, (14b-j) $0, (16b), (18a) 30%, (17a) 30%"					(15) 0-30%		(10b) 50%		"(17a) 30%, (17b) 30%"			"(18b) $0, $500 allowance/3 years"	"(14a) $500 deductible, 50%"	(13e) 30%											5100	2.2445	0	0.7376	0.087	1.0868	0.0691	0	0.0051	1.3748	1.0533	0.4716	0	0	0.2825	0.7344	1.5036	0	0	0	0	0.1254		0																		9.7758	500	3.297025493	7.1718	0	2.225412216	0.087029557	1.413402602	1.197322717	0	1.510027361	3.032949225	6.350577109	2.720326452	0	0	1.408491097	5.581593823	11.81268004	0	0	0	0	1.94721305	0	0.017215064	0	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1625
H3916_015_0	2011	11																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	251.3106948	0	472.7707899	0	51.74374522	8.195149848	0	312.0814497	467.371727	0	1626.615851	0	0	753.4857981	4246.123478	5782.248311	0	0	0	0	43.46471329	0	5.113652632	0	329.5090672	0			0	0											3400	"(1a), (1b) $100 per admit"		(2) $25 per day (days 16-75)	(6) $0	(10a)  $75	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) $50"	( 8a) $0	"( 8b) X-Ray and Diag. X-Ray $10 - $50, Therapeutic Services $0"			"(3) $25, (5) $0, (9c) $25, (9d) $0, (12) $0, (13a) $0"	"(7a) $15-$25, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $25, (14b-j) $0, (16b), (18a) $25, (17a) $0-$25"					(15) 0-10% ($300 quarterly max)		(10b) $40		"(17a) $25, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												100	0	25	0	75	0.15	0	50	50	0	17.07820804	0	0	25	15	25	0	0	0	0	0.1	0	40		25	0		0	0	0											NO	97.65855889	0	22.4646307	0	69.86831725	0.145506678	0	49.22220356	49.19263239	0	16.86854689	0	0	24.3643739	14.88956276	24.67314914	0	0	0	0	0.048050993	0	37.26310254		25	0		0	0	0												2.0452	0	0.885051767	0	0.301270701	1.19244903	0	1.280111387	1.91593713	0	2.286553812	0	0	1.52985081	5.268576836	11.88885624	0	0	0	0	2.088522628	0	0.015879214	0	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3848		2.787228361	2.0452	0	0.885051767	0	0.301270701	1.19244903	0	1.280111387	1.91593713	0	2.286553812	0	0	1.52985081	5.268576836	11.88885624	0	0	0	0	2.088522628	0	0.015879214	0	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3848	YES	"(1a), (1b)  20%"		(2) 20%	(6) 20%	"(10a) $75 emergency, 20% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) 20%"	( 8a) 20%	( 8b) 20%			"(3), (5), (9c), (9d), (12), (13a) 20%"	"(7a) 20%, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 20%, (14b-j) $0, (16b), (18a) 20%, (17a) 20%"					(15) 0-20%		(10b) 50%		"(17a) 20%, (17b) 20%"			"(18b) $0, $500 allowance/3 years"	"(14a) $500 deductible, 50%"	(13e) 20%											5100	2.2756	0	0.3942	0.1623	0.9207	0.0692	0	0.0012	0.988	0.7499	0.3223	0	0	0.1892	0.4841	1.156	0	0	0	0	0.1442		0																		7.8568	500	1.925065908	4.3209	0	1.279257159	0.162255623	1.222002356	1.261666377	0	1.281277749	2.903889393	0.749867957	2.608872951	0	0	1.719017098	5.752628363	13.04485099	0	0	0	0	2.232702112	0	0.015879214	0	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2415
H3916_018_0	2011	11																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	176.055523	0	311.3591128	0	38.64463356	8.24023514	0	325.891091	317.0232489	3825.429404	1315.816669	0	0	494.2717472	3510.025276	4086.107399	0	0	0	0	36.64447402	0	3.819113427	0	329.5090672	0			0	0											3400	"(1a), (1b) $250 per admit"		(2) $50 per day (days 16-75)	(6) $0	(10a)  $75	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $35-$50"	"(9a), (9b) $100"	( 8a) $0-$50	"( 8b) X-Ray and Diag. X-Ray $15 - $50, Therapeutic Services $0"			"(3) $35, (5) $0, (9c) $35, (9d) $0, (12) $0, (13a) $0"	"(7a) $15-$35, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $35, (14b-j) $0, (16b), (18a) $35, (17a) $0-$35"					(15) 0-10% ($300 quarterly max)		(10b) $40		"(17a) $35, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												250	0	50	0	75	0.15	0	50	100	15	21.3306605	0	0	35	15	35	0	0	0	0	0.1	0	40		35	0		0	0	0											NO	232.7752868	0	39.90278929	0	65.77144263	0.134742118	0	47.73088934	98.68375984	14.64194095	20.88461462	0	0	30.54056945	14.82928157	34.24899099	0	0	0	0	0.036710708	0	35.07810274		35	0		0	0	0												3.4151	0	1.035341423	0	0.211809442	1.110306734	0	1.296255967	2.60708718	4.667642621	2.290027004	0	0	1.257945052	4.337596094	11.66208796	0	0	0	0	1.345244572	0	0.011163938	0	0.961068113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2087		3.782058569	3.4151	0	1.035341423	0	0.211809442	1.110306734	0	1.296255967	2.60708718	4.667642621	2.290027004	0	0	1.257945052	4.337596094	11.66208796	0	0	0	0	1.345244572	0	0.011163938	0	0.961068113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2087	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $75 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $35-$50"	"(9a), (9b) 30%"	( 8a) 30%	( 8b) 30%			"(3), (5), (9c), (9d), (12), (13a) 30%"	"(7a) 30%, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 30%, (14b-j) $0, (16b), (18a) 30%, (17a) 30%"					(15) 0-30%		(10b) 50%		"(17a) 30%, (17b) 30%"			"(18b) $0, $500 allowance/3 years"	"(14a) $500 deductible, 50%"	(13e) 30%											5100	3.3839	0	0.6226	0.2166	0.6391	0.1122	0	0.0024	1.4243	1.0738	0.6667	0	0	0.2462	0.8335	1.7202	0	0	0	0	0.1626		0																		11.1042	500	5.354611489	6.799	0	1.65797112	0.216634041	0.85091065	1.222511352	0	1.298610253	4.031427901	5.741485903	2.956686422	0	0	1.504115442	5.171046887	13.38233056	0	0	0	0	1.507893472	0	0.011163938	0	0.961068113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3129
H3916_019_0	2011	11																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	Coin	V	P	V	P													4.904401128	0	0.343672508	0.83243992	0	2.059754018	0	0	7.676539042	5.288082335	12.16692152	0	0	2.976698317	0	4.901807538	0	0	0	23.72214666	2.20608668	0	0	0	0	0	0	0	0	0											67.0785	YES	0	0	0	0	108.5026671	0	0	413.8069716	0	0	0	0	0	0	2978.590382	5404.712063	0	0	0	0	0	0	32.21613284	7.671428571	329.5090672	0			0	0											3400	"(1a), (1b) $0"		(2) $0	(6) $0	(10a)  $75	"(11a), (11b), (11c) $0"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) $0"	( 8a) $0	"( 8b) X-Ray and Diag. X-Ray $0, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $0, (9d) $0, (12) $0, (13a) $0"	"(7a) $15-$25, (14c-j) $0"	"(7b), (7c) $0, (7d) $25, (7f), (7g) $0, (7h) $25, (7i) $0, (14b-j) $0, (16b), (18a) $0, (17a) $0-$25"				"(7g) $0, (14b) $0, (14e-j) $0, (18a) $25"	(15) $0		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $25, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0											1450	0	0	0	0	75	0	0	50	0	0	0	0	0	0	15	25	0	0	0	0	0	0	40	0.3	25	0		0	0	0											NO	0	0	0	0	71.09282482	0	0	49.53606314	0	0	0	0	0	0	14.96967432	24.92922635	0	0	0	0	0	0	37.91617324	0.3	25	0		0	0	0												0	0	0	0	0.642813425	0	0	1.708197356	0	0	0	0	0	0	3.715710662	11.22794087	0	0	0	0	0	0	0.101792706	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.3844	1450	0.096324255	4.9044	0	0.343672508	0.83243992	0.642813425	2.059754018	0	1.708197356	7.676539042	5.288082335	12.16692152	0	0	2.976698317	3.715710662	16.1297484	0	0	0	23.72214666	2.20608668	0	0.101792706	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.4629	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $75 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) 30%"	( 8a) 30%	( 8b) 30%			"(3), (5), (9c), (9d), (12), (13a) 30%"	"(7a) 30%, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 30%, (14b-j) $0, (16b) 30%, (18a) 30%-50%, (17a) 30%"				"(7g) 30%, (14b) $0, (14e-j) $0, (18a) 30%"	(15) 0-30%		(10b) 50%	"(16a), (16b) 50%"	"(17a) 30%, (17b) 30%"			"(18b) $0, $500 allowance/3 years"	(14a) 50%	(13e) 30%											5100	0.5382	0	0	0.0517	0.3387	0.0795	0	0.0017	0.0587	0.0535	0.2951	0	0	0.0292	0.2306	0.5801	0	0	0	0.7824	0.0287		0																		3.0682	1450	0.657796394	5.4426	0	0.343672508	0.884132693	0.98148517	2.139260427	0	1.709892179	7.735277665	5.341560805	12.46202002	0	0	3.005918049	3.94632154	16.70982	0	0	0	24.50456795	2.234830171	0	0.101792706	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5311
H3916_020_0	2011	11																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	Coin	V	P	V	P													3.64530353	0	0.20615389	0.888092321	0	2.03385454	0	0	8.010863268	5.743496109	11.5122324	0	0	4.617798136	0	3.959656264	0	0	0	16.84478183	2.03517705	0	0	0	0	0	0	0	0	0											59.4974	YES	0	0	0	0	109.6933707	0	0	372.8608779	0	0	0	0	0	0	3161.73543	4252.344062	0	0	0	0	0	0	32.56967129	7.671428571	329.5090672	0			0	0											3400	"(1a), (1b) $0"		(2) $0	(6) $0	(10a)  $75	"(11a), (11b), (11c) $0"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) $0"	( 8a) $0	"( 8b) X-Ray and Diag. X-Ray $0, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $0, (9d) $0, (12) $0, (13a) $0"	"(7a) $15-$25, (14c-j) $0"	"(7b), (7c) $0, (7d) $25, (7f), (7g) $0, (7h) $25, (7i) $0, (14b-j) $0, (16b), (18a) $0, (17a) $0-$25"				"(7g) $0, (14b) $0, (14e-j) $0, (18a) $25"	(15) $0		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $25, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0											1250	0	0	0	0	75	0	0	50	0	0	0	0	0	0	15	25	0	0	0	0	0	0	40	0.3	25	0		0	0	0											NO	0	0	0	0	72.49486023	0	0	49.56713922	0	0	0	0	0	0	14.86162907	24.79328502	0	0	0	0	0	0	38.66392546	0.3	25	0		0	0	0												0	0	0	0	0.662683798	0	0	1.540137254	0	0	0	0	0	0	3.915711597	8.785798196	0	0	0	0	0	0	0.104939279	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.9972	1250	0.149685423	3.6453	0	0.20615389	0.888092321	0.662683798	2.03385454	0	1.540137254	8.010863268	5.743496109	11.5122324	0	0	4.617798136	3.915711597	12.74545446	0	0	0	16.84478183	2.03517705	0	0.104939279	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.4946	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $75 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) 30%"	( 8a) 30%	( 8b) 30%			"(3), (5), (9c), (9d), (12), (13a) 30%"	"(7a) 30%, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 30%, (14b-j) $0, (16b) 30%, (18a) 30%-50%, (17a) 30%"				"(7g) 30%, (14b) $0, (14e-j) $0, (18a) 30%"	(15) 0-30%		(10b) 50%	"(16a), (16b) 50%"	"(17a) 30%, (17b) 30%"			"(18b) $0, $500 allowance/3 years"	(14a) 50%	(13e) 30%											5100	1.7339	0	0	0.039	0.3588	0.0601	0	0.0027	0.312	0.1971	0.4644	0	0	0.2199	0.1054	0.6532	0	0	0	0.8415	0.0297		0																		5.0177	1250	1.331440946	5.3792	0	0.20615389	0.927101547	1.021459495	2.094004435	0	1.54281606	8.322847206	5.940589419	11.97664546	0	0	4.837691872	4.02112122	13.39865249	0	0	0	17.68624812	2.064874563	0	0.104939279	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5123
H3916_022_0	2011	11																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	227.6850999	0	322.9767622	0	96.3661756	10.35564949	0	331.666173	407.439516	3831.986112	1635.676159	0	0	444.7240069	3241.317102	5986.820009	0	0	0	0	34.49323925	0	28.61261937	0	329.5090672	0			0	0											3400	"(1a), (1b) $200 per admit"		(2) $60 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $30-$50"	"(9a), (9b) $100"	( 8a) $0-$50	"( 8b) X-Ray and Diag. X-Ray $20 - $50, Therapeutic Services $0"			"(3) $30, (5) $0, (9c) $30, (9d) $0, (12) $0, (13a) $0"	"(7a) $20-$30, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $30, (14b-j) $0, (16b), (18a) $30, (17a) $0-$30"					(15) 0-10% ($300 quarterly max)		(10b) $40		"(17a) $30, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												200	0	60	0	100	0.15	0	50	100	20	25.35051681	0	0	30	20	30	0	0	0	0	0.1	0	40		30	0		0	0	0											NO	191.8157347	0	32.42866833	0	85.72947212	0.139408631	0	48.42089861	99.08734199	19.84051138	25.04547481	0	0	28.8246388	19.92813674	29.81057549	0	0	0	0	0.05276357	0	34.29178885		30	0		0	0	0												3.6395	0	0.872808858	0	0.68845178	1.443666915	0	1.338297845	3.364341555	6.335713672	3.41385717	0	0	1.068250739	5.382784203	14.87254582	0	0	0	0	1.81998643	0	0.081764825	0	0.823772668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1457		3.253712245	3.6395	0	0.872808858	0	0.68845178	1.443666915	0	1.338297845	3.364341555	6.335713672	3.41385717	0	0	1.068250739	5.382784203	14.87254582	0	0	0	0	1.81998643	0	0.081764825	0	0.823772668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1457	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $100 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $30-$50"	"(9a), (9b) 30%"	( 8a) 30%	( 8b) 30%			"(3), (5), (9c), (9d), (12), (13a) 30%"	"(7a) 30%, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 30%, (14b-j) $0, (16b), (18a) 30%, (17a) 30%"					(15) 0-30%		(10b) 50%		"(17a) 30%, (17b) 30%"			"(18b) $0, $500 allowance/3 years"	"(14a) $500 deductible, 50%"	(13e) 30%											5100	0.5166	0	0	0.0428	0.3538	0.0056	0	0	0.0751	0.3665	0.0908	0	0	0.0176	0.2777	0.6241	0	0	0	0	0.0361		0																		2.4065	500	0.112710992	4.1561	0	0.872808858	0.042759327	1.042203022	1.449315405	0	1.338297845	3.439426435	6.702175216	3.504635041	0	0	1.085837523	5.660440255	15.49667141	0	0	0	0	1.856058916	0	0.081764825	0	0.823772668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5522
H3916_024_0	2011	11																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	199.4587889	0	184.4894888	0	73.36806727	13.85074659	0	375.2181905	409.6998372	3655.690434	1578.429275	0	0	555.1234515	3459.226176	4438.379319	0	0	0	0	29.38181062	0	21.78412259	0	329.5090672	0			0	0											3400	"(1a), (1b) $200 per admit"		(2) $60 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $30-$50"	"(9a), (9b) $100"	( 8a) $0-$50	"( 8b) X-Ray and Diag. X-Ray $20 - $50, Therapeutic Services $0"			"(3) $30, (5) $0, (9c) $30, (9d) $0, (12) $0, (13a) $0"	"(7a) $20-$30, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $30, (14b-j) $0, (16b), (18a) $30, (17a) $0-$30"					(15) 0-10% ($300 quarterly max)		(10b) $40		"(17a) $30, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												200	0	60	0	100	0.15	0	50	100	20	25.39538472	0	0	30	20	30	0	0	0	0	0.1	0	40		30	0		0	0	0											NO	197.0429988	0	35.95443506	0	90.42470701	0.127844071	0	49.79032665	98.7620212	19.78695367	25.20531919	0	0	27.65246666	19.9331338	29.82984064	0	0	0	0	0.052778875	0	36.1698828		30	0		0	0	0												3.2752	0	0.552767945	0	0.552857166	1.770735832	0	1.556853022	3.371898667	6.027914771	3.315401142	0	0	1.279211061	5.746101517	11.03301231	0	0	0	0	1.550738898	0	0.065660763	0	0.823772668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.9221		2.51844655	3.2752	0	0.552767945	0	0.552857166	1.770735832	0	1.556853022	3.371898667	6.027914771	3.315401142	0	0	1.279211061	5.746101517	11.03301231	0	0	0	0	1.550738898	0	0.065660763	0	0.823772668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.9221	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $100 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $30-$50"	"(9a), (9b) 30%"	( 8a) 30%	( 8b) 30%			"(3), (5), (9c), (9d), (12), (13a) 30%"	"(7a) 30%, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 30%, (14b-j) $0, (16b), (18a) 30%, (17a) 30%"					(15) 0-30%		(10b) 50%		"(17a) 30%, (17b) 30%"			"(18b) $0, $500 allowance/3 years"	"(14a) $500 deductible, 50%"	(13e) 30%											5100	2.2883	0	0	0.0482	0.5558	0.0692	0	0.0021	0.4339	0.6477	0.378	0	0	0.0324	0.1311	0.6252	0	0	0	0	0.0897		0																		5.3017	500	1.358955667	5.5634	0	0.552767945	0.048209387	1.10868633	1.83992894	0	1.558990899	3.805782768	6.675653066	3.693438603	0	0	1.311652919	5.87717132	11.65824338	0	0	0	0	1.640399381	0	0.065660763	0	0.823772668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2238
H3916_025_0	2011	11																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	Coin	V	P	V	P													3.521973818	0	0.235031537	0.333236075	0	1.701641854	0	0	6.680322943	6.851273992	12.78519666	0	0	3.442615884	0	4.55792637	0	0	0	19.56517231	1.619913503	0	0	0	0	0	0	0	0	0											61.2943	YES	0	0	0	0	49.17356669	0	0	378.237413	0	0	0	0	0	0	3522.878298	4563.253769	0	0	0	0	0	0	4.859650913	7.671428571	329.5090672	0			0	0											3400	"(1a), (1b) $0"		(2) $0	(6) $0	(10a)  $75	"(11a), (11b), (11c) $0"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) $0"	( 8a) $0	"( 8b) X-Ray and Diag. X-Ray, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $0, (9d) $0, (12) $0, (13a) $0"	"(7a) $15-$25, (14c-j) $0"	"(7b), (7c) $0, (7d) $25, (7f), (7g) $0, (7h) $25, (7i) $0, (14b-j) $0, (16b), (18a) $0, (17a) $0-$25"				"(7g) $0, (14b) $0, (14e-j) $0, (18a) $25"	(15) $0		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $25, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0											1300	0	0	0	0	75	0	0	50	0	0	0	0	0	0	15	25	0	0	0	0	0	0	40	0.3	25	0		0	0	0											NO	0	0	0	0	67.24816351	0	0	46.15959366	0	0	0	0	0	0	14.85316676	24.67945522	0	0	0	0	0	0	35.86568721	0.3	25	0		0	0	0												0	0	0	0	0.275569338	0	0	1.454940441	0	0	0	0	0	0	4.360491571	9.384884752	0	0	0	0	0	0	0.01452456	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.4783	1300	0.319488746	3.522	0	0.235031537	0.333236075	0.275569338	1.701641854	0	1.454940441	6.680322943	6.851273992	12.78519666	0	0	3.442615884	4.360491571	13.94281112	0	0	0	19.56517231	1.619913503	0	0.01452456	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.7726	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $75 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) 30%"	( 8a) 30%	( 8b) 30%			"(3), (5), (9c), (9d), (12), (13a) 30%"	"(7a) 30%, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 30%, (14b-j) $0, (16b) 30%, (18a) 30%-50%, (17a) 30%"				"(7g) 30%, (14b) $0, (14e-j) $0, (18a) 30%"	(15) 0-30%		(10b) 50%	"(16a), (16b) 50%"	"(17a) 30%, (17b) 30%"			"(18b) $0, $500 allowance/3 years"	(14a) 50%	(13e) 30%											5100	1.4514	0	0.1005	0.0602	0.5136	0.0178	0	0.0026	0.918	0.2236	0.8587	0	0	0.4735	0.6982	1.5114	0	0	0	2.6067	0.2401		0																		9.6762	1300	4.810777061	4.9733	0	0.335499676	0.393402192	0.789200099	1.719485661	0	1.457496047	7.598366242	7.074864272	13.64386684	0	0	3.916099964	5.05864581	15.4541655	0	0	0	22.17187837	1.860042648	0	0.01452456	2.301428571	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4488
H3916_026_0	2011	11																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	0	0	603.5535502	0	231.5029015	20.1231205	0	0	0	0	0	0	0	1005.973494	0	9814.057075	0	0	0	0	102.8112526	0	68.73681936	7.671428571	329.5090672	0			0	0											3400	"(1a), (1b) $0"		(2) $25 per day (days 16-75)	(6) $0	(10a)  $25	"(11a), (11b), (11c) 0-15%"		"(4a) $0, (4b) $0-$10"	"(9a), (9b) $0"	( 8a) $0	"( 8b) X-Ray and Diag. X-Ray $0, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $10, (9d) $0, (12) $0, (13a) $0"	"(7a) $0-$10, (14c-j) $0"	"(7b) $10, (7c) $0, (7d), (7e), (7f), (7g), (7h) $10, (7i) $0, (14b-j) $0, (16b), (18a) $10, (17a) $0-$10"					(15) 0-10% ($300 quarterly max)		(10b) $10	"(16a) 30%, (16b) 40%"	"(17a) $10, (17b) $0"			"(18b) $0, $1,000 allowance/3 years"	(14a) $0	(13e) $0												0	0	25	0	25	0.15	0	0	0	0	0	0	0	10	0	10	0	0	0	0	0.1	0	10	0.3	10	0		0	0	0											NO	0	0	24.77006388	0	24.73474801	0.14510661	0	0	0	0	0	0	0	9.866432181	0	9.983487028	0	0	0	0	0.04555543	0	9.893899204	0.3	10	0		0	0	0												0	0	1.245838333	0	0.477180494	2.919997798	0	0	0	0	0	0	0	0.827114105	0	8.164875959	0	0	0	0	4.683610798	0	0.05667293	2.301428571	0.274590889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.9513		5.799755455	0	0	1.245838333	0	0.477180494	2.919997798	0	0	0	0	0	0	0	0.827114105	0	8.164875959	0	0	0	0	4.683610798	0	0.05667293	2.301428571	0.274590889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.9513	YES	"(1a), (1b)  20%"		(2) 20%	(6) 20%	"(10a) $25 emergency, 20% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $0, (4b) $0-$10"	"(9a), (9b) 20%"	( 8a) 20%	( 8b) 20%			"(3), (5), (9c), (9d), (12), (13a) 20%"	"(7a) 20%, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 20%, (14b-j) $0, (16b) 20%, (18a) 20%-50%, (17a) 20%"					(15) 0-20%		(10b) 50%	"(16a), (16b) 50%"	"(17a) 20%, (17b) 20%"			"(18b) $0, $1,000 allowance/3 years"	"(14a) $500 deductible, 50%"	(13e) 20%											5100	1.0966	0	0	0.0361	0.2009	0.0533	0	0	0.1343	0.6472	0.2025	0	0	0.0574	0.3558	1.0081	0	0	0	0	0.1138		0																		3.9059	500	0.148735724	1.0966	0	1.245838333	0.036052798	0.678075184	2.973272501	0	0	0.134251938	0.64718243	0.202459399	0	0	0.884520314	0.35583519	9.173006391	0	0	0	0	4.797438508	0	0.05667293	2.301428571	0.274590889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.8572
H3916_027_0	2011	11																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	0	0	863.6633942	0	156.6136623	19.95066431	0	0	0	0	0	0	0	1276.092693	0	8909.867006	0	0	0	0	83.22651785	0	46.50103711	7.671428571	329.5090672	0			0	0											3400	"(1a), (1b) $0"		(2) $25 per day (days 16-75)	(6) $0	(10a)  $25	"(11a), (11b), (11c) 0-15%"		"(4a) $0, (4b) $0-$10"	"(9a), (9b) $0"	( 8a) $0	"( 8b) X-Ray and Diag. X-Ray $0, Therapeutic Services $0"			"(3) $0, (5) $0, (9c) $10, (9d) $0, (12) $0, (13a) $0"	"(7a) $0-$10, (14c-j) $0"	"(7b) $10, (7c) $0, (7d), (7e), (7f), (7g), (7h) $10, (7i) $0, (14b-j) $0, (16b), (18a) $10, (17a) $0-$10"					(15) 0-10% ($300 quarterly max)		(10b) $10	"(16a) 30%, (16b) 40%"	"(17a) $10, (17b) $0"			"(18b) $0, $1,000 allowance/3 years"	(14a) $0	(13e) $0												0	0	25	0	25	0.15	0	0	0	0	0	0	0	10	0	10	0	0	0	0	0.1	0	10	0.3	10	0		0	0	0											NO	0	0	24.67871828	0	24.04969396	0.135954421	0	0	0	0	0	0	0	9.956380449	0	9.933499864	0	0	0	0	0.044055532	0	9.619877586	0.3	10	0		0	0	0												0	0	1.776175466	0	0.313875887	2.712381025	0	0	0	0	0	0	0	1.058772028	0	7.375513558	0	0	0	0	3.66658854	0	0.037277857	2.301428571	0.274590889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.5166		5.030534109	0	0	1.776175466	0	0.313875887	2.712381025	0	0	0	0	0	0	0	1.058772028	0	7.375513558	0	0	0	0	3.66658854	0	0.037277857	2.301428571	0.274590889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.5166	YES	"(1a), (1b)  20%"		(2) 20%	(6) 20%	"(10a) $25 emergency, 20% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $0, (4b) $0-$10"	"(9a), (9b) 20%"	( 8a) 20%	( 8b) 20%			"(3), (5), (9c), (9d), (12), (13a) 20%"	"(7a) 20%, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) 20%, (14b-j) $0, (16b) 20%, (18a) 20%-50%, (17a) 20%"					(15) 0-20%		(10b) 50%	"(16a), (16b) 50%"	"(17a) 20%, (17b) 20%"			"(18b) $0, $1,000 allowance/3 years"	"(14a) $500 deductible, 50%"	(13e) 20%											5100	2.389	0	0	0.0108	0.4451	0.0462	0	0	0.4029	0.7364	0.424	0	0	0.1158	0.4059	0.9226	0	0	0	0	0.1245		0																		6.0232	500	1.270150406	2.389	0	1.776175466	0.010846881	0.75898047	2.758611368	0	0	0.402883318	0.736401573	0.423952024	0	0	1.174549688	0.405884555	8.298075313	0	0	0	0	3.791126968	0	0.037277857	2.301428571	0.274590889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.5398
H3916_801_0	2011	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													0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	224.953845	0	52.03084655	22.33471766	3.397443854	22.07072045	0	16.87033796	41.26523559	11.97887502	46.15264647	0	0	22.95672514	25.22767549	39.62920016	0	0	0	127.0820275	51.40436952	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		"(4a), (4b) FFS"	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d), (12), (13a) FFS"	"(7a), (14c-j) FFS"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14b-j), (16b), (18a) (17a) FFS"				"(7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14a)	(13e)												0.078994108		0.175211848		0.233	0.233		0.233	0.233	0.233	0.233			0.233	0.233	0.233				0.233	0.233																				NO	0.068246223		0.151372642		0.201298176	0.201298176		0.201298176	0.201298176	0.201298176	0.201298176			0.201298176	0.201298176	0.201298176				0.201298176	0.201298176																					15.3523	0	7.876046688	0	0.683899252	4.442795778	0	3.395968266	8.306616672	2.411325696	9.290443569	0	0	4.621146907	5.078285071	7.977285724	0	0	0	25.58138039	10.34760584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3651		16.59361397	15.3523	0	7.876046688	0	0.683899252	4.442795778	0	3.395968266	8.306616672	2.411325696	9.290443569	0	0	4.621146907	5.078285071	7.977285724	0	0	0	25.58138039	10.34760584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.3651	YES	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		"(4a), (4b) FFS"	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d), (12), (13a) FFS"	"(7a), (14c-j) FFS"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14b-j) , (16b), (18a) (17a) FFS"				"(7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14a)	(13e)											10000	5.9629	0	0.4608	0	1.4817	0.0353	0	0.0144	2.3269	0.4475	1.7243	0	0	0.8577	1.1189	1.7576	0	0	0	5.6363	1.5383	0	0	0	0	0	0	0	0	0											23.3628		1.398351491	21.3151	0	8.336856802	0	2.165635038	4.478094823	0	3.410404781	10.63354437	2.858870798	11.01476166	0	0	5.478837623	6.19717254	9.734903682	0	0	0	31.21767012	11.88592953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.7278
H3916_802_0	2011	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													0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	276.6324016	0	58.32303707	28.14799516	7.94821363	28.77806419	0	17.13797282	46.58306137	16.06193368	53.91337437	0	0	26.27764307	27.94524163	41.87465886	0	0	0	152.3707183	69.30290348	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		"(4a), (4b) FFS"	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d), (12), (13a) FFS"	"(7a), (14c-j) FFS"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14b-j), (16b), (18a) (17a) FFS"				"(7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14a)	(13e)												0.085687905		0.174663873		0.233	0.233		0.233	0.233	0.233	0.233			0.233	0.233	0.233				0.233	0.233																				NO	0.074029266		0.150899224		0.201298176	0.201298176		0.201298176	0.201298176	0.201298176	0.201298176			0.201298176	0.201298176	0.201298176				0.201298176	0.201298176																					20.4789	0	8.800901032	0	1.599960909	5.792971841	0	3.449842675	9.377085304	3.233237959	10.85266394	0	0	5.289641631	5.62532618	8.429292465	0	0	0	30.67194772	13.95054809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.5523		20.08781706	20.4789	0	8.800901032	0	1.599960909	5.792971841	0	3.449842675	9.377085304	3.233237959	10.85266394	0	0	5.289641631	5.62532618	8.429292465	0	0	0	30.67194772	13.95054809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.5523	YES	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		"(4a), (4b) FFS"	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d), (12), (13a) FFS"	"(7a), (14c-j) FFS"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14b-j) , (16b), (18a) (17a) FFS"				"(7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14a)	(13e)											10000	0.9213	0	0.2038	0	0.944	0.0111	0	0.0026	0.3624	0.0652	0.319	0	0	0.1898	0.1681	0.3076	0	0	0	1.3876	0.1967	0	0	0	0	0	0	0	0	0											5.0791		0.304006318	21.4002	0	9.004673966	0	2.543945407	5.804031541	0	3.452451635	9.739437323	3.29844218	11.17162963	0	0	5.479447284	5.793472007	8.736845217	0	0	0	32.05959423	14.14727891	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.6315
H3916_804_0	2011	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													0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	274.5394463	0	57.94286357	27.83879138	7.64229712	28.38770251	0	17.10290071	46.36968068	15.45269991	53.66667048	0	0	26.38963843	27.81261386	42.32110977	0	0	0	150.6410363	68.38163574	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		"(4a), (4b) FFS"	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d), (12), (13a) FFS"	"(7a), (14c-j) FFS"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14b-j), (16b), (18a) (17a) FFS"				"(7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14a)	(13e)												0.084342794		0.174774101		0.233	0.233		0.233	0.233	0.233	0.233			0.233	0.233	0.233				0.233	0.233																				NO	0.07286717		0.150994454		0.201298176	0.201298176		0.201298176	0.201298176	0.201298176	0.201298176			0.201298176	0.201298176	0.201298176				0.201298176	0.201298176																					20.0049	0	8.749051055	0	1.538380474	5.714392747	0	3.442782724	9.33413216	3.110600312	10.8030029	0	0	5.312186092	5.598628451	8.51916222	0	0	0	30.3237659	13.76509857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.2161		19.87738034	20.0049	0	8.749051055	0	1.538380474	5.714392747	0	3.442782724	9.33413216	3.110600312	10.8030029	0	0	5.312186092	5.598628451	8.51916222	0	0	0	30.3237659	13.76509857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.2161	YES	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		"(4a), (4b) FFS"	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d), (12), (13a) FFS"	"(7a), (14c-j) FFS"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14b-j) , (16b), (18a) (17a) FFS"				"(7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14a)	(13e)											10000	1.116	0	0.2126	0	0.9443	0.0118	0	0.003	0.4381	0.1073	0.3727	0	0	0.1833	0.2659	0.4045	0	0	0	1.4399	0.2419	0	0	0	0	0	0	0	0	0											5.7414		0.3436471	21.1209	0	8.961663124	0	2.48272204	5.726183589	0	3.445829038	9.772231836	3.217923042	11.17573088	0	0	5.495468499	5.864481286	8.923697625	0	0	0	31.76370055	14.00702922	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.9575
H3920_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1526.332774	183.9091926	1082.954536	454.1971488	327.4754773	11.89324197	5.26273867	575.5831709	367.2705285	22.19840593	46.73230671	0	0.275898748	1104.47941	5886.82087	114.5408942	675.5024009	780.0418625	0	0	18.45662087	731.422142	711.7270997	336.3614816	207.2563259	213.4990513	17.21857854	22.5095321	513.5035659	0											4900	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-98 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $30 (4b)"	$150 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 5, 9d); $150 (9a); $35 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 17b); $0 n/c (13a1); $30 (16b, 18a); $0/$30 (17a)"	$0 (10b)	"$30 (16a1, 16a2); $0 n/c (16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a6); $0 n/c (14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	49.99184553	0	200	0.2	0.179853281	50	150	0.048195467	0.161457007	0	0.2	58.70159486	6.599219365	0.092691249	30	30	0	0	0.2	29.76918734	0	30	30	30	30	0	0	0											NO	149.8743546	100.2515279	40.22836827	0	160.9397206	0.160939721	0.144727684	40.24317184	120.7047905	0.038782825	0.129924228	0	0.160939721	47.23709138	6.383831933	0.089666951	29.02085041	29.02085041	0	0	0.160939721	23.95522347	0	30	30	30	30	0	0	0												19.0632	1.536431464	3.630457826	0	4.391984319	1.914095039	0.761663981	1.930274371	3.694276016	0.860916886	6.071658876	0	0.044403067	4.34769957	3.131706255	10.27053281	1.633637844	1.886456517	0	0	2.970403407	1.460115072	0	0.840903704	0.518140815	0.533747628	0.043046446	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5357	0	13.35525489	19.0632	1.536431464	3.630457826	0	4.391984319	1.914095039	0.761663981	1.930274371	3.694276016	0.860916886	6.071658876	0	0.044403067	4.34769957	3.131706255	10.27053281	1.633637844	1.886456517	0	0	2.970403407	1.460115072	0	0.840903704	0.518140815	0.533747628	0.043046446	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5357	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.0632	1.536431464	3.630457826	0	4.391984319	1.914095039	0.761663981	1.930274371	3.694276016	0.860916886	6.071658876	0	0.044403067	4.34769957	3.131706255	10.27053281	1.633637844	1.886456517	0	0	2.970403407	1.460115072	0	0.840903704	0.518140815	0.533747628	0.043046446	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5357
H3920_007_0	2011	1																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1440.337738	181.981022	988.1402422	397.1471246	310.0688937	9.313817911	4.905735955	559.7004069	41.14138656	20.20970634	43.17752349	0	0.196776487	21.69937834	5225.254007	106.8979834	530.0447264	638.0648961	0	0	15.91570296	645.0330862	0	0	209.453566	0	17.27602589	19.90979071	515.0521124	0											4600	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-92 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $30 (4b)"	20% (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 5, 9c, 9d); 20% (9a)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$25 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 17b); $0 n/c (13a1); $30 (16b, 18a); $0/$30 (17a)"	$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a6); $0 n/c (14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	49.87935666	0	200	0.2	0.181354471	50	0.2	0.048050477	0.162374363	0	0.2	0.16177756	6.66515477	0.093366869	25	30	0	0	0.2	29.76850268	0	0	30	0	30	0	0	0											NO	150.4933238	100.6655588	40.30361475	0	161.6043889	0.161604389	0.146538392	40.4097916	0.161604389	0.03882584	0.131202048	0	0.161604389	0.130719819	6.451639802	0.090377489	24.19913725	29.0389647	0	0	0.161604389	24.05360342	0	0	30	0	30	0	0	0												18.0634	1.526601772	3.31880197	0	4.17570784	1.505153852	0.71887866	1.8847814	6.648628633	0.784658818	5.664979521	0	0.031799944	2.836538804	2.809288061	9.661171276	1.068885423	1.544061999	0	0	2.572047451	1.292947504	0	0	0.523633915	0	0.043190065	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6752	0	12.6215321	18.0634	1.526601772	3.31880197	0	4.17570784	1.505153852	0.71887866	1.8847814	6.648628633	0.784658818	5.664979521	0	0.031799944	2.836538804	2.809288061	9.661171276	1.068885423	1.544061999	0	0	2.572047451	1.292947504	0	0	0.523633915	0	0.043190065	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6752	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.0634	1.526601772	3.31880197	0	4.17570784	1.505153852	0.71887866	1.8847814	6.648628633	0.784658818	5.664979521	0	0.031799944	2.836538804	2.809288061	9.661171276	1.068885423	1.544061999	0	0	2.572047451	1.292947504	0	0	0.523633915	0	0.043190065	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6752
H3920_009_0	2011	4																															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	YES	248.03699	30.2661113	29.13433654	446.8014783	18.34385472	14.90052432	6.209450913	48.06008985	42.48136665	19.58634814	30.3389405	0	1.345178696	34.8266752	22.47530528	86.45628494	5.209677358	8.399329307	0	0	16.35052528	2.370162747	859.5838801	1530.155602	215.6741484	227.8885626	14.90233918	18.29533872	132	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a); $0 n/c (13a1); $0 (16b, 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); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.083118636	0.083118636	0.176835399	0	0.233	0.233	0.233	0.111157093	0.233	0.233	0.233	0	0.233	0.233	0.225929166	0.232697621	0.233	0.233	0	0	0.233	0.053376605	0	0	0	0	0	0	0	0											NO	0.070741331	0.070741331	0.150502609	0	0.198303666	0.198303666	0.198303666	0.094611362	0.198303666	0.198303666	0.198303666	0	0.198303666	0.198303666	0.192285759	0.198046314	0.198303666	0.198303666	0	0	0.198303666	0.050956711	0	0	0	0	0	0	0	0												17.5465	2.141065008	4.384793659	0	3.637653642	2.9548286	1.231356881	4.547030545	8.424210748	3.884044641	6.016323128	0	0.266753867	6.906257372	4.321681135	17.12234859	1.033098119	1.665617795	0	0	3.242369105	0.120775697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4467	0	15.63431655	17.5465	2.141065008	4.384793659	0	3.637653642	2.9548286	1.231356881	4.547030545	8.424210748	3.884044641	6.016323128	0	0.266753867	6.906257372	4.321681135	17.12234859	1.033098119	1.665617795	0	0	3.242369105	0.120775697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4467	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.5465	2.141065008	4.384793659	0	3.637653642	2.9548286	1.231356881	4.547030545	8.424210748	3.884044641	6.016323128	0	0.266753867	6.906257372	4.321681135	17.12234859	1.033098119	1.665617795	0	0	3.242369105	0.120775697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4467
H3921_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1283.59784	117.6527197	831.2106229	982.4552365	161.8395663	9.949053203	9.085394905	463.2316367	31.43499905	13.82055082	30.19638609	0	0.085164347	15.67675405	5860.430877	90.57848242	593.1241594	370.2715596	0	0	16.36871732	1260.672989	0	0	141.3346812	0	14.96822523	10.45	159.5935368	0											4900	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-59 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	64.40652217	0	200	0.2	0.110428543	49.39191446	0.2	0.140994164	0.168506279	0	0.2	0.160337748	6.908542232	0.108705476	38.5	30	0	0	0.2	29.83053721	0	0	30	0	30	0	0	0											NO	150.7670452	100.8486521	52.1365385	0	161.8983194	0.161898319	0.089390978	39.99200263	0.161898319	0.114133591	0.136404417	0	0.161898319	0.12979206	6.691699426	0.105315971	37.29157603	29.05837093	0	0	0.161898319	24.14756921	0	0	30	0	30	0	0	0												16.127	0.98875985	3.611370387	0	2.183462816	1.610734993	0.812152334	1.543796736	5.089273518	1.577389098	4.118920431	0	0.013787965	2.034718203	3.268020161	9.539360863	1.843211224	0.896624027	0	0	2.650067825	2.536849021	0	0	0.353336703	0	0.037420563	0	0	0	0	0	0	0	0	0	0	0	0	0	60.8363	0	11.06775234	16.127	0.98875985	3.611370387	0	2.183462816	1.610734993	0.812152334	1.543796736	5.089273518	1.577389098	4.118920431	0	0.013787965	2.034718203	3.268020161	9.539360863	1.843211224	0.896624027	0	0	2.650067825	2.536849021	0	0	0.353336703	0	0.037420563	0	0	0	0	0	0	0	0	0	0	0	0	0	60.8363	YES	"$275 Days 1-36 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-36 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-57 (2a); $0 n/c (2a1, 2a2)"	25% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	25% (9b)	25% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 25% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											9900	1.3535	0.1176	0.9156	0.3151	0.3853	0.4264	0.3894	0.2724	1.1226	0.2784	0.9169	0	0.0024	0.4487	1.1917	2.1372	0.3532	0.2027	0	0	0.6741	0.5736	0	0	0.0799	0	0.0085	0	0	0											12.1652	0	2.05302236	17.4805	1.106379382	4.526962966	0.315063982	2.568779784	2.037106021	1.201510907	1.816231454	6.211907382	1.855751879	5.035848	0	0.016221135	2.483383093	4.459722671	11.67657717	2.196398884	1.099369421	0	0	3.324207886	3.110476782	0	0	0.433233501	0	0.045882133	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0015
H3921_008_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1225.361905	120.9799572	688.2250501	1000.646073	152.9023324	9.223443664	10.91559146	446.3533052	32.86924177	14.48719581	34.77705816	0	0.095780278	22.0440701	5961.17224	98.30489672	601.3883516	333.1297402	0	0	16.05626149	1304.049157	0	0	131.4460548	0	15.09280629	10.45	166.5606596	0											4900	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-59 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	65.29893183	0	200	0.2	0.10995398	49.30366101	0.2	0.143679552	0.166254586	0	0.2	0.15983824	6.819614771	0.104641157	38.5	30	0	0	0.2	29.82405356	0	0	30	0	30	0	0	0											NO	150.423891	100.6191149	52.73862673	0	161.5298298	0.16152983	0.088804238	39.83009526	0.16152983	0.116042668	0.134275375	0	0.16152983	0.129093218	6.603239449	0.101347531	37.27845741	29.04814863	0	0	0.16152983	24.08737148	0	0	30	0	30	0	0	0												15.3603	1.014408018	3.024670336	0	2.058190645	1.489861285	0.969350782	1.481524555	5.30936303	1.681132857	4.669702535	0	0.015471372	2.845739958	3.280253974	9.962958578	1.868235837	0.806400184	0	0	2.593565186	2.617593039	0	0	0.328615137	0	0.037732016	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4151	0	11.26688162	15.3603	1.014408018	3.024670336	0	2.058190645	1.489861285	0.969350782	1.481524555	5.30936303	1.681132857	4.669702535	0	0.015471372	2.845739958	3.280253974	9.962958578	1.868235837	0.806400184	0	0	2.593565186	2.617593039	0	0	0.328615137	0	0.037732016	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4151	YES	"$275 Days 1-36 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-36 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-57 (2a); $0 n/c (2a1, 2a2)"	25% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	25% (9b)	25% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 25% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											9900	1.2891	0.1207	0.7536	0.2959	0.3632	0.3944	0.4667	0.2614	1.1712	0.2967	1.0385	0	0.0027	0.6276	1.2036	2.2328	0.358	0.1823	0	0	0.6598	0.5921	0	0	0.0743	0	0.0085	0	0	0											12.3931	0	2.11412699	16.6494	1.13507857	3.77822831	0.295916187	2.421400759	1.884236332	1.436078508	1.742970065	6.480546051	1.977803361	5.70822956	0	0.018201614	3.473293578	4.483870119	12.19576007	2.226218599	0.988744085	0	0	3.253331768	3.209693668	0	0	0.402921874	0	0.046264011	0	0	0	0	0	0	0	0	0	0	0	0	0	73.8082
H3923_013_0	2011	7																															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	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	30.55409467	44.34141044	352.1707252	311.1359515	164.1090167	12.87708943	0	212.6774541	375.4122425	2182.290202	791.7570133	0	0.150063621	972.588075	3916.411986	4489.07332	207.403817	737.0120571	2368.726319	15816.15103	1.474974381	336.0097736	0	0	569.4152921	20.26570084	3.300573636	6.277946337	0	0											3400	"1a - $200 copay/admit, $600 max"	"1b - $200 copay/admit, $600 max"	2 - $0 copay Days 1-10/ $50 copay Days 11-100	6 - $10 copay/visit	10a - $100 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 - $30 Urgent Care copay	"9a,9b - $100 copay"	8a - $0 copay	"8b - $100 copay (High Tech Imaging Only), $55 therapeutic radiology copay"	5 - $0 copay	12 - 10% coinsurance	3 - $30 CORF copay; 9c - $30 SA Ind/Grp Session copay; 9d - $30 Cardiac Rehab copay	7a - $10 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 - $0 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 - 15% coinsurance	13a - $0 copay; 17a - $30 Eye Exam copay	0	0	17a - $20 Routine Eye Exam copay	17b - $40 allowance every 2 years	0	0	0	0											0	200	200	50	10	100	0.078850505	0	49.6	100	0	21.62583519	0	0.1	11.81480723	10	19.58788396	30	30	0	1.107906672	0.15	29.25522846	0	0	20	0	0	0	0	0											NO	190.8664502	190.8664502	47.71661254	9.543322508	95.43322508	0.075	0	47.33487964	95.43322508	0	20.63823197	0	0.095	11.27525158	9.543322508	18.69334939	28.62996752	28.62996752	0	1.057311068	0.143	27.91920802	0	0	19.08664502	0	0	0	0	0												0.486	0.705273967	1.40036617	0.247439227	1.305121061	0.965781707	0	0.838921808	2.985566753	0	1.361705409	0	0.014256044	0.913847936	3.114631888	6.992984666	0.494830379	1.758385938	0	1.393549295	0.210921337	0.781760564	0	0	0.905685629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.877	0	1.37	0.486	0.705273967	1.40036617	0.247439227	1.305121061	0.965781707	0	0.838921808	2.985566753	0	1.361705409	0	0.014256044	0.913847936	3.114631888	6.992984666	0.494830379	1.758385938	0	1.393549295	0.210921337	0.781760564	0	0	0.905685629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.877	YES	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	4a - $50 ER copay (WIA) World Wide Coverage; 4b - $30 Urgent Care copay	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	"$500 deductible, 30% coinsurance, no separate OOP Max"	0	0	"$20 Routine Eye Exam copay, no OOP Max"	"No OOP Max, $40 Frames/Contacts OON allowance, $25-$45 Lenses OON allowance"	0	0	0	0											5100	2.3749	0.0501	0.2096	0.0333	0.0429	0.1792	0	0.0373	0.4105	0.1466	0.2965	0	0.0021	0.2522	0.074	0.5277	0.0258	0.0842	0.2479	1.4365	0.0205	0.0362	0	0	0.0222	0.0009	0	0	0	0											6.5109	500	42.83	2.8609	0.755346092	1.609983711	0.28071966	1.347972135	1.144958237	0	0.876192171	3.396091868	0.14664249	1.65822924	0	0.016344084	1.166038573	3.188591944	7.520637319	0.520593336	1.842557675	0.24791368	2.830060882	0.231444669	0.817967659	0	0	0.927859316	0.000939948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.388
H3923_017_0	2011	8																															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	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	195.5313246	47.21623321	326.1515895	650.4715608	321.9273737	16.61783394	0	261.3478334	441.3331526	2802.443856	1101.50399	0	0.260002688	1405.552297	4113.960743	6067.770813	217.2564203	1152.783799	3128.13897	19593.90458	3.222207193	329.7919277	0	950	577.7997215	17.97558642	11.48069212	9.058956812	0	0											3400	1a - $0 copay/admit	1b - $0 copay/admit	2 - $0 copay Days 1-10/ $25 copay Days 11-100	6 - $10 copay/visit	10a - $75 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 - $25 Urgent Care copay	"9a,9b - $50 copay"	8a - $0 copay	"8b - $50 copay (High Tech Imaging Only), $50 therapeutic radiology copay"	5 - $0 copay	12 - 10% coinsurance	3 - $25 CORF copay; 9c - $25 SA Ind/Grp Session copay; 9d - $25 Cardiac Rehab copay	7a - $10 OV copay	7d - $25 Specialist OV copay (excluding MH and Radiology); 18a - $25 Hearing Exam copay	"7e,7h - $25 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 - $0 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 - 10% coinsurance	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 - $20 Routine Hearing Exam/Fitting copay	18b - $400 allowance every 3 years	0	0											0	0	0	25	10	75	0.130731743	0	49.5	50	0	10.81291759	0	0.1	10.4480896	10	17.17307353	25	25	0	1.124534087	0.1	23.97612291	0	10	20	0	20	0	0	0											NO	0	0	23.6905214	9.47620856	71.0715642	0.124	0	46.90723237	47.3810428	0	10.24654623	0	0.095	9.900827611	9.47620856	16.27356264	23.6905214	23.6905214	0	1.065631954	0.095	22.72027412	0	9.47620856	18.95241712	0	18.95241712	0	0	0												0	0	0.643891767	0.513667014	1.906656834	2.060611409	0	1.021591962	1.742568749	0	0.940550963	0	0.024700255	1.159677582	3.248729167	8.228687369	0.428909823	2.275837438	0	1.739990902	0.306109683	0.624413583	0	0.750199844	0.912558444	0	0.018132239	0	0	0	0	0	0	0	0	0	0	0	0	0	28.5475	0	1.67	0	0	0.643891767	0.513667014	1.906656834	2.060611409	0	1.021591962	1.742568749	0	0.940550963	0	0.024700255	1.159677582	3.248729167	8.228687369	0.428909823	2.275837438	0	1.739990902	0.306109683	0.624413583	0	0.750199844	0.912558444	0	0.018132239	0	0	0	0	0	0	0	0	0	0	0	0	0	28.5475	YES	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	4a - $50 ER copay (WIA) World Wide Coverage; 4b - $25 Urgent Care copay	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	"$500 deductible, 20% coinsurance, no separate OOP Max"	0	"20% coinsurance, no OOP Max, $100 Preventive Dental OON allowance"	"$20 Routine Eye Exam copay, no OOP Max"	"No OOP Max, $40 Frames/Contacts OON allowance, $25-$45 Lenses OON allowance"	"20% coinsurance, no OOP Max"	"20% coinsurance, no OOP Max, $400 Hearing Aid OON allowance"	0	0											5100	2.1888	0.0362	0.1934	0.051	0.0434	0.1676	0	0.0587	0.4104	0.1284	0.3274	0	0.0026	0.3562	0.0563	0.5196	0.0196	0.0944	0.2612	1.3644	0.0325	0.0323	0	0.0239	0.0437	0.0006	0.0013	0.003	0	0											6.4171	500	35.02	2.1888	0.03622077	0.837270649	0.564693977	1.950027558	2.228235471	0	1.080248493	2.152958499	0.128376645	1.267966257	0	0.027322902	1.515898661	3.305049802	8.748324762	0.448490232	2.370263834	0.261207103	3.104408898	0.338612082	0.656756484	0	0.774123675	0.956273992	0.000604399	0.019472381	0.003045923	0	0	0	0	0	0	0	0	0	0	0	0	34.9646
H3923_801_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	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	252.2438807	3.517211633	35.30301122	6.208097562	7.80319429	19.04858254	0	15.16268521	42.55993227	14.89633601	26.10191578	0	0.242147115	36.81131278	0	52.85627875	1.562873437	9.309947353	27.03628309	156.9663611	2.58266732	4.741112064	0	0	0	0	0	0	0	0											6700	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing																			0	0.076627077	0.076627077	0.178052508	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	0.063	0.063	0.146	0	0.191	0.191	0	0.191	0.191	0.191	0.191	0	0.191	0.191	0	0.191	0.191	0.191	0.191	0.191	0.191	0.191	0	0	0	0	0	0	0	0												15.8914	0.221584333	5.154239638	0	1.490410109	3.638279265	0	2.896072875	8.128947064	2.845200177	4.985465915	0	0.046250099	7.03096074	0	10.09554924	0.298508826	1.778199944	5.16393007	29.98057497	0.493289458	0.905552404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.0444	0	23.33	15.8914	0.221584333	5.154239638	0	1.490410109	3.638279265	0	2.896072875	8.128947064	2.845200177	4.985465915	0	0.046250099	7.03096074	0	10.09554924	0.298508826	1.778199944	5.16393007	29.98057497	0.493289458	0.905552404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.0444	YES	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	NA	NA	NA	NA	NA	NA	NA	NA											10000	0.7964	0.0111	0.2999	0	0.0889	0.2169	0	0.1727	0.4847	0.1696	0.2972	0	0.0028	0.4192	0	0.6019	0.0178	0.106	0.3079	1.7875	0.0294	0.054	0	0	0	0	0	0	0	0											5.8638	0	12.52	16.6878	0.232689658	5.454160029	0	1.579269584	3.855196463	0	3.068739119	8.613601565	3.014833349	5.282703488	0	0.049007568	7.450152395	0	10.69745418	0.316306168	1.884217686	5.471807822	31.76804147	0.522699781	0.959542182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.9082
H3923_802_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	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	197.6483884	2.879196912	26.44868787	4.611213461	6.066442034	14.56692384	0	11.1720289	34.58430987	12.33596347	22.71203028	0	0.188283396	28.00747332	0	43.68466212	1.287950925	9.723470007	21.71324157	129.3704638	1.867714208	3.842778577	0	0	0	0	0	0	0	0											6700	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing																			0	0.077948248	0.077948248	0.180124716	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	0.068	0.068	0.156	0	0.202	0.202	0	0.202	0.202	0.202	0.202	0	0.202	0.202	0	0.202	0.202	0.202	0.202	0.202	0.202	0.202	0	0	0	0	0	0	0	0												13.4401	0.19578539	4.125995307	0	1.225421291	2.942518615	0	2.256749838	6.986030595	2.491864621	4.587830117	0	0.038033246	5.657509611	0	8.824301748	0.260166087	1.964140941	4.386074796	26.13283369	0.37727827	0.776241273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6689	0	13.98	13.4401	0.19578539	4.125995307	0	1.225421291	2.942518615	0	2.256749838	6.986030595	2.491864621	4.587830117	0	0.038033246	5.657509611	0	8.824301748	0.260166087	1.964140941	4.386074796	26.13283369	0.37727827	0.776241273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6689	YES	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	NA	NA	NA	NA	NA	NA	NA	NA											10000	0.6923	0.0101	0.2349	0	0.0708	0.1699	0	0.1303	0.4034	0.1439	0.2649	0	0.0022	0.3267	0	0.5095	0.015	0.1134	0.2532	1.5089	0.0218	0.0448	0	0	0	0	0	0	0	0											4.9159	0	6.87	14.1324	0.205870528	4.360872074	0	1.296176505	3.112418172	0	2.387053448	7.389400514	2.635743641	4.852729138	0	0.040229267	5.984171392	0	9.333812526	0.275187947	2.077549459	4.639324566	27.64173046	0.399062129	0.821061056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5848
H3923_803_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	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	251.672768	3.509242777	35.1612565	6.18113719	7.783105195	18.98719342	0	15.09222355	42.52674101	14.89651354	26.15817397	0	0.241525287	36.68537956	0	52.85248423	1.559609127	9.412805046	27.00211015	156.9367695	2.568868362	4.736911453	0	0	0	0	0	0	0	0											6700	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing																			0	0.078336413	0.078336413	0.176713804	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	0.064	0.064	0.145	0	0.191	0.191	0	0.191	0.191	0.191	0.191	0	0.191	0.191	0	0.191	0.191	0.191	0.191	0.191	0.191	0.191	0	0	0	0	0	0	0	0												16.1071	0.224591538	5.098382193	0	1.486573092	3.626553944	0	2.882614699	8.122607533	2.845234086	4.996211227	0	0.04613133	7.006907496	0	10.09482449	0.297885343	1.797845764	5.157403038	29.97492298	0.490653857	0.904750087	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.1611	0	23.46	16.1071	0.224591538	5.098382193	0	1.486573092	3.626553944	0	2.882614699	8.122607533	2.845234086	4.996211227	0	0.04613133	7.006907496	0	10.09482449	0.297885343	1.797845764	5.157403038	29.97492298	0.490653857	0.904750087	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.1611	YES	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	NA	NA	NA	NA	NA	NA	NA	NA											10000	0.8156	0.0114	0.296	0	0.0886	0.2161	0	0.1718	0.484	0.1695	0.2977	0	0.0027	0.4175	0	0.6015	0.0177	0.1071	0.3073	1.7861	0.0292	0.0539	0	0	0	0	0	0	0	0											5.8737	0	12.6	16.9226	0.235963494	5.394381258	0	1.575150756	3.842642663	0	3.054375695	8.606594229	3.014767753	5.293911166	0	0.048880071	7.424415051	0	10.696326	0.315634883	1.904970653	5.464707613	31.76098292	0.519889535	0.958659747	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.0349
H3924_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	O	V											8.26969617	0.086845213	1.199410722	0	0.441514896	0.22991887	0.267230036	0.508279388	2.230982767	2.184078908	1.960669642	0	0.008336808	0.658741968	1.505981535	0.140160582	0	0.08438977	0	0	0.221130021	0	0	0	0.309186346	0	0.05994499	0	0	0											20.3665	YES	1334.652058	80.35810928	1448.293745	1103.925059	162.3997302	6.985449129	8.119045746	342.7921158	317.9786895	325.5426917	1645.723474	0	0.361032071	729.2460163	4261.971732	5216.408314	387.4156084	484.1992833	0	0	6.718424245	0	0	623.1981857	561.8023841	0.165484794	8.66093753	0.110323196	0	0											2550	1a1: $275 per stay 1a2: $275 per stay	1b1: $275 per stay	21: $0 days 1-6/$75 days 7-100 22: $0 days 1-6/$75 days 7-100 23: $0 days 1-6/$75 days 7-100	6: 0%	10a: $100	11a: 20%	"11b: 20% 11c: $0 preferred meters, no auth.; 20% non-pref. With auth; 1 meter every 2 years; 200 pref. test strips per month no auth."	4a1: $50 4a2: $50 4b: $25	9a1: $125 9b: $125	8a1: $10 8a2: $10	8b1: $45-$125 8b2: $45-$125 8b3: $45-$125 8b4: $45-$125 8b5: $45-$125 8b6: $45-$125	9a2: $50; included in h5	12: 0%	3: $25 5: $25 9a3: 0% 9c: $10/$25 Group/Indiv 9d1: $25 9d2: $25	7a: $10 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14i: 0% 14j: 0%	7b1: $25 7d1: $25 7f1: $25 7f2: $0 16b1: 0% 17a1: $25 18a1: $25	7e: $10/$25 Group/Indiv 7h: $10/$25 Group/Indiv	7c: $25 7i: $25	7d2: $25; included in i2 14h1: 0% 14h2: 0%	7g: $0; included in i2	151: 0% 152: 0% 153: 20%; $1000 OOP max.	13a1: 0% 14a2: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $25	17b1: $200 max per 2 years 17b2: $200 max per 2 years	18a2: 0%	18b: $800 max per 3 years													0	52.43078618	30.56025858	42.03445813	0	100	0.2	0.2	44.46550939	125	10	63.85313932	0	0	35.03580661	9.79227719	24.7118402	17.5	25	0	0	0.2	0	0	21.67832168	25	0	0	0	0	0											NO	45.86881371	26.73549092	36.77363759	0	87.48450491	0.17496901	0.17496901	38.90043074	109.3556311	8.748450491	55.86160281	0	0	30.65090195	8.566725219	24.7118402	17.5	21.87112623	0	0	0.17496901	0	0	21.67832168	21.87112623	0	0	0	0	0												5.1016	0.179034458	4.438252441	0	1.183955	1.222237117	1.420581395	1.11123008	2.897730023	0.237332843	7.661062585	0	0	1.862670679	3.04259506	10.74225406	0.564981096	0.882498637	0	0	1.175516038	0	0	1.125824228	1.023937571	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8733	250	4.783941772	13.3713	0.265879672	5.637663163	0	1.625469895	1.452155987	1.687811431	1.619509468	5.128712791	2.421411751	9.621732227	0	0.008336808	2.521412647	4.548576595	10.88241464	0.564981096	0.966888407	0	0	1.396646058	0	0	1.125824228	1.333123917	0	0.05994499	0	0	0	0	0	0	0	0	0	0	0	0	0	66.2398	YES	1a1: 20% 1a2: 20%	1b1: 20%	21: 20% 22: 20% 23: 20%	6: 20%	10a: 20%	11a: 20%	11b: 20% 11c: 20%	4a1: $50 4a2: $50 4b: $25	9a1: 20% 9b: 20%	8a1: 20% 8a2: 20%	8b1: 20% 8b2: 20% 8b3: 20% 8b4: 20% 8b5: 20% 8b6: 20%	9a2: 20%;  included in h5	12: 20%	3: 20% 5: 20% 9a3: 20% 9c: 20% 9d1: 20% 9d2: 20%	7a: $20 14a: 20% 14a1: 20% 14a3: 20% 14a4: 20% 14b1: 20% 14b2: 0% 14c1: $20 14c2: $20 14d1: $35 14d2: $35 14e1: $35 14f1: $35 14f2: $35 14g1: $35 14i: $35 14j: 20%	7b1: $35 7d1: $35 7f1: $35 7f2: 0% 16b1: $35 17a1: $35	7e: 20% 7h: 20%	7c: 20% 7i: 20%	7d2: $35; included in i2	7g: 20%; included in i2	153: 20%	13a1: 20% 14a2: 20%		16a1: 20% 16b2: 20% 16b3: 20%	17a2: $35	17b2: $200 max per 2 years	18a2: 0%	18b: $800 max per 3 years													5100	0.6499	0	0.0984	0.0353	0.0563	0.0179	0.0316	0.0181	0.1449	0.1508	0.1399	0	0.0006	0.0428	0.0736	0.2036	0	0.0066	0	0	0.0174	0.0116	0	0	0.0267	0	0.0004	0	0.02	0											1.7464	250	6.739151543	14.0212	0.265879672	5.736070756	0.035276451	1.681769295	1.470043951	1.719384091	1.637578145	5.273612083	2.572252917	9.761648419	0	0.008978306	2.564179267	4.622178372	11.08598561	0.564981096	0.973457555	0	0	1.414063306	0.011580215	0	1.125824228	1.359859765	0	0.060308371	0	0.020019512	0	0	0	0	0	0	0	0	0	0	0	67.9861
H3924_003_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	O	V											8.114141379	0.102903663	1.04919656	0	0.311584397	0.311016896	0.441030829	0.548383597	2.130207775	2.002585961	2.027582136	0	0.004777206	0.660023346	1.507596695	0.159614677	0	0.098680662	0	0	0.249162566	0	0	0	0.224111685	0	0.045260199	0	0	0											19.9879	YES	1178.191208	66.01732245	1106.990668	620.3838814	311.0441659	8.075894078	11.45184815	334.1920586	218.1583821	296.9796394	1556.435088	0	0.173184075	637.9664576	3520.165353	4675.025381	320.001915	537.2877215	0	0	6.469778705	0	0	622.5892369	297.5921164	0.079811878	20.99186294	6.932234743	0	0											2550	1a1: $275 per stay 1a2: $275 per stay	1b1: $275 per stay	21: $0 days 1-6/$75 days 7-100 22: $0 days 1-6/$75 days 7-100 23: $0 days 1-6/$75 days 7-100	6: 0%	10a: $100	11a: 20%	"11b: 20% 11c: $0 preferred meters, no auth.; 20% non-pref. With auth; 1 meter every 2 years; 200 pref. test strips per month no auth."	4a1: $50 4a2: $50 4b: $25	9a1: $125 9b: $125	8a1: $10 8a2: $10	8b1: $45-$125 8b2: $45-$125 8b3: $45-$125 8b4: $45-$125 8b5: $45-$125 8b6: $45-$125	9a2: $50; included in h5	12: 0%	3: $25 5: $25 9a3: 0% 9c: $10/$25 Group/Indiv 9d1: $25 9d2: $25	7a: $10 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14i: 0% 14j: 0%	7b1: $25 7d1: $25 7f1: $25 7f2: $0 16b1: 0% 17a1: $25 18a1: $25	7e: $10/$25 Group/Indiv 7h: $10/$25 Group/Indiv	7c: $25 7i: $25	7d2: $25; included in i2 14h1: 0% 14h2: 0%	7g: $0; included in i2	151: 0% 152: 0% 153: 20%; $1000 OOP max.	13a1: 0% 14a2: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $25	17b1: $200 max per 2 years 17b2: $200 max per 2 years	18a2: 0%	18b: $800 max per 3 years													0	52.43078618	30.56025858	42.03445813	0	100	0.2	0.2	44.44874343	125	10	63.85313932	0	0	34.96276629	9.780407954	24.77341506	17.5	25	0	0	0.2	0	0	21.67832168	25	0	0	0	0	0											NO	46.6722391	27.20378234	37.4177544	0	89.01685917	0.178033718	0.178033718	39.56687534	111.271074	8.901685917	56.84005911	0	0	31.12275643	8.706211975	24.77341506	17.5	22.25421479	0	0	0.178033718	0	0	21.67832168	22.25421479	0	0	0	0	0												4.5824	0.149660073	3.451758746	0	2.307347893	1.437781452	2.038815107	1.101911294	2.022893122	0.220301623	7.372321866	0	0	1.654606223	2.553942146	9.651362013	0.466669459	0.996409697	0	0	1.15183876	0	0	1.124724146	0.551889907	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8366	250	3.898138323	12.6965	0.252563736	4.500955306	0	2.61893229	1.748798347	2.479845937	1.65029489	4.153100898	2.222887584	9.399904002	0	0.004777206	2.314629569	4.061538841	9.81097669	0.466669459	1.095090359	0	0	1.401001326	0	0	1.124724146	0.776001592	0	0.045260199	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8245	YES	1a1: 20% 1a2: 20%	1b1: 20%	21: 20% 22: 20% 23: 20%	6: 20%	10a: 20%	11a: 20%	11b: 20% 11c: 20%	4a1: $50 4a2: $50 4b: $25	9a1: 20% 9b: 20%	8a1: 20% 8a2: 20%	8b1: 20% 8b2: 20% 8b3: 20% 8b4: 20% 8b5: 20% 8b6: 20%	9a2: 20%;  included in h5	12: 20%	3: 20% 5: 20% 9a3: 20% 9c: 20% 9d1: 20% 9d2: 20%	7a: $20 14a: 20% 14a1: 20% 14a3: 20% 14a4: 20% 14b1: 20% 14b2: 0% 14c1: $20 14c2: $20 14d1: $35 14d2: $35 14e1: $35 14f1: $35 14f2: $35 14g1: $35 14i: $35 14j: 20%	7b1: $35 7d1: $35 7f1: $35 7f2: 0% 16b1: $35 17a1: $35	7e: 20% 7h: 20%	7c: 20% 7i: 20%	7d2: $35; included in i2	7g: 20%; included in i2	153: 20%	13a1: 20% 14a2: 20%		16a1: 20% 16b2: 20% 16b3: 20%	17a2: $35	17b2: $200 max per 2 years	18a2: 0%	18b: $800 max per 3 years													5100	0.6882	0	0.0526	0.0188	0.1065	0.0251	0.0216	0.0097	0.1382	0.0847	0.1015	0	0.0003	0.0268	0.0393	0.3106	0	0.016	0	0	0.0093	0.006	0	0.0037	0.0087	0	0.0002	0	0.0097	0											1.6777	250	5.782600928	13.3847	0.252563736	4.553509898	0.018839395	2.725424354	1.773863693	2.501491265	1.660039073	4.291271745	2.307589936	9.501450947	0	0.005119798	2.34142081	4.100883714	10.12162468	0.466669459	1.111117817	0	0	1.41030301	0.00600081	0	1.128421256	0.784739947	0	0.045469469	0	0.009655237	0	0	0	0	0	0	0	0	0	0	0	64.5022
H3924_021_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	O	V											8.858484823	0.096667006	1.219141146	0	0.288102425	0.226952905	0.323648781	0.414630056	2.074930942	1.901167791	1.916804133	0	0.007048905	0.549060324	1.542534677	0.206692335	0	0.095830668	0	0	0.185143691	0	0	0	0.159130399	0	0.040764601	0	0	0											20.1067	YES	1425.414408	72.70851841	1367.093807	836.5753634	86.95551126	6.211808916	8.858421	268.2328674	240.8211756	504.9796925	1488.044352	0	0.271088305	647.7566094	3848.921625	5119.793822	351.7651573	522.2210751	0	0	5.067470847	0	0	623.5684758	174.0679952	0.124693327	9.527372654	0.083128885	0	0											2550	1a1: $275 per stay 1a2: $275 per stay	1b1: $275 per stay	21: $0 days 1-6/$75 days 7-100 22: $0 days 1-6/$75 days 7-100 23: $0 days 1-6/$75 days 7-100	6: 0%	10a: $100	11a: 20%	"11b: 20% 11c: $0 preferred meters, no auth.; 20% non-pref. With auth; 1 meter every 2 years; 200 pref. test strips per month no auth."	4a1: $50 4a2: $50 4b: $25	9a1: $125 9b: $125	8a1: $10 8a2: $10	8b1: $45-$125 8b2: $45-$125 8b3: $45-$125 8b4: $45-$125 8b5: $45-$125 8b6: $45-$125	9a2: $50; included in h5	12: 0%	3: $25 5: $25 9a3: 0% 9c: $10/$25 Group/Indiv 9d1: $25 9d2: $25	7a: $10 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14i: 0% 14j: 0%	7b1: $25 7d1: $25 7f1: $25 7f2: $0 16b1: 0% 17a1: $25 18a1: $25	7e: $10/$25 Group/Indiv 7h: $10/$25 Group/Indiv	7c: $25 7i: $25	7d2: $25; included in i2 14h1: 0% 14h2: 0%	7g: $0; included in i2	151: 0% 152: 0% 153: 20%; $1000 OOP max.	13a1: 0% 14a2: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $25	17b1: $200 max per 2 years 17b2: $200 max per 2 years	18a2: 0%	18b: $800 max per 3 years													0	52.43078618	30.56025858	42.03445813	0	100	0.2	0.2	44.40593048	125	10	63.85313932	0	0	35.16692433	9.80870537	24.75630332	17.5	25	0	0	0.2	0	0	21.67832168	25	0	0	0	0	0											NO	46.90513115	27.3395278	37.60446705	0	89.46104867	0.178922097	0.178922097	39.72601108	111.8263108	8.946104867	57.12368805	0	0	31.46069929	8.774970685	24.75630332	17.5	22.36526217	0	0	0.178922097	0	0	21.67832168	22.36526217	0	0	0	0	0												5.5716	0.16565138	4.284069503	0	0.648260935	1.11142988	1.584967264	0.887985155	2.244178636	0.376466774	7.083548448	0	0	1.698239659	2.814514536	10.56226406	0.512990854	0.973300938	0	0	0.906682512	0	0	1.126493167	0.324423029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8771	250	3.613703825	14.4301	0.262318386	5.503210648	0	0.93636336	1.338382785	1.908616046	1.302615211	4.319109579	2.277634565	9.000352581	0	0.007048905	2.247299983	4.357049212	10.7689564	0.512990854	1.069131606	0	0	1.091826204	0	0	1.126493167	0.483553428	0	0.040764601	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9838	YES	1a1: 20% 1a2: 20%	1b1: 20%	21: 20% 22: 20% 23: 20%	6: 20%	10a: 20%	11a: 20%	11b: 20% 11c: 20%	4a1: $50 4a2: $50 4b: $25	9a1: 20% 9b: 20%	8a1: 20% 8a2: 20%	8b1: 20% 8b2: 20% 8b3: 20% 8b4: 20% 8b5: 20% 8b6: 20%	9a2: 20%;  included in h5	12: 20%	3: 20% 5: 20% 9a3: 20% 9c: 20% 9d1: 20% 9d2: 20%	7a: $20 14a: 20% 14a1: 20% 14a3: 20% 14a4: 20% 14b1: 20% 14b2: 0% 14c1: $20 14c2: $20 14d1: $35 14d2: $35 14e1: $35 14f1: $35 14f2: $35 14g1: $35 14i: $35 14j: 20%	7b1: $35 7d1: $35 7f1: $35 7f2: 0% 16b1: $35 17a1: $35	7e: 20% 7h: 20%	7c: 20% 7i: 20%	7d2: $35; included in i2	7g: 20%; included in i2	153: 20%	13a1: 20% 14a2: 20%		16a1: 20% 16b2: 20% 16b3: 20%	17a2: $35	17b2: $200 max per 2 years	18a2: 0%	18b: $800 max per 3 years													5100	0.4015	0	0.4111	0.0318	0.0777	0.0166	0.0334	0.013	0.1369	0.1101	0.1097	0	0.0005	0.0433	0.0538	0.2733	0	0.0086	0	0	0.0126	0.0085	0	0	0.0177	0	0.0003	0	0.0157	0											1.776	250	7.421964492	14.8316	0.262318386	5.914292656	0.031827091	1.014063965	1.354948736	1.941983868	1.315657982	4.456004193	2.387715457	9.110045932	0	0.007507726	2.290615263	4.410827986	11.04223744	0.512990854	1.077769172	0	0	1.10444803	0.008518296	0	1.126493167	0.501274078	0	0.041030557	0	0.015668573	0	0	0	0	0	0	0	0	0	0	0	64.7598
H3924_023_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	O	V											8.80644564	0.115330401	0.774319829	0	0.169136258	0.195787822	0.261361609	0.398265341	2.053485163	1.762812786	2.110280306	0	0.004130444	0.459138968	1.676098816	0.242630791	0	0.154515012	0	0	0.22371239	0	0	0	0.302945161	0	0.048399818	0	0	0											19.7588	YES	1082.837248	67.27456229	745.4363659	778.0374783	64.55621182	4.54468713	6.066806021	252.3026558	247.4155904	373.0546096	1516.862018	0	0.132888467	514.8920072	3789.619329	4446.495066	327.5306891	521.4292297	0	0	5.192880779	0	0	623.6900915	386.0967018	0.061511075	23.62798289	0.041007383	0	0											2550	1a1: $275 per stay 1a2: $275 per stay	1b1: $275 per stay	21: $0 days 1-6/$75 days 7-100 22: $0 days 1-6/$75 days 7-100 23: $0 days 1-6/$75 days 7-100	6: 0%	10a: $100	11a: 20%	"11b: 20% 11c: $0 preferred meters, no auth.; 20% non-pref. With auth; 1 meter every 2 years; 200 pref. test strips per month no auth."	4a1: $50 4a2: $50 4b: $25	9a1: $125 9b: $125	8a1: $10 8a2: $10	8b1: $45-$125 8b2: $45-$125 8b3: $45-$125 8b4: $45-$125 8b5: $45-$125 8b6: $45-$125	9a2: $50; included in h5	12: 0%	3: $25 5: $25 9a3: 0% 9c: $10/$25 Group/Indiv 9d1: $25 9d2: $25	7a: $10 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14i: 0% 14j: 0%	7b1: $25 7d1: $25 7f1: $25 7f2: $0 16b1: 0% 17a1: $25 18a1: $25	7e: $10/$25 Group/Indiv 7h: $10/$25 Group/Indiv	7c: $25 7i: $25	7d2: $25; included in i2 14h1: 0% 14h2: 0%	7g: $0; included in i2	151: 0% 152: 0% 153: 20%; $1000 OOP max.	13a1: 0% 14a2: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $25	17b1: $200 max per 2 years 17b2: $200 max per 2 years	18a2: 0%	18b: $800 max per 3 years													0	52.43078618	30.56025858	42.03445813	0	100	0.2	0.2	44.35791881	125	10	63.85313932	0	0	35.29397064	9.807190851	24.76480171	17.5	25	0	0	0.2	0	0	21.67832168	25	0	0	0	0	0											NO	48.51475029	28.27772425	38.89492011	0	92.53103725	0.185062075	0.185062075	41.04484238	115.6637966	9.253103725	59.08397213	0	0	32.65787712	9.07469542	24.76480171	17.5	23.13275931	0	0	0.185062075	0	0	21.67832168	23.13275931	0	0	0	0	0												4.3778	0.15853096	2.416140658	0	0.49778777	0.841049228	1.122735708	0.862976895	2.384752209	0.287659417	7.468519431	0	0	1.401273325	2.865803431	9.176380715	0.477648922	1.005174739	0	0	0.96100529	0	0	1.126712869	0.744290173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1762	250	2.211322342	13.1842	0.273861362	3.190460487	0	0.666924028	1.036837051	1.384097317	1.261242236	4.438237372	2.050472203	9.578799737	0	0.004130444	1.860412293	4.541902246	9.419011507	0.477648922	1.159689751	0	0	1.18471768	0	0	1.126712869	1.047235334	0	0.048399818	0	0	0	0	0	0	0	0	0	0	0	0	0	57.935	YES	1a1: 20% 1a2: 20%	1b1: 20%	21: 20% 22: 20% 23: 20%	6: 20%	10a: 20%	11a: 20%	11b: 20% 11c: 20%	4a1: $50 4a2: $50 4b: $25	9a1: 20% 9b: 20%	8a1: 20% 8a2: 20%	8b1: 20% 8b2: 20% 8b3: 20% 8b4: 20% 8b5: 20% 8b6: 20%	9a2: 20%;  included in h5	12: 20%	3: 20% 5: 20% 9a3: 20% 9c: 20% 9d1: 20% 9d2: 20%	7a: $20 14a: 20% 14a1: 20% 14a3: 20% 14a4: 20% 14b1: 20% 14b2: 0% 14c1: $20 14c2: $20 14d1: $35 14d2: $35 14e1: $35 14f1: $35 14f2: $35 14g1: $35 14i: $35 14j: 20%	7b1: $35 7d1: $35 7f1: $35 7f2: 0% 16b1: $35 17a1: $35	7e: 20% 7h: 20%	7c: 20% 7i: 20%	7d2: $35; included in i2	7g: 20%; included in i2	153: 20%	13a1: 20% 14a2: 20%		16a1: 20% 16b2: 20% 16b3: 20%	17a2: $35	17b2: $200 max per 2 years	18a2: 0%	18b: $800 max per 3 years													5100	0.6019	0	0.0788	0.021	0.125	0.0359	0.0528	0.0068	0.1622	0.0725	0.0834	0	0.0002	0.0217	0.028	0.3753	0	0.0107	0	0	0.0066	0.0049	0	0.0278	0.038	0	0.0002	0	0.0077	0											1.7616	250	6.875148876	13.7862	0.273861362	3.26928434	0.021009154	0.79194613	1.072699908	1.436877262	1.268050821	4.60047067	2.123004124	9.662193647	0	0.00436882	1.88213406	4.569857997	9.794302524	0.477648922	1.170385289	0	0	1.191275213	0.004939061	0	1.154536061	1.085282953	0	0.048628402	0	0.007729289	0	0	0	0	0	0	0	0	0	0	0	59.6966
H3924_045_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	Coin	V	V	Coin	Coin	V	Coin	P	V	P	V	P	O	Coin											1.742064551	0.013135682	0.279923787	0	0.068154917	0.055824422	0.050692555	0.102488374	0.416818568	0.378841047	0.371507438	0	0.001383656	0.109678815	0.282844757	0.984458593	0.009692287	0.028582334	0	0	0.032246312	0.005424413	0	0	0.045200399	0	0.013632416	0	0.007404674	0											5	YES	921.186896	28.37481136	906.975613	438.7825297	75.65164945	5.316003158	4.827309922	275.1626752	183.9870491	36.07597073	35.37761163	0	0.173134804	454.544085	2323.220128	4052.177296	0.922969344	395.3022567	0	0	3.070725923	0	0	185.1416399	200.4410658	0.134079292	0.162396746	0.107263434	0	0											3000	1a1: $200 days 1-5 1a2: $200 days 1-5	1b1: $200 days 1-5	21: $0 days 1-3/ $75 days 4-100 22: $0 days 1-3/ $75 days 4-100	6: 0%	10a: $100	11a: 20%	11b: 20% 11c: 20%	4a1: $50 4a2: $50 4b: $35	9a1: $375 9b: $200	8a1: 20% 8a2: 20%	8b1: $45 8b2: 20% 8b3: 20% 8b4: 20% 8b5: $45 8b6: 20%	9a2: $50; included in h5	12: 0%	3: $35 5: 45% 9a3: 0% 9c: 45% 9d1: $35 9d2: $35	7a: $20 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14a5: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14h1: 0% 14i: 0% 14j: 0%	7b1: $35 7d1: $35 7f1: $35 16b1: 20% 17a1: $35 18a1: $35	7e: 45% 7h: 45%	7c: $35 7i: $35	7d2: $35; Included in i2 14h2: 0%	7g: 20%; Included in i2	151: 20%; $1000 OOP max. 152: 20%; $1000 OOP max. 153: 20%; $1000 OOP max.	13a1: 0% 14a2: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $35	17b1: $200 max per 2 or 3 years 17b2: $200 max per 3 years	18a2: $35	18b: $800 max per 3 years													0	129.6882936	86.0089272	56.81574719	0	100	0.2	0.2	47.14282771	337.375	0.2	0.181650636	0	0	69.54437887	19.6564461	40.18098908	0.45	35	0	0	0.2	0	0	22.42253521	35	0	35	0	0	0											NO	111.0536128	73.65045707	48.65199329	0	85.63117745	0.171262355	0.171262355	40.36895845	288.8981849	0.171262355	0.155549578	0	0	59.55167048	16.83204624	34.40745406	0.385340299	29.97091211	0	0	0.171262355	0	0	22.42253521	29.97091211	0	29.97091211	0	0	0												8.5251	0.174151485	3.677180954	0	0.539844985	0.91043122	0.826736465	0.925669217	4.429460377	6.178455703	5.502972578	0	0	2.255738298	3.258712385	11.61875868	0.355657283	0.987297433	0	0	0.525899753	0	0	0.345945412	0.500616797	0	0.000405598	0	0	0	0	0	0	0	0	0	0	0	0	0	51.539	60	8.590146208	10.2672	0.187287168	3.95710474	0	0.607999902	0.966255641	0.877429021	1.028157591	4.846278945	6.557296751	5.874480015	0	0.001383656	2.365417113	3.541557142	12.60321728	0.36534957	1.015879767	0	0	0.558146065	0.005424413	0	0.345945412	0.545817196	0	0.014038014	0	0.007404674	0	0	0	0	0	0	0	0	0	0	0	56.539	YES	1a1: 25% 1a2: 25%	1b1: 25%	21: 25% 22: $1	6: 25%	10a: 25%	11a: 25%	11b: 25% 11c: 25%	4a1: $50 4a2: $50 4b: $35	9a1: 25% 9b: 25%	8a1: 25% 8a2: 25%	8b1: 25% 8b2: 25% 8b3: 25% 8b4: 25% 8b5: 25% 8b6: 25%	9a2: 25%; included in h5	12: 25%	3: 25% 5: 45% 9a3: 25% 9c: 45% 9d1: 25% 9d2: 25%	7a: $30 14a: 25% 14a1: 25% 14a3: 25% 14a4: 25% 14a5: 25% 14b1: 25% 14b2: 25% 14c1: $30 14c2: $30 14d1: $45 14d2: $45 14e1: $45 14f1: $45 14f2: 0% 14g1: $45 14h1: $45 14i: $45 14j: $45	7b1: $45 7d1: $45 7f1: $45 16b1: $45 17a1: $45	7e: 45% 7h: 45%	7c: 25% 7i: 25%	7d2: $45; Included in i2	7g: 25%; Included in i2	151: 20% 152: 20% 153: 20%	13a1: 25% 14a2: 25%		16a1: 20% 16b2: 20% 16b3: 20%	17a2: $45	17b2: 0%	18a2: $45	18b: 0%													5100	0.4761	0	0.0814	0.0243	0.0198	0.0162	0.0147	0.0136	0.1127	0.1012	0.1018	0	0.0004	0.0347	0.064	0.2108	0.0002	0.008	0	0	0.0094	0.0016	0	0	0.0093	0	0.0002	0	0.0022	0											1.3025	60	5.603907949	10.7433	0.187287168	4.038456325	0.024256477	0.627807117	0.982479361	0.892161315	1.041777228	4.958944202	6.65853806	5.976245362	0	0.001753288	2.400156469	3.605594021	12.81401452	0.36557047	1.023849832	0	0	0.567517504	0.007000859	0	0.345945412	0.555137511	0	0.014189762	0	0.009556624	0	0	0	0	0	0	0	0	0	0	0	57.8415
H3924_046_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	Coin	V	V	Coin	Coin	V	Coin	P	V	P	V	P	O	Coin											1.935402081	0.005432504	0.368915506	0	0.079237284	0.04686229	0.029861325	0.097407835	0.344668128	0.285937493	0.332543888	0	0.000579488	0.089531306	0.215864351	1.015754091	0.004936248	0.03959081	0	0	0.038554134	0.00808766	0	0	0.047360418	0	0.010368602	0	0.003104557	0											5	YES	1489.219285	13.29301099	1168.953406	547.8036093	77.31138017	4.986331722	3.177362261	661.9457659	190.1438246	30.42487234	35.38397575	0	0.081110067	503.6447244	1722.989139	4482.971805	0.525236127	544.8559956	0	0	4.102311282	0	0	113.2216121	328.2822287	0.137801614	0.076079509	0.110241292	0	0											3000	1a1: $200 days 1-5 1a2: $200 days 1-5	1b1: $200 days 1-5	21: $0 days 1-3/ $75 days 4-100 22: $0 days 1-3/ $75 days 4-100	6: 0%	10a: $100	11a: 20%	11b: 20% 11c: 20%	4a1: $50 4a2: $50 4b: $35	9a1: $375 9b: $200	8a1: 20% 8a2: 20%	8b1: $45 8b2: 20% 8b3: 20% 8b4: 20% 8b5: $45 8b6: 20%	9a2: $50; included in h5	12: 0%	3: $35 5: 45% 9a3: 0% 9c: 45% 9d1: $35 9d2: $35	7a: $20 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14a5: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14h1: 0% 14i: 0% 14j: 0%	7b1: $35 7d1: $35 7f1: $35 16b1: 20% 17a1: $35 18a1: $35	7e: 45% 7h: 45%	7c: $35 7i: $35	7d2: $35; Included in i2 14h2: 0%	7g: 20%; Included in i2	151: 20%; $1000 OOP max. 152: 20%; $1000 OOP max. 153: 20%; $1000 OOP max.	13a1: 0% 14a2: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $35	17b1: $200 max per 2 or 3 years 17b2: $200 max per 3 years	18a2: $35	18b: $800 max per 3 years													0	129.6882936	86.0089272	56.81574719	0	100	0.2	0.2	47.46086687	337.375	0.2	0.181650636	0	0	58.19333545	19.65956902	41.34673099	0.45	35	0	0	0.2	0	0	22.42253521	35	0	35	0	0	0											NO	105.7279132	70.1184674	46.31883278	0	81.52463899	0.163049278	0.163049278	38.69230037	275.0437508	0.163049278	0.148090025	0	0	47.44190664	16.02739267	33.70777317	0.366860875	28.53362365	0	0	0.163049278	0	0	22.42253521	28.53362365	0	28.53362365	0	0	0												13.121	0.077673796	4.512046445	0	0.525231863	0.813017787	0.518066623	2.134350367	4.358155893	4.960753467	5.240013863	0	0	1.991155499	2.301251959	12.59258306	0.192688585	1.29555966	0	0	0.668878893	0	0	0.211559632	0.78059013	0	0.000180902	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2948	60	12.70974554	15.0564	0.083106301	4.880961951	0	0.604469148	0.859880077	0.547927947	2.231758202	4.702824021	5.24669096	5.57255775	0	0.000579488	2.080686806	2.51711631	13.60833715	0.197624833	1.33515047	0	0	0.707433026	0.00808766	0	0.211559632	0.827950548	0	0.010549504	0	0.003104557	0	0	0	0	0	0	0	0	0	0	0	61.2948	YES	1a1: 25% 1a2: 25%	1b1: 25%	21: 25% 22: $1	6: 25%	10a: 25%	11a: 25%	11b: 25% 11c: 25%	4a1: $50 4a2: $50 4b: $35	9a1: 25% 9b: 25%	8a1: 25% 8a2: 25%	8b1: 25% 8b2: 25% 8b3: 25% 8b4: 25% 8b5: 25% 8b6: 25%	9a2: 25%; included in h5	12: 25%	3: 25% 5: 45% 9a3: 25% 9c: 45% 9d1: 25% 9d2: 25%	7a: $30 14a: 25% 14a1: 25% 14a3: 25% 14a4: 25% 14a5: 25% 14b1: 25% 14b2: 25% 14c1: $30 14c2: $30 14d1: $45 14d2: $45 14e1: $45 14f1: $45 14f2: 0% 14g1: $45 14h1: $45 14i: $45 14j: $45	7b1: $45 7d1: $45 7f1: $45 16b1: $45 17a1: $45	7e: 45% 7h: 45%	7c: 25% 7i: 25%	7d2: $45; Included in i2	7g: 25%; Included in i2	151: 20% 152: 20% 153: 20%	13a1: 25% 14a2: 25%		16a1: 20% 16b2: 20% 16b3: 20%	17a2: $45	17b2: 0%	18a2: $45	18b: 0%													5100	0.5474	0	0.1082	0.0245	0.0232	0.0137	0.0088	0.0287	0.0965	0.0789	0.0933	0	0.0002	0.0281	0.0447	0.2126	0.0006	0.0112	0	0	0.0113	0.0024	0	0	0.0136	0	0.0001	0	0.0009	0											1.3489	60	6.555294791	15.6038	0.083106301	4.989184877	0.024502208	0.62771374	0.873627328	0.556687894	2.260468643	4.799287132	5.325634578	5.665825617	0	0.000735921	2.108797439	2.561814915	13.82095721	0.198188698	1.346352461	0	0	0.718743045	0.010460209	0	0.211559632	0.84153778	0	0.010659748	0	0.004015292	0	0	0	0	0	0	0	0	0	0	0	62.6437
H3924_047_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	Coin	V	V	Coin	Coin	V	Coin	P	V	P	V	P	O	Coin											1.58526603	0.017645348	0.282502759	0	0.089542599	0.054131679	0.068339434	0.102125742	0.391358963	0.396323538	0.440742842	0	0.001014724	0.106717425	0.331583523	0.991983304	0.012438363	0.028361692	0	0	0.051373885	0.004982918	0	0	0.023145174	0	0.008435657	0	0.011984401	0											5	YES	1408.635763	82.66675866	1828.434762	2000.050381	119.9755804	8.630060748	10.89516302	328.6834507	212.9872522	63.18474305	70.26638729	0	0.326918269	757.2606081	4962.310954	8272.549198	1.983013171	794.9702897	0	0	8.190393408	0	0	274.6435371	2.299817617	0.145983219	0.153321174	0	0	0											3000	1a1: $200 days 1-5 1a2: $200 days 1-5	1b1: $200 days 1-5	21: $0 days 1-3/ $75 days 4-100 22: $0 days 1-3/ $75 days 4-100	6: 0%	10a: $100	11a: 20%	11b: 20% 11c: 20%	4a1: $50 4a2: $50 4b: $35	9a1: $375 9b: $200	8a1: 20% 8a2: 20%	8b1: $45 8b2: 20% 8b3: 20% 8b4: 20% 8b5: $45 8b6: 20%	9a2: $50; included in h5	12: 0%	3: $35 5: 45% 9a3: 0% 9c: 45% 9d1: $35 9d2: $35	7a: $20 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14a5: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14h1: 0% 14i: 0% 14j: 0%	7b1: $35 7d1: $35 7f1: $35 16b1: 20% 17a1: $35 18a1: $35	7e: 45% 7h: 45%	7c: $35 7i: $35	7d2: $35; Included in i2 14h2: 0%	7g: 20%; Included in i2	151: 20%; $1000 OOP max. 152: 20%; $1000 OOP max. 153: 20%; $1000 OOP max.	13a1: 0% 14a2: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $35	17b1: $200 max per 2 or 3 years 17b2: $200 max per 3 years	18a2: $35	18b: $800 max per 3 years													0	129.6882936	86.0089272	56.81574719	0	100	0.2	0.2	47.48115431	337.375	0.2	0.181650636	0	0	83.28825318	19.42408849	36.14191728	0.45	35	0	0	0.2	0	0	22.42253521	35	0	35	0	0	0											NO	92.95248533	61.64583803	40.72198623	0	71.67376695	0.143347534	0.143347534	34.03153188	241.8093712	0.143347534	0.130195854	0	0	59.69582848	13.92197591	25.90427356	0.322531951	25.08581843	0	0	0.143347534	0	0	22.42253521	25.08581843	0	25.08581843	0	0	0												10.9113	0.424671801	6.204791266	0	0.716591816	1.237097926	1.56179475	0.932133444	4.29185946	9.057377096	9.148392268	0	0	3.767108281	5.757097798	17.85786479	0.639585107	1.661873362	0	0	1.174072697	0	0	0.513183698	0.004807734	0	0.000320516	0	0	0	0	0	0	0	0	0	0	0	0	0	75.862	60	29.77864103	12.4966	0.44231715	6.487294026	0	0.806134415	1.291229604	1.630134183	1.034259186	4.683218423	9.453700635	9.589135111	0	0.001014724	3.873825705	6.08868132	18.84984809	0.652023471	1.690235054	0	0	1.225446581	0.004982918	0	0.513183698	0.027952908	0	0.008756173	0	0.011984401	0	0	0	0	0	0	0	0	0	0	0	80.862	YES	1a1: 25% 1a2: 25%	1b1: 25%	21: 25% 22: $1	6: 25%	10a: 25%	11a: 25%	11b: 25% 11c: 25%	4a1: $50 4a2: $50 4b: $35	9a1: 25% 9b: 25%	8a1: 25% 8a2: 25%	8b1: 25% 8b2: 25% 8b3: 25% 8b4: 25% 8b5: 25% 8b6: 25%	9a2: 25%; included in h5	12: 25%	3: 25% 5: 45% 9a3: 25% 9c: 45% 9d1: 25% 9d2: 25%	7a: $30 14a: 25% 14a1: 25% 14a3: 25% 14a4: 25% 14a5: 25% 14b1: 25% 14b2: 25% 14c1: $30 14c2: $30 14d1: $45 14d2: $45 14e1: $45 14f1: $45 14f2: 0% 14g1: $45 14h1: $45 14i: $45 14j: $45	7b1: $45 7d1: $45 7f1: $45 16b1: $45 17a1: $45	7e: 45% 7h: 45%	7c: 25% 7i: 25%	7d2: $45; Included in i2	7g: 25%; Included in i2	151: 20% 152: 20% 153: 20%	13a1: 25% 14a2: 25%		16a1: 20% 16b2: 20% 16b3: 20%	17a2: $45	17b2: 0%	18a2: $45	18b: 0%													5100	0.4852	0	0.0893	0.028	0.0283	0.0171	0.0216	0.0109	0.1183	0.1194	0.1333	0	0.0003	0.0418	0.0975	0.2549	0	0.0086	0	0	0.0162	0.0016	0	0	0.0003	0	0.0001	0	0.0038	0											1.4766	60	10.50607176	12.9818	0.44231715	6.576593453	0.028049029	0.834438927	1.308340686	1.651736352	1.045174853	4.801515455	9.573106995	9.722449555	0	0.001321825	3.915582701	6.186217274	19.10476989	0.652023471	1.69879877	0	0	1.241685922	0.006558024	0	0.513183698	0.028258678	0	0.008847914	0	0.015772683	0	0	0	0	0	0	0	0	0	0	0	82.3386
H3924_048_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	Coin	V	V	Coin	Coin	V	Coin	P	V	P	V	P	O	Coin											1.838017182	0.014499354	0.270037489	0	0.070633176	0.046119964	0.048612847	0.088559037	0.348790889	0.400888086	0.382880321	0	0.000692307	0.110037805	0.2752463	0.966142683	0.012901781	0.029690051	0	0	0.047197881	0.004247421	0	0	0.030741442	0	0.005961797	0	0.008102186	0											5	YES	1161.337607	41.90973374	1149.701293	1155.371176	77.83980028	5.513779825	5.811811385	388.6931195	178.9149946	47.92737108	45.77448889	0	0.165738416	521.948374	2999.409797	5388.675615	1.542446557	570.790633	0	0	5.642648059	0	0	179.3029197	138.5887756	0.098818419	0.077729546	0	0	0											3000	1a1: $200 days 1-5 1a2: $200 days 1-5	1b1: $200 days 1-5	21: $0 days 1-3/ $75 days 4-100 22: $0 days 1-3/ $75 days 4-100	6: 0%	10a: $100	11a: 20%	11b: 20% 11c: 20%	4a1: $50 4a2: $50 4b: $35	9a1: $375 9b: $200	8a1: 20% 8a2: 20%	8b1: $45 8b2: 20% 8b3: 20% 8b4: 20% 8b5: $45 8b6: 20%	9a2: $50; included in h5	12: 0%	3: $35 5: 45% 9a3: 0% 9c: 45% 9d1: $35 9d2: $35	7a: $20 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14a5: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14h1: 0% 14i: 0% 14j: 0%	7b1: $35 7d1: $35 7f1: $35 16b1: 20% 17a1: $35 18a1: $35	7e: 45% 7h: 45%	7c: $35 7i: $35	7d2: $35; Included in i2 14h2: 0%	7g: 20%; Included in i2	151: 20%; $1000 OOP max. 152: 20%; $1000 OOP max. 153: 20%; $1000 OOP max.	13a1: 0% 14a2: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $35	17b1: $200 max per 2 or 3 years 17b2: $200 max per 3 years	18a2: $35	18b: $800 max per 3 years													0	129.6882936	86.0089272	56.81574719	0	100	0.2	0.2	47.50597218	337.375	0.2	0.181650636	0	0	77.65453437	19.50505421	40.26469904	0.45	35	0	0	0.2	0	0	22.42253521	35	0	35	0	0	0											NO	104.6188965	69.38297051	45.83297851	0	80.66949882	0.161338998	0.161338998	38.32282967	272.1587217	0.161338998	0.146536658	0	0	62.64352369	15.73462947	32.48133091	0.363012745	28.23432459	0	0	0.161338998	0	0	22.42253521	28.23432459	0	28.23432459	0	0	0												10.1248	0.242318485	4.39118622	0	0.523274806	0.88958771	0.937671823	1.241318351	4.057773019	7.73255401	6.707640609	0	0	2.724723778	3.932883483	14.58594632	0.559927758	1.342990667	0	0	0.910379182	0	0	0.335035503	0.32608004	0	0.000182887	0	0	0	0	0	0	0	0	0	0	0	0	0	61.5663	60	14.6725959	11.9628	0.256817839	4.661223709	0	0.593907983	0.935707674	0.98628467	1.329877388	4.406563907	8.133442095	7.09052093	0	0.000692307	2.834761583	4.208129783	15.552089	0.572829539	1.372680718	0	0	0.957577063	0.004247421	0	0.335035503	0.356821482	0	0.006144684	0	0.008102186	0	0	0	0	0	0	0	0	0	0	0	66.5663	YES	1a1: 25% 1a2: 25%	1b1: 25%	21: 25% 22: $1	6: 25%	10a: 25%	11a: 25%	11b: 25% 11c: 25%	4a1: $50 4a2: $50 4b: $35	9a1: 25% 9b: 25%	8a1: 25% 8a2: 25%	8b1: 25% 8b2: 25% 8b3: 25% 8b4: 25% 8b5: 25% 8b6: 25%	9a2: 25%; included in h5	12: 25%	3: 25% 5: 45% 9a3: 25% 9c: 45% 9d1: 25% 9d2: 25%	7a: $30 14a: 25% 14a1: 25% 14a3: 25% 14a4: 25% 14a5: 25% 14b1: 25% 14b2: 25% 14c1: $30 14c2: $30 14d1: $45 14d2: $45 14e1: $45 14f1: $45 14f2: 0% 14g1: $45 14h1: $45 14i: $45 14j: $45	7b1: $45 7d1: $45 7f1: $45 16b1: $45 17a1: $45	7e: 45% 7h: 45%	7c: 25% 7i: 25%	7d2: $45; Included in i2	7g: 25%; Included in i2	151: 20% 152: 20% 153: 20%	13a1: 25% 14a2: 25%		16a1: 20% 16b2: 20% 16b3: 20%	17a2: $45	17b2: 0%	18a2: $45	18b: 0%													5100	0.5192	0	0.0796	0.044	0.0208	0.0136	0.0143	0.0154	0.0984	0.1131	0.1077	0	0.0002	0.038	0.0733	0.2266	0.0014	0.0083	0	0	0.0139	0.0013	0	0	0.0053	0	0.0001	0	0.0024	0											1.3969	60	7.747553031	12.482	0.256817839	4.740829114	0.043994096	0.614730212	0.949303559	1.000615441	1.345303672	4.504945985	8.246543516	7.198246742	0	0.000885931	2.872809097	4.281435185	15.77869641	0.574212262	1.381024094	0	0	0.971490711	0.005499535	0	0.335035503	0.362084526	0	0.006208652	0	0.010490661	0	0	0	0	0	0	0	0	0	0	0	67.9632
H3924_801_0	2011	2																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	271.0000029	2.697502018	45.44664563	1312.236339	12.86902023	8.328693466	10.03376803	16.1900432	65.0469004	73.77064177	66.63044823	0	0.311865425	21.03036283	50.16678849	155.7822744	1.901493232	3.194977129	0	0	8.055885272	1.050585214	0	0	0	0	0	0	0	0											6700	1a1: Medicare FFS	1b1: Medicare FFS	21: Medicare FFS	6: Medicare FFS	10a: Medicare FFS	11a: Medicare FFS	11b: Medicare FFS 11c: Medicare FFS	4a1: Medicare FFS 4b: Medicare FFS	9a1: Medicare FFS 9b: Medicare FFS	8a1: Medicare FFS 8a2: Medicare FFS	8b1: Medicare FFS 8b2: Medicare FFS 8b3: Medicare FFS 8b4: Medicare FFS 8b5: Medicare FFS 8b6: Medicare FFS	9a2: Medicare FFS; included in h5	12: Medicare FFS	3: 20% 5: Medicare FFS 9a3: Medicare FFS 9c: Medicare FFS 9d1: Medicare FFS 9d2: Medicare FFS	7a: Medicare FFS 14a4: Medicare FFS 14b1: Medicare FFS 14c1: Medicare FFS 14c2: Medicare FFS 14d1: Medicare FFS 14e1: Medicare FFS 14f1: Medicare FFS 14g1: Medicare FFS 14h1: Medicare FFS 14i: Medicare FFS 14j: Medicare FFS	7b1: Medicare FFS 7d1: Medicare FFS 7f1: Medicare FFS 16b1: Medicare FFS 17a1: Medicare FFS 18a1: Medicare FFS	7e: Medicare FFS 7h: Medicare FFS	7c: Medicare FFS 7i: Medicare FFS	7d2: Medicare FFS; Included in i2	7g: Included in i2	151: Medicare FFS 152: Medicare FFS 153: Medicare FFS	13a1: Medicare FFS				17b1: Medicare FFS															0	0.079728646	0.079728646	0.171713097	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.067813641	0.067813641	0.146051525	0	0.19817944	0.19817944	0.19817944	0.19817944	0.19817944	0.19817944	0.19817944	0	0.19817944	0.19817944	0.19817944	0.19817944	0.19817944	0.19817944	0	0	0.19817944	0.19817944	0	0	0	0	0	0	0	0												18.3775	0.182927433	6.63755191	0	2.550375222	1.650575806	1.988486528	3.208533694	12.89095829	14.61982446	13.20478491	0	0.061805315	4.167785525	9.942026042	30.87284387	0.376836864	0.633178778	0	0	1.596510831	0.208204389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.1707	0	21.64136201	18.3775	0.182927433	6.63755191	0	2.550375222	1.650575806	1.988486528	3.208533694	12.89095829	14.61982446	13.20478491	0	0.061805315	4.167785525	9.942026042	30.87284387	0.376836864	0.633178778	0	0	1.596510831	0.208204389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.1707	YES	1a1: Medicare FFS	1b1: Medicare FFS	21: Medicare FFS	6: Medicare FFS	10a: Medicare FFS	11a: Medicare FFS	11b: Medicare FFS 11c: Medicare FFS	4a1: Medicare FFS 4b: Medicare FFS	9a1: Medicare FFS 9b: Medicare FFS	8a1: Medicare FFS 8a2: Medicare FFS	8b1: Medicare FFS 8b2: Medicare FFS 8b3: Medicare FFS 8b4: Medicare FFS 8b5: Medicare FFS 8b6: Medicare FFS	9a2: Medicare FFS; included in h5	12: Medicare FFS	3: 20% 5: Medicare FFS 9a3: Medicare FFS 9c: Medicare FFS 9d1: Medicare FFS 9d2: Medicare FFS	7a: Medicare FFS 14a4: Medicare FFS 14b1: Medicare FFS 14c1: Medicare FFS 14c2: Medicare FFS 14d1: Medicare FFS 14e1: Medicare FFS 14f1: Medicare FFS 14g1: Medicare FFS 14h1: Medicare FFS 14i: Medicare FFS 14j: Medicare FFS	7b1: Medicare FFS 7d1: Medicare FFS 7f1: Medicare FFS 16b1: Medicare FFS 17a1: Medicare FFS	7e: Medicare FFS 7h: Medicare FFS	7c: Medicare FFS 7i: Medicare FFS	7d2: Medicare FFS; Included in i2	7g: Included in i2	151: Medicare FFS 152: Medicare FFS 153: Medicare FFS	13a1: Medicare FFS																			10000	0.2934	0	0	0	0.0431	0.0279	0.0336	0.051	0.2033	0.2295	0.2109	0	0.001	0.0656	0.126	0.4914	0	0.0102	0	0	0.027	0.0035	0	0	0	0	0	0	0	0											1.8172	0	6.259011803	18.6709	0.182927433	6.63755191	0	2.593439181	1.678446344	2.022062804	3.259506268	13.09421478	14.84932891	13.41569147	0	0.062785263	4.23343527	10.06801219	31.36420673	0.376836864	0.64333996	0	0	1.623468463	0.211719992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.9879
H3924_802_0	2011	3																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	271.0000029	2.697502018	45.44664563	1312.236339	12.86902023	8.328693466	10.03376803	16.1900432	65.0469004	73.77064177	66.63044823	0	0.311865425	21.03036283	50.16678849	155.7822744	1.901493232	3.194977129	0	0	8.055885272	1.050585214	0	0	0	0	0	0	0	0											6700	1a1: Medicare FFS	1b1: Medicare FFS	21: Medicare FFS	6: Medicare FFS	10a: Medicare FFS	11a: Medicare FFS	11b: Medicare FFS 11c: Medicare FFS	4a1: Medicare FFS 4b: Medicare FFS	9a1: Medicare FFS 9b: Medicare FFS	8a1: Medicare FFS 8a2: Medicare FFS	8b1: Medicare FFS 8b2: Medicare FFS 8b3: Medicare FFS 8b4: Medicare FFS 8b5: Medicare FFS 8b6: Medicare FFS	9a2: Medicare FFS; included in h5	12: Medicare FFS	3: 20% 5: Medicare FFS 9a3: Medicare FFS 9c: Medicare FFS 9d1: Medicare FFS 9d2: Medicare FFS	7a: Medicare FFS 14a4: Medicare FFS 14b1: Medicare FFS 14c1: Medicare FFS 14c2: Medicare FFS 14d1: Medicare FFS 14e1: Medicare FFS 14f1: Medicare FFS 14g1: Medicare FFS 14h1: Medicare FFS 14i: Medicare FFS 14j: Medicare FFS	7b1: Medicare FFS 7d1: Medicare FFS 7f1: Medicare FFS 16b1: Medicare FFS 17a1: Medicare FFS 18a1: Medicare FFS	7e: Medicare FFS 7h: Medicare FFS	7c: Medicare FFS 7i: Medicare FFS	7d2: Medicare FFS; Included in i2	7g: Included in i2	151: Medicare FFS 152: Medicare FFS 153: Medicare FFS	13a1: Medicare FFS																			0	0.079728646	0.079728646	0.171713097	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.067813641	0.067813641	0.146051525	0	0.19817944	0.19817944	0.19817944	0.19817944	0.19817944	0.19817944	0.19817944	0	0.19817944	0.19817944	0.19817944	0.19817944	0.19817944	0.19817944	0	0	0.19817944	0.19817944	0	0	0	0	0	0	0	0												18.3775	0.182927433	6.63755191	0	2.550375222	1.650575806	1.988486528	3.208533694	12.89095829	14.61982446	13.20478491	0	0.061805315	4.167785525	9.942026042	30.87284387	0.376836864	0.633178778	0	0	1.596510831	0.208204389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.1707	0	21.64136201	18.3775	0.182927433	6.63755191	0	2.550375222	1.650575806	1.988486528	3.208533694	12.89095829	14.61982446	13.20478491	0	0.061805315	4.167785525	9.942026042	30.87284387	0.376836864	0.633178778	0	0	1.596510831	0.208204389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.1707	YES	1a1: Medicare FFS	1b1: Medicare FFS	21: Medicare FFS	6: Medicare FFS	10a: Medicare FFS	11a: Medicare FFS	11b: Medicare FFS 11c: Medicare FFS	4a1: Medicare FFS 4b: Medicare FFS	9a1: Medicare FFS 9b: Medicare FFS	8a1: Medicare FFS 8a2: Medicare FFS	8b1: Medicare FFS 8b2: Medicare FFS 8b3: Medicare FFS 8b4: Medicare FFS 8b5: Medicare FFS 8b6: Medicare FFS	9a2: Medicare FFS; included in h5	12: Medicare FFS	3: 20% 5: Medicare FFS 9a3: Medicare FFS 9c: Medicare FFS 9d1: Medicare FFS 9d2: Medicare FFS	7a: Medicare FFS 14a4: Medicare FFS 14b1: Medicare FFS 14c1: Medicare FFS 14c2: Medicare FFS 14d1: Medicare FFS 14e1: Medicare FFS 14f1: Medicare FFS 14g1: Medicare FFS 14h1: Medicare FFS 14i: Medicare FFS 14j: Medicare FFS	7b1: Medicare FFS 7d1: Medicare FFS 7f1: Medicare FFS 16b1: Medicare FFS 17a1: Medicare FFS	7e: Medicare FFS 7h: Medicare FFS	7c: Medicare FFS 7i: Medicare FFS	7d2: Medicare FFS; Included in i2	7g: Included in i2	151: Medicare FFS 152: Medicare FFS 153: Medicare FFS	13a1: Medicare FFS																			10000	0.2934	0	0	0	0.0431	0.0279	0.0336	0.051	0.2033	0.2295	0.2109	0	0.001	0.0656	0.126	0.4914	0	0.0102	0	0	0.027	0.0035	0	0	0	0	0	0	0	0											1.8172	0	6.259011803	18.6709	0.182927433	6.63755191	0	2.593439181	1.678446344	2.022062804	3.259506268	13.09421478	14.84932891	13.41569147	0	0.062785263	4.23343527	10.06801219	31.36420673	0.376836864	0.64333996	0	0	1.623468463	0.211719992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.9879
H3931_004_0	2011	3																															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	1589.11787	66.9407111	1031.582009	969.5685332	261.096542	12.0470367	0	236.4852315	442.4820997	1778.637707	1908.720722	17.21096157	0.082745008	789.0653877	3260.101601	5844.257735	249.6018327	571.9468113	0	0	313.6839872	0	0	0	1324.697239	142.3235465	80.25891751	0	0	0											3400	$250/day 1-7	$250/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$10 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$300 per procedure	$0 per visit	$40 X-ray; $150 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$20 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	$100.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	180.7137695	180.7137695	72.96419583	10	175	0.05	0.05	49	300	0	22.75	40	25	40	20	40	40	30	40	40	$50 	0	0	0	0	0	0	0	0	0											NO	152.2809782	152.2809782	61.48429723	8.426639467	147.4661907	0.042133197	0.042133197	41.29053339	252.799184	0	19.17060479	33.70655787	21.06659867	33.70655787	16.85327893	33.70655787	33.70655787	25.2799184	33.70655787	33.70655787	42.13319734	0	0	0	0	0	0	0	0	0												20.166	0.849483081	5.285507905	0.680850372	3.208576038	0.507580174	0	0.813716779	9.321592813	0	3.049277551	0.048343523	0.000145263	2.216389846	4.578616803	16.41581763	0.701101551	1.204897393	0	0	1.101375778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1493	0	13.09776604	20.166	0.849483081	5.285507905	0.680850372	3.208576038	0.507580174	0	0.813716779	9.321592813	0	3.049277551	0.048343523	0.000145263	2.216389846	4.578616803	16.41581763	0.701101551	1.204897393	0	0	1.101375778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1493	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			20.166	0.849483081	5.285507905	0.680850372	3.208576038	0.507580174	0	0.813716779	9.321592813	0	3.049277551	0.048343523	0.000145263	2.216389846	4.578616803	16.41581763	0.701101551	1.204897393	0	0	1.101375778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1493
H3931_054_0	2011	2																															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	1690.407926	84.47497399	1269.825796	1289.523108	259.903893	15.79956865	0	308.7351332	433.5419353	1825.127468	1977.901813	41.0516978	0.494313027	437.5078936	3443.478126	5421.239831	181.5973731	476.4005881	0	0	234.5132377	0	0	0	1139.844662	131.5766637	65.89944758	0	0	0											3400	$300/day 1-7	$300/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$15 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$250 per procedure	$0 per visit	$45 X-ray; $200 Complex Radiology	$45 per visit	$25 per visit	$45 per visit	"$25 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$45 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$45 per visit	$45 per visit	$45 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	216.8565234	216.8565234	72.96419583	15	175	0.05	0.05	49	250	0	26.375	45	25	45	25	45	40	33.75	45	45	$50 	0	0	0	0	0	0	0	0	0											NO	180.8305821	180.8305821	60.84279965	12.50807995	145.9275994	0.0416936	0.0416936	40.85972783	208.4679991	0	21.99337391	37.52423984	20.84679991	37.52423984	20.84679991	37.52423984	33.35487986	28.14317988	37.52423984	37.52423984	41.69359982	0	0	0	0	0	0	0	0	0												25.4731	1.27297156	6.438313043	1.34412151	3.160595931	0.658740893	0	1.051236126	7.531634982	0	3.625061176	0.12836948	0.000858737	1.368095928	5.982124958	16.9523253	0.504763213	1.117285621	0	0	0.814808424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.4244	0	15.42486814	25.4731	1.27297156	6.438313043	1.34412151	3.160595931	0.658740893	0	1.051236126	7.531634982	0	3.625061176	0.12836948	0.000858737	1.368095928	5.982124958	16.9523253	0.504763213	1.117285621	0	0	0.814808424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.4244	NO																									0		0																																																							0			25.4731	1.27297156	6.438313043	1.34412151	3.160595931	0.658740893	0	1.051236126	7.531634982	0	3.625061176	0.12836948	0.000858737	1.368095928	5.982124958	16.9523253	0.504763213	1.117285621	0	0	0.814808424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.4244
H3931_055_0	2011	2																															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	1627.440834	104.5032721	1407.477318	850.4775584	264.2818785	9.222040643	0	185.4882711	435.3610435	1726.329447	1769.132767	10.9008753	0.228303712	579.7194989	3359.432191	5491.433992	169.3669526	587.3328554	0	0	220.9204316	0	0	0	1285.109951	0	70.06013799	0	0	0											3400	$300/day 1-7	$300/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$10 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$300 per procedure	$0 per visit	$45 X-ray; $225 Complex Radiology	$45 per visit	$25 per visit	$45 per visit	"$25 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$45 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$45 per visit	$45 per visit	$45 per visit	$50 per script	0	Not Covered	0	$0 per visit	$100.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	216.8565234	216.8565234	72.96419583	10	175	0.05	0.05	49	300	0	27	45	25	45	25	45	40	33.75	45	45	$50 	0	0	0	0	0	0	0	0	0											NO	183.4655425	183.4655425	61.7293663	8.460227047	148.0539733	0.042301135	0.042301135	41.45511253	253.8068114	0	22.84261303	38.07102171	21.15056762	38.07102171	21.15056762	38.07102171	33.84090819	28.55326628	38.07102171	38.07102171	42.30113523	0	0	0	0	0	0	0	0	0												24.8816	1.597729126	7.240223579	0.59960277	3.260665182	0.390102788	0	0.640786429	9.208133188	0	3.367634598	0.034583955	0.000402396	1.839209469	5.921158142	17.42204189	0.477627624	1.397522618	0	0	0.778765421	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.0578	0	14.38862807	24.8816	1.597729126	7.240223579	0.59960277	3.260665182	0.390102788	0	0.640786429	9.208133188	0	3.367634598	0.034583955	0.000402396	1.839209469	5.921158142	17.42204189	0.477627624	1.397522618	0	0	0.778765421	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.0578	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			24.8816	1.597729126	7.240223579	0.59960277	3.260665182	0.390102788	0	0.640786429	9.208133188	0	3.367634598	0.034583955	0.000402396	1.839209469	5.921158142	17.42204189	0.477627624	1.397522618	0	0	0.778765421	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.0578
H3931_058_0	2011	3																															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	2072.996381	150.9195353	1101.221812	1352.883844	275.7270231	16.16191531	0	282.2072611	440.73719	1633.482933	2039.76386	89.26338368	0	673.7260898	3631.299938	6555.217289	308.2615556	532.8628847	0	0	340.6861742	0	0	0	1308.91826	149.7970273	72.5432145	0	0	0											3400	$250/day 1-7	$250/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$10 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$150 per procedure	$0 per visit	$35 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	"$15 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$35 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$35 per visit	$35 per visit	$40 per visit	$35 per visit	$50 per script	0	Not Covered	0	$0 per visit	$100.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	180.7137695	180.7137695	72.96419583	10	175	0.05	0.05	49	150	0	21	35	25	35	15	35	35	26.25	40	35	$50 	0	0	0	0	0	0	0	0	0											NO	150.9085586	150.9085586	60.93017514	8.350695083	146.137164	0.041753475	0.041753475	40.91840591	125.2604263	0	17.53645968	29.22743279	0	29.22743279	12.52604263	29.22743279	29.22743279	21.92057459	33.40278033	29.22743279	41.75347542	0	0	0	0	0	0	0	0	0												26.0694	1.897920795	5.591469825	0.941460039	3.357830432	0.674816134	0	0.962289272	4.600577357	0	2.980853056	0.217411629	0	1.640940334	3.790484817	15.96601439	0.750807825	0.973388384	0	0	1.18540265	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.6011	0	14.14157789	26.0694	1.897920795	5.591469825	0.941460039	3.357830432	0.674816134	0	0.962289272	4.600577357	0	2.980853056	0.217411629	0	1.640940334	3.790484817	15.96601439	0.750807825	0.973388384	0	0	1.18540265	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.6011	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			26.0694	1.897920795	5.591469825	0.941460039	3.357830432	0.674816134	0	0.962289272	4.600577357	0	2.980853056	0.217411629	0	1.640940334	3.790484817	15.96601439	0.750807825	0.973388384	0	0	1.18540265	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.6011
H3931_064_0	2011	3																															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	1072.154106	127.6719369	648.929926	580.8750274	156.3894305	6.802147091	0	176.5852114	441.4215766	1362.322738	1640.938643	34.61235951	0	514.4636244	2859.293376	4057.703767	220.8601753	373.0366659	0	0	215.4769744	0	0	0	1106.641398	150.4317379	61.91744798	23.83077035	15.95810515	0											3400	$300/day 1-7	$300/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$10 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$300 per procedure	$0 per visit	$45 X-ray; $225 Complex Radiology	$45 per visit	$25 per visit	$45 per visit	"$25 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$45 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$45 per visit	$45 per visit	$45 per visit	$50 per script	0	Not Covered	0	$0 per visit	$100.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	216.8565234	216.8565234	72.96419583	10	175	0.05	0.05	49	300	0	27	45	25	45	25	45	40	33.75	45	45	$50 	0	0	0	0	0	0	0	0	0											NO	180.82131	180.82131	60.83967992	8.338292395	145.9201169	0.041691462	0	40.85763274	250.1487719	0	22.51338947	37.52231578	0	37.52231578	20.84573099	37.52231578	33.35316958	28.14173683	0	0	41.69146198	0	0	0	0	0	0	0	0	0												16.1557	1.92381724	3.290057416	0.403625485	1.901696998	0.283591457	0	0.60123781	9.201755438	0	3.078590897	0.10822799	0	1.608655548	4.967005045	12.68787017	0.613865573	0.874824974	0	0	0.748629174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4491	0	11.64811475	16.1557	1.92381724	3.290057416	0.403625485	1.901696998	0.283591457	0	0.60123781	9.201755438	0	3.078590897	0.10822799	0	1.608655548	4.967005045	12.68787017	0.613865573	0.874824974	0	0	0.748629174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4491	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			16.1557	1.92381724	3.290057416	0.403625485	1.901696998	0.283591457	0	0.60123781	9.201755438	0	3.078590897	0.10822799	0	1.608655548	4.967005045	12.68787017	0.613865573	0.874824974	0	0	0.748629174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4491
H3931_065_0	2011	3																															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	2015.364498	124.609742	1320.287035	1178.753496	310.6349142	15.30822079	0	279.4715601	442.0524595	1416.05132	1654.066994	67.34688369	0.540215645	471.0524432	3703.484542	5341.63655	264.9153541	424.1964021	0	0	267.7230513	0	0	0	1083.996021	120.3825513	67.65757477	0	0	0											3400	$300/day 1-7	$300/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$15 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$250 per procedure	$0 per visit	$30 X-ray; $200 Complex Radiology	$45 per visit	$25 per visit	$45 per visit	"$25 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$45 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$45 per visit	$45 per visit	$45 per visit	$50 per script	0	Not Covered	0	$0 per visit	$100.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	216.8565234	216.8565234	72.96419583	15	175	0.05	0.05	49	250	0	19.25	45	25	45	25	45	40	33.75	45	45	$50 	0	0	0	0	0	0	0	0	0											NO	181.1276759	181.1276759	60.9427607	12.52862997	146.1673496	0.0417621	0	40.9268579	208.8104995	0	16.07840846	37.58588991	20.88104995	37.58588991	20.88104995	37.58588991	33.40967992	28.18941743	0	0	41.7620999	0	0	0	0	0	0	0	0	0												30.4199	1.88085608	6.705161404	1.230680531	3.783723509	0.639303446	0	0.953157736	7.692099572	0	2.216230396	0.210941046	0.000940022	1.475410439	6.444387142	16.73084694	0.737561432	0.996487454	0	0	0.931723068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.0494	0	16.38213584	30.4199	1.88085608	6.705161404	1.230680531	3.783723509	0.639303446	0	0.953157736	7.692099572	0	2.216230396	0.210941046	0.000940022	1.475410439	6.444387142	16.73084694	0.737561432	0.996487454	0	0	0.931723068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.0494	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			30.4199	1.88085608	6.705161404	1.230680531	3.783723509	0.639303446	0	0.953157736	7.692099572	0	2.216230396	0.210941046	0.000940022	1.475410439	6.444387142	16.73084694	0.737561432	0.996487454	0	0	0.931723068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.0494
H3931_070_0	2011	3																															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	1706.832264	110.0852348	1048.382206	755.8358212	272.7644582	11.63447077	0	417.3631736	439.3837758	2802.936439	2399.876812	100.6997973	0.541424666	810.9295518	3833.412963	4919.098673	343.6184704	702.4128389	0	0	263.1356791	0	0	0	987.8805555	116.6214217	41.38779077	0	0	0											3400	$300/day 1-7	$300/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$15 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$0 per visit	$40 X-ray; $200 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$20 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	216.8565234	216.8565234	72.96419583	15	150	0.05	0.05	49	200	0	24	40	25	40	20	40	40	30	40	40	$50 	0	0	0	0	0	0	0	0	0											NO	184.8865447	184.8865447	62.20748096	12.78863152	127.8863152	0.042628772	0.042628772	41.77619629	170.5150869	0	20.46181043	34.10301738	21.31438586	34.10301738	17.05150869	34.10301738	34.10301738	25.57726303	34.10301738	34.10301738	42.62877172	0	0	0	0	0	0	0	0	0												26.2975	1.696106556	5.434768012	0.805508817	2.906903456	0.495963199	0	1.452987155	6.24346356	0	4.092152032	0.286180578	0.000961678	2.304595383	5.447122871	13.97967563	0.976535556	1.497149828	0	0	0.934762566	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8524	0	12.94322675	26.2975	1.696106556	5.434768012	0.805508817	2.906903456	0.495963199	0	1.452987155	6.24346356	0	4.092152032	0.286180578	0.000961678	2.304595383	5.447122871	13.97967563	0.976535556	1.497149828	0	0	0.934762566	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8524	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			26.2975	1.696106556	5.434768012	0.805508817	2.906903456	0.495963199	0	1.452987155	6.24346356	0	4.092152032	0.286180578	0.000961678	2.304595383	5.447122871	13.97967563	0.976535556	1.497149828	0	0	0.934762566	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8524
H3931_801_0	2011	2																															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	YES	353.855594	1.677246791	46.08045152	11.78403267	9.108402367	13.15404385	0	11.13714935	46.83282637	16.29730204	63.95515185	0.198104477	0.014337305	31.22188404	44.60091996	133.2756772	1.89115921	10.33061555	0	0	69.42729618	0.000201																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.07458227	0.07458227	0.15267041	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.064329326	0.064329326	0.131682565	0	0.200969117	0.200969117	0.200969117	0.200969117	0.200969117	0.200969117	0.200969117	0.200969117	0.200969117	0.200969117	0.200969117	0.200969117	0.200969117	0.200969117	0.200969117	0.200969117	0.200969117	0.200969117	0	0	0	0	0	0	0	0												22.7633	0.107896156	6.067992034	0	1.83050758	2.643556576	0	2.238223069	9.411951759	3.275254398	12.85301039	0.039812882	0.002881355	6.274634465	8.963407498	26.78429515	0.380064596	2.076134685	0	0	13.9527424	4.04E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.6657	0	19.07257205	22.7633	0.107896156	6.067992034	0	1.83050758	2.643556576	0	2.238223069	9.411951759	3.275254398	12.85301039	0.039812882	0.002881355	6.274634465	8.963407498	26.78429515	0.380064596	2.076134685	0	0	13.9527424	4.04E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.6657	NO																																																																																		0			22.7633	0.107896156	6.067992034	0	1.83050758	2.643556576	0	2.238223069	9.411951759	3.275254398	12.85301039	0.039812882	0.002881355	6.274634465	8.963407498	26.78429515	0.380064596	2.076134685	0	0	13.9527424	4.04E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.6657
H3931_804_0	2011	2																															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	YES	333.4744876	3.166608358	40.07817559	11.20646408	8.684757168	13.24903751	0	11.09606644	47.48451954	13.90075392	81.4570563	0.500403819	0	31.65634643	46.96663747	128.4246208	1.609745759	9.15055059	0	0	90.75532117	0.000236808																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.075216941	0.075216941	0.153563201	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.065194614	0.065194614	0.13310158	0	0.201953774	0.201953774	0.201953774	0.201953774	0.201953774	0.201953774	0.201953774	0.201953774	0.201953774	0.201953774	0.201953774	0.201953774	0.201953774	0.201953774	0.201953774	0.201953774	0.201953774	0.201953774	0	0	0	0	0	0	0	0												21.7407	0.20644581	5.334468495	0	1.75391949	2.675693131	0	2.240892499	9.589677947	2.80730972	16.45055997	0.10105844	0	6.393118645	9.485089709	25.93583689	0.325094232	1.847988229	0	0	18.32837966	4.78E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.2163	0	19.24942561	21.7407	0.20644581	5.334468495	0	1.75391949	2.675693131	0	2.240892499	9.589677947	2.80730972	16.45055997	0.10105844	0	6.393118645	9.485089709	25.93583689	0.325094232	1.847988229	0	0	18.32837966	4.78E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.2163	NO																																																																																		0			21.7407	0.20644581	5.334468495	0	1.75391949	2.675693131	0	2.240892499	9.589677947	2.80730972	16.45055997	0.10105844	0	6.393118645	9.485089709	25.93583689	0.325094232	1.847988229	0	0	18.32837966	4.78E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.2163
H3949_002_0	2011	3																															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	1624.777145	16.67353673	1084.839712	27.08541256	392.8995807	11.83894035	6.035306589	417.0293261	243.4980235	10.89875707	27.13781154	0	0.02965616	829.2084614	0	4034.02138	462.5985826	104.9535546	22.80699722	66.47984383	11.51462426	0.050794511	0	0	0	0	0	0	0	0											6700	1a:  Acute - $175/$0/day for 1-7/8-90	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	2:  Skilled Nursing Services - $0/$50/$110/day for 1-10/11-20/21-100 /2:  Non-Medicare Covered Stay - $0/$50/$110/day for 1-10/11-20/21-100	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 - $35/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/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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $35/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/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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/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:  Eye Glasses & Contact Lenses - $0/service			14c:  Routine Exams - $0/visit													175	0.074558578	46	0	125	0.2	0.2	40.04914236	239.8073991	0	0.197681186	0	0.2	69.83984419	0	34.80373616	20	35	0	35	0.2	0	0	0	0	0	0	0	0	0											NO	164.2678127	0.069986141	43.17896791	0	117.3341519	0.187734643	0.187734643	37.60473088	225.1007824	0	0.185558034	0	0.187734643	65.55679111	0	32.66933493	18.77346431	32.85356254	0	32.85356254	0.187734643	0	0	0	0	0	0	0	0	0												22.2415	1.166916485	3.903521593	0	3.841711591	2.222579241	1.133036128	1.306856298	4.567632965	0	5.035638958	0	0.005567489	4.530020491	0	10.98239963	0.723714832	0.287341514	0	0.182008309	2.161693876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2922	0	4.2	22.2415	1.166916485	3.903521593	0	3.841711591	2.222579241	1.133036128	1.306856298	4.567632965	0	5.035638958	0	0.005567489	4.530020491	0	10.98239963	0.723714832	0.287341514	0	0.182008309	2.161693876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2922	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.2415	1.166916485	3.903521593	0	3.841711591	2.222579241	1.133036128	1.306856298	4.567632965	0	5.035638958	0	0.005567489	4.530020491	0	10.98239963	0.723714832	0.287341514	0	0.182008309	2.161693876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2922
H3949_009_0	2011	5																															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	YES	583.7183702	16.76483007	69.35564232	48.57367041	29.80536922	31.61366486	8.855883335	939.2057938	42.7626494	12.56936598	29.92591678	0	0.04773797	27.14693213	125.6559875	170.7668474	5.821200291	3.151691859	27.27480033	20.25048789	18.67015247	0.003725349	0	0	0	0	0	0	0	0											6700	"1a:  Acute - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	"2:  Skilled Nursing Services - Days 1-20, $0/day; days 21-100, $137.5/day for 1-100/2:  Non-Medicare Covered Stay - Days 1-20, $0/day; days 21-100, $137.5/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 - 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 - $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 - 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/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/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 - 20.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 20.0%/7h:  Psychiatric Services - Individual - 20.0%/7h:  Psychiatric Services - Group - 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:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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 - 20.0%/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%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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 - Non-Routine 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:  Eye Glasses & Contact Lenses - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13c:  Other: Over the Counter Benefit - $0/visit/13e:  Home Safety - $0/service												0.074252012	0.074264498	0.14933448	0	0.2	0.2	0.2	70.17344918	0.2	0	0.2	0	0.2	0.2	0	0.199504055	0.2	0.2	0.180112086	0.170837347	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.059071995	0.059081928	0.118804668	0	0.159112174	0.159112174	0.159112174	55.82725015	0.159112174	0	0.159112174	0	0.159112174	0.159112174	0	0.158717619	0.159112174	0.159112174	0.143290128	0.135911508	0.159112174	0.159112174	0	0	0	0	0	0	0	0												34.4814	0.990498486	8.239774071	0	4.742397083	5.030118932	1.409078847	4.369439733	6.804058096	0	4.761577666	0	0.007595692	4.319407379	0	27.10370747	0.926223831	0.501472542	3.908209625	2.752274347	2.970648542	0.000592748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.3185	0	29.12	34.4814	0.990498486	8.239774071	0	4.742397083	5.030118932	1.409078847	4.369439733	6.804058096	0	4.761577666	0	0.007595692	4.319407379	0	27.10370747	0.926223831	0.501472542	3.908209625	2.752274347	2.970648542	0.000592748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.3185	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4814	0.990498486	8.239774071	0	4.742397083	5.030118932	1.409078847	4.369439733	6.804058096	0	4.761577666	0	0.007595692	4.319407379	0	27.10370747	0.926223831	0.501472542	3.908209625	2.752274347	2.970648542	0.000592748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.3185
H3949_013_0	2011	4																															D	coin	D	coin	T	coin	coin	V	V	coin	P	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	1389.67434	17.19825176	792.4116273	21.629022	297.291942	13.04452246	6.241406144	335.4133074	300.0543416	12.8155649	1639.6582	0	0.034076016	705.6451906	0	4913.091442	473.5734132	166.3695187	30.02895311	94.66045991	10.92348088	0.046598692	0	0	0	0	0	0	0	0											6700	1a:  Acute - $175/$0/day for 1-7/8-90	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	2:  Skilled Nursing Services - $0/$50/$110/day for 1-10/11-20/21-100 /2:  Non-Medicare Covered Stay - $0/$50/$110/day for 1-10/11-20/21-100	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 - 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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $35/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/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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/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:  Eye Glasses & Contact Lenses - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit													175	0.074150865	46	0	100	0.2	0.2	40.04931963	228.1650992	0	18.16478212	0	0.2	66.11111382	0	34.6337109	20	35	0	35	0.2	0	0	0	0	0	0	0	0	0											NO	166.0841525	0.070373049	43.6564058	0	94.90522999	0.18981046	0.18981046	38.01864209	216.5406122	0	17.23932824	0	0.18981046	62.74290462	0	32.86920298	18.981046	33.2168305	0	33.2168305	0.18981046	0	0	0	0	0	0	0	0	0												19.2336	1.210293411	2.882820297	0	2.351213345	2.475986809	1.184684171	1.062663207	5.414495901	0	2.355550493	0	0.006467984	3.689519074	0	13.45744999	0.749076562	0.460522342	0	0.262026704	2.07339093	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8697	0	3.16	19.2336	1.210293411	2.882820297	0	2.351213345	2.475986809	1.184684171	1.062663207	5.414495901	0	2.355550493	0	0.006467984	3.689519074	0	13.45744999	0.749076562	0.460522342	0	0.262026704	2.07339093	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8697	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.2336	1.210293411	2.882820297	0	2.351213345	2.475986809	1.184684171	1.062663207	5.414495901	0	2.355550493	0	0.006467984	3.689519074	0	13.45744999	0.749076562	0.460522342	0	0.262026704	2.07339093	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8697
H3949_016_0	2011	2																															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	YES	604.2752118	16.42402309	408.0581397	6.994615236	58.18078401	27.19860596	5.20868603	105.9360132	24.09179292	20.93053754	20.45577655	0	0.049907215	51.7102916	0	0	4.917907041	0.373572173	26.35031372	14.15337678	8.450507284	0.580609862	0	0	0	0	0	0	0	0											6700	"1a:  Acute - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/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 - 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $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/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/7f:  Routine Podiatry - $0/visit/12 Visits	7e:  Mental Hlth Spec-Non-Physician - Individual - 20.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 20.0%/7h:  Psychiatric Services - Individual - 20.0%/7h:  Psychiatric Services - Group - 20.0%	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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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 - Non-Routine 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:  Eye Glasses & Contact Lenses - $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	13c:  Other: Over the Counter Benefit - $0/visit												0.074236612	0.07424867	0	0	0.2	0.2	0.2	50	0.2	0	0.2	0	0.2	0.023039336	0	0	0.2	0	0	2.44E-06	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.068118506	0.068331066	0	0	0.183062667	0.183120496	0.187102104	45.7094503	0.182376276	0	0.181793387	0	0.18638049	0.021453961	0	0	0.18404454	0	0	2.27E-06	0.180380408	0.184841065	0	0	0	0	0	0	0	0												41.1623	1.122271008	0	0	10.65072952	4.980622202	0.974556113	0.403523077	4.393771472	0	3.718724904	0	0.009301731	1.109390595	0	0	0.90511394	0	0	3.21E-05	1.524305952	0.107320545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.062	0	6.476539164	41.1623	1.122271008	0	0	10.65072952	4.980622202	0.974556113	0.403523077	4.393771472	0	3.718724904	0	0.009301731	1.109390595	0	0	0.90511394	0	0	3.21E-05	1.524305952	0.107320545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.062	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.1623	1.122271008	0	0	10.65072952	4.980622202	0.974556113	0.403523077	4.393771472	0	3.718724904	0	0.009301731	1.109390595	0	0	0.90511394	0	0	3.21E-05	1.524305952	0.107320545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.062
H3949_023_0	2011	2																															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	YES	438.3277098	16.33816935	49.18980572	34.06553394	24.6551004	26.14259827	7.340200115	829.2761965	37.04364269	15.2020741	21.44008478	0	0.032671656	23.81189194	97.5831795	121.5233293	6.090070652	2.175556486	22.33113524	13.44686892	18.38605958	0.003660486	0	0	0	0	0	0	0	0											6700	"1a:  Acute - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	"2:  Skilled Nursing Services - Days 1-20, $0/day; days 21-100, $137.5/day for 1-100/2:  Non-Medicare Covered Stay - Days 1-20, $0/day; days 21-100, $137.5/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 - 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 - $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 - 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/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/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 - 20.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 20.0%/7h:  Psychiatric Services - Individual - 20.0%/7h:  Psychiatric Services - Group - 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:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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 - 20.0%/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%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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 - Non-Routine 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:  Eye Glasses & Contact Lenses - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13c:  Other: Over the Counter Benefit - $0/visit												0.082942116	0.082960689	0.174116445	0	0.2	0.2	0.2	66.06990264	0.2	0	0.2	0	0.2	0.2	0	0.199523663	0.2	0.2	0.180188336	0.173288519	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.070255324	0.070271057	0.147483666	0	0.169408083	0.169408083	0.169408083	55.96387769	0.169408083	0	0.169408083	0	0.169408083	0.169408083	0	0.169004606	0.169408083	0.169408083	0.152626803	0.146782379	0.169408083	0.169408083	0	0	0	0	0	0	0	0												30.7949	1.148100424	7.254692879	0	4.176773289	4.428767452	1.243489229	3.867459302	6.275492489	0	3.632123658	0	0.005534843	4.033926961	0	20.5380024	1.031707193	0.368556853	3.408329772	1.97376341	3.114747104	0.000620116	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2969	0	17.57	30.7949	1.148100424	7.254692879	0	4.176773289	4.428767452	1.243489229	3.867459302	6.275492489	0	3.632123658	0	0.005534843	4.033926961	0	20.5380024	1.031707193	0.368556853	3.408329772	1.97376341	3.114747104	0.000620116	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2969	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7949	1.148100424	7.254692879	0	4.176773289	4.428767452	1.243489229	3.867459302	6.275492489	0	3.632123658	0	0.005534843	4.033926961	0	20.5380024	1.031707193	0.368556853	3.408329772	1.97376341	3.114747104	0.000620116	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2969
H3949_024_0	2011	4																															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	2117.754562	16.44692375	1387.317974	33.79609199	513.1523531	15.44607724	13.70448519	429.0895753	245.8487181	11.25464946	24.03647522	0	0.031154389	712.546708	0	4312.815105	465.4926504	106.9578513	23.52508033	60.55462381	8.593571843	0.052362469	0	0	0	0	0	0	0	0											6700	1a:  Acute - $175/$0/day for 1-7/8-90	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	2:  Skilled Nursing Services - $0/$50/$110/day for 1-10/11-20/21-100 /2:  Non-Medicare Covered Stay - $0/$50/$110/day for 1-10/11-20/21-100	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) - $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/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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $35/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/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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/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:  Eye Glasses & Contact Lenses - $0/service			14c:  Routine Exams - $0/visit													175	0.074580402	46	0	125	0.2	0.034267116	40.04919673	241.4346374	0	0.199644138	0	0.2	67.24592807	0	34.92180048	20	35	0	35	0.2	0	0	0	0	0	0	0	0	0											NO	161.2792096	0.068732962	42.39339223	0	115.1994354	0.184319097	0.031580419	36.92410457	222.5050713	0	0.183991136	0	0.184319097	61.97354358	0	32.18377359	18.43190967	32.25584191	0	32.25584191	0.184319097	0	0	0	0	0	0	0	0	0												28.4625	1.130445783	4.901092919	0	4.926238446	2.847007004	0.432793387	1.320312362	4.558548879	0	4.422498383	0	0.005742349	3.679920372	0	11.56688874	0.714993207	0.287501295	0	0.162770031	1.583959399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.0032	0	6.04	28.4625	1.130445783	4.901092919	0	4.926238446	2.847007004	0.432793387	1.320312362	4.558548879	0	4.422498383	0	0.005742349	3.679920372	0	11.56688874	0.714993207	0.287501295	0	0.162770031	1.583959399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.0032	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.4625	1.130445783	4.901092919	0	4.926238446	2.847007004	0.432793387	1.320312362	4.558548879	0	4.422498383	0	0.005742349	3.679920372	0	11.56688874	0.714993207	0.287501295	0	0.162770031	1.583959399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.0032
H3952_008_0	2011	3	h.5.										OP Facility - Other										Other										D	D	D		T	coin	coin	V	V		V		V	V	V	V	V	V	V	V	coin			v	v		V				v																																																		0	YES	2602.451724	7.830847715	1713.147619	0	353.3694632	0.945410465	21.46225632	363.7471198	380.8760566	0	941.4478251	0	22.69260233	378.1604312	5335.028787	5245.595507	133.2773771	303.7172688	17.46289612	49.2892133	107.4476357	0		809.1476997	237.8475		0.000001				234.2152943										6700	$175 per day; 8 days max (PBP 1a)	$175 per day; 8 days max (PBP 1b)	"$20 for days 1-20, $100 for days 21-100 (PBP 2)"	$0 copay (PBP 6)	$100 copay per trip (PBP 10a)	20% coinsurance (PBP 11a)	20% coinsurance (PBP 11b)	$50 copay per visit (PBP 4a)	"$150 copay per service in Ambulatory Surgical Facility/$300 per service in Outpatient Facility (PBP 9b, 9a)"	$0 copay (PBP 8a)	"$40 copay per encounter for routine X-ray, $80 copay per encounter for complex radiology (PBP 8b)"	$0 copay per visit	$25 copay per visit (PBP 12)	"$40 copay per visit (PBP 3, 5, 9c, 9d)"	$15 copay per visit (PBP 7a)	"$15-$40 copay (PBP 4b, 7b, 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$40 copay per visit (PBP 7c, 7i)"	$40 copay per visit (PBP 8b)	"$40 copay per visit (PBP 7d, 18a)"	20% coinsurance (PBP 15)	$0 copay (PBP 13a)		$15 copay per visit (PBP 16a)	$40 copay per visit (PBP 17a)		$40 copay per visit (PBP 18a)				$25 copay per visit (PBP 8b)											128.0170401	128.0170401	46.94003827	0	100	0.2	0.2	50	240.6424921	0	52.72619157	0	25	40	15	39.59464279	40	40	40	40	0.2	0		15	40		0.0003				25										NO	115.6505941	115.6505941	42.40563057	0	90.34	0.18068	0.18068	45.17	217.3964274	0	47.63284147	0	22.585	36.136	13.551	35.7698003	36.136	36.136	36.136	36.136	0.18068	0		15	40		0.0003				22.585											25.0813	0.075470183	6.05392542	0	2.660283109	0.170816763	3.877800472	1.369204784	6.900091164	0	3.73698625	0	0.042709369	1.138767112	6.024581257	15.63615864	0.401342608	0.914593935	0.052586601	0.148426251	19.41363881	0	0	1.011434625	0.792825	0	2.50E-14	0	0	0	0.440812702	0	0	0	0	0	0	0	0	0	95.9437		10.07260114	25.0813	0.075470183	6.05392542	0	2.660283109	0.170816763	3.877800472	1.369204784	6.900091164	0	3.73698625	0	0.042709369	1.138767112	6.024581257	15.63615864	0.401342608	0.914593935	0.052586601	0.148426251	19.41363881	0	0	1.011434625	0.792825	0	2.50E-14	0	0	0	0.440812702	0	0	0	0	0	0	0	0	0	95.9437	NO																																																																																		0			25.0813	0.075470183	6.05392542	0	2.660283109	0.170816763	3.877800472	1.369204784	6.900091164	0	3.73698625	0	0.042709369	1.138767112	6.024581257	15.63615864	0.401342608	0.914593935	0.052586601	0.148426251	19.41363881	0	0	1.011434625	0.792825	0	2.50E-14	0	0	0	0.440812702	0	0	0	0	0	0	0	0	0	95.9437
H3952_020_0	2011	5	h.5.										OP Facility - Other										Other										D	D	D		T	coin	coin	V	V		V		V	V	V	V	V	V	V	V	coin			v	v		V				v																																																		0	YES	2137.46643	6.431694373	1311.212617	0	280.522191	0.963681565	22.3920879	325.2010765	429.0754669	0	950.3978	0	22.69260233	414.2038929	4917.402317	5211.666442	133.4694669	312.8711988	17.60983484	57.72023956	101.528067	0		809.1476997	237.8475		0.0000001				239.3598906										6700	$175 per day; 8 days max (PBP 1a)	$175 per day; 8 days max (PBP 1b)	$20 for days 1-20; $100 for days 21-100.  100 days per Medicare benefit period.  (PBP 2)	$0 copay (PBP 6)	$100 copay per trip (PBP 10a)	20% coinsurance (PBP 11a)	20% coinsurance (PBP 11b)	$50 copay per visit (PBP 4a)	"$150 copay per service in Ambulatory Surgical Facility/$300 per service in Outpatient Facility (PBP 9b, 9a)"	$0 copay (PBP 8a)	"$40 copay per encounter for routine X-ray, $80 copay per encounter for complex radiology (PBP 8b)"	$0 copay per visit	$25 copay per visit (PBP 12)	"$40 copay per visit (PBP 3, 5, 9c, 9d)"	$15 copay per visit (PBP 7a)	"$15-$40 copay (PBP 4b, 7b, 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$40 copay per visit (PBP 7c, 7i)"	$40 copay per visit (PBP 8b)	"$40 copay per visit (PBP 7d, 18a)"	20% coinsurance (PBP 15)	$0 copay (PBP 13a)		$15 copay per visit (PBP 16a)	$40 copay per visit (PBP 17a)		$40 copay per visit (PBP 18a)				$25 copay per visit (PBP 8b)											137.8855751	137.8855751	46.94003827	0	100	0.2	0.2	50	240.6424921	0	53.00476314	0	25	40	15	39.59464279	40	40	40	40	0.2	0		15	40		40				25										NO	120.8222352	120.8222352	41.13120854	0	87.625	0.17525	0.17525	43.8125	210.8629837	0	46.4454237	0	21.90625	35.05	13.14375	34.69480575	35.05	35.05	35.05	35.05	0.17525	0		15	40		40				21.90625											21.5211	0.064757641	4.494313297	0	2.048396416	0.168885194	3.924213404	1.187322681	7.539677765	0	3.678469042	0	0.041425818	1.209820537	5.386092225	15.06814624	0.389842068	0.913844627	0.051435393	0.1685912	17.79279374	0	0	1.011434625	0.792825	0	3.33E-10	0	0	0	0.436956467	0	0	0	0	0	0	0	0	0	87.8904		12.22881367	21.5211	0.064757641	4.494313297	0	2.048396416	0.168885194	3.924213404	1.187322681	7.539677765	0	3.678469042	0	0.041425818	1.209820537	5.386092225	15.06814624	0.389842068	0.913844627	0.051435393	0.1685912	17.79279374	0	0	1.011434625	0.792825	0	3.33E-10	0	0	0	0.436956467	0	0	0	0	0	0	0	0	0	87.8904	NO																																																																																		0			21.5211	0.064757641	4.494313297	0	2.048396416	0.168885194	3.924213404	1.187322681	7.539677765	0	3.678469042	0	0.041425818	1.209820537	5.386092225	15.06814624	0.389842068	0.913844627	0.051435393	0.1685912	17.79279374	0	0	1.011434625	0.792825	0	3.33E-10	0	0	0	0.436956467	0	0	0	0	0	0	0	0	0	87.8904
H3952_042_0	2011	3	h.5.										OP Facility - Other										Other										D	D	D		T	coin	coin	V	V		V		v	V	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	0	0	0	0	0	0	0	0										0	YES	1843.441637	5.546965807	1217.486276	0	217.7269631	0.555512416	17.97935777	339.041251	352.2897243	0	816.374948	0	22.69260233	309.9567494	4180.118278	4063.660267	105.1015748	259.7399697	18.19688588	26.89159228	71.75997603	0	0	0	0	0	0	0	0	0	246.0694066										6700	$215 per day; 8 days max (PBP 1a)	$215 per day; 8 days max (PBP 1b)	$40 for days 1-20; $130 for days 21-100.  100 days per Medicare benefit period. (PBP 2)	$0 copay (PBP 6)	$100 copay per trip (PBP 10a)	20% coinsurance (PBP 11a)	20% coinsurance (PBP 11b)	$50 copay per visit (PBP 4a)	"$150 copay per service in Ambulatory Surgical Facility/$300 per service in Outpatient Facility (PBP 9b, 9a)"	$0 copay (PBP 8a)	"$45 copay per encounter for routine X-ray, $90 copay per encounter for complex radiology (PBP 8b)"	$0 copay per visit	$25 copay per visit (PBP 12)	"$40-45 copay per visit (PBP 3, 5 9c, 9d)"	$25 copay per visit (PBP 7a)	"$15-$45 copay (PBP 4b, 7b, 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$45 copay per visit (PBP 7c, 7i)"	$45 copay per visit (PBP 8b)	$45 copay per visit (PBP 7d)	20% coinsurance (PBP 15)	$0 copay (PBP 13a)									$25 copay per visit (PBP 8b)											170.93689	170.93689	66.32804593	0	100	0.2	0.2	50	240.6424921	0	59.05329874	0	25	45	25	44.51357135	40	45	45	45	0.2	0	0	0	0	0	0	0	0	0	25										NO	158.3388412	158.3388412	61.43966894	0	92.63	0.18526	0.18526	46.315	222.9071404	0	54.70107062	0	23.1575	41.6835	23.1575	41.23292114	37.052	41.6835	41.6835	41.6835	0.18526	0	0	0	0	0	0	0	0	0	23.1575											24.324	0.073191678	6.233496147	0	1.680670716	0.10291423	3.330855821	1.308557962	6.543991254	0	3.721381974	0	0.043791995	1.076673514	8.066757418	13.96304861	0.324518629	0.902239252	0.063209158	0.093411307	13.29425316	0	0	0	0	0	0	0	0	0	0.47486269	0	0	0	0	0	0	0	0	0	85.6219		6.806609787	24.324	0.073191678	6.233496147	0	1.680670716	0.10291423	3.330855821	1.308557962	6.543991254	0	3.721381974	0	0.043791995	1.076673514	8.066757418	13.96304861	0.324518629	0.902239252	0.063209158	0.093411307	13.29425316	0	0	0	0	0	0	0	0	0	0.47486269	0	0	0	0	0	0	0	0	0	85.6219	NO																																																																																		0			24.324	0.073191678	6.233496147	0	1.680670716	0.10291423	3.330855821	1.308557962	6.543991254	0	3.721381974	0	0.043791995	1.076673514	8.066757418	13.96304861	0.324518629	0.902239252	0.063209158	0.093411307	13.29425316	0	0	0	0	0	0	0	0	0	0.47486269	0	0	0	0	0	0	0	0	0	85.6219
H3952_043_0	2011	6	h.5.										OP Facility - Other										Other										D	D	D		T	coin	coin	V	V		V		V	V	V	V	V	V	V	V	coin										v																																								0										0	YES	1855.867731	5.584356261	1025.194951	0	205.3719001	0.777645817	19.44316551	358.2243196	390.985576	0	878.0299163	0	22.69260233	436.7868952	4160.275486	4415.632526	113.0870296	290.4326591	18.39249729	39.29164842	77.1267862	0									217.7576967										6700	$215 per day; 8 days max (PBP 1a)	$215 per day; 8 days max (PBP 1b)	$40 for days 1-20; $130 for days 21-100.  100 days per Medicare benefit period. (PBP 2)	$0 copay (PBP 6)	$100 copay per trip (PBP 10a)	20% coinsurance (PBP 11a)	20% coinsurance (PBP 11b)	$50 copay per visit (PBP 4a)	"$150 copay per service in Ambulatory Surgical Facility/$300 per service in Outpatient Facility (PBP 9b, 9a)"	$0 copay (PBP 8a)	"$45 copay per encounter for routine X-ray, $90 copay per encounter for complex radiology (PBP 8b)"	$0 copay per visit	$25 copay per visit (PBP 12)	"$40-45 copay per visit (PBP 3, 5 9c, 9d)"	$25 copay per visit (PBP 7a)	"$15-$45 copay (PBP 4b, 7b, 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$45 copay per visit (PBP 7c, 7i)"	$45 copay per visit (PBP 8b)	$45 copay per visit (PBP 7d)	20% coinsurance (PBP 15)	$0 copay (PBP 13a)									$25 copay per visit (PBP 8b)											164.0256776	164.0256776	66.32804593	0	100	0.2	0.2	50	240.6424921	0	59.05329874	0	25	45	25	44.51357135	40	45	45	45	0.2	0									25										NO	152.9703469	152.9703469	61.85753563	0	93.26	0.18652	0.18652	46.63	224.4231881	0	55.0731064	0	23.315	41.967	23.315	41.51335664	37.304	41.967	41.967	41.967	0.18652	0									23.315											23.6577	0.071186743	5.284669433	0	1.59608195	0.145046498	3.626539231	1.392000002	7.312185789	0	4.029652917	0	0.044089835	1.527552969	8.08306858	15.27564399	0.351549879	1.015715617	0.064323161	0.137412717	14.38568816	0	0	0	0	0	0	0	0	0	0.423085058	0	0	0	0	0	0	0	0	0	88.4232		6.388697503	23.6577	0.071186743	5.284669433	0	1.59608195	0.145046498	3.626539231	1.392000002	7.312185789	0	4.029652917	0	0.044089835	1.527552969	8.08306858	15.27564399	0.351549879	1.015715617	0.064323161	0.137412717	14.38568816	0	0	0	0	0	0	0	0	0	0.423085058	0	0	0	0	0	0	0	0	0	88.4232	NO																																																																																		0			23.6577	0.071186743	5.284669433	0	1.59608195	0.145046498	3.626539231	1.392000002	7.312185789	0	4.029652917	0	0.044089835	1.527552969	8.08306858	15.27564399	0.351549879	1.015715617	0.064323161	0.137412717	14.38568816	0	0	0	0	0	0	0	0	0	0.423085058	0	0	0	0	0	0	0	0	0	88.4232
H3952_044_0	2011	4	h.5.										OP Facility - Other										Other										D	D	D		T	coin	coin	V	V		V		V	V	V	V	V	V	V	V	coin			v	v		V				v																																																		0	YES	2396.476619	7.211063047	1819.683286	0	362.4178775	0.781257016	17.18218733	335.6176643	431.0081602	0	779.3023135	0	22.69260233	401.9959904	4751.297904	5499.880391	133.2773771	296.5813483	38.55275266	49.71667975	84.00801269	0		809.1476997	237.8475		0				234.2152943										6700	$175 per day; 8 days max (PBP 1a)	$175 per day; 8 days max (PBP 1b)	$20 for days 1-20; $100 for days 21-100.  100 days per Medicare benefit period.  (PBP 2)	$0 copay (PBP 6)	$100 copay per trip (PBP 10a)	20% coinsurance (PBP 11a)	20% coinsurance (PBP 11b)	$50 copay per visit (PBP 4a)	"$150 copay per service in Ambulatory Surgical Facility/$300 per service in Outpatient Facility (PBP 9b, 9a)"	$0 copay (PBP 8a)	"$40 copay per encounter for routine X-ray, $80 copay per encounter for complex radiology (PBP 8b)"	$0 copay per visit	$25 copay per visit (PBP 12)	"$40 copay per visit (PBP 3, 5, 9c, 9d)"	$15 copay per visit (PBP 7a)	"$15-$40 copay (PBP 4b, 7b, 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$40 copay per visit (PBP 7c, 7i)"	$40 copay per visit (PBP 8b)	"$40 copay per visit (PBP 7d, 18a)"	20% coinsurance (PBP 15)	$0 copay (PBP 13a)		$15 copay per visit (PBP 16a)	$40 copay per visit (PBP 17a)		$40 copay per visit (PBP 18a)				$25 copay per visit (PBP 8b)											128.0170401	128.0170401	46.94003827	0	100	0.2	0.2	50	240.6424921	0	52.72619157	0	25	40	15	39.59464279	40	40	40	40	0.2	0		15	40		0				25										NO	114.7672765	114.7672765	42.08174431	0	89.65	0.1793	0.1793	44.825	215.7359942	0	47.26903075	0	22.4125	35.86	13.4475	35.49659726	35.86	35.86	35.86	35.86	0.1793	0		15	40		0				22.4125											22.9198	0.068966172	6.381287229	0	2.70756356	0.140079383	3.080766189	1.253671817	7.748664494	0	3.069738752	0	0.042383162	1.201298018	5.324423214	16.26891994	0.398277228	0.886283929	0.115208476	0.148570011	15.06263668	0	0	1.011434625	0.792825	0	0	0	0	0	0.437445857	0	0	0	0	0	0	0	0	0	89.0602		10.07260114	22.9198	0.068966172	6.381287229	0	2.70756356	0.140079383	3.080766189	1.253671817	7.748664494	0	3.069738752	0	0.042383162	1.201298018	5.324423214	16.26891994	0.398277228	0.886283929	0.115208476	0.148570011	15.06263668	0	0	1.011434625	0.792825	0	0	0	0	0	0.437445857	0	0	0	0	0	0	0	0	0	89.0602	NO																																																																																		0			22.9198	0.068966172	6.381287229	0	2.70756356	0.140079383	3.080766189	1.253671817	7.748664494	0	3.069738752	0	0.042383162	1.201298018	5.324423214	16.26891994	0.398277228	0.886283929	0.115208476	0.148570011	15.06263668	0	0	1.011434625	0.792825	0	0	0	0	0	0.437445857	0	0	0	0	0	0	0	0	0	89.0602
H3952_045_0	2011	5	h.5.										OP Facility - Other										Other										D	D	D		T	coin	coin	V	V		V		v	V	V	V	V	V	V	V	coin			v	v		V				v																																																		0	YES	1908.322936	5.742195394	1236.640644	0	290.7142202	0.767179507	18.91838119	307.4518793	432.2553413	0	811.0072266	0	22.69260233	475.6867356	4793.224066	5448.742317	133.3259662	331.5931535	46.70080773	53.96763056	106.3805247	0		809.1476997	237.8475		0.0000001				239.3598906										6700	$175 per day; 8 days max (PBP 1a)	$175 per day; 8 days max (PBP 1b)	$20 for days 1--20; $100 for days 21-100.  100 days per Medicare benefit period.  (PBP 2)	$0 copay (PBP 6)	$100 copay per trip (PBP 10a)	20% coinsurance (PBP 11a)	20% coinsurance (PBP 11b)	$50 copay per visit (PBP 4a)	"$150 copay per service in Ambulatory Surgical Facility/$300 per service in Outpatient Facility (PBP 9b, 9a)"	$0 copay (PBP 8a)	"$40 copay per encounter for routine X-ray, $80 copay per encounter for complex radiology (PBP 8b)"	$0 copay per visit	$25 copay per visit (PBP 12)	"$40 copay per visit (PBP 3, 5, 9c, 9d)"	$15 copay per visit (PBP 7a)	"$15-$40 copay (PBP 4b, 7b, 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$40 copay per visit (PBP 7c, 7i)"	$40 copay per visit (PBP 8b)	"$40 copay per visit (PBP 7d, 18a)"	20% coinsurance (PBP 15)	$0 copay (PBP 13a)		$15 copay per visit (PBP 16a)	$40 copay per visit (PBP 17a)		$40 copay per visit (PBP 18a)				$25 copay per visit (PBP 8b)											137.8855751	137.8855751	46.94003827	0	100	0.2	0.2	50	240.6424921	0	53.00476314	0	25	40	15	39.59464279	40	40	40	40	0.2	0		15	40		40				25										NO	120.3189528	120.3189528	40.9598774	0	87.26	0.17452	0.17452	43.63	209.9846386	0	46.25195632	0	21.815	34.904	13.089	34.5502853	34.904	34.904	34.904	34.904	0.17452	0		15	40		40				21.815											19.134	0.057574578	4.221054097	0	2.113976905	0.133888168	3.301635885	1.117843791	7.563915135	0	3.125889235	0	0.04125326	1.383614152	5.22820915	15.6879668	0.387800794	0.964493952	0.135837083	0.156973848	18.56552918	0	0	1.011434625	0.792825	0	3.33E-10	0	0	0	0.435136334	0	0	0	0	0	0	0	0	0	85.5608		12.22881367	19.134	0.057574578	4.221054097	0	2.113976905	0.133888168	3.301635885	1.117843791	7.563915135	0	3.125889235	0	0.04125326	1.383614152	5.22820915	15.6879668	0.387800794	0.964493952	0.135837083	0.156973848	18.56552918	0	0	1.011434625	0.792825	0	3.33E-10	0	0	0	0.435136334	0	0	0	0	0	0	0	0	0	85.5608	NO																																																																																		0			19.134	0.057574578	4.221054097	0	2.113976905	0.133888168	3.301635885	1.117843791	7.563915135	0	3.125889235	0	0.04125326	1.383614152	5.22820915	15.6879668	0.387800794	0.964493952	0.135837083	0.156973848	18.56552918	0	0	1.011434625	0.792825	0	3.33E-10	0	0	0	0.435136334	0	0	0	0	0	0	0	0	0	85.5608
H3952_046_0	2011	4	h.5.										OP Facility - Other										Other										D	D	D		T	coin	coin	V	V		V		v	V	V	V	V	V	V	V	coin										v																																																		0	YES	2038.284777	6.133254094	1435.166206	0	267.9473064	0.69721208	15.58370598	314.2926475	423.0682214	0	738.6100769	0	22.69260233	375.6298955	4042.010668	4934.347784	120.7735163	282.0923483	43.56641528	37.64197021	77.1948713	0	0	0	0	0	0	0	0	0	236.6218429										6700	$215 per day; 8 days max (PBP 1a)	$215 per day; 8 days max (PBP 1b)	$40 for days 1-20; $130 for days 21-100.  100 days per Medicare benefit period. (PBP 2)	$0 copay (PBP 6)	$100 copay per trip (PBP 10a)	20% coinsurance (PBP 11a)	20% coinsurance (PBP 11b)	$50 copay per visit (PBP 4a)	"$150 copay per service in Ambulatory Surgical Facility/$300 per service in Outpatient Facility (PBP 9b, 9a)"	$0 copay (PBP 8a)	"$45 copay per encounter for routine X-ray, $90 copay per encounter for complex radiology (PBP 8b)"	$0 copay per visit	$25 copay per visit (PBP 12)	"$40-45 copay per visit (PBP 3, 5 9c, 9d)"	$25 copay per visit (PBP 7a)	"$15-$45 copay (PBP 4b, 7b, 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$45 copay per visit (PBP 7c, 7i)"	$45 copay per visit (PBP 8b)	$45 copay per visit (PBP 7d)	20% coinsurance (PBP 15)	$0 copay (PBP 13a)									$25 copay per visit (PBP 8b)											170.93689	170.93689	66.32804593	0	100	0.2	0.2	50	240.6424921	0	59.05329874	0	25	45	25	44.51357135	40	45	45	45	0.2	0									25										NO	159.5183058	159.5183058	61.89733246	0	93.32	0.18664	0.18664	46.66	224.5675736	0	55.10853838	0	23.33	41.994	23.33	41.54006478	37.328	41.994	41.994	41.994	0.18664	0									23.33											27.0953	0.081530525	7.40274665	0	2.083736886	0.130127663	2.908542883	1.222074578	7.917283662	0	3.391976815	0	0.044118201	1.314516819	7.858342406	17.08109389	0.375686152	0.987182173	0.15246067	0.131728075	14.40765078	0	0	0	0	0	0	0	0	0	0.460032299	0	0	0	0	0	0	0	0	0	95.0461		6.806609787	27.0953	0.081530525	7.40274665	0	2.083736886	0.130127663	2.908542883	1.222074578	7.917283662	0	3.391976815	0	0.044118201	1.314516819	7.858342406	17.08109389	0.375686152	0.987182173	0.15246067	0.131728075	14.40765078	0	0	0	0	0	0	0	0	0	0.460032299	0	0	0	0	0	0	0	0	0	95.0461	NO																																																																																		0			27.0953	0.081530525	7.40274665	0	2.083736886	0.130127663	2.908542883	1.222074578	7.917283662	0	3.391976815	0	0.044118201	1.314516819	7.858342406	17.08109389	0.375686152	0.987182173	0.15246067	0.131728075	14.40765078	0	0	0	0	0	0	0	0	0	0.460032299	0	0	0	0	0	0	0	0	0	95.0461
H3952_047_0	2011	5	h.5.										OP Facility - Other										Other										D	D	D		T	coin	coin	V	V		V		v	V	V	V	V	V	V	V	coin										v																																																		0	YES	1777.94645	5.349889016	1056.455462	0	225.8434995	0.768585356	16.35251456	305.5172241	425.3175977	0	771.7596137	0	22.69260233	418.1397469	4065.125575	4946.453005	122.193543	300.8670484	48.77131693	41.55178223	82.19737064	0	0	0	0	0	0	0	0	0	225.7023784										6700	$215 per day; 8 days max (PBP 1a)	$215 per day; 8 days max (PBP 1b)	$40 for days 1-20; $130 for days 21-100.  100 days per Medicare benefit period. (PBP 2)	$0 copay (PBP 6)	$100 copay per trip (PBP 10a)	20% coinsurance (PBP 11a)	20% coinsurance (PBP 11b)	$50 copay per visit (PBP 4a)	"$150 copay per service in Ambulatory Surgical Facility/$300 per service in Outpatient Facility (PBP 9b, 9a)"	$0 copay (PBP 8a)	"$45 copay per encounter for routine X-ray, $90 copay per encounter for complex radiology (PBP 8b)"	$0 copay per visit	$25 copay per visit (PBP 12)	"$40-45 copay per visit (PBP 3, 5 9c, 9d)"	$25 copay per visit (PBP 7a)	"$15-$45 copay (PBP 4b, 7b, 7d, 7f)"	"$40 copay per visit (PBP 7e, 7h)"	"$45 copay per visit (PBP 7c, 7i)"	$45 copay per visit (PBP 8b)	$45 copay per visit (PBP 7d)	20% coinsurance (PBP 15)	$0 copay (PBP 13a)									$25 copay per visit (PBP 8b)											164.0256776	164.0256776	66.32804593	0	100	0.2	0.2	50	240.6424921	0	59.05329874	0	25	45	25	44.51357135	40	45	45	45	0.2	0	0								25										NO	153.1343726	153.1343726	61.92386368	0	93.36	0.18672	0.18672	46.68	224.6638306	0	55.1321597	0	23.34	42.012	23.34	41.55787021	37.344	42.012	42.012	42.012	0.18672	0	0								23.34											22.6887	0.068270992	5.451650333	0	1.757062426	0.143510258	3.053341519	1.188462002	7.96279006	0	3.54573119	0	0.044137112	1.463907254	7.906669244	17.13033767	0.380266306	1.053335536	0.170748381	0.14547279	15.34789305	0	0	0	0	0	0	0	0	0	0.438991126	0	0	0	0	0	0	0	0	0	89.9413		6.388697503	22.6887	0.068270992	5.451650333	0	1.757062426	0.143510258	3.053341519	1.188462002	7.96279006	0	3.54573119	0	0.044137112	1.463907254	7.906669244	17.13033767	0.380266306	1.053335536	0.170748381	0.14547279	15.34789305	0	0	0	0	0	0	0	0	0	0.438991126	0	0	0	0	0	0	0	0	0	89.9413	NO																																																																																		0			22.6887	0.068270992	5.451650333	0	1.757062426	0.143510258	3.053341519	1.188462002	7.96279006	0	3.54573119	0	0.044137112	1.463907254	7.906669244	17.13033767	0.380266306	1.053335536	0.170748381	0.14547279	15.34789305	0	0	0	0	0	0	0	0	0	0.438991126	0	0	0	0	0	0	0	0	0	89.9413
H3952_802_0	2011	2																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																											0	YES	435.8523987	4.488967731	41.45555857	17.3587395	9.997537117	1.006592096	17.88392768	10.87089047	54.80191955	7.161513954	26.29378397	0	3.28669605	61.36936863	40.03169177	43.6570836	4.023569161	2.601948496	11.11945338	93.2500047	81.64093441	1.230060297																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0.056794541	0.056794541	0.114882953	0	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689																				24.754	0.254948862	4.762536995	0	1.789166135	0.180140415	3.200520027	1.945462053	9.807389302	1.281629474	4.705553706	0	0.588189391	10.98270452	7.164099157	7.812901778	0.720060711	0.465646497	1.989945042	16.68808513	14.6105179	0.220132439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.9237		34.4006073	24.754	0.254948862	4.762536995	0	1.789166135	0.180140415	3.200520027	1.945462053	9.807389302	1.281629474	4.705553706	0	0.588189391	10.98270452	7.164099157	7.812901778	0.720060711	0.465646497	1.989945042	16.68808513	14.6105179	0.220132439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.9237	NO																																																																																		0			24.754	0.254948862	4.762536995	0	1.789166135	0.180140415	3.200520027	1.945462053	9.807389302	1.281629474	4.705553706	0	0.588189391	10.98270452	7.164099157	7.812901778	0.720060711	0.465646497	1.989945042	16.68808513	14.6105179	0.220132439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.9237
H3952_804_0	2011	2																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																											0	YES	465.455093	5.056121762	54.51248022	19.1020053	10.69946909	1.099251655	22.21742573	12.50828907	65.03543909	7.284208339	27.66075899	0	0.92277713	74.21249919	38.54448654	47.87121658	3.86650336	2.563485498	11.95896567	93.75919563	108.8340352	1.464295208																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0.056794541	0.056794541	0.114882953	0	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689	0.178960689																				26.4353	0.287160115	6.262554715	0	1.914784365	0.196722834	3.976045824	2.238492035	11.63878701	1.303586946	4.950188497	0	0.165140831	13.28112002	6.897947884	8.56706592	0.691952107	0.458763132	2.14018474	16.77921029	19.47701396	0.26205128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.9241		0	26.4353	0.287160115	6.262554715	0	1.914784365	0.196722834	3.976045824	2.238492035	11.63878701	1.303586946	4.950188497	0	0.165140831	13.28112002	6.897947884	8.56706592	0.691952107	0.458763132	2.14018474	16.77921029	19.47701396	0.26205128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.9241	NO																																																																																		0			26.4353	0.287160115	6.262554715	0	1.914784365	0.196722834	3.976045824	2.238492035	11.63878701	1.303586946	4.950188497	0	0.165140831	13.28112002	6.897947884	8.56706592	0.691952107	0.458763132	2.14018474	16.77921029	19.47701396	0.26205128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.9241
H3954_003_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	Coin	V	T	P	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	1481.563631	77.65249419	1313.122289	1693.726648	105.978077	7.820004481	12.52639265	315.2081755	319.5987735	262.5609424	1646.488387	0	0.440825895	626.8285604	4194.70232	3622.514574	362.4553207	527.958535	0	0	5.352874558	0	0	268.3908331	846.0556179	0	0	0	0	0											2800	1a1: $100 days 1-5 1a2: 0%	1b1: $100 days 1-5	21: $0 days 1-6/$75 days 7-100 22: $0 days 1-6/$75 days 7-100 23: $0 days 1-6/$75 days 7-100	6: 0%	10a: $100	11a: 20%	"11b: 20% 11c: $0 preferred meters, no auth.; 20% non-pref. With auth; 1 meter every 2 years; 200 pref. test strips per month no auth."	4a1: $50 4a2: $50 4b: $20	9a1: $125 9b: $125	8a1: $5 8a2: $5	8b1: $25-100 8b2: $25-100 8b3: $25-100 8b4: $25-100 8b5: $25-100 8b6: $25-100	9a2: $0; included in h5	12: 0%	3: $10 5: $25 9a3: 0% 9c: $10/$25 Group/Indiv 9d1: $10 9d2: $10	7a: $10 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14h1: 0% 14h2: 0% 14i: 0% 14j: 0%	7b1: $20 7d1: $20 7f1: $20 7f2: $0 16b1: 0% 17a1: $20 18a1: $20	7e: $10/$25 Group/Indiv 7h: $10/$25 Group/Indiv	7c: $10 7i: $10	7d2: $20; included in i2	7g: $0; included in i2	"151: 10% 152: 10% 153: 10%; $1,000 OOP max."	13a1: 0% 14a2: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $20	17b1: $200 max per 2 years 17b2: $200 max per 2 years	18a2: $20	18b: $800 max per 3 years													0	64.84414681	43.0044636	42.03445813	0	100	0.2	0.2	39.95	125	5	53.83693198	0	0	27.14631246	9.815834014	19.76210375	17.5	9.999701943	0	0	0.1	0	0	21.71650653	19.99902954	0	0	0	0	0											NO	56.28632397	37.32893853	36.48694978	0	86.80247445	0.173604949	0.173604949	34.67758854	108.5030931	4.340123722	46.73178913	0	0	23.56367094	8.520386812	17.15399506	15.19043303	8.679988724	0	0	0.086802474	0	0	21.71650653	17.35965251	0	0	0	0	0												6.9493	0.241557098	3.992652252	0	0.76659661	1.357591478	2.174643756	0.910888284	2.889787956	0.094962248	6.411945676	0	0	1.230865161	2.978373861	5.178383093	0.458821106	0.381889511	0	0	0.464642757	0	0	0.485709273	1.223935961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1926	0	5.732983224	6.9493	0.241557098	3.992652252	0	0.76659661	1.357591478	2.174643756	0.910888284	2.889787956	0.094962248	6.411945676	0	0	1.230865161	2.978373861	5.178383093	0.458821106	0.381889511	0	0	0.464642757	0	0	0.485709273	1.223935961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1926	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	6.9493	0.241557098	3.992652252	0	0.76659661	1.357591478	2.174643756	0.910888284	2.889787956	0.094962248	6.411945676	0	0	1.230865161	2.978373861	5.178383093	0.458821106	0.381889511	0	0	0.464642757	0	0	0.485709273	1.223935961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1926
H3954_005_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	Coin	V	T	P	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	1584.779489	77.45749707	1522.619883	415.7688491	133.630089	5.637457126	8.553217072	272.8399301	302.111304	486.8730938	1968.246195	0	0	613.5781847	4061.257458	3499.66937	361.5451407	534.4468782	0	0	5.268267717	0	0	267.5462289	768.9796833	0	1.799484438	0.578485234	0	0											2800	1a1: $100 days 1-5 1a2: 0%	1b1: $100 days 1-5	21: $0 days 1-6/$75 days 7-100 22: $0 days 1-6/$75 days 7-100 23: $0 days 1-6/$75 days 7-100	6: 0%	10a: $100	11a: 20%	"11b: 20% 11c: $0 preferred meters, no auth.; 20% non-pref. With auth; 1 meter every 2 years; 200 pref. test strips per month no auth."	4a1: $50 4a2: $50 4b: $20	9a1: $125 9b: $125	8a1: $5 8a2: $5	8b1: $25-100 8b2: $25-100 8b3: $25-100 8b4: $25-100 8b5: $25-100 8b6: $25-100	9a2: $0; included in h5	12: 0%	3: $10 5: $25 9a3: 0% 9c: $10/$25 Group/Indiv 9d1: $10 9d2: $10	7a: $10 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14h1: 0% 14h2: 0% 14i: 0% 14j: 0%	7b1: $20 7d1: $20 7f1: $20 7f2: $0 16b1: 0% 17a1: $20 18a1: $20	7e: $10/$25 Group/Indiv 7h: $10/$25 Group/Indiv	7c: $10 7i: $10	7d2: $20; included in i2	7g: $0; included in i2	"151: 10% 152: 10% 153: 10%; $1,000 OOP max."	13a1: 0% 14a2: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $20	17b1: $200 max per 2 years 17b2: $200 max per 2 years	18a2: $20	18b: $800 max per 3 years													0	64.84414681	43.0044636	42.03445813	0	100	0.2	0.2	39.74581933	125	5	53.83693198	0	0	27.25187269	9.901137554	19.79026619	17.5	9.999701943	0	0	0.1	0	0	21.71650653	19.99902954	0	20	0	0	0											NO	55.99559656	37.13612889	36.29848915	0	86.3541265	0.172708253	0.172708253	34.3221551	107.9426581	4.317706325	46.49041234	0	0	23.53311661	8.550040848	17.0897115	15.11197214	8.635155265	0	0	0.086354126	0	0	21.71650653	17.26998727	0	17.2708253	0	0	0												7.3951	0.239705966	4.605733443	0	0.961625801	0.973635371	1.477211178	0.7803712	2.7175581	0.175181253	7.625381433	0	0	1.203283914	2.893659763	4.984028323	0.455305008	0.384585981	0	0	0.454936657	0	0	0.484180786	1.106689112	0	0.002589882	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9207	0	6.073828352	7.3951	0.239705966	4.605733443	0	0.961625801	0.973635371	1.477211178	0.7803712	2.7175581	0.175181253	7.625381433	0	0	1.203283914	2.893659763	4.984028323	0.455305008	0.384585981	0	0	0.454936657	0	0	0.484180786	1.106689112	0	0.002589882	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9207	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.3951	0.239705966	4.605733443	0	0.961625801	0.973635371	1.477211178	0.7803712	2.7175581	0.175181253	7.625381433	0	0	1.203283914	2.893659763	4.984028323	0.455305008	0.384585981	0	0	0.454936657	0	0	0.484180786	1.106689112	0	0.002589882	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9207
H3954_007_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	Coin	V	T	P	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	1482.441191	76.69479107	1398.923398	1163.551907	110.9268484	7.86727938	8.915188701	290.0745369	267.9918085	662.7457857	1925.025155	0	1.589610486	597.5053287	4047.803528	4407.427315	357.9850897	722.790583	0	0	3.995056552	0	0	268.2619128	461.9234874	1.389033477	0.090562022	0.03175988	0	0											2800	1a1: $100 days 1-5 1a2: 0%	1b1: $100 days 1-5	21: $0 days 1-6/$75 days 7-100 22: $0 days 1-6/$75 days 7-100 23: $0 days 1-6/$75 days 7-100	6: 0%	10a: $100	11a: 20%	"11b: 20% 11c: $0 preferred meters, no auth.; 20% non-pref. With auth; 1 meter every 2 years; 200 pref. test strips per month no auth."	4a1: $50 4a2: $50 4b: $20	9a1: $125 9b: $125	8a1: $5 8a2: $5	8b1: $25-100 8b2: $25-100 8b3: $25-100 8b4: $25-100 8b5: $25-100 8b6: $25-100	9a2: $0; included in h5	12: 0%	3: $10 5: $25 9a3: 0% 9c: $10/$25 Group/Indiv 9d1: $10 9d2: $10	7a: $10 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14h1: 0% 14h2: 0% 14i: 0% 14j: 0%	7b1: $20 7d1: $20 7f1: $20 7f2: $0 16b1: 0% 17a1: $20 18a1: $20	7e: $10/$25 Group/Indiv 7h: $10/$25 Group/Indiv	7c: $10 7i: $10	7d2: $20; included in i2	7g: $0; included in i2	"151: 10% 152: 10% 153: 10%; $1,000 OOP max."	13a1: 0% 14a2: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $20	17b1: $200 max per 2 years 17b2: $200 max per 2 years	18a2: $20	18b: $800 max per 3 years													0	64.84414681	43.0044636	42.03445813	0	100	0.2	0.2	39.78990602	125	5	53.83693198	0	0	27.1303795	9.615666779	19.70528668	17.5	9.999701943	0	0	0.1	0	0	21.71650653	19.99902954	0	20	0	0	0											NO	56.16802475	37.2504828	36.4102637	0	86.62003822	0.173240076	0.173240076	34.4660318	108.2750478	4.331001911	46.63357106	0	0	23.50034509	8.329094239	17.06872686	15.15850669	8.661745644	0	0	0.086620038	0	0	21.71650653	17.32316703	0	17.32400764	0	0	0												6.9388	0.2380765	4.244597484	0	0.80070732	1.362928081	1.544467972	0.833143184	2.418068823	0.239196105	7.480899778	0	0	1.170131785	2.809544754	6.269097748	0.452209948	0.521719015	0	0	0.346051951	0	0	0.485475965	0.666831477	0	0.000130741	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8221	0	5.921753267	6.9388	0.2380765	4.244597484	0	0.80070732	1.362928081	1.544467972	0.833143184	2.418068823	0.239196105	7.480899778	0	0	1.170131785	2.809544754	6.269097748	0.452209948	0.521719015	0	0	0.346051951	0	0	0.485475965	0.666831477	0	0.000130741	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8221	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.9388	0.2380765	4.244597484	0	0.80070732	1.362928081	1.544467972	0.833143184	2.418068823	0.239196105	7.480899778	0	0	1.170131785	2.809544754	6.269097748	0.452209948	0.521719015	0	0	0.346051951	0	0	0.485475965	0.666831477	0	0.000130741	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8221
H3954_009_0	2011	4																															Coin	Coin	Coin	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	V	V	V	V	V	V	Coin	Coin	V	Coin	P	V	P	V	P	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	219.9855959	2.830799431	28.67840943	372.6679507	103.91054	5.68245272	5.391478734	285.2621823	52.59955248	54.5856245	50.55812952	0	0.055494896	461.8962928	4665.870196	8051.387038	356.5311829	500.2614897	0	0	5.221794378	0	0	236.9952254	617.1620638	0.03121382	0.708759465	0.020809213	0	0											3400	1a1: 15% 1a2: 15%	1b1: 15%	21: 15% 22: 15% 23: 15%	6: 0%	10a: $100	11a: 20%	11b: 20% 11c: 20%	4a1: $50 4a2: $50 4b: $20	9a1: 15% 9b: $50	8a1: 15% 8a2: 15%	8b1: $25 8b2: 15% 8b3: 15% 8b4: 15% 8b5: $25 8b6: 15%	5: $25 9a2: $50; included in h5	12: 15%	3: $10 9a3: 15% 9c: $10/$25 Group/Indiv 9d1: $10 9d2: $10	7a: $10 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14h1: 0% 14h2: 0% 14i: 0% 14j: 0%	7b1: $20 7d1: $20 7f1: $20 16b1: 15% 17a1: $20 18a1: $20	7e: $10/$25 Group/Indiv 7h: $10/$25 Group/Indiv	7c: $10 7i: $10	7d2: $25; Included in i2	7g: 15%; Included in i2	151: 15% 152: 15% 153: 15%	13a1: 0% 14a2: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $20	17b1: $200 max per 2 years 17b2: $200 max per 2 years	18a2: $20	18b: $800 max per 3 years													0	0.124117058	0.136289195	0.15	0	100	0.2	0.2	39.85913905	0.15	0.15	0.150661083	0	0.15	27.01910271	9.751739563	20.77170949	17.5	10	0	0	0.15	0	0	23.92111034	20	0	20	0	0	0											NO	0.09374479	0.102938325	0.113294005	0	75.52933662	0.151058673	0.151058673	30.10534331	0.113294005	0.113294005	0.113793317	0	0.113294005	20.40734904	7.365424201	15.68873438	13.21763391	7.552933662	0	0	0.113294005	0	0	18.06745595	15.10586732	0	15.10586732	0	0	0												20.6225	0.291397752	3.24909186	0	0.654024513	0.858383769	0.814429624	0.715659661	5.959213959	6.184224011	5.753177249	0	0.006287239	0.785506572	2.863842772	10.52633939	0.392708221	0.314870154	0	0	0.591597998	0	0	0.356825066	0.776897355	0	0.000892202	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7179	0	19.99590305	20.6225	0.291397752	3.24909186	0	0.654024513	0.858383769	0.814429624	0.715659661	5.959213959	6.184224011	5.753177249	0	0.006287239	0.785506572	2.863842772	10.52633939	0.392708221	0.314870154	0	0	0.591597998	0	0	0.356825066	0.776897355	0	0.000892202	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7179	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.6225	0.291397752	3.24909186	0	0.654024513	0.858383769	0.814429624	0.715659661	5.959213959	6.184224011	5.753177249	0	0.006287239	0.785506572	2.863842772	10.52633939	0.392708221	0.314870154	0	0	0.591597998	0	0	0.356825066	0.776897355	0	0.000892202	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7179
H3954_021_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	Coin	V	T	P	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	1651.87774	77.5463278	1949.848504	1747.484427	158.8804599	10.42042356	12.47978601	380.3336165	324.625922	278.4881612	1934.7021	0	0.817011549	1000.54733	4454.574609	3812.72172	361.9597723	571.3022088	0	0	10.35723593	0	0	268.1506592	912.2714968	0	0	0.246135492	0	0											2800	1a1: $100 days 1-5 1a2: 0%	1b1: $100 days 1-5	21: $0 days 1-6/$75 days 7-100 22: $0 days 1-6/$75 days 7-100 23: $0 days 1-6/$75 days 7-100	6: 0%	10a: $100	11a: 20%	"11b: 20% 11c: $0 preferred meters, no auth.; 20% non-pref. With auth; 1 meter every 2 years; 200 pref. test strips per month no auth."	4a1: $50 4a2: $50 4b: $20	9a1: $125 9b: $125	8a1: $5 8a2: $5	8b1: $25-100 8b2: $25-100 8b3: $25-100 8b4: $25-100 8b5: $25-100 8b6: $25-100	9a2: $0; included in h5	12: 0%	3: $10 5: $25 9a3: 0% 9c: $10/$25 Group/Indiv 9d1: $10 9d2: $10	7a: $10 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14h1: 0% 14h2: 0% 14i: 0% 14j: 0%	7b1: $20 7d1: $20 7f1: $20 7f2: $0 16b1: 0% 17a1: $20 18a1: $20	7e: $10/$25 Group/Indiv 7h: $10/$25 Group/Indiv	7c: $10 7i: $10	7d2: $20; included in i2	7g: $0; included in i2	"151: 10% 152: 10% 153: 10%; $1,000 OOP max."	13a1: 0% 14a2: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $20	17b1: $200 max per 2 years 17b2: $200 max per 2 years	18a2: $20	18b: $800 max per 3 years													0	64.84414681	43.0044636	42.03445813	0	100	0.2	0.2	39.93888471	125	5	53.83693198	0	0	27.18121924	9.834428881	19.80508386	17.5	9.999701943	0	0	0.1	0	0	21.71650653	19.99902954	0	0	0	0	0											NO	53.88561102	35.73679216	34.93071575	0	83.1001928	0.166200386	0.166200386	33.1892902	103.875241	4.15500964	44.73859427	0	0	22.5876456	8.172429361	16.45806287	14.54253374	8.309771594	0	0	0.083100193	0	0	21.71650653	16.61923211	0	0	0	0	0												7.4177	0.230938083	5.675800321	0	1.100249737	1.731878414	2.074145247	1.051916897	2.810049656	0.09642675	7.212987691	0	0	1.883334042	3.033724694	5.229167815	0.438651017	0.395615906	0	0	0.860688302	0	0	0.485274629	1.263437646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.992	0	8.644448049	7.4177	0.230938083	5.675800321	0	1.100249737	1.731878414	2.074145247	1.051916897	2.810049656	0.09642675	7.212987691	0	0	1.883334042	3.033724694	5.229167815	0.438651017	0.395615906	0	0	0.860688302	0	0	0.485274629	1.263437646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.992	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.4177	0.230938083	5.675800321	0	1.100249737	1.731878414	2.074145247	1.051916897	2.810049656	0.09642675	7.212987691	0	0	1.883334042	3.033724694	5.229167815	0.438651017	0.395615906	0	0	0.860688302	0	0	0.485274629	1.263437646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.992
H3954_027_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	Coin	V	T	P	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	1852.647257	77.60287262	2173.029866	1113.313372	197.0283715	7.998121291	8.94088702	422.1927402	328.0764291	496.2009653	2336.27758	0	0.165028385	1208.596292	4425.763212	3901.8862	362.2237042	588.3029435	0	0	9.858841343	0	0	268.572894	797.2401876	0	0.773268853	0	0	0											2800	1a1: $100 days 1-5 1a2: 0%	1b1: $100 days 1-5	21: $0 days 1-6/$75 days 7-100 22: $0 days 1-6/$75 days 7-100 23: $0 days 1-6/$75 days 7-100	6: 0%	10a: $100	11a: 20%	"11b: 20% 11c: $0 preferred meters, no auth.; 20% non-pref. With auth; 1 meter every 2 years; 200 pref. test strips per month no auth."	4a1: $50 4a2: $50 4b: $20	9a1: $125 9b: $125	8a1: $5 8a2: $5	8b1: $25-100 8b2: $25-100 8b3: $25-100 8b4: $25-100 8b5: $25-100 8b6: $25-100	9a2: $0; included in h5	12: 0%	3: $10 5: $25 9a3: 0% 9c: $10/$25 Group/Indiv 9d1: $10 9d2: $10	7a: $10 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14h1: 0% 14h2: 0% 14i: 0% 14j: 0%	7b1: $20 7d1: $20 7f1: $20 7f2: $0 16b1: 0% 17a1: $20 18a1: $20	7e: $10/$25 Group/Indiv 7h: $10/$25 Group/Indiv	7c: $10 7i: $10	7d2: $20; included in i2	7g: $0; included in i2	"151: 10% 152: 10% 153: 10%; $1,000 OOP max."	13a1: 0% 14a2: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $20	17b1: $200 max per 2 years 17b2: $200 max per 2 years	18a2: $20	18b: $800 max per 3 years													0	64.84414681	43.0044636	42.03445813	0	100	0.2	0.2	39.81051638	125	5	53.83693198	0	0	27.2713547	9.895002626	19.81371499	17.5	9.999701943	0	0	0.1	0	0	21.71650653	19.99902954	0	20	0	0	0											NO	52.96796552	35.12821214	34.33586281	0	81.68503731	0.163370075	0.163370075	32.51923516	102.1062966	4.084251866	43.97671798	0	0	22.27661627	8.082736587	16.18484048	14.29488153	8.168260263	0	0	0.081685037	0	0	21.71650653	16.33621475	0	16.33700746	0	0	0												8.1776	0.227170848	6.217737946	0	1.341189156	1.306653672	1.46067338	1.144115417	2.791555766	0.168884143	8.561818352	0	0	2.243619652	2.981023187	5.262617143	0.431495412	0.400450963	0	0	0.805319823	0	0	0.486038751	1.085323909	0	0.001052742	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0943	0	10.00181958	8.1776	0.227170848	6.217737946	0	1.341189156	1.306653672	1.46067338	1.144115417	2.791555766	0.168884143	8.561818352	0	0	2.243619652	2.981023187	5.262617143	0.431495412	0.400450963	0	0	0.805319823	0	0	0.486038751	1.085323909	0	0.001052742	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0943	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.1776	0.227170848	6.217737946	0	1.341189156	1.306653672	1.46067338	1.144115417	2.791555766	0.168884143	8.561818352	0	0	2.243619652	2.981023187	5.262617143	0.431495412	0.400450963	0	0	0.805319823	0	0	0.486038751	1.085323909	0	0.001052742	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0943
H3954_033_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	Coin	V	T	P	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	1443.447282	77.6271408	2128.155818	2087.746291	128.2307348	10.13985626	10.28481376	313.587512	334.077081	632.4162463	2291.124144	0	0.62502728	692.2227022	4368.376581	4423.400659	362.3369798	866.3013888	0	0	7.774317811	0	0	268.2496428	634.3505098	0.847339657	0	0	0	0											2800	1a1: $100 days 1-5 1a2: 0%	1b1: $100 days 1-5	21: $0 days 1-6/$75 days 7-100 22: $0 days 1-6/$75 days 7-100 23: $0 days 1-6/$75 days 7-100	6: 0%	10a: $100	11a: 20%	"11b: 20% 11c: $0 preferred meters, no auth.; 20% non-pref. With auth; 1 meter every 2 years; 200 pref. test strips per month no auth."	4a1: $50 4a2: $50 4b: $20	9a1: $125 9b: $125	8a1: $5 8a2: $5	8b1: $25-100 8b2: $25-100 8b3: $25-100 8b4: $25-100 8b5: $25-100 8b6: $25-100	9a2: $0; included in h5	12: 0%	3: $10 5: $25 9a3: 0% 9c: $10/$25 Group/Indiv 9d1: $10 9d2: $10	7a: $10 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14h1: 0% 14h2: 0% 14i: 0% 14j: 0%	7b1: $20 7d1: $20 7f1: $20 7f2: $0 16b1: 0% 17a1: $20 18a1: $20	7e: $10/$25 Group/Indiv 7h: $10/$25 Group/Indiv	7c: $10 7i: $10	7d2: $20; included in i2	7g: $0; included in i2	"151: 10% 152: 10% 153: 10%; $1,000 OOP max."	13a1: 0% 14a2: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $20	17b1: $200 max per 2 years 17b2: $200 max per 2 years	18a2: $20	18b: $800 max per 3 years													0	64.84414681	43.0044636	42.03445813	0	100	0.2	0.2	39.79218561	125	5	53.83693198	0	0	27.08355802	9.611265955	19.73355206	17.5	9.999701943	0	0	0.1	0	0	21.71650653	19.99902954	0	0	0	0	0											NO	54.17129039	35.92625395	35.11590405	0	83.54075588	0.167081512	0.167081512	33.24269264	104.4259448	4.177037794	44.97577992	0	0	22.62580909	8.029324228	16.48555855	14.61963228	8.353826589	0	0	0.083540756	0	0	21.71650653	16.70734045	0	0	0	0	0												6.5161	0.232404365	6.227676293	0	0.892707709	1.694182513	1.718402231	0.868707773	2.907192903	0.220135547	8.587091273	0	0	1.305174892	2.922925994	6.076852547	0.441436117	0.603077631	0	0	0.649472386	0	0	0.48545376	0.883192494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.2322	0	8.421987302	6.5161	0.232404365	6.227676293	0	0.892707709	1.694182513	1.718402231	0.868707773	2.907192903	0.220135547	8.587091273	0	0	1.305174892	2.922925994	6.076852547	0.441436117	0.603077631	0	0	0.649472386	0	0	0.48545376	0.883192494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.2322	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.5161	0.232404365	6.227676293	0	0.892707709	1.694182513	1.718402231	0.868707773	2.907192903	0.220135547	8.587091273	0	0	1.305174892	2.922925994	6.076852547	0.441436117	0.603077631	0	0	0.649472386	0	0	0.48545376	0.883192494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.2322
H3954_039_0	2011	6	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	Coin	Coin	Coin	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	V	V	V	V	V	V	Coin	Coin	V	Coin	P	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	251.9282884	2.854043167	41.62072421	857.6027856	142.5850328	7.374112023	8.026555628	399.0326705	65.34144777	77.03913827	70.3867576	0	0.143544395	886.9646472	5634.296389	10003.9448	362.0157223	571.8557527	0	0	6.562966097	0	0	236.3371572	860.0152612	0.269028364	0.278954026	0.269028364	0	0	0	0	0	0	0	0	0	0	0	0	3400	"1a1: 15%, $2000 MOOP 1a2: 15%, $2000 MOOP"	"1b1: 15%, $2000 MOOP"	21: 15% 22: 15% 23: 15%	6: 0%	10a: $100	11a: 20%	11b: 20% 11c: 20%	4a1: $50 4a2: $50 4b: $20	9a1: 15% 9b: $50	8a1: 15% 8a2: 15%	8b1: $25 8b2: 15% 8b3: 15% 8b4: 15% 8b5: $25 8b6: 15%	5: $25 9a2: $50; included in h5	12: 15%	3: $10 9a3: 15% 9c: $10/$25 Group/Indiv 9d1: $10 9d2: $10	7a: $10 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14h1: 0% 14h2: 0% 14i: 0% 14j: 0%	7b1: $20 7d1: $20 7f1: $20 16b1: 15% 17a1: $20 18a1: $20	7e: $10/$25 Group/Indiv 7h: $10/$25 Group/Indiv	7c: $10 7i: $10	7d2: $25; Included in i2	7g: 15%; Included in i2	151: 15% 152: 15% 153: 15%	13a1: 0% 14a2: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $20	17b1: $200 max per 2 years 17b2: $200 max per 2 years	18a2: $20	18b: $800 max per 3 years			0	0	0	0	0	0	0	0	0	0	0	0.120549417	0.134412434	0.15	0	100	0.2	0.2	39.89369355	0.15	0.15	0.150661083	0	0.15	27.06564217	9.805470934	20.73377036	17.5	10	0	0	0.15	0	0	23.92111034	20	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0.084421792	0.094130182	0.105046289	0	70.030859	0.140061718	0.140061718	27.93789628	0.105046289	0.105046289	0.105509251	0	0.105046289	18.9543017	6.866855525	14.52003749	12.25540033	7.0030859	0	0	0.105046289	0	0	16.75215906	14.0061718	0	14.0061718	0	0	0	0	0	0	0	0	0	0	0	0	0		21.2682	0.268651603	4.372102604	0	0.832112694	1.032830799	1.124213171	0.929011114	6.863876574	8.092675545	7.426454064	0	0.015078806	1.40098296	3.224158274	12.10480446	0.369720633	0.33372958	0	0	0.68941523	0	0	0.329929804	1.003793458	0	0.00032559	0	0	0	0	0	0	0	0	0	0	0	0	0	71.6821	0	30.67577821	21.2682	0.268651603	4.372102604	0	0.832112694	1.032830799	1.124213171	0.929011114	6.863876574	8.092675545	7.426454064	0	0.015078806	1.40098296	3.224158274	12.10480446	0.369720633	0.33372958	0	0	0.68941523	0	0	0.329929804	1.003793458	0	0.00032559	0	0	0	0	0	0	0	0	0	0	0	0	0	71.6821	NO																															0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.2682	0.268651603	4.372102604	0	0.832112694	1.032830799	1.124213171	0.929011114	6.863876574	8.092675545	7.426454064	0	0.015078806	1.40098296	3.224158274	12.10480446	0.369720633	0.33372958	0	0	0.68941523	0	0	0.329929804	1.003793458	0	0.00032559	0	0	0	0	0	0	0	0	0	0	0	0	0	71.6821
H3954_097_0	2011	6																															Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	V	Coin	V	P	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	368.7032224	2.767129092	97.08393763	1302.856107	30.97642512	18.26593118	14.72211335	1546.325122	58.53913691	69.16819181	61.49036713	0	0.467738718	32.56388365	1418.771153	160.666261	1.950564755	3.289756532	0	0	11.80235759	1.723473488	0	1848.851959	2.547419527	0.259228075	0.141523307	0	0	0												1a1: Medicare FFS	1b1: Medicare FFS	21: Medicare FFS	6: 0%	10a: Medicare FFS	11a: Medicare FFS	"11b: Medicare FFS 11c: 20% or $0 preferred meters, no auth.; 20% non-pref. With auth; 1 meter every 2 years; 200 pref. test strips per month no auth."	4a1: $50 4a2: $50 4b: Medicare FFS	9a1: Medicare FFS 9b: Medicare FFS	8a1: Medicare FFS 8a2: Medicare FFS	8b1: Medicare FFS 8b2: Medicare FFS 8b3: Medicare FFS 8b4: Medicare FFS 8b5: Medicare FFS 8b6: Medicare FFS	9a2: Medicare FFS; included in h5	12: Medicare FFS	3: Medicare FFS 5: Medicare FFS 9a3: Medicare FFS 9c: Medicare FFS 9d1: Medicare FFS 9d2: Medicare FFS	7a: 0% 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: $0; 1 per year 14d1: Medicare FFS 14e1: Medicare FFS 14f1: Medicare FFS 14g1: Medicare FFS 14h1: Medicare FFS 14i: Medicare FFS 14j: Medicare FFS	7b1: Medicare FFS 7d1: Medicare FFS 7f1: Medicare FFS 16b1: Medicare FFS 17a1: Medicare FFS 18a1: Medicare FFS	7e: Medicare FFS 7h: Medicare FFS	7c: Medicare FFS 7i: Medicare FFS	7d2: Medicare FFS; Included in i2	7g: Medicare FFS; Included in i2	151: Medicare FFS 152: Medicare FFS 153: Medicare FFS	13a1: Medicare FFS		16a1: $600 max per year 16b2: $600 max per year 16b3: $600 max per year	17a2: 1 per year	17b1: Medicare FFS 17b2: $200 max per 2 years	"18a2: $1,000 max per 3 years"	"18b: $1,000 max per 3 years"		13c: $50 every 3 months											0	0.080742218	0.080742218	0.183617242	0	0.233	0.233	0.233	40.23100832	0.233	0.233	0.233	0	0.233	0.233	0	0.233	0.233	0.233	0	0	0.233	0	0	0	0	0	0	0	0	0											NO	0.075389346	0.075389346	0.171444186	0	0.217553073	0.217553073	0.217553073	37.56386052	0.217553073	0.217553073	0.217553073	0	0.217553073	0.217553073	0	0.217553073	0.217553073	0.217553073	0	0	0.217553073	0	0	0	0	0	0	0	0	0												27.7963	0.208612052	16.64447668	0	6.739016483	3.973809464	3.202841004	4.840495101	12.73536914	15.0477527	13.37741834	0	0.101757996	7.084372965	0	34.95343886	0.424351357	0.715696644	0	0	2.567639165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.4133	0	10.83100744	27.7963	0.208612052	16.64447668	0	6.739016483	3.973809464	3.202841004	4.840495101	12.73536914	15.0477527	13.37741834	0	0.101757996	7.084372965	0	34.95343886	0.424351357	0.715696644	0	0	2.567639165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.4133	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	0	0	27.7963	0.208612052	16.64447668	0	6.739016483	3.973809464	3.202841004	4.840495101	12.73536914	15.0477527	13.37741834	0	0.101757996	7.084372965	0	34.95343886	0.424351357	0.715696644	0	0	2.567639165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.4133
H3954_098_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	O	V	Coin	P	V	P	V	P	O	Coin											12.60533358	0	0	0	1.601665837	0	0	0	22.42107556	13.72352648	12.9580217	0	0.040706342	4.492925163	0	0	0	0	0	0	0.260179949	0	0	0	0	0	0	0	0	0											68.1034	YES	697.408848	66.2631259	674.1176423	548.4843326	45.15158747	4.929529825	8.785180591	199.7627184	80.74405254	131.0413919	552.406433	0	0.138260364	402.9791197	3084.569163	3440.150778	309.2936396	343.8173204	0	0	0	0	0	330.2903477	273.4176113	0.081370524	0.154683186	0.054247016	0	0											2200	"1a1: 0% after paying first $500 to $2,200 in charges 1a2: 0% after paying first $500 to $2,200 in charges"	1b1: $100 days 1-5	"21: 0% after paying first $500 to $2,200 in charges 22: 0% after paying first $500 to $2,200 in charges 23: 0% after paying first $500 to $2,200 in charges"	6: 0%	"10a: 0% after paying first $500 to $2,200 in charges"	11a: 20%	11b: 20% 11c: 0%-20%	4a1: $50 4a2: $50 4b: $25	"9a1: 0% after paying first $500 to $2,200 in charges 9b: 0% after paying first $500 to $2,200 in charges"	"8a1: 0% after paying first $500 to $2,200 in charges 8a2: 0% after paying first $500 to $2,200 in charges"	"8b1: 0% after paying first $500 to $2,200 in charges 8b2: 0% after paying first $500 to $2,200 in charges 8b3: 0% after paying first $500 to $2,200 in charges 8b4: 0% after paying first $500 to $2,200 in charges 8b5: 0% after paying first $500 to $2,200 in charges 8b6: 0% after paying first $500 to $2,200 in charges"	"9a2: 0% after paying first $500 to $2,200 in charges; inlcuded in h5"	"12: 0% after paying first $500 to $2,200 in charges"	"3: $25 5: 0% after paying first $500 to $2,200 in charges 9a3: 0% after paying first $500 to $2,200 in charges 9c: $10/$25 Group/Indiv 9d1: $25 9d2: $25"	7a: $10 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14h1: 0% 14h2: 0% 14i: 0% 14j: 0%	"7b1: $25 7d1: $25 7f1: $25 7f2: $0 16b1: 0% after paying first $500 to $2,200 in charges 17a1: $25 18a1: $25"	7e: $10/$25 Group/Indiv 7h: $10/$25 Group/Indiv	7c: $25 7i: $25	7d2: $25; Included in i2	"7g: 0% after paying first $500 to $2,200 in charges; Included in i2"	"151: 0% after paying first $500 to $2,200 in charges 152: 0% after paying first $500 to $2,200 in charges 153: 0% after paying first $500 to $2,200 in charges"	"13a1: 0% after paying first $500 to $2,200 in charges 14a2: 0%"		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $25	17b1: $200 max per 3 years 17b2: $200 max per 3 years	18a2: $25	18b: $800 max per 3 years													0	0	56.9955364	0	0	0	0.2	0.2	42.42419831	0	0	0	0	0	0	9.791642547	24.49573806	17.5	25	0	0	0	0	0	22.35449735	0	0	25	0	0	0											NO	0	56.9955364	0	0	0	0.2	0.2	42.42419831	0	0	0	0	0	0	9.791642547	24.49573806	17.5	25	0	0	0	0	0	22.35449735	0	0	25	0	0	0												0	0.3147252	0	0	0	0.985905965	1.757036118	0.706231098	0	0	0	0	0	0	2.516916555	7.022419363	0.451053224	0.716286084	0	0	0	0	0	0.615289559	0	0	0.000322257	0	0	0	0	0	0	0	0	0	0	0	0	0	15.0862	2200	0	12.6053	0.3147252	0	0	1.601665837	0.985905965	1.757036118	0.706231098	22.42107556	13.72352648	12.9580217	0	0.040706342	4.492925163	2.516916555	7.022419363	0.451053224	0.716286084	0	0	0.260179949	0	0	0.615289559	0	0	0.000322257	0	0	0	0	0	0	0	0	0	0	0	0	0	83.1896	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.6053	0.3147252	0	0	1.601665837	0.985905965	1.757036118	0.706231098	22.42107556	13.72352648	12.9580217	0	0.040706342	4.492925163	2.516916555	7.022419363	0.451053224	0.716286084	0	0	0.260179949	0	0	0.615289559	0	0	0.000322257	0	0	0	0	0	0	0	0	0	0	0	0	0	83.1896
H3954_100_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	O	V	Coin	P	V	P	V	P	O	Coin											12.41963106	0	0.536870002	0	1.878811016	0	0	0	13.52074519	17.46094892	14.06460256	0	0.015569743	4.078622187	0	0	0	0	0	0	0.628473925	0	0	0	0	0	0	0	0	0											64.6043	YES	836.0568535	73.03566556	807.2557545	658.9328791	22.72161157	6.271645731	11.2052699	310.7211768	47.22811479	82.22379761	279.7995545	0	0.069576696	453.0081131	3735.060802	3339.831996	340.9055415	491.161083	0	0	0	0	0	329.7741353	435.8588627	0.03971876	0.781566671	0.026479173	0	0											2200	"1a1: 0% after paying first $500 to $2,200 in charges 1a2: 0% after paying first $500 to $2,200 in charges"	1b1: $100 days 1-5	"21: 0% after paying first $500 to $2,200 in charges 22: 0% after paying first $500 to $2,200 in charges 23: 0% after paying first $500 to $2,200 in charges"	6: 0%	"10a: 0% after paying first $500 to $2,200 in charges"	11a: 20%	11b: 20% 11c: 0%-20%	4a1: $50 4a2: $50 4b: $25	"9a1: 0% after paying first $500 to $2,200 in charges 9b: 0% after paying first $500 to $2,200 in charges"	"8a1: 0% after paying first $500 to $2,200 in charges 8a2: 0% after paying first $500 to $2,200 in charges"	"8b1: 0% after paying first $500 to $2,200 in charges 8b2: 0% after paying first $500 to $2,200 in charges 8b3: 0% after paying first $500 to $2,200 in charges 8b4: 0% after paying first $500 to $2,200 in charges 8b5: 0% after paying first $500 to $2,200 in charges 8b6: 0% after paying first $500 to $2,200 in charges"	"9a2: 0% after paying first $500 to $2,200 in charges; inlcuded in h5"	"12: 0% after paying first $500 to $2,200 in charges"	"3: $25 5: 0% after paying first $500 to $2,200 in charges 9a3: 0% after paying first $500 to $2,200 in charges 9c: $10/$25 Group/Indiv 9d1: $25 9d2: $25"	7a: $10 14a: 0% 14a1: 0% 14a3: 0% 14a4: 0% 14b1: 0% 14b2: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14h1: 0% 14h2: 0% 14i: 0% 14j: 0%	"7b1: $25 7d1: $25 7f1: $25 7f2: $0 16b1: 0% after paying first $500 to $2,200 in charges 17a1: $25 18a1: $25"	7e: $10/$25 Group/Indiv 7h: $10/$25 Group/Indiv	7c: $25 7i: $25	7d2: $25; Included in i2	"7g: 0% after paying first $500 to $2,200 in charges; Included in i2"	"151: 0% after paying first $500 to $2,200 in charges 152: 0% after paying first $500 to $2,200 in charges 153: 0% after paying first $500 to $2,200 in charges"	"13a1: 0% after paying first $500 to $2,200 in charges 14a2: 0%"		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $25	17b1: $200 max per 3 years 17b2: $200 max per 3 years	18a2: $25	18b: $800 max per 3 years													0	0	56.9955364	0	0	0	0.2	0.2	42.35616285	0	0	0	0	0	0	9.725010451	24.54230849	17.5	25	0	0	0	0	0	22.35449735	0	0	25	0	0	0											NO	0	56.9955364	0	0	0	0.2	0.2	42.35616285	0	0	0	0	0	0	9.725010451	24.54230849	17.5	25	0	0	0	0	0	22.35449735	0	0	25	0	0	0												0	0.346892245	0	0	0	1.254329146	2.241053979	1.096746397	0	0	0	0	0	0	3.026958778	6.83059893	0.497153915	1.023252256	0	0	0	0	0	0.61432792	0	0	0.001628264	0	0	0	0	0	0	0	0	0	0	0	0	0	16.9329	2200	0	12.4196	0.346892245	0.536870002	0	1.878811016	1.254329146	2.241053979	1.096746397	13.52074519	17.46094892	14.06460256	0	0.015569743	4.078622187	3.026958778	6.83059893	0.497153915	1.023252256	0	0	0.628473925	0	0	0.61432792	0	0	0.001628264	0	0	0	0	0	0	0	0	0	0	0	0	0	81.5372	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.4196	0.346892245	0.536870002	0	1.878811016	1.254329146	2.241053979	1.096746397	13.52074519	17.46094892	14.06460256	0	0.015569743	4.078622187	3.026958778	6.83059893	0.497153915	1.023252256	0	0	0.628473925	0	0	0.61432792	0	0	0.001628264	0	0	0	0	0	0	0	0	0	0	0	0	0	81.5372
H3954_134_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	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	2709.440967	77.76695396	3430.084886	2144.183319	212.2352878	16.29629176	20.35544259	524.3033101	321.3957292	433.3603908	2029.042724	0	0.703933074	1194.575929	5974.842231	8768.04636	362.9895798	699.581681	0	0	17.5206918	0	0	264.1347117	1.928377117	0.080859224	0.083842483	0.242577673	0	0											2000	1a1: $100 days 1-5 $0 days 6-90 1a2: $100 days 1-5 $0 days 6-90	1b1: $100 days 1-5 $0 days 6-90	21: $0 days 1-6/$60 days 7-100 22: $0 days 1-6/$60 days 7-100 23: $0 days 1-6/$60 days 7-100	6: 0%	10a: $100	11a: 20%	11b: 20% 11c: 20%	4a1: $50 4a2: $50 4b: $30	9a1: $100 9b: $50	8a1: $5 8a2: $5	8b1: $15-$75 8b2: $15-$75 8b3: $15-$75 8b4: $15-$75 8b5: $15-$75 8b6: $15-$75	9a2: $50; included in h5	12: 0%	3: $10 5: $25 9c: $10/$25 Group/Indiv 9d1: $10 9d2: $10	7a: $5 14a: 0% 14a1: 0% 14a2: 0% 14a3: 0% 14a4: 0% 14b1: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14h1: 0% 14h2: 0% 14i: 0% 14j: 0%	7b1: $30 7d1: $30 7f1: $30 7f2: 0% 16b1: 0% 17a1: $20 18a1: $20	7e: $10/$25 Group/Indiv 7h: $10/$25 Group/Indiv	7c: $10 7i: $10	7d2: $30; included in i2	7g: $0; included in i2	"151: 10%; max $1,000 OOP 152: 10%; max $1,000 OOP 153: 10%; max $1,000 OOP"	13a1: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $20	17b1: $200 max per 2 years 17b2: $200 max per 2 years	18a2: 0%	18b: $800 max per 3 years													0	64.84414681	43.0044636	33.62756651	0	100	0.2	0.2	43.92894711	89.25	5	54.60279933	0	0	27.13699998	4.904644734	29.34865882	17.5	9.999701943	0	0	0.1	0	0	21.71650653	19.99902954	0	0	0	0	0											NO	44.19110816	29.30742397	22.91709432	0	68.14972567	0.136299451	0.136299451	29.93745695	60.82363016	3.407486283	37.21165795	0	0	18.49379104	3.342501932	20.00103047	11.92620199	6.814769442	0	0	0.068149726	0	0	21.71650653	13.62928377	0	0	0	0	0												9.9778	0.189929091	6.550631572	0	1.20531472	2.221175625	2.774435657	1.308025648	1.629037914	0.123055799	6.292003651	0	0	1.841019801	1.664243475	14.61416353	0.360757254	0.397290655	0	0	1.19403034	0	0	0.478006933	0.0021902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8231	0	24.46385324	9.9778	0.189929091	6.550631572	0	1.20531472	2.221175625	2.774435657	1.308025648	1.629037914	0.123055799	6.292003651	0	0	1.841019801	1.664243475	14.61416353	0.360757254	0.397290655	0	0	1.19403034	0	0	0.478006933	0.0021902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8231	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.9778	0.189929091	6.550631572	0	1.20531472	2.221175625	2.774435657	1.308025648	1.629037914	0.123055799	6.292003651	0	0	1.841019801	1.664243475	14.61416353	0.360757254	0.397290655	0	0	1.19403034	0	0	0.478006933	0.0021902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8231
H3954_135_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	Coin	V	T	P	V	P	V	P	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	2902.240614	77.7703439	3689.384918	2316.564144	287.2103316	13.56274226	15.59773942	479.7347648	401.6684072	723.3622655	2712.982443	0	0.526019391	1262.703845	5058.937357	6176.206486	363.0054029	810.083767	0	0	15.9445737	0	0	269.1649921	1.413604567	0.426033155	0.883502854	0.085206631	0	0											2000	1a1: $100 days 1-5 $0 days 6-90 1a2: $100 days 1-5 $0 days 6-90	1b1: $100 days 1-5 $0 days 6-90	21: $0 days 1-6/$60 days 7-100 22: $0 days 1-6/$60 days 7-100 23: $0 days 1-6/$60 days 7-100	6: 0%	10a: $100	11a: 20%	11b: 20% 11c: 20%	4a1: $50 4a2: $50 4b: $30	9a1: $100 9b: $50	8a1: $5 8a2: $5	8b1: $15-$75 8b2: $15-$75 8b3: $15-$75 8b4: $15-$75 8b5: $15-$75 8b6: $15-$75	9a2: $50; included in h5	12: 0%	3: $10 5: $25 9c: $10/$25 Group/Indiv 9d1: $10 9d2: $10	7a: $5 14a: 0% 14a1: 0% 14a2: 0% 14a3: 0% 14a4: 0% 14b1: 0% 14c1: 0% 14c2: 0% 14d1: 0% 14d2: 0% 14e1: 0% 14f1: 0% 14f2: 0% 14g1: 0% 14h1: 0% 14h2: 0% 14i: 0% 14j: 0%	7b1: $30 7d1: $30 7f1: $30 7f2: 0% 16b1: 0% 17a1: $20 18a1: $20	7e: $10/$25 Group/Indiv 7h: $10/$25 Group/Indiv	7c: $10 7i: $10	7d2: $30; included in i2	7g: $0; included in i2	"151: 10%; max $1,000 OOP 152: 10%; max $1,000 OOP 153: 10%; max $1,000 OOP"	13a1: 0%		16a1: $20 16b2: 0% 16b3: $20-$30	17a2: $20	17b1: $200 max per 2 years 17b2: $200 max per 2 years	18a2: 0%	18b: $800 max per 3 years													0	64.84414681	43.0044636	33.62756651	0	100	0.2	0.2	43.81133752	89.25	5	54.60279933	0	0	27.22413722	4.892662259	29.27724472	17.5	9.999701943	0	0	0.1	0	0	21.71650653	19.99902954	0	0	0	0	0											NO	43.50744735	28.85402195	22.56255423	0	67.09541182	0.134190824	0.134190824	29.39539733	59.88265505	3.354770591	36.63597308	0	0	18.26614698	3.282751892	19.64368792	11.74169707	6.7093412	0	0	0.067095412	0	0	21.71650653	13.41843123	0	0	0	0	0												10.5224	0.186998934	6.936828941	0	1.605874623	1.819995555	2.093073499	1.175166169	2.004414223	0.202226205	8.282729311	0	0	1.92206117	1.383936348	10.11028939	0.355191623	0.452927366	0	0	1.069807739	0	0	0.487110276	0.001580696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6126	0	24.5823033	10.5224	0.186998934	6.936828941	0	1.605874623	1.819995555	2.093073499	1.175166169	2.004414223	0.202226205	8.282729311	0	0	1.92206117	1.383936348	10.11028939	0.355191623	0.452927366	0	0	1.069807739	0	0	0.487110276	0.001580696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6126	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.5224	0.186998934	6.936828941	0	1.605874623	1.819995555	2.093073499	1.175166169	2.004414223	0.202226205	8.282729311	0	0	1.92206117	1.383936348	10.11028939	0.355191623	0.452927366	0	0	1.069807739	0	0	0.487110276	0.001580696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6126
H3954_801_0	2011	2																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	297.7656253	2.770777203	33.69764833	1018.314547	11.50783334	8.650014885	12.50966106	16.3336178	87.40608692	78.98649324	58.80615549	0	0.1554417	25.04156044	66.96351315	156.6882148	1.953145563	2.629288094	0	0	6.229898177	0.921592253	0	0	0	0	0	0	0	0											6700	1a1: Medicare FFS	1b1: Medicare FFS	21: Medicare FFS	6: Medicare FFS	10a: Medicare FFS	11a: Medicare FFS	11b: Medicare FFS 11c: Medicare FFS	4a1: Medicare FFS 4b: Medicare FFS	9a1: Medicare FFS 9b: Medicare FFS	8a1: Medicare FFS 8a2: Medicare FFS	8b1: Medicare FFS 8b2: Medicare FFS 8b3: Medicare FFS 8b4: Medicare FFS	9a2: Medicare FFS; included in h5	12: Medicare FFS	3: Medicare FFS 5: Medicare FFS 9c: Medicare FFS 9d1: Medicare FFS	7a: Medicare FFS 14b1: Medicare FFS 14c1: Medicare FFS 14d1: Medicare FFS 14e1: Medicare FFS 14f1: Medicare FFS 14g1: Medicare FFS 14h1: Medicare FFS 14i: Medicare FFS 14j: Medicare FFS	7b1: Medicare FFS 7d1: Medicare FFS 7f1: Medicare FFS 16b1: Medicare FFS 17a1: Medicare FFS 18a1: Medicare FFS	7e: Medicare FFS 7h: Medicare FFS	7c: Medicare FFS 7i: Medicare FFS	7d2: Medicare FFS; Included in i2	7g: Included in i2	151: Medicare FFS 152: Medicare FFS 153: Medicare FFS	13a1: Medicare FFS				17b1: Medicare FFS															0	0.082189829	0.082189829	0.18262243	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.068360304	0.068360304	0.151893792	0	0.193794671	0.193794671	0.193794671	0.193794671	0.193794671	0.193794671	0.193794671	0	0.193794671	0.193794671	0.193794671	0.193794671	0.193794671	0.193794671	0	0	0.193794671	0.193794671	0	0	0	0	0	0	0	0												20.3553	0.189411172	5.118463598	0	2.230156775	1.676326787	2.424305647	3.165368085	16.93883384	15.30716146	11.39631955	0	0.030123773	4.852920962	12.97717199	30.36534101	0.378509202	0.509542021	0	0	1.207321067	0.178599667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.3012	0	26.15808306	20.3553	0.189411172	5.118463598	0	2.230156775	1.676326787	2.424305647	3.165368085	16.93883384	15.30716146	11.39631955	0	0.030123773	4.852920962	12.97717199	30.36534101	0.378509202	0.509542021	0	0	1.207321067	0.178599667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.3012	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.3553	0.189411172	5.118463598	0	2.230156775	1.676326787	2.424305647	3.165368085	16.93883384	15.30716146	11.39631955	0	0.030123773	4.852920962	12.97717199	30.36534101	0.378509202	0.509542021	0	0	1.207321067	0.178599667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.3012
H3954_802_0	2011	2																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	233.0707611	2.858864781	28.13525475	719.2827936	8.144953249	7.990758621	16.5806043	15.57366831	88.69397357	91.03415978	73.31624315	0	0.011228458	30.10404284	64.60108951	156.4500642	2.015185843	3.820243874	0	0	8.084234063	0.932996167	0	0	0	0	0	0	0	0											6700	1a1: Medicare FFS	1b1: Medicare FFS	21: Medicare FFS	6: Medicare FFS	10a: Medicare FFS	11a: Medicare FFS	11b: Medicare FFS 11c: Medicare FFS	4a1: Medicare FFS 4b: Medicare FFS	9a1: Medicare FFS 9b: Medicare FFS	8a1: Medicare FFS 8a2: Medicare FFS	8b1: Medicare FFS 8b2: Medicare FFS 8b3: Medicare FFS 8b4: Medicare FFS	9a2: Medicare FFS; included in h5	12: Medicare FFS	3: Medicare FFS 5: Medicare FFS 9c: Medicare FFS 9d1: Medicare FFS	7a: Medicare FFS 14b1: Medicare FFS 14c1: Medicare FFS 14d1: Medicare FFS 14e1: Medicare FFS 14f1: Medicare FFS 14g1: Medicare FFS 14h1: Medicare FFS 14i: Medicare FFS 14j: Medicare FFS	7b1: Medicare FFS 7d1: Medicare FFS 7f1: Medicare FFS 16b1: Medicare FFS 17a1: Medicare FFS 18a1: Medicare FFS	7e: Medicare FFS 7h: Medicare FFS	7c: Medicare FFS 7i: Medicare FFS	7d2: Medicare FFS; Included in i2	7g: Included in i2	151: Medicare FFS 152: Medicare FFS 153: Medicare FFS	13a1: Medicare FFS				17b1: Medicare FFS															0	0.081372114	0.081372114	0.183642912	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.067217213	0.067217213	0.151697726	0	0.192469015	0.192469015	0.192469015	0.192469015	0.192469015	0.192469015	0.192469015	0	0.192469015	0.192469015	0.192469015	0.192469015	0.192469015	0.192469015	0	0	0.192469015	0.192469015	0	0	0	0	0	0	0	0												15.6664	0.192164922	4.268054177	0	1.567651126	1.537973438	3.191252572	2.997448594	17.0708417	17.52125503	14.11110508	0	0.00216113	5.794095463	12.43370804	30.1117897	0.387860834	0.735278574	0	0	1.555964564	0.179572853	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.3245	0	27.23374066	15.6664	0.192164922	4.268054177	0	1.567651126	1.537973438	3.191252572	2.997448594	17.0708417	17.52125503	14.11110508	0	0.00216113	5.794095463	12.43370804	30.1117897	0.387860834	0.735278574	0	0	1.555964564	0.179572853	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.3245	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.6664	0.192164922	4.268054177	0	1.567651126	1.537973438	3.191252572	2.997448594	17.0708417	17.52125503	14.11110508	0	0.00216113	5.794095463	12.43370804	30.1117897	0.387860834	0.735278574	0	0	1.555964564	0.179572853	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.3245
H3957_003_0	2011	12																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	421.9459931	0	981.4845997	0	376.9071757	13.60888646	0	482.0319009	436.9719399	0	1915.551053	0	0	825.1017344	4081.042591	5302.143593	0	0	0	0	57.79311469	0	143.4264074	0	329.5090672	0			0	0											3400	"(1a), (1b) $200 per admit"		(2) $60 per day (days 16-55)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) $100"	( 8a) $0	"( 8b) X-Ray and Diag. X-Ray $20 - $50, Therapeutic Services $0"			"(3) $25, (5) $0, (9c) $25, (9d) $0, (12) $0, (13a) $0"	"(7a) $10-$25, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $25, (14b-j) $0, (16b), (18a) $25, (17a) $0-$25"					(15) 0-10% ($300 quarterly max)		(10b) $40		"(17a) $25, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												200	0	60	0	100	0.15	0	50	100	0	25.53224441	0	0	25	10	25	0	0	0	0	0.1	0	40		25	0		0	0	0											NO	192.8027621	0	49.19361722	0	89.69246938	0.139878271	0	49.07120095	98.42575665	0	25.19612695	0	0	23.3129896	9.939980761	24.78681675	0	0	0	0	0.047283396	0	35.87698775		25	0		0	0	0												6.7794	0	4.023564809	0	2.81714461	1.903587509	0	1.971157023	3.584107818	0	4.022038958	0	0	1.60296568	3.38045707	10.95193847	0	0	0	0	2.732654723	0	0.428808955	0	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.8843		5.254783949	6.7794	0	4.023564809	0	2.81714461	1.903587509	0	1.971157023	3.584107818	0	4.022038958	0	0	1.60296568	3.38045707	10.95193847	0	0	0	0	2.732654723	0	0.428808955	0	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.8843	NO																																																																																		0			6.7794	0	4.023564809	0	2.81714461	1.903587509	0	1.971157023	3.584107818	0	4.022038958	0	0	1.60296568	3.38045707	10.95193847	0	0	0	0	2.732654723	0	0.428808955	0	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.8843
H3957_006_0	2011	11																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	377.8803253	0	1218.433303	0	319.7760839	13.06048946	0	545.3896282	450.5906494	0	1920.650955	0	0	1263.351957	4373.54751	5207.193651	0	0	0	0	43.93751294	0	121.686022	0	329.5090672	0			0	0											3400	"(1a), (1b) $200 per admit"		(2) $60 per day (days 16-55)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) $100"	( 8a) $0	"( 8b) X-Ray and Diag. X-Ray $20 - $50, Therapeutic Services $0"			"(3) $25, (5) $0, (9c) $25, (9d) $0, (12) $0, (13a) $0"	"(7a) $10-$25, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $25, (14b-j) $0, (16b), (18a) $25, (17a) $0-$25"					(15) 0-10% ($300 quarterly max)		(10b) $40		"(17a) $25, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												200	0	60	0	100	0.15	0	50	100	0	25.55314291	0	0	25	10	25	0	0	0	0	0.1	0	40		25	0		0	0	0											NO	194.4017851	0	52.90087847	0	91.18767529	0.140732654	0	49.10786615	97.85228059	0	25.2958295	0	0	23.71935216	9.94787149	24.84464272	0	0	0	0	0.056865069	0	36.47507011		25	0		0	0	0												6.1217	0	5.371349341	0	2.429969809	1.838037345	0	2.231910071	3.674276888	0	4.048704925	0	0	2.497157497	3.625624048	10.78090549	0	0	0	0	2.498509695	0	0.369875516	0	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1745		3.655521547	6.1217	0	5.371349341	0	2.429969809	1.838037345	0	2.231910071	3.674276888	0	4.048704925	0	0	2.497157497	3.625624048	10.78090549	0	0	0	0	2.498509695	0	0.369875516	0	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1745	NO																																																																																		0			6.1217	0	5.371349341	0	2.429969809	1.838037345	0	2.231910071	3.674276888	0	4.048704925	0	0	2.497157497	3.625624048	10.78090549	0	0	0	0	2.498509695	0	0.369875516	0	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1745
H3957_020_0	2011	9																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	454.5771832	0	1004.121333	0	401.5977117	15.86428674	0	492.1149059	485.0697375	0	2230.142048	0	0	828.4518777	4508.126976	6473.758399	0	0	0	0	74.19763628	0	152.8220228	6.05	329.5090672	0			0	0											3400	"(1a), (1b) $100 per admit"		(2) $40 per day (days 16-55)	(6) $0	(10a)  $75	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) $50"	( 8a) $0	"( 8b) X-Ray and Diag. X-Ray $10 - $30, Therapeutic Services $0"			"(3) $25, (5) $0, (9c) $25, (9d) $0, (12) $0, (13a) $0"	"(7a) $5-$25, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $25, (14b-j) $0, (16b), (18a) $25, (17a) $0-$25"					(15) 0-10% ($300 quarterly max)		(10b) $40	"(16a) 40%, (16b) 50%"	"(17a) $25, (17b) $0"			"(18b) $0, $1,000 allowance/3 years"	(14a) $0	(13e) $0												100	0	40	0	75	0.15	0	50	50	0	13.49867222	0	0	25	5	25	0	0	0	0	0.1	0	40	0.4	25	0		0	0	0											NO	98.58756601	0	37.1003469	0	70.7389382	0.144260429	0	49.58656594	49.76585253	0	13.43120212	0	0	24.15855643	4.988477564	24.91464352	0	0	0	0	0.047737806	0	37.72743371	0.4	25	0		0	0	0												3.7346	0	3.104437481	0	2.367382975	2.288588806	0	2.03352402	2.011659085	0	2.49612405	0	0	1.66785012	1.874057523	13.44094857	0	0	0	0	3.542032373	0	0.480465228	2.42	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1482		4.715747889	3.7346	0	3.104437481	0	2.367382975	2.288588806	0	2.03352402	2.011659085	0	2.49612405	0	0	1.66785012	1.874057523	13.44094857	0	0	0	0	3.542032373	0	0.480465228	2.42	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1482	NO																																																																																		0			3.7346	0	3.104437481	0	2.367382975	2.288588806	0	2.03352402	2.011659085	0	2.49612405	0	0	1.66785012	1.874057523	13.44094857	0	0	0	0	3.542032373	0	0.480465228	2.42	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1482
H3957_021_0	2011	9																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	379.7333209	0	1091.814962	0	298.4438058	14.23257066	0	500.3911755	500.1538735	0	2205.355275	0	0	1195.858691	4806.61763	6057.620987	0	0	0	0	65.82675731	0	113.5683416	6.05	329.5090672	0			0	0											3400	"(1a), (1b) $100 per admit"		(2) $40 per day (days 16-55)	(6) $0	(10a)  $75	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) $50"	( 8a) $0	"( 8b) X-Ray and Diag. X-Ray $10 - $30, Therapeutic Services $0"			"(3) $25, (5) $0, (9c) $25, (9d) $0, (12) $0, (13a) $0"	"(7a) $5-$25, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $25, (14b-j) $0, (16b), (18a) $25, (17a) $0-$25"					(15) 0-10% ($300 quarterly max)		(10b) $40	"(16a) 40%, (16b) 50%"	"(17a) $25, (17b) $0"			"(18b) $0, $1,000 allowance/3 years"	(14a) $0	(13e) $0												100	0	40	0	75	0.15	0	50	50	0	13.52379866	0	0	25	5	25	0	0	0	0	0.1	0	40	0.4	25	0		0	0	0											NO	98.81178107	0	36.99384682	0	70.37676265	0.145063551	0	49.60781232	49.61123173	0	13.44610499	0	0	24.46433816	4.991617146	24.93276356	0	0	0	0	0.04555697	0	37.53427341	0.4	25	0		0	0	0												3.1268	0	3.365869621	0	1.750292407	2.064627246	0	2.068609294	2.06777081	0	2.471119882	0	0	2.437990951	1.999399581	12.58610265	0	0	0	0	2.998867618	0	0.355225432	2.42	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3992		4.39655382	3.1268	0	3.365869621	0	1.750292407	2.064627246	0	2.068609294	2.06777081	0	2.471119882	0	0	2.437990951	1.999399581	12.58610265	0	0	0	0	2.998867618	0	0.355225432	2.42	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3992	NO																																																																																		0			3.1268	0	3.365869621	0	1.750292407	2.064627246	0	2.068609294	2.06777081	0	2.471119882	0	0	2.437990951	1.999399581	12.58610265	0	0	0	0	2.998867618	0	0.355225432	2.42	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3992
H3957_024_0	2011	8																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	319.1477209	0	566.9652921	0	240.0707258	8.068597316	0	375.2696321	359.3510694	3913.032384	1344.014037	0	0	486.3773371	3406.620479	4469.480066	0	0	0	0	38.67417883	0	91.35533614	0	329.5090672	0			0	0											3400	"(1a), (1b) $200 per admit"		(2) $60 per day (days 16-55)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $30-$50"	"(9a), (9b) $150"	( 8a) $0-$75	"( 8b) X-Ray and Diag. X-Ray $30 - $75, Therapeutic Services $0"			"(3) $30, (5) $0, (9c) $30, (9d) $0, (12) $0, (13a) $0"	"(7a) $10-$30, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $30, (14b-j) $0, (16b), (18a) $30, (17a) $0-$30"					(15) 0-10% ($300 quarterly max)		(10b) $40		"(17a) $30, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												200	0	60	0	100	0.15	0	50	150	20	38.77702966	0	0	30	10	30	0	0	0	0	0.1	0	40		30	0		0	0	0											NO	192.6781564	0	48.27886605	0	89.37936767	0.142707849	0	48.79217985	147.2708334	19.56347443	38.18388472	0	0	29.37329138	9.939100882	29.48757285	0	0	0	0	0.050815968	0	35.75174707		30	0		0	0	0												5.1244	0	2.281036783	0	1.788114139	1.151452165	0	1.525851948	4.410160956	6.379375751	4.276639756	0	0	1.190541937	2.821562051	10.98284325	0	0	0	0	1.965265852	0	0.272176073	0	0.823772668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9932		3.7689363	5.1244	0	2.281036783	0	1.788114139	1.151452165	0	1.525851948	4.410160956	6.379375751	4.276639756	0	0	1.190541937	2.821562051	10.98284325	0	0	0	0	1.965265852	0	0.272176073	0	0.823772668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9932	NO																																																																																		0			5.1244	0	2.281036783	0	1.788114139	1.151452165	0	1.525851948	4.410160956	6.379375751	4.276639756	0	0	1.190541937	2.821562051	10.98284325	0	0	0	0	1.965265852	0	0.272176073	0	0.823772668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9932
H3957_025_0	2011	9																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	254.392096	0	439.6698013	0	135.1205466	12.53778993	0	430.1410848	441.0616516	4021.513237	1652.837769	0	0	735.8288055	3866.551208	4743.461357	0	0	0	0	32.39360322	0	51.41810986	0	329.5090672	0			0	0											3400	"(1a), (1b) $200 per admit"		(2) $60 per day (days 16-55)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $30-$50"	"(9a), (9b) $150"	( 8a) $0-$75	"( 8b) X-Ray and Diag. X-Ray $30 - $75, Therapeutic Services $0"			"(3) $30, (5) $0, (9c) $30, (9d) $0, (12) $0, (13a) $0"	"(7a) $10-$30, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $30, (14b-j) $0, (16b), (18a) $30, (17a) $0-$30"					(15) 0-10% ($300 quarterly max)		(10b) $40		"(17a) $30, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												200	0	60	0	100	0.15	0	50	150	20	38.42310343	0	0	30	10	30	0	0	0	0	0.1	0	40		30	0		0	0	0											NO	197.2377178	0	43.88326013	0	90.96268847	0.142725263	0	49.85057913	148.9389169	19.67839585	38.13952048	0	0	29.34114378	9.976070983	29.93256129	0	0	0	0	0.057138484	0	36.38507539		30	0		0	0	0												4.1813	0	1.607845355	0	1.024244016	1.789459369	0	1.786898515	5.474270389	6.594744117	5.253203329	0	0	1.799171565	3.214415776	11.83199565	0	0	0	0	1.850921394	0	0.155904317	0	0.823772668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3882		2.5686651	4.1813	0	1.607845355	0	1.024244016	1.789459369	0	1.786898515	5.474270389	6.594744117	5.253203329	0	0	1.799171565	3.214415776	11.83199565	0	0	0	0	1.850921394	0	0.155904317	0	0.823772668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3882	NO																																																																																		0			4.1813	0	1.607845355	0	1.024244016	1.789459369	0	1.786898515	5.474270389	6.594744117	5.253203329	0	0	1.799171565	3.214415776	11.83199565	0	0	0	0	1.850921394	0	0.155904317	0	0.823772668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3882
H3957_030_0	2011	14																															Coin	Coin	Coin	Coin	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	427.878596	0	155.7922154	43.59810213	36.94456441	49.24366676	0	37.08976477	37.09326043	19.98983118	47.06706285	0	0	47.0147237	29.27018276	49.57953805	0	0	0	198.1637197	59.90884045	0	0	0	329.5090672	0			0	0											3400	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		"(4a), (4b) FFS"	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d), (12), (13a) FFS"	"(7a), (14c-j) FFS"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14b-j), (16b), (18a) (17a) FFS"				"(7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b) $40	(16a) $0	"(17a), (17b) $0"			"(18b) $0, $1,000 allowance/3 years"	(14a) $0	(13e) $0												0.086530154		0.175068086		0.233	0.233		0.233	0.233	0.233	0.233			0.233	0.094762351	0.094762351				0.233	0.233																				NO	0.086530154		0.175068086		0.233	0.233		0.233	0.233	0.233	0.233			0.233	0.094762351	0.094762351				0.233	0.233																					37.0244	0	27.27424503	0	8.608083507	11.47377435	0	8.641915193	8.64272968	4.657630666	10.96662564	0	0	10.95443062	2.773711344	4.698273606	0	0	0	46.17214669	13.95875982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	195.8467		0	37.0244	0	27.27424503	0	8.608083507	11.47377435	0	8.641915193	8.64272968	4.657630666	10.96662564	0	0	10.95443062	2.773711344	4.698273606	0	0	0	46.17214669	13.95875982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	195.8467	NO																																																																																		0			37.0244	0	27.27424503	0	8.608083507	11.47377435	0	8.641915193	8.64272968	4.657630666	10.96662564	0	0	10.95443062	2.773711344	4.698273606	0	0	0	46.17214669	13.95875982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	195.8467
H3957_031_0	2011	9																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	271.5603252	0	494.6305439	0	209.9474164	10.01254656	0	422.6162354	389.8112321	3821.575314	1578.448696	0	0	403.4669426	3620.038873	3864.032907	0	0	0	0	38.17585522	0	79.89235977	0	329.5090672	0			0	0											3400	"(1a), (1b) $350 per admit"		(2) $75 per day (days 16-55)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $40-$50"	"(9a), (9b) $150"	( 8a) $0-$75	"( 8b) X-Ray and Diag. X-Ray $20 - $75, Therapeutic Services $0"			"(3) $40, (5) $0, (9c) $40, (9d) $0, (12) $0, (13a) $0"	"(7a) $10-$40, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $40, (14b-j) $0, (16b), (18a) $40, (17a) $0-$40"					(15) 0-10% ($300 quarterly max)		(10b) $40		"(17a) $40, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												350	0	75	0	100	0.15	0	50	150	20	29.52396335	0	0	40	10	40	0	0	0	0	0.1	0	40		40	0		0	0	0											NO	328.2531156	0	50.05792328	0	86.03583762	0.137235522	0	48.80849875	142.9892798	19.38623371	28.76929166	0	0	36.50687886	9.863353868	39.04292056	0	0	0	0	0.045099005	0	34.41433505		40	0		0	0	0												7.4284	0	2.063348152	0	1.505250152	1.374077056	0	1.718938667	4.64490228	6.173829348	3.784237575	0	0	1.227443233	2.975477035	12.57192749	0	0	0	0	1.72169307	0	0.229120203	0	1.098363557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.517		5.384279778	7.4284	0	2.063348152	0	1.505250152	1.374077056	0	1.718938667	4.64490228	6.173829348	3.784237575	0	0	1.227443233	2.975477035	12.57192749	0	0	0	0	1.72169307	0	0.229120203	0	1.098363557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.517	NO																																																																																		0			7.4284	0	2.063348152	0	1.505250152	1.374077056	0	1.718938667	4.64490228	6.173829348	3.784237575	0	0	1.227443233	2.975477035	12.57192749	0	0	0	0	1.72169307	0	0.229120203	0	1.098363557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.517
H3957_032_0	2011	9																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	223.3029767	0	222.961368	0	102.2028816	20.93633696	0	372.5868231	384.2959096	3875.303587	1585.924461	0	0	603.7184393	3706.014214	3947.426553	0	0	0	0	30.3694092	0	38.89178312	0	329.5090672	0			0	0											3400	"(1a), (1b) $350 per admit"		(2) $75 per day (days 16-55)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $40-$50"	"(9a), (9b) $150"	( 8a) $0-$75	"( 8b) X-Ray and Diag. X-Ray $20 - $75, Therapeutic Services $0"			"(3) $40, (5) $0, (9c) $40, (9d) $0, (12) $0, (13a) $0"	"(7a) $5-$40, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $40, (14b-j) $0, (16b), (18a) $40, (17a) $0-$40"					(15) 0-10% ($300 quarterly max)		(10b) $40		"(17a) $40, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												350	0	75	0	100	0.15	0	50	150	20	29.77305475	0	0	40	5	40	0	0	0	0	0.1	0	40		40	0		0	0	0											NO	341.8577041	0	59.66060533	0	92.41236617	0.128974915	0	49.88700802	147.7764056	19.81635042	29.41754281	0	0	39.24350844	4.979157175	39.72812757	0	0	0	0	0.053074804	0	36.96494647		40	0		0	0	0												6.3615	0	1.108500848	0	0.78706751	2.700262284	0	1.548936819	4.732489017	6.399531155	3.887833394	0	0	1.974335805	1.537735606	13.06865547	0	0	0	0	1.611850435	0	0.119802723	0	1.098363557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9369		2.858924543	6.3615	0	1.108500848	0	0.78706751	2.700262284	0	1.548936819	4.732489017	6.399531155	3.887833394	0	0	1.974335805	1.537735606	13.06865547	0	0	0	0	1.611850435	0	0.119802723	0	1.098363557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9369	NO																																																																																		0			6.3615	0	1.108500848	0	0.78706751	2.700262284	0	1.548936819	4.732489017	6.399531155	3.887833394	0	0	1.974335805	1.537735606	13.06865547	0	0	0	0	1.611850435	0	0.119802723	0	1.098363557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9369
H3957_036_0	2011	8																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	Coin	V	P	V	P													4.904401128	0	0.343672508	0.83243992	0	2.077883532	0	0	7.676539042	5.289602605	12.16992721	0	0	2.976698724	0	4.901807538	0	0	0	23.72214666	2.20608668	0	0	0	0	0	0	0	0	0											67.1012	YES	0	0	0	0	101.9306214	0	0	413.8069716	0	0	0	0	0	0	2978.590382	5404.712063	0	0	0	0	0	0	38.78817855	6.05	329.5090672	0			0	0											3400	"(1a), (1b) $0"		(2) $0	(6) $0	(10a)  $75	"(11a), (11b), (11c) 0%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) $0"	( 8a) $0	"( 8b) X-Ray and Diag. X-Ray $0, Therapeutic Services $0"			"(3), (5), (9c), (9d), (12), (13a) $0"	"(7a) $15-$25, (14c-j) $0"	"(7b), (7c) $0, (7d) $25, (7f), (7g) $0, (7h) $25, (7i), (14b-j) $0, (16b), (18a) $0, (17a) $0-$25"				"(7g) $0, (14b) $0, (14e-j) $0, (18a) $25"	(15) $0		(10b) $40	"(16a) 40%, (16b) 50%"	"(17a) $25, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												0	0	0	0	75	0	0	50	0	0	0	0	0	25	15	25	0	0	0	0	0	0	40	0.4	25	0		0	0	0											NO	0	0	0	0	74.57023769	0	0	50	0	0	0	0	0	25	15	24.98678225	0	0	0	0	0	0	39.77079344	0.4	25	0		0	0	0												0	0	0	0	0.633415889	0	0	1.724195715	0	0	0	0	0	0	3.723237978	11.25386362	0	0	0	0	0	0	0.128553053	2.42	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.5697	1450	0.010344546	4.9044	0	0.343672508	0.83243992	0.633415889	2.077883532	0	1.724195715	7.676539042	5.289602605	12.16992721	0	0	2.976698724	3.723237978	16.15567116	0	0	0	23.72214666	2.20608668	0	0.128553053	2.42	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.6709	NO																																																																																		0			4.9044	0	0.343672508	0.83243992	0.633415889	2.077883532	0	1.724195715	7.676539042	5.289602605	12.16992721	0	0	2.976698724	3.723237978	16.15567116	0	0	0	23.72214666	2.20608668	0	0.128553053	2.42	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.6709
H3957_037_0	2011	8																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	Coin	V	P	V	P													3.800270212	0	0.259046463	0.760661588	0	1.679286372	0	0	7.213924478	5.242439725	11.36352487	0	0	3.352438855	0	4.267811588	0	0	0	19.64890721	1.863571143	0	0	0	0	0	0	0	0	0											59.4519	YES	0	0	0	0	99.39742406	0	0	393.2374054	0	0	0	0	0	0	2951.73308	4926.016671	0	0	0	0	0	0	37.82420807	6.05	329.5090672	0			0	0											3400	"(1a), (1b) $0"		(2) $0	(6) $0	(10a)  $75	"(11a), (11b), (11c) 0%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) $0"	( 8a) $0	"( 8b) X-Ray and Diag. X-Ray $0, Therapeutic Services $0"			"(3), (5), (9c), (9d), (12), (13a) $0"	"(7a) $15-$25, (14c-j) $0"	"(7b), (7c) $0, (7d) $25, (7f), (7g) $0, (7h) $25, (7i), (14b-j) $0, (16b), (18a) $0, (17a) $0-$25"				"(7g) $0, (14b) $0, (14e-j) $0, (18a) $25"	(15) $0		(10b) $40	"(16a) 40%, (16b) 50%"	"(17a) $25, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												0	0	0	0	75	0	0	50	0	0	0	0	0	25	15	25	0	0	0	0	0	0	40	0.4	25	0		0	0	0											NO	0	0	0	0	75	0	0	50	0	0	0	0	0	25	15	24.99752858	0	0	0	0	0	0	40	0.4	25	0		0	0	0												0	0	0	0	0.6212339	0	0	1.638489189	0	0	0	0	0	0	3.689666349	10.26152021	0	0	0	0	0	0	0.126080694	2.42	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.4435	1250	0.001014521	3.8003	0	0.259046463	0.760661588	0.6212339	1.679286372	0	1.638489189	7.213924478	5.242439725	11.36352487	0	0	3.352438855	3.689666349	14.5293318	0	0	0	19.64890721	1.863571143	0	0.126080694	2.42	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8954	NO																																																																																		0			3.8003	0	0.259046463	0.760661588	0.6212339	1.679286372	0	1.638489189	7.213924478	5.242439725	11.36352487	0	0	3.352438855	3.689666349	14.5293318	0	0	0	19.64890721	1.863571143	0	0.126080694	2.42	0.686477223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8954
H3957_805_0	2011	7																															Coin	Coin	Coin	Coin	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	273.9977307	0	47.5643131	26.87394571	10.52669948	25.8966692	0	14.95934514	47.91379769	16.46049906	57.88478873	0	0	24.8391591	29.30460997	44.12574326	0	0	0	153.6693356	84.46690392	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		"(4a), (4b) FFS"	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d), (12), (13a) FFS"	"(7a), (14c-j) FFS"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14b-j), (16b), (18a) (17a) FFS"				"(7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14a)	(13e)												0.085658165		0.176473352		0.233	0.233		0.233	0.233	0.233	0.233			0.233	0.233	0.233				0.233	0.233																				NO	0.074573769		0.153637228		0.202849175	0.202849175		0.202849175	0.202849175	0.202849175	0.202849175			0.202849175	0.202849175	0.202849175				0.202849175	0.202849175																					20.433	0	7.307649199	0	2.13533231	5.253117993	0	3.034490826	9.719274354	3.338998662	11.74188166	0	0	5.038602942	5.944415969	8.950870635	0	0	0	31.17169801	17.13404181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.2034		19.50163822	20.433	0	7.307649199	0	2.13533231	5.253117993	0	3.034490826	9.719274354	3.338998662	11.74188166	0	0	5.038602942	5.944415969	8.950870635	0	0	0	31.17169801	17.13404181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.2034	NO																																																																																		0			20.433	0	7.307649199	0	2.13533231	5.253117993	0	3.034490826	9.719274354	3.338998662	11.74188166	0	0	5.038602942	5.944415969	8.950870635	0	0	0	31.17169801	17.13404181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.2034
H3957_806_0	2011	6																															Coin	Coin	Coin	Coin	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	310.8570574	0	78.00321459	33.92609308	14.27728571	30.65084246	0	18.49806756	45.40484854	16.3818192	54.19979093	0	0	24.31396453	29.2556384	44.61669891	0	0	0	160.0820359	63.75471234	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		"(4a), (4b) FFS"	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d), (12), (13a) FFS"	"(7a), (14c-j) FFS"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14b-j), (16b), (18a) (17a) FFS"				"(7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14a)	(13e)												0.08699998		0.174210208		0.233	0.233		0.233	0.233	0.233	0.233			0.233	0.233	0.233				0.233	0.233																				NO	0.07574195		0.15166694		0.202849175	0.202849175		0.202849175	0.202849175	0.202849175	0.202849175			0.202849175	0.202849175	0.202849175				0.202849175	0.202849175																					23.5449	0	11.83050887	0	2.896135633	6.217498119	0	3.752317751	9.210336087	3.323038516	10.9943829	0	0	4.932067657	5.934482126	9.050460584	0	0	0	32.47250898	12.93259083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.0912		20.3767856	23.5449	0	11.83050887	0	2.896135633	6.217498119	0	3.752317751	9.210336087	3.323038516	10.9943829	0	0	4.932067657	5.934482126	9.050460584	0	0	0	32.47250898	12.93259083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.0912	NO																																																																																		0			23.5449	0	11.83050887	0	2.896135633	6.217498119	0	3.752317751	9.210336087	3.323038516	10.9943829	0	0	4.932067657	5.934482126	9.050460584	0	0	0	32.47250898	12.93259083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.0912
H3957_808_0	2011	6																															Coin	Coin	Coin	Coin	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	306.7335141	0	74.56333859	33.13220523	13.93817276	30.11715287	0	18.09998514	45.69841912	16.38174701	54.65128216	0	0	24.36772938	29.28369792	44.58477838	0	0	0	159.3531519	66.11800181	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		"(4a), (4b) FFS"	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d), (12), (13a) FFS"	"(7a), (14c-j) FFS"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14b-j), (16b), (18a) (17a) FFS"				"(7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14a)	(13e)												0.086831742		0.174493607		0.233	0.233		0.233	0.233	0.233	0.233			0.233	0.233	0.233				0.233	0.233																				NO	0.075595481		0.151913667		0.202849175	0.202849175		0.202849175	0.202849175	0.202849175	0.202849175			0.202849175	0.202849175	0.202849175				0.202849175	0.202849175																					23.1877	0	11.32719018	0	2.827346852	6.109239627	0	3.671567062	9.269886637	3.323023872	11.08596752	0	0	4.942973813	5.940173977	9.043985531	0	0	0	32.32465547	13.41198215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.4657		20.2838004	23.1877	0	11.32719018	0	2.827346852	6.109239627	0	3.671567062	9.269886637	3.323023872	11.08596752	0	0	4.942973813	5.940173977	9.043985531	0	0	0	32.32465547	13.41198215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.4657	NO																																																																																		0			23.1877	0	11.32719018	0	2.827346852	6.109239627	0	3.671567062	9.269886637	3.323023872	11.08596752	0	0	4.942973813	5.940173977	9.043985531	0	0	0	32.32465547	13.41198215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.4657
H3959_001_0	2011	8																															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	YES	2352.689877	108.0007617	1942.09342	0	437.2551487	15.27703069	8.390912839	148.975845	852.1155396	2891.525637	46.60950741	0	0	413.6695806	7410.740121	23128.9469	168.83624	2492.29289	49.71966147	2289.248989	51.08822062	0	0	0	226.4739208	0	0	0	0	209.8723484											6700	1a $175 days 1-9	1b $175 days 1-9	"2 $45 days 1-20, $90 days 21-100"	6 $0	10a $100	11a 20%	11b 20%	4a $50	"9a $175, 9b $175"	8a $10	8b $90 $20 x-ray 15B Outpatient Chemotherapy Drugs 15% 8b Radiation Therapy $55	5 $0	12 $0	4b $50	7a $12	"16b $25, 17a $25, 18a $25, 7b $40, 7d $40, 7f $40"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	8b $90 $20 x-ray 15B Physician Chemotherapy Drugs 15% 8b Radiation Therapy $55	7g $40	15A 20% coinsurance 15B Physician Chemotherapy Drugs 15%			16A $0 for exam/cleaning/x-ray up to $1000 combined max; 16b 50% for restorations/extractions up to $1000 combined max with $25 deductible	17a $25	"17b 1 pair of glasses after cataract surgery - Medicare Covered Only, $150 Allowance every two years Non-Medicare Covered"	18a $25 Medicare covered only		14a $0	"14c $12, 7f $40"												144.3426262	136.3346105	60.16908605	0	83.49241959	0.199050003	0.2	38.79063232	173.1312913	10	0.037561125	0	0	1.609710708	6.295137752	10.32898971	38.23355984	5.638164791	0.325583803	1.792249348	0.209981146	0	0	0	18.1796388	0	0	0	0	8.692128773											NO	140.2565867	132.4752613	58.4658244	0	81.12892289	0.193415311	0.194338416	37.69255022	168.2303046	9.716920804	0.036497848	0	0	1.506660911	6.116935499	10.0365975	37.15124731	5.478560076	0.316367203	1.741514497	0.204037017	0	0	0	17.66501104	0	0	0	0	8.44607269												27.4984	1.19228576	9.462174406	0	2.956169936	2.954811646	1.630676711	0.46793996	11.9459714	2.341393801	1.701146706	0	0	0.051938316	3.777584943	19.34466089	0.522706409	1.137848027	15.72967024	0.332230025	10.42388812	0	0	0	0.333388693	0	0	0	0	0.147716426	0	0	0	0	0	0	0	0	0	0	113.9526	0	3.321773876	27.4984	1.19228576	9.462174406	0	2.956169936	2.954811646	1.630676711	0.46793996	11.9459714	2.341393801	1.701146706	0	0	0.051938316	3.777584943	19.34466089	0.522706409	1.137848027	15.72967024	0.332230025	10.42388812	0	0	0	0.333388693	0	0	0	0	0.147716426	0	0	0	0	0	0	0	0	0	0	113.9526	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	27.4984	1.19228576	9.462174406	0	2.956169936	2.954811646	1.630676711	0.46793996	11.9459714	2.341393801	1.701146706	0	0	0.051938316	3.777584943	19.34466089	0.522706409	1.137848027	15.72967024	0.332230025	10.42388812	0	0	0	0.333388693	0	0	0	0	0.147716426	0	0	0	0	0	0	0	0	0	0	113.9526
H3959_002_0	2011	5																															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	YES	2046.216088	77.48148068	1484.119127	0	359.0970796	15.99120388	7.733340268	198.5474115	1015.038095	3915.21241	40.38735333	0	0	601.2643487	7563.601953	24344.82428	172.2652598	2192.530344	55.52682121	2205.993825	60.81983142	0	0	0	198.4621459	0	290.4606203	0	0	148.8063403											6700	1a $170 days 1-8	1b $170 days 1-8	"2 $50 days 1-20, $90 days 21-100"	6 $0	10a $100	11a 20%	11b 20%	4a $50	"9a $150, 9b $150"	8a $10	8b $90 $20 X-ray 15B Outpatient Chemotherapy Drugs 15% 8b Radiation Therapy $55	5 $0	12 $0	4b $50	7a $5	"16b $30, 17a $25, 18a $30, 7b $35, 7d $35, 7f $35"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	8b $90 $20 X-ray 15B Physician Chemotherapy Drugs 15% 8b Radiation Therapy $55	7g $35	15A 20% coinsurance 15B Physician Chemotherapy Drugs 15%			16A $0 for exam/cleaning/x-ray up to $1000 combined max; 16b 50% for restorations/extractions up to $1000 combined max with $25 deductible	17a $25	"17b 1 pair of glasses after cataract surgery - Medicare Covered Only, $150 Allowance every two years Non-Medicare Covered"	18a $30	"18b $750 Allowance every 3 yrs ($500 for 1st aid, $250 for 2nd aid)"	14a $0	"14c $5, 7f $35"												136.5613724	126.4687101	63.48363204	0	84.4386161	0.199016212	0.2	38.78700915	148.8325561	10	0.047523585	0	0	2.314191816	2.923927551	9.258737143	33.00140844	5.02834788	0.294450396	1.190281216	0.20883756	0	0	0	16.72912031	0	29.81559361	0	0	7.378728344											NO	133.7437898	123.8593628	62.17381524	0	82.69644863	0.194910039	0.195873529	37.98674183	145.76179	9.793676455	0.046543061	0	0	2.241737828	2.863600041	9.067707595	32.32051169	4.924601224	0.288375191	1.165722912	0.20452875	0	0	0	16.38395917	0	29.20042771	0	0	7.226487805												22.8057	0.799733902	7.6894457	0	2.4746711	3.116846168	1.51475665	0.628514105	12.32948081	3.195360299	1.879751063	0	0	0.112323086	1.804927572	18.395979	0.463975112	0.899778135	16.01255765	0.214298129	12.43940407	0	0	0	0.270966308	0	0.706797862	0	0	0.089612267	0	0	0	0	0	0	0	0	0	0	107.8449	0	2.273234403	22.8057	0.799733902	7.6894457	0	2.4746711	3.116846168	1.51475665	0.628514105	12.32948081	3.195360299	1.879751063	0	0	0.112323086	1.804927572	18.395979	0.463975112	0.899778135	16.01255765	0.214298129	12.43940407	0	0	0	0.270966308	0	0.706797862	0	0	0.089612267	0	0	0	0	0	0	0	0	0	0	107.8449	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.8057	0.799733902	7.6894457	0	2.4746711	3.116846168	1.51475665	0.628514105	12.32948081	3.195360299	1.879751063	0	0	0.112323086	1.804927572	18.395979	0.463975112	0.899778135	16.01255765	0.214298129	12.43940407	0	0	0	0.270966308	0	0.706797862	0	0	0.089612267	0	0	0	0	0	0	0	0	0	0	107.8449
H3959_010_0	2011	7																															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	YES	1733.355393	75.29034386	1181.873402	0	307.7101074	11.70183253	4.476145677	154.9831612	724.214009	2738.854716	40.55759402	0	0	379.92731	6119.833535	18944.1293	147.9553601	1564.122579	35.75097266	1699.987416	29.72496023	0	0	0	0	0	0	0	0	99.19039834											6700	1a $185 days 1-6	1b $185 days 1-6	"2 $50 days 1-20, $85 days 21-100"	6 $0	10a $100	11a 20%	11b 20%	4a $50	"9a $175, 9b $175"	8a $10	8b $135 ($25 x-ray) 15B Outpatient Chemotherapy Drugs 15% 8b Radiation Therapy $55	5 $0	12 $0	4b $50 3 $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 $135 ($25 x-ray) 15B Physician Chemotherapy Drugs 15% 8b Radiation Therapy $55	7g $40	"11c 20%, 15A 20% coinsurance, 15B Physician Chemotherapy Drugs 15%"				17a $25 Medicare covered only	17b 1 pair of glasses after cataract surgery.	18a $25 Medicare covered only		14a $0	"14c $15, 7f $40"												133.1135645	95.30957944	63.39431662	0	85.55768422	0.198752885	0.2	49.75465838	173.2612908	5.716372881	0.049316315	0	0	1.114570239	7.844017838	9.60317281	35.60277729	17.9067874	0.488767857	1.795861313	0.217211626	0	0	0	0	0	0	0	0	11.21626618											NO	127.1959834	91.07257947	60.57611388	0	81.75420604	0.189917299	0.191108974	47.54280846	165.5589372	5.462250768	0.047123952	0	0	0.96673383	7.495310986	9.176262492	34.02005111	17.11073879	0.467039617	1.716026061	0.207555455	0	0	0	0	0	0	0	0	10.71764559												18.373	0.571407152	5.966108149	0	2.09638296	2.222380429	0.855431606	0.614027896	9.991675133	1.246692606	1.911234097	0	0	0.030607382	3.822504628	14.48635859	0.419454076	2.230274407	16.69712059	0.243101892	6.169577631	0	0	0	0	0	0	0	0	0.088590628	0	0	0	0	0	0	0	0	0	0	88.0359	0	4.098980934	18.373	0.571407152	5.966108149	0	2.09638296	2.222380429	0.855431606	0.614027896	9.991675133	1.246692606	1.911234097	0	0	0.030607382	3.822504628	14.48635859	0.419454076	2.230274407	16.69712059	0.243101892	6.169577631	0	0	0	0	0	0	0	0	0.088590628	0	0	0	0	0	0	0	0	0	0	88.0359	NO																																										0.0011	0	0.0016	0	0.0069	0	0	0.0004	0.0002	0	0.0001	0	0	0	0.0001	0.0017	0	0	0.0002	0	0	0	0	0	0	0	0	0	0	0											0.0125	0	0	18.3741	0.571407152	5.967692396	0	2.103304075	2.222380429	0.855431606	0.614473894	9.991844427	1.246725069	1.911368498	0	0	0.030607382	3.822647165	14.48803282	0.419454076	2.230274407	16.69735162	0.243107132	6.169577631	0	0	0	0	0	0	0	0	0.088590628	0	0	0	0	0	0	0	0	0	0	88.0484
H3959_011_0	2011	7																															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	YES	1646.647781	83.5760107	1373.183854	0	319.0956868	12.99662549	5.275470738	150.5683102	789.6000713	3441.190574	29.1827746	0	0	508.6995198	5745.759768	18831.17752	179.6804046	1561.395941	37.38012441	1560.874282	22.59679192	0	0	0	0	0	0	0	0	104.4443243											6700	1a $195 days 1-7	1b $195 days 1-7	"2 $50 days 1-20, $90 days 21-100"	6 $0	10a $100	11a 20%	11b 20%	4a $50	"9a $175, 9b $175"	8a $15	8b $140 ($25 x-ray) 15B Outpatient Chemotherapy Drugs 15% 8b Radiation Therapy $55	5 $0	12 $0	4b $50 3 $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 $140 ($25 x-ray) 15B Physician Chemotherapy Drugs 15% 8b Radiation Therapy $55	7g $40	"11c 20%, 15A 20% coinsurance, 15B Physician Chemotherapy Drugs 15%"				17a $25 Medicare covered only	17b 1 pair of glasses after cataract surgery	18a $25 Medicare covered only		14a $0	"14c $15, 7f $40"												147.8288544	109.5735981	65.30779042	0	86.87281556	0.198945196	0.2	49.68553459	173.340249	8.574559322	0.072392369	0	0	0.608218568	8.509529484	9.161793684	35.45730339	16.53562945	0.442931876	2.126313276	0.22237365	0	0	0	0	0	0	0	0	13.26223605											NO	140.5743347	104.1964082	62.10289071	0	82.6096387	0.189182204	0.190185245	47.24727793	164.8337889	8.153773341	0.068839802	0	0	0.497336963	8.091934763	8.712189897	33.71727972	15.72416372	0.421195538	2.02196706	0.211460936	0	0	0	0	0	0	0	0	12.61140809												19.2897	0.725693344	7.106557233	0	2.196698283	2.458730255	1.003316697	0.592828567	10.84606429	2.338223997	2.008936436	0	0	0.021082923	3.874526101	13.67173288	0.504861205	2.04597045	15.74434159	0.263003032	4.778338766	0	0	0	0	0	0	0	0	0.109765833	0	0	0	0	0	0	0	0	0	0	89.5804	0	4.626523044	19.2897	0.725693344	7.106557233	0	2.196698283	2.458730255	1.003316697	0.592828567	10.84606429	2.338223997	2.008936436	0	0	0.021082923	3.874526101	13.67173288	0.504861205	2.04597045	15.74434159	0.263003032	4.778338766	0	0	0	0	0	0	0	0	0.109765833	0	0	0	0	0	0	0	0	0	0	89.5804	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.2897	0.725693344	7.106557233	0	2.196698283	2.458730255	1.003316697	0.592828567	10.84606429	2.338223997	2.008936436	0	0	0.021082923	3.874526101	13.67173288	0.504861205	2.04597045	15.74434159	0.263003032	4.778338766	0	0	0	0	0	0	0	0	0.109765833	0	0	0	0	0	0	0	0	0	0	89.5804
H3959_803_0	2011	4																															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	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	292.1100611	4.572719649	65.46120547	0	14.51179942	17.39586542	8.963953725	5.249862629	72.63655698	15.14559699	44.00841702	4.111605797	0.123765136	7.963142058	43.91027209	140.7421001	2.435275566	18.32589164	60.90932531	11.23165222	48.56201834	0	0	0	0	0	0	0	0	0											6700	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%												0.086513306	0.086513306	0.173974343	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.231744214	0.233	0.23275336	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.078709084	0.078709084	0.158280406	0	0.211981456	0.212068264	0.211981456	0.211981456	0.211981456	0.211981456	0.211984269	0.211981456	0.211981456	0.21072567	0.211989717	0.211757346	0.211981456	0.211981456	0.211983019	0.212025714	0.211981456	0	0	0	0	0	0	0	0	0												22.9917	0.359914575	10.36122615	0	3.076232364	3.689110987	1.900191958	1.112873521	15.39760307	3.210585694	9.329092129	0.871584182	0.026235914	1.678038444	9.308526171	29.80317357	0.516233259	3.884749184	12.91174267	2.381399083	10.29424733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.1045	0	14.18730457	22.9917	0.359914575	10.36122615	0	3.076232364	3.689110987	1.900191958	1.112873521	15.39760307	3.210585694	9.329092129	0.871584182	0.026235914	1.678038444	9.308526171	29.80317357	0.516233259	3.884749184	12.91174267	2.381399083	10.29424733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.1045	YES																																									10000	0.1049	0	0.0129	0	0.2022	0.0058	0.0166	0.0098	0.1623	0.0222	0.0049	0	0	0.0039	0.0303	0.2316	0	0.0281	0.0232	0.0134	0.0423	0	0	0	0	0	0	0	0	0											0.9144	0	0	23.0966	0.359914575	10.37410298	0	3.278444149	3.694897053	1.916799962	1.122713523	15.55990397	3.23283126	9.333992536	0.871584182	0.026235914	1.68191404	9.338856242	30.03472814	0.516233259	3.912836583	12.9349137	2.394831422	10.33656678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.0189
H3959_804_0	2011	3																															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	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	302.9797504	4.997421125	68.41885015	0	16.0113395	18.14819716	8.933446955	5.45519626	71.77730396	15.810701	43.1860414	4.042586667	0.142703268	8.298567348	45.21157858	145.169465	2.416135632	19.0904706	60.63911028	11.83098534	48.84823163	0	0	0	0	0	0	0	0	0											6700	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%												0.086832359	0.086832359	0.173726623	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.231794973	0.233	0.23273802	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.078434649	0.078434649	0.156925216	0	0.210466161	0.210560703	0.210466161	0.210466161	0.210466161	0.210466161	0.210469709	0.210466161	0.210466161	0.209261134	0.21047526	0.210229687	0.210466161	0.210466161	0.210468105	0.210511941	0.210466161	0	0	0	0	0	0	0	0	0												23.7641	0.391970971	10.73664285	0	3.369845159	3.821297158	1.880188286	1.148134215	15.10669362	3.327617544	9.089353579	0.850827697	0.030034209	1.736567612	9.515918761	30.51893119	0.508514791	4.017898061	12.7625986	2.490563693	10.28089979	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.3486	0	15.55973055	23.7641	0.391970971	10.73664285	0	3.369845159	3.821297158	1.880188286	1.148134215	15.10669362	3.327617544	9.089353579	0.850827697	0.030034209	1.736567612	9.515918761	30.51893119	0.508514791	4.017898061	12.7625986	2.490563693	10.28089979	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.3486	YES																																									10000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.7641	0.391970971	10.73664285	0	3.369845159	3.821297158	1.880188286	1.148134215	15.10669362	3.327617544	9.089353579	0.850827697	0.030034209	1.736567612	9.515918761	30.51893119	0.508514791	4.017898061	12.7625986	2.490563693	10.28089979	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.3486
H3959_806_0	2011	4																															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	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	290.1803747	4.542512148	65.02876711	0	14.41593411	17.2809479	8.904737622	5.215181905	72.15671806	15.04554479	43.71769631	4.084444426	0.122947541	7.910537342	43.62019973	139.8123542	2.419188074	18.20483034	60.50695678	11.15745564	48.24121643	0	0	0	0	0	0	0	0	0											6700	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%												0.087537983	0.087537983	0.173177766	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.231735863	0.233	0.23275336	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.079761816	0.079761816	0.157794052	0	0.212302162	0.212387646	0.212302162	0.212302162	0.212302162	0.212302162	0.212304933	0.212302162	0.212302162	0.211038025	0.212310298	0.212077709	0.212302162	0.212302162	0.212303702	0.212345745	0.212302162	0	0	0	0	0	0	0	0	0												23.1453	0.362319017	10.26115264	0	3.06053398	3.670259851	1.89049505	1.107194394	15.31902725	3.19420169	9.281482588	0.867136383	0.026102029	1.669424181	9.261017599	29.65108373	0.513598859	3.864924842	12.84585091	2.369238235	10.24171455	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.6021	0	13.90076457	23.1453	0.362319017	10.26115264	0	3.06053398	3.670259851	1.89049505	1.107194394	15.31902725	3.19420169	9.281482588	0.867136383	0.026102029	1.669424181	9.261017599	29.65108373	0.513598859	3.864924842	12.84585091	2.369238235	10.24171455	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.6021	YES																																									10000	0.1054	0	0.0127	0	0.2009	0.0057	0.0165	0.0098	0.1612	0.0221	0.0049	0	0	0.0038	0.0301	0.23	0	0.0279	0.023	0.0133	0.042	0	0	0	0	0	0	0	0	0											0.9095	0	0	23.2507	0.362319017	10.27388584	0	3.26140995	3.676007694	1.906993341	1.116969392	15.48025598	3.2163003	9.286350622	0.867136383	0.026102029	1.673274175	9.291147308	29.88110864	0.513598859	3.892826695	12.86886887	2.38258184	10.28375443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.5116
H3962_001_0	2011	7																															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	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	360.3029401	51.72642335	1240.244948	1080.662298	399.3895703	22.3959279	0	343.0225755	494.6712527	2309.917814	1074.84909	0	0.265702678	1837.471068	4415.358325	3883.924821	232.2038166	1172.615864	3896.636616	20181.86024	3.196021893	311.0285929	0	1000	585.7985432	22.97514619	0.657055049	16.19865659	0	0											3400	1a - $0 copay/admit	1b - $0 copay/admit	2 - $0 copay Days 1-10/ $50 copay Days 11-100	6 - $0 copay	10a - $75 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 - $35 copay"	8a - $0 copay	"8b - $75 copay (High Tech Imaging Only), $55 therapeutic radiology copay"	5 - $0 copay	12 - 10% coinsurance	3 - $20 CORF copay; 9c - $20 SA Ind/Grp Session copay; 9d - $20 Cardiac Rehab copay	7a - $10 OV copay	7d - $20 Specialist OV copay (excluding MH and Radiology); 18a - $20 Hearing Exam copay	"7e,7h - $20 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 - $0 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 - 10% coinsurance	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 - $20 Routine Hearing Exam/Fitting copay	18b - $400 allowance every 3 years	0	0											0	0	0	50	0	75	0.125002296	0	49.4	35	0	14.90228013	0	0.1	11.37501883	10	14.9507213	20	20	0	0.496478378	0.1	18.85916765	0	10	20	0	20	0	0	0											NO	0	0	47.57608613	0	71.3641292	0.119	0	47.0051731	33.30326029	0	14.17984326	0	0.095	10.82357751	9.515217227	14.22593608	19.03043445	19.03043445	0	0.472409961	0.095	17.94490769	0	9.515217227	19.03043445	0	19.03043445	0	0	0												0	0	4.917166705	0	2.375174075	2.66511542	0	1.343652961	1.372847124	0	1.270099302	0	0.025241754	1.657334211	3.501091133	4.604372188	0.368244959	1.859615778	0	0.794509318	0.30362208	0.465114949	0	0.792934769	0.929000065	0	0.001042004	0	0	0	0	0	0	0	0	0	0	0	0	0	29.2462	0	1.49	0	0	4.917166705	0	2.375174075	2.66511542	0	1.343652961	1.372847124	0	1.270099302	0	0.025241754	1.657334211	3.501091133	4.604372188	0.368244959	1.859615778	0	0.794509318	0.30362208	0.465114949	0	0.792934769	0.929000065	0	0.001042004	0	0	0	0	0	0	0	0	0	0	0	0	0	29.2462	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	4.917166705	0	2.375174075	2.66511542	0	1.343652961	1.372847124	0	1.270099302	0	0.025241754	1.657334211	3.501091133	4.604372188	0.368244959	1.859615778	0	0.794509318	0.30362208	0.465114949	0	0.792934769	0.929000065	0	0.001042004	0	0	0	0	0	0	0	0	0	0	0	0	0	29.2462
H3962_004_0	2011	6																															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	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	186.4221387	47.8843994	319.9294246	505.8560209	172.2199101	15.71050551	0	263.4486389	403.3923197	1709.140179	986.8534204	0	0.184676465	1197.486468	4231.578193	2810.132207	222.3467289	889.5603304	2738.914678	14840.17224	2.461012688	313.5892719	0	900.6447174	557.5170854	19.82250897	7.228148579	10.20554232	0	0											3400	"1a - $250 copay/admit, $750 max"	"1b - $250 copay/admit, $750 max"	2 - $0 copay Days 1-10/ $50 copay Days 11-100	6 - $10 copay	10a - $75 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 - $25 Urgent Care copay	"9a,9b - $100 copay"	8a - $0 copay	"8b - $100 copay (High Tech Imaging Only), $55 therapeutic radiology copay"	5 - $0 copay	12 - 10% coinsurance	3 - $25 CORF copay; 9c - $25 SA Ind/Grp Session copay; 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 - $25 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 - $0 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 - 15% coinsurance	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 - $20 Routine Hearing Exam/Fitting copay	18b - $400 allowance every 3 years	0	0											0	250	250	50	10	75	0.124336256	0	49.5	100	0	19.86970684	0	0.1	12.18086341	15	20.14325014	25	25	0	0.636423997	0.15	24.18199929	0	10	20	0	20	0	0	0											NO	236.0437183	236.0437183	47.20874365	9.441748731	70.81311548	0.117	0	46.73665622	94.41748731	0	18.76047793	0	0.094	11.50086517	14.1626231	19.01875064	23.60437183	23.60437183	0	0.600895546	0.142	22.83203611	0	9.441748731	18.88349746	0	18.88349746	0	0	0												3.667	0.941900973	1.258622183	0.398013787	1.016285698	1.838129145	0	1.026059039	3.173940769	0	1.542820151	0	0.017359588	1.147677534	4.994187254	4.453766977	0.437362905	1.749792733	0	0.743116117	0.349463802	0.596656798	0	0.708638426	0.877322706	0	0.011374394	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9495	0	1.84	3.667	0.941900973	1.258622183	0.398013787	1.016285698	1.838129145	0	1.026059039	3.173940769	0	1.542820151	0	0.017359588	1.147677534	4.994187254	4.453766977	0.437362905	1.749792733	0	0.743116117	0.349463802	0.596656798	0	0.708638426	0.877322706	0	0.011374394	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9495	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	3.667	0.941900973	1.258622183	0.398013787	1.016285698	1.838129145	0	1.026059039	3.173940769	0	1.542820151	0	0.017359588	1.147677534	4.994187254	4.453766977	0.437362905	1.749792733	0	0.743116117	0.349463802	0.596656798	0	0.708638426	0.877322706	0	0.011374394	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9495
H3962_007_0	2011	9																															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	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	23.9111105	41.04294793	241.5896155	539.1119919	230.5036854	13.9848249	0	235.4899471	307.7103668	1430.377838	774.3472706	0	0.137122868	1100.326101	3629.479081	2298.772672	190.7646271	502.5001608	2532.746887	13271.56911	1.81467898	375.3346511	0	0	0	0	3.363714908	17.56457343	0	0											3400	"1a - $500 copay/admit, $1,500 max"	"1a - $500 copay/admit, $1,500 max"	2 - $0 copay Days 1-10/ $60 copay Days 11-100	6 - $10 copay	10a - $100 copay/trip	"11a - 0% coinsurance for diabetic supplies, 25% coinsurance for all other"	"11b,11c - 0% coinsurance for diabetic supplies, 25% 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), $55 therapeutic radiology copay"	5 - $0 copay	12 - 10% coinsurance	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 - $0 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 - 20% coinsurance	13a - $0 copay; 17a - $40 Eye Exam copay	0	0	0	0	0	0	0	0											0	500	500	60	10	100	0.122542257	0	49.8	150	0	29.80456026	0	0.1	19.54483609	20	30.16167452	40	40	0	0.808247439	0.2	38.89968348	0	0	0	0	0	0	0	0											NO	471.6546807	471.6546807	56.59856168	9.433093613	94.33093613	0.116	0	46.97680619	141.4964042	0	28.1149207	0	0.094	18.43682685	18.86618723	28.45178993	37.73237445	37.73237445	0	0.762427376	0.189	36.69443558	0	0	0	0	0	0	0	0												0.9398	1.613174875	1.139468729	0.423791157	1.811969036	1.622239689	0	0.921880467	3.628325869	0	1.814226009	0	0.01288955	1.690543483	5.706202656	5.450349763	0.599833528	1.580043686	0	0.843217301	0.342974327	1.147724431	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.2887	0	1.88	0.9398	1.613174875	1.139468729	0.423791157	1.811969036	1.622239689	0	0.921880467	3.628325869	0	1.814226009	0	0.01288955	1.690543483	5.706202656	5.450349763	0.599833528	1.580043686	0	0.843217301	0.342974327	1.147724431	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.2887	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	0.9398	1.613174875	1.139468729	0.423791157	1.811969036	1.622239689	0	0.921880467	3.628325869	0	1.814226009	0	0.01288955	1.690543483	5.706202656	5.450349763	0.599833528	1.580043686	0	0.843217301	0.342974327	1.147724431	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.2887
H3962_801_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	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	274.3117589	4.024700529	26.88407661	7.020377085	9.229280889	19.07902486	0	16.78836122	43.17470634	11.14252141	28.38183554	0	0.279414098	39.70900663	25.9440472	37.39374812	1.601184501	10.19677223	32.09268209	152.4540104	1.828324762	6.634017992	0	0	0	0	0	0	0	0											6700	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing																			0	0.075611389	0.075611389	0.173407617	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	0.062	0.062	0.143	0	0.192	0.192	0	0.192	0.192	0.192	0.192	0	0.192	0.192	0.192	0.192	0.192	0.192	0.192	0.192	0.192	0.192	0	0	0	0	0	0	0	0												17.0073	0.249531433	3.844422955	0	1.772021931	3.663172774	0	3.223365353	8.289543618	2.13936411	5.449312423	0	0.053647507	7.624129273	4.981257062	7.17959964	0.307427424	1.957780268	6.16179496	29.27117001	0.351038354	1.273731454	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7996	0	22.24	17.0073	0.249531433	3.844422955	0	1.772021931	3.663172774	0	3.223365353	8.289543618	2.13936411	5.449312423	0	0.053647507	7.624129273	4.981257062	7.17959964	0.307427424	1.957780268	6.16179496	29.27117001	0.351038354	1.273731454	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7996	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	17.0073	0.249531433	3.844422955	0	1.772021931	3.663172774	0	3.223365353	8.289543618	2.13936411	5.449312423	0	0.053647507	7.624129273	4.981257062	7.17959964	0.307427424	1.957780268	6.16179496	29.27117001	0.351038354	1.273731454	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7996
H3962_802_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	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	230.4391072	4.213098555	19.6230188	4.528775497	8.353121013	20.86703315	0	19.32079996	48.22025262	8.155479964	24.42841784	0	0.256954552	50.29679699	25.58226636	36.70403113	1.579751225	11.30651472	30.5674939	147.8343641	0.620321005	5.976160636	0	0	0	0	0	0	0	0											6700	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing																			0	0.074564319	0.074564319	0.171620196	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	0.062	0.062	0.143	0	0.194	0.194	0	0.194	0.194	0.194	0.194	0	0.194	0.194	0.194	0.194	0.194	0.194	0.194	0.194	0.194	0.194	0	0	0	0	0	0	0	0												14.2872	0.26121211	2.806091689	0	1.620505477	4.048204432	0	3.748235193	9.354729008	1.582163113	4.739113061	0	0.049849183	9.757578616	4.962959674	7.120582039	0.306471738	2.193463855	5.930093816	28.67986663	0.120342275	1.159375163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7281	0	20.72	14.2872	0.26121211	2.806091689	0	1.620505477	4.048204432	0	3.748235193	9.354729008	1.582163113	4.739113061	0	0.049849183	9.757578616	4.962959674	7.120582039	0.306471738	2.193463855	5.930093816	28.67986663	0.120342275	1.159375163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7281	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	14.2872	0.26121211	2.806091689	0	1.620505477	4.048204432	0	3.748235193	9.354729008	1.582163113	4.739113061	0	0.049849183	9.757578616	4.962959674	7.120582039	0.306471738	2.193463855	5.930093816	28.67986663	0.120342275	1.159375163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.7281
H3962_803_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	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	260.8678032	4.103791888	24.57515216	6.218083318	8.977809207	19.76410323	0	17.71226994	45.05956742	10.19305633	27.1870125	0	0.273162037	43.43355247	25.9440472	37.33238431	1.600222387	10.61451481	31.72759059	151.5816111	1.43220612	6.443861881	0	0	0	0	0	0	0	0											6700	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing	Consistent with Medicare FFS Cost Sharing																			0	0.078336413	0.078336413	0.176713804	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	0.065	0.065	0.146	0	0.192	0.192	0	0.192	0.192	0.192	0.192	0	0.192	0.192	0.192	0.192	0.192	0.192	0.192	0.192	0.192	0.192	0	0	0	0	0	0	0	0												16.9564	0.266746473	3.587972215	0	1.723739368	3.794707821	0	3.400755828	8.651436945	1.957066816	5.2199064	0	0.052447111	8.339242074	4.981257062	7.167817787	0.307242698	2.037986844	6.091697394	29.10366933	0.274983575	1.237221481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1523	0	22.31	16.9564	0.266746473	3.587972215	0	1.723739368	3.794707821	0	3.400755828	8.651436945	1.957066816	5.2199064	0	0.052447111	8.339242074	4.981257062	7.167817787	0.307242698	2.037986844	6.091697394	29.10366933	0.274983575	1.237221481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1523	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	16.9564	0.266746473	3.587972215	0	1.723739368	3.794707821	0	3.400755828	8.651436945	1.957066816	5.2199064	0	0.052447111	8.339242074	4.981257062	7.167817787	0.307242698	2.037986844	6.091697394	29.10366933	0.274983575	1.237221481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1523
H3964_001_0	2011	2																															D	coin	D	coin	T	coin	coin	V	V	coin	coin	O	coin	V	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	1396.869215	19.09339666	953.195815	20.69376909	187.2152164	7.962984031	2.699071423	370.4158381	212.0544572	10.00204301	26.03816511	0	0.026476208	675.5897581	0	3617.147132	459.7113792	100.3853498	22.52912443	16.1197959	17.77444311	0.01160695	0	0	0	0	0	0	0	0											6700	1a:  Acute - $225/$0/day for 1-7/8-90	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	2:  Skilled Nursing Services - $0/$50/$110/day for 1-10/11-20/21-100 /2:  Non-Medicare Covered Stay - $0/$50/$110/day for 1-10/11-20/21-100	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 - 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 - $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/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) - $250/visit	"7a:  Primary Care - $0/visit/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  OP Phys (Surgery, ER, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/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/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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/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	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:  Eye Glasses & Contact Lenses - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13c:  Other: Over the Counter Benefit - $0/visit												225	0.073944329	46	0	100	0.2	0.2	43.42308465	245.0646713	0	0.21471944	0	0.2	70.04182112	0	39.97639707	20	40	0	39.64974694	0.2	0	0	0	0	0	0	0	0	0											NO	211.7178565	0.069579266	43.28453954	0	94.09682509	0.18819365	0.18819365	40.87105445	230.5980751	0	0.202044176	0	0.18819365	65.90712991	0	37.61652043	18.81936502	37.63873004	0	37.30915303	0.18819365	0	0	0	0	0	0	0	0	0												24.6452	1.328504518	3.438220162	0	1.46802979	1.498583031	0.507948103	1.261607157	4.074945804	0	5.260859606	0	0.004982654	3.710515163	0	11.33870742	0.720956354	0.314864757	0	0.050117994	3.345037329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9691	0	3.95	24.6452	1.328504518	3.438220162	0	1.46802979	1.498583031	0.507948103	1.261607157	4.074945804	0	5.260859606	0	0.004982654	3.710515163	0	11.33870742	0.720956354	0.314864757	0	0.050117994	3.345037329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9691	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.6452	1.328504518	3.438220162	0	1.46802979	1.498583031	0.507948103	1.261607157	4.074945804	0	5.260859606	0	0.004982654	3.710515163	0	11.33870742	0.720956354	0.314864757	0	0.050117994	3.345037329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9691
H3964_002_0	2011	5																															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											10.99412319	0	0	0	0	0	0	0	0	0	0	0	0	0	0.085876809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											11.08	YES	550.6309365	18.52430856	48.15364935	42.40122997	23.65371094	31.36088246	6.838372471	940.7477795	55.45887448	12.21498138	34.57179353	0	0.047629978	18.21229666	143.966991	303.6236732	5.922149702	3.632180127	30.89531885	20.64534318	23.74247228	0.034424585	0	0	0	0	0	0	0	0											6700	1a:  Acute - 0/admit	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	"2:  Skilled Nursing Services - Days 1-20, $0/day; days 21-100, $137.5/day for 1-100/2:  Non-Medicare Covered Stay - Days 1-20, $0/day; days 21-100, $137.5/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 - 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 - $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 - 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  OP Phys (Surgery, ER, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/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/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 - 20.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 20.0%/7h:  Psychiatric Services - Individual - 20.0%/7h:  Psychiatric Services - Group - 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:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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 - 20.0%/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%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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 - Non-Routine 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:  Eye Glasses & Contact Lenses - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13c:  Other: Over the Counter Benefit - $0/visit/13e:  Home Safety - $0/service												0	0.073944329	0.14943834	0	0.2	0.2	0.2	71.0372182	0.2	0	0.2	0	0.2	0.2	0	0.19967102	0.2	0.2	0.180456581	0.168945497	0.2	0.2	0	0	0	0	0	0	0	0											NO	0	0.061307296	0.123899435	0	0.165820144	0.165820144	0.165820144	58.89700866	0.165820144	0	0.165820144	0	0.165820144	0.165820144	0	0.165547386	0.165820144	0.165820144	0.149616681	0.140072833	0.165820144	0.165820144	0	0	0	0	0	0	0	0												0	1.13567527	5.966209948	0	3.922261748	5.200266036	1.133939906	4.617269176	9.196198537	0	5.732699772	0	0.00789801	3.01996565	0	50.26410547	0.982011715	0.602288631	4.622455073	2.891851708	3.936980166	0.00570829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.2378	650	21.28	10.9941	1.13567527	5.966209948	0	3.922261748	5.200266036	1.133939906	4.617269176	9.196198537	0	5.732699772	0	0.00789801	3.01996565	0.085876809	50.26410547	0.982011715	0.602288631	4.622455073	2.891851708	3.936980166	0.00570829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3178	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.9941	1.13567527	5.966209948	0	3.922261748	5.200266036	1.133939906	4.617269176	9.196198537	0	5.732699772	0	0.00789801	3.01996565	0.085876809	50.26410547	0.982011715	0.602288631	4.622455073	2.891851708	3.936980166	0.00570829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3178
H3964_003_0	2011	3																															D	coin	D	coin	T	coin	coin	V	V	coin	coin	O	coin	V	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	1387.394851	18.60278728	934.2427406	22.97531598	168.1940554	13.34260433	4.15467201	381.7403547	251.3588233	10.02036062	27.70533923	0	0.027875332	779.7491091	0	3912.804689	460.2538734	111.813903	24.33987083	18.27240792	19.06692711	0.039608453	0	0	0	0	0	0	0	0												1a:  Acute - $225/$0/day for 1-7/8-90	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	2:  Skilled Nursing Services - $0/$50/$110/day for 1-10/11-20/21-100 /2:  Non-Medicare Covered Stay - $0/$50/$110/day for 1-10/11-20/21-100	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 - 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 - $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/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) - $250/visit	"7a:  Primary Care - $0/visit/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  OP Phys (Surgery, ER, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/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/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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/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	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:  Eye Glasses & Contact Lenses - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13c:  Other: Over the Counter Benefit - $0/visit												225	0.073944329	46	0	100	0.2	0.2	43.42302695	245.179956	0	0.205727891	0	0.2	69.28048311	0	39.94703822	20	40	0	39.58663218	0.2	0	0	0	0	0	0	0	0	0											NO	207.2653605	0.068115991	42.37425149	0	92.11793802	0.184235876	0.184235876	40.01546457	225.8547199	0	0.189512291	0	0.184235876	63.81975249	0	36.79838791	18.4235876	36.84717521	0	36.46638929	0.184235876	0	0	0	0	0	0	0	0	0												23.9632	1.267147289	3.298986403	0	1.291140798	2.458186398	0.765439637	1.272959803	4.730881387	0	5.250502309	0	0.005135636	4.146949596	0	11.99874206	0.706627296	0.343335539	0	0.055527395	3.51281202	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0676	0	5.566983489	23.9632	1.267147289	3.298986403	0	1.291140798	2.458186398	0.765439637	1.272959803	4.730881387	0	5.250502309	0	0.005135636	4.146949596	0	11.99874206	0.706627296	0.343335539	0	0.055527395	3.51281202	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0676	YES	1a:  Acute - 20.0%		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 - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	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%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/14c:  Routine Exams - 20.0%/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"	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/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		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) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%"	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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%							14c:  Routine Exams - 20.0%												6700	6.0435	0	0.7369	0.4712	0.2493	0	0	0.1932	0.8485	0.0967	0.4654	0	0.0005	0.1837	0.5673	1.1208	0	0.0469	0.5219	0.2629	0.2805	0.001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.0906	0	3.698887472	30.0068	1.267147289	4.03590456	0.471245664	1.540480247	2.458186398	0.765439637	1.466209743	5.579382717	0.096663331	5.715922741	0	0.005682891	4.330676132	0.567332076	13.11956573	0.706627296	0.390263913	0.52193388	0.318464625	3.793320739	0.00095243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.1582
H4003_001_0	2011	8	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	OTC						A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	Coin	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	NO	193.9776675	0	0	0	0	15.5232	0	409.590502	60.00289279	0.929206415	23.10703899	0	0	22.95631344	0	4913.877707	370.7926314	106.3484268	967.7909949	115.477067	0	0	0	3.506170168	0	0	0	0	0	0	100	0	0	0	0							"$25 per day, Days 1-4"	"$25 per day, Days 1-4"	"$25 per day, Days 1-4"	$0 copay	$0 copay	0%-20% coins	0%-20% coins	$50 copay ER; $0 copay Urgent Care Preferred	$25 Copay	"$0 Regular, 10% Specialty"	$0-$30 copay	$15 copay	0% coins	$4-$25 copay	$0 copay	$10-$15 copay	$10 copay	$4 copay	$0-$30 copay	0%-10% coins	$0 copay	$0 copay	$0 copay	$5 copay Preventive; 0%-50% coins Comprehensive	$0 copay	$175 every two years	$0 copay	$200 per 3 years	$0 copay	0	"$15 copay, $1000 max"	$0 copay	Not covered	"20% coins, $10,000 max"	Not Covered							77.5	0	0	0	0	0.04	0	49	25	0.002	21.4542705	0	0	4	0	15	10	4	6.350554177	0.0044	0	0	0	0.31	0	0	0	0	0	0	15	0	0	0	0						NO	77.5	0	0	0	0	0.04	0	49	25	0.002	21.4542705	0	0	4	0	15	10	4	6.350554177	0.0044	0	0	0	0.31	0	0	0	0	0	0	15	0	0	0	0							1.2528	0	0	0	0	0.620928	0	1.67249455	0.125006027	0.001858413	0.041312055	0	0	0.007652104	0	6.142347134	0.30899386	0.035449476	0.512167429	0.508099095	0	0	0	1.086912752	0	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	12.441		0	1.2528	0	0	0	0	0.620928	0	1.67249455	0.125006027	0.001858413	0.041312055	0	0	0.007652104	0	6.142347134	0.30899386	0.035449476	0.512167429	0.508099095	0	0	0	1.086912752	0	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	12.441	YES	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"	"20% coins, $10,000 max"							3400																0.02																									0.02			1.2528	0	0	0	0	0.620928	0	1.67249455	0.125006027	0.001858413	0.041312055	0	0	0.007652104	0	6.162347134	0.30899386	0.035449476	0.512167429	0.508099095	0	0	0	1.086912752	0	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	12.461
H4003_009_0	2011	8	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	OTC						A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	Coin	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	286.0231641	0	0	0	0	20.04345	0	535.2960182	85.02053151	1.186752723	29.27780652	0	0	36.15437966	0	5404.681157	313.3204866	158.4825894	1383.892307	146.8812193	0	0	0	4.049521813	0	0	0	0	0	0	0	0	0	0	0						3400	$50 Copay per admit	$50 Copay per admit	"$25 per day, Days 1-4"	$0 copay	$0 copay	0%-20% coins	0%-20% coins	$50 copay ER; $0 copay Urgent Care Preferred	$25 Copay	"$0 Regular, 10% Specialty"	$0-$30 copay	$25 copay	0% coins	$0-$4 copay	$0 copay	$0-$10 copay	$10 copay	$4 copay	$0-$30 copay	0%-10% coins	$0 copay	$0 copay	Not covered	$5 copay Preventive; 0%-50% coins Comprehensive	$0 copay	$150 every two years	$0 copay	$200 per 3 years	$0 copay	0	Not covered	$0 copay	$0 copay	Not covered	Not Covered							50	0	0	0	0	0.04	0	49	25	0.002	22.7677974	0	0	4	0	4	10	4	6.371346622	0.0044	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0						NO	50	0	0	0	0	0.04	0	49	25	0.002	22.7677974	0	0	4	0	4	10	4	6.371346622	0.0044	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0							1.1918	0	0	0	0	0.801738	0	2.185792074	0.177126107	0.002373505	0.055549264	0	0	0.01205146	0	1.801560386	0.261100406	0.05282753	0.734771465	0.646277365	0	0	0	1.255351762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.1783		0	1.1918	0	0	0	0	0.801738	0	2.185792074	0.177126107	0.002373505	0.055549264	0	0	0.01205146	0	1.801560386	0.261100406	0.05282753	0.734771465	0.646277365	0	0	0	1.255351762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.1783	NO																																																																																		0			1.1918	0	0	0	0	0.801738	0	2.185792074	0.177126107	0.002373505	0.055549264	0	0	0.01205146	0	1.801560386	0.261100406	0.05282753	0.734771465	0.646277365	0	0	0	1.255351762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.1783
H4003_015_0	2011	8	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	OTC						A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	Coin	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	184.2292603	0	0	0	0	15.5232	0	424.9648395	84.19696933	1.197112551	25.74706708	0	0	31.73938762	0	5575.319803	465.9921575	208.4394658	1368.988259	124.5427361	0	0	0	4.77619665	0	0	0	0	0	0	60	0	0	0	0						3400	$50 Copay per admit	$50 Copay per admit	"$25 per day, Days 1-4"	$0 copay	$0 copay	0%-20% coins	0%-20% coins	$50 copay ER; $0 copay Urgent Care Preferred	$25 Copay	"$0 Regular, 10% Specialty"	$0-$30 copay	$3 copay	0% coins	$4-$25 copay	$0 copay	$3-$10 copay	$10 copay	$4 copay	$0-$30 copay	0%-10% coins	$0 copay	$0 copay	Not covered	0-50% coins; $5 copay Preventative;$600 limit & 10% coins Prosthodontia	$0 copay	$175 every two years	$0-$10 copay	$200 per 3 years	$0 copay	0	$15 copay	$0 copay	Not covered	Not covered	$45 every 3 months							50	0	0	0	0	0.04	0	49	25	0.002	23.13700841	0	0	4	0	3	10	4	6.481297684	0.0044	0	0	0	0.15	0	0	0	0	0	0	15	0	0	0	0						NO	50	0	0	0	0	0.04	0	49	25	0.002	23.13700841	0	0	4	0	3	10	4	6.481297684	0.0044	0	0	0	0.15	0	0	0	0	0	0	15	0	0	0	0							0.7676	0	0	0	0	0.620928	0	1.735273095	0.175410353	0.002394225	0.049642509	0	0	0.010579796	0	1.393829951	0.388326798	0.069479822	0.739401703	0.547988039	0	0	0	0.716429497	0	0	0	0	0	0	0.075	0	0	0	0	0	0	0	0	0	7.2923		0	0.7676	0	0	0	0	0.620928	0	1.735273095	0.175410353	0.002394225	0.049642509	0	0	0.010579796	0	1.393829951	0.388326798	0.069479822	0.739401703	0.547988039	0	0	0	0.716429497	0	0	0	0	0	0	0.075	0	0	0	0	0	0	0	0	0	7.2923	NO																																																																																		0			0.7676	0	0	0	0	0.620928	0	1.735273095	0.175410353	0.002394225	0.049642509	0	0	0.010579796	0	1.393829951	0.388326798	0.069479822	0.739401703	0.547988039	0	0	0	0.716429497	0	0	0	0	0	0	0.075	0	0	0	0	0	0	0	0	0	7.2923
H4003_017_0	2011	7	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	OTC						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	0	0	0	0	0	23.19	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.762590509	0	0	0	0	0	0	150	0	0	0	0						3400	$0 copay	"$0 copay, Days 1-4"	"$0 per day, Days 1-4"	$0 copay	$0 copay	0% - 20%	0% - 20%	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	0% coins	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0-$15 copay	$0 copay	$0 copay	Not Covered	$0 copay Preventive; 0%-50% coins	$0 copay	$200 every two years	$0 copay	$200 per 3 years	$0 copay	0	"$15 copay, $750 max"	$0 copay	Not covered	Not Covered	$25 every 3 months							0	0	0	0	0	0.04	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.31	0	0	0	0	0	0	15	0	0	0	0						NO	0	0	0	0	0	0.04	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.31	0	0	0	0	0	0	15	0	0	0	0							0	0	0	0	0	0.9276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.786403058	0	0	0	0	0	0	0.1875	0	0	0	0	0	0	0	0	0	2.9015		0	0	0	0	0	0	0.9276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.786403058	0	0	0	0	0	0	0.1875	0	0	0	0	0	0	0	0	0	2.9015	NO																																																																																		0			0	0	0	0	0	0.9276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.786403058	0	0	0	0	0	0	0.1875	0	0	0	0	0	0	0	0	0	2.9015
H4003_018_0	2011	5	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	OTC						A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	Coin	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	198.1099049	0	0	0	0	15.5232	0	434.2955955	78.89442118	1.033159133	26.85538728	0	0	32.25493075	0	0	555.1793224	159.9372596	819.1132748	142.5403289	0	0	0	4.636188295	0	0	0	0	0	0	0	0	0	0	0						3400	$50 Copay per admit	$50 Copay per admit	"$25 per day, Days 1-4"	$0 copay	$0 copay	0%-20% coins	0%-20% coins	$50 copay ER; $0 copay Urgent Care	$25 copay	"$0 Regular, 10% Specialty"	$0-$30 copay	$15 copay	0% coins	$4-$25 copay	$0 copay	$0-$15 copay	$10 copay	$4 copay	$0-$30 copay	0%-10% coins	$0 copay	$0 copay	Not covered	0-50% coins; $5 copay Preventative; $500 limit & 0% coins Prosthodontia	$0-$10 copay	$200 per 2 years	$0-$10 copay	$200 per 3 years	$0 copay	0	Not covered	$0 copay	Not covered	Not covered	$45 every 3 months							50	0	0	0	0	0.04	0	49	25	0.002	23.91650705	0	0	4	0	0	10	4	23.72504825	0.0044	0	0	0	0.16	0	0	0	0	0	0	0	0	0	0	0						NO	50	0	0	0	0	0.04	0	49	25	0.002	23.91650705	0	0	4	0	0	10	4	23.72504825	0.0044	0	0	0	0.16	0	0	0	0	0	0	0	0	0	0	0							0.8255	0	0	0	0	0.620928	0	1.773373681	0.164363377	0.002066318	0.053523922	0	0	0.010751644	0	0	0.462649435	0.05331242	1.619458497	0.627177447	0	0	0	0.741790127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.9549		0	0.8255	0	0	0	0	0.620928	0	1.773373681	0.164363377	0.002066318	0.053523922	0	0	0.010751644	0	0	0.462649435	0.05331242	1.619458497	0.627177447	0	0	0	0.741790127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.9549	NO																																																																																		0			0.8255	0	0	0	0	0.620928	0	1.773373681	0.164363377	0.002066318	0.053523922	0	0	0.010751644	0	0	0.462649435	0.05331242	1.619458497	0.627177447	0	0	0	0.741790127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.9549
H4003_019_0	2011	7	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	OTC						A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	Coin	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	0	15.5232	0	366.2131791	0	1.197112551	24.04678906	0	0	31.73938762	0	0	524.2411772	208.4394658	1368.988259	124.3377731	0	0	0	4.77619665	0	0	0	0	0	0	80	0	0	0	0						3400	$0 copay	"$0 copay, Days 1-4"	"$0 per day, Days 1-4"	$0 copay	$0 copay	0%-20% coins	0%-20% coins	"$50 copay ER; $0 copay Urgent Care Preferred, $25 copay Urgent Care non-Preferred,"	0	"$0 Regular, 10% Specialty"	$0-$30 copay	$0 copay	0% coins	$4-$25 copay	$0 copay	$0-$10 copay	$10 copay	$4 copay	$0-$30 copay	0%-10% coins	$0 copay	$0 copay	Not covered	$5 copay Preventive; 0%-50% coins Comprehensive	$0 copay	$175 every two years	$0-$10 copay	$200 per 3 years	$0 copay	0	$15 copay	$0 copay	Not covered	Not covered	$45 every 3 months							0	0	0	0	0	0.04	0	49.025	0	0.002	23.24647402	0	0	4	0	0	10	4	6.481297684	0.0044	0	0	0	0.31	0	0	0	0	0	0	15	0	0	0	0						NO	0	0	0	0	0	0.04	0	49.025	0	0.002	23.24647402	0	0	4	0	0	10	4	6.481297684	0.0044	0	0	0	0.31	0	0	0	0	0	0	15	0	0	0	0							0	0	0	0	0	0.620928	0	1.496133425	0	0.002394225	0.046583588	0	0	0.010579796	0	0	0.436867648	0.069479822	0.739401703	0.547086202	0	0	0	1.480620961	0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	5.5501		0	0	0	0	0	0	0.620928	0	1.496133425	0	0.002394225	0.046583588	0	0	0.010579796	0	0	0.436867648	0.069479822	0.739401703	0.547086202	0	0	0	1.480620961	0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	5.5501	NO																																																																																		0			0	0	0	0	0	0.620928	0	1.496133425	0	0.002394225	0.046583588	0	0	0.010579796	0	0	0.436867648	0.069479822	0.739401703	0.547086202	0	0	0	1.480620961	0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	5.5501
H4003_801_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.91915799	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4003_803_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.3563463	0	0	0	4.993920005	15.5232	7.7616	11.19320089	15.77936943	1.64660183	9.779927345	0.132199886	0.124837288	9.121375237	88.13975595	56.11152003	6.836957037	8.578772113	27.80662286	146.9378283	0.00959057	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8501	0	0	0	1.061707393	3.30023232	1.65011616	2.379674509	3.354693942	0.350067549	2.079212554	0.028105696	0.026540407	1.939204375	18.73851212	11.92930916	1.453537066	1.823846951	5.91168802	31.23898231	0.002038955	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1176		10.41171659	20.8501	0	0	0	1.061707393	3.30023232	1.65011616	2.379674509	3.354693942	0.350067549	2.079212554	0.028105696	0.026540407	1.939204375	18.73851212	11.92930916	1.453537066	1.823846951	5.91168802	31.23898231	0.002038955	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1176	NO																																																																																		0			20.8501	0	0	0	1.061707393	3.30023232	1.65011616	2.379674509	3.354693942	0.350067549	2.079212554	0.028105696	0.026540407	1.939204375	18.73851212	11.92930916	1.453537066	1.823846951	5.91168802	31.23898231	0.002038955	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1176
H4003_804_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.91915799	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4003_805_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4003_806_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4003_807_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4003_808_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4003_809_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.91915799	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4003_810_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.91915799	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4003_811_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.91915799	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4003_812_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.91915799	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4003_813_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4003_814_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4003_815_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4003_816_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4003_817_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.91915799	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4004_015_0	2011	8	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	OTC						A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	Coin	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	NO	221.2098331	0	0	0	0	12.33793842	0	470.2532948	61.03095803	1.356137067	59.66815271	0	0	22.54666195	0	5169.481474	263.715037	116.2930817	884.6892665	108.1721831	0	0	0	3.70435145	0	0	0	0	0	0	100	0	0	0	0							"$25 per day, Days 1-4"	"$25 per day, Days 1-4"	"$25 per day, Days 1-4"	$0 copay	$0 copay	0%-20% coins	0%-20% coins	$50 copay ER; $0 copay Urgent Care Preferred	$25 Copay	"$0 Regular, 10% Specialty"	$0-$30 copay	$15 copay	0% coins	$4-$25 copay	$0 copay	$10-$15 copay	$10 copay	$4 copay	$0-$30 copay	0%-10% coins	$0 copay	$0 copay	$0 copay	"0-50% coins; $5 copay Preventative, $500 max & 20% coins Prosthodontia"	$0 copay	$200 every two years	$0 copay	$200 per 3 years	$0 copay	0	"$15 copay, $1500 max"	$0 copay	Not covered	"20% coins, $7,500 max"	Not Covered							77.5	0	0	0	0	0.04	0	49	25	0.002	23.17815204	0	0	4	0	15	10	4	6.191493054	0.0044	0	0	0	0.25	0	0	0	0	0	0	15	0	0	0	0						NO	77.5	0	0	0	0	0.04	0	49	25	0.002	23.17815204	0	0	4	0	15	10	4	6.191493054	0.0044	0	0	0	0.25	0	0	0	0	0	0	15	0	0	0	0							1.4286	0	0	0	0	0.493517537	0	1.920200954	0.127147829	0.002712274	0.115249793	0	0	0.007515554	0	6.461851842	0.219762531	0.038764361	0.456462287	0.475957605	0	0	0	0.926087862	0	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	12.7989		0	1.4286	0	0	0	0	0.493517537	0	1.920200954	0.127147829	0.002712274	0.115249793	0	0	0.007515554	0	6.461851842	0.219762531	0.038764361	0.456462287	0.475957605	0	0	0	0.926087862	0	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	12.7989	YES	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"	"20% coins, $7,500 max"							3400																0.02																									0.02			1.4286	0	0	0	0	0.493517537	0	1.920200954	0.127147829	0.002712274	0.115249793	0	0	0.007515554	0	6.481851842	0.219762531	0.038764361	0.456462287	0.475957605	0	0	0	0.926087862	0	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	12.8189
H4004_025_0	2011	3	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	OTC						A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	Coin	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	204.1908487	0	0	0	0	12.31058254	0	422.0635983	58.54353934	1.760624723	59.74246499	0	0	27.53973521	0	0	327.8606838	118.3952764	618.50306	113.058721	0	0	0	3.812864875	0	0	0	0	0	0	0	0	0	0	0						3400	$50 Copay per admit	$50 Copay per admit	"$25 per day, Days 1-4"	$0 copay	$0 copay	0%-20% coins	0%-20% coins	$50 copay ER; $0 Urgent Care	$25 copay	"$0 Regular, 10% Specialty"	$0-$30 copay	$15 copay	0% coins	$4-$25 copay	$0 copay	$0 copay	$10 copay	$4 copay	$0-$30 copay	0%-10% coins	$0 copay	$0 copay	Not covered	0-50% coins; $5 copay Preventative; $500 limit & 0% coins Prosthodontia	$0-$10 copay	$200 per 2 years	$0-$10 copay	$200 per 3 years	$0 copay	0	Not covered	$0 copay	Not covered	Not covered	$45 every 3 months							50	0	0	0	0	0.04	0	49	25	0.002	24.75143274	0	0	4	0	0	10	4	23.71744093	0.0044	0	0	0	0.16	0	0	0	0	0	0	0	0	0	0	0						NO	50	0	0	0	0	0.04	0	49	25	0.002	24.75143274	0	0	4	0	0	10	4	23.71744093	0.0044	0	0	0	0.16	0	0	0	0	0	0	0	0	0	0	0							0.8508	0	0	0	0	0.492423302	0	1.72342636	0.121965707	0.003521249	0.123225967	0	0	0.009179912	0	0	0.273217237	0.039465092	1.222442483	0.497458373	0	0	0	0.61005838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9672		0	0.8508	0	0	0	0	0.492423302	0	1.72342636	0.121965707	0.003521249	0.123225967	0	0	0.009179912	0	0	0.273217237	0.039465092	1.222442483	0.497458373	0	0	0	0.61005838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9672	NO																																																																																		0			0.8508	0	0	0	0	0.492423302	0	1.72342636	0.121965707	0.003521249	0.123225967	0	0	0.009179912	0	0	0.273217237	0.039465092	1.222442483	0.497458373	0	0	0	0.61005838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9672
H4004_035_0	2011	8	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	OTC						A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	Coin	O	O	T	Coin	V	V	V	V	V	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	0	0	0	0	0						0	YES	499.2330443	0	0	0	0	124.9209499	0	526.1717876	10.55168953	0.531548495	8.314464802	0	0	0	0	1722.470527	730.7683262	117.7445132	434.3889077	127.0925417	0	0	0	2.044519407	0	0	0	0	0	0	0	0	0	0	0						3400	"$25 per day, Days 1-4"	"$25 per day, Days 1-4"	"$25 per day, Days 1-4"	$0 copay	$0 copay	0%-20% coins	0%-20% coins	$50 copay ER; $25 copay Urgent Care	$25 Copay	"$0 Regular, 10% Specialty"	$0-$30 copay	$25 copay	0% coins	$0-$4 copay	$0 copay	$5 copay	$10 copay	$4 copay	$0-$30 copay	0%-10% coins	$0 copay	$0 copay	Not covered	"$5 copay Preventive, 0%-50% coins Comprehensive"	$0 copay	$50 every two years	$0 copay	$200 per 3 years	$0 copay	0	Not covered	$0 copay	$0 copay	Not covered	$30 every 3 months							77.5	0	0	0	0	0.04	0	49.25	25	0.002	25.86372364	0	0	4	0	5	10	4	2.394799933	0.0044	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0						NO	77.5	0	0	0	0	0.04	0	49.25	25	0.002	25.86372364	0	0	4	0	5	10	4	2.394799933	0.0044	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0							3.2242	0	0	0	0	4.996837995	0	2.159496712	0.021982687	0.001063097	0.017920252	0	0	0	0	0.717696053	0.608973605	0.039248171	0.086689544	0.559207183	0	0	0	0.633801016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.0671		0	3.2242	0	0	0	0	4.996837995	0	2.159496712	0.021982687	0.001063097	0.017920252	0	0	0	0	0.717696053	0.608973605	0.039248171	0.086689544	0.559207183	0	0	0	0.633801016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.0671	NO																																																																																		0			3.2242	0	0	0	0	4.996837995	0	2.159496712	0.021982687	0.001063097	0.017920252	0	0	0	0	0.717696053	0.608973605	0.039248171	0.086689544	0.559207183	0	0	0	0.633801016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.0671
H4004_048_0	2011	6	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	OTC						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	0	0	0	0	0	23.19456849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.486906408	0	0	0	0	0	0	0	0	0	0	0						3400	$0 copay	"$0 copay, Days 1-4"	"$0 per day, Days 1-4"	$0 copay	$0 copay	0%-20% coins	0%-20% coins	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	0% coins	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0-$15 copay	$0 copay	$0 copay	Not Covered	"$500 limit, 0-15% coins"	$0 copay	$200 every two years	$0 copay	$200 per 3 years	$0 copay	0	Not Covered	$0 copay	$0 copay	Not Covered	Not Covered							0	0	0	0	0	0.04	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	0	0						NO	0	0	0	0	0	0.04	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	0	0							0	0	0	0	0	0.92778274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.097381282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.0252		0	0	0	0	0	0	0.92778274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.097381282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.0252	NO																																																																																		0			0	0	0	0	0	0.92778274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.097381282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.0252
H4004_050_0	2011	7	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	OTC						A	A	A	V	Coin	Coin	Coin	V	P	Coin	P	P	Coin	V	V	V	V	V	P	Coin	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	0	16.27098325	0	422.1986676	0	1.670101956	76.23823939	0	0	38.9547536	0	0	380.5657292	172.5033994	1147.261174	119.4044795	0	0	0	4.665605986	0	0	0	0	0	0	0	0	0	0	0						3400	$0 copay	"$0 copay, Days 1-4"	"$0 per day, Days 1-4"	$0 copay	$0 copay	0%-20% coins	0%-20% coins	$50 copay ER; $0 Urgent Care	0	"$0 Regular, 10% Specialty"	$0-$30 copay	$0 copay	0% coins	$4-$25 copay	$0 copay	$0-$10 copay	$10 copay	$4 copay	$0-$30 copay	0%-10% coins	$0 copay	$0 copay	$0 copay	0-50% coins; $5 copay Preventative; $750 limit & 10% coins Prosthodontia	$0 copay	$200 per 2 years	$0-$10 copay	$200 per 3 years	$0 copay	0	Not covered	$0 copay	Not covered	Not covered	$40 every 3 months							0	0	0	0	0	0.04	0	49.025	0	0.002	23.52165584	0	0	4	0	0	10	4	6.060971248	0.0044	0	0	0	0.13	0	0	0	0	0	0	0	0	0	0	0						NO	0	0	0	0	0	0.04	0	49.025	0	0.002	23.52165584	0	0	4	0	0	10	4	6.060971248	0.0044	0	0	0	0.13	0	0	0	0	0	0	0	0	0	0	0							0	0	0	0	0	0.65083933	0	1.724857473	0	0.003340204	0.149437469	0	0	0.012984918	0	0	0.317138108	0.057501133	0.579459749	0.52537971	0	0	0	0.606528778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.6275		0	0	0	0	0	0	0.65083933	0	1.724857473	0	0.003340204	0.149437469	0	0	0.012984918	0	0	0.317138108	0.057501133	0.579459749	0.52537971	0	0	0	0.606528778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.6275	NO																																																																																		0			0	0	0	0	0	0.65083933	0	1.724857473	0	0.003340204	0.149437469	0	0	0.012984918	0	0	0.317138108	0.057501133	0.579459749	0.52537971	0	0	0	0.606528778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.6275
H4004_801_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4004_802_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4004_803_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4004_804_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4004_805_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4004_806_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4004_807_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4004_808_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4004_809_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4004_810_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4004_811_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4004_812_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4004_813_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4004_814_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4004_815_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4004_816_0	2011	2	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	OTC						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	0	0	0	0	0	0	0	0	0						0	YES	149.351201	0	0	0	4.993738021	15.5232	7.7616	11.1960071	15.77879442	1.646541827	9.779570956	0.132195069	0.124832739	9.121042846	94.69626899	60.28762934	7.345621521	9.216711516	29.87449721	157.867457	0.009590221	0	0	0	0	0	0	0	0	0	0	0	0	0	0						3400	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	0	0	0	0	0	0	0	0	0	0	0	0							0.153245085	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	0.1396	0	0	0	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0.2126	0	0	0	0	0	0	0	0	0	0	0	0	0	0							20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406		10.92403581	20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406	NO																																																																																		0			20.8494	0	0	0	1.061668703	3.30023232	1.65011616	2.380271109	3.354571694	0.350054792	2.079136785	0.028104672	0.02653944	1.939133709	20.13242679	12.81715	1.561679135	1.959472868	6.351318108	33.56262136	0.002038881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.406
H4005_001_0	2011	1																															A	A						V	V		V			V		V	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	142.7675108	3.128639827	0	0	0	0	0	308.9699475	199.1273986	0	30.37630023	0	0	8.14541887	0	5666.577097	523.6928358	0	276.6860465	0	0	0	0	0	0	0	0	0	0	0											6700	$25/Admit for IP Medical; $25/Admit for IP Surgical; PBP 1a	$25/Admit for IP Psych; $25/Admit for IP Substance Abuse; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$25/Visit for ER - Facility; $25/Visit for Urgent Care; PBP 4a, 4b"	"$25/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost Sharing for OP Lab Services; PBP 8a	"$10/Case for CT, MRI, PET and other, $0/Case for X-Rays and other; PBP 8b"	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for OP Fac - Other (PBP 9a); $10/Visit for OP Substance Abuse Services (PBP 9c);  No Cost Sharing PBP 3, 5,9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$5/Visit for Specialist, $10/visit for Sub-specialist (PBP 7d); No Cost Sharing PBP 7f, 7g, 14d-e, 17a, 18a"	"$10/Visit for Psychiatric Services; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"$5/Visit for Specialist, $10/Visit Sub-specialist (PBP 7d); $10/Case for Radiology CT, MRI, PET and other, $0/Case X-Rays and other (PBP 8b)"	"No Cost Sharing; PBP 7b, 7d, 7g, 8a, 14d-j"	No Cost Sharing; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14a	PBP 13b											0	25	25	0	0	0	0	0	25	25	0	10	0	0	24.51644059	0	7	10	0	10	0	0	0	0	0	0	0	0	0	0	0											NO	25	25	0	0	0	0	0	25	25	0	10	0	0	24.51644059	0	7	10	0	10	0	0	0	0	0	0	0	0	0	0	0												0.2974	0.006518	0	0	0	0	0	0.643687391	0.414848747	0	0.025313584	0	0	0.01664139	0	3.305503306	0.436410697	0	0.230571705	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.3769	0	0	0.2974	0.006518	0	0	0	0	0	0.643687391	0.414848747	0	0.025313584	0	0	0.01664139	0	3.305503306	0.436410697	0	0.230571705	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.3769	YES	20% Coinsurance for IP Medical; 20% Coinsurance for IP Surgical; PBP 1a	20% Coinsurance for IP Psych; 20% Coinsurance for IP Substance Abuse; PBP 1b	No Cost Sharing; PBP 2	20% Coinsurance for Home Health; PBP 6	20% Coinsurance for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Supplies; PBP 11b, 11c"	"No Cost Sharing; PBP 4a, 4b"	"20% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"25% Coinsurance for OP Fac - Cardiovascular; 25% Coinsurance for OP Fac - Occ Therapy; 20% Coinsurance for OP Fac - Other; PBP 3, 5, 9a, 9c, 9d"	"20% Coinsurance for PCP Services; PBP 7a, 14b-c"	"20% Coinsurance for Specialist Services; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"20% Coinsurance for Psychiatric Services; PBP 7e, 7h"	"25% Coinsurance for PT/ST/OT; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 8b"	"20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (OP); 25% Coinsurance for Chiropractic; 20% Coinsurance for Professional (Non-Covered); PBP 7b, 7d, 7g, 8a, 14d-j"	20% Coinsurance for Part B Rx; PBP 15	20% Coinsurance for Blood; PBP 13a	No Cost Sharing; PBP 10b	"20% Coinsurance for Dental (Non-Covered); PBP 16a, 16b"	No Cost Sharing; PBP 17a	20% Coinsurance for Vision (Non-Covered); PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											10000	0.8108	0.0144	0	0.0898	0.0183	0.1793	0.0653	0	0.1426	0.0186	0.0264	0	0	0.0537	0.3699	1.0415	0.0502	0.1509	0.323	0.264	0.1655	0.0123	0	0.1269	0	0.0322	0	0	0	0											3.9554	0	0	1.1083	0.020884194	0	0.089763206	0.018267389	0.179278487	0.065319865	0.643687391	0.5574731	0.018607563	0.051679638	0	0	0.070385907	0.369892815	4.346953805	0.486597525	0.150916236	0.553561903	0.263957354	0.165452257	0.012343558	0	0.126909644	0	0.032158304	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.3324
H4005_004_0	2011	3																															A	A						V	V		V			V		V	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	185.159732	5.39844896	0	0	0	0	0	376.2232029	259.2544294	0	46.47342538	0	0	13.83589523	0	7985.398324	683.9686441	0	397.2409617	0	0	0	0	0	0	0	0	0	0	0											6700	$25/Admit for IP Medical; $25/Admit for IP Surgical; PBP 1a	$25/Admit for IP Psych; $25/Admit for IP Substance Abuse; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$25/Visit for ER - Facility; $25/Visit for Urgent Care; PBP 4a, 4b"	"$25/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost Sharing for OP Lab Services; PBP 8a	"$10/Case for CT, MRI, PET and other, $0/Case for X-Rays and other; PBP 8b"	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for OP Fac - Other (PBP 9a); $10/Visit for OP Substance Abuse Services (PBP 9c);  No Cost Sharing PBP 3, 5,9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$5/Visit for Specialist, $10/visit for Sub-specialist (PBP 7d); No Cost Sharing PBP 7f, 7g, 14d-e, 17a, 18a"	"$10/Visit for Psychiatric Services; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"$5/Visit for Specialist, $10/Visit Sub-specialist (PBP 7d); $10/Case for Radiology CT, MRI, PET and other, $0/Case X-Rays and other (PBP 8b)"	"No Cost Sharing; PBP 7b, 7d, 7g, 8a, 14d-j"	No Cost Sharing; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14a	PBP 13b											0	25	25	0	0	0	0	0	25	25	0	10	0	0	24.03895023	0	7	10	0	10	0	0	0	0	0	0	0	0	0	0	0											NO	25	25	0	0	0	0	0	25	25	0	10	0	0	24.03895023	0	7	10	0	10	0	0	0	0	0	0	0	0	0	0	0												0.3857	0.011246769	0	0	0	0	0	0.783798339	0.540113395	0	0.038727854	0	0	0.0277167	0	4.658149022	0.56997387	0	0.331034135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.3465	0	0	0.3857	0.011246769	0	0	0	0	0	0.783798339	0.540113395	0	0.038727854	0	0	0.0277167	0	4.658149022	0.56997387	0	0.331034135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.3465	YES	20% Coinsurance for IP Medical; 20% Coinsurance for IP Surgical; PBP 1a	20% Coinsurance for IP Psych; 20% Coinsurance for IP Substance Abuse; PBP 1b	No Cost Sharing; PBP 2	20% Coinsurance for Home Health; PBP 6	20% Coinsurance for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Supplies; PBP 11b, 11c"	"No Cost Sharing; PBP 4a, 4b"	"20% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"25% Coinsurance for OP Fac - Cardiovascular; 25% Coinsurance for OP Fac - Occ Therapy; 20% Coinsurance for OP Fac - Other; PBP 3, 5, 9a, 9c, 9d"	"20% Coinsurance for PCP Services; PBP 7a, 14b-c"	"20% Coinsurance for Specialist Services; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"20% Coinsurance for Psychiatric Services; PBP 7e, 7h"	"25% Coinsurance for PT/ST/OT; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 8b"	"20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (OP); 25% Coinsurance for Chiropractic; 20% Coinsurance for Professional (Non-Covered); PBP 7b, 7d, 7g, 8a, 14d-j"	20% Coinsurance for Part B Rx; PBP 15	20% Coinsurance for Blood; PBP 13a	No Cost Sharing; PBP 10b	"20% Coinsurance for Dental (Non-Covered); PBP 16a, 16b"	No Cost Sharing; PBP 17a	20% Coinsurance for Vision (Non-Covered); PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											10000	1.2306	0.0316	0	0.1143	0.0213	0.213	0.115	0	0.1945	0.0232	0.0363	0	0	0.0904	0.5303	1.4614	0.0684	0.1865	0.39	0.366	0.2652	0.0123	0	0.1482	0	0.0203	0	0	0	0											5.5185	0	8.88E-16	1.6163	0.04284634	0	0.114257669	0.021283369	0.213031963	0.114950071	0.783798339	0.734605413	0.023227626	0.075011209	0	0	0.118095628	0.530270918	6.119534771	0.638353325	0.186476723	0.721019063	0.365982871	0.265236859	0.012284483	0	0.148150709	0	0.020256122	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.865
H4005_801_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	83.22813476	1.712276033	2.502477619	0	1.330315301	14.20919633	7.395136772	5.298846382	20.09536036	1.730889193	2.886611136	0	0.112683464	5.567365213	40.87828325	132.8781031	4.712580076	11.71698753	34.52656835	32.49553176	13.20016791	0.660775394	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 8b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7g, 8a, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 13a	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b											0	0.153771535	0.153771535	0.158361366	0	0.233	0.233	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	0.145796694	0.145796694	0.150148489	0	0.220916242	0.220916242	0.220916242	0.220916242	0.220916242	0.220916242	0.220916242	0	0.220916242	0.220916242	0.220916242	0.220916242	0.220916242	0.220916242	0.220916242	0.220916242	0.220916242	0.220916242	0	0	0	0	0	0	0	0												12.1344	0.249644185	0.375743233	0	0.293888257	3.139042259	1.633705827	1.170601231	4.439391497	0.382381536	0.637699285	0	0.024893607	1.229921402	9.030676725	29.35493121	1.041085482	2.588472856	7.627479738	7.178790766	2.916131493	0.145976017	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5948	0	4.681898185	12.1344	0.249644185	0.375743233	0	0.293888257	3.139042259	1.633705827	1.170601231	4.439391497	0.382381536	0.637699285	0	0.024893607	1.229921402	9.030676725	29.35493121	1.041085482	2.588472856	7.627479738	7.178790766	2.916131493	0.145976017	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5948	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 8b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7g, 8a, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 13a	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											10000	0.871	0.0174	0	0	0.0205	0.2426	0.1196	0.0702	0.3151	0.0271	0.0453	0	0.0017	0.0875	0.627	2.0639	0.0724	0.2047	0.5409	0.5113	0.2258	0.0104	0	0	0	0	0	0	0	0											6.0742	0	0.332251275	13.0054	0.267094046	0.375743233	0	0.314410107	3.381618493	1.753309315	1.240785119	4.754449826	0.409518699	0.682956044	0	0.026624944	1.317424651	9.657630016	31.41881054	1.113492387	2.793134925	8.168384528	7.690104256	3.141907854	0.156335761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.6691
H4005_802_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	91.36850916	1.942785645	2.747333632	0	1.408154169	14.59359531	8.389870131	5.018136366	15.46732205	1.75591498	2.819311115	0	0.127840723	6.04404004	41.84842219	124.2116406	4.544357566	11.73060617	33.07383662	30.60203245	14.67956442	0.7496575	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 8b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7g, 8a, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 13a	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b											0	0.153301942	0.153301942	0.157943148	0	0.233	0.233	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	0.145662687	0.145662687	0.150072615	0	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0	0	0	0	0	0	0	0												13.309	0.282991377	0.412299541	0	0.311750232	3.230865497	1.857427273	1.110961576	3.424299227	0.388740746	0.624165246	0	0.028302565	1.338085648	9.264791884	27.49912517	1.006072031	2.597030406	7.32219274	6.774961805	3.249898136	0.165966131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1989	0	4.415797967	13.309	0.282991377	0.412299541	0	0.311750232	3.230865497	1.857427273	1.110961576	3.424299227	0.388740746	0.624165246	0	0.028302565	1.338085648	9.264791884	27.49912517	1.006072031	2.597030406	7.32219274	6.774961805	3.249898136	0.165966131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1989	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 8b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7g, 8a, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 13a	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											10000	0.9553	0.0198	0	0	0.0218	0.2497	0.136	0.0666	0.243	0.0276	0.0443	0	0.002	0.0952	0.6432	1.9321	0.07	0.2053	0.5192	0.4829	0.2516	0.0118	0	0	0	0	0	0	0	0											5.9773	0	0.313478462	14.2643	0.302772171	0.412299541	0	0.33351936	3.480537569	1.993409393	1.177569526	3.667317667	0.416329214	0.668461511	0	0.030270992	1.433294927	9.907995737	29.43126514	1.07604377	2.802369093	7.841375708	7.257870963	3.501504038	0.17774455	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.1762
H4005_804_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	70.03104377	1.311523741	2.104297398	0	1.007102363	11.95083861	9.471074051	4.331697095	14.70643881	1.454577703	2.289604887	0	0.086246426	4.38751114	34.45676189	112.6468015	3.674941836	11.36065109	26.99467382	27.28375868	10.76453408	0.505748706	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 8b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7g, 8a, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 13a	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b											0	0.150183069	0.150183069	0.158082534	0	0.233	0.233	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	0.144865366	0.144865366	0.152485125	0	0.224749903	0.224749903	0.224749903	0.224749903	0.224749903	0.224749903	0.224749903	0	0.224749903	0.224749903	0.224749903	0.224749903	0.224749903	0.224749903	0.224749903	0.224749903	0.224749903	0.224749903	0	0	0	0	0	0	0	0												10.1451	0.189994366	0.320874052	0	0.226346158	2.685949812	2.128622969	0.9735485	3.305270689	0.326916197	0.514588475	0	0.019383876	0.986092701	7.744153876	25.31735765	0.825942819	2.553305225	6.067050309	6.132022104	2.419327984	0.113666972	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9955	0	2.679511235	10.1451	0.189994366	0.320874052	0	0.226346158	2.685949812	2.128622969	0.9735485	3.305270689	0.326916197	0.514588475	0	0.019383876	0.986092701	7.744153876	25.31735765	0.825942819	2.553305225	6.067050309	6.132022104	2.419327984	0.113666972	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9955	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 8b"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7g, 8a, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 13a	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											10000	0.7282	0.0133	0	0	0.0158	0.2076	0.1558	0.0584	0.2346	0.0232	0.0365	0	0.0013	0.0704	0.5378	1.7789	0.0574	0.2019	0.4302	0.4371	0.1873	0.0081	0	0	0	0	0	0	0	0											5.1838	0	0.190285428	10.8733	0.203274769	0.320874052	0	0.242151627	2.893512354	2.284459308	1.03191807	3.539841815	0.35011705	0.551108207	0	0.020732013	1.056460295	8.281957868	27.09627478	0.883386674	2.755186705	6.497285995	6.569076348	2.606655645	0.121733782	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.1793
H4005_807_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	91.36850916	1.942785645	2.747333632	0	1.408154169	14.59359531	8.389870131	5.018136366	15.46732205	1.75591498	2.819311115	0	0.127840723	6.04404004	41.84842219	124.2116406	4.544357566	11.73060617	33.07383662	30.60203245	14.67956442	0.7496575	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b											0	0.153301942	0.153301942	0.157943148	0	0.233	0.233	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	0.145662687	0.145662687	0.150072615	0	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0.221389276	0	0	0	0	0	0	0	0												13.309	0.282991377	0.412299541	0	0.311750232	3.230865497	1.857427273	1.110961576	3.424299227	0.388740746	0.624165246	0	0.028302565	1.338085648	9.264791884	27.49912517	1.006072031	2.597030406	7.32219274	6.774961805	3.249898136	0.165966131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1989	0	4.415797967	13.309	0.282991377	0.412299541	0	0.311750232	3.230865497	1.857427273	1.110961576	3.424299227	0.388740746	0.624165246	0	0.028302565	1.338085648	9.264791884	27.49912517	1.006072031	2.597030406	7.32219274	6.774961805	3.249898136	0.165966131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1989	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											10000	0.9553	0.0198	0	0	0.0218	0.2497	0.136	0.0666	0.243	0.0276	0.0443	0	0.002	0.0952	0.6432	1.9321	0.07	0.2053	0.5192	0.4829	0.2516	0.0118	0	0	0	0	0	0	0	0											5.9773	0	0.313478462	14.2643	0.302772171	0.412299541	0	0.33351936	3.480537569	1.993409393	1.177569526	3.667317667	0.416329214	0.668461511	0	0.030270992	1.433294927	9.907995737	29.43126514	1.07604377	2.802369093	7.841375708	7.257870963	3.501504038	0.17774455	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.1762
H4006_001_0	2011	9																															D	D	coin	coin	coin	coin	coin	V	coin	P	coin	O	coin	P	V	V	V	V	coin	coin	coin	coin	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	638.986788	37.84701157	0.30597809	8.33933249	1.660709324	8.170159387	7.866415071	441.3305005	10.03316953	7869.902969	8.433975802	0	0.055257973	233.733254	5296.739529	4445.803009	797.2422041	1559.55188	25.95614259	27.0844062	0.734244409	0.654377111	0	2524.212362	0	0	0	0	7.221400552	1087.050971											3400	1a:  Acute - $25/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $25/$0/day for 1-4/5-90	2:  Skilled Nursing Services - 0/day for 1--1/-/1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $0/trip	11a:  Durable Medical Equipment - 10.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $45/visit/4b:  Urgently Needed Care / Urgent Care Centers - $45/visit/4a:  Worldwide Coverage - $45/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $0/visit/9b:  Ambulatory Surgical Center Services - $0/visit	8a:  Outpatient Diagnostic Procedures/Tests - $2/visit/8a:  Outpatient Lab Services - $2/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	9d:  Cardiac Rehabilitation Services - $3/visit/3:  Rehab Services (CORF) - $3/day/5:  Partial Hospitalization - $10/day	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $3/visit/7b:  Chiropractic Services - $3/visit/1-6 Additional Visits/7f:  Podiatry Services - $3/visit/17a:  Vision Exams - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $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 - $3/visit/7i:  Physical/Speech Therapy - $3/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $10/visit/9c:  Outpatient Substance Abuse Svcs - Group - $10/visit/7g:  Other Health Care Professional Services - $3/visit/18a:  Hearing Exams - $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		"16a:  Preventive Dental - Oral Exams - $5/service/16a:  Preventive Dental - Prophylaxis - $5/service/16a:  Preventive Dental - Fluoride Treatment - $5/service/16a:  Preventive Dental - X-Rays - $5/service/16b:  Comprehensive Dental - Emergency Svcs - 5.0%/16b:  Comprehensive Dental - Diagnostic Svcs - $5/visit/16b:  Comprehensive Dental - Restorative Svcs - 5.0%/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - 5.0%/16b:  Comprehensive Dental - Prosthodontics, Other - 5.0%"	17a:  Routine Eye Exams - $0/visit	17b:  Eye Glasses & Contact Lenses - $220 Per Year	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	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/14a:  Nutritional Benefit - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14a:  Other - $15/service/14c:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14e:   Additional Prostate Screening - $0/visit/14f:   Additional Colorectal Screening - $0/visit/	13b:  Acupuncture - $15/visit/13c:  Other: Over-the-Counter Drugs - $0/visit												25	25	0	0	0	0.1	0.124574908	45	0	2	0.070833413	0	0	3	0	3	10	3	0	0.000179611	0	0	0	9.320284435	0	0	0	0	0	0											NO	24.94040495	24.9415307	0	0	0	0.099758607	0.124268048	44.89244188	0	1.995234799	0.070668103	0	0	2.992718227	0	2.99285355	9.976330914	2.992828044	0	0.000179186	0	0	0	9.320284435	0	0	0	0	0	0												1.328	0.078663533	0	0	0	0.81504372	0.977544049	1.651033654	0	1.308525356	0.596013069	0	0	0.058291481	0	1.10880311	0.662796004	0.388955884	0	0.00485314	0	0	0	1.960531432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.9391	0	0.021524545	1.328	0.078663533	0	0	0	0.81504372	0.977544049	1.651033654	0	1.308525356	0.596013069	0	0	0.058291481	0	1.10880311	0.662796004	0.388955884	0	0.00485314	0	0	0	1.960531432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.9391	NO	1a:  Acute - 0/admit for 1-90	1b:  Psych - 0/admit for 1-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - 0/day for 1--1/-/1-100/2:  Non-Medicare Covered Stay - $0/day for 1--1/-/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	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	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/9c:  Outpatient Substance Abuse Svcs - Group - $0/visit/7g:  Other Health Care Professional Services - $0/visit/18a:  Hearing Exams - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.328	0.078663533	0	0	0	0.81504372	0.977544049	1.651033654	0	1.308525356	0.596013069	0	0	0.058291481	0	1.10880311	0.662796004	0.388955884	0	0.00485314	0	0	0	1.960531432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.9391
H4006_007_0	2011	13																															D	D	coin	coin	coin	coin	coin	V	coin	P	coin	O	coin	P	V	V	V	V	coin	coin	coin	coin	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	765.1633356	28.64173655	0.890393261	11.35722062	2.571574662	12.16753297	13.23866914	546.9720267	15.66996435	8872.36839	6.271493445	0	0.053514621	352.2853026	5630.905318	5130.670863	818.1849091	1924.821953	26.9976313	27.61181453	1.198327763	0.555972151	0	2712.105886	0	0	0	0	14.69863563	2942.967338											3400	1a:  Acute - $25/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $25/$0/day for 1-4/5-90	2:  Skilled Nursing Services - 0/day for 1--1/-/1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $0/trip	11a:  Durable Medical Equipment - 10.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $49/visit/4b:  Urgently Needed Care / Urgent Care Centers - $49/visit/4a:  Worldwide Coverage - $49/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $0/visit/9b:  Ambulatory Surgical Center Services - $0/visit	8a:  Outpatient Diagnostic Procedures/Tests - $3/visit/8a:  Outpatient Lab Services - $3/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	9d:  Cardiac Rehabilitation Services - $3/visit/3:  Rehab Services (CORF) - $3/day/5:  Partial Hospitalization - $10/day	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $3/visit/7b:  Chiropractic Services - $3/visit/1-6 Additional Visits/7f:  Podiatry Services - $3/visit/17a:  Vision Exams - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $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 - $3/visit/7i:  Physical/Speech Therapy - $3/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $10/visit/9c:  Outpatient Substance Abuse Svcs - Group - $10/visit/7g:  Other Health Care Professional Services - $3/visit/18a:  Hearing Exams - $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		"16a:  Preventive Dental - Oral Exams - $5/service/16a:  Preventive Dental - Prophylaxis - $5/service/16a:  Preventive Dental - Fluoride Treatment - $5/service/16a:  Preventive Dental - X-Rays - $5/service/16b:  Comprehensive Dental - Emergency Svcs - 5.0%/16b:  Comprehensive Dental - Diagnostic Svcs - $5/visit/16b:  Comprehensive Dental - Restorative Svcs - 5.0%/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - 5.0%/16b:  Comprehensive Dental - Prosthodontics, Other - 5.0%"	17a:  Routine Eye Exams - $0/visit	17b:  Eye Glasses & Contact Lenses - $155 Per Year	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	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/14a:  Nutritional Benefit - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14a:  Other - $15/service/14c:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14e:   Additional Prostate Screening - $0/visit/14f:   Additional Colorectal Screening - $0/visit/	13b:  Acupuncture - $15/visit/13c:  Other: Over-the-Counter Drugs - $0/visit												25	25	0	0	0	0.1	0.14766955	49	0	3	0.06659838	0	0	3	0	3	10	3	0	0.000180808	0	0	0	11.03090794	0	0	0	0	0	0											NO	24.85694962	24.85694962	0	0	0	0.099427798	0.146824583	48.71962126	0	2.982833955	0.066217303	0	0	2.982833955	0	2.982833955	9.942779849	2.982833955	0	0.000179774	0	0	0	11.03090794	0	0	0	0	0	0												1.585	0.05932885	0	0	0	1.209791016	1.943762071	2.220689165	0	2.205400141	0.415281383	0	0	0.08756738	0	1.275328272	0.677919369	0.478452023	0	0.004963877	0	0	0	2.49308253	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.6565	0	0.07	1.585	0.05932885	0	0	0	1.209791016	1.943762071	2.220689165	0	2.205400141	0.415281383	0	0	0.08756738	0	1.275328272	0.677919369	0.478452023	0	0.004963877	0	0	0	2.49308253	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.6565	NO	1a:  Acute - 0/admit for 1-90	1b:  Psych - 0/admit for 1-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - 0/day for 1--1/-/1-100/2:  Non-Medicare Covered Stay - $0/day for 1--1/-/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	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	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/9c:  Outpatient Substance Abuse Svcs - Group - $0/visit/7g:  Other Health Care Professional Services - $0/visit/18a:  Hearing Exams - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.585	0.05932885	0	0	0	1.209791016	1.943762071	2.220689165	0	2.205400141	0.415281383	0	0	0.08756738	0	1.275328272	0.677919369	0.478452023	0	0.004963877	0	0	0	2.49308253	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.6565
H4006_008_0	2011	12																															D	D	coin	coin	coin	coin	coin	V	coin	coin	coin	O	coin	coin	V	coin	V	coin	coin	coin	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	NO	286.2614464	5.467064697	0.606692638	12.73120671	2.858249566	19.7822481	14.80720258	532.3156319	15.42284809	18.46860325	5.684544556	0	0.059870892	14.91104295	5304.715404	120.7833192	566.3940626	13.10069459	33.47417476	31.54387721	1.200740229	0	0	2935.679505	0	0	0	0	21.65239582	3472.41818												1a:  Acute - $25/$0/day for 1-1/2-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $25/$0/day for 1-1/2-90	2:  Skilled Nursing Services - 0/day for 1--1/-/1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $0/trip	11a:  Durable Medical Equipment - 10.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $45/visit/4b:  Urgently Needed Care / Urgent Care Centers - $45/visit/4a:  Worldwide Coverage - $45/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 - 10.0%/8b:  Outpatient Therapeutic Radiological Services - 10.0%/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 - $10/day	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/1-6 Additional Visits/7f:  Podiatry Services - $0/visit/17a:  Vision Exams - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $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 - $0/visit/7i:  Physical/Speech Therapy - $0/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/18a:  Hearing Exams - $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		"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 - 25.0%/16b:  Comprehensive Dental - Prosthodontics, Other - 25.0%"	17a:  Routine Eye Exams - $0/visit	17b:  Eye Glasses & Contact Lenses - $325 Per Year	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	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/14a:  Nutritional Benefit - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14a:  Other - $15/service/14c:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14e:   Additional Prostate Screening - $0/visit/14f:   Additional Colorectal Screening - $0/visit/	13b:  Acupuncture - $15/visit/13c:  Other: Over-the-Counter Drugs - $0/visit												25	25	0	0	0	0.1	0.144150508	45	0	0	0.065835019	0	0	0	0	0	10	0	0	0.000109563	0	0	0	29.76510203	0	0	0	0	0	0											NO	24.93722192	24.93722192	0	0	0	0.099748888	0.143788529	44.88699945	0	0	0.065669699	0	0	0	0	0	9.974888768	0	0	0.000109288	0	0	0	29.76510203	0	0	0	0	0	0												0.5949	0.011361117	0	0	0	1.973257244	2.129105873	1.991170956	0	0	0.373302331	0	0	0	0	0	0.470809814	0	0	0.003447374	0	0	0	7.281733333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.8291	0	0.019	0.5949	0.011361117	0	0	0	1.973257244	2.129105873	1.991170956	0	0	0.373302331	0	0	0	0	0	0.470809814	0	0	0.003447374	0	0	0	7.281733333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.8291	YES	1a:  Acute - 20.0% for 1-100/1a:  Additional Days - 20.0% for 91-999	1b:  Psych - 20.0% for 1-100/1b:  Non-Medicare Covered Stay - 20.0%	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 - 20.0%	11b:  Prosthetics Devices - 25.0%/11b:  Medical Supplies - 25.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - 20.0%/4b:  Urgently Needed Care / Urgent Care Centers - 20.0%/4a:  Worldwide Coverage - 20.0%	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%	9d:  Cardiac Rehabilitation Services - 20.0%/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%	7a:  Primary Care - 20.0%/17a:  Vision Exams - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $5/visit/14e:  Prostate Cancer Screening - $5/visit/14f:  Colorectal Screening - $5/visit/14g:  Bone Mass Measurement - $5/visit/14h:  Mammography - $5/visit/14i:  Diabetes Monitoring - $5/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $5/visit	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $5/visit/14e:  Prostate Cancer Screening - $5/visit/14f:  Colorectal Screening - $5/visit/14g:  Bone Mass Measurement - $5/visit/14h:  Mammography - $5/visit/14i:  Diabetes Monitoring - $5/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $5/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - 20.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 20.0%/7h:  Psychiatric Services - Individual - 20.0%/7h:  Psychiatric Services - Group - 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:  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/18a:  Hearing Exams - 20.0%	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - 20.0%/13a:  3-Pints Deductible Waived - 20.0%			17a:  Routine Eye Exams - 20.0%		18a:  Routine Hearing Test - 20.0%														3400	1.5522	0.0301	0.0509	0.1507	0.0112	0.0816	0.0712	0.0835	0.3531	0.7451	0.1279	0	0.0005	0.3218	0.3566	0.9785	0.0359	0.0991	0.2655	0.2198	0.0175	0.0201	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.573	0	6.016	2.1471	0.041503544	0.050948837	0.150719985	0.011188467	2.054835372	2.200317965	2.074697981	0.353146624	0.745060694	0.501186213	0	0.000455048	0.321828174	0.356627285	0.978451039	0.506701769	0.099144621	0.265505377	0.223244127	0.017520166	0.020148599	0	7.281733333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.402
H4006_013_0	2011	10																															A	A	D	coin	coin	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	coin	coin	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	153.3561486	4.949394117	0.146003447	10.03770103	2.566131801	8.014727832	8.091699614	652.5584828	132.1345227	6918.699068	671.8934599	0	0.033991561	130.3611596	11040.72436	2506.389711	874.6000051	1082.987337	19.28101399	18.27961836	1.31786742	0	500	3426.034663	0	0	0	0	1.971939995	1297.587935											3400	1a:  Acute - $3/$0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $3/$0/admit for 1-90/1b:  Additional Days - $0/day for 91-999	2:  Skilled Nursing Services - $0/$3/day for 1--1/-/1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $0/trip	11a:  Durable Medical Equipment - 10.0%	11b:  Prosthetics Devices - $0/service/11b:  Medical Supplies - $0/service/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - 100.0%/4b:  Urgently Needed Care / Urgent Care Centers - 100.0%/4a:  Worldwide Coverage - 100.0%	9a:  Outpatient Hospital Services (Hospital Surgery) - 100.0%/9b:  Ambulatory Surgical Center Services - 100.0%	8a:  Outpatient Diagnostic Procedures/Tests - 100.0%/8a:  Outpatient Lab Services - 100.0%	8b:  Outpatient Diagnostic Radiological Services - 100.0%/8b:  Outpatient Therapeutic Radiological Services - 100.0%/8b:  Outpatient X-Ray Services - 100.0%		12:  Renal Dialysis - $0/service	9d:  Cardiac Rehabilitation Services - 100.0%/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - 100.0%/17a:  Vision Exams - $1/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - 100.0%/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - 100.0%/7b:  Chiropractic Services - $0/visit/1-6 Additional Visits/7f:  Podiatry Services - 100.0%/17a:  Vision Exams - $1/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - 100.0%/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - 100.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 100.0%/7h:  Psychiatric Services - Individual - 100.0%/7h:  Psychiatric Services - Group - 100.0%	7c:  Occupational Therapy Services - 100.0%/7i:  Physical/Speech Therapy - 100.0%		9c:  Outpatient Substance Abuse Svcs - Individual - 100.0%/9c:  Outpatient Substance Abuse Svcs - Group - 100.0%/7g:  Other Health Care Professional Services - 100.0%/18a:  Hearing Exams - $1/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	10b:  Transportation - $0/trip	"16a:  Preventive Dental - Oral Exams - $1/service/16a:  Preventive Dental - Prophylaxis - $1/service/16a:  Preventive Dental - Fluoride Treatment - $1/service/16a:  Preventive Dental - X-Rays - $1/service/16b:  Comprehensive Dental - Emergency Svcs - $1/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $1/visit/16b:  Comprehensive Dental - Restorative Svcs - $1/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $1/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $1/visit"	17a:  Routine Eye Exams - $1/visit	17b:  Eye Glasses & Contact Lenses - $250 Per Year	18a:  Routine Hearing Test - $1/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Alternative Medicine Program - $0/service/14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Benefit - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14a:  Other - $0/service/14c:  Routine Exams - 100.0%/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14e:   Additional Prostate Screening - $0/visit/14f:   Additional Colorectal Screening - $0/visit/	13b:  Acupuncture - $0/visit/13c:  Other: Over-the-Counter Drugs - $0/visit												3	3	3	0	0	0.1	0	1	1	1	1	0	0	1	0.29186481	1	1	1	0	2.92E-05	0	0	0	10.35426972	0	0	0	0	0	0											NO	2.986881543	2.987361434	2.989152674	0	0	0.099567513	0	0.995460488	0.995234067	0.995223963	0.995471949	0	0	0.99589035	0.29048562	0.995338618	0.995399959	0.995243181	0	2.91E-05	0	0	0	10.35426972	0	0	0	0	0	0												0.0382	0.001232136	3.64E-05	0	0	0.798006514	0	0.054133015	0.010958732	0.573804592	0.055737591	0	0	0.010818785	0.267264305	0.207892206	0.072548067	0.089819647	0	0.000531213	0	0	0	2.956173913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.1371	0	0.01	0.0382	0.001232136	3.64E-05	0	0	0.798006514	0	0.054133015	0.010958732	0.573804592	0.055737591	0	0	0.010818785	0.267264305	0.207892206	0.072548067	0.089819647	0	0.000531213	0	0	0	2.956173913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.1371	NO	1a:  Acute - 0/admit for 1-90	1b:  Psych - 0/admit for 1-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - 0/day for 1--1/-/1-100/2:  Non-Medicare Covered Stay - $0/day for 1--1/-/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	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	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/9c:  Outpatient Substance Abuse Svcs - Group - $0/visit/7g:  Other Health Care Professional Services - $0/visit/18a:  Hearing Exams - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0382	0.001232136	3.64E-05	0	0	0.798006514	0	0.054133015	0.010958732	0.573804592	0.055737591	0	0	0.010818785	0.267264305	0.207892206	0.072548067	0.089819647	0	0.000531213	0	0	0	2.956173913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.1371
H4006_803_0	2011	9																															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	YES	91.14326163	2.197550609	1.480095709	12.71949461	3.19728515	12.45800001	16.4862257	9.823838855	19.7236921	25.40635052	7.539220474	0	0.072565924	19.16359043	129.3593702	127.2440731	4.799416021	15.40510724	32.48956783	36.35332269	1.402184741	0.812634793	0	0	0	0	0	0	0	0											6700	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares																				0.153446731	0.153446731	0.156302543	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.232582003	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.132460631	0.132460631	0.134925867	0	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0	0.201133818	0.201133818	0.216905425	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0	0	0	0	0	0	0	0												12.0729	0.291088939	0.199703198	0	0.643082169	2.505725105	3.315937518	1.975906215	3.967101495	5.110076278	1.516392198	0	0.014595461	3.854446107	28.05874911	25.59308621	0.965324868	3.098488034	6.534750818	7.311882584	0.28202677	0.163448338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4747	0	14.61	12.0729	0.291088939	0.199703198	0	0.643082169	2.505725105	3.315937518	1.975906215	3.967101495	5.110076278	1.516392198	0	0.014595461	3.854446107	28.05874911	25.59308621	0.965324868	3.098488034	6.534750818	7.311882584	0.28202677	0.163448338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4747	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.0729	0.291088939	0.199703198	0	0.643082169	2.505725105	3.315937518	1.975906215	3.967101495	5.110076278	1.516392198	0	0.014595461	3.854446107	28.05874911	25.59308621	0.965324868	3.098488034	6.534750818	7.311882584	0.28202677	0.163448338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4747
H4006_807_0	2011	8																															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	YES	73.83494694	2.930018274	1.396648443	12.21063993	2.327789126	13.63896237	12.4426648	8.597066832	17.36935574	23.47615245	6.453639613	0	0.072909077	15.62374709	128.1233209	121.430622	4.739891487	12.04812007	34.07349481	36.5703133	1.407450977	0.959121353	0	0	0	0	0	0	0	0											6700	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares																				0.153299933	0.153299933	0.155368854	0	0.233	0.233	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	0.134674202	0.134674202	0.136491751	0	0.20469082	0.20469082	0.20469082	0.20469082	0.20469082	0.20469082	0.20469082	0	0.20469082	0.20469082	0.219160766	0.20469082	0.20469082	0.20469082	0.20469082	0.20469082	0.20469082	0.20469082	0	0	0	0	0	0	0	0												9.9437	0.394597872	0.190630992	0	0.476477064	2.791770386	2.546899256	1.759740655	3.555347662	4.805352884	1.321000782	0	0.014923819	3.198037596	28.07960516	24.85573353	0.970212273	2.466139571	6.974531578	7.4856074	0.288092294	0.196323336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.3147	0	12.04	9.9437	0.394597872	0.190630992	0	0.476477064	2.791770386	2.546899256	1.759740655	3.555347662	4.805352884	1.321000782	0	0.014923819	3.198037596	28.07960516	24.85573353	0.970212273	2.466139571	6.974531578	7.4856074	0.288092294	0.196323336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.3147	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	0	0	0	0	0	0	0	0	0	0	9.9437	0.394597872	0.190630992	0	0.476477064	2.791770386	2.546899256	1.759740655	3.555347662	4.805352884	1.321000782	0	0.014923819	3.198037596	28.07960516	24.85573353	0.970212273	2.466139571	6.974531578	7.4856074	0.288092294	0.196323336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.3147
H4006_809_0	2011	8																															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	YES	91.14326163	2.197550609	1.480095709	12.71949461	3.19728515	12.45800001	16.4862257	9.823838855	19.7236921	25.40635052	7.539220474	0	0.072565924	19.16359043	129.3593702	127.2440731	4.799416021	15.40510724	32.48956783	36.35332269	1.402184741	0.812634793	0	0	0	0	0	0	0	0											6700	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares																				0.153446731	0.153446731	0.156302543	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.232582003	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.132460631	0.132460631	0.134925867	0	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0	0.201133818	0.201133818	0.216905425	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0	0	0	0	0	0	0	0												12.0729	0.291088939	0.199703198	0	0.643082169	2.505725105	3.315937518	1.975906215	3.967101495	5.110076278	1.516392198	0	0.014595461	3.854446107	28.05874911	25.59308621	0.965324868	3.098488034	6.534750818	7.311882584	0.28202677	0.163448338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4747	0	14.61	12.0729	0.291088939	0.199703198	0	0.643082169	2.505725105	3.315937518	1.975906215	3.967101495	5.110076278	1.516392198	0	0.014595461	3.854446107	28.05874911	25.59308621	0.965324868	3.098488034	6.534750818	7.311882584	0.28202677	0.163448338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4747	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.0729	0.291088939	0.199703198	0	0.643082169	2.505725105	3.315937518	1.975906215	3.967101495	5.110076278	1.516392198	0	0.014595461	3.854446107	28.05874911	25.59308621	0.965324868	3.098488034	6.534750818	7.311882584	0.28202677	0.163448338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4747
H4006_811_0	2011	8																															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	YES	91.14326163	2.197550609	1.480095709	12.71949461	3.19728515	12.45800001	16.4862257	9.823838855	19.7236921	25.40635052	7.539220474	0	0.072565924	19.16359043	129.3593702	127.2440731	4.799416021	15.40510724	32.48956783	36.35332269	1.402184741	0.812634793	0	0	0	0	0	0	0	0											6700	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares																				0.153446731	0.153446731	0.156302543	0	0.233	0.233	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	0.132442534	0.132442534	0.134907434	0	0.201106339	0.201106339	0.201106339	0.201106339	0.201106339	0.201106339	0.201106339	0	0.201106339	0.201106339	0.217252687	0.201106339	0.201106339	0.201106339	0.201106339	0.201106339	0.201106339	0.201106339	0	0	0	0	0	0	0	0												12.0712	0.291049171	0.199675914	0	0.642994311	2.505382774	3.315484495	1.975636267	3.96655951	5.10937814	1.516185028	0	0.014593467	3.853919513	28.1036707	25.58958969	0.965192985	3.098064719	6.533858041	7.310883636	0.28198824	0.163426008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.5088	0	14.63	12.0712	0.291049171	0.199675914	0	0.642994311	2.505382774	3.315484495	1.975636267	3.96655951	5.10937814	1.516185028	0	0.014593467	3.853919513	28.1036707	25.58958969	0.965192985	3.098064719	6.533858041	7.310883636	0.28198824	0.163426008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.5088	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.0712	0.291049171	0.199675914	0	0.642994311	2.505382774	3.315484495	1.975636267	3.96655951	5.10937814	1.516185028	0	0.014593467	3.853919513	28.1036707	25.58958969	0.965192985	3.098064719	6.533858041	7.310883636	0.28198824	0.163426008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.5088
H4006_813_0	2011	8																															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	YES	91.14326163	2.197550609	1.480095709	12.71949461	3.19728515	12.45800001	16.4862257	9.823838855	19.7236921	25.40635052	7.539220474	0	0.072565924	19.16359043	129.3593702	127.2440731	4.799416021	15.40510724	32.48956783	36.35332269	1.402184741	0.812634793	0	0	0	0	0	0	0	0											6700	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares	Medicare Equivalent Cost Shares																				0.153446731	0.153446731	0.156302543	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.232582003	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.132460631	0.132460631	0.134925867	0	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0	0.201133818	0.201133818	0.216905425	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0.201133818	0	0	0	0	0	0	0	0												12.0729	0.291088939	0.199703198	0	0.643082169	2.505725105	3.315937518	1.975906215	3.967101495	5.110076278	1.516392198	0	0.014595461	3.854446107	28.05874911	25.59308621	0.965324868	3.098488034	6.534750818	7.311882584	0.28202677	0.163448338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4747	0	14.61	12.0729	0.291088939	0.199703198	0	0.643082169	2.505725105	3.315937518	1.975906215	3.967101495	5.110076278	1.516392198	0	0.014595461	3.854446107	28.05874911	25.59308621	0.965324868	3.098488034	6.534750818	7.311882584	0.28202677	0.163448338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4747	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.0729	0.291088939	0.199703198	0	0.643082169	2.505725105	3.315937518	1.975906215	3.967101495	5.110076278	1.516392198	0	0.014595461	3.854446107	28.05874911	25.59308621	0.965324868	3.098488034	6.534750818	7.311882584	0.28202677	0.163448338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4747
H4007_005_0	2011	5																															A	A	A	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V		V	S	O		V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0		0		0	0											0	YES	315.380452	0	0.888724	148.731769	184.087274	17940.63982	49563.33165	1196.412608	176.471786	3230.671744	1806.977269	1.737635	9.324492	413.754305	8554.8705	3498.101634	0.716869	711.724613		1005.777093	1756.153931	0		7.11	1.65		0.17		1.97	0.89											3400	$3/Admit:1a.IP Acute	$3/Admit:1b.IP Psych	$0/Admit:2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$1/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN841: Dental 16a, 16b"	"VIS734: Vision 17a, 17b"		"HER756: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d												3	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											NO	3	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												0.0788	0	0	0	0	0	0	0.099701051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.1785	0	0	0.0788	0	0	0	0	0	0	0.099701051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.1785	NO																																																																																		0	0	0	0.0788	0	0	0	0	0	0	0.099701051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.1785
H4007_010_0	2011	5																															D	D	A	V	T	O	O	V	V	V	V	V	Coin	V	V	V	V	V		V	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	YES	1182.278297	0	2.351845	82.940563	94.399975	1533.077466	18913.23332	582.381483	171.823359	2860.069849	1555.096713	0	0.334892	388.586426	5995.908846	4016.346724	0	1037.262822		586.833823	1081.072989	0							0.47												5000	$50/Day(Days 1-4):1a.IP Acute	$50/Day(Days 1-4):1b.IP Psych	$0/Admit:2.SNF	$0/Visit:6.Home Health	$15/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$35/Visit:4a, 4b.Emergency Room"	"$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-$25/Visit:8b, 9a. $10 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $10 Advanced Imaging -- Office,8b, 9a. $25 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $10 Radiology OP -- Facility"	$10/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$10-$25/Visit:9d. $10 Cardiac Rehab,8b. $25 Nuclear Medicine,9a. $10 OP Other,5. $10 Partial Hospitalization,7h. $10 Psych -- OP,8b. $10 Rad therapy,3, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$10/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a													27.44705	0	0	0	15	0	0	35	8.709393	1.020002	3.856323	0	0.2	11.390701	0	10	0	10		0	0	0							0												NO	27.289614	0	0	0	14.970825	0	0	34.931925	8.692453	1.018018	3.848823	0	0.199611	11.368546	0	9.98055	0	9.98055		0	0	0							0													2.6887	0	0	0	0.117770459	0	0	1.695308857	0.124463873	0.242633549	0.498774333	0	0.066848127	0.368138555	0	3.340445775	0	0.862704455	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.0057	0	0.029770596	2.6887	0	0	0	0.117770459	0	0	1.695308857	0.124463873	0.242633549	0.498774333	0	0.066848127	0.368138555	0	3.340445775	0	0.862704455	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.0057	NO																																																																																		0	0	0	2.6887	0	0	0	0.117770459	0	0	1.695308857	0.124463873	0.242633549	0.498774333	0	0.066848127	0.368138555	0	3.340445775	0	0.862704455	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.0057
H4007_012_0	2011	4																															A	A	A	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V		V	S	O	T	V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0											0	YES	187.3659607	0	5.489244552	70.08743031	98.12898338	4288.677468	14798.22863	682.6848081	144.2087888	2696.950963	1496.363734	0	25.72258714	312.9140704	5807.269589	3468.80281	0	875.7918095		641.0381777	1002.51489	0	2.25	4.85	1.65		0.17		1.97	1.27											3500	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit:2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$35/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN783: Dental 16a, 16b"	"VIS734: Vision 17a, 17b"		"HER756: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13cAssist America: Emergency Care 4a												0	0	0	0	0	0	0	35	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	34.96808	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0		0		0	0												0	0	0	0	0	0	0	1.989348082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.9893	0	0.001815942	0	0	0	0	0	0	0	1.989348082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.9893	NO																																																																																		0	0	0	0	0	0	0	0	0	0	1.989348082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.9893
H4007_801_0	2011	4																															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	YES	151.368782	2.123368	15.556894	8.406438	3.804451	4.845153	1.710583	13.794348	25.586354	2.763064	14.975457	2.655313	0.268124	5.14677	19.959553	36.151513	0.248991	2.761492		3.926829	16.423682	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.153183	0.153183	0.154629	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.148341	0.148341	0.141836	0	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571		0.225571	0.225571	0																				22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441	0	2.093864388	22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441	NO																																																																																		0	0	0	22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441
H4007_802_0	2011	4																															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	YES	151.368782	2.123368	15.556894	8.406438	3.804451	4.845153	1.710583	13.794348	25.586354	2.763064	14.975457	2.655313	0.268124	5.14677	19.959553	36.151513	0.248991	2.761492		3.926829	16.423682	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.153183	0.153183	0.154629	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.148341	0.148341	0.141836	0	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571		0.225571	0.225571	0																				22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441	0	2.093864388	22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441	NO																																																																																		0	0	0	22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441
H4007_803_0	2011	4																															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	YES	151.368782	2.123368	15.556894	8.406438	3.804451	4.845153	1.710583	13.794348	25.586354	2.763064	14.975457	2.655313	0.268124	5.14677	19.959553	36.151513	0.248991	2.761492		3.926829	16.423682	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.153183	0.153183	0.154629	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.148341	0.148341	0.141836	0	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571		0.225571	0.225571	0																				22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441	0	2.093864388	22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441	NO																																																																																		0	0	0	22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441
H4007_805_0	2011	4																															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	YES	151.368782	2.123368	15.556894	8.406438	3.804451	4.845153	1.710583	13.794348	25.586354	2.763064	14.975457	2.655313	0.268124	5.14677	19.959553	36.151513	0.248991	2.761492		3.926829	16.423682	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.153183	0.153183	0.154629	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.148341	0.148341	0.141836	0	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571		0.225571	0.225571	0																				22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441	0	2.093864388	22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441	NO																																																																																		0	0	0	22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441
H4007_806_0	2011	4																															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	YES	151.368782	2.123368	15.556894	8.406438	3.804451	4.845153	1.710583	13.794348	25.586354	2.763064	14.975457	2.655313	0.268124	5.14677	19.959553	36.151513	0.248991	2.761492		3.926829	16.423682	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.153183	0.153183	0.154629	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.148341	0.148341	0.141836	0	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571		0.225571	0.225571	0																				22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441	0	2.093864388	22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441	NO																																																																																		0	0	0	22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441
H4007_807_0	2011	4																															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	YES	151.368782	2.123368	15.556894	8.406438	3.804451	4.845153	1.710583	13.794348	25.586354	2.763064	14.975457	2.655313	0.268124	5.14677	19.959553	36.151513	0.248991	2.761492		3.926829	16.423682	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.153183	0.153183	0.154629	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.148341	0.148341	0.141836	0	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571	0.225571		0.225571	0.225571	0																				22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441	0	2.093864388	22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441	NO																																																																																		0	0	0	22.4542	0.314982532	2.206527617	0	0.858173817	1.092926007	0.385857918	3.111604873	5.771539458	0.62326711	3.378028811	0.598961609	0.060480999	1.160962056	4.50229633	8.154732939	0.056165149	0.622912512	0	0.885778744	3.704706372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9441
H4011_001_0	2011	9																																				Coin	Coin	V								V																									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	0	0	0	0	0	8.517035641	0.601631199	257.4299006	0	0	0	0	0	0	0	4000	0	0	0	0	0	0	0	0	0	0	0	0	0	0											6700	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	5% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"5% Coinsurance for DME/Prosthetics/Supplies; PBP 11b, 11c"	$35/Visit for ER; PBP 4a	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b				"No Cost Sharing; PBP 4b, 7a, 14b-j"	$5/Visit for Specialist; PBP 7d	"No Cost Sharing; PBP 7e, 7h, 9c"	"No Cost Sharing; PBP 7c, 7i"	No Cost Sharing; PBP 8b	"No Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a-b, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	No Cost Sharing; PBP 15		No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-e											0	0	0	0	0	0	0.05	0.05	35	0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0.05	0.05	35	0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0.425851782	0.03008156	0.75083721	0	0	0	0	0	0	0	1.666666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.8734	0	2.66E-15	0	0	0	0	0	0.425851782	0.03008156	0.75083721	0	0	0	0	0	0	0	1.666666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.8734	YES	$300 Deductible for IP Hospital; PBP 1a	$300 Deductible for IP Hospital; PBP 1b	$200 Deductible for SNF; PBP 2	20% Coinsurance for Home Health; PBP 6	20% Coinsurance for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11b, 11c"	$35/Visit for ER; PBP 4a	"20% Coinsurance for OP Hospital; PBP 9a, 9b"	20% Coinsurance for OP Lag; PBP 8a	20% Coinsurance for OP Radiology; PBP 8b				"20% Coinsurance for PCP; 20% Coinsurance for PCP; PBP 4b, 7a, 14b-j"	20% Coinsurance for Specialist; PBP 7d	"50% Coinsurance for Mental Health; PBP 7e, 7h, 9c"	"20% Coinsurance for PT/OT/ST; PBP 7c, 7i"	20% Coinsurance for Radiology; PBP 8b	"20% Coinsurance for Prof Other; 20% Coinsurance for Prof Other; 20% Coinsurance for Prof Other; 20% Coinsurance for Prof Other; 20% Coinsurance for Prof Other; 20% Coinsurance for Prof Other; PBP 3, 4b, 5, 7b, 7f, 7g, 8a-b, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	20% Coinsurance for Part B Rx; PBP 15		No Cost Sharing; PBP 10b	"20% Coinsurance for Dental; PBP 16a, 16b"	20% Coinsurance for Eye Exams; PBP 17a	50% Coinsurance; PBP 17b	20% Coinsurance for Hearing Exams; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-e											10000	0.4537	0.0255	0.1172	0.02	0.298	0.6983	1.0657	0.1716	0.0931	0.1573	0.1193	0	0	0	0.5787	0.3336	0.0274	0.0351	0.0002	0.8507	0.0123	0	0	0.0092	0	0	0.0002	0	0	0											5.067	0	0.090861634	0.4537	0.02551042	0.117175907	0.020004893	0.2979842	1.124159232	1.095775002	0.922397318	0.093065969	0.157296316	0.11932027	0	0	0	0.578684165	2.000252298	0.027369259	0.03505891	0.00020604	0.850711214	0.01232796	0	0	0.009243287	0	0	0.000172104	0	0	0	0	0	0	0	0	0	0	0	0	0	7.9405
H4011_003_0	2011	10																																				Coin	Coin	V								V																									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	0	0	0	0	0	9.710860565	2.502127526	293.2454405	0	0	0	0	0	0	0	4000	0	0	0	0	0	0	0	0	0	0	0	0	0	0											6700	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	5% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"5% Coinsurance for DME/Prosthetics/Supplies; PBP 11b, 11c"	$35/Visit for ER; PBP 4a	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b				"No Cost Sharing; PBP 4b, 7a, 14b-j"	$5/Visit for Specialist; PBP 7d	"No Cost Sharing; PBP 7e, 7h, 9c"	"No Cost Sharing; PBP 7c, 7i"	No Cost Sharing; PBP 8b	"No Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	No Cost Sharing; PBP 15		No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-e											0	0	0	0	0	0	0.05	0.05	35	0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0.05	0.05	35	0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0.485543028	0.125106376	0.855299202	0	0	0	0	0	0	0	1.666666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1326	0	3.11E-15	0	0	0	0	0	0.485543028	0.125106376	0.855299202	0	0	0	0	0	0	0	1.666666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1326	YES	$300 Deductible for IP Hospital; PBP 1a	$300 Deductible for IP Hospital; PBP 1b	$200 Deductible for SNF; PBP 2	20% Coinsurance for Home Health; PBP 6	20% Coinsurance for Ambulance; PBP 10a	20% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"20% Coinsurance for DME/Prosthetics/Supplies; PBP 11b, 11c"	$35/Visit for ER; PBP 4a	"20% Coinsurance for OP Hospital; PBP 9a, 9b"	20% Coinsurance for OP Lag; PBP 8a	20% Coinsurance for OP Radiology; PBP 8b				"20% Coinsurance for PCP; 20% Coinsurance for PCP; PBP 4b, 7a, 14b-j"	20% Coinsurance for Specialist; PBP 7d	"50% Coinsurance for Mental Health; PBP 7e, 7h, 9c"	"20% Coinsurance for PT/OT/ST; PBP 7c, 7i"	20% Coinsurance for Radiology; PBP 8b	"20% Coinsurance for Prof Other; 20% Coinsurance for Prof Other; 20% Coinsurance for Prof Other; 20% Coinsurance for Prof Other; 20% Coinsurance for Prof Other; 20% Coinsurance for Prof Other; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	20% Coinsurance for Part B Rx; PBP 15		No Cost Sharing; PBP 10b	"20% Coinsurance for Dental; PBP 16a, 16b"	20% Coinsurance for Eye Exams; PBP 17a	No Cost Sharing; PBP 17b	20% Coinsurance for Hearing Exams; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-e											10000	0.9598	0.029	0.1304	0.0223	0.3137	0.8669	0.4369	0.1883	0.1459	0.1938	0.1201	0	0	0	1.0849	0.4019	0.0314	0.039	0.0002	0.9095	0.0134	0	0	0.0233	0	0	0.0002	0	0	0											5.9109	0	0.105994591	0.9598	0.029004727	0.130402405	0.022262991	0.313675861	1.352471408	0.561962826	1.043641324	0.145930709	0.19379836	0.120096952	0	0	0	1.084918357	2.068522716	0.031399563	0.039016265	0.000229298	0.909488075	0.013399125	0	0	0.023331746	0	0	0.000189405	0	0	0	0	0	0	0	0	0	0	0	0	0	9.0435
H4011_801_0	2011	9																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	72.80710041	2.824243546	1.9295186	0	0.244352851	9.991772836	0.864057066	6.246640251	9.908427223	23.09617541	24.21707305	0	0	0	75.54764052	16.36374878	1.117393627	8.120280826	0.400204662	85.74891392	5.598781671	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.152850988	0.152850988	0.152501012	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	0.140571738	0.140571738	0.140249876	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0	0	0	0	0	0												10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	0	5.958754469	10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	1.0222	0.0522	0.03	0	0.3727	1.1727	0.6353	0.1937	0.1005	0.2119	0.1769	0	0	0	0.8533	0.4642	0.0132	0.0514	0.0003	1.24	0.0201	0	0	0	0	0	0	0	0	0											6.6105	0	0.247350499	11.2568	0.449189413	0.300630642	0	0.425046595	3.313782641	0.820491967	1.532210991	2.2236848	5.161036606	5.366147953	0	0	0	17.04184686	3.97062913	0.25264588	1.791397618	0.08603471	19.61440207	1.219843678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8258
H4011_802_0	2011	9																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	72.80710041	2.824243546	1.9295186	0	0.244352851	9.991772836	0.864057066	6.246640251	9.908427223	23.09617541	24.21707305	0	0	0	75.54764052	16.36374878	1.117393627	8.120280826	0.400204662	85.74891392	5.598781671	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.152850988	0.152850988	0.152501012	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	0.140571738	0.140571738	0.140249876	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0	0	0	0	0	0												10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	0	5.958754469	10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	1.0222	0.0522	0.03	0	0.3727	1.1727	0.6353	0.1937	0.1005	0.2119	0.1769	0	0	0	0.8533	0.4642	0.0132	0.0514	0.0003	1.24	0.0201	0	0	0	0	0	0	0	0	0											6.6105	0	0.247350499	11.2568	0.449189413	0.300630642	0	0.425046595	3.313782641	0.820491967	1.532210991	2.2236848	5.161036606	5.366147953	0	0	0	17.04184686	3.97062913	0.25264588	1.791397618	0.08603471	19.61440207	1.219843678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8258
H4011_803_0	2011	9																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	72.80710041	2.824243546	1.9295186	0	0.244352851	9.991772836	0.864057066	6.246640251	9.908427223	23.09617541	24.21707305	0	0	0	75.54764052	16.36374878	1.117393627	8.120280826	0.400204662	85.74891392	5.598781671	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.152850988	0.152850988	0.152501012	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	0.140571738	0.140571738	0.140249876	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0	0	0	0	0	0												10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	0	5.958754469	10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	1.0222	0.0522	0.03	0	0.3727	1.1727	0.6353	0.1937	0.1005	0.2119	0.1769	0	0	0	0.8533	0.4642	0.0132	0.0514	0.0003	1.24	0.0201	0	0	0	0	0	0	0	0	0											6.6105	0	0.247350499	11.2568	0.449189413	0.300630642	0	0.425046595	3.313782641	0.820491967	1.532210991	2.2236848	5.161036606	5.366147953	0	0	0	17.04184686	3.97062913	0.25264588	1.791397618	0.08603471	19.61440207	1.219843678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8258
H4011_805_0	2011	9																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	72.80710041	2.824243546	1.9295186	0	0.244352851	9.991772836	0.864057066	6.246640251	9.908427223	23.09617541	24.21707305	0	0	0	75.54764052	16.36374878	1.117393627	8.120280826	0.400204662	85.74891392	5.598781671	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.152850988	0.152850988	0.152501012	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	0.140571738	0.140571738	0.140249876	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0	0	0	0	0	0												10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	0	5.958754469	10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	1.0222	0.0522	0.03	0	0.3727	1.1727	0.6353	0.1937	0.1005	0.2119	0.1769	0	0	0	0.8533	0.4642	0.0132	0.0514	0.0003	1.24	0.0201	0	0	0	0	0	0	0	0	0											6.6105	0	0.247350499	11.2568	0.449189413	0.300630642	0	0.425046595	3.313782641	0.820491967	1.532210991	2.2236848	5.161036606	5.366147953	0	0	0	17.04184686	3.97062913	0.25264588	1.791397618	0.08603471	19.61440207	1.219843678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8258
H4011_806_0	2011	9																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	72.80710041	2.824243546	1.9295186	0	0.244352851	9.991772836	0.864057066	6.246640251	9.908427223	23.09617541	24.21707305	0	0	0	75.54764052	16.36374878	1.117393627	8.120280826	0.400204662	85.74891392	5.598781671	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.152850988	0.152850988	0.152501012	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	0.140571738	0.140571738	0.140249876	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0	0	0	0	0	0												10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	0	5.958754469	10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	1.0222	0.0522	0.03	0	0.3727	1.1727	0.6353	0.1937	0.1005	0.2119	0.1769	0	0	0	0.8533	0.4642	0.0132	0.0514	0.0003	1.24	0.0201	0	0	0	0	0	0	0	0	0											6.6105	0	0.247350499	11.2568	0.449189413	0.300630642	0	0.425046595	3.313782641	0.820491967	1.532210991	2.2236848	5.161036606	5.366147953	0	0	0	17.04184686	3.97062913	0.25264588	1.791397618	0.08603471	19.61440207	1.219843678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8258
H4011_807_0	2011	9																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	72.80710041	2.824243546	1.9295186	0	0.244352851	9.991772836	0.864057066	6.246640251	9.908427223	23.09617541	24.21707305	0	0	0	75.54764052	16.36374878	1.117393627	8.120280826	0.400204662	85.74891392	5.598781671	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.152850988	0.152850988	0.152501012	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	0.140571738	0.140571738	0.140249876	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0	0	0	0	0	0												10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	0	5.958754469	10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	1.0222	0.0522	0.03	0	0.3727	1.1727	0.6353	0.1937	0.1005	0.2119	0.1769	0	0	0	0.8533	0.4642	0.0132	0.0514	0.0003	1.24	0.0201	0	0	0	0	0	0	0	0	0											6.6105	0	0.247350499	11.2568	0.449189413	0.300630642	0	0.425046595	3.313782641	0.820491967	1.532210991	2.2236848	5.161036606	5.366147953	0	0	0	17.04184686	3.97062913	0.25264588	1.791397618	0.08603471	19.61440207	1.219843678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8258
H4011_809_0	2011	9																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	72.80710041	2.824243546	1.9295186	0	0.244352851	9.991772836	0.864057066	6.246640251	9.908427223	23.09617541	24.21707305	0	0	0	75.54764052	16.36374878	1.117393627	8.120280826	0.400204662	85.74891392	5.598781671	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.152850988	0.152850988	0.152501012	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	0.140571738	0.140571738	0.140249876	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0	0	0	0	0	0												10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	0	5.958754469	10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	1.0222	0.0522	0.03	0	0.3727	1.1727	0.6353	0.1937	0.1005	0.2119	0.1769	0	0	0	0.8533	0.4642	0.0132	0.0514	0.0003	1.24	0.0201	0	0	0	0	0	0	0	0	0											6.6105	0	0.247350499	11.2568	0.449189413	0.300630642	0	0.425046595	3.313782641	0.820491967	1.532210991	2.2236848	5.161036606	5.366147953	0	0	0	17.04184686	3.97062913	0.25264588	1.791397618	0.08603471	19.61440207	1.219843678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8258
H4011_810_0	2011	9																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	72.80710041	2.824243546	1.9295186	0	0.244352851	9.991772836	0.864057066	6.246640251	9.908427223	23.09617541	24.21707305	0	0	0	75.54764052	16.36374878	1.117393627	8.120280826	0.400204662	85.74891392	5.598781671	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.152850988	0.152850988	0.152501012	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	0.140571738	0.140571738	0.140249876	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0	0	0	0	0	0												10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	0	5.958754469	10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	1.0222	0.0522	0.03	0	0.3727	1.1727	0.6353	0.1937	0.1005	0.2119	0.1769	0	0	0	0.8533	0.4642	0.0132	0.0514	0.0003	1.24	0.0201	0	0	0	0	0	0	0	0	0											6.6105	0	0.247350499	11.2568	0.449189413	0.300630642	0	0.425046595	3.313782641	0.820491967	1.532210991	2.2236848	5.161036606	5.366147953	0	0	0	17.04184686	3.97062913	0.25264588	1.791397618	0.08603471	19.61440207	1.219843678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8258
H4011_811_0	2011	9																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	63.30436683	2.843229558	1.684409306	0	0.17764058	10.44002827	0.571072699	6.778249057	8.836643193	23.53595937	24.13784914	0	0	0	73.22784078	15.97446015	1.117071735	10.01978184	0.364823953	84.32456455	6.071599332	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.152264246	0.152264246	0.148724546	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	0.14087536	0.14087536	0.137600419	0	0.215572334	0.215572334	0.215572334	0.215572334	0.215572334	0.215572334	0.215572334	0	0	0	0.215572334	0.215572334	0.215572334	0.215572334	0.215572334	0.215572334	0.215572334	0	0	0	0	0	0	0	0	0												8.918	0.400540989	0.231775426	0	0.038294394	2.250581259	0.123107475	1.461202968	1.904935796	5.073701689	5.203452472	0	0	0	15.78589653	3.443651656	0.240809761	2.159987755	0.078645951	18.17804318	1.308868838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.8015	0	5.400482528	8.918	0.400540989	0.231775426	0	0.038294394	2.250581259	0.123107475	1.461202968	1.904935796	5.073701689	5.203452472	0	0	0	15.78589653	3.443651656	0.240809761	2.159987755	0.078645951	18.17804318	1.308868838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.8015	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	0.7945	0.0852	0.0133	0	0.2669	0.8771	0.349	0.1951	0.0541	0.2064	0.1391	0	0	0	0.7577	0.5053	0.0133	0.076	0.0002	1.1159	0.0276	0	0	0	0	0	0	0	0	0											5.4766	0	0.18557256	9.7125	0.485778226	0.245074851	0	0.305166137	3.127656352	0.472110587	1.656280146	1.959048011	5.2801093	5.342592321	0	0	0	16.54363025	3.948940329	0.254078484	2.235961709	0.078829136	19.29395121	1.33642601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2781
H4011_813_0	2011	9																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	72.80710041	2.824243546	1.9295186	0	0.244352851	9.991772836	0.864057066	6.246640251	9.908427223	23.09617541	24.21707305	0	0	0	75.54764052	16.36374878	1.117393627	8.120280826	0.400204662	85.74891392	5.598781671	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.152850988	0.152850988	0.152501012	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	0.140571738	0.140571738	0.140249876	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0	0	0	0	0	0												10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	0	5.958754469	10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	1.0222	0.0522	0.03	0	0.3727	1.1727	0.6353	0.1937	0.1005	0.2119	0.1769	0	0	0	0.8533	0.4642	0.0132	0.0514	0.0003	1.24	0.0201	0	0	0	0	0	0	0	0	0											6.6105	0	0.247350499	11.2568	0.449189413	0.300630642	0	0.425046595	3.313782641	0.820491967	1.532210991	2.2236848	5.161036606	5.366147953	0	0	0	17.04184686	3.97062913	0.25264588	1.791397618	0.08603471	19.61440207	1.219843678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8258
H4011_814_0	2011	9																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	72.80710041	2.824243546	1.9295186	0	0.244352851	9.991772836	0.864057066	6.246640251	9.908427223	23.09617541	24.21707305	0	0	0	75.54764052	16.36374878	1.117393627	8.120280826	0.400204662	85.74891392	5.598781671	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.152850988	0.152850988	0.152501012	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	0.140571738	0.140571738	0.140249876	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0	0	0	0	0	0												10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	0	5.958754469	10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	1.0222	0.0522	0.03	0	0.3727	1.1727	0.6353	0.1937	0.1005	0.2119	0.1769	0	0	0	0.8533	0.4642	0.0132	0.0514	0.0003	1.24	0.0201	0	0	0	0	0	0	0	0	0											6.6105	0	0.247350499	11.2568	0.449189413	0.300630642	0	0.425046595	3.313782641	0.820491967	1.532210991	2.2236848	5.161036606	5.366147953	0	0	0	17.04184686	3.97062913	0.25264588	1.791397618	0.08603471	19.61440207	1.219843678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8258
H4011_815_0	2011	9																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	72.80710041	2.824243546	1.9295186	0	0.244352851	9.991772836	0.864057066	6.246640251	9.908427223	23.09617541	24.21707305	0	0	0	75.54764052	16.36374878	1.117393627	8.120280826	0.400204662	85.74891392	5.598781671	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.152850988	0.152850988	0.152501012	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	0.140571738	0.140571738	0.140249876	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0	0	0	0	0	0												10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	0	5.958754469	10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	1.0222	0.0522	0.03	0	0.3727	1.1727	0.6353	0.1937	0.1005	0.2119	0.1769	0	0	0	0.8533	0.4642	0.0132	0.0514	0.0003	1.24	0.0201	0	0	0	0	0	0	0	0	0											6.6105	0	0.247350499	11.2568	0.449189413	0.300630642	0	0.425046595	3.313782641	0.820491967	1.532210991	2.2236848	5.161036606	5.366147953	0	0	0	17.04184686	3.97062913	0.25264588	1.791397618	0.08603471	19.61440207	1.219843678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8258
H4011_817_0	2011	9																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	72.80710041	2.824243546	1.9295186	0	0.244352851	9.991772836	0.864057066	6.246640251	9.908427223	23.09617541	24.21707305	0	0	0	75.54764052	16.36374878	1.117393627	8.120280826	0.400204662	85.74891392	5.598781671	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.152850988	0.152850988	0.152501012	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	0.140571738	0.140571738	0.140249876	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0	0	0	0	0	0												10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	0	5.958754469	10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	1.0222	0.0522	0.03	0	0.3727	1.1727	0.6353	0.1937	0.1005	0.2119	0.1769	0	0	0	0.8533	0.4642	0.0132	0.0514	0.0003	1.24	0.0201	0	0	0	0	0	0	0	0	0											6.6105	0	0.247350499	11.2568	0.449189413	0.300630642	0	0.425046595	3.313782641	0.820491967	1.532210991	2.2236848	5.161036606	5.366147953	0	0	0	17.04184686	3.97062913	0.25264588	1.791397618	0.08603471	19.61440207	1.219843678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8258
H4011_818_0	2011	8																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	72.80710041	2.824243546	1.9295186	0	0.244352851	9.991772836	0.864057066	6.246640251	9.908427223	23.09617541	24.21707305	0	0	0	75.54764052	16.36374878	1.117393627	8.120280826	0.400204662	85.74891392	5.598781671	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.152850988	0.152850988	0.152501012	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	0.140571738	0.140571738	0.140249876	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0	0	0	0	0	0												10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	0	5.958754469	10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	1.0222	0.0522	0.03	0	0.3727	1.1727	0.6353	0.1937	0.1005	0.2119	0.1769	0	0	0	0.8533	0.4642	0.0132	0.0514	0.0003	1.24	0.0201	0	0	0	0	0	0	0	0	0											6.6105	0	0.247350499	11.2568	0.449189413	0.300630642	0	0.425046595	3.313782641	0.820491967	1.532210991	2.2236848	5.161036606	5.366147953	0	0	0	17.04184686	3.97062913	0.25264588	1.791397618	0.08603471	19.61440207	1.219843678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8258
H4011_819_0	2011	8																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin				Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	72.80710041	2.824243546	1.9295186	0	0.244352851	9.991772836	0.864057066	6.246640251	9.908427223	23.09617541	24.21707305	0	0	0	75.54764052	16.36374878	1.117393627	8.120280826	0.400204662	85.74891392	5.598781671	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.152850988	0.152850988	0.152501012	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	0.140571738	0.140571738	0.140249876	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0.214281996	0	0	0	0	0	0	0	0	0												10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	0	5.958754469	10.2346	0.397008823	0.270614745	0	0.052360417	2.141057032	0.185151873	1.338542544	2.123197567	4.949094578	5.189282762	0	0	0	16.18849924	3.506456758	0.239437337	1.740029987	0.085756654	18.37444847	1.199718114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2153	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	Medicare-FFS Cost Sharing; PBP 4a	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b				"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	Medicare-FFS Cost Sharing; PBP 15		Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	1.0222	0.0522	0.03	0	0.3727	1.1727	0.6353	0.1937	0.1005	0.2119	0.1769	0	0	0	0.8533	0.4642	0.0132	0.0514	0.0003	1.24	0.0201	0	0	0	0	0	0	0	0	0											6.6105	0	0.247350499	11.2568	0.449189413	0.300630642	0	0.425046595	3.313782641	0.820491967	1.532210991	2.2236848	5.161036606	5.366147953	0	0	0	17.04184686	3.97062913	0.25264588	1.791397618	0.08603471	19.61440207	1.219843678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8258
H4012_003_0	2011	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											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											6700	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"No Cost Sharing; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"No Cost Sharing; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 8b"	"No Cost Sharing; PBP 7b, 7d, 7g, 8a, 14d-j"	No Cost Sharing; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b											0	0	0	0	0	0	0	0	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
H4012_008_0	2011	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											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											6700	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"No Cost Sharing; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"No Cost Sharing; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 8b"	"No Cost Sharing; PBP 7b, 7d, 7g, 8a, 14d-j"	No Cost Sharing; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14a	PBP 13b											0	0	0	0	0	0	0	0	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
H4036_003_0	2011	7	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	1147.230099	78.88693847	469.1851915	509.069932	90.53553158	10.08620618	2.027247476	289.8887272	582.1014931	7082.071598	746.6061022	112.2758845	0.02483504	134.3191727	3292.09247	3633.473892	13.91744046	1288.45141	580.6450981	1226.570638	35.12139167	2.081575486	0	1491.951776	302.4	239.2	129.6	0	7955.291477	0	4.915848018	5.482471262	144.7911641	0	0	0	0	0	0	0		1A: $200/day (days1-6) w/$1200 yrly max	1B: $200/day (days1-6) w/$1200 yrly max	2: $115/day (for days 21-100)	6: $0 copay	10A: $100 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $20 copay	9A: $20-$150 copay; 9B: $150 copay	8A: $0-$125 copay	8B: $75-$125 copay	9A: $150 copay	12: 20% coin	3: $20 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $5 copay; 7G: $5 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $20 copay; 7F: $20 copay; 7G: $20 copay	7E: $40 copay; 7H: $40 copay	7C: $20-$40 copay; 7I: $20-$40 copay	8B: $75-$125 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$20; 17B: $0; 18A: $20	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $20 copay	17B: $20 copay	18A: $20 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay									200	200	115	0	100	0.2	0.080929468	49.52380851	105.8519916	18.03593527	95.74590802	150	0.2	6.970954215	4.333512358	19.42715975	40	34.49080018	87.76279403	9.838998677	0.2	0	0	0	20	20	15	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	91.78651968	60.21452297	101.2874266	0	88.07602315	0.176152046	0.071279457	43.61860105	93.23022464	15.88533453	84.32918812	132.1140347	0.176152046	6.139739248	3.816785347	17.11066972	35.23040926	30.37812515	77.29797879	8.665798753	0.176152046	0	0	0	20	20	15	0	0	0	0.176152046	0.176152046	0	0	0	0	0	0	0	0		8.775	0.395844947	3.960213388	0	0.664500798	1.776705858	0.1445011	1.053711728	4.522454414	9.375089706	5.24672387	1.236101675	0.004374743	0.068723725	1.047100858	5.180930975	0.04085976	3.261728181	3.740224373	0.885767859	6.186705012	0	0	0	0.504	0.398666667	0.162	0	0	0	0.865936688	0.965748532	0	0	0	0	0	0	0	0	60.4636		8.041597633	8.775	0.395844947	3.960213388	0	0.664500798	1.776705858	0.1445011	1.053711728	4.522454414	9.375089706	5.24672387	1.236101675	0.004374743	0.068723725	1.047100858	5.180930975	0.04085976	3.261728181	3.740224373	0.885767859	6.186705012	0	0	0	0.504	0.398666667	0.162	0	0	0	0.865936688	0.965748532	0	0	0	0	0	0	0	0	60.4636	YES	1A: 30% coin	1B: 30% coin	2: 25% coin (for days 1-100)	6: $0 copay	10A: $100 copay	11A: 25% coin	11B: 25% coin; 11C: 25% coin	4A: $50 copay; 4B: $20 copay	9A: $30-$225 copay; 9B: $225 copay	8A: 0% - 25% coin	8B: 25% coin	9A: $225 copay	12: 20% coin	3: $30 copay; 5: $50 copay; 9C: $50 copay; 9D: $0 copay	7A: $15 copay; 7G: $15 copay; 14B: $0 copay; 14C: $0 copay	7B: $30 copay; 7D: $30 copay; 7F: $30 copay; 7G: $30 copay	7E: $50 copay; 7H: $50 copay	7C: $30-$60 copay; 7I: $30-$60 copay	8B: 25% coin	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $30; 17B: $0; 18A: $30	15: 20% coinsurance	13A: $0 copay	10B: Not covered	$16A: 20% coinsurance	17A: $30 copay	17B: $30 copay	18A: $30 copay	-			8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin								3400	13.532	0.4731	0.8198	0	0.8267	0.4139	0.3351	0.2503	1.3348	0.7844	0.7112	0.289	0.0001	0.0415	0.6702	1.6217	0.0129	0.7116	1.5863	0.2028	1.5077	0	0	0.247	0.189	0.1495	0.0675	0	0	0	0.1682	0.1102	0.0291	0	0	0	0	0	0	0	27.0856		3.578518454	22.307	0.86893122	4.77997856	0	1.491182523	2.190655258	0.479646275	1.304058994	5.857271011	10.1594764	5.957929738	1.525102679	0.004443223	0.110239807	1.717331471	6.802631233	0.053774932	3.973305848	5.326508021	1.08858571	7.694400628	0	0	0.247044534	0.693	0.548166667	0.2295	0	0	0	1.034099812	1.075947727	0.029057516	0	0	0	0	0	0	0	87.5493
H4036_004_0	2011	7	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	1138.183716	51.7377211	426.6572323	286.0204992	70.41009441	7.638474184	1.852683532	262.1450926	662.0821817	6300.734687	662.4711067	99.49689746	0.014333435	159.0626162	3174.418128	3379.197629	11.06304925	1125.074299	604.6222841	1180.213542	30.66535988	2.198831142	0	0	0	0	129.6	0	7953.883102	0	3.419273441	3.855503047	146.0913084	0	0	0	0	0	0	0		1A: $230/day (days1-7) w/$1610 yrly max	1B: $230/day (days1-7) w/$1610 yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $40 copay	9A: $40-$200 copay; 9B: $200 copay	8A: $0-$150 copay	8B: $100-$150 copay	9A: $200 copay	12: 20% coin	3: $40 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $0 copay; 7G: $0 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $40 copay; 7F: $40 copay; 7G: $40 copay	7E: $40 copay; 7H: $40 copay	7C: $40-$50 copay; 7I: $40-$50 copay	8B: $100-$150 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$35; 17B: $0; 18A: $35	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	-	-	18A: $35 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay									230	230	128	0	125	0.2	0.056723548	49.14102135	131.3138325	25.9392946	122.7845764	200	0.2	4.851034168	0	37.93709753	40	46.18861008	111.2758556	16.47959724	0.2	0	0	0	0	0	20	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	148.9185029	144.27871	113.5121917	0	110.8517497	0.1773628	0.050303237	43.57894559	116.4509448	23.00332953	108.887081	177.3627995	0.1773628	4.301965003	0	33.64314912	35.4725599	40.96070595	98.68098631	14.61433751	0.1773628	0	0	0	0	0	20	0	0	0	0.1773628	0.1773628	0	0	0	0	0	0	0	0		14.1247	0.622054305	4.035899795	0	0.650423513	1.354781165	0.093195978	0.952000561	6.425007965	12.07815636	6.01121209	1.470587356	0.002542218	0.057023484	0	9.473904143	0.03270289	3.840319794	4.972060278	1.437336586	5.438894076	0	0	0	0	0	0.216	0	0	0	0.60645191	0.683822814	0	0	0	0	0	0	0	0	74.5791		9.491123839	14.1247	0.622054305	4.035899795	0	0.650423513	1.354781165	0.093195978	0.952000561	6.425007965	12.07815636	6.01121209	1.470587356	0.002542218	0.057023484	0	9.473904143	0.03270289	3.840319794	4.972060278	1.437336586	5.438894076	0	0	0	0	0	0.216	0	0	0	0.60645191	0.683822814	0	0	0	0	0	0	0	0	74.5791	YES	1A: 20% coin	1B: 20% coin	2: 30% coin (for days 1-100)	6: $0 copay	10A: $125 copay	11A: 30% coin	11B: 30% coin; 11C: 30% coin	4A: $50 copay; 4B: $40 copay	9A: $45-$275 copay; 9B: $275 copay	8A: 0% - 30%	8B: 30% coin	9A: $275 copay	12: 20% coin	3: $45 copay; 5: $50 copay; 9C: $50 copay; 9D: $0 copay	7A: $35 copay; 7G: $35 copay; 14B: $0 copay; 14C: $0 copay	7B: $45 copay; 7D: $45 copay; 7F: $45 copay; 7G: $45 copay	7E: $50 copay; 7H: $50 copay	7C: $45-$90 copay; 7I: $45-$90 copay	8B: 30% coin	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $45; 17B: $0; 18A: $45	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	17A: $45 copay	17B: $45 copay	18A: $45 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 30% coin; 14J: 30% coin								4500	10.7972	0.0944	2.5147	0	1.2539	0.4225	0.431	0.2526	1.3339	1.1335	0.9364	0.4923	0	0.0417	1.6403	3.2513	0.0282	1.5369	2.4874	0.3881	1.6044	0	0	0	0	0	0.0675	0	0	0	0.0805	0.0809	0.0454	0	0	0	0	0	0	0	30.9148		3.937112028	24.9219	0.716437017	6.550552572	0	1.904279403	1.777296423	0.524183574	1.204577063	7.758917614	13.21165634	6.947624823	1.962894433	0.002542218	0.0986981	1.640333647	12.72520201	0.06092757	5.377194808	7.459479602	1.825478923	7.043257294	0	0	0	0	0	0.2835	0	0	0	0.686937027	0.76467913	0.045379568	0	0	0	0	0	0	0	105.4939
H4036_801_0	2011	3																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	265.9100101	3.06192984	72.99237875	19.97257601	7.282420038	11.73416947	2.961881637	10.69143237	45.56458992	7.164844959	23.12145811	0	0.020715676	33.29195777	34.44417977	94.703033	0.963334042	3.830210068	14.95819406	17.94656599	13.07195885	1.334002621	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.067420456	0.067420456	0.126893724	0	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0	0	0	0	0	0	0	0												17.9278	0.206436707	9.262274769	0	1.421585883	2.290602517	0.578182678	2.087052002	8.894567665	1.398634299	4.513491157	0	0.004043864	6.498852983	6.723775814	18.48677968	0.18805041	0.747687243	2.919957569	3.503311361	2.551749566	0.260407843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.4652	0	17.514	17.9278	0.206436707	9.262274769	0	1.421585883	2.290602517	0.578182678	2.087052002	8.894567665	1.398634299	4.513491157	0	0.004043864	6.498852983	6.723775814	18.48677968	0.18805041	0.747687243	2.919957569	3.503311361	2.551749566	0.260407843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.4652	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	Similar to Medicare FFS							0												10000	2.474	0.0285	0.9864	0	0.2222	0.3585	0.0905	0.2566	1.1108	0.1627	0.5766	0	0.0007	0.5711	1.1502	3.0012	0.0309	0.1221	0.5391	0.5797	0.228	0.0233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.5131	0	1.592	20.4018	0.234921762	10.24872243	0	1.643807576	2.649078005	0.668667307	2.34363693	10.00532754	1.561375247	5.090079183	0	0.004710761	7.069940774	7.873965233	21.48801751	0.21891629	0.869795371	3.45910049	4.083025248	2.779717244	0.283681079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9783
H4036_802_0	2011	3																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	265.9100101	3.06192984	72.99237875	19.97257601	7.282420038	11.73416947	2.961881637	10.69143237	45.56458992	7.164844959	23.12145811	0	0.020715676	33.29195777	34.44417977	94.703033	0.963334042	3.830210068	14.95819406	17.94656599	13.07195885	1.334002621	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.067420456	0.067420456	0.126893724	0	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0	0	0	0	0	0	0	0												17.9278	0.206436707	9.262274769	0	1.421585883	2.290602517	0.578182678	2.087052002	8.894567665	1.398634299	4.513491157	0	0.004043864	6.498852983	6.723775814	18.48677968	0.18805041	0.747687243	2.919957569	3.503311361	2.551749566	0.260407843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.4652	0	17.514	17.9278	0.206436707	9.262274769	0	1.421585883	2.290602517	0.578182678	2.087052002	8.894567665	1.398634299	4.513491157	0	0.004043864	6.498852983	6.723775814	18.48677968	0.18805041	0.747687243	2.919957569	3.503311361	2.551749566	0.260407843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.4652	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	Similar to Medicare FFS							0												10000	2.474	0.0285	0.9864	0	0.2222	0.3585	0.0905	0.2566	1.1108	0.1627	0.5766	0	0.0007	0.5711	1.1502	3.0012	0.0309	0.1221	0.5391	0.5797	0.228	0.0233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.5131	0	1.592	20.4018	0.234921762	10.24872243	0	1.643807576	2.649078005	0.668667307	2.34363693	10.00532754	1.561375247	5.090079183	0	0.004710761	7.069940774	7.873965233	21.48801751	0.21891629	0.869795371	3.45910049	4.083025248	2.779717244	0.283681079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9783
H4036_803_0	2011	3																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	265.9100101	3.06192984	72.99237875	19.97257601	7.282420038	11.73416947	2.961881637	10.69143237	45.56458992	7.164844959	23.12145811	0	0.020715676	33.29195777	34.44417977	94.703033	0.963334042	3.830210068	14.95819406	17.94656599	13.07195885	1.334002621	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.067420456	0.067420456	0.126893724	0	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0.195207895	0	0	0	0	0	0	0	0												17.9278	0.206436707	9.262274769	0	1.421585883	2.290602517	0.578182678	2.087052002	8.894567665	1.398634299	4.513491157	0	0.004043864	6.498852983	6.723775814	18.48677968	0.18805041	0.747687243	2.919957569	3.503311361	2.551749566	0.260407843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.4652	0	17.514	17.9278	0.206436707	9.262274769	0	1.421585883	2.290602517	0.578182678	2.087052002	8.894567665	1.398634299	4.513491157	0	0.004043864	6.498852983	6.723775814	18.48677968	0.18805041	0.747687243	2.919957569	3.503311361	2.551749566	0.260407843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.4652	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	Similar to Medicare FFS							0												10000	2.474	0.0285	0.9864	0	0.2222	0.3585	0.0905	0.2566	1.1108	0.1627	0.5766	0	0.0007	0.5711	1.1502	3.0012	0.0309	0.1221	0.5391	0.5797	0.228	0.0233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.5131	0	1.592	20.4018	0.234921762	10.24872243	0	1.643807576	2.649078005	0.668667307	2.34363693	10.00532754	1.561375247	5.090079183	0	0.004710761	7.069940774	7.873965233	21.48801751	0.21891629	0.869795371	3.45910049	4.083025248	2.779717244	0.283681079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9783
H4102_001_0	2011	7																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1419.286612	120.2113984	1471.506646	2185.280808	344.5301001	5.701002373	6.208109444	364.5056007	27.54216654	17.78461845	38.55980289	0	0.133468365	23.87324423	5123.06023	96.05933267	585.7329269	451.29871	0	0	11.05239841	1840.981004	0	0	219.4931331	0	14.54125277	6	0	0											4250	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-53 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												206.8631108	127.8912646	62.27304267	0	200	0.2	0.105056429	47.96219988	0.2	0.115978378	0.1647778	0	0.2	0.159209531	10.25871136	0.136563427	38.5	35	0	0	0.2	34.66443668	0	0	35	0	0	0	0	0											YES	151.8417217	93.87478386	45.70967719	0	146.8040591	0.146804059	0.077113551	35.22155062	0.146804059	0.085130484	0.12095025	0	0.146804059	0.116863027	9.790503525	0.130413736	36.74285908	33.40259917	0	0	0.146804059	25.44440006	0	0	35	0	0	0	0	0											4250	17.9589	0.940401587	5.605174482	0	4.214868099	0.836930289	0.478729366	1.069871039	4.043301845	1.514013168	4.663817791	0	0.019593698	2.789899583	4.17977827	12.52745643	1.793458533	1.256212493	0	0	1.622536949	3.903554764	0	0	0.640188305	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0587	0	18.93117708	17.9589	0.940401587	5.605174482	0	4.214868099	0.836930289	0.478729366	1.069871039	4.043301845	1.514013168	4.663817791	0	0.019593698	2.789899583	4.17977827	12.52745643	1.793458533	1.256212493	0	0	1.622536949	3.903554764	0	0	0.640188305	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0587	NO	"$375 Days 1-12 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-12 (1b); $0 n/c (1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $50 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.361	0.0876	0	0.7001	0.6257	0.1864	0.2029	0.1589	0.9003	0.2248	1.02	0	0.0029	0.62	1.3978	2.9436	0.3358	0.2974	0	0	0.3472	0.7942	0	0	0.1402	0	0.0103	0	0	0											12.3571	0	4.836626905	19.3199	1.027990703	5.605174482	0.700071335	4.84056792	1.023294532	0.681670803	1.228746299	4.943647899	1.738769375	5.683866613	0	0.022502394	3.409880852	5.577591865	15.47110616	2.129293031	1.553632724	0	0	1.969751128	4.697735647	0	0	0.780362149	0	0.010275252	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4158
H4102_025_0	2011	1																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1508.22897	130.1904284	1383.391166	2641.960013	391.3705723	8.882844099	7.465978417	397.6033583	25.94803546	17.6309535	37.16623592	0	0.258516965	24.2260458	5407.817034	114.7612609	680.7149156	537.552178	0	0	11.64161987	2009.4212	0	0	252.9508167	0	17.15606123	0	0	0											3750	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-48 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												206.8631108	127.8912646	59.67158691	0	200	0.2	0.12393498	47.55659151	0.2	0.126523876	0.168453084	0	0.2	0.159900579	10.28639228	0.129751184	38.5	35	0	0	0.2	34.7018155	0	0	35	0	0	0	0	0											NO	150.1741881	92.84384614	43.3191403	0	145.1918494	0.145191849	0.089971745	34.5424864	0.145191849	0.091851177	0.122290074	0	0.145191849	0.116081304	9.801601043	0.123736593	36.68551908	33.35047189	0	0	0.145191849	25.19210385	0	0	35	0	0	0	0	0												18.8748	1.007281675	4.993943001	0	4.735318099	1.289716563	0.671727106	1.144517383	3.767443257	1.619423839	4.545061741	0	0.037534556	2.812190993	4.417105423	14.20016745	2.081031669	1.493968234	0	0	1.690268318	4.218462295	0	0	0.737773215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.3377	0	20.49045585	18.8748	1.007281675	4.993943001	0	4.735318099	1.289716563	0.671727106	1.144517383	3.767443257	1.619423839	4.545061741	0	0.037534556	2.812190993	4.417105423	14.20016745	2.081031669	1.493968234	0	0	1.690268318	4.218462295	0	0	0.737773215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.3377	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.8748	1.007281675	4.993943001	0	4.735318099	1.289716563	0.671727106	1.144517383	3.767443257	1.619423839	4.545061741	0	0.037534556	2.812190993	4.417105423	14.20016745	2.081031669	1.493968234	0	0	1.690268318	4.218462295	0	0	0.737773215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.3377
H4102_801_0	2011	1																															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	238.4794105	8.0703	34.37251269	1926.662546	9.237893028	6.250163427	9.264608089	17.33270177	43.85481812	24.75099246	54.26127477	0	0.018598137	37.55023872	33.60133325	127.3807529	3.8232	16.39652144	0	0	18.64064533	13.57631776	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.064649589	0.064649589	0.12388839	0	0.186295188	0.186295188	0.186295188	0.186295188	0.186295188	0.186295188	0.186295188	0	0.186295188	0.186295188	0.186295188	0.186295188	0.186295188	0.186295188	0	0	0.186295188	0.186295188	0	0	0	0	0	0	0	0												15.4176	0.521741579	4.258355255	0	1.720975022	1.164375373	1.72595191	3.228998942	8.169941605	4.610990804	10.10861441	0	0.003464744	6.995428798	6.25976671	23.73042136	0.712243764	3.054593052	0	0	3.472662534	2.529202675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.6853	0	24.49002956	15.4176	0.521741579	4.258355255	0	1.720975022	1.164375373	1.72595191	3.228998942	8.169941605	4.610990804	10.10861441	0	0.003464744	6.995428798	6.25976671	23.73042136	0.712243764	3.054593052	0	0	3.472662534	2.529202675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.6853	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.4176	0.521741579	4.258355255	0	1.720975022	1.164375373	1.72595191	3.228998942	8.169941605	4.610990804	10.10861441	0	0.003464744	6.995428798	6.25976671	23.73042136	0.712243764	3.054593052	0	0	3.472662534	2.529202675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.6853
H4102_802_0	2011	1																															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	238.3904579	8.0716	34.35969178	1925.943903	9.234447305	6.247832123	9.261152401	17.32623669	43.83846032	24.74176037	54.24103537	0	0.0185912	37.53584364	33.5888	127.33324	3.8222	16.39040556	0	0	18.63369239	13.57125381	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.064656055	0.064656055	0.12390078	0	0.186313819	0.186313819	0.186313819	0.186313819	0.186313819	0.186313819	0.186313819	0	0.186313819	0.186313819	0.186313819	0.186313819	0.186313819	0.186313819	0	0	0.186313819	0.186313819	0	0	0	0	0	0	0	0												15.4134	0.52187781	4.257192601	0	1.720505146	1.164057465	1.725480675	3.228117332	8.167710974	4.60973187	10.10585446	0	0.003463798	6.993446389	6.258057613	23.72394227	0.71212868	3.05375906	0	0	3.471714397	2.528512129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.6589	0	24.47120078	15.4134	0.52187781	4.257192601	0	1.720505146	1.164057465	1.725480675	3.228117332	8.167710974	4.60973187	10.10585446	0	0.003463798	6.993446389	6.258057613	23.72394227	0.71212868	3.05375906	0	0	3.471714397	2.528512129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.6589	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.4134	0.52187781	4.257192601	0	1.720505146	1.164057465	1.725480675	3.228117332	8.167710974	4.60973187	10.10585446	0	0.003463798	6.993446389	6.258057613	23.72394227	0.71212868	3.05375906	0	0	3.471714397	2.528512129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.6589
H4102_803_0	2011	1																															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	238.278782	8.0717	34.34359571	1925.492738	9.230121354	6.244905276	9.25681394	17.31812008	43.81792384	24.73016989	54.21562572	0	0.018582491	37.51827344	33.57306505	127.2735897	3.8223	16.38272734	0	0	18.62496329	13.56489624	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.064664134	0.064664134	0.123916263	0	0.186337102	0.186337102	0.186337102	0.186337102	0.186337102	0.186337102	0.186337102	0	0.186337102	0.186337102	0.186337102	0.186337102	0.186337102	0.186337102	0	0	0.186337102	0.186337102	0	0	0	0	0	0	0	0												15.4081	0.521949494	4.255730042	0	1.719914066	1.163657553	1.724887886	3.227008311	8.164904955	4.608148195	10.10238259	0	0.003462608	6.991046355	6.255907655	23.71579191	0.712236306	3.05270994	0	0	3.470521688	2.527643458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.626	0	24.4476904	15.4081	0.521949494	4.255730042	0	1.719914066	1.163657553	1.724887886	3.227008311	8.164904955	4.608148195	10.10238259	0	0.003462608	6.991046355	6.255907655	23.71579191	0.712236306	3.05270994	0	0	3.470521688	2.527643458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.626	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.4081	0.521949494	4.255730042	0	1.719914066	1.163657553	1.724887886	3.227008311	8.164904955	4.608148195	10.10238259	0	0.003462608	6.991046355	6.255907655	23.71579191	0.712236306	3.05270994	0	0	3.470521688	2.527643458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.626
H4102_806_0	2011	1																															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	225.173449	7.637679	31.2526721	1636.668827	7.845603151	5.308169484	7.868291849	14.72040206	37.24523527	21.02064441	46.08328187	0	0.015795117	31.89078743	28.70497062	108.8189192	3.29859	14.00723188	0	0	15.92434361	11.59798629	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.065023532	0.065023532	0.12460498	0	0.187372749	0.187372749	0.187372749	0.187372749	0.187372749	0.187372749	0.187372749	0	0.187372749	0.187372749	0.187372749	0.187372749	0.187372749	0.187372749	0	0	0.187372749	0.187372749	0	0	0	0	0	0	0	0												14.6416	0.496628868	3.894238567	0	1.470052227	0.994606306	1.474303471	2.758202195	6.978742105	3.93869592	8.634751188	0	0.002959575	5.975464496	5.378529244	20.3897	0.618065875	2.624573538	0	0	2.983788032	2.173146569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.428	0	20.80262914	14.6416	0.496628868	3.894238567	0	1.470052227	0.994606306	1.474303471	2.758202195	6.978742105	3.93869592	8.634751188	0	0.002959575	5.975464496	5.378529244	20.3897	0.618065875	2.624573538	0	0	2.983788032	2.173146569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.428	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0597	0.0359	0.4789	0	0.3226	0.2183	0.3235	0.6053	1.5314	0.8643	1.8948	0	0.0006	1.3113	1.1343	4.2999	0.1303	0.5535	0	0	0.6292	0.4583	0	0	0	0	0	0	0	0											15.8523	0	0	15.7012	0.532571703	4.373169805	0	1.792644968	1.212865746	1.797829118	3.363470492	8.510178543	4.803015358	10.52958731	0	0.003609033	7.286738638	6.512795247	24.68963823	0.748408405	3.178063981	0	0	3.613032417	2.631436589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.2803
H4102_807_0	2011	1																															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	225.173449	7.637679	31.2526721	1636.668827	7.845603151	5.308169484	7.868291849	14.72040206	37.24523527	21.02064441	46.08328187	0	0.015795117	31.89078743	28.70497062	108.8189192	3.29859	14.00723188	0	0	15.92434361	11.59798629	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.065023532	0.065023532	0.12460498	0	0.187372749	0.187372749	0.187372749	0.187372749	0.187372749	0.187372749	0.187372749	0	0.187372749	0.187372749	0.187372749	0.187372749	0.187372749	0.187372749	0	0	0.187372749	0.187372749	0	0	0	0	0	0	0	0												14.6416	0.496628868	3.894238567	0	1.470052227	0.994606306	1.474303471	2.758202195	6.978742105	3.93869592	8.634751188	0	0.002959575	5.975464496	5.378529244	20.3897	0.618065875	2.624573538	0	0	2.983788032	2.173146569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.428	0	20.80262914	14.6416	0.496628868	3.894238567	0	1.470052227	0.994606306	1.474303471	2.758202195	6.978742105	3.93869592	8.634751188	0	0.002959575	5.975464496	5.378529244	20.3897	0.618065875	2.624573538	0	0	2.983788032	2.173146569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.428	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0597	0.0359	0.4789	0	0.3226	0.2183	0.3235	0.6053	1.5314	0.8643	1.8948	0	0.0006	1.3113	1.1343	4.2999	0.1303	0.5535	0	0	0.6292	0.4583	0	0	0	0	0	0	0	0											15.8523	0	0	15.7012	0.532571703	4.373169805	0	1.792644968	1.212865746	1.797829118	3.363470492	8.510178543	4.803015358	10.52958731	0	0.003609033	7.286738638	6.512795247	24.68963823	0.748408405	3.178063981	0	0	3.613032417	2.631436589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.2803
H4102_808_0	2011	1																															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	225.173449	7.637679	31.2526721	1636.668827	7.845603151	5.308169484	7.868291849	14.72040206	37.24523527	21.02064441	46.08328187	0	0.015795117	31.89078743	28.70497062	108.8189192	3.29859	14.00723188	0	0	15.92434361	11.59798629	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.065023532	0.065023532	0.12460498	0	0.187372749	0.187372749	0.187372749	0.187372749	0.187372749	0.187372749	0.187372749	0	0.187372749	0.187372749	0.187372749	0.187372749	0.187372749	0.187372749	0	0	0.187372749	0.187372749	0	0	0	0	0	0	0	0												14.6416	0.496628868	3.894238567	0	1.470052227	0.994606306	1.474303471	2.758202195	6.978742105	3.93869592	8.634751188	0	0.002959575	5.975464496	5.378529244	20.3897	0.618065875	2.624573538	0	0	2.983788032	2.173146569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.428	0	20.80262914	14.6416	0.496628868	3.894238567	0	1.470052227	0.994606306	1.474303471	2.758202195	6.978742105	3.93869592	8.634751188	0	0.002959575	5.975464496	5.378529244	20.3897	0.618065875	2.624573538	0	0	2.983788032	2.173146569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.428	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0597	0.0359	0.4789	0	0.3226	0.2183	0.3235	0.6053	1.5314	0.8643	1.8948	0	0.0006	1.3113	1.1343	4.2999	0.1303	0.5535	0	0	0.6292	0.4583	0	0	0	0	0	0	0	0											15.8523	0	0	15.7012	0.532571703	4.373169805	0	1.792644968	1.212865746	1.797829118	3.363470492	8.510178543	4.803015358	10.52958731	0	0.003609033	7.286738638	6.512795247	24.68963823	0.748408405	3.178063981	0	0	3.613032417	2.631436589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.2803
H4125_001_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	1345.876121	72.46470685	202.84708		138.4003527	10.7454162	9.379855377	365.2056754	212.664179		11.40714643	1.084030071	0.19451244	20.37433949		2945.281649	113.1931767	357.7407372	19.99739077		8.800645898			11.76442105	159.1037094		97.843751														3900	"1a (IP Acute) 175 days 1-5, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 275 copay, 9b (OP ASC) 200 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 25 copay, 7i (PT/ST) 25 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 25 copay, 7f (Podiatry) 25 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 25 copay, 18a (Hearing Exam) 25 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 25 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 25 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0%coin"	18a1 (Routine Hearing Exam) 25 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												108.3169221	172.0337627	49.94161658		150	0.2	0.2	48.78462937	253.5910457		0.2	0.2	0.2	0.198658945		24.42341854	40	25	0.181		0.2			0.321428571	5		25														NO	101.0555081	160.5008613	46.59360089		139.9442111	0.186592281	0.186592281	45.51417647	236.5906589		0.186592281	0.186592281	0.186592281	0.185341129		22.8015338	37.31845629	23.32403518	0.168866015		0.186592281			0.321428571	5		23.32403518															11.334	0.969220656	0.787614657	0	1.614027347	2.005011724	1.750208615	1.38516963	4.192863186	0	2.128485478	0.202271644	0.03629452	3.776203091	0	5.596411589	0.352016218	0.695329795	3.376879685	0	1.642132596	0	0	3.781421048	0.066293212	0	0.190175924	0	0	0	0	0	0	0	0	0	0	0	0	0	45.882	0	3.016347848	11.334	0.969220656	0.787614657	0	1.614027347	2.005011724	1.750208615	1.38516963	4.192863186	0	2.128485478	0.202271644	0.03629452	3.776203091	0	5.596411589	0.352016218	0.695329795	3.376879685	0	1.642132596	0	0	3.781421048	0.066293212	0	0.190175924	0	0	0	0	0	0	0	0	0	0	0	0	0	45.882	NO																																																																																		0	0	0	11.334	0.969220656	0.787614657	0	1.614027347	2.005011724	1.750208615	1.38516963	4.192863186	0	2.128485478	0.202271644	0.03629452	3.776203091	0	5.596411589	0.352016218	0.695329795	3.376879685	0	1.642132596	0	0	3.781421048	0.066293212	0	0.190175924	0	0	0	0	0	0	0	0	0	0	0	0	0	45.882
H4125_005_0	2011	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin	T	Coin	P	P	P	P	O	V																																																			0	YES	350.7140597	6.558701872	23.46346274		11.86336075	11.92859511	12.45293022	26.34721403	67.17351368		18.09542075	3.857303635	0.599160353	32.19904564		7144.666562	4.173927624	1013.308784	44.65875468	18.71345622	25.10144104	1.25964044		13.93798932	159.1037094		200.8019368														3400	"1a (IP Acute) FFS, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 20% coin	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 20% coin, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 20% coin"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 0-20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 20% coin, 5 (Partial Hosp) 20% coin, 7c (OT) 8 copay, 7i (PT/ST) 8 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 20% coin, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 8 copay, 7b1 (Routine Chiro) 0% coin (5 visits), 7d (SPC w/Copay) 8 copay, 7f (Podiatry) 8 copay, 7f1 (Routine Podiatry) 0% coin (3 visits), 17a (Eye Exam) 8 copay, 18a (Hearing Exam) 8 copay"	"7e (MH Non-Phys) 45% coin, 7h (Psych) 45% coin"	7i (PT/ST) 8 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0-20% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 8 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 8 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 81"												0.082851346	0.082851346	0.182284191		0.2	0.2	0.2	0.2	0.2		0.2	0.2	0.2	0.2		8	0.45	8	0.181	0.07872	0.2	0.2		0.135384615	5		8														NO	0.067112643	0.067112643	0.14765691		0.162007368	0.162007368	0.162007368	0.162007368	0.162007368		0.162007368	0.162007368	0.162007368	0.162007368		6.480294731	0.364516579	6.480294731	0.146616668	0.0637661	0.162007368	0.162007368		0.135384615	5		6.480294731															23.5373	0.440171815	3.464542415	0	1.921951854	1.932520301	2.017466453	4.268442806	10.88260417	0	2.931591493	0.624911611	0.097068392	5.216482644	0	3.858295423	1.521465817	0.547211631	6.547717821	1.193284123	4.066618402	0.204071033	0	1.886989318	0.066293212	0	0.108437978	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3355	0	17.6780126	23.5373	0.440171815	3.464542415	0	1.921951854	1.932520301	2.017466453	4.268442806	10.88260417	0	2.931591493	0.624911611	0.097068392	5.216482644	0	3.858295423	1.521465817	0.547211631	6.547717821	1.193284123	4.066618402	0.204071033	0	1.886989318	0.066293212	0	0.108437978	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3355	NO																																																																																		0	0	0	23.5373	0.440171815	3.464542415	0	1.921951854	1.932520301	2.017466453	4.268442806	10.88260417	0	2.931591493	0.624911611	0.097068392	5.216482644	0	3.858295423	1.521465817	0.547211631	6.547717821	1.193284123	4.066618402	0.204071033	0	1.886989318	0.066293212	0	0.108437978	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3355
H4141_001_0	2011	5	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	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	1563.17471	66.531176	649.333413	1612.8979	217.669033	9.685025	1.459024	378.399102	315.265588	1458.678546	1461.339169	74.007173	0.535957	590.661117	4518.544814	4684.863139	71.305734	703.984757		1784.41588	32.829462	0							4.91	0.41	7208.555697										3400	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$0-$195/Visit:9b. $0 Surgery ASC -- Physician,9b. $195 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $195 Surgery OP -- Facility"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0-$175/Visit:8b, 9a. $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,8b, 9a. $175 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0-$175/Visit:9d. $10 Cardiac Rehab,8b. $175 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $0 Rad therapy,3, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"											140.1309	119.971605	68.8913	0	150	0.2	0.2	50	195	0	67.905789	50	0.2	42.650569	10	35	35	10		0	0.2	0							0	0	0										NO	116.877158	100.063157	37.82339	0	128.15115	0.170868	0.170868	42.71705	166.596495	0	58.0147	42.71705	0.170868	36.43813	8.54341	29.901935	29.901935	8.54341		0	0.170868	0							0	0	0											15.225	0.554776626	2.04666591	0	2.324544742	1.654860852	0.249300513	1.34700778	4.376845163	0	7.064929457	0.263447342	0.091577901	1.793548881	3.216981746	11.67387276	0.177681619	0.501202534	0	0	5.609504513	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1717	0	11.69922164	15.225	0.554776626	2.04666591	0	2.324544742	1.654860852	0.249300513	1.34700778	4.376845163	0	7.064929457	0.263447342	0.091577901	1.793548881	3.216981746	11.67387276	0.177681619	0.501202534	0	0	5.609504513	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1717	NO																																																																																		0	0	0	15.225	0.554776626	2.04666591	0	2.324544742	1.654860852	0.249300513	1.34700778	4.376845163	0	7.064929457	0.263447342	0.091577901	1.793548881	3.216981746	11.67387276	0.177681619	0.501202534	0	0	5.609504513	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1717
H4141_801_0	2011	4																															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	YES	299.604315	4.202785	30.791769	16.638867	7.530153	9.590014	3.385759	27.30316	50.643083	5.468935	29.640926	5.255662	0.5307	10.187005	39.505953	71.554709	0.49283	5.465823		7.772377	32.507402	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.079588	0.079588	0.169787	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.072643	0.072643	0.120877	0	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935		0.211935	0.211935	0																				21.7642	0.305302911	3.722016661	0	1.595902976	2.032459617	0.717560834	5.786495215	10.7330418	1.159058739	6.281949652	1.113858726	0.112473905	2.158982905	8.372694149	15.16494725	0.104447926	1.158399198	0	1.647238719	6.889456243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.8204	0	10.0793669	21.7642	0.305302911	3.722016661	0	1.595902976	2.032459617	0.717560834	5.786495215	10.7330418	1.159058739	6.281949652	1.113858726	0.112473905	2.158982905	8.372694149	15.16494725	0.104447926	1.158399198	0	1.647238719	6.889456243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.8204	NO																																																																																		0	0	0	21.7642	0.305302911	3.722016661	0	1.595902976	2.032459617	0.717560834	5.786495215	10.7330418	1.159058739	6.281949652	1.113858726	0.112473905	2.158982905	8.372694149	15.16494725	0.104447926	1.158399198	0	1.647238719	6.889456243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.8204
H4141_802_0	2011	4																															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	YES	299.604315	4.202785	30.791769	16.638867	7.530153	9.590014	3.385759	27.30316	50.643083	5.468935	29.640926	5.255662	0.5307	10.187005	39.505953	71.554709	0.49283	5.465823		7.772377	32.507402	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.079588	0.079588	0.169787	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.072643	0.072643	0.120877	0	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935		0.211935	0.211935	0																				21.7642	0.305302911	3.722016661	0	1.595902976	2.032459617	0.717560834	5.786495215	10.7330418	1.159058739	6.281949652	1.113858726	0.112473905	2.158982905	8.372694149	15.16494725	0.104447926	1.158399198	0	1.647238719	6.889456243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.8204	0	10.0793669	21.7642	0.305302911	3.722016661	0	1.595902976	2.032459617	0.717560834	5.786495215	10.7330418	1.159058739	6.281949652	1.113858726	0.112473905	2.158982905	8.372694149	15.16494725	0.104447926	1.158399198	0	1.647238719	6.889456243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.8204	NO																																																																																		0	0	0	21.7642	0.305302911	3.722016661	0	1.595902976	2.032459617	0.717560834	5.786495215	10.7330418	1.159058739	6.281949652	1.113858726	0.112473905	2.158982905	8.372694149	15.16494725	0.104447926	1.158399198	0	1.647238719	6.889456243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.8204
H4141_803_0	2011	4																															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	YES	299.604315	4.202785	30.791769	16.638867	7.530153	9.590014	3.385759	27.30316	50.643083	5.468935	29.640926	5.255662	0.5307	10.187005	39.505953	71.554709	0.49283	5.465823		7.772377	32.507402	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.079588	0.079588	0.169787	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.072643	0.072643	0.120877	0	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935	0.211935		0.211935	0.211935	0																				21.7642	0.305302911	3.722016661	0	1.595902976	2.032459617	0.717560834	5.786495215	10.7330418	1.159058739	6.281949652	1.113858726	0.112473905	2.158982905	8.372694149	15.16494725	0.104447926	1.158399198	0	1.647238719	6.889456243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.8204	0	10.0793669	21.7642	0.305302911	3.722016661	0	1.595902976	2.032459617	0.717560834	5.786495215	10.7330418	1.159058739	6.281949652	1.113858726	0.112473905	2.158982905	8.372694149	15.16494725	0.104447926	1.158399198	0	1.647238719	6.889456243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.8204	NO																																																																																		0	0	0	21.7642	0.305302911	3.722016661	0	1.595902976	2.032459617	0.717560834	5.786495215	10.7330418	1.159058739	6.281949652	1.113858726	0.112473905	2.158982905	8.372694149	15.16494725	0.104447926	1.158399198	0	1.647238719	6.889456243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.8204
H4152_004_0	2011	4	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	1586.628436	65.39330575	1911.030811		413.9366832	3.025635799		211.6073633	285.3446892		337.2239846		19.59105713	36.52098513	2777.78234	4218.249115	201.5876781	1095.851881							375.2609744		0		888.9711211		124.7649149	448.5632513	24.57627516								3350	$335 per day for days 1-6  (PBP# 1a)	$335 per day for days 1-6 (PBP# 1b)	$100 per day for days 1-30 (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, 16b)"	No Copay	$150 Copay per day for specified services (PBP# 8b)	No Copay	$25 Copay per visit (PBP# 12)	"$40 Copay per visit at a wound care clinic (PBP# 9a, 9b)"	"$15 Copay per visit (PBP# 7a, 7g, 13f)"	"$40 Copay per visit (PBP# 7b, 7d, 7f, 7g, 17a, 18a)"	"$40 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	$40 Copay per visit (PBP# 17a)	Not Covered	$40 Copay per visit (PBP# 18a)	Not Covered	$15 Monthly (PBP# 14a)	Not Covered	$35 Copay per visit (PBP# 4b)	No Copay	$50 Copay per visit (PBP# 5)								0	335	335	100		150	0.2		50	175		150		25	40	15	40	40	15							40		40		15		35	0	50								NO	147.0535463	130.2083642	62.36286099		129.7110926	0.172948123		43.23703086	151.329608		129.7110926		21.61851543	34.58962468	12.97110926	34.58962468	34.58962468	12.97110926							40		40		15		30.2659216	0	43.23703086									19.4433	0.709562948	9.931445735	0	4.474348286	0.523278034	0	0.762439508	3.598424997	0	3.645140957	0	0.035294131	0.105270597	3.002576519	12.15897114	0.581070177	1.18453454	0	0	0	0	0	0	1.250869915	0	0	0	1.111213901	0	0.314677094	0	0.088550431	0	0	0	0	0	0	0	62.9209	0	9.390540871	19.4433	0.709562948	9.931445735	0	4.474348286	0.523278034	0	0.762439508	3.598424997	0	3.645140957	0	0.035294131	0.105270597	3.002576519	12.15897114	0.581070177	1.18453454	0	0	0	0	0	0	1.250869915	0	0	0	1.111213901	0	0.314677094	0	0.088550431	0	0	0	0	0	0	0	62.9209	NO																																																																																		0			19.4433	0.709562948	9.931445735	0	4.474348286	0.523278034	0	0.762439508	3.598424997	0	3.645140957	0	0.035294131	0.105270597	3.002576519	12.15897114	0.581070177	1.18453454	0	0	0	0	0	0	1.250869915	0	0	0	1.111213901	0	0.314677094	0	0.088550431	0	0	0	0	0	0	0	62.9209
H4152_005_0	2011	5	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	1867.055007	81.77737086	2816.524065		474.4990029	6.658530013		249.9211357	318.3222762		374.3861162		3.727895538	32.34201264	3461.134981	4853.814402	359.4446341	1214.117003							434.5783675		0		888.9711211		151.0047638	512.803882	58.94105108								2400	$240 per day for days 1-6  (PBP# 1a)	$240 per day for days 1-6 (PBP# 1b)	$80 per day for days 1-30 (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, 16b)"	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 (PBP# 7a, 7g, 13f)"	"$30 Copay per visit (PBP# 7b, 7d, 7f, 7g, 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)	No Copay	$40 Copay per visit (PBP# 5)								0	240	240	80		150	0.2		50	150		150		25	30	10	30	30	15							30		30		15		35	0	40								NO	109.7890055	99.29121775	39.93735071		120.2124335	0.160283245		40.07081116	120.2124335		120.2124335		20.03540558	24.04248669	8.014162231	24.04248669	24.04248669	12.02124335							30		30		15		28.04956781	0	32.05664893									17.0818	0.676647895	9.373709116	0	4.753389984	1.067250795	0	0.834545219	3.188857954	0	3.75048884	0	0.006224158	0.064798534	2.311508104	9.724814015	0.720161903	1.216266329	0	0	0	0	0	0	1.086445919	0	0	0	1.111213901	0	0.352968197	0	0.157454382	0	0	0	0	0	0	0	57.4786	0	13.43368671	17.0818	0.676647895	9.373709116	0	4.753389984	1.067250795	0	0.834545219	3.188857954	0	3.75048884	0	0.006224158	0.064798534	2.311508104	9.724814015	0.720161903	1.216266329	0	0	0	0	0	0	1.086445919	0	0	0	1.111213901	0	0.352968197	0	0.157454382	0	0	0	0	0	0	0	57.4786	NO																																																																																		0			17.0818	0.676647895	9.373709116	0	4.753389984	1.067250795	0	0.834545219	3.188857954	0	3.75048884	0	0.006224158	0.064798534	2.311508104	9.724814015	0.720161903	1.216266329	0	0	0	0	0	0	1.086445919	0	0	0	1.111213901	0	0.352968197	0	0.157454382	0	0	0	0	0	0	0	57.4786
H4152_007_0	2011	5	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	2694.039981	129.4053716	3826.423254		691.1673409	7.142878966		314.0796654	399.0934602		471.9539728		15.59314997	52.23071373	3915.525525	6037.948438	667.9559589	1807.244626							495.2347154		1.994813873		888.9711211		171.9565451	514.7142583	81.6421836								1750	$175 per day for days 1-8  (PBP# 1a)	$175 per day for days 1-8 (PBP# 1b)	$80 per day for days 1-30 (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, 16b)"	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 (PBP# 7a, 7g, 13f)"	"$30 Copay per visit (PBP# 7b, 7d, 7f, 7g, 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)	No Copay	$40 Copay per visit (PBP# 5)								0	175	175	80		150	0.2		50	95		150		25	30	10	30	30	15							30		30		15		35	0	40								NO	66.23824996	63.13521771	35.24361437		107.10255	0.1428034		35.70085001	67.83161503		107.10255		17.85042501	21.42051001	7.140170003	21.42051001	21.42051001	10.710255							30		30		15		24.99059501	0	28.56068001									14.8707	0.680836359	11.23808213	0	6.168815393	1.020027403	0	0.934409252	2.255929496	0	4.212289499	0	0.023195363	0.093234044	2.329793158	10.77799458	1.192329775	1.613004233	0	0	0	0	0	0	1.238086789	0	0.004987035	0	1.111213901	0	0.358108031	0	0.194313023	0	0	0	0	0	0	0	60.3174	0	22.80725292	14.8707	0.680836359	11.23808213	0	6.168815393	1.020027403	0	0.934409252	2.255929496	0	4.212289499	0	0.023195363	0.093234044	2.329793158	10.77799458	1.192329775	1.613004233	0	0	0	0	0	0	1.238086789	0	0.004987035	0	1.111213901	0	0.358108031	0	0.194313023	0	0	0	0	0	0	0	60.3174	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									0.0139	0	0.0017	0.0044	0	0.0974	0.0051	0	0.0601	0.0066	0.0414	0	0	0	0.0157	0.1865	0.0173	0.0066	0	0	0	0	0	0	0.0046	0	0.0005	0	0	0	0	0.0006	0								0.4624	0	0	14.8846	0.680836359	11.23977968	0.004417647	6.168815393	1.117430758	0.005127079	0.934409252	2.3159844	0.006553042	4.253674736	0	0.023195363	0.093234044	2.3454881	10.9645354	1.209626092	1.619627494	0	0	0	0	0	0	1.242663958	0	0.005467289	0	1.111213901	0	0.358108031	0.00063197	0.194313023	0	0	0	0	0	0	0	60.7797
H4152_013_0	2011	5	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	1387.447928	104.9362224	1835.107429		373.6671341	4.397381436		242.6970125	303.2888378		374.3681121		11.553004	29.02048063	3175.562181	4524.474409	535.3013568	1199.610741							448.8921072		0		888.9711211		145.2616421	494.9785026	69.09880992								3350	$335 per day for days 1-6  (PBP# 1a)	$335 per day for days 1-6 (PBP# 1b)	$100 per day for days 1-30 (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, 16b)"	No Copay	$150 Copay per day for specified services (PBP# 8b)	No Copay	$25 Copay per visit (PBP# 12)	"$40 Copay per visit at a wound care clinic (PBP# 9a, 9b)"	"$15 Copay per visit (PBP# 7a, 7g, 13f)"	"$40 Copay per visit (PBP# 7b, 7d, 7f, 7g, 17a, 18a)"	"$40 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	$40 Copay per visit (PBP# 17a)	Not Covered	$40 Copay per visit (PBP# 18a)	Not Covered	$15 Monthly (PBP# 14a)	Not Covered	$35 Copay per visit (PBP# 4b)	No Copay	$50 Copay per visit (PBP# 5)								0	335	335	100		150	0.2		50	175		150		25	40	15	40	40	15							40		40		15		35	0	50								NO	150.2148937	126.3556469	56.97619704		131.1968164	0.174929088		43.73227212	153.0629524		131.1968164		21.86613606	34.98581769	13.11968164	34.98581769	34.98581769	13.11968164							40		40		15		30.61259048	0	43.73227212									17.3679	1.104940355	8.713120207	0	4.085328198	0.769229926	0	0.884474316	3.868523745	0	4.092992037	0	0.02105163	0.08460877	3.471863736	13.1910364	1.560662973	1.311542584	0	0	0	0	0	0	1.496307024	0	0	0	1.111213901	0	0.370569597	0	0.251820663	0	0	0	0	0	0	0	63.7572	0	8.653765388	17.3679	1.104940355	8.713120207	0	4.085328198	0.769229926	0	0.884474316	3.868523745	0	4.092992037	0	0.02105163	0.08460877	3.471863736	13.1910364	1.560662973	1.311542584	0	0	0	0	0	0	1.496307024	0	0	0	1.111213901	0	0.370569597	0	0.251820663	0	0	0	0	0	0	0	63.7572	NO																																																																																		0			17.3679	1.104940355	8.713120207	0	4.085328198	0.769229926	0	0.884474316	3.868523745	0	4.092992037	0	0.02105163	0.08460877	3.471863736	13.1910364	1.560662973	1.311542584	0	0	0	0	0	0	1.496307024	0	0	0	1.111213901	0	0.370569597	0	0.251820663	0	0	0	0	0	0	0	63.7572
H4152_815_0	2011	4	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	NO	181.2327085	4.518266972	558.1195576		310.0302243	2.42355689		209.3930246	1.224477315		0.613204176		0	0.613204176	3314.299132	5918.084257	427.4137847	0		0					493.7048782		0.615044044		923.4879405		135.7063297	523.8275264	80.9429513									$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 (PBP# 7a, 7g, 13f)"	"$20 Copay per visit (PBP# 7b, 7d, 7f, 7g, 17a, 18a)"	No Copay	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)	No Copay	No Copay								0	100	100	50		50	0		50	0		0		0	0	10	20	0	0		0					20		20		15		25	0	0								NO	100	100	50		50	0		50	0		0		0	0	10	20	0	0		0					20		20		15		25	0	0									1.5103	0.037652225	2.325498157	0	1.291792601	0	0	0.872470936	0	0	0	0	0	0	2.761915943	9.863473762	0	0	0	0	0	0	0	0	0.822841464	0	0.001025073	0	1.154359926	0	0.28272152	0	0	0	0	0	0	0	0	0	20.924	0	0	1.5103	0.037652225	2.325498157	0	1.291792601	0	0	0.872470936	0	0	0	0	0	0	2.761915943	9.863473762	0	0	0	0	0	0	0	0	0.822841464	0	0.001025073	0	1.154359926	0	0.28272152	0	0	0	0	0	0	0	0	0	20.924	NO	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)	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)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)									0.0698	0	0.0085	0.0222	0	0.4948	0.0274	0	0.3353	0.038	0.2518	0	0	0	0.0867	1.0348	0.1104	0.0476	0	0	0	0	0	0	0.023	0	0.0024	0	0	0	0	0.0045	0.1355								2.6926	0	0	1.5801	0.037652225	2.334029307	0.022201273	1.291792601	0.494750927	0.027412631	0.872470936	0.335311047	0.038003456	0.251785486	0	0	0	2.848567948	10.89828644	0.110368905	0.04764067	0	0	0	0	0	0	0.84584443	0	0.003438633	0	1.154359926	0	0.28272152	0.00446013	0.135496099	0	0	0	0	0	0	0	23.6167
H4152_817_0	2011	4	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	NO	204.0061591	5.086026127	631.3150304		399.2062749	3.199293741		239.5817048	0		0		0	0	3560.955437	5493.690412	105.6478925	0		0					545.7415962		0		1033.679145		176.0781204	581.063409	121.0682239									$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 (PBP# 7a, 7g, 13f)"	"$20 Copay per visit (PBP# 7b, 7d, 7f, 7g, 17a, 18a)"	No Copay	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)	No Copay	No Copay								0	100	100	50		50	0		50	0		0		0	0	10	20	0	0		0					20		20		15		25	0	0								NO	100	100	50		50	0		50	0		0		0	0	10	20	0	0		0					20		20		15		25	0	0									1.7001	0.042383551	2.630479293	0	1.663359479	0	0	0.998257103	0	0	0	0	0	0	2.967462864	9.156150687	0	0	0	0	0	0	0	0	0.909569327	0	0	0	1.292098931	0	0.366829417	0	0	0	0	0	0	0	0	0	21.7266	0	0	1.7001	0.042383551	2.630479293	0	1.663359479	0	0	0.998257103	0	0	0	0	0	0	2.967462864	9.156150687	0	0	0	0	0	0	0	0	0.909569327	0	0	0	1.292098931	0	0.366829417	0	0	0	0	0	0	0	0	0	21.7266	NO																																																																																		0			1.7001	0.042383551	2.630479293	0	1.663359479	0	0	0.998257103	0	0	0	0	0	0	2.967462864	9.156150687	0	0	0	0	0	0	0	0	0.909569327	0	0	0	1.292098931	0	0.366829417	0	0	0	0	0	0	0	0	0	21.7266
H4152_821_0	2011	6	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	172.506243	4.300709658	531.2457601		295.1020797	2.306861145		199.3106225	1.165517985		0.583678021		0	0.583678021	3154.713605	5633.124886	406.8335499	0							469.9326868		0.585429297		879.0214322		129.171987	498.6049111	77.04549876								2500	$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 (PBP# 7a, 7g, 13f)"	"$10 Copay per visit (PBP# 7b, 7d, 7f, 7g, 17a, 18a)"	No Copay	No Copay	No Copay	No Copay	No Copay	No Copay	Not Covered	No Copay	$10 Copay per visit (PBP# 17a)	No Copay	$10 Copay per visit (PBP# 18a)	Not Covered	$15 Monthly (PBP# 14a)	Not Covered	$25 Copay per visit (PBP# 4b)	No Copay	No Copay								0	100	100	50		50	0		50	0		0		0	0	10	10	0	0							10		10		15		25	0	0								YES	100	100	50		50	0		50	0		0		0	0	10	10	0	0							10		10		15		25	0	0								3000	1.4376	0.035839247	2.213524	0	1.229591999	0	0	0.830460927	0	0	0	0	0	0	2.628928004	4.694270738	0	0	0	0	0	0	0	0	0.391610572	0	0.000487858	0	1.09877679	0	0.269108306	0	0	0	0	0	0	0	0	0	14.8302	0	0	1.4376	0.035839247	2.213524	0	1.229591999	0	0	0.830460927	0	0	0	0	0	0	2.628928004	4.694270738	0	0	0	0	0	0	0	0	0.391610572	0	0.000487858	0	1.09877679	0	0.269108306	0	0	0	0	0	0	0	0	0	14.8302	NO	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)	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)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)									0.0698	0	0.0085	0.0222	0	0.4948	0.0274	0	0.3353	0.038	0.2518	0	0	0	0.0867	1.0348	0.1104	0.0476	0	0	0	0	0	0	0.023	0	0.0024	0	0	0	0	0.0045	0.1355								2.6926	0	0	1.5073	0.035839247	2.22205515	0.022201273	1.229591999	0.494750927	0.027412631	0.830460927	0.335311047	0.038003456	0.251785486	0	0	0	2.715580008	5.72908342	0.110368905	0.04764067	0	0	0	0	0	0	0.414613539	0	0.002901418	0	1.09877679	0	0.269108306	0.00446013	0.135496099	0	0	0	0	0	0	0	17.5228
H4155_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	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	2302.380925	78.76015643	1462.039722	19631.80185	148.2652346	20.92429988	4.530026615	48.81775775	285.6889438	26974.92444	480.630052	1291.635929	0	25132.26995	5294.236022	45818.34511	1289.147974	6552.760836	8850.195189	0	20.64796629	14.91188117	436.6666667	825	436.1475039	109.036876	90.95737308	7.57978109	0	0											3400	$0 	$0 	21: $15.53	$0 	10a: $12.50	11a: 0.8%	$0 	"4a1: $50.00,4a2: $50.00"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	152: 20.0%	$0 	$0 	"16b2: $15.00,16b2: $15.00"	$0 	$0 	$0 	$0 	$0 	$0 												0	0	15.53	0	12.5	0.008408694	0	38.60335319	0	0	0	0	0	0	0	0	0	0	0	0	0.0746	0	0	5.753495449	0	0	0	0	0	0											NO	0	0	15.52457745	0	12.49563542	0.008405758	0	38.5898742	0	0	0	0	0	0	0	0	0	0	0	0	0.074573952	0	0	5.751486523	0	0	0	0	0	0												0	0	1.891462408	0	0.154389026	0.175884602	0	0.156989261	0	0	0	0	0	0	0	0	0	0	0	0	1.539800451	0	0	0.395414698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.3139		0.001506809	0	0	1.891462408	0	0.154389026	0.175884602	0	0.156989261	0	0	0	0	0	0	0	0	0	0	0	0	1.539800451	0	0	0.395414698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.3139	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	0	0	1.891462408	0	0.154389026	0.175884602	0	0.156989261	0	0	0	0	0	0	0	0	0	0	0	0	1.539800451	0	0	0.395414698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.3139
H4155_003_0	2011	3																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	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	2477.748736	378.2316084	2787.104884	20530.75772	229.5685684	21.6187148	4.680364649	44.35861215	142.5047863	28661.90313	192.5005796	1067.259634	0	69753.76333	6519.269884	38728.17324	2786.465367	5991.174886	9723.754113	0	20.15327004	14.73216435	431.4039943	815.0571648	430.8910884	107.7227721	0	0	0	0											3400	$0 	$0 	21: $6.21	$0 	10a: $12.50	11a: 0.8%	$0 	"4a1: $50.00,4a2: $50.00"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	152: 20.0%	$0 	$0 	"16b2: $25.00,16b2: $25.00"	$0 	$0 	$0 	$0 	$0 	$0 												0	0	6.21	0	12.5	0.008408694	0	38.61572815	0	0	0	0	0	0	0	0	0	0	0	0	0.0746	0	0	9.589159082	0	0	0	0	0	0											NO	0	0	6.208188023	0	12.4963527	0.008406241	0	38.60446071	0	0	0	0	0	0	0	0	0	0	0	0	0.074578233	0	0	9.586361122	0	0	0	0	0	0												0	0	1.44190593	0	0.23906415	0.181732117	0	0.142703358	0	0	0	0	0	0	0	0	0	0	0	0	1.502995268	0	0	0.65111936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1595		0.001214034	0	0	1.44190593	0	0.23906415	0.181732117	0	0.142703358	0	0	0	0	0	0	0	0	0	0	0	0	1.502995268	0	0	0.65111936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1595	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	0	0	1.44190593	0	0.23906415	0.181732117	0	0.142703358	0	0	0	0	0	0	0	0	0	0	0	0	1.502995268	0	0	0.65111936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1595
H4155_004_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	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	4898.746536	1156.614406	6507.783291	35207.60565	500.0474484	37.07367864	8.026302049	115.1996333	214.2935306	104039.2746	0	2579.764426	0	83149.66748	13412.0615	38280.72953	7217.63429	0	29465.18441	0	20.15366872	14.73231007	431.4082613	815.0652266	430.8953504	107.7238376	0	0	0	0											3400	$0 	$0 	21: $6.21	$0 	10a: $12.50	11a: 0.8%	$0 	"4a1: $50.00,4a2: $50.00"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	152: 20.0%	$0 	$0 	"16b2: $15.00,16b2: $15.00"	$0 	$0 	$0 	$0 	$0 	$0 												0	0	6.21	0	12.5	0.008408694	0	38.52091112	0	0	0	0	0	0	0	0	0	0	0	0	0.0746	0	0	5.753495449	0	0	0	0	0	0											NO	0	0	6.203064666	0	12.48603999	0.008399303	0	38.47789093	0	0	0	0	0	0	0	0	0	0	0	0	0.074516687	0	0	5.74706994	0	0	0	0	0	0												0	0	3.364016716	0	0.520301036	0.311393069	0	0.369386577	0	0	0	0	0	0	0	0	0	0	0	0	1.501784617	0	0	0.390353072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4572		0.007219509	0	0	3.364016716	0	0.520301036	0.311393069	0	0.369386577	0	0	0	0	0	0	0	0	0	0	0	0	1.501784617	0	0	0.390353072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4572	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	0	0	3.364016716	0	0.520301036	0.311393069	0	0.369386577	0	0	0	0	0	0	0	0	0	0	0	0	1.501784617	0	0	0.390353072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4572
H4209_001_0	2011	5																															D	D	D	coin	T	coin	coin	V	V	P	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	630.4360234	54.25604927	214.6599477	8.673563236	164.7414562	7.093141961	3.124315245	313.9221568	226.0993524	2857.20125	15.66353441	0	0.015608782	922.8700132	2776.17368	3453.560339	136.918288	84.52471098	16.69774055	11.26017237	2.489079987	28.07335391	0	0	420	315	0	0	0	0											3400	1a:  Acute - $275/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$0/day for 1-5/6-90	2:  Skilled Nursing Services - $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 - $33/visit/8a:  Outpatient Lab Services - $33/visit	8b:  Outpatient Diagnostic Radiological Services - $150/visit/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%	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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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		9c:  Outpatient Substance Abuse Svcs - Individual - $40/visit/9c:  Outpatient Substance Abuse Svcs - Group - $40/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 - $40/service/13a:  3-Pints Deductible Waived - $40/service			17a:  Routine Eye Exams - $25/visit	17b:  Eye Glasses - $10/service			14c:  Routine Exams - $0/visit/													275	275	128	0.1	150	0.25	0.059340554	51.11657958	161.2473296	32.5	0.293121526	0	0.2	40	25	37.77824305	40	40	0	0.001165874	0.2	40	0	0	25	10	0	0	0	0											NO	248.0802967	248.1088209	115.4767864	0.090185784	135.3446768	0.225478425	0.053497039	46.12257624	145.4499854	29.3201251	0.264462277	0	0.180414875	36.08699276	22.55196938	34.07781614	36.06917559	36.06224522	0	0.001051334	0.180474558	36.10591998	0	0	25	10	0	0	0	0												13.0332	1.121783701	2.065686744	0.782232105	1.858073263	1.599350477	0.167141615	1.206574884	2.740512292	6.98112484	4.14241398	0	0.002816056	2.77530029	5.21734865	9.807482855	0.411544147	0.254012571	0	0.011838197	0.449215611	0.084467856	0	0	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8496	0	5.93684499	13.0332	1.121783701	2.065686744	0.782232105	1.858073263	1.599350477	0.167141615	1.206574884	2.740512292	6.98112484	4.14241398	0	0.002816056	2.77530029	5.21734865	9.807482855	0.411544147	0.254012571	0	0.011838197	0.449215611	0.084467856	0	0	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8496	YES	1a:  Acute - 30.0% for 1-90/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-90	2:  Skilled Nursing Services - 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 - 30.0%/4b:  Urgently Needed Care / Urgent Care Centers - 30.0%/4a:  Worldwide Coverage - 35.5%	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 - $35/visit/17a:  Vision Exams - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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:  IP Phys (Surgery, Visits, 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%/13a:  3-Pints Deductible Waived - 30.0%							14c:  Routine Exams - 30.0%/												5100	3.6931	0.1208	0.7039	0.2393	0.7766	0.9294	0.3781	0.2859	0.5762	0.3715	0.3894	0	0.0025	0.3761	3.0484	8.7806	0.1349	0.3183	2.5171	1.5411	0.0721	0.0196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.2749	2200	4.16938243	16.7264	1.242575529	2.769586719	1.021518844	2.634643345	2.52878473	0.54524195	1.492471312	3.316712609	7.352626786	4.531859469	0	0.005291662	3.151411043	8.265732442	18.58804181	0.54648393	0.572326009	2.517050353	1.552907419	0.521356168	0.10409171	0	0	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1246
H4209_003_0	2011	5																															D	D	D	coin	T	coin	coin	V	V	P	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	650.750111	41.51898539	162.6375252	10.78332277	132.1868734	8.103910021	4.181347678	295.5022587	340.7553825	3547.807936	15.33165332	0	0.01775736	1521.288565	3088.696012	4100.278626	176.7791441	132.3206247	18.07346245	13.03224742	2.110503355	18.34278504	0	0	420	315	0	0	0	0											3400	1a:  Acute - $275/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$0/day for 1-5/6-90	2:  Skilled Nursing Services - $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 - $33/visit/8a:  Outpatient Lab Services - $33/visit	8b:  Outpatient Diagnostic Radiological Services - $150/visit/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%	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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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		9c:  Outpatient Substance Abuse Svcs - Individual - $40/visit/9c:  Outpatient Substance Abuse Svcs - Group - $40/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 - $40/service/13a:  3-Pints Deductible Waived - $40/service			17a:  Routine Eye Exams - $25/visit	17b:  Eye Glasses - $10/service			14c:  Routine Exams - $0/visit/													275	275	128	0.1	150	0.25	0.061094104	50.99407764	163.8960858	32.5	0.344611413	0	0.2	40	25	37.40971746	40	40	0	0.001780714	0.2	40	0	0	25	10	0	0	0	0											NO	242.394117	239.9900037	112.234841	0.087785377	131.5708004	0.219429503	0.053394568	44.88283233	145.4037303	28.73030503	0.304228079	0	0.176587706	35.38692011	22.11456174	33.1167586	35.10673491	35.2408453	3.07E-18	0.001584795	0.176065365	35.30891419	0	0	25	10	0	0	0	0												13.1448	0.830345121	1.521133065	0.946618059	1.449327728	1.77823695	0.223261253	1.105248194	4.128925311	8.494133683	4.664319437	0	0.003135732	4.486143077	5.692096554	11.31566146	0.517178212	0.388590889	5.55E-17	0.020653437	0.371586543	0.053971985	0	0	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2729	0	8.106490651	13.1448	0.830345121	1.521133065	0.946618059	1.449327728	1.77823695	0.223261253	1.105248194	4.128925311	8.494133683	4.664319437	0	0.003135732	4.486143077	5.692096554	11.31566146	0.517178212	0.388590889	5.55E-17	0.020653437	0.371586543	0.053971985	0	0	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2729	YES	1a:  Acute - 30.0% for 1-90/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-90	2:  Skilled Nursing Services - 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 - 30.0%/4b:  Urgently Needed Care / Urgent Care Centers - 30.0%/4a:  Worldwide Coverage - 35.5%	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 - $35/visit/17a:  Vision Exams - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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:  IP Phys (Surgery, Visits, 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%/13a:  3-Pints Deductible Waived - 30.0%							14c:  Routine Exams - 30.0%/												5100	3.4247	0.0839	0.548	0.2679	0.5477	0.984	0.4802	0.2438	0.7177	0.371	0.3427	0	0.0027	0.4391	3.3441	10.3708	0.1668	0.4786	2.7303	1.7287	0.0533	0.0119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.338	2200	4.690931236	16.5696	0.914280798	2.069128905	1.21453317	1.99706655	2.762189662	0.703486515	1.349047566	4.846667504	8.865179018	5.007044669	0	0.005800283	4.925234606	9.036237434	21.68650823	0.683951992	0.867199942	2.730263571	1.749331829	0.424854291	0.065872721	0	0	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.6109
H4209_004_0	2011	5																															D	D	D	coin	T	coin	coin	V	V	P	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	901.6677186	71.27711944	293.2320518	18.83770015	169.9294776	13.95126772	6.248511321	319.4773382	350.6227146	3687.275262	15.86031466	0	0.023968437	1099.860966	4105.112506	5132.013332	308.519429	237.5740442	22.03019601	17.35187266	1.412219835	7.043354647	0	873	420	315	0	0	0	0											3400	1a:  Acute - $250/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $250/$0/day for 1-5/6-90	2:  Skilled Nursing Services - $0/$128/day for 1-20/21-100	6:  Home Health Services - 10.0%	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 - 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 - $20/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%	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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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 - $25/service/13a:  3-Pints Deductible Waived - $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:  Eye Glasses - $10/service			14c:  Routine Exams - $0/visit/													250	250	128	0.1	150	0.2	0.065072005	50.87437829	162.7507983	20	0.263647885	0	0.2	25	15.00106673	25	25	25	0	0.001031477	0.2	25	0	10	25	10	0	0	0	0											NO	222.6625422	222.6521934	114.0022976	0.089021913	133.644245	0.178063843	0.05792693	45.32882524	144.9462362	17.81589704	0.234887374	0	0.178110926	22.27473054	13.36228763	22.26804054	22.25917396	22.25397181	5.04E-18	0.000918656	0.178543924	22.37280802	0	10	25	10	0	0	0	0												16.7306	1.322500582	2.785760635	1.676968108	1.892508061	2.484216339	0.361957079	1.206794369	4.235120235	5.474343036	3.725387665	0	0.00426904	2.04159222	4.571141173	9.523323411	0.572282303	0.440580507	1.11E-16	0.015940397	0.252143271	0.013131635	0	0.7275	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1956	0	7.280748703	16.7306	1.322500582	2.785760635	1.676968108	1.892508061	2.484216339	0.361957079	1.206794369	4.235120235	5.474343036	3.725387665	0	0.00426904	2.04159222	4.571141173	9.523323411	0.572282303	0.440580507	1.11E-16	0.015940397	0.252143271	0.013131635	0	0.7275	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1956	YES	1a:  Acute - 20.0% for 1-90/1a:  Additional Days - 20.0% for 91-999	1b:  Psych - 20.0% for 1-90	2:  Skilled Nursing Services - 20.0% 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 - 20.0%	4a:  Emergency Care / Post Stabilization Care - 20.0%/4b:  Urgently Needed Care / Urgent Care Centers - 20.0%/4a:  Worldwide Coverage - 35.5%	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%	9d:  Cardiac Rehabilitation Services - 20.0%/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%	7a:  Primary Care - $35/visit/17a:  Vision Exams - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14c:  Physical Exams (Initial Exam) - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14e:  Prostate Cancer Screening - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14h:  Mammography - 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%/14b:  Immunizations (Hepatitis B) - 20.0%/14c:  Physical Exams (Initial Exam) - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14e:  Prostate Cancer Screening - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14h:  Mammography - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	7e:  Mental Hlth Spec-Non-Physician - Individual - 20.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 20.0%/7h:  Psychiatric Services - Individual - 20.0%/7h:  Psychiatric Services - Group - 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:  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%/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%							14c:  Routine Exams - 20.0%/												5100	3.1315	0.099	0.5868	0.4074	0.6471	1.4346	0.521	0.1728	0.5788	0.2934	0.2466	0	0.0024	0.2957	4.0016	9.2031	0.1954	0.4922	2.1257	1.4969	0.0259	0.0033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.961	1250	4.148715819	19.8621	1.421487241	3.372582158	2.084331434	2.539595612	3.918776435	0.88293015	1.379579413	4.813889925	5.767705124	3.97194688	0	0.006658568	2.337301513	8.572769884	18.7263913	0.767716301	0.932795451	2.12567671	1.512854789	0.278055614	0.016455288	0	0.7275	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1566
H4209_006_0	2011	5																															D	D	D	coin	T	coin	coin	V	V	P	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	840.0582118	54.64868865	209.815599	12.8128876	180.2705935	10.68131236	5.209197708	371.6320265	368.899377	4413.616269	18.51441414	0	0.0205013	2031.07342	4142.341812	5211.961197	298.7977165	161.6704151	32.44964721	15.45541836	4.540088021	16.65951343	0	873	420	315	0	0	0	0											3400	1a:  Acute - $250/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $250/$0/day for 1-5/6-90	2:  Skilled Nursing Services - $0/$128/day for 1-20/21-100	6:  Home Health Services - 10.0%	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 - 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 - $20/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%	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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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 - $25/service/13a:  3-Pints Deductible Waived - $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:  Eye Glasses - $10/service			14c:  Routine Exams - $0/visit/													250	250	128	0.1	150	0.2	0.071939138	50.78752882	166.170155	20	0.27684282	0	0.2	25	15.00104964	25	25	25	0	0.00138746	0.2	25	0	10	25	10	0	0	0	0											NO	222.0483527	222.0655357	113.6928772	0.088825732	133.2313355	0.177643083	0.06389148	45.1101283	147.5919816	17.76369965	0.245892079	0	0.177643727	22.20385548	13.32348877	22.20415758	22.20350459	22.20560403	0	0.001232212	0.177612019	22.20855918	0	10	25	10	0	0	0	0												15.5445	1.011299194	1.98787826	1.138114122	2.001474327	1.897461259	0.332823352	1.3970307	4.537215839	6.533512813	4.552547782	0	0.003641927	3.75813839	4.599203716	9.643933977	0.552863039	0.299165768	0	0.019044353	0.8063742	0.030831982	0	0.7275	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.512	0	7.634749413	15.5445	1.011299194	1.98787826	1.138114122	2.001474327	1.897461259	0.332823352	1.3970307	4.537215839	6.533512813	4.552547782	0	0.003641927	3.75813839	4.599203716	9.643933977	0.552863039	0.299165768	0	0.019044353	0.8063742	0.030831982	0	0.7275	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.512	YES	1a:  Acute - 20.0% for 1-90/1a:  Additional Days - 20.0% for 91-999	1b:  Psych - 20.0% for 1-90	2:  Skilled Nursing Services - 20.0% 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 - 20.0%	4a:  Emergency Care / Post Stabilization Care - 20.0%/4b:  Urgently Needed Care / Urgent Care Centers - 20.0%/4a:  Worldwide Coverage - 35.5%	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%	9d:  Cardiac Rehabilitation Services - 20.0%/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%	7a:  Primary Care - $35/visit/17a:  Vision Exams - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14c:  Physical Exams (Initial Exam) - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14e:  Prostate Cancer Screening - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14h:  Mammography - 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%/14b:  Immunizations (Hepatitis B) - 20.0%/14c:  Physical Exams (Initial Exam) - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14e:  Prostate Cancer Screening - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14h:  Mammography - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	7e:  Mental Hlth Spec-Non-Physician - Individual - 20.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 20.0%/7h:  Psychiatric Services - Individual - 20.0%/7h:  Psychiatric Services - Group - 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:  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%/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%							14c:  Routine Exams - 20.0%/												5100	2.8158	0.0759	0.4709	0.2654	0.656	1.0877	0.4372	0.1951	0.6031	0.289	0.2714	0	0.002	0.3964	3.9593	8.803	0.1787	0.362	3.212	1.3328	0.079	0.006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.4987	1250	3.776852519	18.3603	1.087185268	2.458738972	1.403534986	2.657497692	2.985177848	0.770014111	1.592104276	5.14028754	6.822523665	4.823931313	0	0.005656117	4.154524323	8.558538731	18.44695603	0.731595859	0.661214152	3.211966485	1.351836874	0.885368819	0.036813171	0	0.7275	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0107
H4209_007_0	2011	4																															D	D	D	coin	T	coin	coin	V	V	P	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	862.9918934	108.8081178	314.1859699	15.727872	195.1620224	12.08807724	7.552120851	395.9462268	283.5068353	3033.825613	17.27191444	0	0.021089529	1052.985358	3332.59471	4194.380018	351.3770363	146.2451654	19.022523	14.52930173	7.177265641	42.0079795	0	873	420	315	0	0	0	0											3400	1a:  Acute - $275/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$0/day for 1-5/6-90	2:  Skilled Nursing Services - $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 - $25/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 - $20/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%	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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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 - $25/service/13a:  3-Pints Deductible Waived - $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:  Eye Glasses - $10/service			14c:  Routine Exams - $0/visit/													275	275	128	0.1	150	0.25	0.09950836	50.92165178	165.512979	20	0.24103393	0	0.2	25	15.00123334	25	25	25	0	0.001013615	0.2	25	0	10	25	10	0	0	0	0											NO	245.6263428	245.6263428	114.3278977	0.08931867	133.9780052	0.223296675	0.088879544	45.48254217	147.8339917	17.86373402	0.215288301	0	0.17863734	22.32966753	13.39890212	22.32966753	22.32966753	22.32966753	2.92E-18	0.000905347	0.17863734	22.32966753	0	10	25	10	0	0	0	0												17.6645	2.227178336	2.993351786	1.404792611	2.178951537	2.699227458	0.671229057	1.50072008	3.492662261	4.516287819	3.718441117	0	0.003767377	1.95940108	3.721092526	7.804925941	0.653844366	0.272133827	5.55E-17	0.013154063	1.282127644	0.078168685	0	0.7275	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7209	0	7.0383884	17.6645	2.227178336	2.993351786	1.404792611	2.178951537	2.699227458	0.671229057	1.50072008	3.492662261	4.516287819	3.718441117	0	0.003767377	1.95940108	3.721092526	7.804925941	0.653844366	0.272133827	5.55E-17	0.013154063	1.282127644	0.078168685	0	0.7275	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7209	YES	1a:  Acute - 30.0% for 1-90/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-90	2:  Skilled Nursing Services - 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 - 30.0%/4b:  Urgently Needed Care / Urgent Care Centers - 30.0%/4a:  Worldwide Coverage - 35.5%	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 - $35/visit/17a:  Vision Exams - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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:  IP Phys (Surgery, Visits, 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%/13a:  3-Pints Deductible Waived - 30.0%							14c:  Routine Exams - 30.0%/												5100	3.5231	0.1997	0.7747	0.3455	0.7624	1.2569	0.738	0.2731	0.6961	0.3063	0.3499	0	0.0026	0.3257	3.3346	8.3574	0.287	0.4177	2.2784	1.5858	0.1669	0.0373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.0189	1250	5.308404837	21.1875	2.426904102	3.7680092	1.750245769	2.94136402	3.956086008	1.409192919	1.773858325	4.188795294	4.822560543	4.068370784	0	0.006411889	2.28507522	7.055704258	16.16232206	0.940804395	0.689821227	2.27841388	1.598950528	1.449005024	0.115451345	0	0.7275	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.7399
H4209_008_0	2011	4																															D	D	D	coin	T	coin	coin	V	V	P	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	868.8039789	109.5409196	272.0587798	16.78228551	205.3517004	12.41174444	7.75433447	458.5534888	337.8406479	3598.659439	19.35279712	0	0.021784413	1669.630308	3237.174285	4109.963052	355.9776861	148.1599826	18.64192772	14.60938764	8.109070969	52.58491005	0	873	420	315	0	0	0	0											3400	1a:  Acute - $275/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$0/day for 1-5/6-90	2:  Skilled Nursing Services - $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 - $25/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 - $20/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%	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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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 - $25/service/13a:  3-Pints Deductible Waived - $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:  Eye Glasses - $10/service			14c:  Routine Exams - $0/visit/													275	275	128	0.1	150	0.25	0.09950836	50.70007351	165.512979	20	0.260621367	0	0.2	25	15.00123333	25	25	25	0	0.001002533	0.2	25	0	10	25	10	0	0	0	0											NO	243.6030458	243.6030458	113.386145	0.088582926	132.8743886	0.221457314	0.088147417	44.91160848	146.6162393	17.71658515	0.230866032	0	0.177165852	22.14573144	13.28853138	22.14573144	22.14573144	22.14573144	-5.96E-18	0.000888073	0.177165852	22.14573144	0	10	25	10	0	0	0	0												17.6369	2.223708472	2.570641354	1.486623951	2.273831804	2.748671591	0.683524553	1.716197896	4.127743773	5.312996365	4.467903487	0	0.003859454	3.081265366	3.58477434	7.584844831	0.656948853	0.273425932	-1.11E-16	0.012974209	1.436650463	0.097044275	0	0.7275	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8456	0	7.988410735	17.6369	2.223708472	2.570641354	1.486623951	2.273831804	2.748671591	0.683524553	1.716197896	4.127743773	5.312996365	4.467903487	0	0.003859454	3.081265366	3.58477434	7.584844831	0.656948853	0.273425932	-1.11E-16	0.012974209	1.436650463	0.097044275	0	0.7275	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8456	YES	1a:  Acute - 30.0% for 1-90/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-90	2:  Skilled Nursing Services - 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 - 30.0%/4b:  Urgently Needed Care / Urgent Care Centers - 30.0%/4a:  Worldwide Coverage - 35.5%	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 - $35/visit/17a:  Vision Exams - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 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:  IP Phys (Surgery, Visits, 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%/13a:  3-Pints Deductible Waived - 30.0%							14c:  Routine Exams - 30.0%/												5100	3.4716	0.1968	0.7642	0.3408	0.7518	1.2398	0.728	0.269	0.6867	0.3022	0.3451	0	0.0026	0.3213	3.2813	8.2398	0.2831	0.412	2.2475	1.5643	0.1646	0.0368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.6492	1250	5.126905203	21.1086	2.420519446	3.334791535	1.827428256	3.025674437	3.98848247	1.411478882	1.985190748	4.814434656	5.615189322	4.812990594	0	0.006468096	3.402517872	6.866069057	15.82460322	0.940016637	0.685447939	2.247510122	1.577306094	1.601229382	0.133821244	0	0.7275	0.875	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4947
H4209_809_0	2011	3																															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	YES	256.0842824	2.948060042	43.33752621	33.16443725	8.644879404	13.92737979	3.515481055	8.606502418	40.78904191	4.6685437	19.99160803	0	0.022380628	19.32351322	39.35598764	104.0929923	1.035838534	4.102741808	17.78495586	20.55416675	7.093480458	0.723126773	0	0	0	0	0	0	0	0											6700	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare												0.079135507	0.079135507	0.179577484	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.23339252	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.06734151	0.06734151	0.152814069	0	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0	0.198274736	0.198274736	0.198608756	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0	0	0	0	0	0	0	0												17.2451	0.198526814	6.622583736	0	1.71406118	2.761447549	0.697031077	1.706451993	8.087436508	0.925654269	3.9638308	0	0.004437513	3.831364479	7.816443746	20.63901055	0.205380612	0.813470048	3.526307425	4.075371981	1.406457964	0.14337777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3837	0	15.129	17.2451	0.198526814	6.622583736	0	1.71406118	2.761447549	0.697031077	1.706451993	8.087436508	0.925654269	3.9638308	0	0.004437513	3.831364479	7.816443746	20.63901055	0.205380612	0.813470048	3.526307425	4.075371981	1.406457964	0.14337777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3837	YES	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare											10000	2.2536	0.0259	1.0832	0	0.2059	0.332	0.0838	0.238	1.0287	0.1507	0.534	0	0.0006	0.5293	1.0508	2.7913	0.0287	0.1135	0.5016	0.5394	0.2112	0.0216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.724	0	1.255	19.4987	0.224472049	7.705801012	0	1.91997389	3.093454976	0.780834767	1.944474337	9.116183354	1.076379227	4.497846411	0	0.005057337	4.360632308	8.86729239	23.43032027	0.234067806	0.926963012	4.027912034	4.614802523	1.617697535	0.164932625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.1078
H4209_810_0	2011	3																															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	YES	256.0842824	2.948060042	43.33752621	33.16443725	8.644879404	13.92737979	3.515481055	8.606502418	40.78904191	4.6685437	19.99160803	0	0.022380628	19.32351322	39.35598764	104.0929923	1.035838534	4.102741808	17.78495586	20.55416675	7.093480458	0.723126773	0	0	0	0	0	0	0	0											6700	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare												0.079135507	0.079135507	0.179577484	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.23339252	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.06734151	0.06734151	0.152814069	0	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0	0.198274736	0.198274736	0.198608756	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0	0	0	0	0	0	0	0												17.2451	0.198526814	6.622583736	0	1.71406118	2.761447549	0.697031077	1.706451993	8.087436508	0.925654269	3.9638308	0	0.004437513	3.831364479	7.816443746	20.63901055	0.205380612	0.813470048	3.526307425	4.075371981	1.406457964	0.14337777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3837	0	15.129	17.2451	0.198526814	6.622583736	0	1.71406118	2.761447549	0.697031077	1.706451993	8.087436508	0.925654269	3.9638308	0	0.004437513	3.831364479	7.816443746	20.63901055	0.205380612	0.813470048	3.526307425	4.075371981	1.406457964	0.14337777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3837	YES	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare											10000	2.2536	0.0259	1.0832	0	0.2059	0.332	0.0838	0.238	1.0287	0.1507	0.534	0	0.0006	0.5293	1.0508	2.7913	0.0287	0.1135	0.5016	0.5394	0.2112	0.0216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.724	0	1.255	19.4987	0.224472049	7.705801012	0	1.91997389	3.093454976	0.780834767	1.944474337	9.116183354	1.076379227	4.497846411	0	0.005057337	4.360632308	8.86729239	23.43032027	0.234067806	0.926963012	4.027912034	4.614802523	1.617697535	0.164932625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.1078
H4209_811_0	2011	3																															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	YES	256.0842824	2.948060042	43.33752621	33.16443725	8.644879404	13.92737979	3.515481055	8.606502418	40.78904191	4.6685437	19.99160803	0	0.022380628	19.32351322	39.35598764	104.0929923	1.035838534	4.102741808	17.78495586	20.55416675	7.093480458	0.723126773	0	0	0	0	0	0	0	0											6700	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare												0.079135507	0.079135507	0.179577484	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.23339252	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.06734151	0.06734151	0.152814069	0	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0	0.198274736	0.198274736	0.198608756	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0	0	0	0	0	0	0	0												17.2451	0.198526814	6.622583736	0	1.71406118	2.761447549	0.697031077	1.706451993	8.087436508	0.925654269	3.9638308	0	0.004437513	3.831364479	7.816443746	20.63901055	0.205380612	0.813470048	3.526307425	4.075371981	1.406457964	0.14337777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3837	0	15.129	17.2451	0.198526814	6.622583736	0	1.71406118	2.761447549	0.697031077	1.706451993	8.087436508	0.925654269	3.9638308	0	0.004437513	3.831364479	7.816443746	20.63901055	0.205380612	0.813470048	3.526307425	4.075371981	1.406457964	0.14337777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3837	YES	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare											10000	2.2536	0.0259	1.0832	0	0.2059	0.332	0.0838	0.238	1.0287	0.1507	0.534	0	0.0006	0.5293	1.0508	2.7913	0.0287	0.1135	0.5016	0.5394	0.2112	0.0216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.724	0	1.255	19.4987	0.224472049	7.705801012	0	1.91997389	3.093454976	0.780834767	1.944474337	9.116183354	1.076379227	4.497846411	0	0.005057337	4.360632308	8.86729239	23.43032027	0.234067806	0.926963012	4.027912034	4.614802523	1.617697535	0.164932625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.1078
H4209_812_0	2011	3																															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	YES	256.0842824	2.948060042	43.33752621	33.16443725	8.644879404	13.92737979	3.515481055	8.606502418	40.78904191	4.6685437	19.99160803	0	0.022380628	19.32351322	39.35598764	104.0929923	1.035838534	4.102741808	17.78495586	20.55416675	7.093480458	0.723126773	0	0	0	0	0	0	0	0											6700	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare												0.079135507	0.079135507	0.179577484	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.23339252	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.06734151	0.06734151	0.152814069	0	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0	0.198274736	0.198274736	0.198608756	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0.198274736	0	0	0	0	0	0	0	0												17.2451	0.198526814	6.622583736	0	1.71406118	2.761447549	0.697031077	1.706451993	8.087436508	0.925654269	3.9638308	0	0.004437513	3.831364479	7.816443746	20.63901055	0.205380612	0.813470048	3.526307425	4.075371981	1.406457964	0.14337777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3837	0	15.129	17.2451	0.198526814	6.622583736	0	1.71406118	2.761447549	0.697031077	1.706451993	8.087436508	0.925654269	3.9638308	0	0.004437513	3.831364479	7.816443746	20.63901055	0.205380612	0.813470048	3.526307425	4.075371981	1.406457964	0.14337777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3837	YES	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare											10000	2.2536	0.0259	1.0832	0	0.2059	0.332	0.0838	0.238	1.0287	0.1507	0.534	0	0.0006	0.5293	1.0508	2.7913	0.0287	0.1135	0.5016	0.5394	0.2112	0.0216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.724	0	1.255	19.4987	0.224472049	7.705801012	0	1.91997389	3.093454976	0.780834767	1.944474337	9.116183354	1.076379227	4.497846411	0	0.005057337	4.360632308	8.86729239	23.43032027	0.234067806	0.926963012	4.027912034	4.614802523	1.617697535	0.164932625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.1078
H4213_001_0	2011	7	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	NO	1060.856833	19.14302374	307.4732253	0	224.82676	20.36320683	0.855523053	278.1203917	323.4185206	0	218.289282	0	0	1387.258011	3416.054164	3586.889455	116.8752428	218.8745966	179.1045483	0	18.03427425	0	0	0	0	0	0	0	0	0	6.59956272	4.445234483										"$220 copay per day for days 1-6, $0 after day 6, unlimited coverage"	"$220 copay per day for days 1-6, $0 after day 6, 190 day per lifetime limit"	"$0 copay for days 1-20, $137.5 copay per day for days 21-100*"	No cost sharing	"$250 copay ground, $500 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $50 copay, (4b) $15 to $30 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) $30 copay, (9d) $30 copay"	"(7a) $15 to $30 copay, $15 copay for PCP, $30 copay for Spec; (14b-14j) $0 copay"	"(7b) $20 copay, (7c) $30 copay, (7f) $20 copay, (7g) $30 copay"	"(7e) $30 copay, (7h) $30 copay"	"(7c) $30 copay, (7i) $30 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) $30 copay Medicare covered only"	(17a) $30 copay Medicare covered only  (17b) $30 copay Medicare covered only	(17a) $30 copay Medicare covered only  (17b) $30 copay Medicare covered only	(18a) $30 copay Medicare covered only	Not covered	$0 copay for plan covered services	n/a	20% coinsurance for Therapeutic radiology	20% coinsurance for Therapeutic radiology									25	220	220	137.5	0	250	0.2	0.2	48.94444375	250	0	250	0	0	162.8019941	15	28.85995279	30	30	250	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									NO	185.2906458	185.2906458	115.8066536	0	210.557552	0.168446042	0.168446042	41.2210313	210.557552	0	210.557552	0	0	137.055146	12.63345312	24.30708619	25.26690624	25.26690624	210.557552	0	0.168446042	0.168446042	0	0	0	0	0	0	0	0	0.168446042	0.168446042										16.3806	0.295585269	2.967287108	0	3.944914351	3.430101585	0.144109472	0.955367448	5.674850997	0	3.830204737	0	0	15.84423744	3.596380011	7.265569261	0.24608965	0.460856993	3.14265127	0	3.03780211	0	0	0	0	0	0	0	0	0	1.111670216	0.748782153	0	0	0	0	0	0	0	0	73.077	0	13.62014724	16.3806	0.295585269	2.967287108	0	3.944914351	3.430101585	0.144109472	0.955367448	5.674850997	0	3.830204737	0	0	15.84423744	3.596380011	7.265569261	0.24608965	0.460856993	3.14265127	0	3.03780211	0	0	0	0	0	0	0	0	0	1.111670216	0.748782153	0	0	0	0	0	0	0	0	73.077	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$250 copay ground, $500 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	Not covered	"(16a) not covered, (16b) 30% coinsurance Medicare covered only"	(17a) 30% coinsurance Medicare covered only  (17b) 30% coinsurance Medicare covered only	(17a) 30% coinsurance Medicare covered only  (17b) 30% coinsurance Medicare covered only	(18a) 30% coinsurance Medicare covered only	Not covered	50% coinsurance	n/a	30% coinsurance	30% coinsurance									5000	2.823	0.0285	0.3183	0.2499	0.1608	0.2438	0.0102	0.0816	0.4114	0.0482	0.1509	0	0	0.2855	0.238	0.3139	0.0169	0.0562	0.2103	1.0106	0.2155	0.1853	0	0	0	0	0	0	0.0291	0	0.1	0.0663									7.2542	500	4.069525941	19.2035	0.324111199	3.285549895	0.249862803	4.105717692	3.673874016	0.154337013	1.036984364	6.086261325	0.048210744	3.981144065	0	0	16.12968919	3.834347753	7.579500861	0.263013612	0.517061054	3.352950137	1.010591663	3.253332904	0.185343713	0	0	0	0	0	0	0.029103385	0	1.211657273	0.815091245	0	0	0	0	0	0	0	0	80.3313
H4213_002_0	2011	7	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							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	NO	894.7485166	26.85526718	265.5495772	0	219.1322152	17.83655802	1.011302064	251.9610816	400.4525819	0	263.5052239	0	0	1505.886513	2971.994332	2982.785485	74.85045527	116.8450421	117.9021309	0	26.48464036	0	0	0	0	0	0	0	0	0	4.015297375	5.340512072										"$265 copay per day for days 1-6, $0 after day 6, unlimited coverage"	"$265 copay per day for days 1-6, $0 after day 6, 190 day per lifetime limit"	"$0 copay for days 1-20, $137.5 copay per day for days 21-100*"	No cost sharing	"$250 copay ground, $500 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $50 copay, (4b) $25 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) $25 to $40 copay, $25 copay for PCP, $40 copay for Spec; (14b-14j) $0 copay"	"(7b) $20 copay, (7c) $40 copay, (7f) $20 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	20% coinsurance	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									25	265	265	137.5	0	250	0.2	0.2	48.86695672	250	0	250	0	0	136.5682253	25	37.90101629	40	40	250	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									NO	236.9822413	236.9822413	122.9624837	0	223.5681521	0.178854522	0.178854522	43.70038086	223.5681521	0	223.5681521	0	0	122.1292231	22.35681521	33.89384071	35.77090434	35.77090434	223.5681521	0	0.178854522	0.178854522	0	0	0	0	0	0	0	0	0.178854522	0.178854522										17.67	0.530351784	2.721052963	0	4.082582036	3.190149054	0.180875947	0.917566269	7.460703647	0	4.909281332	0	0	15.32606248	5.537027341	8.424838008	0.223122373	0.348304402	2.196596794	0	4.736897685	0	0	0	0	0	0	0	0	0	0.718154092	0.955174732	0	0	0	0	0	0	0	0	80.1287	0	9.473395861	17.67	0.530351784	2.721052963	0	4.082582036	3.190149054	0.180875947	0.917566269	7.460703647	0	4.909281332	0	0	15.32606248	5.537027341	8.424838008	0.223122373	0.348304402	2.196596794	0	4.736897685	0	0	0	0	0	0	0	0	0	0.718154092	0.955174732	0	0	0	0	0	0	0	0	80.1287	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$250 copay ground, $500 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	Not covered	"(16a) not covered, (16b) 30% coinsurance Medicare covered only"	(17a) 30% coinsurance Medicare covered only  (17b) 30% coinsurance Medicare covered only	(17a) 30% coinsurance Medicare covered only  (17b) 30% coinsurance Medicare covered only	(18a) 30% coinsurance Medicare covered only	Not covered	50% coinsurance	n/a	30% coinsurance	30% coinsurance									6700	3.131	0.0394	0.2437	0.2286	0.1844	0.2429	0.0138	0.0765	0.564	0.0441	0.2092	0	0	0.3488	0.2543	0.331	0.0147	0.0586	0.1708	1.0245	0.3607	0.1188	0	0	0	0	0	0	0.0334	0	0.0736	0.0888									7.8558	500	2.946537481	20.801	0.56978754	2.964710409	0.228601396	4.266957555	3.433073281	0.194649331	0.994031659	8.024705762	0.044144233	5.118492147	0	0	15.67489652	5.791328962	8.755819439	0.237863369	0.406949696	2.367423306	1.024537238	5.097604094	0.1187664	0	0	0	0	0	0	0.033420664	0	0.791773704	1.043942036	0	0	0	0	0	0	0	0	87.9845
H4213_003_0	2011	7	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	NO	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										"$265 copay per day for days 1-6, $0 after day 6, unlimited coverage"	"$265 copay per day for days 1-6, $0 after day 6, 190 day per lifetime limit"	"$0 copay for days 1-20, $137.5 copay per day for days 21-100*"	No cost sharing	"$250 copay ground, $500 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $50 copay, (4b) $25 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) $25 to $40 copay, $25 copay for PCP, $40 copay for Spec; (14b-14j) $0 copay"	"(7b) $20 copay, (7c) $40 copay, (7f) $20 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	20% coinsurance	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									25	265	265	137.5	0	250	0.2	0.2	48.86705182	250	0	250	0	0	140.6114069	25	37.86814883	40	40	250	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									NO	230.9965546	230.9965546	119.8567028	0	217.9212779	0.174337022	0.174337022	42.59668152	217.9212779	0	217.9212779	0	0	122.5688699	21.79212779	33.00910154	34.86740446	34.86740446	217.9212779	0	0.174337022	0.174337022	0	0	0	0	0	0	0	0	0.174337022	0.174337022										20.1573	0.613075884	3.764066843	0	6.22260145	4.049067373	0.213519818	1.119797121	8.703381203	0	3.785873076	0	0	20.1522551	6.973671966	10.69919239	0.33043137	1.423382977	2.707581291	0	2.475248273	0	0	0	0	0	0	0	0	0	0.975976471	1.054311552	0	0	0	0	0	0	0	0	95.4207	0	13.01498888	20.1573	0.613075884	3.764066843	0	6.22260145	4.049067373	0.213519818	1.119797121	8.703381203	0	3.785873076	0	0	20.1522551	6.973671966	10.69919239	0.33043137	1.423382977	2.707581291	0	2.475248273	0	0	0	0	0	0	0	0	0	0.975976471	1.054311552	0	0	0	0	0	0	0	0	95.4207	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$250 copay ground, $500 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	Not covered	"(16a) not covered, (16b) 30% coinsurance Medicare covered only"	(17a) 30% coinsurance Medicare covered only  (17b) 30% coinsurance Medicare covered only	(17a) 30% coinsurance Medicare covered only  (17b) 30% coinsurance Medicare covered only	(18a) 30% coinsurance Medicare covered only	Not covered	50% coinsurance	n/a	30% coinsurance	30% coinsurance									6700	2.573	0.0324	0.2909	0.2334	0.1855	0.2187	0.0124	0.042	0.4507	0.0449	0.1831	0	0	0.3174	0.2054	0.2726	0.0124	0.0492	0.1394	0.8326	0.3011	0.0991	0	0	0	0	0	0	0.0279	0	0.0452	0.0638									6.633	500	3.702695871	22.7302	0.645482792	4.054958798	0.233358893	6.40805356	4.267814114	0.225922381	1.161843095	9.154032609	0.044935549	3.968929665	0	0	20.46962475	7.179091447	10.97180989	0.342792806	1.472560401	2.847015865	0.832648494	2.776314318	0.099129179	0	0	0	0	0	0	0.02787941	0	1.021151007	1.118143903	0	0	0	0	0	0	0	0	102.0537
H4213_004_0	2011	8	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							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	NO	867.2350159	26.56847159	229.2260077	0	128.1379698	19.20773117	2.416470361	279.4208613	309.5795299	0	181.9103338	0	0	832.7309693	3389.565976	3662.136304	92.99706403	204.5890439	172.0441937	0	6.063039946	0	0	0	0	0	0	0	0	0	6.22302344	3.294679665										"$265 copay per day for days 1-6, $0 after day 6, unlimited coverage"	"$265 copay per day for days 1-6, $0 after day 6, 190 day per lifetime limit"	"$0 copay for days 1-20, $137.5 copay per day for days 21-100*"	No cost sharing	"$250 copay ground, $500 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $50 copay, (4b) $15 to $35 copay"	"(9a) $285 copay, (9b) $285 copay"	No cost sharing	"$0 to $285 copay for diag rad, 20% therapeutic rad"	$285 copay	20% coinsurance	"(3) $285 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) $20 copay, (7c) $35 copay, (7f) $20 copay, (7g) $35 copay"	"(7e) $35 copay, (7h) $35 copay"	"(7c) $35 copay, (7i) $35 copay"	"$0 to $285 copay for diag rad, 20% for therapeutic rad"	No cost sharing	20% coinsurance	20% coinsurance	Not covered	"(16a) not covered, (16b) $35 copay Medicare covered only"	(17a) $0 - $35 copay Medicare covered only  (17b) $35 copay Medicare covered only	(17a) $0 - $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									25	265	265	137.5	0	250	0.2	0.2	49.558763	285	0	285	0	0	205.6365371	15	33.28364139	35	35	285	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									NO	235.6663681	235.6663681	122.2797193	0	222.3267624	0.17786141	0.17786141	44.0729573	253.4525091	0	253.4525091	0	0	182.8740221	13.33960574	29.59937692	31.12574674	31.12574674	253.4525091	0	0.17786141	0.17786141	0	0	0	0	0	0	0	0	0.17786141	0.17786141										17.0315	0.5217746	2.335807657	0	2.374041665	3.416314148	0.429796825	1.026241974	6.538642386	0	3.842135878	0	0	12.69040514	3.767956147	9.033079401	0.241216922	0.530665564	3.633752715	0	1.078380833	0	0	0	0	0	0	0	0	0	1.106835723	0.585996371	0	0	0	0	0	0	0	0	70.1846	0	8.735942679	17.0315	0.5217746	2.335807657	0	2.374041665	3.416314148	0.429796825	1.026241974	6.538642386	0	3.842135878	0	0	12.69040514	3.767956147	9.033079401	0.241216922	0.530665564	3.633752715	0	1.078380833	0	0	0	0	0	0	0	0	0	1.106835723	0.585996371	0	0	0	0	0	0	0	0	70.1846	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$250 copay ground, $500 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	Not covered	"(16a) not covered, (16b) 30% coinsurance Medicare covered only"	(17a) 30% coinsurance Medicare covered only  (17b) 30% coinsurance Medicare covered only	(17a) 30% coinsurance Medicare covered only  (17b) 30% coinsurance Medicare covered only	(18a) 30% coinsurance Medicare covered only	Not covered	50% coinsurance	n/a	30% coinsurance	30% coinsurance									5750	2.4404	0.0249	0.2632	0.2091	0.1072	0.2599	0.0327	0.1	0.5967	0.0459	0.134	0	0	0.2287	0.277	0.3694	0.0153	0.0452	0.2276	1.2139	0.0821	0.2394	0	0	0	0	0	0	0.0328	0	0.1071	0.0566									7.1092	500	2.89963893	19.4719	0.546711243	2.598958709	0.209055617	2.481274972	3.676251756	0.462498841	1.126275432	7.135323818	0.045880554	3.976138727	0	0	12.919095	4.044997173	9.402517836	0.256498401	0.575891993	3.8613669	1.213929891	1.160431758	0.239434826	0	0	0	0	0	0	0.032792727	0	1.213889837	0.642612409	0	0	0	0	0	0	0	0	77.2937
H4213_005_0	2011	8	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	NO	1082.081674	18.88976617	262.3624501	0	247.5711396	28.70212101	2.793762007	297.0612829	347.033055	0	221.5400729	0	0	1285.177404	3544.284361	3821.468966	116.1344118	210.3122865	181.4087908	0	35.28172398	0	0	0	0	0	0	0	0	0	5.12226197	4.747843424										"$265 copay per day for days 1-6, $0 after day 6, unlimited coverage"	"$265 copay per day for days 1-6, $0 after day 6, 190 day per lifetime limit"	"$0 copay for days 1-20, $137.5 copay per day for days 21-100*"	No cost sharing	"$250 copay ground, $500 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) $20 copay, (7c) $35 copay, (7f) $20 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) $0 - $35 copay Medicare covered only  (17b) $35 copay Medicare covered only	(17a) $0 - $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									25	265	265	137.5	0	250	0.2	0.2	48.99375878	250	0	250	0	0	182.0644729	15	33.84092014	35	35	250	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									NO	232.1135631	232.1135631	120.4362827	0	218.9750595	0.175180048	0.175180048	42.90755972	218.9750595	0	218.9750595	0	0	159.0403953	13.13850357	29.63774954	30.65650833	30.65650833	218.9750595	0	0.175180048	0.175180048	0	0	0	0	0	0	0	0	0.175180048	0.175180048										20.9305	0.365380911	2.633163185	0	4.517658753	5.028038926	0.489411361	1.062181228	6.33263199	0	4.042645888	0	0	17.03292686	3.880549395	9.438311674	0.29668963	0.537286697	3.310333397	0	6.180654087	0	0	0	0	0	0	0	0	0	0.897318096	0.831727437	0	0	0	0	0	0	0	0	87.8074	0	12.30935372	20.9305	0.365380911	2.633163185	0	4.517658753	5.028038926	0.489411361	1.062181228	6.33263199	0	4.042645888	0	0	17.03292686	3.880549395	9.438311674	0.29668963	0.537286697	3.310333397	0	6.180654087	0	0	0	0	0	0	0	0	0	0.897318096	0.831727437	0	0	0	0	0	0	0	0	87.8074	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$250 copay ground, $500 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	Not covered	"(16a) not covered, (16b) 30% coinsurance Medicare covered only"	(17a) 30% coinsurance Medicare covered only  (17b) 30% coinsurance Medicare covered only	(17a) 30% coinsurance Medicare covered only  (17b) 30% coinsurance Medicare covered only	(18a) 30% coinsurance Medicare covered only	Not covered	50% coinsurance	n/a	30% coinsurance	30% coinsurance									6700	3.1134	0.0248	0.3014	0.2581	0.1919	0.369	0.0358	0.0871	0.5825	0.0504	0.1672	0	0	0.3175	0.2712	0.3866	0.0197	0.0585	0.2022	1.1571	0.4541	0.1659	0	0	0	0	0	0	0.0318	0	0.0847	0.0731									8.4041	500	3.662691214	24.0439	0.390161342	2.934578733	0.258122632	4.709594066	5.397061821	0.525259913	1.14930058	6.9151496	0.050418646	4.209832012	0	0	17.35041661	4.151762218	9.82490208	0.316395248	0.595823533	3.512550374	1.157089407	6.634716334	0.165902383	0	0	0	0	0	0	0.031799786	0	0.981997934	0.904817175	0	0	0	0	0	0	0	0	96.2115
H4213_006_0	2011	9	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	NO	1124.775596	36.85853805	290.8433145	0	268.3844775	27.68575459	1.620410853	312.3967324	419.9122292	0	251.5512611	0	0	1733.934799	3909.814325	3700.258763	87.63657124	199.7072947	172.7802494	0	25.31984086	0	0	0	0	0	0	0	0	0	5.986496717	5.84974186										"$265 copay per day for days 1-6, $0 after day 6, unlimited coverage"	"$265 copay per day for days 1-6, $0 after day 6, 190 day per lifetime limit"	"$0 copay for days 1-20, $137.5 copay per day for days 21-100*"	No cost sharing	"$250 copay ground, $500 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) $20 copay, (7c) $35 copay, (7f) $20 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) $0 - $35 copay Medicare covered only  (17b) $35 copay Medicare covered only	(17a) $0 - $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									25	265	265	137.5	0	250	0.2	0.2	48.51439927	250	0	250	0	0	159.6789095	15	33.68613041	35	35	250	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									NO	228.826818	228.826818	118.7308961	0	215.8743566	0.172699485	0.172699485	41.89118163	215.8743566	0	215.8743566	0	0	137.7848647	12.95246139	29.08666726	30.22240992	30.22240992	215.8743566	0	0.172699485	0.172699485	0	0	0	0	0	0	0	0	0.172699485	0.172699485										21.4482	0.702851831	2.877673947	0	4.828110534	4.781315567	0.27984412	1.090555688	7.554023525	0	4.525288887	0	0	19.90916431	4.220143258	8.969016283	0.220715698	0.502969644	3.108235431	0	4.372723483	0	0	0	0	0	0	0	0	0	1.033864901	1.010247408	0	0	0	0	0	0	0	0	91.435	0	14.34716024	21.4482	0.702851831	2.877673947	0	4.828110534	4.781315567	0.27984412	1.090555688	7.554023525	0	4.525288887	0	0	19.90916431	4.220143258	8.969016283	0.220715698	0.502969644	3.108235431	0	4.372723483	0	0	0	0	0	0	0	0	0	1.033864901	1.010247408	0	0	0	0	0	0	0	0	91.435	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$250 copay ground, $500 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	Not covered	"(16a) not covered, (16b) 30% coinsurance Medicare covered only"	(17a) 30% coinsurance Medicare covered only  (17b) 30% coinsurance Medicare covered only	(17a) 30% coinsurance Medicare covered only  (17b) 30% coinsurance Medicare covered only	(18a) 30% coinsurance Medicare covered only	Not covered	50% coinsurance	n/a	30% coinsurance	30% coinsurance									6700	3.3844	0.0499	0.317	0.2496	0.2057	0.3432	0.0201	0.0868	0.5865	0.0651	0.1969	0	0	0.4842	0.281	0.3602	0.0146	0.0635	0.1995	1.1609	0.314	0.1376	0	0	0	0	0	0	0.0307	0	0.0912	0.0858									8.7285	500	4.153488238	24.8327	0.752758007	3.19469047	0.249615412	5.033834679	5.124502982	0.299930032	1.177376037	8.140525338	0.065112633	4.7222113	0	0	20.39334206	4.501122609	9.329223494	0.235268859	0.566489958	3.307758075	1.160939406	4.686683662	0.137596929	0	0	0	0	0	0	0.030745947	0	1.125068578	1.096026473	0	0	0	0	0	0	0	0	100.1635
H4213_007_0	2011	6	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							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	NO	894.1687011	26.83786442	349.0577191	0	243.7420623	20.64346227	1.170448691	280.6864589	365.9677243	0	233.6462034	0	0	1570.554897	3296.294834	3187.783222	78.04264066	121.828192	122.7703857	0	26.04669043	0	0	0	0	0	0	0	0	0	4.340297196	5.341095498										"$175 copay per day for days 1-6, $0 after day 6, unlimited coverage"	"$175 copay per day for days 1-6, $0 after day 6, 190 day per lifetime limit"	"$0 copay for days 1-20, $137.5 copay per day for days 21-100*"	No cost sharing	"$250 copay ground, $500 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) $20 copay, (7c) $35 copay, (7f) $20 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	20% coinsurance	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									25	175	175	137.5	0	250	0.2	0.2	48.42643147	200	0	200	0	0	125.3029705	15	33.50074451	35	35	200	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									NO	149.6850946	149.6850946	117.6097172	0	213.8358495	0.17106868	0.17106868	41.42122844	171.0686796	0	171.0686796	0	0	107.1770686	12.83015097	28.65464064	29.93701892	29.93701892	171.0686796	0	0.17106868	0.17106868	0	0	0	0	0	0	0	0	0.17106868	0.17106868										11.1536	0.334769023	3.421048302	0	4.343399245	3.531449832	0.200227112	0.968864828	5.217134613	0	3.330795625	0	0	14.02728916	3.524330029	7.612065222	0.194697001	0.303931074	1.750180648	0	4.455772938	0	0	0	0	0	0	0	0	0	0.74248891	0.913694154	0	0	0	0	0	0	0	0	66.0258	0	11.16635172	11.1536	0.334769023	3.421048302	0	4.343399245	3.531449832	0.200227112	0.968864828	5.217134613	0	3.330795625	0	0	14.02728916	3.524330029	7.612065222	0.194697001	0.303931074	1.750180648	0	4.455772938	0	0	0	0	0	0	0	0	0	0.74248891	0.913694154	0	0	0	0	0	0	0	0	66.0258	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$250 copay ground, $500 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	Not covered	"(16a) not covered, (16b) 30% coinsurance Medicare covered only"	(17a) 30% coinsurance Medicare covered only  (17b) 30% coinsurance Medicare covered only	(17a) 30% coinsurance Medicare covered only  (17b) 30% coinsurance Medicare covered only	(18a) 30% coinsurance Medicare covered only	Not covered	50% coinsurance	n/a	30% coinsurance	30% coinsurance									4750	2.6935	0.0339	0.3672	0.2969	0.1765	0.2436	0.0138	0.077	0.4476	0.0442	0.1678	0	0	0.3144	0.224	0.291	0.0126	0.0502	0.1509	0.8858	0.3074	0.1012	0	0	0	0	0	0	0.0286	0	0.0677	0.0774									7.0732	500	4.147424896	13.8472	0.368694284	3.788207139	0.296916514	4.519853958	3.775091013	0.214041147	1.045842737	5.664694534	0.044164779	3.498603533	0	0	14.34171705	3.748336389	7.90302365	0.207318991	0.354145061	1.901086915	0.885794858	4.76318486	0.101218626	0	0	0	0	0	0	0.028605253	0	0.810163842	0.991118586	0	0	0	0	0	0	0	0	73.099
H4268_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	O	V	V	V	V	P	P	Coin	O	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	1017.461753	48.92949921	686.9973622	108.1249992	249.5550273	6.163333426	13.05066673	227.6214905	216.3062026	521.2926853	15.18955486	44.99800565	0	299.1972656	3369.807939	7938.610285	207.862056	472.9002602	0	0	28.45018468	13.17874863	8.131568305	425	358.9138999	32.9848079	23.51392247	0	500	0												1a1: $206.58	1b1: $144.51	21: $40.74	6: $10	10a: $100	11a: 20.0%	"11b: 20.0%,11c: 20.0%"	"4a1: $50,4a2: $500,4b: $25"	"9a1: $250,9b: $100"	"8a1: $15,8a2: $15"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: $275,9a2: $250"	12: 20.0%	"3: $35,9a3: $250,9c: $35,9d1: $35"	7a: $15	"7b1: $35,7d1: $35,7f1: $35,7g: $35,17b1: $10"	"7c: $35,7i: $35"	"7e: $35,7h: $35"	7d2: $35	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16a1: $1.225	$0 	17b2: $10	$0 	$0 	$0 	$0 												206.58	144.51	40.74	10	100	0.2	0.2	49.07514451	181.5693431	15	0.2	250	0	161.1016099	9.879393044	31.46723653	35	35	0	0	0.2	0	0	1.225	0	10	0	0	0	0											NO	180.0489777	125.9506137	35.50777109	8.715702281	87.15702281	0.174314046	0.174314046	42.77243489	158.2504338	13.07355342	0.174314046	217.892557	0	140.4113669	8.610584849	27.42590652	30.50495798	30.50495798	0	0	0.174314046	0	0	1.067673529	0	8.715702281	0	0	0	0												15.2661	0.513558371	2.03281209	0.078532109	1.812539434	1.074355584	2.274914516	0.811327115	2.852545865	0.567928981	2.647752758	0.817060876	0	3.50089142	2.418001432	18.14363197	0.52840194	1.202150214	0	0	4.959266789	0	0	0.037813438	0	0.023957147	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.5635		9.071660225	15.2661	0.513558371	2.03281209	0.078532109	1.812539434	1.074355584	2.274914516	0.811327115	2.852545865	0.567928981	2.647752758	0.817060876	0	3.50089142	2.418001432	18.14363197	0.52840194	1.202150214	0	0	4.959266789	0	0	0.037813438	0	0.023957147	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.5635	YES	1a1: $206.58	1b1: $144.51	21: $40.74	6: $10	10a: $100	11a: 30.0%	"11b: 30.0%,11c: 20.0%"	"4a1: $50,4a2: $500,4b: $25"	"9a1: $250,9b: $100"	"8a1: $15,8a2: $15"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: $275,9a2: $250"	12: 20.0%	"3: $35,9a3: $250,9c: $35,9d1: $35"	7a: $15	"7b1: $35,7d1: $35,7f1: $35,7g: $35,17a1: 50.0%,17b1: 50.0%,18a1: 50.0%"	"7c: $35,7i: $35"	"7e: $35,7h: $35"	7d2: $35	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16b1: 50.0%	17a2: 50.0%	17b2: 50.0%	18a2: 50.0%	18b: 50.0%	$0 	$0 											3400	3.091	0.104	0.4116	0.0159	0.367	0.3108	0.5891	0.1643	0.5776	0.115	0.5106	0.1654	0	0.6755	0.4896	3.6995	0.107	0.2434	0	0	0.9563	0	0	0	0.0183	0.0012	0.0007	0	0	0											12.6137	2000	1.858680633	18.3571	0.617540752	2.444404333	0.094432844	2.179532121	1.385111891	2.863979084	0.97560002	3.430113146	0.682920014	3.158326031	0.98249472	0	4.176364691	2.907584625	21.84314064	0.635389763	1.44555476	0	0	5.915575518	0	0	0.037813438	0.018305203	0.025203873	0.000735175	0	0	0	0	0	0	0	0	0	0	0	0	0	74.1772
H4268_002_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	O	V	V	V	V	P	P	Coin	O	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	1162.581517	55.90827493	784.9832519	123.5467822	285.1488632	7.086631033	15.00572068	260.0869635	247.1577849	595.6442481	17.46502475	51.41603555	0	341.8715346	3850.440977	9070.887983	237.5092564	540.3496498	0	0	32.71216202	15.05842311	9.291367452	0	410.1055051	37.68940493	26.8676946	0	500	0												1a1: $206.58	1b1: $144.51	21: $40.74	6: $10	10a: $100	11a: 20.0%	"11b: 20.0%,11c: 20.0%"	"4a1: $50,4a2: $500,4b: $22.5"	"9a1: $250,9b: $100"	"8a1: $15,8a2: $15"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: $275,9a2: $250"	12: 20.0%	"3: $35,9a3: $250,9c: $35,9d1: $35"	7a: $10	"7b1: $35,7d1: $35,7f1: $35,7g: $35,17b1: $10"	"7c: $35,7i: $35"	"7e: $35,7h: $35"	7d2: $35	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16a1: $1.225	$0 	17b2: $10	$0 	$0 	$0 	$0 												206.58	144.51	40.74	10	100	0.2	0.2	48.98265896	181.5693431	15	0.2	250	0	162.1017277	6.586262029	31.47632165	35	35	0	0	0.2	0	0	0	0	10	0	0	0	0											NO	176.2534128	123.295482	34.75924114	8.531968862	85.31968862	0.170639377	0.170639377	41.7918521	154.9143981	12.79795329	0.170639377	213.2992216	0	138.3046894	5.619378255	26.85549962	29.86189102	29.86189102	0	0	0.170639377	0	0	0	0	8.531968862	0	0	0	0												17.0757	0.574436476	2.273785179	0.087841442	2.027401018	1.209258306	2.560566832	0.905792993	3.190691625	0.635252272	2.980220947	0.913916697	0	3.940203033	1.803090358	20.30026906	0.591039628	1.344655196	0	0	5.581982956	0	0	0	0	0.026797069	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.0229		11.70419243	17.0757	0.574436476	2.273785179	0.087841442	2.027401018	1.209258306	2.560566832	0.905792993	3.190691625	0.635252272	2.980220947	0.913916697	0	3.940203033	1.803090358	20.30026906	0.591039628	1.344655196	0	0	5.581982956	0	0	0	0	0.026797069	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.0229	YES	1a1: $206.58	1b1: $144.51	21: $40.74	6: $10	10a: $100	11a: 30.0%	"11b: 30.0%,11c: 20.0%"	"4a1: $50,4b: $22.5"	"9a1: $250,9b: $100"	"8a1: $15,8a2: $15"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: $275,9a2: $250"	12: 20.0%	"3: $35,9a3: $250,9c: $35,9d1: $35"	7a: $10	"7b1: $35,7d1: $35,7f1: $35,7g: $35,17a1: 50.0%,17b1: 50.0%,18a1: 50.0%"	"7c: $35,7i: $35"	"7e: $35,7h: $35"	7d2: $35	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16b1: 50.0%	17a2: 50.0%	17b2: 50.0%	18a2: 50.0%	18b: 50.0%	$0 	$0 											3400	3.5319	0.1188	0.4703	0.0182	0.4193	0.3573	0.6773	0.1873	0.6599	0.1314	0.5871	0.189	0	0.7766	0.3729	4.2283	0.1222	0.2781	0	0	1.0996	0	0	0	0.0209	0.0014	0.0008	0	0	0											14.2488	2000	2.451691228	20.6076	0.693249782	2.744082498	0.106010086	2.446737582	1.566567434	3.237876165	1.093142272	3.850636869	0.766644386	3.567280603	1.102946239	0	4.716807202	2.176031729	24.52858993	0.713287039	1.622776339	0	0	6.681551427	0	0	0	0.020916059	0.028221614	0.000840033	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2718
H4270_001_0	2011	7																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	O																																																												0	YES	231.3749919	6.725754817	443.65747		136.905906	3.89522214	3.76325728	379.2772896	410.275237	1198.085506	921.5864255			1513.956251	43.34773304	1466.141444	57.71259991	425.9160839		49.19802869	770.9126871																				3400	#1a $300	#1b $300	#2 $125/day days 21-100		#10a $100	#11a 20%	#11b 20%/10% #11C 0%	#4a $50	"#9a $200, #9b $200"	#8a $25	#8b $25			"#4b $25, #9a $25, #9c $25, #9d $25"	#7a $0/$25	#7d $30	"#7e $30, #7h $30"	"#7c $30, #7i $30"		"#7f $30, #17a $30"	#15 $25/$25/$50																					300	300	125		100	0.2	0.09993419	50	200	25	25			25	25	30	30	30		30	44.8015755																				NO	295.5	295.5	123.125		98.5	0.197	0.098435177	49.25	197	24.625	24.625			24.625	24.625	29.55	29.55	29.55		29.55	44.12955186																					5.6976	0.165621712	4.5521105	0	1.123769312	0.767358762	0.370436897	1.556617209	6.735351808	2.4585713	1.891172144	0	0	3.106764391	0.088953161	3.610373305	0.142117277	1.048818357	0	0.121150146	2.835002617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2718		0.552362407	5.6976	0.165621712	4.5521105	0	1.123769312	0.767358762	0.370436897	1.556617209	6.735351808	2.4585713	1.891172144	0	0	3.106764391	0.088953161	3.610373305	0.142117277	1.048818357	0	0.121150146	2.835002617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2718	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.0338	0.0293							0.6311						0.0864																					0.7807		0	5.6976	0.165621712	4.5521105	0	1.123769312	0.801170058	0.399699528	1.556617209	6.735351808	2.4585713	1.891172144	0	0	3.73790857	0.088953161	3.610373305	0.142117277	1.048818357	0	0.207582475	2.835002617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0524
H4270_002_0	2011	10																															A	A	D		T	Coin	Coin	V	V					V	V	V	V	V		V	O																																																												0	YES	215.1923193	6.170519043	335.9672053		100.5549711	9.859454577	7.069871171	378.4804227	511.0598953					0.625244671	35.1737736	2061.662439	141.7246756	624.9440881		98.1110965	1226.996463																				3400	#1a $150	#1b $150	#2 $75/day days 21-100		#10a $100	#11a 20%	#11b 10%/10% #11C 0%	#4a $50	"#9a $100, #9b $100"					#4b $20	#7a $0/$20	#7d $15	"#7e $15, #7h $15"	"#7c $15, #7I $15"		"#7f $15, #17a $15"	#15 $25/$25/$50																					150	150	75		100	0.2	0.054672985	50	100					20	20	15	15	15		15	44.36085811																				NO	149.25	149.25	74.625		99.5	0.199	0.05439962	49.75	99.5					19.9	19.9	14.925	14.925	14.925		14.925	44.13905382																					2.6765	0.076745831	2.089296058	0	0.833768302	1.962031461	0.384598305	1.569116753	4.237538299	0	0	0	0	0.001036864	0.058329841	2.564192659	0.176270065	0.77727421	0	0.122025676	4.513205242	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.0419		0.110763236	2.6765	0.076745831	2.089296058	0	0.833768302	1.962031461	0.384598305	1.569116753	4.237538299	0	0	0	0	0.001036864	0.058329841	2.564192659	0.176270065	0.77727421	0	0.122025676	4.513205242	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.0419	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.0931	0.0752							0.8056						0.1356																					1.1095		0	2.6765	0.076745831	2.089296058	0	0.833768302	2.055140029	0.459793455	1.569116753	4.237538299	0	0	0	0	0.806674229	0.058329841	2.564192659	0.176270065	0.77727421	0	0.257605639	4.513205242	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.1514
H4270_003_0	2011	8																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	O																																																												0	YES	185.4007772	3.999539511	231.0850738		88.52084523	6.508946051	6.162651179	308.8912801	436.2987886	1530.857383	992.9586254			1701.574848	53.53043058	1458.29365	106.3396358	510.1344385		70.99651929	928.9215699																				3400	#1a $300	#1b $300	#2 $125/day days 21-100		#10a $100	#11a 20%	#11b 20%/10% #11C 0%	#4a $50	"#9a $200, #9b $200"	#8a $25	#8b $25			"#4b $25, #9a $25, #9c $25, #9d $25"	#7a $0/$25	#7d $30	"#7e $30, #7h $30"	"#7c $30, #7i $30"		"#7f $30, #17a $30"	#15 $25/$25/$50																					300	300	125		100	0.2	0.078667204	50	200	25	25			25	25	30	30	30		30	42.14270304																				NO	294.6	294.6	122.75		98.2	0.1964	0.077251194	49.1	196.4	24.55	24.55			24.55	24.55	29.46	29.46	29.46		29.46	41.38413438																					4.5516	0.098188695	2.363807734	0	0.724395583	1.278357004	0.476072161	1.263880154	7.14075684	3.131879063	2.031427854	0	0	3.481138543	0.109514339	3.58011091	0.261063806	1.252380047	0	0.174296455	3.203551257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1224		0.643791621	4.5516	0.098188695	2.363807734	0	0.724395583	1.278357004	0.476072161	1.263880154	7.14075684	3.131879063	2.031427854	0	0	3.481138543	0.109514339	3.58011091	0.261063806	1.252380047	0	0.174296455	3.203551257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1224	NO						Section C POS	Section C POS		Section C POS					Section C POS						Section C POS																											0.0678	0.05							0.6881						0.1144																					0.9203		0	4.5516	0.098188695	2.363807734	0	0.724395583	1.346196579	0.526047331	1.263880154	7.14075684	3.131879063	2.031427854	0	0	4.169281731	0.109514339	3.58011091	0.261063806	1.252380047	0	0.288656921	3.203551257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.0427
H4270_004_0	2011	8																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	O																																																												0	YES	185.4007772	3.999539511	231.0850738		88.52084523	6.508946051	6.162651179	308.8912801	436.2987886	1530.857383	992.9586254			1701.574848	53.53043058	1458.29365	106.3396358	510.1344385		70.99651929	928.9215699																				3400	#1a $500	#1b $500	#2 $125/day days 21-100		#10a $100	#11a 20%	#11b 20% #11C 20%	#4a $50	"#9a $250, #9b $250"	#8a $35	#8b $35			"#4b $25, #9a $35, #9c $35, #9d $35"	#7a $0/$25	#7d $35	"#7e $35, #7h $35"	"#7c $35, #7i $35"		"#7f $35, #17a $35, #18a $35"	#15 $25/$25/$50																					500	500	125		100	0.2	0.2	50	250	35	35			35	25	35	35	35		35	42.14270304																				NO	486	486	121.5		97.2	0.1944	0.1944	48.6	243	34.02	34.02			34.02	24.3	34.02	34.02	34.02		34.02	40.96270735																					7.5087	0.16198135	2.339736372	0	0.717018846	1.265339112	1.198019389	1.251009684	8.835050469	4.339980681	2.815037703	0	0	4.823964694	0.108399122	4.134262497	0.301472868	1.446231133	0	0.201275132	3.170928535	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6184		1.285304829	7.5087	0.16198135	2.339736372	0	0.717018846	1.265339112	1.198019389	1.251009684	8.835050469	4.339980681	2.815037703	0	0	4.823964694	0.108399122	4.134262497	0.301472868	1.446231133	0	0.201275132	3.170928535	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6184	NO						Section C POS	Section C POS		Section C POS					Section C POS						Section C POS																											0.0678	0.05							0.6881						0.1144																					0.9203			7.5087	0.16198135	2.339736372	0	0.717018846	1.333178686	1.247994559	1.251009684	8.835050469	4.339980681	2.815037703	0	0	5.512107882	0.108399122	4.134262497	0.301472868	1.446231133	0	0.315635598	3.170928535	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5388
H4270_801_0	2011	5																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	O																																																												0	YES	239.1117108	7.448367989	184.2697238		163.4530741	7.907230435	8.459801149	282.826545	395.2400785	873.3666836	685.8701896			1591.254694	7030.108832	1197.954316	268.6665796	708.6029449		48.8673333	1136.641254																				3400	#1a $300	#1b $300	#2 $125/day days 21-100		#10a $100	#11a 20%	#11b 20% #11C 20%	#4a $50	"#9a $200, #9b $200"	#8a $25	#8b $25			"#4b $25, #9a $25, #9c $25, #9d $25"	#7a $30/$25	#7d $30	"#7e $30, #7h $30"	"#7c $30, #7i $30"		"#7f $30, #17a $30"	#15 $25/$25/$50																					300	300	125		100	0.2	0.2	50	200	25	25			25	29.96610015	30	30	30		30	44.0183793																				NO	294.6	294.6	122.75		98.2	0.1964	0.1964	49.1	196.4	24.55	24.55			24.55	29.42671035	29.46	29.46	29.46		29.46	43.22604847																					5.8702	0.182857434	1.884925717	0	1.33759099	1.552980058	1.661504946	1.157231946	6.468762618	1.786762673	1.403176096	0	0	3.255441895	17.23941469	2.940977847	0.659576453	1.73962023	0	0.119969303	4.094375829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3554		0.978000511	5.8702	0.182857434	1.884925717	0	1.33759099	1.552980058	1.661504946	1.157231946	6.468762618	1.786762673	1.403176096	0	0	3.255441895	17.23941469	2.940977847	0.659576453	1.73962023	0	0.119969303	4.094375829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3554	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.0952	0.0774							0.4495						0.1125																					0.7346		0	5.8702	0.182857434	1.884925717	0	1.33759099	1.648224314	1.73890982	1.157231946	6.468762618	1.786762673	1.403176096	0	0	3.70494025	17.23941469	2.940977847	0.659576453	1.73962023	0	0.232445801	4.094375829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.09
H4270_803_0	2011	5																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	O																																																												0	YES	239.1117108	7.448367989	184.2697238		163.4530741	7.907230435	8.459801149	282.826545	395.2400785	873.3666836	685.8701896			1591.254694	7030.108832	1197.954316	268.6665796	708.6029449		48.8673333	1136.641254																				3400	#1a $300	#1b $300	#2 $125/day days 21-100		#10a $100	#11a 20%	#11b 20% #11C 20%	#4a $50	"#9a $200, #9b $200"	#8a $25	#8b $25			"#4b $25, #9a $25, #9c $25, #9d $25"	#7a $30/$25	#7d $30	"#7e $30, #7h $30"	"#7c $30, #7i $30"		"#7f $30, #17a $30"	#15 $25/$25/$50																					300	300	125		100	0.2	0.2	50	200	25	25			25	29.96610015	30	30	30		30	44.0183793																				NO	294.6	294.6	122.75		98.2	0.1964	0.1964	49.1	196.4	24.55	24.55			24.55	29.42671035	29.46	29.46	29.46		29.46	43.22604847																					5.8702	0.182857434	1.884925717	0	1.33759099	1.552980058	1.661504946	1.157231946	6.468762618	1.786762673	1.403176096	0	0	3.255441895	17.23941469	2.940977847	0.659576453	1.73962023	0	0.119969303	4.094375829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3554		0.978000511	5.8702	0.182857434	1.884925717	0	1.33759099	1.552980058	1.661504946	1.157231946	6.468762618	1.786762673	1.403176096	0	0	3.255441895	17.23941469	2.940977847	0.659576453	1.73962023	0	0.119969303	4.094375829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3554	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.0952	0.0774							0.4495						0.1125																					0.7346		0	5.8702	0.182857434	1.884925717	0	1.33759099	1.648224314	1.73890982	1.157231946	6.468762618	1.786762673	1.403176096	0	0	3.70494025	17.23941469	2.940977847	0.659576453	1.73962023	0	0.232445801	4.094375829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.09
H4346_001_0	2011	4																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	983.9749845	39.51028601	906.7556566	0	354.5391367	1497.898223	5681.22744	462.4916796	169.9754198	0	1081.775037	17.57754167	0	57.86976515	0	3909.212051	291.1773031	81.06178864	0	0	17.73451222	0	0	0	324.3079385	551.7667578	0	0	0	0											3400	1a:$75 Days 1-5; Unlimited Add'l Days	1b:$75 Days 1-5; 60 Add'l Days	"2:$0 Days 1-20, $75 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:$20; Worldwide Coverage	9a:$25; 9b:$0	8a:$0	8b: X-Rays $5; Diagnostic $50; Therapeutic $0	9a:$25	12:$0	3:$15; 5:$30; 9c:$30; 9d:$20	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$20; 7d:$20; 7f:$0; 16b:$0-$20; 17a:$0-$20; 4 Routine Footcare Visits	7e:Visits 1-10:$0; Visits 11+:$15; 7h:$20	7c:$15; 7i: PT $0 ST $15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	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 52 Weeks $0											0	61.58720717	50.60577819	7.724161948	0	27.39309211	1.227103214	0.26036045	40.94946668	25	0	20.0664053	25	0	26.16485989	0	20	19.72061878	15	0	0	0.178355398	0	0	0	20	19.01237072	0	0	0	0											NO	60.71733605	49.89101116	7.615064202	0	27.00618611	1.209771341	0.256683063	40.3710875	24.64689456	0	19.78298302	24.64689456	0	25.79530171	0	19.71751564	19.44208047	14.78813673	0	0	0.162895419	0	0	0	20	19.01237072	0	0	0	0												4.9787	0.164267343	0.575416878	0	0.797895826	0.151009528	0.121522905	1.555941005	0.349113854	0	1.783394765	0.036102651	0	0.124397338	0	6.423329148	0.471757713	0.099896068	0	0	2.888870796	0	0	0	0.540513231	0.874199512	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9363	0	0.526791869	4.9787	0.164267343	0.575416878	0	0.797895826	0.151009528	0.121522905	1.555941005	0.349113854	0	1.783394765	0.036102651	0	0.124397338	0	6.423329148	0.471757713	0.099896068	0	0	2.888870796	0	0	0	0.540513231	0.874199512	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9363	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.9787	0.164267343	0.575416878	0	0.797895826	0.151009528	0.121522905	1.555941005	0.349113854	0	1.783394765	0.036102651	0	0.124397338	0	6.423329148	0.471757713	0.099896068	0	0	2.888870796	0	0	0	0.540513231	0.874199512	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9363
H4346_003_0	2011	6																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	2678.125118	169.0748105	0	0	1315.940999	7903.516265	34644.60725	104.9295121	34.13086828	0	107.8075326	9.792188957	0	0	0	0	0	0	0	0	7.881342088	0	0	0	310	493.1	0	0	0	0											3400	1a:$50 Days 1-5; 150 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:$0	8a:$0	8b: X-Rays $0; Diagnostic $50; Therapeutic $0	9a:$25	12:$0	3:$0; 5:$0; 9c:$0; 9d:$0	"7a:$0; 14b,14c (ippe/ppps), 14c:Comprehensive Health Assessment $0, 14d,14e,14f,14i,14j:$0"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 6 Routine Footcare Visits	7e:$0; 7h:$0; 7g: NP Psych Services $0	7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Comprehensive Health Assessment $0	13c:OTC $40 per month Allowance											0	41.05813812	33.73718546	0	0	13.69654605	1.227103214	0.119202397	50	25	0	50	25	0	0	0	0	0	0	0	0	0.182784036	0	0	0	20	19.01237072	0	0	0	0											NO	40.81116357	33.5342482	0	0	13.61415804	1.219721894	0.118485366	49.69923801	24.84961901	0	49.69923801	24.84961901	0	0	0	0	0	0	0	0	0.178455087	0	0	0	20	19.01237072	0	0	0	0												9.1081	0.472483055	0	0	1.492952395	0.803340985	0.342073247	0.4345764	0.070678256	0	0.446496018	0.02027768	0	0	0	0	0	0	0	0	1.406465588	0	0	0	0.516666667	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.8954	0	0.113945104	9.1081	0.472483055	0	0	1.492952395	0.803340985	0.342073247	0.4345764	0.070678256	0	0.446496018	0.02027768	0	0	0	0	0	0	0	0	1.406465588	0	0	0	0.516666667	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.8954	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.1081	0.472483055	0	0	1.492952395	0.803340985	0.342073247	0.4345764	0.070678256	0	0.446496018	0.02027768	0	0	0	0	0	0	0	0	1.406465588	0	0	0	0.516666667	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.8954
H4346_005_0	2011	5																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	2365.944596	63.39351855	2178.200163	0	880.1580602	7517.102184	7187.586897	744.9986048	260.0587321	0	1635.914661	30.84417521	0	94.51622944	0	5214.630934	472.2255971	85.18507244	0	0	25.81053541	0	0	0	327.8071926	556.0274065	0	0	0	0											3400	1a:$50 Days 1-5; 150 Add'l Days	1b:$50 Days 1-5; 60 Add'l Days	"2:$0 Days 1-31, $50 Days 32-100; 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; 11c:$0	4a:$50 (waived if admitted); 4b:$20; Worldwide Coverage	9a:$25; 9b:$0	8a:$0	8b: X-Rays $5; Diagnostic $50; Therapeutic $0	9a:$25	12:$0	3:$15; 5:$30; 9c:$30; 9d:$20	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$20; 7d:$20; 7f:$0; 16b:$0-$20; 17a:$0-$20; 9 Routine Footcare Visits	7e:Visits 1-10:$0; Visits 11+:$15; 7h:$20	7c:$15; 7i: PT $0 ST $15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	10b:$0 24 Plan Approved Location Trips	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	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 14c:Annual CCC Visit $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0											0	41.05813812	33.73718546	2.142446174	0	27.39309211	1.227103214	0.277334217	41.99158498	25	0	20.94887374	25	0	25.31609931	0	19.99819364	19.82396197	15	0	0	0.179389343	0	0	0	20	19.01237072	0	0	0	0											NO	39.6845718	32.60853561	2.070772396	0	26.47667869	1.186051483	0.268056228	40.58679097	24.16364552	0	20.24804636	24.16364552	0	24.46916998	0	19.32917048	19.16076759	14.49818731	0	0	0.154226681	0	0	0	20	19.01237072	0	0	0	0												7.8243	0.172264151	0.375879731	0	1.941971847	0.742972516	0.160556453	2.519758554	0.523663918	0	2.760339657	0.062108976	0	0.192727807	0	8.399540861	0.754017077	0.102919095	0	0	3.980673199	0	0	0	0.546345321	0.880949932	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.941	0	1.567825028	7.8243	0.172264151	0.375879731	0	1.941971847	0.742972516	0.160556453	2.519758554	0.523663918	0	2.760339657	0.062108976	0	0.192727807	0	8.399540861	0.754017077	0.102919095	0	0	3.980673199	0	0	0	0.546345321	0.880949932	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.941	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.8243	0.172264151	0.375879731	0	1.941971847	0.742972516	0.160556453	2.519758554	0.523663918	0	2.760339657	0.062108976	0	0.192727807	0	8.399540861	0.754017077	0.102919095	0	0	3.980673199	0	0	0	0.546345321	0.880949932	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.941
H4346_006_0	2011	5																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	1443.809886	52.44814006	1290.220285	0	512.4809911	2434.803758	4874.619587	537.3574997	201.6694519	0	1199.419419	16.43232571	0	84.36256429	0	4239.395257	316.3612643	58.22301325	0	0	19.88241057	0	0	0	335.5695579	556.5783859	0	0	0	0											3400	1a:$50 Days 1-5; 100 Add'l Days	1b:$50 Days 1-5; 60 Add'l Days	"2:$0 Days 1-31, $50 Days 32-100; 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; 11c:$0	4a:$50 (waived if admitted); 4b:$20; Worldwide Coverage	9a:$25; 9b:$0	8a:$0	8b: X-Rays $5; Diagnostic $50; Therapeutic $0	9a:$25	12:$0	3:$15; 5:$30; 9c:$30; 9d:$20	"7a:$0; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$20; 7d:$20; 7f:$0; 16b:$0-$20; 17a:$0-$20; 12 Routine Footcare Visits	7e:Visits 1-10:$0; Visits 11+:$15; 7h:$20	7c:$15; 7i: PT $0 ST $15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	10b:$0 24 Plan Approved Location Trips	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	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 14c:Annual CCC Visit $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 52 Weeks $0 13e:Electronic Health Monitoring $0											0	41.05813812	33.73718546	2.142446174	0	27.39309211	1.227103214	0.520410201	41.90631117	25	0	19.28600408	25	0	24.72907567	0	20	19.67547655	15	0	0	0.178604515	0	0	0	20	19.01237072	0	0	0	0											NO	40.39472307	33.19206195	2.107828651	0	26.95047609	1.20727575	0.512001443	41.22919139	24.59605143	0	18.97438193	24.59605143	0	24.32950468	0	19.67684115	19.35756132	14.75763086	0	0	0.160777241	0	0	0	20	19.01237072	0	0	0	0												4.8602	0.145071826	0.226630274	0	1.150967225	0.244956628	0.207984355	1.8462346	0.413356018	0	1.896520179	0.033680861	0	0.171041617	0	6.951492251	0.510331881	0.071602811	0	0	3.196639126	0	0	0	0.559282596	0.881822884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.3678	0	0.662058786	4.8602	0.145071826	0.226630274	0	1.150967225	0.244956628	0.207984355	1.8462346	0.413356018	0	1.896520179	0.033680861	0	0.171041617	0	6.951492251	0.510331881	0.071602811	0	0	3.196639126	0	0	0	0.559282596	0.881822884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.3678	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.8602	0.145071826	0.226630274	0	1.150967225	0.244956628	0.207984355	1.8462346	0.413356018	0	1.896520179	0.033680861	0	0.171041617	0	6.951492251	0.510331881	0.071602811	0	0	3.196639126	0	0	0	0.559282596	0.881822884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.3678
H4346_007_0	2011	6																															D	D	D	V	T	P	P	V	V	V	V	V	P	V	V	V	V	V	V	V	Coin	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	404.6037462	15.1414226	297.9074126	0	119.8789979	389.1422207	991.811772	277.9351785	232.9118648	0	714.352699	7.089564086	0	22.32190143	3347.091833	2481.284501	129.5492203	49.8837593	0	0	8.927270346	0	0	0	320.3955158	530.9154953	0	0	0	0											3400	1a:$100 Days 1-4	1b:$100 Days 1-4; 60 Add'l Days	"2:$0 Days 1-20, $125 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:$25; Worldwide Coverage	9a:$150; 9b:$75	8a:$0	8b: X-Rays $5; Diagnostic $75; Therapeutic $0	9a:$150	12:$0	3:$15; 5:$35; 9c:$35; 9d:$25	"7a:$10; 14b,14c (ippe/ppps) 14d,14e,14f,14i,14j:$0"	7b:$25; 7d:$25; 7f:$25; 16b:$0-$25; 17a:$0-$25	7e:$25; 7h:$25	7c:$15; 7i: PT $0 ST $15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	14a:$0; 17b:$0; First 3 Pints of Blood	0	0	17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	0	7g:Consult with Nutritionist $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0	13c:OTC $20 per month Allowance											0	76.40007321	56.38397018	12.87360325	0	27.39309211	1.227103214	0.499964028	39.83842145	110.8293984	0	26.03594394	150	0	29.92766619	10	24.99965669	25	15	0	0	0.177446105	0	0	0	20	19.01237072	0	0	0	0											NO	75.59733917	55.79154493	12.73834055	0	27.10527343	1.214210065	0.494710916	39.41983995	109.6649161	0	25.76238479	148.423953	0	29.6132168	9.8949302	24.7369858	24.7373255	14.8423953	0	0	0.172207422	0	0	0	20	19.01237072	0	0	0	0												2.5489	0.070396947	0.316237173	0	0.270779418	0.039375033	0.040888342	0.913013354	2.128521677	0	1.533619092	0.087688427	0	0.055085276	2.759936672	5.11495829	0.267058436	0.06169954	0	0	1.537342209	0	0	0	0.533992526	0.841163518	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1207	0	0.218874402	2.5489	0.070396947	0.316237173	0	0.270779418	0.039375033	0.040888342	0.913013354	2.128521677	0	1.533619092	0.087688427	0	0.055085276	2.759936672	5.11495829	0.267058436	0.06169954	0	0	1.537342209	0	0	0	0.533992526	0.841163518	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1207	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.5489	0.070396947	0.316237173	0	0.270779418	0.039375033	0.040888342	0.913013354	2.128521677	0	1.533619092	0.087688427	0	0.055085276	2.759936672	5.11495829	0.267058436	0.06169954	0	0	1.537342209	0	0	0	0.533992526	0.841163518	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1207
H4406_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1438.772172	104.5326163	830.3862542	638.9445847	216.8794509	9.898895519	12.32273242	338.4304848	35.71063843	16.0179063	36.32308794	0	0.051265437	16.33487951	5228.169424	101.5706812	500.2628925	421.5343946	0	0	24.97963482	1118.674671	0	0	233.3290812	175.3000439	14.91034176	1.75054533	160.0976618	0											3750	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-48 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$0 n/c (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	62.67263995	0	200	0.2	0.109165765	49.27058475	0.2	0.133049835	0.165174554	0	0.2	0.159853212	10.6104113	0.094575374	38.5	30	0	0	0.2	29.87932223	0	0	30	15	0	0	0	0											YES	136.4883343	91.29756788	45.92820201	0	146.5653978	0.146565398	0.079999619	36.12432201	0.146565398	0.09750251	0.121044371	0	0.146565398	0.117144748	10.12379305	0.090252318	36.73430004	28.6241299	0	0	0.146565398	21.89637374	0	0	30	15	0	0	0	0											5000	16.3646	0.795297803	3.178178969	0	2.648918582	1.450835559	0.985813894	1.018797651	5.233943926	1.561786074	4.396705328	0	0.007513739	1.913545339	4.410742106	9.166989462	1.531400599	1.005504606	0	0	3.661150113	2.041243224	0	0	0.583322703	0.219125055	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1754	0	17.27260274	16.3646	0.795297803	3.178178969	0	2.648918582	1.450835559	0.985813894	1.018797651	5.233943926	1.561786074	4.396705328	0	0.007513739	1.913545339	4.410742106	9.166989462	1.531400599	1.005504606	0	0	3.661150113	2.041243224	0	0	0.583322703	0.219125055	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1754	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 (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.6969	0.0423	0	0.2155	0.3532	0.2902	0.3612	0.1359	1.0467	0.2082	0.8619	0	0.001	0.382	1.3634	2.284	0.2907	0.2534	0	0	0.8692	0.4837	0	0	0.1484	0	0.0095	0	0	0											10.2971	0	2.991071811	17.0616	0.837589326	3.178178969	0.215460774	3.002090464	1.740988489	1.347013475	1.154648312	6.28068155	1.770014039	5.258572074	0	0.008515522	2.295535206	5.774172975	11.45099617	1.822051623	1.258859816	0	0	4.530363153	2.524909353	0	0	0.731711812	0.219125055	0.009482454	0	0	0	0	0	0	0	0	0	0	0	0	0	72.4725
H4406_801_0	2011	1																															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	268.8605848	5.5806	26.62341269	782.1345712	10.83756702	12.35663869	15.38227693	20.09086566	44.44507541	19.93571341	45.20732346	0	0.063804409	20.31630196	35.75664626	122.8267982	2.6595	6.674046177	0	0	30.10480135	8.521008243	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.076961806	0.076961806	0.20738358	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.061159469	0.061159469	0.164802132	0	0.185158809	0.185158809	0.185158809	0.185158809	0.185158809	0.185158809	0.185158809	0	0.185158809	0.185158809	0.185158809	0.185158809	0.185158809	0.185158809	0	0	0.185158809	0.185158809	0	0	0	0	0	0	0	0												16.4434	0.341306534	4.387595168	0	2.006671006	2.287940507	2.848164081	3.720000765	8.229397244	3.691272959	8.370534185	0	0.011813948	3.76174228	6.620658048	22.74246372	0.492429853	1.235758444	0	0	5.574169173	1.577739741	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.343	0	24.37627904	16.4434	0.341306534	4.387595168	0	2.006671006	2.287940507	2.848164081	3.720000765	8.229397244	3.691272959	8.370534185	0	0.011813948	3.76174228	6.620658048	22.74246372	0.492429853	1.235758444	0	0	5.574169173	1.577739741	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.343	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.4434	0.341306534	4.387595168	0	2.006671006	2.287940507	2.848164081	3.720000765	8.229397244	3.691272959	8.370534185	0	0.011813948	3.76174228	6.620658048	22.74246372	0.492429853	1.235758444	0	0	5.574169173	1.577739741	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.343
H4406_803_0	2011	1																															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	259.2510033	5.5917	25.67184199	768.0299146	10.45021205	11.91498925	14.8324855	19.37278044	42.85652506	19.22317363	43.59152894	0	0.06152392	19.59089193	34.47863666	118.4367381	2.6649	6.43550325	0	0	29.02879929	8.216451428	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078559549	0.078559549	0.19351096	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.063039269	0.063039269	0.155280798	0	0.186968355	0.186968355	0.186968355	0.186968355	0.186968355	0.186968355	0.186968355	0	0.186968355	0.186968355	0.186968355	0.186968355	0.186968355	0.186968355	0	0	0.186968355	0.186968355	0	0	0	0	0	0	0	0												16.343	0.352496681	3.986344106	0	1.953858959	2.227725943	2.773205418	3.622096896	8.012814001	3.594125155	8.150236467	0	0.011503026	3.662876842	6.446413987	22.14392212	0.49825197	1.203235458	0	0	5.427466857	1.536216409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9458	0	22.6370696	16.343	0.352496681	3.986344106	0	1.953858959	2.227725943	2.773205418	3.622096896	8.012814001	3.594125155	8.150236467	0	0.011503026	3.662876842	6.446413987	22.14392212	0.49825197	1.203235458	0	0	5.427466857	1.536216409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9458	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.343	0.352496681	3.986344106	0	1.953858959	2.227725943	2.773205418	3.622096896	8.012814001	3.594125155	8.150236467	0	0.011503026	3.662876842	6.446413987	22.14392212	0.49825197	1.203235458	0	0	5.427466857	1.536216409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9458
H4406_804_0	2011	1																															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	259.2510033	5.5917	25.67184199	768.0299146	10.45021205	11.91498925	14.8324855	19.37278044	42.85652506	19.22317363	43.59152894	0	0.06152392	19.59089193	34.47863666	118.4367381	2.6649	6.43550325	0	0	29.02879929	8.216451428	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078559549	0.078559549	0.19351096	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.063039269	0.063039269	0.155280798	0	0.186968355	0.186968355	0.186968355	0.186968355	0.186968355	0.186968355	0.186968355	0	0.186968355	0.186968355	0.186968355	0.186968355	0.186968355	0.186968355	0	0	0.186968355	0.186968355	0	0	0	0	0	0	0	0												16.343	0.352496681	3.986344106	0	1.953858959	2.227725943	2.773205418	3.622096896	8.012814001	3.594125155	8.150236467	0	0.011503026	3.662876842	6.446413987	22.14392212	0.49825197	1.203235458	0	0	5.427466857	1.536216409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9458	0	22.6370696	16.343	0.352496681	3.986344106	0	1.953858959	2.227725943	2.773205418	3.622096896	8.012814001	3.594125155	8.150236467	0	0.011503026	3.662876842	6.446413987	22.14392212	0.49825197	1.203235458	0	0	5.427466857	1.536216409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9458	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.343	0.352496681	3.986344106	0	1.953858959	2.227725943	2.773205418	3.622096896	8.012814001	3.594125155	8.150236467	0	0.011503026	3.662876842	6.446413987	22.14392212	0.49825197	1.203235458	0	0	5.427466857	1.536216409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9458
H4406_806_0	2011	1																															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	251.4734732	5.428508	25.03004594	672.0261752	9.143935547	10.42561559	12.97842481	16.95118289	37.49945943	16.82027692	38.14258782	0	0.05383343	17.14220544	29.47923435	101.2634111	2.2979835	5.502355279	0	0	24.81962339	7.025065971	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078559549	0.078559549	0.19351096	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.063461986	0.063461986	0.156322051	0	0.188222093	0.188222093	0.188222093	0.188222093	0.188222093	0.188222093	0.188222093	0	0.188222093	0.188222093	0.188222093	0.188222093	0.188222093	0.188222093	0	0	0.188222093	0.188222093	0	0	0	0	0	0	0	0												15.959	0.344503899	3.912748111	0	1.721090683	1.962331184	2.442826277	3.190587115	7.058226725	3.165947721	7.179277697	0	0.010132641	3.22654178	5.548643177	19.06001114	0.432531263	1.035664825	0	0	4.671601453	1.322272618	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2439	0	19.56577824	15.959	0.344503899	3.912748111	0	1.721090683	1.962331184	2.442826277	3.190587115	7.058226725	3.165947721	7.179277697	0	0.010132641	3.22654178	5.548643177	19.06001114	0.432531263	1.035664825	0	0	4.671601453	1.322272618	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2439	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.611	0.0132	0.1242	0	0.3044	0.347	0.432	0.5642	1.2482	0.5599	1.2696	0	0.0018	0.5706	1.1649	4.0014	0.0908	0.2174	0	0	0.9807	0.2776	0	0	0	0	0	0	0	0											12.7789	0	0	16.57	0.357693419	4.036942681	0	2.025453109	2.309355246	2.874822417	3.754819346	8.306423018	3.725822653	8.448880977	0	0.011924525	3.797132332	6.713503917	23.06139634	0.523335208	1.253088302	0	0	5.652339437	1.599865429	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0228
H4406_807_0	2011	1																															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	251.4734732	5.428508	25.03004594	672.0261752	9.143935547	10.42561559	12.97842481	16.95118289	37.49945943	16.82027692	38.14258782	0	0.05383343	17.14220544	29.47923435	101.2634111	2.2979835	5.502355279	0	0	24.81962339	7.025065971	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078559549	0.078559549	0.19351096	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.063461986	0.063461986	0.156322051	0	0.188222093	0.188222093	0.188222093	0.188222093	0.188222093	0.188222093	0.188222093	0	0.188222093	0.188222093	0.188222093	0.188222093	0.188222093	0.188222093	0	0	0.188222093	0.188222093	0	0	0	0	0	0	0	0												15.959	0.344503899	3.912748111	0	1.721090683	1.962331184	2.442826277	3.190587115	7.058226725	3.165947721	7.179277697	0	0.010132641	3.22654178	5.548643177	19.06001114	0.432531263	1.035664825	0	0	4.671601453	1.322272618	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2439	0	19.56577824	15.959	0.344503899	3.912748111	0	1.721090683	1.962331184	2.442826277	3.190587115	7.058226725	3.165947721	7.179277697	0	0.010132641	3.22654178	5.548643177	19.06001114	0.432531263	1.035664825	0	0	4.671601453	1.322272618	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2439	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.611	0.0132	0.1242	0	0.3044	0.347	0.432	0.5642	1.2482	0.5599	1.2696	0	0.0018	0.5706	1.1649	4.0014	0.0908	0.2174	0	0	0.9807	0.2776	0	0	0	0	0	0	0	0											12.7789	0	0	16.57	0.357693419	4.036942681	0	2.025453109	2.309355246	2.874822417	3.754819346	8.306423018	3.725822653	8.448880977	0	0.011924525	3.797132332	6.713503917	23.06139634	0.523335208	1.253088302	0	0	5.652339437	1.599865429	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0228
H4406_808_0	2011	1																															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	251.4734732	5.428508	25.03004594	672.0261752	9.143935547	10.42561559	12.97842481	16.95118289	37.49945943	16.82027692	38.14258782	0	0.05383343	17.14220544	29.47923435	101.2634111	2.2979835	5.502355279	0	0	24.81962339	7.025065971	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078559549	0.078559549	0.19351096	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.063461986	0.063461986	0.156322051	0	0.188222093	0.188222093	0.188222093	0.188222093	0.188222093	0.188222093	0.188222093	0	0.188222093	0.188222093	0.188222093	0.188222093	0.188222093	0.188222093	0	0	0.188222093	0.188222093	0	0	0	0	0	0	0	0												15.959	0.344503899	3.912748111	0	1.721090683	1.962331184	2.442826277	3.190587115	7.058226725	3.165947721	7.179277697	0	0.010132641	3.22654178	5.548643177	19.06001114	0.432531263	1.035664825	0	0	4.671601453	1.322272618	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2439	0	19.56577824	15.959	0.344503899	3.912748111	0	1.721090683	1.962331184	2.442826277	3.190587115	7.058226725	3.165947721	7.179277697	0	0.010132641	3.22654178	5.548643177	19.06001114	0.432531263	1.035664825	0	0	4.671601453	1.322272618	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2439	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.611	0.0132	0.1242	0	0.3044	0.347	0.432	0.5642	1.2482	0.5599	1.2696	0	0.0018	0.5706	1.1649	4.0014	0.0908	0.2174	0	0	0.9807	0.2776	0	0	0	0	0	0	0	0											12.7789	0	0	16.57	0.357693419	4.036942681	0	2.025453109	2.309355246	2.874822417	3.754819346	8.306423018	3.725822653	8.448880977	0	0.011924525	3.797132332	6.713503917	23.06139634	0.523335208	1.253088302	0	0	5.652339437	1.599865429	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.0228
H4407_001_0	2011	6																															D	D	D	V	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	YES	699.4955164	40.8207	233.2620636	735.3191489	163.7284467	5.725433967	1.555781499	329.161596	410.7000551		290.5324252	1.726081334	6.218214781	136.8486237	4185.126715	3107.494607	0.121556749	177.8306317	88.58559857		39.97410395																				3400	1a; $250/days 1-4 Acute/Rehab/LTAC	1b; $225/days 1-7	2a; $0 (1-3 Days); $100 (4-20 Days); $0 (21-100)	6a; $15 CP Per Visit Per PT/OT/ST	10a; $100 Per one-way trip; 20% Coins Air Ambulance per one-way  trip	11a; 20% Coins. On DME/Prosthetics/Supplies	11b; 20% Coins. On DME/Prosthetics/Supplies	4a; $50 Per ER Visit; Waived if Admitted	9a/b; $255 CP Per Surg	8a; No Cost Sharing	"8a/b; $150 CP Per MRI, CT, Test"	1a; $200 Per Admit	12; 20% Coins.	8b; 9a/b; $255 CP Per Surg; $40 CP Per Radiation Therapy Visit	7a; $15 CP Per Visit	"4b, 7b/d/f/g,17a,18a; $40 CP Per Visit, Urgent Care CP Waived if Admitted"	"5; 7e/h, 9c; 20% Coins."	3; 7c/i; 9d; $15 CP Per Visit Per PT/OT/ST	8a; $40 CP Per Visit	14; No Cost Sharing	15; 20% Coins.																				0	250	225	100	15	106.54	0.2	0.2	50	255	0	150	200	0.2	230	15	40	0.2	15	40	0	0.2																				NO	236.25	212.625	94.5	14.175	100.6803	0.189	0.189	47.25	240.975	0	141.75	189	0.189	217.35	14.175	37.8	0.189	14.175	37.8	0	0.189																					13.7713	0.723291778	1.836938751	0.868595745	1.373685761	1.08210702	0.294042703	1.296073784	8.247370481	0	3.431914272	0.027185781	1.175242594	2.478670696	4.943680932	9.788608011	0.022974226	0.210062434	0.279044635	0	7.555105647	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.4059	0	3.62425123	13.7713	0.723291778	1.836938751	0.868595745	1.373685761	1.08210702	0.294042703	1.296073784	8.247370481	0	3.431914272	0.027185781	1.175242594	2.478670696	4.943680932	9.788608011	0.022974226	0.210062434	0.279044635	0	7.555105647	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.4059	NO																																																																																		0	0	0	13.7713	0.723291778	1.836938751	0.868595745	1.373685761	1.08210702	0.294042703	1.296073784	8.247370481	0	3.431914272	0.027185781	1.175242594	2.478670696	4.943680932	9.788608011	0.022974226	0.210062434	0.279044635	0	7.555105647	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.4059
H4407_002_0	2011	8																															D	D	D	V	T	COIN		P	P		P	V	COIN	V	V	V	COIN	V	V		COIN																																																												0	YES	1062.716615	24.05827316	350.1762605	701.4071759	212.8135278	15.33082807		560.6200605	708.4962338		390.9626433	6.596792397	0.654570321	298.9227876	4638.370673	3723.670365	0.915380021	337.7154157	1152.108716		26.62176612																				3400	1a. $200 per days 1-6	1b. $200 per days 1-10	2a. $30 for days 1-30	6a. $20 Copay per PT/OT/ST visit	10a. $100 per trip	11a. 20% coinsurance	11b. 20% coinsurance	4a. $50 per visit	"9a,b. $195 per visit"	8a. 9a. Zero cost share for lab services	"8a/b. 9a. $25/Xray; $100/MRI,MRA,PET,CT, and NUC Scan"	1a. $50 per Observation Stay	"9a. ,12. 20% Coinsurance"	"3, 7i,c. $20 per PT/OT/ST visit"	"7, 17, 18a. $15 per visit; 9d, 14b/c/d/e/f/g/h/i/j. Zero cost share for preventive services"	"4b/b1, 7b/d/f/g.  $40 per visit"	"5, 7e/h, 9c. 20% coinsurance"	"3, 7i,c. $20 per PT/OT/ST visit"	"8a/b. $25/Xray; $100/MRI,MRA,PET,CT, and NUC Scan"		"11c, 15. 20% per Script"																					200	200	30	20	100	0.2		50	195		50.3588809	50	0.2	20	15	40	0.2	20	0		0.2																				NO	195.1085926	195.1085926	29.2662889	19.51085926	97.55429632	0.195108593	0	48.77714816	190.2308778	0	49.12725189	48.77714816	0.195108593	19.51085926	14.63314445	39.02171853	0.195108593	19.51085926	0	0	0.195108593																					17.2788	0.391164651	0.854029967	1.140421391	1.730072829	2.991176288	0	2.278787312	11.23148837	0	1.600576688	0.026814393	0.127712294	0.486020037	5.656162339	12.10866807	0.178598508	0.549093162	0	0	5.194135321	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8237		1.599930585	17.2788	0.391164651	0.854029967	1.140421391	1.730072829	2.991176288	0	2.278787312	11.23148837	0	1.600576688	0.026814393	0.127712294	0.486020037	5.656162339	12.10866807	0.178598508	0.549093162	0	0	5.194135321	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8237	NO																																																																																		0			17.2788	0.391164651	0.854029967	1.140421391	1.730072829	2.991176288	0	2.278787312	11.23148837	0	1.600576688	0.026814393	0.127712294	0.486020037	5.656162339	12.10866807	0.178598508	0.549093162	0	0	5.194135321	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8237
H4407_003_0	2011	9																															COIN	D			COIN	COIN	COIN	V	COIN		COIN	COIN	COIN	COIN							COIN																																																												0	YES	422.8977769	110.2102968			19.91012185	14.69432885	3.702536681	832.9040815			22.09496441	1.052138676	0.12830618	16.23967394							34.40469725																				6700	1a; Medicare FFS Cost Sharing	1b; $225/days 1-7	2a; No Cost Sharing	6a; No Cost Sharing	10a; 20% Coins.	11a; 20% Coins.	11b; 20% Coins.	4a; $50 Per ER Visit; Waived if Admitted	9a/b; No Cost Sharing	8a; No Cost Sharing	8a/b; 20% Coins.	1a; 20% Coins.	12; 20% Coins.	8b; 9a/b; 20% Coins.	7a; No Cost Sharing	"4b, 7b/d/f/g, 17a, 18a; No Cost Sharing"	"5, 7e/h, 9c; No Cost Sharing"	"3, 7c/i, 9d; No Cost Sharing"	8a; No Cost Sharing	14; No Cost Sharing	15; 20% Coins.																				0	0.076961799	225	0	0	0.2	0.2	0.2	50	0	0	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0.2																				NO	0.073960289	216.225	0	0	0.1922	0.1922	0.1922	48.05	0	0	0.1922	0.1922	0.1922	0.1922	0	0	0	0	0	0	0.1922																					31.2776	1.985851785	0	0	3.826725419	2.824250004	0.71162755	3.335086759	0	0	4.246652159	0.202221053	0.024660448	3.121265332	0	0	0	0	0	0	6.612582811	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1686	0	2.360638952	31.2776	1.985851785	0	0	3.826725419	2.824250004	0.71162755	3.335086759	0	0	4.246652159	0.202221053	0.024660448	3.121265332	0	0	0	0	0	0	6.612582811	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1686	NO																																																																																		0	0	0	31.2776	1.985851785	0	0	3.826725419	2.824250004	0.71162755	3.335086759	0	0	4.246652159	0.202221053	0.024660448	3.121265332	0	0	0	0	0	0	6.612582811	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1686
H4407_004_0	2011	8																															D	D	D	V	COIN	COIN		V	COIN		COIN	V	COIN	COIN	V	V	COIN	V	COIN		COIN																																																												0	YES	2404.432975	168.3103083	489.7362013	0	13.5370054	25.24877665		1271.810534	37.37196884		12.51288568	8.515750295	0.008360605	16.5091449	4169.695374	3111.415008	0.058968582	176.5829434	14.6671771		14.09275522																				6700	1a. $140 per day for 1st 6 days	1b. $140 per day for 1st 10 days	2a. $50 days 1-30	6a. $0 Copay per PT/OT/ST Visit	10a. 20% Coinsurance	11a. 20% Coinsurance	11b. 20% Coinsurance	4a. $50 copay per visit	"9a,b. 20% Coinsurance"	"8a., 9a. Zero Cost share for lab services"	"8a/b., 9a. 20% Coinsurance"	1a. $50 per Observation Stay	"9a. , 12. 20% Coinsurance"	9a. 20% Coinsurance	"7, 17, 18a $5 copay per visit; 9d, 14b/c/d/e/f/g/h/i/j. Zero cost share for preventive services"	"4b/b1, 7b/d/f/g., 17a., 18a.  $25 copay per visit"	"5, 7h. 20% Coinsurance"	"3, 7i,c, 9a. $20 per PT/OT/ST visit"	8 a/b. 20% Coinsurance		"11c, 15. 20% Coinsurance per Script"																					140	140	50	0	0.2	0.2		50	0.2		0.2	50	0.2	0.2	5	25	0.2	20	0.2		0.2																				NO	130.844	130.844	46.73291358	0	0.186931654	0.186931654	0	46.73291358	0.186931654	0	0.186931654	46.73291358	0.186931654	0.186931654	4.673291358	23.36645679	0.186931654	18.69316543	0.186931654	0	0.186931654																					26.2171	1.835199498	1.907233298	0	2.530494814	4.71979559	0	4.952950982	6.98600396	0	2.33905442	0.033163819	0.001562862	3.086081768	1.623850113	6.05856203	0.011023095	0.275074514	2.74175968	0	2.634382048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.9533		4.669026161	26.2171	1.835199498	1.907233298	0	2.530494814	4.71979559	0	4.952950982	6.98600396	0	2.33905442	0.033163819	0.001562862	3.086081768	1.623850113	6.05856203	0.011023095	0.275074514	2.74175968	0	2.634382048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.9533	NO																																																																																		0			26.2171	1.835199498	1.907233298	0	2.530494814	4.71979559	0	4.952950982	6.98600396	0	2.33905442	0.033163819	0.001562862	3.086081768	1.623850113	6.05856203	0.011023095	0.275074514	2.74175968	0	2.634382048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.9533
H4407_005_0	2011	4																															D	D	D	P	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	YES	652.3762797	22.8294134	335.3708382		201.1111627	4.680727706	1.786656026	285.1978736	349.9750697		276.5701258	3.486975516	6.24	62.11703804	3112.784244	3268.748345	2.180672977	331.3245458	105.9394785		22.13535217																				3400	1a; $150/days 1-4 Acute/Rehab/LTAC	1b; $225/days 1-7	2a; $0 (1-5 Days); $50 (6-20 Days); $0 (21-100)	6a; No Cost Sharing	10a; $100 Per one-way trip; 20% Air Ambulance Per one-way trip	11a; 20% Coins. On DME/Prosthetics/Supplies	11b; 20% Coins. On DME/Prosthetics/Supplies	4a; $50 CP Per ER Visit; Waived If Admitted	9a/b; $100 CP Per Surg	8a; No Cost Sharing	"8a/b; $100 CP Per MRI, CT, Test"	1a; $100 Per Admit	12; 20% Coins.	8b; 9a/b; $100 CP Per Surg; $30 per Radiation Therapy visit	7a; $15 CP Per Visit	"4b, 7b/d/f/g,17a,18a; $30 CP Per Visit; Urgent Care CP Waived if Admitted"	"5, 7e/h, 9c; 20% Coins."	"3, 7c/i, 9d; $15 CP Per Visit Per PT/OT/ST"	8a; $30 CP Per Visit	14; No Cost Sharing	15; 20% Coins.																				0	150	225	50	0	109.4067761	0.2	0.2	50	100	0	100	100	0.2	75	15	30	0.2	15	30	0	0.2																				NO	145.2	217.8	48.4	0	105.9057592	0.1936	0.1936	48.4	96.8	0	96.8	96.8	0.1936	72.6	14.52	29.04	0.1936	14.52	29.04	0	0.1936																					7.8938	0.414353853	1.352662381	0	1.774902532	0.906188884	0.345896607	1.15029809	2.823132229	0	2.230999015	0.028128269	1.208064	0.37580808	3.766468936	7.910370994	0.422178288	0.4009027	0.256373538	0	4.28540418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5459	0	1.24	7.8938	0.414353853	1.352662381	0	1.774902532	0.906188884	0.345896607	1.15029809	2.823132229	0	2.230999015	0.028128269	1.208064	0.37580808	3.766468936	7.910370994	0.422178288	0.4009027	0.256373538	0	4.28540418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5459	NO																																																																																		0	0	0	7.8938	0.414353853	1.352662381	0	1.774902532	0.906188884	0.345896607	1.15029809	2.823132229	0	2.230999015	0.028128269	1.208064	0.37580808	3.766468936	7.910370994	0.422178288	0.4009027	0.256373538	0	4.28540418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5459
H4407_011_0	2011	5																															D	D	D	V	T	Coin	Coin	P	P	O	V	O	COIN	O	V	V	COIN	V	P		Coin	Coin	T	V	V																																																								0	YES	889.2863902	51.59951597	416.5044768	749.4614438	259.0699176	8.982372599		617.1338019	700.1328588		382.6004143	0	1.869308665	187.5514943	4169.695374	3111.415008	0.273196164	176.5829434	693.9458159		30.13699395																				3400	1a. $220 days/days 1-6	1b. $215 days/days 1-10	"2a. $65/day, days 1-30"	6a. $20 Copay per PT/OT/ST visit	10a. $75 per trip	11a. 20% coinsurance	11b. 20% coinsurance	4a. $50 per visit	9a/b. $200 per visit	"8a., 9a. Zero cost share for lab services"	"8a/b. 9a. $25/Xray; $100/MRI,MRA,PET,CT, and NUC Scan"	1a. $50 per Observation visit	"9a., 12. 20% Coinsurance"	"3, 7i./7c., 9a.   $20 per PT/OT/ST visit"	"7, 17, 18a. $5 per visit; 9d, 14b/c/d/e/f/g/h/i/j. Zero cost share for preventive services"	"4b/b1, 7b/d/f/g, 17a., 18a. $25 per visit"	"5, 7e/h, 9c. 20% Coinsurance"	"3, 7i./7c.  $20 per PT/OT/ST visit"	"8a/b. $25/Xray; $100/MRI,MRA,PET,CT, and NUC Scan"		"11c, 15. 20% coinsurance per script"																					220	215	65	20	75	0.2		50	200		44.05548832	50	0.2	20	5	25	0.2	20	36.14441		0.2																				NO	215.2981458	210.4050062	63.61081582	19.57255871	73.39709518	0.195725587	0	48.93139678	195.7255871	0	43.11393159	48.93139678	0.195725587	19.57255871	4.893139678	24.46569839	0.195725587	19.57255871	35.37192934	0	0.195725587																					15.9551	0.90473304	2.20784913	1.222406509	1.584581616	1.758080151	0	2.516434911	11.41949291	0	1.374617341	0	0.365871536	0.305905219	1.700241824	6.343578431	0.05347148	0.288015002	2.045516864	0	5.898580834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9445		1.22176143	15.9551	0.90473304	2.20784913	1.222406509	1.584581616	1.758080151	0	2.516434911	11.41949291	0	1.374617341	0	0.365871536	0.305905219	1.700241824	6.343578431	0.05347148	0.288015002	2.045516864	0	5.898580834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9445	NO																																																																																		0			15.9551	0.90473304	2.20784913	1.222406509	1.584581616	1.758080151	0	2.516434911	11.41949291	0	1.374617341	0	0.365871536	0.305905219	1.700241824	6.343578431	0.05347148	0.288015002	2.045516864	0	5.898580834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9445
H4407_022_0	2011	5																															D	D	D	V	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	YES	727.4421	41.52999086	508.6406561	1400.881033	220.0299986	6.990251637	2.709515447	376.1047488	491.5910671		342.1084823	4.536350404	6.568398859	222.3831952	4022.062998	4115.737108	0.359396492	456.3007519	92.67628486		42.66609424																				3400	1a; $300/days 1-4 Acute/Rehab/LTAC	1b; $225/days 1-7	2a; $0 (1-3 Days); $100 (4-20 Days); $0 (21-100)	6a; $10 CP Per Visit Per PT/OT/ST	10a; $100 Per one-way trip; 20% Coins Air Ambulance per one-way trip	11a; 20% Coins. On DME/Prosthetics/Supplies	11b; 20% Coins. On DME/Prosthetics/Supplies	4a; $50 Per ER Visit; Waived if Admitted	9a/b; $275 CP Per Surg	8a; No Cost Sharing	"8a/b; $150 CP Per MRI, CT, Test"	1a; $200 Per Admit	12; 20% Coins.	"8b, 9a/b; $275 CP Per Surg; $40 CP Per Radiation Therapy Visit"	7a; $10 CP Per Visit	"4b, 7b/d/f/g, 17a, 18a; $40 CP Per Visit, Urgent Care CP Waived if Admitted"	"5, 7e/h, 9c; 20% Coins."	"3, 7c/i, 9d; $10 CP Per Visit Per PT/OT/ST"	8a; $40 CP Per Visit	14; No Cost Sharing	15; 20% Coins.																				0	300	225	100	10	104.5855258	0.2	0.2	50	275	0	150	200	0.2	250	10	40	0.2	10	40	0	0.2																				NO	280.5	210.375	93.5	9.35	97.78746662	0.187	0.187	46.75	257.125	0	140.25	187	0.187	233.75	9.35	37.4	0.187	9.35	37.4	0	0.187																					17.004	0.728072652	3.963158445	1.091519805	1.793014679	1.307177056	0.506679389	1.465241417	10.53336276	0	3.998392886	0.07069146	1.228290587	4.331839323	3.133857419	12.82738065	0.067207144	0.355534336	0.288841088	0	7.978559622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6728	0	5.052118383	17.004	0.728072652	3.963158445	1.091519805	1.793014679	1.307177056	0.506679389	1.465241417	10.53336276	0	3.998392886	0.07069146	1.228290587	4.331839323	3.133857419	12.82738065	0.067207144	0.355534336	0.288841088	0	7.978559622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6728	NO	30% Coinsurance	Included in Line a1	30% Coinsurance		$100 Copay; 20% Air	30% Coinsurance	Included in Line e1	30% Coinsurance	30% Coinsurance	30% Coinsurance	Included in line h1	Included in line h1	Included in line h1	Included in line h1	30% Coinsurance	Include in line i1	Include in line i1	Include in line i1	Include in line i1	Include in line i1	30% Coinsurance																					0.6986		0.0944		0.02	0.0294		0.0629	0.1743	0.1565					0.7044						0.1293																				2.0699	0	0	17.7026	0.728072652	4.057532172	1.091519805	1.813014679	1.33657029	0.506679389	1.528185812	10.70769934	0.156527804	3.998392886	0.07069146	1.228290587	4.331839323	3.83827638	12.82738065	0.067207144	0.355534336	0.288841088	0	8.107850817	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.7427
H4407_023_0	2011	8																															D	D	D	V	T	COIN		P	P		P	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	YES	1091.0328	27.74991253	140.1524172	511.1751135	166.6807446	13.73721535		532.0530503	716.0607637	0	299.2594905	6.494096334	0.010013615	309.0284801	5199.649333	4132.37812	0.374190309	538.6415586	1308.421483		20.20352854																				3400	1a. $200 per day for 1st 6 days	1b. $200 per day for 1st 10 days	2a. $30/day days 1-30	6a. $20 copay per PT/OT/ST visit	10a. $100 copay per Trip	11a. 20% Coinsurance	11b. 20% Coinsurance	4a. $50 copay per visit	9a/b. $195 copay per visit	"8a, 9a. Zero cost share for lab services"	"8a/b, 9a. $25/Xray; $100/MRI,MRA, CT, PET, and  Nuc Scan"	1a. $50 copay per Observation Stay	"9a, 12. 20% Coinsurance"	"3, 7c/i, 9a.  $20 copay per PT/OT/ST visit"	"7, 17, 18a. $10 copay per visit; 9d, 14b/c/d/e/f/g/h/i/j. Zero cost share for preventive services"	"4b/b1, 7b/d/f/g, 17a, 18a. $40 copay per visit"	"5, 7e/h, 9c. 20% Coinsurance"	"3, 7c/i. $20 copay per PT/OT/ST visit"	"8a/b. $25/Xray; $100/MRI,MRA, CT, PET, and  Nuc Scan"		"11c, 15. 20% coinsurance per Script"																					200	200	30	20	100	0.2	0	50	195	0	55.42821511	50	0.2	20	10	40	0.2	20	44.92202832	0	0.2																				NO	194.9317262	194.9317262	29.23975893	19.49317262	97.46586309	0.194931726	0	48.73293154	190.058433	0	54.02358825	48.73293154	0.194931726	19.49317262	9.746586309	38.98634524	0.194931726	19.49317262	43.78364262	0	0.194931726																					17.7231	0.450778196	0.341501908	0.830368727	1.353806886	2.677819102	0	2.16070874	11.34111556	0	1.347255958	0.026373029	0.001951971	0.501995459	4.223235917	13.42552667	0.072941563	0.874986073	4.773954884	0	3.938308693	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0657		1.72	17.7231	0.450778196	0.341501908	0.830368727	1.353806886	2.677819102	0	2.16070874	11.34111556	0	1.347255958	0.026373029	0.001951971	0.501995459	4.223235917	13.42552667	0.072941563	0.874986073	4.773954884	0	3.938308693	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0657	NO	30% Coinsurance	Included in Line a1	30% Coinsurance	30% Coinsurance	$100 Copay	30% Coinsurance	Included in Line e1	30% Coinsurance	30% Coinsurance	30% Coinsurance	Included in line h1	Included in line h1	Included in line h1	Included in line h1	30% Coinsurance	Include in line i1	Include in line i1	Include in line i1	Include in line i1	Include in line i1	30% Coinsurance																					0.8166		0.021	0.1052	0.014	0.0416		0.089	0.1665	0.1368					0.6967						0.0612																				2.1487			18.5397	0.450778196	0.362472003	0.935572253	1.367837252	2.719447027	0	2.249722765	11.50764295	0.13680001	1.347255958	0.026373029	0.001951971	0.501995459	4.919947479	13.42552667	0.072941563	0.874986073	4.773954884	0	3.999531506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2145
H4407_802_0	2011	4																															COIN	COIN	COIN		COIN	COIN		COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN		COIN																																																												0	YES	345.226384	8.127130841	41.24555491		14.75463465	12.02749212		30.40191661	82.33488665	17.25821046	22.02943768	0.231745322	0.504386878	21.33420171	87.2124973	201.9103427	0.228049115	0.825320607	13.18341075		53.24892545																				6700	1a. FFS	1b. FFS	2a. FFS	6a. FFS	10a. FFS	11a. FFS	11b. FFS	4a. FFS	9a/b. FFS	"8a, 9a. FFS"	"8a/b, 9a. FFS"	1a. FFS	"9a, 12. FFS"	"3, 7c/I, 9a. FFS"	"7, 17, 18a. FFS; 9d, 14b/c/d/e/f/g/h/i/j. Zero cost share for preventive services"	"4b/b1, 7b/d/f/g, 17a, 18a. FFS"	"5, 7e/h, 9c. FFS"	"3, 7c/i. FFS"	8a/b. FFS		"11c, 15. FFS"																					0.08496	0.08496	0.1842		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233																				NO	0.077118192	0.077118192	0.16719834		0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941		0.2114941																					26.6232	0.626749637	6.896188313	0	3.120518177	2.543743622	0	6.429825991	17.41334275	3.650009689	4.659096095	0.049012768	0.106674849	4.51205779	18.44492863	42.70284621	0.048231042	0.174550439	2.788213591	0	11.26183356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.0511		15.44928541	26.6232	0.626749637	6.896188313	0	3.120518177	2.543743622	0	6.429825991	17.41334275	3.650009689	4.659096095	0.049012768	0.106674849	4.51205779	18.44492863	42.70284621	0.048231042	0.174550439	2.788213591	0	11.26183356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.0511	NO																																																																																		0			26.6232	0.626749637	6.896188313	0	3.120518177	2.543743622	0	6.429825991	17.41334275	3.650009689	4.659096095	0.049012768	0.106674849	4.51205779	18.44492863	42.70284621	0.048231042	0.174550439	2.788213591	0	11.26183356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.0511
H4407_807_0	2011	4																															COIN	COIN	COIN		COIN	COIN		COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN		COIN																																																												0	YES	345.226384	8.127130841	41.24555491		14.75463465	12.02749212		30.40191661	82.33488665	17.25821046	22.02943768	0.231745322	0.504386878	21.33420171	87.2124973	201.9103427	0.228049115	0.825320607	13.18341075		53.24892545																				6700	1a. FFS	1b. FFS	2a. FFS	6a. FFS	10a. FFS	11a. FFS	11b. FFS	4a. FFS	9a/b. FFS	"8a, 9a. FFS"	"8a/b, 9a. FFS"	1a. FFS	"9a, 12. FFS"	"3, 7c/I, 9a. FFS"	"7, 17, 18a. FFS; 9d, 14b/c/d/e/f/g/h/i/j. Zero cost share for preventive services"	"4b/b1, 7b/d/f/g, 17a, 18a. FFS"	"5, 7e/h, 9c. FFS"	"3, 7c/i. FFS"	8a/b. FFS		"11c, 15. FFS"																					0.08496	0.08496	0.1842		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233																				NO	0.077118192	0.077118192	0.16719834		0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941	0.2114941		0.2114941																					26.6232	0.626749637	6.896188313	0	3.120518177	2.543743622	0	6.429825991	17.41334275	3.650009689	4.659096095	0.049012768	0.106674849	4.51205779	18.44492863	42.70284621	0.048231042	0.174550439	2.788213591	0	11.26183356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.0511		15.44928541	26.6232	0.626749637	6.896188313	0	3.120518177	2.543743622	0	6.429825991	17.41334275	3.650009689	4.659096095	0.049012768	0.106674849	4.51205779	18.44492863	42.70284621	0.048231042	0.174550439	2.788213591	0	11.26183356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.0511	NO																																																																																		0			26.6232	0.626749637	6.896188313	0	3.120518177	2.543743622	0	6.429825991	17.41334275	3.650009689	4.659096095	0.049012768	0.106674849	4.51205779	18.44492863	42.70284621	0.048231042	0.174550439	2.788213591	0	11.26183356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.0511
H4408_001_0	2011	5	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	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	1288.975949	72.98903528	334.9084434	572.4873699	34.91463132	9.222742785	3.375379438	291.4830648	314.4019472	1055.4934	818.791338	42.83105056	0.235385396	620.2847728	3162.407027	3175.54199	86.68653545	579.7232948		1781.489181	16.2721878	0							4.23	0.58	1136.906595										4900	$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											147.067245	128.620245	34.44565	0	100	0.2	0.2	50	225	21.845751	89.918335	50	0.2	74.232657	15	35	35	15		0	0.2	0							0	0	0										NO	136.416341	119.30531	29.408284	0	91.693	0.183386	0.183386	45.8465	206.30925	20.031024	82.448819	45.8465	0.183386	68.06615	13.75395	32.09255	32.09255	13.75395		0	0.183386	0							0	0	0											14.6531	0.725664957	0.820756885	0	0.266785607	1.691321908	0.618997334	1.113623194	5.405335828	1.76188447	5.625698236	0.163637813	0.043166386	3.518366366	3.624632344	8.492603341	0.231832664	0.664457101	0	0	2.984091432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.406	0	4.621459236	14.6531	0.725664957	0.820756885	0	0.266785607	1.691321908	0.618997334	1.113623194	5.405335828	1.76188447	5.625698236	0.163637813	0.043166386	3.518366366	3.624632344	8.492603341	0.231832664	0.664457101	0	0	2.984091432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.406	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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins										7300	7.0927	0.1088	0.3488	1.8605	0.8998	1.4104	0.5162	0.1403	2.1394	0.1867	0.7966	0.1028	0.0056	0.5287	1.3733	2.1768	0.0307	0.1997		0.3293	0.6142	0							0	0	0.2944										21.1557	0	8.469729908	21.7458	0.834490724	1.169599201	1.860503885	1.166578731	3.101739427	1.135188226	1.253931262	7.544770791	1.948610922	6.42231011	0.266447955	0.048716882	4.047029237	4.997899275	10.66937231	0.262556909	0.864115171	0	0.329259884	3.598339081	0	0	0	0	0	0	0	0	0	0.294435975	0	0	0	0	0	0	0	0	0	73.5617
H4408_002_0	2011	4	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	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	1150.593906	120.4447841	324.0651467	687.3728474	36.99420572	9.88834177	3.15941957	342.5394712	337.1765996	1354.225404	995.0413269	118.2436561	0.449957175	671.7046374	3613.560481	3370.226878	103.657891	641.300812		1584.866849	18.24800086	0							4.23	0.58	671.0841377										4900	$195/Day(Days 1-5):1a.IP Acute	$195/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											120.72684	97.190145	34.44565	0	100	0.2	0.2	50	200	31.909133	90.074269	50	0.2	77.787118	15	35	35	15		0	0.2	0							0	0	0										NO	111.888669	90.075049	29.664215	0	90.9953	0.181991	0.181991	45.49765	181.9906	29.035811	81.963352	45.49765	0.181991	70.782621	13.649295	31.848355	31.848355	13.649295		0	0.181991	0							0	0	0											10.7282	0.904089153	0.801094849	0	0.280524904	1.799589207	0.574985927	1.298728414	5.113580972	3.276752741	6.796410211	0.448317373	0.081888156	3.962084564	4.110212751	8.944681836	0.275111109	0.729441997	0	0	3.320971925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4467	0	5.10655345	10.7282	0.904089153	0.801094849	0	0.280524904	1.799589207	0.574985927	1.298728414	5.113580972	3.276752741	6.796410211	0.448317373	0.081888156	3.962084564	4.110212751	8.944681836	0.275111109	0.729441997	0	0	3.320971925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4467	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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins										7300	7.0951	0.1636	0.3384	2.9451	0.9368	1.2383	0.3956	0.162	2.0491	0.2787	0.9674	0.2571	0.0104	0.5019	1.4486	2.0652	0.0317	0.2127		0.2613	0.6781	0							0	0	0.1382										22.1754	0	9.616373141	17.8233	1.067705115	1.139474889	2.945127579	1.217361243	3.037885595	0.970633473	1.460750702	7.162677925	3.555407375	7.763815563	0.705391756	0.092314102	4.463989018	5.558792373	11.0099065	0.306811322	0.942099544	0	0.261334036	3.999060343	0	0	0	0	0	0	0	0	0	0.13822586	0	0	0	0	0	0	0	0	0	75.6221
H4408_006_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1186.497699	61.92243709	470.7038331	680.7212293	37.14513959	10.64892574	2.801284886	331.5947541	361.8492159	1027.696614	934.7758576	54.19446375	0.179819584	4.00372612	3759.782879	3489.06605	71.46564979	700.1314498		2052.508227	17.14234562	0							4.23	0.58	1323.192391	536.9885513									4900	$225/Day(Days 1-5):1a.IP Acute	$225/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										139.3002	112.142475	34.44565	0	100	0.2	0.2	50	125	62.499494	70.877139	50	0.2	0.2	15	35	35	15		0	0.2	0							0	0	0	68.688918									NO	128.603338	103.531054	28.597778	0	91.0492	0.182098	0.182098	45.5246	113.8115	56.90529	64.533068	45.5246	0.182098	0.182098	13.65738	31.86722	31.86722	13.65738		0	0.182098	0							0	0	0	62.54071										12.7156	0.534241265	1.121756977	0	0.28183627	1.93914808	0.510108375	1.257976545	3.431883503	4.873447819	5.026996166	0.20559844	0.032744787	0.729070519	4.279065292	9.265569618	0.189784299	0.796830105	0	0	3.121586853	0	0	0	0	0	0	0	0	0	0	2.798637105	0	0	0	0	0	0	0	0	53.1119	0	5.139925188	12.7156	0.534241265	1.121756977	0	0.28183627	1.93914808	0.510108375	1.257976545	3.431883503	4.873447819	5.026996166	0.20559844	0.032744787	0.729070519	4.279065292	9.265569618	0.189784299	0.796830105	0	0	3.121586853	0	0	0	0	0	0	0	0	0	0	2.798637105	0	0	0	0	0	0	0	0	53.1119	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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									7300	6.5021	0.1167	0.4434	3.157	0.9562	1.6266	0.4279	0.1594	2.1838	0.3045	0.8658	0.1871	0.0042	0.1414	1.4556	2.2152	0.029	0.2412		0.3507	0.6587	0							0	0	0.383	0.3589									22.7685	0	8.798516985	19.2178	0.650937507	1.565191241	3.157048291	1.237988068	3.565756396	0.938000894	1.417405285	5.615639137	5.177924378	5.892749868	0.392680042	0.036980085	0.8705176	5.73466839	11.48078535	0.218828574	1.038079223	0	0.350680065	3.780244145	0	0	0	0	0	0	0	0	0	0.382999577	3.157512262	0	0	0	0	0	0	0	0	75.8804
H4408_007_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	954.3272694	40.84469382	370.1386747	754.0308415	35.18855496	10.40179307	2.230651731	328.4542175	336.5007791	880.4582756	939.2441669	64.69752757	0.155189454	5.280809289	3778.486993	3117.945751	107.7440202	535.758645		2111.262336	16.96421065	0							4.23	0.58	1302.227325	625.9665566									4900	$225/Day(Days 1-5):1a.IP Acute	$225/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										139.3002	112.142475	34.44565	0	100	0.2	0.2	50	125	59.75766	72.365071	50	0.2	0.2	15	35	35	15		0	0.2	0							0	0	0	68.087855									NO	130.68295	105.205229	30.25854	0	92.2843	0.184569	0.184569	46.14215	115.355375	55.146938	66.781599	46.14215	0.184569	0.184569	13.842645	32.299505	32.299505	13.842645		0	0.184569	0							0	0	0	62.8344										10.3929	0.358089614	0.933321324	0	0.270612597	1.919848544	0.411709159	1.262965314	3.234764463	4.046214828	5.227018943	0.248773585	0.028643162	0.97467369	4.358687841	8.392342032	0.290006543	0.618026394	0	0	3.131067396	0	0	0	0	0	0	0	0	0	0	3.277686084	0	0	0	0	0	0	0	0	49.3773	0	3.989505993	10.3929	0.358089614	0.933321324	0	0.270612597	1.919848544	0.411709159	1.262965314	3.234764463	4.046214828	5.227018943	0.248773585	0.028643162	0.97467369	4.358687841	8.392342032	0.290006543	0.618026394	0	0	3.131067396	0	0	0	0	0	0	0	0	0	0	3.277686084	0	0	0	0	0	0	0	0	49.3773	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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									7300	5.8774	0.095	0.4101	2.6368	0.9528	1.6712	0.3584	0.1661	2.1031	0.193	0.9292	0.2365	0.0038	0.1962	1.5633	2.0104	0.0423	0.2037		0.4034	0.6847	0							0	0	0.3208	0.3707									21.4291	0	5.933358289	16.2703	0.453108111	1.343413564	2.636804605	1.223368535	3.591096241	0.770106253	1.429072791	5.337838385	4.239243782	6.156234454	0.48522731	0.032487883	1.170912778	5.922034767	10.40278615	0.332267832	0.82168425	0	0.40342352	3.815810793	0	0	0	0	0	0	0	0	0	0.320809462	3.648379077	0	0	0	0	0	0	0	0	70.8064
H4408_008_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1140.912332	71.544856	344.708584	590.916278	38.872378	8.784043	3.083889	344.217975	361.693008	1055.216738	972.118479	76.672211	0.408036	5.342778	3544.956039	3736.357066	88.73707	725.381029		1909.648254	20.438659	0							3.72	0.58	1271.210785	660.376597									4900	$225/Day(Days 1-5):1a.IP Acute	$225/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										139.3002	112.142475	34.44565	0	100	0.2	0.2	50	125	56.988071	71.22993	50	0.2	0.2	15	35	35	15		0	0.2	0							0	0	0	65.666512									NO	128.711852	103.618413	29.299918	0	90.8978	0.181796	0.181796	45.4489	113.62225	51.800903	64.746439	45.4489	0.181796	0.181796	13.63467	31.81423	31.81423	13.63467		0	0.181796	0							0	0	0	59.689415										12.2374	0.61778037	0.841661104	0	0.294451137	1.596903881	0.560638685	1.303694027	3.424697782	4.555098324	5.245100817	0.290388971	0.074179313	0.971295669	4.027858813	9.905776922	0.235258463	0.824194246	0	0	3.715666452	0	0	0	0	0	0	0	0	0	0	3.284791063	0	0	0	0	0	0	0	0	54.0068	0	5.241839691	12.2374	0.61778037	0.841661104	0	0.294451137	1.596903881	0.560638685	1.303694027	3.424697782	4.555098324	5.245100817	0.290388971	0.074179313	0.971295669	4.027858813	9.905776922	0.235258463	0.824194246	0	0	3.715666452	0	0	0	0	0	0	0	0	0	0	3.284791063	0	0	0	0	0	0	0	0	54.0068	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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	30% Coins									7300	6.5718	0.1331	0.3603	2.5401	1.0175	1.137	0.3992	0.1683	2.1751	0.2578	0.8977	0.1521	0.0098	0.1919	1.3621	2.2933	0.0315	0.249		0.3133	0.8138	0							0	0	0.2616	0.3533									21.6896	0	7.563440526	18.8092	0.750856811	1.202000522	2.540070801	1.311977114	2.733928806	0.959824225	1.47198935	5.599831075	4.812926351	6.142756121	0.442499115	0.083952147	1.163240578	5.389981407	12.19904906	0.266709007	1.073223188	0	0.313320922	4.529470051	0	0	0	0	0	0	0	0	0	0.261587447	3.638117077	0	0	0	0	0	0	0	0	75.6965
H4454_002_0	2011	6																															D	D	D	V	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	YES	774.4280468	43.64433677	490.9975181	1412.563491	223.6445296	7.09434213	2.720944432	377.3060427	517.4345663		350.0922319	4.859272451	7.195470894	228.3451933	4209.300391	4129.350011	0.540426083	448.9893377	90.64914783		42.99484748																				3400	1a; $300/days 1-4 Acute/Rehab/LTAC	1b; $225/days 1-7	2a; $0 (1-3 Days); $100 (4-20 Days); $0 (21-100)	6a; $15 CP Per Visit Per PT/OT/ST	10a; $100 Per one-way trip; 20% Coins Air Ambulance per one-way  trip	11a; 20% Coins. On DME/Prosthetics/Supplies	11b; 20% Coins. On DME/Prosthetics/Supplies	4a; $50 Per ER Visit; Waived if Admitted	9a/b; $270 CP Per Surg	8a; No Cost Sharing	"8a/b; $150 CP Per MRI, CT, Test"	1a; $200 Per Admit	12; 20% Coins.	8b; 9a/b; $270 CP Per Surg; $40 CP Per Radiation Therapy Visit	7a; $15 CP Per Visit	"4b, 7b/d/f/g,17a,18a; $40 CP Per Visit, Urgent Care CP Waived if Admitted"	"5; 7e/h, 9c; 20% Coins."	3; 7c/i; 9d; $15 CP Per Visit Per PT/OT/ST	8a; $40 CP Per Visit	14; No Cost Sharing	15; 20% Coins.																				0	300	225	100	15	104.5855258	0.2	0.2	50	270	0	150	200	0.2	245	15	40	0.2	15	40	0	0.2																				NO	278.7	209.025	92.9	13.935	97.15995346	0.1858	0.1858	46.45	250.83	0	139.35	185.8	0.1858	227.605	13.935	37.16	0.1858	13.935	37.16	0	0.1858																					17.9861	0.760229791	3.80113912	1.640339354	1.810774341	1.318128768	0.505551475	1.460488807	10.81567602	0	4.065446042	0.075237735	1.336918492	4.331042311	4.88805008	12.78722053	0.100411166	0.521388868	0.280710194	0	7.988442662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4733	0	6.048107835	17.9861	0.760229791	3.80113912	1.640339354	1.810774341	1.318128768	0.505551475	1.460488807	10.81567602	0	4.065446042	0.075237735	1.336918492	4.331042311	4.88805008	12.78722053	0.100411166	0.521388868	0.280710194	0	7.988442662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4733	NO																																																																																		0	0	0	17.9861	0.760229791	3.80113912	1.640339354	1.810774341	1.318128768	0.505551475	1.460488807	10.81567602	0	4.065446042	0.075237735	1.336918492	4.331042311	4.88805008	12.78722053	0.100411166	0.521388868	0.280710194	0	7.988442662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4733
H4454_012_0	2011	4																															D	D	D	P	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	YES	652.3762797	22.8294134	335.3708382		201.1111627	4.671528026	1.783144464	285.1978736	349.9750697		276.5701258	3.486975516	6.24	62.11703804	3112.784244	3268.748345	2.180672977	331.3245458	105.9394785		22.09184651																				3400	1a; $150/days 1-4 Acute/Rehab/LTAC	1b; $225/days 1-7	2a; $0 (1-5 Days); $50 (6-20 Days); $0 (21-100)	6a; No Cost Sharing	10a; $100 Per one-way trip; 20% Air Ambulance Per one-way trip	11a; 20% Coins. On DME/Prosthetics/Supplies	11b; 20% Coins. On DME/Prosthetics/Supplies	4a; $50 CP Per ER Visit; Waived If Admitted	9a/b; $100 CP Per Surg	8a; No Cost Sharing	"8a/b; $100 CP Per MRI, CT, Test"	1a; $100 Per Admit	12; 20% Coins.	8b; 9a/b; $100 CP Per Surg; $30 per Radiation Therapy visit	7a; $15 CP Per Visit	"4b, 7b/d/f/g,17a,18a; $30 CP Per Visit; Urgent Care CP Waived if Admitted"	"5, 7e/h, 9c; 20% Coins."	"3, 7c/i, 9d; $15 CP Per Visit Per PT/OT/ST"	8a; $30 CP Per Visit	14; No Cost Sharing	15; 20% Coins.																				0	150	225	50	0	109.4067761	0.2	0.2	50	100	0	100	100	0.2	75	15	30	0.2	15	30	0	0.2																				NO	145.2	217.8	48.4	0	105.9057592	0.1936	0.1936	48.4	96.8	0	96.8	96.8	0.1936	72.6	14.52	29.04	0.1936	14.52	29.04	0	0.1936																					7.8938	0.414353853	1.352662381	0	1.774902532	0.904407826	0.345216768	1.15029809	2.823132229	0	2.230999015	0.028128269	1.208064	0.37580808	3.766468936	7.910370994	0.422178288	0.4009027	0.256373538	0	4.276981484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.535	0	1.240826511	7.8938	0.414353853	1.352662381	0	1.774902532	0.904407826	0.345216768	1.15029809	2.823132229	0	2.230999015	0.028128269	1.208064	0.37580808	3.766468936	7.910370994	0.422178288	0.4009027	0.256373538	0	4.276981484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.535	NO																																																																																		0	0	0	7.8938	0.414353853	1.352662381	0	1.774902532	0.904407826	0.345216768	1.15029809	2.823132229	0	2.230999015	0.028128269	1.208064	0.37580808	3.766468936	7.910370994	0.422178288	0.4009027	0.256373538	0	4.276981484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.535
H4454_020_0	2011	8																															COIN	D			COIN	COIN	COIN	V			COIN	COIN	COIN	COIN							COIN																																																												0	YES	472.4970832	73.22817383			24.48639578	17.44949591	6.907273029	877.3462552			31.33901016	2.546955479	0.104604678	24.68663541							53.62008237																				6700	1a; Medicare FFS Cost Sharing	1b; $225/days 1-7	2a; No Cost Sharing	6a; No Cost Sharing	10a; 20% Coins.	11a; 20% Coins.	11b; 20% Coins.	4a; $50 Per ER Visit; Waived if Admitted	9a/b; No Cost Sharing	8a; No Cost Sharing	8a/b; 20% Coins.	1a; 20% Coins.	12; 20% Coins.	8b; 9a/b; 20% Coins.	7a; No Cost Sharing	"4b, 7b/d/f/g, 17a, 18a; No Cost Sharing"	"5, 7e/h, 9c; No Cost Sharing"	"3, 7c/i, 9d; No Cost Sharing"	8a; No Cost Sharing	14; No Cost Sharing	15; 20% Coins.																				0	0.079458906	225	0	0	0.2	0.2	0.2	50	0	0	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0.2																				NO	0.075644878	214.2	0	0	0.1904	0.1904	0.1904	47.6	0	0	0.1904	0.1904	0.1904	0.1904	0	0	0	0	0	0	0.1904																					35.742	1.307122903	0	0	4.662209756	3.322384022	1.315144785	3.480140146	0	0	5.966947534	0.484940323	0.019916731	4.700335381	0	0	0	0	0	0	10.20926368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.2104	0	3.589610356	35.742	1.307122903	0	0	4.662209756	3.322384022	1.315144785	3.480140146	0	0	5.966947534	0.484940323	0.019916731	4.700335381	0	0	0	0	0	0	10.20926368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.2104	NO																																																																																		0	0	0	35.742	1.307122903	0	0	4.662209756	3.322384022	1.315144785	3.480140146	0	0	5.966947534	0.484940323	0.019916731	4.700335381	0	0	0	0	0	0	10.20926368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.2104
H4454_028_0	2011	7																															COIN	D			COIN	COIN	COIN	V			COIN	COIN	COIN	COIN							COIN																																																												0	YES	440.5329909	171.7341096			23.58603274	18.17052063	8.180381326	901.8965056			21.00649074	2.599158578	0.912438667	23.40280931							35.6047278																				6700	1a; Medicare FFS Cost Sharing	1b; $225/days 1-7	2a; No Cost Sharing	6a; No Cost Sharing	10a; 10% Coins.	11a; 20% Coins.	11b; 20% Coins.	4a; $50 Per ER Visit; Waived if Admitted	9a/b; No Cost Sharing	8a; No Cost Sharing	8a/b; 10% Coins.	1a; 10% Coins.	12; 10% Coins.	8b; 9a/b; 10% Coins.	7a; No Cost Sharing	"4b, 7b/d/f/g, 17a, 18a; No Cost Sharing"	"5, 7e/h, 9c; No Cost Sharing"	"3, 7c/i, 9d; No Cost Sharing"	8a; No Cost Sharing	14; No Cost Sharing	15; 20% Coins.																				0	0.079821727	225	0	0	0.1	0.2	0.2	50	0	0	0.1	0.1	0.1	0.1	0	0	0	0	0	0	0.2																				NO	0.076628858	216	0	0	0.096	0.192	0.192	48	0	0	0.096	0.096	0.096	0.096	0	0	0	0	0	0	0.192																					33.7575	3.091213973	0	0	2.264259143	3.488739961	1.570633215	3.607586022	0	0	2.016623111	0.249519223	0.087594112	2.246669693	0	0	0	0	0	0	6.836107737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2165	0	2.47	33.7575	3.091213973	0	0	2.264259143	3.488739961	1.570633215	3.607586022	0	0	2.016623111	0.249519223	0.087594112	2.246669693	0	0	0	0	0	0	6.836107737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2165	NO																																																																																		0	0	0	33.7575	3.091213973	0	0	2.264259143	3.488739961	1.570633215	3.607586022	0	0	2.016623111	0.249519223	0.087594112	2.246669693	0	0	0	0	0	0	6.836107737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2165
H4454_030_0	2011	5																															D	D	D	V	T	COIN	COIN	V	V		V	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	YES	774.9126	41.52999086	508.6406561	1400.881033	220.0299986	7.050734758	2.732959518	376.1047488	491.5910671		342.1084823	4.536350404	6.568398859	222.3831952	4022.062998	4115.737108	0.359396492	456.3007519	92.67628486		43.03526242																				3400	1a; $300/days 1-4 Acute/Rehab/LTAC	1b; $225/days 1-7	2a; $0 (1-3 Days); $100 (4-20 Days); $0 (21-100)	6a; $10 CP Per Visit Per PT/OT/ST	10a; $100 Per one-way trip; 20% Coins Air Ambulance per one-way  trip	11a; 20% Coins. On DME/Prosthetics/Supplies	11b; 20% Coins. On DME/Prosthetics/Supplies	4a; $50 Per ER Visit; Waived if Admitted	9a/b; $275 CP Per Surg	8a; No Cost Sharing	"8a/b; $150 CP Per MRI, CT, Test"	1a; $200 Per Admit	12; 20% Coins.	8b; 9a/b; $275 CP Per Surg; $40 CP Per Radiation Therapy Visit	7a; $10 CP Per Visit	"4b, 7b/d/f/g,17a,18a; $40 CP Per Visit, Urgent Care CP Waived if Admitted"	"5, 7e/h, 9c; 20% Coins."	"3, 7c/i, 9d; $10 CP Per Visit Per PT/OT/ST"	8a; $40 CP Per Visit	14; No Cost Sharing	15; 20% Coins.																				0	300	225	100	10	104.5855258	0.2	0.2	50	275	0	150	200	0.2	250	10	40	0.2	10	40	0	0.2																				NO	280.2	210.15	93.4	9.34	97.68288109	0.1868	0.1868	46.7	256.85	0	140.1	186.8	0.1868	233.5	9.34	37.36	0.1868	9.34	37.36	0	0.1868																					18.0942	0.727293965	3.958919773	1.090352404	1.791097016	1.317077253	0.510516838	1.463674314	10.52209713	0	3.99411653	0.070615855	1.226976907	4.32720634	3.1305057	12.81366153	0.067135265	0.355154085	0.288532167	0	8.038987021	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7881	0	5.249109325	18.0942	0.727293965	3.958919773	1.090352404	1.791097016	1.317077253	0.510516838	1.463674314	10.52209713	0	3.99411653	0.070615855	1.226976907	4.32720634	3.1305057	12.81366153	0.067135265	0.355154085	0.288532167	0	8.038987021	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7881	NO	30% Coinsurance	Included in Line a1	30% Coinsurance		$100 Copay; 20% air	30% Coinsurance	Included in Line e1	30% Coinsurance	30% Coinsurance	30% Coinsurance	Included in line h1	Included in line h1	Included in line h1	Included in line h1	30% Coinsurance	Include in line i1	Include in line i1	Include in line i1	Include in line i1	Include in line i1	30% Coinsurance																					0.7046		0.0952		0.02	0.0296		0.0635	0.1758	0.1579					0.7105						0.1304																				2.0876	0	0	18.7989	0.727293965	4.054110069	1.090352404	1.811097016	1.346724811	0.510516838	1.527163335	10.69794215	0.15788216	3.99411653	0.070615855	1.226976907	4.32720634	3.841019642	12.81366153	0.067135265	0.355154085	0.288532167	0	8.169396907	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8758
H4454_803_0	2011	4																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																																																												0	YES	233.0911076	12.26795303	37.93438026	18.79819934	8.609865408	7.823576888	1.740654514	22.94775537	58.206927	2.607957941	28.92068567	0	0	23.49115755	53.50139325	148.3054252	0.119229555	7.773939409	15.5079508	10.62895782	39.41361027																				6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0	0.080977897	0.080977897	0.179121052	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.074426785	0.074426785	0.164630159	0	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503																					17.3482	0.913064308	6.245143056	0	1.84380526	1.675421338	0.372761686	4.914268697	12.46503088	0.558494975	6.193373512	0	0	5.030638437	11.45733941	31.75965131	0.025533045	1.664791457	3.321032316	2.276194506	8.440436464	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.5052	0	10.25	17.3482	0.913064308	6.245143056	0	1.84380526	1.675421338	0.372761686	4.914268697	12.46503088	0.558494975	6.193373512	0	0	5.030638437	11.45733941	31.75965131	0.025533045	1.664791457	3.321032316	2.276194506	8.440436464	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.5052	NO																																																																																		0	0	0	17.3482	0.913064308	6.245143056	0	1.84380526	1.675421338	0.372761686	4.914268697	12.46503088	0.558494975	6.193373512	0	0	5.030638437	11.45733941	31.75965131	0.025533045	1.664791457	3.321032316	2.276194506	8.440436464	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.5052
H4454_805_0	2011	4																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																																																												0	YES	205.7717195	4.199422848	25.19938091	18.05897721	6.169292214	4.563450106	5.774217611	18.2631473	56.33069417	2.87638144	31.5537102	1.105670434	0	15.91832001	45.50591765	147.8601684	0.144868454	5.550834092	8.962083657	8.744269155	41.79385734																				6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0	0.080977897	0.080977897	0.179121052	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.074426785	0.074426785	0.164630159	0	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503	0.2141503																					15.3149	0.312549543	4.148578087	0	1.321155778	0.977264209	1.236550434	3.911058474	12.06323506	0.615977948	6.757236506	0.236779655	0	3.408913006	9.745105918	31.66429942	0.031023623	1.188712786	1.919232904	1.872587863	8.950167087	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.6754	0	9.3	15.3149	0.312549543	4.148578087	0	1.321155778	0.977264209	1.236550434	3.911058474	12.06323506	0.615977948	6.757236506	0.236779655	0	3.408913006	9.745105918	31.66429942	0.031023623	1.188712786	1.919232904	1.872587863	8.950167087	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.6754	NO																																																																																		0	0	0	15.3149	0.312549543	4.148578087	0	1.321155778	0.977264209	1.236550434	3.911058474	12.06323506	0.615977948	6.757236506	0.236779655	0	3.408913006	9.745105918	31.66429942	0.031023623	1.188712786	1.919232904	1.872587863	8.950167087	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.6754
H4456_010_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1018.29752	75.69236725	827.4825314	733.8177387	165.8381729	10.77365395	8.825484765	325.4746178	41.51743245	18.08527418	39.79749905	0	0.056922989	34.54887544	5499.920967	99.15933206	426.9606509	391.095603	0	0	20.52583381	1056.654963	0	0	156.7175375	0	16.3966361	6	152.1790774	0											2940	"$190 Days 1-9 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$190 Days 1-9 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-33 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												153.236077	109.398001	68.81843662	0	200	0.2	0.086500863	49.42815177	0.2	0.122021276	0.149348849	0	0.2	0.158969914	6.733025044	0.121007652	38.5	35	0	0	0.2	34.24999046	0	0	35	0	0	0	0	0											YES	108.5693691	77.50963202	48.75858473	0	141.7020994	0.141702099	0.06128677	35.04257777	0.141702099	0.086453355	0.105815227	0	0.141702099	0.112631853	6.393915707	0.114966377	36.56094447	33.23722224	0	0	0.141702099	24.26647776	0	0	35	0	0	0	0	0											4940	9.213	0.488907294	3.36223976	0	1.958301438	1.526649383	0.540885451	0.950455801	5.883107339	1.563532632	4.211181397	0	0.008066107	3.89130386	2.930502588	11.39998913	1.300840387	1.08324429	0	0	2.908553743	2.136774515	0	0	0.457092818	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8146	0	16.77822658	9.213	0.488907294	3.36223976	0	1.958301438	1.526649383	0.540885451	0.950455801	5.883107339	1.563532632	4.211181397	0	0.008066107	3.89130386	2.930502588	11.39998913	1.300840387	1.08324429	0	0	2.908553743	2.136774515	0	0	0.457092818	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8146	NO	"$290 Days 1-18 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-18 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-29 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$20 (7a, 14c); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20 (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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.5016	0.0313	0.1244	0.1392	0.0934	0.1092	0.0895	0.0453	0.421	0.0746	0.294	0	0.0004	0.2779	0.477	1.0073	0.1024	0.097	0	0	0.3071	0.1942	0	0	0.0409	0	0.0043	0	0	0											4.4319	0	1.150868949	9.7146	0.520202382	3.486630171	0.139184645	2.051723836	1.6358945	0.630376084	0.995796875	6.304095128	1.638122256	4.505173676	0	0.008450907	4.169199671	3.407477787	12.4072976	1.403193664	1.180232756	0	0	3.215620231	2.330990753	0	0	0.497948326	0	0.004274524	0	0	0	0	0	0	0	0	0	0	0	0	0	60.2465
H4456_013_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	777.3890051	76.91986416	267.7767631	703.1465295	172.9866781	12.13419648	10.00034317	395.4112031	41.66435258	17.44227076	35.61283782	0	0.036201936	30.95241264	5653.847781	90.63757798	443.3971846	362.0950672	0	0	23.88098769	780.889573	0	0	152.0309118	0	16.03565674	6	0	0											3400	"$220 Days 1-16 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$220 Days 1-9 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-34 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$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, 18a); $0/$25 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												199.2720069	126.6713695	67.93918858	0	200	0.2	0.085072827	49.64040898	0.2	0.122192231	0.150617448	0	0.2	0.159277134	7.140592173	0.090424422	38.5	25	0	0	0.2	24.62643129	0	0	25	0	0	0	0	0											YES	153.8797152	97.81682123	52.4632795	0	154.4418784	0.154441878	0.065694036	38.3468728	0.154441878	0.094357989	0.116308208	0	0.154441878	0.122995299	6.864906815	0.086965512	37.01358459	24.03479519	0	0	0.154441878	19.01676153	0	0	25	0	0	0	0	0											4400	9.9687	0.627004717	1.17070393	0	2.226365625	1.874028098	0.6569629	1.263565259	6.434720874	1.645817585	4.142065348	0	0.005591095	3.807001239	3.23442818	7.882343338	1.367643266	0.725240065	0	0	3.688224597	1.237499233	0	0	0.316731066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2746	0	11.95701767	9.9687	0.627004717	1.17070393	0	2.226365625	1.874028098	0.6569629	1.263565259	6.434720874	1.645817585	4.142065348	0	0.005591095	3.807001239	3.23442818	7.882343338	1.367643266	0.725240065	0	0	3.688224597	1.237499233	0	0	0.316731066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2746	NO	"$325 Days 1-14 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-14 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-26 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.4196	0.033	0.0288	0.0967	0.0988	0.1248	0.1029	0.0561	0.4285	0.0731	0.2685	0	0.0002	0.2532	0.5019	0.7457	0.1065	0.07	0	0	0.3624	0.1141	0	0	0.0308	0	0.0033	0	0	0											3.9189	0	0.990658636	10.3883	0.660054712	1.199468835	0.096745063	2.325211469	1.998832322	0.759819737	1.319670385	6.86325252	1.718888345	4.410564486	0	0.005839328	4.060237366	3.736300581	8.628044287	1.474149234	0.795221429	0	0	4.050603703	1.351566547	0	0	0.347557298	0	0.003251437	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1935
H4456_015_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1153.693991	67.12034722	896.9342813	586.3080643	146.7101326	11.70200388	10.58801738	357.3454367	501.712166	20.5831301	40.3355521	0	0.086818427	681.6138986	6347.471468	119.3674662	458.0117603	501.0524099	0	0	22.42260509	1434.954158	0	0	252.7967948	250.549226	17.51847244	6	113.562568	0											2900	"$95 Days 1-31 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$95 Days 1-26 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-39 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$75 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $75 (9a); $40/$30 (9c)"	"$20 (7a); $25 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$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, 18a); $0/$25 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												92.11076737	82.80407956	54.22013583	0	200	0.2	0.091824737	49.46904115	75	0.119006539	0.149097811	0	0.2	29.9018165	12.90686699	0.089688039	38.5	25	0	0	0.2	24.42416086	0	0	25	15	0	0	0	0											NO	70.0836428	63.00253163	41.25407638	0	152.1725305	0.152172531	0.069866013	37.65728307	57.06469895	0.090547631	0.113442956	0	0.152172531	22.75117542	12.38180631	0.086046982	36.93379218	23.98298193	0	0	0.152172531	18.58343183	0	0	25	15	0	0	0	0												6.7379	0.352395983	3.083516279	0	1.860437678	1.780723542	0.739742558	1.121388188	2.385837809	1.863753668	4.575784261	0	0.01321138	1.292293115	6.54943019	10.27121025	1.409675931	1.001394241	0	0	3.412104558	2.222197731	0	0	0.526659989	0.313186532	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5129	0	10.69582114	6.7379	0.352395983	3.083516279	0	1.860437678	1.780723542	0.739742558	1.121388188	2.385837809	1.863753668	4.575784261	0	0.01321138	1.292293115	6.54943019	10.27121025	1.409675931	1.001394241	0	0	3.412104558	2.222197731	0	0	0.526659989	0.313186532	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5129	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.7379	0.352395983	3.083516279	0	1.860437678	1.780723542	0.739742558	1.121388188	2.385837809	1.863753668	4.575784261	0	0.01321138	1.292293115	6.54943019	10.27121025	1.409675931	1.001394241	0	0	3.412104558	2.222197731	0	0	0.526659989	0.313186532	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5129
H4456_020_0	2011	1																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1183.812208	69.83395621	913.1680972	1087.767591	225.044807	13.55785311	9.408287005	366.6260655	423.7865662	21.2249713	44.99833554	0	0.071726497	524.2472817	6315.273994	124.6029058	465.9523564	413.823751	0	0	26.23603316	1263.786414	0	0	171.2696442	179.887478	17.61044035	0	162.6362932	0											3200	"$125 Days 1-4 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-42 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$120 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $120 (9a); $40/$30 (9c)"	"$15 (7a); $25 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$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, 18a); $0/$25 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												71.85583463	42.58778118	59.96068544	0	200	0.2	0.105941202	49.49495309	120	0.12331107	0.148758107	0	0.2	47.03640497	10.20585561	0.083953563	38.5	25	0	0	0.2	24.65493762	0	0	25	15	25	0	0	0											NO	56.42660787	33.44313014	47.08564172	0	157.0550482	0.157055048	0.083193003	38.88304488	94.23302894	0.09683313	0.116816059	0	0.157055048	36.93652426	9.836395139	0.080937873	37.10626793	24.09497918	0	0	0.157055048	19.36091209	0	0	25	15	25	0	0	0												5.5665	0.194622174	3.583092155	0	2.945368584	2.129329274	0.782703647	1.18796148	3.32789098	2.055280406	5.256528206	0	0.011265008	1.613656036	5.176627534	10.0850942	1.440812748	0.830922889	0	0	4.120501453	2.039004804	0	0	0.356811759	0.224859348	0.036688417	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9656	0	10.17434125	5.5665	0.194622174	3.583092155	0	2.945368584	2.129329274	0.782703647	1.18796148	3.32789098	2.055280406	5.256528206	0	0.011265008	1.613656036	5.176627534	10.0850942	1.440812748	0.830922889	0	0	4.120501453	2.039004804	0	0	0.356811759	0.224859348	0.036688417	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9656	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.5665	0.194622174	3.583092155	0	2.945368584	2.129329274	0.782703647	1.18796148	3.32789098	2.055280406	5.256528206	0	0.011265008	1.613656036	5.176627534	10.0850942	1.440812748	0.830922889	0	0	4.120501453	2.039004804	0	0	0.356811759	0.224859348	0.036688417	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9656
H4456_021_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1244.959853	70.18278729	848.0903924	1219.963621	246.2342399	15.91840938	10.8991137	377.2112259	454.6476768	22.45072753	49.8779228	0	0.110748145	548.2741005	7038.823075	127.3618922	467.9554969	448.2562726	0	0	24.54739076	1361.278064	0	0	275.399306	0	17.64122259	6	0	0											3200	"$125 Days 1-4 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-42 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$120 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $120 (9a); $40/$30 (9c)"	"$15 (7a); $25 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$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, 18a); $0/$25 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												71.85583463	42.58778118	59.39558711	0	200	0.2	0.090871086	49.40107315	120	0.128683542	0.149350741	0	0.2	47.36294473	10.10658616	0.085979927	38.5	25	0	0	0.2	24.63154019	0	0	25	0	0	0	0	0											NO	55.14100444	32.68117395	45.57921218	0	153.4767628	0.153476763	0.069733001	37.92659191	92.08605768	0.098749667	0.114609341	0	0.153476763	36.34555717	9.707498578	0.082585035	36.97971691	24.01280319	0	0	0.153476763	18.90184526	0	0	25	0	0	0	0	0												5.7207	0.19113799	3.221274328	0	3.149269503	2.44310594	0.760027905	1.192194686	3.488892682	2.217001875	5.71647586	0	0.016997267	1.660610639	5.694113749	10.51818627	1.442071817	0.896990804	0	0	3.767454069	2.144222276	0	0	0.573748554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8145	0	11.58041252	5.7207	0.19113799	3.221274328	0	3.149269503	2.44310594	0.760027905	1.192194686	3.488892682	2.217001875	5.71647586	0	0.016997267	1.660610639	5.694113749	10.51818627	1.442071817	0.896990804	0	0	3.767454069	2.144222276	0	0	0.573748554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8145	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.7207	0.19113799	3.221274328	0	3.149269503	2.44310594	0.760027905	1.192194686	3.488892682	2.217001875	5.71647586	0	0.016997267	1.660610639	5.694113749	10.51818627	1.442071817	0.896990804	0	0	3.767454069	2.144222276	0	0	0.573748554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8145
H4456_025_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	844.3762737	76.5581359	445.1036813	481.5858737	105.2512401	7.917889739	7.507989225	302.1423895	41.20279404	16.70550773	39.03967983	0	0.065886645	27.46475675	5194.621982	87.04398179	423.653772	373.9781352	0	0	20.61239662	1043.977423	0	0	178.6282839	0	16.2261217	6	115.0386593	0											2940	"$190 Days 1-9 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$190 Days 1-9 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-40 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												153.236077	109.398001	54.14888787	0	200	0.2	0.084182758	49.61025138	0.2	0.115987831	0.150335269	0	0.2	0.159373338	6.55227059	0.121958878	38.5	35	0	0	0.2	34.40299357	0	0	35	0	0	0	0	0											YES	113.9244378	81.33271226	40.25737105	0	148.6914049	0.148691405	0.062586263	36.90400312	0.148691405	0.086231968	0.111767812	0	0.148691405	0.118487227	6.264707917	0.116621063	36.81033185	33.46393805	0	0	0.148691405	25.57714723	0	0	35	0	0	0	0	0											4940	8.0163	0.51889007	1.493225338	0	1.304162896	1.177322149	0.469896986	0.92918864	6.12650133	1.440548802	4.363379595	0	0.009796778	3.254222877	2.711899121	10.15116167	1.299569662	1.042898429	0	0	3.064886211	2.225163688	0	0	0.520999161	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.12	0	12.56398698	8.0163	0.51889007	1.493225338	0	1.304162896	1.177322149	0.469896986	0.92918864	6.12650133	1.440548802	4.363379595	0	0.009796778	3.254222877	2.711899121	10.15116167	1.299569662	1.042898429	0	0	3.064886211	2.225163688	0	0	0.520999161	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.12	NO	"$290 Days 1-18 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-18 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-29 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$20 (7a, 14c); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$20 (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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.4352	0.0331	0.0784	0.081	0.062	0.084	0.0796	0.0442	0.4371	0.0685	0.3047	0	0.0005	0.2316	0.449	0.8952	0.1022	0.0933	0	0	0.3226	0.2014	0	0	0.0466	0	0.0042	0	0	0											4.0545	0	0.887737686	8.4514	0.552003089	1.571641632	0.081032464	1.366189368	1.261312967	0.549539691	0.973380294	6.563569349	1.509061838	4.668032217	0	0.010262716	3.485858431	3.16092996	11.04638349	1.401784081	1.136239023	0	0	3.387470681	2.426524613	0	0	0.567566695	0	0.004230072	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1744
H4456_026_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1120.28979	83.55455873	771.5717502	856.0296249	199.3319904	13.24217273	9.964734803	335.0158186	42.93430663	18.91540865	40.24243516	0	0.070778436	29.8134559	5719.768047	107.3495164	490.5021992	366.2698715	0	0	18.00716213	1072.36667	0	0	118.7734008	0	16.08606237	6	147.333829	0											3600	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-46 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	61.88344983	0	200	0.2	0.08524793	49.54267418	0.2	0.125556333	0.15105878	0	0.2	0.158965127	10.46679434	0.101469471	38.5	30	0	0	0.2	29.63130541	0	0	30	0	0	0	0	0											YES	136.2593125	91.1443743	45.27376698	0	146.319467	0.146319467	0.062367159	36.26430026	0.146319467	0.091856679	0.110514201	0	0.146319467	0.116298463	9.9843813	0.09682004	36.72554055	28.61730432	0	0	0.146319467	21.67818407	0	0	30	0	0	0	0	0											4400	12.7208	0.634627331	2.910996635	0	2.430512549	1.937587656	0.621472197	1.012426186	6.282124862	1.737506618	4.447360562	0	0.010356263	3.467259098	4.759028761	10.39358442	1.501163201	0.873471365	0	0	2.634798366	1.937246839	0	0	0.296933502	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6093	0	16.53972521	12.7208	0.634627331	2.910996635	0	2.430512549	1.937587656	0.621472197	1.012426186	6.282124862	1.737506618	4.447360562	0	0.010356263	3.467259098	4.759028761	10.39358442	1.501163201	0.873471365	0	0	2.634798366	1.937246839	0	0	0.296933502	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6093	NO	"$325 Days 1-14 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-14 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-26 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.5667	0.0337	0.0965	0.1152	0.1068	0.1277	0.0961	0.0445	0.4139	0.0763	0.2857	0	0.0005	0.228	0.5096	0.8277	0.1168	0.0702	0	0	0.2561	0.147	0	0	0.0241	0	0.0033	0	0	0											4.1461	0	1.2984588	13.2875	0.668277494	3.007516332	0.115208816	2.537272137	2.065249654	0.717537849	1.056903045	6.696035743	1.813826113	4.733084879	0	0.010811159	3.6952415	5.268590484	11.22129284	1.617937258	0.943630689	0	0	2.890916464	2.084225169	0	0	0.321016344	0	0.003261657	0	0	0	0	0	0	0	0	0	0	0	0	0	64.7554
H4456_801_0	2011	1																															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	217.2690101	4.3014	26.46124512	1143.731178	8.40144716	15.30819432	11.15993354	19.10094686	45.04719332	24.00313952	52.72400912	0	0.03614526	35.85795865	38.14608496	135.4406696	2.025	7.714835808	0	0	36.79841017	10.52314737	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.08631681	0.08631681	0.205795057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.068204953	0.068204953	0.162613078	0	0.184109607	0.184109607	0.184109607	0.184109607	0.184109607	0.184109607	0.184109607	0	0.184109607	0.184109607	0.184109607	0.184109607	0.184109607	0.184109607	0	0	0.184109607	0.184109607	0	0	0	0	0	0	0	0												14.8188	0.293376783	4.302944508	0	1.546787134	2.818385639	2.054650977	3.516667819	8.293621055	4.419208582	9.706996595	0	0.00665469	6.601794673	7.023060709	24.93592845	0.372821954	1.420375388	0	0	6.774940832	1.937412527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.8445	0	26.77929154	14.8188	0.293376783	4.302944508	0	1.546787134	2.818385639	2.054650977	3.516667819	8.293621055	4.419208582	9.706996595	0	0.00665469	6.601794673	7.023060709	24.93592845	0.372821954	1.420375388	0	0	6.774940832	1.937412527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.8445	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	14.8188	0.293376783	4.302944508	0	1.546787134	2.818385639	2.054650977	3.516667819	8.293621055	4.419208582	9.706996595	0	0.00665469	6.601794673	7.023060709	24.93592845	0.372821954	1.420375388	0	0	6.774940832	1.937412527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.8445
H4456_805_0	2011	1																															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	217.2475643	4.3018	26.45863324	1143.618446	8.400617887	15.30668331	11.15883198	19.09906148	45.04274689	24.00077027	52.71880495	0	0.036141693	35.85382082	38.14231972	135.4273008	2.0243	7.714074308	0	0	36.79477794	10.52210868	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.086316824	0.086316824	0.205794236	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.068206752	0.068206752	0.162616694	0	0.184114435	0.184114435	0.184114435	0.184114435	0.184114435	0.184114435	0.184114435	0	0.184114435	0.184114435	0.184114435	0.184114435	0.184114435	0.184114435	0	0	0.184114435	0.184114435	0	0	0	0	0	0	0	0												14.8178	0.293411807	4.302615456	0	1.54667502	2.818181356	2.054502051	3.516412923	8.293019914	4.418888268	9.70629301	0	0.006654207	6.601205978	7.022551661	24.93412104	0.372702852	1.420272436	0	0	6.774449768	1.937272099	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.837	0	26.77396108	14.8178	0.293411807	4.302615456	0	1.54667502	2.818181356	2.054502051	3.516412923	8.293019914	4.418888268	9.70629301	0	0.006654207	6.601205978	7.022551661	24.93412104	0.372702852	1.420272436	0	0	6.774449768	1.937272099	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.837	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	14.8178	0.293411807	4.302615456	0	1.54667502	2.818181356	2.054502051	3.516412923	8.293019914	4.418888268	9.70629301	0	0.006654207	6.601205978	7.022551661	24.93412104	0.372702852	1.420272436	0	0	6.774449768	1.937272099	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.837
H4456_810_0	2011	1																															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	217.2954816	4.3075	26.46446909	1143.744561	8.402470772	15.31005943	11.16129324	19.10327407	45.05268176	24.006064	52.73043289	0	0.036149664	35.86172557	38.15073259	135.4571714	2.025	7.715775765	0	0	36.80289359	10.52442949	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.087745945	0.087745945	0.167153874	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.069437641	0.069437641	0.132277002	0	0.184384249	0.184384249	0.184384249	0.184384249	0.184384249	0.184384249	0.184384249	0	0.184384249	0.184384249	0.184384249	0.184384249	0.184384249	0.184384249	0	0	0.184384249	0.184384249	0	0	0	0	0	0	0	0												15.0885	0.299102637	3.500640642	0	1.549283265	2.822933814	2.057966673	3.522342847	8.3070049	4.426340087	9.722661277	0	0.006665429	6.612337344	7.034394184	24.97616885	0.373378105	1.422667521	0	0	6.785873903	1.940539029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4488	0	26.48487153	15.0885	0.299102637	3.500640642	0	1.549283265	2.822933814	2.057966673	3.522342847	8.3070049	4.426340087	9.722661277	0	0.006665429	6.612337344	7.034394184	24.97616885	0.373378105	1.422667521	0	0	6.785873903	1.940539029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4488	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.0885	0.299102637	3.500640642	0	1.549283265	2.822933814	2.057966673	3.522342847	8.3070049	4.426340087	9.722661277	0	0.006665429	6.612337344	7.034394184	24.97616885	0.373378105	1.422667521	0	0	6.785873903	1.940539029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4488
H4461_001_0	2011	5	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O	T		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	268.88999	4.240984	1043.884025	1962.863784	272.3841	1.098674	13.582661	447.714967	2287.98352	1139.889734	2298.620465	0.940192	0.490356	1527.320115	3582.66055	9463.843884	206.678016	580.79756		2780.826616	38.78556	0	6.98		1.65				4.23	0.58	0.175823										3400	$0/Admit:1a.IP Acute	$100/Admit:1b.IP Psych	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$75/Visit:8b, 9a. $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,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$0/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0-$75/Visit:9d. $10 Cardiac Rehab,8b. $75 Nuclear Medicine,9a. $20 OP Other,5. $20 Partial Hospitalization,7h. $20 Psych -- OP,8b. $0 Rad therapy,3, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$20/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"	$0: Other - Transportation 10b		"VIS734: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											0	100	68.8913	0	0	0.2	0.2	50	100	0	24.417124	0	0.2	21.688217	10	20	20	10		0	0.2	0	0		0				0	0	0										NO	0	88.1485	36.750064	0	0	0.173513	0.173513	43.37835	86.7567	0	21.183491	0	0.173513	18.815982	8.67567	17.35134	17.35134	8.67567		0	0.173513	0	0		0				0	0	0											0	0.031153032	3.196900394	0	0	0.190634222	2.356768258	1.618428045	16.54149165	0	4.057733828	0	0.085083141	2.394835649	2.590165054	13.68419774	0.298845044	0.419900664	0	0	6.729798872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1959	0	10.58035113	0	0.031153032	3.196900394	0	0	0.190634222	2.356768258	1.618428045	16.54149165	0	4.057733828	0	0.085083141	2.394835649	2.590165054	13.68419774	0.298845044	0.419900664	0	0	6.729798872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1959	NO																																																																																		0	0	0	0	0.031153032	3.196900394	0	0	0.190634222	2.356768258	1.618428045	16.54149165	0	4.057733828	0	0.085083141	2.394835649	2.590165054	13.68419774	0.298845044	0.419900664	0	0	6.729798872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1959
H4461_004_0	2011	4	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	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	YES	232.992424	5.336212	981.247935	1656.160723	237.685535	0.606175	9.585984	366.532949	1975.281699	917.872178	1814.520848	0.350303	0.216272	1217.967639	2885.438452	7767.419598	131.342941	391.143138		2317.738902	30.589489	0			1.65				4.23	0.58	0										3400	$0/Admit:1a.IP Acute	$100/Admit:1b.IP Psych	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$75/Visit:8b, 9a. $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,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$0/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0-$75/Visit:9d. $10 Cardiac Rehab,8b. $75 Nuclear Medicine,9a. $20 OP Other,5. $20 Partial Hospitalization,7h. $20 Psych -- OP,8b. $0 Rad therapy,3, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$20/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"			"VIS734: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											0	100	68.8913	0	0	0.2	0.2	50	100	0	26.107535	0	0.2	21.285478	10	20	20	10		0	0.2	0			0				0	0	0										NO	0	90.4468	40.017578	0	0	0.178775	0.178775	44.69375	89.3875	0	23.336873	0	0.178775	19.026557	8.93875	17.8775	17.8775	8.93875		0	0.178775	0			0				0	0	0											0	0.040220275	3.272263815	0	0	0.108368936	1.71373429	1.365144332	14.71379107	0	3.528770215	0	0.038664027	1.931144226	2.14935108	11.57183699	0.195673619	0.291360894	0	0	5.468635896	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.389	0	7.479511126	0	0.040220275	3.272263815	0	0	0.108368936	1.71373429	1.365144332	14.71379107	0	3.528770215	0	0.038664027	1.931144226	2.14935108	11.57183699	0.195673619	0.291360894	0	0	5.468635896	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.389	NO																																																																																		0	0	0	0	0.040220275	3.272263815	0	0	0.108368936	1.71373429	1.365144332	14.71379107	0	3.528770215	0	0.038664027	1.931144226	2.14935108	11.57183699	0.195673619	0.291360894	0	0	5.468635896	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.389
H4461_011_0	2011	7	r.	s.	t.	u.	v.	w.					OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Lab	Radiology	Renal Dialysis	Other		Therapy (PT/OT/ST)					Coin	Coin	D	V	Coin	O	O	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	S	O	T		V				O	O	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	0	0	0					0	YES	309.48214	7.628764	1608.884556	3409.066632	21.566829	457.314904	1427.166679	1068.173959	60.244602	11.180674	24.015276	0.057308	0.01915	56.570701	3687.654236	10390.93872	1058.348699	2.444942		1693.101502	2031.99203	0	6.98		1.65				4.23	0.58	0.440603	414.737784	0	0	1378.621248	615.888167					3400	10% Coins:1a.IP Acute	2% Coins:1b.IP Psych	$0/Day(Days 1-20) $0(Days 20-100):2.SNF	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"10% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician"	10% Coins:8a.Lab -- OP	"10% Coins:8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	10% Coins:9a.Observation	"10% Coins:9a, 12.Dialysis -- OP Hosp"	"10% Coins:5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"10% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"	$0: Other - Transportation 10b		"VIS734: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Visit:8a.Lab -- FSL	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR"	$0/Proc:12.Dialysis -- Dialysis Center	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						0.1	0.02	0	0	0.2	0	0	50	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	0	0	0	0					NO	0.085781	0.017156	0	0	0.17886	0	0	44.715	0.08943	0.08943	0.08943	0.08943	0.08943	0.08943	0	0	0	0.08943		0	0	0	0		0				0	0	0	0	0	0	0	0						26.5477	0.130879075	0	0	3.857443035	0	0	3.980283215	5.387674757	0.999887676	2.147686133	0.005125054	0.001712585	5.05911779	0	0	0	0.218651163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3361	0	6.982151253	26.5477	0.130879075	0	0	3.857443035	0	0	3.980283215	5.387674757	0.999887676	2.147686133	0.005125054	0.001712585	5.05911779	0	0	0	0.218651163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3361	NO																																																																																		0	0	0	26.5477	0.130879075	0	0	3.857443035	0	0	3.980283215	5.387674757	0.999887676	2.147686133	0.005125054	0.001712585	5.05911779	0	0	0	0.218651163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3361
H4461_015_0	2011	5	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O	T		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	206.5135821	5.330916993	569.9965657	1217.5757	235.817566	3.512478237	8.198966314	370.3304582	1176.702615	1156.026501	2027.844196	29.02141454	0.171926718	1014.576113	3699.450159	6275.835784	228.3500077	657.4486614		2317.141573	18.32221493	0	6.98		1.65				4.23	0.58	125.9963047										3400	$500/Admit:1a.IP Acute	$500/Admit:1b.IP Psych	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $25 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"	$0: Other - Transportation 10b		"VIS734: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											500	500	68.8913	0	100	0.2	0.2	50	100	16.462625	39.07961	100	0.2	28.083035	15	25	25	15		0	0.2	0	0		0				0	0	0										NO	444.7755	444.7755	44.435577	0	88.0632	0.176126	0.176126	44.0316	88.0632	14.497514	34.414755	88.0632	0.176126	24.730819	13.20948	22.0158	22.0158	13.20948		0	0.176126	0	0		0				0	0	0											7.6543	0.197588439	2.11067719	0	1.73057079	0.618638742	1.444051141	1.35885355	8.635349808	1.396625865	5.815646765	0.212976553	0.030280765	2.090941518	4.07231774	11.51396212	0.418942342	0.723712912	0	0	3.227018426	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.2525	0	8.004421167	7.6543	0.197588439	2.11067719	0	1.73057079	0.618638742	1.444051141	1.35885355	8.635349808	1.396625865	5.815646765	0.212976553	0.030280765	2.090941518	4.07231774	11.51396212	0.418942342	0.723712912	0	0	3.227018426	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.2525	NO																																																																																		0	0	0	7.6543	0.197588439	2.11067719	0	1.73057079	0.618638742	1.444051141	1.35885355	8.635349808	1.396625865	5.815646765	0.212976553	0.030280765	2.090941518	4.07231774	11.51396212	0.418942342	0.723712912	0	0	3.227018426	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.2525
H4461_018_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O			V				O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0	0	0								0	NO	262.163492	7.99628	592.409705	1119.622206	151.09889	6.02289	1.832316	345.226807	287.627881	276.216456	251.80634	67.519346	0.507976	538.880908	4144.831821	4297.394539	65.408286	645.011046		1636.833102	31.275491	0			1.65				4.23	0.58	256.199305	1054.587275	1082.308164									$200/Admit:1a.IP Acute	$200/Admit:1b.IP Psych	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- OP	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"	$0/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0-$75/Visit:9d. $10 Cardiac Rehab,8b. $75 Nuclear Medicine,9a. $25 OP Other,5. $25 Partial Hospitalization,7h. $25 Psych -- OP,8b. $0 Rad therapy,3, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"			"VIS734: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:8b, 9a. $0 DMAM -- OP,8b. $0 Radiology -- FSR,8b. $75 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"									200	200	68.8913	0	100	0.2	0.2	50	100	0	0	0	0.2	22.652142	10	25	25	10		0	0.2	0			0				0	0	0	0	35.910833								NO	185.3926	185.3926	46.903608	0	92.1983	0.184397	0.184397	46.09915	92.1983	0	0	0	0.184397	20.88489	9.21983	23.049575	23.049575	9.21983		0	0.184397	0			0				0	0	0	0	33.109178									4.0503	0.123537595	2.315512715	0	1.160921732	1.110602847	0.337873573	1.326221863	2.209900138	0	0	0	0.09366925	0.937872374	3.184553731	8.254426478	0.125636099	0.495574349	0	0	5.767106714	0	0	0	0	0	0	0	0	0	0	0	2.986194471	0	0	0	0	0	0	0	34.4799	0	3.782860648	4.0503	0.123537595	2.315512715	0	1.160921732	1.110602847	0.337873573	1.326221863	2.209900138	0	0	0	0.09366925	0.937872374	3.184553731	8.254426478	0.125636099	0.495574349	0	0	5.767106714	0	0	0	0	0	0	0	0	0	0	0	2.986194471	0	0	0	0	0	0	0	34.4799	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Day(Days 1-20) $137(Days 20-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	20% Coins	$0/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		$0/Visit	20% Coins	$0/Service									20% Coins	$0/Visit	20% Coins								3400	1.5658	0.022	0.092	0	0.4177	0.7046	0.2143	0.0952	0.7527	0.0739	0	0.0792	0.008	0.1535	0.5609	1.0159	0.007	0.0787		0	0.4615	0									0.0344	0	0.4136								6.751	0	2.444692214	5.6161	0.145502414	2.407512382	0	1.578604239	1.815158062	0.552217034	1.421466314	2.962636503	0.073886149	0	0.079206768	0.1016673	1.091410435	3.745455608	9.270354016	0.132633151	0.574247795	0	0	6.228644007	0	0	0	0	0	0	0	0	0	0.03439995	0	3.399841759	0	0	0	0	0	0	0	41.2309
H4461_806_0	2011	4																															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	YES	305.466021	4.285011	31.394205	16.964403	7.677479	9.777641	3.452	27.837341	51.633907	5.575932	30.220845	5.358488	0.541082	10.386312	40.278881	72.954666	0.502472	5.572762		7.924441	33.143404	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.086722	0.086722	0.193891	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.0782	0.0782	0.12908	0	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022		0.21022	0.21022	0																				23.8874	0.33508786	4.052363981	0	1.613959635	2.055455691	0.72567944	5.851965825	10.85447993	1.172172425	6.353026036	1.126461347	0.113746258	2.183410509	8.467426364	15.33652989	0.105629664	1.171506028	0	1.665875987	6.967406389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0396	0	11.80068255	23.8874	0.33508786	4.052363981	0	1.613959635	2.055455691	0.72567944	5.851965825	10.85447993	1.172172425	6.353026036	1.126461347	0.113746258	2.183410509	8.467426364	15.33652989	0.105629664	1.171506028	0	1.665875987	6.967406389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0396	NO																																																																																		0	0	0	23.8874	0.33508786	4.052363981	0	1.613959635	2.055455691	0.72567944	5.851965825	10.85447993	1.172172425	6.353026036	1.126461347	0.113746258	2.183410509	8.467426364	15.33652989	0.105629664	1.171506028	0	1.665875987	6.967406389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0396
H4461_807_0	2011	4																															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	YES	305.466021	4.285011	31.394205	16.964403	7.677479	9.777641	3.452	27.837341	51.633907	5.575932	30.220845	5.358488	0.541082	10.386312	40.278881	72.954666	0.502472	5.572762		7.924441	33.143404	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.086722	0.086722	0.193891	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.0782	0.0782	0.12908	0	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022		0.21022	0.21022	0																				23.8874	0.33508786	4.052363981	0	1.613959635	2.055455691	0.72567944	5.851965825	10.85447993	1.172172425	6.353026036	1.126461347	0.113746258	2.183410509	8.467426364	15.33652989	0.105629664	1.171506028	0	1.665875987	6.967406389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0396	0	11.80068255	23.8874	0.33508786	4.052363981	0	1.613959635	2.055455691	0.72567944	5.851965825	10.85447993	1.172172425	6.353026036	1.126461347	0.113746258	2.183410509	8.467426364	15.33652989	0.105629664	1.171506028	0	1.665875987	6.967406389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0396	NO																																																																																		0	0	0	23.8874	0.33508786	4.052363981	0	1.613959635	2.055455691	0.72567944	5.851965825	10.85447993	1.172172425	6.353026036	1.126461347	0.113746258	2.183410509	8.467426364	15.33652989	0.105629664	1.171506028	0	1.665875987	6.967406389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0396
H4461_808_0	2011	4																															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	YES	305.466021	4.285011	31.394205	16.964403	7.677479	9.777641	3.452	27.837341	51.633907	5.575932	30.220845	5.358488	0.541082	10.386312	40.278881	72.954666	0.502472	5.572762		7.924441	33.143404	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.086722	0.086722	0.193891	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.0782	0.0782	0.12908	0	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022	0.21022		0.21022	0.21022	0																				23.8874	0.33508786	4.052363981	0	1.613959635	2.055455691	0.72567944	5.851965825	10.85447993	1.172172425	6.353026036	1.126461347	0.113746258	2.183410509	8.467426364	15.33652989	0.105629664	1.171506028	0	1.665875987	6.967406389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0396	0	11.80068255	23.8874	0.33508786	4.052363981	0	1.613959635	2.055455691	0.72567944	5.851965825	10.85447993	1.172172425	6.353026036	1.126461347	0.113746258	2.183410509	8.467426364	15.33652989	0.105629664	1.171506028	0	1.665875987	6.967406389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0396	NO																																																																																		0	0	0	23.8874	0.33508786	4.052363981	0	1.613959635	2.055455691	0.72567944	5.851965825	10.85447993	1.172172425	6.353026036	1.126461347	0.113746258	2.183410509	8.467426364	15.33652989	0.105629664	1.171506028	0	1.665875987	6.967406389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0396
H4506_003_0	2011	9																															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	1511.450536	75.44084321	600.0888143		206.095985	19.25707587	0.460002533	326.5775417	306.0377922		253.9450784		7.663859648	29.54443839		3430.548466	228.7218405	60.56780486		343.6398933	25.10034465	1035.571226		1386.364181	123.7673326																3000	(1a/1a1) $460/Admit	(1b) $460/Admit	(2a/2a2) $100/Day Days 21-100	(6a) 0%	(10a) $50	(11a) 10%	(11b) 20% (11c) 20%	(4a) $50 (4a1) n/c (4b) $25 (4b1) n/c	(9b) $50	(8a) $0	(8b1) $0 (8b2) $125/$125/$0/$25/$300 (8b3) $50/20%	(9a) $0	(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) $0 (14j) $0	(7b) 50% (7d) $20 (7f) $25	(7e) 35 Ind/20 Grp (7h) 35 Ind/20 Grp	(7c) $10 (7i) $10		(7d) $20 (7g) $25	(15) 10%	(13a) $0 (16b) $0 (17a) $0/$25 (17b) $0 (18a) $25	(10b) $0	(16a) $5	(17a1) $25	(17b1) $0	(18a1) n/c	(18b) n/c	(14a) $0  (14a6) $0													80.67020192	67.29418353	31.19338124		50	0.1	0.2	49.8193045	50		69.11305277		50	79.52590126		20.0074359	31.25	10		25	0.1	25		5	25																NO	74.83674215	62.42797639	28.93771148		46.38437761	0.092768755	0.18553751	46.21674864	46.38437761		64.11531874		46.38437761	73.77518867		18.56064923	28.990236	9.276875521		23.1921888	0.092768755	23.1921888		4.638437761	23.1921888																	9.426	0.392468265	1.447099748	0	0.796636166	1.786454958	0.085347725	1.257779346	1.18294771	0	1.356814137	0	0.029623613	0.18163721	0	5.306100563	0.552558344	0.046823332	0	0.664146774	2.328527728	2.001430283	0	0.535880331	0.239202946	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6175	0	2.308657285	9.426	0.392468265	1.447099748	0	0.796636166	1.786454958	0.085347725	1.257779346	1.18294771	0	1.356814137	0	0.029623613	0.18163721	0	5.306100563	0.552558344	0.046823332	0	0.664146774	2.328527728	2.001430283	0	0.535880331	0.239202946	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6175	NO																																																																																		0	0	0	9.426	0.392468265	1.447099748	0	0.796636166	1.786454958	0.085347725	1.257779346	1.18294771	0	1.356814137	0	0.029623613	0.18163721	0	5.306100563	0.552558344	0.046823332	0	0.664146774	2.328527728	2.001430283	0	0.535880331	0.239202946	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6175
H4506_010_0	2011	7																															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	1138.330572	75.76421594	509.8392115		136.5123553	7.469800352	0.808384845	236.5919663	196.1533038		136.6316496		5.025467078	36.93775207		2126.47641	229.4267364	23.06318953		192.2109553	13.77987125	635.9413916		1310.655313	124.2056443																3000	(1a/1a1) $300/Admit	(1b) $300/Admit	(2a/2a2) $100/Day Days 21-100	(6a) 0%	(10a) $50	(11a) 10%	(11b) 20% (11c) 20%	(4a) $50 (4a1) n/c (4b) $25 (4b1) n/c	(9b) $50	(8a) $0	(8b1) $0 (8b2) $125/$125/$0/$25/$300 (8b3) $50/20%	(9a) $0	(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) $0 (14j) $0	(7b) 50% (7d) $20 (7f) $25	(7e) 35 Ind/20 Grp (7h) 35 Ind/20 Grp	(7c) $10 (7i) $10		(7d) $20 (7g) $25	(15) 10%	(13a) $0 (16b) $0 (17a) $0/$25 (17b) $0 (18a) $25	(10b) $0	(16a) $15	(17a1) $25	(17b1) $0	(18a1) n/c	(18b) n/c	(14a) $0  (14a6) $0													52.61100125	43.887511	31.19338124		50	0.1	0.2	49.76665241	50		69.44773013		50	42.04144848		19.98094531	31.25	10		25	0.1	25		15	25																NO	50.9970068	42.54113481	30.23643415		48.46610555	0.096932211	0.193864422	48.23991658	48.46610555		67.31722038		48.46610555	40.75170559		19.36797208	30.29131597	9.693221111		24.23305278	0.096932211	24.23305278		14.53983167	24.23305278																	4.8376	0.26859131	1.284643312	0	0.551351852	0.724064265	0.156717061	0.95109806	0.792232227	0	0.766471906	0	0.020297068	0.1254397	0	3.432127979	0.57913648	0.018629716	0	0.388154852	1.335713389	1.284233442	0	1.588058968	0.250823494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.3554	0	0.612575522	4.8376	0.26859131	1.284643312	0	0.551351852	0.724064265	0.156717061	0.95109806	0.792232227	0	0.766471906	0	0.020297068	0.1254397	0	3.432127979	0.57913648	0.018629716	0	0.388154852	1.335713389	1.284233442	0	1.588058968	0.250823494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.3554	NO																																																																																		0	0	0	4.8376	0.26859131	1.284643312	0	0.551351852	0.724064265	0.156717061	0.95109806	0.792232227	0	0.766471906	0	0.020297068	0.1254397	0	3.432127979	0.57913648	0.018629716	0	0.388154852	1.335713389	1.284233442	0	1.588058968	0.250823494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.3554
H4506_801_0	2011	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	275.0595079	5.680239589	46.84923748		9.759270215	27.14830395	0.819327425	18.15626502	40.35580194	36.55283321	62.03442662	3.742508475	0.219169604	11.50012463	66.48757815	181.0714227	1.888045424	2.298481938		9.693912853	26.68161713	10.14827228																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.06943462	0.06943462	0.179927374		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																			NO	0.054874843	0.054874843	0.14219832		0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123		0.184142123	0.184142123	0.184142123																				15.0938	0.311702254	6.661882865	0	1.797092732	4.999146315	0.150872691	3.34333318	7.431203028	6.730916294	11.42315099	0.689153454	0.040358356	2.117657359	12.24316377	33.34287612	0.347668692	0.423247343	0	1.785057689	4.913209612	1.868724397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7143	0	30.70211891	15.0938	0.311702254	6.661882865	0	1.797092732	4.999146315	0.150872691	3.34333318	7.431203028	6.730916294	11.42315099	0.689153454	0.040358356	2.117657359	12.24316377	33.34287612	0.347668692	0.423247343	0	1.785057689	4.913209612	1.868724397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7143	NO																																																																																		0	0	0	15.0938	0.311702254	6.661882865	0	1.797092732	4.999146315	0.150872691	3.34333318	7.431203028	6.730916294	11.42315099	0.689153454	0.040358356	2.117657359	12.24316377	33.34287612	0.347668692	0.423247343	0	1.785057689	4.913209612	1.868724397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7143
H4506_806_0	2011	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	275.0595079	5.680239589	46.84923748		9.759270215	27.14830395	0.819327425	18.15626502	40.35580194	36.55283321	62.03442662	3.742508475	0.219169604	11.50012463	66.48757815	181.0714227	1.888045424	2.298481938		9.693912853	26.68161713	10.14827228																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.06943462	0.06943462	0.179927374		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																			NO	0.054874843	0.054874843	0.14219832		0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123		0.184142123	0.184142123	0.184142123																				15.0938	0.311702254	6.661882865	0	1.797092732	4.999146315	0.150872691	3.34333318	7.431203028	6.730916294	11.42315099	0.689153454	0.040358356	2.117657359	12.24316377	33.34287612	0.347668692	0.423247343	0	1.785057689	4.913209612	1.868724397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7143	0	30.70211891	15.0938	0.311702254	6.661882865	0	1.797092732	4.999146315	0.150872691	3.34333318	7.431203028	6.730916294	11.42315099	0.689153454	0.040358356	2.117657359	12.24316377	33.34287612	0.347668692	0.423247343	0	1.785057689	4.913209612	1.868724397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7143	NO																																																																																		0	0	0	15.0938	0.311702254	6.661882865	0	1.797092732	4.999146315	0.150872691	3.34333318	7.431203028	6.730916294	11.42315099	0.689153454	0.040358356	2.117657359	12.24316377	33.34287612	0.347668692	0.423247343	0	1.785057689	4.913209612	1.868724397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7143
H4506_808_0	2011	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	275.0595079	5.680239589	46.84923748		9.759270215	27.14830395	0.819327425	18.15626502	40.35580194	36.55283321	62.03442662	3.742508475	0.219169604	11.50012463	66.48757815	181.0714227	1.888045424	2.298481938		9.693912853	26.68161713	10.14827228																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.06943462	0.06943462	0.179927374		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																			NO	0.054874843	0.054874843	0.14219832		0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123	0.184142123		0.184142123	0.184142123	0.184142123																				15.0938	0.311702254	6.661882865	0	1.797092732	4.999146315	0.150872691	3.34333318	7.431203028	6.730916294	11.42315099	0.689153454	0.040358356	2.117657359	12.24316377	33.34287612	0.347668692	0.423247343	0	1.785057689	4.913209612	1.868724397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7143	0	30.70211891	15.0938	0.311702254	6.661882865	0	1.797092732	4.999146315	0.150872691	3.34333318	7.431203028	6.730916294	11.42315099	0.689153454	0.040358356	2.117657359	12.24316377	33.34287612	0.347668692	0.423247343	0	1.785057689	4.913209612	1.868724397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7143	NO																																																																																		0	0	0	15.0938	0.311702254	6.661882865	0	1.797092732	4.999146315	0.150872691	3.34333318	7.431203028	6.730916294	11.42315099	0.689153454	0.040358356	2.117657359	12.24316377	33.34287612	0.347668692	0.423247343	0	1.785057689	4.913209612	1.868724397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7143
H4510_012_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin			V				O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0	0									0	YES	293.388591	9.628171	668.277595	3261.080327	297.770215	12.11787	1.884509	421.490459	334.55301	1176.246859	2260.344219	94.508394	0.410942	446.5223	5129.061752	5649.251195	133.764255	1174.843342		1750.9918	51.233223	0			2.2				2.76	1.03	12104.01873	0									3400	$65/Admit:1a.IP Acute	$65/Admit:1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	20% Coins:11b.Prosthetics	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$10/Visit:7e, 7h.Psych -- Other Provider"	"$10-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"10% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS122: Vision 17a, 17b"				$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	"$0/Service:11b.Supplies, 11c.Diabetic Monitoring Supplies"	$0/Proc:12.Dialysis -- Dialysis Center										65	65	46.371	0	100	0.2	0.2	50	40.618323	3.069528	44.954106	50	0.2	48.41829	5	10	10	11.314109		0	0.1	0			0				0	0	0	0									NO	61.97386	61.97386	38.414664	0	94.3766	0.188753	0.188753	47.1883	38.334193	2.896916	42.426157	47.1883	0.188753	45.695536	4.71883	9.43766	9.43766	10.677871		0	0.094377	0			0				0	0	0	0										1.5152	0.049724577	2.139304939	0	2.341878373	2.287284316	0.355706727	1.657451519	1.068734971	0.283957362	7.991476559	0.371640871	0.077566535	1.700339653	2.016930872	4.442976003	0.105201797	1.045402138	0	0	4.835237887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.286	0	2.34170604	1.5152	0.049724577	2.139304939	0	2.341878373	2.287284316	0.355706727	1.657451519	1.068734971	0.283957362	7.991476559	0.371640871	0.077566535	1.700339653	2.016930872	4.442976003	0.105201797	1.045402138	0	0	4.835237887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.286	NO																																																																																		0	0	0	1.5152	0.049724577	2.139304939	0	2.341878373	2.287284316	0.355706727	1.657451519	1.068734971	0.283957362	7.991476559	0.371640871	0.077566535	1.700339653	2.016930872	4.442976003	0.105201797	1.045402138	0	0	4.835237887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.286
H4510_015_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin			V				O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0	0									0	YES	1710.763141	56.656732	523.526459	2087.819578	245.735291	12.286072	3.806775	358.803399	327.687287	2725.281027	1987.52654	78.835249	0.44937	452.27943	5430.12383	5673.124869	60.510224	768.091134		1775.019062	46.851445	0			2.2				3.38	1.48	399.628441	1.462984									3400	$65/Day(Days 1-5):1a.IP Acute	$65/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$50/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:9a, 12.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, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$20/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$20-$40/Visit:7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS122: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										40.24228	32.396715	46.371	0	50	0.2	0.105362	50	34.130461	2.186913	38.258633	50	0.2	42.70875	5	20	20	22.833021		0	0.2	0			0				0	0	0	0									NO	37.705527	30.354523	37.741125	0	46.1769	0.184708	0.097305	46.1769	31.520778	2.019697	35.333301	46.1769	0.184708	39.443154	4.61769	18.47076	18.47076	21.087163		0	0.184708	0			0				0	0	0	0										5.3754	0.143315673	1.646539794	0	0.94560783	2.269335787	0.370418241	1.38070239	0.860746519	0.458686826	5.852156124	0.303363951	0.083002234	1.486610601	2.089552376	8.732243992	0.093139152	1.349738578	0	0	8.653836703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0944	0	3.639656229	5.3754	0.143315673	1.646539794	0	0.94560783	2.269335787	0.370418241	1.38070239	0.860746519	0.458686826	5.852156124	0.303363951	0.083002234	1.486610601	2.089552376	8.732243992	0.093139152	1.349738578	0	0	8.653836703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0944	NO																																																																																		0	0	0	5.3754	0.143315673	1.646539794	0	0.94560783	2.269335787	0.370418241	1.38070239	0.860746519	0.458686826	5.852156124	0.303363951	0.083002234	1.486610601	2.089552376	8.732243992	0.093139152	1.349738578	0	0	8.653836703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0944
H4510_018_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin							O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0									0	YES	1701.234532	142.1730721	416.3131311	1586.126157	197.0189296	7.722505529	1.908019815	567.1874198	219.1635143	934.0837704	1157.363226	19.40285018	1.256856687	417.948087	5020.301714	3039.748358	111.0441912	511.19626		1838.449646	18.03426383	0							3.31	0.5	398.8462011	18.25562062									3400	$125/Day(Days 1-5):1a.IP Acute	$125/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $100(Days 21-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:9a, 12.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, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$20/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$20-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										77.389	62.301375	33.0247	0	100	0.2	0.047044	50	100	9.583526	49.307899	50	0.2	42.134979	5	20	20	31.08655		0	0.2	0							0	0	0	0									NO	73.654052	59.294586	29.193042	0	94.5164	0.189033	0.044464	47.2582	94.5164	9.058003	46.604051	47.2582	0.189033	39.824465	4.72582	18.90328	18.90328	29.381888		0	0.189033	0							0	0	0	0										10.4419	0.702507788	1.012787227	0	1.55179333	1.459808388	0.084838193	2.233688043	1.726212199	0.7050778	4.494817901	0.076411981	0.23758739	1.38704658	1.977086854	4.788434528	0.174924953	1.251659271	0	0	3.409070994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7157	0	2.180892511	10.4419	0.702507788	1.012787227	0	1.55179333	1.459808388	0.084838193	2.233688043	1.726212199	0.7050778	4.494817901	0.076411981	0.23758739	1.38704658	1.977086854	4.788434528	0.174924953	1.251659271	0	0	3.409070994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7157	NO																																																																																		0	0	0	10.4419	0.702507788	1.012787227	0	1.55179333	1.459808388	0.084838193	2.233688043	1.726212199	0.7050778	4.494817901	0.076411981	0.23758739	1.38704658	1.977086854	4.788434528	0.174924953	1.251659271	0	0	3.409070994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7157
H4510_020_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin							O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0									0	YES	1564.841314	66.602109	650.02571	1614.617518	217.901105	10.839032	3.297508	378.802539	315.601713	1460.233741	1462.8972	74.086077	0.558289	591.290858	4523.362336	4689.857982	71.381758	704.735322		1786.318364	36.741214	0							4.14	1.48	369.467382	1.613666									3400	$175/Day(Days 1-5):1a.IP Acute	$175/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:9a, 12.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, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										108.3446	87.221925	46.371	0	100	0.2	0.099037	50	100	10.377806	43.54989	50	0.2	42.705727	10	29.570844	30	34.294969		0	0.2	0							0	0	0	0									NO	96.012384	77.293977	31.32732	0	88.6121	0.177224	0.087758	44.30605	88.6121	9.195992	38.590472	44.30605	0.177224	37.842441	8.86121	26.203346	26.58363	30.389492		0	0.177224	0							0	0	0	0										12.5203	0.428995157	1.696963619	0	1.609056209	1.920936607	0.289382707	1.398603686	2.330510879	1.119024817	4.70449112	0.273538453	0.09894221	1.864657451	3.340205297	10.24083095	0.158132187	1.784712369	0	0	6.51142491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2908	0	7.316005677	12.5203	0.428995157	1.696963619	0	1.609056209	1.920936607	0.289382707	1.398603686	2.330510879	1.119024817	4.70449112	0.273538453	0.09894221	1.864657451	3.340205297	10.24083095	0.158132187	1.784712369	0	0	6.51142491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2908	NO																																																																																		0	0	0	12.5203	0.428995157	1.696963619	0	1.609056209	1.920936607	0.289382707	1.398603686	2.330510879	1.119024817	4.70449112	0.273538453	0.09894221	1.864657451	3.340205297	10.24083095	0.158132187	1.784712369	0	0	6.51142491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2908
H4510_021_0	2011	3																															A	A	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V		V	S	Coin	T						O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0						0	0											0	YES	372.766558	11.369796	842.338971	2092.309945	282.368204	3114.28648	9468.056503	490.873108	408.974011	1892.250978	1895.702435	96.004802	31.231221	766.22713	5861.621032	6077.375223	92.500397	913.234687		2314.809321	3472.867918	0	4.5						4.14	1.48											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Day(Days 1-20) $0(Days 21-100):2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$0/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b						$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c												0	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																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin			V				O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0	0									0	YES	1627.45362	69.266988	676.034487	1679.221465	226.619746	9.57991	2.914451	393.959155	328.229544	1518.660496	1521.430525	77.050403	0.493435	614.949542	4704.350748	4877.508204	74.237879	732.933135		1857.792392	32.473154	0			1.65				3.31	0.5	384.250481	1.678232									4000	$125/Day(Days 1-5):1a.IP Acute	$125/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $100(Days 21-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $200 Radiology OP -- Facility"	$200/Visit:9a.Observation	"20% Coins:9a, 12.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. $50 Rad therapy,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$30/Visit:7b. $25 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30-$40/Visit:7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS734: Vision 17a, 17b"				$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										77.389	62.301375	33.0247	0	100	0.2	0.099037	50	178.964225	41.511223	77.191288	200	0.2	138.086068	0	29.892711	30	32.147484		0	0.2	0			0				0	0	0	0									NO	70.289952	56.586345	25.704511	0	89.3176	0.178635	0.088457	44.6588	159.846551	37.076829	68.945406	178.6352	0.178635	123.335162	0	26.699452	26.79528	28.713361		0	0.178635	0			0				0	0	0	0										9.5328	0.326630473	1.448094659	0	1.686760985	1.711307223	0.257803592	1.466145259	4.372196712	4.692259627	8.741303771	1.146992846	0.088144761	6.320408449	0	10.85223301	0.16576873	1.753747808	0	0	5.800841865	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3634	0	7.275257908	9.5328	0.326630473	1.448094659	0	1.686760985	1.711307223	0.257803592	1.466145259	4.372196712	4.692259627	8.741303771	1.146992846	0.088144761	6.320408449	0	10.85223301	0.16576873	1.753747808	0	0	5.800841865	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3634	NO																																																																																		0	0	0	9.5328	0.326630473	1.448094659	0	1.686760985	1.711307223	0.257803592	1.466145259	4.372196712	4.692259627	8.741303771	1.146992846	0.088144761	6.320408449	0	10.85223301	0.16576873	1.753747808	0	0	5.800841865	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3634
H4510_023_0	2011	5																															A	A	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V		V	S	Coin	T	V	V				O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0				0	0											0	YES	416.628147	8.264264789	841.5725966	3089.505032	357.177346	3531.100052	7927.389312	684.6904892	325.8119107	1718.329836	1742.116774	69.78217091	22.70076403	767.3870468	6320.251706	5422.264593	130.7986999	901.8732059		2378.34898	3774.836918	0	8.05	2.62	1.65				4.14	1.48											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Day(Days 1-20) $0(Days 21-100):2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$0/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN772: Dental 16a, 16b"	"VIS734: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c												0	0	0	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	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2011	5																															A	A	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V		V	S	Coin	T	V	V				O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0				0	0											0	YES	484.6722312	58.50701057	1155.04615	3559.178069	589.5467529	5579.947034	15745.52036	994.7535914	474.2877186	1091.377586	3106.981803	185.5864347	131.8901803	1046.070522	7873.13537	8035.669028	309.7221398	1757.002351		2451.098678	9097.40262	0	4.5	2.62	2.2				4.14	1.48											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Day(Days 1-20) $0(Days 21-100):2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$0/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b	"DEN772: Dental 16a, 16b"	"VIS122: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c												0	0	0	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	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2011	2																															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	YES	357.617354	5.016579	36.754046	19.860687	8.988232	11.446949	4.041349	32.58993	60.449213	6.527897	35.380363	6.273327	0.63346	12.159535	47.155578	85.410006	0.588257	6.524184		9.277359	38.801882	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.075701	0.075701	0.188489	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.066562	0.066562	0.115384	0	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492		0.205492	0.205492	0																				23.8037	0.333913531	4.240828844	0	1.84700977	2.352256444	0.830464889	6.696969896	12.42182968	1.34143061	7.270381554	1.289118512	0.130170962	2.498687166	9.690094034	17.55107295	0.120882107	1.340667619	0	1.906423056	7.973476336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6394	0	16.07585951	23.8037	0.333913531	4.240828844	0	1.84700977	2.352256444	0.830464889	6.696969896	12.42182968	1.34143061	7.270381554	1.289118512	0.130170962	2.498687166	9.690094034	17.55107295	0.120882107	1.340667619	0	1.906423056	7.973476336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6394	NO																																																																																		0	0	0	23.8037	0.333913531	4.240828844	0	1.84700977	2.352256444	0.830464889	6.696969896	12.42182968	1.34143061	7.270381554	1.289118512	0.130170962	2.498687166	9.690094034	17.55107295	0.120882107	1.340667619	0	1.906423056	7.973476336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6394
H4510_802_0	2011	2																															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	YES	357.617354	5.016579	36.754046	19.860687	8.988232	11.446949	4.041349	32.58993	60.449213	6.527897	35.380363	6.273327	0.63346	12.159535	47.155578	85.410006	0.588257	6.524184		9.277359	38.801882	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.075701	0.075701	0.188489	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.066562	0.066562	0.115384	0	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492		0.205492	0.205492	0																				23.8037	0.333913531	4.240828844	0	1.84700977	2.352256444	0.830464889	6.696969896	12.42182968	1.34143061	7.270381554	1.289118512	0.130170962	2.498687166	9.690094034	17.55107295	0.120882107	1.340667619	0	1.906423056	7.973476336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6394	0	16.07585951	23.8037	0.333913531	4.240828844	0	1.84700977	2.352256444	0.830464889	6.696969896	12.42182968	1.34143061	7.270381554	1.289118512	0.130170962	2.498687166	9.690094034	17.55107295	0.120882107	1.340667619	0	1.906423056	7.973476336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6394	NO																																																																																		0	0	0	23.8037	0.333913531	4.240828844	0	1.84700977	2.352256444	0.830464889	6.696969896	12.42182968	1.34143061	7.270381554	1.289118512	0.130170962	2.498687166	9.690094034	17.55107295	0.120882107	1.340667619	0	1.906423056	7.973476336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6394
H4510_803_0	2011	2																															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	YES	357.617354	5.016579	36.754046	19.860687	8.988232	11.446949	4.041349	32.58993	60.449213	6.527897	35.380363	6.273327	0.63346	12.159535	47.155578	85.410006	0.588257	6.524184		9.277359	38.801882	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.075701	0.075701	0.188489	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.066562	0.066562	0.115384	0	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492	0.205492		0.205492	0.205492	0																				23.8037	0.333913531	4.240828844	0	1.84700977	2.352256444	0.830464889	6.696969896	12.42182968	1.34143061	7.270381554	1.289118512	0.130170962	2.498687166	9.690094034	17.55107295	0.120882107	1.340667619	0	1.906423056	7.973476336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6394	0	16.07585951	23.8037	0.333913531	4.240828844	0	1.84700977	2.352256444	0.830464889	6.696969896	12.42182968	1.34143061	7.270381554	1.289118512	0.130170962	2.498687166	9.690094034	17.55107295	0.120882107	1.340667619	0	1.906423056	7.973476336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6394	NO																																																																																		0	0	0	23.8037	0.333913531	4.240828844	0	1.84700977	2.352256444	0.830464889	6.696969896	12.42182968	1.34143061	7.270381554	1.289118512	0.130170962	2.498687166	9.690094034	17.55107295	0.120882107	1.340667619	0	1.906423056	7.973476336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6394
H4513_001_0	2011	6																															A	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	V	V	Coin	Coin																																																											0	YES	249.3235297	11.25147836	659.4477009	0	561.1067543	10.81994941	0.55662898	275.3101325	189.1937219	0	1315.827825	0	18.3134393	11.50155059	4769.357731	3131.298882	1.072556683	244.745291	0	105.5157707	5.75017188	22.8597429																			3400	"1a. $300 per Acute or Rehab admit; LTAC is $0 per day, days 1-15, & $50 per day, days 16+"	"1b. $150 per day, days 1-7"	2. Days 1-10 $0 per day; Days 11-100 $25 per day	No Cost Sharing	"10a. $50 per trip, unless being admitted for same condition w/in 3 days"	"11a, b, c. 10% Coinsurance on DME, Proshetics, Supplies; Diabetes Monitoring Supplies at 0% coinsurance"	"11a, b, c. 10% Coinsurance on DME, Proshetics, Supplies; Diabetes Monitoring Supplies at 0% coinsurance"	4a-b. $50 per ER visit; $25 per urgent care visit	9a-b. $200 Amb. Surg and $300 OP Hosp Surg per visit	No Cost Sharing	"8a-b. $0 copay for all x-rays; $30 for Radiation Therapy; $100 copay for CAT scans, MRI's, and Cardiac Nuclear Medicine; $150 copay for PET scans"	No Cost Sharing	12. $30 copay	"5, 7c, 7i, 9c, 9d. $30 for OP PT/OT/ST & Rehab; 20% coinsurance for OP Behavioral Health visits"	7a. $5 copay	"7b, 7d, 7f. $30 copay"	"7e, 7h. 20% Coinsurance"	"7c, 7i.  $30 copay"	"$0 copay for professional component of all x-rays, CAT scans, MRI's, and Cardiac Nuclear Medecine & PET scans"	"7g, 9d. $30 copay"	15. 15% Coinsurance	"15. 15% Coinsurance; Flu, Pneumonia, Hepatitis B & some other immunizations covered annually at 0% coinsurance"																				302.6708958	150	25	0	50	0.1	0.1	48.81600935	250.7981082	0	25.36894353	0	30	51.00693505	5	30	0.2	30	0	30	0.15	0.15																			NO	296.0121361	146.7	24.45	0	48.9	0.0978	0.0978	47.74205714	245.2805498	0	24.81082677	0	29.34	49.88478248	4.89	29.34	0.1956	29.34	0	29.34	0.1467	0.1467																				6.1502	0.137549323	1.343624691	0	2.286510024	1.058191052	0.054438314	1.095322673	3.867128345	0	2.720564685	0	0.044776359	0.047812696	1.943513275	7.656025766	0.209792087	0.598402236	0	0.257986059	0.843550215	3.353524284	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6689		0.761055367	6.1502	0.137549323	1.343624691	0	2.286510024	1.058191052	0.054438314	1.095322673	3.867128345	0	2.720564685	0	0.044776359	0.047812696	1.943513275	7.656025766	0.209792087	0.598402236	0	0.257986059	0.843550215	3.353524284	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6689	NO																																																																																		0			6.1502	0.137549323	1.343624691	0	2.286510024	1.058191052	0.054438314	1.095322673	3.867128345	0	2.720564685	0	0.044776359	0.047812696	1.943513275	7.656025766	0.209792087	0.598402236	0	0.257986059	0.843550215	3.353524284	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6689
H4513_009_0	2011	3																															A	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	V	V	Coin	Coin																																																											0	YES	176.689298	17.70176319	517.9676272	0	381.5573743	7.815879871	0.059672102	221.5330238	159.5023991	0	920.9002231	0	15.36268917	11.19421895	3609.223987	2767.656744	0.459954817	113.6623219	109.7131469	28.22287404	1.038678109	11.92233665																			3400	"1a. $500 per Acute or Rehab admit; LTAC is $0 per day, days 1-15, & $50 per day, days 16+"	"1b. $150 per day, days 1-7"	2. Days 1-10 $0 per day; Days 11-100 $25 per day	No Cost Sharing	"10a. $50 per trip, unless being admitted for same condition w/in 3 days"	"11a, b, c. 10% Coinsurance on DME, Proshetics, Supplies; Diabetes Monitoring Supplies at 0% coinsurance"	"11a, b, c. 10% Coinsurance on DME, Proshetics, Supplies; Diabetes Monitoring Supplies at 0% coinsurance"	4a-b. $50 per ER visit; $25 per urgent care visit	9a-b. $200 Amb. Surg and $300 OP Hosp Surg per visit	No Cost Sharing	"8a-b. $0 copay for all x-rays; $35 for Radiation Therapy; $100 copay for CAT scans, MRI's, and Cardiac Nuclear Medicine; $150 copay for PET scans"	No Cost Sharing	12. $35 copay	"5, 7c, 7i, 9c, 9d. $35 for OP PT/OT/ST & Rehab; 20% coinsurance for OP Behavioral Health visits"	7a. $15 copay	"7b, 7d, 7f. $35 copay"	"7e, 7h.  20% Coinsurance"	"7c, 7i. $35 copay"	"$0 copay for professional component of all x-rays, CAT scans, MRI's, and Cardiac Nuclear Medecine & PET scans"	"7g, 9d. $35 copay"	15. 10% Coinsurance	"15. 10% Coinsurance; Flu, Pneumonia, Hepatitis B & some other immunizations covered annually at 0% coinsurance"																				493.5508233	150	25	0	50	0.1	0.1	48.14664878	250.7981082	0	25.44678671	0	35	49.71038277	15	35	0.2	35	0	35	0.1	0.1																			NO	483.6798068	147	24.5	0	49	0.098	0.098	47.1837158	245.782146	0	24.93785098	0	34.3	48.71617511	14.7	34.3	0.196	34.3	0	34.3	0.098	0.098																				7.1218	0.216846599	1.057517239	0	1.558025945	0.765956227	0.005847866	0.871062603	3.266903495	0	1.913772711	0	0.043911687	0.045444961	4.421299384	7.910885527	0.090151144	0.324884803	0	0.080670382	0.101790455	1.168388991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9651		0.633958738	7.1218	0.216846599	1.057517239	0	1.558025945	0.765956227	0.005847866	0.871062603	3.266903495	0	1.913772711	0	0.043911687	0.045444961	4.421299384	7.910885527	0.090151144	0.324884803	0	0.080670382	0.101790455	1.168388991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9651	NO																																																																																		0			7.1218	0.216846599	1.057517239	0	1.558025945	0.765956227	0.005847866	0.871062603	3.266903495	0	1.913772711	0	0.043911687	0.045444961	4.421299384	7.910885527	0.090151144	0.324884803	0	0.080670382	0.101790455	1.168388991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9651
H4513_010_0	2011	5																																																																																																															0	YES																																									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																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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_802_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	203.7592163	1.234236275	21.5479556	16.98270913	9.979983827	9.825937784	0.488588766	9.677842081	32.100256	4.302774778	6.400029278	37.6637974	0	26.23595901	302.4208285	23.50343799	0.602316754	1.022050468	2.726225539	20.87833067	6.348307035	43.24194785																			6700	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS																				0.069841169	0.069841169	0.181049747	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.064966255	0.064966255	0.168412474	0	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366																				13.2375	0.080183709	3.628944519	0	2.163027763	2.129640347	0.105895068	2.097542588	6.957300345	0.932568776	1.387120586	8.163123392	0	5.686292554	65.54566214	5.094055238	0.130544085	0.221515743	0.590872854	4.525098404	1.375910483	9.372112753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.4249		10.0151154	13.2375	0.080183709	3.628944519	0	2.163027763	2.129640347	0.105895068	2.097542588	6.957300345	0.932568776	1.387120586	8.163123392	0	5.686292554	65.54566214	5.094055238	0.130544085	0.221515743	0.590872854	4.525098404	1.375910483	9.372112753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.4249	NO																																																																																		0			13.2375	0.080183709	3.628944519	0	2.163027763	2.129640347	0.105895068	2.097542588	6.957300345	0.932568776	1.387120586	8.163123392	0	5.686292554	65.54566214	5.094055238	0.130544085	0.221515743	0.590872854	4.525098404	1.375910483	9.372112753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.4249
H4513_804_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	203.7592163	1.234236275	21.5479556	16.98270913	9.979983827	9.825937784	0.488588766	9.677842081	32.100256	4.302774778	6.400029278	37.6637974	0	26.23595901	302.4208285	23.50343799	0.602316754	1.022050468	2.726225539	20.87833067	6.348307035	43.24194785																			6700	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS																				0.069841169	0.069841169	0.181049747	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.064966255	0.064966255	0.168412474	0	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366	0.2167366																				13.2375	0.080183709	3.628944519	0	2.163027763	2.129640347	0.105895068	2.097542588	6.957300345	0.932568776	1.387120586	8.163123392	0	5.686292554	65.54566214	5.094055238	0.130544085	0.221515743	0.590872854	4.525098404	1.375910483	9.372112753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.4249		10.0151154	13.2375	0.080183709	3.628944519	0	2.163027763	2.129640347	0.105895068	2.097542588	6.957300345	0.932568776	1.387120586	8.163123392	0	5.686292554	65.54566214	5.094055238	0.130544085	0.221515743	0.590872854	4.525098404	1.375910483	9.372112753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.4249	NO																																																																																		0			13.2375	0.080183709	3.628944519	0	2.163027763	2.129640347	0.105895068	2.097542588	6.957300345	0.932568776	1.387120586	8.163123392	0	5.686292554	65.54566214	5.094055238	0.130544085	0.221515743	0.590872854	4.525098404	1.375910483	9.372112753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.4249
H4514_001_0	2011	4																															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	2859.762992	389.0559767	857.3324943	1176.703084	444.9028392	20.06102093	24.7321497	1142.98694	450.3417492	15387.49227	7628.887132	0	0.776621945	2440.256644	7050.345723	3766.383355	1489.206023	579.0838376	0	0	22.44911338	250.0455341	885.6436191	981.4342446	18.37881007	18.39950035	22.5483122	0	210.4196854	0											2500	"$125 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-17 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$50 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $0 (4b)"	$0 (9b)	"$0 (8a1a, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$0 (3, 9a, 9c, 9d); $30 (5)"	"$0 (7a, 7a1, 14b, 14c, 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, 16a3, 16a4, 16b1, 16b3); $0 n/c (16a5, 16b2, 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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												116.2838945	90.9001972	0	0	50	0.2	0.2	49.67880086	0	0	0	0	0.2	0.016609586	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	87.10427328	68.09021705	0	0	37.45328346	0.149813134	0.149813134	37.22211221	0	0	0	0	0.149813134	0.012441671	0	0	0	0	0	0	0.149813134	0	0	0	0	0	0	0	0	0												20.7581	2.207575492	0	0	1.388589346	3.005404413	3.705200853	3.545365677	0	0	0	0	0.116348167	0.002530072	0	0	0	0	0	0	3.363172028	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0923	0	12.75959182	20.7581	2.207575492	0	0	1.388589346	3.005404413	3.705200853	3.545365677	0	0	0	0	0.116348167	0.002530072	0	0	0	0	0	0	3.363172028	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0923	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.7581	2.207575492	0	0	1.388589346	3.005404413	3.705200853	3.545365677	0	0	0	0	0.116348167	0.002530072	0	0	0	0	0	0	3.363172028	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0923
H4514_007_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1473.694409	84.75745249	464.7581291	802.9235377	136.8795298	10.12684938	12.38551784	398.0614982	304.2998518	18.47663958	49.90431772	0	0.128317071	533.5619556	6129.515374	124.9230761	505.8212118	440.3951011	0	0	19.23455218	1281.708178	0	0	161.9409388	0	17.55014426	6	51.9203961	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 1-32 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$100 (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$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, 18a); $0/$25 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												159.3767773	111.9031178	66.99436877	0	200	0.2	0.118053806	49.63543981	100	0.128722945	0.162370144	0	0.2	39.7415606	10.42255582	0.068948534	38.5	25	0	0	0.2	24.9215714	0	0	25	0	0	0	0	0											NO	115.6646168	81.21152562	48.61986871	0	145.1461357	0.145146136	0.085675269	36.03989798	72.57306786	0.09341819	0.117836995	0	0.145146136	28.84166974	9.930907411	0.065704091	36.68389423	23.82071054	0	0	0.145146136	18.08634892	0	0	25	0	0	0	0	0												14.2045	0.573606835	1.883039935	0	1.655627901	1.469873054	1.061132573	1.195507982	1.84033115	1.726054225	5.880574825	0	0.018624727	1.282401476	5.072637472	8.207957179	1.546290986	0.874210352	0	0	2.791820921	1.931785111	0	0	0.337376956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5534	0	14.95314235	14.2045	0.573606835	1.883039935	0	1.655627901	1.469873054	1.061132573	1.195507982	1.84033115	1.726054225	5.880574825	0	0.018624727	1.282401476	5.072637472	8.207957179	1.546290986	0.874210352	0	0	2.791820921	1.931785111	0	0	0.337376956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5534	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.2045	0.573606835	1.883039935	0	1.655627901	1.469873054	1.061132573	1.195507982	1.84033115	1.726054225	5.880574825	0	0.018624727	1.282401476	5.072637472	8.207957179	1.546290986	0.874210352	0	0	2.791820921	1.931785111	0	0	0.337376956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5534
H4514_801_0	2011	1																															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	254.3669163	4.5876	13.799346	831.2345112	5.900844414	10.33463671	12.63964957	21.22866648	39.59509804	18.80338929	50.78684947	0	0.130586292	23.85434521	40.36425492	135.9266305	2.1992	5.985663071	0	0	20.83780842	8.510587294	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.071699715	0.071699715	0.183593527	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.05821183	0.05821183	0.14905659	0	0.189168901	0.189168901	0.189168901	0.189168901	0.189168901	0.189168901	0.189168901	0	0.189168901	0.189168901	0.189168901	0.189168901	0.189168901	0.189168901	0	0	0.189168901	0.189168901	0	0	0	0	0	0	0	0												14.8072	0.26705259	2.056883465	0	1.11625625	1.954991863	2.391028612	4.015803496	7.490161162	3.557016477	9.607292474	0	0.024702865	4.512500256	7.635661722	25.71309124	0.416020246	1.132301302	0	0	3.941865307	1.609938441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2497	0	21.37458718	14.8072	0.26705259	2.056883465	0	1.11625625	1.954991863	2.391028612	4.015803496	7.490161162	3.557016477	9.607292474	0	0.024702865	4.512500256	7.635661722	25.71309124	0.416020246	1.132301302	0	0	3.941865307	1.609938441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2497	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.8072	0.26705259	2.056883465	0	1.11625625	1.954991863	2.391028612	4.015803496	7.490161162	3.557016477	9.607292474	0	0.024702865	4.512500256	7.635661722	25.71309124	0.416020246	1.132301302	0	0	3.941865307	1.609938441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2497
H4514_803_0	2011	1																															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	254.3669163	4.588	13.799346	831.2345112	5.900844414	10.33463671	12.63964957	21.22866648	39.59509804	18.80338929	50.78684947	0	0.130586292	23.85314521	40.36425492	135.9266305	2.1984	5.985663071	0	0	20.83780842	8.510587294	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.071699715	0.071699715	0.183593527	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.058211891	0.058211891	0.149056748	0	0.189169101	0.189169101	0.189169101	0.189169101	0.189169101	0.189169101	0.189169101	0	0.189169101	0.189169101	0.189169101	0.189169101	0.189169101	0.189169101	0	0	0.189169101	0.189169101	0	0	0	0	0	0	0	0												14.8072	0.267076157	2.056885642	0	1.116257431	1.954993932	2.391031143	4.015807747	7.490169089	3.557020242	9.607302643	0	0.024702891	4.512278029	7.635669804	25.71311846	0.415869351	1.1323025	0	0	3.94186948	1.609940145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2495	0	21.37440727	14.8072	0.267076157	2.056885642	0	1.116257431	1.954993932	2.391031143	4.015807747	7.490169089	3.557020242	9.607302643	0	0.024702891	4.512278029	7.635669804	25.71311846	0.415869351	1.1323025	0	0	3.94186948	1.609940145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2495	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.8072	0.267076157	2.056885642	0	1.116257431	1.954993932	2.391031143	4.015807747	7.490169089	3.557020242	9.607302643	0	0.024702891	4.512278029	7.635669804	25.71311846	0.415869351	1.1323025	0	0	3.94186948	1.609940145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2495
H4514_806_0	2011	1																															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	254.3669163	4.588	13.799346	831.2345112	5.900844414	10.33463671	12.63964957	21.22866648	39.59509804	18.80338929	50.78684947	0	0.130586292	23.85314521	40.36425492	135.9266305	2.1984	5.985663071	0	0	20.83780842	8.510587294	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.071699715	0.071699715	0.183593527	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.058211891	0.058211891	0.149056748	0	0.189169101	0.189169101	0.189169101	0.189169101	0.189169101	0.189169101	0.189169101	0	0.189169101	0.189169101	0.189169101	0.189169101	0.189169101	0.189169101	0	0	0.189169101	0.189169101	0	0	0	0	0	0	0	0												14.8072	0.267076157	2.056885642	0	1.116257431	1.954993932	2.391031143	4.015807747	7.490169089	3.557020242	9.607302643	0	0.024702891	4.512278029	7.635669804	25.71311846	0.415869351	1.1323025	0	0	3.94186948	1.609940145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2495	0	21.37440727	14.8072	0.267076157	2.056885642	0	1.116257431	1.954993932	2.391031143	4.015807747	7.490169089	3.557020242	9.607302643	0	0.024702891	4.512278029	7.635669804	25.71311846	0.415869351	1.1323025	0	0	3.94186948	1.609940145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2495	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.8072	0.267076157	2.056885642	0	1.116257431	1.954993932	2.391031143	4.015807747	7.490169089	3.557020242	9.607302643	0	0.024702891	4.512278029	7.635669804	25.71311846	0.415869351	1.1323025	0	0	3.94186948	1.609940145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2495
H4520_001_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin			V				O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0	0									0	YES	1536.025839	71.14559683	480.2163167	1169.551066	45.32744751	10.55027503	5.017570497	262.3622298	359.6219863	1457.045318	1384.574256	38.73875553	0.115091633	671.7042069	3662.70334	4446.165709	72.63066617	652.4983651		1649.590193	32.5837946	0			3.1				4.14	1.48	634.5215563	0.313540067									5000	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $100(Days 21-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $50 Rad therapy,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$40/Visit:7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										161.6895	138.428775	33.0247	0	100	0.2	0.2	50	123.03433	22.774939	83.064682	100	0.2	83.103005	15	38.608212	40	57.07754		0	0.2	0			0				0	0	0	0									NO	141.413475	121.069668	24.838042	0	87.4353	0.174871	0.174871	43.71765	107.575436	19.913337	72.627854	87.4353	0.174871	72.661361	13.115295	33.757206	34.97412	49.905919		0	0.174871	0			0				0	0	0	0										18.1012	0.717797816	0.99396942	0	0.330268248	1.844937144	0.87742757	0.955821678	3.223874331	2.417886203	8.379888077	0.282261226	0.020126189	4.067245155	4.003119567	12.50751098	0.211682803	2.713627546	0	0	5.697960746	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.3466	0	9.856622828	18.1012	0.717797816	0.99396942	0	0.330268248	1.844937144	0.87742757	0.955821678	3.223874331	2.417886203	8.379888077	0.282261226	0.020126189	4.067245155	4.003119567	12.50751098	0.211682803	2.713627546	0	0	5.697960746	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.3466	YES	$240/Day(Days 1-15)	$240/Day(Days 1-15)	30% Coins(Days 1-20) 30%(Days 20-100)	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		30% Coins	20%-30% Coins	0% Coins			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins	$0/Proc									7500	3.7099	0.1611	0.5066	2.8771	1.5531	2.1451	1.0202	0.2809	4.6866	0.5059	2.2605	0.3283	0.006	0.6496	2.0104	4.1814	0.0523	0.3439		0.4069	1.685	0			0				0	0	0.2041	0									29.575	500	5.598885735	21.8111	0.878892427	1.500594303	2.877132034	1.883334691	3.990024508	1.897602664	1.236740022	7.910506294	2.923763713	10.64043383	0.610586736	0.026162877	4.716800299	6.013503592	16.68893819	0.263965492	3.05752041	0	0.406946571	7.383006745	0	0	0	0	0	0	0	0	0	0.204108737	0	0	0	0	0	0	0	0	0	96.9217
H4520_002_0	2011	7	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin							O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0									0	YES	1230.693337	97.89192258	452.9407517	1125.092191	38.94151846	12.34225913	3.704336537	296.5514485	371.5153072	1484.32784	1380.206784	72.24353114	0.301059867	749.8877716	4295.283068	3676.342928	122.0021671	755.2174684		1750.704057	27.20972197	0							4.14	1.48	853.4736253	0.819510433									3400	$100/Day(Days 1-5):1a.IP Acute	$100/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"$30-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $30 Partial Hospitalization,7h. $100 Psych -- OP,8b. $50 Rad therapy,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										61.9112	49.8411	46.371	0	100	0.2	0.2	50	129.030586	33.28181	82.637615	100	0.2	78.76232	10	28.52496	30	44.108194		0	0.2	0							0	0	0	0									NO	53.219982	42.844307	30.728856	0	84.1714	0.168343	0.168343	42.0857	108.606851	28.013766	69.557238	84.1714	0.168343	66.295347	8.41714	24.009859	25.25142	37.126484		0	0.168343	0							0	0	0	0										5.4581	0.349509299	1.159862595	0	0.273146844	2.077732929	0.623599126	1.040047941	3.362425634	3.465134398	8.00028098	0.506736596	0.050681321	4.142839169	3.012833244	7.355706279	0.25672733	2.336547438	0	0	4.580566226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0525	0	9.264958897	5.4581	0.349509299	1.159862595	0	0.273146844	2.077732929	0.623599126	1.040047941	3.362425634	3.465134398	8.00028098	0.506736596	0.050681321	4.142839169	3.012833244	7.355706279	0.25672733	2.336547438	0	0	4.580566226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0525	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		30% Coins	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins	$0/Proc									5000	1.0883	0.0697	0.4089	2.8997	1.0017	1.884	0.5654	0.2384	3.5013	0.3389	1.7113	0.413	0.0119	1.2493	1.7306	2.6387	0.05	0.2864		0.3124	1.0673	0							0	0	0.2109	0									21.6782	0	6.937639915	6.5465	0.419201122	1.568785324	2.899743112	1.274849912	3.961699392	1.189042253	1.278431442	6.863722985	3.804070185	9.71161975	0.919714349	0.062536501	5.392183514	4.743429352	9.994390519	0.306684606	2.622991595	0	0.312380999	5.647856172	0	0	0	0	0	0	0	0	0	0.210904438	0	0	0	0	0	0	0	0	0	69.7307
H4520_003_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin							O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0									0	YES	1166.252241	74.296814	402.36222	869.561348	37.836666	12.084749	2.904509	324.530166	349.642414	6320.52912	1019.094214	92.762157	0.001119	786.878294	3350.289856	4775.761504	115.976366	781.509682		1458.298061	25.233959	0							4.14	1.48	544.495644	0									5000	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $100(Days 21-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $50 Rad therapy,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$40/Visit:7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										161.6895	138.428775	33.0247	0	100	0.2	0.2	50	118.713185	4.586124	92.094764	100	0.2	77.824206	15	37.487643	40	59.132969		0	0.2	0							0	0	0	0									NO	146.033591	125.025132	26.677022	0	89.1649	0.17833	0.17833	44.58245	105.850493	4.089213	82.116204	89.1649	0.17833	69.391875	13.374735	33.425819	35.66596	52.725853		0	0.17833	0							0	0	0	0										14.1927	0.774080748	0.894485483	0	0.281141878	2.155073289	0.51796109	1.205695825	3.084151825	2.153832487	6.973679031	0.689260704	0.000199551	4.550246685	3.73410325	13.30281163	0.344700703	3.433813718	0	0	4.499971908	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7879	0	7.51979741	14.1927	0.774080748	0.894485483	0	0.281141878	2.155073289	0.51796109	1.205695825	3.084151825	2.153832487	6.973679031	0.689260704	0.000199551	4.550246685	3.73410325	13.30281163	0.344700703	3.433813718	0	0	4.499971908	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7879	YES	$240/Day(Days 1-15)	$240/Day(Days 1-15)	30% Coins(Days 1-20) 30%(Days 20-100)	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		30% Coins	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins	$0/Proc									7500	2.973	0.1776	0.5582	2.6878	1.3229	2.5074	0.6026	0.3546	5.288	0.5423	1.8021	0.3622	0.0001	0.815	1.8692	4.3034	0.0772	0.4411		0.4715	1.31	0							0	0	0.1656	0									28.6317	500	4.837475308	17.1656	0.951639563	1.452723102	2.687816249	1.604085735	4.662443671	1.120595167	1.560291685	8.372106531	2.696178957	8.775772242	1.051465604	0.000259551	5.365235008	5.6033265	17.60617324	0.421944287	3.874896342	0	0.471497841	5.809929004	0	0	0	0	0	0	0	0	0	0.165589129	0	0	0	0	0	0	0	0	0	91.4196
H4520_005_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin							O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0									0	YES	1837.104	122.132104	361.609707	721.450808	51.025844	10.507318	4.284985	300.369178	307.142807	3699.140505	1053.677708	130.031635	0.603609	688.801583	3501.119382	4215.13947	114.024425	705.118002		1355.820357	28.486323	0							4.14	1.48	771.76408	0									3400	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $50 Rad therapy,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$40/Visit:7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										161.6895	138.428775	46.371	0	100	0.2	0.2	50	130.077544	10.498869	86.643841	100	0.2	73.455766	15	38.920474	40	60.656936		0	0.2	0							0	0	0	0									NO	113.452025	97.130765	24.794574	0	77.7612	0.155522	0.155522	38.8806	101.149859	8.164046	67.37529	77.7612	0.155522	57.120085	11.66418	30.265027	31.10448	47.167562		0	0.155522	0							0	0	0	0										17.3686	0.988565391	0.74716322	0	0.330652572	1.63411911	0.666409437	0.973211155	2.588954302	2.51666277	5.915986762	0.842617998	0.093874479	3.278700414	3.403140556	10.63094249	0.295555871	2.77155809	0	0	4.430249926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.477	0	20.00138645	17.3686	0.988565391	0.74716322	0	0.330652572	1.63411911	0.666409437	0.973211155	2.588954302	2.51666277	5.915986762	0.842617998	0.093874479	3.278700414	3.403140556	10.63094249	0.295555871	2.77155809	0	0	4.430249926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.477	YES	$240/Day(Days 1-7)	$240/Day(Days 1-7)	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		30% Coins	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins	$0/Proc									5000	2.8225	0.1606	0.3247	3.2286	1.5203	1.8577	0.7576	0.2797	3.9249	0.4691	2.0747	0.8195	0.0275	1.5565	1.7696	3.5147	0.0494	0.3561		0.3257	1.2705	0							0	0	0.1946	0									27.3044	500	10.3361858	20.1911	1.149211443	1.071850907	3.228629059	1.850948899	3.491847809	1.424008782	1.252879576	6.513842467	2.985749388	7.99066708	1.662116408	0.121405614	4.835151561	5.172739053	14.14560709	0.344911068	3.127662207	0	0.325701882	5.700757239	0	0	0	0	0	0	0	0	0	0.194622359	0	0	0	0	0	0	0	0	0	86.7814
H4520_006_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin		V					O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0					0	0	0	0									0	YES	1420.486601	67.156809	360.433012	1017.236413	35.194852	10.179268	2.189241	311.431928	349.035839	1773.787319	1318.790965	50.158103	1.148218	835.840386	3909.019927	4361.036064	155.581959	656.218755		1609.205763	32.418152	0		3.06					4.14	1.48	765.998209	0.725077									3400	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $50 Rad therapy,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$40/Visit:7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										161.6895	138.428775	46.371	0	100	0.2	0.2	50	127.737846	17.160368	81.452858	100	0.2	85.312483	15	37.993829	40	56.278491		0	0.2	0		0					0	0	0	0									NO	121.151032	103.722189	26.640974	0	79.2744	0.158549	0.158549	39.6372	101.263411	13.603778	64.571265	79.2744	0.158549	67.630959	11.89116	30.11938	31.70976	44.614436		0	0.158549	0		0					0	0	0	0										14.3411	0.580470936	0.800190542	0	0.232504231	1.613912762	0.347101971	1.028690801	2.945379968	2.010850742	7.096333407	0.33135446	0.182048816	4.710723906	3.873565116	10.9459752	0.411122215	2.439735804	0	0	5.139865581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.0309	0	16.90834135	14.3411	0.580470936	0.800190542	0	0.232504231	1.613912762	0.347101971	1.028690801	2.945379968	2.010850742	7.096333407	0.33135446	0.182048816	4.710723906	3.873565116	10.9459752	0.411122215	2.439735804	0	0	5.139865581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.0309	YES	$240/Day(Days 1-7)	$240/Day(Days 1-7)	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		30% Coins	20%-30% Coins	0% Coins		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins	$0/Proc									5000	2.4485	0.0991	0.334	3.4271	1.0973	1.8832	0.405	0.3034	4.4802	0.3907	1.946	0.3503	0.0548	0.7186	2.0904	3.4689	0.0681	0.3374		0.3958	1.5533	0		0					0	0	0.2218	0									26.074	500	8.288756953	16.7897	0.679577975	1.134196293	3.427062861	1.329783517	3.497158252	0.752128524	1.332115685	7.425578816	2.401585449	9.042291688	0.681687638	0.23685022	5.429286917	5.964013754	14.41492141	0.479179788	2.777098459	0	0.395847996	6.693181855	0	0	0	0	0	0	0	0	0	0.2217523	0	0	0	0	0	0	0	0	0	85.105
H4520_018_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin			V				O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0	0									0	YES	1733.573269	44.43994841	308.322327	1079.007968	54.67512558	14.30386896	3.16549061	383.5768442	434.7703109	1057.190191	1243.231257	135.1641693	0.242855937	840.3820324	4589.401303	4372.339315	140.0625138	573.1322208		1552.352877	18.42900942	0			3.1				4.14	1.48	1721.77363	1.01750453									3400	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $50 Rad therapy,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$40/Visit:7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										161.6895	138.428775	46.371	0	100	0.2	0.2	50	134.722872	43.99213	84.663531	100	0.2	83.753144	15	38.262635	40	54.859262		0	0.2	0			0				0	0	0	0									NO	113.980749	97.583427	25.364195	0	77.176	0.154352	0.154352	38.588	103.973724	33.951366	65.339926	77.176	0.154352	64.637326	11.5764	29.529572	30.8704	42.338184		0	0.154352	0			0				0	0	0	0										16.4662	0.361383538	0.651695635	0	0.351633958	2.207830782	0.488599807	1.233455272	3.767057359	2.991087592	6.769386526	0.869285827	0.0374853	4.526670616	4.427395437	10.75944238	0.360315486	2.022114785	0	0	2.844554462	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1356	0	20.4941222	16.4662	0.361383538	0.651695635	0	0.351633958	2.207830782	0.488599807	1.233455272	3.767057359	2.991087592	6.769386526	0.869285827	0.0374853	4.526670616	4.427395437	10.75944238	0.360315486	2.022114785	0	0	2.844554462	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1356	YES	$240/Day(Days 1-7)	$240/Day(Days 1-7)	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		30% Coins	20%-30% Coins	0% Coins			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins	$0/Proc									5000	2.677	0.0588	0.2924	3.2963	1.5944	2.4752	0.5478	0.3495	5.5318	0.4163	2.1345	0.5184	0.0108	1.4876	2.1591	3.738	0.0497	0.2948		0.3372	0.7866	0			0				0	0	0.4426	0									29.1987	500	11.240904	19.1432	0.420136779	0.944130597	3.296331326	1.945991594	4.682982591	1.036358489	1.582996464	9.298826948	3.407366661	8.903909577	1.387714579	0.048326392	6.01424848	6.586513312	14.49740467	0.409970627	2.316940026	0	0.337199675	3.631138074	0	0	0	0	0	0	0	0	0	0.442552743	0	0	0	0	0	0	0	0	0	90.3343
H4520_020_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin			V				O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0	0									0	YES	1152.165693	61.719817	351.2448	658.397602	32.897833	9.964974	2.757655	288.390197	318.31208	1545.421228	931.398218	72.809595	0.4565	791.164146	3297.752194	3257.245886	90.347862	587.255952		1507.707448	19.935199	0			3.1				4.14	1.48	781.590211	1.230012									3400	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $50 Rad therapy,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$40/Visit:7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										161.6895	138.428775	46.371	0	100	0.2	0.2	50	130.607959	34.804903	83.64784	100	0.2	84.250733	15	37.631611	40	58.759745		0	0.2	0			0				0	0	0	0									NO	131.978408	112.991934	29.963178	0	83.2365	0.166473	0.166473	41.61825	108.713494	28.970383	69.625534	83.2365	0.166473	70.127361	12.485475	31.323236	33.2946	48.909555		0	0.166473	0			0				0	0	0	0										12.6717	0.581153457	0.877034205	0	0.228191706	1.658899117	0.459075101	1.000191276	2.883734867	3.730953739	5.404091525	0.505034655	0.075994925	4.62352114	3.431166881	8.502290133	0.250674661	2.393535607	0	0	3.318672383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.596	0	11.21067335	12.6717	0.581153457	0.877034205	0	0.228191706	1.658899117	0.459075101	1.000191276	2.883734867	3.730953739	5.404091525	0.505034655	0.075994925	4.62352114	3.431166881	8.502290133	0.250674661	2.393535607	0	0	3.318672383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.596	YES	$240/Day(Days 1-7)	$240/Day(Days 1-7)	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		30% Coins	20%-30% Coins	0% Coins			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins	$0/Proc									5000	2.2532	0.1033	0.374	2.6687	1.1135	2.0015	0.5539	0.305	4.3047	0.5058	1.8172	0.3971	0.0237	1.1999	1.7807	2.8553	0.0454	0.3138		0.3715	1.0112	0			0				0	0	0.2541	0									24.2536	500	5.941133882	14.9249	0.684489127	1.251059332	2.668743091	1.341695609	3.660387285	1.012956147	1.305229998	7.188453308	4.236731903	7.221313862	0.902137188	0.099648321	5.823371976	5.211869131	11.35758375	0.296111152	2.707370756	0	0.371470997	4.329895957	0	0	0	0	0	0	0	0	0	0.254096772	0	0	0	0	0	0	0	0	0	76.8495
H4520_021_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin			V				O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0	0									0	YES	1228.489899	65.808392	374.512703	702.012573	35.077121	11.620504	3.215799	307.494352	339.398385	1647.7963	993.097874	77.632803	0.532341	843.574119	3516.208894	3473.019281	96.332877	626.158207		1607.584204	23.24713	0			3.1				4.14	1.48	833.365968	1.311493									3400	$225/Day(Days 1-8):1a.IP Acute	$225/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $50 Rad therapy,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$40/Visit:7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										169.692975	148.407975	46.371	0	100	0.2	0.2	50	130.607959	34.804903	83.64784	100	0.2	84.250733	15	37.631611	40	58.759745		0	0.2	0			0				0	0	0	0									NO	132.815637	116.156251	27.982534	0	81.2498	0.1625	0.1625	40.6249	106.118705	28.278914	67.963702	81.2498	0.1625	68.453552	12.18747	30.575608	32.49992	47.742175		0	0.1625	0			0				0	0	0	0										13.5969	0.637004675	0.87331787	0	0.237500755	1.8883319	0.522567338	1.040993942	3.001376425	3.883157488	5.624550664	0.525637476	0.086505413	4.812137068	3.571140867	8.849139676	0.2609009	2.491179558	0	0	3.777658625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.68	0	13.88911699	13.5969	0.637004675	0.87331787	0	0.237500755	1.8883319	0.522567338	1.040993942	3.001376425	3.883157488	5.624550664	0.525637476	0.086505413	4.812137068	3.571140867	8.849139676	0.2609009	2.491179558	0	0	3.777658625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.68	YES	$240/Day(Days 1-15)	$240/Day(Days 1-15)	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		30% Coins	20%-30% Coins	0% Coins			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins	$0/Proc									5000	2.5707	0.1291	0.3555	2.8864	1.1012	2.1648	0.5991	0.3017	4.6559	0.547	1.9655	0.4295	0.0256	1.2977	1.926	3.0882	0.0491	0.3394		0.4018	1.0937	0			0				0	0	0.2748	0									26.2026	500	8.43717303	16.1676	0.766106377	1.228863835	2.886436872	1.338672122	4.05308447	1.12162969	1.342654229	7.65723782	4.430192568	7.590007283	0.955132578	0.112088276	6.10986101	5.497098417	11.9373444	0.310043199	2.83061496	0	0.401772689	4.871369305	0	0	0	0	0	0	0	0	0	0.274823703	0	0	0	0	0	0	0	0	0	81.8826
H4522_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1241.782097	81.49293644	283.6195952	1127.680501	99.25334748	11.73924322	11.37150303	380.1311755	28.25167988	13.59632669	34.78242143	0	0.009142419	11.88666087	5414.96737	88.66695017	475.7800498	660.1651566	0	0	14.0815994	1234.001196	842.9993377	0	360.3682751	0	17.29252611	11.16519332	525.9661801	0											2900	"$120 Days 1-25 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$120 Days 1-20 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-39 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												114.5276485	97.56020984	54.09766054	0	200	0.2	0.103330276	49.91424535	0.2	0.15347862	0.166755687	0	0.2	0.160456925	10.96288041	0.110596606	38.5	30	0	0	0.2	29.91994856	0	0	30	0	30	0	0	0											NO	84.49712992	71.97875651	39.91260722	0	147.557609	0.147557609	0.076235842	36.84563289	0.147557609	0.113234691	0.123030352	0	0.147557609	0.118383201	10.46677642	0.105592755	36.75775681	28.6424079	0	0	0.147557609	22.07458036	0	0	30	0	30	0	0	0												8.7439	0.488813352	0.943333125	0	1.220465554	1.732214661	0.866916111	1.167181145	4.168750335	1.539575856	4.279293556	0	0.001349033	1.407180968	4.723104397	9.362587528	1.457383947	1.575726641	0	0	2.077847139	2.27000488	0	0	0.900920688	0	0.043231315	0	0	0	0	0	0	0	0	0	0	0	0	0	48.9698	0	11.79484759	8.7439	0.488813352	0.943333125	0	1.220465554	1.732214661	0.866916111	1.167181145	4.168750335	1.539575856	4.279293556	0	0.001349033	1.407180968	4.723104397	9.362587528	1.457383947	1.575726641	0	0	2.077847139	2.27000488	0	0	0.900920688	0	0.043231315	0	0	0	0	0	0	0	0	0	0	0	0	0	48.9698	YES	"$275 Days 1-18 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-18 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-28 (2a); $0 n/c (2a1, 2a2)"	40% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	40% (9b)	40% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 40% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											4900	0.3961	0.022	0.3075	0.6206	0.1508	0.3211	0.3111	0.1443	1.0305	0.1903	1.0013	0	0.0002	0.3454	1.3832	1.8512	0.2461	0.3139	0	0	0.4657	0.4524	0	0	0.1795	0	0.0086	0	0	0											9.7418	0	2.226054548	9.14	0.510838223	1.250867687	0.620604674	1.371309611	2.053355582	1.177997062	1.311439489	5.199227946	1.729860513	5.280605135	0	0.001515768	1.752591386	6.10628402	11.21378414	1.703435782	1.889664516	0	0	2.543571498	2.722379457	0	0	1.080414465	0	0.051844451	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7116
H4522_007_0	2011	4																															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	YES	268.2950433	21.195243	12.45255378	2356.271396	7.572116314	23.39401793	19.63582607	22.54229235	44.70653255	19.23717915	53.65029523	0	0.046567798	27.04532358	33.46456505	107.8124535	9.72384	7.248244733	0	0	22.91326619	8.171651957	0	932.3625324	243.7172132	202.342364	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (16b, 17a, 18a); $0 (17b)"	$0 n/c (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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.071050135	0.071912383	0.19224409	0	0.233	0.233	0.233	0.117221235	0.233	0.233	0.233	0	0.233	0.233	0.228437016	0.232951408	0.238418381	0.233	0	0	0.233	0.232705548	0	0	0	0	0	0	0	0											NO	0.058773513	0.059486775	0.159026588	0	0.19274036	0.19274036	0.19274036	0.096982263	0.19274036	0.19274036	0.19274036	0	0.19274036	0.19274036	0.188658207	0.192386486	0.19690147	0.192426617	0	0	0.19274036	0.192612213	0	0	0	0	0	0	0	0												15.7686	1.260836657	1.980287138	0	1.459452422	4.50897143	3.784616179	2.186202518	8.616753162	3.707780829	10.3405772	0	0.008975494	5.212725394	6.313364834	20.74165911	1.914638391	1.394755213	0	0	4.416311166	1.573959969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1905	0	19.94169757	15.7686	1.260836657	1.980287138	0	1.459452422	4.50897143	3.784616179	2.186202518	8.616753162	3.707780829	10.3405772	0	0.008975494	5.212725394	6.313364834	20.74165911	1.914638391	1.394755213	0	0	4.416311166	1.573959969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1905	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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, 16b1, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5)"	30% (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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	6.111	0.4886	1.2622	0.8478	0.2096	0.6477	0.5202	0.2161	1.2378	0	1.1846	0	0.0009	0.6175	1.6832	5.7396	0.5177	0.3859	0	0	1.2218	0.4355	0	0	0.0737	0	0	0	0	0											23.4014	0	4.888455326	21.8796	1.749460022	3.242510092	0.847754122	1.669099629	5.156675496	4.304843991	2.402298716	9.854531255	3.707780829	11.52516764	0	0.009883823	5.830213737	7.996582152	26.48123022	2.432294887	1.780621391	0	0	5.638106282	2.009492935	0	0	0.073741211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.5919
H4523_001_0	2011	3																															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	1486.260548	120.508735	736.0207397	653.04192	192.1790039	14.49772169	0	396.2893678	384.5893402	2632.662641	2603.825286	75.49509335	0.339410044	286.6982808	3871.102369	5039.79272	312.4000399	739.3601428	0	0	293.3398036	0	0	0	979.1722754	103.9786381	63.76577928	4.153962276	43.12996907	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	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $35 Urgent Care Ctr	$100 per procedure	$5 per visit	$5 X-ray; $150 Complex Radiology	$20 per visit	$25 per visit	$20 per visit	"$5 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$20 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$50 per script	0	Not Covered	0	$0 per visit	$100.00 Every 2 Years	$0 per visit	$750.00 Every 3 Yrs	Fitness Only	0											0	61.28387407	61.28387407	52.43074037	0	150	0.05	0.05	48.5	100	0.75	6.125	20	25	20	5	20	20	15	20	20	$50 	0	0	0	0	0	0	0	0	0											NO	56.36389277	56.36389277	48.2215048	0	137.9577261	0.045985909	0.045985909	44.60633145	91.97181743	0.689788631	5.633273817	18.39436349	22.99295436	18.39436349	4.598590871	18.39436349	18.39436349	13.79577261	18.39436349	18.39436349	45.98590871	0	0	0	0	0	0	0	0	0												6.981	0.566028451	2.95766897	0	2.209381533	0.666690906	0	1.473084574	2.947615048	0.15133173	1.222338401	0.115723682	0.000650337	0.439469366	1.483468001	7.725314932	0.478866657	0.850003701	0	0	1.124124786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3927	0	2.740257214	6.981	0.566028451	2.95766897	0	2.209381533	0.666690906	0	1.473084574	2.947615048	0.15133173	1.222338401	0.115723682	0.000650337	0.439469366	1.483468001	7.725314932	0.478866657	0.850003701	0	0	1.124124786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3927	NO																																																																																		0			6.981	0.566028451	2.95766897	0	2.209381533	0.666690906	0	1.473084574	2.947615048	0.15133173	1.222338401	0.115723682	0.000650337	0.439469366	1.483468001	7.725314932	0.478866657	0.850003701	0	0	1.124124786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3927
H4523_005_0	2011	3																															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	1390.875725	91.059546	797.8473665	841.8531269	206.2087698	12.3358983	0	417.1810313	403.7475368	2969.660817	2558.790497	49.55597525	0.558419333	275.9500206	3666.841673	5228.455488	305.7374775	813.1721236	0	0	282.5982885	0	0	0	969.0268252	100.729694	45.27047987	7.753398977	50.77219943	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	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $35 Urgent Care Ctr	$100 per procedure	$10 per visit	$10 X-ray; $150 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	"$10 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$25 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$50 per script	0	Not Covered	0	$0 per visit	$150.00 Every 2 Years	$0 per visit	$1000.00 Every 3 Yrs	Fitness Only	0											0	61.28387407	61.28387407	52.43074037	0	150	0.05	0.05	48.5	100	1.5	8.5	25	25	25	10	25	25	18.75	25	25	$50 	0	0	0	0	0	0	0	0	0											NO	56.06315405	56.06315405	47.96421112	0	137.2216302	0.045740543	0.045740543	44.36832711	91.48108683	1.372216302	7.77589238	22.87027171	22.87027171	22.87027171	9.148108683	22.87027171	22.87027171	17.15270378	22.87027171	22.87027171	45.74054341	0	0	0	0	0	0	0	0	0												6.4981	0.42542378	3.18900996	0	2.358025297	0.564250692	0	1.542468705	3.077938623	0.339584749	1.658073294	0.094446552	0.001064267	0.525920996	2.795388846	9.964683134	0.582691598	1.162341713	0	0	1.077183274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8566	0	3.339039872	6.4981	0.42542378	3.18900996	0	2.358025297	0.564250692	0	1.542468705	3.077938623	0.339584749	1.658073294	0.094446552	0.001064267	0.525920996	2.795388846	9.964683134	0.582691598	1.162341713	0	0	1.077183274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8566	NO																																																																																		0			6.4981	0.42542378	3.18900996	0	2.358025297	0.564250692	0	1.542468705	3.077938623	0.339584749	1.658073294	0.094446552	0.001064267	0.525920996	2.795388846	9.964683134	0.582691598	1.162341713	0	0	1.077183274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8566
H4523_015_0	2011	3																															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	1571.347555	77.94817543	861.311113	716.0838021	179.5551409	16.69756306	0	298.0053525	386.7852296	3041.841433	2631.984461	44.66861761	1.697572153	286.3907729	3657.148873	5755.496834	245.5426526	646.0066149	0	0	264.1539526	0	0	0	1118.453641	102.8012671	51.19012715	9.413858811	102.427102	0											3400	$125/day 1-5	$125/day 1-5	"$0/d 1-20, $130/d 21-100"	$0 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $35 Urgent Care Ctr	$125 per procedure	$10 per visit	$10 X-ray; $150 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	"$10 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$30 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$50 per script	0	Not Covered	0	$0 per visit	$100.00 Every 2 Years	$0 per visit	$750.00 Every 3 Yrs	Fitness Only	0											0	76.60484259	76.60484259	52.43074037	0	150	0.05	0.05	48.5	125	1.5	8.5	30	25	30	10	30	30	22.5	30	30	$50 	0	0	0	0	0	0	0	0	0											NO	66.84030873	66.84030873	45.74758924	0	130.8800589	0.043626686	0.043626686	42.31788571	109.0667157	1.308800589	7.41653667	26.17601178	21.81334315	26.17601178	8.725337259	26.17601178	26.17601178	19.63200883	26.17601178	26.17601178	43.6266863	0	0	0	0	0	0	0	0	0												8.7524	0.434173343	3.283575584	0	1.958348951	0.728459346	0	1.050913037	3.515449557	0.331763655	1.626684106	0.097437188	0.00308581	0.62471402	2.659154777	12.55466274	0.535610614	1.056867298	0	0	0.960346802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1737	0	5.868874553	8.7524	0.434173343	3.283575584	0	1.958348951	0.728459346	0	1.050913037	3.515449557	0.331763655	1.626684106	0.097437188	0.00308581	0.62471402	2.659154777	12.55466274	0.535610614	1.056867298	0	0	0.960346802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1737	NO																																																																																		0			8.7524	0.434173343	3.283575584	0	1.958348951	0.728459346	0	1.050913037	3.515449557	0.331763655	1.626684106	0.097437188	0.00308581	0.62471402	2.659154777	12.55466274	0.535610614	1.056867298	0	0	0.960346802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1737
H4523_801_0	2011	1																															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	YES	325.2157839	5.980677326	37.42468471	7.462700045	8.713273471	13.4904202	0	15.75932884	42.66206776	18.9718178	62.26959198	0.988079196	0.08473102	28.4413796	34.26500162	144.4164028	3.52196893	10.47355137	0	0	74.0749247	0.001030106																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.075691997	0.075691997	0.185460874	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.060953189	0.060953189	0.14934778	0	0.187630049	0.187630049	0.187630049	0.187630049	0.187630049	0.187630049	0.187630049	0.187630049	0.187630049	0.187630049	0.187630049	0.187630049	0.187630049	0.187630049	0.187630049	0.187630049	0.187630049	0.187630049	0	0	0	0	0	0	0	0												19.8229	0.364541358	5.589293592	0	1.634871927	2.5312082	0	2.956923641	8.004685856	3.559683099	11.68364658	0.185393348	0.015898085	5.336457442	6.429143926	27.0968567	0.660827202	1.965152955	0	0	13.89868174	0.000193279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.7364	0	27.01845978	19.8229	0.364541358	5.589293592	0	1.634871927	2.5312082	0	2.956923641	8.004685856	3.559683099	11.68364658	0.185393348	0.015898085	5.336457442	6.429143926	27.0968567	0.660827202	1.965152955	0	0	13.89868174	0.000193279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.7364	NO																																																																																		0			19.8229	0.364541358	5.589293592	0	1.634871927	2.5312082	0	2.956923641	8.004685856	3.559683099	11.68364658	0.185393348	0.015898085	5.336457442	6.429143926	27.0968567	0.660827202	1.965152955	0	0	13.89868174	0.000193279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.7364
H4523_802_0	2011	2																															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	YES	256.9577039	4.633167368	22.51609004	6.731794974	5.950594798	12.88765398	0	19.93015565	38.84576946	19.66768758	61.39487064	0.858774541	0.027826416	25.89717908	41.67734058	129.3235197	2.404289887	10.03262831	0	0	73.6388602	0.004361593																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.074192152	0.074192152	0.186685912	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.060285869	0.060285869	0.151694245	0	0.189327404	0.189327404	0.189327404	0.189327404	0.189327404	0.189327404	0.189327404	0.189327404	0.189327404	0.189327404	0.189327404	0.189327404	0.189327404	0.189327404	0.189327404	0.189327404	0.189327404	0.189327404	0	0	0	0	0	0	0	0												15.4909	0.279314523	3.415561285	0	1.126610667	2.439986075	0	3.773324636	7.354568698	3.723632239	11.62373149	0.162589555	0.005268303	4.903045693	7.890662709	24.48448629	0.455197964	1.899451475	0	0	13.94185425	0.000825769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.971	0	23.75259719	15.4909	0.279314523	3.415561285	0	1.126610667	2.439986075	0	3.773324636	7.354568698	3.723632239	11.62373149	0.162589555	0.005268303	4.903045693	7.890662709	24.48448629	0.455197964	1.899451475	0	0	13.94185425	0.000825769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.971	NO																																																																																		0			15.4909	0.279314523	3.415561285	0	1.126610667	2.439986075	0	3.773324636	7.354568698	3.723632239	11.62373149	0.162589555	0.005268303	4.903045693	7.890662709	24.48448629	0.455197964	1.899451475	0	0	13.94185425	0.000825769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.971
H4524_001_0	2011	4																															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	1035.205846	192.129584	833.0290864	904.42056	190.020608	12.73462557	0	249.9885056	311.4101766	3122.572549	2256.766879	28.71306567	0.760614904	252.1234798	2652.360016	4435.051592	358.3373566	882.189593	0	0	263.80145	0	0	0	926.8501799	0	53.30504408	6.600104171	45.86221911	0											6700	$200/day 1-7	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100"	$0 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $35 Urgent Care Ctr	$200 per procedure	$20 per visit	$40 X-ray; $150 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$20 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$300.00 Every 3 Yrs	Fitness Only	0											0	144.5710156	144.5710156	71.93854446	0	150	0.05	0.05	48.5	200	3	22.75	40	25	40	20	40	40	30	40	40	$50 	0	0	0	0	0	0	0	0	0											NO	124.7424313	124.7424313	62.07183994	0	129.4268054	0.043142268	0.043142268	41.8480004	172.5690738	2.588536107	19.62973214	34.51381476	21.57113423	34.51381476	17.25690738	34.51381476	34.51381476	25.88536107	34.51381476	34.51381476	43.14226845	0	0	0	0	0	0	0	0	0												10.7612	1.997225953	4.308970677	0	2.049480021	0.549400635	0	0.871793257	4.478313813	0.673574316	3.691644113	0.082583119	0.001367277	0.725145257	3.814294262	12.75587909	1.030632429	1.902983012	0	0	0.948416081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6429	0	8.05	10.7612	1.997225953	4.308970677	0	2.049480021	0.549400635	0	0.871793257	4.478313813	0.673574316	3.691644113	0.082583119	0.001367277	0.725145257	3.814294262	12.75587909	1.030632429	1.902983012	0	0	0.948416081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6429	YES	$200/day 1-10	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$150 copay	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$50 Emer Rm; $35 Urgent Care Ctr	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$25 copay	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP		0	0	$750 ded; 25% coinsurance; $10000 max OOP	Not Covered	$750 ded; 25% coinsurance; $10000 max OOP	$300.00 Every 3 Yrs	0	0	0	0	0	0	0	0	0	0	0	0	10000	2.8229	0.5179	1.3591	0.6514	0.423	0.6128	0	0.3794	1.4894	0.9673	2.3583	0.0272	0.0005	0.9929	1.3871	4.807	0.2125	0.4145	0	0	3.0361	0	0	0	0.3054	0	0.0209	0	0	0	0	0	0	0	0	0	0	0	0	0	22.7854	750	3.586485676	13.5841	2.515076566	5.668065749	0.651419621	2.47250444	1.162159791	0	1.251145805	5.96767483	1.640866176	6.049902192	0.109761716	0.001901574	1.718052605	5.201408831	17.56292461	1.243179677	2.317437004	0	0	3.984530469	0	0	0	0.305358293	0	0.020853894	0	0	0	0	0	0	0	0	0	0	0	0	0	73.4283
H4524_007_0	2011	4																															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	1312.362859	142.6232257	709.1565721	649.1020089	158.9044749	14.40931844	0	255.496718	321.6012077	3173.370219	2322.882528	40.75507578	0.975479197	503.4362464	2874.647678	4729.15007	387.3855733	808.1333067	0	0	248.0106889	0	0	0	954.9126809	77.63067258	38.10040232	9.109328753	57.03295188	0											6700	$225/day 1-7	$225/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100"	$0 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $35 Urgent Care Ctr	$225 per procedure	$20 per visit	$40 X-ray; $200 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$20 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	$75.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness Only	0											0	162.6423925	162.6423925	71.93854446	0	150	0.05	0.05	48.5	225	3	24	40	25	40	20	40	40	30	40	40	$50 	0	0	0	0	0	0	0	0	0											NO	139.7624609	139.7624609	61.81849549	0	128.8985535	0.042966185	0.042966185	41.67719897	193.3478303	2.57797107	20.62376856	34.37294761	21.48309225	34.37294761	17.1864738	34.37294761	34.37294761	25.7797107	34.37294761	34.37294761	42.96618451	0	0	0	0	0	0	0	0	0												15.2849	1.661114418	3.653249363	0	1.706879747	0.619113435	0	0.887365629	5.18174131	0.681738052	3.992215972	0.11673934	0.001746359	1.442048977	4.117088084	13.54623563	1.109632001	1.736120238	0	0	0.888006085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.626	0	9.27	15.2849	1.661114418	3.653249363	0	1.706879747	0.619113435	0	0.887365629	5.18174131	0.681738052	3.992215972	0.11673934	0.001746359	1.442048977	4.117088084	13.54623563	1.109632001	1.736120238	0	0	0.888006085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.626	YES	$225/day 1-10	$750 ded; 20% coinsurance; $10000 max OOP	$750 ded; 20% coinsurance; $10000 max OOP	$750 ded; 20% coinsurance; $10000 max OOP	$150 copay	$750 ded; 20% coinsurance; $10000 max OOP	$750 ded; 20% coinsurance; $10000 max OOP	$50 Emer Rm; $35 Urgent Care Ctr	$750 ded; 20% coinsurance; $10000 max OOP	$750 ded; 20% coinsurance; $10000 max OOP	$750 ded; 20% coinsurance; $10000 max OOP	$750 ded; 20% coinsurance; $10000 max OOP	$25 copay	$750 ded; 20% coinsurance; $10000 max OOP	$750 ded; 20% coinsurance; $10000 max OOP	$750 ded; 20% coinsurance; $10000 max OOP	$750 ded; 20% coinsurance; $10000 max OOP	$750 ded; 20% coinsurance; $10000 max OOP	$750 ded; 20% coinsurance; $10000 max OOP	$750 ded; 20% coinsurance; $10000 max OOP	$750 ded; 20% coinsurance; $10000 max OOP		0	0	$750 ded; 20% coinsurance; $10000 max OOP	$75.00 Every 2 Years	$750 ded; 20% coinsurance; $10000 max OOP	$300.00 Every 3 Yrs	0	0	0	0	0	0	0	0	0	0	0	0	10000	4.1414	0.4205	1.2788	0.3441	0.3817	0.6057	0	0.3026	1.5648	0.9113	2.2697	0.0248	0.0007	1.0432	1.3183	4.7225	0.2087	0.3455	0	0	2.9841	0	0	0	0.2779	0	0.0133	0	0	0	0	0	0	0	0	0	0	0	0	0	23.1595	750	2.441823168	19.4263	2.081625775	4.932004449	0.344054022	2.088571291	1.224800231	0	1.189997663	6.746536695	1.592991531	6.261925899	0.141561349	0.002465928	2.485245915	5.435426031	18.26876724	1.318296633	2.081606967	0	0	3.872101035	0	0	0	0.277850331	0	0.013268208	0	0	0	0	0	0	0	0	0	0	0	0	0	79.7854
H4524_013_0	2011	4																															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	1300.190188	45.56234428	598.4452315	1021.383818	162.4349221	14.59669453	0	267.1282823	325.4448002	3514.877104	2362.476366	32.18878477	1.046704279	493.9292552	2769.862434	4968.668089	275.2192761	773.1156634	0	0	230.0960049	0	0	0	1047.229774	106.9635382	52.25991376	7.407862114	61.77447235	0											6700	$225/day 1-7	$225/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100"	$0 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $35 Urgent Care Ctr	$225 per procedure	$10 per visit	$35 X-ray; $150 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	"$10 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$35 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$50 per script	0	Not Covered	0	$0 per visit	$75.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness Only	0											0	162.6423925	162.6423925	71.93854446	0	150	0.05	0.05	48.5	225	1.5	20.375	35	25	35	10	35	35	26.25	35	35	$50 	0	0	0	0	0	0	0	0	0											NO	141.0493142	141.0493142	62.38768503	0	130.0853781	0.043361793	0.043361793	42.06093892	195.1280671	1.300853781	17.66993052	30.35325489	21.68089635	30.35325489	8.672358539	30.35325489	30.35325489	22.76494117	30.35325489	30.35325489	43.3617927	0	0	0	0	0	0	0	0	0												15.2826	0.535544784	3.111301051	0	1.760867355	0.632938842	0	0.93630553	5.291951234	0.381028431	3.47873277	0.081419532	0.001891124	1.249363382	2.001770011	12.56793741	0.69615007	1.466661049	0	0	0.831447939	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3079	0	7.701577156	15.2826	0.535544784	3.111301051	0	1.760867355	0.632938842	0	0.93630553	5.291951234	0.381028431	3.47873277	0.081419532	0.001891124	1.249363382	2.001770011	12.56793741	0.69615007	1.466661049	0	0	0.831447939	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3079	YES	$225/day 1-10	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$150 copay	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$50 Emer Rm; $35 Urgent Care Ctr	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$25 copay	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP	$750 ded; 25% coinsurance; $10000 max OOP		0	0	$750 ded; 25% coinsurance; $10000 max OOP	$75.00 Every 2 Years	$750 ded; 25% coinsurance; $10000 max OOP	$300.00 Every 3 Yrs	0	0	0	0	0	0	0	0	0	0	0	0	10000	3.9887	0.1612	1.1614	0.5473	0.3632	0.6733	0	0.3132	1.7283	1.144	2.5142	0.0267	0.0007	1.1522	1.4409	6.0569	0.1766	0.3609	0	0	3.089	0	0	0	0.3636	0	0.0206	0	0	0	0	0	0	0	0	0	0	0	0	0	25.283	750	4.169090746	19.2712	0.696776912	4.272687119	0.54725349	2.124080704	1.306213617	0	1.249535197	7.020269653	1.52506976	5.99297385	0.108115247	0.002621195	2.401575656	3.442661663	18.62482301	0.872705632	1.827604529	0	0	3.920481022	0	0	0	0.363620105	0	0.020568199	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5909
H4524_801_0	2011	2																															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	YES	280.2866045	5.721987168	35.80590525	7.112351585	8.336386712	10.78019148	0	13.3632934	36.88120814	16.52293128	53.38923517	0.945340498	0.081066037	24.58747211	25.10616062	120.1421478	3.248755492	7.65259887	0	0	63.82634536	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.075268938	0.075268938	0.189052622	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.05728095	0.05728095	0.143872279	0	0.177316985	0.177316985	0.177316985	0.177316985	0.177316985	0.177316985	0.177316985	0.177316985	0.177316985	0.177316985	0.177316985	0.177316985	0.177316985	0.177316985	0.177316985	0.177316985	0.177316985	0.177316985	0	0	0	0	0	0	0	0												16.0551	0.327760859	5.151477179	0	1.478182961	1.911511055	0	2.3695389	6.539664644	2.929796363	9.466818231	0.167624927	0.014374385	4.359776432	4.451748715	21.30324347	0.57605953	1.356935762	0	0	11.31749515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7771	0	28.1927819	16.0551	0.327760859	5.151477179	0	1.478182961	1.911511055	0	2.3695389	6.539664644	2.929796363	9.466818231	0.167624927	0.014374385	4.359776432	4.451748715	21.30324347	0.57605953	1.356935762	0	0	11.31749515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7771	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	4.0135	0.0819	1.2878	0	0.3695	0.4778	0	0.5923	1.6348	0.7324	2.3665	0.0419	0.0036	1.0899	1.1129	5.3255	0.144	0.3392	0	0	2.8292	0	0	0	0	0	0	0	0	0											22.4428	0	3.453035546	20.0686	0.409695661	6.439261404	0	1.84770429	2.389357252	0	2.961884495	8.174472812	3.662197073	11.83336646	0.209528391	0.017967744	5.449648544	5.564612379	26.62870254	0.7200649	1.696147294	0	0	14.14668204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.2199
H4524_802_0	2011	2																															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	YES	284.4983496	5.654967395	33.16544734	6.119081196	7.425293052	12.52921668	0	16.2687702	41.72646339	19.31864118	56.00824526	0.706608729	0.060594008	27.81764186	28.51671393	128.5847546	2.878012574	9.390782045	0	0	52.09689795	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.074905565	0.074905565	0.190266244	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.057138472	0.057138472	0.145136379	0	0.177733978	0.177733978	0.177733978	0.177733978	0.177733978	0.177733978	0.177733978	0.177733978	0.177733978	0.177733978	0.177733978	0.177733978	0.177733978	0.177733978	0.177733978	0.177733978	0.177733978	0.177733978	0	0	0	0	0	0	0	0												16.2558	0.323116199	4.813512931	0	1.319726869	2.226867517	0	2.891513238	7.416210308	3.433578939	9.954568207	0.12558838	0.010769614	4.944140134	5.068388993	22.85387989	0.511520622	1.669061045	0	0	9.259388891	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.0776	0	28.94230255	16.2558	0.323116199	4.813512931	0	1.319726869	2.226867517	0	2.891513238	7.416210308	3.433578939	9.954568207	0.12558838	0.010769614	4.944140134	5.068388993	22.85387989	0.511520622	1.669061045	0	0	9.259388891	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.0776	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	4.0588	0.0807	1.2019	0	0.3295	0.556	0	0.722	1.8517	0.8573	2.4855	0.0314	0.0027	1.2345	1.2655	5.7063	0.1277	0.4167	0	0	2.3119	0	0	0	0	0	0	0	0	0											23.24	0	3.5448364	20.3146	0.403793254	6.015371738	0	1.649242003	2.782881466	0	3.613478816	9.267921895	4.290889835	12.44006801	0.156945832	0.013458618	6.178614507	6.333886362	28.56013584	0.639239312	2.085799453	0	0	11.57131331	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.3177
H4524_805_0	2011	2																															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	YES	261.6842299	5.342223931	33.42949893	6.640311088	7.783108084	10.06471969	0	12.47638341	34.43343491	15.42631891	49.84583876	0.882599083	0.075685756	22.95562329	23.4398869	112.1684195	3.033138458	7.144702638	0	0	59.59024716	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0	0	0	0	0	0	0	0												0	0	0	0	1.243320021	1.607798241	0	1.993051762	5.500601887	2.464292021	7.962671032	0.140991632	0.012090493	3.667067927	3.744427079	17.91845111	0.484531595	1.141337334	0	0	9.519300842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3999	0	26.32165186	0	0	0	0	1.243320021	1.607798241	0	1.993051762	5.500601887	2.464292021	7.962671032	0.140991632	0.012090493	3.667067927	3.744427079	17.91845111	0.484531595	1.141337334	0	0	9.519300842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3999	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	0	0	0	0	0.3282	0.4245	0	0.5262	1.4522	0.6506	2.1022	0.0372	0.0032	0.9681	0.9886	4.7306	0.1279	0.3013	0	0	2.5132	0	0	0	0	0	0	0	0	0											15.154	0	3.223860625	0	0	0	0	1.571566599	2.032270028	0	2.519233605	6.952805435	3.114885118	10.06488082	0.178214567	0.015282482	4.635203626	4.732986222	22.64906765	0.612451869	1.442659655	0	0	12.03247354	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.554
H4524_806_0	2011	2																															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	YES	261.6877718	5.342296237	33.42995139	6.640400964	7.783213428	10.06485591	0	12.47655228	34.43390097	15.42652771	49.84651342	0.882611029	0.07568678	22.95593399	23.44020416	112.1699377	3.033179511	7.144799341	0	0	59.59105371	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0.159745953	0	0	0	0	0	0	0	0												0	0	0	0	1.243336849	1.607820003	0	1.993078738	5.500676337	2.464325375	7.962778807	0.14099354	0.012090657	3.66711756	3.744477759	17.91869364	0.484538153	1.141352782	0	0	9.519429685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4007	0	26.32187326	0	0	0	0	1.243336849	1.607820003	0	1.993078738	5.500676337	2.464325375	7.962778807	0.14099354	0.012090657	3.66711756	3.744477759	17.91869364	0.484538153	1.141352782	0	0	9.519429685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4007	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	0	0	0	0	0.3283	0.4245	0	0.5262	1.4522	0.6506	2.1022	0.0372	0.0032	0.9681	0.9886	4.7307	0.1279	0.3013	0	0	2.5132	0	0	0	0	0	0	0	0	0											15.1543	0	3.223887742	0	0	0	0	1.57158787	2.032297535	0	2.519267703	6.952899541	3.114927278	10.06501705	0.178216979	0.015282688	4.635266363	4.733050283	22.64937421	0.612460158	1.442679181	0	0	12.03263639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.555
H4525_001_0	2011	6																															COIN	COIN	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	153.6413885	4.367503258	1384.378853	2581.840782	430.1286368	2682.103598	20.33468603	205.4126759	165.6283739	943.5693185	506.7019772	0	0	661.8377697	2250.851898	4569.505767	545.4353614	1930.672237	4143.943127	26859.29524	17796.46601	1007.490227	0	0	0	0	0	0	0	0											3400	"$100 Copay per Day for Days 1-10, $0 Copay for Days After Day 10"	"$100 Copay per Day for Days 1-10, $0 Copay for Days After Day 10"	"$25 Copay per Day for Days 1-20, $110 Copay per Day for Days 21-100; No Prior Hospital Stay Required"	No Cost Sharing for Home Health	$100 Copay for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics; 20% Coinsurance for Diabetes Monitoring Supplies	$50 Copay for Emergency Care/Post Stabilization Care; ER Copay waived if admitted in the first day; $25 Urgently Needed Services; Worldwide Coverage	$100 Copay for Outpatient Hospital Services and ASC Services	$0 Copay for OP Diagnostic Procedures and Tests and Lab  Services	$10 Copay per X-rays; $75 Copay per Visit for MRI/CT/PET/Nuclear/Stress/Ultrsnd; 20% Coinsurance for Radiation/Chemo	No Cost Sharing for Observation (Partial Hospitalization is covered in h5)	No Cost Sharing for Renal Dialysis	$20 Copay for Outpatient Rehabilitation Service; $20 Copay for CORF Visits; $25 Partial Hospitalization; $0 Copay for Cardiac Rehabilitation Services; $0 Copay for Blood	$10 Copay for Primary Care Physician Services	$35 Copay for Physician Specialist Services (Excluding MH and Radiology)	$25 Copay for Individual Mental Health Specialty and Psychiatric Services; $15 Copay for Group Mental Health Specialty and Psychiatric Services	$20 Copay for PT/OT/ST with Medicare FFS Yearly Benefit Maximum	No Cost Sharing for Renal Dialysis	"$25 Copay for Chiropractic Services; $20 Copay for Podiatry Services; $0 Copay for Other Health Care Professional Services; $0 Copay for Immunizations, (Routine) Physical Exams, Pap Smears and Pelvic Exams, Screening, Prostate Cancer Screening, Colorectal Screening, Bone Mass Measurement, Mammography Screening, Diabetes Monitoring, Nutritional Training (diabetes and renal, disease)"	20% Coinsurance for Medicare Part  B Drugs	$10 Copay for Medicare Covered Hearing Exams; $30 Copay for Medicare Covered Hearing Exams; $0 Copay for Medicare Covered Dental Services	Non-Covered	Non-Covered	Non-Covered	Non-Covered	Non-Covered	Non-Covered	Non-Covered	Non-Covered												0.06023033	0.145565232	73.09825127	0	100	20.98922783	6.658409786	49.79326549	100	0	49.85176662	0	0	8.218721025	10	35	24.12	20	0	0.807821887	2.615299954	28.71988256	0	0	0	0	0	0	0	0											NO	0.058488911	0.141356552	70.98478574	0	97.10873312	20.38237324	6.465897389	48.35360929	97.10873312	0	48.410419	0	0	7.981095866	9.710873312	33.98805659	23.42262643	19.42174662	0	0.7844656	2.539684653	27.88951411	0	0	0	0	0	0	0	0												8.9863	0.617375202	8.189153022	0	3.480770583	4.555636383	0.010956833	0.82770369	1.34033013	0	2.044137919	0	0	0.440182557	1.821478136	12.94238505	1.064627392	3.12475225	0	1.75584943	3.766450967	2.341534408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3096		1.706308618	8.9863	0.617375202	8.189153022	0	3.480770583	4.555636383	0.010956833	0.82770369	1.34033013	0	2.044137919	0	0	0.440182557	1.821478136	12.94238505	1.064627392	3.12475225	0	1.75584943	3.766450967	2.341534408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3096	NO																																																																																		0			8.9863	0.617375202	8.189153022	0	3.480770583	4.555636383	0.010956833	0.82770369	1.34033013	0	2.044137919	0	0	0.440182557	1.821478136	12.94238505	1.064627392	3.12475225	0	1.75584943	3.766450967	2.341534408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3096
H4525_002_0	2011	8																															COIN	COIN	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	234.9431606	5.427597089	1721.795766	5022.472307	454.8646744	3316.228732	33.58763869	384.022683	354.5050909	1538.130704	907.472923	0	0	697.8500831	3140.452601	5383.052876	578.123989	1964.558112	4511.793984	29039.04995	17784.38819	1211.533305	0	0	0	0	0	0	0	0											3400	"$100 Copay per Day for Days 1-10, $0 Copay for Days After Day 10"	"$100 Copay per Day for Days 1-10, $0 Copay for Days After Day 10"	"$25 Copay per Day for Days 1-20, $110 Copay per Day for Days 21-100; No Prior Hospital Stay Required"	No Cost Sharing for Home Health	$100 Copay for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics; 20% Coinsurance for Diabetes Monitoring Supplies	$50 Copay for Emergency Care/Post Stabilization Care; ER Copay waived if admitted in the first day; $25 Urgently Needed Services; Worldwide Coverage	$100 Copay for Outpatient Hospital Services and ASC Services	$0 Copay for OP Diagnostic Procedures and Tests and Lab  Services	$10 Copay per X-rays; $75 Copay per Visit for MRI/CT/PET/Nuclear/Stress/Ultrsnd; 20% Coinsurance for Radiation/Chemo	No Cost Sharing for Observation (Partial Hospitalization is covered in h5)	No Cost Sharing for Renal Dialysis	$20 Copay for Outpatient Rehabilitation Service; $20 Copay for CORF Visits; $25 Partial Hospitalization; $0 Copay for Cardiac Rehabilitation Services; $0 Copay for Blood	$10 Copay for Primary Care Physician Services	$35 Copay for Physician Specialist Services (Excluding MH and Radiology)	$25 Copay for Individual Mental Health Specialty and Psychiatric Services; $15 Copay for Group Mental Health Specialty and Psychiatric Services	$20 Copay for PT/OT/ST with Medicare FFS Yearly Benefit Maximum	No Cost Sharing for Renal Dialysis	"$25 Copay for Chiropractic Services; $20 Copay for Podiatry Services; $0 Copay for Other Health Care Professional Services; $0 Copay for Immunizations, (Routine) Physical Exams, Pap Smears and Pelvic Exams, Screening, Prostate Cancer Screening, Colorectal Screening, Bone Mass Measurement, Mammography Screening, Diabetes Monitoring, Nutritional Training (diabetes and renal, disease)"	20% Coinsurance for Medicare Part  B Drugs	$10 Copay for Medicare Covered Hearing Exams; $30 Copay for Medicare Covered Hearing Exams; $0 Copay for Medicare Covered Dental Services	Non-Covered	Non-Covered	Non-Covered	Non-Covered	Non-Covered	Non-Covered	Non-Covered	Non-Covered												0.041893919	0.113066784	73.0713525	0	100	21.37649408	93.27607749	49.85247093	100	0	49.85176662	0	0	8.739106315	10	35	24.12	20	0	0.801823406	3.116549427	28.81529093	0	0	0	0	0	0	0	0											NO	0.040682654	0.109797722	70.95866469	0	97.10873312	20.75844258	90.57921716	48.41110295	97.10873312	0	48.410419	0	0	8.486435428	9.710873312	33.98805659	23.42262643	19.42174662	0	0.778640552	3.026441666	27.98216396	0	0	0	0	0	0	0	0												9.5581	0.595937795	10.1813607	0	3.680944356	5.73664531	0.253528502	1.549246803	2.868795022	0	3.660928703	0	0	0.493521639	2.541378112	15.24662548	1.128431852	3.179595823	0	1.884248489	4.485284451	2.825110298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8697		2.080265365	9.5581	0.595937795	10.1813607	0	3.680944356	5.73664531	0.253528502	1.549246803	2.868795022	0	3.660928703	0	0	0.493521639	2.541378112	15.24662548	1.128431852	3.179595823	0	1.884248489	4.485284451	2.825110298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8697	NO																																																																																		0			9.5581	0.595937795	10.1813607	0	3.680944356	5.73664531	0.253528502	1.549246803	2.868795022	0	3.660928703	0	0	0.493521639	2.541378112	15.24662548	1.128431852	3.179595823	0	1.884248489	4.485284451	2.825110298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8697
H4525_003_0	2011	4																															COIN	COIN	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	386.1072312	7.727595279	1541.480414	6469.573358	523.6486664	3938.487395	70.58434245	869.0452514	510.539988	2438.878409	1398.266377	0	0	1257.457339	9144.580427	2346.459059	528.957464	1266.393794	4933.091121	24801.56022	11048.44417	1245.048836	0	58.56006246	77.47370501	230.1096166	0	17.38405101	0	0											1			No prior hosp stay required															"Yearly maximum benefit of $1,860"						$200 limit	limit one eye exam annually	$225 limit																																																								NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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
H4525_004_0	2011	3																															COIN	COIN	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	175.7022214	6.31497394	1999.993613	3702.426163	590.428813	3853.205722	23.10307121	274.4603951	317.8190971	1299.390893	554.3891028	0	0	492.9769946	2944.690725	6742.116566	788.6451113	2791.55942	5454.281498	37690.50622	25647.48891	1574.040017	0	0	0	0	0	0	0	0											3400	"$100 Copay per Day for Days 1-10, $0 Copay for Days After Day 10"	"$100 Copay per Day for Days 1-10, $0 Copay for Days After Day 10"	"$25 Copay per Day for Days 1-20, $110 Copay per Day for Days 21-100; No Prior Hospital Stay Required"	No Cost Sharing for Home Health	$100 Copay for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics; 20% Coinsurance for Diabetes Monitoring Supplies	$50 Copay for Emergency Care/Post Stabilization Care; ER Copay waived if admitted in the first day; $25 Urgently Needed Services; Worldwide Coverage	$100 Copay for Outpatient Hospital Services and ASC Services	$0 Copay for OP Diagnostic Procedures and Tests and Lab  Services	$10 Copay per X-rays; $75 Copay per Visit for MRI/CT/PET/Nuclear/Stress/Ultrsnd; 20% Coinsurance for Radiation/Chemo	No Cost Sharing for Observation (Partial Hospitalization is covered in h5)	No Cost Sharing for Renal Dialysis	$20 Copay for Outpatient Rehabilitation Service; $20 Copay for CORF Visits; $25 Partial Hospitalization; $0 Copay for Cardiac Rehabilitation Services; $0 Copay for Blood	$10 Copay for Primary Care Physician Services	$35 Copay for Physician Specialist Services (Excluding MH and Radiology)	$25 Copay for Individual Mental Health Specialty and Psychiatric Services; $15 Copay for Group Mental Health Specialty and Psychiatric Services	$20 Copay for PT/OT/ST with Medicare FFS Yearly Benefit Maximum	No Cost Sharing for Renal Dialysis	"$25 Copay for Chiropractic Services; $20 Copay for Podiatry Services; $0 Copay for Other Health Care Professional Services; $0 Copay for Immunizations, (Routine) Physical Exams, Pap Smears and Pelvic Exams, Screening, Prostate Cancer Screening, Colorectal Screening, Bone Mass Measurement, Mammography Screening, Diabetes Monitoring, Nutritional Training (diabetes and renal, disease)"	20% Coinsurance for Medicare Part  B Drugs	$10 Copay for Medicare Covered Hearing Exams; $30 Copay for Medicare Covered Hearing Exams; $0 Copay for Medicare Covered Dental Services	Non-Covered	Non-Covered	Non-Covered	Non-Covered	Non-Covered	Non-Covered	Non-Covered	Non-Covered												0.058561545	0.145565232	73.09825127	0	100	21.43354085	8.473768584	49.77628306	100	0	49.85	0	0	7.935106228	10	35	24.12	20	0	0.815416955	1.916158681	28.81528684	0	0	0	0	0	0	0	0											NO	0.056868375	0.141356552	70.98478574	0	97.10873312	20.81383998	8.228769319	48.33711788	97.10873312	0	48.40870346	0	0	7.70568113	9.710873312	33.98805659	23.42262643	19.42174662	0	0.791841075	1.86075742	27.98216	0	0	0	0	0	0	0	0												9.9919	0.892662943	11.83075984	0	4.777982835	6.683333943	0.015842487	1.105552039	2.57191749	0	2.23643814	0	0	0.316560294	2.382959881	19.09595328	1.539344985	4.518079979	0	2.487074246	3.976979608	3.670419966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0938		2.325124629	9.9919	0.892662943	11.83075984	0	4.777982835	6.683333943	0.015842487	1.105552039	2.57191749	0	2.23643814	0	0	0.316560294	2.382959881	19.09595328	1.539344985	4.518079979	0	2.487074246	3.976979608	3.670419966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0938	NO																																																																																		0			9.9919	0.892662943	11.83075984	0	4.777982835	6.683333943	0.015842487	1.105552039	2.57191749	0	2.23643814	0	0	0.316560294	2.382959881	19.09595328	1.539344985	4.518079979	0	2.487074246	3.976979608	3.670419966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0938
H4525_005_0	2011	3																															COIN	COIN	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	169.48866	5.897148302	2042.348886	4634.260255	477.6110775	3068.050271	16.89226827	289.6411649	238.7760919	1176.228647	628.6545198	0	0	534.7282897	2263.67492	4905.893076	596.518133	2053.322072	4166.072323	28139.71559	18779.93983	1124.355369	0	0	0	0	0	0	0	0											3400	"$100 Copay per Day for Days 1-10, $0 Copay for Days After Day 10"	"$100 Copay per Day for Days 1-10, $0 Copay for Days After Day 10"	"$25 Copay per Day for Days 1-20, $110 Copay per Day for Days 21-100; No Prior Hospital Stay Required"	No Cost Sharing for Home Health	$100 Copay for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics; 20% Coinsurance for Diabetes Monitoring Supplies	$50 Copay for Emergency Care/Post Stabilization Care; ER Copay waived if admitted in the first day; $25 Urgently Needed Services; Worldwide Coverage	$100 Copay for Outpatient Hospital Services and ASC Services	$0 Copay for OP Diagnostic Procedures and Tests and Lab  Services	$10 Copay per X-rays; $75 Copay per Visit for MRI/CT/PET/Nuclear/Stress/Ultrsnd; 20% Coinsurance for Radiation/Chemo	No Cost Sharing for Observation (Partial Hospitalization is covered in h5)	No Cost Sharing for Renal Dialysis	$20 Copay for Outpatient Rehabilitation Service; $20 Copay for CORF Visits; $25 Partial Hospitalization; $0 Copay for Cardiac Rehabilitation Services; $0 Copay for Blood	$10 Copay for Primary Care Physician Services	$35 Copay for Physician Specialist Services (Excluding MH and Radiology)	$25 Copay for Individual Mental Health Specialty and Psychiatric Services; $15 Copay for Group Mental Health Specialty and Psychiatric Services	$20 Copay for PT/OT/ST with Medicare FFS Yearly Benefit Maximum	No Cost Sharing for Renal Dialysis	"$25 Copay for Chiropractic Services; $20 Copay for Podiatry Services; $0 Copay for Other Health Care Professional Services; $0 Copay for Immunizations, (Routine) Physical Exams, Pap Smears and Pelvic Exams, Screening, Prostate Cancer Screening, Colorectal Screening, Bone Mass Measurement, Mammography Screening, Diabetes Monitoring, Nutritional Training (diabetes and renal, disease)"	20% Coinsurance for Medicare Part  B Drugs	$10 Copay for Medicare Covered Hearing Exams; $30 Copay for Medicare Covered Hearing Exams; $0 Copay for Medicare Covered Dental Services	Non-Covered	Non-Covered	Non-Covered	Non-Covered	Non-Covered	Non-Covered	Non-Covered	Non-Covered												0.04511396	0.113066784	73.0713525	0	100	20.46051917	9.369140807	49.78747568	100	0	49.85176662	0	0	9.244573695	10	35	24.12	20	0	0.803345201	2.194928843	28.71529041	0	0	0	0	0	0	0	0											NO	0.043809595	0.109797722	70.95866469	0	97.10873312	19.86895096	9.098253942	48.34798688	97.10873312	0	48.410419	0	0	8.977288398	9.710873312	33.98805659	23.42262643	19.42174662	0	0.780118347	2.131467592	27.88505472	0	0	0	0	0	0	0	0												7.4252	0.647493448	12.07686248	0	3.865017221	5.079911698	0.012807512	1.166963937	1.932270316	0	2.536119059	0	0	0.400034173	1.83185503	13.89514762	1.164335116	3.323258418	0	1.829359034	3.335736093	2.612725916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.1351		1.879753703	7.4252	0.647493448	12.07686248	0	3.865017221	5.079911698	0.012807512	1.166963937	1.932270316	0	2.536119059	0	0	0.400034173	1.83185503	13.89514762	1.164335116	3.323258418	0	1.829359034	3.335736093	2.612725916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.1351	NO																																																																																		0			7.4252	0.647493448	12.07686248	0	3.865017221	5.079911698	0.012807512	1.166963937	1.932270316	0	2.536119059	0	0	0.400034173	1.83185503	13.89514762	1.164335116	3.323258418	0	1.829359034	3.335736093	2.612725916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.1351
H4525_008_0	2011	5																															COIN	COIN	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	207.196456	6.311557847	1889.292313	3353.220376	662.3544205	3707.028862	29.54145326	330.7383964	249.9144784	1400.744551	936.4510515	0	0	861.0245627	3954.16389	5786.026272	756.7286259	2587.781942	5665.616505	36260.21757	23114.24346	1397.499845	0	251.5936751	71.87180239	78.28029116	1.285376396	0	0	0											3400	No Cost Sharing	No Cost Sharing	No prior hosp stay required ; days 1-100 $0/day	No Cost Sharing	$25 Copay	10% coinsurance	10% coinsurance	$25 Emergency Room Copay	$25 Copay per surgery	No Cost Sharing	"$0 X-ray Copay, $25 Radiology"	No Cost Sharing	No Cost Sharing	PT/OT/ST $20 copay	No Cost Sharing	No Cost Sharing	$25 copay per visit	"Yearly maximum benefit of $1,860"	No Cost Sharing	No Cost Sharing	20% coinsurance	No Cost Sharing	Non-Covered	$200 limit	$25 eye exam copay; limit one per year	$100 limit	$25 hearing exam copay ; limit one per year	Non-Covered	Non-Covered	Non-Covered												0	0	0	0	25	10.75787979	5.000127737	25	25	0	15.32760255	0	0	10.25782951	0	0	25	20	0	0	4.996661769	0	0	0	25	0	25	0	0	0											NO	0	0	0	0	22.94832396	9.87501242	4.589782045	22.94832396	22.94832396	0	14.06971155	0	0	9.415999784	0	0	22.94832396	18.35865917	0	0	4.58660052	0	0	0	22.94832396	0	22.94832396	0	0	0												0	0	0	0	1.266660318	3.050579672	0.011299069	0.632490989	0.477926534	0	1.097966348	0	0	0.675617258	0	0	1.447137805	3.959017223	0	0	8.834650089	0	0	0	0.137444784	0	0.002458103	0	0	0	0	0	0	0	0	0	0	0	0	0	21.5932		1.930526606	0	0	0	0	1.266660318	3.050579672	0.011299069	0.632490989	0.477926534	0	1.097966348	0	0	0.675617258	0	0	1.447137805	3.959017223	0	0	8.834650089	0	0	0	0.137444784	0	0.002458103	0	0	0	0	0	0	0	0	0	0	0	0	0	21.5932	NO																																																																																		0			0	0	0	0	1.266660318	3.050579672	0.011299069	0.632490989	0.477926534	0	1.097966348	0	0	0.675617258	0	0	1.447137805	3.959017223	0	0	8.834650089	0	0	0	0.137444784	0	0.002458103	0	0	0	0	0	0	0	0	0	0	0	0	0	21.5932
H4525_009_0	2011	5																															COIN	COIN	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	246.0234781	7.650482245	1741.850901	5197.259551	494.1038728	3312.777484	43.52284248	438.519353	436.7532494	2004.195879	1040.792274	0	0	920.553192	5179.627724	4448.699554	592.7201911	2019.009913	4687.616428	27951.95991	15277.74129	1313.568174	0	247.7787817	78.23265698	93.66668001	0.811273618	0	0	0											3400	No Cost Sharing	No Cost Sharing	No prior hosp stay required ; days 0-100 $0/day	No Cost Sharing	$25 Copay	10% coinsurance	10% coinsurance	$25 Emergency Room Copay	$25 Copay per surgery	No Cost Sharing	"$0 X-Ray, $25 Radiology"	No Cost Sharing	No Cost Sharing	PT/OT/ST $20 copay	No Cost Sharing	No Cost Sharing	$25 per visit	"Yearly maximum benefit of $1,860"	No Cost Sharing	No Cost Sharing	20% coinsurance	No Cost Sharing	Non-Covered	$200 limit	$25 eye exam copay ; limit one annually	$100 limit	$25 hearing exam copay ; limit one annually	Non-Covered	Non-Covered	Non-Covered												0	0	0	0	25	11.25546694	15.64507164	25	25	0	15.32760255	0	0	12.08889162	0	0	25	20	0	0	4.643473955	0	0	0	25	0	25	0	0	0											NO	0	0	0	0	22.94832396	10.33176406	14.3611269	22.94832396	22.94832396	0	14.06971155	0	0	11.09679205	0	0	22.94832396	18.35865917	0	0	4.262397785	0	0	0	22.94832396	0	22.94832396	0	0	0												0	0	0	0	0.944904645	2.85223628	0.052086422	0.838607015	0.835229588	0	1.220303923	0	0	0.851265612	0	0	1.13349458	3.088859571	0	0	5.426650886	0	0	0	0.14960903	0	0.001551447	0	0	0	0	0	0	0	0	0	0	0	0	0	17.3948		1.555167707	0	0	0	0	0.944904645	2.85223628	0.052086422	0.838607015	0.835229588	0	1.220303923	0	0	0.851265612	0	0	1.13349458	3.088859571	0	0	5.426650886	0	0	0	0.14960903	0	0.001551447	0	0	0	0	0	0	0	0	0	0	0	0	0	17.3948	NO																																																																																		0			0	0	0	0	0.944904645	2.85223628	0.052086422	0.838607015	0.835229588	0	1.220303923	0	0	0.851265612	0	0	1.13349458	3.088859571	0	0	5.426650886	0	0	0	0.14960903	0	0.001551447	0	0	0	0	0	0	0	0	0	0	0	0	0	17.3948
H4525_802_0	2011	3																															COIN	COIN	COIN	COIN	COIN	COIN	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	167.0456607	6.131426305	54.06453631	49.94808622	7.888854968	27.31415987	0.069326862	10.05685242	24.81095644	7.885638144	16.62243211	0	0	18.07708329	9.178064471	23.71566535	2.443328774	3.980521032	25.32208793	106.333653	17.90478683	4.95577894	0	0	0	0	0	0	0	0											3400	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing												0.077901944	0.077901944	0.196643055	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	0.069258099	0.069258099	0.174823931	0	0.207146782	0.207146782	0.207146782	0.207146782	0.207146782	0.207146782	0.207146782	0	0	0.207146782	0.207146782	0.207146782	0.207146782	0.207146782	0.207146782	0.207146782	0.207146782	0.207146782	0	0	0	0	0	0	0	0												11.5693	0.424650929	9.451774779	0	1.634150916	5.658040307	0.014360836	2.083244611	5.139509773	1.633484562	3.443283313	0	0	3.744609622	1.901206516	4.91262375	0.506127692	0.824552121	5.245389016	22.02667398	3.708918965	1.026573657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.9484		10.60209852	11.5693	0.424650929	9.451774779	0	1.634150916	5.658040307	0.014360836	2.083244611	5.139509773	1.633484562	3.443283313	0	0	3.744609622	1.901206516	4.91262375	0.506127692	0.824552121	5.245389016	22.02667398	3.708918965	1.026573657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.9484	NO																																																																																		0			11.5693	0.424650929	9.451774779	0	1.634150916	5.658040307	0.014360836	2.083244611	5.139509773	1.633484562	3.443283313	0	0	3.744609622	1.901206516	4.91262375	0.506127692	0.824552121	5.245389016	22.02667398	3.708918965	1.026573657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.9484
H4527_001_0	2011	8																																A	D		T	Coin		V													Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	0	11.77792694	244.4043319	0	185.9945056	14.84627753	0	406.3647441	0	0	0	0	0	0	0	0	0	0	0	0	17.97916228	0	0	0	0	0	0	0	0	0											3350	No Cost Sharing; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$50/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	5% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $20/Visit for Urgent Care; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"No Cost Sharing; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	No Cost Sharing; PBP 7e	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	5% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	0	900	50	0	50	0.05	0	49.31147982	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	899.9767417	49.99870787	0	49.99870787	0.049998708	0	49.31020549	0	0	0	0	0	0	0	0	0	0	0	0	0.049998708	0	0	0	0	0	0	0	0	0												0	0.883321693	1.018325066	0	0.774957079	0.742294693	0	1.66982742	0	0	0	0	0	0	0	0	0	0	0	0	0.898934883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9877	0	0.00015474	0	0.883321693	1.018325066	0	0.774957079	0.742294693	0	1.66982742	0	0	0	0	0	0	0	0	0	0	0	0	0.898934883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9877	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.883321693	1.018325066	0	0.774957079	0.742294693	0	1.66982742	0	0	0	0	0	0	0	0	0	0	0	0	0.898934883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9877
H4527_002_0	2011	7																															D	A	D		T	Coin	Coin	V	V		Coin			V		V	V	V	Coin		Coin					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	817.8138776	5.785493942	108.4656919	0	128.3802936	14.67072253	1.385715616	444.5811413	296.6063952	0	1.09598372	0	0	174.7727592	0	3706.949841	112.6136269	376.2658623	19.0757234	0	20.50973924	0	0	0	0	114.1239495	0	0	0	0											3350	$200/Days 1-6 for IP Med/Surg; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$100/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$125/Case for OP Surg; $125/Visit for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for CORF; $25/Visit for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$15/Visit for Chiro - cvd; $25/Visit for SCP OV; $25/Visit for Podiatry; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Phys Rad - General; 20% Coinsurance for Phys Rad - PET/CAT/MRI; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	$5/Service for Glasses/Contacts (non-cvd); PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	200	900	100	0	100	0.2	0.2	48.22950208	125	0	0.2	0	0	25	0	24.90520069	25	25	0.2	0	0.2	0	0	0	0	5	0	0	0	0											NO	198.3331607	892.4992232	99.16658035	0	99.16658035	0.198333161	0.198333161	47.82754794	123.9582254	0	0.198333161	0	0	24.79164509	0	24.69763585	24.79164509	24.79164509	0.198333161	0	0.198333161	0	0	0	0	4.958329018	0	0	0	0												13.5166	0.430295737	0.896347646	0	1.060919558	2.90969077	0.274833358	1.771935487	3.0639002	0	0.217369915	0	0	0.361075351	0	7.629408108	0.232656423	0.777354143	3.783348514	0	4.067761408	0	0	0	0	0.047155341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0407	0	0.344915738	13.5166	0.430295737	0.896347646	0	1.060919558	2.90969077	0.274833358	1.771935487	3.0639002	0	0.217369915	0	0	0.361075351	0	7.629408108	0.232656423	0.777354143	3.783348514	0	4.067761408	0	0	0	0	0.047155341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0407	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	13.5166	0.430295737	0.896347646	0	1.060919558	2.90969077	0.274833358	1.771935487	3.0639002	0	0.217369915	0	0	0.361075351	0	7.629408108	0.232656423	0.777354143	3.783348514	0	4.067761408	0	0	0	0	0.047155341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0407
H4527_003_0	2011	6																																A	D		T	Coin		V													Coin					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	0	11.90908643	83.74215878	0	0.21574625	48.8275382	0	9.672765394	0	0	0	0	0	0	0	0	0	0	0	0	0.000374545	0	0	0	0	137.9552471	0	0	0	0											3350	No Cost Sharing; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$50/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	5% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"No Cost Sharing; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	No Cost Sharing; PBP 7e	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	5% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	$10/Service for Glasses/Contacts (non-cvd); PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	0	900	50	0	50	0.05	0	44.88358439	0	0	0	0	0	0	0	0	0	0	0	0	0.05	0	0	0	0	10	0	0	0	0											NO	0	900	50	0	50	0.05	0	44.88358439	0	0	0	0	0	0	0	0	0	0	0	0	0.05	0	0	0	0	10	0	0	0	0												0	0.893181482	0.348925662	0	0.000898943	2.44137691	0	0.036179032	0	0	0	0	0	0	0	0	0	0	0	0	1.87E-05	0	0	0	0	0.114962706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.8355	0	4.44E-16	0	0.893181482	0.348925662	0	0.000898943	2.44137691	0	0.036179032	0	0	0	0	0	0	0	0	0	0	0	0	1.87E-05	0	0	0	0	0.114962706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.8355	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.893181482	0.348925662	0	0.000898943	2.44137691	0	0.036179032	0	0	0	0	0	0	0	0	0	0	0	0	1.87E-05	0	0	0	0	0.114962706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.8355
H4527_004_0	2011	6																																A	D		T	Coin		V													Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	0	14.1633964	38.96290517	0	-5.16E-13	35.22145632	0	6.9790087	0	0	0	0	0	0	0	0	0	0	0	0	0.000464183	0	0	0	0	0	0	0	0	0											3350	No Cost Sharing; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$50/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	5% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $20/Visit for Urgent Care; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"No Cost Sharing; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	No Cost Sharing; PBP 7e	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	5% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	0	900	50	0	50	0.05	0	50	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	900	50	0	50	0.05	0	50	0	0	0	0	0	0	0	0	0	0	0	0	0.05	0	0	0	0	0	0	0	0	0												0	1.06225473	0.162345438	0	-2.15E-15	1.761072816	0	0.029079203	0	0	0	0	0	0	0	0	0	0	0	0	2.32E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0148	0	0	0	1.06225473	0.162345438	0	-2.15E-15	1.761072816	0	0.029079203	0	0	0	0	0	0	0	0	0	0	0	0	2.32E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0148	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	1.06225473	0.162345438	0	-2.15E-15	1.761072816	0	0.029079203	0	0	0	0	0	0	0	0	0	0	0	0	2.32E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0148
H4527_005_0	2011	7																															D	A	D		T	Coin	Coin	V	Coin		Coin			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	YES	771.5001227	5.577849921	44.62405405	0	107.2212605	10.53031369	4.479896006	319.6731401	22.20642956	0	19.23637272	0	0	146.7841706	0	2547.330811	17.68648659	464.873086	8.354292694	0	2.981282318	0	0	0	0	0	0	0	0	0											3350	$150/Days 1-5 for IP Med/Surg; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$75/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Surg; 20% Coinsurance for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for CORF; $25/Visit for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$15/Visit for Chiro - cvd; $25/Visit for SCP OV; $25/Visit for Podiatry; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Phys Rad - General; 20% Coinsurance for Phys Rad - PET/CAT/MRI; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	150	900	75	0	100	0.2	0.2	49.59527732	0.2	0	0.2	0	0	25	0	24.88365642	25	25	0.2	0	0.2	0	0	0	0	0	0	0	0	0											NO	149.2062742	895.2376452	74.6031371	0	99.47084946	0.198941699	0.198941699	49.33284364	0.198941699	0	0.198941699	0	0	24.86771237	0	24.75198441	24.86771237	24.86771237	0.198941699	0	0.198941699	0	0	0	0	0	0	0	0	0												9.5927	0.416125102	0.277424535	0	0.888782489	2.094918495	0.891238122	1.314198753	4.417784823	0	3.826916671	0	0	0.304182211	0	5.254291044	0.036651872	0.963360849	1.662017182	0	0.593101369	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5337	0	0.17306812	9.5927	0.416125102	0.277424535	0	0.888782489	2.094918495	0.891238122	1.314198753	4.417784823	0	3.826916671	0	0	0.304182211	0	5.254291044	0.036651872	0.963360849	1.662017182	0	0.593101369	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5337	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.5927	0.416125102	0.277424535	0	0.888782489	2.094918495	0.891238122	1.314198753	4.417784823	0	3.826916671	0	0	0.304182211	0	5.254291044	0.036651872	0.963360849	1.662017182	0	0.593101369	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5337
H4527_006_0	2011	6																																A	D		T	Coin	Coin	V													Coin					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	0	6.489988587	93.46420873	0	0.029209992	16.32117721	1.284056587	16.39010111	0	0	0	0	0	0	0	0	0	0	0	0	0.05129088	0	0	0	0	219.0056323	0	0	0	0											3350	No Cost Sharing; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$50/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	5% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"No Cost Sharing; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	No Cost Sharing; PBP 7e	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	10% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	$10/Service for Glasses/Contacts (non-cvd); PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	0	900	50	0	100	0.05	0.1	49.65337457	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	900	50	0	100	0.05	0.1	49.65337457	0	0	0	0	0	0	0	0	0	0	0	0	0.1	0	0	0	0	10	0	0	0	0												0	0.486749144	0.389434203	0	0.000243417	0.816058861	0.128405659	0.067818652	0	0	0	0	0	0	0	0	0	0	0	0	0.005129088	0	0	0	0	0.182504694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.0763	0	0	0	0.486749144	0.389434203	0	0.000243417	0.816058861	0.128405659	0.067818652	0	0	0	0	0	0	0	0	0	0	0	0	0.005129088	0	0	0	0	0.182504694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.0763	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.486749144	0.389434203	0	0.000243417	0.816058861	0.128405659	0.067818652	0	0	0	0	0	0	0	0	0	0	0	0	0.005129088	0	0	0	0	0.182504694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.0763
H4527_008_0	2011	7																															A	A	D		T	Coin	Coin	V	V		Coin			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	YES	343.1787592	12.54259589	399.3725058	0	334.7532252	17.62901025	4.005300669	568.9553649	642.8544739	0	0.20261814	0	0	147.6626806	0	3897.909255	67.08542099	1181.333103	16.71312796	0	16.54215942	0	0	0	0	0	0	0	0	0											3350	$150/Admit for IP Med/Surg; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$50/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $20/Visit for Urgent Care; PBP 4a, 4b"	"$50/Case for OP Surg; $50/Visit for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad - General; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for CORF; $25/Visit for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $50/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$15/Visit for Chiro - cvd; $25/Visit for SCP OV; $25/Visit for Podiatry; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Phys Rad - General; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	150	900	50	0	100	0.2	0.2	49.31009742	50	0	0.2	0	0	34.8830107	0	24.87977735	25	25	0.2	0	0.2	0	0	0	0	0	0	0	0	0											NO	148.9997264	893.9983584	49.66657547	0	99.33315093	0.198666302	0.198666302	48.98127349	49.66657547	0	0.198666302	0	0	34.65039367	0	24.71386679	24.83328773	24.83328773	0.198666302	0	0.198666302	0	0	0	0	0	0	0	0	0												4.2611	0.934421678	1.652955392	0	2.77100772	3.502290271	0.795718272	2.322346528	2.660698354	0	0.040253397	0	0	0.426380834	0	8.027700842	0.138829297	2.444698739	3.320335324	0	3.286369636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5851	0	0.245605448	4.2611	0.934421678	1.652955392	0	2.77100772	3.502290271	0.795718272	2.322346528	2.660698354	0	0.040253397	0	0	0.426380834	0	8.027700842	0.138829297	2.444698739	3.320335324	0	3.286369636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5851	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.2611	0.934421678	1.652955392	0	2.77100772	3.502290271	0.795718272	2.322346528	2.660698354	0	0.040253397	0	0	0.426380834	0	8.027700842	0.138829297	2.444698739	3.320335324	0	3.286369636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5851
H4527_012_0	2011	6																															A	A	D		T	Coin	Coin	V	Coin		V			V		V	V	V	P		Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	159.0470382	5.61493844	194.2615055	0	103.9935445	8.17905401	2.078950228	254.8591379	30.06424279	0	82.92132297	0	0	74.47079127	0	1836.653817	22.72632687	448.3559304	2170.001433	0	9.446475127	0	0	0	0	0	0	0	0	0											3350	$300/Admit for IP Med/Surg; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$75/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Surg; 20% Coinsurance for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$11/Case for OP Rad - General; $38/Case for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for CORF; $25/Visit for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$25/Visit for SCP OV; $25/Visit for Podiatry; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	"$11/Procedure for Phys Rad - General; $38/Procedure for Phys Rad - PET/CAT/MRI; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	300	900	75	0	100	0.2	0.2	49.61585371	0.2	0	23.45151503	0	0	25	0	25	25	25	18.15754848	0	0.2	0	0	0	0	0	0	0	0	0											NO	299.0454696	897.1364087	74.76136739	0	99.68182319	0.199363646	0.199363646	49.45798757	0.199363646	0	23.37689775	0	0	24.9204558	0	24.9204558	24.9204558	24.9204558	18.09977537	0	0.199363646	0	0	0	0	0	0	0	0	0												3.9635	0.419780476	1.210271315	0	0.86385551	1.630606031	0.414467098	1.050401673	5.993717067	0	0.161536941	0	0	0.154653839	0	3.814187523	0.047195869	0.931102845	3.273044874	0	1.883283727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.8116	0	0.082388762	3.9635	0.419780476	1.210271315	0	0.86385551	1.630606031	0.414467098	1.050401673	5.993717067	0	0.161536941	0	0	0.154653839	0	3.814187523	0.047195869	0.931102845	3.273044874	0	1.883283727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.8116	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.9635	0.419780476	1.210271315	0	0.86385551	1.630606031	0.414467098	1.050401673	5.993717067	0	0.161536941	0	0	0.154653839	0	3.814187523	0.047195869	0.931102845	3.273044874	0	1.883283727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.8116
H4527_013_0	2011	8																															A	A	D		T	Coin	Coin	V	V		V			V		V	V	V	P		Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	170.9716144	5.398487153	147.661573	0	101.0432381	7.52647369	0.886934962	254.0867594	187.4881611	0	112.4292349	0	0	50.87001139	0	1850.069967	15.76713104	352.8333684	2166.9743	0	12.02872744	0	0	0	0	0	0	0	0	0											3350	$500/Admit for IP Med/Surg; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$75/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$150/Case for OP Surg; $100/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$16/Case for OP Rad - General; $38/Case for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$20/Visit for CORF; $20/Visit for OP - PT/OT/ST; $20/Visit for OP Substance Abuse; $20/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$15/Visit for Chiro - cvd; $20/Visit for SCP OV; $20/Visit for Podiatry; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	$20/Visit for MH - Non Phys; $20/Visit for Psych Services ; PBP 7e	"$20/Visit for OP PT/OT/ST; $20/Visit for PT/ST; PBP 7c, 7i"	"$16/Procedure for Phys Rad - General; $38/Procedure for Phys Rad - PET/CAT/MRI; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	500	900	75	0	100	0.2	0.2	49.36755028	135.4022589	0	22.35800236	0	0	20	0	19.96987731	20	20	22.22187639	0	0.2	0	0	0	0	0	0	0	0	0											NO	498.6224823	897.5204681	74.79337234	0	99.72449645	0.199448993	0.199448993	49.23154093	135.0292209	0	22.29640527	0	0	19.94489929	0	19.91485959	19.94489929	19.94489929	22.16065433	0	0.199448993	0	0	0	0	0	0	0	0	0												7.1042	0.40377106	0.920342251	0	0.83970717	1.501147598	0.176898285	1.042423558	2.10969836	0	0.208897316	0	0	0.084549771	0	3.070323636	0.026206153	0.5864355	4.001797368	0	2.399117574	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.4755	0	0.067617176	7.1042	0.40377106	0.920342251	0	0.83970717	1.501147598	0.176898285	1.042423558	2.10969836	0	0.208897316	0	0	0.084549771	0	3.070323636	0.026206153	0.5864355	4.001797368	0	2.399117574	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.4755	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.1042	0.40377106	0.920342251	0	0.83970717	1.501147598	0.176898285	1.042423558	2.10969836	0	0.208897316	0	0	0.084549771	0	3.070323636	0.026206153	0.5864355	4.001797368	0	2.399117574	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.4755
H4527_014_0	2011	6																															A	A	D		T	Coin		V	V		V			V		V	V	V	P		Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	263.0514206	8.87932369	249.8305699	0	170.4956037	14.44248828	0	382.1489568	432.0578033	0	113.1933228	0	0	82.60267815	0	3627.493657	54.16005189	770.3199603	3762.476358	0	15.4980042	0	0	0	0	0	0	0	0	0											3350	$100/Admit for IP Med/Surg; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$75/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$100/Case for OP Surg; $100/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$10/Case for OP Rad - General; $18/Case for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$10/Visit for CORF; $10/Visit for OP - PT/OT/ST; $10/Visit for OP Substance Abuse; $10/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$10/Visit for Chiro - cvd; $10/Visit for SCP OV; $10/Visit for Podiatry; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	$10/Visit for MH - Non Phys; $10/Visit for Psych Services ; PBP 7e	"$10/Visit for OP PT/OT/ST; $10/Visit for PT/ST; PBP 7c, 7i"	"$10/Procedure for Phys Rad - General; $18/Procedure for Phys Rad - PET/CAT/MRI; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	100	900	75	0	100	0.1	0	49.57485668	100	0	14.27833799	0	0	10	0	10	10	10	12.0994858	0	0.2	0	0	0	0	0	0	0	0	0											NO	99.75878022	897.829022	74.81908516	0	99.75878022	0.09975878	0	49.45527232	99.75878022	0	14.24389581	0	0	9.975878022	0	9.975878022	9.975878022	9.975878022	12.07029944	0	0.19951756	0	0	0	0	0	0	0	0	0												2.1868	0.664342875	1.557674557	0	1.417369454	1.440765014	0	1.57494006	3.59179662	0	0.134359491	0	0	0.06866952	0	3.015619521	0.045024506	0.64038483	3.784518024	0	3.092123989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.2144	0	0.056133119	2.1868	0.664342875	1.557674557	0	1.417369454	1.440765014	0	1.57494006	3.59179662	0	0.134359491	0	0	0.06866952	0	3.015619521	0.045024506	0.64038483	3.784518024	0	3.092123989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.2144	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.1868	0.664342875	1.557674557	0	1.417369454	1.440765014	0	1.57494006	3.59179662	0	0.134359491	0	0	0.06866952	0	3.015619521	0.045024506	0.64038483	3.784518024	0	3.092123989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.2144
H4527_015_0	2011	7																																A	D		T	Coin		V													Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	0	6.206971461	175.8251082	0	0.049423451	30.23708379	0	4.345299532	0	0	0	0	0	0	0	0	0	0	0	0	0.014245936	0	0	0	0	0	0	0	0	0											3350	No Cost Sharing; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$75/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	5% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"No Cost Sharing; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	No Cost Sharing; PBP 7e	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	0	900	75	0	100	0.05	0	47.48810623	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	900	75	0	100	0.05	0	47.48810623	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0												0	0.46552286	1.098906926	0	0.000411862	1.51185419	0	0.017195837	0	0	0	0	0	0	0	0	0	0	0	0	0.002849187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0967	0	0	0	0.46552286	1.098906926	0	0.000411862	1.51185419	0	0.017195837	0	0	0	0	0	0	0	0	0	0	0	0	0.002849187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0967	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.46552286	1.098906926	0	0.000411862	1.51185419	0	0.017195837	0	0	0	0	0	0	0	0	0	0	0	0	0.002849187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0967
H4527_020_0	2011	4																																A	D		T	Coin		V													Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	0	13.56088438	198.9078288	0	158.9828396	11.77692625	0	389.1730049	0	0	0	0	0	0	0	0	0	0	0	0	13.6624066	0	0	0	0	0	0	0	0	0											3350	No Cost Sharing; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$100/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$75/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $20/Visit for Urgent Care; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"No Cost Sharing; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	No Cost Sharing; PBP 7e	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	0	900	100	0	75	0.1	0	48.44559331	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	899.8464812	99.98294236	0	74.98720677	0.099982942	0	48.43732963	0	0	0	0	0	0	0	0	0	0	0	0	0.199965885	0	0	0	0	0	0	0	0	0												0	1.016892841	1.657282498	0	0.993473256	1.177491738	0	1.570875093	0	0	0	0	0	0	0	0	0	0	0	0	2.732015223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.148	0	0.001560705	0	1.016892841	1.657282498	0	0.993473256	1.177491738	0	1.570875093	0	0	0	0	0	0	0	0	0	0	0	0	2.732015223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.148	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	1.016892841	1.657282498	0	0.993473256	1.177491738	0	1.570875093	0	0	0	0	0	0	0	0	0	0	0	0	2.732015223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.148
H4527_022_0	2011	5																															D	A	D		T	Coin	Coin	V	V		Coin			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	YES	968.0862345	7.709491324	128.0090813	0	123.9769765	11.23385667	0.923895441	367.2765012	291.5453607	0	1.699212516	0	0	147.0554578	0	3244.575436	106.1171471	285.4608015	18.15979982	0	16.49856262	0	0	0	0	0	0	0	0	0											3350	$200/Days 1-6 for IP Med/Surg; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$100/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$125/Case for OP Surg; $125/Visit for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for CORF; $25/Visit for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$15/Visit for Chiro - cvd; $25/Visit for SCP OV; $25/Visit for Podiatry; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Phys Rad - General; 20% Coinsurance for Phys Rad - PET/CAT/MRI; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	200	900	100	0	100	0.2	0.2	48.77767472	125	0	0.2	0	0	25	0	24.74860974	25	25	0.2	0	0.2	0	0	0	0	0	0	0	0	0											NO	198.3678467	892.65531	99.18392333	0	99.18392333	0.198367847	0.198367847	48.37961149	123.9799042	0	0.198367847	0	0	24.79598083	0	24.54664211	24.79598083	24.79598083	0.198367847	0	0.198367847	0	0	0	0	0	0	0	0	0												16.0031	0.573493197	1.058036909	0	1.024710244	2.228435957	0.183271149	1.480724537	3.012147157	0	0.337069128	0	0	0.303865359	0	6.636952669	0.219273229	0.589856714	3.602320387	0	3.272784339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.526	0	0.333444718	16.0031	0.573493197	1.058036909	0	1.024710244	2.228435957	0.183271149	1.480724537	3.012147157	0	0.337069128	0	0	0.303865359	0	6.636952669	0.219273229	0.589856714	3.602320387	0	3.272784339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.526	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.0031	0.573493197	1.058036909	0	1.024710244	2.228435957	0.183271149	1.480724537	3.012147157	0	0.337069128	0	0	0.303865359	0	6.636952669	0.219273229	0.589856714	3.602320387	0	3.272784339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.526
H4527_023_0	2011	8																															A	A	D		T	Coin		V													Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	307.1755313	5.979930556	43.10465941	0	167.0625085	19.64757252	0	479.8094599	0	0	0	0	0	0	0	0	0	0	0	0	33.03217775	0	0	0	0	0	0	0	0	0											3350	$100/Admit for IP Med/Surg; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$50/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$75/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"No Cost Sharing; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	No Cost Sharing; PBP 7e	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	10% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	100	900	50	0	75	0.1	0	48.76562389	0	0	0	0	0	0	0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0											NO	99.96307222	899.66765	49.98153611	0	74.97230417	0.099963072	0	48.74761582	0	0	0	0	0	0	0	0	0	0	0	0	0.099963072	0	0	0	0	0	0	0	0	0												2.5589	0.448329173	0.179536424	0	1.0437551	1.96403171	0	1.949130602	0	0	0	0	0	0	0	0	0	0	0	0	3.30199797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.4456	0	0.004228179	2.5589	0.448329173	0.179536424	0	1.0437551	1.96403171	0	1.949130602	0	0	0	0	0	0	0	0	0	0	0	0	3.30199797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.4456	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.5589	0.448329173	0.179536424	0	1.0437551	1.96403171	0	1.949130602	0	0	0	0	0	0	0	0	0	0	0	0	3.30199797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.4456
H4527_024_0	2011	5																															D	A	D		T	Coin	Coin	V	V		Coin			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	YES	741.49111	4.837455611	109.0665133	0	90.2617446	6.768027918	1.334676507	208.0908086	253.7143006	0	13.97728199	0	0	73.49890066	0	1671.381026	20.69091875	494.346353	14.68493797	0	5.450534005	0	0	0	0	0	0	0	0	0											3350	$50/Days 1-5 for IP Med/Surg; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$75/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$50/Case for OP Surg; $50/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$10/Visit for CORF; $10/Visit for OP - PT/OT/ST; $10/Visit for OP Substance Abuse; $10/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$10/Visit for SCP OV; $10/Visit for Podiatry; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	$10/Visit for MH - Non Phys; $10/Visit for Psych Services ; PBP 7e	"$10/Visit for OP PT/OT/ST; $10/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Phys Rad - General; 20% Coinsurance for Phys Rad - PET/CAT/MRI; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	50	900	75	0	100	0.2	0.2	49.15697443	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	49.94122716	898.9420889	74.91184075	0	99.88245433	0.199764909	0.199764909	49.09919254	49.94122716	0	0.199764909	0	0	9.988245433	0	9.988245433	9.988245433	9.988245433	0.199764909	0	0.199764909	0	0	0	0	0	0	0	0	0												3.0859	0.362382704	0.680864439	0	0.751297049	1.352014479	0.26662153	0.851424223	1.055900293	0	2.79217046	0	0	0.061177088	0	1.391180325	0.017222165	0.411471059	2.933535293	0	1.088825428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.102	0	0.02012632	3.0859	0.362382704	0.680864439	0	0.751297049	1.352014479	0.26662153	0.851424223	1.055900293	0	2.79217046	0	0	0.061177088	0	1.391180325	0.017222165	0.411471059	2.933535293	0	1.088825428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.102	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.0859	0.362382704	0.680864439	0	0.751297049	1.352014479	0.26662153	0.851424223	1.055900293	0	2.79217046	0	0	0.061177088	0	1.391180325	0.017222165	0.411471059	2.933535293	0	1.088825428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.102
H4527_026_0	2011	6																															A	A	D		T	Coin	Coin	V	V		Coin			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	YES	273.7902741	6.674883416	310.3456307	0	113.0725085	19.28730393	1.02389665	364.0645616	364.7697429	0	0.563543846	0	0	384.342073	0	3863.320143	168.7732839	413.8393868	8.872727597	0	20.08085029	0	0	0	0	0	0	0	0	0											3350	$200/Admit for IP Med/Surg; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$100/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $20/Visit for Urgent Care; PBP 4a, 4b"	"$50/Case for OP Surg; $50/Visit for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad - General; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for CORF; $30/Visit for OP - PT/OT/ST; $30/Visit for OP Substance Abuse; $30/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$15/Visit for Chiro - cvd; $30/Visit for SCP OV; $30/Visit for Podiatry; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	$30/Visit for MH - Non Phys; $30/Visit for Psych Services ; PBP 7e	"$30/Visit for OP PT/OT/ST; $30/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Phys Rad - General; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	200	900	100	0	100	0.2	0.2	47.58124782	50	0	0.2	0	0	29.51930165	0	29.7698131	30	30	0.2	0	0.2	0	0	0	0	0	0	0	0	0											NO	198.8904002	895.0068008	99.44520009	0	99.44520009	0.1988904	0.1988904	47.3172671	49.72260005	0	0.1988904	0	0	29.35552859	0	29.6046502	29.83356003	29.83356003	0.1988904	0	0.1988904	0	0	0	0	0	0	0	0	0												4.5379	0.497838838	2.571865278	0	0.937043186	3.836059597	0.203643214	1.435545009	1.51144167	0	0.112083461	0	0	0.940213726	0	9.531020121	0.419592325	1.028858516	1.764700342	0	3.99388835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.3216	0	0.185899847	4.5379	0.497838838	2.571865278	0	0.937043186	3.836059597	0.203643214	1.435545009	1.51144167	0	0.112083461	0	0	0.940213726	0	9.531020121	0.419592325	1.028858516	1.764700342	0	3.99388835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.3216	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.5379	0.497838838	2.571865278	0	0.937043186	3.836059597	0.203643214	1.435545009	1.51144167	0	0.112083461	0	0	0.940213726	0	9.531020121	0.419592325	1.028858516	1.764700342	0	3.99388835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.3216
H4527_028_0	2011	7																															A	A	D		T	Coin		V						V		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	YES	186.4734387	7.867309995	18.57003046	0	129.0005398	10.23369305	0	302.1170549	0	0	0	0	0	91.22876213	0	2709.991756	37.61533811	801.5324507	0	0	9.469396599	0	0	0	0	0	0	0	0	0											3350	$125/Admit for IP Med/Surg; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$50/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$75/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for OP ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$5/Visit for OP - PT/OT/ST; $20/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$5/Visit for Chiro - cvd; $5/Visit for SCP OV; $5/Visit for Podiatry; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	$5/Visit for MH - Non Phys; $5/Visit for Psych Services ; PBP 7e	"$5/Visit for OP PT/OT/ST; $5/Visit for PT/ST; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	125	900	50	0	75	0.1	0	49.55316723	0	0	0	0	0	11.48651411	0	5	5	5	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	124.978699	899.846633	49.99147961	0	74.98721942	0.099982959	0	49.54472298	0	0	0	0	0	11.48455672	0	4.999147961	4.999147961	4.999147961	0	0	0.199965918	0	0	0	0	0	0	0	0	0												1.9421	0.589947701	0.077361942	0	0.806115982	1.023194915	0	1.247358816	0	0	0	0	0	0.087310158	0	1.128970813	0.015670387	0.333914943	0	0	1.893556588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.1455	0	0.00155873	1.9421	0.589947701	0.077361942	0	0.806115982	1.023194915	0	1.247358816	0	0	0	0	0	0.087310158	0	1.128970813	0.015670387	0.333914943	0	0	1.893556588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.1455	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	1.9421	0.589947701	0.077361942	0	0.806115982	1.023194915	0	1.247358816	0	0	0	0	0	0.087310158	0	1.128970813	0.015670387	0.333914943	0	0	1.893556588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.1455
H4527_030_0	2011	7																															A	A	D		T	Coin	Coin	V	V		V			V		V	V	V	P		Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	266.3058971	11.4346183	29.82191227	0	188.2943514	14.66542281	2.263513767	425.837749	480.8481758	0	70.52413974	0	0	110.2154008	0	3443.617936	51.84377079	1006.881213	4444.158528	0	18.43426722	0	0	0	0	0	0	0	0	0											3350	$75/Admit for IP Med/Surg; PBP 1a	$900/Admit for IP MH/SA; PBP 1b	$50/Days 21-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $20/Visit for Urgent Care; PBP 4a, 4b"	"$50/Case for OP Surg; $50/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$11/Case for OP Rad - General; $38/Case for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for CORF; $25/Visit for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$15/Visit for Chiro - cvd; $25/Visit for SCP OV; $25/Visit for Podiatry; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	"$11/Procedure for Phys Rad - General; $38/Procedure for Phys Rad - PET/CAT/MRI; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	75	900	50	0	100	0.2	0.2	49.27586109	50	0	24.55692082	0	0	25	0	24.88158293	25	25	18.41819011	0	0.2	0	0	0	0	0	0	0	0	0											NO	74.63182837	895.5819405	49.75455225	0	99.5091045	0.199018209	0.199018209	49.03396811	49.75455225	0	24.436372	0	0	24.87727612	0	24.75944036	24.87727612	24.87727612	18.32777605	0	0.199018209	0	0	0	0	0	0	0	0	0												1.6562	0.85338647	0.123647991	0	1.561416858	2.918686182	0.450480456	1.740042884	1.993698807	0	0.143612843	0	0	0.228488247	0	7.105171075	0.10747765	2.08737183	6.787628519	0	3.668754847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4261	0	0.155030378	1.6562	0.85338647	0.123647991	0	1.561416858	2.918686182	0.450480456	1.740042884	1.993698807	0	0.143612843	0	0	0.228488247	0	7.105171075	0.10747765	2.08737183	6.787628519	0	3.668754847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4261	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	1.6562	0.85338647	0.123647991	0	1.561416858	2.918686182	0.450480456	1.740042884	1.993698807	0	0.143612843	0	0	0.228488247	0	7.105171075	0.10747765	2.08737183	6.787628519	0	3.668754847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4261
H4528_001_0	2011	3																															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	940.4734873	7.421473981	287.1766262	15.13052295	161.5854794	11.61286784	6.278887157	281.7010211	177.7848383	11.86042541	10.26034864	0	0.03713879	390.5718404	0	3405.272424	166.4977458	119.0688752	25.96884207	32.94016602	6.221788946	0.015151199	0	0	0	0	0	0	0	0												1a:  Acute - $150/$0/day for 1-5/6-90	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	2:  Skilled Nursing Services - $0/$50/$110/day for 1-10/11-20/21-100 /2:  Non-Medicare Covered Stay - $0/$50/$110/day for 1-10/11-20/21-100	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) - $225/visit/9b:  Ambulatory Surgical Center Services - $175/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 - $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) - $225/visit	"7a:  Primary Care - $0/visit/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  OP Phys (Surgery, ER, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $35/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/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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/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:  Eye Glasses & Contact Lenses - $0/service			14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13c:  Other: Over the Counter Benefit - $0/visit												150	0.070589025	46	0	50	0.2	0.2	40.04618804	223.7638906	0	0.199953717	0	0.2	60.53766061	0	34.84584639	20	35	0	34.9943275	0.2	0	0	0	0	0	0	0	0	0											NO	140.9504733	0.069501501	43.22481182	0	46.98349111	0.187933964	0.187933964	37.64078618	210.2641753	0	0.187890474	0	0.187933964	56.88541278	0	32.74359028	19.99136157	32.88844378	0	32.8831135	0.188962371	0	0	0	0	0	0	0	0	0												11.0467	0.515803585	1.034429636	0	0.632654161	2.182452291	1.180016156	0.883620658	3.115148533	0	1.927821767	0	0.00697964	1.851486697	0	9.291737087	0.277376386	0.326332501	0	0.090264601	1.17568399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5385	0	2.23189062	11.0467	0.515803585	1.034429636	0	0.632654161	2.182452291	1.180016156	0.883620658	3.115148533	0	1.927821767	0	0.00697964	1.851486697	0	9.291737087	0.277376386	0.326332501	0	0.090264601	1.17568399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5385	YES	1a:  Acute - 20.0%		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 - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	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%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/14c:  Routine Exams - 20.0%/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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/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		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) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%"	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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%							14c:  Routine Exams - 20.0%												4000	4.4285	0	0.2552	0.1401	0.0906	0	0	0.1064	0.4684	0.44	0.1807	0	0.0008	0.1039	0.5622	1.2732	0	0.0525	0.403	0.3422	0.1255	0.0003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.9734	0	4.482447175	15.4752	0.515803585	1.289657275	0.140094839	0.723265451	2.182452291	1.180016156	0.990047459	3.583565572	0.439954768	2.10857031	0	0.007746241	1.95542608	0.562160029	10.56489747	0.277376386	0.378788724	0.402969081	0.432436857	1.30122083	0.000311965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.5119
H4528_002_0	2011	5																															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	YES	376.0893211	7.228132993	33.56532606	58.66525935	17.49111288	27.89925855	10.96702323	168.8382428	36.04623621	29.42353207	15.05155985	0	0.061147862	17.28655038	0	0	1.847473909	6.226951635	38.52180143	0	3.977389496	0	0	0	0	0	0	0	0	0											6700	"1a:  Acute - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	"2:  Skilled Nursing Services - Days 1-20, $0/day; days 21-100, $137.50/day for 1-100/2:  Non-Medicare Covered Stay - Days 1-20, $0/day; days 21-100, $137.50/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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  OP Phys (Surgery, ER, Rad & Path) - $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/17a:  Vision Exams - $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/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 - $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/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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 - Non-Routine 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:  Eye Glasses & Contact Lenses - $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	13c:  Other: Over the Counter Benefit - $0/visit/13e:  Home Safety - $0/service												0.070258619	0.070313841	0.191126126	0	0.2	0.2	0.2	50	0.2	0	0.139044072	0	0.2	0.129243847	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0.06732262	0.069497324	0.183139262	0	0.19164231	0.19164231	0.19164231	47.91057753	0.19164231	0	0.133233636	0	0.19164231	0.123842947	0	0	0	0	0	0	0.192756614	0	0	0	0	0	0	0	0	0												25.3193	0.502335904	6.147129035	0	3.35203728	5.34667836	2.101745666	0.67409481	6.90798398	0	2.005374048	0	0.011718518	2.14081735	0	0	0	0	0	0	0.766668131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2759	0	2.39	25.3193	0.502335904	6.147129035	0	3.35203728	5.34667836	2.101745666	0.67409481	6.90798398	0	2.005374048	0	0.011718518	2.14081735	0	0	0	0	0	0	0.766668131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2759	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.3193	0.502335904	6.147129035	0	3.35203728	5.34667836	2.101745666	0.67409481	6.90798398	0	2.005374048	0	0.011718518	2.14081735	0	0	0	0	0	0	0.766668131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2759
H4528_013_0	2011	2																															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	YES	392.5971457	5.248323288	339.0117247	6.381480018	43.64032251	5.668829357	9.258292117	81.83696569	12.22222227	6.186552672	10.70300695	0	0.056471193	75.6465355	0	0	1.817263745	0.705908401	12.87898892	0	2.787172747	0.709806155	0	0	0	0	0	0	0	0											6700	"1a:  Acute - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/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 - 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  OP Phys (Surgery, ER, Rad & Path) - $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/17a:  Vision Exams - $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/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/7f:  Routine Podiatry - $0/visit/12 Visits	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/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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 - Non-Routine 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:  Eye Glasses & Contact Lenses - $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	13c:  Other: Over the Counter Benefit - $0/visit												0.069605466	0.069657872	0	0	0.2	0.2	0.2	50	0.2	0	0.136850958	0	0.2	0.02713714	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.067806086	0.067857138	0	0	0.194829776	0.194829776	0.194829776	48.707444	0.194829776	0	0.133313208	0	0.194829776	0.026435614	0	0	0	0	0	0	0.194829776	0.194829776	0	0	0	0	0	0	0	0												26.6205	0.356136198	0	0	8.502434259	1.104456754	1.803790979	0.332172452	2.381252826	0	1.426852189	0	0.01100227	1.999762641	0	0	0	0	0	0	0.543024242	0.138291374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2197	0	1.2	26.6205	0.356136198	0	0	8.502434259	1.104456754	1.803790979	0.332172452	2.381252826	0	1.426852189	0	0.01100227	1.999762641	0	0	0	0	0	0	0.543024242	0.138291374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2197	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.6205	0.356136198	0	0	8.502434259	1.104456754	1.803790979	0.332172452	2.381252826	0	1.426852189	0	0.01100227	1.999762641	0	0	0	0	0	0	0.543024242	0.138291374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2197
H4528_014_0	2011	3																															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	1583.798397	8.126407617	488.4723427	23.45855505	81.43915549	15.92998901	14.15301245	407.487494	255.6598392	18.33212659	10.88321176	0	0.05807061	600.6488192	0	4778.964099	170.3535337	155.7499673	34.20842326	35.3937364	7.831210468	0.032080074	0	0	0	0	0	0	0	0											6700	1a:  Acute - $150/$0/day for 1-5/6-90	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	2:  Skilled Nursing Services - $0/$50/$110/day for 1-10/11-20/21-100 /2:  Non-Medicare Covered Stay - $0/$50/$110/day for 1-10/11-20/21-100	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) - $225/visit/9b:  Ambulatory Surgical Center Services - $175/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 - $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) - $225/visit	"7a:  Primary Care - $0/visit/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  OP Phys (Surgery, ER, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $35/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/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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/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:  Eye Glasses & Contact Lenses - $0/service			14a:  Written health education materials - $0/service/14c:  Routine Exams - $0/visit													150	0.07080336	46	0	50	0.2	0.03831866	40.04708887	223.9978255	0	0.206446452	0	0.2	62.40752291	0	34.90065583	20	35	0	34.994632	0.2	0	0	0	0	0	0	0	0	0											NO	144.3467265	0.068134888	44.26632945	0	48.11557548	0.192462302	0.036874487	38.54456122	215.5556857	0	0.198665797	0	0.192462302	60.05547758	0	33.5853028	19.24623019	33.68090284	0	33.67573715	0.192462302	0	0	0	0	0	0	0	0	0												19.0513	0.553691875	1.80190647	0	0.326540986	3.065922354	0.52188508	1.308868888	4.592410995	0	2.162121943	0	0.011176403	3.006020975	0	13.37524636	0.273221944	0.43714996	0	0.099325847	1.507212794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.094	0	2.04	19.0513	0.553691875	1.80190647	0	0.326540986	3.065922354	0.52188508	1.308868888	4.592410995	0	2.162121943	0	0.011176403	3.006020975	0	13.37524636	0.273221944	0.43714996	0	0.099325847	1.507212794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.094	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.0513	0.553691875	1.80190647	0	0.326540986	3.065922354	0.52188508	1.308868888	4.592410995	0	2.162121943	0	0.011176403	3.006020975	0	13.37524636	0.273221944	0.43714996	0	0.099325847	1.507212794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.094
H4528_801_0	2011	1																															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	YES	308.2734576	3.548904025	59.00588751	46.2123237	8.218495473	13.26482592	3.348242448	8.884278116	41.91293298	5.551869147	24.03175271	0	0.02654455	19.48318897	57.1978954	122.7922277	1.223738704	4.841217713	20.48787548	23.2114927	7.64464548	0.78108812	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				0.072386386	0.072386386	0.159191608	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.176091146	0.222770147	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.061710344	0.061710344	0.135712934	0	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0	0.198635556	0.198635556	0.150120012	0.189914472	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0	0	0	0	0	0	0	0												19.0237	0.219004087	8.007862129	0	1.632485421	2.634866077	0.665080002	1.764733527	8.325398763	1.102798617	4.773560572	0	0.005272692	3.870054081	8.586548718	23.32002113	0.243078018	0.961637974	4.069620547	4.610627769	1.518498409	0.155151873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.49	0	16.52	19.0237	0.219004087	8.007862129	0	1.632485421	2.634866077	0.665080002	1.764733527	8.325398763	1.102798617	4.773560572	0	0.005272692	3.870054081	8.586548718	23.32002113	0.243078018	0.961637974	4.069620547	4.610627769	1.518498409	0.155151873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.49	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.0237	0.219004087	8.007862129	0	1.632485421	2.634866077	0.665080002	1.764733527	8.325398763	1.102798617	4.773560572	0	0.005272692	3.870054081	8.586548718	23.32002113	0.243078018	0.961637974	4.069620547	4.610627769	1.518498409	0.155151873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.49
H4528_802_0	2011	1																															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	YES	308.2734576	3.548904025	59.00588751	46.2123237	8.218495473	13.26482592	3.348242448	8.884278116	41.91293298	5.551869147	24.03175271	0	0.02654455	19.48318897	57.1978954	122.7922277	1.223738704	4.841217713	20.48787548	23.2114927	7.64464548	0.78108812	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				0.072386386	0.072386386	0.159191608	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.176091146	0.222770147	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.061710344	0.061710344	0.135712934	0	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0	0.198635556	0.198635556	0.150120012	0.189914472	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0	0	0	0	0	0	0	0												19.0237	0.219004087	8.007862129	0	1.632485421	2.634866077	0.665080002	1.764733527	8.325398763	1.102798617	4.773560572	0	0.005272692	3.870054081	8.586548718	23.32002113	0.243078018	0.961637974	4.069620547	4.610627769	1.518498409	0.155151873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.49	0	16.52	19.0237	0.219004087	8.007862129	0	1.632485421	2.634866077	0.665080002	1.764733527	8.325398763	1.102798617	4.773560572	0	0.005272692	3.870054081	8.586548718	23.32002113	0.243078018	0.961637974	4.069620547	4.610627769	1.518498409	0.155151873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.49	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.0237	0.219004087	8.007862129	0	1.632485421	2.634866077	0.665080002	1.764733527	8.325398763	1.102798617	4.773560572	0	0.005272692	3.870054081	8.586548718	23.32002113	0.243078018	0.961637974	4.069620547	4.610627769	1.518498409	0.155151873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.49
H4528_803_0	2011	1																															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	277.4461118	3.194013622	53.10529876	41.59109133	7.396645926	11.93834333	3.013418203	7.995850305	37.72163968	4.996682232	21.62857744	0	0.023890095	17.53487007	51.47810586	110.5130049	1.101364833	4.357095942	18.43908794	20.89034343	6.880180932	0.702979308	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																				0.072386386	0.072386386	0.159191608	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.176091146	0.222770147	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.061710344	0.061710344	0.135712934	0	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0	0.198635556	0.198635556	0.150120012	0.189914472	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0	0	0	0	0	0	0	0												17.1213	0.197103678	7.207075916	0	1.469236879	2.37137947	0.598572002	1.588260174	7.492858887	0.992518755	4.296204514	0	0.004745422	3.483048673	7.727893846	20.98801902	0.218770217	0.865474177	3.662658492	4.149564992	1.366648568	0.139636686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.941	0	14.868	17.1213	0.197103678	7.207075916	0	1.469236879	2.37137947	0.598572002	1.588260174	7.492858887	0.992518755	4.296204514	0	0.004745422	3.483048673	7.727893846	20.98801902	0.218770217	0.865474177	3.662658492	4.149564992	1.366648568	0.139636686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.941	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	Similar to Medicare FFS																			6700	2.0092	0.0231	0.9358	0	0.2006	0.3236	0.0817	0.2315	1.0026	0.1475	0.5225	0	0.0006	0.5154	0.9141	2.5965	0.0277	0.1094	0.4838	0.5197	0.2057	0.021	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.8719	0	2.53	19.1305	0.220234268	8.142894257	0	1.669798918	2.69493996	0.680243557	1.81979378	8.495432345	1.139987276	4.818682629	0	0.005345441	3.9984587	8.641956119	23.58451867	0.246431877	0.974906133	4.146436401	4.669288969	1.572396132	0.160643142	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8129
H4528_804_0	2011	1																															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	277.4461118	3.194013622	53.10529876	41.59109133	7.396645926	11.93834333	3.013418203	7.995850305	37.72163968	4.996682232	21.62857744	0	0.023890095	17.53487007	51.47810586	110.5130049	1.101364833	4.357095942	18.43908794	20.89034343	6.880180932	0.702979308	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																				0.072386386	0.072386386	0.159191608	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.176091146	0.222770147	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.061710344	0.061710344	0.135712934	0	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0	0.198635556	0.198635556	0.150120012	0.189914472	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0.198635556	0	0	0	0	0	0	0	0												17.1213	0.197103678	7.207075916	0	1.469236879	2.37137947	0.598572002	1.588260174	7.492858887	0.992518755	4.296204514	0	0.004745422	3.483048673	7.727893846	20.98801902	0.218770217	0.865474177	3.662658492	4.149564992	1.366648568	0.139636686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.941	0	14.868	17.1213	0.197103678	7.207075916	0	1.469236879	2.37137947	0.598572002	1.588260174	7.492858887	0.992518755	4.296204514	0	0.004745422	3.483048673	7.727893846	20.98801902	0.218770217	0.865474177	3.662658492	4.149564992	1.366648568	0.139636686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.941	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	Similar to Medicare FFS																			6700	2.0092	0.0231	0.9358	0	0.2006	0.3236	0.0817	0.2315	1.0026	0.1475	0.5225	0	0.0006	0.5154	0.9141	2.5965	0.0277	0.1094	0.4838	0.5197	0.2057	0.021	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.8719	0	2.53	19.1305	0.220234268	8.142894257	0	1.669798918	2.69493996	0.680243557	1.81979378	8.495432345	1.139987276	4.818682629	0	0.005345441	3.9984587	8.641956119	23.58451867	0.246431877	0.974906133	4.146436401	4.669288969	1.572396132	0.160643142	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8129
H4529_002_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	949.3736296	40.314467	181.5700212		84.38120592	4.955075372	2.073132642	266.435642	97.57272707		6.466228461	1.704708108	0.14250262	7.111499161		2646.176964	76.78136055	544.041022	26.07649909		4.866335267	0.237613218		13.93798932	159.1037094																3200	"1a (IP Acute) 125 days 1-5, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 125 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 0% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 250 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 25 copay, 7i (PT/ST) 25 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 25 copay, 7f (Podiatry) 25 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 25 copay, 18a (Hearing Exam) 25 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 25 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 25 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0%coin"	18a1 (Routine Hearing Exam) 25 copay	18b (Hearing Aids) 700 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												77.36923009	172.0337627	49.94161658		125	0.2	0.2	49.80990495	248.6172414		0.2	0.2	0.2	0.197934897		24.76834779	40	25	0.181		0.2			0.135384615	25																NO	73.55758438	163.5584069	47.48121018		118.8417933	0.190146869	0.190146869	47.35598742	236.3689504		0.190146869	0.190146869	0.190146869	0.188183505		23.58107095	38.02937384	23.76835865	0.172082917		0.190146869			0.135384615	25																	5.8195	0.549480833	0.718430362	0	0.835667819	0.942192069	0.394199681	1.051443576	1.921930257	0	1.229533098	0.32414491	0.027096427	1.338266836	0	5.199973895	0.243328922	1.077580178	4.48732002	0	0.925318416	0	0	1.886989318	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3038	0	1.39588139	5.8195	0.549480833	0.718430362	0	0.835667819	0.942192069	0.394199681	1.051443576	1.921930257	0	1.229533098	0.32414491	0.027096427	1.338266836	0	5.199973895	0.243328922	1.077580178	4.48732002	0	0.925318416	0	0	1.886989318	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3038	NO	"1a (IP Acute) 20% coin, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 20% coin	"2a (SNF) 20% coin, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 20% coin	10a (Ambulance) n/a	11a (DME) n/a	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) n/a, 4a (ER) - Worldwide Coverage n/a, 4b (UC) n/a"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) n/a, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) n/a	"3 (CORF) n/a, 5 (Partial Hosp) n/a, 7c (OT) 40 copay, 7i (PT/ST) 40 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) n/a, 9c (OP SA) n/a, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 40 copay, 14b (Immunizations) n/a, 14c (Routine Physical) n/a, 14d (Pap & Pelvic Exam) n/a, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) n/a, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) n/a, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) n/a, 14h (Mammography) n/a, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) n/a, 14j (Nutrition Therapy Diabetes) n/a"	"7b (Chiro) 40 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 40 copay, 7f (Podiatry) 40 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 40 copay, 18a (Hearing Exam) 40 copay"	"7e (MH Non-Phys) n/a, 7h (Psych) n/a"	7i (PT/ST) 40 copay	"7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin, 7g (Prof. Other) 20% coin"	8a (OP Diag Proc/Test/Lab) 20% coin	15 (Part B Rx) n/a	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 20% coin, 14a4-1 (Smoking Cessation - Mdcr Covered) n/a, 16b (Comp. Dental) 40 copay, 17b (MCR Eyewear) n/a"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive n/a"	17a1 (Routine Eye Exam) n/a	17b1 (Non MCR Covered) n/a	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) n/a, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												1.5063	0.0209	0.0439	0.1519			0.0466		0.2042	0.013	0.0433	0.0151		0.0608	0.714	0.8571		0.0803	0.2086	0.1436		0.0024																			4.1121	0	1.245765988	7.3258	0.570350022	0.762296813	0.151907145	0.835667819	0.942192069	0.440756145	1.051443576	2.126154476	0.01304918	1.272859899	0.339286531	0.027096427	1.399111076	0.714033578	6.057063001	0.243328922	1.157857698	4.695954306	0.143589309	0.925318416	0.002426078	0	1.886989318	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.416
H4529_004_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1327.846872	57.38737362	384.6632343		150.5108167	6.605447036	7.286673048	373.2210475	137.3300893		2.533768106	3.387183879	0.056144228	7.759388492	3955.949129	3004.044999	74.88092149	494.6728605	33.13070899		11.18623287				159.1037094		260.9166693														4950	"1a (IP Acute) 240 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 125 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 450 copay, 9b (OP ASC) 450 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 35 copay, 7i (PT/ST) 35 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 7 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 35 copay, 7f (Podiatry) 35 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 35 copay, 18a (Hearing Exam) 35 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 35 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 35 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0%coin"	18a1 (Routine Hearing Exam) 35 copay	18b (Hearing Aids) 700 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												173.9569359	172.0337627	49.94161658		125	0.2	0.2	49.49242674	450		0.2	0.2	0.2	0.194215957	7	34.45857167	40	35	0.181		0.2				25		35														NO	162.2881099	160.4939408	46.59159186		116.6151475	0.186584236	0.186584236	46.17253314	419.8145309		0.186584236	0.186584236	0.186584236	0.181188179	6.530448258	32.17015384	37.31684719	32.65224129	0.168858734		0.186584236				25		32.65224129															17.9578	0.767527146	1.493506035	0	1.462653423	1.232472288	1.359578323	1.436046766	4.804430584	0	0.472761186	0.631995116	0.010475628	1.405909473	2.152843425	8.053382479	0.232859992	1.3460148	5.594409561	0	2.087174713	0	0	0	0.331466061	0	0.709959504	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5433	0	3.819853573	17.9578	0.767527146	1.493506035	0	1.462653423	1.232472288	1.359578323	1.436046766	4.804430584	0	0.472761186	0.631995116	0.010475628	1.405909473	2.152843425	8.053382479	0.232859992	1.3460148	5.594409561	0	2.087174713	0	0	0	0.331466061	0	0.709959504	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5433	NO																																																																																		0	0	0	17.9578	0.767527146	1.493506035	0	1.462653423	1.232472288	1.359578323	1.436046766	4.804430584	0	0.472761186	0.631995116	0.010475628	1.405909473	2.152843425	8.053382479	0.232859992	1.3460148	5.594409561	0	2.087174713	0	0	0	0.331466061	0	0.709959504	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5433
H4529_007_0	2011	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin	T	Coin	P	P	P	P	O	V																																																			0	YES	196.7254779	1.930285248	26.45797707		8.124382436	4.18228594	7.467712032	9.691462707	19.95376606		8.398628556	1.064579909	0.164201862	10.72935334		4023.576254	1.424681661	405.0585869	23.85151133	10.50998874	7.373878595	0.351673652		13.93798932	159.1037094		83.73811242														3400	"1a (IP Acute) FFS, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 20% coin	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 20% coin, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 20% coin"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 0-20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 20% coin, 5 (Partial Hosp) 20% coin, 7c (OT) 8 copay, 7i (PT/ST) 8 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 20% coin, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 8 copay, 7b1 (Routine Chiro) 0% coin (5 visits), 7d (SPC w/Copay) 8 copay, 7f (Podiatry) 8 copay, 7f1 (Routine Podiatry) 0% coin (3 visits), 17a (Eye Exam) 8 copay, 18a (Hearing Exam) 8 copay"	"7e (MH Non-Phys) 45% coin, 7h (Psych) 45% coin"	7i (PT/ST) 8 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0-20% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 8 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 8 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 83.5"												0.068683119	0.068683119	0.204810753		0.2	0.2	0.2	0.2	0.2		0.2	0.2	0.2	0.2		8	0.45	8	0.181	0.07872	0.2	0.2		0.135384615	5		8														NO	0.063369606	0.063369606	0.188966038		0.184527458	0.184527458	0.184527458	0.184527458	0.184527458		0.184527458	0.184527458	0.184527458	0.184527458		7.381098313	0.41518678	7.381098313	0.166997349	0.072630007	0.184527458	0.184527458		0.135384615	5		7.381098313															12.4664	0.122321416	4.99965911	0	1.499171637	0.771746592	1.377997917	1.788340976	3.682017725	0	1.549777577	0.196444224	0.030299752	1.979860297	0	2.474867658	0.591508992	0.249148104	3.983139171	0.76334056	1.360683071	0.064893445	0	1.886989318	0.066293212	0	0.051506603	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9564	0	3.354244903	12.4664	0.122321416	4.99965911	0	1.499171637	0.771746592	1.377997917	1.788340976	3.682017725	0	1.549777577	0.196444224	0.030299752	1.979860297	0	2.474867658	0.591508992	0.249148104	3.983139171	0.76334056	1.360683071	0.064893445	0	1.886989318	0.066293212	0	0.051506603	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9564	NO																																																																																		0	0	0	12.4664	0.122321416	4.99965911	0	1.499171637	0.771746592	1.377997917	1.788340976	3.682017725	0	1.549777577	0.196444224	0.030299752	1.979860297	0	2.474867658	0.591508992	0.249148104	3.983139171	0.76334056	1.360683071	0.064893445	0	1.886989318	0.066293212	0	0.051506603	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9564
H4529_014_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	1216.11938	99.33177508	602.0723558		234.4272056	8.768112093	8.617043251	498.0047136	223.2280354		13.39611191	6.086075369	0.051053802	22.61254818		3302.920868	105.4321119	786.0341749	31.28730194		12.63415666			11.76442105	159.1037094																4950	"1a (IP Acute) 150 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 125 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 375 copay, 9b (OP ASC) 200 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 25 copay, 7i (PT/ST) 25 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 25 copay, 7f (Podiatry) 25 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 25 copay, 18a (Hearing Exam) 25 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 25 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 25 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 12 trips/yr	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0%coin"	18a1 (Routine Hearing Exam) 25 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												108.723085	172.0337627	49.94161658		125	0.2	0.2	49.8	373.4186747		0.2	0.2	0.2	0.195384828		24.44348364	40	25	0.181		0.2			0.321428571	5																NO	101.7691423	161.0304608	46.74734428		117.0049837	0.187207974	0.187207974	46.61478552	349.5347677		0.187207974	0.187207974	0.187207974	0.182887989		22.88024058	37.44159479	23.40099675	0.169423216		0.187207974			0.321428571	5																	10.3136	1.33295346	2.345440308	0	2.285762615	1.6414605	1.613179209	1.934531909	6.502163292	0	2.50785897	1.139361839	0.009557679	4.135563466	0	6.297635339	0.328962201	1.532831931	5.300795328	0	2.365214872	0	0	3.781421048	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4346	0	3.524912678	10.3136	1.33295346	2.345440308	0	2.285762615	1.6414605	1.613179209	1.934531909	6.502163292	0	2.50785897	1.139361839	0.009557679	4.135563466	0	6.297635339	0.328962201	1.532831931	5.300795328	0	2.365214872	0	0	3.781421048	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4346	NO																																																																																		0	0	0	10.3136	1.33295346	2.345440308	0	2.285762615	1.6414605	1.613179209	1.934531909	6.502163292	0	2.50785897	1.139361839	0.009557679	4.135563466	0	6.297635339	0.328962201	1.532831931	5.300795328	0	2.365214872	0	0	3.781421048	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4346
H4529_027_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1234.310147	53.03829535	416.530615		91.40936676	6.122642389	8.447027625	251.3908949	353.8556611		8.746346121	2.962205721	0.463881201	12.33590341		4758.358856	212.0778801	485.6309297	34.09004497		16.31369516				159.1037094		260.9166693														4900	"1a (IP Acute) 195 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 375 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 30 copay, 7i (PT/ST) 30 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 30 copay, 7f (Podiatry) 30 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 30 copay, 18a (Hearing Exam) 30 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 30 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 30 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0%coin"	18a1 (Routine Hearing Exam) 30 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												141.3400104	172.0337627	49.94161658		150	0.2	0.2	46	225.927937		0.2	0.2	0.2	0.194097787		29.5291827	40	30	0.181		0.2				25		30														NO	131.8003431	160.4224373	46.57083428		139.8758314	0.186501109	0.186501109	42.89525497	210.6790535		0.186501109	0.186501109	0.186501109	0.180997262		27.53612655	37.30022172	27.97516629	0.168783503		0.186501109				25		27.97516629															13.5569	0.709044384	1.616514854	0	1.065496765	1.141879593	1.575380016	0.898623044	6.212497981	0	1.631203248	0.552454651	0.086514358	2.232764747	0	10.91889764	0.659212662	1.132133834	5.753837217	0	3.042522232	0	0	0	0.331466061	0	0.608265601	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7256	0	3.864649413	13.5569	0.709044384	1.616514854	0	1.065496765	1.141879593	1.575380016	0.898623044	6.212497981	0	1.631203248	0.552454651	0.086514358	2.232764747	0	10.91889764	0.659212662	1.132133834	5.753837217	0	3.042522232	0	0	0	0.331466061	0	0.608265601	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7256	NO																																																																																		0	0	0	13.5569	0.709044384	1.616514854	0	1.065496765	1.141879593	1.575380016	0.898623044	6.212497981	0	1.631203248	0.552454651	0.086514358	2.232764747	0	10.91889764	0.659212662	1.132133834	5.753837217	0	3.042522232	0	0	0	0.331466061	0	0.608265601	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7256
H4529_028_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	1313.924465	56.62973805	429.7043526		96.95258187	6.605936722	9.118434694	268.0475242	377.7883171		9.444420947	3.199798398	0.500780087	13.31883752		5078.347852	222.3223898	517.593106	36.83194132		17.61286614			13.93798932	159.1037094		260.9166693														3400	"1a (IP Acute) 150 days 1-5, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 125 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 200 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 25 copay, 7i (PT/ST) 25 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 25 copay, 7f (Podiatry) 25 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 25 copay, 18a (Hearing Exam) 25 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 25 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 25 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 12 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0%coin"	18a1 (Routine Hearing Exam) 25 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												92.84307611	172.0337627	49.94161658		125	0.2	0.2	46	145.7900452		0.2	0.2	0.2	0.194077324		24.71009648	40	25	0.181		0.2			0.135384615	5		25														NO	84.10723841	155.8466748	45.24248472		113.2384367	0.181181499	0.181181499	41.67174472	132.0722945		0.181181499	0.181181499	0.181181499	0.175816103		22.38506158	36.23629976	22.64768735	0.163969256		0.181181499			0.135384615	5		22.64768735															9.2092	0.735463031	1.620074384	0	0.914896567	1.196873516	1.652091664	0.930834	4.15794749	0	1.711154342	0.57974427	0.090732087	2.341666103	0	9.473260782	0.671345063	0.976857236	6.039306029	0	3.191125486	0	0	1.886989318	0.066293212	0	0.492429929	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9383	0	4.776255134	9.2092	0.735463031	1.620074384	0	0.914896567	1.196873516	1.652091664	0.930834	4.15794749	0	1.711154342	0.57974427	0.090732087	2.341666103	0	9.473260782	0.671345063	0.976857236	6.039306029	0	3.191125486	0	0	1.886989318	0.066293212	0	0.492429929	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9383	NO																																																																																		0	0	0	9.2092	0.735463031	1.620074384	0	0.914896567	1.196873516	1.652091664	0.930834	4.15794749	0	1.711154342	0.57974427	0.090732087	2.341666103	0	9.473260782	0.671345063	0.976857236	6.039306029	0	3.191125486	0	0	1.886989318	0.066293212	0	0.492429929	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9383
H4529_030_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	1568.087883	107.1584782	767.2576616		243.5959761	10.39202934	7.442962451	441.9096599	233.6541267		11.93246823	6.403455838	0.135511567	13.220565		3518.972686	129.4728598	528.4556687	26.1042734		10.98520792			11.76442105	159.1037094		30.14408948														4950	"1a (IP Acute) 150 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 125 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 400 copay, 9b (OP ASC) 200 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 25 copay, 7i (PT/ST) 25 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 25 copay, 7f (Podiatry) 25 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 25 copay, 18a (Hearing Exam) 25 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 25 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 25 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 12 trips/yr	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0%coin"	18a1 (Routine Hearing Exam) 25 copay	18b (Hearing Aids) 700 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												108.723085	172.0337627	49.94161658		125	0.2	0.2	49.51132239	376.6782601		0.2	0.2	0.2	0.196540034		24.51159212	40	25	0.181		0.2			0.321428571	25		25														NO	101.5854902	160.7398659	46.66298422		116.793837	0.186870139	0.186870139	46.26093854	351.9495945		0.186870139	0.186870139	0.186870139	0.183637317		22.90242316	37.37402785	23.3587674	0.169117476		0.186870139			0.321428571	25		23.3587674															13.2746	1.435386618	2.983544346	0	2.370875728	1.94195997	1.390867429	1.703596301	6.852872931	0	2.229822	1.196614684	0.025323065	2.427789089	0	6.716083461	0.403243522	1.028672754	4.41468883	0	2.052807334	0	0	3.781421048	0.331466061	0	0.058677398	0	0	0	0	0	0	0	0	0	0	0	0	0	56.6203	0	3.689272903	13.2746	1.435386618	2.983544346	0	2.370875728	1.94195997	1.390867429	1.703596301	6.852872931	0	2.229822	1.196614684	0.025323065	2.427789089	0	6.716083461	0.403243522	1.028672754	4.41468883	0	2.052807334	0	0	3.781421048	0.331466061	0	0.058677398	0	0	0	0	0	0	0	0	0	0	0	0	0	56.6203	NO																																																																																		0	0	0	13.2746	1.435386618	2.983544346	0	2.370875728	1.94195997	1.390867429	1.703596301	6.852872931	0	2.229822	1.196614684	0.025323065	2.427789089	0	6.716083461	0.403243522	1.028672754	4.41468883	0	2.052807334	0	0	3.781421048	0.331466061	0	0.058677398	0	0	0	0	0	0	0	0	0	0	0	0	0	56.6203
H4529_031_0	2011	6																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin	T	Coin	P	P	P	P	O	V																																																			0	YES	253.4287571	5.228442335	18.70451872		5.204498737	6.743609072	9.50217681	14.40882743	46.97115288		13.62601917	3.074951419	0.476583802	20.92114996		5324.966991	3.30765626	794.3178605	32.77074231	14.35830582	19.09937755	1.004155629		13.93798932	159.1037094		260.9166693														3400	"1a (IP Acute) FFS, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 20% coin	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 20% coin, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 20% coin"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 0-20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 20% coin, 5 (Partial Hosp) 20% coin, 7c (OT) 8 copay, 7i (PT/ST) 8 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 20% coin, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 8 copay, 7b1 (Routine Chiro) 0% coin (5 visits), 7d (SPC w/Copay) 8 copay, 7f (Podiatry) 8 copay, 7f1 (Routine Podiatry) 0% coin (3 visits), 17a (Eye Exam) 8 copay, 18a (Hearing Exam) 8 copay"	"7e (MH Non-Phys) 45% coin, 7h (Psych) 45% coin"	7i (PT/ST) 8 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0-20% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 8 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 8 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 84"												0.077999825	0.077999825	0.194970318		0.2	0.2	0.2	0.2	0.2		0.2	0.2	0.2	0.2		8	0.45	8	0.181	0.07872	0.2	0.2		0.135384615	5		8														NO	0.068059354	0.068059354	0.17012287		0.174511557	0.174511557	0.174511557	0.174511557	0.174511557		0.174511557	0.174511557	0.174511557	0.174511557		6.9804623	0.392651004	6.9804623	0.15793296	0.068687749	0.174511557	0.174511557		0.135384615	5		6.9804623															17.2482	0.35584441	3.1820664	0	0.908245181	1.176837722	1.658239675	2.514506917	8.197009047	0	2.377897827	0.536614561	0.083169382	3.650982464	0	3.097560944	1.298754553	0.462058823	5.175580319	0.986239706	3.333062123	0.175236763	0	1.886989318	0.066293212	0	0.151776581	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5232	0	8.262364856	17.2482	0.35584441	3.1820664	0	0.908245181	1.176837722	1.658239675	2.514506917	8.197009047	0	2.377897827	0.536614561	0.083169382	3.650982464	0	3.097560944	1.298754553	0.462058823	5.175580319	0.986239706	3.333062123	0.175236763	0	1.886989318	0.066293212	0	0.151776581	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5232	NO																																																																																		0	0	0	17.2482	0.35584441	3.1820664	0	0.908245181	1.176837722	1.658239675	2.514506917	8.197009047	0	2.377897827	0.536614561	0.083169382	3.650982464	0	3.097560944	1.298754553	0.462058823	5.175580319	0.986239706	3.333062123	0.175236763	0	1.886989318	0.066293212	0	0.151776581	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5232
H4529_801_0	2011	4																															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	Coin	V																																																			0	YES	227.4986081	4.816220376	21.64941773		4.741326104	5.229990481	7.824387067	13.03318274	40.20030768	5.648840767	15.12595614	3.349618633	0.355966845	19.73472283	54.44655332	110.0499444	2.815356025	11.27613634	28.04070881	15.28431242	15.72331121	0.717295013																			6700	"1a (IP Acute) FFS, 1a1 (Add'l Days) n/a"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) n/a"	6a (Home Health) FFS	10a (Ambulance) FFS	11a (DME) FFS	"11b (Prosthetics) FFS, 11b (Medical Supplies) FFS, 11c (Diabetic Supplies) FFS"	"4a (ER) FFS, 4a (ER) - Worldwide Coverage n/a, 4b (UC) FFS"	"9a (OP Surgery) FFS, 9b (OP ASC) FFS"	8a (OP Diag Proc/Test/Lab) FFS	"8b (X-Ray) FFS, 8b (OP Therap Rad) FFS, 8b (OP Diag) FFS"	9a (OP Observation) FFS	12 (Renal Dialysis) FFS	"3 (CORF) FFS, 5 (Partial Hosp) FFS, 7c (OT) FFS, 7i (PT/ST) FFS, 9a (OP Other) FFS, 9a (OP Chemo) FFS, 9c (OP SA) FFS, 9d (OP Cardiac Rehab) FFS"	"7a (PCP w/Copay) FFS, 14b (Immunizations) FFS, 14c (Routine Physical) FFS, 14d (Pap & Pelvic Exam) FFS, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) FFS, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) FFS, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) FFS, 14h (Mammography) FFS, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) FFS, 14j (Nutrition Therapy Diabetes) FFS"	"7b (Chiro) FFS, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) FFS, 7f (Podiatry) FFS, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) FFS, 18a (Hearing Exam) FFS"	"7e (MH Non-Phys) FFS, 7h (Psych) FFS"	7i (PT/ST) FFS	7g Physician Specialist Services Excluding Psychiatric (Radiology only) FFS	"8a (OP Diag Proc/Test/Lab) FFS, 7g (Prof. Other) FFS"	15 (Part B Rx) FFS	"13a (Blood) FFS, 13a1 (3 Pint Blood) n/a, 14a4-1 (Smoking Cessation - Mdcr Covered) FFS, 16b (Comp. Dental) FFS, 17b (MCR Eyewear) FFS"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive n/a"	17a1 (Routine Eye Exam) n/a	17b1 (Non MCR Covered) n/a	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) n/a, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												0.076653506	0.076653506	0.164633008		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069034452	0.069034452	0.148269141		0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725																				15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	0	10.31335866	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	NO																																																																																		0	0	0	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469
H4590_010_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1155.709329	147.5252905	756.9136782	494.5814059	335.0932685	9.316939853	11.68044616	169.1256175	197.4313395	33.76450423	70.3437029	0	10.2460005	1081.736666	8127.48039	8034.799783	852.8508124	743.5867593	0	0	27.23831417	1378.05305	639.2392537	0	402.7446576	42.8	17.46434425	6	100.8758407	0											6700	"$75 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$75 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$120 Days 21-76 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$75 (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$15 (3, 9d); $60 (5); $75 (9a); $40/$30 (9c)"	"$0 (7a, 14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14e1, 14h1)"	"$10 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$15 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $0/$30 (17a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												48.48354159	29.97451514	58.38948163	0	200	0.2	0.097738734	49.98349526	75	0	0.138915757	0	0	29.62499565	0.000843706	29.78612187	38.5	15	0	0	0.2	29.73600707	0	0	30	20	0	0	0	0											NO	44.59450785	27.57015488	53.70585793	0	183.9573034	0.183957303	0.08989877	45.98747077	68.98398877	0	0.127772841	0	0	27.24867156	0.000840618	29.67712092	38.35910118	14.94510435	0	0	0.183957303	27.35077837	0	0	30	20	0	0	0	0												4.2949	0.338941259	3.387558206	0	5.136904505	1.713919131	1.05005774	0.648138282	1.134966776	0	8.988014732	0	0	2.456323927	0.000569342	19.87081039	2.726215883	0.926081809	0	0	5.010686824	3.140901963	0	0	1.006861644	0.071333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9031	0	3.339195997	4.2949	0.338941259	3.387558206	0	5.136904505	1.713919131	1.05005774	0.648138282	1.134966776	0	8.988014732	0	0	2.456323927	0.000569342	19.87081039	2.726215883	0.926081809	0	0	5.010686824	3.140901963	0	0	1.006861644	0.071333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9031	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	4.2949	0.338941259	3.387558206	0	5.136904505	1.713919131	1.05005774	0.648138282	1.134966776	0	8.988014732	0	0	2.456323927	0.000569342	19.87081039	2.726215883	0.926081809	0	0	5.010686824	3.140901963	0	0	1.006861644	0.071333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9031
H4590_012_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1607.808062	122.909497	890.8769085	727.1175869	250.9702377	14.52379699	11.8393634	321.7146156	365.1984008	24.2648743	56.84282417	0	0.154408453	985.3674034	7447.083507	176.9554032	608.6883103	1069.549618	0	0	29.72867604	1542.227478	0	0	396.0002943	303.3895234	17.46434425	6	100.9437371	0											4900	"$175 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-59 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$175 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $175 (9a); $40/$30 (9c)"	"$5 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$5 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 18a); $0/$35 (17a)"	$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												130.3743387	87.20789285	69.76414203	0	200	0.2	0.111442718	49.99786944	175	0.138578699	0.159067877	0	0.2	67.47652926	3.160233553	0.133362763	38.5	35	0	0	0.2	34.24110649	0	0	35	30	0	0	0	0											NO	101.3797268	67.81328627	54.24893986	0	155.5209834	0.155520983	0.086658406	38.89765462	136.0808604	0.107759478	0.123691963	0	0.155520983	52.47008092	3.10301211	0.130948698	37.80289154	34.36626504	0	0	0.155520983	26.62605277	0	0	35	30	0	0	0	0												13.5833	0.694574742	4.027427319	0	3.252594847	2.258755189	1.025980355	1.042828667	4.141376051	2.614770188	7.031000532	0	0.024013754	4.308525616	1.925699192	23.17207968	1.917514848	3.063035472	0	0	4.623432931	3.421952518	0	0	1.155000858	0.758473809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0423	0	15.44032661	13.5833	0.694574742	4.027427319	0	3.252594847	2.258755189	1.025980355	1.042828667	4.141376051	2.614770188	7.031000532	0	0.024013754	4.308525616	1.925699192	23.17207968	1.917514848	3.063035472	0	0	4.623432931	3.421952518	0	0	1.155000858	0.758473809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0423	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.5833	0.694574742	4.027427319	0	3.252594847	2.258755189	1.025980355	1.042828667	4.141376051	2.614770188	7.031000532	0	0.024013754	4.308525616	1.925699192	23.17207968	1.917514848	3.063035472	0	0	4.623432931	3.421952518	0	0	1.155000858	0.758473809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0423
H4590_020_0	2011	4																															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	YES	488.5390405	7.583160255	81.16248608	1378.41768	18.54486695	53.10497953	30.89422312	37.09422065	72.55987143	40.55525306	97.96174907	0	1.047654719	19.19229468	52.25576342	261.8503859	3.916081564	10.68469447	0	0	58.25655846	15.40763473	904.2135375	981.4342446	479.4579015	556.7461146	27.86409592	14.25883777	0	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (16b, 17a, 18a); $0 (17b)"	$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); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.076474937	0.077403451	0.18609298	0	0.233	0.233	0.233	0.091384042	0.233	0.233	0.233	0	0.233	0.233	0.221925697	0.232989011	0.226088092	0.233	0	0	0.233	0.232304802	0	0	0	0	0	0	0	0											NO	0.056946371	0.05763778	0.138572455	0	0.173501344	0.173501344	0.173501344	0.068065594	0.173501344	0.173501344	0.173501344	0	0.173501344	0.173501344	0.165254964	0.173493161	0.168354454	0.173501344	0	0	0.173501344	0.173521626	0	0	0	0	0	0	0	0												27.8205	0.437076524	11.24688499	0	3.21755934	9.213785325	5.360189236	2.524840166	12.58923522	7.036390915	16.99649513	0	0.181769502	3.329888923	8.635524322	45.42925118	0.659289775	1.853808852	0	0	10.10759119	2.673557831	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	169.3137	0	58.05058614	27.8205	0.437076524	11.24688499	0	3.21755934	9.213785325	5.360189236	2.524840166	12.58923522	7.036390915	16.99649513	0	0.181769502	3.329888923	8.635524322	45.42925118	0.659289775	1.853808852	0	0	10.10759119	2.673557831	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	169.3137	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	27.8205	0.437076524	11.24688499	0	3.21755934	9.213785325	5.360189236	2.524840166	12.58923522	7.036390915	16.99649513	0	0.181769502	3.329888923	8.635524322	45.42925118	0.659289775	1.853808852	0	0	10.10759119	2.673557831	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	169.3137
H4590_022_0	2011	4																															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	4030.077121	251.4562017	1301.498629	1115.056497	785.719158	23.65730703	30.78276977	856.4751176	672.8718459	43849.03123	114.3565472	0	0.133708853	3263.657196	23733.54743	25645.33598	918.444228	2777.428825	0	0	33.32169311	3919.961398	973.7959012	981.4342446	1293.649092	2332.182593	26.31609849	6.964998378	388.1378368	0											6700	"$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); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$50 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$0 (9b)	"$0 (8a1a, 8a2)"	$0 (8b1); 20% (8b2); $20 (8b3)	Included in h.5.	20% (12)	"$0 (3, 9a, 9d); $10 (5, 9c)"	"$0 (7a, 14b, 14c, 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, 16b1, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5)"	$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0	0	0	0	50	0.2	0.106047979	49.97062246	0	0	0.122864084	0	0.2	0.131038862	0.003318281	0	10	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	48.09717136	0.192388685	0.102012156	48.07014829	0	0	0.118188298	0	0.192388685	0.126051972	0.003191999	0	9.619434272	0	0	0	0.192388685	0	0	0	0	0	0	0	0	0												0	0	0	0	3.149239082	4.551398201	3.140216724	3.430907159	0	0	13.51560569	0	0.025724071	0.034282536	0.006313122	0	0.736242824	0	0	0	6.410716735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.0006	0	1.384609894	0	0	0	0	3.149239082	4.551398201	3.140216724	3.430907159	0	0	13.51560569	0	0.025724071	0.034282536	0.006313122	0	0.736242824	0	0	0	6.410716735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.0006	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	3.149239082	4.551398201	3.140216724	3.430907159	0	0	13.51560569	0	0.025724071	0.034282536	0.006313122	0	0.736242824	0	0	0	6.410716735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.0006
H4590_025_0	2011	4																															A	A	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	295.601872	15.21596201	740.4646611	544.9278728	368.120327	10.89009427	14.73825379	378.0484422	391.177214	21.25899749	52.44197503	0	0.108491216	1431.019783	6733.921315	152.8536031	642.8417963	1045.14238	0	0	22.94127525	1444.799542	0	0	200.8885103	186.5986678	17.46434425	6	98.91221839	0											4900	"$150 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$50 Days 11-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$75 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$20 (3, 9d); $60 (5); $75 (9a); $40/$30 (9c)"	"$10 (7a); $20 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $20 (7d, 7f, 7f1)"	"$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, 18a); $0/$20 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												149.231808	150	36.43157661	0	200	0.2	0.116143248	49.9991861	75	0.146724247	0.161261338	0	0.2	29.66438756	6.692369965	0.08246552	38.5	20	0	0	0.2	19.50457568	0	0	20	30	0	0	0	0											NO	129.7540388	130.4219662	31.67651902	0	173.8959549	0.173895955	0.100984205	43.48232195	65.2109831	0.127573765	0.140213472	0	0.173895955	25.79258501	6.627483817	0.081667902	38.12672167	19.80608918	0	0	0.173895955	16.95883407	0	0	20	30	0	0	0	0												3.1963	0.16537464	1.95461191	0	5.334552983	1.893743342	1.48833084	1.369868673	2.125754224	2.712090353	7.353071374	0	0.018866184	3.075808283	3.719079545	12.48323307	2.042454187	1.725015265	0	0	3.989394967	2.041842974	0	0	0.334814184	0.466496669	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4907	0	5.706978547	3.1963	0.16537464	1.95461191	0	5.334552983	1.893743342	1.48833084	1.369868673	2.125754224	2.712090353	7.353071374	0	0.018866184	3.075808283	3.719079545	12.48323307	2.042454187	1.725015265	0	0	3.989394967	2.041842974	0	0	0.334814184	0.466496669	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4907	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.1963	0.16537464	1.95461191	0	5.334552983	1.893743342	1.48833084	1.369868673	2.125754224	2.712090353	7.353071374	0	0.018866184	3.075808283	3.719079545	12.48323307	2.042454187	1.725015265	0	0	3.989394967	2.041842974	0	0	0.334814184	0.466496669	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4907
H4590_027_0	2011	1																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1375.364192	125.8350237	675.5210353	645.9934911	194.3795406	14.03591908	9.570069737	271.8109558	366.0650448	22.45251508	52.20170841	0	0.076487703	851.3742979	6855.154387	165.2851187	606.2674412	1043.726117	0	0	35.9189963	1364.867229	0	0	249.6495479	239.0699895	0	0	322.3285234	0											4500	"$175 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-55 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$175 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $175 (9a); $40/$30 (9c)"	"$5 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$5 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 18a); $0/$35 (17a)"	$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												130.3743387	87.20789285	68.36007248	0	200	0.2	0.137789897	49.98954996	175	0.137004412	0.15857061	0	0.2	67.67005657	3.0960738	0.131202258	38.5	35	0	0	0.2	33.94419237	0	0	35	30	0	0	0	0											NO	102.1132679	68.30395471	53.54175112	0	156.6462678	0.156646268	0.107921365	39.1753573	137.0654844	0.107306149	0.124197471	0	0.156646268	53.00130904	3.041785401	0.128907008	37.82491811	34.38628919	0	0	0.156646268	26.58615525	0	0	35	30	0	0	0	0												11.7036	0.71625248	3.014048262	0	2.537402465	2.19867434	1.032814994	0.887357609	4.181240223	2.409292934	6.483320191	0	0.011981513	3.760329356	1.737659045	21.30641011	1.91100136	2.99082234	0	0	5.626576715	3.023881003	0	0	0.728144515	0.597674974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8585	0	13.66743697	11.7036	0.71625248	3.014048262	0	2.537402465	2.19867434	1.032814994	0.887357609	4.181240223	2.409292934	6.483320191	0	0.011981513	3.760329356	1.737659045	21.30641011	1.91100136	2.99082234	0	0	5.626576715	3.023881003	0	0	0.728144515	0.597674974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8585	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.7036	0.71625248	3.014048262	0	2.537402465	2.19867434	1.032814994	0.887357609	4.181240223	2.409292934	6.483320191	0	0.011981513	3.760329356	1.737659045	21.30641011	1.91100136	2.99082234	0	0	5.626576715	3.023881003	0	0	0.728144515	0.597674974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8585
H4590_029_0	2011	1																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	1101.338972	137.7210265	702.6577165	459.550189	310.7120455	8.847001864	9.185432507	152.3495982	176.7971448	31.29206383	64.61807802	0	9.859150255	1057.385329	7648.301231	8246.598913	850.0410864	721.7638339	0	0	24.35587016	1268.613836	639.2392537	413.7347316	399.3312428	120.9148527	21.58006934	3.925906852	307.8924207	326.6271272											6700	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$120 Days 21-76 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$0 (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$15 (3, 9d); $60 (5); $0 (9a); $40/$30 (9c)"	"$0 (7a, 14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $20 (7a1); $0 n/c (14b1, 14e1, 14h1)"	"$10 (7b, 7b1); $0 (7d); $20 (7f, 7f1)"	"$40/$30 (7e, 7h)"	"$15 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 18a); $0/$20 (17a)"	$0 (10b)	"$20 (16a1); $0 n/c (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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$10 (13b); $0 n/c (13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0	0	58.13645779	0	200	0.2	0.116941	49.98185137	0	0	0.138910557	0	0	0.772057119	0.000633836	1.322230767	38.5	15	0	0	0.2	19.82477875	0	20	20	20	0	0	0	10											NO	0	0	56.29527657	0	193.6660014	0.193666001	0.113237479	48.40469032	0	0	0.13451126	0	0	0.747606076	0.000613763	1.310019318	37.28070527	14.5249501	0	0	0.193666001	19.19692815	0	20	20	20	0	0	0	10												0	0	3.296359207	0	5.014529953	1.713363475	1.040135225	0.61453626	0	0	8.691859112	0	0	0.065875641	0.000391187	0.90026699	2.640844267	0.873631973	0	0	4.716903985	2.029457388	0	0.689557886	0.665552071	0.201524754	0	0	0	0.272189273	0	0	0	0	0	0	0	0	0	0	33.427	0	1.012314857	0	0	3.296359207	0	5.014529953	1.713363475	1.040135225	0.61453626	0	0	8.691859112	0	0	0.065875641	0.000391187	0.90026699	2.640844267	0.873631973	0	0	4.716903985	2.029457388	0	0.689557886	0.665552071	0.201524754	0	0	0	0.272189273	0	0	0	0	0	0	0	0	0	0	33.427	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	3.296359207	0	5.014529953	1.713363475	1.040135225	0.61453626	0	0	8.691859112	0	0	0.065875641	0.000391187	0.90026699	2.640844267	0.873631973	0	0	4.716903985	2.029457388	0	0.689557886	0.665552071	0.201524754	0	0	0	0.272189273	0	0	0	0	0	0	0	0	0	0	33.427
H4590_033_0	2011	4																															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	YES	432.6384331	7.12356345	59.32480764	913.8371108	18.66404852	36.45816868	30.14792837	36.21874285	57.44762815	35.49212702	82.57636248	0	0.558818309	24.39835841	45.25498433	236.4141598	3.624109567	11.45048977	0	0	37.91258539	12.4061526	742.0394492	981.4342446	172.4790775	215.6739023	20.5394607	4.03099833	121.7915135	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (16b, 17a, 18a); $0 (17b)"	$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); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.076967472	0.077901944	0.196643055	0	0.233	0.233	0.233	0.092227551	0.233	0.233	0.233	0	0.233	0.233	0.224013644	0.232886745	0.23000391	0.233	0	0	0.233	0.232145883	0	0	0	0	0	0	0	0											NO	0.05985656	0.060583287	0.15292664	0	0.181200943	0.181200943	0.181200943	0.071738697	0.181200943	0.181200943	0.181200943	0	0.181200943	0.181200943	0.174212376	0.181112866	0.178870925	0.181200943	0	0	0.181200943	0.181112107	0	0	0	0	0	0	0	0												25.8962	0.431568887	9.072343496	0	3.381943199	6.606254559	5.462833063	2.598285423	10.40956442	6.4312069	14.96291478	0	0.101258405	4.421005561	7.883978354	42.81764608	0.648247829	2.074839548	0	0	6.86979624	2.246904443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.3168	0	43.5322363	25.8962	0.431568887	9.072343496	0	3.381943199	6.606254559	5.462833063	2.598285423	10.40956442	6.4312069	14.96291478	0	0.101258405	4.421005561	7.883978354	42.81764608	0.648247829	2.074839548	0	0	6.86979624	2.246904443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.3168	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	25.8962	0.431568887	9.072343496	0	3.381943199	6.606254559	5.462833063	2.598285423	10.40956442	6.4312069	14.96291478	0	0.101258405	4.421005561	7.883978354	42.81764608	0.648247829	2.074839548	0	0	6.86979624	2.246904443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.3168
H4590_037_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	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	2373.712523	194.8341995	784.3670048	720.5522072	561.8197671	13.61122341	26.34380602	393.1168546	396.3295611	39.2160797	86.03380083	0	15.01082133	1778.981032	14545.14127	15353.97702	905.1344632	1047.670945	0	0	30.63295966	2208.478316	835.3313294	0	712.2464648	680.5946749	17.46434425	6	443.709734	0											6700	"$75 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$75 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$100 Days 21-87 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$75 (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$15 (3, 9d); $60 (5); $75 (9a); $40/$30 (9c)"	"$0 (7a, 14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14e1, 14h1)"	"$9 (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$15 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $0/$30 (17a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												48.48354159	29.97451514	33.95779769	0	200	0.2	0.0874296	49.98631022	75	0	0.137793264	0	0	29.55095713	0.000308819	29.9070687	38.5	15	0	0	0.2	29.80181754	0	0	30	20	0	0	0	0											NO	40.85033759	25.25535516	28.61151338	0	168.5121847	0.168512185	0.073664765	42.12856304	63.19206927	0	0.11609922	0	0	24.89848173	0.000305152	29.55285163	38.04284938	14.82188937	0	0	0.168512185	25.10984691	0	0	30	20	0	0	0	0												8.0806	0.410050576	1.870160588	0	7.889456364	2.293656994	1.940610269	1.380120683	2.087073756	0	9.988457181	0	0	3.691160562	0.000369874	37.81281707	2.869491171	1.29403857	0	0	5.162026956	4.621212702	0	0	1.780616162	1.134324458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.3062	0	9.736284873	8.0806	0.410050576	1.870160588	0	7.889456364	2.293656994	1.940610269	1.380120683	2.087073756	0	9.988457181	0	0	3.691160562	0.000369874	37.81281707	2.869491171	1.29403857	0	0	5.162026956	4.621212702	0	0	1.780616162	1.134324458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.3062	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.0806	0.410050576	1.870160588	0	7.889456364	2.293656994	1.940610269	1.380120683	2.087073756	0	9.988457181	0	0	3.691160562	0.000369874	37.81281707	2.869491171	1.29403857	0	0	5.162026956	4.621212702	0	0	1.780616162	1.134324458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.3062
H4590_801_0	2011	1																															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	246.6395281	11.40110995	26.84643354	785.7373697	7.871234071	19.88656121	12.82970036	10.26973392	47.85820661	25.68642973	65.91640891	0	0.05741581	10.55903756	36.48544214	194.5478605	5.299724333	7.143769045	0	0	39.96699162	19.39709225	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.077056169	0.077056169	0.186382513	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.059141632	0.059141632	0.143051053	0	0.178830593	0.178830593	0.178830593	0.178830593	0.178830593	0.178830593	0.178830593	0	0.178830593	0.178830593	0.178830593	0.178830593	0.178830593	0.178830593	0	0	0.178830593	0.178830593	0	0	0	0	0	0	0	0												14.5867	0.674280251	3.840410576	0	1.407617454	3.556325528	2.29434292	1.836542604	8.558511453	4.593519454	11.78787047	0	0.010267703	1.888278946	6.524713244	34.7911092	0.947752844	1.277524453	0	0	7.1473208	3.468793504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.1918	0	33.07519967	14.5867	0.674280251	3.840410576	0	1.407617454	3.556325528	2.29434292	1.836542604	8.558511453	4.593519454	11.78787047	0	0.010267703	1.888278946	6.524713244	34.7911092	0.947752844	1.277524453	0	0	7.1473208	3.468793504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.1918	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.5867	0.674280251	3.840410576	0	1.407617454	3.556325528	2.29434292	1.836542604	8.558511453	4.593519454	11.78787047	0	0.010267703	1.888278946	6.524713244	34.7911092	0.947752844	1.277524453	0	0	7.1473208	3.468793504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.1918
H4590_803_0	2011	1																															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	265.912256	11.45750303	33.30312856	923.7145324	9.009153131	21.05724393	13.63416335	10.25663469	51.53765683	25.29285371	71.90389653	0	0.06854107	10.88332876	36.11524208	203.9328219	5.276667601	6.405894324	0	0	45.22345817	20.71079059	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.077065574	0.077065574	0.186384889	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.057797014	0.057797014	0.139783428	0	0.17474345	0.17474345	0.17474345	0.17474345	0.17474345	0.17474345	0.17474345	0	0.17474345	0.17474345	0.17474345	0.17474345	0.17474345	0.17474345	0	0	0.17474345	0.17474345	0	0	0	0	0	0	0	0												15.3689	0.662209466	4.655225463	0	1.574290503	3.679615458	2.382480747	1.792279734	9.005867976	4.419760527	12.56473497	0	0.011977103	1.901790419	6.310902012	35.63592494	0.922063103	1.119388077	0	0	7.902503117	3.619075007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.529	0	37.84868136	15.3689	0.662209466	4.655225463	0	1.574290503	3.679615458	2.382480747	1.792279734	9.005867976	4.419760527	12.56473497	0	0.011977103	1.901790419	6.310902012	35.63592494	0.922063103	1.119388077	0	0	7.902503117	3.619075007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.529	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.3689	0.662209466	4.655225463	0	1.574290503	3.679615458	2.382480747	1.792279734	9.005867976	4.419760527	12.56473497	0	0.011977103	1.901790419	6.310902012	35.63592494	0.922063103	1.119388077	0	0	7.902503117	3.619075007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.529
H4590_804_0	2011	1																															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	263.5947977	11.33236637	32.94989508	918.0467709	8.932443624	20.84136839	13.5087398	10.1588183	50.98006208	25.16680375	71.44139617	0	0.06884229	10.78470727	36.16061308	204.8144099	5.217319468	6.35502146	0	0	44.86974523	20.92310148	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.076054428	0.076054428	0.187811337	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.057128521	0.057128521	0.141075071	0	0.175018676	0.175018676	0.175018676	0.175018676	0.175018676	0.175018676	0.175018676	0	0.175018676	0.175018676	0.175018676	0.175018676	0.175018676	0.175018676	0	0	0.175018676	0.175018676	0	0	0	0	0	0	0	0												15.0588	0.647401325	4.648408786	0	1.563344458	3.647628705	2.364281756	1.77798293	8.922462975	4.404660676	12.50357858	0	0.012048686	1.887525189	6.32878263	35.84634687	0.913128346	1.112247443	0	0	7.853043409	3.661933522	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1536	0	37.48625532	15.0588	0.647401325	4.648408786	0	1.563344458	3.647628705	2.364281756	1.77798293	8.922462975	4.404660676	12.50357858	0	0.012048686	1.887525189	6.32878263	35.84634687	0.913128346	1.112247443	0	0	7.853043409	3.661933522	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1536	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.0588	0.647401325	4.648408786	0	1.563344458	3.647628705	2.364281756	1.77798293	8.922462975	4.404660676	12.50357858	0	0.012048686	1.887525189	6.32878263	35.84634687	0.913128346	1.112247443	0	0	7.853043409	3.661933522	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1536
H4604_003_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	647.6322605	71.50147791	775.8673737	666.9668436	71.85698858	13.97788576	9.642742569	318.4516613	280.6257362	13.19837231	29.45407893	0	0.02528805	771.51886	5079.816001	89.81665304	437.6107379	503.6183253	0	0	15.40652029	1069.45975	0	0	394.5510032	169.4086213	15.67708319	18.75016812	543.9861879	0											3200	"$175 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-42 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$170 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $170 (9a); $40/$30 (9c)"	"$5 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$5 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 18a); $0/$35 (17a)"	$0 n/c (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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												130.3743387	87.20789285	57.30791892	0	200	0.2	0.108435981	48.93798887	170	0.122542386	0.163782621	0	0.2	67.1748791	3.859835739	0.120746734	38.5	35	0	0	0.2	34.85518259	0	0	35	0	0	0	0	0											YES	103.4240506	69.18074224	45.46153149	0	158.6570664	0.158657066	0.086020673	38.83725372	134.8585064	0.097211077	0.129926351	0	0.158657066	53.28884627	3.725803972	0.116592226	37.16309777	33.78463434	0	0	0.158657066	27.6501051	0	0	35	0	0	0	0	0											6500	5.5817	0.412210443	2.939343253	0	0.950051584	2.21769035	0.829475205	1.030648997	3.153730638	1.28302799	3.826861	0	0.004012128	3.426112493	1.577199886	10.47192347	1.355247553	1.41788008	0	0	2.444353312	2.464222873	0	0	1.150773759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5365	0	8.493368385	5.5817	0.412210443	2.939343253	0	0.950051584	2.21769035	0.829475205	1.030648997	3.153730638	1.28302799	3.826861	0	0.004012128	3.426112493	1.577199886	10.47192347	1.355247553	1.41788008	0	0	2.444353312	2.464222873	0	0	1.150773759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5365	NO	"$400 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$400 Days 1-17 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-38 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9962	0.0914	0.6914	0.4923	0.1294	0.453	0.3125	0.1403	1.2814	0.1747	0.7659	0	0.0005	0.5424	1	1.7229	0.1989	0.2368	0	0	0.4757	0.4108	0	0	0.1923	0	0.0076	0	0	0											10.3165	0	1.939383268	6.5779	0.503565348	3.630789885	0.492272108	1.079415055	2.670646997	1.141950526	1.170987384	4.435121786	1.457731087	4.592772874	0	0.004558438	3.968482378	2.577188062	12.19482177	1.554180184	1.65471342	0	0	2.920099927	2.875061867	0	0	1.343033782	0	0.007639257	0	0	0	0	0	0	0	0	0	0	0	0	0	56.853
H4604_005_0	2011	1																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	595.9375633	68.44362847	802.2358112	501.203424	75.59880748	13.75857706	8.004145385	318.571158	258.8568392	12.27747982	27.46268617	0	0.016110801	773.7153953	4721.915868	86.81450323	433.4020746	504.2854739	0	0	15.97322568	1028.871789	0	0	385.8446032	166.4117255	15.64939628	21.00685046	0	0											2400	"$175 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-34 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$170 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $170 (9a); $40/$30 (9c)"	"$5 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$5 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 18a); $0/$35 (17a)"	$0 n/c (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												130.3743387	87.20789285	50.45898914	0	200	0.2	0.112807517	49.04151374	170	0.123408067	0.164524119	0	0.2	67.19426834	3.883092214	0.123376973	38.5	35	0	0	0.2	34.87895546	0	0	35	0	0	0	0	0											YES	96.09944355	64.28128465	37.19352157	0	147.4207954	0.147420795	0.083150869	36.16861895	125.3076761	0.090964577	0.121271382	0	0.147420795	49.52916243	3.708095769	0.117868019	36.76494898	33.42268089	0	0	0.147420795	25.70941678	0	0	35	0	0	0	0	0											6500	4.7724	0.36663703	2.486497912	0	0.928736361	2.028300374	0.665551647	0.960189902	2.703062413	1.116815762	3.330437911	0	0.002375067	3.193456291	1.459109688	10.23265353	1.327833763	1.404547706	0	0	2.354785635	2.204307803	0	0	1.125380093	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6631	0	10.34570202	4.7724	0.36663703	2.486497912	0	0.928736361	2.028300374	0.665551647	0.960189902	2.703062413	1.116815762	3.330437911	0	0.002375067	3.193456291	1.459109688	10.23265353	1.327833763	1.404547706	0	0	2.354785635	2.204307803	0	0	1.125380093	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6631	NO	"$400 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$400 Days 1-17 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-38 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9304	0.0888	0.7153	0.4363	0.1381	0.4525	0.2633	0.1428	1.2015	0.1661	0.7277	0	0.0004	0.4945	0.9337	1.7019	0.1975	0.2377	0	0	0.5006	0.4015	0	0	0.188	0	0.0076	0	0	0											9.9261	0	1.726858269	5.7029	0.455394566	3.201777941	0.436256636	1.066874293	2.480826889	0.928812012	1.102981259	3.904543398	1.282928155	4.058093749	0	0.002728329	3.68793508	2.392834105	11.93457592	1.525296227	1.642228057	0	0	2.855418244	2.605803247	0	0	1.31339759	0	0.007625765	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5892
H4604_006_0	2011	4																															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	YES	322.1871743	22.9644	41.68894425	3025.032645	13.81633142	29.43377192	23.62707237	34.49584572	33.45231531	19.14748993	47.34905111	0	0.164626238	28.45522127	40.09562989	118.5245385	11.2752	6.033669666	0	0	27.25888926	6.343173655	679.7147741	981.4342446	181.2198621	188.6586528	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (16b, 17a, 18a); $0 (17b)"	$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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.081720494	0.08271242	0.164552424	0	0.233	0.233	0.233	0.102545461	0.233	0.233	0.233	0	0.233	0.233	0.22815594	0.232779433	0.232498512	0.233	0	0	0.233	0.23152374	0	0	0	0	0	0	0	0											NO	0.064230536	0.065010169	0.129334637	0	0.183132948	0.183132948	0.183132948	0.080611268	0.183132948	0.183132948	0.183132948	0	0.183132948	0.183132948	0.179325622	0.182959587	0.182738789	0.183132948	0	0	0.183132948	0.182689446	0	0	0	0	0	0	0	0												20.6943	1.492919523	5.391824479	0	2.5302255	5.390293415	4.32689541	2.780753876	6.126221112	3.506536274	8.671171304	0	0.030148488	5.21108855	7.190173758	21.6852006	2.060416396	1.104963712	0	0	4.992000743	1.15883088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3439	0	28.40647601	20.6943	1.492919523	5.391824479	0	2.5302255	5.390293415	4.32689541	2.780753876	6.126221112	3.506536274	8.671171304	0	0.030148488	5.21108855	7.190173758	21.6852006	2.060416396	1.104963712	0	0	4.992000743	1.15883088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3439	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.6943	1.492919523	5.391824479	0	2.5302255	5.390293415	4.32689541	2.780753876	6.126221112	3.506536274	8.671171304	0	0.030148488	5.21108855	7.190173758	21.6852006	2.060416396	1.104963712	0	0	4.992000743	1.15883088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3439
H4604_010_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	659.3717218	70.42768571	789.9313195	679.0567779	73.15952149	14.48323921	9.991364189	324.2036554	285.7125658	13.77567446	30.74241228	0	0.026394159	784.1393236	5171.896503	87.68815802	341.7240197	512.7472835	0	0	15.04100905	1088.845568	0	0	106.7889946	185.7142857	15.45594466	1.8	598.5575223	0											3200	"$175 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-42 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$170 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $170 (9a); $40/$30 (9c)"	"$5 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$5 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 18a); $0/$35 (17a)"	$0 n/c (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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												130.3743387	87.20789285	57.5573353	0	200	0.2	0.108435981	48.93792173	170	0.119535163	0.163136223	0	0.2	67.22554817	3.859835739	0.125598244	38.5	35	0	0	0.2	34.85518259	0	0	35	0	0	0	0	0											YES	103.0930788	68.95935396	45.51327326	0	158.1493411	0.158149341	0.085745395	38.71249481	134.4269399	0.094522037	0.128999431	0	0.158149341	53.15838073	3.72400234	0.121218104	37.14512735	33.7682976	0	0	0.158149341	27.5616208	0	0	35	0	0	0	0	0											6500	5.6647	0.404720642	2.99603	0	0.96417751	2.290514737	0.856713464	1.04589436	3.20062216	1.302104805	3.965753691	0	0.004174219	3.473631392	1.60501289	10.62939224	1.057781853	1.442883572	0	0	2.378725671	2.500862387	0	0	0.311467901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.0952	0	8.749653791	5.6647	0.404720642	2.99603	0	0.96417751	2.290514737	0.856713464	1.04589436	3.20062216	1.302104805	3.965753691	0	0.004174219	3.473631392	1.60501289	10.62939224	1.057781853	1.442883572	0	0	2.378725671	2.500862387	0	0	0.311467901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.0952	NO	"$400 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$400 Days 1-17 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-38 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0091	0.0895	0.6955	0.5075	0.131	0.4669	0.3221	0.1421	1.3306	0.177	0.7925	0	0.0006	0.5625	1.011	1.7493	0.1552	0.2409	0	0	0.4621	0.4156	0	0	0.052	0	0.0075	0	0	0											10.3208	0	2.026201775	6.6738	0.494245871	3.691549308	0.507474958	1.095215937	2.757460054	1.178838967	1.18803956	4.531258518	1.479069901	4.758297408	0	0.004741524	4.036116848	2.616019297	12.3786436	1.21300608	1.683824526	0	0	2.84082282	2.916448054	0	0	0.363504911	0	0.007531498	0	0	0	0	0	0	0	0	0	0	0	0	0	56.4159
H4604_801_0	2011	1																															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	160.3289881	4.6911	24.72445776	795.2382718	3.722592144	16.64720952	11.48419429	18.4975126	46.05720534	15.37274377	34.3065037	0	0.02945414	24.40462874	32.95301132	106.7806957	2.2402	6.850917687	0	0	18.33668564	8.281766801	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.082959544	0.082959544	0.16171643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.070281502	0.070281502	0.137002605	0	0.19739248	0.19739248	0.19739248	0.19739248	0.19739248	0.19739248	0.19739248	0	0.19739248	0.19739248	0.19739248	0.19739248	0.19739248	0.19739248	0	0	0.19739248	0.19739248	0	0	0	0	0	0	0	0												11.2682	0.329697555	3.387315127	0	0.734811693	3.286033964	2.266893587	3.651269877	9.091345962	3.03446401	6.771845828	0	0.005814026	4.817290179	6.504676613	21.07770629	0.442198633	1.352319629	0	0	3.619523845	1.634758484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2761	0	15.02213469	11.2682	0.329697555	3.387315127	0	0.734811693	3.286033964	2.266893587	3.651269877	9.091345962	3.03446401	6.771845828	0	0.005814026	4.817290179	6.504676613	21.07770629	0.442198633	1.352319629	0	0	3.619523845	1.634758484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2761	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.2682	0.329697555	3.387315127	0	0.734811693	3.286033964	2.266893587	3.651269877	9.091345962	3.03446401	6.771845828	0	0.005814026	4.817290179	6.504676613	21.07770629	0.442198633	1.352319629	0	0	3.619523845	1.634758484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2761
H4604_803_0	2011	1																															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	159.4004202	4.6886	24.58126258	792.9320605	3.701032227	16.55079486	11.41768196	18.39038165	45.79045855	15.28371036	34.10781275	0	0.029283553	24.26209015	32.76215932	106.1622602	2.2398	6.811239632	0	0	18.23048614	8.233801782	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.082176246	0.082176246	0.169925245	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.069689654	0.069689654	0.144105287	0	0.197595901	0.197595901	0.197595901	0.197595901	0.197595901	0.197595901	0.197595901	0	0.197595901	0.197595901	0.197595901	0.197595901	0.197595901	0.197595901	0	0	0.197595901	0.197595901	0	0	0	0	0	0	0	0												11.1086	0.326746911	3.542289897	0	0.731308798	3.270369224	2.256087155	3.633864032	9.048006915	3.01999852	6.739563992	0	0.00578631	4.794089564	6.47366839	20.97722747	0.442575299	1.345873032	0	0	3.602269336	1.626965482	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9453	0	14.86165371	11.1086	0.326746911	3.542289897	0	0.731308798	3.270369224	2.256087155	3.633864032	9.048006915	3.01999852	6.739563992	0	0.00578631	4.794089564	6.47366839	20.97722747	0.442575299	1.345873032	0	0	3.602269336	1.626965482	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9453	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.1086	0.326746911	3.542289897	0	0.731308798	3.270369224	2.256087155	3.633864032	9.048006915	3.01999852	6.739563992	0	0.00578631	4.794089564	6.47366839	20.97722747	0.442575299	1.345873032	0	0	3.602269336	1.626965482	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9453
H4604_805_0	2011	1																															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	160.3289881	4.6916	24.72445776	795.2382717	3.722592143	16.64720952	11.48419429	18.49751259	46.05720533	15.37274377	34.30650369	0	0.02945414	24.40332874	32.95301132	106.7806957	2.2392	6.850917685	0	0	18.33668564	8.281766799	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.082959544	0.082959544	0.16171643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.070281575	0.070281575	0.137002747	0	0.197392683	0.197392683	0.197392683	0.197392683	0.197392683	0.197392683	0.197392683	0	0.197392683	0.197392683	0.197392683	0.197392683	0.197392683	0.197392683	0	0	0.197392683	0.197392683	0	0	0	0	0	0	0	0												11.2682	0.329733036	3.387318623	0	0.734812452	3.286037356	2.266895927	3.651273645	9.091355346	3.034467143	6.771852818	0	0.005814032	4.817038541	6.504683327	21.07772804	0.442001696	1.352321025	0	0	3.619527581	1.634760171	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2758	0	15.02197315	11.2682	0.329733036	3.387318623	0	0.734812452	3.286037356	2.266895927	3.651273645	9.091355346	3.034467143	6.771852818	0	0.005814032	4.817038541	6.504683327	21.07772804	0.442001696	1.352321025	0	0	3.619527581	1.634760171	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2758	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.2682	0.329733036	3.387318623	0	0.734812452	3.286037356	2.266895927	3.651273645	9.091355346	3.034467143	6.771852818	0	0.005814032	4.817038541	6.504683327	21.07772804	0.442001696	1.352321025	0	0	3.619527581	1.634760171	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2758
H4604_806_0	2011	1																															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	151.8277652	4.412642	22.7907787	702.4017617	3.30019364	14.75826866	10.18109519	16.39861985	40.83114407	13.62841517	30.41378183	0	0.026112011	21.63472836	29.37985666	95.20227159	1.991781	6.108060282	0	0	16.34840563	7.383759837	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.082662545	0.082662545	0.165094922	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.07007794	0.07007794	0.139960753	0	0.197527913	0.197527913	0.197527913	0.197527913	0.197527913	0.197527913	0.197527913	0	0.197527913	0.197527913	0.197527913	0.197527913	0.197527913	0.197527913	0	0	0.197527913	0.197527913	0	0	0	0	0	0	0	0												10.6398	0.309228861	3.189814552	0	0.651880363	2.915170014	2.011050488	3.239185161	8.065290687	2.69199241	6.007570861	0	0.005157851	4.273462748	5.803341781	18.80510605	0.393432345	1.206512402	0	0	3.22926645	1.458498673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8957	0	13.44978585	10.6398	0.309228861	3.189814552	0	0.651880363	2.915170014	2.011050488	3.239185161	8.065290687	2.69199241	6.007570861	0	0.005157851	4.273462748	5.803341781	18.80510605	0.393432345	1.206512402	0	0	3.22926645	1.458498673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8957	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.8011	0.0233	0.3495	0	0.1049	0.4689	0.3235	0.521	1.2973	0.433	0.9663	0	0.0008	0.6874	0.8895	2.8824	0.0603	0.1849	0	0	0.495	0.2236	0	0	0	0	0	0	0	0											10.7128	0	0	11.4409	0.332511428	3.539349586	0	0.756736516	3.384080459	2.334531649	3.760214037	9.362607492	3.125004328	6.973899657	0	0.005987501	4.960857072	6.692870887	21.68752963	0.453737172	1.391445142	0	0	3.724244449	1.68205556	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6085
H4604_807_0	2011	1																															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	151.8277652	4.412642	22.7907787	702.4017617	3.30019364	14.75826866	10.18109519	16.39861985	40.83114407	13.62841517	30.41378183	0	0.026112011	21.63472836	29.37985666	95.20227159	1.991781	6.108060282	0	0	16.34840563	7.383759837	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.082662545	0.082662545	0.165094922	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.07007794	0.07007794	0.139960753	0	0.197527913	0.197527913	0.197527913	0.197527913	0.197527913	0.197527913	0.197527913	0	0.197527913	0.197527913	0.197527913	0.197527913	0.197527913	0.197527913	0	0	0.197527913	0.197527913	0	0	0	0	0	0	0	0												10.6398	0.309228861	3.189814552	0	0.651880363	2.915170014	2.011050488	3.239185161	8.065290687	2.69199241	6.007570861	0	0.005157851	4.273462748	5.803341781	18.80510605	0.393432345	1.206512402	0	0	3.22926645	1.458498673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8957	0	13.44978585	10.6398	0.309228861	3.189814552	0	0.651880363	2.915170014	2.011050488	3.239185161	8.065290687	2.69199241	6.007570861	0	0.005157851	4.273462748	5.803341781	18.80510605	0.393432345	1.206512402	0	0	3.22926645	1.458498673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8957	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.8011	0.0233	0.3495	0	0.1049	0.4689	0.3235	0.521	1.2973	0.433	0.9663	0	0.0008	0.6874	0.8895	2.8824	0.0603	0.1849	0	0	0.495	0.2236	0	0	0	0	0	0	0	0											10.7128	0	0	11.4409	0.332511428	3.539349586	0	0.756736516	3.384080459	2.334531649	3.760214037	9.362607492	3.125004328	6.973899657	0	0.005987501	4.960857072	6.692870887	21.68752963	0.453737172	1.391445142	0	0	3.724244449	1.68205556	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6085
H4604_808_0	2011	1																															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	151.8277652	4.412642	22.7907787	702.4017617	3.30019364	14.75826866	10.18109519	16.39861985	40.83114407	13.62841517	30.41378183	0	0.026112011	21.63472836	29.37985666	95.20227159	1.991781	6.108060282	0	0	16.34840563	7.383759837	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.082662545	0.082662545	0.165094922	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.07007794	0.07007794	0.139960753	0	0.197527913	0.197527913	0.197527913	0.197527913	0.197527913	0.197527913	0.197527913	0	0.197527913	0.197527913	0.197527913	0.197527913	0.197527913	0.197527913	0	0	0.197527913	0.197527913	0	0	0	0	0	0	0	0												10.6398	0.309228861	3.189814552	0	0.651880363	2.915170014	2.011050488	3.239185161	8.065290687	2.69199241	6.007570861	0	0.005157851	4.273462748	5.803341781	18.80510605	0.393432345	1.206512402	0	0	3.22926645	1.458498673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8957	0	13.44978585	10.6398	0.309228861	3.189814552	0	0.651880363	2.915170014	2.011050488	3.239185161	8.065290687	2.69199241	6.007570861	0	0.005157851	4.273462748	5.803341781	18.80510605	0.393432345	1.206512402	0	0	3.22926645	1.458498673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8957	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.8011	0.0233	0.3495	0	0.1049	0.4689	0.3235	0.521	1.2973	0.433	0.9663	0	0.0008	0.6874	0.8895	2.8824	0.0603	0.1849	0	0	0.495	0.2236	0	0	0	0	0	0	0	0											10.7128	0	0	11.4409	0.332511428	3.539349586	0	0.756736516	3.384080459	2.334531649	3.760214037	9.362607492	3.125004328	6.973899657	0	0.005987501	4.960857072	6.692870887	21.68752963	0.453737172	1.391445142	0	0	3.724244449	1.68205556	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6085
H4605_001_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	V		Coin			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	0	0	0	0	0	0	0											0	NO	411.7733567	2.140493911	419.318503	12.45186148	0.995341524	11.46193573	0.153431674	280.2326239	448.8683997	0	23.75366464	0	0	329.5663572	2651.381859	3795.962339	118.7396187	819.9486035	18.50755863	0	15.94972563	0	0	0	11.38029263	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; $200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$10/Days 1-5, $35/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	10% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $15/Visit for Urgent Care; PBP 4a, 7a"	"$175/Case for OP Surg; $175/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$35/Visit for OP - PT/OT/ST; $35/Visit for OP Substance Abuse; $35/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP OV; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $35/Visit for SCP OV; $35/Visit for Podiatry - cvd; $35/Visit for Vision Exams; $35/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for MH - Non Phys; $35/Visit for Psych Services ; PBP 7e, 7h"	"$35/Visit for OT; $35/Visit for PT/ST; PBP 7c, 7i"	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											0	200	200	24.97374256	0.1	100	0.2	0.2	42.69900401	175	0	0.11143644	0	0	35	15	30.49028295	35	35	0.095545103	0	0.1984	0	0	0	35	0	0	0	0	0											NO	184.856063	184.856063	23.08273863	0.092428031	92.42803148	0.184856063	0.184856063	39.46584887	161.7490551	0	0.102998508	0	0	32.34981102	13.86420472	28.18156832	32.34981102	32.34981102	0.088310458	0	0.183377214	0	0	0	32.34981102	0	0	0	0	0												6.3432	0.032973606	0.806584951	1.150901045	0.007666455	2.118808312	0.028362775	0.921634865	6.050336626	0	2.446592012	0	0	0.888450781	3.063275074	8.914681001	0.320100352	2.210431864	1.634410971	0	2.924816258	0	0	0	0.030679193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8939	0	3.26822556	6.3432	0.032973606	0.806584951	1.150901045	0.007666455	2.118808312	0.028362775	0.921634865	6.050336626	0	2.446592012	0	0	0.888450781	3.063275074	8.914681001	0.320100352	2.210431864	1.634410971	0	2.924816258	0	0	0	0.030679193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8939	YES	$300/Days 1-5 for IP Med/Surg; $300/Days 1-5 for IP Med/Surg; PBP 1a	No Cost Sharing; PBP 1b	"$30/Days 1-5, $50/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	20% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $35/Visit for Urgent Care; PBP 4a, 4b"	"$225/Case for OP Surg; $225/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$35/Visit for OP - PT/OT/ST; $35/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$35/Visit for PCP OV; PBP 7a, 14b, 14c"	"$35/Visit for Chiro - cvd; $35/Visit for SCP OV; $35/Visit for Podiatry - cvd; $35/Visit for Vision Exams; $35/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for Psych Services ; PBP 7e, 7h"	"$35/Visit for OT; $35/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											2500	0.1137	0	0.325	0.4617	0.5673	0.2619	0.0082	0.0493	0.2185	0	0.1016	0	0.0099	0.0671	0.0711	0.5269	0.0061	0.0424	0.2028	0	0.0205	0	0	1.2705	0.0009	0	0	0	0	0											4.3256	0	0.354364421	6.457	0.032973606	1.13154937	1.612618189	0.57498411	2.380753772	0.036579438	0.970951172	6.268869423	0	2.548153984	0	0.009882613	0.955553963	3.134327652	9.441630732	0.326162859	2.252869411	1.837242531	0	2.94531763	0	0	1.270511863	0.031619551	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2195
H4605_002_0	2011	6																															D	D	D	Coin	T	Coin	Coin	V	V		Coin		Coin	V	V	V	V	V	Coin		Coin				V																1.105560166	0.017885957	0.207878596	0.088894772	8.16E-05	0.135675952	0.006937258	0.1688772	0.425362672	0.048972661	0.198284217	0	7.42E-06	0.228749585	0.202009306	0.84182415	0.010231896	0.070991936	0.126672196	0	0	0.00605821	0	0	0	0	0	0	0	0											3.891	NO	468.0940993	13.07785481	542.6463098	17.24701449	0.401404285	16.91913016	0.542324118	332.6297912	448.4423758	0	28.32170886	0	0.022625136	448.7545148	3397.703923	3875.97309	175.657675	1091.005549	18.72568864	0	17.98142291	0	0	0	8.694133419	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; $200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$10/Days 1-5, $35/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	10% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $15/Visit for Urgent Care; PBP 4a, 7a"	"$175/Case for OP Surg; $175/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$35/Visit for OP - PT/OT/ST; $35/Visit for OP Substance Abuse; $35/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP OV; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $35/Visit for SCP OV; $35/Visit for Podiatry - cvd; $35/Visit for Vision Exams; $35/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for MH - Non Phys; $35/Visit for Psych Services ; PBP 7e, 7h"	"$35/Visit for OT; $35/Visit for PT/ST; PBP 7c, 7i"	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											50	198.6174051	198.7509255	24.80732913	0.099489086	99.96108074	0.198738814	0.199230668	41.00757952	173.8097951	0	0.112751307	0	0.099967206	34.7854923	14.90582843	31.52925401	34.78314662	34.75848507	0.098865848	0	0.1984	0	0	0	35	0	0	0	0	0											NO	186.0988515	186.2239563	23.24376083	0.09321844	93.66068554	0.186212608	0.186673461	38.42293402	162.8548275	0	0.105644763	0	0.093666425	32.59301552	13.96633669	29.54201298	32.59081768	32.56771051	0.092634484	0	0.185895149	0	0	0	32.79400312	0	0	0	0	0												7.2593	0.202950822	1.051095087	1.607739786	0.003132983	3.150555358	0.10123752	1.065051044	6.085917145	0	2.992040229	0	0.002119216	1.218855239	3.954456413	9.542003946	0.477068938	2.960962739	1.734644502	0	3.342659293	0	0	0	0.02375962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7756	50	3.146512753	8.3649	0.220836779	1.258973683	1.696634558	0.003214575	3.286231311	0.108174778	1.233928244	6.511279817	0.048972661	3.190324447	0	0.002126635	1.447604824	4.156465719	10.3838281	0.487300835	3.031954675	1.861316698	0	3.342659293	0.00605821	0	0	0.02375962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6665	YES	$300/Days 1-5 for IP Med/Surg; $300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$30/Days 1-5, $50/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	20% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $35/Visit for Urgent Care; PBP 4a, 4b"	"$225/Case for OP Surg; $225/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$35/Visit for OP - PT/OT/ST; $35/Visit for OP Substance Abuse; $35/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$35/Visit for PCP OV; PBP 7a, 14b, 14c"	"$35/Visit for Chiro - cvd; $35/Visit for SCP OV; $35/Visit for Podiatry - cvd; $35/Visit for Vision Exams; $35/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for MH - Non Phys; $35/Visit for Psych Services ; PBP 7e, 7h"	"$35/Visit for OT; $35/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$35/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											3400	0.1104	0.0187	0.1101	0.9304	0.9697	0.5742	0.0728	0.1092	0.2967	0.0323	0.1004	0	0.091	0.1896	0.1501	0.5247	0.064	0.0473	0.1757	0	0.033	0	0	1.2111	0.0006	0	0	0	0	0											5.812	50	0.332173418	8.4753	0.239488271	1.369102979	2.62700896	0.9729428	3.860426257	0.18097663	1.343083787	6.807953647	0.081225746	3.290740938	0	0.093141607	1.637245263	4.306560283	10.90857786	0.551281285	3.079239968	2.037017036	0	3.375636074	0.006061399	0	1.211140602	0.024336276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.4785
H4605_004_0	2011	6																															D	D	D		T	Coin	Coin	V	V		Coin		Coin	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	0	0	0	0	0	0	0											0	NO	522.9213092	10.84931588	628.5615137	0	1.076662491	21.79760019	0.763728266	363.3024076	521.8471526	0	33.57948011	0	0.027546162	587.8028368	4203.814348	4630.550062	206.7763608	1337.056025	22.32335631	0	22.00172934	0	0	0	10.54653243	0	0	0	0	0												$150/Days 1-5 for IP Med/Surg; $150/Days 1-5 for IP Med/Surg; PBP 1a	$150/Days 1-5 for IP MH/SA; PBP 1b	"$0/Days 1-5, $30/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $10/Visit for Urgent Care; PBP 4a, 7a"	"$100/Case for OP Surg; $100/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$25/Visit for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$10/Visit for PCP OV; PBP 7a, 14b, 14c"	"$10/Visit for Chiro - cvd; $25/Visit for SCP OV; $25/Visit for Podiatry - cvd; $25/Visit for Vision Exams; $25/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OT; $25/Visit for PT/ST; PBP 7c, 7i"	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	10% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											0	150	150	17.96849107	0	100	0.1	0.1	40.74919954	100	0	0.114244677	0	0.1	25	10	22.59337348	25	25	0.099283461	0	0.0989	0	0	0	25	0	0	0	0	0											NO	143.811335	143.811335	17.22715125	0	95.87422331	0.095874223	0.095874223	39.06797857	95.87422331	0	0.109531197	0	0.095874223	23.96855583	9.587422331	21.66122135	23.96855583	23.96855583	0.095187247	0	0.094819607	0	0	0	23.96855583	0	0	0	0	0												6.2668	0.130021217	0.902360356	0	0.008602015	2.089827988	0.073221854	1.182790889	4.169307537	0	3.678000637	0	0.002640967	1.174065426	3.358645296	8.358614155	0.413010896	2.670608498	2.124898839	0	2.086195326	0	0	0	0.021065429	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7107	0	1.665846629	6.2668	0.130021217	0.902360356	0	0.008602015	2.089827988	0.073221854	1.182790889	4.169307537	0	3.678000637	0	0.002640967	1.174065426	3.358645296	8.358614155	0.413010896	2.670608498	2.124898839	0	2.086195326	0	0	0	0.021065429	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7107	YES	$200/Days 1-5 for IP Med/Surg; $200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$20/Days 1-5, $40/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	10% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"$200/Case for OP Surg; $200/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	10% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$25/Visit for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$25/Visit for PCP OV; PBP 7a, 14b, 14c"	"$25/Visit for Chiro - cvd; $25/Visit for SCP OV; $25/Visit for Podiatry - cvd; $25/Visit for Vision Exams; $25/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$25/Visit for MH - Non Phys; $25/Visit for Psych Services ; PBP 7e, 7h"	"$25/Visit for OT; $25/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	10% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$25/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											2500	0.1315	0.0282	0.1392	0.3412	0.709	0.3873	0.0446	0.0649	0.363	0	0.0942	0	0	0.1317	0.1231	0.4617	0.0757	0.0505	0.2631	0	0.0406	0	0	1.3896	0.0006	0	0	0	0	0											4.8396	0	0.208262306	6.3983	0.158196216	1.041562868	0.341165676	0.717589339	2.477128935	0.117785985	1.247678252	4.532274436	0	3.772224418	0	0.002640967	1.305814148	3.481718271	8.820299787	0.488733341	2.721157948	2.387988213	0	2.126767709	0	0	1.389598553	0.021639364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5503
H4605_801_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	174.8080283	2.319473566	32.08398251	0	0.332696557	23.714162	2.02394149	25.41945798	67.48346871	9.55559525	30.1180185	0	0.022017548	40.2754394	34.64239148	137.7487267	1.878634675	11.88096207	20.40974967	2.875303439	36.42055227	0.900208946	0	0	0	0	0	0	0	0												Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 7a"	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 14d-j	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											0	0.082690011	0.082690011	0.164797356	0	0.233	0.233	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	0.075925744	0.075925744	0.151316485	0	0.213939968	0.213939968	0.213939968	0.213939968	0.213939968	0.213939968	0.213939968	0	0.213939968	0.213939968	0.213939968	0.213939968	0.213939968	0.213939968	0.213939968	0.213939968	0.213939968	0.213939968	0	0	0	0	0	0	0	0												13.2724	0.176107755	4.854835457	0	0.071177091	5.073407056	0.433001977	5.438238023	14.43741113	2.044323741	6.44344791	0	0.004710433	8.61652621	7.41139212	29.46995816	0.401915042	2.541812643	4.366461189	0.615142325	7.791811782	0.192590673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.6567	0	10.12573939	13.2724	0.176107755	4.854835457	0	0.071177091	5.073407056	0.433001977	5.438238023	14.43741113	2.044323741	6.44344791	0	0.004710433	8.61652621	7.41139212	29.46995816	0.401915042	2.541812643	4.366461189	0.615142325	7.791811782	0.192590673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.6567	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 14d-j	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											6700	0.3472	0.0365	0.4015	0	0.8179	0.5045	0.0674	0.2066	0.4956	0.4001	0.0942	0	0.0527	1.3338	0.2003	0.8974	0.053	0.0492	0.1934	0.0067	0.0631	0.0005	0	0	0	0	0	0	0	0											6.2213	0	0.554260611	13.6196	0.212574258	5.256336288	0	0.889035122	5.577866476	0.500406874	5.644789646	14.93296554	2.444375412	6.537604377	0	0.057425719	9.950289277	7.611712815	30.36736144	0.454878247	2.591017225	4.559903771	0.621811312	7.854945562	0.193127888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.878
H4605_802_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	174.798964	2.319353295	32.08231887	0	0.332679306	23.71293235	2.023836543	25.41813991	67.4799695	9.555099766	30.1164568	0	0.022016406	40.273351	34.64059518	137.741584	1.878537263	11.88034601	20.40869137	2.875154347	36.41866376	0.900162268	0	0	0	0	0	0	0	0												Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 7a"	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 14d-j	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											0	0.082690934	0.082690934	0.1647873	0	0.233	0.233	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	0.075926231	0.075926231	0.151306534	0	0.213938953	0.213938953	0.213938953	0.213938953	0.213938953	0.213938953	0.213938953	0	0.213938953	0.213938953	0.213938953	0.213938953	0.213938953	0.213938953	0.213938953	0.213938953	0.213938953	0.213938953	0	0	0	0	0	0	0	0												13.2718	0.176099755	4.854264479	0	0.071173062	5.073119922	0.432977471	5.437930241	14.43659403	2.04420804	6.443083238	0	0.004710167	8.61603855	7.410972666	29.46829028	0.401892295	2.541668787	4.366214065	0.615107511	7.791370797	0.192579773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.6501	0	10.12574042	13.2718	0.176099755	4.854264479	0	0.071173062	5.073119922	0.432977471	5.437930241	14.43659403	2.04420804	6.443083238	0	0.004710167	8.61603855	7.410972666	29.46829028	0.401892295	2.541668787	4.366214065	0.615107511	7.791370797	0.192579773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.6501	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 14d-j	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											6700	0.3471	0.0365	0.4015	0	0.8178	0.5044	0.0674	0.2065	0.4955	0.4	0.0942	0	0.0527	1.3337	0.2003	0.8974	0.053	0.0492	0.1934	0.0067	0.0631	0.0005	0	0	0	0	0	0	0	0											6.2209	0	0.554259578	13.619	0.212564601	5.25571809	0	0.888984807	5.577550792	0.500378553	5.644470175	14.93212039	2.44423707	6.537234376	0	0.057422469	9.949726131	7.611282024	30.36564277	0.454852503	2.590870585	4.5596457	0.62177612	7.854501005	0.193116958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.8711
H4606_001_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	722.796233	45.56804	465.089409	724.881752	20.144593	13.040795	1.829136	285.351201	342.940454	1232.567118	827.171621	20.384647	0.150882	5.363026	3020.639272	2550.257613	52.693223	678.59797		1408.081321	19.146241	0		4.11					5.05	0.49	581.731553	795.159567									4000	$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $125 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN749: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$125/Visit:9d. $15 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										147.067245	128.620245	43.922851	0	150	0.2	0.2	50	125	41.441788	71.534943	125	0.2	0.2	15	32.843425	35	39.37944		0	0.2	0		0					0	0	0	50.835302									NO	135.834249	118.796231	35.233549	0	136.6062	0.182142	0.182142	45.5354	113.8385	37.741368	65.147445	113.8385	0.182142	0.182142	13.66062	29.91077	31.87478	35.863171		0	0.182142	0		0					0	0	0	46.296116										8.1817	0.451109284	1.36556254	0	0.229323025	2.375276483	0.333162489	1.082798423	3.253318906	3.876564099	4.490676474	0.193379803	0.027481949	0.976832282	3.438650438	6.356680742	0.139965408	2.028056253	0	0	3.487334628	0	0	0	0	0	0	0	0	0	0	3.067733296	0	0	0	0	0	0	0	0	45.3556	0	4.517339504	8.1817	0.451109284	1.36556254	0	0.229323025	2.375276483	0.333162489	1.082798423	3.253318906	3.876564099	4.490676474	0.193379803	0.027481949	0.976832282	3.438650438	6.356680742	0.139965408	2.028056253	0	0	3.487334628	0	0	0	0	0	0	0	0	0	0	3.067733296	0	0	0	0	0	0	0	0	45.3556	YES	$225/Day(Days 1-8)	$225/Day(Days 1-8)	$0/Day(Days 1-20) $137(Days 21-100)	25% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		50%-80%					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									6000	1.3677	0.0754	0.2053	2.2003	0.878	2.2485	0.3154	0.1549	2.6584	0.4932	1.078	0.0619	0.004	0.1426	1.3514	1.7796	0.0228	0.2526		0.2268	0.7079	0		0					0	0	0.1696	0.445									16.8391	0	2.461500274	9.5494	0.526519616	1.570863537	2.200347338	1.107295923	4.62374991	0.648539333	1.237660532	5.91173903	4.369794514	5.568649423	0.255250226	0.031493205	1.119410984	4.790020381	8.136271093	0.16272282	2.280608194	0	0.22679877	4.195222919	0	0	0	0	0	0	0	0	0	0.169566857	3.512725613	0	0	0	0	0	0	0	0	62.1947
H4606_006_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	800.282887	40.552213	394.855714	451.789702	24.773796	8.434953	1.909929	249.696446	308.034454	1156.473298	908.023947	36.261464	0.260119	4.834744	2922.641493	2945.455969	70.786166	740.232452		1266.409024	17.904364	0		4.11					5.05	0.49	524.826147	726.42914									3400	$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $125 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN749: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$125/Visit:9d. $15 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										147.067245	128.620245	43.922851	0	150	0.2	0.2	50	125	29.905838	70.713988	125	0.2	0.2	10	32.25428	35	38.957615		0	0.2	0		0					0	0	0	50.761541									NO	131.745191	115.220073	32.452398	0	132.6672	0.17689	0.17689	44.2224	110.556	26.450158	62.542845	110.556	0.17689	0.17689	8.84448	28.527233	30.95568	34.455984		0	0.17689	0		0					0	0	0	44.895944										8.7861	0.389369079	1.067834565	0	0.273889179	1.492058836	0.337847341	0.920181343	2.837921425	2.549075121	4.732533414	0.334076868	0.04601245	0.855217866	2.154103686	7.002142393	0.182602825	2.125453127	0	0	3.167102948	0	0	0	0	0	0	0	0	0	0	2.717810166	0	0	0	0	0	0	0	0	41.9714	0	5.589771174	8.7861	0.389369079	1.067834565	0	0.273889179	1.492058836	0.337847341	0.920181343	2.837921425	2.549075121	4.732533414	0.334076868	0.04601245	0.855217866	2.154103686	7.002142393	0.182602825	2.125453127	0	0	3.167102948	0	0	0	0	0	0	0	0	0	0	2.717810166	0	0	0	0	0	0	0	0	41.9714	YES	$225/Day(Days 1-8)	$225/Day(Days 1-8)	$0/Day(Days 1-20) $137(Days 21-100)	25% Coins	$150/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		50%-80%					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									4000	1.3418	0.0595	0.1369	1.3774	0.9826	1.7647	0.3996	0.1233	2.0357	0.3227	0.9026	0.0913	0.0063	0.117	1.1876	1.8266	0.0273	0.2741		0.2111	0.5881	0		0					0	0	0.1268	0.3832									14.2861	0	3.772572222	10.1279	0.448831702	1.204697771	1.37736972	1.256500901	3.256762825	0.73742989	1.043504491	4.873635565	2.871753529	5.63516766	0.425403873	0.052305913	0.972190797	3.341708154	8.828711769	0.209922465	2.399534808	0	0.211050034	3.755221503	0	0	0	0	0	0	0	0	0	0.126834826	3.101025713	0	0	0	0	0	0	0	0	56.2575
H4738_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	O	V	V	V	V	P	P	Coin	O	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	1052.207203	14.73567998	404.3382336	73.50770592	287.9814579	7.489578905	10.85421239	261.3948584	299.5631342	812.3288593	15.70050812	41.25258089	0.171426893	305.3462062	3428.670975	8353.162576	191.8854307	1231.780668	0	0	24.03650237	8.62711928	3.697336834	425	358.805999	24.40242311	29.37328707	0	500	0											3400	1a1: $169.02	1b1: $118.23	21: $40.74	6: $10	10a: $100	11a: 20.0%	"11b: 20.0%,11c: 20.0%"	"4a1: $50,4a2: $500,4b: $44"	"9a1: $250,9b: $100"	"8a1: $15,8a2: $15"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: $225,9a2: $250"	12: 20.0%	"3: $30,9a3: $250,9c: $30,9d1: $30"	7a: $10	"7b1: $30,7d1: $30,7f1: $30,7g: $30,17b1: $10"	"7e: $30,7h: $30"	"7c: $35,7i: $35"	7d2: $30	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16a1: $1.225	$0 	17b2: $10	$0 	$0 	$0 	$0 												169.02	118.23	40.74	10	100	0.2	0.2	49.69026549	155.7915058	15	0.2	250	0.2	136.4558151	6.346703893	27.21636237	30	35	0	0	0.2	0	0	1.225	0	10	0	0	0	0											NO	157.5960582	110.2389182	37.98641232	9.324107098	93.24107098	0.186482142	0.186482142	46.33173571	145.2616685	13.98616065	0.186482142	233.1026774	0.186482142	127.2328634	5.917734681	25.37682776	27.97232129	32.63437484	0	0	0.186482142	0	0	1.142203119	0	9.324107098	0	0	0	0												13.8186	0.135370452	1.279946571	0.057116144	2.237641629	1.396672717	2.024116776	1.009239791	3.62625339	0.94678016	2.927864384	0.801340588	0.031968054	3.237506012	1.690830428	17.66473066	0.447290077	3.349866003	0	0	4.482378446	0	0	0.040453027	0	0.018960901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.225		4.43812166	13.8186	0.135370452	1.279946571	0.057116144	2.237641629	1.396672717	2.024116776	1.009239791	3.62625339	0.94678016	2.927864384	0.801340588	0.031968054	3.237506012	1.690830428	17.66473066	0.447290077	3.349866003	0	0	4.482378446	0	0	0.040453027	0	0.018960901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.225	YES	1a1: 20.0%	1b1: 20.0%	21: 20.0%	6: 20.0%	10a: 20.0%	11a: 30.0%	"11b: 30.0%,11c: 20.0%"	"4a1: 20.0%,4b: 20.0%"	"9a1: 20.0%,9b: 20.0%"	"8a1: 20.0%,8a2: 20.0%"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: 20.0%,9a2: 20.0%"	12: 20.0%	"3: 20.0%,9a3: 20.0%,9c: 20.0%,9d1: 20.0%"	"7a: 20.0%,14b1: 20.0%,14c1: 20.0%,14d1: 20.0%,14e1: 20.0%,14f1: 20.0%,14g1: 20.0%,14h1: 20.0%,14i: 20.0%,14j: 20.0%"	"7b1: 20.0%,7d1: 20.0%,7f1: 20.0%,7g: 20.0%,17a1: 50.0%,17b1: 50.0%,18a1: 50.0%"	"7e: 20.0%,7h: 20.0%"	"7c: 20.0%,7i: 20.0%"	7d2: 20.0%	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	"13a1: 20.0%,14a: 20.0%"	$0 	16b1: 50.0%	17a2: 50.0%	17b2: 50.0%	18a2: 50.0%	18b: 50.0%	$0 	$0 											5100	4.0731	0.0225	0.2934	0.2821	0.1165	0.2333	0.2866	0.212	0.8913	0.1663	0.3261	0.0303	0.0036	0.0755	0.844	2.3991	0.0254	0.1128	0	0	0.4992	0.0038	0	0	0.0168	0.0012	0.001	0	0	0											10.9159	2000	0.791279082	17.8917	0.157908347	1.573318166	0.339180683	2.354190388	1.629992932	2.310688977	1.221227918	4.517579482	1.113098906	3.253939319	0.8316032	0.035528322	3.312964519	2.534821926	20.06382785	0.472698178	3.462702126	0	0	4.981578911	0.003817721	0	0.040453027	0.016831278	0.020165281	0.000997432	0	0	0	0	0	0	0	0	0	0	0	0	0	72.1409
H4738_002_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	O	V	V	V	V	P	P	Coin	O	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	1110.957884	15.55845637	426.9147249	77.61205704	304.061092	7.907926131	11.46049877	275.9900123	316.2894388	857.6857756	16.57749521	43.55594589	0.181002327	322.3954126	3620.113075	8819.566904	202.5994799	1300.557952	0	0	25.37911511	9.10882016	3.903780069	0	378.840168	25.76494845	31.01336388	0	500	0											3400	1a1: $169.02	1b1: $118.23	21: $40.74	6: $10	10a: $100	11a: 20.0%	"11b: 20.0%,11c: 20.0%"	"4a1: $50,4a2: $500,4b: $30"	"9a1: $250,9b: $100"	"8a1: $15,8a2: $15"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: $225,9a2: $250"	12: 20.0%	"3: $30,9a3: $250,9c: $30,9d1: $30"	7a: $10	"7b1: $30,7d1: $30,7f1: $30,7g: $30,17b1: $10"	"7e: $30,7h: $30"	"7c: $35,7i: $35"	7d2: $30	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16a1: $1.225	$0 	17b2: $10	$0 	$0 	$0 	$0 												169.02	118.23	40.74	10	100	0.2	0.2	48.96755162	155.7915058	15	0.2	250	0.2	136.4585845	6.346703893	27.21636237	30	35	0	0	0.2	0	0	0	0	10	0	0	0	0											NO	156.6239296	109.5589113	37.75209379	9.266591504	92.66591504	0.18533183	0.18533183	45.37622978	144.3656244	13.89988726	0.18533183	231.6647876	0.18533183	126.450596	5.881231237	25.22029123	27.79977451	32.43307026	0	0	0.18533183	0	0	0	0	9.266591504	0	0	0	0												14.5002	0.142047295	1.343077061	0.059933269	2.348008277	1.465590422	2.12399521	1.043615518	3.805110194	0.993477965	3.072337525	0.840864913	0.033545492	3.397257672	1.774226841	18.53600382	0.469351655	3.515090619	0	0	4.703557849	0	0	0	0	0.019896104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.1872		5.080124702	14.5002	0.142047295	1.343077061	0.059933269	2.348008277	1.465590422	2.12399521	1.043615518	3.805110194	0.993477965	3.072337525	0.840864913	0.033545492	3.397257672	1.774226841	18.53600382	0.469351655	3.515090619	0	0	4.703557849	0	0	0	0	0.019896104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.1872	YES	1a1: 20.0%	1b1: 20.0%	21: 20.0%	6: 20.0%	10a: 20.0%	11a: 30.0%	"11b: 30.0%,11c: 20.0%"	"4a1: 20.0%,4b: 20.0%"	"9a1: 20.0%,9b: 20.0%"	"8a1: 20.0%,8a2: 20.0%"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: 20.0%,9a2: 20.0%"	12: 20.0%	"3: 20.0%,9a3: 20.0%,9c: 20.0%,9d1: 20.0%"	"7a: 20.0%,14b1: 20.0%,14c1: 20.0%,14d1: 20.0%,14e1: 20.0%,14f1: 20.0%,14g1: 20.0%,14h1: 20.0%,14i: 20.0%,14j: 20.0%"	"7b1: 20.0%,7d1: 20.0%,7f1: 20.0%,7g: 20.0%,17a1: 50.0%,17b1: 50.0%,18a1: 50.0%"	"7e: 20.0%,7h: 20.0%"	"7c: 20.0%,7i: 20.0%"	7d2: 20.0%	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	"13a1: 20.0%,14a: 20.0%"	$0 	16b1: 50.0%	17a2: 50.0%	17b2: 50.0%	18a2: 50.0%	18b: 50.0%	$0 	$0 											5100	4.3004	0.0238	0.3098	0.2978	0.1231	0.2464	0.3026	0.2238	0.9411	0.1756	0.3443	0.032	0.0038	0.0797	0.8911	2.5331	0.0268	0.1191	0	0	0.5271	0.004	0	0	0.0178	0.0013	0.0011	0	0	0											11.5254	2000	0.912185461	18.8007	0.165843141	1.652835583	0.357741219	2.471067128	1.711943261	2.426574544	1.267444717	4.746223303	1.169086817	3.416626107	0.872817911	0.037304627	3.476931083	2.665361377	21.06910714	0.496178983	3.634229456	0	0	5.230642275	0.004030968	0	0	0.017771063	0.021167732	0.001053124	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7126
H4754_001_0	2011	7																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V	V																																																				0	YES	475.8797062	12.84010436	331.4988418	135.6934905	77.86429873	1445.858725	0	351.3448861	259.5553346	1348.399464	596.9343455	0	0	756.2206169	2787.148603	2384.990978	156.3837526	873.7842944	2233.648045	12472.413	480.7560719	28.97195485	0	0	120.9112463	14.12752457	0	0	1641.361223	0											3400	"$225 Copay per Day for Days 1-6, $0 Copay for Days After Day 6, Unlimited Coverage"	"$225 Copay per Day for Days 1-6, $0 Copay for Days After Day 6, Unlimited Coverage"	"$0 Copay per Day for Days 1-20, $50 Copay per Day for Days 21-100"	No Cost Sharing for Home Health	$50 Copay for Ambulance	0-20%; Max OOP $500/yr for DME/Prosthetics Combined	0-20%; Max OOP $500/yr for DME/Prosthetics Combined; $0 Copay for Diabetes Monitoring Supplies	$50 Copay for Emergency Care/Post Stabilization Care; $30 Urgently Needed Services; Worldwide Coverage	$225 Copay for Outpatient Hospital Services and ASC Services	$0-$10 Copay for OP Diagnostic Procedures and Tests and Lab  Services	"$10 Copay per Day for X-Ray, $100 Copay per CT, $150 Copay per MRI/Nuclear, $300 Copay per PET"	No Cost Sharing for Observation (Partial Hospitalization is covered in h5)	No Cost Sharing for Renal Dialysis	$30 Copay for Outpatient Substance Abuse Services; $30 Copay for CORF Visits; $225 Partial Hospitalization; $0 Copay for Cardiac Rehabilitation Services	$15 Copay for Primary Care Physician Services	$30 Copay for Physician Specialist Services (Excluding MH and Radiology)	$30 Copay for Mental Health Specialty Services; $30 Copay for Psychiatric Services	$30 Copay (Medicare FFS Benefit Limit) for Independent Occupational Therapy Services; $30 Copay (Medicare FFS Benefit Limit) for Physical/Speech Therapy	$10 X-Ray (per day) Copay for Specialist Services (Radiology Only); No Other Cost Sharing	"$15 Copay for Chiropractic Services; $30 Copay for Podiatry Services; $30 Copay for Other Health Care Professional Services; $0 Copay for Immunizations, (Routine) Physical Exams, Pap Smears and Pelvic Exams, Screening, Prostate Cancer Screening, Colorectal Screening, Bone Mass Measurement, Mammography Screening, Diabetes Monitoring, Nutritional Training (diabetes and renal, disease)"	20% Coinsurance for Medicare Part  B Drugs	"$30 Copay for Medicare Covered Dental, Hearing and Vision Services; $0 Copay for Blood"	Non-Covered	Non-Covered	$30 Copay for Exam Every 2 Years	$100 Benefit Every 2 Years	"$30 Copay for Routine Hearing Test (please note that, historically, services are covered under other services e.g., office visits, and are typically not charged a copay above that for the primary service)"	Non-Covered	"$15 Copay for Acupuncture, Additional Chiropractic, Naturopath, Additional X-Ray, Additional Lab, Massage with a $500 Yearly Benefit Max; $0 Copay for Nutrition Benefit"	Non-Covered												160.5107716	106.1047945	0.427236265	0	50	11.89129953	0	42.07093899	225	9.149337386	80.85042499	0	0	7.334157117	15	30	30	30	8.402805902	2.098580448	39.4192638	30	0	0	30	30	0	0	13.96401943	0											NO	156.1362434	103.2130358	0.415592454	0	48.63731009	11.56721645	0	40.92434611	218.8678954	8.899983192	78.64694383	0	0	7.134273479	14.59119303	29.18238606	29.18238606	29.18238606	8.173797526	2.04138616	38.34493914	29.18238606	0	0	29.18238606	29.18238606	0	0	13.58344686	0												6.1918	0.110438846	0.011480701	0	0.315592504	1.393713403	0	1.19821331	4.734027485	1.000061047	3.912255162	0	0	0.449590391	3.388985272	5.799977288	0.380304253	2.124925884	1.521448906	2.12175094	1.536213527	0.070455898	0	0	0.294039889	0.03435624	0	0	1.857945246	0	0	0	0	0	0	0	0	0	0	0	38.4476		1.077201377	6.1918	0.110438846	0.011480701	0	0.315592504	1.393713403	0	1.19821331	4.734027485	1.000061047	3.912255162	0	0	0.449590391	3.388985272	5.799977288	0.380304253	2.124925884	1.521448906	2.12175094	1.536213527	0.070455898	0	0	0.294039889	0.03435624	0	0	1.857945246	0	0	0	0	0	0	0	0	0	0	0	38.4476	YES	OON 15%	OON 15%	OON 15%	No Cost Sharing	OON $50 Ambulance	OON 20% DME	OON 20%	$50 ER / $30 Urgent Care	OON 15% Coin OP Surg/ASC	OON 15% Diagnostic	OON 15%	No Cost Sharing for Observation (Partial Hospitalization is covered in h5)	No Cost Sharing for Renal Dialysis	OON 15% OP MH/SA Visits/OON 15% Partial Hospitalization	OON $30 PCP / $40 Specialist	OON $30 PCP / $40 Specialist	OON 15% OP MH/SA Visits	OON 15%	OON 15% Diagnostic/OON 15% Bone Mass/OON 15% Coloretal Screening/OON 15% Mammograms	OON $30 Copay Chiro/OON 15% Podiatry	OON 20% Part B Rx	OON 15%	Non-Covered	Non-Covered	OON 15% Coin Mand Suppl Vision Exams	$100 Vision Hardware Coverage	15% Coin Mand Suppl Hearing Exams	$250 Hearing Aids Coverage	$15 Copay with a $500 yearly max benefit	Non-Covered											5400	5.3523	0.0693	0.3086	0	0.0934	0.6838	0	0.3794	2.0907	0.2311	0.6491	0	0	0.5697	1.9942	2.2222	0.1101	0.2105	0.4624	4.1346	0.452	0.0132	0	0	0	0.0062	0	0	0	0											20.0328		0.3	11.5441	0.179719249	0.320094871	0	0.408998592	2.077550265	0	1.577613322	6.824775929	1.231143674	4.561325509	0	0	1.019259106	5.383226217	8.022222081	0.490417368	2.335452018	1.983800451	6.256369698	1.98816629	0.083636654	0	0	0.294039889	0.040515414	0	0	1.857945246	0	0	0	0	0	0	0	0	0	0	0	58.4804
H4785_001_0	2011	6	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	1652.730296	102.5201336	377.8265219	1813.795925	3.101879626	13.81865313	3.038574632	412.8653399	58.24376845	13.19233153	19.53138559	7.359404161	0.322319267	28.14981322	3197.526218	3474.558125	53.44772899	1.449229103		1524.562006	18.70206192	0							4.21	0.73	1772.734697	510.0640262	304.4412458	0	0	423.3469503						$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						147.067245	128.620245	66.51235	0	0.2	0.2	0.2	50	0.240065	0.25	0.242867	0.25	0.2	0.233434	15	35	35	0.25		0	0.2	0							0	0	0	0	16.087546	0	0	15					NO	125.217464	109.511135	44.594801	0	0.170966	0.170966	0.170966	42.7416	0.205215	0.213708	0.20761	0.213708	0.170966	0.199547	12.82248	29.91912	29.91912	0.213708		0	0.170966	0							0	0	0	0	13.752149	0	0	12.82248						17.2459	0.935591349	1.404091546	0	0.530315952	2.362519852	0.519492951	1.470543768	11.95249494	2.819306786	4.054910962	1.572763544	0.055105636	5.617210779	3.416684665	8.662976792	0.133259085	0.309711853	0	0	3.197416718	0	0	0	0	0	0	0	0	0	0	0	0.348893448	0	0	0.45236315	0	0	0	0	67.0615	0	11.92505692	17.2459	0.935591349	1.404091546	0	0.530315952	2.362519852	0.519492951	1.470543768	11.95249494	2.819306786	4.054910962	1.572763544	0.055105636	5.617210779	3.416684665	8.662976792	0.133259085	0.309711853	0	0	3.197416718	0	0	0	0	0	0	0	0	0	0	0	0.348893448	0	0	0.45236315	0	0	0	0	67.0615	YES	$195/Day(Days 1-8)	$195/Day(Days 1-8)	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins										20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					5000	2.6276	0.1425	0.2167	0	2.1582	1.5848	0.3485	0.2236	1.8544	0.4374	0.6291	0.244	0.0085	0.8715	0.6134	1.5554	0.0239	0.0481		0	0.5889										0.5169	0	0.0626	0	0	0.0812					14.8374	0	2.292303842	19.8735	1.078140177	1.620789209	0	2.688486845	3.947327584	0.867975327	1.694102816	13.80693049	3.256722908	4.684031857	1.816778273	0.063655283	6.488754842	4.030118078	10.21833233	0.157184494	0.3577637	0	0	3.786322363	0	0	0	0	0	0	0	0	0	0.516859867	0	0.411533967	0	0	0.533580675	0	0	0	0	81.8989
H4785_003_0	2011	2	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	NO	332.092138	7.175681	378.172018	1815.454515	3.118327	13.891927	3.054687	413.242877	76.665198	13.262284	30.19847	7.398427	0.324028	28.299079	31.466178	56.700934	0.378662	5.063582		1525.956112	18.80123	0							4.21	0.73	1774.35574	510.530445	164.657029									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	20% Coins:8a.Lab -- OP	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"									0.078101	0.078101	45.408962	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	0.2	0							0	0	0	0	0								NO	0.070401	0.070401	36.317725	0	0.178836	0.178836	0.178836	44.70905	0.178836	0.178836	0.178836	0.178836	0.178836	0.178836	0.178836	0.178836	0.178836	0.178836		0	0.178836	0							0	0	0	0	0									23.3796	0.505175118	1.144528946	0	0.557669127	2.484376657	0.546288004	1.539641371	13.71049735	2.371773821	5.400573581	1.323105091	0.057947871	5.060894092	5.627285409	10.14016823	0.067718397	0.905550751	0	0	3.362336768	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.1851	0	9.189316592	23.3796	0.505175118	1.144528946	0	0.557669127	2.484376657	0.546288004	1.539641371	13.71049735	2.371773821	5.400573581	1.323105091	0.057947871	5.060894092	5.627285409	10.14016823	0.067718397	0.905550751	0	0	3.362336768	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.1851	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Day(Days 1-20) $137(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		$0/Visit	20% Coins	$0/Service									$0/Service	$0/Visit	$0/Visit								6700	3.6302	0.0784	0.1762	0	2.2707	1.6674	0.3667	0.2342	2.2224	0.3682	0.8932	0.2054	0.009	0.7857	1.037	1.8686	0.0125	0.1593		0	0.6196	0									0	0	0								16.6046	0	1.630470046	27.0098	0.583613891	1.320714995	0	2.828362504	4.151812873	0.912939587	1.77382961	15.93290623	2.739951298	6.293793291	1.528494821	0.066943222	5.846547161	6.664278895	12.00879369	0.080197527	1.064857448	0	0	3.981946594	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7898
H4785_801_0	2011	2																															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	379.088017	3.382193	79.35351	27.405191	3.112596	13.852294	5.647645	25.868038	82.55273	21.336055	37.53916	8.126317	0.519972	28.591604	45.949898	89.448846	0.80571	13.606864		9.349158	37.906189	0																				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.078101	0.078101	0.209648	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.058392	0.058392	0.057012	0	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951		0.183951	0.183951	0																				22.1357	0.197493014	4.524102312	0	0.572565147	2.548143334	1.038889945	4.758451458	15.18565724	3.924788653	6.905366021	1.494844138	0.095649369	5.259454147	8.452529687	16.45420467	0.14821116	2.50299624	0	1.719786963	6.972881373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.8917	0	40.45752836	22.1357	0.197493014	4.524102312	0	0.572565147	2.548143334	1.038889945	4.758451458	15.18565724	3.924788653	6.905366021	1.494844138	0.095649369	5.259454147	8.452529687	16.45420467	0.14821116	2.50299624	0	1.719786963	6.972881373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.8917	YES	7% Coins	7% Coins	20% Coins	0% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins		23% Coins	23% Coins	23% Coins																			6700	3.4325	0.0306	0.6951	0	2.3225	1.7037	0.6946	0.7359	2.4613	0.6069	1.1352	0.2312	0.0148	0.8134	1.5517	3.0206	0.0272	0.4346		0.3157	1.2801	0																			21.5075	0	7.266173338	25.5682	0.228117117	5.219158767	0	2.895025378	4.251858803	1.733502945	5.494304856	17.64699164	4.531723183	8.040550315	1.726008731	0.11044084	6.072831675	10.00422104	19.47482043	0.175419295	2.937594052	0	2.035500491	8.252942983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3992
H4785_802_0	2011	2																															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	379.088017	3.382193	79.35351	27.405191	3.112596	13.852294	5.647645	25.868038	82.55273	21.336055	37.53916	8.126317	0.519972	28.591604	45.949898	89.448846	0.80571	13.606864		9.349158	37.906189	0																				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.078101	0.078101	0.209648	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.058392	0.058392	0.057012	0	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951		0.183951	0.183951	0																				22.1357	0.197493014	4.524102312	0	0.572565147	2.548143334	1.038889945	4.758451458	15.18565724	3.924788653	6.905366021	1.494844138	0.095649369	5.259454147	8.452529687	16.45420467	0.14821116	2.50299624	0	1.719786963	6.972881373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.8917	0	40.45752836	22.1357	0.197493014	4.524102312	0	0.572565147	2.548143334	1.038889945	4.758451458	15.18565724	3.924788653	6.905366021	1.494844138	0.095649369	5.259454147	8.452529687	16.45420467	0.14821116	2.50299624	0	1.719786963	6.972881373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.8917	YES	7% Coins	7% Coins	20% Coins	0% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins		23% Coins	23% Coins	23% Coins																			6700	3.4325	0.0306	0.6951	0	2.3225	1.7037	0.6946	0.7359	2.4613	0.6069	1.1352	0.2312	0.0148	0.8134	1.5517	3.0206	0.0272	0.4346		0.3157	1.2801	0																			21.5075	0	7.266173338	25.5682	0.228117117	5.219158767	0	2.895025378	4.251858803	1.733502945	5.494304856	17.64699164	4.531723183	8.040550315	1.726008731	0.11044084	6.072831675	10.00422104	19.47482043	0.175419295	2.937594052	0	2.035500491	8.252942983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3992
H4785_803_0	2011	2																															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	379.088017	3.382193	79.35351	27.405191	3.112596	13.852294	5.647645	25.868038	82.55273	21.336055	37.53916	8.126317	0.519972	28.591604	45.949898	89.448846	0.80571	13.606864		9.349158	37.906189	0																				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.078101	0.078101	0.209648	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.058392	0.058392	0.057012	0	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951	0.183951		0.183951	0.183951	0																				22.1357	0.197493014	4.524102312	0	0.572565147	2.548143334	1.038889945	4.758451458	15.18565724	3.924788653	6.905366021	1.494844138	0.095649369	5.259454147	8.452529687	16.45420467	0.14821116	2.50299624	0	1.719786963	6.972881373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.8917	0	40.45752836	22.1357	0.197493014	4.524102312	0	0.572565147	2.548143334	1.038889945	4.758451458	15.18565724	3.924788653	6.905366021	1.494844138	0.095649369	5.259454147	8.452529687	16.45420467	0.14821116	2.50299624	0	1.719786963	6.972881373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.8917	YES	7% Coins	7% Coins	20% Coins	0% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins		23% Coins	23% Coins	23% Coins																			6700	3.4325	0.0306	0.6951	0	2.3225	1.7037	0.6946	0.7359	2.4613	0.6069	1.1352	0.2312	0.0148	0.8134	1.5517	3.0206	0.0272	0.4346		0.3157	1.2801	0																			21.5075	0	7.266173338	25.5682	0.228117117	5.219158767	0	2.895025378	4.251858803	1.733502945	5.494304856	17.64699164	4.531723183	8.040550315	1.726008731	0.11044084	6.072831675	10.00422104	19.47482043	0.175419295	2.937594052	0	2.035500491	8.252942983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3992
H4837_001_0	2011	6																															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	399.9191941	32.8438	53.71191433	3169.096468	15.14506224	30.58340796	27.73307673	36.80594676	50.15265887	24.01384702	51.6326371	0	0.315075238	38.3513873	48.15893357	153.2617011	16.1758	6.497169775	0	7.841065488	33.09308111	9.935220383	0	0	120.6655306	0	0	0	132	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a); $0 n/c (13a1); FFS (16b, 18a); $0 (17a, 17b)"	$0 n/c (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 (14a1); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.075393538	0.075393538	0.153993856	0	0.233	0.233	0.233	0.093963854	0.233	0.233	0.233	0	0.233	0.233	0.226374986	0.232829425	0.233	0.233	0	0.233	0.233	0.03851536	0	0	0	0	0	0	0	0											NO	0.058657648	0.058657648	0.119810234	0	0.181278561	0.181278561	0.181278561	0.073118986	0.181278561	0.181278561	0.181278561	0	0.181278561	0.181278561	0.176124171	0.18114585	0.181278561	0.181278561	0	0.181278561	0.181278561	0.036650259	0	0	0	0	0	0	0	0												23.4583	1.926540063	6.435237026	0	2.745475087	5.544116181	5.027412238	2.69121349	9.091601822	4.353195628	9.359890147	0	0.057116386	6.952284297	8.481952227	27.76272116	2.932325745	1.177797586	0	1.421417067	5.999066118	0.364128398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.7818	0	35.80141137	23.4583	1.926540063	6.435237026	0	2.745475087	5.544116181	5.027412238	2.69121349	9.091601822	4.353195628	9.359890147	0	0.057116386	6.952284297	8.481952227	27.76272116	2.932325745	1.177797586	0	1.421417067	5.999066118	0.364128398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.7818	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.4583	1.926540063	6.435237026	0	2.745475087	5.544116181	5.027412238	2.69121349	9.091601822	4.353195628	9.359890147	0	0.057116386	6.952284297	8.481952227	27.76272116	2.932325745	1.177797586	0	1.421417067	5.999066118	0.364128398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.7818
H4866_002_0	2011	7																															D	D	D		T	Coin	Coin	V	V		V			V		V	V	V	P		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	830.4215999	24.93189759	576.5618863	0	142.7484354	7.403478206	4.271632163	158.3354611	211.9212312	0	449.1502807	0	0	190.1996128	0	4627.055302	142.5223814	515.0663963	856.6246598	0	40.45877323	561.7050086	0	0	430.5057437	0	0	0	0	0											3400	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical; PBP 1a	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse; PBP 1b	$137.50/Day for SNF	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 0% for Diabetic Supplies; 11c"	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 0% for Diabetic Supplies; 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $25/Visit for PCP Urgent Care; PBP 4a, 4b"	"$100/Case for OP Fac - Surgery; PBP 9a, $50 for ASC; 9b"	No Cost-Sharing; PBP 8a	$20/Case for OP Fac - Radiology; $50/Case for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"$20/Visit for OP Fac - Occ Therapy; $20/Visit for OP Fac - Physical/Speech Therapy; $20/Visit for OP Fac - CORF; $0-$100 - Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$15/Visit for Speclst Office Visits; $15/Visit for Chiropractor; $15/Visit for Vision Exams; $15/Visit for Hearing/Speech Exams; $15/Visit for Podiatrist (Routine); PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse; PBP 7e, 7h"	"$20/Visit for Occ Therapy; $20/Visit for PT/ST; PBP 7c, 7i"	$20/Procedure for Radiology (Office); $50/Procedure for CT/MRI/PET (Office); PBP 8b	"No Cost-Sharing; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"$0-$15/Other for Renal Dialysis - Prof; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$15/Exam for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13c											0	250	250	137.5	0	100	0.2	0.2	47.11297216	100	0	27.76970222	0	0	20	0	15	15	20	24.13109642	0	0.2	15	0	0	15	0	0	0	0	0											NO	235.9502428	235.9502428	129.7726336	0	94.38009714	0.188760194	0.188760194	44.46526889	94.38009714	0	26.20907193	0	0	18.87601943	0	14.15701457	14.15701457	18.87601943	22.77495224	0	0.188760194	14.15701457	0	0	14.15701457	0	0	0	0	0												16.3282	0.490223941	6.235162867	0	1.1227176	1.397481985	0.806314117	0.586702404	1.666762199	0	0.980984335	0	0	0.299184299	0	5.458774111	0.168140953	0.810200275	1.625798809	0	7.637005895	0.662672166	0	0	0.507889674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7842	0	2.785784836	16.3282	0.490223941	6.235162867	0	1.1227176	1.397481985	0.806314117	0.586702404	1.666762199	0	0.980984335	0	0	0.299184299	0	5.458774111	0.168140953	0.810200275	1.625798809	0	7.637005895	0.662672166	0	0	0.507889674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7842	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.3282	0.490223941	6.235162867	0	1.1227176	1.397481985	0.806314117	0.586702404	1.666762199	0	0.980984335	0	0	0.299184299	0	5.458774111	0.168140953	0.810200275	1.625798809	0	7.637005895	0.662672166	0	0	0.507889674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7842
H4875_011_0	2011	7																															A	A	D		P	Coin		P	P	P	P	P	P	P	P	P	P		P	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	YES	564.3155812	27.66855894	290.7917449	0	100.4738126	10.53323524	0	303.1086877	258.7258109	1044.961283	981.5247791	3.275382456	5.202221458	964.9820233	3411.487136	4114.933729	112.1067594	0	598.3106276	1614.183375	13.44765567	0	0	0	0	0	0	0	0	0.103937318											3400	"$100 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$100 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	20% coinsurance; PBP 11a	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$50 copay; PBP 9a, 9b"	$10 - $35 copay; PBP 8a	$15 - $35 copay; PBP 8b	$50 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $30 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15 PCP, $0 Physical Exam/Immun/Screenings/Exams; PBP 7a, 14a-i"	"$30 Specialist, $0 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$30 copay; PBP 7e, 7h, 9c"	$30 copay; included in row i.2.	$15 - $35 copay; PBP 8b	"$0 - $30 copay; PBP 7d, 7g, 8a"	0% - 20% coinsurance; PBP 15	$30 copay; PBP 7g								"20% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											0	100	100	120	0	50	0.2	0	49.43651531	50	10	21.07530521	50	10	25.98422692	15	30	30	0	17.78948203	19.31480179	0.2	0	0	0	0	0	0	0	0	0.2											NO	96.27635624	96.27635624	115.5316275	0	48.13817812	0.192552712	0	47.59567559	48.13817812	9.627635624	20.29053593	48.13817812	9.627635624	25.01666687	14.44145344	28.88290687	28.88290687	0	17.12706509	18.59558738	0.192552712	0	0	0	0	0	0	0	0	0.192552712												4.5275	0.22198567	2.799636962	0	0.403052191	2.028203016	0	1.202221897	1.037882431	0.83837554	1.659638649	0.013139245	0.004173758	2.011719484	4.105569385	9.904270639	0.269830758	0	0.853942088	2.501390666	2.589382575	0	0	0	0	0	0	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	36.9919	0	1.430723446	4.5275	0.22198567	2.799636962	0	0.403052191	2.028203016	0	1.202221897	1.037882431	0.83837554	1.659638649	0.013139245	0.004173758	2.011719484	4.105569385	9.904270639	0.269830758	0	0.853942088	2.501390666	2.589382575	0	0	0	0	0	0	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	36.9919	YES	"$200 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$200 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	30% coinsurance; PBP 11a	"30% coinsurance, $10 Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$75 copay; PBP 9a, 9b"	$20 - $40 copay; PBP 8a	$25 - $40 copay; PBP 8b	$75 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $40 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$40 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams; PBP 7a, 14a-i"	"$40 Specialist, $10 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$40 copay; PBP 7e, 7h, 9c"	$40 copay; included in row i.2.	$25 - 40 copay; PBP 8b	"$0 - $40 copay; PBP 7d, 7g, 8a"	20% coinsurance; PBP 15	$25 copay; PBP 7g								"30% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											6800	0.5018	0.1086	0.2901	0	0.1538	0.3345	0.0252	0.2385	0.0574	0.0442	0.0627	0.0043	0	0.0371	0	2.0817	0.1158	0	0.1475	0.7971	0.0548	0	0	0	0	0	0	0	0	0.0024											5.0577	500	0.195613973	5.0294	0.330579782	3.089745193	0	0.5568145	2.362748568	0.025241506	1.440764589	1.095283015	0.882585962	1.722318716	0.017454851	0.004173758	2.048826276	4.105569385	11.98598157	0.385608189	0	1.001417238	3.298531292	2.644209423	0	0	0	0	0	0	0	0	0.022414803	0	0	0	0	0	0	0	0	0	0	42.0496
H4875_012_0	2011	6																															A	A	D		P	Coin		P	P	P	P	P	P	P	P	P	P		P	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	YES	619.6734998	30.38277397	319.3176731	0	110.3300373	11.56651874	0	332.8428766	284.1061528	1147.469319	1077.809856	3.596689118	5.71254611	1059.644298	3746.14532	4518.598228	123.1041464	0	657.0033736	1772.530645	14.76696389	0	0	0	0	0	0	0	0	0.103937318											3400	"$100 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$100 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	20% coinsurance; PBP 11a	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$50 copay; PBP 9a, 9b"	$10 - $35 copay; PBP 8a	$15 - $35 copay; PBP 8b	$50 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $30 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15 PCP, $0 Physical Exam/Immun/Screenings/Exams; PBP 7a, 14a-i"	"$30 Specialist, $0 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$30 copay; PBP 7e, 7h, 9c"	$30 copay; included in row i.2.	$15 - $35 copay; PBP 8b	"$0 - $30 copay; PBP 7d, 7g, 8a"	0% - 20% coinsurance; PBP 15	$30 copay; PBP 7g								"20% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											0	100	100	120	0	50	0.2	0	49.43651531	50	10	21.07530521	50	10	25.98422752	15	30	30	0	17.78948203	19.31480179	0.2	0	0	0	0	0	0	0	0	0.2											NO	96.27635624	96.27635624	115.5316275	0	48.13817812	0.192552712	0	47.59567559	48.13817812	9.627635624	20.29053593	48.13817812	9.627635624	25.01666745	14.44145344	28.88290687	28.88290687	0	17.12706509	18.59558738	0.192552712	0	0	0	0	0	0	0	0	0.192552712												4.9717	0.243761898	3.074274205	0	0.442590582	2.227164557	0	1.320156798	1.139696049	0.920618041	1.822444966	0.014428172	0.004583193	2.209064084	4.508315266	10.87585432	0.296300466	0	0.937711629	2.746770708	2.843418951	0	0	0	0	0	0	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	40.6188	0	1.570998785	4.9717	0.243761898	3.074274205	0	0.442590582	2.227164557	0	1.320156798	1.139696049	0.920618041	1.822444966	0.014428172	0.004583193	2.209064084	4.508315266	10.87585432	0.296300466	0	0.937711629	2.746770708	2.843418951	0	0	0	0	0	0	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	40.6188	YES	"$200 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$200 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	30% coinsurance; PBP 11a	"30% coinsurance, $10 Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$75 copay; PBP 9a, 9b"	$20 - $40 copay; PBP 8a	$25 - $40 copay; PBP 8b	$75 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $40 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$40 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams; PBP 7a, 14a-i"	"$40 Specialist, $10 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$40 copay; PBP 7e, 7h, 9c"	$40 copay; included in row i.2.	$25 - 40 copay; PBP 8b	"$0 - $40 copay; PBP 7d, 7g, 8a"	20% coinsurance; PBP 15	$25 copay; PBP 7g								"30% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											6800	0.5511	0.1192	0.3186	0	0.1688	0.3674	0.0277	0.2619	0.063	0.0485	0.0688	0.0047	0	0.0407	0	2.2859	0.1271	0	0.1619	0.8753	0.0602	0	0	0	0	0	0	0	0	0.0024											5.5536	500	0.214794094	5.5227	0.363008816	3.392841313	0	0.611436582	2.594528173	0.027717633	1.582099919	1.202727484	0.969165393	1.891273788	0.019167127	0.004583193	2.249810958	4.508315266	13.16177578	0.423435369	0	1.099653714	3.622108795	2.903624173	0	0	0	0	0	0	0	0	0.022414803	0	0	0	0	0	0	0	0	0	0	46.1724
H4875_013_0	2011	6																															A	A	D		P	Coin		P	P	P	P	P	P	P	P	P	P		P	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	YES	569.629085	27.92908159	293.5297927	0	101.4198577	10.63241447	0	305.9627099	261.1619311	1054.800469	990.766657	3.306222925	5.25120473	974.0681372	3443.609145	4153.679276	113.1623384	0	603.9442233	1629.382263	13.57430077	0	0	0	0	0	0	0	0	0.103937318											3400	"$100 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$100 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	20% coinsurance; PBP 11a	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$50 copay; PBP 9a, 9b"	$10 - $35 copay; PBP 8a	$15 - $35 copay; PBP 8b	$50 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $30 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15 PCP, $0 Physical Exam/Immun/Screenings/Exams; PBP 7a, 14a-i"	"$30 Specialist, $0 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$30 copay; PBP 7e, 7h, 9c"	$30 copay; included in row i.2.	$15 - $35 copay; PBP 8b	"$0 - $30 copay; PBP 7d, 7g, 8a"	0% - 20% coinsurance; PBP 15	$30 copay; PBP 7g								"20% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											0	100	100	120	0	50	0.2	0	49.43651531	50	10	21.07530521	50	10	25.9842283	15	30	30	0	17.78948203	19.31480179	0.2	0	0	0	0	0	0	0	0	0.2											NO	96.27635624	96.27635624	115.5316275	0	48.13817812	0.192552712	0	47.59567559	48.13817812	9.627635624	20.29053593	48.13817812	9.627635624	25.0166682	14.44145344	28.88290687	28.88290687	0	17.12706509	18.59558738	0.192552712	0	0	0	0	0	0	0	0	0.192552712												4.5702	0.224075851	2.825997889	0	0.406847265	2.047300247	0	1.213541823	1.047654963	0.846269547	1.675265537	0.013262962	0.004213057	2.030661616	4.14422676	9.997527642	0.27237144	0	0.861982668	2.524943354	2.613768434	0	0	0	0	0	0	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	37.3401	0	1.444187801	4.5702	0.224075851	2.825997889	0	0.406847265	2.047300247	0	1.213541823	1.047654963	0.846269547	1.675265537	0.013262962	0.004213057	2.030661616	4.14422676	9.997527642	0.27237144	0	0.861982668	2.524943354	2.613768434	0	0	0	0	0	0	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	37.3401	YES	"$200 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$200 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	30% coinsurance; PBP 11a	"30% coinsurance, $10 Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$75 copay; PBP 9a, 9b"	$20 - $40 copay; PBP 8a	$25 - $40 copay; PBP 8b	$75 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $40 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$40 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams; PBP 7a, 14a-i"	"$40 Specialist, $10 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$40 copay; PBP 7e, 7h, 9c"	$40 copay; included in row i.2.	$25 - 40 copay; PBP 8b	"$0 - $40 copay; PBP 7d, 7g, 8a"	20% coinsurance; PBP 15	$25 copay; PBP 7g								"30% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											6800	0.5066	0.1096	0.2928	0	0.1552	0.3377	0.0255	0.2408	0.0579	0.0446	0.0633	0.0044	0	0.0375	0	2.1013	0.1169	0	0.1489	0.8046	0.0553	0	0	0	0	0	0	0	0	0.0024											5.1053	500	0.197454968	5.0767	0.333692468	3.118837732	0	0.562057375	2.384995824	0.025479176	1.454330594	1.105596022	0.890896248	1.73853579	0.017619203	0.004213057	2.0681178	4.14422676	12.09883962	0.389239013	0	1.010846421	3.329589726	2.669111522	0	0	0	0	0	0	0	0	0.022414803	0	0	0	0	0	0	0	0	0	0	42.4454
H4875_014_0	2011	6																															A	A	D		P	Coin		P	P	P	P	P	P	P	P	P	P		P	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	YES	609.9336678	29.90522714	314.2987389	0	108.5959047	11.38471986	0	327.6113575	279.6406622	1129.433759	1060.869181	3.540157496	5.622758117	1042.989144	3687.264593	4447.576331	121.1692344	0	646.6768024	1744.670569	14.53473591	0	0	0	0	0	0	0	0	0.103937318											3400	"$100 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$100 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	20% coinsurance; PBP 11a	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$50 copay; PBP 9a, 9b"	$10 - $35 copay; PBP 8a	$15 - $35 copay; PBP 8b	$50 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $30 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15 PCP, $0 Physical Exam/Immun/Screenings/Exams; PBP 7a, 14a-i"	"$30 Specialist, $0 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$30 copay; PBP 7e, 7h, 9c"	$30 copay; included in row i.2.	$15 - $35 copay; PBP 8b	"$0 - $30 copay; PBP 7d, 7g, 8a"	0% - 20% coinsurance; PBP 15	$30 copay; PBP 7g								"20% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											0	100	100	120	0	50	0.2	0	49.43651531	50	10	21.07530521	50	10	25.9842291	15	30	30	0	17.78948203	19.31480179	0.2	0	0	0	0	0	0	0	0	0.2											NO	96.27635624	96.27635624	115.5316275	0	48.13817812	0.192552712	0	47.59567559	48.13817812	9.627635624	20.29053593	48.13817812	9.627635624	25.01666897	14.44145344	28.88290687	28.88290687	0	17.12706509	18.59558738	0.192552712	0	0	0	0	0	0	0	0	0.192552712												4.8935	0.239930525	3.025953736	0	0.435634084	2.192158689	0	1.299406991	1.121782667	0.906148058	1.793800353	0.014201394	0.004511156	2.174342846	4.437454993	10.70491108	0.291643309	0	0.922972974	2.703597835	2.798702825	0	0	0	0	0	0	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	39.9807	0	1.546317559	4.8935	0.239930525	3.025953736	0	0.435634084	2.192158689	0	1.299406991	1.121782667	0.906148058	1.793800353	0.014201394	0.004511156	2.174342846	4.437454993	10.70491108	0.291643309	0	0.922972974	2.703597835	2.798702825	0	0	0	0	0	0	0	0	0.020013412	0	0	0	0	0	0	0	0	0	0	39.9807	YES	"$200 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$200 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	30% coinsurance; PBP 11a	"30% coinsurance, $10 Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$75 copay; PBP 9a, 9b"	$20 - $40 copay; PBP 8a	$25 - $40 copay; PBP 8b	$75 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $40 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$40 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams; PBP 7a, 14a-i"	"$40 Specialist, $10 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$40 copay; PBP 7e, 7h, 9c"	$40 copay; included in row i.2.	$25 - 40 copay; PBP 8b	"$0 - $40 copay; PBP 7d, 7g, 8a"	20% coinsurance; PBP 15	$25 copay; PBP 7g								"30% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											6800	0.5424	0.1174	0.3136	0	0.1662	0.3616	0.0273	0.2578	0.062	0.0478	0.0677	0.0047	0	0.0401	0	2.25	0.1251	0	0.1594	0.8616	0.0593	0	0	0	0	0	0	0	0	0.0024											5.4663	500	0.211419488	5.4359	0.357303158	3.339513707	0	0.601826215	2.553748201	0.027281976	1.557232973	1.183823394	0.953932358	1.861547345	0.018865864	0.004511156	2.214449273	4.437454993	12.95490315	0.416779945	0	1.082369705	3.565177635	2.85796176	0	0	0	0	0	0	0	0	0.022414803	0	0	0	0	0	0	0	0	0	0	45.447
H4875_015_0	2011	6																															A	A	D		P	Coin		P	P	P	P	P	P	P	P	P	P		P	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	YES	582.3008043	28.55037972	300.059528	0	103.6759995	10.86893851	0	312.7690224	266.9716251	1078.265098	1012.806818	3.379771713	5.368020732	995.7368306	3520.214166	4246.080207	115.6796983	0	617.3793021	1665.628788	13.87624895	0	0	0	0	0	0	0	0	0.078816179											3400	"$100 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$100 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	20% coinsurance; PBP 11a	"20% coinsurance, 0% Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$50 copay; PBP 9a, 9b"	$10 - $35 copay; PBP 8a	$15 - $35 copay; PBP 8b	$50 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $30 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15 PCP, $0 Physical Exam/Immun/Screenings/Exams; PBP 7a, 14a-i"	"$30 Specialist, $0 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$30 copay; PBP 7e, 7h, 9c"	$30 copay; included in row i.2.	$15 - $35 copay; PBP 8b	"$0 - $30 copay; PBP 7d, 7g, 8a"	0% - 20% coinsurance; PBP 15	$30 copay; PBP 7g								"20% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											0	100	100	120	0	50	0.2	0	49.43651531	50	10	21.07530521	50	10	25.9842274	15	30	30	0	17.78948203	19.31480179	0.2	0	0	0	0	0	0	0	0	0.2											NO	96.27635624	96.27635624	115.5316275	0	48.13817812	0.192552712	0	47.59567559	48.13817812	9.627635624	20.29053593	48.13817812	9.627635624	25.01666734	14.44145344	28.88290687	28.88290687	0	17.12706509	18.59558738	0.192552712	0	0	0	0	0	0	0	0	0.192552712												4.6718	0.229060544	2.888863801	0	0.415897811	2.092843592	0	1.240537744	1.070960637	0.865095289	1.712532761	0.013558004	0.004306779	2.075834754	4.236417414	10.21992827	0.278430496	0	0.881157958	2.581112138	2.671909375	0	0	0	0	0	0	0	0	0.015176269	0	0	0	0	0	0	0	0	0	0	38.1654	0	1.476110117	4.6718	0.229060544	2.888863801	0	0.415897811	2.092843592	0	1.240537744	1.070960637	0.865095289	1.712532761	0.013558004	0.004306779	2.075834754	4.236417414	10.21992827	0.278430496	0	0.881157958	2.581112138	2.671909375	0	0	0	0	0	0	0	0	0.015176269	0	0	0	0	0	0	0	0	0	0	38.1654	YES	"$200 days 1-5, $0 days 6+, unlimited coverage; PBP 1a"	"$200 days 1-5, $0 days 6-90, plus LTR days; PBP 1b"	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay; PBP 2"	$0 copay; PBP 6	$50 copay; PBP 10a	30% coinsurance; PBP 11a	"30% coinsurance, $10 Diab Mon Supp; PBP 11a, 11b, 11c"	"$50 ER, $40 Urgent Care; PBP 4a, 4b"	"$75 copay; PBP 9a, 9b"	$20 - $40 copay; PBP 8a	$25 - $40 copay; PBP 8b	$75 copay; PBP 9a	$10 copay; PBP 12	"40% for Partial Hosp, $0 - $40 copay for other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$40 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams; PBP 7a, 14a-i"	"$40 Specialist, $10 Screening/Exams; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"$40 copay; PBP 7e, 7h, 9c"	$40 copay; included in row i.2.	$25 - 40 copay; PBP 8b	"$0 - $40 copay; PBP 7d, 7g, 8a"	20% coinsurance; PBP 15	$25 copay; PBP 7g								"30% coinsurance for Shower and Bathroom Safety Bars, $0 for Telemonitoring; PBP 13e, 13f"											6800	2.7235	0.5893	1.5744	0	0.8345	1.8156	0.137	1.2946	0.3115	0.2399	0.3402	0.0234	0	0.2014	0	11.2976	0.6283	0	0.8004	4.3261	0.2975	0	0	0	0	0	0	0	0	0.0096											27.4448	500	1.061473728	7.3953	0.818406527	4.463296488	0	1.250373982	3.90843996	0.136986986	2.535121523	1.38247664	1.105027585	2.052700794	0.036979022	0.004306779	2.277215272	4.236417414	21.51748338	0.906760729	0	1.681513382	6.9072364	2.969457571	0	0	0	0	0	0	0	0	0.024753617	0	0	0	0	0	0	0	0	0	0	65.6103
H4875_801_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	177.8572726	1.925105167	30.06058698	0	3.302697397	11.69809394	2.007939668	6.209437702	38.50326573	14.88940174	30.18699881	0.04224858	0.038305994	29.73632695	33.32042792	60.6429833	1.391330731	0	19.50770692	73.11752983	42.83162468	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	Medicare-FFS Cost Sharing; included in row i.2.	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.076963064	0.076963064	0.169466903	0	0.233	0.233	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	0.066252843	0.066252843	0.145883798	0	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0	0.200575595	0.200575595	0.200575595	0	0	0	0	0	0	0	0	0												11.7835	0.12754369	4.38535261	0	0.662440497	2.346352157	0.402743695	1.245461664	7.722815451	2.98645062	6.054775261	0.008474034	0.007683248	5.964381484	6.683264669	12.16350248	0.27906699	0	3.912769931	14.66559208	8.590978624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9932	0	14.54801063	11.7835	0.12754369	4.38535261	0	0.662440497	2.346352157	0.402743695	1.245461664	7.722815451	2.98645062	6.054775261	0.008474034	0.007683248	5.964381484	6.683264669	12.16350248	0.27906699	0	3.912769931	14.66559208	8.590978624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9932	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	Medicare-FFS Cost Sharing; included in row i.2.	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			10000	0.8957	0	0.3513	0	0.2656	0.1635	0.022	0.1667	0.2631	0.0996	0.2726	0	0	0.1155	0	1.8252	0.0602	0	0.2849	2.0756	0.054	0	0	0	0	0	0	0	0	0											6.9155	0	0.534389902	12.6793	0.12754369	4.736680139	0	0.928001006	2.509893157	0.424763595	1.412209345	7.985881425	3.086058209	6.327340415	0.008474034	0.007683248	6.07988423	6.683264669	13.98874197	0.339235371	0	4.197626108	16.74117152	8.644934799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.9087
H4875_802_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	177.8572726	1.925105167	30.06058698	0	3.302697397	11.69809394	2.007939668	6.209437702	38.50326573	14.88940174	30.18699881	0.04224858	0.038305994	29.73632695	33.32042792	60.6429833	1.391330731	0	19.50770692	73.11752983	42.83162468	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	Medicare-FFS Cost Sharing; included in row i.2.	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			0	0.076963064	0.076963064	0.169466903	0	0.233	0.233	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	0.066252843	0.066252843	0.145883798	0	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0.200575595	0	0.200575595	0.200575595	0.200575595	0	0	0	0	0	0	0	0	0												11.7835	0.12754369	4.38535261	0	0.662440497	2.346352157	0.402743695	1.245461664	7.722815451	2.98645062	6.054775261	0.008474034	0.007683248	5.964381484	6.683264669	12.16350248	0.27906699	0	3.912769931	14.66559208	8.590978624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9932	0	14.54801063	11.7835	0.12754369	4.38535261	0	0.662440497	2.346352157	0.402743695	1.245461664	7.722815451	2.98645062	6.054775261	0.008474034	0.007683248	5.964381484	6.683264669	12.16350248	0.27906699	0	3.912769931	14.66559208	8.590978624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9932	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14a-i"	"Medicare-FFS Cost Sharing; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-i, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	Medicare-FFS Cost Sharing; included in row i.2.	Medicare-FFS Cost Sharing; PBP 8b	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 8a"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g																			10000	0.8957	0	0.3513	0	0.2656	0.1635	0.022	0.1667	0.2631	0.0996	0.2726	0	0	0.1155	0	1.8252	0.0602	0	0.2849	2.0756	0.054	0	0	0	0	0	0	0	0	0											6.9155	0	0.534389902	12.6793	0.12754369	4.736680139	0	0.928001006	2.509893157	0.424763595	1.412209345	7.985881425	3.086058209	6.327340415	0.008474034	0.007683248	6.07988423	6.683264669	13.98874197	0.339235371	0	4.197626108	16.74117152	8.644934799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.9087
H4908_005_0	2011	5																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	851.796279	2.684787798	191.0067988	144.6629432	3.614857836	12.66340837	0.778464762	248.7179806	33.90430352	15.37639103	11.16847553	0	0.923138282	0	3382.886348	6177.138183	10.66368093	5.042329473	6.409584663	0	0	0	0	0	0	0	0	0	0	0											6700	1a1: $265 for days 1-6	1b1: $265 for days 1-6	"21: $50 for days 5-20, $100 for days 21-100"		10a: 20%	11a: 20%	"11b: 20%,11c: 20%"	"4a1: $50,4b: $10"	"9a1: 20%,9b: 20%"	"8a1: 20%,8a2: 20%"	"8b1: 20%,8b2: 20%,8b3: 20%,8b4: 20%,8b5: 20%,8b6: 20%"	"5: $10,9a2: 20%"	12: 20%	"3: 30%,9a3: 20%,9c: $10,9d1: 20%"	"7a: $10,14c1: 30%,14j: $0"	"7b1: $10,7d1: $10,7f1: $10,7g: 20%,17a1: $30,17b1: $25"	"7e: $10,7h: $10"	"7c: 20%,7i: 20%"	7d2: $10		"152: 20%,153: 20%"	"13a1: 30%,13a2: 30%"																				187.09	127.83	39.53	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0	99.35358047	0	10	10.18424329	10	0.2	0.178441135	0	0	0	0	0	0	0	0	0	0	0											NO	183.1964231	125.1696978	38.70733125	0	0.19583775	0.19583775	0.19583775	48.95943746	0.19583775	0.19583775	0.19583775	0	97.28590818	0	9.791887492	9.972296453	9.791887492	0.19583775	0.174727552	0	0	0	0	0	0	0	0	0	0	0												13.0038	0.028004506	0.616113619	0	0.707925625	2.479973399	0.152452787	1.014757701	6.63974251	3.011277819	2.187209117	0	0.007484029	0	2.760403543	5.133354432	0.008701464	0.987478458	1.119931037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8586		0.847138288	13.0038	0.028004506	0.616113619	0	0.707925625	2.479973399	0.152452787	1.014757701	6.63974251	3.011277819	2.187209117	0	0.007484029	0	2.760403543	5.133354432	0.008701464	0.987478458	1.119931037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8586	YES	1a1: $187.09	1b1: $127.83	21: $39.53	6: $15	10a: 30%	11a: 30%	"11b: 30%,11c: 30%"	"4a1: $50,4b: $10"	"9a1: 30%,9b: 30%"	"8a1: 30%,8a2: 30%"	"8b1: 30%,8b2: 30%,8b3: 30%,8b4: 30%,8b5: 30%,8b6: 30%"	"5: 30%,9a2: 30%"	12: 30%	"3: 30%,9a3: 30%,9c: 30%,9d1: 30%"	"7a: 30%,14c1: 30%,14j: 30%"	"7b1: 30%,7d1: 30%,7f1: 30%,7g: 30%,17a1: 30%,17b1: 30%,18a1: 30%"	"7e: 30%,7h: 30%"	"7c: 30%,7i: 30%"	7d2: 30%		"152: 30%,153: 30%"	"13a1: 30%,14a: 30%"		16b1: 30%																	10000	6.1248	0	0	0	0	0	0	0.3743	3.8042	1.5472	0	0	0	0	4.5386	6.5953	0.0038	0.2943	1.566	0	0	0	0	0	0	0	0	0	0	0											24.8485			19.1286	0.028004506	0.616113619	0	0.707925625	2.479973399	0.152452787	1.389017567	10.44392568	4.558522852	2.187209117	0	0.007484029	0	7.29895963	11.72866582	0.012500372	1.281807418	2.685925726	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.7071
H4908_006_0	2011	6																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	907.8264931	4.288944062	261.3516391	213.0732254	2.265248119	14.7761247	1.234995458	294.7865202	44.87432368	17.27355048	12.83435277	0	1.474711877	0	4045.49267	7033.320833	17.03521263	5.69202906	7.89317085	0	0	0	0	0	0	0	0	0	0	0											6700	1a1: $265 for days 1-6	1b1: $265 for days 1-6	"21: $50 for days 5-20, $100 for days 21-100"		10a: 20%	11a: 20%	"11b: 20%,11c: 20%"	"4a1: $50,4b: $10"	"9a1: 20%,9b: 20%"	"8a1: 20%,8a2: 20%"	"8b1: 20%,8b2: 20%,8b3: 20%,8b4: 20%,8b5: 20%,8b6: 20%"	"5: $10,9a2: 20%"	12: 20%	"3: 30%,9a3: 20%,9c: $10,9d1: 20%"	"7a: $10,14c1: 30%,14j: $0"	"7b1: $10,7d1: $10,7f1: $10,7g: 20%,17a1: $30,17b1: $25"	"7e: $10,7h: $10"	"7c: 20%,7i: 20%"	7d2: $10		"152: 20%,153: 20%"	"13a1: 30%,13a2: 30%"																				187.09	127.83	39.53	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0	98.66645121	0	10	10.1062704	10	0.2	0.17234495	0	0	0	0	0	0	0	0	0	0	0											NO	181.1795192	123.7916401	38.28118228	0	0.193681671	0.193681671	0.193681671	48.42041776	0.193681671	0.193681671	0.193681671	0	95.54941573	0	9.684083552	9.786996692	9.684083552	0.193681671	0.16690029	0	0	0	0	0	0	0	0	0	0	0												13.7066	0.044244618	0.833737478	0	0.438737041	2.861864524	0.239195984	1.189473871	8.691333997	3.345570122	2.485778892	0	0.011742322	0	3.264740752	5.736257311	0.013747535	1.1024417	1.317372504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2829		1.477228395	13.7066	0.044244618	0.833737478	0	0.438737041	2.861864524	0.239195984	1.189473871	8.691333997	3.345570122	2.485778892	0	0.011742322	0	3.264740752	5.736257311	0.013747535	1.1024417	1.317372504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2829	YES	1a1: $187.09	1b1: $127.83	21: $39.53	6: $15	10a: 35%	11a: 35%	"11b: 35%,11c: 35%"	"4a1: $50,4b: $10"	"9a1: 35%,9b: 35%"	"8a1: 35%,8a2: 35%"	"8b1: 35%,8b2: 35%,8b3: 35%,8b4: 35%,8b5: 35%,8b6: 35%"	"5: 35%,9a2: 35%"	12: 35%	"3: 35%,9a3: 35%,9c: 35%,9d1: 35%"	"7a: 35%,14c1: 35%,14j: 35%"	"7b1: 35%,7d1: 35%,7f1: 35%,7g: 35%,17a1: 35%,17b1: 35%,18a1: 35%"	"7e: 35%,7h: 35%"	"7c: 35%,7i: 35%"	7d2: 35%		"152: 35%,153: 35%"	"13a1: 35%,14a: 35%"		16b1: 35%																	10000	6.8641	0	0	0	0	0	0	0.4914	5.5513	2.0322	0	0	0	0	6.7314	9.6621	0.0068	0.2107	2.0265	0	0	0	0	0	0	0	0	0	0	0											33.5766		1.095342431	20.5707	0.044244618	0.833737478	0	0.438737041	2.861864524	0.239195984	1.680899696	14.24263332	5.377811732	2.485778892	0	0.011742322	0	9.996189521	15.39833704	0.020556648	1.313094935	3.343867174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8594
H4909_001_0	2011	10	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	946.354622	95.64005007	260.8139527	505.0451294	60.12699049	7.099148823	1.161030156	269.1879456	356.9098703	6293.780434	584.7016586	63.92393144	0.013622678	69.90940554	2960.823213	3095.660863	8.014790222	947.895475	539.9966458	1118.462939	24.71790918	1.059643869	0	0	0	0	129.6	0	5880.133485	0	2.644123692	3.513894358	0.264777911	0	0	0	0	0	0	0		1A: $225/day (days1-7) no yrly max	1B: $225/day (days1-7) no yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $175 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $40 copay	9A: $40-$225 copay; 9B: $225 copay	8A: $0-$135 copay	8B: $90-$135 copay	9A: $225 copay	12: 20% coin	3: $40 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $0 copay; 7G: $0 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $40 copay; 7F: $40 copay; 7G: $40 copay	7E: $40 copay; 7H: $40 copay	7C: $40-$55 copay; 7I: $40-$55 copay	8B: $90-$135 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$40; 17B: $0; 18A: $30	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	17A: OSB	17B: OSB	18A: $40 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 0% coin; 14J: 0% coin									225	225	128	0	175	0.2	0.045681968	49.9527127	196.3924321	19.48556946	110.2538875	225	0.2	19.64546726	0	38.49788753	40	47.76043491	98.13732538	18.89025963	0.2	0	0	0	0	0	30	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	161.1627012	108.2830025	116.6968714	0	159.5465038	0.182338862	0.04164799	45.54160382	179.0498625	17.76488276	100.5178416	205.1312192	0.182338862	17.91066067	0	35.09830492	36.46777231	43.54291664	89.47124092	17.22214217	0.182338862	0	0	0	0	0	30	0	0	0	0.182338862	0.182338862	0	0	0	0	0	0	0	0		12.7098	0.863015982	2.536347692	0	0.799420927	1.294450714	0.048354572	1.021604231	5.3253886	9.317355959	4.897745726	1.092732833	0.002483944	0.104343637	0	9.05437074	0.024356795	3.439511138	4.026180832	1.605193979	4.507035419	0	0	0	0	0	0.324	0	0	0	0.482126504	0.640719497	0	0	0	0	0	0	0	0	64.1165		6.178869844	12.7098	0.863015982	2.536347692	0	0.799420927	1.294450714	0.048354572	1.021604231	5.3253886	9.317355959	4.897745726	1.092732833	0.002483944	0.104343637	0	9.05437074	0.024356795	3.439511138	4.026180832	1.605193979	4.507035419	0	0	0	0	0	0.324	0	0	0	0.482126504	0.640719497	0	0	0	0	0	0	0	0	64.1165	YES	1A: $225/day (days1-7) no yrly max	1B: $225/day (days1-7) no yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $175 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $40 copay	9A: $40-$225 copay; 9B: $225 copay	8A: $0-$135 copay	8B: $90-$135 copay	9A: $225 copay	12: 20% coin	3: $40 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $0 copay; 7G: $0 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $40 copay; 7F: $40 copay; 7G: $40 copay	7E: $40 copay; 7H: $40 copay	7C: $40-$55 copay; 7I: $40-$55 copay	8B: $90-$135 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$40; 17B: $0; 18A: $30	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	17A: OSB	17B: OSB	18A: $40 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 0% coin; 14J: 0% coin								4500	5.0341	0.6463	0.2407	0	0.7346	0.1735	0.0059	0.4666	2.3904	2.9097	1.2297	0.1587	0.0011	0.0222	0	0.5878	0.0043	0.4246	1.0669	0.1621	1.8171	0	0	0	0	0	0.081	0	0	0	0.0749	0.125	0	0	0	0	0	0	0	0	18.3572		1.770216991	17.7439	1.509290366	2.777095895	0	1.534036368	1.467919988	0.054247717	1.488171299	7.715744882	12.22704684	6.127395868	1.25146237	0.003611675	0.126495705	0	9.642178823	0.028704484	3.864127899	5.093093638	1.767282765	6.324168397	0	0	0	0	0	0.405	0	0	0	0.557026003	0.765758981	0	0	0	0	0	0	0	0	82.4737
H4909_004_0	2011	9	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	859.6910699	45.30082635	471.3179449	289.8696695	51.88447988	8.829761026	1.500211506	270.3131956	354.2074128	6826.874634	624.968997	87.09148995	0.01052177	97.3779442	3281.400073	3502.149895	9.903693009	919.4562792	607.4867135	1132.118525	37.0155811	2.60085767	0	745.9758882	302.4	239.2	129.6	0	5879.862027	0	2.610618311	4.778693592	0.323252873	0	0	0	0	0	0	0		1A: $195/day (days1-7) w/$1365 yrly max	1B: $195/day (days1-7) w/$1365 yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $100 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $25 copay	9A: $30-$150 copay; 9B: $150 copay	8A: $0-$115 copay	8B: $65-$115 copay	9A: $150 copay	12: 20% coin	3: $25 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $10 copay; 7G: $10 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: $65-$115 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$25; 17B: $0; 18A: $25	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $25 copay	17B: $25 copay	18A: $25 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 0% coin; 14J: 0% coin									195	195	128	0	100	0.2	0.033170736	49.90645634	135.3168133	13.01451878	85.70340704	150	0.2	8.832496465	8.801466067	24.46041832	40	38.69846982	74.22227828	12.13659567	0.2	0	0	0	25	25	25	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	108.9227224	75.96754344	113.6861116	0	88.81727465	0.177634549	0.029461344	44.3255544	120.1847058	11.55914089	76.11943042	133.225912	0.177634549	7.844782644	7.81722229	21.72507693	35.52690986	34.37092623	65.92220476	10.77939351	0.177634549	0	0	0	25	25	25	0	0	0	0.177634549	0.177634549	0	0	0	0	0	0	0	0		7.8033	0.286782708	4.465192039	0	0.384019842	1.56847062	0.044198247	0.998481855	3.54752614	6.576067143	3.964357007	0.966903598	0.00186903	0.063659067	2.137619483	6.340372989	0.029320634	2.633546995	3.337238626	1.016962591	6.575246066	0	0	0	0.63	0.498333333	0.27	0	0	0	0.463736007	0.848861083	0	0	0	0	0	0	0	0	55.4521		6.805751589	7.8033	0.286782708	4.465192039	0	0.384019842	1.56847062	0.044198247	0.998481855	3.54752614	6.576067143	3.964357007	0.966903598	0.00186903	0.063659067	2.137619483	6.340372989	0.029320634	2.633546995	3.337238626	1.016962591	6.575246066	0	0	0	0.63	0.498333333	0.27	0	0	0	0.463736007	0.848861083	0	0	0	0	0	0	0	0	55.4521	YES	1A: $250/day (days1-7) no yrly max	1B: $250/day (days1-7) no yrly max	2: 30% coin (for days 1-100)	6: $0 copay	10A: $100 copay	11A: 25% coin	11B: 25% coin; 11C: 25% coin	4A: $50 copay; 4B: $25 copay	9A: $40-$250 copay; 9B: $250 copay	8A: 0% - 30% coin	8B: 30% coin	9A: $250 copay	12: 20% coin	3: $35 copay; 5: $50 copay; 9C: $50 copay; 9D: $0 copay	7A: $20 copay; 7G: $20 copay; 14B: $0 copay; 14C: $0 copay	7B: $35 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $50 copay; 7H: $50 copay	7C: $35-$70 copay; 7I: $35-$70 copay	8B: 30% coin	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $35; 17B: $0; 18A: $35	15: 20% coinsurance	13A: $0 copay	10B: Not covered	$16A: 20% coinsurance	17A: $35 copay	17B: $35 copay	18A: $35 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin								3350	4.7269	0.8264	0.6228	0	0.3296	0.1621	0.4482	0.3714	4.2241	1.3588	1.2562	0.3028	0	0.0866	0.3664	0.7613	0.0042	0.9828	3.5651	0.2166	1.4781	0	0	0.1734	0.2205	0.1744	0.0945	0	0	0	0.4599	0.0835	0.0258	0	0	0	0	0	0	0	23.3225		2.853015126	12.5302	1.113220107	5.087961221	0	0.713601792	1.730591392	0.492375132	1.369905831	7.771578812	7.934913921	5.220591663	1.269739805	0.00186903	0.150236579	2.504031444	7.101714653	0.033509983	3.616341559	6.90233434	1.233566598	8.053349911	0	0	0.173441296	0.8505	0.67275	0.3645	0	0	0	0.923594475	0.932377085	0.025831028	0	0	0	0	0	0	0	78.7746
H4909_007_0	2011	6	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	1239.845929	83.02627573	506.9460858	573.6266339	101.8700467	10.98260101	2.244662577	303.7173453	629.3454083	7506.222018	800.5062536	123.9191858	0.029355985	144.5240918	3434.920343	3849.237413	15.42934978	1409.025438	602.3685627	1287.554023	37.78304159	2.222572949	0	1491.951776	302.4	239.2	129.6	0	5881.704183	0	5.531226966	6.087961703	0.385255297	0	0	0	0	0	0	0		1A: $200/day (days1-10) w/$2000 yrly max	1B: $200/day (days1-10) w/$2000 yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $100 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $25 copay	9A: $25-$100 copay; 9B: $100 copay	8A: $0-$100 copay	8B: $50-$100 copay	9A: $100 copay	12: 20% coin	3: $25 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $15 copay; 7G: $15 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: $50-$100 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$25; 17B: $0; 18A: $25	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $25 copay	17B: $25 copay	18A: $25 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 0% coin; 14J: 0% coin									200	200	128	0	100	0.2	0.087432781	49.73901067	74.39597706	12.35586758	70.57413783	100	0.2	7.140420647	13.00072796	24.12593634	40	43.49029882	63.51656586	12.37635699	0.2	0	0	0	25	25	25	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	118.3681326	90.26647059	113.3900523	0	88.58597836	0.177171957	0.077453184	44.06178922	65.90440413	10.94556618	62.51879046	88.58597836	0.177171957	6.325411489	11.51682205	21.37219674	35.43439134	38.5263067	56.26677128	10.96371692	0.177171957	0	0	0	25	25	25	0	0	0	0.177171957	0.177171957	0	0	0	0	0	0	0	0		12.2299	0.62454074	4.790220265	0	0.752021479	1.945808911	0.173856264	1.115194138	3.456386177	6.846654153	4.170556894	0.914791859	0.005201057	0.076181196	3.296613863	6.855554943	0.045560802	4.523712181	2.824444512	1.17636482	6.694095409	0	0	0	0.63	0.498333333	0.27	0	0	0	0.979978305	1.078616087	0	0	0	0	0	0	0	0	65.9745		8.320439075	12.2299	0.62454074	4.790220265	0	0.752021479	1.945808911	0.173856264	1.115194138	3.456386177	6.846654153	4.170556894	0.914791859	0.005201057	0.076181196	3.296613863	6.855554943	0.045560802	4.523712181	2.824444512	1.17636482	6.694095409	0	0	0	0.63	0.498333333	0.27	0	0	0	0.979978305	1.078616087	0	0	0	0	0	0	0	0	65.9745	YES	1A: $250/day (days1-10) no yrly max	1B: $250/day (days1-10) no yrly max	2: 30% coin	6: $0 copay	10A: $100 copay	11A: 30% coin	11B: 30% coin; 11C: 30% coin	4A: $50 copay; 4B: $25 copay	9A: $35-$225 copay; 9B: $225 copay	8A: 0%-30% coin	8B: 30% coin	9A: $225 copay	12: 20% coin	3: $35 copay; 5: $50 copay; 9C: $50 copay; 9D: $0 copay	7A: $25 copay; 7G: $25 copay; 14B: $0 copay; 14C: $0 copay	7B: $35 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $50 copay; 7H: $50 copay	7C: $35-$70 copay; 7I: $35-$70 copay	8B: 30% coin	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $35; 17B: $0; 18A: $35	15: 20% coinsurance	13A: $0 copay	10B: Not covered	$16A: 20% coinsurance	17A: $35 copay	17B: $35 copay	18A: $35 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin								3400	3.1071	0.1888	0.9097	0	0.9005	0.4889	0.3821	0.2019	1.02	0.8249	0.722	0.264	0	0.0345	1.0851	1.8131	0.0117	0.6848	1.548	0.1877	1.4029	0	0	0.2347	0.2205	0.1744	0.0945	0	0	0	0.1559	0.0995	0.0302	0	0	0	0	0	0	0	16.7874		2.069702913	15.3369	0.813360473	5.699969323	0	1.652504383	2.434731478	0.55597955	1.317109623	4.476352733	7.671525652	4.892533337	1.178813172	0.005201057	0.110725773	4.381729854	8.668682961	0.057218744	5.2085287	4.372436322	1.364063024	8.096985142	0	0	0.23465587	0.8505	0.67275	0.3645	0	0	0	1.135855463	1.178098304	0.030170514	0	0	0	0	0	0	0	82.7619
H4909_804_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	284.6191524	3.407832039	46.1368412	9.624582635	7.675887959	15.40851577	3.88934215	13.07479627	51.1527437	6.47521763	27.03603864	0	0.023774785	33.07753696	51.20101143	140.9796266	1.363699162	5.422600395	21.30858367	25.72785897	49.64852247	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.073575112	0.073575112	0.165630082	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.058235279	0.058235279	0.13109751	0	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197																				16.5749	0.19845605	6.048425015	0	1.274037718	2.557493071	0.645549886	2.170144183	8.490291313	1.074751421	4.487419978	0	0.00394612	5.490183016	8.498302751	23.39968518	0.226345692	0.900038858	3.536781602	4.270289367	8.240621882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0876		25.83739674	16.5749	0.19845605	6.048425015	0	1.274037718	2.557493071	0.645549886	2.170144183	8.490291313	1.074751421	4.487419978	0	0.00394612	5.490183016	8.498302751	23.39968518	0.226345692	0.900038858	3.536781602	4.270289367	8.240621882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0876	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.8417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.8417		2.87082186	18.4165	0.19845605	6.048425015	0	1.274037718	2.557493071	0.645549886	2.170144183	8.490291313	1.074751421	4.487419978	0	0.00394612	5.490183016	8.498302751	23.39968518	0.226345692	0.900038858	3.536781602	4.270289367	8.240621882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9293
H4909_805_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	284.6191524	3.407832039	46.1368412	9.624582635	7.675887959	15.40851577	3.88934215	13.07479627	51.1527437	6.47521763	27.03603864	0	0.023774785	33.07753696	51.20101143	140.9796266	1.363699162	5.422600395	21.30858367	25.72785897	49.64852247	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.073575112	0.073575112	0.165630082	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.058235279	0.058235279	0.13109751	0	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197																				16.5749	0.19845605	6.048425015	0	1.274037718	2.557493071	0.645549886	2.170144183	8.490291313	1.074751421	4.487419978	0	0.00394612	5.490183016	8.498302751	23.39968518	0.226345692	0.900038858	3.536781602	4.270289367	8.240621882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0876		25.83739674	16.5749	0.19845605	6.048425015	0	1.274037718	2.557493071	0.645549886	2.170144183	8.490291313	1.074751421	4.487419978	0	0.00394612	5.490183016	8.498302751	23.39968518	0.226345692	0.900038858	3.536781602	4.270289367	8.240621882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0876	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.8417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.8417		2.87082186	18.4165	0.19845605	6.048425015	0	1.274037718	2.557493071	0.645549886	2.170144183	8.490291313	1.074751421	4.487419978	0	0.00394612	5.490183016	8.498302751	23.39968518	0.226345692	0.900038858	3.536781602	4.270289367	8.240621882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9293
H4909_806_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	284.6191524	3.407832039	46.1368412	9.624582635	7.675887959	15.40851577	3.88934215	13.07479627	51.1527437	6.47521763	27.03603864	0	0.023774785	33.07753696	51.20101143	140.9796266	1.363699162	5.422600395	21.30858367	25.72785897	49.64852247	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.073575112	0.073575112	0.165630082	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.058235279	0.058235279	0.13109751	0	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197																				16.5749	0.19845605	6.048425015	0	1.274037718	2.557493071	0.645549886	2.170144183	8.490291313	1.074751421	4.487419978	0	0.00394612	5.490183016	8.498302751	23.39968518	0.226345692	0.900038858	3.536781602	4.270289367	8.240621882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0876		25.83739674	16.5749	0.19845605	6.048425015	0	1.274037718	2.557493071	0.645549886	2.170144183	8.490291313	1.074751421	4.487419978	0	0.00394612	5.490183016	8.498302751	23.39968518	0.226345692	0.900038858	3.536781602	4.270289367	8.240621882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0876	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.8417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.8417		2.87082186	18.4165	0.19845605	6.048425015	0	1.274037718	2.557493071	0.645549886	2.170144183	8.490291313	1.074751421	4.487419978	0	0.00394612	5.490183016	8.498302751	23.39968518	0.226345692	0.900038858	3.536781602	4.270289367	8.240621882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9293
H4909_807_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	284.6191524	3.407832039	46.1368412	9.624582635	7.675887959	15.40851577	3.88934215	13.07479627	51.1527437	6.47521763	27.03603864	0	0.023774785	33.07753696	51.20101143	140.9796266	1.363699162	5.422600395	21.30858367	25.72785897	49.64852247	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.073575112	0.073575112	0.165630082	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.058235279	0.058235279	0.13109751	0	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197	0.165979197																				16.5749	0.19845605	6.048425015	0	1.274037718	2.557493071	0.645549886	2.170144183	8.490291313	1.074751421	4.487419978	0	0.00394612	5.490183016	8.498302751	23.39968518	0.226345692	0.900038858	3.536781602	4.270289367	8.240621882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0876		25.83739674	16.5749	0.19845605	6.048425015	0	1.274037718	2.557493071	0.645549886	2.170144183	8.490291313	1.074751421	4.487419978	0	0.00394612	5.490183016	8.498302751	23.39968518	0.226345692	0.900038858	3.536781602	4.270289367	8.240621882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.0876	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.8417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.8417		2.87082186	18.4165	0.19845605	6.048425015	0	1.274037718	2.557493071	0.645549886	2.170144183	8.490291313	1.074751421	4.487419978	0	0.00394612	5.490183016	8.498302751	23.39968518	0.226345692	0.900038858	3.536781602	4.270289367	8.240621882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9293
H4910_005_0	2011	3																															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	1353.513197	121.4782426	1065.486237	715.089972	200.2472855	9.167188154	0	290.1404698	401.3673803	2999.831884	2567.941337	47.42774113	1.644551409	72.55713253	3322.13959	5180.930843	258.9648278	682.7822626	0	0	277.289896	0	0	0	1147.987337	96.86133291	59.29281655	0	0	0											3400	$250/day 1-8	$250/day 1-8	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$15 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$250 per procedure	$0 per visit	$40 X-ray; $150 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$25 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$50 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	190.46	190.46	47.8866492	15	150	0.05	0.05	49	250	0	22.75	40	25	40	25	40	40	30	50	40	$50 	0	0	0	0	0	0	0	0	0											NO	159.06263	159.06263	39.99252527	12.52724693	125.2724693	0.04175749	0.04175749	40.92233996	208.7874488	0	18.99965784	33.4059918	20.87874488	33.4059918	20.87874488	33.4059918	33.4059918	25.05449385	41.75748976	33.4059918	41.75748976	0	0	0	0	0	0	0	0	0												17.9411	1.610220729	3.550957106	0.746509055	2.090455993	0.382798765	0	0.989435579	6.983372613	0	4.065833896	0.132030894	0.002861347	0.201986915	5.780175412	14.42284444	0.720914743	1.425563667	0	0	0.964910833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.012	0	12.24054495	17.9411	1.610220729	3.550957106	0.746509055	2.090455993	0.382798765	0	0.989435579	6.983372613	0	4.065833896	0.132030894	0.002861347	0.201986915	5.780175412	14.42284444	0.720914743	1.425563667	0	0	0.964910833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.012	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			17.9411	1.610220729	3.550957106	0.746509055	2.090455993	0.382798765	0	0.989435579	6.983372613	0	4.065833896	0.132030894	0.002861347	0.201986915	5.780175412	14.42284444	0.720914743	1.425563667	0	0	0.964910833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.012
H4910_801_0	2011	1																															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	YES	313.9493145	6.409038112	40.10673556	7.963145585	9.337743652	12.07463745	0	14.96787658	41.31058967	18.5063388	59.80122493	1.058825083	0.09078971	27.54039313	28.10941075	134.5137965	3.637378249	8.568018352	0	0	71.46138295	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.066973886	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	0.05772792	0.05772792	0.125231615	0	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0.200833581	0	0	0	0	0	0	0	0												18.1236	0.369980441	5.022631279	0	1.875332494	2.424992675	0	3.006052251	8.29655365	3.71669429	12.01009414	0.212647633	0.018233623	5.53103577	5.645313615	27.01488743	0.730507699	1.720745806	0	0	14.35184543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.0712	0	17.62950198	18.1236	0.369980441	5.022631279	0	1.875332494	2.424992675	0	3.006052251	8.29655365	3.71669429	12.01009414	0.212647633	0.018233623	5.53103577	5.645313615	27.01488743	0.730507699	1.720745806	0	0	14.35184543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.0712	NO																																																																																		0			18.1236	0.369980441	5.022631279	0	1.875332494	2.424992675	0	3.006052251	8.29655365	3.71669429	12.01009414	0.212647633	0.018233623	5.53103577	5.645313615	27.01488743	0.730507699	1.720745806	0	0	14.35184543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.0712
H4910_802_0	2011	1																															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	YES	317.0324736	6.471978475	40.50060629	8.041348159	9.429445553	12.19321719	0	15.11486956	41.71628293	18.68808147	60.38850664	1.069223342	0.091681316	27.8108553	28.38546099	135.8347978	3.673099352	8.652161118	0	0	72.16317397	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.067463352	0.067463352	0.146654157	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.058165216	0.058165216	0.12644155	0	0.200886779	0.200886779	0.200886779	0.200886779	0.200886779	0.200886779	0.200886779	0.200886779	0.200886779	0.200886779	0.200886779	0.200886779	0.200886779	0.200886779	0.200886779	0.200886779	0.200886779	0.200886779	0	0	0	0	0	0	0	0												18.4403	0.376444028	5.120959438	0	1.894250941	2.449456121	0	3.036377455	8.380249693	3.754188485	12.13125256	0.214792833	0.018417564	5.586833132	5.702263818	27.28741495	0.737877096	1.738104775	0	0	14.49662755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.3658	0	17.80263362	18.4403	0.376444028	5.120959438	0	1.894250941	2.449456121	0	3.036377455	8.380249693	3.754188485	12.13125256	0.214792833	0.018417564	5.586833132	5.702263818	27.28741495	0.737877096	1.738104775	0	0	14.49662755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.3658	NO																																																																																		0			18.4403	0.376444028	5.120959438	0	1.894250941	2.449456121	0	3.036377455	8.380249693	3.754188485	12.13125256	0.214792833	0.018417564	5.586833132	5.702263818	27.28741495	0.737877096	1.738104775	0	0	14.49662755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.3658
H4956_001_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1383.71224	57.01337973	334.4971888	865.0213599	35.9360385	10.13244816	6.48851067	356.0354245	397.2072542	1323.585779	1196.992756	88.55918479	0.24692766	4.810734142	3434.017193	3733.75002	85.82488517	663.4093524		1523.423198	18.20167428	0							3.85	0.73	1157.407014	493.7246384									3900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	$125/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$10-$150/Visit:9d. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	66.51235	0	125	0.2	0.2	50	175	56.654675	91.99354	50	0.2	0.2	10	35	35	10		0	0.2	0							0	0	0	72.660264									NO	116.486473	99.728676	41.941025	0	104.867125	0.167787	0.167787	41.94685	146.813975	47.529703	77.176784	41.94685	0.167787	0.167787	8.38937	29.362795	29.362795	8.38937		0	0.167787	0							0	0	0	60.957384										13.432	0.473822406	1.169096247	0	0.31404242	1.70009308	1.08868774	1.244547045	4.859631323	5.242469914	7.698337614	0.309564903	0.041431251	0.807178649	2.400770068	9.136111367	0.210004876	0.463798877	0	0	3.054004322	0	0	0	0	0	0	0	0	0	0	2.508013531	0	0	0	0	0	0	0	0	56.1536	0	11.3939991	13.432	0.473822406	1.169096247	0	0.31404242	1.70009308	1.08868774	1.244547045	4.859631323	5.242469914	7.698337614	0.309564903	0.041431251	0.807178649	2.400770068	9.136111367	0.210004876	0.463798877	0	0	3.054004322	0	0	0	0	0	0	0	0	0	0	2.508013531	0	0	0	0	0	0	0	0	56.1536	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 7-100)	30% Coins	$125/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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									5800	5.6172	0.1017	0.2409	2.4098	0.9882	1.7637	1.1294	0.1463	2.2392	0.274	1.0655	0.166	0.005	0.1453	1.2799	2.197	0.0292	0.2334		0.2348	0.6039	0							0	0	0.3999	0.3332									21.6034	0	16.35276822	19.0492	0.575507397	1.410038911	2.40979263	1.302267012	3.463777639	2.218097676	1.390846519	7.098804801	5.516477624	8.763881886	0.475586863	0.046401814	0.952433844	3.680659473	11.33313648	0.239223542	0.697179587	0	0.234832242	3.657857785	0	0	0	0	0	0	0	0	0	0.399864105	2.841175901	0	0	0	0	0	0	0	0	77.757
H4956_002_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1141.674638	97.93052177	174.5666919	1248.480877	29.14877944	9.372539498	5.443216104	337.4261549	377.1461131	1678.086518	907.2467815	163.6009274	0.191875569	8.508080375	3128.591358	2928.89935	52.14894298	898.7580533		2103.149483	29.32037226	0							3.85	0.73	1856.905693	671.1103982									3900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$30/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$10-$100/Visit:9d. $10 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $30 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	66.51235	0	100	0.2	0.2	50	150	66.641677	72.402627	50	0.2	0.2	10	30	30	10		0	0.2	0							0	0	0	64.127859									NO	121.304314	103.85342	49.133139	0	85.8301	0.17166	0.17166	42.91505	128.74515	57.198618	62.143247	42.91505	0.17166	0.17166	8.58301	25.74903	25.74903	8.58301		0	0.17166	0							0	0	0	55.041005										11.5408	0.847534967	0.714750795	0	0.208486888	1.60889013	0.934382476	1.206721692	4.046311075	7.998685811	4.698271736	0.585078498	0.03293736	1.460497077	2.237727576	6.284693103	0.111898725	0.642837447	0	0	5.033135102	0	0	0	0	0	0	0	0	0	0	3.078215899	0	0	0	0	0	0	0	0	53.2719	0	8.80707263	11.5408	0.847534967	0.714750795	0	0.208486888	1.60889013	0.934382476	1.206721692	4.046311075	7.998685811	4.698271736	0.585078498	0.03293736	1.460497077	2.237727576	6.284693103	0.111898725	0.642837447	0	0	5.033135102	0	0	0	0	0	0	0	0	0	0	3.078215899	0	0	0	0	0	0	0	0	53.2719	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 7-100)	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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									5800	5.2446	0.155	0.1704	3.3026	0.6899	1.7551	1.0193	0.1492	2.0177	0.3379	0.7981	0.22	0.0042	0.2764	1.0351	1.5468	0.0178	0.2711		0.362	1.0694	0							0	0	0.658	0.3283									21.4288	0	11.16221084	16.7854	1.002565698	0.885173621	3.302590161	0.89836271	3.36397818	1.953671371	1.355885481	6.064060328	8.336595951	5.496387027	0.805119824	0.0370925	1.736864703	3.272782324	7.831474036	0.129703279	0.913943373	0	0.362036562	6.102541114	0	0	0	0	0	0	0	0	0	0.657999973	3.406494973	0	0	0	0	0	0	0	0	74.7007
H4956_003_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1084.887176	68.031605	327.781471	561.898994	36.963528	8.86877	3.113635	327.314953	343.931865	1003.399714	924.382042	72.907178	0.411972	5.394312	3370.878935	3552.881103	84.379586	689.760776		1815.873879	20.635802	0							2.98		1208.787248	627.948424									4900	$225/Day(Days 1-5):1a.IP Acute	$225/Day(Days 1-5):1b.IP Psych	"$50/Day(Days 1-20) $100(Days 21-100):2. $50 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$125/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a		$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										139.3002	112.142475	66.51235	0	125	0.2	0.2	50	175	56.988071	94.655292	50	0.2	0.2	15	35	35	15		0	0.2	0							0		0	68.698733									NO	127.50203	102.644456	52.712767	0	112.786125	0.180458	0.180458	45.11445	157.900575	51.41971	85.406429	45.11445	0.180458	0.180458	13.534335	31.580115	31.580115	13.534335		0	0.180458	0							0		0	61.986111										11.5271	0.581922257	1.439855692	0	0.347414424	1.600440497	0.561880345	1.23055284	4.525586604	4.299543526	6.579014103	0.27409727	0.074343643	0.973446755	3.801883729	9.350032818	0.222059752	0.777954451	0	0	3.723895557	0	0	0	0	0	0	0	0	0	0	3.243673393	0	0	0	0	0	0	0	0	55.1347	0	6.000850171	11.5271	0.581922257	1.439855692	0	0.347414424	1.600440497	0.561880345	1.23055284	4.525586604	4.299543526	6.579014103	0.27409727	0.074343643	0.973446755	3.801883729	9.350032818	0.222059752	0.777954451	0	0	3.723895557	0	0	0	0	0	0	0	0	0	0	3.243673393	0	0	0	0	0	0	0	0	55.1347	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 7-100)	30% Coins	$125/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		30% Coins	20%-30% Coins	$0/Service							$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a		35% Coins	30% Coins									7300	6.4929	0.1315	0.3538	2.5316	1.1939	1.5865	0.557	0.158	2.1679	0.257	0.8947	0.1516	0.0097	0.1913	1.3576	2.2856	0.0313	0.2482		0.3123	0.8111	0							0		0.365	0.3522									22.4408	0	8.238314585	18.0201	0.713402579	1.79369819	2.531622974	1.541325606	3.186980994	1.118881166	1.388527907	6.693485766	4.556513959	7.473683182	0.425701532	0.084084098	1.164753069	5.159476052	11.63567767	0.253405767	1.026155591	0	0.312278981	4.534992474	0	0	0	0	0	0	0	0	0	0.365004585	3.595824658	0	0	0	0	0	0	0	0	77.5755
H4956_004_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1076.110474	67.481231	325.12973	557.35325	36.664494	8.30188	2.914613	324.666986	341.149468	995.282243	916.903822	72.317361	0.385639	5.049508	3343.608634	3524.138412	83.696957	684.180634		1801.183518	19.316765	0							3.85	0.73	1199.008199	622.868342									4900	$225/Day(Days 1-5):1a.IP Acute	$225/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	$125/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										139.3002	112.142475	66.51235	0	125	0.2	0.2	50	175	56.988071	94.655292	50	0.2	0.2	15	35	35	15		0	0.2	0							0	0	0	68.698733									NO	128.884863	103.757694	54.292635	0	114.17975	0.182688	0.182688	45.6719	159.85165	52.05507	86.461741	45.6719	0.182688	0.182688	13.70157	31.97033	31.97033	13.70157		0	0.182688	0							0	0	0	62.752033										11.5579	0.583474743	1.47101248	0	0.348861897	1.516653853	0.53246482	1.235679843	4.544442113	4.317457236	6.606425065	0.275239273	0.070451618	0.922484518	3.817723979	9.388989	0.222984945	0.781195737	0	0	3.528941164	0	0	0	0	0	0	0	0	0	0	3.257187896	0	0	0	0	0	0	0	0	54.9795	0	5.232400311	11.5579	0.583474743	1.47101248	0	0.348861897	1.516653853	0.53246482	1.235679843	4.544442113	4.317457236	6.606425065	0.275239273	0.070451618	0.922484518	3.817723979	9.388989	0.222984945	0.781195737	0	0	3.528941164	0	0	0	0	0	0	0	0	0	0	3.257187896	0	0	0	0	0	0	0	0	54.9795	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 7-100)	30% Coins	$125/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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	35% Coins	30% Coins									7300	6.3758	0.1291	0.3556	2.4203	1.2095	1.5168	0.5325	0.16	2.0726	0.2457	0.8553	0.1449	0.0093	0.1829	1.2979	2.1851	0.03	0.2373		0.2985	0.7754	0							0	0	0.349	0.3367									21.7201	0	7.095396874	17.9336	0.712582096	1.826574943	2.420294997	1.558347186	3.033426478	1.06497138	1.395715634	6.617008578	4.56312762	7.461751893	0.420176594	0.079763552	1.105378316	5.11561638	11.57412309	0.252952435	1.01848215	0	0.298546716	4.304370202	0	0	0	0	0	0	0	0	0	0.348953743	3.593852835	0	0	0	0	0	0	0	0	76.6996
H4971_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1137.896383	74.46931781	773.9444764	972.9411597	164.4334614	11.3089361	10.95544645	375.9445278	37.00420374	14.82912296	33.87218439	0	0.091541659	17.9577202	5778.985697	99.58901319	411.3596525	337.1080141	0	0	15.68025922	1305.011832	0	0	129.3324808	0	14.84755841	6	160.8948636	0											3900	"$175 Days 1-22 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-10 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-49 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												165.6477856	106.6104145	61.68517159	0	200	0.2	0.107594839	49.07896873	0.2	0.134052522	0.16544896	0	0.2	0.159928261	6.859060272	0.102013756	38.5	30	0	0	0.2	29.82955004	0	0	30	0	0	0	0	0											YES	126.3615555	81.32591552	47.05546899	0	152.5665497	0.15256655	0.082076867	37.45258236	0.15256655	0.102259654	0.126209885	0	0.15256655	0.121998515	6.582503927	0.097934174	36.94768541	28.79040422	0	0	0.15256655	22.75495765	0	0	30	0	0	0	0	0											5900	11.9822	0.504690454	3.034860025	0	2.090587155	1.725365361	0.899188719	1.173341116	5.645603688	1.516420977	4.275004503	0	0.013966195	2.190815195	3.170016337	9.753167702	1.266565586	0.808789666	0	0	2.392283048	2.474624081	0	0	0.323331202	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2408	0	13.03703794	11.9822	0.504690454	3.034860025	0	2.090587155	1.725365361	0.899188719	1.173341116	5.645603688	1.516420977	4.275004503	0	0.013966195	2.190815195	3.170016337	9.753167702	1.266565586	0.808789666	0	0	2.392283048	2.474624081	0	0	0.323331202	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2408	NO	"$225 Days 1-27 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-27 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-34 (2a); $0 n/c (2a1, 2a2)"	25% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	25% (9b)	25% (8a1a); $10 (8a2)	"$21 (8b1); 25% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $75 (5); 25% (9a); $45/$35 (9c)"	"$20 (7a, 14c); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 25% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9	0.0536	0.6655	0.2983	0.365	0.4518	0.4377	0.2048	1.232	0.2647	0.9403	0	0.0024	0.4775	1.155	1.92	0.2423	0.1598	0	0	0.602	0.4845	0	0	0.064	0	0.0073	0	0	0											10.9285	0	2.55031168	12.8822	0.558245766	3.700358628	0.298283372	2.4555444	2.177165174	1.336866376	1.378176604	6.877556616	1.781145087	5.215350511	0	0.016404297	2.668304207	4.32501035	11.67316588	1.508878109	0.968562167	0	0	2.994297738	2.95916247	0	0	0.38730414	0	0.007344187	0	0	0	0	0	0	0	0	0	0	0	0	0	66.1693
H4971_801_0	2011	1																															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	197.749012	4.1783175	23.56665527	999.2486638	6.642970056	11.36023213	11.00513909	17.57209577	37.17205054	14.89638616	34.02582472	0	0.091956881	18.03048487	32.48968764	103.6135101	1.818414	3.733334567	0	0	16.13375302	8.277418124	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.078722741	0.078722741	0.169378828	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064325374	0.064325374	0.13840164	0	0.190387327	0.190387327	0.190387327	0.190387327	0.190387327	0.190387327	0.190387327	0	0.190387327	0.190387327	0.190387327	0.190387327	0.190387327	0.190387327	0	0	0.190387327	0.190387327	0	0	0	0	0	0	0	0												12.7203	0.268771838	3.26166375	0	1.264737311	2.162844228	2.095239014	3.345504341	7.077087336	2.83608314	6.478085812	0	0.017507425	3.432775816	6.18562478	19.72669922	0.346202981	0.710779588	0	0	3.071662109	1.57591551	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5775	0	17.13964094	12.7203	0.268771838	3.26166375	0	1.264737311	2.162844228	2.095239014	3.345504341	7.077087336	2.83608314	6.478085812	0	0.017507425	3.432775816	6.18562478	19.72669922	0.346202981	0.710779588	0	0	3.071662109	1.57591551	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5775	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.906	0.0191	0.3948	0	0.2731	0.4671	0.4525	0.7225	1.5284	0.6125	1.3991	0	0.0038	0.7414	1.2838	4.0942	0.0719	0.1475	0	0	0.6375	0.3271	0	0	0	0	0	0	0	0											14.0824	0	0	13.6263	0.287915831	3.65644652	0	1.537880609	2.629950243	2.547744439	4.068027572	8.605514591	3.448587488	7.877147664	0	0.021288475	4.174146929	7.469442437	23.82094769	0.418056919	0.858300885	0	0	3.709181227	1.90299454	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6599
H4971_802_0	2011	1																															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	206.5612094	4.1647095	24.61684519	1021.270527	6.938997646	11.86647288	11.495556	18.35515291	38.82853137	15.5602069	35.54210175	0	0.096054713	18.83230506	33.9375105	108.2307909	1.8142245	3.899701422	0	0	16.85271396	8.646280864	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.075668446	0.075668446	0.169552076	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.061195257	0.061195257	0.137121659	0	0.188433826	0.188433826	0.188433826	0.188433826	0.188433826	0.188433826	0.188433826	0	0.188433826	0.188433826	0.188433826	0.188433826	0.188433826	0.188433826	0	0	0.188433826	0.188433826	0	0	0	0	0	0	0	0												12.6406	0.254860467	3.375502643	0	1.307541878	2.236044891	2.166151603	3.458731698	7.31660874	2.932069325	6.69733423	0	0.018099957	3.548643303	6.394974963	20.39434206	0.341861264	0.734835661	0	0	3.175621377	1.629251787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.623	0	18.59500605	12.6406	0.254860467	3.375502643	0	1.307541878	2.236044891	2.166151603	3.458731698	7.31660874	2.932069325	6.69733423	0	0.018099957	3.548643303	6.394974963	20.39434206	0.341861264	0.734835661	0	0	3.175621377	1.629251787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.623	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9097	0.0183	0.4128	0	0.2853	0.4879	0.4727	0.7547	1.5965	0.6398	1.4614	0	0.0039	0.7743	1.341	4.2767	0.0717	0.1541	0	0	0.6659	0.3417	0	0	0	0	0	0	0	0											14.6686	0	0	13.5503	0.273201779	3.78829973	0	1.592857134	2.723966335	2.638821817	4.213452397	8.913146589	3.57186842	8.158741826	0	0.022049501	4.322983376	7.73600279	24.67104062	0.413549656	0.88893088	0	0	3.841549964	1.970906289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.2916
H4971_803_0	2011	1																															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	206.5612094	4.1647095	24.61684519	1021.270527	6.938997646	11.86647288	11.495556	18.35515291	38.82853137	15.5602069	35.54210175	0	0.096054713	18.83230506	33.9375105	108.2307909	1.8142245	3.899701422	0	0	16.85271396	8.646280864	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.075668446	0.075668446	0.169552076	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.061195257	0.061195257	0.137121659	0	0.188433826	0.188433826	0.188433826	0.188433826	0.188433826	0.188433826	0.188433826	0	0.188433826	0.188433826	0.188433826	0.188433826	0.188433826	0.188433826	0	0	0.188433826	0.188433826	0	0	0	0	0	0	0	0												12.6406	0.254860467	3.375502643	0	1.307541878	2.236044891	2.166151603	3.458731698	7.31660874	2.932069325	6.69733423	0	0.018099957	3.548643303	6.394974963	20.39434206	0.341861264	0.734835661	0	0	3.175621377	1.629251787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.623	0	18.59500605	12.6406	0.254860467	3.375502643	0	1.307541878	2.236044891	2.166151603	3.458731698	7.31660874	2.932069325	6.69733423	0	0.018099957	3.548643303	6.394974963	20.39434206	0.341861264	0.734835661	0	0	3.175621377	1.629251787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.623	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9097	0.0183	0.4128	0	0.2853	0.4879	0.4727	0.7547	1.5965	0.6398	1.4614	0	0.0039	0.7743	1.341	4.2767	0.0717	0.1541	0	0	0.6659	0.3417	0	0	0	0	0	0	0	0											14.6686	0	0	13.5503	0.273201779	3.78829973	0	1.592857134	2.723966335	2.638821817	4.213452397	8.913146589	3.57186842	8.158741826	0	0.022049501	4.322983376	7.73600279	24.67104062	0.413549656	0.88893088	0	0	3.841549964	1.970906289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.2916
H5005_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1279.762767	95.03975443	1325.517004	325.3089335	317.0491418	9.241321855	9.076651536	315.1432444	180.8754097	20.37553762	45.20498178	0	0.080494276	1508.659478	6400.121195	135.7960368	469.9807005	895.1216367	0	0	22.84753598	1322.542014	0	0	353.5645829	201.7221221	34.9286885	6	0	0											4200	"$195 Days 1-9 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$195 Days 1-9 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$195 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $195 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												157.2686053	112.2768957	61.57082061	0	200	0.2	0.101368061	49.99876548	195	0.148195266	0.159881494	0	0.2	76.54022742	9.232280314	0.134677224	38.5	30	0	0	0.2	29.16360005	0	0	30	30	0	0	0	0											NO	117.5781356	83.94115303	46.03196091	0	149.5252474	0.149525247	0.075785422	37.40202245	145.7871162	0.110794669	0.1195316	0	0.149525247	57.22348219	9.037788792	0.131870165	37.68894105	29.36800601	0	0	0.149525247	21.80347256	0	0	30	30	0	0	0	0												12.5393	0.664812214	5.084678911	0	3.950570946	1.381810936	0.687877864	0.982249559	2.19744203	2.257500953	5.403423791	0	0.012035927	7.194229066	4.8202453	17.90744582	1.476089576	2.190661467	0	0	3.41628347	2.403000709	0	0	0.883911457	0.504305305	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9579	0	16.82543227	12.5393	0.664812214	5.084678911	0	3.950570946	1.381810936	0.687877864	0.982249559	2.19744203	2.257500953	5.403423791	0	0.012035927	7.194229066	4.8202453	17.90744582	1.476089576	2.190661467	0	0	3.41628347	2.403000709	0	0	0.883911457	0.504305305	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9579	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.5393	0.664812214	5.084678911	0	3.950570946	1.381810936	0.687877864	0.982249559	2.19744203	2.257500953	5.403423791	0	0.012035927	7.194229066	4.8202453	17.90744582	1.476089576	2.190661467	0	0	3.41628347	2.403000709	0	0	0.883911457	0.504305305	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9579
H5005_010_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1384.7448	92.40178702	1192.975849	267.9307797	303.1356625	10.86208145	10.72734961	333.0927326	140.6132872	23.29915593	43.97439953	0	0.12612997	792.828572	5901.9014	152.5327169	459.4690212	891.7340931	0	0	23.0502536	945.5360797	0	0	205.778997	260.6115425	22.74010182	18.2868273	41.93911476	0											4200	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$225 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $225 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	61.25351061	0	200	0.2	0.109065951	49.99936917	225	0.125990834	0.159379174	0	0.2	88.52619636	9.342524527	0.145045997	38.5	35	0	0	0.2	33.81676334	0	0	35	30	0	0	0	0											NO	137.225365	91.79057053	45.13062008	0	147.3568441	0.147356844	0.080358071	36.85901787	165.7764497	0.092828059	0.11742806	0	0.147356844	65.22470459	9.135447221	0.14183451	37.64664647	34.22422406	0	0	0.147356844	24.91565762	0	0	35	30	0	0	0	0												15.8352	0.706801062	4.486644985	0	3.722426215	1.600602043	0.862029125	1.023122582	1.94253096	2.162815416	5.163828448	0	0.018586114	4.309334117	4.493042395	21.63440309	1.44145565	2.543242284	0	0	3.396612627	1.963221102	0	0	0.600188741	0.651528856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.5576	0	17.5411977	15.8352	0.706801062	4.486644985	0	3.722426215	1.600602043	0.862029125	1.023122582	1.94253096	2.162815416	5.163828448	0	0.018586114	4.309334117	4.493042395	21.63440309	1.44145565	2.543242284	0	0	3.396612627	1.963221102	0	0	0.600188741	0.651528856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.5576	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.8352	0.706801062	4.486644985	0	3.722426215	1.600602043	0.862029125	1.023122582	1.94253096	2.162815416	5.163828448	0	0.018586114	4.309334117	4.493042395	21.63440309	1.44145565	2.543242284	0	0	3.396612627	1.963221102	0	0	0.600188741	0.651528856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.5576
H5005_011_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1126.046847	94.16905293	1385.772353	410.4136962	370.6343487	10.95701938	8.933035154	337.6231557	171.1819177	24.90145859	46.68719173	0	0.026153636	820.9284553	6710.54584	136.6224186	449.915161	875.6607491	0	0	26.12403809	1706.841584	0	0	452.5679942	162.3902705	23.93459332	19.73963267	0	0											4200	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$225 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $225 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	62.16248931	0	200	0.2	0.086018355	49.99824585	225	0.11723064	0.15851077	0	0.2	87.91508562	9.112321171	0.162601432	38.5	35	0	0	0.2	34.04468764	0	0	35	30	0	0	0	0											NO	136.7131445	91.44794423	45.62938249	0	146.8068058	0.146806806	0.0631404	36.72174802	165.1576565	0.086051279	0.116352299	0	0.146806806	64.53266452	8.907783974	0.158951645	37.6358204	34.21438218	0	0	0.146806806	24.98995924	0	0	35	30	0	0	0	0												12.8288	0.717630525	5.269328061	0	4.534303738	1.608565017	0.564035409	1.033176037	2.356000364	2.142802367	5.432162111	0	0.003839532	4.41472505	4.981341058	21.71635822	1.411077183	2.496682628	0	0	3.835186587	3.554491801	0	0	1.319989983	0.405975676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6265	0	18.20089654	12.8288	0.717630525	5.269328061	0	4.534303738	1.608565017	0.564035409	1.033176037	2.356000364	2.142802367	5.432162111	0	0.003839532	4.41472505	4.981341058	21.71635822	1.411077183	2.496682628	0	0	3.835186587	3.554491801	0	0	1.319989983	0.405975676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6265	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.8288	0.717630525	5.269328061	0	4.534303738	1.608565017	0.564035409	1.033176037	2.356000364	2.142802367	5.432162111	0	0.003839532	4.41472505	4.981341058	21.71635822	1.411077183	2.496682628	0	0	3.835186587	3.554491801	0	0	1.319989983	0.405975676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6265
H5005_018_0	2011	2																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1285.101037	93.23780991	1174.822986	265.5289907	313.6327172	9.588381281	7.419310639	320.9282387	183.7430387	20.07933826	43.16611893	0	0.057345942	1310.030957	6100.54699	131.2402405	460.998332	875.5329747	0	0	19.73788572	1226.003193	0	0	163.8282588	165.0929158	0	0	154.961202	0											4200	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$225 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $225 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	61.62118298	0	200	0.2	0.105654476	49.99906747	225	0.13974523	0.160574332	0	0.2	88.45254557	9.079882709	0.155672207	38.5	35	0	0	0.2	34.08147814	0	0	35	30	0	0	0	0											NO	139.4131524	93.25398984	46.12535275	0	149.7061579	0.149706158	0.079085628	37.44694481	168.4194276	0.104603607	0.120194831	0	0.149706158	66.20945377	8.889427324	0.152419753	37.69244195	34.26585632	0	0	0.149706158	25.51103574	0	0	35	30	0	0	0	0												14.93	0.724566481	4.515760387	0	3.91272909	1.435439722	0.586760845	1.001481837	2.578824784	2.100371209	5.188344376	0	0.008585041	7.228036176	4.519197425	20.00360507	1.448012739	2.500073926	0	0	2.954883037	2.606384272	0	0	0.477832421	0.41273229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.1336	0	17.32848849	14.93	0.724566481	4.515760387	0	3.91272909	1.435439722	0.586760845	1.001481837	2.578824784	2.100371209	5.188344376	0	0.008585041	7.228036176	4.519197425	20.00360507	1.448012739	2.500073926	0	0	2.954883037	2.606384272	0	0	0.477832421	0.41273229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.1336	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.93	0.724566481	4.515760387	0	3.91272909	1.435439722	0.586760845	1.001481837	2.578824784	2.100371209	5.188344376	0	0.008585041	7.228036176	4.519197425	20.00360507	1.448012739	2.500073926	0	0	2.954883037	2.606384272	0	0	0.477832421	0.41273229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.1336
H5005_019_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	791.0318833	113.7368574	573.7206297	141.1207976	187.5789511	7.409960107	8.959287509	286.8154894	30.17322306	19.69092457	40.95764186	0	0.010558725	19.13920129	6057.621082	111.1536024	456.8931395	750.1187497	0	0	19.02981625	1023.97348	0	0	312.1936767	0	34.9286885	6	0	0											4700	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-57 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												206.8631108	127.8912646	64.77916766	0	200	0.2	0.089357728	49.99256312	0.2	0.131139029	0.158939507	0	0.2	0.166196423	8.646223783	0.1609952	38.5	35	0	0	0.2	34.38329403	0	0	35	0	0	0	0	0											NO	169.01436	104.4916136	52.92683418	0	163.4069596	0.16340696	0.073008373	40.8626062	0.16340696	0.10714515	0.129859108	0	0.16340696	0.135788261	8.523257753	0.158705561	37.95245551	34.50223228	0	0	0.16340696	28.0923477	0	0	35	0	0	0	0	0												11.1413	0.990378979	2.53043472	0	2.554308841	1.210839052	0.654103005	0.976669033	4.930514643	2.109787062	5.318722846	0	0.001725369	2.598878851	4.302555487	17.64069482	1.445018046	2.156730945	0	0	3.109604416	2.397151586	0	0	0.91056489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.98	0	9.443005441	11.1413	0.990378979	2.53043472	0	2.554308841	1.210839052	0.654103005	0.976669033	4.930514643	2.109787062	5.318722846	0	0.001725369	2.598878851	4.302555487	17.64069482	1.445018046	2.156730945	0	0	3.109604416	2.397151586	0	0	0.91056489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.98	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.1413	0.990378979	2.53043472	0	2.554308841	1.210839052	0.654103005	0.976669033	4.930514643	2.109787062	5.318722846	0	0.001725369	2.598878851	4.302555487	17.64069482	1.445018046	2.156730945	0	0	3.109604416	2.397151586	0	0	0.91056489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.98
H5005_801_0	2011	1																															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	299.6934188	8.647108288	42.27613958	368.7463074	13.35102489	11.54714622	12.15013152	21.84500053	44.06148537	27.10869792	53.58143106	0	0.083583947	31.66457972	43.5330811	160.2507696	3.357752768	10.22177606	0	0	39.90234912	13.4180621	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	$0 n/c (8a1a); FFS (8a2)	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.07380814	0.07380814	0.141199736	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.056544051	0.056544051	0.108172418	0	0.178500145	0.178500145	0.178500145	0.178500145	0.178500145	0.178500145	0.178500145	0	0.178500145	0.178500145	0.178500145	0.178500145	0.178500145	0.178500145	0	0	0.178500145	0.178500145	0	0	0	0	0	0	0	0												16.9459	0.488942529	4.573112238	0	2.383159886	2.061167281	2.168800244	3.899335774	7.86498155	4.838906523	9.56429324	0	0.014919747	5.652132087	7.77066131	28.60478569	0.599359358	1.824588514	0	0	7.122575124	2.395126037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.7727	0	33.21060484	16.9459	0.488942529	4.573112238	0	2.383159886	2.061167281	2.168800244	3.899335774	7.86498155	4.838906523	9.56429324	0	0.014919747	5.652132087	7.77066131	28.60478569	0.599359358	1.824588514	0	0	7.122575124	2.395126037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.7727	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.9459	0.488942529	4.573112238	0	2.383159886	2.061167281	2.168800244	3.899335774	7.86498155	4.838906523	9.56429324	0	0.014919747	5.652132087	7.77066131	28.60478569	0.599359358	1.824588514	0	0	7.122575124	2.395126037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.7727
H5005_803_0	2011	1																															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	293.4408474	8.897140772	36.09496599	347.5143103	12.52689915	12.5324895	12.94392835	21.25351309	42.79240383	27.7091872	59.8045986	0	0.056129156	32.87406942	42.68814352	160.1683205	3.374255617	9.73223879	0	0	38.92499287	12.28699812	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	$0 n/c (8a1a); FFS (8a2)	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.07457254	0.07457254	0.140321505	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.057241665	0.057241665	0.10771038	0	0.178850123	0.178850123	0.178850123	0.178850123	0.178850123	0.178850123	0.178850123	0	0.178850123	0.178850123	0.178850123	0.178850123	0.178850123	0.178850123	0	0	0.178850123	0.178850123	0	0	0	0	0	0	0	0												16.797	0.509287149	3.887802486	0	2.240437449	2.241437284	2.315023173	3.801193422	7.653426671	4.955791528	10.69605979	0	0.010038706	5.879531346	7.634779703	28.64612375	0.603486031	1.740612101	0	0	6.961739747	2.197531121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.7713	0	32.93235062	16.797	0.509287149	3.887802486	0	2.240437449	2.241437284	2.315023173	3.801193422	7.653426671	4.955791528	10.69605979	0	0.010038706	5.879531346	7.634779703	28.64612375	0.603486031	1.740612101	0	0	6.961739747	2.197531121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.7713	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.797	0.509287149	3.887802486	0	2.240437449	2.241437284	2.315023173	3.801193422	7.653426671	4.955791528	10.69605979	0	0.010038706	5.879531346	7.634779703	28.64612375	0.603486031	1.740612101	0	0	6.961739747	2.197531121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.7713
H5005_804_0	2011	1																															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	291.2456055	8.908415998	36.12150749	348.7772675	12.46824278	12.55057246	12.97298664	21.29372977	42.85925265	27.49443917	59.52263436	0	0.050752461	32.96851513	42.6015993	159.4413586	3.388093649	9.717634504	0	0	39.00572054	12.121116	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	$0 n/c (8a1a); FFS (8a2)	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.072725501	0.072725501	0.141858446	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.055948434	0.055948434	0.109133079	0	0.179249161	0.179249161	0.179249161	0.179249161	0.179249161	0.179249161	0.179249161	0	0.179249161	0.179249161	0.179249161	0.179249161	0.179249161	0.179249161	0	0	0.179249161	0.179249161	0	0	0	0	0	0	0	0												16.2947	0.49841192	3.942051336	0	2.234922055	2.249679581	2.325396968	3.816883193	7.682485072	4.928355149	10.66938226	0	0.009097336	5.909578671	7.636300925	28.57972972	0.607312943	1.74187783	0	0	6.991742674	2.172699872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.2906	0	32.47274856	16.2947	0.49841192	3.942051336	0	2.234922055	2.249679581	2.325396968	3.816883193	7.682485072	4.928355149	10.66938226	0	0.009097336	5.909578671	7.636300925	28.57972972	0.607312943	1.74187783	0	0	6.991742674	2.172699872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.2906	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.2947	0.49841192	3.942051336	0	2.234922055	2.249679581	2.325396968	3.816883193	7.682485072	4.928355149	10.66938226	0	0.009097336	5.909578671	7.636300925	28.57972972	0.607312943	1.74187783	0	0	6.991742674	2.172699872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.2906
H5006_014_1	2011	2																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	696.2462729	20.92125837	406.7541987	27.09982333	228.7995192	12.52937012	12.44731761	655.1649438	100.302637	34.4145791	37.68480862	0.011221659	0.111513286	0.01302081	4570.812287	1841.343211	1.899878846	7.890295233	0	5.737093151	24.21049859	0.673969154																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	112.2965592	112.2965592	44.91862367	0	89.83724734	0.179674495	0.179674495	44.91862367	0.089837247	0	0.089837247	0.359348989	0.089837247	0.359348989	8.983724734	22.45931183	0.359348989	0.089837247	22.45931183	0.480560454	0.179674495	0.089837247																				6.5155	0.195782111	1.522569898	0	1.71289325	2.251208244	2.236465501	2.452425629	9.01091281	0	3.385499473	0.004032492	0.010018047	0.004679015	3.42190995	3.446275115	0.682719543	0.708842404	0	0.000229752	4.350009099	0.060547534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9725		4.74810173	6.5155	0.195782111	1.522569898	0	1.71289325	2.251208244	2.236465501	2.452425629	9.01091281	0	3.385499473	0.004032492	0.010018047	0.004679015	3.42190995	3.446275115	0.682719543	0.708842404	0	0.000229752	4.350009099	0.060547534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9725	YES																																									3000																																									0			6.5155	0.195782111	1.522569898	0	1.71289325	2.251208244	2.236465501	2.452425629	9.01091281	0	3.385499473	0.004032492	0.010018047	0.004679015	3.42190995	3.446275115	0.682719543	0.708842404	0	0.000229752	4.350009099	0.060547534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9725
H5006_014_2	2011	2																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	683.3404221	20.53345502	379.8765678	30.3608629	216.657979	11.91407414	11.83605109	596.7360356	96.75624848	27.57080858	30.19071196	0.011221659	0.101248756	0.012560423	4305.086977	1734.296265	1.789428916	7.431590956	0	5.566061471	21.89955908	0.609637478																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	113.4309718	113.4309718	45.37238873	0	90.74477745	0.181489555	0.181489555	45.37238873	0.090744777	0	0.090744777	0.354258573	0.090744777	0.354258573	9.074477745	22.68619436	0.36297911	0.090744777	17.71292863	0.471243833	0.181489555	0.090744777																				6.4593	0.194094146	1.436325608	0	1.638381674	2.162280013	2.148119644	2.256278281	8.780124235	0	2.739649438	0.003975369	0.009187796	0.004449638	3.255534663	3.27871518	0.649525315	0.674378067	0	0.000218581	3.974541231	0.055321417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7204		4.051179123	6.4593	0.194094146	1.436325608	0	1.638381674	2.162280013	2.148119644	2.256278281	8.780124235	0	2.739649438	0.003975369	0.009187796	0.004449638	3.255534663	3.27871518	0.649525315	0.674378067	0	0.000218581	3.974541231	0.055321417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7204	YES																																									3000																																									0			6.4593	0.194094146	1.436325608	0	1.638381674	2.162280013	2.148119644	2.256278281	8.780124235	0	2.739649438	0.003975369	0.009187796	0.004449638	3.255534663	3.27871518	0.649525315	0.674378067	0	0.000218581	3.974541231	0.055321417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7204
H5006_014_3	2011	2																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	665.8010309	20.00642005	259.0307041	26.35825862	152.5438579	10.51826198	10.44937984	534.358251	107.0834339	31.55391052	34.55230632	0.011221659	0.105510711	0.013901092	4325.023374	1742.327606	1.79771557	7.466005859	0	5.933890983	23.9448176	0.666573156																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	113.4769532	113.4769532	45.39078128	0	90.78156256	0.181563125	0.181563125	45.39078128	0.090781563	0	0.090781563	0.36312625	0.090781563	0.36312625	9.078156256	22.69539064	0.36312625	0.090781563	22.69539064	0.444259433	0.181563125	0.090781563																				6.2961	0.189188966	0.979800503	0	1.154014148	1.909728515	1.897222059	2.021244875	9.721201456	0	3.136712358	0.004074879	0.009578427	0.005047851	3.2719365	3.295233803	0.652797714	0.677775678	0	0.000219682	4.347495913	0.060512553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6299		4.024226017	6.2961	0.189188966	0.979800503	0	1.154014148	1.909728515	1.897222059	2.021244875	9.721201456	0	3.136712358	0.004074879	0.009578427	0.005047851	3.2719365	3.295233803	0.652797714	0.677775678	0	0.000219682	4.347495913	0.060512553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6299	YES																																									3000																																									0			6.2961	0.189188966	0.979800503	0	1.154014148	1.909728515	1.897222059	2.021244875	9.721201456	0	3.136712358	0.004074879	0.009578427	0.005047851	3.2719365	3.295233803	0.652797714	0.677775678	0	0.000219682	4.347495913	0.060512553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6299
H5006_014_4	2011	2																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	733.4121963	22.03804408	385.4146652	30.03178435	198.668442	11.2873667	11.21344784	600.4513755	93.65303531	21.00660393	23.00274679	0.011221659	0.106541372	0.012157576	4402.631018	1773.591701	1.829973539	7.599974874	0	5.40945646	23.42311783	0.652050136																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	113.5674468	113.5674468	45.42697871	0	90.85395742	0.181707915	0.181707915	45.42697871	0.090853957	0	0.090853957	0.36341583	0.090853957	0.36341583	9.085395742	22.71348936	0.36341583	0.090853957	22.71348936	0.49646955	0.181707915	0.090853957																				6.941	0.208567033	1.459018649	0	1.504151181	2.051003867	2.037572226	2.273057654	8.508748883	0	2.089890578	0.004078129	0.009679705	0.004418256	3.333303759	3.357038018	0.665041352	0.690487794	0	0.000223803	4.2561659	0.059241335	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4527		3.971602179	6.941	0.208567033	1.459018649	0	1.504151181	2.051003867	2.037572226	2.273057654	8.508748883	0	2.089890578	0.004078129	0.009679705	0.004418256	3.333303759	3.357038018	0.665041352	0.690487794	0	0.000223803	4.2561659	0.059241335	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4527	YES																																									3000																																									0			6.941	0.208567033	1.459018649	0	1.504151181	2.051003867	2.037572226	2.273057654	8.508748883	0	2.089890578	0.004078129	0.009679705	0.004418256	3.333303759	3.357038018	0.665041352	0.690487794	0	0.000223803	4.2561659	0.059241335	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4527
H5006_014_5	2011	2																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	809.1262267	24.31314824	357.9954962	28.08555268	221.6067562	13.25452238	13.16772098	583.7363824	99.69143059	29.49526554	32.29803955	0.011221659	0.107438453	0.012941475	4553.588444	1834.404618	1.892719678	7.860562836	0	5.630108421	23.8323238	0.663441566																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	112.2104552	112.2104552	44.88418209	0	89.76836417	0.179536728	0.179536728	44.88418209	0.089768364	0	0.089768364	0.359073457	0.089768364	0.359073457	8.976836417	22.44209104	0.359073457	0.089768364	22.44209104	0.487472856	0.179536728	0.089768364																				7.566	0.227349119	1.33902792	0	1.657772999	2.379673583	2.364089545	2.183377506	8.949136646	0	2.899342176	0.0040294	0.009644574	0.00464694	3.406401548	3.430656288	0.679625397	0.705629867	0	0.00022871	4.278777444	0.059556064	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.145		4.803610998	7.566	0.227349119	1.33902792	0	1.657772999	2.379673583	2.364089545	2.183377506	8.949136646	0	2.899342176	0.0040294	0.009644574	0.00464694	3.406401548	3.430656288	0.679625397	0.705629867	0	0.00022871	4.278777444	0.059556064	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.145	YES																																									3000																																									0			7.566	0.227349119	1.33902792	0	1.657772999	2.379673583	2.364089545	2.183377506	8.949136646	0	2.899342176	0.0040294	0.009644574	0.00464694	3.406401548	3.430656288	0.679625397	0.705629867	0	0.00022871	4.278777444	0.059556064	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.145
H5006_017_4	2011	4																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	669.218919	25.46382395	282.1542449	22.45985114	183.0393312	13.0224703	12.86568812	543.4259766	79.11783097	35.69218914	40.48067014	0.009925677	0.115871366	0	4066.373693	1903.242702	1.932936871	7.56341507	0	4.49415212	35.07593548	0.620070502																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	180.141962	180.141962	45.03549049	0	135.1064715	0.180141962	0.180141962	45.03549049	0.135106471	0	0.135106471	0.360283924	0.135106471	0	13.51064715	27.02129429	0.360283924	0.135106471	0	1.290756793	0.180141962	0.135106471																				10.0462	0.3822586	1.058912901	0	2.060816515	2.345893349	2.317650299	2.039454616	10.68933097	0	5.469200505	0.003576062	0.015654971	0	4.578278344	4.28567343	0.696406081	1.021866322	0	0.000483405	6.318647834	0.083775538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4141		5.888127516	10.0462	0.3822586	1.058912901	0	2.060816515	2.345893349	2.317650299	2.039454616	10.68933097	0	5.469200505	0.003576062	0.015654971	0	4.578278344	4.28567343	0.696406081	1.021866322	0	0.000483405	6.318647834	0.083775538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4141	YES																																									4000																																									0			10.0462	0.3822586	1.058912901	0	2.060816515	2.345893349	2.317650299	2.039454616	10.68933097	0	5.469200505	0.003576062	0.015654971	0	4.578278344	4.28567343	0.696406081	1.021866322	0	0.000483405	6.318647834	0.083775538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4141
H5006_017_5	2011	4																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	685.2937984	26.07547418	274.9358751	26.25360144	180.8416095	12.91988949	12.76434231	516.4239452	79.62995632	29.83421326	33.83678544	0.009925677	0.109767449	0	3996.043381	1870.325006	1.899505597	7.432601382	0	4.549233502	33.10360289	0.585203713																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	180.8934772	180.8934772	45.2233693	0	135.6701079	0.180893477	0.180893477	45.2233693	0.135670108	0	0.135670108	0.361786954	0.135670108	0.361786954	13.56701079	27.13402158	0.361786954	0.135670108	0	1.258301994	0.180893477	0.135670108																				10.3304	0.393073599	1.036127218	0	2.044566723	2.337123735	2.308986265	1.946202566	10.80340477	0	4.590640332	0.00359098	0.014892162	0	4.517863639	4.229119923	0.687216345	1.008381832	0	0.000477026	5.988225836	0.079394651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3197		5.526168885	10.3304	0.393073599	1.036127218	0	2.044566723	2.337123735	2.308986265	1.946202566	10.80340477	0	4.590640332	0.00359098	0.014892162	0	4.517863639	4.229119923	0.687216345	1.008381832	0	0.000477026	5.988225836	0.079394651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3197	YES																																									4000																																									0			10.3304	0.393073599	1.036127218	0	2.044566723	2.337123735	2.308986265	1.946202566	10.80340477	0	4.590640332	0.00359098	0.014892162	0	4.517863639	4.229119923	0.687216345	1.008381832	0	0.000477026	5.988225836	0.079394651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3197
H5006_017_6	2011	4																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	680.3683789	25.88806164	191.0293601	23.22477203	129.7413371	11.62257753	11.48264915	471.2122735	89.79991406	34.79190782	39.45960664	0.009925677	0.116557546	0	4090.691146	1914.624345	1.94449609	7.608645295	0	4.941852301	36.88173926	0.651993404																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	180.0515824	180.0515824	45.0128956	0	135.0386868	0.180051582	0.180051582	45.0128956	0.135038687	0	0.135038687	0.360103165	0.135038687	0	13.50386868	27.00773736	0.360103165	0.135038687	27.00773736	1.180249661	0.180051582	0.135038687																				10.2085	0.388432205	0.716565387	0	1.460008315	2.092663475	2.06746915	1.767552406	12.12646247	0	5.328573463	0.003574268	0.015739778	0	4.603346337	4.309139289	0.700219196	1.027461469	0	0.000486052	6.640615516	0.088044333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5448		5.932378288	10.2085	0.388432205	0.716565387	0	1.460008315	2.092663475	2.06746915	1.767552406	12.12646247	0	5.328573463	0.003574268	0.015739778	0	4.603346337	4.309139289	0.700219196	1.027461469	0	0.000486052	6.640615516	0.088044333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5448	YES																																									4000																																									0			10.2085	0.388432205	0.716565387	0	1.460008315	2.092663475	2.06746915	1.767552406	12.12646247	0	5.328573463	0.003574268	0.015739778	0	4.603346337	4.309139289	0.700219196	1.027461469	0	0.000486052	6.640615516	0.088044333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5448
H5006_017_7	2011	4																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	770.5843567	29.32078554	292.246631	27.20747786	173.7340454	12.82399989	12.66960716	544.4203131	80.75175895	23.81514908	27.01020075	0.009925677	0.121013699	0	4281.470182	2003.91737	2.035182254	7.963492425	0	4.63208191	37.09513587	0.655765818																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	179.7024725	179.7024725	44.92561812	0	134.7768544	0.179702472	0.179702472	44.92561812	0.134776854	0	0.134776854	0.359404945	0.134776854	0.359404945	13.47768544	26.95537087	0.359404945	0.134776854	0	1.31534827	0.179702472	0.134776854																				11.5397	0.439084805	1.094113379	0	1.951277345	2.304504487	2.276759732	2.03820159	10.88346806	0	3.640349893	0.003567337	0.016309846	0	4.80869236	4.501361326	0.731454566	1.073294459	0	0.000507733	6.666087633	0.088382054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.0571		6.105786833	11.5397	0.439084805	1.094113379	0	1.951277345	2.304504487	2.276759732	2.03820159	10.88346806	0	3.640349893	0.003567337	0.016309846	0	4.80869236	4.501361326	0.731454566	1.073294459	0	0.000507733	6.666087633	0.088382054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.0571	YES																																									4000																																									0			11.5397	0.439084805	1.094113379	0	1.951277345	2.304504487	2.276759732	2.03820159	10.88346806	0	3.640349893	0.003567337	0.016309846	0	4.80869236	4.501361326	0.731454566	1.073294459	0	0.000507733	6.666087633	0.088382054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.0571
H5006_017_8	2011	4																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	811.9892987	30.89624631	259.2750982	24.30256363	185.0976947	14.3832464	14.21008134	505.5163492	82.10085792	31.93829547	36.22315231	0.009925677	0.116556893	0	4229.571565	1979.626523	2.010512424	7.866961508	0	4.604699843	36.04961414	0.637283141																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	178.4706839	178.4706839	44.61767097	0	133.8530129	0.178470684	0.178470684	44.61767097	0.133853013	0	0.133853013	0.356941368	0.133853013	0.356941368	13.38530129	26.77060258	0.356941368	0.133853013	0	1.298171146	0.178470684	0.133853013																				12.0764	0.459506184	0.964020919	0	2.06465701	2.566987821	2.536082935	1.879580178	10.9894472	0	4.848578074	0.003542885	0.015601491	0	4.717840811	4.416316242	0.717635054	1.0530165	0	0.000498141	6.43379929	0.085302269	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8288		6.734748887	12.0764	0.459506184	0.964020919	0	2.06465701	2.566987821	2.536082935	1.879580178	10.9894472	0	4.848578074	0.003542885	0.015601491	0	4.717840811	4.416316242	0.717635054	1.0530165	0	0.000498141	6.43379929	0.085302269	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8288	YES																																									4000																																									0			12.0764	0.459506184	0.964020919	0	2.06465701	2.566987821	2.536082935	1.879580178	10.9894472	0	4.848578074	0.003542885	0.015601491	0	4.717840811	4.416316242	0.717635054	1.0530165	0	0.000498141	6.43379929	0.085302269	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8288
H5006_018_4	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	486.1737653	13.89067901	141.7051071	12.97306552	125.7749649	9.492646102	10.9444606	633.0838718	91.96246445	36.13880925	34.57595262	0	0	0	4591.665124	1643.821923	1.107805303	7.163377994	0	8.846542799	28.00392195	0.289521693																				$225 - days 1-5	$225 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	15% Coinsurance																				225	225	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	20	40	0.4	0.15	40	40	0.2	0.15																			NO	192.5036542	192.5036542	42.77858982	0	128.3357695	0.171114359	0.171114359	42.77858982	0.128335769	0	0.128335769	0.342228719	0.128335769	0.342228719	17.11143593	34.22287185	0.342228719	0.128335769	34.22287185	2.808802569	0.171114359	0.08555718																				7.7992	0.222833872	0.505162054	0	1.345118908	1.624328056	1.872754364	2.256869606	11.80207364	0	4.437331484	0	0	0	6.54749863	4.688025585	0.379122789	0.919317627	0	0.002070683	4.791873162	0.02477066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2183		8.308497287	7.7992	0.222833872	0.505162054	0	1.345118908	1.624328056	1.872754364	2.256869606	11.80207364	0	4.437331484	0	0	0	6.54749863	4.688025585	0.379122789	0.919317627	0	0.002070683	4.791873162	0.02477066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2183	YES																																									5000																																									0			7.7992	0.222833872	0.505162054	0	1.345118908	1.624328056	1.872754364	2.256869606	11.80207364	0	4.437331484	0	0	0	6.54749863	4.688025585	0.379122789	0.919317627	0	0.002070683	4.791873162	0.02477066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2183
H5006_018_5	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	476.8580822	13.62451663	132.2572119	14.5249171	119.0247244	9.020731363	10.40037077	576.2570647	88.65439738	28.93372031	27.6824545	0	0	0	4321.974004	1547.272161	1.042738438	6.742637505	0	8.577348965	25.31476476	0.261719539																				$225 - days 1-5	$225 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	15% Coinsurance																				225	225	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	20	40	0.4	0.15	40	40	0.2	0.15																			NO	195.4689229	195.4689229	43.43753842	0	130.3126153	0.173750154	0.173750154	43.43753842	0.130312615	0	0.130312615	0.347500307	0.130312615	0.347500307	17.37501537	34.75003073	0.347500307	0.130312615	34.75003073	2.768805205	0.173750154	0.086875077																				7.7676	0.221930799	0.478743977	0	1.292535259	1.567353461	1.807066019	2.085932365	11.55278638	0	3.607373042	0	0	0	6.257863728	4.480646262	0.362351928	0.878650727	0	0.001979084	4.398444267	0.022736905	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.784		7.068034498	7.7676	0.221930799	0.478743977	0	1.292535259	1.567353461	1.807066019	2.085932365	11.55278638	0	3.607373042	0	0	0	6.257863728	4.480646262	0.362351928	0.878650727	0	0.001979084	4.398444267	0.022736905	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.784	YES																																									5000																																									0			7.7676	0.221930799	0.478743977	0	1.292535259	1.567353461	1.807066019	2.085932365	11.55278638	0	3.607373042	0	0	0	6.257863728	4.480646262	0.362351928	0.878650727	0	0.001979084	4.398444267	0.022736905	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.784
H5006_018_6	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	457.8898857	13.08256816	88.87766885	12.42741547	82.58891744	7.848560061	9.048926449	508.5469674	96.69621571	32.63416588	31.22287083	0	0	0	4279.107829	1531.926016	1.032396357	6.67576272	0	9.011751253	27.2781309	0.282018021																				$225 - days 1-5	$225 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	15% Coinsurance																				225	225	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	20	40	0.4	0.15	40	40	0.2	0.15																			NO	195.2971938	195.2971938	43.39937639	0	130.1981292	0.173597506	0.173597506	43.39937639	0.130198129	0	0.130198129	0	0	0	17.35975056	34.71950111	0.347195011	0.130198129	0	2.606907669	0.173597506	0.086798753																				7.4521	0.212915737	0.321436284	0	0.896076878	1.362490449	1.57087106	1.839218437	12.58966638	0	4.06515937	0	0	0	6.19035371	4.432308918	0.358442865	0.869171817	0	0.001957734	4.735415482	0.024478812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.922		7.136382687	7.4521	0.212915737	0.321436284	0	0.896076878	1.362490449	1.57087106	1.839218437	12.58966638	0	4.06515937	0	0	0	6.19035371	4.432308918	0.358442865	0.869171817	0	0.001957734	4.735415482	0.024478812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.922	YES																																									5000																																									0			7.4521	0.212915737	0.321436284	0	0.896076878	1.362490449	1.57087106	1.839218437	12.58966638	0	4.06515937	0	0	0	6.19035371	4.432308918	0.358442865	0.869171817	0	0.001957734	4.735415482	0.024478812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.922
H5006_018_7	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	539.3081252	15.40880358	141.3975528	15.13970761	115.0080347	9.005563346	10.38288294	611.0104549	90.42318634	23.22990441	22.22530545	0	0	0	4657.461878	1667.377244	1.123679717	7.266026382	0	8.784064382	28.53119931	0.294973009																				$225 - days 1-5	$225 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	15% Coinsurance																				225	225	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	20	40	0.4	0.15	40	40	0.2	0.15																			NO	193.4347179	193.4347179	42.98549288	0	128.9564786	0.171941972	0.171941972	42.98549288	0.128956479	0	0.128956479	0.343883943	0.128956479	0.343883943	17.19419715	34.3883943	0.343883943	0.128956479	34.3883943	2.883193798	0.171941972	0.085970986																				8.6934	0.248383131	0.506503625	0	1.235919264	1.548434316	1.785253362	2.188715463	11.6606557	0	2.866097127	0	0	0	6.673443147	4.778202177	0.386415412	0.937001176	0	0.002110513	4.905710658	0.02535912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4416		7.90485399	8.6934	0.248383131	0.506503625	0	1.235919264	1.548434316	1.785253362	2.188715463	11.6606557	0	2.866097127	0	0	0	6.673443147	4.778202177	0.386415412	0.937001176	0	0.002110513	4.905710658	0.02535912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4416	YES																																									5000																																									0			8.6934	0.248383131	0.506503625	0	1.235919264	1.548434316	1.785253362	2.188715463	11.6606557	0	2.866097127	0	0	0	6.673443147	4.778202177	0.386415412	0.937001176	0	0.002110513	4.905710658	0.02535912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4416
H5006_018_8	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	547.9613175	15.65603764	120.9583927	13.0395953	118.148192	9.739286027	11.22882188	547.0567069	88.64645543	30.03922148	28.74014723	0	0	0	4436.449917	1588.254683	1.0703574	6.921229413	0	8.419831998	26.73538869	0.27640682																				$225 - days 1-5	$225 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	15% Coinsurance																				225	225	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	20	40	0.4	0.15	40	40	0.2	0.15																			NO	193.5842993	193.5842993	43.01873317	0	129.0561995	0.172074933	0.172074933	43.01873317	0.1290562	0	0.1290562	0.344149865	0.1290562	0.344149865	17.20749327	34.41498654	0.344149865	0.1290562	34.41498654	2.867397484	0.172074933	0.086037466																				8.8397	0.25256359	0.433623069	0	1.270646386	1.675886987	1.932198769	1.961140542	11.44037464	0	3.709094175	0	0	0	6.36168184	4.554980293	0.368363355	0.893227564	0	0.002011917	4.600490209	0.023781342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3198		7.841545405	8.8397	0.25256359	0.433623069	0	1.270646386	1.675886987	1.932198769	1.961140542	11.44037464	0	3.709094175	0	0	0	6.36168184	4.554980293	0.368363355	0.893227564	0	0.002011917	4.600490209	0.023781342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3198	YES																																									5000																																									0			8.8397	0.25256359	0.433623069	0	1.270646386	1.675886987	1.932198769	1.961140542	11.44037464	0	3.709094175	0	0	0	6.36168184	4.554980293	0.368363355	0.893227564	0	0.002011917	4.600490209	0.023781342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3198
H5008_001_0	2011	4																															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	YES	249.7896901	44.9094	8414.469694	498.624559	19.43792652	22.7511505	8.17636602	7.867913189	2.430966402	35.71480158	9.354490816	0	0	4.790641566	0.728104382	106.3979657	21.4367	8.043018658	0	0	6.76909032	6.268149543	1461.479073	0	215.1998365	127.7602251	0	0	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.07121927	0.072083723	0	0	0.2	0.2	0.103147283	0.067459116	0.2	0	0.075755907	0	0	0.161677124	0.00607894	0.029651944	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.068273134	0.069101826	0	0	0.191726575	0.191726575	0.098880376	0.064668526	0.191726575	0	0.072622103	0	0	0.154989006	0.005827472	0.028425329	0.191726575	0	0	0	0.191726575	0.191922218	0	0	0	0	0	0	0	0												17.0539	3.103321548	0	0	3.726767071	4.362000156	0.80848215	0.508806351	0.466080861	0	0.679342794	0	0	0.742496776	0.004243008	3.024397148	4.109985063	0	0	0	1.297814501	1.202997161	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0907	0	1.771873516	17.0539	3.103321548	0	0	3.726767071	4.362000156	0.80848215	0.508806351	0.466080861	0	0.679342794	0	0	0.742496776	0.004243008	3.024397148	4.109985063	0	0	0	1.297814501	1.202997161	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0907	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.0539	3.103321548	0	0	3.726767071	4.362000156	0.80848215	0.508806351	0.466080861	0	0.679342794	0	0	0.742496776	0.004243008	3.024397148	4.109985063	0	0	0	1.297814501	1.202997161	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0907
H5008_002_0	2011	4																															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	YES	298.4079629	22.6983	47.39016227	1289.005337	15.6116969	21.0929538	18.00836123	31.61444293	46.90632872	22.39147324	47.8626626	0	0.105940146	21.20524303	46.156155	124.0648622	11.2976	7.407939577	0	0	15.40104235	7.423262021	696.1794858	267.0238505	120.6655306	198.3337391	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.071041174	0.071903473	0.144018601	0	0.233	0.233	0.233	0.087756701	0.233	0.233	0.233	0	0.233	0.233	0.22539071	0.232789283	0.234304946	0.233	0	0	0.233	0.23064038	0	0	0	0	0	0	0	0											NO	0.056460564	0.057145883	0.114459981	0	0.185178687	0.185178687	0.185178687	0.069756793	0.185178687	0.185178687	0.185178687	0	0.185178687	0.185178687	0.179131141	0.185011218	0.186215804	0.185178687	0	0	0.185178687	0.184641076	0	0	0	0	0	0	0	0												16.8483	1.297114395	5.424277072	0	2.890953541	3.9059655	3.334764696	2.205322157	8.686052387	4.146423625	8.863145039	0	0.019617857	3.926759072	8.268004696	22.9533913	2.103791671	1.371792528	0	0	2.851944809	1.37063909	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4682	0	25.93238631	16.8483	1.297114395	5.424277072	0	2.890953541	3.9059655	3.334764696	2.205322157	8.686052387	4.146423625	8.863145039	0	0.019617857	3.926759072	8.268004696	22.9533913	2.103791671	1.371792528	0	0	2.851944809	1.37063909	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4682	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.8483	1.297114395	5.424277072	0	2.890953541	3.9059655	3.334764696	2.205322157	8.686052387	4.146423625	8.863145039	0	0.019617857	3.926759072	8.268004696	22.9533913	2.103791671	1.371792528	0	0	2.851944809	1.37063909	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4682
H5009_001_0	2011	4																															D	D	D	Coin	T	Coin	Coin	V	V		Coin		Coin	V	V	V	V	V	Coin		Coin				V																1.282265994	0.005669172	0.119574342	0.09024798	1.05E-05	0.061458516	0.006277621	0.09626172	0.410421801	0.03241825	0.183942267	0	1.85E-05	0.257505649	0.25369565	0.7842277	0.010804184	0.072357309	0.214140642	0	0	0.00552724	0	0	0	0	0	0	0	0											3.8868	NO	353.719799	6.101537171	295.0136903	11.738822	0.873604295	5.575524129	0.216812001	185.2032934	437.7032985	0	24.61045073	0	0.003104584	427.9807934	3555.221776	3765.22709	201.2684344	1201.059937	28.09754647	0	13.74989346	0	0	0	16.59666646	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; $200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$25/Days 1-5, $50/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	10% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $15/Visit for Urgent Care; PBP 4a, 7a"	"$200/Case for OP Surg; $200/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$40/Visit for OP - PT/OT/ST; $40/Visit for OP Substance Abuse; $40/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP OV; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $40/Visit for SCP OV; $40/Visit for Podiatry - cvd; $40/Visit for Vision Exams; $40/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$40/Visit for OT; $40/Visit for PT/ST; PBP 7c, 7i"	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$40/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											50	198.4911126	198.8583183	39.71196445	0.099236243	99.9876595	0.198587568	0.198870088	49.57699478	198.4820773	0	0.095957226	0	0.099402987	39.71526869	14.90315535	33.02385488	39.75733068	39.69655044	0.122270693	0	0.1984	0	0	0	40	0	0	0	0	0											NO	188.1509256	188.4990021	37.64321119	0.094066635	94.77890693	0.188242356	0.188510158	46.99433308	188.142361	0	0.090958434	0	0.094224692	37.64634329	14.12679106	31.30351169	37.68621411	37.62860016	0.115901129	0	0.188064559	0	0	0	37.91624183	0	0	0	0	0												5.5461	0.095844472	0.925438554	1.104231483	0.006899938	1.049549798	0.040871265	0.725292105	6.862544334	0	2.238528068	0	0.000292528	1.342659323	4.185322932	9.822069186	0.632087109	3.766183676	3.256537348	0	2.585867656	0	0	0	0.052440268	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2387	50	2.431221763	6.8283	0.101513644	1.045012896	1.194479463	0.006910425	1.111008315	0.047148886	0.821553825	7.272966135	0.03241825	2.422470335	0	0.000311063	1.600164971	4.439018582	10.60629689	0.642891294	3.838540985	3.47067799	0	2.585867656	0.00552724	0	0	0.052440268	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1255	YES	$300/Days 1-5 for IP Med/Surg; $300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$50/Days 1-5, $100/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	20% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"$300/Case for OP Surg; $300/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$40/Visit for OP - PT/OT/ST; $40/Visit for OP Substance Abuse; $40/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$40/Visit for PCP OV; PBP 7a, 14b, 14c"	"$40/Visit for Chiro - cvd; $40/Visit for SCP OV; $40/Visit for Podiatry - cvd; $40/Visit for Vision Exams; $40/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$40/Visit for OT; $40/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$40/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											3400	0.2741	0.0845	0.3993	0.0457	1.3904	0.161	0.0085	0.0682	0.2168	0.0126	0.2724	0	0.0001	0.3209	0.1961	0.6307	0.1841	0.1038	0.1753	0	0.0069	0	0	2.6985	0.0002	0	0	0	0	0											7.2501	50	0.347643437	7.1024	0.1859657	1.444293264	1.240158828	1.397275039	1.271990309	0.055672956	0.889768232	7.489784438	0.045057381	2.694837456	0	0.000427655	1.921111309	4.635110359	11.23700169	0.82697382	3.942344882	3.646014504	0	2.592799948	0.005527375	0	2.698506703	0.052606895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.3756
H5009_002_0	2011	7																															D	D	D	Coin	T	Coin	Coin	V	V		Coin		Coin	V	V	V	V	V	Coin		Coin				V																2.501316564	0.033214355	0.224494977	0.193763067	5.77E-06	0.159661505	0.013674381	0.229766838	0.838024568	0.074138211	0.31161537	0	0.000868621	0.541478971	0.522174517	1.514746842	0.034096962	0.154506033	0.337864978	0	0	0.015048917	0	0	0	0	0	0	0	0											7.7005	NO	428.5037996	11.35970894	319.8156144	13.0156924	0.735062755	8.061180488	0.70988889	256.9442371	463.9960097	0	22.64334876	0	0.062666206	425.6798083	4006.924594	4003.199358	333.8768941	1439.690558	25.41475763	0	14.81117774	0	0	0	13.93252845	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; $200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$25/Days 1-5, $50/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	10% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $15/Visit for Urgent Care; PBP 4a, 7a"	"$200/Case for OP Surg; $200/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$40/Visit for OP - PT/OT/ST; $40/Visit for OP Substance Abuse; $40/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP OV; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $40/Visit for SCP OV; $40/Visit for Podiatry - cvd; $40/Visit for Vision Exams; $40/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$40/Visit for OT; $40/Visit for PT/ST; PBP 7c, 7i"	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$40/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											100	197.3100457	197.7429857	39.52969895	0.098656646	99.98921935	0.197444112	0.198127441	49.31718524	197.3160429	0	0.103109027	0	0.098613892	39.49620084	14.82423326	32.94029244	39.55861767	39.46174358	0.122457021	0	0.1984	0	0	0	40	0	0	0	0	0											NO	184.2908089	184.695182	36.92138517	0.09214692	93.3915658	0.184416029	0.185054269	46.0630574	184.2964104	0	0.096305517	0	0.092106988	36.89009738	13.84607626	30.76677175	36.94839573	36.85791375	0.11437686	0	0.185308844	0	0	0	37.36065404	0	0	0	0	0												6.5808	0.174840292	0.984002957	1.199355967	0.005720722	1.486610895	0.13136797	0.986303095	7.126066586	0	2.18067942	0	0.005771995	1.308614132	4.623348623	10.26379341	1.028017968	4.421999201	2.906860177	0	2.744642226	0	0	0	0.043377365	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2021	100	3.405244112	9.0821	0.208054648	1.208497934	1.393119034	0.005726492	1.6462724	0.145042351	1.216069933	7.964091154	0.074138211	2.492294791	0	0.006640617	1.850093103	5.14552314	11.77854025	1.06211493	4.576505235	3.244725155	0	2.744642226	0.015048917	0	0	0.043377365	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9026	YES	$300/Days 1-5 for IP Med/Surg; $300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$50/Days 1-5, $100/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	20% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"$300/Case for OP Surg; $300/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$40/Visit for OP - PT/OT/ST; $40/Visit for OP Substance Abuse; $40/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$40/Visit for PCP OV; PBP 7a, 14b, 14c"	"$40/Visit for Chiro - cvd; $40/Visit for SCP OV; $40/Visit for Podiatry - cvd; $40/Visit for Vision Exams; $40/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$40/Visit for OT; $40/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$40/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											3400	0.2526	0.0835	0.7401	0.0643	2.3684	0.1668	0.0325	0.0853	0.0611	0.0303	0.2087	0	0	0.4392	0.2596	0.6067	0.3003	0.1224	0.2764	0	0.0111	0	0	2.2421	0.0013	0	0	0	0	0											8.3528	100	0.4484347	9.3347	0.291536015	1.94859942	1.457438572	2.374103498	1.813035215	0.17755513	1.301376768	8.025203974	0.104473017	2.701039885	0	0.006640617	2.289309771	5.405144533	12.38527571	1.362387153	4.698891898	3.521107284	0	2.755713311	0.015054447	0	2.242122495	0.044703792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2554
H5009_004_0	2011	7																															D	D	D		T	Coin	Coin	V	V		Coin		Coin	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	0	0	0	0	0	0	0											0	NO	510.736539	10.24064887	292.4353937	0	3.192978118	10.63697114	0.702854657	237.4230538	569.3791805	0	31.90410896	0	0.006504208	508.0043339	5112.110967	4849.702412	356.5540377	1596.219117	32.88821532	0	22.55663978	0	0	0	49.21969525	0	0	0	0	0												$150/Days 1-5 for IP Med/Surg; $150/Days 1-5 for IP Med/Surg; PBP 1a	$150/Days 1-5 for IP MH/SA; PBP 1b	"$20/Days 1-5, $40/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $10/Visit for Urgent Care; PBP 4a, 7a"	"$100/Case for OP Surg; $100/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$30/Visit for OP - PT/OT/ST; $30/Visit for OP Substance Abuse; $30/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$10/Visit for PCP OV; PBP 7a, 14b, 14c"	"$10/Visit for Chiro - cvd; $30/Visit for SCP OV; $30/Visit for Podiatry - cvd; $30/Visit for Vision Exams; $30/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$30/Visit for MH - Non Phys; $30/Visit for Psych Services ; PBP 7e, 7h"	"$30/Visit for OT; $30/Visit for PT/ST; PBP 7c, 7i"	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	10% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$30/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											0	150	150	31.97899405	0	100	0.1	0.1	49.91335837	100	0	0.107154363	0	0.1	30	10	25.10179146	30	30	0.1244949	0	0.0989	0	0	0	30	0	0	0	0	0											NO	144.5803025	144.5803025	30.82355088	0	96.38686832	0.096386868	0.096386868	48.10992301	96.38686832	0	0.103282735	0	0.096386868	28.9160605	9.638686832	24.19483068	28.9160605	28.9160605	0.119996735	0	0.095326613	0	0	0	28.9160605	0	0	0	0	0												6.1535	0.123383009	0.751158103	0	0.025646763	1.025264337	0.067745959	0.95186707	4.573389674	0	3.295143632	0	0.00062692	1.224123671	4.106169722	9.778144058	0.859178177	3.846364045	3.946478466	0	2.150248066	0	0	0	0.118603307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9971	0	1.611776433	6.1535	0.123383009	0.751158103	0	0.025646763	1.025264337	0.067745959	0.95186707	4.573389674	0	3.295143632	0	0.00062692	1.224123671	4.106169722	9.778144058	0.859178177	3.846364045	3.946478466	0	2.150248066	0	0	0	0.118603307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9971	YES	$250/Days 1-5 for IP Med/Surg; $250/Days 1-5 for IP Med/Surg; PBP 1a	$250/Days 1-5 for IP MH/SA; PBP 1b	"$40/Days 1-5, $80/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	10% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$200/Case for OP Surg; $200/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	10% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$30/Visit for OP - PT/OT/ST; $30/Visit for OP Substance Abuse; $30/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$30/Visit for PCP OV; PBP 7a, 14b, 14c"	"$30/Visit for Chiro - cvd; $30/Visit for SCP OV; $30/Visit for Podiatry - cvd; $30/Visit for Vision Exams; $30/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$30/Visit for MH - Non Phys; $30/Visit for Psych Services ; PBP 7e, 7h"	"$30/Visit for OT; $30/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	10% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$30/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											2800	0.6058	0.0621	0.5687	0.0264	1.1657	0.1636	0.0634	0.0883	0.1544	0	0.2322	0	0.0018	0.2559	0.2856	0.5672	0.1873	0.1064	0.2461	0	0.0062	0	0	2.6853	0.0016	0	0	0	0	0											7.4739	0	0.280164086	6.7593	0.185437745	1.319831518	0.026417533	1.191301822	1.188836138	0.1311537	1.040117997	4.727816916	0	3.527391568	0	0.002428606	1.480060308	4.391766976	10.34535988	1.046465898	3.952716573	4.192609896	0	2.156420103	0	0	2.685295815	0.120233593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.471
H5009_801_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	203.5435393	3.012533453	19.82447695	0	0.118200225	14.19570876	1.772482514	17.74825265	70.01504535	7.126878901	27.98102047	0	0.030391427	53.24889108	48.69246492	131.8165587	3.428029357	13.07071894	30.29923253	4.871076032	32.11735147	1.614220288	0	0	0	0	0	0	0	0												Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 7a"	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 14d-j	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											0	0.072067925	0.072067925	0.143487965	0	0.233	0.233	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	0.06600144	0.06600144	0.131409533	0	0.213386684	0.213386684	0.213386684	0.213386684	0.213386684	0.213386684	0.213386684	0	0.213386684	0.213386684	0.213386684	0.213386684	0.213386684	0.213386684	0.213386684	0.213386684	0.213386684	0.213386684	0	0	0	0	0	0	0	0												13.4342	0.198831545	2.605125249	0	0.025222354	3.029175213	0.378224165	3.787240772	14.94027833	1.520781053	5.970777161	0	0.006485126	11.36260427	10.3903236	28.12789829	0.731495816	2.789117366	6.465452743	1.03942276	6.853415116	0.344453114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.0005	0	10.47829068	13.4342	0.198831545	2.605125249	0	0.025222354	3.029175213	0.378224165	3.787240772	14.94027833	1.520781053	5.970777161	0	0.006485126	11.36260427	10.3903236	28.12789829	0.731495816	2.789117366	6.465452743	1.03942276	6.853415116	0.344453114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.0005	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 14d-j	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											6700	0.5732	0.0436	0.9395	0	1.4266	0.2444	0.0614	0.2279	0.4428	0.2472	0.2116	0	0.002	1.1678	0.2496	1.3858	0.1556	0.0806	0.236	0.0211	0.0247	0.0018	0	0	0	0	0	0	0	0											7.7432	0	0.711709322	14.0074	0.242479951	3.544664592	0	1.451799609	3.27361045	0.43957493	4.015160097	15.38304673	1.76797694	6.182337157	0	0.008474172	12.53041247	10.63994181	29.51369196	0.887127646	2.869709426	6.70142378	1.060473413	6.878077815	0.346272414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.7437
H5009_802_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	202.7626258	3.000975592	19.74841852	0	0.117746739	14.14124562	1.765682222	17.68015985	69.7464262	7.099535975	27.87366871	0	0.030274827	53.04459682	48.5056518	131.3108323	3.414877407	13.02057192	30.18298674	4.852387701	31.9941303	1.608027183	0	0	0	0	0	0	0	0												Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 7a"	"Medicare-FFS Cost Sharing; PBP 9a, 9b"	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 14d-j	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											0	0.072093101	0.072093101	0.143516629	0	0.233	0.233	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	0.066023184	0.066023184	0.13143317	0	0.213382442	0.213382442	0.213382442	0.213382442	0.213382442	0.213382442	0.213382442	0	0.213382442	0.213382442	0.213382442	0.213382442	0.213382442	0.213382442	0.213382442	0.213382442	0.213382442	0.213382442	0	0	0	0	0	0	0	0												13.387	0.198133963	2.595597251	0	0.025125087	3.017493521	0.376765584	3.772635681	14.88266273	1.514916323	5.947751494	0	0.006460117	11.3187856	10.35025443	28.01942605	0.72867488	2.778361432	6.440519413	1.035414337	6.82698565	0.343124767	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.5661	0	10.44083096	13.387	0.198133963	2.595597251	0	0.025125087	3.017493521	0.376765584	3.772635681	14.88266273	1.514916323	5.947751494	0	0.006460117	11.3187856	10.35025443	28.01942605	0.72867488	2.778361432	6.440519413	1.035414337	6.82698565	0.343124767	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.5661	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	Medicare-FFS Cost Sharing; PBP 14d-j	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-f											6700	0.5712	0.0435	0.9361	0	1.4211	0.2435	0.0611	0.227	0.4411	0.2462	0.2107	0	0.002	1.1633	0.2487	1.3804	0.155	0.0803	0.2351	0.021	0.0246	0.0018	0	0	0	0	0	0	0	0											7.7137	0	0.709169035	13.9583	0.241629234	3.531700319	0	1.446200898	3.26098612	0.437879756	3.999676059	15.32372365	1.761158925	6.158495632	0	0.008441492	12.48209027	10.59891	29.39987555	0.883706533	2.858642697	6.675580453	1.05638381	6.85155324	0.344937051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.2798
H5010_001_0	2011	4																															D	D	D	Coin	T	Coin	Coin	V	V		Coin		Coin	V	V	V	V	V	Coin		Coin				V																1.338844658	0.012936493	0.080413443	0.114808676	1.02E-05	0.084909417	0.005886955	0.086338204	0.393728531	0.029025557	0.141067099	0	9.83E-05	0.25105015	0.242848698	0.749647445	0.012542887	0.067262758	0.17856345	0	0	0.006765804	0	0	0	0	0	0	0	0											3.7967	NO	417.0780585	7.979409384	247.1256236	16.59378152	1.506709299	10.05850421	0.516996957	221.7817231	464.4274152	0	21.07722225	0	0.018786923	376.6180628	4039.448538	3893.792272	255.6270465	1454.91737	27.0642015	0	18.49271852	0	0	0	28.39597182	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; $200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$25/Days 1-5, $50/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	10% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $15/Visit for Urgent Care; PBP 4a, 7a"	"$200/Case for OP Surg; $200/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$40/Visit for OP - PT/OT/ST; $40/Visit for OP Substance Abuse; $40/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP OV; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $40/Visit for SCP OV; $40/Visit for Podiatry - cvd; $40/Visit for Vision Exams; $40/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$40/Visit for OT; $40/Visit for PT/ST; PBP 7c, 7i"	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$40/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											50	198.7401492	198.8786195	39.76892773	0.09932869	99.98872646	0.198859726	0.19920299	49.63274095	198.6758754	0	0.101907272	0	0.099476742	39.74914871	14.91488406	33.58816076	39.78268651	39.75265795	0.115261015	0	0.1984	0	0	0	40	0	0	0	0	0											NO	186.3171884	186.4470032	37.28302929	0.093119797	93.73857506	0.186429291	0.186751098	46.53026973	186.2569323	0	0.095537195	0	0.093258594	37.26448663	13.98257612	31.48861317	37.29592803	37.26777651	0.108056215	0	0.185998302	0	0	0	37.49965756	0	0	0	0	0												6.4757	0.123978081	0.767799322	1.545209563	0.011769732	1.87519981	0.096549749	0.859963616	7.208568803	0	2.013658689	0	0.001752042	1.169539897	4.706824722	10.21750988	0.794487327	4.518461282	2.92445518	0	3.439614235	0	0	0	0.088736602	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8398	50	3.256463246	7.8146	0.136914573	0.848212764	1.66001824	0.011779975	1.960109227	0.102436705	0.94630182	7.602297334	0.029025557	2.154725788	0	0.001850346	1.420590048	4.94967342	10.96715733	0.807030214	4.58572404	3.10301863	0	3.439614235	0.006765804	0	0	0.088736602	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.6366	YES	$300/Days 1-5 for IP Med/Surg; $300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$50/Days 1-5, $100/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	20% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"$300/Case for OP Surg; $300/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$40/Visit for OP - PT/OT/ST; $40/Visit for OP Substance Abuse; $40/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$40/Visit for PCP OV; PBP 7a, 14b, 14c"	"$40/Visit for Chiro - cvd; $40/Visit for SCP OV; $40/Visit for Podiatry - cvd; $40/Visit for Vision Exams; $40/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$40/Visit for OT; $40/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$40/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											3400	0.7553	0.0578	0.5558	0.0419	1.2591	0.2835	0.0487	0.0742	0.177	0.0084	0.1748	0	0.0006	0.3176	0.5036	0.6961	0.208	0.4062	0.247	0	0.0177	0	0	2.3448	0.0012	0	0	0	0	0											8.1795	50	0.49308172	8.5699	0.194684063	1.404009351	1.701917949	1.27087046	2.243655735	0.151159463	1.020520951	7.779327581	0.03737846	2.329538872	0	0.002487363	1.738170046	5.453274829	11.6632967	1.015061029	4.991961869	3.349990226	0	3.457314712	0.006767938	0	2.344814587	0.089975709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.816
H5010_002_0	2011	7																															D	D	D	Coin	T	Coin	Coin	V	V		Coin		Coin	V	V	V	V	V	Coin		Coin				V																2.566082068	0.028425318	0.210984756	0.30280386	5.01E-06	0.146106916	0.006717969	0.217436633	0.677973882	0.06542916	0.237344017	0	0.000112588	0.507163465	0.475996281	1.469430911	0.028154284	0.133486043	0.442481932	0	0	0.008551342	0	0	0	0	0	0	0	0											7.5247	NO	424.1400896	10.79485102	328.531367	19.95188217	0.812481768	9.241463042	0.386475976	286.284283	438.4009885	0	16.9713494	0	0.010154785	373.8294164	3958.965916	3548.922122	286.7972213	1239.899019	31.57756209	0	15.36194177	0	0	0	21.97379629	0	0	0	0	0												$200/Days 1-5 for IP Med/Surg; $200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	"$25/Days 1-5, $50/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	10% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $15/Visit for Urgent Care; PBP 4a, 7a"	"$200/Case for OP Surg; $200/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$40/Visit for OP - PT/OT/ST; $40/Visit for OP Substance Abuse; $40/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP OV; PBP 7a, 14b, 14c"	"$15/Visit for Chiro - cvd; $40/Visit for SCP OV; $40/Visit for Podiatry - cvd; $40/Visit for Vision Exams; $40/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$40/Visit for OT; $40/Visit for PT/ST; PBP 7c, 7i"	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$40/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											100	197.223181	197.422351	39.58126847	0.098565572	99.98979963	0.197802189	0.198651288	49.30460021	197.2232236	0	0.100808925	0	0.098891284	39.47331406	14.82233884	33.45236458	39.56500501	39.43989585	0.117188846	0	0.1984	0	0	0	40	0	0	0	0	0											NO	184.0614217	184.2473	36.93979841	0.091987763	93.31694471	0.18460179	0.185394223	46.01424015	184.0614615	0	0.094081406	0	0.092291739	36.83904838	13.83316477	31.21990911	36.9246203	36.80786035	0.109368207	0	0.185159705	0	0	0	37.33058574	0	0	0	0	0												6.5057	0.165743513	1.011323539	1.835329013	0.006318193	1.705990617	0.071650413	1.097762812	6.724393887	0	1.596688407	0	0.000937203	1.147626663	4.563752321	9.233085507	0.882489875	3.803169161	3.453581343	0	2.844412612	0	0	0	0.068357891	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7183	100	3.340703097	9.0717	0.194168831	1.222308295	2.138132873	0.006323202	1.852097532	0.078368383	1.315199445	7.402367769	0.06542916	1.834032424	0	0.001049791	1.654790128	5.039748602	10.70251642	0.910644159	3.936655204	3.896063274	0	2.844412612	0.008551342	0	0	0.068357891	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.243	YES	$300/Days 1-5 for IP Med/Surg; $300/Days 1-5 for IP Med/Surg; PBP 1a	$300/Days 1-5 for IP MH/SA; PBP 1b	"$50/Days 1-5, $100/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	20% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $40/Visit for Urgent Care; PBP 4a, 4b"	"$300/Case for OP Surg; $300/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$40/Visit for OP - PT/OT/ST; $40/Visit for OP Substance Abuse; $40/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$40/Visit for PCP OV; PBP 7a, 14b, 14c"	"$40/Visit for Chiro - cvd; $40/Visit for SCP OV; $40/Visit for Podiatry - cvd; $40/Visit for Vision Exams; $40/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$40/Visit for MH - Non Phys; $40/Visit for Psych Services ; PBP 7e, 7h"	"$40/Visit for OT; $40/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	20% Coinsurance for Medicare Part B Drugs; 10% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$40/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											3400	0.4071	0.0317	1.4988	0.0333	2.036	0.6124	0.0455	0.1131	0.2583	0.0132	0.1798	0	0.0004	0.5117	0.8202	1.0286	0.3353	0.1174	0.2683	0	0.1344	0	0	1.8802	0.0007	0	0	0	0	0											10.3263	100	0.591447285	9.4788	0.225892394	2.721099623	2.17139613	2.042289491	2.464492529	0.123828483	1.428305629	7.660637208	0.078593683	2.013881121	0	0.001442537	2.166511824	5.859966642	11.73106661	1.245991587	4.054032366	4.164345116	0	2.978855184	0.008553376	0	1.880173505	0.069023057	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.5692
H5010_004_0	2011	7																															D	D	D		T	Coin	Coin	V	V		Coin		Coin	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	0	0	0	0	0	0	0											0	NO	522.2167742	6.969263868	313.3795067	0	1.770271812	11.8316228	0.611115232	270.7573922	531.7524918	0	18.34954392	0	0.010300399	460.7563734	4855.67145	4482.179374	342.8031645	1613.342029	35.09035932	0	28.65005625	0	0	0	23.73272341	0	0	0	0	0												$150/Days 1-5 for IP Med/Surg; $150/Days 1-5 for IP Med/Surg; PBP 1a	$150/Days 1-5 for IP MH/SA; PBP 1b	"$20/Days 1-5, $40/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $10/Visit for Urgent Care; PBP 4a, 7a"	"$100/Case for OP Surg; $100/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$30/Visit for OP - PT/OT/ST; $30/Visit for OP Substance Abuse; $30/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$10/Visit for PCP OV; PBP 7a, 14b, 14c"	"$10/Visit for Chiro - cvd; $30/Visit for SCP OV; $30/Visit for Podiatry - cvd; $30/Visit for Vision Exams; $30/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$30/Visit for MH - Non Phys; $30/Visit for Psych Services ; PBP 7e, 7h"	"$30/Visit for OT; $30/Visit for PT/ST; PBP 7c, 7i"	0% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; 10% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	10% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$30/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											0	150	150	31.97899405	0	100	0.1	0.1	49.91915271	100	0	0.109419744	0	0.1	30	10	24.2749003	30	30	0.112774652	0	0.0989	0	0	0	30	0	0	0	0	0											NO	144.4719344	144.4719344	30.80044753	0	96.31462292	0.096314623	0.096314623	48.0794437	96.31462292	0	0.105387214	0	0.096314623	28.89438688	9.631462292	23.38027868	28.89438688	28.89438688	0.108618481	0	0.095255162	0	0	0	28.89438688	0	0	0	0	0												6.2871	0.083905253	0.804352421	0	0.014208589	1.139558288	0.058859333	1.084822066	4.267961728	0	1.93380731	0	0.000992079	1.109439409	3.89726804	8.732883573	0.825423938	3.884710728	3.811461525	0	2.729065751	0	0	0	0.057145208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.723	0	1.558222644	6.2871	0.083905253	0.804352421	0	0.014208589	1.139558288	0.058859333	1.084822066	4.267961728	0	1.93380731	0	0.000992079	1.109439409	3.89726804	8.732883573	0.825423938	3.884710728	3.811461525	0	2.729065751	0	0	0	0.057145208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.723	YES	$250/Days 1-5 for IP Med/Surg; $250/Days 1-5 for IP Med/Surg; PBP 1a	$250/Days 1-5 for IP MH/SA; PBP 1b	"$40/Days 1-5, $80/Days 6-25, $0 Days 26-100 for SNF; PBP 2"	10% Coinsurance for HH; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP Worldwide ER; $30/Visit for Urgent Care; PBP 4a, 4b"	"$200/Case for OP Surg; $200/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	10% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 8b	No Cost Sharing; PBP 9a	10% Coinsurance for Renal Dialysis; PBP 12	"$30/Visit for OP - PT/OT/ST; $30/Visit for OP Substance Abuse; $30/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$30/Visit for PCP OV; PBP 7a, 14b, 14c"	"$30/Visit for Chiro - cvd; $30/Visit for SCP OV; $30/Visit for Podiatry - cvd; $30/Visit for Vision Exams; $30/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$30/Visit for MH - Non Phys; $30/Visit for Psych Services ; PBP 7e, 7h"	"$30/Visit for OT; $30/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for OP Rad - General; 30% Coinsurance for OP Rad - PET/CAT/MRI; 20% Coinsurance for OP Radiation Therapy; PBP 7d	No Cost Sharing; PBP 14d-j	10% Coinsurance for Medicare Part B Drugs; 0% Coinsurance for Immunosuppressive Drugs; 0% Coinsurance for Home Infusion Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"20% Coinsurance for Preventive Dental (non-cvd); PBP 16a, 16b"	$30/Exam for Routine Eye Exams (non-cvd); PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											2800	0.4652	0.0651	1.1488	1.2043	1.1951	0.5493	0.0491	0.1625	0.3238	0	0.2241	0	0.0003	0.3097	0.6269	0.7496	0.4671	0.1706	0.2679	0	0.2817	0	0	2.2592	0.0085	0	0	0	0	0											10.5288	0	0.402872043	6.7523	0.149048837	1.953140896	1.204266385	1.209340847	1.688884196	0.10795134	1.247357605	4.591751673	0	2.157864841	0	0.001296359	1.419158619	4.524146372	9.482474415	1.292538169	4.055274374	4.079314909	0	3.010803496	0	0	2.259173911	0.065633935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.2518
H5016_001_0	2011	8																															D	D			T	Coin		V	V		Coin	0		V	V	V	V	V	Coin		Coin				V				V		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	696.5337713	7.622572369	0	0	167.6719329	13.52383823	0	331.8460471	385.4551646	0	26.31034724	0	0	382.3537552	4594.573867	4355.596619	400.1449753	1005.864687	18.51656043	0	26.74203664	0	0	0	359.298529	0	0	0	48	0	0	0	0	0	0	0	0	0	0	0		$125/day (Days 1-6)	$125/day (Days 1-6)			$100 Ambul	10% Coin DME		$50 ER Waived/$50 ER Waived/$50 ER Waived/$50 ER Waived	$100 Copay OP Hosp & Surg/$100 Copay ASC		10% Coin MRI/CT/PET/10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad/10% Coin Rad	0		$10 Copay CORF/$25 Copay Urgent Care/$0 Copay Partial Hospitalization/$10 Copay Mental Health/$10 Copay PT & ST/$100 Copay OP Hosp & Surg/$10 Copay OP Substance Abuse/$10 Copay Cardiac Rehab/$10 Copay Cardiac Rehab	$10 Copay PCP/$10 Copay PCP/$0 Copay Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$10 Copay Chiro/$10 Copay Specialists/$10 Copay Specialists/$10 Copay Specialists/$10 Copay Podiatry/$10 Copay Preventive Dental/$10 Copay Medicare Covered Vision Exams/$10 Copay Medicare Covered Hearing Exams	$10 Copay Mental Health/$10 Copay Psychiatric	$10 Copay OT/$10 Copay PT & ST	10% Coin MRI/CT/PET/10% Coin Rad		10% Coin Part B Rx				$10 Copay Non-Covered Vision Exams				$15 Copay H&E		0	0	0	0	0	0	0	0	0	0	0	125	125	0	0	100	0.1	0	50	100	0	0.1	0	0	80.67373753	10	10	10	10	0.1	0	0.1	0	0	0	10	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0	NO	119.303419	119.303419	0	0	95.44273522	0.095442735	0	47.72136761	95.44273522	0	0.095442735	0	0	76.9972217	9.544273522	9.544273522	9.544273522	9.544273522	0.095442735	0	0.095442735	0	0	0	9.544273522	0	0	0	14.31641028	0	0	0	0	0	0	0	0	0	0	0		6.9249	0.075783245	0	0	1.333588991	1.290752111	0	1.319678934	3.065741268	0	2.511131505	0	0	2.453348071	3.654322476	3.464250457	0.318257758	0.800020642	1.767271175	0	2.552333122	0	0	0	0.285770286	0	0	0	0.057265641	0	0	0	0	0	0	0	0	0	0	0	31.8744	0	1.521961566	6.9249	0.075783245	0	0	1.333588991	1.290752111	0	1.319678934	3.065741268	0	2.511131505	0	0	2.453348071	3.654322476	3.464250457	0.318257758	0.800020642	1.767271175	0	2.552333122	0	0	0	0.285770286	0	0	0	0.057265641	0	0	0	0	0	0	0	0	0	0	0	31.8744	YES	$200/day (Days 1-6)	$200/day (Days 1-6)				20% Coin DME			$200 Copay OP Hosp & Surg/$200 Copay ASC		10% Coin MRI/CT/PET/10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad/10% Coin Rad	0		$25 Copay CORF/$25 Copay Urgent Care/$0 Copay Partial Hospitalization/$25 Copay Mental Health/$25 Copay PT & ST/$200 Copay OP Hosp & Surg/$25 Copay OP Substance Abuse/$25 Copay Cardiac Rehab/$25 Copay Cardiac Rehab	$25 Copay PCP/$25 Copay PCP/$0 Copay Immunizations/$25 Copay Physical Exams/$25 Copay Supp Physical Exams	$25 Copay Chiro/$25 Copay Specialists/$25 Copay Specialists/$25 Copay Specialists/$25 Copay Podiatry/$25 Copay Preventive Dental/$25 Copay Medicare Covered Vision Exams/$25 Copay Medicare Covered Hearing Exams	$25 Copay Mental Health/$25 Copay Psychiatric	$25 Copay OT/$25 Copay PT & ST	10% Coin MRI/CT/PET/10% Coin Rad		10% Coin Part B Rx				$25 Copay Non-Covered Vision Exams						0	0	0	0	0	0	0	0	0	0	2500	0.2726	0.003	0	0	0	0.0546	0	0	0.131	0	0.0531	0	0	0.3158	0.1375	0.1303	0.012	0.0301	0.0624	0	0.0298	0	0	0	0.0011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.2333	0	0.058888529	7.1975	0.078766151	0	0	1.333588991	1.345308588	0	1.319678934	3.196732031	0	2.564277336	0	0	2.769161425	3.791821066	3.594597344	0.330232616	0.830122449	1.829691877	0	2.582123659	0	0	0	0.286877923	0	0	0	0.057265641	0	0	0	0	0	0	0	0	0	0	0	33.1077
H5016_002_0	2011	6																															D	D			T	Coin		V	V		Coin	0		V	V	V	V	V	Coin		Coin				V				V		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	696.5337713	7.622572369	0	0	167.6719329	13.52383823	0	331.8460471	385.4551646	0	26.31034724	0	0	382.3537552	4594.573867	4355.596619	400.1449753	1005.864687	18.51656043	0	26.74203664	0	0	0	359.298529	0	0	0	48	0	0	0	0	0	0	0	0	0	0	0		$125/day (Days 1-6)	$125/day (Days 1-6)			$100 Ambul	10% Coin DME		$50 ER Waived/$50 ER Waived/$50 ER Waived/$50 ER Waived	$100 Copay OP Hosp & Surg/$100 Copay ASC		10% Coin MRI/CT/PET/10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad/10% Coin Rad	0		$10 Copay CORF/$25 Copay Urgent Care/$0 Copay Partial Hospitalization/$10 Copay Mental Health/$10 Copay PT & ST/$100 Copay OP Hosp & Surg/$10 Copay OP Substance Abuse/$10 Copay Cardiac Rehab/$10 Copay Cardiac Rehab	$10 Copay PCP/$10 Copay PCP/$0 Copay Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$10 Copay Chiro/$10 Copay Specialists/$10 Copay Specialists/$10 Copay Specialists/$10 Copay Podiatry/$10 Copay Preventive Dental/$10 Copay Medicare Covered Vision Exams/$10 Copay Medicare Covered Hearing Exams	$10 Copay Mental Health/$10 Copay Psychiatric	$10 Copay OT/$10 Copay PT & ST	10% Coin MRI/CT/PET/10% Coin Rad		10% Coin Part B Rx				$10 Copay Non-Covered Vision Exams				$15 Copay H&E		0	0	0	0	0	0	0	0	0	0	0	125	125	0	0	100	0.1	0	50	100	0	0.1	0	0	80.67373753	10	10	10	10	0.1	0	0.1	0	0	0	10	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0	NO	119.303419	119.303419	0	0	95.44273522	0.095442735	0	47.72136761	95.44273522	0	0.095442735	0	0	76.9972217	9.544273522	9.544273522	9.544273522	9.544273522	0.095442735	0	0.095442735	0	0	0	9.544273522	0	0	0	14.31641028	0	0	0	0	0	0	0	0	0	0	0		6.9249	0.075783245	0	0	1.333588991	1.290752111	0	1.319678934	3.065741268	0	2.511131505	0	0	2.453348071	3.654322476	3.464250457	0.318257758	0.800020642	1.767271175	0	2.552333122	0	0	0	0.285770286	0	0	0	0.057265641	0	0	0	0	0	0	0	0	0	0	0	31.8744	0	1.521961566	6.9249	0.075783245	0	0	1.333588991	1.290752111	0	1.319678934	3.065741268	0	2.511131505	0	0	2.453348071	3.654322476	3.464250457	0.318257758	0.800020642	1.767271175	0	2.552333122	0	0	0	0.285770286	0	0	0	0.057265641	0	0	0	0	0	0	0	0	0	0	0	31.8744	YES	$200/day (Days 1-6)	$200/day (Days 1-6)				20% Coin DME			$200 Copay OP Hosp & Surg/$200 Copay ASC		10% Coin MRI/CT/PET/10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad/10% Coin MRI/CT/PET/10% Coin Rad/10% Coin Rad	0		$25 Copay CORF/$25 Copay Urgent Care/$0 Copay Partial Hospitalization/$25 Copay Mental Health/$25 Copay PT & ST/$200 Copay OP Hosp & Surg/$25 Copay OP Substance Abuse/$25 Copay Cardiac Rehab/$25 Copay Cardiac Rehab	$25 Copay PCP/$25 Copay PCP/$0 Copay Immunizations/$25 Copay Physical Exams/$25 Copay Supp Physical Exams	$25 Copay Chiro/$25 Copay Specialists/$25 Copay Specialists/$25 Copay Specialists/$25 Copay Podiatry/$25 Copay Preventive Dental/$25 Copay Medicare Covered Vision Exams/$25 Copay Medicare Covered Hearing Exams	$25 Copay Mental Health/$25 Copay Psychiatric	$25 Copay OT/$25 Copay PT & ST	10% Coin MRI/CT/PET/10% Coin Rad		10% Coin Part B Rx				$25 Copay Non-Covered Vision Exams						0	0	0	0	0	0	0	0	0	0	2500	0.2726	0.003	0	0	0	0.0546	0	0	0.131	0	0.0531	0	0	0.3158	0.1375	0.1303	0.012	0.0301	0.0624	0	0.0298	0	0	0	0.0011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.2333	0	0.058888529	7.1975	0.078766151	0	0	1.333588991	1.345308588	0	1.319678934	3.196732031	0	2.564277336	0	0	2.769161425	3.791821066	3.594597344	0.330232616	0.830122449	1.829691877	0	2.582123659	0	0	0	0.286877923	0	0	0	0.057265641	0	0	0	0	0	0	0	0	0	0	0	33.1077
H5041_001_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		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	YES	1219.598609	38.25272462	365.9680674	350.3734823	43.16943547	10.99452244	2.04313023	439.0266112	400.1550736	1695.784037	1004.575218	87.53149166	0.153777815	7.800368719	3389.868799	3095.613548	131.9026488	512.7756905		1238.749431	21.52048437	0		2.88					3	0.56	1560.489036	1205.300944									4000	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										165.92202	145.11002	32.5726	0	150	0.2	0.2	50	189.99163	39.781633	113.198515	150	0.172999	0.2	10	33.134973	35	64.604889		0	0.2	0		0					0	0	0	137.92362									NO	134.944047	118.017689	22.127186	0	123.58395	0.164779	0.164779	41.19465	156.532774	32.775809	93.263464	123.58395	0.142533	0.164779	8.23893	27.299672	28.836255	53.227515		0	0.164779	0		0					0	0	0	113.634305										13.7148	0.37620818	0.674820292	0	0.444587446	1.811666414	0.336664956	1.507128966	5.219781975	4.631724475	7.807513724	0.901457291	0.021918413	1.285336957	2.327407645	7.042436209	0.316964868	2.274481313	0	0	3.546123894	0	0	0	0	0	0	0	0	0	0	11.41362792	0	0	0	0	0	0	0	0	65.6546	0	14.4307856	13.7148	0.37620818	0.674820292	0	0.444587446	1.811666414	0.336664956	1.507128966	5.219781975	4.631724475	7.807513724	0.901457291	0.021918413	1.285336957	2.327407645	7.042436209	0.316964868	2.274481313	0	0	3.546123894	0	0	0	0	0	0	0	0	0	0	11.41362792	0	0	0	0	0	0	0	0	65.6546	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									6000	5.5682	0.064	0.2877	3.7602	1.9048	2.5589	0.4755	0.2412	2.9507	0.4883	1.2045	0.2184	0.0036	0.3149	1.405	1.8341	0.0479	0.1722		0.2161	0.9624	0		0					0	0	0.6624	0.6548									25.9956	500	13.35847725	19.2829	0.44017742	0.962545226	3.760245146	2.349376189	4.370526999	0.812182477	1.748343876	8.170458331	5.120018105	9.011965745	1.119820893	0.025498485	1.600256104	3.732361068	8.87657332	0.364866215	2.44664526	0	0.216081579	4.508536275	0	0	0	0	0	0	0	0	0	0.662446215	12.06842281	0	0	0	0	0	0	0	0	91.6503
H5041_002_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin			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	YES	1137.61908	52.711715	560.414885	496.871942	40.325175	9.277828	2.874425	351.882414	371.34581	1405.323584	932.582142	86.061658	0.373638	7.634583	3240.863806	3151.278809	90.022079	579.884139		1430.627182	18.352048	0			3.1				3	0.56	1022.060535	682.494307									4000	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										165.92202	145.11002	32.5726	0	150	0.2	0.2	50	184.085226	30.381622	106.990671	150	0.172843	0.2	10	33.428061	35	70.92209		0	0.2	0			0				0	0	0	128.277878									NO	141.638835	123.872733	22.712613	0	128.442	0.171256	0.171256	42.814	157.628497	26.015175	91.613972	128.442	0.148002	0.171256	8.5628	28.62378	29.9698	60.729168		0	0.171256	0			0				0	0	0	109.841782										13.4276	0.544128683	1.0607072	0	0.431620511	1.588883712	0.492262528	1.255457806	4.877890158	3.046644914	7.119796187	0.921160956	0.055299171	1.307468146	2.312572383	7.516792612	0.224828642	2.934656775	0	0	3.142898332	0	0	0	0	0	0	0	0	0	0	6.24719924	0	0	0	0	0	0	0	0	58.5079	0	10.1528623	13.4276	0.544128683	1.0607072	0	0.431620511	1.588883712	0.492262528	1.255457806	4.877890158	3.046644914	7.119796187	0.921160956	0.055299171	1.307468146	2.312572383	7.516792612	0.224828642	2.934656775	0	0	3.142898332	0	0	0	0	0	0	0	0	0	0	6.24719924	0	0	0	0	0	0	0	0	58.5079	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									6000	5.7436	0.0896	0.3682	2.5438	1.9202	1.7477	0.5415	0.2086	2.6192	0.3877	1.056	0.1934	0.0094	0.3326	1.3919	2.1648	0.0361	0.229		0.2601	0.8719	0			0				0	0	0.3196	0.4775									23.5124	500	11.00772493	19.1711	0.633767708	1.428880613	2.543816997	2.351786397	3.336595821	1.033732669	1.464100367	7.497099706	3.434327507	8.175786172	1.114571414	0.064678206	1.640097906	3.704455705	9.681604652	0.260909985	3.163677453	0	0.260132516	4.014762137	0	0	0	0	0	0	0	0	0	0.319615163	6.724658353	0	0	0	0	0	0	0	0	82.0202
H5042_001_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	P	V	V	V	V	V	V	V	V	V	S	V	T	P	P	P	P	P	O	V																																																			0	YES	1155.230929	74.73980413	740.4618207		323.9395555	9.404412505		242.7070367	367.6235741		665.0790104		21.13055707	788.4489959	2243.727577	9152.621423	58.50538844	1765.093108			2570.154007				5008.005248																5000	"1a (IP Acute): $200/day (days 1-5), 1a1 (Add'l Days): 0"	1b (IP Psych): $200/day (days 1-5) (190 day lifetime limit)	"2a (SNF): $25 days 1-20 $75 days 21-100, 2a2 (Waiver 3 Day): 0"	6a (Home Health): $0	10a (Ambulance): $75	"11a (DME): Lesser of 20% - $200 max  per item , 11b (Prosthetics): Lesser of 20% - $200 max  per item , 11b (Medical Supplies): Lesser of 20% - $200 max  per item , 11c (Diabetic Supplies): Lesser of 20% or $10 max per item"		"4a (ER): $50 (waived if admit), 4a (ER) - Worldwide Coverage: $50 (waived if admit), 4b (UC): 35"	"9b (OP Surg): $175, 9b (OP ASC): $175"	8a (OP Diag Proc/Test/Lab): $0 - $20	8b (Radiology): $0 - $20	9a (OP Observation): 0	12 (Renal Dialysis): $20	"3 (CORF): 0, 5 (Partial Hosp): $20, 9a (OP Other): 0, 9a (OP Chemo): 0, 9c (OP SA): $20, 9d (OP Cardiac Rehab): $20, 7e (MH Non-Phys): $20, 7i (PT/ST): $20, 13a (Blood): 0"	"7a (PCP w/Copay): $20, 14b (Immunizations): $0 , 14c (Routine Physical): $0 , 14d (Pap & Pelvic Exam): $0 , 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): $0 , 14f (Colorectal Screening): $0 , 14g (Bone Mass): $0 , 14h (Mammography): $0 , 14i (Diabetes Educ.): $0 , 14j (Nutrition Therapy Diabetes): $0"	"7b (Chiro): $20, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): $20, 7f (Podiatry): $20, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): $20, 17a (Eye Exam): $20,18a (Hearing Exam): $20"	"7e (MH Non-Phys): $20, 7h (Psych): $20"	"7c (OT): $20, 7i (PT/ST): $20"	8b (Radiology): $0 - $20		15 (Part B Rx): $15		10b (Transportation): 0	"16a (Preventive Dental): $250 annual max to include up to 2 preventative office visits per year, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): $20, 17b1 (Non MCR Covered): $100 annual eyewear"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): Silver Sneakers, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												0	123.7907681	113.9771182	40.56667554		37.5	0.174708793		50	175		0.256068212		20	20	20	20	20	20			15				1.031956704																NO	116.0037495	106.8074241	38.01484183		35.14107453	0.163718792		46.85476604	163.9916811		0.239960323		18.74190641	18.74190641	18.74190641	18.74190641	18.74190641	18.74190641			14.05642981				0.967041799																	11.1676	0.665230497	2.345711583	0	0.948632005	1.539679059	0	0.947665118	5.023933996	0	0.013299381	0	0.033002244	1.231419775	3.504311022	14.29479785	0.09137521	2.756767487	0	0	3.010599117	0	0	0	0.4035792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9776	0	3.220606562	11.1676	0.665230497	2.345711583	0	0.948632005	1.539679059	0	0.947665118	5.023933996	0	0.013299381	0	0.033002244	1.231419775	3.504311022	14.29479785	0.09137521	2.756767487	0	0	3.010599117	0	0	0	0.4035792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9776	YES	"1a (IP Acute): $300/day (days 1-5), 1a1 (Add'l Days): 0"	1b (IP Psych): $300/day (days 1-5)	"2a (SNF): $25 days 1-20 $75 days 21-100, 2a2 (Waiver 3 Day): 0"	6a (Home Health): $0	10a (Ambulance): $75	"11a (DME): 20%, 11b (Prosthetics): 20%, 11b (Medical Supplies): 20%, 11c (Diabetic Supplies): 20%"		"4a (ER): $50 (waived if admit), 4a (ER) - Worldwide Coverage: $50 (waived if admit), 4b (UC): 35"	"9b (OP Surg): $175, 9b (OP ASC): $175"	8a (OP Diag Proc/Test/Lab):  $20	8b (Radiology):  $20	9a (OP Observation): 0	12 (Renal Dialysis):  $20	"3 (CORF): 0, 5 (Partial Hosp): $20, 9a (OP Other): 0, 9a (OP Chemo): 0, 9c (OP SA):  $20, 9d (OP Cardiac Rehab):  $20, 7e (MH Non-Phys): $20, 7i (PT/ST): $20, 13a (Blood): 0"	"7a (PCP w/Copay):  $20, 14b (Immunizations):  $0, 14c (Routine Physical):  $0, 14d (Pap & Pelvic Exam):  $0, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening):  $0, 14f (Colorectal Screening):  $0, 14g (Bone Mass):  $0, 14h (Mammography):  $0, 14i (Diabetes Educ.):  $0, 14j (Nutrition Therapy Diabetes): $0"	"7b (Chiro): $20, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): $20, 7f (Podiatry): $20, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): $20, 17a (Eye Exam): $20,18a (Hearing Exam): $20"	"7e (MH Non-Phys): $20, 7h (Psych): $20"	"7c (OT): $20, 7i (PT/ST): $20"	8b (Radiology):  $20		15 (Part B Rx): $15		10b (Transportation): 0	"16a (Preventive Dental): $250 annual max to include up to 2 preventative office visits per year, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): $20, 17b1 (Non MCR Covered): $100 annual eyewear"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): n/a, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												5000	1.0033	0.0525	0.1403		0.0572	0.1051		0.0565	0.2994	0.3227	0.0617		0.002	0.0731	0.2089	0.8519	0.001	0.1636			0.1797				0.024																3.6028	0	0.220187627	12.1709	0.717755589	2.485986398	0	1.005796372	1.644801998	0	1.00417548	5.323332519	0.322697393	0.07498814	0	0.035001943	1.304532172	3.713205686	15.14669589	0.092342839	2.920333142	0	0	3.190347498	0	0	0	0.427582647	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5804
H5042_002_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	V	P	V	V	V	V	V	V	V	V	V	S	V	T	P	P	P	P	P	O	V																																																			0	YES	1125.169793	95.38632896	639.3617482		468.9236955	7.30200782		186.2814708	267.6523148		370.9123109		26.27246564	411.1303752	1707.683268	6769.314962	169.0649441	831.9246501			1973.604475				2681.745407																5000	"1a (IP Acute): $275/day (days 1-5), 1a1 (Add'l Days): 0"	1b (IP Psych): $275/day (days 1-5) (190 day lifetime limit)	"2a (SNF): $35 days 1-20 $90 days 21-100, 2a2 (Waiver 3 Day): 0"	6a (Home Health): $0	10a (Ambulance): 125	"11a (DME): Lesser of 20% or $300 max per item , 11b (Prosthetics): Lesser of 20% or $300 max per item , 11b (Medical Supplies): Lesser of 20% or $300 max per item , 11c (Diabetic Supplies): Lesser of 20% or $10 max per item"		"4a (ER): $50 (waived if admit), 4a (ER) - Worldwide Coverage: $50 (waived if admit), 4b (UC): 35"	"9b (OP Surg): $250, 9b (OP ASC): $250"	8a (OP Diag Proc/Test/Lab): $0 - $35	8b (Radiology): $0 - $35	9a (OP Observation): 0	12 (Renal Dialysis): $25	"3 (CORF): 0, 5 (Partial Hosp): $35, 9a (OP Other): 0, 9a (OP Chemo): 0, 9c (OP SA): $35, 9d (OP Cardiac Rehab): $35, 7e (MH Non-Phys): $35, 7i (PT/ST): $35, 13a (Blood): 0"	"7a (PCP w/Copay): $35, 14b (Immunizations): $0 , 14c (Routine Physical): $0 , 14d (Pap & Pelvic Exam): $0 , 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): $0 , 14f (Colorectal Screening): $0 , 14g (Bone Mass): $0 , 14h (Mammography): $0 , 14i (Diabetes Educ.): $0 , 14j (Nutrition Therapy Diabetes): $0"	"7b (Chiro): $35, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): $35, 7f (Podiatry): $35, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): $35, 17a (Eye Exam): $35,18a (Hearing Exam): $35"	"7e (MH Non-Phys): $35, 7h (Psych): $35"	"7c (OT): $35, 7i (PT/ST): $35"	8b (Radiology): $0 - $35		15 (Part B Rx): $15		10b (Transportation): 0	"16a (Preventive Dental): $100 annual max to include up to 2 preventative office visits per year, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): $35, 17b1 (Non MCR Covered): n/a"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): Silver Sneakers, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												0	170.2123062	156.7185375	52.1233431		62.5	0.18039515		50	250		0.547491905		25	35	35	35	35	35			15				1.641103197																NO	156.3278771	143.9348119	47.87157731		57.40179743	0.165680094		45.92143794	229.6071897		0.502832311		22.96071897	32.14500656	32.14500656	32.14500656	32.14500656	32.14500656			13.77643138				1.507236372																	14.658	1.144117776	2.550604613	0	2.243088581	1.20979734	0	0.712859417	5.121241318	0	0.015542225	0	0.050269558	1.101315717	4.574457489	18.13330615	0.452882811	2.228518611	0	0	2.265768885	0	0	0	0.336835351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7986	0	5.044625059	14.658	1.144117776	2.550604613	0	2.243088581	1.20979734	0	0.712859417	5.121241318	0	0.015542225	0	0.050269558	1.101315717	4.574457489	18.13330615	0.452882811	2.228518611	0	0	2.265768885	0	0	0	0.336835351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7986	YES	"1a (IP Acute): $375/day (days 1-5), 1a1 (Add'l Days): 0"	1b (IP Psych): $375/day (days 1-5)	"2a (SNF): $35 days 1-20 $90 days 21-100, 2a2 (Waiver 3 Day): 0"	6a (Home Health): $0	10a (Ambulance): 125	"11a (DME): 20%, 11b (Prosthetics): 20%, 11b (Medical Supplies): 20%, 11c (Diabetic Supplies): 20%"		"4a (ER): $50 (waived if admit), 4a (ER) - Worldwide Coverage: $50 (waived if admit), 4b (UC): 35"	"9b (OP Surg): $250, 9b (OP ASC): $250"	8a (OP Diag Proc/Test/Lab): $35	8b (Radiology): $35	9a (OP Observation): 0	12 (Renal Dialysis):  $25	"3 (CORF): 0, 5 (Partial Hosp): $35, 9a (OP Other): 0, 9a (OP Chemo): 0, 9c (OP SA): $35, 9d (OP Cardiac Rehab): $35, 7e (MH Non-Phys): $35, 7i (PT/ST): $35, 13a (Blood): 0"	"7a (PCP w/Copay): $35, 14b (Immunizations):  $0, 14c (Routine Physical):  $0, 14d (Pap & Pelvic Exam):  $0, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening):  $0, 14f (Colorectal Screening):  $0, 14g (Bone Mass):  $0, 14h (Mammography):  $0, 14i (Diabetes Educ.):  $0, 14j (Nutrition Therapy Diabetes): $0"	"7b (Chiro): $35, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): $35, 7f (Podiatry): $35, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): $35, 17a (Eye Exam): $35,18a (Hearing Exam): $35"	"7e (MH Non-Phys): $35, 7h (Psych): $35"	"7c (OT): $35, 7i (PT/ST): $35"	8b (Radiology): $35		15 (Part B Rx): $15		10b (Transportation): 0	"16a (Preventive Dental): $100 annual max to include up to 2 preventative office visits per year, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): $35, 17b1 (Non MCR Covered): n/a"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): n/a, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												5000	1.2628	0.0657	0.1617		0.1404	0.0848		0.0451	0.324	0.07	0.063		0.0032	0.0701	0.2889	1.1461	0.0001	0.1423			0.144				0.0214																4.0334	0	0.352010606	15.9208	1.209798829	2.712278337	0	2.38347384	1.294588245	0	0.757914774	5.445281881	0.070033277	0.078524901	0	0.053495726	1.171374441	4.863325338	19.27940287	0.452936844	2.370796593	0	0	2.409737618	0	0	0	0.358231825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.832
H5042_004_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	V	P	V	V	V	V	V	V	V	V	V	S	V	T	P	P	P	P	P	O	V																																																			0	YES	1369.15214	45.07911227	813.6897336		496.2124057	8.949578373		227.9562367	332.5583773		472.3537614		39.0014637	548.2503018	2064.246945	8284.197061	250.9768352	1160.755431			2593.317373				3685.652601																5000	"1a (IP Acute): $200/day (days 1-5), 1a1 (Add'l Days): 0"	1b (IP Psych): $200/day (days 1-5) (190 day lifetime limit)	"2a (SNF): $25 days 1-20 $75 days 21-100, 2a2 (Waiver 3 Day): 0"	6a (Home Health): $0	10a (Ambulance): $75	"11a (DME): Lesser of 20% - $200 max  per item , 11b (Prosthetics): Lesser of 20% - $200 max  per item , 11b (Medical Supplies): Lesser of 20% - $200 max  per item , 11c (Diabetic Supplies): Lesser of 20% or $10 max per item"		"4a (ER): $50 (waived if admit), 4a (ER) - Worldwide Coverage: $50 (waived if admit), 4b (UC): 35"	"9b (OP Surg): $175, 9b (OP ASC): $175"	8a (OP Diag Proc/Test/Lab): $0 - $20	8b (Radiology): $0 - $20	9a (OP Observation): 0	12 (Renal Dialysis): $20	"3 (CORF): 0, 5 (Partial Hosp): $20, 9a (OP Other): 0, 9a (OP Chemo): 0, 9c (OP SA): $20, 9d (OP Cardiac Rehab): $20, 7e (MH Non-Phys): $20, 7i (PT/ST): $20, 13a (Blood): 0"	"7a (PCP w/Copay): $20, 14b (Immunizations): $0 , 14c (Routine Physical): $0 , 14d (Pap & Pelvic Exam): $0 , 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): $0 , 14f (Colorectal Screening): $0 , 14g (Bone Mass): $0 , 14h (Mammography): $0 , 14i (Diabetes Educ.): $0 , 14j (Nutrition Therapy Diabetes): $0"	"7b (Chiro): $20, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): $20, 7f (Podiatry): $20, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): $20, 17a (Eye Exam): $20,18a (Hearing Exam): $20"	"7e (MH Non-Phys): $20, 7h (Psych): $20"	"7c (OT): $20, 7i (PT/ST): $20"	8b (Radiology): $0 - $20		15 (Part B Rx): $15		10b (Transportation): 0	"16a (Preventive Dental): $250 annual max to include up to 2 preventative office visits per year, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): $20, 17b1 (Non MCR Covered): $100 annual eyewear"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): Silver Sneakers, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												0	123.7907681	113.9771182	40.56667554		37.5	0.174708793		50	175		0.312478236		20	20	20	20	20	20			15				1.115051345																NO	116.1856997	106.97495	38.07446756		35.1961928	0.163975583		46.92825706	164.2488997		0.29328118		18.77130282	18.77130282	18.77130282	18.77130282	18.77130282	18.77130282			14.07847712				1.046548323																	13.2563	0.401861315	2.581733614	0	1.455398958	1.467512331	0	0.89146574	4.551862297	0	0.011544372	0	0.061009024	0.85761437	3.229050375	12.95876431	0.392596848	1.815740974	0	0	3.042496608	0	0	0	0.321434463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2964	0	3.095840849	13.2563	0.401861315	2.581733614	0	1.455398958	1.467512331	0	0.89146574	4.551862297	0	0.011544372	0	0.061009024	0.85761437	3.229050375	12.95876431	0.392596848	1.815740974	0	0	3.042496608	0	0	0	0.321434463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2964	YES	"1a (IP Acute): $300/day (days 1-5), 1a1 (Add'l Days): 0"	1b (IP Psych): $300/day (days 1-5)	"2a (SNF): $25 days 1-20 $75 days 21-100, 2a2 (Waiver 3 Day): 0"	6a (Home Health): $0	10a (Ambulance): $75	"11a (DME): 20%, 11b (Prosthetics): 20%, 11b (Medical Supplies): 20%, 11c (Diabetic Supplies): 20%"		"4a (ER): $50 (waived if admit), 4a (ER) - Worldwide Coverage: $50 (waived if admit), 4b (UC): 35"	"9b (OP Surg): $175, 9b (OP ASC): $175"	8a (OP Diag Proc/Test/Lab):  $20	8b (Radiology):  $20	9a (OP Observation): 0	12 (Renal Dialysis):  $20	"3 (CORF): 0, 5 (Partial Hosp): $20, 9a (OP Other): 0, 9a (OP Chemo): 0, 9c (OP SA):  $20, 9d (OP Cardiac Rehab):  $20, 7e (MH Non-Phys): $20, 7i (PT/ST): $20, 13a (Blood): 0"	"7a (PCP w/Copay):  $20, 14b (Immunizations):  $0, 14c (Routine Physical):  $0, 14d (Pap & Pelvic Exam):  $0, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening):  $0, 14f (Colorectal Screening):  $0, 14g (Bone Mass):  $0, 14h (Mammography):  $0, 14i (Diabetes Educ.):  $0, 14j (Nutrition Therapy Diabetes): $0"	"7b (Chiro): $20, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): $20, 7f (Podiatry): $20, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): $20, 17a (Eye Exam): $20,18a (Hearing Exam): $20"	"7e (MH Non-Phys): $20, 7h (Psych): $20"	"7c (OT): $20, 7i (PT/ST): $20"	8b (Radiology):  $20		15 (Part B Rx): $15		10b (Transportation): 0	"16a (Preventive Dental): $250 annual max to include up to 2 preventative office visits per year, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): $20, 17b1 (Non MCR Covered): $100 annual eyewear"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): n/a, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												5000	1.2761	0.004	0.1657		0.0934	0.1078		0.0572	0.2921	0.0508	0.0474		0.0039	0.055	0.2072	0.8317		0.1165			0.1953				0.0206																3.5249	0	0.22740416	14.5325	0.40589572	2.747422479	0	1.548802631	1.575327256	0	0.948677663	4.843988832	0.050751683	0.05896447	0	0.064924422	0.912653802	3.436282325	13.79042368	0.392596848	1.932270449	0	0	3.237756028	0	0	0	0.34206328	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.8213
H5042_005_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	P	V	V	V	V	V	V	V	V	V	S	V	T	P	P	P	P	P	O	V																																																			0	YES	1210.132074	27.50381004	534.9249142		468.8626845	7.187730301		212.5855307	302.3483607		452.4973668		23.79569594	361.8841021	1873.201681	7470.402912	153.1267776	1020.787939			2275.426506				2801.241344																5000	"1a (IP Acute): $275/day (days 1-5), 1a1 (Add'l Days): 0"	1b (IP Psych): $275/day (days 1-5) (190 day lifetime limit)	"2a (SNF): $35 days 1-20 $90 days 21-100, 2a2 (Waiver 3 Day): 0"	6a (Home Health): $0	10a (Ambulance): 125	"11a (DME): Lesser of 20% or $300 max per item , 11b (Prosthetics): Lesser of 20% or $300 max per item , 11b (Medical Supplies): Lesser of 20% or $300 max per item , 11c (Diabetic Supplies): Lesser of 20% or $10 max per item"		"4a (ER): $50 (waived if admit), 4a (ER) - Worldwide Coverage: $50 (waived if admit), 4b (UC): 35"	"9b (OP Surg): $250, 9b (OP ASC): $250"	8a (OP Diag Proc/Test/Lab): $0 - $35	8b (Radiology): $0 - $35	9a (OP Observation): 0	12 (Renal Dialysis): $25	"3 (CORF): 0, 5 (Partial Hosp): $35, 9a (OP Other): 0, 9a (OP Chemo): 0, 9c (OP SA): $35, 9d (OP Cardiac Rehab): $35, 7e (MH Non-Phys): $35, 7i (PT/ST): $35, 13a (Blood): 0"	"7a (PCP w/Copay): $35, 14b (Immunizations): $0 , 14c (Routine Physical): $0 , 14d (Pap & Pelvic Exam): $0 , 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): $0 , 14f (Colorectal Screening): $0 , 14g (Bone Mass): $0 , 14h (Mammography): $0 , 14i (Diabetes Educ.): $0 , 14j (Nutrition Therapy Diabetes): $0"	"7b (Chiro): $35, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): $35, 7f (Podiatry): $35, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): $35, 17a (Eye Exam): $35,18a (Hearing Exam): $35"	"7e (MH Non-Phys): $35, 7h (Psych): $35"	"7c (OT): $35, 7i (PT/ST): $35"	8b (Radiology): $0 - $35		15 (Part B Rx): $15		10b (Transportation): 0	"16a (Preventive Dental): $100 annual max to include up to 2 preventative office visits per year, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): $35, 17b1 (Non MCR Covered): n/a"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): Silver Sneakers, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												0	170.2123062	156.7185375	52.1233431		62.5	0.18039515		50	250		0.549471558		25	35	35	35	35	35			15				2.089034779																NO	155.1287933	142.8307868	47.50438731		56.96150765	0.164409275		45.56920612	227.8460306		0.500779654		22.78460306	31.89844429	31.89844429	31.89844429	31.89844429	31.89844429			13.67076184				1.903913129																	15.6439	0.327365902	2.117606692	0	2.225593783	1.181729531	0	0.807279489	5.740739487	0	0.018883456	0	0.045181291	0.961961656	4.979351622	19.85785259	0.407042165	2.713462267	0	0	2.592234487	0	0	0	0.444443348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.0646	0	5.840211701	15.6439	0.327365902	2.117606692	0	2.225593783	1.181729531	0	0.807279489	5.740739487	0	0.018883456	0	0.045181291	0.961961656	4.979351622	19.85785259	0.407042165	2.713462267	0	0	2.592234487	0	0	0	0.444443348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.0646	YES	"1a (IP Acute): $375/day (days 1-5), 1a1 (Add'l Days): 0"	1b (IP Psych): $375/day (days 1-5)	"2a (SNF): $35 days 1-20 $90 days 21-100, 2a2 (Waiver 3 Day): 0"	6a (Home Health): $0	10a (Ambulance): 125	"11a (DME): 20%, 11b (Prosthetics): 20%, 11b (Medical Supplies): 20%, 11c (Diabetic Supplies): 20%"		"4a (ER): $50 (waived if admit), 4a (ER) - Worldwide Coverage: $50 (waived if admit), 4b (UC): 35"	"9b (OP Surg): $250, 9b (OP ASC): $250"	8a (OP Diag Proc/Test/Lab): $35	8b (Radiology): $35	9a (OP Observation): 0	12 (Renal Dialysis):  $25	"3 (CORF): 0, 5 (Partial Hosp): $35, 9a (OP Other): 0, 9a (OP Chemo): 0, 9c (OP SA): $35, 9d (OP Cardiac Rehab): $35, 7e (MH Non-Phys): $35, 7i (PT/ST): $35, 13a (Blood): 0"	"7a (PCP w/Copay): $35, 14b (Immunizations):  $0, 14c (Routine Physical):  $0, 14d (Pap & Pelvic Exam):  $0, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening):  $0, 14f (Colorectal Screening):  $0, 14g (Bone Mass):  $0, 14h (Mammography):  $0, 14i (Diabetes Educ.):  $0, 14j (Nutrition Therapy Diabetes): $0"	"7b (Chiro): $35, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): $35, 7f (Podiatry): $35, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): $35, 17a (Eye Exam): $35,18a (Hearing Exam): $35"	"7e (MH Non-Phys): $35, 7h (Psych): $35"	"7c (OT): $35, 7i (PT/ST): $35"	8b (Radiology): $35		15 (Part B Rx): $15		10b (Transportation): 0	"16a (Preventive Dental): $100 annual max to include up to 2 preventative office visits per year, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): $35, 17b1 (Non MCR Covered): n/a"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): n/a, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												5000	1.3324	0.003	0.1351		0.1385	0.0823		0.0503	0.358	0.1395	0.0748		0.0029	0.0613	0.3105	1.2388		0.1695			0.162				0.0275																4.2864	0	0.40321509	16.9763	0.330353651	2.252664939	0	2.364056203	1.2640286	0	0.857541473	6.098699437	0.139504536	0.093657192	0	0.048080907	1.023294365	5.289870612	21.09668121	0.407042165	2.882999723	0	0	2.754220311	0	0	0	0.471970661	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.351
H5042_006_0	2011	3																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	P	P	P	P	P	O	V																																																			0	YES	199.0689102	5.881586573	968.7023322		590.7437377	10.60932917		271.3832177	395.9126708				46.43146802	652.695154		9862.384495	298.7893733	1381.886051			3087.359326				6581.686095																2500	"1a (IP Acute): $150 (No Max), 1a1 (Add'l Days): 0"	1b (IP Psych): $150 (190 lifetime limit) (No Max)	"2a (SNF): $0 days 1-20 $30 days 21-100, 2a2 (Waiver 3 Day): 0"	6a (Home Health): $0	10a (Ambulance): $50	"11a (DME): Lesser of 20% - $200 max  per item , 11b (Prosthetics): Lesser of 20% - $200 max  per item , 11b (Medical Supplies): Lesser of 20% - $200 max  per item , 11c (Diabetic Supplies): Lesser of 20% or $10 max per item"		"4a (ER): $50 (waived if admit), 4a (ER) - Worldwide Coverage: $50 (waived if admit), 4b (UC): 35"	"9b (OP Surg): $50, 9b (OP ASC): $50"	8a (OP Diag Proc/Test/Lab): $0	8b (Radiology): $0	9a (OP Observation): 0	12 (Renal Dialysis): $10	"3 (CORF): 0, 5 (Partial Hosp): 0, 9a (OP Other): 0, 9a (OP Chemo): 0, 9c (OP SA): $10, 9d (OP Cardiac Rehab): 10, 7e (MH Non-Phys): $10, 7i (PT/ST): $10, 13a (Blood): 0"	"7a (PCP w/Copay): $0 , 14b (Immunizations): $0 , 14c (Routine Physical): $0 , 14d (Pap & Pelvic Exam): $0 , 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): $0 , 14f (Colorectal Screening): $0 , 14g (Bone Mass): $0 , 14h (Mammography): $0 , 14i (Diabetes Educ.): $0 , 14j (Nutrition Therapy Diabetes): $0"	"7b (Chiro): $10, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): $10, 7f (Podiatry): $10, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): 10, 17a (Eye Exam): $10,18a (Hearing Exam): $10"	"7e (MH Non-Phys): $10, 7h (Psych): $10"	"7c (OT): $10, 7i (PT/ST): $10"	8b (Radiology): $0		15 (Part B Rx): $15		10b (Transportation): 0	"16a (Preventive Dental): $400 annual max to include up to 2 preventative office visits per year, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): $10, 17b1 (Non MCR Covered): $150 annual eyewear"			18b (Hearing Aids): $600 max every 3 years	"14a5 (Membership in Health Club / Fitness Classes): Silver Sneakers, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												0	150	150	9.340005325		25	0.174708793		50	50				10	10		10	10	10			15				0.5551607																NO	140.0697347	140.0697347	8.721680453		23.34495578	0.163142762		46.68991157	46.68991157				9.337982314	9.337982314		9.337982314	9.337982314	9.337982314			14.00697347				0.51840808																	2.3236	0.068652689	0.70405935	0	1.149240536	1.730835263	0	1.05590487	1.540427299	0	0	0	0.036131352	0.50790465	0	7.674564332	0.23250749	1.075335625	0	0	3.603713347	0	0	0	0.284333271	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9872	0	1.558788572	2.3236	0.068652689	0.70405935	0	1.149240536	1.730835263	0	1.05590487	1.540427299	0	0	0	0.036131352	0.50790465	0	7.674564332	0.23250749	1.075335625	0	0	3.603713347	0	0	0	0.284333271	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9872	YES	"1a (IP Acute): $300 per Stay, 1a1 (Add'l Days): 0"	1b (IP Psych): $300 per Stay	"2a (SNF): $0 days 1-20 $30 days 21-100, 2a2 (Waiver 3 Day): 0"	6a (Home Health): $0	10a (Ambulance): $50	"11a (DME): 20%, 11b (Prosthetics): 20%, 11b (Medical Supplies): 20%, 11c (Diabetic Supplies): 20%"		"4a (ER): $50 (waived if admit), 4a (ER) - Worldwide Coverage: $50 (waived if admit), 4b (UC): 35"	"9b (OP Surg):  $50, 9b (OP ASC):  $50"	8a (OP Diag Proc/Test/Lab): / $0	8b (Radiology):  $0	9a (OP Observation): 0	12 (Renal Dialysis): $10	"3 (CORF): 0, 5 (Partial Hosp): 0, 9a (OP Other): 0, 9a (OP Chemo): 0, 9c (OP SA): $10, 9d (OP Cardiac Rehab): 10, 7e (MH Non-Phys): $10, 7i (PT/ST): $10, 13a (Blood): 0"	"7a (PCP w/Copay):  $0, 14b (Immunizations):  $0, 14c (Routine Physical):  $0, 14d (Pap & Pelvic Exam):  $0, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening):  $0, 14f (Colorectal Screening):  $0, 14g (Bone Mass):  $0, 14h (Mammography):  $0, 14i (Diabetes Educ.):  $0, 14j (Nutrition Therapy Diabetes): $0"	"7b (Chiro): $10, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): $10, 7f (Podiatry): $10, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): 10, 17a (Eye Exam): $10,18a (Hearing Exam): $10"	"7e (MH Non-Phys): $10, 7h (Psych): $10"	"7c (OT): $10, 7i (PT/ST): $10"	8b (Radiology):  $0		15 (Part B Rx): $15		10b (Transportation): 0	"16a (Preventive Dental): $400 annual max to include up to 2 preventative office visits per year, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): $10, 17b1 (Non MCR Covered): $150 annual eyewear"			18b (Hearing Aids): $600 max every 3 years	"14a5 (Membership in Health Club / Fitness Classes): n/a, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												2500	0.2982	0.0011	0.0452		0.0738	0.1272		0.0678	0.0989				0.0023	0.0326		0.4925		0.069			0.2313				0.0182																1.5581	0	0.110461389	2.6219	0.069760165	0.749244025	0	1.222995768	1.857995948	0	1.123670064	1.639287867	0	0	0	0.038450167	0.540500633	0	8.167097661	0.23250749	1.144347834	0	0	3.83499018	0	0	0	0.302581031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.5453
H5042_007_0	2011	5																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	P	P	P	P	P	O	V																																																			0	YES	198.859018	5.875385205	967.6809616		590.1208753	10.58696865		271.0970794	395.4952324				46.38251207	652.0069719		9851.985893	298.4743388	1380.429032			3084.104107				6574.746564																2500	"1a (IP Acute): $150 (No Max), 1a1 (Add'l Days): 0"	1b (IP Psych): $150 (190 lifetime limit) (No Max)	"2a (SNF): $0 days 1-20 $30 days 21-100, 2a2 (Waiver 3 Day): 0"	6a (Home Health): $0	10a (Ambulance): $50	"11a (DME): Lesser of 20% - $200 max  per item , 11b (Prosthetics): Lesser of 20% - $200 max  per item , 11b (Medical Supplies): Lesser of 20% - $200 max  per item , 11c (Diabetic Supplies): Lesser of 20% or $10 max per item"		"4a (ER): $50 (waived if admit), 4a (ER) - Worldwide Coverage: $50 (waived if admit), 4b (UC): 35"	"9b (OP Surg): $50, 9b (OP ASC): $50"	8a (OP Diag Proc/Test/Lab): $0	8b (Radiology): $0	9a (OP Observation): 0	12 (Renal Dialysis): $10	"3 (CORF): 0, 5 (Partial Hosp): 0, 9a (OP Other): 0, 9a (OP Chemo): 0, 9c (OP SA): $10, 9d (OP Cardiac Rehab): 10, 7e (MH Non-Phys): $10, 7i (PT/ST): $10, 13a (Blood): 0"	"7a (PCP w/Copay): $0 , 14b (Immunizations): $0 , 14c (Routine Physical): $0 , 14d (Pap & Pelvic Exam): $0 , 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): $0 , 14f (Colorectal Screening): $0 , 14g (Bone Mass): $0 , 14h (Mammography): $0 , 14i (Diabetes Educ.): $0 , 14j (Nutrition Therapy Diabetes): $0"	"7b (Chiro): $10, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): $10, 7f (Podiatry): $10, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): 10, 17a (Eye Exam): $10,18a (Hearing Exam): $10"	"7e (MH Non-Phys): $10, 7h (Psych): $10"	"7c (OT): $10, 7i (PT/ST): $10"	8b (Radiology): $0		15 (Part B Rx): $15		10b (Transportation): 0	"16a (Preventive Dental): $400 annual max to include up to 2 preventative office visits per year, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): $10, 17b1 (Non MCR Covered): $150 annual eyewear"			18b (Hearing Aids): $600 max every 3 years	"14a5 (Membership in Health Club / Fitness Classes): Silver Sneakers, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												0	150	150	9.340005325		25	0.174708793		50	50				10	10		10	10	10			15				0.554575355																NO	140.0899438	140.0899438	8.722938808		23.34832397	0.1631663		46.69664794	46.69664794				9.339329588	9.339329588		9.339329588	9.339329588	9.339329588			14.00899438				0.517936202																	2.3215	0.068590199	0.703418484	0	1.148194448	1.727436503	0	1.05494374	1.539025136	0	0	0	0.036098464	0.507442334	0	7.667578613	0.232295852	1.074356808	0	0	3.600433092	0	0	0	0.283774939	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9651	0	1.553825913	2.3215	0.068590199	0.703418484	0	1.148194448	1.727436503	0	1.05494374	1.539025136	0	0	0	0.036098464	0.507442334	0	7.667578613	0.232295852	1.074356808	0	0	3.600433092	0	0	0	0.283774939	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9651	YES	"1a (IP Acute): $300 per Stay, 1a1 (Add'l Days): 0"	1b (IP Psych): $300 per Stay	"2a (SNF): $0 days 1-20 $30 days 21-100, 2a2 (Waiver 3 Day): 0"	6a (Home Health): $0	10a (Ambulance): $50	"11a (DME): 20%, 11b (Prosthetics): 20%, 11b (Medical Supplies): 20%, 11c (Diabetic Supplies): 20%"		"4a (ER): $50 (waived if admit), 4a (ER) - Worldwide Coverage: $50 (waived if admit), 4b (UC): 35"	"9b (OP Surg):  $50, 9b (OP ASC):  $50"	8a (OP Diag Proc/Test/Lab): / $0	8b (Radiology):  $0	9a (OP Observation): 0	12 (Renal Dialysis): $10	"3 (CORF): 0, 5 (Partial Hosp): 0, 9a (OP Other): 0, 9a (OP Chemo): 0, 9c (OP SA): $10, 9d (OP Cardiac Rehab): 10, 7e (MH Non-Phys): $10, 7i (PT/ST): $10, 13a (Blood): 0"	"7a (PCP w/Copay):  $0, 14b (Immunizations):  $0, 14c (Routine Physical):  $0, 14d (Pap & Pelvic Exam):  $0, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening):  $0, 14f (Colorectal Screening):  $0, 14g (Bone Mass):  $0, 14h (Mammography):  $0, 14i (Diabetes Educ.):  $0, 14j (Nutrition Therapy Diabetes): $0"	"7b (Chiro): $10, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): $10, 7f (Podiatry): $10, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): 10, 17a (Eye Exam): $10,18a (Hearing Exam): $10"	"7e (MH Non-Phys): $10, 7h (Psych): $10"	"7c (OT): $10, 7i (PT/ST): $10"	8b (Radiology):  $0		15 (Part B Rx): $15		10b (Transportation): 0	"16a (Preventive Dental): $400 annual max to include up to 2 preventative office visits per year, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): $10, 17b1 (Non MCR Covered): $150 annual eyewear"			18b (Hearing Aids): $600 max every 3 years	"14a5 (Membership in Health Club / Fitness Classes): n/a, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												2500	0.298	0.0011	0.0451		0.0737	0.1269		0.0677	0.0988				0.0023	0.0326		0.4921		0.0689			0.2311				0.0182																1.5565	0	0.110109523	2.6195	0.069696666	0.74856203	0	1.221882544	1.854347488	0	1.122647251	1.637795716	0	0	0	0.038415168	0.540008646	0	8.159663617	0.232295852	1.143306199	0	0	3.831499407	0	0	0	0.301986867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.5216
H5042_801_0	2011	2																															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	Coin	V																																																			0	YES	166.338832	0.84177856	14.03921218		6.578948394	6.106532157		7.037084699	41.42328304	7.289293946	5.82131063	0.783456036	0.354038581	24.04421498	17.73398149	64.0037536	0.214432651	5.458852173	25.12190409	67.50847142	37.94959024																				6700	"1a (IP Acute): FFS, 1a1 (Add'l Days): n/a"	1b (IP Psych): FFS	"2a (SNF): FFS, 2a2 (Waiver 3 Day): n/a"	6a (Home Health): FFS	10a (Ambulance): FFS	"11a (DME): FFS, 11b (Prosthetics): FFS, 11b (Medical Supplies): FFS, 11c (Diabetic Supplies): FFS"		"4a (ER): FFS, 4a (ER) - Worldwide Coverage: n/a, 4b (UC): FFS"	"9b (OP Surg): FFS, 9b (OP ASC): FFS"	8a (OP Diag Proc/Test/Lab): FFS	8b (X-Ray): FFS	9a (OP Observation): FFS	12 (Renal Dialysis): FFS	"3 (CORF): FFS, 5 (Partial Hosp): FFS, 9a (OP Other): FFS, 9a (OP Chemo): FFS, 9c (OP SA): FFS, 9d (OP Cardiac Rehab): FFS, 7e (MH Non-Phys): FFS, 7i (PT/ST): FFS, 13a (Blood): FFS"	"7a (PCP w/Copay): FFS, 14b (Immunizations): FFS, 14c (Routine Physical): FFS, 14d (Pap & Pelvic Exam): FFS, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): FFS, 14f (Colorectal Screening): FFS, 14g (Bone Mass): FFS, 14h (Mammography): FFS, 14i (Diabetes Educ.): FFS, 14j (Nutrition Therapy Diabetes): FFS"	"7b (Chiro): FFS, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): FFS, 7f (Podiatry): FFS, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): FFS, 17a (Eye Exam): FFS,18a (Hearing Exam): FFS"	"7e (MH Non-Phys): FFS, 7h (Psych): FFS"	"7c (OT): FFS, 7i (PT/ST): FFS"	8b (X-Ray): FFS	7g (Prof. Other): FFS	15 (Part B Rx): FFS		10b (Transportation): n/a	"16a (Preventive Dental): n/a, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): n/a, 17b1 (Non MCR Covered): n/a"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): n/a, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												0	0.092258776	0.092258776	0.198417052		0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.083691675	0.083691675	0.179992151		0.211363745	0.211363745		0.211363745	0.211363745	0.211363745	0.211363745	0.211363745	0.211363745	0.211363745	0.211363745	0.211363745	0.211363745	0.211363745	0.211363745	0.211363745	0.211363745																					13.9212	0.070449858	2.526948003	0	1.390551174	1.290699508	0	1.487384579	8.755380253	1.54069247	1.230414018	0.165594202	0.074830921	5.082075335	3.74832075	13.52807309	0.045323288	1.153803441	5.309859743	14.26884337	8.021167532	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6116	0	8.558901979	13.9212	0.070449858	2.526948003	0	1.390551174	1.290699508	0	1.487384579	8.755380253	1.54069247	1.230414018	0.165594202	0.074830921	5.082075335	3.74832075	13.52807309	0.045323288	1.153803441	5.309859743	14.26884337	8.021167532	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6116	YES	"1a (IP Acute): FFS, 1a1 (Add'l Days): n/a"	1b (IP Psych): FFS	"2a (SNF): FFS, 2a2 (Waiver 3 Day): n/a"	6a (Home Health): FFS	10a (Ambulance): FFS	"11a (DME): FFS, 11b (Prosthetics): FFS, 11b (Medical Supplies): FFS, 11c (Diabetic Supplies): FFS"		"4a (ER): FFS, 4a (ER) - Worldwide Coverage: n/a, 4b (UC): FFS"	"9b (OP Surg): FFS, 9b (OP ASC): FFS"	8a (OP Diag Proc/Test/Lab): FFS	8b (X-Ray): FFS	9a (OP Observation): FFS	12 (Renal Dialysis): FFS	"3 (CORF): FFS, 5 (Partial Hosp): FFS, 9a (OP Other): FFS, 9a (OP Chemo): FFS, 9c (OP SA): FFS, 9d (OP Cardiac Rehab): FFS, 7e (MH Non-Phys): FFS, 7i (PT/ST): FFS, 13a (Blood): FFS"	"7a (PCP w/Copay): FFS, 14b (Immunizations): FFS, 14c (Routine Physical): FFS, 14d (Pap & Pelvic Exam): FFS, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): FFS, 14f (Colorectal Screening): FFS, 14g (Bone Mass): FFS, 14h (Mammography): FFS, 14i (Diabetes Educ.): FFS, 14j (Nutrition Therapy Diabetes): FFS"	"7b (Chiro): FFS, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): FFS, 7f (Podiatry): FFS, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): FFS, 17a (Eye Exam): FFS,18a (Hearing Exam): FFS"	"7e (MH Non-Phys): FFS, 7h (Psych): FFS"	"7c (OT): FFS, 7i (PT/ST): FFS"	8b (X-Ray): FFS	7g (Prof. Other): FFS	15 (Part B Rx): FFS		10b (Transportation): n/a	"16a (Preventive Dental): n/a, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): n/a, 17b1 (Non MCR Covered): n/a"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): n/a, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												6700	0.8713	0.0009	0.1592		0.0878	0.0814		0.0928	0.5433	0.0936	0.0765	0.0103	0.0048	0.3155	0.2358	0.8487		0.0723	0.3374	0.8972	0.5061																				5.2352	0	0.535903911	14.7925	0.071385504	2.686179231	0	1.478379906	1.372135219	0	1.580196907	9.298726091	1.634326012	1.306942428	0.175879209	0.079633372	5.397598863	3.984141921	14.37676403	0.045323288	1.226128399	5.647279452	15.1659985	8.527305046	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.8468
H5042_802_0	2011	3																															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	Coin	V																																																			0	YES	192.4984912	1.422407376	14.2419651		9.094935899	7.024717611		8.013918864	45.79920958	6.161663338	8.511030145	0.640201319	0.291470572	32.11904023	23.05066819	82.08131598	0.169552868	7.035292789	33.84608822	86.64995198	53.12894904																				6700	"1a (IP Acute): FFS, 1a1 (Add'l Days): n/a"	1b (IP Psych): FFS	"2a (SNF): FFS, 2a2 (Waiver 3 Day): n/a"	6a (Home Health): FFS	10a (Ambulance): FFS	"11a (DME): FFS, 11b (Prosthetics): FFS, 11b (Medical Supplies): FFS, 11c (Diabetic Supplies): FFS"		"4a (ER): FFS, 4a (ER) - Worldwide Coverage: n/a, 4b (UC): FFS"	"9b (OP Surg): FFS, 9b (OP ASC): FFS"	8a (OP Diag Proc/Test/Lab): FFS	8b (X-Ray): FFS	9a (OP Observation): FFS	12 (Renal Dialysis): FFS	"3 (CORF): FFS, 5 (Partial Hosp): FFS, 9a (OP Other): FFS, 9a (OP Chemo): FFS, 9c (OP SA): FFS, 9d (OP Cardiac Rehab): FFS, 7e (MH Non-Phys): FFS, 7i (PT/ST): FFS, 13a (Blood): FFS"	"7a (PCP w/Copay): FFS, 14b (Immunizations): FFS, 14c (Routine Physical): FFS, 14d (Pap & Pelvic Exam): FFS, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): FFS, 14f (Colorectal Screening): FFS, 14g (Bone Mass): FFS, 14h (Mammography): FFS, 14i (Diabetes Educ.): FFS, 14j (Nutrition Therapy Diabetes): FFS"	"7b (Chiro): FFS, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): FFS, 7f (Podiatry): FFS, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): FFS, 17a (Eye Exam): FFS,18a (Hearing Exam): FFS"	"7e (MH Non-Phys): FFS, 7h (Psych): FFS"	"7c (OT): FFS, 7i (PT/ST): FFS"	8b (X-Ray): FFS	7g (Prof. Other): FFS	15 (Part B Rx): FFS		10b (Transportation): n/a	"16a (Preventive Dental): n/a, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): n/a, 17b1 (Non MCR Covered): n/a"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): n/a, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												0	0.092258776	0.092258776	0.198417053		0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.081087049	0.081087049	0.174390491		0.204785747	0.204785747		0.204785747	0.204785747	0.204785747	0.204785747	0.204785747	0.204785747	0.204785747	0.204785747	0.204785747	0.204785747	0.204785747	0.204785747	0.204785747	0.204785747																					15.6091	0.115338816	2.483663285	0	1.862513242	1.438562044	0	1.641136361	9.379025348	1.26182083	1.742937666	0.131104105	0.059689019	6.577521646	4.720448305	16.80908361	0.034722011	1.440727689	6.931196461	17.74467515	10.88005152	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.8634	0	13.89639738	15.6091	0.115338816	2.483663285	0	1.862513242	1.438562044	0	1.641136361	9.379025348	1.26182083	1.742937666	0.131104105	0.059689019	6.577521646	4.720448305	16.80908361	0.034722011	1.440727689	6.931196461	17.74467515	10.88005152	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.8634	YES	"1a (IP Acute): FFS, 1a1 (Add'l Days): n/a"	1b (IP Psych): FFS	"2a (SNF): FFS, 2a2 (Waiver 3 Day): n/a"	6a (Home Health): FFS	10a (Ambulance): FFS	"11a (DME): FFS, 11b (Prosthetics): FFS, 11b (Medical Supplies): FFS, 11c (Diabetic Supplies): FFS"		"4a (ER): FFS, 4a (ER) - Worldwide Coverage: n/a, 4b (UC): FFS"	"9b (OP Surg): FFS, 9b (OP ASC): FFS"	8a (OP Diag Proc/Test/Lab): FFS	8b (X-Ray): FFS	9a (OP Observation): FFS	12 (Renal Dialysis): FFS	"3 (CORF): FFS, 5 (Partial Hosp): FFS, 9a (OP Other): FFS, 9a (OP Chemo): FFS, 9c (OP SA): FFS, 9d (OP Cardiac Rehab): FFS, 7e (MH Non-Phys): FFS, 7i (PT/ST): FFS, 13a (Blood): FFS"	"7a (PCP w/Copay): FFS, 14b (Immunizations): FFS, 14c (Routine Physical): FFS, 14d (Pap & Pelvic Exam): FFS, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): FFS, 14f (Colorectal Screening): FFS, 14g (Bone Mass): FFS, 14h (Mammography): FFS, 14i (Diabetes Educ.): FFS, 14j (Nutrition Therapy Diabetes): FFS"	"7b (Chiro): FFS, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): FFS, 7f (Podiatry): FFS, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): FFS, 17a (Eye Exam): FFS,18a (Hearing Exam): FFS"	"7e (MH Non-Phys): FFS, 7h (Psych): FFS"	"7c (OT): FFS, 7i (PT/ST): FFS"	8b (X-Ray): FFS	7g (Prof. Other): FFS	15 (Part B Rx): FFS		10b (Transportation): n/a	"16a (Preventive Dental): n/a, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): n/a, 17b1 (Non MCR Covered): n/a"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): n/a, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												6700	0.9574	0.0043	0.1541		0.114	0.0888		0.1005	0.5729	0.0765	0.1056	0.0081	0.0038	0.3991	0.2891	1.0281		0.0881	0.4264	1.0868	0.6654																				6.1689	0	0.849925849	16.5665	0.119653877	2.637768568	0	1.976543158	1.527321331	0	1.741654062	9.951926966	1.338331993	1.848492502	0.139232198	0.063506615	6.976628325	5.009518326	17.83717997	0.034722011	1.5287836	7.357583319	18.83148263	11.54544106	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.0323
H5042_803_0	2011	2																															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	Coin	V																																																			0	YES	198.9679341	1.412266217	18.60682497		9.013788551	8.242969347		8.019606824	42.92894585	4.71934178	6.27743948	0.824073514	0.593976553	25.11511374	22.96988111	79.4467065	0.359757308	6.690733159	37.34544029	86.6491863	51.29542039																				6700	"1a (IP Acute): FFS, 1a1 (Add'l Days): n/a"	1b (IP Psych): FFS	"2a (SNF): FFS, 2a2 (Waiver 3 Day): n/a"	6a (Home Health): FFS	10a (Ambulance): FFS	"11a (DME): FFS, 11b (Prosthetics): FFS, 11b (Medical Supplies): FFS, 11c (Diabetic Supplies): FFS"		"4a (ER): FFS, 4a (ER) - Worldwide Coverage: n/a, 4b (UC): FFS"	"9b (OP Surg): FFS, 9b (OP ASC): FFS"	8a (OP Diag Proc/Test/Lab): FFS	8b (X-Ray): FFS	9a (OP Observation): FFS	12 (Renal Dialysis): FFS	"3 (CORF): FFS, 5 (Partial Hosp): FFS, 9a (OP Other): FFS, 9a (OP Chemo): FFS, 9c (OP SA): FFS, 9d (OP Cardiac Rehab): FFS, 7e (MH Non-Phys): FFS, 7i (PT/ST): FFS, 13a (Blood): FFS"	"7a (PCP w/Copay): FFS, 14b (Immunizations): FFS, 14c (Routine Physical): FFS, 14d (Pap & Pelvic Exam): FFS, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): FFS, 14f (Colorectal Screening): FFS, 14g (Bone Mass): FFS, 14h (Mammography): FFS, 14i (Diabetes Educ.): FFS, 14j (Nutrition Therapy Diabetes): FFS"	"7b (Chiro): FFS, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): FFS, 7f (Podiatry): FFS, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): FFS, 17a (Eye Exam): FFS,18a (Hearing Exam): FFS"	"7e (MH Non-Phys): FFS, 7h (Psych): FFS"	"7c (OT): FFS, 7i (PT/ST): FFS"	8b (X-Ray): FFS	7g (Prof. Other): FFS	15 (Part B Rx): FFS		10b (Transportation): n/a	"16a (Preventive Dental): n/a, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): n/a, 17b1 (Non MCR Covered): n/a"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): n/a, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												0	0.092258772	0.092258772	0.198417043		0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.081229585	0.081229585	0.174697036		0.205145731	0.205145731		0.205145731	0.205145731	0.205145731	0.205145731	0.205145731	0.205145731	0.205145731	0.205145731	0.205145731	0.205145731	0.205145731	0.205145731	0.205145731	0.205145731																					16.1621	0.114717798	3.250557163	0	1.849140243	1.691009973	0	1.645188105	8.806689984	0.96815282	1.287789912	0.169055163	0.121851754	5.15225837	4.712173055	16.29815269	0.073802676	1.372575346	7.661257653	17.77571068	10.52303652	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6352	0	13.52826454	16.1621	0.114717798	3.250557163	0	1.849140243	1.691009973	0	1.645188105	8.806689984	0.96815282	1.287789912	0.169055163	0.121851754	5.15225837	4.712173055	16.29815269	0.073802676	1.372575346	7.661257653	17.77571068	10.52303652	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6352	YES	"1a (IP Acute): FFS, 1a1 (Add'l Days): n/a"	1b (IP Psych): FFS	"2a (SNF): FFS, 2a2 (Waiver 3 Day): n/a"	6a (Home Health): FFS	10a (Ambulance): FFS	"11a (DME): FFS, 11b (Prosthetics): FFS, 11b (Medical Supplies): FFS, 11c (Diabetic Supplies): FFS"		"4a (ER): FFS, 4a (ER) - Worldwide Coverage: n/a, 4b (UC): FFS"	"9b (OP Surg): FFS, 9b (OP ASC): FFS"	8a (OP Diag Proc/Test/Lab): FFS	8b (X-Ray): FFS	9a (OP Observation): FFS	12 (Renal Dialysis): FFS	"3 (CORF): FFS, 5 (Partial Hosp): FFS, 9a (OP Other): FFS, 9a (OP Chemo): FFS, 9c (OP SA): FFS, 9d (OP Cardiac Rehab): FFS, 7e (MH Non-Phys): FFS, 7i (PT/ST): FFS, 13a (Blood): FFS"	"7a (PCP w/Copay): FFS, 14b (Immunizations): FFS, 14c (Routine Physical): FFS, 14d (Pap & Pelvic Exam): FFS, 14d1 (Add'l Pap): $0, 14d2 (Add'l Pelvic): $0, 14e (Prostate Screening): FFS, 14f (Colorectal Screening): FFS, 14g (Bone Mass): FFS, 14h (Mammography): FFS, 14i (Diabetes Educ.): FFS, 14j (Nutrition Therapy Diabetes): FFS"	"7b (Chiro): FFS, 7b1 (Routine Chiro): n/a, 7d (SPC w/Copay): FFS, 7f (Podiatry): FFS, 7f1 (Routine Podiatry): n/a, 7g (Prof. Other): FFS, 17a (Eye Exam): FFS,18a (Hearing Exam): FFS"	"7e (MH Non-Phys): FFS, 7h (Psych): FFS"	"7c (OT): FFS, 7i (PT/ST): FFS"	8b (X-Ray): FFS	7g (Prof. Other): FFS	15 (Part B Rx): FFS		10b (Transportation): n/a	"16a (Preventive Dental): n/a, 16b (Comp Dental): n/a"	"17a1 (Routine Eye Exam): n/a, 17b1 (Non MCR Covered): n/a"			18b (Hearing Aids): n/a	"14a5 (Membership in Health Club / Fitness Classes): n/a, 14a1 (Written health education materials, incl. newsletters): $0, 14a2 (Nutritional Training): $0, 14a4 (Smoking Cessation): $0, 14a6 (Nursing Hotline): $0"												6700	1.0372	0.0015	0.2086		0.1187	0.1085		0.1056	0.5652	0.0621	0.0826	0.0108	0.0078	0.3307	0.3024	1.046	0.0001	0.0881	0.4917	1.1408	0.6753																				6.3838	0	0.866780424	17.1993	0.116241368	3.459169361	0	1.967813194	1.79953454	0	1.750771946	9.371880156	1.030286318	1.370436877	0.179904679	0.129671879	5.482916745	5.014587912	17.34412521	0.073860905	1.460663617	8.152936994	18.91650898	11.19837729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.019
H5050_001_0	2011	5																															D	D	D		T	Coin	Coin	V	V		V				V	V	V	V		V		V	T				V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	488.1003718	7.433000586	221.9951688	0	206.344096	3.975763143	1.987881572	245.7582921	358.8953368	0	2019.261886	0	0	0	3404.740085	2215.593159	113.1489945	203.9836239	0	462.7802477	0	488.4538848	11.66823013	0	0	0	49.07129279	0	0	0											2500	$200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	$60/Days 11-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	$50/Case for OP Emergency; PBP 4a	"$200/Case for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$75/Case for OP Rad - Diag; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 13a"	"$10/Visit for Phys - Primary Care; PBP 4b, 7a"	"$30/Visit for Phys - Specialist; PBP 4b, 7d, 7f"	"$10/Visit for Phys - SA; $10/Visit for Phys - MH; PBP 7e, 7h, 9c"	"$10/Visit for Phys - PT/ST/OT; PBP 7c, 7i"	No Cost Sharing;	"$10/Visit for Phys - Chiro; $10/Visit for Phys - Other; PBP 7b, 7g, 9d"	No Cost Sharing; PBP 15	"$10/Visit for Other Medicare Part B; PBP 7g, 17a, 18a"	$150/Trip for Transportation; PBP 10b	No Cost Sharing;	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$10/Exam for Routine Hearing Test; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	200	200	60	0	150	0.2	0.2	50	200	0	75	0	0	0	10	30	10	10	0	10	0	10	150	0	0	0	10	0	0	0											NO	197.347455	197.347455	59.20423651	0	148.0105913	0.197347455	0.197347455	49.33686376	197.347455	0	74.00529564	0	0	0	9.867372752	29.60211825	9.867372752	9.867372752	0	9.867372752	0	9.867372752	148.0105913	0	0	0	9.867372752	0	0	0												8.0271	0.122240312	1.09525454	0	2.545092638	0.784606738	0.392303369	1.010411948	5.902256778	0	12.45300607	0	0	0	2.799653295	5.465520892	0.093040275	0.167731871	0	0.380535434	0	0.401646379	0.14391847	0	0	0	0.040350395	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8247	0	0.538297776	8.0271	0.122240312	1.09525454	0	2.545092638	0.784606738	0.392303369	1.010411948	5.902256778	0	12.45300607	0	0	0	2.799653295	5.465520892	0.093040275	0.167731871	0	0.380535434	0	0.401646379	0.14391847	0	0	0	0.040350395	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8247	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.0271	0.122240312	1.09525454	0	2.545092638	0.784606738	0.392303369	1.010411948	5.902256778	0	12.45300607	0	0	0	2.799653295	5.465520892	0.093040275	0.167731871	0	0.380535434	0	0.401646379	0.14391847	0	0	0	0.040350395	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8247
H5050_004_0	2011	7																															D	D	D		T	Coin	Coin	V	V		V				V	V	V	V		V		V	T				V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	724.1778738	11.02808945	517.5606223	0	467.6563339	10.47270799	5.236353994	467.7282662	437.1187548	0	2712.762352	0	0	0	4616.896361	3114.032759	283.8581851	267.7659964	0	794.3208282	0	641.7479582	34.96287091	0	0	0	70.97213197	0	0	0											1000	$100/Days 1-3 for IP Med/Surg; PBP 1a	$100/Days 1-3 for IP MH/SA; PBP 1b	$25/Days 11-150 for SNF; PBP 2	No Cost Sharing; PBP 6	$75/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	$50/Case for OP Emergency; PBP 4a	"$100/Case for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$40/Case for OP Rad - Diag; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 13a"	"$10/Visit for Phys - Primary Care; PBP 4b, 7a"	"$20/Visit for Phys - Specialist; PBP 4b, 7d, 7f"	"$10/Visit for Phys - SA; $10/Visit for Phys - MH; PBP 7e, 7h, 9c"	"$10/Visit for Phys - PT/ST/OT; PBP 7c, 7i"	No Cost Sharing;	"$10/Visit for Phys - Chiro; $10/Visit for Phys - Other; PBP 7b, 7g, 9d"	No Cost Sharing; PBP 15	"$10/Visit for Other Medicare Part B; PBP 7g, 17a, 18a"	$75/Trip for Transportation; PBP 10b	No Cost Sharing;	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$10/Exam for Routine Hearing Test; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	100	100	25	0	75	0.2	0.2	50	100	0	40	0	0	0	10	20	10	10	0	10	0	10	75	0	0	0	10	0	0	0											NO	96.61756382	96.61756382	24.15439095	0	72.46317286	0.193235128	0.193235128	48.30878191	96.61756382	0	38.64702553	0	0	0	9.661756382	19.32351276	9.661756382	9.661756382	0	9.661756382	0	9.661756382	72.46317286	0	0	0	9.661756382	0	0	0												5.8307	0.088792261	1.041780134	0	2.82398848	2.023695065	1.011847532	1.882948567	3.519445765	0	8.736682987	0	0	0	3.717277323	5.014504313	0.228547386	0.215590819	0	0.639544528	0	0.516701036	0.211126713	0	0	0	0.057142954	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5603	0	1.218984759	5.8307	0.088792261	1.041780134	0	2.82398848	2.023695065	1.011847532	1.882948567	3.519445765	0	8.736682987	0	0	0	3.717277323	5.014504313	0.228547386	0.215590819	0	0.639544528	0	0.516701036	0.211126713	0	0	0	0.057142954	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5603	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.8307	0.088792261	1.041780134	0	2.82398848	2.023695065	1.011847532	1.882948567	3.519445765	0	8.736682987	0	0	0	3.717277323	5.014504313	0.228547386	0.215590819	0	0.639544528	0	0.516701036	0.211126713	0	0	0	0.057142954	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5603
H5050_009_0	2011	7																															D	D	D		T	Coin	Coin	V	V		V				V	V	V	V		V		V	T				V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	693.8706407	10.56655798	322.7285245	0	335.6195279	7.508692001	3.754346	371.1931125	441.2487984	0	2462.215056	0	0	0	4169.571918	2763.277196	373.2858269	254.1414951	0	549.1636989	0	519.8427778	27.30196596	0	0	0	54.89341395	0	0	0											2500	$200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	$50/Days 11-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	$50/Case for OP Emergency; PBP 4a	"$200/Case for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$50/Case for OP Rad - Diag; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 13a"	"$10/Visit for Phys - Primary Care; PBP 4b, 7a"	"$30/Visit for Phys - Specialist; PBP 4b, 7d, 7f"	"$10/Visit for Phys - SA; $10/Visit for Phys - MH; PBP 7e, 7h, 9c"	"$10/Visit for Phys - PT/ST/OT; PBP 7c, 7i"	No Cost Sharing;	"$10/Visit for Phys - Chiro; $10/Visit for Phys - Other; PBP 7b, 7g, 9d"	No Cost Sharing; PBP 15	"$10/Visit for Other Medicare Part B; PBP 7g, 17a, 18a"	$150/Trip for Transportation; PBP 10b	No Cost Sharing;	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$10/Exam for Routine Hearing Test; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	200	200	50	0	150	0.2	0.2	50	200	0	50	0	0	0	10	30	10	10	0	10	0	10	150	0	0	0	10	0	0	0											NO	196.5780741	196.5780741	49.14451852	0	147.4335556	0.196578074	0.196578074	49.14451852	196.5780741	0	49.14451852	0	0	0	9.828903704	29.48671111	9.828903704	9.828903704	0	9.828903704	0	9.828903704	147.4335556	0	0	0	9.828903704	0	0	0												11.3666	0.173096135	1.321694829	0	4.123465026	1.476044212	0.738022106	1.520175566	7.228319915	0	10.08369778	0	0	0	3.415193406	6.789996365	0.305749204	0.208161024	0	0.449806426	0	0.425790384	0.335435493	0	0	0	0.04496184	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0063	0	0.829570496	11.3666	0.173096135	1.321694829	0	4.123465026	1.476044212	0.738022106	1.520175566	7.228319915	0	10.08369778	0	0	0	3.415193406	6.789996365	0.305749204	0.208161024	0	0.449806426	0	0.425790384	0.335435493	0	0	0	0.04496184	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0063	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.3666	0.173096135	1.321694829	0	4.123465026	1.476044212	0.738022106	1.520175566	7.228319915	0	10.08369778	0	0	0	3.415193406	6.789996365	0.305749204	0.208161024	0	0.449806426	0	0.425790384	0.335435493	0	0	0	0.04496184	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0063
H5050_012_0	2011	6																															D	D	D		T			V	V		V				V	V	V	V		V		V	T				V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	834.3891697	12.70643406	330.2460772	0	330.2646115	0	0	377.3072316	477.3005632	0	2968.206737	0	0	0	5165.960329	3436.253714	445.5753927	297.650906	0	651.5230574	0	694.6864188	24.20471386	0	0	0	38.14585231	0	0	0											2500	$100/Days 1-5 for IP Med/Surg; PBP 1a	$100/Days 1-5 for IP MH/SA; PBP 1b	$25/Days 11-100 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	$50/Case for OP Emergency; PBP 4a	"$200/Case for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$40/Case for OP Rad - Diag; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 13a"	"$10/Visit for Phys - Primary Care; PBP 4b, 7a"	"$20/Visit for Phys - Specialist; PBP 4b, 7d, 7f"	"$10/Visit for Phys - SA; $10/Visit for Phys - MH; PBP 7e, 7h, 9c"	"$10/Visit for Phys - PT/ST/OT; PBP 7c, 7i"	No Cost Sharing;	"$10/Visit for Phys - Chiro; $10/Visit for Phys - Other; PBP 7b, 7g, 9d"	No Cost Sharing; PBP 15	"$10/Visit for Other Medicare Part B; PBP 7g, 17a, 18a"	$150/Trip for Transportation; PBP 10b	No Cost Sharing;	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$10/Exam for Routine Hearing Test; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	100	100	25	0	150	0	0	50	200	0	40	0	0	0	10	20	10	10	0	10	0	10	150	0	0	0	10	0	0	0											NO	98.65135448	98.65135448	24.66283862	0	147.9770317	0	0	49.32567724	197.302709	0	39.46054179	0	0	0	9.865135448	19.7302709	9.865135448	9.865135448	0	9.865135448	0	9.865135448	147.9770317	0	0	0	9.865135448	0	0	0												6.8595	0.104458911	0.678733809	0	4.072631408	0	0	1.550911227	7.84772451	0	9.760587166	0	0	0	4.246908197	5.649851388	0.366305133	0.244697209	0	0.535613601	0	0.571097968	0.298478476	0	0	0	0.0313595	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8188	0	0.55261387	6.8595	0.104458911	0.678733809	0	4.072631408	0	0	1.550911227	7.84772451	0	9.760587166	0	0	0	4.246908197	5.649851388	0.366305133	0.244697209	0	0.535613601	0	0.571097968	0.298478476	0	0	0	0.0313595	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	6.8595	0.104458911	0.678733809	0	4.072631408	0	0	1.550911227	7.84772451	0	9.760587166	0	0	0	4.246908197	5.649851388	0.366305133	0.244697209	0	0.535613601	0	0.571097968	0.298478476	0	0	0	0.0313595	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8188
H5050_013_0	2011	6																															D	D	D		T	Coin	Coin	V	V		V				V	V	V	V		V		V	T				V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	441.1014295	6.717280652	509.3143235	0	189.4081703	3.669117661	1.834558831	227.3406714	326.8383923	0	1789.886944	0	0	0	2952.73314	2019.955731	98.12754496	176.9031384	0	401.3789912	0	423.6076578	10.71054691	0	0	0	42.55667945	0	0	0											3200	$350/Days 1-3 for IP Med/Surg; PBP 1a	$350/Days 1-3 for IP MH/SA; PBP 1b	$75/Day for SNF; PBP 2	No Cost Sharing; PBP 6	$200/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	$50/Case for OP Emergency; PBP 4a	"$300/Case for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$150/Case for OP Rad - Diag; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 13a"	"$20/Visit for Phys - Primary Care; PBP 4b, 7a"	"$40/Visit for Phys - Specialist; PBP 4b, 7d, 7f"	"$20/Visit for Phys - SA; $20/Visit for Phys - MH; PBP 7e, 7h, 9c"	"$20/Visit for Phys - PT/ST/OT; PBP 7c, 7i"	No Cost Sharing;	"$20/Visit for Phys - Chiro; $20/Visit for Phys - Other; PBP 7b, 7g, 9d"	No Cost Sharing; PBP 15	"$20/Visit for Other Medicare Part B; PBP 7g, 17a, 18a"	$200/Trip for Transportation; PBP 10b	No Cost Sharing;	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$20/Exam for Routine Hearing Test; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	350	350	75	0	200	0.2	0.2	50	300	0	150	0	0	0	20	40	20	20	0	20	0	20	200	0	0	0	20	0	0	0											NO	343.7216656	343.7216656	73.65464264	0	196.4123804	0.19641238	0.19641238	49.10309509	294.6185705	0	147.3092853	0	0	0	19.64123804	39.28247607	19.64123804	19.64123804	0	19.64123804	0	19.64123804	196.4123804	0	0	0	19.64123804	0	0	0												12.6347	0.192406241	3.126113707	0	3.100175798	0.720660134	0.360330067	0.930260884	8.024388327	0	21.9722472	0	0	0	4.832944538	6.612405222	0.160612206	0.289549721	0	0.656965026	0	0.693348237	0.175307001	0	0	0	0.069655489	0	0	0	0	0	0	0	0	0	0	0	0	0	64.552	0	1.149300363	12.6347	0.192406241	3.126113707	0	3.100175798	0.720660134	0.360330067	0.930260884	8.024388327	0	21.9722472	0	0	0	4.832944538	6.612405222	0.160612206	0.289549721	0	0.656965026	0	0.693348237	0.175307001	0	0	0	0.069655489	0	0	0	0	0	0	0	0	0	0	0	0	0	64.552	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	0	12.6347	0.192406241	3.126113707	0	3.100175798	0.720660134	0.360330067	0.930260884	8.024388327	0	21.9722472	0	0	0	4.832944538	6.612405222	0.160612206	0.289549721	0	0.656965026	0	0.693348237	0.175307001	0	0	0	0.069655489	0	0	0	0	0	0	0	0	0	0	0	0	0	64.552
H5050_801_0	2011	4																															D	D			T	Coin	Coin	V	V						V	V	V	V		V		V	T																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	593.1114829	9.032154562	0	0	229.8701405	7.76830018	3.88415009	275.8718807	459.005666	0	0	0	0	0	3708.84406	2774.64454	212.904778	255.6698329	0	1057.625403	0	511.2865231	13.54883362	0	0	0	0	0	0	0											2500	$200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	$50/Case for OP Emergency; PBP 4a	"$200/Case for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 13a"	"$20/Visit for Phys - Primary Care; PBP 4b, 7a"	"$20/Visit for Phys - Specialist; PBP 4b, 7d, 7f"	"$20/Visit for Phys - MH; PBP 7e, 7h, 9c"	"$20/Visit for Phys - PT/ST/OT; PBP 7c, 7i"	No Cost Sharing;	"$20/Visit for Phys - Chiro; $20/Visit for Phys - Other; PBP 7b, 7g, 9d"	No Cost Sharing; PBP 15	"$20/Visit for Other Medicare Part B; PBP 7g, 17a, 18a"	$150/Trip for Transportation; PBP 10b	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	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	197.7919985	197.7919985	0	0	148.3439988	0.197791998	0.197791998	49.44799961	197.7919985	0	0	0	0	0	19.77919985	19.77919985	19.77919985	19.77919985	0	19.77919985	0	19.77919985	148.3439988	0	0	0	0	0	0	0												9.7761	0.148873992	0	0	2.841654655	1.536507617	0.768253809	1.136776054	7.565637332	0	0	0	0	0	6.113163989	4.573354071	0.350923846	0.42141206	0	1.743248683	0	0.842736527	0.16749068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9861	0	0.398138645	9.7761	0.148873992	0	0	2.841654655	1.536507617	0.768253809	1.136776054	7.565637332	0	0	0	0	0	6.113163989	4.573354071	0.350923846	0.42141206	0	1.743248683	0	0.842736527	0.16749068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9861	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.7761	0.148873992	0	0	2.841654655	1.536507617	0.768253809	1.136776054	7.565637332	0	0	0	0	0	6.113163989	4.573354071	0.350923846	0.42141206	0	1.743248683	0	0.842736527	0.16749068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9861
H5050_802_0	2011	5																															D	D			T	Coin	Coin	V	V						V	V	V	V		V		V	T																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	393.2373922	5.988386683	0	0	226.6985691	7.491919664	3.745959758	274.4339026	445.0667024	0	0	0	0	0	3456.052711	2700.357272	211.6599932	246.3570799	0	814.4801734	0	506.3718506	21.33491609	0	0	0	0	0	0	0											2500	$200/Days 1-5 for IP Med/Surg; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosth/Supplies; PBP 11b, 11c"	$50/Case for OP Emergency; PBP 4a	"$200/Case for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 13a"	"$20/Visit for Phys - Primary Care; PBP 4b, 7a"	"$20/Visit for Phys - Specialist; PBP 4b, 7d, 7f"	"$20/Visit for Phys - MH; PBP 7e, 7h, 9c"	"$20/Visit for Phys - PT/ST/OT; PBP 7c, 7i"	No Cost Sharing;	"$20/Visit for Phys - Chiro; $20/Visit for Phys - Other; PBP 7b, 7g, 9d"	No Cost Sharing; PBP 15	"$20/Visit for Other Medicare Part B; PBP 7g, 17a, 18a"	$150/Trip for Transportation; PBP 10b	No Cost Sharing;					No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	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	198.3860716	198.3860716	0	0	148.7895537	0.198386072	0.198386072	49.59651789	198.3860716	0	0	0	0	0	19.83860716	19.83860716	19.83860716	19.83860716	0	19.83860716	0	19.83860716	148.7895537	0	0	0	0	0	0	0												6.5011	0.099001042	0	0	2.81086491	1.486292511	0.743146241	1.134247163	7.357919557	0	0	0	0	0	5.713606004	4.464277258	0.349919955	0.407281777	0	1.346512683	0	0.837142685	0.264534387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5158	0	0.244428096	6.5011	0.099001042	0	0	2.81086491	1.486292511	0.743146241	1.134247163	7.357919557	0	0	0	0	0	5.713606004	4.464277258	0.349919955	0.407281777	0	1.346512683	0	0.837142685	0.264534387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5158	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.5011	0.099001042	0	0	2.81086491	1.486292511	0.743146241	1.134247163	7.357919557	0	0	0	0	0	5.713606004	4.464277258	0.349919955	0.407281777	0	1.346512683	0	0.837142685	0.264534387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5158
H5087_001_0	2011	8																																																																							0	0	0	0	0	0	0	0	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											6700	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"No Cost Sharing; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-c, 14g-h"	"No Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d,"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14a	No Cost Sharing; PBP 13b											0	0	0	0	0	0	0	0	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
H5087_002_0	2011	11																																																																							0	0	0	0	0	0	0	0	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	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"No Cost Sharing; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-c, 14g-h"	"No Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14a	No Cost Sharing; PBP 13b											0	0	0	0	0	0	0	0	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
H5087_005_0	2011	16																															D	D			T	Coin	Coin	V			Coin		Coin		V	V	V				Coin			P	V	P		Coin		V											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	411.259421	12.2978793	0	0	86.14715335	1.881621426	0.108791224	182.6883131	0	0	2.341224891	0	0.172729877	0	151.7382798	1053.652151	104.1403381	0	0	0	7.525681008	0	0	388.2118761	443.0009625	748.6607629	0	0.206148664	0	422.317916											3400	$150/Days 1-3 for IP Medical; $150/Days 1-3 for IP Surg; PBP 1a	$150/Days 1-3 for IP S/A; $150/Days 1-3 for IP Psych; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% coinsurance on DME claims that exceed $500; PBP 11a	"20% coinsurance on Prosthetic claims that exceed $500; PBP 11b, 11c"	"$50/Visit for OP ER; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for Therapeutic; PBP 8b	No Cost Sharing;	20% Coinsurance for Dialysis; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"20% Coinsurance for Bone Mass Measurements; $50/Visit for Colorectal Cancer Screening; PBP 4b, 7a, 14b-c, 14g-h"	"$10/Visit for Chiro; $10/Visit for Vision; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$10/Visit for OP Psych; $10/Visit for OP Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"Dental copays vary by service; PBP 16a, 16b"	$10/Visit for Professional; PBP 17a	$25/Service for Hardware; PBP 17b	No Cost Sharing; PBP 18a	20% Coinsurance for Hardware; PBP 18b	PBP 14a	$10/Visit for Acupuncture; PBP 13b											0	150	150	0	0	50	0.07	0.07	50	0	0	0.2	0	0.2	0	24.58016624	10	10	0	0	0	0.2	0	0	30	10	25	0	0.2	0	10											NO	149.5941495	149.5941495	0	0	49.86471649	0.069810603	0.069810603	49.86471649	0	0	0.199458866	0	0.199458866	0	24.51366041	9.972943298	9.972943298	0	0	0	0.199458866	0	0	29.91882989	9.972943298	24.93235825	0	0.199458866	0	9.972943298												5.1268	0.153307566	0	0	0.357975282	0.131357127	0.007594781	0.759141745	0	0	0.466978062	0	0.034452505	0	0.309971722	0.875667763	0.086548807	0	0	0	1.501063799	0	0	0.967903757	0.368168623	1.555489862	0	0.041118179	0	0.350979386	0	0	0	0	0	0	0	0	0	0	13.0946	0	0.035525661	5.1268	0.153307566	0	0	0.357975282	0.131357127	0.007594781	0.759141745	0	0	0.466978062	0	0.034452505	0	0.309971722	0.875667763	0.086548807	0	0	0	1.501063799	0	0	0.967903757	0.368168623	1.555489862	0	0.041118179	0	0.350979386	0	0	0	0	0	0	0	0	0	0	13.0946	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.1268	0.153307566	0	0	0.357975282	0.131357127	0.007594781	0.759141745	0	0	0.466978062	0	0.034452505	0	0.309971722	0.875667763	0.086548807	0	0	0	1.501063799	0	0	0.967903757	0.368168623	1.555489862	0	0.041118179	0	0.350979386	0	0	0	0	0	0	0	0	0	0	13.0946
H5106_013_0	2011	10																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	252.8879462	0	123.9767776	0	236.4882903	13.53770991	0	543.3105977	444.463028	3282.682286	1422.112952	0	0	492.5985757	3423.154876	4057.022581	0	0	0	0	23.74624625	0	11.08049232	0	189.9004876	0			0	0											3400	"(1a), (1b) $250 per admit"		(2) $50 per day (days 16-75)	(6) $0	(10a)  $75	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $30-$50"	"(9a), (9b) $100"	( 8a) $0-$50	"( 8b) X-Ray and Diag. X-Ray $20 - $50, Therapeutic Services $0"			"(3) $30, (5) $0, (9c) $30, (9d) $0, (12) $0, (13a) $0"	"(7a) $15-$30, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $30, (14b-j) $0, (16b), (18a) $30, (17a) $0-$30"					(15) 0-20%		(10b) $40		"(17a) $30, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												250	0	50	0	75	0.15	0	50	100	20	26.79062114	0	0	30	15	30	0	0	0	0	0.2	0	40		30	0		0	0	0											NO	233.3154187	0	42.66578621	0	61.40747324	0.134637677	0	48.21262137	92.75439543	19.4096783	25.94672578	0	0	28.12706925	14.77370769	29.11654517	0	0	0	0	0.134558703	0	32.7506524		30	0		0	0	0												4.9169	0	0.440797224	0	1.21017903	1.82268582	0	2.182869011	3.435491621	5.309650595	3.074931233	0	0	1.154612854	4.214390794	9.843873437	0	0	0	0	3.195264104	0	0.030241113	0	0.474751219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3066		3.523322313	4.9169	0	0.440797224	0	1.21017903	1.82268582	0	2.182869011	3.435491621	5.309650595	3.074931233	0	0	1.154612854	4.214390794	9.843873437	0	0	0	0	3.195264104	0	0.030241113	0	0.474751219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3066	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $75 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $30-$50"	"(9a), (9b) 30%"	( 8a) 30%	( 8b) 30%			"(3), (5), (9c), (9d), (12), (13a) 30%"	"(7a) 30%, (14c-j) $0"	"(7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 30%, (14b-j) $0, (16b), (18a) 30%, (17a) 30%"					(15) 0-30%		(10b) 50%		"(17a) 30%, (17b) 30%"		"(18b) $0, $500 allowance/3 years"		"(14a) $500 deductible, 50%"	(13e) 30%											5100	4.0505	0	0.393	1.7443	0.2316	1.0996	0	0.0301	1.7659	3.1639	0.9097	0	0	0.2238	0.6224	1.3463	0	0	0	0	0.273		0																		15.8541	500	8.463553334	8.9674	0	0.833767446	1.74425949	1.441742307	2.922308954	0	2.212935581	5.201426988	8.473512018	3.984679271	0	0	1.378459943	4.836816193	11.19012683	0	0	0	0	3.468220764	0	0.030241113	0	0.474751219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1607
H5106_014_0	2011	10																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	310.3038443	0	220.4134178	0	260.6984282	15.38889095	0	475.8130078	552.8652092	4382.869544	1787.08719	0	0	662.3010241	4209.181291	5895.816113	0	0	0	0	34.89591052	0	12.21484128	7.671428571	189.9004876	0			0	0											3400	"(1a), (1b) $200 per admit"		(2) $35 per day (days 16-75)	(6) $0	(10a)  $75	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) $75"	( 8a) $0-$50	"( 8b) X-Ray and Diag. X-Ray $20 - $50, Therapeutic Services $0"			"(3) $25, (5) $0, (9c) $25, (9d) $0, (12) $0, (13a) $0"	"(7a) $15-$25, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $25, (14b-j) $0, (16b), (18a) $25, (17a) $0-$25"					(15) 0-20%		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $25, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												200	0	35	0	75	0.15	0	50	75	20	26.77201337	0	0	25	15	25	0	0	0	0	0.2	0	40	0.3	25	0		0	0	0											NO	190.4519496	0	28.59223569	0	63.92409786	0.121734429	0	48.52830757	70.72419612	19.34127848	26.19226775	0	0	23.91859234	14.76573699	24.4643682	0	0	0	0	0.144335387	0	34.09285219	0.3	25	0		0	0	0												4.9248	0	0.525176033	0	1.388742653	1.873357848	0	1.924199999	3.25841229	7.064191701	3.900655514	0	0	1.320109017	5.179305325	12.01978468	0	0	0	0	5.036714741	0	0.034703232	2.301428571	0.395626016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1472		3.957332642	4.9248	0	0.525176033	0	1.388742653	1.873357848	0	1.924199999	3.25841229	7.064191701	3.900655514	0	0	1.320109017	5.179305325	12.01978468	0	0	0	0	5.036714741	0	0.034703232	2.301428571	0.395626016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1472	YES	"(1a), (1b)  20%"		(2) 20%	(6) 20%	"(10a) $75 emergency, 20% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) 20%"	( 8a) 20%	( 8b) 20%			"(3), (5), (9c), (9d), (12), (13a) 20%"	"(7a) 20%, (14c-j) $0"	"(7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 20%, (14b-j) $0, (16b) 20%, (18a) 20%-50%, (17a) 20%"					(15) 0-20%		(10b) 50%	"(16a), (16b) 50%"	"(17a) 20%, (17b) 20%"		"(18b) $0, $500 allowance/3 years"		"(14a) $500 deductible, 50%"	(13e) 20%											5100	3.9967	0	0.5947	2.0142	0.2579	1.1856	0	0.0337	1.5756	3.2822	0.5457	0	0	0.1978	0.7681	1.5032	0	0	0	0	0.2868		0																		16.2421	500	5.088566498	8.9215	0	1.119885222	2.014161758	1.646620235	3.058963425	0	1.957894977	4.833990156	10.34643048	4.446393869	0	0	1.517883766	5.94743011	13.52300824	0	0	0	0	5.323472006	0	0.034703232	2.301428571	0.395626016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.3894
H5106_015_0	2011	9																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	293.9125237	0	353.2466654	0	295.475023	13.03584501	0	527.526114	359.0564334	3870.498653	1543.912178	0	0	575.5471542	3448.118817	4440.320226	0	0	0	0	46.12049053	0	13.84427414	0	189.9004876	0			0	0											3400	"(1a), (1b) $250 per admit"		(2) $50 per day (days 16-75)	(6) $0	(10a)  $75	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $30-$50"	"(9a), (9b) $100"	( 8a) $0-$50	"( 8b) X-Ray and Diag. X-Ray $20 - $50, Therapeutic Services $0"			"(3) $30, (5) $0, (9c) $30, (9d) $0, (12) $0, (13a) $0"	"(7a) $15-$30, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $30, (14b-j) $0, (16b), (18a) $30, (17a) $0-$30"					(15) 0-20%		(10b) $40		"(17a) $30, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												250	0	50	0	75	0.15	0	50	100	20	26.36897814	0	0	30	15	30	0	0	0	0	0.2	0	40		30	0		0	0	0											NO	232.9073898	0	43.4426772	0	51.48142724	0.130410893	0	47.1839436	94.41381632	18.77306505	25.27994078	0	0	27.80846238	14.52273809	28.64945445	0	0	0	0	0.095683924	0	27.45676119		30	0		0	0	0												5.7045	0	1.278831738	0	1.267622991	1.700016186	0	2.074230201	2.824990679	6.05509358	3.252500702	0	0	1.333756782	4.173010542	10.60106267	0	0	0	0	4.412989497	0	0.031676577	0	0.474751219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1851		7.796326466	5.7045	0	1.278831738	0	1.267622991	1.700016186	0	2.074230201	2.824990679	6.05509358	3.252500702	0	0	1.333756782	4.173010542	10.60106267	0	0	0	0	4.412989497	0	0.031676577	0	0.474751219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1851	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $75 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $30-$50"	"(9a), (9b) 30%"	( 8a) 30%	( 8b) 30%			"(3), (5), (9c), (9d), (12), (13a) 30%"	"(7a) 30%, (14c-j) $0"	"(7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 30%, (14b-j) $0, (16b), (18a) 30%, (17a) 30%"					(15) 0-30%		(10b) 50%		"(17a) 30%, (17b) 30%"		"(18b) $0, $500 allowance/3 years"		"(14a) $500 deductible, 50%"	(13e) 30%											5100	3.4569	0	0.4784	1.449	0.0987	1.6786	0	0.014	1.3664	2.1972	0.761	0	0	0.4615	0.9279	1.9105	0	0	0	0	0.4953		0																		15.2953	500	3.956839937	9.1615	0	1.757207716	1.448975532	1.366302585	3.378582036	0	2.088228182	4.191375753	8.25232603	4.013484296	0	0	1.795261334	5.100871155	12.51158011	0	0	0	0	4.908296216	0	0.031676577	0	0.474751219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4804
H5106_016_0	2011	9																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	337.1930888	0	581.357842	0	309.8683073	14.91506993	0	576.9003502	438.2588127	4772.258573	1875.598338	0	0	791.1014838	4293.059266	6047.075616	0	0	0	0	57.18284843	0	14.51866134	7.671428571	189.9004876	0			0	0											3400	"(1a), (1b) $200 per admit"		(2) $35 per day (days 16-75)	(6) $0	(10a)  $75	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) $75"	( 8a) $0-$50	"( 8b) X-Ray and Diag. X-Ray $20 - $50, Therapeutic Services $0"			"(3) $25, (5) $0, (9c) $25, (9d) $0, (12) $0, (13a) $0"	"(7a) $15-$25, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $25, (14b-j) $0, (16b), (18a) $25, (17a) $0-$25"					(15) 0-20%		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $25, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												200	0	35	0	75	0.15	0	50	75	20	26.12488112	0	0	25	15	25	0	0	0	0	0.2	0	40	0.3	25	0		0	0	0											NO	188.0494992	0	30.34400396	0	64.77144847	0.137639969	0	48.23192679	71.19567039	19.1013794	25.21245357	0	0	24.14286207	14.7467328	24.40543292	0	0	0	0	0.101242415	0	34.54477252	0.3	25	0		0	0	0												5.2841	0	1.470060388	0	1.672551592	2.052909763	0	2.318751288	2.600177498	7.596393468	3.940703002	0	0	1.591621167	5.275716491	12.29845819	0	0	0	0	5.789329681	0	0.041795321	2.301428571	0.395626016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6296		7.978315378	5.2841	0	1.470060388	0	1.672551592	2.052909763	0	2.318751288	2.600177498	7.596393468	3.940703002	0	0	1.591621167	5.275716491	12.29845819	0	0	0	0	5.789329681	0	0.041795321	2.301428571	0.395626016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6296	YES	"(1a), (1b)  20%"		(2) 20%	(6) 20%	"(10a) $75 emergency, 20% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $25-$50"	"(9a), (9b) 20%"	( 8a) 20%	( 8b) 20%			"(3), (5), (9c), (9d), (12), (13a) 20%"	"(7a) 20%, (14c-j) $0"	"(7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 20%, (14b-j) $0, (16b) 20%, (18a) 20%-50%, (17a) 20%"					(15) 0-20%		(10b) 50%	"(16a), (16b) 50%"	"(17a) 20%, (17b) 20%"		"(18b) $0, $500 allowance/3 years"		"(14a) $500 deductible, 50%"	(13e) 20%											5100	4.0301	0	0.659	1.6863	0.268	1.4769	0	0.0224	1.3036	2.1044	0.6502	0	0	0.2685	1.1079	2.0228	0	0	0	0	0.4249		0																		16.0249	500	3.114034284	9.3142	0	2.129013025	1.686284677	1.940570019	3.529838602	0	2.341181695	3.903736685	9.700772204	4.590922921	0	0	1.860091615	6.383643319	14.32121455	0	0	0	0	6.214254998	0	0.041795321	2.301428571	0.395626016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6545
H5106_017_0	2011	10																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	185.1844946	0	139.525121	0	198.3275413	9.230864284	0	383.9330885	303.6847051	2595.931657	1091.975989	0	0	328.9013069	2588.205784	3294.456406	0	0	0	0	19.78465706	0	9.29249729	0	189.9004876	0			0	0											3400	"(1a), (1b) $250 per admit"		(2) $50 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $35-$50"	"(9a), (9b) $250"	( 8a) $0-$50	"( 8b) X-Ray and Diag. X-Ray $20 - $50, Therapeutic Services $0"			"(3) $35, (5) $0, (9c) $35, (9d) $0, (12) $0, (13a) $0"	"(7a) $15-$35, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $35, (14b-j) $0, (16b), (18a) $35, (17a) $0-$35"					(15) 0-20%		(10b) $40		"(17a) $35, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												250	0	50	0	100	0.15	0	50	250	20	26.71711361	0	0	35	15	35	0	0	0	0	0.2	0	40		35	0		0	0	0											NO	229.1537855	0	41.27703969	0	74.11006193	0.118805823	0	48.47607803	235.7247771	19.42967632	25.9686749	0	0	32.59479847	14.73901205	34.17728144	0	0	0	0	0.148157062	0	29.64402477		35	0		0	0	0												3.5363	0	0.479931996	0	1.224838864	1.096680429	0	1.550964196	5.965500785	4.203175987	2.363097455	0	0	0.893372651	3.178966353	9.382963648	0	0	0	0	2.931236669	0	0.022955585	0	0.553876422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3839		3.121525373	3.5363	0	0.479931996	0	1.224838864	1.096680429	0	1.550964196	5.965500785	4.203175987	2.363097455	0	0	0.893372651	3.178966353	9.382963648	0	0	0	0	2.931236669	0	0.022955585	0	0.553876422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3839	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $100 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $35-$50"	"(9a), (9b) 30%"	( 8a) 30%	( 8b) 30%			"(3), (5), (9c), (9d), (12), (13a) 30%"	"(7a) 30%, (14c-j) $0"	"(7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 30%, (14b-j) $0, (16b), (18a) 30%, (17a) 30%"					(15) 0-30%		(10b) 50%		"(17a) 30%, (17b) 30%"		"(18b) $0, $500 allowance/3 years"		"(14a) $500 deductible, 50%"	(13e) 30%											5100	2.6153	0	0.296	1.2824	0.1872	1.0579	0	0.0612	1.4281	2.6007	0.5107	0	0	0.1992	0.6135	1.166	0	0	0	0	0.1893		0																		12.2076	500	4.716402131	6.1517	0	0.775957005	1.282393784	1.412039148	2.154605338	0	1.612198046	7.393619474	6.803862807	2.873810132	0	0	1.092524483	3.792483895	10.54894664	0	0	0	0	3.1205857	0	0.022955585	0	0.553876422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5915
H5106_018_0	2011	10																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	T	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	322.3915007	0	364.3130808	0	288.3988999	12.16647927	0	532.4719624	345.1603385	3872.815175	1641.661644	0	0	583.9390524	3514.817762	4720.632181	0	0	0	0	39.91968221	0	13.51272737	0	189.9004876	0			0	0											3400	"(1a), (1b) $250 per admit"		(2) $50 per day (days 16-75)	(6) $0	(10a)  $100	"(11a), (11b), (11c) 0-15%"		"(4a) $50, (4b) $35-$50"	"(9a), (9b) $250"	( 8a) $0-$50	"( 8b) X-Ray and Diag. X-Ray $20 - $50, Therapeutic Services $0"			"(3) $35, (5) $0, (9c) $35, (9d) $0, (12) $0, (13a) $0"	"(7a) $15-$35, (14c-j) $0"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i) $35, (14b-j) $0, (16b), (18a) $35, (17a) $0-$35"					(15) 0-20%		(10b) $40		"(17a) $35, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0												250	0	50	0	100	0.15	0	50	250	20	26.2455058	0	0	35	15	35	0	0	0	0	0.2	0	40		35	0		0	0	0											NO	226.7546442	0	42.12283367	0	77.60349583	0.134888868	0	47.89213092	235.8656259	19.06818376	25.25468067	0	0	33.26344617	14.58551589	33.8575376	0	0	0	0	0.119901005	0	31.04139833		35	0		0	0	0												6.092	0	1.278824942	0	1.865063569	1.641122611	0	2.125101411	6.784288273	6.153962618	3.45497005	0	0	1.618652103	4.272119194	13.31908179	0	0	0	0	4.786409998	0	0.034954496	0	0.553876422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9804		6.433734662	6.092	0	1.278824942	0	1.865063569	1.641122611	0	2.125101411	6.784288273	6.153962618	3.45497005	0	0	1.618652103	4.272119194	13.31908179	0	0	0	0	4.786409998	0	0.034954496	0	0.553876422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9804	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $100 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $35-$50"	"(9a), (9b) 30%"	( 8a) 30%	( 8b) 30%			"(3), (5), (9c), (9d), (12), (13a) 30%"	"(7a) 30%, (14c-j) $0"	"(7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 30%, (14b-j) $0, (16b), (18a) 30%, (17a) 30%"					(15) 0-30%		(10b) 50%		"(17a) 30%, (17b) 30%"		"(18b) $0, $500 allowance/3 years"		"(14a) $500 deductible, 50%"	(13e) 30%											5100	3.4101	0	0.4837	2.3548	0.2148	1.1998	0	0.0137	1.4796	2.0043	0.6223	0	0	0.278	0.9869	1.7638	0	0	0	0	0.3723		0																		15.1842	500	3.98541862	9.5021	0	1.762495922	2.354819234	2.079908453	2.840931384	0	2.138808377	8.263932335	8.158243421	4.077296774	0	0	1.896642354	5.259015516	15.08292173	0	0	0	0	5.158695659	0	0.034954496	0	0.553876422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1646
H5106_025_0	2011	10																															Coin	Coin	Coin	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	V	Coin	Coin	O	T	Coin	V	P	V	P													2.254542682	0	0.180489882	0.49333621	0	1.171787565	0	0	4.86510938	4.034469816	8.442073468	0	0	2.5258299	0	3.153093773	0	0	0	13.99291246	1.243883482	0	0	0	0	0	0	0	0	0											42.3575	YES	155.1474253	0	22.02043229	7.312495591	112.247932	13.32572802	0	308.7213779	30.58508813	7.24189628	98.85066612	0	0	17.84503334	2247.943496	3662.94552	0	0	0	81.00563279	38.31431602	0	5.25929781	7.671428571	189.9004876	0			0	0											3400	"(1a), (1b) 5%, $1,000 coinsurance annual OOP Max"		(2) 5%	(6) $0	(10a)  $75	"(11a), (11b), (11c) 0-5%"		"(4a) $50, (4b) $30-$50"	"(9a), (9b) 5%"	( 8a) 5%	"( 8b) X-Ray and Diag. X-Ray 5%, Therapeutic Services 5%"			"(3) 5%, (5) 5%, (9c) 5%, (9d) $0, (12) 5%, (13a) 5%"	"(7a) $15-$30, (14c-j) $0"	"(7b), (7c) 5%, (7d) $30, (7f), (7g) 5%, (7h) $30, (7i) 5%, (14b-j) $0, (16b), (18a) $0, (17a) $0-$30"				"(7g) 5%, (14b), (14e-j) $0, (18a) $30"	(15) 0-5%		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $30, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0											1000	0.05	0	0.05	0	75	0.05	0	50	0.05	0.05	0.05	0	0	0.05	15	30	0	0	0	0.05	0.05	0	40	0.3	30	0		0	0	0											NO	0.039580321	0	0.047806525	0	71.70978738	0.047806525	0	47.80652492	0.047806525	0.047806525	0.047806525	0	0	0.047806525	14.34195748	28.68391495	0	0	0	0.047806525	0.047806525	0	38.24521994	0.3	30	0	0	0	0	0												6.1408	0	1.052720345	0	0.670772945	0.637056749	0	1.229908021	1.462166778	0.346209895	4.725706834	0	0	0.853109031	2.686659169	8.755634815	0	0	0	3.872597803	1.831674304	0	0.016761917	2.301428571	0.474751219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0579	1000	2.907760177	8.3953	0	1.233210228	0.49333621	0.670772945	1.808844314	0	1.229908021	6.327276158	4.380679711	13.1677803	0	0	3.378938931	2.686659169	11.90872859	0	0	0	17.86551026	3.075557786	0	0.016761917	2.301428571	0.474751219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.4155	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $75 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $30-$50"	"(9a), (9b) 30%"	( 8a) 30%	( 8b) 30%			"(3), (5), (9c), (9d), (12), (13a) 30%"	"(7a) 30%, (14c-j) $0"	"(7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 30%, (14b-j) $0, (16b) 30%, (18a) 30%-50%, (17a) 30%"				"(7e), (7g) 30%, (14b) $0, (14e-j) $0, (18a) 30%"	(15) 0-30%		(10b) 50%	"(16a), (16b) 50%"	"(17a) 30%, (17b) 30%"		"(18b) $0, $500 allowance/3 years"		(14a) 50%	(13e) 30%											5100	1.2204	0	0.1868	0.3484	0.0968	0.0643	0	0.0055	0.1719	0.0838	0.6233	0	0	0.0741	0.0955	0.2829	0	0	0	0.731	0.064		0																		4.0486	1000	0.170109531	9.6157	0	1.4199793	0.841700151	0.767532438	1.873144581	0	1.235427656	6.499131438	4.464522507	13.79103511	0	0	3.453080011	2.782117742	12.19163902	0	0	0	18.59655088	3.1395295	0	0.016761917	2.301428571	0.474751219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.4641
H5106_026_0	2011	10																															Coin	Coin	Coin	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	V	Coin	Coin	O	T	Coin	V	P	V	P													2.254542682	0	0.180489882	0.49333621	0	1.171787565	0	0	4.86510938	4.034469816	8.442073468	0	0	2.5258299	0	3.153093773	0	0	0	13.99291246	1.243883482	0	0	0	0	0	0	0	0	0											42.3575	YES	170.6484968	0	24.38124316	10.71034814	117.9692756	13.94149904	0	324.4570895	32.12150968	4.034469816	103.0056191	0	0	18.53404784	2362.522509	3849.648024	0	0	0	84.47157126	40.49433942	0	5.527367337	7.671428571	189.9004876	0			0	0											3400	"(1a), (1b) 5%, $1,000 coinsurance annual OOP Max"		(2) 5%	(6) $0	(10a)  $75	"(11a), (11b), (11c) 0-5%"		"(4a) $50, (4b) $30-$50"	"(9a), (9b) 5%"	( 8a) 5%	"( 8b) X-Ray and Diag. X-Ray 5%, Therapeutic Services 5%"			"(3) 5%, (5) 5%, (9c) 5%, (9d) $0, (12) 5%, (13a) 5%"	"(7a) $15-$30, (14c-j) $0"	"(7b), (7c) 5%, (7d) $30, (7f), (7g) 5%, (7h) $30, (7i) 5%, (14b-j) $0, (16b), (18a) $0, (17a) $0-$30"				"(7g) 5%, (14b), (14e-j) $0, (18a) $30"	(15) 0-5%		(10b) $40	"(16a) 30%, (16b) 40%"	"(17a) $30, (17b) $0"			"(18b) $0, $500 allowance/3 years"	(14a) $0	(13e) $0											1000	0.05	0	0.05	0	75	0.05	0	50	0.05	0.05	0.05	0	0	0.05	15	30	0	0	0	0.05	0.05	0	40	0.3	30	0		0	0	0											NO	0.039251158	0	0.04740895	0	71.1134253	0.04740895	0	47.4089502	0.04740895	0.04740895	0.04740895	0	0	0.04740895	14.22268506	28.44537012	0	0	0	0.04740895	0.04740895	0	37.92716016	0.3	30	0	0	0	0	0												6.6982	0	1.155889143	0	0.699099939	0.660951834	0	1.2818475	1.522847053	0.191269979	4.883388266	0	0	0.878679751	2.800117799	9.125388574	0	0	0	4.004708515	1.919794121	0	0.017469779	2.301428571	0.474751219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6158	1000	3.42694664	8.9527	0	1.336379025	0.49333621	0.699099939	1.832739399	0	1.2818475	6.387956433	4.225739794	13.32546173	0	0	3.404509651	2.800117799	12.27848235	0	0	0	17.99762098	3.163677603	0	0.017469779	2.301428571	0.474751219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9733	YES	"(1a), (1b)  30%"		(2) 30%	(6) 30%	"(10a) $75 emergency, 30% non-emergency"	"(11a), (11b), (11c) 0-50%"		"(4a) $50, (4b) $30-$50"	"(9a), (9b) 30%"	( 8a) 30%	( 8b) 30%			"(3), (5), (9c), (9d), (12), (13a) 30%"	"(7a) 30%, (14c-j) $0"	"(7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i) 30%, (14b-j) $0, (16b) 30%, (18a) 30%-50%, (17a) 30%"				"(7e), (7g) 30%, (14b) $0, (14e-j) $0, (18a) 30%"	(15) 0-30%		(10b) 50%	"(16a), (16b) 50%"	"(17a) 30%, (17b) 30%"		"(18b) $0, $500 allowance/3 years"		(14a) 50%	(13e) 30%											5100	0.914	0	0.1367	0.2209	0.1547	0.0694	0	0.0058	0.1776	0.089	0.6826	0	0	0.0869	0.0955	0.2829	0	0	0	0.7776	0.0554		0																		3.7489	1000	0.174436287	9.8667	0	1.473069255	0.714259061	0.853826977	1.902111442	0	1.287648475	6.565512174	4.314742245	14.00802247	0	0	3.491364832	2.895576372	12.56139278	0	0	0	18.77525341	3.219096196	0	0.017469779	2.301428571	0.474751219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.7222
H5106_806_0	2011	6																															Coin	Coin	Coin	Coin	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	288.3694076	0	28.00751537	8.223642566	9.949859691	25.20905116	0	25.98961754	71.84951594	10.85305946	45.01272235	0	0	28.52759868	27.40397209	33.76026541	0	0	0	122.3220951	42.78495577	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		"(4a), (4b) FFS"	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d), (12), (13a) FFS"	"(7a), (14c-j) FFS"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14b-j), (16b), (18a) (17a) FFS"				"(7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14a)	(13e)												0.079190141		0.182694748		0.233	0.233		0.233	0.233	0.233	0.233			0.233	0.233	0.233				0.233	0.233																				NO	0.072108556		0.166357256		0.212163957	0.212163957		0.212163957	0.212163957	0.212163957	0.212163957			0.212163957	0.212163957	0.212163957				0.212163957	0.212163957																					20.7939	0	4.659253397	0	2.1110016	5.348452037	0	5.514060089	15.24387759	2.302628036	9.550077276	0	0	6.05252821	5.814135147	7.162711487	0	0	0	25.95233969	9.077425503	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.5824		11.74386042	20.7939	0	4.659253397	0	2.1110016	5.348452037	0	5.514060089	15.24387759	2.302628036	9.550077276	0	0	6.05252821	5.814135147	7.162711487	0	0	0	25.95233969	9.077425503	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.5824	YES	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		"(4a), (4b) FFS"	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d), (12), (13a) FFS"	"(7a), (14c-j) FFS"	"(7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i), (14b-j) , (16b), (18a) (17a) FFS"				"(7e), (7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"		(18b)		(14a)	(13e)											10000	0.8759	0	0.9035	0	0.4851	0.3233	0	0.034	0.538	0.0993	0.4117	0	0	0.2609	0.356	0.4386	0	0	0	1.589	0.6432	0	0	0	0	0	0	0	0	0											6.9585		0.417553781	21.6698	0	5.562786914	0	2.596072192	5.671762516	0	5.548026429	15.78184702	2.401898755	9.961799456	0	0	6.31346433	6.170128255	7.601276443	0	0	0	27.54137295	9.720646935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.5409
H5106_807_0	2011	6																															Coin	Coin	Coin	Coin	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	284.4276338	0	27.62467555	8.111232101	9.81385325	24.86446405	0	25.63436073	70.86739185	10.70470701	44.39743527	0	0	28.13764974	27.02938221	33.2987902	0	0	0	120.6500522	42.20012044	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		"(4a), (4b) FFS"	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d), (12), (13a) FFS"	"(7a), (14c-j) FFS"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14b-j), (16b), (18a) (17a) FFS"				"(7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14a)	(13e)												0.082582344		0.181918722		0.233	0.233		0.233	0.233	0.233	0.233			0.233	0.233	0.233				0.233	0.233																				NO	0.075197412		0.165650626		0.212163957	0.212163957		0.212163957	0.212163957	0.212163957	0.212163957			0.212163957	0.212163957	0.212163957				0.212163957	0.212163957																					21.3882	0	4.576044808	0	2.082145936	5.275343074	0	5.4386874	15.03550625	2.271152995	9.419535533	0	0	5.969795101	5.734660677	7.064803082	0	0	0	25.59759244	8.953344524	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.8068		11.66769499	21.3882	0	4.576044808	0	2.082145936	5.275343074	0	5.4386874	15.03550625	2.271152995	9.419535533	0	0	5.969795101	5.734660677	7.064803082	0	0	0	25.59759244	8.953344524	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.8068	YES	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		"(4a), (4b) FFS"	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d), (12), (13a) FFS"	"(7a), (14c-j) FFS"	"(7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i), (14b-j) , (16b), (18a) (17a) FFS"				"(7e), (7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"		(18b)		(14a)	(13e)											10000	0.901	0	0.8874	0	0.4784	0.3189	0	0.0335	0.5306	0.0979	0.4061	0	0	0.2574	0.3511	0.4326	0	0	0	1.5673	0.6344	0	0	0	0	0	0	0	0	0											6.8966		0.413839796	22.2892	0	5.463442319	0	2.560586009	5.594234163	0	5.472189448	15.56612208	2.369066764	9.825629809	0	0	6.227164439	6.085787651	7.497373214	0	0	0	27.16490491	9.587773645	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.7035
H5106_808_0	2011	6																															Coin	Coin	Coin	Coin	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	289.7120433	0	27.91827831	9.39275043	8.774678624	21.63065262	0	28.89184932	85.39572612	11.23494941	46.59659893	0	0	29.53140811	28.1814255	34.71804749	0	0	0	125.7923852	46.69754139	0	0	0	0	0			0	0											6700	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		"(4a), (4b) FFS"	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d), (12), (13a) FFS"	"(7a), (14c-j) FFS"	"(7b), (7c), (7d), (7e), (7f), (7g), (7h), (7i), (14b-j), (16b), (18a) (17a) FFS"				"(7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"			(18b)	(14a)	(13e)												0.0780312		0.180552069		0.233	0.233		0.233	0.233	0.233	0.233			0.233	0.233	0.233				0.233	0.233																				NO	0.071053254		0.164406186		0.212163957	0.212163957		0.212163957	0.212163957	0.212163957	0.212163957			0.212163957	0.212163957	0.212163957				0.212163957	0.212163957																					20.585	0	4.589937663	0	1.861670535	4.589244845	0	6.129809067	18.11789514	2.38365132	9.886118796	0	0	6.26550039	5.97908274	7.365918325	0	0	0	26.68861015	9.907535147	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.35		12.21207006	20.585	0	4.589937663	0	1.861670535	4.589244845	0	6.129809067	18.11789514	2.38365132	9.886118796	0	0	6.26550039	5.97908274	7.365918325	0	0	0	26.68861015	9.907535147	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.35	YES	"(1a), (1b) FFS"		(2) FFS	(6) FFS	(10a) FFS	"(11a), (11b), (11c) FFS"		"(4a), (4b) FFS"	"(9a), (9b) FFS"	(8a) FFS	(8b) FFS			"(3), (5), (9c), (9d), (12), (13a) FFS"	"(7a), (14c-j) FFS"	"(7b), (7c), (7d), (7e) (7f), (7g), (7h), (7i), (14b-j) , (16b), (18a) (17a) FFS"				"(7e), (7g), (14b), (14e-j), (18a) FFS"	(15) FFS		(10b)	"(16a), (16b)"	"(17a), (17b)"		(18b)		(14a)	(13e)											10000	0.8671	0	0.8901	0	0.4278	0.2774	0	0.0378	0.6394	0.1028	0.4262	0	0	0.2701	0.3661	0.451	0	0	0	1.6341	0.702	0	0	0	0	0	0	0	0	0											7.0919		0.425558419	21.4521	0	5.480029308	0	2.289449286	4.866661739	0	6.16756839	18.75729109	2.486415109	10.31232837	0	0	6.53561815	6.345175408	7.816925413	0	0	0	28.32272444	10.6095777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.4419
H5151_002_0	2011	4																															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	2051.6	48.5	3024.3	2406.8	410	15.34235165	0	411.6	365.7	15406.9	1215.3	249.6	60.9	6307.5	3747.7	3450.9	187.7	50.7	926	0	26.59015212	0	0	0.7	199.5	162	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-12	$100 / days 11-100	$0.00 	125	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$250.00 	$10.00 	"$25 X-Rays, $125 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	$0.00 	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												127.6910435	127.6910435	43.0866677	$0.00 	125	20%	20%	$50.00 	$250.00 	$10.00 	56.42380972	$0.00 	41.62096591	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	101.7697617	101.7697617	34.34007415	0	99.625	0.1594	0.1594	39.85	199.25	7.97	44.96977635	0	33.17190983	0	0	27.895	27.895	27.895	0	0	0.15143	0	0	0	27.895	11.955	0	0	0	0												17.3992	0.411319454	8.654557189	0	3.403854167	2.445570853	0	1.366855	6.07214375	10.23274942	4.5543141	0	0.168347442	0	0	8.021904625	0.436324292	0.117856375	0	0	4.026546736	0	0	0	0.463754375	0.1613925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.9367		17.3038339	17.3992	0.411319454	8.654557189	0	3.403854167	2.445570853	0	1.366855	6.07214375	10.23274942	4.5543141	0	0.168347442	0	0	8.021904625	0.436324292	0.117856375	0	0	4.026546736	0	0	0	0.463754375	0.1613925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.9367	NO																																																																																		0		0	17.3992	0.411319454	8.654557189	0	3.403854167	2.445570853	0	1.366855	6.07214375	10.23274942	4.5543141	0	0.168347442	0	0	8.021904625	0.436324292	0.117856375	0	0	4.026546736	0	0	0	0.463754375	0.1613925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.9367
H5151_004_0	2011	3																															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	2088.4	37	2374.9	1936.3	354.2	11.31221885	0	364	354.8	12713.6	1228.9	171.5	74	5457.8	3363.2	3224	119	62.9	688.7	0	13.68939315	0	0	0.3	204.8	161.7	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-12	$100 / days 11-100	$0.00 	$125.00 	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$250.00 	$10.00 	"$25 X-Rays, $125 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	$0.00 	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												127.6910435	127.6910435	43.0866677	$0.00 	$125.00 	20%	20%	$50.00 	$250.00 	$10.00 	56.42380972	$0.00 	41.62096591	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	101.7697617	101.7697617	34.34007415	0	99.625	0.1594	0.1594	39.85	199.25	7.97	44.96977635	0	33.17190983	0	0	27.895	27.895	27.895	0	0	0.15143	0	0	0	27.895	11.955	0	0	0	0												17.7113	0.313790099	6.796186842	0	2.940597917	1.803167685	0	1.208783333	5.891158333	8.443949333	4.605279846	0	0.204560111	0	0	7.494456667	0.276625417	0.146216292	0	0	2.072984805	0	0	0	0.476074667	0.161093625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5463		15.42144283	17.7113	0.313790099	6.796186842	0	2.940597917	1.803167685	0	1.208783333	5.891158333	8.443949333	4.605279846	0	0.204560111	0	0	7.494456667	0.276625417	0.146216292	0	0	2.072984805	0	0	0	0.476074667	0.161093625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5463	NO																																																																																		0		0	17.7113	0.313790099	6.796186842	0	2.940597917	1.803167685	0	1.208783333	5.891158333	8.443949333	4.605279846	0	0.204560111	0	0	7.494456667	0.276625417	0.146216292	0	0	2.072984805	0	0	0	0.476074667	0.161093625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5463
H5151_006_0	2011	6																															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	2059.8	48.7	3042.8	2406.8	410	15.34235165	0	411.6	368.3	15407	1215.3	249.6	60.9	6307.6	3747.8	3451	187.7	50.7	926	0	13.68939315	0	0	0.7	199.5	162	0	0	0	0											3400	$100 / days 1-12	$100 / days 1-12	$75 / days 11-100	$0.00 	125	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$175.00 	$5.00 	"$20 X-Rays, $100 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	$0.00 	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												72.9663106	72.9663106	32.31500077	$0.00 	125	20%	20%	$50.00 	$175.00 	$5.00 	49.92380972	$0.00 	41.62096591	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	62.31322925	62.31322925	27.59701066	0	106.75	0.1708	0.1708	42.7	149.45	4.27	42.6349335	0	35.54430489	0	0	29.89	29.89	29.89	0	0	0.16226	0	0	0	29.89	12.81	0	0	0	0												10.6961	0.252887855	6.997682003	0	3.647291667	2.620473661	0	1.46461	4.586869583	5.482324167	4.31785289	0	0.180387347	0	0	8.595865833	0.467529417	0.12628525	0	0	2.221240932	0	0	0	0.49692125	0.172935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3272		8.945871789	10.6961	0.252887855	6.997682003	0	3.647291667	2.620473661	0	1.46461	4.586869583	5.482324167	4.31785289	0	0.180387347	0	0	8.595865833	0.467529417	0.12628525	0	0	2.221240932	0	0	0	0.49692125	0.172935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3272	NO																																																																																		0		0	10.6961	0.252887855	6.997682003	0	3.647291667	2.620473661	0	1.46461	4.586869583	5.482324167	4.31785289	0	0.180387347	0	0	8.595865833	0.467529417	0.12628525	0	0	2.221240932	0	0	0	0.49692125	0.172935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3272
H5151_802_0	2011	3																															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	1647.8	38.9	2429.1	1933.1	329.3	12.32311758	0	330.6	293.7	12375.1	976.1	200.4	48.9	5066.3	3010.3	2771.9	150.8	40.7	743.8	0	21.35745409	0	0	0.5	160.3	130.1	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-12	$100 / days 11-100	$0.00 	$125.00 	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$250.00 	$10.00 	"$25 X-Rays, $125 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	$0.00 	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												127.6910435	127.6910435	43.0866677	$0.00 	$125.00 	20%	20%	$50.00 	$250.00 	$10.00 	56.42380972	$0.00 	41.62096591	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	101.7697617	101.7697617	34.34007415	0	99.625	0.1594	0.1594	39.85	199.25	7.97	44.96977635	0	33.17190983	0	0	27.895	27.895	27.895	0	0	0.15143	0	0	0	27.895	11.955	0	0	0	0												13.9747	0.329903644	6.951289511	0	2.733876042	1.964304942	0	1.0978675	4.87664375	8.219128917	3.657916558	0	0.135175533	0	0	6.443512542	0.350547167	0.094610542	0	0	3.234159273	0	0	0	0.372630708	0.129612125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5659		13.89820606	13.9747	0.329903644	6.951289511	0	2.733876042	1.964304942	0	1.0978675	4.87664375	8.219128917	3.657916558	0	0.135175533	0	0	6.443512542	0.350547167	0.094610542	0	0	3.234159273	0	0	0	0.372630708	0.129612125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5659	NO																																																																																		0		0	13.9747	0.329903644	6.951289511	0	2.733876042	1.964304942	0	1.0978675	4.87664375	8.219128917	3.657916558	0	0.135175533	0	0	6.443512542	0.350547167	0.094610542	0	0	3.234159273	0	0	0	0.372630708	0.129612125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5659
H5151_803_0	2011	3																															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	1442.7	155.8	1216.4	1381.5	225.6	9.975484441	0	345	384.5	14374.1	1282	157.1	16	5246.3	3392.7	3325.4	184.5	38.9	919	0	15.42643913	0	0	0	250.5	190.3	0	0	0	0											3400	$175 / days 1-12	$175 / days 1-12	$100 / days 11-100	$0.00 	125	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$250.00 	$10.00 	"$25 X-Rays, $125 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	$0.00 	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												127.6910435	127.6910435	43.0866677	$0.00 	125	20%	20%	$50.00 	$250.00 	$10.00 	56.42380972	$0.00 	41.62096591	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	101.7697617	101.7697617	34.34007415	0	99.625	0.1594	0.1594	39.85	199.25	7.97	44.96977635	0	33.17190983	0	0	27.895	27.895	27.895	0	0	0.15143	0	0	0	27.895	11.955	0	0	0	0												12.2353	1.32131074	3.48093885	0	1.87295	1.59009222	0	1.1456875	6.384302083	9.546798083	4.804271107	0	0.044229213	0	0	7.730169417	0.428885625	0.090426292	0	0	2.336025678	0	0	0	0.582308125	0.189586375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7833		13.69887068	12.2353	1.32131074	3.48093885	0	1.87295	1.59009222	0	1.1456875	6.384302083	9.546798083	4.804271107	0	0.044229213	0	0	7.730169417	0.428885625	0.090426292	0	0	2.336025678	0	0	0	0.582308125	0.189586375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7833	NO																																																																																		0		0	12.2353	1.32131074	3.48093885	0	1.87295	1.59009222	0	1.1456875	6.384302083	9.546798083	4.804271107	0	0.044229213	0	0	7.730169417	0.428885625	0.090426292	0	0	2.336025678	0	0	0	0.582308125	0.189586375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7833
H5162_001_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	592.8202435	17.81344614	351.764704	28.17078192	198.8240544	11.42098526	11.34619136	553.9427464	83.57093832	34.2159763	37.46733367	0.010660576	0.093679762	0.010848717	4085.91966	1646.00512	1.735785751	7.202791916	0	0	20.95395726	0.554148224																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	114.5257964	114.5257964	45.81031856	0	91.62063712	0.183241274	0.183241274	45.81031856	0.091620637	0	0.091620637	0.366482548	0.091620637	0.366482548	9.162063712	22.90515928	0.366482548	0.091620637	22.90515928	22.90515928	0.183241274	0.091620637																				5.6578	0.170008259	1.342871096	0	1.518032212	2.092795892	2.079090562	2.11469114	7.656822614	0	3.432780983	0.003906915	0.008582999	0.003975866	3.119621354	3.141834121	0.636135186	0.659924384	0	0	3.839629829	0.050771413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5292		3.432336919	5.6578	0.170008259	1.342871096	0	1.518032212	2.092795892	2.079090562	2.11469114	7.656822614	0	3.432780983	0.003906915	0.008582999	0.003975866	3.119621354	3.141834121	0.636135186	0.659924384	0	0	3.839629829	0.050771413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5292	YES	$200 - days 1-5	$200 - days 1-5	$75 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	50% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																			3000	0.648	0.0195	0.1258	0	0.1479	0.1531	0.1521	0.0146	0.8645	0	0.3876	0.0003	0.001	0.0003	0.3764	0.3076	0.0465	0.0745	0	0	0.0266	0.0057																			3.352		0	6.3058	0.189479771	1.468677344	0	1.665894601	2.245910476	2.231202427	2.129320747	8.521350317	0	3.820374428	0.004192756	0.009552101	0.004266751	3.496011008	3.449436956	0.682676549	0.73443609	0	2.05E-05	3.866192705	0.056503986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8813
H5162_002_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	586.8790901	17.63492252	348.2393721	27.88845867	196.8314703	11.3065259	11.23248157	548.3912173	82.73340321	33.87306904	37.09184181	0.010660576	0.092740917	0.010739993	4044.9712	1629.50911	1.718389973	7.130606642	0	0	20.74395992	0.548594636																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	132.6044727	132.6044727	44.20149092	0	132.6044727	0.176805964	0.176805964	44.20149092	0.132604473	0	0.132604473	0.353611927	0.132604473	0.353611927	13.26044727	26.52089455	0.353611927	0.132604473	26.52089455	26.52089455	0.176805964	0.132604473																				6.4852	0.194872467	1.282724954	0	2.175061112	1.999061208	1.985969729	2.019975784	10.97081931	0	4.918544127	0.003769707	0.01229786	0.00379779	4.469843944	3.601336605	0.60764319	0.945550334	0	0	3.667655824	0.072746102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4169		5.957982634	6.4852	0.194872467	1.282724954	0	2.175061112	1.999061208	1.985969729	2.019975784	10.97081931	0	4.918544127	0.003769707	0.01229786	0.00379779	4.469843944	3.601336605	0.60764319	0.945550334	0	0	3.667655824	0.072746102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4169	YES	$225 - days 1-5	$225 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$25 Copay	"$45 Copay, Chiropractor $25 Copay"	50% Coinsurance	20% Coinsurance	$45 Copay	$45 Copay	20% Coinsurance	20% Coinsurance																			3000	0.7178	0.0216	0.1236	0	0.1957	0.1498	0.1489	0.0174	0.8709	0	0.3904	0.0003	0.001	0.0003	0.4671	0.3418	0.0455	0.0751	0	0	0.0315	0.0058																			3.6045		0	7.203	0.216441092	1.406368899	0	2.370778062	2.148902185	2.134829425	2.037348351	11.84167591	0	5.308975003	0.004052268	0.013274057	0.004082455	4.93693534	3.94313431	0.653189494	1.020607513	0	2.28E-05	3.699199072	0.078520641	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0214
H5162_003_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	716.1426673	21.5191181	363.81359	27.33271469	183.870672	10.30441268	10.236931	551.8116489	95.40670567	20.60632235	22.56442863	0.010660576	0.091066239	0.012385253	4122.344087	1660.678633	1.713471006	7.11613382	0	0	20.87860815	0.552155542																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	114.3196695	114.3196695	45.7278678	0	91.45573559	0.182911471	0.182911471	45.7278678	0.091455736	0	0.091455736	0.365822942	0.091455736	0.365822942	9.145573559	22.8639339	0.365822942	0.091455736	22.8639339	22.8639339	0.182911471	0.091455736																				6.8224	0.205004872	1.386368312	0	1.40133563	1.884795282	1.87245211	2.102764178	8.725490448	0	2.063646419	0.003899883	0.00832853	0.00453081	3.141766757	3.164137207	0.626827005	0.650811253	0	0	3.818936932	0.050497791	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.934		3.544011208	6.8224	0.205004872	1.386368312	0	1.40133563	1.884795282	1.87245211	2.102764178	8.725490448	0	2.063646419	0.003899883	0.00832853	0.00453081	3.141766757	3.164137207	0.626827005	0.650811253	0	0	3.818936932	0.050497791	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.934	YES	$200 - days 1-5	$200 - days 1-5	$75 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	50% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																			3000	0.6546	0.0197	0.1258	0	0.1467	0.1378	0.1369	0.0144	0.9847	0	0.2329	0.0003	0.0009	0.0003	0.3757	0.3071	0.0458	0.0734	0	0	0.0262	0.0057																			3.2889		0	7.477	0.224673438	1.512184142	0	1.548059913	2.022582803	2.009337286	2.117196988	9.710156709	0	2.296527655	0.004184983	0.009268399	0.004862034	3.517481149	3.471192451	0.672651047	0.724254905	0	2.05E-05	3.845149094	0.056196436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.223
H5162_004_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	701.5275108	21.07995242	356.3888229	26.77490419	180.1182093	10.09411854	10.02801404	540.5501867	93.45963004	20.18578516	22.10393009	0.010660576	0.089207744	0.012132493	4038.214616	1626.787232	1.67850221	6.970906599	0	0.279015427	20.4525141	0.540887062																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	132.5895618	132.5895618	44.1965206	0	132.5895618	0.176786082	0.176786082	44.1965206	0.132589562	0	0.132589562	0.353572165	0.132589562	0.353572165	13.25895618	26.51791236	0.353572165	0.132589562	26.51791236	10.30743514	0.176786082	0.132589562																				7.7513	0.232915138	1.312595496	0	1.990149537	1.784499672	1.772813317	1.990869789	12.39177139	0	2.930750404	0.003769283	0.011828016	0.004289712	4.461875887	3.594916771	0.59347166	0.924269451	0	0.000239661	3.615719843	0.071715978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4397		5.966726159	7.7513	0.232915138	1.312595496	0	1.990149537	1.784499672	1.772813317	1.990869789	12.39177139	0	2.930750404	0.003769283	0.011828016	0.004289712	4.461875887	3.594916771	0.59347166	0.924269451	0	0.000239661	3.615719843	0.071715978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4397	YES	$225 - days 1-5	$225 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$25 Copay	"$45 Copay, Chiropractor $25 Copay"	50% Coinsurance	20% Coinsurance	$45 Copay	$45 Copay	20% Coinsurance	20% Coinsurance																			3000	0.7271	0.0218	0.1236	0	0.1937	0.1334	0.1326	0.0168	0.9813	0	0.2321	0.0003	0.0009	0.0003	0.4661	0.341	0.0444	0.0732	0	0	0.0305	0.0057																			3.525		0	8.4784	0.254764726	1.436235729	0	2.183879253	1.917926939	1.905366794	2.007645439	13.37311356	0	3.162845466	0.004051113	0.012764712	0.004610454	4.927999798	3.935944821	0.637845611	0.997465168	0	0.000262396	3.646186955	0.077395386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.9647
H5162_005_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	601.5370454	18.07537424	371.7282504	32.43610386	193.027986	10.89050487	10.81918499	595.621515	103.7919903	33.28984176	36.91300011	0.010660576	0.099025301	0.013473815	4179.280978	1683.615553	1.750021917	7.389399196	0	0.264971121	22.55139232	0.596393982																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	113.527728	113.527728	45.41109121	0	90.82218242	0.181644365	0.181644365	45.41109121	0.090822182	0	0.090822182	0.36328873	0.090822182	0.36328873	9.082218242	22.7055456	0.36328873	0.090822182	22.7055456	9.618006568	0.181644365	0.090822182																				5.6909	0.171004681	1.406715457	0	1.460935247	1.97819884	1.965243985	2.253985245	9.426615074	0	3.35251923	0.003872867	0.008993694	0.004894885	3.163095161	3.185617477	0.635763239	0.671121362	0	0.000212374	4.096333334	0.054165803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.5302		3.994631046	5.6909	0.171004681	1.406715457	0	1.460935247	1.97819884	1.965243985	2.253985245	9.426615074	0	3.35251923	0.003872867	0.008993694	0.004894885	3.163095161	3.185617477	0.635763239	0.671121362	0	0.000212374	4.096333334	0.054165803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.5302	YES	$200 - days 1-5	$200 - days 1-5	$75 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	50% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																			3000	0.6473	0.0195	0.1263	0	0.1474	0.1462	0.1452	0.0172	1.0716	0	0.3811	0.0003	0.001	0.0004	0.3761	0.3078	0.047	0.0763	0	0	0.0312	0.0062																			3.548		0	6.3382	0.19045569	1.533010811	0	1.608320617	2.124402046	2.110489733	2.271153095	10.49824754	0	3.733638901	0.0041591	0.010016111	0.005256652	3.53914719	3.493453951	0.682750742	0.747415496	0	0.000232897	4.127533731	0.060323457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.0783
H5162_006_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	585.7071232	17.5997065	361.945928	31.58252218	187.9483022	10.60391264	10.53446959	579.9472646	101.0606221	32.4137933	35.94160537	0.010660576	0.096419372	0.013119241	4069.299899	1639.309881	1.703968709	7.194941322	0	0.272132503	21.95793463	0.580699404																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	131.396301	131.396301	43.79876701	0	131.396301	0.175195068	0.175195068	43.79876701	0.131396301	0	0.131396301	0.350390136	0.131396301	0.350390136	13.1396301	26.27926021	0.350390136	0.131396301	26.27926021	10.55364587	0.175195068	0.131396301																				6.4133	0.192711361	1.321065448	0	2.057975975	1.857753196	1.845587117	2.116747927	13.27899193	0	4.722593999	0.003735361	0.012669149	0.004596852	4.455757955	3.589987576	0.597053828	0.945388676	0	0.000239333	3.846921851	0.076301754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3394		6.70253109	6.4133	0.192711361	1.321065448	0	2.057975975	1.857753196	1.845587117	2.116747927	13.27899193	0	4.722593999	0.003735361	0.012669149	0.004596852	4.455757955	3.589987576	0.597053828	0.945388676	0	0.000239333	3.846921851	0.076301754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3394	YES	$225 - days 1-5	$225 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$25 Copay	"$45 Copay, Chiropractor $25 Copay"	50% Coinsurance	20% Coinsurance	$45 Copay	$45 Copay	20% Coinsurance	20% Coinsurance																			3000	0.7156	0.0215	0.1238	0	0.1945	0.1405	0.1396	0.0195	1.063	0	0.378	0.0003	0.001	0.0003	0.4661	0.3413	0.0452	0.0757	0	0	0.0355	0.0061																			3.7676		0	7.1289	0.214213241	1.444910802	0	2.252472589	1.998243792	1.985157666	2.136279986	14.34198007	0	5.100639372	0.004017843	0.013683319	0.004944485	4.921880578	3.931298132	0.642205384	1.021067384	0	0.000262087	3.8824189	0.082409737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.107
H5162_007_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	587.9220703	17.66626266	363.811124	27.15122425	246.2449599	13.79996962	13.70959619	551.5289141	93.61035189	33.3139235	36.47956373	0.010660576	0.090971487	0.012152039	4134.317359	1665.502043	1.718447751	7.136802499	0	0.272251401	20.8568844	0.551581036																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	113.6382277	113.6382277	45.45529108	0	90.91058216	0.181821164	0.181821164	45.45529108	0.090910582	0	0.090910582	0.363642329	0.090910582	0.363642329	9.091058216	22.72764554	0.363642329	0.090910582	22.72764554	9.269114241	0.181821164	0.090910582																				5.5675	0.167296898	1.378095045	0	1.865522722	2.509126543	2.492694742	2.089158944	8.510171587	0	3.316378375	0.003876637	0.008270271	0.004418996	3.132109983	3.154411674	0.624900342	0.64881087	0	0.000210294	3.792223006	0.050144553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3154		3.930826264	5.5675	0.167296898	1.378095045	0	1.865522722	2.509126543	2.492694742	2.089158944	8.510171587	0	3.316378375	0.003876637	0.008270271	0.004418996	3.132109983	3.154411674	0.624900342	0.64881087	0	0.000210294	3.792223006	0.050144553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3154	YES	$200 - days 1-5	$200 - days 1-5	$75 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	50% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																			3000	0.6463	0.0194	0.126	0	0.1504	0.1851	0.1839	0.0157	0.9664	0	0.3766	0.0003	0.0009	0.0003	0.3758	0.3075	0.0461	0.0737	0	0	0.0285	0.0057																			3.5085		0	6.2138	0.186716223	1.504114872	0	2.015894436	2.694264575	2.676620338	2.104833426	9.476550034	0	3.692972026	0.004162678	0.009209407	0.004745055	3.507872034	3.461895123	0.671009144	0.722487039	0	0.000230793	3.820675189	0.055838753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8239
H5162_008_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	568.5825285	17.0851356	351.8436529	26.25809187	238.1447968	13.34602325	13.25862263	533.3865156	90.531064	32.21807075	35.27957808	0.010660576	0.087979003	0.011752301	3998.320078	1610.715792	1.661919864	6.902039259	0	0.281511653	20.17080268	0.533436923																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	131.8365168	131.8365168	43.94550562	0	131.8365168	0.175782022	0.175782022	43.94550562	0.131836517	0	0.131836517	0.351564045	0.131836517	0.351564045	13.18365168	26.36730337	0.351564045	0.131836517	26.36730337	10.05766108	0.175782022	0.131836517																				6.2467	0.187703731	1.288495602	0	2.616348376	2.345990958	2.330627501	1.953328343	11.93530014	0	4.65113669	0.003747875	0.011598845	0.004131686	4.392704936	3.539185993	0.58427127	0.909940815	0	0.000235946	3.545664489	0.070326466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6174		6.42260888	6.2467	0.187703731	1.288495602	0	2.616348376	2.345990958	2.330627501	1.953328343	11.93530014	0	4.65113669	0.003747875	0.011598845	0.004131686	4.392704936	3.539185993	0.58427127	0.909940815	0	0.000235946	3.545664489	0.070326466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6174	YES	$225 - days 1-5	$225 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$25 Copay	"$45 Copay, Chiropractor $25 Copay"	50% Coinsurance	20% Coinsurance	$45 Copay	$45 Copay	20% Coinsurance	20% Coinsurance																			3000	0.7148	0.0215	0.1236	0	0.1997	0.1769	0.1757	0.0176	0.9528	0	0.3713	0.0003	0.0009	0.0003	0.466	0.3411	0.0441	0.0726	0	0	0.032	0.0056																			3.7169		0	6.9615	0.209182993	1.412127658	0	2.8160133	2.522891543	2.506369597	1.970952111	12.88810735	0	5.022441683	0.004030486	0.012524793	0.004443238	4.858682711	3.8802721	0.628328528	0.98258232	0	0.000258685	3.577654999	0.075940699	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3343
H5162_009_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	774.204244	23.26378991	486.3080243	37.20446244	336.1278762	18.837155	18.71379399	846.2221159	122.6473822	45.20695109	49.50272078	0.010660576	0.146539255	0.015921446	5941.338013	2393.456946	2.520473782	10.25614444	0	0.191546547	32.07333269	0.848211158																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	107.2844291	107.2844291	42.91377164	0	85.82754328	0.171655087	0.171655087	42.91377164	0.085827543	0	0.085827543	0.343310173	0.085827543	0.343310173	8.582754328	21.45688582	0.343310173	0.085827543	21.45688582	17.87420458	0.171655087	0.085827543																				6.9217	0.207986868	1.739109292	0	2.40408582	3.233493473	3.212317927	3.02621522	10.5265235	0	4.24869691	0.003659884	0.012577104	0.005465994	4.249420379	4.2796777	0.865304291	0.88025968	0	0.000285312	5.5055507	0.07279988	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3951		8.486726119	6.9217	0.207986868	1.739109292	0	2.40408582	3.233493473	3.212317927	3.02621522	10.5265235	0	4.24869691	0.003659884	0.012577104	0.005465994	4.249420379	4.2796777	0.865304291	0.88025968	0	0.000285312	5.5055507	0.07279988	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3951	YES	$200 - days 1-5	$200 - days 1-5	$75 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	50% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																			3000	0.6464	0.0194	0.1281	0	0.1548	0.2495	0.2479	0.0323	1.2323	0	0.4974	0.0003	0.0015	0.0004	0.379	0.3145	0.0668	0.1031	0	0	0.0588	0.0085																			4.1411		0	7.5681	0.227410954	1.867241141	0	2.558919492	3.483031646	3.460221921	3.058537547	11.75884493	0	4.746084321	0.003942328	0.014049484	0.005887821	4.628423176	4.594180897	0.93208236	0.98331012	0	0.000306279	5.564354254	0.081322433	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5362
H5162_010_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	743.2360742	22.33323832	466.8557033	35.71628394	322.6827611	18.0836688	17.96524223	812.3732312	117.7414869	43.39867304	47.52261195	0.010660576	0.140677685	0.015284588	5703.684493	2297.718668	2.419654831	9.845898658	0	0.199527653	30.79039938	0.814282712																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	123.2957869	123.2957869	41.09859562	0	123.2957869	0.164394382	0.164394382	41.09859562	0.123295787	0	0.123295787	0.328788765	0.123295787	0.328788765	12.32957869	24.65915737	0.328788765	0.123295787	24.65915737	18.93131285	0.164394382	0.123295787																				7.6365	0.229466183	1.598926147	0	3.315452079	2.972853566	2.953384902	2.782283244	14.51702927	0	5.859337834	0.003505078	0.017344966	0.005025401	5.860335563	4.721650519	0.795555323	1.213957822	0	0.000314777	5.061768693	0.100397628	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6451		12.91832377	7.6365	0.229466183	1.598926147	0	3.315452079	2.972853566	2.953384902	2.782283244	14.51702927	0	5.859337834	0.003505078	0.017344966	0.005025401	5.860335563	4.721650519	0.795555323	1.213957822	0	0.000314777	5.061768693	0.100397628	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6451	YES	$225 - days 1-5	$225 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$25 Copay	"$45 Copay, Chiropractor $25 Copay"	50% Coinsurance	20% Coinsurance	$45 Copay	$45 Copay	20% Coinsurance	20% Coinsurance																			3000	0.7105	0.0213	0.1245	0	0.2054	0.2341	0.2325	0.0338	1.2074	0	0.4873	0.0003	0.0014	0.0004	0.4711	0.3474	0.0626	0.101	0	0	0.0615	0.0084																			4.311		0	8.3469	0.250814455	1.723421218	0	3.520884065	3.206919209	3.185917693	2.816076283	15.72446241	0	6.346679874	0.003781048	0.018787609	0.005421072	6.331473334	5.06901989	0.858192841	1.314927027	0	0.000337935	5.123247893	0.108748057	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.9561
H5162_011_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			4.683391627	0.073582112	0.676327222	0.548667697	0.161459195	0.202696585	0.201369163	0.288593997	1.552131167	0.576632892	0.631686312	0.00016073	0.00160828	0.00020149	0.457137252	0.530370029	0.027101594	0.11029858	0	0.00014585	0.368727652	0.009751369																			11.102	NO	857.2858395	25.76027944	409.4165718	36.39089356	239.8937761	13.4440389	13.3559964	644.95678	102.9465383	38.24571106	41.87999213	0.010660576	0.106670638	0.013364015	4237.926107	1707.240634	1.797538363	7.315655525	0	0.250897523	24.45620329	0.646768601																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	180.210911	180.210911	45.05272774	0	135.1581832	0.180210911	0.180210911	45.05272774	0.180210911	0	0.180210911	0.360421822	0.180210911	0.360421822	18.0210911	36.04218219	0.360421822	0.180210911	36.04218219	16.35001605	0.180210911	0.180210911																				12.8744	0.386856952	1.537111112	0	2.701967245	2.422762498	2.406896278	2.421421851	18.55208945	0	7.547231533	0.003842304	0.019223213	0.004816683	6.364337703	5.127723165	0.647872052	1.318360947	0	0.000341848	4.407274674	0.116554759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.861	200	11.62264807	17.5577	0.460439064	2.213438334	0.548667697	2.863426441	2.625459083	2.608265441	2.710015849	20.10422062	0.576632892	8.178917844	0.004003035	0.020831493	0.005018173	6.821474955	5.658093195	0.674973646	1.428659526	0	0.000487698	4.776002326	0.126306128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.9631	YES	$300 - days 1-5	$300 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	3.1431	0.0944	0.3838	0	0.65	0.5816	0.5778	0.396	4.4538	0	1.8119	0.0009	0.0043	0.0012	1.6455	1.2446	0.1555	0.3165	0	0.0001	0.7207	0.028																			16.2096	200	0	20.7009	0.554885459	2.59720076	0.548667697	3.513389275	3.207090223	3.186087587	3.105971366	24.5580096	0.576632892	9.990777191	0.004925454	0.0251521	0.006174511	8.466998779	6.902669382	0.830507901	1.745157648	0	0.00057067	5.496688283	0.154287359	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.1727
H5162_012_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			4.648877583	0.073039852	0.671343059	0.544624315	0.160269329	0.201202822	0.199885182	0.286467217	1.540692806	0.572383422	0.627031128	0.000164008	0.001596428	0.000200005	0.4537684	0.526461491	0.02690187	0.109485739	0	0.000144775	0.36601033	0.009679507																			11.0202	NO	833.9583337	25.05931945	398.2759848	35.40066517	233.3660543	13.07821472	12.99256793	627.4069357	100.145272	37.20501144	40.74040051	0.010660576	0.103768036	0.013000369	4122.60839	1660.785107	1.748625755	7.116590069	0	0.257915636	23.79072837	0.629169456																				$250 - days 1-5	$250 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				250	250	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	224.5681631	224.5681631	44.91363261	0	134.7408978	0.17965453	0.17965453	44.91363261	0.17965453	0	0.17965453	0.359309061	0.17965453	0.359309061	17.96545305	35.93090609	0.359309061	0.17965453	35.93090609	15.4245563	0.17965453	0.17965453																				15.6067	0.468960445	1.490668438	0	2.620329307	2.349560524	2.33417369	2.348260384	17.99155181	0	7.319197524	0.003830442	0.018642398	0.00467115	6.172043955	4.972792809	0.628297078	1.278527647	0	0.00033152	4.274112135	0.113033143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9957	200	12.06963353	20.2556	0.542000297	2.162011497	0.544624315	2.780598636	2.550763346	2.534058873	2.634727601	19.53224462	0.572383422	7.946228652	0.00399445	0.020238825	0.004871155	6.625812355	5.4992543	0.655198948	1.388013386	0	0.000476295	4.640122465	0.12271265	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0159	YES	$375 - days 1-5	$375 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	3.7711	0.1133	0.3686	0	0.6235	0.5529	0.5493	0.3736	4.2341	0	1.7225	0.0009	0.0041	0.0011	1.5825	1.1944	0.1479	0.3009	0	0.0001	0.6799	0.0266																			16.2473	200	0	24.0267	0.655317616	2.530646347	0.544624315	3.404139609	3.103699303	3.083373755	3.008290281	23.76630278	0.572383422	9.668698639	0.004895891	0.024341734	0.005970445	8.208311204	6.693611301	0.803059811	1.68889685	0	0.000555919	5.320050806	0.149313407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2632
H5162_013_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	627.8750797	18.86679653	359.187704	31.89474842	275.7954805	16.19019042	16.08416388	575.8355067	98.69592211	26.69694297	29.23380767	0.010660576	0.099613261	0.012812225	4205.43867	1694.15313	1.748009646	7.25957458	0	0.270363777	21.80254877	0.57659007																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	112.9376496	112.9376496	45.17505982	0	90.35011965	0.180700239	0.180700239	45.17505982	0.09035012	0	0.09035012	0.361400479	0.09035012	0.361400479	9.035011965	22.58752991	0.361400479	0.09035012	22.58752991	9.435863281	0.180700239	0.09035012																				5.9092	0.177564305	1.352193835	0	2.076512888	2.925571282	2.906412262	2.167783622	8.917188372	0	2.641278021	0.003852737	0.00900007	0.004630344	3.166349058	3.188894543	0.631731523	0.655903432	0	0.000212593	3.93972578	0.052094982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7261		4.349770208	5.9092	0.177564305	1.352193835	0	2.076512888	2.925571282	2.906412262	2.167783622	8.917188372	0	2.641278021	0.003852737	0.00900007	0.004630344	3.166349058	3.188894543	0.631731523	0.655903432	0	0.000212593	3.93972578	0.052094982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7261	YES	$200 - days 1-5	$200 - days 1-5	$75 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	50% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																			3000	0.647	0.0194	0.1255	0	0.1518	0.2168	0.2154	0.0169	1.0155	0	0.3008	0.0003	0.001	0.0003	0.3749	0.307	0.0468	0.0747	0	0	0.0307	0.0059																			3.5509		0	6.5563	0.197006661	1.477741064	0	2.228282648	3.142361842	3.1217831	2.184690963	9.932709097	0	2.942076037	0.004138233	0.01002503	0.004973462	3.541238492	3.495915834	0.678544065	0.730600018	0	0.000233061	3.97045315	0.058027741	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2771
H5162_014_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	615.0613026	18.48175987	351.8573427	31.24383519	270.1670013	15.85977837	15.75591564	564.0837616	96.68171962	26.1521074	28.63719935	0.010660576	0.097580337	0.012550751	4119.613391	1659.578577	1.712335979	7.111419997	0	0.275996355	21.35759879	0.564822926																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	130.6355851	130.6355851	43.54519502	0	130.6355851	0.17418078	0.17418078	43.54519502	0.130635585	0	0.130635585	0.34836156	0.130635585	0.34836156	13.06355851	26.12711701	0.34836156	0.130635585	26.12711701	10.47356914	0.17418078	0.130635585																				6.6957	0.201197959	1.276808051	0	2.941118689	2.762468568	2.744377676	2.046928117	12.63007301	0	3.741037292	0.003713735	0.012747464	0.004372199	4.484734212	3.613333639	0.596512033	0.929004512	0	0.000240889	3.720083218	0.073785973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4783		7.186047333	6.6957	0.201197959	1.276808051	0	2.941118689	2.762468568	2.744377676	2.046928117	12.63007301	0	3.741037292	0.003713735	0.012747464	0.004372199	4.484734212	3.613333639	0.596512033	0.929004512	0	0.000240889	3.720083218	0.073785973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4783	YES	$225 - days 1-5	$225 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$25 Copay	"$45 Copay, Chiropractor $25 Copay"	50% Coinsurance	20% Coinsurance	$45 Copay	$45 Copay	20% Coinsurance	20% Coinsurance																			3000	0.7159	0.0215	0.1231	0	0.2023	0.2095	0.2081	0.0193	1.0138	0	0.3003	0.0003	0.001	0.0003	0.4649	0.3405	0.0452	0.0746	0	0	0.0351	0.0059																			3.7816		0	7.4116	0.222708599	1.399879193	0	3.143378378	2.971973002	2.952510106	2.066230081	13.64384976	0	4.041318742	0.003995383	0.013770664	0.004703785	4.949655757	3.953867912	0.641751251	1.00357282	0	0.000263591	3.75516257	0.079708544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2599
H5162_801_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	637.937135	19.16914768	363.7747398	29.78779897	208.0798645	11.80905939	11.73172406	574.6617084	95.07409623	30.51884987	33.4897638	0.010660576	0.096372227	0.012351305	4138.507286	1667.189947	1.736648977	7.205165718	0	0.269635203	21.75370158	0.575298258																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	113.8080833	113.8080833	45.52323333	0	91.04646665	0.182092933	0.182092933	45.52323333	0.091046467	0	0.091046467	0.364185867	0.091046467	0.364185867	9.104646665	22.76161666	0.364185867	0.091046467	22.76161666	9.382538112	0.182092933	0.091046467																				6.0502	0.18180033	1.380016863	0	1.578744703	2.150346264	2.136264048	2.180038253	8.656160532	0	3.049124663	0.003882431	0.008774351	0.004498171	3.139970547	3.162328207	0.632463013	0.65600488	0	0.000210822	3.96119533	0.052378874	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9844		3.83373634	6.0502	0.18180033	1.380016863	0	1.578744703	2.150346264	2.136264048	2.180038253	8.656160532	0	3.049124663	0.003882431	0.008774351	0.004498171	3.139970547	3.162328207	0.632463013	0.65600488	0	0.000210822	3.96119533	0.052378874	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9844	YES	$200 - days 1-5	$200 - days 1-5	$75 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	50% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																			3000	0.6495	0.0195	0.1259	0	0.1481	0.1582	0.1572	0.016	0.9812	0	0.3456	0.0003	0.001	0.0003	0.3757	0.3073	0.0465	0.0744	0	0	0.029	0.0059																			3.4418		0	6.6997	0.201318405	1.505945633	0	1.726849408	2.308584631	2.29346614	2.195988638	9.637335328	0	3.394742591	0.004168129	0.009768922	0.004829179	3.515668207	3.469653886	0.679004314	0.730362958	0	0.00023131	3.990177662	0.058316013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4262
H5162_802_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	637.937135	19.16914768	363.7747398	29.78779897	208.0798645	11.80905939	11.73172406	574.6617084	95.07409623	30.51884987	33.4897638	0.010660576	0.096372227	0.012351305	4138.507286	1667.189947	1.736648977	7.205165718	0	0.269635203	21.75370158	0.575298258																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	131.2745342	131.2745342	43.75817808	0	131.2745342	0.175032712	0.175032712	43.75817808	0.131274534	0	0.131274534	0.350065425	0.131274534	0.350065425	13.12745342	26.25490685	0.350065425	0.131274534	26.25490685	10.82250298	0.175032712	0.131274534																				6.9787	0.209701744	1.326509987	0	2.276298941	2.066971695	2.053435483	2.095512448	12.4808077	0	4.396353145	0.003731899	0.012651219	0.004323765	4.527338471	3.647659731	0.607940762	0.945854774	0	0.000243177	3.80760939	0.075522011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5172		6.778023301	6.9787	0.209701744	1.326509987	0	2.276298941	2.066971695	2.053435483	2.095512448	12.4808077	0	4.396353145	0.003731899	0.012651219	0.004323765	4.527338471	3.647659731	0.607940762	0.945854774	0	0.000243177	3.80760939	0.075522011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5172	YES	$225 - days 1-5	$225 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$25 Copay	"$45 Copay, Chiropractor $25 Copay"	50% Coinsurance	20% Coinsurance	$45 Copay	$45 Copay	20% Coinsurance	20% Coinsurance																			3000	0.7194	0.0216	0.1236	0	0.1961	0.1561	0.1551	0.0191	0.9977	0	0.3515	0.0003	0.001	0.0003	0.4659	0.3412	0.0459	0.0756	0	0	0.0347	0.006																			3.7113		0	7.6981	0.231318957	1.450156873	0	2.472399848	2.223061573	2.208503158	2.114636775	13.47855102	0	4.747807319	0.004013718	0.013662586	0.004650279	4.993227656	3.988817365	0.653850147	1.021468492	0	0.000265921	3.84235887	0.081559407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.2285
H5206_002_0	2011	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	552.3652823		268.2583418		33.95177271	69.44751851		72.06735439	24.76621051	142.6766399					305.7300503						67.26742274	1.191080357																			6700	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																			YES	0.084423725		0.151735372		0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																			6700	46.6327	0	40.70427915	0	7.91076304	16.18127181	0	16.79169357	5.770527049	33.24365709	0	0	0	0	71.23510171	0	0	0	0	0	15.6733095	0.277521723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	254.4209	0	0	46.6327	0	40.70427915	0	7.91076304	16.18127181	0	16.79169357	5.770527049	33.24365709	0	0	0	0	71.23510171	0	0	0	0	0	15.6733095	0.277521723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	254.4209	NO																																																																																		0	0	0	46.6327	0	40.70427915	0	7.91076304	16.18127181	0	16.79169357	5.770527049	33.24365709	0	0	0	0	71.23510171	0	0	0	0	0	15.6733095	0.277521723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	254.4209
H5206_003_0	2011	9																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	617.2342107		289.4691532		81.41997801	38.33225581		31.85177647	20.34589729	205.145531					338.2784917						49.51633721	7.231537689																			6700	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																			YES	0.080820393		0.12715202		0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																			6700	49.8851	0	36.80658751	0	18.97085488	8.931415604	0	7.421463917	4.74059407	47.79890873	0	0	0	0	78.81888857	0	0	0	0	0	11.53730657	1.684948282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	266.5961	0	0	49.8851	0	36.80658751	0	18.97085488	8.931415604	0	7.421463917	4.74059407	47.79890873	0	0	0	0	78.81888857	0	0	0	0	0	11.53730657	1.684948282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	266.5961	NO																																																																																		0	0	0	49.8851	0	36.80658751	0	18.97085488	8.931415604	0	7.421463917	4.74059407	47.79890873	0	0	0	0	78.81888857	0	0	0	0	0	11.53730657	1.684948282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	266.5961
H5207_001_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	793.1294287	27.42408343	407.880072	0	42.84226269	43.41583728	32.40378369	27.92687444	58.15304995	19.31758317	48.59727142	0	21.4704966	140.3559591	71.82631907	72.56266138	5.767008718	9.712738424	30.21897548	142.238204	140.3034573	14.68511021	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;	Medicare-FFS Cost Sharing;																			0	0.078479118	0.078479118	0.154026126	0	0.233	0.233	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	0.078479118	0.078479118	0.154026126	0	0.233	0.233	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												62.2441	2.152217888	62.82418753	0	9.982247207	10.11589009	7.550081599	6.506961744	13.54966064	4.500996879	11.32316424	0	5.002625708	32.70293846	16.73553234	16.9071001	1.343713031	2.263068053	7.041021286	33.14150152	32.69070555	3.421630678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	341.9993	0	0	62.2441	2.152217888	62.82418753	0	9.982247207	10.11589009	7.550081599	6.506961744	13.54966064	4.500996879	11.32316424	0	5.002625708	32.70293846	16.73553234	16.9071001	1.343713031	2.263068053	7.041021286	33.14150152	32.69070555	3.421630678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	341.9993	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	62.2441	2.152217888	62.82418753	0	9.982247207	10.11589009	7.550081599	6.506961744	13.54966064	4.500996879	11.32316424	0	5.002625708	32.70293846	16.73553234	16.9071001	1.343713031	2.263068053	7.041021286	33.14150152	32.69070555	3.421630678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	341.9993
H5209_002_0	2011	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	601.4415374		354.2164895		57.76600572	81.66171768		24.55423983	51.14695817	139.3901355					489.7172908						44.75720202	6.594445612																			6700	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																				45.1968	0	50.5014122	0	13.45947933	19.02718022	0	5.72113788	11.91724125	32.47790157	0	0	0	0	114.1041288	0	0	0	0	0	10.42842807	1.536505828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	304.3702	0	0	45.1968	0	50.5014122	0	13.45947933	19.02718022	0	5.72113788	11.91724125	32.47790157	0	0	0	0	114.1041288	0	0	0	0	0	10.42842807	1.536505828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	304.3702	NO																																																																																		0	0	0	45.1968	0	50.5014122	0	13.45947933	19.02718022	0	5.72113788	11.91724125	32.47790157	0	0	0	0	114.1041288	0	0	0	0	0	10.42842807	1.536505828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	304.3702
H5211_001_0	2011	9																															D	D	D			Coin	Coin	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	YES	1023.841664	30.73898309	573.6389641	0	0	6.73972169	3.855835175	282.1286154	0	0	479.9460917	0	0	0	0	4900.276828	79.54359088	0	0	0	0	0	0	0	481.5754032	0	1.845721667	0	0	0											900	$50/Days 1-5 for IP Acute; PBP 1a	$50/Days 1-5 for IP Mental Health; PBP 1b	$100/Days Custom for SNF; PBP 2	No Cost Sharing;	No Cost Sharing;	20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosthetics/Supplies; PBP 11b	$50/Visit for OP ER; PBP 4a	No Cost Sharing;	No Cost Sharing;	"$100/Day for OP MRI, CT, PET Scans; PBP 8b"	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	"$20/Visit for Specialist excl. MH; PBP 7b, 7d, 7f, 7g"	"$20/Visit for Mental Health (MH); PBP 5, 7e, 7h, 9c"	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	$20/Exam for Routine Vision Exams; PBP 17a	No Cost Sharing;	$20/Exam for Routine Hearing Exams; PBP 18a	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;											0	50	50	100	0	0	0.2	0.2	50	0	0	100	0	0	0	0	20	20	0	0	0	0	0	0	0	20	0	20	0	0	0											NO	46.75396833	46.75396833	93.50793666	0	0	0.187015873	0.187015873	46.75396833	0	0	93.50793666	0	0	0	0	18.70158733	18.70158733	0	0	0	0	0	0	0	18.70158733	0	18.70158733	0	0	0												3.9891	0.11976412	4.469982993	0	0	1.260434938	0.721102383	1.099219362	0	0	3.739897396	0	0	0	0	7.63691292	0.123965951	0	0	0	0	0	0	0	0.750518705	0	0.002876494	0	0	0	0	0	0	0	0	0	0	0	0	0	23.9137	0	1.560346524	3.9891	0.11976412	4.469982993	0	0	1.260434938	0.721102383	1.099219362	0	0	3.739897396	0	0	0	0	7.63691292	0.123965951	0	0	0	0	0	0	0	0.750518705	0	0.002876494	0	0	0	0	0	0	0	0	0	0	0	0	0	23.9137	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.9891	0.11976412	4.469982993	0	0	1.260434938	0.721102383	1.099219362	0	0	3.739897396	0	0	0	0	7.63691292	0.123965951	0	0	0	0	0	0	0	0.750518705	0	0.002876494	0	0	0	0	0	0	0	0	0	0	0	0	0	23.9137
H5211_002_0	2011	10																															D	D	D		T	Coin	Coin	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	YES	472.7548983	14.19360565	281.8703192	0	47.35573534	3.580921677	2.048666754	196.953379	637.595335	0	493.2638376	0	0	0	0	4532.844332	73.57925435	0	0	0	0	0	0	0	464.8618456	0	3.13110959	0	0	0											3400	$300/Days 1-5 for IP Acute; PBP 1a	$300/Days 1-5 for IP Mental Health; PBP 1b	$100/Days Custom for SNF; PBP 2	No Cost Sharing;	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosthetics/Supplies; PBP 11b	$50/Visit for OP ER; PBP 4a	"$250/Case for OP Surgery (not including Colonoscopies); PBP 9a, 9b"	No Cost Sharing;	"$100/Day for OP MRI, CT, PET Scans; PBP 8b"	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	"$20/Visit for Specialist excl. MH; PBP 7b, 7d, 7f, 7g"	"$20/Visit for Mental Health (MH); PBP 5, 7e, 7h, 9c"	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	$20/Exam for Routine Vision Exams; PBP 17a	No Cost Sharing;	$20/Exam for Routine Hearing Exams; PBP 18a	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;											0	300	300	100	0	150	0.2	0.2	50	250	0	100	0	0	0	0	20	20	0	0	0	0	0	0	0	20	0	20	0	0	0											NO	293.5916336	293.5916336	97.86387785	0	146.7958168	0.195727756	0.195727756	48.93193893	244.6596946	0	97.86387785	0	0	0	0	19.57277557	19.57277557	0	0	0	0	0	0	0	19.57277557	0	19.57277557	0	0	0												11.5664	0.347260322	2.298743541	0	0.579301987	0.700885763	0.400980946	0.803109226	12.99949	0	4.022725996	0	0	0	0	7.393362068	0.120012519	0	0	0	0	0	0	0	0.758219715	0	0.005107042	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9956	0	0.895115102	11.5664	0.347260322	2.298743541	0	0.579301987	0.700885763	0.400980946	0.803109226	12.99949	0	4.022725996	0	0	0	0	7.393362068	0.120012519	0	0	0	0	0	0	0	0.758219715	0	0.005107042	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9956	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	11.5664	0.347260322	2.298743541	0	0.579301987	0.700885763	0.400980946	0.803109226	12.99949	0	4.022725996	0	0	0	0	7.393362068	0.120012519	0	0	0	0	0	0	0	0.758219715	0	0.005107042	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9956
H5211_003_0	2011	9																															D	D	D		T	Coin	Coin	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	YES	563.0806555	16.90547216	291.9890564	0	68.03654982	2.532224402	1.448700758	179.6612066	565.7414085	0	370.4816605	0	0	0	0	4104.414294	66.6247771	0	0	0	0	0	0	0	454.3258111	0	5.042524899	0	0	0											3400	$300/Days 1-5 for IP Acute; PBP 1a	$300/Days 1-5 for IP Mental Health; PBP 1b	$100/Days Custom for SNF; PBP 2	No Cost Sharing;	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosthetics/Supplies; PBP 11b	$50/Visit for OP ER; PBP 4a	"$250/Case for OP Surgery (not including Colonoscopies); PBP 9a, 9b"	No Cost Sharing;	"$100/Day for OP MRI, CT, PET Scans; PBP 8b"	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	"$20/Visit for Specialist excl. MH; PBP 7b, 7d, 7f, 7g"	"$20/Visit for Mental Health (MH); PBP 5, 7e, 7h, 9c"	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	$20/Exam for Routine Vision Exams; PBP 17a	No Cost Sharing;	$20/Exam for Routine Hearing Exams; PBP 18a	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;											0	300	300	100	0	150	0.2	0.2	50	250	0	100	0	0	0	0	20	20	0	0	0	0	0	0	0	20	0	20	0	0	0											NO	293.820396	293.820396	97.94013199	0	146.910198	0.195880264	0.195880264	48.970066	244.85033	0	97.94013199	0	0	0	0	19.5880264	19.5880264	0	0	0	0	0	0	0	19.5880264	0	19.5880264	0	0	0												13.787	0.413931044	2.38312056	0	0.832938584	0.496012784	0.283771887	0.733168429	11.54349755	0	3.023751894	0	0	0	0	6.699781294	0.108753991	0	0	0	0	0	0	0	0.741612165	0	0.008231093	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0556	0	0.843061702	13.787	0.413931044	2.38312056	0	0.832938584	0.496012784	0.283771887	0.733168429	11.54349755	0	3.023751894	0	0	0	0	6.699781294	0.108753991	0	0	0	0	0	0	0	0.741612165	0	0.008231093	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0556	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.787	0.413931044	2.38312056	0	0.832938584	0.496012784	0.283771887	0.733168429	11.54349755	0	3.023751894	0	0	0	0	6.699781294	0.108753991	0	0	0	0	0	0	0	0.741612165	0	0.008231093	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0556
H5211_004_0	2011	10																															D	D	D			Coin	Coin	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	YES	887.3679754	26.64160891	442.719319	0	0	7.748056854	4.432709765	270.6492632	0	0	516.0724274	0	0	0	0	5160.718622	83.77120419	0	0	0	0	0	0	0	512.2837168	0	1.51527437	0	0	0											900	$50/Days 1-5 for IP Acute; PBP 1a	$50/Days 1-5 for IP Mental Health; PBP 1b	$100/Days Custom for SNF; PBP 2	No Cost Sharing;	No Cost Sharing;	20% Coinsurance for DME; PBP 11a	20% Coinsurance for Prosthetics/Supplies; PBP 11b	$50/Visit for OP ER; PBP 4a	No Cost Sharing;	No Cost Sharing;	"$100/Day for OP MRI, CT, PET Scans; PBP 8b"	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	"$20/Visit for Specialist excl. MH; PBP 7b, 7d, 7f, 7g"	"$20/Visit for Mental Health (MH); PBP 5, 7e, 7h, 9c"	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;	$20/Exam for Routine Vision Exams; PBP 17a	No Cost Sharing;	$20/Exam for Routine Hearing Exams; PBP 18a	No Cost Sharing;	No Cost Sharing;	No Cost Sharing;											0	50	50	100	0	0	0.2	0.2	50	0	0	100	0	0	0	0	20	20	0	0	0	0	0	0	0	20	0	20	0	0	0											NO	46.83485878	46.83485878	93.66971756	0	0	0.187339435	0.187339435	46.83485878	0	0	93.66971756	0	0	0	0	18.73394351	18.73394351	0	0	0	0	0	0	0	18.73394351	0	18.73394351	0	0	0												3.4633	0.103979666	3.455782797	0	0	1.451516594	0.830421343	1.056318335	0	0	4.02836321	0	0	0	0	8.056717596	0.130780417	0	0	0	0	0	0	0	0.799757851	0	0.002365589	0	0	0	0	0	0	0	0	0	0	0	0	0	23.3793	0	1.486098557	3.4633	0.103979666	3.455782797	0	0	1.451516594	0.830421343	1.056318335	0	0	4.02836321	0	0	0	0	8.056717596	0.130780417	0	0	0	0	0	0	0	0.799757851	0	0.002365589	0	0	0	0	0	0	0	0	0	0	0	0	0	23.3793	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.4633	0.103979666	3.455782797	0	0	1.451516594	0.830421343	1.056318335	0	0	4.02836321	0	0	0	0	8.056717596	0.130780417	0	0	0	0	0	0	0	0.799757851	0	0.002365589	0	0	0	0	0	0	0	0	0	0	0	0	0	23.3793
H5211_005_0	2011	12																																																																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	0	0	0	0	0	0	0	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	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
H5211_006_0	2011	8																																																																							0	0	0	0	0	0	0	0	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	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	-4.44E-16	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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
H5214_003_0	2011	6	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1020.278548	71.558654	373.170328	398.120476	40.245869	7.80041	2.537339	302.132398	350.881762	551.109097	891.386208	52.649136	0.420716	7.109146	3104.616429	4281.190713	68.722464	834.25706		1821.771369	21.117345	0							4.91	0.41	840.025787	574.350313									4900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$195/Visit:9b. $0 Surgery ASC -- Physician,9b. $195 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $195 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$175/Visit:8b, 9a. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $175 Advanced Imaging -- FSR,8b. $175 Advanced Imaging -- Office,8b, 9a. $175 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$175/Visit:9d. $15 Cardiac Rehab,8b. $175 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	34.44565	0	150	0.2	0.2	50	195	58.243281	105.817118	50	0.2	0.2	15	35	35	15		0	0.2	0							0	0	0	68.885459									NO	129.149122	110.56967	29.089799	0	135.7203	0.18096	0.18096	45.2401	176.43639	52.698637	95.74354	45.2401	0.18096	0.18096	13.57203	31.66807	31.66807	13.57203		0	0.18096	0							0	0	0	62.327701										10.9807	0.659351397	0.90462082	0	0.455181785	1.411562194	0.459156865	1.139041658	5.15902595	2.420224854	7.112039255	0.198487681	0.076132767	1.28647106	3.511328943	11.29808727	0.181358983	0.943546821	0	0	3.821394751	0	0	0	0	0	0	0	0	0	0	2.983161215	0	0	0	0	0	0	0	0	55.0008	0	5.623321713	10.9807	0.659351397	0.90462082	0	0.455181785	1.411562194	0.459156865	1.139041658	5.15902595	2.420224854	7.112039255	0.198487681	0.076132767	1.28647106	3.511328943	11.29808727	0.181358983	0.943546821	0	0	3.821394751	0	0	0	0	0	0	0	0	0	0	2.983161215	0	0	0	0	0	0	0	0	55.0008	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$150/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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	30% Coins									7300	6.3887	0.1496	0.3945	4.032	2.2893	1.4628	0.4758	0.214	3.4181	0.3112	1.3779	0.2052	0.0146	0.37	1.9486	4.1882	0.0389	0.4969		0.4625	1.2247	0							0	0	0.2546	0.5747									30.2929	1000	9.508902414	17.3694	0.808954202	1.299070992	4.032018223	2.74452577	2.874369089	0.934982859	1.353049606	8.577143939	2.731455603	8.489937583	0.403731685	0.090730782	1.656486934	5.459932451	15.48625057	0.220268288	1.440406849	0	0.462491087	5.04608219	0	0	0	0	0	0	0	0	0	0.254601183	3.557856576	0	0	0	0	0	0	0	0	85.2938
H5214_004_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1185.631555	31.60045528	178.8646151	370.658186	31.86841452	8.658782678	2.448677453	329.4392561	409.304379	1479.907616	1109.60959	100.8103468	0.027458118	7.992606238	3400.011548	3532.585551	72.63118643	600.2030943		2160.564158	30.74480661	0							3.9	0.41	1269.656936	926.5643487									4900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	34.44565	0	150	0.2	0.2	50	175	51.645865	97.9671	50	0.2	0.2	15	35	35	15		0	0.2	0							0	0	0	72.1103									NO	127.847165	109.455014	29.317175	0	134.2857	0.179048	0.179048	44.7619	156.66665	46.235341	87.703871	44.7619	0.179048	0.179048	13.42857	31.33333	31.33333	13.42857		0	0.179048	0							0	0	0	64.555881										12.6316	0.28823569	0.436983769	0	0.356622696	1.550337721	0.438430801	1.228860586	5.343695491	5.702002771	8.109754696	0.376038555	0.004916321	1.431060162	3.804774423	9.223972401	0.189648078	0.671655772	0	0	5.504796134	0	0	0	0	0	0	0	0	0	0	4.984598153	0	0	0	0	0	0	0	0	62.278	0	7.042621891	12.6316	0.28823569	0.436983769	0	0.356622696	1.550337721	0.438430801	1.228860586	5.343695491	5.702002771	8.109754696	0.376038555	0.004916321	1.431060162	3.804774423	9.223972401	0.189648078	0.671655772	0	0	5.504796134	0	0	0	0	0	0	0	0	0	0	4.984598153	0	0	0	0	0	0	0	0	62.278	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$150/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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	30% Coins									7300	6.9219	0.0598	0.1685	2.2814	1.5625	1.3996	0.3958	0.2011	3.0933	0.4283	1.2282	0.1943	0.0008	0.3586	1.642	2.7984	0.0287	0.2519		0.5096	1.5604	0							0	0	0.3414	0.4426									25.869	500	8.619959874	19.5535	0.348057319	0.605514525	2.281441968	1.919095994	2.949888918	0.834219723	1.429987573	8.436971681	6.13030669	9.33792689	0.570294486	0.005737532	1.789613788	5.446769213	12.02235105	0.218312612	0.923594657	0	0.50955769	7.065211433	0	0	0	0	0	0	0	0	0	0.341425031	5.427204227	0	0	0	0	0	0	0	0	88.147
H5214_008_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1082.907281	67.907449	327.183277	560.873541	36.89607	8.128531	2.853754	326.717611	343.304197	1001.568532	922.695067	72.774124	0.377587	4.944071	3364.727156	3546.397175	84.225595	688.501978		1812.559949	18.913417	0							3.9	0.41	1206.581239	626.802432									3900	$175/Day(Days 1-7):1a.IP Acute	$175/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										125.7585	107.666825	34.44565	0	150	0.2	0.2	50	175	56.988071	94.655292	50	0.2	0.2	15	35	35	15		0	0.2	0							0	0	0	68.698733									NO	112.732938	96.515126	27.356115	0	132.49695	0.176663	0.176663	44.16565	154.579775	50.338304	83.61025	44.16565	0.176663	0.176663	13.249695	30.915955	30.915955	13.249695		0	0.176663	0							0	0	0	60.682484										10.1733	0.546174666	0.745871946	0	0.407384728	1.436010672	0.504152743	1.202474638	4.422323794	4.201438437	6.428897102	0.267843041	0.066705652	0.873434415	3.715134048	9.136687956	0.216992892	0.760203435	0	0	3.341300987	0	0	0	0	0	0	0	0	0	0	3.169660713	0	0	0	0	0	0	0	0	51.616	0	6.735821284	10.1733	0.546174666	0.745871946	0	0.407384728	1.436010672	0.504152743	1.202474638	4.422323794	4.201438437	6.428897102	0.267843041	0.066705652	0.873434415	3.715134048	9.136687956	0.216992892	0.760203435	0	0	3.341300987	0	0	0	0	0	0	0	0	0	0	3.169660713	0	0	0	0	0	0	0	0	51.616	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									5800	5.3335	0.108	0.277	2.8765	1.7729	1.5452	0.5425	0.1955	2.4632	0.292	1.0166	0.1723	0.0111	0.2174	1.5425	2.597	0.0356	0.282		0.3548	0.9216	0							0	0	0.3555	0.4001									23.3127	500	9.513258824	15.5068	0.654176425	1.022852709	2.876523841	2.1802686	2.981169991	1.046625337	1.397960597	6.88557063	4.493417954	7.445453868	0.44010152	0.077773085	1.090803899	5.257680751	11.73372221	0.252609165	1.042218572	0	0.354822979	4.262899573	0	0	0	0	0	0	0	0	0	0.35548435	3.569787573	0	0	0	0	0	0	0	0	74.9287
H5214_009_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1163.051411	72.933164	351.397556	602.38284	39.626686	8.491351	2.981132	350.897426	368.711558	1075.692918	990.982159	78.160014	0.394441	5.164751	3613.7449	3808.860008	90.458988	739.456841		1946.704434	19.757624	0		4.92					3.9	0.41	1295.878268	673.191017									3900	$175/Day(Days 1-5):1a.IP Acute	$175/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN750: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										108.3446	87.221925	34.44565	0	100	0.2	0.2	50	125	56.988071	71.22993	50	0.2	0.2	15	35	35	15		0	0.2	0		0					0	0	0	65.666512									NO	96.709365	77.855075	26.882488	0	87.6322	0.175264	0.175264	43.8161	109.54025	49.9399	62.420354	43.8161	0.175264	0.175264	13.14483	30.67127	30.67127	13.14483		0	0.175264	0		0					0	0	0	57.545009										9.3732	0.473184746	0.787203382	0	0.289381139	1.488228142	0.522485119	1.281246392	3.365729687	4.476666396	5.154788098	0.285388916	0.069131307	0.905194919	3.958505198	9.735214475	0.23120767	0.810002872	0	0	3.462800213	0	0	0	0	0	0	0	0	0	0	3.228231928	0	0	0	0	0	0	0	0	49.8978	0	6.94757949	9.3732	0.473184746	0.787203382	0	0.289381139	1.488228142	0.522485119	1.281246392	3.365729687	4.476666396	5.154788098	0.285388916	0.069131307	0.905194919	3.958505198	9.735214475	0.23120767	0.810002872	0	0	3.462800213	0	0	0	0	0	0	0	0	0	0	3.228231928	0	0	0	0	0	0	0	0	49.8978	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		30% Coins	20%-30% Coins	$0/Service		50%-55%					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	35% Coins	30% Coins									5800	5.3488	0.1083	0.2738	2.2766	0.9617	1.4268	0.5009	0.1591	1.9496	0.2311	0.8046	0.1363	0.0088	0.172	1.2209	2.0554	0.0282	0.2232		0.2808	0.7294	0		0					0	0	0.3282	0.3167									19.5412	0	9.702012725	14.722	0.581496284	1.060961708	2.276648329	1.251126098	2.91497891	1.023387214	1.440315725	5.315287123	4.707755903	5.95935059	0.42172406	0.07789069	1.077233735	5.179366322	11.79065862	0.259396435	1.03320592	0	0.280827601	4.192206645	0	0	0	0	0	0	0	0	0	0.328243044	3.544915666	0	0	0	0	0	0	0	0	69.4389
H5214_010_0	2011	6																															A	A	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	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	YES	223.077861	9.478817	367.044782	629.206078	41.391205	8.733028	10568.73476	366.522382	385.129751	1123.59197	1035.109165	81.640366	0.405667	803.811927	3774.659741	3978.463044	94.486996	772.383786		2033.388371	20.319957	0							3.9	0.41											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Day(Days 1-20) $0(Days 21-100):2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$0/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d												0	0	0	0	0	0.2	0	0	0	0	0	0	0.2	0	0	0	0	0		0	0.2	0							0	0											NO	0	0	0	0	0	0.19956	0	0	0	0	0	0	0.19956	0	0	0	0	0		0	0.19956	0							0	0												0	0	0	0	0	1.742763068	0	0	0	0	0	0	0.080954907	0	0	0	0	0	0	0	4.055050619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.8788	0	0.012961807	0	0	0	0	0	1.742763068	0	0	0	0	0	0	0.080954907	0	0	0	0	0	0	0	4.055050619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.8788	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		30% Coins	20%-30% Coins	30% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d											5100	4.9049	0.0993	0.241	3.046	0	1.6362	0.9509	0	2.6084	0.3092	1.0765	0.1824	0.0117	0.6539	1.6335	2.7501	0.0377	0.2986		0.3757	0.9759	0							0	0											21.7919	500	11.16312489	4.9049	0.099321867	0.2410423	3.046039258	0	3.378979806	0.950874017	0	2.608408312	0.309185699	1.076463151	0.182409619	0.092674509	0.653886261	1.633450136	2.750079885	0.037715131	0.298634192	0	0.375733053	5.030959412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.6707
H5214_011_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1016.314039	63.731489	307.063184	526.382696	34.627151	7.342233	2.577702	306.626154	322.19275	939.977205	865.954051	68.298889	0.341061	4.465817	3157.813697	3328.311941	79.046153	646.162639		1701.096811	17.083865	0			3.1				3.9	0.41	1132.382682	588.257298									3900	$175/Day(Days 1-7):1a.IP Acute	$175/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										125.7585	107.666825	34.44565	0	150	0.2	0.2	50	175	56.988071	94.655292	50	0.2	0.2	15	35	35	15		0	0.2	0			0				0	0	0	68.698733									NO	114.446271	97.981979	28.237855	0	134.2476	0.178997	0.178997	44.7492	156.6222	51.003412	84.714972	44.7492	0.178997	0.178997	13.42476	31.32444	31.32444	13.42476		0	0.178997	0			0				0	0	0	61.484267										9.6928	0.520378118	0.722567139	0	0.387384326	1.31423768	0.461400925	1.143439591	4.205211444	3.995170388	6.113272765	0.254693387	0.061048896	0.799367846	3.532740917	8.688125641	0.206339706	0.722881529	0	0	3.057960583	0	0	0	0	0	0	0	0	0	0	3.014047398	0	0	0	0	0	0	0	0	48.893	0	5.622200512	9.6928	0.520378118	0.722567139	0	0.387384326	1.31423768	0.461400925	1.143439591	4.205211444	3.995170388	6.113272765	0.254693387	0.061048896	0.799367846	3.532740917	8.688125641	0.206339706	0.722881529	0	0	3.057960583	0	0	0	0	0	0	0	0	0	0	3.014047398	0	0	0	0	0	0	0	0	48.893	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$150/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		30% Coins	20%-30% Coins	$0/Service			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	35% Coins	30% Coins									5800	5.1667	0.1046	0.2773	2.0568	1.3171	1.289	0.4525	0.1452	1.7613	0.2088	0.7269	0.1232	0.0079	0.1554	1.1029	1.8569	0.0255	0.2016		0.2537	0.659	0			0				0	0	0.2965	0.2861									18.4748	0	7.402176956	14.8595	0.625002075	0.999836514	2.056763944	1.704479974	2.603189609	0.913924513	1.28866834	5.966476058	4.203941021	6.8401286	0.377861127	0.068962314	0.95479069	4.635688655	10.5450503	0.231805752	0.924527165	0	0.253704672	3.716919135	0	0	0	0	0	0	0	0	0	0.296540466	3.300145475	0	0	0	0	0	0	0	0	67.3679
H5214_012_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1171.956599	73.491594	354.088118	606.995132	39.930097	9.565113	3.358106	353.584158	371.534689	1083.929225	998.569859	78.758465	0.444319	5.817853	3641.414425	3838.023481	91.151609	745.118673		1961.609854	22.256049	0			3.1				3.9	0.41	1305.800478	678.345469									3900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	34.44565	0	150	0.2	0.2	50	175	56.988071	94.655292	50	0.2	0.2	15	35	35	15		0	0.2	0			0				0	0	0	68.698733									NO	119.643762	102.431756	24.796115	0	127.2789	0.169705	0.169705	42.4263	148.49205	48.35586	80.317477	42.4263	0.169705	0.169705	12.72789	29.69841	29.69841	12.72789		0	0.169705	0			0				0	0	0	58.292661										11.6848	0.627322752	0.731667475	0	0.423521569	1.623247502	0.569887379	1.25010563	4.597495635	4.367860821	6.683550974	0.278452522	0.075403156	0.987318743	3.86229352	9.498599577	0.225588155	0.790315709	0	0	3.776962796	0	0	0	0	0	0	0	0	0	0	3.295213539	0	0	0	0	0	0	0	0	55.3496	0	9.94518136	11.6848	0.627322752	0.731667475	0	0.423521569	1.623247502	0.569887379	1.25010563	4.597495635	4.367860821	6.683550974	0.278452522	0.075403156	0.987318743	3.86229352	9.498599577	0.225588155	0.790315709	0	0	3.776962796	0	0	0	0	0	0	0	0	0	0	3.295213539	0	0	0	0	0	0	0	0	55.3496	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$150/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		30% Coins	20%-30% Coins	$0/Service			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	35% Coins	30% Coins									5800	5.3682	0.1087	0.2645	2.4475	1.3873	1.5338	0.5385	0.153	2.0959	0.2484	0.8649	0.1466	0.0094	0.185	1.3125	2.2097	0.0303	0.24		0.3019	0.7842	0			0				0	0	0.3529	0.3405									20.9236	0	12.50011328	17.053	0.7360275	0.99614616	2.447523873	1.810856878	3.157084027	1.108385003	1.403079313	6.693378294	4.616294964	7.548500409	0.425020438	0.084819919	1.172269996	5.174787476	11.70831704	0.255892862	1.030271597	0	0.301905313	4.561115452	0	0	0	0	0	0	0	0	0	0.352879286	3.635666249	0	0	0	0	0	0	0	0	76.2732
H5214_013_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1175.069151	73.686778	355.028526	608.607226	40.036146	8.516733	2.990042	354.523228	372.521432	1086.807988	1001.22192	78.967636	0.395619	5.180189	3651.08551	3848.216731	91.393695	747.097604		1966.819614	19.81668	0			1.82				3.9	0.41	1309.2685	680.14706									3900	$175/Day(Days 1-5):1a.IP Acute	$175/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"			"VIS742: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										108.3446	87.221925	34.44565	0	150	0.2	0.2	50	175	56.988071	94.655292	50	0.2	0.2	15	35	35	15		0	0.2	0			0				0	0	0	68.698733									NO	95.11009	76.567592	26.052898	0	129.3315	0.172442	0.172442	43.1105	150.88675	49.135685	81.61274	43.1105	0.172442	0.172442	12.93315	30.17735	30.17735	12.93315		0	0.172442	0			0				0	0	0	59.232735										9.3134	0.470168263	0.770793498	0	0.431494568	1.468642472	0.515608823	1.273639468	4.684045682	4.450087913	6.80937202	0.283694523	0.068221332	0.893282152	3.935003047	9.677415264	0.22983496	0.805193781	0	0	3.417227933	0	0	0	0	0	0	0	0	0	0	3.357247547	0	0	0	0	0	0	0	0	52.8544	0	8.369660074	9.3134	0.470168263	0.770793498	0	0.431494568	1.468642472	0.515608823	1.273639468	4.684045682	4.450087913	6.80937202	0.283694523	0.068221332	0.893282152	3.935003047	9.677415264	0.22983496	0.805193781	0	0	3.417227933	0	0	0	0	0	0	0	0	0	0	3.357247547	0	0	0	0	0	0	0	0	52.8544	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 7-100)	30% Coins	$150/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		30% Coins	20%-30% Coins	$0/Service			"VIS742: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	35% Coins	30% Coins									5800	5.2976	0.1073	0.2705	2.2666	1.4467	1.4204	0.4987	0.1595	1.9409	0.2301	0.801	0.1357	0.0087	0.1713	1.2154	2.0463	0.0281	0.2222		0.2796	0.7262	0			0				0	0	0.3268	0.3153									19.9149	0	10.09433324	14.611	0.577442964	1.041292118	2.266552548	1.87823074	2.889066388	1.014289617	1.43316295	6.624957594	4.680152597	7.610366088	0.419425386	0.076941755	1.064558018	5.150450391	11.72374455	0.257898779	1.027407396	0	0.279582298	4.143400184	0	0	0	0	0	0	0	0	0	0.326787187	3.672527268	0	0	0	0	0	0	0	0	72.7692
H5215_001_0	2011	5																																	D		T	Coin	Coin	V	V	P	P			V	V	V	V	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	YES	0	0	976.3688367	0	3.985994612	10.52310195	0.991394431	290.3825233	340.0112817	2264.896001	876.5284451	0	0	1356.928257	4813.946702	2076.055213	36.68882861	205.8564668	226.680237	43.92215855	9.414354661	0	0	0	0	0	0	0	0	0											2500	1A IP Acute: $0 Per Day	1B IP Psych: $0 Per Day	2 SNF: $50 / Day for Days 1 - 100	6 Home Health: $0	10A Ambulance: $50	"11A DME: 15%, 11C Diabetes Monitoring Supplies: $10"	11B Prosthetics/Medical Supplies: 15%	"4A ER: $50, 4B Urgent Care: $10"	"9A OP Hospital: $30, 9B ASC Services: $30"	8A OP Diagnostic Procedures/Tests: $3	8B OP Radiology: min 15.00/ max 50.00		12 Renal Dialysis: $10	"3 CORF: $10, 5 Partial Hosp: $10, 9C OP Substance Abuse: $10, 9D Cardiac Rehab: $10"	"7A PCP: $10, 7D: Physician Specialist: $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: $0"	"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): $15"	"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: 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, 13E Other 1 Copay $0"											0	0	0	50	0	50	0.126723533	0.15	45.85470679	30	3	22.70315239	0	0	10	15.09137859	20	20	20	20	20	0.1	0	0	0	0	0	0	0	0	0											NO	0	0	49.63226316	0	49.63226316	0.125791515	0.148896789	45.51745749	29.7793579	2.97793579	22.53617668	0	0	9.926452632	14.98038548	19.85290526	19.85290526	19.85290526	19.85290526	19.85290526	0.099264526	0	0	0	0	0	0	0	0	0												0	0	4.03828292	0	0.016486161	1.323716938	0.147615448	1.10145618	0.843776471	0.562059572	1.646133326	0	0	1.122457005	6.009564772	3.434643956	0.06069832	0.340570744	0.375021772	0.072665204	0.934511456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.0297	0	0.163222814	0	0	4.03828292	0	0.016486161	1.323716938	0.147615448	1.10145618	0.843776471	0.562059572	1.646133326	0	0	1.122457005	6.009564772	3.434643956	0.06069832	0.340570744	0.375021772	0.072665204	0.934511456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.0297	YES	1A IP Acute: $100 Per Day for Days 1-7	1B IP Psych: $150 Per Day for Days 1-7	2 SNF: $100 / Day for Days 1 - 100	6 Home Health: $40	10A Ambulance: $50	"11A DME: 25%, 11C Diabetes Monitoring Supplies: 20%"	11B Prosthetics/Medical Supplies: 25%	"4A ER: $50, 4B Urgent Care: $40"	"9A OP Hospital: $100, 9B ASC Services: $100"	8A OP Diagnostic Procedures/Tests: $35	8B OP Radiology: min 35.00/ max 125.00 or 10% coinsurance		12 Renal Dialysis: $40	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, 9D Cardiac Rehab: $40"	"7A PCP: $35, 7D: Physician Specialist: $45, 14B Immunizations: $0, 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: $0, 14J Nutrition Therapy: $40"	"7B Chiropractic: $45, 7D Physician Specialist (excl. Radiology): $45, 7F Podiatry: $45, 16B Comprehensive Dental (Medicare Covered): $45, 17A Routine Eye Exams (Medicare Covered): $45, 17B Eye Wear (Medicare Covered): $45"	"7E Mental Health: $40, 7H Psychiatric: $40"	"7C Occupational Therapy: $45, 7I Physical and Speech Therapy: $45"	7D Physician Specialist (Radiology): $45	"7G Other Health Care: $45, 18A Hearing Exams (Medicare Covered): $45"	15 Part B Drugs: 20%	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): $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, 13E Other 1 Copay $35"											3000	1.1075	0.0689	1.3201	0.1015	0.5244	0.8388	0.042	0.2051	0.5552	0.8429	0.6053	0	0	0.4819	3.7878	2.511	0.1338	0.4183	0.561	0.1093	0.2665	0.0554	0	0	0	0	0	0	0	0											14.5366	0	0.295350345	1.1075	0.068858814	5.358347389	0.101527473	0.540848722	2.162561194	0.189588532	1.306556043	1.398953576	1.404967249	2.251425201	0	0	1.604347178	9.79736299	5.945622512	0.194531773	0.758848541	0.93600431	0.181937437	1.201057774	0.055409281	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5662
H5215_002_0	2011	7																																	D		T	Coin	Coin	V	V	P	P			V	V	V	V	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	YES	0	0	600.8519829	0	4.467874176	13.72709337	0.316303528	240.0468063	336.7955136	2551.635438	988.4852124	0	0	1736.864254	4941.239569	2074.097875	99.39736401	223.4018393	245.3782096	55.62434981	10.29833368	0	0	0	0	0	0	0	0	0											2500	1A IP Acute: $0 Per Day	1B IP Psych: $0 Per Day	2 SNF: $50 / Day for Days 1 - 100	6 Home Health: $0	10A Ambulance: $50	"11A DME: 15%, 11C Diabetes Monitoring Supplies: $10"	11B Prosthetics/Medical Supplies: 15%	"4A ER: $50, 4B Urgent Care: $10"	"9A OP Hospital: $30, 9B ASC Services: $30"	8A OP Diagnostic Procedures/Tests: $3	8B OP Radiology: min 15.00/ max 50.00		12 Renal Dialysis: $10	"3 CORF: $10, 5 Partial Hosp: $10, 9C OP Substance Abuse: $10, 9D Cardiac Rehab: $10"	"7A PCP: $10, 7D: Physician Specialist: $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: $0"	"7B Chiropractic: $25, 7D Physician Specialist (excl. Radiology): $25, 7F Podiatry: $25, 16B Comprehensive Dental (Medicare Covered): $25, 17A Routine Eye Exams (Medicare Covered): $25, 17B Eye Wear (Medicare Covered): $15"	"7E Mental Health: $25, 7H Psychiatric: $25"	"7C Occupational Therapy: $25, 7I Physical and Speech Therapy: $25"	7D Physician Specialist (Radiology): $25	"7G Other Health Care: $25, 18A Hearing Exams (Medicare Covered): $25"	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, 13E Other 1 Copay $0"											0	0	0	50	0	50	0.1163674	0.15	48.19589112	30	3	20.18780275	0	0	10	17.59563376	25	25	25	25	25	0.1	0	0	0	0	0	0	0	0	0											NO	0	0	49.62626725	0	49.62626725	0.115497594	0.148878802	47.83564346	29.77576035	2.977576035	20.03690589	0	0	9.92525345	17.46411247	24.81313362	24.81313362	24.81313362	24.81313362	24.81313362	0.099252534	0	0	0	0	0	0	0	0	0												0	0	2.484836756	0	0.018476993	1.585446254	0.04709089	0.956899454	0.835695208	0.633140711	1.650515431	0	0	1.436568161	7.191196965	4.288738978	0.205530006	0.461941641	0.507383525	0.115017869	1.022135719	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.4406	0	0.176530009	0	0	2.484836756	0	0.018476993	1.585446254	0.04709089	0.956899454	0.835695208	0.633140711	1.650515431	0	0	1.436568161	7.191196965	4.288738978	0.205530006	0.461941641	0.507383525	0.115017869	1.022135719	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.4406	YES	1A IP Acute: $100 Per Day for Days 1-7	1B IP Psych: $150 Per Day for Days 1-7	2 SNF: $100 / Day for Days 1 - 100	6 Home Health: $40	10A Ambulance: $50	"11A DME: 25%, 11C Diabetes Monitoring Supplies: 20%"	11B Prosthetics/Medical Supplies: 25%	"4A ER: $50, 4B Urgent Care: $40"	"9A OP Hospital: $100, 9B ASC Services: $100"	8A OP Diagnostic Procedures/Tests: $35	8B OP Radiology: min 35.00/ max 125.00 or 10% coinsurance		12 Renal Dialysis: $40	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, 9D Cardiac Rehab: $40"	"7A PCP: $35, 7D: Physician Specialist: $45, 14B Immunizations: $0, 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: $0, 14J Nutrition Therapy: $40"	"7B Chiropractic: $45, 7D Physician Specialist (excl. Radiology): $45, 7F Podiatry: $45, 16B Comprehensive Dental (Medicare Covered): $45, 17A Routine Eye Exams (Medicare Covered): $45, 17B Eye Wear (Medicare Covered): $45"	"7E Mental Health: $40, 7H Psychiatric: $40"	"7C Occupational Therapy: $45, 7I Physical and Speech Therapy: $45"	7D Physician Specialist (Radiology): $45	"7G Other Health Care: $45, 18A Hearing Exams (Medicare Covered): $45"	15 Part B Drugs: 20%	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): $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, 13E Other 1 Copay $35"											3000	0.8102	0.0451	1.3214	0.1137	0.4357	0.5221	0.031	0.1893	0.6616	0.7747	0.6733	0	0	0.5695	3.2269	2.4721	0.2133	0.524	0.5593	0.0787	0.2729	0.0536	0	0	0	0	0	0	0	0											13.5485	0	0.326322776	0.8102	0.04513372	3.806259971	0.113665461	0.454162152	2.107568804	0.078064435	1.146244531	1.49732981	1.407823279	2.323824683	0	0	2.00604808	10.41807378	6.760831224	0.418838732	0.985921296	1.066731333	0.193687679	1.295045189	0.053634461	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9891
H5215_005_0	2011	8																																	D		T			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	YES	0	0	998.186293	0	22.46165783	0	0	286.5478982	0	0	0	0	0	0	3260.130217	2760.851356	0	0	0	0	42.79655371	0	0	0	0	0	0	0	0	0											1250	1A IP Acute: $0 Per Day	1B IP Psych: $0 Per Day	2 SNF: $35 per Day for Days 1-100	6 Home Health: $0	10A Ambulance: $50	"11A DME: 0%, 11C Diabetes Monitoring Supplies: $0"	11B Prosthetics/Medical Supplies: 0%	"4A ER: $50, 4B Urgent Care: $0"	"9A OP Hospital: $0, 9B ASC Services: $0"	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0		12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 7D Physician Specialist: $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: $0"	"7B Chiropractic: $10, 7D Physician Specialist (excl. Radiology): $10"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7F Podiatry: $0, 7G Other Health Care: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Eye Exams (Medicare Covered): $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 10%	"13A Blood: $0, 17B Eyewear (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): $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, 13E Other 1 Copay $0"											0	0	0	35	0	50	0	0	50	0	0	0	0	0	0	10	10	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0											NO	0	0	33.20235895	0	47.43194136	0	0	47.43194136	0	0	0	0	0	0	9.486388272	9.486388272	0	0	0	0	0.094863883	0	0	0	0	0	0	0	0	0												0	0	2.761844967	0	0.088783336	0	0	1.132626925	0	0	0	0	0	0	2.577238422	2.182542327	0	0	0	0	4.059847252	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.8029	0	0.693173291	0	0	2.761844967	0	0.088783336	0	0	1.132626925	0	0	0	0	0	0	2.577238422	2.182542327	0	0	0	0	4.059847252	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.8029	YES	1A IP Acute: 100 Per Day for days 1-7	1B IP Psych: 150 Per Day for days 1-7	2 SNF: $100 per Day for Days 1-100	6 Home Health: $40	10A Ambulance: $50	"11A DME: 20%, 11C Diabetes Monitoring Supplies: 10%"	11B Prosthetics/Medical Supplies: 20%	"4A ER: $50, 4B Urgent Care: $40"	"9A OP Hospital: $100, 9B ASC Services: $100"	8A OP Diagnostic Procedures/Tests: $30	8B OP Radiology: $30 min / $50 max		12 Renal Dialysis: $35	"3 CORF: $35, 5 Partial Hosp: $35, 9C OP Substance Abuse: $35, 9D Cardiac Rehab: $35"	"7A PCP: $30, 7D Physician Specialist: $35, 14B Immunizations: $0, 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: $35, 7D Physician Specialist (excl. Radiology): $35, 7F Podiatry: $35, 16B Comprehensive Dental (Medicare Covered): $30, 17A Routine Eye Exams (Medicare Covered): $35, 17B Eye Wear (Medicare Covered): $35"	"7E Mental Health: $35, 7H Psychiatric: $35"	"7C Occupational Therapy: $35, 7I Physical and Speech Therapy: $35"	7D Physician Specialist (Radiology): $35	"7F Podiatry: $35, 7G Other Health Care: $35, 16B Comprehensive Dental (Medicare Covered): $30, 17A Eye Exams (Medicare Covered): $35, 18A Hearing Exams (Medicare Covered): $35"	15 Part B Drugs: 20%	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): $35	17B Eye Wear (non Medicare Covered): $100 allowance	18A Routine Hearing Exams (Non Medicare Covered): $35	18B Hearing Aids (Non Medicare Covered): $100 allowance	14A Health Education/Wellness Program: 50%	"13B Acupuncture: Not Covered, 13E Other 1 Copay: $35"											2500	0.5055	0.0321	1.4067	0.1237	1.3009	0.5762	0.0182	0.1343	0.4019	0.8272	0.416	0	0	0.3937	2.4173	1.5815	0.2415	0.4951	0.3088	0.0747	0.3604	0.0039	0	0	0.1202	0	0.0175	0	0	0											11.7576	0	2.450032828	0.5055	0.032087802	4.16855238	0.123696078	1.389724877	0.576245042	0.018210817	1.26694836	0.401915214	0.827243887	0.416045672	0	0	0.393724985	4.994526886	3.764039596	0.241537259	0.495112982	0.308763966	0.074747567	4.420247996	0.00385879	0	0	0.120189484	0	0.017546516	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5605
H5215_006_0	2011	7																																	D		T			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	YES	0	0	1748.255974	0	32.03942601	0	0	354.5205453	0	0	0	0	0	0	3340.138778	2643.929608	0	0	0	0	28.10851779	0	0	0	0	0	0	0	0	0											1250	1A IP Acute: $0 Per Day	1B IP Psych: $0 Per Day	2 SNF: $25 per Day for Days 1-100	6 Home Health: $0	10A Ambulance: $50	"11A DME: 0%, 11C Diabetes Monitoring Supplies: $0"	11B Prosthetics/Medical Supplies: 0%	"4A ER: $50, 4B Urgent Care: $0"	"9A OP Hospital: $0, 9B ASC Services: $0"	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0		12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 7D Physician Specialist: $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: $0"	"7B Chiropractic: $10, 7D Physician Specialist (excl. Radiology): $10"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7F Podiatry: $0, 7G Other Health Care: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Eye Exams (Medicare Covered): $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 10%	"13A Blood: $0, 17B Eyewear (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 copay	17B Eye Wear (non Medicare Covered): $125 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, 13E Other 1 Copay $0"											0	0	0	25	0	50	0	0	50	0	0	0	0	0	0	10	10	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0											NO	0	0	23.89061056	0	47.78122113	0	0	47.78122113	0	0	0	0	0	0	9.556244226	9.556244226	0	0	0	0	0.095562442	0	0	0	0	0	0	0	0	0												0	0	3.480575219	0	0.127573575	0	0	1.411618714	0	0	0	0	0	0	2.659931826	2.105503088	0	0	0	0	2.686118608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.4713	0	0.579120896	0	0	3.480575219	0	0.127573575	0	0	1.411618714	0	0	0	0	0	0	2.659931826	2.105503088	0	0	0	0	2.686118608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.4713	YES	1A IP Acute: 100 Per Day for days 1-7	1B IP Psych: 150 Per Day for days 1-7	2 SNF: $100 per Day for Days 1-100	6 Home Health: $40	10A Ambulance: $50	"11A DME: 20%, 11C Diabetes Monitoring Supplies: 10%"	11B Prosthetics/Medical Supplies: 20%	"4A ER: $50, 4B Urgent Care: $40"	"9A OP Hospital: $100, 9B ASC Services: $100"	8A OP Diagnostic Procedures/Tests: $30	8B OP Radiology: $30 min / $50 max		12 Renal Dialysis: $35	"3 CORF: $35, 5 Partial Hosp: $35, 9C OP Substance Abuse: $35, 9D Cardiac Rehab: $35"	"7A PCP: $30, 7D Physician Specialist: $35, 14B Immunizations: $0, 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: $35, 7D Physician Specialist (excl. Radiology): $35, 7F Podiatry: $35, 16B Comprehensive Dental (Medicare Covered): $30, 17A Routine Eye Exams (Medicare Covered): $35, 17B Eye Wear (Medicare Covered): $35"	"7E Mental Health: $35, 7H Psychiatric: $35"	"7C Occupational Therapy: $35, 7I Physical and Speech Therapy: $35"	7D Physician Specialist (Radiology): $35	"7F Podiatry: $35, 7G Other Health Care: $35, 16B Comprehensive Dental (Medicare Covered): $30, 17A Eye Exams (Medicare Covered): $35, 18A Hearing Exams (Medicare Covered): $35"	15 Part B Drugs: 20%	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): $35	17B Eye Wear (non Medicare Covered): $125 allowance	18A Routine Hearing Exams (Non Medicare Covered): $35	18B Hearing Aids (Non Medicare Covered): $100 allowance	14A Health Education/Wellness Program: 50%	"13B Acupuncture: Not Covered, 13E Other 1 Copay: $35"											2500	0.3713	0.0236	2.655	0.1718	1.5798	0.4482	0.0252	0.1249	0.3545	0.6382	0.2608	0	0	0.4643	2.0261	1.3148	0.0809	0.4397	0.2154	0.0684	0.2263	0.0118	0	0	0.1111	0	0.0215	0	0	0											11.6338	0	2.923306657	0.3713	0.023573885	6.135608873	0.171800869	1.707357937	0.448201481	0.025194709	1.53650881	0.354544333	0.638186797	0.260817407	0	0	0.46429695	4.686012203	3.420328497	0.080935411	0.439749068	0.215379048	0.068416032	2.912413531	0.011831493	0	0	0.111067274	0	0.021543215	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1051
H5215_007_0	2011	8																															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	261.2197868	15.04378941	122.3475881	0	7.283514074	19.69198207	6.598919844	38.3848255	47.53778088	17.33769989	31.95087331	0	3.133326485	59.54281866	41.9699414	54.45165947	4.82601628	2.624334953	11.68469226	27.22673894	52.87020105	20.13951693	0	43.83471322	0	0	0	0	0	0											4000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	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	"16A & 16B: Preventive 0%, Basic 20%, Major 50%"	17A: No Cost Sharing	17B Eye Wear (non Medicare Covered): $125 allowance	Non Covered	Non Covered	14A: No Cost Sharing	13E: No Cost Sharing											0	0.084423725	0.084423725	0.151735372	0	0.233	0.233	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	0.25	0	0	0	0	0	0											NO	0.070619409	0.070619409	0.126924775	0	0.194901639	0.194901639	0.194901639	0.194901639	0.194901639	0.194901639	0.194901639	0	0.194901639	0.194901639	0.194901639	0.194901639	0.194901639	0.194901639	0.194901639	0.194901639	0.194901639	0.194901639	0	0.20912193	0	0	0	0	0	0												18.4472	1.062383521	15.52894012	0	1.419568832	3.837999584	1.286140295	7.48126541	9.265191418	3.379146129	6.227277583	0	0.610690468	11.60499296	8.180010376	10.61271769	0.940598484	0.511487184	2.277365675	5.30653605	10.30448885	3.925224863	0	9.166799852	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.376	0	25.68070099	18.4472	1.062383521	15.52894012	0	1.419568832	3.837999584	1.286140295	7.48126541	9.265191418	3.379146129	6.227277583	0	0.610690468	11.60499296	8.180010376	10.61271769	0.940598484	0.511487184	2.277365675	5.30653605	10.30448885	3.925224863	0	9.166799852	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.376	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	Medicare FFS Cost Sharing	Non Covered	"16A & 16B: Preventive 0%, Basic 20%, Major 50%"	17A: No Cost Sharing	17B Eye Wear (non Medicare Covered): $125 allowance	Non Covered	Non Covered	14A: No Cost Sharing	13E: No Cost Sharing											10000	7.7124	0.7465	7.833	0	3.0069	2.8287	0.7467	2.3782	4.948	1.042	2.0458	0	0.2737	3.4862	3.8095	4.2362	0.9997	1.8175	1.2207	2.3252	3.0677	1.6768	0	0	0	0	0	0	0	0											56.2016	0	4.496032416	26.1596	1.808926544	23.36193929	0	4.426480807	6.666694734	2.032850358	9.859454167	14.21315032	4.421117608	8.273120642	0	0.88441033	15.09121642	11.98952509	14.84891288	1.940295252	2.329030303	3.498096923	7.631737171	13.37219886	5.602010027	0	9.166799852	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	187.5776
H5215_008_0	2011	9																															D		D	V	T	Coin	Coin	V	V		V			V	V	V	V	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	NO	337.0943063	0	283.9960903	58.61745389	3.12674584	6.244173959	0.0350044	135.4547051	250.5611421	0	562.4677966	0	0	539.8066163	3585.858388	1723.959237	61.95753492	220.2371003	148.2754341	40.29076855	4.333029604	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: $75 per Day for days 1-100	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%	"8B OP Radiology: x-rays:  5%, Therapeutic Radiological services:  5%, CAT, PET, MRI, MRA, and NUC:  $60"		12 Renal Dialysis: $20	"3 CORF: $30, 5 Partial Hosp: $25, 9C OP Substance Abuse: $30, 9D Cardiac Rehab: $30"	"7A PCP: $15, 7D Physician Specialist: $30, 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, 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): $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, 13E Other 1 Copay $0"											0	175	0	75	10	75	0.19278877	0.2	50	100	0	19.62439117	0	0	30	19.53511916	30	30	30	30	30	0.2	0	0	0	0	0	0	0	0	0											NO	168.7677237	0	72.32902443	9.643869924	72.32902443	0.185922982	0.192877398	48.21934962	96.43869924	0	18.92550758	0	0	28.93160977	18.83941482	28.93160977	28.93160977	28.93160977	28.93160977	28.93160977	0.192877398	0	0	0	0	0	0	0	0	0												4.7409	0	1.711763346	0.047108258	0.018846206	1.160935444	0.006751558	0.544294815	2.013649219	0	0.887082379	0	0	1.301456198	5.629622803	4.156409659	0.149377602	0.530984487	0.35748725	0.097139733	0.835743478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1895	0	0.893274425	4.7409	0	1.711763346	0.047108258	0.018846206	1.160935444	0.006751558	0.544294815	2.013649219	0	0.887082379	0	0	1.301456198	5.629622803	4.156409659	0.149377602	0.530984487	0.35748725	0.097139733	0.835743478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1895	YES	1A IP Acute: $215 Per Day for days 1-7	1B IP Psych: $300 Per Day for days 1-7	2 SNF: $100/day for days 1-100	6 Home Health: $40	10A Ambulance: $75	"11A DME: 30%, 11C Diabetes Monitoring Supplies: $50"	11B Prosthetics/Medical Supplies: 30%	"4A ER: $50, 4B Urgent Care: $50"	"9A OP Hospital: $215, 9B ASC Services: $215"	8A OP Diagnostic Procedures/Tests: $25	"8B OP Radiology: 10%, $125 copay"		12 Renal Dialysis: $50	"3 CORF: $55, 5 Partial Hosp: $50, 9C OP Substance Abuse: $55, 9D Cardiac Rehab: $55"	"7A PCP: $35, 7D Physician Specialist: $55, 14B Immunizations: $20, 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: $20"	"7B Chiropractic: $55, 7D Physician Specialist (excl. Radiology): $55, 7F Podiatry: $55, 16B Comprehensive Dental (Medicare Covered): $55, 17A Routine Eye Exams (Medicare Covered): $55, 17B Eye Wear (Medicare Covered): $55"	"7E Mental Health: $40, 7H Psychiatric: $40"	"7C Occupational Therapy: $55, 7I Physical and Speech Therapy: $55"	7D Physician Specialist (Radiology): $55	"7G Other Health Care: $55, 18A Hearing Exams (Medicare Covered): $55"	15 Part B Drugs: 30%	13A Blood: $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): 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, 13E Other 1 Copay: $50"											2900	1.8089	0.1012	0.8522	0.1617	0.3428	0.4953	0.0307	0.2555	1.5411	0.6614	0.5524	0	0	0.5432	3.6986	2.4317	0.1677	0.3885	0.4546	0.0798	0.4097	0.0047	0	0	0	0	0	0	0	0											14.982	0	0.55325547	6.5498	0.101233011	2.564007546	0.208850018	0.361635139	1.656214577	0.037476926	0.79981209	3.554766106	0.661443702	1.439518025	0	0	1.844659043	9.328212418	6.588098709	0.317030903	0.919524538	0.81213244	0.17696797	1.245400423	0.004689559	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1715
H5215_806_0	2011	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	186.3261207	0.763814204	54.51180241	0	0.364167373	19.42961072	0.721790128	19.19569469	50.37376931	14.48058388	29.06950974	0	0	25.84547219	49.72347255	64.68987291	0.892679988	1.515403238	13.37002444	8.11839022	47.73219578	1.951485954	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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, 11c"	Medicare-FFS Cost Sharing; PBP 11b	"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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-j"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 16b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7g, 18a"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 17b"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.084423725	0.084423725	0.151735372	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	0.072843358	0.072843358	0.130921895	0	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0	0	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0	0	0	0	0	0	0	0												13.5726	0.055638792	7.136788456	0	0.073212022	3.906118999	0.145108318	3.859092642	10.12711681	2.911169176	5.844119367	0	0	5.195960508	9.996381486	13.00521896	0.179463928	0.304655892	2.687902874	1.632117017	9.596056223	0.392325738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6211	0	14.4066009	13.5726	0.055638792	7.136788456	0	0.073212022	3.906118999	0.145108318	3.859092642	10.12711681	2.911169176	5.844119367	0	0	5.195960508	9.996381486	13.00521896	0.179463928	0.304655892	2.687902874	1.632117017	9.596056223	0.392325738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6211	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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, 11c"	Medicare-FFS Cost Sharing; PBP 11b	"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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-j"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 16b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7g, 18a"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 17b"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	4.0643	0.064	1.8125	0	1.3766	0.8197	0.0343	0.5862	2.7474	0.476	0.9443	0	0	0.5914	2.6282	3.4923	0.1235	0.3388	0.7415	0.3219	1.2085	0.1527	0	0	0	0	0	0	0	0											22.524	0	1.643251549	17.6369	0.119640974	8.949255664	0	1.449803498	4.725864703	0.179446542	4.445275377	12.87451726	3.387120616	6.788438976	0	0	5.787315014	12.6245699	16.49747528	0.303003443	0.643493278	3.429417876	1.953991595	10.80453022	0.545042173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1451
H5215_807_0	2011	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	186.3261207	0.763814204	54.51180241	0	0.364167373	19.42961072	0.721790128	19.19569469	50.37376931	14.48058388	29.06950974	0	0	25.84547219	49.72347255	64.68987291	0.892679988	1.515403238	13.37002444	8.11839022	47.73219578	1.951485954	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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, 11c"	Medicare-FFS Cost Sharing; PBP 11b	"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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-j"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 16b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7g, 18a"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 17b"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.084423725	0.084423725	0.151735372	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	0.072843358	0.072843358	0.130921895	0	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0	0	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0	0	0	0	0	0	0	0												13.5726	0.055638792	7.136788456	0	0.073212022	3.906118999	0.145108318	3.859092642	10.12711681	2.911169176	5.844119367	0	0	5.195960508	9.996381486	13.00521896	0.179463928	0.304655892	2.687902874	1.632117017	9.596056223	0.392325738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6211	0	14.4066009	13.5726	0.055638792	7.136788456	0	0.073212022	3.906118999	0.145108318	3.859092642	10.12711681	2.911169176	5.844119367	0	0	5.195960508	9.996381486	13.00521896	0.179463928	0.304655892	2.687902874	1.632117017	9.596056223	0.392325738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6211	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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, 11c"	Medicare-FFS Cost Sharing; PBP 11b	"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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-j"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 16b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7g, 18a"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 17b"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	4.0643	0.064	1.8125	0	1.3766	0.8197	0.0343	0.5862	2.7474	0.476	0.9443	0	0	0.5914	2.6282	3.4923	0.1235	0.3388	0.7415	0.3219	1.2085	0.1527	0	0	0	0	0	0	0	0											22.524	0	1.643251549	17.6369	0.119640974	8.949255664	0	1.449803498	4.725864703	0.179446542	4.445275377	12.87451726	3.387120616	6.788438976	0	0	5.787315014	12.6245699	16.49747528	0.303003443	0.643493278	3.429417876	1.953991595	10.80453022	0.545042173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1451
H5215_808_0	2011	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	186.3261207	0.763814204	54.51180241	0	0.364167373	19.42961072	0.721790128	19.19569469	50.37376931	14.48058388	29.06950974	0	0	25.84547219	49.72347255	64.68987291	0.892679988	1.515403238	13.37002444	8.11839022	47.73219578	1.951485954	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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, 11c"	Medicare-FFS Cost Sharing; PBP 11b	"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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-j"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 16b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7g, 18a"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 17b"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											0	0.084423725	0.084423725	0.151735372	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	0.072843358	0.072843358	0.130921895	0	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0	0	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0.201039488	0	0	0	0	0	0	0	0												13.5726	0.055638792	7.136788456	0	0.073212022	3.906118999	0.145108318	3.859092642	10.12711681	2.911169176	5.844119367	0	0	5.195960508	9.996381486	13.00521896	0.179463928	0.304655892	2.687902874	1.632117017	9.596056223	0.392325738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6211	0	14.4066009	13.5726	0.055638792	7.136788456	0	0.073212022	3.906118999	0.145108318	3.859092642	10.12711681	2.911169176	5.844119367	0	0	5.195960508	9.996381486	13.00521896	0.179463928	0.304655892	2.687902874	1.632117017	9.596056223	0.392325738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6211	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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, 11c"	Medicare-FFS Cost Sharing; PBP 11b	"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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-j"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 16b, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7g, 18a"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 17b"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b-e											10000	4.0643	0.064	1.8125	0	1.3766	0.8197	0.0343	0.5862	2.7474	0.476	0.9443	0	0	0.5914	2.6282	3.4923	0.1235	0.3388	0.7415	0.3219	1.2085	0.1527	0	0	0	0	0	0	0	0											22.524	0	1.643251549	17.6369	0.119640974	8.949255664	0	1.449803498	4.725864703	0.179446542	4.445275377	12.87451726	3.387120616	6.788438976	0	0	5.787315014	12.6245699	16.49747528	0.303003443	0.643493278	3.429417876	1.953991595	10.80453022	0.545042173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1451
H5216_001_0	2011	9	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Radiology	Renal Dialysis	Other	Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V					O	O	O	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	YES	1043.110529	35.67815819	685.4400704	433.2458237	40.38097155	8.670485033	2.208687821	352.261286	515.1913302	2111.173205	149.107971	106.4465273	0.081852616	6.251569934	3172.890957	2843.420954	127.9095774	361.024707		1378.93469	38.44538682	0		3.74					6.04	0.6	729.0602732	881.3986783	8.041320798	1421.766224	453.6629202						4500	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"							161.6895	138.428775	45.243839	0	100	0.2	0.2	50	138.303392	27.07715	35	50	0.2	0.2	10	33.417021	35	35		0	0.2	0		0					0	0	0	40.641722	0	46.394184	50						NO	143.675834	123.006564	30.945429	0	88.197	0.176394	0.176394	44.0985	121.979442	23.881234	30.86895	44.0985	0.176394	0.176394	8.8197	29.47281	30.86895	30.86895		0	0.176394	0		0					0	0	0	35.844779	0	40.918279	44.0985							12.4891	0.365720637	1.767603086	0	0.296790046	1.529421537	0.389599279	1.294516193	5.236895915	4.201451776	0.383567209	0.391177682	0.01443831	1.102739427	2.331995531	6.983633793	0.329036196	0.928704469	0	0	6.781535563	0	0	0	0	0	0	0	0	0	0	2.632795069	0	4.848018918	1.667154524	0	0	0	0	0	55.9659	0	7.96123914	12.4891	0.365720637	1.767603086	0	0.296790046	1.529421537	0.389599279	1.294516193	5.236895915	4.201451776	0.383567209	0.391177682	0.01443831	1.102739427	2.331995531	6.983633793	0.329036196	0.928704469	0	0	6.781535563	0	0	0	0	0	0	0	0	0	0	2.632795069	0	4.848018918	1.667154524	0	0	0	0	0	55.9659	YES	30% Coins	30% Coins	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	20% Coins	$40/Visit	$40/Visit	$40/Visit	$40/Visit		$40/Visit	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$0/Proc	30% Coins	30% Coins						6000	5.7847	0.0568	0.369	1.5774	1.2098	1.5414	0.3927	0.1971	3.3557	0.4871	0.0788	0.2257	0.0022	0.1714	1.6775	1.5033	0.0676	0.1909		0.729	1.5687	0		0					0	0	0.2095	1.0211	0	0.7405	0.1283						23.2861	500	13.64285333	18.2738	0.422492889	2.136558846	1.577394974	1.506574354	3.070862569	0.782260817	1.491635974	8.592586417	4.688553955	0.462399541	0.616887816	0.01668224	1.274108915	4.009480584	8.486930378	0.396661087	1.119575683	0	0.729033036	8.350252032	0	0	0	0	0	0	0	0	0	0.209460696	3.653864535	0	5.588515622	1.795467901	0	0	0	0	0	79.252
H5216_003_0	2011	10	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Radiology	Renal Dialysis	Other	Therapy (PT/OT/ST)						A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V				O	O	O	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	174.9382518	6.2444907	518.6695563	284.0156613	21.28125053	5.787585419	1.739299429	244.1153317	347.0401679	1252.2334	132.9573597	25.93211216	0.064789345	3.031143741	2537.927196	2706.288132	96.23646954	304.1147397		2000.468528	18.17938671	0		4.94	3.1				6.04	0.6	568.6342318	541.5155247	0.341882438	667.0684577	380.3747962						4500	$650/Admit:1a.IP Acute	$650/Admit:1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN749: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"							650	650	45.243839	0	100	0.2	0.2	50	91.57368	41.280006	30	50	0.2	0.2	10	27.398413	30	30		0	0.2	0		0	0				0	0	0	39.309979	0	46.614635	50						NO	618.0486	618.0486	38.728862	0	94.4395	0.188879	0.188879	47.21975	86.481725	38.984631	28.33185	47.21975	0.188879	0.188879	9.44395	25.874924	28.33185	28.33185		0	0.188879	0		0	0				0	0	0	37.124148	0	44.022628	47.21975							9.01	0.321616561	1.673956806	0	0.167482555	1.093153346	0.328517137	0.960588744	2.501052697	4.068154753	0.313910664	0.102042321	0.012237347	0.572519399	1.997338129	5.835416646	0.227213102	0.718011099	0	0	3.433704383	0	0	0	0	0	0	0	0	0	0	1.675275207	0	2.447175547	1.496766898	0	0	0	0	0	38.9562	0	2.409713582	9.01	0.321616561	1.673956806	0	0.167482555	1.093153346	0.328517137	0.960588744	2.501052697	4.068154753	0.313910664	0.102042321	0.012237347	0.572519399	1.997338129	5.835416646	0.227213102	0.718011099	0	0	3.433704383	0	0	0	0	0	0	0	0	0	0	1.675275207	0	2.447175547	1.496766898	0	0	0	0	0	38.9562	YES	30% Coins	30% Coins	30% Coins(Days 1-20) 30%(Days 21-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	$35/Visit		$35/Visit	20%-30% Coins	0% Coins		50%-80%	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	30% Coins	$0/Proc	30% Coins	30% Coins						6000	5.6604	0.0957	0.4107	1.3125	0.7585	1.02	0.3065	0.1625	3.0867	0.4157	0.0732	0.1135	0.0021	0.0988	1.3967	1.4893	0.053	0.1674		1.1009	0.7996	0		0	0				0	0	0.161	0.8198	0	0.5265	0.1091						20.14	500	7.125843753	14.6704	0.417321361	2.084675691	1.312549684	0.925937816	2.113156298	0.635050846	1.123091972	5.587719523	4.483839224	0.387079409	0.21556672	0.01435004	0.671363988	3.394003506	7.324733969	0.280173702	0.885370719	0	1.100892543	4.233313983	0	0	0	0	0	0	0	0	0	0.160992231	2.495052642	0	2.973683793	1.605845487	0	0	0	0	0	59.0962
H5216_006_0	2011	8	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Radiology	Renal Dialysis	Other	Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V					O	O	O	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	YES	1086.991957	55.900721	430.26851	557.221956	34.90368	8.691694	2.540216	323.131875	355.048162	1412.924698	165.012079	70.868319	0.333523	5.729859	3359.208846	3350.449952	87.689277	197.709177		1521.137719	18.324542	0		3.74					6.04	0.6	886.726587	824.844939	1.712682	735.114886	484.055692						4500	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	45.243839	0	100	0.2	0.2	50	131.299616	26.279162	35	50	0.2	0.2	10	32.901443	35	50		0	0.2	0		0					0	0	0	39.396913	0	46.069397	35						NO	148.749166	127.350043	36.065538	0	91.249	0.182498	0.182498	45.6245	119.809587	23.979473	31.93715	45.6245	0.182498	0.182498	9.1249	30.022238	31.93715	45.6245		0	0.182498	0		0					0	0	0	35.949289	0	42.037864	31.93715							13.4741	0.593246602	1.293155441	0	0.265410491	1.586216772	0.46358434	1.228560853	3.544847805	2.823432471	0.43916796	0.269444302	0.06086728	1.045687808	2.5543704	8.382333822	0.233378799	0.751698529	0	0	3.344192266	0	0	0	0	0	0	0	0	0	0	2.471049091	0	2.575221634	1.288279937	0	0	0	0	0	48.6882	0	4.749084881	13.4741	0.593246602	1.293155441	0	0.265410491	1.586216772	0.46358434	1.228560853	3.544847805	2.823432471	0.43916796	0.269444302	0.06086728	1.045687808	2.5543704	8.382333822	0.233378799	0.751698529	0	0	3.344192266	0	0	0	0	0	0	0	0	0	0	2.471049091	0	2.575221634	1.288279937	0	0	0	0	0	48.6882	YES	30% Coins	30% Coins	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	20% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins		$40/Visit	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$0/Proc	30% Coins	$40/Visit						6000	5.7147	0.0965	0.3209	2.3831	1.1384	1.6822	0.4916	0.1969	2.599	0.3608	0.095	0.1769	0.01	0.171	1.9335	1.9285	0.0505	0.0661		0.8755	0.7301	0		0					0	0	0.2555	0.888	0	0.4618	0.2786						22.9052	500	9.540848678	19.1888	0.689708316	1.614079854	2.383135932	1.403834711	3.268463507	0.955234304	1.425416024	6.143827449	3.184255077	0.534145516	0.446324546	0.070820626	1.216685694	4.487861851	10.31078384	0.283850944	0.817842256	0	0.875535553	4.074301373	0	0	0	0	0	0	0	0	0	0.255504939	3.359050354	0	3.037049724	1.566892428	0	0	0	0	0	71.5934
H5216_007_0	2011	8	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Radiology	Renal Dialysis	Other	Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V					O	O	O	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	YES	1076.641194	55.368413	426.171324	551.91587	34.571313	8.473964	2.476584	320.054886	351.667254	1399.470275	163.44077	70.193483	0.325168	5.586325	3327.221141	3318.545654	86.854266	195.826513		1506.652849	17.865508	0		3.74					6.04	0.6	878.282829	816.990443	1.696373	728.114833	479.446324						4500	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	45.243839	0	100	0.2	0.2	50	131.299616	26.279162	35	50	0.2	0.2	10	32.901443	35	50		0	0.2	0		0					0	0	0	39.396913	0	46.069397	35						NO	149.070605	127.62524	36.286373	0	91.4409	0.182882	0.182882	45.72045	120.061551	24.029903	32.004315	45.72045	0.182882	0.182882	9.14409	30.085376	32.004315	45.72045		0	0.182882	0		0					0	0	0	36.024892	0	42.126271	32.004315							13.3746	0.58886725	1.288684302	0	0.263435998	1.549735484	0.452922635	1.219421118	3.518476329	2.802427913	0.435900824	0.267439802	0.059467374	1.021638289	2.535367464	8.319974481	0.231642607	0.746106358	0	0	3.267279834	0	0	0	0	0	0	0	0	0	0	2.45266604	0	2.556063565	1.278695932	0	0	0	0	0	48.2308	0	4.587020041	13.3746	0.58886725	1.288684302	0	0.263435998	1.549735484	0.452922635	1.219421118	3.518476329	2.802427913	0.435900824	0.267439802	0.059467374	1.021638289	2.535367464	8.319974481	0.231642607	0.746106358	0	0	3.267279834	0	0	0	0	0	0	0	0	0	0	2.45266604	0	2.556063565	1.278695932	0	0	0	0	0	48.2308	YES	30% Coins	30% Coins	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	20% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins		$40/Visit	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$0/Proc	30% Coins	$40/Visit						6000	5.6884	0.096	0.3221	2.3453	1.1382	1.6555	0.4838	0.1968	2.5577	0.3551	0.095	0.1741	0.0098	0.1683	1.9331	1.928	0.0505	0.0651		0.8753	0.7185	0		0					0	0	0.2514	0.8739	0	0.4545	0.2786						22.7148	500	9.113858671	19.0631	0.684884924	1.610815312	2.345250271	1.401605432	3.205238997	0.936756583	1.416232231	6.076138484	3.157514799	0.530857124	0.441507927	0.0692627	1.189917674	4.468426188	10.2479929	0.282103456	0.811198717	0	0.875339602	3.985782042	0	0	0	0	0	0	0	0	0	0.251443357	3.326551019	0	3.010549758	1.557246068	0	0	0	0	0	70.9457
H5253_004_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1097.001148	111.8099528	851.4164465	463.566262	169.955631	6.226927952	8.004408483	248.2293605	49.69104715	14.76589546	38.10944416	0	0.19935229	25.10207353	5337.767493	91.27908524	616.8264986	529.3576828	0	0	22.53108095	1174.758624	0	0	445.3686483	211.7750972	27.75296193	3.840601052	836.3542236	0											3950	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-50 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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, 18a); $0/$40 (17a)"	$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												185.9463355	119.8302997	60.37500219	0	200	0.2	0.097090548	49.50740242	0.2	0.154075312	0.163202778	0	0.2	0.160831139	12.12390662	0.132984302	38.5	40	0	0	0.2	39.72580558	0	0	40	15	0	0	0	0											NO	141.5474794	91.21812933	45.95911697	0	152.2455165	0.152245517	0.073908003	37.7110924	0.152245517	0.117286377	0.124234456	0	0.152245517	0.122429099	11.63150814	0.127590895	36.93636693	38.37544616	0	0	0.152245517	30.24037895	0	0	40	15	0	0	0	0												12.9398	0.849924561	3.260862338	0	2.156248569	0.948021862	0.591589846	0.780083363	7.565239139	1.731838388	4.734506081	0	0.030350492	3.073224243	5.173857173	11.64638019	1.898610823	1.692861438	0	0	3.430256057	2.960428831	0	0	1.484562161	0.264718872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2134	0	14.99417148	12.9398	0.849924561	3.260862338	0	2.156248569	0.948021862	0.591589846	0.780083363	7.565239139	1.731838388	4.734506081	0	0.030350492	3.073224243	5.173857173	11.64638019	1.898610823	1.692861438	0	0	3.430256057	2.960428831	0	0	1.484562161	0.264718872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2134	NO	"$340 Days 1-Unlimited (1a); $340 (1a1); $0 n/c (1a2, 1a3)"	"$340 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $50 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.1562	0.0158	0.6535	0.0262	0.0286	0.0189	0.0243	0.0103	0.1506	0.023	0.0924	0	0.0004	0.0609	0.2884	0.5458	0.0811	0.08	0	0	0.2452	0.1756	0	0	0.0673	0	0.0042	0	0	0											2.7486	0	0	13.096	0.865752006	3.914361803	0.026247884	2.184860628	0.966891341	0.615845629	0.790427799	7.71581807	1.754818792	4.826930746	0	0.030753224	3.134086341	5.462282327	12.19215015	1.979709126	1.772859361	0	0	3.675412897	3.136000804	0	0	1.55186744	0.264718872	0.0041941	0	0	0	0	0	0	0	0	0	0	0	0	0	69.962
H5253_007_0	2011	4																															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	YES	227.0421731	44.672705	9639.966073	51.00270368	19.58190305	22.82625047	10.68792662	10.67494771	6.111280303	29.32202838	9.644002781	0	0	10.46947289	2.424453815	96.33947969	19.4500505	69.94508909	0	0	1.37084361	5.774993978	1312.6921	141.3930691	122.1887268	84.8559682	0	0	0	0											3000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.076793974	0.077726015	0	0	0.2	0.2	0.08857836	0.084471883	0.2	0	0.087194751	0	0	0.160904147	0.009332461	0.033016056	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.068918515	0.069754973	0	0	0.179489385	0.179489385	0.079494377	0.075809032	0.179489385	0	0.078252661	0	0	0.144402931	0.008375388	0.029630158	0.179489385	0	0	0	0.179489385	0.181057062	0	0	0	0	0	0	0	0												15.6474	3.116143326	0	0	3.514743732	4.097069653	0.849630065	0.80925745	1.096909942	0	0.754668877	0	0	1.511822575	0.020305742	2.854553962	3.491077598	0	0	0	0.246051876	1.045603446	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.0552	0	4.452834331	15.6474	3.116143326	0	0	3.514743732	4.097069653	0.849630065	0.80925745	1.096909942	0	0.754668877	0	0	1.511822575	0.020305742	2.854553962	3.491077598	0	0	0	0.246051876	1.045603446	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.0552	NO	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0248	0.2041	0	0.0028	0.2131	0.2484	0.1163	0.0327	0.0665	0	0.0742	0	0	0.0916	0.0764	3.3907	0.6846	0.0187	0	0	0.0482	0.2033	0	0	0.0164	0	0	0	0	0											6.5128	0	0	16.6722	3.320231826	0	0.002789183	3.727811071	4.345438181	0.965923567	0.84196279	1.163405738	0	0.828853012	0	0	1.603470797	0.096747991	6.24527308	4.175632448	0.018748275	0	0	0.294299445	1.248857424	0	0	0.016401408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5681
H5253_011_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	634.5750359	105.661271	525.4555019	227.0268495	79.79901755	6.597363481	7.730063002	260.0637473	43.9781842	14.6967438	37.29351063	0	0.021894091	22.95875536	5564.352559	78.99564605	604.846722	448.9956624	0	0	27.10837022	1267.643734	0	0	503.031048	248.9093265	16.59068718	2.25	809.1953771	0											2900	"$175 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-12 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-28 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$0 n/c (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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												160.1656724	116.8098224	67.11082495	0	200	0.2	0.09537367	49.43002799	0.2	0.144981002	0.161801391	0	0.2	0.160246009	5.424519984	0.110464686	38.5	30	0	0	0.2	29.84143731	0	0	30	15	0	0	0	0											YES	121.1421291	88.34970919	50.7596172	0	151.2710274	0.151271027	0.072136366	37.41164995	0.151271027	0.109657126	0.122379313	0	0.151271027	0.121202892	5.199359151	0.105893407	36.90194302	28.75476079	0	0	0.151271027	22.5707244	0	0	30	15	0	0	0	0											3900	6.4061	0.777928547	2.222660011	0	1.005939948	0.997989952	0.557618651	0.81078449	6.652625108	1.611602686	4.563954209	0	0.003311942	2.782667552	2.410922283	8.365118098	1.860001606	1.075896906	0	0	4.100711014	2.384303114	0	0	1.25757762	0.311136658	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1589	0	11.82727908	6.4061	0.777928547	2.222660011	0	1.005939948	0.997989952	0.557618651	0.81078449	6.652625108	1.611602686	4.563954209	0	0.003311942	2.782667552	2.410922283	8.365118098	1.860001606	1.075896906	0	0	4.100711014	2.384303114	0	0	1.25757762	0.311136658	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1589	NO	"$275 Days 1-15 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-15 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-26 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.2373	0.0318	0.4801	0.0204	0.0293	0.0436	0.0511	0.0236	0.2908	0.047	0.1961	0	0.0001	0.1209	0.3542	0.5489	0.1213	0.0724	0	0	0.3373	0.1526	0	0	0.0854	0	0.0028	0	0	0											3.2474	0	0.888179271	6.6435	0.809752313	2.702746519	0.020449695	1.03525649	1.04161723	0.608736284	0.834417499	6.943445596	1.658570319	4.760083399	0	0.003408463	2.903612263	2.765146167	8.914055544	1.981284246	1.148336206	0	0	4.438054613	2.53691361	0	0	1.342968693	0.311136658	0.00281632	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4063
H5253_021_0	2011	3																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1283.30118	107.9966558	1050.318125	497.5559577	173.0859946	9.304020913	8.114744602	248.29473	47.98708884	15.4114675	38.07179449	0	0.130126955	27.47200705	5025.167408	92.72848658	615.3050163	481.5734621	0	0	17.04202145	1176.201488	0	0	437.0787677	218.6990274	46.710685	3.259425811	0	0											3600	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-46 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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, 18a); $0/$40 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												185.9463355	119.8302997	58.08766601	0	200	0.2	0.109741221	49.56005578	0.2	0.146904695	0.163473904	0	0.2	0.161038046	12.49586964	0.136063254	38.5	40	0	0	0.2	38.81201987	0	0	40	15	0	0	0	0											NO	137.4159752	88.555644	42.9272954	0	147.8017567	0.147801757	0.081099726	36.65304388	0.147801757	0.10856386	0.120808651	0	0.147801757	0.11900853	11.93714973	0.129990274	36.77857389	38.21150534	0	0	0.147801757	28.6824236	0	0	40	15	0	0	0	0												14.6955	0.796976117	3.757276369	0	2.131867839	1.375150636	0.658103564	0.758396469	7.092576031	1.673128397	4.599402137	0	0.019232993	3.269403187	4.998847982	12.05380136	1.88583675	1.533470576	0	0	2.518840709	2.811359109	0	0	1.456929226	0.273373784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3595	0	17.25743833	14.6955	0.796976117	3.757276369	0	2.131867839	1.375150636	0.658103564	0.758396469	7.092576031	1.673128397	4.599402137	0	0.019232993	3.269403187	4.998847982	12.05380136	1.88583675	1.533470576	0	0	2.518840709	2.811359109	0	0	1.456929226	0.273373784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3595	NO	"$340 Days 1-Unlimited (1a); $340 (1a1); $0 n/c (1a2, 1a3)"	"$340 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $50 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.1827	0.0153	0.8062	0.0273	0.0291	0.0282	0.0246	0.0104	0.1454	0.0229	0.0925	0	0.0003	0.0667	0.2759	0.5676	0.0809	0.0728	0	0	0.1854	0.1716	0	0	0.0661	0	0.0071	0	0	0											2.8787	0	0	14.8782	0.812263764	4.563441597	0.027295121	2.161006895	1.403344638	0.6826937	0.768754635	7.237991452	1.695997255	4.691853794	0	0.019495875	3.336100706	5.274703847	12.6213752	1.966735013	1.606247222	0	0	2.70427203	2.983005058	0	0	1.522981716	0.273373784	0.007059041	0	0	0	0	0	0	0	0	0	0	0	0	0	71.2382
H5253_024_0	2011	4																															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	YES	365.4353104	22.8321	50.01429612	2035.142622	15.15024187	23.48739915	26.66708148	38.09475011	59.54891673	21.47085062	58.1105265	0	0.116698516	35.32651007	45.2781787	138.5720713	11.244	11.43112557	0	0	17.49899031	8.784993749	865.8373915	475.2708206	120.6655306	198.3337391	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.077115621	0.078051617	0.152898213	0	0.233	0.233	0.233	0.095997691	0.233	0.233	0.233	0	0.233	0.233	0.226203246	0.232839522	0.232467345	0.233	0	0	0.233	0.230991389	0	0	0	0	0	0	0	0											NO	0.060321811	0.061053971	0.119600893	0	0.182258559	0.182258559	0.182258559	0.075105828	0.182258559	0.182258559	0.182258559	0	0.182258559	0.182258559	0.176941964	0.182133029	0.181841902	0.182258559	0	0	0.182258559	0.18188666	0	0	0	0	0	0	0	0												22.0437	1.393990374	5.981754467	0	2.761261251	4.280779522	4.860303843	2.861137744	10.85329975	3.913246294	10.59114082	0	0.021269303	6.438558818	8.011609856	25.23855108	2.04463035	2.083420473	0	0	3.189340756	1.59787317	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.1659	0	32.88366015	22.0437	1.393990374	5.981754467	0	2.761261251	4.280779522	4.860303843	2.861137744	10.85329975	3.913246294	10.59114082	0	0.021269303	6.438558818	8.011609856	25.23855108	2.04463035	2.083420473	0	0	3.189340756	1.59787317	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.1659	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.0437	1.393990374	5.981754467	0	2.761261251	4.280779522	4.860303843	2.861137744	10.85329975	3.913246294	10.59114082	0	0.021269303	6.438558818	8.011609856	25.23855108	2.04463035	2.083420473	0	0	3.189340756	1.59787317	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.1659
H5253_028_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1013.831583	104.6928649	646.9239931	882.4428325	132.7491988	9.025904705	8.918462789	315.4486578	30.24699261	12.76231634	28.70477732	0	0.075642934	18.62206079	6018.484002	81.86842665	635.8867622	419.8672622	0	0	20.00336701	1232.484454	0	0	299.1236125	201.7811648	16.42273794	2.25	676.2215745	0											2900	"$175 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-12 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-39 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$0 n/c (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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												160.1656724	116.8098224	54.18217345	0	200	0.2	0.115484187	48.84243002	0.2	0.166153517	0.169539068	0	0.2	0.159979358	6.519624992	0.11681118	38.5	30	0	0	0.2	29.77626524	0	0	30	15	0	0	0	0											NO	119.0970432	86.8582153	40.28913658	0	148.7173143	0.148717314	0.085872491	36.33938828	0.148717314	0.123549524	0.126066974	0	0.148717314	0.118958502	6.233651461	0.111720905	36.81125549	28.68409518	0	0	0.148717314	22.14123098	0	0	30	15	0	0	0	0												10.062	0.757786283	2.17200076	0	1.64517536	1.342308307	0.765850614	0.955267605	4.498251505	1.576778107	3.618724423	0	0.011249414	2.215252462	3.126427633	9.146414735	1.950649172	1.003626043	0	0	2.974847018	2.274060248	0	0	0.747809031	0.252226456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0967	0	12.71914733	10.062	0.757786283	2.17200076	0	1.64517536	1.342308307	0.765850614	0.955267605	4.498251505	1.576778107	3.618724423	0	0.011249414	2.215252462	3.126427633	9.146414735	1.950649172	1.003626043	0	0	2.974847018	2.274060248	0	0	0.747809031	0.252226456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0967	NO	"$295 Days 1-Unlimited (1a); $295 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-40 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.6391	0.0656	1.0118	0.0664	0.0684	0.0837	0.0827	0.0397	0.2806	0.0656	0.2204	0	0.0005	0.1376	0.4197	0.6424	0.1342	0.0713	0	0	0.3493	0.2077	0	0	0.0508	0	0.0028	0	0	0											4.6403	0	0	10.7011	0.823397634	3.183844745	0.066385403	1.713602782	1.426053814	0.848599238	0.994977087	4.778893705	1.642360697	3.839127932	0	0.011717308	2.352875386	3.546118562	9.788781214	2.084807821	1.074899806	0	0	3.324112156	2.48178793	0	0	0.798586188	0.252226456	0.00278781	0	0	0	0	0	0	0	0	0	0	0	0	0	55.737
H5253_801_0	2011	1																															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	197.033797	5.95	24.00315322	316.6241296	4.740156444	6.104126908	7.256275878	10.99862071	55.76166776	17.45118571	46.00807476	0	0.08796474	29.14007604	30.80127348	101.9170923	2.8547	9.440364977	0	0	23.08759392	8.717808116	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.076128202	0.076128202	0.153775637	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.06408432	0.06408432	0.129447522	0	0.196138173	0.196138173	0.196138173	0.196138173	0.196138173	0.196138173	0.196138173	0	0.196138173	0.196138173	0.196138173	0.196138173	0.196138173	0.196138173	0	0	0.196138173	0.196138173	0	0	0	0	0	0	0	0												12.6268	0.381301701	3.107148695	0	0.929725625	1.1972523	1.423232694	2.157249372	10.93699164	3.422843683	9.023939729	0	0.017253243	5.715481277	6.041305508	19.98983229	0.559915643	1.85161594	0	0	4.528358493	1.709894957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6201	0	16.09127883	12.6268	0.381301701	3.107148695	0	0.929725625	1.1972523	1.423232694	2.157249372	10.93699164	3.422843683	9.023939729	0	0.017253243	5.715481277	6.041305508	19.98983229	0.559915643	1.85161594	0	0	4.528358493	1.709894957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6201	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.6268	0.381301701	3.107148695	0	0.929725625	1.1972523	1.423232694	2.157249372	10.93699164	3.422843683	9.023939729	0	0.017253243	5.715481277	6.041305508	19.98983229	0.559915643	1.85161594	0	0	4.528358493	1.709894957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6201
H5253_802_0	2011	1																															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	196.9976331	5.9509	23.99874765	316.570913	4.739286429	6.103006547	7.254944051	10.99660201	55.75143318	17.44798269	45.99963036	0	0.087948595	29.13443172	30.79562017	101.8983863	2.8534	9.438632278	0	0	23.08335639	8.716208037	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.076130063	0.076130063	0.153775093	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064088235	0.064088235	0.129451808	0	0.196145362	0.196145362	0.196145362	0.196145362	0.196145362	0.196145362	0.196145362	0	0.196145362	0.196145362	0.196145362	0.196145362	0.196145362	0.196145362	0	0	0.196145362	0.196145362	0	0	0	0	0	0	0	0												12.6252	0.381382679	3.106681278	0	0.92958905	1.197076426	1.423023624	2.156932477	10.93538502	3.422340875	9.022614132	0	0.017250709	5.714583645	6.040418053	19.98689583	0.559681175	1.851343941	0	0	4.527693287	1.709643777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6078	0	16.08523014	12.6252	0.381382679	3.106681278	0	0.92958905	1.197076426	1.423023624	2.156932477	10.93538502	3.422340875	9.022614132	0	0.017250709	5.714583645	6.040418053	19.98689583	0.559681175	1.851343941	0	0	4.527693287	1.709643777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6078	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.6252	0.381382679	3.106681278	0	0.92958905	1.197076426	1.423023624	2.156932477	10.93538502	3.422340875	9.022614132	0	0.017250709	5.714583645	6.040418053	19.98689583	0.559681175	1.851343941	0	0	4.527693287	1.709643777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6078
H5253_805_0	2011	1																															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	184.5709286	5.9747	22.48489521	306.4235595	4.440329983	5.718025986	6.797298723	10.30293111	52.23460621	16.34735563	43.09795176	0	0.082400755	27.29800565	28.85301777	95.47058754	2.8617	8.843238857	0	0	21.62724727	8.16638548	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.079588652	0.079588652	0.152838226	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.067805695	0.067805695	0.130210802	0	0.19850477	0.19850477	0.19850477	0.19850477	0.19850477	0.19850477	0.19850477	0	0.19850477	0.19850477	0.19850477	0.19850477	0.19850477	0.19850477	0	0	0.19850477	0.19850477	0	0	0	0	0	0	0	0												12.515	0.405118686	2.927776241	0	0.88142668	1.135055431	1.349296217	2.045180967	10.36881847	3.245028064	8.555148988	0	0.016356943	5.418784325	5.727461647	18.95136699	0.568061099	1.755425092	0	0	4.293111738	1.621066469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.7794	0	14.21124927	12.515	0.405118686	2.927776241	0	0.88142668	1.135055431	1.349296217	2.045180967	10.36881847	3.245028064	8.555148988	0	0.016356943	5.418784325	5.727461647	18.95136699	0.568061099	1.755425092	0	0	4.293111738	1.621066469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.7794	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.515	0.405118686	2.927776241	0	0.88142668	1.135055431	1.349296217	2.045180967	10.36881847	3.245028064	8.555148988	0	0.016356943	5.418784325	5.727461647	18.95136699	0.568061099	1.755425092	0	0	4.293111738	1.621066469	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.7794
H5253_807_0	2011	1																															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	179.9566553	5.8274775	19.67428331	297.2308527	4.307120083	5.546485206	6.593379761	9.993843179	50.66756802	15.85693496	41.80501321	0	0.079928733	26.47916248	27.26610179	90.21970523	2.711016	8.356860719	0	0	20.43774867	7.717234279	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.079588652	0.079588652	0.152838226	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.067848743	0.067848743	0.130293469	0	0.198630794	0.198630794	0.198630794	0.198630794	0.198630794	0.198630794	0.198630794	0	0.198630794	0.198630794	0.198630794	0.198630794	0.198630794	0.198630794	0	0	0.198630794	0.198630794	0	0	0	0	0	0	0	0												12.2098	0.395387021	2.563430615	0	0.855526681	1.101702759	1.309648255	1.985085003	10.06413925	3.149675578	8.303762956	0	0.015876308	5.259577062	5.415887441	17.92041166	0.53849126	1.659929878	0	0	4.059566241	1.53288037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.3408	0	13.55535789	12.2098	0.395387021	2.563430615	0	0.855526681	1.101702759	1.309648255	1.985085003	10.06413925	3.149675578	8.303762956	0	0.015876308	5.259577062	5.415887441	17.92041166	0.53849126	1.659929878	0	0	4.059566241	1.53288037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.3408	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.3672	0.0119	0.4296	0	0.031	0.04	0.0475	0.072	0.3651	0.1143	0.3013	0	0.0006	0.1908	0.3698	1.2235	0.0368	0.1133	0	0	0.2772	0.1047	0	0	0	0	0	0	0	0											4.0964	0	0	12.5771	0.407279356	2.992999552	0	0.886564587	1.141671761	1.357161373	2.057102492	10.42925915	3.263943594	8.605017639	0	0.016452289	5.45039082	5.785638864	19.14386724	0.575254932	1.773255984	0	0	4.336719415	1.6375326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4372
H5253_808_0	2011	1																															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	179.9566553	5.8274775	19.67428331	297.2308527	4.307120083	5.546485206	6.593379761	9.993843179	50.66756802	15.85693496	41.80501321	0	0.079928733	26.47916248	27.26610179	90.21970523	2.711016	8.356860719	0	0	20.43774867	7.717234279	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.079588652	0.079588652	0.152838226	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.067848743	0.067848743	0.130293469	0	0.198630794	0.198630794	0.198630794	0.198630794	0.198630794	0.198630794	0.198630794	0	0.198630794	0.198630794	0.198630794	0.198630794	0.198630794	0.198630794	0	0	0.198630794	0.198630794	0	0	0	0	0	0	0	0												12.2098	0.395387021	2.563430615	0	0.855526681	1.101702759	1.309648255	1.985085003	10.06413925	3.149675578	8.303762956	0	0.015876308	5.259577062	5.415887441	17.92041166	0.53849126	1.659929878	0	0	4.059566241	1.53288037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.3408	0	13.55535789	12.2098	0.395387021	2.563430615	0	0.855526681	1.101702759	1.309648255	1.985085003	10.06413925	3.149675578	8.303762956	0	0.015876308	5.259577062	5.415887441	17.92041166	0.53849126	1.659929878	0	0	4.059566241	1.53288037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.3408	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.3672	0.0119	0.4296	0	0.031	0.04	0.0475	0.072	0.3651	0.1143	0.3013	0	0.0006	0.1908	0.3698	1.2235	0.0368	0.1133	0	0	0.2772	0.1047	0	0	0	0	0	0	0	0											4.0964	0	0	12.5771	0.407279356	2.992999552	0	0.886564587	1.141671761	1.357161373	2.057102492	10.42925915	3.263943594	8.605017639	0	0.016452289	5.45039082	5.785638864	19.14386724	0.575254932	1.773255984	0	0	4.336719415	1.6375326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4372
H5253_809_0	2011	1																															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	179.9566553	5.8274775	19.67428331	297.2308527	4.307120083	5.546485206	6.593379761	9.993843179	50.66756802	15.85693496	41.80501321	0	0.079928733	26.47916248	27.26610179	90.21970523	2.711016	8.356860719	0	0	20.43774867	7.717234279	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.079588652	0.079588652	0.152838226	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.067848743	0.067848743	0.130293469	0	0.198630794	0.198630794	0.198630794	0.198630794	0.198630794	0.198630794	0.198630794	0	0.198630794	0.198630794	0.198630794	0.198630794	0.198630794	0.198630794	0	0	0.198630794	0.198630794	0	0	0	0	0	0	0	0												12.2098	0.395387021	2.563430615	0	0.855526681	1.101702759	1.309648255	1.985085003	10.06413925	3.149675578	8.303762956	0	0.015876308	5.259577062	5.415887441	17.92041166	0.53849126	1.659929878	0	0	4.059566241	1.53288037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.3408	0	13.55535789	12.2098	0.395387021	2.563430615	0	0.855526681	1.101702759	1.309648255	1.985085003	10.06413925	3.149675578	8.303762956	0	0.015876308	5.259577062	5.415887441	17.92041166	0.53849126	1.659929878	0	0	4.059566241	1.53288037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.3408	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.3672	0.0119	0.4296	0	0.031	0.04	0.0475	0.072	0.3651	0.1143	0.3013	0	0.0006	0.1908	0.3698	1.2235	0.0368	0.1133	0	0	0.2772	0.1047	0	0	0	0	0	0	0	0											4.0964	0	0	12.5771	0.407279356	2.992999552	0	0.886564587	1.141671761	1.357161373	2.057102492	10.42925915	3.263943594	8.605017639	0	0.016452289	5.45039082	5.785638864	19.14386724	0.575254932	1.773255984	0	0	4.336719415	1.6375326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4372
H5262_001_0	2011	4	f-UC	e3	e4								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	36.17452546	0	0	10.58424415	1.429768524	269.063455	0	0	0	0	0	93.49875709	6071.233039	1531.49542	157.3242805	291.990797	0	0	0	125.9160865	0	0	0.289621579	0	0	0	0	0	4.115122025	1.54493118	0.51497706								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: $0, 14J Nutrition Therapy: $0"	"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 Diabetes Monitoring Supplies: 5%	11C Diabetes Non Preferred Monitoring Supplies: 25%								0			0.1			0.1	0.1	50						10	15	15	15	15		15		15			15						15	0.05	0.25								NO			0.099906939			0.099906939	0.099906939	49.9534693						9.99069386	14.98604079	14.98604079	14.98604079	14.98604079		14.98604079		14.98604079			14.98604079						14.98604079	0.049953469	0.249767347									0	0	3.614086094	0	0	1.05743943	0.142843796	1.12005442	0	0	0	0	0	0.077843122	7.581978831	1.912587736	0.19647234	0.364648833	0	0	0	0.157248634	0	0	0.00036169	0	0	0	0	0	0.005139116	0.077174672	0.128624454	0	0	0	0	0	0	0	16.4365	0	0.01531036	0	0	3.614086094	0	0	1.05743943	0.142843796	1.12005442	0	0	0	0	0	0.077843122	7.581978831	1.912587736	0.19647234	0.364648833	0	0	0	0.157248634	0	0	0.00036169	0	0	0	0	0	0.005139116	0.077174672	0.128624454	0	0	0	0	0	0	0	16.4365	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	0	0	0	0	3.614086094	0	0	1.05743943	0.142843796	1.12005442	0	0	0	0	0	0.077843122	7.581978831	1.912587736	0.19647234	0.364648833	0	0	0	0.157248634	0	0	0.00036169	0	0	0	0	0	0.005139116	0.077174672	0.128624454	0	0	0	0	0	0	0	16.4365
H5262_003_0	2011	3	f-UC	e3	e4								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	159.7209662	2.378223579	24.82247042	0	0	6.520852322	0.858317023	576.1728692	181.3252854	23.30221153	5.411140449	0	0	51.81988719	3656.870658	1071.057756	96.91758016	188.4535107	20.0998447	2.910798743	0	67.89427224	0	0	0	0	0	0	0	0	2.506776205	0.207004657	0.069001552								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%	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: $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 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 Diabetes Monitoring Supplies: 15%	11C Diabetes Non Preferred Monitoring Supplies: 35%								0	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	199.5948755	199.5948755	0.099797438			0.199594876	0.199594876	49.89871888	74.84807832	0.099797438	0.099797438			14.96961566	29.93923133	29.93923133	29.93923133	29.93923133		29.93923133		29.93923133			29.93923133						29.93923133	0.149696157	0.349291032									2.6566	0.03955677	2.477218947	0	0	1.301528707	0.171315679	2.395857336	1.13098743	2.325501005	0.540017952	0	0	0.06464365	9.123658047	2.672220493	0.241803154	0.470179438	0	0.007262256	0	0.16939186	0	0	0	0	0	0	0	0	0.006254246	0.030987802	0.024101623	0	0	0	0	0	0	0	25.8491	0	0.052467144	2.6566	0.03955677	2.477218947	0	0	1.301528707	0.171315679	2.395857336	1.13098743	2.325501005	0.540017952	0	0	0.06464365	9.123658047	2.672220493	0.241803154	0.470179438	0	0.007262256	0	0.16939186	0	0	0	0	0	0	0	0	0.006254246	0.030987802	0.024101623	0	0	0	0	0	0	0	25.8491	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	0	0	2.6566	0.03955677	2.477218947	0	0	1.301528707	0.171315679	2.395857336	1.13098743	2.325501005	0.540017952	0	0	0.06464365	9.123658047	2.672220493	0.241803154	0.470179438	0	0.007262256	0	0.16939186	0	0	0	0	0	0	0	0	0.006254246	0.030987802	0.024101623	0	0	0	0	0	0	0	25.8491
H5262_004_0	2011	3	f-UC	e3	e4								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	161.0828587	2.398501974	25.03412414	0	0	6.576453662	0.865635633	581.0857215	182.8713914	23.50090246	5.457279611	0	0	52.26173973	3688.051691	1080.190342	97.74396713	190.060397	20.27123002	2.935618246	0	68.47318622	0	0	0	0	0	0	0	0	2.528150729	0.208769723	0.069589908								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%	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: $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 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 Diabetes Monitoring Supplies: 15%	11C Diabetes Non Preferred Monitoring Supplies: 35%								0	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	199.5948755	199.5948755	0.099797438			0.199594876	0.199594876	49.89871888	74.84807832	0.099797438	0.099797438			14.96961566	29.93923133	29.93923133	29.93923133	29.93923133		29.93923133		29.93923133			29.93923133						29.93923133	0.149696157	0.349291032									2.6793	0.039894059	2.498341445	0	0	1.31262645	0.172776436	2.416286088	1.140631019	2.34532985	0.544622522	0	0	0.065194846	9.201452727	2.695005711	0.243864937	0.474188516	0	0.007324179	0	0.170836214	0	0	0	0	0	0	0	0	0.006307574	0.031252025	0.024307131	0	0	0	0	0	0	0	26.0695	0	0.052467144	2.6793	0.039894059	2.498341445	0	0	1.31262645	0.172776436	2.416286088	1.140631019	2.34532985	0.544622522	0	0	0.065194846	9.201452727	2.695005711	0.243864937	0.474188516	0	0.007324179	0	0.170836214	0	0	0	0	0	0	0	0	0.006307574	0.031252025	0.024307131	0	0	0	0	0	0	0	26.0695	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	0	0	2.6793	0.039894059	2.498341445	0	0	1.31262645	0.172776436	2.416286088	1.140631019	2.34532985	0.544622522	0	0	0.065194846	9.201452727	2.695005711	0.243864937	0.474188516	0	0.007324179	0	0.170836214	0	0	0	0	0	0	0	0	0.006307574	0.031252025	0.024307131	0	0	0	0	0	0	0	26.0695
H5262_005_0	2011	4	f-UC	e3	e4								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	42.3676133	0	0	10.18227965	1.246787472	294.5889818	0	0	0	0	0	87.79463012	6308.543706	1395.146777	46.44602965	243.4364827	0	0	0.518405386	159.0424652	0	0	0.318867499	0	0	0	0	0	2.533419799	1.06003951	0.353346503								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: $0, 14J Nutrition Therapy: $0"	"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 Diabetes Monitoring Supplies: 5%	11C Diabetes Non Preferred Monitoring Supplies: 25%								0			0.1			0.1	0.1	50						10	15	15	15	15		15		15			15						15	0.05	0.25								NO			0.099906939			0.099906939	0.099906939	49.9534693						9.99069386	14.98604079	14.98604079	14.98604079	14.98604079		14.98604079		14.98604079			14.98604079						14.98604079	0.049953469	0.249767347									0	0	4.23281854	0	0	1.017280388	0.124562719	1.226311805	0	0	0	0	0	0.073094106	7.878341109	1.742310542	0.058003508	0.304012422	0	0	0	0.198618073	0	0	0.000398213	0	0	0	0	0	0.003163828	0.052952651	0.088254419	0	0	0	0	0	0	0	17.0001	0	0.01531036	0	0	4.23281854	0	0	1.017280388	0.124562719	1.226311805	0	0	0	0	0	0.073094106	7.878341109	1.742310542	0.058003508	0.304012422	0	0	0	0.198618073	0	0	0.000398213	0	0	0	0	0	0.003163828	0.052952651	0.088254419	0	0	0	0	0	0	0	17.0001	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0	0	0	0	0	4.23281854	0	0	1.017280388	0.124562719	1.226311805	0	0	0	0	0	0.073094106	7.878341109	1.742310542	0.058003508	0.304012422	0	0	0	0.198618073	0	0	0.000398213	0	0	0	0	0	0.003163828	0.052952651	0.088254419	0	0	0	0	0	0	0	17.0001
H5291_001_0	2011	5	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	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	YES	1187.535886	43.71855448	776.4388045	590.4271288	195.8718822	13.49793729	2.674114204	385.0662822	290.8281944	627.8390672	1033.45425	23.05261607	0.566085564	537.8701694	4234.580303	3117.731968	67.80382465	815.1530381		1617.814796	27.41983412	0							5.55	0.29	142.5690678										6700	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $125(Days 21-100):2. $0 SNF 1,2. $125 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $175 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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a	$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies											161.6895	138.428775	41.280875	0	100	0.2	0.2	50	186.735754	14.035731	56.65899	100	0.192475	49.694496	10	34.136981	35	37.682991		0	0.2	0							0	0	0										NO	157.036885	134.445487	38.28731	0	96.9284	0.193857	0.193857	48.4642	180.999979	13.604609	54.918652	96.9284	0.186563	48.16808	9.69284	33.088429	33.92494	36.52552		0	0.193857	0							0	0	0											15.5406	0.489813529	2.477312767	0	1.582129013	2.61666963	0.518395757	1.555160776	4.38665809	0.711792085	4.729659525	0.186204433	0.105610621	2.159014446	3.420425779	8.59673774	0.191686724	2.481157383	0	0	5.315526783	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0645	0	1.890475651	15.5406	0.489813529	2.477312767	0	1.582129013	2.61666963	0.518395757	1.555160776	4.38665809	0.711792085	4.729659525	0.186204433	0.105610621	2.159014446	3.420425779	8.59673774	0.191686724	2.481157383	0	0	5.315526783	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0645	NO																																																																																		0	0	0	15.5406	0.489813529	2.477312767	0	1.582129013	2.61666963	0.518395757	1.555160776	4.38665809	0.711792085	4.729659525	0.186204433	0.105610621	2.159014446	3.420425779	8.59673774	0.191686724	2.481157383	0	0	5.315526783	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0645
H5291_801_0	2011	2																															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	YES	308.278242	4.32446	31.68323	17.120583	7.74816	9.867658	3.483779	28.093621	52.109265	5.627266	30.499069	5.40782	0.546063	10.48193	40.649702	73.626311	0.507098	5.624066		7.997396	33.448534	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.075467	0.075467	0.149626	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.068931	0.068931	0.109109	0	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672		0.211672	0.211672	0																				21.2499	0.298089352	3.456925542	0	1.640068524	2.088706904	0.737418468	5.946632944	11.03007234	1.191134649	6.455798933	1.144684075	0.115586247	2.218731087	8.604403722	15.5846285	0.107338448	1.190457298	0	1.692824806	7.080118089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8335	0	10.06048133	21.2499	0.298089352	3.456925542	0	1.640068524	2.088706904	0.737418468	5.946632944	11.03007234	1.191134649	6.455798933	1.144684075	0.115586247	2.218731087	8.604403722	15.5846285	0.107338448	1.190457298	0	1.692824806	7.080118089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8335	NO																																																																																		0	0	0	21.2499	0.298089352	3.456925542	0	1.640068524	2.088706904	0.737418468	5.946632944	11.03007234	1.191134649	6.455798933	1.144684075	0.115586247	2.218731087	8.604403722	15.5846285	0.107338448	1.190457298	0	1.692824806	7.080118089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8335
H5291_802_0	2011	2																															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	YES	308.278242	4.32446	31.68323	17.120583	7.74816	9.867658	3.483779	28.093621	52.109265	5.627266	30.499069	5.40782	0.546063	10.48193	40.649702	73.626311	0.507098	5.624066		7.997396	33.448534	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.075467	0.075467	0.149626	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.068931	0.068931	0.109109	0	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672		0.211672	0.211672	0																				21.2499	0.298089352	3.456925542	0	1.640068524	2.088706904	0.737418468	5.946632944	11.03007234	1.191134649	6.455798933	1.144684075	0.115586247	2.218731087	8.604403722	15.5846285	0.107338448	1.190457298	0	1.692824806	7.080118089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8335	0	10.06048133	21.2499	0.298089352	3.456925542	0	1.640068524	2.088706904	0.737418468	5.946632944	11.03007234	1.191134649	6.455798933	1.144684075	0.115586247	2.218731087	8.604403722	15.5846285	0.107338448	1.190457298	0	1.692824806	7.080118089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8335	NO																																																																																		0	0	0	21.2499	0.298089352	3.456925542	0	1.640068524	2.088706904	0.737418468	5.946632944	11.03007234	1.191134649	6.455798933	1.144684075	0.115586247	2.218731087	8.604403722	15.5846285	0.107338448	1.190457298	0	1.692824806	7.080118089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8335
H5291_803_0	2011	2																															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	YES	308.278242	4.32446	31.68323	17.120583	7.74816	9.867658	3.483779	28.093621	52.109265	5.627266	30.499069	5.40782	0.546063	10.48193	40.649702	73.626311	0.507098	5.624066		7.997396	33.448534	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.075467	0.075467	0.149626	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.068931	0.068931	0.109109	0	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672	0.211672		0.211672	0.211672	0																				21.2499	0.298089352	3.456925542	0	1.640068524	2.088706904	0.737418468	5.946632944	11.03007234	1.191134649	6.455798933	1.144684075	0.115586247	2.218731087	8.604403722	15.5846285	0.107338448	1.190457298	0	1.692824806	7.080118089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8335	0	10.06048133	21.2499	0.298089352	3.456925542	0	1.640068524	2.088706904	0.737418468	5.946632944	11.03007234	1.191134649	6.455798933	1.144684075	0.115586247	2.218731087	8.604403722	15.5846285	0.107338448	1.190457298	0	1.692824806	7.080118089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8335	NO																																																																																		0	0	0	21.2499	0.298089352	3.456925542	0	1.640068524	2.088706904	0.737418468	5.946632944	11.03007234	1.191134649	6.455798933	1.144684075	0.115586247	2.218731087	8.604403722	15.5846285	0.107338448	1.190457298	0	1.692824806	7.080118089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8335
H5294_001_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	330.0122294	43.98313609	64.88984898	0	16.09420603	24.65961434	12.56707511	33.56036461	32.3548425	8.770071623	16.93838989	0	2.247637166	30.71044053	40.18665817	49.16718007	6.172900916	4.66058828	22.01986052	62.44298704	26.74403275	32.82067997	0	0	0	0	0	0	0	0											3400	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a; No Cost-Sharing PBP; 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, No Cost-Sharing PBP; 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, No Cost-Sharing PBP; 14a"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											0	0.073720536	0.073720536	0.192357549	0	0.233	0.233	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	0.073445942	0.073445942	0.191641057	0	0.232132123	0.232132123	0.232132123	0.232132123	0.232132123	0.232132123	0.232132123	0	0.232132123	0.232132123	0.232155129	0.232132123	0.232132123	0.232132123	0.232132123	0.232132123	0.232132123	0.232132123	0	0	0	0	0	0	0	0												24.2381	3.230382879	12.43555923	0	3.73598222	5.724288639	2.917221832	7.790438699	7.510598293	2.035815348	3.931944413	0	0.521748788	7.128879772	9.329538806	11.41328191	1.432928597	1.081872254	5.111516981	14.49502318	6.208149112	7.618734133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.892	0	0.51461121	24.2381	3.230382879	12.43555923	0	3.73598222	5.724288639	2.917221832	7.790438699	7.510598293	2.035815348	3.931944413	0	0.521748788	7.128879772	9.329538806	11.41328191	1.432928597	1.081872254	5.111516981	14.49502318	6.208149112	7.618734133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.892	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.2381	3.230382879	12.43555923	0	3.73598222	5.724288639	2.917221832	7.790438699	7.510598293	2.035815348	3.931944413	0	0.521748788	7.128879772	9.329538806	11.41328191	1.432928597	1.081872254	5.111516981	14.49502318	6.208149112	7.618734133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.892
H5302_003_0	2011	8																															D	D	D	V	T	COIN	COIN	V	V	O	O	O	COIN	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	1064.189568	70.3516335	474.3994689	0	203.2814438	5.436295567	4.441498929	415.3195051	329.7815396	1914.820339	815.7079747	92.58237234	0.06350268	363.6952414	3358.031562	10362.06925	181.36	361.4454002	1920.457199	1402.013645	22.84390774	0	0	0	0	0	0	0	0	0											6700	$225/day days 1 - 5; $125/day days 6 - 21; $0 after day 21	$225/day days 1 - 5; $125/day days 6 - 10; $0 after day 10	$50/day days 1 - 20; $125/day days 21 - 100	$0 copay	$200 copay	20% coinsurance	20% coinsurance	(4a) $50/visit; waive if admitted; (4b) $25/visit	(9a) $350/visit (9b) $350/visit	$40 copay	"$40 copay except: MRI, CT, PET @ $375 copay and EKG Preventive Screenings @ $0 copay"	$225/visit	20% coinsurance	"$40/visit, except for (5) at $75/visit"	"(7a) $25/visit; (14b) - (14j) $0 copay; AAA Screening, HIV Screening and Cardiovascular Preventive Screening $0 copay; (17a) $25/visit, except $0 copay for Glaucoma Testing."	"(7g) $35/visit; (7b, 7d, 7f) $40/visit; (14d, 14e, 14f, 14g, 14h, 14i, 14j) $0 copay; AAA Screening, HIV Screening and Cardiovascular Preventive Screening $0 copay; (17a) $35/visit, except $0 copay for Glaucoma Testing."	$40/visit	$40/visit	"$40 copay except: MRI, CT, PET @ $375 copay"	"(7g) $35/visit, (7b, 7d, 7f) $40/visit, (14d, 14e, 14f, 14g, 14h, 14i, 14j) $0 copay"	20% coinsurance	$0 copay	not covered	not covered	not covered	not covered	not covered	not covered	(14a): $0/visit	"(13c): $10/Month; (13d): $0/discharge; (14b, 14c): $0/visit"												196.4415826	165.3226608	63.27819945	0	120	0.2	0.2	49.01870821	301.6363457	26.04113184	91.73820272	74.25	0.052445516	55.56656275	23.69874045	18.38512583	40	40	17.54357433	11.05350305	0.210906983	0	0	0	0	0	0	0	0	0											NO	195.8345719	164.8118086	63.08266782	0	119.6291962	0.199381994	0.199381994	48.86723885	300.7042799	25.96066392	91.45472878	74.02056516	0.052283458	55.39486032	23.62551059	18.32831521	39.87639874	39.87639874	17.48936413	11.01934738	0.210255274	0	0	0	0	0	0	0	0	0												17.3671	0.966231663	2.493865342	0	2.026532977	1.083899448	0.885554912	1.691293121	8.263893365	4.142500607	6.216695966	0.571083294	0.00332014	1.678903925	6.611267521	15.82660596	0.602665306	1.201095075	2.798964605	1.287439616	4.803052072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.522	0	0.249586616	17.3671	0.966231663	2.493865342	0	2.026532977	1.083899448	0.885554912	1.691293121	8.263893365	4.142500607	6.216695966	0.571083294	0.00332014	1.678903925	6.611267521	15.82660596	0.602665306	1.201095075	2.798964605	1.287439616	4.803052072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.522	NO	20% coinsurance	20% coinsurance	20% coinsurance	$0 copay	$200 copay	20% coinsurance	20% coinsurance	(4a) $50/visit; waive if admitted; (4b) $25/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	not covered	not covered	not covered	"(13c): $10/Month; (13d): $0/discharge; (14b, 14c): $0/visit"												3.018	0.0011	0.3756	0	0.1965	0.3098	0.1884	0.1038	1.5331	0.2673	0.499	0.0022	0.0017	0.4698	1.0953	4.6852	0	0.3243	0.6203	0.4012	0.5228	0	0	0	0	0	0	0	0	0											14.6153	0	0	20.3851	0.967302732	2.869509079	0	2.223065969	1.393664693	1.073954475	1.795085869	9.796980819	4.409815076	6.715689163	0.573326483	0.004973592	2.148665322	7.706592159	20.5117785	0.602665306	1.525357734	3.419308302	1.688599932	5.325843021	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1372
H5302_005_0	2011	5																															D	D	D	V	T	COIN	COIN	V	V	O	O	O	COIN	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	0.26024781	0	0	0	0	0	0											0.2602	YES	1147.294571	70.3516335	492.0653289	0	212.981839	5.488613406	4.471499844	465.8940325	299.5215105	2023.868406	860.9744702	99.19112862	0.07153468	382.2785768	3568.183293	11014.03744	181.36	392.4547093	2060.595236	1471.346419	23.0114432	0	0	0	85.07661511	101.1298554	0	13.22490772	0	0											6700	$225/day days 1 - 5; $125/day days 6 - 21; $0 after day 21	$225/day days 1 - 5; $125/day days 6 - 10; $0 after day 10	$50/day days 1 - 20; $125/day days 21 - 100	$0 copay	$100 copay	20% coinsurance	20% coinsurance	(4a) $50/visit; waive if admitted; (4b) $20/visit	(9a) $275/visit (9b) $275/visit	$40 copay	"$40 copay except: MRI, CT, PET @ $300 copay and EKG Preventive Screenings @ $0 copay"	$225/visit	20% coinsurance	$40/visit	"(7a) $20/visit; (14b) - (14j) $0 copay; AAA Screening, HIV Screening and Cardiovascular Preventive Screening $0 copay; (17a) $20/visit, except Glaucoma Testing at $0 copay"	"(7b, 7d, 7f, 7g) $40/visit; (14d, 14e, 14f, 14g, 14h, 14i, 14j) $0 copay; AAA Screening, HIV Screening and Cardiovascular Preventive Screening $0 copay; (17a) $40/visit, except Glaucoma Testing at $0 copay"	$40/visit	$40/visit	"$40 copay except: MRI, CT, PET @ $300 copay"	"(7b, 7d, 7f, 7g) $40/visit, (14d, 14e, 14f, 14g, 14h, 14i, 14j) $0 copay"	20% coinsurance	$0 copay	not covered	(16a): $25 deductible	(17a1): $40/visit	(17b1): $100 allowance	(18a): $40/visit (Hearing Aid Fitting/Eval Only)	(18b): $40/visit (Hearing Aid Fitting/Eval Only)	not covered	"(13c): $10/Month; (14b, 14c): $0/visit"												196.4415826	165.32	63.27819945	0	80	0.2	0.2	48.81943658	241.3293873	27.85279535	116.1018083	185.9723915	0.052514247	51.6899962	18.95569127	18.53526925	40	40	20.71931152	39.02216922	0.210934078	0	0	0	40	40	0	40	0	0											NO	194.4835385	163.6721622	62.64746992	0	79.20259484	0.198006487	0.198006487	48.3328257	238.9239211	27.57517081	114.9445561	184.1186997	0.051990808	51.17477283	18.76674919	18.35051776	39.60129742	39.60129742	20.51279045	38.63321324	0.208831579	0	0	0	39.60129742	39.60129742	0	39.60129742	0	0												18.5942	0.959550331	2.568887324	0	1.405726192	1.08678106	0.885385976	1.876497922	5.963571145	4.650709749	8.247027356	1.521911802	0.003719146	1.63025161	5.580266744	16.84277413	0.598507608	1.295142972	3.522379856	4.736903328	4.805516013	0	0	0	0.280762028	0.333739457	0	0.043643625	0	0	0	0	0	0	0	0	0	0	0	0	87.4338	25	0.880276391	18.5942	0.959550331	2.568887324	0	1.405726192	1.08678106	0.885385976	1.876497922	5.963571145	4.650709749	8.247027356	1.521911802	0.003719146	1.63025161	5.580266744	16.84277413	0.598507608	1.295142972	3.522379856	4.736903328	4.805516013	0	0	0.26024781	0.280762028	0.333739457	0	0.043643625	0	0	0	0	0	0	0	0	0	0	0	0	87.6941	NO	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	$100 copay	20% coinsurance	20% coinsurance	(4a) $50/visit; waive if admitted; (4b) $20/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	(17a1): $40/visit	(17b1): $100 allowance	(18a): $40/visit (Hearing Aid Fitting/Eval Only)	(18b): $40/visit (Hearing Aid Fitting/Eval Only)	not covered	"(13c): $10/Month; (14b, 14c): $0/visit"												2.9987	0.0011	0.3344	0	0.1367	0.3071	0.1869	0.1074	1.4765	0.2829	0.5284	0.0024	0.0017	0.4978	1.0324	4.3694	0	0.2965	0.5858	0.3861	0.5175	0	0	0	0.0232	0.0285	0	0.0222	0	0											14.1236	0	0	21.5929	0.9606214	2.903321029	0	1.542383907	1.393865422	1.072253326	1.983894518	7.440071184	4.933594523	8.775416334	1.52427904	0.005464035	2.12808786	6.612661754	21.21221454	0.598507608	1.591626195	4.108157928	5.123027798	5.32300426	0	0	0.26024781	0.303973165	0.36223651	0	0.065851557	0	0	0	0	0	0	0	0	0	0	0	0	101.8177
H5302_006_0	2011	8																															D	D	D	V	T	COIN	COIN	V	V	O	O	O	COIN	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	0.26	0	0	0	0	0	0											0.26	YES	1110.84255	8.632132068	495.4354166	0	211.9017043	5.916599758	4.819398113	433.1970914	353.2165099	2049.276166	867.3760168	100.4090773	0.070367435	387.1212231	3762.611926	11657.78249	0	415.7304331	2181.408836	1556.572148	25.18308302	0	0	0	84.71815105	0	0	0	0	0											6700	$225/day days 1 - 5; $125/day days 6 - 21; $0 after day 21	$225/day days 1 - 5; $125/day days 6 - 10; $0 after day 10	$50/day days 1 - 20; $125/day days 21 - 100	$0 copay	$100 copay	20% coinsurance	20% coinsurance	(4a) $50/visit; waive if admitted; (4b) $15/visit	(9a) $250/visit (9b) $250/visit	$35 copay	"$35 copay except: MRI, CT, PET @ $300 copay and EKG Preventive Screenings @ $0 copay"	$225/visit	20% coinsurance	$35/visit	"(7a) $15/visit; (14b) - (14j) $0 copay; AAA Screening, HIV Screening and Cardiovascular Preventive Screening $0 copay; (17a) $15/visit, except $0 for Glaucoma Testing"	"(7b, 7d, 7f, 7g) $35/visit; (14d, 14e, 14f, 14g, 14h, 14i, 14j) $0 copay; AAA Screening, HIV Screening and Cardiovascular Preventive Screening $0 copay; (17a) $35/visit, except $0 for Glaucoma Testing."	$35/visit	$35/visit	"$35 copay except: MRI, CT, PET @ $300 copay"	"(7b, 7d, 7f, 7g) $35/visit, (14d, 14e, 14f, 14g, 14h, 14i, 14j) $0 copay"	20% coinsurance	$0 copay	not covered	"(16a, 16b): $25 deductible"	(17a1): $35/visit	(17b1): $100 allowance	not covered	not covered	(14a): $0/visit	"(13c): $10/Month; (13d): $0/discharge; (14b, 14c): $0/visit"												196.4415826	165.3226608	63.28472022	0	60	0.2	0.2	48.62279962	219.395031	26.27570827	110.5424406	180.5901723	0.05253184	45.72137687	14.26986239	17.84098691	0	35	18.52136204	34.14407443	0.176533213	0	0	0	35	0	0	0	0	0											NO	195.4052347	164.4504841	62.95085515	0	59.68346381	0.198944879	0.198944879	48.36628503	218.2375899	26.13708806	109.9592625	179.6374502	0.052254703	45.48016903	14.19458026	17.74686495	0	34.81535389	18.42365068	33.96394384	0.175601893	0	0	0	34.81535389	0	0	0	0	0												18.0887	0.118296525	2.599006929	0	1.053918975	1.177077225	0.958794576	1.746011166	6.423759986	4.463509301	7.948002262	1.503102552	0.003677029	1.467194888	4.450724747	17.24075762	0	1.206150179	3.349126199	4.405610751	4.422197062	0	0	0	0.245791034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.8714	25	0.439515399	18.0887	0.118296525	2.599006929	0	1.053918975	1.177077225	0.958794576	1.746011166	6.423759986	4.463509301	7.948002262	1.503102552	0.003677029	1.467194888	4.450724747	17.24075762	0	1.206150179	3.349126199	4.405610751	4.422197062	0	0	0.26	0.245791034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.1314	NO	$225/day days 1 - 5; $125/day days 6 - 21; $0 after day 21	$225/day days 1 - 5; $125/day days 6 - 10; $0 after day 10	20% coinsurance	$0 copay	$100 copay	20% coinsurance	20% coinsurance	(4a) $50/visit; waive if admitted; (4b) $15/visit	(9a) $250/visit (9b) $250/visit	$35 copay	"$35 copay except: MRI, CT, PET @ $300 copay and EKG Preventive Screenings @ $0 copay"	$225/visit	20% coinsurance	$35/visit	"(7a) $15/visit; (14b) - (14j) $0 copay; AAA Screening, HIV Screening and Cardiovascular Preventive Screening $0 copay; (17a) $15/visit, except $0 for Glaucoma Testing"	"(7b, 7d, 7f, 7g) $35/visit; (14d, 14e, 14f, 14g, 14h, 14i, 14j) $0 copay; AAA Screening, HIV Screening and Cardiovascular Preventive Screening $0 copay; (17a) $35/visit, except $0 for Glaucoma Testing."	$35/visit	$35/visit	"$35 copay except: MRI, CT, PET @ $300 copay"	"(7b, 7d, 7f, 7g) $35/visit, (14d, 14e, 14f, 14g, 14h, 14i, 14j) $0 copay"	20% coinsurance	$0 copay	not covered	not covered	(17a1): $35/visit	(17b1): $100 allowance	not covered	not covered	not covered	"(13c): $10/Month; (13d): $0/discharge; (14b, 14c): $0/visit"												1.2408	0.0181	0.3992	0	0.102	0.1415	0.2014	0.1033	1.6172	0.2828	0.568	0.003	0.0007	0.2982	0.8331	3.7757	0	0.5602	0.4784	0.2405	0.4877	0	0	0	0.0371	0	0	0	0	0											11.3889	0	0	19.3295	0.136406766	2.998230162	0	1.155915145	1.318606996	1.160188981	1.849298614	8.040942312	4.746312582	8.516034892	1.506111662	0.004338621	1.765405642	5.283786162	21.01645699	0	1.766370857	3.827484405	4.64613092	4.909943578	0	0	0.26	0.282855225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5203
H5302_007_0	2011	6																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	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	0.259492208	0	0	0	0	0	0											0.2595	YES	339.2036861	5.82269486	16.27296988	0	24.39165612	20.29583637	11.31249747	774.5305821	53.0387601	9.170352757	27.8316791	1.545277939	0.492474401	14.72037136	27.41569557	133.3144087	2.906408325	6.980304616	13.54372406	13.17849917	35.68819467	0	0	0	6.8777571	0	0.011887926	0.007789616	0	0											6700	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share; Part B Deductible Waived	FFS Medicare Cost-Share; Part B Deductible Waived	FFS Medicare Cost-Share; Part B Deductible Waived	(4a) $50/visit; waive if admitted; (4b) $25/visit	FFS Medicare Cost-Share; Part B Deductible Waived	FFS Medicare Cost-Share; Part B Deductible Waived	FFS Medicare Cost-Share; Part B Deductible Waived	FFS Medicare Cost-Share; Part B Deductible Waived	FFS Medicare Cost-Share; Part B Deductible Waived	FFS Medicare Cost-Share; Part B Deductible Waived	FFS Medicare Cost-Share; Part B Deductible Waived; 14(b) - 14(h) $0 copay	FFS Medicare Cost-Share; Part B Deductible Waived; 14(b) - 14(h) $0 copay	FFS Medicare Cost-Share; Part B Deductible Waived	FFS Medicare Cost-Share; Part B Deductible Waived	FFS Medicare Cost-Share; Part B Deductible Waived	FFS Medicare Cost-Share; Part B Deductible Waived	FFS Medicare Cost-Share; Part B Deductible Waived	FFS Medicare Cost-Share; Part B Deductible Waived	not covered	"(16a, 16b): $25 deductible"	(17a): $40/visit	(17b): $100 allowance	(18a): $40/visit (Hearing Aid Fitting/Eval Only)	(18b): $40/visit (Hearing Aid Fitting/Eval Only)	(14a): $0/visit	"(13c): $10/Month; (13d): $0/discharge; (14b, 14c): $0/visit"												0.080298664	0.080298664	0.175105713	0	0.2	0.2	0.2	49.25973611	0.2	0.2	0.2	0.2	0.2	0.2	0.200878094	0.181919599	0.2	0.2	0.199926609	0.197755932	0.2	0	0	0	40	0	0.786110463	0.05848262	0	0											NO	0.077395528	0.077395528	0.168774902	0	0.192769155	0.192769155	0.192769155	47.47878859	0.192769155	0.192769155	0.192769155	0.192769155	0.192769155	0.192769155	0.193615502	0.175342437	0.192769155	0.192769155	0.192698418	0.19060622	0.192769155	0	0	0	38.55383105	0	0.757689249	0.056368227	0	0												26.2528	0.450650542	2.7464689	0	4.701958945	3.912411232	2.180700581	3.064481147	10.22423698	1.767761154	5.365089269	0.297881923	0.094933874	2.837633552	5.308103672	23.37567328	0.560265878	1.345587424	2.6098542	2.511903909	6.879583138	0	0	0	0.02209699	0	0.009007353	0.000439087	0	0	0	0	0	0	0	0	0	0	0	0	106.5196	25	3.995589875	26.2528	0.450650542	2.7464689	0	4.701958945	3.912411232	2.180700581	3.064481147	10.22423698	1.767761154	5.365089269	0.297881923	0.094933874	2.837633552	5.308103672	23.37567328	0.560265878	1.345587424	2.6098542	2.511903909	6.879583138	0	0	0.259492208	0.02209699	0	0.009007353	0.000439087	0	0	0	0	0	0	0	0	0	0	0	0	106.7791	NO																																										0.0477	0	0.0144	0	0.0203	0.0563	0.0361	0.0013	0.0642	0.0046	0.0133	0.0005	0	0.0172	0.0392	0.1855	0	0.0164	0.0123	0.0113	0.0155	0	0	0	0	0	0	0	0	0											0.5561	0	0	26.3005	0.450650542	2.760895122	0	4.7222498	3.968708994	2.216782598	3.065772453	10.28847071	1.772343764	5.378412643	0.29839916	0.094955649	2.854850575	5.347312317	23.56114295	0.560265878	1.361972145	2.622148853	2.523169618	6.895126166	0	0	0.259492208	0.02209699	0	0.009007353	0.000439087	0	0	0	0	0	0	0	0	0	0	0	0	107.3352
H5302_008_0	2011	6																															D	D	D	V	T	COIN	COIN	V	V	O	O	O	COIN	O	P	P	P	P	P	P	COIN	V	T	V	V	V	V	V	P	O											16.70522854	0.309512795	1.31729574	0	2.456741966	0.042812201	0	0	17.89340359	0	4.734369964	0.571002667	0	0	0	22.01002276	0	0	0.755487123	0	0	0	0	3.71	0	0	0	0	0	0											70.5059	YES	0	0	0	0	0	6.796976201	5.35924481	461.027398	0	1803.140653	984.7420445	0	0.070929007	484.5103959	4507.32135	12953.27089	167.348881	615.0665192	2480.311223	1815.004882	26.56391263	0	0	0	38.14445556	0	0	0	0	0											3400	0% after Deductible	0% after Deductible	0% after Deductible	$0 copay	0% after Deductible	20% coinsurance	20% coinsurance	(4a) $50/visit; waive if admitted; (4b) $25/visit	0% after Deductible	$35 copay	"$35 copay except: MRI, CT, PET @ 0% after Deductible"	0% after Deductible	20% coinsurance	$35/visit	(7a) $10/visit; (14b) - (14j) $0 copay; (17a) $10/visit; Office Surgery @ 0% after Deductible	"(7b, 7d, 7f, 7g) $35/visit; (14d, 14e, 14f, 14g, 14h, 14i, 14j) $0 copay; (17a) $35/visit; Office Surgery @ 0% after Deductible"	$35/visit	$35/visit	"$35 copay except: MRI, CT, PET @ 0% after Deductible"	"(7b, 7d, 7f, 7g) $35/visit, (14d, 14e, 14f, 14g, 14h, 14j) $0 copay, (14i) 20% coinsurance"	20% coinsurance	$0 copay	not covered	16 (a): $25 deductible	17 (a): $35/visit	17 (b): $100 allowance	not covered	not covered	14 (a): $0/visit	14 (c): Physicals $0/visit											1500	0	0	0	0	0	0.183277789	0.2	48.14410745	0	29.78671507	15.1692824	0	0.052437868	34.19177611	9.532714604	16.74372223	35	35	11.53034105	10.91511369	0.215777978	0	0	0	35	0	0	0	0	0											NO	0	0	0	0	0	0.16281569	0.177670945	42.76904536	0	26.46116909	13.4757037	0	0.046583428	30.37442588	8.468432065	14.87436477	31.09241539	31.09241539	10.24303296	9.696492822	0.191687386	0	0	0	31.09241539	0	0	0	0	0												0	0	0	0	0	1.10665437	0.95218209	1.643141808	0	3.97610081	1.105841002	0	0.003304116	1.226393759	3.18082872	16.05597301	0.433606744	1.593658643	2.117159134	1.466598484	5.091966979	0	0	0	0.098833605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0522	1500	5.033624031	16.7052	0.309512795	1.31729574	0	2.456741966	1.149466571	0.95218209	1.643141808	17.89340359	3.97610081	5.840210966	0.571002667	0.003304116	1.226393759	3.18082872	38.06599577	0.433606744	1.593658643	2.872646257	1.466598484	5.091966979	0	0	3.71	0.098833605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.5581	YES	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											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	16.7052	0.309512795	1.31729574	0	2.456741966	1.149466571	0.95218209	1.643141808	17.89340359	3.97610081	5.840210966	0.571002667	0.003304116	1.226393759	3.18082872	38.06599577	0.433606744	1.593658643	2.872646257	1.466598484	5.091966979	0	0	3.71	0.098833605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.5581
H5302_009_0	2011	6																															D	D	D	V	T	COIN	COIN	V	V	O	O	O	COIN	O	P	P	P	P	P	P	COIN	V	T	V	V	V	V	V	P	O											14.70194378	0.273349753	0.889147529	0	2.171474015	0.093634056	0	0	21.6017039	0	4.239206404	0.208985439	0	0	0	21.16976378	0	0	1.139673839	0	6.728215662	0	0	3.450430086	0	0	0	0	0	0											76.6675	YES	0	0	0	0	0	11.08781077	8.913345596	470.3418108	0	1855.399139	960.0814412	0	0.080162027	464.8021076	4395.680703	14541.62542	168.6140119	769.8159871	2773.289651	2203.553395	0	0	0	0	0	35.25159727	0	0	0	0											3400	0% after Deductible	0% after Deductible	0% after Deductible	$0 copay	0% after Deductible	20% coinsurance	20% coinsurance	(4a) $50/visit; waive if admitted; (4b) $10/visit	0% after Deductible	$35 copay	0% after Deductible except Radiation Therapy @ $35/visit and EKG Preventive Screening @ $0 copay	0% after Deductible	20% coinsurance	"$35/visit, except (5) at $75/visit"	"(7a) $10/visit; (14b) - (14j) $0 copay; AAA Screening, HIV Screening and Cardiovascular Preventive Screening $0 copay; (17a) $10/visit, except Glaucoma Testing at $0 copay; Office Surgery @ 0% after Deductible"	"(7b, 7d, 7f, 7g) $35/visit; (14d, 14e, 14f, 14g, 14h, 14i, 14j) $0 copay; AAA Screening, HIV Screening and Cardiovascular Preventive Screening $0 copay; (17a) $35/visit, except for Glaucoma Testing at $0 copay; Office Surgery @ 0% after Deductible"	$35/visit	$35/visit	"$35 copay except: MRI, CT, PET @ 0% after Deductible"	"(7b, 7d, 7f, 7g) $35/visit, (14d, 14e, 14f, 14g, 14h, 14i, 14j) $0 copay"	0% after Deductible	$0 copay	not covered	(16a): $25 deductible	(17a): $35/visit	(17b): $100 allowance	not covered	not covered	(14a): $0/visit	"(13c): $10/Month; (13d): $0/discharge; (14b, 14c): $0/visit"												0	0	0	0	0	0.174799658	0.2	47.38931205	0	29.93355052	3.702726946	0	0.084097717	33.4845156	9.811020827	16.04358365	35	35	10.9740123	10.08849093	0	0	0	0	0	35	0	0	0	0											NO	0	0	0	0	0	0.158381574	0.18121497	42.93826382	0	27.12203731	3.354947763	0	0.076198826	30.33947746	8.889519226	14.53668765	31.71261976	31.71261976	9.943276549	9.140927905	0	0	0	0	0	31.71261976	0	0	0	0												0	0	0	0	0	1.756104924	1.615231655	1.682971729	0	4.193517056	0.26841859	0	0.006108252	1.175154422	3.256290677	17.61558889	0.445599337	2.034406807	2.297965496	1.67854356	0	0	0	0	0	0.093160042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1191	1500	3.951482104	14.7019	0.273349753	0.889147529	0	2.171474015	1.84973898	1.615231655	1.682971729	21.6017039	4.193517056	4.507624995	0.208985439	0.006108252	1.175154422	3.256290677	38.78535267	0.445599337	2.034406807	3.437639335	1.67854356	6.728215662	0	0	3.450430086	0	0.093160042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.7866	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	14.7019	0.273349753	0.889147529	0	2.171474015	1.84973898	1.615231655	1.682971729	21.6017039	4.193517056	4.507624995	0.208985439	0.006108252	1.175154422	3.256290677	38.78535267	0.445599337	2.034406807	3.437639335	1.67854356	6.728215662	0	0	3.450430086	0	0.093160042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.7866
H5302_809_0	2011	2																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	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	268.5109363	5.891814445	26.08238601	0	10.5666387	7.132820324	5.843319773	24.45463384	53.00310557	8.285259366	23.80416793	1.896994219	0.086648872	12.26940513	34.90705215	131.5467492	0	4.008739702	20.71240653	11.51048307	31.30762701	0	0	0	0	0	0	0	0	0												FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered												0.080298664	0.080298664	0.175105713	0	0.233	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	0	0	0	0	0	0	0	0											NO	0.066031913	0.066031913	0.14399449	0	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0	0.191602636	0.191602636	0.191602636	0.191602636	0	0	0	0	0	0	0	0	0												17.7303	0.389047776	3.75571988	0	2.024595828	1.366667175	1.119595471	4.685572303	10.15553474	1.587477534	4.560941321	0.363469093	0.016602152	2.350850364	6.688283203	25.20470389	0	0.768085093	3.968551688	2.205438896	5.99862386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9401	0	20.51259805	17.7303	0.389047776	3.75571988	0	2.024595828	1.366667175	1.119595471	4.685572303	10.15553474	1.587477534	4.560941321	0.363469093	0.016602152	2.350850364	6.688283203	25.20470389	0	0.768085093	3.968551688	2.205438896	5.99862386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9401	NO	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered												1.4808	0	0.5872	0	0.2629	0.4681	0.2851	0.4532	2.3371	0.4082	0.7535	0.0033	0.0025	0.7151	1.6643	7.1331	0	0.495	0.9428	0.6218	0.5773	0	0	0	0	0	0	0	0	0											19.1914	0	0	19.2111	0.389047776	4.342964026	0	2.287518545	1.834792224	1.404660315	5.138746861	12.4926765	1.99567113	5.314446996	0.366794074	0.019052993	3.065964735	8.352611658	32.33777551	0	1.263059017	4.911348447	2.827267807	6.575923368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.1314
H5302_810_0	2011	2																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	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	YES	268.5109363	5.891814445	26.08238601	0	10.5666387	7.132820324	5.843319773	24.45463384	53.00310557	8.285259366	23.80416793	1.896994219	0.086648872	12.26940513	34.90705215	131.5467492	0	4.008739702	20.71240653	11.51048307	31.30762701	0	0	0	0	0	0	0	0	0											6700	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered												0.080298664	0.080298664	0.175105713	0	0.233	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	0	0	0	0	0	0	0	0											NO	0.066031913	0.066031913	0.14399449	0	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0	0.191602636	0.191602636	0.191602636	0.191602636	0	0	0	0	0	0	0	0	0												17.7303	0.389047776	3.75571988	0	2.024595828	1.366667175	1.119595471	4.685572303	10.15553474	1.587477534	4.560941321	0.363469093	0.016602152	2.350850364	6.688283203	25.20470389	0	0.768085093	3.968551688	2.205438896	5.99862386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9401	0	20.51259805	17.7303	0.389047776	3.75571988	0	2.024595828	1.366667175	1.119595471	4.685572303	10.15553474	1.587477534	4.560941321	0.363469093	0.016602152	2.350850364	6.688283203	25.20470389	0	0.768085093	3.968551688	2.205438896	5.99862386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9401	NO	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered												1.4808	0	0.5872	0	0.2629	0.4681	0.2851	0.4532	2.3371	0.4082	0.7535	0.0033	0.0025	0.7151	1.6643	7.1331	0	0.495	0.9428	0.6218	0.5773	0	0	0	0	0	0	0	0	0											19.1914	0	0	19.2111	0.389047776	4.342964026	0	2.287518545	1.834792224	1.404660315	5.138746861	12.4926765	1.99567113	5.314446996	0.366794074	0.019052993	3.065964735	8.352611658	32.33777551	0	1.263059017	4.911348447	2.827267807	6.575923368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.1314
H5302_811_0	2011	2																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	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	YES	268.5109363	5.891814445	26.08238601	0	10.5666387	7.132820324	5.843319773	24.45463384	53.00310557	8.285259366	23.80416793	1.896994219	0.086648872	12.26940513	34.90705215	131.5467492	0	4.008739702	20.71240653	11.51048307	31.30762701	0	0	0	0	0	0	0	0	0											6700	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered												0.080298664	0.080298664	0.175105713	0	0.233	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	0	0	0	0	0	0	0	0											NO	0.066031913	0.066031913	0.14399449	0	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0.191602636	0	0.191602636	0.191602636	0.191602636	0.191602636	0	0	0	0	0	0	0	0	0												17.7303	0.389047776	3.75571988	0	2.024595828	1.366667175	1.119595471	4.685572303	10.15553474	1.587477534	4.560941321	0.363469093	0.016602152	2.350850364	6.688283203	25.20470389	0	0.768085093	3.968551688	2.205438896	5.99862386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9401	0	20.51259805	17.7303	0.389047776	3.75571988	0	2.024595828	1.366667175	1.119595471	4.685572303	10.15553474	1.587477534	4.560941321	0.363469093	0.016602152	2.350850364	6.688283203	25.20470389	0	0.768085093	3.968551688	2.205438896	5.99862386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9401	NO	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	FFS Medicare Cost-Share	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered												1.4808	0	0.5872	0	0.2629	0.4681	0.2851	0.4532	2.3371	0.4082	0.7535	0.0033	0.0025	0.7151	1.6643	7.1331	0	0.495	0.9428	0.6218	0.5773	0	0	0	0	0	0	0	0	0											19.1914	0	0	19.2111	0.389047776	4.342964026	0	2.287518545	1.834792224	1.404660315	5.138746861	12.4926765	1.99567113	5.314446996	0.366794074	0.019052993	3.065964735	8.352611658	32.33777551	0	1.263059017	4.911348447	2.827267807	6.575923368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.1314
H5378_010_0	2011	11																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	3072.870472	158.446172	2816.70646	55.16821414	392.0398434	30.15169861	5.101846322	342.7120562	418.0090138	3.937505879	15.82255168	0	2.651643215	11.23172003	5977.011202	147.1903641	1.673744559	612.2986054	55.58484773	59.0563817	19.81002215	22.80413165	0	0	0	0	1.539097543	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: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $300; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	193.2806604	139.004653	35.01559476	0.15	150	0.2	0.2	49.50267054	219.0699625	0	0.2	0	38.07017017	0.243373869	16.80292065	0.085583975	0.45	0	0.133117997	0.026336588	0.2	0	0	0	0	0	20	0	0	0											NO	152.4630764	109.6492375	27.62089745	0.118322554	118.3225545	0.157763406	0.157763406	39.04854954	172.8061172	0	0.157763406	0	30.03039855	0.191977452	13.25442996	0.067510097	0.354967663	0	0.105005743	0.020774749	0.157763406	0	0	0	0	0	20	0	0	0												39.0416	1.447791829	6.483330023	6.527644022	3.86559631	4.756834668	0.804884652	1.115200725	6.019542884	0	2.496219644	0	0.006635825	2.156236997	6.60182303	9.936835709	0.594125195	0	5.83672825	1.226881497	3.125296567	0	0	0	0	0	0.002565163	0	0	0	0	0	0	0	0	0	0	0	0	0	102.0458	0	27.31912271	39.0416	1.447791829	6.483330023	6.527644022	3.86559631	4.756834668	0.804884652	1.115200725	6.019542884	0	2.496219644	0	0.006635825	2.156236997	6.60182303	9.936835709	0.594125195	0	5.83672825	1.226881497	3.125296567	0	0	0	0	0	0.002565163	0	0	0	0	0	0	0	0	0	0	0	0	0	102.0458	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $300; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	4.3387	0.1609	0.7205	0.7604	0.4296	0.5541	0.0938	0.121	0.6689	0	0.2718	0	0.0007	0.237	0.7337	1.068	0.0657	0	0.6456	0.1363	0.3404	0	0	0	0	0	0.0003	0	0	0											11.3473	0	3.035458079	43.3803	1.60868416	7.203819019	7.288015757	4.295177959	5.310933914	0.898641533	1.236227195	6.688491464	0	2.768056742	0	0.007358463	2.393196935	7.33548009	11.00479094	0.659828899	0	6.482320317	1.363224181	3.465696322	0	0	0	0	0	0.002850181	0	0	0	0	0	0	0	0	0	0	0	0	0	113.3931
H5378_016_0	2011	10																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	YES	2721.002502	140.1018789	2466.138145	53.61993513	346.7440025	26.6680054	4.512384758	303.1154922	369.4467701	3.445522269	13.99443192	0	2.345275351	9.903201422	5187.736818	130.251681	1.480362002	535.2571726	49.16674138	52.0191397	17.52119456	20.16936802	0	0	0	0	1.36127195	0	0	0											6700	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.50267054	283.0797191	0.2	0.2	0	25	0.273661498	20.92761984	0.094731404	0.45	0	0.133106885	0.099101301	0.2	0	0	0	0	0	20	0	0	0											NO	165.5976068	125.5295462	42.15473667	0	133.7649599	0.17835328	0.17835328	44.14481827	252.4409819	0.17835328	0.17835328	0	22.29415999	0.244042129	18.66254819	0.084478283	0.40129488	0	0.118700248	0.088375211	0.17835328	0	0	0	0	0	20	0	0	0												37.5493	1.465577107	8.663283674	0	3.865183133	4.756326231	0.804798622	1.115081526	7.771958782	0.614520198	2.495952834	0	0.004357162	2.416798357	8.068032365	11.00343832	0.594061692	0	5.836104387	4.597202433	3.124962517	0	0	0	0	0	0.002268787	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7492	0	12.71312478	37.5493	1.465577107	8.663283674	0	3.865183133	4.756326231	0.804798622	1.115081526	7.771958782	0.614520198	2.495952834	0	0.004357162	2.416798357	8.068032365	11.00343832	0.594061692	0	5.836104387	4.597202433	3.124962517	0	0	0	0	0	0.002268787	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7492	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%	9a: 20%	12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9c: 45%; 9d: 20%	7a : 20%; 14a: 20%; 14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 50%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%; 9a: 20%; 9b: 20%	7e: 45%; 7h: 45%	7c: 20%; 7i: 20%; 9d: 20%	8b: 20%	8a: 20%; 17a: 20%; 18a: 20%	15: 20%	13a: 20%	0	0	17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline												10000	1.9812	0.0773	0.4571	0.4813	0.1129	0.2602	0.0445	0.0575	0.4893	0.0314	0.1426	0	0.0001	0.0983	0.3357	0.6242	0.0312	0.0376	0.3388	0.5087	0.1616	0.0035	0	0	0	0	0	0	0	0											6.275	0	0.66911183	39.5305	1.542906113	9.120389008	0.481307699	3.978096741	5.016489981	0.849308997	1.172537934	8.261212539	0.64595216	2.638589942	0	0.004425775	2.515092259	8.403714051	11.62767793	0.625254032	0.037592072	6.174860667	5.105938142	3.286564747	0.003458469	0	0	0	0	0.002268787	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0242
H5378_182_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1202.932939	58.44448641	1653.97	17.64475085	192.0321314	23.42361093	3.445328924	268.0838525	310.5885782	4.068153374	16.38868837	0	10.22985998	11.43049191	5031.300403	81.71764224	0.676800831	288.9373859	22.62955618	37.01819143	9.280226708	44.32939324	0	0	0	0	0	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: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	128.8537736	92.6697687	35.01559476	0.15	150	0.2	0.2	49.68634605	127.0036683	0	0.2	0	30.10432661	0.151865851	4.147483013	0.067085932	0.45	0	0.093156608	0.031232656	0.2	0	0	0	0	0	0	0	0	0											NO	92.12617675	66.25581272	25.03498953	0.107245028	107.2450277	0.14299337	0.14299337	35.52409038	90.8034128	0	0.14299337	0	21.52359561	0.10857905	2.96531287	0.047964218	0.321735083	0	0.066603887	0.022330314	0.14299337	0	0	0	0	0	0	0	0	0												9.2351	0.322690579	3.450593469	1.892311793	1.716207604	3.349421069	0.492659194	0.793619584	2.350208573	0	2.343473784	0	0.018348614	1.241111949	1.243281653	3.919522794	0.217750572	0	1.507216392	0.826627829	1.327010894	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2472	0	14.45053137	9.2351	0.322690579	3.450593469	1.892311793	1.716207604	3.349421069	0.492659194	0.793619584	2.350208573	0	2.343473784	0	0.018348614	1.241111949	1.243281653	3.919522794	0.217750572	0	1.507216392	0.826627829	1.327010894	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2472	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	1.0193	0.0356	0.3808	0.2084	0.1894	0.3689	0.0543	0.0863	0.2594	0	0.2485	0	0.0019	0.1332	0.1372	0.4057	0.022	0	0.152	0.0912	0.1408	0	0	0	0	0	0	0	0	0											3.9349	0	1.605614596	10.2544	0.358306239	3.83143869	2.100722904	1.905627038	3.718311952	0.546918567	0.879921916	2.609603287	0	2.592013217	0	0.020294595	1.374297465	1.380503809	4.32518231	0.239703711	0	1.659170672	0.917863513	1.467771486	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1821
H5378_183_0	2011	10																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1364.731692	74.17379898	2419.889643	18.9028366	233.6464635	19.82891885	2.124219601	257.5243903	300.3308652	2.801796011	15.69894813	0	3.720654062	17.49220735	4355.750104	77.83268778	0.746963691	318.4055139	25.70381724	29.59227342	15.76031317	27.28479646	0	0	0	0	0	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $10; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.66352692	293.8346337	0.2	0.2	0	25	0.12802437	7.447053351	0.09807777	0.45	0	0.123259614	0.117330525	0.2	0	0	0	0	0	0	0	0	0											NO	156.4102822	118.5651903	39.81599969	0	126.3437047	0.168458273	0.168458273	41.83115988	247.4943747	0.168458273	0.168458273	0	21.05728412	0.107833821	6.272588732	0.082610059	0.379031114	0	0.103820508	0.098826488	0.168458273	0	0	0	0	0	0	0	0	0												17.7882	0.732869216	8.029193773	0	2.459979983	3.340345425	0.357842365	0.897711995	6.194183306	0.471985717	2.64461769	0	0.006528906	1.886251561	2.276819085	6.429762896	0.28312248	0	2.668583374	2.92450046	2.654955139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0474	0	11.61761266	17.7882	0.732869216	8.029193773	0	2.459979983	3.340345425	0.357842365	0.897711995	6.194183306	0.471985717	2.64461769	0	0.006528906	1.886251561	2.276819085	6.429762896	0.28312248	0	2.668583374	2.92450046	2.654955139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0474	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $10; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	2.1335	0.0879	0.963	0	0.2951	0.4029	0.0432	0.106	0.7429	0	0.3123	0	0.0008	0.2245	0.2731	0.7377	0.0316	0	0.2982	0.1027	0.3136	0	0	0	0	0	0	0	0	0											7.0689	0	1.290845852	19.9217	0.820770984	8.992230994	0	2.755034799	3.743229767	0.401002299	1.00368318	6.937125779	0.471985717	2.956965612	0	0.007311996	2.110746595	2.549905224	7.167416522	0.314674432	0	2.966780427	3.02719058	2.968568853	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1163
H5378_184_0	2011	10																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1971.137566	131.6475121	3469.776848	28.23750445	262.7560886	28.3222408	1.880814109	338.9901468	397.310039	6.185434791	18.40191183	0	38.31403431	10.5445055	5118.906471	102.204278	0.928115754	466.0453107	35.5826362	38.44260266	26.92926407	28.31906883	0	0	0	0	0	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.71160156	284.1280718	0.2	0.2	0	25	0.259475219	20.5360216	0.109619815	0.45	0.013831259	0.120321539	0.099077081	0.2	0	0	0	0	0	0	0	0	0											NO	158.4202129	120.0887973	40.32765019	0	127.9672686	0.170623025	0.170623025	42.40971913	242.3939552	0.170623025	0.170623025	0	21.3278781	0.221362233	17.51959062	0.093518322	0.383901806	0.011799656	0.102648124	0.084524156	0.170623025	0	0	0	0	0	0	0	0	0												26.0223	1.317449283	11.66066225	0	2.802014914	4.832426395	0.320910192	1.198039743	8.025462651	1.055377594	3.139789859	0	0.068096421	2.334155288	7.473428815	9.557972583	0.356305314	0.000458265	3.652490871	3.249328544	4.594752491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.6615	0	15.78178774	26.0223	1.317449283	11.66066225	0	2.802014914	4.832426395	0.320910192	1.198039743	8.025462651	1.055377594	3.139789859	0	0.068096421	2.334155288	7.473428815	9.557972583	0.356305314	0.000458265	3.652490871	3.249328544	4.594752491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.6615	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	2.8717	0.1454	1.2868	0	0.3092	0.5375	0.0357	0.1304	0.8856	0	0.3411	0	0.0075	0.2556	0.8247	1.0169	0.0388	0	0.3981	0.1456	0.4991	0	0	0	0	0	0	0	0	0											9.7298	0	1.753531972	28.894	1.46283426	12.94745569	0	3.11122672	5.369946246	0.356605635	1.32845782	8.911099549	1.055377594	3.480860674	0	0.075611091	2.589778272	8.298146916	10.57484517	0.395122147	0.000458265	4.050589293	3.394922562	5.093898899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.3912
H5378_185_0	2011	10																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1713.809523	70.57066549	1858.746053	36.3508509	216.0707114	27.43128433	2.57047877	302.2116237	325.1849277	5.448439985	16.96241378	0	11.02405935	12.64177482	4651.381857	94.10345687	1.367311546	338.9764951	34.16135023	36.32093939	20.08459064	45.61679732	0	0	0	0	0.367742099	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.87696432	278.31474	0.2	0.2	0	25	0.334794278	19.97340042	0.105648228	0.45	0	0.125144315	0.1088967	0.2	0	0	0	0	0	20	0	0	0											NO	157.7995213	119.6182885	40.16964616	0	127.4658919	0.169954523	0.169954523	42.38407829	236.5042438	0.169954523	0.169954523	0	21.24431532	0.284499008	16.97284866	0.089776971	0.382397676	0	0.106344211	0.092537433	0.169954523	0	0	0	0	0	20	0	0	0												22.5365	0.703461852	6.222097602	0	2.295137162	4.662070832	0.436864492	1.067413427	6.408967951	0.925987016	2.882838935	0	0.019516549	3.5965724	6.578933362	8.448323277	0.522856757	0	3.632861848	3.361046501	3.413467012	0	0	0	0	0	0.000612903	0	0	0	0	0	0	0	0	0	0	0	0	0	77.7156	0	13.73886706	22.5365	0.703461852	6.222097602	0	2.295137162	4.662070832	0.436864492	1.067413427	6.408967951	0.925987016	2.882838935	0	0.019516549	3.5965724	6.578933362	8.448323277	0.522856757	0	3.632861848	3.361046501	3.413467012	0	0	0	0	0	0.000612903	0	0	0	0	0	0	0	0	0	0	0	0	0	77.7156	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	2.4751	0.0773	0.6833	0	0.2521	0.5077	0.0476	0.1166	0.7039	0	0.2818	0	0.0021	0.3673	0.7225	0.8931	0.0548	0	0.3806	0.1114	0.3339	0	0	0	0	0	0.0001	0	0	0											8.0111	0	1.526540785	25.0116	0.780720255	6.90544571	0	2.547202902	5.169750973	0.48443722	1.183968422	7.112839282	0.925987016	3.164684949	0	0.021659974	3.963877923	7.301471315	9.341374403	0.577622236	0	4.013463681	3.472415922	3.747408807	0	0	0	0	0	0.000681004	0	0	0	0	0	0	0	0	0	0	0	0	0	85.7266
H5378_188_0	2011	10																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	2927.402571	153.2127861	5378.719049	39.31344627	423.7286461	47.24862498	3.450098199	562.8487052	589.1861666	13.80891076	32.21376045	0	27.39180102	19.45120444	9104.43177	164.7944974	1.798235323	783.584004	58.50839499	65.3502491	29.68041702	73.27567693	0	0	0	0	0.458927006	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: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $300; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	193.2806604	139.004653	35.01559476	0.15	150	0.2	0.2	49.68766093	222.0064836	0	0.2	0	50	0.189914628	16.33678465	0.096744587	0.45	0.045682794	0.123628656	0.03649	0.2	0	0	0	0	0	20	0	0	0											NO	159.4221683	114.6541157	28.88163788	0.123723321	123.7233213	0.164964428	0.164964428	40.98348293	183.1158634	0	0.164964428	0	41.2411071	0.15664579	13.47494171	0.079797077	0.371169964	0.03768018	0.101971653	0.03009776	0.164964428	0	0	0	0	0	20	0	0	0												38.8911	1.463873042	12.94551799	4.863990145	4.36875962	7.794342413	0.569143477	1.922291692	8.990777801	0	5.314124579	0	0.094139017	3.046949286	10.22347395	13.15011924	0.66745094	0.002460466	5.966197746	1.966896132	4.896213029	0	0	0	0	0	0.000764878	0	0	0	0	0	0	0	0	0	0	0	0	0	127.1386	0	27.00185293	38.8911	1.463873042	12.94551799	4.863990145	4.36875962	7.794342413	0.569143477	1.922291692	8.990777801	0	5.314124579	0	0.094139017	3.046949286	10.22347395	13.15011924	0.66745094	0.002460466	5.966197746	1.966896132	4.896213029	0	0	0	0	0	0.000764878	0	0	0	0	0	0	0	0	0	0	0	0	0	127.1386	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $300; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	4.3159	0.1625	1.4366	0.5398	0.4848	0.865	0.0632	0.2133	0.9978	0	0.5897	0	0.0104	0.3381	1.1345	1.3786	0.0741	0	0.6621	0.2183	0.5434	0	0	0	0	0	0.0001	0	0	0											14.0282	0	3.000205882	43.207	1.626326146	14.38214501	5.403770764	4.853582101	8.65931846	0.632304094	2.135617741	9.988528096	0	5.903858804	0	0.104586081	3.385084052	11.35802253	14.52872831	0.741521214	0.002460466	6.628295697	2.185172153	5.439569578	0	0	0	0	0	0.000849865	0	0	0	0	0	0	0	0	0	0	0	0	0	141.1667
H5378_190_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	YES	1315.459298	64.14371018	1819.769407	19.61133697	213.4349682	25.7481858	3.829326188	297.9629926	341.8063365	4.295488838	18.21528073	0	11.37002346	12.33548439	5267.359548	89.92385793	0.7522333	293.515735	25.11588975	39.78248254	10.31454933	49.27010168	0	0	0	0	0	0	0	0											3400	1a: $335 Per Day (Days 1-6)	1b: $335 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 20%	10a: $150	11a: 30%	11b: 30%; 11c: 0%-30%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $50	3: $40; 5: $335; 7c: $40; 7i: $40; 9c: 45%; 9d: $40	7a : $15; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $40; 7i: $40; 9d: $40	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	234.7479911	177.948277	47.27105293	0.2	150	0.3	0.3	49.68634605	275.5699509	0.2	0.2	0	30.10432661	0.221815909	12.28479108	0.107983811	0.45	0	0.093289509	0.113363461	0.2	0	0	0	0	0	0	0	0	0											NO	139.2747331	105.5757652	28.04566398	0.118658935	88.99420124	0.177988402	0.177988402	29.47864453	163.4941844	0.118658935	0.118658935	0	17.86073667	0.131602198	7.28850113	0.06406622	0.266982604	0	0.055348169	0.067257938	0.118658935	0	0	0	0	0	0	0	0	0												15.2675	0.564335107	4.253053442	2.327060358	1.582872876	4.582878458	0.681575651	0.731962095	4.656945685	0.509698131	2.161405812	0	0.016923083	1.623376858	3.199263002	5.761081663	0.200833205	0	1.390118504	2.675687731	1.223913439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4105	0	36.61306572	15.2675	0.564335107	4.253053442	2.327060358	1.582872876	4.582878458	0.681575651	0.731962095	4.656945685	0.509698131	2.161405812	0	0.016923083	1.623376858	3.199263002	5.761081663	0.200833205	0	1.390118504	2.675687731	1.223913439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4105	YES	1a: $335 Per Day (Days 1-6)	1b: $335 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 30%	11b: 30%; 11c: 20%-30%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%	9a: 20%	12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9c: 45%; 9d: 20%	7a : 20%; 14a: 20%; 14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 50%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%; 9a: 20%; 9b: 20%	7e: 45%; 7h: 45%	7c: 20%; 7i: 20%; 9d: 20%	8b: 20%	8a: 20%; 17a: 20%; 18a: 20%	15: 20%	13a: 20%	0	0	17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline												5100	0.8025	0.0297	0.2235	0.1221	0.0489	0.2404	0.0357	0.0379	0.274	0.0249	0.1207	0	0.0002	0.079	0.1986	0.3081	0.0096	0.0127	0.0738	0.2401	0.0618	0.0051	0	0	0	0	0	0	0	0											2.9492	0	1.927003459	16.07	0.593997194	4.47659871	2.449112597	1.6317489	4.823246341	0.717323685	0.769868158	4.930937046	0.534628137	2.282061316	0	0.017094027	1.702383989	3.397859797	6.069163246	0.210475552	0.012668389	1.463886603	2.915804325	1.28573888	0.005129599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.3597
H5378_194_0	2011	11																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	YES	2000.990767	104.5767561	3635.236069	29.49554484	289.2973958	32.25862657	2.355527372	384.2805205	402.0056164	9.327627985	21.99369123	0	18.70153641	13.24815054	6103.146737	112.5618567	1.227731004	528.7792511	39.94957849	44.44969581	20.26407096	50.0283913	0	0	0	0	0.313328799	0	0	0											6700	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.68766093	287.8301312	0.2	0.2	0	25	0.212841769	20.33632588	0.106852167	0.45	0.046218996	0.123618033	0.101991009	0.2	0	0	0	0	0	20	0	0	0											NO	161.8455547	122.6853422	41.19960955	0	130.7341608	0.174312214	0.174312214	43.30583101	250.8615376	0.174312214	0.174312214	0	21.78902679	0.185504601	17.72434998	0.093128189	0.392202482	0.040282678	0.107740666	0.088891393	0.174312214	0	0	0	0	0	20	0	0	0												26.9876	1.069169592	12.48085889	0	3.151754354	5.623072628	0.410597192	1.38679894	8.403978921	1.625919489	3.833769019	0	0.033957356	2.457592875	9.014525729	10.48268191	0.481519147	0.001775054	4.304194179	3.951195365	3.53227508	0	0	0	0	0	0.000522215	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2338	0	14.62366053	26.9876	1.069169592	12.48085889	0	3.151754354	5.623072628	0.410597192	1.38679894	8.403978921	1.625919489	3.833769019	0	0.033957356	2.457592875	9.014525729	10.48268191	0.481519147	0.001775054	4.304194179	3.951195365	3.53227508	0	0	0	0	0	0.000522215	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2338	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%	9a: 20%	12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9c: 45%; 9d: 20%	7a : 20%; 14a: 20%; 14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 50%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%; 9a: 20%; 9b: 20%	7e: 45%; 7h: 45%	7c: 20%; 7i: 20%; 9d: 20%	8b: 20%	8a: 20%; 17a: 20%; 18a: 20%	15: 20%	13a: 20%	0	0	17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline												10000	1.4307	0.0567	0.6616	0.248	0.1204	0.2948	0.0218	0.0735	0.5311	0.0853	0.2246	0	0.0019	0.1312	0.3357	0.5821	0.0255	0.0351	0.2522	0.4203	0.1873	0.0081	0	0	0	0	0	0	0	0											5.7279	0	0.769666343	28.4183	1.125848616	13.14249657	0.248028391	3.272171499	5.917888303	0.432363849	1.460316191	8.935056156	1.711186232	4.058398833	0	0.035810612	2.588799294	9.35020618	11.06478855	0.507045533	0.036920268	4.556391516	4.371481092	3.719528724	0.008108805	0	0	0	0	0.000522215	0	0	0	0	0	0	0	0	0	0	0	0	0	104.9617
H5378_801_0	2011	7																															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	302.5353059	6.241489373	58.70376768	26.10235508	11.54104458	28.23386024	2.084545724	14.85832568	53.80345903	9.953020842	22.75750241	0	0.187755436	12.97507796	39.26315613	104.7936585	1.146712847	3.551848624	41.50739673	44.2491441	18.9706442	0.821512229	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	0	0	0	0	0	0	0	0											0	0.081738963	0.081738963	0.177293583	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.065669223	0.065669223	0.14243797	0	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0	0	0	0	0	0	0	0												19.8673	0.409873759	8.361645485	0	2.160398157	5.285169743	0.390211537	2.781368636	10.07160946	1.863131863	4.260036077	0	0.035146428	2.428838597	7.349772333	19.61659753	0.214656161	0.664879784	7.769877569	8.283112391	3.551164237	0.153781011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5185	0	27.13314378	19.8673	0.409873759	8.361645485	0	2.160398157	5.285169743	0.390211537	2.781368636	10.07160946	1.863131863	4.260036077	0	0.035146428	2.428838597	7.349772333	19.61659753	0.214656161	0.664879784	7.769877569	8.283112391	3.551164237	0.153781011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5185	YES	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	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	0	0	0	0	0	0	0											6700	1.0456	0.0216	0.4401	0	0.1137	0.2782	0.0205	0.1464	0.5301	0.0981	0.2242	0	0.0018	0.1278	0.3868	1.0325	0.0113	0.035	0.4089	0.436	0.1869	0.0081	0	0	0	0	0	0	0	0											5.5536	0		20.9129	0.431446062	8.801732089	0	2.274103324	5.563336572	0.410748986	2.927756459	10.60169416	1.961191434	4.484248502	0	0.03699624	2.556672207	7.736602456	20.64905004	0.225953854	0.699873456	8.178818494	8.719065674	3.738067618	0.161874749	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0721
H5378_802_0	2011	7																															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	302.5353059	6.241489373	58.70376768	26.10235508	11.54104458	28.23386024	2.084545724	14.85832568	53.80345903	9.953020842	22.75750241	0	0.187755436	12.97507796	39.26315613	104.7936585	1.146712847	3.551848624	41.50739673	44.2491441	18.9706442	0.821512229	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	0	0	0	0	0	0	0	0											0	0.081738963	0.081738963	0.177293583	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.065669223	0.065669223	0.14243797	0	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0	0	0	0	0	0	0	0												19.8673	0.409873759	8.361645485	0	2.160398157	5.285169743	0.390211537	2.781368636	10.07160946	1.863131863	4.260036077	0	0.035146428	2.428838597	7.349772333	19.61659753	0.214656161	0.664879784	7.769877569	8.283112391	3.551164237	0.153781011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5185	0	27.13314378	19.8673	0.409873759	8.361645485	0	2.160398157	5.285169743	0.390211537	2.781368636	10.07160946	1.863131863	4.260036077	0	0.035146428	2.428838597	7.349772333	19.61659753	0.214656161	0.664879784	7.769877569	8.283112391	3.551164237	0.153781011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5185	YES	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	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	0	0	0	0	0	0	0											6700	1.0456	0.0216	0.4401	0	0.1137	0.2782	0.0205	0.1464	0.5301	0.0981	0.2242	0	0.0018	0.1278	0.3868	1.0325	0.0113	0.035	0.4089	0.436	0.1869	0.0081	0	0	0	0	0	0	0	0											5.5536	0		20.9129	0.431446062	8.801732089	0	2.274103324	5.563336572	0.410748986	2.927756459	10.60169416	1.961191434	4.484248502	0	0.03699624	2.556672207	7.736602456	20.64905004	0.225953854	0.699873456	8.178818494	8.719065674	3.738067618	0.161874749	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0721
H5378_803_0	2011	7																															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	302.5353059	6.241489373	58.70376768	26.10235508	11.54104458	28.23386024	2.084545724	14.85832568	53.80345903	9.953020842	22.75750241	0	0.187755436	12.97507796	39.26315613	104.7936585	1.146712847	3.551848624	41.50739673	44.2491441	18.9706442	0.821512229	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	0	0	0	0	0	0	0	0											0	0.081738963	0.081738963	0.177293583	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.065669223	0.065669223	0.14243797	0	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0.187192601	0	0	0	0	0	0	0	0												19.8673	0.409873759	8.361645485	0	2.160398157	5.285169743	0.390211537	2.781368636	10.07160946	1.863131863	4.260036077	0	0.035146428	2.428838597	7.349772333	19.61659753	0.214656161	0.664879784	7.769877569	8.283112391	3.551164237	0.153781011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5185	0	27.13314378	19.8673	0.409873759	8.361645485	0	2.160398157	5.285169743	0.390211537	2.781368636	10.07160946	1.863131863	4.260036077	0	0.035146428	2.428838597	7.349772333	19.61659753	0.214656161	0.664879784	7.769877569	8.283112391	3.551164237	0.153781011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5185	YES	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	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	0	0	0	0	0	0	0											6700	1.0456	0.0216	0.4401	0	0.1137	0.2782	0.0205	0.1464	0.5301	0.0981	0.2242	0	0.0018	0.1278	0.3868	1.0325	0.0113	0.035	0.4089	0.436	0.1869	0.0081	0	0	0	0	0	0	0	0											5.5536	0		20.9129	0.431446062	8.801732089	0	2.274103324	5.563336572	0.410748986	2.927756459	10.60169416	1.961191434	4.484248502	0	0.03699624	2.556672207	7.736602456	20.64905004	0.225953854	0.699873456	8.178818494	8.719065674	3.738067618	0.161874749	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0721
H5402_007_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	Coin	Coin	Coin	V	T	V	V	P	V	P	O	V																																																			0	YES	1141.564865	26.48424028	624.921291		156.5669894	16.54675853	2.845211415	257.1753211	365.1238068	19.83038621	26.0273819	77.46244613	0.03945079	24.16828319		6139.639718	103.6891816	535.6122994	47.67505175	0.105649057	31.08199852	178.4437369			151.0259691	788.45701	260.9166693														3400	1a: $145/d (1-5) then $0	1b: $150/d (1-5) then $0	"2: $0 (1-10), $100/d (11-100)"	6: $0/visit	10a: $100/trip	11a: 0% - 20%	11b: 20%;11c: 20%	4a: $50/visit;4b: $25/visit	9a: $175/visit;9b: $100/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: $175/visit	12a: 20%	3: $25/visit;5: $125/visit;9a: $175/visit;9c: $30/visit;9d: $25/visit;13a: 20%	7a: $0/visit;14c1: $0/visit;14d: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit	7b: $10/visit;7d: $25/visit;7f: $10/visit;16b: $0/visit;17a: $0-$25;18a: $15/visit	7e: $30/visit;7h: $30/visit	7c: $25/visit;7i: $25/visit	"8b: $5/visit, 8b: 20% chemotherapy 14h: $0/visit"	7g: $25/visit;14b: $0/visit;14i: 20%;14j: 0% - 20%	15: 20%	17b: $15/copay	10b: $10 allowance/trip 12 trips/year	"16a: X-rays, 1 Exam/year, 2 cleanings"	17a1: $25/visit	17b1: $15/copay	"18a1: $0 hearing test, $15 copay for fitting every 2 years"	"18b: $1,000 Allowance /2 yr"	14a: $0/copay	13c: $20/Qtr												108.6132555	142.0227806	31.95573829		100	0.2	0.2	49.93975904	174.2695743	17.5	225.2156906	175	0.2	144.0212554		23.57802274	30	25	0.036556442	0.2	0.2	15			25	15	15														NO	99.12404958	129.6146873	29.16386376		91.26330768	0.182526615	0.182526615	45.57667594	159.0441778	15.97107884	205.5392887	159.7107884	0.182526615	133.5495803		21.51808344	27.3789923	22.81582692	0.033362618	0.182526615	0.182526615	13.68949615			25	15	15															9.4297	0.28606221	1.518759949	0	1.190735111	3.02022383	0.519326809	0.976766356	4.839234638	0.026392722	0.44580413	1.030965695	0.007200819	0.268972006	0	11.00943998	0.236575442	1.018369793	1.590564548	0.019283765	5.673291988	0.203567071	0	0	0.314637436	0.985571263	0.326145837	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9376	0	4.141553624	9.4297	0.28606221	1.518759949	0	1.190735111	3.02022383	0.519326809	0.976766356	4.839234638	0.026392722	0.44580413	1.030965695	0.007200819	0.268972006	0	11.00943998	0.236575442	1.018369793	1.590564548	0.019283765	5.673291988	0.203567071	0	0	0.314637436	0.985571263	0.326145837	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9376	NO																																																																																		0	0	0	9.4297	0.28606221	1.518759949	0	1.190735111	3.02022383	0.519326809	0.976766356	4.839234638	0.026392722	0.44580413	1.030965695	0.007200819	0.268972006	0	11.00943998	0.236575442	1.018369793	1.590564548	0.019283765	5.673291988	0.203567071	0	0	0.314637436	0.985571263	0.326145837	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9376
H5402_032_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	Coin	Coin	V	T	V	V	P	V	P	O	V																																																			0	YES	1517.810348	86.37883597	938.6561896		157.5049248	7.457207145	5.107530207	265.2306277	409.6294123	2828.615032	15.04124848	64.86699089	0.626347947	590.9170895		8094.747581	643.4357675	1773.78622	4572.950654	0.018448241	29.45972653				150.9683858																6700	1a: $75/day days 1-5 then $0	1b: $75/day 1 -10 then $0	"2: $0/days 1-10, $50/day 11+"	6: $0/visit	10a: $100/trip	11a: 0% - 20%	11b: 20%;11c: 20%	4a: $50/visit;4b: $25/visit	9a: $175/visit;9b: $50/visit	8a: $0 - $200 per visit;8a: $175/visit	8b: $5/visit;8b: 20%	9a: $175/visit	12a: 20%	3: $10/visit;5: $0/visit;9a: $175/visit;9c: $20/visit;9d: $10/visit;13a: 20%	7a: $0/visit;14c1: $0/visit;14d: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit	7b: $20/visit;7d: $20/visit;7f: $10/visit;16b: $0/visit;17a: $0-$20;18a: $0/visit	7e: $20/visit;7h: $20/visit	7c: $10/visit;7i: $10/visit	14h: $0/visit	7g: $20/visit;14b: $0/visit;14i: 20%;14j: 0% - 20%	15: 20%	17b: $0/copay	10b: $10 allowance/trip 12 trips/year	"16a: X-rays, 1 Exam/year, 2 cleanings"	17a1: $10/visit	17b1: $0/copay	18a1: $0/visit	"18b: $1,000 Allowance /2 yr"	14a: $0/copay													49.86221149	53.64723115	17.21193186		100	0.2	0.2	46.72553996	93.93249315	11.80347748	0.189714508	175	0.2	68.37229638		18.72004851	20	10	5.567619297	0.2	0.2				10																NO	48.15114319	51.80627637	16.62128837		96.56840672	0.193136813	0.193136813	45.12210947	90.70911203	11.80347748	0.183204278	168.9947118	0.193136813	68.22515789		18.07765258	19.31368134	9.656840672	5.376561247	0.193136813	0.193136813				10																	6.0904	0.372913821	1.3001396	0	1.26749997	1.440261225	0.986452109	0.997313785	3.096426687	2.782291153	2.75562107	0.913514869	0.120970847	3.359617644	0	12.19450288	1.035592782	1.427430909	2.048895773	0.003563034	5.689757708	0	0	0	0.125806988	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0089	0	1.49053476	6.0904	0.372913821	1.3001396	0	1.26749997	1.440261225	0.986452109	0.997313785	3.096426687	2.782291153	2.75562107	0.913514869	0.120970847	3.359617644	0	12.19450288	1.035592782	1.427430909	2.048895773	0.003563034	5.689757708	0	0	0	0.125806988	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0089	NO																																																																																		0	0	0	6.0904	0.372913821	1.3001396	0	1.26749997	1.440261225	0.986452109	0.997313785	3.096426687	2.782291153	2.75562107	0.913514869	0.120970847	3.359617644	0	12.19450288	1.035592782	1.427430909	2.048895773	0.003563034	5.689757708	0	0	0	0.125806988	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0089
H5402_035_0	2011	6																															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	V																																																			0	YES	1735.122497	43.49563464	929.6885229		218.7271052	11.37175215	5.234743282	321.7298696	489.8727675	2524.490334	471.0646044	82.00190077	0.254458658	422.6124123		7575.637807	255.1542483	846.2744238	5071.568805	0.054447107	44.98442804	74.98247118			134.0744438	788.45701	260.9166693														3400	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;14c1: $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"	7g: $10/visit;14b: $0/visit;14i: 20%;14j: 0% - 20%	15: 20%	17b: $15/copay		"16a: X-rays, 1 Exam/year, 2 cleanings"	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	13c: $30/Qtr												75.17849443	90.86890704	29.44244865		100	0.2	0.2	47.16647289	114.1521812	14.275986	68.4244631	150	0.2	76.60832565		9.322912109	25	15	6.053439445	0.2	0.2	15			15	15	7.5														NO	67.58972114	81.69629006	26.4704276		89.9056594	0.179811319	0.179811319	42.40532847	102.6292712	14.275986	62.5725889	134.8584891	0.179811319	72.98494158		8.381825607	22.47641485	13.48584891	5.442384649	0.179811319	0.179811319	13.48584891			15	15	7.5															9.773	0.296119332	2.050771062	0	1.638733718	2.044769751	0.941266093	1.136921733	4.189607094	3.003299056	2.456310986	0.92155437	0.045754547	2.570361852	0	5.291472913	0.477912728	0.951060751	2.300119018	0.009790206	8.088709331	0.084266856	0	0	0.167593055	0.985571263	0.163072918	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5881	0	4.875562177	9.773	0.296119332	2.050771062	0	1.638733718	2.044769751	0.941266093	1.136921733	4.189607094	3.003299056	2.456310986	0.92155437	0.045754547	2.570361852	0	5.291472913	0.477912728	0.951060751	2.300119018	0.009790206	8.088709331	0.084266856	0	0	0.167593055	0.985571263	0.163072918	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5881	NO																																																																																		0	0	0	9.773	0.296119332	2.050771062	0	1.638733718	2.044769751	0.941266093	1.136921733	4.189607094	3.003299056	2.456310986	0.92155437	0.045754547	2.570361852	0	5.291472913	0.477912728	0.951060751	2.300119018	0.009790206	8.088709331	0.084266856	0	0	0.167593055	0.985571263	0.163072918	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5881
H5402_036_0	2011	5																															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	V																																																			0	YES	1231.73327	31.28864152	634.1403875		278.6228616	15.6731216	3.529299198	297.210182	291.2151698	38.36330009	52.69684079	39.62802427	0.01283004	32.46125393		6438.865069	68.42097398	609.8177251	3858.104688	0.005841986	33.3279867	177.6916275			170.8330108	788.45701	260.9166693														3400	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;14c1: $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: $0-$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: $0/visit;14i: 20%;14j: 0% - 20%	15: 20%	17b: $15/copay	10b: $10 allowance/trip 12 trips/year	"16a: X-rays, 1 Exam/year, 2 cleanings"	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	13c: $30/Qtr												76.17289473	78.22001946	29.51549403		100	0.2	0.2	49.95744681	147.6212316	17.5	168.7630079	150	0.2	125.0894934		17.8797638	25	20	5.910969857	0.2	0.2	15			15	15	7.5														NO	70.57284502	72.46947001	27.34558524		92.64823828	0.185296477	0.185296477	46.28469436	136.7684704	16.2134417	156.3559537	138.9723574	0.185296477	115.8932119		16.56528617	23.16205957	18.52964766	5.476409438	0.185296477	0.185296477	13.89723574			15	15	7.5															7.2439	0.188955939	1.445078335	0	2.151159773	2.90417421	0.653966706	1.14635687	3.319087777	0.051833427	0.686622067	0.458933329	0.002377361	0.313503248	0	8.888470204	0.132064223	0.941642298	1.76071341	0.001082499	6.175558507	0.205785203	0	0	0.213541263	0.985571263	0.163072918	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0335	0	3.068617471	7.2439	0.188955939	1.445078335	0	2.151159773	2.90417421	0.653966706	1.14635687	3.319087777	0.051833427	0.686622067	0.458933329	0.002377361	0.313503248	0	8.888470204	0.132064223	0.941642298	1.76071341	0.001082499	6.175558507	0.205785203	0	0	0.213541263	0.985571263	0.163072918	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0335	NO																																																																																		0	0	0	7.2439	0.188955939	1.445078335	0	2.151159773	2.90417421	0.653966706	1.14635687	3.319087777	0.051833427	0.686622067	0.458933329	0.002377361	0.313503248	0	8.888470204	0.132064223	0.941642298	1.76071341	0.001082499	6.175558507	0.205785203	0	0	0.213541263	0.985571263	0.163072918	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0335
H5402_038_0	2011	7																															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	V																																																			0	YES	1396.771053	29.68278524	812.0792105		226.8346964	12.84882883	5.184527254	298.9334753	352.271916	1051.230702	244.1506119	23.43544846	0.137777523	205.7417097	4942.309117	5358.928947	166.0060833	440.3007422	3800.699276	0.003556975	39.08392427	34.30141213			150.9258749	788.45701	260.9166693														3400	1a: $195/d (1-8) then $0	1b: $195/d (1-8) then $0	"2: $0 (1-8), $100/d (9-100)"	6: $0/visit	10a: $150/trip	11a: 0% - 20%	11b: 20%;11c: 20%	4a: $50/visit;4b: $30/visit	9a: $190/visit;9b: $125/visit	8a: $0 - $175 per visit;8a: $175/visit	8b: $10/visit;8b: MRIs $150 CT $100;8b: 20%	9a: $190/visit	12a: 20%	3: $30/visit;5: $125/visit;9a: $190/visit;9c: $30/visit;9d: $25/visit;13a: 20%	7a: $5/visit;14c: $0/visit;14c1: $0/visit;14d: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit	7b: $25/visit;7d: $25/visit;7f: $25/visit;16b: $0/visit;17a: $5 - $30;18a: $15/visit	7e: $30/visit;7h: $30/visit	7c: $30/visit;7i: $30/visit	"8b: $10/visit, 8b: 20%14h: $0/visit"	7g: $25/visit;14b: $0/visit;14i: 20%;14j: 0% - 20%	15: 20%	17b: $30/copay	10b: $10 allowance/trip 12 trips/year	"16a: X-rays, 1 Exam/year, 2 cleanings"	17a1: $30/visit	17b1: $25/copay	18a1: $15/visit	"18b: $1,000 Allowance /2 yr"	14a: $0/copay													159.0864817	194.2127897	39.31460642		150	0.2	0.2	48.93992576	166.4142057	16.24068948	79.2721849	190	0.2	96.20217852	5	24.99958906	30	30	10.63291909	0.2	0.2	29.97839628			30	25	15														NO	138.5622014	169.1567467	34.24249726		130.6479972	0.17419733	0.17419733	42.62602189	144.9445512	16.24068948	70.27552636	165.4874631	0.17419733	90.93218608	4.354933239	21.77430827	26.12959944	26.12959944	9.261130559	0.17419733	0.17419733	26.11078288			30	25	15															16.1283	0.418420282	2.317301678	0	2.469624898	2.23823167	0.903130803	1.061862072	4.25499123	1.42272595	1.42981773	0.323189409	0.024000477	1.559045286	1.793618854	9.723914241	0.361472705	0.958740169	2.933231018	0.000619616	6.808315236	0.074636394	0	0	0.377314687	1.642618771	0.326145837	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5513	0	8.093359094	16.1283	0.418420282	2.317301678	0	2.469624898	2.23823167	0.903130803	1.061862072	4.25499123	1.42272595	1.42981773	0.323189409	0.024000477	1.559045286	1.793618854	9.723914241	0.361472705	0.958740169	2.933231018	0.000619616	6.808315236	0.074636394	0	0	0.377314687	1.642618771	0.326145837	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5513	NO																																																																																		0	0	0	16.1283	0.418420282	2.317301678	0	2.469624898	2.23823167	0.903130803	1.061862072	4.25499123	1.42272595	1.42981773	0.323189409	0.024000477	1.559045286	1.793618854	9.723914241	0.361472705	0.958740169	2.933231018	0.000619616	6.808315236	0.074636394	0	0	0.377314687	1.642618771	0.326145837	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5513
H5402_039_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	Coin	Coin	V	T	V	V	P	V	P	O	V																																																			0	YES	620.9843547	5.425546483	167.955211		109.3388418	14.38105692	1.53139948	200.8657944	192.2217628	0.255309011	0.964184648	10.84365471	0.060632163	14.45820628	3424.983366	2820.442868	42.91273377	227.72092	25.24288287	0.016271577	19.48148916	94.27693773			150.9614538	788.45701	260.9166693														3400	1a: $260/d (1-5) then $0	1b: $260/d (1-5) then $0	"2: $0 (1-10), $75/d (11-20), $100/d (20+)"	6: $0/visit	10a: $150/trip	11a: 0% - 20%	11b: 20%;11c: 20%	4a: $50/visit;4b: $35/visit	9a: $200/visit;9b: $140/visit	8a: 20%	8b: 20%	9a: $200/visit	12a: 20%	3: $35/visit;5: $200/visit;9a: $200/visit;9c: $35/visit;9d: $25/visit;13a: 20%	7a: $20/visit;14c: $0/visit;14c1: $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: $20-$35;18a: $20/visit	7e: $35/visit;7h: $25/visit	7c: $35/visit;7i: $35/visit	"8b: 20%, 14h: $0/visit"	7g: $35/visit;14b: $0/visit;14i: 20%;14j: 0% - 20%	15: 20%	17b: $25/copay	10b: $10 allowance/trip 12 trips/year	"16a: X-rays, 1 Exam/year, 2 cleanings"	17a1: $20/visit	17b1: $25/copay	18a1: $20/visit	"18b: $1,000 Allowance /2 yr"	14a: $0/copay													193.2940908	252.9570523	33.0474841		150	0.2	0.2	49.92287918	198.5986879	0.02	0.2	200	0.2	134.9258878	20	34.98852756	35	35	0.2	0.2	0.2	25			20	25	20														NO	174.1822681	227.9460946	29.77993643		135.1688513	0.180225135	0.180225135	44.98678822	178.9623768	0.018022514	0.180225135	180.2251351	0.180225135	123.5581471	18.02251351	31.52906053	31.53939864	31.53939864	0.180225135	0.180225135	0.180225135	22.52814189			20	25	20															9.0137	0.103061011	0.416807959	0	1.231600471	2.591827925	0.275996678	0.753025579	2.866705296	0.00460131	0.173770308	0.162858261	0.01092744	0.148869098	5.143900749	7.410492825	0.112786818	0.598515073	4.549401976	0.002932547	3.511054015	0.176990352	0	0	0.251602423	1.642618771	0.434861116	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5889	0	4.305073363	9.0137	0.103061011	0.416807959	0	1.231600471	2.591827925	0.275996678	0.753025579	2.866705296	0.00460131	0.173770308	0.162858261	0.01092744	0.148869098	5.143900749	7.410492825	0.112786818	0.598515073	4.549401976	0.002932547	3.511054015	0.176990352	0	0	0.251602423	1.642618771	0.434861116	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5889	NO																																																																																		0	0	0	9.0137	0.103061011	0.416807959	0	1.231600471	2.591827925	0.275996678	0.753025579	2.866705296	0.00460131	0.173770308	0.162858261	0.01092744	0.148869098	5.143900749	7.410492825	0.112786818	0.598515073	4.549401976	0.002932547	3.511054015	0.176990352	0	0	0.251602423	1.642618771	0.434861116	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5889
H5402_040_0	2011	2																															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	V																																																			0	YES	1175.615873	36.96719697	681.0980149		143.8204491	8.937576777	6.154082936	231.1660253	362.6524267	2283.584682	413.1010212	34.1383431	0.142417744	334.3680482		5211.408791	202.7750404	707.3278219	3517.788132	0.018395075	25.20815469	35.99053873			150.9278399	788.45701	260.9166693														3400	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;14c1: $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: $0-$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: $0/visit;14i: 20%;14j: 0% - 20%	15: 20%	17b: $15/copay	10b: $10 allowance/trip 12 trips/year	"16a: X-rays, 1 Exam/year, 2 cleanings"	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												80.22404414	63.93825615	25.59388434		100	0.2	0.2	46.4327403	82.58178125	11.81884022	63.39013663	150	0.2	72.21748636		5	25	15	5.685487315	0.2	0.2	15			15	15	7.5														NO	74.92456557	59.71459201	23.9031912		93.39415181	0.186788304	0.186788304	43.36546397	77.12655415	11.81884022	59.83072506	140.0912277	0.186788304	70.13322822		4.669707591	23.34853795	14.00912277	5.309912654	0.186788304	0.186788304	14.00912277			15	15	7.5															7.3402	0.183956757	1.356701339	0	1.119332405	1.669434805	1.149510712	0.835385162	2.330844335	2.249110208	2.059677802	0.3985402	0.026601969	1.954192553	0	2.027979599	0.394541727	0.825753525	1.556595643	0.003435985	4.708588451	0.042016323	0	0	0.1886598	0.985571263	0.163072918	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5697	0	2.017448663	7.3402	0.183956757	1.356701339	0	1.119332405	1.669434805	1.149510712	0.835385162	2.330844335	2.249110208	2.059677802	0.3985402	0.026601969	1.954192553	0	2.027979599	0.394541727	0.825753525	1.556595643	0.003435985	4.708588451	0.042016323	0	0	0.1886598	0.985571263	0.163072918	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5697	NO																																																																																		0	0	0	7.3402	0.183956757	1.356701339	0	1.119332405	1.669434805	1.149510712	0.835385162	2.330844335	2.249110208	2.059677802	0.3985402	0.026601969	1.954192553	0	2.027979599	0.394541727	0.825753525	1.556595643	0.003435985	4.708588451	0.042016323	0	0	0.1886598	0.985571263	0.163072918	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5697
H5402_041_0	2011	5																															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	V																																																			0	YES	2364.796787	44.79079621	948.7300966		379.9887645	15.9064495	5.421228598	540.6445913	353.6879303	820.1743428	63.02438743	40.16234954	0.557854748	102.853738					91.09980726	0.023439229	24.94278878																				3400	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: $30/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;14c1: $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: $30/visit14h: $0/visit"	7g: $0/visit;14b: $0/visit;14i: 20%;14j: 0% - 20%	15: 20%	17b: $0/copay		"16a: X-rays, 1 Exam/year, 2 cleanings"	17a1: $0/visit	17b1: $0/copay	18a1: $0/visit	"18b: $1,000 Allowance /2 yr"	14a: $0/copay	13c: $30/Qtr												57.33112113	49.46685198	3.539907053		100	0.2	0.2	50	119.1387225	15.26137904	30	150	0.2	103.9886513					29.91182974	0.2	0.2																				NO	53.82251555	46.43953157	3.323268387		93.88010296	0.187760206	0.187760206	46.94005148	111.8475553	15.26137904	28.16403089	140.8201544	0.187760206	101.6022889					28.08125656	0.187760206	0.187760206																					10.6066	0.173338633	0.262740395	0	2.972782028	2.986598233	1.017890998	2.114823746	3.296594196	1.043082627	0.1479184	0.471305689	0.104742922	0.870847933	0	0	0	0	0.213183088	0.004400954	4.683263158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9701	0	1.91458154	10.6066	0.173338633	0.262740395	0	2.972782028	2.986598233	1.017890998	2.114823746	3.296594196	1.043082627	0.1479184	0.471305689	0.104742922	0.870847933	0	0	0	0	0.213183088	0.004400954	4.683263158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9701	NO																																																																																		0	0	0	10.6066	0.173338633	0.262740395	0	2.972782028	2.986598233	1.017890998	2.114823746	3.296594196	1.043082627	0.1479184	0.471305689	0.104742922	0.870847933	0	0	0	0	0.213183088	0.004400954	4.683263158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9701
H5404_001_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V		P		Coin	V		V	V	V	P	V	Coin	Coin		V		V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1276.109875	18.92022476	368.1280656	610.5638875	18.32296465	2.818059951	0.5014016	249.985816	334.7595274	0	230.5546978	0	1.581912285	189.9442143	0	5064.422937	1418.071478	521.4939562	205.7869254	5.18141016	17.30989411	3.49196243	0	0	0	33.41661393	0	0	0	0											3400	$150/Days 1-10 for IP Medical; $150/Days 1-10 for IP Surgical; PBP 1a	$150/Days 1-10 for IP Psych; $150/Days 1-10 for IP Substance Abuse; PBP 1b	$100/Days 11-25 for SNF; PBP 2	$20/Visit for Home Health; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$200/Visit for OP Fac - Surgery; $50/Visit for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$30/Visit for OP Fac - Cardiovascular; $30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; $200/Visit for OP Fac - Other; $150/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$30/Visit for Speclst Office Visits; $30/Visit for Speclst Consults; $30/Visit for Cardio; $20/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"$0-30/Visit for Allergy Testing; $0-30/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-30/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride; $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	150	150	100	20	125	0.2	0.2	49.38086101	200	0	100	0	0.2	133.9129329	0	28.68049601	30	30	100	27.2637892	0.216743005	0.2	0	0	0	48.52302328	0	0	0	0											NO	118.9826139	150	88.05319356	20	125	0.2	0.2	49.38086101	200	0	100	0	0.2	133.9129329	0	28.68049601	30	30	100	27.2637892	0.216743005	0.2	0	0	0	48.52302328	0	0	0	0												12.6529	0.236502809	2.701237651	1.017606479	0.190864215	0.56361199	0.10028032	1.028709569	5.579325456	0	1.921289149	0	0.316382457	2.119665568	0	12.10418015	3.545178694	1.30373489	1.714891045	0.011772073	3.751798459	0.698392486	0	0	0	0.135122928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6935	0	3.664962288	12.6529	0.236502809	2.701237651	1.017606479	0.190864215	0.56361199	0.10028032	1.028709569	5.579325456	0	1.921289149	0	0.316382457	2.119665568	0	12.10418015	3.545178694	1.30373489	1.714891045	0.011772073	3.751798459	0.698392486	0	0	0	0.135122928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6935	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.6529	0.236502809	2.701237651	1.017606479	0.190864215	0.56361199	0.10028032	1.028709569	5.579325456	0	1.921289149	0	0.316382457	2.119665568	0	12.10418015	3.545178694	1.30373489	1.714891045	0.011772073	3.751798459	0.698392486	0	0	0	0.135122928	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6935
H5404_034_0	2011	8																															D	D	D		T	Coin	Coin	V	V		P		Coin	V		V	V	V	P	V	Coin	Coin		V		V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	532.486006	53.08041103	489.7694117	0	150.218781	5.90478583	3.7082272	180.7392937	194.9144	0	100.8936948	0	0.299484568	959.8351975	0	3653.376117	235.3238777	285.283664	92.197411	49.18283893	34.34883612	7.465583704	0	2584.621649	0	31.77142857	122.8523629	0	0	0											3400	$100/Days 1-5 for IP Medical; $100/Days 1-5 for IP Surgical; PBP 1a	$100/Days 1-5 for IP Psych; $100/Days 1-5 for IP Substance Abuse; PBP 1b	$50/Days 11-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $5/Visit for PCP Urgent Care; $5/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$100/Visit for OP Fac - Surgery; $25/Visit for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$15/Visit for OP Fac - Cardiovascular; $15/Visit for OP Fac - Occ Therapy; $15/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; $100/Visit for OP Fac - Other; $150/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$15/Visit for Speclst Office Visits; $15/Visit for Speclst Consults; $15/Visit for Cardio; $15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse; PBP 7e, 7h"	"$15/Visit for Occ Therapy; $15/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"$0-15/Visit for Allergy Testing; $0-15/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-15/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride; $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	100	100	50	0	100	0.2	0.2	45.56019372	100	0	100	0	0.2	74.52829016	0	13.55275179	15	16.75630918	100	11.88967972	0.054297419	0.199827131	0	4	0	50	10	0	0	0											NO	89.44765934	100	48.72525642	0	100	0.2	0.2	45.56019372	100	0	100	0	0.2	74.52829016	0	13.55275179	15	16.75630918	100	11.88967972	0.054297419	0.199827131	0	4	0	50	10	0	0	0												3.9691	0.442336759	1.988678348	0	1.251823175	1.180957166	0.74164544	0.68620977	1.624286667	0	0.84078079	0	0.059896914	5.961239675	0	4.126108309	0.294154847	0.39835844	0.768311758	0.048730684	1.865053141	1.491826174	0	0.86154055	0	0.132380952	0.102376969	0	0	0	0	0	0	0	0	0	0	0	0	0	28.8358	0	0.520275345	3.9691	0.442336759	1.988678348	0	1.251823175	1.180957166	0.74164544	0.68620977	1.624286667	0	0.84078079	0	0.059896914	5.961239675	0	4.126108309	0.294154847	0.39835844	0.768311758	0.048730684	1.865053141	1.491826174	0	0.86154055	0	0.132380952	0.102376969	0	0	0	0	0	0	0	0	0	0	0	0	0	28.8358	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.9691	0.442336759	1.988678348	0	1.251823175	1.180957166	0.74164544	0.68620977	1.624286667	0	0.84078079	0	0.059896914	5.961239675	0	4.126108309	0.294154847	0.39835844	0.768311758	0.048730684	1.865053141	1.491826174	0	0.86154055	0	0.132380952	0.102376969	0	0	0	0	0	0	0	0	0	0	0	0	0	28.8358
H5404_086_0	2011	8																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	P		Coin	Coin	V	V	V	V	P	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	0	0	0	0	0	0	0	0											0	YES	1396.15042	59.3339669	325.4691377	611.7533258	18.46589822	15.01210874	1.581506671	326.5814256	73.45718147	17.24076129	229.7477187	0	0.466296518	11.84344506	4783.076873	6911.682665	843.2858575	1062.462921	489.1077477	1.776956795	33.17604751	5.40758351	0	0	0	63.37765957	0	0	0	0											3400	$300/Days 1-7 for IP Medical; $300/Days 1-7 for IP Surgical; PBP 1a	$300/Days 1-7 for IP Psych; $300/Days 1-7 for IP Substance Abuse; PBP 1b	$100/Days 6-20 for SNF; PBP 2	$20/Visit for Home Health; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; $15/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; 10% Coinsurance for ASC; PBP 9a, 9b"	5-25% Coinsurance for OP Fac - Pathology; PBP 8a	$0-50/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40/Visit for OP Fac - Cardiovascular; $40/Visit for OP Fac - Occ Therapy; $40/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $150/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; PBP 7a, 14b-c"	"$40/Visit for Speclst Office Visits; $40/Visit for Speclst Consults; $40/Visit for Cardio; $30/Visit for Chiropractor; $40/Exam for Vision Exams; $40/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$40/Visit for Occ Therapy; $40/Visit for PT/ST; PBP 7c, 7i"	"$0-50/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $15-40/Visit for Allergy Testing; $15-40/Visit for Allergy Tx; 5-25% Coinsurance for Prof Path (OP); 5-25% Coinsurance for Prof Path (Office); PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $15-40/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride; $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	300	300	100	20	150	0.2	0.2	45.23869499	0.25	0.15	50	0	0.2	0.252376633	15	37.99548506	40	40	50	0.229486981	0.238856414	0.2	0	0	0	35.03909838	0	0	0	0											NO	156.1644546	300	31.44389851	20	150	0.2	0.2	45.23869499	0.25	0.15	50	0	0.2	0.252376633	15	37.99548506	40	40	50	0.229486981	0.238856414	0.2	0	0	0	35.03909838	0	0	0	0												18.1691	1.483349173	0.852834878	1.019588876	0.230823728	3.002421749	0.316301334	1.231176459	18.36429537	2.586114193	0.957282161	0	0.093259304	2.989008788	5.978846092	21.88439462	2.810952858	3.541543068	2.037948949	0.40778845	7.924311738	1.081516702	0	0	0	0.185058004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1479	0	18.59407936	18.1691	1.483349173	0.852834878	1.019588876	0.230823728	3.002421749	0.316301334	1.231176459	18.36429537	2.586114193	0.957282161	0	0.093259304	2.989008788	5.978846092	21.88439462	2.810952858	3.541543068	2.037948949	0.40778845	7.924311738	1.081516702	0	0	0	0.185058004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1479	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.1691	1.483349173	0.852834878	1.019588876	0.230823728	3.002421749	0.316301334	1.231176459	18.36429537	2.586114193	0.957282161	0	0.093259304	2.989008788	5.978846092	21.88439462	2.810952858	3.541543068	2.037948949	0.40778845	7.924311738	1.081516702	0	0	0	0.185058004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1479
H5404_111_0	2011	8																																														V								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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.19983745	0	0	0	0	0	0	0	2925	0	340.3674392	181.0910204	0	0	0											3400	No Cost-Sharing; PBP 1a	No Cost-Sharing; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	No Cost-Sharing; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"No Cost-Sharing; PBP 4a, 4b"	"No Cost-Sharing; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$10/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	"No Cost-Sharing; PBP 7d, 8a, 8b, 14g-h"	"No Cost-Sharing; PBP 7g, 14f, 14i"	No Cost-Sharing; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride; $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0	0	0	0	4	0	22.80033501	10	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0	0	0	0	4	0	22.80033501	10	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.020999865	0	0	0	0	0	0	0	0.975	0	0.646707637	0.150909184	0	0	0	0	0	0	0	0	0	0	0	0	0	1.7936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.020999865	0	0	0	0	0	0	0	0.975	0	0.646707637	0.150909184	0	0	0	0	0	0	0	0	0	0	0	0	0	1.7936	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.020999865	0	0	0	0	0	0	0	0.975	0	0.646707637	0.150909184	0	0	0	0	0	0	0	0	0	0	0	0	0	1.7936
H5404_113_0	2011	7																																														V								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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.32270771	0	0	0	0	0	0	0	2925	0	340.3674392	196.3883621	0	0	0											3400	No Cost-Sharing; PBP 1a	No Cost-Sharing; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	No Cost-Sharing; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"No Cost-Sharing; PBP 4a, 4b"	"No Cost-Sharing; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$10/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	"No Cost-Sharing; PBP 7d, 8a, 8b, 14g-h"	"No Cost-Sharing; PBP 7g, 14f, 14i"	No Cost-Sharing; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride; $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0	0	0	0	4	0	22.80033501	10	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0	0	0	0	4	0	22.80033501	10	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.022768923	0	0	0	0	0	0	0	0.975	0	0.646707637	0.163656968	0	0	0	0	0	0	0	0	0	0	0	0	0	1.8081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.022768923	0	0	0	0	0	0	0	0.975	0	0.646707637	0.163656968	0	0	0	0	0	0	0	0	0	0	0	0	0	1.8081	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.022768923	0	0	0	0	0	0	0	0.975	0	0.646707637	0.163656968	0	0	0	0	0	0	0	0	0	0	0	0	0	1.8081
H5404_116_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V		P		Coin	V		V	V	V	P	V	Coin	Coin		V		V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	853.0663397	44.60950482	190.8247145	1036.16063	95.51367042	4.173130094	2.507079463	237.7954609	228.5246762	0	119.4645663	0	0.180552036	688.9681506	0	3172.205935	327.6914922	236.3356143	99.58798552	37.58387245	23.98347555	4.934807948	0	1795.776989	0	31.77142857	82.79082278	0	0	0											3400	$150/Days 1-10 for IP Medical; $150/Days 1-10 for IP Surgical; PBP 1a	$150/Days 1-10 for IP Psych; $150/Days 1-10 for IP Substance Abuse; PBP 1b	$100/Days 11-25 for SNF; PBP 2	$20/Visit for Home Health; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$200/Visit for OP Fac - Surgery; $50/Visit for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$30/Visit for OP Fac - Cardiovascular; $30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; $200/Visit for OP Fac - Other; $150/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$30/Visit for Speclst Office Visits; $30/Visit for Speclst Consults; $30/Visit for Cardio; $20/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"$0-30/Visit for Allergy Testing; $0-30/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-30/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride; $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	150	150	100	20	125	0.2	0.2	48.15232799	200	0	100	0	0.2	114.4755211	0	28.39818036	13.10426893	29.90367832	100	23.77940752	0.076563944	0.200208744	0	4	0	50	10	0	0	0											NO	128.7463758	150	89.44304497	20	125	0.2	0.2	48.15232799	200	0	100	0	0.2	114.4755211	0	28.39818036	13.10426893	29.90367832	100	23.77940752	0.076563944	0.200208744	0	4	0	50	10	0	0	0												9.1524	0.55761881	1.422328627	1.726934384	0.994934067	0.834626019	0.501415893	0.954200419	3.808744603	0	0.995538053	0	0.036110407	6.572499005	0	7.507073025	0.357846453	0.588942015	0.829899879	0.074476852	1.836269468	0.987991699	0	0.59859233	0	0.132380952	0.068992352	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5398	0	1.678773275	9.1524	0.55761881	1.422328627	1.726934384	0.994934067	0.834626019	0.501415893	0.954200419	3.808744603	0	0.995538053	0	0.036110407	6.572499005	0	7.507073025	0.357846453	0.588942015	0.829899879	0.074476852	1.836269468	0.987991699	0	0.59859233	0	0.132380952	0.068992352	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5398	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.1524	0.55761881	1.422328627	1.726934384	0.994934067	0.834626019	0.501415893	0.954200419	3.808744603	0	0.995538053	0	0.036110407	6.572499005	0	7.507073025	0.357846453	0.588942015	0.829899879	0.074476852	1.836269468	0.987991699	0	0.59859233	0	0.132380952	0.068992352	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5398
H5404_135_0	2011	8																															D	D	D		T	Coin	Coin	V	V		P		Coin	V		V	V	V	P	V	Coin	Coin		V		V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	2769.673181	77.51477243	489.7196722	0	497.1754521	15.9116585	8.973986391	688.0920638	1249.257589	0	538.2666513	0	0.46082406	4492.041147	0	9044.684284	261.546005	990.5939433	241.6742074	179.4277369	58.33761569	15.01077749	0	2925	0	370.5928963	260.187354	0	0	0											3400	$50/Days 1-5 for IP Medical; $50/Days 1-5 for IP Surgical; PBP 1a	$50/Days 1-5 for IP Psych; $50/Days 1-5 for IP Substance Abuse; PBP 1b	$25/Days 6-20 for SNF; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $5/Visit for PCP Urgent Care; $5/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$100/Visit for OP Fac - Surgery; $25/Visit for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-200/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$15-100/Visit for OP Fac - Cardiovascular; $15-100/Visit for OP Fac - Occ Therapy; $15-100/Visit for OP Fac - Physical/Speech Therapy; $100/Visit for OP Fac - CORF; $100/Visit for OP Fac - Other; $50/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$15/Visit for Speclst Office Visits; $15/Visit for Speclst Consults; $15/Visit for Cardio; $15/Visit for Chiropractor; $15/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse; PBP 7e, 7h"	"$15-100/Visit for Occ Therapy; $15-100/Visit for PT/ST; PBP 7c, 7i"	"$0-200/Service for Prof Radiology (Office); PBP 7d, 14g-h"	"$0-15/Visit for Allergy Testing; $0-15/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-15/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride; $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	50	50	25	0	100	0.2	0.2	47.24989725	100	0	199.9999999	0	0.2	46.76499739	0	14.01882187	15	15	199.9999999	11.88952334	0.05951112	0.2	0	4	0	22.57194044	10	0	0	0											NO	44.10476406	44.10476406	22.05238203	0	88.20952813	0.176419056	0.176419056	41.6789114	88.20952813	0	176.4190562	0	0.176419056	41.25118353	0	12.36593662	13.23142922	13.23142922	176.4190562	10.48769243	0.052494478	0.180001607	0	4	0	22.57194044	10	0	0	0												10.1796	0.284897562	0.899957108	0	3.654634336	2.807119776	1.58318221	2.38991068	9.183035203	0	7.913374549	0	0.081298146	15.44183448	0	9.320499383	0.288385621	1.092247804	3.55299463	0.156815243	3.062402695	2.701964064	0	0.975	0	0.697083399	0.216822795	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4831	0	9.909622833	10.1796	0.284897562	0.899957108	0	3.654634336	2.807119776	1.58318221	2.38991068	9.183035203	0	7.913374549	0	0.081298146	15.44183448	0	9.320499383	0.288385621	1.092247804	3.55299463	0.156815243	3.062402695	2.701964064	0	0.975	0	0.697083399	0.216822795	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4831	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.1796	0.284897562	0.899957108	0	3.654634336	2.807119776	1.58318221	2.38991068	9.183035203	0	7.913374549	0	0.081298146	15.44183448	0	9.320499383	0.288385621	1.092247804	3.55299463	0.156815243	3.062402695	2.701964064	0	0.975	0	0.697083399	0.216822795	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4831
H5404_136_0	2011	8																															D	D	D		T	Coin	Coin	V	V		P		Coin	V		V	V	V	P	V	Coin	Coin		V		V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	3849.759155	107.7431109	647.7120792	0	560.35612	13.10184225	7.389283403	939.9633826	1707.848375	0	817.0143594	0	0.413300596	5528.847036	0	11785.93672	330.95453	1253.475667	300.4088798	227.0438898	57.50856505	14.30022779	0	2925	0	373.4599593	341.5424485	0	0	0											3400	$50/Days 1-5 for IP Medical; $50/Days 1-5 for IP Surgical; PBP 1a	$50/Days 1-5 for IP Psych; $50/Days 1-5 for IP Substance Abuse; PBP 1b	$25/Days 6-20 for SNF; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $5/Visit for PCP Urgent Care; $5/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$100/Visit for OP Fac - Surgery; $25/Visit for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-200/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$15-100/Visit for OP Fac - Cardiovascular; $15-100/Visit for OP Fac - Occ Therapy; $15-100/Visit for OP Fac - Physical/Speech Therapy; $100/Visit for OP Fac - CORF; $100/Visit for OP Fac - Other; $50/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$15/Visit for Speclst Office Visits; $15/Visit for Speclst Consults; $15/Visit for Cardio; $15/Visit for Chiropractor; $15/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse; PBP 7e, 7h"	"$15-100/Visit for Occ Therapy; $15-100/Visit for PT/ST; PBP 7c, 7i"	"$0-200/Service for Prof Radiology (Office); PBP 7d, 14g-h"	"$0-15/Visit for Allergy Testing; $0-15/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-15/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride; $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	50	50	25	0	100	0.2	0.2	47.35732938	100	0	199.999999	0	0.2	37.05268067	0	14.01159332	15	15	199.999999	11.88952334	0.070700747	0.2	0	4	0	22.55219558	10	0	0	0											NO	42.7476495	42.7476495	21.37382475	0	85.495299	0.170990598	0.170990598	40.48829035	85.495299	0	170.9905971	0	0.170990598	31.67830012	0	11.97925361	12.82429485	12.82429485	170.9905971	10.16498353	0.060445815	0.175614858	0	4	0	22.55219558	10	0	0	0												13.714	0.383813729	1.153673706	0	3.992317836	2.240291841	1.263497988	3.171459196	12.16775063	0	11.64181443	0	0.070670516	14.59537298	0	11.76556042	0.353688206	1.339578462	4.280591145	0.192324783	3.476152103	2.511332466	0	0.975	0	0.701861837	0.284618707	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2754	0	14.90554429	13.714	0.383813729	1.153673706	0	3.992317836	2.240291841	1.263497988	3.171459196	12.16775063	0	11.64181443	0	0.070670516	14.59537298	0	11.76556042	0.353688206	1.339578462	4.280591145	0.192324783	3.476152103	2.511332466	0	0.975	0	0.701861837	0.284618707	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2754	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.714	0.383813729	1.153673706	0	3.992317836	2.240291841	1.263497988	3.171459196	12.16775063	0	11.64181443	0	0.070670516	14.59537298	0	11.76556042	0.353688206	1.339578462	4.280591145	0.192324783	3.476152103	2.511332466	0	0.975	0	0.701861837	0.284618707	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2754
H5404_137_0	2011	8																															D	D	D		T	Coin	Coin	V	V		P		Coin	V		V	V	V	P	V	Coin	Coin		V		V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	3986.993765	111.5838924	631.6792775	0	593.140586	19.72509223	11.12471772	943.2729495	1718.204848	0	864.0192656	0	0.692883006	6245.199952	0	12229.22756	345.7019712	1309.330949	310.8471481	237.1610391	85.90469939	21.0107381	0	2925	0	381.9934192	353.8059617	0	0	0											3400	$50/Days 1-5 for IP Medical; $50/Days 1-5 for IP Surgical; PBP 1a	$50/Days 1-5 for IP Psych; $50/Days 1-5 for IP Substance Abuse; PBP 1b	$25/Days 6-20 for SNF; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $5/Visit for PCP Urgent Care; $5/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$100/Visit for OP Fac - Surgery; $25/Visit for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-200/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$15-100/Visit for OP Fac - Cardiovascular; $15-100/Visit for OP Fac - Occ Therapy; $15-100/Visit for OP Fac - Physical/Speech Therapy; $100/Visit for OP Fac - CORF; $100/Visit for OP Fac - Other; $50/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$15/Visit for Speclst Office Visits; $15/Visit for Speclst Consults; $15/Visit for Cardio; $15/Visit for Chiropractor; $15/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse; PBP 7e, 7h"	"$15-100/Visit for Occ Therapy; $15-100/Visit for PT/ST; PBP 7c, 7i"	"$0-200/Service for Prof Radiology (Office); PBP 7d, 14g-h"	"$0-15/Visit for Allergy Testing; $0-15/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-15/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride; $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	50	50	25	0	100	0.2	0.2	47.27204595	100	0	199.999999	0	0.2	49.71853931	0	14.01321803	15	15	199.999999	11.88952334	0.065380428	0.2	0	4	0	22.49518135	10	0	0	0											NO	41.71426219	41.71426219	20.85713109	0	83.42852438	0.166857049	0.166857049	39.43837038	83.42852438	0	166.8570479	0	0.166857049	41.47944369	0	11.69102102	12.51427866	12.51427866	166.8570479	9.919253877	0.054545927	0.170729309	0	4	0	22.49518135	10	0	0	0												13.8595	0.387886645	1.097918125	0	4.123736986	3.291270675	1.856237566	3.100095662	11.94560792	0	12.01397533	0	0.115612413	21.58728498	0	11.91434637	0.360517567	1.365444362	4.322253123	0.19603838	4.685751434	3.587148797	0	0.975	0	0.71608427	0.294838301	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7966	0	19.72795472	13.8595	0.387886645	1.097918125	0	4.123736986	3.291270675	1.856237566	3.100095662	11.94560792	0	12.01397533	0	0.115612413	21.58728498	0	11.91434637	0.360517567	1.365444362	4.322253123	0.19603838	4.685751434	3.587148797	0	0.975	0	0.71608427	0.294838301	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7966	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.8595	0.387886645	1.097918125	0	4.123736986	3.291270675	1.856237566	3.100095662	11.94560792	0	12.01397533	0	0.115612413	21.58728498	0	11.91434637	0.360517567	1.365444362	4.322253123	0.19603838	4.685751434	3.587148797	0	0.975	0	0.71608427	0.294838301	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7966
H5404_138_0	2011	9																															D	D	D		T	Coin	Coin	V	V		P		Coin	V		V	V	V	P	V	Coin	Coin		V		V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	617.9068283	9.638772876	482.8531521	0	189.8588104	7.626127076	4.964607031	241.6154698	267.2363996	0	134.5567365	0	0.313544233	1306.499948	0	5128.882348	118.7352912	379.706402	109.1326952	79.70566691	42.41839457	9.688821932	0	2925	0	31.77142857	172.7760199	0	0	0											3400	$50/Days 1-5 for IP Medical; $50/Days 1-5 for IP Surgical; PBP 1a	$50/Days 1-5 for IP Psych; $50/Days 1-5 for IP Substance Abuse; PBP 1b	$25/Days 6-20 for SNF; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $5/Visit for PCP Urgent Care; $5/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$100/Visit for OP Fac - Surgery; $25/Visit for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-200/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$15-$100/Visit for OP Fac - Cardiovascular; $15-$100/Visit for OP Fac - Occ Therapy; $15-$100/Visit for OP Fac - Physical/Speech Therapy; $100/Visit for OP Fac - CORF; $100/Visit for OP Fac - Other; $150/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$15/Visit for Speclst Office Visits; $15/Visit for Speclst Consults; $15-$100/Visit for Cardio; $15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse; PBP 7e, 7h"	"$15-$100/Visit for Occ Therapy; $15-$100/Visit for PT/ST; PBP 7c, 7i"	"$0-200/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"$0-15/Visit for Allergy Testing; $0-15/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-15/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride; $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	50	50	25	0	100	0.2	0.2	45.66921901	100	0	200	0	0.2	74.78386088	0	14.6912892	15	15	200	11.88968481	0.051188375	0.199848738	0	4	0	50	10	0	0	0											NO	33.39073359	50	22.6383482	0	100	0.2	0.2	45.66921901	100	0	200	0	0.2	74.78386088	0	14.6912892	15	15	200	11.88968481	0.051188375	0.199848738	0	4	0	50	10	0	0	0												1.7194	0.040161554	0.910916482	0	1.582156754	1.525225415	0.992921406	0.919532484	2.226969996	0	2.242612274	0	0.062708847	8.142092528	0	6.27915782	0.148419114	0.474633003	1.818878253	0.078972938	2.171328678	1.936298831	0	0.975	0	0.132380952	0.143980017	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5237	0	0.950275845	1.7194	0.040161554	0.910916482	0	1.582156754	1.525225415	0.992921406	0.919532484	2.226969996	0	2.242612274	0	0.062708847	8.142092528	0	6.27915782	0.148419114	0.474633003	1.818878253	0.078972938	2.171328678	1.936298831	0	0.975	0	0.132380952	0.143980017	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5237	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	1.7194	0.040161554	0.910916482	0	1.582156754	1.525225415	0.992921406	0.919532484	2.226969996	0	2.242612274	0	0.062708847	8.142092528	0	6.27915782	0.148419114	0.474633003	1.818878253	0.078972938	2.171328678	1.936298831	0	0.975	0	0.132380952	0.143980017	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5237
H5404_140_0	2011	9																															D	D	D	V	T	Coin	Coin	V	V		P		Coin	V		V	V	V	P	V	Coin	Coin				V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	616.2212543	9.61234998	501.2981077	2198.623218	180.874315	7.241743505	4.714640821	239.0190452	264.5703759	0	132.4823138	0	0.309789249	1288.450512	0	4882.13551	112.9355734	361.0349951	103.8835348	75.7966368	40.03819778	9.061050297	0	0	0	31.77142857	164.5040428	0	0	0											3400	$50/Days 1-5 for IP Medical; $50/Days 1-5 for IP Surgical; PBP 1a	$50/Days 1-5 for IP Psych; $50/Days 1-5 for IP Substance Abuse; PBP 1b	$25/Days 6-20 for SNF; PBP 2	$20/Visit for Home Health; PBP 6	$100/Trip for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for DME / Medical Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $5/Visit for PCP Urgent Care; $5/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$150/Visit for OP Fac - Surgery; $25/Visit for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-200/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$15-$100/Visit for OP Fac - Cardiovascular; $15-$100/Visit for OP Fac - Occ Therapy; $15-$100/Visit for OP Fac - Physical/Speech Therapy; $100/Visit for OP Fac - CORF; $150/Visit for OP Fac - Other; $150/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$15/Visit for Speclst Office Visits; $15/Visit for Speclst Consults; $15-$100/Visit for Cardio; $15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse; PBP 7e, 7h"	"$15-$100/Visit for Occ Therapy; $15-$100/Visit for PT/ST; PBP 7c, 7i"	"$0-200/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"$0-15/Visit for Allergy Testing; $0-15/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-15/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	50	50	25	20	100	0.23	0.23	45.83267806	150	0	200	0	0.2	94.66846368	0	14.69126671	15	15	200	11.88968518	0.053006156	0.199854905	0	0	0	50	10	0	0	0											NO	48.03820772	48.03820772	24.01910386	19.21528309	96.07641544	0.220975756	0.220975756	44.03439418	144.1146232	0	192.1528309	0	0.192152831	90.95406646	0	14.11484244	14.41146232	14.41146232	192.1528309	11.42318333	0.050926415	0.193577256	0	0	0	50	10	0	0	0												2.4668	0.038480005	1.003394276	3.520597294	1.44814632	1.600249742	1.041821317	0.877088238	3.177371669	0	2.121404303	0	0.059526881	9.765817791	0	5.742547791	0.135630563	0.433586852	1.663459608	0.07215324	2.039001875	1.754013251	0	0	0	0.132380952	0.137086702	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2306	0	1.576352823	2.4668	0.038480005	1.003394276	3.520597294	1.44814632	1.600249742	1.041821317	0.877088238	3.177371669	0	2.121404303	0	0.059526881	9.765817791	0	5.742547791	0.135630563	0.433586852	1.663459608	0.07215324	2.039001875	1.754013251	0	0	0	0.132380952	0.137086702	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2306	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.4668	0.038480005	1.003394276	3.520597294	1.44814632	1.600249742	1.041821317	0.877088238	3.177371669	0	2.121404303	0	0.059526881	9.765817791	0	5.742547791	0.135630563	0.433586852	1.663459608	0.07215324	2.039001875	1.754013251	0	0	0	0.132380952	0.137086702	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2306
H5404_141_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V		P		Coin	V		V	V	V	P	V	Coin	Coin				V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	805.4331989	12.52930592	353.6315802	2146.922255	180.3771445	7.734058176	5.036272193	238.9247227	264.1785178	0	133.5958363	0	0.326193078	1285.819879	0	4792.459381	110.3833907	392.8206095	105.1174279	74.86101259	41.93206576	9.592090026	0	0	0	31.77142857	164.4721392	0	0	0											3400	$150/Days 1-10 for IP Medical; $150/Days 1-10 for IP Surgical; PBP 1a	$150/Days 1-10 for IP Psych; $150/Days 1-10 for IP Substance Abuse; PBP 1b	$100/Days 11-25 for SNF; PBP 2	$30/Visit for Home Health; PBP 6	$125/Trip for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for DME / Medical Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$250/Visit for OP Fac - Surgery; $50/Visit for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$30/Visit for OP Fac - Cardiovascular; $30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; $250/Visit for OP Fac - Other; $150/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$30/Visit for Speclst Office Visits; $30/Visit for Speclst Consults; $30/Visit for Cardio; $20/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"$0-30/Visit for Allergy Testing; $0-30/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-30/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	150	150	100	30	125	0.23	0.23	46.34518716	250	0	100	0	0.2	102.9198757	0	28.38264192	30	30.11056185	100	23.77940618	0.06502219	0.200177584	0	0	0	50	10	0	0	0											NO	88.80703962	150	84.51406473	30	125	0.23	0.23	46.34518716	250	0	100	0	0.2	102.9198757	0	28.38264192	30	30.11056185	100	23.77940618	0.06502219	0.200177584	0	0	0	50	10	0	0	0												5.9607	0.156616324	2.490570188	5.367305636	1.878928589	1.778833381	1.158342604	0.922750916	5.503719121	0	1.113298636	0	0.065238616	11.02803518	0	11.33522155	0.275958477	0.985670771	0.875978566	0.148345869	2.726514735	1.920121405	0	0	0	0.132380952	0.137060116	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9616	0	4.563596466	5.9607	0.156616324	2.490570188	5.367305636	1.878928589	1.778833381	1.158342604	0.922750916	5.503719121	0	1.113298636	0	0.065238616	11.02803518	0	11.33522155	0.275958477	0.985670771	0.875978566	0.148345869	2.726514735	1.920121405	0	0	0	0.132380952	0.137060116	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9616	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.9607	0.156616324	2.490570188	5.367305636	1.878928589	1.778833381	1.158342604	0.922750916	5.503719121	0	1.113298636	0	0.065238616	11.02803518	0	11.33522155	0.275958477	0.985670771	0.875978566	0.148345869	2.726514735	1.920121405	0	0	0	0.132380952	0.137060116	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9616
H5404_801_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	298.4703651	2.790584593	69.32641177	0	9.643070404	13.5943178	8.713856063	18.25811838	64.083441	6.501829754	31.96665224	0	0.452569399	31.27737447	36.86321127	61.40444451	1.955934126	7.559331731	39.2920086	124.9840759	63.29155642	15.16682487	0	0	0	0	0	0	0	0											6700	8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical; PBP 1a	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse; PBP 1b	16% Coinsurance for SNF; PBP 2	No Cost-Sharing; PBP 6	23% Coinsurance for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for DME / Medical Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"23% Coinsurance for ER - Facility; 23% Coinsurance for PCP Urgent Care; PBP 4a, 4b"	"23% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	23% Coinsurance for OP Fac - Pathology; PBP 8a	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	23% Coinsurance for Renal Dialysis - Fac; PBP 12	"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; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"23% Coinsurance for PCP Office Visits; 23% Coinsurance for PCP Consults; 23% Coinsurance for Medical Nutrition Therapy; 23% Coinsurance for Hepatitis B (HBV) Vaccine; PBP 7a, 14b-c"	"23% Coinsurance for Speclst Office Visits; 23% Coinsurance for Speclst Consults; 23% Coinsurance for Cardio; 23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Diabetes Self-Management Training; 23% Coinsurance for Prostate Cancer Screening; 23% Coinsurance for Pneumococcal Vaccine; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"23% Coinsurance for Occ Therapy; 23% Coinsurance for PT/ST; 23% Coinsurance for Prof - CORF; PBP 7c, 7i"	"23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office); 23% Coinsurance for Prof Radiology (Office); 23% Coinsurance for Initial Preventive Physical Examination (IPPE); 23% Coinsurance for Glaucoma Screening; PBP 7d, 8a, 8b, 14g-h"	"23% Coinsurance for Prof - Primary Surgeon (IP); 23% Coinsurance for Prof - Asst Surgeon (IP); 23% Coinsurance for Prof - Anesthesia (IP); 23% Coinsurance for Prof - Primary Surgeon (OP); 23% Coinsurance for Prof - Asst Surgeon (OP); 23% Coinsurance for Prof - Asst Surgeon (OP); 23% Coinsurance for Prof - Anesthesia (OP); 23% Coinsurance for Prof - IP Visits; 23% Coinsurance for Allergy Testing; 23% Coinsurance for Allergy Tx; 23% Coinsurance for Prof - ER Visits; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for PCP Immunizations; 23% Coinsurance for Speclst Immunizations; 23% Coinsurance for Cardio Screenings; 23% Coinsurance for Diabetes Screening Tests; 23% Coinsurance for Pelvic Tests; 23% Coinsurance for Colorectal Cancer Screening; 23% Coinsurance for Influenza Virus Vaccine; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"23% Coinsurance for Renal Dialysis - Prof; 23% Coinsurance for Bone Mass Measurements; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b											0	0.081539439	0.081539439	0.159123883	0	0.233	0.233	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	0.2	0.233	0	0	0	0	0	0	0	0											NO	0.072501403	0.072501403	0.141486193	0	0.207173696	0.207173696	0.207173696	0.207173696	0.207173696	0.207173696	0.207173696	0	0.207173696	0.207173696	0.207173696	0.207173696	0.207173696	0.207173696	0.207173696	0.207173696	0.177831499	0.207173696	0	0	0	0	0	0	0	0												21.6395	0.202321299	9.808730063	0	1.997790535	2.816385061	1.805281766	3.782601864	13.27640332	1.3470081	6.622649489	0	0.093760475	6.479849266	7.637087721	12.72138571	0.405218102	1.566094693	8.14027064	25.89341293	11.25523233	3.142167164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.6332	0	17.53135224	21.6395	0.202321299	9.808730063	0	1.997790535	2.816385061	1.805281766	3.782601864	13.27640332	1.3470081	6.622649489	0	0.093760475	6.479849266	7.637087721	12.72138571	0.405218102	1.566094693	8.14027064	25.89341293	11.25523233	3.142167164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.6332	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.6395	0.202321299	9.808730063	0	1.997790535	2.816385061	1.805281766	3.782601864	13.27640332	1.3470081	6.622649489	0	0.093760475	6.479849266	7.637087721	12.72138571	0.405218102	1.566094693	8.14027064	25.89341293	11.25523233	3.142167164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.6332
H5407_001_0	2011	9																															D	D	D		T	Coin	Coin	V	V	V	V			V		V	V	V	P		Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	763.299296	2.011058577	142.3565101	0	238.1127353	8.310534838	2.901061997	343.9522505	221.1272749	64.57908998	159.2055071	0	0	31.65073924	0	3757.208099	30.80955461	56.28412134	2181.573772	0	7.33710828	0	0	0	0	0	0	0	0	0											3400	$80/Days 1-7 for IP Med/Surg; PBP 1a	$150/Days 1-7 for IP MH/SA; PBP 1b	$100/Days 15-45 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $25/Visit for Urgent Care; PBP 4a, 4b"	"$200/Case for OP Surg; $75/Visit for ASC services; PBP 9a, 9b"	$43/Case for OP Lab; PBP 8a	$12/Case for OP Rad - General; $53/Case for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$35/Visit for CORF; $35/Visit for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $35/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$10/Visit for Chiro - cvd; $10/Visit for Chiro - non-cvd; $10/Visit for SCP OV; $10/Visit for Podiatry; $10/Visit for Footcare (non-cvd); PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	$20/Visit for MH - Non Phys; $20/Visit for Psych Services ; PBP 7e	"$35/Visit for OP PT/OT/ST; $35/Visit for PT/ST; PBP 7c, 7i"	"$10/Procedure for Phys Rad - General; $25/Procedure for Phys Rad - PET/CAT/MRI; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	80	150	100	0	150	0.2	0.2	48.52613317	157.5699976	43	25.00593019	0	0	33.65995121	0	10	20	35	13.47049737	0	0.2	0	0	0	0	0	0	0	0	0											NO	79.80546478	149.6352465	99.75683097	0	149.6352465	0.199513662	0.199513662	48.40813264	157.1868361	42.89543732	24.94512351	0	0	33.57810064	0	9.975683097	19.95136619	34.91489084	13.43774129	0	0.199513662	0	0	0	0	0	0	0	0	0												5.0763	0.025077104	1.183419527	0	2.969171486	1.658065238	0.578801503	1.38750718	2.896524727	0.230845692	0.330950087	0	0	0.088564309	0	3.123393111	0.051224392	0.163762829	2.442951997	0	1.463853341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.6704	0	0.05769939	5.0763	0.025077104	1.183419527	0	2.969171486	1.658065238	0.578801503	1.38750718	2.896524727	0.230845692	0.330950087	0	0	0.088564309	0	3.123393111	0.051224392	0.163762829	2.442951997	0	1.463853341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.6704	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.0763	0.025077104	1.183419527	0	2.969171486	1.658065238	0.578801503	1.38750718	2.896524727	0.230845692	0.330950087	0	0	0.088564309	0	3.123393111	0.051224392	0.163762829	2.442951997	0	1.463853341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.6704
H5407_004_0	2011	8																															D	D	D		T	Coin	Coin	V	V	V	V			V		V	V	V	P		Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1010.092913	6.489767677	141.4981964	0	202.0681259	6.909827509	1.168411872	441.471803	229.9755154	72.38732635	396.8841096	0	0	63.53508185	0	2303.104338	11.6837221	82.76643527	1886.848267	0	6.724476359	0	0	0	0	0	0	0	0	0											3400	$80/Days 1-7 for IP Med/Surg; PBP 1a	$145/Days 1-10 for IP MH/SA; PBP 1b	$90/Days 15-45 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $20/Visit for Urgent Care; PBP 4a, 4b"	"$125/Case for OP Surg; $50/Visit for ASC services; PBP 9a, 9b"	$26/Case for OP Lab; PBP 8a	$28/Case for OP Rad - General; $70/Case for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for CORF; $25/Case for OP - PT/OT/ST; $25/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$15/Visit for Chiro - cvd; $15/Visit for Chiro - non-cvd; $25/Visit for SCP OV; $25/Visit for Podiatry; $25/Visit for Footcare (non-cvd); PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	$15/Visit for MH - Non Phys; $15/Visit for Psych Services ; PBP 7e	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	"$15/Procedure for Phys Rad - General; $20/Procedure for Phys Rad - PET/CAT/MRI; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	80	145	90	0	100	0.2	0.2	46.89554428	106.5114047	26	41.67010043	0	0	25	0	24.99196152	15	25	16.22945143	0	0.2	0	0	0	0	0	0	0	0	0											NO	79.76475725	144.5736225	89.7353519	0	99.70594656	0.199411893	0.199411893	46.75764631	106.1982043	25.9235461	41.54756807	0	0	24.92648664	0	24.9184718	14.95589198	24.92648664	16.18172817	0	0.199411893	0	0	0	0	0	0	0	0	0												6.7142	0.078187435	1.058115871	0	1.67894948	1.377901785	0.232995223	1.720181869	2.035248897	0.156378016	1.374130796	0	0	0.131975531	0	4.782486708	0.014561707	0.171923037	2.544372146	0	1.340940561	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.4125	0	0.074946716	6.7142	0.078187435	1.058115871	0	1.67894948	1.377901785	0.232995223	1.720181869	2.035248897	0.156378016	1.374130796	0	0	0.131975531	0	4.782486708	0.014561707	0.171923037	2.544372146	0	1.340940561	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.4125	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.7142	0.078187435	1.058115871	0	1.67894948	1.377901785	0.232995223	1.720181869	2.035248897	0.156378016	1.374130796	0	0	0.131975531	0	4.782486708	0.014561707	0.171923037	2.544372146	0	1.340940561	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.4125
H5407_011_0	2011	5																																			T	Coin	Coin	V													Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	0	0	0	0	439.1849729	15.61462387	2.15874001	546.5872004	0	0	0	0	0	0	0	0	0	0	0	0	0.37	0	0	0	0	0	0	0	0	0											3400	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"No Cost Sharing; PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	No Cost Sharing; PBP 7e	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	0	0	0	0	50	0.2	0.2	50	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	49.99575	0.199983	0.199983	49.99575	0	0	0	0	0	0	0	0	0	0	0	0	0.199983	0	0	0	0	0	0	0	0	0												0	0	0	0	1.829781843	3.122659326	0.431711303	2.277253086	0	0	0	0	0	0	0	0	0	0	0	0	0.07399371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.7354	0	0.000657564	0	0	0	0	1.829781843	3.122659326	0.431711303	2.277253086	0	0	0	0	0	0	0	0	0	0	0	0	0.07399371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.7354	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	1.829781843	3.122659326	0.431711303	2.277253086	0	0	0	0	0	0	0	0	0	0	0	0	0.07399371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.7354
H5407_024_0	2011	4																															D	D	D		T	Coin	Coin	V	V	V	V			V		V	V	V	P		Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	472.7273559	5.189953866	236.7544809	0	202.0525332	3.942394343	0.571738422	308.3662887	181.0637039	40.1556943	117.9317067	0	0	46.73314826	0	2160.233722	13.64900649	100.6939622	1744.110502	0	6.102341288	0	0	0	0	0	0	0	0	0											3400	$150/Days 1-5 for IP Med/Surg; PBP 1a	$150/Days 1-5 for IP MH/SA; PBP 1b	$75/Days 15-60 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; 20% Coinsurance for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $20/Visit for Urgent Care; PBP 4a, 4b"	"$150/Case for OP Surg; $75/Visit for ASC services; PBP 9a, 9b"	$22/Case for OP Lab; PBP 8a	$56/Case for OP Rad - General; $73/Case for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for CORF; $25/Visit for OP - PT/OT/ST; $20/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$15/Visit for Chiro - cvd; $15/Visit for Chiro - non-cvd; $20/Visit for SCP OV; $20/Visit for Podiatry; $20/Visit for Footcare (non-cvd); PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	$20/Visit for MH - Non Phys; $20/Visit for Psych Services ; PBP 7e	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	"$18/Procedure for Phys Rad - General; $14/Procedure for Phys Rad - PET/CAT/MRI; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	150	150	75	0	100	0.2	0.2	48.00284405	132.4450712	22	61.88962279	0	0	25	0	19.99481843	20	25	17.2453943	0	0.2	0	0	0	0	0	0	0	0	0											NO	149.6966264	149.6966264	74.84831322	0	99.79775096	0.199595502	0.199595502	47.90575875	132.1772023	21.95550521	61.76445162	0	0	24.94943774	0	19.9543791	19.95955019	24.94943774	17.21051565	0	0.199595502	0	0	0	0	0	0	0	0	0												5.8971	0.064743215	1.476722795	0	1.680365699	0.786884178	0.114116417	1.23104342	1.994374486	0.07346988	0.606998933	0	0	0.097163814	0	3.592176886	0.022702336	0.209354812	2.501420091	0	1.217999872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.5667	0	0.043706796	5.8971	0.064743215	1.476722795	0	1.680365699	0.786884178	0.114116417	1.23104342	1.994374486	0.07346988	0.606998933	0	0	0.097163814	0	3.592176886	0.022702336	0.209354812	2.501420091	0	1.217999872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.5667	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.8971	0.064743215	1.476722795	0	1.680365699	0.786884178	0.114116417	1.23104342	1.994374486	0.07346988	0.606998933	0	0	0.097163814	0	3.592176886	0.022702336	0.209354812	2.501420091	0	1.217999872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.5667
H5407_029_0	2011	4																															D	D	D		T	Coin	Coin	V	V	V	V			V		V	V	V	P		Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	450.577481	6.968789891	210.8996322	0	177.7977469	4.933827333	0.844162382	312.306775	213.1114335	43.31316578	338.5353658	0	0	45.79772604	0	2255.677813	8.123171484	81.13338298	1753.315534	0	5.588554453	0	0	0	0	0	0	0	0	0											3400	$150/Days 1-5 for IP Med/Surg; PBP 1a	$150/Days 1-5 for IP MH/SA; PBP 1b	$75/Days 15-60 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; 20% Coinsurance for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $20/Visit for Urgent Care; PBP 4a, 4b"	"$150/Case for OP Surg; $75/Visit for ASC services; PBP 9a, 9b"	$22/Case for OP Lab; PBP 8a	$56/Case for OP Rad - General; $73/Case for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$25/Visit for CORF; $25/Visit for OP - PT/OT/ST; $20/Visit for OP Substance Abuse; $25/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$15/Visit for Chiro - cvd; $15/Visit for Chiro - non-cvd; $20/Visit for SCP OV; $20/Visit for Podiatry; $20/Visit for Footcare (non-cvd); PBP 7b, 7d, 7f, 14d-e, 17a, 18a"	$20/Visit for MH - Non Phys; $20/Visit for Psych Services ; PBP 7e	"$25/Visit for OP PT/OT/ST; $25/Visit for PT/ST; PBP 7c, 7i"	"$18/Procedure for Phys Rad - General; $14/Procedure for Phys Rad - PET/CAT/MRI; PBP 7d, 14f-h"	No Cost Sharing; PBP 14i-j	20% Coinsurance for Medicare Part B Drugs; PBP 15	No Cost Sharing; PBP 13a	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	150	150	75	0	100	0.2	0.2	46.14925151	133.4249993	22	61.87073531	0	0	25	0	19.99441737	20	25	17.32809179	0	0.2	0	0	0	0	0	0	0	0	0											NO	149.6620019	149.6620019	74.83100093	0	99.7746679	0.199549336	0.199549336	46.04526243	133.1243499	21.95042694	61.73132069	0	0	24.94366698	0	19.94936353	19.95493358	24.94366698	17.28904604	0	0.199549336	0	0	0	0	0	0	0	0	0												5.6195	0.086913587	1.315152547	0	1.478309262	0.984541967	0.168452043	1.198353951	2.364193421	0.07922854	1.741519603	0	0	0.095196936	0	3.749944725	0.013508112	0.168647007	2.526096081	0	1.115192329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.7048	0	0.051276694	5.6195	0.086913587	1.315152547	0	1.478309262	0.984541967	0.168452043	1.198353951	2.364193421	0.07922854	1.741519603	0	0	0.095196936	0	3.749944725	0.013508112	0.168647007	2.526096081	0	1.115192329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.7048	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.6195	0.086913587	1.315152547	0	1.478309262	0.984541967	0.168452043	1.198353951	2.364193421	0.07922854	1.741519603	0	0	0.095196936	0	3.749944725	0.013508112	0.168647007	2.526096081	0	1.115192329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.7048
H5410_001_0	2011	5																															Coin	D	D	V	T	O	O	V	V	P	P	V	P	P	V	Coin	V	V	P	V	S	O	T	P	V	P	V	V	O	O																																																			0	YES	0.059832147															0.049272583																									6700	"$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 $2,500 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; $70 credit toward the purchase of upgraded glasses"	$0 copay for exams	$1800 limit for hearing aids every 3 years	No cost sharing	$25 limit for vitamins every 3 months												0.3															0.3																									NO	0.3															0.3																										0.0179	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.014781775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0327	0	0	0.0179	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.014781775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0327	NO																																																																																		0	0	0	0.0179	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.014781775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0327
H5410_004_0	2011	5																															D	D	D	V	T	Coin	Coin	P	P	O	V	O	Coin	O	V	V	COIN	V	p		Coin																																																												0	YES	1008.057457	38.87176563	541.3191065	708.1486259	295.0416901	10.52612336		637.3273698	766.1380812		652.1383325	1.924453021	1.120723069	285.4154125	6029.922366	4461.260545	0.097942153	169.6567513	804.529908		35.97259373																				3400	1a. $215 per day 1-6	1b. $215 per day 1-10	2a. $100 for days 1-30	6a. $20 copay per PT/OT/ST visit	10a. $85 copay per trip	11a. 20% coinsurance	11b. 20% coinsurance	4a. $50 copay per visit	9a/b. $200 copay per visit	"8a, 9a. Zero cost share for lab services"	"8a/b, 9a. $25/Xray; $100/MRI,MRA,PET,CT, and NUC Scan"	1a. $50 copay per Observation Stay	"9a, 12. 20%  coinsurance"	"3, 7c/i, 9a. $20 copay per PT/OT/ST visit"	"7, 17, 18a. $10 copay per visit; 9d, 14b/c/d/e/f/g/h/i/j. Zero cost share for preventive services"	"4b/b1, 7b/d/f/g, 17a, 18a. $40 copay per visit"	"5, 7e/h, 9c. 20% coinsurance"	"3, 7c/i. $20 copay per PT/OT/ST visit"	"8a/b. $25/Xray; $100/MRI,MRA,PET,CT, and NUC Scan"		"11c, 15. 20% per script"																					215	215	100	20	85	0.2		50	200		49.75246149	50	0.2	20	10	40	0.2	20	40.5792157		0.2																				NO	208.4936251	208.4936251	96.9737791	19.39475582	82.42771224	0.193947558	0	48.48688955	193.9475582	0	48.2468421	48.48688955	0.193947558	19.39475582	9.69737791	38.78951164	0.193947558	19.39475582	39.35119899	0	0.193947558																					17.5145	0.675376277	4.374479955	1.144530807	2.026634294	2.041515923	0	2.575168482	12.38255084	0	2.62196793	0.007775895	0.217361503	0.461296853	4.872869663	14.42084315	0.018995641	0.274204272	2.638268042	0	6.976796715	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2451		2.35	17.5145	0.675376277	4.374479955	1.144530807	2.026634294	2.041515923	0	2.575168482	12.38255084	0	2.62196793	0.007775895	0.217361503	0.461296853	4.872869663	14.42084315	0.018995641	0.274204272	2.638268042	0	6.976796715	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2451	NO																																																																																		0			17.5145	0.675376277	4.374479955	1.144530807	2.026634294	2.041515923	0	2.575168482	12.38255084	0	2.62196793	0.007775895	0.217361503	0.461296853	4.872869663	14.42084315	0.018995641	0.274204272	2.638268042	0	6.976796715	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2451
H5410_005_0	2011	8																															D	D	D	V	T	Coin		P	P		V	V	Coin	V	V	V	Coin	V	V		Coin																																																												0	YES	972.3838297	85.51466973	483.509599	705.7036563	266.4817953	9.372868121		650.0031809	757.2749805		644.9568553	6.752082889	1.840335929	237.2680148	3874.563172	3924.857642	0.188256919	171.3687581	954.5575982		28.45272392																				3400	1a. $220 per day; days 1-6	1b. $195 per day; days 1-10	2a. $60 per day; days 1-30	6a. $20 copay per PT/OT/ST	10a. $85 copay per Trip	11a. 20% Coinsurance	11b. 20% Coinsurance	4a. $50 copay per visit	9a/b. $215 copay per visit	"8a, 9a. Zero cost share for lab services"	"8a/b, 9a. $25/Xray; $100/MRI,MRA,PET,CT, and NUC Scans"	1a. $50 copay per Observation Stay	"9a, 12. 20% Coinsurance"	"3, 7c/I, 9a. $20 copay per PT/OT/ST visit"	"7,17 18a. $10 copay per visit; 9d, 14b/c/d/e/f/g/h/i/j. Zero cost share for preventive services"	"4b/b1, 7b/d/f/g, 17a, 18a. $40 copay per visit"	"5, 7e/h, 9c. 20% Coinsurance"	"3, 7c/i. $20 copay per PT/OT/ST visit"	"8a/b. $25/Xray; $100/MRI,MRA,PET,CT, and NUC Scans"		"11c, 15. 20% per script"																					220	195	60	20	85	0.2		50	215		41.598543	50	0.2	20	10	40	0.2	20	27.06503745		0.2																				NO	214.204812	189.8633561	58.41949417	19.47316472	82.76095008	0.194731647	0	48.68291181	209.3365208	0	40.50276401	48.68291181	0.194731647	19.47316472	9.736582362	38.94632945	0.194731647	19.47316472	26.35209662	0	0.194731647																					17.3574	1.353008516	2.353865517	1.145190295	1.837857214	1.825194049	0	2.637003961	13.21044248	0	2.176877942	0.027392588	0.358371647	0.385029928	3.143750287	12.73823323	0.03665958	0.278091005	2.096216172	0	5.540645798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5013		1.8560222	17.3574	1.353008516	2.353865517	1.145190295	1.837857214	1.825194049	0	2.637003961	13.21044248	0	2.176877942	0.027392588	0.358371647	0.385029928	3.143750287	12.73823323	0.03665958	0.278091005	2.096216172	0	5.540645798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5013	NO																																																																																		0			17.3574	1.353008516	2.353865517	1.145190295	1.837857214	1.825194049	0	2.637003961	13.21044248	0	2.176877942	0.027392588	0.358371647	0.385029928	3.143750287	12.73823323	0.03665958	0.278091005	2.096216172	0	5.540645798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5013
H5410_010_0	2011	10																															D	D	D	V	COIN	COIN		V	V	COIN	COIN	V	COIN	COIN	V	V	COIN	V	COIN	V	COIN		T	V																																																									0	YES	2826.949611	0	1338.670199	1669.128666	13.90774874	19.078396		1060.637591	684.2440136		19.42478734	5.915928777	5.424567945	23.58765456	7976.89135	13765.16914	0.270812267	215.156416	12.43801547		25.21101654																				6700	1a. $130 Days 1-6	1b. $130 Days 1-10	2a. $50 days 1-30	6a. $0 copay per PT/OT/ST visit	10a. 20% Coinsurance	11a. 20% Coinsurance	11b. 20% Coinsurance	4a. $50 copay per visit	9a/b. $100 copay per visit	"8a, 9a. Zero cost share for lab services"	"8a/b, 9a. 20% Coinsurance"	1a. $50 copay per Observation stay	"9a, 12. 20% Coinsurance"	"3, 7c/I, 9a. 20% Coinsurance"	"7, 17, 18a. $0 copay per visit; 9d, 14b/c/d/e/f/g/h/i/j. Zero cost share for preventive services"	"4b/b1, 7b/d/f/g, 17a, 18a. $0 copay per visit"	"5, 7e/h, 9c. 20% Coinsurance"	"3, 7c/i. $20 copay per PT/OT/ST visit"	8a/b. 20% Coinsurance		11c. 15. 20% Coinsurance																					130	130	50	0	0.2	0.2		50	100		0.2	50	0.2	0.2	0	0	0.2	20	0.2		0.2																				NO	121.610095	121.610095	46.77311345	0	0.187092454	0.187092454	0	46.77311345	93.5462269	0	0.187092454	46.77311345	0.187092454	0.187092454	0	0	0.187092454	18.70924538	0.187092454	0	0.187092454																					28.6488	0	5.217814426	0	2.602034839	3.569423922	0	4.134110198	5.334037146	0	3.634231129	0.023058867	1.014895728	4.413072171	0	0	0.050666932	0.335451182	2.327058835	0	4.716790947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0214		4.554832985	28.6488	0	5.217814426	0	2.602034839	3.569423922	0	4.134110198	5.334037146	0	3.634231129	0.023058867	1.014895728	4.413072171	0	0	0.050666932	0.335451182	2.327058835	0	4.716790947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0214	NO																																																																																		0			28.6488	0	5.217814426	0	2.602034839	3.569423922	0	4.134110198	5.334037146	0	3.634231129	0.023058867	1.014895728	4.413072171	0	0	0.050666932	0.335451182	2.327058835	0	4.716790947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0214
H5410_012_0	2011	9																															D	D	D	V	T	COIN		P	P		P	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	YES	962.6599914	84.65952304	478.674503	698.6466197	263.8169774	9.27913944		643.5031491	749.7022307		638.5072867	6.68456206	1.82193257	234.8953347	3835.81754	3885.609065	0.18637435	169.6550705	945.0120222		28.16819668																				3400	1a. $220 per day 1-6	1b. $195 per day 1-10	2a. $60 for days 1-30	6a. $20 copay per PT/OT/ST visit	10a. $85 copay per trip	11a. 20% coinsurance	11b. 20% coinsurance	4a. $50 copay per visit	9a/b. $215 copay per visit	"8a, 9a. Zero cost share for lab services"	"8a/b, 9a. $25/Xray; $100/MRI,MRA,PET,CT, and NUC Scan"	1a. $50 copay per Observation Stay	"9a, 12. 20%  coinsurance"	"3, 7c/i, 9a. $20 copay per PT/OT/ST visit"	"7, 17, 18a. $5 copay per visit; 9d, 14b/c/d/e/f/g/h/i/j. Zero cost share for preventive services"	"4b/b1, 7b/d/f/g, 17a, 18a. $40 copay per visit"	"5, 7e/h, 9c. 20% coinsurance"	"3, 7c/i. $20 copay per PT/OT/ST visit"	"8a/b. $25/Xray; $100/MRI,MRA,PET,CT, and NUC Scan"		"11c, 15. 20% per script"																					220	195	60	20	85	0.2		50	215		49.75246149	50	0.2	20	5	40	0.2	20	40.5792157		0.2																				NO	214.2795309	189.9295842	58.43987207	19.47995736	82.78981876	0.194799574	0	48.69989339	209.4095416	0	48.45879141	48.69989339	0.194799574	19.47995736	4.869989339	38.95991471	0.194799574	19.47995736	39.52406957	0	0.194799574																					17.1899	1.339945668	2.331139726	1.134133863	1.820113312	1.807572406	0	2.611544563	13.08290004	0	2.578440951	0.027128122	0.354911688	0.381312592	1.556699211	12.61524981	0.036305644	0.275406128	3.112560076	0	5.487152701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7424		1.785476902	17.1899	1.339945668	2.331139726	1.134133863	1.820113312	1.807572406	0	2.611544563	13.08290004	0	2.578440951	0.027128122	0.354911688	0.381312592	1.556699211	12.61524981	0.036305644	0.275406128	3.112560076	0	5.487152701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7424	NO	30% Coinsurance	Included in Line a1	30% Coinsurance	30% Coinsurance	$100 Copay	30% Coinsurance	Included in Line e1	30% Coinsurance	30% Coinsurance	30% Coinsurance	Included in line h1	Included in line h1	Included in line h1	Included in line h1	30% Coinsurance	Include in line i1	Include in line i1	Include in line i1	Include in line i1	Include in line i1	30% Coinsurance																					0.7058		0.1054	0.0303	0.0246	0.0363		0.0788	0.2144	0.1933					0.6543						0.1361																				2.1792			17.8956	1.339945668	2.436544666	1.164410871	1.84470012	1.843893519	0	2.690314821	13.29727105	0.193329716	2.578440951	0.027128122	0.354911688	0.381312592	2.210960408	12.61524981	0.036305644	0.275406128	3.112560076	0	5.623253113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9216
H5414_009_0	2011	4																															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	1303.294789	144.7376834	743.6100622	857.8853766	154.8116215	12.96455802	0	307.4397474	410.7929497	3703.24643	2947.054128	32.55517968	0.214436708	524.1396992	3557.423294	5960.893931	396.7135371	793.6436476	0	0	319.4530777	0	0	0	1025.894611	71.47981322	43.25915677	10.99579804	41.19857379	0											3400	$275/day 1-8	$275/day 1-6	"$0/d 1-4, $100/d 5-20, $125/d 21-100"	$15 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$275 per procedure	$0 per visit	$50 X-ray; $175 Complex Radiology	$50 per visit	$25 per visit	$50 per visit	"$30 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$50 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$50 per visit	$50 per visit	$50 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness Only	0											0	209.5	185.333116	93.46291549	15	175	0.05	0.05	49	275	0	28.125	50	25	50	30	50	40	37.5	50	50	$50 	0	0	0	0	0	0	0	0	0											NO	174.5402744	154.4061715	77.8665533	12.49691702	145.7973652	0.04165639	0.04165639	40.82326227	229.1101454	0	23.43171941	41.65639007	20.82819504	41.65639007	24.99383404	41.65639007	33.32511206	31.24229255	41.65639007	41.65639007	41.65639007	0	0	0	0	0	0	0	0	0												18.9565	1.862365964	4.825196045	0.893410197	1.880927211	0.540056686	0	1.04589112	7.843069369	0	5.754545452	0.113010939	0.000372194	1.819480647	7.40947062	20.69244356	1.101710257	2.066270585	0	0	1.108938501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9136	0	15.60578784	18.9565	1.862365964	4.825196045	0.893410197	1.880927211	0.540056686	0	1.04589112	7.843069369	0	5.754545452	0.113010939	0.000372194	1.819480647	7.40947062	20.69244356	1.101710257	2.066270585	0	0	1.108938501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9136	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			18.9565	1.862365964	4.825196045	0.893410197	1.880927211	0.540056686	0	1.04589112	7.843069369	0	5.754545452	0.113010939	0.000372194	1.819480647	7.40947062	20.69244356	1.101710257	2.066270585	0	0	1.108938501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9136
H5414_010_0	2011	3																															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	1475.114668	131.2726548	785.9529464	654.1989293	196.7060919	10.94324613	0	288.9414858	384.781145	3329.805713	2794.937109	85.85507225	1.595155112	126.9594408	3195.394266	5625.164083	346.4212606	829.8426126	0	0	251.3178537	0	0	0	1122.331704	80.81062335	47.1415265	12.23528097	87.2454187	0											3400	$275/day 1-8	$275/day 1-6	"$0/d 1-4, $100/d 5-20, $125/d 21-100"	$15 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$275 per procedure	$0 per visit	$50 X-ray; $175 Complex Radiology	$50 per visit	$25 per visit	$50 per visit	"$30 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$50 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$50 per visit	$50 per visit	$50 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness Only	0											0	209.5	185.333116	93.46291549	15	175	0.05	0.05	49	275	0	28.125	50	25	50	30	50	40	37.5	50	50	$50 	0	0	0	0	0	0	0	0	0											NO	171.1137783	151.374939	76.33791218	12.25158317	142.935137	0.040838611	0.040838611	40.02183837	224.6123582	0	22.97171845	40.83861058	20.41930529	40.83861058	24.50316635	40.83861058	32.67088846	30.62895793	40.83861058	40.83861058	40.83861058	0	0	0	0	0	0	0	0	0												21.0344	1.655949177	4.999833917	0.667914383	2.343017683	0.446906967	0	0.96366412	7.202216697	0	5.350375695	0.292183488	0.00271433	0.432070597	6.524773104	19.14365712	0.943157531	2.118101206	0	0	0.85528933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.9762	0	16.81952732	21.0344	1.655949177	4.999833917	0.667914383	2.343017683	0.446906967	0	0.96366412	7.202216697	0	5.350375695	0.292183488	0.00271433	0.432070597	6.524773104	19.14365712	0.943157531	2.118101206	0	0	0.85528933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.9762	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			21.0344	1.655949177	4.999833917	0.667914383	2.343017683	0.446906967	0	0.96366412	7.202216697	0	5.350375695	0.292183488	0.00271433	0.432070597	6.524773104	19.14365712	0.943157531	2.118101206	0	0	0.85528933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.9762
H5414_019_0	2011	3																															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	1555.1065	103.5787588	1103.515322	857.2168876	232.4558301	11.07365636	0	279.7168469	400	2981.297336	2588.237616	64.50079188	2.602563472	0	3375.597959	5574.089877	292.0235642	733.4678385	0	0	278	0	0	0	1276.297822	100.5098252	62.16698521	14.43247347	4.096907246	0											3400	$275/day 1-8	$275/day 1-6	"$0/d 1-6, $100/d 7-21, $125/d 22-100"	$15 per visit	$200 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$275 per procedure	$0 per visit	$50 X-ray; $200 Complex Radiology	$50 per visit	$25 per visit	$50 per visit	"$30 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$50 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$50 per visit	$50 per visit	$50 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	209.5	185.333116	0	15	200	0.05	0.05	49	275	0	28.75	50	25	50	30	50	40	37.5	50	50	$50 	0	0	0	0	0	0	0	0	0											NO	171.3671267	151.5990623	0	12.26972267	163.5963023	0.040899076	0.040899076	40.08109406	224.9449157	0	23.51696845	40.89907557	20.44953779	0	24.53944534	40.89907557	32.71926046	30.67430668	40.89907557	40.89907557	40.89907557	0	0	0	0	0	0	0	0	0												22.2078	1.308536893	0	0.876484457	3.169076188	0.452902308	0	0.934279771	7.498163855	0	5.072291864	0.21983523	0.004435102	0	6.902941802	18.99792693	0.796232922	1.874884785	0	0	0.947495251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.2633	0	15.85762484	22.2078	1.308536893	0	0.876484457	3.169076188	0.452902308	0	0.934279771	7.498163855	0	5.072291864	0.21983523	0.004435102	0	6.902941802	18.99792693	0.796232922	1.874884785	0	0	0.947495251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.2633	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			22.2078	1.308536893	0	0.876484457	3.169076188	0.452902308	0	0.934279771	7.498163855	0	5.072291864	0.21983523	0.004435102	0	6.902941802	18.99792693	0.796232922	1.874884785	0	0	0.947495251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.2633
H5414_801_0	2011	1																															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	YES	291.4274948	5.244404185	34.56885665	8.87267078	8.398251179	13.94967298	0	14.34760765	40.56814729	19.44526617	58.46192011	0.866438095	0.074299898	27.04543068	31.50139469	133.4432698	2.977584342	9.288664509	0	0	71.96627899	0.000495528																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.083517011	0.083517011	0.15791713	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.070942622	0.070942622	0.134140999	0	0.19791933	0.19791933	0.19791933	0.19791933	0.19791933	0.19791933	0.19791933	0.19791933	0.19791933	0.19791933	0.19791933	0.19791933	0.19791933	0.19791933	0.19791933	0.19791933	0.19791933	0.19791933	0	0	0	0	0	0	0	0												20.6746	0.372051783	4.637100952	0	1.662176249	2.760909934	0	2.839668897	8.029220543	3.848594057	11.57074408	0.171484848	0.014705386	5.352813528	6.234734941	26.41100259	0.589321499	1.838406259	0	0	14.24351774	9.81E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2512	0	19.72114074	20.6746	0.372051783	4.637100952	0	1.662176249	2.760909934	0	2.839668897	8.029220543	3.848594057	11.57074408	0.171484848	0.014705386	5.352813528	6.234734941	26.41100259	0.589321499	1.838406259	0	0	14.24351774	9.81E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2512	NO																																																																																		0			20.6746	0.372051783	4.637100952	0	1.662176249	2.760909934	0	2.839668897	8.029220543	3.848594057	11.57074408	0.171484848	0.014705386	5.352813528	6.234734941	26.41100259	0.589321499	1.838406259	0	0	14.24351774	9.81E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.2512
H5414_803_0	2011	2																															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	YES	250.1002226	3.348416917	32.11684886	6.16679325	6.877567339	9.838966614	0	13.32084382	44.54367934	17.82360053	68.61752687	0.491580497	0.042154634	29.69578654	34.12754096	130.2210172	2.263626094	8.692306097	0	0	56.2941828	0.001335781																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.083585943	0.083585943	0.158490906	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.071367597	0.071367597	0.135323174	0	0.198940749	0.198940749	0.198940749	0.198940749	0.198940749	0.198940749	0.198940749	0.198940749	0.198940749	0.198940749	0.198940749	0.198940749	0.198940749	0.198940749	0.198940749	0.198940749	0.198940749	0.198940749	0	0	0	0	0	0	0	0												17.8491	0.23896847	4.346153933	0	1.368228398	1.957371388	0	2.650058646	8.861552931	3.545840438	13.65082219	0.097795392	0.008386274	5.907702015	6.789358559	25.9062667	0.450327471	1.729253885	0	0	11.19920689	0.000265741	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5566	0	18.24238645	17.8491	0.23896847	4.346153933	0	1.368228398	1.957371388	0	2.650058646	8.861552931	3.545840438	13.65082219	0.097795392	0.008386274	5.907702015	6.789358559	25.9062667	0.450327471	1.729253885	0	0	11.19920689	0.000265741	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5566	NO																																																																																		0			17.8491	0.23896847	4.346153933	0	1.368228398	1.957371388	0	2.650058646	8.861552931	3.545840438	13.65082219	0.097795392	0.008386274	5.907702015	6.789358559	25.9062667	0.450327471	1.729253885	0	0	11.19920689	0.000265741	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5566
H5415_039_0	2011	8	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	Professional								Prosthetics/Supplies	Other	Therapy (PT/OT/ST)								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	YES	1353.808181	37.09241359	451.2166092	751.9632839	33.16735652	8.877157771	3.065129093	349.0281619	399.7363677	957.2696557	1580.18778	107.5260702	0.187040489	10.58957938	3891.041912	4683.929189	91.43752751	143.1988823		1387.677661	32.85356111	0							6.42	0.58	689.6094292	758.7031805	776.770984								6000	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$200/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$35/Visit:7b. $25 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$150/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"									161.6895	138.428775	34.44565	0	150	0.2	0.2	50	127.588084	89.106534	88.869488	200	0.174586	0.2	15	34.350924	35	150		0	0.2	0							0	0	0	118.015698	35								NO	144.370291	123.601115	27.212615	0	131.7414	0.175655	0.175655	43.9138	112.057552	78.26013	78.051938	175.6552	0.153335	0.175655	13.17414	30.169592	30.73966	131.7414		0	0.175655	0							0	0	0	103.650355	30.73966									16.2875	0.382055306	1.023231989	0	0.364126165	1.559317148	0.538405251	1.277262741	3.732789901	6.243003975	10.27805989	1.573959447	0.028679853	1.860112566	4.271760908	11.77601938	0.234229876	1.572101769	0	0	5.770892276	0	0	0	0	0	0	0	0	0	0	6.553321167	1.989806329	0	0	0	0	0	0	0	77.3166	0	10.53523607	16.2875	0.382055306	1.023231989	0	0.364126165	1.559317148	0.538405251	1.277262741	3.732789901	6.243003975	10.27805989	1.573959447	0.028679853	1.860112566	4.271760908	11.77601938	0.234229876	1.572101769	0	0	5.770892276	0	0	0	0	0	0	0	0	0	0	6.553321167	1.989806329	0	0	0	0	0	0	0	77.3166	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$150/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins		$40/Visit	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins	$40/Visit								7500	2.3049	0.0541	0.5439	2.0354	1.3911	1.9639	0.6781	0.1823	2.6948	0.3071	1.5817	0.2228	0.0042	0.4064	1.92	2.3112	0.0451	0.0456		0.6847	1.4081	0							0	0	0.2364	0.4326	0.3833								21.8377	0	4.502649909	18.5924	0.436122352	1.56716361	2.035442697	1.755234728	3.523237681	1.216513259	1.459548817	6.427609919	6.550066394	11.8597494	1.796761765	0.032857049	2.266501938	6.191742896	14.08724087	0.279348487	1.617662999	0	0.684730768	7.179015293	0	0	0	0	0	0	0	0	0	0.236374259	6.985873001	2.373093463	0	0	0	0	0	0	0	99.1543
H5415_056_0	2011	5	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	Professional								Prosthetics/Supplies	Other	Therapy (PT/OT/ST)								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	YES	1007.36483	51.805738	398.749375	516.402901	32.346826	12.228085	3.573755	299.460989	329.039262	1309.421507	917.345469	65.67689	0.537527	8.061168	3113.131448	3105.014184	81.265637	183.226077		1409.70743	25.780252	0							4.63	0.58	821.769813	681.26436	448.596401								6000	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$200/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$35/Visit:7b. $25 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$150/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"									161.6895	138.428775	34.44565	0	150	0.2	0.2	50	131.299616	78.837487	109.6635	200	0.174586	0.2	15	34.160577	35	150		0	0.2	0							0	0	0	127.399032	35								NO	149.850756	128.293159	29.715263	0	136.287	0.181716	0.181716	45.429	119.296205	71.630164	99.638062	181.716	0.158625	0.181716	13.6287	31.037617	31.8003	136.287		0	0.181716	0							0	0	0	115.752213	31.8003									12.5795	0.553860149	0.987411879	0	0.36737099	2.222038694	0.649408464	1.133684439	3.271094604	7.816173108	7.61687706	0.994545145	0.08526522	1.464843204	3.535661214	8.031020085	0.21535597	2.080944363	0	0	4.684684272	0	0	0	0	0	0	0	0	0	0	6.571488109	1.188791678	0	0	0	0	0	0	0	66.0501	0	6.419816702	12.5795	0.553860149	0.987411879	0	0.36737099	2.222038694	0.649408464	1.133684439	3.271094604	7.816173108	7.61687706	0.994545145	0.08526522	1.464843204	3.535661214	8.031020085	0.21535597	2.080944363	0	0	4.684684272	0	0	0	0	0	0	0	0	0	0	6.571488109	1.188791678	0	0	0	0	0	0	0	66.0501	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$150/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins		$40/Visit	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins	$40/Visit								7500	1.731	0.0762	0.6754	2.8979	1.3679	2.7275	0.7971	0.1577	3.1604	0.4388	1.3529	0.2151	0.0121	0.3119	1.5488	1.5447	0.0404	0.0804		0.7013	1.0981	0							0	0	0.4143	0.5616	0.2232								22.1349	0	4.54381807	14.3106	0.630075868	1.662845873	2.897948505	1.735237362	4.94957331	1.446552196	1.291371158	6.431514264	8.254942034	8.969763625	1.20963544	0.097368918	1.776748869	5.084444109	9.57576464	0.255785625	2.161376964	0	0.701329445	5.782740611	0	0	0	0	0	0	0	0	0	0.414266957	7.133081248	1.411968388	0	0	0	0	0	0	0	88.1849
H5415_801_0	2011	3																															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	YES	303.027948	5.125266	30.069813	16.035266	2.183995	12.716672	5.647999	28.802194	80.499642	11.609505	34.014492	5.758822	0.555282	23.215158	41.095804	65.061146	0.997072	7.778061		8.06649	26.579831	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082282	0.082282	0.159435	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.070453	0.070453	0.098963	0	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377		0.200377	0.200377	0																				21.3492	0.361090365	2.975798904	0	0.437622366	2.548128585	1.131729096	5.771297227	16.13027677	2.326277783	6.815721863	1.153935476	0.111265741	4.651783715	8.234653918	13.03675725	0.199790296	1.558544529	0	1.616339067	5.325986796	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7362	0	17.03099189	21.3492	0.361090365	2.975798904	0	0.437622366	2.548128585	1.131729096	5.771297227	16.13027677	2.326277783	6.815721863	1.153935476	0.111265741	4.651783715	8.234653918	13.03675725	0.199790296	1.558544529	0	1.616339067	5.325986796	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7362	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	Medicare FFS Cost Sharing																			10000	3.5392	0.0599	0.5772	0	1.875	1.7996	0.7993	0.9427	2.7564	0.38	1.1808	0.1885	0.0182	0.7599	1.5968	2.528	0.0387	0.289		0.3134	1.0328	0																			20.6754	0	1.840183282	24.8884	0.420950837	3.552949131	0	2.312666445	4.347758613	1.931019086	6.714028021	18.88663907	2.706271361	7.996482977	1.342428963	0.129441008	5.411712275	9.83146166	15.56475574	0.23853229	1.847590299	0	1.929768412	6.358766079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.4117
H5415_803_0	2011	3																															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	YES	303.027948	5.125266	30.069813	16.035266	2.183995	12.716672	5.647999	28.802194	80.499642	11.609505	34.014492	5.758822	0.555282	23.215158	41.095804	65.061146	0.997072	7.778061		8.06649	26.579831	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082282	0.082282	0.159435	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.070453	0.070453	0.098963	0	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377		0.200377	0.200377	0																				21.3492	0.361090365	2.975798904	0	0.437622366	2.548128585	1.131729096	5.771297227	16.13027677	2.326277783	6.815721863	1.153935476	0.111265741	4.651783715	8.234653918	13.03675725	0.199790296	1.558544529	0	1.616339067	5.325986796	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7362	0	17.03099189	21.3492	0.361090365	2.975798904	0	0.437622366	2.548128585	1.131729096	5.771297227	16.13027677	2.326277783	6.815721863	1.153935476	0.111265741	4.651783715	8.234653918	13.03675725	0.199790296	1.558544529	0	1.616339067	5.325986796	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7362	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	Medicare FFS Cost Sharing																			10000	3.5392	0.0599	0.5772	0	1.875	1.7996	0.7993	0.9427	2.7564	0.38	1.1808	0.1885	0.0182	0.7599	1.5968	2.528	0.0387	0.289		0.3134	1.0328	0																			20.6754	0	1.840183282	24.8884	0.420950837	3.552949131	0	2.312666445	4.347758613	1.931019086	6.714028021	18.88663907	2.706271361	7.996482977	1.342428963	0.129441008	5.411712275	9.83146166	15.56475574	0.23853229	1.847590299	0	1.929768412	6.358766079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.4117
H5415_804_0	2011	3																															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	YES	303.027948	5.125266	30.069813	16.035266	2.183995	12.716672	5.647999	28.802194	80.499642	11.609505	34.014492	5.758822	0.555282	23.215158	41.095804	65.061146	0.997072	7.778061		8.06649	26.579831	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082282	0.082282	0.159435	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.070453	0.070453	0.098963	0	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377	0.200377		0.200377	0.200377	0																				21.3492	0.361090365	2.975798904	0	0.437622366	2.548128585	1.131729096	5.771297227	16.13027677	2.326277783	6.815721863	1.153935476	0.111265741	4.651783715	8.234653918	13.03675725	0.199790296	1.558544529	0	1.616339067	5.325986796	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7362	0	17.03099189	21.3492	0.361090365	2.975798904	0	0.437622366	2.548128585	1.131729096	5.771297227	16.13027677	2.326277783	6.815721863	1.153935476	0.111265741	4.651783715	8.234653918	13.03675725	0.199790296	1.558544529	0	1.616339067	5.325986796	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7362	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	Medicare FFS Cost Sharing																			10000	3.5392	0.0599	0.5772	0	1.875	1.7996	0.7993	0.9427	2.7564	0.38	1.1808	0.1885	0.0182	0.7599	1.5968	2.528	0.0387	0.289		0.3134	1.0328	0																			20.6754	0	1.840183282	24.8884	0.420950837	3.552949131	0	2.312666445	4.347758613	1.931019086	6.714028021	18.88663907	2.706271361	7.996482977	1.342428963	0.129441008	5.411712275	9.83146166	15.56475574	0.23853229	1.847590299	0	1.929768412	6.358766079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.4117
H5415_806_0	2011	5																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0																			0	YES				16.599764	2.260879	13.164343	5.846827	29.816132	83.333508	12.018199	35.21192	5.961553	0.57483	24.032415	42.542519	67.351526	1.032173	8.051875		8.350458	27.515532	0																			6700				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare 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	0																			NO				0	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709		0.198709	0.198709	0																				0	0	0	0	0.449257005	2.615873433	1.161817146	5.924733774	16.55911804	2.388124305	6.996925411	1.184614235	0.114223894	4.775457152	8.453581408	13.38335438	0.205102065	1.599980029	0	1.659311159	5.467583848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9391	0	12.587	0	0	0	0	0.449257005	2.615873433	1.161817146	5.924733774	16.55911804	2.388124305	6.996925411	1.184614235	0.114223894	4.775457152	8.453581408	13.38335438	0.205102065	1.599980029	0	1.659311159	5.467583848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9391	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																			10000				0	1.9303	1.8527	0.8229	0.9705	2.8376	0.3912	1.2156	0.1941	0.0187	0.7823	1.6439	2.6025	0.0399	0.2976		0.3227	1.0632	0																			16.9856	0	1.375903978	0	0	0	0	2.379581753	4.46856077	1.984672015	6.895258507	19.3967445	2.77932077	8.212498206	1.378664966	0.13293479	5.557790317	10.0974668	15.98588418	0.244986412	1.897547522	0	1.981981262	6.530811829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9247
H5415_807_0	2011	5																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0																			0	YES				16.599764	2.260879	13.164343	5.846827	29.816132	83.333508	12.018199	35.21192	5.961553	0.57483	24.032415	42.542519	67.351526	1.032173	8.051875		8.350458	27.515532	0																			6700				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare 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	0																			NO				0	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709		0.198709	0.198709	0																				0	0	0	0	0.449257005	2.615873433	1.161817146	5.924733774	16.55911804	2.388124305	6.996925411	1.184614235	0.114223894	4.775457152	8.453581408	13.38335438	0.205102065	1.599980029	0	1.659311159	5.467583848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9391	0	12.587	0	0	0	0	0.449257005	2.615873433	1.161817146	5.924733774	16.55911804	2.388124305	6.996925411	1.184614235	0.114223894	4.775457152	8.453581408	13.38335438	0.205102065	1.599980029	0	1.659311159	5.467583848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9391	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																			10000				0	1.9303	1.8527	0.8229	0.9705	2.8376	0.3912	1.2156	0.1941	0.0187	0.7823	1.6439	2.6025	0.0399	0.2976		0.3227	1.0632	0																			16.9856	0	1.375903978	0	0	0	0	2.379581753	4.46856077	1.984672015	6.895258507	19.3967445	2.77932077	8.212498206	1.378664966	0.13293479	5.557790317	10.0974668	15.98588418	0.244986412	1.897547522	0	1.981981262	6.530811829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9247
H5415_808_0	2011	5																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0																			0	YES				16.599764	2.260879	13.164343	5.846827	29.816132	83.333508	12.018199	35.21192	5.961553	0.57483	24.032415	42.542519	67.351526	1.032173	8.051875		8.350458	27.515532	0																			6700				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare 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	0																			NO				0	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709	0.198709		0.198709	0.198709	0																				0	0	0	0	0.449257005	2.615873433	1.161817146	5.924733774	16.55911804	2.388124305	6.996925411	1.184614235	0.114223894	4.775457152	8.453581408	13.38335438	0.205102065	1.599980029	0	1.659311159	5.467583848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9391	0	12.587	0	0	0	0	0.449257005	2.615873433	1.161817146	5.924733774	16.55911804	2.388124305	6.996925411	1.184614235	0.114223894	4.775457152	8.453581408	13.38335438	0.205102065	1.599980029	0	1.659311159	5.467583848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9391	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																			10000				0	1.9303	1.8527	0.8229	0.9705	2.8376	0.3912	1.2156	0.1941	0.0187	0.7823	1.6439	2.6025	0.0399	0.2976		0.3227	1.0632	0																			16.9856	0	1.375903978	0	0	0	0	2.379581753	4.46856077	1.984672015	6.895258507	19.3967445	2.77932077	8.212498206	1.378664966	0.13293479	5.557790317	10.0974668	15.98588418	0.244986412	1.897547522	0	1.981981262	6.530811829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9247
H5416_002_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	958.2468266	5.919797551	1019.929309		146.6563369	7.678278151	5.264876276	304.1930973	112.9707581		2.871326266	5.644179965	0.011619542	6.938947489	4326.574108	3534.903839	49.17831588	899.511029	35.9264761		17.67687361	0.558259999		11.76442105	159.1037094																6700	"1a (IP Acute) 250 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 425 copay, 9b (OP ASC) 200 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 39 copay, 7i (PT/ST) 39 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 5 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 39 copay, 7f (Podiatry) 39 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 39 copay, 18a (Hearing Exam) 39 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 39 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 39 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 70 allowance, 0% Coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 20"												181.2051416	172.0337627	49.94161658		150	0.2	0.2	49.79661269	422.7643636		0.2	0.2	0.2	0.19713825	5	36.12524265	40	39	0.181		0.2	39		0.321428571	25																NO	173.5152044	164.7330381	47.8222071		143.6343386	0.191512451	0.191512451	47.68335686	404.8231983		0.191512451	0.191512451	0.191512451	0.188772148	4.787811286	34.62324458	38.30249029	37.34492803	0.173318769		0.191512451	37.34492803		0.321428571	25																	13.8559	0.08126552	4.064605886	0	1.755407163	1.470485872	1.008289362	1.208745667	3.811098633	0	0.549894732	1.080930741	0.002225287	1.309880022	1.726235029	10.19915335	0.156970997	2.799347887	6.226732596	0	3.385341398	0.001737348	0	3.781421048	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8071	0	2.414406813	13.8559	0.08126552	4.064605886	0	1.755407163	1.470485872	1.008289362	1.208745667	3.811098633	0	0.549894732	1.080930741	0.002225287	1.309880022	1.726235029	10.19915335	0.156970997	2.799347887	6.226732596	0	3.385341398	0.001737348	0	3.781421048	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8071	NO																																																																																		0	0	0	13.8559	0.08126552	4.064605886	0	1.755407163	1.470485872	1.008289362	1.208745667	3.811098633	0	0.549894732	1.080930741	0.002225287	1.309880022	1.726235029	10.19915335	0.156970997	2.799347887	6.226732596	0	3.385341398	0.001737348	0	3.781421048	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8071
H5416_004_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1015.390164	36.57661896	318.3523445		147.681297	6.979807136	8.102133573	354.1090167	214.4308393		11.07368282	4.146875714	0.091545077	24.67971879	3993.413488	3819.794706	108.5993528	1159.145267	24.91563134		14.01156095				159.1037094																5900	"1a (IP Acute) 225 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 425 copay, 9b (OP ASC) 200 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 39 copay, 7i (PT/ST) 39 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 5 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 39 copay, 7f (Podiatry) 39 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 39 copay, 18a (Hearing Exam) 39 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 39 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 39 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0% Coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												163.0846274	172.0337627	49.94161658		150	0.2	0.2	48.43688823	301.4205499		0.2	0.2	0.2	0.197773916	5	37.65547367	40	39	0.181		0.2				25																NO	153.8795431	162.323557	47.1227317		141.5334593	0.188711279	0.188711279	45.70293565	284.4072875		0.188711279	0.188711279	0.188711279	0.186610843	4.717781975	35.55100951	37.7422558	36.79869941	0.170783708		0.188711279				25																	13.0206	0.494770574	1.25013601	0	1.741820402	1.317168332	1.528963989	1.3486518	5.082141112	0	2.089728848	0.78256222	0.017275589	4.605503129	1.570004515	11.31646316	0.341565379	3.55458652	4.255183895	0	2.644139588	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.2928	0	3.400362971	13.0206	0.494770574	1.25013601	0	1.741820402	1.317168332	1.528963989	1.3486518	5.082141112	0	2.089728848	0.78256222	0.017275589	4.605503129	1.570004515	11.31646316	0.341565379	3.55458652	4.255183895	0	2.644139588	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.2928	NO																																																																																		0	0	0	13.0206	0.494770574	1.25013601	0	1.741820402	1.317168332	1.528963989	1.3486518	5.082141112	0	2.089728848	0.78256222	0.017275589	4.605503129	1.570004515	11.31646316	0.341565379	3.55458652	4.255183895	0	2.644139588	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.2928
H5416_009_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	861.4224962	52.46238257	741.7016568		76.73819428	6.526205825	6.991390672	407.9256187	253.4833369		11.82237573	2.13006538	0.000662172	18.84778649	4229.830791	3559.824946	88.80149909	1061.766447	20.38125643		10.62650782				159.1037094																5900	"1a (IP Acute) 250 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 425 copay, 9b (OP ASC) 200 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 39 copay, 7i (PT/ST) 39 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 10 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 39 copay, 7f (Podiatry) 39 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 39 copay, 18a (Hearing Exam) 39 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 39 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 39 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 70 allowance, 0% Coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												181.2051416	172.0337627	49.94161658		150	0.2	0.2	48.39479463	301.0270424		0.2	0.2	0.2	0.19868206	10	37.13391548	40	39	0.181		0.2				25																NO	171.294872	162.6250839	47.21026536		141.7963672	0.189061823	0.189061823	45.74804047	284.5636069		0.189061823	0.189061823	0.189061823	0.187815962	9.453091147	35.12303679	37.81236459	36.86705547	0.17110095		0.189061823				25																	12.2964	0.710974947	2.917994336	0	0.906766431	1.23385637	1.321805065	1.555149809	6.011011055	0	2.235159907	0.402714044	0.000125191	3.539915153	3.332081334	10.41932188	0.279816222	3.262016874	3.487252333	0	2.00906694	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2529	0	3.229059161	12.2964	0.710974947	2.917994336	0	0.906766431	1.23385637	1.321805065	1.555149809	6.011011055	0	2.235159907	0.402714044	0.000125191	3.539915153	3.332081334	10.41932188	0.279816222	3.262016874	3.487252333	0	2.00906694	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2529	NO																																																																																		0	0	0	12.2964	0.710974947	2.917994336	0	0.906766431	1.23385637	1.321805065	1.555149809	6.011011055	0	2.235159907	0.402714044	0.000125191	3.539915153	3.332081334	10.41932188	0.279816222	3.262016874	3.487252333	0	2.00906694	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2529
H5416_011_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	917.0482515	14.83600859	468.9661128		64.63421869	4.510602293	6.664404919	228.9907181	371.4837544		9.869877925	1.758350341	1.192079365	10.35611256	4522.660036	5044.12189	117.3672314	1361.813142	34.93379383		18.40253652			11.76442105	159.1037094																4950	"1a (IP Acute) 250 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 350 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 30 copay, 7i (PT/ST) 30 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 5 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 30 copay, 7f (Podiatry) 30 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 30 copay, 18a (Hearing Exam) 30 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 30 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 30 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0%coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 7"												181.2051416	172.0337627	49.94161658		150	0.2	0.2	46	172.6293598		0.2	0.2	0.2	0.194050986	5	29.41040431	40	30	0.181		0.2			0.321428571	25																NO	168.754765	160.21354	46.51019114		139.6936893	0.186258252	0.186258252	42.83939806	160.7682144		0.186258252	0.186258252	0.186258252	0.180717988	4.656456311	27.38965255	37.25165049	27.93873786	0.168563718		0.186258252			0.321428571	25																	12.8964	0.198077455	1.817641962	0	0.752416039	0.8401369	1.241300414	0.817485377	4.976898323	0	1.838346214	0.327507262	0.222034619	1.871535826	1.754964072	11.51306217	0.36434359	3.170611699	5.888570187	0	3.427624293	0	0	3.781421048	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0318	0	3.978025472	12.8964	0.198077455	1.817641962	0	0.752416039	0.8401369	1.241300414	0.817485377	4.976898323	0	1.838346214	0.327507262	0.222034619	1.871535826	1.754964072	11.51306217	0.36434359	3.170611699	5.888570187	0	3.427624293	0	0	3.781421048	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0318	NO																																																																																		0	0	0	12.8964	0.198077455	1.817641962	0	0.752416039	0.8401369	1.241300414	0.817485377	4.976898323	0	1.838346214	0.327507262	0.222034619	1.871535826	1.754964072	11.51306217	0.36434359	3.170611699	5.888570187	0	3.427624293	0	0	3.781421048	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0318
H5416_013_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	991.6281599	60.56565198	539.8937064		51.52656603	3.977903439	5.813609168	209.0333457	207.4905598		13.24256609	0.105457471	0.667209848	9.397529779		4358.229436	300.3519315	523.256136	12.75332105		14.4801542			11.76442105	159.1037094		260.9166693														3600	"1a (IP Acute) 165 days 1-5, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 275 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 20 copay, 7i (PT/ST) 20 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 20 copay, 7f (Podiatry) 20 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 20 copay, 18a (Hearing Exam) 20 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 20 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 20 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 20 copay	18b (Hearing Aids) 700 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 18"												102.1273837	172.0337627	49.94161658		150	0.2	0.2	46	191.1902779		0.2	0.2	0.2	0.196789533		19.90920932	40	20	0.181		0.2			0.321428571	25		20														NO	96.27041203	162.1676833	47.07748139		141.3975496	0.188530066	0.188530066	43.36191522	180.2255787		0.188530066	0.188530066	0.188530066	0.185503718		18.76742275	37.70601323	18.85300662	0.17061971		0.188530066			0.321428571	25		18.85300662															7.9554	0.818482623	2.11806966	0	0.607144181	0.749954399	1.096040121	0.755340518	3.116258851	0	2.496621862	0.019881904	0.125789117	1.743276715	0	6.81606119	0.943756159	0.822079283	2.175967938	0	2.729944429	0	0	3.781421048	0.331466061	0	0.409921974	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6128	0	2.159773358	7.9554	0.818482623	2.11806966	0	0.607144181	0.749954399	1.096040121	0.755340518	3.116258851	0	2.496621862	0.019881904	0.125789117	1.743276715	0	6.81606119	0.943756159	0.822079283	2.175967938	0	2.729944429	0	0	3.781421048	0.331466061	0	0.409921974	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6128	NO																																																																																		0	0	0	7.9554	0.818482623	2.11806966	0	0.607144181	0.749954399	1.096040121	0.755340518	3.116258851	0	2.496621862	0.019881904	0.125789117	1.743276715	0	6.81606119	0.943756159	0.822079283	2.175967938	0	2.729944429	0	0	3.781421048	0.331466061	0	0.409921974	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6128
H5416_014_0	2011	6																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin	T	Coin	P	P	P	P	O	V																																																			0	YES	253.0619533	22.85261963	24.47659999		9.8623762	11.66792787	14.57831321	24.60601828	30.81087061		10.93879192	4.121882754	1.650121713	26.69368135		3845.757774	14.01936223	495.4344855	20.37383442	9.760444377	10.79460627	0.4088093		13.93798932	159.1037094		260.9166693														3400	"1a (IP Acute) FFS, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 20% coin	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 20% coin, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 20% coin"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 0-20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 20% coin, 5 (Partial Hosp) 20% coin, 7c (OT) 8 copay, 7i (PT/ST) 8 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 20% coin, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 8 copay, 7b1 (Routine Chiro) 0% coin (5 visits), 7d (SPC w/Copay) 8 copay, 7f (Podiatry) 8 copay, 7f1 (Routine Podiatry) 0% coin (3 visits), 17a (Eye Exam) 8 copay, 18a (Hearing Exam) 8 copay"	"7e (MH Non-Phys) 45% coin, 7h (Psych) 45% coin"	7i (PT/ST) 8 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0-20% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 8 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 8 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 14"												0.072967157	0.072967157	0.150834751		0.2	0.2	0.2	0.2	0.2		0.2	0.2	0.2	0.2		8	0.45	8	0.181	0.07872	0.2	0.199880289		0.135384615	5		8														NO	0.063308446	0.063308446	0.130868655		0.173525868	0.173525868	0.173525868	0.173525868	0.173525868		0.173525868	0.173525868	0.173525868	0.173525868		6.941034729	0.390433203	6.941034729	0.157040911	0.068299782	0.173525868	0.173422003		0.135384615	5		6.941034729															16.021	1.446763841	3.203219728	0	1.711377393	2.024687314	2.529714457	4.269780684	5.346483072	0	1.898163366	0.715253284	0.286338803	4.632044232	0	2.224461522	5.473624506	0.286568997	3.199525513	0.666636221	1.873143425	0.070896528	0	1.886989318	0.066293212	0	0.150919305	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9838	0	8.853485315	16.021	1.446763841	3.203219728	0	1.711377393	2.024687314	2.529714457	4.269780684	5.346483072	0	1.898163366	0.715253284	0.286338803	4.632044232	0	2.224461522	5.473624506	0.286568997	3.199525513	0.666636221	1.873143425	0.070896528	0	1.886989318	0.066293212	0	0.150919305	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9838	NO																																																																																		0	0	0	16.021	1.446763841	3.203219728	0	1.711377393	2.024687314	2.529714457	4.269780684	5.346483072	0	1.898163366	0.715253284	0.286338803	4.632044232	0	2.224461522	5.473624506	0.286568997	3.199525513	0.666636221	1.873143425	0.070896528	0	1.886989318	0.066293212	0	0.150919305	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9838
H5416_016_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1025.920424	92.72888765	610.3035702		70.85736306	3.657568368	5.957299706	284.4473654	290.6514181		20.25616038	3.430513805	0.003947395	30.74325524	3381.100972	4341.292596	568.2821923	733.9860892	15.47669653		14.19154864				159.1037094																4950	"1a (IP Acute) 250 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 400 copay , 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 40 copay , 7i (PT/ST) 40 copay , 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 5 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 40 copay , 7f (Podiatry) 40 copay , 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 40 copay , 18a (Hearing Exam) 40 copay "	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 40 copay 	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 40 copay , 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0% Coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a 	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												181.2051416	172.0337627	49.94161658		150	0.2	0.2	46	290.3116721		0.2	0.2	0.2	0.196765122	5	38.97218671	40	40	0.181		0.2				25																NO	166.113914	157.706351	45.78235104		137.5076164	0.183343489	0.183343489	42.16900237	266.1337736		0.183343489	0.183343489	0.183343489	0.18037802	4.583587214	35.72648334	36.66869771	36.66869771	0.165925857		0.183343489				25																	14.2016	1.218661209	2.328427691	0	0.811952258	0.670591344	1.09223211	0.999571802	6.446013227	0	3.71383511	0.628962369	0.000723729	5.545407494	1.291464265	12.92492647	1.736513994	2.242859503	2.567984138	0	2.601928036	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3552	0	5.543921118	14.2016	1.218661209	2.328427691	0	0.811952258	0.670591344	1.09223211	0.999571802	6.446013227	0	3.71383511	0.628962369	0.000723729	5.545407494	1.291464265	12.92492647	1.736513994	2.242859503	2.567984138	0	2.601928036	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3552	NO																																																																																		0	0	0	14.2016	1.218661209	2.328427691	0	0.811952258	0.670591344	1.09223211	0.999571802	6.446013227	0	3.71383511	0.628962369	0.000723729	5.545407494	1.291464265	12.92492647	1.736513994	2.242859503	2.567984138	0	2.601928036	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3552
H5416_017_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1148.056353	77.05439527	493.8914124		107.228549	5.459644793	8.81178379	301.1903912	287.6533178		16.57771314	1.578892492	0.046417272	28.92735178		3570.511771	227.6880471	348.7850525	14.31881049		13.22963596				159.1037094																4950	"1a (IP Acute) 195 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 125 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 325 copay, 9b (OP ASC) 175 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 35 copay, 7i (PT/ST) 35 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 35 copay, 7f (Podiatry) 35 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 35 copay, 18a (Hearing Exam) 35 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 35 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 35 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0% Coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												141.3400104	172.0337627	49.94161658		125	0.2	0.2	46	275.1881095		0.2	0.2	0.2	0.19557498		33.88105466	40	35	0.181		0.2				25																NO	132.3725697	161.11893	46.77302699		117.0692656	0.187310825	0.187310825	43.08148973	257.728559		0.187310825	0.187310825	0.187310825	0.183166554		31.73144148	37.46216498	32.77939436	0.169516297		0.187310825				25																	12.6643	1.03457681	1.925066363	0	1.04609729	1.02265057	1.650542491	1.081310895	6.17803959	0	3.105185123	0.295743655	0.008694458	5.298523339	0	9.441457112	0.710807265	0.952746898	2.427271725	0	2.478054024	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6525	0	3.476689395	12.6643	1.03457681	1.925066363	0	1.04609729	1.02265057	1.650542491	1.081310895	6.17803959	0	3.105185123	0.295743655	0.008694458	5.298523339	0	9.441457112	0.710807265	0.952746898	2.427271725	0	2.478054024	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6525	NO																																																																																		0	0	0	12.6643	1.03457681	1.925066363	0	1.04609729	1.02265057	1.650542491	1.081310895	6.17803959	0	3.105185123	0.295743655	0.008694458	5.298523339	0	9.441457112	0.710807265	0.952746898	2.427271725	0	2.478054024	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6525
H5416_018_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	1064.946553	71.47629331	458.1377524		99.46608745	4.926039813	7.950553456	279.386694	266.8295928		14.95747032	1.424577527	0.041880624	26.10010211		3312.036202	211.2053126	323.5358947	12.91934425		11.9366215			11.76442105	159.1037094																4950	"1a (IP Acute) 195 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 125 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 325 copay, 9b (OP ASC) 175 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 35 copay, 7i (PT/ST) 35 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 35 copay, 7f (Podiatry) 35 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 35 copay, 18a (Hearing Exam) 35 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 35 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 35 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0% Coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												141.3400104	172.0337627	49.94161658		125	0.2	0.2	46	275.1881095		0.2	0.2	0.2	0.195604155		33.88105466	40	35	0.181		0.2			0.321428571	25																NO	133.4226749	162.3970787	47.14407517		117.9979704	0.188796753	0.188796753	43.42325311	259.7731072		0.188796753	0.188796753	0.188796753	0.184647146		31.98316549	37.75935053	33.03943172	0.170861061		0.188796753			0.321428571	25																	11.8407	0.967295103	1.799873386	0	0.97806637	0.93002032	1.501038675	1.010989927	5.776262703	0	2.823921825	0.268955611	0.007906926	4.819309377	0	8.827450162	0.664581286	0.890786842	2.207412868	0	2.253595378	0	0	3.781421048	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.681	0	2.822705226	11.8407	0.967295103	1.799873386	0	0.97806637	0.93002032	1.501038675	1.010989927	5.776262703	0	2.823921825	0.268955611	0.007906926	4.819309377	0	8.827450162	0.664581286	0.890786842	2.207412868	0	2.253595378	0	0	3.781421048	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.681	NO																																																																																		0	0	0	11.8407	0.967295103	1.799873386	0	0.97806637	0.93002032	1.501038675	1.010989927	5.776262703	0	2.823921825	0.268955611	0.007906926	4.819309377	0	8.827450162	0.664581286	0.890786842	2.207412868	0	2.253595378	0	0	3.781421048	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.681
H5416_019_0	2011	6																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin	T	Coin	P	P	P	P	O	V																																																			0	YES	287.7764156	5.937062596	21.23957602		5.909873878	7.657582625	10.79002405	16.36168192	53.33723832		15.47277823	3.491705155	0.543187477	23.75663131		6709.950923	3.793590966	1000.913972	37.92859797	16.6181896	21.68795078	1.14025066		13.93798932	159.1037094		260.9166693														3400	"1a (IP Acute) FFS, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 20% coin	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 20% coin, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 20% coin"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 0-20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 20% coin, 5 (Partial Hosp) 20% coin, 7c (OT) 8 copay, 7i (PT/ST) 8 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 20% coin, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 8 copay, 7b1 (Routine Chiro) 0% coin (5 visits), 7d (SPC w/Copay) 8 copay, 7f (Podiatry) 8 copay, 7f1 (Routine Podiatry) 0% coin (3 visits), 17a (Eye Exam) 8 copay, 18a (Hearing Exam) 8 copay"	"7e (MH Non-Phys) 45% coin, 7h (Psych) 45% coin"	7i (PT/ST) 8 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0-20% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 8 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 8 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 76"												0.081271472	0.081271472	0.191399066		0.2	0.2	0.2	0.2	0.2		0.2	0.2	0.2	0.2		8	0.45	8	0.181	0.07872	0.2	0.2		0.135384615	5		8														NO	0.068999346	0.068999346	0.162497493		0.169799671	0.169799671	0.169799671	0.169799671	0.169799671		0.169799671	0.169799671	0.169799671	0.169799671		6.791986859	0.382049261	6.791986859	0.153668703	0.066833151	0.169799671	0.169799671		0.135384615	5		6.791986859															19.8564	0.409653436	3.451377854	0	1.003494643	1.300255014	1.832142538	2.778208214	9.056645544	0	2.62727266	0.592890388	0.092233055	4.033868192	0	3.797824874	1.449338624	0.566516212	5.828438446	1.11064597	3.682606918	0.193614188	0	1.886989318	0.066293212	0	0.147678549	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7644	0	11.34934984	19.8564	0.409653436	3.451377854	0	1.003494643	1.300255014	1.832142538	2.778208214	9.056645544	0	2.62727266	0.592890388	0.092233055	4.033868192	0	3.797824874	1.449338624	0.566516212	5.828438446	1.11064597	3.682606918	0.193614188	0	1.886989318	0.066293212	0	0.147678549	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7644	NO																																																																																		0	0	0	19.8564	0.409653436	3.451377854	0	1.003494643	1.300255014	1.832142538	2.778208214	9.056645544	0	2.62727266	0.592890388	0.092233055	4.033868192	0	3.797824874	1.449338624	0.566516212	5.828438446	1.11064597	3.682606918	0.193614188	0	1.886989318	0.066293212	0	0.147678549	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7644
H5416_020_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	854.0601451	13.74249895	424.2039995		59.98049656	4.26147144	6.301103182	213.5674857	347.0514448		9.341725539	1.664932648	1.128844665	9.802418715	4224.06355	4710.249529	109.0272922	1271.92599	33.06374898		17.42336372			11.76442105	159.1037094																4950	"1a (IP Acute) 195 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery)  350 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 15 copay, 7i (PT/ST) 15 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 8 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 15 copay, 7f (Podiatry) 15 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 15 copay, 18a (Hearing Exam) 15 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 15 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 15 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 70 allowance, 0% Coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												141.3400104	172.0337627	49.94161658		150	0.2	0.2	46	172.612055		0.2	0.2	0.2	0.193969114	8	15.09076696	40	15	0.181		0.2			0.321428571	25																NO	134.6479108	163.8883899	47.57700465		142.8978713	0.190530495	0.190530495	43.82201386	164.4393015		0.190530495	0.190530495	0.190530495	0.184785156	7.621219802	14.3762565	38.10609901	14.28978713	0.172430098		0.190530495			0.321428571	25																	9.5831	0.187686335	1.681862972	0	0.714257106	0.811940263	1.200552309	0.77991311	4.755741431	0	1.779883591	0.317220442	0.215079333	1.811341473	2.682709731	5.642979617	0.346217066	1.514629303	5.701185477	0	3.319682115	0	0	3.781421048	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1589	0	2.139417659	9.5831	0.187686335	1.681862972	0	0.714257106	0.811940263	1.200552309	0.77991311	4.755741431	0	1.779883591	0.317220442	0.215079333	1.811341473	2.682709731	5.642979617	0.346217066	1.514629303	5.701185477	0	3.319682115	0	0	3.781421048	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1589	NO																																																																																		0	0	0	9.5831	0.187686335	1.681862972	0	0.714257106	0.811940263	1.200552309	0.77991311	4.755741431	0	1.779883591	0.317220442	0.215079333	1.811341473	2.682709731	5.642979617	0.346217066	1.514629303	5.701185477	0	3.319682115	0	0	3.781421048	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1589
H5416_021_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	999.6765685	16.17276968	511.2211202		70.45792175	5.360054278	7.919468351	249.6233485	404.9553601		11.72860695	2.089488866	1.416575811	12.30641095	4930.162898	5498.609756	127.9423094	1484.515876	41.51264486		21.86816488				159.1037094																6700	"1a (IP Acute) 250 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 350 copay, 9b (OP ASC) 175 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 30 copay, 7i (PT/ST) 30 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 5 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 30 copay, 7f (Podiatry) 30 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 30 copay, 18a (Hearing Exam) 30 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 30 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 30 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 12 trips/yr	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0% Coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												181.2051416	172.0337627	49.94161658		150	0.2	0.2	46	225.8405519		0.2	0.2	0.2	0.193553744	5	29.41040431	40	30	0.181		0.2				25																NO	171.4362065	162.759265	47.24921829		141.9133626	0.189217817	0.189217817	43.52009787	213.6652809		0.189217817	0.189217817	0.189217817	0.183119085	4.730445421	27.82486248	37.84356337	28.38267253	0.171242124		0.189217817				25																	14.2817	0.219355676	2.012899859	0	0.833243383	1.014217769	1.498504512	0.905302713	7.210408397	0	2.219261401	0.395368522	0.268041382	2.253538708	1.943488876	12.74983836	0.403482741	3.511210665	7.108713488	0	4.137846416	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.2979	0	3.588012154	14.2817	0.219355676	2.012899859	0	0.833243383	1.014217769	1.498504512	0.905302713	7.210408397	0	2.219261401	0.395368522	0.268041382	2.253538708	1.943488876	12.74983836	0.403482741	3.511210665	7.108713488	0	4.137846416	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.2979	NO																																																																																		0	0	0	14.2817	0.219355676	2.012899859	0	0.833243383	1.014217769	1.498504512	0.905302713	7.210408397	0	2.219261401	0.395368522	0.268041382	2.253538708	1.943488876	12.74983836	0.403482741	3.511210665	7.108713488	0	4.137846416	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.2979
H5416_022_0	2011	6																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin	T	Coin	P	P	P	P	O	V																																																			0	YES	278.9121847	5.754186269	20.58534414		5.727835032	7.421709993	10.45766441	15.85770133	51.69431843		14.99617809	3.384151933	0.522111766	23.02486785		6307.426882	3.595440671	940.870025	35.21309094	15.42840634	21.01990784	1.105128098		13.93798932	159.1037094		260.9166693														3400	"1a (IP Acute) FFS, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 20% coin	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 20% coin, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 20% coin"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 0-20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 20% coin, 5 (Partial Hosp) 20% coin, 7c (OT) 8 copay, 7i (PT/ST) 8 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 20% coin, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 8 copay, 7b1 (Routine Chiro) 0% coin (5 visits), 7d (SPC w/Copay) 8 copay, 7f (Podiatry) 8 copay, 7f1 (Routine Podiatry) 0% coin (3 visits), 17a (Eye Exam) 8 copay, 18a (Hearing Exam) 8 copay"	"7e (MH Non-Phys) 45% coin, 7h (Psych) 45% coin"	7i (PT/ST) 8 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0-20% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 8 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 8 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 83.5"												0.0640854	0.0640854	0.129449295		0.2	0.2	0.2	0.2	0.2		0.2	0.2	0.2	0.2		8	0.45	8	0.181	0.07872	0.2	0.2		0.135384615	5		8														NO	0.055711248	0.055711248	0.112533928		0.173865648	0.173865648	0.173865648	0.173865648	0.173865648		0.173865648	0.173865648	0.173865648	0.173865648		6.954625927	0.391197708	6.954625927	0.157348412	0.068433519	0.173865648	0.173865648		0.135384615	5		6.954625927															15.5385	0.3205729	2.31654963	0	0.99587375	1.290380418	1.818228601	2.75710952	8.987866181	0	2.607320224	0.588387769	0.090777301	4.003233573	0	3.655482877	1.406528151	0.545283256	5.540723927	1.055820141	3.654639901	0.192143813	0	1.886989318	0.066293212	0	0.151214819	0	0	0	0	0	0	0	0	0	0	0	0	0	59.47	0	8.645533131	15.5385	0.3205729	2.31654963	0	0.99587375	1.290380418	1.818228601	2.75710952	8.987866181	0	2.607320224	0.588387769	0.090777301	4.003233573	0	3.655482877	1.406528151	0.545283256	5.540723927	1.055820141	3.654639901	0.192143813	0	1.886989318	0.066293212	0	0.151214819	0	0	0	0	0	0	0	0	0	0	0	0	0	59.47	NO																																																																																		0	0	0	15.5385	0.3205729	2.31654963	0	0.99587375	1.290380418	1.818228601	2.75710952	8.987866181	0	2.607320224	0.588387769	0.090777301	4.003233573	0	3.655482877	1.406528151	0.545283256	5.540723927	1.055820141	3.654639901	0.192143813	0	1.886989318	0.066293212	0	0.151214819	0	0	0	0	0	0	0	0	0	0	0	0	0	59.47
H5416_023_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	1183.884146	72.30806673	644.5678181		61.51649083	4.867571718	7.113837729	249.5605448	247.718645		16.20429987	0.129043304	0.816433037	11.49931135		5203.199084	358.5838969	624.7045703	15.60563393		17.71867773			13.93798932	159.1037094		260.9166693														3600	"1a (IP Acute) 150 days 1-5, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 200 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 20 copay, 7i (PT/ST) 20 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 20 copay, 7f (Podiatry) 20 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 20 copay, 18a (Hearing Exam) 20 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 20 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 20 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 20 copay	18b (Hearing Aids) 700 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 25"												92.84307611	172.0337627	49.94161658		150	0.2	0.2	46	152.1087302		0.2	0.2	0.2	0.196760894		19.90920932	40	20	0.181		0.2			0.135384615	25		20														NO	86.2615611	159.8385314	46.40132566		139.3667111	0.185822281	0.185822281	42.73912473	141.3259564		0.185822281	0.185822281	0.185822281	0.182812791		18.49787349	37.16445629	18.58222815	0.168169165		0.185822281			0.135384615	25		18.58222815															8.5103	0.963134599	2.492400103	0	0.714445917	0.904503282	1.321909557	0.888833271	2.917422868	0	3.011119972	0.023979121	0.15171145	2.1022212	0	8.020676532	1.110547964	0.967366904	2.624386422	0	3.292525119	0	0	1.886989318	0.331466061	0	0.404034423	0	0	0	0	0	0	0	0	0	0	0	0	0	42.64	0	3.084049031	8.5103	0.963134599	2.492400103	0	0.714445917	0.904503282	1.321909557	0.888833271	2.917422868	0	3.011119972	0.023979121	0.15171145	2.1022212	0	8.020676532	1.110547964	0.967366904	2.624386422	0	3.292525119	0	0	1.886989318	0.331466061	0	0.404034423	0	0	0	0	0	0	0	0	0	0	0	0	0	42.64	NO																																																																																		0	0	0	8.5103	0.963134599	2.492400103	0	0.714445917	0.904503282	1.321909557	0.888833271	2.917422868	0	3.011119972	0.023979121	0.15171145	2.1022212	0	8.020676532	1.110547964	0.967366904	2.624386422	0	3.292525119	0	0	1.886989318	0.331466061	0	0.404034423	0	0	0	0	0	0	0	0	0	0	0	0	0	42.64
H5416_801_0	2011	5																															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	Coin	V																																																			0	YES	227.4986081	4.816220376	21.64941773		4.741326104	5.229990481	7.824387067	13.03318274	40.20030768	5.648840767	15.12595614	3.349618633	0.355966845	19.73472283	54.44655332	110.0499444	2.815356025	11.27613634	28.04070881	15.28431242	15.72331121	0.717295013																			6700	"1a (IP Acute) FFS, 1a1 (Add'l Days) n/a"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) n/a"	6a (Home Health) FFS	10a (Ambulance) FFS	11a (DME) FFS	"11b (Prosthetics) FFS, 11b (Medical Supplies) FFS, 11c (Diabetic Supplies) FFS"	"4a (ER) FFS, 4a (ER) - Worldwide Coverage n/a, 4b (UC) FFS"	"9a (OP Surgery) FFS, 9b (OP ASC) FFS"	8a (OP Diag Proc/Test/Lab) FFS	"8b (X-Ray) FFS, 8b (OP Therap Rad) FFS, 8b (OP Diag) FFS"	9a (OP Observation) FFS	12 (Renal Dialysis) FFS	"3 (CORF) FFS, 5 (Partial Hosp) FFS, 7c (OT) FFS, 7i (PT/ST) FFS, 9a (OP Other) FFS, 9a (OP Chemo) FFS, 9c (OP SA) FFS, 9d (OP Cardiac Rehab) FFS"	"7a (PCP w/Copay) FFS, 14b (Immunizations) FFS, 14c (Routine Physical) FFS, 14d (Pap & Pelvic Exam) FFS, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) FFS, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) FFS, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) FFS, 14h (Mammography) FFS, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) FFS, 14j (Nutrition Therapy Diabetes) FFS"	"7b (Chiro) FFS, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) FFS, 7f (Podiatry) FFS, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) FFS, 18a (Hearing Exam) FFS"	"7e (MH Non-Phys) FFS, 7h (Psych) FFS"	7i (PT/ST) FFS	7g Physician Specialist Services Excluding Psychiatric (Radiology only) FFS	"8a (OP Diag Proc/Test/Lab) FFS, 7g (Prof. Other) FFS"	15 (Part B Rx) FFS	"13a (Blood) FFS, 13a1 (3 Pint Blood) n/a, 14a4-1 (Smoking Cessation - Mdcr Covered) FFS, 16b (Comp. Dental) FFS, 17b (MCR Eyewear) FFS"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive n/a"	17a1 (Routine Eye Exam) n/a	17b1 (Non MCR Covered) n/a	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) n/a, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												0.076653506	0.076653506	0.164633008		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069034452	0.069034452	0.148269141		0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725																				15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	0	10.31335866	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	NO																																																																																		0	0	0	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469
H5417_001_0	2011	5																															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	YES	422.6630315	45.173601	11959.18713	263.6675083	16.07623702	55.84851543	15.60278676	7.941620806	3.278349481	44.49177847	16.06992735	0	0.46606843	8.421859196	0.86424115	193.3899171	20.866349	97.67015283	0	0	21.95883751	10.70086744	875.8657074	134.3234157	266.8982616	74.04916684	0	0	0	0											5000	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/20% (8a1a); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7f); $0 n/c (7b1); $0/20% (7d); $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, 18a); $0/20% (17a); $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 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.083680541	0.0846965	0	0	0.2	0.2	0.09719718	0.073863252	0.2	0	0.103846158	0	0.2	0.161056318	0.001871013	0.026235538	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.077068949	0.078004638	0	0	0.184198018	0.184198018	0.089517639	0.068027323	0.184198018	0	0.095641283	0	0.184198018	0.148331273	0.001708062	0.02395062	0.182581499	0	0	0	0.184198018	0.185131889	0	0	0	0	0	0	0	0												32.5742	3.523750379	0	0	2.961211001	10.28718587	1.396724637	0.540247202	0.603865478	0	1.536948465	0	0.085848881	1.249225096	0.001476177	4.631808366	3.809809282	0	0	0	4.044774354	1.981071803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2281	0	6.009259535	32.5742	3.523750379	0	0	2.961211001	10.28718587	1.396724637	0.540247202	0.603865478	0	1.536948465	0	0.085848881	1.249225096	0.001476177	4.631808366	3.809809282	0	0	0	4.044774354	1.981071803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2281	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.1655	0.1261	0	0.0242	0.1374	0.4772	0.1333	0.0167	0.028	0	0.0986	0	0.0027	0.058	0.0068	1.6382	0.1767	0.0388	0	0	0.1876	0.0919	0	0	0.0068	0	0	0	0	0											4.4145	0	0.395351772	33.7396	3.649824437	0	0.024161828	3.098586769	10.76442645	1.530054646	0.556955879	0.631879856	0	1.635565515	0	0.088504001	1.307178838	0.00829103	6.270022398	3.986553012	0.03883172	0	0	4.232418525	2.072977196	0	0	0.006789752	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6427
H5420_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	P	P	Coin	P	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	1879.976024	5.422887826	585.3978322	242.0444311	541.9553293	14.02382169	4.728896014	302.3723889	387.1609398	164.052423	34.62743216	11.9126443	0.005717869	204.0292723	30754.58832	29931.02577	418.9838664	1397.704091	0	0	36.28421384	1.075735072	6859.673871	107.7379561	474.5391627	3.87264626	170.3877245	0	18245.8874	0												$0 	$0 	$0 	$0 	$0 	$0 	$0 	"4a1: $25,4a2: $25"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"16a1: $0,16b1: $10-$150 restorative, $0-$125 endo/perio/extractions/prostho/surgery/other"	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	17.67978835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.23732636	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	17.67551369	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.23720748	0	0	0	0	0	0												0	0	0	0	0	0	0	0.445382275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.145780295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5912		0.000108779	0	0	0	0	0	0	0	0.445382275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.145780295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5912	YES	$0 	$0 	$0 	$0 	$0 	$0 	$0 	4a1: $25	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											500	0	0	0	0	0	0	0	0.0041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.0041		1.00E-06	0	0	0	0	0	0	0	0.449532198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.145780295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5953
H5420_003_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	P	P	Coin	P	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	1839.479545	41.43183194	914.8502908	189.9474917	768.7046504	13.360858	3.472660197	384.1223823	363.5768635	229.0110827	596.5354024	119.8772593	0.000981435	374.033414	13135.49819	33882.6989	368.9029434	836.8221535	0	0	51.34082444	12.2439325	761.9955578	162.5777047	454.7841963	4.369240584	184.1953056	1.747696233	0	0												$0 	1b1: $175 days 1-10; $0 days 11+	21: $0 days 1-6; $100 days 7-100	$0 	10a: $100	"11a: 20% coins on elec wheelchair, power vehicles, BiPap machines, $0 - $25 copay on diab mon supplies"	"11b,11c: 20% coins on elec wheelchair, power vehicles, BiPap machines, $0 - $25 copay on diab mon supplies"	"4a1: $50,4a2: $50,4b: $10"	"9a1: $75,9b: $75"	$0 	"8b2: $100,8b3: $25,8b4: $25"	5: $35	12: 20.0%	"3: $25,9c: $35,9d1: $25,9d2: $25"	$0 	$0 	"7e: $35,7h: $35"	"7c: $25,7i: $25"	$0 	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	109.6813914	56.04594418	0	100	0.108565212	0.108565212	94.9311259	75	0	33.77537666	0	0.2	3.021781934	0	0	35	8.620689655	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	98.81647687	50.49409636	0	90.09411314	0.097810865	0.097810865	85.52735597	67.57058485	0	30.42962606	0	0.180188226	2.722447634	0	0	31.5329396	7.766733891	0	0	0.180188226	0	0	0	0	0	0	0	0	0												0	0.341178972	3.849544895	0	5.771313645	1.306837082	0.339663899	2.737747644	2.047258442	0	1.512695769	0	0.000176843	0.084857199	0	0	0.969382853	0.541614582	0	0	9.251012091	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.7533		3.161436053	0	0.341178972	3.849544895	0	5.771313645	1.306837082	0.339663899	2.737747644	2.047258442	0	1.512695769	0	0.000176843	0.084857199	0	0	0.969382853	0.541614582	0	0	9.251012091	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.7533	YES	$0 	$0 	$0 	$0 	$0 	$0 	$0 	4a1: $100	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											2500	0	0	0	0	0	0	0	0.0569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.0569			0	0.341178972	3.849544895	0	5.771313645	1.306837082	0.339663899	2.794600403	2.047258442	0	1.512695769	0	0.000176843	0.084857199	0	0	0.969382853	0.541614582	0	0	9.251012091	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.8101
H5420_005_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	P	P	Coin	P	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	1772.005555	10.48245747	762.2497898	141.7266209	548.081758	12.72212623	4.157297731	290.2572993	387.2966973	149.1627852	415.872745	43.24113707	0.002094835	541.1334479	14667.40022	35947.06335	359.1597392	1029.34034	0	0	37.10735283	10.20552066	159.7310421	237.9269214	508.5685705	0	188.3980103	1.663865022	0	0												$0 	1b1: $175 days 1-5; $0 days 6-90	21: $0 days 1-6; $25 days 7-100	$0 	10a: $25	"11a: 20% coins on elec wheelchair, power vehicles, BiPap machines, $25 copay on diab mon supplies"	"11b,11c: 20% coins on elec wheelchair, power vehicles, BiPap machines, $25 copay on diab mon supplies"	"4a1: $50,4a2: $50,4b: $25"	0	$0 	"8b2: $25,8b3: $25,8b4: $25"	5: $25	12: 20.0%	"3: $25,9c: $25,9d1: $25,9d2: $25"	$0 	$0 	"7e: $25,7h: $25"	"7c: $25,7i: $25"	$0 	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16b1: $10	$0 	$0 	$0 	$0 	$0 	$0 												0	75.2578113	14.01148604	0	12.5	0.108565212	0.108565212	47.07036464	0	0	9.596427987	0	0.2	3.318872594	0	0	25	8.620689655	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	74.54914319	13.87954634	0	12.38229326	0.107542904	0.107542904	46.62712472	0	0	9.506062849	0	0.198116692	3.287620301	0	0	24.76458653	8.539512595	0	0	0.198116692	0	0	0	0	0	0	0	0	0												0	0.065121519	0.881640107	0	0.565542422	1.368174398	0.44708787	1.127821941	0	0	0.329442704	0	0.000415022	0.148253442	0	0	0.741203536	0.7325054	0	0	7.351585999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.7588		0.130791829	0	0.065121519	0.881640107	0	0.565542422	1.368174398	0.44708787	1.127821941	0	0	0.329442704	0	0.000415022	0.148253442	0	0	0.741203536	0.7325054	0	0	7.351585999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.7588	YES	$0 	$0 	$0 	$0 	$0 	$0 	$0 	4a1: $50	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											3400	0	0	0	0	0	0	0	0.0044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.0044		4.22E-05	0	0.065121519	0.881640107	0	0.565542422	1.368174398	0.44708787	1.132260928	0	0	0.329442704	0	0.000415022	0.148253442	0	0	0.741203536	0.7325054	0	0	7.351585999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.7632
H5420_006_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	P	P	Coin	P	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	2388.997402	76.02247157	730.1315178	242.9713069	728.8332901	15.5209796	3.739717295	567.8461472	395.1798311	122.3275588	324.678265	54.42226157	0.070457578	314.7833084	31746.86116	32958.23701	676.2968081	1010.775372	0	0	58.24067072	4.612868925	5368.424496	483.5126978	448.9488031	11.86166295	110.1082946	0	0	0												$0 	$0 	$0 	$0 	$0 	$0 	$0 	"4a1: $25,4a2: $25"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"16a1, 16b2: $10-$175 restorative, $15-$175 endo/perio/extractions, $10-$175 prostho/surgery/other"	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	22.87627714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.4798886	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	22.52311165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.23502194	0	0	0	0	0	0												0	0	0	0	0	0	0	1.065805181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.419715043	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.4855		0.026578317	0	0	0	0	0	0	0	1.065805181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.419715043	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.4855	YES	$0 	$0 	$0 	$0 	$0 	$0 	$0 	4a1: $25	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											500	0	0	0	0	0	0	0	0.0403	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.0403			0	0	0	0	0	0	0	1.106145358	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.419715043	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.5259
H5420_007_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	P	P	Coin	P	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	1315.179892	3.046033776	482.777928	46.27999147	408.1987548	9.395203514	2.381942014	220.6298468	302.2124505	59.45837386	22.79034994	9.740693404	0.002713199	148.2253081	6172.827132	20759.17215	211.6343952	978.9990403	0	0	24.03749048	0.668520774	11906.83325	103.2552804	623.1813094	0	89.09271669	0	0	0												$0 	$0 	$0 	$0 	10a: $25	"11a:20% coins on elec wheelchair, power vehicles, BiPap machines, $0-$25 copay on diab mon supplies"	"11b,11c: 20% coins on elec wheelchair, power vehicles, BiPap machines, $0-$25 copay on diab mon supplies"	"4a1: $25,4a2: $25,4b: $10"	$0 	$0 	8b2: $25	$0 	12: 20.0%	"3: $25,9d1: $25,9d2: $25"	$0 	$0 	$0 	"7c: $25,7i: $25"	$0 	$0 	$0 	$0 	$0 	"16a1,16b1: '$10-$175 restorative, $15-$125 endo/perio/extractions, $10-$175 prostho/surgery/other"	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	12.5	0.108565212	0.108565212	20.91784687	0	0	1.720539985	0	0.2	6.249764604	0	0	0	8.620689655	0	0	0	0	0	19.61866314	0	0	0	0	0	0											NO	0	0	0	0	12.49669554	0.108536512	0.108536512	20.91231708	0	0	1.720085148	0	0.199947129	6.248112434	0	0	0	8.618410714	0	0	0	0	0	19.61866314	0	0	0	0	0	0												0	0	0	0	0.42509463	1.019722623	0.258527679	0.384490109	0	0	0.003266779	0	0.000542496	0.077177366	0	0	0	0.703117985	0	0	0	0	0	0.16881088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0408		0.000759419	0	0	0	0	0.42509463	1.019722623	0.258527679	0.384490109	0	0	0.003266779	0	0.000542496	0.077177366	0	0	0	0.703117985	0	0	0	0	0	0.16881088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0408	YES	$0 	$0 	$0 	$0 	$0 	$0 	$0 	4a1: $25	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											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	0	0	0	0.42509463	1.019722623	0.258527679	0.384490109	0	0	0.003266779	0	0.000542496	0.077177366	0	0	0	0.703117985	0	0	0	0	0	0.16881088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0408
H5420_008_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	P	P	Coin	P	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	1217.355577	8.577219053	424.3967042	81.00705308	343.7491416	9.680407498	1.966125134	202.7635595	263.4284311	29.78677837	142.4158811	13.32085587	0.002142507	215.623372	8470.424694	21442.53775	99.76917172	698.8436358	0	0	19.36581094	2.117718666	43.42818719	235.7315163	458.2675735	0	112.1100744	0	0	0												$0 	1b1: $175 days 1-5; $0 days 6-90	21: $0 days 1-6; $25 days 7-100	$0 	10a: $100	"11a: 20% coins on elec wheelchair, power vehicles, BiPap machines, $0-$25 copay on diab mon supplies"	"11b,11c: 20% coins on elec wheelchair, power vehicles, BiPap machines, $0-$25 copay on diab mon supplies"	"4a1: $50,4a2: $50,4b: $15"	"9a1: $100,9b: $100"	$0 	"8b2: $50,8b3: $50,8b4: $50"	5: $10	12: 20.0%	"3: $25,9c: $10,9d1: $25,9d2: $25"	$0 	"7b1: $10,7d1: $10,17a1: $10,18a1: $10"	"7e: $10,7h: $10"	"7c: $25,7i: $25"	$0 	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	75.2578113	14.01148604	0	50	0.108565212	0.108565212	42.99093595	100	0	21.50286558	0	0.2	4.470319671	0	1.649936623	10	8.620689655	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	73.83336367	13.74628264	0	49.05362141	0.106510337	0.106510337	42.17722193	98.10724282	0	21.09586854	0	0.196214486	4.385707375	0	1.618707329	9.810724282	8.457520933	0	0	0.196214486	0	0	0	0	0	0	0	0	0												0	0.052773744	0.48615642	0	1.405178354	1.03106346	0.20941265	0.712666971	2.153686421	0	0.250365559	0	0.000420391	0.078805084	0	2.892432751	0.08156732	0.49254039	0	0	3.799852632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.6469		0.263286473	0	0.052773744	0.48615642	0	1.405178354	1.03106346	0.20941265	0.712666971	2.153686421	0	0.250365559	0	0.000420391	0.078805084	0	2.892432751	0.08156732	0.49254039	0	0	3.799852632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.6469	YES	$0 	$0 	$0 	$0 	$0 	$0 	$0 	4a1: $50	$0 	$0 	$0 	$0 	$0 	$0 	$0 	7d1: $10	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											2500	0	0	0	0	0	0	0	0.1261	0	0	0	0	0	0	0	0.0308	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.1568		0.003025191	0	0.052773744	0.48615642	0	1.405178354	1.03106346	0.20941265	0.838721162	2.153686421	0	0.250365559	0	0.000420391	0.078805084	0	2.923183221	0.08156732	0.49254039	0	0	3.799852632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.8037
H5420_009_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	P	P	Coin	P	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	908.3714572	26.62341084	283.0453467	176.6276373	284.9631115	11.33935857	1.45642392	214.5560383	323.3429255	94.10189764	267.2305309	21.34485423	0.001086034	290.3362572	16272.07103	22727.99273	154.9389811	351.1375771	0	0	36.66570931	5.180430768	848.0043444	246.6685461	370.6752106	0	176.0668298	1.169305413	0	0												1a1:$75 days 1-5; $0 days 6-90	1b1:$175 days 1-5; $0 days 6-90	21: $0 days 1-7; $75 days 8-30; $0 days 31-100	$0 	10a: $100	$0 	11b: 20.0%	"4a1: $50,4a2: $50"	"9a1: $50,9b: $50"	$0 	"8b2: $25,8b3: $55,8b4: $55"	5: $25	12: 20.0%	"3: $20,9c: $25,9d1: $020,9d2: $20"	$0 	"7b1: $20,7d1: 20,7f1: $20,7f2: $10,7g: $20,17a1: $20,18a1: $20"	"7e: $25,7h: $25"	"7c: $20,7i: $20"	7d2: $20	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	$0 	17a2: $20	$0 	18a2: $20	$0 	$0 	$0 												48.04951279	75.2578113	41.22835208	0	50	0	0.196058101	43.9472956	50	0	11.54474298	0	0.2	2.037052755	0	5.374293449	25	6.896551724	0	0	0.2	0	0	0	10	0	10	0	0	0											NO	46.1332789	72.25649952	39.58414882	0	48.0059799	0	0.188239225	42.19465978	48.0059799	0	11.08433399	0	0.19202392	1.955814272	0	5.159964465	24.00298995	6.621514468	0	0	0.19202392	0	0	0	9.601195979	0	9.601195979	0	0	0												3.4922	0.160309539	0.933675761	0	1.13999445	0	0.27415611	0.754426587	1.293532832	0	0.246839371	0	0.000208545	0.047320316	0	9.772969571	0.309916567	0.193755212	0	0	7.040693217	0	0	0	0.296577112	0	0.140871012	0	0	0	0	0	0	0	0	0	0	0	0	0	26.0974		1.084006443	3.4922	0.160309539	0.933675761	0	1.13999445	0	0.27415611	0.754426587	1.293532832	0	0.246839371	0	0.000208545	0.047320316	0	9.772969571	0.309916567	0.193755212	0	0	7.040693217	0	0	0	0.296577112	0	0.140871012	0	0	0	0	0	0	0	0	0	0	0	0	0	26.0974	YES	1a1: $48.6331101091636	$0 	$0 	$0 	$0 	$0 	$0 	4a1: $50	$0 	$0 	$0 	$0 	$0 	$0 	$0 	7d1: $2.24719101123595	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 											3400	0.0003	0	0	0	0	0	0	0.035	0	0	0	0	0	0	0	0.1975	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.2328		0.009668774	3.4924	0.160309539	0.933675761	0	1.13999445	0	0.27415611	0.789428797	1.293532832	0	0.246839371	0	0.000208545	0.047320316	0	9.970475036	0.309916567	0.193755212	0	0	7.040693217	0	0	0	0.296577112	0	0.140871012	0	0	0	0	0	0	0	0	0	0	0	0	0	26.3302
H5421_046_0	2011	8																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1857.620555	68.96569061	2368.613245	35.08707591	269.0200164	27.44250768	1.805696954	387.0925982	396.7651767	8.410341637	20.04537421	0	21.158302	12.11256445	5847.019663	100.8094479	0.560954586	413.3583843	37.62292809	39.64869057	14.10088426	81.35870887	0	0	0	0	0	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.79087057	284.7740831	0.2	0.2	0	25	0.282665216	21.6249956	0.10705746	0.45	0.035369248	0.127984181	0.104138321	0.2	0	0	0	0	0	0	0	0	0											NO	156.3902767	118.5500253	39.81090706	0	126.3275448	0.168436726	0.168436726	41.93305623	239.8320717	0.168436726	0.168436726	0	21.05459081	0.238056018	18.21221734	0.090162041	0.378982635	0.029787402	0.107786183	0.087703589	0.168436726	0	0	0	0	0	0	0	0	0												24.2095	0.681323697	7.85805348	0	2.832053183	4.62232616	0.304145684	1.352664641	7.929751192	1.416610414	3.376377213	0	0.037123283	2.883468866	8.873932742	9.089185549	0.212592047	0.001026073	4.055231802	3.477332475	2.375106785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5878	0	16.03825259	24.2095	0.681323697	7.85805348	0	2.832053183	4.62232616	0.304145684	1.352664641	7.929751192	1.416610414	3.376377213	0	0.037123283	2.883468866	8.873932742	9.089185549	0.212592047	0.001026073	4.055231802	3.477332475	2.375106785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5878	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.2095	0.681323697	7.85805348	0	2.832053183	4.62232616	0.304145684	1.352664641	7.929751192	1.416610414	3.376377213	0	0.037123283	2.883468866	8.873932742	9.089185549	0.212592047	0.001026073	4.055231802	3.477332475	2.375106785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5878
H5421_047_0	2011	8																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1606.679578	88.67171866	3086.961353	18.7720068	212.1391323	27.8083906	2.52958876	319.7599594	330.9424454	6.158156167	18.73367381	0	50.95784077	12.32925549	5224.008958	84.36515396	0.847262585	262.4302099	26.23935423	34.46070885	16.07221106	56.71458429	0	0	0	0	0	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.80433688	299.169444	0.2	0.2	0	25	0.204895243	21.2600484	0.113408557	0.45	0.047157453	0.114608303	0.112154167	0.2	0	0	0	0	0	0	0	0	0											NO	149.7475082	113.5145436	38.1199155	0	120.9617085	0.161282278	0.161282278	40.16278453	241.2536472	0.161282278	0.161282278	0	20.16028475	0.165229858	17.14434518	0.091453952	0.362885125	0.038028308	0.092421441	0.090442398	0.161282278	0	0	0	0	0	0	0	0	0												20.0497	0.83879414	9.806225495	0	2.138392656	4.485000583	0.407977838	1.070204196	6.653422664	0.993201455	3.021409587	0	0.085610382	2.037161133	7.463517733	7.715526765	0.307458989	0.000831648	2.425078917	3.116709131	2.592162812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2084	0	18.05466156	20.0497	0.83879414	9.806225495	0	2.138392656	4.485000583	0.407977838	1.070204196	6.653422664	0.993201455	3.021409587	0	0.085610382	2.037161133	7.463517733	7.715526765	0.307458989	0.000831648	2.425078917	3.116709131	2.592162812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2084	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.0497	0.83879414	9.806225495	0	2.138392656	4.485000583	0.407977838	1.070204196	6.653422664	0.993201455	3.021409587	0	0.085610382	2.037161133	7.463517733	7.715526765	0.307458989	0.000831648	2.425078917	3.116709131	2.592162812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2084
H5421_048_0	2011	8																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1848.781457	59.70093613	3220.189618	25.59693359	324.5304458	29.20048557	1.907251648	408.6002127	384.1636867	7.209952062	20.22797141	0	6.357507499	13.55146637	5667.124653	104.6850668	0.945144852	600.1554746	35.26808756	43.89319185	18.51610543	32.84155853	0	0	0	0	0.106514788	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.83643382	288.1417907	0.2	0.2	0	25	0.214715855	20.93183599	0.109003816	0.45	0.013843335	0.121077823	0.108406616	0.2	0	0	0	0	0	20	0	0	0											NO	157.5573054	119.4346793	40.10798736	0	127.2702369	0.169693649	0.169693649	42.28463159	244.4791597	0.169693649	0.169693649	0	21.21170615	0.182179585	17.75999816	0.092486277	0.381810711	0.01174563	0.102730688	0.091979572	0.169693649	0	0	0	0	0	20	0	0	0												24.2741	0.594196847	10.76294371	0	3.441922226	4.955136955	0.323648492	1.439792455	7.826667944	1.223483076	3.432558284	0	0.011237798	2.468800517	8.387343619	9.681932088	0.360866428	0.000587434	3.623114898	4.037276987	3.142065499	0	0	0	0	0	0.000177525	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9878	0	16.0713004	24.2741	0.594196847	10.76294371	0	3.441922226	4.955136955	0.323648492	1.439792455	7.826667944	1.223483076	3.432558284	0	0.011237798	2.468800517	8.387343619	9.681932088	0.360866428	0.000587434	3.623114898	4.037276987	3.142065499	0	0	0	0	0	0.000177525	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9878	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.2741	0.594196847	10.76294371	0	3.441922226	4.955136955	0.323648492	1.439792455	7.826667944	1.223483076	3.432558284	0	0.011237798	2.468800517	8.387343619	9.681932088	0.360866428	0.000587434	3.623114898	4.037276987	3.142065499	0	0	0	0	0	0.000177525	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9878
H5421_049_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	2115.174925	104.4773049	2990.872398	28.75282566	276.9058065	32.09478938	3.353756888	374.1972555	376.0849321	7.970150478	21.0633848	0	39.63705999	11.92187999	5582.215738	102.9930432	0.679359232	331.6946704	38.19749025	39.86990157	20.51530027	40.2094363	0	0	0	0	0	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.85038341	287.9695228	0.2	0.2	0	25	0.23981946	21.46996424	0.106218747	0.45	0.01669333	0.12624	0.104867762	0.2	0	0	0	0	0	0	0	0	0											NO	158.1922483	119.9159912	40.26961924	0	127.7831254	0.170377501	0.170377501	42.46691864	245.3176377	0.170377501	0.170377501	0	21.29718757	0.204299201	18.28999422	0.090486423	0.383349376	0.014220839	0.107542279	0.089335535	0.170377501	0	0	0	0	0	0	0	0	0												27.8837	1.044041631	10.03677439	0	2.94865745	5.468229995	0.571404716	1.324250367	7.688355592	1.357934318	3.588726856	0	0.070346492	2.435630551	8.508224465	9.319472053	0.260431938	0.000393081	4.107845138	3.561799006	3.495345583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.6716	0	16.28610308	27.8837	1.044041631	10.03677439	0	2.94865745	5.468229995	0.571404716	1.324250367	7.688355592	1.357934318	3.588726856	0	0.070346492	2.435630551	8.508224465	9.319472053	0.260431938	0.000393081	4.107845138	3.561799006	3.495345583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.6716	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	27.8837	1.044041631	10.03677439	0	2.94865745	5.468229995	0.571404716	1.324250367	7.688355592	1.357934318	3.588726856	0	0.070346492	2.435630551	8.508224465	9.319472053	0.260431938	0.000393081	4.107845138	3.561799006	3.495345583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.6716
H5421_056_0	2011	7																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1869.744768	127.5200876	2394.622603	29.38688353	268.61279	32.78045183	1.440761051	418.5445546	436.2295157	8.686323082	24.69737058	0	30.10134729	11.90835669	6344.633802	109.5702312	1.097949454	436.3282042	36.20723597	42.84008756	12.70281762	37.24403987	0	0	0	0	0.493552924	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.93186773	291.7163935	0.2	0.2	0	25	0.25009792	20.92463646	0.105802803	0.45	0.022623013	0.115736737	0.107181676	0.2	0	0	0	0	0	20	0	0	0											NO	158.0946651	119.8420192	40.24477833	0	127.7043005	0.170272401	0.170272401	42.51009495	248.3562532	0.170272401	0.170272401	0	21.28405009	0.212923866	17.81444042	0.090076486	0.383112902	0.019260373	0.098533861	0.091250407	0.170272401	0	0	0	0	0	20	0	0	0												24.6331	1.273522066	8.030921319	0	2.858584038	5.581606228	0.245321843	1.482697396	9.028360672	1.479041084	4.205280579	0	0.053389882	2.535573346	9.418841737	9.8697014	0.420638601	0.00070032	3.567638743	3.909175405	2.162939252	0	0	0	0	0	0.000822588	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7578	0	15.84512476	24.6331	1.273522066	8.030921319	0	2.858584038	5.581606228	0.245321843	1.482697396	9.028360672	1.479041084	4.205280579	0	0.053389882	2.535573346	9.418841737	9.8697014	0.420638601	0.00070032	3.567638743	3.909175405	2.162939252	0	0	0	0	0	0.000822588	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7578	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.6331	1.273522066	8.030921319	0	2.858584038	5.581606228	0.245321843	1.482697396	9.028360672	1.479041084	4.205280579	0	0.053389882	2.535573346	9.418841737	9.8697014	0.420638601	0.00070032	3.567638743	3.909175405	2.162939252	0	0	0	0	0	0.000822588	0	0	0	0	0	0	0	0	0	0	0	0	0	90.7578
H5421_057_0	2011	7																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	2360.621624	77.0362067	1836.560814	35.56499543	289.0250898	37.50089242	1.325984529	391.1852352	416.0266909	8.989106575	22.83880992	0	51.20217112	12.20286967	6085.662685	117.9920504	0.875361031	438.1551249	35.24938766	52.6578662	12.01176173	41.82712571	0	0	0	0	0	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.81967902	286.5708415	0.2	0.2	0	25	0.243898391	21.93857535	0.105161829	0.45	0	0.105978725	0.099586987	0.2	0	0	0	0	0	0	0	0	0											NO	160.7968498	121.8903823	40.93264989	0	129.8870472	0.17318273	0.17318273	43.13954001	248.1456028	0.17318273	0.17318273	0	21.6478412	0.211194945	18.99691182	0.091061063	0.389661142	0	0.091768425	0.086233731	0.17318273	0	0	0	0	0	0	0	0	0												31.6317	0.782497724	6.264608401	0	3.128384624	6.494506913	0.22963762	1.406295926	8.602932834	1.556758014	3.955287443	0	0.092368039	2.577184392	9.634066449	10.74448158	0.341094179	0	3.234780778	4.540884278	2.080229685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2977	0	15.06650791	31.6317	0.782497724	6.264608401	0	3.128384624	6.494506913	0.22963762	1.406295926	8.602932834	1.556758014	3.955287443	0	0.092368039	2.577184392	9.634066449	10.74448158	0.341094179	0	3.234780778	4.540884278	2.080229685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2977	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	31.6317	0.782497724	6.264608401	0	3.128384624	6.494506913	0.22963762	1.406295926	8.602932834	1.556758014	3.955287443	0	0.092368039	2.577184392	9.634066449	10.74448158	0.341094179	0	3.234780778	4.540884278	2.080229685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2977
H5421_065_0	2011	12																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1541.301567	62.74021097	1986.012674	19.06087393	176.604451	27.2762356	2.202827052	327.1226218	393.7542981	7.00515744	21.07074545	0	7.989884624	12.01574213	5340.13841	86.38492464	1.103209099	269.6054385	21.91342075	35.40711825	13.44829893	10.84341485	0	0	0	0	0	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.85373049	286.7149362	0.2	0.2	0	25	0.23339652	21.02631966	0.108542968	0.45	0.040955631	0.096607256	0.107642886	0.2	0	0	0	0	0	0	0	0	0											NO	152.0837741	115.2855257	38.71463829	0	122.8488765	0.163798502	0.163798502	40.82983187	234.8173853	0.163798502	0.163798502	0	20.47481275	0.191150002	17.22039831	0.088895878	0.368546629	0.033542355	0.079120619	0.088158718	0.163798502	0	0	0	0	0	0	0	0	0												19.5339	0.602753184	6.407313526	0	1.807971533	4.467806531	0.360819771	1.113030138	7.705029559	1.147434295	3.45135654	0	0.013632616	2.296809132	7.663275873	7.679263719	0.406583995	0.0007536	1.733803415	3.121446142	2.202811219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7158	0	15.85008196	19.5339	0.602753184	6.407313526	0	1.807971533	4.467806531	0.360819771	1.113030138	7.705029559	1.147434295	3.45135654	0	0.013632616	2.296809132	7.663275873	7.679263719	0.406583995	0.0007536	1.733803415	3.121446142	2.202811219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7158	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.5339	0.602753184	6.407313526	0	1.807971533	4.467806531	0.360819771	1.113030138	7.705029559	1.147434295	3.45135654	0	0.013632616	2.296809132	7.663275873	7.679263719	0.406583995	0.0007536	1.733803415	3.121446142	2.202811219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7158
H5421_067_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1884.686108	69.65084923	3964.002513	32.83907989	256.5525051	35.6492771	1.38619368	372.5905234	481.1430214	9.096567371	20.98781574	0	18.23010398	14.30100706	10012.45078	114.9124008	0.984099105	512.5779108	43.3806277	47.98611041	30.14235523	53.80103857	0	0	0	0	0	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: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $300; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	193.2806604	139.004653	35.01559476	0.2	150	0.2	0.2	49.93329873	220.2663504	0	0.2	0	50	0.188261287	11.10173415	0.109505492	0.45	0.033566434	0.126614585	0.03424151	0.2	0	0	0	0	0	0	0	0	0											NO	137.7432442	99.0629473	24.95418637	0.142531844	106.8988827	0.142531844	0.142531844	35.58542561	156.974845	0	0.142531844	0	35.63296089	0.134166141	7.911753178	0.078040099	0.320696648	0.023921428	0.090233051	0.024402528	0.142531844	0	0	0	0	0	0	0	0	0												21.6336	0.574984867	8.243204792	4.680614597	2.285431345	5.081157186	0.197576741	1.104899363	6.293945933	0	2.991432069	0	0.054132715	1.918710935	6.601336604	8.967775079	0.315597284	0.0010218	3.91436641	1.170982393	4.296245459	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.327	0	32.38745368	21.6336	0.574984867	8.243204792	4.680614597	2.285431345	5.081157186	0.197576741	1.104899363	6.293945933	0	2.991432069	0	0.054132715	1.918710935	6.601336604	8.967775079	0.315597284	0.0010218	3.91436641	1.170982393	4.296245459	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.327	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $300; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												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		21.6336	0.574984867	8.243204792	4.680614597	2.285431345	5.081157186	0.197576741	1.104899363	6.293945933	0	2.991432069	0	0.054132715	1.918710935	6.601336604	8.967775079	0.315597284	0.0010218	3.91436641	1.170982393	4.296245459	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.327
H5421_068_0	2011	8																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	2202.269408	74.00724563	3015.477064	26.62478114	283.7786706	39.14776423	2.13388489	404.5363325	538.9569251	11.53090449	27.39697694	0	12.66926656	17.18122198	7472.133251	131.1310845	1.697730432	595.6715038	43.65209581	50.71362319	20.74570881	64.40207767	0	0	0	0	0.128803904	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: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $300; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	193.2806604	139.004653	35.01559476	0.2	150	0.2	0.2	49.74037946	225.5314438	0	0.2	0	50	0.166318451	17.22113347	0.102924882	0.45	0.016866183	0.120038917	0.035400787	0.2	0	0	0	0	0	20	0	0	0											NO	143.0089786	102.8499872	25.90815052	0.147980639	110.9854796	0.147980639	0.147980639	36.8030658	166.8714364	0	0.147980639	0	36.99515986	0.123059554	12.74197172	0.07615445	0.332956439	0.012479343	0.088817178	0.026193156	0.147980639	0	0	0	0	0	20	0	0	0												26.2454	0.634303689	6.510452804	3.939952138	2.624609321	5.793111184	0.315773651	1.240681438	7.494709686	0	4.054222166	0	0.039058462	2.114313511	7.934142544	9.986215557	0.565270279	0.000619466	3.877055985	1.328349831	3.069963256	0	0	0	0	0	0.000214673	0	0	0	0	0	0	0	0	0	0	0	0	0	87.7684	0	30.85298011	26.2454	0.634303689	6.510452804	3.939952138	2.624609321	5.793111184	0.315773651	1.240681438	7.494709686	0	4.054222166	0	0.039058462	2.114313511	7.934142544	9.986215557	0.565270279	0.000619466	3.877055985	1.328349831	3.069963256	0	0	0	0	0	0.000214673	0	0	0	0	0	0	0	0	0	0	0	0	0	87.7684	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $300; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												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		26.2454	0.634303689	6.510452804	3.939952138	2.624609321	5.793111184	0.315773651	1.240681438	7.494709686	0	4.054222166	0	0.039058462	2.114313511	7.934142544	9.986215557	0.565270279	0.000619466	3.877055985	1.328349831	3.069963256	0	0	0	0	0	0.000214673	0	0	0	0	0	0	0	0	0	0	0	0	0	87.7684
H5421_070_0	2011	10																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1413.129699	63.55950594	2473.395667	26.97801983	204.3924882	30.38721058	2.776380864	325.1205545	346.8243946	7.386409501	19.09318849	0	7.044434026	13.09121257	5105.559462	85.85758526	1.203702624	327.3503228	24.54408979	35.00371974	11.81879891	12.08332	0	0	0	0	0.071312716	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.67632474	281.7004262	0.2	0.2	0	25	0.268712698	21.09321216	0.117489868	0.45	0.058187954	0.099196509	0.104636354	0.2	0	0	0	0	0	20	0	0	0											NO	150.0103993	113.7138254	38.18683737	0	121.1740643	0.161565419	0.161565419	40.12988111	227.565237	0.161565419	0.161565419	0	20.19567738	0.217073398	17.03966831	0.094911499	0.363522193	0.047005806	0.080133628	0.084528082	0.161565419	0	0	0	0	0	20	0	0	0												17.6653	0.602299547	7.870929842	0	2.063922375	4.90952241	0.448567138	1.0872541	6.577097962	1.193388346	3.084799	0	0.011855593	2.841753996	7.249753312	8.148872133	0.437572617	0.00128228	1.96680696	2.958797284	1.909509198	0	0	0	0	0	0.000118855	0	0	0	0	0	0	0	0	0	0	0	0	0	71.0294	0	16.89707209	17.6653	0.602299547	7.870929842	0	2.063922375	4.90952241	0.448567138	1.0872541	6.577097962	1.193388346	3.084799	0	0.011855593	2.841753996	7.249753312	8.148872133	0.437572617	0.00128228	1.96680696	2.958797284	1.909509198	0	0	0	0	0	0.000118855	0	0	0	0	0	0	0	0	0	0	0	0	0	71.0294	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.6653	0.602299547	7.870929842	0	2.063922375	4.90952241	0.448567138	1.0872541	6.577097962	1.193388346	3.084799	0	0.011855593	2.841753996	7.249753312	8.148872133	0.437572617	0.00128228	1.96680696	2.958797284	1.909509198	0	0	0	0	0	0.000118855	0	0	0	0	0	0	0	0	0	0	0	0	0	71.0294
H5421_072_0	2011	10																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1358.573041	85.69218717	2754.712498	21.27356444	239.4300101	31.93685308	1.899606288	336.5804477	351.1121374	7.319987158	21.99828586	0	8.83526834	13.83235905	5252.210549	83.03869422	0.743493578	411.776776	34.57479835	36.64984085	17.04539052	29.46648284	0	0	0	0	0.148027625	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.78310978	284.5263409	0.2	0.2	0	25	0.205655966	20.46875618	0.118678663	0.45	0.02803984	0.128427209	0.105432944	0.2	0	0	0	0	0	20	0	0	0											NO	144.8931519	109.8347492	36.88418439	0	117.0404998	0.156054	0.156054	38.84426699	222.0073675	0.156054	0.156054	0	19.50674996	0.16046718	15.97115635	0.092601401	0.351121499	0.021878646	0.100207899	0.082266163	0.156054	0	0	0	0	0	20	0	0	0												16.404	0.784331657	8.467110312	0	2.33525067	4.98387366	0.296441159	1.089518398	6.495790111	1.142313274	3.432920495	0	0.014362281	2.219639651	6.99032299	7.689499383	0.26105658	0.00075076	3.464667884	3.015041772	2.660001367	0	0	0	0	0	0.000246713	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7471	0	20.20447221	16.404	0.784331657	8.467110312	0	2.33525067	4.98387366	0.296441159	1.089518398	6.495790111	1.142313274	3.432920495	0	0.014362281	2.219639651	6.99032299	7.689499383	0.26105658	0.00075076	3.464667884	3.015041772	2.660001367	0	0	0	0	0	0.000246713	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7471	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		16.404	0.784331657	8.467110312	0	2.33525067	4.98387366	0.296441159	1.089518398	6.495790111	1.142313274	3.432920495	0	0.014362281	2.219639651	6.99032299	7.689499383	0.26105658	0.00075076	3.464667884	3.015041772	2.660001367	0	0	0	0	0	0.000246713	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7471
H5421_073_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1672.430235	56.48006749	1269.535234	22.56906049	211.1613896	28.2147954	2.006160505	404.8994028	380.4098504	6.879522327	22.33572624	0	1.775828401	10.71241306	5329.725193	93.51817641	0.906770671	233.0951489	28.26554764	37.05830052	18.72860878	39.06822481	0	0	0	0	0	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.89785826	284.3866321	0.2	0.2	0	25	0.197057977	21.33132775	0.09271196	0.45	0	0.106188625	0.108472277	0.2	0	0	0	0	0	0	0	0	0											NO	156.234009	118.4315682	39.77112735	0	126.2013163	0.168268422	0.168268422	41.98116929	239.2664488	0.168268422	0.168268422	0	21.03355272	0.165793173	17.94694427	0.078002476	0.378603949	0	0.089340961	0.091262294	0.168268422	0	0	0	0	0	0	0	0	0												21.7742	0.55741858	4.207570622	0	2.22073711	4.747659091	0.337573462	1.416512531	7.584942831	1.157606364	3.758397404	0	0.003112665	1.776044958	7.971023416	7.294649328	0.343306957	0	2.525271202	3.382025522	3.151433441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2095	0	13.99421403	21.7742	0.55741858	4.207570622	0	2.22073711	4.747659091	0.337573462	1.416512531	7.584942831	1.157606364	3.758397404	0	0.003112665	1.776044958	7.971023416	7.294649328	0.343306957	0	2.525271202	3.382025522	3.151433441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2095	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		21.7742	0.55741858	4.207570622	0	2.22073711	4.747659091	0.337573462	1.416512531	7.584942831	1.157606364	3.758397404	0	0.003112665	1.776044958	7.971023416	7.294649328	0.343306957	0	2.525271202	3.382025522	3.151433441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2095
H5421_074_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1874.184017	101.2527188	2959.358924	24.25138879	254.5335189	33.69021887	2.863934223	397.5645048	381.8446375	8.686839018	22.33357013	0	10.07822414	9.742945087	5662.121553	97.5180103	0.747139326	354.4260927	27.23175975	38.31057937	16.77652113	24.91293331	0	0	0	0	1.095933923	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	36.45	0	150	0.2	0.2	49.77967357	296.9377389	0.2	0.2	0	25	0.203976949	21.2654692	0.096369933	0.45	0.081160033	0.102337595	0.101128842	0.2	0	0	0	0	0	20	0	0	0											NO	155.8582833	118.1467532	30.59316928	0	125.897816	0.167863755	0.167863755	41.78101455	249.2254188	0.167863755	0.167863755	0	20.98296933	0.171201682	17.84850752	0.080885094	0.377693448	0.068119139	0.085893864	0.084879336	0.167863755	0	0	0	0	0	20	0	0	0												24.3423	0.996889998	7.544680711	0	2.67043451	5.655366634	0.480750752	1.384220697	7.930449139	1.458205414	3.748996936	0	0.017622589	1.668008591	8.421701592	7.887753465	0.282189628	0.002011933	2.339041079	3.251776538	2.816169827	0	0	0	0	0	0.001826557	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9004	0	15.8702959	24.3423	0.996889998	7.544680711	0	2.67043451	5.655366634	0.480750752	1.384220697	7.930449139	1.458205414	3.748996936	0	0.017622589	1.668008591	8.421701592	7.887753465	0.282189628	0.002011933	2.339041079	3.251776538	2.816169827	0	0	0	0	0	0.001826557	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9004	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		24.3423	0.996889998	7.544680711	0	2.67043451	5.655366634	0.480750752	1.384220697	7.930449139	1.458205414	3.748996936	0	0.017622589	1.668008591	8.421701592	7.887753465	0.282189628	0.002011933	2.339041079	3.251776538	2.816169827	0	0	0	0	0	0.001826557	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9004
H5421_075_0	2011	10																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	2056.803012	43.77513045	1788.898758	29.09908743	250.0625338	39.10697279	3.52050591	410.6255318	423.8826647	11.18801581	23.86888504	0	50.16759003	15.68116513	6215.838501	111.7518974	1.410901963	395.6278505	42.84728102	45.96780895	21.1388208	51.14376636	0	0	0	0	0.086098123	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.84176671	287.8536819	0.2	0.2	0	25	0.21914045	21.39783175	0.110962948	0.45	0.016974673	0.12758203	0.105429292	0.2	0	0	0	0	0	20	0	0	0											NO	160.1699991	121.4152046	40.77307798	0	129.3806953	0.172507594	0.172507594	42.99041623	248.2847301	0.172507594	0.172507594	0	21.56344922	0.189016959	18.45644234	0.095709756	0.388142086	0.0146413	0.110044345	0.090936768	0.172507594	0	0	0	0	0	20	0	0	0												27.4532	0.442913868	6.078242379	0	2.696105375	6.746249777	0.607314003	1.471080211	8.770299418	1.930017687	4.117563925	0	0.090148857	2.964006145	9.56018874	10.69574679	0.547630431	0.000482709	4.715100963	4.180163962	3.646607111	0	0	0	0	0	0.000143497	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7132	0	15.41308492	27.4532	0.442913868	6.078242379	0	2.696105375	6.746249777	0.607314003	1.471080211	8.770299418	1.930017687	4.117563925	0	0.090148857	2.964006145	9.56018874	10.69574679	0.547630431	0.000482709	4.715100963	4.180163962	3.646607111	0	0	0	0	0	0.000143497	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7132	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		27.4532	0.442913868	6.078242379	0	2.696105375	6.746249777	0.607314003	1.471080211	8.770299418	1.930017687	4.117563925	0	0.090148857	2.964006145	9.56018874	10.69574679	0.547630431	0.000482709	4.715100963	4.180163962	3.646607111	0	0	0	0	0	0.000143497	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7132
H5422_002_0	2011	11	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									D	A	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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1274.877221	97.02510428	194.3279772	542.5410266	181.3595958	7.870810391	2.987744132	286.7627394	481.2145617	18042.06346	705.7828793	30.87701508	0.012555998	55.26818999	4722.871772	3237.77939	6.398479754	987.6308272	1120.019803	1556.299153	50.70197418	11.9377485	0.007725409	0	378	179.4	162	0	5640.427344	0	5.380575732	17.5643142	0	0	0	0	0	0	0	0	3300	1A: $215/day (days1-7) no yrly max	1B: $215/day (days1-7) no yrly max	2: $120/day (for days 21-100)	6: $0 copay	10A: $100 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $40 copay	9A: $25 - $215 copay; 9B: $190 copay	8A: $0 -$160 copay	8B: $40 - $160 copay	9A: $215 copay	12: 20% coin	3: $25 copay; 5: $25 copay; 9C: $40 copay; 9D: $25 copay	7A: $10 copay; 7G: $10 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: $40 - $160 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $25	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	17A: $0 copay	17B: $0 copay	18A: $25 copay	-	14A: $0 copay or not covered;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										215	215	120	0	100	0.2	0.2	49.98752321	160.3080496	11.07275543	87.43342925	215	0.2	37.48766678	8.769205111	24.88187067	40	42.26027896	77.13616956	0.699132909	0.2	0	0	0	0	0	25	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	141.4265146	99.89791984	106.2127416	0	88.51061801	0.177021236	0.177021236	44.24426572	141.8896454	9.800564259	77.38786858	190.2978287	0.177021236	33.18056555	7.761677638	22.02309751	35.4042472	37.40483408	68.27370039	0.618806858	0.177021236	0	0	0	0	0	25	0	0	0	0.177021236	0.177021236	0	0	0	0	0	0	0	0		15.0251	0.807717174	1.720008936	0	1.337687492	1.393300584	0.528894159	1.05730057	5.68994696	14.73520019	4.551586059	0.489652411	0.002222678	0.15281915	3.054784019	5.942160934	0.01887778	3.078513936	6.372324707	0.080254049	8.975326138	0	0	0	0	0	0.3375	0	0	0	0.952476167	3.109256609	0	0	0	0	0	0	0	0	79.4129		10.26461968	15.0251	0.807717174	1.720008936	0	1.337687492	1.393300584	0.528894159	1.05730057	5.68994696	14.73520019	4.551586059	0.489652411	0.002222678	0.15281915	3.054784019	5.942160934	0.01887778	3.078513936	6.372324707	0.080254049	8.975326138	0	0	0	0	0	0.3375	0	0	0	0.952476167	3.109256609	0	0	0	0	0	0	0	0	79.4129	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	15.0251	0.807717174	1.720008936	0	1.337687492	1.393300584	0.528894159	1.05730057	5.68994696	14.73520019	4.551586059	0.489652411	0.002222678	0.15281915	3.054784019	5.942160934	0.01887778	3.078513936	6.372324707	0.080254049	8.975326138	0	0	0	0	0	0.3375	0	0	0	0.952476167	3.109256609	0	0	0	0	0	0	0	0	79.4129
H5422_006_0	2011	10	H.6	H.7	I.7								OP Facility - Other	OP Facility - Other	Professional								Lab	Radiology	Radiology								D	A	D	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	YES	1865.512033	68.78584505	757.5816004	825.0331961	355.8749262	10.0971153	1.853876213	367.7008045	756.2137627	31.65727857	506.7322106	86.34111602	0.066179129	95.78214725	4546.619398	4137.871912	12.9586488	1585.82068	569.0440653	1682.308486	28.57619307	5.415366348	0.040718457	0	0	0	162	0	5642.497657	0	9327.781	19.90670473	19.81127969	0	0	0	0	0	0	0	4500	1A: $265/day (days1-6) no yrly max	1B: $265/day (days1-6) no yrly max	2: $130/day (for days 21-100)	6: $0 copay	10A: $150 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $40 copay	9A: $35 - $265 copay; 9B: $240 copay	8A: 30% coin	8B: $55 copay	9A: $265 copay	12: 20% coin	3: $35 copay; 5: $35 copay; 9C: $40 copay; 9D: $35 copay	7A: $25 copay; 7G: $25 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35-$50 copay; 7I: $35-$50 copay	8B: $55 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $35	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	-	-	18A: $35 copay	-	14A: $0 copay or not covered;  Silver Sneakers		8A: $0 - $5 copay	8B: 20% - 30% coinsurance	8B: 20% - 30% coinsurance									265	265	130	0	150	0.2	0.2	49.93423834	162.7202892	0.3	55	265	0.2	36.8078713	21.86640943	34.44304094	40	45.00010005	55	0.700356577	0.2	0	0	0	0	0	35	0	0	0	4.318858205	0.251792805	0.246305418	0	0	0	0	0	0	0	NO	171.8444163	166.1976277	115.2003267	0	132.9234538	0.177231272	0.177231272	44.24954284	144.195619	0.265846908	48.73859974	234.8314351	0.177231272	32.61752922	19.37705777	30.52191976	35.44625436	39.87712481	48.73859974	0.620625435	0.177231272	0	0	0	0	0	35	0	0	0	3.827183662	0.223127796	0.218265113	0	0	0	0	0	0	0		26.7148	0.952670355	7.272803987	0	3.94201036	1.789524587	0.328564839	1.355882708	9.086892633	8.415989614	2.058118199	1.689634015	0.011729011	0.260348082	7.34167556	10.52464954	0.038277963	5.269830767	2.311200911	0.087006953	5.064595042	0	0	0	0	0	0.4725	0	0	0	2.974927587	4.441739144	4.324111197	0	0	0	0	0	0	0	106.7295		13.65073315	26.7148	0.952670355	7.272803987	0	3.94201036	1.789524587	0.328564839	1.355882708	9.086892633	8.415989614	2.058118199	1.689634015	0.011729011	0.260348082	7.34167556	10.52464954	0.038277963	5.269830767	2.311200911	0.087006953	5.064595042	0	0	0	0	0	0.4725	0	0	0	2.974927587	4.441739144	4.324111197	0	0	0	0	0	0	0	106.7295	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	26.7148	0.952670355	7.272803987	0	3.94201036	1.789524587	0.328564839	1.355882708	9.086892633	8.415989614	2.058118199	1.689634015	0.011729011	0.260348082	7.34167556	10.52464954	0.038277963	5.269830767	2.311200911	0.087006953	5.064595042	0	0	0	0	0	0.4725	0	0	0	2.974927587	4.441739144	4.324111197	0	0	0	0	0	0	0	106.7295
H5422_803_0	2011	5																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	287.5384053	3.310266058	49.16558374	47.03746381	9.865047518	15.91048655	4.016047159	11.3564632	51.56085989	3.718766299	24.12205718	0	0.028702145	15.64813671	53.67429965	134.0644014	1.328416125	5.255330778	25.69386172	28.49382825	6.863421898	0.700455681	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.066624883	0.066624883	0.144099319	0	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0	0	0	0	0	0	0	0												19.1572	0.220546088	7.084727116	0	1.913278242	3.085761897	0.778892918	2.202531098	9.999979342	0.721236733	4.678356295	0	0.005566642	3.034880414	10.40987076	26.00114209	0.257639881	1.019245981	4.983200182	5.526240145	1.331127474	0.135849991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5473	0	20.65	19.1572	0.220546088	7.084727116	0	1.913278242	3.085761897	0.778892918	2.202531098	9.999979342	0.721236733	4.678356295	0	0.005566642	3.034880414	10.40987076	26.00114209	0.257639881	1.019245981	4.983200182	5.526240145	1.331127474	0.135849991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5473	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1572	0.220546088	7.084727116	0	1.913278242	3.085761897	0.778892918	2.202531098	9.999979342	0.721236733	4.678356295	0	0.005566642	3.034880414	10.40987076	26.00114209	0.257639881	1.019245981	4.983200182	5.526240145	1.331127474	0.135849991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5473
H5422_804_0	2011	5																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	287.5384053	3.310266058	49.16558374	47.03746381	9.865047518	15.91048655	4.016047159	11.3564632	51.56085989	3.718766299	24.12205718	0	0.028702145	15.64813671	53.67429965	134.0644014	1.328416125	5.255330778	25.69386172	28.49382825	6.863421898	0.700455681	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.066624883	0.066624883	0.144099319	0	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0	0	0	0	0	0	0	0												19.1572	0.220546088	7.084727116	0	1.913278242	3.085761897	0.778892918	2.202531098	9.999979342	0.721236733	4.678356295	0	0.005566642	3.034880414	10.40987076	26.00114209	0.257639881	1.019245981	4.983200182	5.526240145	1.331127474	0.135849991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5473	0	20.65	19.1572	0.220546088	7.084727116	0	1.913278242	3.085761897	0.778892918	2.202531098	9.999979342	0.721236733	4.678356295	0	0.005566642	3.034880414	10.40987076	26.00114209	0.257639881	1.019245981	4.983200182	5.526240145	1.331127474	0.135849991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5473	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1572	0.220546088	7.084727116	0	1.913278242	3.085761897	0.778892918	2.202531098	9.999979342	0.721236733	4.678356295	0	0.005566642	3.034880414	10.40987076	26.00114209	0.257639881	1.019245981	4.983200182	5.526240145	1.331127474	0.135849991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5473
H5422_805_0	2011	5																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	287.5384053	3.310266058	49.16558374	47.03746381	9.865047518	15.91048655	4.016047159	11.3564632	51.56085989	3.718766299	24.12205718	0	0.028702145	15.64813671	53.67429965	134.0644014	1.328416125	5.255330778	25.69386172	28.49382825	6.863421898	0.700455681	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.066624883	0.066624883	0.144099319	0	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0.193945162	0	0	0	0	0	0	0	0												19.1572	0.220546088	7.084727116	0	1.913278242	3.085761897	0.778892918	2.202531098	9.999979342	0.721236733	4.678356295	0	0.005566642	3.034880414	10.40987076	26.00114209	0.257639881	1.019245981	4.983200182	5.526240145	1.331127474	0.135849991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5473	0	20.65	19.1572	0.220546088	7.084727116	0	1.913278242	3.085761897	0.778892918	2.202531098	9.999979342	0.721236733	4.678356295	0	0.005566642	3.034880414	10.40987076	26.00114209	0.257639881	1.019245981	4.983200182	5.526240145	1.331127474	0.135849991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5473	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1572	0.220546088	7.084727116	0	1.913278242	3.085761897	0.778892918	2.202531098	9.999979342	0.721236733	4.678356295	0	0.005566642	3.034880414	10.40987076	26.00114209	0.257639881	1.019245981	4.983200182	5.526240145	1.331127474	0.135849991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5473
H5424_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	898.7768213	97.46822764	396.568324	34.12308838	74.91807565	2.770380183	6.835857546	353.5686539	24.629027	18.68800847	32.86434643	0	0.016753868	14.25803987	6909.597102	74.6416638	471.1082526	754.7181157	0	0	11.04801106	1967.780076	0	0	345.0093405	141.2423546	16.23313663	15.32214892	0	0											3750	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-48 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												185.9463355	119.8302997	60.269872	0	200	0.2	0.102578544	49.98143477	0.2	0.136845348	0.160093751	0	0.2	0.161980405	6.975917978	0.133200486	38.5	30	0	0	0.2	29.89547442	0	0	30	0	30	0	0	0											NO	148.2915182	95.56422296	48.0650011	0	159.4992639	0.159499264	0.081806012	39.87469614	0.159499264	0.109133661	0.127674178	0	0.159499264	0.129178777	6.741217328	0.128755565	37.20469019	28.99066768	0	0	0.159499264	23.84153082	0	0	30	0	30	0	0	0												11.1067	0.776206286	1.588421411	0	0.995781493	0.4418736	0.559214242	1.17487022	3.928311677	2.039490787	4.195928401	0	0.00267223	1.841836149	3.881591309	9.610529565	1.460619715	1.823315174	0	0	1.762149631	3.909574112	0	0	0.862523351	0	0.040582842	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0022	0	9.296170121	11.1067	0.776206286	1.588421411	0	0.995781493	0.4418736	0.559214242	1.17487022	3.928311677	2.039490787	4.195928401	0	0.00267223	1.841836149	3.881591309	9.610529565	1.460619715	1.823315174	0	0	1.762149631	3.909574112	0	0	0.862523351	0	0.040582842	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0022	YES	"$400 Days 1-22 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$400 Days 1-22 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-49 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											8500	0.1133	0.0108	0.2915	0.0501	0.1897	0.1262	0.3115	0.2238	1.1224	0.3885	1.1754	0	0.0005	0.525	2.1652	2.8243	0.3261	0.5404	0	0	0.5223	1.1568	0	0	0.1819	0	0.012	0	0	0											12.2578	0	1.779014185	11.22	0.786981891	1.879926744	0.050124153	1.185454159	0.5681232	0.870732598	1.398655024	5.050686442	2.427965223	5.371340957	0	0.003181226	2.366881016	6.046779941	12.43480356	1.786728993	2.363758893	0	0	2.284463444	5.066343569	0	0	1.044469493	0	0.052611887	0	0	0	0	0	0	0	0	0	0	0	0	0	64.26
H5424_003_0	2011	1																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	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	1024.468942	86.32204331	517.6536666	49.17665146	100.6623523	4.404284116	6.529712938	420.9861946	26.11763167	18.86602399	31.31263842	0	0.023882626	17.90748015	6829.677331	4828.956569	465.8325883	883.9825309	0	0	10.31405438	2120.66741	0	0	232.6046379	137.4194539	15.47863237	13.92794411	120.9532731	617.54476											3750	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-48 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$10 (7b, 7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$10 (13b); $0 n/c (13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												185.9463355	119.8302997	60.9171132	0	200	0.2	0.112240673	49.99104043	0.2	0.142570359	0.162739677	0	0.2	0.161593868	6.893992678	27.92560608	38.5	30	0	0	0.2	29.86368417	0	0	30	0	30	0	0	10											NO	146.6778214	94.52430048	48.05251701	0	157.7636053	0.157763605	0.088537466	39.44616967	0.157763605	0.112462069	0.128371991	0	0.157763605	0.127468156	6.651788219	26.97749831	37.14739171	28.94601951	0	0	0.157763605	23.55701241	0	0	30	0	30	0	0	10												12.5222	0.679960897	2.072880135	0	1.323404634	0.694835741	0.57812424	1.383857738	4.120411733	2.121712091	4.01966574	0	0.003767809	2.28263347	3.785797267	10.8560973	1.442038802	2.132314632	0	0	1.627182405	4.16304904	0	0	0.581511595	0	0.038696581	0	0	0.514620633	0	0	0	0	0	0	0	0	0	0	56.9448	0	10.71355318	12.5222	0.679960897	2.072880135	0	1.323404634	0.694835741	0.57812424	1.383857738	4.120411733	2.121712091	4.01966574	0	0.003767809	2.28263347	3.785797267	10.8560973	1.442038802	2.132314632	0	0	1.627182405	4.16304904	0	0	0.581511595	0	0.038696581	0	0	0.514620633	0	0	0	0	0	0	0	0	0	0	56.9448	YES	"$400 Days 1-22 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$400 Days 1-22 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-49 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b, 7b1); $45 (7d, 7f, 7f1)"	"$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 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"50% (13b); $0 n/c (13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											8500	0.1277	0.0094	0.374	0.0673	0.2521	0.1985	0.2943	0.2636	1.1773	0.4041	1.1225	0	0.0007	0.651	2.1219	3.2318	0.322	0.632	0	0	0.4823	1.2313	0	0	0.1562	0	0.0115	0	0	0.1746											13.3061	0	2.006819435	12.6499	0.689400384	2.446880956	0.067313567	1.575481707	0.893360238	0.872453112	1.647449688	5.297672229	2.525847727	5.142184743	0	0.004485487	2.933653166	5.907664733	14.08788685	1.763999561	2.764348011	0	0	2.109490962	5.394344264	0	0	0.737721121	0	0.050166526	0	0	0.689216384	0	0	0	0	0	0	0	0	0	0	70.251
H5424_005_0	2011	4																															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	448.8272691	22.38222	12.29627304	375.7028863	14.82056715	18.13070994	11.27503889	35.79995571	25.09965186	26.35411329	45.80195532	0	0.025753303	25.40878435	42.31579911	121.5060145	9.971098	11.93513163	0	0.757492167	10.58353975	11.22415069	0	451.5072796	0	0	0	0	210.4196854	0											3400	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.071929384	0.072802617	0.142238508	0	0.233	0.233	0.233	0.117604994	0.233	0.233	0.233	0	0.233	0.233	0.2316128	0.232814967	0.239086212	0.233	0	0.233	0.233	0.231391933	0	0	0	0	0	0	0	0											NO	0.048960459	0.049554846	0.09681805	0	0.158597035	0.158597035	0.158597035	0.080081729	0.158597035	0.158597035	0.158597035	0	0.158597035	0.158597035	0.158549634	0.159372573	0.163665529	0.159499236	0	0.159499236	0.158597035	0.158575037	0	0	0	0	0	0	0	0												21.9748	1.109147474	1.190501172	0	2.350498002	2.875476833	1.788187734	2.866922359	3.980730358	4.179684221	7.264054296	0	0.004084397	4.029757853	6.70915445	19.36472611	1.631925028	1.90364438	0	0.120819422	1.678518021	1.779870115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8025	0	40.45545616	21.9748	1.109147474	1.190501172	0	2.350498002	2.875476833	1.788187734	2.866922359	3.980730358	4.179684221	7.264054296	0	0.004084397	4.029757853	6.70915445	19.36472611	1.631925028	1.90364438	0	0.120819422	1.678518021	1.779870115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8025	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.848	0.0933	0.3263	0.2343	0.6037	0.7385	0.444	0.5058	1.0223	0	1.48	0	0.0007	0.8537	1.527	4.5924	0.3768	0.451	0	0	0.3977	0.4221	0	0.1	0	0	0	0	0	0											16.0176	0	7.402961268	23.8228	1.202422951	1.516779677	0.234311562	2.954149704	3.613952885	2.232198876	3.372769122	5.003056117	4.179684221	8.744059104	0	0.004824001	4.883495831	8.236148672	23.95714002	2.008702898	2.354637187	0	0.120819422	2.076176093	2.201999871	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8201
H5425_001_0	2011	9																															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	538.3910648	14.844356	300.2077301	0	146.6753018	3.526419446	0.425581369	148.071214	192.6468659	0	16.53536459	0	0	163.0847331	4204.108936	3809.723796	183.030028	1570.126053	63.6545737	2720	7.475484963	2599.031707	0	0	279.96875	111.9875	0	0	0	0											5000	$200/day (1-5); $0/day (6-90)	$125/day copay (1-5); $0/day (6-90)	$0/day (1-10); $50/day (11-100)	$0 Copay	$100/run	0% - 20%	0% - 20%	$50 ER ($0 if admitted immed.) Worldwide coverage; $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; $10/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 (up to 12 one-way trips)	Not Covered	$15/visit for routine vision	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$0 Copay												200	125	50	0	100	0.06	0.05570521	45.05	116.5	0	0.098	0	0	10	10	10	25	10	0.098	10	0.2	0	0	0	15	25	0	0	0	0											NO	196	122.5	49	0	98	0.0588	0.054591105	44.149	114.17	0	0.09604	0	0	9.8	9.8	9.8	24.5	9.8	0.09604	9.8	0.196	0	0	0	14.7	24.5	0	0	0	0												8.7937	0.151536134	1.225848231	0	1.197848298	0.207353463	0.023232957	0.544766336	1.83287439	0	1.588056415	0	0	0.133185865	3.433355631	3.111274433	0.373686307	1.28226961	6.113385258	2.221333333	1.465195053	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2705		0.699398476	8.7937	0.151536134	1.225848231	0	1.197848298	0.207353463	0.023232957	0.544766336	1.83287439	0	1.588056415	0	0	0.133185865	3.433355631	3.111274433	0.373686307	1.28226961	6.113385258	2.221333333	1.465195053	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2705	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			8.7937	0.151536134	1.225848231	0	1.197848298	0.207353463	0.023232957	0.544766336	1.83287439	0	1.588056415	0	0	0.133185865	3.433355631	3.111274433	0.373686307	1.28226961	6.113385258	2.221333333	1.465195053	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2705
H5425_003_0	2011	8																															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	537.1537172	9.562779438	433.1030939	0	193.1358838	1.631489036	0.320326651	302.4217646	190.7107011	0	12.4458408	0	0	173.1834795	3922.793103	3548.465387	179.0957259	1535.214278	77.41827842	2720	2.603466667	2802	0	0	280	111.9875	0	0	0	0											5000	$100/day (1-4); $0/day (5-90)	$100/day (1-4); $0/day (5-90)	$0/day (1-10); $50/day (11-100)	$0 Copay	$100/run	0% - 20%	0% - 20%	$50 ER ($0 if admitted immed.) Worldwide coverage; $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; $10/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 (up to 12 one-way trips)	Not Covered	$15/visit for routine vision	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$0 Copay												100	100	50	0	100	0.06	0.055684211	46.25	116.5	0	0.088	0	0	10	5	10	25	10	0.098	10	0.2	0	0	0	15	25	0	0	0	0											NO	98	98	49	0	98	0.0588	0.054570526	45.325	114.17	0	0.08624	0	0	9.8	4.9	9.8	24.5	9.8	0.09604	9.8	0.196	0	0	0	14.7	24.5	0	0	0	0												4.3868	0.078096032	1.7685043	0	1.577276385	0.095931555	0.017480394	1.142272207	1.814453395	0	1.07332931	0	0	0.141433175	1.601807184	2.8979134	0.365653774	1.253758327	7.435251459	2.221333333	0.510279467	0	0	0	0.343	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9532		0.59268826	4.3868	0.078096032	1.7685043	0	1.577276385	0.095931555	0.017480394	1.142272207	1.814453395	0	1.07332931	0	0	0.141433175	1.601807184	2.8979134	0.365653774	1.253758327	7.435251459	2.221333333	0.510279467	0	0	0	0.343	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9532	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			4.3868	0.078096032	1.7685043	0	1.577276385	0.095931555	0.017480394	1.142272207	1.814453395	0	1.07332931	0	0	0.141433175	1.601807184	2.8979134	0.365653774	1.253758327	7.435251459	2.221333333	0.510279467	0	0	0	0.343	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9532
H5425_004_0	2011	9																															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	475.2690164	0	275.0419703	0	162.4918989	14.9824786	0.341838362	260.0068377	171.4218133	0	12.98833181	0	0	199.7414321	4057.342889	3671.85564	176.7029866	1513.536591	59.43698682	2720	7.658271114	644.902913	0	0	279.96875	111.9875	0	0	0	0											4000	$100/day (1-5); $0/day (6-90)	$0 Copay	$0/day (1-10); $50/day (11-100)	$0 Copay	$100/run	20% coinsurance	20% coinsurance	$50 ER ($0 if admitted immed.) Worldwide coverage; $25 Urgent care	$75/OP hospital and $75/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; $25/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 (up to 12 one-way trips)	Not Covered	$15/visit for routine vision	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$0 Copay												100	0	50	0	100	0.2	0.2	40	75	0	0.088	0	0	25	10	25	25	25	0.088	25	0.2	0	0	0	15	25	0	0	0	0											NO	98	0	49	0	98	0.196	0.196	39.2	73.5	0	0.08624	0	0	24.5	9.8	24.5	24.5	24.5	0.08624	24.5	0.196	0	0	0	14.7	24.5	0	0	0	0												3.8814	0	1.123088045	0	1.327017174	2.936565806	0.067000319	0.84935567	1.049958607	0	1.120113735	0	0	0.407805424	3.313496693	7.496705264	0.360768598	3.090137206	5.125845744	5.553333333	1.501021138	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7752		0.811738352	3.8814	0	1.123088045	0	1.327017174	2.936565806	0.067000319	0.84935567	1.049958607	0	1.120113735	0	0	0.407805424	3.313496693	7.496705264	0.360768598	3.090137206	5.125845744	5.553333333	1.501021138	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7752	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			3.8814	0	1.123088045	0	1.327017174	2.936565806	0.067000319	0.84935567	1.049958607	0	1.120113735	0	0	0.407805424	3.313496693	7.496705264	0.360768598	3.090137206	5.125845744	5.553333333	1.501021138	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7752
H5425_005_0	2011	9																															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	627.3070337	0	265.9160046	0	125.3917672	15.6538033	0.376727129	251.3797417	165.733992	0	14.63720191	0	0	180.1218822	3281.257505	2969.505956	142.9033771	1224.028492	54.49017669	2720	4.901476868	632.1277098	0	0	279.96875	111.9875	0	0	0	0											5000	$150/day (1-8); $0/day (9-90)	$0 Copay	$0/day (1-10); $50/day (11-100)	$0 Copay	$100/run	20% coinsurance	20% coinsurance	$50 ER ($0 if admitted immed.) Worldwide coverage; $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	$10/visit	$35/visit	$25/visit	$25/visit PT/OT/ST; $25/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 (up to 12 one-way trips)	Not Covered	$15/visit for routine vision	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$0 Copay												150	0	50	0	100	0.2	0.2	44	200	0	0.088	0	0	25	10	35	25	25	0.088	25	0.2	0	0	0	15	25	0	0	0	0											NO	147	0	49	0	98	0.196	0.196	43.12	196	0	0.08624	0	0	24.5	9.8	34.3	24.5	24.5	0.08624	24.5	0.196	0	0	0	14.7	24.5	0	0	0	0												7.6845	0	1.085823685	0	1.024032766	3.068145447	0.073838517	0.903291205	2.706988536	0	1.262312293	0	0	0.367748843	2.679693629	8.487837856	0.291761062	2.499058171	4.699232838	5.553333333	0.960689466	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9199		0.896324524	7.6845	0	1.085823685	0	1.024032766	3.068145447	0.073838517	0.903291205	2.706988536	0	1.262312293	0	0	0.367748843	2.679693629	8.487837856	0.291761062	2.499058171	4.699232838	5.553333333	0.960689466	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9199	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			7.6845	0	1.085823685	0	1.024032766	3.068145447	0.073838517	0.903291205	2.706988536	0	1.262312293	0	0	0.367748843	2.679693629	8.487837856	0.291761062	2.499058171	4.699232838	5.553333333	0.960689466	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9199
H5425_006_0	2011	13																															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	615.5304312	7.960898552	177.1041205	0	247.2857329	4.197115058	0.532646084	796.9276111	194.7011077	0	20.69521329	0	0	104.9765415	5816.608889	5271.473881	263.8490148	2265.430584	82.33920698	2720	0.534539851	0	0	0	279.96875	111.9875	0	0	0	359.5											5000	$0 Copay	$150/day (1-8); $0/day (9-90)	$0/day (1-20); $50/day (21-100)	$0 Copay	$100/run	0% - 20%	0% - 20%	$50 ER ($0 if admitted immed.) Worldwide coverage; $35 Urgent care	$100/OP hospital and $100/ASC visits	$0 Copay	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	$0 Copay	$10/visit cardiac rehab	$0 Copay	$0 Copay	$25/visit	$10/visit PT/OT/ST; $10/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 (up to 12 one-way trips)	Not Covered	$15/visit for routine vision	$25 (1 pair every 2 years)	$0/visit for routine hearing	$0 Copay	$0 Copay	$10 routine chiropractic (20 visits/yr); $0 copay for health club membership												0	150	50	0	100	0.06	0.055702532	46.25	100	0	0.045	0	0	10	0	0	25	10	0.098	10	0.2	0	0	0	15	25	0	0	0	10											NO	0	147	49	0	98	0.0588	0.054588481	45.325	98	0	0.0441	0	0	9.8	0	0	24.5	9.8	0.09604	9.8	0.196	0	0	0	14.7	24.5	0	0	0	9.8												0	0.097521007	0.723175159	0	2.019500152	0.246790365	0.029076341	3.010061998	1.590059046	0	0.912658906	0	0	0.085730842	0	0	0.538691739	1.850101644	7.907857438	2.221333333	0.104769811	0	0	0	0.342961719	0.228641146	0	0	0	0.293591667	0	0	0	0	0	0	0	0	0	0	22.2025		0.4531127	0	0.097521007	0.723175159	0	2.019500152	0.246790365	0.029076341	3.010061998	1.590059046	0	0.912658906	0	0	0.085730842	0	0	0.538691739	1.850101644	7.907857438	2.221333333	0.104769811	0	0	0	0.342961719	0.228641146	0	0	0	0.293591667	0	0	0	0	0	0	0	0	0	0	22.2025	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0.097521007	0.723175159	0	2.019500152	0.246790365	0.029076341	3.010061998	1.590059046	0	0.912658906	0	0	0.085730842	0	0	0.538691739	1.850101644	7.907857438	2.221333333	0.104769811	0	0	0	0.342961719	0.228641146	0	0	0	0.293591667	0	0	0	0	0	0	0	0	0	0	22.2025
H5425_007_0	2011	12																															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	695.2024014	13.43508864	121.8756163	0	196.5233032	3.915496594	0.282090697	554.9872335	214.4868046	0	10.96023667	0	0	0	3295.247329	2986.111829	156.3631516	1344.200806	79.9594781	2720	0.534539851	0	0	0	279.96875	111.9875	0	0	0	0											5000	$50/day (1-5); $0/day (6-90)	$50/day (1-8); $0/day (9-90)	$0/day (1-20); $50/day (21-100)	$0 Copay	$50/run	0% - 20%	0% - 20%	$50 ER ($0 if admitted immed.) Worldwide coverage; $35 Urgent care	$50/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; $10/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 (up to 12 one-way trips)	Not Covered	$15/visit for routine vision	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$0 Copay												50	50	50	0	50	0.06	0.055702532	46.25	50	0	0.045	0	0	10	5	10	25	10	0.098	10	0.2	0	0	0	15	25	0	0	0	0											NO	49	49	49	0	49	0.0588	0.054588481	45.325	49	0	0.0441	0	0	9.8	4.9	9.8	24.5	9.8	0.09604	9.8	0.196	0	0	0	14.7	24.5	0	0	0	0												2.8387	0.054859945	0.497658767	0	0.802470155	0.2302312	0.015398903	2.09623303	0.875821119	0	0.483346437	0	0	0	1.345559326	2.438657994	0.319241435	1.097763991	7.679308277	2.221333333	0.104769811	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.673		0.483122443	2.8387	0.054859945	0.497658767	0	0.802470155	0.2302312	0.015398903	2.09623303	0.875821119	0	0.483346437	0	0	0	1.345559326	2.438657994	0.319241435	1.097763991	7.679308277	2.221333333	0.104769811	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.673	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			2.8387	0.054859945	0.497658767	0	0.802470155	0.2302312	0.015398903	2.09623303	0.875821119	0	0.483346437	0	0	0	1.345559326	2.438657994	0.319241435	1.097763991	7.679308277	2.221333333	0.104769811	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.673
H5425_008_0	2011	12																															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	640.8302005	9.772196145	270.3699994	0	176.5595466	6.010315143	0.463506334	841.0339964	212.2477235	0	10.08447736	0	0	0	3980.141966	3603.199012	191.4529985	1555.265405	47.64898086	2720	0.961471027	0	0	0	279.96875	111.9875	0	0	0	0											5000	$150/day (1-10); $0/day (11-90)	$150/day (1-10); $0/day (11-90)	$0/day (1-10); $50/day (11-100)	$0 Copay	$150/run	0% - 20%	0% - 20%	$50 ER ($0 if admitted immed.) Worldwide coverage; $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; $10/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 (up to 12 one-way trips)	Not Covered	$15/visit for routine vision	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$0 Copay												150	150	50	0	150	0.06	0.055692475	46.25	66.5	0	0.075	0	0	10	10	10	25	10	0.098	10	0.2	0	0	0	15	25	0	0	0	0											NO	147	147	49	0	147	0.0588	0.054578626	45.325	65.17	0	0.0735	0	0	9.8	9.8	9.8	24.5	9.8	0.09604	9.8	0.196	0	0	0	14.7	24.5	0	0	0	0												7.8502	0.119709403	1.104010831	0	2.162854446	0.35340653	0.025297539	3.176655491	1.152682011	0	0.741209086	0	0	0	3.250449272	2.942612527	0.390883205	1.270133414	4.576208122	2.221333333	0.188448321	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.0977		0.655054415	7.8502	0.119709403	1.104010831	0	2.162854446	0.35340653	0.025297539	3.176655491	1.152682011	0	0.741209086	0	0	0	3.250449272	2.942612527	0.390883205	1.270133414	4.576208122	2.221333333	0.188448321	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.0977	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			7.8502	0.119709403	1.104010831	0	2.162854446	0.35340653	0.025297539	3.176655491	1.152682011	0	0.741209086	0	0	0	3.250449272	2.942612527	0.390883205	1.270133414	4.576208122	2.221333333	0.188448321	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.0977
H5425_009_0	2011	12																															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	501.5147903	8.801464618	294.7643074	0	222.6724815	5.922042496	0.415983165	1431.143657	115.4122264	0	14.11012623	0	0	0	3587.654931	3247.882818	180.7146458	1468.032567	103.4014081	2720	0.579598659	0	0	0	279.96875	111.9875	0	0	0	0											5000	$150/day (1-10); $0/day (11-90)	$150/day (1-10); $0/day (11-90)	$0/day (1-10); $50/day (11-100)	$0 Copay	$150/run	0% - 20%	0% - 20%	$50 ER ($0 if admitted immed.) Worldwide coverage; $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; $10/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 (up to 12 one-way trips)	Not Covered	$15/visit for routine vision	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$0 Copay												150	150	50	0	150	0.06	0.055692475	46.25	66.5	0	0.075	0	0	10	10	10	25	10	0.098	10	0.2	0	0	0	15	25	0	0	0	0											NO	147	147	49	0	147	0.0588	0.054578626	45.325	65.17	0	0.0735	0	0	9.8	9.8	9.8	24.5	9.8	0.09604	9.8	0.196	0	0	0	14.7	24.5	0	0	0	0												6.1436	0.107817942	1.203620922	0	2.727737899	0.348216099	0.02270379	5.405548854	0.626784566	0	1.037094278	0	0	0	2.929918194	2.652437635	0.368959069	1.198893263	9.930671236	2.221333333	0.113601337	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6105		0.767561173	6.1436	0.107817942	1.203620922	0	2.727737899	0.348216099	0.02270379	5.405548854	0.626784566	0	1.037094278	0	0	0	2.929918194	2.652437635	0.368959069	1.198893263	9.930671236	2.221333333	0.113601337	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6105	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			6.1436	0.107817942	1.203620922	0	2.727737899	0.348216099	0.02270379	5.405548854	0.626784566	0	1.037094278	0	0	0	2.929918194	2.652437635	0.368959069	1.198893263	9.930671236	2.221333333	0.113601337	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6105
H5425_010_0	2011	12																															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	YES	375.0980361	2.334885921	64.91462523	30.15455324	14.03464057	5.459843977	0.557263406	24.41785797	21.4901298	1.724883026	21.65168466	0.153702213	0.307404426	29.41987581	342.0865501	280.5072458	4.798759953	13.52056188	95.10918398	49.77268392	5.910547141	40.00993963	0	0	0	0	0	0	0	234											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0 Copay	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$10 acupuncture (10 visits/yr-combo w/ chiro)												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	0.063859289	0.063859289	0.152435997	0	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0	0	0	0	0	0	0	9.8												23.9535	0.149104154	9.89532561	0	3.204669828	1.246700774	0.127245526	5.57557369	4.907056238	0.39385979	4.943945675	0.035096363	0.070192727	6.717734443	78.11204285	64.05102451	1.095748848	3.087285101	21.71723107	11.36509465	1.349614334	9.135869616	0	0	0	0	0	0	0	0.1911	0	0	0	0	0	0	0	0	0	0	251.325		5.102131795	23.9535	0.149104154	9.89532561	0	3.204669828	1.246700774	0.127245526	5.57557369	4.907056238	0.39385979	4.943945675	0.035096363	0.070192727	6.717734443	78.11204285	64.05102451	1.095748848	3.087285101	21.71723107	11.36509465	1.349614334	9.135869616	0	0	0	0	0	0	0	0.1911	0	0	0	0	0	0	0	0	0	0	251.325	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			23.9535	0.149104154	9.89532561	0	3.204669828	1.246700774	0.127245526	5.57557369	4.907056238	0.39385979	4.943945675	0.035096363	0.070192727	6.717734443	78.11204285	64.05102451	1.095748848	3.087285101	21.71723107	11.36509465	1.349614334	9.135869616	0	0	0	0	0	0	0	0.1911	0	0	0	0	0	0	0	0	0	0	251.325
H5425_011_0	2011	13																															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	YES	372.9811741	2.118806539	54.42706664	32.03964429	12.12220396	11.08825861	0.505692093	30.37644291	34.04823586	42.67010579	19.64795394	0.139478015	0.278956031	29.50742416	213.5522738	285.4689179	4.883641444	13.75971647	96.79149553	50.65307379	7.384700548	47.55059432	0	0	0	0	0	0	0	234											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0 Copay	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$10 acupuncture (10 visits/yr-combo w/ chiro)												0.068592167	0.068592167	0.140424165	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.067220324	0.067220324	0.137615681	0	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0	0	0	0	0	0	0	9.8												25.0719	0.142426861	7.490017853	0	2.767984053	2.531892972	0.115469733	6.936156974	7.774574177	9.743291956	4.486413804	0.03184841	0.06369682	6.737725233	48.76252619	65.18397271	1.115130687	3.141893659	22.10137009	11.56612287	1.686222523	10.85770271	0	0	0	0	0	0	0	0.1911	0	0	0	0	0	0	0	0	0	0	238.4995		4.832923122	25.0719	0.142426861	7.490017853	0	2.767984053	2.531892972	0.115469733	6.936156974	7.774574177	9.743291956	4.486413804	0.03184841	0.06369682	6.737725233	48.76252619	65.18397271	1.115130687	3.141893659	22.10137009	11.56612287	1.686222523	10.85770271	0	0	0	0	0	0	0	0.1911	0	0	0	0	0	0	0	0	0	0	238.4995	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			25.0719	0.142426861	7.490017853	0	2.767984053	2.531892972	0.115469733	6.936156974	7.774574177	9.743291956	4.486413804	0.03184841	0.06369682	6.737725233	48.76252619	65.18397271	1.115130687	3.141893659	22.10137009	11.56612287	1.686222523	10.85770271	0	0	0	0	0	0	0	0.1911	0	0	0	0	0	0	0	0	0	0	238.4995
H5425_012_0	2011	15																															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	YES	320.5505137	1.607518892	23.63855779	16.68126103	14.60598203	7.596406188	0.383663906	44.11768918	15.50078735	38.95753995	14.90672063	0.105820678	0.211641356	22.38700935	178.7320387	340.163853	5.819331585	16.39603431	115.3364377	60.35804134	6.028588389	30.31735097	0	0	0	0	0	0	0	234											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0 Copay	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$0 cost sharing	$10 acupuncture (10 visits/yr-combo w/ chiro)												0.068592167	0.068592167	0.140424165	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.067220324	0.067220324	0.137615681	0	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0	0	0	0	0	0	0	9.8												21.5475	0.10805794	3.253036234	0	3.335129937	1.734563389	0.087605816	10.07383315	3.539449784	8.895564673	3.40380059	0.024163094	0.048326187	5.111849715	40.81167371	77.6730142	1.328786174	3.743870474	26.33592218	13.78215516	1.376567873	6.922663921	0	0	0	0	0	0	0	0.1911	0	0	0	0	0	0	0	0	0	0	233.3286		4.733715828	21.5475	0.10805794	3.253036234	0	3.335129937	1.734563389	0.087605816	10.07383315	3.539449784	8.895564673	3.40380059	0.024163094	0.048326187	5.111849715	40.81167371	77.6730142	1.328786174	3.743870474	26.33592218	13.78215516	1.376567873	6.922663921	0	0	0	0	0	0	0	0.1911	0	0	0	0	0	0	0	0	0	0	233.3286	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			21.5475	0.10805794	3.253036234	0	3.335129937	1.734563389	0.087605816	10.07383315	3.539449784	8.895564673	3.40380059	0.024163094	0.048326187	5.111849715	40.81167371	77.6730142	1.328786174	3.743870474	26.33592218	13.78215516	1.376567873	6.922663921	0	0	0	0	0	0	0	0.1911	0	0	0	0	0	0	0	0	0	0	233.3286
H5425_014_0	2011	10																															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	1025.122479	15.00041586	243.7512327	0	196.5233032	3.265739809	0.235279178	554.9872335	214.4868046	0	9.141441033	0	0	0	3295.247329	2986.111829	156.3631516	1344.200806	53.32866122	2720	0.534539851	0	0	0	279.96875	111.9875	0	0	0	719											5000	$50/day (1-10); $0/day (11-90)	$150/day (1-10); $0/day (11-90)	$0/day (1-10); $50/day (11-100)	$0 Copay	$150/run	20% coinsurance	20% coinsurance	$50 ER ($0 if admitted immed.) Worldwide coverage; $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	$10/visit cardiac rehab	$0/visit	$0/visit	$35/visit	$10/visit PT/OT/ST; $10/visit CORF	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/dental/chiropractic/podiatry	20% coinsurance	$0 Copay	Not Covered	Not Covered	$15/visit for routine vision	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$10 routine chiropractic (20 visits/yr); $0 copay for health club membership												50	150	50	0	150	0.2	0.2	46.25	200	0	0.2	0	0	10	0	0	35	10	0.098	10	0.2	0	0	0	15	25	0	0	0	10											NO	49	147	49	0	147	0.196	0.196	45.325	196	0	0.196	0	0	9.8	0	0	34.3	9.8	0.09604	9.8	0.196	0	0	0	14.7	24.5	0	0	0	9.8												4.1859	0.183755094	0.995317533	0	2.407410464	0.640085003	0.046114719	2.09623303	3.503284476	0	1.791722442	0	0	0	0	0	0.446938008	1.097763991	5.121684624	2.221333333	0.104769811	0	0	0	0.342961719	0.228641146	0	0	0	0.587183333	0	0	0	0	0	0	0	0	0	0	26.0011		0.530635011	4.1859	0.183755094	0.995317533	0	2.407410464	0.640085003	0.046114719	2.09623303	3.503284476	0	1.791722442	0	0	0	0	0	0.446938008	1.097763991	5.121684624	2.221333333	0.104769811	0	0	0	0.342961719	0.228641146	0	0	0	0.587183333	0	0	0	0	0	0	0	0	0	0	26.0011	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			4.1859	0.183755094	0.995317533	0	2.407410464	0.640085003	0.046114719	2.09623303	3.503284476	0	1.791722442	0	0	0	0	0	0.446938008	1.097763991	5.121684624	2.221333333	0.104769811	0	0	0	0.342961719	0.228641146	0	0	0	0.587183333	0	0	0	0	0	0	0	0	0	0	26.0011
H5425_015_0	2011	10																															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	0	8.996784755	270.3699994	0	176.5595466	5.195013344	0.400631503	841.0339964	212.2477235	0	8.716513729	0	0	0	3980.141966	3603.199012	191.4529985	1555.265405	37.10961044	2720	0.961471027	0	0	0	279.96875	111.9875	0	0	0	719											5000	$0 Copay	$50/day (1-10); $0/day (11-90)	$0/day (1-10); $50/day (11-100)	$0 Copay	$100/run	20% coinsurance	20% coinsurance	$50 ER ($0 if admitted immed.) Worldwide coverage; $35 Urgent care	$100/OP hospital and $50/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; $10/visit CORF	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/dental/chiropractic/podiatry	20% coinsurance	$0 Copay	Not Covered	Not Covered	$15/visit for routine vision	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$10 routine chiropractic (20 visits/yr); $0 copay for health club membership												0	50	50	0	100	0.2	0.2	46.25	66.5	0	0.2	0	0	10	0	0	35	10	0.098	10	0.2	0	0	0	15	25	0	0	0	10											NO	0	49	49	0	98	0.196	0.196	45.325	65.17	0	0.196	0	0	9.8	0	0	34.3	9.8	0.09604	9.8	0.196	0	0	0	14.7	24.5	0	0	0	9.8												0	0.036736871	1.104010831	0	1.441902964	1.018222615	0.078523775	3.176655491	1.152682011	0	1.708436691	0	0	0	0	0	0.547236487	1.270133414	3.564006987	2.221333333	0.188448321	0	0	0	0.342961719	0.228641146	0	0	0	0.587183333	0	0	0	0	0	0	0	0	0	0	18.6671		0.380961551	0	0.036736871	1.104010831	0	1.441902964	1.018222615	0.078523775	3.176655491	1.152682011	0	1.708436691	0	0	0	0	0	0.547236487	1.270133414	3.564006987	2.221333333	0.188448321	0	0	0	0.342961719	0.228641146	0	0	0	0.587183333	0	0	0	0	0	0	0	0	0	0	18.6671	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0.036736871	1.104010831	0	1.441902964	1.018222615	0.078523775	3.176655491	1.152682011	0	1.708436691	0	0	0	0	0	0.547236487	1.270133414	3.564006987	2.221333333	0.188448321	0	0	0	0.342961719	0.228641146	0	0	0	0.587183333	0	0	0	0	0	0	0	0	0	0	18.6671
H5425_016_0	2011	10																															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	0	8.918955748	294.7643074	0	222.6724815	5.237572008	0.367903773	1567.991367	115.4122264	0	12.4792759	0	0	0	3587.654931	3247.882818	180.7146458	1468.032567	75.56753232	2720	0.579598659	0	0	0	279.96875	111.9875	0	0	0	719											5000	$0 Copay	$50/day (1-10); $0/day (11-90)	$0/day (1-10); $50/day (11-100)	$0 Copay	$100/run	20% coinsurance	20% coinsurance	$50 ER ($0 if admitted immed.) Worldwide coverage; $35 Urgent care	$100/OP hospital and $50/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; $10/visit CORF	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/dental/chiropractic/podiatry	20% coinsurance	$0 Copay	Not Covered	Not Covered	$15/visit for routine vision	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$10 routine chiropractic (20 visits/yr); $0 copay for health club membership												0	50	50	0	100	0.2	0.2	46.25	66.5	0	0.2	0	0	10	0	0	35	10	0.098	10	0.2	0	0	0	15	25	0	0	0	10											NO	0	49	49	0	98	0.196	0.196	45.325	65.17	0	0.196	0	0	9.8	0	0	34.3	9.8	0.09604	9.8	0.196	0	0	0	14.7	24.5	0	0	0	9.8												0	0.036419069	1.203620922	0	1.818491932	1.026564114	0.07210914	5.922434061	0.626784566	0	2.445938076	0	0	0	0	0	0.516542696	1.198893263	7.257505804	2.221333333	0.113601337	0	0	0	0.342961719	0.228641146	0	0	0	0.587183333	0	0	0	0	0	0	0	0	0	0	25.619		0.522837235	0	0.036419069	1.203620922	0	1.818491932	1.026564114	0.07210914	5.922434061	0.626784566	0	2.445938076	0	0	0	0	0	0.516542696	1.198893263	7.257505804	2.221333333	0.113601337	0	0	0	0.342961719	0.228641146	0	0	0	0.587183333	0	0	0	0	0	0	0	0	0	0	25.619	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0.036419069	1.203620922	0	1.818491932	1.026564114	0.07210914	5.922434061	0.626784566	0	2.445938076	0	0	0	0	0	0.516542696	1.198893263	7.257505804	2.221333333	0.113601337	0	0	0	0.342961719	0.228641146	0	0	0	0.587183333	0	0	0	0	0	0	0	0	0	0	25.619
H5425_018_0	2011	9																															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	YES	727.11	20.13	253.18	0	149.61	13.8	8.38	251.39	369.86	9.95	10.77	0	0	475.35	4394.92	3982.03	199.93	640.53	20.17	8696.98	9.91	0	0	0	374.86	306.26	160.12	0	0	0											5000	$150/Days 1-5 for IP Medical/Surgical	$220/Days 1-8 for IP Mental	$75/Days 21-100 for SNF	No cost-sharing	$100/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	$175/Case for OP Fac - Surgery;$150/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	Not Covered	$15/Exam for Vision (Refractions)	$25/Service for Vision Hardware	$0/visit for routine hearing	Not covered	No cost-sharing	No cost-sharing												150	220	75	0	100	0.1	0.1	48.69415264	162.48	0.02	0.2	0	0	15	10	15	25	15	0.2	1.971906345	0.2	0	0	0	15	25	0	0	0	0											NO	147	215.6	73.5	0	98	0.098	0.098	47.72026958	159.2304	0.0196	0.196	0	0	14.7	9.8	14.7	24.5	14.7	0.196	1.932468218	0.196	0	0	0	15	25	0	0	0	0												8.9071	0.361669	1.5507275	0	1.221815	1.3524	0.82124	0.999699881	4.907746312	0.19502	2.11092	0	0	0.58230375	3.589184667	4.87798675	0.408190417	0.78464925	3.95332	1.400553121	1.94236	0	0	0	0.468575	0.638041667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0735		0.815650676	8.9071	0.361669	1.5507275	0	1.221815	1.3524	0.82124	0.999699881	4.907746312	0.19502	2.11092	0	0	0.58230375	3.589184667	4.87798675	0.408190417	0.78464925	3.95332	1.400553121	1.94236	0	0	0	0.468575	0.638041667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0735	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			8.9071	0.361669	1.5507275	0	1.221815	1.3524	0.82124	0.999699881	4.907746312	0.19502	2.11092	0	0	0.58230375	3.589184667	4.87798675	0.408190417	0.78464925	3.95332	1.400553121	1.94236	0	0	0	0.468575	0.638041667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0735
H5425_019_0	2011	10																															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	YES	668.34	18.2	225.03	0	131.09	13.17	8.07	249.51	382.24	8.86	11.27	0	0	529.18	4290.58	3884.86	172.35	539.34	14.18	8252.28	9.83	0	0	0	359.26	306.26	153.47	0	0	0											5000	$150/Days 1-5 for IP Medical/Surgical	$220/Days 1-8 for IP Mental	$75/Days 21-100 for SNF	No cost-sharing	$100/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	$175/Case for OP Fac - Surgery;$150/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	Not Covered	$15/Exam for Vision (Refractions)	$25/Service for Vision Hardware	$0/visit for routine hearing	Not covered	No cost-sharing	No cost-sharing												150	220	75	0	100	0.1	0.1	48.69415264	162.48	0.02	0.2	0	0	15	10	15	25	15	0.2	1.971906345	0.2	0	0	0	15	25	0	0	0	0											NO	147	215.6	73.5	0	98	0.098	0.098	47.72026958	159.2304	0.0196	0.196	0	0	14.7	9.8	14.7	24.5	14.7	0.196	1.932468218	0.196	0	0	0	15	25	0	0	0	0												8.1872	0.326993333	1.37830875	0	1.070568333	1.29066	0.79086	0.992223705	5.072019008	0.173656	2.20892	0	0	0.6482455	3.503973667	4.7589535	0.35188125	0.6606915	2.77928	1.328939069	1.92668	0	0	0	0.449075	0.638041667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5371		0.764286094	8.1872	0.326993333	1.37830875	0	1.070568333	1.29066	0.79086	0.992223705	5.072019008	0.173656	2.20892	0	0	0.6482455	3.503973667	4.7589535	0.35188125	0.6606915	2.77928	1.328939069	1.92668	0	0	0	0.449075	0.638041667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5371	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			8.1872	0.326993333	1.37830875	0	1.070568333	1.29066	0.79086	0.992223705	5.072019008	0.173656	2.20892	0	0	0.6482455	3.503973667	4.7589535	0.35188125	0.6606915	2.77928	1.328939069	1.92668	0	0	0	0.449075	0.638041667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5371
H5425_020_0	2011	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	P	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	YES	627.1	16.83	259.74	0	155.05	12.7	7.7	245.5	376.16	7.39	10.75	0	0	467.23	4421.51	4003.13	208.55	667.42	17.32	10557.04	9.3	0	0	0	355.16	306.26	151.72	0	0	0											5000	$150/Days 1-5 for IP Medical/Surgical	$220/Days 1-8 for IP Mental	$75/Days 21-100 for SNF	No cost-sharing	$100/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	$175/Case for OP Fac - Surgery;$150/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	Not Covered	$15/Exam for Vision (Refractions)	$25/Service for Vision Hardware	$0/visit for routine hearing	Not Covered	No cost-sharing	No cost-sharing												150	220	75	0	100	0.1	0.1	48.69415264	162.48	0.02	0.2	0	0	15	10	15	25	15	0.2	1.971906345	0.2	0	0	0	15	25	0	0	0	0											NO	147	215.6	73.5	0	98	0.098	0.098	47.72026958	159.2304	0.0196	0.196	0	0	14.7	9.8	14.7	24.5	14.7	0.196	1.932468218	0.196	0	0	0	15	25	0	0	0	0												7.682	0.302379	1.5909075	0	1.266241667	1.2446	0.7546	0.976277182	4.991342272	0.144844	2.107	0	0	0.57235675	3.610899833	4.90383425	0.425789583	0.8175895	3.39472	1.700095357	1.8228	0	0	0	0.44395	0.638041667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3902		0.781801059	7.682	0.302379	1.5909075	0	1.266241667	1.2446	0.7546	0.976277182	4.991342272	0.144844	2.107	0	0	0.57235675	3.610899833	4.90383425	0.425789583	0.8175895	3.39472	1.700095357	1.8228	0	0	0	0.44395	0.638041667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3902	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			7.682	0.302379	1.5909075	0	1.266241667	1.2446	0.7546	0.976277182	4.991342272	0.144844	2.107	0	0	0.57235675	3.610899833	4.90383425	0.425789583	0.8175895	3.39472	1.700095357	1.8228	0	0	0	0.44395	0.638041667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3902
H5425_022_0	2011	9																															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	YES	864.72	17.74	214.16	0	126.65	11.34	7.03	213.26	313.76	8.44	9.14	0	0	298.7	4373.69	3962.8	169.6	543.37	18.44	7844.74	8.41	0	0	0	374.86	306.26	0	0	0	288.84											5000	$125/Days 1-8 IP Medical/Surgical	$220/Days 1-8 for IP Mental	$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	$5 per visit PCP	$10 per visit Specialists	$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	Not covered	Not Covered	$15/Exam for Vision (Refractions)	$25/Service for Vision Hardware	Not Covered	Not covered	No cost-sharing	$10 routine chiropractic (20 visits/yr)												125	220	100	0	150	0.2	0.2	48.73558673	187.4834615	0.02	0.2	0	0	15	5	10	25	15	0.2	2.307562085	0.2	0	0	0	15	25	0	0	0	10											NO	122.5	215.6	98	0	147	0.196	0.196	47.76087499	183.7337923	0.0196	0.196	0	0	14.7	4.9	9.8	24.5	14.7	0.196	2.261410844	0.196	0	0	0	15	25	0	0	0	10												8.8273	0.318728667	1.748973333	0	1.5514625	2.22264	1.37788	0.84879035	4.804026222	0.165424	1.79144	0	0	0.3659075	1.785923417	3.236286667	0.346266667	0.66562825	3.61424	1.478348342	1.64836	0	0	0	0.468575	0.638041667	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	38.145		0.750972978	8.8273	0.318728667	1.748973333	0	1.5514625	2.22264	1.37788	0.84879035	4.804026222	0.165424	1.79144	0	0	0.3659075	1.785923417	3.236286667	0.346266667	0.66562825	3.61424	1.478348342	1.64836	0	0	0	0.468575	0.638041667	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	38.145	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			8.8273	0.318728667	1.748973333	0	1.5514625	2.22264	1.37788	0.84879035	4.804026222	0.165424	1.79144	0	0	0.3659075	1.785923417	3.236286667	0.346266667	0.66562825	3.61424	1.478348342	1.64836	0	0	0	0.468575	0.638041667	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	38.145
H5425_023_0	2011	10																															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	YES	795.39	16.03	190.51	0	111.08	10.86	6.77	211.8	324.47	7.53	9.56	0	0	327.25	4373.69	3962.8	146.31	457.83	12.94	7437.29	8.35	0	0	0	359.26	306.26	0	0	0	317.72											5000	$125/Days 1-8 IP Medical/Surgical	$220/Days 1-8 for IP Mental	$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	$5 per visit PCP	$10 per visit Specialists	$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	Not covered	Not Covered	$15/Exam for Vision (Refractions)	$25/Service for Vision Hardware	Not Covered	Not covered	No cost-sharing	$10 routine chiropractic (20 visits/yr)												125	220	100	0	150	0.2	0.2	48.75345685	187.4833749	0.02	0.2	0	0	15	5	10	25	15	0.2	2.141539532	0.2	0	0	0	15	25	0	0	0	10											NO	122.5	215.6	98	0	147	0.196	0.196	47.77838771	183.7337074	0.0196	0.196	0	0	14.7	4.9	9.8	24.5	14.7	0.196	2.098708741	0.196	0	0	0	15	25	0	0	0	10												8.1196	0.288005667	1.555831667	0	1.36073	2.12856	1.32692	0.843288543	4.968006338	0.147588	1.87376	0	0	0.40088125	1.785923417	3.236286667	0.29871625	0.56084175	2.53624	1.300725461	1.6366	0	0	0	0.449075	0.638041667	0	0	0	0.264766667	0	0	0	0	0	0	0	0	0	0	35.7204		0.701398189	8.1196	0.288005667	1.555831667	0	1.36073	2.12856	1.32692	0.843288543	4.968006338	0.147588	1.87376	0	0	0.40088125	1.785923417	3.236286667	0.29871625	0.56084175	2.53624	1.300725461	1.6366	0	0	0	0.449075	0.638041667	0	0	0	0.264766667	0	0	0	0	0	0	0	0	0	0	35.7204	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			8.1196	0.288005667	1.555831667	0	1.36073	2.12856	1.32692	0.843288543	4.968006338	0.147588	1.87376	0	0	0.40088125	1.785923417	3.236286667	0.29871625	0.56084175	2.53624	1.300725461	1.6366	0	0	0	0.449075	0.638041667	0	0	0	0.264766667	0	0	0	0	0	0	0	0	0	0	35.7204
H5425_024_0	2011	10																															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	YES	753.49	14.96	219.82	0	131.31	10.12	6.27	201.32	308.47	6.06	8.82	0	0	278.48	4373.69	3962.8	171.85	549.97	15.35	9315.33	7.89	0	0	0	355.16	306.26	0	0	0	329.63											5000	$125/Days 1-8 IP Medical/Surgical	$220/Days 1-8 for IP Mental	$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	$5 per visit PCP	$10 per visit Specialists	$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	Not covered	Not Covered	$15/Exam for Vision (Refractions)	$25/Service for Vision Hardware	Not Covered	Not covered	No cost-sharing	$10 routine chiropractic (20 visits/yr)												125	220	100	0	150	0.2	0.2	48.69415264	187.4837688	0.02	0.2	0	0	15	5	10	25	15	0.2	1.86750361	0.2	0	0	0	15	25	0	0	0	10											NO	122.5	215.6	98	0	147	0.196	0.196	47.72026958	183.7340935	0.0196	0.196	0	0	14.7	4.9	9.8	24.5	14.7	0.196	1.830153538	0.196	0	0	0	15	25	0	0	0	10												7.6919	0.268781333	1.795196667	0	1.6085475	1.98352	1.22892	0.800587056	4.723037984	0.118776	1.72872	0	0	0.341138	1.785923417	3.236286667	0.350860417	0.67371325	3.0086	1.420707013	1.54644	0	0	0	0.44395	0.638041667	0	0	0	0.274691667	0	0	0	0	0	0	0	0	0	0	35.6683		0.700237396	7.6919	0.268781333	1.795196667	0	1.6085475	1.98352	1.22892	0.800587056	4.723037984	0.118776	1.72872	0	0	0.341138	1.785923417	3.236286667	0.350860417	0.67371325	3.0086	1.420707013	1.54644	0	0	0	0.44395	0.638041667	0	0	0	0.274691667	0	0	0	0	0	0	0	0	0	0	35.6683	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			7.6919	0.268781333	1.795196667	0	1.6085475	1.98352	1.22892	0.800587056	4.723037984	0.118776	1.72872	0	0	0.341138	1.785923417	3.236286667	0.350860417	0.67371325	3.0086	1.420707013	1.54644	0	0	0	0.44395	0.638041667	0	0	0	0.274691667	0	0	0	0	0	0	0	0	0	0	35.6683
H5425_025_0	2011	8																															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	383.2											1050	$100/day (1-10)	$100/day (1-10) Prior auth req'd	$30/day (1-20); $100/day (21-100)	$10Copay	$100/run	"0%-10%DME, Prior auth req'd"	"0%-10%Prosthetics, Prior auth req'd"	$50 ER ($0 if admitted immed.) Worldwide coverage; $25 Urgent care	$100/OP hospital and $50/ASC visits	0	10%	0.1	0	$20/visit cardiac rehab	$10/visit	$20/visit	"$25/visit, Prior auth req'd"	$20 PT/OT/ST/CORF	10%	"$25 hearing/vision/dental, $20 chiro/pod"	20% coinsurance		Not covered	Not Covered	$30 (1 per yr)/visit	$25 (1 pair every 2 years)	$25/visit	$0 (every 3 yrs)	$0 copay for Health Club Membership	$10 routine chiropractic (20 visits/yr); $0 copay for health club membership												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	10											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	8												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	0.255466667	0	0	0	0	0	0	0	0	0	0	34.8612		8.712652378	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	0.255466667	0	0	0	0	0	0	0	0	0	0	34.8612	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	0.255466667	0	0	0	0	0	0	0	0	0	0	49.1662
H5425_026_0	2011	8																															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	383.2											1050	$100/day (1-10)	$100/day (1-10) Prior auth req'd	$30/day (1-20); $100/day (21-100)	$10Copay	$100/run	"0%-10%DME, Prior auth req'd"	"0%-10%Prosthetics, Prior auth req'd"	$50 ER ($0 if admitted immed.) Worldwide coverage; $25 Urgent care	$100/OP hospital and $50/ASC visits	0	10%	0.1	0	$20/visit cardiac rehab	$10/visit	$20/visit	"$25/visit, Prior auth req'd"	$20 PT/OT/ST/CORF	10%	"$25 hearing/vision/dental, $20 chiro/pod"	20% coinsurance		Not covered	Not Covered	$30 (1 per yr)/visit	$25 (1 pair every 2 years)	$25/visit	$0 (every 3 yrs)	$0 copay for Health Club Membership	$10 routine chiropractic (20 visits/yr); $0 copay for health club membership												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	10											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	8												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	0.255466667	0	0	0	0	0	0	0	0	0	0	31.3805		7.845123314	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	0.255466667	0	0	0	0	0	0	0	0	0	0	31.3805	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	0.255466667	0	0	0	0	0	0	0	0	0	0	44.663
H5425_027_0	2011	8																															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	383.2											1050	$100/day (1-10)	$100/day (1-10) Prior auth req'd	$30/day (1-20); $100/day (21-100)	$10Copay	$100/run	"0%-10%DME, Prior auth req'd"	"0%-10%Prosthetics, Prior auth req'd"	$50 ER ($0 if admitted immed.) Worldwide coverage; $25 Urgent care	$100/OP hospital and $50/ASC visits	0	10%	0.1	0	$20/visit cardiac rehab	$10/visit	$20/visit	"$25/visit, Prior auth req'd"	$20 PT/OT/ST/CORF	10%	"$25 hearing/vision/dental, $20 chiro/pod"	20% coinsurance		Not covered	Not Covered	$30 (1 per yr)/visit	$25 (1 pair every 2 years)	$25/visit	$0 (every 3 yrs)	$0 copay for Health Club Membership	$10 routine chiropractic (20 visits/yr); $0 copay for health club membership												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	10											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	8												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	0.255466667	0	0	0	0	0	0	0	0	0	0	46.2105		11.55261428	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	0.255466667	0	0	0	0	0	0	0	0	0	0	46.2105	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	0.255466667	0	0	0	0	0	0	0	0	0	0	56.3514
H5425_028_0	2011	8																															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	615.5304312	7.960898552	354.208241	0	247.2857329	11.44937311	1.453013241	796.9276111	194.7011077	0	56.45478271	0	0	104.9765415	5816.608889	5271.473881	263.8490148	2265.430584	220.7648175	2720	0.534539851	0	0	0	279.96875	111.9875	0	0	0	0											5000	$50 day (1-8); $0/day (9-90)	$100/day (1-8); $0/day (9-90)	$0/day (1-10); $50/day (11-100)	$0 Copay	$100/run	0%-20%DME	0%-20%Prosthetics	$50 ER ($0 if admitted immed.) Worldwide coverage; $35 Urgent care	$100/OP hospital and $50/ASC visits	$0 Copay	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	0% - 10%	$0 Copay	$0 Copay	$0/visit	$0/visit	$25/visit	$10/visit PT/OT/ST; $10/visit CORF	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/chiropractic/podiatry; $0 dental	20% coinsurance	$0 Copay	Unlimited	Not Covered	$15/visit for routine vision (1 per yr)	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$0 Copay												50	100	50	0	100	0.06	0.055702532	46.25	66.5	0	0.045	0	0	10	0	0	25	10	0.098	10	0.2	0	0	0	15	25	0	0	0	0											NO	49	98	49	0	98	0.0588	0.054588481	45.325	65.17	0	0.0441	0	0	9.8	0	0	24.5	9.8	0.09604	9.8	0.196	0	0	0	14.7	24.5	0	0	0	0												2.5134	0.065014005	1.446350318	0	2.019500152	0.673223139	0.079317786	3.010061998	1.057389266	0	2.489655918	0	0	0.085730842	0	0	0.538691739	1.850101644	21.20225307	2.221333333	0.104769811	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9284		0.814865547	2.5134	0.065014005	1.446350318	0	2.019500152	0.673223139	0.079317786	3.010061998	1.057389266	0	2.489655918	0	0	0.085730842	0	0	0.538691739	1.850101644	21.20225307	2.221333333	0.104769811	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9284	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			2.5134	0.065014005	1.446350318	0	2.019500152	0.673223139	0.079317786	3.010061998	1.057389266	0	2.489655918	0	0	0.085730842	0	0	0.538691739	1.850101644	21.20225307	2.221333333	0.104769811	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9284
H5425_801_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	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	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											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	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												0.065810822	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	0.064494605	0.064494605	0.144720543	0	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0	0	0	0	0	0	0	0												17.8981	0.111410889	6.950424387	0	2.370947168	0.922360751	0.094141499	4.12503982	3.630442983	0.291393749	3.657735313	0.02596574	0.05193148	4.970057544	43.43820116	35.61885192	0.609347255	1.716842965	12.07697837	6.32014283	0.029062686	9.135869616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	154.0452		4.431068419	17.8981	0.111410889	6.950424387	0	2.370947168	0.922360751	0.094141499	4.12503982	3.630442983	0.291393749	3.657735313	0.02596574	0.05193148	4.970057544	43.43820116	35.61885192	0.609347255	1.716842965	12.07697837	6.32014283	0.029062686	9.135869616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	154.0452	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			17.8981	0.111410889	6.950424387	0	2.370947168	0.922360751	0.094141499	4.12503982	3.630442983	0.291393749	3.657735313	0.02596574	0.05193148	4.970057544	43.43820116	35.61885192	0.609347255	1.716842965	12.07697837	6.32014283	0.029062686	9.135869616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	154.0452
H5425_803_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	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	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											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	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												0.065880216	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	0.064562612	0.064562612	0.149768159	0	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0	0	0	0	0	0	0	0												17.2536	0.10739937	6.92655073	0	2.28317008	0.888213157	0.090656197	3.972322801	3.496036904	0.280605784	3.522318818	0.025004438	0.050008875	4.78605632	40.18905534	32.95458772	0.563768524	1.588424361	11.17362918	5.847400747	0.029062686	9.135869616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.1638		3.670006424	17.2536	0.10739937	6.92655073	0	2.28317008	0.888213157	0.090656197	3.972322801	3.496036904	0.280605784	3.522318818	0.025004438	0.050008875	4.78605632	40.18905534	32.95458772	0.563768524	1.588424361	11.17362918	5.847400747	0.029062686	9.135869616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.1638	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			17.2536	0.10739937	6.92655073	0	2.28317008	0.888213157	0.090656197	3.972322801	3.496036904	0.280605784	3.522318818	0.025004438	0.050008875	4.78605632	40.18905534	32.95458772	0.563768524	1.588424361	11.17362918	5.847400747	0.029062686	9.135869616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.1638
H5425_804_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	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	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											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	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												0.068221323	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	0.066856897	0.066856897	0.138386462	0	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0	0	0	0	0	0	0	0												19.1451	0.119172875	6.858066567	0	2.446520324	0.951760694	0.097142228	4.256524097	3.746162151	0.300681828	3.774324414	0.026793389	0.053586779	5.128476481	42.76555304	35.06728778	0.599911406	1.690257352	11.88996425	6.222274315	0.029062686	9.135869616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	154.3044		3.504947656	19.1451	0.119172875	6.858066567	0	2.446520324	0.951760694	0.097142228	4.256524097	3.746162151	0.300681828	3.774324414	0.026793389	0.053586779	5.128476481	42.76555304	35.06728778	0.599911406	1.690257352	11.88996425	6.222274315	0.029062686	9.135869616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	154.3044	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			19.1451	0.119172875	6.858066567	0	2.446520324	0.951760694	0.097142228	4.256524097	3.746162151	0.300681828	3.774324414	0.026793389	0.053586779	5.128476481	42.76555304	35.06728778	0.599911406	1.690257352	11.88996425	6.222274315	0.029062686	9.135869616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	154.3044
H5426_001_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin					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	YES	1622.957714	19.57302	817.746402	28.151335	264.508935	6.405601	3.600966	369.45264	457.316325	193.284458	1854.8647	78.670293	0.884582	2.849795	6242.820823	6904.853771	24.351868	1561.495587		1527.498299	33.65803	0					0.4		4.11	0.58	622.197903	389.172546									6700	$175/Day(Days 1-10):1a.IP Acute	$175/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$175/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 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:8b, 9a. $75 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$35/Visit:7b. $25 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$75/Visit:7c, 7d, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"20% Coins:7g, 13a.Other Part B"					"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										141.405425	127.515675	34.44565	0	150	0.2	0.2	50	147.357698	55.916184	77.008951	150	0.164889	0.2	0	34.601879	35	47.134466		0	0.2	0					0		0	0	0	83.078725									NO	133.789612	120.647936	30.131677	0	140.36325	0.187151	0.187151	46.78775	137.890703	52.323849	72.061511	140.36325	0.154295	0.187151	0	32.378882	32.751425	44.106312		0	0.187151	0					0		0	0	0	77.741332										18.0946	0.196787039	2.053339204	0	3.093944481	1.198814633	0.673924388	1.440488146	5.254972462	0.842782233	11.13869608	0.9202015	0.13648658	0.533341984	0	18.63095379	0.066463198	5.739317629	0	0	6.299133973	0	0	0	0	0	0	0	0	0	0	2.521232675	0	0	0	0	0	0	0	0	78.8355	0	5.350920772	18.0946	0.196787039	2.053339204	0	3.093944481	1.198814633	0.673924388	1.440488146	5.254972462	0.842782233	11.13869608	0.9202015	0.13648658	0.533341984	0	18.63095379	0.066463198	5.739317629	0	0	6.299133973	0	0	0	0	0	0	0	0	0	0	2.521232675	0	0	0	0	0	0	0	0	78.8355	NO																																																																																		0	0	0	18.0946	0.196787039	2.053339204	0	3.093944481	1.198814633	0.673924388	1.440488146	5.254972462	0.842782233	11.13869608	0.9202015	0.13648658	0.533341984	0	18.63095379	0.066463198	5.739317629	0	0	6.299133973	0	0	0	0	0	0	0	0	0	0	2.521232675	0	0	0	0	0	0	0	0	78.8355
H5426_002_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O			V		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	YES	1509.551514	5.173588	575.988828	545.392635	183.744394	5.957618	2.911577	359.374483	348.488859	246.74329	1230.691106	131.115786	0.099577	0.287971	5828.836046	6075.200493	44.65967	847.675453		1479.351601	24.466621	0			2.2		0.4		0.66	0.58	719.374348	436.380195									5500	$160/Day(Days 1-10):1a.IP Acute	$160/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $75 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$75/Visit:7c, 7d, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$25/Service:7g, 13a.Other Part B"			"VIS867: Vision 17a, 17b"		"HER751: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$25-$150/Visit:9d. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $25 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF"										129.28496	116.58576	34.44565	0	150	0.2	0.2	50	104.787713	56.645407	84.48409	100	0.097573	0.2	0	25	25	36.264291		0	0.2	0			0		0		0	0	0	78.291289									NO	123.889511	111.720286	31.286192	0	142.64505	0.190193	0.190193	47.54835	99.649657	53.867913	80.341581	95.0967	0.092788	0.190193	0	23.774175	23.774175	34.486144		0	0.190193	0			0		0		0	0	0	74.452433										15.5848	0.048166228	1.501708089	0	2.184185689	1.13309724	0.553761564	1.423971975	2.893899606	1.10762884	8.239639098	1.039056547	0.009239551	0.054770068	0	12.03607331	0.088478901	2.436088145	0	0	4.653380048	0	0	0	0	0	0	0	0	0	0	2.707463936	0	0	0	0	0	0	0	0	57.6954	0	2.923835291	15.5848	0.048166228	1.501708089	0	2.184185689	1.13309724	0.553761564	1.423971975	2.893899606	1.10762884	8.239639098	1.039056547	0.009239551	0.054770068	0	12.03607331	0.088478901	2.436088145	0	0	4.653380048	0	0	0	0	0	0	0	0	0	0	2.707463936	0	0	0	0	0	0	0	0	57.6954	NO																																																																																		0	0	0	15.5848	0.048166228	1.501708089	0	2.184185689	1.13309724	0.553761564	1.423971975	2.893899606	1.10762884	8.239639098	1.039056547	0.009239551	0.054770068	0	12.03607331	0.088478901	2.436088145	0	0	4.653380048	0	0	0	0	0	0	0	0	0	0	2.707463936	0	0	0	0	0	0	0	0	57.6954
H5426_008_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin			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	YES	1396.927813	39.77576877	743.0021877	719.7275817	217.10478	4.813539817	1.573213529	449.3954981	210.7514249	146.597737	1296.877715	72.10481344	0.18403011	5.98516755	4584.062624	3779.357981	62.75411152	238.8586702		635.160879	24.73458992	0			1.75				0.66	0.58	237.6769459	316.5039259									6700	$255/Day(Days 1-7):1a.IP Acute	$255/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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-$150/Visit:8b, 9a. $100 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$40/Visit:7b. $25 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS866: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$40-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"										183.2481	156.885945	34.44565	0	150	0.2	0.2	50	124.264166	82.702617	61.387981	150	0.193281	0.2	5	39.715267	40	50.325443		0	0.2	0			0				0	0	0	97.880082									NO	177.112587	151.63309	31.749555	0	144.5688	0.192758	0.192758	48.1896	119.76481	79.70812	59.165245	144.5688	0.186283	0.192758	4.81896	38.277257	38.55168	48.503259		0	0.192758	0			0				0	0	0	94.33604										20.6178	0.502610227	1.965832402	0	2.615548126	0.927848308	0.303249494	1.804682441	2.103383697	0.973752501	6.394173978	0.868675529	0.034281681	1.153688927	1.840867869	12.05528806	0.201606369	0.965451996	0	0	4.767790083	0	0	0	0	0	0	0	0	0	0	2.488143918	0	0	0	0	0	0	0	0	62.5847	0	2.382472572	20.6178	0.502610227	1.965832402	0	2.615548126	0.927848308	0.303249494	1.804682441	2.103383697	0.973752501	6.394173978	0.868675529	0.034281681	1.153688927	1.840867869	12.05528806	0.201606369	0.965451996	0	0	4.767790083	0	0	0	0	0	0	0	0	0	0	2.488143918	0	0	0	0	0	0	0	0	62.5847	NO																																																																																		0	0	0	20.6178	0.502610227	1.965832402	0	2.615548126	0.927848308	0.303249494	1.804682441	2.103383697	0.973752501	6.394173978	0.868675529	0.034281681	1.153688927	1.840867869	12.05528806	0.201606369	0.965451996	0	0	4.767790083	0	0	0	0	0	0	0	0	0	0	2.488143918	0	0	0	0	0	0	0	0	62.5847
H5426_013_0	2011	5																															A	A	A	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V		V	S	Coin	T						O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0						0	0											0	YES	373.4035124	3.874826694	93.60595868	664.9454896	324.9500035	592.7185168	10491.96074	606.6356416	377.2579897	169.7043327	2220.761679	32.22999009	12.21116333	408.4585408	6170.605141	6590.241194	40.55193773	813.6870446		1031.61881	3431.200057	0	1.92						3.36	1.69											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-100) $0(Days 100-100):2.SNF	$0/Visit:6.Home Health	$25/Trip:10a.Ambulance Emergency	$0/Service:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$25/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"$0/Proc:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"$0/Script:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"	$0: Other - Transportation 10b						$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$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											NO	0	0	0	0	24.977175	0	0	24.977175	0	0	0	0	0	0	0	0	0	0		0	0	0	0						0	0												0	0	0	0	0.676361092	0	0	1.262670382	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.939	0	0.001771954	0	0	0	0	0.676361092	0	0	1.262670382	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.939	NO																																																																																		0	0	0	0	0	0	0	0.676361092	0	0	1.262670382	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.939
H5426_019_0	2011	7	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1049.132919	51.271766	616.373539	513.776319	189.948595	1.725824	0.048388	204.237293	196.177444	80.653926	1534.455199	33.208257	0.272407	0.656106	5711.429893	3646.429826	79.736886	385.539818		214.866192	20.957176	0			1.21				0.04	0.36	5380.342626	198.847809									6700	$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	0% Coins:11c.Diabetic Monitoring Supplies	"$50/Visit:4a, 4b.Emergency Room"	"$0-$175/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $175 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$150/Visit:8b, 9a. $100 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$195/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$40/Visit:7b. $25 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$25/Service:7g, 13a.Other Part B"			"VIS856: Vision 17a, 17b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0/Service:11b.Prosthetics, 11b.Supplies"	"$40-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"										147.067245	128.620245	34.44565	0	150	0.044921971	0	50	141.753156	47.729126	40.852165	195	0.190782	0.2	5	39.992617	40	42.57402		0	0.2	0			0				0	0	0	70.781297									NO	144.317823	126.21569	33.498257	0	147.13455	0.044063826	0	49.04485	139.045246	46.817357	40.071766	191.274915	0.187138	0.196179	4.904485	39.228638	39.23588	41.760728		0	0.196179	0			0				0	0	0	69.429162										12.6174	0.53927511	1.720619935	0	2.329000087	0.076046409	0	0.834732283	2.273128413	0.314666971	5.124027473	0.529325545	0.050977701	0.128714219	2.334301853	11.92037297	0.260712241	1.341701956	0	0	4.111357831	0	0	0	0	0	0	0	0	0	0	1.150486395	0	0	0	0	0	0	0	0	47.6568	0	0.936213906	12.6174	0.53927511	1.720619935	0	2.329000087	0.076046409	0	0.834732283	2.273128413	0.314666971	5.124027473	0.529325545	0.050977701	0.128714219	2.334301853	11.92037297	0.260712241	1.341701956	0	0	4.111357831	0	0	0	0	0	0	0	0	0	0	1.150486395	0	0	0	0	0	0	0	0	47.6568	NO																																																																																		0	0	0	12.6174	0.53927511	1.720619935	0	2.329000087	0.076046409	0	0.834732283	2.273128413	0.314666971	5.124027473	0.529325545	0.050977701	0.128714219	2.334301853	11.92037297	0.260712241	1.341701956	0	0	4.111357831	0	0	0	0	0	0	0	0	0	0	1.150486395	0	0	0	0	0	0	0	0	47.6568
H5426_020_0	2011	4	r.										OP Facility - Other										Other										D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin			V				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	YES	1068.813211	4.801595	574.321723	22.135866	256.248406	3.438538	1908.64393	234.66964	173.866773	105.099873	1241.341752	35.431898	0.912934	1.966829	6058.46431	5397.264396	0.171798	364.424132		252.490125	39.774064	0			1.05				3.75	0.58	64.785101										6700	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$220/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $220 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$220/Visit:8b, 9a. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $220 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$220/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$40/Visit:7b. $25 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"			"VIS830: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	"$40-$220/Visit:9d. $50 Cardiac Rehab,8b. $220 Nuclear Medicine,9a. $50 OP Other,5. $40 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"											165.92202	145.11002	34.44565	0	150	0.044921971	0	50	137.579992	15.734589	19.412407	220	0.185836	0.2	0	39.996489	40	40.958552		0	0.067717	0			0				0	0	69.29003										NO	162.868723	142.439705	33.535217	0	147.26445	0.044102729	0	49.08815	135.070946	15.447638	19.058383	215.98786	0.182446	0.196353	0	39.267073	39.27052	40.211591		0	0.066482	0			0				0	0	68.026388											14.5064	0.056994815	1.605000301	0	3.144690048	0.151648909	0	0.959958207	1.957029126	0.135295399	1.971497212	0.637738319	0.166561157	0.386192775	0	17.66123125	0.000562216	1.221172846	0	0	2.644259323	0	0	0	0	0	0	0	0	0	0.367258035	0	0	0	0	0	0	0	0	0	47.5734	0	0.897148673	14.5064	0.056994815	1.605000301	0	3.144690048	0.151648909	0	0.959958207	1.957029126	0.135295399	1.971497212	0.637738319	0.166561157	0.386192775	0	17.66123125	0.000562216	1.221172846	0	0	2.644259323	0	0	0	0	0	0	0	0	0	0.367258035	0	0	0	0	0	0	0	0	0	47.5734	NO																																																																																		0	0	0	14.5064	0.056994815	1.605000301	0	3.144690048	0.151648909	0	0.959958207	1.957029126	0.135295399	1.971497212	0.637738319	0.166561157	0.386192775	0	17.66123125	0.000562216	1.221172846	0	0	2.644259323	0	0	0	0	0	0	0	0	0	0.367258035	0	0	0	0	0	0	0	0	0	47.5734
H5426_021_0	2011	4	r.										OP Facility - Other										Other										D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							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	YES	1154.917012	2.21748	456.488459	10.704427	252.398246	3.422367	1482.229774	189.333229	235.879508	142.722212	1544.800748	29.145372	0.871928	6.061198	7583.903567	4659.389918	0.192257	709.246812		289.25407	27.861107	0							3.13	0.36	83.23661										6700	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$220/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $220 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$220/Visit:8b, 9a. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $220 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$220/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$40/Visit:7b. $25 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"							$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$40-$220/Visit:9d. $50 Cardiac Rehab,8b. $220 Nuclear Medicine,9a. $50 OP Other,5. $40 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"											165.92202	145.11002	34.44565	0	150	0.044921971	0	50	129.008467	15.864349	21.385259	220	0.187574	0.2	0	39.997336	40	40.501323		0	0.033572	0							0	0	62.304314										NO	162.989348	142.5452	33.696147	0	147.4104	0.044146438	0	49.1368	126.781265	15.590467	21.016064	216.20192	0.184335	0.196547	0	39.306822	39.30944	39.802108		0	0.032992	0							0	0	61.228693											15.6866	0.026340928	1.281825185	0	3.100510534	0.151085312	0	0.775269084	2.492091868	0.185425495	2.705469282	0.525107115	0.160726848	1.191310283	0	15.26215084	0.000629793	2.352459851	0	0	0.919193642	0	0	0	0	0	0	0	0	0	0.424705737	0	0	0	0	0	0	0	0	0	47.2409	0	0.8399232	15.6866	0.026340928	1.281825185	0	3.100510534	0.151085312	0	0.775269084	2.492091868	0.185425495	2.705469282	0.525107115	0.160726848	1.191310283	0	15.26215084	0.000629793	2.352459851	0	0	0.919193642	0	0	0	0	0	0	0	0	0	0.424705737	0	0	0	0	0	0	0	0	0	47.2409	NO																																																																																		0	0	0	15.6866	0.026340928	1.281825185	0	3.100510534	0.151085312	0	0.775269084	2.492091868	0.185425495	2.705469282	0.525107115	0.160726848	1.191310283	0	15.26215084	0.000629793	2.352459851	0	0	0.919193642	0	0	0	0	0	0	0	0	0	0.424705737	0	0	0	0	0	0	0	0	0	47.2409
H5426_023_0	2011	4	r.										OP Facility - Other										Other										D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin			V				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	YES	1054.890619	2.986863	771.942804	6.194451	241.916319	4.413821	1767.293753	191.619048	218.166008	103.847873	1519.982143	29.132411	0.441588	3.164235	6989.639932	5380.936381	0.098752	327.9899		348.547186	38.12978	0			1.05				0.66	0.58	65.743639										6700	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	0% - 20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$220/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $220 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$220/Visit:8b, 9a. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,8b, 9a. $220 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$220/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$40/Visit:7b. $25 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"0%-20% Coins:15. 0% Part B Rx,15. 0% Part B Rx at Pharmacy,15. 20% Part B Rx - Chemo"	"0% Coins:7g, 13a.Other Part B"			"VIS830: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	"$40-$220/Visit:9d. $50 Cardiac Rehab,8b. $220 Nuclear Medicine,9a. $50 OP Other,5. $40 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"											165.92202	145.11002	34.44565	0	150	0.044921971	0	50	124.065864	15.92885	17.327186	220	0.191186	0.2	5	39.998808	40	41.148705		0	0.036939	0			0				0	0	63.251421										NO	162.49656	142.114224	33.065413	0	146.91075	0.043996803	0	48.97025	121.510727	15.600795	16.970333	215.4691	0.187249	0.195881	4.897025	39.175032	39.1762	40.301248		0	0.036178	0			0				0	0	61.948758											14.2847	0.035372976	2.127050636	0	2.961675655	0.194194012	0	0.78196939	2.209125853	0.135009115	2.14955026	0.523094532	0.082686911	0.619813516	2.852370124	17.56652958	0.000322394	1.101533525	0	0	1.379459181	0	0	0	0	0	0	0	0	0	0.339394732	0	0	0	0	0	0	0	0	0	49.3438	0	1.078329805	14.2847	0.035372976	2.127050636	0	2.961675655	0.194194012	0	0.78196939	2.209125853	0.135009115	2.14955026	0.523094532	0.082686911	0.619813516	2.852370124	17.56652958	0.000322394	1.101533525	0	0	1.379459181	0	0	0	0	0	0	0	0	0	0.339394732	0	0	0	0	0	0	0	0	0	49.3438	NO																																																																																		0	0	0	14.2847	0.035372976	2.127050636	0	2.961675655	0.194194012	0	0.78196939	2.209125853	0.135009115	2.14955026	0.523094532	0.082686911	0.619813516	2.852370124	17.56652958	0.000322394	1.101533525	0	0	1.379459181	0	0	0	0	0	0	0	0	0	0.339394732	0	0	0	0	0	0	0	0	0	49.3438
H5426_801_0	2011	2																															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	YES	475.916039	6.676046	48.912168	26.430539	11.961511	15.233564	5.378215	43.370576	80.445623	8.687303	47.084077	8.348523	0.843004	16.181871	62.754493	113.663363	0.782851	8.682362		12.346279	51.637422	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.079961	0.079961	0.156729	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.063542	0.063542	0.079415	0	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193		0.19193	0.19193	0																				30.2407	0.424209315	3.884359822	0	2.295772806	2.923777939	1.032240805	8.324114652	15.43992842	1.667354065	9.036846899	1.602332019	0.161797758	3.105786501	12.04446984	21.81540926	0.150252592	1.666405739	0	2.369621328	9.910770404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0961	0	31.72271939	30.2407	0.424209315	3.884359822	0	2.295772806	2.923777939	1.032240805	8.324114652	15.43992842	1.667354065	9.036846899	1.602332019	0.161797758	3.105786501	12.04446984	21.81540926	0.150252592	1.666405739	0	2.369621328	9.910770404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0961	NO																																																																																		0	0	0	30.2407	0.424209315	3.884359822	0	2.295772806	2.923777939	1.032240805	8.324114652	15.43992842	1.667354065	9.036846899	1.602332019	0.161797758	3.105786501	12.04446984	21.81540926	0.150252592	1.666405739	0	2.369621328	9.910770404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0961
H5426_802_0	2011	2																															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	YES	475.916039	6.676046	48.912168	26.430539	11.961511	15.233564	5.378215	43.370576	80.445623	8.687303	47.084077	8.348523	0.843004	16.181871	62.754493	113.663363	0.782851	8.682362		12.346279	51.637422	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.079961	0.079961	0.156729	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.063542	0.063542	0.079415	0	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193		0.19193	0.19193	0																				30.2407	0.424209315	3.884359822	0	2.295772806	2.923777939	1.032240805	8.324114652	15.43992842	1.667354065	9.036846899	1.602332019	0.161797758	3.105786501	12.04446984	21.81540926	0.150252592	1.666405739	0	2.369621328	9.910770404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0961	0	31.72271939	30.2407	0.424209315	3.884359822	0	2.295772806	2.923777939	1.032240805	8.324114652	15.43992842	1.667354065	9.036846899	1.602332019	0.161797758	3.105786501	12.04446984	21.81540926	0.150252592	1.666405739	0	2.369621328	9.910770404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0961	NO																																																																																		0	0	0	30.2407	0.424209315	3.884359822	0	2.295772806	2.923777939	1.032240805	8.324114652	15.43992842	1.667354065	9.036846899	1.602332019	0.161797758	3.105786501	12.04446984	21.81540926	0.150252592	1.666405739	0	2.369621328	9.910770404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0961
H5426_803_0	2011	2																															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	YES	475.916039	6.676046	48.912168	26.430539	11.961511	15.233564	5.378215	43.370576	80.445623	8.687303	47.084077	8.348523	0.843004	16.181871	62.754493	113.663363	0.782851	8.682362		12.346279	51.637422	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.079961	0.079961	0.156729	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.063542	0.063542	0.079415	0	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193	0.19193		0.19193	0.19193	0																				30.2407	0.424209315	3.884359822	0	2.295772806	2.923777939	1.032240805	8.324114652	15.43992842	1.667354065	9.036846899	1.602332019	0.161797758	3.105786501	12.04446984	21.81540926	0.150252592	1.666405739	0	2.369621328	9.910770404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0961	0	31.72271939	30.2407	0.424209315	3.884359822	0	2.295772806	2.923777939	1.032240805	8.324114652	15.43992842	1.667354065	9.036846899	1.602332019	0.161797758	3.105786501	12.04446984	21.81540926	0.150252592	1.666405739	0	2.369621328	9.910770404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0961	NO																																																																																		0	0	0	30.2407	0.424209315	3.884359822	0	2.295772806	2.923777939	1.032240805	8.324114652	15.43992842	1.667354065	9.036846899	1.602332019	0.161797758	3.105786501	12.04446984	21.81540926	0.150252592	1.666405739	0	2.369621328	9.910770404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0961
H5427_052_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	Coin	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	882.1655244	3.931587438	279.6796057	280.5861317	104.7050038	2.357491351	2.345260055	113.3805459	169.3152451	501.2259378	124.3161924	0.761196573	1.622205916	71.11192565	6089.431774	2641.391897	290.7655807	20.48335192	32.30728674	0	34.6112523	0	3.454045411	577.3297416	761.4863755	0.540735305	174.8713139	0	13272.47696	0											3400	$250 days 1-8	$250 days 1-8	$95 days 9-100	15	100	0.2	0.2	50	195	0	025-200; see grid75-200(NUC); 20%(other)	250	0.2	195	0	30	30	25-50	30	30	0.2	30	0	$0: $0- $75	0	10	0	0	0	0												197	141	43	15	100	0.2	0.199420996	49.30035527	59.00635007	0	18.49066134	195	43.72999155	21.72953451	0	29.261406	30	28	30	0	0.2	0	0	1	0	10	0	0	0	0											NO	184.6781612	132.1808159	40.31046158	14.06178892	93.74525949	0.187490519	0.186947731	46.21674598	55.31565599	0	17.33411845	182.803256	40.99479405	20.37040851	0	27.43118099	28.12357785	26.24867266	28.12357785	0	0.187490519	0	0	0.937452595	0	9.374525949	0	0	0	0												13.5764	0.043306703	0.939501167	0.328795247	0.81796648	0.442007277	0.438441045	0.436673324	0.780481988	0	0.179575967	0.011595768	0.005541833	0.120714915	0	6.038041599	0.68144737	0.044805067	0.075716374	0	6.489281655	0	0	0.045101605	0	0.000422428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4958		2.101419529	13.5764	0.043306703	0.939501167	0.328795247	0.81796648	0.442007277	0.438441045	0.436673324	0.780481988	0	0.179575967	0.011595768	0.005541833	0.120714915	0	6.038041599	0.68144737	0.044805067	0.075716374	0	6.489281655	0	0	0.045101605	0	0.000422428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4958	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			13.5764	0.043306703	0.939501167	0.328795247	0.81796648	0.442007277	0.438441045	0.436673324	0.780481988	0	0.179575967	0.011595768	0.005541833	0.120714915	0	6.038041599	0.68144737	0.044805067	0.075716374	0	6.489281655	0	0	0.045101605	0	0.000422428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4958
H5427_053_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	998.1399169	7.847011925	358.2196592	362.9870941	122.494605	1.83924608	3.923036052	98.75214884	204.5941956	356.8544437	205.6070381	1.519263828	0.057372271	134.2016382	7385.147388	2939.236305	372.14273	11.92494338	326.5818116	0	34.21717585	0	3.454045411	577.3297416	491.7033467	1.079247621	178.5112554	0	13272.47696	0											3400	$225 days 1-8	$225 days 1-8	$95 days 9-100	15	100	0.2	0.2	50	200	0	025-200; see grid75-200(NUC); 20%(other)	225	0.2	200	0	30	30	25-50	30	30	0.2	30	0	$0: $0- $75	0	10	0	0	0	0												177	126	43	15	100	0.2	0.199328142	49.17948718	61.13861386	0	17.09852217	200	0.2	23.54716981	0	29.35395745	30	28	30	0	0.2	0	0	1	0	10	0	0	0	0											NO	164.0263525	116.7645222	39.84820994	13.90053835	92.67025568	0.185340511	0.184717898	45.57475651	56.65730978	0	15.84524421	185.3405114	0.185340511	21.82122247	0	27.20238742	27.8010767	25.94767159	27.8010767	0	0.185340511	0	0	0.926702557	0	9.267025568	0	0	0	0												13.6434	0.076354383	1.189534349	0.420476335	0.945967197	0.340886809	0.724654975	0.375050428	0.965979726	0	0.271491144	0.023465095	0.010633406	0.244036984	0	6.662853724	0.862164049	0.025785376	0.7566105	0	6.34182887	0	0	0.044584412	0	0.000833451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.9266		2.683423201	13.6434	0.076354383	1.189534349	0.420476335	0.945967197	0.340886809	0.724654975	0.375050428	0.965979726	0	0.271491144	0.023465095	0.010633406	0.244036984	0	6.662853724	0.862164049	0.025785376	0.7566105	0	6.34182887	0	0	0.044584412	0	0.000833451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.9266	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			13.6434	0.076354383	1.189534349	0.420476335	0.945967197	0.340886809	0.724654975	0.375050428	0.965979726	0	0.271491144	0.023465095	0.010633406	0.244036984	0	6.662853724	0.862164049	0.025785376	0.7566105	0	6.34182887	0	0	0.044584412	0	0.000833451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.9266
H5427_054_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	1052.123903	9.27359951	529.197053	442.3054237	134.7078425	1.792652711	3.691014765	139.6386402	192.913858	170.9687247	198.5795638	6.034925861	0.059941527	126.108381	7045.779237	2895.985412	437.0458962	13.14085846	321.7761569	0	33.68610036	0.06464725	798.9306028	577.3297416	234.4124208	0.900283179	153.92182	0.200062929	13272.47696	0											3400	$195 days 1-10	$195 days 1-10	$95 days 9-100	15	100	0.2	0.2	50	200	0	025-200; see grid75-200(NUC); 20%(other)	195	0.2	200	0	30	30	$25-50	30	30	0.2	30	0	$0: $0- $75	0	10	0	0	0	0												164	122	43	15	100	0.2	0.199480449	48.84301809	67.59062472	0	17.75361865	200	0.2	23.76022006	0	29.44674193	30	28	30	0	0.2	0	0	1	0	10	0	0	0	0											NO	151.521336	112.7170914	39.72815516	13.85865878	92.39105852	0.184782117	0.184302098	45.12658142	62.44769364	0	16.4027562	184.782117	0.184782117	21.95231882	0	27.20615657	27.71731756	25.86949639	27.71731756	0	0.184782117	0	0	0.923910585	0	9.239105852	0	0	0	0												13.2849	0.087107764	1.752001886	0.510813329	1.037150013	0.331250163	0.680261765	0.525117872	1.003918792	0	0.271437681	0.092928865	0.011076122	0.230697615	0	6.565719378	1.009478324	0.028328949	0.743230994	0	6.224588939	0	0	0.044450088	0	0.000693151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4352		2.835938067	13.2849	0.087107764	1.752001886	0.510813329	1.037150013	0.331250163	0.680261765	0.525117872	1.003918792	0	0.271437681	0.092928865	0.011076122	0.230697615	0	6.565719378	1.009478324	0.028328949	0.743230994	0	6.224588939	0	0	0.044450088	0	0.000693151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4352	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			13.2849	0.087107764	1.752001886	0.510813329	1.037150013	0.331250163	0.680261765	0.525117872	1.003918792	0	0.271437681	0.092928865	0.011076122	0.230697615	0	6.565719378	1.009478324	0.028328949	0.743230994	0	6.224588939	0	0	0.044450088	0	0.000693151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4352
H5427_059_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	1608.50263	11.30508969	946.3914883	1027.814759	221.6990178	3.11741031	5.183210168	170.2172796	180.6944605	311.0158135	65.20444064	6.738534075	0	52.58828347	8166.317151	3336.554818	694.1117934	30.8549978	370.7283131	0	42.3998361	0.028066743	3.456659368	577.7666541	758.4511838	0.53852498	156.3979782	0.179508327	13282.52132	0											3400	$125 days 1-7	$125 days 1-7	$95 days 9-100	0	100	0.2	0.2	50	200	0	025-150; see grid75-150 (NUC);20% (other)	125	0.2	200	0	20	20	20-40	20	20	0.2	20	0	$0: $0- $75	0	10	0	0	0	0												94	66	43	0	100	0.2	0.199561094	49.36659459	66.6314529	0	22.69752061	200	0.2	80.53723485	0	19.68773017	20	22	20	0	0.2	0	0	1	0	10	0	0	0	0											NO	86.68674554	60.86516176	39.65457509	0	92.21994207	0.184439884	0.184035125	45.52584493	61.44748727	0	20.93164036	184.4398841	0.184439884	74.27139132	0	18.15601336	18.44398841	20.28838725	18.44398841	0	0.184439884	0	0	0.922199421	0	9.221994207	0	0	0	0												11.6197	0.057340509	3.127396028	0	1.703755882	0.574974796	0.953892732	0.64577379	0.92526838	0	0.113736325	0.103571204	0	0.325483748	0	5.048211154	1.066849156	0.052166512	0.569809059	0	7.820220858	0	0	0.044401339	0	0.000413856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.7529		2.931900913	11.6197	0.057340509	3.127396028	0	1.703755882	0.574974796	0.953892732	0.64577379	0.92526838	0	0.113736325	0.103571204	0	0.325483748	0	5.048211154	1.066849156	0.052166512	0.569809059	0	7.820220858	0	0	0.044401339	0	0.000413856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.7529	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			11.6197	0.057340509	3.127396028	0	1.703755882	0.574974796	0.953892732	0.64577379	0.92526838	0	0.113736325	0.103571204	0	0.325483748	0	5.048211154	1.066849156	0.052166512	0.569809059	0	7.820220858	0	0	0.044401339	0	0.000413856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.7529
H5427_060_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	1559.596102	13.04138403	793.1068014	964.2652524	233.8354211	4.531768529	7.791193962	191.2277369	212.0214326	148.2881044	35.64633542	14.85263976	0	42.33002332	6960.91651	3146.230959	2288.732029	40.93573405	349.5812176	0	52.30235659	0.063464042	3.45739558	577.889709	1098.456734	1.186981833	146.8477802	0.395660611	13285.35028	0											3400	$100 days 1-7	$100 days 1-7	$95 days 9-100	0	100	0.2	0.2	50	200	0	025-150; see grid75-150 (NUC);20% (other)	200	0.2	200	0	20	20	20-40	20	20	0.2	20	0	$0: $0- $75	0	10	0	0	0	0												75	53	43	0	100	0.2	0.199995718	48.75728155	64.9737303	0	43.99259794	200	0.2	79.29824561	0	19.72231062	20	22	20	0	0.2	0	0	1	0	10	0	0	0	0											NO	68.55886943	48.44826773	39.30708514	0	91.41182591	0.182823652	0.182819738	44.56992133	59.39367323	0	40.21443704	182.8236518	0.182823652	72.48797423	0	18.02852425	18.28236518	20.1106017	18.28236518	0	0.182823652	0	0	0.914118259	0	9.141182591	0	0	0	0												8.9103	0.052652705	2.597893047	0	1.781276901	0.828514472	1.424384037	0.710250433	1.049394307	0	0.119458109	0.226284487	0	0.25570147	0	4.726825094	3.486952897	0.06860352	0.532597624	0	9.562107832	0	0	0.044021628	0	0.000904201	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3782		3.417742054	8.9103	0.052652705	2.597893047	0	1.781276901	0.828514472	1.424384037	0.710250433	1.049394307	0	0.119458109	0.226284487	0	0.25570147	0	4.726825094	3.486952897	0.06860352	0.532597624	0	9.562107832	0	0	0.044021628	0	0.000904201	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3782	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			8.9103	0.052652705	2.597893047	0	1.781276901	0.828514472	1.424384037	0.710250433	1.049394307	0	0.119458109	0.226284487	0	0.25570147	0	4.726825094	3.486952897	0.06860352	0.532597624	0	9.562107832	0	0	0.044021628	0	0.000904201	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3782
H5427_062_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	1568.51706	13.11598132	797.6434071	969.7808919	235.17297	5.277263875	9.52643605	192.321568	213.2342045	149.1363189	35.85023403	14.93759751	0	42.57215291	19346.29801	3515.808375	3755.524811	41.16988825	0	0	62.9083396	0.082659096	3.477172035	581.1952635	1104.739955	1.193771421	147.6877559	0.397923807	13361.34307	0											3400	$25 days 31-90	$25 days 31-90	$25 days 31-100	0	25	0.1	0.2	25	50	0	00-50; see grid0-50; see grid	25	0.2	50	0	0	0	0-25	0	0	0.2	0	0	$0: $0- $75	0	10	0	0	0	0												0.66	2.84	0.27	0	25	0.1	0.199993043	24.22330097	4.991243433	0	3.771145833	50	0.2	19.73684211	0	0	0	2.82	0	0	0.2	0	0	1.23	0	10	0	0	0	0											NO	0.650891547	2.80080605	0.266273815	0	24.65498284	0.098619931	0.197233002	23.88900279	4.922360846	0	3.719101432	49.30996567	0.197239863	19.46446013	0	0	0	2.781082064	0	0	0.197239863	0	0	1.213025155	0	9.861993134	0	0	0	0												0.0851	0.003061277	0.017699296	0	0.483182128	0.520443401	1.878927577	0.382864206	0.087467975	0	0.011110888	0.061381035	0	0.069053664	0	0	0	0.009541403	0	0	12.40803226	0	0	0.058750373	0	0.00098108	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.0776		0.224986535	0.0851	0.003061277	0.017699296	0	0.483182128	0.520443401	1.878927577	0.382864206	0.087467975	0	0.011110888	0.061381035	0	0.069053664	0	0	0	0.009541403	0	0	12.40803226	0	0	0.058750373	0	0.00098108	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.0776	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0.0851	0.003061277	0.017699296	0	0.483182128	0.520443401	1.878927577	0.382864206	0.087467975	0	0.011110888	0.061381035	0	0.069053664	0	0	0	0.009541403	0	0	12.40803226	0	0	0.058750373	0	0.00098108	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.0776
H5427_070_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	1822.824975	9.073796888	658.0917659	1802.634539	246.4750372	5.594649141	8.630077884	190.806074	253.7574385	105.5320531	25.86373893	22.44777341	1.821790154	51.23948278	7490.514611	4082.147723	1304.115414	35.51779958	453.5719692	0	73.84323931	0.019653915	3.461836663	2185.943179	825.6766145	495.4059687	137.9009162	0.51998953	13210.58427	0											3400	$95 days 1-7	$95 days 1-7	$95 days 9-100	0	100	0.2	0.2	50	200	0	025-150; see grid75-150 (NUC);20% (other)	200	0.2	200	0	15	15	20-40	15	15	0.2	15	0	$0: $0- $75	0	10	0	0	0	0												71	50	43	0	100	0.2	0.2	49.48849105	65.28846154	0	23.56603774	200	0.2	63.85714286	0	14.84263357	15	22	15	0	0.2	0	0	1	0	10	0	0	0	0											NO	63.84294472	44.95982022	38.66544539	0	89.91964045	0.179839281	0.179839281	44.49987321	58.70714987	0	21.1904964	179.8392809	0.179839281	57.42011326	0	13.34644274	13.48794607	19.7823209	13.48794607	0	0.179839281	0	0	0.899196404	0	8.991964045	0	0	0	0												9.6979	0.033996356	2.120450936	0	1.846912227	1.006137678	1.552027001	0.707570508	1.241447998	0	0.045672122	0.336415952	0.327629431	0.245181409	0	4.540179237	1.465819865	0.058552042	0.509812855	0	13.27991506	0	0	0.163799354	0	0.371222721	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.5506		4.433786181	9.6979	0.033996356	2.120450936	0	1.846912227	1.006137678	1.552027001	0.707570508	1.241447998	0	0.045672122	0.336415952	0.327629431	0.245181409	0	4.540179237	1.465819865	0.058552042	0.509812855	0	13.27991506	0	0	0.163799354	0	0.371222721	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.5506	NO																																										0	0	0	0	0	0	0	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	0.033996356	2.120450936	0	1.846912227	1.006137678	1.552027001	0.707570508	1.241447998	0	0.045672122	0.336415952	0.327629431	0.245181409	0	4.540179237	1.465819865	0.058552042	0.509812855	0	13.27991506	0	0	0.163799354	0	0.371222721	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.5506
H5427_072_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	978.5886587	3.195391539	334.4253915	507.2510437	126.3510098	3.416542823	3.643104689	157.5008619	207.2515433	139.3232888	27.83975955	9.022144299	0	22.94202407	7077.129966	3565.961368	910.2675839	33.10889389	396.2179297	0	58.13115698	0.304286048	76.66428082	2185.943179	1368.177105	820.9062629	139.4482794	0.824028325	13210.58427	0											3400	$195 days 1-10	$195 days 1-10	$95 days 9-100	0	100	0.2	0.2	50	200	0	025-200; see grid75-200(NUC); 20%(other)	200	0.2	200	0	25	25	25-50	25	25	0.2	25	0	$0: $0- $75	0	10	0	0	0	0												164	122	43	0	100	0.2	0.199454731	49.21440262	67.53731343	0	27.59259259	200	0.2	135.1123596	0	24.6911452	25	28	25	0	0.2	0	0	1	0	10	0	0	0	0											NO	149.0568353	110.8837433	39.08197511	0	90.88831421	0.181776628	0.181281043	44.73014089	61.38352564	0	25.07844225	181.7766284	0.181776628	122.8013459	0	22.44136563	22.72207855	25.44872798	22.72207855	0	0.181776628	0	0	0.908883142	0	9.088831421	0	0	0	0												12.1554	0.029526415	1.089167069	0	0.956985857	0.621047635	0.660425816	0.587086312	1.060152535	0	0.058181484	0.136667914	0	0.234775953	0	6.668753574	1.723597629	0.070214936	0.750241244	0	10.56688572	0	0	0.165563909	0	0.621756553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1565		3.825242115	12.1554	0.029526415	1.089167069	0	0.956985857	0.621047635	0.660425816	0.587086312	1.060152535	0	0.058181484	0.136667914	0	0.234775953	0	6.668753574	1.723597629	0.070214936	0.750241244	0	10.56688572	0	0	0.165563909	0	0.621756553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1565	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			12.1554	0.029526415	1.089167069	0	0.956985857	0.621047635	0.660425816	0.587086312	1.060152535	0	0.058181484	0.136667914	0	0.234775953	0	6.668753574	1.723597629	0.070214936	0.750241244	0	10.56688572	0	0	0.165563909	0	0.621756553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1565
H5427_076_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	2263.507936	11.26746207	817.1908741	2238.436296	306.0624089	8.633250167	15.6116911	236.9350149	315.1053907	116.5443144	32.11651098	27.87470764	1.257794351	63.62705005	8348.487202	5014.888852	1304.115414	44.10452036	557.2098724	0	95.33903476	0.050972309	6.923673326	488.622593	619.2574608	371.5544765	143.6836569	0.645701285	14499.67436	0											3400	$95 days 1-7	$95 days 1-7	$95 days 9-100	0	100	0-20%	0.2	50	200	0	025-150; see grid75-150 (NUC);20% (other)	200	0.2	200	0	15	15	20-40	15	15	0.2	15	0	$0: $0- $75	0	10	0	0	0	0												71	50	43	0	100	0.184	0.2	49.48849105	65.28846154	0	23.75471698	200	0.2	63.85714286	0	14.87179004	15	22	15	0	0.2	0	0	1	0	10	0	0	0	0											NO	60.58030463	42.66218636	36.68948027	0	85.32437272	0.156996846	0.170648745	42.22574455	55.70697026	0	20.26856325	170.6487454	0.170648745	54.48570658	0	12.68926156	12.79865591	18.771362	12.79865591	0	0.170648745	0	0	0.853243727	0	8.532437272	0	0	0	0												11.427	0.040057881	2.498525704	0	2.176215254	1.355393045	2.664115501	0.833729785	1.462797219	0	0.054246295	0.396398657	0.214641028	0.288897065	0	5.302936362	1.390910371	0.068991826	0.594294785	0	16.26948667	0	0	0.034742847	0	0.264188772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3376		8.141970441	11.427	0.040057881	2.498525704	0	2.176215254	1.355393045	2.664115501	0.833729785	1.462797219	0	0.054246295	0.396398657	0.214641028	0.288897065	0	5.302936362	1.390910371	0.068991826	0.594294785	0	16.26948667	0	0	0.034742847	0	0.264188772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3376	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			11.427	0.040057881	2.498525704	0	2.176215254	1.355393045	2.664115501	0.833729785	1.462797219	0	0.054246295	0.396398657	0.214641028	0.288897065	0	5.302936362	1.390910371	0.068991826	0.594294785	0	16.26948667	0	0	0.034742847	0	0.264188772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3376
H5427_077_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	1165.977976	3.807275025	398.4642963	604.3842223	150.545884	4.828189186	4.80332227	187.6606014	246.9380091	151.13414	33.17077734	10.74978895	0	27.33517762	7874.073357	4206.030923	910.2675839	39.44889485	467.3367692	0	82.90914194	0.419463353	6.923673326	488.622593	1026.739162	616.0434969	143.7612787	0.981820983	14499.67436	0											3400	$195 days 1-10	$195 days 1-10	$95 days 9-100	0	100	0-20%	0.2	50	200	0	025-200; see grid75-200(NUC); 20%(other)	200	0.2	200	0	25	25	25-50	25	25	0.2	25	0	$0: $0- $75	0	10	0	0	0	0												164	122	43	0	100	0.184	0.19927551	49.21440262	67.53731343	0	27.59259259	200	0	135.1123596	0	24.73657075	25	28	25	0	0.2	0	0	1	0	10	0	0	0	0											NO	142.3438783	105.8899582	37.32187053	0	86.79504774	0.159702888	0.172961274	42.71566425	58.61904344	0	23.94900391	173.5900955	0	117.270837	0	21.47011839	21.69876194	24.30261337	21.69876194	0	0.173590095	0	0	0.867950477	0	8.679504774	0	0	0	0												13.8308	0.033596016	1.239286073	0	1.088886433	0.771075756	0.830788739	0.668003937	1.20627249	0	0.06620059	0.155504741	0	0.26713493	0	7.525331823	1.6459733	0.079892603	0.845052442	0	14.39220587	0	0	0.035341684	0	0.445579373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1269		6.865589447	13.8308	0.033596016	1.239286073	0	1.088886433	0.771075756	0.830788739	0.668003937	1.20627249	0	0.06620059	0.155504741	0	0.26713493	0	7.525331823	1.6459733	0.079892603	0.845052442	0	14.39220587	0	0	0.035341684	0	0.445579373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1269	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			13.8308	0.033596016	1.239286073	0	1.088886433	0.771075756	0.830788739	0.668003937	1.20627249	0	0.06620059	0.155504741	0	0.26713493	0	7.525331823	1.6459733	0.079892603	0.845052442	0	14.39220587	0	0	0.035341684	0	0.445579373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1269
H5427_078_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	2884.193406	15.26951584	1399.401567	1790.41607	573.2452706	8.123512774	18.34750136	672.2377379	251.9556573	186.89606	47.57317089	16.00188475	0.656150688	53.6279381	8575.695648	3509.209083	415.2802004	48.46516612	389.9121203	0	64.80373633	0.068218066	6.954344069	1162.390527	1587.978049	0	151.7937269	0	14563.90556	0											3400	$60 days 1-5	$60 days 1-5	$40 days 17-100	0	100	0.2	0.2	50	75	0	00-50; see grid0-50; see grid	75	0.2	75	0	20	$10-20	20	20	20	0.2	20	0	$0: $0- $75	0	10	0	0	0	0												38.91	25.8	7.24	0	100	0.2	0.199747035	49.81785064	54.25170068	0	3.372545455	75	0.2	28.62903226	0	19.70583568	19.12508864	20	20	0	0.2	0	0	1.23	0	0	0	0	0	0											NO	34.78590746	23.06544365	6.472628373	0	89.40094438	0.178801889	0.178575736	44.53762894	48.50153275	0	3.015087486	67.05070828	0.178801889	25.59462521	0	17.61720319	17.09800986	17.88018888	17.88018888	0	0.178801889	0	0	1.099631616	0	0	0	0	0	0												8.3608	0.029349846	0.754817191	0	4.270722379	1.452499427	3.276418556	2.494989578	1.018352964	0	0.011953106	0.089411476	0.117320982	0.114382248	0	5.151870788	0.591705413	0.07221386	0.580975196	0	11.58703045	0	0	0.106516781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0813		4.75189578	8.3608	0.029349846	0.754817191	0	4.270722379	1.452499427	3.276418556	2.494989578	1.018352964	0	0.011953106	0.089411476	0.117320982	0.114382248	0	5.151870788	0.591705413	0.07221386	0.580975196	0	11.58703045	0	0	0.106516781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0813	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			8.3608	0.029349846	0.754817191	0	4.270722379	1.452499427	3.276418556	2.494989578	1.018352964	0	0.011953106	0.089411476	0.117320982	0.114382248	0	5.151870788	0.591705413	0.07221386	0.580975196	0	11.58703045	0	0	0.106516781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0813
H5427_080_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	1822.824975	9.073796888	658.0917659	1802.634539	246.4750372	7.073800996	12.79170578	190.806074	253.7574385	109.7016582	25.86373893	22.44777341	1.030595287	51.23948278	7490.514611	4080.363705	1304.115414	35.51779958	453.373745	0	78.56783324	0.041765032	6.923673326	488.622593	619.2574608	371.5544765	137.9009162	0.51998953	14499.67436	0											3400	$150 days 1-7	$150 days 1-7	$95 days 9-100	0	100	0.2	0.2	50	200	0	025-150; see grid75-150 (NUC);20% (other)	200	0.2	200	0	25	25	20-40	25	25	0.2	25	0	$0: $0- $75	0	10	0	0	0	0												113	79	43	0	100	0.2	0.2	49.48849105	65.28846154	0	23.75471698	200	0.2	64.52380952	0	24.73684333	25	22	25	0	0.2	0	0	1	0	10	0	0	0	0											NO	95.84252794	67.00495316	36.47105045	0	84.8163964	0.169632793	0.169632793	41.97435474	55.37532035	0	20.14789492	169.6327928	0.169632793	54.72677006	0	20.98089909	21.2040991	18.65960721	21.2040991	0	0.169632793	0	0	0.848163964	0	8.48163964	0	0	0	0												14.5587	0.050665778	2.000108166	0	1.742093705	1.199948619	2.169892776	0.667413486	1.170991621	0	0.043424991	0.317323208	0.174822757	0.233680949	0	7.134141597	2.304382707	0.055229016	0.801115152	0	13.32768098	0	0	0.034536006	0	0.262615931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2487		8.637361148	14.5587	0.050665778	2.000108166	0	1.742093705	1.199948619	2.169892776	0.667413486	1.170991621	0	0.043424991	0.317323208	0.174822757	0.233680949	0	7.134141597	2.304382707	0.055229016	0.801115152	0	13.32768098	0	0	0.034536006	0	0.262615931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2487	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			14.5587	0.050665778	2.000108166	0	1.742093705	1.199948619	2.169892776	0.667413486	1.170991621	0	0.043424991	0.317323208	0.174822757	0.233680949	0	7.134141597	2.304382707	0.055229016	0.801115152	0	13.32768098	0	0	0.034536006	0	0.262615931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2487
H5427_081_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	2263.507936	11.26746207	817.1908741	2238.436296	306.0624089	8.95532215	16.19410076	236.9350149	315.1053907	116.5443144	32.11651098	27.87470764	1.30471762	63.62705005	8348.487202	5014.888852	1304.115414	44.10452036	557.2098724	0	98.80277968	0.052873881	6.923673326	488.622593	619.2574608	371.5544765	143.6836569	0.645701285	14499.67436	0											3400	$150 days 1-7	$150 days 1-7	$95 days 9-100	0	100	0-20%	0.2	50	200	0	025-150; see grid75-150 (NUC);20% (other)	200	0.2	200	0	25	25	20-40	25	25	0.2	25	0	$0: $0- $75	0	10	0	0	0	0												113	79	43	0	100	0.184	0.2	49.48849105	65.28846154	0	23.75471698	200	0.2	64.52380952	0	24.78554419	25	22	25	0	0.2	0	0	1	0	10	0	0	0	0											NO	90.33088384	63.15167986	34.37369916	0	79.93883526	0.147087457	0.159877671	39.56052333	52.19083571	0	18.98924407	159.8776705	0.159877671	51.5795818	0	19.81327534	19.98470881	17.58654376	19.98470881	0	0.159877671	0	0	0.799388353	0	7.993883526	0	0	0	0												17.0387	0.059296596	2.340822772	0	2.03885604	1.317215561	2.589075106	0.781106099	1.370467807	0	0.050822355	0.37137861	0.208595214	0.273488053	0	8.280114468	2.171863901	0.064637173	0.927973087	0	15.79635826	0	0	0.032549934	0	0.247513601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9609		14.04373699	17.0387	0.059296596	2.340822772	0	2.03885604	1.317215561	2.589075106	0.781106099	1.370467807	0	0.050822355	0.37137861	0.208595214	0.273488053	0	8.280114468	2.171863901	0.064637173	0.927973087	0	15.79635826	0	0	0.032549934	0	0.247513601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9609	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			17.0387	0.059296596	2.340822772	0	2.03885604	1.317215561	2.589075106	0.781106099	1.370467807	0	0.050822355	0.37137861	0.208595214	0.273488053	0	8.280114468	2.171863901	0.064637173	0.927973087	0	15.79635826	0	0	0.032549934	0	0.247513601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9609
H5427_082_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	1042.092816	3.402752053	356.1274648	540.1683987	134.5503839	4.61739651	4.593615251	167.7216625	220.7008456	147.1855121	29.64638225	9.607623876	0	24.430815	7347.205226	3781.710822	910.2675839	35.25744977	420.1900913	0	79.34365466	0.40115011	3.461836663	488.622593	1026.565297	615.9391784	140.909907	0.877502503	14499.67436	0											3400	$225 days 1-8	$225 days 1-8	$95 days 9-100	0	100	0.2	0.2	50	200	0	025-200; see grid75-200(NUC); 20%(other)	200	0.2	200	0	30	30	25-50	30	30	0.2	30	0	$0: $0- $75	0	10	0	0	0	0												177	126	43	0	100	0.2	0.199195011	49.21440262	67.53731343	0	27.59259259	200	0	135.6179775	0	29.64966683	30	28	30	0	0.2	0	0	1	0	10	0	0	0	0											NO	154.1961886	109.7667783	37.46009101	0	87.11649072	0.174232981	0.173531703	42.87386049	58.83613739	0	24.03769837	174.2329814	0	118.1456228	0	25.82974926	26.13494722	24.3926174	26.13494722	0	0.174232981	0	0	0.871164907	0	8.711649072	0	0	0	0												13.3906	0.031125761	1.111713937	0	0.976796439	0.80450276	0.797137879	0.599239597	1.082098773	0	0.0593859	0.139497079	0	0.240532821	0	8.140053524	1.982482938	0.071668457	0.915137155	0	13.82428151	0	0	0.035472571	0	0.447153831	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6488		6.60304121	13.3906	0.031125761	1.111713937	0	0.976796439	0.80450276	0.797137879	0.599239597	1.082098773	0	0.0593859	0.139497079	0	0.240532821	0	8.140053524	1.982482938	0.071668457	0.915137155	0	13.82428151	0	0	0.035472571	0	0.447153831	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6488	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			13.3906	0.031125761	1.111713937	0	0.976796439	0.80450276	0.797137879	0.599239597	1.082098773	0	0.0593859	0.139497079	0	0.240532821	0	8.140053524	1.982482938	0.071668457	0.915137155	0	13.82428151	0	0	0.035472571	0	0.447153831	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6488
H5427_083_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	1158.690614	3.783479556	395.9738944	600.6068209	149.6049723	5.224828235	5.197918485	186.4877227	245.3946465	150.9018677	32.96345998	10.68260277	0	27.16433276	7843.081114	4181.070917	910.2675839	39.20233925	464.5634352	0	89.61815818	0.453922555	6.923673326	488.622593	1026.728934	616.0373605	143.593551	0.975684602	14499.67436	0											3400	$225 days 1-8	$225 days 1-8	$95 days 9-100	0	100	0-20%	0.2	50	200	0	025-200; see grid75-200(NUC); 20%(other)	200	0.2	200	0	30	30	25-50	30	30	0.2	30	0	$0: $0- $75	0	10	0	0	0	0												177	126	43	0	100	0.184	0.19927551	49.21440262	67.53731343	0	27.59259259	200	0	135.6179775	0	29.68193172	30	28	30	0	0.2	0	0	1	0	10	0	0	0	0											NO	150.2781201	106.9776448	36.50824386	0	84.9028927	0.156221323	0.169190672	41.78445145	57.34113276	0	23.42690928	169.8057854	0	115.1435859	0	25.20081864	25.47086781	23.77280996	25.47086781	0	0.169805785	0	0	0.849028927	0	8.49028927	0	0	0	0												14.5105	0.033728978	1.204692625	0	1.058491242	0.816229577	0.879439324	0.649357266	1.172600584	0	0.064352666	0.151163979	0	0.26064989	0	8.780534159	1.932108775	0.07766248	0.986069487	0	15.21768174	0	0	0.034571226	0	0.435861283	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2657		8.582418869	14.5105	0.033728978	1.204692625	0	1.058491242	0.816229577	0.879439324	0.649357266	1.172600584	0	0.064352666	0.151163979	0	0.26064989	0	8.780534159	1.932108775	0.07766248	0.986069487	0	15.21768174	0	0	0.034571226	0	0.435861283	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2657	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			14.5105	0.033728978	1.204692625	0	1.058491242	0.816229577	0.879439324	0.649357266	1.172600584	0	0.064352666	0.151163979	0	0.26064989	0	8.780534159	1.932108775	0.07766248	0.986069487	0	15.21768174	0	0	0.034571226	0	0.435861283	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2657
H5427_084_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	953.8153398	9.253098274	574.329561	490.0846403	137.3214531	2.244555273	4.066052424	161.9570984	186.6624185	120.4539874	34.67413347	8.090631144	0.050827634	27.45035567	6055.152034	2788.892798	327.4744814	15.92770858	309.8769775	0	40.67769449	0.11379117	679.8715522	581.1952635	2191.543785	0.615791269	145.0648695	0.307895635	13361.34307	0											3400	$225 days 1-8	$225 days 1-8	$95 days 9-100	15	100	0.2	0.2	50	200	0	025-200; see grid75-200(NUC); 20%(other)	200	0.2	200	0	30	30	$25-50	30	30	0.2	30	0	$0: $0- $75	0	10	0	0	0	0												177.04	126.47	43.14	15	100	0.2	0.199562144	48.53702052	69.85294118	0	60.94672434	200	0.2	110.1578947	0	29.52108024	30	27.82	30	0	0.2	0	0	1.23	0	10	0	0	0	0											NO	162.867695	116.3458958	39.68658136	13.79922857	91.99485711	0.183989714	0.18358691	44.65156267	64.26111343	0	56.06785197	183.9897142	0.183989714	101.3395979	0	27.15787559	27.59845713	25.59296925	27.59845713	0	0.183989714	0	0	1.131536743	0	9.199485711	0	0	0	0												12.9455	0.089713334	1.899431404	0.563565831	1.052738955	0.412975083	0.746473999	0.602636461	0.999594571	0	0.162008682	0.124049409	0.009351762	0.231817334	0	6.311700303	0.753149203	0.03396978	0.712677207	0	7.484277385	0	0	0.05480365	0	0.00047208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1909		3.062215073	12.9455	0.089713334	1.899431404	0.563565831	1.052738955	0.412975083	0.746473999	0.602636461	0.999594571	0	0.162008682	0.124049409	0.009351762	0.231817334	0	6.311700303	0.753149203	0.03396978	0.712677207	0	7.484277385	0	0	0.05480365	0	0.00047208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1909	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			12.9455	0.089713334	1.899431404	0.563565831	1.052738955	0.412975083	0.746473999	0.602636461	0.999594571	0	0.162008682	0.124049409	0.009351762	0.231817334	0	6.311700303	0.753149203	0.03396978	0.712677207	0	7.484277385	0	0	0.05480365	0	0.00047208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1909
H5427_086_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	1490.091207	12.46018225	757.7612367	921.2918473	223.4143215	4.052602932	7.315696841	182.7054896	202.5724942	152.8000098	34.05772233	14.19071764	0	40.44354526	6834.040692	3014.590341	1063.736942	39.11139383	334.9544823	0	49.23756022	0.063476927	3.477172035	490.7871114	947.0308118	1.13408285	146.5337769	0.378027617	14563.90556	0											3400	$295 days 1-6	$295 days 1-6	$95 days 9-100	15	100	0.2	0.2	50	200	0	025-20075-200; 20%	200	0.2	200	5	35	35	25-50	35	35	0.2	35	0	$0: $0- $75	0	10	0	0	0	0												208.27	142.3	43.14	15	100	0.2	0.199993739	48.75728155	64.9737303	0	47.36294623	200	0	79.56140351	4.55473627	34.49054554	35	27.82	35	0	0.2	0	0	1.23	0	10	0	0	0	0											NO	170.2103592	116.2958377	35.25651747	12.25887256	81.72581705	0.163451634	0.163446517	39.84728672	53.10031195	0	38.70775478	163.4516341	0	65.02220707	3.722395431	28.18768014	28.60403597	22.7361223	28.60403597	0	0.163451634	0	0	1.00522755	0	8.172581705	0	0	0	0												21.1357	0.120755611	2.22633519	0.941166612	1.52155983	0.662404572	1.195725168	0.606693169	0.896388553	0	0.109858164	0.193291332	0	0.219144048	2.11991682	7.081192358	2.535597478	0.074103453	0.798420838	0	8.047959677	0	0	0.041112727	0	0.000772365	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5281		11.29827259	21.1357	0.120755611	2.22633519	0.941166612	1.52155983	0.662404572	1.195725168	0.606693169	0.896388553	0	0.109858164	0.193291332	0	0.219144048	2.11991682	7.081192358	2.535597478	0.074103453	0.798420838	0	8.047959677	0	0	0.041112727	0	0.000772365	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5281	NO	1a1: $208.27	1b1: $142.3	21: $43.14	6: $15	10a: $100	11a: 20%	"11b: 20%,11c: 2%"	"4a1: $50,4a2: $500,4b: $10"	"9a1: $200,9b: $50"		"8b2: $30.49,8b3: $89.36,8b4: 20%,8b5: $31.37,8b6: $30.49"	"5: $195,9a2: $200"	12: 20%	"3: $50,9a3: $200,9c: $35,9d1: $35"		"7b1: $35,7d1: $35,7f1: $35,7g: $35"	"7e: $35,7h: $35"	"7c: $27.82,7i: $27.82"	7d2: $35		"151: 20%,152: 20%,153: 20%"																					1.1124	0.0064	0.1172	0.0495	0.0801	0.0349	0.0629	0.0319	0.0472	0	0.0055	0.0102	0	0.0115	0	0.3918	0	0.0039	0.0392	0	0.4151	0	0	0	0	0	0	0	0	0											2.4196			22.2482	0.127111169	2.343510727	0.990701697	1.601641927	0.69726797	1.258658072	0.638624388	0.943566898	0	0.115370544	0.20346456	0	0.230677945	2.11991682	7.472971796	2.535597478	0.078003635	0.837598782	0	8.463022168	0	0	0.041112727	0	0.000772365	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9477
H5428_001_0	2011	4																															A	A	D		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		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	290.56759	29.056759	1466.948239	0	23.09577927	23.8412952	7.881168419	16.55330903	48.54468971	26.78162895	36.50012607	0.047795887	0.589482612	62.91531988	73.57475749	134.2305252	19.04652181	2.41114404	20.90675529	3.113122685	16.26821143	1.877029854	0	4793.903352	0	0	0	0	0	0											3400	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 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): 1 / 2 years at $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"											0	846.9966175	846.9966175	63.99880866	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	4.094544742	0	0	0	0	0	0											NO	677.918395	677.918395	51.22330922	0	0.186488332	0.186488332	0.186488332	0.186488332	0.186488332	0.186488332	0.186488332	0.186488332	0.186488332	0.186488332	0.186488332	0.186488332	0.186488332	0.186488332	0.186488332	0.186488332	0.186488332	0.186488332	0	3.277188058	0	0	0	0	0	0												16.4151	1.641509286	6.261828603	0	4.307093341	4.446123364	1.469745949	3.086998983	9.05301819	4.994461299	6.806847612	0.008913375	0.109931629	11.73297303	13.72083377	25.03242669	3.551954074	0.449650229	3.898865912	0.580561055	3.033831607	0.350044166	0	1.309210235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.2619	0	30.493091	16.4151	1.641509286	6.261828603	0	4.307093341	4.446123364	1.469745949	3.086998983	9.05301819	4.994461299	6.806847612	0.008913375	0.109931629	11.73297303	13.72083377	25.03242669	3.551954074	0.449650229	3.898865912	0.580561055	3.033831607	0.350044166	0	1.309210235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.2619	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.4151	1.641509286	6.261828603	0	4.307093341	4.446123364	1.469745949	3.086998983	9.05301819	4.994461299	6.806847612	0.008913375	0.109931629	11.73297303	13.72083377	25.03242669	3.551954074	0.449650229	3.898865912	0.580561055	3.033831607	0.350044166	0	1.309210235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.2619
H5429_001_0	2011	10																															D	D	D		T	Coin	Coin	V	Coin		P		Coin	Coin	V	V	V	V	P	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	0	0	0	0	0	0	0	0											0	NO	283.0302764	25.21882116	382.1944576	0	17.85370687	2.378809324	1.114383996	117.6804702	17.67609504	0	162.636094	0	0.031937262	4.144019401	2833.579338	3490.500733	343.9178376	286.3185988	136.8523645	1.714780087	23.5672237	2.84084688	0	3124.17332	0	31.77142857	26.65251753	0	0	0												$268/Days 1-6 for IP Medical; $268/Days 1-6 for IP Surgical; PBP 1a	$299/Days 1-6 for IP Psych; $299/Days 1-6 for IP Substance Abuse; PBP 1b	"$50 days 1-20, $128 days 21-100 for SNF; PBP 2"	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; 10% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-50/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $150/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$5/Visit for PCP Office Visits; $5/Visit for PCP Consults; PBP 7a, 14b-c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; $25/Visit for Cardio; $25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit or 25% for Occ Therapy; $25/Visit or 25% for PT/ST; PBP 7c, 7i"	"$0-50/Service for Prof Radiology (Office); PBP 7d, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $5-25/Visit for Allergy Testing; $5-25/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $5-25/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride; $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	268	299	85	0	125	0.2	0.2	47.62664757	0.25	0	50	0	0.2	0.196689429	5	24.27342487	25	25.05476797	50	0.249153129	0.173361313	0.200037394	0	4	0	50	10	0	0	0											NO	200.1009268	223.2469296	63.4648462	0	125	0.2	0.2	47.62664757	0.25	0	50	0	0.2	0.196689429	5	24.27342487	25	25.05476797	50	0.249153129	0.173361313	0.200037394	0	4	0	50	10	0	0	0												4.7196	0.469168699	2.021326039	0	0.185976113	0.475761865	0.222876799	0.467060523	4.419023761	0	0.677650392	0	0.006387452	0.815084808	1.180658057	7.060533943	0.716495495	0.597803838	0.570218185	0.427242824	4.085644848	0.568275607	0	1.041391107	0	0.132380952	0.022210431	0	0	0	0	0	0	0	0	0	0	0	0	0	30.8827	0	2.446542751	4.7196	0.469168699	2.021326039	0	0.185976113	0.475761865	0.222876799	0.467060523	4.419023761	0	0.677650392	0	0.006387452	0.815084808	1.180658057	7.060533943	0.716495495	0.597803838	0.570218185	0.427242824	4.085644848	0.568275607	0	1.041391107	0	0.132380952	0.022210431	0	0	0	0	0	0	0	0	0	0	0	0	0	30.8827	YES	$268/Days Custom for IP Medical; $268/Days Custom for IP Surgical; PBP 1a	$299/Days Custom for IP Psych; $299/Days Custom for IP Substance Abuse; PBP 1b	"$50 days 1-20, $128 days 21-100 for SNF; PBP 2"	30% Coinsurance for Home Health; PBP 6	$125/Run for Ambulance; PBP 10a	25% Coinsurance for DME; PBP 11a	"25% Coinsurance for DME / Medical Supplies; 30% Coinsurance for Diabetes Monitoring Supplies; 25% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; 10% Coinsurance for ASC; PBP 9a, 9b"	30% Coinsurance for OP Fac - Pathology; PBP 8a	30% Coinsurance for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	30% Coinsurance for Renal Dialysis - Fac; PBP 12	"25% Coinsurance for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 30% Coinsurance for OP Fac - Other; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$25/Visit for PCP Office Visits; $25/Consult for PCP Consults; PBP 7a, 14b-c"	"$40/Visit for Speclst Office Visits; $40/Consult for Speclst Consults; 25% Coinsurance for Cardio; $40/Visit for Chiropractor; 30% Coinsurance for Vision Exams; 30% Coinsurance for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit or 25% for Occ Therapy; $25/Visit or 25% for PT/ST; PBP 7c, 7i"	"30% Coinsurance for Prof Radiology (IP); 30% Coinsurance for Prof Radiology (OP); 30% Coinsurance for Prof Radiology (OP); 30% Coinsurance for Prof Radiology (Office); 30% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"30% Coinsurance for Prof - Primary Surgeon (IP); 30% Coinsurance for Prof - Asst Surgeon (IP); 30% Coinsurance for Prof - Anesthesia (IP); 30% Coinsurance for Prof - Primary Surgeon (OP); 30% Coinsurance for Prof - PCP Asst Surgeon (OP); 30% Coinsurance for Prof - Speclst Asst Surgeon (OP); 30% Coinsurance for Prof - Anesthesia (OP); 30% Coinsurance for Prof - IP Visits; $25-$40/Visit for Allergy Testing; $25-$40/Visit for Allergy Tx; 30% Coinsurance for Prof Path (IP); 30% Coinsurance for Prof Path (OP); 30% Coinsurance for Prof Path (Office); 30% Coinsurance for PCP Immunizations; 30% Coinsurance for Speclst Immunizations; 30% Coinsurance for Diabetes Screening Tests; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $25-40/Visit for Tx Injections	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											6700	17.5232	1.0758	0.9251	1.0608	1.352	2.0921	0.3006	0.7677	9.3651	0.8343	2.2728	0	0.008	1.7841	3.9336	9.88	0.3294	1.0697	5.318	14.3519	4.4753	1.285	0	0	0	0	0	0	0	0											80.0047	0	6.601410252	22.2428	1.544931389	2.946431832	1.060823179	1.537944748	2.567862373	0.523433519	1.234802694	13.78416713	0.834322776	2.950472636	0	0.014413067	2.599209813	5.114279186	16.94057798	1.045863968	1.66747498	5.888259511	14.77913976	8.560953173	1.853295375	0	1.041391107	0	0.132380952	0.022210431	0	0	0	0	0	0	0	0	0	0	0	0	0	110.8874
H5429_053_0	2011	9																															D	D	D		T	Coin	Coin	V	Coin		P		Coin	Coin	V	V	V	V	P	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	0	0	0	0	0	0	0	0											0	NO	330.9953055	6.857914832	496.8762304	0	96.73014717	4.121164602	2.581701978	128.5543659	21.83140374	0	82.77242002	0	0.129594387	9.487762206	2058.55312	2477.38911	121.4236798	210.403243	58.15233197	7.524218576	17.99552193	4.618612314	0	2414.869043	0	31.77142857	135.200586	0	0	0												$268/Days 1-6 for IP Medical; $268/Days 1-6 for IP Surgical; PBP 1a	$299/Days 1-6 for IP Psych; $299/Days 1-6 for IP Substance Abuse; PBP 1b	"$50 days 1-20, $128 days 21-100 for SNF; PBP 2"	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; 10% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-50/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $150/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$5/Visit for PCP Office Visits; $5/Visit for PCP Consults; PBP 7a, 14b-c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; $25/Visit for Cardio; $25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit or 25% for Occ Therapy; $25/Visit or 25% for PT/ST; PBP 7c, 7i"	"$0-50/Service for Prof Radiology (Office); PBP 7d, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $5-25/Visit for Allergy Testing; $5-25/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $5-25/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride; $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	268	299	85	0	125	0.2	0.2	46.88797938	0.25	0	50	0	0.2	0.16712774	5	24.06317089	25	25.39786813	50	0.253208227	0.063523794	0.200120896	0	4	0	50	10	0	0	0											NO	249.3413318	278.1830531	79.08213883	0	116.297263	0.186075621	0.186075621	43.62354935	0.232594526	0	46.51890519	0	0.186075621	0.15549199	4.669158063	22.38784731	23.2594526	23.62962039	46.51890519	0.23557939	0.059101147	0.190300017	0	4	0	50	10	0	0	0												6.8776	0.15897964	3.274502919	0	0.93745428	0.766848262	0.480391798	0.467333144	5.077865004	0	0.32087353	0	0.024114356	1.475271027	0.800975825	4.62195076	0.235354027	0.414312397	0.225431901	1.772550824	1.063555992	0.878922003	0	0.804956348	0	0.132380952	0.112667155	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9243	0	2.211948831	6.8776	0.15897964	3.274502919	0	0.93745428	0.766848262	0.480391798	0.467333144	5.077865004	0	0.32087353	0	0.024114356	1.475271027	0.800975825	4.62195076	0.235354027	0.414312397	0.225431901	1.772550824	1.063555992	0.878922003	0	0.804956348	0	0.132380952	0.112667155	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9243	YES	$268/Days Custom for IP Medical; $268/Days Custom for IP Surgical; PBP 1a	$299/Days Custom for IP Psych; $299/Days Custom for IP Substance Abuse; PBP 1b	"$50 days 1-20, $128 days 21-100 for SNF; PBP 2"	30% Coinsurance for Home Health; PBP 6	$125/Run for Ambulance; PBP 10a	25% Coinsurance for DME; PBP 11a	"25% Coinsurance for DME / Medical Supplies; 30% Coinsurance for Diabetes Monitoring Supplies; 25% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; 10% Coinsurance for ASC; PBP 9a, 9b"	30% Coinsurance for OP Fac - Pathology; PBP 8a	30% Coinsurance for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	30% Coinsurance for Renal Dialysis - Fac; PBP 12	"25% Coinsurance for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 30% Coinsurance for OP Fac - Other; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$25/Visit for PCP Office Visits; $25/Consult for PCP Consults; PBP 7a, 14b-c"	"$40/Visit for Speclst Office Visits; $40/Consult for Speclst Consults; 25% Coinsurance for Cardio; $40/Visit for Chiropractor; 30% Coinsurance for Vision Exams; 30% Coinsurance for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit or 25% for Occ Therapy; $25/Visit or 25% for PT/ST; PBP 7c, 7i"	"30% Coinsurance for Prof Radiology (IP); 30% Coinsurance for Prof Radiology (OP); 30% Coinsurance for Prof Radiology (OP); 30% Coinsurance for Prof Radiology (Office); 30% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"30% Coinsurance for Prof - Primary Surgeon (IP); 30% Coinsurance for Prof - Asst Surgeon (IP); 30% Coinsurance for Prof - Anesthesia (IP); 30% Coinsurance for Prof - Primary Surgeon (OP); 30% Coinsurance for Prof - PCP Asst Surgeon (OP); 30% Coinsurance for Prof - Speclst Asst Surgeon (OP); 30% Coinsurance for Prof - Anesthesia (OP); 30% Coinsurance for Prof - IP Visits; $25-$40/Visit for Allergy Testing; $25-$40/Visit for Allergy Tx; 30% Coinsurance for Prof Path (IP); 30% Coinsurance for Prof Path (OP); 30% Coinsurance for Prof Path (Office); 30% Coinsurance for PCP Immunizations; 30% Coinsurance for Speclst Immunizations; 30% Coinsurance for Diabetes Screening Tests; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $25-40/Visit for Tx Injections	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											6700	9.2789	0.2053	3.6307	4.9381	1.3855	1.4055	0.7056	0.5528	10.7616	0.6063	2.4308	0	0.0313	1.761	3.9354	8.6984	0.2322	0.7004	4.9396	15.246	1.7563	1.0641	0	0	0	0	0	0	0	0											74.2657	0	5.557441673	16.1565	0.364274089	6.905153143	4.938100868	2.322944847	2.172344583	1.185990593	1.020134166	15.83943482	0.606255262	2.751705587	0	0.05544662	3.236293086	4.73634083	13.32033271	0.467564374	1.114745464	5.165012764	17.01853172	2.819869626	1.943012562	0	0.804956348	0	0.132380952	0.112667155	0	0	0	0	0	0	0	0	0	0	0	0	0	105.19
H5430_001_0	2011	6																															COIN	COIN	COIN	COIN	COIN	COIN	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	352.5742626	12.36830871	44.99943059	8.979349402	17.42243267	14.40783147	5.340625489	38.36034977	0.023009721	0.794328315	1.674394419	0	0	88.64328308	18.51623396	42.38652065	1.011921839	0	0.507890665	204.9326662	36.46836034	0	1.826666667	12	4.999899776	1.10493577	0.046718786	3.27365385	0	7.65											1	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS (excluding Physical Exams which are 0% cost sharing)	FFS	FFS	FFS	FFS	FFS	FFS	FFS	$0 copay for 10 one way trips	"$1,250 max (preventative - 1 exam/cleaning per six months and 1 flouride treatment per year)"	$0 copay	$350 max	$0 copay	"$1,000 max"		$100 per annual visit; OTC benefit - $65 per quarter.												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	0.216482411	0.233	0.233	0	0.233	0.233	0.233	0	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	0.216482411	0.233	0.233	0	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												27.8325	0.976366052	5.971804059	0	4.059426812	3.357024733	1.244365739	8.937961497	0.005361265	0.185078498	0.3901339	0	0	20.65388496	4.008438968	9.876059312	0.235777789	0	0.118338525	47.74931123	8.497127958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.099		0	27.8325	0.976366052	5.971804059	0	4.059426812	3.357024733	1.244365739	8.937961497	0.005361265	0.185078498	0.3901339	0	0	20.65388496	4.008438968	9.876059312	0.235777789	0	0.118338525	47.74931123	8.497127958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.099	NO																																																																																		0			27.8325	0.976366052	5.971804059	0	4.059426812	3.357024733	1.244365739	8.937961497	0.005361265	0.185078498	0.3901339	0	0	20.65388496	4.008438968	9.876059312	0.235777789	0	0.118338525	47.74931123	8.497127958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.099
H5431_001_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	O	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	0	0	0	0	0	0	0	0	0	0	YES	2030.030349	42.06920434	326.7058961	9.170271361	646.3997919	3.53384895	3.041491569	261.55044	199.239894	5475.657056	12.692889	18.077751	0	107.312607	6332.617994	9857.400505	342.1864649	647.5590514	3399.922739	0	17.8318109	0.368133016	189.9156911	1108.49435	772.7093618	21.940017	27.37769237	6.268886683	14619.76653	0	0	0	0	0	0	0	0	0	0	0	3400	$0 	1b1: $200 days 1-5	$0 	$0 	10a: $25	$0 	$0 	"4a1: $50,4a2: $50"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 Cost Share & $200 allowance	$0 	$0 Cost Share & $700 allowance every 2 years	$0 	$0 	0	0	0	0	0	0	0	0	0	0	0	0	86.0089272	0	0	25	0	0	48.45588235	0	0	0	0	0	0	0	0	0	0	0	0	0.199780814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	86.0089272	0	0	25	0	0	48.45588235	0	0	0	0	0	0	0	0	0	0	0	0	0.199780814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0.301527261	0	0	1.346666233	0	0	1.056138113	0	0	0	0	0	0	0	0	0	0	0	0	3.562453703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.2668	0	0	0	0.301527261	0	0	1.346666233	0	0	1.056138113	0	0	0	0	0	0	0	0	0	0	0	0	3.562453703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.2668	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.301527261	0	0	1.346666233	0	0	1.056138113	0	0	0	0	0	0	0	0	0	0	0	0	3.562453703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.2668
H5431_002_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	O	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	0	0	0	0	0	0	0	0	0	0	YES	1763.251357	42.84821629	356.0225643	9.513034806	623.1844472	4.781922141	2.930558765	385.6163168	231.2253831	5577.080367	15.37773439	34.81554768	0	98.26444802	7107.862596	15328.62349	282.2664479	882.1964455	4363.893465	0	18.82163165	3.441923837	208.7813528	1129.020774	808.5405307	19.14588221	26.13556192	6.384970114	15398.83849	0	0	0	0	0	0	0	0	0	0	0	3400	$0 	"1b1: $75, days 1-5"	"21: $25, days 7-25"	$0 	10a: $25	$0 	$0 	"4a1: $25,4a2: $25,4b: $25"	"9a1: $50,9b: $50"	$0 	$0 	$0 	$0 	$0 	$0 	17a1: $10	$0 	$0 	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	17a2: $10	$0 Cost Share & $200 allowance	$0 	$0 Cost Share & $700 allowance every 2 years	$0 	$0 	0	0	0	0	0	0	0	0	0	0	0	0	32.2533477	13.65946557	0	25	0	0	25	50	0	0	0	0	0	0	0.533314285	0	0	0	0	0.199758337	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	32.2533477	13.65946557	0	25	0	0	25	50	0	0	0	0	0	0	0.533314285	0	0	0	0	0.199758337	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0.115166535	0.405256497	0	1.298300932	0	0	0.803367327	0.963439096	0	0	0	0	0	0	0.681247823	0	0	0	0	3.759777843	0	0	0	0.673783776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.7003	0	0	0	0.115166535	0.405256497	0	1.298300932	0	0	0.803367327	0.963439096	0	0	0	0	0	0	0.681247823	0	0	0	0	3.759777843	0	0	0	0.673783776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.7003	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.115166535	0.405256497	0	1.298300932	0	0	0.803367327	0.963439096	0	0	0	0	0	0	0.681247823	0	0	0	0	3.759777843	0	0	0	0.673783776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.7003
H5431_005_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	O	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	0	0	0	0	0	0	0	0	0	0	YES	1470.93113	43.11767234	237.2851843	9.633058696	452.9570157	3.580713469	2.337523411	192.5102384	149.4716957	5609.267093	9.014829897	13.0860434	0	80.26106618	7247.215729	17294.61271	338.0695674	486.2938132	2468.018644	0	16.84093796	0	139.5488196	1136.120754	761.8038509	21.57153217	26.41941735	6.42512275	11053.2435	0	0	0	0	0	0	0	0	0	0	0	3400	"1a1: $50, days 1-5"	"1b1: $200, days 1-5"	$0 	$0 	10a: $25	$0 	$0 	"4a1: $50,4a2: $50,4b: $25"	9a1: $100	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 20.0%,153: 20.0%"	$0 	$0 	$0 	$0 	$0 Cost Share & $200 allowance	$0 	$0 Cost Share & $700 allowance every 2 years	$0 	$0 	0	0	0	0	0	0	0	0	0	0	0	32.42207341	86.0089272	0	0	25	0	0	49.20694864	28.21011673	0	0	0	0	0	0	0	0	0	0	0	0.199820162	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	32.42207341	86.0089272	0	0	25	0	0	49.20694864	28.21011673	0	0	0	0	0	0	0	0	0	0	0	0.199820162	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		3.9742	0.309042062	0	0	0.943660449	0	0	0.789403451	0.351384499	0	0	0	0	0	0	0	0	0	0	0	3.365158952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.7329	0	0	3.9742	0.309042062	0	0	0.943660449	0	0	0.789403451	0.351384499	0	0	0	0	0	0	0	0	0	0	0	3.365158952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.7329	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.9742	0.309042062	0	0	0.943660449	0	0	0.789403451	0.351384499	0	0	0	0	0	0	0	0	0	0	0	3.365158952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.7329
H5431_006_0	2011	6																															D	D	D	Coin	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	O	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	0	0	0	0	0	0	0	0	0	0	YES	2279.877111	43.50951074	367.7813661	9.808938016	702.0630071	3.847862239	3.655981253	298.3822134	231.6744074	5663.387855	13.97258099	20.28277885	0	124.4010436	7792.109622	22951.70782	344.5408597	753.7335443	3821.249748	0	20.04755803	0	216.2943956	1146.445424	798.8242541	22.547292	29.15462864	6.48351203	17132.03041	0	0	0	0	0	0	0	0	0	0	0	3400	$0 	"1b1: $200, days 1-5"	$0 	$0 	$0 	$0 	$0 	"4a1: $50,4a2: $50"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"152: 10.0%,153: 10.0%"	$0 	$0 	$0 	$0 	$0 Cost Share & $200 allowance	$0 	$0 Cost Share & $700 allowance every 2 years	$0 	$0 	0	0	0	0	0	0	0	0	0	0	0	0	86.0089272	0	0	0	0	0	48.41389728	0	0	0	0	0	0	0	0	0	0	0	0	0.099881858	0	0	0	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	48.41389728	0	0	0	0	0	0	0	0	0	0	0	0	0.099881858	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0.311850528	0	0	0	0	0	1.203820486	0	0	0	0	0	0	0	0	0	0	0	0	2.002387344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.5181	0	0	0	0.311850528	0	0	0	0	0	1.203820486	0	0	0	0	0	0	0	0	0	0	0	0	2.002387344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.5181	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.311850528	0	0	0	0	0	1.203820486	0	0	0	0	0	0	0	0	0	0	0	0	2.002387344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.5181
H5433_001_0	2011	4																															Coin		Coin		Coin	Coin		Coin	Coin					Coin	Coin		Coin																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	272.6013206	0	32.60594064	0	14.61055966	6.270379802	0	20.49862373	15.75110631	0	0	0	0	28.25027005	382.3745183	0	4.98055364	0	0	0	0	0	0	0	0	0	0	0	0	0											6700	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing	33% of Standard Medicare Cost Sharing											0	0.021432503	0	0.051160685	0	0.076635644	0.076635644	0	0.076635644	0.076635644	0	0	0	0	0.076635644	0.076635644	0	0.076635644	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0.021279629	0	0.04404613	0	0.070638454	0.070638454	0	0.070638454	0.070638454	0	0	0	0	0.070638454	0.070638454	0	0.070638454	0	0	0	0	0	0	0	0	0	0	0	0	0												5.8009	0	1.43616551	0	1.032067349	0.442929936	0	1.447991092	1.1126338	0	0	0	0	1.995555405	27.01034487	0	0.35181861	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6304	0	3.108737763	5.8009	0	1.43616551	0	1.032067349	0.442929936	0	1.447991092	1.1126338	0	0	0	0	1.995555405	27.01034487	0	0.35181861	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6304	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.8009	0	1.43616551	0	1.032067349	0.442929936	0	1.447991092	1.1126338	0	0	0	0	1.995555405	27.01034487	0	0.35181861	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6304
H5434_002_0	2011	10	g.2.	h.6.	h.7.	h.8.	h.9.	f.2.	i.7.	i.8.	i.9.	e.3.	OP Facility - Surgery	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Emergency	Professional	Professional	Professional	DME/Prosthetics/Supplies	ASC	AIXIDTF	IDTF	MH/SA	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine	DME Scooter	D	D	D		T	O		V	V	V	V		V	V	V	V	V	V			Coin									O	V	V	V	V	V	V	V	O	O	Coin																																									0	YES	1042.664892	31.58182906	489.5183504	601.1372678	22.68694682	810.9334208	64.26302558	161.0371036	175.4990248	68.56055295	20.48821189	0	13.4922371	586.8623425	5261.194182	13210.14701	215.2761386	1639.347868	0	0	49.04786034	0	0	0	0	0	0	0	0	194.7093071	222.1721709	10.1941347	653.4240455	1.199309964	136.6213934	59.54459994	591.3597548	99.64266952	0	0.561972366	6700	225 Copay for 7 days (#1A)	225 Copay for 7 days (#1B)	50 Copay for days 7 to 25 (#2)	0 Copay (#6)	150 Copay (#10A)	0 Copay (#11A)	0 Copay (#11A)	50 Copay (#4A)	150 Copay (#9A)	15 Copay (#8A)	50 Copay (#9A)		25 Copay (#9A)	"150 Copay (#8B,#9A)"	15 Copay PCP/0 Copay Immunizations (#7A)	50 Copay (multiple)/40 Spec Chiro	40 Copay (#7H)	50 Copay (#7I)			0.2 Coins (#15)									(multiple)	50 Copay (#9B)	100 Copay (#8B)	75 Copay (#8B)	40 Copay (#7E)	50 Copay (#3)	25 Copay (#4B)	100 Copay (#8B)	5 Copay (#7G)	5 Copay (#7G)	0.2 Coins (#11A)	0	153.7488194	161.6297468	23.15484805	0	135.4625551	0	0	47.27866093	140.9794714	5.973285195	21.2195122	0	11.62468645	79.12741556	11.39485675	28.89621429	32.27251517	32.63460714	0	0	0.176445427	0	0	0	0	0	0	0	0	46.15088257	48.46437591	95.14563107	48.88297151	16.66666667	47.40668463	21.0585321	41.58108068	4.934804413	0	0.158853479	NO	145.6457945	161.6297468	20.53427162	0	135.4625551	0	0	47.27866093	130.5891564	5.534688704	16.34146341	0	11.62468645	75.6655946	11.17882946	27.57309828	31.95520299	32.40966556	0	0	0.112925722	0	0	0	0	0	0	0	0	44.33142125	48.08149303	88.34951456	48.29011242	16.66666667	47.33358521	20.980475	37.76081997	4.934804413	0	0.143121494		12.655	0.425380253	0.837658564	0	0.256102649	0	0	0.634468218	1.909855799	0.031621776	0.027900614	0	0.013070252	3.700440674	4.901166043	30.35372348	0.573266059	4.427559678	0	0	5.538765059	0	0	0	0	0	0	0	0	0.719311693	0.890197474	0.075053904	2.629493385	0.001665708	0.538898364	0.104106166	1.860852437	0.040976424	0	0.080430325	73.2269	0	6.119233654	12.655	0.425380253	0.837658564	0	0.256102649	0	0	0.634468218	1.909855799	0.031621776	0.027900614	0	0.013070252	3.700440674	4.901166043	30.35372348	0.573266059	4.427559678	0	0	5.538765059	0	0	0	0	0	0	0	0	0.719311693	0.890197474	0.075053904	2.629493385	0.001665708	0.538898364	0.104106166	1.860852437	0.040976424	0	0.080430325	73.2269	YES	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded	0 Copay	150 Copay	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded	50 Copay	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded		25 Copay	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded			0.3 Coins 1000 Ded									(multiple)	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded	0.3 Coins 1000 Ded	10000	11.7621	0.476	0.9174	0	1.7777	2.6818	0.3937	0.2468	3.1651	0.0707	0.0839	0	0.0036	1.4966	5.3197	12.7083	0.7881	2.0578	0	0	0.7773	0	0	0	0	0	0	0	0	0.0025	7.4064	0.1894	3.7113	0.0138	0.1479	0.0698	0.3917	0.0157	0	0	56.6751	1000	3.266091018	24.4171	0.901352194	1.755075102	0	2.033845067	2.681796118	0.393689591	0.881257007	5.075005409	0.102357246	0.111782616	0	0.016671968	5.19708686	10.22084819	43.06198732	1.361344999	6.485349744	0	0	6.316112384	0	0	0	0	0	0	0	0	0.721841098	8.296575116	0.264462768	6.340743611	0.015436064	0.686751336	0.173922752	2.252575866	0.056660307	0	0.080430325	129.9021
H5434_801_0	2011	11	g.2.	h.6.	h.7.	h.8.	h.9.	f.2.	i.7.	i.8.	i.9.	e.3.	OP Facility - Surgery	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Emergency	Professional	Professional	Professional	DME/Prosthetics/Supplies	ASC	AIXIDTF	IDTF	MH/SA	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine	DME Scooter	Coin		Coin		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin																			0		0		0	0		0	0					0						0	0	0																			0	YES	171.5097512		10.18976213		0.467482705	14.36469799		9.919582962	50.43474178					33.25398429						237.6816217	41.4405279	0																			3000	8.4% coinsurance		16.4% 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																				0.08387287		0.164077909		0.233	0.233		0.233	0.233					0.233						0.233	0.233	0.233																			YES	0.039608871		0.029621301		0.138426856	0.138426856		0.138426856	0.138426856					0.138426856						0.138426856	0.138426856	0.138426856																			3000	6.7933	0	0.301834008	0	0.064712161	1.988459974	0	1.373136678	6.981522716	0	0	0	0	4.60324448	0	0	0	0	0	32.90151951	5.736481969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7442	0	45.90383126	6.7933	0	0.301834008	0	0.064712161	1.988459974	0	1.373136678	6.981522716	0	0	0	0	4.60324448	0	0	0	0	0	32.90151951	5.736481969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7442	YES	8.4% coinsurance		16.4% 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																			3000	2.797		0.209		0.6904	0.8443		0.539	3.3306					2.018						6.58	1.2884	0																			18.2968	500	14.59802548	9.5903	0	0.510871367	0	0.755087871	2.832763084	0	1.912122175	10.3121299	0	0	0	0	6.621292532	0	0	0	0	0	39.48156319	7.024870827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.041
H5434_802_0	2011	8	g.2.	h.6.	h.7.	h.8.	h.9.	f.2.	i.7.	i.8.	i.9.	e.3.	OP Facility - Surgery	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Emergency	Professional	Professional	Professional	DME/Prosthetics/Supplies	ASC	AIXIDTF	IDTF	MH/SA	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine	DME Scooter	Coin		Coin		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin																			0		0		0	0		0	0					0						0	0	0																			0	YES	188.8442312		15.08937141		4.782503771	16.14277803		12.0490002	58.57883769					46.92096985						238.9891431	21.40720498	0																			1500	8.4% coinsurance		16.4% 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																				0.084097028		0.164115023		0.233	0.233		0.233	0.233					0.233						0.233	0.233	0.233																			YES	0.03971473		0.029628001		0.138426856	0.138426856		0.138426856	0.138426856					0.138426856						0.138426856	0.138426856	0.138426856																			1500	7.4999	0	0.447067912	0	0.662026959	2.234594003	0	1.667905211	8.108884303	0	0	0	0	6.495122316	0	0	0	0	0	33.08251559	2.963332072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.1613	0	45.90383126	7.4999	0	0.447067912	0	0.662026959	2.234594003	0	1.667905211	8.108884303	0	0	0	0	6.495122316	0	0	0	0	0	33.08251559	2.963332072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.1613	YES	8.4% coinsurance		16.4% 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																			1500	2.1282		0.0114		0.1621	0.8807		0.0584	2.9392					0.1927						6.7952	2.4257	0																			15.5935	100	14.59802548	9.6281	0	0.45844132	0	0.82414165	3.115282987	0	1.726271738	11.04807686	0	0	0	0	6.68784461	0	0	0	0	0	39.87766612	5.389061302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.7549
H5435_001_0	2011	2																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1547.28662	84.92959827	889.0475631	327.5164528	150.9063056	15.07384288	14.39666303	419.1464112	44.77534	22.31879798	39.61272036	0	0.022106774	25.68097754	5522.70512	99.43521613	194.1434077	480.2972941	0	0	15.62111171	1164.576905	0	0	169.0968317	0	17.21687489	0	0	0												"$325 Days 1-4 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-62 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $0 n/c (4b)"	20% (9b)	$0/20% (8a1a); $0/$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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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, 18a); $0/$40 (17a)"	$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 (14a1); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.8251701	110.7282311	69.7385119	0	200	0.2	0.10744592	50	0.2	0.084852576	0.161546393	0	0.2	0.159962903	10.9211392	0.157494152	38.5	40	0	0	0.2	39.66123661	0	0	28.14810067	0	40	0	0	0											NO	148.4002996	87.9544371	55.39519145	0	158.8654244	0.158865424	0.085347208	39.72747674	0.158865424	0.067400703	0.128320682	0	0.158865424	0.127062872	10.54399439	0.152055896	37.17046149	38.61866129	0	0	0.158865424	31.50399593	0	0	28.14810067	0	40	0	0	0												19.1348	0.622494584	4.104079997	0	1.997816191	2.394712446	1.228715	1.387635775	7.113253391	1.504302667	5.083131278	0	0.003512002	3.263098773	4.852614319	15.11971091	0.601366672	1.54570321	0	0	2.481654541	3.057402173	0	0	0.39664622	0	0.057389583	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9501	0	14.61129341	19.1348	0.622494584	4.104079997	0	1.997816191	2.394712446	1.228715	1.387635775	7.113253391	1.504302667	5.083131278	0	0.003512002	3.263098773	4.852614319	15.11971091	0.601366672	1.54570321	0	0	2.481654541	3.057402173	0	0	0.39664622	0	0.057389583	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9501	YES	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 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 (8a1a, 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, 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 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											5200	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.1348	0.622494584	4.104079997	0	1.997816191	2.394712446	1.228715	1.387635775	7.113253391	1.504302667	5.083131278	0	0.003512002	3.263098773	4.852614319	15.11971091	0.601366672	1.54570321	0	0	2.481654541	3.057402173	0	0	0.39664622	0	0.057389583	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9501
H5435_014_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1208.957212	49.4716831	449.6606531	167.6666886	108.4802936	14.29619041	14.44566803	382.6129275	50.46628028	24.60087079	40.74540556	0	0.050385709	31.67391107	6021.597331	101.888115	184.9045297	694.989542	0	0	15.37329089	1327.901243	0	0	221.7287368	0	17.6800249	0	0	0												"$295 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-62 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $0 n/c (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												190.7019303	117.8997596	70.33985507	0	200	0.2	0.108776888	50	0.2	0.081308179	0.159317841	0	0.2	0.159351874	10.22277366	0.138266021	38.5	35	0	0	0.2	34.75513999	0	0	31.12172798	0	35	0	0	0											NO	157.3594262	97.28605516	58.04156892	0	165.0318127	0.165031813	0.089758235	41.26940423	0.165031813	0.067092181	0.13146256	0	0.165031813	0.131490643	9.92684971	0.134264902	37.38552047	33.98683679	0	0	0.165031813	28.67851876	0	0	31.12172798	0	35	0	0	0												15.8534	0.401075408	2.174917482	0	1.491891624	2.359326218	1.296617668	1.315850631	8.328541712	1.650526074	5.356495338	0	0.008315245	4.164822924	4.981290977	13.67999776	0.576062673	1.968374678	0	0	2.537082063	3.173520058	0	0	0.575048453	0	0.051566739	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9447	0	11.2497599	15.8534	0.401075408	2.174917482	0	1.491891624	2.359326218	1.296617668	1.315850631	8.328541712	1.650526074	5.356495338	0	0.008315245	4.164822924	4.981290977	13.67999776	0.576062673	1.968374678	0	0	2.537082063	3.173520058	0	0	0.575048453	0	0.051566739	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9447	YES	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 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 (8a1a, 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, 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 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											5200	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.8534	0.401075408	2.174917482	0	1.491891624	2.359326218	1.296617668	1.315850631	8.328541712	1.650526074	5.356495338	0	0.008315245	4.164822924	4.981290977	13.67999776	0.576062673	1.968374678	0	0	2.537082063	3.173520058	0	0	0.575048453	0	0.051566739	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9447
H5435_024_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1025.576819	17.58942262	749.8035031	123.8414059	79.62653076	13.18983229	10.16794308	334.803433	47.2734973	21.49427489	39.85708329	0	0.09603544	32.10969831	5556.074984	85.56451731	238.9467282	587.0819672	0	0	13.47677384	1156.437522	0	0	226.5485489	0	17.40312411	0	0	0												"$325 Days 1-4 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-68 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $0 n/c (4b)"	20% (9b)	$0/20% (8a1a); $0/$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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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, 18a); $0/$40 (17a)"	$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 (14a1); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.8251701	110.7282311	72.22945663	0	200	0.2	0.112588076	50	0.2	0.073884884	0.157277088	0	0.2	0.159452389	10.13972005	0.155922021	38.5	40	0	0	0.2	39.64913055	0	0	26.90939837	0	40	0	0	0											NO	160.5224679	95.13904854	62.06043133	0	171.8424428	0.171842443	0.09673705	42.97082807	0.171842443	0.063482794	0.135134395	0	0.171842443	0.137003441	9.908072394	0.152360472	37.62044565	39.0861773	0	0	0.171842443	34.06701723	0	0	26.90939837	0	40	0	0	0												13.719	0.139453411	3.877760735	0	1.140268129	2.266573001	0.983616822	1.198898396	8.123593254	1.364516634	5.386062838	0	0.016502965	4.399139144	4.587499431	13.03665024	0.749106867	1.912232488	0	0	2.315881736	3.283031415	0	0	0.508023763	0	0.058010414	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0658	0	8.374129655	13.719	0.139453411	3.877760735	0	1.140268129	2.266573001	0.983616822	1.198898396	8.123593254	1.364516634	5.386062838	0	0.016502965	4.399139144	4.587499431	13.03665024	0.749106867	1.912232488	0	0	2.315881736	3.283031415	0	0	0.508023763	0	0.058010414	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0658	YES	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 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 (8a1a, 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, 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 (14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											5800	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.719	0.139453411	3.877760735	0	1.140268129	2.266573001	0.983616822	1.198898396	8.123593254	1.364516634	5.386062838	0	0.016502965	4.399139144	4.587499431	13.03665024	0.749106867	1.912232488	0	0	2.315881736	3.283031415	0	0	0.508023763	0	0.058010414	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0658
H5439_001_0	2011	3																															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											10.92687829	0	5.459514672	2.232839065	0	1.442591889	0.245467354	0.024468654	5.921348999	0.435781254	5.48415338	0	0	1.180278699	1.677015603	11.22158384	0	0.941547267	1.521860042	2.54633159	0.912867758	0.042586875	0	0	0.220729578	0	0.092798025	0	0	0											52.5306	YES	164.4043473	4.035839232	38.30384349	16.39597721	176.3999683	10.53113337	1.792647934	262.7311345	453.1962179	3.185447828	39.80915016	0	4.889282359	206.6196808	3236.549644	4195.54915	226.1049537	400.6415836	11.18436809	29.24799282	6.652017985	0	0	0	209.5083919	0	71.28993277	0	1000	0											3400	1a:  Acute - $100/$0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $100/$0/admit for 1-90	2:  Skilled Nursing Services - $75/$0/day for 1-1/2-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $200/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 - $25/visit/4a:  Worldwide Coverage - $0/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 - $15/visit/8b:  Outpatient Therapeutic Radiological Services - $15/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $15/service	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 - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/18a:  Hearing Exams - $20/visit	15:  Medicare Part B Rx Drugs - Chemo - 10.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $20/visit		18a:  Routine Hearing Test - $20/visit		14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/												900	100	100	75	0	200	0.1	0.1	37.38765067	90.20763592	0	0.012712699	0	15	25	15.00065637	20.74957257	25	25	0	0.001225283	0.1	0	0	0	20	0	20	0	0	0											NO	90.17353083	90.50009083	67.66857014	0	180.798339	0.09019806	0.090167191	33.8369799	81.07495894	-1.63E-18	0.011534136	0	13.59653826	22.53975219	13.52146293	18.71034721	22.66008473	22.69876718	0	0.001099725	0.090341261	0	0	0	17.98237078	0	17.92167795	0	0	0												1.2354	0.030436985	0.215997193	0	2.657735106	0.949887802	0.161638029	0.740835676	3.061905396	-5.20E-18	0.459164134	0	0.005539776	0.388096367	3.64690717	6.541681777	0.426963117	0.757839169	0	0.032164748	0.600951695	0	0	0	0.313954799	0	0.106469601	0	0	0	0	0	0	0	0	0	0	0	0	0	22.3336	0	2.425181967	12.1623	0.030436985	5.675511865	2.232839065	2.657735106	2.392479691	0.407105382	0.76530433	8.983254395	0.435781254	5.943317513	0	0.005539776	1.568375066	5.323922773	17.76326562	0.426963117	1.699386436	1.521860042	2.578496338	1.513819453	0.042586875	0	0	0.534684377	0	0.199267626	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8642	YES	1a:  Acute - $200/$0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $200/$0/admit for 1-90	2:  Skilled Nursing Services - 10.0% for 1-100	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 - 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	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%/14b:  Immunizations (Hepatitis B) - 10.0%/14c:  Physical Exams (Initial Exam) - 10.0%/14d:  Pap Smears and Pelvic Exams Screening - 10.0%/14e:  Prostate Cancer Screening - 10.0%/14f:  Colorectal Screening - 10.0%/14g:  Bone Mass Measurement - 10.0%/14h:  Mammography - 10.0%/14i:  Diabetes Monitoring - 10.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 10.0%/14c:  Routine Exams - 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%/14b:  Immunizations (Hepatitis B) - 10.0%/14c:  Physical Exams (Initial Exam) - 10.0%/14d:  Pap Smears and Pelvic Exams Screening - 10.0%/14e:  Prostate Cancer Screening - 10.0%/14f:  Colorectal Screening - 10.0%/14g:  Bone Mass Measurement - 10.0%/14h:  Mammography - 10.0%/14i:  Diabetes Monitoring - 10.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 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%/18a:  Hearing Exams - 10.0%	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 10.0%/13a:  3-Pints Deductible Waived - 10.0%			17a:  Routine Eye Exams - 10.0%		18a:  Routine Hearing Test - 10.0%		14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/												5100	2.3319	0.0146	1.6324	0.4171	0.7166	0.6306	0.1086	0.3136	1.6044	0.1718	1.3921	0	0.0015	0.4522	1.3127	4.0959	0.16	0.3262	0.3847	0.8232	0.4519	0.0139	0	0	0.063	0	0.0263	0	0	0	0	0	0	0	0	0	0	0	0	0	17.4449	0	1.294908719	14.4942	0.045046716	7.307885885	2.649942762	3.374290455	3.023100021	0.515688817	1.078923157	10.5876327	0.60755894	7.335405741	0	0.007028443	2.020566438	6.636577928	21.85918161	0.586949578	2.025546968	1.906555145	3.401676253	1.965677132	0.05650631	0	0	0.597650139	0	0.225555922	0	0	0	0	0	0	0	0	0	0	0	0	0	92.3092
H5439_002_0	2011	3																															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											9.573830017	0	0	2.759840074	0	1.160237903	0.216096085	0.011768921	4.769160351	0.725845651	1.273336726	0	0	0.693003852	0.938227114	6.607284845	0	0.3989209	2.624704311	1.055394033	0.695094155	0.070255061	0	0	0	0	0	0	0	0											33.573	YES	456.0761237	13.63507612	416.4249491	22.56054442	144.309368	9.48446216	1.766495593	235.4005256	911.3447928	5.93348622	10.40899798	0	2.208679956	257.018562	3083.866382	3755.710384	102.8987138	121.7225843	21.45586577	16.97606018	5.682105538	6.475851149	0	0	0	0	0	0	1000	0											3400	1a:  Acute - $200/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-5/6-90	2:  Skilled Nursing Services - $0/$125/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $250/trip	11a:  Durable Medical Equipment - 15.0%	11b:  Prosthetics Devices - 15.0%/11b:  Medical Supplies - 15.0%/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 - $0/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 - $25/visit/8b:  Outpatient Therapeutic Radiological Services - $25/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $20/service	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/18a:  Hearing Exams - $25/visit	15:  Medicare Part B Rx Drugs - Chemo - 10.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - 20.0%/13a:  3-Pints Deductible Waived - 20.0%							14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/												500	200	200	125	0	250	0.15	0.053259759	39.33069356	157.6563818	0	0.020255635	0	20	25	20.00054014	27.92921239	25	25	0	0.003656139	0.1	212.8421601	0	0	0	0	0	0	0	0											NO	167.4370519	167.4370519	104.6481575	-1.23E-18	209.2963149	0.125577789	0.044588285	32.92707691	131.987599	0	0.016957719	0	16.74370519	20.92963149	16.74415739	23.38192493	20.92963149	20.92963149	0	0.003060865	0.083718526	178.1883191	0	0	0	0	0	0	0	0												6.3637	0.190251412	3.631508638	-2.78E-17	2.516951577	1.191037788	0.078765009	0.645920934	10.02385092	0	0.176512864	0	0.003081791	0.448275316	4.303062006	7.317978186	0.179469347	0.212300736	0	0.051961434	0.4756975	0.096160086	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9065	0	7.372	15.9375	0.190251412	3.631508638	2.759840074	2.516951577	2.351275691	0.294861094	0.657689855	14.79301127	0.725845651	1.44984959	0	0.003081791	1.141279168	5.24128912	13.92526303	0.179469347	0.611221636	2.624704311	1.107355467	1.170791656	0.166415147	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.4795	YES	1a:  Acute - 15.0% for 1-100/1a:  Additional Days - 15.0% for 91-999	1b:  Psych - 15.0% for 1-100	2:  Skilled Nursing Services - 30.0% for 1-100	6:  Home Health Services - 30.0%	10a:  Ambulance - $250/trip	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/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 - $0/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 - $20/service	9d:  Cardiac Rehabilitation Services - $40/visit/3:  Rehab Services (CORF) - $40/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $30/visit/17a:  Vision Exams - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 30.0%/14i:  Diabetes Monitoring - 30.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 30.0%/14c:  Routine Exams - 30.0%	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $40/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 30.0%/14i:  Diabetes Monitoring - 30.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 30.0%	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		9c:  Outpatient Substance Abuse Svcs - Individual - 30.0%/9c:  Outpatient Substance Abuse Svcs - Group - 30.0%/7g:  Other Health Care Professional Services - $40/visit/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%/13a:  3-Pints Deductible Waived - 30.0%							14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/												5100	1.8436	0.0171	0.6397	0.5022	0.1717	0.2061	0.0316	0.0665	0.7638	0.089	0.3155	0	0.0002	0.102	0.4442	0.8663	0.0152	0.0386	0.0964	0.0606	0.1229	0.0126	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4056	0	2.0665	17.7811	0.207383016	4.271242035	3.262024277	2.688611814	2.557383051	0.326415719	0.724153203	15.55676479	0.81488403	1.765310845	0	0.003248368	1.243325065	5.685516504	14.79156102	0.194637704	0.649839349	2.721079037	1.167957036	1.2936447	0.179005118	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.885
H5439_003_0	2011	3																															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											10.32900837	0	0	3.107291994	0	1.071773546	0.199619463	0.009265753	4.130293375	0.890116172	2.234446263	0	0	0.699788417	1.343967162	6.91954924	0	0.401587916	1.803870585	0.891866858	0.583497083	0.059057798	0	0	0	0	0	0	0	0											34.675	YES	678.7019011	20.0779342	537.5902062	34.06953792	153.2778332	11.7513351	2.188704147	244.0737813	756.3551047	9.759574167	24.49932347	0	2.299195916	298.0592229	3531.942692	4265.665359	107.1157013	130.3253689	19.77832705	20.73886054	6.397685197	6.244507336	0	0	0	0	0	0	1000	0											3400	1a:  Acute - $200/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-5/6-90	2:  Skilled Nursing Services - $0/$125/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $250/trip	11a:  Durable Medical Equipment - 15.0%	11b:  Prosthetics Devices - 15.0%/11b:  Medical Supplies - 15.0%/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 - $0/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 - $25/visit/8b:  Outpatient Therapeutic Radiological Services - $25/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $20/service	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/18a:  Hearing Exams - $25/visit	15:  Medicare Part B Rx Drugs - Chemo - 10.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - 20.0%/13a:  3-Pints Deductible Waived - 20.0%							14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/												500	200	200	125	0	250	0.15	0.053259759	39.33069356	177.0177187	0	0.017345585	0	20	25	20.00055529	27.9961073	25	25	0	0.003513425	0.1	248.8711132	0	0	0	0	0	0	0	0											NO	161.4580455	161.4580455	100.9112784	8.15E-19	201.8225569	0.121093534	0.042996083	31.75128455	142.9046744	-7.11E-19	0.014002922	0	16.14580455	20.18225569	16.14625283	22.60098383	20.18225569	20.18225569	0	0.002836354	0.080729023	200.9112176	0	0	0	0	0	0	0	0												9.1318	0.270145334	4.520742916	2.78E-17	2.57791035	1.423010698	0.094105704	0.645804673	9.007223333	-6.94E-18	0.343062104	0	0.003093531	0.501292287	4.752303308	8.034019484	0.180153039	0.219188326	0	0.058822746	0.516478874	0.104549298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3837	0	10.1175	19.4608	0.270145334	4.520742916	3.107291994	2.57791035	2.494784244	0.293725168	0.655070427	13.13751671	0.890116172	2.577508367	0	0.003093531	1.201080705	6.09627047	14.95356872	0.180153039	0.620776242	1.803870585	0.950689604	1.099975957	0.163607096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.0587	YES	1a:  Acute - 15.0% for 1-100/1a:  Additional Days - 15.0% for 91-999	1b:  Psych - 15.0% for 1-100	2:  Skilled Nursing Services - 30.0% for 1-100	6:  Home Health Services - 30.0%	10a:  Ambulance - $250/trip	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/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 - $0/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 - $20/service	9d:  Cardiac Rehabilitation Services - $40/visit/3:  Rehab Services (CORF) - $40/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $30/visit/17a:  Vision Exams - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 30.0%/14i:  Diabetes Monitoring - 30.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 30.0%/14c:  Routine Exams - 30.0%	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $40/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14e:  Prostate Cancer Screening - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14h:  Mammography - 30.0%/14i:  Diabetes Monitoring - 30.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 30.0%	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		9c:  Outpatient Substance Abuse Svcs - Individual - 30.0%/9c:  Outpatient Substance Abuse Svcs - Group - 30.0%/7g:  Other Health Care Professional Services - $40/visit/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%/13a:  3-Pints Deductible Waived - 30.0%							14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/												5100	1.9556	0.0184	0.6888	0.5339	0.1765	0.2191	0.0334	0.0679	0.8118	0.0947	0.3354	0	0.0002	0.1047	0.4553	0.8889	0.0156	0.0396	0.0975	0.0615	0.1305	0.0134	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.7426	0	2.533	21.4164	0.288573256	5.209580137	3.641200605	2.754433123	2.713911993	0.327147547	0.722934565	13.94934763	0.98477936	2.912898208	0	0.003264826	1.305782398	6.551592645	15.84246769	0.195751063	0.660328978	1.901339381	1.012146792	1.230449603	0.176992412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.8013
H5439_801_0	2011	1																															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	YES	288.2297481	3.318879887	66.14380875	33.67146497	7.222055813	12.67308001	2.260516302	10.23072296	52.12914048	7.322764463	20.77635764	0	0.026567638	7.635995723	45.28760801	119.7381184	1.229625124	4.864504907	22.91870905	22.74080937	7.246481816	0.741793502	0	0	0	0	0	0	1000	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS							14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/												0	0.063572024	0.063572024	0.125811378	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.230006091	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.054105585	0.054105585	0.107076947	0	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0	0.198304232	0.198304232	0.195756142	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0	0	0	0	0	0	0	0												15.5948	0.179569939	7.082477122	0	1.432164229	2.513125392	0.448269948	2.028795654	10.33742915	1.45213518	4.120039637	0	0.005268475	1.514250264	8.865327418	23.74457556	0.243839865	0.964651908	4.544876988	4.509598728	1.437008008	0.14710079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1653	0	15.9505	15.5948	0.179569939	7.082477122	0	1.432164229	2.513125392	0.448269948	2.028795654	10.33742915	1.45213518	4.120039637	0	0.005268475	1.514250264	8.865327418	23.74457556	0.243839865	0.964651908	4.544876988	4.509598728	1.437008008	0.14710079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1653	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	Similar to Medicare FFS																			10000	0.9427	0.0109	0.3991	0	0.1051	0.1837	0.0328	0.1229	0.6811	0.0784	0.2779	0	0.0003	0.1297	0.5388	1.4299	0.0147	0.0581	0.257	0.2764	0.1099	0.0112	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.6606	0	0.5515	16.5375	0.190420647	7.481569043	0	1.537214664	2.696776678	0.481028104	2.151732064	11.01856131	1.530580182	4.397968761	0	0.005585944	1.643932435	9.40413039	25.17448639	0.25853321	1.022783898	4.801864802	4.785976746	1.546930988	0.158319043	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8259
H5439_802_0	2011	1																															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	YES	288.2297481	3.318879887	66.14380875	33.67146497	7.222055813	12.67308001	2.260516302	10.23072296	52.12914048	7.322764463	20.77635764	0	0.026567638	7.635995723	45.28760801	119.7381184	1.229625124	4.864504907	22.91870905	22.74080937	7.246481816	0.741793502	0	0	0	0	0	0	1000	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS							14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/												0	0.063572024	0.063572024	0.125811378	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.230006091	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.054105585	0.054105585	0.107076947	0	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0	0.198304232	0.198304232	0.195756142	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0	0	0	0	0	0	0	0												15.5948	0.179569939	7.082477122	0	1.432164229	2.513125392	0.448269948	2.028795654	10.33742915	1.45213518	4.120039637	0	0.005268475	1.514250264	8.865327418	23.74457556	0.243839865	0.964651908	4.544876988	4.509598728	1.437008008	0.14710079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1653	0	15.9505	15.5948	0.179569939	7.082477122	0	1.432164229	2.513125392	0.448269948	2.028795654	10.33742915	1.45213518	4.120039637	0	0.005268475	1.514250264	8.865327418	23.74457556	0.243839865	0.964651908	4.544876988	4.509598728	1.437008008	0.14710079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1653	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	Similar to Medicare FFS																			10000	0.9427	0.0109	0.3991	0	0.1051	0.1837	0.0328	0.1229	0.6811	0.0784	0.2779	0	0.0003	0.1297	0.5388	1.4299	0.0147	0.0581	0.257	0.2764	0.1099	0.0112	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.6606	0	0.5515	16.5375	0.190420647	7.481569043	0	1.537214664	2.696776678	0.481028104	2.151732064	11.01856131	1.530580182	4.397968761	0	0.005585944	1.643932435	9.40413039	25.17448639	0.25853321	1.022783898	4.801864802	4.785976746	1.546930988	0.158319043	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8259
H5439_803_0	2011	1																															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	YES	288.2297481	3.318879887	66.14380875	33.67146497	7.222055813	12.67308001	2.260516302	10.23072296	52.12914048	7.322764463	20.77635764	0	0.026567638	7.635995723	45.28760801	119.7381184	1.229625124	4.864504907	22.91870905	22.74080937	7.246481816	0.741793502	0	0	0	0	0	0	1000	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS							14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/												0	0.063572024	0.063572024	0.125811378	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.230006091	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.054105585	0.054105585	0.107076947	0	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0	0.198304232	0.198304232	0.195756142	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0.198304232	0	0	0	0	0	0	0	0												15.5948	0.179569939	7.082477122	0	1.432164229	2.513125392	0.448269948	2.028795654	10.33742915	1.45213518	4.120039637	0	0.005268475	1.514250264	8.865327418	23.74457556	0.243839865	0.964651908	4.544876988	4.509598728	1.437008008	0.14710079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1653	0	15.9505	15.5948	0.179569939	7.082477122	0	1.432164229	2.513125392	0.448269948	2.028795654	10.33742915	1.45213518	4.120039637	0	0.005268475	1.514250264	8.865327418	23.74457556	0.243839865	0.964651908	4.544876988	4.509598728	1.437008008	0.14710079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1653	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	Similar to Medicare FFS																			10000	0.9427	0.0109	0.3991	0	0.1051	0.1837	0.0328	0.1229	0.6811	0.0784	0.2779	0	0.0003	0.1297	0.5388	1.4299	0.0147	0.0581	0.257	0.2764	0.1099	0.0112	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.6606	0	0.5515	16.5375	0.190420647	7.481569043	0	1.537214664	2.696776678	0.481028104	2.151732064	11.01856131	1.530580182	4.397968761	0	0.005585944	1.643932435	9.40413039	25.17448639	0.25853321	1.022783898	4.801864802	4.785976746	1.546930988	0.158319043	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.8259
H5440_001_0	2011	4																															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	YES	481.7306096	22.9966	70.06391978	4934.039371	23.2926924	39.14775213	26.06358554	65.70666584	72.27599263	31.59305593	64.41529449	0	0.255578181	42.41114682	45.45002703	197.2117572	11.1299	7.902017068	0	0	33.83020376	9.060813545	727.3585129	401.4379233	198.5683518	197.9260424	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.085112275	0.086145537	0.162197162	0	0.233	0.233	0.233	0.058099146	0.233	0.233	0.233	0	0.233	0.233	0.22683562	0.232911472	0.227940178	0.233	0	0	0.233	0.231259404	0	0	0	0	0	0	0	0											NO	0.063285371	0.064053654	0.120601963	0	0.173247528	0.173247528	0.173247528	0.043209373	0.173247528	0.173247528	0.173247528	0	0.173247528	0.173247528	0.168663994	0.173181703	0.16948529	0.173247528	0	0	0.173247528	0.173070158	0	0	0	0	0	0	0	0												30.4865	1.47301625	8.449846281	0	4.035401385	6.782251294	4.515451773	2.839143838	12.52163708	5.47341885	11.15979055	0	0.044278288	7.347626358	7.665783074	34.15346796	1.886354324	1.369004925	0	0	5.860999182	1.568156431	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	147.6321	0	50.90334566	30.4865	1.47301625	8.449846281	0	4.035401385	6.782251294	4.515451773	2.839143838	12.52163708	5.47341885	11.15979055	0	0.044278288	7.347626358	7.665783074	34.15346796	1.886354324	1.369004925	0	0	5.860999182	1.568156431	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	147.6321	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	30.4865	1.47301625	8.449846281	0	4.035401385	6.782251294	4.515451773	2.839143838	12.52163708	5.47341885	11.15979055	0	0.044278288	7.347626358	7.665783074	34.15346796	1.886354324	1.369004925	0	0	5.860999182	1.568156431	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	147.6321
H5470_002_0	2011	8	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Radiology	Renal Dialysis	Other	Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							O	O	O	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	YES	1059.30589	54.47691	419.309419	543.029316	34.014671	9.429042	2.755713	314.901592	346.00496	1376.937009	160.809164	69.063278	0.361816	6.215944	3273.648615	3265.112813	85.455801	192.673455		1482.393806	19.879081	0							3.7	0.6	864.141349	803.835848	1.669059	716.39125	471.726624						4500	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $95 Surgery OP -- Facility"	"$20/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	$30/Visit:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $20 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $20 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	45.243839	0	100	0.2	0.2	50	96.870038	20	30	50	0.2	0.2	10	28.321154	30	50		0	0.2	0							0	0	0	26.638297	0	46.069397	30						NO	150.788879	129.096322	37.335442	0	92.6154	0.185231	0.185231	46.3077	89.716574	18.52308	27.78462	46.3077	0.185231	0.185231	9.26154	26.229751	27.78462	46.3077		0	0.185231	0							0	0	0	24.671165	0	42.667356	27.78462							13.311	0.58606406	1.304591874	0	0.26252353	1.746550879	0.510443475	1.215197371	2.586864967	2.125426198	0.372335126	0.266513463	0.067019539	1.151385523	2.526585633	7.136924673	0.19786308	0.743522046	0	0	3.682222053	0	0	0	0	0	0	0	0	0	0	1.65263057	0	2.547210042	1.092228749	0	0	0	0	0	45.0851	0	3.663690701	13.311	0.58606406	1.304591874	0	0.26252353	1.746550879	0.510443475	1.215197371	2.586864967	2.125426198	0.372335126	0.266513463	0.067019539	1.151385523	2.526585633	7.136924673	0.19786308	0.743522046	0	0	3.682222053	0	0	0	0	0	0	0	0	0	0	1.65263057	0	2.547210042	1.092228749	0	0	0	0	0	45.0851	YES	30% Coins	30% Coins	30% Coins(Days 1-20) 30%(Days 21-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins		$35/Visit	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	30% Coins	$0/Proc	30% Coins	$35/Visit						6000	5.9119	0.0998	0.3239	2.6093	1.1197	1.5349	0.4486	0.1936	2.8456	0.3951	0.0817	0.1937	0.0109	0.1872	1.664	1.6597	0.0434	0.0724		0.7535	0.7994	0							0	0	0.2331	0.9723	0	0.5057	0.2398						22.8994	500	10.29040389	19.2229	0.685854045	1.628504149	2.60931289	1.382253602	3.281471008	0.959035998	1.408819969	5.432506066	2.520493903	0.454075808	0.460180679	0.077917583	1.338612196	4.190609388	8.796609606	0.241301	0.815943491	0	0.753513525	4.481623941	0	0	0	0	0	0	0	0	0	0.233128726	2.624910021	0	3.052869009	1.332011451	0	0	0	0	0	67.9844
H5470_005_0	2011	8	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Radiology	Renal Dialysis	Other	Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							O	O	O	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	YES	1132.515035	58.241836	448.288097	580.558337	36.365441	9.89114	2.890765	336.664594	369.917531	1472.097795	171.922763	73.836274	0.379548	6.520575	3499.892062	3490.766348	91.361693	205.989211		1584.842763	20.853314	0							4.51	0.6	923.862578	859.389335	1.784409	765.901397	504.32788						4500	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	45.243839	0	100	0.2	0.2	50	96.870038	26.279162	30	50	0.2	0.2	10	28.321154	30	50		0	0.2	0							0	0	0	39.396913	0	46.069397	30						NO	148.475102	127.115407	35.668433	0	91.2091	0.182418	0.182418	45.60455	88.35429	23.968988	27.36273	45.60455	0.182418	0.182418	9.12091	25.83147	27.36273	45.60455		0	0.182418	0							0	0	0	35.93357	0	42.019482	27.36273							14.0125	0.616952891	1.332477829	0	0.276404929	1.804321977	0.52732757	1.279453109	2.723650068	2.940391199	0.392023012	0.280605837	0.069236387	1.18947025	2.660183376	7.514302183	0.208325445	0.782837106	0	0	3.804019833	0	0	0	0	0	0	0	0	0	0	2.573410569	0	2.68189833	1.149982301	0	0	0	0	0	48.8198	0	4.826646217	14.0125	0.616952891	1.332477829	0	0.276404929	1.804321977	0.52732757	1.279453109	2.723650068	2.940391199	0.392023012	0.280605837	0.069236387	1.18947025	2.660183376	7.514302183	0.208325445	0.782837106	0	0	3.804019833	0	0	0	0	0	0	0	0	0	0	2.573410569	0	2.68189833	1.149982301	0	0	0	0	0	48.8198	YES	30% Coins	30% Coins	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	20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins		$35/Visit	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$0/Proc	30% Coins	$35/Visit						6000	5.8796	0.0992	0.317	2.6317	1.151	1.8577	0.5429	0.199	2.87	0.3984	0.084	0.1953	0.011	0.1888	1.7104	1.706	0.0446	0.073		0.7745	0.8062	0							0	0	0.2821	0.9806	0	0.51	0.2465						23.5598	500	11.57924731	19.8921	0.716197881	1.649477532	2.631654126	1.427363855	3.661996828	1.070247954	1.478475771	5.593656337	3.338841133	0.476043411	0.475931375	0.08022773	1.37830011	4.37061614	9.220275119	0.252974832	0.855878451	0	0.774528738	4.610266332	0	0	0	0	0	0	0	0	0	0.282149548	3.554015025	0	3.191886845	1.396452454	0	0	0	0	0	72.3796
H5470_007_0	2011	7	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Radiology	Renal Dialysis	Other	Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							O	O	O	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	YES	1115.865701	57.385611	441.697723	572.02343	35.830825	8.520823	2.490278	331.71522	364.479298	1450.456186	169.395292	72.750792	0.326965	5.617215	3448.439436	3439.447881	90.018566	202.960922		1561.543667	17.964296	0							4.51	0.6	910.280686	846.755278	1.758176	754.641725	496.913653						3400	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	49.091	0	100	0.2	0.2	50	96.870038	26.279162	30	50	0.2	0.2	10	28.321154	30	50		0	0.2	0							0	0	0	39.396913	0	46.069397	30						NO	138.804453	118.835981	31.748966	0	86.6375	0.173275	0.173275	43.31875	83.925779	22.767609	25.99125	43.31875	0.173275	0.173275	8.66375	24.53674	25.99125	43.31875		0	0.173275	0							0	0	0	34.132501	0	39.913374	25.99125							12.9073	0.568289615	1.168620499	0	0.258691092	1.476445605	0.43150292	1.197457391	2.549100751	2.75195161	0.366899615	0.262622781	0.05665486	0.973322929	2.48970143	7.032736533	0.194974588	0.732667787	0	0	3.112763389	0	0	0	0	0	0	0	0	0	0	2.408489614	0	2.510024784	1.076283915	0	0	0	0	0	44.5265	0	7.468959925	12.9073	0.568289615	1.168620499	0	0.258691092	1.476445605	0.43150292	1.197457391	2.549100751	2.75195161	0.366899615	0.262622781	0.05665486	0.973322929	2.48970143	7.032736533	0.194974588	0.732667787	0	0	3.112763389	0	0	0	0	0	0	0	0	0	0	2.408489614	0	2.510024784	1.076283915	0	0	0	0	0	44.5265	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	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins		$35/Visit	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$0/Proc	30% Coins	$35/Visit						5100	4.9366	0.0833	0.2642	1.6939	0.8473	1.1957	0.3495	0.1465	1.8473	0.2565	0.0619	0.1257	0.0071	0.1215	1.2592	1.2559	0.0329	0.047		0.5702	0.519	0							0	0	0.1816	0.6312	0	0.3283	0.1814						16.9437	0	9.957159404	17.8438	0.651616717	1.432842696	1.693903377	1.10602083	2.672165756	0.780961493	1.343976797	4.396423018	3.008419788	0.428754979	0.388347042	0.063729558	1.094865951	3.748912785	8.288664582	0.227845226	0.779682082	0	0.570203869	3.631715956	0	0	0	0	0	0	0	0	0	0.181609845	3.039670017	0	2.838286293	1.257733909	0	0	0	0	0	61.4702
H5475_001_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	433.3180881	11.94689158	88.38881735	0	22.09178216	28.16296353	20.12441909	17.64101655	34.47031476	11.43858943	24.15617287	0	4.995769579	38.2190635	47.1706623	74.81017775	4.112406374	9.098010424	26.40160652	107.3098594	52.1019043	13.79144599	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	No Cost-Sharing; PBP 18b	PBP 14a	PBP 13b											0	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												30.3964	0.838049947	14.65037086	0	5.147385244	6.561970502	4.688989647	4.110356855	8.03158334	2.665191337	5.628388279	0	1.164014312	8.905041796	10.99076432	17.43077142	0.958190685	2.119836429	6.151574319	25.00319724	12.1397437	3.213406915	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	170.7952	0	4.14E-10	30.3964	0.838049947	14.65037086	0	5.147385244	6.561970502	4.688989647	4.110356855	8.03158334	2.665191337	5.628388279	0	1.164014312	8.905041796	10.99076432	17.43077142	0.958190685	2.119836429	6.151574319	25.00319724	12.1397437	3.213406915	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	170.7952	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	30.3964	0.838049947	14.65037086	0	5.147385244	6.561970502	4.688989647	4.110356855	8.03158334	2.665191337	5.628388279	0	1.164014312	8.905041796	10.99076432	17.43077142	0.958190685	2.119836429	6.151574319	25.00319724	12.1397437	3.213406915	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	170.7952
H5480_801_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	179.6182604	5.196381498	33.19050218	0	2.633058595	23.99129734	0.640412153	10.68279371	69.12515467	6.505691551	21.30697715	0	0	18.3121242	88.46605829	70.69437721	0.404133725	27.60099672	27.73400453	10.39884049	40.05860744	12.31927294	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b											0	0.082158767	0.082158767	0.168649671	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	0.074429488	0.074429488	0.152783557	0	0.211079977	0.211079977	0.211079977	0.211079977	0.211079977	0.211079977	0.211079977	0	0	0.211079977	0.211079977	0.211079977	0.211079977	0.211079977	0.211079977	0.211079977	0.211079977	0.211079977	0	0	0	0	0	0	0	0												13.3689	0.386764012	5.070962969	0	0.555785947	5.064082489	0.135178183	2.25492385	14.59093605	1.373221222	4.497476244	0	0	3.865322752	18.67341354	14.92216751	0.085304537	5.826017751	5.854093036	2.19498701	8.455569933	2.600351848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.7755	0	11.39985194	13.3689	0.386764012	5.070962969	0	0.555785947	5.064082489	0.135178183	2.25492385	14.59093605	1.373221222	4.497476244	0	0	3.865322752	18.67341354	14.92216751	0.085304537	5.826017751	5.854093036	2.19498701	8.455569933	2.600351848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.7755	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.3689	0.386764012	5.070962969	0	0.555785947	5.064082489	0.135178183	2.25492385	14.59093605	1.373221222	4.497476244	0	0	3.865322752	18.67341354	14.92216751	0.085304537	5.826017751	5.854093036	2.19498701	8.455569933	2.600351848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.7755
H5480_802_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	193.3975691	5.713700513	36.8522932	0	2.751055548	25.15283491	0.736848406	11.53066692	74.65313053	6.953874446	22.92592247	0	0	19.34817037	93.91161627	75.62635796	0.425763427	29.18148445	29.0023364	11.16551422	42.85296338	12.77070237	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b											0	0.08306429	0.08306429	0.158370308	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	0.074584446	0.074584446	0.142202645	0	0.209213563	0.209213563	0.209213563	0.209213563	0.209213563	0.209213563	0.209213563	0	0	0.209213563	0.209213563	0.209213563	0.209213563	0.209213563	0.209213563	0.209213563	0.209213563	0.209213563	0	0	0	0	0	0	0	0												14.4245	0.426153189	5.240493574	0	0.575558133	5.262314208	0.15415868	2.412371909	15.61844742	1.454844849	4.796413924	0	0	4.047899659	19.64758384	15.8220598	0.089075483	6.105162333	6.067682131	2.335977012	8.965421152	2.671804143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.1179	0	13.20196653	14.4245	0.426153189	5.240493574	0	0.575558133	5.262314208	0.15415868	2.412371909	15.61844742	1.454844849	4.796413924	0	0	4.047899659	19.64758384	15.8220598	0.089075483	6.105162333	6.067682131	2.335977012	8.965421152	2.671804143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.1179	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.4245	0.426153189	5.240493574	0	0.575558133	5.262314208	0.15415868	2.412371909	15.61844742	1.454844849	4.796413924	0	0	4.047899659	19.64758384	15.8220598	0.089075483	6.105162333	6.067682131	2.335977012	8.965421152	2.671804143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.1179
H5480_803_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	172.1955326	3.691202875	33.79189531	0	2.591187619	23.2263354	0.560340149	9.812515733	61.81742458	6.190308083	19.75842715	0	0	17.47516503	83.68584046	68.10238837	0.380108554	27.69059565	28.16842992	10.64400782	44.47269619	12.62668623	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b											0	0.082998143	0.082998143	0.161249827	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	0.075542808	0.075542808	0.146765508	0	0.212070699	0.212070699	0.212070699	0.212070699	0.212070699	0.212070699	0.212070699	0	0	0.212070699	0.212070699	0.212070699	0.212070699	0.212070699	0.212070699	0.212070699	0.212070699	0.212070699	0	0	0	0	0	0	0	0												13.0081	0.278843829	4.959484694	0	0.549514969	4.92562518	0.118831727	2.080947069	13.10966443	1.312782962	4.190183454	0	0	3.705970461	17.74731467	14.4425211	0.080609887	5.872363972	5.97369862	2.257282177	9.431355763	2.677750174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7229	0	10.532503	13.0081	0.278843829	4.959484694	0	0.549514969	4.92562518	0.118831727	2.080947069	13.10966443	1.312782962	4.190183454	0	0	3.705970461	17.74731467	14.4425211	0.080609887	5.872363972	5.97369862	2.257282177	9.431355763	2.677750174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7229	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.0081	0.278843829	4.959484694	0	0.549514969	4.92562518	0.118831727	2.080947069	13.10966443	1.312782962	4.190183454	0	0	3.705970461	17.74731467	14.4425211	0.080609887	5.872363972	5.97369862	2.257282177	9.431355763	2.677750174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7229
H5507_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1627.713583	90.01386877	1142.509488	1374.386257	203.2198944	9.473724973	11.64384039	345.9787469	42.94701023	17.16548924	54.90303251	0	0.035449453	30.92634283	5665.472122	126.0003651	466.7770925	545.309183	0	0	22.52969602	3856.914634	0	0	26.14058709	0	18.39996586	10.45	0	0											3900	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-49 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												187.4696942	115.9014585	60.29582368	0	200	0.2	0.109171967	49.27104491	0.2	0.129870429	0.161792354	0	0.2	0.158930076	12.51985734	0.123898013	38.5	35	0	0	0.2	33.51176667	0	0	35	0	35	0	0	0											NO	131.7691275	81.46508231	42.38086647	0	140.5764575	0.140576457	0.076735042	34.65922354	0.140576457	0.091283624	0.11372098	0	0.140576457	0.111709135	11.53997262	0.114206841	35.48674189	32.26067445	0	0	0.140576457	23.55482722	0	0	35	0	35	0	0	0												17.8735	0.611082269	4.035045172	0	2.38066107	1.331782696	0.893490583	0.999279561	6.037338558	1.566928066	6.243626644	0	0.004983359	3.45475502	5.448282764	14.39010369	1.380366517	1.466003502	0	0	3.167144855	7.570746483	0	0	0.076243379	0	0.053666567	0	0	0	0	0	0	0	0	0	0	0	0	0	78.9851	0	25.66825724	17.8735	0.611082269	4.035045172	0	2.38066107	1.331782696	0.893490583	0.999279561	6.037338558	1.566928066	6.243626644	0	0.004983359	3.45475502	5.448282764	14.39010369	1.380366517	1.466003502	0	0	3.167144855	7.570746483	0	0	0.076243379	0	0.053666567	0	0	0	0	0	0	0	0	0	0	0	0	0	78.9851	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-58 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"50% (7b); $0 n/c (7b1); 30% (7d, 7f, 7f1)"	"$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)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.2847	0.0049	0	0.0385	0.0363	0.0304	0.0374	0.0152	0.1379	0.0239	0.1399	0	0.0001	0.0802	0.606	2.8464	0.1265	0.1654	0	0	0.3852	0.3659	0	0	0.0024	0	0.0027	0	0	0											5.3298	0	0.985483638	18.1582	0.615959253	4.035045172	0.038524323	2.416914792	1.362204128	0.930880554	1.014497016	6.175247307	1.590789915	6.383566917	0	0.005059247	3.534914057	6.054315719	17.23653089	1.5068234	1.631398027	0	0	3.552338148	7.936609884	0	0	0.078647914	0	0.056377426	0	0	0	0	0	0	0	0	0	0	0	0	0	84.3148
H5508_001_0	2011	9																															A	A	A	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	YES	254.6367486	4.971878557	74.58540117	97.13400046	13.18035745	8.491005798	0.681743405	325.3989015	87.04322308	2112.66451	1401.223785	0	0	1090.759883	4267.949768	3281.106347	178.9891747	0	9200.043579	6070.559167	48.53441381	406.0855268	0	367.4889969	234.4220718	3.295089362	0	0	0	0.259368235											3400	Days 1-5: $125 copay	Days 1-5: $125 copay	Days 21-100: $75 copay	$0 copay	$50 copay	20% coinsurance	0.2	$50 copay; waived if admitted within 72 hours	$150 copay	$0 copay	"$0 copay for x-rays, $50 for all other"	-	-	"$150 copay for outpatient hospital services, $25 copay for outpatient substance abuse services and PT/OT/ST, $0 copay for all other"	"$0 copay for immunizations and routine exams, $10 copay for all other"	"$25 copay for chiropractic and podiatry, $30 copay for physician, $0 copay for all other"	$25 copay	-	$0 copay for Medicare covered x-rays; $100 copay for all other	$0 copay	20% coinsurance	$0 copay	-	"$0 copay for comprehensive services, $10 copay for all other"	$20 copay	allotted $100 every 2 years for either eye glasses or contacts	-	-	-	-												432.5876663	441.6666667	908.1859507	0	50	0.2	0.2	49.85962687	150	0	6	0	0	60.47930416	8.422911378	29.83203889	25	0	0.709809543	0	0.2	0	0	10	20	0	0	0	0	0											NO	411.7726862	420.414829	864.4864328	0	47.59413158	0.190376526	0.190376526	47.46051284	142.7823948	0	5.71129579	0	0	57.56919921	8.017623049	28.39659969	23.79706579	0	0.675655376	0	0.190376526	0	0	9.518826317	19.03765263	0	0	0	0	0												8.7377	0.174187623	5.373172283	0	0.052275639	1.616488189	0.129787941	1.286966562	1.035686653	0	0.666900292	0	0	5.232847749	2.851567703	7.76435529	0.354951431	0	0.518004909	0	9.239813108	0	0	0.291505328	0.371903831	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6981		2.310025593	8.7377	0.174187623	5.373172283	0	0.052275639	1.616488189	0.129787941	1.286966562	1.035686653	0	0.666900292	0	0	5.232847749	2.851567703	7.76435529	0.354951431	0	0.518004909	0	9.239813108	0	0	0.291505328	0.371903831	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6981	YES	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											5100	2.1879	0.016	2.3961	0	1.508	2.1994	0.0604	0.2383	1.7415	0.1693	0.47	0	0	0.5419	0.086	0.1944	0.1585	0	1.4417	4.9034	0.423	0.0216	0	0	0	0	0	0	0	0											18.7575		0.558616662	10.9256	0.190171723	7.76923062	0	1.560258047	3.815849107	0.190203795	1.525287848	2.777230085	0.16926473	1.136912866	0	0	5.774738016	2.93756389	7.958779134	0.513472489	0	1.95973755	4.903372202	9.662830214	0.021647907	0	0.291505328	0.371903831	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4556
H5508_002_0	2011	5																															A	A	A	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	YES	240.4844981	5.900477711	67.71364912	101.439448	8.094305977	7.08457511	0.576944721	320.0825951	215.057189	2003.950362	1329.154186	0	0	943.7030754	4040.59531	3162.648316	116.7455069	0	8443.106516	5823.466198	36.60197662	380.8248112	0	374.5808205	240.7248038	4.492472355	0	0	0	0.244953017											3400	Days 1-5: $125 copay	Days 1-5: $125 copay	Days 21-100: $75 copay	$0 copay	$50 copay	20% coinsurance	0.2	$50 copay; waived if admitted within 72 hours	$150 copay	$0 copay	"$0 copay for x-rays, $50 for all other"	-	-	"$150 copay for outpatient hospital services, $25 copay for outpatient substance abuse services and PT/OT/ST, $0 copay for all other"	"$0 copay for immunizations and routine exams, $10 copay for all other"	"$25 copay for chiropractic and podiatry, $30 copay for physician, $0 copay for all other"	$25 copay	-	$0 copay for Medicare covered x-rays; $100 copay for all other	$0 copay	20% coinsurance	$0 copay	-	"$0 copay for comprehensive services, $10 copay for all other"	$20 copay	allotted $100 every 2 years for either eye glasses or contacts	-	-	-	-												432.5876663	441.6666667	909.0886107	0	50	0.2	0.2	49.85886784	150	0	6	0	0	55.50954228	8.422133413	29.82826004	25	0	0.727368948	0	0.2	0	0	10	20	0	0	0	0	0											NO	411.7726862	420.414829	865.3456592	0	47.59413158	0.190376526	0.190376526	47.45979033	142.7823948	0	5.71129579	0	0	52.83856919	8.016882517	28.39300267	23.79706579	0	0.692369868	0	0.190376526	0	0	9.518826317	19.03765263	0	0	0	0	0												8.2521	0.206720694	4.882976028	0	0.032103455	1.3487368	0.109836732	1.265921071	2.558865038	0	0.632599392	0	0	4.155326687	2.699414825	7.483090174	0.231516709	0	0.487146046	0	6.968157165	0	0	0.297130814	0.381902933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9935		2.122759437	8.2521	0.206720694	4.882976028	0	0.032103455	1.3487368	0.109836732	1.265921071	2.558865038	0	0.632599392	0	0	4.155326687	2.699414825	7.483090174	0.231516709	0	0.487146046	0	6.968157165	0	0	0.297130814	0.381902933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9935	YES	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											5100	2.0503	0.013	3.4291	0	1.1921	1.9294	0.0354	0.1846	1.7116	0.1711	0.4129	0	0	0.9006	0.0746	0.3173	0.0868	0	1.214	4.8265	0.5475	0.0192	0	0	0	0	0	0	0	0											19.116		0.569294215	10.3023	0.219689276	8.312112343	0	1.224181682	3.278127354	0.14527528	1.450516116	4.270505659	0.171100879	1.045454113	0	0	5.055970728	2.773989846	7.800362638	0.318283358	0	1.701194158	4.82652229	7.515677603	0.019205409	0	0.297130814	0.381902933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1095
H5508_004_0	2011	9																															A	A	A	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	NO	287.5915811	6.857519491	79.71825297	109.2501738	12.47279628	8.425631544	0.78370026	386.2003923	352.4037267	2309.811711	1555.303089	0	0	1290.47092	4936.145948	4024.868438	194.0478459	0	10030.92982	6602.171842	52.00472349	445.6661284	0	369.189129	298.7845125	3.607116376	0	0	0	0.271882354												-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	$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	9.518826317	19.03765263	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.292853933	0.47401298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.7669		0.038764882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.292853933	0.47401298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.7669	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												2.4139	0.025	2.7142	0	1.4725	2.3135	0.0624	0.2552	1.932	0.1836	0.4836	0	0	0.7713	0.0955	0.2556	0.1662	0	1.4697	5.2188	0.5598	0.0244	0	0	0	0	0	0	0	0											20.4172		0.608045528	2.4139	0.025024096	2.714243899	0	1.472467617	2.313487919	0.062419779	0.255187292	1.93198248	0.183568982	0.483622036	0	0	0.771314308	0.095513527	0.255594214	0.16623862	0	1.46969097	5.218770358	0.559825715	0.024379526	0	0.292853933	0.47401298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1841
H5508_801_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	242.0946674	2.707205701	41.05571059	11.43376521	0.448790047	8.663904994	0.805862986	7.953794948	14.53104508	8.489039283	36.80532084	0	0	62.00397961	28.87769812	22.91877471	1.160406527	0	40.47982707	72.98989458	53.47539604	3.032960309	0	0	0	0	0	0	0	0											3400	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												0.078178457	0.078178457	0.183397922	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	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074416715	0.074416715	0.174573297	0	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0	0	0.221788653	0.221788653	0.221788653	0.221788653	0	0.221788653	0.221788653	0.221788653	0.221788653	0	0	0	0	0	0	0	0												18.0159	0.201461355	7.167230739	0	0.09953654	1.92155582	0.178731266	1.764061469	3.222820918	1.882772589	8.16300254	0	0	13.75177913	6.404745772	5.083124176	0.257365001	0	8.977966327	16.18833042	11.86023607	0.672676182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8133		5.348828409	18.0159	0.201461355	7.167230739	0	0.09953654	1.92155582	0.178731266	1.764061469	3.222820918	1.882772589	8.16300254	0	0	13.75177913	6.404745772	5.083124176	0.257365001	0	8.977966327	16.18833042	11.86023607	0.672676182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8133	YES	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											5100	2.5834	0.0268	2.2438	0	1.5141	2.3789	0.0642	0.2624	1.9866	0.1888	0.4974	0	0	0.6783	0.0982	0.2627	0.145	0	1.5113	5.3664	0.5757	0.023	0	0	0	0	0	0	0	0											20.4068		0.607736088	20.5993	0.228242173	9.410997348	0	1.613644946	4.300468241	0.242916251	2.026465353	5.209439082	2.071532796	8.660423097	0	0	14.43012236	6.502959552	5.345803239	0.402379666	0	10.48921939	21.55468511	12.43589343	0.695686131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.2201
H5508_802_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	242.0946674	2.707205701	41.05571059	11.43376521	0.448790047	8.663904994	0.805862986	7.953794948	14.53104508	8.489039283	36.80532084	0	0	62.00397961	28.87769812	22.91877471	1.160406527	0	40.47982707	72.98989458	53.47539604	3.032960309	0	0	0	0	0	0	0	0											3400	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												0.078178457	0.078178457	0.183397922	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	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074416715	0.074416715	0.174573297	0	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0	0	0.221788653	0.221788653	0.221788653	0.221788653	0	0.221788653	0.221788653	0.221788653	0.221788653	0	0	0	0	0	0	0	0												18.0159	0.201461355	7.167230739	0	0.09953654	1.92155582	0.178731266	1.764061469	3.222820918	1.882772589	8.16300254	0	0	13.75177913	6.404745772	5.083124176	0.257365001	0	8.977966327	16.18833042	11.86023607	0.672676182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8133		5.348828409	18.0159	0.201461355	7.167230739	0	0.09953654	1.92155582	0.178731266	1.764061469	3.222820918	1.882772589	8.16300254	0	0	13.75177913	6.404745772	5.083124176	0.257365001	0	8.977966327	16.18833042	11.86023607	0.672676182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8133	YES	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											5100	2.5834	0.0268	2.2438	0	1.5141	2.3789	0.0642	0.2624	1.9866	0.1888	0.4974	0	0	0.6783	0.0982	0.2627	0.145	0	1.5113	5.3664	0.5757	0.023	0	0	0	0	0	0	0	0											20.4068		0.607736088	20.5993	0.228242173	9.410997348	0	1.613644946	4.300468241	0.242916251	2.026465353	5.209439082	2.071532796	8.660423097	0	0	14.43012236	6.502959552	5.345803239	0.402379666	0	10.48921939	21.55468511	12.43589343	0.695686131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.2201
H5508_803_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	242.0946674	2.707205701	41.05571059	11.43376521	0.448790047	8.663904994	0.805862986	7.953794948	14.53104508	8.489039283	36.80532084	0	0	62.00397961	28.87769812	22.91877471	1.160406527	0	40.47982707	72.98989458	53.47539604	3.032960309	0	0	0	0	0	0	0	0											3400	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												0.078178457	0.078178457	0.183397922	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	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074416715	0.074416715	0.174573297	0	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0	0	0.221788653	0.221788653	0.221788653	0.221788653	0	0.221788653	0.221788653	0.221788653	0.221788653	0	0	0	0	0	0	0	0												18.0159	0.201461355	7.167230739	0	0.09953654	1.92155582	0.178731266	1.764061469	3.222820918	1.882772589	8.16300254	0	0	13.75177913	6.404745772	5.083124176	0.257365001	0	8.977966327	16.18833042	11.86023607	0.672676182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8133		5.348828409	18.0159	0.201461355	7.167230739	0	0.09953654	1.92155582	0.178731266	1.764061469	3.222820918	1.882772589	8.16300254	0	0	13.75177913	6.404745772	5.083124176	0.257365001	0	8.977966327	16.18833042	11.86023607	0.672676182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8133	YES	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											5100	2.5834	0.0268	2.2438	0	1.5141	2.3789	0.0642	0.2624	1.9866	0.1888	0.4974	0	0	0.6783	0.0982	0.2627	0.145	0	1.5113	5.3664	0.5757	0.023	0	0	0	0	0	0	0	0											20.4068		0.607736088	20.5993	0.228242173	9.410997348	0	1.613644946	4.300468241	0.242916251	2.026465353	5.209439082	2.071532796	8.660423097	0	0	14.43012236	6.502959552	5.345803239	0.402379666	0	10.48921939	21.55468511	12.43589343	0.695686131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.2201
H5508_804_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	242.0946674	2.707205701	41.05571059	11.43376521	0.448790047	8.663904994	0.805862986	7.953794948	14.53104508	8.489039283	36.80532084	0	0	62.00397961	28.87769812	22.91877471	1.160406527	0	40.47982707	72.98989458	53.47539604	3.032960309	0	0	0	0	0	0	0	0											3400	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												0.078178457	0.078178457	0.183397922	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	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074416715	0.074416715	0.174573297	0	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0	0	0.221788653	0.221788653	0.221788653	0.221788653	0	0.221788653	0.221788653	0.221788653	0.221788653	0	0	0	0	0	0	0	0												18.0159	0.201461355	7.167230739	0	0.09953654	1.92155582	0.178731266	1.764061469	3.222820918	1.882772589	8.16300254	0	0	13.75177913	6.404745772	5.083124176	0.257365001	0	8.977966327	16.18833042	11.86023607	0.672676182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8133		5.348828409	18.0159	0.201461355	7.167230739	0	0.09953654	1.92155582	0.178731266	1.764061469	3.222820918	1.882772589	8.16300254	0	0	13.75177913	6.404745772	5.083124176	0.257365001	0	8.977966327	16.18833042	11.86023607	0.672676182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8133	YES	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											5100	2.5834	0.0268	2.2438	0	1.5141	2.3789	0.0642	0.2624	1.9866	0.1888	0.4974	0	0	0.6783	0.0982	0.2627	0.145	0	1.5113	5.3664	0.5757	0.023	0	0	0	0	0	0	0	0											20.4068		0.607736088	20.5993	0.228242173	9.410997348	0	1.613644946	4.300468241	0.242916251	2.026465353	5.209439082	2.071532796	8.660423097	0	0	14.43012236	6.502959552	5.345803239	0.402379666	0	10.48921939	21.55468511	12.43589343	0.695686131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.2201
H5509_001_0	2011	12																															D	D	D	V	COIN	COIN	COIN	V	V	O	COIN	O	COIN	COIN	COIN	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	1285.940327	18.95812502	779.9284456	0	0.195886696	8.541964574	3.769869394	448.6402757	748.0311368	0	15.87140163	21.06134531	0	0	31.94852676	86.64755522	229.6457578	764.5636683	30.49902411	0	19.47440116	0	0	0	0	0	0	0	0	104.8190634											5300	1a $250 days 1-6	1b $195 days 1-9	2 $50 days 1-100	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $20"	"9a $300, 9b $300"	8a $0	"8b X-ray $10, Ther. 20%, CT $150, Other Diag. $400"	5 $40	12 $0	"3 $40, 4b $20, 9d $40, 13a $0, 14b $0"	"7a $20, 14b $0, 14c $0, 14d - 14g $0, 14i - 14j $0"	"17a $40, 18a $20, 7b $20, 7d $40, 7f $20, 14d - 14g $0, 14i - 14j $0, 16b $40-$300"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $400, 14h $0"	7g $40	15 20%								14a $0	7f $20												181.1218335	170.2023121	50	0	0.205952022	0.2	0.2	49.07840843	300	0	0.182751288	40	0	0	0.170942113	0.15025813	40	40	0.302789246	0	0.242834028	0	0	0	0	0	0	0	0	20											NO	153.8502783	144.5749117	42.47148875	0	0.17494178	0.169885955	0.169885955	41.68866142	254.8289325	0	0.155234385	33.977191	0	0	0.145203321	0.127633729	33.977191	33.977191	0.257198201	0	0.206270454	0	0	0	0	0	0	0	0	20												16.4869	0.228405771	2.760393517	0	0.034268767	1.451159809	0.640447862	1.558601046	15.884998	0	2.463787277	0.059633779	0	0	4.639032173	11.05915062	0.650226481	2.164810482	7.844294145	0	4.016993566	0	0	0	0	0	0	0	0	0.174698439	0	0	0	0	0	0	0	0	0	0	72.1178	0	12.75265245	16.4869	0.228405771	2.760393517	0	0.034268767	1.451159809	0.640447862	1.558601046	15.884998	0	2.463787277	0.059633779	0	0	4.639032173	11.05915062	0.650226481	2.164810482	7.844294145	0	4.016993566	0	0	0	0	0	0	0	0	0.174698439	0	0	0	0	0	0	0	0	0	0	72.1178	YES	0.2	0.2	0.2	0	10a $150	30%	0.3	"4a $50, 4b $20"	30%	30%	30%	30%	30%	30%	30%	30%	30%	30%	30%	30%	30%								OON: $50/visit	30%											10000	2.0058	0	0.7635	0	2.5965	1.9669	0.0409	0.4905	0.802	0.7592	0.1273	0.0027	0	0.0857	0.6382	2.1739	0.0143	0.4898	0.1779	0.0072	0.3654	0	0	0	0	0	0	0	0.8667	0.022											14.3965	0	0	18.4927	0.228405771	3.523878861	0	2.630811577	3.418020102	0.681315729	2.049068912	16.68703617	0.759187351	2.591105727	0.062302045	2.29E-05	0.085749712	5.27719574	13.2330436	0.66457601	2.654644243	8.022233691	0.007227251	4.382402784	0	0	0	0	0	0	0	0.866666667	0.19671969	0	0	0	0	0	0	0	0	0	0	86.5143
H5509_003_0	2011	8																															D	D	D	V	COIN	COIN	COIN	V	V	O	COIN	O	COIN	COIN	COIN	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	1254.625558	31.24029211	653.346356	0	4.832939805	14.67820827	2.843275183	503.9586701	480.2988431	0	13.04792869	90.88460399	0	4.491117354	35.35216468	95.27564195	238.1488921	949.7135886	26.97772655	0	32.35416127	0	0	0	0	0	0	0	0	173.8910948											5900	1a $200 days 1-6	1b $195 days 1-9	2 $50 days 1-100	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $10"	"9a $325, 9b $325"	8a $0	"8b X-ray $10, Ther. 20%, CT $150, Other Diag. $300"	5 $40	12 $0	"3 $40, 4b $10, 9d $40, 13a $0, 14b $0"	"7a $10, 14b $0, 14c $0, 14d - 14g $0, 14i - 14j $0"	"17a $40, 18a $10, 7b $20, 7d $40, 7f $10, 14d - 14g $0, 14i - 14j $0, 16b $40-$325"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $300, 14h $0"	7g $40	15 20%								14a $0	7f $10												144.9241324	170.2023121	50	0	0.32117307	0.2	0.2	48.91547049	325	0	0.333193915	40	0	0.085491686	0.08508224	0.14663933	40	40	0.331874953	0	0.221843472	0	0	0	0	0	0	0	0	10											NO	127.5379914	149.7836189	44.00164047	0	0.282642839	0.176006562	0.176006562	43.04721892	286.010663	0	0.293221577	35.20131237	0	0.075235489	0.074875163	0.129047421	35.20131237	35.20131237	0.292060847	0	0.195229534	0	0	0	0	0	0	0	0	10												13.3344	0.389940334	2.395692621	0	1.365995828	2.583460972	0.500435089	1.807834933	11.44754921	0	3.825934232	0.266604778	0	0.337891409	2.646999087	12.29507591	0.698596128	2.785930391	7.879137677	0	6.316487828	0	0	0	0	0	0	0	0	0.144909246	0	0	0	0	0	0	0	0	0	0	71.0228	0	9.662170161	13.3344	0.389940334	2.395692621	0	1.365995828	2.583460972	0.500435089	1.807834933	11.44754921	0	3.825934232	0.266604778	0	0.337891409	2.646999087	12.29507591	0.698596128	2.785930391	7.879137677	0	6.316487828	0	0	0	0	0	0	0	0	0.144909246	0	0	0	0	0	0	0	0	0	0	71.0228	YES	0.2	0.2	0.2	0	10a $150	20%	0.2	"4a $50, 4b $10"	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%								OON: $50/visit	20%											10000	5.1416	0.1039	0.4726	0	0.1972	0.3729	0.0722	0.2609	1.3697	0.1794	0.3201	0.026	0.0526	0.1138	0.5548	0.9389	0.0438	0.166	0.3145	0.0224	0.9285	0	0	0	0	0	0	0	0.8667	0.0138											12.5322	0	0	18.4759	0.493822566	2.868302835	0	1.56314908	2.956330142	0.572662546	2.068758523	12.81728399	0.179442224	4.146050357	0.292568982	0.052580521	0.451716967	3.201758543	13.23396636	0.742418703	2.951980297	8.193615189	0.022393101	7.244942167	0	0	0	0	0	0	0	0.866666667	0.158686296	0	0	0	0	0	0	0	0	0	0	83.555
H5509_010_0	2011	8																															D	D	D	V	COIN	COIN	COIN	V	V	O	COIN	O	COIN	COIN	COIN	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	1521.652507	4.438654154	542.5007187	0	7.741827946	18.14027479	1.161346678	436.3489023	513.7223645	0	34.04614046	50.83151157	0	15.8297284	30.8785528	91.64652827	101.4491205	729.6899177	13.4096605	0	12.74469418	0	0	0	0	0	0	0	0	147.2305217											5500	1a $250 days 1-7	1b $195 days 1-9	2 $50 days 1-100	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $20"	"9a $325, 9b $325"	8a $0	"8b X-ray $10, Ther. 20%, CT $150, Other Diag. $425"	5 $40	12 $0	"3 $40, 4b $20, 9d $40, 13a $0, 14b $0"	"7a $20, 14b $0, 14c $0, 14d - 14g $0, 14i - 14j $0"	"17a $40, 18a $20, 7b $20, 7d $40, 7f $20, 14d - 14g $0, 14i - 14j $0, 16b $40-$325"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $425, 14h $0"	7g $40	15 20%								14a $0	7f $20												191.6199435	170.2023121	50	0	0.255085002	0.2	0.2	49.23843344	325	0	0.257651506	40	0	0.006929098	0.192123081	0.139388693	40	40	0.330415834	0	0.240980071	0	0	0	0	0	0	0	0	20											NO	163.4271921	145.1607043	42.64357588	0	0.217554733	0.170574304	0.170574304	41.99405746	277.1832432	0	0.219743631	34.11486071	0	0.00590963	0.163856304	0.118880646	34.11486071	34.11486071	0.281802254	0	0.205525039	0	0	0	0	0	0	0	0	17.05743035												20.7233	0.05369318	1.927847547	0	1.684271309	3.094264739	0.198095901	1.527005073	11.86626926	0	7.481422528	0.144509161	0	0.093547845	5.059645524	10.8949985	0.288410218	2.074439158	3.778872551	0	2.619353769	0	0	0	0	0	0	0	0	0.209281197	0	0	0	0	0	0	0	0	0	0	73.7192	0	12.71726788	20.7233	0.05369318	1.927847547	0	1.684271309	3.094264739	0.198095901	1.527005073	11.86626926	0	7.481422528	0.144509161	0	0.093547845	5.059645524	10.8949985	0.288410218	2.074439158	3.778872551	0	2.619353769	0	0	0	0	0	0	0	0	0.209281197	0	0	0	0	0	0	0	0	0	0	73.7192	YES	0.25	0.25	0.25	0	10a $150	25%	0.25	"4a $50, 4b $40"	25%	25%	25%	25%	25%	25%	25%	25%	25%	25%	25%	25%	25%								OON: $50/visit	25%											10000	8.5074	0.0235	0.5535	0	0.2509	0.576	0.0369	0.2298	1.7181	0.4984	1.0189	0.0235	0.0252	0.4997	0.629	0.9926	0.0191	0.1591	0.1506	0.0092	0.5373	0	0	0	0	0	0	0	0.8667	0.0146											17.34	0	0	29.2306	0.077232927	2.481363559	0	1.935219846	3.670284397	0.234972879	1.756760354	13.58432262	0.498409844	8.500294534	0.168034022	0.025202253	0.593218773	5.688631368	11.88759797	0.307543774	2.233522677	3.929470364	0.009237394	3.156688694	0	0	0	0	0	0	0	0.866666667	0.223865926	0	0	0	0	0	0	0	0	0	0	91.0592
H5509_011_0	2011	8																															D	D	D	V	COIN	COIN	COIN	V	V	O	COIN	O	COIN	COIN	COIN	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	1015.204887	19.19596692	492.9288548	0	7.987091102	10.26439363	1.699991274	448.1195049	417.8306873	0	34.47915028	2.939561205	0	20.27991237	21.8093384	74.6430999	79.29569597	613.1226678	11.89820791	0	12.74341384	0	0	0	0	0	0	0	0	41.26850945											5500	1a $200 days 1-7	1b $195 days 1-9	2 $50 days 1-100	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $10"	"9a $300, 9b $300"	8a $0	"8b X-ray $10, Ther. 20%, CT $150, Other Diag. $400"	5 $40	12 $0	"3 $40, 4b $10, 9d $40, 13a $0, 14b $0"	"7a $10, 14b $0, 14c $0, 14d - 14g $0, 14i - 14j $0"	"17a $40, 18a $10, 7b $15, 7d $40, 7f $10, 14d - 14g $0, 14i - 14j $0, 16b $40-$300"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $400, 14h $0"	7g $40	15 20%								14a $0	7f $10												153.3000172	170.2023121	50	0	0.210812971	0.2	0.2	41.55329949	300	0	0.260150062	40	0	0.003741494	0.101753556	0.13650637	40	39.95629342	0.445343609	0	0.245966275	0	0	0	0	0	0	0	0	10											NO	139.2313699	154.5825076	45.41140061	0	0.191466246	0.181645602	0.181645602	37.7398706	272.4684036	0	0.236275573	36.32912048	0	0.00339813	0.09241543	0.123978909	36.32912048	36.28942495	0.404473541	0	0.223393461	0	0	0	0	0	0	0	0	10												11.779	0.247280059	1.865382475	0	1.52925835	1.864481965	0.308795939	1.409331011	9.487138364	0	8.146581004	0.008899306	0	0.06891378	2.015519393	9.254170092	0.240061908	1.854155753	4.812510279	0	2.84679532	0	0	0	0	0	0	0	0	0.034390425	0	0	0	0	0	0	0	0	0	0	57.7727	0	5.834172708	11.779	0.247280059	1.865382475	0	1.52925835	1.864481965	0.308795939	1.409331011	9.487138364	0	8.146581004	0.008899306	0	0.06891378	2.015519393	9.254170092	0.240061908	1.854155753	4.812510279	0	2.84679532	0	0	0	0	0	0	0	0	0.034390425	0	0	0	0	0	0	0	0	0	0	57.7727	YES	0.2	0.2	0.2	0	10a $150	25%	0.25	"4a $50, 4b $10"	25%	25%	25%	25%	25%	25%	25%	25%	25%	25%	25%	25%	25%								OON: $50/visit	25%											10000	4.7941	0.0481	0.4167	0	0.2139	0.3259	0.054	0.1971	1.3133	0.2352	1.0551	0.0007	0.001	0.6427	0.4498	0.8292	0.0396	0.1379	0.1843	0.0094	0.5276	0	0	0	0	0	0	0	0.8667	0.0035											12.3458	0	0	16.5731	0.295370465	2.282039162	0	1.743123196	2.19041377	0.362776841	1.606424169	10.80045536	0.235247104	9.201681589	0.009562797	0.001010974	0.711631755	2.465291323	10.0833611	0.27966553	1.992100514	4.99685733	0.00936431	3.374434093	0	0	0	0	0	0	0	0.866666667	0.037906139	0	0	0	0	0	0	0	0	0	0	70.1185
H5509_012_0	2011	8																															D	D	D	V	COIN	COIN	COIN	V	V	O	COIN	O	COIN	COIN	COIN	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	1056.067585	21.9380806	565.6602622	0	6.243776261	9.773660798	3.221646422	446.2497576	556.4214749	0	11.14546291	26.87604713	0	7.168116101	30.92990576	72.52066446	326.9220482	878.8674423	22.03872941	0	12.99859172	0	0	0	0	0	0	0	0	193.0039592											5500	1a $180 days 1-7	1b $195 days 1-9	2 $50 days 1-55	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $20"	"9a $300, 9b $300"	8a $0	"8b X-ray $10, Ther. 20%, CT $150, Other Diag. $400"	5 $40	12 $0	"3 $40, 4b $20, 9d $40, 13a $0, 14b $0"	"7a $20, 14b $0, 14c $0, 14d - 14g $0, 14i - 14j $0"	"17a $40, 18a $20, 7b $20, 7d $40, 7f $20, 14d - 14g $0, 14i - 14j $0, 16b $40-$300"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $400, 14h $0"	7g $40	15 20%								14a $0	7f $20												137.9812077	170.2023121	47.20746996	0	0.338001857	0.2	0.2	48.59798289	300	0	0.233194218	40	0	0.016748598	0.143605915	0.151542982	40	40	0.264202372	0	0.240513865	0	0	0	0	0	0	0	0	20											NO	124.4008576	153.450705	42.56122878	0	0.304735127	0.180315653	0.180315653	43.81488501	270.473479	0	0.210242838	36.06313053	0	0.015100172	0.129471971	0.136627858	36.06313053	36.06313053	0.238199115	0	0.216842072	0	0	0	0	0	0	0	0	20												10.948	0.280534494	2.006266319	0	1.902697955	1.762344026	0.580913277	1.629365151	12.54143767	0	2.343253751	0.080769533	0	0.108239788	4.004555874	9.908343055	0.982486041	2.641225941	5.249605846	0	2.818641565	0	0	0	0	0	0	0	0	0.321673265	0	0	0	0	0	0	0	0	0	0	60.1103	0	6.526891389	10.948	0.280534494	2.006266319	0	1.902697955	1.762344026	0.580913277	1.629365151	12.54143767	0	2.343253751	0.080769533	0	0.108239788	4.004555874	9.908343055	0.982486041	2.641225941	5.249605846	0	2.818641565	0	0	0	0	0	0	0	0	0.321673265	0	0	0	0	0	0	0	0	0	0	60.1103	YES	0.2	0.2	0.2	0	10a $150	20%	0.2	"4a $50, 4b $40"	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%								OON: $50/visit	20%											10000	3.8919	0.1212	0.4226	0	0.2681	0.2483	0.0818	0.234	1.0607	0.2348	0.2433	0.0155	0.0035	0.1799	0.4316	0.674	0.0524	0.1609	0.1659	0.0099	0.4189	0	0	0	0	0	0	0	0.8667	0.015											9.8008	0	0	14.8399	0.401728927	2.428842814	0	2.170750449	2.010623429	0.662752464	1.863325274	13.60211413	0.234801746	2.586542726	0.096255289	0.003465544	0.288172481	4.436203263	10.58238006	1.034851394	2.802151268	5.415465562	0.009876815	3.237527907	0	0	0	0	0	0	0	0.866666667	0.336689154	0	0	0	0	0	0	0	0	0	0	69.9111
H5509_014_0	2011	8																															D	D	D	V	COIN	COIN	COIN	V	V	O	COIN	O	COIN	COIN	COIN	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	1207.660706	14.40367474	956.304093	0	7.180985522	11.35735514	2.916498537	492.5081418	624.5682554	0	13.95448878	20.08660872	0	9.640324658	29.29578157	83.59891185	183.252913	783.0478871	24.85014024	0	16.35567608	0	0	0	0	0	0	0	0	126.0437845											5000	1a $200 days 1-6	1b $195 days 1-9	2 $50 days 1-50	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $20"	"9a $300, 9b $300"	8a $0	"8b X-ray $10, Ther. 20%, CT $150, Other Diag. $400"	5 $40	12 $0	"3 $40, 4b $20, 9d $40, 13a $0, 14b $0"	"7a $20, 14b $0, 14c $0, 14d - 14g $0, 14i - 14j $0"	"17a $40, 18a $20, 7b $15, 7d $40, 7f $20, 14d - 14g $0, 14i - 14j $0, 16b $40-$300"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $400, 14h $0"	7g $40	15 20%								14a $0	7f $20												144.9046783	170.2023121	46.17577921	0	0.355852107	0.2	0.2	49.13070284	300	0	0.228086271	40	0	0.020174528	0.174999295	0.151997424	40	40	0.313285985	0	0.240681199	0	0	0	0	0	0	0	0	20											NO	123.8993331	145.5298284	39.48215005	0	0.304267877	0.171008051	0.171008051	42.0087287	256.5120766	0	0.195022944	34.20161021	0	0.017250034	0.149631442	0.129963916	34.20161021	34.20161021	0.267872129	0	0.205792114	0	0	0	0	0	0	0	0	20												12.469	0.17468036	3.146411808	0	2.184943217	1.942199167	0.498744731	1.724136743	13.35077502	0	2.721445479	0.05724953	0	0.166295926	4.38357004	10.86484198	0.522295392	2.231791551	6.656659969	0	3.365869161	0	0	0	0	0	0	0	0	0.210072974	0	0	0	0	0	0	0	0	0	0	66.671	0	11.26749389	12.469	0.17468036	3.146411808	0	2.184943217	1.942199167	0.498744731	1.724136743	13.35077502	0	2.721445479	0.05724953	0	0.166295926	4.38357004	10.86484198	0.522295392	2.231791551	6.656659969	0	3.365869161	0	0	0	0	0	0	0	0	0.210072974	0	0	0	0	0	0	0	0	0	0	66.671	YES	0.2	0.2	0.2	0	10a $150	20%	0.2	"4a $50, 4b $40"	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%								OON; $50/visit	20%											10000	4.5305	0.0994	0.6683	0	0.3246	0.2885	0.0741	0.2591	1.2809	0.2802	0.3098	0.0194	0.0056	0.2418	0.4457	0.7282	0.0397	0.1343	0.2262	0.0127	0.5084	0	0	0	0	0	0	0	0.8667	0.0096											11.3536	0	0	16.9996	0.274036669	3.814682329	0	2.50951221	2.230709011	0.572832274	1.983274928	14.63170549	0.280190183	3.031211124	0.076643184	0.005614136	0.408142785	4.829234063	11.59308336	0.561984698	2.366093422	6.882812468	0.0127018	3.874227426	0	0	0	0	0	0	0	0.866666667	0.219679045	0	0	0	0	0	0	0	0	0	0	78.0246
H5509_015_0	2011	9																															D	D	D	V	COIN	COIN	COIN	V	V	O	COIN	O	COIN	COIN	COIN	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	1150.050616	13.7165637	910.6846862	0	7.18401948	11.36215361	2.917730755	469.0135971	594.7739321	0	13.96038454	19.12839974	0	9.64439766	29.30815901	83.63250236	174.5110398	745.6934719	24.86063939	0	16.37956507	0	0	0	0	0	0	0	0	126.6316005											5500	1a $250 days 1-7	1b $195 days 1-9	2 $50 days 1-100	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $20"	"9a $300, 9b $300"	8a $0	"8b X-ray $10, Ther. 20%, CT $150, Other Diag. $400"	5 $40	12 $0	"3 $40, 4b $20, 9d $40, 13a $0, 14b $0"	"7a $20, 14b $0, 14c $0, 14d - 14g $0, 14i - 14j $0"	"17a $40, 18a $20, 7b $15, 7d $40, 7f $20, 14d - 14g $0, 14i - 14j $0, 16b $40-$300"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $400, 14h $0"	7g $40	15 20%								14a $0	7f $20												191.5661927	170.2023121	50	0	0.338952056	0.2	0.2	49.13070284	300	0	0.223182983	40	0	0.020174528	0.166580771	0.144688479	40	40	0.311249796	0	0.240272989	0	0	0	0	0	0	0	0	20											NO	166.5174757	147.9470828	43.46212486	0	0.294631532	0.173848499	0.173848499	42.70649482	260.7727491	0	0.194000134	34.76969989	0	0.017536557	0.144799085	0.125769375	34.76969989	34.76969989	0.27055155	0	0.208855493	0	0	0	0	0	0	0	0	20												15.9586	0.169110466	3.298357628	0	2.116638662	1.975293355	0.507243113	1.669160563	12.92506945	0	2.708316465	0.05542406	0	0.169129533	4.243794621	10.51840755	0.505641373	2.160628185	6.726084516	0	3.420962136	0	0	0	0	0	0	0	0	0.211052668	0	0	0	0	0	0	0	0	0	0	69.3389	0	10.39869788	15.9586	0.169110466	3.298357628	0	2.116638662	1.975293355	0.507243113	1.669160563	12.92506945	0	2.708316465	0.05542406	0	0.169129533	4.243794621	10.51840755	0.505641373	2.160628185	6.726084516	0	3.420962136	0	0	0	0	0	0	0	0	0.211052668	0	0	0	0	0	0	0	0	0	0	69.3389	YES	0.2	0.2	0.2	0	10a $150	20%	0.2	"4a $50, 4b $40"	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%								OON: $50/visit	20%											10000	4.3458	0.0953	0.641	0	0.2965	0.2767	0.0711	0.2366	1.2287	0.2688	0.2971	0.0186	0.0054	0.232	0.4275	0.6985	0.0381	0.1288	0.2169	0.0122	0.4876	0	0	0	0	0	0	0	0.8667	0.0093											10.8992	0	0	20.3044	0.264414692	3.939373838	0	2.413184932	2.252036801	0.578309118	1.905772521	14.15375929	0.268763088	3.00544883	0.074026776	0.005385173	0.401113067	4.671282973	11.2169488	0.543712016	2.289452776	6.943013758	0.012183778	3.908587848	0	0	0	0	0	0	0	0.866666667	0.220306033	0	0	0	0	0	0	0	0	0	0	80.2381
H5509_016_0	2011	7																															D	D	D	V	COIN	COIN	COIN	V	V	O	COIN	O	COIN	COIN	COIN	COIN	P	P	COIN	P	COIN	V	T	COIN	COIN	COIN	COIN	COIN	P	COIN											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1248.048196	14.88537318	988.2855277	0	7.277817198	11.51050288	2.955825931	508.9789664	645.4555328	0	14.14265746	20.75836007	0	0	29.69081922	84.7244451	189.3813936	809.2351586	25.18523084	0	16.59342388	0	0	0	0	0	0	0	0	0											5900	1a $200 days 1-5	1b $195 days 1-9	2 $50 days 1-100	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $15"	"9a $300, 9b $300"	8a $0	"8b X-ray $10, Ther. 20%, CT $150, Other Diag. $300"	5 $40	12 $0	"3 $40, 4b $15, 9d $40, 13a $0, 14b $0"	"7a $15, 14b $0, 14c $0, 14d - 14g $0, 14i - 14j $0"	"17a $40, 18a $15, 7b $35, 7d $40, 7f $15, 14d - 14g $0, 14i - 14j $0, 16b $40-$300"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $300, 14h $0"	7g $40	15 20%								14a $0	7f $15												134.0498017	170.2023121	50	0	0.362770331	0.2	0.2	48.98581998	300	0	0.216894813	40	0	0	0.133847962	0.164845053	40	40	0.303685977	0	0.24049669	0	0	0	0	0	0	0	0	0											NO	118.7307658	150.7518146	44.28606543	0	0.321313413	0.177144262	0.177144262	43.38778457	265.7163926	0	0.192108357	35.42885234	0	0	0.118551992	0.146006776	35.42885234	35.42885234	0.268981141	0	0.213013043	0	0	0	0	0	0	0	0	0												12.3485	0.186999751	3.647273128	0	2.33846028	2.039019535	0.523607602	1.840289145	14.29234298	0	2.716922695	0.061287073	0	0	3.519905769	12.37034309	0.559130453	2.389189412	6.774352134	0	3.534615713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1422	0	8.920957202	12.3485	0.186999751	3.647273128	0	2.33846028	2.039019535	0.523607602	1.840289145	14.29234298	0	2.716922695	0.061287073	0	0	3.519905769	12.37034309	0.559130453	2.389189412	6.774352134	0	3.534615713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1422	YES	0.2	0.2	0.2	0	10a $150	25%	0.25	"4a $50, 4b $15"	25%	25%	25%	25%	25%	25%	25%	25%	25%	25%	25%	25%	25%								OON: $50/visit	25%											10000	4.4025	0.0965	0.6494	0	0.3225	0.3504	0.09	0.253	1.5559	0.3403	0.3763	0.0236	0.0068	0.2938	0.5413	0.8846	0.0482	0.1631	0.2747	0.0154	0.6175	0	0	0	0	0	0	0	0.8667	0											12.1727	0	0	16.751	0.283548312	4.296658728	0	2.660995689	2.389465447	0.613599945	2.093321271	15.84825817	0.340340222	3.093187514	0.084844074	0.006819355	0.293765516	4.061243053	13.25492022	0.60734009	2.552322638	7.049054092	0.015428568	4.152106172	0	0	0	0	0	0	0	0.866666667	0	0	0	0	0	0	0	0	0	0	0	81.3149
H5509_801_0	2011	4																															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	YES	173.4704788	3.043913563	18.78089456	0	4.487543926	9.888419989	3.34871044	11.8566555	53.86367327	14.50847269	33.04501315	0.807546818	0.131172322	20.58780759	26.44776192	88.9366623	2.369200522	4.96635339	24.95204408	2.3135533	21.88866875	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 17.0%	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%																				0.086	0.086	0.169	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.075258485	0.075258485	0.147891674	0	0.203897989	0.203897989	0.203897989	0.203897989	0.203897989	0.203897989	0.203897989	0.203897989	0.203897989	0.203897989	0.203897989	0.203897989	0.203897989	0.203897989	0.203897989	0.203897989	0.203897989	0	0	0	0	0	0	0	0	0												13.0551	0.229080324	2.77753794	0	0.915001181	2.016228947	0.682795324	2.41754821	10.98269464	2.958248401	6.737811718	0.164657172	0.026745773	4.197812559	5.39264546	18.13400656	0.483075221	1.012629467	5.087671602	0.471728865	4.463055533	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2061	0	11.73313615	13.0551	0.229080324	2.77753794	0	0.915001181	2.016228947	0.682795324	2.41754821	10.98269464	2.958248401	6.737811718	0.164657172	0.026745773	4.197812559	5.39264546	18.13400656	0.483075221	1.012629467	5.087671602	0.471728865	4.463055533	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2061	YES	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 17.0%	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%																			10000	1.8949	0.0332	0.4031	0	0.1328	0.2926	0.0991	0.3509	1.5941	0.4288	0.9779	0.0239	0.0039	0.6093	0.7827	2.6279	0.0701	0.147	0.7384	0.0685	0.7638	0	0	0	0	0	0	0	0	0											12.043	0	0	14.95	0.262329753	3.180678425	0	1.047807294	2.30887068	0.781898358	2.768438667	12.57675706	3.387060299	7.715758641	0.188556025	0.030627737	4.807096056	6.175350774	20.76191989	0.55319026	1.159605654	5.826112063	0.540197057	5.226902269	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2491
H5509_802_0	2011	4																															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	YES	175.3340595	4.758720439	25.86237329	0	7.059656225	11.16546227	2.867221636	14.44846133	49.57259247	10.89312791	13.71871497	0.750543244	0.217269637	9.41750254	26.61933867	82.18643202	1.535994204	5.197543519	24.43027447	2.07847206	16.07933202	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 17.0%	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%																				0.086	0.086	0.17	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.076860603	0.076860603	0.151933751	0	0.208238611	0.208238611	0.208238611	0.208238611	0.208238611	0.208238611	0.208238611	0.208238611	0.208238611	0.208238611	0.208238611	0.208238611	0.208238611	0.208238611	0.208238611	0.208238611	0.208238611	0	0	0	0	0	0	0	0	0												13.4763	0.365758124	3.929367374	0	1.470093008	2.325080355	0.597066251	3.008727521	10.32292781	2.268369826	2.856766153	0.156292083	0.045243928	1.961087649	5.543174114	17.11438846	0.3198533	1.082329244	5.087326425	0.432818135	3.348337769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7113	0	9.002733256	13.4763	0.365758124	3.929367374	0	1.470093008	2.325080355	0.597066251	3.008727521	10.32292781	2.268369826	2.856766153	0.156292083	0.045243928	1.961087649	5.543174114	17.11438846	0.3198533	1.082329244	5.087326425	0.432818135	3.348337769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7113	YES	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 17.0%	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%																			10000	1.9152	0.052	0.5584	0	0.2089	0.3304	0.0849	0.4276	1.4671	0.3209	0.406	0.0222	0.0064	0.2787	0.7878	2.4214	0.0455	0.1538	0.723	0.0615	0.5822	0	0	0	0	0	0	0	0	0											10.854	0	0	15.3915	0.417738818	4.487799934	0	1.679019209	2.655515372	0.681919919	3.436320884	11.78999832	2.5892762	3.26276312	0.17850395	0.051673889	2.239792715	6.330957137	19.53580742	0.365310107	1.236147361	5.810325433	0.494329243	3.930568758	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.5653
H5509_803_0	2011	4																															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	YES	131.0008571	3.873365661	16.79765178	0	5.159525487	9.188122267	2.26583617	10.76044276	43.6225758	11.10996849	11.40962519	0.452285485	0.130929036	7.284778408	23.47776301	69.32683487	1.569855097	4.309669035	23.21278885	1.829317829	13.73326422	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 17.0%	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%																				0.086	0.086	0.17	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.079352748	0.079352748	0.156860083	0	0.214990584	0.214990584	0.214990584	0.214990584	0.214990584	0.214990584	0.214990584	0.214990584	0.214990584	0.214990584	0.214990584	0.214990584	0.214990584	0.214990584	0.214990584	0.214990584	0.214990584	0	0	0	0	0	0	0	0	0												10.3953	0.307362208	2.634881049	0	1.109249398	1.975359773	0.487133442	2.313393874	9.37844305	2.388538615	2.452961984	0.097237121	0.02814851	1.566158765	5.047497981	14.90461672	0.337504064	0.926538263	4.990531033	0.393286109	2.952522496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.6866	0	5.418696144	10.3953	0.307362208	2.634881049	0	1.109249398	1.975359773	0.487133442	2.313393874	9.37844305	2.388538615	2.452961984	0.097237121	0.02814851	1.566158765	5.047497981	14.90461672	0.337504064	0.926538263	4.990531033	0.393286109	2.952522496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.6866	YES	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 17.0%	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%																			10000	1.431	0.0423	0.3627	0	0.1527	0.2719	0.0671	0.3184	1.291	0.3279	0.3377	0.0134	0.0039	0.2156	0.6948	2.0452	0.0465	0.1275	0.687	0.0541	0.5051	0	0	0	0	0	0	0	0	0											8.9957	0	0	11.8262	0.349671951	2.997583867	0	1.261942394	2.247276623	0.554189475	2.631842586	10.66942646	2.716446047	2.790622853	0.110622233	0.032023275	1.781747227	5.742307997	16.94977074	0.383962964	1.054080278	5.6774993	0.447423649	3.45762156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6823
H5516_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1383.814098	121.2227351	843.0112219	1280.229218	170.2064259	11.26107286	10.63270106	351.6301448	35.43104604	17.12750603	35.37009279	0	0.054395151	21.69124733	6942.666504	113.0625754	591.2866032	483.3792936	0	0	23.79985093	1610.632487	0	0	217.8838961	0	17.70599749	10.45	86.00405213	0											4200	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												187.4696942	115.9014585	62.99555896	0	200	0.2	0.112061538	48.69829915	0.2	0.162194887	0.169041242	0	0.2	0.160724192	12.89499523	0.123939731	38.5	35	0	0	0.2	34.87409557	0	0	35	0	35	0	0	0											NO	142.1201745	87.86452441	47.75673143	0	151.6193592	0.151619359	0.084953493	36.93775538	0.151619359	0.122959424	0.128149624	0	0.151619359	0.121844495	12.36807044	0.118895811	36.92678465	33.56980423	0	0	0.151619359	26.43794012	0	0	35	0	35	0	0	0												16.389	0.887598164	3.354955043	0	2.150549104	1.707396651	0.903285096	1.082369023	5.372032499	2.105988281	4.532664091	0	0.008247358	2.642959077	7.155615694	13.44266665	1.819526089	1.352245688	0	0	3.608518148	3.548483772	0	0	0.635494697	0	0.051642493	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7512	0	16.41977837	16.389	0.887598164	3.354955043	0	2.150549104	1.707396651	0.903285096	1.082369023	5.372032499	2.105988281	4.532664091	0	0.008247358	2.642959077	7.155615694	13.44266665	1.819526089	1.352245688	0	0	3.608518148	3.548483772	0	0	0.635494697	0	0.051642493	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7512	YES	"$375 Days 1-27 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-27 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-58 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.6434	0.0514	0.0886	0.1133	0.0896	0.1067	0.1008	0.0451	0.3358	0.0877	0.2769	0	0.0003	0.1646	0.6898	0.999	0.1197	0.1012	0	0	0.315	0.2647	0	0	0.0453	0	0.0039	0	0	0											4.6428	0	0.937374657	17.0324	0.93897751	3.443547424	0.113340331	2.240155316	1.814108942	1.004042803	1.127467732	5.70778453	2.193737792	4.809566109	0	0.008590998	2.807534192	7.845453717	14.44171384	1.939177464	1.453434141	0	0	3.923547511	3.813221289	0	0	0.680746474	0	0.055506897	0	0	0	0	0	0	0	0	0	0	0	0	0	77.394
H5520_001_0	2011	4																															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	427.6201659	20.15509812	181.473068	5.216614132	153.546407	9.146319193	2.671216372	298.6183804	386.1349138	8.672738236	32.95996194	0	0.018542849	398.0492714	1943.818352	2659.114983	145.3952046	374.6320295	4.885764083	16.32389344	5.534190149	250	0	1457.128177	589.44	0	0	0	1650	0											2500	1a:  Acute - $175/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-8/9-90	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 15.0%	11b:  Prosthetics Devices - 15.0%/11b:  Medical Supplies - 15.0%/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) - $175/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - 0%-15%/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 - $12/visit		12:  Renal Dialysis - 15.0%	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/visit/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $12/visit/17a:  Vision Exams - $12/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $12/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $12/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $12/visit/18a:  Hearing Exams - $12/visit	15:  Medicare Part B Rx Drugs - Chemo - 15.0%/Medicare Part B Rx Drugs - Non-Chemo - 15.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $17/service/16a:  Preventive Dental - Prophylaxis - $17/service/16a:  Preventive Dental - X-Rays - $17/service	17a:  Routine Eye Exams - $10/visit	17b:  Eye Glasses & Contact Lenses - $0 Per Year			7b: Routine Chiro - $15/service/7g: Naturopathy - $15/service/13b: Acupuncture - $15/service/14a:  Nursing Hotline - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/												0	175	175	100	0	100	0.15	0.049539926	48.07466126	163.7513686	0	0.141454833	0	0.15	25	12	13.635638	25	25	0	0.001892826	0.15	0	0	17.16041793	7.125407166	0	0	0	5.909090909	0											NO	155.3993895	155.6282194	88.86016583	0	88.85991357	0.13271888	0.044011564	42.71881267	145.441095	0	0.125578007	0	0.127665549	22.18699237	10.65200749	12.10704206	22.22987257	22.17647496	0	0.001681244	0.132364955	0	0	17.16041793	7.125407166	0	0	0	5.909090909	0												5.5377	0.261391836	1.343810576	0	1.137010038	1.21388924	0.11756441	1.063051888	4.679990389	0	4.139046325	0	0.002367283	0.735959679	1.725463971	2.682834745	0.269343072	0.692334819	0	0.027444455	0.73253283	0	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	29.6079	0	3.334170519	5.5377	0.261391836	1.343810576	0	1.137010038	1.21388924	0.11756441	1.063051888	4.679990389	0	4.139046325	0	0.002367283	0.735959679	1.725463971	2.682834745	0.269343072	0.692334819	0	0.027444455	0.73253283	0	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	29.6079	YES	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/$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 - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $175/visit	8a:  Outpatient Diagnostic Procedures/Tests - 20.0%/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/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/visit/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/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/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 - $17/service/16a:  Preventive Dental - Prophylaxis - $17/service/16a:  Preventive Dental - X-Rays - $17/service - priced as In-Network		17b:  Eye Glasses & Contact Lenses - $0 Per Year - priced as In-Network															5100	1.8485	0.0872	0.5174	0	0.2269	0.2802	0.0276	0.1736	1.0414	0	1.305	0	0.0007	0.2077	0.5548	0.8533	0.1269	0.2336	0	0.0091	0.2203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.7143	0	0.584629425	7.3861	0.348632562	1.861177147	0	1.363953903	1.494129934	0.145202701	1.236682798	5.721376715	0	5.444072912	0	0.00310209	0.94370259	2.280219298	3.536116908	0.396230487	0.92588791	0	0.036557402	0.952820392	0	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	37.3222
H5520_002_0	2011	6																															D	D	D	coin	T	coin	coin	V	V	P	coin	O	coin	P	V	V	V	V	coin	coin	coin	O	T	P	V	V	V	V	O	O											1.103457	0.018496669	0.413662865	0.146742915	0.137309203	0.273133774	0.071899211	0.506675498	1.157119017	0.177622419	0.78608234	0	0	0.391810804	0.111057192	0.891572884	0	0	0.031132227	0.198852013	0.216030838	0.005843131	0	0	0	0	0	0	0	0											6.6385	YES	520.4463536	20.13163704	211.4427134	8.121663974	164.9465916	15.11691878	3.97934872	330.9863104	441.728883	1224.07666	43.50667711	0	0.148927677	506.2003864	2414.825831	3184.527433	145.6686776	494.8635487	6.062755243	20.3982886	11.9564878	250	0	1457.128177	589.44	0	0	0	1650	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 1-8/9-90	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 15.0%	11b:  Prosthetics Devices - 15.0%/11b:  Medical Supplies - 15.0%/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) - $175/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $12/visit	8b:  Outpatient Diagnostic Radiological Services - 15.0%/8b:  Outpatient Therapeutic Radiological Services - 15.0%/8b:  Outpatient X-Ray Services - $12/visit		12:  Renal Dialysis - 15.0%	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/visit/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $12/visit/17a:  Vision Exams - $12/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $12/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $12/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $12/visit/18a:  Hearing Exams - $12/visit	15:  Medicare Part B Rx Drugs - Chemo - 15.0%/Medicare Part B Rx Drugs - Non-Chemo - 15.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $17/service/16a:  Preventive Dental - Prophylaxis - $17/service/16a:  Preventive Dental - X-Rays - $17/service	17a:  Routine Eye Exams - $10/visit	17b:  Eye Glasses & Contact Lenses - $0 Per Year			7b: Routine Chiro - $15/service/7g: Naturopathy - $15/service/13b: Acupuncture - $15/service/14a:  Nursing Hotline - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/												100	200	200	100	0	175	0.15	0.038542965	48.77482348	165.7913112	12	0.141699389	0	0.15	25	12	13.69510971	25	25	0	0.001741164	0.15	0	0	17.16041793	7.125407166	0	0	0	5.909090909	0											NO	161.4706107	161.4706107	80.73530535	0	141.2867844	0.121102958	0.03111778	39.37850267	133.8521214	9.688236642	0.114401435	0	0.121102958	20.18382634	9.688236642	11.05678864	20.18382634	20.18382634	0	0.001405734	0.121102958	0	0	17.16041793	7.125407166	0	0	0	5.909090909	0												7.0031	0.270888977	1.422574336	0	1.942064459	1.830703581	0.123828499	1.086145442	4.927195671	0.988262029	4.977226275	0	0.018035582	0.851421724	1.949617009	2.934220563	0.245012608	0.832353327	0	0.028674574	1.44796604	0	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	36.1255	0	7.8455	8.1065	0.289385647	1.836237201	0.146742915	2.079373662	2.103837354	0.19572771	1.59282094	6.084314688	1.165884448	5.763308615	0	0.018035582	1.243232528	2.0606742	3.825793448	0.245012608	0.832353327	0.031132227	0.227526587	1.663996878	0.005843131	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	42.764	YES	1a:  Acute - $225/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $225/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $0/$150/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 18.0%	11b:  Prosthetics Devices - 18.0%/11b:  Medical Supplies - 18.0%/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) - $200/visit/9b:  Ambulatory Surgical Center Services - $175/visit	8a:  Outpatient Diagnostic Procedures/Tests - 0%-18%/visit/8a:  Outpatient Lab Services - $20/visit	8b:  Outpatient Diagnostic Radiological Services - 18.0%/8b:  Outpatient Therapeutic Radiological Services - 18.0%/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 18.0%	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/visit/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/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/18a:  Hearing Exams - $20/visit	15:  Medicare Part B Rx Drugs - Chemo - 18.0%/Medicare Part B Rx Drugs - Non-Chemo - 18.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $17/service/16a:  Preventive Dental - Prophylaxis - $17/service/16a:  Preventive Dental - X-Rays - $17/service - priced as In-Network		17b:  Eye Glasses & Contact Lenses - $0 Per Year - priced as In-Network															5100	2.6034	0.0961	0.6487	0.0342	0.4283	0.4451	0.0387	0.2479	1.3258	0.282	1.6353	0	0.0053	0.316	0.6842	1.1437	0.1205	0.2933	0.0064	0.0489	0.4531	0.0012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.8581	0	1.3635	10.7099	0.385444885	2.484961927	0.180951835	2.50763192	2.548919577	0.234456659	1.840683994	7.410131375	1.447924982	7.398594349	0	0.023385566	1.559238701	2.74488986	4.969464493	0.365540744	1.125638421	0.037569494	0.276383419	2.117125574	0.006993972	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	53.6221
H5520_003_0	2011	4																															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											1.219601455	0.020514355	0.478332438	0.22921366	0.161113516	0.270902113	0.109262877	0.408193154	0.866385729	0.174412572	0.615985184	0	0	0.342947552	0.126944866	1.136375163	0	0	0.033555589	0.178557607	0.238905021	0.006045023	0	0	0	0	0	0	0	0											6.6172	YES	475.5426871	18.10954927	192.9361851	10.37565507	152.4189563	12.25384179	4.94568092	283.8934369	340.5991251	7.891118687	27.86983982	0	0	325.6921916	1993.71097	3031.266328	128.0908846	509.1324311	5.356690852	18.21010283	10.80995627	250	0	1457.128177	589.44	0	0	0	1650	0											2500	1a:  Acute - $175/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-8/9-90	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 15.0%	11b:  Prosthetics Devices - 15.0%/11b:  Medical Supplies - 15.0%/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) - $175/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - 0%-15%/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 - $12/visit		12:  Renal Dialysis - 15.0%	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/visit/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $12/visit/17a:  Vision Exams - $12/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $12/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $12/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $12/visit/18a:  Hearing Exams - $12/visit	15:  Medicare Part B Rx Drugs - Chemo - 15.0%/Medicare Part B Rx Drugs - Non-Chemo - 15.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $17/service/16a:  Preventive Dental - Prophylaxis - $17/service/16a:  Preventive Dental - X-Rays - $17/service	17a:  Routine Eye Exams - $10/visit	17b:  Eye Glasses & Contact Lenses - $0 Per Year			7b: Routine Chiro - $15/service/7g: Naturopathy - $15/service/13b: Acupuncture - $15/service/14a:  Nursing Hotline - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/												100	175	175	100	0	100	0.15	0.077305361	47.79256722	164.934477	0	0.148258598	0	0	25	12	13.5782443	25	25	0	0.001943733	0.15	0	0	17.16041793	7.125407166	0	0	0	5.909090909	0											NO	151.7434742	151.7480909	86.73050859	0	86.73110263	0.129833855	0.067279202	41.44799587	142.9751554	0	0.128437634	0	0	21.71432773	10.39469737	11.76416274	21.67637893	21.65939798	0	0.001682169	0.130007302	0	0	17.16041793	7.125407166	0	0	0	5.909090909	0												6.0134	0.229007461	1.394454455	0	1.101622012	1.590963521	0.332741466	0.980567833	4.058101069	0	3.579536295	0	0	0.589348916	1.727001847	2.971692534	0.231378879	0.918958496	0	0.030632477	1.405373254	0	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	30.401	0	4.173304549	7.233	0.249521816	1.872786893	0.22921366	1.262735528	1.861865635	0.442004343	1.388760988	4.924486798	0.174412572	4.195521479	0	0	0.932296468	1.853946713	4.108067697	0.231378879	0.918958496	0.033555589	0.209190084	1.644278275	0.006045023	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	37.0182	YES	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/$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 - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $175/visit	8a:  Outpatient Diagnostic Procedures/Tests - 20.0%/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/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/visit/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/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/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 - $17/service/16a:  Preventive Dental - Prophylaxis - $17/service/16a:  Preventive Dental - X-Rays - $17/service - priced as In-Network		17b:  Eye Glasses & Contact Lenses - $0 Per Year - priced as In-Network															5100	2.0924	0.0746	0.6384	0.0621	0.2256	0.3836	0.0894	0.2029	1.0239	0.0214	0.8345	0	0	0.2401	0.6	1.1525	0.1033	0.2937	0.0095	0.045	0.3815	0.001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.4755	0	0.524223382	9.3254	0.324127936	2.511190855	0.291325929	1.48834009	2.245479276	0.531392964	1.591671962	5.948390168	0.195796593	5.029975514	0	0	1.172440312	2.453947772	5.260547828	0.334628914	1.21263085	0.043078477	0.254223796	2.025823366	0.007064346	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	45.4937
H5520_004_0	2011	6																															D	D	D	coin	T	coin	coin	V	V	P	coin	O	coin	P	V	V	V	V	coin	coin	coin	O	T	P	V	V	V	V	O	O											1.199294811	0.020402291	0.440871502	0.203850482	0.1479575	0.321928884	0.092860435	0.388953088	0.886427128	0.179090946	0.663851854	0	0	0.319081454	0.134592498	1.141758601	0	0	0.038388302	0.205616335	0.230076819	0.006497071	0	0	0	0	0	0	0	0											6.6215	YES	528.1305286	20.14954507	213.5165924	10.24223731	162.8876074	16.17495334	4.665667705	305.7334128	396.9564289	1734.131084	33.35448693	0	0	292.6195726	2480.017878	3690.264161	145.284123	621.5678741	6.79538183	22.33916449	11.55995003	250	0	1457.128177	589.44	0	0	0	1650	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 1-8/9-90	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 15.0%	11b:  Prosthetics Devices - 15.0%/11b:  Medical Supplies - 15.0%/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) - $175/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - 0%-15%/visit/8a:  Outpatient Lab Services - $12/visit	8b:  Outpatient Diagnostic Radiological Services - 15.0%/8b:  Outpatient Therapeutic Radiological Services - 15.0%/8b:  Outpatient X-Ray Services - $12/visit		12:  Renal Dialysis - 15.0%	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/visit/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $12/visit/17a:  Vision Exams - $12/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $12/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $12/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $12/visit/18a:  Hearing Exams - $12/visit	15:  Medicare Part B Rx Drugs - Chemo - 15.0%/Medicare Part B Rx Drugs - Non-Chemo - 15.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $17/service/16a:  Preventive Dental - Prophylaxis - $17/service/16a:  Preventive Dental - X-Rays - $17/service	17a:  Routine Eye Exams - $10/visit	17b:  Eye Glasses & Contact Lenses - $0 Per Year			7b: Routine Chiro - $15/service/7g: Naturopathy - $15/service/13b: Acupuncture - $15/service/14a:  Nursing Hotline - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/												100	200	200	100	0	175	0.15	0.048284898	48.587013	164.1505954	12	0.150519661	0	0	25	12	13.62130346	25	25	0	0.002193568	0.15	0	0	17.16041793	7.125407166	0	0	0	5.909090909	0											NO	162.369413	162.369413	81.18470648	0	142.0732363	0.12177706	0.039199953	39.44522389	133.2651791	9.742164777	0.122198945	0	0	20.29617662	9.742164777	11.05841523	20.29617662	20.29617662	0	0.001780842	0.12177706	0	0	17.16041793	7.125407166	0	0	0	5.909090909	0												7.146	0.27263915	1.444523491	0	1.928497462	1.969738259	0.182893954	1.00497691	4.408372465	1.407849231	4.075883109	0	0	0.494921544	2.013395235	3.400706117	0.245726018	1.051287613	0	0.039782516	1.407736726	0	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	35.7412	0	7.531	8.3453	0.293041441	1.885394992	0.203850482	2.076454962	2.291667143	0.275754388	1.393929998	5.294799592	1.586940176	4.739734962	0	0	0.814002998	2.147987733	4.542464719	0.245726018	1.051287613	0.038388302	0.245398851	1.637813545	0.006497071	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	42.3627	YES	1a:  Acute - $225/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $225/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $0/$150/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 18.0%	11b:  Prosthetics Devices - 18.0%/11b:  Medical Supplies - 18.0%/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) - $200/visit/9b:  Ambulatory Surgical Center Services - $175/visit	8a:  Outpatient Diagnostic Procedures/Tests - 0%-18%/visit/8a:  Outpatient Lab Services - $20/visit	8b:  Outpatient Diagnostic Radiological Services - 18.0%/8b:  Outpatient Therapeutic Radiological Services - 18.0%/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 18.0%	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/visit/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/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/18a:  Hearing Exams - $20/visit	15:  Medicare Part B Rx Drugs - Chemo - 18.0%/Medicare Part B Rx Drugs - Non-Chemo - 18.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $17/service/16a:  Preventive Dental - Prophylaxis - $17/service/16a:  Preventive Dental - X-Rays - $17/service - priced as In-Network		17b:  Eye Glasses & Contact Lenses - $0 Per Year - priced as In-Network															5100	2.4413	0.0882	0.6585	0.0539	0.3867	0.4505	0.052	0.2116	1.1251	0.3674	0.9248	0	0	0.2098	0.7046	1.3011	0.1107	0.3393	0.0107	0.0528	0.3726	0.0011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.8627	0	0.9405	10.7866	0.381203953	2.543928129	0.257731083	2.463124293	2.742214534	0.327799949	1.605527155	6.419905801	1.954294008	5.664509034	0	0	1.023814736	2.852598943	5.843531495	0.356432584	1.390542445	0.049123278	0.298244545	2.010405175	0.007646897	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	52.2254
H5520_005_0	2011	6																															D	D	D	coin	T	coin	coin	V	coin	P	coin	O	coin	P	V	V	V	V	coin	coin	coin	O	T	P	V	V	V	V	O	O											1.8864399	0.055723129	0	0.231330837	0.254939502	0.528052529	0.126412134	1.176238765	1.778444926	0.396611517	1.400248143	0	0	0.662774671	0.225689579	1.681197702	0	0	0.066579359	0.482545695	0.31879112	0.013637572	0	0	0	0	0	0	0	0											11.2857	YES	349.7632453	20.97502384	129.395597	4.939224562	125.7667647	11.24763098	2.697448373	338.5381808	37.98950899	974.5041614	29.87161562	0	0.357952824	364.2243685	2001.545368	2657.926824	167.8739023	353.4034838	5.074236622	17.89846467	6.807747429	250	0	0	0	0	0	0	1650	0											3000	1a:  Acute - $280/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $280/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $250/trip	11a:  Durable Medical Equipment - 15.0%	11b:  Prosthetics Devices - 15.0%/11b:  Medical Supplies - 15.0%/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) - 15.0%/9b:  Ambulatory Surgical Center Services - 12.0%	8a:  Outpatient Diagnostic Procedures/Tests - 0%-15%/visit/8a:  Outpatient Lab Services - $15/visit	8b:  Outpatient Diagnostic Radiological Services - 15.0%/8b:  Outpatient Therapeutic Radiological Services - 15.0%/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 15.0%	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/visit/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $15/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $15/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $15/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $15/visit/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 15.0%/Medicare Part B Rx Drugs - Non-Chemo - 15.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							7b: Routine Chiro - $15/service/7g: Naturopathy - $15/service/13b: Acupuncture - $15/service/14a:  Nursing Hotline - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/												175	280	280	100	0	250	0.15	0.017741866	48.91003073	0.143765757	15	0.153892512	0	0.15	25	15	16.10949993	25	25	0	0.003018452	0.15	0	0	0	0	0	0	0	5.909090909	0											NO	243.3817092	243.6619334	86.87092172	0	217.4001871	0.130402196	0.015364419	42.55910854	0.124889174	13.03915245	0.133747065	0	0.130694935	21.72960592	13.04420613	14.00913918	21.75742467	21.72914152	0	0.002627302	0.130317444	0	0	0	0	0	0	0	5.909090909	0												7.0938	0.425901239	0.936726232	0	2.278476516	1.466715779	0.041444726	1.200656932	4.744478393	1.058892361	3.995240902	0	0.046782621	0.659537666	2.175714198	3.102938901	0.304375315	0.639929526	0	0.047024665	0.887168244	0	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	31.9183	0	4.678492492	8.9803	0.481624368	0.936726232	0.231330837	2.533416017	1.994768308	0.16785686	2.376895697	6.522923319	1.455503878	5.395489045	0	0.046782621	1.322312338	2.401403777	4.784136603	0.304375315	0.639929526	0.066579359	0.52957036	1.205959363	0.013637572	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	43.204	YES	1a:  Acute - $280/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $280/$0/day for 1-7/8-190	2:  Skilled Nursing Services - $0/$150/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 - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 17.0%/9b:  Ambulatory Surgical Center Services - 15.0%	8a:  Outpatient Diagnostic Procedures/Tests - 0%-20%/visit/8a:  Outpatient Lab Services - $20/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/visit/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/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/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																			5100	2.4352	0.135	0.353	0.0711	0.5029	0.4139	0.0297	0.3468	1.2698	0.2639	1.4452	0	0.0148	0.2952	0.6458	1.1906	0.1413	0.2216	0.0139	0.1111	0.3323	0.0027	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.2359	0	0.844911222	11.4155	0.616647205	1.289772121	0.30241983	3.036323354	2.408643659	0.197580339	2.723733241	7.792702432	1.719360275	6.840691234	0	0.061606636	1.617535961	3.047163908	5.974782088	0.445630159	0.861545078	0.080454314	0.640672204	1.538299005	0.016350036	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	53.4399
H5520_006_0	2011	6																															D	D	D	coin	T	coin	coin	V	coin	P	coin	O	coin	P	V	V	V	V	coin	coin	coin	O	T	P	V	V	V	V	O	O											2.24534154	0.043063268	0	0.377064354	0.304209726	0.560629078	0.164840402	0.807502547	1.715357703	0.329640193	1.121230694	0	0	0.561101821	0.252996131	1.998933113	0	0	0.067199559	0.350458222	0.359549797	0.010041641	0	0	0	0	0	0	0	0											11.2692	YES	389.6978335	15.30946159	318.8063814	7.413557501	132.9513332	11.38051332	3.380511436	236.6835144	33.86666621	1233.045043	22.78934379	0	0	252.4894714	1754.133306	2674.107261	117.512959	387.4215813	4.814975152	15.25380781	7.599474449	250	0	0	0	0	0	0	1650	0											3000	1a:  Acute - $280/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $280/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $250/trip	11a:  Durable Medical Equipment - 15.0%	11b:  Prosthetics Devices - 15.0%/11b:  Medical Supplies - 15.0%/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) - 15.0%/9b:  Ambulatory Surgical Center Services - 12.0%	8a:  Outpatient Diagnostic Procedures/Tests - 0%-15%/visit/8a:  Outpatient Lab Services - $15/visit	8b:  Outpatient Diagnostic Radiological Services - 15.0%/8b:  Outpatient Therapeutic Radiological Services - 15.0%/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 15.0%	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/visit/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $15/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $15/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $15/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $15/visit/18a:  Hearing Exams - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - 15.0%/Medicare Part B Rx Drugs - Non-Chemo - 15.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							7b: Routine Chiro - $15/service/7g: Naturopathy - $15/service/13b: Acupuncture - $15/service/14a:  Nursing Hotline - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/												175	280	280	100	0	250	0.15	0.043219017	48.59492723	0.141047187	15	0.163211828	0	0	25	15	16.03738421	25	25	0	0.003333428	0.15	0	0	0	0	0	0	0	5.909090909	0											NO	242.7657932	242.8214072	86.97608013	0	216.8152882	0.129896595	0.0373813	42.11716322	0.122260835	12.99661343	0.141359202	0	0	21.68564612	12.99619975	13.89715113	21.6800765	21.63586862	0	0.002891791	0.129719686	0	0	0	0	0	0	0	5.909090909	0												7.8838	0.30978875	2.310710781	0	2.402156801	1.478289928	0.126367911	0.830703184	4.140566905	1.335450814	3.221483449	0	0	0.45628311	1.899755569	3.096872728	0.212307495	0.69851687	0	0.04411082	0.985801438	0	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	32.2454	0	4.828219052	10.1291	0.352852019	2.310710781	0.377064354	2.706366527	2.038919006	0.291208312	1.63820573	5.855924609	1.665091006	4.342714143	0	0	1.017384932	2.1527517	5.095805842	0.212307495	0.69851687	0.067199559	0.394569042	1.345351235	0.010041641	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	43.5146	YES	1a:  Acute - $280/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $280/$0/day for 1-7/8-190	2:  Skilled Nursing Services - $0/$150/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 - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 17.0%/9b:  Ambulatory Surgical Center Services - 15.0%	8a:  Outpatient Diagnostic Procedures/Tests - 0%-20%/visit/8a:  Outpatient Lab Services - $20/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/visit/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/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/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							14a:  Health Education/Wellness - $0-$15/service/												5100	2.5737	0.0923	0.8898	0.1593	0.4759	0.3832	0.0516	0.2191	1.0807	0.2945	0.7754	0	0	0.2321	0.5829	1.2265	0.0949	0.2262	0.0193	0.0821	0.285	0.0016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.7462	0	0.69744367	12.7029	0.445149346	3.200545321	0.536389763	3.182288013	2.422158435	0.342780824	1.857298099	6.936649546	1.959624151	5.118074399	0	0	1.249443954	2.735660931	6.322300739	0.307250092	0.924695747	0.086472133	0.476620445	1.630384144	0.011651863	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	53.2608
H5520_009_0	2011	5																															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	506.8694925	19.77512639	202.7930517	7.832723434	152.7419661	14.51060347	3.714959527	316.5270491	432.4273864	11.12567773	44.93819513	0	0.125216043	499.8777647	2379.130093	3124.56702	139.5658465	479.7646657	5.785914015	18.9401014	10.57370954	250	0	1457.128177	589.44	0	0	0	1750	0											1750	1a:  Acute - $125/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $125/$0/day for 1-8/9-90	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $75/trip	11a:  Durable Medical Equipment - 12.0%	11b:  Prosthetics Devices - 12.0%/11b:  Medical Supplies - 12.0%/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 - $50/visit	8a:  Outpatient Diagnostic Procedures/Tests - 0%-12%/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 12.0%/8b:  Outpatient Therapeutic Radiological Services - 12.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 12.0%	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/visit/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $10/visit/18a:  Hearing Exams - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - 12.0%/Medicare Part B Rx Drugs - Non-Chemo - 12.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $17/service/16a:  Preventive Dental - Prophylaxis - $17/service/16a:  Preventive Dental - X-Rays - $17/service	17a:  Routine Eye Exams - $10/visit	17b:  Eye Glasses & Contact Lenses - $0 Per Year	/18a:  Fitting for Hearing Aid - $0/visit	"18b:  Hearing Aids - $0/service, $250 Per Three Years"	7b: Routine Chiro - $15/service/7g: Naturopathy - $15/service/13b: Acupuncture - $15/service/14a:  Nursing Hotline - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/												0	125	125	75	0	75	0.12	0.02978236	47.83370622	81.01868704	0	0.089990907	0	0.12	25	10	12.05376387	25	25	0	0.001564219	0.12	0	0	17.16041793	7.125407166	0	0	0	5.571428571	0											NO	104.7916717	104.7916717	62.87500299	0	62.87500299	0.100600005	0.024967547	40.10059229	67.9206692	0	0.07544238	0	0.100600005	20.95833433	8.383333732	10.10507252	20.95833433	20.95833433	0	0.001311337	0.100600005	0	0	17.16041793	7.125407166	0	0	0	5.571428571	0												4.4263	0.172689046	1.062551144	0	0.800304298	1.459766779	0.092753425	1.057743512	2.447563122	0	3.390244409	0	0.012596735	0.873050443	1.662086797	2.631164695	0.243755639	0.837922355	0	0.024836863	1.06371523	0	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	25.5053	0	4.2925	4.4263	0.172689046	1.062551144	0	0.800304298	1.459766779	0.092753425	1.057743512	2.447563122	0	3.390244409	0	0.012596735	0.873050443	1.662086797	2.631164695	0.243755639	0.837922355	0	0.024836863	1.06371523	0	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	25.5053	YES	1a:  Acute - $125/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $125/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $75/trip	11a:  Durable Medical Equipment - 12.0%	11b:  Prosthetics Devices - 12.0%/11b:  Medical Supplies - 12.0%/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) - $100/visit/9b:  Ambulatory Surgical Center Services - $50/visit	8a:  Outpatient Diagnostic Procedures/Tests - 0%-12%/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 12.0%/8b:  Outpatient Therapeutic Radiological Services - 12.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 12.0%	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/visit/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/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/18a:  Hearing Exams - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - 12.0%/Medicare Part B Rx Drugs - Non-Chemo - 12.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $17/service/16a:  Preventive Dental - Prophylaxis - $17/service/16a:  Preventive Dental - X-Rays - $17/service - priced as In-Network		17b:  Eye Glasses & Contact Lenses - $0 Per Year - priced as In-Network	/18a:  Fitting for Hearing Aid - $0/visit	"18b:  Hearing Aids - $0/service, $250/Per Three Years"													3500	1.3787	0.0538	0.2823	0	0.1814	0.2911	0.0185	0.189	0.5147	0	0.7592	0	0.0032	0.2648	0.3627	0.6742	0.1247	0.3071	0	0.0059	0.2727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.684	0	0.507	5.805	0.226477339	1.344825813	0	0.9816897	1.750818783	0.111246838	1.246711758	2.96231293	0	4.149492547	0	0.015817443	1.137812316	2.024792946	3.305380748	0.368491582	1.145052878	0	0.030780517	1.336390324	0	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	31.1893
H5520_010_0	2011	5																															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	505.0847836	19.16797481	200.2128179	9.110636517	164.8392382	16.85272248	4.917884995	322.4127073	384.1860427	9.539498918	35.05468725	0	0	286.3116029	2355.065028	3479.964097	133.5377496	577.7847411	6.316305539	20.89263381	13.88919762	250	0	1457.128177	589.44	0	0	0	1750	0											1750	1a:  Acute - $120/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $120/$0/day for 1-8/9-90	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 12.0%	11b:  Prosthetics Devices - 12.0%/11b:  Medical Supplies - 12.0%/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) - $125/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - 0%-12%/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 12.0%/8b:  Outpatient Therapeutic Radiological Services - 12.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 12.0%	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/visit/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $10/visit/18a:  Hearing Exams - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - 12.0%/Medicare Part B Rx Drugs - Non-Chemo - 12.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $17/service/16a:  Preventive Dental - Prophylaxis - $17/service/16a:  Preventive Dental - X-Rays - $17/service	17a:  Routine Eye Exams - $10/visit	17b:  Eye Glasses & Contact Lenses - $0 Per Year	/18a:  Fitting for Hearing Aid - $0/visit	"18b:  Hearing Aids - $0/service, $250 Per Three Years"	7b: Routine Chiro - $15/service/7g: Naturopathy - $15/service/13b: Acupuncture - $15/service/14a:  Nursing Hotline - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/												0	120	120	100	0	100	0.12	0.040849844	47.52150261	114.1460087	0	0.089761084	0	0	25	10	11.96434788	25	25	0	0.001837897	0.12	0	0	17.16041793	7.125407166	0	0	0	5.571428571	0											NO	99.49090101	99.49090101	82.90908417	0	82.90908417	0.099490901	0.033868232	39.3996426	94.63741046	0	0.074420093	0	0	20.72727104	8.290908417	9.919531251	20.72727104	20.72727104	0	0.001523784	0.099490901	0	0	17.16041793	7.125407166	0	0	0	5.571428571	0												4.1876	0.158919924	1.383288447	0	1.13888919	1.676692544	0.166560069	1.058578786	3.029864351	0	2.608773084	0	0	0.494538183	1.627135706	2.876634384	0.230656094	0.997991744	0	0.031835855	1.381848785	0	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	26.2961	0	4.7515	4.1876	0.158919924	1.383288447	0	1.13888919	1.676692544	0.166560069	1.058578786	3.029864351	0	2.608773084	0	0	0.494538183	1.627135706	2.876634384	0.230656094	0.997991744	0	0.031835855	1.381848785	0	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	26.2961	YES	1a:  Acute - $120/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $120/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 12.0%	11b:  Prosthetics Devices - 12.0%/11b:  Medical Supplies - 12.0%/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) - $125/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - 0%-12%/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 12.0%/8b:  Outpatient Therapeutic Radiological Services - 12.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 12.0%	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/visit/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $10/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/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/18a:  Hearing Exams - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - 12.0%/Medicare Part B Rx Drugs - Non-Chemo - 12.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $17/service/16a:  Preventive Dental - Prophylaxis - $17/service/16a:  Preventive Dental - X-Rays - $17/service - priced as In-Network		17b:  Eye Glasses & Contact Lenses - $0 Per Year - priced as In-Network	/18a:  Fitting for Hearing Aid - $0/visit	"18b:  Hearing Aids - $0/service, $250/Per Three Years"													3500	1.2194	0.0463	0.3831	0	0.2158	0.2861	0.0284	0.1659	0.6146	0	0.3908	0	0	0.1594	0.3648	0.7309	0.1127	0.3492	0	0.0076	0.2424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.3172	0	0.405	5.407	0.20519495	1.766342638	0	1.354663363	1.962830707	0.194984596	1.224480767	3.644446168	0	2.999599448	0	0	0.653906215	1.991953982	3.607546812	0.343316608	1.347144926	0	0.039419759	1.624243631	0	0	2.083744041	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	31.6133
H5520_807_0	2011	1																															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	YES	185.6508503	3.15890158	22.35759907	8.301021056	7.518024542	14.98383848	3.7902132	21.09665202	59.88555586	9.90634193	42.77467093	0	0.103817727	19.82624773	31.02549016	87.34402497	1.054103383	4.416854868	5.618554255	19.27926805	11.57901549	0.309710068	0	0	0	0	0	0	500	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.083092101	0.083092101	0.12765981	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.225849597	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070378182	0.070378182	0.108126587	0	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0	0.197348678	0.197348678	0.191292358	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0	0	0	0	0	0	0	0												13.0658	0.222317749	2.417450876	0	1.483672207	2.95704072	0.747993565	4.163396394	11.8183353	1.955003487	8.441524774	0	0.020488291	3.912683786	5.934939166	17.23722789	0.208025909	0.87166047	1.108814256	3.804738068	2.285103403	0.061120873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.7173	0	14.943	13.0658	0.222317749	2.417450876	0	1.483672207	2.95704072	0.747993565	4.163396394	11.8183353	1.955003487	8.441524774	0	0.020488291	3.912683786	5.934939166	17.23722789	0.208025909	0.87166047	1.108814256	3.804738068	2.285103403	0.061120873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.7173	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	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS											10000	2.9456	0.0501	0.5618	0	0.2707	0.5384	0.1362	0.6241	2.1908	0.2756	1.6916	0	0.005	0.7545	1.3764	3.811	0.0506	0.2118	0.2857	0.9087	0.5103	0.0136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.2126	0	1.7235	16.0113	0.272417464	2.979300395	0	1.754397214	3.495458649	0.884188222	4.787474674	14.00916385	2.230600523	10.13311229	0	0.025463937	4.66719974	7.311346293	21.04818258	0.258631023	1.083501432	1.394466076	4.713466927	2.795438739	0.074718056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9299
H5520_808_0	2011	1																															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	YES	185.6508503	3.15890158	22.35759907	8.301021056	7.518024542	14.98383848	3.7902132	21.09665202	59.88555586	9.90634193	42.77467093	0	0.103817727	19.82624773	31.02549016	87.34402497	1.054103383	4.416854868	5.618554255	19.27926805	11.57901549	0.309710068	0	0	0	0	0	0	500	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.083092101	0.083092101	0.12765981	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.225849597	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070378182	0.070378182	0.108126587	0	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0	0.197348678	0.197348678	0.191292358	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0	0	0	0	0	0	0	0												13.0658	0.222317749	2.417450876	0	1.483672207	2.95704072	0.747993565	4.163396394	11.8183353	1.955003487	8.441524774	0	0.020488291	3.912683786	5.934939166	17.23722789	0.208025909	0.87166047	1.108814256	3.804738068	2.285103403	0.061120873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.7173	0	14.943	13.0658	0.222317749	2.417450876	0	1.483672207	2.95704072	0.747993565	4.163396394	11.8183353	1.955003487	8.441524774	0	0.020488291	3.912683786	5.934939166	17.23722789	0.208025909	0.87166047	1.108814256	3.804738068	2.285103403	0.061120873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.7173	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	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS											10000	2.9456	0.0501	0.5618	0	0.2707	0.5384	0.1362	0.6241	2.1908	0.2756	1.6916	0	0.005	0.7545	1.3764	3.811	0.0506	0.2118	0.2857	0.9087	0.5103	0.0136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.2126	0	1.7235	16.0113	0.272417464	2.979300395	0	1.754397214	3.495458649	0.884188222	4.787474674	14.00916385	2.230600523	10.13311229	0	0.025463937	4.66719974	7.311346293	21.04818258	0.258631023	1.083501432	1.394466076	4.713466927	2.795438739	0.074718056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9299
H5520_809_0	2011	1																															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	YES	185.6508503	3.15890158	22.35759907	8.301021056	7.518024542	14.98383848	3.7902132	21.09665202	59.88555586	9.90634193	42.77467093	0	0.103817727	19.82624773	31.02549016	87.34402497	1.054103383	4.416854868	5.618554255	19.27926805	11.57901549	0.309710068	0	0	0	0	0	0	500	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.083092101	0.083092101	0.12765981	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.225849597	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070378182	0.070378182	0.108126587	0	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0	0.197348678	0.197348678	0.191292358	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0.197348678	0	0	0	0	0	0	0	0												13.0658	0.222317749	2.417450876	0	1.483672207	2.95704072	0.747993565	4.163396394	11.8183353	1.955003487	8.441524774	0	0.020488291	3.912683786	5.934939166	17.23722789	0.208025909	0.87166047	1.108814256	3.804738068	2.285103403	0.061120873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.7173	0	14.943	13.0658	0.222317749	2.417450876	0	1.483672207	2.95704072	0.747993565	4.163396394	11.8183353	1.955003487	8.441524774	0	0.020488291	3.912683786	5.934939166	17.23722789	0.208025909	0.87166047	1.108814256	3.804738068	2.285103403	0.061120873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.7173	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	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS											10000	2.9456	0.0501	0.5618	0	0.2707	0.5384	0.1362	0.6241	2.1908	0.2756	1.6916	0	0.005	0.7545	1.3764	3.811	0.0506	0.2118	0.2857	0.9087	0.5103	0.0136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.2126	0	1.7235	16.0113	0.272417464	2.979300395	0	1.754397214	3.495458649	0.884188222	4.787474674	14.00916385	2.230600523	10.13311229	0	0.025463937	4.66719974	7.311346293	21.04818258	0.258631023	1.083501432	1.394466076	4.713466927	2.795438739	0.074718056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9299
H5521_012_0	2011	4																															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	1461.852342	33.0263604	1110.85953	854.1783186	225.8238973	12.93169152	0	265.9079786	372.6957857	4086.794486	2142.882126	55.77691808	0.681820675	762.911211	2966.593137	5184.579083	215.9082332	775.0497985	0	0	309.377579	0	0	0	1141.534578	106.3864523	54.20724948	0	0	0											6700	$250/day 1-7	$250/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100"	$0 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$0 per visit	$35 X-ray; $200 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	"$10 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$35 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$35 per visit	$35 per visit	$40 per visit	$35 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	180.7137695	180.7137695	71.93854446	0	150	0.05	0.05	49	200	0	21.625	35	25	35	10	35	35	26.25	40	35	$50 	0	0	0	0	0	0	0	0	0											NO	165.409077	165.409077	65.84605187	0	137.296464	0.045765488	0.045765488	44.85017824	183.061952	0	19.79357356	32.0358416	22.882744	32.0358416	9.153097601	32.0358416	32.0358416	24.0268812	36.6123904	32.0358416	45.765488	0	0	0	0	0	0	0	0	0												20.1503	0.455238316	6.095476184	0	2.583735216	0.591825173	0	0.99383502	5.685534837	0	3.534607916	0.148905043	0.001300161	2.036708559	2.262793043	13.84102952	0.576400163	1.551835786	0	0	1.179901323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6894	0	5.707895695	20.1503	0.455238316	6.095476184	0	2.583735216	0.591825173	0	0.99383502	5.685534837	0	3.534607916	0.148905043	0.001300161	2.036708559	2.262793043	13.84102952	0.576400163	1.551835786	0	0	1.179901323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6894	YES	$250 ded; 20% coinsurance; $10000 max OOP	$250 ded; 20% coinsurance; $10000 max OOP	$250 ded; 20% coinsurance; $10000 max OOP	$250 ded; 20% coinsurance; $10000 max OOP	$150 per trip	$250 ded; 20% coinsurance; $10000 max OOP	$250 ded; 20% coinsurance; $10000 max OOP	$50 Emer Rm; $40 Urgent Care Ctr	$250 ded; 20% coinsurance; $10000 max OOP	$250 ded; 20% coinsurance; $10000 max OOP	$250 ded; 20% coinsurance; $10000 max OOP	$250 ded; 20% coinsurance; $10000 max OOP	$25 per visit	$250 ded; 20% coinsurance; $10000 max OOP	$250 ded; 20% coinsurance; $10000 max OOP	$250 ded; 20% coinsurance; $10000 max OOP	$250 ded; 20% coinsurance; $10000 max OOP	$250 ded; 20% coinsurance; $10000 max OOP	$250 ded; 20% coinsurance; $10000 max OOP	$250 ded; 20% coinsurance; $10000 max OOP	$250 ded; 20% coinsurance; $10000 max OOP		Not Covered	0	$250 ded; 20% coinsurance; $10000 max OOP	$50.00 Every 2 Years	$250 ded; 20% coinsurance; $10000 max OOP	Not Covered	0	0	0	0	0	0	0	0	0	0	0	0	10000	7.6332	0.0609	1.147	0.1902	0.3644	0.3469	0	0.1709	1.1469	0.6108	1.5347	0.0208	0.0002	0.7646	0.8775	2.8897	0.0708	0.2343	0	0	2.2057	0	0	0	0.1953	0	0.0105	0	0	0	0	0	0	0	0	0	0	0	0	0	20.4755	250	3.00580716	27.7835	0.516144707	7.24247542	0.190193507	2.948178621	0.938709497	0	1.164740816	6.832428583	0.610835358	5.06928258	0.169729284	0.001535839	2.801304382	3.140300298	16.73073522	0.647215897	1.786175656	0	0	3.385611346	0	0	0	0.195331945	0	0.010469427	0	0	0	0	0	0	0	0	0	0	0	0	0	82.1649
H5521_013_0	2011	4																															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	1197.204009	144.6494755	740.3197895	786.6813315	172.915147	9.751510216	0	252.5894214	334.7921895	3191.011503	2210.081183	87.971355	19.83557888	365.6368209	2703.824135	4902.087874	444.6972326	962.0072947	0	0	234.8231806	0	0	0	1210.867168	86.59481236	63.32903161	12.26442963	77.32902858	0											6700	$175/day 1-7	$175/day 1-7	"$0/d 1-4, $50/d 5-20, $125/d 21-100"	$0 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 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; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$30 per visit; Chiropractic Visits $30 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$30 per visit	$30 per visit	$40 per visit	$30 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	126.4996386	126.4996386	71.93854446	0	150	0.05	0.05	49	175	4.5	18.625	30	25	30	10	30	30	22.5	40	30	$50 	0	0	0	0	0	0	0	0	0											NO	114.7262999	114.7262999	65.24321423	0	136.0394794	0.045346493	0.045346493	44.43956326	158.7127259	4.081184381	16.89156869	27.20789587	22.67324656	27.20789587	9.069298625	27.20789587	27.20789587	20.40592191	36.2771945	27.20789587	45.34649312	0	0	0	0	0	0	0	0	0												11.4459	1.382924925	4.025070219	0	1.960273881	0.442196791	0	0.935413631	4.427981751	1.085258859	3.110978175	0.199459622	0.037478081	0.829017379	2.043482376	11.1146247	1.008273	1.635887144	0	0	0.887367312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5716	0	4.779227323	11.4459	1.382924925	4.025070219	0	1.960273881	0.442196791	0	0.935413631	4.427981751	1.085258859	3.110978175	0.199459622	0.037478081	0.829017379	2.043482376	11.1146247	1.008273	1.635887144	0	0	0.887367312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5716	YES	$1000 ded; 35% coinsurance; $10000 max OOP	$1000 ded; 35% coinsurance; $10000 max OOP	$1000 ded; 35% coinsurance; $10000 max OOP	$1000 ded; 35% coinsurance; $10000 max OOP	$150 copay	$1000 ded; 35% coinsurance; $10000 max OOP	$1000 ded; 35% coinsurance; $10000 max OOP	$50 Emer Rm; $40 Urgent Care Ctr	$1000 ded; 35% coinsurance; $10000 max OOP	$1000 ded; 35% coinsurance; $10000 max OOP	$1000 ded; 35% coinsurance; $10000 max OOP	$1000 ded; 35% coinsurance; $10000 max OOP	$25 copay	$1000 ded; 35% coinsurance; $10000 max OOP	$1000 ded; 35% coinsurance; $10000 max OOP	$1000 ded; 35% coinsurance; $10000 max OOP	$1000 ded; 35% coinsurance; $10000 max OOP	$1000 ded; 35% coinsurance; $10000 max OOP	$1000 ded; 35% coinsurance; $10000 max OOP	$1000 ded; 35% coinsurance; $10000 max OOP	$1000 ded; 35% coinsurance; $10000 max OOP		0	0	0	$50.00 Every 2 Years	0	Not Covered	Not Covered	0											10000	10.3816	0.3668	1.2196	0.2692	0.2838	0.436	0	0.2394	1.4285	0.9339	2.4545	0.0786	1.4497	0.9524	1.2458	5.1039	0.2683	0.4688	0	0	1.947	0	0	0	0	0.0076	0	0	0	0											29.5353	1000	8.894360655	21.8275	1.749731671	5.244669131	0.269154932	2.244059201	0.878210496	0	1.174814895	5.856516631	2.019110676	5.565509604	0.278063579	1.48719409	1.781373969	3.289250527	16.21852749	1.276533872	2.104714016	0	0	2.834406506	0	0	0	0	0.007587285	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.1069
H5521_015_0	2011	4																															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	1337.39159	89.07773256	949.0231773	737.2065234	199.9120139	11.53237051	0	240.5564883	344	2563.915709	2225.88435	55.47068102	2.238204586	0	2903.014245	4793.717294	251.1402652	630.7823411	0	0	239.08	0	0	0	1097.616127	86.43844963	53.46360728	0	0	0											6700	$200/day 1-7	$200/day 1-7	"$0/d 1-10, $50/d 11-20, $100/d 21-100"	$0 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 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; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$35 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$35 per visit	$35 per visit	$50 per visit	$35 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	144.5710156	144.5710156	51.87372562	0	150	0.05	0.05	49	250	5.25	22.75	35	25	35	15	35	35	26.25	50	35	$50 	0	0	0	0	0	0	0	0	0											NO	128.445647	128.445647	46.08775985	0	133.2690856	0.044423029	0.044423029	43.53456795	222.1151426	4.664417995	20.21247798	31.09611996	22.21151426	31.09611996	13.32690856	31.09611996	31.09611996	23.32208997	44.42302852	31.09611996	44.42302852	0	0	0	0	0	0	0	0	0												14.3152	0.953470582	3.644862691	0	2.220174274	0.512302824	0	0.872710232	6.367300755	0.996597881	3.749219866	0.143743579	0.004142826	0	3.224017115	12.42216734	0.650790651	1.225930209	0	0	0.885054805	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1877	0	6.551761949	14.3152	0.953470582	3.644862691	0	2.220174274	0.512302824	0	0.872710232	6.367300755	0.996597881	3.749219866	0.143743579	0.004142826	0	3.224017115	12.42216734	0.650790651	1.225930209	0	0	0.885054805	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1877	YES	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$150 per trip	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$50 Emer Rm; $40 Urgent Care Ctr	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$25 per visit	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP		Not Covered	0	$750 ded; 30% coinsurance; $10000 max OOP	$50.00 Every 2 Years	$750 ded; 30% coinsurance; $10000 max OOP	Not Covered	Not Covered	0	0	0	0	0	0	0	0	0	0	0	10000	11.6166	0.2371	1.484	0.2946	0.3265	0.4468	0	0.1994	1.5286	0.6848	2.2127	0.0392	0.0011	1.019	1.0401	4.9772	0.1346	0.317	0	0	2.6442	0	0	0	0.325	0	0.0218	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5503	750	7.337370628	25.9318	1.190614906	5.128873941	0.294648703	2.546636385	0.959083085	0	1.072094551	7.895856468	1.681361041	5.961957685	0.182921745	0.005199414	1.019037143	4.26410879	17.39938586	0.785379273	1.542960141	0	0	3.529236504	0	0	0	0.324985382	0	0.021804933	0	0	0	0	0	0	0	0	0	0	0	0	0	81.7379
H5521_016_0	2011	4																															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	1345.189334	93.38793063	867.8234725	566.2138845	184.2964412	10.21406843	0	234.5506716	318.5621774	2844.420414	2159.634825	41.8153035	0.871174546	527.126944	2915.989531	4708.42858	348.8946374	898.8938693	0	0	213.1169088	0	0	0	902.0529056	0	34.20391716	7.509948477	51.60009019	0											6700	$200/day 1-8	$200/day 1-8	"$0/d 1-4, $50/d 5-20, $105/d 21-100"	$0 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$250 per procedure	$40 per visit	$50 X-ray; $250 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$10 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$50 per visit	$40 per visit	$50 per script		Not Covered		$0 per visit	Not Covered	$0 per visit	$300.00 Every 3 Yrs	Fitness Only												0	152.3663772	152.3663772	63.87227671	0	150	0.05	0.05	49	250	6	30	40	25	40	10	40	40	30	50	40	$50 	0	0	0	0	0	0	0	0	0											NO	130.9970218	130.9970218	54.91420208	0	128.9625286	0.04298751	0.04298751	42.12775934	214.9375477	5.158501144	25.79250572	34.39000762	21.49375477	34.39000762	8.597501906	34.39000762	34.39000762	25.79250572	42.98750953	34.39000762	42.98750953	0	0	0	0	0	0	0	0	0												14.6846	1.019461732	3.971319461	0	1.980611256	0.439077364	0	0.823424521	5.705914432	1.222745497	4.641866132	0.119835717	0.001560401	1.510658302	2.089185463	13.49357456	0.999874103	1.932060439	0	0	0.763447096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.3993	0	9.037202445	14.6846	1.019461732	3.971319461	0	1.980611256	0.439077364	0	0.823424521	5.705914432	1.222745497	4.641866132	0.119835717	0.001560401	1.510658302	2.089185463	13.49357456	0.999874103	1.932060439	0	0	0.763447096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.3993	YES	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$150 copay	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$50 Emer Rm; $40 Urgent Care Ctr	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$25 copay	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP		Not Covered		$500 ded; 35% coinsurance; $10000 max OOP	Not Covered	$500 ded; 35% coinsurance; $10000 max OOP	$300.00 Every 3 Yrs	0												10000	14.318	0.2559	1.781	0.3452	0.3407	0.5242	0	0.2063	1.7383	0.9338	2.5635	0.0303	0.0004	1.1588	1.7949	5.6281	0.2188	0.4986	0	0	2.4553		0		0.3664	0.0036	0.0165	0.0029	0												35.1817	500	11.95881283	29.0027	1.275388262	5.752313931	0.345222124	2.321348116	0.963287337	0	1.029708247	7.444170295	2.156575889	7.205407957	0.150121629	0.001997202	2.669495543	3.884121195	19.12164205	1.21864948	2.430703381	0	0	3.218739691	0	0	0	0.366396403	0.003552255	0.016506822	0.00293418	0	0	0	0	0	0	0	0	0	0	0	0	90.5809
H5521_020_0	2011	4																															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	1163.708655	55.08203012	954.2408422	629.8313153	161.700032	10.60570858	0	264.0032054	325.6572728	3117.041768	2270.830407	50.77215541	1.240174785	523.1593225	2886.130855	4841.720274	306.0491267	783.7892254	0	0	246.6833724	0	0	0	1013.66375	79.23657074	50.19175393	11.77449116	75.40909067	0											6700	$200/day 1-7	$200/day 1-7	"$0/d 1-20, $105/d 21-100"	$0 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$225 per procedure	$35 per visit	$50 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	"$0 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$35 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$35 per visit	$35 per visit	$50 per visit	$35 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness Only	0											0	144.5710156	144.5710156	42.34790568	0	150	0.05	0.05	49	225	5.25	28.125	35	25	35	0	35	35	26.25	50	35	$50 	0	0	0	0	0	0	0	0												NO	130.1220389	130.1220389	38.11549507	0	135.00843	0.04500281	0.04500281	44.1027538	202.512645	4.72529505	25.31408063	31.501967	22.501405	31.501967	0	31.501967	31.501967	23.62647525	45.00281	31.501967	45.00281	0	0	0	0	0	0	0	0													12.6187	0.597282172	3.030946843	0	1.819238954	0.477286688	0	0.970272364	5.495809639	1.227411836	4.790332002	0.13328523	0.002325473	1.373378976	0	12.71030936	0.803429124	1.543181395	0	0	0.925120412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.5183	0	5.387554883	12.6187	0.597282172	3.030946843	0	1.819238954	0.477286688	0	0.970272364	5.495809639	1.227411836	4.790332002	0.13328523	0.002325473	1.373378976	0	12.71030936	0.803429124	1.543181395	0	0	0.925120412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.5183	YES	$500 ded; 25% coinsurance; $10000 max OOP	$500 ded; 25% coinsurance; $10000 max OOP	$500 ded; 25% coinsurance; $10000 max OOP	$500 ded; 25% coinsurance; $10000 max OOP	$150 copay	$500 ded; 25% coinsurance; $10000 max OOP	$500 ded; 25% coinsurance; $10000 max OOP	$50 Emer Rm; $40 Urgent Care Ctr	$500 ded; 25% coinsurance; $10000 max OOP	$500 ded; 25% coinsurance; $10000 max OOP	$500 ded; 25% coinsurance; $10000 max OOP	$500 ded; 25% coinsurance; $10000 max OOP	$25 copay	$500 ded; 25% coinsurance; $10000 max OOP	$500 ded; 25% coinsurance; $10000 max OOP	$500 ded; 25% coinsurance; $10000 max OOP	$500 ded; 25% coinsurance; $10000 max OOP	$500 ded; 25% coinsurance; $10000 max OOP	$500 ded; 25% coinsurance; $10000 max OOP	$500 ded; 25% coinsurance; $10000 max OOP	$500 ded; 25% coinsurance; $10000 max OOP		Not Covered		$500 ded; 25% coinsurance; $10000 max OOP	$50.00 Every 2 Years	$500 ded; 25% coinsurance; $10000 max OOP	$300.00 Every 3 Yrs	0												10000	10.258	0.149	1.0703	0.2679	0.3615	0.4721	0	0.263	1.5114	0.799	1.9813	0.0303	0.154	1.0076	1.1458	4.4773	0.1629	0.3369	0	0	2.2015	0	0	0	0.2829	0	0.0171	0	0												26.9497	500	5.07895972	22.8766	0.746256302	4.101223111	0.26788357	2.180766898	0.949422069	0	1.23329438	7.00716094	2.026412755	6.771677657	0.163622022	0.156318596	2.380946505	1.145800328	17.18760643	0.966348746	1.880074642	0	0	3.126591665	0	0	0	0.282862309	0	0.017108638	0	0	0	0	0	0	0	0	0	0	0	0	0	75.468
H5521_022_0	2011	4																															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	1302.215268	44.97014694	799.649161	838.0060508	178.1248546	15.4317028	0	224.5510836	324.1222639	3082.810483	2508.474798	24.77266488	0.999560329	115.8954664	3043.2554	5071.929006	194.6241974	986.5469637	0	0	219.3091882	0	0	0	885.0562068	39.36193655	60.32600731	8.580519069	58.52611745	0											6700	$225/day 1-5	$225/day 1-5	"$0/d 1-20, $130/d 21-100"	$0 per visit	$200 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $35 Urgent Care Ctr	$200 per procedure	$25 per visit	$45 X-ray; $250 Complex Radiology	$45 per visit	$25 per visit	$45 per visit	"$25 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$45 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$45 per visit	$45 per visit	$45 per visit	$50 per script	0	Not Covered	0	$0 per visit	$100.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Fitness Only	0											0	137.8887167	137.8887167	52.43074037	0	200	0.05	0.05	48.5	200	3.75	27.625	45	25	45	25	45	40	33.75	45	45	$50 	0	0	0	0	0	0	0	0	0											NO	120.2108508	120.2108508	45.70891701	0	174.3592278	0.043589807	0.043589807	42.28211274	174.3592278	3.269235521	24.08336834	39.23082625	21.79490347	39.23082625	21.79490347	39.23082625	34.87184556	29.42311969	39.23082625	39.23082625	43.58980695	0	0	0	0	0	0	0	0	0												13.045	0.450491635	3.045924762	0	2.588142674	0.672664946	0	0.791207853	4.709475637	0.839869461	5.034376876	0.080987676	0.001815443	0.378889575	5.527288141	16.58133047	0.565575413	2.418940783	0	0	0.796637098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5287	0	8.46	13.045	0.450491635	3.045924762	0	2.588142674	0.672664946	0	0.791207853	4.709475637	0.839869461	5.034376876	0.080987676	0.001815443	0.378889575	5.527288141	16.58133047	0.565575413	2.418940783	0	0	0.796637098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5287	YES	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$200 copay	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$50 Emer Rm; $35 Urgent Care Ctr	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$25 copay	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP		0	0	$750 ded; 35% coinsurance; $10000 max OOP	$100.00 Every 2 Years	$750 ded; 35% coinsurance; $10000 max OOP	$500.00 Every 3 Yrs	0	0	0	0	0	0	0	0	0	0	0	0	10000	13.2851	0.1743	1.4944	0.4358	0.4533	0.8446	0	0.2275	1.506	1.184	2.952	0.0225	0.0006	1.004	1.8907	6.488	0.1413	0.6771	0	0	2.2126	0	0	0	0.3294	0	0.0264	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3494	750	11.06571229	26.3301	0.624774434	4.540344136	0.435758161	3.041418416	1.51727573	0	1.018687861	6.215489649	2.023891896	7.986360521	0.103471099	0.002401613	1.382898904	7.418014188	23.06930375	0.706844174	3.096004165	0	0	3.00923508	0	0	0	0.329448643	0	0.026358614	0	0	0	0	0	0	0	0	0	0	0	0	0	92.8781
H5521_027_0	2011	4																															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	1312.217386	78.66005099	945.3966505	618.2174059	185.3309597	9.523526156	0	270.4746983	344.7895524	3342.352003	2470.681096	52.75048387	1.477681462	287.7551139	2845.147526	5030.051822	399.540828	799.804476	0	0	260.2571664	0	0	0	1019.92687	74.43630125	50.18476044	0	0	0											6700	$225/day 1-5	$225/day 1-5	"$0/d 1-10, $50/d 11-20, $100/d 21-100"	$0 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 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; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$50 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	137.8887167	137.8887167	51.87372562	0	150	0.05	0.05	49	250	6	22.75	40	25	40	25	40	40	30	50	40	$50 	0	0	0	0	0	0	0	0	0											NO	126.8444518	126.8444518	47.71887393	0	137.9856759	0.045995225	0.045995225	45.07532079	229.9761265	5.519427035	20.92782751	36.79618024	22.99761265	36.79618024	22.99761265	36.79618024	36.79618024	27.59713518	45.99522529	36.79618024	45.99522529	0	0	0	0	0	0	0	0	0												13.8706	0.83146592	3.759438632	0	2.131084811	0.438036731	0	1.015977816	6.607780475	1.537322334	4.308832318	0.161751359	0.002831929	0.88235742	5.452633395	15.42389112	1.22513136	1.839359353	0	0	0.997548917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4861	0	5.266483108	13.8706	0.83146592	3.759438632	0	2.131084811	0.438036731	0	1.015977816	6.607780475	1.537322334	4.308832318	0.161751359	0.002831929	0.88235742	5.452633395	15.42389112	1.22513136	1.839359353	0	0	0.997548917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4861	YES	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$150 per trip	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$50 Emer Rm; $40 Urgent Care Ctr	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$25 per visit	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP	$750 ded; 35% coinsurance; $10000 max OOP		Not Covered	0	$750 ded; 35% coinsurance; $10000 max OOP	$50.00 Every 2 Years	$750 ded; 35% coinsurance; $10000 max OOP	Not Covered	0	0	0	0	0	0	0	0	0	0	0	0	10000	10.6254	0.2133	1.2782	0.325	0.2796	0.3995	0	0.1973	1.39	0.9594	2.3429	0.0521	0.0006	0.9267	1.197	5.1065	0.2019	0.4241	0	0	3.4695	0	0	0	0.2926	0	0.0179	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6997	750	9.433430451	24.4961	1.04479222	5.037673576	0.325047257	2.410729983	0.837518944	0	1.213326014	7.997804395	2.496703161	6.651710835	0.213890688	0.00346051	1.809040032	6.649651284	20.53040733	1.426983751	2.263436139	0	0	4.467022329	0	0	0	0.292612631	0	0.017925284	0	0	0	0	0	0	0	0	0	0	0	0	0	90.1858
H5521_028_0	2011	4																															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	1109.595102	77.14114353	750.8593594	756.8459147	165.844684	11.14074435	0	260.1674208	345.0679255	2960.053844	2245.750146	50.08928909	1.533229356	247.6104889	2711.653221	4661.13766	207.5430293	892.0201261	0	0	231.9380506	0	0	0	1032.635694	88.11229036	60.01895277	9.878673045	105.6266725	0											6700	$225/day 1-5	$225/day 1-5	"$0/d 1-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$20 per visit	$40 X-ray; $250 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$20 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	$100.00 Every 2 Years	$0 per visit	$500.00 Every 3 Yrs	Fitness Only	0											0	137.8887167	137.8887167	40.33133874	0	100	0.05	0.05	47.5	150	3	25.25	40	25	40	20	40	40	30	40	40	$50 	0	0	0	0	0	0	0	0	0											NO	122.3196742	122.3196742	35.77751924	0	88.70898005	0.04435449	0.04435449	42.13676552	133.0634701	2.661269401	22.39901746	35.48359202	22.17724501	35.48359202	17.74179601	35.48359202	35.48359202	26.61269401	35.48359202	35.48359202	44.35449002	0	0	0	0	0	0	0	0	0												11.3104	0.786323295	2.238657098	0	1.22599273	0.494142034	0	0.913551134	3.826327965	0.656458393	4.191883061	0.148112325	0.002833567	0.732175797	4.009133191	13.78282559	0.613697681	1.978254889	0	0	0.857291162	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7681	0	6.08	11.3104	0.786323295	2.238657098	0	1.22599273	0.494142034	0	0.913551134	3.826327965	0.656458393	4.191883061	0.148112325	0.002833567	0.732175797	4.009133191	13.78282559	0.613697681	1.978254889	0	0	0.857291162	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7681	YES	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$100 copay	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$50 Emer Rm; $25 Urgent Care Ctr	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$25 copay	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP	$750 ded; 30% coinsurance; $10000 max OOP		0	0	$750 ded; 30% coinsurance; $10000 max OOP	$100.00 Every 2 Years	$750 ded; 30% coinsurance; $10000 max OOP	$500.00 Every 3 Yrs	0	0	0	0	0	0	0	0	0	0	0	0	10000	9.3809	0.2015	0.9796	0.2549	0.1997	0.4486	0	0.2241	1.3179	0.7103	1.88	0.0298	0.0007	0.8786	1.0515	4.3812	0.103	0.3463	0	0	2.0353	0	0	0	0.2747	0	0.0177	0	0	0	0	0	0	0	0	0	0	0	0	0	24.7163	750	5.896825673	20.6914	0.987870278	3.218239294	0.254860779	1.425675785	0.942770317	0	1.137641142	5.144236703	1.36671294	6.071915437	0.177926506	0.003583393	1.610781607	5.060629379	18.16401242	0.716720341	2.32452407	0	0	2.892572321	0	0	0	0.274703169	0	0.017659631	0	0	0	0	0	0	0	0	0	0	0	0	0	72.4844
H5521_031_0	2011	4																															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	1331.139049	125.2241627	846.5846322	756.0188532	171.2553158	11.11027171	0	224.5423128	342.3747223	3326.216046	2670.52686	39.64062933	1.545927268	214.7422282	2888.507752	5351.442371	452.1421267	889.5308452	0	0	257.7735548	0	0	0	1201.356441	72.97347044	51.52480204	12.55405195	101.9620048	0											6700	$200/day 1-8	$200/day 1-8	"$0/d 1-4, $50/d 5-20, $105/d 21-100"	$0 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$275 per procedure	$40 per visit	$40 X-ray; $150 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$25 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$50 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness Only	0											0	152.3663772	152.3663772	63.87227671	0	175	0.05	0.05	49	275	6	22.75	40	25	40	25	40	40	30	50	40	$50 	0	0	0	0	0	0	0	0	0											NO	130.2443352	130.2443352	54.59867438	0	149.5917871	0.042740511	0.042740511	41.88570038	235.0728082	5.128861271	19.44693232	34.19240847	21.37025529	34.19240847	21.37025529	34.19240847	34.19240847	25.64430635	42.74051059	34.19240847	42.74051059	0	0	0	0	0	0	0	0	0												14.4478	1.359144818	3.851866556	0	2.134865728	0.474858685	0	0.783759336	6.706915619	1.421641721	4.327796258	0.112950716	0.002753072	0.611879499	5.14401234	15.24822529	1.288319024	1.900950125	0	0	0.918114446	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7358	0	10.31600017	14.4478	1.359144818	3.851866556	0	2.134865728	0.474858685	0	0.783759336	6.706915619	1.421641721	4.327796258	0.112950716	0.002753072	0.611879499	5.14401234	15.24822529	1.288319024	1.900950125	0	0	0.918114446	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7358	YES	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$175 copay	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$50 Emer Rm; $40 Urgent Care Ctr	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$25 copay	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP		0	0	$500 ded; 30% coinsurance; $10000 max OOP	$50.00 Every 2 Years	$500 ded; 30% coinsurance; $10000 max OOP	$300.00 Every 3 Yrs	0	0	0	0	0	0	0	0	0	0	0	0	10000	10.6075	0.2872	1.2372	0.2675	0.2991	0.403	0	0.1576	1.4884	0.9325	2.711	0.0294	0.1723	0.9923	1.1037	5.0441	0.2372	0.3502	0	0	3.4198	0	0	0	0.3338	0	0.0197	0	0	0	0	0	0	0	0	0	0	0	0	0	30.0935	500	8.163321479	25.0553	1.646325498	5.089024068	0.267523724	2.433946444	0.877853615	0	0.941311299	8.195311908	2.354096607	7.038808007	0.142389648	0.175076656	1.604143675	6.247747897	20.29235316	1.525550263	2.251170333	0	0	4.337903477	0	0	0	0.333817121	0	0.019710724	0	0	0	0	0	0	0	0	0	0	0	0	0	90.8294
H5521_032_0	2011	4																															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	1251.860017	98.06784165	828.2960793	647.8740679	174.9540682	10.51937967	0	225.0114811	341.7571582	3397.506851	2414.40719	29.60831253	1.194675451	346.1230182	3019.690023	5084.260026	288.2726932	760.0045535	0	0	264.1529042	0	0	0	1106.14949	65.63725916	43.60475043	9.284066925	68.35597617	0											6700	$200/day 1-8	$200/day 1-8	"$0/d 1-4, $50/d 5-20, $105/d 21-100"	$0 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$275 per procedure	$40 per visit	$40 X-ray; $150 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$30 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$50 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness Only	0											0	152.3663772	152.3663772	63.87227671	0	175	0.05	0.05	49	275	6	22.75	40	25	40	30	40	40	30	50	40	$50 	0	0	0	0	0	0	0	0	0											NO	133.300749	133.300749	55.8799289	0	153.1022231	0.043743492	0.043743492	42.86862246	240.5892077	5.249219077	19.903289	34.99479385	21.87174616	34.99479385	26.24609539	34.99479385	34.99479385	26.24609539	43.74349231	34.99479385	43.74349231	0	0	0	0	0	0	0	0	0												13.9062	1.089376395	3.857093835	0	2.232154731	0.460154404	0	0.803827686	6.851923661	1.486188148	4.004553672	0.086344733	0.00217747	1.009375306	6.604589365	14.82688596	0.840670289	1.662262667	0	0	0.962914211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6866	0	8.679839358	13.9062	1.089376395	3.857093835	0	2.232154731	0.460154404	0	0.803827686	6.851923661	1.486188148	4.004553672	0.086344733	0.00217747	1.009375306	6.604589365	14.82688596	0.840670289	1.662262667	0	0	0.962914211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6866	YES	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$175 copay	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$50 Emer Rm; $40 Urgent Care Ctr	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$25 copay	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP		0	0	$500 ded; 30% coinsurance; $10000 max OOP	$50.00 Every 2 Years	$500 ded; 30% coinsurance; $10000 max OOP	$300.00 Every 3 Yrs	0	0	0	0	0	0	0	0	0	0	0	0	10000	8.7101	0.2301	0.9863	0.2226	0.3058	0.3896	0	0.1763	1.3367	0.8444	2.1116	0.0183	0.1138	0.8912	1.1272	5.2765	0.1321	0.2798	0	0	2.3659	0	0	0	0.2785	0	0.0141	0	0	0	0	0	0	0	0	0	0	0	0	0	25.811	500	6.851827211	22.6163	1.319517623	4.843343943	0.222599213	2.537963274	0.849796037	0	0.980119896	8.188650161	2.330555373	6.11618097	0.104660104	0.115992506	1.900526299	7.731833442	20.1033771	0.972766478	1.942083873	0	0	3.328807759	0	0	0	0.278500667	0	0.014074474	0	0	0	0	0	0	0	0	0	0	0	0	0	86.4976
H5521_033_0	2011	4																															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	1240.473775	118.9282119	736.4517689	621.7094472	181.9138782	8.920576615	0	228.8235883	337.0299477	2940.019597	2257.469557	36.80676824	1.485128287	137.1655832	2830.938089	4669.685842	260.9480685	599.4199884	0	0	237.016588	0	0	0	1080.201253	70.25776126	46.03182183	9.408734616	90.31134761	0											6700	$265/day 1-6	$265/day 1-6	"$0/d 1-4, $50/d 5-20, $105/d 21-100"	$0 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$275 per procedure	$45 per visit	$45 X-ray; $150 Complex Radiology	$45 per visit	$25 per visit	$45 per visit	"$35 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$45 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$45 per visit	$50 per visit	$45 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness Only	0											0	178.5937298	178.5937298	63.87227671	0	175	0.05	0.05	49	275	6.75	25.125	45	25	45	35	45	40	33.75	50	45	$50 	0	0	0	0	0	0	0	0	0											NO	159.294355	159.294355	56.97004665	0	156.0889744	0.04459685	0.04459685	43.70491283	245.2826741	6.020574727	22.40991704	40.13716485	22.29842491	40.13716485	31.21779488	40.13716485	35.67747986	30.10287363	44.59684983	40.13716485	44.59684983	0	0	0	0	0	0	0	0	0												16.4667	1.578716067	3.496307636	0	2.366229223	0.397829616	0	0.833392915	6.888967233	1.47505064	4.215808791	0.123109944	0.002759668	0.458786469	7.364637049	15.61899587	0.775830788	1.50368868	0	0	0.880849432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4477	0	7.808184166	16.4667	1.578716067	3.496307636	0	2.366229223	0.397829616	0	0.833392915	6.888967233	1.47505064	4.215808791	0.123109944	0.002759668	0.458786469	7.364637049	15.61899587	0.775830788	1.50368868	0	0	0.880849432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4477	YES	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$175 copay	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$50 Emer Rm; $40 Urgent Care Ctr	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$25 copay	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP		0	0	$500 ded; 30% coinsurance; $10000 max OOP	$50.00 Every 2 Years	$500 ded; 30% coinsurance; $10000 max OOP	$300.00 Every 3 Yrs	0	0	0	0	0	0	0	0	0	0	0	0	10000	7.9907	0.2393	0.94	0.2009	0.321	0.3353	0	0.1803	1.2393	0.6499	1.8858	0.022	0.1351	0.8262	0.9582	5.0484	0.1127	0.2388	0	0	2.0098	0	0	0	0.2618	0	0.0145	0	0	0	0	0	0	0	0	0	0	0	0	0	23.6103	500	6.178371313	24.4575	1.818057717	4.436295074	0.200940832	2.687250872	0.733085969	0	1.013654834	8.128296394	2.124986758	6.101590137	0.145157695	0.137819759	1.285005954	8.322812441	20.66743544	0.888564763	1.742509848	0	0	2.89068409	0	0	0	0.261811976	0	0.014536531	0	0	0	0	0	0	0	0	0	0	0	0	0	88.058
H5521_034_0	2011	4																															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	1290.499467	67.87211909	984.7265136	718.0530729	179.3979453	11.0775203	0	225.7847247	340.7154972	3286.830982	2410.454183	37.5675957	1.515827162	349.903656	3081.870973	5233.282638	287.7730703	833.825265	0	0	271.5959182	0	0	0	1104.221548	72.37141198	46.26710369	10.92069528	96.68745077	0											6700	$200/day 1-7	$200/day 1-7	"$0/d 1-4, $50/d 5-20, $105/d 21-100"	$0 per visit	$125 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$225 per procedure	$30 per visit	$35 X-ray; $150 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	"$15 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$30 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$30 per visit	$30 per visit	$50 per visit	$30 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	$300.00 Every 3 Yrs	Fitness Only	0											0	144.5710156	144.5710156	63.87227671	0	125	0.05	0.05	49	225	4.5	20.375	30	25	30	15	30	30	22.5	50	30	$50 	0	0	0	0	0	0	0	0	0											NO	131.8365871	131.8365871	58.24613554	0	113.9894696	0.045595788	0.045595788	44.68387207	205.1810452	4.103620905	18.58028354	27.3574727	22.79789392	27.3574727	13.67873635	27.3574727	27.3574727	20.51810452	45.59578783	27.3574727	45.59578783	0	0	0	0	0	0	0	0	0												14.1779	0.745669045	4.779709499	0	1.704123052	0.505088266	0	0.840744646	5.82569682	1.123992361	3.732243515	0.085646206	0.002879806	0.797706643	3.513008375	11.93078224	0.656061993	1.425709495	0	0	1.031969155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.879	0	5.107711327	14.1779	0.745669045	4.779709499	0	1.704123052	0.505088266	0	0.840744646	5.82569682	1.123992361	3.732243515	0.085646206	0.002879806	0.797706643	3.513008375	11.93078224	0.656061993	1.425709495	0	0	1.031969155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.879	YES	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$125 copay	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$50 Emer Rm; $40 Urgent Care Ctr	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$25 copay	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP	$500 ded; 30% coinsurance; $10000 max OOP		0	0	$500 ded; 30% coinsurance; $10000 max OOP	$50.00 Every 2 Years	$500 ded; 30% coinsurance; $10000 max OOP	$300.00 Every 3 Yrs	0	0	0	0	0	0	0	0	0	0	0	0	10000	9.4336	0.1782	1.1305	0.2473	0.2336	0.411	0	0.1652	1.2838	0.7858	1.985	0.023	0.1427	0.8559	1.058	4.4179	0.1307	0.2951	0	0	2.484	0	0	0	0.2735	0	0.0155	0	0	0	0	0	0	0	0	0	0	0	0	0	25.5502	500	6.772161672	23.6115	0.923851736	5.910247839	0.24725254	1.937729703	0.916103438	0	1.005966258	7.109534639	1.9097688	5.717242834	0.108644619	0.14555614	1.653598504	4.570979285	16.34863268	0.786787087	1.720761847	0	0	3.51594945	0	0	0	0.273509938	0	0.015500006	0	0	0	0	0	0	0	0	0	0	0	0	0	78.4291
H5521_036_0	2011	4																															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	1504.524867	77.6080063	925.1409579	771.798242	154.9483988	11.77833686	0	271.6280221	352.5673743	4037.625334	2561.692342	77.6080063	37.73354789	586.0186781	2988.953106	5134.570171	417.3169829	1079.661175	0	0	280.3709654	0	0	0	1033.524553	78.67846156	54.32560441	12.84546311	20.07103611	0											6700	$225/day 1-7	$225/day 1-7	"$0/d 1-10, $50/d 11-20, $100/d 21-100"	$0 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$300 per procedure	$50 per visit	$50 X-ray; $175 Complex Radiology	$50 per visit	$25 per visit	$50 per visit	"$20 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$50 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$50 per visit	$50 per visit	$50 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	162.6423925	162.6423925	51.87372562	0	150	0.05	0.05	49	300	7.5	28.125	50	25	50	20	50	40	37.5	50	50	$50 	0	0	0	0	0	0	0	0	0											NO	145.9215106	145.9215106	46.54070986	0	134.5788527	0.044859618	0.044859618	43.96242521	269.1577054	6.728942634	25.23353488	44.85961756	22.42980878	44.85961756	17.94384702	44.85961756	35.88769405	33.64471317	44.85961756	44.85961756	44.85961756	0	0	0	0	0	0	0	0	0												18.2952	0.943723126	3.588059741	0	1.737731478	0.528371687	0	0.995118884	7.908018788	2.264079104	5.386712755	0.290122124	0.070529689	2.190714482	4.469443108	19.19457118	1.24804535	3.027074212	0	0	1.04811119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1856	0	8.386209965	18.2952	0.943723126	3.588059741	0	1.737731478	0.528371687	0	0.995118884	7.908018788	2.264079104	5.386712755	0.290122124	0.070529689	2.190714482	4.469443108	19.19457118	1.24804535	3.027074212	0	0	1.04811119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1856	YES	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$150 copay	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$50 Emer Rm; $40 Urgent Care Ctr	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$25 copay	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP		0	0	$500 ded; 35% coinsurance; $10000 max OOP	$50.00 Every 2 Years	$500 ded; 35% coinsurance; $10000 max OOP	Not Covered	Not Covered	0	0	0	0	0	0	0	0	0	0	0	10000	14.1637	0.2557	1.3804	0.3024	0.2159	0.4598	0	0.1732	1.6425	1.0328	1.9755	0.1211	3.0293	1.095	1.5002	4.5666	0.1973	0.5382	0	0	3.2813	0	0	0	0.3277	0	0.0155	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2742	500	12.72495555	32.4589	1.199391192	4.968491803	0.302400266	1.953641204	0.988149487	0	1.168342646	9.550516208	3.296921772	7.362232313	0.411213786	3.099860603	3.285712765	5.969612801	23.76119864	1.44539107	3.565260523	0	0	4.329421849	0	0	0	0.327692074	0	0.015514436	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4599
H5521_037_0	2011	4																															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	1360.500166	102.0854849	1287.581962	914.6375438	241.4549347	10.06822778	0	254.0623723	383.5190481	4258.444432	3023.175563	13.43230065	0	654.5292783	2906.104541	6071.190646	217.7782857	721.7861591	0	0	282.0959416	0	0	0	1385.435596	61.73119689	65.24753089	13.28392845	29.30278333	0											6700	$225/day 1-7	$200/day 1-7	"$0/d 1-20, $130/d 21-100"	$0 per visit	$200 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 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; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$35 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$35 per visit	$35 per visit	$40 per visit	$35 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	162.6423925	144.5710156	52.43074037	0	200	0.05	0.05	49	200	5.25	21	35	25	35	20	35	35	26.25	40	35	$50 	0	0	0	0	0	0	0	0	0											NO	143.2529825	127.3359844	46.18021054	0	176.1570034	0.044039251	0.044039251	43.15846583	176.1570034	4.624121339	18.49648535	30.82747559	0	30.82747559	17.61570034	30.82747559	30.82747559	23.12060669	35.23140068	0	44.03925084	0	0	0	0	0	0	0	0	0												16.2413	1.083262976	4.955067174	0	3.544498145	0.443397209	0	0.913745184	5.629963854	1.640963647	4.659843544	0.034506993	0	1.681457113	4.266088896	15.59662345	0.559462899	1.390677825	0	0	1.035274495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6761	0	8.618618711	16.2413	1.083262976	4.955067174	0	3.544498145	0.443397209	0	0.913745184	5.629963854	1.640963647	4.659843544	0.034506993	0	1.681457113	4.266088896	15.59662345	0.559462899	1.390677825	0	0	1.035274495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6761	YES	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP	$200 copay	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP	$50 Emer Rm; $40 Urgent Care Ctr	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP	$25 copay	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP	$1000 ded; 30% coinsurance; $10000 max OOP		0	0	0	Not Covered	0	Not Covered	Not Covered	0											10000	5.9041	0.146	0.961	0.1414	0.2934	0.2358	0	0.1234	0.7272	0.6414	1.7208	0.0034	0	0.4848	0.8544	3.1509	0.0718	0.1487	0	0	1.5985	0	0	0	0	0.0029	0	0	0	0											17.2097	1000	4.024705638	22.1454	1.229262848	5.91606921	0.141377955	3.837864698	0.679170294	0	1.037134942	6.357190044	2.282330875	6.380645813	0.03790496	0	2.166274579	5.120465609	18.74751735	0.631255173	1.539396146	0	0	2.633725962	0	0	0	0	0.00291157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.8859
H5521_038_0	2011	4																															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	1481.450461	62.09672589	1203.493687	1217.910316	205.0394558	16.583629	0	224.731008	382.2984929	4876.593543	3344.15898	81.61283974	0	823.2812495	3136.773996	7349.810843	614.9379809	975.1700571	0	0	316.9302686	0	0	0	1542.906873	68.24627049	67.04369304	12.62706326	22.54832725	0											6700	$175/day 1-7	$175/day 1-7	"$0/d 1-20, $130/d 21-100"	$0 per visit	$200 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$30 per visit	$30 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	"$10 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$30 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$30 per visit	$30 per visit	$40 per visit	$30 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	126.4996386	126.4996386	52.43074037	0	200	0.05	0.05	49	200	4.5	18.625	30	25	30	10	30	30	22.5	40	30	$50 	0	0	0	0	0	0	0	0	0											NO	114.1513863	114.1513863	47.31271774	0	180.4770156	0.045119254	0.045119254	44.21686883	180.4770156	4.060732851	16.80692208	27.07155234	0	27.07155234	9.023850781	27.07155234	27.07155234	20.30366426	36.09540312	0	45.1192539	0	0	0	0	0	0	0	0	0												14.0925	0.590702279	4.745046428	0	3.083742423	0.748240967	0	0.828075125	5.749674257	1.650211967	4.683751616	0.184115522	0	1.857291787	2.35881504	16.58089908	1.387277145	1.649960453	0	0	1.191638105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3819	0	6.639948487	14.0925	0.590702279	4.745046428	0	3.083742423	0.748240967	0	0.828075125	5.749674257	1.650211967	4.683751616	0.184115522	0	1.857291787	2.35881504	16.58089908	1.387277145	1.649960453	0	0	1.191638105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3819	YES	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$200 copay	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$50 Emer Rm; $40 Urgent Care Ctr	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$25 copay	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP	$500 ded; 35% coinsurance; $10000 max OOP		0	0	0	Not Covered	0	Not Covered	Not Covered	0											10000	5.9776	0.0607	0.8694	0.1622	0.2131	0.371	0	0.0772	0.955	0.7647	1.6926	0.0371	0	0.6367	0.8924	3.5553	0.1885	0.2029	0	0	1.7564	0	0	0	0	0.0014	0	0.0021	0.0046	0											18.4208	500	6.466963162	20.07	0.651399182	5.614408914	0.162208045	3.296851338	1.119234583	0	0.905266979	6.704711668	2.414870562	6.376334084	0.221208941	0	2.493983392	3.25119759	20.13616011	1.57578779	1.852879347	0	0	2.947998378	0	0	0	0	0.001424942	0	0.00208262	0.004613605	0	0	0	0	0	0	0	0	0	0	0	79.8027
H5521_039_0	2011	5																															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	1150.262782	154.3278935	723.4568423	840.5185005	210.9022619	11.36716726	0	279.4527465	319.4566153	3286.230219	2362.901551	84.09598131	1.568610978	304.9990255	2951.680551	4658.935194	262.7717766	838.838637	0	0	251.1713185	0	0	0	1043.397432	98.2370401	60.06393595	13.21766587	115.4432573	0											6700	$175/day 1-10	$175/day 1-10	"$0/d 1-4, $50/d 5-20, $105/d 21-100"	$0 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$20 per visit	$20 X-ray; $175 Complex Radiology	$20 per visit	$20 per visit	$20 per visit	"$5 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$20 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$20 per visit	$20 per visit	$40 per visit	$20 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	143.4382958	143.4382958	63.87227671	0	175	0.05	0.05	49	200	3	13.875	20	20	20	5	20	20	15	40	20	$50 	0	0	0	0	0	0	0	0	0											NO	131.9798229	131.9798229	58.76988235	0	161.0202413	0.046005783	0.046005783	45.08566758	184.023133	2.760346995	12.76660485	18.4023133	18.4023133	18.4023133	4.600578324	18.4023133	18.4023133	13.80173497	36.80462659	18.4023133	46.00578324	0	0	0	0	0	0	0	0	0												12.651	1.697347338	3.543122792	0	2.829961093	0.522955433	0	1.049942803	4.8989506	0.755927976	2.513852534	0.128963383	0.002405506	0.467723968	1.131619797	7.144598755	0.40296738	0.964785713	0	0	0.962944436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.669	0	3.6177	12.651	1.697347338	3.543122792	0	2.829961093	0.522955433	0	1.049942803	4.8989506	0.755927976	2.513852534	0.128963383	0.002405506	0.467723968	1.131619797	7.144598755	0.40296738	0.964785713	0	0	0.962944436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.669	YES	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$175 copay	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$50 Emer Rm; $40 Urgent Care Ctr	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$20 copay	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0	0	0	0	0	0	0	0	0	0	0		9.5189	0.2791	0.9892	0.3126	0.3657	0.5432	0	0.2338	1.5104	0.9095	2.5974	0.0451	0.0912	1.0069	1.2204	4.5079	0.1487	0.3459	0	0	2.3153	0	0	0	0.3094	0	0.0257	0	0	0	0	0	0	0	0	0	0	0	0	0	27.2764	1000	9.820472371	22.1699	1.976444381	4.532359275	0.312585864	3.19563222	1.066187569	0	1.283750292	6.409329333	1.66541671	5.111267845	0.174048785	0.093613408	1.474643164	2.351975977	11.65254587	0.551695679	1.310650203	0	0	3.278294355	0	0	0	0.309364754	0	0.025744363	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9455
H5521_040_0	2011	4																															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	1206.631226	100.7371277	836.27417	542.9182551	194.1848366	9.65993508	0	220.2807568	309.2061965	3051.325455	2253.747734	57.4399102	1.447803517	129.9006978	2667.982664	5204.994514	498.5963749	817.0615556	0	0	259.5280413	1.179452461	0	0	1231.321219	78.32311431	71.14645944	8.028770896	90.73804008	0											6700	$175/day 1-10	$175/day 1-10	"$0/d 1-4, $50/d 5-20, $125/d 21-100"	$0 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 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; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$30 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$30 per visit	$30 per visit	$40 per visit	$30 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	143.4382958	143.4382958	71.93854446	0	150	0.05	0.05	49	175	4.5	18.625	30	25	30	15	30	30	22.5	40	30	$50 	0	0	0	0	0	0	0	0	0											NO	125.4569008	125.4569008	62.92034347	0	131.1960312	0.04373201	0.04373201	42.85737018	153.0620364	3.935880935	16.29017387	26.23920623	21.86600519	26.23920623	13.11960312	26.23920623	26.23920623	19.67940467	34.98560831	26.23920623	43.73201039	0	0	0	0	0	0	0	0	0												12.615	1.053180653	4.384888168	0	2.123023323	0.422448381	0	0.786721161	3.943977507	1.000804474	3.059495203	0.125598137	0.00263814	0.284040933	2.916906139	11.38124371	1.090231092	1.339940416	0	0	0.945806916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.476	0	6.8046	12.615	1.053180653	4.384888168	0	2.123023323	0.422448381	0	0.786721161	3.943977507	1.000804474	3.059495203	0.125598137	0.00263814	0.284040933	2.916906139	11.38124371	1.090231092	1.339940416	0	0	0.945806916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.476	YES	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$150 copay	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$50 Emer Rm; $40 Urgent Care Ctr	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$25 copay	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	$1000 ded; 40% coinsurance; $10000 max OOP	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0	0	0	0	0	0	0	0	0	0	0		12.989	0.2882	1.6874	0.2633	0.2928	0.4375	0	0.1762	1.5591	1.1034	2.6642	0.0426	0.1418	1.0394	1.2851	6.5123	0.3273	0.4411	0	0	4.0261	0.0001	0	0	0.4571	0	0.0376	0	0	0	0	0	0	0	0	0	0	0	0	0	35.7718	1000	13.59975653	25.604	1.341346468	6.072293306	0.263283938	2.415838353	0.859969623	0	0.962945266	5.503094678	2.104228619	5.723732904	0.168231675	0.144426981	1.323452364	4.201983243	17.89356975	1.417539101	1.781067882	0	0	4.971901135	9.97E-05	0	0	0.457077102	0	0.037649837	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2477
H5521_801_0	2011	3																															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	YES	287.9226587	3.159387631	25.8878181	11.63832469	7.467157898	11.19268907	0	11.41981695	38.74879016	21.24090064	65.30453234	0.639852855	0.044755528	25.83252517	32.26595956	125.9299406	4.583784695	11.25715211	0	0	74.35499218	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.078908892	0.078908892	0.168516011	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.064976452	0.064976452	0.138762215	0	0.191860677	0.191860677	0.191860677	0.191860677	0.191860677	0.191860677	0.191860677	0.191860677	0.191860677	0.191860677	0.191860677	0.191860677	0.191860677	0.191860677	0.191860677	0.191860677	0.191860677	0.191860677	0	0	0	0	0	0	0	0												18.7082	0.2052858	3.592250969	0	1.432653969	2.1474369	0	2.19101381	7.434369109	4.075293574	12.52937178	0.122762602	0.008586826	4.956245765	6.190568842	24.16100364	0.879448034	2.159804823	0	0	14.26579913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.0601	0	22.52728908	18.7082	0.2052858	3.592250969	0	1.432653969	2.1474369	0	2.19101381	7.434369109	4.075293574	12.52937178	0.122762602	0.008586826	4.956245765	6.190568842	24.16100364	0.879448034	2.159804823	0	0	14.26579913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.0601	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	3.3251	0.0365	0.6385	0	0.2546	0.3817	0	0.3894	1.3213	0.7243	2.2269	0.0218	0.0015	0.8809	1.1003	4.2942	0.1563	0.3839	0	0	2.5355	0	0	0	0	0	0	0	0	0											18.6728	0	2.097264788	22.0333	0.241772112	4.230716911	0	1.687285612	2.529109934	0	2.580431952	8.755710942	4.79961272	14.75626996	0.144581718	0.010112999	5.837140266	7.290844798	28.4552409	1.035756049	2.543676059	0	0	16.80131988	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.7329
H5521_802_0	2011	3																															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	YES	250.6807317	2.317069185	34.79345035	7.610784176	6.00547703	10.08584583	0	8.694003138	38.57688984	25.27494951	62.70345262	0.203558119	0.01865622	25.71792651	28.2040048	103.858671	2.963455815	10.67633762	0	0	68.05376298	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.074814801	0.074814801	0.16252902	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.061638117	0.061638117	0.133903755	0	0.191963103	0.191963103	0.191963103	0.191963103	0.191963103	0.191963103	0.191963103	0.191963103	0.191963103	0.191963103	0.191963103	0.191963103	0.191963103	0.191963103	0.191963103	0.191963103	0.191963103	0.191963103	0	0	0	0	0	0	0	0												15.4515	0.142819781	4.658973659	0	1.152830005	1.936110261	0	1.668927819	7.405339474	4.851857734	12.03674933	0.039075648	0.003581306	4.936892974	5.414128276	19.93703275	0.568874174	2.049462898	0	0	13.06381151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.318	0	20.37658844	15.4515	0.142819781	4.658973659	0	1.152830005	1.936110261	0	1.668927819	7.405339474	4.851857734	12.03674933	0.039075648	0.003581306	4.936892974	5.414128276	19.93703275	0.568874174	2.049462898	0	0	13.06381151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.318	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	2.7456	0.0254	0.8278	0	0.2048	0.344	0	0.2966	1.3158	0.8621	2.1388	0.0069	0.0006	0.8772	0.962	3.5426	0.1011	0.3642	0	0	2.3213	0	0	0	0	0	0	0	0	0											16.937	0	1.897037024	18.197	0.168197295	5.486822337	0	1.357675292	2.280135885	0	1.965478045	8.72118733	5.713979804	14.17554808	0.046018964	0.004217665	5.814124875	6.376159673	23.47962548	0.669956894	2.413630047	0	0	15.38510797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.2549
H5521_805_0	2011	2																															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	YES	240.5372303	4.910385864	30.72840946	6.101089872	7.15425991	9.251174355	0	11.46787526	31.65076132	14.17892402	45.81765382	0.811235575	0.069559971	21.10050756	21.5364694	103.0598716	2.786834845	6.564522704	0	0	54.75126821	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0	0	0	0	0	0	0	0												0	0	0	0	1.273023983	1.646147466	0	2.040585667	5.631914236	2.522987781	8.152761136	0.144350688	0.012377452	3.754609493	3.832184236	18.33840116	0.495887435	1.168086559	0	0	9.742402205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7557	0	18.18109453	0	0	0	0	1.273023983	1.646147466	0	2.040585667	5.631914236	2.522987781	8.152761136	0.144350688	0.012377452	3.754609493	3.832184236	18.33840116	0.495887435	1.168086559	0	0	9.742402205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7557	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	0	0	0	0	0.2347	0.3035	0	0.3762	1.0383	0.4651	1.503	0.0266	0.0023	0.6922	0.7065	3.3808	0.0914	0.2153	0	0	1.7961	0	0	0	0	0	0	0	0	0											10.832	0	1.692639058	0	0	0	0	1.507713357	1.949624325	0	2.416779502	6.670190376	2.98811525	9.655770063	0.170962577	0.014659308	4.446793587	4.538669686	21.71919206	0.587307167	1.383430109	0	0	11.53847071	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.5877
H5521_806_0	2011	2																															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	YES	239.5621762	4.890480872	30.60384721	6.076358181	7.125259036	9.213673321	0	11.42138849	31.52246017	14.12144761	45.63192503	0.807947109	0.069277999	21.01497346	21.44916806	102.6421028	2.775537989	6.537912418	0	0	54.52932566	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0.177939298	0	0	0	0	0	0	0	0												0	0	0	0	1.267863588	1.639474558	0	2.032313845	5.609084419	2.512760468	8.119712686	0.143765541	0.012327279	3.739389615	3.816649898	18.26406368	0.49387728	1.163351543	0	0	9.702909904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5175	0	18.10739471	0	0	0	0	1.267863588	1.639474558	0	2.032313845	5.609084419	2.512760468	8.119712686	0.143765541	0.012327279	3.739389615	3.816649898	18.26406368	0.49387728	1.163351543	0	0	9.702909904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5175	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	0	0	0	0	0.2337	0.3022	0	0.3747	1.0341	0.4632	1.4969	0.0265	0.0023	0.6894	0.7036	3.3671	0.091	0.2145	0	0	1.7888	0	0	0	0	0	0	0	0	0											10.788	0	1.68577769	0	0	0	0	1.501601613	1.941721227	0	2.406982721	6.643151751	2.976002473	9.616628938	0.170269555	0.014599884	4.428767836	4.520271501	21.63115003	0.584926429	1.377822165	0	0	11.49169777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.3056
H5522_001_0	2011	6																															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	YES	1596.412748	69.4448747	1335.687469	0	208.8600951	13.12134947	7.232999949	106.45409	813.116288	985.0057793	41.15594562	0	0	451.3432665	6414.729702	23280.99456	156.7239265	2562.222506	39.64144835	1986.53581	35.19068063	0	0	0	213.1366676	0	242.9154806	0	0	235.726411											6700	1a $150 days 1-5	1b $150 days 1-5	"2 $40 days 1-20, $90 days 21-100"	6 $0	10a $75	11a 20%	11b 20%	4a $50	"9a $175, 9b $175"	8a $10	8b $75 $20 X-Ray 15B Outpatient Chemotherapy Drugs 15% 8B Radiation Therapy $55	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 $20 X-Ray 15B Physician Chemotherapy Drugs 15% 8B Radiation Therapy $55	7g $30	15A 20% coinsurance 15B Physician Chemotherapy Drugs 15%			16A $0 for exam/cleaning/x-ray up to $1000 combined max; 16b 50% for restorations/extractions up to $1000 combined max with $25 deductible	17a $25	"17b 1 pair of glasses after cataract surgery - Medicare Covered Only, $150 Allowance every two years Non-Medicare Covered"	18a $25	"18b $750 Allowance every 3 yrs ($500 for 1st aid, $250 for 2nd aid)"	14a $0	"14c $10, 7f $30"												99.34623888	87.16475096	56.85454005	0	74.76817825	0.199006915	0.2	38.78650924	121.3923326	10	0.039461649	0	0	1.577385485	5.42711903	7.888342784	29.74977207	4.611822623	0.288578825	1.339916432	0.212729917	0	0	0	18.67276029	0	24.65110802	0	0	7.042015118											NO	99.34623888	87.16475096	56.85454005	0	74.76817825	0.199006915	0.2	38.78650924	121.3923326	10	0.039461649	0	0	1.577385485	5.42711903	7.888342784	29.74977207	4.611822623	0.288578825	1.339916432	0.212729917	0	0	0	18.67276029	0	24.65110802	0	0	7.042015118												13.2165	0.504428767	6.328324725	0	1.301340735	2.611239278	1.44659999	0.344081879	8.225506909	0.820838149	1.624081486	0	0	0.059328526	2.901125136	15.30403879	0.388541758	0.984709643	11.43968259	0.221815998	7.486110573	0	0	0	0.331654159	0	0.499011313	0	0	0.138332413	0	0	0	0	0	0	0	0	0	0	76.1773	0	0	13.2165	0.504428767	6.328324725	0	1.301340735	2.611239278	1.44659999	0.344081879	8.225506909	0.820838149	1.624081486	0	0	0.059328526	2.901125136	15.30403879	0.388541758	0.984709643	11.43968259	0.221815998	7.486110573	0	0	0	0.331654159	0	0.499011313	0	0	0.138332413	0	0	0	0	0	0	0	0	0	0	76.1773	YES	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	"18b $750 Allowance every 3 yrs ($500 for 1st aid, $250 for 2nd aid)"	14a OON:  $50/visit	0.2											10000	0.9504	0	0.2189	0	0.5971	0.1366	0.0134	0.0339	0.0033	0.0784	1.0423	0.0305	0	0.0036	0.034	0.3019	0	0	0.0045	0.0009	0	0	0	0	0.0005	0	0	0	0.8667	0											4.3167	750	0	14.1668	0.504428767	6.547205693	0	1.898414178	2.747805308	1.460023119	0.377984601	8.228763794	0.899283252	2.666377749	0.03046889	0	0.062882459	2.935115896	15.60596956	0.388541758	0.984709643	11.44415846	0.222765053	7.486110573	0	0	0	0.332150524	0	0.499011313	0	0.866666667	0.138332413	0	0	0	0	0	0	0	0	0	0	80.494
H5522_002_0	2011	6																															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	YES	1540.044647	61.39407147	926.838359	0	32.26277356	11.12619229	5.938307801	91.88127862	1069.36244	3833.955631	35.40396993	0	0	583.1655926	7594.112382	19652.91959	178.6013436	1807.992654	46.53407097	1963.075965	33.65131431	0	0	0	229.0912177	0	261.6547822	0	0	602.8201485											6700	1a $145 days 1-5	1b $145 days 1-5	2 $50 days 11-100	6 $0	10a $75	11a 15%	11b 15%	4a $50	"9a $150, 9b $150"	8a $15	8b $115  $20 X-Ray 15B Outpatient Chemotherapy Drugs 15% 8b Radiation Therapy $55	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 $115 $20 X-Ray 15B Physician Chemotherapy Drugs 15% 8b Radiation Therapy $55	7g $35	15A 20% coinsurance 15B Physician Chemotherapy Drugs 15%			16A $0 for exam/cleaning/x-ray up to $1000 combined max; 16b 50% for restorations/extractions up to $1000 combined max with $25 deductible	17a $25	"17b 1 pair of glasses after cataract surgery - Medicare Covered Only, $150 Allowance every two years Non-Medicare Covered"	18a $25	"18b $750 Allowance every 3 yrs ($500 for 1st aid, $250 for 2nd aid)"	14a $0	"14c $15, 7f $35"												95.00184641	84.25925926	29.24705751	0	45.76459774	0.149999785	0.15	45.37846672	146.9761697	15	0.065678045	0	0	20.3379705	8.957454749	12.01676643	10.2794828	7.563300713	0.318962532	0.0774034	0.214551802	0	0	0	18.34443183	0	24.90017251	0	0	3.492858693											NO	94.71178593	84.00199814	29.15776013	0	45.62486886	0.149541804	0.149542019	45.23991679	146.5274208	14.95420187	0.065477516	0	0	20.27336135	8.930105769	11.98007673	10.2480974	7.540208376	0.317988672	0.077167072	0.213896731	0	0	0	18.28842245	0	24.82414708	0	0	3.482194266												12.155	0.429768723	2.252044213	0	0.122665401	1.663830864	0.888026536	0.346391783	13.05757668	4.777812204	2.318164023	0	0	0.985227232	5.651352232	19.62029038	0.152526997	1.136053446	14.79730745	0.012623735	7.197906122	0	0	0	0.349143081	0	0.541279733	0	0	0.174928072	0	0	0	0	0	0	0	0	0	0	88.63	0	0.271557001	12.155	0.429768723	2.252044213	0	0.122665401	1.663830864	0.888026536	0.346391783	13.05757668	4.777812204	2.318164023	0	0	0.985227232	5.651352232	19.62029038	0.152526997	1.136053446	14.79730745	0.012623735	7.197906122	0	0	0	0.349143081	0	0.541279733	0	0	0.174928072	0	0	0	0	0	0	0	0	0	0	88.63	YES	0.2	0.2	0.2	0	75	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	"18b $750 Allowance every 3 yrs ($500 for 1st aid, $250 for 2nd aid)"	14a OON:  $50/visit	0.2											10000	1.5973	0.0129	0.5912	0	1.2186	0.3149	0.1391	0.0188	0.9168	0.0742	0.0896	0.0107	0.0006	0.0179	0.4066	1.9663	0	0.3153	0.1378	0.1299	0.0715	0	0	0	0.0066	0.0002	0.0091	0	0.8667	0.0558											8.9681	1000	0	13.7523	0.442629548	2.843264395	0	1.341269957	1.97874621	1.027109226	0.36518645	13.97433642	4.85199582	2.407714643	0.010706653	0.000572332	1.00315991	6.057905155	21.5865414	0.152526997	1.451317451	14.93509602	0.142521978	7.269361071	0	0	0	0.355741602	0.000193416	0.550403012	0	0.866666667	0.23074558	0	0	0	0	0	0	0	0	0	0	97.598
H5522_004_0	2011	6																															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	YES	1237.748347	130.9458787	880.4453048	0	26.81797315	6.774137359	4.771235971	86.23036054	850.0980043	2055.869574	25.40191773	0	0	407.4240246	5673.925193	12827.31033	145.4405906	1420.443955	28.55886811	1347.276345	14.03504815	0	0	0	0	0	0	0	0	418.7955529											6700	1a $150 days 1-7	1b $150 days 1-7	"2 $50 days 1-20, $85 days 21-100"	6 $0	10a $125	11a 20%	11b 20%	4a $50	"9a $150, 9b $150"	8a $20	8b $135 $25 X-Ray 15B Outpatient Chemotherapy Drugs 15% 8b Radiation Therapy $55	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 $135 $25 X-Ray 15B Physician Chemotherapy Drugs 15% 8b Radiation Therapy $55	7g $40	15A 20% coinsurance 15B Physician Chemotherapy Drugs 15%				17a $25 Medicare covered only	17b 1 pair of glasses after cataract surgery	18a $25 Medicare covered only		14a $0	"14c $15, 7f $40"												114.45512	84.28738318	63.39431662	0	123.6587329	0.2	0.2	49.82758621	148.0631725	20	0.079171889	0	0	1.891122702	9.589760245	12.38092031	38.92480456	31.47569797	0.419453948	2.164644983	0.236593241	0	0	0	0	0	0	0	0	23.03774938											NO	112.8258003	83.08751464	62.49187021	0	121.8983956	0.197152911	0.197152911	49.11826826	145.9554271	19.71529107	0.078044842	0	0	1.84323765	9.453245725	12.20467238	38.37069258	31.02762735	0.413482834	2.133830295	0.233225231	0	0	0	0	0	0	0	0	22.70979673												11.6375	0.906663968	4.585056143	0	0.272422325	1.335540898	0.940663059	0.352957165	10.33970144	3.377672253	1.982488652	0	0	0.062581608	4.469750756	13.04609333	0.465054682	3.672750477	11.80860172	0.23957159	3.273327345	0	0	0	0	0	0	0	0	0.79256349	0	0	0	0	0	0	0	0	0	0	73.561	0	1.063017368	11.6375	0.906663968	4.585056143	0	0.272422325	1.335540898	0.940663059	0.352957165	10.33970144	3.377672253	1.982488652	0	0	0.062581608	4.469750756	13.04609333	0.465054682	3.672750477	11.80860172	0.23957159	3.273327345	0	0	0	0	0	0	0	0	0.79256349	0	0	0	0	0	0	0	0	0	0	73.561	YES	0.2	0.2	0.2	0	125	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		14a OON:  $50/visit	0.2											10000	3.1003	0	0.5769	0	1.6397	0.3321	0.2002	0.0221	1.1187	0.1539	0.1048	0	0	0.0411	0.3904	2.0354	0	0.2944	0.2264	0.2088	0.1686	0	0	0	0	0	0	0	0.8667	0.0478											11.5281	1500	0	14.7378	0.906663968	5.162004332	0	1.912136855	1.667592102	1.140864388	0.375048514	11.45835414	3.531541491	2.087258633	0	0	0.103700066	4.860104869	15.0814929	0.465054682	3.967172792	12.0349545	0.448402906	3.441887782	0	0	0	0	0	0	0	0.866666667	0.840331911	0	0	0	0	0	0	0	0	0	0	85.089
H5522_005_0	2011	8																															D	D	D	V	T	COIN	COIN	COIN	V	O	COIN	O	O	O	COIN	COIN	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	YES	1684.179588	53.1140001	1013.137787	0	208.3808847	11.57143206	5.982345581	4.418447956	735.6699075	1522.093926	31.28587137	0	0	583.6233642	31.51962364	96.40296528	167.8762921	1622.071485	47.56225583	1674.878179	35.16743833	0	0	0	0	0	0	0	0	150.0774428											6100	1a $170 days 1-5	1b $170 days 1-5	"2 $50 days 1-20, $90 days 21-100"	6 $0	10a $100	11a 20%	11b 20%	4a $50	"9a $175, 9b $175"	8a $15	8b $140 $40 X-Ray 15B Outpatient Chemotherapy Drugs 15% 8B Radiation Therapy $55	5 $0	12 $0	4b $50	7a $25	"16b $25, 17a $25, 18a $25, 7b $40, 7d $50, 7f $50"	"7e $40, 7h $40, 9c $40"	"7c $50, 7i $50"	8b $140 $40 X-Ray 15B Physician Chemotherapy Drugs 15% 8B Radiation Therapy $55	7g $50	15A 20% coinsurance 15B Physician Chemotherapy Drugs 15%				17a $25 Medicare covered only	17b 1 pair of glasses after cataract surgery.	18a $25 Medicare covered only		14a $0	"14c $25, 7f $50"												111.2179681	78.44626168	65.30779042	0	98.86042393	0.19887865	0.2	0.14998221	173.3058804	15	0.073594009	0	0	1.907225513	0.215343223	0.192075271	38.02243353	27.71247073	0.368968032	3.254808454	0.212389384	0	0	0	0	0	0	0	0	19.87109092											NO	102.2712075	72.13981145	60.0575679	0	90.9128388	0.182890401	0.183921604	0.137924843	159.3734777	13.79412031	0.067677641	0	0	1.671252079	0.198031355	0.17663396	34.96573485	25.48461036	0.339305961	2.99314796	0.195314981	0	0	0	0	0	0	0	0	18.2736146												14.3536	0.319302829	5.070549289	0	1.578708148	2.116303854	1.100282596	0.609413742	9.770522632	1.749662229	2.117353975	0	0	0.081281813	6.241873785	17.02803753	0.489159826	3.444821647	16.13815694	0.417763184	6.868727565	0	0	0	0	0	0	0	0	0.228538112	0	0	0	0	0	0	0	0	0	0	89.724	0	7.848906581	14.3536	0.319302829	5.070549289	0	1.578708148	2.116303854	1.100282596	0.609413742	9.770522632	1.749662229	2.117353975	0	0	0.081281813	6.241873785	17.02803753	0.489159826	3.444821647	16.13815694	0.417763184	6.868727565	0	0	0	0	0	0	0	0	0.228538112	0	0	0	0	0	0	0	0	0	0	89.724	YES	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.			14a OON:  $50/visit	0.2											10000	2.9371	0.0058	0.0598	0	0.6637	0.026	0.1008	0.0104	0.2045	0.048	0.0141	0.0021	0	0.0086	0.1061	0.4303	0	0.0173	0.1733	0.0799	0.1258	0	0	0	0	0	0	0	0.8667	0.0005											5.881	1500	0	17.2906	0.32515074	5.130348308	0	2.242404437	2.142327152	1.201094128	0.61984386	9.975040771	1.797658755	2.131404237	0.002140123	0	0.089929768	6.347965978	17.45833269	0.489159826	3.462163532	16.31146377	0.497703887	6.994555224	0	0	0	0	0	0	0	0.866666667	0.229084626	0	0	0	0	0	0	0	0	0	0	95.6051
H5522_008_0	2011	7																															D	D	D	V	T	O	O	V	V	O	COIN	O	O	O	P	P	P	P	COIN	P	COIN	V	T	V	V	V	V	V	P	O											9.533479983	0.136513002	1.625392004	0	2.107334815	2.010259141	1.186504869	0	18.23619145	5.361970395	7.834124473	0.075092482	0	1.569031873	0.010008087	0.451391735	0.56930385	3.047087002	0.322317278	0	0	0	0	0	0	0	0	0	0	0.412688505											54.4887	YES	1288.274932	59.81299782	906.0238247	0	0	0	0	91.15117686	0	0	30.54861279	0	0	0	6882.409372	17936.03616	0	0	40.38136301	1771.00883	28.49943558	0	0	0	218.8930358	0	0	0	0	0											3400	1a $85 days 1-4	1b $85 days 1-4	2 $45 days 1-100	6 $0	10a $0	11a 0%	11b 0%	4a $50	"9a $0, 9b $0"	8a $0	8b $135 $25 X-Ray 8b Radiation Therapy $55	5 $0	12 $0	4b $50	7a $15	"16b $0, 17a $30, 18a $0, 7b $0, 7d $35, 7f $0"	"7e $0, 7h $0, 9c $0"	"7c $0, 7i $0"	8b $135 $25 X-Ray 8b Radiation Therapy $55	7g $0	15 $0				17a $30	"17b 1 pair of glasses after cataract surgery - Medicare Covered Only, $150 Allowance every two years Non-Medicare Covered"	18a $0 Medicare covered only		14a $0	"14c $15, 7f $0"												49.34780867	33.46378505	45	0	0	0	0	49.57081545	0	0	0.040014705	0	0	0	8.965992441	10.12949581	0	0	0.373674079	2.16272416	0.160894679	0	0	0	19.57300374	0	0	0	0	0											NO	39.23328456	26.60491391	35.77662013	0	0	0	0	39.41058298	0	0	0.031813131	0	0	0	7.128286792	8.053313862	0	0	0.297084346	1.719443571	0.127917063	0	0	0	15.56124265	0	0	0	0	0												4.2119	0.132609971	2.70120585	0	0	0	0	0.299360085	0	0	0.971847022	0	0	0	4.088315652	12.03704405	0	0	11.99667082	0.253762479	3.645564088	0	0	0	0.28385397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6222	1400	10.47258581	13.7454	0.269122973	4.326597855	0	2.107334815	2.010259141	1.186504869	0.299360085	18.23619145	5.361970395	8.805971495	0.075092482	0	1.569031873	4.098323739	12.48843579	0.56930385	3.047087002	12.3189881	0.253762479	3.645564088	0	0	0	0.28385397	0	0	0	0	0.412688505	0	0	0	0	0	0	0	0	0	0	95.1109	YES	0.3	0.3	0.3	0	0	0.25	0.25	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			14a OON:  $50/visit	0.3											5100	0.8746	0.0061	0.3142	0	0	0.1405	0.0699	0.0079	0.5616	0.0496	0.0494	0.0053	0	0.0127	0.2467	1.1691	0	0.1869	0.0817	0.0729	0.0376	0	0	0	0.0039	0	0	0	0.8667	0.0322											4.7894	2000	4.049923697	14.62	0.275223437	4.640760021	0	2.107334815	2.15079559	1.256414495	0.307304821	18.79779192	5.411522091	8.855386968	0.080345283	0	1.581729374	4.345007094	13.65757979	0.56930385	3.234014509	12.40065782	0.326661985	3.683164162	0	0	0	0.287732741	0	0	0	0.866666667	0.444888376	0	0	0	0	0	0	0	0	0	0	99.9003
H5522_009_0	2011	7																															D	D	D	V	T	O	O	V	V	O	COIN	O	O	O	P	P	P	P	COIN	P	COIN	V	T	V	V	V	V	V	P	O											9.656391286	0.170491522	1.423084227	0	2.960356043	2.393631175	1.356685404	0	15.41678552	3.195871808	8.152123576	0.949554897	0	1.723773227	0.001932304	0.343025391	0.546257957	3.431628016	0.115765123	0	0	0	0	0	0	0	0	0	0	0.101954267											51.9393	YES	1613.007021	60.12028503	1184.694938	0	0	0	0	179.8805931	0	0	32.49373983	0	0	0	6386.717183	19931.22269	0	0	50.58181411	1916.79167	44.77417618	0	0	0	176.1341137	0	0	0	0	0											3400	1a $110 days 1-4	1b $110 days 1-4	2 $60 days 1-100	6 $0	10a $0	11a 0%	11b 0%	4a $50	"9a $0, 9b $0"	8a $0	8b $95 $25 X-Ray 8b Radiation Therapy $55	5 $0	12 $0	4b $50	7a $15	"16b $0, 17a $30, 18a $0, 7b $0, 7d $35, 7f $0"	"7e $0, 7h $0, 9c $0"	"7c $0, 7i $0"	8b $95 $25 X-Ray 8b Radiation Therapy $55	7g $0	15 $0				17a $30	"17b 1 pair of glasses after cataract surgery - Medicare Covered Only, $150 Allowance every two years Non-Medicare Covered"	18a $0 Medicare covered only		14a $0	"14c $15, 7f $0"												63.83882833	43.30607477	60	0	0	0	0	49.98112495	0	0	0.029473868	0	0	0	8.596494627	9.453256835	0	0	0.298232529	2.290697782	0.157251889	0	0	0	17.87098068	0	0	0	0	0											NO	49.00804178	33.2453771	46.06103501	0	0	0	0	38.36970577	0	0	0.022626614	0	0	0	6.599390666	7.257113234	0	0	0.228948316	1.758531845	0.120719746	0	0	0	13.71926444	0	0	0	0	0												6.5875	0.166560129	4.547356252	0	0	0	0	0.575163786	0	0	0.735223324	0	0	0	3.512370147	12.053595	0	0	11.58062117	0.280894933	5.405127184	0	0	0	0.201369207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6458	1250	13.81330904	16.2439	0.337051651	5.970440479	0	2.960356043	2.393631175	1.356685404	0.575163786	15.41678552	3.195871808	8.8873469	0.949554897	0	1.723773227	3.514302451	12.39662039	0.546257957	3.431628016	11.69638629	0.280894933	5.405127184	0	0	0	0.201369207	0	0	0	0	0.101954267	0	0	0	0	0	0	0	0	0	0	97.5851	YES	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			14a OON:  $50/visit	0.3											5100	0.4856	0.0113	0.122	0	0	0.0546	0.026	0.0031	0.0959	0.0087	0.0281	0.0043	0	0.0098	0.0299	0.2347	0	0.0118	0.0711	0.0245	0.2496	0	0	0	0.0002	0	0	0	0.8667	0.0011											2.3386	2000	0.044321653	16.7295	0.3483159	6.092430427	0	2.960356043	2.448185072	1.382662442	0.578224751	15.51268572	3.204554748	8.915428275	0.953832225	0	1.733527481	3.544229545	12.63127288	0.546257957	3.443421807	11.76744652	0.30534552	5.654763268	0	0	0	0.201582769	0	0	0	0.866666667	0.103033086	0	0	0	0	0	0	0	0	0	0	99.9237
H5522_010_0	2011	6																															D	D	D	V	T	COIN	COIN	COIN	V	O	COIN	O	O	O	COIN	COIN	COIN	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	YES	1908.358668	86.49075998	1562.54543	0	344.7317815	12.5644947	6.91720631	4.371910803	702.9356373	873.4936838	37.59863898	0	0	342.9800602	34.28136677	104.9276862	1.248428271	1989.454309	38.44497001	1795.912359	40.79992888	0	0	0	0	0	0	0	0	176.2181793											6700	1a $1100 per admit	1b $1100 per admit	"2 $50 days 1-20, $90 days 21-100"	6 $0	10a $150	11a 20%	11b 20%	4a $50	"9a $200, 9b $200"	8a $30	8b $145 $20 X-Ray 15B Outpatient Chemotherapy Drugs 15% 8b Radiation Therapy $55	5 $0	12 $0	4b $50	7a $30	"16b $50, 17a $50, 18a $50, 7b $40, 7d $50, 7f $50"	"7e 45%, 7h 45%, 9c 45%"	"7c $50, 7i $50"	8b $145 $20 X-Ray 15B Physician Chemotherapy Drugs 15% 8b Radiation Therapy $55	7g $50	15A 20% coinsurance 15B Physician Chemotherapy Drugs 15%				17a $50 Medicare covered only	17b 1 pair of glasses after cataract surgery.	18a $50 Medicare covered only		14a Fitness Not Covered - $0 for other benefit	"14c $30, 7f $50"												194.0458753	133.6448598	65.30779042	0	149.4213891	0.199051739	0.2	0.149979544	197.4030008	30	0.077864273	0	0	1.103668195	0.213360167	0.183864866	0.441882271	16.6521941	0.477664824	3.172236168	0.210121016	0	0	0	0	0	0	0	0	10.8224962											NO	170.752586	117.6021154	57.46823574	0	131.4848283	0.175157545	0.175991977	0.131975982	173.7067218	26.39879655	0.068517437	0	0	0.719189838	0.187748388	0.161793706	0.388838672	14.6532628	0.420325883	2.791440573	0.184898065	0	0	0	0	0	0	0	0	9.52336251												27.1548	0.847624695	7.483060761	0	3.777249926	2.200766051	1.217372814	0.576987221	10.1753871	1.921598503	2.57616238	0	0	0.020555648	6.436271347	16.97663922	0.485437192	2.429333069	16.15941597	0.417765219	7.543827917	0	0	0	0	0	0	0	0	0.139849134	0	0	0	0	0	0	0	0	0	0	108.5401	0	14.81472623	27.1548	0.847624695	7.483060761	0	3.777249926	2.200766051	1.217372814	0.576987221	10.1753871	1.921598503	2.57616238	0	0	0.020555648	6.436271347	16.97663922	0.485437192	2.429333069	16.15941597	0.417765219	7.543827917	0	0	0	0	0	0	0	0	0.139849134	0	0	0	0	0	0	0	0	0	0	108.5401	YES	0.3	0.3	0.3	0	175	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				0.3	1 pair of glasses after cataract surgery.				0.3											10000	0.1154	0	0.0269	0	0.1085	0.0164	0.0016	0.0027	0.0004	0.0094	0.1248	0.0036	0	0.0004	0.0039	0.0348	0	0	0.0005	0.0001	0	0	0	0	0	0	0	0	0	0											0.4494	1500	0	27.2701	0.847624695	7.509926996	0	3.885785165	2.217145156	1.218982722	0.579654462	10.17578274	1.93099129	2.700963871	0.003648255	0	0.020981185	6.440184573	17.01139936	0.485437192	2.429333069	16.15993126	0.41787448	7.543827917	0	0	0	0	0	0	0	0	0.139849134	0	0	0	0	0	0	0	0	0	0	108.9895
H5522_802_0	2011	7																															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	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	296.560028	4.612715145	66.45843303	0	14.74583115	17.50316616	9.027624448	5.33495562	73.81389481	15.38216039	44.67515349	4.178249224	0.125157302	8.092121881	44.1822268	141.5996788	2.435377046	18.50779864	61.27250544	11.30087587	48.79781366	0	0	0	0	0	0	0	0	0											6700	FFS 8.8%	FFS 8.8%	FFS 17.2%	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%												0.088143746	0.088143746	0.172083678	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.232753505	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.079869975	0.079869975	0.155930734	0	0.211129036	0.211218811	0.211129036	0.211129036	0.211129036	0.211129036	0.211129036	0.211129036	0.211129036	0.211129036	0.211129036	0.210905775	0.211132011	0.211129036	0.211130859	0.211174807	0.211129036	0	0	0	0	0	0	0	0	0												23.6862	0.368417443	10.36291223	0	3.11327311	3.69699795	1.905993643	1.126364035	15.58425643	3.247620688	9.432222072	0.882149729	0.026424341	1.708481889	9.328150934	29.86419002	0.514186054	3.907533678	12.93651669	2.386460282	10.30263534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.381	0	14.954053	23.6862	0.368417443	10.36291223	0	3.11327311	3.69699795	1.905993643	1.126364035	15.58425643	3.247620688	9.432222072	0.882149729	0.026424341	1.708481889	9.328150934	29.86419002	0.514186054	3.907533678	12.93651669	2.386460282	10.30263534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.381	YES	FFS 8.8%	FFS 8.8%	FFS 17.2%	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%											10000	0.1085	0	0.0129	0	0.2055	0.0058	0.0167	0.01	0.1649	0.0226	0.005	0	0	0.0039	0.0309	0.233	0	0.0284	0.0233	0.0135	0.0426	0	0	0	0	0	0	0	0	0											0.9275	0	0	23.7947	0.368417443	10.37584315	0	3.318738068	3.702819853	1.922704513	1.136363529	15.74918799	3.270226824	9.437201907	0.882149729	0.026424341	1.712420303	9.359008118	30.09717878	0.514186054	3.935923259	12.95983123	2.399975818	10.3452169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.3085
H5522_803_0	2011	5																															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	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	270.3963119	3.472073825	65.62158624	0	8.729580603	17.09303478	10.12437177	4.914921759	83.42866489	15.30323251	43.40392183	3.725384076	0.054671482	7.567605603	42.74649613	135.3787835	2.730665958	17.66530181	59.52978872	10.06536309	60.08549243	0	0	0	0	0	0	0	0	0											6700	FFS 8.2%	FFS 8.2%	FFS 17.8%	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%												0.081890007	0.081890007	0.177663125	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.23280985	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.074714905	0.074714905	0.162096501	0	0.212584827	0.212650689	0.212584827	0.212584827	0.212584827	0.212584827	0.212584827	0.212584827	0.212584827	0.212584827	0.212584827	0.212411988	0.212585893	0.212584827	0.212585581	0.212634528	0.212584827	0	0	0	0	0	0	0	0	0												20.2026	0.259415667	10.6370295	0	1.855776386	3.634845619	2.152287824	1.044837794	17.73566833	3.253235041	9.227015231	0.791960131	0.011622328	1.608758131	9.087256502	28.7560765	0.580501061	3.755375136	12.65517471	2.140243733	12.77326404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.163	0	13.65041569	20.2026	0.259415667	10.6370295	0	1.855776386	3.634845619	2.152287824	1.044837794	17.73566833	3.253235041	9.227015231	0.791960131	0.011622328	1.608758131	9.087256502	28.7560765	0.580501061	3.755375136	12.65517471	2.140243733	12.77326404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.163	YES	FFS 8.2%	FFS 8.2%	FFS 17.8%	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%											10000	0.6573	0	0.0919	0	1.2775	0.0345	0.094	0.0654	1.1357	0.1323	0.033	0	0	0.0255	0.1161	1.2827	0	0.1872	0.0823	0.0405	0.2929	0	0	0	0	0	0	0	0	0											5.5488	0	0	20.8599	0.259415667	10.72895497	0	3.133267644	3.669303231	2.246302223	1.11028239	18.8713395	3.38558014	9.259979772	0.791960131	0.011622328	1.634256467	9.203373134	30.03877604	0.580501061	3.942542324	12.73746834	2.180783605	13.06616061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	147.7118
H5522_805_0	2011	5																															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	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	294.6009451	2.647819845	66.01940696	0	14.64841982	17.38753981	8.967987735	5.29971277	73.32627837	14.73350587	41.52529782	4.150647605	0.12433051	8.033047181	43.88798558	138.3958493	0.006320365	18.38553566	58.6099218	11.19479087	48.47545408	0	0	0	0	0	0	0	0	0											6700	FFS 8.8%	FFS 8.8%	FFS 17.2%	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%												0.088143746	0.088143746	0.172083678	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.232777423	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.0804392	0.0804392	0.157042036	0	0.21263373	0.21271733	0.21263373	0.21263373	0.21263373	0.21263373	0.21263373	0.21263373	0.21263373	0.21263373	0.21263373	0.2124307	0.21263373	0.21263373	0.212634572	0.212676472	0.21263373	0	0	0	0	0	0	0	0	0												23.6975	0.21298851	10.36782209	0	3.114748151	3.698631036	1.906896686	1.126897696	15.59164011	3.132840315	8.829678981	0.882567684	0.02643686	1.708096788	9.332066094	29.39952714	0.001343923	3.909385032	12.46249562	2.380868631	10.30751663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.0899	0	13.60732772	23.6975	0.21298851	10.36782209	0	3.114748151	3.698631036	1.906896686	1.126897696	15.59164011	3.132840315	8.829678981	0.882567684	0.02643686	1.708096788	9.332066094	29.39952714	0.001343923	3.909385032	12.46249562	2.380868631	10.30751663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.0899	YES	FFS 8.8%	FFS 8.8%	FFS 17.2%	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%											10000	0.1077	0	0.0128	0	0.2041	0.0058	0.0166	0.0099	0.1638	0.0225	0.0049	0	0	0.0039	0.0307	0.2314	0	0.0282	0.0232	0.0134	0.0423	0	0	0	0	0	0	0	0	0											0.9214	0	0	23.8052	0.21298851	10.38066759	0	3.318855802	3.70441448	1.923497163	1.136831134	15.75548213	3.155297114	8.834625919	0.882567684	0.02643686	1.712009185	9.362719434	29.63097677	0.001343923	3.937587071	12.48565614	2.394294883	10.3498169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.0113
H5525_004_0	2011	6	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Radiology	Renal Dialysis	Other	Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V			V		O	O	O	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	1247.274309	27.335009	934.99301	558.427496	45.674227	10.241998	3.816843	347.786525	355.475164	1898.150437	69.892701	42.471617	0.187596	7.855084	3622.576011	3611.773758	47.369152	311.990008		1652.567767	30.571822	0		3.2			0.28		4.51	0.6	663.066597	1029.575983	0.786398	1132.57651	617.886309						4000	$175/Day(Days 1-10):1a.IP Acute	$175/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	$30/Visit:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"			"HER724: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30-$50/Visit:9d. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							141.405425	127.515675	45.243839	0	100	0.2	0.2	50	100	0	30	50	0.2	0.2	10	27.568143	30	30		0	0.2	0		0			0		0	0	0	40.094755	0	46.000333	30						NO	125.850828	113.488951	28.429419	0	89.3688	0.178738	0.178738	44.6844	89.3688	0	26.81064	44.6844	0.178738	0.178738	8.93688	24.637318	26.81064	26.81064		0	0.178738	0		0			0		0	0	0	35.832201	0	41.109945	26.81064							13.0809	0.258518458	2.215109004	0	0.340154238	1.830634239	0.682214884	1.295052683	2.647365736	0	0.15615567	0.15815156	0.033530534	1.404002004	2.697877258	7.415368218	0.105833107	0.697054316	0	0	5.464346321	0	0	0	0	0	0	0	0	0	0	3.074331131	0	3.88001317	1.380493949	0	0	0	0	0	48.8171	0	6.915674973	13.0809	0.258518458	2.215109004	0	0.340154238	1.830634239	0.682214884	1.295052683	2.647365736	0	0.15615567	0.15815156	0.033530534	1.404002004	2.697877258	7.415368218	0.105833107	0.697054316	0	0	5.464346321	0	0	0	0	0	0	0	0	0	0	3.074331131	0	3.88001317	1.380493949	0	0	0	0	0	48.8171	YES	$200/Day(Days 1-10)	$200/Day(Days 1-10)	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	20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins		$35/Visit	20%-30% Coins	0% Coins		0.5			"HER724: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$0/Proc	30% Coins	$35/Visit						6000	2.3393	0.0462	0.6421	2.6252	1.5454	2.0564	0.7664	0.2198	3.1586	0.6745	0.0365	0.1575	0.0058	0.2432	1.8927	1.887	0.0247	0.1075		0.8634	1.2473	0		0			0		0	0	0.2071	1.3186	0	1.0112	0.3228						23.3991	500	6.238920746	15.4202	0.304750616	2.857169155	2.625189066	1.885566068	3.88704579	1.448569108	1.514848739	5.805975132	0.674450453	0.192671842	0.31561144	0.039338132	1.647187253	4.590529921	9.302377127	0.130581614	0.804565945	0	0.863401285	6.711632827	0	0	0	0	0	0	0	0	0	0.20713924	4.392944802	0	4.891168425	1.703315102	0	0	0	0	0	72.2162
H5526_002_0	2011	5	h.6.										OP Facility - Other										Cardiac Rehab and CORF										BP	BP	D	COIN	T	COIN	COIN	V	V	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	YES	239.7333909	3.267167334	89.98490583	0	178.7624922	13.07768968	0.2945929	311.9990219	373.8030358	0	626.1699371	0.107763787	0	2.727360299	4325.205258	5364.161942	1.277862026	728.1282895	1219.61655	1497.45676	0.004833027	25.99700108									17.78967515										3400	$450 Copay	$450 Copay	$35/Day for 20 Days ($700 Max)	0% Coinsurance	$125 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$200 Copay	0% Coinsurance	$25 Copay	45% Coinsurance	0% Coinsurance	45% 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										0	450	450	508	0	125	0.2	0.2	50	200	0	25	0.45	0	0.45	15	25	0.2	25	25	25	0.2	25									25										NO	424.9844746	424.9844746	479.7602514	0	118.051243	0.188881989	0.188881989	47.22049718	188.8819887	0	23.61024859	0.424984475	0	0.424984475	14.16614915	23.61024859	0.188881989	23.61024859	23.61024859	23.61024859	0.188881989	23.61024859									23.61024859											8.4902	0.115707949	3.59759842	0	1.758594533	2.470140035	0.055643293	1.227729078	5.883721733	0	1.232002323	0.045797936	0	1.159085784	5.105958567	10.55409975	0.241365121	1.432607493	2.399620827	2.946277196	0.000912872	0.051149638	0	0	0	0	0	0	0	0	0.035001554	0	0	0	0	0	0	0	0	0	48.8033	0	2.872667825	8.4902	0.115707949	3.59759842	0	1.758594533	2.470140035	0.055643293	1.227729078	5.883721733	0	1.232002323	0.045797936	0	1.159085784	5.105958567	10.55409975	0.241365121	1.432607493	2.399620827	2.946277196	0.000912872	0.051149638	0	0	0	0	0	0	0	0	0.035001554	0	0	0	0	0	0	0	0	0	48.8033	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	$30 Copay	$125 Copay	35% Coinsurance	35% Coinsurance	$50 Copay	20% Coinsurance	$30 Copay	$30 Copay	50% Coinsurance	$30 Copay	50% Coinsurance	$30 Copay	$30 Copay	50% Coinsurance	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	$30 Copay									$30 Copay										6700	1.5216	0.0088	0.3484	0.0128	0.2208	0.1101	0.0024	0.041	0.2735	0.1907	0.0724	0.0479	0.0004	0.5685	0.3676	0.8491	0.0173	0.0514	0.4195	1.3303	0.1254	0.0022									0.0014										6.5836	0	0.078467364	10.0118	0.124531487	3.94595578	0.01283556	1.97938254	2.580239617	0.058072315	1.268704954	6.157263376	0.190745363	1.304385941	0.093683052	0.000351222	1.727567169	5.473606729	11.40324239	0.258689799	1.484022999	2.819134099	4.276561071	0.126330945	0.053352757	0	0	0	0	0	0	0	0	0.036374512	0	0	0	0	0	0	0	0	0	55.3868
H5526_003_0	2011	8	h.6.										OP Facility - Other										Cardiac Rehab and CORF										BP	BP	D	COIN	T	COIN	COIN	V	V	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	YES	219.0311442	2.24417156	42.68160279	0	137.0750865	10.55266572	0.707926493	244.1174164	359.0497144	0	839.3507561	0.068417901	0	3.057504171	3868.178459	6582.583626	1.616969866	1095.462046	965.8020654	1514.848672	0.143778253	30.16541583									31.73757348										3400	$250 Copay	$250 Copay	$20/Day for 20 Days ($400 Max)	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$150 Copay	0% Coinsurance	$30 Copay	45% Coinsurance	0% Coinsurance	50% Coinsurance	$20 Copay	$30 Copay	20% Coinsurance	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	"$0 Copay for Blood, $30 Copay for other"									$30 Copay										0	250	250	290	0	100	0.2	0.2	50	150	0	30	0.45	0	0.5	20	30	0.2	30	30	30	0.2	30									30										NO	228.9197554	228.9197554	265.5469162	0	91.56790215	0.183135804	0.183135804	45.78395108	137.3518532	0	27.47037065	0.41205556	0	0.457839511	18.31358043	27.47037065	0.183135804	27.47037065	27.47037065	27.47037065	0.183135804	27.47037065									27.47037065											4.1784	0.042811267	0.944497333	0	1.045973176	1.932570925	0.129646688	0.931388321	4.10967864	0	1.921439698	0.028191977	0	1.399846214	5.903349778	15.06883433	0.296125077	2.507729036	2.210911726	3.467787874	0.026330946	0.069054596	0	0	0	0	0	0	0	0	0.072653576	0	0	0	0	0	0	0	0	0	46.2872	0	4.26239105	4.1784	0.042811267	0.944497333	0	1.045973176	1.932570925	0.129646688	0.931388321	4.10967864	0	1.921439698	0.028191977	0	1.399846214	5.903349778	15.06883433	0.296125077	2.507729036	2.210911726	3.467787874	0.026330946	0.069054596	0	0	0	0	0	0	0	0	0.072653576	0	0	0	0	0	0	0	0	0	46.2872	YES	$1000 Copay	$1000 Copay	20% Coinsurance	$25 Copay	$100 Copay	50% Coinsurance	50% Coinsurance	$50 Copay	20% Coinsurance	$25 Copay	20% Coinsurance	50% Coinsurance	$25 Copay	50% Coinsurance	$25 Copay	20% Coinsurance	50% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance									20% Coinsurance										6700	0.643	0.0054	0.2131	0.01	0.1224	0.1424	0.0086	0.0342	0.275	0.5125	0.1929	0.0727	0	0.625	0.2364	0.4472	0.0186	0.0242	0.2227	0.6921	0.2898	0.0125									0.0015										4.802	0	0.09762588	4.8213	0.048223425	1.157612489	0.009952928	1.168375467	2.075005786	0.13829186	0.96556004	4.384674728	0.512465207	2.114358661	0.100847957	0	2.024837014	6.139781477	15.51599093	0.314733525	2.531912043	2.433598045	4.159849647	0.316153892	0.081519482	0	0	0	0	0	0	0	0	0.074153938	0	0	0	0	0	0	0	0	0	51.0892
H5526_004_0	2011	8	h.6.										OP Facility - Other										Cardiac Rehab and CORF										BP	BP	D	COIN	T	COIN	COIN	V	V	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	YES	195.8808185	2.077135	56.01925072	0	131.4949921	14.02247518	1.402834831	280.7653059	386.8977607	0	661.1309421	0.064267401	0	2.198141056	3877.785907	6424.016681	2.635086428	1260.717908	1033.790557	1728.804719	0.005516697	28.45090487									29.79954385										3400	$550 Copay	$550 Copay	$35/Day for 20 Days ($700 Max)	0% Coinsurance	$125 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$200 Copay	0% Coinsurance	$35 Copay	45% Coinsurance	0% Coinsurance	45% Coinsurance	$20 Copay	$35 Copay	20% Coinsurance	$35 Copay	$35 Copay	$35 Copay	20% Coinsurance	"$0 Copay for Blood, $35 Copay for other"									$35 Copay										0	550	550	508	0	125	0.2	0.2	50	200	0	35	0.45	0	0.45	20	35	0.2	35	35	35	0.2	35									35										NO	520.424746	520.424746	480.68322	0	118.2783514	0.189245362	0.189245362	47.31134055	189.2453622	0	33.11793838	0.425802065	0	0.425802065	18.92453622	33.11793838	0.189245362	33.11793838	33.11793838	33.11793838	0.189245362	33.11793838									33.11793838											8.4951	0.090082705	2.243959485	0	1.29608424	2.653688395	0.265479986	1.106948584	6.101550571	0	1.824607817	0.027365192	0	0.935973001	6.115441654	17.72918238	0.498677886	3.479364834	2.85308433	4.771204014	0.001044009	0.07851961	0	0	0	0	0	0	0	0	0.082241621	0	0	0	0	0	0	0	0	0	60.6496	0	3.44666046	8.4951	0.090082705	2.243959485	0	1.29608424	2.653688395	0.265479986	1.106948584	6.101550571	0	1.824607817	0.027365192	0	0.935973001	6.115441654	17.72918238	0.498677886	3.479364834	2.85308433	4.771204014	0.001044009	0.07851961	0	0	0	0	0	0	0	0	0.082241621	0	0	0	0	0	0	0	0	0	60.6496	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	$25 Copay	$125 Copay	35% Coinsurance	35% Coinsurance	$50 Copay	20% Coinsurance	$25 Copay	$40 Copay	50% Coinsurance	$25 Copay	50% Coinsurance	$25 Copay	$40 Copay	50% Coinsurance	$40 Copay	$40 Copay	$40 Copay	20% Coinsurance	$40 Copay									$40 Copay										6700	1.2886	0.0051	0.1966	0.0117	0.1556	0.1233	0.0176	0.0384	0.2788	0.2114	0.109	0.039	0.0005	0.5135	0.2682	1.1478	0.0272	0.1461	0.4925	1.7755	0.4061	0.0051									0.0028										7.2604	0	0.084297768	9.7837	0.095173348	2.440511138	0.011674675	1.451641913	2.777012302	0.283101876	1.145310652	6.380365173	0.2114404	1.93358049	0.066342125	0.000482915	1.449464282	6.383677448	18.87703184	0.525870731	3.625441627	3.345592449	6.546703759	0.407160934	0.083630033	0	0	0	0	0	0	0	0	0.085088277	0	0	0	0	0	0	0	0	0	67.91
H5526_806_0	2011	2	h.6.										OP Facility - Other										Cardiac Rehab and CORF										BP	BP	A	COIN	T	COIN	COIN	V	COIN	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	YES	267.1943361	0.830176215	72.75684208	0	189.5280553	10.7143812	0.448273764	406.9654713	33.12793656	0	689.8179028	0.06144096	0	14.09345963	3771.002813	6897.681452	1.59925067	1353.293589	1298.293385	2042.882729	0.018293508	16.9209007									7.267623949										3400	$500 Copay	$500 Copay	$50/Day for 4 Days ($200 Max)	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	$30 Copay	45% Coinsurance	0% Coinsurance	50% Coinsurance	$20 Copay	$30 Copay	45% Coinsurance	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	"$0 Copay for Blood, $30 Copay for other"									$30 Copay										250	500	500	193	0	100	0.2	0.2	50	0.2	0	30	0.45	0	0.5	20	30	0.45	30	30	30	0.2	30									30										NO	483.1208618	483.1208618	186.4846526	0	96.62417235	0.193248345	0.193248345	48.31208618	0.193248345	0	28.98725171	0.434808776	0	0.483120862	19.32483447	28.98725171	0.434808776	28.98725171	28.98725171	28.98725171	0.193248345	28.98725171									28.98725171											10.7573	0.033422954	1.130669535	0	1.526082623	2.070536431	0.086628163	1.63844591	6.401918904	0	1.666327098	0.026715069	0	6.808844363	6.072833762	16.66206904	0.695368226	3.269021824	3.136163095	4.934796323	0.00353519	0.040874201	0	0	0	0	0	0	0	0	0.017555704	0	0	0	0	0	0	0	0	0	66.9791	0	2.34009561	10.7573	0.033422954	1.130669535	0	1.526082623	2.070536431	0.086628163	1.63844591	6.401918904	0	1.666327098	0.026715069	0	6.808844363	6.072833762	16.66206904	0.695368226	3.269021824	3.136163095	4.934796323	0.00353519	0.040874201	0	0	0	0	0	0	0	0	0.017555704	0	0	0	0	0	0	0	0	0	66.9791	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	$10 Copay	$100 Copay	50% Coinsurance	50% Coinsurance	$50 Copay	25% Coinsurance	$45 Copay	$45 Copay	50% Coinsurance	$30 Copay	50% Coinsurance	$30 Copay	$45 Copay	50% Coinsurance	$45 Copay	$45 Copay	$45 Copay	30% Coinsurance	$45 Copay									$45 Copay										6700	2.291	0.0164	0.2746	0.0084	0.1715	0.2817	0.018	0.0489	0.578	0.9086	0.2276	0.0648	0.0004	0.7116	0.4752	2.0228	0.0254	0.2433	0.8799	2.815	0.5769	0.0045									0.0043										12.649	0	0.084730805	13.0482	0.049868368	1.40525949	0.00840463	1.697610908	2.352267889	0.104666519	1.687342414	6.97992763	0.908581002	1.893898127	0.091564059	0.000430672	7.520430629	6.54802275	18.6848335	0.720721644	3.512360733	4.01609537	7.749840196	0.580448143	0.045376681	0	0	0	0	0	0	0	0	0.021862424	0	0	0	0	0	0	0	0	0	79.6281
H5526_808_0	2011	2	h.6.										OP Facility - Other										Cardiac Rehab and CORF										BP	BP	A	COIN	T	COIN	COIN	V	COIN	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	YES	382.0285877	2.358143977	54.24027128	0	157.7910035	10.16980001	0.554865537	2328.029579	33.87753751	0	769.3492628	0.043032403	0	11.67325784	4043.325008	6527.761327	0.814528935	1357.829573	998.8584143	1773.975313	0.048505816	12.94370864									4.914639667										3400	$500 Copay	$500 Copay	$50/Day for 4 Days ($200 Max)	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	$30 Copay	45% Coinsurance	0% Coinsurance	50% Coinsurance	$20 Copay	$30 Copay	45% Coinsurance	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	"$0 Copay for Blood, $30 Copay for other"									$30 Copay										250	500	500	193	0	100	0.2	0.2	50	0.2	0	30	0.45	0	0.5	20	30	0.45	30	30	30	0.2	30									30										NO	485.1785216	485.1785216	187.2789093	0	97.03570431	0.194071409	0.194071409	36.38838912	0.194071409	0	29.11071129	0.436660669	0	0.485178522	19.40714086	29.11071129	0.436660669	29.11071129	29.11071129	29.11071129	0.194071409	29.11071129									29.11071129											15.446	0.095343401	0.846504904	0	1.275946763	1.973667414	0.107683536	7.059437182	6.574661426	0	1.866358689	0.018790558	0	5.663613979	6.539114833	15.83564795	0.35567275	3.293948723	2.423123243	4.303473599	0.009413592	0.031400047	0	0	0	0	0	0	0	0	0.011922388	0	0	0	0	0	0	0	0	0	73.7317	0	2.324279212	15.446	0.095343401	0.846504904	0	1.275946763	1.973667414	0.107683536	7.059437182	6.574661426	0	1.866358689	0.018790558	0	5.663613979	6.539114833	15.83564795	0.35567275	3.293948723	2.423123243	4.303473599	0.009413592	0.031400047	0	0	0	0	0	0	0	0	0.011922388	0	0	0	0	0	0	0	0	0	73.7317	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	$10 Copay	$100 Copay	50% Coinsurance	50% Coinsurance	$50 Copay	25% Coinsurance	$45 Copay	$45 Copay	50% Coinsurance	$30 Copay	50% Coinsurance	$30 Copay	$45 Copay	50% Coinsurance	$45 Copay	$45 Copay	$45 Copay	30% Coinsurance	$45 Copay									$45 Copay										6700	2.413	0.0177	0.2744	0.0097	0.1765	0.2986	0.0204	0.0518	0.5783	0.9819	0.238	0.0666	0.0006	0.7658	0.4777	2.0997	0.0247	0.2573	0.8975	2.7988	0.5549	0.0043									0.0043										13.0124	0	0.07431699	17.859	0.11305109	1.120876291	0.009692927	1.452438113	2.272252508	0.1280984	7.111189474	7.152951864	0.981893455	2.104371051	0.08534399	0.000561169	6.429415326	7.016813932	17.93538808	0.380373677	3.551277189	3.320663319	7.102252013	0.564280324	0.035736356	0	0	0	0	0	0	0	0	0.016258697	0	0	0	0	0	0	0	0	0	86.7442
H5526_810_0	2011	2	h.6.										OP Facility - Other										Cardiac Rehab and CORF										BP	BP	A	COIN	T	COIN	COIN	V	COIN	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	YES	254.5691917	1.52274598	43.76970339	0	102.5390126	7.374458162	0.362649258	1584.3538	27.98614521	0	900.1113928	0.059953715	0	19.02153362	4175.154511	6376.11583	0.691363799	1304.994235	819.776466	1702.814812	0.057336355	13.39557432									3.194577261										3400	$500 Copay	$500 Copay	$50/Day for 4 Days ($200 Max)	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	$30 Copay	45% Coinsurance	0% Coinsurance	50% Coinsurance	$20 Copay	$30 Copay	45% Coinsurance	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	"$0 Copay for Blood, $30 Copay for other"									$30 Copay										250	500	500	193	0	100	0.2	0.2	50	0.2	0	30	0.45	0	0.5	20	30	0.45	30	30	30	0.2	30									30										NO	484.8931266	484.8931266	187.1687469	0	96.97862532	0.193957251	0.193957251	48.48931266	0.193957251	0	29.0935876	0.436403814	0	0.484893127	19.39572506	29.0935876	0.436403814	29.0935876	29.0935876	29.0935876	0.193957251	29.0935876									29.0935876											10.2866	0.061530755	0.682693378	0	0.828674373	1.43032963	0.070338453	6.402018898	5.42811578	0	2.182289138	0.02616403	0	9.223410908	6.74834575	15.4586737	0.301713799	3.163913673	1.987519869	4.128415991	0.011120802	0.03247711	0	0	0	0	0	0	0	0	0.007745143	0	0	0	0	0	0	0	0	0	68.4621	0	2.132939503	10.2866	0.061530755	0.682693378	0	0.828674373	1.43032963	0.070338453	6.402018898	5.42811578	0	2.182289138	0.02616403	0	9.223410908	6.74834575	15.4586737	0.301713799	3.163913673	1.987519869	4.128415991	0.011120802	0.03247711	0	0	0	0	0	0	0	0	0.007745143	0	0	0	0	0	0	0	0	0	68.4621	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	$10 Copay	$100 Copay	50% Coinsurance	50% Coinsurance	$50 Copay	25% Coinsurance	$45 Copay	$45 Copay	50% Coinsurance	$30 Copay	50% Coinsurance	$30 Copay	$45 Copay	50% Coinsurance	$45 Copay	$45 Copay	$45 Copay	30% Coinsurance	$45 Copay									$45 Copay										6700	2.515	0.0175	0.2932	0.0097	0.1835	0.3095	0.0221	0.0526	0.6014	1.0456	0.2457	0.0732	0.0005	0.8146	0.4845	2.1275	0.0245	0.2585	0.9115	2.7881	0.5696	0.0043									0.0043										13.3571	0	0.078485729	12.8015	0.079037897	0.975878345	0.009722633	1.012136012	1.73981837	0.092477092	6.45463258	6.029556404	1.045624492	2.428014618	0.099372088	0.000546277	10.03804219	7.232859777	17.58614789	0.32616724	3.422402742	2.899003924	6.916525725	0.580768732	0.036772836	0	0	0	0	0	0	0	0	0.012090531	0	0	0	0	0	0	0	0	0	81.8191
H5528_001_0	2011	4	i.7	i.8	i.9	i.10							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	High Tech Radiology							A	A	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	Coin	V	V	V	V																																															0	YES	349.4981088	0.65087075	968.2550883	676.0000269	17.21834014	8.65775476	5.606593339	226.4765851	263.9578367	359.4812247	585.1456463	0	0.710040818	193.4426124	4920.472763	12442.86714	978.9366803	1287.028531	1436.015782	1070.035279	15.49224557	0	0	49.7	535.2	401.6958503	0	0	0	0.774763323	190.3966258	875.3485035	40.40804084	1198.735687							6700	1A IP Acute: $100 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 - $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	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	5 Partial Hosp - $20	12 Renal Dialysis - $0	3 CORF - $20; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $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 Nutritional Training - $0	7D Physician Specialist - $20	7E Mental Health - $20; 7H Psychiatric Services - $20	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Specialist Copays - $20;	7G Other Health Care - $20	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"	13A Blood - $20	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - $0	7B Chiropractic - $20	7F Podiatry - $20	18A Hearing Exams (Medicare Covered) - $20	7D High Tech Radiology: $50								415.8896914	475	27.75169455	0	75	0.2	0.2	50	100	20	20	20	0	20	10	20	20	20	20	20	0.2	20	0	0	20	0.4	0	0	0	0	20	20	20	50							YES	395.0952068	451.25	26.36410982	0	71.25	0.19	0.19	47.5	95	19	19	19	0	19	9.5	19	19	19	19	19	0.19	19	0	0	19	0.38	0	0	0	0	19	19	19	47.5							2500	11.5071	0.024475452	2.12726529	0	0.102233895	1.644973404	1.065252734	0.896469816	2.089666208	0.569178606	0.926480607	0	0	0.306284136	3.895374271	19.70120631	1.549983077	2.037795174	2.273691655	1.694222525	2.943526659	0	0	0	0.8474	0.012720369	0	0	0	0	0.301461324	1.385968464	0.063979398	4.744995429	0	0	0	0	0	0	62.7117		3.300615286	11.5071	0.024475452	2.12726529	0	0.102233895	1.644973404	1.065252734	0.896469816	2.089666208	0.569178606	0.926480607	0	0	0.306284136	3.895374271	19.70120631	1.549983077	2.037795174	2.273691655	1.694222525	2.943526659	0	0	0	0.8474	0.012720369	0	0	0	0	0.301461324	1.385968464	0.063979398	4.744995429	0	0	0	0	0	0	62.7117	YES	"1A IP Acute: 25%;$2,500 max oop"	"1B IP Psych: 25%; $2,500 OOP Max"	2 SNF: 25%	6 Home Health - $0	10A Ambulance - $75 per trip one way	11A DME - 30%	11B Pros./Med Supp. - 30%; 11C Diabetes Mon Supplies - 30%	4A Emergency Care - $50; 4B Urgent Care - $20	9B ASC Services - 25%; 9A Outpatient Hospital - 25%	8A Outpatient C/D/T - 25%	8B Outpatient X-Rays - 25%; Outpatient Radiology Therapy - 25%; 25% High-tech Radiology	5 Partial Hosp - 25%	12 Renal Dialysis - $0	3 CORF - 50%; 9D Cardiac Rehab Svcs - 50%; 9C Outpatient Sub Abuse - 25%;	7A Primary Care - 25%; 14B Immunizations - 0%; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%; 14J Nutritional Training - 25%	7D Physician Specialist - 25%;	7E Mental Health - 25%; 7H Psychiatric Services - 25%	7C Occupational Therapy - 50%; 7I PT and ST Services - 50%	7D Specialist Copays; 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%	13A Blood - 25%	10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%; 17A Eye Exams (Medicare Covered) - 25%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - 25%	7B Chiropractic - $40	7F Podiatry - $40	18A Hearing Exams (Medicare Covered) - 25%	7D High Tech Radiology: 25%							10000	0.0551	0	0.4653	0	1.6038	0.495	0.1683	0	0.1782	0	0.0099	0	0	0.0099	2.0295	9.0585	0.1683	0.7821	0.2871	0.5544	0.8415	0	0	0	0	0.0198	0	0	0	0.0297	0.0396	0.3762	0.0495	0.6633							17.885		0.288725133	11.5622	0.024475452	2.59256529	0	1.706033895	2.139973404	1.233552734	0.896469816	2.267866208	0.569178606	0.936380607	0	0	0.316184136	5.924874271	28.75970631	1.718283077	2.819895174	2.560791655	2.248622525	3.785026659	0	0	0	0.8474	0.032520369	0	0	0	0.0297	0.341061324	1.762168464	0.113479398	5.408295429	0	0	0	0	0	0	80.5967
H5528_002_0	2011	6	i.7	i.8	i.9	i.10							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	High Tech Radiology							A	A	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	Coin	V	V	V	V																																															0	YES	326.7	1.1	944.8	551.6	17.1	7.276716667	5.92725	232.9	255	433.1	554.9	0	1.7	221.6	4994.3	12063.2	959.4	1189.4	1347.3	1111.1	18.8487955	0	0	48.7	524.6	394	0	0	0	0.92129975	155.4	835.2	45.9	1203							6700	1A IP Acute: $225 days 1-7	1B IP Psych: $200 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 - $25	9B ASC Services - $150; 9A Outpatient Hospital - $150	8A Outpatient C/D/T - $25	8B Outpatient X-Rays - $25; Outpatient Radiology Therapy - $50; $50 High-tech Radiology	5 Partial Hosp - $25	12 Renal Dialysis - $0	3 CORF - $25; 9D Cardiac Rehab Svcs - $25; 9C Outpatient Sub Abuse - $25;	7A Primary Care - $15; 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 Nutritional Training - $0	7D Physician Specialist - $25	7E Mental Health - $25; 7H Psychiatric Services - $25	7C Occupational Therapy - $25; 7I PT and ST Services - $25	7D Specialist Copays - $25;	7G Other Health Care - $25	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"	13A Blood - $25	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - $0	7B Chiropractic - $25	7F Podiatry - $25	18A Hearing Exams (Medicare Covered) - $25	7D High Tech Radiology: $50								935.7518056	950	27.75169455	0	100	0.2	0.2	50	150	25	25	25	0	25	15	25	25	25	25	25	0.2	25	0	0	20	0.4	0	0	0	0	25	25	25	50							YES	888.9642154	902.5	26.36410982	0	95	0.19	0.19	47.5	142.5	23.75	23.75	23.75	0	23.75	14.25	23.75	23.75	23.75	23.75	23.75	0.147354455	23.75	0	0	19	0.38	0	0	0	0	23.75	23.75	23.75	47.5							2500	24.2021	0.082729167	2.075734246	0	0.135375	1.382576167	1.1261775	0.921895833	3.028125	0.857177083	1.098239583	0	0	0.438583333	5.93073125	23.87508333	1.8988125	2.354020833	2.66653125	2.199052083	2.777453996	0	0	0	0.830616667	0.012476667	0	0	0	0	0.3075625	1.653	0.09084375	4.761875	0	0	0	0	0	0	84.7067		5.30437192	24.2021	0.082729167	2.075734246	0	0.135375	1.382576167	1.1261775	0.921895833	3.028125	0.857177083	1.098239583	0	0	0.438583333	5.93073125	23.87508333	1.8988125	2.354020833	2.66653125	2.199052083	2.777453996	0	0	0	0.830616667	0.012476667	0	0	0	0	0.3075625	1.653	0.09084375	4.761875	0	0	0	0	0	0	84.7067	YES	"1A IP Acute: 25%;$2,500 max oop"	"1B IP Psych: 25%; $2,500 OOP Max"	2 SNF: 25%	6 Home Health - $0	10A Ambulance - $100 per trip one way	11A DME - 30%	11B Pros./Med Supp. - 30%; 11C Diabetes Mon Supplies - 30%	4A Emergency Care - $50; 4B Urgent Care - $25	9B ASC Services - 25%; 9A Outpatient Hospital - 25%	8A Outpatient C/D/T - 25%	8B Outpatient X-Rays - 25%; Outpatient Radiology Therapy - 25%; 25% High-tech Radiology	5 Partial Hosp - 25%	12 Renal Dialysis - $0	3 CORF - 50%; 9D Cardiac Rehab Svcs - 50%; 9C Outpatient Sub Abuse - 25%;	7A Primary Care - 25%; 14B Immunizations - 0; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%; 14J Nutritional Training - 25%	7D Physician Specialist - 25%;	7E Mental Health - 25%; 7H Psychiatric Services - 25%	7C Occupational Therapy - 50%; 7I PT and ST Services - 50%	7D Specialist Copays; 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%	13A Blood - 25%	10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%; 17A Eye Exams (Medicare Covered) - 25%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - 25%	7B Chiropractic - $40	7F Podiatry - $40	18A Hearing Exams (Medicare Covered) - 25%	7D High Tech Radiology: 25%							10000	0.1541	0	0.99	0	2.0394	0.396	0.1782	0	0.1881	0	0.0297	0	0	0.0297	1.8909	7.92	0.1683	0.7227	0.3762	0.5346	1.386	0	0	0	0	0.0396	0	0	0	0.0396	0.0099	0.3663	0.099	0.5544							18.1127		0.291025133	24.3562	0.082729167	3.065734246	0	2.174775	1.778576167	1.3043775	0.921895833	3.216225	0.857177083	1.127939583	0	0	0.468283333	7.82163125	31.79508333	2.0671125	3.076720833	3.04273125	2.733652083	4.163453996	0	0	0	0.830616667	0.052076667	0	0	0	0.0396	0.3174625	2.0193	0.18984375	5.316275	0	0	0	0	0	0	102.8195
H5528_003_0	2011	6	i.7	i.8	i.9	i.10							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	High Tech Radiology							A	A	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	Coin	V	V	V	V																																															0	YES	314.6	1	716.7	608.9	15.7	8.11468625	7.301326667	215.5	269.5	408.2	581.3	0	0	216	5055.3	13182.6	901.7	1423.6	1439.9	1026.4	30.907737	0	0	45.8	492.6	369.5	0	0	0	0.936280833	178.6	990.4	45.7	1254.7							6700	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	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	5 Partial Hosp - $20	12 Renal Dialysis - $0	3 CORF - $20; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $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 Nutritional Training - $0	7D Physician Specialist - $20	7E Mental Health - $20; 7H Psychiatric Services - $20	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Specialist Copays - $20;	7G Other Health Care - $20	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"	13A Blood - $10	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - $0	7B Chiropractic - $20	7F Podiatry - $20	18A Hearing Exams (Medicare Covered) - $20	7D High Tech Radiology: $50								207.9448457	237.5	27.75169455	0	75	0.2	0.2	50	50	10	10	20	0	20	10	20	20	20	20	20	0.2	10	0	0	20	0.4	0	0	0	0	20	20	20	50							YES	207.9448457	225.625	26.36410982	0	71.25	0.19	0.19	47.5	47.5	9.5	9.5	19	0	19	9.5	19	19	19	19	19	0.1106461	9.5	0	0	19	0.38	0	0	0	0	19	19	19	47.5							2500	5.4516	0.018802083	1.574596459	0	0.09321875	1.541790388	1.387252067	0.853020833	1.066770833	0.323158333	0.460195833	0	0	0.342	4.0021125	20.87245	1.427691667	2.254033333	2.279841667	1.625133333	3.419820564	0	0	0	0.77995	0.011700833	0	0	0	0	0.282783333	1.568133333	0.072358333	4.966520833	0	0	0	0	0	0	56.675		5.277701296	5.4516	0.018802083	1.574596459	0	0.09321875	1.541790388	1.387252067	0.853020833	1.066770833	0.323158333	0.460195833	0	0	0.342	4.0021125	20.87245	1.427691667	2.254033333	2.279841667	1.625133333	3.419820564	0	0	0	0.77995	0.011700833	0	0	0	0	0.282783333	1.568133333	0.072358333	4.966520833	0	0	0	0	0	0	56.675	YES	"1A IP Acute: 25%;$2,500 max oop"	"1B IP Psych: 25%; $2,500 OOP Max"	2 SNF: 25%	6 Home Health - $0	10A Ambulance - $75 per trip one way	11A DME - 30%	11B Pros./Med Supp. - 30%; 11C Diabetes Mon Supplies - 30%	4A Emergency Care - $50; 4B Urgent Care - $20	9B ASC Services - 25%; 9A Outpatient Hospital - 25%	8A Outpatient C/D/T - 25%	8B Outpatient X-Rays - 25%; Outpatient Radiology Therapy - 25%; 25% High-tech Radiology	5 Partial Hosp - 25%	12 Renal Dialysis - $0	3 CORF - 25%; 9D Cardiac Rehab Svcs - 25%; 9C Outpatient Sub Abuse - 25%;	7A Primary Care - 25%; 14B Immunizations - 0; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%; 14J Nutritional Training - 25%	7D Physician Specialist - 25%;	7E Mental Health - 25%; 7H Psychiatric Services - 25%	7C Occupational Therapy - 25%; 7I PT and ST Services - 25%	7D Specialist Copays; 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%	13A Blood - 25%	10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%; 17A Eye Exams (Medicare Covered) - 25%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - 25%	7B Chiropractic - $40	7F Podiatry - $40	18A Hearing Exams (Medicare Covered) - 25%	7D High Tech Radiology: 25%							10000	0.0452	0	0.2277	0	1.2771	0.7821	0.3267	0	0.2574	0	0.0099	0	0	0	1.9305	8.9595	0.1881	0.594	0.2178	0.495	1.0197	0	0	0	0	0	0	0	0	0.0396	0.1188	0.3564	0.0198	0.6237							17.489		0.284725133	5.4969	0.018802083	1.802296459	0	1.37031875	2.323890388	1.713952067	0.853020833	1.324170833	0.323158333	0.470095833	0	0	0.342	5.9326125	29.83195	1.615791667	2.848033333	2.497641667	2.120133333	4.439520564	0	0	0	0.77995	0.011700833	0	0	0	0.0396	0.401583333	1.924533333	0.092158333	5.590220833	0	0	0	0	0	0	74.164
H5528_004_0	2011	4	i.7	i.8	i.9	i.10							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	High Tech Radiology							A	A	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	Coin	V	V	V	V																																															0	YES	343.4168956	0.436828782	811.8479547	531.9627054	19.29271153	8.123156294	7.441515458	295.9803199	389.0542172	444.4832781	525.735963	0	11.73977353	139.1049968	6360.148729	13761.87052	1069.763065	1405.028315	1496.941253	985.8076884	16.47929833	0	0	54.34002666	584.9666357	438.7386277	0	0	0	1.973447269	233.0419723	1048.451779	51.3546036	1324.830873							6700	1A IP Acute: $100 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 - $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	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	5 Partial Hosp - $20	12 Renal Dialysis - $0	3 CORF - $20; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $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 Nutritional Training - $0	7D Physician Specialist - $20	7E Mental Health - $20; 7H Psychiatric Services - $20	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Specialist Copays - $20;	7G Other Health Care - $20	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"	13A Blood - $20	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - $0	7B Chiropractic - $20	7F Podiatry - $20	18A Hearing Exams (Medicare Covered) - $20	7D High Tech Radiology: $50								415.8896914	475	27.75169455	0	75	0.2	0.2	50	100	20	20	20	0	20	10	20	20	20	20	20	0.2	20	0	0	20	0.4	0	0	0	0	20	20	20	50							YES	395.0952068	451.25	26.36410982	0	71.25	0.19	0.19	47.5	95	19	19	19	0	19	9.5	19	19	19	19	19	0.19	19	0	0	19	0.38	0	0	0	0	19	19	19	47.5							2500	11.3069	0.016426582	1.783637386	0	0.114550475	1.543399696	1.413887937	1.171588766	3.080012552	0.70376519	0.832415275	0	0	0.220249578	5.035117744	21.78962832	1.693791519	2.224628166	2.370156984	1.560862173	3.131066682	0	0	0	0.926197173	0.01389339	0	0	0	0	0.368983123	1.66004865	0.081311456	5.244122207	0	0	0	0	0	0	68.2866		3.59403185	11.3069	0.016426582	1.783637386	0	0.114550475	1.543399696	1.413887937	1.171588766	3.080012552	0.70376519	0.832415275	0	0	0.220249578	5.035117744	21.78962832	1.693791519	2.224628166	2.370156984	1.560862173	3.131066682	0	0	0	0.926197173	0.01389339	0	0	0	0	0.368983123	1.66004865	0.081311456	5.244122207	0	0	0	0	0	0	68.2866	YES	"1A IP Acute: 25%;$2,500 max oop"	"1B IP Psych: 25%; $2,500 OOP Max"	2 SNF: 25%	6 Home Health - $0	10A Ambulance - $75 per trip one way	11A DME - 30%	11B Pros./Med Supp. - 30%; 11C Diabetes Mon Supplies - 30%	4A Emergency Care - $50; 4B Urgent Care - $20	9B ASC Services - 25%; 9A Outpatient Hospital - 25%	8A Outpatient C/D/T - 25%	8B Outpatient X-Rays - 25%; Outpatient Radiology Therapy - 25%; 25% High-tech Radiology	5 Partial Hosp - 25%	12 Renal Dialysis - $0	3 CORF - 50%; 9D Cardiac Rehab Svcs - 50%; 9C Outpatient Sub Abuse - 25%;	7A Primary Care - 25%; 14B Immunizations - $0; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%; 14J Nutritional Training - 25%	7D Physician Specialist - 25%;	7E Mental Health - 25%; 7H Psychiatric Services - 25%	7C Occupational Therapy - 50%; 7I PT and ST Services - 50%	7D Specialist Copays; 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%	13A Blood - 25%	10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%; 17A Eye Exams (Medicare Covered) - 25%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - 25%	7B Chiropractic - $40	7F Podiatry - $40	18A Hearing Exams (Medicare Covered) - 25%	7D High Tech Radiology: 25%							10000	0.0353	0	0.7821	0	1.4058	0.7029	0.4554	0	0.3267	0	0	0	0	0.0396	1.9602	8.9199	0.1782	0.9801	0.3564	0.396	0.5841	0	0	0	0	0	0	0	0	0.0693	0.0495	0.2178	0.2673	0.4356							18.1622		0.291525133	11.3422	0.016426582	2.565737386	0	1.520350475	2.246299696	1.869287937	1.171588766	3.406712552	0.70376519	0.832415275	0	0	0.259849578	6.995317744	30.70952832	1.871991519	3.204728166	2.726556984	1.956862173	3.715166682	0	0	0	0.926197173	0.01389339	0	0	0	0.0693	0.418483123	1.87784865	0.348611456	5.679722207	0	0	0	0	0	0	86.4488
H5528_005_0	2011	8	i.7	i.8	i.9	i.10							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	High Tech Radiology							A	A	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	Coin	V	V	V	V																																															0	YES	324.2	1	585.6	535.8	16.2	5.85471925	6.66720375	290.6	289.3	451	494	0	22.8	111.4	5703.8	12483.8	923.1	1102.4	1408.8	793.4	15.64977608	0	0	46.9	504.6	378.5	0	0	0	2.010300833	232.9	755.7	42.6	1194.3							6700	1A IP Acute: $200 days 1-7	1B IP Psych: $200 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 - $25	9B ASC Services - $150; 9A Outpatient Hospital - $150	8A Outpatient C/D/T - $25	8B Outpatient X-Rays - $25; Outpatient Radiology Therapy - $50; $50 High-tech Radiology	5 Partial Hosp - $25	12 Renal Dialysis - $0	3 CORF - $25; 9D Cardiac Rehab Svcs - $25; 9C Outpatient Sub Abuse - $25;	7A Primary Care - $15; 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 Nutritional Training - $0	7D Physician Specialist - $25	7E Mental Health - $25; 7H Psychiatric Services - $25	7C Occupational Therapy - $25; 7I PT and ST Services - $25	7D Specialist Copays - $25;	7G Other Health Care - $25	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"	13A Blood - $25	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - $0	7B Chiropractic - $25	7F Podiatry - $25	18A Hearing Exams (Medicare Covered) - $25	7D High Tech Radiology: $50								831.7793828	950	27.75169455	0	100	0.2	0.2	50	150	25	25	25	0	25	15	25	25	25	25	25	0.2	25	0	0	20	0.4	0	0	0	0	25	25	25	50							YES	790.1904137	902.5	26.36410982	0	95	0.19	0.19	47.5	142.5	23.75	23.75	23.75	0	23.75	14.25	23.75	23.75	23.75	23.75	23.75	0.16133548	23.75	0	0	19	0.38	0	0	0	0	23.75	23.75	23.75	47.5							2500	21.3483	0.075208333	1.286568559	0	0.12825	1.112396658	1.266768713	1.150291667	3.4354375	0.892604167	0.977708333	0	0	0.220479167	6.7732625	24.70752083	1.82696875	2.181833333	2.78825	1.570270833	2.524864142	0	0	0	0.79895	0.011985833	0	0	0	0	0.460947917	1.49565625	0.0843125	4.7274375	0	0	0	0	0	0	81.8463		4.779902672	21.3483	0.075208333	1.286568559	0	0.12825	1.112396658	1.266768713	1.150291667	3.4354375	0.892604167	0.977708333	0	0	0.220479167	6.7732625	24.70752083	1.82696875	2.181833333	2.78825	1.570270833	2.524864142	0	0	0	0.79895	0.011985833	0	0	0	0	0.460947917	1.49565625	0.0843125	4.7274375	0	0	0	0	0	0	81.8463	YES	"1A IP Acute: 25%;$2,500 max oop"	"1B IP Psych: 25%; $2,500 OOP Max"	2 SNF: 25%	6 Home Health - $0	10A Ambulance - $100 per trip one way	11A DME - 30%	11B Pros./Med Supp. - 30%; 11C Diabetes Mon Supplies - 30%	4A Emergency Care - $50; 4B Urgent Care - $25	9B ASC Services - 25%; 9A Outpatient Hospital - 25%	8A Outpatient C/D/T - 25%	8B Outpatient X-Rays - 25%; Outpatient Radiology Therapy - 25%; 25% High-tech Radiology	5 Partial Hosp - 25%	12 Renal Dialysis - $0	3 CORF - 50%; 9D Cardiac Rehab Svcs - 50%; 9C Outpatient Sub Abuse - 25%;	7A Primary Care - 25%; 14B Immunizations - $0; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%; 14J Nutritional Training - 25%	7D Physician Specialist - 25%;	7E Mental Health - 25%; 7H Psychiatric Services - 25%	7C Occupational Therapy - 50%; 7I PT and ST Services - 50%	7D Specialist Copays; 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%	13A Blood - 25%	10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%; 17A Eye Exams (Medicare Covered) - 25%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - 25%	7B Chiropractic - $40	7F Podiatry - $40	18A Hearing Exams (Medicare Covered) - 25%	7D High Tech Radiology: 25%							10000	0	0	1.4553	0	1.782	0.3663	0.2475	0	0.2178	0	0	0	0	0.0297	1.7226	7.4646	0.1683	0.8217	0.4851	0.3762	0.3366	0	0	0	0	0	0	0	0	0.0297	0.0198	0.1782	0.0297	0.3663							16.0974		0.216362567	21.3483	0.075208333	2.741868559	0	1.91025	1.478696658	1.514268713	1.150291667	3.6532375	0.892604167	0.977708333	0	0	0.250179167	8.4958625	32.17212083	1.99526875	3.003533333	3.27335	1.946470833	2.861464142	0	0	0	0.79895	0.011985833	0	0	0	0.0297	0.480747917	1.67385625	0.1140125	5.0937375	0	0	0	0	0	0	97.9437
H5528_008_0	2011	6	i.7	i.8	i.9	i.10							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	High Tech Radiology							A	A	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	Coin	V	V	V	V																																															0	YES	312.9130871	0.116066142	805.4759621	576.2833098	18.26735298	5.650395718	6.575289415	234.7687105	337.6460301	403.6728284	507.9601467	0	11.45963195	184.7960688	5181.360184	14023.55694	930.5065049	1632.83737	1433.080549	937.9685691	27.69534421	0	0	47.31452194	508.8763222	381.6322416	0	0	0	1.667025337	323.2918416	952.0414748	40.39588212	1269.933676							6700	1A IP Acute: $100 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 - $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	9B ASC Services - $100; 9A Outpatient Hospital - $100	8A Outpatient C/D/T - $10	8B Outpatient X-Rays - $10; Outpatient Radiology Therapy - $50; $50 High-tech Radiology	5 Partial Hosp - $20	12 Renal Dialysis - $0	3 CORF - $20; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $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 Nutritional Training - $0	7D Physician Specialist - $20	7E Mental Health - $20; 7H Psychiatric Services - $20	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Specialist Copays - $20;	7G Other Health Care - $20	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"	13A Blood - $10	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - $0	7B Chiropractic - $20	7F Podiatry - $20	18A Hearing Exams (Medicare Covered) - $20	7D High Tech Radiology: $50								415.8896914	475	27.75169455	0	75	0.2	0.2	50	100	10	10	20	0	20	10	20	20	20	20	20	0.2	10	0	0	20	0.4	0	0	0	0	20	20	20	50							YES	395.0952068	451.25	26.36410982	0	71.25	0.19	0.19	47.5	95	9.5	9.5	19	0	19	9.5	19	19	19	19	19	0.19	0.132280223	0	0	19	0.38	0	0	0	0	19	19	19	47.5							2500	10.3025	0.004364571	1.76963806	0	0.108462408	1.073575186	1.249304989	0.929292812	2.673031072	0.319574322	0.402135116	0	0	0.292593776	4.101910146	22.20396516	1.473301966	2.585325836	2.269044203	1.485116901	5.2621154	0	0	0	0.805720843	0.012085021	0	0	0	0	0.511878749	1.507399002	0.063960147	5.026820803	0	0	0	0	0	0	66.4332		3.496481837	10.3025	0.004364571	1.76963806	0	0.108462408	1.073575186	1.249304989	0.929292812	2.673031072	0.319574322	0.402135116	0	0	0.292593776	4.101910146	22.20396516	1.473301966	2.585325836	2.269044203	1.485116901	5.2621154	0	0	0	0.805720843	0.012085021	0	0	0	0	0.511878749	1.507399002	0.063960147	5.026820803	0	0	0	0	0	0	66.4332	YES	"1A IP Acute: 25%;$2,500 max oop"	"1B IP Psych: 25%; $2,500 OOP Max"	2 SNF: 25%	6 Home Health - $0	10A Ambulance - $75 per trip one way	11A DME - 30%	11B Pros./Med Supp. - 30%; 11C Diabetes Mon Supplies - 30%	4A Emergency Care - $50; 4B Urgent Care - $20	9B ASC Services - 25%; 9A Outpatient Hospital - 25%	8A Outpatient C/D/T - 25%	8B Outpatient X-Rays - 25%; Outpatient Radiology Therapy - 25%; 25% High-tech Radiology	5 Partial Hosp - 25%	12 Renal Dialysis - $0	3 CORF - 25%; 9D Cardiac Rehab Svcs - 25%; 9C Outpatient Sub Abuse - 25%;	7A Primary Care - 25%; 14B Immunizations - 0; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%; 14J Nutritional Training - 25%	7D Physician Specialist - 25%;	7E Mental Health - 25%; 7H Psychiatric Services - 25%	7C Occupational Therapy - 25%; 7I PT and ST Services - 25%	7D Specialist Copays; 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%	13A Blood - 25%	10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%; 17A Eye Exams (Medicare Covered) - 25%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - 25%	7B Chiropractic - $40	7F Podiatry - $40	18A Hearing Exams (Medicare Covered) - 25%	7D High Tech Radiology: 25%							10000	0.3719	0	0.2673	0	1.0296	0.3762	0.2277	0	0.1188	0	0.0099	0	0	0.0594	2.1681	9.3753	0.1188	0.495	0.3564	0.5445	1.6731	0	0	0	0	0	0	0	0	0.0792	0.198	0.2178	0.0495	0.594							18.3305		0.293225133	10.6745	0.004364571	2.03693806	0	1.138062408	1.449775186	1.477004989	0.929292812	2.791831072	0.319574322	0.412035116	0	0	0.351993776	6.270010146	31.57926516	1.592101966	3.080325836	2.625444203	2.029616901	6.9352154	0	0	0	0.805720843	0.012085021	0	0	0	0.0792	0.709878749	1.725199002	0.113460147	5.620820803	0	0	0	0	0	0	84.7637
H5528_009_0	2011	5	i.7	i.8	i.9	i.10							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	High Tech Radiology							A	A	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	Coin	V	V	V	V																																															0	YES	373.5055126	0	877.356114	480.4925136	17.98030887	8.536361649	5.89918035	293.6270481	319.0568202	350.1318959	358.0101663	0	0.086700986	203.9063274	6628.653594	12891.39745	1020.419927	955.9433686	1620.224516	1059.782389	18.53986992	0	0	51.78082365	557.6422563	418.3367437	0	0	0	1.507876024	241.4638565	963.676426	57.1980909	1325.045751							6700	1A IP Acute: $100 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 - $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	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	5 Partial Hosp - $20	12 Renal Dialysis - $0	3 CORF - $20; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $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 Nutritional Training - $0	7D Physician Specialist - $20	7E Mental Health - $20; 7H Psychiatric Services - $20	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Specialist Copays - $20;	7G Other Health Care - $20	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"	13A Blood - $20	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - $0	7B Chiropractic - $20	7F Podiatry - $20	18A Hearing Exams (Medicare Covered) - $20	7D High Tech Radiology: $50								415.8896914	475	27.75169455	0	75	0.2	0.2	50	100	20	20	20	0	20	10	20	20	20	20	20	0.2	20	0	0	20	0.4	0	0	0	0	20	20	20	50							YES	395.0952068	451.25	26.36410982	0	71.25	0.19	0.19	47.5	95	19	19	19	0	19	9.5	19	19	19	19	19	0.157012535	19	0	0	19	0.38	0	0	0	0	19	19	19	47.5							2500	12.2975	0	1.927559412	0	0.106758084	1.621908713	1.120844266	1.162273732	2.525866494	0.554375502	0.56684943	0	0	0.322851685	5.247684096	20.4113793	1.615664884	1.513577	2.565355483	1.677988782	2.910991977	0	0	0	0.882933572	0.01324733	0	0	0	0	0.382317773	1.525821008	0.090563644	5.244972765	0	0	0	0	0	0	66.2893		4.13268268	12.2975	0	1.927559412	0	0.106758084	1.621908713	1.120844266	1.162273732	2.525866494	0.554375502	0.56684943	0	0	0.322851685	5.247684096	20.4113793	1.615664884	1.513577	2.565355483	1.677988782	2.910991977	0	0	0	0.882933572	0.01324733	0	0	0	0	0.382317773	1.525821008	0.090563644	5.244972765	0	0	0	0	0	0	66.2893	YES	"1A IP Acute: 25%;$2,500 max oop"	"1B IP Psych: 25%; $2,500 OOP Max"	2 SNF: 25%	6 Home Health - $0	10A Ambulance - $75 per trip one way	11A DME - 30%	11B Pros./Med Supp. - 30%; 11C Diabetes Mon Supplies - 30%	4A Emergency Care - $50; 4B Urgent Care - $20	9B ASC Services - 25%; 9A Outpatient Hospital - 25%	8A Outpatient C/D/T - 25%	8B Outpatient X-Rays - 25%; Outpatient Radiology Therapy - 25%; 25% High-tech Radiology	5 Partial Hosp - 25%	12 Renal Dialysis - $0	3 CORF - 50%; 9D Cardiac Rehab Svcs - 50%; 9C Outpatient Sub Abuse - 25%;	7A Primary Care - 25%; 14B Immunizations - 0%; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%; 14J Nutritional Training - 25%	7D Physician Specialist - 25%;	7E Mental Health - 25%; 7H Psychiatric Services - 25%	7C Occupational Therapy - 50%; 7I PT and ST Services - 50%	7D Specialist Copays; 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%	13A Blood - 25%	10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%; 17A Eye Exams (Medicare Covered) - 25%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - 25%	7B Chiropractic - $40	7F Podiatry - $40	18A Hearing Exams (Medicare Covered) - 25%	7D High Tech Radiology: 25%							10000	0.0749	0	2.1384	0	0.6435	0.4653	0.5544	0	0.198	0	0	0	0	0.0198	2.6829	10.5435	0.2376	1.188	0.3663	0.3366	0.4257	0	0	0	0	0	0	0	0	0.0396	0.0891	0.2277	0.0099	0.3564							20.5976		0.316125133	12.3725	0	4.065959412	0	0.750258084	2.087208713	1.675244266	1.162273732	2.723866494	0.554375502	0.56684943	0	0	0.342651685	7.930584096	30.9548793	1.853264884	2.701577	2.931655483	2.014588782	3.336691977	0	0	0	0.882933572	0.01324733	0	0	0	0.0396	0.471417773	1.753521008	0.100463644	5.601372765	0	0	0	0	0	0	86.8869
H5528_010_0	2011	6	i.7	i.8	i.9	i.10							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	High Tech Radiology							A	A	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	Coin	V	V	V	V																																															0	YES	306.1	0	581.9	409.1	16.6	6.579155	5.647507917	281.4	330	307.9	356.5	0	0.6	182.1	6469.6	11339.6	946.6	807.3	1429.9	931.7	21.0306425	0	0	48.1	517.4	388.6	0	0	0	1.582966667	203.9	756.7	42.9	1220							6700	1A IP Acute: $200 days 1-7	1B IP Psych: $200 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 - $25	9B ASC Services - $150; 9A Outpatient Hospital - $150	8A Outpatient C/D/T - $25	8B Outpatient X-Rays - $25; Outpatient Radiology Therapy - $50; $50 High-tech Radiology	5 Partial Hosp - $25	12 Renal Dialysis - $0	3 CORF - $25; 9D Cardiac Rehab Svcs - $25; 9C Outpatient Sub Abuse - $25;	7A Primary Care - $15; 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 Nutritional Training - $0	7D Physician Specialist - $25	7E Mental Health - $25; 7H Psychiatric Services - $25	7C Occupational Therapy - $25; 7I PT and ST Services - $25	7D Specialist Copays - $25;	7G Other Health Care - $25	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"	13A Blood - $25	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - $0	7B Chiropractic - $25	7F Podiatry - $25	18A Hearing Exams (Medicare Covered) - $25	7D High Tech Radiology: $50								831.7793828	950	27.75169455	0	100	0.2	0.2	50	150	25	25	25	0	25	15	25	25	25	25	25	0.2	25	0	0	20	0.4	0	0	0	0	25	25	25	50							YES	790.1904137	902.5	26.36410982	0	95	0.19	0.19	47.5	142.5	23.75	23.75	23.75	0	23.75	14.25	23.75	23.75	23.75	23.75	23.75	0.149078665	23.75	0	0	19	0.38	0	0	0	0	23.75	23.75	23.75	47.5							2500	20.1564	0	1.278439625	0	0.131416667	1.25003945	1.073026504	1.113875	3.91875	0.609385417	0.705572917	0	0	0.36040625	7.68265	22.44295833	1.873479167	1.59778125	2.830010417	1.843989583	3.135220106	0	0	0	0.819216667	0.012305667	0	0	0	0	0.403552083	1.497635417	0.08490625	4.829166667	0	0	0	0	0	0	79.6502		5.098013857	20.1564	0	1.278439625	0	0.131416667	1.25003945	1.073026504	1.113875	3.91875	0.609385417	0.705572917	0	0	0.36040625	7.68265	22.44295833	1.873479167	1.59778125	2.830010417	1.843989583	3.135220106	0	0	0	0.819216667	0.012305667	0	0	0	0	0.403552083	1.497635417	0.08490625	4.829166667	0	0	0	0	0	0	79.6502	YES	"1A IP Acute: 25%;$2,500 max oop"	"1B IP Psych: 25%; $2,500 OOP Max"	2 SNF: 25%	6 Home Health - $0	10A Ambulance - $100 per trip one way	11A DME - 30%	11B Pros./Med Supp. - 30%; 11C Diabetes Mon Supplies - 30%	4A Emergency Care - $50; 4B Urgent Care - $25	9B ASC Services - 25%; 9A Outpatient Hospital - 25%	8A Outpatient C/D/T - 25%	8B Outpatient X-Rays - 25%; Outpatient Radiology Therapy - 25%; 25% High-tech Radiology	5 Partial Hosp - 25%	12 Renal Dialysis - $0	3 CORF - 50%; 9D Cardiac Rehab Svcs - 50%; 9C Outpatient Sub Abuse - 25%;	7A Primary Care - 25%; 14B Immunizations - $0; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%; 14J Nutritional Training - 25%	7D Physician Specialist - 25%;	7E Mental Health - 25%; 7H Psychiatric Services - 25%	7C Occupational Therapy - 50%; 7I PT and ST Services - 50%	7D Specialist Copays; 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%	13A Blood - 25%	10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%; 17A Eye Exams (Medicare Covered) - 25%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - 25%	7B Chiropractic - $40	7F Podiatry - $40	18A Hearing Exams (Medicare Covered) - 25%	7D High Tech Radiology: 25%							10000	0	0	1.0296	0	0.6138	0.3663	0.3168	0	0.2277	0	0	0	0	0	2.178	8.3952	0.1782	0.7029	0.1386	0.2673	0.2475	0	0	0	0	0	0	0	0	0.0396	0.0198	0.1485	0.0198	0.2673							15.1569		0.206862567	20.1564	0	2.308039625	0	0.745216667	1.61633945	1.389826504	1.113875	4.14645	0.609385417	0.705572917	0	0	0.36040625	9.86065	30.83815833	2.051679167	2.30068125	2.968610417	2.111289583	3.382720106	0	0	0	0.819216667	0.012305667	0	0	0	0.0396	0.423352083	1.646135417	0.10470625	5.096466667	0	0	0	0	0	0	94.8071
H5528_011_0	2011	6	i.6.	i.6.	i.6.	i.6.							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	High Tech Radiology							A	A	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	Coin	V	V	V	V																																															0	YES	337.6	0	716.9	463.8	15.8	8.598823167	6.581189333	284.8	386.5	336.4	444.2	0	0	222.3	6742.1	13849.1	907.6	1447.8	1667.3	1032.1	21.783522	0	0	46	495	371.3	0	0	0	1.622712083	1.052474167	4.769531	0.806912333	31.41277967							6700	1A IP Acute: $100 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 - $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	9B ASC Services - $100; 9A Outpatient Hospital - $100	8A Outpatient C/D/T - $10	8B Outpatient X-Rays - $10; Outpatient Radiology Therapy - $50; $50 High-tech Radiology	5 Partial Hosp - $20	12 Renal Dialysis - $0	3 CORF - $20; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $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 Nutritional Training - $0	7D Physician Specialist - $20	7E Mental Health - $20; 7H Psychiatric Services - $20	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Specialist Copays - $20;	7G Other Health Care - $20	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"	13A Blood - $10	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - $0	7B Chiropractic - $20	7F Podiatry - $20	18A Hearing Exams (Medicare Covered) - $20	7D High Tech Radiology: $50								415.8896914	475	27.75169455	0	75	0.2	0.2	50	100	10	10	20	0	20	10	20	20	20	20	20	0.2	10	0	0	20	0.4	0	0	0	0	20	20	20	50							YES	395.0952068	451.25	26.36410982	0	71.25	0.19	0.19	47.5	95	9.5	9.5	19	0	19	9.5	19	19	19	19	19	0.150817266	9.5	0	0	19	0.38	0	0	0	0	19	19	19	47.5							2500	11.1153	0	1.575035861	0	0.0938125	1.633776402	1.250425973	1.127333333	3.059791667	0.266316667	0.351658333	0	0	0.351975	5.337495833	21.92774167	1.437033333	2.29235	2.639891667	1.634158333	3.28533124	0	0	0	0.78375	0.011757833	0	0	0	0	0.001666417	0.007551757	0.001277611	0.124342253	0	0	0	0	0	0	60.3098		4.07266198	11.1153	0	1.575035861	0	0.0938125	1.633776402	1.250425973	1.127333333	3.059791667	0.266316667	0.351658333	0	0	0.351975	5.337495833	21.92774167	1.437033333	2.29235	2.639891667	1.634158333	3.28533124	0	0	0	0.78375	0.011757833	0	0	0	0	0.001666417	0.007551757	0.001277611	0.124342253	0	0	0	0	0	0	60.3098	YES	"1A IP Acute: 25%;$2,500 max oop"	"1B IP Psych: 25%; $2,500 OOP Max"	2 SNF: 25%	6 Home Health - $0	10A Ambulance - $75 per trip one way	11A DME - 30%	11B Pros./Med Supp. - 30%; 11C Diabetes Mon Supplies - 30%	4A Emergency Care - $50; 4B Urgent Care - $20	9B ASC Services - 25%; 9A Outpatient Hospital - 25%	8A Outpatient C/D/T - 25%	8B Outpatient X-Rays - 25%; Outpatient Radiology Therapy - 25%; 25% High-tech Radiology	5 Partial Hosp - 25%	12 Renal Dialysis - $0	3 CORF - 25%; 9D Cardiac Rehab Svcs - 25%; 9C Outpatient Sub Abuse - 25%;	7A Primary Care - 25%; 14B Immunizations - 0%; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%; 14J Nutritional Training - 25%	7D Physician Specialist - 25%;	7E Mental Health - 25%; 7H Psychiatric Services - 25%	7C Occupational Therapy - 25%; 7I PT and ST Services - 25%	7D Specialist Copays; 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%	13A Blood - 25%	10B Transportation - NA	16A Preventative Dental - 50%;16B Comp Dental - NA	17A Eye Exams (Routine) - 50%; 17A Eye Exams (Medicare Covered) - 25%	17B Eye Wear - 50%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - 25%	7B Chiropractic - $40	7F Podiatry - $40	18A Hearing Exams (Medicare Covered) - 25%	7D High Tech Radiology: 25%							10000	0.4214	0	0.7425	0	0.4554	0.8811	0.4554	0	0.2178	0	0.0099	0	0	0.0396	2.4453	10.296	0.2475	0.4356	0.3168	0.3366	1.3563	0	0	0	0	0	0	0	0	0.0495	0.3366	0.2376	0.0198	0.4257							19.7264		0.307325133	11.5368	0	2.317535861	0	0.5492125	2.514876402	1.705825973	1.127333333	3.277591667	0.266316667	0.361558333	0	0	0.391575	7.782795833	32.22374167	1.684533333	2.72795	2.956691667	1.970758333	4.64163124	0	0	0	0.78375	0.011757833	0	0	0	0.0495	0.338266417	0.245151757	0.021077611	0.550042253	0	0	0	0	0	0	80.0363
H5528_018_0	2011	6	i.7	i.8	i.9	i.10							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	High Tech Radiology							A	A	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	Coin	V	V	V	V																																															0	YES	436.0517081	1.1	895.0373606	744.0000481	18.05098885	8.694858804	6.696374087	444.8702507	310.8406209	692.5585164	679.9914181	0	5.729102237	209.3598346	5722.505165	11528.81567	1029.163874	1339.919106	1615.941316	898.3696269	18.17768816	0	0	52.27159295	562.8365336	424.6132566	0	0	0	2.818696276	112.4021693	890.4336209	37.52327698	1314.57574							6700	1A IP Acute: $0 days 1-7	1B IP Psych: $0 days 1-7	2 SNF: $25 days 1-100	6 Home Health - $0	10A Ambulance - $0 per trip one way	11A DME - 0% coinsurance	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; Outpatient Radiology Therapy - $0; $0 High-tech Radiology	5 Partial Hosp - $0	12 Renal Dialysis - $0	3 CORF - $0 9D Cardiac Rehab Svcs - $0; 9C Outpatient Sub Abuse - $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 Nutritional Training - $0	7D Physician Specialist - $0	7E Mental Health - $0; 7H Psychiatric Services - $0	7C Occupational Therapy - $0; 7I PT and ST Services - $0	7D Specialist Copays - $0	7G Other Health Care - $0	15 Medicare Part B Rx Drugs - 0%	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $0; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	"13B Acupunture - NA; 13C OTC - $125/quarter (benefit, not cost sharing); 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - $0"	7B Chiropractic - 0	7F Podiatry - $0	18A Hearing Exams (Medicare Covered) - $0	7D High Tech Radiology: $0								0	0	0	0	0	0	0	0	0	0	0	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		5.155433209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: 0%	6 Home Health - $0	10A Ambulance - $0 per trip one way	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%; Outpatient Radiology Therapy - 0%; 0% High-tech Radiology	5 Partial Hosp - 0%	12 Renal Dialysis - $0	3 CORF - 0%; 9D Cardiac Rehab Svcs - 0%; 9C Outpatient Sub Abuse - 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 Nutritional Training - 0%	7D Physician Specialist - 0%;	7E Mental Health - 0%; 7H Psychiatric Services - 0%	7C Occupational Therapy - 0%; 7I PT and ST Services - 0%	7D Specialist Copays; 0%	7G Other Health Care - 0%	15 Medicare Part B Rx Drugs - 0%	13A Blood - 0%	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - 0%; 17A Eye Exams (Medicare Covered) - 0%	17B Eye Wear - 0%	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	"13B Acupunture - NA; 13C OTC - $125/quarter (benefit, not cost sharing); 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - 0%"	7B Chiropractic - $0	7F Podiatry - $0	18A Hearing Exams (Medicare Covered) - 0%	7D High Tech Radiology: 0%							10000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0							0		0.290125133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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_019_0	2011	5	i.7	i.8	i.9	i.10							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	High Tech Radiology							A	A	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	Coin	V	V	V	V																																															0	YES	329.7	1.1	899.1	583.3	16.9	7.3860615	6.070244667	230.3	262.1	424.7	570.1	0	1.2	219.9	5063.3	12525.7	958.2	1271.7	1395	1099.5	21.060501	0	0	48.7	523.8	393.3	0.1	2.3	0	0.88531625	166.3	888.1	43.4	1230.2							6700	1A IP Acute: $0	1B IP Psych: $0	2 SNF: $0	6 Home Health - $0	10A Ambulance - $0	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; Outpatient Radiology Therapy - $0; $0 High-tech Radiology	5 Partial Hosp - $0	12 Renal Dialysis - $0	3 CORF - $0; 9D Cardiac Rehab Svcs - $0; 9C Outpatient Sub Abuse - $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 Nutritional Training - $0	7D Physician Specialist - $0	7E Mental Health - $0; 7H Psychiatric Services - $0	7C Occupational Therapy - $0; 7I PT and ST Services - $0	7D Specialist Copays - $0;	7G Other Health Care - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $0; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $0	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - $0	7B Chiropractic - $0	7F Podiatry - $0	18A Hearing Exams (Medicare Covered) - $0	7D High Tech Radiology: $0								0	0	0	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	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	0.155109953	0	0	0	0	0	0	0	0	0	0	0	0	0							2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.266693322	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.2667		0.945406878	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.266693322	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.2667	YES	"1A IP Acute: 35%;$2,500 max oop"	"1B IP Psych: 35%;$2,500 max oop"	2 SNF: 35%	6 Home Health - $0	10A Ambulance - $0	11A DME - 35%%	11B Pros./Med Supp. - 35%%; 11C Diabetes Mon Supplies - 35%%	4A Emergency Care - $0; 4B Urgent Care - $0	9B ASC Services - 35%; 9A Outpatient Hospital - 35%	8A Outpatient C/D/T - 35%	8B Outpatient X-Rays - 35%; Outpatient Radiology Therapy - 35%; 35% High-tech Radiology	5 Partial Hosp - 35%	12 Renal Dialysis - 0%	3 CORF - 35%; 9D Cardiac Rehab Svcs - 35%%; 9C Outpatient Sub Abuse - 35%;	7A Primary Care - 35%; 14B Immunizations - $0; 14D Pap/Pelvic - 35%; 14E Prostate Screening - 35%; 14F Colorectal Screening - 35%; 14G Bone Mass Meas. - 35%; 14H Mammography - 35%; 14I Diabetes Monitoring - 35%; 14J Nutritional Training - 35%	7D Physician Specialist - 35%;	7E Mental Health - 35%; 7H Psychiatric Services - 35%	7C Occupational Therapy - 35%; 7I PT and ST Services - 35%	7D Specialist Copays; 35%	7G Other Health Care - 35%	15 Medicare Part B Rx Drugs - 35%	13A Blood - 35%	10B Transportation - NA	16A Preventative Dental - 35%;16B Comp Dental - NA	17A Eye Exams (Routine) - 35%; 17A Eye Exams (Medicare Covered) - 35%	17B Eye Wear - 35%	18A Hearing Exams (Routine) - 35%	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - 35%	7B Chiropractic - 35%	7F Podiatry - 35%	18A Hearing Exams (Medicare Covered) - 35%	7D High Tech Radiology: 35%							10000	0.1562	0	1.02	0	0	0.58	0.25	0	0	0	0.03	0	0	0.01	2.62	11.38	0.23	0.59	0.44	0.72	1.22	0	0	0	0	0.02	0	0	0	0.05	0	0	0	0.8							20.1162		0.053762567	0.1562	0	1.02	0	0	0.58	0.25	0	0	0	0.03	0	0	0.01	2.62	11.38	0.23	0.59	0.44	0.72	4.486693322	0	0	0	0	0.02	0	0	0	0.05	0	0	0	0.8	0	0	0	0	0	0	23.3829
H5528_020_0	2011	4	i.7	i.8	i.9	i.10							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	High Tech Radiology							A	A	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	Coin	V	V	V	V																																															0	YES	343.1	0.7	724.2	580.1	18.3	6.427614667	7.104922583	291.4	336.8	462.2	532.6	0	18.9	145	5986.5	13907.1	1003.5	1379.3	1514.5	915.5	20.3796255	0	0	51	548.7	411.5	0	0	0	2.005965	274.8	907.1	45.8	1309.6							6700	1A IP Acute: $0	1B IP Psych: $0	2 SNF: $0	6 Home Health - $0	10A Ambulance - $0	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; Outpatient Radiology Therapy - $0; $0 High-tech Radiology	5 Partial Hosp - $0	12 Renal Dialysis - $0	3 CORF - $0; 9D Cardiac Rehab Svcs - $0; 9C Outpatient Sub Abuse - $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 Nutritional Training - $0	7D Physician Specialist - $0	7E Mental Health - $0; 7H Psychiatric Services - $0	7C Occupational Therapy - $0; 7I PT and ST Services - $0	7D Specialist Copays - $0;	7G Other Health Care - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $0; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $0	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - $0	7B Chiropractic - $0	7F Podiatry - $0	18A Hearing Exams (Medicare Covered) - $0	7D High Tech Radiology: $0								0	0	0	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	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	0.169826821	0	0	0	0	0	0	0	0	0	0	0	0	0							2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.461007021	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.461		0.614918079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.461007021	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.461	YES	"1A IP Acute: 35%;$2,500 max oop"	"1B IP Psych: 35%;$2,500 max oop"	2 SNF: 35%	6 Home Health - $0	10A Ambulance - $0	11A DME - 35%%	11B Pros./Med Supp. - 35%%; 11C Diabetes Mon Supplies - 35%%	4A Emergency Care - $0; 4B Urgent Care - $0	9B ASC Services - 35%; 9A Outpatient Hospital - 35%	8A Outpatient C/D/T - 35%	8B Outpatient X-Rays - 35%; Outpatient Radiology Therapy - 35%; 35% High-tech Radiology	5 Partial Hosp - 35%	12 Renal Dialysis - 0%	3 CORF - 35%; 9D Cardiac Rehab Svcs - 35%%; 9C Outpatient Sub Abuse - 35%;	7A Primary Care - 35%; 14B Immunizations - $0; 14D Pap/Pelvic - 35%; 14E Prostate Screening - 35%; 14F Colorectal Screening - 35%; 14G Bone Mass Meas. - 35%; 14H Mammography - 35%; 14I Diabetes Monitoring - 35%; 14J Nutritional Training - 35%	7D Physician Specialist - 35%;	7E Mental Health - 35%; 7H Psychiatric Services - 35%	7C Occupational Therapy - 35%; 7I PT and ST Services - 35%	7D Specialist Copays; 35%	7G Other Health Care - 35%	15 Medicare Part B Rx Drugs - 35%	13A Blood - 35%	10B Transportation - NA	16A Preventative Dental - 35%%;16B Comp Dental - NA	17A Eye Exams (Routine) - 35%%; 17A Eye Exams (Medicare Covered) - 35%	17B Eye Wear - 35%%	18A Hearing Exams (Routine) - 35%	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - 35%	7B Chiropractic - 35%	7F Podiatry - 35%	18A Hearing Exams (Medicare Covered) - 35%	7D High Tech Radiology: 35%							10000	0.1662	0	1.5	0	0	0.51	0.33	0	0	0	0.01	0	0	0.05	2.81	12.27	0.23	0.66	0.64	0.64	0.57	0	0	0	0	0	0	0	0	0.08	0	0	0	0.66							21.1262		0.053762567	0.1662	0	1.5	0	0	0.51	0.33	0	0	0	0.01	0	0	0.05	2.81	12.27	0.23	0.66	0.64	0.64	4.031007021	0	0	0	0	0	0	0	0	0.08	0	0	0	0.66	0	0	0	0	0	0	24.5872
H5528_021_0	2011	4	i.7	i.8	i.9	i.10							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	High Tech Radiology							A	A	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	Coin	V	V	V	V																																															0	YES	351.6	0	737.6	471.8	17.4	8.329499	6.469613	299.9	372.8	346.1	418.5	0	0.2	215.6	6987.9	13506.4	993.2	1198.3	1662.8	1057.4	22.08052267	0	0	50.4	542.4	407	0	0	0	1.677781	245	930.1	57.1	1394							6700	1A IP Acute: $0	1B IP Psych: $0	2 SNF: $0	6 Home Health - $0	10A Ambulance - $0	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; Outpatient Radiology Therapy - $0; $0 High-tech Radiology	5 Partial Hosp - $0	12 Renal Dialysis - $0	3 CORF - $0; 9D Cardiac Rehab Svcs - $0; 9C Outpatient Sub Abuse - $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 Nutritional Training - $0	7D Physician Specialist - $0	7E Mental Health - $0; 7H Psychiatric Services - $0	7C Occupational Therapy - $0; 7I PT and ST Services - $0	7D Specialist Copays - $0;	7G Other Health Care - $0	"15 Medicare Part B Rx Drugs - 20%, $3,000 OOP max"	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $0; 17A Eye Exams (Medicare Covered) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $0	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - $0	7B Chiropractic - $0	7F Podiatry - $0	18A Hearing Exams (Medicare Covered) - $0	7D High Tech Radiology: $0								0	0	0	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	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	0.158755017	0	0	0	0	0	0	0	0	0	0	0	0	0							2500	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.505393757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.5054		0.910710777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.505393757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.5054	YES	"1A IP Acute: 35%;$2,500 max oop"	"1B IP Psych: 35%;$2,500 max oop"	2 SNF: 35%	6 Home Health - $0	10A Ambulance - $0	11A DME - 35%	11B Pros./Med Supp. - 35%; 11C Diabetes Mon Supplies - 35%	4A Emergency Care - $0; 4B Urgent Care - $0	9B ASC Services - 35%; 9A Outpatient Hospital - 35%	8A Outpatient C/D/T - 35%	8B Outpatient X-Rays - 35%; Outpatient Radiology Therapy - 35%; 35% High-tech Radiology	5 Partial Hosp - 35%	12 Renal Dialysis - 0%	3 CORF - 35%; 9D Cardiac Rehab Svcs - 35%; 9C Outpatient Sub Abuse - 35%;	7A Primary Care - 35%; 14B Immunizations - $0; 14D Pap/Pelvic - 35%; 14E Prostate Screening - 35%; 14F Colorectal Screening - 35%; 14G Bone Mass Meas. - 35%; 14H Mammography - 35%; 14I Diabetes Monitoring - 35%; 14J Nutritional Training - 35%	7D Physician Specialist - 35%;	7E Mental Health - 35%; 7H Psychiatric Services - 35%	7C Occupational Therapy - 35%; 7I PT and ST Services - 35%	7D Specialist Copays; 35%	7G Other Health Care - 35%	15 Medicare Part B Rx Drugs - 35%	13A Blood - 35%	10B Transportation - NA	16A Preventative Dental - 35%;16B Comp Dental - NA	17A Eye Exams (Routine) - 35%; 17A Eye Exams (Medicare Covered) - 35%	17B Eye Wear - 35%	18A Hearing Exams (Routine) - 35%	18B Hearing Aids - NA	14A Health Education/Wellness Programs - $0	13B Acupunture - NA; 13C OTC - NA; 13D Meal Benefit - NA; 13E Other - NA; 14C Routine Physical Exams - 35%	7B Chiropractic - 35%	7F Podiatry - 35%	18A Hearing Exams (Medicare Covered) - 35%	7D High Tech Radiology: 35%							10000	0.3362	0	1.62	0	0	0.79	0.53	0	0	0	0.01	0	0	0.04	3.58	14.5	0.33	0.65	0.4	0.42	0.87	0	0	0	0	0	0	0	0	0.06	0	0	0	0.54							24.6762		0.053762567	0.3362	0	1.62	0	0	0.79	0.53	0	0	0	0.01	0	0	0.04	3.58	14.5	0.33	0.65	0.4	0.42	4.375393757	0	0	0	0	0	0	0	0	0.06	0	0	0	0.54	0	0	0	0	0	0	28.1816
H5528_804_0	2011	4	i.7	i.8	i.9	i.10							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	High Tech Radiology							Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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	326.5528088	0	29.95969167	13.626129	0.640248167	7.534795917	4.447157833	9.240499333	49.58326275	3.2698935	25.02870708	0	0	4.402832167	33.5496375	142.2408917	10.4770575	4.4803125	12.9454915	5.01539175	8.518154	0	0	0.50252125	1.205270917	2.410913	0	0	0	0.993044	0.780785833	5.043835667	0.648216417	25.1520995							6700	Medicare Cost Sharing	Medicare Cost Sharing	Medicare 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	0.5	0.2	0.2	0.2	0.2	0.2	0.2	Non covered	Non covered	Non covered	Non covered	Non covered	Non covered	Non covered	0.2	0.2	0.2	0.2								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	0.233	0.233	0.233	0.233							NO	0.058488758	0.058488758	0.137406773	0	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0	0	0	0	0	0	0	0	0.22135	0.22135	0.22135	0.22135								19.0997	0	4.116664565	0	0.141718932	1.667827076	0.984378386	2.045384527	10.97525521	0.723790926	5.540104313	0	0	0.9745669	7.426212261	31.48502137	2.319096678	0.991717172	2.865484544	1.110156964	1.885493388	0	0	0	0	0	0	0	0	0	0.172826944	1.116453025	0.143482704	5.567417224	0	0	0	0	0	0	101.3527		5.177083377	19.0997	0	4.116664565	0	0.141718932	1.667827076	0.984378386	2.045384527	10.97525521	0.723790926	5.540104313	0	0	0.9745669	7.426212261	31.48502137	2.319096678	0.991717172	2.865484544	1.110156964	1.885493388	0	0	0	0	0	0	0	0	0	0.172826944	1.116453025	0.143482704	5.567417224	0	0	0	0	0	0	101.3527	YES	Medicare Cost Sharing	Medicare Cost Sharing	Medicare 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	0.5	0.2	0.2	0.2	0.2	0.2	0.2	Non covered	Non covered	Non covered	Non covered	Non covered	Non covered	Non covered	0.2	0.2	0.2	0.2							10000	0	0	0.7029	0	1.5444	0.3366	0.3168	0	0.1782	0	0	0	0	0	1.7622	7.4745	0.1485	0.4158	0.2277	0.297	0.0297	0	0	0	0	0	0	0	0	0	0.0198	0.1386	0.1188	0.3366							14.0481		0.1419	19.0997	0	4.819564565	0	1.686118932	2.004427076	1.301178386	2.045384527	11.15345521	0.723790926	5.540104313	0	0	0.9745669	9.188412261	38.95952137	2.467596678	1.407517172	3.093184544	1.407156964	1.915193388	0	0	0	0	0	0	0	0	0	0.192626944	1.255053025	0.262282704	5.904017224	0	0	0	0	0	0	115.4008
H5528_807_0	2011	4	i.7	i.8	i.9	i.10							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	High Tech Radiology							Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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	428.9608674	1.62539083	28.11304089	20.25317949	0.797297953	7.839205008	5.959244768	9.697755987	54.3230231	6.645922678	61.42028581	0	0.676847691	6.410937323	37.39586646	165.9000392	10.71699664	5.106055847	20.09339999	5.561628261	21.42981244	0	0	0.513697324	1.233105007	2.493330303	0	0	0	1.02473922	0.762639396	4.452351527	0.718880227	27.03738221							6700	Medicare Cost Sharing	Medicare Cost Sharing	Medicare 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	0.5	0.2	0.2	0.2	0.2	0.2	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	0.2	0.2	0.2	0.2								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	0.233	0.233	0.233	0.233							NO	0.058488758	0.058488758	0.137406773	0	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0.22135	0	0	0	0	0	0	0	0	0.22135	0.22135	0.22135	0.22135								25.0894	0.095067091	3.86292224	0	0.176481902	1.735208028	1.319078829	2.146598288	12.02440116	1.471074985	13.59538026	0	0.149820236	1.419060976	8.277575042	36.72197367	2.372207207	1.130225462	4.447674089	1.231066416	4.743488983	0	0	0	0	0	0	0	0	0	0.16881023	0.98552801	0.159124138	5.984724551	0	0	0	0	0	0	129.3069		6.62464333	25.0894	0.095067091	3.86292224	0	0.176481902	1.735208028	1.319078829	2.146598288	12.02440116	1.471074985	13.59538026	0	0.149820236	1.419060976	8.277575042	36.72197367	2.372207207	1.130225462	4.447674089	1.231066416	4.743488983	0	0	0	0	0	0	0	0	0	0.16881023	0.98552801	0.159124138	5.984724551	0	0	0	0	0	0	129.3069	YES	Medicare Cost Sharing	Medicare Cost Sharing	Medicare 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	0.5	0.2	0.2	0.2	0.2	0.2	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	0.2	0.2	0.2	0.2							10000	0.0144	0	1.1744	0	2.0935	0.5	0.1939	0	0.2359	0.0006	0.0083	0	0.0545	0.0058	2.1428	9.2363	0.1191	0.3329	0.2864	0.4965	0.8935	0	0	0	0	0	0	0	0	0	0.0604	0.2339	0.0354	0.7789							18.8973		0.190881894	25.1038	0.095067091	5.037318332	0	2.269949812	2.235202539	1.512962125	2.146598288	12.26026	1.47167952	13.60364397	0	0.204335231	1.424822568	10.42032627	45.95831192	2.491315806	1.463132504	4.734070391	1.727569791	5.637023088	0	0	0	0	0	0	0	0	0	0.229171116	1.219450155	0.194543222	6.763602062	0	0	0	0	0	0	148.2042
H5529_001_0	2011	7	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	1328.279189	78.39093796	575.0364962	596.2218492	124.8333442	11.13513987	2.035034222	310.7319677	777.1764227	8009.222889	884.9402601	120.0863784	0.050465838	129.6697162	3719.470768	4161.153677	17.49261735	1549.491641	632.487887	1384.993487	44.31824702	3.678809565	0	745.9758882	302.4	239.2	129.6	0	6153.971276	0	6.393843533	6.990853527	167.2750129	0	0	0	0	0	0	0		1A: $250/day (days1-7) w/$1750 yrly max	1B: $250/day (days1-7) w/$1750 yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $35 copay	9A: $35-$200 copay; 9B: $200 copay	8A: $0-$125 copay	8B: $75-$125 copay	9A: $200 copay	12: 20% coin	3: $35 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $20 copay; 7G: $20 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35-$50 copay; 7I: $35-$50 copay	8B: $75-$125 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$35; 17B: $0; 18A: $35	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $35 copay	17B: $35 copay	18A: $35 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay									250	250	128	0	125	0.2	0.090095219	49.84072022	131.4592391	18.75969077	95.09990485	200	0.2	4.847161572	17.40144055	33.9118137	40	46.05628254	89.75779967	17.51004419	0.2	0	0	0	35	35	35	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	123.7020426	94.41082269	113.5388945	0	110.8778267	0.177404523	0.079916497	44.20984589	116.6073178	16.64026993	84.35576612	177.4045226	0.177404523	4.299541924	15.43547127	30.0805456	35.48090453	40.85296409	79.61719802	15.53180515	0.177404523	0	0	0	35	35	35	0	0	0	0.177404523	0.177404523	0	0	0	0	0	0	0	0		13.6926	0.616746079	5.440750672	0	1.153437492	1.975424173	0.162632805	1.144784367	7.552038177	11.10630257	6.220817801	1.77532222	0.008952868	0.046460032	4.784315349	10.43081441	0.051721157	5.275110532	4.196409446	1.792620748	7.862257458	0	0	0	0.882	0.697666667	0.378	0	0	0	1.13429676	1.240209033	0	0	0	0	0	0	0	0	89.6217		11.16549782	13.6926	0.616746079	5.440750672	0	1.153437492	1.975424173	0.162632805	1.144784367	7.552038177	11.10630257	6.220817801	1.77532222	0.008952868	0.046460032	4.784315349	10.43081441	0.051721157	5.275110532	4.196409446	1.792620748	7.862257458	0	0	0	0.882	0.697666667	0.378	0	0	0	1.13429676	1.240209033	0	0	0	0	0	0	0	0	89.6217	YES	1A: $300/day (days1-10) no yrly max	1B: $300/day (days1-10) no yrly max	2: 30% coin (for days 1-100)	6: $0 copay	10A: $125 copay	11A: 30% coin	11B: 30% coin; 11C: 30% coin	4A: $50 copay; 4B: $35 copay	9A: $45-$275 copay; 9B: $275 copay	8A: 0% - 30%	8B: 30% coin	9A: $275 copay	12: 20% coin	3: $45 copay; 5: $50 copay; 9C: $50 copay; 9D: $0 copay	7A: $30 copay; 7G: $30 copay; 14B: $0 copay; 14C: $0 copay	7B: $45 copay; 7D: $45 copay; 7F: $45 copay; 7G: $45 copay	7E: $50 copay; 7H: $50 copay	7C: $45-$90 copay; 7I: $45-$90 copay	8B: 30% coin	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $45; 17B: $0; 18A: $45	15: 20% coinsurance	13A: $0 copay	10B: Not covered	$16A: 20% coinsurance	17A: $45 copay	17B: $45 copay	18A: $45 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin								4500	3.9191	0.2582	1.0513	0	1.127	0.5454	0.2745	0.189	0.7138	0.6791	0.6582	0.3712	0	0.0374	1.1378	2.0282	0.0164	0.868	1.3253	0.2067	1.5706	0	0	0.1807	0.2835	0.2243	0.1215	0	0	0	0.1194	0.0883	0.0292	0	0	0	0	0	0	0	18.0243		2.192538325	17.6117	0.874973522	6.492013847	0	2.280433212	2.520873547	0.437157254	1.333766935	8.265797156	11.7854201	6.879040201	2.146537978	0.008952868	0.083852568	5.922113661	12.45900415	0.068123824	6.143092924	5.52175901	1.999303021	9.432886418	0	0	0.180728745	1.1655	0.921916667	0.4995	0	0	0	1.253745537	1.328550102	0.029226232	0	0	0	0	0	0	0	107.646
H5529_004_0	2011	7	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	1328.279189	78.39093796	575.0364962	596.2218492	124.8333442	11.13513987	2.035034222	310.3405067	777.1764227	8009.222889	884.9402601	120.0863784	0.050465838	129.6697162	3719.470768	4161.153677	17.49261735	1549.491641	632.487887	1384.993487	44.31824702	3.678809565	0	1491.951776	302.4	239.2	129.6	0	6156.047551	0	6.393843533	6.990853527	167.2750129	0	0	0	0	0	0	0		1A: $200/day (days1-5) w/$1000 yrly max	1B: $200/day (days1-5) w/$1000 yrly max	2: $115/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $20 copay	9A: $20-$175 copay; 9B: $175 copay	8A: $0-$125 copay	8B: $75-$125 copay	9A: $175 copay	12: 20% coin	3: $20 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $10 copay; 7G: $10 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $20 copay; 7F: $20 copay; 7G: $20 copay	7E: $40 copay; 7H: $40 copay	7C: $20-$40 copay; 7I: $20-$40 copay	8B: $75-$125 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$20; 17B: $0; 18A: $20	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $20 copay	17B: $20 copay	18A: $20 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay									200	200	115	0	125	0.2	0.090095219	49.68144044	110.6132246	18.75969077	95.09990485	175	0.2	4.847161572	8.700720276	19.56472548	40	34.74171005	89.75779967	10.00573954	0.2	0	0	0	20	20	20	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	82.13259689	57.53931698	102.29375	0	111.1888587	0.177902174	0.080140677	44.19218129	98.39166564	16.68694885	84.59239906	155.6644022	0.177902174	4.311602905	7.739385259	17.40303597	35.58043478	30.90312872	79.84053844	8.900214076	0.177902174	0	0	0	20	20	20	0	0	0	0.177902174	0.177902174	0	0	0	0	0	0	0	0		9.0913	0.375880086	4.901886632	0	1.156673089	1.98096559	0.163089019	1.142885328	6.372306893	11.13745772	6.238268302	1.557764525	0.008977982	0.04659036	2.398868103	6.034725594	0.051866244	3.99034497	4.208181121	1.027228211	7.88431249	0	0	0	0.504	0.398666667	0.216	0	0	0	1.137478664	1.24368804	0	0	0	0	0	0	0	0	73.2694		8.96207942	9.0913	0.375880086	4.901886632	0	1.156673089	1.98096559	0.163089019	1.142885328	6.372306893	11.13745772	6.238268302	1.557764525	0.008977982	0.04659036	2.398868103	6.034725594	0.051866244	3.99034497	4.208181121	1.027228211	7.88431249	0	0	0	0.504	0.398666667	0.216	0	0	0	1.137478664	1.24368804	0	0	0	0	0	0	0	0	73.2694	YES	1A: $275/day (days1-5) no yrly max	1B: $275/day (days1-5) no yrly max	2: 25% coin (for days 1-100)	6: $0 copay	10A: $125 copay	11A: 25% coin	11B: 25% coin; 11C: 25% coin	4A: $50 copay; 4B: $20 copay	9A: $25-$225 copay; 9B: $225 copay	8A: 0% - 25%	8B: 25% coin	9A: $225 copay	12: 20% coin	3: $25 copay; 5: $50 copay; 9C: $50 copay; 9D: $0 copay	7A: $15 copay; 7G: $15 copay; 14B: $0 copay; 14C: $0 copay	7B: $25 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $50 copay; 7H: $50 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: 25% coin	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $25; 17B: $0; 18A: $25	15: 20% coinsurance	13A: $0 copay	10B: Not covered	$16A: 20% coinsurance	17A: $25 copay	17B: $25 copay	18A: $25 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin								3800	2.7718	0.1582	0.8785	0	1.1302	0.4558	0.2294	0.1883	0.5696	0.5675	0.5501	0.3046	0	0.0353	0.5705	1.1299	0.0164	0.4836	1.1076	0.1151	1.575	0	0	0.247	0.1575	0.1246	0.0675	0	0	0	0.1198	0.0886	0.0293	0	0	0	0	0	0	0	13.6719		1.624120368	11.8631	0.534128419	5.780396761	0	2.286830233	2.436781803	0.392501135	1.331212336	6.941931868	11.70497654	6.788325662	1.862338504	0.008977982	0.081914025	2.969363122	7.164658465	0.068314923	4.473910102	5.315737293	1.142373796	9.459347344	0	0	0.247044534	0.6615	0.52325	0.2835	0	0	0	1.257262517	1.332276922	0.029308217	0	0	0	0	0	0	0	86.9412
H5529_804_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	314.3005296	3.763216234	50.94820044	10.6282778	7.790244609	15.63807439	3.947286214	13.26958675	51.91482575	6.571686494	27.43882602	0	0.024128986	33.57033158	51.96381258	143.0799644	1.384015778	5.503387194	21.62604248	26.11115687	50.38819438	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.071547611	0.071547611	0.154560026	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.056192874	0.056192874	0.121390106	0	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564																				17.6615	0.211465936	6.184607467	0	1.283026522	2.575537123	0.650104478	2.185455347	8.550193434	1.082334187	4.519080373	0	0.003973961	5.528918272	8.558261396	23.56477855	0.227942643	0.906388963	3.561734895	4.300417826	8.298762493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8544		27.28528446	17.6615	0.211465936	6.184607467	0	1.283026522	2.575537123	0.650104478	2.185455347	8.550193434	1.082334187	4.519080373	0	0.003973961	5.528918272	8.558261396	23.56477855	0.227942643	0.906388963	3.561734895	4.300417826	8.298762493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8544	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.9624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.9624		3.031698273	19.6238	0.211465936	6.184607467	0	1.283026522	2.575537123	0.650104478	2.185455347	8.550193434	1.082334187	4.519080373	0	0.003973961	5.528918272	8.558261396	23.56477855	0.227942643	0.906388963	3.561734895	4.300417826	8.298762493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8168
H5529_805_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	314.3005296	3.763216234	50.94820044	10.6282778	7.790244609	15.63807439	3.947286214	13.26958675	51.91482575	6.571686494	27.43882602	0	0.024128986	33.57033158	51.96381258	143.0799644	1.384015778	5.503387194	21.62604248	26.11115687	50.38819438	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.071547611	0.071547611	0.154560026	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.056192874	0.056192874	0.121390106	0	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564																				17.6615	0.211465936	6.184607467	0	1.283026522	2.575537123	0.650104478	2.185455347	8.550193434	1.082334187	4.519080373	0	0.003973961	5.528918272	8.558261396	23.56477855	0.227942643	0.906388963	3.561734895	4.300417826	8.298762493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8544		27.28528446	17.6615	0.211465936	6.184607467	0	1.283026522	2.575537123	0.650104478	2.185455347	8.550193434	1.082334187	4.519080373	0	0.003973961	5.528918272	8.558261396	23.56477855	0.227942643	0.906388963	3.561734895	4.300417826	8.298762493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8544	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.9624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.9624		3.031698273	19.6238	0.211465936	6.184607467	0	1.283026522	2.575537123	0.650104478	2.185455347	8.550193434	1.082334187	4.519080373	0	0.003973961	5.528918272	8.558261396	23.56477855	0.227942643	0.906388963	3.561734895	4.300417826	8.298762493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8168
H5529_806_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	314.3005296	3.763216234	50.94820044	10.6282778	7.790244609	15.63807439	3.947286214	13.26958675	51.91482575	6.571686494	27.43882602	0	0.024128986	33.57033158	51.96381258	143.0799644	1.384015778	5.503387194	21.62604248	26.11115687	50.38819438	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.071547611	0.071547611	0.154560026	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.056192874	0.056192874	0.121390106	0	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564																				17.6615	0.211465936	6.184607467	0	1.283026522	2.575537123	0.650104478	2.185455347	8.550193434	1.082334187	4.519080373	0	0.003973961	5.528918272	8.558261396	23.56477855	0.227942643	0.906388963	3.561734895	4.300417826	8.298762493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8544		27.28528446	17.6615	0.211465936	6.184607467	0	1.283026522	2.575537123	0.650104478	2.185455347	8.550193434	1.082334187	4.519080373	0	0.003973961	5.528918272	8.558261396	23.56477855	0.227942643	0.906388963	3.561734895	4.300417826	8.298762493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8544	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.9624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.9624		3.031698273	19.6238	0.211465936	6.184607467	0	1.283026522	2.575537123	0.650104478	2.185455347	8.550193434	1.082334187	4.519080373	0	0.003973961	5.528918272	8.558261396	23.56477855	0.227942643	0.906388963	3.561734895	4.300417826	8.298762493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8168
H5529_807_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	314.3005296	3.763216234	50.94820044	10.6282778	7.790244609	15.63807439	3.947286214	13.26958675	51.91482575	6.571686494	27.43882602	0	0.024128986	33.57033158	51.96381258	143.0799644	1.384015778	5.503387194	21.62604248	26.11115687	50.38819438	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.071547611	0.071547611	0.154560026	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.056192874	0.056192874	0.121390106	0	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564	0.164696564																				17.6615	0.211465936	6.184607467	0	1.283026522	2.575537123	0.650104478	2.185455347	8.550193434	1.082334187	4.519080373	0	0.003973961	5.528918272	8.558261396	23.56477855	0.227942643	0.906388963	3.561734895	4.300417826	8.298762493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8544		27.28528446	17.6615	0.211465936	6.184607467	0	1.283026522	2.575537123	0.650104478	2.185455347	8.550193434	1.082334187	4.519080373	0	0.003973961	5.528918272	8.558261396	23.56477855	0.227942643	0.906388963	3.561734895	4.300417826	8.298762493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8544	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.9624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.9624		3.031698273	19.6238	0.211465936	6.184607467	0	1.283026522	2.575537123	0.650104478	2.185455347	8.550193434	1.082334187	4.519080373	0	0.003973961	5.528918272	8.558261396	23.56477855	0.227942643	0.906388963	3.561734895	4.300417826	8.298762493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8168
H5530_001_0	2011	9	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	1451.788136	133.7667516	301.7779706	865.3737339	126.7046307	11.4777734	3.772908616	301.9932248	490.8289474	8202.826403	709.3579906	47.95480073	0	198.9292207	3535.775139	3900.85248	5.744699427	1317.371682	750.4920688	1174.282414	24.18714481	0	0	0	302.4	239.2	0	0	4516.750946	0	6.276938404	3.416537767	0.129124626	0	0	0	0	0	0	0		1A: $215/day (days1-8) w/$1720 yrly max	1B: $215/day (days1-8) w/$1720 yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $100 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $30 copay	9A: $30-$200 copay; 9B: $200 copay	8A: $0-$125 copay	8B: $75-$125 copay	9A: $200 copay	12: 20% coin	3: $30 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $15 copay; 7G: $15 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $30 copay; 7F: $30 copay; 7G: $30 copay	7E: $40 copay; 7H: $40 copay	7C: $30-$50 copay; 7I: $30-$50 copay	8B: $75-$125 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$30; 17B: $0; 18A: $30	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	17A: $30 copay	17B: $30 copay	18A: $30 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 0% coin; 14J: 0% coin									215	215	128	0	100	0.2	0.079881228	50	169.0362511	17.81689772	97.51675807	200	0.2	11.56521739	13.17971638	28.7254902	40	44.29758993	86.28425578	14.3830509	0.2	0	0	0	30	30	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	110.4667057	65.81174096	115.8393111	0	90.49946178	0.180998924	0.072292081	45.24973089	152.9768975	16.12419655	88.2521412	180.9989236	0	10.46645949	11.92757239	25.99641402	36.19978471	40.08908046	78.08678708	13.01658366	0.180998924	0	0	0	30	30	0	0	0	0	0.180998924	0.180998924	0	0	0	0	0	0	0	0		13.3645	0.733618567	2.913146018	0	0.955558407	2.077464631	0.272751416	1.138759346	6.25712413	11.02199876	5.216863463	0.723313943	0	0.173507053	3.514434493	8.450681341	0.01732974	4.401018281	4.883626198	1.273762107	4.377847175	0	0	0	0.756	0.598	0	0	0	0	1.136119094	0.618389658	0	0	0	0	0	0	0	0	74.8758		7.718244822	13.3645	0.733618567	2.913146018	0	0.955558407	2.077464631	0.272751416	1.138759346	6.25712413	11.02199876	5.216863463	0.723313943	0	0.173507053	3.514434493	8.450681341	0.01732974	4.401018281	4.883626198	1.273762107	4.377847175	0	0	0	0.756	0.598	0	0	0	0	1.136119094	0.618389658	0	0	0	0	0	0	0	0	74.8758	YES	1A: $285/day (days1-10) no yrly max	1B: $285/day (days1-10) no yrly max	2: 30% coin (for days 1-100)	6: $0 copay	10A: $100 copay	11A: 30% coin	11B: 30% coin; 11C: 30% coin	4A: $50 copay; 4B: $30 copay	9A: $40-$275 copay; 9B: $275 copay	8A: 0% - 30%	8B: 30% coin	9A: $275 copay	12: 20% coin	3: $40 copay; 5: $50 copay; 9C: $50 copay; 9D: $0 copay	7A: $20 copay; 7G: $30 copay; 14B: $0 copay; 14C: $0 copay	7B: $40 copay; 7D: $40 copay; 7F: $40 copay; 7G: $40 copay	7E: $50 copay; 7H: $50 copay	7C: $40-$80 copay; 7I: $40-$80 copay	8B: 30% coin	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $40; 17B: $0; 18A: $40	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	17A: $40 copay	17B: $40 copay	18A: $40 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin								4500	2.0319	0.0161	0.5398	0	0.72	0.2829	0.4695	0.1592	0.6306	0.775	0.4389	0.3321	0	0.0077	0.6562	2.0391	0.0072	0.5027	1.3127	0.1456	1.0793	0	0	0	0.252	0.1993	0	0	0	0	0.0959	0.188	0.0012	0	0	0	0	0	0	0	12.8832		1.305089465	15.3964	0.749680757	3.452947305	0	1.675524133	2.360413681	0.742290361	1.297927529	6.88775838	11.79703641	5.655812636	1.055430434	0	0.181248696	4.170653988	10.48981411	0.024550465	4.903741789	6.19635568	1.419331924	5.457184102	0	0	0	1.008	0.797333333	0	0	0	0	1.232050266	0.806436653	0.001173601	0	0	0	0	0	0	0	87.7591
H5530_004_0	2011	8	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	1451.694424	133.758117	301.7584909	865.3178742	126.6964519	11.47703252	3.772665076	301.5825354	490.7972645	8202.296912	709.3122018	47.95170526	0	198.9163799	3535.546905	3900.600681	5.744328609	1317.286646	750.4436247	1174.206614	24.18558354	0	0	1491.951776	302.4	239.2	129.6	0	4521.991386	0	6.276533229	3.416317231	0.129116291	0	0	0	0	0	0	0		1A: $175/day (days1-7) w/$1225 yrly max	1B: $175/day (days1-7) w/$1225 yrly max	2: $120/day (for days 21-100)	6: $0 copay	10A: $100 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $15 copay	9A: $15-$150 copay; 9B: $150 copay	8A: $0-$75 copay	8B: $50-$75 copay	9A: $150 copay	12: 20% coin	3: $15 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $5 copay; 7G: $5 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $15 copay; 7F: $15 copay; 7G: $15 copay	7E: $40 copay; 7H: $40 copay	7C: $15-$30 copay; 7I: $15-$30 copay	8B: $50-$75 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$15; 17B: $0; 18A: $15	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $15 copay	17B: $15 copay	18A: $15 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 0% coin; 14J: 0% coin									175	175	120	0	100	0.2	0.079876071	49.99677251	125.4030453	11.79253964	61.25442483	150	0.2	11.56447086	4.392955211	14.68042487	40	25.72153202	55.6385362	7.191061241	0.2	0	0	0	15	15	15	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	84.54143337	49.24290353	109.3464033	0	91.12200271	0.182244005	0.072784676	45.55806041	114.2697664	10.74559829	55.81625865	136.6830041	0	10.53777745	4.002948766	13.37709715	36.44880109	23.43797511	50.69894847	6.55263902	0.182244005	0	0	0	15	15	15	0	0	0	0.182244005	0.182244005	0	0	0	0	0	0	0	0		10.2274	0.548886504	2.749683803	0	0.962069536	2.091620376	0.274592205	1.144959614	4.673607396	7.344882309	3.299262777	0.546181927	0	0.174678045	1.179384427	4.348226187	0.017447824	2.572877635	3.170558555	0.64117934	4.407677618	0	0	0	0.378	0.299	0.162	0	0	0	1.143860556	0.622603336	0	0	0	0	0	0	0	0	52.9806		5.080145022	10.2274	0.548886504	2.749683803	0	0.962069536	2.091620376	0.274592205	1.144959614	4.673607396	7.344882309	3.299262777	0.546181927	0	0.174678045	1.179384427	4.348226187	0.017447824	2.572877635	3.170558555	0.64117934	4.407677618	0	0	0	0.378	0.299	0.162	0	0	0	1.143860556	0.622603336	0	0	0	0	0	0	0	0	52.9806	YES	1A: $250/day (days1-7) no yrly max	1B: $250/day (days1-7) no yrly max	2: 25% coin (for days 1-100)	6: $0 copay	10A: $100 copay	11A: 25% coin	11B: 25% coin; 11C: 25% coin	4A: $50 copay; 4B: $15 copay	9A: $25-$225 copay; 9B: $225 copay	8A: 0% - 25%	8B: 25% coin	9A: $225 copay	12: 20% coin	3: $25 copay; 5: $50 copay; 9C: $50 copay; 9D: $0 copay	7A: $15 copay; 7G: $15 copay; 14B: $0 copay; 14C: $0 copay	7B: $25 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $50 copay; 7H: $50 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: 25% coin	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $25; 17B: $0; 18A: $25	15: 20% coinsurance	13A: $0 copay	10B: Not covered	$16A: 20% coinsurance	17A: $25 copay	17B: $25 copay	18A: $25 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin								3400	1.5816	0.0142	0.4529	0	0.7249	0.2374	0.3939	0.1588	0.5144	0.6502	0.3683	0.2736	0	0.0078	0.4955	1.2831	0.0073	0.3163	1.1013	0.0916	1.0867	0	0	0.2259	0.1575	0.1246	0.0675	0	0	0	0.0966	0.1893	0.0012	0	0	0	0	0	0	0	10.6223		0.978859001	11.809	0.563071235	3.202583359	0	1.686941075	2.329017919	0.66851541	1.303799117	5.188004216	7.995105931	3.667522464	0.819765168	0	0.182471936	1.67487065	5.631285434	0.024717751	2.889200367	4.271882758	0.732774504	5.494369095	0	0	0.225910931	0.5355	0.423583333	0.2295	0	0	0	1.240445398	0.811931674	0.001181598	0	0	0	0	0	0	0	63.6029
H5530_804_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	288.4839882	3.454106899	46.76333213	9.755274585	7.789721903	15.63702511	3.947021361	13.2686964	51.91134239	6.571245551	27.43698494	0	0.024127367	33.5680791	51.96032593	143.0703641	1.383922914	5.503017931	21.62459143	26.10940488	50.38481346	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.068452977	0.068452977	0.13910912	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.054306794	0.054306794	0.110361459	0	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347																				15.6666	0.187581473	5.16086955	0	1.295932	2.601443476	0.656643632	2.207438015	8.636196593	1.093220977	4.564536091	0	0.004013934	5.584531568	8.644345708	23.80180774	0.230235432	0.915505986	3.597561038	4.3436741	8.382236603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5744		25.41680964	15.6666	0.187581473	5.16086955	0	1.295932	2.601443476	0.656643632	2.207438015	8.636196593	1.093220977	4.564536091	0	0.004013934	5.584531568	8.644345708	23.80180774	0.230235432	0.915505986	3.597561038	4.3436741	8.382236603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5744	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.7407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.7407		2.82408996	17.4074	0.187581473	5.16086955	0	1.295932	2.601443476	0.656643632	2.207438015	8.636196593	1.093220977	4.564536091	0	0.004013934	5.584531568	8.644345708	23.80180774	0.230235432	0.915505986	3.597561038	4.3436741	8.382236603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3152
H5530_805_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	288.4839882	3.454106899	46.76333213	9.755274585	7.789721903	15.63702511	3.947021361	13.2686964	51.91134239	6.571245551	27.43698494	0	0.024127367	33.5680791	51.96032593	143.0703641	1.383922914	5.503017931	21.62459143	26.10940488	50.38481346	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.068452977	0.068452977	0.13910912	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.054306794	0.054306794	0.110361459	0	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347																				15.6666	0.187581473	5.16086955	0	1.295932	2.601443476	0.656643632	2.207438015	8.636196593	1.093220977	4.564536091	0	0.004013934	5.584531568	8.644345708	23.80180774	0.230235432	0.915505986	3.597561038	4.3436741	8.382236603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5744		25.41680964	15.6666	0.187581473	5.16086955	0	1.295932	2.601443476	0.656643632	2.207438015	8.636196593	1.093220977	4.564536091	0	0.004013934	5.584531568	8.644345708	23.80180774	0.230235432	0.915505986	3.597561038	4.3436741	8.382236603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5744	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.7407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.7407		2.82408996	17.4074	0.187581473	5.16086955	0	1.295932	2.601443476	0.656643632	2.207438015	8.636196593	1.093220977	4.564536091	0	0.004013934	5.584531568	8.644345708	23.80180774	0.230235432	0.915505986	3.597561038	4.3436741	8.382236603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3152
H5530_806_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	288.4839882	3.454106899	46.76333213	9.755274585	7.789721903	15.63702511	3.947021361	13.2686964	51.91134239	6.571245551	27.43698494	0	0.024127367	33.5680791	51.96032593	143.0703641	1.383922914	5.503017931	21.62459143	26.10940488	50.38481346	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.068452977	0.068452977	0.13910912	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.054306794	0.054306794	0.110361459	0	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347																				15.6666	0.187581473	5.16086955	0	1.295932	2.601443476	0.656643632	2.207438015	8.636196593	1.093220977	4.564536091	0	0.004013934	5.584531568	8.644345708	23.80180774	0.230235432	0.915505986	3.597561038	4.3436741	8.382236603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5744		25.41680964	15.6666	0.187581473	5.16086955	0	1.295932	2.601443476	0.656643632	2.207438015	8.636196593	1.093220977	4.564536091	0	0.004013934	5.584531568	8.644345708	23.80180774	0.230235432	0.915505986	3.597561038	4.3436741	8.382236603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5744	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.7407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.7407		2.82408996	17.4074	0.187581473	5.16086955	0	1.295932	2.601443476	0.656643632	2.207438015	8.636196593	1.093220977	4.564536091	0	0.004013934	5.584531568	8.644345708	23.80180774	0.230235432	0.915505986	3.597561038	4.3436741	8.382236603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3152
H5530_807_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	288.4839882	3.454106899	46.76333213	9.755274585	7.789721903	15.63702511	3.947021361	13.2686964	51.91134239	6.571245551	27.43698494	0	0.024127367	33.5680791	51.96032593	143.0703641	1.383922914	5.503017931	21.62459143	26.10940488	50.38481346	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.068452977	0.068452977	0.13910912	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																			NO	0.054306794	0.054306794	0.110361459	0	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347	0.166364347																				15.6666	0.187581473	5.16086955	0	1.295932	2.601443476	0.656643632	2.207438015	8.636196593	1.093220977	4.564536091	0	0.004013934	5.584531568	8.644345708	23.80180774	0.230235432	0.915505986	3.597561038	4.3436741	8.382236603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5744		25.41680964	15.6666	0.187581473	5.16086955	0	1.295932	2.601443476	0.656643632	2.207438015	8.636196593	1.093220977	4.564536091	0	0.004013934	5.584531568	8.644345708	23.80180774	0.230235432	0.915505986	3.597561038	4.3436741	8.382236603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5744	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.7407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.7407		2.82408996	17.4074	0.187581473	5.16086955	0	1.295932	2.601443476	0.656643632	2.207438015	8.636196593	1.093220977	4.564536091	0	0.004013934	5.584531568	8.644345708	23.80180774	0.230235432	0.915505986	3.597561038	4.3436741	8.382236603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3152
H5532_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1593.210955	84.18439705	1479.666652	2757.864871	228.7865194	12.42125827	11.56237008	299.8835975	56.72592105	23.54019701	65.76002983	0	0.18636753	23.11385004	6570.995086	158.869627	451.2539552	978.2968224	0	0	29.00737965	2433.918308	0	0	186.3347904	0	17.35494546	10.45	118.0591744	0											4950	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-60 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												187.4696942	115.9014585	64.25181613	0	200	0.2	0.133694764	49.21722143	0.2	0.12283611	0.161060565	0	0.2	0.159254801	10.60914116	0.12998561	38.5	35	0	0	0.2	34.85532674	0	0	35	0	35	0	0	0											NO	137.5576027	85.04375524	47.14535773	0	146.7518292	0.146751829	0.098099756	36.13770093	0.146751829	0.090132119	0.118179663	0	0.146751829	0.116854667	10.12668262	0.124097041	36.749184	33.40834909	0	0	0.146751829	25.57541478	0	0	35	0	35	0	0	0												18.2632	0.596613105	5.81328447	0	2.797903352	1.822842372	1.134265683	0.90309198	8.324632677	2.121727835	7.771498143	0	0.027349776	2.700961247	5.545198476	19.71525067	1.381934553	2.723606813	0	0	4.256886024	5.187372522	0	0	0.543476472	0	0.050618591	0	0	0	0	0	0	0	0	0	0	0	0	0	91.6817	0	23.78985929	18.2632	0.596613105	5.81328447	0	2.797903352	1.822842372	1.134265683	0.90309198	8.324632677	2.121727835	7.771498143	0	0.027349776	2.700961247	5.545198476	19.71525067	1.381934553	2.723606813	0	0	4.256886024	5.187372522	0	0	0.543476472	0	0.050618591	0	0	0	0	0	0	0	0	0	0	0	0	0	91.6817	YES	"$375 Days 1-27 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-27 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-58 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.7169	0.0345	0.1514	0.2288	0.1166	0.1139	0.106	0.0376	0.5203	0.0884	0.4792	0	0.0011	0.1681	0.9068	1.3088	0.0909	0.1812	0	0	0.3716	0.345	0	0	0.0361	0	0.0034	0	0	0											6.0069	0	1.380708966	18.9801	0.631148543	5.964645869	0.228822156	2.914482658	1.93677002	1.240315618	0.940720813	8.844922219	2.210133162	8.250736954	0	0.02848935	2.86910269	6.45196884	21.02409989	1.472810068	2.904768869	0	0	4.62851893	5.532415926	0	0	0.579626078	0	0.053985512	0	0	0	0	0	0	0	0	0	0	0	0	0	97.6886
H5533_003_0	2011	7																															A	A	D		T	coin	coin	V	V		P	V		V	V	V	V	V			S	P	T	V																	5.215499062	0.09444154	0.385660262	1.27339794	2.862658868	3.799368705	0	0	8.266083802	0	25.74492672	1.570625133	0.01130279	0	2.320415692	7.579425114	0.031158797	1.293699894	0	0	0.176032439	1.208609559	0	0	0	0	0.000335835	0	0	0.050163324											61.8838	YES	294.9847771	4.683727759	1451.325104	0	296.3689899	19.38044145	0	1350.68196	1435.835867	0	9930.91207	1767.639272	0	106.7670446	38736.9579	6533.568015	51.85297821	793.1001139	0	0	325.8853659	452.9183374	0	0	0	0	0	0	0	0											3400	1a $0/stay	1b $0/stay	2 $0/days 1-100	6 $0/vst	10a $0/trip	11a $0/item	"11b $0/item, 11c $0/item"	"4a $50/vst, 4b $50/vst"	"9a $0/vst, 9b $0/vst"	8a $0/vst	8b $0/all x-rays	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $30/vst, 9d $0/vst"	"7a $20/PCP; $30/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $25/vst, 7d $25/vst, 7f $25/vst, 7g $25/vst, 16b $25/vst, 17a $0/vst, 18a $25/vst"	"7e $30/vst, 7h $30/vst"	"7c $0/vst, 7i $0/vst"			15 $0/vst	13a $0/vst	10b not covrd	"16a not covrd, 16b not covrd"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	18a not covrd	18b not covrd	14a $0/vst	13b not covrd											1200	0	0	0	0	0	0	0	22.26244898	0	0	0	0	0	30.83664708	1.775776107	15.62208211	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	21.62395619	0	0	0	0	0	29.95224407	1.724846389	15.17403675	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	2.433923961	0	0	0	0	0	0.266492715	5.567941829	8.261716764	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.5301	1200	0.488085244	5.2155	0.09444154	0.385660262	1.27339794	2.862658868	3.799368705	0	2.433923961	8.266083802	0	25.74492672	1.570625133	0.01130279	0.266492715	7.888357521	15.84114188	0.031158797	1.293699894	0	0	0.176032439	1.208609559	0	0	0	0	0.000335835	0	0	0.050163324	0	0	0	0	0	0	0	0	0	0	78.4139	YES	1a 30% coin	1b 30% coin	2 30% coin	6 30% coin	10a 30% coin	11a 50% coin	"11b 50% coin, 11c 30% coin"	refer to In Network	"9a 30% coin, 9b 30% coin"	8a 30% coin	8b 30% coin	5 30% coin	12 30% coin	"3 30% coin, 9c $50/vst, 9d 30% coin"	"7a $30/vst, 14b $0/vst, 14c 30% coin, 14d 30% coin, 14e 30% coin, 14f 30% coin, 14g 30% coin, 14h 30% coin, 14i 30% coin, 14j 30% coin"	"7b $50/vst, 7d $50/vst, 7f $50/vst, 7g $50/vst, 16b $50/vst, 17a $50/vst, 18a $50/vst"	"7e $50/vst, 7h $50/vst"	"7c 30% coin, 7i 30% coin"			15 30% coin	13a 30% coin	10b not covrd	"16a not covrd, 16b not covrd"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	18a not covrd	18b not covrd	14a 50% coin	13b not covrd											5100	4.1005	0.0448	0.7597	0.4104	0.2875	0.7095	0	0.1319	0.9801	0	2.0911	0.1908	0.0071	0.0289	1.1644	1.9261	0.0078	0.1391	0	0	0.1186	0.1778	0	0	0	0	0.002	0.0006	0	0.003											13.2817	1200	0.29	9.316	0.139272992	1.145327867	1.683800821	3.150202935	4.508883557	0	2.565807681	9.24615844	0	27.83603391	1.761413563	0.018383729	0.29537287	9.052731135	17.76725413	0.038949934	1.432843298	0	0	0.294640313	1.38637462	0	0	0	0	0.002304048	0.000611956	0	0.053207516	0	0	0	0	0	0	0	0	0	0	91.6955
H5533_004_0	2011	7																															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	0	0	0	0	0											0	YES	296.5571845	12.88822417	1359.190787		303.5365915	24.34036806	0	1486.476021	1700.318256		10740.80922	2163.610949		411.2945155	24470.56236	6970.897716	88.99432652	1120.151364			344.2242019	722.3004836	0	0	0	0	0	0	0	0											3400	1a $250/stay-$750 combined max (1a/1b)	1b $250/stay-$750 combined max (1a/1b)	"2 $25/days 1-10; $70/days 11-55; $0/days 56-100 - $3,400 max"	6 $0/vst	10a $100/trp	11a 20% coin	"11b 20% coin, 11c $10-$50/item"	"4a $50/vst, 4b $50 vst"	"9a $150/vst, 9b $150/vst -$300 combined max (9a/9b)"	8a $0/vst	8b $30/x-ray; $90/diag x-ray; $0-$25/thera x-ray-$100 max per year	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $30/vst, 9d $0/vst"	"7a $15/PCP; $30/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $30/vst, 7d $30/vst, 7f $30/vst, 7g $30/vst, 16b $30/vst, 17a $0/vst, 18a $30/vst"	"7e $30/vst, 7h $30/vst"	"7c $30/vst, 7i $30/vst"	0	0	"15 10% coin - $2,000 max"	13a $0/vst	10b not covrd	"16a not covrd, 16b not covrd"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	18a not covrd	18b not covrd	14a $0 vst	13b not covrd											0	228.696291	214.3604043	45.5383228		100	0.136381539	0	11.83958216	21.40718104		7.309777436	5.546490356		30	2.357855993	17.71689248	4.206862258	23.46713021			72.98293174	25.13326268	0	0	0	0	0	0	0	0											NO	222.1372223	208.2124925	44.23227193		97.13197414	0.132470081	0	11.50001988	20.79321755		7.100131129	5.387415578		29.13959224	2.290232073	17.20876742	4.08620836	22.79408685			70.88976238	24.41243421	0	0	0	0	0	0	0	0												5.4897	0.223624106	5.01000804	0	2.456925697	3.224370534	0	1.424541983	2.946257285	0	6.355096156	0.971355944	0	0.998746206	4.670272231	9.996713126	0.030304113	2.127735623	0	0	2.033497656	1.469426086	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4286	0	1.459483037	5.4897	0.223624106	5.01000804	0	2.456925697	3.224370534	0	1.424541983	2.946257285	0	6.355096156	0.971355944	0	0.998746206	4.670272231	9.996713126	0.030304113	2.127735623	0	0	2.033497656	1.469426086	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4286	YES	1a 30% coin	1b 30% coin	2 30% coin	6 30% coin	10a 30% coin	11a 50% coin	"11b 50% coin, 11c 50% coin"	Refer to In Network	"9a 30% coin, 9b 30% coin"	8a 30% coin	8b 30% coin	5 30% coin	12 30% coin	"3 30% coin, 9c $45/vst, 9d 30% coin"	"7a $25/vst, 14b $0/vst, 14c 30% coin, 14d 30% coin, 14e 30% coin, 14f 30% coin, 14g 30% coin, 14h 30% coin, 14i 30% coin, 14j 30% coin"	"7b $45/vst, 7d $45/vst, 7f $45/vst, 7g $45/vst, 16b $45/vst, 17a $45/vst, 18a $45/vst"	"7e $45/vst, 7h $45/vst"	"7c $45/vst, 7i $45/vst"	0	0	15 50% coin	13a 30% coin	10b not covrd	"16a not covrd, 16b not covrd"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	18a not covrd	18b not covrd	14a 50% coin	13b not covrd											5100	7.3262	0.2448	0.9314		0.4417	1.5106	0	0.1528	2.1989		3.6561	0.4405		0.0887	1.3028	2.6742	0.0223	0.2295			0.2453	0	0	0	0	0	0.0001	0.0014	0												21.4671	500	0.27	12.8159	0.468378425	5.941410996	0	2.89858276	4.735010234	0	1.57735651	5.145176397	0	10.01116271	1.411843868	0	1.087419242	5.973053235	12.67091492	0.052575553	2.357193434	0	0	2.278766602	1.469426086	0	0	0	0	5.09E-05	0.001414723	0	0	0	0	0	0	0	0	0	0	0	0	70.8957
H5533_801_0	2011	4																															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	323.286044	2.929779774	1329.2895		341.6267657	24.59030903	0	1360.59376	1857.209231		12189.9827	2027.865472		254.1510376	45642.4232	9144.199286	64.74251494	1664.0293			425.2286529	887.5069889	0	0.441572168																	3400	1a $150/stay	1b $150/stay	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/vst	10a $75/trp	11a 20% coin	"11b 20% coin, 11c $25-$50/item"	"4a $50/vst, 4b $50 vst"	"9a $100/vst, 9b $100/vst"	8a $0/vst	8b $25/x-ray; $75/diag x-ray; $0/thera x-ray	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $25/vst, 9d $0/vst"	"7a $15/PCP; $25/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $25/vst, 7d $25/vst, 7f $25/vst, 7g $25/vst, 16b $25/vst, 17a $25/vst, 18a $25/vst"	"7e $25/vst, 7h $25/vst"	"7c $25/vst, 7i $25/vst"	0	0	15 20% coin	13a $0/vst	10b not covrd	"16a $25/vst-6 mo; $25/x-ray-1yr, 16b 20% coin"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	"18a $25/vst - 1 yr, $25/fitting - 3yr"	"18b $1,000 max-3 yr"	14a $0/vst	13b not covrd												20.42763158	32.39564428	46.56267036		23.38643296	0.138593354	0	9.59147244	1.786907153		22.0955433	1.323224673		25	0.441705184	14.32307357	1.941747573	21.4177789			252.4928296	53.98367331	0	0	0	0	0	0	0												NO	19.88520871	31.5354301	45.3262736		22.76544388	0.134913231	0	9.336786329	1.73945871		21.50883172	1.288088572		24.33616524	0.429976414	13.94274741	1.890187592	20.84906426			245.7882889	52.55022377	0	0	0	0	0	0	0													0.5357	0.007699322	5.020978298	0	0.64810708	3.317558035	0	1.058631102	0.269211564	0	21.84935721	0.217672528	0	0.515421804	1.635430454	10.62460508	0.010197958	2.89112115	0	0	8.709685249	3.886557572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.198	0	1.669549146	0.5357	0.007699322	5.020978298	0	0.64810708	3.317558035	0	1.058631102	0.269211564	0	21.84935721	0.217672528	0	0.515421804	1.635430454	10.62460508	0.010197958	2.89112115	0	0	8.709685249	3.886557572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.198	YES	1a 20% coin	1b 20% coin	2 20% coin	6 20% coin	10a 20% coin	11a 50% coin	"11b 50% coin, 11c 50% coin"	Refer to In Network	"9a 20% coin, 9b 20% coin"	8a 20% coin	8b 20% coin	5 20% coin	12 20% coin	"3 20% coin, 9c 20% coin, 9d 20% coin"	"7a 20% coin, 14b $0/vst, 14c 20% coin, 14d 20% coin, 14e 20% coin, 14f 20% coin, 14g 20% coin, 14h 20% coin, 14i 20% coin, 14j 20% coin"	"7b 20% coin, 7d 20% coin, 7f 20% coin, 7g 20% coin, 17a 20% coin, 18a 20% coin"	"7e 20% coin, 7h 20% coin"	"7c 20% coin, 7i 20% coin"	0	0	15 20% coin	13a 20% coin	10b not covrd	"16a 50% coin, 16b 50% coin"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	18a 20% coin	18b 50% coin	14a 50% coin	13b not covrd											5100	6.4603	0.0533	0.6711		0.3671	1.527	0	0.1401	2.1875		3.719	0.4331		0.0001	2.3243	3.4916	0.0189	0.3786			0.2304	0	0	0	0	0	0	0	0												22.0023	500	0.05	6.9961	0.061003747	5.692107398	0	1.015158353	4.844527344	0	1.198775828	2.456699902	0	25.56834035	0.650734342	0	0.515499673	3.959708815	14.11615925	0.029049436	3.269746627	0	0	8.940072946	3.886557572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2002
H5533_802_0	2011	5																															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	308.6090645	6.892527755	1355.241684		247.1066145	29.63663731	0	1365.304835	1820.407782		11470.15645	2278.216245		387.6582031	296907.4869	9750.155519	80.24995737	1895.964292			587.5980434	962.9907161	0	431.275731																	3400	1a $150/stay	1b $150/stay	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/vst	10a $75/trp	11a 20% coin	"11b 20% coin, 11c $25-$50/item"	"4a $50/vst, 4b $50 vst"	"9a $100/vst, 9b $100/vst"	8a $0/vst	8b $25/x-ray; $75/diag x-ray; $0/thera x-ray	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $25/vst, 9d $0/vst"	"7a $15/PCP; $25/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $25/vst, 7d $25/vst, 7f $25/vst, 7g $25/vst, 16b $25/vst, 17a $25/vst, 18a $25/vst"	"7e $25/vst, 7h $25/vst"	"7c $25/vst, 7i $25/vst"	0	0	15 20% coin	13a $0/vst	10b not covrd	"16a $25/vst-6 mo; $25/x-ray-1yr, 16b 20% coin"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	"18a $25/vst - 1 yr, $25/fitting - 3yr"	"18b $1,000 max-3 yr"	14a $0/vst	13b not covrd												24.70916667	105.3103448	47.47561058		55.38684453	0.127114871	0	10.65265686	1.926285035		9.002106803	1.205020265		25	0.241240484	14.48134943	13.37632562	22.12656086			196.8021283	52.72887144	0	0	0	0	0	0	0												NO	24.05305452	102.5139981	46.21497217		53.91613603	0.12373954	0	10.36979271	1.875135637		8.763070348	1.173022892		24.33616524	0.234834731	14.0968205	13.02113882	21.53902565			191.5763645	51.32874114	0	0	0	0	0	0	0													0.6186	0.058881715	5.219371392	0	1.11025282	3.667223864	0	1.179827344	0.284459292	0	8.376148987	0.222699984	0	0.786176174	5.810349149	11.45384935	0.08707882	3.403101961	0	0	9.380824748	4.119091766	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7779	0	1.669549146	0.6186	0.058881715	5.219371392	0	1.11025282	3.667223864	0	1.179827344	0.284459292	0	8.376148987	0.222699984	0	0.786176174	5.810349149	11.45384935	0.08707882	3.403101961	0	0	9.380824748	4.119091766	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7779	YES	1a 20% coin	1b 20% coin	2 20% coin	6 20% coin	10a 20% coin	11a 50% coin	"11b 50% coin, 11c 50% coin"	Refer to In Network	"9a 20% coin, 9b 20% coin"	8a 20% coin	8b 20% coin	5 20% coin	12 20% coin	"3 20% coin, 9c 20% coin, 9d 20% coin"	"7a 20% coin, 14b $0/vst, 14c 20% coin, 14d 20% coin, 14e 20% coin, 14f 20% coin, 14g 20% coin, 14h 20% coin, 14i 20% coin, 14j 20% coin"	"7b 20% coin, 7d 20% coin, 7f 20% coin, 7g 20% coin, 17a 20% coin, 18a 20% coin"	"7e 20% coin, 7h 20% coin"	"7c 20% coin, 7i 20% coin"	0	0	15 20% coin	13a 20% coin	10b not covrd	"16a 50% coin, 16b 50% coin"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	18a 20% coin	18b 50% coin	14a 50% coin	13b not covrd											5100	2.4732	0.0203	0.255		0.3889	1.0239	0	0.1203	0.983		2.0992	0.1646		0.1427	1.0725	1.7353	0.0072	0.6575			0.0875	0	0	0	0	0	0	0	0												11.2309	500	0.05	3.0918	0.079137396	5.47440045	0	1.499128567	4.691097449	0	1.300175058	1.267455821	0	10.47531402	0.387263473	0	0.92886601	6.882862083	13.18911014	0.094242381	4.060567486	0	0	9.468372073	4.119091766	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0088
H5533_803_0	2011	4																															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	308.6090645	6.892527755	1355.241684		247.1066145	29.63663731	0	1365.304835	1820.407782		11470.15645	2278.216245		387.6582031	296907.4869	9750.155519	80.24995737	1895.964292			587.5980434	962.9907161	0	431.275731																	3400	1a $150/stay	1b $150/stay	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/vst	10a $75/trp	11a 20% coin	"11b 20% coin, 11c $25-$50/item"	"4a $50/vst, 4b $50 vst"	"9a $100/vst, 9b $100/vst"	8a $0/vst	8b $25/x-ray; $75/diag x-ray; $0/thera x-ray	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $25/vst, 9d $0/vst"	"7a $15/PCP; $25/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $25/vst, 7d $25/vst, 7f $25/vst, 7g $25/vst, 16b $25/vst, 17a $25/vst, 18a $25/vst"	"7e $25/vst, 7h $25/vst"	"7c $25/vst, 7i $25/vst"	0	0	15 20% coin	13a $0/vst	10b not covrd	"16a $25/vst-6 mo; $25/x-ray-1yr, 16b 20% coin"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	"18a $25/vst - 1 yr, $25/fitting - 3yr"	"18b $1,000 max-3 yr"	14a $0/vst	13b not covrd												24.70916667	105.3103448	47.47561058		55.38684453	0.127114871	0	10.65265686	1.926285035		9.002106803	1.205020265		25	0.241240484	14.48134943	13.37632562	22.12656086			196.8021283	52.72887144	0	0	0	0	0	0	0												NO	24.05305452	102.5139981	46.21497217		53.91613603	0.12373954	0	10.36979271	1.875135637		8.763070348	1.173022892		24.33616524	0.234834731	14.0968205	13.02113882	21.53902565			191.5763645	51.32874114	0	0	0	0	0	0	0													0.6186	0.058881715	5.219371392	0	1.11025282	3.667223864	0	1.179827344	0.284459292	0	8.376148987	0.222699984	0	0.786176174	5.810349149	11.45384935	0.08707882	3.403101961	0	0	9.380824748	4.119091766	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7779	0	1.669549146	0.6186	0.058881715	5.219371392	0	1.11025282	3.667223864	0	1.179827344	0.284459292	0	8.376148987	0.222699984	0	0.786176174	5.810349149	11.45384935	0.08707882	3.403101961	0	0	9.380824748	4.119091766	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7779	YES	1a 20% coin	1b 20% coin	2 20% coin	6 20% coin	10a 20% coin	11a 50% coin	"11b 50% coin, 11c 50% coin"	Refer to In Network	"9a 20% coin, 9b 20% coin"	8a 20% coin	8b 20% coin	5 20% coin	12 20% coin	"3 20% coin, 9c 20% coin, 9d 20% coin"	"7a 20% coin, 14b $0/vst, 14c 20% coin, 14d 20% coin, 14e 20% coin, 14f 20% coin, 14g 20% coin, 14h 20% coin, 14i 20% coin, 14j 20% coin"	"7b 20% coin, 7d 20% coin, 7f 20% coin, 7g 20% coin, 17a 20% coin, 18a 20% coin"	"7e 20% coin, 7h 20% coin"	"7c 20% coin, 7i 20% coin"	0	0	15 20% coin	13a 20% coin	10b not covrd	"16a 50% coin, 16b 50% coin"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	18a 20% coin	18b 50% coin	14a 50% coin	13b not covrd											5100	2.4732	0.0203	0.255		0.3889	1.0239	0	0.1203	0.983		2.0992	0.1646		0.1427	1.0725	1.7353	0.0072	0.6575			0.0875	0	0	0	0	0	0	0	0												11.2309	500	0.05	3.0918	0.079137396	5.47440045	0	1.499128567	4.691097449	0	1.300175058	1.267455821	0	10.47531402	0.387263473	0	0.92886601	6.882862083	13.18911014	0.094242381	4.060567486	0	0	9.468372073	4.119091766	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0088
H5549_001_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	894.6131454	14.59553394	79.47484537		50.650447	20.2837622	20.59778044	8.495951753	23.59919156	6.61673275	15.69568498	0.440410221	5.201765171	23.14268317	274.6678988	1.438290332	9.460087639	16.77224665	38.76993793	129.1971268	13.56592382	16.37793518																			6700	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)																				0.061567114	0.061567114	0.144638709		0.2	0.2	0.2	0.2	0.2	0.2	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	0.043886551	0.043886551	0.103102024		0.142564912	0.142564912	0.142564912	0.142564912	0.142564912	0.142564912	0.142564912	0.142564912	0.142564912	0.142564912	0.142564912	0.142564912	0.142564912	0.142564912	0.142564912	0.142564912	0.142564912	0.142564912																				39.2615	0.640547642	8.194017424	0	7.220976526	2.891752777	2.936520759	1.211224615	3.364416672	0.943313923	2.237653951	0.062787045	0.741589195	3.299334594	39.15800486	0.205049735	1.348676563	2.39113387	5.527232796	18.41897703	1.934024738	2.33491889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.3236	0	58.14362564	39.2615	0.640547642	8.194017424	0	7.220976526	2.891752777	2.936520759	1.211224615	3.364416672	0.943313923	2.237653951	0.062787045	0.741589195	3.299334594	39.15800486	0.205049735	1.348676563	2.39113387	5.527232796	18.41897703	1.934024738	2.33491889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.3236	NO																																																																																		0	0	0	39.2615	0.640547642	8.194017424	0	7.220976526	2.891752777	2.936520759	1.211224615	3.364416672	0.943313923	2.237653951	0.062787045	0.741589195	3.299334594	39.15800486	0.205049735	1.348676563	2.39113387	5.527232796	18.41897703	1.934024738	2.33491889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.3236
H5549_002_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	485.7492959	22.42167499	44.65091529		28.18508377	10.20785672	13.5159543	7.648047519	26.90335627	5.667445682	10.15193557	0.588890417	3.780206476	18.5595468	196.4758588	1.516389534	9.561386895	22.3197316	37.2986097	105.6769724	10.67244807	13.94320568																			6700	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)	Medicare Coinsurance (No Deductible)																				0.061567114	0.061567114	0.144638709		0.2	0.2	0.2	0.2	0.2	0.2	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	0.049254953	0.049254953	0.115713932		0.1600041	0.1600041	0.1600041	0.1600041	0.1600041	0.1600041	0.1600041	0.1600041	0.1600041	0.1600041	0.1600041	0.1600041	0.1600041	0.1600041	0.1600041	0.160021508	0.1600041	0.1600041																				23.9256	1.104378554	5.166732993	0	4.50972897	1.63329893	2.162608107	1.223718962	4.304647315	0.906814547	1.624351318	0.094224881	0.604848536	2.969603587	31.43694302	0.242628543	1.529861108	3.571248573	5.967930487	16.91058851	1.707635452	2.23097008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.8283	0	28.45113465	23.9256	1.104378554	5.166732993	0	4.50972897	1.63329893	2.162608107	1.223718962	4.304647315	0.906814547	1.624351318	0.094224881	0.604848536	2.969603587	31.43694302	0.242628543	1.529861108	3.571248573	5.967930487	16.91058851	1.707635452	2.23097008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.8283	NO																																																																																		0	0	0	23.9256	1.104378554	5.166732993	0	4.50972897	1.63329893	2.162608107	1.223718962	4.304647315	0.906814547	1.624351318	0.094224881	0.604848536	2.969603587	31.43694302	0.242628543	1.529861108	3.571248573	5.967930487	16.91058851	1.707635452	2.23097008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.8283
H5549_003_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	P	P	Coin	P	P	Coin	Coin	Coin	Coin																																																											0	YES								593.0872117						150.2010774	20740.0769		1049.901767	10201.06633																							6700								"$50 - ER, $10 UC"						"$10 - OP PT, OT, ST"	$10 - Specialist Office Visit		$20 - MH/SA	"$10 - PT, OT, ST, CORF"																															42						10	4.467172609		20	10																							NO								41.78574018						9.948985757	4.444383666		19.89797151	9.948985757																								0	0	0	0	0	0	0	2.065215678	0	0	0	0	0	0.124529032	7.681404917	0	1.740909621	8.457521968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.0696	0	0.102908429	0	0	0	0	0	0	0	2.065215678	0	0	0	0	0	0.124529032	7.681404917	0	1.740909621	8.457521968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.0696	NO																																																																																		0	0	0	0	0	0	0	0	0	0	2.065215678	0	0	0	0	0	0.124529032	7.681404917	0	1.740909621	8.457521968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.0696
H5549_004_0	2011	9																															D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	V	V	V	V	V	Coin	V	Coin	Coin							O																																																				0	NO	1896.316031	175.4813082	1073.628696		264.18859	7.866093155	8.757054494	199.8971884	201.18985		12.46705659	3.046734358	0.636750234	1775.548255		6048.082404	1286.27804	2565.00527	42.80442224	1.345306004	22.38113015	0.400540838																				$230 per day 1-6	$230 per day 1-6	"$0 Days 1-20, $125 Days 21-100"		50	0.2	0.2	"ER - $50, UC $25"	200		0.2	0.2	0.2	0.2		20	20	20	0.2	20	0.2	0.2							Nurseline - $0													178.94	178.94	38.875		50	0.2	0.2	45	200		0.2	0.2	0.2	38.04066718		20	21.60151999	20	0.2	20	0.2	0.2																			NO	137.6454305	137.6454305	29.90368901		38.46133634	0.153845345	0.153845345	34.61520271	153.8453454		0.153845345	0.153845345	0.153845345	29.2618979		15.38453454	16.61646652	15.38453454	0.153845345	15.38453454	0.153845345	0.153845345																				21.7516	2.012850017	2.675454887	0	0.846753851	1.210161818	1.347232073	0.576623475	2.579343497	0	1.917998626	0.4687259	0.09796106	4.329659313	0	7.753911053	1.781116332	3.288451014	6.585261124	0.001724742	3.443232698	0.061621344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7297	0	18.8193343	21.7516	2.012850017	2.675454887	0	0.846753851	1.210161818	1.347232073	0.576623475	2.579343497	0	1.917998626	0.4687259	0.09796106	4.329659313	0	7.753911053	1.781116332	3.288451014	6.585261124	0.001724742	3.443232698	0.061621344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7297	NO																																																																																		0	0	0	21.7516	2.012850017	2.675454887	0	0.846753851	1.210161818	1.347232073	0.576623475	2.579343497	0	1.917998626	0.4687259	0.09796106	4.329659313	0	7.753911053	1.781116332	3.288451014	6.585261124	0.001724742	3.443232698	0.061621344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7297
H5549_005_0	2011	6																															D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	V	V	V	V	V	Coin	V	Coin	Coin							O																																																				0	YES								184.2047055																																	3400								ER - $50																					Nurseline - $0																				50																																	NO								50																																		0	0	0	0	0	0	0	0.767519606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.7675	0	0	0	0	0	0	0	0	0	0.767519606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.7675	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0.767519606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.7675
H5575_005_0	2011	7																															Coin	Coin	Coin	Coin	Coin	Coin	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	431.3613531	3.704447704	0	0	54.48839703	54.6091136	40.64700452	80.80683366	79.91678974	27.20188526	69.3248165	34.18221628	0.795365517	5.871227754	0	52.83236238	5.604694307	122.6598468	19.20629957	44.2281136	45.62670012	70.80294283	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	Medicare-FFS Cost Sharing; PBP 10a	Medicare-FFS Cost Sharing; PBP 11a	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 4b"	Medicare-FFS Cost Sharing; PBP 9b	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14c; Medicare-FFS Cost Sharing; PBP 14b, 14d-j"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"5% Coinsurance for Occ Therapy; 5% Coinsurance for PT/ST; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7g, 18a"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 16b, 17a"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											0	0.08048831	0.08048831	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.221901364	0	0.233	0.233	0.05	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074714643	0.074714643	0	0	0.216286212	0.216286212	0.216286212	0.216286212	0.216286212	0.216286212	0.216286212	0.216286212	0.216286212	0.205983714	0	0.216286212	0.216286212	0.04641335	0.216286212	0.216286212	0.216286212	0.216286212	0	0	0	0	0	0	0	0												32.229	0.276776486	0	0	11.78508898	11.81119831	8.791386631	17.47740395	17.28489972	5.883392718	14.99400195	7.393142072	0.172026595	1.2093773	0	11.42691152	1.2122181	5.693054423	4.154057779	9.565931148	9.868426128	15.31370029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	186.542	0	14.41849513	32.229	0.276776486	0	0	11.78508898	11.81119831	8.791386631	17.47740395	17.28489972	5.883392718	14.99400195	7.393142072	0.172026595	1.2093773	0	11.42691152	1.2122181	5.693054423	4.154057779	9.565931148	9.868426128	15.31370029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	186.542	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	32.229	0.276776486	0	0	11.78508898	11.81119831	8.791386631	17.47740395	17.28489972	5.883392718	14.99400195	7.393142072	0.172026595	1.2093773	0	11.42691152	1.2122181	5.693054423	4.154057779	9.565931148	9.868426128	15.31370029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	186.542
H5575_006_0	2011	6																															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	1486.666302	32.2317582	0	0	513.0291344	25.39744015	0	947.3393391	1884.330249	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											750	$75/Days 1-10 for IP Medical; $75/Days 1-10 for IP Surgical; PBP 1a	$75/Days 1-10 for IP Psych; $75/Days 1-10 for IP Substance Abuse; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME / Medical Supplies; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"$50/Visit for ER - Facility; $20/Visit for PCP Urgent Care; PBP 4a, 4b"	$50/Visit for OP Fac - Surgery; $50/Visit for Prof - Primary Surgeon (OP); $50/Visit for Prof - Anesthesia (OP); PBP 9b	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14b-j"	"No Cost-Sharing; PBP 7b, 7d, 7f"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	No Cost-Sharing; PBP 7d	"No Cost-Sharing; PBP 7g, 18a"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 13a, 16b, 17a"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	75	75	0	0	50	0.2	0	48.88554342	50	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	61.8160287	61.8160287	0	0	41.2106858	0.164842743	0	40.2921354	41.2106858	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												7.6583	0.166036607	0	0	1.761856872	4.186583705	0	3.18086041	6.471211821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.4249	0	4.995998224	7.6583	0.166036607	0	0	1.761856872	4.186583705	0	3.18086041	6.471211821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.4249	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.6583	0.166036607	0	0	1.761856872	4.186583705	0	3.18086041	6.471211821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.4249
H5575_007_0	2011	6																															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	1487.6964	32.25826882	0	0	513.0291344	0	0	2368.348348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											500	$65/Days 1-10 for IP Medical; $65/Days 1-10 for IP Surgical; PBP 1a	$65/Days 1-10 for IP Psych; $65/Days 1-10 for IP Substance Abuse; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"$50/Visit for ER - Facility; $20/Visit for PCP Urgent Care; PBP 4a, 4b"	No Cost-Sharing; PBP 9b	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14b-j"	"No Cost-Sharing; PBP 7b, 7d, 7f"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	No Cost-Sharing; PBP 7d	"No Cost-Sharing; PBP 7g, 18a"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 13a, 16b, 17a"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	65	65	0	0	50	0	0	48.88554342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	53.04924705	53.04924705	0	0	40.80711312	0	0	39.897558	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												6.5768	0.142606406	0	0	1.74460316	0	0	7.874276297	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.3383	0	3.680625163	6.5768	0.142606406	0	0	1.74460316	0	0	7.874276297	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.3383	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.5768	0.142606406	0	0	1.74460316	0	0	7.874276297	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.3383
H5576_006_0	2011	7																															A	A	D	Coin	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	Coin	Coin	P	P	Coin	O	T	Coin	V	Coin	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	YES	425.1045308	6.409134101	675.7382252	51.08227872	220.7811198	9.866833311	14.9364608	343.6499114	488.0032166	1801.921094	1200.580317	129.9417597	0.210875471	542.6608226	12240.38335	3096.06718	0.005416585	0.056676176	124.4985543	0	25.48154889	43.63151375	0	5.458127233	183.3094602	0.368503568	0	0	395.6817019	0	0	0	0	0	0	0	0	0	0	0	3400	1a1: $150 per admit	1b1: $150 per admit	21: $75 per day	6:$0	10a: $150	"11a: 20.0%,17b1: 20.0%"	"11b: 20.0%,11c: 20.0%"	"4a1: $50,4a2: $50,4b: $50"	"9a1: $100,9b: $100"	"8a1:$0,8a2: $50"	"8b1:$0,8b2: $50,8b3:$0,8b4:$0,8b5:$0,8b6:$0"	"5: 45.0%,9a2:$0"	12: 20.0%	"3: 20.0%,9a3:$0,9c: 45.0%,9d1: 20.0%,9d2: 20.0%"	"7a: $5,14b1:$0,14c1:$0,14d1:$0,14e1:$0,14f1:$0,14g1:$0,14h1:$0,14i:$0,14j:$0"	"7b1: $25,7d1: $25,7d3: 20.0%,7f1: $25,7g: $25,16b1: 20.0%,17a1: $25,18a1: 20.0%"	"7e: 45.0%,7h: 45.0%"	"7c: 20.0%,7i: 20.0%"	7d2: $50	$0 	"151:$0,152:$0,153: 20.0%"	"13a1:$0,14a:$0"	$0 	"16a1: 20.0%,16a2: 20.0%,16a3: 20.0% Endodontics, only extractions, $275 maximum"	17a2: $25	17b2: 20.0%	$0 	$0 	14a1:$0	"13a2:$0,VT:$0"	0	0	0	0	0	0	0	0	0	0	0	150	150	75	0	150	0.2	0.2	50	100	4.255925127	11.72157601	0	0.2	19.5642729	4.325679445	26.0054177	0.45	0.2	50	0	0.046013882	0	0	0.18662013	25	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	148.1381332	148.1381332	74.06906658	0	148.1381332	0.197517511	0.197517511	49.37984693	98.75875544	4.203098688	11.57608259	0	0.197517511	19.32143242	4.271987185	25.68262686	0.4444144	0.197517511	49.37937772	0	0.045442737	0	0	0.18662013	25	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0		5.2478	0.079119763	4.170941633	0	2.725508577	1.948872356	2.950212559	1.414115002	4.016215861	0.631137682	1.158168075	0	0.041651598	0.873748701	4.3575634	6.626261511	0.002407208	0.011194537	0.512305095	0	1.157951317	0	0	1.018596416	0.381894709	0.073700714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3994	0	0.476647707	5.2478	0.079119763	4.170941633	0	2.725508577	1.948872356	2.950212559	1.414115002	4.016215861	0.631137682	1.158168075	0	0.041651598	0.873748701	4.3575634	6.626261511	0.002407208	0.011194537	0.512305095	0	1.157951317	0	0	1.018596416	0.381894709	0.073700714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3994	NO	1a1: $150 per admit&20.0%	1b1: $150 per admit&20.0%	21: $75 per day&20.0%	6: $0&20.0%	10a: $150&20.0%	"11a: $0&40.0%,17b1: $0&40.0%"	"11b: $0&40.0%,11c: $0&40.0%"	$0 	"9a1: $100&20.0%,9b: $100&20.0%"	"8a1: $0&20.0%,8a2: $50&20.0%"	"8b1: $0&20.0%,8b2: $50&20.0%,8b3: $0&20.0%,8b4: $0&20.0%,8b5: $0&20.0%,8b6: $0&20.0%"	"5: $0&65.0%,9a2: $0&20.0%"	$0 	"3: $0&40.0%,9a3: $0&20.0%,9c: $0&65.0%,9d1: $0&40.0%,9d2: $0&40.0%"	"7a: $5&20.0%,14b1: $0&20.0%,14c1: $0&20.0%,14d1: $0&20.0%,14e1: $0&20.0%,14f1: $0&20.0%,14g1: $0&20.0%,14h1: $0&20.0%,14i: $0&20.0%,14j: $0&20.0%"	"7b1: $25&20.0%,7d1: $25&20.0%,7d3: $0&40.0%,7f1: $25&20.0%,7g: $25&20.0%"	"7e: $0&65.0%,7h: $0&65.0%"	"7c: $0&40.0%,7i: $0&40.0%"	7d2: $50&20.0%	$0 	$0 	14a: $0&20.0%	$0 	"16a1: $0&40.0%,16a2: $0&40.0%,16a3: $0&40.0%"	$0 	17b2: $0&40.0%	$0 	$0 	$0 	$0 	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0.0112	0.0534	0	0.2899	0.0025	0.0001	0	0	0.0342	0.424	0.0593	0	0	0.0073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.882	0	0	5.2478	0.079119763	4.170941633	0	2.725508577	1.960025276	3.003635194	1.414115002	4.306118272	0.633662386	1.158287008	0	0.041651598	0.9079832	4.781551683	6.685562963	0.002407208	0.011194537	0.519619717	0	1.157951317	0	0	1.018596416	0.381894709	0.073700714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2814
H5576_007_0	2011	7																															D	D	D	Coin	T	Coin	Coin	V	V	P	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	P	Coin	Coin	T	Coin	V	Coin	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	YES	1904.084896	73.61043286	511.6421026	32.44610367	203.2214471	5.966037049	8.779414901	254.8723794	327.9585375	1331.396276	16.90298343	2.27991426	0.1212152	7.636802597	6971.409382	3987.156485	0.013226563	0.031331112	11.86679498	0	20.18977962	0.457445855	0	3.018159936	166.3296858	0.233181045	0	0	1349.92045	0	0	0	0	0	0	0	0	0	0	0	4800	1a1: $125 days 1-3	1b1: $125 days 1-3	"21: $50 days 1-20, $125, 21+"	6:$0	10a: $150	"11a: 20.0%,17b1: 20.0%"	"11b: 20.0%,11c: 20.0%"	"4a1: $50,4a2: $50,4b: $50"	"9a1: $150,9b: $150"	"8a1:$0,8a2: 20.0%"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: 45.0%,9a2: 25.0%"	12: 20.0%	"3: 20.0%,9a3: 25.0%,9c: 45.0%,9d1: 20.0%,9d2: 20.0%"	"7a: $5,14b1:$0,14c1:$0,14d1:$0,14e1:$0,14f1:$0,14g1:$0,14h1:$0,14i:$0,14j:$0"	"7b1: $35,7d1: $35,7d3: 20.0%,7f1: $35,7g: $35,16b1: 20.0%,17a1: $35,18a1: 20.0%"	"7e: 45.0%,7h: 45.0%"	"7c: 20.0%,7i: 20.0%"	7d2: 25.0%	$0 	"151:$0,152: 20.0%,153: 20.0%"	"13a1: 25.0%,14a:$0"	$0 	"16a1: 20.0%,16a2: 20.0%,16a3: 20.0% Endodontics, only extractions, $275 maximum"	17a2: $35	17b2: 20.0%	$0 	$0 	14a1:$0	"13a2:$0,VT:$0"	0	0	0	0	0	0	0	0	0	0	0	59.8300032	37.05556411	57.79771469	0	150	0.2	0.2	50	150	3.986975832	0.2	0.25	0.2	0.247070327	4.075399779	35.45477588	0.45	0.2	0.25	0	0.199753345	0.25	0	0.18662013	22.19315058	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	58.10604828	35.9878369	56.13231858	0	145.6778669	0.194237156	0.194237156	48.56059367	145.6778669	3.87209423	0.194237156	0.242796445	0.194237156	0.239951188	3.95797031	34.43317414	0.437033601	0.194237156	0.242796445	0	0.193997608	0.242796445	0	0.18662013	22.19315058	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0		9.2199	0.220756688	2.393304792	0	2.467072243	1.158826068	1.70528858	1.031396171	3.981358348	0.429607653	3.283187427	0.553555077	0.023544496	1.832459856	2.299385946	11.44087113	0.005780453	0.006085666	2.881215633	0	3.916768958	0.111066227	0	0.563249401	0.30761498	0.046636209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8789	0	1.452613837	9.2199	0.220756688	2.393304792	0	2.467072243	1.158826068	1.70528858	1.031396171	3.981358348	0.429607653	3.283187427	0.553555077	0.023544496	1.832459856	2.299385946	11.44087113	0.005780453	0.006085666	2.881215633	0	3.916768958	0.111066227	0	0.563249401	0.30761498	0.046636209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8789	NO	1a1: $125 days 1-3&20.0%	1b1: $125 days 1-3&20.0%	"21: $50 days 1-20, $125, 21+ &20.0%"	6: $0&20.0%	10a: $150&20.0%	"11a: $0&40.0%,17b1: $0&40.0%"	"11b: $0&40.0%,11c: $0&40.0%"	$0 	"9a1: $150&20.0%,9b: $150&20.0%"	"8a1: $0&20.0%,8a2: $0&40.0%"	"8b1: $0&40.0%,8b2: $0&40.0%,8b3: $0&40.0%,8b4: $0&40.0%,8b5: $0&40.0%,8b6: $0&40.0%"	"5: $0&65.0%,9a2: $0&45.0%"	$0 	"3: $0&40.0%,9a3: $0&45.0%,9c: $0&65.0%,9d1: $0&40.0%,9d2: $0&40.0%"	"7a: $5&20.0%,14b1: $0&20.0%,14c1: $0&20.0%,14d1: $0&20.0%,14e1: $0&20.0%,14f1: $0&20.0%,14g1: $0&20.0%,14h1: $0&20.0%,14i: $0&20.0%,14j: $0&20.0%"	"7b1: $35&20.0%,7d1: $35&20.0%,7d3: $0&40.0%,7f1: $35&20.0%,7g: $35&20.0%"	"7e: $0&65.0%,7h: $0&65.0%"	"7c: $0&40.0%,7i: $0&40.0%"	7d2: $0&45.0%	$0 	$0 	14a: $0&20.0%	$0 	"16a1: $0&40.0%,16a2: $0&40.0%,16a3: $0&40.0%"	$0 	17b2: $0&40.0%	$0 	$0 	$0 	$0 	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0.0047	0.0119	0	0.1772	0.009	0.0006	0	0	0	0.0883	0.0039	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.2955	0	0	9.2199	0.220756688	2.393304792	0	2.467072243	1.163512041	1.717176984	1.031396171	4.158528226	0.438637379	3.283768263	0.553555077	0.023544496	1.832459856	2.387686139	11.44472803	0.005780453	0.006085666	2.881215633	0	3.916768958	0.111066227	0	0.563249401	0.30761498	0.046636209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1744
H5576_008_0	2011	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	370.4561388	6.565418027	23.04841695	53.44655832	12.95211516	9.827501949	14.46181382	375.8061961	57.18057339	16.38670661	27.84329049	3.755568672	0.19967067	12.57965577	163.2050206	85.5866479	0.02178734	0.051609898	19.54747345	0	32.89478904	0.753523654	0	6.506153249	0.506716065	0.384105421	0.154212645	0.674724921	0.060091194	0	0	0	0	0	0	0	0	0	0	0	6700	1a1: std medicare	1b1: std medicare	21: std medicare	6:$0	10a: std medicare	"11a: std medicare,17b1: std medicare"	"11b: std medicare,11c: std medicare"	"4a1: $50,4b: $50"	"9a1: std medicare,9b: std medicare"	"8a1: std medicare,8a2: std medicare"	"8b1: std medicare,8b2: std medicare,8b3: std medicare,8b4: std medicare,8b5: std medicare,8b6: std medicare"	"5: 45.0%,9a2: std medicare"	12: std medicare	"3: 20.0%,9a3: std medicare,9c: 45.0%,9d1: std medicare,9d2: std medicare"	"7a:$0,14b1: std medicare,14c1:$0,14d1: std medicare,14e1: std medicare,14f1:$0,14g1:$0,14h1:$0,14i:$0,14j:$0"	"7b1: std medicare,7d1: std medicare,7d3: std medicare,7f1: std medicare,7g: std medicare,16b1: std medicare,17a1: std medicare,18a1: std medicare"	"7e: 45.0%,7h: 45.0%"	"7c: std medicare,7i: std medicare"	7d2: std medicare	$0 	"151: std medicare,152: 20.0%,153: std medicare"	"13a1: std medicare,14a:$0"	$0 	"16a1: 20.0%,16a2: 20.0%,16a3: 20.0%,16b2: 20.0%Endodontics, only extractions, $275 maximum"	17a2: 20.0%	17b2: 20.0%	18a2: 20.0%	18b: 20.0%	14a1:$0	"13a2:$0,VT:$0"	0	0	0	0	0	0	0	0	0	0	0	0.07894102	0.07894102	0.07894102	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.253002849	0.003093056	0.233	0.45	0.233	0.233	0	0.206706611	0.233	0	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0	NO	0.072891978	0.072891978	0.072891978	0	0.215145826	0.215145826	0.215145826	46.1686321	0.215145826	0.215145826	0.215145826	0.215145826	0.215145826	0.233615909	0.002856043	0.215145826	0.415517689	0.215145826	0.215145826	0	0.190889491	0.215145826	0	0.2	0.2	0.2	0.2	0.184674528	0	0	0	0	0	0	0	0	0	0	0	0		27.0033	0.478566307	1.680044702	0	2.78659351	2.114346021	3.111398874	1.445871501	12.30216167	3.525531523	5.990367721	0.807994922	0.042958311	2.938807719	0.466120563	18.41361002	0.009053025	0.011103654	4.205557314	0	6.279269543	0.162117469	0	1.30123065	0.101343213	0.076821084	0.030842529	0.124604507	0	0	0	0	0	0	0	0	0	0	0	0	95.4096	0	7.791575374	27.0033	0.478566307	1.680044702	0	2.78659351	2.114346021	3.111398874	1.445871501	12.30216167	3.525531523	5.990367721	0.807994922	0.042958311	2.938807719	0.466120563	18.41361002	0.009053025	0.011103654	4.205557314	0	6.279269543	0.162117469	0	1.30123065	0.101343213	0.076821084	0.030842529	0.124604507	0	0	0	0	0	0	0	0	0	0	0	0	95.4096	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0033	0.478566307	1.680044702	0	2.78659351	2.114346021	3.111398874	1.445871501	12.30216167	3.525531523	5.990367721	0.807994922	0.042958311	2.938807719	0.466120563	18.41361002	0.009053025	0.011103654	4.205557314	0	6.279269543	0.162117469	0	1.30123065	0.101343213	0.076821084	0.030842529	0.124604507	0	0	0	0	0	0	0	0	0	0	0	0	95.4096
H5576_009_0	2011	6																															A	A	D	Coin	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	Coin	Coin	P	P	O	Coin	T	Coin	V	Coin	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	YES	291.8457967	3.660060516	551.7859864	36.48793455	182.1082278	7.679071752	12.22203564	322.4015284	338.731177	1379.300363	847.8611314	93.03870719	0.090241946	455.7035746	8203.658541	3347.826759	0.059725043	0.023325297	142.877014	0	1980.657477	0.340557983	0	5.458127233	172.2874305	0.251763766	0	0	891.1413079	0	0	0	0	0	0	0	0	0	0	0	3400	1a1: $250 per admit	1b1: $250 per admit	21: $100 per day	6:$0	10a: $150	"11a: 20.0%,17b1: 20.0%"	"11b: 20.0%,11c: 20.0%"	"4a1: $50,4a2: $50,4b: $50"	"9a1: $150,9b: $150"	"8a1:$0,8a2: $150"	"8b1:$0,8b2: $150,8b3: 20.0%,8b4:$0,8b5:$0,8b6:$0"	"5: 45.0%,9a2:$0"	12: 20.0%	"3: 20.0%,9a3:$0,9c: 45.0%,9d1: 20.0%,9d2: 20.0%"	"7a: $10,14b1:$0,14c1:$0,14d1:$0,14e1:$0,14f1:$0,14g1:$0,14h1:$0,14i:$0,14j:$0"	"7b1: $30,7d1: $30,7d3: 20.0%,7f1: $30,7g: $30,16b1: 20.0%,17a1: $30,18a1: 20.0%"	"7e: 45.0%,7h: 45.0%"	"7c: 20.0%,7i: 20.0%"	7d2: $150	$0 	"151:$0,152: 20.0%,153: 20.0%"	"13a1:$0,14a:$0"	$0 	"16a1: 20.0%,16a2: 20.0%,16a3: 20.0% Endodontics, only extractions, $275 maximum"	17a2: $30	17b2: 20.0%	$0 	$0 	14a1:$0	"13a2:$0,VT:$0"	0	0	0	0	0	0	0	0	0	0	0	250	250	100	0	150	0.2	0.2	50	150	12.63000677	35.28624492	0	0.2	23.60377591	8.38263545	30.69865984	0.45	0.2	150	0	26.66193562	0	0	0.18662013	24.55130412	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	241.2218773	241.2218773	96.48875093	0	144.7331264	0.192977502	0.192977502	48.24596052	144.7331264	12.18653578	34.04725697	0	0.192977502	22.77498855	8.088300241	29.62075343	0.434199379	0.192977502	144.7331264	0	25.72576865	0	0	0.18662013	24.55130412	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0		5.8666	0.073573889	4.436761718	0	2.196424429	1.481888083	2.358577906	1.296214284	4.085468521	1.400741102	2.405612152	0	0.017414665	0.864886975	5.529471113	8.263762579	0.025932577	0.004501258	1.723253077	0	4.246161336	0	0	1.018596416	0.352490092	0.050352753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6987	0	1.683997253	5.8666	0.073573889	4.436761718	0	2.196424429	1.481888083	2.358577906	1.296214284	4.085468521	1.400741102	2.405612152	0	0.017414665	0.864886975	5.529471113	8.263762579	0.025932577	0.004501258	1.723253077	0	4.246161336	0	0	1.018596416	0.352490092	0.050352753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6987	NO	1a1: $250 per admit&20.0%	1b1: $250 per admit&20.0%	21: $100 per day&20.0%	6: $0&20.0%	10a: $150&20.0%	"11a: $0&40.0%,17b1: $0&40.0%"	"11b: $0&40.0%,11c: $0&40.0%"	$0 	"9a1: $150&20.0%,9b: $150&20.0%"	"8a1: $0&20.0%,8a2: $150&20.0%"	"8b1: $0&20.0%,8b2: $150&20.0%,8b3: $0&40.0%,8b4: $0&20.0%,8b5: $0&20.0%,8b6: $0&20.0%"	"5: $0&65.0%,9a2: $0&20.0%"	$0 	"3: $0&40.0%,9a3: $0&20.0%,9c: $0&65.0%,9d1: $0&40.0%,9d2: $0&40.0%"	"7a: $10&20.0%,14b1: $0&20.0%,14c1: $0&20.0%,14d1: $0&20.0%,14e1: $0&20.0%,14f1: $0&20.0%,14g1: $0&20.0%,14h1: $0&20.0%,14i: $0&20.0%,14j: $0&20.0%"	"7b1: $30&20.0%,7d1: $30&20.0%,7d3: $0&40.0%,7f1: $30&20.0%,7g: $30&20.0%"	"7e: $0&65.0%,7h: $0&65.0%"	"7c: $0&40.0%,7i: $0&40.0%"	7d2: $150&20.0%	$0 	$0 	14a: $0&20.0%	$0 	"16a1: $0&40.0%,16a2: $0&40.0%,16a3: $0&40.0%"	$0 	17b2: $0&40.0%	$0 	$0 	$0 	$0 	0	0	0	0	0	0	0	0	0	0		0.0875	0	0	0	0	0.019	0.114	0	0.1245	0.007	0.0002	0	0	0	0.2419	0.1149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.709	0	0	5.9541	0.073573889	4.436761718	0	2.196424429	1.500862075	2.472587732	1.296214284	4.209989372	1.407787746	2.405828361	0	0.017414665	0.864886975	5.77136099	8.378624353	0.025932577	0.004501258	1.723253077	0	4.246161336	0	0	1.018596416	0.352490092	0.050352753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4077
H5576_010_0	2011	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	375.7544923	6.659318226	23.37806099	54.21096394	13.13735945	9.968057264	14.66865019	378.4840908	58.22968335	16.62107326	28.24151198	3.809281725	0.202526408	12.75957306	165.5392184	86.91150407	0.022098948	0.052348036	19.82704615	0	33.36525828	0.764300732	0	6.599205829	0.513963241	0.38959899	0.156418231	0.684375	0.060950633	0	0	0	0	0	0	0	0	0	0	0	6700	1a1: std medicare	1b1: std medicare	21: std medicare	6:$0	10a: std medicare	"11a: std medicare,17b1: std medicare"	"11b: std medicare,11c: std medicare"	"4a1: $50,4b: $50"	"9a1: std medicare,9b: std medicare"	"8a1: std medicare,8a2: std medicare"	"8b1: std medicare,8b2: std medicare,8b3: std medicare,8b4: std medicare,8b5: std medicare,8b6: std medicare"	"5: 45.0%,9a2: std medicare"	12: std medicare	"3: 20.0%,9a3: std medicare,9c: 45.0%,9d1: std medicare,9d2: std medicare"	"7a:$0,14b1: std medicare,14c1:$0,14d1: std medicare,14e1: std medicare,14f1:$0,14g1:$0,14h1:$0,14i:$0,14j:$0"	"7b1: std medicare,7d1: std medicare,7d3: std medicare,7f1: std medicare,7g: std medicare,16b1: std medicare,17a1: std medicare,18a1: std medicare"	"7e: 45.0%,7h: 45.0%"	"7c: std medicare,7i: std medicare"	7d2: std medicare	$0 	"151: std medicare,152: 20.0%,153: std medicare"	"13a1: std medicare,14a:$0"	$0 	"16a1: 20.0%,16a2: 20.0%,16a3: 20.0%,16b2: 20.0% Endodontics, only extractions, $275 maximum"	17a2: 20.0%	17b2: 20.0%	18a2: 20.0%	18b: 20.0%	14a1:$0	"13a2:$0,VT:$0"	0	0	0	0	0	0	0	0	0	0	0	0.079192112	0.079192112	0.079192112	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.253002849	0.003093056	0.233	0.45	0.233	0.233	0	0.206706611	0.233	0	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0	NO	0.072923305	0.072923305	0.072923305	0	0.214555839	0.214555839	0.214555839	46.04202556	0.214555839	0.214555839	0.214555839	0.214555839	0.214555839	0.232975273	0.002848211	0.214555839	0.41437823	0.214555839	0.214555839	0	0.190366819	0.214555839	0	0.2	0.2	0.2	0.2	0.184168102	0	0	0	0	0	0	0	0	0	0	0	0		27.4013	0.485619491	1.704805461	0	2.818697181	2.13870489	3.147244549	1.452181182	12.49351857	3.56614832	6.0593813	0.817303637	0.043453223	2.972665013	0.471490626	18.64737068	0.009157323	0.011231577	4.254008524	0	6.351638072	0.163985185	0	1.319841166	0.102792648	0.077919798	0.031283646	0.126040045	0	0	0	0	0	0	0	0	0	0	0	0	96.6677	0	8.177466281	27.4013	0.485619491	1.704805461	0	2.818697181	2.13870489	3.147244549	1.452181182	12.49351857	3.56614832	6.0593813	0.817303637	0.043453223	2.972665013	0.471490626	18.64737068	0.009157323	0.011231577	4.254008524	0	6.351638072	0.163985185	0	1.319841166	0.102792648	0.077919798	0.031283646	0.126040045	0	0	0	0	0	0	0	0	0	0	0	0	96.6677	NO	1a1: INN Cost Share +20%	1b1: INN Cost Share +20%	21: INN Cost Share +20%	6: INN CS+20%	10a: INN CS+20%	"11a: INN CS+20%,17b1: INN CS+20%"	"11b: INN CS+20%,11c: INN CS+20%"	$0 	"9a1: INN CS+20%,9b: INN CS+20%"	"8a1: INN CS+20%,8a2: INN CS+20%"	"8b1: INN CS+20%,8b2: INN CS+20%,8b3: INN CS+20%,8b4: INN CS+20%,8b5: INN CS+20%,8b6: INN CS+20%"	"5: INN CS+20%,9a2: INN CS+20%"	$0 	"3: INN CS+20%,9a3: INN CS+20%,9c: INN CS+20%,9d1: INN CS+20%,9d2: INN CS+20%"	"7a: INN CS+20%,14b1: INN CS+20%,14c1: INN CS+20%,14d1: INN CS+20%,14e1: INN CS+20%,14f1: INN CS+20%,14g1: INN CS+20%,14h1: INN CS+20%,14i: INN CS+20%,14j: INN CS+20%"	"7b1: INN CS+20%,7d1: INN CS+20%,7d3: INN CS+20%,7f1: INN CS+20%,7g: INN CS+20%,16b1: INN CS+20%,17a1: INN CS+20%,18a1: INN CS+20%"	"7e: INN CS+20%,7h: INN CS+20%"	"7c: INN CS+20%,7i: INN CS+20%"	7d2: INN CS+20%	$0 	$0 	14a: INN CS+20%	$0 	"16a1: INN CS+20%,16a2: INN CS+20%,16a3: INN CS+20%,16b2: INN CS+20%"	17a2: INN CS+20%	17b2: INN CS+20%	18a2: INN CS+20%	18b: INN CS+20%	$0 	$0 	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0.0085	0.0215	0	0.3185	0.0163	0.0011	0	0	0	0.101	0.0043	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.4712	0	0	27.4013	0.485619491	1.704805461	0	2.818697181	2.147180136	3.16874641	1.452181182	12.81203358	3.582479857	6.060431824	0.817303637	0.043453223	2.972665013	0.572530148	18.65164663	0.009157323	0.011231577	4.254008524	0	6.351638072	0.163985185	0	1.319841166	0.102792648	0.077919798	0.031283646	0.126040045	0	0	0	0	0	0	0	0	0	0	0	0	97.1389
H5576_801_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	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	0	0	YES	310.523787	5.503265448	19.31964669	44.79998021	10.85672345	8.237609806	12.12218323	12.14896825	47.65351569	13.73566709	23.33880614	3.147993201	0.167367972	9.42230887	137.978216	71.62002859	0.018262587	0.043260455	16.38508543	0	27.77271555	0.631618683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6700	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	$0 	$0 	$0 	$0 	$0 	$0 	0	0	0	0	0	0	0	0	0	0	0	0	0	0.078968309	0.078968309	0.078968309	0	0.233	0.233	0.233	0.233	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0.072057273	0.072057273	0.072057273	0	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0	0.212608636	0.212608636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		22.3755	0.396550299	1.392121048	0	2.308233164	1.751386985	2.577280842	2.582975568	10.13154897	2.920321444	4.962031738	0.669290541	0.035583876	2.003264237	29.33536031	15.22703659	0.003882784	0.009197546	3.483610664	0	5.904719171	0.134287587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.2042	0	10.37789844	22.3755	0.396550299	1.392121048	0	2.308233164	1.751386985	2.577280842	2.582975568	10.13154897	2.920321444	4.962031738	0.669290541	0.035583876	2.003264237	29.33536031	15.22703659	0.003882784	0.009197546	3.483610664	0	5.904719171	0.134287587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.2042	NO	1a1: INN Cost Share +20%	1b1: INN Cost Share +20%	21: INN Cost Share +20%	6: INN CS+20%	10a: INN CS+20%	11a: INN CS+20%	"11b: INN CS+20%,11c: INN CS+20%"	$0 	"9a1: INN CS+20%,9b: INN CS+20%"	"8a1: INN CS+20%,8a2: INN CS+20%"	"8b1: INN CS+20%,8b2: INN CS+20%,8b3: INN CS+20%,8b4: INN CS+20%,8b5: INN CS+20%,8b6: INN CS+20%"	"5: INN CS+20%,9a2: INN CS+20%"	$0 	"3: INN CS+20%,9a3: INN CS+20%,9c: INN CS+20%,9d1: INN CS+20%,9d2: INN CS+20%"	"7a: INN CS+20%,14b1: INN CS+20%,14c1: INN CS+20%,14d1: INN CS+20%,14e1: INN CS+20%,14f1: INN CS+20%,14g1: INN CS+20%,14h1: INN CS+20%,14i: INN CS+20%,14j: INN CS+20%"	"7b1: INN CS+20%,7d1: INN CS+20%,7d3: INN CS+20%,7f1: INN CS+20%,7g: INN CS+20%"	"7e: INN CS+20%,7h: INN CS+20%"	"7c: INN CS+20%,7i: INN CS+20%"	7d2: INN CS+20%	$0 	$0 	14a: INN CS+20%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0.007	0.0178	0	0.2632	0.0135	0.0009	0	0	0	0.18	0.0035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.4859	0	0	22.3755	0.396550299	1.392121048	0	2.308233164	1.758390934	2.595049995	2.582975568	10.39477001	2.933817838	4.962899892	0.669290541	0.035583876	2.003264237	29.51536157	15.23057023	0.003882784	0.009197546	3.483610664	0	5.904719171	0.134287587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.6901
H5576_802_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	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	0	0	YES	310.523787	5.503265448	19.31964669	44.79998021	10.85672345	8.237609806	12.12218323	12.14896825	47.65351569	13.73566709	23.33880614	3.147993201	0.167367972	9.42230887	137.978216	71.62002859	0.018262587	0.043260455	16.38508543	0	27.77271555	0.631618683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6700	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	$0 	$0 	$0 	$0 	$0 	$0 	0	0	0	0	0	0	0	0	0	0	0	0	0	0.078968309	0.078968309	0.217367386	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.072057273	0.072057273	0.072057273	0	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0	0.212608636	0.212608636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		22.3755	0.396550299	1.392121048	0	2.308233164	1.751386985	2.577280842	2.582975568	10.13154897	2.920321444	4.962031738	0.669290541	0.035583876	2.003264237	29.33536031	15.22703659	0.003882784	0.009197546	3.483610664	0	5.904719171	0.134287587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.2042	0	10.37789844	22.3755	0.396550299	1.392121048	0	2.308233164	1.751386985	2.577280842	2.582975568	10.13154897	2.920321444	4.962031738	0.669290541	0.035583876	2.003264237	29.33536031	15.22703659	0.003882784	0.009197546	3.483610664	0	5.904719171	0.134287587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.2042	NO	1a1: INN Cost Share +20%	1b1: INN Cost Share +20%	21: INN Cost Share +20%	6: INN CS+20%	10a: INN CS+20%	11a: INN CS+20%	"11b: INN CS+20%,11c: INN CS+20%"	$0 	"9a1: INN CS+20%,9b: INN CS+20%"	"8a1: INN CS+20%,8a2: INN CS+20%"	"8b1: INN CS+20%,8b2: INN CS+20%,8b3: INN CS+20%,8b4: INN CS+20%,8b5: INN CS+20%,8b6: INN CS+20%"	"5: INN CS+20%,9a2: INN CS+20%"	$0 	"3: INN CS+20%,9a3: INN CS+20%,9c: INN CS+20%,9d1: INN CS+20%,9d2: INN CS+20%"	"7a: INN CS+20%,14b1: INN CS+20%,14c1: INN CS+20%,14d1: INN CS+20%,14e1: INN CS+20%,14f1: INN CS+20%,14g1: INN CS+20%,14h1: INN CS+20%,14i: INN CS+20%,14j: INN CS+20%"	"7b1: INN CS+20%,7d1: INN CS+20%,7d3: INN CS+20%,7f1: INN CS+20%,7g: INN CS+20%"	"7e: INN CS+20%,7h: INN CS+20%"	"7c: INN CS+20%,7i: INN CS+20%"	7d2: INN CS+20%	$0 	$0 	14a: INN CS+20%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0.007	0.0178	0	0.2632	0.0135	0.0009	0	0	0	0.18	0.0035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.4859	0	0	22.3755	0.396550299	1.392121048	0	2.308233164	1.758390934	2.595049995	2.582975568	10.39477001	2.933817838	4.962899892	0.669290541	0.035583876	2.003264237	29.51536157	15.23057023	0.003882784	0.009197546	3.483610664	0	5.904719171	0.134287587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.6901
H5576_803_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	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	0	0	YES	310.523787	5.503265448	19.31964669	44.79998021	10.85672345	8.237609806	12.12218323	12.14896825	47.65351569	13.73566709	23.33880614	3.147993201	0.167367972	9.42230887	137.978216	71.62002859	0.018262587	0.043260455	16.38508543	0	27.77271555	0.631618683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6700	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	Standard Medicare	$0 	$0 	$0 	$0 	$0 	$0 	0	0	0	0	0	0	0	0	0	0	0	0	0	0.078968309	0.078968309	0.078968309	0	0.233	0.233	0.233	0.233	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0.072057273	0.072057273	0.072057273	0	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0.212608636	0	0.212608636	0.212608636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		22.3755	0.396550299	1.392121048	0	2.308233164	1.751386985	2.577280842	2.582975568	10.13154897	2.920321444	4.962031738	0.669290541	0.035583876	2.003264237	29.33536031	15.22703659	0.003882784	0.009197546	3.483610664	0	5.904719171	0.134287587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.2042	0	10.37789844	22.3755	0.396550299	1.392121048	0	2.308233164	1.751386985	2.577280842	2.582975568	10.13154897	2.920321444	4.962031738	0.669290541	0.035583876	2.003264237	29.33536031	15.22703659	0.003882784	0.009197546	3.483610664	0	5.904719171	0.134287587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.2042	NO	1a1: INN Cost Share +20%	1b1: INN Cost Share +20%	21: INN Cost Share +20%	6: INN CS+20%	10a: INN CS+20%	11a: INN CS+20%	"11b: INN CS+20%,11c: INN CS+20%"	$0 	"9a1: INN CS+20%,9b: INN CS+20%"	"8a1: INN CS+20%,8a2: INN CS+20%"	"8b1: INN CS+20%,8b2: INN CS+20%,8b3: INN CS+20%,8b4: INN CS+20%,8b5: INN CS+20%,8b6: INN CS+20%"	"5: INN CS+20%,9a2: INN CS+20%"	$0 	"3: INN CS+20%,9a3: INN CS+20%,9c: INN CS+20%,9d1: INN CS+20%,9d2: INN CS+20%"	"7a: INN CS+20%,14b1: INN CS+20%,14c1: INN CS+20%,14d1: INN CS+20%,14e1: INN CS+20%,14f1: INN CS+20%,14g1: INN CS+20%,14h1: INN CS+20%,14i: INN CS+20%,14j: INN CS+20%"	"7b1: INN CS+20%,7d1: INN CS+20%,7d3: INN CS+20%,7f1: INN CS+20%,7g: INN CS+20%"	"7e: INN CS+20%,7h: INN CS+20%"	"7c: INN CS+20%,7i: INN CS+20%"	7d2: INN CS+20%	$0 	$0 	14a: INN CS+20%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0.007	0.0178	0	0.2632	0.0135	0.0009	0	0	0	0.18	0.0035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.4859	0	0	22.3755	0.396550299	1.392121048	0	2.308233164	1.758390934	2.595049995	2.582975568	10.39477001	2.933817838	4.962899892	0.669290541	0.035583876	2.003264237	29.51536157	15.23057023	0.003882784	0.009197546	3.483610664	0	5.904719171	0.134287587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.6901
H5577_002_0	2011	14																															A	A	D	coin	coin	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	coin	coin	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	329.3502213	11.78522811	0.448949449	19.40133851	5.290965904	18.03918508	21.70833085	1204.75801	205.4210602	11118.40261	1278.417483	0	0.065776997	343.7695095	14099.44493	4443.180342	1696.749398	1836.209605	27.33182089	32.09009254	3.033562126	0	500	2864.903285	0	0	0	0	13.02834346	11436.7811											3400	1a:  Acute - $3/$0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $3/$0/admit for 1-90/1b:  Additional Days - $0/day for 91-999	2:  Skilled Nursing Services - $0/$3/day for 1--1/-/1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $0/trip	11a:  Durable Medical Equipment - 10.0%	11b:  Prosthetics Devices - $0/service/11b:  Medical Supplies - $0/service/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - 100.0%/4b:  Urgently Needed Care / Urgent Care Centers - 100.0%/4a:  Worldwide Coverage - 100.0%	9a:  Outpatient Hospital Services (Hospital Surgery) - 100.0%/9b:  Ambulatory Surgical Center Services - 100.0%	8a:  Outpatient Diagnostic Procedures/Tests - 100.0%/8a:  Outpatient Lab Services - 100.0%	8b:  Outpatient Diagnostic Radiological Services - 100.0%/8b:  Outpatient Therapeutic Radiological Services - 100.0%/8b:  Outpatient X-Ray Services - 100.0%		12:  Renal Dialysis - $0/service	9d:  Cardiac Rehabilitation Services - 100.0%/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - 100.0%/17a:  Vision Exams - $1/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - 100.0%/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - 100.0%/7b:  Chiropractic Services - $0/visit/1-6 Additional Visits/7f:  Podiatry Services - 100.0%/17a:  Vision Exams - $1/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - 100.0%/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - 100.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 100.0%/7h:  Psychiatric Services - Individual - 100.0%/7h:  Psychiatric Services - Group - 100.0%	7c:  Occupational Therapy Services - 100.0%/7i:  Physical/Speech Therapy - 100.0%		9c:  Outpatient Substance Abuse Svcs - Individual - 100.0%/9c:  Outpatient Substance Abuse Svcs - Group - 100.0%/7g:  Other Health Care Professional Services - 100.0%/18a:  Hearing Exams - $1/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	10b:  Transportation - $0/trip	"16a:  Preventive Dental - Oral Exams - $1/service/16a:  Preventive Dental - Prophylaxis - $1/service/16a:  Preventive Dental - Fluoride Treatment - $1/service/16a:  Preventive Dental - X-Rays - $1/service/16b:  Comprehensive Dental - Emergency Svcs - $1/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $1/visit/16b:  Comprehensive Dental - Restorative Svcs - $1/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $1/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $1/visit"	17a:  Routine Eye Exams - $1/visit	17b:  Eye Glasses & Contact Lenses - $225 Per Year	18a:  Routine Hearing Test - $1/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Alternative Medicine Program - $0/service/14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/14a:  Nutritional Benefit - $0/service/14a:  Nutritional Training - $0/service/14a:  Smoking Cessation - $0/service/14a:  Other - $0/service/14c:  Routine Exams - 100.0%/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14e:   Additional Prostate Screening - $0/visit/14f:   Additional Colorectal Screening - $0/visit/	13b:  Acupuncture - $0/visit/13c:  Other: Over-the-Counter Drugs - $0/visit												3	3	3	0	0	0.1	0	1	1	1	1	0	0	1	0.380735729	1	1	1	0	3.23E-05	0	0	0	11.90422581	0	0	0	0	0	0											NO	2.992825723	2.992825723	2.992825723	0	0	0.099760857	0	0.997608574	0.997608574	0.997608574	0.997608574	0	0	0.997608574	0.379825227	0.997608574	0.997608574	0.997608574	0	3.22E-05	0	0	0	11.90422581	0	0	0	0	0	0												0.0821	0.002939261	0.000111969	0	0	1.79960457	0	0.10015641	0.017077484	0.924317814	0.10628002	0	0	0.028578951	0.446277073	0.369379567	0.141057646	0.152651537	0	0.001032856	0	0	0	2.84203797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.0136	0	0.01	0.0821	0.002939261	0.000111969	0	0	1.79960457	0	0.10015641	0.017077484	0.924317814	0.10628002	0	0	0.028578951	0.446277073	0.369379567	0.141057646	0.152651537	0	0.001032856	0	0	0	2.84203797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.0136	NO	1a:  Acute - 0/admit for 1-90	1b:  Psych - 0/admit for 1-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - 0/day for 1--1/-/1-100/2:  Non-Medicare Covered Stay - $0/day for 1--1/-/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	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	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $0/visit/9c:  Outpatient Substance Abuse Svcs - Group - $0/visit/7g:  Other Health Care Professional Services - $0/visit/18a:  Hearing Exams - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0821	0.002939261	0.000111969	0	0	1.79960457	0	0.10015641	0.017077484	0.924317814	0.10628002	0	0	0.028578951	0.446277073	0.369379567	0.141057646	0.152651537	0	0.001032856	0	0	0	2.84203797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.0136
H5578_002_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1851.325132	151.4761365	850.6328304		245.4810901	9.548314906	9.774174815	570.1931503	236.5775164		14.15736306	1.983738249	0.13669868	22.59198444	4323.285217	4051.912239	139.2691413	612.7642124	21.19961215		7.438945942				159.1037094		92.6557595														4950	"1a (IP Acute) 225 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 350 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 35 copay, 7i (PT/ST) 35 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 10 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 35 copay, 7f (Podiatry) 35 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 35 copay, 18a (Hearing Exam) 35 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 35 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 35 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 70 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 35 copay	18b (Hearing Aids) 700 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												163.0846274	172.0337627	49.94161658		150	0.2	0.2	49.0692393	263.8673131		0.2	0.2	0.2	0.198728273	10	34.63261715	40	35	0.181		0.2				25		35														NO	147.013824	155.0810871	45.02023364		135.2185914	0.180291455	0.180291455	44.23382279	237.8651093		0.180291455	0.180291455	0.180291455	0.179145048	9.014572759	31.22705305	36.05829104	31.55100466	0.163163767		0.180291455				25		31.55100466															22.6809	1.957590327	3.191307397	0	2.766133935	1.721479589	1.762200201	2.101818564	4.6894614	0	2.552451587	0.357651056	0.024645604	4.047242137	3.247714096	10.54410654	0.418483936	1.611110543	3.459008576	0	1.341178389	0	0	0	0.331466061	0	0.243615192	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0495	0	7.509201763	22.6809	1.957590327	3.191307397	0	2.766133935	1.721479589	1.762200201	2.101818564	4.6894614	0	2.552451587	0.357651056	0.024645604	4.047242137	3.247714096	10.54410654	0.418483936	1.611110543	3.459008576	0	1.341178389	0	0	0	0.331466061	0	0.243615192	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0495	NO																																																																																		0	0	0	22.6809	1.957590327	3.191307397	0	2.766133935	1.721479589	1.762200201	2.101818564	4.6894614	0	2.552451587	0.357651056	0.024645604	4.047242137	3.247714096	10.54410654	0.418483936	1.611110543	3.459008576	0	1.341178389	0	0	0	0.331466061	0	0.243615192	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0495
H5578_006_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1540.023616	48.27729997	735.5861864		289.4837712	9.034274303	10.89588259	586.9985712	222.2589023		9.289220839	4.000899056	0.097491007	20.32528947	4081.564475	3792.722478	65.54003625	733.7881543	27.35597148		17.11579989				159.1037094																4950	"1a (IP Acute) 220 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 275 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 35 copay, 7i (PT/ST) 35 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 10 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 35 copay, 7f (Podiatry) 35 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 35 copay, 18a (Hearing Exam) 35 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 35 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 35 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0% Coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												159.4605246	172.0337627	49.94161658		150	0.2	0.2	49.23915918	224.4558521		0.2	0.2	0.2	0.198180826	10	34.5754697	40	35	0.181		0.2				25																NO	145.2541155	156.7071983	45.49229574		136.6364333	0.182181911	0.182181911	44.85242058	204.4589804		0.182181911	0.182181911	0.182181911	0.180524808	9.109095552	31.52069884	36.43638221	31.88183443	0.164874629		0.182181911				25																	18.6412	0.630450035	2.788625361	0	3.296169165	1.645881357	1.985032713	2.194025566	3.78690238	0	1.692328005	0.728891436	0.017761098	3.669218981	3.098280067	9.962438586	0.199003484	1.949542704	4.510305661	0	3.118189133	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2457	0	6.242187975	18.6412	0.630450035	2.788625361	0	3.296169165	1.645881357	1.985032713	2.194025566	3.78690238	0	1.692328005	0.728891436	0.017761098	3.669218981	3.098280067	9.962438586	0.199003484	1.949542704	4.510305661	0	3.118189133	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2457	NO																																																																																		0	0	0	18.6412	0.630450035	2.788625361	0	3.296169165	1.645881357	1.985032713	2.194025566	3.78690238	0	1.692328005	0.728891436	0.017761098	3.669218981	3.098280067	9.962438586	0.199003484	1.949542704	4.510305661	0	3.118189133	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2457
H5578_007_0	2011	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin	T	Coin	P	P	P	P	O	V																																																			0	YES	286.7358388	9.39655848	21.30630712		12.30265222	7.494872394	8.49537972	31.99452041	38.9339594		12.17800437	2.260000977	0.325236123	23.36349872		4626.428168	2.544395409	697.040776	28.24591405	14.20137708	16.21078437	0.689060679		13.93798932	159.1037094		157.7665494														3400	"1a (IP Acute) FFS, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 20% coin	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 20% coin, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 20% coin"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 0-20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 20% coin, 5 (Partial Hosp) 20% coin, 7c (OT) 8 copay, 7i (PT/ST) 8 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 20% coin, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 8 copay, 7b1 (Routine Chiro) 0% coin (5 visits), 7d (SPC w/Copay) 8 copay, 7f (Podiatry) 8 copay, 7f1 (Routine Podiatry) 0% coin (3 visits), 17a (Eye Exam) 8 copay, 18a (Hearing Exam) 8 copay"	"7e (MH Non-Phys) 45% coin, 7h (Psych) 45% coin"	7i (PT/ST) 8 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0-20% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 8 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 8 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												0.082006619	0.082006619	0.190342139		0.2	0.2	0.2	0.2	0.2		0.2	0.2	0.2	0.2		8	0.45	8	0.181	0.07872	0.2	0.2		0.135384615	5		8														NO	0.070532968	0.070532968	0.163711127		0.172017744	0.172017744	0.172017744	0.172017744	0.172017744		0.172017744	0.172017744	0.172017744	0.172017744		6.880709749	0.387039923	6.880709749	0.155676058	0.067706184	0.172017744	0.172017744		0.135384615	5		6.880709749															20.2243	0.662767158	3.488079548	0	2.116274476	1.289251039	1.461356052	5.503625212	6.69733185	0	2.094832835	0.388760269	0.055946384	4.018936335	0	2.652759116	0.984782604	0.399677939	4.397212556	0.961521048	2.788542552	0.118530663	0	1.886989318	0.066293212	0	0.090462153	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3483	0	9.824496925	20.2243	0.662767158	3.488079548	0	2.116274476	1.289251039	1.461356052	5.503625212	6.69733185	0	2.094832835	0.388760269	0.055946384	4.018936335	0	2.652759116	0.984782604	0.399677939	4.397212556	0.961521048	2.788542552	0.118530663	0	1.886989318	0.066293212	0	0.090462153	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3483	NO																																																																																		0	0	0	20.2243	0.662767158	3.488079548	0	2.116274476	1.289251039	1.461356052	5.503625212	6.69733185	0	2.094832835	0.388760269	0.055946384	4.018936335	0	2.652759116	0.984782604	0.399677939	4.397212556	0.961521048	2.788542552	0.118530663	0	1.886989318	0.066293212	0	0.090462153	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3483
H5578_009_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1284.684622	39.39024247	314.0626214		77.54908785	5.372101681	8.014840401	258.0770728	363.5993096		11.9672164	3.18036136	0.276088856	15.13422521	4165.296654	5444.218475	140.5556551	595.9135804	26.89539801		12.3141739				159.1037094																3400	"1a (IP Acute) 185 days 1-5, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 275 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 20 copay, 7i (PT/ST) 20 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 7 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 20 copay, 7f (Podiatry) 20 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 20 copay, 18a (Hearing Exam) 20 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 20 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 20 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 12 trips/yr	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0% Coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												114.5064605	172.0337627	49.94161658		150	0.2	0.2	46	183.2255011		0.2	0.2	0.2	0.197131373	7	19.92520855	40	20	0.181		0.2				25																NO	103.6165629	155.6728513	45.19202353		135.7345635	0.180979418	0.180979418	41.62526615	165.8002228		0.180979418	0.180979418	0.180979418	0.178383605	6.334279632	18.03026324	36.19588361	18.09794181	0.163786373		0.180979418				25																	11.0929	0.51099928	1.182760448	0	0.877174299	0.972239836	1.450521152	0.89521057	5.023737214	0	2.16581986	0.575579948	0.0499664	2.699697659	2.19867948	8.180057684	0.423961344	0.898734108	4.405099699	0	2.228612027	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1632	0	4.81682545	11.0929	0.51099928	1.182760448	0	0.877174299	0.972239836	1.450521152	0.89521057	5.023737214	0	2.16581986	0.575579948	0.0499664	2.699697659	2.19867948	8.180057684	0.423961344	0.898734108	4.405099699	0	2.228612027	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1632	NO																																																																																		0	0	0	11.0929	0.51099928	1.182760448	0	0.877174299	0.972239836	1.450521152	0.89521057	5.023737214	0	2.16581986	0.575579948	0.0499664	2.699697659	2.19867948	8.180057684	0.423961344	0.898734108	4.405099699	0	2.228612027	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1632
H5578_013_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	1511.766769	45.62073131	558.4922772		140.8575355	6.742806164	7.188549921	322.7601069	322.3600844		13.68271373	2.592692331	0.200938513	12.46871848	4342.894197	4927.939465	123.4058453	588.5434854	24.9189458		9.394423991			11.76442105	159.1037094		260.9166693														3400	"1a (IP Acute) 160 days 1-5, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 200 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 35 copay, 7i (PT/ST) 35 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 10 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 35 copay, 7f (Podiatry) 35 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 35 copay, 18a (Hearing Exam) 35 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 35 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 35 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 12 trips/yr	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 5 copay	17b1 (Non MCR Covered) 100 allowance 0%coin	18a1 (Routine Hearing Exam) 35 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												99.03261452	172.0337627	49.94161658		150	0.2	0.2	47.48331348	155.4766769		0.2	0.2	0.2	0.197495881	10	34.55330165	40	35	0.181		0.2			0.321428571	5		35														NO	87.98768904	152.8471533	44.37171988		133.2707757	0.177694368	0.177694368	42.1875868	138.1366489		0.177694368	0.177694368	0.177694368	0.175469529	8.88471838	30.70646848	35.53887352	31.09651433	0.160813403		0.177694368			0.321428571	5		31.09651433															11.0847	0.581083243	2.06510524	0	1.564349418	1.198158677	1.277364832	1.134705835	3.710811816	0	2.431341164	0.460706824	0.035705642	2.187880154	3.215449324	12.60996815	0.365475394	1.525137577	4.007300466	0	1.66933623	0	0	3.781421048	0.066293212	0	0.676133246	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6485	0	6.499290507	11.0847	0.581083243	2.06510524	0	1.564349418	1.198158677	1.277364832	1.134705835	3.710811816	0	2.431341164	0.460706824	0.035705642	2.187880154	3.215449324	12.60996815	0.365475394	1.525137577	4.007300466	0	1.66933623	0	0	3.781421048	0.066293212	0	0.676133246	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6485	NO																																																																																		0	0	0	11.0847	0.581083243	2.06510524	0	1.564349418	1.198158677	1.277364832	1.134705835	3.710811816	0	2.431341164	0.460706824	0.035705642	2.187880154	3.215449324	12.60996815	0.365475394	1.525137577	4.007300466	0	1.66933623	0	0	3.781421048	0.066293212	0	0.676133246	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6485
H5578_801_0	2011	4																															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	Coin	V																																																			0	YES	227.4986081	4.816220376	21.64941773		4.741326104	5.229990481	7.824387067	13.03318274	40.20030768	5.648840767	15.12595614	3.349618633	0.355966845	19.73472283	54.44655332	110.0499444	2.815356025	11.27613634	28.04070881	15.28431242	15.72331121	0.717295013																			6700	"1a (IP Acute) FFS, 1a1 (Add'l Days) n/a"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) n/a"	6a (Home Health) FFS	10a (Ambulance) FFS	11a (DME) FFS	"11b (Prosthetics) FFS, 11b (Medical Supplies) FFS, 11c (Diabetic Supplies) FFS"	"4a (ER) FFS, 4a (ER) - Worldwide Coverage n/a, 4b (UC) FFS"	"9a (OP Surgery) FFS, 9b (OP ASC) FFS"	8a (OP Diag Proc/Test/Lab) FFS	"8b (X-Ray) FFS, 8b (OP Therap Rad) FFS, 8b (OP Diag) FFS"	9a (OP Observation) FFS	12 (Renal Dialysis) FFS	"3 (CORF) FFS, 5 (Partial Hosp) FFS, 7c (OT) FFS, 7i (PT/ST) FFS, 9a (OP Other) FFS, 9a (OP Chemo) FFS, 9c (OP SA) FFS, 9d (OP Cardiac Rehab) FFS"	"7a (PCP w/Copay) FFS, 14b (Immunizations) FFS, 14c (Routine Physical) FFS, 14d (Pap & Pelvic Exam) FFS, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) FFS, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) FFS, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) FFS, 14h (Mammography) FFS, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) FFS, 14j (Nutrition Therapy Diabetes) FFS"	"7b (Chiro) FFS, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) FFS, 7f (Podiatry) FFS, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) FFS, 18a (Hearing Exam) FFS"	"7e (MH Non-Phys) FFS, 7h (Psych) FFS"	7i (PT/ST) FFS	7g Physician Specialist Services Excluding Psychiatric (Radiology only) FFS	"8a (OP Diag Proc/Test/Lab) FFS, 7g (Prof. Other) FFS"	15 (Part B Rx) FFS	"13a (Blood) FFS, 13a1 (3 Pint Blood) n/a, 14a4-1 (Smoking Cessation - Mdcr Covered) FFS, 16b (Comp. Dental) FFS, 17b (MCR Eyewear) FFS"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive n/a"	17a1 (Routine Eye Exam) n/a	17b1 (Non MCR Covered) n/a	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) n/a, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												0.076653506	0.076653506	0.164633008		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069034452	0.069034452	0.148269141		0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725																				15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	0	10.31335866	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	NO																																																																																		0	0	0	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469
H5580_001_0	2011	3																															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	YES	500.7369934	2.548183004	104.7342677		22.7280603	37.97303312	12.03293993	18.08858698	29.04242435	8.659848737	18.53841226	1.196743966	0.619002427	29.01275783	1.423108093	202.4878914	4.816761333	10.87157735	45.90382919	67.58245222	24.12070797	3.043262614																			6700	1a (IP Acute) FFS	1b (IP Psych) FFS	2a (SNF) FFS	6a (Home Health) FFS	10a (Ambulance) FFS	11a (DME) FFS	"11b (Prosthetics) FFS, 11b (Medical Supplies) FFS, 11c (Diabetic Supplies) FFS"	"4a (ER) FFS, 4b (UC) FFS"	"9a (OP Surgery) FFS, 9b (OP ASC) FFS"	8a (OP Diag Proc/Test/Lab) FFS	"8b (X-Ray) FFS, 8b (OP Therap Rad) FFS, 8b (OP Diag) FFS"	9a (OP Observation) FFS	12 (Renal Dialysis) FFS	"3 (CORF) FFS, 5 (Partial Hosp) FFS, 7c (OT) FFS, 7i (PT/ST) FFS, 9a (OP Other) FFS, 9a (OP Chemo) FFS, 9c (OP SA) FFS, 9d (OP Cardiac Rehab) FFS"	"7a (PCP w/Copay) FFS, 14b (Immunizations) FFS, 14c (Routine Physical) FFS, 14d (Pap & Pelvic Exam) FFS, 14e (Prostate Screening) FFS, 14f (Colorectal Screening) FFS, 14g (Bone Mass) FFS, 14h (Mammography) FFS,  14i (Diabetes Educ.) FFS, 14j (Nutrition Therapy Diabetes) FFS"	"7b (Chiro) FFS, 7b1 (Routine Chiro) 12 visits/year, 7d (SPC w/Copay) FFS, 7f (Podiatry) FFS, 7f1 (Routine Podiatry) 1 visit/3 months, 17a (Eye Exam) FFS, 18a (Hearing Exam) FFS"	"7e (MH Non-Phys) FFS, 7h (Psych) FFS"	7i (PT/ST) FFS	7g Physician Specialist Services Excluding Psychiatric (Radiology only) FFS	8a (OP Diag Proc/Test/Lab) FFS	15 (Part B Rx) FFS	"13a (Blood) FFS, 16b (Comp. Dental) FFS, 17b (MCR Eyewear) FFS"		"16a (Preventive Dental), 16b (Restorative Dental) - $140 max"	17a1 (Routine Eye Exam) - $0	17b (Non MCR Covered) - $175 MAB per year		18b (Non MCR Covered) - $1200 MAB every 3 years	"14a1 (Written health education materials, incl. newsletters) 0 copay, 14a2 (Nutritional Training) 0 copay, 14a3 (Nutritional Benefit) 0 copay, 14a4-2 (Additional Smoking Cessation) 0 copay"													0.077788258	0.077788258	0.134720767		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.063508513	0.063508513	0.109989808		0.190227726	0.190227726	0.190227726	0.190227726	0.190227726	0.190227726	0.190227726	0.190227726	0.190227726	0.190227726	0.190227726	0.190227726	0.190227726	0.190227726	0.190227726	0.190227726	0.190227726	0.190227726																				31.8011	0.161831313	11.51970196	0	4.323507233	7.223523751	2.288998803	3.440950773	5.52467435	1.647343335	3.526520013	0.227653884	0.117751424	5.519030955	0.270714617	38.51881117	0.916281556	2.068075441	8.732181053	12.85605622	4.588427433	0.578912927	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.852	0	32.79449436	31.8011	0.161831313	11.51970196	0	4.323507233	7.223523751	2.288998803	3.440950773	5.52467435	1.647343335	3.526520013	0.227653884	0.117751424	5.519030955	0.270714617	38.51881117	0.916281556	2.068075441	8.732181053	12.85605622	4.588427433	0.578912927	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.852	NO																																																																																		0	0	0	31.8011	0.161831313	11.51970196	0	4.323507233	7.223523751	2.288998803	3.440950773	5.52467435	1.647343335	3.526520013	0.227653884	0.117751424	5.519030955	0.270714617	38.51881117	0.916281556	2.068075441	8.732181053	12.85605622	4.588427433	0.578912927	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.852
H5587_001_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	V	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0.892020644	0.726390693	0.088004339	0.000121135	1.229655754	0	0.64581757	0.012197564	0.025493128	0.800417697	0.940256605	1.675451218	0.056250079	0.214903728	1.471858017	3.419631472	1.231969574	0.477306767	0	0	0	0	0	0	0	0											13.9077	YES	373.3123895	35.85857385	31.79973839	0	24.13275786	19.65179934	2.380872475	963.4938541	33.26714999	0	17.47197125	0.329993313	0.68969199	21.65452852	25.43773525	45.32771616	1.521791614	5.814013022	39.81969855	92.51483007	33.32974818	12.91307405	0	0	0	0	0	0	0	0											3400	Medicare FFS Cost Sharing; PBP 1a	Medicare FFS Cost Sharing; PBP 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	"Medicare FFS Cost Sharing; PBP 11b, 11c"	"$50/visit; 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 5	Medicare FFS Cost Sharing; PBP 12	"Medicare FFS Cost Sharing; PBP 3, 9a, 9c, 9d, 13a"	"Medicare FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"Medicare FFS Cost Sharing; PBP 7e, 7h"	"Medicare FFS Cost Sharing; PBP 7c, 7i"	Medicare FFS Cost Sharing; PBP 7d	"Medicare FFS Cost Sharing; PBP 7d, 7g"	Medicare FFS Cost Sharing; PBP 15	Medicare FFS Cost Sharing; PBP 7g		"Exams 2/yr, x-rays 1/yr; PBP 16a, 16b"	CIF 1/yr; PBP 17a	$100/yr allowance; PBP 17b		$1500/yr allowance; PBP 18b		OTC $50/qtr allowance; PBP 13c											0	0.077502979	0.100199325	0.148674481	0	0.192607387	0.190722506	0.17966862	49.92625823	0.183676929	0	0.192520307	0.192607387	0.192599162	0.192607387	0.192805582	0.192305248	0.433366622	0.15569892	0.192607387	0.193559673	0.192607387	0.192607387	0	0	0	0	0	0	0	0											NO	0.077502979	0.100199325	0.148674481	0	0.192607387	0.190722506	0.17966862	49.92625823	0.183676929	0	0.192520307	0.192607387	0.192599162	0.192607387	0.192805582	0.192305248	0.433366622	0.15569892	0.192607387	0.193559673	0.192607387	0.192607387	0	0	0	0	0	0	0	0												28.9328	3.593004894	4.727809586	0	4.648147443	3.748040418	0.427768071	4.008636914	6.110407937	0	3.363709265	0.06355915	0.132834099	4.170822165	4.90453734	8.716757688	0.659493691	0.905235548	7.669568107	17.90714028	6.419555721	2.487153456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.597	0	1.42E-14	28.9328	3.593004894	4.727809586	0	5.540168087	4.474431111	0.51577241	4.008758049	7.34006369	0	4.009526835	0.075756713	0.158327227	4.971239862	5.844793944	10.39220891	0.71574377	1.120139276	9.141426124	21.32677176	7.651525295	2.964460223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.5047	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	28.9328	3.593004894	4.727809586	0	5.540168087	4.474431111	0.51577241	4.008758049	7.34006369	0	4.009526835	0.075756713	0.158327227	4.971239862	5.844793944	10.39220891	0.71574377	1.120139276	9.141426124	21.32677176	7.651525295	2.964460223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.5047
H5587_002_0	2011	2																															Coin	Coin	Coin		Coin	Coin	Coin	V	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0.836082326	0.680838974	0.082485616	0.000113539	1.152544451	0	0.605318565	0.011432658	0.023894463	0.75022377	0.881293426	1.57038423	0.052722655	0.201427187	1.379558291	3.205187521	1.154713172	0.447375018	0	0	0	0	0	0	0	0											13.0356	YES	349.8166187	33.60168429	29.79830639	0	22.61387511	18.41494199	2.231023621	902.8528698	31.17336111	0	16.37230929	0.309223986	0.64628372	20.29162214	23.83671901	42.47485175	1.426012133	5.448087001	37.31350123	86.6920733	31.23201945	12.10034284	0	0	0	0	0	0	0	0											3400	Medicare FFS Cost Sharing; PBP 1a	Medicare FFS Cost Sharing; PBP 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	"Medicare FFS Cost Sharing; PBP 11b, 11c"	"$50/visit; 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 5	Medicare FFS Cost Sharing; PBP 12	"Medicare FFS Cost Sharing; PBP 3, 9a, 9c, 9d, 13a"	"Medicare FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"Medicare FFS Cost Sharing; PBP 7e, 7h"	"Medicare FFS Cost Sharing; PBP 7c, 7i"	Medicare FFS Cost Sharing; PBP 7d	"Medicare FFS Cost Sharing; PBP 7d, 7g"	Medicare FFS Cost Sharing; PBP 15	Medicare FFS Cost Sharing; PBP 7g		"Exams 2/yr, x-rays 1/yr; PBP 16a, 16b"	CIF 1/yr; PBP 17a	$100/yr allowance; PBP 17b		$1500/yr allowance; PBP 18b		OTC $50/qtr allowance; PBP 13c											0	0.077502979	0.100199325	0.159615141	0	0.192605581	0.190720717	0.179666935	49.92625819	0.183675206	0	0.192518501	0.192605581	0.192597355	0.192605581	0.192820308	0.192303622	0.433362558	0.15569746	0.192605581	0.193558111	0.192605581	0.192605581	0	0	0	0	0	0	0	0											NO	0.077502979	0.100199325	0.159615141	0	0.192605581	0.190720717	0.179666935	49.92625819	0.183675206	0	0.192518501	0.192605581	0.192597355	0.192605581	0.192820308	0.192303622	0.433362558	0.15569746	0.192605581	0.193558111	0.192605581	0.192605581	0	0	0	0	0	0	0	0												27.1118	3.366866084	4.756260862	0	4.355558558	3.512110947	0.400841175	3.75633879	5.725773527	0	3.151972448	0.059558265	0.124472535	3.908279674	4.596203499	8.168067837	0.617980265	0.848253307	7.186788588	16.77995396	6.015461256	2.330593565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7732	0	2.84E-14	27.1118	3.366866084	4.756260862	0	5.191640884	4.192949921	0.483326791	3.756452329	6.878317978	0	3.757291013	0.070990924	0.148366998	4.658503444	5.477496925	9.738452067	0.67070292	1.049680494	8.566346879	19.98514148	7.170174428	2.777968583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.8088	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	27.1118	3.366866084	4.756260862	0	5.191640884	4.192949921	0.483326791	3.756452329	6.878317978	0	3.757291013	0.070990924	0.148366998	4.658503444	5.477496925	9.738452067	0.67070292	1.049680494	8.566346879	19.98514148	7.170174428	2.777968583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.8088
H5590_001_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	662.8642018	21.39097305	186.7724165	0	46.80927795	60.00305586	19.28324943	73.71149673	64.69393443	10.21205128	33.29456612	0	8.199946726	68.06644972	98.9998393	97.93717974	10.06972727	8.707005254	37.96325596	104.9987298	41.89448192	38.82245322	0	0	0	0	0	0	0	0											3400	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a; No Cost-Sharing PBP; 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, No Cost-Sharing PBP; 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, No Cost-Sharing PBP; 14a"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											0	0.07716743	0.07716743	0.136134747	0	0.233	0.233	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	0.076745117	0.076745117	0.135389725	0	0.231724866	0.231724866	0.231724866	0.231724866	0.231724866	0.231724866	0.231724866	0	0.231724866	0.231724866	0.231746906	0.231724866	0.231724866	0.231724866	0.231724866	0.231724866	0.231724866	0.231724866	0	0	0	0	0	0	0	0												50.8716	1.641652734	25.28706618	0	10.84687366	13.90420008	4.468408391	17.0807867	14.99119329	2.366386215	7.715178872	0	1.900131556	15.77268894	22.94290649	22.69447985	2.333406202	2.017629626	8.7970304	24.3308166	9.70799321	8.99612777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	268.6665	0	1.476222424	50.8716	1.641652734	25.28706618	0	10.84687366	13.90420008	4.468408391	17.0807867	14.99119329	2.366386215	7.715178872	0	1.900131556	15.77268894	22.94290649	22.69447985	2.333406202	2.017629626	8.7970304	24.3308166	9.70799321	8.99612777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	268.6665	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	50.8716	1.641652734	25.28706618	0	10.84687366	13.90420008	4.468408391	17.0807867	14.99119329	2.366386215	7.715178872	0	1.900131556	15.77268894	22.94290649	22.69447985	2.333406202	2.017629626	8.7970304	24.3308166	9.70799321	8.99612777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	268.6665
H5590_002_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	668.1071749	25.43433502	174.5207461	0	46.15993369	59.64532272	19.73781948	74.33266006	68.18471011	11.13507084	35.1801422	0	8.408623145	69.7381011	97.68328794	99.66750915	10.38691264	8.885967461	38.63313064	106.1289643	43.19216734	40.48211286	0	0	0	0	0	0	0	0											3400	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a; No Cost-Sharing PBP; 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, No Cost-Sharing PBP; 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, No Cost-Sharing PBP; 14a"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-f											0	0.074223718	0.074223718	0.141947473	0	0.233	0.233	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	0.073816701	0.073816701	0.141169083	0	0.23172231	0.23172231	0.23172231	0.23172231	0.23172231	0.23172231	0.23172231	0	0.23172231	0.23172231	0.231744236	0.23172231	0.23172231	0.23172231	0.23172231	0.23172231	0.23172231	0.23172231	0	0	0	0	0	0	0	0												49.3175	1.877478704	24.63693372	0	10.69628646	13.82115196	4.573693125	17.2245357	15.79991853	2.580244337	8.152023817	0	1.948465579	16.15987388	22.63753891	23.09518545	2.406879392	2.059076907	8.952158275	24.59244878	10.00858879	9.380608706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	269.9206	0	1.486157123	49.3175	1.877478704	24.63693372	0	10.69628646	13.82115196	4.573693125	17.2245357	15.79991853	2.580244337	8.152023817	0	1.948465579	16.15987388	22.63753891	23.09518545	2.406879392	2.059076907	8.952158275	24.59244878	10.00858879	9.380608706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	269.9206	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	49.3175	1.877478704	24.63693372	0	10.69628646	13.82115196	4.573693125	17.2245357	15.79991853	2.580244337	8.152023817	0	1.948465579	16.15987388	22.63753891	23.09518545	2.406879392	2.059076907	8.952158275	24.59244878	10.00858879	9.380608706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	269.9206
H5591_001_0	2011	9																															D	D	D		T	Coin	Coin	V	V		Coin	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	NO	477.7889499	10.32221331	8.259672834	0	1.189539341	6.152598409	0.810655303	220.2451257	382.8378586	0	9.277775336	1.145222737	0	623.5194819	3440.927676	3040.404614	315.780332	860.5908311	3.572310034	0	4.891839303	0	0	0	0	0	0	0	0	0												$178/Days Custom for IP Medical; $178/Days Custom for IP Medical; $178/Days Custom for IP Surg; $178/Days Custom for IP Surg; PBP 1a	$178/Days Custom for IP Psych; $178/Days Custom for IP Psych; $178/Days Custom for IP S/A; $178/Days Custom for IP S/A; PBP 1b	$135/Days Custom for SNF; PBP 2	No Cost Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; PBP 4a, 4b"	"$150/Visit for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad; 20% Coinsurance for OP Rad; 20% Coinsurance for OP Rad; PBP 8b	$50/Visit for Partial Hospitalization; PBP 5	$75/Service for Renal Dialysis; PBP 12	"$20/Visit for OP PT/OT/ST; PBP 3, 9c, 9d, 13a"	"$5/Visit for OV; $5/Visit for OV; $20/Visit for OV; PBP 4b, 7a, 14b-c"	"$20/Visit for OV; $20/Visit for OV; $20/Visit for OV; $20/Visit for Consult; $20/Visit for Chiro; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$19/Visit for OP Psych; PBP 7e, 7h"	"$20/Visit for PT/OT/ST; $20/Visit for PT/OT/ST; PBP 7c, 7i"	"20% Coinsurance for Office Rad; 20% Coinsurance for Office Rad; 20% Coinsurance for Office Rad; 20% Coinsurance for Office Rad; 20% Coinsurance for Office Rad; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	"No Cost Sharing; PBP 13a, 13b, 14c"											0	178	178	135	0	125	0.2	0.2	50	150	0	0.2	1.082080367	0	20.66343346	5.002167404	20	18.5	20	0.2	0	0.2	0	0	0	0	0	0	0	0	0											NO	171.5408516	171.5408516	130.1012077	0	120.4640812	0.19274253	0.19274253	48.18563247	144.5568974	0	0.19274253	1.042814537	0	19.9136122	4.820652001	19.27425299	17.82868401	19.27425299	0.19274253	0	0.19274253	0	0	0	0	0	0	0	0	0												6.83	0.147556772	0.089549451	0	0.011941397	1.185867383	0.156247754	0.884387556	4.611821087	0	1.78822189	9.95E-05	0	1.03471043	1.382292907	4.883460643	0.469162313	1.38227045	0.688536073	0	0.942865483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.489	0	0.997409641	6.83	0.147556772	0.089549451	0	0.011941397	1.185867383	0.156247754	0.884387556	4.611821087	0	1.78822189	9.95E-05	0	1.03471043	1.382292907	4.883460643	0.469162313	1.38227045	0.688536073	0	0.942865483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.489	YES	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	30% Coinsurance for DME; PBP 11a	"30% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; PBP 4a, 4b"	"$200/Visit for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	30% Coinsurance for OP Rad; 30% Coinsurance for OP Rad; PBP 8b	No Cost Sharing; PBP 5	No Cost Sharing; PBP 12	"$30/Visit for OP PT/OT/ST; PBP 3, 9c, 9d, 13a"	"$30/Visit for OV; $30/Visit for Consult; PBP 4b, 7a, 14b-c"	"$30/Visit for OV; $30/Visit for OV; $30/Visit for OV; $30/Visit for Consult; $30/Visit for Chiro; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for OP Psych; $30/Visit for OP Psych; PBP 7e, 7h"	"$30/Visit for PT/OT/ST; PBP 7c, 7i"	"30% Coinsurance for Office Rad; 30% Coinsurance for Office Rad; 30% Coinsurance for Office Rad; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	"No Cost Sharing; PBP 13a, 13b, 14c"											2500	0	0	0	0	1.0431	0.3454	0.02	0.0896	0.1399	0	0.154	0	0	0.0403	0.058	1.0087	0.1878	0.154	1.1485	0	1.6425	0	0	0	0	0	0	0	0	0											6.0318	0	0.227118257	6.83	0.147556772	0.089549451	0	1.05502302	1.531287333	0.17620472	0.974001433	4.75168613	0	1.942231237	9.95E-05	0	1.075040486	1.440270082	5.892131718	0.656989193	1.536279867	1.837015093	0	2.585389089	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5208
H5591_003_0	2011	8																															D	D	D		T	Coin	Coin	V	V		Coin	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	YES	368.4102941	5.716136644	5.089211023	0	83.13144387	5.096405756	0.490631084	194.5068208	305.5090845	0	8.677409471	5.092482373	0	533.4261132	2485.887007	2670.535205	261.1881847	598.526621	5.029964589	0	8.548219056	0	0	0	0	0	0	0	0	0											3400	$182/Days Custom for IP Medical; $182/Days Custom for IP Medical; $182/Days Custom for IP Surg; $182/Days Custom for IP Surg; PBP 1a	$182/Days Custom for IP Psych; $182/Days Custom for IP Psych; $182/Days Custom for IP S/A; $182/Days Custom for IP S/A; PBP 1b	$135/Days Custom for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for OP ER; PBP 4a, 4b"	"$175/Visit for OP Surg; PBP 9a, 9b"	No Cost Sharing; PBP 8a	20% Coinsurance for OP Rad; 20% Coinsurance for OP Rad; 20% Coinsurance for OP Rad; PBP 8b	$50/Visit for Partial Hospitalization; PBP 5	$100/Service for Renal Dialysis; PBP 12	"$25/Visit for OP PT/OT/ST; PBP 3, 9c, 9d, 13a"	"$20/Visit for OV; $20/Visit for OV; $20/Visit for OV; $20/Visit for Consult; PBP 4b, 7a, 14b-c"	"$25/Visit for OV; $25/Visit for OV; $25/Visit for OV; $25/Visit for OV; $25/Visit for Consult; $25/Visit for Chiro; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$24/Visit for OP Psych; $24/Visit for OP Psych; PBP 7e, 7h"	"$25/Visit for PT/OT/ST; $25/Visit for PT/OT/ST; PBP 7c, 7i"	"20% Coinsurance for Office Rad; 20% Coinsurance for Office Rad; 20% Coinsurance for Office Rad; 20% Coinsurance for Office Rad; 20% Coinsurance for Office Rad; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14a	No Cost Sharing; PBP 13b											0	182	182	135	0	150	0.2	0.2	50	175	0	0.2	50	0	24.61616711	20	25	24	25	0.2	0	0.2	0	0	0	0	0	0	0	0	0											NO	178.1542077	178.1542077	132.1473519	0	146.8303909	0.195773855	0.195773855	48.94346365	171.3021228	0	0.195773855	48.94346365	0	24.0960096	19.57738546	24.47173182	23.49286255	24.47173182	0.195773855	0	0.195773855	0	0	0	0	0	0	0	0	0												5.4695	0.084862816	0.056043813	0	1.0171852	0.997742999	0.096052738	0.793319793	4.361196225	0	1.6988099	0.02077031	0	1.071120062	4.055597345	5.44605178	0.511338177	1.220581913	0.984735556	0	1.673517795	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5584	0	0.638073727	5.4695	0.084862816	0.056043813	0	1.0171852	0.997742999	0.096052738	0.793319793	4.361196225	0	1.6988099	0.02077031	0	1.071120062	4.055597345	5.44605178	0.511338177	1.220581913	0.984735556	0	1.673517795	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5584	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.4695	0.084862816	0.056043813	0	1.0171852	0.997742999	0.096052738	0.793319793	4.361196225	0	1.6988099	0.02077031	0	1.071120062	4.055597345	5.44605178	0.511338177	1.220581913	0.984735556	0	1.673517795	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5584
H5594_001_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	758.3082253	2.095932077	325.5726204	323.546539	288.4105114	1.014710408	3.766964562	133.50637	145.2744086	274.678225	15.42018863	4.869533251	0	5.275327688	1000.0095	2442.994864	179.0564889	141.1598382	271.4438738	0	44.34810585	0.132245365	3.397288187	526.6695377	901.6224974	0.864799135	212.4723016	0	12964.26327	0											3400	$150 days 1-7	$150 days 1-7	$75 days 8-100	15	100	0.2	0.2	50	250	0	025-200; see grid75-200(NUC); 20%(other)	250	0.2	250	0	20	20	20	20	20	0.2	20	0	$0:$0-75	0	10	0	0	0	0												113	79	38	15	100	0.2	0.199617901	47.62917933	76.81564246	0	22.44736842	250	0	153.8461538	0	18.9906876	20	20	20	0	0.2	0	0	1	0	10	0	0	0	0											NO	107.6515336	75.26080667	36.20140067	14.29002658	95.26684388	0.190533688	0.190169674	45.37481591	73.17983818	0	21.38489943	238.1671097	0	146.5643752	0	18.0918287	19.05336878	19.05336878	19.05336878	0	0.190533688	0	0	0.952668439	0	9.526684388	0	0	0	0												6.8028	0.013145128	0.982182073	0.38529072	2.289663264	0.193336516	0.716362422	0.504818913	0.88592981	0	0.027479932	0.096646888	0	0.064431259	0	3.683187051	0.284302443	0.224130871	0.430993352	0	8.449808152	0	0	0.041811787	0	0.000686556	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.077		1.295585341	6.8028	0.013145128	0.982182073	0.38529072	2.289663264	0.193336516	0.716362422	0.504818913	0.88592981	0	0.027479932	0.096646888	0	0.064431259	0	3.683187051	0.284302443	0.224130871	0.430993352	0	8.449808152	0	0	0.041811787	0	0.000686556	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.077	NO																7d1: 40%																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.8583	0	0	0	0	0	0	0	0	0	0	0	0	0	0											1.8583			6.8028	0.013145128	0.982182073	0.38529072	2.289663264	0.193336516	0.716362422	0.504818913	0.88592981	0	0.027479932	0.096646888	0	0.064431259	0	5.541443053	0.284302443	0.224130871	0.430993352	0	8.449808152	0	0	0.041811787	0	0.000686556	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.9352
H5594_002_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	1484.910846	4.742018578	826.7591092	1356.84672	551.5209429	4.999285351	8.024841271	235.1894953	264.0189303	317.7810387	21.66155298	9.547652334	0	23.69217654	836.7517351	1799.45998	179.0564889	66.12348284	199.9399977	0	72.72139787	0.183589592	2.427040847	526.6404758	901.3854193	0.390642777	223.0097133	0	12964.26327	0											3400	$50 days 6-10	0	$100 days 21-100	0	100	0.2	0.2	50	200	0	00-50; see grid$50 (NUC); 20%(other)	200	0.2	200	0	0	0	0	0	0	0.2	0	0	$0:$0-75	0	10	0	0	0	0												10	0	10	0	100	0.2	0.199344043	47.56480554	26.70369501	0	3.363652899	200	0	37.19060569	0	0	0	0	0	0	0.2	0	0	1.000501886	0	10	0	0	0	0											NO	9.646326362	0	9.646326362	0	96.46326362	0.192926527	0.19229377	45.88256375	25.75925571	0	3.244689363	192.9265272	0	35.875272	0	0	0	0	0	0	0.192926527	0	0	0.965116772	0	9.646326362	0	0	0	0												1.1937	0	0.664599016	0	4.433459175	0.964494761	1.543126978	0.899258084	0.566744262	0	0.005857084	0.153499617	0	0.070830273	0	0	0	0	0	0	14.02988675	0	0	0.042355796	0	0.000314022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5681		0.900766199	1.1937	0	0.664599016	0	4.433459175	0.964494761	1.543126978	0.899258084	0.566744262	0	0.005857084	0.153499617	0	0.070830273	0	0	0	0	0	0	14.02988675	0	0	0.042355796	0	0.000314022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5681	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			1.1937	0	0.664599016	0	4.433459175	0.964494761	1.543126978	0.899258084	0.566744262	0	0.005857084	0.153499617	0	0.070830273	0	0	0	0	0	0	14.02988675	0	0	0.042355796	0	0.000314022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5681
H5594_006_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	1236.552771	2.799335594	526.9351051	636.0878132	469.7866574	2.275957043	9.451885241	195.7219402	217.0086189	358.3123251	28.95019614	6.504461963	0	9.830552348	1443.611496	3709.203461	179.0564889	188.5286437	412.1337179	0	89.99865691	0.217680577	1.19E-05	526.6695377	901.7675972	1.154998546	214.6487972	0	12964.26327	0											3400	$175 days 1-5	$175 days 1-5	$100 days 8-100	0	100	0.2	0.2	50	200	0	025-150; see grid75-150(NUC); 20%(other)	200	0.2	200	0	25	25	25	25	25	0.2	25	0	$0:$0-75	0	10	0	0	0	0												113	75	51	0	100	0.2	0.199749338	47.8401312	67.98162761	0	38.09977465	200	0	144.8691916	0	24.04720312	25	25	25	0	0.2	0	0	1	0	10	0	0	0	0											NO	97.67090999	64.82582521	44.08156114	0	86.43443362	0.172868867	0.172652209	41.35034644	58.75953479	0	32.93132443	172.8688672	0	125.2168653	0	20.78506382	21.6086084	21.6086084	21.6086084	0	0.172868867	0	0	0.864344336	0	8.643443362	0	0	0	0												10.0646	0.015122437	1.935676838	0	3.383811971	0.393442116	1.631888866	0.674430836	1.062610458	0	0.079447358	0.093701581	0	0.102579246	0	6.424669221	0.322430129	0.339486803	0.742136343	0	15.55796587	0	0	0.037935319	0	0.00083193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8628		6.7271541	10.0646	0.015122437	1.935676838	0	3.383811971	0.393442116	1.631888866	0.674430836	1.062610458	0	0.079447358	0.093701581	0	0.102579246	0	6.424669221	0.322430129	0.339486803	0.742136343	0	15.55796587	0	0	0.037935319	0	0.00083193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8628	NO																7d1: 20%																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.3954	0	0	0	0	0	0	0	0	0	0	0	0	0	0											2.3954			10.0646	0.015122437	1.935676838	0	3.383811971	0.393442116	1.631888866	0.674430836	1.062610458	0	0.079447358	0.093701581	0	0.102579246	0	8.820098731	0.322430129	0.339486803	0.742136343	0	15.55796587	0	0	0.037935319	0	0.00083193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2582
H5594_016_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	2832.972053	14.99831921	1390.163608	1767.122063	573.3157768	8.28718909	18.71717352	683.2311442	243.9223495	179.2686153	45.63168365	15.34898149	0.652169912	51.43934753	8406.565286	3440.000316	407.0900603	47.50933122	382.2222573	0	73.92567808	0.078200865	7.693344522	1285.911612	1756.72412	0	167.9240903	0	16111.53704	0											3400	$60 days 1-5	$60 days 1-5	$40 days 9-100	0	100	0.2	0.2	50	75	0	00-50; see grid$50 (NUC); 20%(other)	75	0.2	75	0	20	20-Oct	20	20	20	0.2	20	0	$0:$0-75	0	10	0	0	0	0												39	26	18	0	100	0.2	0.199747031	49.8178509	54.2517045	0	6.799996762	75	0.2	91.49558812	0	19.70583559	36.38910225	20	20	0	0.2	0	0	1	0	0	0	0	0	0											NO	34.32669674	22.88446449	15.8430908	0	88.01717113	0.176034342	0.175811686	43.84826308	47.75081559	0	5.985164787	66.01287835	0.176034342	80.53182837	0	17.34451903	32.0286584	17.60343423	17.60343423	0	0.176034342	0	0	0.880171711	0	0	0	0	0	0												8.1039	0.028602375	1.835374022	0	4.20513607	1.458829881	3.290697831	2.49654158	0.970624261	0	0.022759429	0.084435871	0.114804302	0.345208726	0	4.972095913	1.086545707	0.069693949	0.560702031	0	13.01345812	0	0	0.094318585	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7537		5.820573191	8.1039	0.028602375	1.835374022	0	4.20513607	1.458829881	3.290697831	2.49654158	0.970624261	0	0.022759429	0.084435871	0.114804302	0.345208726	0	4.972095913	1.086545707	0.069693949	0.560702031	0	13.01345812	0	0	0.094318585	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7537	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			8.1039	0.028602375	1.835374022	0	4.20513607	1.458829881	3.290697831	2.49654158	0.970624261	0	0.022759429	0.084435871	0.114804302	0.345208726	0	4.972095913	1.086545707	0.069693949	0.560702031	0	13.01345812	0	0	0.094318585	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7537
H5594_017_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	2288.233913	12.11438314	1122.855916	1427.330354	463.074949	6.261290881	14.14154764	551.8559756	197.0196197	144.7981063	36.85741185	12.39749308	0.49273961	41.54835518	6790.117401	2778.543297	288.0409782	38.37404933	308.727033	0	53.9882819	0.05908378	0	1038.651331	1418.934064	0	135.6349289	0	13013.54368	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:$0-75	0	10	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.004625904	0	0	0	0	0	0	0	1	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.004625904	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	0.001071106	0	0	0	0	0	0	0	0.086554278	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0876		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.001071106	0	0	0	0	0	0	0	0.086554278	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0876	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.001071106	0	0	0	0	0	0	0	0.086554278	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0876
H5594_018_0	2011	9																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	760.5619855	1.427091405	308.0457368	257.3561002	331.5479	1.94819665	4.862397489	114.3814273	112.1320162	532.6271589	58.39606539	9.923930321	0	3.59189827	2037.462835	2311.989348	179.0564889	96.11379781	256.8877053	0	50.39813162	0.099956101	1.80E-06	526.6695377	901.4845128	0.58882987	212.1629307	0	12964.26327	0											3400	$250 days 1-7	$250 days 1-7	$100 days 9-35	15	100	0.2	0.2	50	250	0	025-200; see grid75-200(NUC); 20%(other)	250	0.2	250	0	30	30	25	30	30	0.2	30	0	$0:$0-75	0	10	0	0	0	0												188	131	45	15	100	0.2	0.199776259	48.11583138	117.7412224	0	25.58898617	250	0	153.8461538	0	28.41291463	30	25	30	0	0.2	0	0	1	0	10	0	0	0	0											NO	171.8767498	119.765182	41.14071138	13.71357046	91.42380307	0.182847606	0.182643053	43.98932292	107.6435033	0	23.39442433	228.5595077	0	140.6520047	0	25.97616711	27.42714092	22.85595077	27.42714092	0	0.182847606	0	0	0.914238031	0	9.142380307	0	0	0	0												10.8936	0.014242988	1.056101729	0.294105918	2.525947493	0.356223094	0.888083124	0.419296795	1.005856922	0	0.113845194	0.189017386	0	0.042100641	0	5.004718472	0.40925063	0.183064353	0.587141274	0	9.21517772	0	0	0.04012511	0	0.000448609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2383		3.117989028	10.8936	0.014242988	1.056101729	0.294105918	2.525947493	0.356223094	0.888083124	0.419296795	1.005856922	0	0.113845194	0.189017386	0	0.042100641	0	5.004718472	0.40925063	0.183064353	0.587141274	0	9.21517772	0	0	0.04012511	0	0.000448609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2383	NO																7d1: 40%																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1381	0	0	0	0	0	0	0	0	0	0	0	0	0	0											3.1381			10.8936	0.014242988	1.056101729	0.294105918	2.525947493	0.356223094	0.888083124	0.419296795	1.005856922	0	0.113845194	0.189017386	0	0.042100641	0	8.142787981	0.40925063	0.183064353	0.587141274	0	9.21517772	0	0	0.04012511	0	0.000448609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3764
H5594_019_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	1198.425538	11.35143489	434.8260774	544.6466807	434.1881231	3.206062296	10.47730232	220.5941996	208.7357498	535.6447844	89.00018697	105.8509396	0	7.04558646	1376.848541	3589.404953	179.0564889	188.5293016	398.8227725	0	128.4623659	0.212069801	0	444.7431652	773.0261566	1.155002577	214.6488274	0	12874.14426	0											3400	$100 days 1-5	$100 days 1-5	$75 days 8-100	0	100	0.2	0.2	50	200	0	025-150; see grid75-150(NUC); 20%(other)	200	0.2	200	0	15	15	15	15	15	0.2	15	0	$0:$0-75	0	10	0	0	0	0												65	43	38	0	100	0.2	0.199779699	48.0836523	73.31656249	0	10.63908453	200	0	123.0769231	0	14.40924054	15	15	15	0	0.2	0	0	1	0	10	0	0	0	0											NO	56.2640481	37.22083182	32.89282812	0	86.56007401	0.173120148	0.172929455	41.62124501	63.46287075	0	9.209199443	173.120148	0	106.5354757	0	12.47264927	12.9840111	12.9840111	12.9840111	0	0.173120148	0	0	0.86560074	0	8.656007401	0	0	0	0												5.619	0.035209154	1.191888286	0	3.131946339	0.555033979	1.811834183	0.765117102	1.103914159	0	0.068301706	1.527077528	0	0.062550409	0	3.730782423	0.193739287	0.203988879	0.431526609	0	22.23942379	0	0	0.032080834	0	0.000833143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7043		6.630565438	5.619	0.035209154	1.191888286	0	3.131946339	0.555033979	1.811834183	0.765117102	1.103914159	0	0.068301706	1.527077528	0	0.062550409	0	3.730782423	0.193739287	0.203988879	0.431526609	0	22.23942379	0	0	0.032080834	0	0.000833143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7043	NO																7d1: 20%																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.3464	0	0	0	0	0	0	0	0	0	0	0	0	0	0											2.3464			5.619	0.035209154	1.191888286	0	3.131946339	0.555033979	1.811834183	0.765117102	1.103914159	0	0.068301706	1.527077528	0	0.062550409	0	6.077184544	0.193739287	0.203988879	0.431526609	0	22.23942379	0	0	0.032080834	0	0.000833143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0507
H5594_022_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	766.554335	1.930786913	299.9197168	298.0532768	265.6857287	1.047036652	3.886971032	139.4428119	150.2836094	390.0482169	22.43309988	4.485847218	0	4.859667819	1562.756461	2520.341021	179.0564889	130.037405	280.0378912	0	45.80006973	0.136458386	5.68E-07	234.0753501	483.178739	0.796658857	104.676714	0	12874.14426	0											3400	$250 days 1-7	$250 days 1-7	$100 days 9-35	15	100	0.2	0.2	50	250	0	025-200; see grid75-200(NUC); 20%(other)	250	0.2	250	0	30	30	25	30	30	0.2	30	0	$0:$0-75	0	10	0	0	0	0												188	131	45	15	100	0.2	0.199617901	47.90896307	117.9095268	0	26.68459353	250	0	153.8461538	0	28.26775731	30	25	30	0	0.2	0	0	1	0	10	0	0	0	0											NO	172.4859329	120.189666	41.2865265	13.7621755	91.74783666	0.183495673	0.183145106	43.95543718	108.1794401	0	24.48253728	229.3695917	0	141.1505179	0	25.93505581	27.524351	22.93695917	27.524351	0	0.183495673	0	0	0.917478367	0	9.174783666	0	0	0	0												11.0183	0.019338386	1.031886944	0.341821792	2.031340903	0.192126695	0.71187972	0.51077248	1.354799726	0	0.045768267	0.085743079	0	0.057162052	0	5.447098752	0.410701137	0.248555221	0.642321767	0	8.404114633	0	0	0.017896589	0	0.000609098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5723		2.929677654	11.0183	0.019338386	1.031886944	0.341821792	2.031340903	0.192126695	0.71187972	0.51077248	1.354799726	0	0.045768267	0.085743079	0	0.057162052	0	5.447098752	0.410701137	0.248555221	0.642321767	0	8.404114633	0	0	0.017896589	0	0.000609098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5723	NO																7d1: 40%																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1376	0	0	0	0	0	0	0	0	0	0	0	0	0	0											3.1376			11.0183	0.019338386	1.031886944	0.341821792	2.031340903	0.192126695	0.71187972	0.51077248	1.354799726	0	0.045768267	0.085743079	0	0.057162052	0	8.584655375	0.410701137	0.248555221	0.642321767	0	8.404114633	0	0	0.017896589	0	0.000609098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.7098
H5594_023_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	1536.760357	2.799270777	434.8260768	432.1200967	406.8133855	1.654127194	6.140706226	183.3799766	194.0246123	365.9026372	20.59479116	6.503618261	0	7.04558645	1300.221274	3234.981954	179.0564889	188.5293014	359.4424393	0	72.64022436	0.215579394	5.04E-09	444.7431652	773.0261566	1.155002575	214.6488274	0	10871.05263	0											3400	$75 days 1-5	$75 days 1-5	$75 days 8-100	0	100	0.2	0.2	50	200	0	025-150; see grid75-150(NUC); 20%(other)	200	0.2	200	0	15	15	15	15	15	0.2	15	0	$0:$0-75	0	10	0	0	0	0												49	32	38	0	100	0.2	0.199617901	47.6947582	70.11173176	0	20.76315789	200	0	123.0769231	0	14.34451723	15	15	15	0	0.2	0	0	1	0	10	0	0	0	0											NO	45.41784636	29.66063436	35.2220033	0	92.68948237	0.185378965	0.185024799	44.2080245	64.98620125	0	19.24526358	185.3789647	0	114.0793629	0	13.29585877	13.90342236	13.90342236	13.90342236	0	0.185378965	0	0	0.926894824	0	9.268948237	0	0	0	0												5.8164	0.006919012	1.276287126	0	3.142276843	0.306640387	1.136182935	0.675572208	1.050743542	0	0.033029349	0.100469502	0	0.066979668	0	3.584321932	0.207458166	0.218433542	0.416456671	0	13.46596959	0	0	0.034352511	0	0.000892138	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.5393		2.487541717	5.8164	0.006919012	1.276287126	0	3.142276843	0.306640387	1.136182935	0.675572208	1.050743542	0	0.033029349	0.100469502	0	0.066979668	0	3.584321932	0.207458166	0.218433542	0.416456671	0	13.46596959	0	0	0.034352511	0	0.000892138	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.5393	NO																7d1: 20%																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.3547	0	0	0	0	0	0	0	0	0	0	0	0	0	0											2.3547			5.8164	0.006919012	1.276287126	0	3.142276843	0.306640387	1.136182935	0.675572208	1.050743542	0	0.033029349	0.100469502	0	0.066979668	0	5.938978574	0.207458166	0.218433542	0.416456671	0	13.46596959	0	0	0.034352511	0	0.000892138	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.894
H5594_024_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	1287.313841	3.550231222	720.1466702	1042.827251	481.2049155	3.964034444	8.846843708	235.7652539	306.5635408	784.9202363	21.99558427	13.74724017	0	17.87141222	18781.35302	25317.48371	181.2636218	1403.000801	2813.053746	0	80.92140451	0.302686621	5.04E-07	444.7431652	772.4486553	1.464855146	217.7051493	0	0.001909544	0											3400	$100 days 1-5	$100 days 1-5	$75 days 8-100	0	100	0.2	0.2	50	200	0	025-150; see grid75-150(NUC); 20%(other)	200	0.2	200	0	25	25	15	25	25	0.2	25	0	$0:$0-75	0	10	0	0	0	0												65	43	38	0	100	0.2	0.199354473	47.55102129	69.17039828	0	21.45600905	200	0	53.84615385	0	14.76042339	15	15	15	0	0.2	0	0	1	0	10	0	0	0	0											NO	50.93029929	33.69235184	29.77463651	0	78.35430661	0.156708613	0.156202815	37.25827302	54.19798595	0	16.81170711	156.7086132	0	42.19078048	0	11.5654274	11.75314599	11.75314599	11.75314599	0	0.156708613	0	0	0.783543066	0	7.835430661	0	0	0	0												5.4636	0.00996797	1.786842112	0	3.142039791	0.62119834	1.38190189	0.732017183	1.384593873	0	0.030815277	0.179525912	0	0.062834069	0	24.40062664	0.177534817	1.374139436	2.755185946	0	12.68108108	0	0	0.029039619	0	0.000956481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2139		15.52931867	5.4636	0.00996797	1.786842112	0	3.142039791	0.62119834	1.38190189	0.732017183	1.384593873	0	0.030815277	0.179525912	0	0.062834069	0	24.40062664	0.177534817	1.374139436	2.755185946	0	12.68108108	0	0	0.029039619	0	0.000956481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2139	NO																7d1: 20%																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.9773	0	0	0	0	0	0	0	0	0	0	0	0	0	0											1.9773			5.4636	0.00996797	1.786842112	0	3.142039791	0.62119834	1.38190189	0.732017183	1.384593873	0	0.030815277	0.179525912	0	0.062834069	0	26.37796111	0.177534817	1.374139436	2.755185946	0	12.68108108	0	0	0.029039619	0	0.000956481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1912
H5594_025_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	O	V	V	V	V	P	P	Coin	Coin	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	1806.800158	5.663950338	799.0849855	1104.661409	689.4130418	3.750386353	5.960928869	273.0534775	212.7404663	772.6455019	28.51160529	6.579601221	0	18.64220346	22263.75764	26184.6413	187.2726333	406.1122804	2909.404588	0	57.89750568	0.043189883	1.59E-07	444.7431652	773.617152	0	227.0192483	0	0.000603851	0											3400	$100 days 1-5	$100 days 1-5	$75 days 8-100	0	100	0.2	0.2	50	200	0	025-150; see grid75-150(NUC); 20%(other)	200	0.2	200	0	15	15	15	15	15	0.2	15	0	$0:$0-75	0	10	0	0	0	0												65	43	38	0	100	0.2	0.199075653	48.67469893	73.19587336	0	13.53846154	200	0	70.58823529	0	14.6342795	15	15	15	0	0.2	0	0	1	0	0	0	0	0	0											NO	51.17474612	33.85406282	29.91754389	0	78.73037865	0.157460757	0.156733015	38.32177477	57.62738825	0	10.65888203	157.4607573	0	55.57438493	0	11.52162366	11.8095568	11.8095568	11.8095568	0	0.157460757	0	0	0.787303786	0	0	0	0	0	0												7.7052	0.015978978	1.992221677	0	4.523145819	0.590538675	0.934274354	0.871991155	1.021639787	0	0.025325153	0.086335749	0	0.086335749	0	25.14079856	0.184300567	0.39966717	2.863231561	0	9.11658509	0	0	0.029178998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5868		15.01719377	7.7052	0.015978978	1.992221677	0	4.523145819	0.590538675	0.934274354	0.871991155	1.021639787	0	0.025325153	0.086335749	0	0.086335749	0	25.14079856	0.184300567	0.39966717	2.863231561	0	9.11658509	0	0	0.029178998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5868	NO																7d1: 20%																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.091	0	0	0	0	0	0	0	0	0	0	0	0	0	0											2.091			7.7052	0.015978978	1.992221677	0	4.523145819	0.590538675	0.934274354	0.871991155	1.021639787	0	0.025325153	0.086335749	0	0.086335749	0	27.23180136	0.184300567	0.39966717	2.863231561	0	9.11658509	0	0	0.029178998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6778
H5608_001_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	646.9150451	16.7383191	52.33327494	0	23.65758514	29.99358785	9.986483687	28.53552919	21.24825898	10.50017237	25.02254974	0	0.102686545	56.2738884	32.49097524	47.09300027	0.747112228	0.791525582	11.74813038	40.43245544	8.877474458	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	PBP 14a	No Cost-Sharing; PBP 13b											0	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	0	0	0	0	0	0	0	0											NO	0.060237683	0.060237683	0.120249712	0	0.189477632	0.189477632	0.189477632	0.189477632	0.189477632	0.189477632	0.189477632	0	0.189477632	0.189477632	0.190080232	0.189567009	0.189477632	0.189477632	0.189477632	0.189477632	0.189477632	0	0	0	0	0	0	0	0	0												38.9687	1.00827756	6.293061251	0	4.482583209	5.683113997	1.89221528	5.406844494	4.026069793	1.989547794	4.741213469	0	0.019456803	10.66264311	6.175892118	8.927279203	0.141561056	0.149976393	2.226007923	7.661045906	1.682082837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.1375	0	25.72835869	38.9687	1.00827756	6.293061251	0	4.482583209	5.683113997	1.89221528	5.406844494	4.026069793	1.989547794	4.741213469	0	0.019456803	10.66264311	6.175892118	8.927279203	0.141561056	0.149976393	2.226007923	7.661045906	1.682082837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.1375	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	38.9687	1.00827756	6.293061251	0	4.482583209	5.683113997	1.89221528	5.406844494	4.026069793	1.989547794	4.741213469	0	0.019456803	10.66264311	6.175892118	8.927279203	0.141561056	0.149976393	2.226007923	7.661045906	1.682082837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.1375
H5608_002_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	449.1335776	11.69410549	38.87347254	0	13.13173014	21.64666055	3.650467072	30.24179956	32.27585795	16.01756588	27.89688301	0	1.814630363	56.61811164	28.50922298	40.46465957	1.488625495	1.423761064	11.33741318	43.29867237	8.436802769	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	PBP 14a	No Cost-Sharing; PBP 13b											0	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	0	0	0	0	0	0	0	0											NO	0.062787502	0.062787502	0.125339798	0	0.197498087	0.197498087	0.197498087	0.197498087	0.197498087	0.197498087	0.197498087	0	0.197498087	0.197498087	0.197974909	0.197498087	0.197498087	0.197498087	0.197498087	0.197498087	0.197498087	0	0	0	0	0	0	0	0	0												28.2	0.73424367	4.872393199	0	2.593491582	4.275174048	0.720960263	5.972697558	6.374420199	3.163438619	5.509581026	0	0.358386025	11.18196874	5.644110824	7.991692854	0.294000687	0.281190086	2.239117414	8.55140496	1.666252407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6245	0	18.07204782	28.2	0.73424367	4.872393199	0	2.593491582	4.275174048	0.720960263	5.972697558	6.374420199	3.163438619	5.509581026	0	0.358386025	11.18196874	5.644110824	7.991692854	0.294000687	0.281190086	2.239117414	8.55140496	1.666252407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6245	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	28.2	0.73424367	4.872393199	0	2.593491582	4.275174048	0.720960263	5.972697558	6.374420199	3.163438619	5.509581026	0	0.358386025	11.18196874	5.644110824	7.991692854	0.294000687	0.281190086	2.239117414	8.55140496	1.666252407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6245
H5609_001_0	2011	7																															D	A	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	V	P	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	1315.299159	18.83361799	1043.566969	1440.520883	301.5366211	6.856031745	11.53491622	998.1544831	434.6486665	5433.305512	370.5396887	9.427590795	0.181199362	545.5214876	6364.686006	17729.68259	158.6739666	369.1642285	155.6638913	0	30.30172911	8.697569355	0	0	653.0538347	0.642137497	25.25740822	0	1050.711349	0											3350	$200 days 1-6	$948.48 per admit	$75 days 15-100	$0 	$175 waived if admitted	11a: 20.0%	11b: 20.0%	"4a1: $50 (waived if admitted),4b: $10"	"9a1: $100,9b: $100"	$0 	"8b3: 20.0%,8b4: 20.0%"	5: $100	$0 	9c: $30	7a: $5	"7b1: $10,7d1: $10,7f1: $10,7g: $10,17a1: $10,18a1: $10"	"7e: $30,7h: $30"	"7c: $10,7i: $10"	7d2: $10	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	$0 	17a2: $20	$0 	18a2: $10	$0 	$0 	$0 												141.2	153.8075676	17.33	0	140	0.2	0.162579856	37.62496395	100	0	32.16215828	9.090909091	0	0.028054863	3.886840356	9.796736409	30	10	10	0	0.2	0	0	0	20	0	10	0	0	0											NO	125.6796144	136.9013866	15.42512548	0	124.6115157	0.178016451	0.144709445	33.48931275	89.00822549	0	28.62696637	8.091656862	0	0.024971136	3.459607628	8.719901233	26.70246765	8.900822549	8.900822549	0	0.178016451	0	0	0	17.8016451	0	8.900822549	0	0	0												13.7755	0.214862368	1.341429286	0	3.131244616	1.220486439	1.669211327	2.785625639	3.22394221	0	0.883952267	0.006357069	0	0.001135191	1.834943021	12.88342343	0.353082205	0.273822107	0.115461389	0	5.394206274	0	0	0	0.96878605	0	0.018734309	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0962		6.186467094	13.7755	0.214862368	1.341429286	0	3.131244616	1.220486439	1.669211327	2.785625639	3.22394221	0	0.883952267	0.006357069	0	0.001135191	1.834943021	12.88342343	0.353082205	0.273822107	0.115461389	0	5.394206274	0	0	0	0.96878605	0	0.018734309	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0962	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	13.7755	0.214862368	1.341429286	0	3.131244616	1.220486439	1.669211327	2.785625639	3.22394221	0	0.883952267	0.006357069	0	0.001135191	1.834943021	12.88342343	0.353082205	0.273822107	0.115461389	0	5.394206274	0	0	0	0.96878605	0	0.018734309	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0962
H5609_801_0	2011	4																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	V	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	YES	1057.246453	16.05487145	701.1087761	690.3126763	216.145791	522.6244138	693.3365255	716.0164281	363.5708945	4494.495615	287.1769806	5.25795231	0.079663116	358.7500504	5078.65003	14429.71779	128.0043848	330.261271	141.580758	0	1145.937928	6.106920187	0	0	0	0	0	0	0	0											6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	"Medicare FFS.  Preventive services in 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, and 14j will have no member cost-sharing."	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												157.3117799	79.69603352	68.08425911	0	125.6143365	27.79583784	33.85854417	52.64488897	249.2611366	18.46513894	80.50995273	47.7737317	232.334183	177.3777702	17.30977426	39.17294862	19.8954711	46.90494033	84.77285508	0	55.09770286	146.7216736	0	0	0	0	0	0	0	0											NO	142.5847227	72.23512978	61.71041488	0	113.8546989	25.19367483	30.68880877	47.71643228	225.9260562	16.73648798	72.97285231	43.30129816	210.5837533	160.7721951	15.68928509	35.50569461	18.03291674	42.51384042	76.83667452	0	49.93962109	132.9860304	0	0	0	0	0	0	0	0												12.5623	0.09664381	3.605476121	0	2.050767828	1.097235795	1.773139337	2.847145783	6.845011529	6.268505987	1.746343616	0.018973013	0.00139798	4.806419424	6.640032348	42.69476277	0.192357701	1.170056248	0.906549552	0	4.768975494	0.067677923	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1597		10.34513496	12.5623	0.09664381	3.605476121	0	2.050767828	1.097235795	1.773139337	2.847145783	6.845011529	6.268505987	1.746343616	0.018973013	0.00139798	4.806419424	6.640032348	42.69476277	0.192357701	1.170056248	0.906549552	0	4.768975494	0.067677923	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1597	NO	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	12.5623	0.09664381	3.605476121	0	2.050767828	1.097235795	1.773139337	2.847145783	6.845011529	6.268505987	1.746343616	0.018973013	0.00139798	4.806419424	6.640032348	42.69476277	0.192357701	1.170056248	0.906549552	0	4.768975494	0.067677923	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1597
H5619_001_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	884.9082445	61.24760259	409.9952222		204.504022	3.513640732	6.742824528	315.4050358	237.788584		14.30962748	2.65833818		19.58423343	4106.398393	3710.973905	219.0280255	1339.65941	13.65095112		9.023660496				159.1037094																4950	"1a (IP Acute) 250 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 400 copay, 9b (OP ASC) 250 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 29 copay, 7i (PT/ST) 29 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 5 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 29 copay, 7f (Podiatry) 29 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 29 copay, 18a (Hearing Exam) 29 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 29 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 29 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 70 allowance, 0% Coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												181.2051416	172.0337627	49.94161658		150	0.2	0.2	49.8	398.6068249		0.2	0.2		0.198277603	5	27.78264631	40	29	0.181		0.2				25																NO	169.4769319	160.8991557	46.70922622		140.2914926	0.187055323	0.187055323	46.57677555	372.8076429		0.187055323	0.187055323		0.185444406	4.676383087	26.05613772	37.4110647	27.1230219	0.169285068		0.187055323				25																	12.4976	0.821223962	1.595879965	0	2.390847874	0.657245204	1.261281223	1.224212463	7.387450127	0	2.676691998	0.497256308	0	3.631786528	1.600257666	8.057803929	0.682839303	3.027967627	2.310902185	0	1.687923733	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3407	0	3.575460793	12.4976	0.821223962	1.595879965	0	2.390847874	0.657245204	1.261281223	1.224212463	7.387450127	0	2.676691998	0.497256308	0	3.631786528	1.600257666	8.057803929	0.682839303	3.027967627	2.310902185	0	1.687923733	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3407	NO																																																																																		0	0	0	12.4976	0.821223962	1.595879965	0	2.390847874	0.657245204	1.261281223	1.224212463	7.387450127	0	2.676691998	0.497256308	0	3.631786528	1.600257666	8.057803929	0.682839303	3.027967627	2.310902185	0	1.687923733	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3407
H5619_003_0	2011	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin	T	Coin	P	P	P	P	O	V																																																			0	YES	188.055427	8.810263371	33.62664613		15.3248518	15.75300901	12.84211726	26.18097187	44.17334844		16.33808884	3.389955662		33.5708207		4199.880961	3.10245064	1599.36357	13.07127491	6.611618618	6.386608982			13.93798932	159.1037094																3400	"1a (IP Acute) FFS, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 20% coin	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 20% coin, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 20% coin"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 0-20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 20% coin, 5 (Partial Hosp) 20% coin, 7c (OT) 8 copay, 7i (PT/ST) 8 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 20% coin, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 8 copay, 7b1 (Routine Chiro) 0% coin (5 visits), 7d (SPC w/Copay) 8 copay, 7f (Podiatry) 8 copay, 7f1 (Routine Podiatry) 0% coin (3 visits), 17a (Eye Exam) 8 copay, 18a (Hearing Exam) 8 copay"	"7e (MH Non-Phys) 45% coin, 7h (Psych) 45% coin"	7i (PT/ST) 8 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0-20% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 8 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 8 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 51.5"												0.079617072	0.079617072	0.139113108		0.2	0.2	0.2	0.2	0.2		0.2	0.2		0.2		8	0.45	8	0.181	0.07872	0.2			0.135384615	5																NO	0.069719883	0.069719883	0.121819974		0.175138023	0.175138023	0.175138023	0.175138023	0.175138023		0.175138023	0.175138023		0.175138023		7.005520922	0.394060552	7.005520922	0.158499911	0.068934326	0.175138023			0.135384615	5																	13.1112	0.614250528	4.096397148	0	2.683964249	2.758950855	2.249143029	4.585283655	7.736432918	0	2.861420579	0.593710133	0	5.879527169	0	2.451862829	1.222553411	0.933697912	2.071795909	0.455767472	1.118538071	0	0	1.886989318	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3778	0	7.867866564	13.1112	0.614250528	4.096397148	0	2.683964249	2.758950855	2.249143029	4.585283655	7.736432918	0	2.861420579	0.593710133	0	5.879527169	0	2.451862829	1.222553411	0.933697912	2.071795909	0.455767472	1.118538071	0	0	1.886989318	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3778	NO																																																																																		0	0	0	13.1112	0.614250528	4.096397148	0	2.683964249	2.758950855	2.249143029	4.585283655	7.736432918	0	2.861420579	0.593710133	0	5.879527169	0	2.451862829	1.222553411	0.933697912	2.071795909	0.455767472	1.118538071	0	0	1.886989318	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3778
H5619_004_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	983.3802983	76.19143331	466.0638574		139.2288983	4.148284429	6.568634766	375.6194162	266.8562236		17.64580685	4.34389403	0.308313228	42.55716636	2726.067239	3382.415927	341.9204765	698.4205167	11.93089011		6.404622817	2.111267836			159.1037094																4950	"1a (IP Acute) 250 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 400 copay , 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 39 copay, 7i (PT/ST) 39 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 5 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 39 copay, 7f (Podiatry) 39 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 39 copay, 18a (Hearing Exam) 39 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 39 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 39 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0% Coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 20"												181.2051416	172.0337627	49.94161658		150	0.2	0.2	47.95577648	353.0545663		0.2	0.2	0.2	0.198707858	5	36.87842543	40	39	0.181		0.2				25																NO	167.3739115	158.902576	46.12961664		138.5506311	0.184734175	0.184734175	44.29535399	326.1062199		0.184734175	0.184734175	0.184734175	0.183540661	4.618354371	34.08223621	36.94683497	36.02316409	0.167184428		0.184734175				25																	13.716	1.008917918	1.791612256	0	1.607520977	0.766329901	1.213451323	1.38651625	7.251956194	0	3.259783568	0.802465679	0.05695599	7.810970438	1.049162046	9.606691549	1.052739951	2.09660974	1.994659042	0	1.183152711	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.987	0	4.75875294	13.716	1.008917918	1.791612256	0	1.607520977	0.766329901	1.213451323	1.38651625	7.251956194	0	3.259783568	0.802465679	0.05695599	7.810970438	1.049162046	9.606691549	1.052739951	2.09660974	1.994659042	0	1.183152711	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.987	NO																																																																																		0	0	0	13.716	1.008917918	1.791612256	0	1.607520977	0.766329901	1.213451323	1.38651625	7.251956194	0	3.259783568	0.802465679	0.05695599	7.810970438	1.049162046	9.606691549	1.052739951	2.09660974	1.994659042	0	1.183152711	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.987
H5619_007_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	796.5521281	53.23404915	543.9638012		96.81473133	3.588502252	4.630007141	359.4567987	239.7683975		18.67288774	4.056846154	0.284808476	31.67545494	3444.936339	3177.084364	287.3888977	855.4522583	12.7402648		9.477309888				159.1037094																4950	"1a (IP Acute) 250 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 350 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 35 copay, 7i (PT/ST) 35 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 5 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 35 copay, 7f (Podiatry) 35 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 35 copay, 18a (Hearing Exam) 35 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 35 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 35 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0% Coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												181.2051416	172.0337627	49.94161658		150	0.2	0.2	47.98422442	309.0641906		0.2	0.2	0.2	0.198994775	5	33.71992085	40	35	0.181		0.2				25																NO	169.8142038	161.2193572	46.80218112		140.5706833	0.187427578	0.187427578	44.96783477	289.6357631		0.187427578	0.187427578	0.187427578	0.186485543	4.685689443	31.61284407	37.48551555	32.7998261	0.169621958		0.187427578				25																	11.2722	0.715196599	2.121557695	0	1.134109411	0.672584285	0.867791023	1.346999494	5.787125231	0	3.499814118	0.760364848	0.053380963	5.907014427	1.345158486	8.369722716	0.897743416	2.338223776	2.161028659	0	1.776309236	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3577	0	3.419215252	11.2722	0.715196599	2.121557695	0	1.134109411	0.672584285	0.867791023	1.346999494	5.787125231	0	3.499814118	0.760364848	0.053380963	5.907014427	1.345158486	8.369722716	0.897743416	2.338223776	2.161028659	0	1.776309236	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3577	NO																																																																																		0	0	0	11.2722	0.715196599	2.121557695	0	1.134109411	0.672584285	0.867791023	1.346999494	5.787125231	0	3.499814118	0.760364848	0.053380963	5.907014427	1.345158486	8.369722716	0.897743416	2.338223776	2.161028659	0	1.776309236	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.3577
H5619_009_0	2011	6																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin	T	Coin	P	P	P	P	O	V																																																			0	YES	162.0789787	3.343821766	11.96237288		3.328508768	4.312838384	6.077065329	9.215086961	30.04014452		8.714446206	1.966568401	0.304895304	13.3800073		3810.025538	2.117241248	568.3361678	20.99351424	9.198183392	12.21490269	0.642202253		13.93798932	159.1037094		260.9166693														3400	"1a (IP Acute) FFS, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 20% coin	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 20% coin, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 20% coin"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 0-20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 20% coin, 5 (Partial Hosp) 20% coin, 7c (OT) 8 copay, 7i (PT/ST) 8 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 20% coin, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 8 copay, 7b1 (Routine Chiro) 0% coin (5 visits), 7d (SPC w/Copay) 8 copay, 7f (Podiatry) 8 copay, 7f1 (Routine Podiatry) 0% coin (3 visits), 17a (Eye Exam) 8 copay, 18a (Hearing Exam) 8 copay"	"7e (MH Non-Phys) 45% coin, 7h (Psych) 45% coin"	7i (PT/ST) 8 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0-20% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 8 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 8 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 51.5"												0.079016647	0.079016647	0.138234417		0.2	0.2	0.2	0.2	0.2		0.2	0.2	0.2	0.2		8	0.45	8	0.181	0.07872	0.2	0.2		0.135384615	5		8														NO	0.073326289	0.073326289	0.12827951		0.185597065	0.185597065	0.185597065	0.185597065	0.185597065		0.185597065	0.185597065	0.185597065	0.185597065		7.423882603	0.417593396	7.423882603	0.167965344	0.073051005	0.185597065	0.185597065		0.135384615	5		7.423882603															11.8847	0.245190042	1.534527336	0	0.617761458	0.800450146	1.127885489	1.710293094	5.575362658	0	1.61737564	0.364989323	0.056587674	2.483290085	0	2.357098525	0.884145964	0.351605082	3.526182839	0.671936539	2.26705009	0.119190853	0	1.886989318	0.066293212	0	0.161417894	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3103	0	2.976627041	11.8847	0.245190042	1.534527336	0	0.617761458	0.800450146	1.127885489	1.710293094	5.575362658	0	1.61737564	0.364989323	0.056587674	2.483290085	0	2.357098525	0.884145964	0.351605082	3.526182839	0.671936539	2.26705009	0.119190853	0	1.886989318	0.066293212	0	0.161417894	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3103	NO																																																																																		0	0	0	11.8847	0.245190042	1.534527336	0	0.617761458	0.800450146	1.127885489	1.710293094	5.575362658	0	1.61737564	0.364989323	0.056587674	2.483290085	0	2.357098525	0.884145964	0.351605082	3.526182839	0.671936539	2.26705009	0.119190853	0	1.886989318	0.066293212	0	0.161417894	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3103
H5619_801_0	2011	3																															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	Coin	V																																																			0	YES	227.4986081	4.816220376	21.64941773		4.741326104	5.229990481	7.824387067	13.03318274	40.20030768	5.648840767	15.12595614	3.349618633	0.355966845	19.73472283	54.44655332	110.0499444	2.815356025	11.27613634	28.04070881	15.28431242	15.72331121	0.717295013																			6700	"1a (IP Acute) FFS, 1a1 (Add'l Days) n/a"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) n/a"	6a (Home Health) FFS	10a (Ambulance) FFS	11a (DME) FFS	"11b (Prosthetics) FFS, 11b (Medical Supplies) FFS, 11c (Diabetic Supplies) FFS"	"4a (ER) FFS, 4a (ER) - Worldwide Coverage n/a, 4b (UC) FFS"	"9a (OP Surgery) FFS, 9b (OP ASC) FFS"	8a (OP Diag Proc/Test/Lab) FFS	"8b (X-Ray) FFS, 8b (OP Therap Rad) FFS, 8b (OP Diag) FFS"	9a (OP Observation) FFS	12 (Renal Dialysis) FFS	"3 (CORF) FFS, 5 (Partial Hosp) FFS, 7c (OT) FFS, 7i (PT/ST) FFS, 9a (OP Other) FFS, 9a (OP Chemo) FFS, 9c (OP SA) FFS, 9d (OP Cardiac Rehab) FFS"	"7a (PCP w/Copay) FFS, 14b (Immunizations) FFS, 14c (Routine Physical) FFS, 14d (Pap & Pelvic Exam) FFS, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) FFS, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) FFS, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) FFS, 14h (Mammography) FFS, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) FFS, 14j (Nutrition Therapy Diabetes) FFS"	"7b (Chiro) FFS, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) FFS, 7f (Podiatry) FFS, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) FFS, 18a (Hearing Exam) FFS"	"7e (MH Non-Phys) FFS, 7h (Psych) FFS"	7i (PT/ST) FFS	7g Physician Specialist Services Excluding Psychiatric (Radiology only) FFS	"8a (OP Diag Proc/Test/Lab) FFS, 7g (Prof. Other) FFS"	15 (Part B Rx) FFS	"13a (Blood) FFS, 13a1 (3 Pint Blood) n/a, 14a4-1 (Smoking Cessation - Mdcr Covered) FFS, 16b (Comp. Dental) FFS, 17b (MCR Eyewear) FFS"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive n/a"	17a1 (Routine Eye Exam) n/a	17b1 (Non MCR Covered) n/a	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) n/a, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												0.076653506	0.076653506	0.164633008		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069034452	0.069034452	0.148269141		0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725																				15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	0	10.31335866	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	NO																																																																																		0	0	0	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469
H5628_001_0	2011	7																															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	325.4343198	17.60718157	53.4108432	0	13.35560151	20.65880046	1.221905249	66.55379423	19.69120365	6.451733339	8.980751979	0	6.011610624	17.33357779	36.36877091	68.34878832	4.957161921	0.884972774	14.58005071	51.65585843	5.539590636	0	0	0	0	0	0	0	0	0											6700	8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical; PBP 1a	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse; PBP 1b	17% Coinsurance for SNF; PBP 2	No Cost-Sharing; PBP 6	23% Coinsurance for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for DME / Medical Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"23% Coinsurance for ER - Facility; 23% Coinsurance for PCP Urgent Care; PBP 4a, 4b"	"23% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	23% Coinsurance for OP Fac - Pathology; PBP 8a	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	23% Coinsurance; PBP 9a	23% Coinsurance for Renal Dialysis - Fac; PBP 12	"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 OP Substance Abuse; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"23% Coinsurance for Prof - Asst Surgeon (OP); 23% Coinsurance for PCP Office Visits; 23% Coinsurance for PCP Consults; 23% Coinsurance for PCP Immunizations; PBP 7a, 14b, 14c"	"23% Coinsurance for Prof - Asst Surgeon (OP); 23% Coinsurance for Speclst Office Visits; 23% Coinsurance for Speclst Consults; 23% Coinsurance for Cardio; 23% Coinsurance for Chiropractor; 23% Coinsurance for Speclst Immunizations; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; PBP 7e, 7h"	"23% Coinsurance for Occ Therapy; 23% Coinsurance for PT/ST; PBP 7c, 7i"	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office); 23% Coinsurance for Prof Radiology (Office); PBP 8b	"23% Coinsurance for Prof - Primary Surgeon (IP); 23% Coinsurance for Prof - Asst Surgeon (IP); 23% Coinsurance for Prof - Anesthesia (IP); 23% Coinsurance for Prof - Primary Surgeon (OP); 23% Coinsurance for Prof - Anesthesia (OP); 23% Coinsurance for Prof - IP Visits; 23% Coinsurance for Allergy Testing; 23% Coinsurance for Allergy Tx; 23% Coinsurance for Renal Dialysis - Prof; 23% Coinsurance for Prof - ER Visits; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14d-j"	23% Coinsurance for Part B Rx; 23% Coinsurance for Tx Injections; PBP 15	23% Coinsurance																			0	0.082640318	0.082640318	0.165333631	0	0.233	0.233	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	0.081409552	0.081409552	0.162871309	0	0.22952992	0.22952992	0.22952992	0.22952992	0.22952992	0.22952992	0.22952992	0	0.22952992	0.22952992	0.229597031	0.229549218	0.22952992	0.22952992	0.22952992	0.22952992	0.22952992	0	0	0	0	0	0	0	0	0												26.4935	1.433392763	8.699093974	0	3.065510144	4.741812813	0.280463814	15.27608705	4.519720395	1.480865836	2.061351282	0	1.379844505	3.978574721	8.350161817	15.68941088	1.137816978	0.20312773	3.346557871	11.85656504	1.271501794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.2653	0	1.7387881	26.4935	1.433392763	8.699093974	0	3.065510144	4.741812813	0.280463814	15.27608705	4.519720395	1.480865836	2.061351282	0	1.379844505	3.978574721	8.350161817	15.68941088	1.137816978	0.20312773	3.346557871	11.85656504	1.271501794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.2653	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	26.4935	1.433392763	8.699093974	0	3.065510144	4.741812813	0.280463814	15.27608705	4.519720395	1.480865836	2.061351282	0	1.379844505	3.978574721	8.350161817	15.68941088	1.137816978	0.20312773	3.346557871	11.85656504	1.271501794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.2653
H5628_002_0	2011	9																															D	D	D		T	Coin	Coin	V	Coin		Coin		Coin	Coin	V	V	V	V	Coin	V	Coin			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	YES	748.3959527	7.102544849	927.4070858	0	170.6695784	13.23911121	5.257568351	317.4631595	28.30347431	0	15.63231023	0	0.268241177	18.00068306	4134.201881	3894.542078	145.8830723	384.6737141	10.43264331	52.59356229	8.733054886	0	0	2554.753004	318.6760054	0	0	0	0	0											3400	$175 /Days 1-15 for IP Medical;$175 /Days 1-15 for IP Surgical; PBP 1a	$325 /Days 1-6 for IP Psych; $325 /Days 1-6 for IP Substance Abuse; PBP 1b	$100 /Days 8-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$175/Run for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for ER - Facility; $35/Visit for PCP Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Hospital Services; 20% Coinsurance for Ambulatory Surgery Center Services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b		20% Coinsurance for Renal Dialysis - Fac; PBP 12	"20% Coinsurance for OP Fac - Cardiovascular; $35/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy; $35/Case for OP Fac - CORF; 20% Coinsurance for OP Fac - Other; $35/Visit for Prof - CORF; $35/Visit for OP Substance Abuse; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"$15/Visit for Prof - Asst Surgeon (OP); $15/Visit for PCP Office Visits; $15/Consult for PCP Consults; PBP 7a, 14b, 14c"	"$35/Visit for Prof - Asst Surgeon (OP); $35/Visit for Speclst Office Visits; $35/Consult for Speclst Consults; $25/Visit for Chiropractor; $25/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; PBP 7e, 7h"	"$35/Visit for Occ Therapy; $35/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 8b	"$15/Visit for Allergy Testing; $15/Visit for Allergy Tx; PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; PBP 15			"$15/Procedure for Dental: Preventive Services; 20% Coinsurance for Dental: Comprehensive Services; PBP 16a, 16b"	$25/Exam for Vision Exams (Refractions); PBP 17a																0	175	325	100	0	175	0.2	0.2	47.23873573	0.2	0	0.2	0	0.2	0.130026878	15	33.47799733	35	35	0.2	15.10860844	0.2	0	0	17.76409589	25	0	0	0	0	0											NO	168.5007539	312.9299716	96.28614511	0	168.5007539	0.19257229	0.19257229	45.48435764	0.19257229	0	0.19257229	0	0.19257229	0.125197868	14.46538637	32.23467309	33.70015079	33.70015079	0.19257229	14.54749664	0.19257229	0	0	17.61258347	24.78712273	0	0	0	0	0												10.5088	0.185216596	7.441371103	0	2.396496053	2.549485967	1.012461978	1.203300657	5.450464869	0	3.010349782	0	0.051655818	2.253647148	4.983568962	10.46160756	0.409690128	1.080296847	2.009038015	0.063758723	1.68174438	0	0	3.749650043	0.658255105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1608	0	2.218890052	10.5088	0.185216596	7.441371103	0	2.396496053	2.549485967	1.012461978	1.203300657	5.450464869	0	3.010349782	0	0.051655818	2.253647148	4.983568962	10.46160756	0.409690128	1.080296847	2.009038015	0.063758723	1.68174438	0	0	3.749650043	0.658255105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1608	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.5088	0.185216596	7.441371103	0	2.396496053	2.549485967	1.012461978	1.203300657	5.450464869	0	3.010349782	0	0.051655818	2.253647148	4.983568962	10.46160756	0.409690128	1.080296847	2.009038015	0.063758723	1.68174438	0	0	3.749650043	0.658255105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1608
H5628_006_0	2011	7																															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	196.0505603	31.21031786	60.72623084	0	11.34167842	38.61337294	6.42756115	35.09003564	30.48351384	13.39172468	20.18358825	0	0.150910878	44.90135977	33.54787097	62.14620468	12.96422973	3.158353437	18.44144795	62.97628779	15.45849385	0	0	0	0	0	0	0	0	0											6700	8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical; PBP 1a	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse; PBP 1b	17% Coinsurance for SNF; PBP 2	No Cost-Sharing; PBP 6	23% Coinsurance for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for DME / Medical Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"23% Coinsurance for ER - Facility; 23% Coinsurance for PCP Urgent Care; PBP 4a, 4b"	"23% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	23% Coinsurance for OP Fac - Pathology; PBP 8a	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	23% Coinsurance; PBP 9a	23% Coinsurance for Renal Dialysis - Fac; PBP 12	"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 OP Substance Abuse; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"23% Coinsurance for Prof - Asst Surgeon (OP); 23% Coinsurance for PCP Office Visits; 23% Coinsurance for PCP Consults; 23% Coinsurance for PCP Immunizations; PBP 7a, 14b, 14c"	"23% Coinsurance for Prof - Asst Surgeon (OP); 23% Coinsurance for Speclst Office Visits; 23% Coinsurance for Speclst Consults; 23% Coinsurance for Cardio; 23% Coinsurance for Chiropractor; 23% Coinsurance for Speclst Immunizations; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; PBP 7e, 7h"	"23% Coinsurance for Occ Therapy; 23% Coinsurance for PT/ST; PBP 7c, 7i"	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office); 23% Coinsurance for Prof Radiology (Office); PBP 8b	"23% Coinsurance for Prof - Primary Surgeon (IP); 23% Coinsurance for Prof - Asst Surgeon (IP); 23% Coinsurance for Prof - Anesthesia (IP); 23% Coinsurance for Prof - Primary Surgeon (OP); 23% Coinsurance for Prof - Anesthesia (OP); 23% Coinsurance for Prof - IP Visits; 23% Coinsurance for Allergy Testing; 23% Coinsurance for Allergy Tx; 23% Coinsurance for Renal Dialysis - Prof; 23% Coinsurance for Prof - ER Visits; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14d-j"	23% Coinsurance for Part B Rx; 23% Coinsurance for Tx Injections; PBP 15	23% Coinsurance																			0	0.08227264	0.08227264	0.169029181	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.220927215	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.080945925	0.080945925	0.166303444	0	0.22924268	0.22924268	0.22924268	0.22924268	0.22924268	0.22924268	0.22924268	0	0.22924268	0.217364579	0.22935383	0.229312242	0.22924268	0.22924268	0.22924268	0.22924268	0.22924268	0	0	0	0	0	0	0	0	0												15.8695	2.526348035	10.09898132	0	2.599996755	8.851833089	1.473471343	8.044133805	6.988122402	3.069954853	4.626939858	0	0.034595214	9.759965156	7.694332693	14.25088554	2.971954765	0.724029406	4.227566947	14.43685298	3.543746555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.7932	0	1.988024131	15.8695	2.526348035	10.09898132	0	2.599996755	8.851833089	1.473471343	8.044133805	6.988122402	3.069954853	4.626939858	0	0.034595214	9.759965156	7.694332693	14.25088554	2.971954765	0.724029406	4.227566947	14.43685298	3.543746555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.7932	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.8695	2.526348035	10.09898132	0	2.599996755	8.851833089	1.473471343	8.044133805	6.988122402	3.069954853	4.626939858	0	0.034595214	9.759965156	7.694332693	14.25088554	2.971954765	0.724029406	4.227566947	14.43685298	3.543746555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.7932
H5640_001_0	2011	5																																																																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	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											6700	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"No Cost Sharing; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-c"	"No Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b											0	0	0	0	0	0	0	0	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
H5649_001_0	2011	7																															A	A	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	V	V	V	P	P	O	V																																																			0	YES			607.807379		195.4199311	1.295583919	0.958964538	176.5500258			0.911104005			0.725884916			129.9774626				3.346183043									178.2310037											2000	(1a) $0.00	(1b) $0.00	"(2) $0.00 days 1 - 20, $75 days 21 - 47"	(6) $0.00	(10a) $50/trip	(11a) 0-20%	"(11b) 0-20%, (11c) $0.00"	"(4a) $50/visit (waived if admitted), (4b) $0/visit"	(9a) $0.00	(8a) $0.00	(8b) 0-20% (14h) $0.00	"(9a) $0.00, (9b) $0.00"	(12a) 20%	"(3) $0.00, (5) $10/visit, (7g) $0.00, (9b) $0.00, (9c) $5/visit, (9d) $0.00"	"(7a) $0.00, (7g) $0.00, (14b) $0.00, (14c) $0.00, (14g) $0.00, (14i) $0.00, (14j) $0.00"	"(7b) $0.00 (7d) $0.00, (7f) $0.00, (14d) $0.00, (14e) $0.00, (14f) $0.00"	"(7e) $5/visit, (7h) $5/visit"	(7c) $0.00 (7i) $0.00	(7g) $0.00	(7g) $0.00	(15) 20%	(13a) $0.00	(10b) not covered	"(16a) $0.00, (16b) $0.00"	"(17a) $0.00, 1 per year"	"(17b) $0.00, Limited to $300 every 2 years (1 pair)"	"(18a) $0.00, 1 routine every year, 1 fitting every 2 years"	(18b)Limited to $500 every 2 yrs (1)	(14a) $0.00	"(13b) $10/visit, 6 treatments per year; (13c) Limited to $12 per month"														11.41451381		50	0.085	0.091291786	10			0.2			10			4.986038254				0.2									10											NO			11.37362783		49.82090352	0.084695536	0.090964786	9.964180704			0.199283614			9.964180704			4.968178616				0.199283614									9.964180704												0	0	0.576081243	0	0.811333128	0.109730174	0.087232004	0.14659803	0	0	0.181568099	0	0	0.000602737	0	0	0.053812604	0	0	0	0.66683945	0	0	0	0	0	0	0	0	0.147993827	0	0	0	0	0	0	0	0	0	0	2.7818	0	0.01	0	0	0.576081243	0	0.811333128	0.109730174	0.087232004	0.14659803	0	0	0.181568099	0	0	0.000602737	0	0	0.053812604	0	0	0	0.66683945	0	0	0	0	0	0	0	0	0.147993827	0	0	0	0	0	0	0	0	0	0	2.7818	NO																																																																																		0	0	0	0	0	0.576081243	0	0.811333128	0.109730174	0.087232004	0.14659803	0	0	0.181568099	0	0	0.000602737	0	0	0.053812604	0	0	0	0.66683945	0	0	0	0	0	0	0	0	0.147993827	0	0	0	0	0	0	0	0	0	0	2.7818
H5649_002_0	2011	11																															Coin	Coin	Coin	Coin	Coin	Coin	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																																									0	(1a) $0.00	(1b) $0.00	(2) $0.00	(6) $0.00	(10a) $0.00	(11a) $0.00	"(11b) $0.00, (11c) $0.00"	"(4a) $0.00, (4b) $0.00"	(9a) $0.00	(8a) $0.00	"(8b) $0.00, (14h) $0.00"	(9a) $0.00	(12a) $0.00	"(3) $0.00, (5) $0.00, (7g) $0.00, (9b) $0.00, (9c) $0.00, (9d) $0.00"	"(7a) $0.00, (7g) $0.00, (14b) $0.00, (14c) $0.00, (14g) $0.00, (14i) $0.00, (14j) $0.00"	"(7b) $0.00, (7d) $0.00, (7f) $0.00, (14d) $0.00, (14e) $0.00, (14f) $0.00"	"(7e) $0.00, (7h) $0.00"	(7c) $0.00 (7i) $0.00	(7g) $0.00	(7g) $0.00	(15) $0.00	(13a) $0.00	"(10b) $0/Trip, 40 single trips on bus/subway/taxi/van"	"(16a) $0.00, (16b) $0.00"	"(17a) $0.00, 1 per year"	"(17b) $0.00, Limited to $200 every 2 years (1 pair)"	"(18a) $0.00, 1 routine every year, 1 fitting every 2 years"	(18b) Limited to $500 every 2 years	(14a) $0.00	"(13b) 24 treatments per year, (13c) $0.00, Limited to $18/month"																																																				NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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
H5652_001_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	Coin	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	1498.590049	226.8229695	2424.582459	2030.774187	453.5045051	9.303060079	4.445976566	381.4468067	376.4784237	16408.85814	5597.636519	0	6.385146229	680.722408	9008.372495	155.0914493	1529.875144	2525.511752	0	0	829.3245473	2673.990631	795.2396865	489.7857815	244.4113829	202.7718975	16.51658496	24.21559839	1292.471462	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$75 Days 21-54 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$50 (9b)	$0/$30 (8a1a); $0 (8a2)	$0 (8b1); $50 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $50 (9a)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d); $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, 18a); $0/$30 (17a)"	$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a9, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6, 14a8, 14a10)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0	0	21.83868052	0	0	0.2	0.2	47.78007856	50	0	8.204090307	0	0	19.92391339	0.016545552	0.066835847	27.77551964	0	0	0	0	29.86006622	0	30	30	0	30	0	0	0											NO	0	0	19.49937019	0	0	0.17857645	0.17857645	42.66971166	44.64411246	0	7.325286606	0	0	17.7897086	0.016238334	0.065594838	27.2597835	0	0	0	0	26.66152309	0	30	30	0	30	0	0	0												0	0	3.939819243	0	0	1.661307442	0.793946711	1.356352104	1.400628757	0	3.417024318	0	0	1.00915444	0.01219008	10.17319853	3.475338767	0	0	0	0	5.941055246	0	1.224464454	0.611028457	0	0.041291462	0	0	0	0	0	0	0	0	0	0	0	0	0	35.0568	0	2.599876231	0	0	3.939819243	0	0	1.661307442	0.793946711	1.356352104	1.400628757	0	3.417024318	0	0	1.00915444	0.01219008	10.17319853	3.475338767	0	0	0	0	5.941055246	0	1.224464454	0.611028457	0	0.041291462	0	0	0	0	0	0	0	0	0	0	0	0	0	35.0568	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"50% (7b); $0 n/c (7b1); 30% (7d, 7f, 7f1)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.59	0.0438	0	0	0	0	0	0	0	0	0	0	0	0	0.9733	3.2442	0.2023	0.3973	0	0	0.3587	0.3763	0	0	0.0176	0	0.0019	0	0	0											7.2055	0	0	1.59	0.04376825	3.939819243	0	0	1.661307442	0.793946711	1.356352104	1.400628757	0	3.417024318	0	0	1.00915444	0.985475558	13.41741357	3.67766412	0.397337009	0	0	0.358725133	6.317362507	0	1.224464454	0.628661996	0	0.043170186	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2623
H5652_002_0	2011	3																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	Coin	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	1975.161958	365.7028169	2653.769436	3426.176535	522.1053207	9.978778483	6.876449911	472.5820046	357.789103	16106.40558	5925.999262	0	11.06421736	736.8378509	7571.404365	161.9435078	1845.756976	1309.605352	0	0	848.223197	2628.552827	1252.78671	393.124121	160.3525548	184.8829978	16.42427902	13.13786932	1829.120875	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$75 Days 21-54 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$50 (9b)	$0/$30 (8a1a); $0 (8a2)	$0 (8b1); $50 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $50 (9a)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d); $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, 18a); $0/$30 (17a)"	$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a9, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6, 14a8, 14a10)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0	0	22.68460694	0	0	0.2	0.2	46.7743111	50	0	8.064472034	0	0	20.09238259	0	0.033938532	26.54182207	0	0	0	0	29.76033225	0	30	30	0	30	0	0	0											NO	0	0	20.5362665	0	0	0.181059046	0.181059046	42.34995041	45.2647616	0	7.30072808	0	0	18.18953816	0	0.033384254	26.10834576	0	0	0	0	26.94188688	0	30	30	0	30	0	0	0												0	0	4.541543031	0	0	1.806748116	1.245043463	1.667818705	1.349603204	0	3.605342434	0	0	1.116895017	0	5.406363216	4.015805108	0	0	0	0	5.901514411	0	0.982810302	0.400881387	0	0.041060698	0	0	0	0	0	0	0	0	0	0	0	0	0	32.0814	0	2.377586545	0	0	4.541543031	0	0	1.806748116	1.245043463	1.667818705	1.349603204	0	3.605342434	0	0	1.116895017	0	5.406363216	4.015805108	0	0	0	0	5.901514411	0	0.982810302	0.400881387	0	0.041060698	0	0	0	0	0	0	0	0	0	0	0	0	0	32.0814	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"50% (7b); $0 n/c (7b1); 30% (7d, 7f, 7f1)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.9761	0.0566	0	0	0	0	0	0	0	0	0	0	0	0	0.7962	3.3835	0.2049	0.2453	0	0	0.2646	0.3548	0	0	0.0153	0	0.0017	0	0	0											7.2992	0	0	1.9761	0.056633817	4.541543031	0	0	1.806748116	1.245043463	1.667818705	1.349603204	0	3.605342434	0	0	1.116895017	0.796192322	8.789905712	4.22071973	0.245335383	0	0	0.26461701	6.256327456	0	0.982810302	0.416177325	0	0.042723142	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3806
H5652_003_0	2011	6																															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	1094.171282	484.8680018	8309.609082	26.08995092	908.4538233	3284.995242	1129.90999	187.8058825	93.9227068	32354.90646	3612.634185	0	0	364.6884465	241.2579277	5492.656622	2476.635412	35.39841157	0	0	594.2868444	1144.874537	1167.356945	0	101.6088422	122.8041657	17.22057444	10.45	0	0											500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 Days 1-20 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$50 (10a)	$0 (11a)	"$0 (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $20 (4b)	$0 (9b)	"$0 (8a1a, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0	0	0	0	50	0	0	49.73329182	0	0	0	0	0	0	0.44612766	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	47.22046961	0	0	46.9685879	0	0	0	0	0	0	0.421327152	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	3.574801346	0	0	0.735081425	0	0	0	0	0	0	0.00847071	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.3184	0	0.254190499	0	0	0	0	3.574801346	0	0	0.735081425	0	0	0	0	0	0	0.00847071	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.3184	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $20 (4b)	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0066	1.8416	0.1796	0.0049	0	0	0.0418	0.0843	0	0	0.0062	0	0.0009	0	0	0											2.1659	0	0	0	0	0	0	3.574801346	0	0	0.735081425	0	0	0	0	0	0	0.015048229	1.841572282	0.179619347	0.004854696	0	0	0.041796089	0.084298629	0	0	0.006226084	0	0.000935865	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4842
H5652_004_0	2011	6																															D	D	D	V	T	O	Coin	V	V	O	O	V	O	O	V	Coin	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	2054.899586	74.29919685	3000.415104	1336.077568	662.4952639	3444.768666	18.5021159	504.0477676	620.7676871	28022.57092	8720.615163	0	4.879370375	1166.277831	15053.44802	254.857284	1135.742417	4373.656919	0	0	2208.260533	3134.764271	509.6251588	601.7863708	306.9695154	232.9741989	18.78764944	34.8310185	1476.091319	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$75 Days 21-54 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$0 (10a)	$0 (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $30 (4b)"	$50 (9b)	$0/$30 (8a1a); $0 (8a2)	$0 (8b1); $50 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $50 (9a)"	"$0 (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d); $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, 18a); $0/$30 (17a)"	$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a9, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6, 14a8, 14a10)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0	0	21.15222833	0	0	0	0.114392596	49.33134212	50	0	7.981046178	0	0	19.74811328	0.098086509	0.096318772	27.52778824	0	0	0	0	29.88587107	0	30	0	0	30	0	0	0											NO	0	0	17.26428305	0	0	0	0.093366341	40.27542528	40.80960828	0	6.514067365	0	0	16.11825535	0.094895156	0.093184934	26.63214115	0	0	0	0	24.39261383	0	30	0	0	30	0	0	0												0	0	4.316667968	0	0	0	1.72747486	1.691728184	2.111107179	0	4.733889553	0	0	1.566530323	0.119041608	23.74885927	2.520604364	0	0	0	0	6.372091191	0	1.504465927	0	0	0.046969124	0	0	0	0	0	0	0	0	0	0	0	0	0	50.4594	0	5.95828456	0	0	4.316667968	0	0	0	1.72747486	1.691728184	2.111107179	0	4.733889553	0	0	1.566530323	0.119041608	23.74885927	2.520604364	0	0	0	0	6.372091191	0	1.504465927	0	0	0.046969124	0	0	0	0	0	0	0	0	0	0	0	0	0	50.4594	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"50% (7b); $0 n/c (7b1); 30% (7d, 7f, 7f1)"	/30% (7e); 30% (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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												2.344	0.0265	0	0	0	0	0	0	0	0	0	0	0	0	1.6589	5.3287	0.1775	0.6906	0	0	0.9377	0.4489	0	0	0.0185	0	0.0023	0	0	0											11.6336	0	0	2.344	0.026458663	4.316667968	0	0	0	1.72747486	1.691728184	2.111107179	0	4.733889553	0	0	1.566530323	1.777982805	29.07756779	2.698104791	0.690603732	0	0	0.937746727	6.820993463	0	1.504465927	0.018462184	0	0.049244024	0	0	0	0	0	0	0	0	0	0	0	0	0	62.093
H5656_001_0	2011	8																															D	D	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	V																																																			0	YES	2212.18416	145.0198996	905.9975799		99.2652017	13.38089024	0.513889825	405.097006	197.2705463		57.48203555		3.126308779	31.97265956		3097.396273	478.2741918	120.7308304		261.4247662	24.34189322	817.362292		1448.49473	135.6972423																3000	(1a/1a1) $225/Day  Days 1-7	(1b) $225/Day Days 1-7	(2a/2a2) $125/Day Days 21-100	(6a) 0%	(10a) $100	(11a) 15%	(11b) 15% (11c) 20%	(4a) $50 (4a1) $50 (4b) $25 (4b1) n/c	(9b) $75	(8a) $0	(8b1) 20% (8b2) 20% (8b3) 20%	(9a) $0	(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) $0 (14j) $0	(7b) 50% (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) $0/$25 (17b) $0 (18a) $20	(10b) n/c	(16a) $15	(17a1) $25	(17b1) $0	(18a1) n/c	(18b) n/c	(14a) $0  (14a6) n/c													200.2010626	158.5528067	38.99172655		100	0.15	0.15	49.96431854	75		0.2		50	64.81998915		19.86711865	31.25	20		19.91668697	0.2	25		15	25																NO	152.2692959	120.5923881	29.65639978		76.05818569	0.114087279	0.114087279	38.00195417	57.04363926		0.152116371		38.02909284	49.30090771		15.11056999	23.76818303	15.21163714		15.18465691	0.152116371	19.01454642		11.40872785	19.01454642																	28.0706	1.457358002	2.239052202	0	0.629160929	1.526589352	0.058628292	1.282873155	0.93775249	0	8.743958667	0	0.009907557	0.131356762	0	3.900285264	0.947309044	0.153042799	0	0.330803782	3.702800468	1.29514777	0	1.377123514	0.215018459	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0088	0	17.94435557	28.0706	1.457358002	2.239052202	0	0.629160929	1.526589352	0.058628292	1.282873155	0.93775249	0	8.743958667	0	0.009907557	0.131356762	0	3.900285264	0.947309044	0.153042799	0	0.330803782	3.702800468	1.29514777	0	1.377123514	0.215018459	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0088	NO																																																																																		0	0	0	28.0706	1.457358002	2.239052202	0	0.629160929	1.526589352	0.058628292	1.282873155	0.93775249	0	8.743958667	0	0.009907557	0.131356762	0	3.900285264	0.947309044	0.153042799	0	0.330803782	3.702800468	1.29514777	0	1.377123514	0.215018459	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0088
H5656_003_0	2011	5																															D	D	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	V																																																			0	YES	1761.138749	143.7307699	753.5381029		80.21616653	12.7808246	0.253588628	305.8140584	154.5973305		54.35928285		6.521951109	16.94190124		2282.005499	429.2564297	107.9214873		184.9466835	30.24829756	609.7627634		1238.217032	121.9574227																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) 20%	(4a) $50 (4a1) $50 (4b) $25 (4b1) n/c	(9b) $75	(8a) $0	(8b1) 20% (8b2) 20% (8b3) 20%	(9a) $0	(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) $0 (14j) $0	(7b) 50% (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) $0/$25 (17b) $0 (18a) $20	(10b) n/c	(16a) $15	(17a1) $25	(17b1) $0	(18a1) n/c	(18b) n/c	(14a) $0  (14a6) n/c													66.73368752	52.85093557	38.99172655		100	0.15	0.15	49.97773277	75		0.2		50	61.0962556		19.91391872	31.25	20		19.98810352	0.2	25		15	25																NO	58.78045834	46.55223369	34.34474616		88.08213741	0.132123206	0.132123206	44.02145525	66.06160306		0.176164275		44.04106871	53.81488781		17.54060526	27.52566794	17.61642748		17.61642748	0.176164275	22.02053435		13.21232061	22.02053435																	8.6267	0.557582366	2.156672905	0	0.58880095	1.688643523	0.033504943	1.121864991	0.851078957	0	9.576163643	0	0.023936141	0.07597721	0	3.335646471	0.984630829	0.158432588	0	0.27150832	5.328669404	1.118941823	0	1.363310035	0.223797301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0859	0	5.152986517	8.6267	0.557582366	2.156672905	0	0.58880095	1.688643523	0.033504943	1.121864991	0.851078957	0	9.576163643	0	0.023936141	0.07597721	0	3.335646471	0.984630829	0.158432588	0	0.27150832	5.328669404	1.118941823	0	1.363310035	0.223797301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0859	NO																																																																																		0	0	0	8.6267	0.557582366	2.156672905	0	0.58880095	1.688643523	0.033504943	1.121864991	0.851078957	0	9.576163643	0	0.023936141	0.07597721	0	3.335646471	0.984630829	0.158432588	0	0.27150832	5.328669404	1.118941823	0	1.363310035	0.223797301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0859
H5656_014_0	2011	7																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	P	V	V	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	YES	1214.31979	23.72742529	1561.809133	31.91180288	203.1907732	11.2922979	1.068150759	258.1003575	306.9744034	5.038839236	18.56225385	0	19.10174933	1401.392547	4635.560454	14344.56988	1.051542479	364.8628014	16.98529432	27.02209893	10.86586758	0	0	0	382.6555037	0	163.9952159	0	0	0											6700	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	"11a: 20%, 11c: 0%-20%"	11b: 20%	4a: $50; 4b: $35	9a: $350; 9b: $175	8a: 20%	8b: 20%-30%	9a: $0	12: $50	3: $45; 5: $265; 7c: $45; 7i: $45; 9d: $45	7a : $30; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 17a: $0-$20; 18a: $20	7e: 45%; 7h: 45%; 9c: 45%	7c: $45; 7i: $45	8b: 20%-30%	8a: 20%	13a: $0; 15: 20%	0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a: $0	0												185.6961721	140.765055	47.27105293	0	150	0.2	0.2	48.81277987	262.5	0.2	0.239980919	0	0	15.09258376	26.89847141	11.85334413	0.45	0	0.188648403	0.122924862	0.2	0	0	0	20	0	20	0	0	0											NO	157.3840208	119.3033227	40.06387581	0	127.1302626	0.169507017	0.169507017	41.37054349	222.4779595	0.169507017	0.203392249	0	0	12.79149424	22.79739822	10.04612501	0.381390788	0	0.15988614	0.104183133	0.169507017	0	0	0	20	0	20	0	0	0												15.9262	0.235896723	5.214343928	0	2.152641363	1.91412373	0.181059049	0.889812672	5.691253242	0.854118607	3.775418548	0	0	1.493825392	8.806559804	12.00894519	0.401048614	0	2.715713149	2.815246929	1.841840798	0	0	0	0.637759173	0	0.27332536	0	0	0	0	0	0	0	0	0	0	0	0	0	67.8291		12.03803404	15.9262	0.235896723	5.214343928	0	2.152641363	1.91412373	0.181059049	0.889812672	5.691253242	0.854118607	3.775418548	0	0	1.493825392	8.806559804	12.00894519	0.401048614	0	2.715713149	2.815246929	1.841840798	0	0	0	0.637759173	0	0.27332536	0	0	0	0	0	0	0	0	0	0	0	0	0	67.8291	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			15.9262	0.235896723	5.214343928	0	2.152641363	1.91412373	0.181059049	0.889812672	5.691253242	0.854118607	3.775418548	0	0	1.493825392	8.806559804	12.00894519	0.401048614	0	2.715713149	2.815246929	1.841840798	0	0	0	0.637759173	0	0.27332536	0	0	0	0	0	0	0	0	0	0	0	0	0	67.8291
H5656_015_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	P	V	V	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	YES	1215.330278	23.74648321	1570.602487	30.80515412	203.1907732	11.2922979	1.068150759	258.1003575	307.4030445	5.132974984	18.56225385	0	19.11115703	1403.887202	4706.742745	14429.04467	1.051542479	369.0842119	16.98656339	27.22001122	10.86586758	0	0	0	382.6555037	0	163.9952159	0	0	0											3250	1a: $250 Per Day (Days 1-6)	1b: $250 Per Day (Days 1-6)	2: $100 Per Day (Days 21-100)	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $245; 9b: $123	8a: 0%	8b: 20%	9a: $0	12: $50	3: $30; 5: $250; 7c: $30; 7i: $30; 9d: $30	7a : $15; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $40; 7f: $40; 7g: $40; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 17a: $0-$20; 18a: $20	7e: 45%; 7h: 45%; 9c: 45%	7c: $30; 7i: $30	8b: 20%	8a: 0%	13a: $0; 15: 20%	0	0	16a: $15	17a: $0-$20	17b: $20	18a: $20	0	14a: $0	0												175.185068	132.7972217	35.01559476	0.15	150	0.2	0.2	48.81277987	184	0	0.2	0	0	10.08712892	13.46222005	9.581160729	0.45	0	0.181850081	0.039625417	0.2	0	0	0	20	0	20	0	0	0											NO	113.5898472	86.10560416	22.70408149	0.097259871	97.25987082	0.129679828	0.129679828	31.65016443	119.3054415	0	0.129679828	0	0	6.540485708	8.728891889	6.212416365	0.291779612	0	0.117911436	0.025693086	0.129679828	0	0	0	20	0	20	0	0	0												11.5041	0.170392107	2.97159057	2.99610531	1.64685903	1.464383247	0.138517606	0.680743229	3.056237997	0	2.407149882	0	0	0.765175348	3.423720714	7.469936103	0.306818657	0	2.00291008	0.699366093	1.409083836	0	0	0	0.637759173	0	0.27332536	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0242		23.37849949	11.5041	0.170392107	2.97159057	2.99610531	1.64685903	1.464383247	0.138517606	0.680743229	3.056237997	0	2.407149882	0	0	0.765175348	3.423720714	7.469936103	0.306818657	0	2.00291008	0.699366093	1.409083836	0	0	0	0.637759173	0	0.27332536	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0242	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			11.5041	0.170392107	2.97159057	2.99610531	1.64685903	1.464383247	0.138517606	0.680743229	3.056237997	0	2.407149882	0	0	0.765175348	3.423720714	7.469936103	0.306818657	0	2.00291008	0.699366093	1.409083836	0	0	0	0.637759173	0	0.27332536	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0242
H5656_801_0	2011	7																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	321.9226799	11.68367815	36.07805532		7.960493433	14.62665395	0.561733076	20.02747364	34.76551847	25.69139008	62.8336252	3.102876128	0.030729973	8.42129817	56.74362893	130.921584	3.961964683	6.178398621		11.34804259	26.60812861	5.576159631																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0.063452011	0.063452011	0.152551		0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352		0.191003352	0.191003352	0.191003352																				20.4266	0.741352878	5.503743418	0	1.520480932	2.793739937	0.107292901	3.825314605	6.640330573	4.907141631	12.00143305	0.592659742	0.005869528	1.608496181	10.83822335	25.00646144	0.756748536	1.180094849	0	2.167514178	5.082241765	1.065065183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7708	0	23.47611995	20.4266	0.741352878	5.503743418	0	1.520480932	2.793739937	0.107292901	3.825314605	6.640330573	4.907141631	12.00143305	0.592659742	0.005869528	1.608496181	10.83822335	25.00646144	0.756748536	1.180094849	0	2.167514178	5.082241765	1.065065183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7708	NO																																																																																		0	0	0	20.4266	0.741352878	5.503743418	0	1.520480932	2.793739937	0.107292901	3.825314605	6.640330573	4.907141631	12.00143305	0.592659742	0.005869528	1.608496181	10.83822335	25.00646144	0.756748536	1.180094849	0	2.167514178	5.082241765	1.065065183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7708
H5656_802_0	2011	7																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	321.9226799	11.68367815	36.07805532		7.960493433	14.62665395	0.561733076	20.02747364	34.76551847	25.69139008	62.8336252	3.102876128	0.030729973	8.42129817	56.74362893	130.921584	3.961964683	6.178398621		11.34804259	26.60812861	5.576159631																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0.063452011	0.063452011	0.152551		0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352		0.191003352	0.191003352	0.191003352																				20.4266	0.741352878	5.503743418	0	1.520480932	2.793739937	0.107292901	3.825314605	6.640330573	4.907141631	12.00143305	0.592659742	0.005869528	1.608496181	10.83822335	25.00646144	0.756748536	1.180094849	0	2.167514178	5.082241765	1.065065183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7708	0	23.47611995	20.4266	0.741352878	5.503743418	0	1.520480932	2.793739937	0.107292901	3.825314605	6.640330573	4.907141631	12.00143305	0.592659742	0.005869528	1.608496181	10.83822335	25.00646144	0.756748536	1.180094849	0	2.167514178	5.082241765	1.065065183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7708	NO																																																																																		0	0	0	20.4266	0.741352878	5.503743418	0	1.520480932	2.793739937	0.107292901	3.825314605	6.640330573	4.907141631	12.00143305	0.592659742	0.005869528	1.608496181	10.83822335	25.00646144	0.756748536	1.180094849	0	2.167514178	5.082241765	1.065065183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7708
H5656_803_0	2011	7																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	321.9226799	11.68367815	36.07805532		7.960493433	14.62665395	0.561733076	20.02747364	34.76551847	25.69139008	62.8336252	3.102876128	0.030729973	8.42129817	56.74362893	130.921584	3.961964683	6.178398621		11.34804259	26.60812861	5.576159631																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0.063452011	0.063452011	0.152551		0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352	0.191003352		0.191003352	0.191003352	0.191003352																				20.4266	0.741352878	5.503743418	0	1.520480932	2.793739937	0.107292901	3.825314605	6.640330573	4.907141631	12.00143305	0.592659742	0.005869528	1.608496181	10.83822335	25.00646144	0.756748536	1.180094849	0	2.167514178	5.082241765	1.065065183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7708	0	23.47611995	20.4266	0.741352878	5.503743418	0	1.520480932	2.793739937	0.107292901	3.825314605	6.640330573	4.907141631	12.00143305	0.592659742	0.005869528	1.608496181	10.83822335	25.00646144	0.756748536	1.180094849	0	2.167514178	5.082241765	1.065065183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7708	NO																																																																																		0	0	0	20.4266	0.741352878	5.503743418	0	1.520480932	2.793739937	0.107292901	3.825314605	6.640330573	4.907141631	12.00143305	0.592659742	0.005869528	1.608496181	10.83822335	25.00646144	0.756748536	1.180094849	0	2.167514178	5.082241765	1.065065183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7708
H5665_002_0	2011	6																															D	A	D	Coin	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	Coin	Coin	Coin	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	2514.805628	1.10884828	206.2820909	38.76143626	237.1916784	24.66087902	15.56856227	509.5462549	267.9799781	15.35615105	13.84741501	0	0.004050544	1507.505489	4540.581781	3707.298613	176.478742	272.7840556	40.48342348	47.17336018	4.634471681	51.07082596	660	70.27304004	175.6826001	0	0	0	0	12000											3400	1A IP Acute: $220 Per Day for days 0	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: $210, 9B ASC Services: $210"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $50, 5 Partial Hosp: $40, 9D Cardiac Rehab: $50"	"7A PCP: $35, 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): $50	"7E Mental Health: $40, MH (Group): $35, 7H Psychiatric: $40, Psychiatric (Group): $35, 9C OP Substance Abuse: $40, OP Substance Abuse (Group): $35"	"7C Occupational Therapy: $50, 7I Physical and Speech Therapy: $50"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $15, 7F Podiatry: $50, 7G Other Health Care: $50, 18A Hearing Exams (Medicare Covered): $50"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $50"	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): $50	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	220	1000	130	0	175	0.147	0.270864297	49.57419912	210	0.18	0.2	0	1.87E-16	42.00791949	33.67762711	50	39.75	41.49160894	0.12	0.150428067	0.12	0.101014961	0	10	25	0	0	0	0	0											NO	206.1563337	621.7819801	108.100291	0	172.6576701	0.142606032	0.267108378	48.8621527	197.7899364	0.175776021	0.195879045	0	1.87E-16	40.88964698	33.44214782	49.25409859	39.46916079	41.28355942	0.115466949	0.1462156	0.115466949	0.096384714	0	10	25	0	0	0	0	0												43.2036	0.057455157	1.858262838	0	3.41274688	3.516790093	4.158493407	2.074793909	4.416978568	2.699243129	2.712418426	0	7.59E-19	5.136780607	12.65390059	15.21663762	0.580455654	0.938458064	4.674497409	6.897481167	0.535128307	4.92244695	0	0.058560867	0.366005417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.0911	0	5.029033615	43.2036	0.057455157	1.858262838	0	3.41274688	3.516790093	4.158493407	2.074793909	4.416978568	2.699243129	2.712418426	0	7.59E-19	5.136780607	12.65390059	15.21663762	0.580455654	0.938458064	4.674497409	6.897481167	0.535128307	4.92244695	0	0.058560867	0.366005417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.0911	NO	1A IP Acute: $220 Per Day for days 0	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: $210, 9B ASC Services: $210"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $50, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, OP Substance Abuse (Group): $35, 9D Cardiac Rehab: $50"	"7A PCP: $35, 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): $50	"7E Mental Health: $40, MH (Group): $35, 7H Psychiatric: $40, Psychiatric (Group): $35, 9C OP Substance Abuse: $40, OP Substance Abuse (Group): $35"	"7C Occupational Therapy: $50, 7I Physical and Speech Therapy: $50"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $15, 7F Podiatry: $50, 7G Other Health Care: $50, 18A Hearing Exams (Medicare Covered): $50"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $50"	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): $50	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	0.000111672	43.2036	0.057455157	1.858262838	0	3.41274688	3.516790093	4.158493407	2.104793909	4.416978568	2.699243129	2.712418426	0	7.59E-19	5.136780607	12.65390059	15.21663762	0.580455654	0.938458064	4.674497409	6.897481167	0.535128307	4.92244695	0	0.058560867	0.366005417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.1211
H5679_001_0	2011	9	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1864.11498	41.91783594	853.9387358	712.2587047	341.1728618	12.10287667	3.356883387	398.7846813	909.6942019	12760.28865	761.717279	103.9390086	0.0559219	78.416242	4539.895133	4028.991519	12.35353431	1530.314638	773.8244291	1617.569249	49.83969172	11.4184748	0.034407425	0	0	0	162	0	4129.480296	0	5.185070474	9.66821284	0	0	0	0	0	0	0	0	3400	1A: $250/day (days1-7) no yrly max	1B: $250/day (days1-7) no yrly max	2: $135/day (for days 21-100)	6: $0 copay	10A: $150 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $35 copay	9A: $35 - $250 copay; 9B: $150 copay	8A: $0 -$200 copay	8B: $40 - $200 copay	9A: $250 copay	12: 20% coin	3: $35 copay; 5: $35 copay; 9C: $40 copay; 9D: $35 copay	7A: $20 copay; 7G: $20 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35-$50 copay; 7I: $35-$50 copay	8B: $35 - $200 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $35	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	17A: $0 copay	-	18A: $35 copay	-	14A: $0 copay or not covered;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										250	250	135	0	150	0.2	0.2	49.9166463	109.9167135	26.51195092	91.32954647	250	0.2	37.30262543	17.41292593	32.91512078	40	43.68405781	80.73171947	0.983484207	0.2	0	0	0	0	0	35	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	157.573982	94.30696916	115.9573825	0	128.8415361	0.171788715	0.171788715	42.87558258	94.41225479	22.77226988	78.44692706	214.7358935	0.171788715	32.04085041	14.95672084	28.27223149	34.35774296	37.52214074	69.34399166	0.844757439	0.171788715	0	0	0	0	0	35	0	0	0	0.171788715	0.171788715	0	0	0	0	0	0	0	0		24.478	0.329428672	8.251708385	0	3.663102966	2.079137629	0.576674683	1.424843794	7.157190064	24.2150614	4.979531652	1.859952991	0.009606751	0.209376923	5.658495343	9.492381741	0.035369963	4.785056769	4.471672897	0.113871138	8.561896587	0	0	0	0	0	0.4725	0	0	0	0.890736593	1.660889858	0	0	0	0	0	0	0	0	115.3765		18.86962826	24.478	0.329428672	8.251708385	0	3.663102966	2.079137629	0.576674683	1.424843794	7.157190064	24.2150614	4.979531652	1.859952991	0.009606751	0.209376923	5.658495343	9.492381741	0.035369963	4.785056769	4.471672897	0.113871138	8.561896587	0	0	0	0	0	0.4725	0	0	0	0.890736593	1.660889858	0	0	0	0	0	0	0	0	115.3765	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	24.478	0.329428672	8.251708385	0	3.663102966	2.079137629	0.576674683	1.424843794	7.157190064	24.2150614	4.979531652	1.859952991	0.009606751	0.209376923	5.658495343	9.492381741	0.035369963	4.785056769	4.471672897	0.113871138	8.561896587	0	0	0	0	0	0.4725	0	0	0	0.890736593	1.660889858	0	0	0	0	0	0	0	0	115.3765
H5679_002_0	2011	7	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1793.099911	58.9427169	813.5652362	881.6311034	342.4051831	13.10806076	1.963051393	373.4194773	875.1763542	11005.43547	820.2152356	136.4304312	0.078634515	205.5595801	4651.055522	4547.713272	15.39755922	1807.379328	712.4378563	1683.405398	51.29882748	4.086247256	0.048381961	1572.93321	378	179.4	162	0	4130.357198	0	5.218498397	5.561558912	0	0	0	0	0	0	0	0	3400	1A: $200/day (days1-5) $2000 yrly max	1B: $200/day (days1-5) no yrly max	2: $135/day (for days 21-100)	6: $0 copay	10A: $150 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $35 copay	9A: $35 - $175 copay; 9B: $150 copay	8A: $0 -$175 copay	8B: $35 - $175 copay	9A: $175 copay	12: 20% coin	3: $35 copay; 5: $35 copay; 9C: $40 copay; 9D: $35 copay	7A: $10 copay; 7G: $10 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35-$50 copay; 7I: $35-$50 copay	8B: $35 - $175 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $35	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $0 copay	17B: $0 copay	18A: $35 copay	-	14A: $0 copay or not covered;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										200	200	135	0	150	0.2	0.2	49.88279229	96.16140016	9.221204739	90.83325868	175	0.2	35.42114561	8.782613831	34.08403631	40	45.56238419	65.54926616	0.76253926	0.2	0	0	0	0	0	35	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	111.5117403	87.77077325	118.4825604	0	131.6472893	0.175529719	0.175529719	43.77956258	84.39591778	8.092977386	79.71968189	153.5885042	0.175529719	31.08731869	7.708048692	29.9138066	35.10594381	39.98776248	57.52922137	0.66924151	0.175529719	0	0	0	0	0	35	0	0	0	0.175529719	0.175529719	0	0	0	0	0	0	0	0		16.6626	0.431120653	8.032774351	0	3.75639285	2.300854222	0.34457386	1.362345115	6.155109303	7.422228367	5.448941472	1.746178821	0.013802694	0.532524681	2.98754687	11.33661794	0.045045487	6.022754606	3.415499596	0.093883731	9.004468776	0	0	0	0	0	0.4725	0	0	0	0.916001558	0.976218873	0	0	0	0	0	0	0	0	89.48		12.40837818	16.6626	0.431120653	8.032774351	0	3.75639285	2.300854222	0.34457386	1.362345115	6.155109303	7.422228367	5.448941472	1.746178821	0.013802694	0.532524681	2.98754687	11.33661794	0.045045487	6.022754606	3.415499596	0.093883731	9.004468776	0	0	0	0	0	0.4725	0	0	0	0.916001558	0.976218873	0	0	0	0	0	0	0	0	89.48	NO																								$16A: 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	0	0	0	0	0	0	0	0	0	0	0		0	16.6626	0.431120653	8.032774351	0	3.75639285	2.300854222	0.34457386	1.362345115	6.155109303	7.422228367	5.448941472	1.746178821	0.013802694	0.532524681	2.98754687	11.33661794	0.045045487	6.022754606	3.415499596	0.093883731	9.004468776	0	0	0	0	0	0.4725	0	0	0	0.916001558	0.976218873	0	0	0	0	0	0	0	0	89.48
H5679_801_0	2011	4																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	282.9689996	3.257849902	87.73606445	41.93480773	12.11026793	19.54981078	4.934667572	10.45290452	43.7424334	3.235579013	23.9119243	0	0.028735144	28.61615457	51.00066475	129.1594742	1.329943414	5.261372866	20.62206089	26.45389733	10.49962094	1.070644424	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.061384796	0.061384796	0.122539642	0	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0	0	0	0	0	0	0	0												17.37	0.199982453	10.75114593	0	2.338321708	3.774792367	0.952814618	2.018308239	8.44604613	0.624744613	4.617054884	0	0.00554835	5.525375311	9.847508101	24.93887039	0.256793291	1.015896796	3.981828721	5.107873976	2.02732852	0.206726318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.007	0	21.5	17.37	0.199982453	10.75114593	0	2.338321708	3.774792367	0.952814618	2.018308239	8.44604613	0.624744613	4.617054884	0	0.00554835	5.525375311	9.847508101	24.93887039	0.256793291	1.015896796	3.981828721	5.107873976	2.02732852	0.206726318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.007	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.37	0.199982453	10.75114593	0	2.338321708	3.774792367	0.952814618	2.018308239	8.44604613	0.624744613	4.617054884	0	0.00554835	5.525375311	9.847508101	24.93887039	0.256793291	1.015896796	3.981828721	5.107873976	2.02732852	0.206726318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.007
H5679_802_0	2011	4																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	282.9689996	3.257849902	87.73606445	41.93480773	12.11026793	19.54981078	4.934667572	10.45290452	43.7424334	3.235579013	23.9119243	0	0.028735144	28.61615457	51.00066475	129.1594742	1.329943414	5.261372866	20.62206089	26.45389733	10.49962094	1.070644424	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.061384796	0.061384796	0.122539642	0	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0	0	0	0	0	0	0	0												17.37	0.199982453	10.75114593	0	2.338321708	3.774792367	0.952814618	2.018308239	8.44604613	0.624744613	4.617054884	0	0.00554835	5.525375311	9.847508101	24.93887039	0.256793291	1.015896796	3.981828721	5.107873976	2.02732852	0.206726318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.007	0	21.5	17.37	0.199982453	10.75114593	0	2.338321708	3.774792367	0.952814618	2.018308239	8.44604613	0.624744613	4.617054884	0	0.00554835	5.525375311	9.847508101	24.93887039	0.256793291	1.015896796	3.981828721	5.107873976	2.02732852	0.206726318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.007	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.37	0.199982453	10.75114593	0	2.338321708	3.774792367	0.952814618	2.018308239	8.44604613	0.624744613	4.617054884	0	0.00554835	5.525375311	9.847508101	24.93887039	0.256793291	1.015896796	3.981828721	5.107873976	2.02732852	0.206726318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.007
H5679_803_0	2011	4																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	282.9689996	3.257849902	87.73606445	41.93480773	12.11026793	19.54981078	4.934667572	10.45290452	43.7424334	3.235579013	23.9119243	0	0.028735144	28.61615457	51.00066475	129.1594742	1.329943414	5.261372866	20.62206089	26.45389733	10.49962094	1.070644424	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.061384796	0.061384796	0.122539642	0	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0.193085877	0	0	0	0	0	0	0	0												17.37	0.199982453	10.75114593	0	2.338321708	3.774792367	0.952814618	2.018308239	8.44604613	0.624744613	4.617054884	0	0.00554835	5.525375311	9.847508101	24.93887039	0.256793291	1.015896796	3.981828721	5.107873976	2.02732852	0.206726318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.007	0	21.5	17.37	0.199982453	10.75114593	0	2.338321708	3.774792367	0.952814618	2.018308239	8.44604613	0.624744613	4.617054884	0	0.00554835	5.525375311	9.847508101	24.93887039	0.256793291	1.015896796	3.981828721	5.107873976	2.02732852	0.206726318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.007	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.37	0.199982453	10.75114593	0	2.338321708	3.774792367	0.952814618	2.018308239	8.44604613	0.624744613	4.617054884	0	0.00554835	5.525375311	9.847508101	24.93887039	0.256793291	1.015896796	3.981828721	5.107873976	2.02732852	0.206726318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.007
H5685_001_0	2011	6																															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	308.4205904	24.85594952	56.92430162	0	13.64132977	14.4480163	8.272943421	22.13642582	29.65588722	6.3436586	13.99175321	0	2.458937559	24.20063189	50.39563872	76.71022092	10.08481516	4.36149115	16.19294019	38.27586726	26.22413814	22.40377785	0	0	0	0	0	0	0	0											6700	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: 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, 1 exam / 2 years"	17B Eye Wear (Medicare Covered): $0 frames and glasses / 2 years	"18A Routine Hearing Exams (Non Medicare Covered): $0, 1 exam / year"	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Written materials at $0	"7F Podiatry: 3 routine visits at $0; 13B Acupuncture, not covered; 13E Other 1: Emergency Response Service at $0"											0	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	0.064041722	0.064041722	0.15132104	0	0.212717854	0.212717854	0.212717854	0.212717854	0.212717854	0.212717854	0.212717854	0	0.212717854	0.212717854	0.212717854	0.212717854	0.212717854	0.212717854	0.212717854	0.212717854	0.212717854	0.212717854	0	0	0	0	0	0	0	0												19.7518	1.591817814	8.613844518	0	2.901754393	3.07335102	1.75980277	4.708812994	6.308336686	1.349409444	2.976295715	0	0.523059921	5.147906479	10.72005212	16.31763357	2.145220239	0.927767037	3.444527487	8.141960341	5.578342387	4.765683544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7474	0	10.55950018	19.7518	1.591817814	8.613844518	0	2.901754393	3.07335102	1.75980277	4.708812994	6.308336686	1.349409444	2.976295715	0	0.523059921	5.147906479	10.72005212	16.31763357	2.145220239	0.927767037	3.444527487	8.141960341	5.578342387	4.765683544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7474	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.7518	1.591817814	8.613844518	0	2.901754393	3.07335102	1.75980277	4.708812994	6.308336686	1.349409444	2.976295715	0	0.523059921	5.147906479	10.72005212	16.31763357	2.145220239	0.927767037	3.444527487	8.141960341	5.578342387	4.765683544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7474
H5696_001_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	Coin	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	2507.920715	29.99755653	1190.223153	1240.45073	250.7681033	9.956397229	22.60334429	695.7310292	390.8193433	113.1319152	124.4118326	75.62293795	0	122.2066677	5362.467659	5939.951346	171.5975599	153.466497	2.590151848	0	21.69578999	0.662360941	0	377.6871156	726.3274336	12.89296161	130.9391762	7.091128884	0	0											3400	1a1:  $100 Days 1 to 5	1b1:  $175 Days 1 to 5	21:  $60 Days 6 to 60	$0 	10a: $135	11a: 20.0%	11b: 20.0%	"4a1: $50,4a2: $50,4b: $5"	"9a1: $100,9b: $25"	"8a1: $1.5; Cardic Screen $0; AAA $0; EKG $0,8a2: $1.5"	"8b1: $3; $0 Office, $0 Facility,8b2: $100,8b3: $50,8b4: $55,8b5: $35,8b6: $35"	"5: $100,9a2: $100"	12: 20.0%	"3: $20,9a3: $100,9c: $20,9d1: $20"	$0 	"7b1: $20,7d1: $20,7f1: $20,7g: $20,17a1: $25,18a1: $20"	"7c: $20,7i: $20"	"7e: $20,7h: $20"	7d2: $20	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $5,16b2: $5,16b1: $20,16b2: $5"	$0 	$0 	$0 	$0 	$0 	$0 												64.84414681	75.2578113	37.19478665	0	135	0.2	0.15920449	49.60869565	56.23065015	1.5	47.49203725	100	0	23.96039604	0	20.23060122	20	20	20	0	0.2	0	0	5	0	0	0	0	0	0											NO	64.1489592	74.45097983	36.79602506	0	133.5526785	0.19785582	0.157497674	49.07731191	55.62780698	1.48391865	46.98287987	98.92791	0	23.70351903	0	20.01371096	19.785582	19.785582	19.785582	0	0.19785582	0	0	5	0	0	0	0	0	0												13.4067	0.18611229	3.649623413	0	2.790895989	1.969931138	3.559974153	2.845384061	1.811701916	0.01398988	0.487102182	0.623434933	0	0.241394006	0	9.906705782	0.282929799	0.25303533	0.004270638	0	4.29263832	0	0	0.157369631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4832		0.502009585	13.4067	0.18611229	3.649623413	0	2.790895989	1.969931138	3.559974153	2.845384061	1.811701916	0.01398988	0.487102182	0.623434933	0	0.241394006	0	9.906705782	0.282929799	0.25303533	0.004270638	0	4.29263832	0	0	0.157369631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4832	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			13.4067	0.18611229	3.649623413	0	2.790895989	1.969931138	3.559974153	2.845384061	1.811701916	0.01398988	0.487102182	0.623434933	0	0.241394006	0	9.906705782	0.282929799	0.25303533	0.004270638	0	4.29263832	0	0	0.157369631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4832
H5696_002_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	Coin	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	1577.520629	14.02423882	659.1398152	568.9069227	120.3075982	10.12	10.75411027	475.0788979	350.215857	68.1252751	81.65942982	61.93206827	0	62.9309726	4440.232499	4546.989134	63.43494769	108.0743553	4.912470697	0	24.81317295	0.464470161	0	380.2024339	698.3282524	15.09158918	125.1737559	3.826036693	0	0											4200	1a1:  $145 Days 1 to 5	1b1:  $250 Days 1 to 7	21:  $50 Days 4 to 20; $100 Days 21 to 100	$0 	10a: $50	11a: 20.0%	"11b: 20.0%,11c: 20.0%"	"4a1: $50,4a2: $50,4b: $10"	"9a1: $100,9b: $70"	"8a1: $6; Cardic Screen $0; AAA $0; EKG $0,8a2: $6"	"8b1: $4.5; $0 Office, $10 Facility,8b2: $150,8b3: $75,8b4: $55,8b5: $40,8b6: $40"	"5: $145,9a2: $100"	12: 20.0%	"3: $25,9a3: $100,9c: $28,9d1: $28"	$0 	"7b1: $28,7d1: $28,7f1: $28,7g: $28,17a1: $28,18a1: $28"	"7c: $28,7i: $28"	"7e: $28,7h: $28"	7d2: $28	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	"16a1: $15,16b2: $15,16b1: $28,16b2: $15"	17a2: $20	"17b1: $20,17b2: $20"	18a2: $10	$0 	$0 	$0 												94.02401288	131.3683238	43.07564125	0	50	0.2	0.2	49.71404542	81.20935539	6	68.13477841	100	0	26.75555556	0	27.56057457	28	28	28	0	0.2	0	0	15	20	20	10	0	0	0											NO	93.57109784	130.7355207	42.86814527	0	50	0.199036597	0.199036597	49.47457214	80.81816875	5.971097913	67.80657219	99.51829855	0	26.62667366	0	27.42781488	27.86512359	27.86512359	27.86512359	0	0.199036597	0	0	15	20	19.96743427	10	0	0	0												12.3009	0.152788847	2.354675112	0	0.501281659	2.014250363	2.140461514	1.958693767	2.358650353	0.033898557	0.461420502	0.513614505	0	0.139636873	0	10.39283135	0.147301888	0.250958772	0.011407217	0	4.938729508	0	0	0.475253042	1.163880421	0.025111693	0.104311463	0	0	0	0	0	0	0	0	0	0	0	0	0	42.44		0.194477904	12.3009	0.152788847	2.354675112	0	0.501281659	2.014250363	2.140461514	1.958693767	2.358650353	0.033898557	0.461420502	0.513614505	0	0.139636873	0	10.39283135	0.147301888	0.250958772	0.011407217	0	4.938729508	0	0	0.475253042	1.163880421	0.025111693	0.104311463	0	0	0	0	0	0	0	0	0	0	0	0	0	42.44	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			12.3009	0.152788847	2.354675112	0	0.501281659	2.014250363	2.140461514	1.958693767	2.358650353	0.033898557	0.461420502	0.513614505	0	0.139636873	0	10.39283135	0.147301888	0.250958772	0.011407217	0	4.938729508	0	0	0.475253042	1.163880421	0.025111693	0.104311463	0	0	0	0	0	0	0	0	0	0	0	0	0	42.44
H5696_003_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	Coin	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	2548.910973	62.39541838	918.2122303	1163.231223	296.6257035	5.06	16.40240272	497.0975162	381.5457917	0	0	35.26578605	1.998825495	76.15909116	6726.514202	5049.788884	1.204671597	314.820844	0	0	30.55235067	0.275715162	0	0	35.57909381	14.39154356	40.7760401	4.797181188	0	0											3400	1a1:  $60 Days 1 to 10	1b1:  $100 Days 1 to 10	21:  $75 Days 6 to 50	$0 	10a: $125	11a: 20%	11b: 20%	"4a1: $50,4a2: $50,4b: $20"	"9a1: $125,9b: $50"	"8a1: $1.5; Cardic Screen $0; AAA $0; EKG $0,8a2: $1.5"	"8b1: $3; $0 Office, $10 Facility,8b2: $125,8b3: $60,8b4: $55,8b5: $25,8b6: $25"	"5: $60,9a2: $125"	12: 20%	"3: $20,9a3: $125,9c: $15,9d1: $15"	$0 	"7b1: $15,7d1: $15,7f1: $15,7g: $15,17a1: $20,18a1: $20"	"7c: $15,7i: $15"	"7e: $15,7h: $15"	7d2: $15	$0 	"151: 20%,152: 20%,153: 20%"	$0 	$0 	"16a1: $5,16b2: $5,16b1: $20,16b2: $5"	$0 	$0 	$0 	$0 	$0 	$0 												50.34733889	62.67508081	46.39350116	0	125	0.2	0.146360162	49.90943396	79.0560472	0	0	125	649.3265476	46.40394089	0	15.60005257	15	15	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	49.67858961	61.84258567	45.77726958	0	123.3396608	0.197343457	0.144416102	49.24650125	78.00596837	0	0	123.3396608	640.7017291	45.78757064	0	15.42731044	14.8007593	14.8007593	0	0	0.197343457	0	0	0	0	0	0	0	0	0												10.5522	0.321557834	3.502770733	0	3.048809471	0.998557894	2.368771066	2.040026121	2.480237413	0	0	0.362472508	0.106720913	0.29059498	0	6.492055065	0.001485838	0.388298961	0	0	6.029306509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9839		0.510081618	10.5522	0.321557834	3.502770733	0	3.048809471	0.998557894	2.368771066	2.040026121	2.480237413	0	0	0.362472508	0.106720913	0.29059498	0	6.492055065	0.001485838	0.388298961	0	0	6.029306509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9839	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			10.5522	0.321557834	3.502770733	0	3.048809471	0.998557894	2.368771066	2.040026121	2.480237413	0	0	0.362472508	0.106720913	0.29059498	0	6.492055065	0.001485838	0.388298961	0	0	6.029306509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9839
H5696_004_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	Coin	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	933.754958	7.31307608	365.3101873	290.4845139	111.1299769	5.06	5.077994086	283.5229881	209.1025204	109.9903431	98.86180684	16.92159125	0	34.87919829	3988.183391	2540.560966	8.131852685	99.98482505	5.174815345	0	21.77369131	0.095986654	0	0	24.2866837	7.727581177	25.75860392	2.943840448	0.554444501	0											4300	1a1:  $175 Days 1 to 7	1b1:  $225 Days 1 to 7	21:  $50 Days 4 to 20;  $100 Days 21 to 100	$0 	10a: $175	11a: 20%	11b: 20%	"4a1: $50,4a2: $50,4b: $10"	"9a1: $200,9b: $100"	"8a1: $11; Cardic Screen $0; AAA $0; EKG $0,8a2: $11"	"8b1: $6; $0 Office, $20 Facility,8b2: $150,8b3: $60,8b4: $55,8b5: $30,8b6: $30"	"5: $175,9a2: $200"	12: 20%	"3: $25,9a3: $200,9c: $25,9d1: $25"	$0 	"7b1: $25,7d1: $25,7f1: $25,7g: $25,17a1: $25,17b1: $20,18a1: $25"	"7c: $25,7i: $25"	"7e: $25,7h: $25"	7d2: $25	$0 	"151: 20%,152: 20%,153: 20%"	$0 	$0 	"16a1: $15,16b2: $15,16b1: $25,16b2: $15"	17a2: $20	17b2: $20	18a2: $10	$0 	$0 	$0 												131.4623006	118.2314915	43.07564125	0	175	0.2	0.132350398	49.63459196	137.2419488	11	48.91188542	200	0	84.77722772	0	24.31440444	25	25	25	0	0.2	0	0	0	20	20	10	0	0	0											NO	131.1907932	117.9873094	42.98667766	0	174.6385747	0.199586942	0.132077056	49.53208225	136.9585047	10.97728184	48.81086831	199.5869425	0	84.60213836	0	24.2641882	24.94836781	24.94836781	24.94836781	0	0.199586942	0	0	0	19.95869425	19.95869425	9.979347123	0	0	0												10.2083	0.071904181	1.308622606	0	1.617298398	1.009909929	0.670686512	1.17029033	2.386530711	0.10061625	0.402127553	0.281444055	0	0.245904563	0	5.137054116	0.016906371	0.207871516	0.0107586	0	4.345744474	0	0	0	0.040394208	0.012852702	0.021421171	0	0	0	0	0	0	0	0	0	0	0	0	0	29.2667		0.060569198	10.2083	0.071904181	1.308622606	0	1.617298398	1.009909929	0.670686512	1.17029033	2.386530711	0.10061625	0.402127553	0.281444055	0	0.245904563	0	5.137054116	0.016906371	0.207871516	0.0107586	0	4.345744474	0	0	0	0.040394208	0.012852702	0.021421171	0	0	0	0	0	0	0	0	0	0	0	0	0	29.2667	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			10.2083	0.071904181	1.308622606	0	1.617298398	1.009909929	0.670686512	1.17029033	2.386530711	0.10061625	0.402127553	0.281444055	0	0.245904563	0	5.137054116	0.016906371	0.207871516	0.0107586	0	4.345744474	0	0	0	0.040394208	0.012852702	0.021421171	0	0	0	0	0	0	0	0	0	0	0	0	0	29.2667
H5696_019_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	Coin	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	788.5425925	10.40380758	360.4391916	189.4001785	107.2206771	5.06	5.489368287	163.8609102	192.0113002	42.64853597	39.10550612	14.94158888	0	23.50206148	3013.460141	3519.184783	37.40219998	135.5025071	2035.048705	1621.103434	6.765344257	0.257386991	0	60.48968737	36.48356529	6.80146246	9.795742292	1.694277013	1.813611345	0											4400	1a1:  $250 Days 1 to 5	1b1:  $250 Days 1 to 5	21:  $50 Days 1 to 88	$0 	10a: $100	11a: 20%	"11b: 20%,11c: 20%"	"4a1: $50,4a2: $50,4b: $35"	"9a1: $200,9b: $150"	"8a1: $5.5; Cardic Screen $0; AAA $0; EKG $0,8a2: $5.5"	"8b1: $9; $0 Office, $30 Facility,8b2: $125,8b3: $40,8b4: $55,8b5: $40,8b6: $40"	"5: $250,9a2: $200"	12: 20%	"3: $30,9a3: $100,9c: $30,9d1: $30"	$0 	"7b1: $30,7d1: $30,7f1: $30,17a1: $25,17b1: $10,18a1: $25"	"7c: $30,7i: $30"	"7e: $30,7h: $30"	7d2: $30	7g: $30	"151: 20%,152: 20%,153: 20%"	$0 	$0 	"16a1: $10,16b2: $10,16b1: $30,16b2: $10"	17a2: $10	17b2: $10	18a2: $10	$0 	$0 	$0 												162.110367	107.511159	49.98571684	0	100	0.2	0.2	49.74276573	170.0994115	5.5	52.37220746	200	0	33.09361786	0	29.43235005	30	30	30	30	0.2	0	0	10	10	10	10	0	0	0											NO	161.621309	107.186817	49.83491884	0	99.69831783	0.199396636	0.199396636	49.59270067	169.5862519	5.483407481	52.21420984	199.3966357	0	32.99378032	0	29.3435579	29.90949535	29.90949535	29.90949535	29.90949535	0.199396636	0	0	10	10	10	10	0	0	0												10.6204	0.092929252	1.496871488	0	0.890810095	1.008946976	1.094561568	0.677192089	2.713539726	0.019488275	0.170155259	0.248275213	0	0.064618488	0	8.605450203	0.093223411	0.337734301	5.072273315	4.040532136	1.348986884	0	0	0.050408073	0.030402971	0.005667885	0.008163119	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6907		0.116789672	10.6204	0.092929252	1.496871488	0	0.890810095	1.008946976	1.094561568	0.677192089	2.713539726	0.019488275	0.170155259	0.248275213	0	0.064618488	0	8.605450203	0.093223411	0.337734301	5.072273315	4.040532136	1.348986884	0	0	0.050408073	0.030402971	0.005667885	0.008163119	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6907	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			10.6204	0.092929252	1.496871488	0	0.890810095	1.008946976	1.094561568	0.677192089	2.713539726	0.019488275	0.170155259	0.248275213	0	0.064618488	0	8.605450203	0.093223411	0.337734301	5.072273315	4.040532136	1.348986884	0	0	0.050408073	0.030402971	0.005667885	0.008163119	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6907
H5696_021_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	Coin	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	3654.22876	42.60617021	1464.811176	842.9711541	408.6099654	5.06	28.9850976	899.4152072	403.753321	194.0080017	178.7553327	20.77341699	0	104.9917753	4541.801313	5547.292095	514.0930325	249.8249739	277.2313498	196.0156398	26.28460326	0.511395115	131.1079977	0	74.7854774	7.710569435	24.64585496	1.250615549	3.902093445	0											700	$0 Days 1 to 90	$0 Days 1 to 90	$0 Days 1 to 100	$0 	10a: $25	11a: 20%	"11b: 20%,11c: 20%"	"4a1: $25,4a2: $25"	$0 	; Cardic Screen $0; AAA $0; EKG $0	"; $0 Office, $0 Facility"	$0 	12: 20%	$0 	$0 	$0 	$0 	$0 	$0 	$0 	"151: 20%,152: 20%,153: 20%"	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	25	0.2	0.2	24.85712569	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	23.7841432	0.190273146	0.190273146	23.64821748	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	0.809869828	0.962782117	5.515085697	1.772463869	0	0	0	0	0	0	0	0	0	0	0	0	5.256920653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.3171		0.463161843	0	0	0	0	0.809869828	0.962782117	5.515085697	1.772463869	0	0	0	0	0	0	0	0	0	0	0	0	5.256920653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.3171	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0	0	0.809869828	0.962782117	5.515085697	1.772463869	0	0	0	0	0	0	0	0	0	0	0	0	5.256920653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.3171
H5696_023_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	Coin	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	1804.734769	25.0361671	808.1921241	1077.295256	237.3732529	5.06	19.00043534	261.9585547	363.0291782	70.13063669	66.2115717	21.65799074	0	61.87997355	6661.630786	4888.109984	162.2698763	362.0715608	2.759691774	33.66823965	23.26642925	0.2641528	0	0	40.11168393	14.8358283	41.21063418	4.945276101	0	0											3400	1a1:  $100 Days 1 to 10	1b1:  $175 Days 1 to 8	21:  $50 Days 6 to 75	$0 	10a: $125	11a: 20%	11b: 20%	"4a1: $50,4a2: $50,4b: $10"	"9a1: $110,9b: $50"	"8a1: $6.5; Cardic Screen $0; AAA $0; EKG $0,8a2: $6.5"	"8b1: $6; $0 Office, $20 Facility,8b2: $100,8b3: $50,8b4: $55,8b5: $25,8b6: $25"	"5: $100,9a2: $110"	12: 20%	"3: $20,9a3: $110,9c: $20,9d1: $20"	$0 	"7b1: $20,7d1: $20,7f1: $20,17a1: $20,18a1: $20"	"7c: $20,7i: $20"	"7e: $20,7h: $20"	7d2: $20	7g: $20	"151: 20%,152: 20%,153: 20%"	$0 	$0 	"16a1: $5,16b2: $5,16b1: $20,16b2: $5"	$0 	$0 	$0 	$0 	$0 	$0 												83.91223149	98.36847776	30.99565554	0	125	0.2	0.149547337	49.60629921	70.625	6.5	44.82087227	110	0	38.83333333	0	19.91230969	20	20	20	20	0.2	0	0	0	0	0	0	0	0	0											NO	83.32100025	97.67539029	30.77726545	0	124.1192714	0.198590834	0.148493652	49.25678171	70.12738833	6.454202112	44.50507207	109.2249588	0	38.55972031	0	19.77201097	19.85908342	19.85908342	19.85908342	19.85908342	0.198590834	0	0	0	0	0	0	0	0	0												12.531	0.203784783	2.072828628	0	2.455216266	1.004869621	2.82144403	1.075269612	2.121524013	0.037719775	0.245562564	0.197132762	0	0.198839539	0	8.05398035	0.268544251	0.599200778	0.004567079	0.055718365	4.620499593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5677		0.273669843	12.531	0.203784783	2.072828628	0	2.455216266	1.004869621	2.82144403	1.075269612	2.121524013	0.037719775	0.245562564	0.197132762	0	0.198839539	0	8.05398035	0.268544251	0.599200778	0.004567079	0.055718365	4.620499593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5677	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			12.531	0.203784783	2.072828628	0	2.455216266	1.004869621	2.82144403	1.075269612	2.121524013	0.037719775	0.245562564	0.197132762	0	0.198839539	0	8.05398035	0.268544251	0.599200778	0.004567079	0.055718365	4.620499593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5677
H5696_024_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	Coin	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	800.5582444	6.131190055	435.5779279	341.9133294	189.2637125	5.06	7.152211214	273.0244243	957.70524	73.76746868	52.81157226	27.55681301	0	60.62498863	5173.448073	3316.939477	0	107.0901032	3.176401366	14.97446358	20.99274716	0.136500742	0	0	48.58985324	40.45841629	33.35696135	5.402888106	0	0											4000	1a1:  $265 Days 1 to 6	1b1:  $295 Days 1 to 6	21:  $50 Days 4 to 20;  $100 Days 21 to 100	$0 	10a: $150	11a: 20%	"11b: 20%,11c: 20%"	"4a1: $50,4a2: $50,4b: $30"	"9a1: $200,9b: $120"	"8a1: $12; Cardic Screen $0; AAA $0; EKG $0,8a2: $12"	"8b1: $9; $0 Office, $30 Facility,8b2: $150,8b3: $150,8b4: $55,8b5: $40,8b6: $40"	"5: $265,9a2: $200"	12: 20%	"3: $35,9a3: $100,9c: $35,9d1: $35"	$0 	"7b1: $35,7d1: $35,7f1: $35,17a1: $35,18a1: $35"	"7c: $35,7i: $35"	"7e: $35,7h: $35"	7d2: $35	7g: $35	"151: 20%,152: 20%,153: 20%"	$0 	$0 	16b1: $35	17a2: $15	"17b1: $15,17b2: $15"	18a2: $10	18b: $10	$0 	$0 												187.0921991	142.301062	43.07564125	0	150	0.2	0.2	49.56521739	144.8605578	12	56.05282171	200	0	69.12587413	0	35	0	35	35	35	0.2	0	0	0	15	15	10	10	0	0											NO	184.6872787	140.4718958	42.52193838	0	148.0718701	0.19742916	0.19742916	48.92809622	142.9984913	11.84574961	55.33230757	197.4291602	0	68.23731637	0	34.55010303	0	34.55010303	34.55010303	34.55010303	0.19742916	0	0	0	15	14.88675789	10	10	0	0												12.3211	0.071771658	1.543468151	0	2.335385988	0.99899155	1.412055053	1.113213775	11.4125337	0.072819247	0.243515513	0.453376538	0	0.344740544	0	9.550050055	0	0.308331175	0.009145416	0.043114105	4.144580442	0	0	0	0.060737317	0.050191221	0.027797468	0.004502407	0	0	0	0	0	0	0	0	0	0	0	0	46.5214		0.604298903	12.3211	0.071771658	1.543468151	0	2.335385988	0.99899155	1.412055053	1.113213775	11.4125337	0.072819247	0.243515513	0.453376538	0	0.344740544	0	9.550050055	0	0.308331175	0.009145416	0.043114105	4.144580442	0	0	0	0.060737317	0.050191221	0.027797468	0.004502407	0	0	0	0	0	0	0	0	0	0	0	0	46.5214	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			12.3211	0.071771658	1.543468151	0	2.335385988	0.99899155	1.412055053	1.113213775	11.4125337	0.072819247	0.243515513	0.453376538	0	0.344740544	0	9.550050055	0	0.308331175	0.009145416	0.043114105	4.144580442	0	0	0	0.060737317	0.050191221	0.027797468	0.004502407	0	0	0	0	0	0	0	0	0	0	0	0	46.5214
H5696_025_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	Coin	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	2720.963566	32.54578898	1291.33023	1345.82454	272.0703523	5.06	34.3191965	383.3233754	424.0186652	122.7422452	134.9803691	82.04695535	0	133.9006311	5817.998566	5950.761206	186.1744296	166.5031691	2.81018007	0	32.94123517	1.005678407	0	0	111.9055434	9.791735044	29.37520513	7.693506106	0	0											3000	$0 Days 1 to 90	$0 Days 1 to 100	21:  $25 Days 11 to 100	$0 	10a: $50	11a: 20%	"11b: 20%,11c: 20%"	"4a1: $50,4a2: $50"	"9a1: $50,9b: $25"	"8a1: 60%; Cardic Screen $0; AAA $0; EKG $0,8a2: 60%"	"8b1: $1.5; $0 Office, $5 Facility,8b2: $50,8b3: $50,8b4: $55,8b5: $10,8b6: $10"	9a2: $50	12: 20%	"3: $5,9a3: $25,9d1: $25"	$0 	$0 	"7c: $5,7i: $5"	$0 	$0 	$0 	"151: 20%,152: 20%,153: 20%"	$0 	$0 	"16b2: $5,16b2: $5"	$0 	$0 	$0 	$0 	$0 	$0 												0	0	9.117121943	0	50	0.2	0.2	49.14383562	35.41021672	547.6346566	24.29307788	50	0	6.12745098	0	0	0	5	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	9.028814185	0	49.51570376	0.198062815	0.198062815	48.66783212	35.06723602	542.3303085	24.05777695	49.51570376	0	6.068100951	0	0	0	4.951570376	0	0	0.198062815	0	0	0	0	0	0	0	0	0												0	0	0.971598392	0	1.122646247	1.002197844	6.797356669	1.554626473	1.239096884	5.547236642	0.270610634	0.338551061	0	0.067710212	0	0	0	0.068704347	0	0	6.524433769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.5048		0.249453465	0	0	0.971598392	0	1.122646247	1.002197844	6.797356669	1.554626473	1.239096884	5.547236642	0.270610634	0.338551061	0	0.067710212	0	0	0	0.068704347	0	0	6.524433769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.5048	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0.971598392	0	1.122646247	1.002197844	6.797356669	1.554626473	1.239096884	5.547236642	0.270610634	0.338551061	0	0.067710212	0	0	0	0.068704347	0	0	6.524433769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.5048
H5696_027_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	Coin	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	2915.299709	34.87026814	1383.559373	1441.945764	260.0288738	5.06	26.92486372	410.7010246	454.3028458	131.5087185	144.6209113	87.9068974	0	143.4640566	6233.530554	6375.775341	199.4713443	178.3951268	3.010888216	0	25.84379467	0.78899732	0	0	119.8980398	10.49107848	31.47323545	8.242990237	0	0											3000	1a1:  $50 Days 1 to 6	1b1:  $50 Days 1 to 6	21:  $25 Days 11 to 100	$0 	10a: $100	11a: 20%	"11b: 20%,11c: 20%"	"4a1: $50,4a2: $50,4b: $5"	"9a1: $75,9b: $50"	"8a1: $1.5; Cardic Screen $0; AAA $0; EKG $0,8a2: $1.5"	"8b1: $1.5; $0 Office, $5 Facility,8b2: $75,8b3: $50,8b4: $55,8b5: $10,8b6: $10"	9a2: $75	12: 20%	"3: $5,9a3: $25,9c: $5,9d1: $15"	$0 	"7b1: $5,7d1: $5,7f1: $5,7g: $5,17a1: $5,18a1: $5"	"7c: $5,7i: $5"	"7e: $5,7h: $5"	7d2: $5	$0 	"151: 20%,152: 20%,153: 20%"	$0 	$0 	"16b2: $5,16b1: $5,16b2: $5"	$0 	$0 	$0 	$0 	$0 	$0 												35.30041493	24.11882407	9.117121943	0	100	0.2	0.2	49.22945205	60.41021672	1.5	31.90875052	75	0	6.12745098	0	4.955743423	5	5	5	0	0.2	0	0	0	0	0	0	0	0	0											NO	34.77617641	23.76064084	8.981725615	0	98.51492249	0.197029845	0.197029845	48.49835653	59.51307817	1.477723837	31.43488084	73.88619187	0	6.036453584	0	4.882146792	4.925746124	4.925746124	4.925746124	0	0.197029845	0	0	0	0	0	0	0	0	0												8.4486	0.069044993	1.035562555	0	2.134727029	0.996971016	5.305001724	1.659860393	2.253080065	0.016194464	0.378845093	0.541258824	0	0.072167843	0	2.593955927	0.081878767	0.073227425	0.001235906	0	5.091998858	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7536		0.463599495	8.4486	0.069044993	1.035562555	0	2.134727029	0.996971016	5.305001724	1.659860393	2.253080065	0.016194464	0.378845093	0.541258824	0	0.072167843	0	2.593955927	0.081878767	0.073227425	0.001235906	0	5.091998858	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7536	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			8.4486	0.069044993	1.035562555	0	2.134727029	0.996971016	5.305001724	1.659860393	2.253080065	0.016194464	0.378845093	0.541258824	0	0.072167843	0	2.593955927	0.081878767	0.073227425	0.001235906	0	5.091998858	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7536
H5696_028_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	Coin	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	1776.355292	16.66328595	758.7630916	675.7731646	143.0692223	5.06	13.49144199	301.980589	417.2693291	80.89189382	97.19955728	73.53808529	0	74.72418344	5265.914958	4956.335117	74.39434868	128.4762472	5.839829419	0	31.12907298	0.582695554	0	0	84.4260075	11.88030644	24.51893032	4.549904596	0	0											4600	1a1:  $125 Days 1 to 7	1b1:  $125 Days 1 to 7	21:  $0 Days 11 to 100	$0 	10a: $100	11a: 20%	"11b: 20%,11c: 20%"	"4a1: $50,4a2: $50"	"9a1: $120,9b: $85"	"8a1: $2.5; Cardic Screen $0; AAA $0; EKG $0,8a2: $2.5"	"8b1: $4.5; $0 Office, $15 Facility,8b2: $100,8b3: $100,8b4: $55,8b5: $25,8b6: $25"	"5: $125,9a2: $120"	12: 20%	"3: $20,9a3: $120,9c: $20,9d1: $20"	$0 	"7b1: $20,7d1: $20,7f1: $20,17a1: $20,17b1: $20,18a1: $20"	"7c: $20,7i: $20"	"7e: $20,7h: $20"	7d2: $20	$0 	"151: 20%,152: 20%,153: 20%"	$0 	$0 	"16b2: $15,16b1: $20,16b2: $15"	17a2: $20	17b2: $20	18a2: $10	18b: $10	$0 	$0 												93.90164332	65.68416192	35	0	100	0.2	0.2	49.33228594	98.03297328	2.5	51.06102576	120	0	32.06349206	0	19.07173953	20	20	20	0	0.2	0	0	0	20	20	10	10	0	0											NO	92.6722775	64.82422102	34.54177795	0	98.69079414	0.197381588	0.197381588	48.68642476	96.74951985	2.467269853	50.39253182	118.428953	0	31.64371495	0	18.8220512	19.73815883	19.73815883	19.73815883	0	0.197381588	0	0	0	20	20	10	10	0	0												13.7182	0.090015378	2.184085519	0	1.176634597	0.998750837	2.662962248	1.225196269	3.36421727	0.016631844	0.408177649	0.725753204	0	0.197045897	0	7.774032778	0.122367289	0.211323714	0.009605623	0	6.144305866	0	0	0	0.140710012	0.019800511	0.020432442	0.003791587	0	0	0	0	0	0	0	0	0	0	0	0	41.2141		0.544284417	13.7182	0.090015378	2.184085519	0	1.176634597	0.998750837	2.662962248	1.225196269	3.36421727	0.016631844	0.408177649	0.725753204	0	0.197045897	0	7.774032778	0.122367289	0.211323714	0.009605623	0	6.144305866	0	0	0	0.140710012	0.019800511	0.020432442	0.003791587	0	0	0	0	0	0	0	0	0	0	0	0	41.2141	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			13.7182	0.090015378	2.184085519	0	1.176634597	0.998750837	2.662962248	1.225196269	3.36421727	0.016631844	0.408177649	0.725753204	0	0.197045897	0	7.774032778	0.122367289	0.211323714	0.009605623	0	6.144305866	0	0	0	0.140710012	0.019800511	0.020432442	0.003791587	0	0	0	0	0	0	0	0	0	0	0	0	41.2141
H5696_030_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	Coin	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	1496.005189	14.0334326	639.0126613	569.1204714	120.4895777	5.06	10.66748362	254.3210416	351.4145422	68.1252751	81.85921069	61.93206827	0	62.9309726	4434.831331	4174.110376	62.65319342	108.1997129	4.918168767	0	24.61329754	0.460728755	0	0	71.10162359	10.00531829	20.64927392	3.831824026	0	0											4600	1a1:  $225 Days 1 to 5	1b1:  $295 Days 1 to 6	21:  $50 Days 4 to 20; $100 Days 21 to 100	$0 	10a: $160	11a: 20%	"11b: 20%,11c: 20%"	"4a1: $50,4a2: $50,4b: $15"	"9a1: $225,9b: $125"	"8a1: $11; Cardic Screen $0; AAA $0; EKG $0,8a2: $11"	"8b1: $7.5; $0 Office, $25 Facility,8b2: $200,8b3: $100,8b4: $55,8b5: $60,8b6: $60"	"5: $225,9a2: $225"	12: 20%	"3: $40,9a3: $225,9c: $40,9d1: $40"	$0 	"7b1: $40,7d1: $40,7f1: $40,7g: $40,17a1: $40,17b1: $20,18a1: $40"	"7c: $40,7i: $40"	"7e: $40,7h: $40"	7d2: $40	$0 	"151: 20%,152: 20%,153: 20%"	$0 	$0 	"16b2: $15,16b1: $40,16b2: $15"	17a2: $20	17b2: $20	18a2: $10	18b: $10	$0 	$0 												145.8993303	142.301062	43.07564125	0	160	0.2	0.2	49.53260016	162.2370665	11	91.24333427	225	0	60.12698413	0	39.57735353	40	40	40	0	0.2	0	0	0	20	20	10	10	0	0											NO	142.8186852	139.2963939	42.16610477	0	156.6216211	0.195777026	0.195777026	48.48672584	158.8114522	10.76773645	89.3167433	220.2491547	0	58.85741078	0	38.74168293	39.15540527	39.15540527	39.15540527	0	0.195777026	0	0	0	20	20	10	10	0	0												17.8048	0.162900546	2.245389569	0	1.572606082	0.990631753	2.088448221	1.027599552	4.650721149	0.061129584	0.609283176	1.13670714	0	0.308662842	0	13.47600506	0.204434265	0.353050301	0.016047741	0	4.818718202	0	0	0	0.118502706	0.01667553	0.017207728	0.003193187	0	0	0	0	0	0	0	0	0	0	0	0	51.6827		1.111456742	17.8048	0.162900546	2.245389569	0	1.572606082	0.990631753	2.088448221	1.027599552	4.650721149	0.061129584	0.609283176	1.13670714	0	0.308662842	0	13.47600506	0.204434265	0.353050301	0.016047741	0	4.818718202	0	0	0	0.118502706	0.01667553	0.017207728	0.003193187	0	0	0	0	0	0	0	0	0	0	0	0	51.6827	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			17.8048	0.162900546	2.245389569	0	1.572606082	0.990631753	2.088448221	1.027599552	4.650721149	0.061129584	0.609283176	1.13670714	0	0.308662842	0	13.47600506	0.204434265	0.353050301	0.016047741	0	4.818718202	0	0	0	0.118502706	0.01667553	0.017207728	0.003193187	0	0	0	0	0	0	0	0	0	0	0	0	51.6827
H5696_031_0	2011	10																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	Coin	Coin	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	2425.746277	29.01465768	1151.224345	1199.806167	216.363371	5.06	22.19319957	476.8087772	378.013771	109.425039	120.335359	73.14507953	0	119.3727698	7901.834489	5342.430812	165.9750006	149.4579567	2.505283027	0	21.30211313	0.650342195	0	0	103.5052438	8.729357908	26.18807373	6.858781214	4800	0											3400	1a1:  $50 Days 6 to 12	1b1:  $75 Days 5 to 10	21:  $20 Days 6 to 75	$0 	$0 	11a: 20%	11b: 20%	"4a1: $25,4a2: $25,4b: $5"	"9a1: $25,9b: $25"	"8a1: $1.5; Cardic Screen $0; AAA $0; EKG $0,8a2: $1.5"	"; $0 Office, $10 Facility,8b2: $75,8b3: $30,8b4: $55,8b5: $20,8b6: $20"	9a2: $25	12: 20%	"3: $10,9a3: $25,9c: $5,9d1: $5"	$0 	"7b1: $5,7d1: $5,7f1: $5,7g: $5,17a1: $5,18a1: $5"	"7c: $5,7i: $5"	"7e: $5,7h: $5"	7d2: $5	$0 	"151: 20%,152: 20%,153: 20%"	$0 	$0 	"16b2: $5,16b1: $5,16b2: $5"	$0 	$0 	$0 	$0 	$0 	$0 												11.31801239	19.3473911	12.41278343	0	0	0.2	0.15920449	24.74455865	25	1.5	33.4234968	25	0	5.980392157	0	4.959553868	5	5	5	0	0.2	0	0	0	0	0	0	0	0	0											NO	11.29434172	19.30692765	12.38682313	0	0	0.2	0.15920449	24.74455865	24.96948669	1.496862876	33.40752985	24.94771459	0	5.968192228	0	4.95733754	5	4.99970953	4.989542918	0	0.199581717	0	0	0	0	0	0	0	0	0												2.2831	0.046681991	1.188334362	0	0	1.012	3.533257008	0.983201896	0.786567485	0.013649523	0.335008925	0.152066881	0	0.05936997	0	2.207019401	0.06915625	0.062270531	0.001041685	0	4.251512308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.9842		0.018866091	2.2831	0.046681991	1.188334362	0	0	1.012	3.533257008	0.983201896	0.786567485	0.013649523	0.335008925	0.152066881	0	0.05936997	0	2.207019401	0.06915625	0.062270531	0.001041685	0	4.251512308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.9842	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			2.2831	0.046681991	1.188334362	0	0	1.012	3.533257008	0.983201896	0.786567485	0.013649523	0.335008925	0.152066881	0	0.05936997	0	2.207019401	0.06915625	0.062270531	0.001041685	0	4.251512308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.9842
H5698_003_0	2011	7																															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	P	V	P	V	O																																																			0	YES	2406.488738	265.8127855	1595.837992	27.58905153	19.58635377	32.83787298	11.02451602	43.60976016	45.73101721	27.73033249		0.129827666		27.60565481	44.23559363	150.1895543	2.960500892	5.870542939	23.28485522		30.82141175	0.02262413			101.8519613																3400	"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, 40 annual trip limit"	Preventive Dental- $650 annual allowance	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;												147.139448	79.16766501	78.21383355	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233	0.233	0.233	0.233		0.209273631	0.233			9.934900835																NO	88.15829613	47.43314287	46.86165672	0.139601468	0.139601468	0.139601468	0.139601468	0.139601468	0.139601468	0.139601468		0.139601468		0.139601468	0.139601468	0.139601468	0.139601468	0.139601468	0.139601468		0.125385863	0.139601468			5.952475302																	17.6793	1.050694653	6.231967681	3.851472107	2.734283748	4.584215288	1.539038626	6.087986556	6.384117156	3.871195135	0	0.018124133	0	3.853789948	6.175353828	20.96668232	0.413290272	0.819536415	3.250599981	0	3.864569325	0.003158362	0	0	0.050522607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4299	0	62.50806734	17.6793	1.050694653	6.231967681	3.851472107	2.734283748	4.584215288	1.539038626	6.087986556	6.384117156	3.871195135	0	0.018124133	0	3.853789948	6.175353828	20.96668232	0.413290272	0.819536415	3.250599981	0	3.864569325	0.003158362	0	0	0.050522607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4299	NO																																																																																		0	0	0	17.6793	1.050694653	6.231967681	3.851472107	2.734283748	4.584215288	1.539038626	6.087986556	6.384117156	3.871195135	0	0.018124133	0	3.853789948	6.175353828	20.96668232	0.413290272	0.819536415	3.250599981	0	3.864569325	0.003158362	0	0	0.050522607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4299
H5698_009_0	2011	8																															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	P	V	P	V	O																																																			0	YES	2617.843149	143.4670629	771.9041317		15.0856668	17.59232631	9.374422808	30.81027772	34.94836147	12.13392213		0.064458099		23.54851412	45.79938515	133.50841	0.839203131	3.841578786	20.16465602		14.86776166	0.003304132			21.63346325		0.491690368														3400	"Medicare FFS Cost Sharing, unlimited days"	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, 40 annual trip limit"	Preventive Dental- $650 annual allowance	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;												123.4300236	70.65781421	86.44396692		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233	0.233	0.233	0.233		0.195005155	0.233			9.783630626		8.900790663														NO	83.44224931	47.76671655	58.43861024		0.157514708	0.157514708	0.157514708	0.157514708	0.157514708	0.157514708		0.157514708		0.157514708	0.157514708	0.157514708	0.157514708	0.157514708	0.157514708		0.131829099	0.157514708			6.614015961		6.760287887															18.2032	0.571079211	3.759083724	0	2.376214398	2.771050138	1.476609469	4.85307189	5.504880943	1.911271198	0	0.010153099	0	3.709237319	7.214076768	21.02953818	0.132186836	0.60510516	3.1762299	0	1.960003621	0.000520449	0	0	0.011923673	0	0.000276997	0	0	0	0	0	0	0	0	0	0	0	0	0	79.2757	0	37.99102554	18.2032	0.571079211	3.759083724	0	2.376214398	2.771050138	1.476609469	4.85307189	5.504880943	1.911271198	0	0.010153099	0	3.709237319	7.214076768	21.02953818	0.132186836	0.60510516	3.1762299	0	1.960003621	0.000520449	0	0	0.011923673	0	0.000276997	0	0	0	0	0	0	0	0	0	0	0	0	0	79.2757	NO																																																																																		0	0	0	18.2032	0.571079211	3.759083724	0	2.376214398	2.771050138	1.476609469	4.85307189	5.504880943	1.911271198	0	0.010153099	0	3.709237319	7.214076768	21.02953818	0.132186836	0.60510516	3.1762299	0	1.960003621	0.000520449	0	0	0.011923673	0	0.000276997	0	0	0	0	0	0	0	0	0	0	0	0	0	79.2757
H5698_020_0	2011	8																															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	P	V	P	V	O																																																			0	YES	1459.199207	24.34190957	385.50036		380.5643625	13.88236393	4.294325928	375.285369	320.7228782	245.7961542		2.769343943		25.73076286	2972.098638	3706.895627	106.3917833	310.9583853			15.51006389		15109.04957		64.52337026		1.271507831			120											3400	"Days 1-7: $100/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/day	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	ER: $50/visit; UC: $35/visit	Surgery: 20% or $300 /visit; ASC: 20% or $300	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% coinsurance; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$0/visit	$50/observation	$0/visit	Mammography Screening: $0/visit; CORF: $25/visit; Outpatient Mental Health: $25/visit; Partial Hospitalization: $50/day	$15/visit	$25/visit	Individual: $25/visit; Group: $15/visit	$25/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	"$3/visit, 40 trip limit"	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;												51.98789974	105.3832117	39.96648045		50	0.168	0.202274748	50	130.18047	76.58574127		50		25	15	24.99999465	25	25			0.190913958		0.985169287		20.08603313		8.903153018			20											NO	48.24167186	97.78933834	37.08651138		46.3970194	0.155893985	0.187698908	46.3970194	120.7997159	71.06700248		46.3970194		23.1985097	13.91910582	23.1985097	23.1985097	23.1985097			0.177156773		0.985169287		20.08603313		8.903153018			18.55880776												5.8662	0.198364936	1.191405291	0	1.471421009	2.164177037	0.806040288	1.451010212	3.228602713	1.455666325	0	0.010707442	0	0.049742946	3.447412954	7.166204515	0.205677568	0.601147593	0	0	2.747712863	0	1.240414299	0	0.108001546	0	0.000943369	0	0	0.185588078	0	0	0	0	0	0	0	0	0	0	33.5964	0	2.504158185	5.8662	0.198364936	1.191405291	0	1.471421009	2.164177037	0.806040288	1.451010212	3.228602713	1.455666325	0	0.010707442	0	0.049742946	3.447412954	7.166204515	0.205677568	0.601147593	0	0	2.747712863	0	1.240414299	0	0.108001546	0	0.000943369	0	0	0.185588078	0	0	0	0	0	0	0	0	0	0	33.5964	NO																																																																																		0	0	0	5.8662	0.198364936	1.191405291	0	1.471421009	2.164177037	0.806040288	1.451010212	3.228602713	1.455666325	0	0.010707442	0	0.049742946	3.447412954	7.166204515	0.205677568	0.601147593	0	0	2.747712863	0	1.240414299	0	0.108001546	0	0.000943369	0	0	0.185588078	0	0	0	0	0	0	0	0	0	0	33.5964
H5698_028_0	2011	7																															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	P	V	P	V	O																																																			0	YES	1568.267058	51.40340693	553.654999		479.509322	12.03335298	6.639293141	374.2488315	328.0855592	175.2435005		1.272955209		49.64525316	2650.777506	3240.615915	78.64512131	249.6440502			10.71913873		5279.051908		56.02474032		0.440921871			120											3400	"Days 1-7: $100/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/day	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	ER: $50/visit; UC: $35/visit	Surgery: 20% or $300 /visit; ASC: 20% or $300	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$0/visit	$50/observation	$0/visit	Mammography Screening: $0/visit; CORF: $25/visit; Outpatient Mental Health: $25/visit; Partial Hospitalization: $50/day	$15/visit	$25/visit	Individual: $25/visit; Group: $15/visit	$25/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	"$3/visit, 40 trip limit"	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;												51.98789974	105.3832117	39.96648045		50	0.168	0.200488065	50	123.5638618	82.04059339		50		25	15	25	25	25			0.183405423		2.826686751		24.65533178		9.194573408			20											NO	48.43031604	98.17173366	37.23153443		46.57845026	0.156503593	0.186775852	46.57845026	115.1082638	76.42647396		46.57845026		23.28922513	13.97353508	23.28922513	23.28922513	23.28922513			0.170854807		2.794707015		24.65533178		9.194573408			18.6313801												6.3293	0.420530131	1.71778543	0	1.861233425	1.883262975	1.240059634	1.452660882	3.147113258	1.116103569	0	0.004941023	0	0.096349956	3.086727705	6.289286134	0.152631995	0.484501374	0	0	1.831416382	0	1.229450283	0	0.115109047	0	0.000337841	0	0	0.186313801	0	0	0	0	0	0	0	0	0	0	32.6451	0	2.313260982	6.3293	0.420530131	1.71778543	0	1.861233425	1.883262975	1.240059634	1.452660882	3.147113258	1.116103569	0	0.004941023	0	0.096349956	3.086727705	6.289286134	0.152631995	0.484501374	0	0	1.831416382	0	1.229450283	0	0.115109047	0	0.000337841	0	0	0.186313801	0	0	0	0	0	0	0	0	0	0	32.6451	NO																																																																																		0	0	0	6.3293	0.420530131	1.71778543	0	1.861233425	1.883262975	1.240059634	1.452660882	3.147113258	1.116103569	0	0.004941023	0	0.096349956	3.086727705	6.289286134	0.152631995	0.484501374	0	0	1.831416382	0	1.229450283	0	0.115109047	0	0.000337841	0	0	0.186313801	0	0	0	0	0	0	0	0	0	0	32.6451
H5698_030_0	2011	6																															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	P	V	P	V	O																																																			0	YES	2694.750542	86.20077796	909.3379453	33.98506988	12.02400805		0.001962733	29.46745712	54.02939291	32.39734919		0.326258075		43.67546204	37.72593953	121.9980257	0.598144066	10.2193645	21.43788367		29.44068467				83.1146362																3400	"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, 40 annual trip limit"	Preventive Dental- $650 annual allowance	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;												125.2843684	76.37329328	84.45503978	0.233	0.233		0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233	0.233	0.233	0.233		0.212882327				10																NO	80.14678548	48.85744352	54.02748997	0.149054517	0.149054517		0.149054517	0.149054517	0.149054517	0.149054517		0.149054517		0.149054517	0.149054517	0.149054517	0.149054517	0.149054517	0.149054517		0.13618486				6.397189571																	17.998	0.35096247	4.094103893	5.065628176	1.792232712	0	0.000292554	4.392257588	8.053325064	4.828971236	0	0.04863024	0	6.5100249	5.623221696	18.18435679	0.089156075	1.52324244	3.195413396	0	4.009375529	0	0	0	0.04430834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8035	0	48.32335049	17.998	0.35096247	4.094103893	5.065628176	1.792232712	0	0.000292554	4.392257588	8.053325064	4.828971236	0	0.04863024	0	6.5100249	5.623221696	18.18435679	0.089156075	1.52324244	3.195413396	0	4.009375529	0	0	0	0.04430834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8035	NO																																																																																		0	0	0	17.998	0.35096247	4.094103893	5.065628176	1.792232712	0	0.000292554	4.392257588	8.053325064	4.828971236	0	0.04863024	0	6.5100249	5.623221696	18.18435679	0.089156075	1.52324244	3.195413396	0	4.009375529	0	0	0	0.04430834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8035
H5698_035_0	2011	5																															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	1211.472323	35.654055	96.77548032		406.2395604	8.156352195	1.400932629	281.0648728	173.9137846	162.1229543		0.517140429		15.61761245	1872.727383	1864.182968	38.85434984	86.69644957			6.094141234				45.99386736		0.179255758														3400	"Days 1-7: $150/day; Days 8-60: $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: $75/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												76.01735811	72.76534574	39.96648045		50	0.168	0.203208776	35	141.4999474	75		50		30	20	30	30	30			0.190994469				20.91686816		9.156658588														NO	73.26850928	70.13409229	38.52126036		48.19195977	0.161924985	0.195860583	33.73437184	136.3831954	72.28793966		48.19195977		28.91517586	19.27678391	28.91517586	28.91517586	28.91517586			0.184087955				20.91686816		9.156658588															7.3969	0.208380399	0.310659456	0	1.631456713	1.320717205	0.274387481	0.790128911	1.976576472	0.976627861	0	0.002076834	0	0.037632168	3.008346757	4.491931529	0.093623363	0.20890359	0	0	1.121858	0	0	0	0.080170638	0	0.000136782	0	0	0	0	0	0	0	0	0	0	0	0	0	23.9305	0	0.894799239	7.3969	0.208380399	0.310659456	0	1.631456713	1.320717205	0.274387481	0.790128911	1.976576472	0.976627861	0	0.002076834	0	0.037632168	3.008346757	4.491931529	0.093623363	0.20890359	0	0	1.121858	0	0	0	0.080170638	0	0.000136782	0	0	0	0	0	0	0	0	0	0	0	0	0	23.9305	NO																																																																																		0	0	0	7.3969	0.208380399	0.310659456	0	1.631456713	1.320717205	0.274387481	0.790128911	1.976576472	0.976627861	0	0.002076834	0	0.037632168	3.008346757	4.491931529	0.093623363	0.20890359	0	0	1.121858	0	0	0	0.080170638	0	0.000136782	0	0	0	0	0	0	0	0	0	0	0	0	0	23.9305
H5698_036_0	2011	8																															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	P	V	P	V	O																																																			0	YES	1733.296762	42.17097044	557.1111432		478.3831939	12.70400903	4.023356777	381.9690229	258.2325789	197.4403259		1.075969079		61.86822203	3135.404952	3764.701776	125.1946147	294.4240919			12.52605068		6723.949095		60.15463032		0.559483611			120											3400	"Days 1-7: $100/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/day	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	ER: $50/visit; UC: $35/visit	Surgery: 20% or $300 /visit; ASC: 20% or $300	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$0/visit	$50/observation	$0/visit	Mammography Screening: $0/visit; CORF: $25/visit; Outpatient Mental Health: $25/visit; Partial Hospitalization: $50/day	$15/visit	$25/visit	Individual: $25/visit; Group: $15/visit	$25/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	"$3/visit, 40 trip limit"	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;												51.98789974	105.3832117	39.96648045		50	0.168	0.202358207	50	124.3419373	77.2808508		50		25	15	25	25	25			0.184504652		2.553109931		21.49120232		9.590397641			20											NO	48.07259582	97.44660905	36.95653163		46.23440845	0.155347612	0.187135976	46.23440845	114.9775183	71.46068843		46.23440845		23.11720423	13.87032254	23.11720423	23.11720423	23.11720423			0.170609268		2.553109931		21.49120232		9.590397641			18.49376338												6.9437	0.342451506	1.715741299	0	1.843146999	1.973537471	0.752914799	1.471675985	2.474245089	1.175768468	0	0.004145566	0	0.119185027	3.62408983	7.252448317	0.241179123	0.567188488	0	0	2.137060342	0	1.430581768	0	0.107732944	0	0.000447139	0	0	0.184937634	0	0	0	0	0	0	0	0	0	0	34.3622	0	2.673245138	6.9437	0.342451506	1.715741299	0	1.843146999	1.973537471	0.752914799	1.471675985	2.474245089	1.175768468	0	0.004145566	0	0.119185027	3.62408983	7.252448317	0.241179123	0.567188488	0	0	2.137060342	0	1.430581768	0	0.107732944	0	0.000447139	0	0	0.184937634	0	0	0	0	0	0	0	0	0	0	34.3622	NO																																																																																		0	0	0	6.9437	0.342451506	1.715741299	0	1.843146999	1.973537471	0.752914799	1.471675985	2.474245089	1.175768468	0	0.004145566	0	0.119185027	3.62408983	7.252448317	0.241179123	0.567188488	0	0	2.137060342	0	1.430581768	0	0.107732944	0	0.000447139	0	0	0.184937634	0	0	0	0	0	0	0	0	0	0	34.3622
H5698_061_0	2011	5																															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	P	V	P	V	O																																																			0	YES	1240.539901	51.51360779	377.9856955		356.9670287	13.59214264	5.976288633	337.5778865	256.4497365	225.5665387		2.96077778		15.90074688	2949.140395	2933.849769	71.43586754	242.8474226			19.84370623				67.367146		249			120											6700	Days 1-7: $175/day; Days 8-60: $0/day; Days 61+: $125/day	Medicare FFS Cost Sharing	Days 11 - 20 : $50/day; Days 21-100: $140/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	ER: $50/visit; UC: $35/visit	$300/visit; ASC: $300/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $75/visit; PET Scan: $100/visit; CT Scan: $100/visit; MRI: $100/visit; Other Imaging: $0/visit;	$0/visit	$100/observation	$0/visit	Mammography Screening: $0/visit; CORF: $30/visit; Partial Hospitalization: $100/day; Outpatient Mental Health: $30/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: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Not Covered	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: Not Covered; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing												89.01433305	79.32004215	68.05921788		50	0.168	0.200124599	50	300	98.89725146		100		30	20	30	30	30			0.194995001				29.84546895		30			20											NO	86.34481372	76.94125237	66.01813762		48.50051153	0.162961719	0.194122908	48.50051153	291.0030692	95.93134569		97.00102305		29.10030692	19.40020461	29.10030692	29.10030692	29.10030692			0.189147146				28.95082359		29.10030692			19.40020461												8.9262	0.330293458	2.079492639	0	1.442756958	2.214998926	1.160134531	1.364391681	6.218971701	1.8032418	0	0.023933206	0	0.038559718	4.767827257	7.114660726	0.173233806	0.588911211	0	0	3.753380395	0	0	0	0.162527863	0	0.603831368	0	0	0.194002046	0	0	0	0	0	0	0	0	0	0	42.9613	0	1.328231463	8.9262	0.330293458	2.079492639	0	1.442756958	2.214998926	1.160134531	1.364391681	6.218971701	1.8032418	0	0.023933206	0	0.038559718	4.767827257	7.114660726	0.173233806	0.588911211	0	0	3.753380395	0	0	0	0.162527863	0	0.603831368	0	0	0.194002046	0	0	0	0	0	0	0	0	0	0	42.9613	NO																																																																																		0	0	0	8.9262	0.330293458	2.079492639	0	1.442756958	2.214998926	1.160134531	1.364391681	6.218971701	1.8032418	0	0.023933206	0	0.038559718	4.767827257	7.114660726	0.173233806	0.588911211	0	0	3.753380395	0	0	0	0.162527863	0	0.603831368	0	0	0.194002046	0	0	0	0	0	0	0	0	0	0	42.9613
H5698_062_0	2011	6																															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	P	V	P	V	O																																																			0	YES	1284.780979	59.91643613	616.5763055		427.6836304	12.18104174	5.329645227	365.2493745	276.2926943	224.256679		3.04094047		10.84027211	3581.923141	3324.11898	121.5606935	271.40348			18.22247552				91.80187846		249.0133514			120											6700	Days 1-7: $175/day; Days 8-60: $0/day; Days 61+: $125/day	Medicare FFS Cost Sharing	Days 11 - 20 : $50/day; Days 21-100: $140/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	ER: $50/visit; UC: $35/visit	$300/visit; ASC: $300/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $75/visit; PET Scan: $100/visit; CT Scan: $100/visit; MRI: $100/visit; Other Imaging: $0/visit;	$0/visit	$100/observation	$0/visit	Mammography Screening: $0/visit; CORF: $30/visit; Partial Hospitalization: $100/day; Outpatient Mental Health: $30/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: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Not Covered	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: Not Covered; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing												89.01433305	76.5430867	68.05921788		50	0.168	0.20011369	50	300	93.99418038		100		30	20	30	30	30			0.194916312				29.76841692		30			20											NO	85.87216332	73.8411469	65.65675519		48.23502035	0.162069668	0.193049758	48.23502035	289.4101221	90.67622407		96.4700407		28.94101221	19.29400814	28.94101221	28.94101221	28.94101221			0.188035846				28.71831146		28.94101221			19.29400814												9.1939	0.36869153	3.373533295	0	1.719110718	1.974177395	1.028886721	1.468150918	6.663491867	1.694562406	0	0.024446638	0	0.026144037	5.759137853	8.016947334	0.293174126	0.654557619	0	0	3.4264786	0	0	0	0.219699578	0	0.600558204	0	0	0.192940081	0	0	0	0	0	0	0	0	0	0	46.6986	0	1.708754465	9.1939	0.36869153	3.373533295	0	1.719110718	1.974177395	1.028886721	1.468150918	6.663491867	1.694562406	0	0.024446638	0	0.026144037	5.759137853	8.016947334	0.293174126	0.654557619	0	0	3.4264786	0	0	0	0.219699578	0	0.600558204	0	0	0.192940081	0	0	0	0	0	0	0	0	0	0	46.6986	NO																																																																																		0	0	0	9.1939	0.36869153	3.373533295	0	1.719110718	1.974177395	1.028886721	1.468150918	6.663491867	1.694562406	0	0.024446638	0	0.026144037	5.759137853	8.016947334	0.293174126	0.654557619	0	0	3.4264786	0	0	0	0.219699578	0	0.600558204	0	0	0.192940081	0	0	0	0	0	0	0	0	0	0	46.6986
H5698_063_0	2011	6																															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	P	V	P	V	O																																																			0	YES	1034.057737	66.68329034	412.6894725		277.3214173	10.14791419	8.34847484	318.6344115	263.6546114	209.6350032		4.093891958		20.63264758	3053.080008	3067.0751	100.7984209	344.4567442			13.74690755				73.60881933		249			120											6700	Days 1-7: $175/day; Days 8-60: $0/day; Days 61+: $125/day	Medicare FFS Cost Sharing	Days 11 - 20 : $50/day; Days 21-100: $140/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	ER: $50/visit; UC: $35/visit	$300/visit; ASC: $300/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $75/visit; PET Scan: $100/visit; CT Scan: $100/visit; MRI: $100/visit; Other Imaging: $0/visit;	$0/visit	$100/observation	$0/visit	Mammography Screening: $0/visit; CORF: $30/visit; Partial Hospitalization: $100/day; Outpatient Mental Health: $30/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: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Not Covered	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: Not Covered; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing												89.01433305	67.88460168	68.05921788		50	0.168	0.200235167	50	300	98.5781692		100		30	20	30	30	30			0.193996537				29.88345297		30			20											NO	86.627137	66.06406507	66.23399839		48.65909457	0.163494558	0.194865238	48.65909457	291.9545674	95.93448916		97.31818915		29.19545674	19.46363783	29.19545674	29.19545674	29.19545674			0.188793917				29.08229959		29.19545674			19.46363783												7.4648	0.367114103	2.277839488	0	1.124517423	1.659128743	1.626827537	1.292038497	6.414597334	1.675935579	0	0.033200846	0	0.050198298	4.952003628	7.462054869	0.245237995	0.838047665	0	0	2.595332522	0	0	0	0.178392811	0	0.605805727	0	0	0.194636378	0	0	0	0	0	0	0	0	0	0	41.0577	0	1.131431016	7.4648	0.367114103	2.277839488	0	1.124517423	1.659128743	1.626827537	1.292038497	6.414597334	1.675935579	0	0.033200846	0	0.050198298	4.952003628	7.462054869	0.245237995	0.838047665	0	0	2.595332522	0	0	0	0.178392811	0	0.605805727	0	0	0.194636378	0	0	0	0	0	0	0	0	0	0	41.0577	NO																																																																																		0	0	0	7.4648	0.367114103	2.277839488	0	1.124517423	1.659128743	1.626827537	1.292038497	6.414597334	1.675935579	0	0.033200846	0	0.050198298	4.952003628	7.462054869	0.245237995	0.838047665	0	0	2.595332522	0	0	0	0.178392811	0	0.605805727	0	0	0.194636378	0	0	0	0	0	0	0	0	0	0	41.0577
H5698_067_0	2011	7																															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	P	V	P	V	O																																																			0	YES	1736.785473	35.61105678	510.6607696		475.3174858	16.63598624	3.964910187	375.3682621	349.428179	351.2592437		1.831064693		17.08993714		5476.554364	73.21764786	539.5976217			40.85639869				86.14775152		1.272889235			593.1201949											3400	"Days 1-5: $75/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/day	Days 11 - 100 : $50/day	No Cost Sharing	$50/trip	10% Coinsurance	10% Coinsurance	ER: $25/visit; UC: $15/visit	Surgery: 10% or $300 /visit; ASC: 10% or $300	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $50/visit; Nuclear Medicine: $50/visit; PET Scan: $50/visit; CT Scan: $50/visit; MRI: $50/visit; Other Imaging: $0/visit;	$0/visit	$50/observation	$0/visit	Mammography Screening: $0/visit; CORF: $15/visit; Partial Hospitalization: $50/day; Outpatient Mental Health: $15/visit	$0/visit	$15/visit	Individual: $15./visit; Group: $10/visit	$15/visit	No Cost Sharing	No Cost Sharing	15% Coinsurance	No Cost Sharing	Not Covered	$250 Annual Allowance	Routine Eye Exam: $15	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: $15	$500 Annual Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20/installation; Fitness Program: No Cost Sharing;												33.46074975	105.3832117	32.08938547		50	0.084	0.1	25	99.61486551	50		50		15		15	15	15			0.147846014				14.95225737		15			20											NO	31.70508451	99.85381849	30.40567488		47.37653033	0.079592571	0.094753061	23.68826517	94.38813394	47.37653033		47.37653033		14.2129591		14.2129591	14.2129591	14.2129591			0.140088623				14.16812373		14.2129591			18.95061213												4.5887	0.296325	1.293915445	0	1.87657444	1.324100915	0.375687375	0.740985244	2.74848948	1.386787018	0	0.007229124	0	0.020241548	0	6.486503599	0.086719953	0.639106577	0	0	5.723516634	0	0	0	0.101712667	0	0.001507627	0	0	0.936665897	0	0	0	0	0	0	0	0	0	0	28.6348	0	1.585646263	4.5887	0.296325	1.293915445	0	1.87657444	1.324100915	0.375687375	0.740985244	2.74848948	1.386787018	0	0.007229124	0	0.020241548	0	6.486503599	0.086719953	0.639106577	0	0	5.723516634	0	0	0	0.101712667	0	0.001507627	0	0	0.936665897	0	0	0	0	0	0	0	0	0	0	28.6348	NO																																																																																		0	0	0	4.5887	0.296325	1.293915445	0	1.87657444	1.324100915	0.375687375	0.740985244	2.74848948	1.386787018	0	0.007229124	0	0.020241548	0	6.486503599	0.086719953	0.639106577	0	0	5.723516634	0	0	0	0.101712667	0	0.001507627	0	0	0.936665897	0	0	0	0	0	0	0	0	0	0	28.6348
H5698_068_0	2011	8																															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	P	V	P	V	O																																																			0	YES	1908.831158	42.20232153	996.6436483		562.2228179	21.20777801	8.792124436	411.9976559	423.3683364	315.7258945		2.274136095		21.6042929		6963.707006	224.0188209	860.2948615			38.66115214				109.9808194		3.554001237			686.2230024											3400	"Days 1-5: $75/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/day	Days 11 - 100 : $50/day	No Cost Sharing	$50/trip	10% Coinsurance	10% Coinsurance	ER: $25/visit; UC: $15/visit	Surgery: 10% or $300 /visit; ASC: 10% or $300	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $50/visit; Nuclear Medicine: $50/visit; PET Scan: $50/visit; CT Scan: $50/visit; MRI: $50/visit; Other Imaging: $0/visit;	$0/visit	$50/observation	$0/visit	Mammography Screening: $0/visit; CORF: $15/visit; Partial Hospitalization: $50/day; Outpatient Mental Health: $15/visit	$0/visit	$15/visit	Individual: $15./visit; Group: $10/visit	$15/visit	No Cost Sharing	No Cost Sharing	15% Coinsurance	No Cost Sharing	Not Covered	$250 Annual Allowance	Routine Eye Exam: $15	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: $15	$500 Annual Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20/installation; Fitness Program: No Cost Sharing;												33.45732512	105.3832117	32.08938547		50	0.084	0.1	25	92.58883194	50		50		15		15	15	15			0.148393522				15		15			20											NO	31.06501099	97.8479486	29.79488375		46.42482756	0.07799371	0.092849655	23.21241378	85.96841114	46.42482756		46.42482756		13.92744827		13.92744827	13.92744827	13.92744827			0.137782873				13.92744827		13.92744827			18.56993102												4.9415	0.344117549	2.47457347	0	2.175091448	1.654073295	0.816345722	0.796955005	3.033025267	1.221460018	0	0.008798031	0	0.025074389	0	8.082222424	0.260000878	0.998476015	0	0	5.326844626	0	0	0	0.127646014	0	0.004124847	0	0	1.061926152	0	0	0	0	0	0	0	0	0	0	33.3522	0	2.568453738	4.9415	0.344117549	2.47457347	0	2.175091448	1.654073295	0.816345722	0.796955005	3.033025267	1.221460018	0	0.008798031	0	0.025074389	0	8.082222424	0.260000878	0.998476015	0	0	5.326844626	0	0	0	0.127646014	0	0.004124847	0	0	1.061926152	0	0	0	0	0	0	0	0	0	0	33.3522	NO																																																																																		0	0	0	4.9415	0.344117549	2.47457347	0	2.175091448	1.654073295	0.816345722	0.796955005	3.033025267	1.221460018	0	0.008798031	0	0.025074389	0	8.082222424	0.260000878	0.998476015	0	0	5.326844626	0	0	0	0.127646014	0	0.004124847	0	0	1.061926152	0	0	0	0	0	0	0	0	0	0	33.3522
H5698_069_0	2011	7																															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	P	V	P	V	O																																																			0	YES	1836.469238	58.90935828	748.8810905		529.5954573	26.03477389	6.874159082	406.1253957	424.7124843	328.731875		16.32099524		31.42124923		7176.653033	184.753465	822.0484821			34.51819873				131.2174158		0.552418341			953.4886758											3400	"Days 1-5: $75/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/day	Days 11 - 100 : $50/day	No Cost Sharing	$50/trip	10% Coinsurance	10% Coinsurance	ER: $25/visit; UC: $15/visit	Surgery: 10% or $300 /visit; ASC: 10% or $300	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $50/visit; Nuclear Medicine: $50/visit; PET Scan: $50/visit; CT Scan: $50/visit; MRI: $50/visit; Other Imaging: $0/visit;	$0/visit	$50/observation	$0/visit	Mammography Screening: $0/visit; CORF: $15/visit; Partial Hospitalization: $50/day; Outpatient Mental Health: $15/visit	$0/visit	$15/visit	Individual: $15./visit; Group: $10/visit	$15/visit	No Cost Sharing	No Cost Sharing	15% Coinsurance	No Cost Sharing	Not Covered	$250 Annual Allowance	Routine Eye Exam: $15	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: $15	$500 Annual Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20/installation; Fitness Program: No Cost Sharing;												33.50235694	105.3832117	32.08938547		50	0.084	0.1	25	92.85091318	50		50		15		15	15	15			0.147550862				14.99455352		15			20											NO	31.17134264	98.05089847	29.85668236		46.52111893	0.07815548	0.093042238	23.26055946	86.39056749	46.52111893		46.52111893		13.95633568		13.95633568	13.95633568	13.95633568			0.137284624				13.95132857		13.95633568			18.60844757												4.7704	0.481342959	1.863258737	0	2.053114438	2.034760245	0.639587144	0.787225326	3.057596045	1.274414554	0	0.06327258	0	0.036543792	0	8.346648231	0.214873448	0.95606538	0	0	4.738817944	0	0	0	0.152554774	0	0.000642478	0	0	1.478578669	0	0	0	0	0	0	0	0	0	0	32.9497	0	2.464002701	4.7704	0.481342959	1.863258737	0	2.053114438	2.034760245	0.639587144	0.787225326	3.057596045	1.274414554	0	0.06327258	0	0.036543792	0	8.346648231	0.214873448	0.95606538	0	0	4.738817944	0	0	0	0.152554774	0	0.000642478	0	0	1.478578669	0	0	0	0	0	0	0	0	0	0	32.9497	NO																																																																																		0	0	0	4.7704	0.481342959	1.863258737	0	2.053114438	2.034760245	0.639587144	0.787225326	3.057596045	1.274414554	0	0.06327258	0	0.036543792	0	8.346648231	0.214873448	0.95606538	0	0	4.738817944	0	0	0	0.152554774	0	0.000642478	0	0	1.478578669	0	0	0	0	0	0	0	0	0	0	32.9497
H5698_122_0	2011	7																															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	P	V	P	V	O																																																			0	YES																																									3400	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	No Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered																																																				NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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
H5698_128_0	2011	7																															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	P	V	P	V	O																																																			0	YES	2285.501827	96.22057734	925.0130773	20.94301998	11.77426785	31.09412357	3.078437952	34.0247007	56.21151306	21.70933068		0.037622706		23.40200209	52.03137874	149.3902252	2.219055342	5.049127141	23.33092359		39.10679925				91.65723454																3400	"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, 40 annual trip limit"	Preventive Dental: $650 annual allowance	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;												136.2712697	86.53378546	77.44990199	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233	0.233	0.233	0.233		0.20826391				10																NO	85.09187709	54.03429684	48.36204694	0.145492204	0.145492204	0.145492204	0.145492204	0.145492204	0.145492204	0.145492204		0.145492204		0.145492204	0.145492204	0.145492204	0.145492204	0.145492204	0.145492204		0.130046246				6.244300599																	16.2065	0.433267603	3.727960489	3.047046135	1.713064179	4.523952568	0.447888722	4.950328695	8.178336923	3.158538367	0	0.00547381	0	3.404808861	7.570159969	21.73511311	0.322855252	0.734608636	3.394467493	0	5.085692438	0	0	0	0.04769461	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.6877	0	53.34215437	16.2065	0.433267603	3.727960489	3.047046135	1.713064179	4.523952568	0.447888722	4.950328695	8.178336923	3.158538367	0	0.00547381	0	3.404808861	7.570159969	21.73511311	0.322855252	0.734608636	3.394467493	0	5.085692438	0	0	0	0.04769461	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.6877	NO																																																																																		0	0	0	16.2065	0.433267603	3.727960489	3.047046135	1.713064179	4.523952568	0.447888722	4.950328695	8.178336923	3.158538367	0	0.00547381	0	3.404808861	7.570159969	21.73511311	0.322855252	0.734608636	3.394467493	0	5.085692438	0	0	0	0.04769461	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.6877
H5698_129_0	2011	8																															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	P	V	P	V	O																																																			0	YES	1663.381572	1174.282313	1082.949616		479.3658007	18.783326	7.841481647	650.4564294	461.0003106	431.1027601		21.88942701			3961.137219	5070.174406		603.7557063			23.83377025				136.4085701		178.151587														4500	"Days 1-7: $150/day; Days 8-60: $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: 5% Coinsurance; 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	$10/visit	$20/visit	Individual: $0/visit; Group: $0/visit	$20/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	"No Cost Sharing, 100 annual trip limit"	$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;												76.01735811	47.44525547	39.96648045		50	0.164	0.2	50	69.49510187	65.86425544		20			10	20		20			0.197791088				30		30														NO	69.92091334	43.64023795	36.76124619		45.99009692	0.150847518	0.183960388	45.99009692	63.92172941	60.58206982		18.39603877			9.198019384	18.39603877		18.39603877			0.181928626				27.59405815		27.59405815															9.6921	4.270496631	3.317548121	0	1.837173303	2.833418104	1.442522004	2.492879519	2.455661426	2.176424793	0	0.033556562	0	0	3.036218077	7.772593744	0	0.925559448	0	0	4.336045084	0	0	0	0.313672168	0	0.409660438	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3455	0	4.128083721	9.6921	4.270496631	3.317548121	0	1.837173303	2.833418104	1.442522004	2.492879519	2.455661426	2.176424793	0	0.033556562	0	0	3.036218077	7.772593744	0	0.925559448	0	0	4.336045084	0	0	0	0.313672168	0	0.409660438	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3455	NO																																																																																		0	0	0	9.6921	4.270496631	3.317548121	0	1.837173303	2.833418104	1.442522004	2.492879519	2.455661426	2.176424793	0	0.033556562	0	0	3.036218077	7.772593744	0	0.925559448	0	0	4.336045084	0	0	0	0.313672168	0	0.409660438	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3455
H5698_134_0	2011	6																															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	P	V	P	V	O																																																			0	YES	2401.391945	121.6669703	776.3807551	34.20931517	16.52683718		0.037929293	35.37624202	46.93630647	20.80300094		0.161451621		34.02848815	48.11777567	147.1401909	0.895997453	6.573775622	23.86414093		24.53788747	0.002749516			41.68000179		0.374056406														3400	"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, 40 annual trip limit"	Preventive Dental: $650 annual allowance	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;												143.824142	84.05384238	90.95841905	0.233	0.233		0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233	0.233	0.233	0.233		0.205064434	0.233			9.91497445		9.748040858														NO	91.12065927	53.25282267	57.62725918	0.147618566	0.147618566		0.147618566	0.147618566	0.147618566	0.147618566		0.147618566		0.147618566	0.147618566	0.147618566	0.147618566	0.147618566	0.147618566		0.129919818	0.147618566			6.281692321		6.335560774															18.2347	0.5399258	3.72839125	5.049930051	2.439668005	0	0.005599068	5.222190119	6.928670256	3.070909168	0	0.023833257	0	5.023236626	7.103077045	21.72062399	0.132265859	0.970411331	3.522790264	0	3.187957886	0.00040588	0	0	0.021818412	0	0.000197488	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9266	0	50.27766539	18.2347	0.5399258	3.72839125	5.049930051	2.439668005	0	0.005599068	5.222190119	6.928670256	3.070909168	0	0.023833257	0	5.023236626	7.103077045	21.72062399	0.132265859	0.970411331	3.522790264	0	3.187957886	0.00040588	0	0	0.021818412	0	0.000197488	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9266	NO																																																																																		0	0	0	18.2347	0.5399258	3.72839125	5.049930051	2.439668005	0	0.005599068	5.222190119	6.928670256	3.070909168	0	0.023833257	0	5.023236626	7.103077045	21.72062399	0.132265859	0.970411331	3.522790264	0	3.187957886	0.00040588	0	0	0.021818412	0	0.000197488	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9266
H5698_140_0	2011	7																															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	P	V	P	V	O																																																			0	YES	1714.889841	67.87980812	949.234044	25.51993793	17.23236141	32.39573178	10.81312966	33.37642515	49.44628765	22.30333589		0.029100596		19.46295731	45.97316272	161.7404618	1.317115944	7.546180466	22.02603918		37.45073975	0.003604887			57.82372499																3400	"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, 40 annual trip limit"	Preventive Dental: $650 annual allowance	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;												165.3166889	81.25569638	88.30113801	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233	0.233	0.233	0.233		0.209560382	0.233			9.971722041																NO	102.7519988	50.5041885	54.88325764	0.14482032	0.14482032	0.14482032	0.14482032	0.14482032	0.14482032	0.14482032		0.14482032		0.14482032	0.14482032	0.14482032	0.14482032	0.14482032	0.14482032		0.130251509	0.14482032			6.197888297																	14.684	0.285684552	4.341421383	3.695805568	2.495596087	4.69156023	1.565960894	4.833584558	7.160827182	3.229976233	0	0.004214358	0	2.818631699	6.657848119	23.42330538	0.190745152	1.092840267	3.189818034	0	4.878015352	0.000522061	0	0	0.029865416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2703	0	54.35578617	14.684	0.285684552	4.341421383	3.695805568	2.495596087	4.69156023	1.565960894	4.833584558	7.160827182	3.229976233	0	0.004214358	0	2.818631699	6.657848119	23.42330538	0.190745152	1.092840267	3.189818034	0	4.878015352	0.000522061	0	0	0.029865416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2703	NO																																																																																		0	0	0	14.684	0.285684552	4.341421383	3.695805568	2.495596087	4.69156023	1.565960894	4.833584558	7.160827182	3.229976233	0	0.004214358	0	2.818631699	6.657848119	23.42330538	0.190745152	1.092840267	3.189818034	0	4.878015352	0.000522061	0	0	0.029865416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2703
H5698_141_0	2011	7																															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	P	V	P	V	O																																																			0	YES	1803.266396	1216.039993	1365.489936		556.3920198	23.46152649	8.067341617	721.0693086	597.8902334	452.9402108		23.11401822			4427.127409	6029.807755		593.770069			19.41425468				125.7609442		162.1320636														4500	"Days 1-7: $150/day; Days 8-60: $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: 5% Coinsurance; 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	$10/visit	$20/visit	Individual: $0/visit; Group: $0/visit	$20/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	"No Cost Sharing, 100 annual trip limit"	$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;												76.01735811	47.44525547	39.96648045		50	0.164	0.2	50	72.75119608	66.17101982		20			10	20		20			0.195255261				30		30														NO	68.83193779	42.96056788	36.18871221		45.27382923	0.14849816	0.181095317	45.27382923	65.87450455	59.91630903		18.10953169			9.054765845	18.10953169		18.10953169			0.176799067				27.16429754		27.16429754															10.3435	4.35348072	4.117943526	0	2.099166441	3.483993511	1.460957787	2.720464062	3.282143575	2.261542137	0	0.034882004	0	0	3.340550171	9.099749553	0	0.896074823	0	0	3.432422112	0	0	0	0.284683976	0	0.367016968	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5786	0	5.384330569	10.3435	4.35348072	4.117943526	0	2.099166441	3.483993511	1.460957787	2.720464062	3.282143575	2.261542137	0	0.034882004	0	0	3.340550171	9.099749553	0	0.896074823	0	0	3.432422112	0	0	0	0.284683976	0	0.367016968	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5786	NO																																																																																		0	0	0	10.3435	4.35348072	4.117943526	0	2.099166441	3.483993511	1.460957787	2.720464062	3.282143575	2.261542137	0	0.034882004	0	0	3.340550171	9.099749553	0	0.896074823	0	0	3.432422112	0	0	0	0.284683976	0	0.367016968	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5786
H5698_150_0	2011	5																															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	P	V	P	V	O																																																			0	YES	1296.52692	61.87681048	572.2392344		445.4477837	12.42707661	5.567989436	373.3991668	280.046814	212.5064602		2.489438476		8.861072068	3662.269627	3346.140136	114.274692	290.2361449			20.5613735				96.26404904		249			120											6700	Days 1-7: $175/day; Days 8-60: $0/day; Days 61+: $125/day	Medicare FFS Cost Sharing	Days 11 - 20 : $50/day; Days 21-100: $140/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	ER: $50/visit; UC: $35/visit	$300/visit; ASC: $300/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $75/visit; PET Scan: $100/visit; CT Scan: $100/visit; MRI: $100/visit; Other Imaging: $0/visit;	$0/visit	$100/observation	$0/visit	Mammography Screening: $0/visit; CORF: $30/visit; Partial Hospitalization: $100/day; Outpatient Mental Health: $30/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: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Not Covered	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: Not Covered; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing												89.01433305	80.32142381	68.05921788		50	0.168	0.200100448	50	300	99.05352875		100		30	20	30	30	30			0.195679191				29.74672044		30			20											NO	85.78459628	77.40709478	65.58980255		48.18583331	0.1619044	0.192840136	48.18583331	289.1149998	95.45953649		96.37166661		28.91149998	19.27433332	28.91149998	28.91149998	28.91149998			0.188579298				28.66822557		28.91149998			19.27433332												9.2685	0.399142011	3.127754866	0	1.788689388	2.011998381	1.073731843	1.499379167	6.747144549	1.690480683	0	0.019992611	0	0.021348907	5.882317126	8.061827541	0.275321063	0.699263525	0	0	3.877449373	0	0	0	0.229976623	0	0.599913625	0	0	0.192743333	0	0	0	0	0	0	0	0	0	0	47.467	0	1.787095443	9.2685	0.399142011	3.127754866	0	1.788689388	2.011998381	1.073731843	1.499379167	6.747144549	1.690480683	0	0.019992611	0	0.021348907	5.882317126	8.061827541	0.275321063	0.699263525	0	0	3.877449373	0	0	0	0.229976623	0	0.599913625	0	0	0.192743333	0	0	0	0	0	0	0	0	0	0	47.467	NO																																																																																		0	0	0	9.2685	0.399142011	3.127754866	0	1.788689388	2.011998381	1.073731843	1.499379167	6.747144549	1.690480683	0	0.019992611	0	0.021348907	5.882317126	8.061827541	0.275321063	0.699263525	0	0	3.877449373	0	0	0	0.229976623	0	0.599913625	0	0	0.192743333	0	0	0	0	0	0	0	0	0	0	47.467
H5698_151_0	2011	8																															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	P	V	P	V	O																																																			0	YES	1663.58191	33.46016582	241.0027242		564.6609219	14.40100452	5.353140889	372.0848307	337.8938931	267.0456411		2.290560898		25.90020344	3251.888788	4076.793314	120.4775466	355.1450371			15.52294476		18027.56821		75.5362154		0.439983808			120											3400	"Days 1-7: $100/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/day	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	ER: $50/visit; UC: $35/visit	Surgery: 20% or $300 /visit; ASC: 20% or $300	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$0/visit	$50/observation	$0/visit	Mammography Screening: $0/visit; CORF: $25/visit; Outpatient Mental Health: $25/visit; Partial Hospitalization: $50/day	$15/visit	$25/visit	Individual: $25/visit; Group: $15/visit	$25/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	"$3/visit, 40 trip limit"	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;												51.98789974	105.3832117	39.96648045		50	0.168	0.200975745	50	117.4880794	74.68172054		50		25	15	25	25	25			0.186955638		0.996468764		22.21741194		9.295565912			20											NO	48.07957956	104.5391421	36.96097141		46.23996284	0.155366275	0.18586222	46.23996284	108.6528885	69.06559965		46.23996284		23.11998142	13.87198885	23.11998142	23.11998142	23.11998142			0.177930021		0.996468764		22.21741194		9.295565912			18.49598514												6.6654	0.291491419	0.7423079	0	2.175825004	2.237430431	0.994946649	1.433765729	3.059428959	1.536972278	0	0.008826288	0	0.049901019	3.759180418	7.854615472	0.232119887	0.684245555	0	0	2.761997879	0	1.496992384	0	0.139851601	0	0.000340825	0	0	0.184959851	0	0	0	0	0	0	0	0	0	0	36.3106	0	2.713471179	6.6654	0.291491419	0.7423079	0	2.175825004	2.237430431	0.994946649	1.433765729	3.059428959	1.536972278	0	0.008826288	0	0.049901019	3.759180418	7.854615472	0.232119887	0.684245555	0	0	2.761997879	0	1.496992384	0	0.139851601	0	0.000340825	0	0	0.184959851	0	0	0	0	0	0	0	0	0	0	36.3106	NO																																																																																		0	0	0	6.6654	0.291491419	0.7423079	0	2.175825004	2.237430431	0.994946649	1.433765729	3.059428959	1.536972278	0	0.008826288	0	0.049901019	3.759180418	7.854615472	0.232119887	0.684245555	0	0	2.761997879	0	1.496992384	0	0.139851601	0	0.000340825	0	0	0.184959851	0	0	0	0	0	0	0	0	0	0	36.3106
H5698_152_0	2011	6																															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	P	V	P	V	O																																																			0	YES	1857.734662	55.23674392	363.9087399		689.8037366	23.85718146	10.21758072	389.325922	465.2686202	306.4043488		3.377005363		8.04829068		6628.848089	293.2882131	929.4504134			29.99766261				139.3770877		1.822281366			682.7337199											3400	"Days 1-5: $75/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/day	Days 11 - 100 : $50/day	No Cost Sharing	$50/trip	10% Coinsurance	10% Coinsurance	ER: $25/visit; UC: $15/visit	Surgery: 10% or $300 /visit; ASC: 10% or $300	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $50/visit; Nuclear Medicine: $50/visit; PET Scan: $50/visit; CT Scan: $50/visit; MRI: $50/visit; Other Imaging: $0/visit;	$0/visit	$50/observation	$0/visit	Mammography Screening: $0/visit; CORF: $15/visit; Partial Hospitalization: $50/day; Outpatient Mental Health: $15/visit	$0/visit	$15/visit	Individual: $15./visit; Group: $10/visit	$15/visit	No Cost Sharing	No Cost Sharing	15% Coinsurance	No Cost Sharing	Not Covered	$250 Annual Allowance	Routine Eye Exam: $15	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: $15	$500 Annual Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20/installation; Fitness Program: No Cost Sharing;												33.46507375	105.3832117	32.08938547		50	0.084	0.1	25	91.05799246	50		50		15		15	15	15			0.147946099				14.99418516		15			20											NO	31.3126502	98.60512092	30.02544414		46.78407469	0.078597245	0.093568149	23.39203734	85.2012784	46.78407469		46.78407469		14.03522241		14.03522241	14.03522241	14.03522241			0.138430427				14.02984189		14.03522241			18.71362988												4.8475	0.453885484	0.910543462	0	2.689319128	1.875108748	0.95604012	0.758927209	3.30345677	1.194570328	0	0.013165839	0	0.009413296	0	7.753113102	0.343030442	1.087086939	0	0	4.152589234	0	0	0	0.162953209	0	0.002131344	0	0	1.064702178	0	0	0	0	0	0	0	0	0	0	31.5776	0	2.170634457	4.8475	0.453885484	0.910543462	0	2.689319128	1.875108748	0.95604012	0.758927209	3.30345677	1.194570328	0	0.013165839	0	0.009413296	0	7.753113102	0.343030442	1.087086939	0	0	4.152589234	0	0	0	0.162953209	0	0.002131344	0	0	1.064702178	0	0	0	0	0	0	0	0	0	0	31.5776	NO																																																																																		0	0	0	4.8475	0.453885484	0.910543462	0	2.689319128	1.875108748	0.95604012	0.758927209	3.30345677	1.194570328	0	0.013165839	0	0.009413296	0	7.753113102	0.343030442	1.087086939	0	0	4.152589234	0	0	0	0.162953209	0	0.002131344	0	0	1.064702178	0	0	0	0	0	0	0	0	0	0	31.5776
H5698_153_0	2011	5																															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	P	V	P	V	O																																																			0	YES	1758.940278	66.02740411	1044.841229		324.9446742	19.88521776	13.36626181	402.090954	463.7967425	509.5863849		30.80622509		11.64319615	4422.23938	5192.594617	233.0719741	531.1922743			36.01795016		25742.23071				186.6670553														4500	"Days 1-7: $150/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/day	Days 11 - 20 : $50/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: 5% Coinsurance; 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	$10/visit	$20/visit	Individual: $20/visit; Group: $10/visit	$0/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	"$3/trip, 20 annual trip limit"	$250 Annual Allowance	Routine Eye Exam: $0	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 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;												76.01735811	105.3832117	52.0726257		50	0.15	0.2	50	85.62464738	56.31184239		50		17.41669731	10	19.1365833	19.98033947	20			0.193352425		0.226838038				30														NO	69.76611475	96.71708438	47.79046352		45.888279	0.137664837	0.183553116	45.888279	78.58335416	51.68107069		45.888279		15.98444531	9.177655799	17.56289747	18.33726784	18.3553116			0.177452201		0.226838038				27.5329674															10.2262	0.532164835	4.161120554	0	1.242595989	2.737495262	2.453419004	1.537605157	3.037225306	2.194664165	0	0.117803721	0	0.015509169	3.382149241	7.599750573	0.356158601	0.812516643	0	0	6.391464518	0	0.486609759	0	0	0	0.428291496	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7127	0	4.231596876	10.2262	0.532164835	4.161120554	0	1.242595989	2.737495262	2.453419004	1.537605157	3.037225306	2.194664165	0	0.117803721	0	0.015509169	3.382149241	7.599750573	0.356158601	0.812516643	0	0	6.391464518	0	0.486609759	0	0	0	0.428291496	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7127	NO																																																																																		0	0	0	10.2262	0.532164835	4.161120554	0	1.242595989	2.737495262	2.453419004	1.537605157	3.037225306	2.194664165	0	0.117803721	0	0.015509169	3.382149241	7.599750573	0.356158601	0.812516643	0	0	6.391464518	0	0.486609759	0	0	0	0.428291496	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7127
H5698_154_0	2011	6																															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	P	V	P	V	O																																																			0	YES	1656.20867	76.21166236	1115.473622		238.4369215	20.0876031	11.63520603	347.6920802	463.8464796	580.8850501		41.33467271		15.62241725	4098.719261	4808.888192	229.7141749	608.7031291			36.57498897						249														4500	"Days 1-7: $150/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/day	Days 11 - 20 : $50/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: 5% Coinsurance; 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	$10/visit	$20/visit	Individual: $20/visit; Group: $10/visit	$0/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	"$3/trip, 20 annual trip limit"	$250 Annual Allowance	Routine Eye Exam: $0	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 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;												76.01735811	105.3832117	52.0726257		50	0.15	0.2	50	80.12452816	52.99775455		50		17.41669731	10	19.15300278	20	20			0.2						30														NO	70.22232628	97.34953251	48.10297283		46.18834962	0.138565049	0.184753398	46.18834962	74.0163944	48.95757633		46.18834962		16.0889701	9.237669925	17.69291178	18.47533985	18.47533985			0.184753398						27.71300977															9.6919	0.618264142	4.471466446	0	0.917750658	2.783439705	2.149643855	1.338276947	2.861020331	2.369893681	0	0.15909836	0	0.020945717	3.155217971	7.090269544	0.353670621	0.937166431	0	0	6.757353511	0	0	0	0	0	0.575044953	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2504	0	3.816773089	9.6919	0.618264142	4.471466446	0	0.917750658	2.783439705	2.149643855	1.338276947	2.861020331	2.369893681	0	0.15909836	0	0.020945717	3.155217971	7.090269544	0.353670621	0.937166431	0	0	6.757353511	0	0	0	0	0	0.575044953	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2504	NO																																																																																		0	0	0	9.6919	0.618264142	4.471466446	0	0.917750658	2.783439705	2.149643855	1.338276947	2.861020331	2.369893681	0	0.15909836	0	0.020945717	3.155217971	7.090269544	0.353670621	0.937166431	0	0	6.757353511	0	0	0	0	0	0.575044953	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2504
H5698_155_0	2011	7																															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	P	V	P	V	O																																																			0	YES	2108.990046	58.60937778	938.8248901		370.7106308	18.11176342	13.28530308	441.2880467	405.7262482	474.9095789		32.09178015		27.38804849	4131.884308	4854.995542	198.1427528	475.7348255			36.47520068		24423.14653				183.8502868														4500	"Days 1-7: $150/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/day	Days 11 - 20 : $50/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: 5% Coinsurance; 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	$10/visit	$20/visit	Individual: $20/visit; Group: $10/visit	$0/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	"$3/trip, 20 annual trip limit"	$250 Annual Allowance	Routine Eye Exam: $0	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 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;												76.01735811	105.3832117	52.0726257		50	0.15	0.2	50	84.38901765	55.53614861		50		18.92732626	10	19.13821728	20	20			0.194780182		0.1139792				30														NO	69.74353823	96.68578645	47.77499839		45.87342942	0.137620288	0.183493718	45.87342942	77.42427289	50.95267187		45.87342942		17.36522731	9.174685883	17.55871319	18.34937177	18.34937177			0.178704698		0.1139792				27.52405765															12.2574	0.472224482	3.737696468	0	1.41714733	2.492546102	2.437769652	1.686949672	2.61775498	2.016492662	0	0.122680001	0	0.039633307	3.15906172	7.103956187	0.30298292	0.727452931	0	0	6.518289735	0	0.231977559	0	0	0	0.421692158	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7637	0	4.2757412	12.2574	0.472224482	3.737696468	0	1.41714733	2.492546102	2.437769652	1.686949672	2.61775498	2.016492662	0	0.122680001	0	0.039633307	3.15906172	7.103956187	0.30298292	0.727452931	0	0	6.518289735	0	0.231977559	0	0	0	0.421692158	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7637	NO																																																																																		0	0	0	12.2574	0.472224482	3.737696468	0	1.41714733	2.492546102	2.437769652	1.686949672	2.61775498	2.016492662	0	0.122680001	0	0.039633307	3.15906172	7.103956187	0.30298292	0.727452931	0	0	6.518289735	0	0.231977559	0	0	0	0.421692158	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7637
H5698_156_0	2011	7																															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	P	V	P	V	O																																																			0	YES	2154.01603	67.48413884	1137.546827		403.7074657	20.37485663	13.43419574	426.5469551	471.5461641	501.8085784		31.70270329		25.00022137	4655.848015	5501.888632	244.100208	561.3532415			39.69997567		50.97712485				173.2014116														4500	"Days 1-7: $150/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/day	Days 11 - 20 : $50/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: 5% Coinsurance; 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	$10/visit	$20/visit	Individual: $20/visit; Group: $10/visit	$0/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	"$3/trip, 20 annual trip limit"	$250 Annual Allowance	Routine Eye Exam: $0	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 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;												76.01735811	105.3832117	52.0726257		50	0.15	0.2	50	88.08871236	56.66738885		50		18.82910661	10	19.13361859	20	20			0.192589797		3				30														NO	68.87905606	95.48735085	47.18281974		45.30482101	0.135914463	0.181219284	45.30482101	79.81686693	51.34611818		45.30482101		17.0609861	9.060964202	17.33690331	18.1219284	18.1219284			0.174504926		2.718289261				27.18289261															12.3639	0.536990137	4.472722239	0	1.524157873	2.769237698	2.434535333	1.610386121	3.136444786	2.147160214	0	0.119690442	0	0.035544036	3.51553935	7.948809269	0.368630541	0.847733604	0	0	6.927841316	0	0.011547548	0	0	0	0.392342948	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1632	0	5.302313477	12.3639	0.536990137	4.472722239	0	1.524157873	2.769237698	2.434535333	1.610386121	3.136444786	2.147160214	0	0.119690442	0	0.035544036	3.51553935	7.948809269	0.368630541	0.847733604	0	0	6.927841316	0	0.011547548	0	0	0	0.392342948	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1632	NO																																																																																		0	0	0	12.3639	0.536990137	4.472722239	0	1.524157873	2.769237698	2.434535333	1.610386121	3.136444786	2.147160214	0	0.119690442	0	0.035544036	3.51553935	7.948809269	0.368630541	0.847733604	0	0	6.927841316	0	0.011547548	0	0	0	0.392342948	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1632
H5698_157_0	2011	7																															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	P	V	P	V	O																																																			0	YES	1724.821654	41.97252832	554.9773943		476.550975	12.39026229	2.908616145	380.5060725	257.243542	196.6841248		1.071848092		61.63126527	3123.396277	2755.441903	124.7151163	218.8215865			12.21669891		101.1546375		59.92423666		0.557340776			120											3400	"Days 1-7: $100/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/day	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	ER: $50/visit; UC: $35/visit	Surgery: 20% or $300 /visit; ASC: 20% or $300	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$0/visit	$50/observation	$0/visit	Mammography Screening: $0/visit; CORF: $25/visit; Outpatient Mental Health: $25/visit; Partial Hospitalization: $50/day	$15/visit	$25/visit	Individual: $25/visit; Group: $15/visit	$25/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	"$3/visit, 40 trip limit"	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;												51.98789974	105.3832117	39.96648045		50	0.168	0.203313912	50	121.7373622	76.99763579		50		25	15	25	25	25			0.184504652		3		21.04102878		9.389508777			20											NO	48.80656313	98.93441357	37.52078004		46.94031051	0.157719443	0.190891805	46.94031051	114.2877916	72.28585865		46.94031051		23.47015525	14.08209315	23.47015525	23.47015525	23.47015525			0.173214113		2.816418631		21.04102878		9.389508777			18.7761242												7.0152	0.346043956	1.735265395	0	1.864120895	1.954185271	0.555230987	1.488422766	2.449983027	1.184790071	0	0.00419274	0	0.12054128	3.665329777	5.389220772	0.243923595	0.427981384	0	0	2.116104662	0	0.02374115	0	0.105072299	0	0.000436096	0	0	0.187761242	0	0	0	0	0	0	0	0	0	0	30.8776	0	2.005741143	7.0152	0.346043956	1.735265395	0	1.864120895	1.954185271	0.555230987	1.488422766	2.449983027	1.184790071	0	0.00419274	0	0.12054128	3.665329777	5.389220772	0.243923595	0.427981384	0	0	2.116104662	0	0.02374115	0	0.105072299	0	0.000436096	0	0	0.187761242	0	0	0	0	0	0	0	0	0	0	30.8776	NO																																																																																		0	0	0	7.0152	0.346043956	1.735265395	0	1.864120895	1.954185271	0.555230987	1.488422766	2.449983027	1.184790071	0	0.00419274	0	0.12054128	3.665329777	5.389220772	0.243923595	0.427981384	0	0	2.116104662	0	0.02374115	0	0.105072299	0	0.000436096	0	0	0.187761242	0	0	0	0	0	0	0	0	0	0	30.8776
H5698_158_0	2011	6																															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	P	V	P	V	O																																																			0	YES	2689.763674	109.5948161	1088.616503	29.74627091	18.79093169	27.98005084	9.133920216	39.44372492	45.37960723	20.25588905		0.09010405		26.85160354	46.38920237	145.772592	1.831813153	4.635835069	19.18053215		25.98744467	0.011161796			61.32814952																3400	"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, 40 annual trip limit"	Preventive Dental: $650 annual allowance	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;												137.3602307	76.13902146	82.10324807	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233	0.233	0.233	0.233		0.209320313	0.233			9.912463538																NO	84.82815091	47.02039571	50.70366205	0.143891424	0.143891424	0.143891424	0.143891424	0.143891424	0.143891424	0.143891424		0.143891424		0.143891424	0.143891424	0.143891424	0.143891424	0.143891424	0.143891424		0.129267802	0.143891424			6.121538589																	19.014	0.429432635	4.59973694	4.280233272	2.703853914	4.026089352	1.314292784	5.675613736	6.529736292	2.914648714	0	0.0129652	0	3.863715464	6.675008376	20.9754258	0.263582203	0.667056908	2.75991408	0	3.359339858	0.001606087	0	0	0.031285219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0975	0	55.79527006	19.014	0.429432635	4.59973694	4.280233272	2.703853914	4.026089352	1.314292784	5.675613736	6.529736292	2.914648714	0	0.0129652	0	3.863715464	6.675008376	20.9754258	0.263582203	0.667056908	2.75991408	0	3.359339858	0.001606087	0	0	0.031285219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0975	NO																																																																																		0	0	0	19.014	0.429432635	4.59973694	4.280233272	2.703853914	4.026089352	1.314292784	5.675613736	6.529736292	2.914648714	0	0.0129652	0	3.863715464	6.675008376	20.9754258	0.263582203	0.667056908	2.75991408	0	3.359339858	0.001606087	0	0	0.031285219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0975
H5698_159_0	2011	5																															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	P	V	P	V	O																																																			0	YES	1293.297226	61.96825251	472.83307		422.1080489	11.85340437	5.767119003	381.9953788	266.1603236	192.6245862				14.31669222	3515.245878	3172.164313	94.4814466	278.3031509			15.92194823				76.7464744		249			120											6700	Days 1-7: $175/day; Days 8-60: $0/day; Days 61+: $125/day	Medicare FFS Cost Sharing	Days 11 - 20 : $50/day; Days 21-100: $140/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	ER: $50/visit; UC: $35/visit	$300/visit; ASC: $300/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: 5% Coinsurance; Nuclear Medicine: $75/visit; PET Scan: $100/visit; CT Scan: $100/visit; MRI: $100/visit; Other Imaging: $0/visit;	$0/visit	$100/observation	$0/visit	Mammography Screening: $0/visit; CORF: $30/visit; Partial Hospitalization: $100/day; Outpatient Mental Health: $30/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: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Not Covered	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: Not Covered; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing												89.01433305	69.78645497	68.05921788		50	0.168	0.200188555	50	300	106.1491197				30	20	30	30	30			0.19370372				19.3054424		30			20											NO	86.08296297	67.48828659	65.8179299		48.35342805	0.162467518	0.193596058	48.35342805	290.1205683	102.6534764				29.01205683	19.34137122	29.01205683	29.01205683	29.01205683			0.187324778				19.3054424		29.01205683			19.34137122												9.2776	0.348510932	2.593407822	0	1.700864265	1.925793191	1.116491506	1.539232172	6.434882028	1.647798618	0	0	0	0.034613057	5.665806289	7.669250945	0.228425092	0.672845569	0	0	2.982575411	0	0	0	0.12346872	0	0.602000179	0	0	0.193413712	0	0	0	0	0	0	0	0	0	0	44.757	0	1.519897195	9.2776	0.348510932	2.593407822	0	1.700864265	1.925793191	1.116491506	1.539232172	6.434882028	1.647798618	0	0	0	0.034613057	5.665806289	7.669250945	0.228425092	0.672845569	0	0	2.982575411	0	0	0	0.12346872	0	0.602000179	0	0	0.193413712	0	0	0	0	0	0	0	0	0	0	44.757	NO																																																																																		0	0	0	9.2776	0.348510932	2.593407822	0	1.700864265	1.925793191	1.116491506	1.539232172	6.434882028	1.647798618	0	0	0	0.034613057	5.665806289	7.669250945	0.228425092	0.672845569	0	0	2.982575411	0	0	0	0.12346872	0	0.602000179	0	0	0.193413712	0	0	0	0	0	0	0	0	0	0	44.757
H5698_160_0	2011	6																															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	P	V	P	V	O																																																			0	YES	1840.726821	40.69660368	613.8763688		542.1635201	19.9302441	2.000077032	397.2981749	408.2631659	304.4612508		2.192998205		20.83348295		6715.252002	216.0261531	766.5714081			36.63416118				106.0568627		3.427199608			665.3033696											3400	"Days 1-5: $75/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/day	Days 11 - 100 : $50/day	No Cost Sharing	$50/trip	10% Coinsurance	10% Coinsurance	ER: $25/visit; UC: $15/visit	Surgery: 10% or $300 /visit; ASC: 10% or $300	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $50/visit; Nuclear Medicine: $50/visit; PET Scan: $50/visit; CT Scan: $50/visit; MRI: $50/visit; Other Imaging: $0/visit;	$0/visit	$50/observation	$0/visit	Mammography Screening: $0/visit; CORF: $15/visit; Partial Hospitalization: $50/day; Outpatient Mental Health: $15/visit	$0/visit	$15/visit	Individual: $15./visit; Group: $10/visit	$15/visit	No Cost Sharing	No Cost Sharing	15% Coinsurance	No Cost Sharing	Not Covered	$250 Annual Allowance	Routine Eye Exam: $15	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: $15	$500 Annual Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20/installation; Fitness Program: No Cost Sharing;												33.45732512	105.3832117	32.08938547		50	0.084	0.1	25	89.33321929	50		50		15		15	15	15			0.148422608				15		15			20											NO	31.42775129	98.99050073	30.14279301		46.96692156	0.078904428	0.093933843	23.48346078	83.91412605	46.96692156		46.96692156		14.09007647		14.09007647	14.09007647	14.09007647			0.13941906				14.09007647		14.09007647			18.78676862												4.8208	0.335714765	1.541995693	0	2.121979293	1.572584515	0.187874922	0.777494676	2.854920564	1.191633974	0	0.008583198	0	0.024462114	0	7.88486785	0.253652085	0.90008748	0	0	5.107500314	0	0	0	0.124529109	0	0.004024125	0	0	1.041575039	0	0	0	0	0	0	0	0	0	0	30.7543	0	1.986083328	4.8208	0.335714765	1.541995693	0	2.121979293	1.572584515	0.187874922	0.777494676	2.854920564	1.191633974	0	0.008583198	0	0.024462114	0	7.88486785	0.253652085	0.90008748	0	0	5.107500314	0	0	0	0.124529109	0	0.004024125	0	0	1.041575039	0	0	0	0	0	0	0	0	0	0	30.7543	NO																																																																																		0	0	0	4.8208	0.335714765	1.541995693	0	2.121979293	1.572584515	0.187874922	0.777494676	2.854920564	1.191633974	0	0.008583198	0	0.024462114	0	7.88486785	0.253652085	0.90008748	0	0	5.107500314	0	0	0	0.124529109	0	0.004024125	0	0	1.041575039	0	0	0	0	0	0	0	0	0	0	30.7543
H5698_163_0	2011	7																															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	2198.793235	71.74176451	1090.262099		387.4978124	18.63465805	13.12312396	414.1861499	461.8368496	495.8193951		31.55505686		24.03887563	4536.037294	5358.583676	238.5572397	489.8459176			36.18232512		47.43164622				173.2014116														4500	"Days 1-7: $150/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/day	Days 11 - 20 : $50/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: 5% Coinsurance; 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	$10/visit	$20/visit	Individual: $20/visit; Group: $10/visit	$0/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	"$3/trip, 20 annual trip limit"	$250 Annual Allowance	Routine Eye Exam: $0	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 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;												76.01735811	105.3832117	52.0726257		50	0.15	0.2	50	81.85317042	56.21344721		50		18.78345194	10	19.13448446	20	20			0.192960482		3				30														NO	69.21489978	95.95293255	47.41287594		45.52572038	0.136577161	0.182102882	45.52572038	74.52849097	51.18315358		45.52572038		17.10260362	9.105144075	17.42222378	18.21028815	18.21028815			0.175693299		2.731543223				27.31543223															12.6824	0.573652724	4.307705136	0	1.470093088	2.545068695	2.389758688	1.57134357	2.868333623	2.114800021	0	0.119713891	0	0.034260613	3.441772758	7.77987033	0.36201634	0.743352942	0	0	6.356992079	0	0.010796799	0	0	0	0.394255952	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7662	0	4.891037522	12.6824	0.573652724	4.307705136	0	1.470093088	2.545068695	2.389758688	1.57134357	2.868333623	2.114800021	0	0.119713891	0	0.034260613	3.441772758	7.77987033	0.36201634	0.743352942	0	0	6.356992079	0	0.010796799	0	0	0	0.394255952	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7662	NO																																																																																		0	0	0	12.6824	0.573652724	4.307705136	0	1.470093088	2.545068695	2.389758688	1.57134357	2.868333623	2.114800021	0	0.119713891	0	0.034260613	3.441772758	7.77987033	0.36201634	0.743352942	0	0	6.356992079	0	0.010796799	0	0	0	0.394255952	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7662
H5698_801_0	2011	4																															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	P	V	P	V	O																																																			0	YES	1706.52452	41.56494816	549.1051201		471.5085389	12.20193483	2.864406243	376.4798977	254.521621		194.6029894	1.060506754		60.97913836	3090.347292	2726.286282	123.3954926	216.5062123			12.03100955		100.0843096		59.290172		0.551443494			120											3400	"Days 1-7: $100/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/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: 5% Coinsurance; 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	$15/visit	$25/visit	Individual: $25/visit; Group: $15/visit	$20/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	"$3/visit, 40 trip limit"	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;												51.98789974	105.3832117	39.96648045		50	0.168	0.203343571	50	121.1691018		76.93584458	50		25	15	25	25	25			0.190110633		3		20.94281093		9.345679294			20											NO	48.86776612	99.05847644	37.56783077		46.99917324	0.157917222	0.191158663	46.99917324	113.8969522		72.31842175	46.99917324		23.49958662	14.09975197	23.49958662	23.49958662	23.49958662			0.178700852		2.819950394		20.94281093		9.345679294			18.7996693												6.9495	0.34311337	1.719057352	0	1.846709292	1.926895653	0.547556067	1.474520328	2.415769741	0	1.172781755	0.004153578	0	0.119415379	3.631094193	5.338883386	0.241645255	0.423983874	0	0	2.149951654	0	0.023519399	0	0.103475239	0	0.000429468	0	0	0.187996693	0	0	0	0	0	0	0	0	0	0	30.6205	0	1.948377893	6.9495	0.34311337	1.719057352	0	1.846709292	1.926895653	0.547556067	1.474520328	2.415769741	0	1.172781755	0.004153578	0	0.119415379	3.631094193	5.338883386	0.241645255	0.423983874	0	0	2.149951654	0	0.023519399	0	0.103475239	0	0.000429468	0	0	0.187996693	0	0	0	0	0	0	0	0	0	0	30.6205	NO																																																																																		0	0	0	6.9495	0.34311337	1.719057352	0	1.846709292	1.926895653	0.547556067	1.474520328	2.415769741	0	1.172781755	0.004153578	0	0.119415379	3.631094193	5.338883386	0.241645255	0.423983874	0	0	2.149951654	0	0.023519399	0	0.103475239	0	0.000429468	0	0	0.187996693	0	0	0	0	0	0	0	0	0	0	30.6205
H5698_802_0	2011	4																															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	P	V	P	V	O																																																			0	YES	1706.52452	41.56494816	549.1051201		471.5085389	12.20193483	2.864406243	376.4798977	254.521621		194.6029894	1.060506754		60.97913836	3090.347292	2726.286282	123.3954926	216.5062123			12.03100955		100.0843096		59.290172		0.551443494			120											3400	"Days 1-7: $100/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/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: 5% Coinsurance; 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	$15/visit	$25/visit	Individual: $25/visit; Group: $15/visit	$20/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	"$3/visit, 40 trip limit"	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;												51.98789974	105.3832117	39.96648045		50	0.168	0.203343571	50	121.1691018		76.93584458	50		25	15	25	25	25			0.190110633		3		20.94281093		9.345679294			20											NO	48.86776612	99.05847644	37.56783077		46.99917324	0.157917222	0.191158663	46.99917324	113.8969522		72.31842175	46.99917324		23.49958662	14.09975197	23.49958662	23.49958662	23.49958662			0.178700852		2.819950394		20.94281093		9.345679294			18.7996693												6.9495	0.34311337	1.719057352	0	1.846709292	1.926895653	0.547556067	1.474520328	2.415769741	0	1.172781755	0.004153578	0	0.119415379	3.631094193	5.338883386	0.241645255	0.423983874	0	0	2.149951654	0	0.023519399	0	0.103475239	0	0.000429468	0	0	0.187996693	0	0	0	0	0	0	0	0	0	0	30.6205	0	1.948377893	6.9495	0.34311337	1.719057352	0	1.846709292	1.926895653	0.547556067	1.474520328	2.415769741	0	1.172781755	0.004153578	0	0.119415379	3.631094193	5.338883386	0.241645255	0.423983874	0	0	2.149951654	0	0.023519399	0	0.103475239	0	0.000429468	0	0	0.187996693	0	0	0	0	0	0	0	0	0	0	30.6205	NO																																																																																		0	0	0	6.9495	0.34311337	1.719057352	0	1.846709292	1.926895653	0.547556067	1.474520328	2.415769741	0	1.172781755	0.004153578	0	0.119415379	3.631094193	5.338883386	0.241645255	0.423983874	0	0	2.149951654	0	0.023519399	0	0.103475239	0	0.000429468	0	0	0.187996693	0	0	0	0	0	0	0	0	0	0	30.6205
H5698_803_0	2011	4																															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	P	V	P	V	O																																																			0	YES	1706.52452	41.56494816	549.1051201		471.5085389	12.20193483	2.864406243	376.4798977	254.521621		194.6029894	1.060506754		60.97913836	3090.347292	2726.286282	123.3954926	216.5062123			12.03100955		100.0843096		59.290172		0.551443494			120											3400	"Days 1-7: $100/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/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: 5% Coinsurance; 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	$15/visit	$25/visit	Individual: $25/visit; Group: $15/visit	$20/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	"$3/visit, 40 trip limit"	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;												51.98789974	105.3832117	39.96648045		50	0.168	0.203343571	50	121.1691018		76.93584458	50		25	15	25	25	25			0.190110633		3		20.94281093		9.345679294			20											NO	48.86776612	99.05847644	37.56783077		46.99917324	0.157917222	0.191158663	46.99917324	113.8969522		72.31842175	46.99917324		23.49958662	14.09975197	23.49958662	23.49958662	23.49958662			0.178700852		2.819950394		20.94281093		9.345679294			18.7996693												6.9495	0.34311337	1.719057352	0	1.846709292	1.926895653	0.547556067	1.474520328	2.415769741	0	1.172781755	0.004153578	0	0.119415379	3.631094193	5.338883386	0.241645255	0.423983874	0	0	2.149951654	0	0.023519399	0	0.103475239	0	0.000429468	0	0	0.187996693	0	0	0	0	0	0	0	0	0	0	30.6205	0	1.948377893	6.9495	0.34311337	1.719057352	0	1.846709292	1.926895653	0.547556067	1.474520328	2.415769741	0	1.172781755	0.004153578	0	0.119415379	3.631094193	5.338883386	0.241645255	0.423983874	0	0	2.149951654	0	0.023519399	0	0.103475239	0	0.000429468	0	0	0.187996693	0	0	0	0	0	0	0	0	0	0	30.6205	NO																																																																																		0	0	0	6.9495	0.34311337	1.719057352	0	1.846709292	1.926895653	0.547556067	1.474520328	2.415769741	0	1.172781755	0.004153578	0	0.119415379	3.631094193	5.338883386	0.241645255	0.423983874	0	0	2.149951654	0	0.023519399	0	0.103475239	0	0.000429468	0	0	0.187996693	0	0	0	0	0	0	0	0	0	0	30.6205
H5698_804_0	2011	4																															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	P	V	P	V	O																																																			0	YES	1706.52452	41.56494816	549.1051201		471.5085389	12.20193483	2.864406243	376.4798977	254.521621		194.6029894	1.060506754		60.97913836	3090.347292	2726.286282	123.3954926	216.5062123			12.03100955		100.0843096		59.290172		0.551443494			120											3400	"Days 1-7: $100/day; Days 8-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 7 : $175/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: 5% Coinsurance; 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	$15/visit	$25/visit	Individual: $25/visit; Group: $15/visit	$20/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	"$3/visit, 40 trip limit"	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;												51.98789974	105.3832117	39.96648045		50	0.168	0.203343571	50	121.1691018		76.93584458	50		25	15	25	25	25			0.190110633		3		20.94281093		9.345679294			20											NO	48.86776612	99.05847644	37.56783077		46.99917324	0.157917222	0.191158663	46.99917324	113.8969522		72.31842175	46.99917324		23.49958662	14.09975197	23.49958662	23.49958662	23.49958662			0.178700852		2.819950394		20.94281093		9.345679294			18.7996693												6.9495	0.34311337	1.719057352	0	1.846709292	1.926895653	0.547556067	1.474520328	2.415769741	0	1.172781755	0.004153578	0	0.119415379	3.631094193	5.338883386	0.241645255	0.423983874	0	0	2.149951654	0	0.023519399	0	0.103475239	0	0.000429468	0	0	0.187996693	0	0	0	0	0	0	0	0	0	0	30.6205	0	1.948377893	6.9495	0.34311337	1.719057352	0	1.846709292	1.926895653	0.547556067	1.474520328	2.415769741	0	1.172781755	0.004153578	0	0.119415379	3.631094193	5.338883386	0.241645255	0.423983874	0	0	2.149951654	0	0.023519399	0	0.103475239	0	0.000429468	0	0	0.187996693	0	0	0	0	0	0	0	0	0	0	30.6205	NO																																																																																		0	0	0	6.9495	0.34311337	1.719057352	0	1.846709292	1.926895653	0.547556067	1.474520328	2.415769741	0	1.172781755	0.004153578	0	0.119415379	3.631094193	5.338883386	0.241645255	0.423983874	0	0	2.149951654	0	0.023519399	0	0.103475239	0	0.000429468	0	0	0.187996693	0	0	0	0	0	0	0	0	0	0	30.6205
H5700_002_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	1074.710085	46.69934335	324.1875932		96.44005363	6.970918879	6.737170618	224.3853517	259.7618808		8.12106846	0.602626167	0.14571039	9.465144867		2973.066229	88.29864048	521.7188974	17.93973425		9.92315217			11.76442105	159.1037094		260.9166693														3400	"1a (IP Acute) 150 days 1-5, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 125 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 300 copay, 9b (OP ASC) 150 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 25 copay, 7i (PT/ST) 25 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 25 copay, 7f (Podiatry) 25 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 25 copay, 18a (Hearing Exam) 25 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 25 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 25 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 12 trips/yr	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 100 allowance, 0%coin"	18a1 (Routine Hearing Exam) 25 copay	18b (Hearing Aids) 700 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 13"												92.84307611	172.0337627	49.94161658		125	0.2	0.2	48.28366352	267.6884388		0.2	0.2	0.2	0.19433681		24.66099856	40	25	0.181		0.2			0.321428571	5		25														NO	87.00006292	161.2069398	46.79857634		117.1332136	0.187413142	0.187413142	45.24496538	250.8416566		0.187413142	0.187413142	0.187413142	0.182106361		23.12593016	37.48262835	23.42664272	0.169608893		0.187413142			0.321428571	5		23.42664272															7.7917	0.627354853	1.264293152	0	0.941361117	1.306441808	1.262634312	0.846025622	5.429925042	0	1.521994955	0.112940063	0.027308042	1.723663088	0	5.729576832	0.275805427	1.018510184	3.042738473	0	1.859729124	0	0	3.781421048	0.066293212	0	0.509366799	0	0	0	0	0	0	0	0	0	0	0	0	0	39.139	0	2.365718745	7.7917	0.627354853	1.264293152	0	0.941361117	1.306441808	1.262634312	0.846025622	5.429925042	0	1.521994955	0.112940063	0.027308042	1.723663088	0	5.729576832	0.275805427	1.018510184	3.042738473	0	1.859729124	0	0	3.781421048	0.066293212	0	0.509366799	0	0	0	0	0	0	0	0	0	0	0	0	0	39.139	NO																																																																																		0	0	0	7.7917	0.627354853	1.264293152	0	0.941361117	1.306441808	1.262634312	0.846025622	5.429925042	0	1.521994955	0.112940063	0.027308042	1.723663088	0	5.729576832	0.275805427	1.018510184	3.042738473	0	1.859729124	0	0	3.781421048	0.066293212	0	0.509366799	0	0	0	0	0	0	0	0	0	0	0	0	0	39.139
H5700_005_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1256.936813	120.6760103	363.4418985		195.5364432	8.921930982	5.50930871	338.8514482	230.1098696		10.46364036	2.607073928	0.060720926	11.88434652		2909.5179	112.4708791	578.0930125	20.63015837		8.970418463																				4950	"1a (IP Acute) 235 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 125 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 400 copay, 9b (OP ASC) 350 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 45 copay, 7i (PT/ST) 45 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 45 copay, 7f (Podiatry) 45 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 45 copay, 18a (Hearing Exam) 45 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 45 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 45 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive n/a"	17a1 (Routine Eye Exam) n/a	17b1 (Non MCR Covered) n/a	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												170.3328331	172.0337627	49.94161658		125	0.2	0.2	49.45407882	395.5241456		0.2	0.2	0.2	0.197825742		43.96240127	40	45	0.181		0.2																				NO	158.4037567	159.9855635	46.44400928		116.2457597	0.185993216	0.185993216	45.9906157	367.8240383		0.185993216	0.185993216	0.185993216	0.183971229		40.89064143	37.1986431	41.84847349	0.16832386		0.185993216																					16.592	1.608868292	1.406641576	0	1.894190199	1.659418632	1.024694042	1.298665561	7.053328457	0	1.946166116	0.484898063	0.01129368	2.186377836	0	9.914337765	0.348647008	2.016025842	3.47254789	0	1.668436974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5865	0	4.108951131	16.592	1.608868292	1.406641576	0	1.894190199	1.659418632	1.024694042	1.298665561	7.053328457	0	1.946166116	0.484898063	0.01129368	2.186377836	0	9.914337765	0.348647008	2.016025842	3.47254789	0	1.668436974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5865	NO																																																																																		0	0	0	16.592	1.608868292	1.406641576	0	1.894190199	1.659418632	1.024694042	1.298665561	7.053328457	0	1.946166116	0.484898063	0.01129368	2.186377836	0	9.914337765	0.348647008	2.016025842	3.47254789	0	1.668436974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5865
H5700_009_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	1446.22528	61.08101305	284.3444276		127.4095252	9.976715802	6.982285864	360.1211221	240.7757161		10.91055585	1.362908206	0.155935054	28.51067454		3241.325849	94.08949539	513.9781001	18.92105146		9.208985566			11.76442105	159.1037094		86.99396753														3400	"1a (IP Acute) 150 days 1-5, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 125 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 300 copay, 9b (OP ASC) 150 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 25 copay, 7i (PT/ST) 25 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 25 copay, 7f (Podiatry) 25 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 25 copay, 18a (Hearing Exam) 25 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 25 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 25 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 12 trips/yr	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 100 allowance, 0%coin"	18a1 (Routine Hearing Exam) 25 copay	18b (Hearing Aids) 700 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												92.84307611	172.0337627	49.94161658		125	0.2	0.2	48.93569576	268.5005507		0.2	0.2	0.2	0.199276122		24.26318327	40	25	0.181		0.2			0.321428571	5		25														NO	85.00453633	157.5093248	45.72515409		114.4465208	0.183114433	0.183114433	44.80416098	245.8316309		0.183114433	0.183114433	0.183114433	0.182451671		22.2438462	36.62288666	22.88930416	0.165718562		0.183114433			0.321428571	5		22.88930416															10.2446	0.80173576	1.083474397	0	1.215131407	1.82688066	1.278557319	1.344577061	4.932523916	0	1.997880251	0.249568164	0.028553959	5.201820203	0	6.008296139	0.28715241	0.980383422	3.135569442	0	1.686298173	0	0	3.781421048	0.066293212	0	0.165935949	0	0	0	0	0	0	0	0	0	0	0	0	0	46.3167	0	3.907600324	10.2446	0.80173576	1.083474397	0	1.215131407	1.82688066	1.278557319	1.344577061	4.932523916	0	1.997880251	0.249568164	0.028553959	5.201820203	0	6.008296139	0.28715241	0.980383422	3.135569442	0	1.686298173	0	0	3.781421048	0.066293212	0	0.165935949	0	0	0	0	0	0	0	0	0	0	0	0	0	46.3167	NO																																																																																		0	0	0	10.2446	0.80173576	1.083474397	0	1.215131407	1.82688066	1.278557319	1.344577061	4.932523916	0	1.997880251	0.249568164	0.028553959	5.201820203	0	6.008296139	0.28715241	0.980383422	3.135569442	0	1.686298173	0	0	3.781421048	0.066293212	0	0.165935949	0	0	0	0	0	0	0	0	0	0	0	0	0	46.3167
H5700_018_0	2011	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin	T	Coin	P	P	P	P	O	V																																																			0	YES	284.6589124	4.008068654	14.33868643		9.782230129	10.43641141	8.333345199	15.59536983	52.20561499		15.76095561	2.35722527	0.366293024	21.32300092		5352.136466	2.611661736	703.0551271	37.91861351	14.1646923	15.25945572	0.769775096		13.93798932	159.1037094		176.8916437														3400	"1a (IP Acute) FFS, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 20% coin	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 20% coin, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 20% coin"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 0-20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 20% coin, 5 (Partial Hosp) 20% coin, 7c (OT) 8 copay, 7i (PT/ST) 8 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 20% coin, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 8 copay, 7b1 (Routine Chiro) 0% coin (5 visits), 7d (SPC w/Copay) 8 copay, 7f (Podiatry) 8 copay, 7f1 (Routine Podiatry) 0% coin (3 visits), 17a (Eye Exam) 8 copay, 18a (Hearing Exam) 8 copay"	"7e (MH Non-Phys) 45% coin, 7h (Psych) 45% coin"	7i (PT/ST) 8 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0-20% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 8 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 8 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 85"												0.082702792	0.082702792	0.191849289		0.2	0.2	0.2	0.2	0.2		0.2	0.2	0.2	0.2		7.998953214	0.45	8	0.181	0.07872	0.2	0.2		0.135384615	5		8														NO	0.07110774	0.07110774	0.164951738		0.171959707	0.171959707	0.171959707	0.171959707	0.171959707		0.171959707	0.171959707	0.171959707	0.171959707		6.878388296	0.386909342	6.878388296	0.155623535	0.067683341	0.171959707	0.171959707		0.135384615	5		6.878388296															20.2415	0.285004702	2.365191244	0	1.682149431	1.794642252	1.432999602	2.681775233	8.977262278	0	2.710249314	0.405347768	0.062987641	3.666696998	0	3.067839402	1.010476323	0.402990513	5.901028684	0.958713697	2.62401154	0.1323703	0	1.886989318	0.066293212	0	0.101394118	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4579	0	9.865601357	20.2415	0.285004702	2.365191244	0	1.682149431	1.794642252	1.432999602	2.681775233	8.977262278	0	2.710249314	0.405347768	0.062987641	3.666696998	0	3.067839402	1.010476323	0.402990513	5.901028684	0.958713697	2.62401154	0.1323703	0	1.886989318	0.066293212	0	0.101394118	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4579	NO																																																																																		0	0	0	20.2415	0.285004702	2.365191244	0	1.682149431	1.794642252	1.432999602	2.681775233	8.977262278	0	2.710249314	0.405347768	0.062987641	3.666696998	0	3.067839402	1.010476323	0.402990513	5.901028684	0.958713697	2.62401154	0.1323703	0	1.886989318	0.066293212	0	0.101394118	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4579
H5700_020_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	1259.830352	44.43828621	536.3174527		274.2353566	13.7207788	10.69043114	484.7190691	117.2512461		15.25766199	1.932922376	0.01433261	24.31311507		2625.137323	49.35058907	493.6791468	20.05411461		7.53123961			11.76442105	159.1037094																3400	"1a (IP Acute) 150 days 1-5, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 125 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 200 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 25 copay, 7i (PT/ST) 25 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 25 copay, 7f (Podiatry) 25 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 25 copay, 18a (Hearing Exam) 25 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 25 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 25 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 12 trips/yr	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0%coin"	18a1 (Routine Hearing Exam) 25 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 8"												92.84307611	172.0337627	49.94161658		125	0.2	0.2	49.8	199.1185567		0.2	0.2	0.2	0.19961932		24.76096186	40	25	0.181		0.2			0.321428571	5																NO	85.43239896	158.3021337	45.9553075		115.022577	0.184036123	0.184036123	45.82499467	183.2250361		0.184036123	0.184036123	0.184036123	0.183685829		22.81497807	36.80722464	23.0045154	0.166552691		0.184036123			0.321428571	5																	8.9692	0.586222961	2.053886122	0	2.628604785	2.525118937	1.967425502	1.85102073	1.790280318	0	2.807960962	0.35572754	0.002637718	4.465974687	0	4.991037536	0.151371518	0.946404128	3.340066764	0	1.386020141	0	0	3.781421048	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6667	0	3.533533332	8.9692	0.586222961	2.053886122	0	2.628604785	2.525118937	1.967425502	1.85102073	1.790280318	0	2.807960962	0.35572754	0.002637718	4.465974687	0	4.991037536	0.151371518	0.946404128	3.340066764	0	1.386020141	0	0	3.781421048	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6667	NO																																																																																		0	0	0	8.9692	0.586222961	2.053886122	0	2.628604785	2.525118937	1.967425502	1.85102073	1.790280318	0	2.807960962	0.35572754	0.002637718	4.465974687	0	4.991037536	0.151371518	0.946404128	3.340066764	0	1.386020141	0	0	3.781421048	0.066293212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.6667
H5700_027_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1495.604812	66.22017882	316.7456942		126.5228003	9.853615272	4.986329109	355.5137865	160.9766425		8.362143853	1.448865582	0.012111262	13.5696395		2838.630246	86.15465585	699.6757189	25.027263		27.99704485																				4950	"1a (IP Acute) 235 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 125 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 400 copay, 9b (OP ASC) 350 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 45 copay, 7i (PT/ST) 45 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 45 copay, 7f (Podiatry) 45 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 45 copay, 18a (Hearing Exam) 45 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 45 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 45 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive n/a"	17a1 (Routine Eye Exam) n/a	17b1 (Non MCR Covered) n/a	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												170.3328331	172.0337627	49.94161658		125	0.2	0.2	49.8	399.5547703		0.2	0.2	0.2	0.199208452		44.47828515	40	44.99848886	0.181		0.2																				NO	157.2095902	158.7794722	46.09387945		115.3694118	0.184591059	0.184591059	45.96317368	368.7711908		0.184591059	0.184591059	0.184591059	0.183860496		41.06491331	36.91821179	41.53298827	0.167054908		0.184591059																					19.5936	0.87620042	1.21666982	0	1.216405088	1.818889278	0.920431771	1.361711826	4.946962347	0	1.543576989	0.267447632	0.002235631	2.494920646	0	9.714008746	0.265056319	2.421635285	4.180927127	0	5.168004157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0087	0	4.838806023	19.5936	0.87620042	1.21666982	0	1.216405088	1.818889278	0.920431771	1.361711826	4.946962347	0	1.543576989	0.267447632	0.002235631	2.494920646	0	9.714008746	0.265056319	2.421635285	4.180927127	0	5.168004157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0087	NO																																																																																		0	0	0	19.5936	0.87620042	1.21666982	0	1.216405088	1.818889278	0.920431771	1.361711826	4.946962347	0	1.543576989	0.267447632	0.002235631	2.494920646	0	9.714008746	0.265056319	2.421635285	4.180927127	0	5.168004157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0087
H5700_028_0	2011	5																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin	T	Coin	P	P	P	P	O	V																																																			0	YES	278.3986954	25.14064011	26.92721453		10.8498043	12.83612908	16.03790426	27.06959027	33.89567681		12.03399153	4.534568577	1.823069161	29.36627165		4033.686082	15.60031319	519.6445814	23.09619402	11.06463871	11.8753699	0.449739577		13.93798932	159.1037094		260.9166693														3400	"1a (IP Acute) FFS, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 20% coin	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 20% coin, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 20% coin"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 0-20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 20% coin, 5 (Partial Hosp) 20% coin, 7c (OT) 8 copay, 7i (PT/ST) 8 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 20% coin, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 8 copay, 7b1 (Routine Chiro) 0% coin (5 visits), 7d (SPC w/Copay) 8 copay, 7f (Podiatry) 8 copay, 7f1 (Routine Podiatry) 0% coin (3 visits), 17a (Eye Exam) 8 copay, 18a (Hearing Exam) 8 copay"	"7e (MH Non-Phys) 45% coin, 7h (Psych) 45% coin"	7i (PT/ST) 8 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0-20% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 8 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 8 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 7"												0.080463273	0.080463273	0.191026447		0.2	0.2	0.2	0.2	0.2		0.2	0.2	0.2	0.2		8	0.45	8	0.181	0.07872	0.2	0.199858801		0.135384615	5		8														NO	0.067977982	0.067977982	0.161385336		0.168966485	0.168966485	0.168966485	0.168966485	0.168966485		0.168966485	0.168966485	0.168966485	0.168966485		6.758659415	0.380174592	6.758659415	0.152914669	0.066505209	0.168966485	0.168847196		0.135384615	5		6.758659415															18.925	1.709009982	4.345657578	0	1.833253299	2.168875616	2.709868316	4.573853528	5.727233381	0	2.033341253	0.766190115	0.308037589	4.961915709	0	2.271859201	5.930842703	0.292675062	3.531746871	0.735856106	2.006539515	0.075937267	0	1.886989318	0.066293212	0	0.146953909	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0079	0	11.94836811	18.925	1.709009982	4.345657578	0	1.833253299	2.168875616	2.709868316	4.573853528	5.727233381	0	2.033341253	0.766190115	0.308037589	4.961915709	0	2.271859201	5.930842703	0.292675062	3.531746871	0.735856106	2.006539515	0.075937267	0	1.886989318	0.066293212	0	0.146953909	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0079	NO																																																																																		0	0	0	18.925	1.709009982	4.345657578	0	1.833253299	2.168875616	2.709868316	4.573853528	5.727233381	0	2.033341253	0.766190115	0.308037589	4.961915709	0	2.271859201	5.930842703	0.292675062	3.531746871	0.735856106	2.006539515	0.075937267	0	1.886989318	0.066293212	0	0.146953909	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0079
H5700_801_0	2011	3																															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	Coin	V																																																			0	YES	227.4986081	4.816220376	21.64941773		4.741326104	5.229990481	7.824387067	13.03318274	40.20030768	5.648840767	15.12595614	3.349618633	0.355966845	19.73472283	54.44655332	110.0499444	2.815356025	11.27613634	28.04070881	15.28431242	15.72331121	0.717295013																			6700	"1a (IP Acute) FFS, 1a1 (Add'l Days) n/a"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) n/a"	6a (Home Health) FFS	10a (Ambulance) FFS	11a (DME) FFS	"11b (Prosthetics) FFS, 11b (Medical Supplies) FFS, 11c (Diabetic Supplies) FFS"	"4a (ER) FFS, 4a (ER) - Worldwide Coverage n/a, 4b (UC) FFS"	"9a (OP Surgery) FFS, 9b (OP ASC) FFS"	8a (OP Diag Proc/Test/Lab) FFS	"8b (X-Ray) FFS, 8b (OP Therap Rad) FFS, 8b (OP Diag) FFS"	9a (OP Observation) FFS	12 (Renal Dialysis) FFS	"3 (CORF) FFS, 5 (Partial Hosp) FFS, 7c (OT) FFS, 7i (PT/ST) FFS, 9a (OP Other) FFS, 9a (OP Chemo) FFS, 9c (OP SA) FFS, 9d (OP Cardiac Rehab) FFS"	"7a (PCP w/Copay) FFS, 14b (Immunizations) FFS, 14c (Routine Physical) FFS, 14d (Pap & Pelvic Exam) FFS, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) FFS, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) FFS, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) FFS, 14h (Mammography) FFS, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) FFS, 14j (Nutrition Therapy Diabetes) FFS"	"7b (Chiro) FFS, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) FFS, 7f (Podiatry) FFS, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) FFS, 18a (Hearing Exam) FFS"	"7e (MH Non-Phys) FFS, 7h (Psych) FFS"	7i (PT/ST) FFS	7g Physician Specialist Services Excluding Psychiatric (Radiology only) FFS	"8a (OP Diag Proc/Test/Lab) FFS, 7g (Prof. Other) FFS"	15 (Part B Rx) FFS	"13a (Blood) FFS, 13a1 (3 Pint Blood) n/a, 14a4-1 (Smoking Cessation - Mdcr Covered) FFS, 16b (Comp. Dental) FFS, 17b (MCR Eyewear) FFS"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive n/a"	17a1 (Routine Eye Exam) n/a	17b1 (Non MCR Covered) n/a	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) n/a, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												0.076653506	0.076653506	0.164633008		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069034452	0.069034452	0.148269141		0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725																				15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	0	10.31335866	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	NO																																																																																		0	0	0	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469
H5703_001_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin		Coin	Coin	Coin	Coin		Coin																																																												0	YES	330.6229137	46.03956089	48.46955342		20.57665346	33.4427552	18.1712259	37.02038623	37.25517704	24.42255849	31.39926052			68.59132466		148.8255935	27.62503282	5.186550514	28.17188888		20.84142301																				6700	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																				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																					26.9073	3.746873933	6.667316157	0	4.794360255	7.792161962	4.233895634	8.625749991	8.680456251	5.690456127	7.316027702	0	0	15.98177864	0	34.67636328	6.436632646	1.20846627	6.564050109	0	4.856051561	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	154.178		0	26.9073	3.746873933	6.667316157	0	4.794360255	7.792161962	4.233895634	8.625749991	8.680456251	5.690456127	7.316027702	0	0	15.98177864	0	34.67636328	6.436632646	1.20846627	6.564050109	0	4.856051561	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	154.178	NO																																																																																		0			26.9073	3.746873933	6.667316157	0	4.794360255	7.792161962	4.233895634	8.625749991	8.680456251	5.690456127	7.316027702	0	0	15.98177864	0	34.67636328	6.436632646	1.20846627	6.564050109	0	4.856051561	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	154.178
H5732_001_0	2011	8																																						V																																	0	0	0	0	0	0	0	0	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	525.5581212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											6700	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$45/Visit for ER - Facility; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"No Cost Sharing; PBP 7d, 7f, 7g, 14d-e, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 8b"	"No Cost Sharing; PBP 7b, 7d, 7g, 8a, 14d-j"	No Cost Sharing; PBP 15	No Cost Sharing; PBP 13a	PBP 10b	"No Cost Sharing; PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b											0	0	0	0	0	0	0	0	45	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	45	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	1.970842954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.9708	0	0	0	0	0	0	0	0	0	1.970842954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.9708	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	1.970842954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.9708
H5746_006_0	2011	6																															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	234.0136706	8.423301401	22.41254973	0	12.18473882	18.78692639	4.340770378	17.65147333	31.16031657	9.26605979	11.84159551	0.720792062	0.511592335	23.46797866	41.30813295	80.13294602	3.598557717	10.62249684	17.95904662	41.14704811	29.48339842	7.221192767	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 1b	Medicare-FFS Cost Sharing; PBP 2	No Cost-Sharing; PBP 6	20% Coinsurance for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"20% Coinsurance for ER - Facility; 20% Coinsurance for ER - Worldwide; 20% Coinsurance for PCP Urgent Care; PBP 4a, 4b"	20% Coinsurance for OP Fac - Surgery; PBP 9b	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	20% Coinsurance for OP Fac - Observation; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"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; PBP 3, 5, 9a, 9c, 9d, 13a"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for PCP Office Visits; 20% Coinsurance for PCP Consults; 20% Coinsurance for PCP Immunizations; $0/ for Influenza Virus Vaccine; $0/ for Hepatitis B (HBV) Vaccine; $0/ for Initial Preventive Physical Examination (IPPE); $0/ for Pneumococcal Vaccine; PBP 7a, 14b-c"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for Speclst Office Visits; 20% Coinsurance for Speclst Consults; 20% Coinsurance for Cardio; 20% Coinsurance for Chiropractor; 20% Coinsurance for Speclst Immunizations; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing/Speech Exams; $0/ for Prostate Cancer Screenings; $0/ for Screening Pap Tests; $0/ for Screening Pelvic Exam; 20% Coinsurance for Podiatrist (Routine); PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"20% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; 20% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"20% Coinsurance for Occ Therapy; 20% Coinsurance for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); $0/ for Bone Mass Measurements; $0/ for Screening Mammography; $0/ for Ultrasound Screening for Abdominal Aortic Aneurysm; PBP 7d, 14g-h"	"20% Coinsurance for Prof - Primary Surgeon (IP); 20% Coinsurance for Prof - Asst Surgeon (IP); 20% Coinsurance for Prof - Anesthesia (IP); 20% Coinsurance for Prof - Primary Surgeon (OP); 20% Coinsurance for Prof - Anesthesia (OP); 20% Coinsurance for Prof - IP Visits; 20% Coinsurance for Allergy Testing; 20% Coinsurance for Allergy Tx; 20% Coinsurance for Prof - ER Visits; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); $0/ for Cardiovascular Disease Screenings; $0/ for Colorectal Cancer Screening; $0/ for Diabetes Screening Tests; $0/ for Diabetes Self-Management Training; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"20% Coinsurance for Renal Dialysis - Prof; $0/ for Glaucoma Screening; 20% Coinsurance for Medical Nutrition Therapy (MNT); $0/ for Smoking and Tobacco-Use Cessation Counseling; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	"No Cost-Sharing; PBP 13b-f, 14a"											0	0.076460586	0.076460586	0.166983846	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	0.07590476	0.07590476	0.143692688	0	0.191848222	0.191848222	0.191848222	0.191876658	0.191848222	0.191848222	0.191848222	0.191848222	0.191848222	0.191848222	0.191910238	0.191867049	0.191848222	0.191848222	0.191848222	0.191848222	0.191848222	0.194176182	0	0	0	0	0	0	0	0												17.7628	0.639368673	3.220519521	0	2.337620483	3.604238431	0.832769081	3.386905711	5.978051343	1.777677099	2.271789048	0.138282676	0.09814808	4.502289989	7.927453647	15.37487184	0.690376901	2.037907137	3.445411169	7.893988036	5.656337576	1.40218364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.9789	0	3.581477802	17.7628	0.639368673	3.220519521	0	2.337620483	3.604238431	0.832769081	3.386905711	5.978051343	1.777677099	2.271789048	0.138282676	0.09814808	4.502289989	7.927453647	15.37487184	0.690376901	2.037907137	3.445411169	7.893988036	5.656337576	1.40218364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.9789	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.7628	0.639368673	3.220519521	0	2.337620483	3.604238431	0.832769081	3.386905711	5.978051343	1.777677099	2.271789048	0.138282676	0.09814808	4.502289989	7.927453647	15.37487184	0.690376901	2.037907137	3.445411169	7.893988036	5.656337576	1.40218364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.9789
H5746_012_0	2011	7																															D	D	D		T	Coin	Coin	V	V	V	V	V	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	0	0	0	0	0	0	0											0	NO	477.5252629	49.50021538	330.2337183	0	281.0709207	13.07230195	4.764040046	355.1651419	221.7311186	1591.124246	416.8340006	42.9552179	0.492902789	2139.870305	4206.048495	3082.117789	209.2409709	351.3354409	317.2352738	0	23.04250587	0.951966224	0	0	0	0	0	0	0	0												$125/Days 1-5 for IP Medical; $125/Days 1-5 for IP Surgical; PBP 1a	$125/Days 1-5 for IP Psych; $125/Days 1-5 for IP Substance Abuse; PBP 1b	$50/$125 per day for SNF days 11-20/21-100; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $20/Visit for PCP Urgent Care; PBP 4a, 4b"	$125/Visit for OP Fac - Surgery; PBP 9b	$200/Visit for OP Fac - Pathology; PBP 8a	$50/Visit for OP Fac - Radiology; $100/Visit for OP Fac - CT/MRI/PET; PBP 8b	$200/Visit for OP Fac - Observation; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$200/Visit for OP Fac - Cardiovascular; $20/Visit for OP Fac - Occ Therapy; $20/Visit for OP Fac - Physical/Speech Therapy; $20/Visit for OP Fac - CORF; $200/Visit for OP Fac - Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$5/Visit for PCP Office Visits; $5/Visit for PCP Consults; $0/ for Influenza Virus Vaccine; $0/ for Hepatitis B (HBV) Vaccine; $0/ for Initial Preventive Physical Examination (IPPE); $0/ for Pneumococcal Vaccine; PBP 7a, 14b-c"	"$20/Visit for Speclst Office Visits; $20/Visit for Speclst Consults; $20/Visit for Chiropractor; $20/Visit for Vision Exams; $20/Visit for Hearing/Speech Exams; $0/ for Prostate Cancer Screenings; $0/ for Screening Pap Tests; $0/ for Screening Pelvic Exam; $30/Visit for Podiatrist (Routine); PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse; PBP 7e, 7h"	"$20/Visit for Occ Therapy; $20/Visit for PT/ST; PBP 7c, 7i"	"$50/Visit for Prof Radiology (Office); $100/Visit for Prof Radiology (Office); $0/ for Bone Mass Measurements; $0/ for Screening Mammography; $0/ for Ultrasound Screening for Abdominal Aortic Aneurysm; PBP 7d, 14g-h"	"No Cost-Sharing; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"$0/ for Glaucoma Screening; $20/Visit for Medical Nutrition Therapy (MNT); $0/ for Smoking and Tobacco-Use Cessation Counseling; PBP 7g, 14a, 14j"	PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	"No Cost-Sharing; PBP 13b-f, 14a"											0	125	125	95.8095805	0	100	0.2	0.2	49.40692325	125	50.8406508	63.05153368	91.91188571	0.2	60.40084028	5	20.11179992	20	20	58.01023362	0	0.2	20	0	0	0	0	0	0	0	0											NO	105.4891995	105.4891995	89.23786309	0	99.97911537	0.199958231	0.199958231	49.39665012	124.9738942	50.83003291	63.0383656	91.89269025	0.199958231	60.38822579	4.998963587	20.10761178	19.99582307	19.99582307	57.9981184	0	0.199958231	19.99582307	0	0	0	0	0	0	0	0												4.1978	0.435144842	2.455779278	0	2.341768501	2.613914369	0.952609019	1.461997354	2.30921678	6.739741482	2.189711177	0.328939211	0.09855997	10.76858093	1.752156939	5.164502331	0.34866212	0.585436776	1.533254081	0	4.607538706	0.001586279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.8869	0	1.046882764	4.1978	0.435144842	2.455779278	0	2.341768501	2.613914369	0.952609019	1.461997354	2.30921678	6.739741482	2.189711177	0.328939211	0.09855997	10.76858093	1.752156939	5.164502331	0.34866212	0.585436776	1.533254081	0	4.607538706	0.001586279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.8869	YES	$225/Days 1-5 for IP Medical; $225/Days 1-5 for IP Surgical; PBP 1a	$225/Days 1-5 for IP Psych; $225/Days 1-5 for IP Substance Abuse; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	No Cost-Sharing; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $30/Visit for PCP Urgent Care; PBP 4a, 4b"	$175/Visit for OP Fac - Surgery; PBP 9b	No Cost-Sharing; PBP 8a	$100/Visit for OP Fac - Radiology; $150/Visit for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$30/Visit for Speclst Office Visits; $30/Visit for Speclst Consults; $30/Visit for Chiropractor; $30/Visit for Vision Exams; $30/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	"$100/ for Prof Radiology (Office); $150/ for Prof Radiology (Office); PBP 7d, 14g-h"	"No Cost-Sharing; PBP 7d, 7g, 14f, 14i"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	"No Cost-Sharing; PBP 13b-f, 14a"											6700	3.1672	0.2782	0	0	0	0	0	0.6413	1.4855	0	1.6714	0	0	0	0	3.2191	0.2229	0	1.2069	0	0	0	0	0	0	0	0	0	0	0											11.8926	0	0.639027073	7.3651	0.713389498	2.455779278	0	2.341768501	2.613914369	0.952609019	2.103266197	3.79470121	6.739741482	3.861160178	0.328939211	0.09855997	10.76858093	1.752156939	8.383596271	0.57155469	0.585436776	2.740165595	0	4.607538706	0.001586279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7795
H5749_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1130.748007	78.95100902	791.3944369	791.9703897	124.9185989	10.10394096	11.52209504	309.9428194	36.75368308	14.30908565	30.02479041	0	0.123774784	17.87184929	5551.214649	95.62046804	396.7374519	394.3351637	0	0	16.07426423	1267.584296	0	0	205.2730982	0	14.90110731	6	111.5336554	0											3400	"$220 Days 1-16 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$220 Days 1-9 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-25 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												199.2720069	126.6713695	60.68222009	0	200	0.2	0.114144242	49.2794272	0.2	0.146735503	0.166234566	0	0.2	0.160514595	9.993344998	0.11710344	38.5	35	0	0	0.2	34.76375993	0	0	35	0	0	0	0	0											NO	143.8259624	91.42594547	43.79781608	0	144.3513966	0.144351397	0.082384404	35.58739853	0.144351397	0.105907374	0.119980959	0	0.144351397	0.11585253	9.514603076	0.111541536	36.65561616	33.32328742	0	0	0.144351397	25.09098648	0	0	35	0	0	0	0	0												13.5526	0.60151422	2.888445666	0	1.502681184	1.458517989	0.94924093	0.919171553	5.305445481	1.515437684	3.60240314	0	0.017867063	2.07049895	4.401466998	10.66565387	1.21188798	1.095045333	0	0	2.32034249	2.650411703	0	0	0.598713203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3273	0	16.04016468	13.5526	0.60151422	2.888445666	0	1.502681184	1.458517989	0.94924093	0.919171553	5.305445481	1.515437684	3.60240314	0	0.017867063	2.07049895	4.401466998	10.66565387	1.21188798	1.095045333	0	0	2.32034249	2.650411703	0	0	0.598713203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3273	NO	"$325 Days 1-Unlimited (1a); $325 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.7824	0.1237	1.1414	0.5138	0.3674	0.5349	0.61	0.2246	1.9458	0.3705	1.2927	0	0.0044	0.7555	1.7241	2.4199	0.2439	0.2508	0	0	0.8178	0.7997	0	0	0.1305	0	0.0095	0	0	0											16.0633	0	0	15.335	0.725244619	4.02987995	0.513789149	1.870088828	1.993432511	1.559234197	1.143786326	7.251228704	1.88596431	4.895076497	0	0.022235585	2.825972561	6.125576786	13.08554676	1.455788708	1.345828661	0	0	3.138155933	3.45013491	0	0	0.729259691	0	0.009476581	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3907
H5749_801_0	2011	1																															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	200.080787	4.0815495	24.05549452	832.4292139	5.19923479	10.62965869	12.12160068	13.89519746	38.3405041	14.92687293	31.32109501	0	0.129118695	18.62320716	32.71465685	100.7539365	1.7615565	6.643796164	0	0	16.9106236	8.550269082	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.07040863	0.07040863	0.138728317	0	0.190704719	0.190704719	0.190704719	0.190704719	0.190704719	0.190704719	0.190704719	0	0.190704719	0.190704719	0.190704719	0.190704719	0.190704719	0.190704719	0	0	0.190704719	0.190704719	0	0	0	0	0	0	0	0												14.0874	0.287376309	3.337178274	0	0.991518611	2.027126077	2.311646454	2.649879731	7.31171507	2.846625111	5.97308063	0	0.024623544	3.551533494	6.23883945	19.21425117	0.335937138	1.267003282	0	0	3.224935725	1.630576665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3113	0	17.14641093	14.0874	0.287376309	3.337178274	0	0.991518611	2.027126077	2.311646454	2.649879731	7.31171507	2.846625111	5.97308063	0	0.024623544	3.551533494	6.23883945	19.21425117	0.335937138	1.267003282	0	0	3.224935725	1.630576665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3113	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0017	0.0204	0.4033	0	0.2138	0.4371	0.4984	0.5713	1.5765	0.6138	1.2878	0	0.0053	0.7657	1.2927	3.9813	0.0696	0.2625	0	0	0.6682	0.3379	0	0	0	0	0	0	0	0											14.0073	0	0	15.0892	0.307811388	3.740428858	0	1.205298912	2.464192631	2.810058153	3.221217556	8.888186385	3.460383004	7.26093036	0	0.029932601	4.317275953	7.53154668	23.19550467	0.405544373	1.529530362	0	0	3.893152589	1.968437298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3186
H5749_802_0	2011	1																															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	200.080787	4.0815495	24.05549452	832.4292139	5.19923479	10.62965869	12.12160068	13.89519746	38.3405041	14.92687293	31.32109501	0	0.129118695	18.62320716	32.71465685	100.7539365	1.7615565	6.643796164	0	0	16.9106236	8.550269082	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.07040863	0.07040863	0.138728317	0	0.190704719	0.190704719	0.190704719	0.190704719	0.190704719	0.190704719	0.190704719	0	0.190704719	0.190704719	0.190704719	0.190704719	0.190704719	0.190704719	0	0	0.190704719	0.190704719	0	0	0	0	0	0	0	0												14.0874	0.287376309	3.337178274	0	0.991518611	2.027126077	2.311646454	2.649879731	7.31171507	2.846625111	5.97308063	0	0.024623544	3.551533494	6.23883945	19.21425117	0.335937138	1.267003282	0	0	3.224935725	1.630576665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3113	0	17.14641093	14.0874	0.287376309	3.337178274	0	0.991518611	2.027126077	2.311646454	2.649879731	7.31171507	2.846625111	5.97308063	0	0.024623544	3.551533494	6.23883945	19.21425117	0.335937138	1.267003282	0	0	3.224935725	1.630576665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3113	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0017	0.0204	0.4033	0	0.2138	0.4371	0.4984	0.5713	1.5765	0.6138	1.2878	0	0.0053	0.7657	1.2927	3.9813	0.0696	0.2625	0	0	0.6682	0.3379	0	0	0	0	0	0	0	0											14.0073	0	0	15.0892	0.307811388	3.740428858	0	1.205298912	2.464192631	2.810058153	3.221217556	8.888186385	3.460383004	7.26093036	0	0.029932601	4.317275953	7.53154668	23.19550467	0.405544373	1.529530362	0	0	3.893152589	1.968437298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3186
H5749_803_0	2011	1																															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	200.080787	4.0815495	24.05549452	832.4292139	5.19923479	10.62965869	12.12160068	13.89519746	38.3405041	14.92687293	31.32109501	0	0.129118695	18.62320716	32.71465685	100.7539365	1.7615565	6.643796164	0	0	16.9106236	8.550269082	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.07040863	0.07040863	0.138728317	0	0.190704719	0.190704719	0.190704719	0.190704719	0.190704719	0.190704719	0.190704719	0	0.190704719	0.190704719	0.190704719	0.190704719	0.190704719	0.190704719	0	0	0.190704719	0.190704719	0	0	0	0	0	0	0	0												14.0874	0.287376309	3.337178274	0	0.991518611	2.027126077	2.311646454	2.649879731	7.31171507	2.846625111	5.97308063	0	0.024623544	3.551533494	6.23883945	19.21425117	0.335937138	1.267003282	0	0	3.224935725	1.630576665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3113	0	17.14641093	14.0874	0.287376309	3.337178274	0	0.991518611	2.027126077	2.311646454	2.649879731	7.31171507	2.846625111	5.97308063	0	0.024623544	3.551533494	6.23883945	19.21425117	0.335937138	1.267003282	0	0	3.224935725	1.630576665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3113	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0017	0.0204	0.4033	0	0.2138	0.4371	0.4984	0.5713	1.5765	0.6138	1.2878	0	0.0053	0.7657	1.2927	3.9813	0.0696	0.2625	0	0	0.6682	0.3379	0	0	0	0	0	0	0	0											14.0073	0	0	15.0892	0.307811388	3.740428858	0	1.205298912	2.464192631	2.810058153	3.221217556	8.888186385	3.460383004	7.26093036	0	0.029932601	4.317275953	7.53154668	23.19550467	0.405544373	1.529530362	0	0	3.893152589	1.968437298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3186
H5750_004_0	2011	7																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin		Coin	Coin	Coin	Coin		Coin																																																												0	YES	400.7214528	54.25749154	75.70082779		16.49904751	24.18572098	16.37379742	37.17552272	39.95749802	19.7335142	28.35631301			59.15147788		181.9274135	13.21428569	3.230372421	31.42309037		33.54695358																				6700	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																					0.080820393	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																				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																					32.3865	4.385111802	9.625513155	0	3.844278069	5.635272988	3.8150948	8.661896794	9.31009704	4.597908809	6.60702093	0	0	13.78229435	0	42.38908735	3.078928566	0.752676774	7.321580057	0	7.816440185	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	164.0097		0	32.3865	4.385111802	9.625513155	0	3.844278069	5.635272988	3.8150948	8.661896794	9.31009704	4.597908809	6.60702093	0	0	13.78229435	0	42.38908735	3.078928566	0.752676774	7.321580057	0	7.816440185	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	164.0097	NO																																																																																		0			32.3865	4.385111802	9.625513155	0	3.844278069	5.635272988	3.8150948	8.661896794	9.31009704	4.597908809	6.60702093	0	0	13.78229435	0	42.38908735	3.078928566	0.752676774	7.321580057	0	7.816440185	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	164.0097
H5774_003_0	2011	3																																				Coin	Coin	V											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	YES	0	0	0	0	0	26.42472076	4.948602166	155.5523819	0	0	0	0	0	0	0	0	0	0	293.1201692	0	0	0	0	748.237671	0	0	0	0	0	0											2500	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	"10% Coinsurance for DME (0% Cost Share for Diabetic Supplies); PBP 11a, 11c"	10% Coinsurance for DME Prosthetics; PBP 11b	"$50/Visit for OP ER; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-c"	"No Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"$25/Procedure for CT Scan; $25/Procedure for MRI; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"$5/Procedure for Non-Dental; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	"No Cost Sharing; PBP 11a, 13b-f"											0	0	0	0	0	0	0.087436041	0.1	50	0	0	0	0	0	0	0	0	0	0	25	0	0	0	0	5	0	0	0	0	0	0											NO	0	0	0	0	0	0.087427718	0.09999048	49.99524019	0	0	0	0	0	0	0	0	0	0	24.9976201	0	0	0	0	4.999524019	0	0	0	0	0	0												0	0	0	0	0	2.310253027	0.494813108	0.648073225	0	0	0	0	0	0	0	0	0	0	0.610608886	0	0	0	0	0.311736017	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.3755	0	0.000416569	0	0	0	0	0	2.310253027	0.494813108	0.648073225	0	0	0	0	0	0	0	0	0	0	0.610608886	0	0	0	0	0.311736017	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.3755	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	2.310253027	0.494813108	0.648073225	0	0	0	0	0	0	0	0	0	0	0.610608886	0	0	0	0	0.311736017	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.3755
H5774_005_0	2011	5																																				Coin	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	0	0	0	0	0	23.21900184	3.724527561	455.9486123	0	0	0	0	0	0	0	3898.853054	1333.488503	0	0	0	0	0	0	0	0	0	15.9370665	0	0	0											2500	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	"10% Coinsurance for DME (0% Cost Share for Diabetic Supplies); PBP 11a, 11c"	10% Coinsurance for DME Prosthetics; PBP 11b	"$25/Visit for OP ER; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-c"	"$5/Visit for Cardio; $10/Visit for Chiro; $5/Visit for Derm; $5/Visit for E&M Home Spec.; $5/Visit for E&M Office Spec.; $5/Visit for ESRD; $5/Visit for Gastro; $5/Visit for Neuro; $5/Visit for Ophthalm Exam; $5/Visit for Otorhino; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$10/Visit for Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	$5/Exam for Non-Hearing Exams; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	"No Cost Sharing; PBP 11a, 13b-f"											0	0	0	0	0	0	0.067604288	0.1	25	0	0	0	0	0	0	0	5.224695573	10	0	0	0	0	0	0	0	0	0	5	0	0	0											NO	0	0	0	0	0	0.067580978	0.099965521	24.99138032	0	0	0	0	0	0	0	5.222894165	9.996552129	0	0	0	0	0	0	0	0	0	4.998276064	0	0	0												0	0	0	0	0	1.569162864	0.372324339	0.949565431	0	0	0	0	0	0	0	1.696941405	1.110857278	0	0	0	0	0	0	0	0	0	0.006638155	0	0	0	0	0	0	0	0	0	0	0	0	0	5.7055	0	0.001967858	0	0	0	0	0	1.569162864	0.372324339	0.949565431	0	0	0	0	0	0	0	1.696941405	1.110857278	0	0	0	0	0	0	0	0	0	0.006638155	0	0	0	0	0	0	0	0	0	0	0	0	0	5.7055	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	1.569162864	0.372324339	0.949565431	0	0	0	0	0	0	0	1.696941405	1.110857278	0	0	0	0	0	0	0	0	0	0.006638155	0	0	0	0	0	0	0	0	0	0	0	0	0	5.7055
H5774_008_0	2011	5																																				Coin	Coin	V								V	V		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	YES	0	0	0	0	0	36.11909606	3.326996622	145.9893404	0	0	0	0	0	0	0	2772.387711	2053.130323	0	404.1720706	0	0	0	0	2543.932257	0	0	0	0	0	0											2500	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	"10% Coinsurance for DME (0% Cost Share for Diabetic Supplies); PBP 11a, 11c"	10% Coinsurance for DME Prosthetics; PBP 11b	"$50/Visit for OP ER; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-c"	"$10/Visit for Cardio; $10/Visit for Chiro; $10/Visit for Derm; $10/Visit for E&M Home Spec.; $10/Visit for E&M Office Spec.; $10/Visit for ESRD; $10/Visit for Gastro; $10/Visit for Neuro; $10/Visit for Ophthalm Exam; $10/Visit for Otorhino; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$10/Visit for Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"$25/Procedure for CT Scan; $25/Procedure for MRI; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"$10/Procedure for Non-Dental; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	"No Cost Sharing; PBP 11a, 13b-f"											0	0	0	0	0	0	0.094852954	0.1	50	0	0	0	0	0	0	0	10	10	0	25	0	0	0	0	10	0	0	0	0	0	0											NO	0	0	0	0	0	0.094529688	0.099659193	49.82959652	0	0	0	0	0	0	0	9.965919304	9.965919304	0	24.91479826	0	0	0	0	9.965919304	0	0	0	0	0	0												0	0	0	0	0	3.414326897	0.331565799	0.606215827	0	0	0	0	0	0	0	2.302449351	1.705110927	0	0.839155467	0	0	0	0	2.112718632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.3115	0	0.038682357	0	0	0	0	0	3.414326897	0.331565799	0.606215827	0	0	0	0	0	0	0	2.302449351	1.705110927	0	0.839155467	0	0	0	0	2.112718632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.3115	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	3.414326897	0.331565799	0.606215827	0	0	0	0	0	0	0	2.302449351	1.705110927	0	0.839155467	0	0	0	0	2.112718632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.3115
H5774_009_0	2011	4																															A	A			T	Coin	Coin	V								V	V	V	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	YES	349.9006079	0.059761477	0	0	494.3236885	31.82169368	5.558449684	111.606173	0	0	0	0	0	0	0	8337.491292	1440.933622	5550.195635	415.4217227	0	0	0	0	756.9888133	0	0	0	0	0	0											3400	$100/Admit for IP Surg; $100/Admit for IP Surgery; PBP 1a	$100/Admit for IP Mental Health; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	$25/Trip for Ambulance; PBP 10a	"20%  Coinsurance for DME (0% Cost Share for Diabetic Supplies); PBP 11a, 11c"	20% Coinsurance for DME Prosthetics; PBP 11b	"$50/Visit for OP ER; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-c"	"$5/Visit for Cardio; $5/Visit for Spec. Consults; $5/Visit for Derm; $5/Visit for E&M Home Spec.; $5/Visit for E&M Office Spec.; $5/Visit for ESRD; $5/Visit for Gastro; $5/Visit for Neuro; $5/Visit for Ophthalm Exam; $5/Visit for Otorhino; $5/Visit for Pulmonary; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$10/Visit for Psych; PBP 7e, 7h"	"$5/Visit for Prof Phys; PBP 7c, 7i"	"$25/Procedure for CT Scan; $25/Procedure for MRI; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"$5/Procedure for Non-Dental; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	"No Cost Sharing; PBP 11a, 13b-f"											0	100	100	0	0	25	0.148938252	0.2	50	0	0	0	0	0	0	0	5	10	5	25	0	0	0	0	5	0	0	0	0	0	0											NO	99.32371493	99.32371493	0	0	24.83092873	0.147931005	0.19864743	49.66185747	0	0	0	0	0	0	0	4.966185747	9.932371493	4.966185747	24.83092873	0	0	0	0	4.966185747	0	0	0	0	0	0												2.8961	0.000494644	0	0	1.022876357	4.707415111	1.104171744	0.461880821	0	0	0	0	0	0	0	3.450460868	1.192657336	2.296941871	0.859608933	0	0	0	0	0.313278921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.3059	0	0.124643049	2.8961	0.000494644	0	0	1.022876357	4.707415111	1.104171744	0.461880821	0	0	0	0	0	0	0	3.450460868	1.192657336	2.296941871	0.859608933	0	0	0	0	0.313278921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.3059	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.8961	0.000494644	0	0	1.022876357	4.707415111	1.104171744	0.461880821	0	0	0	0	0	0	0	3.450460868	1.192657336	2.296941871	0.859608933	0	0	0	0	0.313278921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.3059
H5774_014_0	2011	7																																				Coin	Coin	V									V		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	YES	0	0	0	0	0	19.83605296	7.881573403	101.1442617	0	0	0	0	0	0	0	0	1281.905766	0	376.084351	0	0	0	0	933.5370274	0	0	0	0	0	0											2500	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	"10% Coinsurance for DME (0% Cost Share for Diabetic Supplies); PBP 11a, 11c"	10% Coinsurance for DME Prosthetics; PBP 11b	"$50/Visit for OP ER; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-c"	"No Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$10/Visit for Psych; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"$25/Procedure for CT Scan; $25/Procedure for MRI; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"$5/Procedure for Non-Dental; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	"No Cost Sharing; PBP 11a, 13b-f"											0	0	0	0	0	0	0.081667958	0.1	50	0	0	0	0	0	0	0	0	10	0	25	0	0	0	0	5	0	0	0	0	0	0											NO	0	0	0	0	0	0.081648586	0.099976279	49.98813957	0	0	0	0	0	0	0	0	9.997627914	0	24.99406979	0	0	0	0	4.998813957	0	0	0	0	0	0												0	0	0	0	0	1.61958567	0.787970383	0.421334456	0	0	0	0	0	0	0	0	1.068001406	0	0.783323209	0	0	0	0	0.388881494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.0691	0	0.001202718	0	0	0	0	0	1.61958567	0.787970383	0.421334456	0	0	0	0	0	0	0	0	1.068001406	0	0.783323209	0	0	0	0	0.388881494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.0691	NO	20% Coinsurance for IP Surg; 20% Coinsurance for IP Surgery; PBP 1a	20% Coinsurance for IP Mental Health; PBP 1b	20% Coinsurance for SNF; PBP 2	20% Coinsurance for Home Health; PBP 6	$50/Trip for Ambulance; PBP 10a	"20% Coinsurance for DME (0% Cost Share for Diabetic Supplies); PBP 11a, 11c"	20% Coinsurance for DME Prosthetics; PBP 11b	"$50/Visit for OP ER; PBP 4a, 4b"	"20% Coinsurance for OP Surg; PBP 9a, 9b"	20% Coinsurance for OP Path; PBP 8a	20% Coinsurance for OP Rad; 20% Coinsurance for OP MRI; PBP 8b	20% Coinsurance for OP Observation;	20% Coinsurance for OP Other; PBP 12	"20% Coinsurance for OP Cardio; 20% Coinsurance for OP PT/OT/ST; 20% Coinsurance for Chemo; PBP 3, 5, 9a, 9c, 9d, 13a"	"40% Coinsurance for E&M Home PCP; 40% Coinsurance for E&M Office PCP; 20% Coinsurance for Immunizations; PBP 4b, 7a, 14b-c"	"20% Coinsurance for Cardio; 20% Coinsurance for Chiro; 40% Coinsurance for PCP Consults; 20% Coinsurance for Spec. Consults; 20% Coinsurance for Derm; 20% Coinsurance for E&M Home Spec.; 20% Coinsurance for E&M Office Spec.; 20% Coinsurance for ESRD; 20% Coinsurance for Gastro; 20% Coinsurance for Neuro; 20% Coinsurance for Ophthalm Exam; 20% Coinsurance for Otorhino; 20% Coinsurance for Pulmonary; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"20% Coinsurance for Psych; PBP 7e, 7h"	"20% Coinsurance for Prof Phys; PBP 7c, 7i"	"20% Coinsurance for Rad; 20% Coinsurance for CT Scan; 20% Coinsurance for Doppler & Duplex; 20% Coinsurance for MRI; 20% Coinsurance for Nuclear Med.; PBP 7d, 14g-h"	"20% Coinsurance for Prof Allergy; 20% Coinsurance for Prof Anesthesia; 40% Coinsurance for E&M Inp PCP; 20% Coinsurance for E&M Inp Spec.; 20% Coinsurance for Prof ER ; 20% Coinsurance for Prof IP Surg; 20% Coinsurance for Prof OP Surg; 20% Coinsurance for Prof Path; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for OP Pharm; 20% Coinsurance for HCPCS; 20% Coinsurance for Prof Rx; 20% Coinsurance for Injections; PBP 15	"20% Coinsurance for Misc; 20% Coinsurance for Ophthalm; 20% Coinsurance for Venipuncture; 20% Coinsurance for Other; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	"No Cost Sharing; PBP 11a, 13b-f"												1.0033	0	0.0102	0.0601	0.1512	0	0	0.0223	0.1053	0.0228	0.103	0.0139	0.0768	0.257	0.9482	0.6954	0	0.069	0.2394	0.7691	0.1054	0.0784	0	0	0	0	0	0	0	0											4.7308	0	8.88E-16	1.0033	3.44E-11	0.010227342	0.060057357	0.151207191	1.619585739	0.787970405	0.44359729	0.105301173	0.022810735	0.10299894	0.013902256	0.076803574	0.257028633	0.948228196	0.695408768	1.068001416	0.068981239	1.022761324	0.76905153	0.105388331	0.078437921	0	0.388881494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.7999
H5774_019_0	2011	7																																				Coin	Coin																	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	0	0	0	0	0	17.98984496	22.9196657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	844.436902	0	0	0	0	0	0											2500	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	"10% Coinsurance for DME (0% Cost Share for Diabetic Supplies); PBP 11a, 11c"	10% Coinsurance for DME Prosthetics; PBP 11b	"No Cost Sharing; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-c"	"No Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"$5/Procedure for Non-Dental; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	"No Cost Sharing; PBP 11a, 13b-f"											0	0	0	0	0	0	0.078234264	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5	0	0	0	0	0	0											NO	0	0	0	0	0	0.078229289	0.099993641	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.999682039	0	0	0	0	0	0												0	0	0	0	0	1.407332779	2.291820818	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.351826334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.051	0	0.000257627	0	0	0	0	0	1.407332779	2.291820818	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.351826334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.051	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	1.407332779	2.291820818	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.351826334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.051
H5774_802_0	2011	4																															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	125.8950289	0.023208289	0.948133198	0	5.11591788	29.10468547	4.655630672	6.143949277	12.31581058	1.850041049	10.23795356	2.228323451	10.11379686	24.25548384	57.13896451	60.4465084	6.812930211	7.896750684	24.66683072	75.03059628	15.15571774	5.888805125	0	0	0	0	0	0	0	0											3400	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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, 11c"	Medicare-FFS Cost Sharing; PBP 11b	"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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	"PBP 11a, 13b-f"											0	0.152760809	0.152760809	0.151922691	0	0.233	0.232990323	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.232999964	0.233	0	0	0	0	0	0	0	0											NO	0.14833636	0.14833636	0.147522517	0	0.226251563	0.226242166	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251529	0.226251563	0	0	0	0	0	0	0	0												18.6748	0.003442633	0.139870995	0	1.157484418	6.584707096	1.053343718	1.390078129	2.786471397	0.418574679	2.316352998	0.504161664	2.288262351	5.487841139	12.92778005	13.67611702	1.541436111	1.786652188	5.580909013	16.97578971	3.429004308	1.332351366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0554	0	2.984367482	18.6748	0.003442633	0.139870995	0	1.157484418	6.584707096	1.053343718	1.390078129	2.786471397	0.418574679	2.316352998	0.504161664	2.288262351	5.487841139	12.92778005	13.67611702	1.541436111	1.786652188	5.580909013	16.97578971	3.429004308	1.332351366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0554	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.6748	0.003442633	0.139870995	0	1.157484418	6.584707096	1.053343718	1.390078129	2.786471397	0.418574679	2.316352998	0.504161664	2.288262351	5.487841139	12.92778005	13.67611702	1.541436111	1.786652188	5.580909013	16.97578971	3.429004308	1.332351366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0554
H5774_806_0	2011	2																															A	A				Coin	Coin	V											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	YES	221.9240047	0.072103904	0	0	0	26.33187116	5.575073915	304.0876266	0	0	0	0	0	0	0	0	0	0	445.0532063	0	0	0	0	861.9481578	0	0	0	0	0	0											3400	$400/Admit for IP Surg; $400/Admit for IP Surgery; PBP 1a	$400/Admit for IP Mental Health; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	"20%  Coinsurance for DME (0% Cost Share for Diabetic Supplies); PBP 11a, 11c"	20% Coinsurance for DME Prosthetics; PBP 11b	"$50/Visit for OP ER; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-c"	"No Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"$25/Procedure for CT Scan; $25/Procedure for MRI; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"$5/Procedure for Non-Dental; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	"No Cost Sharing; PBP 11a, 13b-f"											0	400	400	0	0	0	0.173569663	0.2	50	0	0	0	0	0	0	0	0	0	0	25	0	0	0	0	5	0	0	0	0	0	0											NO	398.24276	398.24276	0	0	0	0.172807154	0.19912138	49.780345	0	0	0	0	0	0	0	0	0	0	24.8901725	0	0	0	0	4.9780345	0	0	0	0	0	0												7.365	0.002392905	0	0	0	4.550335714	1.110116412	1.26146558	0	0	0	0	0	0	0	0	0	0	0.923120923	0	0	0	0	0.357567306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.57	0	0.06870224	7.365	0.002392905	0	0	0	4.550335714	1.110116412	1.26146558	0	0	0	0	0	0	0	0	0	0	0.923120923	0	0	0	0	0.357567306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.57	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.365	0.002392905	0	0	0	4.550335714	1.110116412	1.26146558	0	0	0	0	0	0	0	0	0	0	0.923120923	0	0	0	0	0.357567306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.57
H5774_808_0	2011	4																															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	125.8950289	0.023208289	0.948133198	0	5.11591788	29.10468547	4.655630672	6.143949277	12.31581058	1.850041049	10.23795356	2.228323451	10.11379686	24.25548384	57.13896451	60.4465084	6.812930211	7.896750684	24.66683072	75.03059628	15.15571774	5.888805125	0	0	0	0	0	0	0	0											3400	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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, 11c"	Medicare-FFS Cost Sharing; PBP 11b	"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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	"PBP 11a, 13b-f"											0	0.152760809	0.152760809	0.151922691	0	0.233	0.232990323	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.232999964	0.233	0	0	0	0	0	0	0	0											NO	0.14833636	0.14833636	0.147522517	0	0.226251563	0.226242166	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251563	0.226251529	0.226251563	0	0	0	0	0	0	0	0												18.6748	0.003442633	0.139870995	0	1.157484418	6.584707096	1.053343718	1.390078129	2.786471397	0.418574679	2.316352998	0.504161664	2.288262351	5.487841139	12.92778005	13.67611702	1.541436111	1.786652188	5.580909013	16.97578971	3.429004308	1.332351366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0554	0	2.984367482	18.6748	0.003442633	0.139870995	0	1.157484418	6.584707096	1.053343718	1.390078129	2.786471397	0.418574679	2.316352998	0.504161664	2.288262351	5.487841139	12.92778005	13.67611702	1.541436111	1.786652188	5.580909013	16.97578971	3.429004308	1.332351366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0554	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.6748	0.003442633	0.139870995	0	1.157484418	6.584707096	1.053343718	1.390078129	2.786471397	0.418574679	2.316352998	0.504161664	2.288262351	5.487841139	12.92778005	13.67611702	1.541436111	1.786652188	5.580909013	16.97578971	3.429004308	1.332351366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0554
H5782_001_0	2011	5																																																																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	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											6700	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"No Cost Sharing; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-c"	"No Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	"No Cost Sharing; PBP 7d, 14g-h"	"No Cost Sharing; PBP 7d, 7g, 14f, 14i"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	No Cost Sharing; PBP 13b											0	0	0	0	0	0	0	0	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
H5783_002_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1650.367213	48.63591728	833.765232		203.3291862	10.47758955	11.07312666	462.6567637	249.4717844		16.45445299	0.690708093	0.16629886	19.53267031	4464.877834	3734.824636	106.9538521	696.9656912	21.05253048		6.635686273				159.1037094																3900	"1a (IP Acute) 195 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 350 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 29 copay, 7i (PT/ST) 29 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 10 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 29 copay, 7f (Podiatry) 29 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 29 copay, 18a (Hearing Exam) 29 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 29 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 29 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 70 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 29 copay	18b (Hearing Aids) 750 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												141.3400104	172.0337627	49.94161658		150	0.2	0.2	49.8	347.5227273		0.2	0.2	0.2	0.200048013	10	28.52131444	39.98332987	29	0.181		0.2				25																NO	125.4195911	152.6560251	44.31623511		133.1041268	0.177472169	0.177472169	44.1905701	308.3780611		0.177472169	0.177472169	0.177472169	0.177514774	8.873608454	25.36331104	35.49443382	25.73346452	0.160612313		0.177472169				25																	17.249	0.618713817	3.079111338	0	2.255329482	1.859480543	1.965171806	1.703755513	6.410968763	0	2.920207462	0.122581464	0.029513419	3.467337547	3.301631475	7.89395991	0.316355535	1.494611824	3.381295615	0	1.177649636	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5782	0	7.501310839	17.249	0.618713817	3.079111338	0	2.255329482	1.859480543	1.965171806	1.703755513	6.410968763	0	2.920207462	0.122581464	0.029513419	3.467337547	3.301631475	7.89395991	0.316355535	1.494611824	3.381295615	0	1.177649636	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5782	NO																																																																																		0	0	0	17.249	0.618713817	3.079111338	0	2.255329482	1.859480543	1.965171806	1.703755513	6.410968763	0	2.920207462	0.122581464	0.029513419	3.467337547	3.301631475	7.89395991	0.316355535	1.494611824	3.381295615	0	1.177649636	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5782
H5783_006_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1476.141735	244.9490967	761.1491591		271.410732	9.339001093	8.693015892	462.2639866	118.7680771		9.706205079	0.629371571	0.174074425	11.70851703	5152.687651	3714.669013	275.2829308	763.0757739	26.0055551		14.32991157				159.1037094																3900	"1a (IP Acute) 195 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 275 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 30 copay, 7i (PT/ST) 30 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 5 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 30 copay, 7f (Podiatry) 30 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 30 copay, 18a (Hearing Exam) 30 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 30 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 30 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0%coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												141.3400104	172.0337627	49.94161658		150	0.2	0.2	49.8	273.4644608		0.2	0.2	0.2	0.199053604	5	29.45335962	39.49495903	30	0.181		0.2				25																NO	126.8279908	154.3702764	44.81388439		134.59882	0.179465093	0.179465093	44.68680823	245.3866248		0.179465093	0.179465093	0.179465093	0.178615868	4.486627332	26.49143377	35.54456184	26.91976399	0.162415909		0.179465093				25																	15.6013	3.151071646	2.842504202	0	3.044297021	1.676024702	1.560092908	1.721425177	2.428674799	0	1.741925	0.112950228	0.031240283	2.091326936	1.926515771	8.200575678	0.81540093	1.711818312	4.223715882	0	2.571718918	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7841	0	6.320917061	15.6013	3.151071646	2.842504202	0	3.044297021	1.676024702	1.560092908	1.721425177	2.428674799	0	1.741925	0.112950228	0.031240283	2.091326936	1.926515771	8.200575678	0.81540093	1.711818312	4.223715882	0	2.571718918	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7841	NO																																																																																		0	0	0	15.6013	3.151071646	2.842504202	0	3.044297021	1.676024702	1.560092908	1.721425177	2.428674799	0	1.741925	0.112950228	0.031240283	2.091326936	1.926515771	8.200575678	0.81540093	1.711818312	4.223715882	0	2.571718918	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7841
H5783_008_0	2011	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin	T	Coin	P	P	P	P	O	V																																																			0	YES	470.2792286	22.26526115	39.43942073		17.56371657	17.32796139	10.5081416	32.14465847	43.53695723		11.91022007	3.535107962	0.456138579	15.82304465		5255.500188	2.952012643	1092.610095	34.2306442	13.50670164	14.59774383	0.484848923		13.93798932	159.1037094		106.6941694														3400	"1a (IP Acute) FFS, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 20% coin	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 20% coin, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 20% coin"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 0-20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 20% coin, 5 (Partial Hosp) 20% coin, 7c (OT) 8 copay, 7i (PT/ST) 8 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 20% coin, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 8 copay, 7b1 (Routine Chiro) 0% coin (5 visits), 7d (SPC w/Copay) 8 copay, 7f (Podiatry) 8 copay, 7f1 (Routine Podiatry) 0% coin (3 visits), 17a (Eye Exam) 8 copay, 18a (Hearing Exam) 8 copay"	"7e (MH Non-Phys) 45% coin, 7h (Psych) 45% coin"	7i (PT/ST) 8 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0-20% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 8 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 8 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 81.5"												0.079948731	0.079948731	0.181743511		0.2	0.2	0.2	0.2	0.2		0.2	0.2	0.2	0.2		8	0.45	8	0.181	0.07872	0.2	0.2		0.135384615	5		8														NO	0.064758756	0.064758756	0.14721289		0.162000711	0.162000711	0.162000711	0.162000711	0.162000711		0.162000711	0.162000711	0.162000711	0.162000711		6.480028455	0.364501601	6.480028455	0.146610644	0.06376348	0.162000711	0.162000711		0.135384615	5		6.480028455															30.4547	1.441870623	5.805991109	0	2.845334578	2.807142071	1.702326414	5.20745754	7.053018042	0	1.929464123	0.572690005	0.073894774	2.563344489	0	2.837982564	1.076013333	0.590012042	5.018576784	0.8612343	2.364844885	0.078545871	0	1.886989318	0.066293212	0	0.057615104	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2953	0	17.67241966	30.4547	1.441870623	5.805991109	0	2.845334578	2.807142071	1.702326414	5.20745754	7.053018042	0	1.929464123	0.572690005	0.073894774	2.563344489	0	2.837982564	1.076013333	0.590012042	5.018576784	0.8612343	2.364844885	0.078545871	0	1.886989318	0.066293212	0	0.057615104	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2953	NO																																																																																		0	0	0	30.4547	1.441870623	5.805991109	0	2.845334578	2.807142071	1.702326414	5.20745754	7.053018042	0	1.929464123	0.572690005	0.073894774	2.563344489	0	2.837982564	1.076013333	0.590012042	5.018576784	0.8612343	2.364844885	0.078545871	0	1.886989318	0.066293212	0	0.057615104	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2953
H5783_011_0	2011	5																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin	T	Coin	P	P	P	P	O	V																																																			0	YES	470.5851839	9.708556859	34.73192814		9.664096621	12.52203006	17.64434184	26.75537214	87.2194966		25.30179609	5.709796298	0.884575359	38.84793231		10243.43673	6.134778061	1527.999095	60.71559245	26.60217569	35.4651311	1.864590139		13.93798932	159.1037094		260.9166693														3400	"1a (IP Acute) FFS, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 20% coin	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 20% coin, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 20% coin"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 0-20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 20% coin, 5 (Partial Hosp) 20% coin, 7c (OT) 8 copay, 7i (PT/ST) 8 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 20% coin, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 8 copay, 7b1 (Routine Chiro) 0% coin (5 visits), 7d (SPC w/Copay) 8 copay, 7f (Podiatry) 8 copay, 7f1 (Routine Podiatry) 0% coin (3 visits), 17a (Eye Exam) 8 copay, 18a (Hearing Exam) 8 copay"	"7e (MH Non-Phys) 45% coin, 7h (Psych) 45% coin"	7i (PT/ST) 8 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0-20% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 8 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 8 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 81.5"												0.080395047	0.080395047	0.18858252		0.2	0.2	0.2	0.2	0.2		0.2	0.2	0.2	0.2		8	0.45	8	0.181	0.07872	0.2	0.2		0.135384615	5		8														NO	0.06038355	0.06038355	0.141641586		0.150217089	0.150217089	0.150217089	0.150217089	0.150217089		0.150217089	0.150217089	0.150217089	0.150217089		6.008683562	0.33798845	6.008683562	0.135946466	0.059125446	0.150217089	0.150217089		0.135384615	5		6.008683562															28.4156	0.586237126	4.919485395	0	1.451712463	1.881022905	2.650481669	4.019114119	13.10185889	0	3.800762157	0.857708979	0.132878336	5.835623307	0	5.129130823	2.07348413	0.765105254	8.254070199	1.572865509	5.327468757	0.280093303	0	1.886989318	0.066293212	0	0.130647142	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1386	0	30.21941381	28.4156	0.586237126	4.919485395	0	1.451712463	1.881022905	2.650481669	4.019114119	13.10185889	0	3.800762157	0.857708979	0.132878336	5.835623307	0	5.129130823	2.07348413	0.765105254	8.254070199	1.572865509	5.327468757	0.280093303	0	1.886989318	0.066293212	0	0.130647142	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1386	NO																																																																																		0	0	0	28.4156	0.586237126	4.919485395	0	1.451712463	1.881022905	2.650481669	4.019114119	13.10185889	0	3.800762157	0.857708979	0.132878336	5.835623307	0	5.129130823	2.07348413	0.765105254	8.254070199	1.572865509	5.327468757	0.280093303	0	1.886989318	0.066293212	0	0.130647142	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1386
H5783_012_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1350.467874	95.62529492	752.9423477		190.1122897	9.423929371	10.34550887	462.9011609	283.6946642		11.19717118	0.757046768	0.383306139	10.70146403	4474.585213	4388.435315	256.2359673	596.1290742	31.36808007		16.57448383				159.1037094																4950	"1a (IP Acute) 195 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 275 copay, 9b (OP ASC) 100 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 30 copay, 7i (PT/ST) 30 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 5 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 30 copay, 7f (Podiatry) 30 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 30 copay, 18a (Hearing Exam) 30 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 30 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 30 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) n/a	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0%coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												141.3400104	172.0337627	49.94161658		150	0.2	0.2	49.03844054	226.0827295		0.2	0.2	0.2	0.196999828	5	29.6750376	40	30	0.181		0.2				25																NO	130.506509	158.8476309	46.113666		138.5027233	0.184670298	0.184670298	45.27971707	208.7538248		0.184670298	0.184670298	0.184670298	0.181900084	4.616757442	27.40091055	36.93405954	27.70054465	0.167126619		0.184670298				25																	14.6871	1.265820962	2.893410995	0	2.194255821	1.740319842	1.910508202	1.746669466	4.935195519	0	2.067784936	0.139804052	0.070785259	1.946597207	1.721506215	10.02059363	0.788652873	1.37609167	5.242441179	0	3.060814862	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1398	0	4.798571559	14.6871	1.265820962	2.893410995	0	2.194255821	1.740319842	1.910508202	1.746669466	4.935195519	0	2.067784936	0.139804052	0.070785259	1.946597207	1.721506215	10.02059363	0.788652873	1.37609167	5.242441179	0	3.060814862	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1398	NO																																																																																		0	0	0	14.6871	1.265820962	2.893410995	0	2.194255821	1.740319842	1.910508202	1.746669466	4.935195519	0	2.067784936	0.139804052	0.070785259	1.946597207	1.721506215	10.02059363	0.788652873	1.37609167	5.242441179	0	3.060814862	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1398
H5783_801_0	2011	4																															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	Coin	V																																																			0	YES	227.4986081	4.816220376	21.64941773		4.741326104	5.229990481	7.824387067	13.03318274	40.20030768	5.648840767	15.12595614	3.349618633	0.355966845	19.73472283	54.44655332	110.0499444	2.815356025	11.27613634	28.04070881	15.28431242	15.72331121	0.717295013																			6700	"1a (IP Acute) FFS, 1a1 (Add'l Days) n/a"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) n/a"	6a (Home Health) FFS	10a (Ambulance) FFS	11a (DME) FFS	"11b (Prosthetics) FFS, 11b (Medical Supplies) FFS, 11c (Diabetic Supplies) FFS"	"4a (ER) FFS, 4a (ER) - Worldwide Coverage n/a, 4b (UC) FFS"	"9a (OP Surgery) FFS, 9b (OP ASC) FFS"	8a (OP Diag Proc/Test/Lab) FFS	"8b (X-Ray) FFS, 8b (OP Therap Rad) FFS, 8b (OP Diag) FFS"	9a (OP Observation) FFS	12 (Renal Dialysis) FFS	"3 (CORF) FFS, 5 (Partial Hosp) FFS, 7c (OT) FFS, 7i (PT/ST) FFS, 9a (OP Other) FFS, 9a (OP Chemo) FFS, 9c (OP SA) FFS, 9d (OP Cardiac Rehab) FFS"	"7a (PCP w/Copay) FFS, 14b (Immunizations) FFS, 14c (Routine Physical) FFS, 14d (Pap & Pelvic Exam) FFS, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) FFS, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) FFS, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) FFS, 14h (Mammography) FFS, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) FFS, 14j (Nutrition Therapy Diabetes) FFS"	"7b (Chiro) FFS, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) FFS, 7f (Podiatry) FFS, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) FFS, 18a (Hearing Exam) FFS"	"7e (MH Non-Phys) FFS, 7h (Psych) FFS"	7i (PT/ST) FFS	7g Physician Specialist Services Excluding Psychiatric (Radiology only) FFS	"8a (OP Diag Proc/Test/Lab) FFS, 7g (Prof. Other) FFS"	15 (Part B Rx) FFS	"13a (Blood) FFS, 13a1 (3 Pint Blood) n/a, 14a4-1 (Smoking Cessation - Mdcr Covered) FFS, 16b (Comp. Dental) FFS, 17b (MCR Eyewear) FFS"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive n/a"	17a1 (Routine Eye Exam) n/a	17b1 (Non MCR Covered) n/a	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) n/a, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												0.076653506	0.076653506	0.164633008		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069034452	0.069034452	0.148269141		0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725																				15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	0	10.31335866	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	NO																																																																																		0	0	0	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469
H5793_001_0	2011	3																															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	1153.822679	153.0145458	774.8035021	1053.570808	193.4307098	9.532764794	0	337.6401134	400.1855003	3408.515903	2437.450625	180.9876412	1.102510516	353.4706635	2953.154721	4970.608423	250.4356231	724.9746586	0	0	252.6327665	0	0	0	1301.212077	101.149848	52.07139255	9.663735381	68.29394948	0											3400	$300/day 1-7	$300/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$15 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$200 per procedure	$40 per visit	$40 X-ray; $175 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$25 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	216.8565234	216.8565234	72.96419583	15	150	0.05	0.05	49	200	6	23.375	40	25	40	25	40	40	30	40	40	$50 	0	0	0	0	0	0	0	0	0											NO	185.1594044	185.1594044	62.29928818	12.80750527	128.0750527	0.042691684	0.042691684	41.83785055	170.7667369	5.123002108	19.95836238	34.15334739	21.34584212	34.15334739	21.34584212	34.15334739	34.15334739	25.61501054	34.15334739	34.15334739	42.69168423	0	0	0	0	0	0	0	0	0												17.8034	2.361006847	4.022475555	1.124467806	2.064470696	0.406969784	0	1.17717805	5.694864339	1.455152846	4.053960238	0.515111149	0.001961168	1.006017197	5.253131201	14.14690968	0.712767903	1.54751946	0	0	0.898776524	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2462	0	10.9981905	17.8034	2.361006847	4.022475555	1.124467806	2.064470696	0.406969784	0	1.17717805	5.694864339	1.455152846	4.053960238	0.515111149	0.001961168	1.006017197	5.253131201	14.14690968	0.712767903	1.54751946	0	0	0.898776524	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2462	NO																																																																																		0			17.8034	2.361006847	4.022475555	1.124467806	2.064470696	0.406969784	0	1.17717805	5.694864339	1.455152846	4.053960238	0.515111149	0.001961168	1.006017197	5.253131201	14.14690968	0.712767903	1.54751946	0	0	0.898776524	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2462
H5793_008_0	2011	3																															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	1219.871696	65.37915373	1173.578296	909.3472498	255.2749704	9.110052845	0	367.0082792	393.9951379	4875.431378	2964.718909	49.23341058	0.469493178	648.1289742	3242.393301	5857.133208	274.2831077	1226.642132	0	0	315.9506077	0	0	0	1755.687722	86.57330545	71.64070018	17.40177027	93.2278392	0											3400	$175/day 1-7	$175/day 1-7	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$10 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$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; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$25 per visit; Chiropractic Visits $13 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$25 per visit	$25 per visit	$40 per visit	$25 per visit	$50 per script	0	Not Covered	0	$0 per visit	$50.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	126.4996386	126.4996386	72.96419583	10	150	0.05	0.05	48.5	175	3.75	16.25	25	25	25	10	25	25	18.75	40	25	$50 	0	0	0	0	0	0	0	0	0											NO	113.1080771	113.1080771	65.24002739	8.941375513	134.1206327	0.044706878	0.044706878	43.36567124	156.4740715	3.353015817	14.52973521	22.35343878	22.35343878	22.35343878	8.941375513	22.35343878	22.35343878	16.76507909	35.76550205	22.35343878	44.70687756	0	0	0	0	0	0	0	0	0												11.4981	0.61624253	6.380356681	0.677567936	2.853136711	0.407282017	0	1.326296698	5.137501947	1.362283211	3.58971506	0.091711336	0.000874566	1.207325946	2.415954672	10.91058905	0.510930888	1.713729363	0	0	1.177097094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8767	0	6.142002741	11.4981	0.61624253	6.380356681	0.677567936	2.853136711	0.407282017	0	1.326296698	5.137501947	1.362283211	3.58971506	0.091711336	0.000874566	1.207325946	2.415954672	10.91058905	0.510930888	1.713729363	0	0	1.177097094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8767	NO																																																																																		0			11.4981	0.61624253	6.380356681	0.677567936	2.853136711	0.407282017	0	1.326296698	5.137501947	1.362283211	3.58971506	0.091711336	0.000874566	1.207325946	2.415954672	10.91058905	0.510930888	1.713729363	0	0	1.177097094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8767
H5793_801_0	2011	2																															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	YES	302.170398	6.168580429	38.60198984	7.664380075	8.987405244	11.62161481	0	14.40630387	39.76067711	17.81200819	57.55757093	1.019099523	0.087383413	26.50711809	27.054787	129.4670367	3.500909167	8.246558906	0	0	68.78025697	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.067405172	0.067405172	0.157907468	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.053807531	0.053807531	0.126052804	0	0.185996923	0.185996923	0.185996923	0.185996923	0.185996923	0.185996923	0.185996923	0.185996923	0.185996923	0.185996923	0.185996923	0.185996923	0.185996923	0.185996923	0.185996923	0.185996923	0.185996923	0.185996923	0	0	0	0	0	0	0	0												16.259	0.33191608	4.865889044	0	1.671629725	2.161584599	0	2.679528197	7.395363615	3.312978723	10.70553111	0.189549376	0.016253046	4.930242413	5.032107146	24.08047052	0.651158334	1.533834585	0	0	12.79291619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.61	0	24.91962282	16.259	0.33191608	4.865889044	0	1.671629725	2.161584599	0	2.679528197	7.395363615	3.312978723	10.70553111	0.189549376	0.016253046	4.930242413	5.032107146	24.08047052	0.651158334	1.533834585	0	0	12.79291619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.61	NO																																																																																		0			16.259	0.33191608	4.865889044	0	1.671629725	2.161584599	0	2.679528197	7.395363615	3.312978723	10.70553111	0.189549376	0.016253046	4.930242413	5.032107146	24.08047052	0.651158334	1.533834585	0	0	12.79291619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.61
H5793_802_0	2011	2																															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	YES	301.2868578	6.150543623	38.48911839	7.641969581	8.961126251	11.58763344	0	14.36418012	39.64441768	17.75992624	57.38927375	1.016119697	0.087127906	26.42961181	26.97567934	129.0884777	3.490672578	8.222446132	0	0	68.57914487	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.06768088	0.06768088	0.158957514	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.054041482	0.054041482	0.126923581	0	0.186044645	0.186044645	0.186044645	0.186044645	0.186044645	0.186044645	0.186044645	0.186044645	0.186044645	0.186044645	0.186044645	0.186044645	0.186044645	0.186044645	0.186044645	0.186044645	0.186044645	0.186044645	0	0	0	0	0	0	0	0												16.282	0.332384493	4.885176717	0	1.667169552	2.15581715	0	2.672378792	7.375631614	3.304139172	10.67696706	0.189043628	0.01620968	4.917087746	5.018680687	24.01622001	0.649420941	1.529742072	0	0	12.75878266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4468	0	24.84675834	16.282	0.332384493	4.885176717	0	1.667169552	2.15581715	0	2.672378792	7.375631614	3.304139172	10.67696706	0.189043628	0.01620968	4.917087746	5.018680687	24.01622001	0.649420941	1.529742072	0	0	12.75878266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4468	NO																																																																																		0			16.282	0.332384493	4.885176717	0	1.667169552	2.15581715	0	2.672378792	7.375631614	3.304139172	10.67696706	0.189043628	0.01620968	4.917087746	5.018680687	24.01622001	0.649420941	1.529742072	0	0	12.75878266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4468
H5810_001_0	2011	9																																																																							0	0	0	0	0	0	0	0	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											6700	No Cost-Sharing; PBP 1a	No Cost-Sharing; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	No Cost-Sharing; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"No Cost-Sharing; PBP 4a, 4b"	"No Cost-Sharing; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b, 14c"	"No Cost-Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	No Cost-Sharing; PBP 8b	"No Cost-Sharing; PBP 7d, 7g, 14d-j"	No Cost-Sharing; PBP 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	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
H5810_002_0	2011	11																															D	D	D		T	Coin	Coin	V	V		Coin		Coin	V	V	V	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	675.7079296	17.13091562	176.4830701	0	177.0842352	1.864128169	1.020165926	255.2218104	211.5376307	0	11.2387427	0	0.49182795	613.847582	5334.961166	5524.569253	117.2758108	251.2933308	19.90601668	53.41571672	13.51325762	0	0	0	780.8207279	0	195.117674	0	0	0											3350	$200 /Days 1-8 for IP Medical; $200 /Days 1-8 for IP Surgical; PBP 1a	$100 /Days 1-8 for IP Psych; $100 /Days 1-8 for IP Substance Abuse; PBP 1b	$50 /Days 11-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$50/Run for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for ER - Facility; $25/Visit for PCP Urgent Care; PBP 4a, 4b"	"$50/Case for OP Hospital Services; $50/Case for Ambulatory Surgery Center Services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	20% Coinsurance for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET; PBP 8b		20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$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; $50/Case for OP Fac - Other; $10/Visit for Prof - CORF; $15/Visit for OP Substance Abuse; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"$5/Visit for Prof - Asst Surgeon (OP); $5/Visit for PCP Office Visits; $5/Consult for PCP Consults; PBP 7a, 14b, 14c"	"$10/Visit for Prof - Asst Surgeon (OP); $10/Visit for Speclst Office Visits; $10/Consult for Speclst Consults; $10/Visit for Chiropractor; $10/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; PBP 7e, 7h"	"$10/Visit for Occ Therapy; $10/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); $33/Procedure for Prof Radiology (Office); PBP 8b	"$5/Visit for Allergy Testing; $5/Visit for Allergy Tx; PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; PBP 15				$10/Exam for Vision Exams (Refractions); PBP 17a		$10/Exam for Hearing Exam; PBP 18a														0	200	100	50	0	50	0.2	0.2	46.78856164	50	0	0.197399168	0	0.2	34.25197179	5	10	15	10	0.192797361	5.107378786	0.2	0	0	0	10	0	10	0	0	0											NO	197.273541	98.63677052	49.31838526	0	49.31838526	0.197273541	0.197273541	46.15072617	49.31838526	0	0.194708164	0	0.197273541	33.78503881	4.934862027	9.863677052	14.79551558	9.863677052	0.19016909	5.037753493	0.197273541	0	0	0	9.962143784	0	9.962002027	0	0	0												11.1083	0.140811516	0.72532167	0	0.727792378	0.367743165	0.201251745	0.98155599	0.869391197	0	2.188274957	0	0.097024641	1.728238699	2.19394144	4.541047247	0.14459634	0.206556355	3.785509086	0.022424601	2.665808181	0	0	0	0.648220697	0	0.161980222	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5058	0	0.453593985	11.1083	0.140811516	0.72532167	0	0.727792378	0.367743165	0.201251745	0.98155599	0.869391197	0	2.188274957	0	0.097024641	1.728238699	2.19394144	4.541047247	0.14459634	0.206556355	3.785509086	0.022424601	2.665808181	0	0	0	0.648220697	0	0.161980222	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5058	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.1083	0.140811516	0.72532167	0	0.727792378	0.367743165	0.201251745	0.98155599	0.869391197	0	2.188274957	0	0.097024641	1.728238699	2.19394144	4.541047247	0.14459634	0.206556355	3.785509086	0.022424601	2.665808181	0	0	0	0.648220697	0	0.161980222	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5058
H5810_007_0	2011	9																																																																							0	0	0	0	0	0	0	0	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											6700	No Cost-Sharing; PBP 1a	No Cost-Sharing; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	No Cost-Sharing; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"No Cost-Sharing; PBP 4a, 4b"	"No Cost-Sharing; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b, 14c"	"No Cost-Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	No Cost-Sharing; PBP 8b	"No Cost-Sharing; PBP 7d, 7g, 14d-j"	No Cost-Sharing; PBP 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	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
H5810_009_0	2011	11																															A	A	D		T	Coin	Coin	V	V		Coin		Coin	V	V	V	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	186.7403883	2.247520459	244.8652005	0	150.3643551	1.990281131	1.305081586	199.2790282	222.910864	0	10.02726089	0	0.228637333	726.2185037	3957.584978	4032.019395	87.67236346	321.6242473	15.87668549	66.45804643	5.889953104	0	0	0	1055.435929	0	197.5850439	0	0	0											3350	$300/Admit for IP Medical; $300/Admit for IP Surgical; PBP 1a	$500/Admit for IP Psych; $500/Admit for IP Substance Abuse; PBP 1b	$50 /Days 11-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$100/Run for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for ER - Facility; $25/Visit for PCP Urgent Care; PBP 4a, 4b"	"$50/Case for OP Hospital Services; $50/Case for Ambulatory Surgery Center Services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	20% Coinsurance for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET; PBP 8b		20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$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; $50/Case for OP Fac - Other; $15/Visit for Prof - CORF; $15/Visit for OP Substance Abuse; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"$10/Visit for Prof - Asst Surgeon (OP); $10/Visit for PCP Office Visits; $10/Consult for PCP Consults; PBP 7a, 14b, 14c"	"$15/Visit for Prof - Asst Surgeon (OP); $15/Visit for Speclst Office Visits; $15/Consult for Speclst Consults; $15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; PBP 7e, 7h"	"$10/Visit for Occ Therapy; $15/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); $33/Procedure for Prof Radiology (Office); PBP 8b	"$10/Visit for Allergy Testing; $10/Visit for Allergy Tx; PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; PBP 15				$15/Exam for Vision Exams (Refractions); PBP 17a		$15/Exam for Hearing Exam; PBP 18a														0	300	500	50	0	100	0.2	0.2	47.84053559	50	0	0.206365329	0	0.2	34.1896907	10	15	15	12.48015258	0.175466725	10	0.2	0	0	0	15	0	15	0	0	0											NO	297.5015381	495.8358968	49.58358968	0	99.16717935	0.198334359	0.198334359	47.44210974	49.58358968	0	0.204646676	0	0.198334359	33.9049519	9.924620215	14.8750769	14.8750769	12.37621529	0.174005401	9.916717935	0.198334359	0	0	0	15	0	15	0	0	0												4.6296	0.092866777	1.011774636	0	1.242600748	0.394741132	0.258842519	0.78785146	0.921060068	0	2.052045606	0	0.045346639	2.051866953	3.273127323	4.998049881	0.108677762	0.331707577	2.762629031	0.054920475	1.168180072	0	0	0	1.319294911	0	0.246981305	0	0	0	0	0	0	0	0	0	0	0	0	0	27.7522	0	0.217285166	4.6296	0.092866777	1.011774636	0	1.242600748	0.394741132	0.258842519	0.78785146	0.921060068	0	2.052045606	0	0.045346639	2.051866953	3.273127323	4.998049881	0.108677762	0.331707577	2.762629031	0.054920475	1.168180072	0	0	0	1.319294911	0	0.246981305	0	0	0	0	0	0	0	0	0	0	0	0	0	27.7522	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.6296	0.092866777	1.011774636	0	1.242600748	0.394741132	0.258842519	0.78785146	0.921060068	0	2.052045606	0	0.045346639	2.051866953	3.273127323	4.998049881	0.108677762	0.331707577	2.762629031	0.054920475	1.168180072	0	0	0	1.319294911	0	0.246981305	0	0	0	0	0	0	0	0	0	0	0	0	0	27.7522
H5811_001_0	2011	9																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	P	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	YES	727.11	20.13	253.18	0	149.61	13.8	8.38	251.39	369.86	9.95	10.77	0	0	475.35	4394.92	3982.03	199.93	640.53	20.17	8696.98	9.91	0	0	0	374.86	306.26	160.12	0	0	0											5000	$150/Days 1-5 for IP Medical/Surgical	$220/Days 1-8 for IP Mental	$75/Days 21-100 for SNF	No cost-sharing	$100/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	$175/Case for OP Fac - Surgery;$150/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	Not Covered	$15/Exam for Vision (Refractions)	$25/Service for Vision Hardware	$0/Exam for Routine Hearing	Not covered	No cost-sharing	No cost-sharing												150	220	75	0	100	0.1	0.1	48.73558673	162.48	0.02	0.2	0	0	15	10	15	25	15	0.2	2.417615797	0.2	0	0	0	15	25	0	0	0	0											NO	147	215.6	73.5	0	98	0.098	0.098	47.760875	159.2304	0.0196	0.196	0	0	14.7	9.8	14.7	24.5	14.7	0.196	2.369263481	0.196	0	0	0	15	25	0	0	0	0												8.9071	0.361669	1.5507275	0	1.221815	1.3524	0.82124	1.00055053	4.907746312	0.19502	2.11092	0	0	0.58230375	3.589184667	4.87798675	0.408190417	0.78464925	3.95332	1.717119759	1.94236	0	0	0	0.468575	0.638041667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3909		0.82212858	8.9071	0.361669	1.5507275	0	1.221815	1.3524	0.82124	1.00055053	4.907746312	0.19502	2.11092	0	0	0.58230375	3.589184667	4.87798675	0.408190417	0.78464925	3.95332	1.717119759	1.94236	0	0	0	0.468575	0.638041667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3909	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			8.9071	0.361669	1.5507275	0	1.221815	1.3524	0.82124	1.00055053	4.907746312	0.19502	2.11092	0	0	0.58230375	3.589184667	4.87798675	0.408190417	0.78464925	3.95332	1.717119759	1.94236	0	0	0	0.468575	0.638041667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3909
H5811_002_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	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	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	374.8636168	306.2638666															5000	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Not Covered	$15/Exam for Vision (Refractions)	$25/Service for Vision Hardware																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	25															NO	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	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	0.468579521	0.638049722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1066		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.468579521	0.638049722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1066	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																0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0															0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.468579521	0.638049722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1066
H5811_005_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	P	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	YES	864.72	17.74	214.16	0	126.65	11.34	7.03	213.26	313.76	8.44	9.14	0	0	298.7	4373.69	3962.8	169.6	543.37	18.44	7844.74	8.41	0	0	0	374.86	306.26	0	0	0	288.84											5000	$125/Days 1-8 IP Medical/Surgical	$220/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	$5 per visit PCP	$10 per visit Specialists	$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	Not covered	Not Covered	$15/Exam for Vision (Refractions)	$25/Service for Vision Hardware	Not covered	Not covered	No cost-sharing	$10 routine chiropractic (20 visits/yr)												125	220	100	0	150	0.2	0.2	48.73558673	187.4834615	0.02	0.2	0	0	15	5	10	25	15	0.2	2.307562085	0.2	0	0	0	15	25	0	0	0	10											NO	122.5	215.6	98	0	147	0.196	0.196	47.76087499	183.7337923	0.0196	0.196	0	0	14.7	4.9	9.8	24.5	14.7	0.196	2.261410844	0.196	0	0	0	15	25	0	0	0	10												8.8273	0.318728667	1.748973333	0	1.5514625	2.22264	1.37788	0.84879035	4.804026222	0.165424	1.79144	0	0	0.3659075	1.785923417	3.236286667	0.346266667	0.66562825	3.61424	1.478348342	1.64836	0	0	0	0.468575	0.638041667	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	38.145		0.750972978	8.8273	0.318728667	1.748973333	0	1.5514625	2.22264	1.37788	0.84879035	4.804026222	0.165424	1.79144	0	0	0.3659075	1.785923417	3.236286667	0.346266667	0.66562825	3.61424	1.478348342	1.64836	0	0	0	0.468575	0.638041667	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	38.145	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			8.8273	0.318728667	1.748973333	0	1.5514625	2.22264	1.37788	0.84879035	4.804026222	0.165424	1.79144	0	0	0.3659075	1.785923417	3.236286667	0.346266667	0.66562825	3.61424	1.478348342	1.64836	0	0	0	0.468575	0.638041667	0	0	0	0.2407	0	0	0	0	0	0	0	0	0	0	38.145
H5813_003_0	2011	3																															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	1488.951849	77.84216885	1306.894797	858.4358245	290.7161883	10.3876256	0	301.6570317	406.3077327	2648.667396	2360.244546	42.66320123	1.72143141	46.06881317	3484.719941	4965.826459	278.1985823	813.8498655	0	0	246.4038885	0	0	0	1165.890301	98.33237615	58.63784564														3400	$223/day 1-10	$300/day 1-7	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$15 per visit	$200 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $35 Urgent Care Ctr	$300 per procedure	$0 per visit	$40 X-ray; $175 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$10 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$50 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	$75.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	182.7813712	216.8565234	47.8866492	15	200	0.05	0.05	48.5	300	0	23.375	40	25	40	10	40	40	30	50	40	$50 	0	0	0	0	0	0	0	0	0											NO	152.3659807	180.7709213	39.91816136	12.5039532	166.719376	0.041679844	0.041679844	40.42944867	250.0790639	0	19.48532707	33.34387519	20.839922	33.34387519	8.335968798	33.34387519	33.34387519	25.00790639	41.67984399	33.34387519	41.67984399	0	0	0	0	0	0	0	0	0												18.9055	1.172633381	4.347403117	0.894486781	4.039001792	0.432954615	0	1.016318957	8.467421457	0	3.832511411	0.118546371	0.002989541	0.128009396	2.420709725	13.79832481	0.773018234	1.696056771	0	0	0.855839636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9017	0	12.55647459	18.9055	1.172633381	4.347403117	0.894486781	4.039001792	0.432954615	0	1.016318957	8.467421457	0	3.832511411	0.118546371	0.002989541	0.128009396	2.420709725	13.79832481	0.773018234	1.696056771	0	0	0.855839636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9017	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			18.9055	1.172633381	4.347403117	0.894486781	4.039001792	0.432954615	0	1.016318957	8.467421457	0	3.832511411	0.118546371	0.002989541	0.128009396	2.420709725	13.79832481	0.773018234	1.696056771	0	0	0.855839636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9017
H5813_006_0	2011	3																															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	1557.099942	159.5160556	784.4565158	1052.598397	227.3838995	10.66323435	0	272.6011991	408.073201	2872.372663	2713.710659	65.28123955	1.255040314	306.1733367	3496.39694	5800.925091	345.8679117	1020.0972	0	0	303.3357002	0	0	0	1156.905401	95.81876957	60.85915769	0	0	0											3400	$150/day 1-10	$300/day 1-7	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$10 per visit	$200 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $35 Urgent Care Ctr	$300 per procedure	$0 per visit	$30 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	"$10 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$30 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$30 per visit	$30 per visit	$40 per visit	$30 per visit	$50 per script	0	Not Covered	0	$0 per visit	$100.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	122.9471107	216.8565234	47.8866492	10	200	0.05	0.05	48.5	300	0	18.625	30	25	30	10	30	30	22.5	40	30	$50 	0	0	0	0	0	0	0	0	0											NO	104.4132428	184.166124	40.66789615	8.492533269	169.8506654	0.042462666	0	41.18878636	254.7759981	0	15.81734321	25.47759981	21.23133317	25.47759981	8.492533269	25.47759981	25.47759981	19.10819986	33.97013308	25.47759981	42.46266635	0	0	0	0	0	0	0	0	0												13.5485	2.448121139	2.658516343	0.744935575	3.218442219	0.452789362	0	0.935676046	8.663938089	0	3.576974406	0.138600775	0.002220515	0.650046812	2.474438945	12.31613733	0.734323687	1.624351764	0	0	1.073370219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2614	0	9.809167153	13.5485	2.448121139	2.658516343	0.744935575	3.218442219	0.452789362	0	0.935676046	8.663938089	0	3.576974406	0.138600775	0.002220515	0.650046812	2.474438945	12.31613733	0.734323687	1.624351764	0	0	1.073370219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2614	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			13.5485	2.448121139	2.658516343	0.744935575	3.218442219	0.452789362	0	0.935676046	8.663938089	0	3.576974406	0.138600775	0.002220515	0.650046812	2.474438945	12.31613733	0.734323687	1.624351764	0	0	1.073370219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2614
H5813_801_0	2011	1																															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	YES	318.2185777	6.496359759	40.65161896	8.074886097	9.464573335	12.23910506	0	15.17178542	41.87244561	18.75902596	60.61455029	1.073276082	0.092036931	27.91496375	28.50384783	136.4013221	3.688418696	8.688246565	0	0	72.46414391	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.073944329	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	0.060064654	0.060064654	0.121497677	0	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0	0	0	0	0	0	0	0												19.1137	0.3902016	4.939077286	0	1.791311316	2.316432725	0	2.871486114	7.924983304	3.550424758	11.47220546	0.203133467	0.017419359	5.283322206	5.394777279	25.81597956	0.698088114	1.644379925	0	0	13.71491735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1418	0	24.7582385	19.1137	0.3902016	4.939077286	0	1.791311316	2.316432725	0	2.871486114	7.924983304	3.550424758	11.47220546	0.203133467	0.017419359	5.283322206	5.394777279	25.81597956	0.698088114	1.644379925	0	0	13.71491735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1418	NO																																																																																		0			19.1137	0.3902016	4.939077286	0	1.791311316	2.316432725	0	2.871486114	7.924983304	3.550424758	11.47220546	0.203133467	0.017419359	5.283322206	5.394777279	25.81597956	0.698088114	1.644379925	0	0	13.71491735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1418
H5813_802_0	2011	2																															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	YES	318.218577	6.496359745	40.65161887	8.07488608	9.464573315	12.23910504	0	15.17178538	41.87244552	18.75902592	60.61455016	1.07327608	0.092036931	27.9149637	28.50384777	136.4013218	3.688418688	8.688246546	0	0	72.46414376	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.073944329	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	0.060064654	0.060064654	0.121497677	0	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0.189264878	0	0	0	0	0	0	0	0												19.1137	0.390201599	4.939077276	0	1.791311313	2.31643272	0	2.871486108	7.924983287	3.550424751	11.47220543	0.203133466	0.017419359	5.283322195	5.394777268	25.81597951	0.698088112	1.644379921	0	0	13.71491732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1418	0	24.75821715	19.1137	0.390201599	4.939077276	0	1.791311313	2.31643272	0	2.871486108	7.924983287	3.550424751	11.47220543	0.203133466	0.017419359	5.283322195	5.394777268	25.81597951	0.698088112	1.644379921	0	0	13.71491732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1418	NO																																																																																		0			19.1137	0.390201599	4.939077276	0	1.791311313	2.31643272	0	2.871486108	7.924983287	3.550424751	11.47220543	0.203133466	0.017419359	5.283322195	5.394777268	25.81597951	0.698088112	1.644379921	0	0	13.71491732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1418
H5817_009_0	2011	6																																	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	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											6700	No Cost-Sharing; PBP 1a	No Cost-Sharing; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	No Cost-Sharing; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"No Cost-Sharing; PBP 4a, 4b"	No Cost-Sharing; PBP 9b	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"No Cost-Sharing; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	"No Cost-Sharing; PBP 7d, 14g-h"	"No Cost-Sharing; PBP 7d, 7g, 14f, 14i"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	"No Cost-Sharing; PBP 13b-f, 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	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2011	7																															A	A	D		T	Coin	Coin	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0											0	YES	271.559631	25.96964667	303.9764264	0	230.9527168	4.690287349	2.749638313	351.0931243	281.7773456	1665.208816	156.9760289	39.93314799	0.205067214	930.724236	0	5898.659474	593.6330217	416.2801288	90.68046898	0	24.99313226	1.883996151	0	0	0	0	0	0	0	0											6700	$200/Admit for IP Medical; $200/Admit for IP Surgical; PBP 1a	$200/Admit for IP Psych; $200/Admit for IP Substance Abuse; PBP 1b	$25/$50 per day for SNF days 8-14/15-100; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; PBP 4a, 4b"	$75/Visit for OP Fac - Surgery; PBP 9b	$150/Visit for OP Fac - Pathology; PBP 8a	$100/Visit for OP Fac - CT/MRI/PET; PBP 8b	$150/Visit for OP Fac - Observation; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$150/Visit for OP Fac - Cardiovascular; $15/Visit for OP Fac - Occ Therapy; $15/Visit for OP Fac - Physical/Speech Therapy; $15/Visit for OP Fac - CORF; $150/Visit for OP Fac - Other; $15/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$15/Visit for Speclst Office Visits; $15/Visit for Speclst Consults; $15/Visit for Chiropractor; $15/Visit for Vision Exams; $15/Visit for Hearing/Speech Exams; $15/Visit for Podiatrist (Routine); PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse; PBP 7e, 7h"	"$15/Visit for Occ Therapy; $15/Visit for PT/ST; PBP 7c, 7i"	"$100/Visit for Prof Radiology (Office); PBP 7d, 14g-h"	"No Cost-Sharing; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"$15/Visit for Bone Mass Measurements; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	PBP 14a	"No Cost-Sharing; PBP 13b-f, 14a"											0	200	200	43.09500062	0	100	0.2	0.2	48.77763686	75	49.89706269	78.43262176	91.91188571	0.2	85.54041854	0	15	15	15	96.35644312	0	0.2	15	0	0	0	0	0	0	0	0											NO	180.803923	180.803923	43.09500062	0	99.99114588	0.199982292	0.199982292	48.77333135	74.99335941	49.89264474	78.42567724	91.90374772	0.199982292	85.53284468	0	14.99867481	14.99867188	14.99867188	96.34791161	0	0.199982292	14.99867188	0	0	0	0	0	0	0	0												4.0916	0.3912845	1.091655357	0	1.924435567	0.937974413	0.549878971	1.426998441	1.760952479	6.923472658	1.025912615	0.30583383	0.041009811	6.633957627	0	7.372672937	0.741975576	0.520304089	0.728072817	0	4.998183867	0.002354787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4685	0	0.479126128	4.0916	0.3912845	1.091655357	0	1.924435567	0.937974413	0.549878971	1.426998441	1.760952479	6.923472658	1.025912615	0.30583383	0.041009811	6.633957627	0	7.372672937	0.741975576	0.520304089	0.728072817	0	4.998183867	0.002354787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4685	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.0916	0.3912845	1.091655357	0	1.924435567	0.937974413	0.549878971	1.426998441	1.760952479	6.923472658	1.025912615	0.30583383	0.041009811	6.633957627	0	7.372672937	0.741975576	0.520304089	0.728072817	0	4.998183867	0.002354787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4685
H5820_002_0	2011	8																															D	D	D		T	Coin	Coin	V	Coin	Coin	P		Coin	Coin	V	V	V	V	P	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	0	0	0	0	0	0	0	0											0	YES	1305.580766	70.59431397	121.4319033	0	19.52502364	21.68051986	2.270841954	455.1787285	47.85642872	4.794188501	193.5966787	0	0.889229699	13.41020849	4143.048402	5196.704384	165.0626591	598.5295801	263.6755847	20.1248869	20.33630842	2.637004701	0	0	0	62.15567347	0	0	0	0											6700	$268/Days 1-6 for IP Medical; $268/Days 1-6 for IP Surgical; PBP 1a	$299/Days 1-6 for IP Psych; $299/Days 1-6 for IP Substance Abuse; PBP 1b	"$50 days 1-20, $128 days 21-100 for SNF; PBP 2"	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; $40/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; 10% Coinsurance for ASC; PBP 9a, 9b"	5% Coinsurance for OP Fac - Pathology; PBP 8a	$0-50/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40/Visit for OP Fac - Cardiovascular; $40/Visit for OP Fac - Occ Therapy; $40/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $269/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; PBP 7a, 14b-c"	"$40/Visit for Speclst Office Visits; $40/Visit for Speclst Consults; $40/Visit for Cardio; $20/Visit for Chiropractor; $40/Exam for Vision Exams; $40/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$40/Visit for Occ Therapy; $40/Visit for PT/ST; PBP 7c, 7i"	"$0-50/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $15-40/Visit for Allergy Testing; $15-40/Visit for Allergy Tx; 5% Coinsurance for Prof Path (OP); 5% Coinsurance for Prof Path (Office); PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $15-40/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride;  $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$40/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	268	299	65	0	125	0.2	0.2	49.29786478	0.25	0.05	50	0	0.2	0.261435008	15	36.97171494	40	40	50	0.064054202	0.239557586	0.2	0	0	0	35.3347684	0	0	0	0											NO	241.3050688	293.9814292	63.90900635	0	122.9019353	0.196643096	0.196643096	48.4704239	0.245803871	0.049160774	49.16077411	0	0.196643096	0.257046948	14.74823223	36.35116253	39.32861929	39.32861929	49.16077411	0.062979083	0.235536728	0.196643096	0	0	0	34.74169135	0	0	0	0												26.2536	1.729451443	0.646716023	0	0.199971933	4.263324557	0.446545393	1.838558827	11.76329541	0.235686018	0.793113549	0	0.174860882	3.447053161	5.091886665	15.74218714	0.540973873	1.961611832	1.080207988	1.267446927	4.789947542	0.51854877	0	0	0	0.179949435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9649	0	3.872487634	26.2536	1.729451443	0.646716023	0	0.199971933	4.263324557	0.446545393	1.838558827	11.76329541	0.235686018	0.793113549	0	0.174860882	3.447053161	5.091886665	15.74218714	0.540973873	1.961611832	1.080207988	1.267446927	4.789947542	0.51854877	0	0	0	0.179949435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9649	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	26.2536	1.729451443	0.646716023	0	0.199971933	4.263324557	0.446545393	1.838558827	11.76329541	0.235686018	0.793113549	0	0.174860882	3.447053161	5.091886665	15.74218714	0.540973873	1.961611832	1.080207988	1.267446927	4.789947542	0.51854877	0	0	0	0.179949435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9649
H5820_008_0	2011	8																															D	D	D		T	Coin	Coin	V	Coin	Coin	P		Coin	Coin	V	V	V	V	P	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	0	0	0	0	0	0	0	0											0	YES	354.6620668	19.64801895	630.8593647	0	193.3829168	16.5116837	5.280183363	410.2913466	58.00059081	6.52757876	249.9283079	0	0.825520565	18.98379098	4101.385243	5614.271209	214.8058462	709.3928606	243.1080526	24.17171208	35.4787457	4.820117668	0	1375.50903	0	48.58328483	68.54277886	0	0	0											6700	$1000/Stay for IP Medical; $1000/Stay for IP Surgical; PBP 1a	$1000/Stay for IP Psych; $1000/Stay for IP Substance Abuse; PBP 1b	"$50 days 1-20, $128 days 21-100 for SNF; PBP 2"	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $30/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; 10% Coinsurance for ASC; PBP 9a, 9b"	5% Coinsurance for OP Fac - Pathology; PBP 8a	$0-50/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$30/Visit for OP Fac - Cardiovascular; $30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $269/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$10/Visit for PCP Office Visits; $10/Visit for PCP Consults; PBP 7a, 14b-c"	"$30/Visit for Speclst Office Visits; $30/Visit for Speclst Consults; $30/Visit for Cardio; $30/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	"$0-50/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $10-30/Visit for Allergy Testing; $10-30/Visit for Allergy Tx; 5% Coinsurance for Prof Path (OP); 5% Coinsurance for Prof Path (Office); PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $10-30/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride;  $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$30/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	1000	1000	65	0	100	0.2	0.2	47.98337791	0.25	0.05	50	0	0.2	0.210442216	10	29.04974172	30	29.73205765	50	0.11740341	0.131435996	0.200342684	0	4	0	39.61874049	30	0	0	0											NO	886.123846	981.982652	63.82887238	0	98.1982652	0.19639653	0.19639653	47.1188447	0.245495663	0.049099133	49.0991326	0	0.19639653	0.206650605	9.81982652	28.52634241	29.45947956	29.19636482	49.0991326	0.115288112	0.129067868	0.19673304	0	3.927930608	0	38.90491586	29.45947956	0	0	0												26.1895	1.60783448	3.355586823	0	1.582488913	3.24283739	1.037009692	1.611037853	14.2388935	0.320498455	1.022605261	0	0.162129375	3.923011898	3.356240965	13.34621858	0.527339036	1.725974396	0.994699542	2.786711042	4.579166053	0.948276402	0	0.450242002	0	0.157510717	0.168269549	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3341	0	4.487505793	26.1895	1.60783448	3.355586823	0	1.582488913	3.24283739	1.037009692	1.611037853	14.2388935	0.320498455	1.022605261	0	0.162129375	3.923011898	3.356240965	13.34621858	0.527339036	1.725974396	0.994699542	2.786711042	4.579166053	0.948276402	0	0.450242002	0	0.157510717	0.168269549	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3341	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	26.1895	1.60783448	3.355586823	0	1.582488913	3.24283739	1.037009692	1.611037853	14.2388935	0.320498455	1.022605261	0	0.162129375	3.923011898	3.356240965	13.34621858	0.527339036	1.725974396	0.994699542	2.786711042	4.579166053	0.948276402	0	0.450242002	0	0.157510717	0.168269549	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3341
H5820_011_0	2011	9																															D	D	D		T	Coin	Coin	V	Coin	Coin	P		Coin	Coin	V	V	V	V	P	Coin	O	Coin		V		V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1185.613797	61.06410771	104.7306348	0	19.7720574	14.66795521	1.483161425	350.0946755	47.74123066	4.197463837	165.0147946	0	0.766974415	11.94654183	3643.037314	4937.38302	130.2227207	588.0186791	331.0302727	17.45345582	1780.487344	2.782547271	0	0	0	61.32653521	0	0	0	0											6700	$268/Days 1-6 for IP Medical; $268/Days 1-6 for IP Surgical; PBP 1a	$299/Days 1-6 for IP Psych; $299/Days 1-6 for IP Substance Abuse; PBP 1b	"$50 days 1-20, $128 days 21-100 for SNF; PBP 2"	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; $40/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; 10% Coinsurance for ASC; PBP 9a, 9b"	5% Coinsurance for OP Fac - Pathology; PBP 8a	$0-50/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40/Visit for OP Fac - Cardiovascular; $40/Visit for OP Fac - Occ Therapy; $40/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $269/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; PBP 7a, 14b-c"	"$40/Visit for Speclst Office Visits; $40/Visit for Speclst Consults; $40/Visit for Cardio; $20/Visit for Chiropractor; $40/Exam for Vision Exams; $40/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$40/Visit for Occ Therapy; $40/Visit for PT/ST; PBP 7c, 7i"	"$0-50/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $15-40/Visit for Allergy Testing; $15-40/Visit for Allergy Tx; 5% Coinsurance for Prof Path (OP); 5% Coinsurance for Prof Path (Office); PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $15-40/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride;  $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$40/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	268	299	65	0	125	0.2	0.2	49.5013548	0.25	0.05	50	0	0.2	0.271754439	15	37.08902371	40	40	50	0.062268848	34.35624357	0.2	0	0	0	35.54209534	0	0	0	0											NO	244.10336	294.6189423	64.04759614	0	123.1684541	0.197069527	0.197069527	48.77604278	0.246336908	0.049267382	49.26738165	0	0.197069527	0.267772593	14.78021449	36.54558172	39.41390532	39.41390532	49.26738165	0.061356462	33.85284328	0.197069527	0	0	0	35.02131952	0	0	0	0												24.1177	1.499220235	0.558978783	0	0.202941145	2.89060699	0.29228592	1.423019406	11.76042716	0.206798053	0.677487239	0	0.151147285	3.198956483	4.487072743	15.03662789	0.427715499	1.931342712	1.359082899	1.070882293	5.022879917	0.548355273	0	0	0	0.178978015	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.0425	0	3.148020674	24.1177	1.499220235	0.558978783	0	0.202941145	2.89060699	0.29228592	1.423019406	11.76042716	0.206798053	0.677487239	0	0.151147285	3.198956483	4.487072743	15.03662789	0.427715499	1.931342712	1.359082899	1.070882293	5.022879917	0.548355273	0	0	0	0.178978015	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.0425	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.1177	1.499220235	0.558978783	0	0.202941145	2.89060699	0.29228592	1.423019406	11.76042716	0.206798053	0.677487239	0	0.151147285	3.198956483	4.487072743	15.03662789	0.427715499	1.931342712	1.359082899	1.070882293	5.022879917	0.548355273	0	0	0	0.178978015	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.0425
H5820_026_0	2011	7																															D	D	D		T	Coin	Coin	V	Coin	Coin	P		Coin	Coin	V	V	V	V	P	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	0	0	0	0	0	0	0	0											0	YES	966.9807312	90.08749769	420.6094513	0	92.5044255	17.67195632	4.434722247	485.6168317	45.48168883	4.832889872	171.2233504	0	0.627352638	15.90471935	3254.36416	4227.995849	164.5376757	457.6375322	184.6939114	17.59649753	23.13527276	3.5659968	0	876.2816125	0	49.36320024	40.65195284	0	0	0											6700	$268/Days 1-6 for IP Medical; $268/Days 1-6 for IP Surgical; PBP 1a	$299/Days 1-6 for IP Psych; $299/Days 1-6 for IP Substance Abuse; PBP 1b	"$50 days 1-20, $128 days 21-100 for SNF; PBP 2"	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; $40/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; 10% Coinsurance for ASC; PBP 9a, 9b"	5% Coinsurance for OP Fac - Pathology; PBP 8a	$0-50/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40/Visit for OP Fac - Cardiovascular; $40/Visit for OP Fac - Occ Therapy; $40/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $269/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; PBP 7a, 14b-c"	"$40/Visit for Speclst Office Visits; $40/Visit for Speclst Consults; $40/Visit for Cardio; $20/Visit for Chiropractor; $40/Exam for Vision Exams; $40/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$40/Visit for Occ Therapy; $40/Visit for PT/ST; PBP 7c, 7i"	"$0-50/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $15-40/Visit for Allergy Testing; $15-40/Visit for Allergy Tx; 5% Coinsurance for Prof Path (OP); 5% Coinsurance for Prof Path (Office); PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $15-40/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride;  $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$40/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	268	299	65	0	125	0.2	0.2	49.34059749	0.25	0.05	50	0	0.2	0.243228641	15	36.18890008	40	39.37508559	50	0.103890757	0.202832269	0.200461222	0	4	0	39.30877359	40	0	0	0											NO	242.0942926	295.2638207	64.1877871	0	123.4380521	0.197500883	0.197500883	48.72405796	0.246876104	0.049375221	49.37522085	0	0.197500883	0.240189358	14.81256625	35.73669867	39.50017668	38.88307093	49.37522085	0.102592581	0.200297762	0.197956342	0	3.950017668	0	38.81758755	39.50017668	0	0	0												19.5084	2.216631563	2.249832493	0	0.951547175	3.490226984	0.875861561	1.971768554	11.22834215	0.238625005	0.704515895	0	0.1239027	3.820144325	4.017123728	12.5912178	0.541605605	1.482862719	0.759941889	1.805270104	4.63394335	0.705911681	0	0.288443988	0	0.159680029	0.133813277	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4996	0	2.783368878	19.5084	2.216631563	2.249832493	0	0.951547175	3.490226984	0.875861561	1.971768554	11.22834215	0.238625005	0.704515895	0	0.1239027	3.820144325	4.017123728	12.5912178	0.541605605	1.482862719	0.759941889	1.805270104	4.63394335	0.705911681	0	0.288443988	0	0.159680029	0.133813277	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4996	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.5084	2.216631563	2.249832493	0	0.951547175	3.490226984	0.875861561	1.971768554	11.22834215	0.238625005	0.704515895	0	0.1239027	3.820144325	4.017123728	12.5912178	0.541605605	1.482862719	0.759941889	1.805270104	4.63394335	0.705911681	0	0.288443988	0	0.159680029	0.133813277	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4996
H5820_029_0	2011	7																															D	D	D		T	Coin	Coin	V	Coin	Coin	P		Coin	Coin	V	V	V	V	P	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	0	0	0	0	0	0	0	0											0	YES	1088.225545	55.10261711	642.5307252	0	113.6472265	14.33848144	3.100982398	343.3338725	44.53476599	5.581863195	185.0745901	0	0.508754034	15.63393478	3394.511844	4571.309204	106.855689	602.230511	204.4381814	19.05074679	24.2624601	5.21314837	0	1101.463258	0	53.5090547	51.51044822	0	0	0											6700	$268/Days 1-6 for IP Medical; $268/Days 1-6 for IP Surgical; PBP 1a	$299/Days 1-6 for IP Psych; $299/Days 1-6 for IP Substance Abuse; PBP 1b	"$50 days 1-20, $128 days 21-100 for SNF; PBP 2"	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; $40/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; 10% Coinsurance for ASC; PBP 9a, 9b"	5% Coinsurance for OP Fac - Pathology; PBP 8a	$0-50/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40/Visit for OP Fac - Cardiovascular; $40/Visit for OP Fac - Occ Therapy; $40/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $269/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; PBP 7a, 14b-c"	"$40/Visit for Speclst Office Visits; $40/Visit for Speclst Consults; $40/Visit for Cardio; $20/Visit for Chiropractor; $40/Exam for Vision Exams; $40/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$40/Visit for Occ Therapy; $40/Visit for PT/ST; PBP 7c, 7i"	"$0-50/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $15-40/Visit for Allergy Testing; $15-40/Visit for Allergy Tx; 5% Coinsurance for Prof Path (OP); 5% Coinsurance for Prof Path (Office); PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $15-40/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride;  $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$40/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	268	299	65	0	125	0.2	0.2	49.00972652	0.25	0.05	50	0	0.2	0.236241392	15	36.79622441	40	39.38477902	50	0.112002208	0.158146415	0.200413381	0	4	0	37.81273959	40	0	0	0											NO	242.3113431	294.8593826	64.09986579	0	123.2689727	0.197230356	0.197230356	48.33102911	0.246537945	0.049307589	49.30758907	0	0.197230356	0.232969869	14.79227672	36.28666225	39.44607125	38.83936999	49.30758907	0.110451177	0.155956369	0.197638012	0	3.944607125	0	37.28910051	39.44607125	0	0	0												21.9741	1.353960305	3.432177771	0	1.167431404	2.827983804	0.611607863	1.382806615	10.9795097	0.275228217	0.760465153	0	0.100341739	3.642235744	4.184379877	13.82312943	0.351253093	1.949187803	0.840029486	2.104177402	3.783885177	1.030316281	0	0.362069985	0	0.166275377	0.169323734	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2719	0	3.106116962	21.9741	1.353960305	3.432177771	0	1.167431404	2.827983804	0.611607863	1.382806615	10.9795097	0.275228217	0.760465153	0	0.100341739	3.642235744	4.184379877	13.82312943	0.351253093	1.949187803	0.840029486	2.104177402	3.783885177	1.030316281	0	0.362069985	0	0.166275377	0.169323734	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2719	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	21.9741	1.353960305	3.432177771	0	1.167431404	2.827983804	0.611607863	1.382806615	10.9795097	0.275228217	0.760465153	0	0.100341739	3.642235744	4.184379877	13.82312943	0.351253093	1.949187803	0.840029486	2.104177402	3.783885177	1.030316281	0	0.362069985	0	0.166275377	0.169323734	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2719
H5820_032_0	2011	10																															D	D	D		T	Coin	Coin	V	Coin	Coin	P		Coin	Coin	V	V	V	V	P	Coin	O	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	1005.424729	30.08852616	1378.7719	0	304.6229629	12.61588251	7.958135591	377.4140861	45.87722893	6.38112386	245.1844371	0	0.447103644	24.00033977	3855.359984	4704.709473	127.9588753	536.5001099	155.8040413	27.0148979	875.8705336	8.027013567	0	0	0	31.77142857	146.0627388	0	0	0											6700	$268/Days 1-6 for IP Medical; $268/Days 1-6 for IP Surgical; PBP 1a	$299/Days 1-6 for IP Psych; $299/Days 1-6 for IP Substance Abuse; PBP 1b	"$50 days 1-20, $128 days 21-100 for SNF; PBP 2"	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; $40/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"30% Coinsurance for OP Fac - Surgery; 15% Coinsurance for ASC; PBP 9a, 9b"	5% Coinsurance for OP Fac - Pathology; PBP 8a	$0-50/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40/Visit for OP Fac - Cardiovascular; $40/Visit for OP Fac - Occ Therapy; $40/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 30% Coinsurance for OP Fac - Other; $269/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; PBP 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $40/Visit for Cardio; $20/Visit for Chiropractor; $40/Exam for Vision Exams; $40/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$40/Visit for Occ Therapy; $40/Visit for PT/ST; PBP 7c, 7i"	"$0-50/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $15-40/Visit for Allergy Testing; $15-40/Visit for Allergy Tx; 5% Coinsurance for Prof Path (OP); 5% Coinsurance for Prof Path (Office); PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $15-40/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$40/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	268	299	65	0	125	0.2	0.204400944	47.94907734	0.3	0.05	50	0	0.2	0.24948169	15	43.52099326	40	38.09198624	50	0.184380303	55.30738078	0.200732635	0	0	0	50	40	0	0	0											NO	221.4017357	293.7514356	63.85900775	0	122.8057841	0.196489255	0.200812946	47.10739233	0.294733882	0.049122314	49.12231365	0	0.196489255	0.245102356	14.7366941	42.75703763	39.29785092	37.42332991	49.12231365	0.181143742	54.33653012	0.197209029	0	0	0	49.12231365	39.29785092	0	0	0												18.5502	0.736545646	7.337250453	0	3.117455152	2.47888535	1.598096653	1.481582785	13.52157377	0.313455568	1.003668902	0	0.087851062	5.882539833	4.73460506	16.76328666	0.4190424	1.673135051	0.637787915	4.893579685	3.965980469	1.582999551	0	0	0	0.130057173	0.478329311	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3879	0	5.205671922	18.5502	0.736545646	7.337250453	0	3.117455152	2.47888535	1.598096653	1.481582785	13.52157377	0.313455568	1.003668902	0	0.087851062	5.882539833	4.73460506	16.76328666	0.4190424	1.673135051	0.637787915	4.893579685	3.965980469	1.582999551	0	0	0	0.130057173	0.478329311	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3879	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.5502	0.736545646	7.337250453	0	3.117455152	2.47888535	1.598096653	1.481582785	13.52157377	0.313455568	1.003668902	0	0.087851062	5.882539833	4.73460506	16.76328666	0.4190424	1.673135051	0.637787915	4.893579685	3.965980469	1.582999551	0	0	0	0.130057173	0.478329311	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3879
H5820_033_0	2011	10																															D	D	D		T	Coin	Coin	V	Coin	Coin	P		Coin	Coin	V	V	V	V	P	Coin	O	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	1090.158575	32.6242869	1262.516749	0	313.2866397	13.42878126	8.4709145	402.6003043	51.82162683	6.87523828	254.6549283	0	0.449106353	24.7899083	3897.405525	4804.79711	136.4123992	571.9436577	164.2538521	28.60432042	899.4860642	8.724471706	0	0	0	31.77142857	147.6556605	0	0	0											6700	$268/Days 1-6 for IP Medical; $268/Days 1-6 for IP Surgical; PBP 1a	$299/Days 1-6 for IP Psych; $299/Days 1-6 for IP Substance Abuse; PBP 1b	"$50 days 1-20, $128 days 21-100 for SNF; PBP 2"	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; $40/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"30% Coinsurance for OP Fac - Surgery; 15% Coinsurance for ASC; PBP 9a, 9b"	5% Coinsurance for OP Fac - Pathology; PBP 8a	$0-50/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40/Visit for OP Fac - Cardiovascular; $40/Visit for OP Fac - Occ Therapy; $40/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 30% Coinsurance for OP Fac - Other; $269/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; PBP 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $40/Visit for Cardio; $20/Visit for Chiropractor; $40/Exam for Vision Exams; $40/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$40/Visit for Occ Therapy; $40/Visit for PT/ST; PBP 7c, 7i"	"$0-50/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $15-40/Visit for Allergy Testing; $15-40/Visit for Allergy Tx; 5% Coinsurance for Prof Path (OP); 5% Coinsurance for Prof Path (Office); PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $15-40/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$40/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	268	299	65	0	125	0.2	0.204400944	48.05641315	0.3	0.05	50	0	0.2	0.247642909	15	43.4114368	40	38.14013417	50	0.187871906	54.06084385	0.200709233	0	0	0	50	40	0	0	0											NO	219.0104511	293.2495925	63.74991142	0	122.5959835	0.196153574	0.200469878	47.13218588	0.29423036	0.049038393	49.0383934	0	0.196153574	0.242880208	14.71151802	42.57654232	39.23071472	37.40661808	49.0383934	0.184258729	53.02113857	0.196849166	0	0	0	49.0383934	39.23071472	0	0	0												19.8963	0.797254903	6.707110911	0	3.200640309	2.634103433	1.6981632	1.581286031	15.24749594	0.33715064	1.040655713	0	0.088093816	6.020978084	4.778062634	17.04763729	0.445962993	1.782873164	0.671228751	5.270595718	3.974314604	1.717404984	0	0	0	0.129834984	0.482719758	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5499	0	5.934041874	19.8963	0.797254903	6.707110911	0	3.200640309	2.634103433	1.6981632	1.581286031	15.24749594	0.33715064	1.040655713	0	0.088093816	6.020978084	4.778062634	17.04763729	0.445962993	1.782873164	0.671228751	5.270595718	3.974314604	1.717404984	0	0	0	0.129834984	0.482719758	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5499	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.8963	0.797254903	6.707110911	0	3.200640309	2.634103433	1.6981632	1.581286031	15.24749594	0.33715064	1.040655713	0	0.088093816	6.020978084	4.778062634	17.04763729	0.445962993	1.782873164	0.671228751	5.270595718	3.974314604	1.717404984	0	0	0	0.129834984	0.482719758	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5499
H5821_001_0	2011	11																															D	D	A	V	T	O	O	V	V	V	V	V	V	V	P	P	Coin	P	P	P	S	O	T	P	P	P	P	P	P	P																																																			0	YES	896.628912		8.014222376			2920.15886	3.47250898	444.2104805		44.67524413	63.92041017			58.58143948		9870.866797	8.040657141	3997.141109	4185.051385	16214.20842	1543.942155																				6700	1a (IP Acute) - $110 per day 1 through 5	1b (IP Psych) - Medicare Cost Share	2 (SNF) - $0	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) -$35 (UC) - $35	"9a,9b - $0"	8a (OP Diag Proc/Test/Lab) - $5	"8b (OP Radiation Therapy,OP nuclear med,CT Scan,MRI,Diagnostic Radiology,Other Imaging) - $5"	5 - 0%	12 (OP - Other Renal Dialysis) - 0%	"3,9d - $0, 9c - 20%"	"7a - $2, 14b-14j - $0"	"7b,7f,7g - $0, 7d - $2"	"7e,7h - 42%"	"7c,7i - $5"	(Prof/Specialist) Radiology - $5	"(Prof/Specialist) Lab/Path - $5; Cardiovascular, chemo, other med - $0"	15 (Part B Rx) - $16	"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%	OTC  - $0												68.08492248		170.3298762			14.26230502	81.1145703	35		5	5			5		2	0.42	5	5	5	16																				NO	67.21052292		168.1423673			14.0791374	80.07283386	34.55050276		4.935786109	4.935786109			4.935786109		1.974314443	0.414606033	4.935786109	4.935786109	4.935786109	15.79451555																					5.0219	0	0.112294194	0	0	3.426109819	0.023171136	1.278974619	0	0.018375621	0.026291456	0	0	0.024095455	0	1.624016241	3.333704961	1.64408613	1.721376541	6.66915539	2.032151531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.9557	0	0.350690058	5.0219	0	0.112294194	0	0	3.426109819	0.023171136	1.278974619	0	0.018375621	0.026291456	0	0	0.024095455	0	1.624016241	3.333704961	1.64408613	1.721376541	6.66915539	2.032151531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.9557	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%												0.9545								0.0701	0.0031	0.0178			0.0483	0.0214	2.3715		0.2143	0.4876	1.7193		0.0013		0.0607	0.0705	0.1539		0.0023													6.1965	0	0	5.9764	0	0.112294194	0	0	3.426109819	0.023171136	1.278974619	0.070100164	0.021428868	0.0440735	0	0	0.072355231	0.021393672	3.995545416	3.333704961	1.858363974	2.209019557	8.388448702	2.032151531	0.001260737	0	0.060678927	0.070500413	0.153948885	0	0.002335604	0	0	0	0	0	0	0	0	0	0	0	0	33.1522
H5821_013_0	2011	8																															A	A	A	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	YES								453.2551326		47.04605469	80.38154488								5145.459735	19534.01705	1754.415807			1063.151793		407.8567491															6700	"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) - 0%	"11b (Med Supp) - 0%, (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) - $16	"13a (Blood), 14a (Education/Wellness) - 0%; 17b Med Cov Eyewear - 50%, 16b Comp Dental (exluding Diagnostic, ER) - 0%"	10b (Transportation) - 0%	16a (Preventative Den) - 0%	17a (Routine Eye Exam) - 0%	17b (Non MCR Covered) Eyewear - 50%	"18a (Hearing Exam), (Routine Hearing Exam) - 0%"	18b (Hearing Aids) - 0%	14a (Health & Education)  - 0%	(Other) - $0																			25		5	5								5	5	19			44.6986879		74.56018206															NO								24.83239421		4.966478842	4.966478842								4.966478842	4.966478842	18.8726196			44.39901754		74.06031334																0	0	0	0	0	0	0	0.937950844	0	0.019471103	0.03326777	0	0	0	0	0	0	0	2.129568075	8.084606866	2.759201846	0	0	3.933574594	0	2.517166553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.4148	0	0.13778937	0	0	0	0	0	0	0	0.937950844	0	0.019471103	0.03326777	0	0	0	0	0	0	0	2.129568075	8.084606866	2.759201846	0	0	3.933574594	0	2.517166553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.4148	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%												1.3097								0.0887	0.0044	0.0224			0.0504	0.0182	2.8874		0.3026	0.6331	2.1089		0.0016		0.3063	0.0763	0.2075		0.005													8.0227	0	0	1.3097	0	0	0	0	0	0	0.937950844	0.088668185	0.023903794	0.05570058	0	0	0.05042457	0.018212241	2.88744712	0	0.302615694	2.762662464	10.19353119	2.759201846	0.001590473	0	4.239893102	0.076283833	2.72469855	0	0.005033544	0	0	0	0	0	0	0	0	0	0	0	0	28.4375
H5821_020_0	2011	11																															A	A	A	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	YES						3782.403835	3.786190025	455.3913103		69.80474771	80.2577322								5805.228067	20603.05128	1799.09873					527.8385777															6700	"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) -$35"	9b (OP Surg/ASC) - 0%	8a (OP Diag Proc/Test/Lab) - $6	8b (OP Diag & Therap Rad) - $6	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) - $15	"13a (Blood), 14a (Education/Wellness) - 0%; 17b Med Cov Eyewear"	10b (Transportation) - 0%	"16a (Preventative Den) - 0%,  16b Comp Dental (exluding Diagnostic, ER) - 0%"	17a (Routine Eye Exam) - 0%	17b (Non MCR Covered) - 50%	"18a (Hearing Exam), (Routine Hearing Exam) - 0%"	18b (Hearing Aids) - 0%	14a (Health & Education)  - 0%	(Other) - $0																	15.03754271	105.0899464	35		6	6								6	6	15					70.78418011															NO						14.91163447	104.210036	34.70694757		5.94976244	5.94976244								5.94976244	5.94976244	14.8744061					70.19150936																0	0	0	0	0	4.70015195	0.032879917	1.317103527	0	0.034610139	0.03979287	0	0	0	0	0	0	0	2.878310659	10.21527172	2.23004376	0	0	0	0	3.087482206	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5356	0	0.207169788	0	0	0	0	0	4.70015195	0.032879917	1.317103527	0	0.034610139	0.03979287	0	0	0	0	0	0	0	2.878310659	10.21527172	2.23004376	0	0	0	0	3.087482206	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5356	NO																																																																																		0	0	0	0	0	0	0	0	4.70015195	0.032879917	1.317103527	0	0.034610139	0.03979287	0	0	0	0	0	0	0	2.878310659	10.21527172	2.23004376	0	0	0	0	3.087482206	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5356
H5821_804_0	2011	6																															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	YES	77.84043831		1.032273128		0.001580997	25.42552729	0.080128062	6.145200151	11.39803539	0.060904936	1.481952219			13.45999324	2.695642085	100.3305961	0.189408453	8.696854537	32.75356048	94.78841842	14.74583521	0.180738858																			6700	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												0.152992991		0.153410146		0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.135916074		0.136286667		0.206992785	0.206992785	0.206992785	0.206992785	0.206992785	0.206992785	0.206992785			0.206992785	0.206992785	0.206992785	0.206992785	0.206992785	0.206992785	0.206992785	0.206992785	0.206992785																				10.5798	0	0.140685064	0	0.000327255	5.262900697	0.016585931	1.272012092	2.359311086	0.012606882	0.306753417	0	0	2.786121483	0.557978462	20.76770947	0.039206183	1.800186139	6.779750694	19.62051869	3.052281493	0.037411639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.3921	0	9.472498894	10.5798	0	0.140685064	0	0.000327255	5.262900697	0.016585931	1.272012092	2.359311086	0.012606882	0.306753417	0	0	2.786121483	0.557978462	20.76770947	0.039206183	1.800186139	6.779750694	19.62051869	3.052281493	0.037411639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.3921	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												0.4938				0.003				0.0685	0.0057	0.013			0.1422	0.0336	3.5225		0.4069	0.7894	3.0562		0.0004																			8.5353	0	0	11.0736	0	0.140685064	0	0.003360143	5.262900697	0.016585931	1.272012092	2.427813195	0.018349051	0.319753898	0	0	2.928363533	0.591560181	24.29018827	0.039206183	2.207054611	7.56915262	22.67672026	3.052281493	0.037776218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.9274
H5823_002_0	2011	8																															D	D	D		T	Coin	Coin	V	Coin	V	Coin		Coin	Coin	V	V	V	V	Coin	V	Coin			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	YES	696.1839655	61.57191347	878.0376543	0	284.3394326	13.39223764	3.54923615	519.1795935	30.91349304	0	12.05149477	0	2.331472081	17.86246034	3933.280827	4088.033644	223.7157981	359.447984	17.9710095	457.9900468	9.569062981	0	0	2540.36795	385.0359823	0	0	0	0	0											3400	$290 /Days 1-6 for IP Medical; $290 /Days 1-6 for IP Surgical; PBP 1a	$290 /Days 1-6 for IP Psych; $290 /Days 1-6 for IP Substance Abuse; PBP 1b	$100 /Days 1-26 for SNF; PBP 2	No Cost-Sharing; PBP 6	$150/Run for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for ER - Facility; $50/Visit for PCP Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Hospital Services; 20% Coinsurance for Ambulatory Surgery Center Services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	20% Coinsurance for Outpatient Diagnostic Radiological Services; 20% Coinsurance for Therapeutic Radiological Services; $0/Case for Outpatient X-Ray Services; PBP 8b		20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$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; 20% Coinsurance for OP Fac - Other; $30/Visit for Prof - CORF; $30/Visit for OP Substance Abuse; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"$10/Visit for Prof - Asst Surgeon (OP); $10/Visit for PCP Office Visits; $10/Consult for PCP Consults; PBP 7a, 14b, 14c"	"$35/Visit for Prof - Asst Surgeon (OP); $35/Visit for Speclst Office Visits; $35/Consult for Speclst Consults; $25/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; PBP 7e, 7h"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for Outpatient Diagnostic Radiological Services; 20% Coinsurance for Therapeutic Radiological Services; $0/Case for Outpatient X-Ray Services; PBP 8b	"$10/Visit for Allergy Testing; $10/Visit for Allergy Tx; PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; PBP 15			"$15/Procedure for Dental: Preventive Services; PBP 16a, 16b"	$30/Exam for Vision Exams (Refractions); PBP 17a																0	290	290	100	0	150	0.2	0.2	50	0.2	0	0.150997452	0	0.2	0.129139312	10	32.46299389	30	30	0.150629096	32.92372499	0.2	0	0	15	30	0	0	0	0	0											NO	277.2593224	277.2593224	95.60666289	0	143.4099943	0.191213326	0.191213326	47.80333144	0.191213326	0	0.144363625	0	0.191213326	0.123465787	9.575346557	31.03678513	28.68199887	28.68199887	0.144011452	31.47727476	0.191213326	0	0	15	30	0	0	0	0	0												16.0853	1.422615584	6.995520835	0	3.398093034	2.560774298	0.678661248	2.068209515	5.911071816	0	1.739797471	0	0.445808531	2.205402716	3.138543919	10.57328515	0.534718022	0.859140556	2.588031173	1.201356545	1.829732357	0	0	3.175459938	0.962589956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3741	0	2.946755499	16.0853	1.422615584	6.995520835	0	3.398093034	2.560774298	0.678661248	2.068209515	5.911071816	0	1.739797471	0	0.445808531	2.205402716	3.138543919	10.57328515	0.534718022	0.859140556	2.588031173	1.201356545	1.829732357	0	0	3.175459938	0.962589956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3741	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.0853	1.422615584	6.995520835	0	3.398093034	2.560774298	0.678661248	2.068209515	5.911071816	0	1.739797471	0	0.445808531	2.205402716	3.138543919	10.57328515	0.534718022	0.859140556	2.588031173	1.201356545	1.829732357	0	0	3.175459938	0.962589956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3741
H5823_004_0	2011	9																															D	D	D		T	Coin	Coin	V	Coin		Coin		Coin	Coin		V	V	V	Coin		Coin			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	YES	626.8803658	9.959690766	753.1379576	0	178.3874451	7.176500232	4.632200143	235.7721287	34.66383494	0	15.51042706	0	0.376580328	20.43651199	0	4334.953635	94.75356621	335.9120486	26.89683116	0	7.328338257	0	0	2571.41321	385.0359823	0	0	0	0	0											2000	$225/Days 1-6 for IP Medical; $225/Days 1-6 for IP Surgical; PBP 1a	$290/Days 1-6 for IP Psych; $290/Days 1-6 for IP Substance Abuse; PBP 1b	$100/Days 1-26 for SNF; PBP 2	No Cost-Sharing; PBP 6	$150/Run for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for ER - Facility; $50/Visit for PCP Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Hospital Services; $100/Case for Ambulatory Surgery Center Services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b		20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$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; 20% Coinsurance for OP Fac - Other; $30/Case for Prof - CORF; $30/Visit for OP Substance Abuse; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b, 14c"	"$25/Visit for Prof - Asst Surgeon (OP); $25/Visit for Speclst Office Visits; $25/Consult for Speclst Consults; $25/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; PBP 7e, 7h"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 8b	"No Cost-Sharing; PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; PBP 15			"$15/Procedure for Dental: Preventive Services; PBP 16a, 16b"	$30/Exam for Vision Exams (Refractions); PBP 17a																0	225	290	100	0	150	0.2	0.2	50	0.176666667	0	0.2	0	0.2	0.107717778	0	25.66349244	30	30	0.2	0	0.2	0	0	15	30	0	0	0	0	0											NO	210.9253032	271.8592797	93.7445792	0	140.6168688	0.187489158	0.187489158	46.8722896	0.165615423	0	0.187489158	0	0.187489158	0.100979578	0	24.058133	28.12337376	28.12337376	0.187489158	0	0.187489158	0	0	15	30	0	0	0	0	0												11.0187	0.225636196	5.883550076	0	2.090356997	1.345515989	0.868487306	0.920931625	5.740865695	0	2.908036915	0	0.070604729	2.06367035	0	8.69090759	0.22206583	0.787248341	5.042864238	0	1.373983972	0	0	3.214266513	0.962589956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4303	0	3.286602639	11.0187	0.225636196	5.883550076	0	2.090356997	1.345515989	0.868487306	0.920931625	5.740865695	0	2.908036915	0	0.070604729	2.06367035	0	8.69090759	0.22206583	0.787248341	5.042864238	0	1.373983972	0	0	3.214266513	0.962589956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4303	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.0187	0.225636196	5.883550076	0	2.090356997	1.345515989	0.868487306	0.920931625	5.740865695	0	2.908036915	0	0.070604729	2.06367035	0	8.69090759	0.22206583	0.787248341	5.042864238	0	1.373983972	0	0	3.214266513	0.962589956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4303
H5823_006_0	2011	7																															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	122.2983421	15.43617764	19.25398225	0	6.702164332	4.745599663	1.887306842	14.44034422	13.89221029	2.982417251	9.305731128	0	0.138848007	12.56583655	27.38138232	42.73102054	2.515629098	2.383548722	11.15426169	36.56316364	13.60138322	0	0	0	0	0	0	0	0	0											6700	7% Coinsurance for IP Medical; 7% Coinsurance for IP Surgical; PBP 1a	7% Coinsurance for IP Psych; 7% Coinsurance for IP Substance Abuse; PBP 1b	15% Coinsurance for SNF; PBP 2	No Cost-Sharing; PBP 6	23% Coinsurance for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for DME / Medical Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"23% Coinsurance for ER - Facility; 23% Coinsurance for PCP Urgent Care; PBP 4a, 4b"	"23% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	23% Coinsurance for OP Fac - Pathology; PBP 8a	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	23% Coinsurance; PBP 9a	23% Coinsurance for Renal Dialysis - Fac; PBP 12	"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 OP Substance Abuse; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"23% Coinsurance for Prof - Asst Surgeon (OP); 23% Coinsurance for PCP Office Visits; 23% Coinsurance for PCP Consults; 23% Coinsurance for PCP Immunizations; PBP 7a, 14b, 14c"	"23% Coinsurance for Prof - Asst Surgeon (OP); 23% Coinsurance for Speclst Office Visits; 23% Coinsurance for Speclst Consults; 23% Coinsurance for Cardio; 23% Coinsurance for Chiropractor; 23% Coinsurance for Speclst Immunizations; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; PBP 7e, 7h"	"23% Coinsurance for Occ Therapy; 23% Coinsurance for PT/ST; PBP 7c, 7i"	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office); 23% Coinsurance for Prof Radiology (Office); PBP 8b	"23% Coinsurance for Prof - Primary Surgeon (IP); 23% Coinsurance for Prof - Asst Surgeon (IP); 23% Coinsurance for Prof - Anesthesia (IP); 23% Coinsurance for Prof - Primary Surgeon (OP); 23% Coinsurance for Prof - Anesthesia (OP); 23% Coinsurance for Prof - IP Visits; 23% Coinsurance for Allergy Testing; 23% Coinsurance for Allergy Tx; 23% Coinsurance for Renal Dialysis - Prof; 23% Coinsurance for Prof - ER Visits; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14d-j"	23% Coinsurance for Part B Rx; 23% Coinsurance for Tx Injections; PBP 15	23% Coinsurance																			0	0.072014977	0.072014977	0.145213417	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.193308762	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.071710543	0.071710543	0.144599546	0	0.232015022	0.232015022	0.232015022	0.232015022	0.232015022	0.232015022	0.232015022	0	0.232015022	0.192491574	0.232052553	0.232053796	0.232015022	0.232015022	0.232015022	0.232015022	0.232015022	0	0	0	0	0	0	0	0	0												8.7701	1.106936677	2.784117099	0	1.555002808	1.101050412	0.437883539	3.350376788	3.223201481	0.691965605	2.159069416	0	0.032214823	2.418817655	6.353919672	9.915895526	0.583663741	0.55301911	2.587956276	8.483203232	3.155725231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2641	0	0.248899089	8.7701	1.106936677	2.784117099	0	1.555002808	1.101050412	0.437883539	3.350376788	3.223201481	0.691965605	2.159069416	0	0.032214823	2.418817655	6.353919672	9.915895526	0.583663741	0.55301911	2.587956276	8.483203232	3.155725231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2641	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.7701	1.106936677	2.784117099	0	1.555002808	1.101050412	0.437883539	3.350376788	3.223201481	0.691965605	2.159069416	0	0.032214823	2.418817655	6.353919672	9.915895526	0.583663741	0.55301911	2.587956276	8.483203232	3.155725231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2641
H5826_005_0	2011	5																															A	A	A	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	V	V	Coin	Coin	Coin	Coin	V	Coin	V	V	V	V																																																			0	YES	216.8219661	13.51426471	200.89886	46.01538733	301.9029192	9.16880447	15.08627911	894.7712776	41.62273235	4.956265996	21.43624319	0	0	17.50004561	10370.37148	794.5765953	705.1100826	777.9331826	7582.803514	3721.120946	23.46049295	5.984728374	0	30.46646207	226.4030952	8.017899188	0	14.19397184	0	2.64034256											2000	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS		"20% for Medicare covered, 0% all other"		"20%, $270 annual benefit limit"															0	822.2300422	767.1755167	384.6781798	0	128.2410971	0.233	0.233	141.956386	0.233	0.233	0.233	0	0	0.233	21.56854306	20.69820255	20.44792595	20.96781436	15.28433306	57.28004485	0.233	0.207872912	0	0.030603723	0	0.2	0	0	0	0											NO	822.2300422	767.1755167	384.6781798	0	128.2410971	0.233	0.233	141.956386	0.233	0.233	0.233	0	0	0.233	21.56854306	20.69820255	20.44792595	20.96781436	15.28433306	57.28004485	0.233	0.207872912	0	0.030603723	0	0.2	0	0	0	0												14.8565	0.863984417	6.440117315	0	3.226363465	2.136331442	3.515103032	10.58487474	9.698096638	1.154809977	4.994644663	0	0	4.077510627	18.63948366	1.370525609	1.20150323	1.359296546	9.658174535	17.76216456	5.466294858	1.244062915	0	0.93238716	0	1.603579838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.7858	0	0	14.8565	0.863984417	6.440117315	0	3.226363465	2.136331442	3.515103032	10.58487474	9.698096638	1.154809977	4.994644663	0	0	4.077510627	18.63948366	1.370525609	1.20150323	1.359296546	9.658174535	17.76216456	5.466294858	1.244062915	0	0.93238716	0	1.603579838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.7858	NO																																																																																		0	0	0	14.8565	0.863984417	6.440117315	0	3.226363465	2.136331442	3.515103032	10.58487474	9.698096638	1.154809977	4.994644663	0	0	4.077510627	18.63948366	1.370525609	1.20150323	1.359296546	9.658174535	17.76216456	5.466294858	1.244062915	0	0.93238716	0	1.603579838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.7858
H5826_006_0	2011	4																															A	A	A	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	Coin	Coin	V	Coin	V	V	V	V																																																			0	YES	187.4742231	4.970522678	103.7472804	28.66056902	89.57430242	2.337733567	2.300378047	427.365134	12.90382284	2.457382088	17.26941455	0	0	7.171369833	7051.409572	2310.746593	151.2375878	406.7195378	21.11390008	3313.280941	6.871220845	434.0787463	0	7.301295139	355.5758411	1.196137203	0	0	0	2.255920811											2800	Days 1-5: $175/day	Days 1-5: $175/day	"Days 21-55: $100/day, 3 day requirement waived"		$100/trip	0.2	11b: 20%;11c: 0%	$50/visit; 20% (worldwide)	0.2	0	0.15			0.2	0	"$5/visit, $0 podiatry (add'l services)"	5	5	"15% radiology, 0% lab"	"$5, $0 outpatient surgery not in office, pap smears, pelvic exams, prostate cancer screening, colorectal screening, bone mass measurement, mammography, diabetes monitoring, nutritional training"	0.2	"$0, $5 Medicare covered vision exams, hearing"																			0	560.8108108	781.6666667	200.591716	0	100	0.2	0.138577385	49.91921787	0.2	0	0.15	0	0	0.2	0	4.864724228	5	5	0.09116038	3.600939961	0.2	4.120725076	0	0	0	0	0	0	0	0											NO	452.0135135	630.0233333	161.6769231	0	80.6	0.1612	0.111693372	40.2348896	0.1612	0	0.1209	0	0	0.1612	0	3.920967728	4.03	4.03	0.073475266	2.902357608	0.1612	3.321304411	0	0	0	0	0	0	0	0												7.0617	0.260962106	1.39779509	0	0.601640731	0.376842651	0.256936982	1.432915749	2.080096241	0	2.087872219	0	0	1.156024817	0	0.755030235	0.050790623	0.136589978	1.551349423	0.801360512	1.1076408	0.120142305	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.2357	0	5.11132971	7.0617	0.260962106	1.39779509	0	0.601640731	0.376842651	0.256936982	1.432915749	2.080096241	0	2.087872219	0	0	1.156024817	0	0.755030235	0.050790623	0.136589978	1.551349423	0.801360512	1.1076408	0.120142305	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.2357	NO																																																																																		0	0	0	7.0617	0.260962106	1.39779509	0	0.601640731	0.376842651	0.256936982	1.432915749	2.080096241	0	2.087872219	0	0	1.156024817	0	0.755030235	0.050790623	0.136589978	1.551349423	0.801360512	1.1076408	0.120142305	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.2357
H5826_008_0	2011	5																															A	A	A	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	Coin	Coin	V	Coin	V	V	V	V																																																			0	YES	199.7045507	6.501497825	130.7316903	46.41450837	154.263098	5.716788144	12.95134889	599.7004051	34.57368014	4.725124482	14.16638416	0	0	16.89601286	7474.42617	2836.529508	446.7025105	739.6185573	32.57593225	3506.016428	19.50615266	338.9399126	0	10.19730299	350.7725987	0.939655111	0	0.708970099	0	2.410294313											2800	Days 1-5: $175/day	Days 1-5: $175/day	Days 21-55: $100/day; 3 day requirement waived		$100/trip	0.2	11b: 20%;11c: 0%	"$50/visit, 20% (worldwide)"	0.2	0	0.15	0		0.2	0	"$5, $0 podiatry routine visits"	5	5	"15% radiology, 0% lab"	"$5, $0 outpatient surgery not in office, pap smears, pelvic exams, prostate cancer screening, colorectal screening, bone mass measurement, mammography, diabetes monitoring, nutritional training"	0.2	"$0, $5 Medicare covered eye exams, hearing"		0																	0	560.8108108	781.6666667	200.591716	0	100	0.2	0.10806766	49.94925666	0.2	0	0.15	0	0	0.2	0	4.86363226	5	5	0.077114651	3.623633673	0.2	3.956720432	0	0	0	0	0	0	0	0											NO	452.0135135	630.0233333	161.6769231	0	80.6	0.1612	0.087102534	40.25910087	0.1612	0	0.1209	0	0	0.1612	0	3.920087602	4.03	4.03	0.062154408	2.920648741	0.1612	3.189116668	0	0	0	0	0	0	0	0												7.5224	0.341341278	1.76135812	0	1.036133808	0.921546249	1.128095302	2.011949925	5.573277239	0	1.712715845	0	0	2.723637273	0	0.926620346	0.150017593	0.248388565	2.024737794	0.853320205	3.144391809	0.090076577	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.17	0	8.074784986	7.5224	0.341341278	1.76135812	0	1.036133808	0.921546249	1.128095302	2.011949925	5.573277239	0	1.712715845	0	0	2.723637273	0	0.926620346	0.150017593	0.248388565	2.024737794	0.853320205	3.144391809	0.090076577	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.17	NO																																																																																		0	0	0	7.5224	0.341341278	1.76135812	0	1.036133808	0.921546249	1.128095302	2.011949925	5.573277239	0	1.712715845	0	0	2.723637273	0	0.926620346	0.150017593	0.248388565	2.024737794	0.853320205	3.144391809	0.090076577	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.17
H5826_009_0	2011	5																															A	A	A	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	Coin	Coin	V	Coin	V	V	V	V																																																			0	YES	170.3378248	1.172746212	142.5748021	30.98094057	164.5070029	5.685386285	9.072500343	498.8458325	30.24443605	5.939701899	18.36870691	0	0	20.61833983	2659.658506	6720.713249	269.7313396	402.3695685	37.75807678	3587.005683	20.30864902	336.3646083	0	9.066911371	241.2748522	0.985698701	0	0	0	2.046407465											2800	Days 1-10: $175/day	Days 1-10: $175/day	Days 21-55: $100/day; 3 day requirement waived		$150/trip	0.2	11b: 20%;11c: 0%	"$50/visit, 20% (worldwide)"	0.2	0	0.15	0		0.2	0	"$20, $0 podiatry routine visits"	$20 	$20 	"15% radiology, 0% lab"	"$20, $0 outpatient surgery not in office, pap smears, pelvic exams, prostate cancer screening, colorectal screening, bone mass measurement, mammography, diabetes monitoring, nutritional training"	0.2	"$0, $20 Medicare covered eye exams, hearing"																			0	692.9054054	1178.333333	200.591716	0	150	0.2	0.118353062	49.96643917	0.2	0	0.15	0	0	0.2	0	19.44859742	20	20	0.099229318	10.71806582	0.2	18.57341019	0	0	0	0	0	0	0	0											NO	558.4817568	949.7366667	161.6769231	0	120.9	0.1612	0.095392568	40.27294997	0.1612	0	0.1209	0	0	0.1612	0	15.67556952	16.12	16.12	0.07997883	8.638761052	0.1612	14.97016861	0	0	0	0	0	0	0	0												7.9275	0.092816673	1.920921277	0	1.657408054	0.916484269	0.865449102	1.674166105	4.875403091	0	2.220776666	0	0	3.32367638	0	8.779250648	0.3623391	0.540516454	3.019846812	2.582273749	3.273754221	0.419619575	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4522	0	10.93151943	7.9275	0.092816673	1.920921277	0	1.657408054	0.916484269	0.865449102	1.674166105	4.875403091	0	2.220776666	0	0	3.32367638	0	8.779250648	0.3623391	0.540516454	3.019846812	2.582273749	3.273754221	0.419619575	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4522	NO																																																																																		0	0	0	7.9275	0.092816673	1.920921277	0	1.657408054	0.916484269	0.865449102	1.674166105	4.875403091	0	2.220776666	0	0	3.32367638	0	8.779250648	0.3623391	0.540516454	3.019846812	2.582273749	3.273754221	0.419619575	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4522
H5826_010_0	2011	6																															A	A	A	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	V	V	V																																																			0	YES	156.6932281	9.33879889	79.25743364	6.764495518	143.1369397	3.087422624	10.07365346	488.5957591	22.16286887	3.637204961	16.42067876	0	0	12.76169891	6230.371626	2090.628504	2.254740848	2.270414193	34.02015304	54.82546348	4.104733056	5.115147829	0	0	176.3676378	0.834815806	0	0	0	1.898587415											3400	Days 1-7: $250/day	Days 1-7: $275/day	Days 21-60: $100/day		$175/trip	0.2	11b: 20%;11c: 0%	"$50/visit, 20% (worldwide)"	0.2	0	0.2	0		0.2	"$10, $0 routine physicals, immunizations"	"$40, 20% chiro, $0 podiatry routine visits"	0.2	0.2	"20% radiology, 0% lab"	"20%, $40 outpatient surgery in office, $0 outpatient surgery not in office, pap smears, pelvic exams, prostate cancer screening, colorectal screening, bone mass measurement, mammography, diabetes monitoring, nutritional training"	0.2	"0%, 20% Medicare covered eye exams, hearing"																			0	899.1312741	1576.666667	209.4674556	0	175	0.2	0.104147324	49.96985938	0.2	0	0.2	0	0	0.2	8.693198314	34.62443909	0.2	0.2	0.091517138	0.093260376	0.2	0.184956767	0	0	0	0	0	0	0	0											NO	760.6650579	1333.86	177.2094675	0	148.05	0.1692	0.088108636	42.27450103	0.1692	0	0.1692	0	0	0.1692	7.354445774	29.29227547	0.1692	0.1692	0.077423498	0.078898278	0.1692	0.156473425	0	0	0	0	0	0	0	0												9.9326	1.038054191	1.170430634	0	1.765951993	0.522391908	0.887575867	1.721261827	3.749957412	0	2.778378846	0	0	2.159279455	3.818410856	5.103272171	0.381502152	0.384154081	2.633959268	4.325634686	0.694520833	0.800384701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.8677	0	8.142589111	9.9326	1.038054191	1.170430634	0	1.765951993	0.522391908	0.887575867	1.721261827	3.749957412	0	2.778378846	0	0	2.159279455	3.818410856	5.103272171	0.381502152	0.384154081	2.633959268	4.325634686	0.694520833	0.800384701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.8677	NO																																																																																		0	0	0	9.9326	1.038054191	1.170430634	0	1.765951993	0.522391908	0.887575867	1.721261827	3.749957412	0	2.778378846	0	0	2.159279455	3.818410856	5.103272171	0.381502152	0.384154081	2.633959268	4.325634686	0.694520833	0.800384701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.8677
H5826_011_0	2011	4																															A	A	A	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	V	V	V	V	V	Coin	V	Coin	Coin	Coin	Coin	V	Coin	V	V	V	V																																																			0	YES	187.1583792	7.397258573	136.3745284	34.3412456	184.3412761	4.418142614	8.698194205	614.5870114	352.3750611	4.82024368	16.31840963	0	0	780.9373508	6956.63236	2143.820089	313.4147533	437.9763143	33.91543423	2703.264071	15.71345519	3.641204312	0	6.415274892	226.5123379	0.722705085	0	0	0	2.183338594											1000	$500/admit	$500/admit	Days 21-55: $100/day; 3 day requirement waived		$100/trip	0.2	11b: 20%;11c: 0%	"$50/visit, 20% (worldwide)"	50	0	0.15	0		"$50, 20% outpatient substance abuse, cardiac rehab, renal dialysis"	0	"$15, $0 podiatry routine visits"	$15 	$15 	"15% radiology, 0% lab"	"$15, $0 outpatient surgery not in office, pap smears, pelvic exams, prostate cancer screening, colorectal screening, bone mass measurement, mammography, diabetes monitoring, nutritional training"	0.2	"$0, $15 Medicare covered eye exams, hearing"																			0	500	500	200.591716	0	100	0.2	0.133149095	49.95825153	50	0	0.15	0	0	60.97916747	0	14.59083382	15	15	0.083359566	10.54198746	0.2	0.132673335	0	0	0	0	0	0	0	0											YES	275.5	275.5	110.5260355	0	55.1	0.1102	0.073365151	27.52699659	27.55	0	0.08265	0	0	33.59952128	0	8.039549437	8.265	8.265	0.045931121	5.808635089	0.1102	0.073103008	0	0	0	0	0	0	0	0											2000	4.2968	0.169828728	1.256077997	0	0.846433693	0.486879316	0.638144334	1.409811214	0.808994411	0	1.348716556	0	0	2.186593428	0	1.436278966	0.215864411	0.301656186	1.557773912	1.308522878	1.731622762	0.266182987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.2662	0	16.87282214	4.2968	0.169828728	1.256077997	0	0.846433693	0.486879316	0.638144334	1.409811214	0.808994411	0	1.348716556	0	0	2.186593428	0	1.436278966	0.215864411	0.301656186	1.557773912	1.308522878	1.731622762	0.266182987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.2662	NO	0	0	0	0	0	0.298940399	0.588537283	0	1.897523441	0	0	0	0	0.98420754	0	1.196619075	0.178745938	0.252155143	0	0.852317567	0	0	0	0	0	0.045169068	0	0	0	0												0	0	0	0	0	0.2176	0.4285	0	1.3814	0	0	0	0	0.7165	0	0.8711	0.1301	0.1836	0	0.6205	0	0	0	0	0	0.0329	0	0	0	0											4.5822	0	1.749164316	4.2968	0.169828728	1.256077997	0	0.846433693	0.704507927	1.066599475	1.409811214	2.190391476	0	1.348716556	0	0	2.903096517	0	2.307417653	0.345991454	0.485225131	1.557773912	1.929010067	1.731622762	0.266182987	0	0	0	0.032883081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.8484
H5826_012_0	2011	5																															A	A	A	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	Coin	Coin	V	Coin	V	V	V	V																																																			0	YES	186.4293526	7.386588702	135.8054811	34.19807674	183.510592	5.454630709	10.74881342	612.0849822	29.52155283	4.674104143	15.86263444	0	0	15.3075777	6934.668123	2840.699199	416.7631082	581.3613825	32.96268823	3420.089207	15.28652451	428.0675745	0	6.624424618	281.9029351	0.878298684	0	0	0	2.17483777											2300	Days 1-10: $150/day	Days 1-10: $150/day	Days 21-55: $100/day; 3 day requirement waived		$150/trip	0.2	11b: 20%;11c: 0%	"$50/visit, 20% (worldwide)"	0.2	0	0.15	0		0.2	0	"$20, $0 podiatry routine visits"	$20 	$20 	"15% radiology, 0% lab"	"$20, $0 outpatient surgery not in office, pap smears, pelvic exams, prostate cancer screening, colorectal screening, bone mass measurement, mammography, diabetes monitoring, nutritional training"	0.2	"$0, $20 Medicare covered eye exams, hearing"		0																	0	593.9189189	1010	200.591716	0	150	0.2	0.133157701	49.95563826	0.2	0	0.15	0	0	0.2	0	19.45441254	20	20	0.083297475	14.28075977	0.2	17.98099298	0	0	0	0	0	0	0	0											NO	451.9722973	768.61	152.6502959	0	114.15	0.1522	0.101333011	38.01624072	0.1522	0	0.11415	0	0	0.1522	0	14.80480794	15.22	15.22	0.063389378	10.86765819	0.1522	13.68353566	0	0	0	0	0	0	0	0												7.0217	0.473117162	1.727562239	0	1.745644507	0.830194794	1.089209624	1.939097502	4.49318034	0	1.810719722	0	0	2.329813326	0	3.504667172	0.528594542	0.73736002	2.08948431	3.097363372	2.32660903	0.48812316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2325	0	11.37918971	7.0217	0.473117162	1.727562239	0	1.745644507	0.830194794	1.089209624	1.939097502	4.49318034	0	1.810719722	0	0	2.329813326	0	3.504667172	0.528594542	0.73736002	2.08948431	3.097363372	2.32660903	0.48812316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2325	NO																																																																																		0	0	0	7.0217	0.473117162	1.727562239	0	1.745644507	0.830194794	1.089209624	1.939097502	4.49318034	0	1.810719722	0	0	2.329813326	0	3.504667172	0.528594542	0.73736002	2.08948431	3.097363372	2.32660903	0.48812316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2325
H5832_001_0	2011	3																															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	1434.552526	178.0159475	946.504767	749.4625772	210.592032	14.8465551	0	352.1978933	394.1474251	2973.981871	2593.594918	50.98122499	2.057392596	192.2512332	3274.725166	5196.053383	394.7688889	737.1191202	0	0	259.9824772	0	0	0	1136.806296	0	55.87302678	0	0	0											3400	$200/day 1-10	$200/day 1-10	"$0/d 1-20, $130/d 21-100"	$0 per visit	$200 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $35 Urgent Care Ctr	$300 per procedure	$50 per visit	$50 X-ray; $250 Complex Radiology	$50 per visit	$25 per visit	$50 per visit	"$30 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$50 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$50 per visit	$50 per visit	$50 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	163.9294809	163.9294809	52.43074037	0	200	0.05	0.05	48.5	300	7.5	30	50	25	50	30	50	40	37.5	50	50	$50 	0	0	0	0	0	0	0	0	0											NO	115.8303135	115.8303135	37.04683905	0	141.3172455	0.035329311	0.035329311	34.26943204	211.9758683	5.299396708	21.19758683	35.32931138	17.66465569	35.32931138	21.19758683	35.32931138	28.26344911	26.49698354	35.32931138	35.32931138	35.32931138	0	0	0	0	0	0	0	0	0												13.8471	1.718303584	2.922084147	0	2.480023824	0.524518568	0	1.005801814	6.962478555	1.313359145	4.581496123	0.150094298	0.003028594	0.56600864	5.784689254	15.29774899	0.9297942	1.627619433	0	0	0.765416824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4795	0	25.11445019	13.8471	1.718303584	2.922084147	0	2.480023824	0.524518568	0	1.005801814	6.962478555	1.313359145	4.581496123	0.150094298	0.003028594	0.56600864	5.784689254	15.29774899	0.9297942	1.627619433	0	0	0.765416824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4795	NO																																																																																		0			13.8471	1.718303584	2.922084147	0	2.480023824	0.524518568	0	1.005801814	6.962478555	1.313359145	4.581496123	0.150094298	0.003028594	0.56600864	5.784689254	15.29774899	0.9297942	1.627619433	0	0	0.765416824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4795
H5832_801_0	2011	1																															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	YES	316.5709514	6.462556847	40.44164725	8.02964191	9.415718572	12.17546682	0	15.09286598	41.65555416	18.66087617	60.30059565	1.067666812	0.09154785	27.77036946	28.34413866	135.6370553	3.667752212	8.639565673	0	0	72.05812193	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.085444234	0.085444234	0.193290126	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.069122932	0.069122932	0.156368422	0	0.188493035	0.188493035	0.188493035	0.188493035	0.188493035	0.188493035	0.188493035	0.188493035	0.188493035	0.188493035	0.188493035	0.188493035	0.188493035	0.188493035	0.188493035	0.188493035	0.188493035	0.188493035	0	0	0	0	0	0	0	0												21.8823	0.446710874	6.323796577	0	1.774797368	2.294990691	0	2.844900112	7.851781817	3.51744518	11.36624227	0.201247758	0.017256132	5.234521214	5.342672712	25.56664018	0.691345745	1.628497953	0	0	13.58245408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.5676	0	26.10721882	21.8823	0.446710874	6.323796577	0	1.774797368	2.294990691	0	2.844900112	7.851781817	3.51744518	11.36624227	0.201247758	0.017256132	5.234521214	5.342672712	25.56664018	0.691345745	1.628497953	0	0	13.58245408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.5676	NO																																																																																		0			21.8823	0.446710874	6.323796577	0	1.774797368	2.294990691	0	2.844900112	7.851781817	3.51744518	11.36624227	0.201247758	0.017256132	5.234521214	5.342672712	25.56664018	0.691345745	1.628497953	0	0	13.58245408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.5676
H5832_802_0	2011	1																															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	YES	318.5575891	6.503112556	40.69543839	8.080031845	9.474806817	12.25187384	0	15.18758111	41.91696316	18.7779823	60.67901142	1.074366944	0.092122358	27.94464212	28.52201201	136.4882443	3.690769153	8.693783179	0	0	72.51032193	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.084931059	0.084931059	0.192885392	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.068686132	0.068686132	0.155991833	0	0.188433643	0.188433643	0.188433643	0.188433643	0.188433643	0.188433643	0.188433643	0.188433643	0.188433643	0.188433643	0.188433643	0.188433643	0.188433643	0.188433643	0.188433643	0.188433643	0.188433643	0.188433643	0	0	0	0	0	0	0	0												21.8805	0.44667365	6.348156034	0	1.785372365	2.308665221	0	2.861851236	7.89856607	3.538403613	11.43396717	0.202446877	0.017358951	5.265710717	5.374506627	25.71897709	0.695465077	1.638201236	0	0	13.66338411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0782	0	26.27105441	21.8805	0.44667365	6.348156034	0	1.785372365	2.308665221	0	2.861851236	7.89856607	3.538403613	11.43396717	0.202446877	0.017358951	5.265710717	5.374506627	25.71897709	0.695465077	1.638201236	0	0	13.66338411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0782	NO																																																																																		0			21.8805	0.44667365	6.348156034	0	1.785372365	2.308665221	0	2.861851236	7.89856607	3.538403613	11.43396717	0.202446877	0.017358951	5.265710717	5.374506627	25.71897709	0.695465077	1.638201236	0	0	13.66338411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0782
H5850_002_0	2011	5																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	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	1436.123136	0	720.6561814	0	1680.602999	0	0	510.1089721	302.3457632	0	1646.581327	102.8800297	0.925023641	41.63402896	16355.54109	12810.93347	0	0	0	0	723.8030489	0	0	2100.591872	0	0	0	0	0	0											3400	0	0	0	0	0	0	0	0	0	0	0	0	(12) 20%	0	0	0	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0.2	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	0.2	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	0.185004728	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	4.3173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.185004728	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	4.3173	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.185004728	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	4.3173
H5850_003_0	2011	6																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	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	1409.713717	0	1041.396818	0	735.8197872	0	0	341.0663319	368.6795117	0	1887.872415	113.138234	0.060962786	34.88022833	8731.922394	14116.61949	0	0	0	0	683.9650119	0	0	144.6015143	0	0	0	0	0	0											6700	$50 copay (days 1-10) PBP L.1a	0	"(2) $25 days 1-20, $75 days 21-100"	0	(10a) $50	0	0	(4a) $50	"(9a,9b) $100 @ Hospital; $50 ASC"	0	$50 L.8a Diag; $75 (L. 8b. MRI/CT @ Hosp); $55 (Therapy) L.8b	(9a) $100 copay	(12) 20%	"(7c,7i) $25 @ Hospital, (8b) $55 @ Hospital"	0	$0 	$0 	$0 	$0 	$0 	(15) 20% chemo; $50 Part B Rx	0	Not covered	0	0	0	0	0	0	0											0	44.37574364	0	35.35245678	0	50	0	0	50	67.64789088	0	1.732206124	50	0.2	15.78803879	0	0	0	0	0	0	125.8095723	0	0	0	0	0	0	0	0	0											NO	44.21361181	0	35.22329255	0	49.81731931	0	0	49.81731931	67.40073161	0	1.725877312	49.81731931	0.199269277	15.7303554	0	0	0	0	0	0	125.3499127	0	0	0	0	0	0	0	0	0												5.194	0	3.056785399	0	3.054714108	0	0	1.41591753	2.070772402	0	0.271519681	0.469686961	0.01214801	0.045723199	0	0	0	0	0	0	7.144579543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.7359	0	0.083372779	5.194	0	3.056785399	0	3.054714108	0	0	1.41591753	2.070772402	0	0.271519681	0.469686961	0.01214801	0.045723199	0	0	0	0	0	0	7.144579543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.7359	NO																																																																																		0	0	0	5.194	0	3.056785399	0	3.054714108	0	0	1.41591753	2.070772402	0	0.271519681	0.469686961	0.01214801	0.045723199	0	0	0	0	0	0	7.144579543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.7359
H5850_004_0	2011	6																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	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	1187.99814	0	926.9368351	0	750.0700882	0	0	308.0189898	406.1274779	0	1964.160114	52.08031576	0	61.36255835	14425.27193	14352.00447	0	0	0	0	746.9742269	0	0	144.6015143	0	0	0	0	0	0											6700	$100 copay (days 1-10) PBP L.1a	0	"(2) $35 days 1-20, $100 days 21-100"	0	(10a) $100	0	0	(4a) $50	"(9a,9b) $150 @ Hospital; $100 ASC"	0	"$100 (L.8a Diag, L. 8b MRI/CT @ Hosp); $10 (L.8a diag @ freest.); $55 L.8b Ther. @ Hosp"	(9a) $150 copay	(12) 20%	"(7c,7i) $50 @ Hospital, (8b) $55 @ Hospital"	0	"(7b,7c,7d,7g,7i) $20"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20% chemo; $50 Part B Rx	0	Not covered	0	0	0	Not covered	Not covered	0	0											0	88.99469857	0	48.44273218	0	100	0	0	50	119.2497654	0	13.39736026	44.13722617	0.2	39.40692502	0	9.784496677	0	0	0	0	115.371133	0	0	0	0	0	0	0	0	0											NO	86.9256799	0	47.31649749	0	97.67512144	0	0	48.83756072	116.4773532	0	13.0858879	43.11108926	0	38.49076187	0	9.557019011	0	0	0	0	112.6888943	0	0	0	0	0	0	0	0	0												8.6056	0	3.654950369	0	6.105265579	0	0	1.253574676	3.942054473	0	2.141898256	0.187103262	0	0.196824302	0	11.4301983	0	0	0	0	7.014641639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.5321	0	1.059960973	8.6056	0	3.654950369	0	6.105265579	0	0	1.253574676	3.942054473	0	2.141898256	0.187103262	0	0.196824302	0	11.4301983	0	0	0	0	7.014641639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.5321	NO																																																																																		0	0	0	8.6056	0	3.654950369	0	6.105265579	0	0	1.253574676	3.942054473	0	2.141898256	0.187103262	0	0.196824302	0	11.4301983	0	0	0	0	7.014641639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.5321
H5850_005_0	2011	6																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	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	1487.95523	0	1079.462807	0	511.7372458	0	0	366.6635398	434.9154469	0	1911.826969	26.98509124	0.434318725	83.45072036	15258.26329	14841.29513	0	0	0	0	757.9513996	0	0	144.6015143	0	0	0	0	0	0											5000	$100 copay (days 1-10) PBP L.1a	0	"(2) $35 days 1-20, $100 days 21-100"	0	(10a) $75	0	0	(4a) $50	"(9a,9b) $100 @ Hospital; $50 ASC"	0	"$100 (L.8a Diag, 8b. MRI/CT @ Hosp); $15 (L. 8a diag @ freest.), $55 (Therapy) L.8b"	(9a) $100 copay	20% coinsurance PBP L.12	"(7c,7i) $50 @ Hospital, (8b) $55 @ Hospital"	0	"(7b,7c,7d,7g,7i) $20"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20% chemo; $50 Part B Rx	0	Not covered	0	0	0	Not covered	Not covered	0	0											0	89.00791282	0	48.44273218	0	75	0	0	50	68.05231504	0	20.00582939	50	0.2	45.66077303	0	8.116201307	0	0	0	0	117.1985398	0	0	0	0	0	0	0	0	0											NO	85.37369514	0	46.46480204	0	71.93772927	0	0	47.95848618	65.2737202	0	19.18898585	47.95848618	0.191833945	43.79643104	0	7.784814565	0	0	0	0	112.4132911	0	0	0	0	0	0	0	0	0												10.586	0	4.179752137	0	3.067767954	0	0	1.465385692	2.365712433	0	3.057168388	0.10784701	0.083317074	0.30457031	0	9.628060871	0	0	0	0	7.100317607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9459	0	1.785568739	10.586	0	4.179752137	0	3.067767954	0	0	1.465385692	2.365712433	0	3.057168388	0.10784701	0.083317074	0.30457031	0	9.628060871	0	0	0	0	7.100317607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9459	NO																																																																																		0	0	0	10.586	0	4.179752137	0	3.067767954	0	0	1.465385692	2.365712433	0	3.057168388	0.10784701	0.083317074	0.30457031	0	9.628060871	0	0	0	0	7.100317607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9459
H5850_006_0	2011	6																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	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	776.5324002	0	352.7025155	0	497.3590838	0	0	200.7458677	364.7152631	0	1879.586391	56.51045865	0.286052429	36.60724328	8574.261937	10377.2024	0	0	0	0	428.2325898	0	0	144.6015143	0	0	0	0	0	0											3400	0	0	(2) $50 days 6-100	0	(10a) $50	0	0	(4a) $50	0	0	0	0	(12) 20%	0	0	0	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20% chemo; $50 Part B Rx	0	0	0	0	0	Not covered	0	0	0											0	0	0	35.33451787	0	50	0	0	50	0	0	0	44.81831386	0.2	0	0	0	0	0	0	0	115.2329366	0	0	0	0	0	0	0	0	0											NO	0	0	35.29457652	0	49.94348111	0	0	49.94348111	0	0	0	44.76765224	0.199773924	0	0	0	0	0	0	0	115.1026799	0	0	0	0	0	0	0	0	0												0	0	1.037373827	0	2.069987	0	0	0.835495621	0	0	0	0.210820047	0.057145816	0	0	0	0	0	0	0	4.107559892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.3184	0	0.009413555	0	0	1.037373827	0	2.069987	0	0	0.835495621	0	0	0	0.210820047	0.057145816	0	0	0	0	0	0	0	4.107559892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.3184	NO																																																																																		0	0	0	0	0	1.037373827	0	2.069987	0	0	0.835495621	0	0	0	0.210820047	0.057145816	0	0	0	0	0	0	0	4.107559892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.3184
H5850_007_0	2011	7																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	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	1609.109929	0	1029.015767	0	529.112793	0	0	331.2746944	450.2894667	0	1924.119218	23.73205186	1.232177579	99.23543704	18463.7062	16330.02157	0	0	0	0	673.3982976	0	0	144.6015143	0	0	0	0	0	0											3400	$100 copay (days 1-10) PBP L.1a	0	"(2) $20 days 1-20, $75 days 21-100"	0	(10a) $100	0	0	(4a) $50	"(9a,9b) $100 @ Hospital; $50 ASC"	0	$75 (L.8a diag @ Hosp.); $ $55 L. 8b Ther. @ Hosp; $100 L. 8b MRI/CT @ Hosp; $10 (L.8a diag @ freest.)	(9a) $100 copay	(12) 20%	"(7c,7i) $50 @ Hospital, (8b) $55 @ Hospital"	0	"(7b,7c,7d,7g,7i) $15"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20% chemo; $50 Part B Rx	0	Not covered	0	0	0	Not covered	Not covered	0	0											0	88.96862623	0	31.43408734	0	100	0	0	50	63.46421966	0	15.42404949	50	0.2	45.87642007	0	7.130165094	0	0	0	0	127.849516	0	0	0	0	0	0	0	0	0											NO	81.31103525	0	28.72853377	0	91.39293108	0	0	45.69646554	58.00181054	0	14.09649092	45.69646554	0.182785862	41.92780498	0	6.51646687	0	0	0	0	116.84542	0	0	0	0	0	0	0	0	0												10.9032	0	2.463509519	0	4.029764085	0	0	1.261506888	2.176467028	0	2.260277425	0.090372574	0.225224641	0.346727004	0	8.867837043	0	0	0	0	6.55695891	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1818	0	3.690010085	10.9032	0	2.463509519	0	4.029764085	0	0	1.261506888	2.176467028	0	2.260277425	0.090372574	0.225224641	0.346727004	0	8.867837043	0	0	0	0	6.55695891	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1818	NO																																																																																		0	0	0	10.9032	0	2.463509519	0	4.029764085	0	0	1.261506888	2.176467028	0	2.260277425	0.090372574	0.225224641	0.346727004	0	8.867837043	0	0	0	0	6.55695891	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1818
H5850_012_0	2011	6																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	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	1289.668033	0	826.62877	0	833.2089181	0	0	260.3476328	374.1952117	0	1967.43991	93.11893586	1.873024601	71.23824885	8627.623078	13606.14501	0	0	0	0	746.2591915	0	0	144.6015143	0	0	0	0	0	0											3400	0	0	0	0	0	0	0	(4a) $50	0	0	0	0	(12) 20%	0	0	0	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20% chemo; $50 Part B Rx	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	50	0	0	0	50	0.2	0	0	0	0	0	0	0	84.74566548	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	49.97173584	0	0	0	49.97173584	0.199886943	0	0	0	0	0	0	0	84.69776019	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	1.084168594	0	0	0	0.387776239	0.374393162	0	0	0	0	0	0	0	5.267206837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.1135	0	0.004019018	0	0	0	0	0	0	0	1.084168594	0	0	0	0.387776239	0.374393162	0	0	0	0	0	0	0	5.267206837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.1135	NO																																																																																		0	0	0	0	0	0	0	0	0	0	1.084168594	0	0	0	0.387776239	0.374393162	0	0	0	0	0	0	0	5.267206837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.1135
H5850_016_0	2011	7																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	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	1897.781687	0	621.5464774	0	686.7880349	0	0	319.59061	578.4922196	0	2017.656191	52.59505291	0.822086984	86.31829583	14144.06813	14259.34567	0	0	0	0	393.0780125	0	0	144.6015143	0	0	0	0	0	0											6700	$125 copay (days 1-10) PBP L.1a	0	"(2) $20 days 1-20, $75 days 21-100"	0	(10a) $100	0	0	(4a) $50	"(9a,9b) $150 @ Hospital; $75 ASC"	0	$100 L.8a Diag; $55 L. 8b Ther. @ Hosp.; $150 (L. 8b. MRI/CT @ Hosp); $20 (L.8a diag @ freest.)	(9a) $150 copay	(12) 20%	"(7c,7i) $50 @ Hospital, (8b) $55 @ Hospital"	0	"(7b,7c,7d,7g,7i) $20"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20% chemo; $50 Part B Rx	0	Not covered	0	0	0	0	0	0	0											0	111.3095066	0	31.43408734	0	100	0	0	50	99.62345225	0	29.9046561	50	0.2	45.90893385	0	8.639026187	0	0	0	0	68.73518047	0	0	0	0	0	0	0	0	0											NO	108.1945874	0	30.55442622	0	97.20156942	0	0	48.60078471	96.8355591	0	29.06779506	48.60078471	0.194403139	44.6242042	0	8.397269037	0	0	0	0	66.81167416	0	0	0	0	0	0	0	0	0												17.1108	0	1.582582999	0	5.563072905	0	0	1.29436287	4.668218127	0	4.88740139	0.213013404	0.15981629	0.320990438	0	9.978296825	0	0	0	0	2.188516674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9671	0	1.38097097	17.1108	0	1.582582999	0	5.563072905	0	0	1.29436287	4.668218127	0	4.88740139	0.213013404	0.15981629	0.320990438	0	9.978296825	0	0	0	0	2.188516674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9671	NO																																																																																		0	0	0	17.1108	0	1.582582999	0	5.563072905	0	0	1.29436287	4.668218127	0	4.88740139	0.213013404	0.15981629	0.320990438	0	9.978296825	0	0	0	0	2.188516674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9671
H5850_017_0	2011	7																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	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	1184.090332	0	591.0474687	0	521.7031305	0	0	282.3619465	496.2877477	0	2060.714581	54.62668417	0	193.9999316	14264.53707	12834.31213	0	0	0	0	429.0503165	0	0	144.6015143	0	0	0	0	0	0											6700	$150 copay (days 1-10) PBP L.1a	0	"(2) $35 days 1-20, $100 days 21-100"	0	(10a) $100	0	0	(4a) $50	"(9a,9b) $175 @ Hospital; $75 ASC"	0	"$150 L.8a Diag; $55 L. 8b. MRI/CT @ Hosp) $25 (L. 8a diag @ freest.), $100 (Therapy) L.8b"	(9a) $175 copay	(12) 20%	"(7c,7i) $50 @ Hospital, (8b) $55 @ Hospital"	0	"(7b,7c,7d,7g,7i) $25"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20% chemo; $50 Part B Rx	0	Not covered	0	0	0	Not covered	Not covered	0	0											0	133.5729945	0	48.44273218	0	100	0	0	50	105.6337086	0	38.39473187	50	0.2	52.02863583	0	11.71211754	0	0	0	0	76.85383493	0	0	0	0	0	0	0	0	0											NO	129.129525	0	46.83122529	0	96.67337738	0	0	48.33668869	102.1196737	0	37.11748403	48.33668869	0	50.29783945	0	11.32249959	0	0	0	0	74.29719787	0	0	0	0	0	0	0	0	0												12.7418	0	2.306623097	0	4.202900301	0	0	1.137370126	4.22339524	0	6.374045045	0.220039419	0	0.813148118	0	12.10970781	0	0	0	0	2.656436355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7854	0	1.609930594	12.7418	0	2.306623097	0	4.202900301	0	0	1.137370126	4.22339524	0	6.374045045	0.220039419	0	0.813148118	0	12.10970781	0	0	0	0	2.656436355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7854	NO	"20% coinsurance, $10k max benefit"	Included in A.1	"20% coinsurance, $10k max benefit"	not covered	not covered	not covered	not covered	"20% coinsurance, $10k max benefit"	"20% coinsurance, $10k max benefit"	Included in H.5	"20% coinsurance, $10k max benefit"	"20% coinsurance, $10k max benefit"	"20% coinsurance, $10k max benefit"	"20% coinsurance, $10k max benefit"	"20% coinsurance, $10k max benefit"	"20% coinsurance, $10k max benefit"	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												1.4919	0	0.151	0	0	0	0	0.0497	0.6661	0	0.3952	0.1208	0	0.0273	1.0592	1.8221	0	0	0	0	0	0	0	0	0	0	0	0	0	0											5.7833	0	0	14.2337	0	2.457640169	0	4.202900301	0	0	1.187074752	4.889506797	0	6.76920963	0.340846061	0	0.840404796	1.059185916	13.93183649	0	0	0	0	2.656436355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5687
H5850_019_0	2011	6																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	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	844.7233662	0	444.5685007	0	404.455452	0	0	201.9023093	442.2324584	0	1443.724692	43.63084606	0	131.4322782	11120.36458	11203.30837	0	0	0	0	219.0130956	0	0	144.6015143	0	0	0	0	0	0											6700	$175 copay (days 1-10) PBP L.1a	0	"(2) $35 days 1-20, $100 days 21-100"	0	(10a) $150	0	0	(4a) $50	"(9a,9b) $200 @ Hospital; $75 ASC"	0	"$200 (L.8a Diag, 8b. MRI/CT @ Hosp); $50 (L. 8a diag @ freest.), $55 (Therapy) L.8b"	(9a) $200 copay	(12) 20%	"(7c,7i) $50 @ Hospital, (8b) $55 @ Hospital"	0	"(7b,7c,7d,7g,7i) $30"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20% chemo; $50 Part B Rx	0	Not covered	0	0	0	Not covered	0	0	0											0	155.8944288	0	48.44273218	0	150	0	0	50	110.6381339	0	74.00106575	50	0.2	54.12162362	0	12.48614637	0	0	0	0	68.40845198	0	0	0	0	0	0	0	0	0											NO	152.3092241	0	47.32866342	0	146.5503532	0	0	48.85011774	108.0937173	0	72.2992155	48.85011774	0	52.87695372	0	12.19899441	0	0	0	0	66.83521867	0	0	0	0	0	0	0	0	0												10.7216	0	1.753402745	0	4.939424113	0	0	0.821912632	3.983545862	0	8.698346889	0.177614331	0	0.579144874	0	11.38909134	0	0	0	0	1.219815678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2839	0	1.042398007	10.7216	0	1.753402745	0	4.939424113	0	0	0.821912632	3.983545862	0	8.698346889	0.177614331	0	0.579144874	0	11.38909134	0	0	0	0	1.219815678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2839	NO																																																																																		0	0	0	10.7216	0	1.753402745	0	4.939424113	0	0	0.821912632	3.983545862	0	8.698346889	0.177614331	0	0.579144874	0	11.38909134	0	0	0	0	1.219815678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2839
H5850_020_0	2011	7																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	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	1070.559966	0	502.7142191	0	561.6461076	0	0	275.4331377	552.1960573	0	2251.206871	64.51355568	0	113.9223795	16930.87984	13608.49451	0	0	0	0	377.4168669	0	0	0	0	0	0	0	0	0											3400	$50 copay (days 1-5) PBP L.1a	0	(2) $25 days 21-100	0	(10a) $50	0	0	(4a) $50	"(9a,9b) $50 @ Hospital; $25 ASC"	0	"$25 (L.8a Diag); $10 (L. 8a diag @ freest.), $50 (L.8b CT/MRI @ Hosp, L.8b Therapy)"	(9a) $50 copay	(12) 20%	"(7c,7i) $25 @ Hospital, (8b) $50 @ Hospital"	0	0	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20% chemo; $50 Part B Rx	0	Not covered	Not covered	0	0	0	0	0	0											0	35.10597471	0	5.253536527	0	50	0	0	50	31.57243147	0	3.727093291	50	0.2	39.54288544	0	0	0	0	0	0	88.41664668	0	0	0	0	0	0	0	0	0											NO	34.94714757	0	5.229768373	0	49.77378901	0	0	49.77378901	31.42959085	0	3.710231101	49.77378901	0	39.36398473	0	0	0	0	0	0	88.01663033	0	0	0	0	0	0	0	0	0												3.1178	0	0.21908991	0	2.329604571	0	0	1.142445907	1.446274679	0	0.696041479	0.267590342	0	0.373703234	0	0	0	0	0	0	2.768246738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.3607	0	0.056176899	3.1178	0	0.21908991	0	2.329604571	0	0	1.142445907	1.446274679	0	0.696041479	0.267590342	0	0.373703234	0	0	0	0	0	0	2.768246738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.3607	NO																																																																																		0	0	0	3.1178	0	0.21908991	0	2.329604571	0	0	1.142445907	1.446274679	0	0.696041479	0.267590342	0	0.373703234	0	0	0	0	0	0	2.768246738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.3607
H5850_021_0	2011	5																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	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	1501.673323	0	840.2446055	0	1671.749994	0	0	549.1801976	303.4756929	0	1636.474447	94.87488452	0.52728137	84.79434795	15153.43607	13448.94366	0	0	0	0	751.8988977	0	0	2100.591872	0	0	0	0	0	0											6700	0	0	0	0	0	0	0	0	0	0	0	0	(12) 20%	0	0	0	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0.2	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	0.2	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	0.105456274	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	4.2378	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.105456274	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	4.2378	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.105456274	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	4.2378
H5850_022_0	2011	6																															D	D	D	V	T	P	P	V	V	P	V	V	Coin	V	V	V	V	V	V	V	S	O	V	P	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	848.3487005	0	560.2934483	0	406.7418691	0	0	225.8702392	253.8185944	0	1329.820275	66.79714026	0.027829548	22.17279151	13258.07705	10141.93143	0	0	0	0	483.870561	0	0	144.6015143	0	0	0	0	0	0											6700	$175 copay (days 1-10) PBP L.1a	0	"(2) $35 days 1-20, $100 days 21-100"	0	(10a) $100	0	0	(4a) $50	"(9a,9b) $150 @ Hospital; $50 ASC"	0	"$150 (L.8a Diag, 8b. MRI/CT @ Hosp); $25 (L. 8a diag @ freest.), $55 (Therapy) L.8b"	(9a) $150 copay	(12) 20%	"(7c,7i) $50 @ Hospital, (8b) $55 @ Hospital"	0	"(7b,7c,7d,7g,7i) $20"	$0 	Included in i.2.	Included in i.2.	Included in i.2.	(15) 20% chemo; $50 Part B Rx	0	Not covered	0	0	0	Not covered	Not covered	0	0											0	155.8242686	0	48.44273218	0	100	0	0	50	83.18661878	0	27.91582375	50	0.2	26.18078785	0	11.33428263	0	0	0	0	158.0398185	0	0	0	0	0	0	0	0	0											NO	153.380679	0	47.68306775	0	98.43182992	0	0	49.21591496	81.88211111	0	27.47805615	49.21591496	0.19686366	25.77022857	0	11.1565418	0	0	0	0	155.5614853	0	0	0	0	0	0	0	0	0												10.8434	0	2.226375871	0	3.336362207	0	0	0.92636754	1.731933529	0	3.045073017	0.273956865	0.005478627	0.047616492	0	9.429073488	0	0	0	0	6.272635264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1382	0	0.607600543	10.8434	0	2.226375871	0	3.336362207	0	0	0.92636754	1.731933529	0	3.045073017	0.273956865	0.005478627	0.047616492	0	9.429073488	0	0	0	0	6.272635264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1382	NO																																																																																		0	0	0	10.8434	0	2.226375871	0	3.336362207	0	0	0.92636754	1.731933529	0	3.045073017	0.273956865	0.005478627	0.047616492	0	9.429073488	0	0	0	0	6.272635264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1382
H5850_802_0	2011	2																															Coin	Coin	Coin	Coin	Coin	Coin	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	252.2614318	0	24.22153091	5.2	11.50682335	8.415110721	0	17.52723274	55.76704228	0	0	0	0	52.63047057	0	0	0	0	0	385.0897854	40.90685109	0	0	0	0	0	0	0	0	0											6700	FFS	included in a.1	FFS	FFS	FFS	FFS	included in e.1.	FFS	FFS	included in h.5	included in h.5	included in h.5	included in h.5	FFS	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	FFS	FFS	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered											0	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	0	0	0	0	0	0	0	0	0	0	NO	0.061078309	0	0.12478614	0	0.181898003	0.181898003	0	0.181898003	0.181898003	0	0	0	0	0.181898003	0	0	0	0	0	0.181898003	0.181898003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		15.4077	0	3.022511337	0	2.093068182	1.530691831	0	3.188168626	10.1439136	0	0	0	0	9.57337747	0	0	0	0	0	70.04706277	7.440874504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4474	0	34.40007642	15.4077	0	3.022511337	0	2.093068182	1.530691831	0	3.188168626	10.1439136	0	0	0	0	9.57337747	0	0	0	0	0	70.04706277	7.440874504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4474	NO																																																																																		0	0	0	15.4077	0	3.022511337	0	2.093068182	1.530691831	0	3.188168626	10.1439136	0	0	0	0	9.57337747	0	0	0	0	0	70.04706277	7.440874504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4474
H5850_803_0	2011	2																															Coin	Coin	Coin	Coin	Coin	Coin	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	252.2614318	0	24.22153091	5.2	11.50682335	8.415110721	0	17.52723274	55.76704228	0	0	0	0	52.63047057	0	0	0	0	0	385.0897854	40.90685109	0	0	0	0	0	0	0	0	0											6700	FFS	included in a.1	FFS	FFS	FFS	FFS	included in e.1.	FFS	FFS	included in h.5	included in h.5	included in h.5	included in h.5	FFS	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	FFS	FFS	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered											0	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	0	0	0	0	0	0	0	0	0	0	NO	0.061078309	0	0.12478614	0	0.181898003	0.181898003	0	0.181898003	0.181898003	0	0	0	0	0.181898003	0	0	0	0	0	0.181898003	0.181898003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		15.4077	0	3.022511337	0	2.093068182	1.530691831	0	3.188168626	10.1439136	0	0	0	0	9.57337747	0	0	0	0	0	70.04706277	7.440874504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4474	0	34.40007642	15.4077	0	3.022511337	0	2.093068182	1.530691831	0	3.188168626	10.1439136	0	0	0	0	9.57337747	0	0	0	0	0	70.04706277	7.440874504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4474	NO																																																																																		0	0	0	15.4077	0	3.022511337	0	2.093068182	1.530691831	0	3.188168626	10.1439136	0	0	0	0	9.57337747	0	0	0	0	0	70.04706277	7.440874504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4474
H5850_805_0	2011	2																															Coin	Coin	Coin	Coin	Coin	Coin	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	252.2614318	0	24.22153091	5.2	11.50682335	8.415110721	0	17.52723274	55.76704228	0	0	0	0	52.63047057	0	0	0	0	0	385.0897854	40.90685109	0	0	0	0	0	0	0	0	0											6700	FFS	included in a.1	FFS	FFS	FFS	FFS	included in e.1.	FFS	FFS	included in h.5	included in h.5	included in h.5	included in h.5	FFS	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	FFS	FFS	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered											0	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	0	0	0	0	0	0	0	0	0	0	NO	0.061078309	0	0.12478614	0	0.181898003	0.181898003	0	0.181898003	0.181898003	0	0	0	0	0.181898003	0	0	0	0	0	0.181898003	0.181898003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		15.4077	0	3.022511337	0	2.093068182	1.530691831	0	3.188168626	10.1439136	0	0	0	0	9.57337747	0	0	0	0	0	70.04706277	7.440874504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4474	0	34.40007642	15.4077	0	3.022511337	0	2.093068182	1.530691831	0	3.188168626	10.1439136	0	0	0	0	9.57337747	0	0	0	0	0	70.04706277	7.440874504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4474	NO																																																																																		0	0	0	15.4077	0	3.022511337	0	2.093068182	1.530691831	0	3.188168626	10.1439136	0	0	0	0	9.57337747	0	0	0	0	0	70.04706277	7.440874504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4474
H5852_001_0	2011	4																															D	D	D	Coin	T	Coin	Coin	V	V	P	P	V	P	O	V	V	V	V	P	P	O	O	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	0	0	0	0	0	0	0	0	0	0	YES	3115.426715	270.055354	1052.648217	90.22569578	3157.790986	30.76159337	3.000966108	712.4831478	222.9375359	19879.88228	333.4835781	581.0558465	0	30143.71598	29868.864	23030.75156	1831.059324	22.63190588	5225.592824	0	240204.6155	361.0109005	57.41208616	14458.26321	108.7360946	14.69406684	41.25385	17.18910417	7258.526395	0	0	0	0	0	0	0	0	0	0	0	0	1a1:$0	1b1:$0	"21:$0,22:$0"	6:$0	10a:$0	"11a:$0,17b1:$0"	"11b:$0,11c:$0"	"4a1:$0,4b:$0"	"9a1:$0,9b:$0"	"8a1:$0,8a2:$0"	"8b1:$0,8b2:$0,8b3:$0,8b4:$0,8b5:$0,8b6:$0"	"5:$0,9a2:$0"	12:$0	"3:$0,9a3:$0,9c:$0,9d1:$0,9d2:$0"	"7a:$0,14b1:$0,14c1:$0,14c2:$0,14d1:$0,14e1:$0,14f1:$0,14g1:$0,14h1:$0,14i:$0,14j:$0"	"7b1:$0,7d1:$0,7d3:$0,7f1:$0,7g:$0,16b1:$0,17a1:$0,18a1:$0"	"7e:$0,7h:$0"	"7c:$0,7i:$0"	7d2:$0	$0 	"151:$0,152:$0,153:$0"	"13a1:$0,14a:$0"	10b:$0	"16a1:$0,16a2:$0,16a3:$0,16a4:$0,16b2:$0"	17a2:$0	17b2:$0 $100 allowance	18a2:$0	18b:$0 $400 allowance	"14a3:$0,14a4:$0"	VT:$0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	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	0	0	0
H5854_002_0	2011	7	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	976.4863543	76.61027523	609.9356528	1959.455116	200.3653352	5.83309827	1.368274555	330.15203	419.0424349	10001.23466	310.79534	15.93822257	0	182.6254669	5051.290647	4346.399892	389.544891	856.4870427	1146.247036	2551.551018	22.91046349	0	0	2131.35968	378	179.4	162	14.7	9091.307957	0	14.87702679	3.583684288	0	0	0	0	0	0	0	0	3300	1A: $190/day (days1-6) no yrly max	1B: $190/day (days1-6) no yrly max	2: $60/day (for days 1-100)	6: $0 copay	10A: $175 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $30 copay	9A: $30-$275 copay; 9B: $275 copay	8A: $0 copay	8B: $90 copay	9A: $30 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $10 copay; 7G: $10 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $30 copay; 7F: $30 copay; 7G: $30 copay	7E: $40 copay; 7H: $40 copay	7C: $30-$50 copay; 7I: $30-$50 copay	8B: $30 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $0	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $0 copay	17B: $0 copay	18A: $0 copay	-	14A: $0 copay;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										190	190	60	0	175	0.2	0.2	48.85947047	243.9381933	0	90	30	0.1	13.38181818	7.9929087	28.16924209	40	32.83793876	30	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	121.057774	97.28328623	55.46854039	0	161.7832428	0.184895135	0.184895135	45.16939185	225.5149255	0	83.20281059	27.7342702	0	12.37116537	7.389249651	26.04177904	36.97902693	30.35787554	27.7342702	0	0.184895135	0	0	0	0	0	0	0	0	0	0.184895135	0.184895135	0	0	0	0	0	0	0	0		9.8509	0.621074944	2.819353366	0	2.701312807	1.07851149	0.252987308	1.242730535	7.875026959	0	2.154920484	0.036836248	0	0.188274154	3.110437304	9.432332136	1.200415918	2.166760587	2.64919375	0	4.236033231	0	0	0	0	0	0	0	0	0	2.750689872	0.662605789	0	0	0	0	0	0	0	0	55.0304		4.495668973	9.8509	0.621074944	2.819353366	0	2.701312807	1.07851149	0.252987308	1.242730535	7.875026959	0	2.154920484	0.036836248	0	0.188274154	3.110437304	9.432332136	1.200415918	2.166760587	2.64919375	0	4.236033231	0	0	0	0	0	0	0	0	0	2.750689872	0.662605789	0	0	0	0	0	0	0	0	55.0304	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	9.8509	0.621074944	2.819353366	0	2.701312807	1.07851149	0.252987308	1.242730535	7.875026959	0	2.154920484	0.036836248	0	0.188274154	3.110437304	9.432332136	1.200415918	2.166760587	2.64919375	0	4.236033231	0	0	0	0	0	0	0	0	0	2.750689872	0.662605789	0	0	0	0	0	0	0	0	55.0304
H5854_004_0	2011	4	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	778.436884	52.88897302	472.7129716	1651.546165	181.8843335	4.70740602	1.013426947	337.9164962	355.9743073	8951.155988	259.1399134	11.92010566	0	212.2409928	4431.868586	3869.3551	429.9055161	637.4259029	964.4608697	2237.936361	17.94967208	0	0	2131.35968	378	179.4	162	14.7	9089.974163	0	11.14495046	2.528080369	0	0	0	0	0	0	0	0	6000	1A: $250/day (days1-7) no yrly max	1B: $250/day (days1-7) no yrly max	2: $50/day (for days 1-100)	6: $0 copay	10A: $175 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $35 copay	9A: $35-$300 copay; 9B: $300 copay	8A: $0 copay	8B: $105 copay	9A: $35 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $25 copay; 7G: $25 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35-$50 copay; 7I: $35-$50 copay	8B: $35 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $0	15: 20% coinsurance	13A: $0 copay	10B: Not covered	"16A: $0 Copay, 16B: $0 Copay"	17A: $0 copay	17B: $0 copay	18A: $0 copay	-	14A: $0 copay;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										250	250	50	0	175	0.2	0.2	49.33341878	269.6695103	0	105	35	0.1	14.17381043	19.92141434	32.7074968	40	37.28975095	35	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	200.7991186	112.6479256	48.94422932	0	171.3048026	0.195776917	0.195776917	48.29172323	263.975327	0	102.7828816	34.26096052	0	13.87452456	19.50076543	32.01686448	39.15538346	36.50236243	34.26096052	0	0.195776917	0	0	0	0	0	0	0	0	0	0.195776917	0.195776917	0	0	0	0	0	0	0	0		13.0258	0.496486092	1.928047674	0	2.596471655	0.921601439	0.198405604	1.359880826	7.830702847	0	2.219595586	0.034032856	0	0.245395239	7.202069143	10.32371815	1.402759611	1.938962611	2.753612982	0	3.514131465	0	0	0	0	0	0	0	0	0	2.181924044	0.494939781	0	0	0	0	0	0	0	0	60.6685		1.30867418	13.0258	0.496486092	1.928047674	0	2.596471655	0.921601439	0.198405604	1.359880826	7.830702847	0	2.219595586	0.034032856	0	0.245395239	7.202069143	10.32371815	1.402759611	1.938962611	2.753612982	0	3.514131465	0	0	0	0	0	0	0	0	0	2.181924044	0.494939781	0	0	0	0	0	0	0	0	60.6685	NO																								-	-	-	-	-														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	13.0258	0.496486092	1.928047674	0	2.596471655	0.921601439	0.198405604	1.359880826	7.830702847	0	2.219595586	0.034032856	0	0.245395239	7.202069143	10.32371815	1.402759611	1.938962611	2.753612982	0	3.514131465	0	0	0	0	0	0	0	0	0	2.181924044	0.494939781	0	0	0	0	0	0	0	0	60.6685
H5854_005_0	2011	7	H.6	I.7									OP Facility - Other	Professional									Radiology	Radiology									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		Coin	Coin									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	908.3102215	70.10633198	585.8448041	1986.823219	192.5303691	4.448961563	1.108067235	320.8770629	382.8546913	9384.574184	306.0496002	18.13620737	0	263.5240551	4838.691317	4156.023914	522.8001803	685.4230127	1082.264054	2538.646539	23.34542971	0	0	0	378	179.4	0	0	9089.19484	0	14.73843154	3.269678317	0	0	0	0	0	0	0	0	6000	1A: $250/day (days1-7) no yrly max	1B: $250/day (days1-7) no yrly max	2: $50/day (for days 1-100)	6: $0 copay	10A: $225 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $35 copay	9A: $35-$300 copay; 9B: $300 copay	8A: $0 copay	8B: $105 copay	9A: $35 copay	12: 10% coin	3: $0 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $25 copay; 7G: $25 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35-$50 copay; 7I: $35-$50 copay	8B: $35 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 17A: $0; 17B: $0; 18A: $35	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	17A: $0 copay	17B: $0 copay	18A: Not Covered	-	14A: $0 copay;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance										250	250	50	0	225	0.2	0.2	48.90440747	265.8107463	0	105	35	0.1	22.71704099	19.75042924	32.55748816	40	37.20613646	45	0.256034562	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	186.7405683	176.8771388	48.50027191	0	218.2512236	0.194001088	0.194001088	47.4375412	257.8378695	0	101.850571	33.95019034	0	22.0356533	19.15802377	31.58094057	38.80021753	36.0901547	43.65024472	0.248354917	0.194001088	0	0	0	0	0	0	0	0	0	0.194001088	0.194001088	0	0	0	0	0	0	0	0		14.1349	1.033350618	2.367802691	0	3.50166572	0.863103382	0.214966249	1.268468241	8.226203162	0	2.597610545	0.051310641	0	0.483910393	7.724980273	10.93759535	1.690396727	2.061418547	3.936757567	0.052540446	4.529038756	0	0	0	0	0	0	0	0	0	2.859271748	0.63432115	0	0	0	0	0	0	0	0	69.1696		2.138865453	14.1349	1.033350618	2.367802691	0	3.50166572	0.863103382	0.214966249	1.268468241	8.226203162	0	2.597610545	0.051310641	0	0.483910393	7.724980273	10.93759535	1.690396727	2.061418547	3.936757567	0.052540446	4.529038756	0	0	0	0	0	0	0	0	0	2.859271748	0.63432115	0	0	0	0	0	0	0	0	69.1696	NO																								-	-	-	18A: 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	0	0	0	0	0	0	0	0		0	14.1349	1.033350618	2.367802691	0	3.50166572	0.863103382	0.214966249	1.268468241	8.226203162	0	2.597610545	0.051310641	0	0.483910393	7.724980273	10.93759535	1.690396727	2.061418547	3.936757567	0.052540446	4.529038756	0	0	0	0	0	0	0	0	0	2.859271748	0.63432115	0	0	0	0	0	0	0	0	69.1696
H5854_801_0	2011	4																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	356.407385	4.10384658	115.3007933	51.84977315	9.129728328	14.75761648	3.725045337	12.77224483	48.98197357	8.984882222	25.53849924	0	0.031685564	22.44605362	53.85381525	136.7024962	1.466497177	5.801591539	23.08398433	26.19335586	12.16888697	1.245422878	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.054819166	0.054819166	0.129277142	0	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0	0	0	0	0	0	0	0												19.538	0.224969446	14.90575697	0	1.709618782	2.763488397	0.697546218	2.391710779	9.172288482	1.682495124	4.7822998	0	0.00593339	4.203213224	10.08458201	25.59869765	0.274613989	1.086397043	4.322671141	4.904927237	2.278726921	0.233215958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.8611	0	27.08	19.538	0.224969446	14.90575697	0	1.709618782	2.763488397	0.697546218	2.391710779	9.172288482	1.682495124	4.7822998	0	0.00593339	4.203213224	10.08458201	25.59869765	0.274613989	1.086397043	4.322671141	4.904927237	2.278726921	0.233215958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.8611	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.538	0.224969446	14.90575697	0	1.709618782	2.763488397	0.697546218	2.391710779	9.172288482	1.682495124	4.7822998	0	0.00593339	4.203213224	10.08458201	25.59869765	0.274613989	1.086397043	4.322671141	4.904927237	2.278726921	0.233215958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.8611
H5854_803_0	2011	4																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	356.407385	4.10384658	115.3007933	51.84977315	9.129728328	14.75761648	3.725045337	12.77224483	48.98197357	8.984882222	25.53849924	0	0.031685564	22.44605362	53.85381525	136.7024962	1.466497177	5.801591539	23.08398433	26.19335586	12.16888697	1.245422878	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.054819166	0.054819166	0.129277142	0	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0	0	0	0	0	0	0	0												19.538	0.224969446	14.90575697	0	1.709618782	2.763488397	0.697546218	2.391710779	9.172288482	1.682495124	4.7822998	0	0.00593339	4.203213224	10.08458201	25.59869765	0.274613989	1.086397043	4.322671141	4.904927237	2.278726921	0.233215958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.8611	0	27.08	19.538	0.224969446	14.90575697	0	1.709618782	2.763488397	0.697546218	2.391710779	9.172288482	1.682495124	4.7822998	0	0.00593339	4.203213224	10.08458201	25.59869765	0.274613989	1.086397043	4.322671141	4.904927237	2.278726921	0.233215958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.8611	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.538	0.224969446	14.90575697	0	1.709618782	2.763488397	0.697546218	2.391710779	9.172288482	1.682495124	4.7822998	0	0.00593339	4.203213224	10.08458201	25.59869765	0.274613989	1.086397043	4.322671141	4.904927237	2.278726921	0.233215958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.8611
H5854_805_0	2011	4																															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	V	V	V	O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	356.407385	4.10384658	115.3007933	51.84977315	9.129728328	14.75761648	3.725045337	12.77224483	48.98197357	8.984882222	25.53849924	0	0.031685564	22.44605362	53.85381525	136.7024962	1.466497177	5.801591539	23.08398433	26.19335586	12.16888697	1.245422878	0	0	0	0	0	0	0	0											6700	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	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	0.054819166	0.054819166	0.129277142	0	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0.187258451	0	0	0	0	0	0	0	0												19.538	0.224969446	14.90575697	0	1.709618782	2.763488397	0.697546218	2.391710779	9.172288482	1.682495124	4.7822998	0	0.00593339	4.203213224	10.08458201	25.59869765	0.274613989	1.086397043	4.322671141	4.904927237	2.278726921	0.233215958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.8611	0	27.08	19.538	0.224969446	14.90575697	0	1.709618782	2.763488397	0.697546218	2.391710779	9.172288482	1.682495124	4.7822998	0	0.00593339	4.203213224	10.08458201	25.59869765	0.274613989	1.086397043	4.322671141	4.904927237	2.278726921	0.233215958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.8611	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.538	0.224969446	14.90575697	0	1.709618782	2.763488397	0.697546218	2.391710779	9.172288482	1.682495124	4.7822998	0	0.00593339	4.203213224	10.08458201	25.59869765	0.274613989	1.086397043	4.322671141	4.904927237	2.278726921	0.233215958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.8611
H5859_001_0	2011	7																															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	Coin	Coin	Coin	Coin	Coin											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	316.2715992	49.40738102	38.8129138	36.06009893	31.14850654	41.97535543	7.942244802	82.07815095	48.74006835	16.87168154	36.42999338	3.450527974	0.027550869	22.5028626	35.41950384	63.36311211	4.910481585	0.934881542	17.85483958	48.07243256	16.13323596	0	0	0	97.6	2.72	0	0	1.403154811	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.  Preventive services in 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, and 14j will have no member cost-sharing."	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	$0 	$0 	17a2: $5	$0 	$0 	$0 	$0 	$0 												0.084225548	0.084225548	0.131435334	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.212252188	0.230689856	0.233	0.233	0.233	0.233	0.233	0	0	0	5	0	0	0	0	0											NO	0.084225548	0.084225548	0.131435334	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.212252188	0.230689856	0.233	0.233	0.233	0.233	0.233	0	0	0	5	0	0	0	0	0												26.6381	4.161363722	5.101388286	0	7.257602023	9.780257815	1.850543039	19.12420917	11.35643592	3.931101799	8.488188458	0.803973018	0.006419352	5.243166986	7.517867191	14.61722718	1.144142209	0.217827399	4.160177622	11.20087679	3.759043978	0	0	0	0.040666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.4006		0	26.6381	4.161363722	5.101388286	0	7.257602023	9.780257815	1.850543039	19.12420917	11.35643592	3.931101799	8.488188458	0.803973018	0.006419352	5.243166986	7.517867191	14.61722718	1.144142209	0.217827399	4.160177622	11.20087679	3.759043978	0	0	0	0.040666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.4006	YES	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	"Medicare FFS.  Preventive services in 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, and 14j will have no member cost-sharing."	Medicare FFS	No OON coverage	No OON coverage	No OON coverage	Medicare FFS	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage	No OON coverage											6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.4124	0.8018	0	0	0	0.6144	0	0	0	0	0	0	0	0	0	0											1.8287		0	26.6381	4.161363722	5.101388286	0	7.257602023	9.780257815	1.850543039	19.12420917	11.35643592	3.931101799	8.488188458	0.803973018	0.006419352	5.243166986	7.930269094	15.41907326	1.144142209	0.217827399	4.160177622	11.81531473	3.759043978	0	0	0	0.040666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.2293
H5859_003_0	2011	8																															D	D	D	Coin	T	Coin	Coin	V	V	P	Coin	V	P	O	V	V	V	V	P	P	O	O	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	1028.242353	130.8342721	1022.702584	14.72257417	181.6806955	16.13835909	6.369765835	738.5386282	211.1121349	11184.66164	12.52563451	118.4580051	0	13466.60994	5400.469418	4417.384156	489.1983886	1063.487283	4764.944046	14671.23196	40810.9941	0	0	0	464.3000317	447.3362985	0	0	142.9752476	0												$250 Copay Days 1-5	$250 Copay Days 1-5	$100 Copay Days 21-100	$0 	10a: $150	11a: 20.0%	11b: 20.0%; 11c: 0%	"4a1: $50,4b: $30; 7a urgent care component: $30 copay"	"9a1: 20.0%,9b: 20.0%"	8a2: 20.0%	8b: 20.0%	"5: 20.0%,9a2: 20.0%"	12: 20.0%	"3: 20.0%,9a3: 20.0%,9c: 20.0% ;9d: 0%"	"7a: $15 copay. 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j: $0 copay"	"7b1: 20.0%,7d1: $30,7f1: $30,7f2: $30,7g: $30,17a1: $20,18a1: $20"	"7e: $30,7h: $30"	"7c: $30,7i: $30"	7d2: $30	$0 	15: 20%	$0 	$0 	16b1: 20.0%	17a2: $20	$0 	$0 	$0 	$0 	$0 												162.11	105.7362286	28.63	0	150	0.2	0.086865836	45.42503598	337.6828456	0	0.2	31.20381154	0	6.4749261	12.69030247	29.71509979	30	30	30	0	1.62118997	0	0	0	20	0	0	0	0	0											NO	158.9564126	103.6793016	28.07304973	0	147.081993	0.196109324	0.085176002	44.5413655	331.1137729	0	0.196109324	30.59679194	0	6.348966903	12.4434332	29.14288427	29.4163986	29.4163986	29.4163986	0	1.589652345	0	0	0	20	0	0	0	0	0												13.6205	1.130400496	2.392531708	0	2.226829899	3.164882692	0.542551188	2.741293248	5.825177958	0	2.456393717	0.302036245	0	7.124921731	5.600031703	10.72794294	1.199204566	2.606997153	11.68062445	0	5.406274375	0	0	0	0.773833386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.5224		1.560124429	13.6205	1.130400496	2.392531708	0	2.226829899	3.164882692	0.542551188	2.741293248	5.825177958	0	2.456393717	0.302036245	0	7.124921731	5.600031703	10.72794294	1.199204566	2.606997153	11.68062445	0	5.406274375	0	0	0	0.773833386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.5224	YES	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage	"7a: $15 copay. 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j: $0 copay"	"7b1: 20.0%,7d1: $30,7f1: $30,7f2: $30,7g: $30,17a1: $20,18a1: $20"	No OON Coverage	No OON Coverage	No OON Coverage	$0 	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage	No OON Coverage											6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.3197	0.5497	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.8693		0.017054851	13.6205	1.130400496	2.392531708	0	2.226829899	3.164882692	0.542551188	2.741293248	5.825177958	0	2.456393717	0.302036245	0	7.124921731	5.919695246	11.27759643	1.199204566	2.606997153	11.68062445	0	5.406274375	0	0	0	0.773833386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.3917
H5862_001_0	2011	5																															D	D	D		T	Coin	Coin	V	Coin	Coin	Coin		Coin	V	V	V	V	V	P		Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	585.4291167	20.88714057	225.3775617	0	137.9861491	9.007078237	3.321869624	235.7995205	38.53712563	8.690215913	17.27304605	0	0.181592863	1940.200577	1852.850972	6510.29184	75.76761435	265.3053877	1185.168204	0	12.96892502	0	0	0	0	0	0	0	0	0											3000	$150/Days 1-10 for IP Med/Surg; PBP 1a	$150/Days 1-10 for IP MH/SA; PBP 1b	$100/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; 20% Coinsurance for DMS; PBP 11b, 11c"	"$50/Visit for OP ER; $250/Visit for OP ER; $30/Days Custom for Urgent Care; PBP 4a, 4b"	"20% Coinsurance for OP Surg; 20% Coinsurance for ASC services; PBP 9a, 9b"	20% Coinsurance for OP Lab; PBP 8a	20% Coinsurance for OP Rad - General; 20% Coinsurance for OP Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing; PBP 9a	20% Coinsurance for Renal Dialysis; PBP 12	"20% Coinsurance for CORF; $30/Day for Partial Hosp; $30/Case for OP - PT/OT/ST; 20% Coinsurance for OP - Other; $30/Visit for OP Substance Abuse; $30/Visit for Cardiac Rehab; PBP 3, 5,7c, 7i,  9c, 9d, 13a"	"$30/Visit for PCP OV; PBP 4b, 7a, 14b-j"	"$20/Visit for Chiro - cvd; $30/Visit for SCP OV; $30/Visit for SCP - Office Surg; $30/Visit for Podiatry; $30/Exam for Vision Exams; $30/Visit for Hearing Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$30/Visit for MH - Non Phys; $30/Visit for Psych Services ; PBP 7e, 7h"	"$30/Visit for OP PT/OT/ST; $30/Visit for PT/ST; PBP 7c, 7i"	$30/Procedure for Phys Rad - General; 20% Coinsurance for Phys Rad - PET/CAT/MRI; PBP 8b	No Cost Sharing;	20% Coinsurance for Medicare Part B Drugs; PBP 15	20% Coinsurance for Blood;	PBP 10b	"$30/Procedure for Comprehensive Dental; PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b											0	150	150	100	0	150	0.2	0.2	50.43327037	0.2	0.2	0.2	0	0.2	30.07629396	30	29.63312696	30	30	21.98251117	0	0.2	0	0	0	0	0	0	0	0	0											NO	137.0028314	137.0028314	91.33522091	0	137.0028314	0.182670442	0.182670442	46.06333891	0.182670442	0.182670442	0.182670442	0	0.182670442	27.47024953	27.46053022	27.06548197	27.40056627	27.40056627	20.07777514	0	0.182670442	0	0	0	0	0	0	0	0	0												6.6838	0.23846645	1.715409115	0	1.575374426	1.645326961	0.606807392	0.905142769	7.039593766	1.58744558	3.155274954	0	0.033171649	4.441482833	4.24002251	14.6836822	0.173006295	0.605793155	1.982961726	0	2.369039264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6818	0	5.082540592	6.6838	0.23846645	1.715409115	0	1.575374426	1.645326961	0.606807392	0.905142769	7.039593766	1.58744558	3.155274954	0	0.033171649	4.441482833	4.24002251	14.6836822	0.173006295	0.605793155	1.982961726	0	2.369039264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6818	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.6838	0.23846645	1.715409115	0	1.575374426	1.645326961	0.606807392	0.905142769	7.039593766	1.58744558	3.155274954	0	0.033171649	4.441482833	4.24002251	14.6836822	0.173006295	0.605793155	1.982961726	0	2.369039264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6818
H5868_001_0	2011	6	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							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		V	Coin	Coin							O	O	O	V	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	YES	780.928628	48.495663	341.346776	238.377827	21.483708	8.369317	2.495267	232.821232	287.005409	1263.322849	176.724486	52.118292	0.627042	652.052491	3377.352272	2976.603178	124.955086	241.669903		1823.65871	14.147747	0							5.25	0.48	610.555804	449.832967	0	433.623957							3400	$200/Day(Days 1-7):1a.IP Acute	$200/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								143.724	123.0478	46.371	0	100	0.2	0.2	50	150	16.776813	30	50	0.2	47.166681	10	27.542358	30	50		0	0.2	0							0	0	0	35.594678	0	30							NO	132.911069	113.790422	37.298885	0	91.5132	0.183026	0.183026	45.7566	137.2698	15.352999	27.45396	45.7566	0.183026	43.163739	9.15132	25.204893	27.45396	45.7566		0	0.183026	0							0	0	0	32.573829	0	27.45396								8.6495	0.45986183	1.060987845	0	0.163836906	1.531802613	0.456698738	0.887758999	3.283097924	1.616316203	0.404315581	0.198729653	0.114764989	2.345418628	2.575602616	6.252080384	0.285875994	0.921499424	0	0	2.589405542	0	0	0	0	0	0	0	0	0	0	1.221065179	0	0.992057898	0	0	0	0	0	0	36.0107	0	3.395545657	8.6495	0.45986183	1.060987845	0	0.163836906	1.531802613	0.456698738	0.887758999	3.283097924	1.616316203	0.404315581	0.198729653	0.114764989	2.345418628	2.575602616	6.252080384	0.285875994	0.921499424	0	0	2.589405542	0	0	0	0	0	0	0	0	0	0	1.221065179	0	0.992057898	0	0	0	0	0	0	36.0107	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		$35/Visit	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$0/Proc	$35/Visit							5100	4.7418	0.0601	0.2654	1.2236	0.5444	1.2586	0.3752	0.1102	1.639	0.2081	0.0692	0.0732	0.0145	0.3086	1.3216	1.1648	0.0489	0.0733		0.7136	0.5301	0							0	0	0.145	0.4149	0	0.1697							15.4738	0	6.510056439	13.3913	0.52000645	1.326372832	1.223556044	0.708272002	2.790378343	0.831936279	0.997962039	4.922098553	1.824378215	0.473469055	0.271955702	0.129304372	2.653996882	3.897183158	7.416845125	0.334771757	0.994777701	0	0.713609855	3.119517339	0	0	0	0	0	0	0	0	0	0.145048062	1.635978119	0	1.161737854	0	0	0	0	0	0	51.4845
H5868_004_0	2011	4	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							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		V	Coin	Coin							O	O	O	V	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	YES	1063.442261	34.673606	378.014216	465.232907	34.005617	4.5697	1.532618	283.74736	276.870074	850.641016	121.625007	56.413845	0.025084	542.86807	2264.109192	2508.967015	29.357183	164.14631		933.578033	9.291997	0							1.42	0.48	521.591547	578.471458	0.41098	326.747676							3400	$200/Day(Days 1-7):1a.IP Acute	$200/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								143.724	123.0478	46.371	0	100	0.2	0.2	50	150	34.094012	30	50	0.2	48.041608	10	28.303497	30	50		0	0.2	0							0	0	0	42.120406	0	30							NO	132.178651	113.16337	35.823406	0	91.7089	0.183418	0.183418	45.85445	137.56335	31.267243	27.51267	45.85445	0.183418	44.05843	9.17089	25.956826	27.51267	45.85445		0	0.183418	0							0	0	0	38.628161	0	27.51267								11.7137	0.326981842	1.128479728	0	0.259884811	0.838165235	0.281109728	1.084256594	3.173931241	2.216433279	0.27885239	0.21556882	0.004600857	1.993159572	1.730324696	5.427068354	0.067307874	0.627236564	0	0	1.704319506	0	0	0	0	0	0	0	0	0	0	1.862107384	0	0.749141749	0	0	0	0	0	0	35.6826	0	3.419341802	11.7137	0.326981842	1.128479728	0	0.259884811	0.838165235	0.281109728	1.084256594	3.173931241	2.216433279	0.27885239	0.21556882	0.004600857	1.993159572	1.730324696	5.427068354	0.067307874	0.627236564	0	0	1.704319506	0	0	0	0	0	0	0	0	0	0	1.862107384	0	0.749141749	0	0	0	0	0	0	35.6826	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		$35/Visit	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$0/Proc	$35/Visit							5100	5.3055	0.0534	0.2716	2.1344	1.251	0.9976	0.3346	0.195	2.2502	0.2556	0.0691	0.1757	0.0008	0.5259	1.2862	1.4253	0.0167	0.0667		0.5303	0.557	0							0	0	0.1493	0.69	0	0.1856							18.7275	500	7.217625911	17.0191	0.380358672	1.400109207	2.134395633	1.510916293	1.835768002	0.615692614	1.279233657	5.424172387	2.47201587	0.347943292	0.391292901	0.005445385	2.519023305	3.016485718	6.852324517	0.083984659	0.693918589	0	0.530332938	2.261279886	0	0	0	0	0	0	0	0	0	0.14934264	2.552152367	0	0.934755644	0	0	0	0	0	0	54.4101
H5868_007_0	2011	7	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Radiology									Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin							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	YES	208.796157	3.719213	16.22372	684.307402	1.459125	8.440501	2.335781	325.96634	54.175885	6.269711	22.032599	4.713047	0.488061	14.573465	27.350245	43.855163	0.697866	4.417085		1567.039982	16.885452	0							1.42	0.48	812.347987	172.148324									6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $155 plan year deductible	"8a. $0 Lab -- FSL,8a. 20% coinsurance after $155 plan year deductible Lab -- OP"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit:14b-j.Preventive Services	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"										0.089439	0.089439	0.111326	0	0.233	0.233	0.233	50	0.233	0.204591	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0							0	0	0	0									NO	0.084115	0.084115	0.096466	0	0.216698	0.216698	0.216698	46.50175	0.216698	0.190277	0.216698	0.216698	0.216698	0.216698	0.216698	0.216698	0.216698	0.216698		0	0.216698	0							0	0	0	0										17.5629	0.312841601	1.565037374	0	0.316189469	1.829039686	0.506159071	1.263167104	11.73980593	1.1929818	4.774420138	1.021307859	0.105761843	3.158040719	5.926743391	9.503326112	0.151226166	0.957173485	0	0	3.659043677	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5452	0	4.840906083	17.5629	0.312841601	1.565037374	0	0.316189469	1.829039686	0.506159071	1.263167104	11.73980593	1.1929818	4.774420138	1.021307859	0.105761843	3.158040719	5.926743391	9.503326112	0.151226166	0.957173485	0	0	3.659043677	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5452	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	$50/Visit	20% coinsurance after $155 plan year deductible	"8a. $0 Lab -- FSL,8a. 20% coinsurance after $155 plan year deductible Lab -- OP"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	$0/Visit									8000	2.7339	0.0487	0.2528	0	1.293	1.2329	0.3412	0.193	1.9161	0.186	0.7962	0.1592	0.0165	0.4924	1.0969	1.7589	0.028	0.1685		0	0.6772	0							0	0	0.1344	0									13.5258	0	0.68580043	20.2968	0.361540003	1.817858186	0	1.609224745	3.061962834	0.847352011	1.456136118	13.65593289	1.378975725	5.570596446	1.18053674	0.122250839	3.650449332	7.023661781	11.26219637	0.179215013	1.125660867	0	0	4.336257195	0	0	0	0	0	0	0	0	0	0.13435561	0	0	0	0	0	0	0	0	0	79.071
H5883_001_1	2011	11																															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											5.278430524	0.124266614	0.323817069	0	0.122151864	0.418570482	0	0.000530913	1.151120557	0.001585429	0.447244541	0	0	0.100963595	0.02562538	0.297819622	0	0.017599837	0.445092443	1.854732213	0	0.002808231	0	0	0	0	0.005700103	0	0	0	0	0	0	0	0	0	0	0	0	0	10.6181	YES	145.3896433	7.916900216	492.6798689	0	243.399111	7.0133065	8.958031458	151.1980411	405.6333857	0	480.8172531	0	0	204.4988246	1704.065168	1012.632735	0	210.0984926	728.8564271	2581.36481	0	0	0	0	0	0	63.96042327	0	0	0	0	0	0	0	0	0	0	0	0	0	4400	"$175 per day, days 1-5"	"$175 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			No cost-sharing or $35 copay	No cost-sharing or $20 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $35 copay for other services"							"$25 copay on exam, $0 on hearing aid/fitting"															586.39	586.39	22.97974488	0	46.5	0.2	0	49.97958444	91.66666667	0	24.62	0	0	35	20	35	0	35	27.28021686	40.42828157	0	0	0	0	0	0	35	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	515.9161787	515.9161787	20.21798149	0	40.91151334	0.17	0	43.9729126	80.6499367	0	24.62	0	0	30.79361219	17.59634982	30.79361219	0	30.79361219	27.28021686	35.56950926	0	0	0	0	0	0	30.79361219	0	0	0	0	0	0	0	0	0	0	0	0	0		6.2507	0.340371409	0.830082706	0	0.829818831	1.192262105	0	0.55405152	2.72619224	0	0.986476731	0	0	0.524771458	2.498777235	2.598551645	0	0.539140959	1.656946783	7.65148996	0	0	0	0	0	0	0.164131039	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3438	150	3.352519282	11.5292	0.464638023	1.153899775	0	0.951970696	1.610832587	0	0.554582433	3.877312797	0.001585429	1.433721272	0	0	0.625735053	2.524402615	2.896371267	0	0.556740796	2.102039225	9.506222173	0	0.002808231	0	0	0	0	0.169831142	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9619	NO	"$175 per day, days 1-5"	"$175 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			No cost-sharing or $35 copay	No cost-sharing or $20 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $35 copay for other services"							"$25 copay on exam, $0 on hearing aid/fitting"															0.8905	0.0359	0.0891	0	0.0735	0.1244	0	0.0428	0.2995	0.0001	0.1107	0	0	0.0483	0.195	0.2237	0	0.043	0.1624	0.7342	0	0.0002	0	0	0	0	0.0131	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0866			12.4197	0.500525717	1.243024642	0	1.025498972	1.735250013	0	0.59741725	4.176788535	0.001707884	1.544458981	0	0	0.674065554	2.719382328	3.12008108	0	0.59974232	2.264396451	10.2404634	0	0.003025133	0	0	0	0	0.182948553	0	0	0	0	0	0	0	0	0	0	0	0	0	43.0484
H5883_001_2	2011	9																															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											5.298084015	0	0.664052998	0	0.123297493	0.404908792	0	0.000532854	1.209399009	0	0.514034564	0	0	0.085277493	0.02686292	0.289354426	0	0.018916307	0.457282626	1.556337559	0	0.002671391	0	0	0	0	0.005690043	0	0	0	0	0	0	0	0	0	0	0	0	0	10.6567	YES	154.3030324	0	734.6625056	0	235.8134765	7.0133065	9.291245178	139.9150807	395.4852044	0	437.3579333	0	0	150.5337724	1747.710718	984.6143657	0	212.5884173	701.903197	2447.308427	0	0	0	0	0	0	60.21308659	0	0	0	0	0	0	0	0	0	0	0	0	0	4400	"$175 per day, days 1-5"	"$175 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			No cost-sharing or $35 copay	No cost-sharing or $20 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $35 copay for other services"							"$25 copay on exam, $0 on hearing aid/fitting"															586.39	586.39	22.97974488	0	46.5	0.2	0	49.97561315	91.66666667	0	24.62	0	0	35	20	35	0	35	27.28021686	40.32119153	0	0	0	0	0	0	35	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	517.2786021	517.2786021	20.27137282	0	41.01955183	0.17	0	44.08553235	80.8629158	0	24.62	0	0	30.87493149	17.64281799	30.87493149	0	30.87493149	27.28021686	35.56897217	0	0	0	0	0	0	30.87493149	0	0	0	0	0	0	0	0	0	0	0	0	0		6.6515	0	1.241051463	0	0.80608026	1.192262105	0	0.514019235	2.665007232	0	0.897312693	0	0	0.387309992	2.569545175	2.53332509	0	0.546971068	1.595672619	7.254020445	0	0	0	0	0	0	0.15492291	0	0	0	0	0	0	0	0	0	0	0	0	0	29.009	150	3.230572694	11.9496	0	1.905104461	0	0.929377753	1.597170897	0	0.514552089	3.874406241	0	1.411347257	0	0	0.472587486	2.596408095	2.822679516	0	0.565887375	2.052955245	8.810358004	0	0.002671391	0	0	0	0	0.160612954	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6657	NO	"$175 per day, days 1-5"	"$175 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			No cost-sharing or $35 copay	No cost-sharing or $20 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $35 copay for other services"							"$25 copay on exam, $0 on hearing aid/fitting"															0.923	0	0.1471	0	0.0718	0.1234	0	0.0397	0.2993	0	0.109	0	0	0.0365	0.2005	0.218	0	0.0437	0.1586	0.6805	0	0.0002	0	0	0	0	0.0124	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0637			12.8725	0	2.052250847	0	1.001160996	1.720533122	0	0.554295043	4.173657483	0	1.520356843	0	0	0.50908918	2.796949365	3.040697529	0	0.609595363	2.211521324	9.4908521	0	0.002877724	0	0	0	0	0.173018371	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7294
H5883_001_3	2011	9																															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											4.162682125	0.071184003	0.857356543	0	0.148189318	0.366093866	0	0.000476439	1.455441339	0.000991413	0.16711355	0	0	0.151894277	0.021617242	0.315194362	0	0.017351264	0.364915276	1.462911857	0	0.002871995	0	0	0	0	0.004771941	0	0	0	0	0	0	0	0	0	0	0	0	0	9.5711	YES	165.0981388	4.761321142	665.3876497	0	323.9511547	7.0133065	7.123943533	140.1614122	394.5807444	0	434.3969858	0	0	114.78863	1783.542872	1140.020063	0	174.5834094	733.2360802	2861.453863	0	0	0	0	0	0	63.35107283	0	0	0	0	0	0	0	0	0	0	0	0	0	4400	"$175 per day, days 1-5"	"$175 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			No cost-sharing or $35 copay	No cost-sharing or $20 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $35 copay for other services"							"$25 copay on exam, $0 on hearing aid/fitting"															586.39	586.39	22.97974488	0	46.5	0.2	0	49.97606289	91.66666667	0	24.62	0	0	35	20	35	0	35	27.28021686	40.01570256	0	0	0	0	0	0	35	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	509.6321508	509.6321508	19.97171986	0	40.41319772	0.17	0	43.43424755	79.66759408	0	24.62	0	0	30.41853592	17.38202053	30.41853592	0	30.41853592	27.28021686	34.77768816	0	0	0	0	0	0	30.41853592	0	0	0	0	0	0	0	0	0	0	0	0	0		7.0116	0.202210195	1.107411312	0	1.090991839	1.192262105	0	0.507317123	2.619608215	0	0.891237816	0	0	0.290975172	2.5834649	2.88981177	0	0.442547642	1.666903273	8.292895843	0	0	0	0	0	0	0.16058724	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9498	150	3.829984347	11.1743	0.273394197	1.964767854	0	1.239181156	1.558355971	0	0.507793562	4.075049554	0.000991413	1.058351366	0	0	0.442869449	2.605082143	3.205006132	0	0.459898906	2.031818549	9.755807701	0	0.002871995	0	0	0	0	0.165359181	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5209	NO	"$175 per day, days 1-5"	"$175 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			No cost-sharing or $35 copay	No cost-sharing or $20 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $35 copay for other services"							"$25 copay on exam, $0 on hearing aid/fitting"															0.8631	0.0211	0.1518	0	0.0957	0.1204	0	0.0392	0.3147	0.0001	0.0817	0	0	0.0342	0.2012	0.2475	0	0.0355	0.1569	0.7535	0	0.0002	0	0	0	0	0.0128	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1298			12.0374	0.294510608	2.116522519	0	1.334892983	1.67872021	0	0.547014502	4.389798076	0.001067988	1.140096269	0	0	0.477075783	2.806293378	3.452554274	0	0.495420561	2.188752073	10.5093264	0	0.003093822	0	0	0	0	0.178131187	0	0	0	0	0	0	0	0	0	0	0	0	0	43.6506
H5883_001_4	2011	9																															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											5.277594327	0	0.684104292	0	0.145689307	0.396678343	0	0.000521085	1.037530695	0	0.185931771	0	0	0.189557555	0.031082667	0.346208019	0	0.016006279	0.451727314	1.671890082	0	0.003438335	0	0	0	0	0.009149281	0	0	0	0	0	0	0	0	0	0	0	0	0	10.4471	YES	175.5099779	0	613.5347552	0	289.6212307	7.0133065	12.60698109	166.1217958	437.1424066	0	460.9218269	0	0	143.4406473	2076.276271	1177.06735	0	218.8990088	857.7423508	3056.574687	0	0	0	0	0	0	73.50506659	0	0	0	0	0	0	0	0	0	0	0	0	0	4400	"$175 per day, days 1-5"	"$175 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			No cost-sharing or $35 copay	No cost-sharing or $20 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $35 copay for other services"							"$25 copay on exam, $0 on hearing aid/fitting"															586.39	586.39	22.97974488	0	46.5	0.2	0	49.97871915	91.66666667	0	24.62	0	0	35	20	35	0	35	27.28021686	40.50101224	0	0	0	0	0	0	35	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	503.3389128	503.3389128	19.7250973	0	39.91415175	0.17	0	42.90017593	78.6838117	0	24.62	0	0	30.04290992	17.1673771	30.04290992	0	30.04290992	27.28021686	34.7648075	0	0	0	0	0	0	30.04290992	0	0	0	0	0	0	0	0	0	0	0	0	0		7.3618	0	1.008502729	0	0.963332146	1.192262105	0	0.593887856	2.8663359	0	0.945657948	0	0	0.359114537	2.970351475	2.946877363	0	0.548030267	1.949949778	8.855102549	0	0	0	0	0	0	0.184025508	0	0	0	0	0	0	0	0	0	0	0	0	0	32.7452	150	4.453605444	12.6393	0	1.69260702	0	1.109021453	1.588940448	0	0.594408941	3.903866595	0	1.131589719	0	0	0.548672092	3.001434142	3.293085383	0	0.564036545	2.401677092	10.52699263	0	0.003438335	0	0	0	0	0.193174789	0	0	0	0	0	0	0	0	0	0	0	0	0	43.1923	NO	"$175 per day, days 1-5"	"$175 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			No cost-sharing or $35 copay	No cost-sharing or $20 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $35 copay for other services"							"$25 copay on exam, $0 on hearing aid/fitting"															0.9762	0	0.1307	0	0.0857	0.1227	0	0.0459	0.3015	0	0.0874	0	0	0.0424	0.2318	0.2544	0	0.0436	0.1855	0.8131	0	0.0003	0	0	0	0	0.0149	0	0	0	0	0	0	0	0	0	0	0	0	0	3.3361			13.6156	0	1.823340537	0	1.19468001	1.71166697	0	0.640319876	4.205393295	0	1.218991403	0	0	0.591050407	3.233258798	3.547436586	0	0.607601579	2.587177736	11.34007609	0	0.003703905	0	0	0	0	0.208095216	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5284
H5883_001_5	2011	9																															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											4.063460371	0.059893664	0.852151093	0	0.138005556	0.387331952	0	0.000501006	1.342564847	0.00126112	0.313439055	0	0	0.162710499	0.030995736	0.431741611	0	0.012892935	0.604071703	2.029895264	0	0.004168756	0	0	0	0	0.006816405	0	0	0	0	0	0	0	0	0	0	0	0	0	10.4419	YES	181.5154366	9.663163215	858.6361893	0	330.2773157	7.0133065	10.47816382	166.5787244	483.2158661	0	483.9719335	0	0	118.1538463	2088.506126	1395.207537	0	174.0484332	862.5660026	3392.457968	0	0	0	0	0	0	60.68871022	0	0	0	0	0	0	0	0	0	0	0	0	0	4400	"$175 per day, days 1-5"	"$175 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			No cost-sharing or $35 copay	No cost-sharing or $20 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $35 copay for other services"							"$25 copay on exam, $0 on hearing aid/fitting"															586.39	586.39	22.97974488	0	46.5	0.2	0	49.98137258	91.66666667	0	24.62	0	0	35	20	35	0	35	27.28021686	39.98954669	0	0	0	0	0	0	35	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	493.8952359	493.8952359	19.35501376	0	39.16527988	0.17	0	42.09751497	77.20754098	0	24.62	0	0	29.47924292	16.84528167	29.47924292	0	29.47924292	27.28021686	33.68175889	0	0	0	0	0	0	29.47924292	0	0	0	0	0	0	0	0	0	0	0	0	0		7.4708	0.397715856	1.384909605	0	1.077950292	1.192262105	0	0.584379195	3.108992399	0	0.992949084	0	0	0.290257161	2.931789497	3.427471826	0	0.427568004	1.960915634	9.521995945	0	0	0	0	0	0	0.149088103	0	0	0	0	0	0	0	0	0	0	0	0	0	34.919	150	5.349322847	11.5343	0.45760952	2.237060698	0	1.215955848	1.579594057	0	0.584880201	4.451557245	0.00126112	1.306388138	0	0	0.452967661	2.962785233	3.859213437	0	0.440460938	2.564987336	11.55189121	0	0.004168756	0	0	0	0	0.155904508	0	0	0	0	0	0	0	0	0	0	0	0	0	45.3609	NO	"$175 per day, days 1-5"	"$175 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			No cost-sharing or $35 copay	No cost-sharing or $20 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	No cost-sharing or $35 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $35 copay for other services"							"$25 copay on exam, $0 on hearing aid/fitting"															0.8909	0.0353	0.1728	0	0.0939	0.122	0	0.0452	0.3438	0.0001	0.1009	0	0	0.035	0.2288	0.2981	0	0.034	0.1981	0.8922	0	0.0003	0	0	0	0	0.012	0	0	0	0	0	0	0	0	0	0	0	0	0	3.5036			12.4251	0.492954347	2.409846707	0	1.3098738	1.701598682	0	0.630055156	4.795386454	0.001358527	1.407290895	0	0	0.48795396	3.191624726	4.157291217	0	0.474481243	2.763101731	12.44413574	0	0.004490742	0	0	0	0	0.167946254	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8645
H5883_002_1	2011	9																															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	3.254955961	0.02314605	0.385655672	0	0.087610631	0.248546184	0	0.000325341	0.681230083	0.003202113	0.158832392	0	0	0.111232897	0.023640676	0.244108386	0	0.02410278	0.268019127	1.328620567	0	0.002569182	0	0	0	0	0.004050814	0	0	0	0	0	0	0	0	0	0	0	0	0	6.8498	YES	185.9560672	5.101651523	662.2485168	0	269.6910331	7.0133065	9.977348833	218.4472111	635.467139	0	626.3874084	0	0	268.6854246	2304.144233	1370.927305	0	278.8104092	926.009428	3611.296134	0	0	0	0	0	0	83.45832969	0	0	0	0	0	0	0	0	0	0	0	0	0	4200	"$125 per day, days 1-5"	"$125 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$100 OP copay or $60 ASC copay		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$30 copay		No cost-sharing or $30 copay	No cost-sharing or $15 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$40 copay for office surgery, $30 copay for other services"							"$25 copay on exam, $0 on hearing aid/fitting"															453.92	453.92	22.35261261	0	46.5	0.2	0	49.98132806	73.33333333	0	24.62	0	0	30	15	30	0	30	21.82417349	33.45207277	0	0	0	0	0	0	30	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	376.4818191	376.4818191	18.53928502	0	38.56715851	0.17	0	41.45457638	60.82275893	0	24.62	0	0	24.88203775	12.44101887	24.88203775	0	24.88203775	21.82417349	27.74519125	0	0	0	0	0	0	24.88203775	0	0	0	0	0	0	0	0	0	0	0	0	0		5.8341	0.160056587	1.023134501	0	0.866768068	1.192262105	0	0.754636383	3.220905384	0	1.285138166	0	0	0.557120073	2.388825158	2.842622079	0	0.57811426	1.684115867	8.349675157	0	0	0	0	0	0	0.173051109	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9105	100	5.371103789	9.089	0.183202637	1.408790172	0	0.954378699	1.440808289	0	0.754961724	3.902135467	0.003202113	1.443970558	0	0	0.66835297	2.412465833	3.086730465	0	0.60221704	1.952134995	9.678295725	0	0.002569182	0	0	0	0	0.177101923	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7604	NO	"$125 per day, days 1-5"	"$125 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$100 OP copay or $60 ASC copay	0	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$30 copay	0	No cost-sharing or $30 copay	No cost-sharing or $15 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$40 copay for office surgery, $30 copay for other services"	0	0	0	0	0	0	"$25 copay on exam, $0 on hearing aid/fitting"	0	0	0	0	0	0	0	0	0	0	0	0	0		0.702	0.0142	0.1088	0	0.0737	0.1113	0	0.0583	0.3014	0.0002	0.1115	0	0	0.0516	0.1863	0.2384	0	0.0465	0.1508	0.7475	0	0.0002	0	0	0	0	0.0137	0	0	0	0	0	0	0	0	0	0	0	0	0	2.9165			9.7911	0.197352836	1.517602254	0	1.028092965	1.552093385	0	0.813273429	4.203528457	0.003449438	1.555499901	0	0	0.719975191	2.598799777	3.325143234	0	0.648731057	2.102913923	10.42582756	0	0.00276762	0	0	0	0	0.190780915	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6769
H5883_002_2	2011	9																															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	2.905209949	0.032954134	0.46828457	0	0.093695972	0.230643748	0.001235925	0.000301882	0.756049509	0.001576678	0.176040761	0	0	0.085179781	0.022902791	0.228044249	0	0.022275084	0.496718216	1.173791673	0	0.00197412	0	0	0	0	0.004671443	0	0	0	0	0	0	0	0	0	0	0	0	0	6.7016	YES	207.7586995	9.406916933	825.1567354	0	353.7043218	7.0133065	10.24758215	219.7342702	553.7183476	0	673.1667531	0	0	183.1670321	2531.576035	1381.396218	0	404.2165336	1120.201896	3394.341452	0	0	0	0	0	0	85.7427999	0	0	0	0	0	0	0	0	0	0	0	0	0	4200	"$125 per day, days 1-5"	"$125 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$100 OP copay or $60 ASC copay		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$30 copay		No cost-sharing or $30 copay	No cost-sharing or $15 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$40 copay for office surgery, $30 copay for other services"							"$25 copay on exam, $0 on hearing aid/fitting"															453.92	453.92	22.35261261	0	46.5	0.2	0.039514476	49.98431926	73.33333333	0	24.62	0	0	30	15	30	0	30	21.82417349	33.36519567	0	0	0	0	0	0	30	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	373.6053779	373.6053779	18.39763897	0	38.27249311	0.17	0.033587304	41.14031214	60.35805365	0	24.62	0	0	24.69193104	12.34596552	24.69193104	0	24.69193104	21.82417349	27.46170368	0	0	0	0	0	0	24.69193104	0	0	0	0	0	0	0	0	0	0	0	0	0		6.4683	0.292872896	1.265077976	0	1.128095518	1.192262105	0.344188659	0.753328039	2.785113477	0	1.381113788	0	0	0.376895644	2.604562536	2.842445013	0	0.831740564	2.037290043	7.767866597	0	0	0	0	0	0	0.176429609	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2476	100	5.636082142	9.3735	0.325827031	1.733362546	0	1.22179149	1.422905853	0.345424584	0.753629921	3.541162987	0.001576678	1.55715455	0	0	0.462075425	2.627465328	3.070489262	0	0.854015649	2.534008259	8.94165827	0	0.00197412	0	0	0	0	0.181101051	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9491	NO	"$125 per day, days 1-5"	"$125 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$100 OP copay or $60 ASC copay	0	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$30 copay	0	No cost-sharing or $30 copay	No cost-sharing or $15 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$40 copay for office surgery, $30 copay for other services"	0	0	0	0	0	0	"$25 copay on exam, $0 on hearing aid/fitting"	0	0	0	0	0	0	0	0	0	0	0	0	0		0.724	0.0252	0.1339	0	0.0944	0.1099	0.0258	0.0582	0.2735	0.0001	0.1203	0	0	0.0357	0.2029	0.2372	0	0.066	0.1957	0.6906	0	0.0002	0	0	0	0	0.014	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0075			10.0975	0.350993246	1.867243936	0	1.316160175	1.532808201	0.371262041	0.81183876	3.814675199	0.001698458	1.677425993	0	0	0.497765189	2.830405394	3.307647594	0	0.919978077	2.729729892	9.63229373	0	0.002126597	0	0	0	0	0.195088928	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9567
H5883_002_3	2011	9																															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	2.763922218	0.022728257	0.494102537	0	0.098702652	0.237792094	0.000633804	0.000304455	0.78287174	0.001320102	0.282845076	0	0	0.123826157	0.024673318	0.264975215	0.000266639	0.039887823	0.315355952	1.336153646	0	0.003312763	0	0	0	0	0.004852931	0	0	0	0	0	0	0	0	0	0	0	0	0	6.7985	YES	179.3538744	4.014473187	854.6936028	0	279.8033978	7.0133065	10.17503204	168.0426583	535.3327888	0	688.7146796	0	0	144.4199874	2355.486354	1343.34706	0.924888755	610.6455539	993.879488	3744.18724	0	0	0	0	0	0	80.70045054	0	0	0	0	0	0	0	0	0	0	0	0	0	4200	"$125 per day, days 1-5"	"$125 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$100 OP copay or $60 ASC copay		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$30 copay		No cost-sharing or $30 copay	No cost-sharing or $15 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$40 copay for office surgery, $30 copay for other services"							"$25 copay on exam, $0 on hearing aid/fitting"															453.92	453.92	22.35261261	0	46.5	0.2	0.109440347	49.98048048	73.33333333	0	24.62	0	0	30	15	30	30	30	21.82417349	33.75244645	0	0	0	0	0	0	30	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	375.5098738	375.5098738	18.49142303	0	38.4675915	0.17	0.093024295	41.34685389	60.66573569	0	24.62	0	0	24.81780097	12.40890048	24.81780097	24.81780097	24.81780097	21.82417349	27.92204994	0	0	0	0	0	0	24.81780097	0	0	0	0	0	0	0	0	0	0	0	0	0		5.6124	0.12562286	1.317041747	0	0.896946901	1.192262105	0.94652518	0.579002937	2.706363123	0	1.413012951	0	0	0.298682209	2.435749647	2.778243331	0.001912809	1.262906651	1.807549864	8.712115258	0	0	0	0	0	0	0.166900643	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2533	100	5.586314472	8.3764	0.148351117	1.811144285	0	0.995649552	1.430054199	0.947158984	0.579307391	3.489234863	0.001320102	1.695858027	0	0	0.422508365	2.460422964	3.043218546	0.002179448	1.302794474	2.122905817	10.0482689	0	0.003312763	0	0	0	0	0.171753574	0	0	0	0	0	0	0	0	0	0	0	0	0	39.0518	NO	"$125 per day, days 1-5"	"$125 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$100 OP copay or $60 ASC copay	0	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$30 copay	0	No cost-sharing or $30 copay	No cost-sharing or $15 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$40 copay for office surgery, $30 copay for other services"	0	0	0	0	0	0	"$25 copay on exam, $0 on hearing aid/fitting"	0	0	0	0	0	0	0	0	0	0	0	0	0		0.647	0.0115	0.1399	0	0.0769	0.1105	0.0712	0.0447	0.2695	0.0001	0.131	0	0	0.0326	0.19	0.2351	0.0002	0.1006	0.164	0.7761	0	0.0003	0	0	0	0	0.0133	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0143			9.0233	0.159809455	1.951033378	0	1.072551494	1.540508671	1.018359771	0.624051913	3.758736252	0.001422064	1.826842644	0	0	0.45514205	2.650461019	3.278270544	0.002347784	1.403419664	2.286874735	10.82437671	0	0.003568634	0	0	0	0	0.18501947	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0661
H5883_002_4	2011	9																															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	2.683308823	0.031715406	0.585678224	0	0.105415843	0.219276016	0.000912565	0.000278077	0.659614086	0.002000023	0.160460639	0	0	0.134185757	0.022743408	0.262550247	0	0.007197054	0.488761037	1.257829724	0	0.002600936	0	0	0	0	0.005620788	0	0	0	0	0	0	0	0	0	0	0	0	0	6.6301	YES	205.1648424	9.854697752	958.5194238	0	471.6239481	7.0133065	10.00437689	190.1369004	599.8755636	0	504.7757734	0	0	137.4285382	2603.758794	1721.896676	0	161.8126493	1233.341803	4157.18403	0	0	0	0	0	0	96.75289605	0	0	0	0	0	0	0	0	0	0	0	0	0	4200	"$125 per day, days 1-5"	"$125 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$100 OP copay or $60 ASC copay		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$30 copay		No cost-sharing or $30 copay	No cost-sharing or $15 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$40 copay for office surgery, $30 copay for other services"							"$25 copay on exam, $0 on hearing aid/fitting"															453.92	453.92	22.35261261	0	46.5	0.2	0.028377199	49.98084415	73.33333333	0	24.62	0	0	30	15	30	0	30	21.82417349	33.00699363	0	0	0	0	0	0	30	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	365.4761135	365.4761135	17.99732548	0	37.43972347	0.17	0.024120619	40.24234373	59.04472518	0	24.62	0	0	24.1546603	12.07733015	24.1546603	0	24.1546603	21.82417349	26.57575729	0	0	0	0	0	0	24.1546603	0	0	0	0	0	0	0	0	0	0	0	0	0		6.2486	0.300138053	1.437565504	0	1.47145585	1.192262105	0.241311764	0.637629542	2.951623983	0	1.035631628	0	0	0.276628305	2.620537883	3.465985774	0	0.325710798	2.243055457	9.206692816	0	0	0	0	0	0	0.194752778	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8496	100	6.806278895	8.9319	0.331853459	2.023243728	0	1.576871693	1.411538121	0.242224329	0.637907618	3.611238069	0.002000023	1.196092267	0	0	0.410814062	2.64328129	3.728536021	0	0.332907852	2.731816494	10.46452254	0	0.002600936	0	0	0	0	0.200373566	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4797	NO	"$125 per day, days 1-5"	"$125 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$100 OP copay or $60 ASC copay	0	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$30 copay	0	No cost-sharing or $30 copay	No cost-sharing or $15 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$40 copay for office surgery, $30 copay for other services"	0	0	0	0	0	0	"$25 copay on exam, $0 on hearing aid/fitting"	0	0	0	0	0	0	0	0	0	0	0	0	0		0.6899	0.0256	0.1563	0	0.1218	0.109	0.0177	0.0493	0.2789	0.0002	0.0924	0	0	0.0317	0.2042	0.288	0	0.0257	0.211	0.8083	0	0.0002	0	0	0	0	0.0155	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1256			9.6218	0.357485144	2.17951495	0	1.698666048	1.520562449	0.259949908	0.687178303	3.890162738	0.002154501	1.288475996	0	0	0.442544503	2.84744295	4.016520544	0	0.358620975	2.942816432	11.27278093	0	0.002801827	0	0	0	0	0.215850012	0	0	0	0	0	0	0	0	0	0	0	0	0	43.6053
H5883_002_7	2011	9																															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	2.837915181	0.045985916	0.332307044	0	0.078609428	0.213787796	0.004555465	0.000280558	0.709394848	0.001015942	0.265807096	0	0	0.103643124	0.024011485	0.289541068	0	0.012523307	0.386354165	1.368054163	0	0.003030769	0	0	0	0	0.006446001	0	0	0	0	0	0	0	0	0	0	0	0	0	6.6833	YES	198.4518698	11.43277879	642.5430611	0	345.5864773	7.0133065	10.12076282	195.5132735	586.0835948	0	711.7636148	0	0	169.6891852	2814.723471	1608.238223	0	248.2381738	1151.586181	4339.198559	0	0	0	0	0	0	106.1981492	0	0	0	0	0	0	0	0	0	0	0	0	0	4200	"$125 per day, days 1-5"	"$125 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$100 OP copay or $60 ASC copay		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$30 copay		No cost-sharing or $30 copay	No cost-sharing or $15 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$40 copay for office surgery, $30 copay for other services"							"$25 copay on exam, $0 on hearing aid/fitting"															453.92	453.92	22.35261261	0	46.5	0.2	0.026232743	49.9819665	73.33333333	0	24.62	0	0	30	15	30	0	30	21.82417349	33.51203896	0	0	0	0	0	0	30	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	365.5205219	365.5205219	17.99951231	0	37.44427271	0.17	0.022297832	40.24813729	59.05189961	0	24.62	0	0	24.1575953	12.07879765	24.1575953	0	24.1575953	21.82417349	26.98567583	0	0	0	0	0	0	24.1575953	0	0	0	0	0	0	0	0	0	0	0	0	0		6.0449	0.348242939	0.963788478	0	1.078352858	1.192262105	0.225671067	0.655753756	2.884112467	0	1.460301683	0	0	0.341606889	2.83320627	3.237597343	0	0.499736445	2.09436805	9.75801714	0	0	0	0	0	0	0.213790993	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8317	100	6.839602749	8.8828	0.394228855	1.296095522	0	1.156962286	1.406049901	0.230226532	0.656034314	3.593507315	0.001015942	1.726108779	0	0	0.445250012	2.857217755	3.527138411	0	0.512259752	2.480722215	11.1260713	0	0.003030769	0	0	0	0	0.220236994	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5149	NO	"$125 per day, days 1-5"	"$125 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$100 OP copay or $60 ASC copay	0	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$30 copay	0	No cost-sharing or $30 copay	No cost-sharing or $15 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	No cost-sharing or $30 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$40 copay for office surgery, $30 copay for other services"	0	0	0	0	0	0	"$25 copay on exam, $0 on hearing aid/fitting"	0	0	0	0	0	0	0	0	0	0	0	0	0		0.6861	0.0304	0.1001	0	0.0894	0.1086	0.0169	0.0507	0.2776	0.0001	0.1333	0	0	0.0344	0.2207	0.2724	0	0.0396	0.1916	0.8594	0	0.0002	0	0	0	0	0.017	0	0	0	0	0	0	0	0	0	0	0	0	0	3.1284			9.5689	0.424678288	1.396203298	0	1.246323695	1.514650329	0.247091167	0.706705067	3.871062496	0.001094412	1.859429903	0	0	0.479640216	3.077903432	3.799567393	0	0.551825651	2.672328143	11.98542637	0	0.00326486	0	0	0	0	0.23724765	0	0	0	0	0	0	0	0	0	0	0	0	0	43.6433
H5883_003_1	2011	11																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	292.7715711	13.38426909	1569.975661	0	555.6209872	7.0133065	13.38843429	337.2572161	772.124075	0	1059.013425	0	0	515.5602099	3440.296529	2377.937694	0	495.6488029	1432.655109	5678.378625	0	0	0	0	0	0	127.35684	0	0	0	0	0	0	0	0	0	0	0	0	0	4000	"$75 per day, days 1-5"	"$75 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$75 OP copay or $45 ASC copay	0	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	$25 copay	0	No cost-sharing or $25 copay	No cost-sharing or $10 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	"$30 copay for office surgery, $25 copay for other services"	0	0	0	0	0	0	"$25 copay on exam, $0 on hearing aid/fitting"	0	0	0	0	0	0	0	0	0	0	0	0	0		272.3290202	272.3290202	20.00203072	0	46.5	0.2	0.012628919	49.9876199	55	0	24.62	0	0	20	10.45430335	20	0	25	16.37	23.53925215	0	0	0	0	0	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	229.7501615	229.7501615	16.87469732	0	39.22968805	0.17	0.010734582	42.17201581	46.40070629	0	24.62	0	0	16.87298411	8.819764716	16.87298411	0	21.09123013	16.37	19.85887137	0	0	0	0	0	0	16.87298411	0	0	0	0	0	0	0	0	0	0	0	0	0		5.6054	0.256253165	2.207738673	0	1.816403167	1.192262105	0.14371924	1.185234721	2.985591869	0	2.172742543	0	0	0.724919936	2.528550495	3.34357541	0	0.871153581	1.954380344	9.397182559	0	0	0	0	0	0	0.179074161	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5641	0	5.961894255	5.6054	0.256253165	2.207738673	0	1.816403167	1.192262105	0.14371924	1.185234721	2.985591869	0	2.172742543	0	0	0.724919936	2.528550495	3.34357541	0	0.871153581	1.954380344	9.397182559	0	0	0	0	0	0	0.179074161	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5641	NO	"$75 per day, days 1-5"	"$75 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$75 OP copay or $45 ASC copay	0	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	$25 copay	0	No cost-sharing or $25 copay	No cost-sharing or $10 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	"$30 copay for office surgery, $25 copay for other services"	0	0	0	0	0	0	"$25 copay on exam, $0 on hearing aid/fitting"	0	0	0	0	0	0	0	0	0	0	0	0	0		0.4329	0.0198	0.1705	0	0.1403	0.0921	0.011	0.0915	0.2306	0	0.1678	0	0	0.056	0.1953	0.2583	0	0.0673	0.151	0.7258	0	0	0	0	0	0	0.0138	0	0	0	0	0	0	0	0	0	0	0	0	0	2.8241			6.0383	0.276045638	2.378259909	0	1.956698445	1.28435	0.154736883	1.276779835	3.2161929	0	2.340560749	0	0	0.780911274	2.723850582	3.60182636	0	0.938439708	2.105332698	10.12300179	0	0	0	0	0	0	0.192905485	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3882
H5883_003_2	2011	11																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	272.156728	6.694995968	953.8882696	0	432.9602189	7.0133065	12.72270071	234.5752989	683.5428185	0	739.6970098	0	0	318.0939981	3430.996095	1639.799432	0	262.9326594	1196.213576	4296.137197	0	0	0	0	0	0	86.2159351	0	0	0	0	0	0	0	0	0	0	0	0	0	4000	"$75 per day, days 1-5"	"$75 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$75 OP copay or $45 ASC copay	0	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	$25 copay	0	No cost-sharing or $25 copay	No cost-sharing or $10 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	"$30 copay for office surgery, $25 copay for other services"	0	0	0	0	0	0	"$25 copay on exam, $0 on hearing aid/fitting"	0	0	0	0	0	0	0	0	0	0	0	0	0		272.3290202	272.3290202	20.00203072	0	46.5	0.2	0.025633391	49.98276036	55	0	24.62	0	0	20	10.45553484	20	0	25	16.37	23.31098583	0	0	0	0	0	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	241.3447149	241.3447149	17.72629446	0	41.20945037	0.17	0.021788382	44.29595876	48.74236065	0	24.62	0	0	17.72449478	9.265953634	17.72449478	0	22.15561848	16.37	20.65877234	0	0	0	0	0	0	17.72449478	0	0	0	0	0	0	0	0	0	0	0	0	0		5.4736	0.134650158	1.409075362	0	1.486837721	1.192262105	0.277207069	0.865894814	2.776457548	0	1.517611698	0	0	0.469837951	2.649287561	2.422051373	0	0.485452974	1.631834686	7.396076692	0	0	0	0	0	0	0.127344491	0	0	0	0	0	0	0	0	0	0	0	0	0	30.3155	0	3.391008512	5.4736	0.134650158	1.409075362	0	1.486837721	1.192262105	0.277207069	0.865894814	2.776457548	0	1.517611698	0	0	0.469837951	2.649287561	2.422051373	0	0.485452974	1.631834686	7.396076692	0	0	0	0	0	0	0.127344491	0	0	0	0	0	0	0	0	0	0	0	0	0	30.3155	NO	"$75 per day, days 1-5"	"$75 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$75 OP copay or $45 ASC copay	0	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	$25 copay	0	No cost-sharing or $25 copay	No cost-sharing or $10 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	"$30 copay for office surgery, $25 copay for other services"	0	0	0	0	0	0	"$25 copay on exam, $0 on hearing aid/fitting"	0	0	0	0	0	0	0	0	0	0	0	0	0		0.4228	0.0104	0.1088	0	0.1148	0.0921	0.0223	0.0669	0.2144	0	0.1172	0	0	0.0363	0.2046	0.1871	0	0.0375	0.126	0.5713	0	0	0	0	0	0	0.0098	0	0	0	0	0	0	0	0	0	0	0	0	0	2.3424			5.8964	0.145050262	1.517909471	0	1.601678036	1.28435	0.299530454	0.932774764	2.990905471	0	1.634828933	0	0	0.506127277	2.853913132	2.609125685	0	0.522948372	1.757874272	7.967334581	0	0	0	0	0	0	0.13718032	0	0	0	0	0	0	0	0	0	0	0	0	0	32.6579
H5883_003_3	2011	11																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	315.719073	6.30067117	1297.958509	0	522.7000585	7.0133065	12.34610647	254.7597264	888.7202369	0	1118.871984	0	0	324.517399	4018.735119	2243.145142	0.647539271	1038.073453	1551.78869	5868.138818	0	0	0	0	0	0	158.4435463	0	0	0	0	0	0	0	0	0	0	0	0	0	4000	"$75 per day, days 1-5"	"$75 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$75 OP copay or $45 ASC copay	0	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	$25 copay	0	No cost-sharing or $25 copay	No cost-sharing or $10 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	"$30 copay for office surgery, $25 copay for other services"	0	0	0	0	0	0	"$25 copay on exam, $0 on hearing aid/fitting"	0	0	0	0	0	0	0	0	0	0	0	0	0		272.3290202	272.3290202	20.00203072	0	46.5	0.2	0.023307653	49.98371654	55	0	24.62	0	0	20	10.38891298	20	20	25	16.37	23.69499388	0	0	0	0	0	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	227.086558	227.086558	16.67906089	0	38.77487951	0.17	0.019811505	41.67984057	45.86276071	0	24.62	0	0	16.67736753	8.662986	16.67736753	16.67736753	20.84670941	16.37	19.75850608	0	0	0	0	0	0	16.67736753	0	0	0	0	0	0	0	0	0	0	0	0	0		5.9746	0.119233144	1.80406075	0	1.688969316	1.192262105	0.244594956	0.884862065	3.396596964	0	2.295552354	0	0	0.451007994	2.901187173	3.117479663	0.000899938	1.803367969	2.116898405	9.662138041	0	0	0	0	0	0	0.220201771	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8739	0	6.583566143	5.9746	0.119233144	1.80406075	0	1.688969316	1.192262105	0.244594956	0.884862065	3.396596964	0	2.295552354	0	0	0.451007994	2.901187173	3.117479663	0.000899938	1.803367969	2.116898405	9.662138041	0	0	0	0	0	0	0.220201771	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8739	NO	"$75 per day, days 1-5"	"$75 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$75 OP copay or $45 ASC copay	0	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	$25 copay	0	No cost-sharing or $25 copay	No cost-sharing or $10 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	"$30 copay for office surgery, $25 copay for other services"	0	0	0	0	0	0	"$25 copay on exam, $0 on hearing aid/fitting"	0	0	0	0	0	0	0	0	0	0	0	0	0		0.4615	0.0092	0.1393	0	0.1305	0.0921	0.0185	0.0683	0.2623	0	0.1773	0	0	0.0348	0.2241	0.2408	0.0001	0.1393	0.1635	0.7463	0	0	0	0	0	0	0.017	0	0	0	0	0	0	0	0	0	0	0	0	0	2.9249			6.4361	0.128442469	1.943402725	0	1.819421863	1.28435	0.263128432	0.953207007	3.658943191	0	2.472856139	0	0	0.485842933	3.125268957	3.358267438	0.000969447	1.942656436	2.280403323	10.40842189	0	0	0	0	0	0	0.237209707	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7989
H5883_003_4	2011	11																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	293.9043949	8.48821357	1049.732677	0	515.6347366	7.0133065	12.99381399	259.0028344	811.6412238	0	560.4697282	0	0	201.0438511	3746.011096	2121.281084	1.541876352	189.9412898	1595.004048	5588.575531	0	0	0	0	0	0	108.3782653	0	0	0	0	0	0	0	0	0	0	0	0	0	4000	"$75 per day, days 1-5"	"$75 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$75 OP copay or $45 ASC copay	0	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	$25 copay	0	No cost-sharing or $25 copay	No cost-sharing or $10 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	"$30 copay for office surgery, $25 copay for other services"	0	0	0	0	0	0	"$25 copay on exam, $0 on hearing aid/fitting"	0	0	0	0	0	0	0	0	0	0	0	0	0		272.3290202	272.3290202	20.00203072	0	46.5	0.2	0.00859872	49.98682553	55	0	24.62	0	0	20	10.41722734	20	20	25	16.37	23.26779092	0	0	0	0	0	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	234.1495106	234.1495106	17.19782086	0	39.980874	0.17	0.007308912	42.97885964	47.2892058	0	24.62	0	0	17.19607484	8.956771048	17.19607484	17.19607484	21.49509355	16.37	20.0057337	0	0	0	0	0	0	17.19607484	0	0	0	0	0	0	0	0	0	0	0	0	0		5.7348	0.165625921	1.504426211	0	1.71796062	1.192262105	0.094970645	0.927637206	3.198489073	0	1.149897059	0	0	0.288097092	2.796013644	3.039809022	0.002209518	0.340233816	2.175851356	9.316962818	0	0	0	0	0	0	0.15530673	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8006	0	4.819550248	5.7348	0.165625921	1.504426211	0	1.71796062	1.192262105	0.094970645	0.927637206	3.198489073	0	1.149897059	0	0	0.288097092	2.796013644	3.039809022	0.002209518	0.340233816	2.175851356	9.316962818	0	0	0	0	0	0	0.15530673	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8006	NO	"$75 per day, days 1-5"	"$75 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$75 OP copay or $45 ASC copay	0	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	$25 copay	0	No cost-sharing or $25 copay	No cost-sharing or $10 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	"$30 copay for office surgery, $25 copay for other services"	0	0	0	0	0	0	"$25 copay on exam, $0 on hearing aid/fitting"	0	0	0	0	0	0	0	0	0	0	0	0	0		0.4429	0.0128	0.1162	0	0.1327	0.0921	0.0074	0.0716	0.247	0	0.0888	0	0	0.0223	0.216	0.2348	0.0002	0.0263	0.1681	0.7196	0	0	0	0	0	0	0.012	0	0	0	0	0	0	0	0	0	0	0	0	0	2.6108			6.1777	0.17841853	1.620625025	0	1.850652396	1.28435	0.102390588	0.999286013	3.44553385	0	1.238712764	0	0	0.310349125	3.011972039	3.274597676	0.002380177	0.366512783	2.34390968	10.03658604	0	0	0	0	0	0	0.167302305	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4113
H5883_003_5	2011	11																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	308.4968887	8.536810268	1156.561177	0	529.9652324	7.0133065	12.97562626	234.1504113	751.9515304	0	784.2501196	0	0	246.2767428	3952.248875	2392.110926	0.657099749	415.8655749	1443.494587	6038.94311	0	0	0	0	0	0	112.8497395	0	0	0	0	0	0	0	0	0	0	0	0	0	4000	"$75 per day, days 1-5"	"$75 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$75 OP copay or $45 ASC copay	0	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	$25 copay	0	No cost-sharing or $25 copay	No cost-sharing or $10 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	"$30 copay for office surgery, $25 copay for other services"	0	0	0	0	0	0	"$25 copay on exam, $0 on hearing aid/fitting"	0	0	0	0	0	0	0	0	0	0	0	0	0		272.3290202	272.3290202	20.00203072	0	46.5	0.2	0.022017862	49.98109853	55	0	24.62	0	0	20	10.39545542	20	20	25	16.37	23.38672336	0	0	0	0	0	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	230.9791634	230.9791634	16.9649651	0	39.43953931	0.17	0.018715182	42.39207528	46.64891746	0	24.62	0	0	16.96324271	8.817031673	16.96324271	16.96324271	21.20405339	16.37	19.83573323	0	0	0	0	0	0	16.96324271	0	0	0	0	0	0	0	0	0	0	0	0	0		5.938	0.164318774	1.635084999	0	1.741798718	1.192262105	0.242841212	0.827176822	2.92314374	0	1.609019829	0	0	0.34813768	2.903925293	3.38149652	0.000928879	0.734836321	1.9691672	9.982238711	0	0	0	0	0	0	0.159524793	0	0	0	0	0	0	0	0	0	0	0	0	0	35.7539	0	5.57422749	5.938	0.164318774	1.635084999	0	1.741798718	1.192262105	0.242841212	0.827176822	2.92314374	0	1.609019829	0	0	0.34813768	2.903925293	3.38149652	0.000928879	0.734836321	1.9691672	9.982238711	0	0	0	0	0	0	0.159524793	0	0	0	0	0	0	0	0	0	0	0	0	0	35.7539	NO	"$75 per day, days 1-5"	"$75 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$75 OP copay or $45 ASC copay	0	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	$25 copay	0	No cost-sharing or $25 copay	No cost-sharing or $10 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	No cost-sharing or $25 copay	"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	"$30 copay for office surgery, $25 copay for other services"	0	0	0	0	0	0	"$25 copay on exam, $0 on hearing aid/fitting"	0	0	0	0	0	0	0	0	0	0	0	0	0		0.4586	0.0127	0.1263	0	0.1345	0.0921	0.0187	0.0639	0.2258	0	0.1243	0	0	0.0269	0.2243	0.2612	0.0001	0.0568	0.1521	0.771	0	0	0	0	0	0	0.0123	0	0	0	0	0	0	0	0	0	0	0	0	0	2.7615			6.3967	0.177010422	1.761375632	0	1.876331701	1.28435	0.261557217	0.891066274	3.148921405	0	1.733297241	0	0	0.375027125	3.128218564	3.64267642	0.001000623	0.791593581	2.121261661	10.75324648	0	0	0	0	0	0	0.171846163	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5155
H5883_004_1	2011	10																															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	4.867412438	0.044928144	0.810017439	0	0.151057541	0.602472171	0.002986568	0.000769303	1.244368726	0.002753214	0.346923946	0	0	0.226884191	0.03477496	0.428686346	0.000157961	0.02993723	0.611657866	2.144430033	0	0.004302651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.5545	YES	127.3846603	4.318961391	503.0019682	0	216.5964354	7.0133065	5.57870776	116.7625153	338.0465569	0	365.9419358	0	0	120.9856396	1594.170233	928.9148603	0.224261409	186.4240672	621.4234883	2379.282529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5000	"$225 per day, days 1-5"	"$225 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay	0	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$40 copay	0	No cost-sharing or $40 copay	No cost-sharing or $25 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $40 copay for other services"	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		703.668	703.668	22.97974488	0	46.5	0.2	0.025246079	49.97259951	91.66666667	0	24.62	0	0	40	24.75364732	40	40	40	27.28021686	43.42258188	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	622.3677587	622.3677587	20.32471608	0	41.12749305	0.17	0.021459167	44.19887611	81.07570315	0	24.62	0	0	35.37848865	21.89366577	35.37848865	35.37848865	35.37848865	27.28021686	38.405633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		6.6067	0.223998527	0.851947683	0	0.742339033	1.192262105	0.119714423	0.430064329	2.283946858	0	0.750790872	0	0	0.356690757	2.908519188	2.738633653	0.000661169	0.549616812	1.41271396	7.614820968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.7834	200	3.119061283	11.4741	0.268926671	1.661965122	0	0.893396574	1.794734276	0.122700991	0.430833632	3.528315584	0.002753214	1.097714818	0	0	0.583574948	2.943294148	3.167319999	0.00081913	0.579554042	2.024371826	9.759251001	0	0.004302651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3379	NO	"$225 per day, days 1-5"	"$225 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay	0	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$40 copay	0	No cost-sharing or $40 copay	No cost-sharing or $25 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $40 copay for other services"	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0.8862	0.0208	0.1284	0	0.069	0.1386	0.0099	0.0333	0.2725	0.0002	0.0848	0	0	0.0451	0.2273	0.2446	0.0001	0.0448	0.1564	0.7538	0	0.0003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.116			12.3603	0.289698019	1.790331921	0	0.962400704	1.933355893	0.132553054	0.464110344	3.800835488	0.002965867	1.182500073	0	0	0.628649087	3.170628189	3.41195734	0.000882398	0.624317615	2.18073018	10.51303566	0	0.004634979	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.4539
H5883_004_2	2011	10																															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	4.908775138	0.045306732	0.816900872	0	0.151701843	0.565626447	0.002999306	0.000723939	1.254943226	0.002776611	0.349872065	0	0	0.228812226	0.034923285	0.430514812	0.000158635	0.030064921	0.614266757	2.153518209	0	0.004321003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.5962	YES	136.7992233	4.634258717	540.1771172	0	231.6281081	7.0133065	7.15344105	125.040025	363.0304176	0	392.9874482	0	0	129.927273	1696.013805	993.381037	0.239825026	199.3617942	664.5499341	2544.305751	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5000	"$225 per day, days 1-5"	"$225 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay	0	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$40 copay	0	No cost-sharing or $40 copay	No cost-sharing or $25 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $40 copay for other services"	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		703.668	703.668	22.97974488	0	46.5	0.2	0.021054867	49.97403859	91.66666667	0	24.62	0	0	40	24.7684405	40	40	40	27.28021686	43.42271326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	615.6155286	615.6155286	20.10420794	0	40.68129016	0.17	0.017896637	43.72060998	80.1960917	0	24.62	0	0	34.9946582	21.66907774	34.9946582	34.9946582	34.9946582	27.28021686	37.98907521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		7.018	0.237743469	0.904986091	0	0.785244189	1.192262105	0.128022538	0.455568847	2.426135055	0	0.806279248	0	0	0.378896709	3.062587916	2.896919154	0.000699383	0.581383154	1.510755526	8.054651879	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.4401	200	3.577436492	11.9268	0.283050201	1.721886963	0	0.936946033	1.757888552	0.131021844	0.456292786	3.68107828	0.002776611	1.156151313	0	0	0.607708936	3.097511201	3.327433966	0.000858018	0.611448074	2.125022283	10.20817009	0	0.004321003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0363	NO	"$225 per day, days 1-5"	"$225 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay	0	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$40 copay	0	No cost-sharing or $40 copay	No cost-sharing or $25 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $40 copay for other services"	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0.9212	0.0219	0.133	0	0.0724	0.1358	0.0104	0.0352	0.2843	0.0002	0.0893	0	0	0.0469	0.2392	0.257	0.0001	0.0472	0.1641	0.7885	0	0.0003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.2471			12.848	0.304912422	1.854882003	0	1.009313835	1.893664281	0.14143098	0.491535911	3.965397264	0.00299107	1.245450084	0	0	0.654647135	3.336756653	3.584438184	0.00092429	0.658675077	2.289154673	10.99662834	0	0.004654748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2834
H5883_004_3	2011	10																															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	4.917903628	0.0453902	0.818420003	0	0.151960112	0.556701846	0.003004412	0.000712575	1.257276952	0.002781774	0.350522697	0	0	0.229237732	0.034982741	0.431247753	0.000158905	0.030116105	0.615312531	2.157169396	0	0.004328359	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.6072	YES	139.3110735	4.718358166	550.0956237	0	235.8441664	7.0133065	7.447599154	127.2469678	369.6962304	0	400.2033195	0	0	132.3129433	1724.605047	1011.462402	0.244190284	202.9905461	676.6459674	2590.591958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5000	"$225 per day, days 1-5"	"$225 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay	0	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$40 copay	0	No cost-sharing or $40 copay	No cost-sharing or $25 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $40 copay for other services"	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		703.668	703.668	22.97974488	0	46.5	0.2	0.020591363	49.97438673	91.66666667	0	24.62	0	0	40	24.77227939	40	40	40	27.28021686	43.42274609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	613.9128034	613.9128034	20.0486019	0	40.56877016	0.17	0.017502658	43.59998729	79.97427808	0	24.62	0	0	34.8978668	21.61249267	34.8978668	34.8978668	34.8978668	27.28021686	37.88403023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		7.1271	0.241388374	0.919054014	0	0.797325648	1.192262105	0.130352784	0.462330515	2.463849095	0	0.821083811	0	0	0.384786623	3.106084494	2.941490015	0.000710143	0.590328087	1.538254061	8.178505336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.8949	200	3.703892405	12.045	0.286778575	1.737474017	0	0.94928576	1.748963951	0.133357197	0.46304309	3.721126047	0.002781774	1.171606508	0	0	0.614024354	3.141067235	3.372737769	0.000869048	0.620444192	2.153566592	10.33567473	0	0.004328359	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5021	NO	"$225 per day, days 1-5"	"$225 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay	0	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$40 copay	0	No cost-sharing or $40 copay	No cost-sharing or $25 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $40 copay for other services"	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0.9303	0.0222	0.1342	0	0.0733	0.1351	0.0106	0.0358	0.2874	0.0002	0.0905	0	0	0.0474	0.2426	0.2605	0.0001	0.0479	0.1663	0.7983	0	0.0003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.283			12.9753	0.308928767	1.871672969	0	1.022606658	1.884050362	0.143923314	0.498807595	4.008538238	0.002996633	1.262099006	0	0	0.661450344	3.383676866	3.63324116	0.000936172	0.668366037	2.319903686	11.13398118	0	0.004662673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7851
H5883_004_4	2011	10																															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	4.944031497	0.045628553	0.82276811	0	0.153469274	0.525623709	0.00303425	0.000671088	1.26395662	0.002796553	0.352384956	0	0	0.230455627	0.035330165	0.435530606	0.000160483	0.030415198	0.621423387	2.178534588	0	0.004371345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.6506	YES	148.9893333	5.042285862	588.3120282	0	253.3875636	7.0133065	7.791277844	135.7432565	395.3798753	0	428.0063619	0	0	141.5050269	1843.723258	1086.700586	0.262354511	218.0901089	726.9786475	2783.197331	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5000	"$225 per day, days 1-5"	"$225 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay	0	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$40 copay	0	No cost-sharing or $40 copay	No cost-sharing or $25 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $40 copay for other services"	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		703.668	703.668	22.97974488	0	46.5	0.2	0.021147199	49.97559609	91.66666667	0	24.62	0	0	40	24.78699184	40	40	40	27.28021686	43.42286565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	604.7322991	604.7322991	19.7487934	0	39.96210132	0.17	0.017975119	42.94902869	78.77833593	0	24.62	0	0	34.37600113	21.30194149	34.37600113	34.37600113	34.37600113	27.28021686	37.31761197	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		7.5082	0.25410276	0.968204392	0	0.843824958	1.192262105	0.140049147	0.485836751	2.595614053	0	0.878126386	0	0	0.405364747	3.272907081	3.113035047	0.000751558	0.624755486	1.65267793	8.655189836	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5909	200	4.33766406	12.4523	0.299731313	1.790972502	0	0.997294232	1.717885814	0.143083397	0.48650784	3.859570674	0.002796553	1.230511342	0	0	0.635820375	3.308237246	3.548565654	0.000912042	0.655170683	2.274101317	10.83372442	0	0.004371345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2415	NO	"$225 per day, days 1-5"	"$225 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay	0	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$40 copay	0	No cost-sharing or $40 copay	No cost-sharing or $25 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $40 copay for other services"	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0.9618	0.0232	0.1383	0	0.077	0.1327	0.0112	0.0376	0.2981	0.0002	0.095	0	0	0.0491	0.2555	0.2741	0.0001	0.0506	0.1756	0.8368	0	0.0003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.4172			13.414	0.322881949	1.929303567	0	1.074323206	1.850571813	0.154254492	0.524084714	4.157676046	0.003012553	1.32555353	0	0	0.684929844	3.563758748	3.822649632	0.000982486	0.705774732	2.449748268	11.67049922	0	0.004708979	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6588
H5883_004_5	2011	11																															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	4.968056878	0.045848212	0.826766328	0	0.154399693	0.502256055	0.003052645	0.000640802	1.270098782	0.002810143	0.354097361	0	0	0.23157552	0.035544357	0.438171041	0.000161456	0.030599592	0.625190811	2.191700855	0	0.004397847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.6854	YES	157.0045634	5.310581847	619.9616518	0	267.3388381	7.0133065	8.424317914	142.781172	416.6502619	0	451.0319667	0	0	149.1176213	1938.359691	1146.53327	0.276799497	230.0979395	767.0053894	2936.362844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5000	"$225 per day, days 1-5"	"$225 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay	0	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$40 copay	0	No cost-sharing or $40 copay	No cost-sharing or $25 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $40 copay for other services"	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		703.668	703.668	22.97974488	0	46.5	0.2	0.020634956	49.97650375	91.66666667	0	24.62	0	0	40	24.79739152	40	40	40	27.28021686	43.42295266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	597.9584146	597.9584146	19.52757809	0	39.51446745	0.17	0.017539713	42.46870819	77.89590357	0	24.62	0	0	33.99093974	21.07216602	33.99093974	33.99093974	33.99093974	27.28021686	36.89967418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		7.8235	0.264625592	1.008862464	0	0.880312651	1.192262105	0.147760118	0.505310994	2.704612385	0	0.925367252	0	0	0.42238734	3.403786435	3.247645274	0.000784056	0.651770433	1.74367278	9.02923602	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.9519	200	4.857499422	12.7916	0.310473803	1.835628792	0	1.034712344	1.69451816	0.150812764	0.505951796	3.974711167	0.002810143	1.279464612	0	0	0.65396286	3.439330792	3.685816316	0.000945512	0.682370025	2.36886359	11.22093687	0	0.004397847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6373	NO	"$225 per day, days 1-5"	"$225 per day, days 1-5"	"$0 copay days 1-20, $130 copay days 21 - 100"	0	$50 copay	20% coinsurance	20% coinsurance; no cost-sharing for diabetes monitoring supplies	"$50 ER copay, $35 urgent care copay"	$125 OP copay or $75 ASC copay	0	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	$40 copay	0	No cost-sharing or $40 copay	No cost-sharing or $25 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	No cost-sharing or $40 copay	"$20 copay for low-tech radiology, $40 copay for high-tech radiology"	"$50 copay for office surgery, $40 copay for other services"	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0.988	0.024	0.1418	0	0.0799	0.1309	0.0116	0.0391	0.307	0.0002	0.0988	0	0	0.0505	0.2656	0.2847	0.0001	0.0527	0.183	0.8667	0	0.0003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.5249			13.7796	0.334454167	1.977409019	0	1.114631416	1.825399289	0.162458193	0.545030481	4.281709756	0.003027192	1.378287851	0	0	0.704473618	3.704977692	3.970501256	0.001018542	0.735074895	2.551829786	12.08761917	0	0.004737528	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1622
H5883_801_0	2011	9																															Coin	Coin	Coin	Coin	Coin	Coin	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	0	0	YES	260.0539336	2.773964614	40.12215777	11.62188669	8.206172	17.69211674	0.359893865	17.50839743	74.031925	0.158361097	20.3521078	0	0	17.6149244	26.07504504	25.96110663	0	1.747172832	45.77577114	144.5655298	24.97127	2.991379006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6700	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	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	0	0	0	0	0	0	0	0	0		0.072933311	0.072933311	0.168141252	0	0.232999983	0.232999983	0.232999983	0.232999983	0.232999983	0.232999983	0.233	0.233	0.23	0.232999983	0.232999983	0.232999983	0	0.232999983	0.23	0.232999983	0.232999983	0.232999983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0.067522816	0.067522816	0.155667839	0	0.215715081	0.198049985	0.215715081	0.215715081	0.215715081	0.215715081	0.233	0.215715097	0.212937649	0.215715081	0.215715081	0.215715081	0	0.215715081	0.23	0.215715081	0.215715081	0.215715081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		17.5596	0.187305904	6.245729614	0	1.770195059	3.503923463	0.077634534	3.776825371	15.96980271	0.034160877	4.742041117	0	0	3.799804845	5.624780456	5.600202223	0	0.376891529	10.52842736	31.18496498	5.386679534	0.645285565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.0142		9.504782751	17.5596	0.187305904	6.245729614	0	1.770195059	3.503923463	0.077634534	3.776825371	15.96980271	0.034160877	4.742041117	0	0	3.799804845	5.624780456	5.600202223	0	0.376891529	10.52842736	31.18496498	5.386679534	0.645285565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.0142	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												1.3563	0.0145	0.4824	0	0.1367	0.2706	0.006	0.2917	1.2335	0.0026	0.3663	0	0	0.2935	0.4344	0.4325	0	0.0291	0.8132	2.4087	0.4161	0.0498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.0379			18.9158	0.20177303	6.72813704	0	1.906921317	3.774559369	0.083630867	4.068539665	17.20327772	0.036799393	5.108306708	0	0	4.093294027	6.059227035	6.032750429	0	0.406001863	11.34162163	33.59362812	5.802735682	0.695126107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.0522
H5883_805_0	2011	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	0	0	0	0	0	0	0	0	0	0	YES	265.1852903	2.380535469	40.84542907	11.8313913	8.206172	17.39061261	0.03374756	16.59884177	68.025824	0.131362074	20.14936516	0	0	25.83731899	25.55043169	25.07568206	0	2.572086708	40.89286087	148.3056109	27.579793	3.292053415	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6700	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	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	0	0	0	0	0	0	0	0	0		0.072933311	0.072933311	0.168141252	0	0.232999983	0.232999983	0.232999983	0.232999983	0.232999983	0.232999983	0.233	0.233	0.23	0.232999983	0.232999983	0.232999983	0	0.232999983	0.23	0.232999983	0.232999983	0.232999983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0.066539682	0.066539682	0.153401312	0	0.212574264	0.198049985	0.212574264	0.212574264	0.212574264	0.212574264	0.233	0.212574279	0.209837272	0.212574264	0.212574264	0.212574264	0	0.212574264	0.23	0.212574264	0.212574264	0.212574264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		17.6453	0.158400074	6.265742389	0	1.744420971	3.444210574	0.007173863	3.528486568	14.46053945	0.027924196	4.694802082	0	0	5.492349061	5.431364206	5.330444651	0	0.546759438	9.405357999	31.52595604	5.862754191	0.699805831	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.2718		11.34308714	17.6453	0.158400074	6.265742389	0	1.744420971	3.444210574	0.007173863	3.528486568	14.46053945	0.027924196	4.694802082	0	0	5.492349061	5.431364206	5.330444651	0	0.546759438	9.405357999	31.52595604	5.862754191	0.699805831	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.2718	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												1.3629	0.0122	0.484	0	0.1347	0.266	0.0006	0.2725	1.1169	0.0022	0.3626	0	0	0.4242	0.4195	0.4117	0	0.0422	0.7265	2.435	0.4528	0.0541	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.9806			19.0082	0.170634573	6.749695561	0	1.879156492	3.710234379	0.007727957	3.801019679	15.57744205	0.030081004	5.057419026	0	0	5.916566909	5.850871707	5.742157332	0	0.588990023	10.13180868	33.96095663	6.315581376	0.753857407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.2524
H5883_807_0	2011	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	0	0	0	0	0	0	0	0	0	0	YES	232.5889106	1.554585718	35.7433224	10.35350205	7.370702	17.14482644	0	15.95797731	67.069675	0.154518066	23.76830838	0	0	14.82336841	22.25221829	23.16049795	0	2.79322472	34.49689932	135.3388204	17.563436	2.040293068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6700	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	Medicare Cost-Sharing	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	0	0	0	0	0	0	0	0	0		0.072933311	0.072933311	0.168141252	0	0.232999983	0.232999983	0	0.232999983	0.232999983	0.232999983	0.233	0.233	0.23	0.232999983	0.232999983	0.232999983	0	0.232999983	0.23	0.232999983	0.232999983	0.232999983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0.06848991	0.06848991	0.157897387	0	0.218804653	0.198049985	0	0.218804653	0.218804653	0.218804653	0.233	0.218804669	0.215987442	0.218804653	0.218804653	0.218804653	0	0.218804653	0.23	0.218804653	0.218804653	0.218804653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		15.93	0.106473435	5.643777201	0	1.612743894	3.395532626	0	3.491679688	14.67515697	0.033809272	5.538015853	0	0	3.243421982	4.868888902	5.067624718	0	0.611170566	7.934286844	29.61276364	3.84296152	0.446425617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0547		6.978928591	15.93	0.106473435	5.643777201	0	1.612743894	3.395532626	0	3.491679688	14.67515697	0.033809272	5.538015853	0	0	3.243421982	4.868888902	5.067624718	0	0.611170566	7.934286844	29.61276364	3.84296152	0.446425617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0547	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												1.2304	0.0082	0.4359	0	0.1246	0.2623	0	0.2697	1.1335	0.0026	0.4277	0	0	0.2505	0.3761	0.3914	0	0.0472	0.6128	2.2872	0.2968	0.0345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.1915			17.1604	0.114697227	6.079691049	0	1.737308945	3.657796646	0	3.76136991	15.80863618	0.036420631	5.96576091	0	0	3.493937285	5.244951958	5.459037723	0	0.658376135	8.547114989	31.89999315	4.139784035	0.480906621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2462
H5884_007_0	2011	6																															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	1284.73253	26.13555209	278.6138645	24.27252218	168.0911815	24.17768076	7.025108783	301.8271677	407.9074918	14.94127774	19.0739996	0	6.877242004	294.8664812	3965.936882	4916.602707	421.3859285	87.06111677	22.67763688	28.61628011	13.79800563	0	2.571428571	1223.84044	231.7546986	0	35.18990374	0	360	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	2:  Skilled Nursing Services - $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	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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $20/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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/18a:  Hearing Exams - $20/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	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year	18a:  Routine Hearing Test - $20/visit		14c:  Routine Exams - $0/visit/												0	100	100	75	0	100	0.2	0.032840032	29.21288555	200	0	0.109970032	0	10	20	20	32.11039474	20	20	0	0.00136323	0.089464187	0	0	0	20	0	20	0	0	0											NO	87.54496787	87.54496787	65.6587259	0	87.54496787	0.175089936	0.028749796	25.58995406	175.0899357	0	0.096273229	0	8.754496787	17.50899357	17.50899357	28.11103476	17.50899357	17.50899357	0	0.001193439	0.078321394	0	0	0	20	0	20	0	0	0												9.3727	0.190669672	1.524452613	0	1.226294757	4.233268571	0.201970443	0.64364528	5.951708044	0	1.836315527	0	0.005017233	0.43023461	5.786630282	11.5175658	0.61483696	0.127029378	0	0.034151797	1.080679036	0	0	0	0.386257831	0	0.05864984	0	0	0	0	0	0	0	0	0	0	0	0	0	45.222	0	6.37	9.3727	0.190669672	1.524452613	0	1.226294757	4.233268571	0.201970443	0.64364528	5.951708044	0	1.836315527	0	0.005017233	0.43023461	5.786630282	11.5175658	0.61483696	0.127029378	0	0.034151797	1.080679036	0	0	0	0.386257831	0	0.05864984	0	0	0	0	0	0	0	0	0	0	0	0	0	45.222	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	0	0	9.3727	0.190669672	1.524452613	0	1.226294757	4.233268571	0.201970443	0.64364528	5.951708044	0	1.836315527	0	0.005017233	0.43023461	5.786630282	11.5175658	0.61483696	0.127029378	0	0.034151797	1.080679036	0	0	0	0.386257831	0	0.05864984	0	0	0	0	0	0	0	0	0	0	0	0	0	45.222
H5887_001_0	2011	10																																				Coin	Coin	V								V																									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	0	0	0	0	0	10.50209308	2.031906705	347.0867081	0	0	0	0	0	0	0	4000	0	0	0	0	0	0	0	0	0	0	0	0	0	0											6700	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	5% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"5% Coinsurance for DME/Prosthetics/Supplies; PBP 11b, 11c"	$35/Visit for ER; PBP 4a	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b				"No Cost Sharing; PBP 4b, 7a, 14b-j"	$5/Visit for Specialist; PBP 7d	"No Cost Sharing; PBP 7e, 7h, 9c"	"No Cost Sharing; PBP 7c, 7i"	No Cost Sharing; PBP 8b	"No Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	No Cost Sharing; PBP 15		No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-e											0	0	0	0	0	0	0.05	0.05	35	0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0.05	0.05	35	0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0.525104654	0.101595335	1.012336232	0	0	0	0	0	0	0	1.666666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.3057	0	0	0	0	0	0	0	0.525104654	0.101595335	1.012336232	0	0	0	0	0	0	0	1.666666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.3057	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0.525104654	0.101595335	1.012336232	0	0	0	0	0	0	0	1.666666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.3057
H5887_006_0	2011	7																																				Coin	Coin	V																																	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	0	0	0	0	0	18.26650046	4.361150617	487.0860263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											6700	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	5% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"5% Coinsurance for DME/Prosthetics/Supplies; PBP 11b, 11c"	$25/Visit for ER; PBP 4a	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b				"No Cost Sharing; PBP 4b, 7a, 14b-j"	No Cost Sharing; PBP 7d	"No Cost Sharing; PBP 7e, 7h, 9c"	"No Cost Sharing; PBP 7c, 7i"	No Cost Sharing; PBP 8b	"No Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	No Cost Sharing; PBP 15		No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-e											0	0	0	0	0	0	0.05	0.05	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	0.05	0.05	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	0.913325023	0.218057531	1.014762555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.1461	0	0	0	0	0	0	0	0.913325023	0.218057531	1.014762555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.1461	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0.913325023	0.218057531	1.014762555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.1461
H5887_007_0	2011	9																																				Coin	Coin	V								V																									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	0	0	0	0	0	17.66865023	3.54106451	424.4277411	0	0	0	0	0	0	0	4000	0	0	0	0	0	0	0	0	0	0	0	0	0	0											6700	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	5% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"5% Coinsurance for DME/Prosthetics/Supplies; PBP 11b, 11c"	$35/Visit for ER; PBP 4a	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b				"No Cost Sharing; PBP 4b, 7a, 14b-j"	$5/Visit for Specialist; PBP 7d	"No Cost Sharing; PBP 7e, 7h, 9c"	"No Cost Sharing; PBP 7c, 7i"	No Cost Sharing; PBP 8b	"No Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	No Cost Sharing; PBP 15		No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-e											0	0	0	0	0	0	0.05	0.05	35	0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0.05	0.05	35	0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0.883432512	0.177053225	1.237914245	0	0	0	0	0	0	0	1.666666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.9651	0	1.78E-15	0	0	0	0	0	0.883432512	0.177053225	1.237914245	0	0	0	0	0	0	0	1.666666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.9651	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0.883432512	0.177053225	1.237914245	0	0	0	0	0	0	0	1.666666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.9651
H5887_010_0	2011	9																																				Coin	Coin	V																																	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	0	0	0	0	0	18.21019499	4.347707613	485.5846107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											6700	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	5% Coinsurance for DME/Prosthetics/Supplies; PBP 11a	"5% Coinsurance for DME/Prosthetics/Supplies; PBP 11b, 11c"	$25/Visit for ER; PBP 4a	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b				"No Cost Sharing; PBP 4b, 7a, 14b-j"	No Cost Sharing; PBP 7d	"No Cost Sharing; PBP 7e, 7h, 9c"	"No Cost Sharing; PBP 7c, 7i"	No Cost Sharing; PBP 8b	"No Cost Sharing; PBP 3, 4b, 5, 7b, 7f, 7g, 8a, 9a, 9d, 12, 13a, 13b, 14d-j, 17a, 18a"	No Cost Sharing; PBP 15		No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	No Cost Sharing; PBP 14a	No Cost Sharing; PBP 13b-e											0	0	0	0	0	0	0.05	0.05	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	0.05	0.05	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	0.91050975	0.217385381	1.011634606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.1395	0	0	0	0	0	0	0	0.91050975	0.217385381	1.011634606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.1395	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0.91050975	0.217385381	1.011634606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.1395
H5895_001_0	2011	4																																																																																																															0	YES																																									10	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	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance											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	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2011	3																															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	666.431518	25.02099955	40.1569889	0	9.421148545	14.07668325	7.874247947	61.80989082	70.33576725	15.15282182	23.23380771	2.028287795	0.26473751	40.31251264	76.69981673	136.3070944	4.536896915	12.11603075	22.7023913	47.5790271	36.38878973	9.64267394	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 1b	Medicare-FFS Cost Sharing; PBP 2	No Cost-Sharing; PBP 6	20% Coinsurance for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"20% Coinsurance for ER - Facility; 20% Coinsurance for ER - Worldwide; 20% Coinsurance for PCP Urgent Care; PBP 4a, 4b"	20% Coinsurance for OP Fac - Surgery; PBP 9b	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	20% Coinsurance for OP Fac - Observation; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"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; PBP 3, 5, 9a, 9c, 9d, 13a"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for PCP Office Visits; 20% Coinsurance for PCP Consults; 20% Coinsurance for PCP Immunizations; $0/ for Influenza Virus Vaccine; $0/ for Hepatitis B (HBV) Vaccine; $0/ for Initial Preventive Physical Examination (IPPE); $0/ for Pneumococcal Vaccine; PBP 7a, 14b-c"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for Speclst Office Visits; 20% Coinsurance for Speclst Consults; 20% Coinsurance for Cardio; 20% Coinsurance for Chiropractor; 20% Coinsurance for Speclst Immunizations; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing/Speech Exams; $0/ for Prostate Cancer Screenings; $0/ for Screening Pap Tests; $0/ for Screening Pelvic Exam; 20% Coinsurance for Podiatrist (Routine); PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"20% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; 20% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"20% Coinsurance for Occ Therapy; 20% Coinsurance for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); $0/ for Bone Mass Measurements; $0/ for Screening Mammography; $0/ for Ultrasound Screening for Abdominal Aortic Aneurysm; PBP 7d, 14g-h"	"20% Coinsurance for Prof - Primary Surgeon (IP); 20% Coinsurance for Prof - Asst Surgeon (IP); 20% Coinsurance for Prof - Anesthesia (IP); 20% Coinsurance for Prof - Primary Surgeon (OP); 20% Coinsurance for Prof - Anesthesia (OP); 20% Coinsurance for Prof - IP Visits; 20% Coinsurance for Allergy Testing; 20% Coinsurance for Allergy Tx; 20% Coinsurance for Prof - ER Visits; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); $0/ for Cardiovascular Disease Screenings; $0/ for Colorectal Cancer Screening; $0/ for Diabetes Screening Tests; $0/ for Diabetes Self-Management Training; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"20% Coinsurance for Renal Dialysis - Prof; $0/ for Glaucoma Screening; 20% Coinsurance for Medical Nutrition Therapy (MNT); $0/ for Smoking and Tobacco-Use Cessation Counseling; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	PBP 14a	"No Cost-Sharing; PBP 13b-f, 14a"											0	0.059080027	0.059080027	0.146966941	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	0.058566827	0.058566827	0.115507415	0	0.182847901	0.182847901	0.182847901	0.182859474	0.182847901	0.182847901	0.182847901	0.182847901	0.182847901	0.182847901	0.182942402	0.182879692	0.182847901	0.182847901	0.182847901	0.182847901	0.182847901	0.185740135	0	0	0	0	0	0	0	0												39.0308	1.465400556	4.63842997	0	1.722637241	2.573891991	1.439789713	11.30252411	12.86074744	2.77066167	4.248252983	0.370868167	0.048406698	7.37105834	14.03164868	24.92779946	0.82956208	2.215390797	4.151084607	8.699725259	6.653613839	1.79103156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.1433	0	11.70600385	39.0308	1.465400556	4.63842997	0	1.722637241	2.573891991	1.439789713	11.30252411	12.86074744	2.77066167	4.248252983	0.370868167	0.048406698	7.37105834	14.03164868	24.92779946	0.82956208	2.215390797	4.151084607	8.699725259	6.653613839	1.79103156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.1433	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	39.0308	1.465400556	4.63842997	0	1.722637241	2.573891991	1.439789713	11.30252411	12.86074744	2.77066167	4.248252983	0.370868167	0.048406698	7.37105834	14.03164868	24.92779946	0.82956208	2.215390797	4.151084607	8.699725259	6.653613839	1.79103156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.1433
H5926_001_0	2011	7																															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	226.4539737	0	32.4994918	0	14.18118267	13.0760568	0.404414128	45.98707877	57.07564855	7.634500674	17.86915827	0	0	41.43306255	44.00715531	67.60739758	1.97679921	1.897097336	17.20277533	69.32722685	19.45411278	0	0	0	0	0	0	0	0	0											6700	7% Coinsurance for IP Medical; 7% Coinsurance for IP Surgical; PBP 1a	7% Coinsurance for IP Psych; 7% Coinsurance for IP Substance Abuse; PBP 1b	17% Coinsurance for SNF; PBP 2	No Cost-Sharing; PBP 6	23% Coinsurance for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for DME / Medical Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"23% Coinsurance for ER - Facility; 23% Coinsurance for PCP Urgent Care; PBP 4a, 4b"	"23% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	23% Coinsurance for OP Fac - Pathology; PBP 8a	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	23% Coinsurance; PBP 9a	23% Coinsurance for Renal Dialysis - Fac; PBP 12	"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 OP Substance Abuse; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"23% Coinsurance for Prof - Asst Surgeon (OP); 23% Coinsurance for PCP Office Visits; 23% Coinsurance for PCP Consults; 23% Coinsurance for PCP Immunizations; PBP 7a, 14b, 14c"	"23% Coinsurance for Prof - Asst Surgeon (OP); 23% Coinsurance for Speclst Office Visits; 23% Coinsurance for Speclst Consults; 23% Coinsurance for Cardio; 23% Coinsurance for Chiropractor; 23% Coinsurance for Speclst Immunizations; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; PBP 7e, 7h"	"23% Coinsurance for Occ Therapy; 23% Coinsurance for PT/ST; PBP 7c, 7i"	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office); 23% Coinsurance for Prof Radiology (Office); PBP 8b	"23% Coinsurance for Prof - Primary Surgeon (IP); 23% Coinsurance for Prof - Asst Surgeon (IP); 23% Coinsurance for Prof - Anesthesia (IP); 23% Coinsurance for Prof - Primary Surgeon (OP); 23% Coinsurance for Prof - Anesthesia (OP); 23% Coinsurance for Prof - IP Visits; 23% Coinsurance for Allergy Testing; 23% Coinsurance for Allergy Tx; 23% Coinsurance for Renal Dialysis - Prof; 23% Coinsurance for Prof - ER Visits; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14d-j"	23% Coinsurance for Part B Rx; 23% Coinsurance for Tx Injections; PBP 15	23% Coinsurance																			0	0.070322971	0	0.165825158	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	0	0	0	0	0	0	0	0											NO	0.069250232	0	0.163295584	0	0.22944571	0.22944571	0.22944571	0.22944571	0.22944571	0.22944571	0.22944571	0	0	0.22944571	0.229507822	0.229472069	0.22944571	0.22944571	0.22944571	0.22944571	0.22944571	0	0	0	0	0	0	0	0	0												15.682	0	5.307023506	0	3.253811526	3.000245136	0.092791087	10.55153794	13.0957627	1.751703427	4.100001705	0	0	9.506638452	10.09998635	15.5140094	0.453568098	0.435280845	3.947103	15.90683479	4.463662718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.162	0	1.810343111	15.682	0	5.307023506	0	3.253811526	3.000245136	0.092791087	10.55153794	13.0957627	1.751703427	4.100001705	0	0	9.506638452	10.09998635	15.5140094	0.453568098	0.435280845	3.947103	15.90683479	4.463662718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.162	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.682	0	5.307023506	0	3.253811526	3.000245136	0.092791087	10.55153794	13.0957627	1.751703427	4.100001705	0	0	9.506638452	10.09998635	15.5140094	0.453568098	0.435280845	3.947103	15.90683479	4.463662718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.162
H5926_002_0	2011	9																															A	A	D		T	Coin	Coin	V	V		Coin		Coin	V	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	0	0	0	0	0	0	0											0	YES	288.94518	2.50446009	828.4328555	0	244.4470969	9.974940298	4.81714656	446.0397483	307.9187272	0	18.03002123	0	0.31023985	935.705541	4346.56722	4371.584049	122.5566566	413.2709741	15.56223501	72.37549719	9.195541847	0	0	0	359.0011004	0	0	0	0	0											3000	$500/Admit for IP Medical; $500/Admit for IP Surgical; PBP 1a	$500/Admit for IP Psych; $500/Admit for IP Substance Abuse; PBP 1b	$100 /Days 11-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$75/Run for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for ER - Facility; $30/Visit for PCP Urgent Care; PBP 4a, 4b"	"$50/Case for OP Hospital Services; $50/Case for Ambulatory Surgery Center Services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	20% Coinsurance for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET; PBP 8b		20% Coinsurance for Renal Dialysis - Fac; PBP 12	"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; $50/Case for OP Fac - Other; $20/Visit for Prof - CORF; $30/Visit for OP Substance Abuse; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"$10/Visit for Prof - Asst Surgeon (OP); $10/Visit for PCP Office Visits; $10/Consult for PCP Consults; PBP 7a, 14b, 14c"	"$20/Visit for Prof - Asst Surgeon (OP); $20/Visit for Speclst Office Visits; $20/Consult for Speclst Consults; $20/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; PBP 7e, 7h"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); $33/Procedure for Prof Radiology (Office); PBP 8b	"$10/Visit for Allergy Testing; $10/Visit for Allergy Tx; PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; PBP 15				$20/Exam for Vision Exams (Refractions); PBP 17a																0	500	500	100	0	75	0.2	0.2	48.42964697	50	0	0.186493427	0	0.2	43.50054267	10	20.09897545	30	30	0.221964992	10.10772701	0.2	0	0	0	20	0	0	0	0	0											NO	482.0290719	482.0290719	96.40581438	0	72.30436079	0.192811629	0.192811629	46.68899557	48.20290719	0	0.179790507	0	0.192811629	41.93705242	9.654061315	19.37658096	28.92174431	28.92174431	0.213987158	9.744436538	0.192811629	0	0	0	19.78247104	0	0	0	0	0												11.6067	0.100601881	6.655478674	0	1.472882591	1.923284486	0.928801874	1.735428986	1.236881486	0	3.241626653	0	0.059817851	3.270061027	3.496835537	7.058862687	0.295379357	0.99604312	3.330118446	0.058771537	1.773007401	0	0	0	0.591827406	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8324	0	1.837221106	11.6067	0.100601881	6.655478674	0	1.472882591	1.923284486	0.928801874	1.735428986	1.236881486	0	3.241626653	0	0.059817851	3.270061027	3.496835537	7.058862687	0.295379357	0.99604312	3.330118446	0.058771537	1.773007401	0	0	0	0.591827406	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8324	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.6067	0.100601881	6.655478674	0	1.472882591	1.923284486	0.928801874	1.735428986	1.236881486	0	3.241626653	0	0.059817851	3.270061027	3.496835537	7.058862687	0.295379357	0.99604312	3.330118446	0.058771537	1.773007401	0	0	0	0.591827406	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8324
H5928_001_0	2011	9																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	948.9985637	42.77361637	534.767213	39.18986431	1318.61915	3405.902119	40.9040752	532.5958776	53.16393862	0	0	0	0	3162.409532	4619.331045	8918.363897	1125.52946	0	7636.929963	58060.6861	676.9878148	76.38900871	786.0520554	707.27695	2103.492839	0	150.8095466	30.09594998	0	454.2857143											1	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	"No Cost Sharing ($25,000 max)"	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	"Oral Exam and Cleaning Every 6 Months, X-Rays annually"	No Cost Sharing	$200 Annual Benefit Max	No Cost Sharing	"$1,000 Benefit Limit"	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	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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_004_0	2011	7																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	961.0819619	43.33634899	584.7320061	65.80835602	1134.872655	2820.47073	37.93321662	403.8088853	53.46160744	0	0	0	0	2636.320734	3814.570258	7365.3006	928.6544557	0	6332.230219	47960.6152	578.4925067	62.9972585	789.5351259	641.268708	1734.7297	0	124.3711386	32.84141202	0	0											3400	"$50 copay, days 1 - 3"	"$75 copay, days 1 - 8"	Days 21 - 100: $50 copay per day	No Cost Sharing	$50 Copay waived if Admitted	0-20% of Cost	20% Coinsurance	"$50 ER and $25 Urgent Care Copays; waived if Admitted within 1 day ($25,000 max)"	$20 Copay to Contracted Providers/ $50 to Non-Contracted					"$10 dialysis copay, $20 copay OP hospital services, $10 OP SA/MH 10% coinsurance on therapeutic radiology"	No Cost Sharing ($15 in-network urgent care)	$5 Copay	$10 Copay	$10 Copay	No Cost Sharing	$5 Chiropractic and Podiatry Copay	20% Coinsurance		No Cost Sharing	"Oral Exam and Cleaning Every 6 Months, X-Rays annually"	$5 copay	$150 Limit Every Two Years	$10 Copay	"$1,000 Benefit Limit"														18.79050603	34.16026439	30.19857489	0	50	21.49228711	16.90196708	39.8446491	20	0	0	0	0	19.98082578	0	5	10	0	0	2.4457953	124.4526783	0	0	0	5	0	10	0	0	0											NO	16.52721318	30.04570345	26.56119447	0	43.9775628	18.90356812	14.86614637	35.04541116	17.59102512	0	0	0	0	17.57416041	0	4.39775628	8.795512559	0	0	2.151202328	109.4625095	0	0	0	4.39775628	0	8.795512559	0	0	0												1.3237	0.108505924	1.294265044	0	4.159077789	4.443080048	0.046993396	1.179304035	0.078370373	0	0	0	0	3.860926956	0	2.699233081	0.680665994	0	0	8.597748921	5.276936792	0	0	0	0.635743203	0	0.091158993	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4757		4.72121671	1.3237	0.108505924	1.294265044	0	4.159077789	4.443080048	0.046993396	1.179304035	0.078370373	0	0	0	0	3.860926956	0	2.699233081	0.680665994	0	0	8.597748921	5.276936792	0	0	0	0.635743203	0	0.091158993	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4757	NO																																																																																		0			1.3237	0.108505924	1.294265044	0	4.159077789	4.443080048	0.046993396	1.179304035	0.078370373	0	0	0	0	3.860926956	0	2.699233081	0.680665994	0	0	8.597748921	5.276936792	0	0	0	0.635743203	0	0.091158993	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4757
H5928_005_0	2011	6																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	1324.252531	59.68720283	782.3694495	70.50487935	1664.091585	4131.331686	52.23391158	707.4276991	80.3362503	0	0	0	0	3824.346273	5589.939862	10792.25005	1386.949221	0	9248.12608	70278.67727	958.1675534	92.61394012	1198.043934	569.5208587	2550.272129	0	182.8413086	38.25308898	0	497.1428571											1	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	"No Cost Sharing ($25,000 max)"	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	"Oral Exam and Cleaning Every 6 Months, X-Rays annually"	No Cost Sharing	$200 Annual Benefit Max	No Cost Sharing	"$1,000 Benefit Limit"	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	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2011	5																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V		V																																																			0	YES	1261.231214	56.88941901	1178.643342	106.0327867	1260.503106	3070.834707	42.51790185	560.8511772	100.2274658	0	0	0	0	2927.394901	4156.320119	8024.910048	1025.996143	0	6889.765531	52282.93281	625.0979693	68.84349402	1240.38437	633.1706694	1895.715092	0	135.9129578	59.90909086	0	556.8											3400	"$50 copay, days 1 - 3"	"$50 copay, days 1 - 8"	Days 21 - 100: $50 copay per day	No Cost Sharing	$50 Copay waived if Admitted	0-20% of Cost	20% Coinsurance	"$50 ER and $25 Urgent Care Copays; waived if Admitted within 1 day ($25,000 max)"	$20 Copay to Contracted Providers/ $50 to Non-Contracted					"$10 dialysis copay, $20 copay OP hospital services, $10 OP SA/MH 10% coinsurance on therapeutic radiology"	No Cost Sharing ($15 in-network urgent care)	$5 Copay	$10 Copay	$10 Copay	No Cost Sharing	$5 Chiropractic and Podiatry Copay	20% Coinsurance		No Cost Sharing	"Oral Exam and Cleaning Every 6 Months, X-Rays annually"	$5 copay	$150 Limit Every Two Years	$10 Copay	$500 Benefit Limit		$5 Acupuncture and $10 Routine Chiro Copays (15 visit max)												20.18245057	34.54967049	28.62446004	0	50	26.33579774	24.49674107	39.87811054	20	0	0	0	0	19.96772778	0	5	10	0	0	2.443568801	145.311129	0	0	0	5	0	10	0	0	7.5											NO	17.65488123	30.22280802	25.03964721	0	43.73820009	23.03760782	21.42886725	34.88393556	17.49528003	0	0	0	0	17.46704946	0	4.373820009	8.747640017	0	0	2.137546023	127.1129447	0	0	0	4.373820009	0	8.747640017	0	0	6.560730013												1.8556	0.143279832	2.459401124	0	4.594344756	5.895390472	0.075925873	1.63039136	0.146125632	0	0	0	0	4.261079293	0	2.924959344	0.74792041	0	0	9.313097924	6.621503636	0	0	0	0.690959717	0	0.099076469	0	0	0.304417873	0	0	0	0	0	0	0	0	0	0	41.7634		5.979083557	1.8556	0.143279832	2.459401124	0	4.594344756	5.895390472	0.075925873	1.63039136	0.146125632	0	0	0	0	4.261079293	0	2.924959344	0.74792041	0	0	9.313097924	6.621503636	0	0	0	0.690959717	0	0.099076469	0	0	0.304417873	0	0	0	0	0	0	0	0	0	0	41.7634	NO																																																																																		0			1.8556	0.143279832	2.459401124	0	4.594344756	5.895390472	0.075925873	1.63039136	0.146125632	0	0	0	0	4.261079293	0	2.924959344	0.74792041	0	0	9.313097924	6.621503636	0	0	0	0.690959717	0	0.099076469	0	0	0.304417873	0	0	0	0	0	0	0	0	0	0	41.7634
H5928_007_0	2011	7																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V		V																																																			0	YES	1050.138784	47.33224603	555.9020937	44.18819219	1249.099366	3135.920954	40.66836795	579.7734034	53.15787829	0	0	0	0	2919.508436	4251.643733	8209.023125	1035.593748	0	7031.36496	53427.75169	665.520034	70.39605376	896.7368014	1060.97564	1938.467294	0	138.9780693	24.83496663	0	0											1	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	"No Cost Sharing ($25,000 max)"	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	"Oral Exam and Cleaning Every 6 Months, X-Rays annually"	No Cost Sharing	$200 Annual Benefit Max	No Cost Sharing	"$1,000 Benefit Limit"	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	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2011	5																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V		V																																																			0	YES	1178.942352	53.18534447	1049.631125	85.00158128	1268.606763	2905.268494	36.73946125	542.3923212	53.09890798	0	0	0	0	2785.332484	3942.006796	7614.117777	958.132888	0	6554.052316	49478.39101	627.3890134	65.1456361	1164.899835	646.8041118	1793.888694	0	128.6125322	38.98594649	0	0											3400	"$50 copay, days 1 - 3"	"$50 copay, days 1 - 8"	Days 21 - 100: $50 copay per day	No Cost Sharing	$50 Copay waived if Admitted	0-20% of Cost	20% Coinsurance	"$50 ER and $25 Urgent Care Copays; waived if Admitted within 1 day ($25,000 max)"	$20 Copay to Contracted Providers/ $50 to Non-Contracted					"$10 dialysis copay, $20 copay OP hospital services, $10 OP SA/MH 10% coinsurance on therapeutic radiology"	No Cost Sharing ($15 in-network urgent care)	$5 Copay	$10 Copay	$10 Copay	No Cost Sharing	$5 Chiropractic and Podiatry Copay	20% Coinsurance		No Cost Sharing	"Oral Exam and Cleaning Every 6 Months, X-Rays annually"	$5 copay	$150 Limit Every Two Years	$10 Copay	$500 Benefit Limit														21.16990133	36.44150493	28.21018651	0	50	21.91260737	14.31962247	39.80185253	20	0	0	0	0	19.97236328	0	5	10	0	0	2.445284673	126.5881569	0	0	0	5	0	10	0	0	0											NO	18.68176145	32.15846363	24.89458815	0	44.12340226	19.33717579	12.63660925	35.123863	17.64936091	0	0	0	0	17.62497238	0	4.412340226	8.824680453	0	0	2.157885586	111.7100034	0	0	0	4.412340226	0	8.824680453	0	0	0												1.8354	0.142529914	2.177511213	0	4.664603876	4.681640633	0.038688518	1.587576132	0.078096816	0	0	0	0	4.090950675	0	2.79967318	0.704601381	0	0	8.897392232	5.840469067	0	0	0	0.659603937	0	0.094580375	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2933		5.100114105	1.8354	0.142529914	2.177511213	0	4.664603876	4.681640633	0.038688518	1.587576132	0.078096816	0	0	0	0	4.090950675	0	2.79967318	0.704601381	0	0	8.897392232	5.840469067	0	0	0	0.659603937	0	0.094580375	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2933	NO																																																																																		0			1.8354	0.142529914	2.177511213	0	4.664603876	4.681640633	0.038688518	1.587576132	0.078096816	0	0	0	0	4.090950675	0	2.79967318	0.704601381	0	0	8.897392232	5.840469067	0	0	0	0.659603937	0	0.094580375	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2933
H5928_009_0	2011	6																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V		V																																																			0	YES	1300.565241	58.61956046	823.4548106	64.52094172	1362.135198	3200.295817	44.38697756	687.1416114	76.79266608	0	0	0	0	3048.569491	4388.242184	8474.852977	1060.117993	0	7301.700649	54834.01886	666.6132356	72.04531836	1125.068492	568.2890642	2001.389728	0.921437386	142.2340986	52.65999307	0	0											1	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	"No Cost Sharing ($25,000 max)"	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	"Oral Exam and Cleaning Every 6 Months, X-Rays annually"	No Cost Sharing	$200 Annual Benefit Max	No Cost Sharing	"$1,000 Benefit Limit"	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	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2011	5																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V		V																																																			0	YES	1050.288298	47.37163063	716.2401163	42.06167807	997.9914959	2404.67508	31.02941372	530.8122042	105.4343782	0	0	0	0	2378.274019	3365.259401	6471.132509	796.9582624	0	5462.109521	41281.56169	512.6343108	54.22006505	992.2270135	636.120887	1506.506288	3.367642189	107.0429315	72.24509875	0	0											3400	"$50 copay, days 1 - 3"	"$50 copay, days 1 - 8"	Days 21 - 100: $50 copay per day	No Cost Sharing	$50 Copay waived if Admitted	0-20% of Cost	20% Coinsurance	"$50 ER and $25 Urgent Care Copays; waived if Admitted within 1 day ($25,000 max)"	$20 Copay to Contracted Providers/ $50 to Non-Contracted					"$10 dialysis copay, $20 copay OP hospital services, $10 OP SA/MH 10% coinsurance on therapeutic radiology"	No Cost Sharing ($15 in-network urgent care)	$5 Copay	$10 Copay	$10 Copay	No Cost Sharing	$5 Chiropractic and Podiatry Copay	20% Coinsurance		No Cost Sharing	"Oral Exam and Cleaning Every 6 Months, X-Rays annually"	$5 copay	$150 Limit Every Two Years	$10 Copay	$500 Benefit Limit														20.94090648	35.90233952	26.40630128	0	50	23.1966916	16.8522574	39.87320119	20	0	0	0	0	19.86294584	0	5	10	0	0	2.445093979	133.6787401	0	0	0	5	0	10	0	0	0											NO	18.36158974	31.480205	23.15380526	0	43.84143962	20.33952708	14.77654451	34.96197085	17.53657585	0	0	0	0	17.41640282	0	4.384143962	8.768287924	0	0	2.143928801	117.2133682	0	0	0	4.384143962	0	8.768287924	0	0	0												1.6071	0.124272387	1.381973681	0	3.646115326	4.075829493	0.038208959	1.546520067	0.154079831	0	0	0	0	3.451748194	0	2.364198043	0.582329959	0	0	7.37539409	5.00729952	0	0	0	0.550395037	0	0.07821527	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9837		4.492856612	1.6071	0.124272387	1.381973681	0	3.646115326	4.075829493	0.038208959	1.546520067	0.154079831	0	0	0	0	3.451748194	0	2.364198043	0.582329959	0	0	7.37539409	5.00729952	0	0	0	0.550395037	0	0.07821527	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9837	NO																																																																																		0			1.6071	0.124272387	1.381973681	0	3.646115326	4.075829493	0.038208959	1.546520067	0.154079831	0	0	0	0	3.451748194	0	2.364198043	0.582329959	0	0	7.37539409	5.00729952	0	0	0	0.550395037	0	0.07821527	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9837
H5928_012_0	2011	4																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	977.5666508	44.1083428	570.6589136	71.07360726	904.0409611	2046.512365	29.48429152	412.5145452	84.04333659	0	0	0	0	1919.656614	2757.525009	5326.856118	669.8973722	0	4582.223789	34630.62025	489.2567673	45.57264992	880.168045	619.3625964	1254.915391	0	89.97093676	38.68171941	0	0											3400	"$50 copay, days 1 - 3"	"$50 copay, days 1 - 8"	Days 21 - 100: $50 copay per day	No Cost Sharing	$50 Copay waived if Admitted	0-20% of Cost	20% Coinsurance	"$50 ER and $25 Urgent Care Copays; waived if Admitted within 1 day ($25,000 max)"	$20 Copay to Contracted Providers/ $50 to Non-Contracted					"$10 dialysis copay, $20 copay OP hospital services, $10 OP SA/MH 10% coinsurance on therapeutic radiology"	No Cost Sharing ($15 in-network urgent care)	$5 Copay	$10 Copay	$10 Copay	No Cost Sharing	$5 Chiropractic and Podiatry Copay	20% Coinsurance		No Cost Sharing	"Oral Exam and Cleaning Every 6 Months, X-Rays annually"	$5 copay	$150 Limit Every Two Years	$10 Copay	$500 Benefit Limit														22.29970184	37.72241993	26.91483937	0	50	29.21682933	20.24051965	39.89030054	20	0	0	0	0	19.97664411	0	5	10	0	0	0.697184693	154.2450314	0	0	0	5	0	10	0	0	0											NO	19.00966401	32.1569559	22.9438966	0	42.62313494	24.90625718	17.254288	34.00499325	17.04925398	0	0	0	0	17.02934395	0	4.262313494	8.524626988	0	0	0.594323945	131.4881357	0	0	0	4.262313494	0	8.524626988	0	0	0												1.5486	0.11819917	1.091094926	0	3.211088323	4.247580275	0.042394205	1.16896286	0.119406349	0	0	0	0	2.724207728	0	1.892060893	0.475885435	0	0	1.715150571	5.360955018	0	0	0	0.445736901	0	0.063914056	0	0	0	0	0	0	0	0	0	0	0	0	0	24.2252		4.192706869	1.5486	0.11819917	1.091094926	0	3.211088323	4.247580275	0.042394205	1.16896286	0.119406349	0	0	0	0	2.724207728	0	1.892060893	0.475885435	0	0	1.715150571	5.360955018	0	0	0	0.445736901	0	0.063914056	0	0	0	0	0	0	0	0	0	0	0	0	0	24.2252	NO																																																																																		0			1.5486	0.11819917	1.091094926	0	3.211088323	4.247580275	0.042394205	1.16896286	0.119406349	0	0	0	0	2.724207728	0	1.892060893	0.475885435	0	0	1.715150571	5.360955018	0	0	0	0.445736901	0	0.063914056	0	0	0	0	0	0	0	0	0	0	0	0	0	24.2252
H5928_015_0	2011	6																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	991.0595349	44.66940412	593.9368074	44.56493717	1289.593226	3239.352421	39.78883507	538.9986854	60.45562101	0	0	0	0	3022.7922	4388.034318	8472.079981	1069.115829	0	7259.612072	55162.66784	674.1275882	72.5205991	893.8627648	1061.244537	1996.970028	0	143.1724125	24.24182294	0	0											1	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	"No Cost Sharing ($25,000 max)"	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	"Oral Exam and Cleaning Every 6 Months, X-Rays annually"	No Cost Sharing	$200 Annual Benefit Max	No Cost Sharing	"$1,000 Benefit Limit"	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	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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_016_0	2011	4																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V		V																																																			0	YES	1022.672584	46.14671201	673.7851386	77.1770247	1251.846632	3081.887661	42.1989269	454.6171033	61.06119117	0	0	0	0	2861.735804	4157.139852	8026.848904	1011.994832	0	6903.015023	52270.49118	669.5305827	68.84349402	942.4716532	663.3787378	1895.715092	0	135.9129578	29.3354747	0	556.8											3400	"$50 copay, days 1 - 3"	"$50 copay, days 1 - 8"	Days 21 - 100: $50 copay per day	No Cost Sharing	$50 Copay waived if Admitted	0-20% of Cost	20% Coinsurance	"$50 ER and $25 Urgent Care Copays; waived if Admitted within 1 day ($25,000 max)"	$20 Copay to Contracted Providers/ $50 to Non-Contracted					"$10 dialysis copay, $20 copay OP hospital services, $10 OP SA/MH 10% coinsurance on therapeutic radiology"	No Cost Sharing ($15 in-network urgent care)	$5 Copay	$10 Copay	$10 Copay	No Cost Sharing	$5 Chiropractic and Podiatry Copay	20% Coinsurance		No Cost Sharing	"Oral Exam and Cleaning Every 6 Months, X-Rays annually"	$5 copay	$150 Limit Every Two Years	$10 Copay	$500 Benefit Limit		$5 Acupuncture and $10 Routine Chiro Copays (15 visit max)												20.18245057	34.54967049	28.62446004	0	50	17.89585662	15.00441413	39.84962764	20	0	0	0	0	19.98085002	0	5	10	0	0	2.446255047	106.9793643	0	0	0	5	0	10	0	0	7.5											NO	18.26851119	31.27326088	25.90994918	0	45.25840686	16.1987592	13.58151759	36.07061322	18.10336275	0	0	0	0	18.0860288	0	4.525840686	9.051681373	0	0	2.214272124	96.83431194	0	0	0	4.525840686	0	9.051681373	0	0	6.78876103												1.5569	0.12026318	1.454811558	0	4.721382015	4.160229676	0.047760456	1.366526475	0.092117741	0	0	0	0	4.313119681	0	3.02735328	0.763354564	0	0	9.645090961	5.402794441	0	0	0	0.714975374	0	0.102520066	0	0	0.314998512	0	0	0	0	0	0	0	0	0	0	37.8042		3.960636282	1.5569	0.12026318	1.454811558	0	4.721382015	4.160229676	0.047760456	1.366526475	0.092117741	0	0	0	0	4.313119681	0	3.02735328	0.763354564	0	0	9.645090961	5.402794441	0	0	0	0.714975374	0	0.102520066	0	0	0.314998512	0	0	0	0	0	0	0	0	0	0	37.8042	NO																																																																																		0			1.5569	0.12026318	1.454811558	0	4.721382015	4.160229676	0.047760456	1.366526475	0.092117741	0	0	0	0	4.313119681	0	3.02735328	0.763354564	0	0	9.645090961	5.402794441	0	0	0	0.714975374	0	0.102520066	0	0	0.314998512	0	0	0	0	0	0	0	0	0	0	37.8042
H5928_017_0	2011	6																															D	A	A	V	T	P	P	V	V	V	V	V		V	V	V	V	V	V	V	S	V			V	P	V	V																																																					0	YES	904.753959	40.77940709	542.2143261	40.68403755	1269.159833	3236.226309	39.28462346	1017.162049	103.8470705	0	0	0	0	6018.552049	4387.703824	8471.298285	1069.065274	0	7255.871069	55153.66922	657.3075261	72.5205991	816.0214868	562.6889515	1996.970028	0	143.1724125	22.13074443	0	497.1428571											1	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	"No Cost Sharing ($25,000 max)"	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	Oral Exam and Cleaning Every 6 Months	No Cost Sharing	$200 Annual Benefit Max	No Cost Sharing	"$1,000 Benefit Limit"	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	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H5932_001_0	2011	3																															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	YES	3177.086166	284.3306686	60.26116783	25.6643614	23.24340716	23.64944367	14.24568629	1032.423972	31.84178453	17.88784366	25.52942335	0.532076437	0.149049856	47.5047089	34.52518246	154.9806589	21.52091877	0.453191615	0.907263563	12.67475763	33.92672201	0.032110453	3.146450746	6.758932256	4.260977879	0	0.578936978	1.029610385	1.700301827	0.847399539											3400	$185/day: PBP 1a	"$140/day for days 1-15, $0 per day after day 15: PBP 1a"	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																				185	78.38563252	0.10643862	0	0.196184396	0.2130681	0.206827194	55.78351627	0.175898601	4.56E-07	0.20660022	0.194101074	0.197232191	0.219487576	0.271024372	0.227034794	0.366663808	0.205741857	0.201972305	0.000307204	0.22006846	0.027135666	0	0.008125542	0	0	3.61E-05	0	0	0.006081504											NO	185	78.38563252	0.10643862	0	0.196184396	0.2130681	0.206827194	55.78351627	0.175898601	4.56E-07	0.20660022	0.194101074	0.197232191	0.219487576	0.271024372	0.227034794	0.366663808	0.205741857	0.201972305	0.000307204	0.22006846	0.027135666	0	0.008125542	0	0	3.61E-05	0	0	0.006081504												48.9801	1.857286608	6.414115537	0	4.559993802	5.03894202	2.946395318	4.799353286	5.600925365	8.15E-06	5.274384481	0.103276608	0.02939743	10.42669342	9.357165905	35.18600201	7.890942018	0.093240485	0.183242113	0.00389374	7.466201477	0.000871339	0	0.054919988	0	0	2.09E-05	0	0	0.005153464	0	0	0	0	0	0	0	0	0	0	156.2725			48.9801	1.857286608	6.414115537	0	4.559993802	5.03894202	2.946395318	4.799353286	5.600925365	8.15E-06	5.274384481	0.103276608	0.02939743	10.42669342	9.357165905	35.18600201	7.890942018	0.093240485	0.183242113	0.00389374	7.466201477	0.000871339	0	0.054919988	0	0	2.09E-05	0	0	0.005153464	0	0	0	0	0	0	0	0	0	0	156.2725	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			48.9801	1.857286608	6.414115537	0	4.559993802	5.03894202	2.946395318	4.799353286	5.600925365	8.15E-06	5.274384481	0.103276608	0.02939743	10.42669342	9.357165905	35.18600201	7.890942018	0.093240485	0.183242113	0.00389374	7.466201477	0.000871339	0	0.054919988	0	0	2.09E-05	0	0	0.005153464	0	0	0	0	0	0	0	0	0	0	156.2725
H5938_001_0	2011	7																															D	D	D		T	Coin	Coin	V	V	P	P			V	V	V	V	V	P	P	O	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	1031.53439	71.24922802	531.0169126	0	158.8820434	10.09551155	0.980523805	327.3804833	553.3647431	96.70094847	669.1852708	0	0	223.1172974	3399.47138	5128.506878	227.1135474	215.6684553	584.5515292	39.54686284	253.198159	361.4705202	0	0	0	0	0	0	0	0											3400	$150 per day (days 1-5): $750 max	$150 per day (days 1-5); $750 max	$100/Days 7-100; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $20/Visit for PCP Urgent Care; $20/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$100/Visit for OP Fac - Surgery; PBP 9a, 9b"	$10/Service for OP Fac - Pathology; PBP 8a	$0-$100/Service for OP Fac - Radiology; $100/Service for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"$30/Visit for OP Fac - Cardiovascular; $30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; $30/Visit for OP Fac - CORF; $40/Visit for OP Fac - Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$10/Visit for PCP Office Visits; $10/Visit for PCP Consults; $15/Visit for Routine Physicals; PBP 4b, 7a, 14b-c"	"$30/Visit for Speclst Office Visits; $30/Visit for Speclst Consults; $30/Visit for Cardio; $30/Visit for Chiropractor; $15/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	"$40/Service for Prof Radiology (Office); $100/Service for Prof Radiology (Office); PBP 7d, 14g-h"	"Varies: PBP 7d, 7g, 14f, 14i"	"$25 Professional Fees for Part B Drugs; PBP 4a, 4b, 7a, 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"Varies - Prof; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$10-$30/Exam for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	$30/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	92.94123183	92.94123183	100	0	100	0.2	0.2	48.48085842	100	10	51.27472527	0	0	32.32359727	10	27.33318562	30	30	85.9432799	13.56268837	24.6612938	20	0	0	10	0	30	0	0	0											NO	88.20187736	88.20187736	94.9006976	0	94.9006976	0.189801395	0.189801395	46.00867284	94.9006976	9.49006976	48.66007198	0	0	30.6753193	9.49006976	25.93938382	28.47020928	28.47020928	81.56077216	12.87108588	23.40373986	18.98258751	0	0	10	0	30	0	0	0												7.5819	0.523692973	4.19948962	0	1.256501396	1.916142177	0.186104786	1.255195129	4.376225012	0.076474896	2.713550287	0	0	0.570349528	2.688435046	11.08585903	0.538830852	0.511677171	3.973039507	0.042417589	0.493815321	0.571803815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.5615	0	2.394349215	7.5819	0.523692973	4.19948962	0	1.256501396	1.916142177	0.186104786	1.255195129	4.376225012	0.076474896	2.713550287	0	0	0.570349528	2.688435046	11.08585903	0.538830852	0.511677171	3.973039507	0.042417589	0.493815321	0.571803815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.5615	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.5819	0.523692973	4.19948962	0	1.256501396	1.916142177	0.186104786	1.255195129	4.376225012	0.076474896	2.713550287	0	0	0.570349528	2.688435046	11.08585903	0.538830852	0.511677171	3.973039507	0.042417589	0.493815321	0.571803815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.5615
H5938_006_0	2011	5																															A	A	D		T	Coin	Coin	V	V	P	P			V	V	V	V	V	P	P	O	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	232.7778684	7.598946824	560.3577323	0	185.9543171	12.89442646	4.296047685	317.5968799	564.1907539	232.9885307	670.7577509	0	0	497.4672708	3861.132188	5762.227326	350.9461087	292.6904229	845.1824437	1851.575687	317.3805025	343.2606435	0	0	9.48E-05	0	3.73E-05	0	0	0											3400	"$250 per admit, $100 per day (days 6-10), $750 max"	"$250 per admit, $100 per day (days 6-10), $750 max"	$75/Days 7-100; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $20/Visit for PCP Urgent Care; $20/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$100/Visit for OP Fac - Surgery; PBP 9a, 9b"	$10/Service for OP Fac - Pathology; PBP 8a	$0-$100/Service for OP Fac - Radiology; $100/Service for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; $25/Visit for OP Fac - CORF; $40/Visit for OP Fac - Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$10/Visit for PCP Office Visits; $10/Visit for PCP Consults; $15/Visit for Routine Physicals; PBP 4b, 7a, 14b-c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; $25/Visit for Cardio; $25/Visit for Chiropractor; $15/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"$40/Service for Prof Radiology (Office); $100/Service for Prof Radiology (Office); PBP 7d, 14g-h"	"Varies: PBP 7d, 7g, 14f, 14i"	"$25 Professional fees for Part B Drugs; PBP 4a, 4b, 7a, 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"Varies - Prof; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$10-$25/Exam for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	$30/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	363.651164	363.651164	75	0	100	0.2	0.2	48.57438448	100	10	51.86157806	0	0	32.88848471	10.01274979	23.55580365	25	25	71.42326591	10.12325388	20.99597035	20	0	0	10	0	30	0	0	0											NO	343.0569276	343.0569276	70.75261161	0	94.33681547	0.188673631	0.188673631	45.82352745	94.33681547	9.433681547	48.9245612	0	0	31.02594913	9.447414685	22.22179502	23.58420387	23.58420387	67.37843456	9.549955335	19.80692981	18.86802273	0	0	10	0	30	0	0	0												6.6547	0.217239279	3.303897749	0	1.461861508	2.432838259	0.810550915	1.212784112	4.43532992	0.183161634	2.734710719	0	0	1.28619952	3.039809745	10.67058621	0.689732048	0.575239217	4.745589165	1.473538759	0.523861111	0.539720802	0	0	7.90E-08	0	9.32E-08	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9913	0	2.820422345	6.6547	0.217239279	3.303897749	0	1.461861508	2.432838259	0.810550915	1.212784112	4.43532992	0.183161634	2.734710719	0	0	1.28619952	3.039809745	10.67058621	0.689732048	0.575239217	4.745589165	1.473538759	0.523861111	0.539720802	0	0	7.90E-08	0	9.32E-08	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9913	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.6547	0.217239279	3.303897749	0	1.461861508	2.432838259	0.810550915	1.212784112	4.43532992	0.183161634	2.734710719	0	0	1.28619952	3.039809745	10.67058621	0.689732048	0.575239217	4.745589165	1.473538759	0.523861111	0.539720802	0	0	7.90E-08	0	9.32E-08	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9913
H5938_802_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	184.9066424	2.684443298	62.49805766	0	7.107036271	9.018567584	2.093618638	16.95980372	64.99772482	1.207499941	10.53777271	0	0.021594411	8.747914829	52.78268323	63.78198159	1.630737715	2.779063528	32.67974361	123.1440952	32.62514376	12.58409087	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 1b	Medicare-FFS Cost Sharing; PBP 2	Medicare-FFS Cost Sharing; PBP 6	Medicare-FFS Cost Sharing; PBP 10a	20% coinsurance: PBP 11a	"Medicare-FFS Cost Sharing; PBP 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;	20% coinsurance: PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	"20% coinsurance: PBP 4a, 4b, 7a, 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.083003351	0.083003351	0.166836512	0	0.233	0.2	0.233	0.233	0.233	0.233	0.233	0	0.2	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.2	0.233	0	0	0	0	0	0	0	0											NO	0.076041889	0.076041889	0.152843994	0	0.213458374	0.183226072	0.213458374	0.213458374	0.213458374	0.213458374	0.213458374	0	0.183226072	0.213458374	0.213458374	0.213458374	0.213458374	0.213458374	0.213458374	0.213458374	0.183226072	0.213458374	0	0	0	0	0	0	0	0												14.0607	0.20413014	9.552452725	0	1.517056405	1.652436713	0.44690043	3.620212121	13.87430864	0.257750974	2.249375825	0	0.003956659	1.867315673	11.26690573	13.61479807	0.348094621	0.593214381	6.975764926	26.28613831	5.977776936	2.686179573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.0554	0	10.71615609	14.0607	0.20413014	9.552452725	0	1.517056405	1.652436713	0.44690043	3.620212121	13.87430864	0.257750974	2.249375825	0	0.003956659	1.867315673	11.26690573	13.61479807	0.348094621	0.593214381	6.975764926	26.28613831	5.977776936	2.686179573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.0554	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.0607	0.20413014	9.552452725	0	1.517056405	1.652436713	0.44690043	3.620212121	13.87430864	0.257750974	2.249375825	0	0.003956659	1.867315673	11.26690573	13.61479807	0.348094621	0.593214381	6.975764926	26.28613831	5.977776936	2.686179573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.0554
H5938_803_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	205.1824372	1.877634266	41.00961787	0	13.19437568	16.29549613	10.09649121	16.4047477	51.21155902	3.641269106	13.68751547	0	0.349347235	20.84513758	27.1236316	44.75830341	0.98473979	3.978090895	31.80256091	98.23727764	29.20439717	7.675066935	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 1b	Medicare-FFS Cost Sharing; PBP 2	Medicare-FFS Cost Sharing; PBP 6	Medicare-FFS Cost Sharing; PBP 10a	20% coinsurance: PBP 11a	"Medicare-FFS Cost Sharing; PBP 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;	20% coinsurance: PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	"20% coinsurance: PBP 4a, 4b, 7a, 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.083003351	0.083003351	0.166836512	0	0.233	0.2	0.233	0.233	0.233	0.233	0.233	0	0.2	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.2	0.233	0	0	0	0	0	0	0	0											NO	0.077110344	0.077110344	0.154991585	0	0.21645765	0.185800558	0.21645765	0.21645765	0.21645765	0.21645765	0.21645765	0	0.185800558	0.21645765	0.21645765	0.21645765	0.21645765	0.21645765	0.21645765	0.21645765	0.185800558	0.21645765	0	0	0	0	0	0	0	0												15.8217	0.144785024	6.356145657	0	2.856023547	3.027712265	2.185462756	3.550933127	11.08513369	0.788180552	2.962767426	0	0.064908911	4.512089485	5.871117543	9.688277153	0.21315446	0.861088205	6.883907584	21.26421021	5.426193277	1.661326949	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.2251	0	8.041621947	15.8217	0.144785024	6.356145657	0	2.856023547	3.027712265	2.185462756	3.550933127	11.08513369	0.788180552	2.962767426	0	0.064908911	4.512089485	5.871117543	9.688277153	0.21315446	0.861088205	6.883907584	21.26421021	5.426193277	1.661326949	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.2251	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.8217	0.144785024	6.356145657	0	2.856023547	3.027712265	2.185462756	3.550933127	11.08513369	0.788180552	2.962767426	0	0.064908911	4.512089485	5.871117543	9.688277153	0.21315446	0.861088205	6.883907584	21.26421021	5.426193277	1.661326949	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.2251
H5938_804_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	179.5236388	2.314312798	46.57075949	0	7.986623574	9.906121286	3.345075534	17.92015311	66.63924875	2.005506674	11.84602823	0	0.114631895	12.64644644	44.01219154	57.71777097	1.050496743	3.133630143	34.73609147	115.9797734	27.23576965	11.24229752	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 1b	Medicare-FFS Cost Sharing; PBP 2	Medicare-FFS Cost Sharing; PBP 6	Medicare-FFS Cost Sharing; PBP 10a	20% coinsurance: PBP 11a	"Medicare-FFS Cost Sharing; PBP 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;	20% coinsurance: PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	"20% coinsurance: PBP 4a, 4b, 7a, 7b, 7d, 7f, 7g, 14b-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.083003351	0.083003351	0.166836512	0	0.233	0.2	0.233	0.233	0.233	0.233	0.233	0	0.2	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.2	0.233	0	0	0	0	0	0	0	0											NO	0.07649101	0.07649101	0.153746724	0	0.214719107	0.184308246	0.214719107	0.214719107	0.214719107	0.214719107	0.214719107	0	0.184308246	0.214719107	0.214719107	0.214719107	0.214719107	0.214719107	0.214719107	0.214719107	0.184308246	0.214719107	0	0	0	0	0	0	0	0												13.7319	0.177024123	7.160101724	0	1.714880679	1.825779839	0.71825163	3.847799266	14.30871996	0.430620601	2.543568598	0	0.021127604	2.715433682	9.450258447	12.39310822	0.225561722	0.672850265	7.458502529	24.90307332	5.019776933	2.41393608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.7323	0	9.512738088	13.7319	0.177024123	7.160101724	0	1.714880679	1.825779839	0.71825163	3.847799266	14.30871996	0.430620601	2.543568598	0	0.021127604	2.715433682	9.450258447	12.39310822	0.225561722	0.672850265	7.458502529	24.90307332	5.019776933	2.41393608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.7323	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.7319	0.177024123	7.160101724	0	1.714880679	1.825779839	0.71825163	3.847799266	14.30871996	0.430620601	2.543568598	0	0.021127604	2.715433682	9.450258447	12.39310822	0.225561722	0.672850265	7.458502529	24.90307332	5.019776933	2.41393608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.7323
H5948_001_0	2011	6																																A	D		T	Coin	Coin	V			V		Coin			V	V				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	YES	0	33.30910551	366.6286975	0	261.2170725	17.65029153	1.010000221	319.8988144	0	0	243.406581	0	0.327659544	0	0	3587.308337	136.4762583	0	0	0	9.605784907	0	0	1091.208862	0	0	0	0	0	0.85405445											3400	No Cost Sharing; PBP 1a	$250/Admit for IP S/A; $250/Admit for IP Psych; PBP 1b	$75/Days Custom for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance on DME items > $150; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $25/Visit for Urgent Care PCP; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$100/Visit for Diagnostic Radiology; $55/Visit for Therapeutic Radiology; PBP 8b	No Cost Sharing;	20% Coinsurance for Dialysis; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-c"	"$10/Visit for Specialist Office Visit; $10/Visit for Specialist Consult; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$10/Visit for OP Psych non-physician; $10/Visit for OP Psych; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	No Cost Sharing; PBP 14g-h	"No Cost Sharing; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"$15/visit for Dental; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	$50/Other for Worldwide ER; PBP 13b											0	0	250	75	0	100	0.07	0.2	48.15218584	0	0	91.5	0	0.2	0	0	10	12.07550289	0	0	0	0.2	0	0	15	0	0	0	0	0	50											NO	0	248.8071992	74.64215975	0	99.52287966	0.069666016	0.199045759	47.92244197	0	0	91.06343489	0	0.199045759	0	0	9.952287966	12.01788821	0	0	0	0.199045759	0	0	14.92843195	0	0	0	0	0	49.76143983												0	0.690628771	2.280496484	0	2.16642294	1.229625488	0.201036261	1.277527698	0	0	1.847119945	0	0.065219243	0	0	2.975160466	0.136679701	0	0	0	1.911990751	0	0	1.357503104	0	0	0	0	0	0.003541582	0	0	0	0	0	0	0	0	0	0	16.143	0	0.077390555	0	0.690628771	2.280496484	0	2.16642294	1.229625488	0.201036261	1.277527698	0	0	1.847119945	0	0.065219243	0	0	2.975160466	0.136679701	0	0	0	1.911990751	0	0	1.357503104	0	0	0	0	0	0.003541582	0	0	0	0	0	0	0	0	0	0	16.143	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.690628771	2.280496484	0	2.16642294	1.229625488	0.201036261	1.277527698	0	0	1.847119945	0	0.065219243	0	0	2.975160466	0.136679701	0	0	0	1.911990751	0	0	1.357503104	0	0	0	0	0	0.003541582	0	0	0	0	0	0	0	0	0	0	16.143
H5948_002_0	2011	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											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	No Cost-Sharing; PBP 1a	No Cost-Sharing; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	No Cost-Sharing; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"No Cost-Sharing; PBP 4a, 4b"	"No Cost-Sharing; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 4b, 7a, 14b-c"	"No Cost-Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	No Cost-Sharing; PBP 14g-h	"No Cost-Sharing; PBP 7g, 14f, 14i"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	0	0	0	0	0	0	0	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
H5950_001_0	2011	3																															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	1764.312992	268.291323	1307.07176	912.3979854	306.9228862	11.05509997	0	399.1047215	401.5984129	2940.277755	2632.06024	51.52693686	2.079077168	136.1276968	3410.329854	5790.356111	357.9725509	709.1392162	0	0	251.9924875	0	0	0	1133.381951	87.71488712	54.61046904	11.52948867	188.8195067	0											3400	$250/day 1-8	$250/day 1-8	"$0/d 1-5, $75/d 6-14, $100/d 15-100"	$15 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $40 Urgent Care Ctr	$300 per procedure	$40 per visit	$40 X-ray; $175 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	"$15 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$40 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$40 per visit	$50 per visit	$40 per visit	$50 per script	0	Not Covered	0	$0 per visit	$100.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	190.46	190.46	72.96419583	15	150	0.05	0.05	49	300	6	23.375	40	25	40	15	40	40	30	50	40	$50 	0	0	0	0	0	0	0	0	0											NO	166.7402706	166.7402706	63.87729579	13.13191252	131.3191252	0.043773042	0.043773042	42.8975809	262.6382504	5.252765008	20.46389701	35.01843339	21.88652087	35.01843339	13.13191252	35.01843339	35.01843339	26.26382504	43.77304174	35.01843339	43.77304174	0	0	0	0	0	0	0	0	0												24.5152	3.727913983	6.957684117	0.998460877	3.358737077	0.483915352	0	1.426718923	8.789592044	1.287049009	4.488517474	0.150366051	0.00379198	0.397248224	3.732012776	16.89743332	1.044636494	1.552059025	0	0	0.919206473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7305	0	11.48436364	24.5152	3.727913983	6.957684117	0.998460877	3.358737077	0.483915352	0	1.426718923	8.789592044	1.287049009	4.488517474	0.150366051	0.00379198	0.397248224	3.732012776	16.89743332	1.044636494	1.552059025	0	0	0.919206473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7305	NO																							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			24.5152	3.727913983	6.957684117	0.998460877	3.358737077	0.483915352	0	1.426718923	8.789592044	1.287049009	4.488517474	0.150366051	0.00379198	0.397248224	3.732012776	16.89743332	1.044636494	1.552059025	0	0	0.919206473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7305
H5950_801_0	2011	1																															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	YES	319.0701489	6.513744391	40.76040502	8.096494956	9.489901077	12.27185761	0	15.21238599	41.98449868	18.8092262	60.7767583	1.07614823	0.092283227	27.9896658	28.58012577	136.7663398	3.698289116	8.711496811	0	0	72.65806212	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.07947395	0.07947395	0.186367184	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.062654524	0.062654524	0.146925465	0	0.18368917	0.18368917	0.18368917	0.18368917	0.18368917	0.18368917	0.18368917	0.18368917	0.18368917	0.18368917	0.18368917	0.18368917	0.18368917	0.18368917	0.18368917	0.18368917	0.18368917	0.18368917	0	0	0	0	0	0	0	0												19.9912	0.408115551	5.98874146	0	1.743192051	2.254207337	0	2.794350553	7.712097708	3.455051145	11.16403228	0.197676775	0.016951429	5.141398475	5.249859576	25.12249543	0.679335658	1.600207617	0	0	13.34649911	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8654	0	28.6877511	19.9912	0.408115551	5.98874146	0	1.743192051	2.254207337	0	2.794350553	7.712097708	3.455051145	11.16403228	0.197676775	0.016951429	5.141398475	5.249859576	25.12249543	0.679335658	1.600207617	0	0	13.34649911	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8654	NO																																																																																		0			19.9912	0.408115551	5.98874146	0	1.743192051	2.254207337	0	2.794350553	7.712097708	3.455051145	11.16403228	0.197676775	0.016951429	5.141398475	5.249859576	25.12249543	0.679335658	1.600207617	0	0	13.34649911	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8654
H5950_802_0	2011	1																															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	YES	317.3034821	6.477678291	40.53471781	8.051665288	9.437356227	12.20390928	0	15.12815618	41.75203375	18.70508096	60.44024209	1.070189681	0.091772262	27.83468918	28.42187982	136.0090752	3.677811975	8.663261926	0	0	72.25576004	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.078806609	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	0.062124097	0.062124097	0.150438929	0	0.183676405	0.183676405	0.183676405	0.183676405	0.183676405	0.183676405	0.183676405	0.183676405	0.183676405	0.183676405	0.183676405	0.183676405	0.183676405	0.183676405	0.183676405	0.183676405	0.183676405	0.183676405	0	0	0	0	0	0	0	0												19.7122	0.402419915	6.097999525	0	1.733419666	2.241570185	0	2.778685343	7.668863465	3.435682029	11.10144639	0.196568593	0.016856399	5.112575647	5.220428712	24.98165799	0.675527282	1.591236807	0	0	13.27167825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.2388	0	28.52886819	19.7122	0.402419915	6.097999525	0	1.733419666	2.241570185	0	2.778685343	7.668863465	3.435682029	11.10144639	0.196568593	0.016856399	5.112575647	5.220428712	24.98165799	0.675527282	1.591236807	0	0	13.27167825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.2388	NO																																																																																		0			19.7122	0.402419915	6.097999525	0	1.733419666	2.241570185	0	2.778685343	7.668863465	3.435682029	11.10144639	0.196568593	0.016856399	5.112575647	5.220428712	24.98165799	0.675527282	1.591236807	0	0	13.27167825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.2388
H5969_001_0	2011	12																															D	D	D		Coin	Coin	Coin	V	Coin		Coin		Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin			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	0	0	0	0	0	0	0											0	YES	816.9466578	10.04631654	48.18619724	0	10.06531373	7.355351378	2.597053845	318.2462924	28.60382589	0	19.38388951	0	0.170446361	28.27780287	5620.352674	4151.363857	153.4499635	206.9487022	12.73170698	28.34083452	20.69352201	3.125742974	0	0	203.1402538	0.835270883	64.91916263	0.408184737	0	417.7372242											3400	$220/Days 1-10 for IP Medical; $220/Days 1-10 for IP Surgical; PBP 1a	$210/Days 1-10 for IP Psych; $210/Days 1-10 for IP Substance Abuse; PBP 1b	$90/Days 1-10 for SNF; PBP 2	No Cost-Sharing; PBP 6	25% Coinsurance for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"25% Coinsurance for DME / Medical Supplies; 25% Coinsurance for Diabetes Monitoring Supplies; 25% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $30/Visit for PCP Urgent Care; $30/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; Clinical LabPBP 8a	"20% Coinsurance for OP Fac - Therapeutic Radiology; 25% Coinsurance for OP Fac - Diagnostic Radiology; 25% Coinsurance for OP Fac - CT/MRI/PET, OP Fac - Diagnostic Tests; PBP 8a, 8b"	No Cost-Sharing; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"25% Coinsurance for OP Fac - Cardiovascular; $30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; $30/Visit for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $30/Visit for Prof - CORF; $35/Visit for OP Substance Abuse; PBP 3, 5, 9a, 9c, 9d"	"25% Coinsurance for Prof - Outpatient Surgery; $4/Visit for PCP Office Visits; $4/Consult for PCP Consults; PBP 7a, 14b, 14c"	"25% Coinsurance for Prof - Outpatient Surgery; $20/Visit for Speclst Office Visits; $20/Consult for Speclst Consults; 25% Coinsurance for Cardio; $30/Visit for Chiropractor; $30/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	25% Coinsurance for Prof Radiology (OP); 25% Coinsurance for Prof Radiology (OP); 25% Coinsurance for Prof Radiology (Office); 25% Coinsurance for Prof Radiology (Office); PBP 7d	"25% Coinsurance for Prof - Outpatient Surgery; 25% Coinsurance for Prof - Anesthesia (OP); 25% Coinsurance for Allergy Testing; 25% Coinsurance for Allergy Immunotherapy; 25% Coinsurance for Prof Path (OP); 25% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14d, 14e, 14f, 14g, 14h, 14i, 14j"	20% Coinsurance for Part B Rx; 20% Coinsurance for Therapeutic Injections; PBP 15	"25% Coinsurance for Renal Dialysis - Prof, Blood Products; PBP 13a, 14a"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$25/Exam for Vision (Refractions); PBP 17a	$100 Maximum Plan Benefit Every Two Years for Vision Hardware; PBP 17b	$30/Exam for Routine Hearing Exams; PBP 18a	$500 Maximum Plan Benefit Every Two Years for Hearing Aids; PBP 18b	No Cost-Sharing; PBP 14a	$25/Visit for Acupuncture; PBP 13b-f											0	220	210	90	0	0.25	0.2	0.25	49.45442612	0.25	0	0.245371072	0	0.2	0.233053225	4.560241142	21.9942796	35	30	0.25	0.25	0.2	0.25	0	0	22.6338163	0.274723494	30	0.621127483	0	25											NO	200.4976804	191.3841495	82.02177836	0	0.227838273	0.182270619	0.227838273	45.0704442	0.227838273	0	0.223619685	0	0.182270619	0.212393778	4.15598987	20.04455474	31.89735825	27.34059279	0.227838273	0.227838273	0.182270619	0.227838273	0	0	20.62739849	0.2635424	27.34059279	0.566066453	0	22.78382732												13.6497	0.160225479	0.329359799	0	2.293263699	1.340664446	0.591708264	1.195291814	6.517046298	0	4.334619275	0	0.031067364	6.00602938	1.946510732	6.934353341	0.407887372	0.47150835	2.900770133	6.457126799	3.771821057	0.712163882	0	0	0.349187914	0.220129293	0.147910699	0.231059686	0	0.793137732	0	0	0	0	0	0	0	0	0	0	61.7925	0	5.998456347	13.6497	0.160225479	0.329359799	0	2.293263699	1.340664446	0.591708264	1.195291814	6.517046298	0	4.334619275	0	0.031067364	6.00602938	1.946510732	6.934353341	0.407887372	0.47150835	2.900770133	6.457126799	3.771821057	0.712163882	0	0	0.349187914	0.220129293	0.147910699	0.231059686	0	0.793137732	0	0	0	0	0	0	0	0	0	0	61.7925	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.6497	0.160225479	0.329359799	0	2.293263699	1.340664446	0.591708264	1.195291814	6.517046298	0	4.334619275	0	0.031067364	6.00602938	1.946510732	6.934353341	0.407887372	0.47150835	2.900770133	6.457126799	3.771821057	0.712163882	0	0	0.349187914	0.220129293	0.147910699	0.231059686	0	0.793137732	0	0	0	0	0	0	0	0	0	0	61.7925
H5969_002_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	192.4744077	1.712749102	4.901433714	0	5.132939939	5.437664723	3.450617537	9.863631373	27.71907194	2.308322222	25.14811145	0	0.373755925	19.17959624	36.84085849	45.49524403	2.37975171	2.309340217	14.59017918	51.67235449	23.70743984	8.719810168	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 8a, 8b"	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h, 9c"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d, 14e, 14f, 14g, 14h, 14i, 14j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing;PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b-f											0	0.072765235	0.072765235	0.142296843	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.067001453	0.067001453	0.131025418	0	0.214543918	0.214543918	0.214543918	0.214543918	0.214543918	0.214543918	0.214543918	0.214543918	0.214543918	0.214543918	0.214543918	0.214543918	0.214543918	0.214543918	0.214543918	0.214543918	0.214543918	0.214543918	0	0	0	0	0	0	0	0												12.8961	0.114756678	0.642212399	0	1.101241046	1.166617896	0.740309007	2.116182123	5.946958303	0.495236494	5.395374367	0	0.080187061	4.114865727	7.903982131	9.760727915	0.510561256	0.495454899	3.130234209	11.0859894	5.086287035	1.870782239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.654	0	6.422092059	12.8961	0.114756678	0.642212399	0	1.101241046	1.166617896	0.740309007	2.116182123	5.946958303	0.495236494	5.395374367	0	0.080187061	4.114865727	7.903982131	9.760727915	0.510561256	0.495454899	3.130234209	11.0859894	5.086287035	1.870782239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.654	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.8961	0.114756678	0.642212399	0	1.101241046	1.166617896	0.740309007	2.116182123	5.946958303	0.495236494	5.395374367	0	0.080187061	4.114865727	7.903982131	9.760727915	0.510561256	0.495454899	3.130234209	11.0859894	5.086287035	1.870782239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.654
H5969_801_0	2011	8																															D	D	D		Coin	Coin	Coin	V	Coin		Coin		Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin			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	0	0	0	0	0	0	0											0	YES	816.6470778	19.74394993	60.41829543	0	7.100147429	8.321113034	5.569317309	247.24838	34.15532713	0	24.72881041	0	0.491082549	23.55888985	34.16472653	7200.015621	98.15861535	340.9538877	16.74297169	28.24514667	35.17508483	7.657710586	0	0	382.0861062	2.194664063	162.8922326	1.07250042	0	420.0362081											3400	$220/Days 1-10 for IP Medical; $220/Days 1-10 for IP Surgical; PBP 1a	$210/Days 1-10 for IP Psych; $210/Days 1-10 for IP Substance Abuse; PBP 1b	$90/Days 1-10 for SNF; PBP 2	No Cost-Sharing; PBP 6	25% Coinsurance for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"25% Coinsurance for DME / Medical Supplies; 25% Coinsurance for Diabetes Monitoring Supplies; 25% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $30/Visit for PCP Urgent Care; $30/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing for Clinical Lab; PBP 8a	"20% Coinsurance for OP Fac - Therapeutic Radiology; 25% Coinsurance for OP Fac - Diagnostic Radiology; 25% Coinsurance for OP Fac - CT/MRI/PET, OP Fac - Diagnostic Tests; PBP 8a, 8b"	No Cost-Sharing; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"25% Coinsurance for OP Fac - Cardiovascular; $30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; $30/Visit for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $30/Visit for Prof - CORF; $35/Visit for OP Substance Abuse; PBP 3, 5, 9a, 9c, 9d"	"25% Coinsurance for Prof - Outpatient; 25% Coinsurance for Prof - Home Visits; $2/Visit for PCP Office Visits; $2/Consult for PCP Consults; PBP 7a, 14b, 14c"	"25% Coinsurance for Prof - Outpatient; 25% Coinsurance for Prof - Home Visits; $20/Visit for Speclst Office Visits; $20/Consult for Speclst Consults; 25% Coinsurance for Cardio; $30/Visit for Chiropractor; $30/Visit Podiatry; 25% Coinsurance for Vision Exams; 25% Coinsurance Other Health Professional; $30/Visit for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	25% Coinsurance for Prof Radiology (OP); 25% Coinsurance for Prof Radiology (OP); 25% Coinsurance for Prof Radiology (Office); 25% Coinsurance for Prof Radiology (Office); PBP 7d	"25% Coinsurance for Prof - Outpatient Surgery; 25% Coinsurance for Prof - Anesthesia (OP); 25% Coinsurance for Allergy Testing; 25% Coinsurance for Allergy Immunotherapy; 25% Coinsurance for Prof Path (OP); 25% Coinsurance for Prof Path (Office); 25% Coinsurance for Prof (ER); PBP 7d, 7g, 14d, 14e, 14f, 14g, 14h, 14i, 14j"	20% Coinsurance for Part B Rx; 20% Coinsurance for Therapeutic Injections; PBP 15	"25% Coinsurance for Renal Dialysis - Prof; 25% Coinsurance for Blood Products; 0% Coinsurance for Medicare-covered Smoking Cessation; 0% Coinsurance for HIV Testing; PBP 13a, 14a"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$25/Exam for Vision (Refractions); PBP 17a	$100 Maximum Plan Benefit Every Two Years for Vision Hardware; PBP 17b	$30/Exam for Routine Hearing Exams; PBP 18a	$500 Maximum Plan Benefit Every Two Years for Hearing Aids; PBP 18b	No Cost-Sharing; PBP 14a	$15/Visit for Acupuncture; PBP 13b-f											0	220	210	90	0	0.25	0.2	0.25	48.07108216	0.25	0	0.245684028	0	0.2	0.220906101	0.050711191	20.68086886	35	30	0.25	0.25	0.2	0.25	0	0	25	0.413919414	30	0.581196745	0	15											NO	195.9757038	187.0677172	80.17187881	0	0.222699663	0.178159731	0.222699663	42.82165526	0.222699663	0	0.218855001	0	0.178159731	0.196782857	0.045173461	18.42249014	31.17795287	26.7239596	0.222699663	0.222699663	0.178159731	0.222699663	0	0	22.26996634	0.413919414	26.7239596	0.517729278	0	13.3619798												13.3369	0.30778797	0.403654022	0	1.581200442	1.482487257	1.24028509	0.882298741	7.606379854	0	5.412023832	0	0.087491135	4.635985658	1.543338937	11.05351806	0.255032057	0.75930316	3.728654159	6.290184655	6.266783641	1.70536957	0	0	0.70908706	0.908414063	0.362760454	0.555264868	0	0.467709611	0	0	0	0	0	0	0	0	0	0	71.5819	0	8.66373456	13.3369	0.30778797	0.403654022	0	1.581200442	1.482487257	1.24028509	0.882298741	7.606379854	0	5.412023832	0	0.087491135	4.635985658	1.543338937	11.05351806	0.255032057	0.75930316	3.728654159	6.290184655	6.266783641	1.70536957	0	0	0.70908706	0.908414063	0.362760454	0.555264868	0	0.467709611	0	0	0	0	0	0	0	0	0	0	71.5819	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.3369	0.30778797	0.403654022	0	1.581200442	1.482487257	1.24028509	0.882298741	7.606379854	0	5.412023832	0	0.087491135	4.635985658	1.543338937	11.05351806	0.255032057	0.75930316	3.728654159	6.290184655	6.266783641	1.70536957	0	0	0.70908706	0.908414063	0.362760454	0.555264868	0	0.467709611	0	0	0	0	0	0	0	0	0	0	71.5819
H5970_001_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	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	YES	1254.361731	58.121	617.92475	547.86102	44.463351	8.93334	2.767697	387.992643	409.453377	1549.538115	1028.283872	94.893319	0.359764	7.351108	3573.441768	3474.663544	99.260159	639.391942		1577.438372	17.670631	0		3.57	3.1				3.41	0.56	1126.944551	752.531983									4000	$215/Day(Days 1-7):1a.IP Acute	$215/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										154.5033	132.276385	32.5726	0	150	0.2	0.2	50	184.085226	30.381622	106.990671	150	0.172844	0.2	10	33.428061	35	70.92209		0	0.2	0		0	0				0	0	0	128.277878									NO	129.001449	110.443242	21.636089	0	126.35415	0.168472	0.168472	42.11805	155.066215	25.592293	90.124769	126.35415	0.145597	0.168472	8.42361	28.158495	29.482635	59.742003		0	0.168472	0		0	0				0	0	0	108.056282										13.4845	0.534922639	1.114122907	0	0.46817741	1.505017656	0.466279449	1.361791128	5.291032116	3.304686121	7.722820536	0.999180389	0.052380559	1.238455867	2.508439984	8.153441336	0.24387092	3.183212943	0	0	2.977006546	0	0	0	0	0	0	0	0	0	0	6.776317347	0	0	0	0	0	0	0	0	61.3857	0	11.9902182	13.4845	0.534922639	1.114122907	0	0.46817741	1.505017656	0.466279449	1.361791128	5.291032116	3.304686121	7.722820536	0.999180389	0.052380559	1.238455867	2.508439984	8.153441336	0.24387092	3.183212943	0	0	2.977006546	0	0	0	0	0	0	0	0	0	0	6.776317347	0	0	0	0	0	0	0	0	61.3857	YES	20% Coins	20% Coins	20% Coins(Days 1-8) 20%(Days 9-100)	20% Coins	$150/Trip	40% Coins	40% Coins	$50/Visit	20% Coins	20% Coins	20% Coins	20% Coins	0%-20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		20% Coins	20% Coins	0% Coins		0.5	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	20% Coins									6000	4.8785	0.0761	0.3776	1.3941	1.8075	1.9156	0.5935	0.1964	1.4354	0.2125	0.5787	0.106	0.0077	0.1823	0.7628	1.1864	0.0198	0.1255		0.1426	0.5202	0		0	0				0	0	0.3503	0.2617									17.131	0	4.864159185	18.363	0.611060442	1.49175313	1.394072013	2.275717127	3.420593463	1.059756602	1.558195887	6.726421226	3.517145384	8.30152804	1.105174074	0.060090521	1.42074507	3.271225069	9.339809598	0.263644385	3.308721708	0	0.142558848	3.497185723	0	0	0	0	0	0	0	0	0	0.350313333	7.037976036	0	0	0	0	0	0	0	0	78.5167
H5970_002_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V		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	1255.037628	58.152318	618.257711	548.156228	44.48731	9.832687	3.04633	388.201708	409.674006	1550.373064	1028.83795	94.944451	0.395984	8.091167	3575.367272	3476.535822	99.313644	639.73647		1578.288355	19.449589	0		3.57	3.1		0.28		3.41	0.56	1127.551791	752.937475									4000	$215/Day(Days 1-7):1a.IP Acute	$215/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										154.5033	132.276385	32.5726	0	150	0.2	0.2	50	184.085226	30.381622	106.990671	150	0.172843	0.2	10	33.428061	35	70.92209		0	0.2	0		0	0		0		0	0	0	128.277878									NO	128.579809	110.082259	21.529707	0	126.0234	0.168031	0.168031	42.0078	154.660307	25.525302	89.888854	126.0234	0.145215	0.168031	8.40156	28.084786	29.40546	59.58562		0	0.168031	0		0	0		0		0	0	0	107.773429										13.4477	0.533461544	1.109242281	0	0.467203505	1.652196229	0.511877876	1.358958309	5.280025628	3.297811723	7.706755356	0.997101877	0.057502817	1.359566882	2.503221888	8.136480382	0.243363616	3.176591183	0	0	3.268133889	0	0	0	0	0	0	0	0	0	0	6.762221125	0	0	0	0	0	0	0	0	61.8694	0	12.28769508	13.4477	0.533461544	1.109242281	0	0.467203505	1.652196229	0.511877876	1.358958309	5.280025628	3.297811723	7.706755356	0.997101877	0.057502817	1.359566882	2.503221888	8.136480382	0.243363616	3.176591183	0	0	3.268133889	0	0	0	0	0	0	0	0	0	0	6.762221125	0	0	0	0	0	0	0	0	61.8694	YES	20% Coins	20% Coins	20% Coins(Days 1-8) 20%(Days 9-100)	20% Coins	$150/Trip	20% Coins	20% Coins	$50/Visit	20% Coins	20% Coins	20% Coins	20% Coins	0%-20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		20% Coins	20% Coins	20% Coins		0.5	"VIS752: Vision 17a, 17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	20% Coins									6000	5.2167	0.0814	0.3885	1.5237	1.7959	1.0468	0.3243	0.1951	1.5688	0.2322	0.6325	0.1158	0.0084	0.1992	0.8337	1.2967	0.0216	0.1372		0.1558	0.5685	0		0	0		0		0	0	0.1914	0.286									16.8204	0	5.206818828	18.6644	0.614878288	1.497715314	1.523673669	2.263053879	2.699025797	0.83620312	1.554092918	6.848857513	3.530022557	8.339263446	1.112949264	0.065929332	1.558802796	3.336920172	9.433141123	0.264975352	3.313768056	0	0.155811894	3.83667193	0	0	0	0	0	0	0	0	0	0.191440426	7.048205289	0	0	0	0	0	0	0	0	78.6898
H5970_004_0	2011	5																															A	A	A	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O		V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0		0		0	0											0	YES	253.536386	9.088905	49.285233	575.576738	46.712706	9.802166	10474.62535	407.620787	430.167197	1627.927634	1080.303682	99.693874	0.394755	927.047401	3754.218465	3650.443154	104.281627	671.738114		1657.239336	19.389218	0		3.57	1.82		0.28		3.41	0.56											6700	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-20) $0(Days 21-100):2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$0/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a, 17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d												0	0	0	0	0	0.2	0	0	0	0	0	0	0.2	0	0	0	0	0		0	0.2	0		0	0		0		0	0											NO	0	0	0	0	0	0.199764	0	0	0	0	0	0	0.199764	0	0	0	0	0		0	0.199764	0		0	0		0		0	0												0	0	0	0	0	1.958119889	0	0	0	0	0	0	0.078857838	0	0	0	0	0	0	0	3.873267745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9102	0	0.006982329	0	0	0	0	0	1.958119889	0	0	0	0	0	0	0.078857838	0	0	0	0	0	0	0	3.873267745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9102	YES	30% Coins	30% Coins	30% Coins(Days 1-20) 30%(Days 21-100)	20% Coins	$0/Trip	20% Coins	20% Coins	$0/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	30% Coins		0.5	"VIS742: Vision 17a, 17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d											10000	9.0672	0.1415	0.709	2.6757	0	1.8383	0.9057	0	4.1325	0.6117	1.6661	0.3052	0.0171	1.2781	2.1961	3.4156	0.0569	0.3613		0.4104	1.3756	0		0	0		0		0	0											31.1641	1000	5.293413538	9.0672	0.141511239	0.708958845	2.675699075	0	3.796440768	0.905728083	0	4.132500659	0.611672562	1.666105174	0.30515704	0.095980793	1.278130247	2.196066603	3.415566678	0.05692823	0.361341604	0	0.410428699	5.24886535	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0743
H5970_801_0	2011	3																															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	YES	308.101589	5.211079	30.573276	16.303747	2.220562	12.929589	5.742564	29.284433	81.847459	11.803885	34.583999	5.855242	0.564581	23.603854	41.783876	66.150473	1.013767	7.90829		8.201548	27.02486	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.070357	0.070357	0.157501	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.060898	0.060898	0.099613	0	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244		0.201244	0.201244	0																				18.7628	0.317344289	3.045495742	0	0.446874779	2.602002209	1.15565655	5.893316435	16.47131004	2.375461033	6.959822295	1.178332321	0.113618539	4.750133994	8.408754342	13.31238579	0.204014526	1.591495913	0	1.650512326	5.438590926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.6779	0	16.18213518	18.7628	0.317344289	3.045495742	0	0.446874779	2.602002209	1.15565655	5.893316435	16.47131004	2.375461033	6.959822295	1.178332321	0.113618539	4.750133994	8.408754342	13.31238579	0.204014526	1.591495913	0	1.650512326	5.438590926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.6779	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	Medicare FFS Cost Sharing																			10000	3.0877	0.0522	0.5871	0	1.9099	1.833	0.8141	0.9602	2.8075	0.387	1.2027	0.192	0.0185	0.774	1.6264	2.5749	0.0395	0.2944		0.3192	1.052	0																			20.5325	0	1.780489667	21.8504	0.36956776	3.632558525	0	2.356725757	4.435039181	1.969783777	6.8535473	19.27883901	2.762508427	8.162502264	1.370324653	0.132131023	5.524169438	10.03520393	15.88731223	0.243475659	1.885907134	0	1.969759953	6.490541984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.2103
H5970_802_0	2011	3																															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	YES	308.101589	5.211079	30.573276	16.303747	2.220562	12.929589	5.742564	29.284433	81.847459	11.803885	34.583999	5.855242	0.564581	23.603854	41.783876	66.150473	1.013767	7.90829		8.201548	27.02486	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.070357	0.070357	0.157501	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.060898	0.060898	0.099613	0	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244		0.201244	0.201244	0																				18.7628	0.317344289	3.045495742	0	0.446874779	2.602002209	1.15565655	5.893316435	16.47131004	2.375461033	6.959822295	1.178332321	0.113618539	4.750133994	8.408754342	13.31238579	0.204014526	1.591495913	0	1.650512326	5.438590926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.6779	0	16.18213518	18.7628	0.317344289	3.045495742	0	0.446874779	2.602002209	1.15565655	5.893316435	16.47131004	2.375461033	6.959822295	1.178332321	0.113618539	4.750133994	8.408754342	13.31238579	0.204014526	1.591495913	0	1.650512326	5.438590926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.6779	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	Medicare FFS Cost Sharing																			10000	3.0877	0.0522	0.5871	0	1.9099	1.833	0.8141	0.9602	2.8075	0.387	1.2027	0.192	0.0185	0.774	1.6264	2.5749	0.0395	0.2944		0.3192	1.052	0																			20.5325	0	1.780489667	21.8504	0.36956776	3.632558525	0	2.356725757	4.435039181	1.969783777	6.8535473	19.27883901	2.762508427	8.162502264	1.370324653	0.132131023	5.524169438	10.03520393	15.88731223	0.243475659	1.885907134	0	1.969759953	6.490541984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.2103
H5970_803_0	2011	3																															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	YES	308.101589	5.211079	30.573276	16.303747	2.220562	12.929589	5.742564	29.284433	81.847459	11.803885	34.583999	5.855242	0.564581	23.603854	41.783876	66.150473	1.013767	7.90829		8.201548	27.02486	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.070357	0.070357	0.157501	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.060898	0.060898	0.099613	0	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244		0.201244	0.201244	0																				18.7628	0.317344289	3.045495742	0	0.446874779	2.602002209	1.15565655	5.893316435	16.47131004	2.375461033	6.959822295	1.178332321	0.113618539	4.750133994	8.408754342	13.31238579	0.204014526	1.591495913	0	1.650512326	5.438590926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.6779	0	16.18213518	18.7628	0.317344289	3.045495742	0	0.446874779	2.602002209	1.15565655	5.893316435	16.47131004	2.375461033	6.959822295	1.178332321	0.113618539	4.750133994	8.408754342	13.31238579	0.204014526	1.591495913	0	1.650512326	5.438590926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.6779	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	Medicare FFS Cost Sharing																			10000	3.0877	0.0522	0.5871	0	1.9099	1.833	0.8141	0.9602	2.8075	0.387	1.2027	0.192	0.0185	0.774	1.6264	2.5749	0.0395	0.2944		0.3192	1.052	0																			20.5325	0	1.780489667	21.8504	0.36956776	3.632558525	0	2.356725757	4.435039181	1.969783777	6.8535473	19.27883901	2.762508427	8.162502264	1.370324653	0.132131023	5.524169438	10.03520393	15.88731223	0.243475659	1.885907134	0	1.969759953	6.490541984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.2103
H5970_805_0	2011	5																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0																			0	YES				16.303747	2.220562	12.929589	5.742564	29.284433	81.847459	11.803885	34.583999	5.855242	0.564581	23.603854	41.783876	66.150473	1.013767	7.90829		8.201548	27.02486	0																			6700				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare 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	0																			NO				0	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244		0.201244	0.201244	0																				0	0	0	0	0.446874779	2.602002209	1.15565655	5.893316435	16.47131004	2.375461033	6.959822295	1.178332321	0.113618539	4.750133994	8.408754342	13.31238579	0.204014526	1.591495913	0	1.650512326	5.438590926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5523	0	11.4486	0	0	0	0	0.446874779	2.602002209	1.15565655	5.893316435	16.47131004	2.375461033	6.959822295	1.178332321	0.113618539	4.750133994	8.408754342	13.31238579	0.204014526	1.591495913	0	1.650512326	5.438590926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5523	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																			10000				0	1.9099	1.833	0.8141	0.9602	2.8075	0.387	1.2027	0.192	0.0185	0.774	1.6264	2.5749	0.0395	0.2944		0.3192	1.052	0																			16.8055	0	1.259667762	0	0	0	0	2.356725757	4.435039181	1.969783777	6.8535473	19.27883901	2.762508427	8.162502264	1.370324653	0.132131023	5.524169438	10.03520393	15.88731223	0.243475659	1.885907134	0	1.969759953	6.490541984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3578
H5970_806_0	2011	5																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0																			0	YES				16.303747	2.220562	12.929589	5.742564	29.284433	81.847459	11.803885	34.583999	5.855242	0.564581	23.603854	41.783876	66.150473	1.013767	7.90829		8.201548	27.02486	0																			6700				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare 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	0																			NO				0	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244		0.201244	0.201244	0																				0	0	0	0	0.446874779	2.602002209	1.15565655	5.893316435	16.47131004	2.375461033	6.959822295	1.178332321	0.113618539	4.750133994	8.408754342	13.31238579	0.204014526	1.591495913	0	1.650512326	5.438590926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5523	0	11.4486	0	0	0	0	0.446874779	2.602002209	1.15565655	5.893316435	16.47131004	2.375461033	6.959822295	1.178332321	0.113618539	4.750133994	8.408754342	13.31238579	0.204014526	1.591495913	0	1.650512326	5.438590926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5523	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																			10000				0	1.9099	1.833	0.8141	0.9602	2.8075	0.387	1.2027	0.192	0.0185	0.774	1.6264	2.5749	0.0395	0.2944		0.3192	1.052	0																			16.8055	0	1.259667762	0	0	0	0	2.356725757	4.435039181	1.969783777	6.8535473	19.27883901	2.762508427	8.162502264	1.370324653	0.132131023	5.524169438	10.03520393	15.88731223	0.243475659	1.885907134	0	1.969759953	6.490541984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3578
H5970_807_0	2011	5																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0																			0	YES				16.303747	2.220562	12.929589	5.742564	29.284433	81.847459	11.803885	34.583999	5.855242	0.564581	23.603854	41.783876	66.150473	1.013767	7.90829		8.201548	27.02486	0																			6700				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare 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	0																			NO				0	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244	0.201244		0.201244	0.201244	0																				0	0	0	0	0.446874779	2.602002209	1.15565655	5.893316435	16.47131004	2.375461033	6.959822295	1.178332321	0.113618539	4.750133994	8.408754342	13.31238579	0.204014526	1.591495913	0	1.650512326	5.438590926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5523	0	11.4486	0	0	0	0	0.446874779	2.602002209	1.15565655	5.893316435	16.47131004	2.375461033	6.959822295	1.178332321	0.113618539	4.750133994	8.408754342	13.31238579	0.204014526	1.591495913	0	1.650512326	5.438590926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5523	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																			10000				0	1.9099	1.833	0.8141	0.9602	2.8075	0.387	1.2027	0.192	0.0185	0.774	1.6264	2.5749	0.0395	0.2944		0.3192	1.052	0																			16.8055	0	1.259667762	0	0	0	0	2.356725757	4.435039181	1.969783777	6.8535473	19.27883901	2.762508427	8.162502264	1.370324653	0.132131023	5.524169438	10.03520393	15.88731223	0.243475659	1.885907134	0	1.969759953	6.490541984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3578
H5980_005_0	2011	7																															Coin	Coin	Coin	Coin	Coin	Coin	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	493.1821919	4.490923972	0	0	57.85844114	39.09909293	3.657880135	62.02124318	131.7433342	14.63961459	62.95661629	22.65958172	0.734905353	6.650784605	0	78.44301721	3.402175076	0	34.40120053	105.0081175	92.08925112	39.64570518	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	Medicare-FFS Cost Sharing; PBP 10a	Medicare-FFS Cost Sharing; PBP 11a	"Medicare-FFS Cost Sharing; PBP 11b, 11c"	"Medicare-FFS Cost Sharing; PBP 4a, 4b"	Medicare-FFS Cost Sharing; PBP 9b	Medicare-FFS Cost Sharing; PBP 8a	Medicare-FFS Cost Sharing; PBP 8b	Medicare-FFS Cost Sharing; PBP 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14c; Medicare-FFS Cost Sharing; PBP 14b, 14d-j"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7g, 18a"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 16b, 17a"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											0	0.074401858	0.074401858	0	0	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	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.068859092	0.068859092	0	0	0.215642039	0.215642039	0.215642039	0.215642039	0.215642039	0.215642039	0.215642039	0.215642039	0.215642039	0.215642039	0	0.215642039	0.215642039	0	0.215642039	0.215642039	0.215642039	0.215642039	0	0	0	0	0	0	0	0												33.9601	0.309240946	0	0	12.47671224	8.431408134	0.788792732	13.37438736	28.40940125	3.156916345	13.57609312	4.886358411	0.158476489	1.434188755	0	16.9156122	0.733651971	0	7.418345036	22.6441646	19.85831391	8.549280713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	197.0814	0	16.68319908	33.9601	0.309240946	0	0	12.47671224	8.431408134	0.788792732	13.37438736	28.40940125	3.156916345	13.57609312	4.886358411	0.158476489	1.434188755	0	16.9156122	0.733651971	0	7.418345036	22.6441646	19.85831391	8.549280713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	197.0814	NO																																																																																		0	0	0	33.9601	0.309240946	0	0	12.47671224	8.431408134	0.788792732	13.37438736	28.40940125	3.156916345	13.57609312	4.886358411	0.158476489	1.434188755	0	16.9156122	0.733651971	0	7.418345036	22.6441646	19.85831391	8.549280713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	197.0814
H5980_006_0	2011	6																															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	2513.773837	60.28502629	0	0	1018.04613	54.35518485	0	1087.612645	3075.468004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											750	$75/Days 1-10 for IP Medical; $75/Days 1-10 for IP Surgical; PBP 1a	$75/Days 1-10 for IP Psych; $75/Days 1-10 for IP Substance Abuse; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; 20% Coinsurance for DME / Medical Supplies; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"$50/Visit for ER - Facility; $20/Visit for PCP Urgent Care; PBP 4a, 4b"	$50/Visit for OP Fac - Surgery; $50/Visit for Prof - Primary Surgeon (OP); $50/Visit for Prof - Anesthesia (OP); PBP 9b	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14b-j"	"No Cost-Sharing; PBP 7b, 7d, 7f"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	No Cost-Sharing; PBP 7d	"No Cost-Sharing; PBP 7g, 18a"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 13a, 16b, 17a"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	75	75	0	0	50	0.2	0	48.09575548	50	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	56.42775288	56.42775288	0	0	37.61850192	0.150474008	0	36.18580539	37.61850192	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												11.8206	0.283479047	0	0	3.191447524	8.179042502	0	3.279678294	9.641208252	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3954	0	11.97893672	11.8206	0.283479047	0	0	3.191447524	8.179042502	0	3.279678294	9.641208252	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3954	NO																																																																																		0	0	0	11.8206	0.283479047	0	0	3.191447524	8.179042502	0	3.279678294	9.641208252	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3954
H5980_007_0	2011	9																															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	2518.842396	60.42076925	0	0	1018.04613	0	0	2719.031613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											500	$65/Days 1-10 for IP Medical; $65/Days 1-10 for IP Surgical; PBP 1a	$65/Days 1-10 for IP Psych; $65/Days 1-10 for IP Substance Abuse; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"$50/Visit for ER - Facility; $20/Visit for PCP Urgent Care; PBP 4a, 4b"	No Cost-Sharing; PBP 9b	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 9c, 9d"	"No Cost-Sharing; PBP 7a, 14b-j"	"No Cost-Sharing; PBP 7b, 7d, 7f"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	No Cost-Sharing; PBP 7d	"No Cost-Sharing; PBP 7g, 18a"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 13a, 16b, 17a"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	65	65	0	0	50	0	0	48.09575548	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	50.75987684	50.75987684	0	0	39.04605911	0	0	37.55899422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												10.6547	0.255579234	0	0	3.312557447	0	0	8.510341055	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.7332	0	5.671208363	10.6547	0.255579234	0	0	3.312557447	0	0	8.510341055	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.7332	NO																																																																																		0	0	0	10.6547	0.255579234	0	0	3.312557447	0	0	8.510341055	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.7332
H5985_001_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	V	V	V	V	V	V	Coin	V	Coin	Coin	T	P	V	P	V	P	O	O																																																			0	YES	1540.414164	477.6932208	879.6484398		238.3575294	9.679001116	9.423058585	468.3281858	565.2704683		260.7612018	56.01894016		434.6953678	4875.713127	6164.095773	240.1861619	886.5656869	2.000118563	4.081323106	28.12132158																				6700	"1a: $175, 1-10 days then $0 days 11+"	"1b: $125, 1-10 days then $0 days 11+"	"2: $0, 1-20 days then $75 , 21+ days"	6: $0/visit	10a: $150/trip	11a: 20%	11b: 20%;11c: 20%	4a: $50/visit;4b: $35/visit	9a: $250/visit;9b: $200/visit	8a: $0/visit;8a: 20%	8b: $0/visit;8b: $150/visit;8b: 20%	9a: $250/visit	12a: $0/visit	3: $20/visit;5: $35/visit;9a: $250/visit;9c: $35/visit;9d: $20/visit	7a: $10/visit;14c: $0/visit;14d: $0/visit;14e: $0/visit;14f: $25/visit;14g: $0/visit	7b: $40/visit;7d: $40/visit;7f: $40/visit;14c1: $0/visit;16b: $35/visit;17a: $30/visit;18a: $30/visit	7e: $35/visit;7h: $35/visit	7c: $30/visit;7i: $30/visit	14h: $0/visit;8b: 20%	7g: $30/visit;14b: $0/visit;14i: 20%;14j: $5/visit	15: 20%	13a: 20%;17b: $0/visit							14a: $0													154.390154	89.54771718	13.98813941		150	0.2	0.2	48.70345424	188.3267016		103.0310078	250		76.63897421	10.0316192	39.09927884	35	30	0.2	11.38808955	0.2																				NO	145.3662978	84.31379714	13.17055516		141.2327413	0.188310322	0.188310322	45.85681567	177.3193088		97.00901115	235.3879021		72.15954944	9.445287196	36.81398888	32.95430629	28.24654825	0.188310322	10.72247404	0.188310322																					18.6604	3.356344109	0.965454858	0	2.805323939	1.822655814	1.774459193	1.789669941	8.352780729	0	2.108015528	1.0988484	0	2.613951824	3.83770923	18.91041277	0.659597362	2.086868371	0.37664297	0.003646823	5.295535112	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5183	0	4.75	18.6604	3.356344109	0.965454858	0	2.805323939	1.822655814	1.774459193	1.789669941	8.352780729	0	2.108015528	1.0988484	0	2.613951824	3.83770923	18.91041277	0.659597362	2.086868371	0.37664297	0.003646823	5.295535112	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5183	NO																																																																																		0	0	0	18.6604	3.356344109	0.965454858	0	2.805323939	1.822655814	1.774459193	1.789669941	8.352780729	0	2.108015528	1.0988484	0	2.613951824	3.83770923	18.91041277	0.659597362	2.086868371	0.37664297	0.003646823	5.295535112	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5183
H5985_002_0	2011	4																															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	V	O	Coin	V																																																			0	YES	243.8231234	30.59854098	11.82491313		17.48726473	24.92623706	5.15265178	48.7152986	59.16916792	0.861506095	11.62444725	0.272511181	3.133780832	18.5246191	46.56686025	112.918365	1.987795679	2.818825628	36.962922	13.71914486	36.77151297																				6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		16a1 $0 copay; 16b1$0 copay with combined $500 allowance	17a1 $0 copay	17b1 $200 allowance	18a1 $0 copay	18b1 $1000 allowance	14a1 $0 copay	14c1 $0 copay; 7b1 $0 copay; 7f1 $0 copay; 14a $0 copay; 13c $17.50/month												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																				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																					19.2476	2.415477925	1.569265729	0	4.074532683	5.807813234	1.200567865	11.35066457	13.78641613	0.20073092	2.708496209	0.063495105	0.730170934	4.31623625	10.85007844	26.30997905	0.463156393	0.656786371	8.612360826	3.196560754	8.567762522	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.1282	0	0	19.2476	2.415477925	1.569265729	0	4.074532683	5.807813234	1.200567865	11.35066457	13.78641613	0.20073092	2.708496209	0.063495105	0.730170934	4.31623625	10.85007844	26.30997905	0.463156393	0.656786371	8.612360826	3.196560754	8.567762522	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.1282	NO																																																																																		0	0	0	19.2476	2.415477925	1.569265729	0	4.074532683	5.807813234	1.200567865	11.35066457	13.78641613	0.20073092	2.708496209	0.063495105	0.730170934	4.31623625	10.85007844	26.30997905	0.463156393	0.656786371	8.612360826	3.196560754	8.567762522	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.1282
H5989_002_0	2011	9																															Coin	Coin	Coin	Coin	Coin	Coin	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	490.3353337	31.08532065	572.1192699	0	37.14226862	3.92813581	16.01070256	16.00007325	9.868588031	8.398206342	7.821247672	0	1.722581072	64.81951856	0.575540648	25.14822611	7.829714959	0.850048452	19.00310703	167.2166568	5.405565225	5.464418023	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"$0 Primary Care; Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	PBP 14a	No Cost-Sharing; PBP 13b											0	0.061567114	0.061567114	0.144638709	0	0.233	0.233	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	0.061539852	0.061539852	0.144574663	0	0.232896828	0.232896828	0.232896828	0.232896828	0.232896828	0.232896828	0.232896828	0	0.232896828	0.232896828	0.232896828	0.232896828	0.232896828	0.232896828	0.232896828	0.232896828	0.232896828	0.232896828	0	0	0	0	0	0	0	0												30.1752	1.912986035	82.71395081	0	8.650316556	0.914850371	3.728841844	3.726366311	2.298362852	1.95591562	1.821543776	0	0.401183668	15.09626028	0.134041591	5.856942098	1.82351578	0.197973588	4.425763354	38.94422901	1.258938996	1.272645626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	207.3098	0	0.091836841	30.1752	1.912986035	82.71395081	0	8.650316556	0.914850371	3.728841844	3.726366311	2.298362852	1.95591562	1.821543776	0	0.401183668	15.09626028	0.134041591	5.856942098	1.82351578	0.197973588	4.425763354	38.94422901	1.258938996	1.272645626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	207.3098	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	30.1752	1.912986035	82.71395081	0	8.650316556	0.914850371	3.728841844	3.726366311	2.298362852	1.95591562	1.821543776	0	0.401183668	15.09626028	0.134041591	5.856942098	1.82351578	0.197973588	4.425763354	38.94422901	1.258938996	1.272645626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	207.3098
H5989_004_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	V	V	V	V	V	Coin	Coin	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	963.4508949	19.96246107	545.2593003	0	185.4355917	8.735248525	6.022147346	235.3116099	259.8911182	5.135315169	20.81997384	0	0.383519609	1348.625815	0	4577.627652	130.2448414	437.0206532	33.90080815	16.28565502	48.63804555	543.7991133	0	0	0	0	154.7208326	0	0	33.73627749											3400	$200/Days 1-7 for IP Medical; $200/Days 1-7 for IP Surgical;PBP 1a	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse;PBP 1b	$100/Days 21-100 for SNF;PBP 2	No Cost-Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $25/Visit for PCP Urgent Care; $50/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$250/Case for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	20% Coinsurance for OP Fac - Observation	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; $25/Visit for OP Fac - CORF; $25/Visit for OP Fac - Other; $25/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 4b, 7a, 14b-c"	"$25/Visit for Specialist Office Visits; $25/Visit for Specialist Consults; $25/Visit for Cardio; $25/Visit for Chiropractor; $25/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"$25/Visit for Renal Dialysis - Prof; PBP 7g, 14a, 14j"	PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	$25/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	$25/Visit for Acupuncture; $50/Visit for Foreign Travel; PBP 13b											0	200	200	100	0	50	0.2	0.2	47.67424121	250	0.2	0.2	0	0.2	25	0	25	25	25	0.2	0.2	0.2	25	0	0	0	0	25	0	0	25.18526051											NO	173.2530386	173.2530386	86.62651928	0	43.31325964	0.173253039	0.173253039	41.29853575	216.5662982	0.173253039	0.173253039	0	0.173253039	21.65662982	0	21.65662982	21.65662982	21.65662982	0.173253039	0.173253039	0.173253039	21.65662982	0	0	0	0	21.65662982	0	0	21.81711455												13.9101	0.288213087	3.936159607	0	0.669318327	1.51340835	1.043355326	0.809835411	4.690304784	0.889708957	3.60712373	0	0.066445938	2.433890837	0	8.261332293	0.23505536	0.788699543	5.873418022	2.821539217	8.426689181	0.981404674	0	0	0	0	0.27922765	0	0	0.061335686	0	0	0	0	0	0	0	0	0	0	61.5865	0	9.507784777	13.9101	0.288213087	3.936159607	0	0.669318327	1.51340835	1.043355326	0.809835411	4.690304784	0.889708957	3.60712373	0	0.066445938	2.433890837	0	8.261332293	0.23505536	0.788699543	5.873418022	2.821539217	8.426689181	0.981404674	0	0	0	0	0.27922765	0	0	0.061335686	0	0	0	0	0	0	0	0	0	0	61.5865	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.9101	0.288213087	3.936159607	0	0.669318327	1.51340835	1.043355326	0.809835411	4.690304784	0.889708957	3.60712373	0	0.066445938	2.433890837	0	8.261332293	0.23505536	0.788699543	5.873418022	2.821539217	8.426689181	0.981404674	0	0	0	0	0.27922765	0	0	0.061335686	0	0	0	0	0	0	0	0	0	0	61.5865
H5989_005_0	2011	8																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	V	V	V	V	V	Coin	Coin	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	951.5681318	19.71961461	551.4468299	0	183.211936	8.577822272	5.913222196	232.2917716	256.6612365	5.064161334	20.54381799	0	0.377342248	1325.943179	0	4519.630375	128.819131	432.4164052	33.95784623	16.1786216	48.4855784	537.9189556	0	0	0	0	152.6548229	0	0	34.44799986											3400	$200/Days 1-7 for IP Medical; $200/Days 1-7 for IP Surgical;PBP 1a	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse;PBP 1b	$50/Days 21-100 for SNF;PBP 2	No Cost-Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $30/Visit for PCP Urgent Care; $50/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$250/Case for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	20% Coinsurance for OP Fac - Observation	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$30/Visit for OP Fac - Cardiovascular; $30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; $30/Visit for OP Fac - CORF; $30/Visit for OP Fac - Other; $30/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 4b, 7a, 14b-c"	"$30/Visit for Specialist Office Visits; $30/Visit for Specialist Consults; $30/Visit for Cardio; $30/Visit for Chiropractor; $30/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"$30/Visit for Renal Dialysis - Prof; PBP 7g, 14a, 14j"	PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	$30/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	$30/Visit for Acupuncture; $50/Visit for Foreign Travel; PBP 13b											0	200	200	50	0	50	0.2	0.2	48.13980649	250	0.2	0.2	0	0.2	30	0	30	30	30	0.2	0.2	0.2	30	0	0	0	0	30	0	0	30.14514631											NO	173.209808	173.209808	43.302452	0	43.302452	0.173209808	0.173209808	41.6914332	216.51226	0.173209808	0.173209808	0	0.173209808	25.9814712	0	25.9814712	25.9814712	25.9814712	0.173209808	0.173209808	0.173209808	25.9814712	0	0	0	0	25.9814712	0	0	26.10717502												13.7351	0.284635888	1.989916657	0	0.661127172	1.485762949	1.024228081	0.807048073	4.630858697	0.877162412	3.558390769	0	0.065359378	2.870829543	0	9.785553868	0.278909212	0.936234532	5.881832026	2.802295941	8.398177726	1.164660488	0	0	0	0	0.330516407	0	0	0.074944997	0	0	0	0	0	0	0	0	0	0	61.6435	0	9.534343495	13.7351	0.284635888	1.989916657	0	0.661127172	1.485762949	1.024228081	0.807048073	4.630858697	0.877162412	3.558390769	0	0.065359378	2.870829543	0	9.785553868	0.278909212	0.936234532	5.881832026	2.802295941	8.398177726	1.164660488	0	0	0	0	0.330516407	0	0	0.074944997	0	0	0	0	0	0	0	0	0	0	61.6435	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.7351	0.284635888	1.989916657	0	0.661127172	1.485762949	1.024228081	0.807048073	4.630858697	0.877162412	3.558390769	0	0.065359378	2.870829543	0	9.785553868	0.278909212	0.936234532	5.881832026	2.802295941	8.398177726	1.164660488	0	0	0	0	0.330516407	0	0	0.074944997	0	0	0	0	0	0	0	0	0	0	61.6435
H5989_007_0	2011	6																															D	D	D	V	T	O	O	V	V	Coin	Coin	Coin	Coin	V	V	V	V	V	Coin	Coin	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	1992.63618	253.1946936	5251.517415	0	1092.836705	0	0	285.1071852	79.83658892	7.906057688	7.365309086	0	1.485971625	1581.53169	829.8909791	1408.990689	1033.973976	83.91296283	22.22628858	4.278764751	5.813743817	1843.247907	0	0	0	0	0	0	0	0.65											3400	$200/Days 1-7 for IP Medical; $200/Days 1-7 for IP Surgical;PBP 1a	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse;PBP 1b	$100/Days 21-100 for SNF;PBP 2	No Cost-Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $50/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$250/Case for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	20% Coinsurance for OP Fac - Observation	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$50/Visit for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $50/Visit for OP Fac - Physical/Speech Therapy; $50/Visit for OP Fac - Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$10/Visit for PCP Office Visits; $10/Visit for PCP Consults; $10/Visit for Routine Physicals; PBP 4b, 7a, 14b-c"	"$50/Visit for Specialist Office Visits; $50/Visit for Specialist Consults; $50/Visit for Cardio; $40/Visit for Chiropractor; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $50/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"$10/Visit for Allergy Testing; $10/Visit for Allergy Tx; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"$50/Visit for Renal Dialysis - Prof; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost-Sharing; PBP 14a	$50/Visit for Foreign Travel; PBP 13b											0	200	200	100	0	50	0	0	44.38488688	250	0.2	0.2	0	0.2	50	10	49.85029994	40	50	0.2	0.198655447	0.2	40.57268277	0	0	0	0	0	0	0	50											NO	199.8992611	199.8992611	99.94963055	0	49.97481528	0	0	44.36253046	249.8740764	0.199899261	0.199899261	0	0.199899261	49.97481528	9.994963055	49.82519062	39.97985222	49.97481528	0.199899261	0.198555385	0.199899261	40.55224653	0	0	0	0	0	0	0	49.97481528												33.1939	4.217786014	43.74060213	0	4.551192704	0	0	1.054006349	1.662424493	1.58041509	1.472319844	0	0.29704463	6.586396173	0.691227473	5.850269137	3.444843898	0.349461235	4.443018663	0.849571782	1.162163093	6.228986963	0	0	0	0	0	0	0	0.002706969	0	0	0	0	0	0	0	0	0	0	121.3783	0	0.061168396	33.1939	4.217786014	43.74060213	0	4.551192704	0	0	1.054006349	1.662424493	1.58041509	1.472319844	0	0.29704463	6.586396173	0.691227473	5.850269137	3.444843898	0.349461235	4.443018663	0.849571782	1.162163093	6.228986963	0	0	0	0	0	0	0	0.002706969	0	0	0	0	0	0	0	0	0	0	121.3783	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	33.1939	4.217786014	43.74060213	0	4.551192704	0	0	1.054006349	1.662424493	1.58041509	1.472319844	0	0.29704463	6.586396173	0.691227473	5.850269137	3.444843898	0.349461235	4.443018663	0.849571782	1.162163093	6.228986963	0	0	0	0	0	0	0	0.002706969	0	0	0	0	0	0	0	0	0	0	121.3783
H5991_001_0	2011	9																															D	D	D	V	T	P	P	V	V	P	P	P	P	P	V	V	V	V	P	P	S	P																																																											0	YES								680.0232823						1010.73883		8655.143422	437.0298383	4754.440754		4258.166585																					3400								4a ER $30 copay;4b UC $10 copay						5 Partial Hosp $10 copay; 9c OP SA $10 copay; 3 CORF $10 copay		7b Chiro $10 copay; 7d SPC $10 copay;7f Podiatry $10 copay	7e MH $10 copay; 7h Psych $10 copay	7c OT $10 copay; 7i PT/ST $10 copay		7g Prof Other $10 copay																													29.60827334						10		10	10	10		10																					NO								29.60827334						10		10	10	10		10																						0	0	0	0	0	0	0	1.677859602	0	0	0	0	0	0.842282358	0	7.212619519	0.364191532	3.962033962	0	3.548472154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.6075	0	1.12E-15	0	0	0	0	0	0	0	1.677859602	0	0	0	0	0	0.842282358	0	7.212619519	0.364191532	3.962033962	0	3.548472154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.6075	NO																																																																																		0	0	0	0	0	0	0	0	0	0	1.677859602	0	0	0	0	0	0.842282358	0	7.212619519	0.364191532	3.962033962	0	3.548472154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.6075
H5991_002_0	2011	9																															A	A	D	V	T	Coin	Coin	V	V	V	P	V	V	V	V	V	V	V	V	V	Coin	O																																																											0	YES	338.691249	11.00152172	711.3891711			4.65270105	5.539249294	444.6153821	273.0316785		279.6700072					14241.80134	659.9987318	3389.587318	4578.310225	4650.293076	14.84857597																				3400	1a IP Acute $150 per Admit	1b IP Psych $150 per Admit	$0 from 1-20 days; $25 from 21-100 days			11a DME 20%	Prosthetic/Supplies 20%	4a ER $50 copay	OutP Surg $75		$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%																					150	150	6.1			0.2	0.2	50	75		25					10	10	10	10	10	0.2																				NO	138.8494719	138.8494719	5.646545191			0.185132629	0.185132629	46.2831573	69.42473596		23.14157865					9.256631461	9.256631461	9.256631461	9.256631461	9.256631461	0.185132629																					3.9189	0.12729629	0.334740925	0	0	0.861366778	1.025495786	1.714850306	1.579596016	0	0.539333789	0	0	0	0	10.98592553	0.509113752	2.61468005	3.531644206	3.587170765	2.74895591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0791	0	2.736776041	3.9189	0.12729629	0.334740925	0	0	0.861366778	1.025495786	1.714850306	1.579596016	0	0.539333789	0	0	0	0	10.98592553	0.509113752	2.61468005	3.531644206	3.587170765	2.74895591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0791	NO																																																																																		0	0	0	3.9189	0.12729629	0.334740925	0	0	0.861366778	1.025495786	1.714850306	1.579596016	0	0.539333789	0	0	0	0	10.98592553	0.509113752	2.61468005	3.531644206	3.587170765	2.74895591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0791
H5992_005_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	373.3531449	8.770099211	55.18088536	0	24.08383901	24.13614742	10.17700146	41.37471116	71.70841665	22.19637575	33.88635992	0	0.326041414	71.76054627	52.3029745	140.9259347	6.797103131	43.01908788	29.00500926	61.08189923	54.11725281	9.65295229	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.086389954	0.086389954	0.191037159	0	0.233	0.233	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	0.078790039	0.078790039	0.174231198	0	0.212502475	0.212502475	0.212502475	0.212502475	0.212502475	0.212502475	0.212502475	0	0.212502475	0.212502475	0.212728386	0.212502475	0.212502475	0.212502475	0.212502475	0.212502475	0.212502475	0.212502475	0	0	0	0	0	0	0	0												29.4165	0.690996461	9.614231777	0	5.117875403	5.128991071	2.162638	8.792228536	15.23821604	4.71678479	7.200935361	0	0.069284607	15.24929371	11.12632737	29.94710995	1.44440124	9.141662658	6.163636263	12.98005478	11.50005018	2.051276255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	187.7525	0	18.09724093	29.4165	0.690996461	9.614231777	0	5.117875403	5.128991071	2.162638	8.792228536	15.23821604	4.71678479	7.200935361	0	0.069284607	15.24929371	11.12632737	29.94710995	1.44440124	9.141662658	6.163636263	12.98005478	11.50005018	2.051276255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	187.7525	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	29.4165	0.690996461	9.614231777	0	5.117875403	5.128991071	2.162638	8.792228536	15.23821604	4.71678479	7.200935361	0	0.069284607	15.24929371	11.12632737	29.94710995	1.44440124	9.141662658	6.163636263	12.98005478	11.50005018	2.051276255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	187.7525
H5995_001_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	318.1778271	14.93143369	60.56416466	0	25.50116642	24.60219794	1.335369876	15.46587587	30.98357823	13.78831298	20.21886046	0	9.47388808	40.03234197	53.76131092	126.4265541	15.93618106	4.424828412	24.83874282	37.30452892	28.23929413	0	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 5	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	No Cost Sharing; PBP 13b											0	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	0	0	0	0	0	0	0	0											NO	0.074007426	0.074007426	0.111884945	0	0.209712168	0.209712168	0.209712168	0.209712168	0.209712168	0.209712168	0.209712168	0	0.209712168	0.209712168	0.209712168	0.209712168	0.209712168	0.209712168	0.209712168	0.209712168	0.209712168	0	0	0	0	0	0	0	0	0												23.5475	1.105036973	6.77621824	0	5.347904908	5.159380279	0.280043313	3.243382365	6.497633377	2.891577015	4.240141071	0	1.986789613	8.395269245	11.27440109	26.51318682	3.342011087	0.927940362	5.208986619	7.823213654	5.922123609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.4828	0	14.48967216	23.5475	1.105036973	6.77621824	0	5.347904908	5.159380279	0.280043313	3.243382365	6.497633377	2.891577015	4.240141071	0	1.986789613	8.395269245	11.27440109	26.51318682	3.342011087	0.927940362	5.208986619	7.823213654	5.922123609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.4828	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.5475	1.105036973	6.77621824	0	5.347904908	5.159380279	0.280043313	3.243382365	6.497633377	2.891577015	4.240141071	0	1.986789613	8.395269245	11.27440109	26.51318682	3.342011087	0.927940362	5.208986619	7.823213654	5.922123609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.4828
H5998_003_0	2011	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	321.4071583	15.57656045	5.262794179	416.2623642	9.943672922	14.36445777	7.781259412	31.81299401	27.48130773	15.79228503	28.43003557	0	10.08549118	19.93302896	20.77239814	72.10319363	1.516097565	4.774949854	0	0.327911617	9.204375641	1.903800034	0	92.67781002	424.0684783	444.4032964	16.89178711	0.439051524	210.4196854	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a); $0 n/c (13a1); $0 (16b, 17a, 17b, 18a)"	$0 n/c (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.077552861	0.077552861	0.207565901	0	0.233	0.233	0.233	0.106520417	0.233	0.233	0.233	0	0.233	0.233	0.225012533	0.232637428	0.233	0.233	0	0.233	0.233	0.064531207	0	0	0	0	0	0	0	0											NO	0.070195482	0.070195482	0.187874287	0	0.210895474	0.210895474	0.210895474	0.09642147	0.210895474	0.210895474	0.210895474	0	0.210895474	0.210895474	0.203665771	0.210567299	0.210895474	0.210895474	0	0.210895474	0.210895474	0.064444497	0	0	0	0	0	0	0	0												22.5613	1.093404171	0.988743706	0	2.097075612	3.029399128	1.64103239	3.067455634	5.795683415	3.330521434	5.995765821	0	2.126984442	4.203785588	4.230626493	15.18257471	0.319738114	1.007015312	0	0.069155076	1.941161162	0.122689436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8041	0	8.2467508	22.5613	1.093404171	0.988743706	0	2.097075612	3.029399128	1.64103239	3.067455634	5.795683415	3.330521434	5.995765821	0	2.126984442	4.203785588	4.230626493	15.18257471	0.319738114	1.007015312	0	0.069155076	1.941161162	0.122689436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8041	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.5613	1.093404171	0.988743706	0	2.097075612	3.029399128	1.64103239	3.067455634	5.795683415	3.330521434	5.995765821	0	2.126984442	4.203785588	4.230626493	15.18257471	0.319738114	1.007015312	0	0.069155076	1.941161162	0.122689436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8041
H6169_001_0	2011	6																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1486.97228	76.53006803	3026.889302	18.97853423	232.2486863	23.13274404	2.395507243	303.1679374	352.8509885	4.610715108	17.51820142	0	8.288237443	8.533557615	5731.350404	92.28987543	0.989995992	492.1947489	31.94636867	38.52374564	13.20203635	36.02511126	0	0	0	0	0.158770792	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: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0			17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												0	128.8537736	92.6697687	35.01559476	0.15	150	0.2	0.2	49.86005419	129.4000508	0	0.2	0	50	0.126028951	4.144089405	0.079281012	0.45	0.093547381	0.123419586	0.039640756	0.2	0	0	0	0	0	20	0	0	0											NO	89.82126765	64.59815546	24.40863796	0.104561859	104.5618593	0.139415812	0.139415812	34.75639982	90.20206608	0	0.139415812	0	34.85395311	0.087852143	2.888757957	0.055265133	0.313685578	0.065209921	0.08603321	0.027632741	0.139415812	0	0	0	0	0	20	0	0	0												11.1301	0.411975103	6.156853761	1.984430826	2.023696206	3.225070304	0.333971589	0.878085504	2.652324015	0	2.442314284	0	0.024073153	0.749691323	1.379707007	5.100412261	0.310547465	0.002674665	2.748448629	1.064516689	1.840572624	0	0	0	0	0	0.000264618	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4598	0	19.32021372	11.1301	0.411975103	6.156853761	1.984430826	2.023696206	3.225070304	0.333971589	0.878085504	2.652324015	0	2.442314284	0	0.024073153	0.749691323	1.379707007	5.100412261	0.310547465	0.002674665	2.748448629	1.064516689	1.840572624	0	0	0	0	0	0.000264618	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4598	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0			17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	0.5845	0.0216	0.3233	0.1092	0.1063	0.1774	0.0184	0.0458	0.1393	0	0.1257	0	0.0013	0.0389	0.0725	0.248	0.0163	0	0.1439	0.0559	0.0947	0	0	0	0	0	0	0	0	0											2.3228	0	1.016853354	11.7146	0.433609387	6.480172141	2.093610241	2.129967721	3.402507222	0.352346037	0.92389492	2.791607022	0	2.567980445	0	0.025337321	0.788561249	1.452160349	5.348362548	0.326803019	0.002674665	2.892331949	1.120418262	1.935280496	0	0	0	0	0	0.000278545	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7825
H6169_011_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1463.009678	75.57026723	2996.357293	18.97853423	232.2486863	22.87853806	2.395507243	303.1679374	349.6472975	4.610715108	17.51820142	0	8.288237443	8.30208873	5731.350404	91.3567012	0.989995992	450.0534523	31.90646914	38.09667163	13.20203635	36.02511126	0	0	0	0	0.158770792	0	0	0												1a: $335 Per Day (Days 1-6)	1b: $335 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 20%	10a: $150	11a: 30%	11b: 30%; 11c: 0%-30%	4a: $50; 4b: $35	9a: $300; 9b: $150	8a: 0%-20%	8b: 20%	9a: $0	12: $50	3: $40; 5: $335; 7c: $40; 7i: $40; 9c: 45%; 9d: $40	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $40; 7i: $40; 9d: $40	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	234.7479911	177.948277	47.27105293	0.2	150	0.3	0.3	49.86005419	258.9502339	0.2	0.2	0	50	0.19885747	4.144089405	0.126774149	0.45	0.102306803	0.123573924	0.117912493	0.2	0	0	0	0	0	20	0	0	0											NO	134.5213979	101.9725488	27.08848791	0.1146092	85.95690036	0.171913801	0.171913801	28.57210473	148.3903964	0.1146092	0.1146092	0	28.65230012	0.113954478	2.374753867	0.07264742	0.257870701	0.058626504	0.070813543	0.067569282	0.1146092	0	0	0	0	0	20	0	0	0												16.4005	0.642174397	6.763899026	2.175114634	1.663614765	3.933136433	0.411820755	0.721845505	4.323691756	0.528430372	2.007747059	0	0.019789756	0.946060188	1.134212211	6.636828598	0.255290961	0.002198755	2.259410137	2.574164767	1.513074831	0	0	0	0	0	0.000264618	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9133	0	40.91352295	16.4005	0.642174397	6.763899026	2.175114634	1.663614765	3.933136433	0.411820755	0.721845505	4.323691756	0.528430372	2.007747059	0	0.019789756	0.946060188	1.134212211	6.636828598	0.255290961	0.002198755	2.259410137	2.574164767	1.513074831	0	0	0	0	0	0.000264618	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9133	YES	1a: $335 Per Day (Days 1-6)	1b: $335 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 20%	10a: $150	11a: 30%	11b: 30%; 11c: 0%-30%	4a: $50; 4b: $35	9a: $300; 9b: $150	8a: 0%-20%	8b: 20%	9a: $0	12: $50	3: $40; 5: $335; 7c: $40; 7i: $40; 9c: 45%; 9d: $40	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $40; 7i: $40; 9d: $40	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	0.8348	0.0327	0.3443	0.116	0.0847	0.2097	0.022	0.0365	0.2201	0	0.1001	0	0.001	0.0478	0.0577	0.322	0.013	0	0.1146	0.0445	0.0755	0	0	0	0	0	0	0	0	0											2.677	0	2.153343313	17.2353	0.674861469	7.108185652	2.29110941	1.748293782	4.142883208	0.433782382	0.758347255	4.543770329	0.528430372	2.107880071	0	0.020797066	0.993817588	1.191944312	6.9587981	0.268243673	0.002198755	2.374058902	2.618708126	1.588539733	0	0	0	0	0	0.000278545	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5902
H6169_012_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1842.009786	83.31968097	3976.439373	26.14180562	248.3735398	29.34500791	2.702669982	344.7189466	355.5140798	6.01467708	18.55021511	0	5.077110348	18.21187212	5529.645872	89.86356255	0.826462435	355.8287916	25.61408232	36.63327792	17.05167607	34.64381179	0	0	0	0	0	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $10; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	41.85	0	150	0.2	0.2	49.66103004	289.0736821	0.2	0.2	0	25	0.138630371	7.92944422	0.109887467	0.45	0.016238892	0.105741793	0.111754295	0.2	0	0	0	0	0	0	0	0	0											NO	158.1839818	119.9097248	35.64962899	0	127.776448	0.170368597	0.170368597	42.30340015	246.2453887	0.170368597	0.170368597	0	21.29607467	0.118091309	6.754641447	0.093606868	0.383329344	0.013832986	0.090075404	0.095197112	0.170368597	0	0	0	0	0	0	0	0	0												24.2814	0.832570002	11.8132157	0	2.644690725	4.999467836	0.460450094	1.215231962	7.295308565	1.024712098	3.160374129	0	0.00901021	2.150663826	3.112564599	8.411846644	0.316807303	0.000410181	2.307198823	3.487382262	2.905070134	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.4283	0	13.9885209	24.2814	0.832570002	11.8132157	0	2.644690725	4.999467836	0.460450094	1.215231962	7.295308565	1.024712098	3.160374129	0	0.00901021	2.150663826	3.112564599	8.411846644	0.316807303	0.000410181	2.307198823	3.487382262	2.905070134	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.4283	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $10; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	1.2671	0.0434	0.6164	0	0.138	0.2609	0.024	0.0624	0.3807	0	0.1644	0	0.0005	0.112	0.1624	0.4221	0.0165	0	0.12	0.0587	0.1511	0	0	0	0	0	0	0	0	0											4.0006	0	0.736237942	25.5484	0.876015466	12.42965713	0	2.782696918	5.260351848	0.484477465	1.277635667	7.675994956	1.024712098	3.324749422	0	0.009480384	2.26270907	3.274985554	8.833908201	0.333282975	0.000410181	2.427199326	3.546094046	3.056169197	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.429
H6169_013_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1818.453079	81.87635256	3913.678368	25.08613352	234.1713788	25.25636159	1.879681156	329.390224	405.7013319	6.666547115	17.78824948	0	24.68971661	10.12024218	4974.643841	96.9094888	0.762364898	384.052061	27.18457448	35.90613944	21.44844048	28.95707504	0	0	0	0	0	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.78017861	278.4570611	0.2	0.2	0	25	0.213228267	20.43433819	0.109295235	0.45	0.015355741	0.104475558	0.099007159	0.2	0	0	0	0	0	0	0	0	0											NO	154.6047802	117.1965482	39.3563888	0	124.8852724	0.166513696	0.166513696	41.44540776	231.8345728	0.166513696	0.166513696	0	20.81421206	0.177527134	17.01298594	0.090995768	0.374655817	0.012784706	0.086983056	0.08243024	0.166513696	0	0	0	0	0	0	0	0	0												23.4285	0.799635492	12.83568729	0	2.437046368	4.205530129	0.312992657	1.137642679	7.837966246	1.110071403	2.961987175	0	0.04282475	1.796617593	7.052795477	8.818353376	0.285624444	0.000409166	2.364597377	2.959751694	3.571459109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.9595	0	16.88444745	23.4285	0.799635492	12.83568729	0	2.437046368	4.205530129	0.312992657	1.137642679	7.837966246	1.110071403	2.961987175	0	0.04282475	1.796617593	7.052795477	8.818353376	0.285624444	0.000409166	2.364597377	2.959751694	3.571459109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.9595	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	1.2236	0.0418	0.6703	0	0.1273	0.2196	0.0163	0.0588	0.4093	0	0.1547	0	0.0022	0.0938	0.3683	0.444	0.0149	0	0.1235	0.0675	0.1865	0	0	0	0	0	0	0	0	0											4.2226	0	0.888655129	24.652	0.841396479	13.50603144	0	2.564321187	4.425164064	0.329338708	1.196443927	8.247304266	1.110071403	3.116677043	0	0.045061274	1.890446	7.421127929	9.262355398	0.300541189	0.000409166	2.488088544	3.027276817	3.757978666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.182
H6169_014_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1888.714781	100.6282965	2794.605658	34.44660702	245.2474885	26.72881202	1.47200642	335.8252277	356.3875315	6.224469934	20.47977022	0	5.129179204	11.03816837	4964.616101	99.9345973	1.607781271	408.5754011	35.49028043	37.04154274	31.22504076	39.75113883	0	0	0	0	0	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.75100995	291.2456239	0.2	0.2	0	25	0.257038802	20.94962761	0.101687103	0.45	0.080962555	0.124872417	0.106578722	0.2	0	0	0	0	0	0	0	0	0											NO	158.8965027	120.4498439	40.44889513	0	128.3520018	0.171136002	0.171136002	42.57094478	249.2130589	0.171136002	0.171136002	0	21.3920003	0.219942965	17.9261776	0.087011622	0.385056005	0.06927804	0.106850831	0.091197282	0.171136002	0	0	0	0	0	0	0	0	0												25.0092	1.010055218	9.4198926	0	2.623167173	4.574262037	0.251913294	1.191366435	7.401368907	1.065230901	3.504826005	0	0.009143617	2.427767484	7.416382496	8.695471374	0.619085834	0.002358775	3.792165962	3.378088024	5.34372865	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.7355	0	14.79756426	25.0092	1.010055218	9.4198926	0	2.623167173	4.574262037	0.251913294	1.191366435	7.401368907	1.065230901	3.504826005	0	0.009143617	2.427767484	7.416382496	8.695471374	0.619085834	0.002358775	3.792165962	3.378088024	5.34372865	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.7355	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	1.3042	0.0527	0.4912	0	0.1368	0.2381	0.0131	0.0614	0.386	0	0.1683	0	0.0005	0.1212	0.3868	0.433	0.0319	0	0.1956	0.0617	0.2566	0	0	0	0	0	0	0	0	0											4.339	0	0.778819171	26.3134	1.062727754	9.91112281	0	2.759960555	4.812395247	0.265027742	1.252768514	7.78733679	1.065230901	3.673098723	0	0.00962044	2.548929273	7.80313331	9.128428814	0.651021117	0.002358775	3.987783255	3.439775445	5.600332192	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.0744
H6169_015_0	2011	9																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	2115.979783	67.21145153	2775.291314	34.26025069	255.626656	31.72839998	3.001698443	356.0645917	399.1061108	8.200744443	23.22445952	0	12.01947215	15.25005811	5913.786736	108.0192153	1.004829834	545.2910612	40.68485886	45.55275684	28.50245007	60.9818825	0	0	0	0	0.20137633	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.78335234	283.33382	0.2	0.2	0	25	0.202266463	20.87208136	0.109272676	0.45	0.028805449	0.122331701	0.103969776	0.2	0	0	0	0	0	20	0	0	0											NO	160.2279876	121.4591622	40.78783961	0	129.4275368	0.172570049	0.172570049	42.95557778	244.4746561	0.172570049	0.172570049	0	21.57125613	0.174525667	18.00948052	0.094285955	0.38828261	0.024854789	0.105553938	0.089710347	0.172570049	0	0	0	0	0	20	0	0	0												28.2533	0.680287216	9.433178082	0	2.757094036	5.475371542	0.518003248	1.274580022	8.1309441	1.415202871	4.007846119	0	0.021606259	2.66152657	8.875352254	10.18469492	0.390157951	0.001129425	4.294447063	4.086553618	4.918669206	0	0	0	0	0	0.000335627	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3802	0	15.47850372	28.2533	0.680287216	9.433178082	0	2.757094036	5.475371542	0.518003248	1.274580022	8.1309441	1.415202871	4.007846119	0	0.021606259	2.66152657	8.875352254	10.18469492	0.390157951	0.001129425	4.294447063	4.086553618	4.918669206	0	0	0	0	0	0.000335627	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3802	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	1.4749	0.0355	0.4924	0	0.1439	0.2858	0.027	0.0665	0.4244	0	0.2065	0	0.0011	0.1378	0.4633	0.5087	0.0204	0	0.2242	0.069	0.2534	0	0	0	0	0	0	0	0	0											4.835	0	0.81465809	29.7281	0.715799389	9.925606338	0	2.901019126	5.761195433	0.545043916	1.34111531	8.555393484	1.415202871	4.214326228	0	0.022734144	2.799277487	9.338661034	10.69344359	0.410524873	0.001129425	4.518624648	4.155562672	5.172087864	0	0	0	0	0	0.000353292	0	0	0	0	0	0	0	0	0	0	0	0	0	102.2152
H6169_016_0	2011	10																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	2319.457319	128.756535	2835.011757	44.32030991	306.6540035	24.19540168	2.804922742	329.0304951	373.9015086	5.364027691	16.48805846	0	8.3285119	10.45588354	5125.461997	113.3326618	1.403302304	514.3147894	41.79343002	45.72291498	17.2070785	37.97367414	0	0	0	0	0.885416339	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.66519073	287.7778381	0.2	0.2	0	25	0.225517459	20.65848706	0.098576346	0.45	0.017103173	0.130508933	0.098431203	0.2	0	0	0	0	0	20	0	0	0											NO	161.8645169	122.6997162	41.20443659	0	130.7494779	0.174332637	0.174332637	43.29131837	250.8453472	0.174332637	0.174332637	0	21.79157964	0.196575267	18.00724264	0.085925371	0.392248434	0.014908206	0.113759832	0.085798856	0.174332637	0	0	0	0	0	20	0	0	0												31.2865	1.316532525	9.734588516	0	3.34123757	4.218048182	0.488989579	1.18701366	7.815954478	0.935125093	2.874406713	0	0.015124286	2.0553681	7.691286484	9.738151063	0.550443131	0.000638959	4.754413583	3.922973802	2.999755373	0	0	0	0	0	0.001475694	0	0	0	0	0	0	0	0	0	0	0	0	0	94.928	0	13.97623489	31.2865	1.316532525	9.734588516	0	3.34123757	4.218048182	0.488989579	1.18701366	7.815954478	0.935125093	2.874406713	0	0.015124286	2.0553681	7.691286484	9.738151063	0.550443131	0.000638959	4.754413583	3.922973802	2.999755373	0	0	0	0	0	0.001475694	0	0	0	0	0	0	0	0	0	0	0	0	0	94.928	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	1.6361	0.0688	0.509	0	0.1747	0.2236	0.0259	0.0619	0.4087	0	0.1501	0	0.0008	0.1074	0.4022	0.4873	0.0288	0	0.2486	0.0653	0.1567	0	0	0	0	0	0.0001	0	0	0											4.7561	0	0.73559131	32.9225	1.385377617	10.24363681	0	3.515960035	4.441600801	0.51490557	1.248945736	8.224672147	0.935125093	3.024524831	0	0.015915176	2.162787748	8.093484922	10.22543469	0.57922731	0.000638959	5.003034893	3.988306824	3.156420716	0	0	0	0	0	0.001553362	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6841
H6169_021_0	2011	8																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1653.20084	109.0163272	2833.915607	20.64904946	231.5437628	29.47903759	2.882591858	349.4960813	390.3204169	5.838950468	22.85404375	0	11.36901992	15.38589587	6917.042937	107.0456693	1.064142047	706.6863283	40.10721674	48.9541269	20.54781927	57.36187325	0	0	0	0	0	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: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	128.8537736	92.6697687	35.01559476	0.15	150	0.2	0.2	49.81404785	129.7536418	0	0.2	0	50	0.10317251	4.166171459	0.08715354	0.45	0	0.124874764	0.032933703	0.2	0	0	0	0	0	0	0	0	0											NO	97.81458783	70.34683563	26.58079678	0.113866965	113.8669654	0.151822621	0.151822621	37.81449642	98.49768956	0	0.151822621	0	37.95565513	0.078319604	3.162595342	0.066159394	0.341600896	0	0.094794069	0.025000405	0.151822621	0	0	0	0	0	0	0	0	0												13.4756	0.639079471	6.277311236	2.3512446	2.197098802	4.475584737	0.43764265	1.10133486	3.203804937	0	3.469760812	0	0.035959883	1.205017272	1.822983981	7.082076666	0.363511877	0	3.801926284	1.223873016	3.119623768	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2834	0	17.86023865	13.4756	0.639079471	6.277311236	2.3512446	2.197098802	4.475584737	0.43764265	1.10133486	3.203804937	0	3.469760812	0	0.035959883	1.205017272	1.822983981	7.082076666	0.363511877	0	3.801926284	1.223873016	3.119623768	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2834	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%	9a: $0	12: $50	3: $15; 5: $200; 7c: $15; 7i: $15; 9c: 45%; 9d: $15	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $30; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $15; 7i: $15; 9d: $15	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	0.708	0.0336	0.3298	0.1294	0.1154	0.2463	0.0241	0.0574	0.1683	0	0.1786	0	0.0019	0.0625	0.0958	0.346	0.019	0	0.1991	0.0643	0.1606	0	0	0	0	0	0	0	0	0											2.9401	0	0.94001256	14.1836	0.672654219	6.607096739	2.480660892	2.312525822	4.721928133	0.461731206	1.158690738	3.37212038	0	3.648369541	0	0.037849076	1.267512636	1.918756465	7.428107745	0.38255016	0	4.001045356	1.288170541	3.28021564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2235
H6169_024_0	2011	7																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1857.85054	69.23682488	2291.955067	35.63231921	233.0016005	33.74136008	1.169053389	311.7798979	411.7219513	8.63358723	21.79848871	0	4.754165284	15.16673695	5935.787982	108.7656932	1.058110302	547.5553954	32.00359726	43.43455033	22.47003163	74.72782441	0	0	0	0	0.753669946	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: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $300; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	193.2806604	139.004653	35.01559476	0.2	150	0.2	0.2	49.80845619	214.9135514	0	0.2	0	50	0.254176999	16.49679651	0.105469566	0.45	0.01134655	0.110532426	0.0367888	0.2	0	0	0	0	0	20	0	0	0											NO	134.7097919	96.88133234	24.4046325	0.139392934	104.5447007	0.139392934	0.139392934	34.71473431	149.7871527	0	0.139392934	0	34.84823357	0.177152388	11.49768436	0.073508562	0.313634102	0.007908145	0.077037196	0.025640494	0.139392934	0	0	0	0	0	20	0	0	0												20.8559	0.558979653	4.661193426	4.96689353	2.029923549	4.703307189	0.162957782	0.90194636	5.139221568	0	3.038555305	0	0.013806189	2.686823674	5.687318055	7.995209672	0.331859475	0.000360846	2.465467388	1.113683337	3.132163643	0	0	0	0	0	0.001256117	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4468	0	30.62923269	20.8559	0.558979653	4.661193426	4.96689353	2.029923549	4.703307189	0.162957782	0.90194636	5.139221568	0	3.038555305	0	0.013806189	2.686823674	5.687318055	7.995209672	0.331859475	0.000360846	2.465467388	1.113683337	3.132163643	0	0	0	0	0	0.001256117	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4468	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%	9a: $0	12: $50	3: $35; 5: $300; 7c: $35; 7i: $35; 9c: 45%; 9d: $35	7a : $20; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $45; 7f: $45; 7g: $45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $35; 7i: $35; 9d: $35	8b: 20%	8a: 0%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	1.0906	0.0292	0.2437	0.2593	0.1062	0.2455	0.0085	0.0472	0.2687	0	0.1463	0	0.0007	0.1335	0.2974	0.3994	0.0172	0	0.1275	0.0582	0.1509	0	0	0	0	0	0.0001	0	0	0											3.6302	0	1.612064878	21.9465	0.588210429	4.904941648	5.226185455	2.136074531	4.948838841	0.171464837	0.949111925	5.40796736	0	3.184846978	0	0.014528157	2.820308567	5.984725507	8.394633821	0.349025879	0.000360846	2.593000919	1.171921283	3.283026067	0	0	0	0	0	0.001322228	0	0	0	0	0	0	0	0	0	0	0	0	0	74.077
H6169_031_0	2011	12																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1409.420939	88.70088914	2192.751866	21.79348185	256.2079587	22.35959554	2.156808837	327.7664203	271.6962549	5.945395687	12.51712299	0	6.790082649	9.790775906	4835.484857	78.23481375	0.75927344	321.5112472	24.60697624	31.98281603	10.87233435	24.6080602	0	0	0	0	0.113762228	0	0	0												1a: $335 Per Day (Days 1-6)	1b: $335 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 20%	10a: $150	11a: 30%	11b: 30%; 11c: 0%-30%	4a: $50; 4b: $35	9a: $300; 9b: $150	8a: 0%-20%	8b: 20%	9a: $0	12: $50	3: $40; 5: $335; 7c: $40; 7i: $40; 9c: 45%; 9d: $40	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $40; 7i: $40; 9d: $40	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	234.7479911	177.948277	47.27105293	0.2	150	0.3	0.3	49.72968476	262.4450419	0.2	0.2	0	50	0.2004444	4.116245598	0.105420281	0.45	0.027599202	0.118497607	0.112203104	0.2	0	0	0	0	0	20	0	0	0											NO	131.9215274	100.0017439	26.56495365	0.112394169	84.29562704	0.168591254	0.168591254	27.94663306	147.4864625	0.112394169	0.112394169	0	28.09854235	0.112643909	2.313210025	0.059243125	0.252886881	0.015509947	0.066592201	0.063054873	0.112394169	0	0	0	0	0	20	0	0	0												15.4944	0.739186967	4.854195974	2.449460291	1.799767544	3.769632252	0.363619107	0.763330656	3.339293293	0.66822781	1.406851642	0	0.015899285	1.102871272	0.932124337	4.634874818	0.192010292	0.000415552	1.638632698	2.016672415	1.221986988	0	0	0	0	0	0.000189604	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4037	0	36.94871454	15.4944	0.739186967	4.854195974	2.449460291	1.799767544	3.769632252	0.363619107	0.763330656	3.339293293	0.66822781	1.406851642	0	0.015899285	1.102871272	0.932124337	4.634874818	0.192010292	0.000415552	1.638632698	2.016672415	1.221986988	0	0	0	0	0	0.000189604	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4037	YES	1a: $335 Per Day (Days 1-6)	1b: $335 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 20%	10a: $150	11a: 30%	11b: 30%; 11c: 0%-30%	4a: $50; 4b: $35	9a: $300; 9b: $150	8a: 0%-20%	8b: 20%	9a: $0	12: $50	3: $40; 5: $335; 7c: $40; 7i: $40; 9c: 45%; 9d: $40	7a : $5; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $40; 7i: $40; 9d: $40	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	0.7892	0.0376	0.2472	0.1307	0.0917	0.2012	0.0194	0.0389	0.1701	0	0.0702	0	0.0008	0.0555	0.0475	0.2296	0.0097	0	0.0832	0.0349	0.061	0	0	0	0	0	0	0	0	0											2.3185	0	1.944669186	16.2836	0.776836312	5.101436941	2.580169677	1.891435922	3.970789348	0.38302274	0.802198841	3.509375034	0.66822781	1.47706127	0	0.016709091	1.158396073	0.979600649	4.864492981	0.201759715	0.000415552	1.721835129	2.051583821	1.282975288	0	0	0	0	0	0.000199583	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7221
H6169_032_0	2011	13																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1563.540038	86.65720349	2401.399275	29.64966004	252.908041	27.95492859	1.671336781	297.9466653	332.5685815	5.349070398	18.10138953	0	6.217373141	11.85134069	5333.35435	84.59914928	1.165682669	514.5088426	33.16539684	34.71343523	12.54825853	48.17658956	0	0	0	0	0.038426197	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $10; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.74028306	288.7484015	0.2	0.2	0	25	0.202823612	8.236261615	0.107634555	0.45	0.005825446	0.131928409	0.113040357	0.2	0	0	0	0	0	20	0	0	0											NO	155.6841629	118.014763	39.63115783	0	125.7571665	0.167676222	0.167676222	41.70131373	242.0812054	0.167676222	0.167676222	0	20.95952775	0.170043485	6.905126156	0.090238777	0.3772715	0.004883944	0.110606286	0.0947709	0.167676222	0	0	0	0	0	20	0	0	0												20.2849	0.852235778	7.930852806	0	2.650416552	4.687376813	0.280243437	1.03539728	6.709050256	0.896911916	3.03517261	0	0.010859434	2.015243276	3.068957052	7.634123805	0.439778848	0.000209403	3.668301376	3.289823489	2.104044583	0	0	0	0	0	6.40E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	70.5939	0	13.60873035	20.2849	0.852235778	7.930852806	0	2.650416552	4.687376813	0.280243437	1.03539728	6.709050256	0.896911916	3.03517261	0	0.010859434	2.015243276	3.068957052	7.634123805	0.439778848	0.000209403	3.668301376	3.289823489	2.104044583	0	0	0	0	0	6.40E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	70.5939	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $10; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	1.0572	0.0444	0.4134	0	0.1381	0.2443	0.0146	0.0536	0.3497	0	0.1577	0	0.0006	0.1049	0.16	0.3851	0.0228	0	0.1906	0.0565	0.1093	0	0	0	0	0	0	0	0	0											3.5028	0	0.716248966	21.3421	0.896654383	8.34420956	0	2.788556499	4.93168331	0.29484975	1.088958151	7.058726553	0.896911916	3.192847633	0	0.011425428	2.120105113	3.228911367	8.019260826	0.462625042	0.000209403	3.85886698	3.346372987	2.213348969	0	0	0	0	0	6.74E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0967
H6169_033_0	2011	11																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1633.031433	132.866458	3054.095409	23.73878522	238.6379061	29.54637602	1.962690998	367.7792635	393.1412199	5.426411981	17.26172352	0	24.61528761	12.83187441	4804.301154	92.61977973	0.959943366	354.721842	32.28617968	35.87185459	19.44241253	24.61528761	0	0	0	0	0.541192842	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.617406	277.120417	0.2	0.2	0	25	0.368626475	20.50886662	0.112907658	0.45	0	0.124371873	0.102690649	0.2	0	0	0	0	0	20	0	0	0											NO	154.1718768	116.8683903	39.24618836	0	124.5355855	0.166047447	0.166047447	41.19421805	230.0756893	0.166047447	0.166047447	0	20.75593092	0.306047426	17.02722475	0.093740142	0.373606757	0	0.10325816	0.085257601	0.166047447	0	0	0	0	0	20	0	0	0												20.9806	1.293990755	9.988466974	0	2.476575947	4.906100317	0.32589983	1.262531598	7.53768643	0.901041858	2.866265128	0	0.042576101	3.927162135	6.816992959	8.682191278	0.358641328	0	3.333811514	3.058348259	3.228362971	0	0	0	0	0	0.000901988	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9882	0	16.76434789	20.9806	1.293990755	9.988466974	0	2.476575947	4.906100317	0.32589983	1.262531598	7.53768643	0.901041858	2.866265128	0	0.042576101	3.927162135	6.816992959	8.682191278	0.358641328	0	3.333811514	3.058348259	3.228362971	0	0	0	0	0	0.000901988	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9882	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	1.0952	0.0675	0.5214	0	0.1293	0.2561	0.017	0.0647	0.3935	0	0.1496	0	0.0022	0.205	0.3559	0.4377	0.0187	0	0.174	0.0595	0.1685	0	0	0	0	0	0	0	0	0											4.116	0	0.882334099	22.0759	1.361540694	10.5098929	0	2.605860142	5.162212482	0.342912713	1.327253466	7.931174755	0.901041858	3.015892188	0	0.044798692	4.132170988	7.172859068	9.119851471	0.377363408	0	3.507845805	3.117808409	3.396892552	0	0	0	0	0	0.000949461	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1042
H6169_034_0	2011	10																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	1670.043441	43.68431097	2620.980084	30.89314596	281.495029	30.16773155	3.842976289	348.1871929	355.729454	6.517179472	19.3173416	0	7.304214084	9.23538417	4760.186106	89.98776376	0.846985847	322.5037635	30.77129537	35.08614333	13.55761767	71.17410679	0	0	0	0	0.093848509	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.82841741	284.1966709	0.2	0.2	0	25	0.242989037	20.30717156	0.09861025	0.45	0.022697979	0.120444738	0.105185742	0.2	0	0	0	0	0	20	0	0	0											NO	156.7224242	118.8018063	39.89545896	0	126.595844	0.168794459	0.168794459	42.05380373	239.8541162	0.168794459	0.168794459	0	21.09930734	0.205076015	17.13869016	0.083224319	0.379787532	0.019156466	0.101652021	0.088773852	0.168794459	0	0	0	0	0	20	0	0	0												21.8111	0.432481254	8.713766946	0	2.969675066	5.092145918	0.648673103	1.220216322	7.110264482	1.100063781	3.26066022	0	0.012842821	1.893955779	6.798612897	7.489170368	0.321674665	0.000514836	3.127964376	3.114732078	2.288450736	0	0	0	0	0	0.000156414	0	0	0	0	0	0	0	0	0	0	0	0	0	77.4071	0	14.31046036	21.8111	0.432481254	8.713766946	0	2.969675066	5.092145918	0.648673103	1.220216322	7.110264482	1.100063781	3.26066022	0	0.012842821	1.893955779	6.798612897	7.489170368	0.321674665	0.000514836	3.127964376	3.114732078	2.288450736	0	0	0	0	0	0.000156414	0	0	0	0	0	0	0	0	0	0	0	0	0	77.4071	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	1.1364	0.0225	0.454	0	0.1547	0.2649	0.0337	0.0636	0.3705	0	0.1564	0	0.0007	0.0933	0.3542	0.3786	0.0166	0	0.1612	0.0534	0.1098	0	0	0	0	0	0	0	0	0											3.8245	0	0.753182124	22.9475	0.45501398	9.167763313	0	3.124398241	5.357000253	0.682412097	1.283790868	7.480716694	1.100063781	3.417068634	0	0.013511946	1.987230566	7.152827736	7.867786225	0.338253121	0.000514836	3.28917328	3.168164523	2.398251066	0	0	0	0	0	0.000164647	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2316
H6169_035_0	2011	10																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	2436.481987	72.2236233	3005.240653	33.12799722	283.8781997	38.55160635	3.39746026	370.1239238	417.8246575	7.940767278	19.574651	0	12.91580243	14.55431053	6205.24413	114.532343	1.239076485	545.4181482	38.30944317	45.13008116	19.03023176	34.55100178	0	0	0	0	0.216393604	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.7760394	288.6452256	0.2	0.2	0	25	0.25552683	20.78443766	0.102195065	0.45	0.03094635	0.117372253	0.103089828	0.2	0	0	0	0	0	20	0	0	0											NO	162.0556541	122.8446058	41.25309272	0	130.903873	0.174538497	0.174538497	43.43917559	251.8985196	0.174538497	0.174538497	0	21.81731216	0.222996344	18.13842258	0.089184866	0.392711619	0.027006647	0.102429883	0.089965718	0.174538497	0	0	0	0	0	20	0	0	0												32.9038	0.739356878	10.33128927	0	3.096729649	6.72873944	0.592987608	1.339823176	8.770784389	1.385969588	3.416530171	0	0.023482341	3.245558041	9.379445019	10.21455164	0.486599732	0.001227493	3.924031781	4.060160173	3.321508055	0	0	0	0	0	0.000360656	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9629	0	15.16595816	32.9038	0.739356878	10.33128927	0	3.096729649	6.72873944	0.592987608	1.339823176	8.770784389	1.385969588	3.416530171	0	0.023482341	3.245558041	9.379445019	10.21455164	0.486599732	0.001227493	3.924031781	4.060160173	3.321508055	0	0	0	0	0	0.000360656	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9629	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	1.7201	0.0387	0.5401	0	0.1619	0.3518	0.031	0.07	0.4585	0	0.1763	0	0.0012	0.1688	0.4903	0.514	0.0254	0	0.2051	0.0711	0.1714	0	0	0	0	0	0	0	0	0											5.1958	0	0.798208324	34.624	0.77800907	10.87138972	0	3.258620873	7.080505329	0.623987889	1.409866621	9.229304562	1.385969588	3.592803872	0	0.024709954	3.41432426	9.869784829	10.72855663	0.512038254	0.001227493	4.129172809	4.131245295	3.492887034	0	0	0	0	0	0.000379638	0	0	0	0	0	0	0	0	0	0	0	0	0	109.1587
H6169_036_0	2011	13																															D	D	D	Coin	T	Coin	Coin	P	P	Coin	Coin	P	P	Coin	V	Coin	Coin	V	Coin	Coin	Coin	P	T	P	V	P	V	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	0											0	NO	2503.302875	126.6126504	2761.956221	50.33218863	343.8201464	32.7732179	4.410351203	336.2859886	377.099278	5.280093323	17.05987002	0	6.768439903	10.95459637	5696.788091	124.0714522	1.755234898	576.2778803	44.04499802	49.03201349	19.20315183	26.49032556	0	0	0	0	0.100996096	0	0	0												1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20	0	14a2: Newsletters; 14a8: Nurseline												0	185.6961721	140.765055	47.27105293	0	150	0.2	0.2	49.33123911	287.2250706	0.2	0.2	0	25	0.255206269	20.4089212	0.102253463	0.45	0.01366996	0.128912267	0.101292752	0.2	0	0	0	0	0	20	0	0	0											NO	163.051248	123.5993054	41.50653236	0	131.7080849	0.17561078	0.17561078	43.31548686	252.1990932	0.17561078	0.17561078	0	21.95134749	0.224084859	17.92013284	0.089784052	0.395124255	0.012002962	0.113191919	0.088940496	0.17561078	0	0	0	0	0	20	0	0	0												34.0139	1.30410297	9.553268771	0	3.773657754	5.755330354	0.774505214	1.213865943	7.925341331	0.927241306	2.995897079	0	0.012381365	2.454759188	8.507266615	11.13963776	0.693535881	0.00057642	4.985537846	4.360931608	3.372280468	0	0	0	0	0	0.000168327	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7642	0	14.41097855	34.0139	1.30410297	9.553268771	0	3.773657754	5.755330354	0.774505214	1.213865943	7.925341331	0.927241306	2.995897079	0	0.012381365	2.454759188	8.507266615	11.13963776	0.693535881	0.00057642	4.985537846	4.360931608	3.372280468	0	0	0	0	0	0.000168327	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7642	YES	1a: $265 Per Day (Days 1-6)	1b: $265 Per Day (Days 1-6)	2: $135 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%	11b: 20%; 11c: 0%-20%	4a: $50; 4b: $35	9a: $325; 9b: $163	8a: 0%-20%	8b: 20%	9a: $0	12: $25	3: $45; 5: $265; 7c: $45; 7i: $45; 9c: 45%; 9d: $45	7a : $25; 14a: $0; 14b: $0; 14c: $0 - 1 exam every year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 50%; 7d: $50; 7f: $50; 7g: $50; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 45%; 7h: 45%	7c: $45; 7i: $45; 9d: $45	8b: 20%	8a: 0%-20%; 17a: $0-$20; 18a: $20	15: 20%	13a: $0	0	0	17a: $0-$20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												6700	1.7793	0.0682	0.4997	0	0.1974	0.3051	0.0411	0.0622	0.4146	0	0.1565	0	0.0006	0.1283	0.445	0.5631	0.0363	0	0.2608	0.066	0.1762	0	0	0	0	0	0	0	0	0											5.2006	0	0.758472555	35.7932	1.372323008	10.05301793	0	3.971064769	6.060468965	0.815568269	1.276111588	8.339930592	0.927241306	3.152417304	0	0.013029057	2.583096548	8.952297464	11.70270542	0.729816025	0.00057642	5.24634055	4.426923976	3.548465983	0	0	0	0	0	0.000177186	0	0	0	0	0	0	0	0	0	0	0	0	0	108.9648
H6169_801_0	2011	5																															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	289.9435562	5.98225518	56.26887421	24.83437356	10.98207227	26.86233599	1.983284154	13.95809955	50.4657626	9.33502648	21.34446326	0	0.176097488	12.17657542	32.9012784	96.8995141	1.059207354	3.289653381	38.33963737	41.46570727	17.79396214	0.770503602	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	0	0	0	0	0	0	0	0											0	0.082752392	0.082752392	0.16360035	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.065764211	0.065764211	0.130014947	0	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0	0	0	0	0	0	0	0												19.0679	0.393418291	7.315794691	0	2.033523864	4.974034038	0.367239949	2.584587667	9.344623678	1.728544363	3.952302838	0	0.032607548	2.254707135	6.092250456	17.94264957	0.196130874	0.609137191	7.099258284	7.678105115	3.2948651	0.142672296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1044	0	26.39589532	19.0679	0.393418291	7.315794691	0	2.033523864	4.974034038	0.367239949	2.584587667	9.344623678	1.728544363	3.952302838	0	0.032607548	2.254707135	6.092250456	17.94264957	0.196130874	0.609137191	7.099258284	7.678105115	3.2948651	0.142672296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1044	YES	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	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	0	0	0	0	0	0	0											6700	1.0036	0.0207	0.385	0	0.107	0.2618	0.0193	0.136	0.4918	0.091	0.208	0	0.0017	0.1187	0.3206	0.9443	0.0103	0.0321	0.3736	0.4041	0.1734	0.0075	0	0	0	0	0	0	0	0											5.1108	0		20.0715	0.414124517	7.700836517	0	2.140551435	5.235825303	0.386568367	2.720618596	9.836445977	1.819520382	4.160318777	0	0.034323734	2.373375932	6.412895216	18.88699955	0.206453551	0.641197043	7.472903457	8.082215911	3.468279053	0.150181364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.2151
H6169_802_0	2011	5																															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	289.9435562	5.98225518	56.26887421	24.83437356	10.98207227	26.86233599	1.983284154	13.95809955	50.4657626	9.33502648	21.34446326	0	0.176097488	12.17657542	32.9012784	96.8995141	1.059207354	3.289653381	38.33963737	41.46570727	17.79396214	0.770503602	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	0	0	0	0	0	0	0	0											0	0.082752392	0.082752392	0.16360035	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.065764211	0.065764211	0.130014947	0	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0	0	0	0	0	0	0	0												19.0679	0.393418291	7.315794691	0	2.033523864	4.974034038	0.367239949	2.584587667	9.344623678	1.728544363	3.952302838	0	0.032607548	2.254707135	6.092250456	17.94264957	0.196130874	0.609137191	7.099258284	7.678105115	3.2948651	0.142672296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1044	0	26.39589532	19.0679	0.393418291	7.315794691	0	2.033523864	4.974034038	0.367239949	2.584587667	9.344623678	1.728544363	3.952302838	0	0.032607548	2.254707135	6.092250456	17.94264957	0.196130874	0.609137191	7.099258284	7.678105115	3.2948651	0.142672296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1044	YES	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	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	0	0	0	0	0	0	0											6700	1.0036	0.0207	0.385	0	0.107	0.2618	0.0193	0.136	0.4918	0.091	0.208	0	0.0017	0.1187	0.3206	0.9443	0.0103	0.0321	0.3736	0.4041	0.1734	0.0075	0	0	0	0	0	0	0	0											5.1108	0		20.0715	0.414124517	7.700836517	0	2.140551435	5.235825303	0.386568367	2.720618596	9.836445977	1.819520382	4.160318777	0	0.034323734	2.373375932	6.412895216	18.88699955	0.206453551	0.641197043	7.472903457	8.082215911	3.468279053	0.150181364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.2151
H6169_803_0	2011	5																															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	289.9435562	5.98225518	56.26887421	24.83437356	10.98207227	26.86233599	1.983284154	13.95809955	50.4657626	9.33502648	21.34446326	0	0.176097488	12.17657542	32.9012784	96.8995141	1.059207354	3.289653381	38.33963737	41.46570727	17.79396214	0.770503602	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	0	0	0	0	0	0	0	0											0	0.082752392	0.082752392	0.16360035	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.065764211	0.065764211	0.130014947	0	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0.185167591	0	0	0	0	0	0	0	0												19.0679	0.393418291	7.315794691	0	2.033523864	4.974034038	0.367239949	2.584587667	9.344623678	1.728544363	3.952302838	0	0.032607548	2.254707135	6.092250456	17.94264957	0.196130874	0.609137191	7.099258284	7.678105115	3.2948651	0.142672296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1044	0	26.39589532	19.0679	0.393418291	7.315794691	0	2.033523864	4.974034038	0.367239949	2.584587667	9.344623678	1.728544363	3.952302838	0	0.032607548	2.254707135	6.092250456	17.94264957	0.196130874	0.609137191	7.099258284	7.678105115	3.2948651	0.142672296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1044	YES	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	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	0	0	0	0	0	0	0											6700	1.0036	0.0207	0.385	0	0.107	0.2618	0.0193	0.136	0.4918	0.091	0.208	0	0.0017	0.1187	0.3206	0.9443	0.0103	0.0321	0.3736	0.4041	0.1734	0.0075	0	0	0	0	0	0	0	0											5.1108	0		20.0715	0.414124517	7.700836517	0	2.140551435	5.235825303	0.386568367	2.720618596	9.836445977	1.819520382	4.160318777	0	0.034323734	2.373375932	6.412895216	18.88699955	0.206453551	0.641197043	7.472903457	8.082215911	3.468279053	0.150181364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.2151
H6178_001_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	373.4999283	14.87274794	77.99598074	0	16.29509044	19.69546315	3.916558609	31.81578534	36.71534106	8.629396594	24.22336537	0	0.184443536	35.1871807	8.280311676	56.36879621	1.905022855	3.180727804	17.7974774	65.47393507	21.26704707	0.202303811	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"No Cost Sharing for PCP Office Visits and Consults; PBP 7a, No Cost-Sharing for PBP 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, No Cost-Sharing for 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, No Cost-Sharing for 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	0.079632262	0.079632262	0.168704165	0	0.233	0.233	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	0.079632262	0.079632262	0.168704165	0	0.233	0.233	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												29.7426	1.184350566	13.15824679	0	3.796756072	4.589042914	0.912558156	7.413077985	8.554674467	2.010649406	5.64404413	0	0.042975344	8.198613102	1.92931262	13.13392952	0.443870325	0.741109578	4.146812233	15.25542687	4.955221968	0.047136788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9005	0	0	29.7426	1.184350566	13.15824679	0	3.796756072	4.589042914	0.912558156	7.413077985	8.554674467	2.010649406	5.64404413	0	0.042975344	8.198613102	1.92931262	13.13392952	0.443870325	0.741109578	4.146812233	15.25542687	4.955221968	0.047136788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9005	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	29.7426	1.184350566	13.15824679	0	3.796756072	4.589042914	0.912558156	7.413077985	8.554674467	2.010649406	5.64404413	0	0.042975344	8.198613102	1.92931262	13.13392952	0.443870325	0.741109578	4.146812233	15.25542687	4.955221968	0.047136788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9005
H6181_007_0	2011	5																															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	385.1465564	17.61941003	38.72438097	0	10.86067736	8.309180503	3.216768871	10.84907874	30.41811685	11.63200567	13.5319291	0.793813085	0.21001529	14.42331436	50.40255428	94.82694223	2.188159719	5.070481744	24.78037326	53.58741677	40.4541478	12.5782031	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 1b	Medicare-FFS Cost Sharing; PBP 2	No Cost-Sharing; PBP 6	20% Coinsurance for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"20% Coinsurance for ER - Facility; 20% Coinsurance for PCP Urgent Care; PBP 4a, 4b"	20% Coinsurance for OP Fac - Surgery; PBP 9b	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	20% Coinsurance for OP Fac - Observation; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"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; PBP 3, 5, 9a, 9c, 9d, 13a"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for PCP Office Visits; 20% Coinsurance for PCP Consults; 20% Coinsurance for PCP Immunizations; PBP 7a, 14b-c"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for Speclst Office Visits; 20% Coinsurance for Speclst Consults; 20% Coinsurance for Cardio; 20% Coinsurance for Chiropractor; 20% Coinsurance for Speclst Immunizations; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing/Speech Exams; 20% Coinsurance for Podiatrist (Routine); PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"20% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; 20% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"20% Coinsurance for Occ Therapy; 20% Coinsurance for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof - Primary Surgeon (IP); 20% Coinsurance for Prof - Asst Surgeon (IP); 20% Coinsurance for Prof - Anesthesia (IP); 20% Coinsurance for Prof - Primary Surgeon (OP); 20% Coinsurance for Prof - Anesthesia (OP); 20% Coinsurance for Prof - IP Visits; 20% Coinsurance for Allergy Testing; 20% Coinsurance for Allergy Tx; 20% Coinsurance for Prof - ER Visits; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"20% Coinsurance for Renal Dialysis - Prof; 20% Coinsurance for Bone Mass Measurements; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	"No Cost-Sharing; PBP 13b-f, 14a"											0	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	0.2	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	0.061154481	0.061154481	0.12689673	0	0.19084888	0.19084888	0.19084888	0.19084888	0.19084888	0.19084888	0.19084888	0.19084888	0.19084888	0.19084888	0.190921914	0.190874897	0.19084888	0.19084888	0.19084888	0.19084888	0.19084888	0.192881866	0	0	0	0	0	0	0	0												23.5534	1.077505882	4.913997328	0	2.072748106	1.585797789	0.613916735	2.070534522	5.805263521	2.21995525	2.582553507	0.151498338	0.040081183	2.752673386	9.622952152	18.1000828	0.417607831	0.96769576	4.729306473	10.22709845	7.720628782	2.426107282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6514	0	4.37337534	23.5534	1.077505882	4.913997328	0	2.072748106	1.585797789	0.613916735	2.070534522	5.805263521	2.21995525	2.582553507	0.151498338	0.040081183	2.752673386	9.622952152	18.1000828	0.417607831	0.96769576	4.729306473	10.22709845	7.720628782	2.426107282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6514	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.5534	1.077505882	4.913997328	0	2.072748106	1.585797789	0.613916735	2.070534522	5.805263521	2.21995525	2.582553507	0.151498338	0.040081183	2.752673386	9.622952152	18.1000828	0.417607831	0.96769576	4.729306473	10.22709845	7.720628782	2.426107282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6514
H6181_009_0	2011	6																																	D		T	Coin	Coin	V					Coin	V		V	V	V			Coin	V																			20.50429622	0.697574915	0	0	0	0	0	0	13.53708066	5.116662229	7.92238124	0.449145819	0	6.974730056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											55.2019	YES	0	0	227.2801936	0	305.0132539	4.107643001	2.359428832	219.8556504	0	0	0	0	0.196831628	38.8929878	0	4535.656954	115.3115117	383.7828461	0	0	33.83316451	2.196137636	0	0	0	0	0	0	0	0											3400	No Cost-Sharing; PBP 1a	No Cost-Sharing; PBP 1b	$50/$100 per day for SNF days 8-20/21-100; PBP 2	No Cost-Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $20/Visit for PCP Urgent Care; PBP 4a, 4b"	No Cost-Sharing; PBP 9b	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$20/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$20/Visit for Speclst Office Visits; $20/Visit for Speclst Consults; $20/Visit for Chiropractor; $20/Visit for Vision Exams; $20/Visit for Hearing/Speech Exams; $20/Visit for Podiatrist (Routine); PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse; PBP 7e, 7h"	"$20/Visit for Occ Therapy; $20/Visit for PT/ST; PBP 7c, 7i"	"No Cost-Sharing; PBP 7d, 14g-h"	"No Cost-Sharing; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"$20/Visit for Bone Mass Measurements; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	"No Cost-Sharing; PBP 13b-f, 14a"											0	0	0	77.47919908	0	50	0.2	0.2	48.11739659	0	0	0	0	0.2	9.733833234	0	20	20	20	0	0	0.2	20	0	0	0	0	0	0	0	0											NO	0	0	65.66672598	0	50	0.2	0.2	48.11739659	0	0	0	0	0.2	9.733833234	0	20	20	20	0	0	0.2	20	0	0	0	0	0	0	0	0												0	0	1.243728849	0	1.270888558	0.8215286	0.471885766	0.88157346	0	0	0	0	0.039366326	0.031548155	0	7.559428256	0.192185853	0.639638077	0	0	6.766632902	0.003660229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.9221	1500	0.223728431	20.5043	0.697574915	1.243728849	0	1.270888558	0.8215286	0.471885766	0.88157346	13.53708066	5.116662229	7.92238124	0.449145819	0.039366326	7.006278211	0	7.559428256	0.192185853	0.639638077	0	0	6.766632902	0.003660229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1239	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.5043	0.697574915	1.243728849	0	1.270888558	0.8215286	0.471885766	0.88157346	13.53708066	5.116662229	7.92238124	0.449145819	0.039366326	7.006278211	0	7.559428256	0.192185853	0.639638077	0	0	6.766632902	0.003660229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1239
H6264_001_0	2011	7																															D	D	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																			0	YES	1982.247309	171.6176539	29.12069866		7.672285283	6.757944822	4.038501157	301.0723877	29.32383356	6.229832063	17.14598234	2.276078245	0.281149536	46.69179541		11800.22734	1474.27917	1770.702512	3916.814909	14444.47448	18.66859196	10.06557896																			6700	"$75 Copay per day, Max $450"	"$75 Copay per day, Max $450"	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	"4A ER: $50 copay, 4B UC: $50 copay"	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	"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: $15 copay, 7B Chiropractic:  $15 copay, 7F Podiatry:  $15 copay for medically necessary services,"	"7E Mental Health: $15 copay, 7H Psychiatric: $15 copay, 9C OP Mental Health: FFS"	"7C Occupational Therapy:  $15 copay, 7I Physical and Speech Therapy:  $15 copay"	7D Physician Specialist: $15 copay	7G Other Health Care:  $15 copay	Medicare FFS	Medicare FFS	Not Covered	"2 Oral Exams, 2 Cleanings, 1 X-Ray/yr - $0"	Eye Exam (1/yr) - $0	Eyewear ($100/yr)	Hearing Test (1/yr) -  $0	Hearing Aids ($500/2 yrs)	"Smoking Cessation, Materials/Newsletters - $0"	ER and UC worldwide coverage												51.15695255	51.15695255	0.144638709		0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233		15	14.63907687	15	15	15	0.233	0.233																			NO	45.55796449	45.55796449	0.128808399		0.207498789	0.207498789	0.207498789	44.52763722	0.207498789	0.207498789	0.207498789	0.207498789	0.207498789	0.207498789		13.35829117	13.03687009	13.35829117	13.35829117	13.35829117	0.207498789	0.207498789																				7.5256	0.651545915	3.750990576	0	1.591989908	1.40226537	0.837984101	1.117170171	6.084659967	1.292682612	3.557770579	0.472283481	0.058338188	9.688491025	0	13.13590606	1.601665501	1.971129977	4.360162833	16.07945799	3.873710232	2.08859545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1424	0	9.972247692	7.5256	0.651545915	3.750990576	0	1.591989908	1.40226537	0.837984101	1.117170171	6.084659967	1.292682612	3.557770579	0.472283481	0.058338188	9.688491025	0	13.13590606	1.601665501	1.971129977	4.360162833	16.07945799	3.873710232	2.08859545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1424	NO																																																																																		0	0	0	7.5256	0.651545915	3.750990576	0	1.591989908	1.40226537	0.837984101	1.117170171	6.084659967	1.292682612	3.557770579	0.472283481	0.058338188	9.688491025	0	13.13590606	1.601665501	1.971129977	4.360162833	16.07945799	3.873710232	2.08859545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1424
H6264_002_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	323.9845346	53.12507604	25.93416198		16.74794657	11.68813266	15.48544314	12.34366553	24.94344417	6.584921782	12.89029319	1.069980687	10.81535938	35.88989601	70.39112418	98.6206577	28.67949277	40.71423438	46.9229585	89.5339972	13.65773726	13.15825649																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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																				19.9468	3.270757603	3.751083705	0	3.902271551	2.72333491	3.608108252	2.876074068	5.811822491	1.534286775	3.003438313	0.2493055	2.519978735	8.36234577	16.40113193	22.97861324	6.682321815	9.486416611	10.93304933	20.86142135	3.182252781	3.065873762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	155.1507	0	-1.69E-14	19.9468	3.270757603	3.751083705	0	3.902271551	2.72333491	3.608108252	2.876074068	5.811822491	1.534286775	3.003438313	0.2493055	2.519978735	8.36234577	16.40113193	22.97861324	6.682321815	9.486416611	10.93304933	20.86142135	3.182252781	3.065873762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	155.1507	NO																																																																																		0	0	0	19.9468	3.270757603	3.751083705	0	3.902271551	2.72333491	3.608108252	2.876074068	5.811822491	1.534286775	3.003438313	0.2493055	2.519978735	8.36234577	16.40113193	22.97861324	6.682321815	9.486416611	10.93304933	20.86142135	3.182252781	3.065873762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	155.1507
H6328_001_0	2011	12																															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																																																			0	YES	1426.152396	41.82334015	716.2364679	5746.254583	151.1876053	16.60251201	2.594432582	542.0714453	281.3053465	5586.898844	1017.100002	1787.897076	0	576.0532495	10322.61443	15680.48838	1449.439857	3036.479847	0	0	45.94013887	0	0	464.2768	168	144.228	54	28.61666667	544.289	0											3000	1a. $100 days 1-5	1b. $975 per admission	"2. $0 days 1-20, $100 days 21-100"	6. $5	10a. $100	"11a. 20% to 30%, varies by service"	"11b. 20% to 30%, varies by service, 11c. $0"	"4a. $50 ER waived if admitted, 4b. $30 UC"	"9a. $100 Hosp, 9b. $75 ASC"	8a. $2	"8b. $50-$150 or 20%, varies by service"	5. $50	12. $25	"3. $10, 9c. $35, 9d. $10"	"7a. $5, 14b-j. $0"	"7b. $10, 7f. $20, 7g. $0"	"7e. $35, 7h. $35"	"7c. $10, 7i. $10"			15. 20%	"13a. $0, 14a. $0"		16a. $10 16b. $20	17a. $20	"17b. $150 allowance, no CS under allowance"	18a. $20	"18b. $300 allowance, no CS under allowance"														66.42625575	108.3500077	10.39695293	5	100	0.25	0.25	36.1	87.5	2	100.2828971	10	25	3.5	4.032051282	15.76157553	35	10	0		0.2	0.2	0	0	20	0	20	0													NO	52.87867143	86.25210606	8.276502286	3.980253804	79.60507608	0.19901269	0.19901269	28.73743247	69.65444157	1.592101522	79.83027655	7.960507608	19.90126902	2.786177663	3.209717491	12.54701419	27.86177663	7.960507608	0	0	0.159210152	0.159210152	0	0	15.92101522	0	15.92101522	0	0	0												6.2844	0.300612598	0.493994397	1.905962638	1.002941735	3.30411058	0.516325008	1.298145129	1.632847235	0.741242513	6.766281204	1.186047356	0	0.133748891	2.761056341	16.39527585	3.365330793	2.014326744	0	0	7.3141365	0	0	0	0.222894213	0	0.071644568	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7113	0	14.78572147	6.2844	0.300612598	0.493994397	1.905962638	1.002941735	3.30411058	0.516325008	1.298145129	1.632847235	0.741242513	6.766281204	1.186047356	0	0.133748891	2.761056341	16.39527585	3.365330793	2.014326744	0	0	7.3141365	0	0	0	0.222894213	0	0.071644568	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7113	YES	1a. $300 days 1-5	1b. Medicare FFS	"2. $0 days 1-10, $125 days 11-100"	6. $40	10a. $100	"11a. 30 to 40%, varies by service"	"11b. 30% to 40%, varies by service, 11c. 20%"	"$50 ER, $30 UC"	"9a. $200 Hosp, 9b. $150 ASC"	"8a. $10 to $25, varies by service"	"8b. $10-$200 or 30%, varies by service"	5. $100	12. $50	"3. $35, 9c. $50, 9d. $20"	"7a. $20, 14b-h. $30, 14i. 20%, 14j. 20%"	"7b. $20, 7f. $30, 7g. $30"	"7e. $50, 7h. $50"	"7c. $20, 7i. $20"	7d. $30		15. 30%	"13a. 30%, 14a. $30"		16a. 50% 16b. $30	17a. $30	17b. 50%	18a. $30	18b. 50%													5100	3.8843	0.0678	0.2778	3.222	0.1695	1.0861	0.1631	0.3302	0.7778	1.4022	1.9552	0.5128	0	0.0413	3.2214	5.78	1.031	0.864	0	0	1.656	0	0	0	0.0371	0.1183	0.0119	0.0469	0	0	0	0	0	0	0	0	0				26.6567	0	6.829482028	10.1687	0.368454804	0.771769112	5.127965396	1.172487611	4.390190133	0.679408516	1.628335484	2.41067886	2.143415594	8.721433995	1.698867739	0	0.175056058	5.982444004	22.17524793	4.396353149	2.878295977	0	0	8.970088797	0	0	0	0.260043249	0.118273242	0.08358533	0.046933826	0	0	0	0	0	0	0	0	0	0	0	0	84.368
H6328_002_0	2011	11																															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																																																			0	YES	1445.168203	60.3747934	675.962182	6820.427935	159.0820488	19.81213023	3.110112944	417.4695136	236.0494232	4498.656305	818.9844607	1439.64204	0	428.7079408	11220.15378	14374.61824	1709.02793	3479.988471	0	0	46.02712798	0	0	0	168	144.228	0	0	544.289	0											3400	1a. $150 days 1-6	1b. $975 per admission	"2. $0 days 1-15, $100 days 16-100"	6. $5	10a. $125	"11a. 20% to 30%, varies by service"	"11b. 20% to 30%, varies by service, 11c. $0"	"4a. $50 ER waived if admitted, 4b. $30 UC"	"9a. $125 Hosp, 9b. $100 ASC"	8a. $2	"8b. $65-$175 or 20%, varies by service"	5. $50	12. $25	"3. $30, 9c. $35, 9d. $10"	"7a. $15, 14b-j. $0"	"7b. $10, 7f. $25, 7g. $0"	"7e. $35, 7h. $35"	"7c. $10, 7i. $10"			15. 20%	"13a. $0, 14a. $0"		16b. $25	17a. $25	"17b. $100 allowance, no CS under allowance"	18a. $25															108.4850911	108.3500077	20.51181337	10	125	0.25	0.25	36.1	112.5	2	115.2828971	10	25	3.5	12.09615385	19.69882673	35	10	0		0.2	0.2	0	0	25	0	0	0													NO	85.40533485	85.29898992	16.14800957	7.872541197	98.40676496	0.19681353	0.19681353	28.41987372	88.56608846	1.574508239	90.75693569	7.872541197	19.68135299	2.755389419	9.522746947	15.5079825	27.55389419	7.872541197	0	0	0.157450824	0.157450824	0	0	19.68135299	0	0	0	0	0												10.2854	0.429159074	0.909620316	4.474508325	1.304562482	3.899295285	0.612112307	0.988702572	1.742164508	0.590264285	6.194043336	0.944470106	0	0.09843811	8.90389043	18.57677734	3.924197896	2.283029383	0	0	7.247009224	0	0	0	0.275538942	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6832	0	19.91199322	10.2854	0.429159074	0.909620316	4.474508325	1.304562482	3.899295285	0.612112307	0.988702572	1.742164508	0.590264285	6.194043336	0.944470106	0	0.09843811	8.90389043	18.57677734	3.924197896	2.283029383	0	0	7.247009224	0	0	0	0.275538942	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6832	YES	1a. $300 days 1-6	1b. Medicare FFS	"2. $0 days 1-10, $125 days 11-100"	6. $40	10a. $125	"11a. 30 to 40%, varies by service"	"11b. 30% to 40%, varies by service, 11c. 20%"	"4a. $50 ER waived if admitted, 4b. $30 UC"	"9a. $225 Hosp, 9b. $175 ASC"	"8a. $10 to $25, varies by service"	"8b. $10-$200 or 30%, varies by service"	5. $125	12. $55	"3. $40, 9c. $55, 9d. $20"	"7a. $25, 14b-h. $30, 14i. 20%, 14j. 20%"	"7b. $20, 7f. $35, 7g. $35"	"7e. $55, 7h. $55"	"7c. $20, 7i. $20"	7d. $35		15. 30%	"13a. 30%, 14a. $30"		16b. $35	17a. $35	17b. 50%	18a. $35														5100	4.2382	0.0969	0.5115	3.782	0.2205	1.2817	0.1933	0.2515	0.7377	1.1166	1.5833	0.5105	0	0.0334	4.0993	6.0363	1.3225	0.9792	0	0	1.6408	0	0	0	0.0429	0.078	0	0	0	0	0	0	0	0	0	0	0				28.756	0	7.770965843	14.5236	0.526011631	1.421102887	8.256554696	1.525096916	5.181015366	0.805450652	1.240184509	2.479859239	1.706839059	7.777364605	1.454929826	0	0.131880027	13.0031792	24.61311423	5.246662047	3.262248446	0	0	8.887763615	0	0	0	0.318400555	0.077977521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.4392
H6328_003_0	2011	11																															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																																																			0	YES	1535.74634	59.15053496	724.1626909	7274.797183	160.9946098	20.19873567	2.358707439	471.5863672	229.9705726	5046.872549	918.7877253	1615.080016	0	380.9059933	11522.14034	14326.69733	1812.32229	3707.099326			46.53490325	0		0	0		0														3400	1a. $200 days 1-6	1b. $975 per admission	"2. $0 days 1-10, $100 days 11-100"	6. $15	10a. $150	"11a. 20% to 30%, varies by service"	"11b. 20% to 30%, varies by service, 11c. $0"	"4a. $50 ER waived if admitted, 4b. $30 UC"	"9a. $150 Hosp, 9b. $100 ASC"	8a. $2	"8b. $75-$200 or 20%, varies by service"	5. $75	12. $35	"3. $35, 9c. $45, 9d. $15"	"7a. $25, 14b-j. $0"	"7b. $15, 7f. $35, 7g. $0"	"7e. $40, 7h. $40"	"7c. $15, 7i. $15"			15. 20%	"13a. $0, 14a. $0"		16b. $35	17a. $35		18a. $35															144.6467881	108.3500077	36.46848777	25	150	0.25	0.25	36.1	125	2	130.7374426	15	35	4.5	20.16025641	27.5796145	40	15			0.2	0.2		0	0		0														NO	104.5796278	78.33705556	26.36671666	18.075	108.45	0.18075	0.18075	26.1003	90.375	1.446	94.52317099	10.845	25.305	3.2535	14.57586538	19.94006128	28.92	10.845			0.1446	0.1446		0	0		0															13.384	0.386139895	1.591149374	10.95766326	1.454988786	3.650921473	0.42633637	1.025712138	1.731965875	0.608148142	7.237227438	1.459628564	0	0.103273137	13.99543054	23.80626856	4.367696719	3.350291016	0	0	6.728947009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.2658	0	36.88190635	13.384	0.386139895	1.591149374	10.95766326	1.454988786	3.650921473	0.42633637	1.025712138	1.731965875	0.608148142	7.237227438	1.459628564	0	0.103273137	13.99543054	23.80626856	4.367696719	3.350291016	0	0	6.728947009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.2658	YES	1a. $300 days 1-6	1b. Medicare FFS	"2. $0 days 1-10, $150 days 11-100"	6. $45	10a. $150	"11a. 30 to 40%, varies by service"	"11b. 30% to 40%, varies by service, 11c. 20%"	"4a. $50 ER waived if admitted, 4b. $30 UC"	"9a. $250 Hosp, 9b. $175 ASC"	"8a. $10 to $25, varies by service"	"8b. $10-$250 or 30%, varies by service"	5. $150	12. $60	"3. $45, 9c. $60, 9d. $25"	"7a. $35, 14b-h. $30, 14i. 20%, 14j. 20%"	"7b. $20, 7f. $45, 7g. $45"	"7e. $60, 7h. $60"	"7c. $25, 7i. $25"	7d. $45		15. 30%	"13a. 30%, 14a. $30"		16b. $45	17a. $45		18a. $45														5100	4.1362	0.0871	1.0737	4.1678	0.246	1.2001	0.1347	0.2609	0.7013	1.1833	1.9854	0.6311	0	0.0298	5.0666	6.9829	1.405	1.1975	0		1.5235	0		0	0		0														32.0128	0	12.26491522	17.5202	0.47328389	2.664799765	15.12551241	1.700952573	4.850999698	0.560996573	1.286607663	2.433256928	1.791421664	9.222651134	2.09073935	0	0.133041803	19.06203151	30.78913874	5.772715393	4.547774811	0	0	8.252409863	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.2785
H6328_005_0	2011	8																															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																																																			0	YES	1535.74634	59.15053496	724.1626909	7274.797183	160.9946098	20.24585255	2.362522812	471.5863672	229.9705726	5046.872549	918.7877253	1615.080016	0	380.9059933	11522.14034	14326.69733	1812.32229	3707.099326			47.11638397	0		464.2768	168	144.228	54	28.61666667													3000	1a. $100 days 1-5	1b. $975 per admission	"2. $0 days 1-20, $100 days 21-100"	6. $5	10a. $100	"11a. 20% to 30%, varies by service"	"11b. 20% to 30%, varies by service, 11c. $0"	"4a. $50 ER waived if admitted, 4b. $30 UC"	"9a. $100 Hosp, 9b. $75 ASC"	8a. $2	"8b. $50-$150 or 20%, varies by service"	5. $50	12. $25	"3. $10, 9c. $35, 9d. $10"	"7a. $5, 14b-j. $0"	"7b. $10, 7f. $20, 7g. $0"	"7e. $35, 7h. $35"	"7c. $10, 7i. $10"			15. 20%	"13a. $0, 14a. $0"		16a. $10 16b. $20	17a. $20	"17b. $150 allowance, no CS under allowance"	18a. $20	"18b. $300 allowance, no CS under allowance"														66.42625575	108.3500077	10.39695293	5	100	0.25	0.25	36.1	87.5	2	100.2828971	10	25	3.5	4.032051282	15.76157553	35	10			0.2	0.2		0	20	0	20	0													NO	52.70094601	85.96221239	8.248684929	3.966876155	79.33752311	0.198343808	0.198343808	28.64084584	69.42033272	1.586750462	79.56196668	7.933752311	19.83438078	2.776813309	3.198929618	12.50484363	27.76813309	7.933752311			0.158675046	0.158675046		0	15.86750462	0	15.86750462	0														6.7446	0.423725904	0.49778249	2.404851623	1.064409464	4.015639486	0.46859177	1.125552704	1.330386139	0.667343946	6.091713199	1.067803734	0	0.088142069	3.071542999	14.92942582	4.193733879	2.450933987	0	0	7.476194403	0	0	0	0.222145065	0	0.071403771	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4059	0	15.21110216	6.7446	0.423725904	0.49778249	2.404851623	1.064409464	4.015639486	0.46859177	1.125552704	1.330386139	0.667343946	6.091713199	1.067803734	0	0.088142069	3.071542999	14.92942582	4.193733879	2.450933987	0	0	7.476194403	0	0	0	0.222145065	0	0.071403771	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4059	YES	1a. $300 days 1-5	1b. Medicare FFS	"2. $0 days 1-10, $125 days 11-100"	6. $40	10a. $100	"11a. 30 to 40%, varies by service"	"11b. 30% to 40%, varies by service, 11c. 20%"	"4a. $50 ER waived if admitted, 4b. $30 UC"	"9a. $200 Hosp, 9b. $150 ASC"	"8a. $10 to $25, varies by service"	"8b. $10-$200 or 30%, varies by service"	5. $100	12. $50	"3. $35, 9c. $50, 9d. $20"	"7a. $20, 14b-h. $30, 14i. 20%, 14j. 20%"	"7b. $20, 7f. $30, 7g. $35"	"7e. $50, 7h. $50"	"7c. $20, 7i. $20"	7d. $30		15. 30%	"13a. 30%, 14a. $30"		16a. 50% 16b. $30	17a. $30	17b. 50%	18a. $30	18b. 50%													5100	4.1687	0.0956	0.2799	4.0654	0.1799	1.32	0.148	0.2863	0.6337	1.2624	1.7602	0.4617	0	0.0272	3.5836	5.2632	1.2848	1.0512	0		1.6926	0		0	0.037	0.1179	0.0119	0.0468													27.7782	0	7.234495091	10.9133	0.519352304	0.777687262	6.470219121	1.244346372	5.335602553	0.616598527	1.411843225	1.964135819	1.929726635	7.851945992	1.529498215	0	0.115363971	6.655182556	20.19262878	5.478550632	3.502169376	0	0	9.168837315	0	0	0	0.259169242	0.117875725	0.083304399	0.046776081	0	0	0	0	0	0	0	0	0	0	0	0	86.1842
H6328_006_0	2011	9																															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																																																			0	YES	1535.74634	59.15053496	724.1626909	7274.797183	160.9946098	20.28401266	2.362342117	471.5863672	229.9705726	5046.872549	918.7877253	1615.080016	0	380.9059933	11522.14034	14326.69733	1812.32229	3707.099326			47.7594989	0		0	168	144.228	0														3400	1a. $150 days 1-6	1b. $975 per admission	"2. $0 days 1-15, $100 days 16-100"	6. $5	10a. $125	"11a. 20% to 30%, varies by service"	"11b. 20% to 30%, varies by service, 11c. $0"	"4a. $50 ER waived if admitted, 4b. $30 UC"	"9a. $125 Hosp, 9b. $100 ASC"	8a. $2	"8b. $65-$175 or 20%, varies by service"	5. $50	12. $25	"3. $30, 9c. $35, 9d. $10"	"7a. $10, 14b-j. $0"	"7b. $10, 7f. $25, 7g. $0"	"7e. $35, 7h. $35"	"7c. $10, 7i. $10"			15. 20%	"13a. $0, 14a. $0"		16b. $25	17a. $25	"17b. $100 allowance, no CS under allowance"	18a. $25															108.4850911	108.3500077	20.51181337	10	125	0.25	0.25	36.1	112.5	2	115.2828971	10	25	3.5	8.064102564	19.69882673	35	10			0.2	0.2		0	25	0	0														NO	84.68132408	84.57588068	16.01111727	7.805802923	97.57253654	0.195145073	0.195145073	28.17894855	87.81528288	1.561160585	89.98755753	7.805802923	19.51450731	2.732031023	6.294679536	15.37651593	27.32031023	7.805802923			0.156116058	0.156116058		0	19.51450731	0	0															10.8374	0.416892382	0.966221147	4.732136093	1.30905437	3.958325133	0.460999425	1.107400665	1.682910907	0.656581542	6.889955274	1.050583026	0	0.086720583	6.044015083	18.35789081	4.1261006	2.411407229	0	0	7.456024722	0	0	0	0.273203102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.8238	0	20.47065009	10.8374	0.416892382	0.966221147	4.732136093	1.30905437	3.958325133	0.460999425	1.107400665	1.682910907	0.656581542	6.889955274	1.050583026	0	0.086720583	6.044015083	18.35789081	4.1261006	2.411407229	0	0	7.456024722	0	0	0	0.273203102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.8238	YES	1a. $300 days 1-6	1b. Medicare FFS	"2. $0 days 1-10, $125 days 11-100"	6. $40	10a. $125	"11a. 30 to 40%, varies by service"	"11b. 30% to 40%, varies by service, 11c. 20%"	"4a. $50 ER waived if admitted, 4b. $30 UC"	"9a. $225 Hosp, 9b. $175 ASC"	"8a. $10 to $25, varies by service"	"8b. $10-$200 or 30%, varies by service"	5. $125	12. $55	"3. $40, 9c. $55, 9d. $20"	"7a. $25, 14b-h. $30, 14i. 20%, 14j. 20%"	"7b. $20, 7f. $35, 7g. $40"	"7e. $55, 7h. $55"	"7c. $20, 7i. $20"	7d. $35		15. 30%	"13a. 30%, 14a. $30"		16b. $35	17a. $35	17b. 50%	18a. $35														5100	4.4656	0.0941	0.5433	3.9998	0.2213	1.3011	0.1456	0.2817	0.7126	1.242	1.7612	0.5678	0	0.0295	4.1739	5.9652	1.3905	1.0343	0		1.6881	0		0	0.0425	0.0773	0														29.7375	0	8.35914483	15.303	0.510976594	1.509530557	8.731940505	1.530348152	5.259448653	0.606608106	1.389074116	2.395515545	1.898605505	8.651165543	1.618393815	0	0.116181759	10.21794838	24.32310272	5.51660645	3.445689111	0	0	9.14410113	0	0	0	0.315701363	0.077316478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5613
H6328_801_0	2011	2																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	228.0136225	4.052710775	24.26141091	63.32245696	6.881748018	20.06762477	2.350788399	4.790580651	16.36682042	6.308165022	8.746683769	1.408017191	0	47.19479335	124.8630457	135.7188372	16.69428853	16.28604131	0	0	50.12448914	0																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069663106	0.069663106	0.167483682	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																				15.8841	0.28232442	4.063390427	0	1.443102559	4.208180915	0.492960327	1.004584763	3.432122241	1.322822205	1.834179586	0.295261205	0	9.896748166	26.18378069	28.46024016	3.500792304	3.415182862	0	0	10.51110537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.2309	0	12.83438137	15.8841	0.28232442	4.063390427	0	1.443102559	4.208180915	0.492960327	1.004584763	3.432122241	1.322822205	1.834179586	0.295261205	0	9.896748166	26.18378069	28.46024016	3.500792304	3.415182862	0	0	10.51110537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.2309	YES	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			10000	3.3565	0.0597	1.9334	0	0.313	1.014	0.1188	0.2637	0.8418	0.2098	0.2909	0.0468	0	1.5694	4.1181	4.4761	0.5506	0.5371	0	0	1.6283	0																			21.3279	0	2.355052782	19.2406	0.341982598	5.996813113	0	1.756070423	5.222219407	0.611748173	1.268244056	4.273923585	1.532596185	2.125044942	0.342083913	0	11.46618073	30.30185181	32.93634293	4.051381689	3.952307966	0	0	12.13936218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.5588
H6328_802_0	2011	2																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	228.0136225	4.052710775	24.26141091	63.32245696	6.881748018	20.06762477	2.350788399	4.790580651	16.36682042	6.308165022	8.746683769	1.408017191	0	47.19479335	124.8630457	135.7188372	16.69428853	16.28604131	0	0	50.12448914	0																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069663106	0.069663106	0.167483682	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																				15.8841	0.28232442	4.063390427	0	1.443102559	4.208180915	0.492960327	1.004584763	3.432122241	1.322822205	1.834179586	0.295261205	0	9.896748166	26.18378069	28.46024016	3.500792304	3.415182862	0	0	10.51110537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.2309	0	12.83438137	15.8841	0.28232442	4.063390427	0	1.443102559	4.208180915	0.492960327	1.004584763	3.432122241	1.322822205	1.834179586	0.295261205	0	9.896748166	26.18378069	28.46024016	3.500792304	3.415182862	0	0	10.51110537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.2309	YES	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			10000	3.3565	0.0597	1.9334	0	0.313	1.014	0.1188	0.2637	0.8418	0.2098	0.2909	0.0468	0	1.5694	4.1181	4.4761	0.5506	0.5371	0	0	1.6283	0																			21.3279	0	2.355052782	19.2406	0.341982598	5.996813113	0	1.756070423	5.222219407	0.611748173	1.268244056	4.273923585	1.532596185	2.125044942	0.342083913	0	11.46618073	30.30185181	32.93634293	4.051381689	3.952307966	0	0	12.13936218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.5588
H6328_803_0	2011	2																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	228.0136225	4.052710775	24.26141091	63.32245696	6.881748018	20.06762477	2.350788399	4.790580651	16.36682042	6.308165022	8.746683769	1.408017191	0	47.19479335	124.8630457	135.7188372	16.69428853	16.28604131	0	0	50.12448914	0																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069663106	0.069663106	0.167483682	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																				15.8841	0.28232442	4.063390427	0	1.443102559	4.208180915	0.492960327	1.004584763	3.432122241	1.322822205	1.834179586	0.295261205	0	9.896748166	26.18378069	28.46024016	3.500792304	3.415182862	0	0	10.51110537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.2309	0	12.83438137	15.8841	0.28232442	4.063390427	0	1.443102559	4.208180915	0.492960327	1.004584763	3.432122241	1.322822205	1.834179586	0.295261205	0	9.896748166	26.18378069	28.46024016	3.500792304	3.415182862	0	0	10.51110537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.2309	YES	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			10000	3.3565	0.0597	1.9334	0	0.313	1.014	0.1188	0.2637	0.8418	0.2098	0.2909	0.0468	0	1.5694	4.1181	4.4761	0.5506	0.5371	0	0	1.6283	0																			21.3279	0	2.355052782	19.2406	0.341982598	5.996813113	0	1.756070423	5.222219407	0.611748173	1.268244056	4.273923585	1.532596185	2.125044942	0.342083913	0	11.46618073	30.30185181	32.93634293	4.051381689	3.952307966	0	0	12.13936218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.5588
H6328_804_0	2011	2																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	228.0136225	4.052710775	24.26141091	63.32245696	6.881748018	20.06762477	2.350788399	4.790580651	16.36682042	6.308165022	8.746683769	1.408017191	0	47.19479335	124.8630457	135.7188372	16.69428853	16.28604131	0	0	50.12448914	0																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069663106	0.069663106	0.167483682	0	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097	0.2097																				15.8841	0.28232442	4.063390427	0	1.443102559	4.208180915	0.492960327	1.004584763	3.432122241	1.322822205	1.834179586	0.295261205	0	9.896748166	26.18378069	28.46024016	3.500792304	3.415182862	0	0	10.51110537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.2309	0	12.83438137	15.8841	0.28232442	4.063390427	0	1.443102559	4.208180915	0.492960327	1.004584763	3.432122241	1.322822205	1.834179586	0.295261205	0	9.896748166	26.18378069	28.46024016	3.500792304	3.415182862	0	0	10.51110537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.2309	YES	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			10000	3.3565	0.0597	1.9334	0	0.313	1.014	0.1188	0.2637	0.8418	0.2098	0.2909	0.0468	0	1.5694	4.1181	4.4761	0.5506	0.5371	0	0	1.6283	0																			21.3279	0	2.355052782	19.2406	0.341982598	5.996813113	0	1.756070423	5.222219407	0.611748173	1.268244056	4.273923585	1.532596185	2.125044942	0.342083913	0	11.46618073	30.30185181	32.93634293	4.051381689	3.952307966	0	0	12.13936218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.5588
H6411_002_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin			V				O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0			0				0	0	0	0									0	YES	1145.690517	50.24829514	179.9858026	1203.668841	30.97041473	8.781364051	1.874233009	321.3318294	271.1202995	1217.666227	1002.19921	90.38592182	2.085043652	679.9463871	3600.641853	3447.127975	83.06728772	502.9268626		1686.169274	15.38966859	0			3.1				3.91	1.48	1472.591637	17.43449615									5000	$175/Day(Days 1-7):1a.IP Acute	$175/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $100(Days 21-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$75/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$30/Visit:7b. $15 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30-$75/Visit:7c, 7d, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										125.7585	107.666825	33.0247	0	100	0.2	0.2	50	61.950964	0	63.882563	75	0.2	64.413448	15	29.510857	30	40.405663		0	0.2	0			0				0	0	0	0									NO	120.075725	102.801577	30.707885	0	94.2921	0.188584	0.188584	47.14605	58.414865	0	60.236211	70.719075	0.188584	60.736793	14.143815	27.826407	28.28763	38.099348		0	0.188584	0			0				0	0	0	0										11.4641	0.430466999	0.460581944	0	0.243355454	1.656024758	0.353450358	1.262460541	1.319787975	0	5.03072359	0.532667399	0.393205872	3.441480247	4.24390102	7.993432167	0.195814725	1.596765463	0	0	2.902245262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5205	0	2.484249259	11.4641	0.430466999	0.460581944	0	0.243355454	1.656024758	0.353450358	1.262460541	1.319787975	0	5.03072359	0.532667399	0.393205872	3.441480247	4.24390102	7.993432167	0.195814725	1.596765463	0	0	2.902245262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5205	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	30% Coins(Days 1-20) 30%(Days 20-100)	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		30% Coins	20%-30% Coins	0% Coins			"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins	$0/Proc									7500	2.5355	0.0952	0.3214	4.9577	1.1847	1.9934	0.4255	0.3841	3.4174	0.5367	1.8635	0.2614	0.1221	1.1577	1.9507	3.0353	0.0335	0.2693		0.4398	0.8936	0			0				0	0	0.5554	0									26.4339	500	2.531556279	13.9997	0.525673129	0.78193495	4.9577123	1.428090445	3.649397475	0.778902504	1.646590315	4.737216205	0.53672273	6.894206571	0.794079151	0.515306797	4.599157937	6.194627534	11.02873136	0.229272513	1.866079819	0	0.439839958	3.795842305	0	0	0	0	0	0	0	0	0	0.555391648	0	0	0	0	0	0	0	0	0	69.9544
H6411_007_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin		V					O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0					0	0	0	0									0	YES	1117.833686	59.880702	340.778476	638.778799	31.917549	7.409205	2.050385	304.279023	335.849449	1545.033351	965.101906	76.821032	0.369648	822.13375	3199.486421	3160.187112	87.655694	585.344406		1462.781077	14.822314	0		3.26					3.08	0.5	758.300539	1.297779									3400	$150/Day(Days 1-5):1a.IP Acute	$150/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	15% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$75/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$30/Visit:7b. $15 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30-$75/Visit:7c, 7d, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										92.8668	74.76165	46.371	0	100	0.15	0.2	50	65.303979	0	62.995098	75	0.2	65.807143	15	28.578966	30	44.893462		0	0.2	0		0					0	0	0	0									NO	85.7949	69.068476	37.521141	0	91.2166	0.136825	0.182433	45.6083	59.56807	0	57.461987	68.41245	0.182433	60.027038	13.68249	26.068761	27.36498	40.95029		0	0.182433	0		0					0	0	0	0										7.992	0.344655736	1.065533104	0	0.242617525	1.013764474	0.374057887	1.156470747	1.667158624	0	4.621389431	0.437959584	0.067435994	4.112521154	3.648078413	6.865180212	0.199891359	1.997501931	0	0	2.70407921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5103	0	3.741365564	7.992	0.344655736	1.065533104	0	0.242617525	1.013764474	0.374057887	1.156470747	1.667158624	0	4.621389431	0.437959584	0.067435994	4.112521154	3.648078413	6.865180212	0.199891359	1.997501931	0	0	2.70407921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5103	YES	$200/Day(Days 1-5)	$200/Day(Days 1-5)	30% Coins(Days 1-14) 30%(Days 15-100)	20% Coins	$100/Trip	25% 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		30% Coins	20%-30% Coins	0% Coins		"DEN767: Dental 16a, 16b"					$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: OTC items 13c	25% Coins	$0/Proc									5000	1.9014	0.082	0.3866	1.5338	1.2526	1.4379	0.4775	0.223	2.6817	0.2964	1.1804	0.2228	0.0133	0.6891	1.5352	2.4616	0.0392	0.2358		0.3203	0.8718	0		0					0	0	0.1826	0									18.025	500	2.530822435	9.8934	0.426651787	1.452086136	1.533846395	1.495253673	2.451695725	0.8515686	1.379520384	4.348843024	0.296449685	5.801763862	0.660805476	0.080709776	4.801663568	5.183252775	9.326778381	0.239062439	2.233305125	0	0.320251716	3.57587235	0	0	0	0	0	0	0	0	0	0.182551003	0	0	0	0	0	0	0	0	0	56.5353
H6411_008_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin		V					O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0					0	0	0	0									0	YES	1105.364722	36.040491	392.916093	483.573074	35.346168	4.296422	1.440964	294.933099	287.784701	884.174538	727.6953	58.637762	0.023584	564.268728	2353.363713	2607.874193	30.514486	510.24575		970.381054	8.736314	0		3.26					3.91	1.48	542.153455	0.427182									3400	$150/Day(Days 1-5):1a.IP Acute	$150/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	15% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$75/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$30/Visit:7b. $15 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30-$75/Visit:7c, 7d, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										92.8668	74.76165	46.371	0	100	0.15	0.2	50	65.57362	0	64.107756	75	0.2	68.592233	15	28.727623	30	45.047208		0	0.2	0		0					0	0	0	0									NO	87.669231	70.57739	38.758273	0	93.7047	0.140557	0.187409	46.85235	61.445564	0	60.071981	70.278525	0.187409	64.274146	14.055705	26.919133	28.11141	42.211351		0	0.187409	0		0					0	0	0	0										8.0755	0.211970316	1.269062433	0	0.276008506	0.603892187	0.270049622	1.151525732	1.473591105	0	3.64284152	0.343414619	0.004419854	3.022324217	2.756515509	5.850142687	0.071483769	1.794846871	0	0	1.63726387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4549	0	2.278960696	8.0755	0.211970316	1.269062433	0	0.276008506	0.603892187	0.270049622	1.151525732	1.473591105	0	3.64284152	0.343414619	0.004419854	3.022324217	2.756515509	5.850142687	0.071483769	1.794846871	0	0	1.63726387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4549	YES	$200/Day(Days 1-5)	$200/Day(Days 1-5)	30% Coins(Days 1-14) 30%(Days 15-100)	20% Coins	$100/Trip	25% 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		30% Coins	20%-30% Coins	0% Coins		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	25% Coins	$0/Proc									5000	1.986	0.0521	0.441	1.5737	1.5296	0.9194	0.37	0.2384	2.4887	0.2827	0.9872	0.1943	0.0009	0.5816	1.23	2.0198	0.0161	0.2356		0.2147	0.616	0		0					0	0	0.1376	0									16.1157	500	1.661003195	10.0616	0.264100988	1.710034147	1.573742474	1.805653974	1.523338863	0.640093668	1.389925636	3.9623287	0.282671221	4.630068098	0.537763449	0.00535358	3.603922213	3.986485233	7.869944385	0.087570676	2.030473343	0	0.214682295	2.253254578	0	0	0	0	0	0	0	0	0	0.137642771	0	0	0	0	0	0	0	0	0	48.5706
H6528_001_0	2011	5																															D	A	D	Coin	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	Coin	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	1187.713169	3.673441448	258.059938	0	261.1798246	7.014053038	6.181290039	285.8714967	394.4165592	3.104139523	17.63615916	840.7913136	0.252116684	489.4836853	2719.437211	3337.067809	112.1681233	422.0347022	17.08961225	11.467595	6.099817241	0	0	241.8461538	294.2275045	0	0	0	0	0												$220/Days 1-15 for IP Medical; $220/Days 1-15 for IP Surgical; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse; PBP 1b	$130/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"35% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 35% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $40/Visit for PCP Urgent Care; $40/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$175/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$45/Visit for OP Fac - Other; PBP 9c	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$45/Visit for OP Fac - Cardiovascular; $45/Visit for OP Fac - Occ Therapy; $45/Visit for OP Fac - Physical/Speech Therapy; $45/Visit for OP Fac - CORF; $45/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$30/Visit for PCP Office Visits; $30/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$45/Visit for Speclst Office Visits; $45/Visit for Speclst Consults; $15/Visit for Chiropractor; $45/Visit for Vision Exams; $45/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$45/Visit for Occ Therapy; $45/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$10/Visit for Dental - Preventive; PBP 16a, 16b"	$30/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	Not Covered; PBP 18a	Not Covered; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											0	220	1000	130	0	150	0.2	0.246401957	49.44798142	175	0.2	0.2	45	0.2	45	30	40.87324727	39.5	45	0.2	0.2	0.2	0	0	10	30	0	0	0	0	0											NO	201.1217379	914.1897178	118.8446633	0	137.1284577	0.182837944	0.225258135	45.20483619	159.9832006	0.182837944	0.182837944	41.1385373	0.182837944	41.1385373	27.49402469	37.42185927	36.11049385	41.1385373	0.182837944	0.182837944	0.182837944	0	0	10	30	0	0	0	0	0												19.9062	0.279851867	2.555753871	0	2.984598877	1.282435034	1.392385867	1.076897848	5.258335293	0.567554487	3.224559074	2.882410401	0.046096496	1.67805357	6.230689483	10.40660683	0.337537194	1.446824195	3.124629561	2.096711488	1.11527804	0	0	0.201538462	0.735568761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.8306	0	6.338848176	19.9062	0.279851867	2.555753871	0	2.984598877	1.282435034	1.392385867	1.076897848	5.258335293	0.567554487	3.224559074	2.882410401	0.046096496	1.67805357	6.230689483	10.40660683	0.337537194	1.446824195	3.124629561	2.096711488	1.11527804	0	0	0.201538462	0.735568761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.8306	YES	$220/Days 1-15 for IP Medical; $220/Days 1-15 for IP Surgical; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse; PBP 1b	$130/Days 21-100 for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$150/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; PBP 11a	"35% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 35% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Worldwide; ; PBP 4a, 4b"	"$175/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$45/Visit for OP Fac - Other; PBP 9c	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$45/Visit for OP Fac - Cardiovascular; $45/Visit for OP Fac - Occ Therapy; $45/Visit for OP Fac - Physical/Speech Therapy; $45/Visit for OP Fac - CORF; $45/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$30/Visit for PCP Office Visits; $30/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$45/Visit for Speclst Office Visits; $45/Visit for Speclst Consults; $15/Visit for Chiropractor; $45/Visit for Vision Exams; $45/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$45/Visit for Occ Therapy; $45/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$10/Visit for Dental - Preventive; PBP 16a, 16b"	$30/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	Not Covered; PBP 18a	Not Covered; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											3400	0	0	0	2.1185	0	1.3811	0	0.0037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											3.5033	0	0.328489711	19.9062	0.279851867	2.555753871	2.118519067	2.984598877	2.663518916	1.392385867	1.080600549	5.258335293	0.567554487	3.224559074	2.882410401	0.046096496	1.67805357	6.230689483	10.40660683	0.337537194	1.446824195	3.124629561	2.096711488	1.11527804	0	0	0.201538462	0.735568761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.3339
H6528_005_0	2011	5																															D	A	D	Coin	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	Coin	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	1171.423838	3.910005975	471.848759	0	281.4487049	6.779866248	5.885616915	285.280876	335.3209339	4.649173079	20.30770505	904.247168	0.300313086	611.1467051	2844.711208	3423.239644	105.5759842	372.6958057	15.85835649	10.66395092	10.06170014	0	0	236.3076923	220.0032201	0	0	0	0	0												$220/Days 1-15 for IP Medical; $220/Days 1-15 for IP Surgical; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse; PBP 1b	$130/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"35% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 35% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $35/Visit for PCP Urgent Care; $35/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$175/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$50/Visit for OP Fac - Other; PBP 9c	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$50/Visit for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $50/Visit for OP Fac - Physical/Speech Therapy; $50/Visit for OP Fac - CORF; $50/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35/Visit for PCP Office Visits; $35/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $15/Visit for Chiropractor; $50/Visit for Vision Exams; $50/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $50/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$10/Visit for Dental - Preventive; PBP 16a, 16b"	$10/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	Not Covered; PBP 18a	Not Covered; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											0	220	1000	130	0	150	0.2	0.244830269	49.11871311	175	0.2	0.2	50	0.2	50	35	45.95227751	39.75	50	0.2	0.2	0.2	0	0	10	10	0	0	0	0	0											NO	198.9310312	904.23196	117.5501548	0	135.634794	0.180846392	0.221383354	44.41471023	158.240593	0.180846392	0.180846392	45.211598	0.180846392	45.211598	31.73364931	41.62013692	35.94322041	45.211598	0.180846392	0.180846392	0.180846392	0	0	10	10	0	0	0	0	0												19.4194	0.294629364	4.622157888	0	3.181186426	1.226114349	1.302977611	1.055888953	4.421781952	0.840786177	3.672575189	3.406871621	0.054310538	2.302576596	7.522755654	11.87297523	0.316228406	1.404181079	2.867926554	1.928537047	1.819622167	0	0	0.196923077	0.183336017	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9137	0	7.743925318	19.4194	0.294629364	4.622157888	0	3.181186426	1.226114349	1.302977611	1.055888953	4.421781952	0.840786177	3.672575189	3.406871621	0.054310538	2.302576596	7.522755654	11.87297523	0.316228406	1.404181079	2.867926554	1.928537047	1.819622167	0	0	0.196923077	0.183336017	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9137	YES	$220/Days 1-15 for IP Medical; $220/Days 1-15 for IP Surgical; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse; PBP 1b	$130/Days 21-100 for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$150/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; PBP 11a	"35% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 35% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Worldwide; ; PBP 4a, 4b"	"$175/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$50/Visit for OP Fac - Other; PBP 9c	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$50/Visit for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $50/Visit for OP Fac - Physical/Speech Therapy; $50/Visit for OP Fac - CORF; $50/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35/Visit for PCP Office Visits; $35/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $15/Visit for Chiropractor; $50/Visit for Vision Exams; $50/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $50/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$10/Visit for Dental - Preventive; PBP 16a, 16b"	$10/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	Not Covered; PBP 18a	Not Covered; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											3400	0	0	0	2.6433	0	1.3204	0	0.0037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											3.9674	0	0.419804538	19.4194	0.294629364	4.622157888	2.643320328	3.181186426	2.546545187	1.302977611	1.059570118	4.421781952	0.840786177	3.672575189	3.406871621	0.054310538	2.302576596	7.522755654	11.87297523	0.316228406	1.404181079	2.867926554	1.928537047	1.819622167	0	0	0.196923077	0.183336017	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8812
H6528_006_0	2011	5																															D	A	D	Coin	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	Coin	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	1012.350841	3.207017893	317.0297491	0	252.0300722	6.35380256	5.515750083	280.9524753	335.3703642	3.392785152	19.15345617	499.3353127	0.177770836	435.3819299	3078.653765	3641.115703	97.28610882	343.4315577	18.06251669	13.10752218	5.936962064	0	0	260.3076923	230.3563128	0	0	0	0	0												$220/Days 1-15 for IP Medical; $220/Days 1-15 for IP Surgical; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse; PBP 1b	$130/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"35% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 35% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $35/Visit for PCP Urgent Care; $35/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$175/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$50/Visit for OP Fac - Other; PBP 9c	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$50/Visit for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $50/Visit for OP Fac - Physical/Speech Therapy; $50/Visit for OP Fac - CORF; $50/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35/Visit for PCP Office Visits; $35/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $15/Visit for Chiropractor; $50/Visit for Vision Exams; $50/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $50/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$10/Visit for Dental - Preventive; PBP 16a, 16b"	$10/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	Not Covered; PBP 18a	Not Covered; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											0	220	1000	130	0	150	0.2	0.244830269	49.03154428	175	0.2	0.2	50	0.2	50	35	46.49329488	39.75	50	0.2	0.2	0.2	0	0	10	10	0	0	0	0	0											NO	200.8466722	912.939419	118.6821245	0	136.9409128	0.182587884	0.223515203	44.76282954	159.7643983	0.182587884	0.182587884	45.64697095	0.182587884	45.64697095	32.03789353	42.51944616	36.2893419	45.64697095	0.182587884	0.182587884	0.182587884	0	0	10	10	0	0	0	0	0												16.9439	0.243984421	3.135480345	0	2.876102346	1.160127363	1.232854	1.04801898	4.465020371	0.619481461	3.49718903	1.899428709	0.032458801	1.656155525	8.219465129	12.90151859	0.294204072	1.306384195	3.297996698	2.393274737	1.084017339	0	0	0.216923077	0.191963594	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.716	0	6.465518739	16.9439	0.243984421	3.135480345	0	2.876102346	1.160127363	1.232854	1.04801898	4.465020371	0.619481461	3.49718903	1.899428709	0.032458801	1.656155525	8.219465129	12.90151859	0.294204072	1.306384195	3.297996698	2.393274737	1.084017339	0	0	0.216923077	0.191963594	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.716	YES	$220/Days 1-15 for IP Medical; $220/Days 1-15 for IP Surgical; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse; PBP 1b	$130/Days 21-100 for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$150/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; PBP 11a	"35% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 35% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Worldwide; ; PBP 4a, 4b"	"$175/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$50/Visit for OP Fac - Other; PBP 9c	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$50/Visit for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $50/Visit for OP Fac - Physical/Speech Therapy; $50/Visit for OP Fac - CORF; $50/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35/Visit for PCP Office Visits; $35/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $15/Visit for Chiropractor; $50/Visit for Vision Exams; $50/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $50/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$10/Visit for Dental - Preventive; PBP 16a, 16b"	$10/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	Not Covered; PBP 18a	Not Covered; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											3400	0	0	0	2.6942	0	1.2494	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											3.9472	0	0.376069049	16.9439	0.243984421	3.135480345	2.694187865	2.876102346	2.409495293	1.232854	1.051621909	4.465020371	0.619481461	3.49718903	1.899428709	0.032458801	1.656155525	8.219465129	12.90151859	0.294204072	1.306384195	3.297996698	2.393274737	1.084017339	0	0	0.216923077	0.191963594	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6631
H6528_007_0	2011	5																															D	A	D	Coin	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	Coin	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	1155.174196	3.350849235	327.3529571	0	290.5601146	7.025799077	6.099111749	208.8630528	293.5164213	3.400334623	15.73142206	807.9708544	0.258994144	334.2827356	3014.590996	3575.12453	97.86866232	345.4880409	23.32529737	12.54699084	5.923363938	0	0	249.2307692	230.3563128	0	0	0	0	0												$220/Days 1-15 for IP Medical; $220/Days 1-15 for IP Surgical; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse; PBP 1b	$130/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"35% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 35% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $35/Visit for PCP Urgent Care; $35/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$175/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$50/Visit for OP Fac - Other; PBP 9c	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$50/Visit for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $50/Visit for OP Fac - Physical/Speech Therapy; $50/Visit for OP Fac - CORF; $50/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35/Visit for PCP Office Visits; $35/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $15/Visit for Chiropractor; $50/Visit for Vision Exams; $50/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $50/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$10/Visit for Dental - Preventive; PBP 16a, 16b"	$10/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	Not Covered; PBP 18a	Not Covered; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											0	220	1000	130	0	150	0.2	0.244830269	48.72438811	175	0.2	0.2	50	0.2	50	35	46.40718072	39.75	50	0.2	0.2	0.2	0	0	10	10	0	0	0	0	0											NO	199.9386788	908.8121763	118.1455829	0	136.3218264	0.181762435	0.222504729	44.28131719	159.0421309	0.181762435	0.181762435	45.44060882	0.181762435	45.44060882	31.90222319	42.2538663	36.12528401	45.44060882	0.181762435	0.181762435	0.181762435	0	0	10	10	0	0	0	0	0												19.247	0.253774382	3.222942161	0	3.300807127	1.27702635	1.357081208	0.770727591	3.89012309	0.618053102	2.859381584	3.059557294	0.047075406	1.265834252	8.014346232	12.58856949	0.294627768	1.308265577	4.239662854	2.28057161	1.076645054	0	0	0.207692308	0.191963594	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.3717	0	7.06950424	19.247	0.253774382	3.222942161	0	3.300807127	1.27702635	1.357081208	0.770727591	3.89012309	0.618053102	2.859381584	3.059557294	0.047075406	1.265834252	8.014346232	12.58856949	0.294627768	1.308265577	4.239662854	2.28057161	1.076645054	0	0	0.207692308	0.191963594	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.3717	YES	$220/Days 1-15 for IP Medical; $220/Days 1-15 for IP Surgical; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse; PBP 1b	$130/Days 21-100 for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$150/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; PBP 11a	"35% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 35% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Worldwide; ; PBP 4a, 4b"	"$175/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$50/Visit for OP Fac - Other; PBP 9c	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$50/Visit for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $50/Visit for OP Fac - Physical/Speech Therapy; $50/Visit for OP Fac - CORF; $50/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35/Visit for PCP Office Visits; $35/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $15/Visit for Chiropractor; $50/Visit for Vision Exams; $50/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $50/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$10/Visit for Dental - Preventive; PBP 16a, 16b"	$10/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	Not Covered; PBP 18a	Not Covered; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											3400	0	0	0	2.3094	0	1.3753	0	0.0026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											3.6873	0	0.369706961	19.247	0.253774382	3.222942161	2.309379599	3.300807127	2.652285496	1.357081208	0.773347415	3.89012309	0.618053102	2.859381584	3.059557294	0.047075406	1.265834252	8.014346232	12.58856949	0.294627768	1.308265577	4.239662854	2.28057161	1.076645054	0	0	0.207692308	0.191963594	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.059
H6609_001_0	2011	3	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							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		V	Coin	Coin							O	O	O	V	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	YES	1073.296159	57.494892	327.200937	613.328118	30.645868	7.511053	2.078571	292.155721	322.468296	1483.475029	193.255986	73.760274	0.374729	789.377711	3072.010199	3034.276682	84.163253	186.010307		1404.499909	15.026065	0							3.78	0.48	728.087788	733.393642	1.246072	376.012389							3400	$200/Day(Days 1-7):1a.IP Acute	$200/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								143.724	123.0478	46.371	0	100	0.2	0.2	50	87.243183	18.365847	30	50	0.2	46.491501	10	28.105289	30	50		0	0.2	0							0	0	0	39.480931	0	30							NO	129.993759	111.292798	35.310682	0	90.0364	0.180073	0.180073	45.0182	78.550622	16.535948	27.01092	45.0182	0.180073	41.859273	9.00364	25.30499	27.01092	45.0182		0	0.180073	0							0	0	0	35.547209	0	27.01092								11.6268	0.533230617	0.962807353	0	0.229936969	1.352537847	0.374294516	1.096027057	2.110840436	2.044222162	0.435001831	0.276712897	0.067478575	2.753564759	2.304939492	6.398528425	0.189443908	0.697820767	0	0	2.705788603	0	0	0	0	0	0	0	0	0	0	2.172508089	0	0.846370047	0	0	0	0	0	0	39.1789	0	4.469359169	11.6268	0.533230617	0.962807353	0	0.229936969	1.352537847	0.374294516	1.096027057	2.110840436	2.044222162	0.435001831	0.276712897	0.067478575	2.753564759	2.304939492	6.398528425	0.189443908	0.697820767	0	0	2.705788603	0	0	0	0	0	0	0	0	0	0	2.172508089	0	0.846370047	0	0	0	0	0	0	39.1789	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		$35/Visit	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$0/Proc	$35/Visit							5100	4.9812	0.0887	0.2378	2.0084	1.0357	1.5063	0.4168	0.1844	2.341	0.2588	0.1008	0.1945	0.0116	0.6016	1.6031	1.5834	0.0439	0.0566		0.7329	0.761	0							0	0	0.1912	0.7808	0	0.1962							19.9168	500	8.364007407	16.608	0.621958846	1.200590949	2.008444509	1.265615083	2.858819218	0.791135096	1.280444238	4.451802422	2.303006311	0.535849585	0.471245152	0.079065878	3.355148052	3.908022158	7.981920417	0.233363246	0.754403386	0	0.732917316	3.466815984	0	0	0	0	0	0	0	0	0	0.19122852	2.953264707	0	1.042586498	0	0	0	0	0	0	59.0957
H6609_002_0	2011	2	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin							O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0									0	YES	1012.748951	33.020748	359.994627	443.055684	32.3846	4.491821	1.506498	270.221386	263.671934	810.091744	666.723515	53.724649	0.024657	516.99005	2156.181199	2389.366876	27.957753	467.493524		889.07523	9.133637	0							3.78	0.48	496.72776	0.391389									5000	$200/Day(Days 1-7):1a.IP Acute	$200/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $100(Days 21-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										143.724	123.0478	33.0247	0	100	0.2	0.2	50	87.458896	34.094012	40.883406	50	0.2	48.531206	10	32.879371	35	40.015736		0	0.2	0							0	0	0	0									NO	139.597828	119.515221	31.395691	0	96.8279	0.193656	0.193656	48.41395	84.684613	33.012515	39.586543	48.41395	0.193656	46.991747	9.68279	31.836405	33.889765	38.746397		0	0.193656	0							0	0	0	0										11.7815	0.3288735	0.941856673	0	0.261311068	0.869868088	0.291742377	1.090207056	1.860746307	2.228597154	2.199439925	0.216751873	0.004774976	2.024522136	1.739820813	6.339070963	0.078956807	1.50947414	0	0	1.768783607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5363	0	1.143403766	11.7815	0.3288735	0.941856673	0	0.261311068	0.869868088	0.291742377	1.090207056	1.860746307	2.228597154	2.199439925	0.216751873	0.004774976	2.024522136	1.739820813	6.339070963	0.078956807	1.50947414	0	0	1.768783607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5363	YES	30% Coins	30% Coins	30% Coins(Days 1-20) 30%(Days 21-100)	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		30% Coins	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	$0/Proc									6000	6.0651	0.061	0.33	2.226	1.2641	0.867	0.2908	0.197	2.3469	0.2666	0.9309	0.1833	0.0009	0.5484	1.1599	1.9047	0.0152	0.2222		0.2024	0.5809	0							0	0	0.1298	0									19.793	500	5.537341452	17.8465	0.389892631	1.271827444	2.226048568	1.525410464	1.736902265	0.582534206	1.287220795	4.207615581	2.495154921	3.130389842	0.400021733	0.005655816	2.572966894	2.899677308	8.24373524	0.094126538	1.731669023	0	0.202444477	2.349660204	0	0	0	0	0	0	0	0	0	0.129796332	0	0	0	0	0	0	0	0	0	55.3293
H6609_003_0	2011	4	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							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		V	Coin	Coin							O	O	O	V	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	YES	1193.24728	63.920497	363.768774	681.873408	34.070837	9.685211	2.680237	324.80692	358.507215	1649.267567	214.854193	82.003691	0.483199	877.59823	3415.336751	3373.386151	93.569303	206.798739		1561.466221	19.375526	0							4.8	0.48	809.458569	815.357402	1.385332	418.035374							3400	$200/Day(Days 1-7):1a.IP Acute	$200/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								143.724	123.0478	46.371	0	100	0.2	0.2	50	150	18.365847	30	50	0.2	46.491501	10	28.105289	30	50		0	0.2	0							0	0	0	39.480931	0	30							NO	124.609858	106.683427	32.077881	0	86.9817	0.173963	0.173963	43.49085	130.47255	15.974926	26.09451	43.49085	0.173963	40.439098	8.69817	24.446458	26.09451	43.49085		0	0.173963	0							0	0	0	34.341185	0	26.09451								12.3909	0.568271473	0.972410954	0	0.24696161	1.684868361	0.466262069	1.17717742	3.897945878	2.195577278	0.467209574	0.297200852	0.084058748	2.957440069	2.475598306	6.872278572	0.203470426	0.749487745	0	0	3.37062463	0	0	0	0	0	0	0	0	0	0	2.333361615	0	0.909035687	0	0	0	0	0	0	44.3201	0	6.969278763	12.3909	0.568271473	0.972410954	0	0.24696161	1.684868361	0.466262069	1.17717742	3.897945878	2.195577278	0.467209574	0.297200852	0.084058748	2.957440069	2.475598306	6.872278572	0.203470426	0.749487745	0	0	3.37062463	0	0	0	0	0	0	0	0	0	0	2.333361615	0	0.909035687	0	0	0	0	0	0	44.3201	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		$35/Visit	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$0/Proc	$35/Visit							5100	5.0677	0.0903	0.2263	2.3396	1.0402	1.7546	0.4856	0.1852	2.7269	0.3014	0.1013	0.2266	0.0135	0.7008	1.61	1.5903	0.0441	0.0659		0.7361	0.8865	0							0	0	0.2228	0.9095	0	0.1971							21.5221	500	12.89108649	17.4585	0.658540322	1.198756422	2.339561383	1.287126085	3.439478538	0.951823834	1.362393462	6.624844313	2.497025201	0.568494179	0.523804109	0.097556313	3.658201785	4.085625216	8.462529512	0.247580014	0.815398696	0	0.73609217	4.25711663	0	0	0	0	0	0	0	0	0	0.222754621	3.242835252	0	1.106102111	0	0	0	0	0	0	65.8422
H6609_004_0	2011	2	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin							O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0									0	YES	979.078934	31.922934	348.026187	428.325783	31.307937	4.941223	1.657221	261.237562	254.905854	783.159302	644.557516	51.938511	0.027123	499.802114	2084.496447	2309.929594	27.028265	451.951157		859.51689	10.047448	0							4.8	0.48	480.213468	0.378377									3400	$200/Day(Days 1-7):1a.IP Acute	$200/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:9a, 12.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, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										143.724	123.0478	46.371	0	100	0.2	0.2	50	150	34.094012	40.014775	50	0.2	48.041608	10	28.303497	30	36.687648		0	0.2	0							0	0	0	0									NO	133.777724	114.5324	37.432665	0	92.6928	0.185386	0.185386	46.3464	139.0392	31.602694	37.090816	46.3464	0.185386	44.531111	9.26928	26.235304	27.80784	34.006808		0	0.185386	0							0	0	0	0										10.9149	0.304684187	1.085628972	0	0.241835029	0.916033567	0.307225572	1.008951712	2.953492168	2.062495315	1.992263686	0.200596917	0.005028224	1.854728618	1.610148436	5.050142093	0.062633139	1.280784685	0	0	1.862656195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.7142	0	2.781124495	10.9149	0.304684187	1.085628972	0	0.241835029	0.916033567	0.307225572	1.008951712	2.953492168	2.062495315	1.992263686	0.200596917	0.005028224	1.854728618	1.610148436	5.050142093	0.062633139	1.280784685	0	0	1.862656195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.7142	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		30% Coins	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	$0/Proc									5100	5.367	0.054	0.2683	2.241	1.1184	1.0474	0.3513	0.1743	2.3626	0.2683	0.9372	0.1845	0.0009	0.5521	1.1676	1.9175	0.0153	0.2237		0.2038	0.5848	0							0	0	0.1568	0									19.1968	500	8.341626102	16.2819	0.358680277	1.353902553	2.241002139	1.360223389	1.963463519	0.658519402	1.183255941	5.316125397	2.330843482	2.929467431	0.385098258	0.005914921	2.406857586	2.777795843	6.967600979	0.077904701	1.504471707	0	0.203804189	2.447435075	0	0	0	0	0	0	0	0	0	0.156802204	0	0	0	0	0	0	0	0	0	52.9111
H6609_005_0	2011	4	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							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		V	Coin	Coin							O	O	O	V	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	YES	998.59507	53.493265	304.427851	570.640667	28.512924	8.861553	2.452301	271.821771	300.0246	1380.225616	179.805428	68.626581	0.442106	734.437262	2858.199218	2823.091941	78.305516	173.064045		1306.74714	17.727775	0							3.45	0.29	677.413098	682.349665	1.159346	349.842041							4000	$200/Day(Days 1-7):1a.IP Acute	$200/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $100(Days 21-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Membership in health club/fitness class 14a	$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								143.724	123.0478	33.0247	0	100	0.2	0.2	50	150	18.365847	30	50	0.2	46.491501	10	28.105289	30	50		0	0.2	0							0	0	0	39.480931	0	30							NO	134.812393	115.418221	28.841395	0	92.7637	0.185527	0.185527	46.38185	139.14555	17.036839	27.82911	46.38185	0.185527	43.127236	9.27637	26.071506	27.82911	46.38185		0	0.185527	0							0	0	0	36.623972	0	27.82911								11.2186	0.514508123	0.731676992	0	0.220413694	1.644057343	0.454968048	1.050633051	3.478923998	1.9595568	0.41698542	0.265252315	0.0820226	2.63952076	2.209476123	6.13352154	0.181597735	0.668919215	0	0	3.288980912	0	0	0	0	0	0	0	0	0	0	2.082529585	0	0.811316053	0	0	0	0	0	0	40.0534	0	3.033862776	11.2186	0.514508123	0.731676992	0	0.220413694	1.644057343	0.454968048	1.050633051	3.478923998	1.9595568	0.41698542	0.265252315	0.0820226	2.63952076	2.209476123	6.13352154	0.181597735	0.668919215	0	0	3.288980912	0	0	0	0	0	0	0	0	0	0	2.082529585	0	0.811316053	0	0	0	0	0	0	40.0534	YES	30% Coins	30% Coins	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	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins		$35/Visit	20%-30% Coins	0% Coins							$0: Membership in health club/fitness class 14a	$0: OTC items 13c	30% Coins	30% Coins	$0/Proc	$35/Visit							6000	5.9753	0.1064	0.2857	2.3749	0.9658	1.7811	0.4929	0.172	2.7681	0.306	0.094	0.23	0.0137	0.7114	1.4949	1.4765	0.041	0.0669		0.6834	0.8999	0							0	0	0.2261	0.9232	0	0.183							22.2723	500	9.151968688	17.1939	0.620944788	1.017338709	2.37491814	1.186185415	3.425184142	0.947867563	1.222602408	6.247033224	2.265560549	0.511026132	0.495280218	0.095724245	3.350873011	3.704353611	7.610037441	0.222552598	0.735826307	0	0.683446724	4.188870301	0	0	0	0	0	0	0	0	0	0.226121044	3.005747844	0	0.994288249	0	0	0	0	0	0	62.3257
H6609_006_0	2011	3	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional					Prosthetics/Supplies	Lab	Radiology	Renal Dialysis	Other	Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	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	YES	936.229117	30.525813	332.794669	409.579918	29.937731	4.925659	1.652002	249.804386	243.749787	5.004265	8.11411	3.751338	0.027038	10.885539	1993.267549	2208.834516	25.845361	1.423515		821.899758	10.015802	0							4.87	0.48	459.196716	238.234803	323.775688	0.361817	46.798536	287.660835					6000	$200/Day(Days 1-7):1a.IP Acute	$200/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $100(Days 21-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$125/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	20% Coins:8a.Lab -- OP	"20% Coins:8b.Radiology OP -- Facility, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"20% Coins:7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$50/Visit:8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$0/Proc:12.Dialysis -- Dialysis Center	"$35/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						143.724	123.0478	33.0247	0	125	0.2	0.2	50	150	0.2	0.2	0.2	0.2	0.2	15	33.303497	35	0.2		0	0.2	0							0	0	0	0	32.645404	0	35	35					NO	140.838884	120.577738	32.271407	0	122.383625	0.195814	0.195814	48.95345	146.86035	0.195814	0.195814	0.195814	0.195814	0.195814	14.686035	32.606421	34.267415	0.195814		0	0.195814	0							0	0	0	0	31.962103	0	34.267415	34.267415						10.9881	0.30672779	0.894979351	0	0.305324004	0.964512991	0.32348512	1.019065543	2.983098253	0.979905147	1.588856336	0.734564499	0.005294419	2.131540934	2.439433082	6.001849012	0.073804476	0.278744166	0	0	1.961234253	0	0	0	0	0	0	0	0	0	0	0	0.862379324	0	0.133638738	0.821449434	0	0	0	0	35.798	0	0.756975124	10.9881	0.30672779	0.894979351	0	0.305324004	0.964512991	0.32348512	1.019065543	2.983098253	0.979905147	1.588856336	0.734564499	0.005294419	2.131540934	2.439433082	6.001849012	0.073804476	0.278744166	0	0	1.961234253	0	0	0	0	0	0	0	0	0	0	0	0.862379324	0	0.133638738	0.821449434	0	0	0	0	35.798	YES	30% Coins	30% Coins	30% Coins(Days 1-20) 30%(Days 21-100)	25% Coins	$125/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		30% Coins	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	30% Coins	30% Coins	$0/Proc	30% Coins	30% Coins					7500	7.3331	0.0738	0.4184	2.0748	1.4899	0.9697	0.3252	0.1858	2.6249	0.2734	0.4434	0.205	0.001	0.5948	1.2972	2.1303	0.017	0.0778		0.2264	0.6497	0							0	0	0.1452	0.0247	0.5979	0	0.0186	0.1707					22.3685	500	4.755968811	18.3213	0.380504986	1.313393496	2.074768304	1.795185154	1.934246348	0.648721081	1.204825061	5.607951968	1.25334507	2.0322221	0.939542413	0.006279534	2.726342289	3.736673312	8.132118641	0.09077119	0.356527263	0	0.226423866	2.610915504	0	0	0	0	0	0	0	0	0	0.145170653	0.02469117	1.460234201	0	0.152245439	0.992179682	0	0	0	0	58.1665
H6609_009_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1057.736319	54.396192	418.68813	542.224712	33.964271	8.364517	2.444596	314.435004	345.492286	1374.896805	963.215701	68.960947	0.367691	5.514173	3268.798059	3260.274906	85.329181	663.415639		1480.197348	17.634759	0							5.38	0.49	862.860953	715.329777									3400	$250/Day(Days 1-5):1a.IP Acute	$250/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $125 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$25/Visit:7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$30-$125/Visit:9d. $30 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"										154.778	124.60275	43.922851	0	150	0.2	0.2	50	125	26.279162	73.904422	125	0.2	0.2	10	23.740866	25	32.249903		0	0.2	0							0	0	0	52.683626									NO	134.031247	107.900748	29.889061	0	130.098	0.173464	0.173464	43.366	108.415	22.792443	64.098783	108.415	0.173464	0.173464	8.6732	20.590928	21.683	27.970986		0	0.173464	0							0	0	0	45.693562										11.8141	0.489115817	1.042849588	0	0.368223644	1.450942577	0.424049401	1.136315699	3.121378849	2.611438088	5.145079517	0.623033422	0.063781152	0.956510505	2.362578277	5.594340487	0.154182719	1.546365796	0	0	3.058995835	0	0	0	0	0	0	0	0	0	0	2.72383046	0	0	0	0	0	0	0	0	44.6872	0	7.188533875	11.8141	0.489115817	1.042849588	0	0.368223644	1.450942577	0.424049401	1.136315699	3.121378849	2.611438088	5.145079517	0.623033422	0.063781152	0.956510505	2.362578277	5.594340487	0.154182719	1.546365796	0	0	3.058995835	0	0	0	0	0	0	0	0	0	0	2.72383046	0	0	0	0	0	0	0	0	44.6872	YES	$275/Day(Days 1-5)	$275/Day(Days 1-5)	$0/Day(Days 1-20) $137(Days 21-100)	25% Coins	$150/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									4000	1.6978	0.0703	0.1337	1.5128	1.3153	1.7086	0.4993	0.1516	1.9797	0.2749	0.8475	0.1347	0.0087	0.1303	1.137	1.8001	0.0276	0.2061		0.2232	0.5562	0							0	0	0.2595	0.3518									15.0264	0	4.490715337	13.5119	0.559404423	1.176511789	1.512770103	1.683495133	3.159516332	0.92339379	1.287939315	5.101119116	2.88629015	5.992550613	0.757769759	0.072466583	1.086765955	3.499588568	7.394407289	0.181769045	1.752423868	0	0.223178151	3.615147232	0	0	0	0	0	0	0	0	0	0.259504046	3.075622037	0	0	0	0	0	0	0	0	59.7135
H6609_010_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1030.360652	52.988344	407.851906	528.191192	33.085229	8.793136	2.569863	306.296994	336.550472	1339.312589	938.286358	67.176143	0.386532	5.796732	3184.197079	3175.894516	83.120745	646.245532		1441.887809	18.538408	0							5.38	0.49	840.528928	696.81606									3400	$250/Day(Days 1-5):1a.IP Acute	$250/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $125 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$25/Visit:7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$30-$125/Visit:9d. $30 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"										154.778	124.60275	43.922851	0	150	0.2	0.2	50	125	26.279162	73.904422	125	0.2	0.2	10	23.740866	25	32.249903		0	0.2	0							0	0	0	52.683626									NO	134.778361	108.502206	30.365887	0	130.57485	0.1741	0.1741	43.52495	108.812375	22.875985	64.333725	108.812375	0.1741	0.1741	8.70499	20.6664	21.762475	28.073509		0	0.1741	0							0	0	0	45.861043										11.5725	0.479112685	1.032065408	0	0.360008234	1.530884978	0.447413148	1.110963446	3.051738014	2.553174558	5.030288044	0.609132972	0.067295221	1.009211041	2.309866978	5.469525535	0.150742761	1.51186498	0	0	3.227536833	0	0	0	0	0	0	0	0	0	0	2.663059274	0	0	0	0	0	0	0	0	44.1864	0	6.876137775	11.5725	0.479112685	1.032065408	0	0.360008234	1.530884978	0.447413148	1.110963446	3.051738014	2.553174558	5.030288044	0.609132972	0.067295221	1.009211041	2.309866978	5.469525535	0.150742761	1.51186498	0	0	3.227536833	0	0	0	0	0	0	0	0	0	0	2.663059274	0	0	0	0	0	0	0	0	44.1864	YES	$275/Day(Days 1-5)	$275/Day(Days 1-5)	$0/Day(Days 1-20) $137(Days 21-100)	25% Coins	$150/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									4000	1.6376	0.0678	0.1289	1.5761	1.2698	1.7801	0.5203	0.1464	2.0627	0.2864	0.883	0.1404	0.009	0.1357	1.1846	1.8755	0.0287	0.2147		0.2325	0.5794	0							0	0	0.2704	0.3665									15.3965	0	4.776351878	13.2101	0.546909912	1.160961281	1.576124306	1.629827595	3.311013477	0.967669412	1.25734737	5.114389444	2.839537663	5.913250642	0.749512114	0.076344363	1.144921609	3.494494887	7.344978831	0.179484656	1.726552277	0	0.232524672	3.806979817	0	0	0	0	0	0	0	0	0	0.270371974	3.02958406	0	0	0	0	0	0	0	0	59.5829
H6609_011_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	982.54006	50.529075	388.922884	503.677042	31.549694	8.221192	2.402709	292.081289	320.930656	1277.153072	894.73907	64.058397	0.361391	5.419688	3036.413689	3028.496461	79.262986	616.252302		1374.96762	17.332591	0							5.38	0.49	801.518712	664.475777									3400	$250/Day(Days 1-5):1a.IP Acute	$250/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $125 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$25/Visit:7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$30-$125/Visit:9d. $30 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"										154.778	124.60275	43.922851	0	150	0.2	0.2	50	125	26.279162	73.904422	125	0.2	0.2	10	23.740866	25	32.249903		0	0.2	0							0	0	0	52.683626									NO	136.768032	110.103974	31.481396	0	132.05805	0.176077	0.176077	44.01935	110.048375	23.135833	65.064492	110.048375	0.176077	0.176077	8.80387	20.90115	22.009675	28.392396		0	0.176077	0							0	0	0	46.381979										11.1983	0.463620997	1.02031961	0	0.347199256	1.447562824	0.423061793	1.071435707	2.943158098	2.462333349	4.851311922	0.587460208	0.063632643	0.954282404	2.227682615	5.274921567	0.14537938	1.458073283	0	0	3.051870626	0	0	0	0	0	0	0	0	0	0	2.568308461	0	0	0	0	0	0	0	0	42.56	0	5.998213175	11.1983	0.463620997	1.02031961	0	0.347199256	1.447562824	0.423061793	1.071435707	2.943158098	2.462333349	4.851311922	0.587460208	0.063632643	0.954282404	2.227682615	5.274921567	0.14537938	1.458073283	0	0	3.051870626	0	0	0	0	0	0	0	0	0	0	2.568308461	0	0	0	0	0	0	0	0	42.56	YES	$275/Day(Days 1-5)	$275/Day(Days 1-5)	$0/Day(Days 1-20) $137(Days 21-100)	25% Coins	$150/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									4000	1.609	0.0666	0.1295	1.5035	1.2355	1.6981	0.4963	0.1424	1.9676	0.2732	0.8423	0.1339	0.0086	0.1295	1.1301	1.7891	0.0274	0.2048		0.2218	0.5528	0							0	0	0.2579	0.3496									14.7696	0	4.1721723	12.8074	0.530236698	1.149821487	1.503523754	1.582667901	3.14569389	0.919353938	1.213859704	4.910798048	2.735505756	5.693603027	0.721373074	0.072264952	1.083741666	3.357743282	7.063986437	0.172797182	1.662871881	0	0.221814162	3.604623023	0	0	0	0	0	0	0	0	0	0.257917609	2.917950346	0	0	0	0	0	0	0	0	57.3295
H6609_012_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1054.446366	54.227	417.385854	540.538191	33.85863	8.288954	2.422512	313.456994	344.417677	1370.620364	960.219742	68.746452	0.364369	5.464359	3258.63088	3250.134237	85.063776	661.352169		1475.593383	17.47545	0							5.38	0.49	860.177135	713.104833									3400	$275/Day(Days 1-5):1a.IP Acute	$275/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $125 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$30/Visit:7b. $15 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30-$50/Visit:7c, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$30-$125/Visit:9d. $30 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"										170.2558	137.063025	43.922851	0	150	0.2	0.2	50	125	26.279162	73.904422	125	0.2	0.2	15	28.740866	30	35.799923		0	0.2	0							0	0	0	52.683625									NO	143.317757	115.376776	28.516033	0	127.5747	0.1701	0.1701	42.5249	106.31225	22.350375	62.855563	106.31225	0.1701	0.1701	12.75747	24.444049	25.51494	30.447763		0	0.1701	0							0	0	0	44.807318										12.5934	0.521378036	0.991849066	0	0.359958714	1.409951075	0.412069291	1.11081061	3.051318182	2.55282326	5.029596041	0.609049166	0.061979167	0.929487466	3.464323808	6.620536712	0.180866428	1.678057842	0	0	2.972574045	0	0	0	0	0	0	0	0	0	0	2.662692918	0	0	0	0	0	0	0	0	47.2127	0	8.820384642	12.5934	0.521378036	0.991849066	0	0.359958714	1.409951075	0.412069291	1.11081061	3.051318182	2.55282326	5.029596041	0.609049166	0.061979167	0.929487466	3.464323808	6.620536712	0.180866428	1.678057842	0	0	2.972574045	0	0	0	0	0	0	0	0	0	0	2.662692918	0	0	0	0	0	0	0	0	47.2127	YES	$275/Day(Days 1-5)	$275/Day(Days 1-5)	$0/Day(Days 1-20) $137(Days 21-100)	25% Coins	$150/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	35% Coins	30% Coins									4000	1.6997	0.0704	0.1341	1.5036	1.3152	1.6983	0.4963	0.1516	1.9678	0.2732	0.8424	0.1339	0.0086	0.1295	1.1302	1.7892	0.0274	0.2048		0.2218	0.5528	0							0	0	0.2257	0.3497									14.9261	0	4.399582376	14.2931	0.59174538	1.125991909	1.503644842	1.675110837	3.10821881	0.908401846	1.262420464	5.019116474	2.82601767	5.871955008	0.742972884	0.07061229	1.05895712	4.594475964	8.409745653	0.208286246	1.882872605	0	0.221831718	3.525370704	0	0	0	0	0	0	0	0	0	0.225696114	3.012362364	0	0	0	0	0	0	0	0	62.1389
H6609_013_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	YES	1111.259897	57.148748	439.874588	569.662369	35.682931	9.251267	2.703757	330.346045	362.974888	685.28045	1011.956346	72.450509	0.406671	6.098749	3434.205793	3425.251351	89.647009	696.9858		1555.098301	19.50428	0							4.39	0.49	906.523447	759.18889	751.526896								1500	$150/Day(Days 1-5):1a.IP Acute	$150/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL	"$0-$125/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $15 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$15/Visit:7b. $5 Chiropractic,7f. $15 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Spec Cap"	"$15/Visit:7e, 7h.Psych -- Other Provider"	"$15-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$50/Visit:8a.Lab -- OP	"$15-$125/Visit:9d. $15 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"									92.8668	74.76165	42.271616	0	100	0.2	0.2	50	50	0	55.567098	125	0.2	0.2	5	14.160577	15	25.149865		0	0.2	0							0	0	0	50	51.717204								NO	64.286949	51.753677	18.017642	0	75.574	0.151148	0.151148	37.787	37.787	0	41.994279	94.4675	0.151148	0.151148	3.7787	10.701715	11.3361	19.006759		0	0.151148	0							0	0	0	37.787	39.08476									5.9533	0.246471487	0.660458571	0	0.224725152	1.398310505	0.408667463	1.040232167	1.142977674	0	3.541364761	0.570351538	0.061467508	0.921813714	1.081402786	3.05467198	0.084687288	1.103953427	0	0	2.948032913	0	0	0	0	0	0	0	0	0	0	2.390622549	2.447770697	0	0	0	0	0	0	0	29.2813	0	10.89189613	5.9533	0.246471487	0.660458571	0	0.224725152	1.398310505	0.408667463	1.040232167	1.142977674	0	3.541364761	0.570351538	0.061467508	0.921813714	1.081402786	3.05467198	0.084687288	1.103953427	0	0	2.948032913	0	0	0	0	0	0	0	0	0	0	2.390622549	2.447770697	0	0	0	0	0	0	0	29.2813	YES	$150/Day(Days 1-5)	$150/Day(Days 1-5)	$0/Day(Days 1-20) $128(Days 21-100)	40% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	$0-$50/Visit	30% Coins	$0-$125/Visit	$125/Visit	20% Coins	20% Coins	$15/Visit	$15/Visit	$15/Visit	$15-$50/Visit		$0/Visit	20% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	$50/Visit	$15-$125/Visit								2250	0.8427	0.0349	0.0954	2.4278	0.8355	1.7138	0.5009	0.1445	0.1587	0.0385	0.4958	0.0792	0.0087	0.1307	0.5321	0.5307	0.0139	0.1651		0	0.496	0							0	0	0.2603	0.332	0.3399								10.1772	0	4.496267583	6.796	0.281361987	0.755881722	2.42783757	1.060191031	3.11211185	0.909539155	1.184700087	1.301714937	0.038456417	4.037196976	0.64956222	0.070179615	1.052467643	1.613508733	3.585390498	0.09857746	1.269022011	0	0	3.444059114	0	0	0	0	0	0	0	0	0	0.260297795	2.722633303	2.787718213	0	0	0	0	0	0	0	39.4584
H6609_014_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	YES	1112.876122	57.231866	440.514345	570.49089	35.734829	9.221993	2.6952	330.826503	363.502801	686.277127	1013.428142	72.555881	0.405384	6.07945	3439.200528	3430.233062	89.777392	697.999502		1557.360047	19.442561	0							4.39	0.49	907.841902	760.29306	752.619922								3000	$250/Day(Days 1-5):1a.IP Acute	$250/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a.Lab -- FSL	"$0-$125/Visit:8b, 9a. $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,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$25/Visit:7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$50/Visit:8a.Lab -- OP	"$15-$125/Visit:9d. $15 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"									154.778	124.60275	42.271616	0	100	0.2	0.2	50	125	0	57.234127	125	0.2	0.2	10	23.740866	25	32.249903		0	0.2	0							0	0	0	50	51.717204								NO	128.64683	103.566068	26.843871	0	84.8084	0.169617	0.169617	42.4042	106.0105	0	48.539348	106.0105	0.169617	0.169617	8.48084	20.134248	21.2021	27.350627		0	0.169617	0							0	0	0	42.4042	43.860533									11.9307	0.493939944	0.985425854	0	0.252551139	1.564206787	0.457151738	1.1690361	3.211259474	0	4.099261771	0.640973769	0.068760018	1.031178071	2.430609117	5.755430264	0.158622437	1.590893669	0	0	3.297788869	0	0	0	0	0	0	0	0	0	0	2.686634915	2.750859244	0	0	0	0	0	0	0	44.5752	0	8.672648961	11.9307	0.493939944	0.985425854	0	0.252551139	1.564206787	0.457151738	1.1690361	3.211259474	0	4.099261771	0.640973769	0.068760018	1.031178071	2.430609117	5.755430264	0.158622437	1.590893669	0	0	3.297788869	0	0	0	0	0	0	0	0	0	0	2.686634915	2.750859244	0	0	0	0	0	0	0	44.5752	YES	$250/Day(Days 1-5)	$250/Day(Days 1-5)	$0/Day(Days 1-20) $128(Days 21-100)	40% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	$0-$125/Visit	30% Coins	$0-$125/Visit	$125/Visit	20% Coins	20% Coins	$25/Visit	$25/Visit	$25/Visit	$25-$50/Visit		$0/Visit	20% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	$50/Visit	$15-$125/Visit								4500	1.8001	0.0745	0.1576	2.8729	0.9932	2.028	0.5927	0.1717	0.4718	0.0455	0.6102	0.0942	0.0103	0.1546	1.0543	1.0515	0.0275	0.257		0	0.587	0							0	0	0.308	0.3947	0.4041								14.1614	0	2.850781092	13.7308	0.568466956	1.143057404	2.872895136	1.245750676	3.592172592	1.049840475	1.340779164	3.68302553	0.045506156	4.709421146	0.735139206	0.07906922	1.18578275	3.484885925	6.806958122	0.186143434	1.847894473	0	0	3.884743842	0	0	0	0	0	0	0	0	0	0.308014345	3.081328385	3.154987918	0	0	0	0	0	0	0	58.7367
H6609_015_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	YES	1104.178694	56.784583	437.071606	566.032349	35.455552	8.603509	2.514444	328.241004	360.661929	680.913685	1005.507928	71.988837	0.378197	5.671725	3412.322243	3403.424861	89.075757	692.544446		1545.188856	18.138623	0							3.68	0.49	900.746871	754.351163	746.737995								1500	$150/Day(Days 1-5):1a.IP Acute	$150/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $20 Advanced Imaging -- Office,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$20/Visit:7b. $10 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$20-$25/Visit:7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $20 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$50/Visit:8a.Lab -- OP	"$15-$50/Visit:9d. $15 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $25 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) -- CORF"									92.8668	74.76165	42.271616	0	100	0.2	0.2	50	75	0	33.561156	50	0.2	0.2	10	19.160577	20	21.449981		0	0.2	0							0	0	0	50	42.831762								NO	64.468411	51.899762	18.105609	0	75.679	0.151358	0.151358	37.8395	56.75925	0	25.398747	37.8395	0.151358	0.151358	7.5679	14.500533	15.1358	16.233131		0	0.151358	0							0	0	0	37.8395	32.414649									5.9321	0.245592195	0.659453967	0	0.223603393	1.302209915	0.380581215	1.035039623	1.705908383	0	2.128220122	0.2270018	0.057243142	0.858460953	2.152009459	4.112622876	0.112352737	0.93684706	0	0	2.7454257	0	0	0	0	0	0	0	0	0	0	2.378689236	2.017104167	0	0	0	0	0	0	0	29.2104	0	10.79157341	5.9321	0.245592195	0.659453967	0	0.223603393	1.302209915	0.380581215	1.035039623	1.705908383	0	2.128220122	0.2270018	0.057243142	0.858460953	2.152009459	4.112622876	0.112352737	0.93684706	0	0	2.7454257	0	0	0	0	0	0	0	0	0	0	2.378689236	2.017104167	0	0	0	0	0	0	0	29.2104	YES	$150/Day(Days 1-5)	$150/Day(Days 1-5)	$0/Day(Days 1-20) $128(Days 21-100)	40% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	$0-$75/Visit	20% Coins	$0-$50/Visit	$50/Visit	20% Coins	20% Coins	$20/Visit	$20/Visit	$20/Visit	$20-$25/Visit		$0/Visit	20% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	$50/Visit	$15-$50/Visit								2250	0.8517	0.0353	0.0971	2.2836	0.8396	1.612	0.4711	0.1452	0.2393	0.0241	0.3039	0.0318	0.0082	0.1229	0.713	0.7111	0.0186	0.1472		0	0.4666	0							0	0	0.2448	0.3337	0.2829								9.9835	0	4.244241612	6.7838	0.280855336	0.756510091	2.283566626	1.063202665	2.914171125	0.851689322	1.180222284	1.945192284	0.024114015	2.432108322	0.258842826	0.065437437	0.981350942	2.864994118	4.82374848	0.130964593	1.084002028	0	0	3.211976385	0	0	0	0	0	0	0	0	0	0.244830019	2.712342584	2.300038802	0	0	0	0	0	0	0	39.194
H6609_016_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	YES	1097.796825	56.456383	434.545445	562.760828	35.250628	8.566894	2.503743	326.343855	358.577395	676.978179	999.69635	71.572761	0.376586	5.647587	3392.599899	3383.753941	88.560922	688.541717		1536.258062	18.061428	0							3.68	0.49	895.540786	749.991208	742.422041								3000	$250/Day(Days 1-5):1a.IP Acute	$250/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a.Lab -- FSL	"$0-$125/Visit:8b, 9a. $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,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$25/Visit:7b. $15 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$50/Visit:8a.Lab -- OP	"$15-$125/Visit:9d. $15 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"									154.778	124.60275	42.271616	0	100	0.2	0.2	50	125	0	57.234127	125	0.2	0.2	15	24.160577	25	32.249903		0	0.2	0							0	0	0	50	51.717204								NO	128.54251	103.482085	26.886185	0	84.677	0.169354	0.169354	42.3385	105.84625	0	48.464142	105.84625	0.169354	0.169354	12.70155	20.458452	21.16925	27.308251		0	0.169354	0							0	0	0	42.3385	43.792577									11.7595	0.486852019	0.973605769	0	0.248743119	1.450837766	0.424018892	1.151409109	3.162839383	0	4.037452155	0.631309029	0.063776345	0.956441449	3.590939771	5.768863965	0.156230692	1.566905836	0	0	3.058775078	0	0	0	0	0	0	0	0	0	0	2.64612523	2.7093812	0	0	0	0	0	0	0	44.844	0	8.779240501	11.7595	0.486852019	0.973605769	0	0.248743119	1.450837766	0.424018892	1.151409109	3.162839383	0	4.037452155	0.631309029	0.063776345	0.956441449	3.590939771	5.768863965	0.156230692	1.566905836	0	0	3.058775078	0	0	0	0	0	0	0	0	0	0	2.64612523	2.7093812	0	0	0	0	0	0	0	44.844	YES	$250/Day(Days 1-5)	$250/Day(Days 1-5)	$0/Day(Days 1-20) $128(Days 21-100)	40% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	$0-$125/Visit	30% Coins	$0-$125/Visit	$125/Visit	20% Coins	20% Coins	$25/Visit	$25/Visit	$25/Visit	$25-$50/Visit		$0/Visit	20% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	$50/Visit	$15-$125/Visit								4500	1.7988	0.0745	0.1588	2.6968	0.99	1.9037	0.5564	0.1712	0.4703	0.0427	0.6082	0.0939	0.0097	0.1451	1.0509	1.0482	0.0274	0.2562		0	0.551	0							0	0	0.2891	0.3934	0.4028								13.739	0	2.5877173	13.5583	0.561323564	1.132453959	2.69679562	1.238756985	3.354495573	0.980377911	1.322601311	3.633092262	0.042716527	4.645654463	0.725172435	0.073453538	1.101569338	4.641835008	6.817019068	0.183663416	1.823082316	0	0	3.609751551	0	0	0	0	0	0	0	0	0	0.289133839	3.039552731	3.112213641	0	0	0	0	0	0	0	58.583
H6609_017_0	2011	3	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							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		V	Coin	Coin									O	V	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	YES	1145.507818	61.363164	349.215106	654.593002	32.70773	8.405438	2.326078	311.812038	344.164051	1583.283636	206.258301	78.722886	0.419351	842.487261	3278.695886	3238.423647	89.82578	198.525131		1498.995047	16.815308	0									777.073733	782.736566	1.329908	401.310606							4000	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $50(Days 15-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"									$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								161.6895	138.428775	23.1855	0	100	0.2	0.2	50	150	18.365847	30	50	0.2	46.491501	10	28.105289	30	50		0	0.2	0									0	39.480931	0	30							NO	147.919052	126.63935	19.310507	0	90.7413	0.181483	0.181483	45.37065	136.11195	16.665409	27.22239	45.37065	0.181483	42.186992	9.07413	25.503104	27.22239	45.37065		0	0.181483	0									0	35.82551	0	27.22239								14.1202	0.6475826	0.561960062	0	0.247328495	1.525444105	0.422143614	1.178926237	3.903736675	2.198839113	0.467903659	0.297642376	0.076105078	2.961833612	2.479276058	6.882487922	0.203772701	0.750601186	0	0	3.051692542	0	0	0	0	0	0	0	0	0	0	2.336828056	0	0.910386152	0	0	0	0	0	0	45.2247	0	4.537867179	14.1202	0.6475826	0.561960062	0	0.247328495	1.525444105	0.422143614	1.178926237	3.903736675	2.198839113	0.467903659	0.297642376	0.076105078	2.961833612	2.479276058	6.882487922	0.203772701	0.750601186	0	0	3.051692542	0	0	0	0	0	0	0	0	0	0	2.336828056	0	0.910386152	0	0	0	0	0	0	45.2247	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		$35/Visit	20%-30% Coins	0% Coins									30% Coins	30% Coins	$0/Proc	$35/Visit							6000	5.8475	0.1042	0.2834	2.2405	1.1019	1.6803	0.465	0.1962	2.6115	0.2887	0.1073	0.217	0.0129	0.6711	1.7056	1.6846	0.0467	0.0631		0.7798	0.849	0									0.2133	0.871	0	0.2088							22.2493	500	8.67125748	19.9677	0.751741225	0.845382082	2.240527707	1.349208308	3.205781671	0.887151716	1.375131571	6.515205305	2.487526966	0.575197712	0.514653615	0.089031419	3.632931762	4.184829548	8.567092095	0.250499414	0.813722159	0	0.779766202	3.900659575	0	0	0	0	0	0	0	0	0	0.213325565	3.20780403	0	1.119144977	0	0	0	0	0	0	67.474
H6609_018_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Radiology									Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	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	YES	207.928786	3.703763	16.156323	654.593002	1.453065	8.405438	2.326078	311.812038	53.95083	6.243664	21.941075	4.693468	0.486034	14.512925	27.236628	43.67298	0.694967	4.398737		1498.995047	16.815308	0									777.073733	164.673198									6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing									$0/Service:11c.Diabetic Monitoring Supplies	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"										0.090551	0.090551	0.152308	0	0.233	0.233	0.233	50	0.233	0.204591	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0									0	0									NO	0.084827	0.084827	0.12703	0	0.216289	0.216289	0.216289	46.41405	0.216289	0.189918	0.216289	0.216289	0.216289	0.216289	0.216289	0.216289	0.216289	0.216289		0	0.216289	0									0	0										17.638	0.314179104	2.052337711	0	0.314281976	1.81800378	0.503105085	1.206038294	11.66897107	1.18578418	4.745613171	1.0151455	0.105123808	3.138986035	5.890983033	9.445985171	0.150313717	0.951398427	0	0	3.636966152	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7812	0	5.156494294	17.638	0.314179104	2.052337711	0	0.314281976	1.81800378	0.503105085	1.206038294	11.66897107	1.18578418	4.745613171	1.0151455	0.105123808	3.138986035	5.890983033	9.445985171	0.150313717	0.951398427	0	0	3.636966152	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7812	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	Medicare FFS Cost Sharing									20% Coins	$0/Visit									8000	2.7488	0.049	0.3358	0	1.2858	1.226	0.3393	0.1843	1.9053	0.1849	0.7917	0.1583	0.0164	0.4896	1.0907	1.749	0.0278	0.1675		0	0.6734	0									0.1336	0									13.5573	0	0.7244024	20.3867	0.36314207	2.388104517	0	1.600040506	3.043988222	0.842377806	1.390354942	13.57431436	1.3707315	5.537309249	1.173478212	0.121520049	3.628623301	6.981728293	11.19495705	0.178145231	1.118937226	0	0	4.310368565	0	0	0	0	0	0	0	0	0	0.133599675	0	0	0	0	0	0	0	0	0	79.3385
H6609_019_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Radiology									Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin							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	YES	194.776371	3.469483	15.134365	630.423281	1.361151	7.873757	2.178943	300.298915	50.5382	5.848727	20.553204	4.396585	0.455289	13.594916	25.513791	40.91047	0.651007	4.120496		1443.647233	15.751665	0							1.42	0.48	748.381622	158.592924									6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"										0.087996	0.087996	0.128305	0	0.233	0.233	0.233	50	0.233	0.204591	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0							0	0	0	0									NO	0.083415	0.083415	0.11283	0	0.218722	0.218722	0.218722	46.9361	0.218722	0.192054	0.218722	0.218722	0.218722	0.218722	0.218722	0.218722	0.218722	0.218722		0	0.218722	0							0	0	0	0										16.2473	0.289406924	1.707610403	0	0.297713669	1.722163879	0.476582771	1.174571659	11.05381618	1.123271415	4.495437885	0.961629864	0.099581721	2.973507217	5.580427395	8.948019819	0.142389553	0.901243126	0	0	3.445235672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6399	0	3.975181453	16.2473	0.289406924	1.707610403	0	0.297713669	1.722163879	0.476582771	1.174571659	11.05381618	1.123271415	4.495437885	0.961629864	0.099581721	2.973507217	5.580427395	8.948019819	0.142389553	0.901243126	0	0	3.445235672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6399	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	Medicare FFS Cost Sharing							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	$0/Visit									8000	2.5222	0.0449	0.2748	0	1.2142	1.1577	0.3204	0.179	1.7993	0.1747	0.7476	0.1495	0.0155	0.4624	1.03	1.6516	0.0263	0.1582		0	0.6359	0							0	0	0.1262	0									12.6904	0	0.560184684	18.7694	0.334333179	1.982419051	0	1.511909145	2.879912218	0.796972161	1.353522196	12.85311179	1.297924896	5.243069179	1.111150236	0.115065233	3.435892211	6.610463856	10.59964715	0.168671828	1.059457279	0	0	4.081157764	0	0	0	0	0	0	0	0	0	0.12616373	0	0	0	0	0	0	0	0	0	74.3303
H6609_021_0	2011	3	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	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		V	Coin	Coin									O	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	YES	1124.445695	60.234897	342.794188	642.557189	32.106342	8.649282	2.393558	306.078839	337.836005	1554.172254	202.465889	77.27543	0.431516	145.075872	3218.411448	3178.879682	88.174179	194.874906		1471.433456	17.303123	0									762.785902	768.344615	1.305455	681.920818	393.931823						3400	$200/Day(Days 1-7):1a.IP Acute	$200/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	$30/Visit:5.Partial Hospitalization	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"									$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,7h. $50 Psych -- OP,8b. $50 Rad therapy,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							143.724	123.0478	46.371	0	100	0.2	0.2	50	150	18.365847	30	50	0.2	30	10	28.105289	30	50		0	0.2	0									0	39.480931	0	50	30						NO	127.070125	108.789759	33.583084	0	88.2776	0.176555	0.176555	44.1388	132.4164	16.212929	26.48328	44.1388	0.176555	26.48328	8.82776	24.810674	26.48328	44.1388		0	0.176555	0									0	34.852818	0	44.1388	26.48328							11.907	0.546078327	0.959340501	0	0.236189235	1.527073984	0.422594633	1.125829388	3.727918964	2.099807034	0.446830069	0.284237062	0.076186307	0.320173745	2.367613654	6.57251229	0.194595123	0.716795375	0	0	3.054952881	0	0	0	0	0	0	0	0	0	0	2.231581252	0	2.508263883	0.869383897	0	0	0	0	0	42.1949	0	5.819442536	11.907	0.546078327	0.959340501	0	0.236189235	1.527073984	0.422594633	1.125829388	3.727918964	2.099807034	0.446830069	0.284237062	0.076186307	0.320173745	2.367613654	6.57251229	0.194595123	0.716795375	0	0	3.054952881	0	0	0	0	0	0	0	0	0	0	2.231581252	0	2.508263883	0.869383897	0	0	0	0	0	42.1949	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	$35/Visit	$35/Visit	$35/Visit	$35/Visit	30% Coins		$35/Visit	20%-30% Coins	0% Coins									30% Coins	30% Coins	$0/Proc	30% Coins	$35/Visit						5100	5.0551	0.09	0.2325	2.1911	1.0279	1.6433	0.4547	0.183	2.5539	0.2823	0.1001	0.2122	0.0126	0.0607	1.5911	1.5716	0.0436	0.0617		0.7274	0.8302	0									0.2086	0.8518	0	0.6132	0.1947						20.7935	500	10.67456385	16.9621	0.636123876	1.191802486	2.191093536	1.264124082	3.170337587	0.877342898	1.308867772	6.281769166	2.382125149	0.546923832	0.496460315	0.088827216	0.38090358	3.958710842	8.144066023	0.238186098	0.778523828	0	0.727437644	3.885188527	0	0	0	0	0	0	0	0	0	0.208618796	3.083339619	0	3.121423845	1.064133333	0	0	0	0	0	62.9884
H6609_022_0	2011	8	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Radiology									Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	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	YES	215.499419	3.838616	16.744571	571.616363	1.50597	8.711478	2.41077	272.286539	55.915165	6.470996	22.739941	4.864356	0.503729	15.041337	28.228307	45.263102	0.72027	4.558893		1308.981451	17.427548	0									678.571356	143.799115									6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $155 plan year deductible	"8a. $0 Lab -- FSL,8a. 23% Lab -- OP"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit:14b-j.Preventive Services	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible									$0/Service:11c.Diabetic Monitoring Supplies	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"										0.080983	0.080983	0.130411	0	0.233	0.233	0.233	50	0.233	0.204591	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0									0	0									NO	0.076024	0.076024	0.111063	0	0.216268	0.216268	0.216268	46.4095	0.216268	0.1899	0.216268	0.216268	0.216268	0.216268	0.216268	0.216268	0.216268	0.216268		0	0.216268	0									0	0										16.3831	0.291826943	1.859702289	0	0.32569312	1.884013924	0.521372406	1.053056844	12.0926609	1.22884214	4.91792156	1.052004543	0.108940463	3.25295987	6.104879498	9.788960543	0.155771352	0.985942671	0	0	3.769020951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7767	0	5.06664458	16.3831	0.291826943	1.859702289	0	0.32569312	1.884013924	0.521372406	1.053056844	12.0926609	1.22884214	4.91792156	1.052004543	0.108940463	3.25295987	6.104879498	9.788960543	0.155771352	0.985942671	0	0	3.769020951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7767	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	$50/Visit	20% coinsurance after $155 plan year deductible	"8a. $0 Lab -- FSL,8a. 23% Lab -- OP"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible									20% Coins	$0/Visit									8000	2.5507	0.0454	0.302	0	1.332	1.2701	0.3515	0.1609	1.9739	0.1916	0.8202	0.164	0.017	0.5072	1.13	1.8119	0.0288	0.1736		0	0.6976	0									0.1384	0									13.6668	0	0.726685903	18.9339	0.337262336	2.161715848	0	1.657694602	3.154091561	0.872847043	1.213940396	14.06653095	1.420441079	5.738090886	1.216031775	0.125926259	3.76020754	7.234854231	11.60083456	0.184603666	1.159507262	0	0	4.466642552	0	0	0	0	0	0	0	0	0	0.138404581	0	0	0	0	0	0	0	0	0	79.4435
H6609_023_0	2011	8	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Radiology									Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin							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	YES	238.302579	4.244801	18.516405	681.838527	1.665325	9.633287	2.665867	324.790304	61.831854	7.155727	25.14618	5.37908	0.557032	16.632941	31.215297	50.052636	0.796486	5.041295		1561.386345	19.271649	0							1.42	0.48	809.417161	171.52724									6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $155 plan year deductible	"8a. $0 Lab -- FSL,8a. 20% coinsurance after $155 plan year deductible Lab -- OP"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit:14b-j.Preventive Services	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"										0.08277	0.08277	0.151224	0	0.233	0.233	0.233	50	0.233	0.204591	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0							0	0	0	0									NO	0.076195	0.076195	0.118948	0	0.212421	0.212421	0.212421	45.58385	0.212421	0.186521	0.212421	0.212421	0.212421	0.212421	0.212421	0.212421	0.212421	0.212421		0	0.212421	0							0	0	0	0										18.1575	0.323432612	2.202489342	0	0.353750002	2.046312458	0.566286134	1.233766042	13.13438426	1.334693356	5.341576702	1.142629553	0.118325294	3.53318596	6.630784604	10.63223099	0.169190353	1.070876925	0	0	4.093702952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.0851	0	7.172215508	18.1575	0.323432612	2.202489342	0	0.353750002	2.046312458	0.566286134	1.233766042	13.13438426	1.334693356	5.341576702	1.142629553	0.118325294	3.53318596	6.630784604	10.63223099	0.169190353	1.070876925	0	0	4.093702952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.0851	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	$50/Visit	20% coinsurance after $155 plan year deductible	"8a. $0 Lab -- FSL,8a. 20% coinsurance after $155 plan year deductible Lab -- OP"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	$0/Visit									8000	2.8472	0.0507	0.3668	0	1.4538	1.3862	0.3836	0.1894	2.1543	0.2091	0.8952	0.179	0.0185	0.5536	1.2333	1.9775	0.0315	0.1894		0	0.7614	0							0	0	0.1511	0									15.0317	0	1.024685744	21.0046	0.374147972	2.569257556	0	1.807538837	3.432515675	0.94989708	1.423175874	15.28872905	1.543810497	6.23673591	1.321654105	0.136864477	4.086812123	7.864074649	12.60976793	0.200658971	1.260310848	0	0	4.855109293	0	0	0	0	0	0	0	0	0	0.151059206	0	0	0	0	0	0	0	0	0	87.1167
H6609_024_0	2011	2	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							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		V	Coin	Coin							O	O	O	V	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	YES	1023.185042	33.361017	363.70427	447.621248	32.718314	4.64222	1.556939	273.005941	266.388998	818.43951	117.020823	54.278267	0.025482	522.317486	2178.400034	2413.988625	28.24585	157.932457		898.236899	9.439457	0							1.42	0.48	501.846399	556.573088	0.395423	314.378455							4000	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $50(Days 15-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.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, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								161.6895	138.428775	23.1855	0	100	0.2	0.2	50	150	34.094012	30	50	0.2	48.041608	10	28.303497	30	50		0	0.2	0							0	0	0	42.120406	0	30							NO	153.543098	131.454318	20.829575	0	94.3327	0.188665	0.188665	47.16635	141.49905	32.161802	28.29981	47.16635	0.188665	45.318945	9.43327	26.699453	28.29981	47.16635		0	0.188665	0							0	0	0	39.733316	0	28.29981								13.0919	0.365454145	0.631317114	0	0.257200575	0.875824436	0.293739896	1.073057814	3.141149179	2.193540789	0.275972255	0.213342312	0.004807562	1.972573118	1.712452974	5.371014653	0.066612682	0.620758129	0	0	1.780895155	0	0	0	0	0	0	0	0	0	0	1.842874532	0	0.741404212	0	0	0	0	0	0	36.5259	0	2.133379925	13.0919	0.365454145	0.631317114	0	0.257200575	0.875824436	0.293739896	1.073057814	3.141149179	2.193540789	0.275972255	0.213342312	0.004807562	1.972573118	1.712452974	5.371014653	0.066612682	0.620758129	0	0	1.780895155	0	0	0	0	0	0	0	0	0	0	1.842874532	0	0.741404212	0	0	0	0	0	0	36.5259	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 15-100)	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		$35/Visit	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	30% Coins	$0/Proc	$35/Visit							6000	6.1256	0.0616	0.3297	2.2828	1.2672	0.8891	0.2982	0.1975	2.4067	0.2733	0.07	0.1879	0.0009	0.5624	1.3028	1.4437	0.0169	0.0713		0.5372	0.5957	0							0	0	0.1331	0.738	0	0.188							19.9798	500	5.908472553	19.2175	0.427081946	0.961031812	2.282764076	1.524434326	1.764948973	0.591940745	1.270560051	5.54781176	2.466890105	0.345957962	0.401281753	0.005710628	2.534990828	3.015271222	6.81472948	0.083505452	0.692075072	0	0.537201343	2.376572028	0	0	0	0	0	0	0	0	0	0.133103582	2.580886555	0	0.929422015	0	0	0	0	0	0	56.5057
H6609_028_0	2011	6	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Radiology									Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	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	YES	213.960844	3.81121	16.625022	642.557189	1.495218	8.649282	2.393558	306.078839	55.515956	6.424796	22.57759	4.829626	0.500134	14.933949	28.026769	44.939941	0.715129	4.526344		1471.433456	17.303123	0									762.785902	161.6454									6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing									$0/Service:11c.Diabetic Monitoring Supplies	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"										0.081383	0.081383	0.137556	0	0.233	0.233	0.233	50	0.233	0.204591	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0									0	0									NO	0.076383	0.076383	0.116538	0	0.216301	0.216301	0.216301	46.4166	0.216301	0.189929	0.216301	0.216301	0.216301	0.216301	0.216301	0.216301	0.216301	0.216301		0	0.216301	0									0	0										16.343	0.291111653	1.937446814	0	0.323417149	1.870848346	0.517728989	1.183928253	12.0081568	1.220255079	4.883555295	1.044652933	0.108179484	3.230228103	6.062218161	9.720554178	0.154683118	0.979052734	0	0	3.742682808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.6217	0	5.070671011	16.343	0.291111653	1.937446814	0	0.323417149	1.870848346	0.517728989	1.183928253	12.0081568	1.220255079	4.883555295	1.044652933	0.108179484	3.230228103	6.062218161	9.720554178	0.154683118	0.979052734	0	0	3.742682808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.6217	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	Medicare FFS Cost Sharing									20% Coins	$0/Visit									8000	2.5448	0.0453	0.3152	0	1.3228	1.2613	0.349	0.1809	1.9602	0.1903	0.8145	0.1629	0.0169	0.5037	1.1221	1.7993	0.0286	0.1724		0	0.6928	0									0.1374	0									13.6204	0	0.723990844	18.8877	0.336440455	2.252679805	0	1.646188571	3.132125363	0.866768263	1.364816667	13.96834904	1.410526458	5.698041605	1.207543605	0.125047456	3.733960711	7.184362719	11.51987323	0.183315631	1.151414665	0	0	4.435470376	0	0	0	0	0	0	0	0	0	0.137445573	0	0	0	0	0	0	0	0	0	79.2421
H6609_029_0	2011	4	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	OP Facility - Surgery					Prosthetics/Supplies	Lab	Radiology	Other							D	D	D	V	Coin	Coin	Coin	V	Coin	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	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	YES	1066.747012	54.859585	422.254869	546.84384	1.462945	8.518236	2.489522	317.113627	32.836728	657.830697	0	69.548414	0.374448	5.61551	3296.644446	3288.048684	86.056087	669.067175		1492.806921	17.958847	0							5.21	0.49	870.211533	728.778643	971.421188	721.42356	0	130.317545					3400	$250/Day(Days 1-5):1a.IP Acute	$250/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	20% Coins:9a.Surgery OP -- Facility	$0/Visit:8a.Lab -- FSL	$0/Visit:8b.Radiology OP -- Physician	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$25/Visit:7b. $15 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$50/Visit:8a.Lab -- OP	"$0-$150/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $50 Radiology OP -- Facility"	"$30-$150/Visit:9d. $30 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	$125/Visit:9b.Surgery ASC -- Facility						154.778	124.60275	43.922851	0	0.2	0.2	0.2	50	0.2	0	0	125	0.2	0.2	15	24.160577	25	32.249903		0	0.2	0							0	0	0	50	82.809991	54.007688	0	125					NO	129.093055	103.925297	28.096657	0	0.168037	0.168037	0.168037	42.00915	0.168037	0	0	105.022875	0.168037	0.168037	12.602745	20.299306	21.004575	27.095821		0	0.168037	0							0	0	0	42.00915	69.575547	45.376341	0	105.022875						11.4758	0.475108222	0.988662518	0	0.245828889	1.431378823	0.418331808	1.110139494	5.517785263	0	0	0.608681199	0.062921119	0.943613454	3.462230776	5.562092198	0.150630961	1.510743701	0	0	3.017750773	0	0	0	0	0	0	0	0	0	0	2.551280944	5.632263377	2.727963455	0	1.140526937	0	0	0	0	49.0337	0	9.800412821	11.4758	0.475108222	0.988662518	0	0.245828889	1.431378823	0.418331808	1.110139494	5.517785263	0	0	0.608681199	0.062921119	0.943613454	3.462230776	5.562092198	0.150630961	1.510743701	0	0	3.017750773	0	0	0	0	0	0	0	0	0	0	2.551280944	5.632263377	2.727963455	0	1.140526937	0	0	0	0	49.0337	YES	$250/Day(Days 1-5)	$250/Day(Days 1-5)	$0/Day(Days 1-20) $133(Days 21-100)	25% Coins	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	30% Coins	30% Coins	$125/Visit	20% Coins	20% Coins	$25/Visit	$25/Visit	$25/Visit	$25-$50/Visit		$0/Visit	20% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	$50/Visit	$0-$150/Visit	$30-$150/Visit	30% Coins	$125/Visit					4000	1.7102	0.0708	0.1519	1.6527	0.9724	0.9333	0.2728	0.164	0.8321	0.0419	0.1483	0.0899	0.0095	0.1423	1.007	1.0044	0.0263	0.2455		0	0.5403	0							0	0	0.1418	0.377	0.8778	0.4031	0.6025	0.1685					12.5862	0	2.607683145	13.186	0.545912704	1.140570104	1.652687432	1.218239739	2.364679387	0.691096135	1.274183285	6.349901725	0.04188497	0.148299469	0.698625187	0.07241013	1.085916216	4.469244151	6.566479859	0.176918186	1.756223108	0	0	3.558001919	0	0	0	0	0	0	0	0	0	0.141752894	2.92828023	6.510021932	3.131070883	0.602496785	1.309061041	0	0	0	0	61.62
H6609_036_0	2011	3	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	Coin	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1079.448408	55.512779	427.282516	553.354925	1.611747	9.384662	2.742742	320.889392	352.584185	1403.119229	982.987572	70.376504	0.412535	6.186687	3335.896479	3327.198369	87.080728	677.033532		1510.581269	19.785514	0							3.43	0.49	880.572848	730.013306									3400	$250/Day(Days 1-5):1a.IP Acute	$250/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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-$150/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$25/Visit:7b. $15 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$30-$150/Visit:9d. $30 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"										154.778	124.60275	43.922851	0	0.2	0.2	0.2	50	125	26.279162	82.809991	125	0.2	0.2	15	24.160577	25	32.249903		0	0.2	0							0	0	0	54.007688									NO	131.111979	105.550616	28.70903	0	0.170344	0.170344	0.170344	42.58605	106.465125	22.382515	70.531009	106.465125	0.170344	0.170344	12.775815	20.578071	21.293025	27.46792		0	0.170344	0							0	0	0	45.999482										11.7941	0.488284002	1.022238881	0	0.274551431	1.598620864	0.467209643	1.138784308	3.128159944	2.617111432	5.777592107	0.624386941	0.070272862	1.05386501	3.551566356	5.705610356	0.154517677	1.549725241	0	0	3.370343597	0	0	0	0	0	0	0	0	0	0	2.798352827	0	0	0	0	0	0	0	0	47.1852	0	8.657109418	11.7941	0.488284002	1.022238881	0	0.274551431	1.598620864	0.467209643	1.138784308	3.128159944	2.617111432	5.777592107	0.624386941	0.070272862	1.05386501	3.551566356	5.705610356	0.154517677	1.549725241	0	0	3.370343597	0	0	0	0	0	0	0	0	0	0	2.798352827	0	0	0	0	0	0	0	0	47.1852	YES	30% Coins	30% Coins	$0/Day(Days 1-20) $137(Days 21-100)	25% Coins	20% Coins	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									5100	5.0617	0.0854	0.0902	1.5112	0.8892	1.7068	0.4988	0.1378	1.9777	0.2746	0.8466	0.1346	0.0087	0.1301	1.1358	1.7982	0.0276	0.2058		0.2229	0.5556	0							0	0	0.2592	0.3514									17.91	0	11.21786902	16.8558	0.573722937	1.112406221	1.511214511	1.163722319	3.305437948	0.966040422	1.276558136	5.105864417	2.891681089	6.624192002	0.758984701	0.078949434	1.183986563	4.687407466	7.503826461	0.182075621	1.755571231	0	0.222948396	3.92592331	0	0	0	0	0	0	0	0	0	0.259237115	3.149782765	0	0	0	0	0	0	0	0	65.0953
H6609_038_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1091.391483	56.126976	432.009992	559.477273	35.04495	8.209362	2.399251	324.439729	356.485195	1418.643414	993.863398	71.155153	0.36087	5.41189	3372.805012	3364.010669	88.044194	684.524267		1527.294419	17.30765	0							5.38	0.49	890.315552	738.090212									3400	$250/Day(Days 1-5):1a.IP Acute	$250/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $125 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$25/Visit:7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$30-$125/Visit:9d. $30 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"										154.778	124.60275	43.922851	0	150	0.2	0.2	50	125	26.279162	73.904422	125	0.2	0.2	10	23.740866	25	32.249903		0	0.2	0							0	0	0	52.683625									NO	132.89626	106.987036	29.246733	0	129.33165	0.172442	0.172442	43.11055	107.776375	22.658183	63.721205	107.776375	0.172442	0.172442	8.62211	20.469636	21.555275	27.806221		0	0.172442	0							0	0	0	45.424401										12.0868	0.5004049	1.052906741	0	0.377701767	1.415638802	0.413731641	1.165564597	3.201723505	2.678656841	5.277514444	0.639070371	0.062229145	0.933237135	2.423391319	5.738339491	0.158151401	1.586169421	0	0	2.984565781	0	0	0	0	0	0	0	0	0	0	2.793942147	0	0	0	0	0	0	0	0	45.4898	0	7.690729603	12.0868	0.5004049	1.052906741	0	0.377701767	1.415638802	0.413731641	1.165564597	3.201723505	2.678656841	5.277514444	0.639070371	0.062229145	0.933237135	2.423391319	5.738339491	0.158151401	1.586169421	0	0	2.984565781	0	0	0	0	0	0	0	0	0	0	2.793942147	0	0	0	0	0	0	0	0	45.4898	YES	$275/Day(Days 1-5)	$275/Day(Days 1-5)	$0/Day(Days 1-20) $137(Days 21-100)	25% Coins	$150/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									4000	1.7497	0.0724	0.1369	1.4862	1.3585	1.6786	0.4906	0.1566	1.945	0.27	0.8326	0.1324	0.0085	0.128	1.1171	1.7685	0.0271	0.2024		0.2193	0.5464	0							0	0	0.255	0.3456									14.9276	0	4.452414644	13.8365	0.572843839	1.189855089	1.486241142	1.736222739	3.094250124	0.904319177	1.322173985	5.146745883	2.94868941	6.110123434	0.771443729	0.070762273	1.061208173	3.540462566	7.506839095	0.185254021	1.788613488	0	0.219264322	3.53096444	0	0	0	0	0	0	0	0	0	0.254953101	3.139564568	0	0	0	0	0	0	0	0	60.4173
H6609_041_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	YES	986.212751	50.71795	390.376661	505.559764	31.667625	7.742864	2.262914	293.173076	322.130281	608.167648	898.083567	64.297844	0.340363	5.104359	3047.76367	3039.816847	79.559267	618.555826		1380.107189	16.32414	0							4.39	0.49	804.514754	673.759366	666.959556								1500	$150/Day(Days 1-5):1a.IP Acute	$150/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL	"$0-$125/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $15 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$15/Visit:7b. $5 Chiropractic,7f. $15 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Spec Cap"	"$15/Visit:7e, 7h.Psych -- Other Provider"	"$15-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$50/Visit:8a.Lab -- OP	"$15-$125/Visit:9d. $15 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"									92.8668	74.76165	42.271616	0	100	0.2	0.2	50	50	0	55.567098	125	0.2	0.2	5	14.160577	15	25.149865		0	0.2	0							0	0	0	50	51.717204								NO	69.074326	55.607715	20.213188	0	78.6731	0.157346	0.157346	39.33655	39.33655	0	43.716358	98.341375	0.157346	0.157346	3.933655	11.140565	11.800965	19.786178		0	0.157346	0							0	0	0	39.33655	40.687528									5.6768	0.235025776	0.65756307	0	0.207615852	1.218308679	0.356060466	0.96103478	1.055957825	0	3.271745227	0.526928199	0.053554757	0.803150471	0.9990709	2.822106431	0.078239677	1.01990464	0	0	2.568538132	0	0	0	0	0	0	0	0	0	0	2.208614082	2.261411301	0	0	0	0	0	0	0	26.9817	0	8.287318447	5.6768	0.235025776	0.65756307	0	0.207615852	1.218308679	0.356060466	0.96103478	1.055957825	0	3.271745227	0.526928199	0.053554757	0.803150471	0.9990709	2.822106431	0.078239677	1.01990464	0	0	2.568538132	0	0	0	0	0	0	0	0	0	0	2.208614082	2.261411301	0	0	0	0	0	0	0	26.9817	YES	$150/Day(Days 1-5)	$150/Day(Days 1-5)	$0/Day(Days 1-20) $128(Days 21-100)	25% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	$0-$50/Visit	30% Coins	$0-$125/Visit	$125/Visit	20% Coins	20% Coins	$15/Visit	$15/Visit	$15/Visit	$15-$50/Visit		$0/Visit	20% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	$50/Visit	$15-$125/Visit								2250	0.8835	0.0366	0.1098	1.4226	0.8305	1.0042	0.2935	0.1436	0.1578	0.0361	0.4929	0.0787	0.0082	0.1225	0.529	0.5276	0.0138	0.1641		0	0.465	0							0	0	0.1525	0.33	0.3379								8.1405	0	2.290003604	6.5603	0.271604142	0.767406591	1.42256529	1.038146819	2.222492187	0.649540902	1.10464936	1.213757463	0.036052993	3.764648678	0.605671003	0.061722318	0.925638874	1.528033816	3.349690114	0.092047803	1.1839982	0	0	3.033564033	0	0	0	0	0	0	0	0	0	0.152518834	2.538663724	2.59935082	0	0	0	0	0	0	0	35.1221
H6609_042_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	YES	986.212751	50.71795	390.376661	505.559764	31.667625	7.742864	2.262914	293.173076	322.130281	608.167648	898.083567	64.297844	0.340363	5.104359	3047.76367	3039.816847	79.559267	618.555826		1380.107189	16.32414	0							4.39	0.49	804.514754	673.759366	666.959556								3000	$250/Day(Days 1-5):1a.IP Acute	$250/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a.Lab -- FSL	"$0-$125/Visit:8b, 9a. $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,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$25/Visit:7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$50/Visit:8a.Lab -- OP	"$15-$125/Visit:9d. $15 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"									154.778	124.60275	42.271616	0	100	0.2	0.2	50	125	0	57.234127	125	0.2	0.2	10	23.740866	25	32.249903		0	0.2	0							0	0	0	50	51.717204								NO	134.779289	108.502953	29.452918	0	87.5044	0.175009	0.175009	43.7522	109.3805	0	50.08238	109.3805	0.175009	0.175009	8.75044	20.774302	21.8761	28.220084		0	0.175009	0							0	0	0	43.7522	45.254829									11.0768	0.458587279	0.958144315	0	0.230921377	1.355070886	0.396030316	1.068913921	2.936230933	0	3.748180206	0.586077527	0.059566588	0.893308764	2.222439427	5.2625061	0.145037207	1.454641447	0	0	2.856871417	0	0	0	0	0	0	0	0	0	0	2.456537878	2.515261721	0	0	0	0	0	0	0	40.6811	0	6.153816379	11.0768	0.458587279	0.958144315	0	0.230921377	1.355070886	0.396030316	1.068913921	2.936230933	0	3.748180206	0.586077527	0.059566588	0.893308764	2.222439427	5.2625061	0.145037207	1.454641447	0	0	2.856871417	0	0	0	0	0	0	0	0	0	0	2.456537878	2.515261721	0	0	0	0	0	0	0	40.6811	YES	$250/Day(Days 1-5)	$250/Day(Days 1-5)	$0/Day(Days 1-20) $128(Days 21-100)	35% Coins	$100/Trip	35% Coins	35% Coins	$50/Visit	$0-$125/Visit	30% Coins	$0-$125/Visit	$125/Visit	20% Coins	20% Coins	$25/Visit	$25/Visit	$25/Visit	$25-$50/Visit		$0/Visit	20% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	35% Coins	$50/Visit	$15-$125/Visit								4500	1.6871	0.0698	0.156	2.2105	0.9218	1.5604	0.456	0.1594	0.4379	0.04	0.5663	0.0874	0.0091	0.136	0.9785	0.976	0.0255	0.2385		0	0.5162	0							0	0	0.237	0.3663	0.3751								12.211	0	1.766087143	12.7639	0.52843456	1.114154693	2.210546352	1.152760663	2.915487273	0.852074135	1.228317444	3.374101137	0.040016648	4.314500335	0.673477291	0.068632089	1.029263505	3.200967654	6.238482884	0.170580851	1.693177035	0	0	3.373022122	0	0	0	0	0	0	0	0	0	0.237001391	2.822873075	2.890354207	0	0	0	0	0	0	0	52.8921
H6609_045_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	YES	1134.144778	58.325649	448.933205	581.393787	36.417773	9.365333	2.737093	337.149071	370.44986	699.392865	1032.796206	73.942528	0.411685	6.173945	3504.928572	3495.789724	91.493166	711.339271		1587.123426	19.744763	0							4.39	0.49	925.19206	774.823348	767.003567								1500	$150/Day(Days 1-5):1a.IP Acute	$150/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL	"$0-$125/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $15 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$15/Visit:7b. $5 Chiropractic,7f. $15 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Spec Cap"	"$15/Visit:7e, 7h.Psych -- Other Provider"	"$15-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$50/Visit:8a.Lab -- OP	"$15-$125/Visit:9d. $15 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"									92.8668	74.76165	42.271616	0	100	0.2	0.2	50	50	0	55.567098	125	0.2	0.2	5	14.160577	15	25.149865		0	0.2	0							0	0	0	50	51.717204								NO	63.554973	51.164406	17.693419	0	75.1158	0.150232	0.150232	37.5579	37.5579	0	41.73967	93.89475	0.150232	0.150232	3.75579	10.636831	11.26737	18.891522		0	0.150232	0							0	0	0	37.5579	38.847791									6.0067	0.248683099	0.661930275	0	0.227962513	1.406972707	0.411198956	1.055217591	1.159443233	0	3.592381068	0.578567932	0.061848261	0.927524105	1.096981307	3.098677042	0.085907279	1.119856791	0	0	2.966295235	0	0	0	0	0	0	0	0	0	0	2.425061485	2.483032856	0	0	0	0	0	0	0	29.6143	0	11.3234967	6.0067	0.248683099	0.661930275	0	0.227962513	1.406972707	0.411198956	1.055217591	1.159443233	0	3.592381068	0.578567932	0.061848261	0.927524105	1.096981307	3.098677042	0.085907279	1.119856791	0	0	2.966295235	0	0	0	0	0	0	0	0	0	0	2.425061485	2.483032856	0	0	0	0	0	0	0	29.6143	YES	$150/Day(Days 1-5)	$150/Day(Days 1-5)	$0/Day(Days 1-20) $128(Days 21-100)	40% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	$0-$50/Visit	30% Coins	$0-$125/Visit	$125/Visit	20% Coins	20% Coins	$15/Visit	$15/Visit	$15/Visit	$15-$50/Visit		$0/Visit	20% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	$50/Visit	$15-$125/Visit								2250	0.8502	0.0352	0.0955	2.4419	0.8472	1.7237	0.5038	0.1465	0.161	0.0387	0.5028	0.0803	0.0088	0.1314	0.5396	0.5382	0.0141	0.1674		0	0.4989	0							0	0	0.2618	0.3367	0.3447								10.2682	0	4.641839794	6.8569	0.283882822	0.757396192	2.441921461	1.075134581	3.130715735	0.914976427	1.201709735	1.320404656	0.038679469	4.095160682	0.658888477	0.070610817	1.058936068	1.636542897	3.636831764	0.099992074	1.287238247	0	0	3.465198866	0	0	0	0	0	0	0	0	0	0.261807815	2.761724232	2.827743571	0	0	0	0	0	0	0	39.8824
H6609_046_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	YES	1134.144778	58.325649	448.933205	581.393787	36.417773	9.365333	2.737093	337.149071	370.44986	699.392865	1032.796206	73.942528	0.411685	6.173945	3504.928572	3495.789724	91.493166	711.339271		1587.123426	19.744763	0							4.39	0.49	925.19206	774.823348	767.003567								3000	$250/Day(Days 1-5):1a.IP Acute	$250/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a.Lab -- FSL	"$0-$125/Visit:8b, 9a. $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,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$25/Visit:7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$50/Visit:8a.Lab -- OP	"$15-$125/Visit:9d. $15 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"									154.778	124.60275	42.271616	0	100	0.2	0.2	50	125	0	57.234127	125	0.2	0.2	10	23.740866	25	32.249903		0	0.2	0							0	0	0	50	51.717204								NO	127.695255	102.80001	26.448547	0	84.4093	0.168819	0.168819	42.20465	105.511625	0	48.310926	105.511625	0.168819	0.168819	8.44093	20.039499	21.102325	27.221918		0	0.168819	0							0	0	0	42.20465	43.65413									12.0687	0.499656442	0.989469248	0	0.256166561	1.581046152	0.462073303	1.185771545	3.257230559	0	4.15794509	0.65014969	0.06950025	1.042279221	2.465404728	5.83782289	0.16089321	1.613668275	0	0	3.333291145	0	0	0	0	0	0	0	0	0	0	2.725095685	2.790239452	0	0	0	0	0	0	0	45.1464	0	9.092096725	12.0687	0.499656442	0.989469248	0	0.256166561	1.581046152	0.462073303	1.185771545	3.257230559	0	4.15794509	0.65014969	0.06950025	1.042279221	2.465404728	5.83782289	0.16089321	1.613668275	0	0	3.333291145	0	0	0	0	0	0	0	0	0	0	2.725095685	2.790239452	0	0	0	0	0	0	0	45.1464	YES	$250/Day(Days 1-5)	$250/Day(Days 1-5)	$0/Day(Days 1-20) $128(Days 21-100)	40% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	$0-$125/Visit	30% Coins	$0-$125/Visit	$125/Visit	20% Coins	20% Coins	$25/Visit	$25/Visit	$25/Visit	$25-$50/Visit		$0/Visit	20% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	$50/Visit	$15-$125/Visit								4500	1.822	0.0754	0.1584	2.9035	1.0073	2.0496	0.599	0.1742	0.4785	0.046	0.6188	0.0955	0.0104	0.1563	1.0692	1.0665	0.0279	0.2606		0	0.5932	0							0	0	0.3113	0.4003	0.4099								14.3337	0	2.975356355	13.8907	0.575087601	1.147908396	2.903479811	1.26346636	3.630601455	1.061071977	1.359952815	3.735694188	0.045990447	4.776766793	0.745651977	0.079919056	1.198529939	3.534648906	6.904279091	0.188804916	1.874317671	0	0	3.926494752	0	0	0	0	0	0	0	0	0	0.311293265	3.125392543	3.200105461	0	0	0	0	0	0	0	59.4802
H6609_049_0	2011	5	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	YES	1134.144778	58.325649	448.933205	581.393787	36.417773	8.928735	2.609493	337.149071	370.44986	699.392865	1032.796206	73.942528	0.392492	5.886124	3504.928572	3495.789724	91.493166	711.339271		1587.123426	18.824292	0							4.39	0.49	925.19206	774.823348	767.003567								1500	$150/Day(Days 1-5):1a.IP Acute	$150/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL	"$0-$125/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $15 Advanced Imaging -- Office,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$15/Visit:7b. $5 Chiropractic,7f. $15 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Spec Cap"	"$15/Visit:7e, 7h.Psych -- Other Provider"	"$15-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$50/Visit:8a.Lab -- OP	"$15-$125/Visit:9d. $15 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"									92.8668	74.76165	42.271616	0	100	0.2	0.2	50	50	0	55.567098	125	0.2	0.2	5	14.160577	15	25.149865		0	0.2	0							0	0	0	50	51.717204								NO	63.804692	51.36544	17.769677	0	75.3204	0.150641	0.150641	37.6602	37.6602	0	41.85336	94.1505	0.150641	0.150641	3.76602	10.665803	11.29806	18.942979		0	0.150641	0							0	0	0	37.6602	38.953605									6.0303	0.249660219	0.664783171	0	0.228583436	1.345033569	0.393096635	1.058091787	1.162601318	0	3.602165951	0.580143832	0.059125387	0.886691605	1.099969258	3.107117044	0.086141273	1.122907073	0	0	2.835710171	0	0	0	0	0	0	0	0	0	0	2.431666854	2.489796165	0	0	0	0	0	0	0	29.4336	0	11.14580747	6.0303	0.249660219	0.664783171	0	0.228583436	1.345033569	0.393096635	1.058091787	1.162601318	0	3.602165951	0.580143832	0.059125387	0.886691605	1.099969258	3.107117044	0.086141273	1.122907073	0	0	2.835710171	0	0	0	0	0	0	0	0	0	0	2.431666854	2.489796165	0	0	0	0	0	0	0	29.4336	YES	$150/Day(Days 1-5)	$150/Day(Days 1-5)	$0/Day(Days 1-20) $128(Days 21-100)	40% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	$0-$50/Visit	30% Coins	$0-$125/Visit	$125/Visit	20% Coins	20% Coins	$15/Visit	$15/Visit	$15/Visit	$15-$50/Visit		$0/Visit	20% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	$50/Visit	$15-$125/Visit								2250	0.8617	0.0357	0.0971	2.3496	0.855	1.6586	0.4847	0.1478	0.1624	0.0372	0.5074	0.0811	0.0084	0.1264	0.5445	0.5431	0.0142	0.1689		0	0.48	0							0	0	0.2519	0.3398	0.3479								10.1037	0	4.431670462	6.892	0.285335861	0.761892354	2.349582931	1.083579256	3.003595344	0.87782412	1.205936806	1.325049242	0.03721678	4.109588805	0.661206149	0.067556556	1.013134347	1.644513775	3.6502417	0.100356143	1.29183432	0	0	3.315748414	0	0	0	0	0	0	0	0	0	0.251907883	2.771438729	2.837690332	0	0	0	0	0	0	0	39.5373
H6609_050_0	2011	4	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	YES	1134.144778	58.325649	448.933205	581.393787	36.417773	8.928735	2.609493	337.149071	370.44986	699.392865	1032.796206	73.942528	0.392492	5.886124	3504.928572	3495.789724	91.493166	711.339271		1587.123426	18.824292	0							4.39	0.49	925.19206	774.823348	767.003567								3000	$250/Day(Days 1-5):1a.IP Acute	$250/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a.Lab -- FSL	"$0-$125/Visit:8b, 9a. $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,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$25/Visit:7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$50/Visit:8a.Lab -- OP	"$15-$125/Visit:9d. $15 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"									154.778	124.60275	42.271616	0	100	0.2	0.2	50	125	0	57.234127	125	0.2	0.2	10	23.740866	25	32.249903		0	0.2	0							0	0	0	50	51.717204								NO	127.953734	103.008097	26.526834	0	84.5469	0.169094	0.169094	42.27345	105.683625	0	48.38968	105.683625	0.169094	0.169094	8.45469	20.072166	21.136725	27.266294		0	0.169094	0							0	0	0	42.27345	43.725293									12.0932	0.500667842	0.992398051	0	0.256584151	1.509795516	0.441249609	1.187704533	3.26254034	0	4.164723159	0.651209533	0.066368042	0.995308252	2.469423712	5.847339303	0.161155491	1.616298808	0	0	3.183074831	0	0	0	0	0	0	0	0	0	0	2.729538005	2.794787975	0	0	0	0	0	0	0	44.9233	0	8.956858838	12.0932	0.500667842	0.992398051	0	0.256584151	1.509795516	0.441249609	1.187704533	3.26254034	0	4.164723159	0.651209533	0.066368042	0.995308252	2.469423712	5.847339303	0.161155491	1.616298808	0	0	3.183074831	0	0	0	0	0	0	0	0	0	0	2.729538005	2.794787975	0	0	0	0	0	0	0	44.9233	YES	$250/Day(Days 1-5)	$250/Day(Days 1-5)	$0/Day(Days 1-20) $128(Days 21-100)	40% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	$0-$125/Visit	30% Coins	$0-$125/Visit	$125/Visit	20% Coins	20% Coins	$25/Visit	$25/Visit	$25/Visit	$25-$50/Visit		$0/Visit	20% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	$50/Visit	$15-$125/Visit								4500	1.834	0.0759	0.1601	2.7833	1.0128	1.9647	0.5742	0.1751	0.4811	0.0441	0.6222	0.096	0.01	0.1498	1.0751	1.0723	0.0281	0.2621		0	0.5686	0							0	0	0.2984	0.4025	0.4121								14.1026	0	2.831785994	13.9272	0.576598993	1.152507877	2.783285831	1.269401243	3.474506541	1.015451576	1.362839848	3.743624663	0.04408652	4.78693434	0.747234915	0.076355497	1.145090703	3.544524472	6.919636815	0.189220078	1.878375861	0	0	3.751721983	0	0	0	0	0	0	0	0	0	0.298406849	3.132027413	3.206898946	0	0	0	0	0	0	0	59.0259
H6609_051_0	2011	4	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										A	A	A	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	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	221.794312	9.362072	26.781466	671.132967	33.534174	10.606951	2.935313	319.690765	352.860235	1623.289341	1013.984348	80.71202	0.613333	863.774853	3361.540514	3320.250693	92.095458	614.992119		1536.870987	21.219493	0							4.87	0.77	796.708486										3000	$100/Admit:1a.IP Acute	$100/Admit:1b.IP Psych	$0/Admit(Days 1-1) $0(Days 2-100):2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$0/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0-$15/Visit:8b, 9a. $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,8b, 9a. $0 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $0 Radiology OP -- Facility"	$0/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.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, 7c, 7d, 7i. $0 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$15/Visit:7b. $10 Chiropractic,7f. $15 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $15 Spec Cap"	"$15/Visit:7e, 7h.Psych -- Other Provider"	"$0-$15/Visit:7c, 7d, 7i. $0 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies											100	100	0	0	0	0.2	0.2	0	0	0	3.128302	0	0.2	2.631375	10	14.526322	15	10.035513		0	0.2	0							0	0	0										NO	98.2897	98.2897	0	0	0	0.195546	0.195546	0	0	0	3.058631	0	0.195546	2.572771	9.77729	14.202806	14.665935	9.812012		0	0.195546	0							0	0	0											1.8167	0.076682937	0	0	0	2.07414684	0.573988716	0	0	0	0.25845033	0	0.119934815	0.185191241	2.738896371	3.929739705	0.1125555	0.502859171	0	0	4.149386978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.5385	0	0.366536952	1.8167	0.076682937	0	0	0	2.07414684	0.573988716	0	0	0	0.25845033	0	0.119934815	0.185191241	2.738896371	3.929739705	0.1125555	0.502859171	0	0	4.149386978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.5385	YES	30% Coins	30% Coins	30% Coins(Days 1-1) 30%(Days 2-100)	25% Coins	$0/Trip	20% Coins	20% Coins	$0/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	30% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	20% Coins										4500	4.4479	0.0792	0.1903	2.5485	0	1.5291	0.4231	0	3.5646	0.394	1.569	0.2962	0.0204	0.916	2.0406	3.272	0.0521	0.3134		0.4257	1.1588	0							0	0	0.1941										23.4351	1000	15.94958571	6.2646	0.155911913	0.190281612	2.548526228	0	3.603209448	0.997133586	0	3.564551225	0.39404683	1.827427855	0.296211532	0.140384208	1.101213477	4.779482086	7.201747918	0.16462317	0.816294317	0	0.42568544	5.308193041	0	0	0	0	0	0	0	0	0	0.194120454	0	0	0	0	0	0	0	0	0	39.9736
H6609_801_0	2011	2																															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	YES	257.3762533	2.550426922	28.11910218	13.6912063	1.475682792	9.85833632	3.725335542	19.77719715	60.7980915	8.124001904	25.48341153	5.842035566	0.194111852	20.6992937	34.4649122	58.95037355	0.592848734	5.301861567		7.356433108	18.87819974	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.079814	0.079814	0.135446	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.072341	0.072341	0.098607	0	0.209666	0.209666	0.209666	0.209666	0.209666	0.209666	0.209666	0.209666	0.209666	0.209666	0.209666	0.209666	0.209666	0.209666		0.209666	0.209666	0																				18.6189	0.184500434	2.772740308	0	0.309400508	2.066957943	0.781076202	4.146605818	12.74729265	1.703326983	5.343004961	1.224876229	0.040698656	4.339938113	7.226120281	12.35988902	0.124300223	1.111620107	0	1.542393904	3.958116626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6017	0	9.547297461	18.6189	0.184500434	2.772740308	0	0.309400508	2.066957943	0.781076202	4.146605818	12.74729265	1.703326983	5.343004961	1.224876229	0.040698656	4.339938113	7.226120281	12.35988902	0.124300223	1.111620107	0	1.542393904	3.958116626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6017	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	Medicare FFS Cost Sharing																			10000	2.9979	0.0297	0.5114	0	1.3057	1.4378	0.5433	0.6671	2.1624	0.274	0.9137	0.1971	0.0065	0.6983	1.3801	2.3606	0.0237	0.2041		0.2946	0.756	0																			16.7641	0	0.916668818	21.6167	0.214207395	3.284184457	0	1.615074752	3.504747241	1.32439801	4.813733249	14.90968316	1.977366904	6.256703591	1.421940813	0.047246593	5.038223991	8.606231694	14.72049577	0.148040321	1.315707218	0	1.836974389	4.714074679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3658
H6609_802_0	2011	2																															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	YES	313.049793	5.294771	31.064292	16.56559	2.256225	13.137242	5.834791	29.75475	83.161953	11.993458	35.139429	5.94928	0.573647	23.982937	42.454939	67.21287	1.030048	8.035299		8.333267	27.458886	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.074412	0.074412	0.145348	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.063878	0.063878	0.092016	0	0.200154	0.200154	0.200154	0.200154	0.200154	0.200154	0.200154	0.200154	0.200154	0.200154	0.200154	0.200154	0.200154	0.200154		0.200154	0.200154	0																				19.997	0.338219382	2.858411893	0	0.451592459	2.629471535	1.167856758	5.955532232	16.64519754	2.400538593	7.033297272	1.190772189	0.114817742	4.800280772	8.497525861	13.45292478	0.206168227	1.608297236	0	1.667936723	5.496005868	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.5118	0	17.04220746	19.997	0.338219382	2.858411893	0	0.451592459	2.629471535	1.167856758	5.955532232	16.64519754	2.400538593	7.033297272	1.190772189	0.114817742	4.800280772	8.497525861	13.45292478	0.206168227	1.608297236	0	1.667936723	5.496005868	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.5118	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	Medicare FFS Cost Sharing																			10000	3.3096	0.056	0.5517	0	1.9348	1.857	0.8248	0.9728	2.8442	0.3921	1.2184	0.1945	0.0188	0.7841	1.6477	2.6085	0.04	0.2983		0.3234	1.0657	0																			20.9422	0	1.868603473	23.3066	0.394196051	3.410125799	0	2.38637966	4.486441886	1.992613538	6.928300743	19.48938412	2.792639431	8.251680443	1.385271224	0.133571993	5.584422422	10.14521159	16.06147132	0.24614471	1.906552643	0	1.991352583	6.561691532	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.454
H6609_803_0	2011	2																															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	YES	258.399908	4.37045	25.641321	13.673693	1.862351	10.843841	4.816197	24.560388	68.644163	9.89973	29.005052	4.9107	0.473504	19.796178	35.043474	55.479352	0.85023	6.632557		6.878508	22.665321	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.076073	0.076073	0.16422	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.068352	0.068352	0.115013	0	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742		0.207742	0.207742	0																				17.6622	0.298728998	2.949085252	0	0.386888521	2.252721217	1.000526397	5.102224124	14.26027571	2.05658971	6.025567513	1.020158639	0.098366668	4.11249761	7.280001376	11.52539154	0.176628481	1.377860656	0	1.428955009	4.708539115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7232	0	10.92761068	17.6622	0.298728998	2.949085252	0	0.386888521	2.252721217	1.000526397	5.102224124	14.26027571	2.05658971	6.025567513	1.020158639	0.098366668	4.11249761	7.280001376	11.52539154	0.176628481	1.377860656	0	1.428955009	4.708539115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7232	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	Medicare FFS Cost Sharing																			10000	2.8522	0.0482	0.5511	0	1.6358	1.57	0.6973	0.8224	2.4047	0.3315	1.0301	0.1644	0.0159	0.663	1.3931	2.2054	0.0338	0.2522		0.2734	0.901	0																			17.8455	0	1.12368017	20.5144	0.3469701	3.500186739	0	2.02268386	3.82272526	1.697830296	5.924665939	16.66493657	2.388097358	7.055668039	1.184600977	0.114222649	4.775461743	8.673062179	13.73082673	0.210427183	1.63002538	0	1.702391842	5.609539268	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5687
H6609_805_0	2011	5																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0																			0	YES				13.673693	1.862351	10.843841	4.816197	24.560388	68.644163	9.89973	29.005052	4.9107	0.473504	19.796178	35.043474	55.479352	0.85023	6.632557		6.878508	22.665321	0																			6700				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare 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	0																			NO				0	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742		0.207742	0.207742	0																				0	0	0	0	0.386888521	2.252721217	1.000526397	5.102224124	14.26027571	2.05658971	6.025567513	1.020158639	0.098366668	4.11249761	7.280001376	11.52539154	0.176628481	1.377860656	0	1.428955009	4.708539115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8132	0	7.637	0	0	0	0	0.386888521	2.252721217	1.000526397	5.102224124	14.26027571	2.05658971	6.025567513	1.020158639	0.098366668	4.11249761	7.280001376	11.52539154	0.176628481	1.377860656	0	1.428955009	4.708539115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8132	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																			10000				0	1.6358	1.57	0.6973	0.8224	2.4047	0.3315	1.0301	0.1644	0.0159	0.663	1.3931	2.2054	0.0338	0.2522		0.2734	0.901	0																			14.394	0	0.785308492	0	0	0	0	2.02268386	3.82272526	1.697830296	5.924665939	16.66493657	2.388097358	7.055668039	1.184600977	0.114222649	4.775461743	8.673062179	13.73082673	0.210427183	1.63002538	0	1.702391842	5.609539268	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2072
H6609_806_0	2011	5																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0																			0	YES				13.673693	1.862351	10.843841	4.816197	24.560388	68.644163	9.89973	29.005052	4.9107	0.473504	19.796178	35.043474	55.479352	0.85023	6.632557		6.878508	22.665321	0																			6700				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare 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	0																			NO				0	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742		0.207742	0.207742	0																				0	0	0	0	0.386888521	2.252721217	1.000526397	5.102224124	14.26027571	2.05658971	6.025567513	1.020158639	0.098366668	4.11249761	7.280001376	11.52539154	0.176628481	1.377860656	0	1.428955009	4.708539115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8132	0	7.637	0	0	0	0	0.386888521	2.252721217	1.000526397	5.102224124	14.26027571	2.05658971	6.025567513	1.020158639	0.098366668	4.11249761	7.280001376	11.52539154	0.176628481	1.377860656	0	1.428955009	4.708539115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8132	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																			10000				0	1.6358	1.57	0.6973	0.8224	2.4047	0.3315	1.0301	0.1644	0.0159	0.663	1.3931	2.2054	0.0338	0.2522		0.2734	0.901	0																			14.394	0	0.785308492	0	0	0	0	2.02268386	3.82272526	1.697830296	5.924665939	16.66493657	2.388097358	7.055668039	1.184600977	0.114222649	4.775461743	8.673062179	13.73082673	0.210427183	1.63002538	0	1.702391842	5.609539268	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2072
H6609_807_0	2011	5																																		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0																			0	YES				13.673693	1.862351	10.843841	4.816197	24.560388	68.644163	9.89973	29.005052	4.9107	0.473504	19.796178	35.043474	55.479352	0.85023	6.632557		6.878508	22.665321	0																			6700				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare 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	0																			NO				0	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742	0.207742		0.207742	0.207742	0																				0	0	0	0	0.386888521	2.252721217	1.000526397	5.102224124	14.26027571	2.05658971	6.025567513	1.020158639	0.098366668	4.11249761	7.280001376	11.52539154	0.176628481	1.377860656	0	1.428955009	4.708539115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8132	0	7.637	0	0	0	0	0.386888521	2.252721217	1.000526397	5.102224124	14.26027571	2.05658971	6.025567513	1.020158639	0.098366668	4.11249761	7.280001376	11.52539154	0.176628481	1.377860656	0	1.428955009	4.708539115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8132	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																			10000				0	1.6358	1.57	0.6973	0.8224	2.4047	0.3315	1.0301	0.1644	0.0159	0.663	1.3931	2.2054	0.0338	0.2522		0.2734	0.901	0																			14.394	0	0.785308492	0	0	0	0	2.02268386	3.82272526	1.697830296	5.924665939	16.66493657	2.388097358	7.055668039	1.184600977	0.114222649	4.775461743	8.673062179	13.73082673	0.210427183	1.63002538	0	1.702391842	5.609539268	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2072
H6622_001_0	2011	9	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V					O	O	O	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	NO	1517.275903	64.577651	630.267323	1191.171049	160.754782	5.119242	1.557404	367.288336	306.008583	1415.848013	1419.370358	71.834133	0.401868	2.669077	4409.705025	4572.01718	69.588167	686.230124		1741.434023	26.583056	0		2.78					4.73	0.36	272.571581	1.564616	531.003765									$150/Day(Days 1-10):1a.IP Acute	$150/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-13) $75(Days 14-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6.Home Health	$50/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$50/Visit:8b, 9a. $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,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $20 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$20/Visit:7b. $10 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$20/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center	"$20-$100/Visit:9d. $20 Cardiac Rehab,8b. $20 Nuclear Medicine,9a. $100 OP Other,5. $20 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF"									121.20465	109.29915	36.81825	0	50	0.2	0.2	50	100	0	24.203294	100	0.2	0.2	10	19.785422	20	20		0	0.2	0		0					0	0	0	0	74.06854								NO	107.707058	97.127378	25.280736	0	44.63435	0.178537	0.178537	44.63435	89.2687	0	21.605966	89.2687	0.178537	0.178537	8.92687	17.662189	17.85374	17.85374		0	0.178537	0		0					0	0	0	0	66.120023									13.6184	0.52268816	1.327801817	0	0.5979321	0.913974109	0.278054238	1.366139678	2.276415699	0	2.555572308	0.534378306	0.071748307	0.476529	3.280405291	6.729319295	0.103534087	1.020981185	0	0	4.746059069	0	0	0	0	0	0	0	0	0	0	0	2.925831763	0	0	0	0	0	0	0	43.3458	0	5.729287001	13.6184	0.52268816	1.327801817	0	0.5979321	0.913974109	0.278054238	1.366139678	2.276415699	0	2.555572308	0.534378306	0.071748307	0.476529	3.280405291	6.729319295	0.103534087	1.020981185	0	0	4.746059069	0	0	0	0	0	0	0	0	0	0	0	2.925831763	0	0	0	0	0	0	0	43.3458	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$50/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	30% Coins									30% Coins	0% Coins	30% Coins								3400	2.0595	0.0289	0.0941	0.8733	0.1758	0.62	0.1886	0.0815	0.6624	0.0725	0.3865	0.0697	0.0044	0.029	0.4936	0.894	0.0062	0.0692		0.0971	0.3004	0									0.0303	0	0.0916								7.3284	0	8.333611996	15.6779	0.551578041	1.421943836	0.873268009	0.773691333	1.533956168	0.466668602	1.447617671	2.938795121	0.072527427	2.942081319	0.604077417	0.076115377	0.50553402	3.773977741	7.623297303	0.109691247	1.090210808	0	0.09710519	5.046438608	0	0	0	0	0	0	0	0	0	0.030270579	0	3.017432042	0	0	0	0	0	0	0	50.6742
H6622_002_0	2011	10	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V			V		O	O	O	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	NO	1512.908248	64.391757	628.453025	1187.742125	160.29203	5.917707	1.800317	366.231054	305.127702	1411.77233	1415.284535	71.62735	0.464549	3.08538	4397.011177	4558.856098	69.387849	684.25473		1736.421103	30.729297	0		2.78			0.25		6.04	0.6	271.786952	1.560112	529.475211									$250/Day(Days 1-7):1a.IP Acute	$250/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-13) $84(Days 14-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6.Home Health	$50/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$50/Visit:8b, 9a. $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,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $20 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$20/Visit:7b. $10 Chiropractic,7f. $20 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $20 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $20 Spec Cap"	"$20/Visit:7e, 7h.Psych -- Other Provider"	"$20/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"			"HER834: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center	"$20-$100/Visit:9d. $20 Cardiac Rehab,8b. $20 Nuclear Medicine,9a. $100 OP Other,5. $20 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $20 Therapy (AT,PT,ST,OT) -- CORF"									179.655	153.80975	41.23644	0	50	0.2	0.2	50	100	0	24.203294	100	0.2	0.2	10	19.785422	20	20		0	0.2	0		0			0		0	0	0	0	74.06854								NO	147.152536	125.983105	23.883734	0	42.79895	0.171196	0.171196	42.79895	85.5979	0	20.717512	85.5979	0.171196	0.171196	8.55979	16.935906	17.11958	17.11958		0	0.171196	0		0			0		0	0	0	0	63.401115									18.5524	0.67602279	1.250817073	0	0.571694215	1.013087768	0.308207069	1.306192047	2.17652421	0	2.443431195	0.510929229	0.079528931	0.528204714	3.136457692	6.434029862	0.098990903	0.976179466	0	0	5.260732729	0	0	0	0	0	0	0	0	0	0	0	2.797443229	0	0	0	0	0	0	0	48.1208	0	9.806652927	18.5524	0.67602279	1.250817073	0	0.571694215	1.013087768	0.308207069	1.306192047	2.17652421	0	2.443431195	0.510929229	0.079528931	0.528204714	3.136457692	6.434029862	0.098990903	0.976179466	0	0	5.260732729	0	0	0	0	0	0	0	0	0	0	0	2.797443229	0	0	0	0	0	0	0	48.1208	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$50/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	30% Coins									30% Coins	0% Coins	30% Coins								3400	1.9732	0.0277	0.0844	0.9594	0.1666	0.6812	0.2072	0.0772	0.7277	0.0797	0.4246	0.0766	0.0048	0.0319	0.5423	0.9822	0.0068	0.0761		0.1067	0.33	0									0.0333	0	0.1006								7.7001	0	10.33803863	20.5255	0.703702194	1.335257892	0.959430106	0.73825939	1.694241104	0.515431197	1.383407885	2.904258118	0.07968362	2.868074445	0.587505243	0.084326944	0.560071598	3.678729268	7.416213175	0.105755502	1.052239611	0	0.106686152	5.590749513	0	0	0	0	0	0	0	0	0	0.033257198	0	2.898081411	0	0	0	0	0	0	0	55.8209
H6622_801_0	2011	2																															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	YES	295.288035	4.142236	30.348164	16.399158	7.421669	9.451854	3.336981	26.909814	49.913487	5.390145	29.213898	5.179946	0.523053	10.040242	38.936808	70.523849	0.485729	5.38708		7.660403	32.039082	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.078137	0.078137	0.153703	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.071755	0.071755	0.113795	0	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838		0.212838	0.212838	0																				21.1884	0.297226144	3.453469322	0	1.579613187	2.011713702	0.710236362	5.727430992	10.62348675	1.147227682	6.217827623	1.102489347	0.111325554	2.136945027	8.287232341	15.01015497	0.103381589	1.146575333	0	1.630424854	6.819134135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3043	0	9.219245369	21.1884	0.297226144	3.453469322	0	1.579613187	2.011713702	0.710236362	5.727430992	10.62348675	1.147227682	6.217827623	1.102489347	0.111325554	2.136945027	8.287232341	15.01015497	0.103381589	1.146575333	0	1.630424854	6.819134135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3043	NO																																																																																		0	0	0	21.1884	0.297226144	3.453469322	0	1.579613187	2.011713702	0.710236362	5.727430992	10.62348675	1.147227682	6.217827623	1.102489347	0.111325554	2.136945027	8.287232341	15.01015497	0.103381589	1.146575333	0	1.630424854	6.819134135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3043
H6622_802_0	2011	2																															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	YES	295.288035	4.142236	30.348164	16.399158	7.421669	9.451854	3.336981	26.909814	49.913487	5.390145	29.213898	5.179946	0.523053	10.040242	38.936808	70.523849	0.485729	5.38708		7.660403	32.039082	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.078137	0.078137	0.153703	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.071755	0.071755	0.113795	0	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838		0.212838	0.212838	0																				21.1884	0.297226144	3.453469322	0	1.579613187	2.011713702	0.710236362	5.727430992	10.62348675	1.147227682	6.217827623	1.102489347	0.111325554	2.136945027	8.287232341	15.01015497	0.103381589	1.146575333	0	1.630424854	6.819134135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3043	0	9.219245369	21.1884	0.297226144	3.453469322	0	1.579613187	2.011713702	0.710236362	5.727430992	10.62348675	1.147227682	6.217827623	1.102489347	0.111325554	2.136945027	8.287232341	15.01015497	0.103381589	1.146575333	0	1.630424854	6.819134135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3043	NO																																																																																		0	0	0	21.1884	0.297226144	3.453469322	0	1.579613187	2.011713702	0.710236362	5.727430992	10.62348675	1.147227682	6.217827623	1.102489347	0.111325554	2.136945027	8.287232341	15.01015497	0.103381589	1.146575333	0	1.630424854	6.819134135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3043
H6622_803_0	2011	2																															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	YES	295.288035	4.142236	30.348164	16.399158	7.421669	9.451854	3.336981	26.909814	49.913487	5.390145	29.213898	5.179946	0.523053	10.040242	38.936808	70.523849	0.485729	5.38708		7.660403	32.039082	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.078137	0.078137	0.153703	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.071755	0.071755	0.113795	0	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838	0.212838		0.212838	0.212838	0																				21.1884	0.297226144	3.453469322	0	1.579613187	2.011713702	0.710236362	5.727430992	10.62348675	1.147227682	6.217827623	1.102489347	0.111325554	2.136945027	8.287232341	15.01015497	0.103381589	1.146575333	0	1.630424854	6.819134135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3043	0	9.219245369	21.1884	0.297226144	3.453469322	0	1.579613187	2.011713702	0.710236362	5.727430992	10.62348675	1.147227682	6.217827623	1.102489347	0.111325554	2.136945027	8.287232341	15.01015497	0.103381589	1.146575333	0	1.630424854	6.819134135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3043	NO																																																																																		0	0	0	21.1884	0.297226144	3.453469322	0	1.579613187	2.011713702	0.710236362	5.727430992	10.62348675	1.147227682	6.217827623	1.102489347	0.111325554	2.136945027	8.287232341	15.01015497	0.103381589	1.146575333	0	1.630424854	6.819134135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3043
H6642_001_0	2011	8																															D	D	D		T	Coin	Coin	V	Coin		P		Coin	Coin		V	V	V	P	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	0	0	0	0	0	0	0	0											0	YES	478.6919049	9.405683178	372.6993161	0	129.657166	4.730891262	3.089710296	149.2380932	25.11943843	0	94.7623335	0	0.261408179	14.97627573	0	3157.864547	75.10410932	274.8130018	75.05969489	8.672917918	26.61551716	5.977140234	0	2925	0	31.77142857	177.7412512	0	0	0											3400	$200/Days 1-7 for IP Medical; $200/Days 1-7 for IP Surgical; PBP 1a	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse; PBP 1b	$100/Days 11-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery, 10% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $200/day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; $25/Visit for Cardio; $25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $0-25/Visit for Allergy Testing; $0-25/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-25/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride;  $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	200	200	100	0	125	0.2	0.2	46.12292745	0.25	0	100	0	0.2	0.176091565	0	24.06567412	25	25.39094921	100	0.253515108	0.070495729	0.200112539	0	4	0	50	10	0	0	0											NO	180.9555041	180.9555041	90.47775205	0	113.0971901	0.180955504	0.180955504	41.73098793	0.22619438	0	90.47775205	0	0.180955504	0.159323689	0	21.77408096	23.99816663	22.97316007	90.47775205	0.229374771	0.063782951	0.186635461	0	4	0	50	10	0	0	0												7.2185	0.141834178	2.810083026	0	1.221988429	0.856080813	0.559100084	0.518987756	5.681875804	0	0.714490243	0	0.047303249	2.386075501	0	5.729966527	0.150196744	0.526110257	0.565936039	1.989348558	1.69761622	1.115546325	0	0.975	0	0.132380952	0.148117709	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1865	0	3.524653122	7.2185	0.141834178	2.810083026	0	1.221988429	0.856080813	0.559100084	0.518987756	5.681875804	0	0.714490243	0	0.047303249	2.386075501	0	5.729966527	0.150196744	0.526110257	0.565936039	1.989348558	1.69761622	1.115546325	0	0.975	0	0.132380952	0.148117709	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1865	NO	$200/Days 1-7 for IP Medical; $200/Days 1-7 for IP Surgical; PBP 1a	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse; PBP 1b	$100/Days 11-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery, 10% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $200/day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; $25/Visit for Cardio; $25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $0-25/Visit for Allergy Testing; $0-25/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-25/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b												8.9807	0.256	2.4322	0	1.2941	1.2148	0.7121	0.4466	5.5523	0	0.8533	0	0.0364	1.9366	0	4.7765	0.1379	0.57	0.626	1.9311	1.4772	1.0079	0	0	0	0	0	0	0	0											34.2418	0	0	16.1992	0.397862777	5.242279617	0	2.516137958	2.070927424	1.271208438	0.965599717	11.23417877	0	1.567760685	0	0.083748787	4.322707478	0	10.50646123	0.288050602	1.096137921	1.191929729	3.920413681	3.174796317	2.123399844	0	0.975	0	0.132380952	0.148117709	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4283
H6642_002_0	2011	8																															D	D	D		T	Coin	Coin	V	Coin		P		Coin	Coin		V	V	V	P	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	0	0	0	0	0	0	0	0											0	YES	480.3962193	8.558172115	414.97697	0	137.070911	4.32372508	2.787476347	163.4559605	22.16099619	0	92.02407279	0	0.220974231	12.8129461	0	2909.641364	63.66934474	236.3892246	65.75142589	7.599953157	24.04527747	5.480588733	0	2925	0	31.77142857	164.7919697	0	0	0											3400	$200/Days 1-7 for IP Medical; $200/Days 1-7 for IP Surgical; PBP 1a	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse; PBP 1b	$100/Days 11-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery, 10% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $200/day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; $25/Visit for Cardio; $25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $0-25/Visit for Allergy Testing; $0-25/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-25/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride;  $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	200	200	100	0	125	0.2	0.2	46.73931743	0.25	0	100	0	0.2	0.180629745	0	24.05590029	25	25.44877994	100	0.25311942	0.066321944	0.200116356	0	4	0	50	10	0	0	0											NO	182.3693909	182.3693909	91.18469544	0	113.9808693	0.182369391	0.182369391	42.61910425	0.227961739	0	91.18469544	0	0.182369391	0.164706683	0	21.93529942	24.15490736	23.20539248	91.18469544	0.230806173	0.060475463	0.187961959	0	4	0	50	10	0	0	0												7.3008	0.130062386	3.153295719	0	1.301955133	0.788515109	0.508350364	0.580528885	5.051859221	0	0.699265588	0	0.040298936	2.110377846	0	5.318654542	0.128160594	0.457125395	0.499626979	1.7541161	1.45414929	1.030142194	0	0.975	0	0.132380952	0.137326641	0	0	0	0	0	0	0	0	0	0	0	0	0	33.552	0	3.082432882	7.3008	0.130062386	3.153295719	0	1.301955133	0.788515109	0.508350364	0.580528885	5.051859221	0	0.699265588	0	0.040298936	2.110377846	0	5.318654542	0.128160594	0.457125395	0.499626979	1.7541161	1.45414929	1.030142194	0	0.975	0	0.132380952	0.137326641	0	0	0	0	0	0	0	0	0	0	0	0	0	33.552	NO	$200/Days 1-7 for IP Medical; $200/Days 1-7 for IP Surgical; PBP 1a	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse; PBP 1b	$100/Days 11-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery, 10% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $200/day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; $25/Visit for Cardio; $25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $0-25/Visit for Allergy Testing; $0-25/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-25/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b												8.323	0.2196	3.159	0	1.4011	1.1364	0.6606	0.5477	5.11	0	0.8031	0	0.0291	1.62	0	4.5035	0.1177	0.4947	0.5497	1.774	1.224	0.9301	0	0	0	0	0	0	0	0											32.6032	0	7.11E-15	15.6238	0.349615305	6.312288676	0	2.703104683	1.924918496	1.168931835	1.128238628	10.16181202	0	1.502397377	0	0.069409318	3.730331186	0	9.822158393	0.245835351	0.951848264	1.04930062	3.528106576	2.678173436	1.960236311	0	0.975	0	0.132380952	0.137326641	0	0	0	0	0	0	0	0	0	0	0	0	0	66.1552
H6642_004_0	2011	7																															D	D	D		T	Coin	Coin	V	Coin		P		Coin	Coin		V	V	V	P	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	0	0	0	0	0	0	0	0											0	YES	486.4225442	8.796990015	418.7765498	0	136.3733612	4.371554339	2.820352169	156.4639492	23.13887641	0	90.81682085	0	0.239248605	13.84402549	0	2900.331638	63.71570709	236.5205352	65.87534326	7.633847686	24.39011547	5.464669124	0	2925	0	31.77142857	164.1934974	0	0	0											3400	$200/Days 1-7 for IP Medical; $200/Days 1-7 for IP Surgical; PBP 1a	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse; PBP 1b	$100/Days 11-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery, 10% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $200/day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; $25/Visit for Cardio; $25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $0-25/Visit for Allergy Testing; $0-25/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-25/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride;  $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	200	200	100	0	125	0.2	0.2	46.60884859	0.25	0	100	0	0.2	0.177486689	0	24.0569442	25	25.43791986	100	0.25312693	0.068715504	0.200118636	0	4	0	50	10	0	0	0											NO	182.0519136	182.0519136	91.02595678	0	113.782446	0.182051914	0.182051914	42.42615037	0.227564892	0	91.02595678	0	0.182051914	0.161558957	0	21.89806363	24.1411047	23.15510994	91.02595678	0.23041121	0.062548945	0.187756432	0	4	0	50	10	0	0	0												7.3795	0.133459072	3.176628011	0	1.29307455	0.795849833	0.513450509	0.553180253	5.265595911	0	0.688890667	0	0.043555666	2.236626321	0	5.292637228	0.12818063	0.45638825	0.499697179	1.758924082	1.52557599	1.026026778	0	0.975	0	0.132380952	0.136827915	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0115	0	3.188774535	7.3795	0.133459072	3.176628011	0	1.29307455	0.795849833	0.513450509	0.553180253	5.265595911	0	0.688890667	0	0.043555666	2.236626321	0	5.292637228	0.12818063	0.45638825	0.499697179	1.758924082	1.52557599	1.026026778	0	0.975	0	0.132380952	0.136827915	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0115	NO	$200/Days 1-7 for IP Medical; $200/Days 1-7 for IP Surgical; PBP 1a	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse; PBP 1b	$100/Days 11-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery, 10% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $200/day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; $25/Visit for Cardio; $25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $0-25/Visit for Allergy Testing; $0-25/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-25/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b												8.8039	0.2332	2.9524	0	1.3757	1.1342	0.6595	0.4953	5.218	0	0.8069	0	0.0326	1.7683	0	4.4288	0.1175	0.4935	0.5507	1.7384	1.3023	0.9251	0	0	0	0	0	0	0	0											33.0363	0	0	16.1834	0.366662568	6.129062252	0	2.668770263	1.930096914	1.172977842	1.048484989	10.48357225	0	1.495777373	0	0.076143429	4.004949314	0	9.721433555	0.245632421	0.949926084	1.05035184	3.497286756	2.827851574	1.951170344	0	0.975	0	0.132380952	0.136827915	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0478
H6642_005_0	2011	8																															D	D	D	V	T	Coin	Coin	V	Coin		P		Coin	Coin		V	V	V	P	Coin	Coin	Coin				V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	483.0461524	9.491238569	413.6261683	1580.344511	124.630866	4.547493156	2.969934342	147.2523097	24.85383729	0	93.76036114	0	0.258644172	14.81792363	0	3035.44652	72.19261746	264.1595792	72.1499248	8.336702894	25.76463894	5.745429941	0	0	0	31.77142857	170.8509198	0	0	0											3400	$200/Days 1-7 for IP Medical; $200/Days 1-7 for IP Surgical; PBP 1a	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse; PBP 1b	$100/Days 11-100 for SNF; PBP 2	$10/Visit for Home Health; PBP 6	$125/Trip for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for DME / Medical Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"30% Coinsurance for OP Fac - Surgery, 15% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 30% Coinsurance for OP Fac - Other; $200/day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; $25/Visit for Cardio; $25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $0-25/Visit for Allergy Testing; $0-25/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-25/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	200	200	100	10	125	0.23	0.23	46.22296863	0.3	0	100	0	0.2	0.203001077	0	24.06567412	25	25.39094921	100	0.302238498	0.071405016	0.200112539	0	0	0	50	10	0	0	0											NO	178.7156224	178.7156224	89.35781119	8.935781119	111.697264	0.205522966	0.205522966	41.30383303	0.268073434	0	89.35781119	0	0.178715622	0.181397319	0	21.50455965	23.90589327	22.68879646	89.35781119	0.270073706	0.063805959	0.185219703	0	0	0	50	10	0	0	0												7.194	0.141352717	3.080060754	1.176801053	1.160077228	0.93461428	0.610389714	0.506840401	6.662653501	0	0.698185054	0	0.046223754	2.687931621	0	5.439661728	0.143819084	0.499455244	0.53726328	2.251524248	1.643937507	1.064166826	0	0	0	0.132380952	0.142375766	0	0	0	0	0	0	0	0	0	0	0	0	0	36.7537	0	4.292790793	7.194	0.141352717	3.080060754	1.176801053	1.160077228	0.93461428	0.610389714	0.506840401	6.662653501	0	0.698185054	0	0.046223754	2.687931621	0	5.439661728	0.143819084	0.499455244	0.53726328	2.251524248	1.643937507	1.064166826	0	0	0	0.132380952	0.142375766	0	0	0	0	0	0	0	0	0	0	0	0	0	36.7537	NO	$200/Days 1-7 for IP Medical; $200/Days 1-7 for IP Surgical; PBP 1a	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse; PBP 1b	$100/Days 11-100 for SNF; PBP 2	$10/Visit for Home Health; PBP 6	$125/Trip for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for DME / Medical Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"30% Coinsurance for OP Fac - Surgery, 15% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 30% Coinsurance for OP Fac - Other; $200/day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; $25/Visit for Cardio; $25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $0-25/Visit for Allergy Testing; $0-25/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-25/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b												9.0624	0.2584	2.6993	1.6453	1.244	1.3429	0.7872	0.4416	6.5923	0	0.8442	0	0.0361	2.1941	0	4.5913	0.1325	0.5479	0.6017	2.2117	1.4477	0.9688	0	0	0	0	0	0	0	0											37.6494	0	0	16.2564	0.399710188	5.779341684	2.822064049	2.404057654	2.277528817	1.397567825	0.948464166	13.25496813	0	1.542433415	0	0.082283934	4.88205045	0	10.03099046	0.276328889	1.04738517	1.138989649	4.463215531	3.091639779	2.032949815	0	0	0	0.132380952	0.142375766	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4031
H6642_006_0	2011	8																															D	D	D	V	T	Coin	Coin	V	Coin		P		Coin	Coin		V	V	V	P	Coin	Coin	Coin				V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	466.5310213	8.922486549	418.296551	1927.212568	123.1135075	4.360197095	2.843082964	157.7892572	22.64981049	0	94.17986644	0	0.218465318	12.60932865	0	2980.658481	70.27435081	257.1498896	70.02684179	8.044487574	24.42758162	5.606751168	0	0	0	31.77142857	167.9518021	0	0	0											3400	$200/Days 1-7 for IP Medical; $200/Days 1-7 for IP Surgical; PBP 1a	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse; PBP 1b	$100/Days 11-100 for SNF; PBP 2	$10/Visit for Home Health; PBP 6	$125/Trip for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for DME / Medical Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"30% Coinsurance for OP Fac - Surgery, 15% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 30% Coinsurance for OP Fac - Other; $200/day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; $25/Visit for Cardio; $25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $0-25/Visit for Allergy Testing; $0-25/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-25/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	200	200	100	10	125	0.23	0.23	46.52968352	0.3	0	100	0	0.2	0.208036955	0	24.06350472	25	25.39835864	100	0.302239302	0.067574586	0.200110994	0	0	0	50	10	0	0	0											NO	179.5953713	179.5953713	89.79768565	8.979768565	112.2471071	0.206534677	0.206534677	41.78257894	0.269393057	0	89.79768565	0	0.179595371	0.186812371	0	21.60847033	23.96620263	22.80713825	89.79768565	0.271403898	0.060680415	0.185939234	0	0	0	50	10	0	0	0												6.9822	0.13353644	3.13017185	1.442160236	1.151594588	0.900531899	0.587195222	0.549403508	6.101701687	0	0.70476117	0	0.03923536	2.355578581	0	5.367289196	0.140350778	0.488737757	0.524020694	2.183305285	1.482275779	1.042515016	0	0	0	0.132380952	0.139959835	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5789	0	3.962460754	6.9822	0.13353644	3.13017185	1.442160236	1.151594588	0.900531899	0.587195222	0.549403508	6.101701687	0	0.70476117	0	0.03923536	2.355578581	0	5.367289196	0.140350778	0.488737757	0.524020694	2.183305285	1.482275779	1.042515016	0	0	0	0.132380952	0.139959835	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5789	NO	$200/Days 1-7 for IP Medical; $200/Days 1-7 for IP Surgical; PBP 1a	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse; PBP 1b	$100/Days 11-100 for SNF; PBP 2	$10/Visit for Home Health; PBP 6	$125/Trip for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for DME / Medical Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"30% Coinsurance for OP Fac - Surgery, 15% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 30% Coinsurance for OP Fac - Other; $200/day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; $25/Visit for Cardio; $25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $0-25/Visit for Allergy Testing; $0-25/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-25/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b												8.1005	0.2293	3.1954	2.3092	1.264	1.3235	0.7753	0.5361	6.2813	0	0.8165	0	0.0283	1.8022	0	4.6166	0.1291	0.5338	0.5812	2.235	1.2723	0.9459	0	0	0	0	0	0	0	0											36.9755	0	0	15.0827	0.362815433	6.325603897	3.751395621	2.415583755	2.224045183	1.36248014	1.085532542	12.38295252	0	1.521270971	0	0.067548105	4.157811828	0	9.9838492	0.2694119	1.022571874	1.105211792	4.418309353	2.754592647	1.988399715	0	0	0	0.132380952	0.139959835	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5545
H6642_007_0	2011	6																															D	D	D		T	Coin	Coin	V	Coin		P		Coin	Coin		V	V	V	P	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	0	0	0	0	0	0	0	0											0	YES	3656.836603	102.3437924	721.3279921	0	441.5568954	13.25957828	7.741942345	816.4453876	69.84301927	0	662.3169765	0	0.495981741	31.64523212	0	6974.457534	182.4097537	773.7382604	219.2290179	19.69056003	53.79152155	13.10395506	0	2925	0	370.5928963	215.4247466	0	0	0											3400	$150/Days 1-7 for IP Medical; $150/Days 1-7 for IP Surgical; PBP 1a	$150/Days 1-7 for IP Psych; $150/Days 1-7 for IP Substance Abuse; PBP 1b	$100/Days 11-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; $100/Visit for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$25/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $200/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; $25/Visit for Cardio; $25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $0-25/Visit for Allergy Testing; $0-25/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $0-25/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride; $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	150	150	100	0	125	0.2	0.2	48.36244292	0.25	0	100	0	0.2	0.218234209	0	23.34523748	25	24.95586717	100	0.254694465	0.077790477	0.2	0	4	0	22.57194044	10	0	0	0											NO	124.3443442	124.3443442	82.89622948	0	103.6202868	0.165792459	0.165792459	40.09064167	0.207240574	0	82.89622948	0	0.165792459	0.180907931	0	19.35232163	20.72405737	20.68747292	82.89622948	0.211132108	0.064485373	0.17161694	0	4	0	22.57194044	10	0	0	0												37.8922	1.060489313	4.982947564	0	3.812854347	2.198338088	1.283555658	2.727651623	14.47430738	0	4.575298339	0	0.082230032	5.724873467	0	11.24766212	0.315022517	1.333890775	1.514438248	4.157309442	3.468766314	2.248860663	0	0.975	0	0.697083399	0.179520622	0	0	0	0	0	0	0	0	0	0	0	0	0	104.9523	0	21.18044529	37.8922	1.060489313	4.982947564	0	3.812854347	2.198338088	1.283555658	2.727651623	14.47430738	0	4.575298339	0	0.082230032	5.724873467	0	11.24766212	0.315022517	1.333890775	1.514438248	4.157309442	3.468766314	2.248860663	0	0.975	0	0.697083399	0.179520622	0	0	0	0	0	0	0	0	0	0	0	0	0	104.9523	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	37.8922	1.060489313	4.982947564	0	3.812854347	2.198338088	1.283555658	2.727651623	14.47430738	0	4.575298339	0	0.082230032	5.724873467	0	11.24766212	0.315022517	1.333890775	1.514438248	4.157309442	3.468766314	2.248860663	0	0.975	0	0.697083399	0.179520622	0	0	0	0	0	0	0	0	0	0	0	0	0	104.9523
H6705_001_0	2011	9																															D	D	D		T	Coin	Coin	V	Coin		P		Coin	Coin	V	V	V	V	P	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	0	0	0	0	0	0	0	0											0	YES	329.3262903	5.596899598	254.3227864	0	86.79368354	3.296827746	2.196413453	108.3534961	18.86197134	0	57.12074138	0	0.180910402	10.14634912	2032.708982	2234.090524	52.63959781	189.1268497	50.38544066	6.40051995	21.45156716	4.9634377	0	2925	0	31.77142857	127.1251415	0	0	0											3400	$200/Days 1-7 for IP Medical; $200/Days 1-7 for IP Surgical; PBP 1a	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse; PBP 1b	$100/Days 11-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery, 10% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$30/Visit for OP Fac - Cardiovascular; $30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $200/day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$5/Visit for PCP Office Visits; $5/Visit for PCP Consults; PBP 7a, 14b-c"	"$30/Visit for Speclst Office Visits; $30/Visit for Speclst Consults; $30/Visit for Cardio; $30/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $5-30/Visit for Allergy Testing; $5-30/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $5-30/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride;  $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	200	200	100	0	125	0.2	0.2	46.24406163	0.25	0	100	0	0.2	0.185080471	5	28.76431431	30	30.39002981	100	0.254690432	0.064477119	0.200123414	0	4	0	50	10	0	0	0											NO	185.27172	185.27172	92.63586	0	115.794825	0.18527172	0.18527172	42.83858419	0.23158965	0	92.63586	0	0.18527172	0.171450886	4.655327564	26.64606993	29.18109005	28.15206547	92.63586	0.235934672	0.059728933	0.189722907	0	4	0	50	10	0	0	0												5.0846	0.086412268	1.96328417	0	0.837521616	0.610808947	0.406933298	0.386809197	4.368237342	0	0.440952417	0	0.033517581	1.73960055	0.788577179	4.960811028	0.128006737	0.443692621	0.388958219	1.510104576	1.281279224	0.941677828	0	0.975	0	0.132380952	0.105937618	0	0	0	0	0	0	0	0	0	0	0	0	0	27.6151	0	2.064698315	5.0846	0.086412268	1.96328417	0	0.837521616	0.610808947	0.406933298	0.386809197	4.368237342	0	0.440952417	0	0.033517581	1.73960055	0.788577179	4.960811028	0.128006737	0.443692621	0.388958219	1.510104576	1.281279224	0.941677828	0	0.975	0	0.132380952	0.105937618	0	0	0	0	0	0	0	0	0	0	0	0	0	27.6151	NO	$200/Days 1-7 for IP Medical; $200/Days 1-7 for IP Surgical; PBP 1a	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse; PBP 1b	$100/Days 11-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery, 10% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$30/Visit for OP Fac - Cardiovascular; $30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $200/day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$5/Visit for PCP Office Visits; $5/Visit for PCP Consults; PBP 7a, 14b-c"	"$30/Visit for Speclst Office Visits; $30/Visit for Speclst Consults; $30/Visit for Cardio; $30/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $5-30/Visit for Allergy Testing; $5-30/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $5-30/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b												7.7515	0.2203	1.776	0	1.1035	1.0961	0.6424	0.367	5.1228	0	0.3581	0	0.0184	1.0324	0.7679	5.2349	0.1652	0.6837	0.5785	1.8723	1.0588	1.1759	0	0	0	0	0	0	0	0											31.0258	0	3.55E-15	12.8361	0.306695792	3.739238954	0	1.940992667	1.706929966	1.04928788	0.753782398	9.491043055	0	0.799091627	0	0.051966201	2.772030138	1.556508111	10.19570872	0.293241542	1.127405247	0.967466541	3.382442421	2.340051541	2.117562295	0	0.975	0	0.132380952	0.105937618	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6408
H6705_002_0	2011	9																															D	D	D	V	T	Coin	Coin	V	Coin		P		Coin	Coin	V	V	V	V	P	Coin	Coin	Coin				V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	329.3266064	5.596904969	254.3230305	815.1455489	86.79376684	3.29683091	2.196415561	108.3536001	18.86198945	0	57.1207962	0	0.180910576	10.14635886	2032.710933	2234.092668	52.63964833	189.1270312	50.38548902	6.400526093	21.45158774	4.963442464	0	0	0	31.77142857	127.1252635	0	0	0											3400	$200/Days 1-7 for IP Medical; $200/Days 1-7 for IP Surgical; PBP 1a	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse; PBP 1b	$100/Days 11-100 for SNF; PBP 2	$30/Visit for Home Health; PBP 6	$125/Trip for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for DME / Medical Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"30% Coinsurance for OP Fac - Surgery, 15% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$30/Visit for OP Fac - Cardiovascular; $30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 30% Coinsurance for OP Fac - Other; $200/day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$5/Visit for PCP Office Visits; $5/Visit for PCP Consults; PBP 7a, 14b-c"	"$30/Visit for Speclst Office Visits; $30/Visit for Speclst Consults; $30/Visit for Cardio; $30/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"30% Coinsurance for Prof - Primary Surgeon (OP); 30% Coinsurance for Prof - Anesthesia (OP); $5-30/Visit for Allergy Testing; $5-30/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $5-30/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$10/Visit for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	200	200	100	30	125	0.23	0.23	46.24406163	0.3	0	100	0	0.2	0.212568539	5	28.76431431	30	30.39002981	100	0.30330799	0.064477119	0.200123414	0	0	0	50	10	0	0	0											NO	182.5875497	182.5875497	91.29377487	27.38813246	114.1172186	0.209975682	0.209975682	42.21794952	0.273881325	0	91.29377487	0	0.18258755	0.194061844	4.592512388	26.26002834	29.03184639	27.7442054	91.29377487	0.276901313	0.058863595	0.187827452	0	0	0	50	10	0	0	0												5.0109	0.08516043	1.934842458	1.860442856	0.825388605	0.692254319	0.461193856	0.381205568	5.165946654	0	0.434564426	0	0.033032019	1.96902111	0.777937512	4.888944733	0.127352182	0.437264933	0.383323458	1.772314081	1.262717583	0.932270753	0	0	0	0.132380952	0.10593772	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6744	0	2.766234565	5.0109	0.08516043	1.934842458	1.860442856	0.825388605	0.692254319	0.461193856	0.381205568	5.165946654	0	0.434564426	0	0.033032019	1.96902111	0.777937512	4.888944733	0.127352182	0.437264933	0.383323458	1.772314081	1.262717583	0.932270753	0	0	0	0.132380952	0.10593772	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6744	NO	$200/Days 1-7 for IP Medical; $200/Days 1-7 for IP Surgical; PBP 1a	$200/Days 1-7 for IP Psych; $200/Days 1-7 for IP Substance Abuse; PBP 1b	$100/Days 11-100 for SNF; PBP 2	$30/Visit for Home Health; PBP 6	$125/Trip for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for DME / Medical Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; $10/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"30% Coinsurance for OP Fac - Surgery, 15% Coinsurance for ASC; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$0-100/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$30/Visit for OP Fac - Cardiovascular; $30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 30% Coinsurance for OP Fac - Other; $200/day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$5/Visit for PCP Office Visits; $5/Visit for PCP Consults; PBP 7a, 14b-c"	"$30/Visit for Speclst Office Visits; $30/Visit for Speclst Consults; $30/Visit for Cardio; $30/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	"$0-100/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"30% Coinsurance for Prof - Primary Surgeon (OP); 30% Coinsurance for Prof - Anesthesia (OP); $5-30/Visit for Allergy Testing; $5-30/Visit for Allergy Tx; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $5-30/Visit for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b												7.7515	0.2203	1.776	2.3381	1.1035	1.2605	0.7387	0.367	6.1474	0	0.3581	0	0.0184	1.1746	0.7679	5.2349	0.1652	0.6837	0.5785	2.2263	1.0588	1.1759	0	0	0	0	0	0	0	0											35.1454	0	0	12.7624	0.305444166	3.710798947	4.198525524	1.928860714	1.9527947	1.199902334	0.748179122	11.31331941	0	0.79270398	0	0.051480656	3.143659936	1.54586918	10.12384745	0.292587146	1.120978216	0.961832335	3.998618193	2.321490916	2.108156349	0	0	0	0.132380952	0.10593772	0	0	0	0	0	0	0	0	0	0	0	0	0	64.8198
H6743_001_0	2011	8																															D	D	D		Coin	Coin	Coin	V	Coin	Coin	Coin	0	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.556918774	0.71034426	0.318352068	0.844736739	2.118307515	0.548374501	1.040090464	0	0	1.475799423	1.168875294	1.733814445	0.030883514	0.155588642	1.008522188	0	1.370257212	0.049134961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.13	YES	575.6332442	6.289052154	448.234768	0	10.03489214	11.29522127	5.062132902	217.5859349	31.97993474	9.493428921	18.00598837	0	0.064263089	25.54895769	2649.40072	28.67661358	0.510801255	2.573375348	16.68056299	38.60265429	24.1674004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3400	$250/ day (Days 1-8)	$250/ day (Days 1-8)	$75/day (Days 1-100)		20% Ambul	20% Coin DME	20% Coin Prosthetics/20% Coin Diabetic Supplies	$50 ER Waived/$50 ER Waived/$50 ER Waived/$50 ER Waived	20% Coin OP Hosp & Surg/20% Coin ASC	20% Coin Lab/20% Coin Lab/20% Coin Lab	20% Coin MRI/CT/PET/20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad/20% Coin Rad	0	20% Coin Dialysis	20% Coin CORF/$40 Copay Urgent Care/20% Coin Partial Hospitalization/20% Coin Mental Health/20% Coin PT & ST/20% Coin OP Hosp & Surg/20% Coin OP Substance Abuse/20% Coin Cardiac Rehab/20% Coin Cardiac Rehab	$35 Copay PCP/$35 Copay PCP/$0 Copay Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	50% Coin Chiro/$40 Copay Specialists/$40 Copay Specialists/$40 Copay Specialists/20% Coin Podiatry/$40 Copay Preventive Dental/$35 Copay Medicare Covered Vision Exams/$40 Copay Medicare Covered Hearing Exams	20% Coin Mental Health/20% Coin Psychiatric	20% Coin OT/20% Coin PT & ST	20% Coin MRI/CT/PET/20% Coin Rad	$50 ER Waived/20% Coin Other/20% Coin Other/20% Coin Other/20% Coin Other/20% Coin Other/20% Coin Other/20% Coin Lab/20% Coin ASC/$0 Copay Pap & Pelvic/$0 Copay Prostate Screen/$0 Copay Colorectal Screen/$0 Copay Bone Mass/$0 Copay Mammogram/$0 Copay Diab Monitor/$0 Copay Nutrition Ther/0/0	20% Coin Part B Rx										0	0	0	0	0	0	0	0	0	0	150	250	250	75	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0	0.2	0.200015621	35	0.431437423	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	224.5989568	224.5989568	67.37968704	0	0.179679165	0.179679165	0.179679165	44.91979136	0.179679165	0.179679165	0.179679165	0	0.179679165	0.1796932	31.44385395	0.38760158	0.179679165	0.179679165	0.179679165	0.179679165	0.179679165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5000	10.7739	0.117709546	2.516826532	0	1.803061044	2.029515932	0.909559815	0.8144929	5.746127984	1.705771386	3.235300964	0	0.011546738	4.590973955	6.942280776	11.11510074	0.091780343	0.462381935	2.997149638	6.936092708	4.342378335	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.1419	150	7.887079788	10.7739	0.117709546	2.516826532	0	2.359979819	2.739860192	1.227911883	1.659229639	7.864435499	2.254145887	4.275391428	0	0.011546738	6.066773378	8.111156071	12.84891518	0.122663857	0.617970576	4.005671825	6.936092708	5.712635547	0.049134961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.2719	YES	$350/ day (Days 1-8)	$350/ day (Days 1-8)				30% Coin DME	30% Coin Prosthetics/30% Coin Diabetic Supplies		30% Coin OP Hosp & Surg/30% Coin ASC	30% Coin Lab/30% Coin Lab/30% Coin Lab	30% Coin MRI/CT/PET/30% Coin Rad/30% Coin MRI/CT/PET/30% Coin Rad/30% Coin MRI/CT/PET/30% Coin Rad/30% Coin Rad	0	30% Coin Dialysis	30% Coin CORF/$40 Copay Urgent Care/30% Coin Partial Hospitalization/30% Coin Mental Health/30% Coin PT & ST/30% Coin OP Hosp & Surg/30% Coin OP Substance Abuse/30% Coin Cardiac Rehab/30% Coin Cardiac Rehab	$40 Copay PCP/$40 Copay PCP/$0 Copay Immunizations/$0 Copay Physical Exams/No Coverage Supp Physical Exams	50% Coin Chiro/$45 Copay Specialists/$45 Copay Specialists/$45 Copay Specialists/30% Coin Podiatry/$45 Copay Preventive Dental/$40 Copay Medicare Covered Vision Exams/$45 Copay Medicare Covered Hearing Exams	30% Coin Mental Health/30% Coin Psychiatric	30% Coin OT/30% Coin PT & ST	30% Coin MRI/CT/PET/30% Coin Rad	$50 ER Waived/30% Coin Other/30% Coin Other/30% Coin Other/30% Coin Other/30% Coin Other/30% Coin Other/30% Coin Lab/30% Coin ASC/$0 Copay Pap & Pelvic/$0 Copay Prostate Screen/$0 Copay Colorectal Screen/$0 Copay Bone Mass/$0 Copay Mammogram/$0 Copay Diab Monitor/$0 Copay Nutrition Ther/0/0	30% Coin Part B Rx										0	0	0	0	0	0	0	0	0	0	5000	0.3552	0.0039	0	0	0	0.2853	0.1278	0	1.1737	0.0735	0.1394	0	0.0005	0.1978	0.4424	0.7283	0.0087	0.0436	0.2829	0.6202	0.0991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.5824	0	0.51824172	11.1291	0.121590081	2.516826532	0	2.359979819	3.025129888	1.35576003	1.659229639	9.038182753	2.327637077	4.414780633	0	0.012018059	6.264543184	8.553578401	13.57724964	0.131326392	0.661611726	4.288552809	7.556322617	5.811767122	0.049134961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.8543
H6743_002_0	2011	7																															D	D	D		T	Coin	Coin	V	V		Coin	0		V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	611.4718475	4.203084439	77.53335844	0	124.8072088	12.12390094	4.497715346	244.2645439	190.6748516	0	17.94845034	0	0	141.6370296	2954.806507	33.5184046	72.81665932	370.3082338	20.49853146	55.3190429	26.34036524	0	0	0	290.7455266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3400	$200/day (Days 1-8)	$200/day (Days 1-8)	$0 Days 1-20 & $137.50 per Days 21-100		$200 Ambul Waived	20% Coin DME	20% Coin Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$50 ER Waived/$50 ER Waived/$50 ER Waived	$200 Copay OP Hosp & Surg/$200 Copay ASC		20% Coin MRI/CT/PET/20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad/20% Coin Rad	0		$30 Copay CORF/$30 Copay Urgent Care/$30 Copay Partial Hospitalization/$30 Copay Mental Health/$30 Copay PT & ST/$200 Copay OP Hosp & Surg/$30 Copay OP Substance Abuse/$30 Copay Cardiac Rehab/$30 Copay Cardiac Rehab	$25 Copay PCP/$25 Copay PCP/$0 Copay Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	50% Coin Chiro/$30 Copay Specialists/$30 Copay Specialists/$30 Copay Specialists/$30 Copay Podiatry/$30 Copay Preventive Dental/$25 Copay Medicare Covered Vision Exams/$30 Copay Medicare Covered Hearing Exams	$30 Copay Mental Health/$30 Copay Psychiatric	$30 Copay OT/$30 Copay PT & ST	20% Coin MRI/CT/PET/20% Coin Rad	$50 ER Waived/$30 Copay Other/$30 Copay Other/$30 Copay Other/$30 Copay Other/$30 Copay Other/$30 Copay Other/$0 Copay Lab/$200 Copay ASC/$0 Copay Pap & Pelvic/$0 Copay Prostate Screen/$0 Copay Colorectal Screen/$0 Copay Bone Mass/$0 Copay Mammogram/$0 Copay Diab Monitor/$0 Copay Nutrition Ther/0/0	20% Coin Part B Rx				$25 Copay Non-Covered Vision Exams						0	0	0	0	0	0	0	0	0	0	0	200	200	137.5	0	200	0.2	0.05549914	50	200	0	0.2	0	0	81.02150815	25	0.33138681	30	30	0.2	30	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	183.8463839	183.8463839	126.3943889	0	183.8463839	0.183846384	0.051016581	45.96159597	183.8463839	0	0.183846384	0	0	74.47755646	22.98079799	0.304621334	27.57695758	27.57695758	0.183846384	27.57695758	0.183846384	0	0	0	22.98079799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5000	9.3681	0.06439349	0.816648455	0	1.912112836	2.228935346	0.22945806	0.93556569	2.921240164	0	3.299757692	0	0	0.879064989	5.658650953	10.21042112	0.167338494	0.850997871	3.768580885	0.127127575	4.8425809	0	0	0	0.556797018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8377	0	4.291116182	9.3681	0.06439349	0.816648455	0	1.912112836	2.228935346	0.22945806	0.93556569	2.921240164	0	3.299757692	0	0	0.879064989	5.658650953	10.21042112	0.167338494	0.850997871	3.768580885	0.127127575	4.8425809	0	0	0	0.556797018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8377	YES	$325/ day (Days 1-8)	$325/ day (Days 1-8)				30% Coin DME	30% Coin Prosthetics/$0 Copay Diabetic Supplies		$325 Copay OP Hosp & Surg/$325 Copay ASC		30% Coin MRI/CT/PET/30% Coin Rad/30% Coin MRI/CT/PET/30% Coin Rad/30% Coin MRI/CT/PET/30% Coin Rad/30% Coin Rad	0		$40 Copay CORF/$40 Copay Urgent Care/$40 Copay Partial Hospitalization/$40 Copay Mental Health/$40 Copay PT & ST/$325 Copay OP Hosp & Surg/$40 Copay OP Substance Abuse/$40 Copay Cardiac Rehab/$40 Copay Cardiac Rehab	$30 Copay PCP/$30 Copay PCP/$0 Copay Immunizations/$0 Copay Physical Exams/No Coverage Supp Physical Exams	50% Coin Chiro/$40 Copay Specialists/$40 Copay Specialists/$40 Copay Specialists/$40 Copay Podiatry/$40 Copay Preventive Dental/$30 Copay Medicare Covered Vision Exams/$40 Copay Medicare Covered Hearing Exams	$40 Copay Mental Health/$40 Copay Psychiatric	$40 Copay OT/$40 Copay PT & ST	30% Coin MRI/CT/PET/30% Coin Rad	$50 ER Waived/$40 Copay Other/$40 Copay Other/$40 Copay Other/$40 Copay Other/$40 Copay Other/$40 Copay Other/$0 Copay Lab/$325 Copay ASC/$0 Copay Pap & Pelvic/$0 Copay Prostate Screen/$0 Copay Colorectal Screen/$0 Copay Bone Mass/$0 Copay Mammogram/$0 Copay Diab Monitor/$0 Copay Nutrition Ther/0/0	30% Coin Part B Rx				$30 Copay Non-Covered Vision Exams						0	0	0	0	0	0	0	0	0	0	5000	0.3798	0.0026	0	0	0	0.2935	0.0302	0	1.8263	0	0.1332	0	0	0.3566	0.3378	0.6213	0.01	0.0508	0.3332	0.0076	0.1036	0	0	0	0.0241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.5103	0	0.452547129	9.7478	0.06700381	0.816648455	0	1.912112836	2.522398099	0.259668624	0.93556569	4.747551904	0	3.432922308	0	0	1.235636996	5.99643576	10.83175019	0.177327518	0.901796932	4.101750593	0.134716268	4.946131727	0	0	0	0.580847403	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3481
H6743_003_0	2011	10																															D	D	D		T	Coin	Coin	V	V		Coin	0		V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	579.5792007	4.251279966	58.12921966	0	112.2789946	13.11661416	4.920584517	221.2281776	167.5901848	0	19.30344548	0	0	138.2311967	2773.087986	29.78457045	137.2016876	347.2404466	14.55936477	48.18713961	23.26621595	0	0	0	290.7455266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3400	$200/day (Days 1-8)	$200/day (Days 1-8)	$0 Days 1-20 & $137.50 per Days 21-100		$200 Ambul Waived	20% Coin DME	20% Coin Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$50 ER Waived/$50 ER Waived/$50 ER Waived	$200 Copay OP Hosp & Surg/$200 Copay ASC		20% Coin MRI/CT/PET/20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad/20% Coin Rad	0		$30 Copay CORF/$30 Copay Urgent Care/$30 Copay Partial Hospitalization/$30 Copay Mental Health/$30 Copay PT & ST/$200 Copay OP Hosp & Surg/$30 Copay OP Substance Abuse/$30 Copay Cardiac Rehab/$30 Copay Cardiac Rehab	$25 Copay PCP/$25 Copay PCP/$0 Copay Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	50% Coin Chiro/$30 Copay Specialists/$30 Copay Specialists/$30 Copay Specialists/$30 Copay Podiatry/$30 Copay Preventive Dental/$25 Copay Medicare Covered Vision Exams/$30 Copay Medicare Covered Hearing Exams	$30 Copay Mental Health/$30 Copay Psychiatric	$30 Copay OT/$30 Copay PT & ST	20% Coin MRI/CT/PET/20% Coin Rad	$50 ER Waived/$30 Copay Other/$30 Copay Other/$30 Copay Other/$30 Copay Other/$30 Copay Other/$30 Copay Other/$0 Copay Lab/$200 Copay ASC/$0 Copay Pap & Pelvic/$0 Copay Prostate Screen/$0 Copay Colorectal Screen/$0 Copay Bone Mass/$0 Copay Mammogram/$0 Copay Diab Monitor/$0 Copay Nutrition Ther/0/0	20% Coin Part B Rx				$25 Copay Non-Covered Vision Exams						0	0	0	0	0	0	0	0	0	0	0	200	200	137.5	0	200	0.2	0.057837352	50	200	0	0.2	0	0	81.96830171	25	0.33254835	30	30	0.2	30	0.2	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	183.8463839	183.8463839	126.3943889	0	183.8463839	0.183846384	0.05316594	45.96159597	183.8463839	0	0.183846384	0	0	75.34787931	22.98079799	0.305689058	27.57695758	27.57695758	0.183846384	27.57695758	0.183846384	0	0	0	22.98079799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5000	8.8795	0.065131871	0.612267266	0	1.720173929	2.411442082	0.261607502	0.847333343	2.567570787	0	3.548868648	0	0	0.867952294	5.3106479	9.10481729	0.315300427	0.797986255	2.676686565	0.110737892	4.277409669	0	0	0	0.556797018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9322	0	3.947955744	8.8795	0.065131871	0.612267266	0	1.720173929	2.411442082	0.261607502	0.847333343	2.567570787	0	3.548868648	0	0	0.867952294	5.3106479	9.10481729	0.315300427	0.797986255	2.676686565	0.110737892	4.277409669	0	0	0	0.556797018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9322	YES	$325/ day (Days 1-8)	$325/ day (Days 1-8)				30% Coin DME	30% Coin Prosthetics/$0 Copay Diabetic Supplies		$325 Copay OP Hosp & Surg/$325 Copay ASC		30% Coin MRI/CT/PET/30% Coin Rad/30% Coin MRI/CT/PET/30% Coin Rad/30% Coin MRI/CT/PET/30% Coin Rad/30% Coin Rad	0		$40 Copay CORF/$40 Copay Urgent Care/$40 Copay Partial Hospitalization/$40 Copay Mental Health/$40 Copay PT & ST/$325 Copay OP Hosp & Surg/$40 Copay OP Substance Abuse/$40 Copay Cardiac Rehab/$40 Copay Cardiac Rehab	$30 Copay PCP/$30 Copay PCP/$0 Copay Immunizations/$0 Copay Physical Exams/No Coverage Supp Physical Exams	50% Coin Chiro/$40 Copay Specialists/$40 Copay Specialists/$40 Copay Specialists/$40 Copay Podiatry/$40 Copay Preventive Dental/$30 Copay Medicare Covered Vision Exams/$40 Copay Medicare Covered Hearing Exams	$40 Copay Mental Health/$40 Copay Psychiatric	$40 Copay OT/$40 Copay PT & ST	30% Coin MRI/CT/PET/30% Coin Rad	$50 ER Waived/$40 Copay Other/$40 Copay Other/$40 Copay Other/$40 Copay Other/$40 Copay Other/$40 Copay Other/$0 Copay Lab/$325 Copay ASC/$0 Copay Pap & Pelvic/$0 Copay Prostate Screen/$0 Copay Colorectal Screen/$0 Copay Bone Mass/$0 Copay Mammogram/$0 Copay Diab Monitor/$0 Copay Nutrition Ther/0/0	30% Coin Part B Rx				$30 Copay Non-Covered Vision Exams						0	0	0	0	0	0	0	0	0	0	5000	0.3641	0.0027	0	0	0	0.3211	0.0348	0	1.6236	0	0.1449	0	0	0.3584	0.3206	0.5617	0.019	0.0482	0.2394	0.0067	0.0925	0	0	0	0.0243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.162	0	0.365696168	9.2435	0.067802389	0.612267266	0	1.720173929	2.73257328	0.296445715	0.847333343	4.191175196	0	3.69372811	0	0	1.226334452	5.631293189	9.666552968	0.334337576	0.846166918	2.916037614	0.117424003	4.369923716	0	0	0	0.581123101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0942
H6743_004_0	2011	10																															D	D	D		T	Coin	Coin	V	V		Coin	0		V	V	Coin	V	V	Coin	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	0	0	0	0	0	0	0	0	0	YES	826.7886739	10.99898497	721.6028665	0	164.8614563	15.27761307	7.652867381	305.7995733	216.8621387	0	26.26960765	0	0	203.3411296	3978.559763	41.99128621	97.75150565	528.1454093	26.30968073	71.6580393	38.30336567	0	0	459.4469345	290.7455266	0	0	0	0	0.284086264	0	0	0	0	0	0	0	0	0	0	1750	$175/day (Days 1-8)	$175/day (Days 1-8)	$25/day (Days 1-100)		$100 Ambul Waived	15% Coin DME	15% Coin Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$50 ER Waived/$50 ER Waived/$50 ER Waived	$175 Copay OP Hosp & Surg/$175 Copay ASC		15% Coin MRI/CT/PET/15% Coin Rad/15% Coin MRI/CT/PET/15% Coin Rad/15% Coin MRI/CT/PET/15% Coin Rad/15% Coin Rad	0		$25 Copay CORF/$25 Copay Urgent Care/$25 Copay Partial Hospitalization/$25 Copay Mental Health/$25 Copay PT & ST/$175 Copay OP Hosp & Surg/$25 Copay OP Substance Abuse/$25 Copay Cardiac Rehab/$25 Copay Cardiac Rehab	$20 Copay PCP/$20 Copay PCP/$0 Copay Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	50% Coin Chiro/$25 Copay Specialists/$25 Copay Specialists/$25 Copay Specialists/$25 Copay Podiatry/$25 Copay Preventive Dental/$20 Copay Medicare Covered Vision Exams/$25 Copay Medicare Covered Hearing Exams	$25 Copay Mental Health/$25 Copay Psychiatric	$25 Copay OT/$25 Copay PT & ST	15% Coin MRI/CT/PET/15% Coin Rad	$50 ER Waived/$25 Copay Other/$25 Copay Other/$25 Copay Other/$25 Copay Other/$25 Copay Other/$25 Copay Other/$0 Copay Lab/$175 Copay ASC/$0 Copay Pap & Pelvic/$0 Copay Prostate Screen/$0 Copay Colorectal Screen/$0 Copay Bone Mass/$0 Copay Mammogram/$0 Copay Diab Monitor/$0 Copay Nutrition Ther/0/0	15% Coin Part B Rx			"$25 Copay, $250 Benefit/No Coverage Supp Comp Dental"	$20 Copay Non-Covered Vision Exams					50% Coin Supp Chiro/No Coverage Supp Podiatry/$25 Copay Acupuncture/No Coverage OTC/No Coverage Meals/	0	0	0	0	0	0	0	0	0	0	0	175	175	25	0	100	0.15	0.032963812	50	175	0	0.15	0	0	65.09660284	20	0.279290683	25	25	0.15	25	0.15	0	0	25	20	0	0	0	0	0.530909548	0	0	0	0	0	0	0	0	0	0	YES	148.72153	148.72153	21.24593286	0	84.98373143	0.127475597	0.028013878	42.49186572	148.72153	0	0.127475597	0	0	55.32152213	16.99674629	0.237351644	21.24593286	21.24593286	0.127475597	21.24593286	0.127475597	0	0	21.24593286	16.99674629	0	0	0	0	0.451186744	0	0	0	0	0	0	0	0	0	0	3000	10.2468	0.136315489	1.277593838	0	1.167545144	1.947522849	0.214386492	1.082832867	2.687672423	0	3.348733922	0	0	0.9374284	5.63521424	9.966700824	0.173068494	0.935078492	3.353842261	0.126870158	4.882744412	0	0	0.813448227	0.411810662	0	0	0	0	0.128175957	0	0	0	0	0	0	0	0	0	0	49.4738	0	8.741805374	10.2468	0.136315489	1.277593838	0	1.167545144	1.947522849	0.214386492	1.082832867	2.687672423	0	3.348733922	0	0	0.9374284	5.63521424	9.966700824	0.173068494	0.935078492	3.353842261	0.126870158	4.882744412	0	0	0.813448227	0.411810662	0	0	0	0	0.128175957	0	0	0	0	0	0	0	0	0	0	49.4738	YES	$300/day (Days 1-8)	$300/day (Days 1-8)				25% Coin DME	25% Coin Prosthetics/$0 Copay Diabetic Supplies		$300 Copay OP Hosp & Surg/$300 Copay ASC		20% Coin MRI/CT/PET/20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad/20% Coin MRI/CT/PET/20% Coin Rad/20% Coin Rad	0		$30 Copay CORF/$25 Copay Urgent Care/$30 Copay Partial Hospitalization/$30 Copay Mental Health/$30 Copay PT & ST/$300 Copay OP Hosp & Surg/$30 Copay OP Substance Abuse/$30 Copay Cardiac Rehab/$30 Copay Cardiac Rehab	$25 Copay PCP/$25 Copay PCP/$0 Copay Immunizations/$0 Copay Physical Exams/No Coverage Supp Physical Exams	50% Coin Chiro/$30 Copay Specialists/$30 Copay Specialists/$30 Copay Specialists/$30 Copay Podiatry/$30 Copay Preventive Dental/$25 Copay Medicare Covered Vision Exams/$30 Copay Medicare Covered Hearing Exams	$30 Copay Mental Health/$30 Copay Psychiatric	$30 Copay OT/$30 Copay PT & ST	20% Coin MRI/CT/PET/20% Coin Rad	$50 ER Waived/$30 Copay Other/$30 Copay Other/$30 Copay Other/$30 Copay Other/$30 Copay Other/$30 Copay Other/$0 Copay Lab/$300 Copay ASC/$0 Copay Pap & Pelvic/$0 Copay Prostate Screen/$0 Copay Colorectal Screen/$0 Copay Bone Mass/$0 Copay Mammogram/$0 Copay Diab Monitor/$0 Copay Nutrition Ther/0/0	20% Coin Part B Rx				$25 Copay Non-Covered Vision Exams						0	0	0	0	0	0	0	0	0	0	3000	0.3378	0.0045	0	0	0	0.2594	0.0285	0	1.3666	0	0.1367	0	0	0.3002	0.3402	0.6161	0.0104	0.0565	0.2999	0.0077	0.1056	0	0	0	0.018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.8881	0	0.687006602	10.5846	0.140809407	1.277593838	0	1.167545144	2.206874027	0.242936293	1.082832867	4.054285519	0	3.485424186	0	0	1.237619142	5.975456133	10.58277099	0.18351799	0.991536483	3.653745012	0.1345303	4.988350955	0	0	0.813448227	0.42980239	0	0	0	0	0.128175957	0	0	0	0	0	0	0	0	0	0	53.3618
H6743_005_0	2011	9																															D	D	D		T	Coin	Coin	V	V		Coin	0		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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	755.720069	5.908831367	479.5456228	0	160.6250449	18.71912954	7.363331307	357.4071059	249.2188499	0	15.17246684	0	0	231.3449203	4051.793067	6333.409498	88.9900904	503.5170367	6.777023194	73.28710037	0	0	0	459.4469345	290.7455266	0	21.37221617	0	0	142.4147387	0	0	0	0	0	0	0	0	0	0	1300	$150/day (Days 1-8)	$150/day (Days 1-8)	$20/day (Days 1-100)		$50 Ambul Waived	10% Coin DME	10% Coin Prosthetics/$0 Copay Diabetic Supplies	$50 ER Waived/$50 ER Waived/$50 ER Waived/$50 ER Waived	$75 Copay OP Hosp & Surg/$75 Copay ASC		10% Coin MRI/CT/PET/$0 Copay Rad/10% Coin MRI/CT/PET/$0 Copay Rad/10% Coin MRI/CT/PET/$0 Copay Rad/$0 Copay Rad	0		$15 Copay CORF/$15 Copay Urgent Care/$15 Copay Partial Hospitalization/$15 Copay Mental Health/$15 Copay PT & ST/$75 Copay OP Hosp & Surg/$15 Copay OP Substance Abuse/$15 Copay Cardiac Rehab/$15 Copay Cardiac Rehab	$10 Copay PCP/$10 Copay PCP/$0 Copay Immunizations/$0 Copay Physical Exams/$0 Copay Supp Physical Exams	$15 Copay Chiro/$15 Copay Specialists/$15 Copay Specialists/$15 Copay Specialists/$15 Copay Podiatry/$15 Copay Preventive Dental/$10 Copay Medicare Covered Vision Exams/$15 Copay Medicare Covered Hearing Exams	$15 Copay Mental Health/$15 Copay Psychiatric	$15 Copay OT/$15 Copay PT & ST	10% Coin MRI/CT/PET/$0 Copay Rad	$50 ER Waived/$15 Copay Other/$15 Copay Other/$15 Copay Other/$15 Copay Other/$15 Copay Other/$15 Copay Other/$0 Copay Lab/$75 Copay ASC/$0 Copay Pap & Pelvic/$0 Copay Prostate Screen/$0 Copay Colorectal Screen/$0 Copay Bone Mass/$0 Copay Mammogram/$0 Copay Diab Monitor/$0 Copay Nutrition Ther/0/0				"$15 Copay, $500 Benefit/No Coverage Supp Comp Dental"	$10 Copay Non-Covered Vision Exams		$15 Copay Non-Covered Hearing Exams			$15 Copay Supp Chiro/$15 Copay Podiatry/$15 Copay Acupuncture/No Coverage OTC/No Coverage Meals/	0	0	0	0	0	0	0	0	0	0	0	150	150	20	0	50	0.1	0.022989711	50	75	0	0.1	0	0	29.06330762	10	14.67891634	15	15	0.1	15	0	0	0	15	10	0	15	0	0	15	0	0	0	0	0	0	0	0	0	0	YES	136.4465177	136.4465177	18.19286903	0	45.48217257	0.090964345	0.02091244	45.48217257	68.22325885	0	0.090964345	0	0	26.43724746	9.096434514	13.35258012	13.64465177	13.64465177	0.090964345	13.64465177	0	0	0	13.64465177	9.096434514	0	13.64465177	0	0	13.64465177	0	0	0	0	0	0	0	0	0	0	2500	8.5929	0.067186622	0.727025892	0	0.608798001	1.702773361	0.153985223	1.354637639	1.416876843	0	1.38015351	0	0	0.509676909	3.071405858	7.047279813	0.101186566	0.572526219	0.616467477	0.083331414	0	0	0	0.522416119	0.220395637	0	0.024301371	0	0	0.161933293	0	0	0	0	0	0	0	0	0	0	28.9353	0	2.874196837	8.5929	0.067186622	0.727025892	0	0.608798001	1.702773361	0.153985223	1.354637639	1.416876843	0	1.38015351	0	0	0.509676909	3.071405858	7.047279813	0.101186566	0.572526219	0.616467477	0.083331414	0	0	0	0.522416119	0.220395637	0	0.024301371	0	0	0.161933293	0	0	0	0	0	0	0	0	0	0	28.9353	YES	$250/ day (Days 1-8)	$250/ day (Days 1-8)				25% Coin DME	25% Coin Prosthetics/$0 Copay Diabetic Supplies		$150 Copay OP Hosp & Surg/$150 Copay ASC		15% Coin MRI/CT/PET/$0 Copay Rad/15% Coin MRI/CT/PET/$0 Copay Rad/15% Coin MRI/CT/PET/$0 Copay Rad/$0 Copay Rad	0		$25 Copay CORF/$25 Copay Urgent Care/$25 Copay Partial Hospitalization/$25 Copay Mental Health/$25 Copay PT & ST/$150 Copay OP Hosp & Surg/$25 Copay OP Substance Abuse/$25 Copay Cardiac Rehab/$25 Copay Cardiac Rehab	$20 Copay PCP/$20 Copay PCP/$0 Copay Immunizations/$0 Copay Physical Exams/No Coverage Supp Physical Exams	$25 Copay Chiro/$25 Copay Specialists/$25 Copay Specialists/$25 Copay Specialists/$25 Copay Podiatry/$25 Copay Preventive Dental/$20 Copay Medicare Covered Vision Exams/$25 Copay Medicare Covered Hearing Exams	$25 Copay Mental Health/$25 Copay Psychiatric	$25 Copay OT/$25 Copay PT & ST	15% Coin MRI/CT/PET/$0 Copay Rad	$50 ER Waived/$25 Copay Other/$25 Copay Other/$25 Copay Other/$25 Copay Other/$25 Copay Other/$25 Copay Other/$0 Copay Lab/$150 Copay ASC/$0 Copay Pap & Pelvic/$0 Copay Prostate Screen/$0 Copay Colorectal Screen/$0 Copay Bone Mass/$0 Copay Mammogram/$0 Copay Diab Monitor/$0 Copay Nutrition Ther/0/0					$20 Copay Non-Covered Vision Exams						0	0	0	0	0	0	0	0	0	0	2500	0.2833	0.0022	0	0	0	0.2268	0.0205	0	0.7204	0	0.0563	0	0	0.1392	0.1854	0.4255	0.0061	0.0346	0.0551	0.005	0	0	0	0	0.0096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.1702	0	0.215569624	8.8762	0.069401566	0.727025892	0	0.608798001	1.929531305	0.1744914	1.354637639	2.137322695	0	1.436489293	0	0	0.648922464	3.256850616	7.472779132	0.107295989	0.607094098	0.671592399	0.088362782	0	0	0	0.522416119	0.230024573	0	0.024301371	0	0	0.161933293	0	0	0	0	0	0	0	0	0	0	31.1055
H6815_001_0	2011	5																															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	701.4752869	19.25907086	470.7794662	27.48038475	175.8450737	12.02081957	3.275892824	276.523283	335.5539195	10.56793976	20.41586278	0	0.018640076	447.8099217	3218.431324	4112.744486	90.47776981	125.1274496	15.30743164	15.27014008	5.997519459	250	0	0	0	0	0	0	1650	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 1-8/9-90	2:  Skilled Nursing Services - $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) - $175/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - 0%-20%/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 - $15/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/visit/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $15/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14c:  Routine Exams - $0/visit	7d:  Physician Specialist Services - $15/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $15/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $15/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							7b: Routine Chiro - $15/service/7g: Naturopathy - $15/service/13b: Acupuncture - $15/service/14a:  Nursing Hotline - $0/service/14a:  Smoking Cessation - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/													200	200	100	0	125	0.2	0.052463811	46.77170785	172.9526193	0	0.185465582	0	0.2	25	15	16.129575	25	25	0	0.003049478	0.2	0	0	0	0	0	0	0	5.909090909	0											NO	170.0662927	170.0662927	85.03314633	0	106.2914329	0.170066293	0.044611629	39.77145478	147.0670538	0	0.15770722	0	0.170066293	21.25828658	12.75497195	13.71548511	21.25828658	21.25828658	0	0.002593067	0.170066293	0	0	0	0	0	0	0	5.909090909	0												9.9414	0.272943232	3.33598827	0	1.557568738	2.044336219	0.146142916	0.916477771	4.112410528	0	3.21972896	0	0.003170049	0.793305971	3.420916772	4.700690481	0.16028353	0.221666265	0	0.039596495	1.0199759	0	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	36.7191	0	6.32	9.9414	0.272943232	3.33598827	0	1.557568738	2.044336219	0.146142916	0.916477771	4.112410528	0	3.21972896	0	0.003170049	0.793305971	3.420916772	4.700690481	0.16028353	0.221666265	0	0.039596495	1.0199759	0	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	36.7191	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.9414	0.272943232	3.33598827	0	1.557568738	2.044336219	0.146142916	0.916477771	4.112410528	0	3.21972896	0	0.003170049	0.793305971	3.420916772	4.700690481	0.16028353	0.221666265	0	0.039596495	1.0199759	0	0	0	0	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	36.7191
H6864_001_0	2011	7																															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	546.214316	5.114380357	71.51332195	0	5.428716085	5.71727092	15.54094204	14.39763487	55.47233893	23.03715317	40.78949837	21.77438801	0.706196368	20.49919638	48.3424284	87.14577299	3.844609929	5.306488652	28.8554378	73.14307505	47.27706632	11.43533903	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	PBP 10b	"PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	PBP 13b											0	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											YES	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											6700	33.6288	0.314877638	10.34359456	0	1.264890848	1.332124124	3.621039496	3.354648925	12.92505497	5.367656688	9.503953121	5.073432406	0.164543754	4.776312756	11.26378582	20.30496511	0.895794114	1.236411856	6.723317008	17.04233649	11.01555645	2.664433995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	162.8176	0	0	33.6288	0.314877638	10.34359456	0	1.264890848	1.332124124	3.621039496	3.354648925	12.92505497	5.367656688	9.503953121	5.073432406	0.164543754	4.776312756	11.26378582	20.30496511	0.895794114	1.236411856	6.723317008	17.04233649	11.01555645	2.664433995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	162.8176	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b												11.4265	0.144	5.2544	0	2.7809	1.0646	1.4777	1.196	3.8101	0.4753	2.0159	0.9985	0.0324	1.046	5.5494	10.7856	0.2129	0.7564	3.7388	9.7974	5.5522	1.5268	0	0	0	0	0	0	0	0											69.6418	0	0	45.0553	0.458837783	15.59801981	0	4.045756227	2.396698493	5.098777447	4.550611788	16.73519431	5.842971671	11.51981616	6.071885637	0.196926021	5.82228105	16.81322473	31.09057846	1.108731606	1.992834111	10.46209845	26.83978379	16.56779978	4.191218852	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	232.4594
H6881_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	O	V	V	V	V	P	P	Coin	O	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	1162.581517	55.90827493	784.9832519	123.5467822	285.1488632	6.53330968	13.83407994	260.0869635	247.1577849	595.6442481	16.10136251	51.41603555	0	341.8715346	3850.440977	9070.887983	237.5092564	540.3496498	0	0	30.15800933	15.05842311	9.291367452	425	410.1055051	37.68940493	26.8676946	0	500	0											3400	1a1: $169.02	1b1: $118.23	21: $40.74	6: $10	10a: $100	11a: 20.0%	"11b: 20.0%,11c: 20.0%"	"4a1: $50,4a2: $500,4b: $44"	"9a1: $250,9b: $100"	"8a1: $15,8a2: $15"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: $225,9a2: $250"	12: 20.0%	"3: $30,9a3: $250,9c: $30,9d1: $30"	7a: $10	"7b1: $30,7d1: $30,7f1: $30,7g: $30,17b1: $10"	"7c: $35,7i: $35"	"7e: $30,7h: $30"	7d2: $30	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16a1: $1.225	$0 	17b2: $10	$0 	$0 	$0 	$0 												169.02	118.23	40.74	10	100	0.2	0.2	49.77803468	181.5693431	15	0.2	250	0	149.3252469	6.586262029	27.07782493	30	35	0	0	0.2	0	0	1.225	0	10	0	0	0	0											NO	156.2535313	109.2998166	37.66281426	9.24467704	92.4467704	0.184893541	0.184893541	46.01818543	167.8549937	13.86701556	0.184893541	231.116926	0	138.0463682	6.088786537	25.03257464	27.73403112	32.35636964	0	0	0.184893541	0	0	1.132472937	0	9.24467704	0	0	0	0												15.1381	0.50923035	2.463723201	0.095179175	2.196757624	1.20796676	2.557832023	0.997394176	3.45722237	0.688317338	2.977037927	0.990259674	0	3.932843646	1.953709432	18.92230671	0.548924092	1.456979417	0	0	5.576021128	0	0	0.040108417	0	0.029035531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.739		5.371107517	15.1381	0.50923035	2.463723201	0.095179175	2.196757624	1.20796676	2.557832023	0.997394176	3.45722237	0.688317338	2.977037927	0.990259674	0	3.932843646	1.953709432	18.92230671	0.548924092	1.456979417	0	0	5.576021128	0	0	0.040108417	0	0.029035531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.739	YES	1a1: 20.0%	1b1: 20.0%	21: 20.0%	6: 20.0%	10a: 20.0%	11a: 30.0%	"11b: 30.0%,11c: 20.0%"	"4a1: 20.0%,4b: 20.0%"	"9a1: 20.0%,9b: 20.0%"	"8a1: 20.0%,8a2: 20.0%"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: 20.0%,9a2: 20.0%"	12: 20.0%	"3: 20.0%,9a3: 20.0%,9c: 20.0%,9d1: 20.0%"	"7a: 20.0%,14i: 20.0%,14j: 20.0%"	"7b1: 20.0%,7d1: 20.0%,7f1: 20.0%,7g: 20.0%,17a1: 50.0%,17b1: 50.0%,18a1: 50.0%"	"7c: 20.0%,7i: 20.0%"	"7e: 20.0%,7h: 20.0%"	7d2: 20.0%	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	13a1: 20.0%	$0 	16b1: 50.0%	17a2: 50.0%	17b2: 50.0%	18a2: 50.0%	18b: 50.0%	$0 	$0 											5100	4.1207	0.0635	0.575	0.3518	0.1155	0.2074	0.3932	0.2308	0.7066	0.1336	0.3408	0.0412	0	0.095	0.7871	2.2079	0.0339	0.0453	0	0	0.6383	0.0052	0	0	0.0183	0.0012	0.0007	0	0	0											11.113	2000	0.966425741	19.2588	0.572715471	3.038768138	0.447023071	2.312300217	1.415373416	2.950988685	1.228185959	4.163869258	0.821944481	3.317807504	1.031416554	0	4.027806465	2.740825198	21.13024466	0.582841868	1.502235927	0	0	6.214285876	0.005179967	0	0.040108417	0.018305203	0.030282257	0.000735175	0	0	0	0	0	0	0	0	0	0	0	0	0	76.852
H6881_002_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	O	V	V	V	V	P	P	Coin	O	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	1162.581517	55.90827493	784.9832519	123.5467822	285.1488632	7.465403351	15.80775928	260.0869635	247.1577849	595.6442481	18.39851034	51.41603555	0	341.8715346	3850.440977	9070.887983	237.5092564	540.3496498	0	0	34.46058964	15.05842311	9.291367452	0	410.1055051	37.68940493	26.8676946	0	500	0											3400	1a1: $169.02	1b1: $118.23	21: $40.74	6: $10	10a: $100	11a: 20.0%	"11b: 20.0%,11c: 20.0%"	"4a1: $50,4a2: $500,4b: $44"	"9a1: $250,9b: $100"	"8a1: $15,8a2: $15"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: $225,9a2: $250"	12: 20.0%	"3: $30,9a3: $250,9c: $30,9d1: $30"	7a: $10	"7b1: $30,7d1: $30,7f1: $30,7g: $30,17b1: $10"	"7c: $35,7i: $35"	"7e: $30,7h: $30"	7d2: $30	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16a1: $1.225	$0 	17b2: $10	$0 	$0 	$0 	$0 												169.02	118.23	40.74	10	100	0.2	0.2	49.77803468	181.5693431	15	0.2	250	0	170.4033091	6.586262029	27.08748783	30	35	0	0	0.2	0	0	0	0	10	0	0	0	0											NO	155.5154923	108.7835561	37.48491987	9.20101126	92.0101126	0.184020225	0.184020225	45.80082576	167.062157	13.80151689	0.184020225	230.0252815	0	156.7882766	6.060027109	24.92322806	27.60303378	32.20353941	0	0	0.184020225	0	0	0	0	9.20101126	0	0	0	0												15.0666	0.50682508	2.452086192	0.094729611	2.186381584	1.373785206	2.908947422	0.992683141	3.440892723	0.685066179	3.385698015	0.985582338	0	4.466787394	1.944481392	18.83965082	0.546331336	1.450097604	0	0	6.341445467	0	0	0	0	0.028898387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.697		5.878607354	15.0666	0.50682508	2.452086192	0.094729611	2.186381584	1.373785206	2.908947422	0.992683141	3.440892723	0.685066179	3.385698015	0.985582338	0	4.466787394	1.944481392	18.83965082	0.546331336	1.450097604	0	0	6.341445467	0	0	0	0	0.028898387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.697	YES	1a1: 20.0%	1b1: 20.0%	21: 20.0%	6: 20.0%	10a: 20.0%	11a: 30.0%	"11b: 30.0%,11c: 20.0%"	"4a1: 20.0%,4b: 20.0%"	"9a1: 20.0%,9b: 20.0%"	"8a1: 20.0%,8a2: 20.0%"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: 20.0%,9a2: 20.0%"	12: 20.0%	"3: 20.0%,9a3: 20.0%,9c: 20.0%,9d1: 20.0%"	"7a: 20.0%,14b1: 20.0%,14c1: 20.0%,14d1: 20.0%,14e1: 20.0%,14f1: 20.0%,14g1: 20.0%,14h1: 20.0%,14i: 20.0%,14j: 20.0%"	"7b1: 20.0%,7d1: 20.0%,7f1: 20.0%,7g: 20.0%,17a1: 50.0%,17b1: 50.0%,18a1: 50.0%"	"7c: 20.0%,7i: 20.0%"	"7e: 20.0%,7h: 20.0%"	7d2: 20.0%	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	"13a1: 20.0%,14a: 20.0%"	$0 	16b1: 50.0%	17a2: 50.0%	17b2: 50.0%	18a2: 50.0%	18b: 50.0%	$0 	$0 											5100	4.7082	0.0725	0.6571	0.402	0.132	0.237	0.4492	0.2637	0.8075	0.1527	0.3894	0.047	0	0.1085	0.9764	2.5229	0.0388	0.0517	0	0	0.7293	0.0059	0	0	0.0209	0.0014	0.0008	0	0	0											12.7752	2000	1.109358127	19.7748	0.579362138	3.109171591	0.496740675	2.318408398	1.610782138	3.358194926	1.256401506	4.248355449	0.837757628	3.775084478	1.032610985	0	4.575298362	2.920926919	21.36258925	0.58508809	1.501810765	0	0	7.070770115	0.005918983	0	0	0.020916059	0.030322932	0.000840033	0	0	0	0	0	0	0	0	0	0	0	0	0	80.4722
H6900_001_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							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	YES	1269.270417	63.90880762	513.8578895	510.4206114	45.35364505	11.48940929	3.427908995	346.147152	457.7363133	1772.266995	1062.066259	68.75791284	0.78799596	4.467379584	3650.945179	3512.317757	78.08863192	891.9323638		1396.104297	27.8886718	0							4.1	0.56	1132.429015	789.5193594									6700	$220/Day(Days 1-7):1a.IP Acute	$220/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										158.0964	135.35258	32.5726	0	150	0.2	0.2	50	183.375353	36.320557	112.117268	150	0.193927	0.2	10	32.55997	35	85.67881		0	0.2	0							0	0	0	128.983374									NO	147.192649	126.017448	28.171814	0	137.39055	0.183187	0.183187	45.79685	167.960271	33.267342	102.692354	137.39055	0.177625	0.183187	9.15937	29.822881	32.057795	78.476392		0	0.183187	0							0	0	0	118.140644										15.5689	0.671135403	1.206359074	0	0.51926352	2.104710419	0.627948365	1.321037433	6.406792936	4.913217686	9.088840356	0.787223955	0.139967782	0.818365864	2.786696479	8.728952875	0.208612446	5.832969485	0	0	5.108842121	0	0	0	0	0	0	0	0	0	0	7.772860464	0	0	0	0	0	0	0	0	74.6127	0	6.638101009	15.5689	0.671135403	1.206359074	0	0.51926352	2.104710419	0.627948365	1.321037433	6.406792936	4.913217686	9.088840356	0.787223955	0.139967782	0.818365864	2.786696479	8.728952875	0.208612446	5.832969485	0	0	5.108842121	0	0	0	0	0	0	0	0	0	0	7.772860464	0	0	0	0	0	0	0	0	74.6127	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									10000	8.8406	0.1431	0.6402	2.5689	2.3686	2.3737	0.7082	0.2251	3.1215	0.4942	1.3378	0.1347	0.0243	0.2135	1.6427	2.8531	0.0367	0.4392		0.2598	1.4642	0							0	0	0.3835	0.6247									30.8982	500	7.349994427	24.4095	0.814235787	1.846528515	2.568903197	2.887828145	4.478443015	1.336160422	1.546138036	9.52825113	5.407388176	10.42668553	0.921919915	0.164308277	1.031837188	4.429443589	11.58205662	0.245276807	6.272182499	0	0.25982176	6.573014928	0	0	0	0	0	0	0	0	0	0.383547546	8.397514456	0	0	0	0	0	0	0	0	105.511
H6900_002_0	2011	6	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin					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	YES	1104.018088	84.22734326	530.4592757	499.2909843	40.11717226	10.36505941	3.452757324	375.4888931	400.3627216	2029.067627	1044.728281	80.19230912	0.26425134	5.39945628	3751.018657	3527.565058	104.1191505	798.0776739		1622.109161	19.74976377	0					0.28		4.1	0.56	1180.548667	779.4012038									6700	$220/Day(Days 1-7):1a.IP Acute	$220/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"					"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										158.0964	135.35258	32.5726	0	150	0.2	0.2	50	181.428543	19.795177	112.862575	150	0.172843	0.2	10	32.603828	35	55.181593		0	0.2	0					0		0	0	0	126.927159									NO	149.493584	127.987369	29.104465	0	139.78815	0.186384	0.186384	46.59605	169.07707	18.447541	105.179004	139.78815	0.161076	0.186384	9.31921	30.384192	32.617235	51.424885		0	0.186384	0					0		0	0	0	118.286085										13.7536	0.898336338	1.286561119	0	0.467325441	1.931881233	0.643538721	1.458024936	5.641012992	3.119275687	9.156956675	0.934161211	0.042564549	1.006372259	2.913044215	8.931851167	0.283006567	3.420087717	0	0	3.68103997	0	0	0	0	0	0	0	0	0	0	7.682693087	0	0	0	0	0	0	0	0	67.2514	0	4.744999517	13.7536	0.898336338	1.286561119	0	0.467325441	1.931881233	0.643538721	1.458024936	5.641012992	3.119275687	9.156956675	0.934161211	0.042564549	1.006372259	2.913044215	8.931851167	0.283006567	3.420087717	0	0	3.68103997	0	0	0	0	0	0	0	0	0	0	7.682693087	0	0	0	0	0	0	0	0	67.2514	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins					"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									10000	8.158	0.1942	0.62	3.2372	2.1071	2.1537	0.7174	0.2456	3.2674	0.5409	1.4521	0.213	0.0073	0.2595	1.832	2.6999	0.0481	0.4404		0.313	1.0467	0					0		0	0	0.4462	0.6568									30.6564	500	6.370756354	21.9116	1.092488023	1.906572584	3.237209782	2.574411694	4.085579409	1.360967869	1.70360435	8.908430562	3.660213343	10.60904653	1.147191146	0.049881275	1.265859105	4.745082411	11.63170954	0.331113651	3.860438774	0	0.312960853	4.727720851	0	0	0	0	0	0	0	0	0	0.446165704	8.339473456	0	0	0	0	0	0	0	0	97.9078
H6900_004_0	2011	6	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	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	YES	1261.10177	58.433301	621.245034	550.804831	44.702265	10.148365	3.144132	390.077437	411.653485	1557.864219	1033.809131	95.403208	0.408697	8.350935	3592.642877	3493.333891	99.793512	642.827575		1585.914392	20.074019	0		3.43	3.1				4.1	0.56	1132.999941	756.575549									6700	$220/Day(Days 1-7):1a.IP Acute	$220/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										158.0964	135.35258	32.5726	0	150	0.2	0.2	50	184.085226	30.381622	106.990671	150	0.172843	0.2	10	33.428061	35	70.92209		0	0.2	0		0	0				0	0	0	128.277878									NO	148.52888	127.161448	28.422232	0	139.02495	0.185367	0.185367	46.34165	170.616262	28.15869	99.162485	139.02495	0.160197	0.185367	9.26833	30.98223	32.439155	65.732934		0	0.185367	0		0	0				0	0	0	118.892171										15.6092	0.619205264	1.471430874	0	0.51789418	1.881171975	0.582818316	1.506402672	5.852898237	3.655617967	8.542923537	1.105285519	0.065472033	1.547987768	2.774816646	9.01927284	0.2697681	3.521245213	0	0	3.72106068	0	0	0	0	0	0	0	0	0	0	7.495909129	0	0	0	0	0	0	0	0	69.7604	0	5.370036088	15.6092	0.619205264	1.471430874	0	0.51789418	1.881171975	0.582818316	1.506402672	5.852898237	3.655617967	8.542923537	1.105285519	0.065472033	1.547987768	2.774816646	9.01927284	0.2697681	3.521245213	0	0	3.72106068	0	0	0	0	0	0	0	0	0	0	7.495909129	0	0	0	0	0	0	0	0	69.7604	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$150/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									10000	8.5001	0.1327	0.6566	2.4207	1.8518	2.2175	0.687	0.2012	2.4924	0.3689	1.0049	0.184	0.0089	0.3165	1.3245	2.06	0.0343	0.2179		0.2475	0.8297	0		0	0				0	0	0.4055	0.4543									26.6171	0	7.049216481	24.1093	0.75186547	2.128000962	2.420682142	2.369694458	4.098656303	1.269831729	1.707616722	8.345323689	4.024534311	9.547798143	1.289333954	0.07439701	1.864516479	4.099325113	11.07929601	0.304102963	3.739180125	0	0.247540591	4.550721603	0	0	0	0	0	0	0	0	0	0.405525533	7.950256497	0	0	0	0	0	0	0	0	96.3775
H6900_005_0	2011	5																															A	A	A	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O		V	V		V		O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0		0		0	0											0	YES	256.574424	9.197814	49.875801	582.473673	47.272448	10.344583	10600.13913	412.505164	435.32174	1647.434522	1093.248583	100.88847	0.416599	938.155887	3799.203953	3694.185139	105.531197	679.787317		1677.097456	20.462147	0		3.43	1.82		0.28		4.1	0.56											6700	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Admit(Days 1-20) $0(Days 21-100):2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$0/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a, 17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d												0	0	0	0	0	0.2	0	0	0	0	0	0	0.2	0	0	0	0	0		0	0.2	0		0	0		0		0	0											NO	0	0	0	0	0	0.199758	0	0	0	0	0	0	0.199758	0	0	0	0	0		0	0.199758	0		0	0		0		0	0												0	0	0	0	0	2.066413211	0	0	0	0	0	0	0.083218983	0	0	0	0	0	0	0	4.08747756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.2371	0	0.007556046	0	0	0	0	0	2.066413211	0	0	0	0	0	0	0.083218983	0	0	0	0	0	0	0	4.08747756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.2371	YES	30% Coins	30% Coins	30% Coins(Days 1-20) 30%(Days 21-100)	20% Coins	$0/Trip	20% Coins	20% Coins	$0/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	30% Coins		0.5	"VIS742: Vision 17a, 17b"		"HER833: Hearing 18a, 18b"		$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d											10000	9.2559	0.1445	0.7054	2.7496	0	1.8891	0.9308	0	4.2467	0.6286	1.7121	0.3136	0.0176	1.3135	2.2568	3.51	0.0585	0.3713		0.4218	1.4136	0		0	0		0		0	0											31.9393	1000	6.122611562	9.2559	0.144455844	0.705430032	2.749644242	0	3.95553745	0.930757914	0	4.246705853	0.628576552	1.71214972	0.313589888	0.10081509	1.313452477	2.256756861	3.509958941	0.05850131	0.371327167	0	0.42177105	5.501091024	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1764
H6923_001_0	2011	3																															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	1622.575603	83.1305919	1017.025319	757.3431981	215.3253111	10.38148275	0	268.7183733	354.5559504	2750.536669	2454.473562	44.64314938	1.687647346	132.8142089	3042.48586	4666.984878	249.5179542	704.0894038	0	0	237.5419336	0	0	0	1006.926661	0	50.91653852	0	0	0											3400	$300/day 1-7	$300/day 1-7	"$0/d 1-20, $130/d 21-100"	$0 per visit	$150 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$30 per visit	$50 X-ray; $250 Complex Radiology	$50 per visit	$25 per visit	$50 per visit	"$30 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$50 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$50 per visit	$50 per visit	$50 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	216.8565234	216.8565234	52.43074037	0	150	0.05	0.05	48.5	250	4.5	30	50	25	50	30	50	40	37.5	50	50	$50 	0	0	0	0	0	0	0	0	0											NO	182.2205185	182.2205185	44.05657964	0	126.0422207	0.042014074	0.042014074	40.75365135	210.0703678	3.78126662	25.20844413	42.01407355	21.00703678	42.01407355	25.20844413	42.01407355	33.61125884	31.51055517	42.01407355	42.01407355	42.01407355	0	0	0	0	0	0	0	0	0												24.6389	1.26234163	3.73388808	0	2.261673365	0.43616838	0	0.912604575	6.206808242	0.866709375	5.156121639	0.15630338	0.002954372	0.465005495	6.391361236	16.33992049	0.698884379	1.848854	0	0	0.831675356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2102	0	13.72551945	24.6389	1.26234163	3.73388808	0	2.261673365	0.43616838	0	0.912604575	6.206808242	0.866709375	5.156121639	0.15630338	0.002954372	0.465005495	6.391361236	16.33992049	0.698884379	1.848854	0	0	0.831675356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2102	NO																																																																																		0			24.6389	1.26234163	3.73388808	0	2.261673365	0.43616838	0	0.912604575	6.206808242	0.866709375	5.156121639	0.15630338	0.002954372	0.465005495	6.391361236	16.33992049	0.698884379	1.848854	0	0	0.831675356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2102
H6923_003_0	2011	3																															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	1619.904465	89.7115529	919.9539428	730.227995	215.767859	15.23981205	0	277.3527007	366.6807446	3183.268418	2619.899741	65.46382323	1.857492079	286.9331979	3453.653185	5319.685099	319.1119324	845.0871396	0	0	263.879762	0	0	0	1170.188351	89.18662173	64.31372702	10.30069216	96.41215683	0											3400	$150/day 1-5	$150/day 1-5	"$0/d 1-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $35 Urgent Care Ctr	$100 per procedure	$15 per visit	$30 X-ray; $150 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	"$15 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$30 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$50 per script	0	Not Covered	0	$0 per visit	$200.00 Every 2 Years	$0 per visit	$1000.00 Every 3 Yrs	Fitness Only	0											0	91.92581111	91.92581111	40.33133874	0	100	0.05	0.05	48.5	100	2.25	18	30	25	30	15	30	30	22.5	30	30	$50 	0	0	0	0	0	0	0	0	0											NO	79.79154557	79.79154557	35.00757637	0	86.79993639	0.043399968	0.043399968	42.09796915	86.79993639	1.952998569	15.62398855	26.03998092	21.6999841	26.03998092	13.01999046	26.03998092	26.03998092	19.52998569	26.03998092	26.03998092	43.3999682	0	0	0	0	0	0	0	0	0												10.7712	0.596518622	2.683779826	0	1.560719703	0.661407358	0	0.972998787	2.652322109	0.518076555	3.411106964	0.142056392	0.003358962	0.622644583	3.74721096	11.54370821	0.692472386	1.375378312	0	0	0.95436444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9093	0	6.525420882	10.7712	0.596518622	2.683779826	0	1.560719703	0.661407358	0	0.972998787	2.652322109	0.518076555	3.411106964	0.142056392	0.003358962	0.622644583	3.74721096	11.54370821	0.692472386	1.375378312	0	0	0.95436444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9093	NO																																																																																		0			10.7712	0.596518622	2.683779826	0	1.560719703	0.661407358	0	0.972998787	2.652322109	0.518076555	3.411106964	0.142056392	0.003358962	0.622644583	3.74721096	11.54370821	0.692472386	1.375378312	0	0	0.95436444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9093
H6923_801_0	2011	1																															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	YES	330.9012673	6.755273978	42.2718005	8.39671292	9.841786528	12.72689799	0	15.77646113	43.54128353	19.50667214	63.03035999	1.116051798	0.095705089	29.02752237	29.63987659	141.8376345	3.835421645	9.034519039	0	0	75.35222245	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.078469749	0.078469749	0.146878636	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.066287594	0.066287594	0.124076239	0	0.196827562	0.196827562	0.196827562	0.196827562	0.196827562	0.196827562	0.196827562	0.196827562	0.196827562	0.196827562	0.196827562	0.196827562	0.196827562	0.196827562	0.196827562	0.196827562	0.196827562	0.196827562	0	0	0	0	0	0	0	0												21.9346	0.447790861	5.244926036	0	1.93713485	2.505004305	0	3.105242384	8.570124692	3.839450724	12.4061121	0.219669755	0.018837399	5.713416465	5.833944652	27.91755583	0.754916692	1.778242358	0	0	14.83139425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.0584	0	21.51267888	21.9346	0.447790861	5.244926036	0	1.93713485	2.505004305	0	3.105242384	8.570124692	3.839450724	12.4061121	0.219669755	0.018837399	5.713416465	5.833944652	27.91755583	0.754916692	1.778242358	0	0	14.83139425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.0584	NO																																																																																		0			21.9346	0.447790861	5.244926036	0	1.93713485	2.505004305	0	3.105242384	8.570124692	3.839450724	12.4061121	0.219669755	0.018837399	5.713416465	5.833944652	27.91755583	0.754916692	1.778242358	0	0	14.83139425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.0584
H6923_802_0	2011	1																															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	YES	320.0055103	6.532839581	40.87989508	8.120230015	9.517720937	12.30783284	0	15.25698144	42.10757719	18.86436587	60.95492675	1.079302983	0.092553758	28.07171814	28.66390906	137.1672735	3.709130734	8.737034762	0	0	72.87106088	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.074074074	0.074074074	0.147870662	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.06245338	0.06245338	0.124672807	0	0.196447108	0.196447108	0.196447108	0.196447108	0.196447108	0.196447108	0.196447108	0.196447108	0.196447108	0.196447108	0.196447108	0.196447108	0.196447108	0.196447108	0.196447108	0.196447108	0.196447108	0.196447108	0	0	0	0	0	0	0	0												19.9854	0.407997914	5.096611253	0	1.869728749	2.417838162	0	2.997189875	8.271911746	3.705850112	11.97441905	0.212025949	0.018181918	5.514607834	5.630942026	26.94611413	0.728648004	1.716365208	0	0	14.31530914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.8092	0	20.80431979	19.9854	0.407997914	5.096611253	0	1.869728749	2.417838162	0	2.997189875	8.271911746	3.705850112	11.97441905	0.212025949	0.018181918	5.514607834	5.630942026	26.94611413	0.728648004	1.716365208	0	0	14.31530914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.8092	NO																																																																																		0			19.9854	0.407997914	5.096611253	0	1.869728749	2.417838162	0	2.997189875	8.271911746	3.705850112	11.97441905	0.212025949	0.018181918	5.514607834	5.630942026	26.94611413	0.728648004	1.716365208	0	0	14.31530914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.8092
H6952_002_0	2011	5																															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	597.0377179	1.1172	39.2659852	2189.582718	13.80723182	29.12111038	23.24032489	33.42405033	50.38539409	19.38396931	68.40415411	0	0.230335109	39.55994964	45.16612775	146.671263	0.5574	4.876161931	0	5.7321949	24.69055424	7.941544014	639.2392537	981.4342446	123.2886943	316.6668939	0	11	132	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a); $0 n/c (13a1); FFS (16b, 17a, 18a); $0 (17b)"	$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 n/c (18a1, 18a2)"	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.07014795	0.07014795	0.165749144	0	0.233	0.233	0.233	0.099709123	0.233	0.233	0.233	0	0.233	0.233	0.226574506	0.232876436	0.233	0.233	0	0.233	0.233	0.231943716	0	0	0	0	0	0	0	0											NO	0.055114424	0.055114424	0.130227165	0	0.183065376	0.183065376	0.183065376	0.078353479	0.183065376	0.183065376	0.183065376	0	0.183065376	0.183065376	0.178016941	0.182968294	0.183065376	0.183065376	0	0.183065376	0.183065376	0.182235467	0	0	0	0	0	0	0	0												32.9054	0.061573834	5.113497942	0	2.527626087	5.331067029	4.25449882	2.618890621	9.223821127	3.548533635	12.52243221	0	0.042166383	7.242057064	8.040335891	26.83619071	0.102040641	0.892656419	0	1.049366416	4.519985602	1.447230979	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.2794	0	34.99011706	32.9054	0.061573834	5.113497942	0	2.527626087	5.331067029	4.25449882	2.618890621	9.223821127	3.548533635	12.52243221	0	0.042166383	7.242057064	8.040335891	26.83619071	0.102040641	0.892656419	0	1.049366416	4.519985602	1.447230979	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.2794	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	32.9054	0.061573834	5.113497942	0	2.527626087	5.331067029	4.25449882	2.618890621	9.223821127	3.548533635	12.52243221	0	0.042166383	7.242057064	8.040335891	26.83619071	0.102040641	0.892656419	0	1.049366416	4.519985602	1.447230979	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.2794
H7002_002_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1138.54993	71.396714	343.994822	589.692711	38.791888	10.917614	3.832941	343.505228	360.944078	1053.031779	970.105585	76.513452	0.507145	6.640494	3537.615761	3728.620468	88.553329	723.879036		1905.694087	25.40304	0							4.21	0.73	1268.578583	659.009204									3900	$175/Day(Days 1-8):1a.IP Acute	$175/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$10-$100/Visit:9d. $10 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"										131.983425	115.428425	66.51235	0	100	0.2	0.2	50	125	56.988071	71.22993	50	0.2	0.2	10	35	35	10		0	0.2	0							0	0	0	65.462555									NO	115.200017	100.7502	45.4572	0	86.6616	0.173323	0.173323	43.3308	108.327	49.386774	61.728997	43.3308	0.173323	0.173323	8.66616	30.33156	30.33156	8.66616		0	0.173323	0							0	0	0	56.730898										10.9301	0.599436101	1.303086785	0	0.280147257	1.892273611	0.664336833	1.240363028	3.258332428	4.333820207	4.990303729	0.276282424	0.087899893	1.150950342	2.55479535	9.424572954	0.223830051	0.522770962	0	0	4.402931102	0	0	0	0	0	0	0	0	0	0	3.115515328	0	0	0	0	0	0	0	0	51.2517	0	8.196526858	10.9301	0.599436101	1.303086785	0	0.280147257	1.892273611	0.664336833	1.240363028	3.258332428	4.333820207	4.990303729	0.276282424	0.087899893	1.150950342	2.55479535	9.424572954	0.223830051	0.522770962	0	0	4.402931102	0	0	0	0	0	0	0	0	0	0	3.115515328	0	0	0	0	0	0	0	0	51.2517	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 7-100)	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		30% Coins	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									5800	5.3978	0.1093	0.256	2.6703	0.8589	1.9125	0.6714	0.1421	2.2866	0.271	0.9437	0.1599	0.0103	0.2018	1.432	2.4108	0.0331	0.2618		0.3294	0.8555	0							0	0	0.44	0.3714									22.0256	0	15.67021342	16.3279	0.708739455	1.559047984	2.670296797	1.139013892	3.80478337	1.335778434	1.382416639	5.544982014	4.604866716	5.933980644	0.436191023	0.098173909	1.352735916	3.986752037	11.83541837	0.256892814	0.78456727	0	0.329384626	5.258457387	0	0	0	0	0	0	0	0	0	0.439998075	3.486956067	0	0	0	0	0	0	0	0	73.2773
H7006_001_0	2011	10																															D	D			T	Coin	Coin	V	V			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	0	0	0	0	0	0	0											0	YES	478.4069801	10.87944187	0	0	154.7825234	8.873120545	5.351496143	241.8046886	264.2544498	0	0	9	0	1000.943657	3126.012892	3483.342219	87.10369	303.3417562	0	0	26.6369677	0	0	0	273.6536668	0	0	0	0	0											2000	$100/Days Custom for IP Medical; $100/Days Custom for IP Surgical; PBP 1a	$100/Days Custom for IP Psych; $100/Days Custom for IP Substance Abuse; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for DME / Medical Supplies; 10% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; $15/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$100/Visit for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	$100/Visit for Partial Hospitilization; PBP 5	No Cost-Sharing; PBP 12	"$15/Visit for OP Fac - Occ Therapy; $15/Visit for OP Fac - Physical/Speech Therapy; $15/Visit for OP Fac - CORF; $100/Visit for OP Fac - Other; $15/Visit for Prof - CORF; PBP 3, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; $15/Visit for Routine Physicals; PBP 4b, 7a, 14b-c"	"$15/Visit for Speclst Office Visits; $15/Visit for Speclst Consults; $15/Visit for Chiropractor; $15/Visit for Vision Exams; $15/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse; PBP 7e, 7h"	"$15/Visit for Occ Therapy; $15/Visit for PT/ST; PBP 7c, 7i"	"No Cost-Sharing; PBP 7d, 14g-h"	"No Cost-Sharing; PBP 7d, 7g, 14f, 14i"	10% Coinsurance for Part B Rx; 10% Coinsurance for Tx Injections; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$15/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	100	100	0	0	100	0.1	0.1	47.54674472	100	0	0	100	0	76.04409592	15	15	15	15	0	0	0.1	0	0	0	15	0	0	0	0	0											NO	93.91815048	93.91815048	0	0	93.91815048	0.09391815	0.09391815	44.65502325	93.91815048	0	0	100	0	71.41920844	14.10893113	14.08772257	14.08772257	14.08772257	0	0	0.09391815	0	0	0	15	0	0	0	0	0												3.7443	0.085148088	0	0	1.21140736	0.833347071	0.50260262	0.899816166	2.068190765	0	0	0.075	0	5.957216975	3.675391718	4.089363233	0.102257718	0.356116209	0	0	2.501694741	0	0	0	0.342067083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.4439	0	1.679533309	3.7443	0.085148088	0	0	1.21140736	0.833347071	0.50260262	0.899816166	2.068190765	0	0	0.075	0	5.957216975	3.675391718	4.089363233	0.102257718	0.356116209	0	0	2.501694741	0	0	0	0.342067083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.4439	YES	$200/Days Custom for IP Medical; $200/Days Custom for IP Surgical; PBP 1a	$200/Days Custom for IP Psych; $200/Days Custom for IP Substance Abuse; PBP 1b	$50/Day for SNF; PBP 2	$30/Visit for Home Health; PBP 6	$100/Run for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; $15/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$200/Case for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$200/Visit for Partial Hospitilization; PBP 5	No Cost-Sharing; PBP 12	"$30/Visit for OP Fac - Cardiovascular; $30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; $30/Visit for OP Fac - CORF; $200/Visit for OP Fac - Other; $30/Visit for Prof - CORF; PBP 3, 9c, 9d, 13a"	"$30/Visit for PCP Office Visits; $30/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$30/Visit for Speclst Office Visits; $30/Visit for Speclst Consults; $30/Visit for Cardio; $30/Visit for Chiropractor; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$30/Exam for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											5500	0.8034	0.0174	0.3916	0.3103	0.1286	0.1687	0.1032	0.0936	0.4241	0.1287	0.3625	0.0167	0	1.0464	0.7587	0.7905	0.021	0.0723	0.2537	0.1703	0.1382	0	0	0	0.0737	0	0	0	0	0											6.2734	0	0.592733789	4.5476	0.102499751	0.391593333	0.310267312	1.340029764	1.002049466	0.605806479	0.993379073	2.492285985	0.128671547	0.362491994	0.091666667	0	7.003655012	4.434088818	4.879891751	0.123297482	0.428370183	0.253670718	0.170335193	2.639896489	0	0	0	0.415721281	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.7173
H7006_002_0	2011	7																															D	D			T	Coin	Coin	V	V			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	0	0	0	0	0	0	0											0	YES	459.2628904	10.41132072	0	0	147.9263646	8.474635864	5.11406446	229.007725	250.0540731	0	0	9	0	948.8737721	2991.995695	3332.065697	83.29259876	289.849001	0	0	25.43521459	0	0	0	261.9209356	0	0	0	0	0											2000	$100/Days Custom for IP Medical; $100/Days Custom for IP Surgical; PBP 1a	$100/Days Custom for IP Psych; $100/Days Custom for IP Substance Abuse; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for DME / Medical Supplies; 10% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; $15/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$100/Visit for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	$100/Visit for Partial Hospitilization; PBP 5	No Cost-Sharing; PBP 12	"$15/Visit for OP Fac - Occ Therapy; $15/Visit for OP Fac - Physical/Speech Therapy; $15/Visit for OP Fac - CORF; $100/Visit for OP Fac - Other; $15/Visit for Prof - CORF; PBP 3, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; $15/Visit for Routine Physicals; PBP 4b, 7a, 14b-c"	"$15/Visit for Speclst Office Visits; $15/Visit for Speclst Consults; $15/Visit for Chiropractor; $15/Visit for Vision Exams; $15/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse; PBP 7e, 7h"	"$15/Visit for Occ Therapy; $15/Visit for PT/ST; PBP 7c, 7i"	"No Cost-Sharing; PBP 7d, 14g-h"	"No Cost-Sharing; PBP 7d, 7g, 14f, 14i"	10% Coinsurance for Part B Rx; 10% Coinsurance for Tx Injections; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$15/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	100	100	0	0	100	0.1	0.1	47.52267353	100	0	0	100	0	76.03954352	15	15	15	15	0	0	0.1	0	0	0	15	0	0	0	0	0											NO	94.34947469	94.34947469	0	0	94.34947469	0.094349475	0.094349475	44.83739283	94.34947469	0	0	100	0	71.74290986	14.17214339	14.1524212	14.1524212	14.1524212	0	0	0.094349475	0	0	0	15	0	0	0	0	0												3.6109	0.081858553	0	0	1.163064566	0.799577442	0.482509295	0.855675777	1.966039203	0	0	0.075	0	5.672913792	3.533582668	3.929733101	0.098232662	0.341838762	0	0	2.399799135	0	0	0	0.327401169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.3382	0	1.488173629	3.6109	0.081858553	0	0	1.163064566	0.799577442	0.482509295	0.855675777	1.966039203	0	0	0.075	0	5.672913792	3.533582668	3.929733101	0.098232662	0.341838762	0	0	2.399799135	0	0	0	0.327401169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.3382	YES	$200/Days Custom for IP Medical; $200/Days Custom for IP Surgical; PBP 1a	$200/Days Custom for IP Psych; $200/Days Custom for IP Substance Abuse; PBP 1b	$50/Day for SNF; PBP 2	$30/Visit for Home Health; PBP 6	$100/Run for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; $15/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$200/Case for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$200/Visit for Partial Hospitilization; PBP 5	No Cost-Sharing; PBP 12	"$30/Visit for OP Fac - Cardiovascular; $30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; $30/Visit for OP Fac - CORF; $200/Visit for OP Fac - Other; $30/Visit for Prof - CORF; PBP 3, 9c, 9d, 13a"	"$30/Visit for PCP Office Visits; $30/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$30/Visit for Speclst Office Visits; $30/Visit for Speclst Consults; $30/Visit for Cardio; $30/Visit for Chiropractor; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$30/Exam for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											5500	0.7753	0.0167	0.3684	0.3112	0.1237	0.1623	0.0993	0.0893	0.4045	0.1227	0.3458	0.0167	0	0.9982	0.7298	0.7604	0.0202	0.0695	0.244	0.1639	0.1318	0	0	0	0.0705	0	0	0	0	0											6.0243	0	0.533885177	4.3862	0.098603292	0.368384067	0.311231933	1.286792178	0.961859782	0.581785679	0.944939052	2.37056711	0.122734775	0.34576699	0.091666667	0	6.671135161	4.263407162	4.690177652	0.118471746	0.411343074	0.244017149	0.163853	2.531624399	0	0	0	0.397868339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3624
H7015_001_0	2011	8	i.6.	i.6.	i.6.	i.6.	q.						Professional	Professional	Professional	Professional	Professional						Chiropractic	Podiatry	Hearing Exams	Vision Exams	Acupuncture						A	A	D	V	T	Coin	Coin	V	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	V	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	YES	342.9114073	13.48394404	555.6314583	0	280.5419849	9.105366349	1.819750762	363.7992635	6.761680432	5.174148142	23.52233251		0.424664942	5.020377377	4099.422688	4751.294301	1.516803489	876.7083872	25.38834057	660.6293437	6.849869834			9.899441765	137.5	137.5	115				0	433.8331537	2.143094157	631.8304146	500						6700	1A IP Acute: $200 per day; days 1-8	1B IP Psych: $200 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 - $100 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 Lab - $0; D/T - 15%	8B Outpatient X-Rays - 15%; Outpatient Diagnostic Radiology - 15%; Therapeutic Radiology - 20%		12 ESRD - 20%	3 CORF - $30; 5 Partial Hosp - $0; 9D Cardiac Rehab Svcs - 20%	7A Primary Care - $0-$15; 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; 14C Routine Physical Exams - $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 - 15%; Outpatient Diagnostic Radiology - 15%; Therapeutic Radiology - 20%	7G Other Health Care - $30	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - NC	16A Preventative Dental - $0; 16B Comp Dental - $0-$150	17A Eye Exams (Routine) - $0	17B Eye Wear - $0; Eyewear every 2 years	18A Hearing Exams (Routine) - $30	18B Hearing Aids - $0 ($500 max every 3 years)	14A Health Education & Wellness - $0		7B Chiropractic Services - $30	7F Podiatry Services - $30	18A Hearing Exams (Medicare Covered) - $30	17A Eye Exams (Medicare Covered) - $30	13B Acupuncture - $5						0	847.5039411	1179.967159	50	0	100	0.2	0.2	50	0.2	0.15	0.166527099		0.2	0.097800704	15	30	0.45	30	0.16466877	30	0.2	0		0.1	0	0	30				30	30	30	30	5						NO	826.8483276	1151.208655	48.7813854	0	97.5627708	0.195125542	0.195125542	48.7813854	0.195125542	0.146344156	0.162468452		0.195125542	0.095417076	14.63441562	29.26883124	0.439032469	29.26883124	0.160655414	29.26883124	0.195125542	0		0.1	0	0	30				29.26883124	29.26883124	29.26883124	29.26883124	5							23.628	1.293569424	2.258706026	0	2.280871114	1.77668954	0.355079853	1.478886007	1.319376556	0.757206344	3.821636958	0	0.082862977	0.479029731	4.999387952	11.58873592	0.66592598	2.138352486	4.078774373	1.611320731	1.336584561	0	0	0.989944177	0	0	0.2875	0	0	0	0	1.058149114	0.005227155	1.541078148	0.208333333	0	0	0	0	0	70.0412	0	1.714372524	23.628	1.293569424	2.258706026	0	2.280871114	1.77668954	0.355079853	1.478886007	1.319376556	0.757206344	3.821636958	0	0.082862977	0.479029731	4.999387952	11.58873592	0.66592598	2.138352486	4.078774373	1.611320731	1.336584561	0	0	0.989944177	0	0	0.2875	0	0	0	0	1.058149114	0.005227155	1.541078148	0.208333333	0	0	0	0	0	70.0412	NO																																																																																		0			23.628	1.293569424	2.258706026	0	2.280871114	1.77668954	0.355079853	1.478886007	1.319376556	0.757206344	3.821636958	0	0.082862977	0.479029731	4.999387952	11.58873592	0.66592598	2.138352486	4.078774373	1.611320731	1.336584561	0	0	0.989944177	0	0	0.2875	0	0	0	0	1.058149114	0.005227155	1.541078148	0.208333333	0	0	0	0	0	70.0412
H7015_002_0	2011	7	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	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	V	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	YES	410.2844626	3.446106558	349.2387505	0	372.5839862	6.575514413	1.299334182	661.5867802	8.059430261	6.392667668	24.20900736		0.10240562	5.300039113	4184.850214	3721.203893	1.489582528	299.1226799	26.78673509	871.7545249	7.751145491			1.732161477	137.5	137.5	115				0	215.1726037	1.312171496	402.711764							6700	1A IP Acute: $200 per day; days 1-8	1B IP Psych: $200 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 - $100 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 Lab - $0; D/T - 15%	8B Outpatient X-Rays - 15%; Outpatient Diagnostic Radiology - 15%; Therapeutic Radiology - 20%		12 ESRD - 20%	3 CORF - $30; 5 Partial Hosp - $0; 9D Cardiac Rehab Svcs - 20%	7A Primary Care - $0-$15; 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; 14C Routine Physical Exams - $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 - 15%; Outpatient Diagnostic Radiology - 15%; Therapeutic Radiology - 20%	7G Other Health Care - $30	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - NC	16A Preventative Dental - $0; 16B Comp Dental - NC	17A Eye Exams (Routine) - $0	17B Eye Wear - $0; Eyewear every 2 years	18A Hearing Exams (Routine) - $30	18B Hearing Aids - $0 ($500 max every 3 years)	14A Health Education & Wellness - $0		7B Chiropractic Services - $30	7F Podiatry Services - $30	18A Hearing Exams (Medicare Covered) - $30	17A Eye Exams (Medicare Covered) - $30							0	847.5039411	1179.967159	50	0	100	0.2	0.2	50	0.2	0.15	0.166527099		0.2	0.016723051	15	30	0.45	30	0.16466877	30	0.2	0		0	0	0	30				30	30	30	30							NO	790.2129068	1100.201702	46.62001369	0	93.24002739	0.186480055	0.186480055	46.62001369	0.186480055	0.139860041	0.155269913		0.186480055	0.015592578	13.98600411	27.97200822	0.419580123	27.97200822	0.153537206	27.97200822	0.186480055	0		0	0	0	30				27.97200822	27.97200822	27.97200822	27.97200822								27.0177	0.315951025	1.356792944	0	2.894978423	1.226202288	0.24229991	2.570265396	1.502922997	0.894078763	3.758930469	0	0.019096606	0.082641272	4.877444357	8.674128822	0.624999221	0.697255172	4.112760461	2.032060394	1.445434036	0	0	0	0	0	0.2875	0	0	0	0	0.501567487	0.003058673	0.938721398	0	0	0	0	0	0	66.0768	0	4.770176735	27.0177	0.315951025	1.356792944	0	2.894978423	1.226202288	0.24229991	2.570265396	1.502922997	0.894078763	3.758930469	0	0.019096606	0.082641272	4.877444357	8.674128822	0.624999221	0.697255172	4.112760461	2.032060394	1.445434036	0	0	0	0	0	0.2875	0	0	0	0	0.501567487	0.003058673	0.938721398	0	0	0	0	0	0	66.0768	NO																																																																																		0			27.0177	0.315951025	1.356792944	0	2.894978423	1.226202288	0.24229991	2.570265396	1.502922997	0.894078763	3.758930469	0	0.019096606	0.082641272	4.877444357	8.674128822	0.624999221	0.697255172	4.112760461	2.032060394	1.445434036	0	0	0	0	0	0.2875	0	0	0	0	0.501567487	0.003058673	0.938721398	0	0	0	0	0	0	66.0768
H7015_003_0	2011	6	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	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	V	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	YES	279.8246986	9.636019172	443.1583158	0	224.8419018	5.196335804	2.45685355	282.497043	4.938229445	2.197423268	15.16794834		0.556051742	5.647142283	2041.969862	3505.285299	0.967992211	335.5802195	14.96445542	328.5670471	0.896346915			1.410039481	137.5	137.5	115				0	178.1481781	0.736821773	339.5176319							6700	1A IP Acute: $200 per day; days 1-8	1B IP Psych: $200 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 - $100 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 Lab - $0; D/T - 15%	8B Outpatient X-Rays - 15%; Outpatient Diagnostic Radiology - 15%; Therapeutic Radiology - 20%		12 ESRD - 20%	3 CORF - $30; 5 Partial Hosp - $0; 9D Cardiac Rehab Svcs - 20%	7A Primary Care - $0-$15; 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; 14C Routine Physical Exams - $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 - 15%; Outpatient Diagnostic Radiology - 15%; Therapeutic Radiology - 20%	7G Other Health Care - $30	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - NC	16A Preventative Dental - $0; 16B Comp Dental - NC	17A Eye Exams (Routine) - $0	17B Eye Wear - $0; Eyewear every 2 years	18A Hearing Exams (Routine) - $30	18B Hearing Aids - $0 ($500 max every 3 years)	14A Health Education & Wellness - $0		7B Chiropractic Services - $30	7F Podiatry Services - $30	18A Hearing Exams (Medicare Covered) - $30	17A Eye Exams (Medicare Covered) - $30							0	847.5039411	1179.967159	50	0	100	0.2	0.2	50	0.2	0.15	0.166527099		0.2	0.158741136	15	30	0.45	30	0.16466877	30	0.2	0		0	0	0	30				30	30	30	30							NO	847.5039411	1179.967159	50	0	100	0.2	0.2	50	0.2	0.15	0.166527099		0.2	0.158741136	15	30	0.45	30	0.16466877	30	0.2	0		0	0	0	30				30	30	30	30								19.7627	0.947515514	1.846492982	0	1.873682515	1.039267161	0.49137071	1.177071012	0.987645889	0.32961349	2.525874441	0	0.111210348	0.89643378	2.552462327	8.763213247	0.435596495	0.838950549	2.464178463	0.821417618	0.179269383	0	0	0	0	0	0.2875	0	0	0	0	0.445370445	0.001842054	0.84879408	0	0	0	0	0	0	49.6275	0	0	19.7627	0.947515514	1.846492982	0	1.873682515	1.039267161	0.49137071	1.177071012	0.987645889	0.32961349	2.525874441	0	0.111210348	0.89643378	2.552462327	8.763213247	0.435596495	0.838950549	2.464178463	0.821417618	0.179269383	0	0	0	0	0	0.2875	0	0	0	0	0.445370445	0.001842054	0.84879408	0	0	0	0	0	0	49.6275	NO																																																																																		0			19.7627	0.947515514	1.846492982	0	1.873682515	1.039267161	0.49137071	1.177071012	0.987645889	0.32961349	2.525874441	0	0.111210348	0.89643378	2.552462327	8.763213247	0.435596495	0.838950549	2.464178463	0.821417618	0.179269383	0	0	0	0	0	0.2875	0	0	0	0	0.445370445	0.001842054	0.84879408	0	0	0	0	0	0	49.6275
H7015_004_0	2011	7	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							0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0			0	0	0					0	0	0	0							0	YES	446.4500964	13.20463813	46.31369789	0.309825634	25.78445736	15.91615085	9.505267438	5.226691456	34.77229248	4.154695015	15.27470182		0.506819711	9.021044742	34.50790945	60.68826631	3.690159911	6.341788618	10.33246413	11.84983065	8.927051984			4.303875017	206.25	412.5					0	4.678703901	0.151367452	4.789171061							6700	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 - 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; 14C Routine Physical Exams - $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 - 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%;	15 Medicare Part B Rx Drugs - 20%	13A Blood - 20%	10B Transportation - NC	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) - NA	18B Hearing Aids - NA	14A Health Education & Wellness - $0		7B Chiropractic Services - 20%	7F Podiatry Services - 20%	18A Hearing Exams (Medicare Covered) - 20%	17A Eye Exams (Medicare Covered) - 20%							0	0.061567114	0.061567114	0.144638709	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0.2	0.199593136	0	0.2	0.4443266	0.2	0.2	0.2	0.2	0.199741119		0.1	0	0					0.2	0.2	0.2	0.2							NO	0.061487421	0.061487421	0.144451487	0	0.199741119	0.199741119	0.199741119	0.199741119	0.199741119	0.199741119	0.199741119		0.199741119	0.199334781	0	0.199741119	0.443751461	0.199741119	0.199741119	0.199741119	0.199741119	0.199741119		0.1	0	0					0.199741119	0.199741119	0.199741119	0.199741119								27.4511	0.811919142	6.690082551	0	5.150216353	3.179109773	1.89859275	1.043985198	6.945456593	0.829863429	3.050986026	0	0.101232736	1.798207979	0	12.12194219	1.63751385	1.266715952	2.063817943	2.366898427	1.783099348	0	0	0.430387502	0	0	0	0	0	0	0	0.93452955	0.030234304	0.956594384	0	0	0	0	0	0	82.5425	0	0.106651918	27.4511	0.811919142	6.690082551	0	5.150216353	3.179109773	1.89859275	1.043985198	6.945456593	0.829863429	3.050986026	0	0.101232736	1.798207979	0	12.12194219	1.63751385	1.266715952	2.063817943	2.366898427	1.783099348	0	0	0.430387502	0	0	0	0	0	0	0	0.93452955	0.030234304	0.956594384	0	0	0	0	0	0	82.5425	NO																																																																																		0			27.4511	0.811919142	6.690082551	0	5.150216353	3.179109773	1.89859275	1.043985198	6.945456593	0.829863429	3.050986026	0	0.101232736	1.798207979	0	12.12194219	1.63751385	1.266715952	2.063817943	2.366898427	1.783099348	0	0	0.430387502	0	0	0	0	0	0	0	0.93452955	0.030234304	0.956594384	0	0	0	0	0	0	82.5425
H7015_801_0	2011	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	316.282101	13.21506314	27.12389583	11.46496606	12.88477238	10.00407032	2.657339806	9.371299971	29.32517011	11.03685468	20.64913933		0.567874859	9.716152298	39.01993999	106.8183233	2.300609565	6.362875026	30.64968249	49.35747	17.37684284																				6700	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	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	0.0516	0.0516	0.1196	0	0.1965	0.1965	0.1965	0.1965	0.1965	0.1965	0.1965		0.1965	0.1965	0.1965	0.1965	0.1965	0.1965	0.1965	0.1965	0.1965																					16.3202	0.681897258	3.244017941	0	2.531857773	1.965799817	0.522167272	1.841460444	5.762395926	2.168741945	4.057555878	0	0.11158741	1.909223927	7.667418209	20.98980053	0.452069779	1.250304943	6.02266261	9.698742854	3.414549617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6124	0	17.03387529	16.3202	0.681897258	3.244017941	0	2.531857773	1.965799817	0.522167272	1.841460444	5.762395926	2.168741945	4.057555878	0	0.11158741	1.909223927	7.667418209	20.98980053	0.452069779	1.250304943	6.02266261	9.698742854	3.414549617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6124	NO																																																																																		0			16.3202	0.681897258	3.244017941	0	2.531857773	1.965799817	0.522167272	1.841460444	5.762395926	2.168741945	4.057555878	0	0.11158741	1.909223927	7.667418209	20.98980053	0.452069779	1.250304943	6.02266261	9.698742854	3.414549617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6124
H7015_802_0	2011	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	316.282101	13.21506314	27.12389583	11.46496606	12.88477238	10.00407032	2.657339806	9.371299971	29.32517011	11.03685468	20.64913933		0.567874859	9.716152298	39.01993999	106.8183233	2.300609565	6.362875026	30.64968249	49.35747	17.37684284																				6700	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	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	0.0516	0.0516	0.1196	0	0.1965	0.1965	0.1965	0.1965	0.1965	0.1965	0.1965		0.1965	0.1965	0.1965	0.1965	0.1965	0.1965	0.1965	0.1965	0.1965																					16.3202	0.681897258	3.244017941	0	2.531857773	1.965799817	0.522167272	1.841460444	5.762395926	2.168741945	4.057555878	0	0.11158741	1.909223927	7.667418209	20.98980053	0.452069779	1.250304943	6.02266261	9.698742854	3.414549617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6124	0	17.03387529	16.3202	0.681897258	3.244017941	0	2.531857773	1.965799817	0.522167272	1.841460444	5.762395926	2.168741945	4.057555878	0	0.11158741	1.909223927	7.667418209	20.98980053	0.452069779	1.250304943	6.02266261	9.698742854	3.414549617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6124	NO																																																																																		0			16.3202	0.681897258	3.244017941	0	2.531857773	1.965799817	0.522167272	1.841460444	5.762395926	2.168741945	4.057555878	0	0.11158741	1.909223927	7.667418209	20.98980053	0.452069779	1.250304943	6.02266261	9.698742854	3.414549617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6124
H7086_001_0	2011	2																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	304.7354888	19.98302088	40.37579609	0	12.85096404	6.700525198	3.852733083	53.83515026	14.57461263	6.696349293	19.19014051	0	1.209333602	47.6179	81.85305205	106.5969319	6.423941584	5.238627857	26.01039831	45.26510828	19.21377993	23.74017386	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.074913319	0.074913319	0.140752625	0	0.233	0.233	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	0.063975904	0.063975904	0.12020261	0	0.198981781	0.198981781	0.198981781	0.198981781	0.198981781	0.198981781	0.198981781	0	0.198981781	0.198981781	0.198981781	0.198981781	0.198981781	0.198981781	0.198981781	0.198981781	0.198981781	0.198981781	0	0	0	0	0	0	0	0												19.4957	1.278431826	4.853276059	0	2.557107709	1.333282436	0.76662369	10.71221407	2.900082374	1.332451507	3.818488331	0	0.240635354	9.475094537	16.28726606	21.21084733	1.278247336	1.0423915	5.175595374	9.006931853	3.823192145	4.72386207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.3117	0	20.73963601	19.4957	1.278431826	4.853276059	0	2.557107709	1.333282436	0.76662369	10.71221407	2.900082374	1.332451507	3.818488331	0	0.240635354	9.475094537	16.28726606	21.21084733	1.278247336	1.0423915	5.175595374	9.006931853	3.823192145	4.72386207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.3117	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.4957	1.278431826	4.853276059	0	2.557107709	1.333282436	0.76662369	10.71221407	2.900082374	1.332451507	3.818488331	0	0.240635354	9.475094537	16.28726606	21.21084733	1.278247336	1.0423915	5.175595374	9.006931853	3.823192145	4.72386207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.3117
H7149_001_0	2011	11																															D	COIN	D	COIN	T	COIN	COIN	V	V	O	COIN	COIN	COIN	COIN	P	COIN	P	P	COIN	COIN	COIN	V	T	COIN	COIN	COIN	COIN	COIN	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	YES	1078.204284	3.278910996	907.5717456	0	142.6726256	7.226778309	5.255756795	325.9051361	405.6240263	1830.289193	25.46905379	0.402012239	0.071844814	12.06394325	3839.259761	109.8137135	192.4902813	818.0352237	8.641784113	6.5775427	22.20817532	0	0	0	0	0	0	0	0	0											6700	1a $160 days 1-9	1b $160 days 1-9	2 $50 days 1-50	6 $0	"10a $150,"	11a 20%	11b 20%	"4a $50, 4b $40"	"9a $300, 9b $300"	"8a $0 -20%, 8b 20%, 11c $0, 11c 20%"	8b 20%/$300 Adv. Imaging; 14h $0	5 20%	12 20%	"3 20%, 9d 20%, 13a $0 , 9a 20%, 9b 20%"	7a $10; 14c $0	"17a $0 - 20%, 18a 20%, 7b $20,7d $45,7f $45, 14d - 14g $0, 14i - 14j $0, 17b 20%"	"7e $40, 7h $40, 9c $40"	"7c $45,7i $45"	"8b 20% Ther., $300 Adv. Imaging, 14h $0"	"7g $45, 14b $0, 14a $0"	"15 20%, 11c 20%"	15 20%							14a $0													143.0672204	0.110539146	48.82880638	0	150	0.2	0.2	49.11694561	300	6.851748026	0.485027734	0.2	0.2	0.193538398	9.7261479	0.134536366	40	45	0.246174761	0.000458827	0.221421283	0	0	0	0	0	0	0	0	0											NO	123.4075935	0.095349375	42.11898065	0	129.387703	0.172516937	0.172516937	42.36752514	258.775406	5.910212924	0.418377496	0.172516937	0.172516937	0.166943258	8.389626239	0.116049009	34.50338747	38.8163109	0.212346579	0.000395777	0.190994608	0	0	0	0	0	0	0	0	0												11.0882	0.312642114	3.185499733	0	1.538340275	1.246741661	0.906707066	1.150649504	8.747126842	0.901449904	10.65567895	0.06935392	0.012394447	2.013993995	2.684162869	12.7437726	0.553463896	2.646092464	1.835053295	0.002603243	4.24164174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.5356	0	10.59954852	11.0882	0.312642114	3.185499733	0	1.538340275	1.246741661	0.906707066	1.150649504	8.747126842	0.901449904	10.65567895	0.06935392	0.012394447	2.013993995	2.684162869	12.7437726	0.553463896	2.646092464	1.835053295	0.002603243	4.24164174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.5356	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.0882	0.312642114	3.185499733	0	1.538340275	1.246741661	0.906707066	1.150649504	8.747126842	0.901449904	10.65567895	0.06935392	0.012394447	2.013993995	2.684162869	12.7437726	0.553463896	2.646092464	1.835053295	0.002603243	4.24164174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.5356
H7149_801_0	2011	5																															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	YES	212.430249	3.836737864	23.44098104	0	5.540838862	7.670439432	5.854267094	16.14631823	62.34841609	11.48317679	24.6501191	1.180095707	0.145162254	12.79727132	29.31520269	118.3321591	1.262956529	6.389045254	10.2833878	8.077665907	18.96800199	0	0	0	0	0	0	0	0	0											6700	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	0.065326243	0.065326243	0.12954761	0	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0	0	0	0	0	0	0	0	0												13.8773	0.250639672	3.036723066	0	1.041155065	1.441319097	1.100050008	3.033984821	11.71562119	2.157754083	4.63189726	0.22174668	0.027276811	2.404679901	5.508492939	22.2352842	0.237316699	1.200537859	1.932306923	1.517839262	3.564195211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1361	0	19.47135064	13.8773	0.250639672	3.036723066	0	1.041155065	1.441319097	1.100050008	3.033984821	11.71562119	2.157754083	4.63189726	0.22174668	0.027276811	2.404679901	5.508492939	22.2352842	0.237316699	1.200537859	1.932306923	1.517839262	3.564195211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1361	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%																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.8773	0.250639672	3.036723066	0	1.041155065	1.441319097	1.100050008	3.033984821	11.71562119	2.157754083	4.63189726	0.22174668	0.027276811	2.404679901	5.508492939	22.2352842	0.237316699	1.200537859	1.932306923	1.517839262	3.564195211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1361
H7149_802_0	2011	4																															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	YES	212.430249	3.836737864	23.44098104	0	5.540838862	7.670439432	5.854267094	16.14631823	62.34841609	11.48317679	24.6501191	1.180095707	0.145162254	12.79727132	29.31520269	118.3321591	1.262956529	6.389045254	10.2833878	8.077665907	18.96800199	0	0	0	0	0	0	0	0	0											6700	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	0.065326243	0.065326243	0.12954761	0	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0	0	0	0	0	0	0	0	0												13.8773	0.250639672	3.036723066	0	1.041155065	1.441319097	1.100050008	3.033984821	11.71562119	2.157754083	4.63189726	0.22174668	0.027276811	2.404679901	5.508492939	22.2352842	0.237316699	1.200537859	1.932306923	1.517839262	3.564195211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1361	0	19.47135064	13.8773	0.250639672	3.036723066	0	1.041155065	1.441319097	1.100050008	3.033984821	11.71562119	2.157754083	4.63189726	0.22174668	0.027276811	2.404679901	5.508492939	22.2352842	0.237316699	1.200537859	1.932306923	1.517839262	3.564195211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1361	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%																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.8773	0.250639672	3.036723066	0	1.041155065	1.441319097	1.100050008	3.033984821	11.71562119	2.157754083	4.63189726	0.22174668	0.027276811	2.404679901	5.508492939	22.2352842	0.237316699	1.200537859	1.932306923	1.517839262	3.564195211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1361
H7149_803_0	2011	4																															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	YES	212.430249	3.836737864	23.44098104	0	5.540838862	7.670439432	5.854267094	16.14631823	62.34841609	11.48317679	24.6501191	1.180095707	0.145162254	12.79727132	29.31520269	118.3321591	1.262956529	6.389045254	10.2833878	8.077665907	18.96800199	0	0	0	0	0	0	0	0	0											6700	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	0.065326243	0.065326243	0.12954761	0	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0.187905675	0	0	0	0	0	0	0	0	0												13.8773	0.250639672	3.036723066	0	1.041155065	1.441319097	1.100050008	3.033984821	11.71562119	2.157754083	4.63189726	0.22174668	0.027276811	2.404679901	5.508492939	22.2352842	0.237316699	1.200537859	1.932306923	1.517839262	3.564195211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1361	0	19.47135064	13.8773	0.250639672	3.036723066	0	1.041155065	1.441319097	1.100050008	3.033984821	11.71562119	2.157754083	4.63189726	0.22174668	0.027276811	2.404679901	5.508492939	22.2352842	0.237316699	1.200537859	1.932306923	1.517839262	3.564195211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1361	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%																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.8773	0.250639672	3.036723066	0	1.041155065	1.441319097	1.100050008	3.033984821	11.71562119	2.157754083	4.63189726	0.22174668	0.027276811	2.404679901	5.508492939	22.2352842	0.237316699	1.200537859	1.932306923	1.517839262	3.564195211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1361
H7173_001_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	341.3368225	21.58249656	106.6866806	0	12.92440353	16.0274816	12.97989299	25.8330174	33.46097776	6.137814366	22.34851354	0	3.632198121	34.1826867	30.89327773	41.35942475	5.943357204	3.719176967	13.18154572	51.95466844	33.04364631	33.80330941	0	0	0	0	0	0	0	0											3400	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a; No Cost-Sharing PBP; 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, No Cost-Sharing PBP; 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, No Cost-Sharing PBP; 14a"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b-f											0	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	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079296727	0.079296727	0.169164138	0	0.232144502	0.232144502	0.232144502	0.232144502	0.232144502	0.232144502	0.232144502	0	0.232144502	0.232144502	0.232191292	0.232144502	0.232144502	0.232144502	0.232144502	0.232144502	0.232144502	0.232144502	0	0	0	0	0	0	0	0												27.0669	1.711421348	18.04756033	0	3.000329226	3.720691742	3.0132108	5.996992969	7.767782032	1.424859862	5.188084554	0	0.843194825	7.935322794	7.173150075	9.601363077	1.379717701	0.863386486	3.060023373	12.06099065	7.670900831	7.847252442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.3731	0	0.497425474	27.0669	1.711421348	18.04756033	0	3.000329226	3.720691742	3.0132108	5.996992969	7.767782032	1.424859862	5.188084554	0	0.843194825	7.935322794	7.173150075	9.601363077	1.379717701	0.863386486	3.060023373	12.06099065	7.670900831	7.847252442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.3731	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	27.0669	1.711421348	18.04756033	0	3.000329226	3.720691742	3.0132108	5.996992969	7.767782032	1.424859862	5.188084554	0	0.843194825	7.935322794	7.173150075	9.601363077	1.379717701	0.863386486	3.060023373	12.06099065	7.670900831	7.847252442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.3731
H7179_001_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	1970.756075	166.4403286	309.3618757		269.9923917	8.846947473	9.992559792	362.9986788	277.7139951		12.65769409	3.369570588	0.034507606	26.86659493		3964.711622	138.1448806	620.3787903	26.71930965		10.29426443			11.76442105	159.1037094		107.4870924														4950	"1a (IP Acute) 125 days 1-5, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 200 copay, 9b (OP ASC) 200 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 20 copay, 7i (PT/ST) 20 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 20 copay, 7f (Podiatry) 20 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 20 copay, 18a (Hearing Exam) 20 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 20 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 20 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 12 trips/yr	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0%coin"	18a1 (Routine Hearing Exam) 20 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 12"												77.36923009	172.0337627	49.94161658		150	0.2	0.2	48.59340078	200		0.2	0.2	0.2	0.198842943		19.88424227	40	20	0.181		0.2			0.321428571	5		20														NO	72.67894529	161.6047156	46.91405117		140.9066858	0.187875581	0.187875581	45.64756703	187.875581		0.187875581	0.187875581	0.187875581	0.186788667		18.67881785	37.57511621	18.7875581	0.170027401		0.187875581			0.321428571	5		18.7875581															11.936	2.241461831	1.209451572	0	3.170311092	1.662125397	1.877357977	1.380833877	4.347973183	0	2.378071633	0.633060032	0.006483137	5.018375462	0	6.171343851	0.432567495	0.971283548	4.543014773	0	1.93404091	0	0	3.781421048	0.066293212	0	0.168285	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9298	0	3.232011946	11.936	2.241461831	1.209451572	0	3.170311092	1.662125397	1.877357977	1.380833877	4.347973183	0	2.378071633	0.633060032	0.006483137	5.018375462	0	6.171343851	0.432567495	0.971283548	4.543014773	0	1.93404091	0	0	3.781421048	0.066293212	0	0.168285	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9298	NO																																																																																		0	0	0	11.936	2.241461831	1.209451572	0	3.170311092	1.662125397	1.877357977	1.380833877	4.347973183	0	2.378071633	0.633060032	0.006483137	5.018375462	0	6.171343851	0.432567495	0.971283548	4.543014773	0	1.93404091	0	0	3.781421048	0.066293212	0	0.168285	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9298
H7179_002_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	1745.743728	139.9612256	524.4726689		243.4276697	9.125705905	6.977812816	425.1513984	254.2182013		9.091172295	1.827455954	0.633283714	21.38824869		3473.899687	99.22892631	720.4918128	32.12829614		7.973449082			11.76442105	159.1037094		45.40360694														4950	"1a (IP Acute) 125 days 1-5, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 200 copay, 9b (OP ASC) 200 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 20 copay, 7i (PT/ST) 20 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 20 copay, 7f (Podiatry) 20 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 20 copay, 18a (Hearing Exam) 20 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 20 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 20 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 12 trips/yr	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0%coin"	18a1 (Routine Hearing Exam) 20 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 12"												77.36923009	172.0337627	49.94161658		150	0.2	0.2	49.36336019	200		0.2	0.2	0.2	0.199058957		19.89908137	39.71529668	20	0.181		0.2			0.321428571	5		20														NO	73.22384709	162.8163279	47.26578372		141.963117	0.189284156	0.189284156	46.71850986	189.284156		0.189284156	0.189284156	0.189284156	0.188393533		18.83301322	37.58738207	18.9284156	0.171302161		0.189284156			0.321428571	5		18.9284156															10.6525	1.898997733	2.065800978	0	2.879812562	1.72735154	1.32078941	1.655203316	4.009956473	0	1.720814875	0.345908458	0.119870573	4.029407744	0	5.451999894	0.310812964	1.136480706	5.503646563	0	1.50924758	0	0	3.781421048	0.066293212	0	0.071618195	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2579	0	2.627364226	10.6525	1.898997733	2.065800978	0	2.879812562	1.72735154	1.32078941	1.655203316	4.009956473	0	1.720814875	0.345908458	0.119870573	4.029407744	0	5.451999894	0.310812964	1.136480706	5.503646563	0	1.50924758	0	0	3.781421048	0.066293212	0	0.071618195	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2579	NO																																																																																		0	0	0	10.6525	1.898997733	2.065800978	0	2.879812562	1.72735154	1.32078941	1.655203316	4.009956473	0	1.720814875	0.345908458	0.119870573	4.029407744	0	5.451999894	0.310812964	1.136480706	5.503646563	0	1.50924758	0	0	3.781421048	0.066293212	0	0.071618195	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2579
H7179_003_0	2011	7																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin	T	Coin	P	P	P	P	O	V																																																			0	YES	341.1166757	23.31373036	13.80983776		11.71830423	13.23940839	10.65459065	24.53294177	37.34513519		11.54367941	2.908048906	0.217555424	14.30553406		3500.780008	6.131228856	456.1387465	27.47740319	11.56469963	11.04307674	0.468056891		13.93798932	159.1037094		86.22099201														3400	"1a (IP Acute) FFS, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 20% coin	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 20% coin, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 20% coin"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 0-20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 20% coin, 5 (Partial Hosp) 20% coin, 7c (OT) 8 copay, 7i (PT/ST) 8 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 20% coin, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 8 copay, 7b1 (Routine Chiro) 0% coin (5 visits), 7d (SPC w/Copay) 8 copay, 7f (Podiatry) 8 copay, 7f1 (Routine Podiatry) 0% coin (3 visits), 17a (Eye Exam) 8 copay, 18a (Hearing Exam) 8 copay"	"7e (MH Non-Phys) 45% coin, 7h (Psych) 45% coin"	7i (PT/ST) 8 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0-20% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 8 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 8 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 38"												0.078125102	0.078125102	0.217407633		0.2	0.2	0.2	0.2	0.2		0.2	0.2	0.2	0.2		8	0.45	8	0.181	0.07872	0.2	0.2		0.135384615	5		8														NO	0.06715591	0.06715591	0.18688241		0.171918904	0.171918904	0.171918904	0.171918904	0.171918904		0.171918904	0.171918904	0.171918904	0.171918904		6.876756163	0.386817534	6.876756163	0.155586608	0.067667281	0.171918904	0.171918904		0.135384615	5		6.876756163															22.908	1.565654775	2.580815759	0	2.01459802	2.276104581	1.831725548	4.217676464	6.420334714	0	1.984576712	0.499948581	0.03740189	2.459391737	0	2.006167541	2.371666827	0.261396245	4.275115963	0.782551775	1.89851365	0.080467828	0	1.886989318	0.066293212	0	0.049410062	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4748	0	9.885536446	22.908	1.565654775	2.580815759	0	2.01459802	2.276104581	1.831725548	4.217676464	6.420334714	0	1.984576712	0.499948581	0.03740189	2.459391737	0	2.006167541	2.371666827	0.261396245	4.275115963	0.782551775	1.89851365	0.080467828	0	1.886989318	0.066293212	0	0.049410062	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4748	NO																																																																																		0	0	0	22.908	1.565654775	2.580815759	0	2.01459802	2.276104581	1.831725548	4.217676464	6.420334714	0	1.984576712	0.499948581	0.03740189	2.459391737	0	2.006167541	2.371666827	0.261396245	4.275115963	0.782551775	1.89851365	0.080467828	0	1.886989318	0.066293212	0	0.049410062	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4748
H7179_007_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	1679.160694	100.137491	893.2176183		109.7683945	13.46992779	7.801889227	375.9726983	240.8448274		12.96420865	5.279475882	0.043107827	19.65130504		3477.021899	142.7818932	531.7318936	23.60322905		9.014381074	1.262890232		11.76442105	159.1037094		130.0133609														4950	"1a (IP Acute) 125 days 1-5, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 200 copay, 9b (OP ASC) 200 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 20 copay, 7i (PT/ST) 20 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 20 copay, 7f (Podiatry) 20 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 20 copay, 18a (Hearing Exam) 20 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 20 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 20 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 12 trips/yr	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0%coin"	18a1 (Routine Hearing Exam) 20 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 12"												77.36923009	172.0337627	49.94161658		150	0.2	0.2	48.42190743	200		0.2	0.2	0.2	0.198261482		19.95026151	40	20	0.181		0.2	20		0.321428571	5		20														NO	73.35642055	163.1111106	47.35135951		142.2201445	0.189626859	0.189626859	45.91047114	189.6268593		0.189626859	0.189626859	0.189626859	0.187978511		18.91552716	37.92537186	18.96268593	0.171612308		0.189626859	18.96268593		0.321428571	5		18.96268593															10.2648	1.361128114	3.524589047	0	1.300939743	2.554260102	1.479447751	1.438423643	3.805887351	0	2.45836217	1.00113043	0.008174402	3.694023056	0	5.480808514	0.4512547	0.840255408	4.050604606	0	1.709368772	0.001995649	0	3.781421048	0.066293212	0	0.205450211	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4786	0	2.496141396	10.2648	1.361128114	3.524589047	0	1.300939743	2.554260102	1.479447751	1.438423643	3.805887351	0	2.45836217	1.00113043	0.008174402	3.694023056	0	5.480808514	0.4512547	0.840255408	4.050604606	0	1.709368772	0.001995649	0	3.781421048	0.066293212	0	0.205450211	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4786	NO																																																																																		0	0	0	10.2648	1.361128114	3.524589047	0	1.300939743	2.554260102	1.479447751	1.438423643	3.805887351	0	2.45836217	1.00113043	0.008174402	3.694023056	0	5.480808514	0.4512547	0.840255408	4.050604606	0	1.709368772	0.001995649	0	3.781421048	0.066293212	0	0.205450211	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4786
H7179_010_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	P	P	P	P	P	O	V																																																			0	YES	1525.437489	124.9051603	352.3577232		59.93302145	6.811325543	7.536569747	246.4231979	357.6772233		10.78027582	1.965420217	0.075665792	15.69057569		4534.443236	227.1267432	640.7588702	29.82082984		14.08697771				159.1037094																4950	"1a (IP Acute) 150 days 1-7, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 300 copay, 9b (OP ASC) 300 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 35 copay, 7i (PT/ST) 35 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 35 copay, 7f (Podiatry) 35 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 35 copay, 18a (Hearing Exam) 35 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 35 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 35 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 12 trips/yr	"16a Preventive - 'Limited"" Plan; 16b Comprehensive n/a"	17a1 (Routine Eye Exam) 25 copay	"17b1 (Non MCR Covered) 100 allowance, 0%coin"	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												108.723085	172.0337627	49.94161658		150	0.2	0.2	46	300		0.2	0.2	0.2	0.196209256		34.61091741	40	35	0.181		0.2				25																NO	100.8500606	159.5761874	46.32516689		139.1379677	0.18551729	0.18551729	42.66897675	278.2759354		0.18551729	0.18551729	0.18551729	0.182001047		32.10461805	37.10345805	32.46552579	0.167893148		0.18551729				25																	12.82	1.660990772	1.360252528	0	0.694913233	1.263618658	1.398163997	0.876218809	8.294413656	0	1.999927557	0.364619433	0.014037313	2.855701212	0	12.13138068	0.702265632	1.733547802	5.006712988	0	2.613377933	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1216	0	4.355351434	12.82	1.660990772	1.360252528	0	0.694913233	1.263618658	1.398163997	0.876218809	8.294413656	0	1.999927557	0.364619433	0.014037313	2.855701212	0	12.13138068	0.702265632	1.733547802	5.006712988	0	2.613377933	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1216	NO																																																																																		0	0	0	12.82	1.660990772	1.360252528	0	0.694913233	1.263618658	1.398163997	0.876218809	8.294413656	0	1.999927557	0.364619433	0.014037313	2.855701212	0	12.13138068	0.702265632	1.733547802	5.006712988	0	2.613377933	0	0	0	0.331466061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1216
H7179_011_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	1585.600417	129.831393	366.2546362		62.29676696	7.11098391	7.868134606	256.142076	371.7839363		11.25454471	2.051887177	0.078994643	16.38086898		4713.280705	236.0845732	666.0302627	31.13277142		14.70672209			11.76442105	159.1037094		260.9166693														4950	"1a (IP Acute) 125 days 1-5, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 150 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 250 copay, 9b (OP ASC) 250 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 20 copay, 7i (PT/ST) 20 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 20 copay, 7f (Podiatry) 20 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 20 copay, 18a (Hearing Exam) 20 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 20 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 20 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 12 trips/yr	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0%coin"	18a1 (Routine Hearing Exam) 20 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 12"												77.36923009	172.0337627	49.94161658		150	0.2	0.2	46	250		0.2	0.2	0.2	0.196203807		19.9351529	40	20	0.181		0.2			0.321428571	5		20														NO	73.04665785	162.4223401	47.15140857		141.6195904	0.188826121	0.188826121	43.43000773	236.0326507		0.188826121	0.188826121	0.188826121	0.185242018		18.82138793	37.76522412	18.88261206	0.170887639		0.188826121			0.321428571	5		18.88261206															9.6519	1.757293223	1.439118499	0	0.735203552	1.342739505	1.485709334	0.927021028	7.312762332	0	2.125152017	0.387449896	0.014916252	3.034425233	0	7.392540379	0.742982235	1.048032589	5.320205808	0	2.77701328	0	0	3.781421048	0.066293212	0	0.410565687	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7527	0	2.834804034	9.6519	1.757293223	1.439118499	0	0.735203552	1.342739505	1.485709334	0.927021028	7.312762332	0	2.125152017	0.387449896	0.014916252	3.034425233	0	7.392540379	0.742982235	1.048032589	5.320205808	0	2.77701328	0	0	3.781421048	0.066293212	0	0.410565687	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7527	NO																																																																																		0	0	0	9.6519	1.757293223	1.439118499	0	0.735203552	1.342739505	1.485709334	0.927021028	7.312762332	0	2.125152017	0.387449896	0.014916252	3.034425233	0	7.392540379	0.742982235	1.048032589	5.320205808	0	2.77701328	0	0	3.781421048	0.066293212	0	0.410565687	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7527
H7179_012_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	T	Coin	P	P	P	P	O	V																																																			0	YES	1631.702882	133.5878251	393.034287		64.51589094	7.174465404	7.939650765	262.8409187	380.7905932		11.34500331	2.070784127	0.079678651	16.52508072		4828.621107	242.3393621	683.1093514	31.40297709		14.83368332			11.76442105	159.1037094		260.9166693														4950	"1a (IP Acute) 100 days 1-4, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) 250 days 1-7	"2a (SNF) 50 days 1-100, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 100 copay	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 50 copay, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 30 copay"	"9a (OP Surgery) 250 copay, 9b (OP ASC) 250 copay"	8a (OP Diag Proc/Test/Lab) 0% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 50 copay, 5 (Partial Hosp) 50 copay, 7c (OT) 15 copay, 7i (PT/ST) 15 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 50 copay, 9d (OP Cardiac Rehab) 15 copay"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 17 copay, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) 15 copay, 7f (Podiatry) 15 copay, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) 15 copay, 18a (Hearing Exam) 15 copay"	"7e (MH Non-Phys) 40 copay, 7h (Psych) 40 copay"	7i (PT/ST) 15 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 0 copay, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 15 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 12 trips/yr	"16a, 16b Preventive and Comprehensive - ""Standard"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0%coin"	18a1 (Routine Hearing Exam) 15 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 12"												54.43675246	172.0337627	49.94161658		100	0.2	0.2	46	250		0.2	0.2	0.2	0.196227565		15.04320756	40	15	0.181		0.2			0.321428571	5		15														NO	51.80810607	163.7265822	47.53003168		95.17119176	0.190342384	0.190342384	43.77874821	237.9279794		0.190342384	0.190342384	0.190342384	0.186752112		14.31679992	38.0684767	14.27567876	0.172259857		0.190342384			0.321428571	5		14.27567876															7.0446	1.822656503	1.556744343	0	0.511671186	1.365604846	1.511252051	0.958903867	7.550061369	0	2.159434972	0.394157987	0.015166224	3.086093729	0	5.760866855	0.768790864	0.812654138	5.409472346	0	2.823478639	0	0	3.781421048	0.066293212	0	0.31039688	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7097	0	2.225477172	7.0446	1.822656503	1.556744343	0	0.511671186	1.365604846	1.511252051	0.958903867	7.550061369	0	2.159434972	0.394157987	0.015166224	3.086093729	0	5.760866855	0.768790864	0.812654138	5.409472346	0	2.823478639	0	0	3.781421048	0.066293212	0	0.31039688	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7097	NO																																																																																		0	0	0	7.0446	1.822656503	1.556744343	0	0.511671186	1.365604846	1.511252051	0.958903867	7.550061369	0	2.159434972	0.394157987	0.015166224	3.086093729	0	5.760866855	0.768790864	0.812654138	5.409472346	0	2.823478639	0	0	3.781421048	0.066293212	0	0.31039688	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7097
H7179_013_0	2011	5																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	Coin	T	Coin	P	P	P	P	O	V																																																			0	YES	314.014514	28.35690688	30.37203953		12.23783042	14.47826768	18.08964911	30.53262954	38.23198404		13.57351188	5.114680389	2.054121805	33.12312762		4283.939803	17.54623654	551.8838255	25.85907778	12.38824686	13.39459764	0.507275203		13.93798932	159.1037094		260.9166693														3400	"1a (IP Acute) FFS, 1a1 (Add'l Days) Unlimited"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) 0 copay"	6a (Home Health) 0 copay	10a (Ambulance) 20% coin	11a (DME) 20% coin	"11b (Prosthetics) 20% coin, 11b (Medical Supplies) 20% coin, 11c (Diabetic Supplies) 20% coin"	"4a (ER) 20% coin, 4a (ER) - Worldwide Coverage $10,000 annual max, 4b (UC) 20% coin"	"9a (OP Surgery) 20% coin, 9b (OP ASC) 20% coin"	8a (OP Diag Proc/Test/Lab) 0-20% coin	"8b (X-Ray) 20% coin, 8b (OP Therap Rad) 20% coin, 8b (OP Diag) 20% coin"	9a (OP Observation) 20% coin	12 (Renal Dialysis) 20% coin	"3 (CORF) 20% coin, 5 (Partial Hosp) 20% coin, 7c (OT) 8 copay, 7i (PT/ST) 8 copay, 9a (OP Other) 20% coin, 9a (OP Chemo) 20% coin, 9c (OP SA) 20% coin, 9d (OP Cardiac Rehab) 20% coin"	"7a (PCP w/Copay) 0 copay, 14b (Immunizations) 0 copay, 14c (Routine Physical) 0 copay, 14d (Pap & Pelvic Exam) 0 copay, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) 0 copay, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) 0 copay, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) 0 copay, 14h (Mammography) 0 copay, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) 0 copay, 14j (Nutrition Therapy Diabetes) 0 copay"	"7b (Chiro) 8 copay, 7b1 (Routine Chiro) 0% coin (5 visits), 7d (SPC w/Copay) 8 copay, 7f (Podiatry) 8 copay, 7f1 (Routine Podiatry) 0% coin (3 visits), 17a (Eye Exam) 8 copay, 18a (Hearing Exam) 8 copay"	"7e (MH Non-Phys) 45% coin, 7h (Psych) 45% coin"	7i (PT/ST) 8 copay	7g Physician Specialist Services Excluding Psychiatric (Radiology only) 20% coin	"8a (OP Diag Proc/Test/Lab) 0-20% coin, 7g (Prof. Other) 0% coin"	15 (Part B Rx) 20% coin	"13a (Blood) 20% coin, 13a1 (3 Pint Blood) 0 copay, 14a4-1 (Smoking Cessation - Mdcr Covered) 0 copay, 16b (Comp. Dental) 8 copay, 17b (MCR Eyewear) 0% coin"	10b (Transportation) 24 trips/yr	"16a, 16b Preventive and Comprehensive - ""Comprehensive"" Plan"	17a1 (Routine Eye Exam) 5 copay	"17b1 (Non MCR Covered) 150 allowance, 0% Coin"	18a1 (Routine Hearing Exam) 8 copay	18b (Hearing Aids) 1200 allowance / 3yrs	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) Silver Sneakers, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) otc rx - 39"												0.079310839	0.079310839	0.216280993		0.2	0.2	0.2	0.2	0.2		0.2	0.2	0.2	0.2		8	0.45	8	0.181	0.07872	0.2	0.199833114		0.135384615	5		8														NO	0.065269576	0.065269576	0.177990408		0.164591817	0.164591817	0.164591817	0.164591817	0.164591817		0.164591817	0.164591817	0.164591817	0.164591817		6.583672678	0.370331588	6.583672678	0.148955594	0.064783339	0.164591817	0.164454477		0.135384615	5		6.583672678															20.4956	1.850843282	5.405931715	0	2.014246744	2.383004384	2.977408215	5.025420972	6.292671719	0	2.234088983	0.841834538	0.33809164	5.451795759	0	2.35033812	6.497925645	0.302785205	3.8518543	0.802551998	2.204641162	0.083423678	0	1.886989318	0.066293212	0	0.143149162	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5009	0	15.39183788	20.4956	1.850843282	5.405931715	0	2.014246744	2.383004384	2.977408215	5.025420972	6.292671719	0	2.234088983	0.841834538	0.33809164	5.451795759	0	2.35033812	6.497925645	0.302785205	3.8518543	0.802551998	2.204641162	0.083423678	0	1.886989318	0.066293212	0	0.143149162	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5009	NO																																																																																		0	0	0	20.4956	1.850843282	5.405931715	0	2.014246744	2.383004384	2.977408215	5.025420972	6.292671719	0	2.234088983	0.841834538	0.33809164	5.451795759	0	2.35033812	6.497925645	0.302785205	3.8518543	0.802551998	2.204641162	0.083423678	0	1.886989318	0.066293212	0	0.143149162	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5009
H7179_801_0	2011	3																															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	Coin	V																																																			0	YES	227.4986081	4.816220376	21.64941773		4.741326104	5.229990481	7.824387067	13.03318274	40.20030768	5.648840767	15.12595614	3.349618633	0.355966845	19.73472283	54.44655332	110.0499444	2.815356025	11.27613634	28.04070881	15.28431242	15.72331121	0.717295013																			6700	"1a (IP Acute) FFS, 1a1 (Add'l Days) n/a"	1b (IP Psych) FFS	"2a (SNF) FFS, 2a2 (Waiver 3 Day) n/a"	6a (Home Health) FFS	10a (Ambulance) FFS	11a (DME) FFS	"11b (Prosthetics) FFS, 11b (Medical Supplies) FFS, 11c (Diabetic Supplies) FFS"	"4a (ER) FFS, 4a (ER) - Worldwide Coverage n/a, 4b (UC) FFS"	"9a (OP Surgery) FFS, 9b (OP ASC) FFS"	8a (OP Diag Proc/Test/Lab) FFS	"8b (X-Ray) FFS, 8b (OP Therap Rad) FFS, 8b (OP Diag) FFS"	9a (OP Observation) FFS	12 (Renal Dialysis) FFS	"3 (CORF) FFS, 5 (Partial Hosp) FFS, 7c (OT) FFS, 7i (PT/ST) FFS, 9a (OP Other) FFS, 9a (OP Chemo) FFS, 9c (OP SA) FFS, 9d (OP Cardiac Rehab) FFS"	"7a (PCP w/Copay) FFS, 14b (Immunizations) FFS, 14c (Routine Physical) FFS, 14d (Pap & Pelvic Exam) FFS, 14d1 (Add'l Pap) n/a, 14d2 (Add'l Pelvic) n/a, 14e (Prostate Screening) FFS, 14e1 (Add'l Prostate) n/a, 14f (Colorectal Screening) FFS, 14f1 (Add'l Colorectal) n/a, 14g (Bone Mass) FFS, 14h (Mammography) FFS, 14h1 (Add'l Mammography) n/a, 14i (Diabetes Educ.) FFS, 14j (Nutrition Therapy Diabetes) FFS"	"7b (Chiro) FFS, 7b1 (Routine Chiro) n/a, 7d (SPC w/Copay) FFS, 7f (Podiatry) FFS, 7f1 (Routine Podiatry) n/a, 17a (Eye Exam) FFS, 18a (Hearing Exam) FFS"	"7e (MH Non-Phys) FFS, 7h (Psych) FFS"	7i (PT/ST) FFS	7g Physician Specialist Services Excluding Psychiatric (Radiology only) FFS	"8a (OP Diag Proc/Test/Lab) FFS, 7g (Prof. Other) FFS"	15 (Part B Rx) FFS	"13a (Blood) FFS, 13a1 (3 Pint Blood) n/a, 14a4-1 (Smoking Cessation - Mdcr Covered) FFS, 16b (Comp. Dental) FFS, 17b (MCR Eyewear) FFS"	10b (Transportation) n/a	"16a, 16b Preventive and Comprehensive n/a"	17a1 (Routine Eye Exam) n/a	17b1 (Non MCR Covered) n/a	18a1 (Routine Hearing Exam) n/a	18b (Hearing Aids) n/a	"14a1 (Written health education materials, incl. newsletters) n/a, 14a2 (Nutritional Training) n/a, 14a3 (Nutritional Benefit) n/a, 14a4-2 (Additional Smoking Cessation) n/a, 14a5 (Membership in Health Club / Fitness Classes) n/a, 14a6 (Nursing Hotline) n/a"	"13b (Acupuncture) n/a, 13c (Other) n/a"												0.076653506	0.076653506	0.164633008		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069034452	0.069034452	0.148269141		0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725	0.209840725																				15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	0	10.31335866	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469	NO																																																																																		0	0	0	15.7052	0.332485136	3.209940566	0	0.994923309	1.097464997	1.641875059	2.734892521	8.435661728	1.185356845	3.17404161	0.702886404	0.074696341	4.141148555	11.42510425	23.09296016	0.590776351	2.366192631	5.884082679	3.207271207	3.299391031	0.150517706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4469
H7187_002_0	2011	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	472.0821108	21.661653	51.25888127	1800.432469	14.73161201	22.24200185	21.57452179	32.17457103	32.91449601	17.52983105	43.38405116	0	0.161429958	33.27907624	33.51194013	126.8092103	9.374211	5.601740057	0	0	17.66162556	6.766466969	770.938504	475.2708206	140.6498093	228.9828502	0	0	210.4196854	0											6700	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.080114523	0.08108711	0.184219613	0	0.233	0.233	0.233	0.111039019	0.233	0.233	0.233	0	0.233	0.233	0.226893011	0.232877943	0.235001862	0.233	0	0	0.233	0.231658788	0	0	0	0	0	0	0	0											NO	0.06327899	0.064047194	0.145507089	0	0.184036603	0.184036603	0.184036603	0.087718514	0.184036603	0.184036603	0.184036603	0	0.184036603	0.184036603	0.179212957	0.183940196	0.185617787	0.184036603	0	0	0.184036603	0.18361667	0	0	0	0	0	0	0	0												29.8729	1.3873681	7.458530621	0	2.711155833	4.093342466	3.970501703	2.822305544	6.057472036	3.226130558	7.984253403	0	0.029709021	6.124568143	6.005773878	23.32531094	1.740020298	1.030925211	0	0	3.250385571	1.242436131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.3331	0	29.88046096	29.8729	1.3873681	7.458530621	0	2.711155833	4.093342466	3.970501703	2.822305544	6.057472036	3.226130558	7.984253403	0	0.029709021	6.124568143	6.005773878	23.32531094	1.740020298	1.030925211	0	0	3.250385571	1.242436131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.3331	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												10.6599	0.4891	1.6142	0.9462	0.9053	1.3668	1.2897	0.6546	2.0226	0	2.1068	0	0.007	1.6829	2.4475	9.9642	0.7366	0.4402	0	0	1.3879	0.5289	0	0	0.0603	0	0	0	0	0											39.3107	0	0	40.5328	1.8765022	9.072760584	0.946226569	3.616414063	5.460114494	5.260208507	3.476867959	8.080069317	3.226130558	10.09109508	0	0.036667758	7.807444949	8.453288118	33.28951997	2.476652206	1.471113774	0	0	4.638248181	1.771333551	0	0	0.060340053	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.6438
H7187_003_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1173.168475	90.40269284	765.3368806	773.9346424	135.8906721	10.1578058	11.69041186	408.9766127	32.38392619	13.73214554	30.31433626	0	0.064545428	17.31011623	5407.613936	92.55030064	455.0304431	352.8115472	0	0	15.52172063	1232.94812	0	0	110.1148833	0	14.63282882	6	177.245131	0											3600	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-46 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												167.6241497	112.1244337	59.83928379	0	200	0.2	0.116154534	49.49623711	0.2	0.149059888	0.165589207	0	0.2	0.160022543	6.939753675	0.103551486	38.5	30	0	0	0.2	29.85362872	0	0	30	0	0	0	0	0											YES	126.4268862	84.56742685	45.13248441	0	150.8456704	0.15084567	0.087607043	37.34483417	0.15084567	0.112425194	0.124892075	0	0.15084567	0.120693539	6.64898443	0.099234922	36.8868857	28.74302782	0	0	0.15084567	22.51645319	0	0	30	0	0	0	0	0											5000	12.36	0.637093593	2.878462903	0	1.708209962	1.532261026	1.024162412	1.272763649	4.884975058	1.543839127	3.78602035	0	0.009736398	2.089219192	2.996261739	9.184221844	1.398721329	0.845072676	0	0	2.341384355	2.31346822	0	0	0.275287208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0812	0	13.13501682	12.36	0.637093593	2.878462903	0	1.708209962	1.532261026	1.024162412	1.272763649	4.884975058	1.543839127	3.78602035	0	0.009736398	2.089219192	2.996261739	9.184221844	1.398721329	0.845072676	0	0	2.341384355	2.31346822	0	0	0.275287208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0812	NO	"$275 Days 1-19 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-19 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-29 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0355	0.0679	0.5785	0.3067	0.2854	0.384	0.442	0.2127	1.2243	0.2579	0.9272	0	0.0016	0.5218	0.907	1.7952	0.2659	0.1659	0	0	0.5639	0.4335	0	0	0.0545	0	0.0072	0	0	0											10.4386	0	3.061344257	13.3955	0.704995071	3.456982086	0.306704122	1.993615305	1.916273085	1.466114072	1.485432639	6.109237309	1.801781619	4.713206934	0	0.011363142	2.610975364	3.9032553	10.97943504	1.664659776	1.010978738	0	0	2.9053003	2.746967941	0	0	0.329754365	0	0.007237973	0	0	0	0	0	0	0	0	0	0	0	0	0	63.5198
H7187_009_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1170.467488	86.81206171	740.2429265	1174.565628	141.639988	9.247573898	9.580692245	327.2179988	30.85925562	13.64149682	30.8229204	0	0.10732304	18.1767738	5770.381321	87.14796888	454.3808365	313.4344541	0	0	15.78531399	1305.18347	0	0	103.1690287	0	14.93201433	6	210.4196854	0											3600	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-46 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	59.1611281	0	200	0.2	0.114663452	48.92768041	0.2	0.157360469	0.167321907	0	0.2	0.159728634	6.85647951	0.110292551	38.5	30	0	0	0.2	29.78896301	0	0	30	0	0	0	0	0											NO	140.6801543	94.10149227	44.68638307	0	151.0667038	0.151066704	0.086609149	36.97349536	0.151066704	0.118859637	0.126383845	0	0.151066704	0.120648391	6.570593255	0.105733522	36.89471251	28.74912663	0	0	0.151066704	22.50060225	0	0	30	0	0	0	0	0												13.7218	0.680762046	2.756564915	0	1.783090509	1.397000507	0.829775599	1.00819943	4.661806028	1.621423354	3.895519195	0	0.016212938	2.192998514	3.159569049	9.214461665	1.397020861	0.750913901	0	0	2.384635353	2.44728451	0	0	0.257922572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.177	0	13.38907206	13.7218	0.680762046	2.756564915	0	1.783090509	1.397000507	0.829775599	1.00819943	4.661806028	1.621423354	3.895519195	0	0.016212938	2.192998514	3.159569049	9.214461665	1.397020861	0.750913901	0	0	2.384635353	2.44728451	0	0	0.257922572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.177	NO	"$300 Days 1-Unlimited (1a); $300 (1a1); $0 n/c (1a2, 1a3)"	"$300 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.7031	0.1256	1.0677	0.4884	0.4166	0.4896	0.5072	0.2354	1.6337	0.3788	1.3362	0	0.0038	0.7659	0.9724	1.8953	0.2793	0.155	0	0	0.8031	0.6413	0	0	0.051	0	0.0074	0	0	0											13.9569	0	0	15.4249	0.806346734	3.824222982	0.488422106	2.199678709	1.886577948	1.336988717	1.243640866	6.295531326	2.000240824	5.231722515	0	0.02000081	2.958921197	4.131952758	11.10975063	1.676358787	0.905950924	0	0	3.187747819	3.088627646	0	0	0.308954036	0	0.007385962	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1339
H7187_801_0	2011	1																															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	209.4998206	5.01039	21.02110317	818.2729212	5.299110626	10.81369187	12.44525778	16.23857166	34.25588247	14.52593366	32.06665967	0	0.068276483	18.30092038	31.069606	98.70343899	2.1745215	4.494481543	0	0	16.53705021	7.754211682	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.066800782	0.066800782	0.151762889	0	0.191948906	0.191948906	0.191948906	0.191948906	0.191948906	0.191948906	0.191948906	0	0.191948906	0.191948906	0.191948906	0.191948906	0.191948906	0.191948906	0	0	0.191948906	0.191948906	0	0	0	0	0	0	0	0												13.9948	0.334697972	3.190223356	0	1.017158489	2.075676327	2.38885362	3.11697607	6.575379174	2.788237079	6.155160253	0	0.013105596	3.512841652	5.963776891	18.94601716	0.417397024	0.862710817	0	0	3.174268701	1.488412452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0156	0	16.2570624	13.9948	0.334697972	3.190223356	0	1.017158489	2.075676327	2.38885362	3.11697607	6.575379174	2.788237079	6.155160253	0	0.013105596	3.512841652	5.963776891	18.94601716	0.417397024	0.862710817	0	0	3.174268701	1.488412452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0156	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9887	0.0236	0.383	0	0.2179	0.4446	0.5117	0.6677	1.4085	0.5973	1.3185	0	0.0028	0.7525	1.2277	3.9002	0.0859	0.1776	0	0	0.6535	0.3064	0	0	0	0	0	0	0	0											13.6682	0	0	14.9835	0.358343785	3.573217812	0	1.23504545	2.520309892	2.900573337	3.784667928	7.983900459	3.385509292	7.473665847	0	0.015912965	4.265332437	7.191480561	22.84624604	0.503322414	1.040308546	0	0	3.827723953	1.794817179	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.6838
H7187_803_0	2011	1																															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	209.4997974	5.010957	21.02110084	818.2728758	5.299110039	10.81369067	12.4452564	16.23856986	34.25587867	14.52593205	32.06665612	0	0.068276476	18.30032336	31.06960256	98.70342806	2.173581	4.494481045	0	0	16.53704837	7.754210824	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.081087121	0.081087121	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	0.066800857	0.066800857	0.151763039	0	0.191949098	0.191949098	0.191949098	0.191949098	0.191949098	0.191949098	0.191949098	0	0.191949098	0.191949098	0.191949098	0.191949098	0.191949098	0.191949098	0	0	0.191949098	0.191949098	0	0	0	0	0	0	0	0												13.9948	0.334736224	3.190226153	0	1.017159392	2.075678169	2.38885574	3.116978837	6.57538501	2.788239554	6.155165716	0	0.013105608	3.51273056	5.963782184	18.94603398	0.417216912	0.862711582	0	0	3.174271518	1.488413773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0155	0	16.25693016	13.9948	0.334736224	3.190226153	0	1.017159392	2.075678169	2.38885574	3.116978837	6.57538501	2.788239554	6.155165716	0	0.013105608	3.51273056	5.963782184	18.94603398	0.417216912	0.862711582	0	0	3.174271518	1.488413773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0155	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9887	0.0236	0.383	0	0.2179	0.4446	0.5117	0.6677	1.4085	0.5973	1.3185	0	0.0028	0.7525	1.2277	3.9002	0.0859	0.1776	0	0	0.6535	0.3064	0	0	0	0	0	0	0	0											13.6681	0	0	14.9835	0.358384715	3.573220561	0	1.235046328	2.520311685	2.9005754	3.784670621	7.983906139	3.385511701	7.473671165	0	0.015912976	4.265196797	7.191485719	22.84626242	0.503105139	1.040309292	0	0	3.827726699	1.794818466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.6836
H7187_804_0	2011	1																															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	203.7265981	5.027589	20.44182103	806.9195142	5.153082126	10.5156971	12.10230168	15.79108256	33.31188724	14.12564001	31.18299323	0	0.066394976	17.79647928	30.21341554	95.9834514	2.176146	4.370626344	0	0	16.08133588	7.540527542	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.084307079	0.084307079	0.181628643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.069869269	0.069869269	0.150524259	0	0.193098136	0.193098136	0.193098136	0.193098136	0.193098136	0.193098136	0.193098136	0	0.193098136	0.193098136	0.193098136	0.193098136	0.193098136	0.193098136	0	0	0.193098136	0.193098136	0	0	0	0	0	0	0	0												14.2342	0.351273969	3.076989964	0	0.995050551	2.030561505	2.33693189	3.049228599	6.432463317	2.72763475	6.021377853	0	0.012820746	3.436466968	5.834154208	18.53422551	0.420209735	0.843959798	0	0	3.105275975	1.456061809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8989	0	15.47713743	14.2342	0.351273969	3.076989964	0	0.995050551	2.030561505	2.33693189	3.049228599	6.432463317	2.72763475	6.021377853	0	0.012820746	3.436466968	5.834154208	18.53422551	0.420209735	0.843959798	0	0	3.105275975	1.456061809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8989	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9996	0.0247	0.3672	0	0.2119	0.4324	0.4976	0.6493	1.3697	0.5808	1.2822	0	0.0027	0.7317	1.1939	3.7927	0.086	0.1727	0	0	0.6354	0.298	0	0	0	0	0	0	0	0											13.3286	0	0	15.2339	0.375943147	3.444191963	0	1.206933163	2.462942227	2.834550059	3.698520758	7.802169739	3.30844783	7.303549163	0	0.015550751	4.168216322	7.028025838	22.3269751	0.506199317	1.016663437	0	0	3.740723849	1.754022889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2275
H7188_003_0	2011	8	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin		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	1255.668098	81.069778	277.497712	334.017933	32.195807	10.967646	3.086533	387.396937	395.970376	1494.133113	1100.366382	74.259579	0.077496	945.623096	3426.154195	3122.346273	79.716287	578.144555		1652.179903	15.950692	0		3.07	2.01				4.64	0.93	1116.88465										4000	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $125(Days 21-100):2. $0 SNF 1,2. $125 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$75/Visit:8b, 9a. $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,8b, 9a. $75 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $35 Radiology OP -- Facility"	$75/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$75/Visit:7c, 7d, 7i. $75 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS751: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies											161.6895	138.428775	41.280875	0	150	0.2	0.2	50	189.759791	0	37.479595	75	0.2	44.784567	10	32.821188	35	48.622783		0	0.2	0		0	0				0	0	0										NO	144.387592	123.615927	32.134684	0	133.70115	0.178268	0.178268	44.56705	169.140681	0	33.4071	66.850575	0.178268	39.91832	8.91341	29.25487	31.196935	43.33948		0	0.178268	0		0	0				0	0	0											15.1086	0.835126313	0.74310844	0	0.358718035	1.955180317	0.550230065	1.438761555	5.581224921	0	3.06333748	0.413691296	0.013815057	3.145640445	2.544893089	7.611986193	0.207241985	2.088040365	0	0	2.843497961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.5031	0	6.000595759	15.1086	0.835126313	0.74310844	0	0.358718035	1.955180317	0.550230065	1.438761555	5.581224921	0	3.06333748	0.413691296	0.013815057	3.145640445	2.544893089	7.611986193	0.207241985	2.088040365	0	0	2.843497961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.5031	YES	$250/Day(Days 1-15)	$250/Day(Days 1-15)	30% Coins(Days 1-20) 30%(Days 20-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5	"VIS751: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins										5100	2.8509	0.1726	0.3163	1.5531	1.5967	2.1518	0.6056	0.2392	3.3542	0.453	1.3846	0.2108	0.0023	0.8218	1.6351	2.4909	0.0397	0.2377		0.3313	0.7887	0		0	0				0	0	0.3685										21.6047	500	5.934096692	17.9595	1.007688857	1.059395028	1.553123322	1.955404667	4.106945702	1.155783209	1.677993637	8.935395701	0.452983851	4.447904907	0.624504593	0.016159219	3.967488798	4.179978464	10.10286504	0.246951398	2.325736242	0	0.331303458	3.632149156	0	0	0	0	0	0	0	0	0	0.368467857	0	0	0	0	0	0	0	0	0	70.1077
H7188_005_0	2011	3	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	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	241.847777	10.208541	390.410898	731.81325	36.566157	10.465761	2.896241	348.595509	384.763986	1770.058556	1105.663437	88.009573	0.605169	941.872795	3665.473181	3620.450155	100.422241	670.596445		1675.826711	20.937037	0							4.64	1.53	868.742642										3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Day(Days 1-1) $0(Days 2-100):2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$0/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies											0	0	0	0	0	0.2	0.2	0	0	0	0	0	0.2	0	0	0	0	0		0	0.2	0							0	0	0										NO	0	0	0	0	0	0.199398	0.199398	0	0	0	0	0	0.199398	0	0	0	0	0		0	0.199398	0							0	0	0											0	0	0	0	0	2.086851812	0.577504663	0	0	0	0	0	0.120669488	0	0	0	0	0	0	0	4.174803304	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.9598	0	0.021012333	0	0	0	0	0	2.086851812	0.577504663	0	0	0	0	0	0.120669488	0	0	0	0	0	0	0	4.174803304	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.9598	YES	30% Coins	30% Coins	30% Coins(Days 1-1) 30%(Days 2-100)	30% Coins	$0/Trip	25% Coins	25% Coins	$0/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	30% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	25% Coins										5100	5.0885	0.0906	0.2248	3.0259	0	1.8911	0.5233	0	3.5269	0.3899	1.5524	0.2931	0.0202	0.9063	2.019	3.2374	0.0515	0.3101		0.4212	1.1466	0							0	0	0.2401										24.9591	1000	14.80137189	5.0885	0.090639764	0.224753946	3.025928004	0	3.97799104	1.100848764	0	3.526899469	0.389885133	1.552404382	0.293082935	0.140903099	0.906347028	2.019031635	3.237446599	0.05151747	0.310123987	0	0.421188943	5.321369184	0	0	0	0	0	0	0	0	0	0.240087634	0	0	0	0	0	0	0	0	0	31.919
H7200_006_0	2011	3																															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	388.8072615	22.87424734	31.50127844	0	11.31256409	18.19203282	5.132872121	37.7684004	43.70374486	17.40941048	16.89894127	0.484453275	3.410876916	29.22760326	53.35772993	109.0336735	3.813124364	7.299158028	18.49640978	37.52894548	31.52802492	8.82109873	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 1b	Medicare-FFS Cost Sharing; PBP 2	No Cost-Sharing; PBP 6	20% Coinsurance for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"20% Coinsurance for ER - Facility; 20% Coinsurance for PCP Urgent Care; PBP 4a, 4b"	20% Coinsurance for OP Fac - Surgery; PBP 9b	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	20% Coinsurance for OP Fac - Observation; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"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; PBP 3, 5, 9a, 9c, 9d, 13a"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for PCP Office Visits; 20% Coinsurance for PCP Consults; 20% Coinsurance for PCP Immunizations; PBP 7a, 14b-c"	"20% Coinsurance for Prof - Asst Surgeon (OP); 20% Coinsurance for Speclst Office Visits; 20% Coinsurance for Speclst Consults; 20% Coinsurance for Cardio; 20% Coinsurance for Chiropractor; 20% Coinsurance for Speclst Immunizations; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing/Speech Exams; 20% Coinsurance for Podiatrist (Routine); PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"20% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; 20% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"20% Coinsurance for Occ Therapy; 20% Coinsurance for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof - Primary Surgeon (IP); 20% Coinsurance for Prof - Asst Surgeon (IP); 20% Coinsurance for Prof - Anesthesia (IP); 20% Coinsurance for Prof - Primary Surgeon (OP); 20% Coinsurance for Prof - Anesthesia (OP); 20% Coinsurance for Prof - IP Visits; 20% Coinsurance for Allergy Testing; 20% Coinsurance for Allergy Tx; 20% Coinsurance for Prof - ER Visits; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"20% Coinsurance for Renal Dialysis - Prof; 20% Coinsurance for Bone Mass Measurements; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	PBP 14a	"No Cost-Sharing; PBP 13b-f, 14a"											0	0.081109694	0.081109694	0.180005621	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	0.080568999	0.080568999	0.157104754	0	0.188285098	0.188285098	0.188285098	0.188285098	0.188285098	0.188285098	0.188285098	0.188285098	0.188285098	0.188285098	0.188348356	0.188305889	0.188285098	0.188285098	0.188285098	0.188285098	0.188285098	0.190058441	0	0	0	0	0	0	0	0												31.3258	1.842955205	4.949000596	0	2.129987244	3.42528869	0.966443333	7.111226986	8.228763902	3.277932565	3.18181882	0.091215332	0.642217296	5.503122156	10.04984069	20.5316828	0.717954496	1.374322688	3.482598335	7.066141194	5.936257274	1.676524274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.5111	0	6.234475551	31.3258	1.842955205	4.949000596	0	2.129987244	3.42528869	0.966443333	7.111226986	8.228763902	3.277932565	3.18181882	0.091215332	0.642217296	5.503122156	10.04984069	20.5316828	0.717954496	1.374322688	3.482598335	7.066141194	5.936257274	1.676524274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.5111	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	31.3258	1.842955205	4.949000596	0	2.129987244	3.42528869	0.966443333	7.111226986	8.228763902	3.277932565	3.18181882	0.091215332	0.642217296	5.503122156	10.04984069	20.5316828	0.717954496	1.374322688	3.482598335	7.066141194	5.936257274	1.676524274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.5111
H7200_007_0	2011	5																															D	D	D		T	Coin	Coin	V	V	V	V	V	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	0	0	0	0	0	0	0											0	YES	1145.508321	111.913886	656.0032747	0	283.6061011	9.753876269	5.040903335	388.9333254	372.4526837	1632.737681	822.2893333	62.55560304	0.285767109	1607.464698	4883.911107	5626.084116	194.5397079	515.6862962	892.7008251	0	38.84000508	2.766641773	0	0	0	0	0	0	0	0											6700	$250/days 1-7 for IP Medical; $250/days 1-7 for IP Surgical; PBP 1a	$250/days 1-7 for IP Psych; $250/days 1-7 for IP Substance Abuse; PBP 1b	$50/$125 per day for SNF days 8-20/21-100; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $35/Visit for PCP Urgent Care; PBP 4a, 4b"	$150/Visit for OP Fac - Surgery; PBP 9b	$200/Visit for OP Fac - Pathology; PBP 8a	$50/Visit for OP Fac - Radiology; $100/Visit for OP Fac - CT/MRI/PET; PBP 8b	$200/Visit for OP Fac - Observation; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$200/Visit for OP Fac - Cardiovascular; $35/Visit for OP Fac - Occ Therapy; $35/Visit for OP Fac - Physical/Speech Therapy; $35/Visit for OP Fac - CORF; $200/Visit for OP Fac - Other; $35/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; PBP 7a, 14b-c"	"$35/Visit for Speclst Office Visits; $35/Visit for Speclst Consults; $35/Visit for Chiropractor; $35/Visit for Vision Exams; $35/Visit for Hearing/Speech Exams; $35/Visit for Podiatrist (Routine); PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse; PBP 7e, 7h"	"$35/Visit for Occ Therapy; $35/Visit for PT/ST; PBP 7c, 7i"	"$50/Visit for Prof Radiology (Office); $100/Visit for Prof Radiology (Office); PBP 7d, 14g-h"	"No Cost-Sharing; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"$35/Visit for Bone Mass Measurements; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	"No Cost-Sharing; PBP 13b-f, 14a"											0	250	250	91.21879862	0	100	0.2	0.2	49.22004671	150	35.22800175	62.67868758	91.91188571	0.2	77.21210907	15	33.99127283	35	35	57.82701997	0	0.2	35	0	0	0	0	0	0	0	0											NO	217.0532737	217.0532737	85.76975616	0	99.96427307	0.199928546	0.199928546	49.20253518	149.9464096	35.21541587	62.65629441	91.87904841	0.199928546	77.18452356	14.9947202	33.97918321	34.98749557	34.98749557	57.80636015	0	0.199928546	34.98749557	0	0	0	0	0	0	0	0												20.7197	2.024272943	4.688770076	0	2.362539812	1.950078302	1.007820475	1.594708802	4.653995222	4.791461368	4.29346688	0.47896244	0.057133003	10.33928307	6.102740045	15.93081191	0.567204764	1.503547667	4.30031545	0	7.765225748	0.008066489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1401	0	3.774349496	20.7197	2.024272943	4.688770076	0	2.362539812	1.950078302	1.007820475	1.594708802	4.653995222	4.791461368	4.29346688	0.47896244	0.057133003	10.33928307	6.102740045	15.93081191	0.567204764	1.503547667	4.30031545	0	7.765225748	0.008066489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1401	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.7197	2.024272943	4.688770076	0	2.362539812	1.950078302	1.007820475	1.594708802	4.653995222	4.791461368	4.29346688	0.47896244	0.057133003	10.33928307	6.102740045	15.93081191	0.567204764	1.503547667	4.30031545	0	7.765225748	0.008066489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1401
H7220_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	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	0	0														0	YES	890.496354	19.27556021	838.7479539	1255.116494	514.7462193	11.15019401	5.698881903	202.5288964	466.8114698	1.588096095	18.7093331	2.955692981	7.084618123	467.8719093	2711.431984	5347.926432	107.4526672	734.853403	0	710.2771583	27.89818592	0	0	0	695.2110189	32.77797231	0														5500	1a (IP Acute): $320 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: 90 days plus 60 medicare-covered lifetime reserve days;	1b (IP Psych): $320 Copay per day (days 1-5); 1b (IP Psych) - Limit: 90 days plus 60 medicare-covered lifetime reserve days;	2a (SNF): $100 Copay per day (days 21-100); 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): $320 Copay per visits; 9b (OP Surg): $320 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): n/a;	12 (Renal Dialysis): 20% Coinsurance;	3 (CORF): $15 Copay per visits; 5 (Partial Hosp): $55 Copay per visits; 9a (OP Chemo): $0 Copay per visits; 9a (OP Other): $320 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): 10% Coinsurance; 14c (AAA Screening, Cardiovascular Screening, EKG Screening, HIV Screening, Welcome to Medicare Physical, and Glaucoma tests): 0% Coinsurance; 14h (Mammography): $0 Copay per visits; 7a (PCP w/Copay): $35 Copay per visits;"	7d (SPC w/Copay): $50 Copay per visits;	7e (MH Non-Phys): $25 Copay per visits; 7h (Psych): $40 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;	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;	"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;"	18a1 (Routine Hearing Exam): 20% Coinsurance;															231.0570159	158.7546559	94.17092032	0	50	0.2	0.19592643	49.85958633	320	0.2	0.2	0	0.2	114.6008944	30.91950176	49.02364613	40	25	0	17.32230949	0.2	0	0	0	25	40	0														NO	198.5719043	136.4347852	80.93110223	0	42.97032563	0.171881303	0.16838045	42.84965321	275.0100841	0.171881303	0.171881303	0	0.171881303	98.48875497	26.57242118	42.13124076	34.37626051	21.48516282	0	14.88690559	0.171881303	0	0	0	21.48516282	34.37626051	0															14.7356	0.219154743	5.656733033	0	1.843234389	1.91650987	0.959580298	0.723191081	10.69815513	0.272964025	3.215784543	0	1.217713391	3.840010152	6.00410939	18.77623134	0.307818407	1.315703751	0	0.881152416	4.795176534	0	0	0	1.244726828	0.093898676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.7175	0	12.87768308	14.7356	0.219154743	5.656733033	0	1.843234389	1.91650987	0.959580298	0.723191081	10.69815513	0.272964025	3.215784543	0	1.217713391	3.840010152	6.00410939	18.77623134	0.307818407	1.315703751	0	0.881152416	4.795176534	0	0	0	1.244726828	0.093898676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.7175	NO																																																																																		0	0	0	14.7356	0.219154743	5.656733033	0	1.843234389	1.91650987	0.959580298	0.723191081	10.69815513	0.272964025	3.215784543	0	1.217713391	3.840010152	6.00410939	18.77623134	0.307818407	1.315703751	0	0.881152416	4.795176534	0	0	0	1.244726828	0.093898676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.7175
H7220_002_0	2011	5																															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														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0														0	YES	1116.157891	24.16019846	1051.295879	1573.176772	645.1885537	14.17736275	7.246072662	253.8519388	585.1066132	514.9530194	1229.978583	3.704697981	9.008022725	586.4357796	3398.53857	7157.505545	134.6823509	921.0733104	0	890.2691759	35.47227082	0	0	367.8200467	670.9665359	41.08426979	0														4500	1a (IP Acute): $320 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: 90 days plus 60 medicare-covered lifetime reserve days;	1b (IP Psych): $320 Copay per day (days 1-5); 1b (IP Psych) - Limit: 90 days plus 60 medicare-covered lifetime reserve days;	2a (SNF): $75 Copay per day (days 21-100); 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): $320 Copay per visits; 9b (OP Surg): $320 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): n/a;	12 (Renal Dialysis): 0% Coinsurance;	3 (CORF): $15 Copay per visits; 5 (Partial Hosp): $40 Copay per visits; 9a (OP Chemo): $0 Copay per visits; 9a (OP Other): $320 Copay per visits; 9c (OP SA): $25 Copay per visits; 9d (OP Cardiac Rehab): $0 Copay per visits;	"14b (Immunizations): $0 Copay per visits; 14c (Routine Physical): 10% Coinsurance; 14c (AAA Screening, Cardiovascular Screening, EKG Screening, HIV Screening, Welcome to Medicare Physical, and Glaucoma tests): 0% Coinsurance; 14h (Mammography): $0 Copay per visits; 7a (PCP w/Copay): $35 Copay per visits;"	7d (SPC w/Copay): $50 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;"	18a1 (Routine Hearing Exam) $25 Copay;															231.4129229	159.0386115	70.7345396	0	50	0.1	0.172411683	49.86064088	320	10	30.86144791	0	0	114.2860022	22.17115747	47.56009853	40	15	0	14.50214459	0.2	0	0	10	25	40	0														NO	195.8453451	134.5947814	59.86282073	0	42.31512714	0.084630254	0.145912446	42.19718716	270.8168137	8.463025428	26.11812184	0	0	96.72053429	18.76350694	40.25023232	33.85210171	12.69453814	0	12.27320184	0.169260509	0	0	8.463025428	21.15756357	33.85210171	0															18.2162	0.270986386	5.244461397	0	2.275102973	1.199833814	1.057292185	0.892653148	13.20472572	0.363171708	2.677060874	0	0	4.726698494	5.314041838	24.00760509	0.379940053	0.974383356	0	0.910537774	6.0040546	0	0	0.259405867	1.183001428	0.115899073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.277	0	16.21365272	18.2162	0.270986386	5.244461397	0	2.275102973	1.199833814	1.057292185	0.892653148	13.20472572	0.363171708	2.677060874	0	0	4.726698494	5.314041838	24.00760509	0.379940053	0.974383356	0	0.910537774	6.0040546	0	0	0.259405867	1.183001428	0.115899073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.277	NO																																																																																		0	0	0	18.2162	0.270986386	5.244461397	0	2.275102973	1.199833814	1.057292185	0.892653148	13.20472572	0.363171708	2.677060874	0	0	4.726698494	5.314041838	24.00760509	0.379940053	0.974383356	0	0.910537774	6.0040546	0	0	0.259405867	1.183001428	0.115899073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.277
H7220_003_0	2011	8																															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														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0														0	NO	1201.649666	26.01074152	1131.819568	1693.673768	694.6065749	15.04600999	7.690039651	273.2956508	629.9226764	554.3956894	1324.188419	3.988458197	9.559944424	631.3536499	3658.848599	7705.732506	144.9983046	991.6226407	0	958.4590728	37.64565743	100	0	373.4145568	681.7067749	44.23110694	0															1a (IP Acute): $320 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: 90 days plus 60 medicare-covered lifetime reserve days;	1b (IP Psych): $320 Copay per day (days 1-5); 1b (IP Psych) - Limit: 90 days plus 60 medicare-covered lifetime reserve days;	2a (SNF): $75 Copay per day (days 21-100); 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): $320 Copay per visits; 9b (OP Surg): $320 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): n/a;	12 (Renal Dialysis): 0% Coinsurance;	3 (CORF): $15 Copay per visits; 5 (Partial Hosp): $40 Copay per visits; 9a (OP Chemo): $0 Copay per visits; 9a (OP Other): $320 Copay per visits; 9c (OP SA): $25 Copay per visits; 9d (OP Cardiac Rehab): $0 Copay per visits;	"14b (Immunizations): $0 Copay per visits; 14c (Routine Physical): 10% Coinsurance; 14c (AAA Screening, Cardiovascular Screening, EKG Screening, HIV Screening, Welcome to Medicare Physical, and Glaucoma tests): 0% Coinsurance; 14h (Mammography): $0 Copay per visits; 7a (PCP w/Copay): $25 Copay per visits;"	7d (SPC w/Copay): $50 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, and $25 Copay for 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;"	18a1 (Routine Hearing Exam) $25 Copay;															231.3781182	158.970979	70.72660937	0	50	0.1	0.172411683	49.85958518	320	10	30.86144791	0	0	112.8006978	22.17115747	47.49856679	40	15	0	14.50214459	0.2	0	0	10	25	40	0														NO	194.93652	133.9333627	59.58730759	0	42.1250984	0.084250197	0.145257182	42.00679864	269.6006298	8.425019681	26.0008306	0	0	95.03480987	18.6792438	40.017636	33.70007872	12.63752952	0	12.21808536	0.168500394	0	0	8.425019681	21.0625492	33.70007872	0															19.5205	0.29030884	5.620173393	0	2.438364193	1.267629303	1.117033492	0.956689615	14.15229586	0.389232883	2.869166563	0	0	5.00004784	5.695377084	25.69709988	0.407204523	1.044305033	0	0.975877897	6.343308096	0	0	0.262168749	1.196540207	0.124215982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.3675	0	17.82807936	19.5205	0.29030884	5.620173393	0	2.438364193	1.267629303	1.117033492	0.956689615	14.15229586	0.389232883	2.869166563	0	0	5.00004784	5.695377084	25.69709988	0.407204523	1.044305033	0	0.975877897	6.343308096	0	0	0.262168749	1.196540207	0.124215982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.3675	YES																																									4000																																									0	0	0	19.5205	0.29030884	5.620173393	0	2.438364193	1.267629303	1.117033492	0.956689615	14.15229586	0.389232883	2.869166563	0	0	5.00004784	5.695377084	25.69709988	0.407204523	1.044305033	0	0.975877897	6.343308096	0	0	0.262168749	1.196540207	0.124215982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.3675
H7220_004_0	2011	10																															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														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0														0	NO	1340.21012	29.01000184	1262.328016	1794.520358	774.7006367	17.07777116	8.72847602	304.8089701	702.5581331	618.3222403	1476.878636	4.448361441	10.85088627	704.1541101	4080.745046	8566.991121	161.7178457	1105.965188	0	1068.977578	42.72919686	100	0	330.3207572	631.1821739	46.86476425	85.94002814															1a (IP Acute): $175 Copay per admit (days 1-100); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: 90 days plus 60 medicare-covered lifetime reserve days;	1b (IP Psych): $175 Copay per admit (days 1-100); 1b (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: 90 days plus 60 medicare-covered lifetime reserve days;	2a (SNF): $75 Copay per day (days 21-100); 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): 10% Coinsurance; 11b (Prosthetics): 10% 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): $175 Copay per visits; 9b (OP Surg): $175 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): n/a;	12 (Renal Dialysis): 0% Coinsurance;	3 (CORF): $15 Copay per visits; 5 (Partial Hosp): $35 Copay per visits; 9a (OP Chemo): $0 Copay per visits; 9a (OP Other): $175 Copay per visits; 9c (OP SA): $25 Copay per visits; 9d (OP Cardiac Rehab): $0 Copay per visits;	"14b (Immunizations): $0 Copay per visits; 14c (Routine Physical): 10% Coinsurance; 14c (AAA Screening, Cardiovascular Screening, EKG Screening, HIV Screening, Welcome to Medicare Physical, and Glaucoma tests): 0% Coinsurance; 14h (Mammography): $0 Copay per visits; 7a (PCP w/Copay): $10 Copay per visits;"	7d (SPC w/Copay): $35 Copay per visits; 18a (Hearing Exam): $10 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, and $25 Copay for 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;															175.6294154	178.5377949	70.71546222	0	50	0.1	0.172411683	49.86087837	175	0	30.86144791	0	0	109.1073193	8.977844717	34.39502316	35	15	0	11.3798972	0.2	0	0	10	10	40	0														NO	153.6403199	156.1845655	61.86176852	0	43.73991669	0.087479833	0.150825453	43.61821332	153.0897084	0	26.99754321	0	0	95.44690108	7.853803599	30.08870895	30.61794168	13.12197501	0	9.955115107	0.174959667	0	0	8.747983338	8.747983338	34.99193335	0															17.1592	0.377576211	6.507486962	0	2.823778442	1.493960576	1.31647635	1.107935223	8.962868311	0	3.322674567	0	0	5.600777308	2.670780844	21.48080853	0.412622297	1.209370629	0	0.886816236	7.475886044	0	0	0.240803373	0.460130928	0.136657392	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6466	0	11.97155236	17.1592	0.377576211	6.507486962	0	2.823778442	1.493960576	1.31647635	1.107935223	8.962868311	0	3.322674567	0	0	5.600777308	2.670780844	21.48080853	0.412622297	1.209370629	0	0.886816236	7.475886044	0	0	0.240803373	0.460130928	0.136657392	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.6466	YES	1a (IP Acute): 30% Coinsurance; 1a1 (Add'l Days): 30% Coinsurance; 1a (IP Acute) - Limit: 10 additional days; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	1b (IP Psych): 30% Coinsurance; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	2a (SNF): 30% Coinsurance; 2a2 (Waiver 3 Day): 3-day period is waived; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	6a (Home Health): 30% Coinsurance; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	10a (Ambulance): 30% Coinsurance; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	11a (DME): 30% Coinsurance; 11b (Prosthetics): 30% Coinsurance; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	11b (Medical Supplies): 30% Coinsurance; 11c (Diabetic Supplies): 30% Coinsurance; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	4a (ER): $50 Copay per visits; 50 copay Worldwide Coverage; 4b (UC): $50 Copay per visits; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	9b (OP ASC): 30% Coinsurance; 9b (OP Surg): 30% Coinsurance; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	8a (OP Diag Proc/Test/Lab): 30% Coinsurance; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	8b (OP Diag): 30% Coinsurance; 8b (OP Therap Rad): 30% Coinsurance; 8b (X-Ray): 30% Coinsurance; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	9a (OP Observation): 30% Coinsurance; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	12 (Renal Dialysis): 30% Coinsurance; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	3 (CORF): 30% Coinsurance; 5 (Partial Hosp): Not covered; 9a (OP Chemo): 30% Coinsurance; 9a (OP Other): 30% Coinsurance; 9c (OP SA): 30% Coinsurance; 9d (OP Cardiac Rehab): 30% Coinsurance; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	14b (Immunizations): Not covered; 14c (Routine Physical): Not covered; 14h (Mammography): Not covered; 7a (PCP w/Copay): 30% Coinsurance; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	7d (SPC w/Copay): 30% Coinsurance; 18a (Hearing Exam): 30% Coinsurance; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	7h (Psych): 30% Coinsurance; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	7c (OT): 30% Coinsurance; 7i (PT/ST): 30% Coinsurance; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only): Not covered; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	7b (Chiro): 30% Coinsurance; 7f (Podiatry): 30% Coinsurance; 8a (OP Diag Proc/Test/Lab): 30% Coinsurance; 8b (X-Ray): 30% Coinsurance; All other Services: No Cost Sharing; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	15 (Part B Rx): 30% Coinsurance; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	13a (Blood): 0% Coinsurance; 14a (Helath Education/Wellness Programs): Not covered; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	10b (Transportation): Not Covered; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): Not Covered; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	17a (Eye Exam): Not covered; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	17b (Eyewear): Not covered; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;	18a (Hearing Exam): Not covered; Annual Aggregate (all OON benefits) Out-of-Network benefit limit of $10K;														4000	3.4125	0.026	1.0999	0.5103	0.1468	0.2477	0.1266	0.0583	0.8907	0.0353	0.4156	0	0	0.2037	0.3195	1.3287	0.0177	0.0841	0	0.1204	0.6197	0	0	0	0	0	0														9.6634	0	1.383027538	20.5717	0.403545564	7.607361581	0.510288048	2.970554219	1.741643513	1.443067494	1.166251954	9.853558653	0.035276902	3.738271154	0	0	5.804505043	2.99023782	22.80955088	0.430278343	1.293479268	0	1.00718347	8.09559765	0	0	0.240803373	0.460130928	0.136657392	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.31
H7220_801_0	2011	5																															Coin	Coin	Coin	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	NO	225.7930925	1.718281243	72.77400954	33.76358232	9.711526734	16.38812292	8.375995706	15.10669884	58.93317867	2.334122078	27.49825253	0.092809941	10.41269708	13.47979476	23.36144214	84.33040297	1.168225168	5.565109636	24.98029293	109.3688719	41.00367219	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	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance															0.075611328	0.075611328	0.185130862	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0														NO	0.075611328	0.075611328	0.185130862	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0															17.0725	0.129921527	13.47271513	0	2.262785729	3.818432641	1.951607	3.51986083	13.73143063	0.543850444	6.40709284	0.021624716	2.42615842	3.14079218	5.44321602	19.64898389	0.272196464	1.296670545	5.820408254	25.48294716	9.553855621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.0171	0	51991.92681	17.0725	0.129921527	13.47271513	0	2.262785729	3.818432641	1.951607	3.51986083	13.73143063	0.543850444	6.40709284	0.021624716	2.42615842	3.14079218	5.44321602	19.64898389	0.272196464	1.296670545	5.820408254	25.48294716	9.553855621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.0171	YES	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	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance														4000	0.0165	0.0001	0.013	0	0.0022	0.0037	0.0019	0.0034	0.0133	0	0.0062	0	0.0023	0.033	0.2153	0.209	0.2103	0.2113	0.2156	0.2118	0.0092	0	0	0	0	0	0														1.378	0	6.307574901	17.089	0.130047024	13.48572904	0	2.264971458	3.82212104	1.953492146	3.523260825	13.74469445	0.543850444	6.413281745	0.021624716	2.428501958	3.173826016	5.658473872	19.85796375	0.482459391	1.507923059	6.036030453	25.69474152	9.563084129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.3951
H7220_802_0	2011	5																															Coin	Coin	Coin	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	NO	229.9859093	1.750188501	73.91627225	35.10783424	9.892028958	16.69271897	8.531675229	15.38721948	60.02752581	2.377465062	28.00887549	0.094533355	10.60605345	13.73010495	23.91681913	86.33520923	1.195997656	5.697410279	25.57415524	111.9689235	41.76578244	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	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance															0.075611328	0.075611328	0.185130862	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0														NO	0.075611328	0.075611328	0.185130862	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0															17.3895	0.132334077	13.68418321	0	2.304842747	3.88940352	1.987880328	3.585222138	13.98641351	0.553949359	6.526067988	0.022026272	2.471210454	3.199114453	5.572618858	20.11610375	0.278667454	1.327496595	5.958778171	26.08875918	9.731427308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.806	0	54505.18561	17.3895	0.132334077	13.68418321	0	2.304842747	3.88940352	1.987880328	3.585222138	13.98641351	0.553949359	6.526067988	0.022026272	2.471210454	3.199114453	5.572618858	20.11610375	0.278667454	1.327496595	5.958778171	26.08875918	9.731427308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.806	YES	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	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance														4000	0.0166	0.0001	0.013	0	0.0022	0.0037	0.0019	0.0034	0.0133	0.0005	0.0062	0	0.0024	0.003	0.2253	0.2192	0.2203	0.2113	0.2157	0.2118	0.0093	0	0	0	0	0	0														1.3792	0	6.453410149	17.4061	0.132460123	13.69721711	0	2.307038062	3.893108096	1.989773743	3.588636987	13.99973528	0.554476985	6.532283933	0.022047251	2.47356423	3.202161543	5.797926662	20.33526392	0.498932879	1.538761008	6.174453783	26.30057059	9.740696291	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.1852
H7220_804_0	2011	5																															Coin	Coin	Coin	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	YES	237.6762647	1.808711963	76.60400308	35.54051206	10.2226307	17.25060673	8.816812552	15.90174311	62.03474879	2.456963633	28.9454468	0.097694397	10.96070265	14.18921736	24.59092191	88.7685932	1.229707212	5.857993511	26.29497054	115.1248015	43.16163766	0	0	0	0	0	0														4000	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	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance															0.075611328	0.075611328	0.185130862	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0														NO	0.075611328	0.075611328	0.185130862	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0															17.971	0.136759114	14.18176514	0	2.381872952	4.019391368	2.054317325	3.705106144	14.45409647	0.572472526	6.744289104	0.022762794	2.553843718	3.306087645	5.729684806	20.68308222	0.28652178	1.364912488	6.126728135	26.82407874	10.05666157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.1755	0	57659.11626	17.971	0.136759114	14.18176514	0	2.381872952	4.019391368	2.054317325	3.705106144	14.45409647	0.572472526	6.744289104	0.022762794	2.553843718	3.306087645	5.729684806	20.68308222	0.28652178	1.364912488	6.126728135	26.82407874	10.05666157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.1755	NO																																																																																		0	0	0	17.971	0.136759114	14.18176514	0	2.381872952	4.019391368	2.054317325	3.705106144	14.45409647	0.572472526	6.744289104	0.022762794	2.553843718	3.306087645	5.729684806	20.68308222	0.28652178	1.364912488	6.126728135	26.82407874	10.05666157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.1755
H7220_805_0	2011	5																															Coin	Coin	Coin	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	YES	242.0897435	1.842298455	77.80638146	36.95551007	10.4126325	17.57123324	8.98068527	16.19702715	63.18668987	2.502587697	29.48294312	0.099508512	11.16423509	14.45270102	25.17552761	90.87890958	1.258941327	5.997256951	26.92008698	117.8616901	43.96385669	0	0	0	0	0	0														4000	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	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance															0.075611328	0.075611328	0.185130862	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0														NO	0.075611328	0.075611328	0.185130862	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0															18.3047	0.139298633	14.40436248	0	2.426143372	4.094097344	2.092499668	3.773907325	14.72249874	0.583102933	6.869525747	0.023185483	2.601266776	3.367479337	5.865897933	21.17478593	0.293333329	1.397360869	6.272380266	27.46177379	10.24357861	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.1112	0	16.67032794	18.3047	0.139298633	14.40436248	0	2.426143372	4.094097344	2.092499668	3.773907325	14.72249874	0.583102933	6.869525747	0.023185483	2.601266776	3.367479337	5.865897933	21.17478593	0.293333329	1.397360869	6.272380266	27.46177379	10.24357861	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.1112	NO																																																																																		0	0	0	18.3047	0.139298633	14.40436248	0	2.426143372	4.094097344	2.092499668	3.773907325	14.72249874	0.583102933	6.869525747	0.023185483	2.601266776	3.367479337	5.865897933	21.17478593	0.293333329	1.397360869	6.272380266	27.46177379	10.24357861	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.1112
H7281_001_0	2011	5																															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	833.0662166	14.46315051	1111.295233	22.62751678	146.3297558	9.706514551	2.547826271	152.2534476	236.1197761	8.318383057	9.654950523	0	0.024906982	635.0471404	3298.76911	3749.031533	528.657305	145.0760978	24.50415608	34.98312423	3.785819468	0.219164071	0	0	0	0	0	0	0	0												1a:  Acute - $225/$0/day for 1-7/8-90	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	2:  Skilled Nursing Services - $0/$50/$110/day for 1-10/11-20/21-100 /2:  Non-Medicare Covered Stay - $0/$50/$110/day for 1-10/11-20/21-100	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 - 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 - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/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/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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/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:  Eye Glasses & Contact Lenses - $0/service			14c:  Routine Exams - $0/visit													225	0.073944329	46	0	150	0.2	0.2	43.42320582	195.890634	0	0.182112505	0	0.2	53.09998863	5	37.06754625	20	40	0	40	0.2	0	0	0	0	0	0	0	0	0											NO	216.5350682	0.071162401	44.26939173	0	144.3567122	0.192475616	0.192475616	41.79678435	188.5208524	0	0.175261083	0	0.192475616	51.10226516	4.811890405	35.67299402	19.24756162	38.49512324	0	38.49512324	0.192475616	0	0	0	0	0	0	0	0	0												15.0323	1.029232519	4.099696998	0	1.760306869	1.868267369	0.490394432	0.53030871	3.709458455	0	1.692137085	0	0.004793987	2.70436228	1.322776286	11.14493162	0.847947004	0.465393522	0	0.112223307	0.728677935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5432	0	1.858496452	15.0323	1.029232519	4.099696998	0	1.760306869	1.868267369	0.490394432	0.53030871	3.709458455	0	1.692137085	0	0.004793987	2.70436228	1.322776286	11.14493162	0.847947004	0.465393522	0	0.112223307	0.728677935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5432	YES	1a:  Acute - 20.0%		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 - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	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%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/14c:  Routine Exams - 20.0%/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/Vision Exams:   - /visit"	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/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		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) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%"	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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%							14c:  Routine Exams - 20.0%												6700	5.1113	0	1.0872	0.6651	0.1599	0	0	0.0877	0.7958	0.1174	0.416	0	0.0005	0.3512	0.5477	1.47	0	0.0877	0.3484	0.3991	0.1638	0.0167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.8255	0	3.33	20.1436	1.029232519	5.186902008	0.665082072	1.92022137	1.868267369	0.490394432	0.618004631	4.505251876	0.117420569	2.108155888	0	0.00526919	3.055584185	1.870481129	12.614912	0.847947004	0.553075625	0.348410815	0.511330729	0.892461136	0.01667389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3687
H7281_002_0	2011	3																															A	coin	D	coin	T	coin	coin	V	V	coin	P	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	204.1749875	14.46315051	1122.435549	22.85434911	148.8599418	9.803818704	2.572387309	161.6266265	240.3391373	8.346195202	96.01712703	0	0.025156665	646.6167293	0	3934.513302	528.657305	149.9381155	25.04769239	36.15553354	3.805981444	0.221361108	0	0	0	0	0	0	0	0												1a:  Acute - $350/admit for 1-90	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	2:  Skilled Nursing Services - $0/$50/$110/day for 1-10/11-20/21-100 /2:  Non-Medicare Covered Stay - $0/$50/$110/day for 1-10/11-20/21-100	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 - 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) - $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 - $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 - $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) - $150/visit	"7a:  Primary Care - $0/visit/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $25/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/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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/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 - Non-Rountine 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:  Eye Glasses & Contact Lenses - $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													350	0.073944329	46	0	100	0.2	0.2	33.14252705	145.8908583	0	50	0	0.2	37.28319444	0	23.87111111	20	25	0	25	0.2	0	0	0	0	0	0	0	0	0											NO	345.7936833	0.073055662	45.4471698	0	98.79819522	0.19759639	0.19759639	32.74641992	144.137535	0	49.39909761	0	0.19759639	36.83512322	0	23.58422695	19.75963904	24.6995488	0	24.6995488	0.19759639	0	0	0	0	0	0	0	0	0												5.8835	1.056615039	4.250959915	0	1.225591132	1.937199188	0.508294447	0.441057782	2.886824235	0	0.395263286	0	0.004970866	1.984850575	0	7.732704556	0.87050646	0.308616983	0	0.07441878	0.752048195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.3135	0	0.368710096	5.8835	1.056615039	4.250959915	0	1.225591132	1.937199188	0.508294447	0.441057782	2.886824235	0	0.395263286	0	0.004970866	1.984850575	0	7.732704556	0.87050646	0.308616983	0	0.07441878	0.752048195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.3135	YES	1a:  Acute - 20.0%		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 - $25/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	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%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/14c:  Routine Exams - 20.0%/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/Vision Exams:   - /visit"	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/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		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) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%"	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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%							14c:  Routine Exams - 20.0%												6700	5.1463	0	1.0947	0.6696	0.161	0	0	0.0708	0.8013	0.1182	0.4189	0	0.0005	0.3536	0.5521	1.4835	0	0.0883	0.3508	0.4018	0.1649	0.0168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.8932	0	3.397	11.0299	1.056615039	5.345621272	0.669643386	1.386602369	1.937199188	0.508294447	0.51189488	3.688075424	0.118225871	0.814135259	0	0.005449329	2.338481256	0.5521398	9.216160736	0.87050646	0.396900434	0.350800311	0.47626339	0.916954667	0.016788244	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2066
H7281_003_0	2011	2																															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	YES	306.4477505	14.56001017	67.99250493	36.804568	11.48183221	18.41986674	6.129578005	242.5337327	21.06990536	9.219434219	9.305761627	0	0.112728767	15.90374361	96.99882698	110.8441993	6.795775009	5.117540191	18.5738168	15.52632193	3.873418345	0.141876712	0	0	0	0	0	0	0	0											6700	"1a:  Acute - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	"2:  Skilled Nursing Services - Days 1-20, $0/day; days 21-100, $137.50/day for 1-100/2:  Non-Medicare Covered Stay - Days 1-20, $0/day; days 21-100, $137.50/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 - 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 - $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 - 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/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/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/7f:  Routine Podiatry - $0/visit/12 Visits	7e:  Mental Hlth Spec-Non-Physician - Individual - 20.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 20.0%/7h:  Psychiatric Services - Individual - 20.0%/7h:  Psychiatric Services - Group - 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:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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 - 20.0%/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%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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 - Non-Rountine 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:  Eye Glasses & Contact Lenses - $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	13c:  Other: Over the Counter Benefit - $0/visit												0.073920649	0.073944329	0.149573229	0	0.2	0.2	0.2	79.10675068	0.2	0	0.2	0	0.2	0.2	0	0.195771211	0.2	0.2	0.182744932	0.144863492	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.067443464	0.067465068	0.1364671	0	0.182475302	0.182475302	0.182475302	72.17514102	0.182475302	0	0.182475302	0	0.182475302	0.182475302	0	0.178617054	0.182475302	0.182475302	0.166732183	0.132170047	0.182475302	0.182475302	0	0	0	0	0	0	0	0												20.6679	0.982292084	9.278739976	0	2.095150797	3.361170742	1.118496596	1.458742197	3.844737339	0	1.698071661	0	0.020570216	2.902040414	0	19.79866438	1.240061096	0.933824691	3.096853023	2.052114698	0.706803182	0.025888996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2821	0	7.23	20.6679	0.982292084	9.278739976	0	2.095150797	3.361170742	1.118496596	1.458742197	3.844737339	0	1.698071661	0	0.020570216	2.902040414	0	19.79866438	1.240061096	0.933824691	3.096853023	2.052114698	0.706803182	0.025888996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2821	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.6679	0.982292084	9.278739976	0	2.095150797	3.361170742	1.118496596	1.458742197	3.844737339	0	1.698071661	0	0.020570216	2.902040414	0	19.79866438	1.240061096	0.933824691	3.096853023	2.052114698	0.706803182	0.025888996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2821
H7281_004_0	2011	2																															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	YES	418.0145254	16.31132151	400.1787162	1.348838784	38.1514707	20.75853591	5.457745095	61.99575268	14.85968064	12.44334494	4.314656798	0	0.05580402	33.62251033	0	0	5.10286017	0.465248893	30.47135729	14.21608279	2.234032278	0.160731131	0	0	0	0	0	0	0	0											6700	"1a:  Acute - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/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 - 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $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/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/7f:  Routine Podiatry - $0/visit/12 Visits	7e:  Mental Hlth Spec-Non-Physician - Individual - 20.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 20.0%/7h:  Psychiatric Services - Individual - 20.0%/7h:  Psychiatric Services - Group - 20.0%	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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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 - Non-Rountine 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:  Eye Glasses & Contact Lenses - $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	13c:  Other: Over the Counter Benefit - $0/visit												0.073926969	0.073944329	0	0	0.2	0.2	0.2	50	0.2	0	0.2	0	0.2	0.023016546	0	0	0.2	0	0	3.34E-06	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.071402063	0.071451845	0	0	0.193030471	0.19178158	0.193855087	48.45789868	0.192645832	0	0.193608106	0	0.193922534	0.022304049	0	0	0.193275806	0	0	3.20E-06	0.193520134	0.194109571	0	0	0	0	0	0	0	0												29.8471	1.165474024	0	0	7.364396346	3.981104811	1.058011653	0.250348659	2.86265554	0	0.835352531	0	0.010821657	0.749918133	0	0	0.986259414	0	0	4.55E-05	0.432330227	0.031199451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.575	0	1.785	29.8471	1.165474024	0	0	7.364396346	3.981104811	1.058011653	0.250348659	2.86265554	0	0.835352531	0	0.010821657	0.749918133	0	0	0.986259414	0	0	4.55E-05	0.432330227	0.031199451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.575	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8471	1.165474024	0	0	7.364396346	3.981104811	1.058011653	0.250348659	2.86265554	0	0.835352531	0	0.010821657	0.749918133	0	0	0.986259414	0	0	4.55E-05	0.432330227	0.031199451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.575
H7281_005_0	2011	4																															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	1622.57788	16.09762113	1090.527736	22.55236864	457.0196265	13.31833158	11.83011541	363.0505913	205.2597244	8.31291559	9.391070837	0	0.030742947	434.7096362	3512.239964	3802.395169	480.0273598	101.1449729	33.7255575	52.29123906	3.8868203	0.016234492	0	0	0	0	0	0	0	0											6700	1a:  Acute - $225/$0/day for 1-7/8-90	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	2:  Skilled Nursing Services - $0/$50/$110/day for 1-10/11-20/21-100 /2:  Non-Medicare Covered Stay - $0/$50/$110/day for 1-10/11-20/21-100	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) - $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/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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/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/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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/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:  Eye Glasses & Contact Lenses - $0/service			14c:  Routine Exams - $0/visit													225	0.073944329	46	0	150	0.2	0.034455768	43.42320582	195.7173187	0	0.204335694	0	0.2	56.35190089	5	39.89271636	20	40	0	40	0.2	0	0	0	0	0	0	0	0	0											NO	210.8307285	0.069287719	43.10317116	0	140.553819	0.187405092	0.032285932	40.70077307	183.3921106	0	0.191467748	0	0.187405092	52.80316586	4.6851273	37.38049089	18.7405092	37.4810184	0	37.4810184	0.187405092	0	0	0	0	0	0	0	0	0												28.5074	1.115367444	3.917100304	0	5.352987822	2.495923155	0.3819463	1.231369978	3.136917839	0	1.798087181	0	0.005761385	1.912837085	1.371274278	11.8446165	0.749663096	0.315918049	0	0.163327408	0.728409916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0289	0	4.37	28.5074	1.115367444	3.917100304	0	5.352987822	2.495923155	0.3819463	1.231369978	3.136917839	0	1.798087181	0	0.005761385	1.912837085	1.371274278	11.8446165	0.749663096	0.315918049	0	0.163327408	0.728409916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0289	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.5074	1.115367444	3.917100304	0	5.352987822	2.495923155	0.3819463	1.231369978	3.136917839	0	1.798087181	0	0.005761385	1.912837085	1.371274278	11.8446165	0.749663096	0.315918049	0	0.163327408	0.728409916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0289
H7292_001_0	2011	3																																																																																																															0	YES																																									6700																																																																																		NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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
H7301_002_0	2011	13																															D	D	D	V	T	COIN	COIN	V	V	COIN	COIN	O	COIN	COIN	COIN	P	P	P	COIN	P	COIN	V	T	COIN	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	986.3105745	39.01335686	502.5418813	0	116.5092047	3.903814337	4.933626243	327.8598703	358.6559705	10.58759485	23.60031258	11.05476536	0	10.66709597	22.76777049	7805.150799	167.1031159	638.8450517	11.09254655	1807.536819	23.93256375	0	0	0	34.85299623	0	0	0	0	0											4000	1a $225 days 1-6	1b $225 days 1-6	2 $137.50 days 21-49	6 0%	10a $100	11a 20%	"11b 20%, 11c 20%"	"4a $50, 4b $30"	"9a $300,9b $300"	8a $40 lab	"8a 20%, 8b $258a3- $40 lab8a3- $40 diagnostic proc/tests8b2- $25 x-rays8b2- $150 diag. rad services8b1 - 20% therapeutic radiology"	9a 20%	12 $0	"9a 20%,9d 20%, 4b $30, 3 20%3 (CORF) - $455 - Part Hosp - $759a OP Hosp $3009b (ASC) - $3009c4 - OPSA - $409d (card rehab) - $457i (PT/SP) - $457e MH - $407c OT - $45"	"14c $0,7a $20, 14c (routine exam) - $20, 7a(PCP) - $20"	"17a $45,17b 30%,18a $45,7b $20,7d $45,7f $45,8a 20%, 14d-j $0"	"7h $40,9c $40, 7e $40"	"7c $45,7i $45"	"8a 20%, 8b $25, 14h: $0/visit;14h1: $0/visit;7a: $20/visit;7d: $45/visit;8b: $25/visit"	7g $45	15 20%				17a1: $45/visit (post cataract)	17b4 - 30% (post cataract)	18a $45			7f $45												177.6779752	151.9909432	21.75045236	0	100	0.2	0.2	49.16176961	300	0.167260854	0.290990869	75	0	0.246267729	0.211822641	23.39734708	40	45	0.204090188	41.25036757	0.213696924	0	0	0	45	0	0	0	0	0											NO	143.0800626	122.4151276	17.51804644	0	80.54106716	0.161082134	0.161082134	39.59541388	241.6232015	0.134713677	0.234367151	60.40580037	0	0.198164237	0.170604215	18.84447303	32.21642687	36.24348022	0.164376415	33.22348625	0.172113783	0	0	0	45	0	0	0	0	0												11.7601	0.397985422	0.733629335	0	0.781981307	0.628834745	0.794719045	1.081812272	7.221633652	1.426293831	5.531138026	0.055647662	0	2.113836929	3.88427762	12.25699614	0.448622109	1.929497333	1.823353037	5.004389555	4.119124086	0	0	0	0.130698736	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1246	0	14.98271757	11.7601	0.397985422	0.733629335	0	0.781981307	0.628834745	0.794719045	1.081812272	7.221633652	1.426293831	5.531138026	0.055647662	0	2.113836929	3.88427762	12.25699614	0.448622109	1.929497333	1.823353037	5.004389555	4.119124086	0	0	0	0.130698736	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1246	YES	OON: 30%	OON: 30%	OON: 30%	OON: 30%	10a $100	OON: 30%	OON: 30%	"4a $50, 4b $30"	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	"OON: 30%, 0% for flu and pneumonia vaccines"	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%											10000	2.2244	0	0.1876	0.7535	0.3571	0.623	1.004	0.0435	1.2265	0.3989	0.8532	0.0021	0	0.7062	1.2391	5.5517	0.0014	0.257	0.4072	0.3754	1.4753	0	0	0	0.0198	0.0241	0	0	0	0											17.7312	0	1.8524	13.9846	0.397985422	0.92120338	0.753496606	1.139088787	1.251813572	1.798734007	1.125296951	8.448180039	1.825209572	6.384334476	0.057772136	0	2.820073846	5.12338501	17.80873418	0.450003673	2.186448351	2.230563448	5.379827178	5.594444779	0	0	0	0.150533624	0.024141383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.8558
H7301_801_0	2011	14																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	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	YES	262.2545969	6.54189054	26.10452441	0	8.142153938	7.744165942	8.691953328	21.53800309	75.0502131	14.84819275	37.61874148	0.343760171	0.137782472	21.2370154	33.04703904	130.5150872	1.914779417	6.374054283	10.74813324	10.35668267	23.49366157	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.5%	FFS Medicare 8.5%	FFS Medicare 18.6%		FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																				0.084551692	0.084551692	0.186254233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.061979121	0.061979121	0.136530368	0	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0	0	0	0	0	0	0	0	0												16.2543	0.405460626	3.564060335	0	1.390651601	1.322676634	1.484555427	3.678616091	12.81831562	2.53601973	6.425150333	0.058713043	0.023532767	3.627208439	5.644319442	22.29152341	0.327037671	1.088666324	1.835743811	1.768885414	4.012635764	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5581	0	32.98092476	16.2543	0.405460626	3.564060335	0	1.390651601	1.322676634	1.484555427	3.678616091	12.81831562	2.53601973	6.425150333	0.058713043	0.023532767	3.627208439	5.644319442	22.29152341	0.327037671	1.088666324	1.835743811	1.768885414	4.012635764	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5581	YES	FFS Medicare 8.5%	FFS Medicare 8.5%	FFS Medicare 18.6%		FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																			10000	2.426	0	0.5402	0	0.2108	0.2757	0.225	0.5576	1.943	0.3844	0.9636	0.0089	0	0.539	0.8556	3.377	0	0.165	0.2561	0.268	0.4352	0	0	0	0	0	0	0	0	0											13.431	0	0	18.6804	0.405460626	4.104291243	0	1.60144292	1.598359323	1.709580441	4.23621106	14.76128225	2.920422942	7.38874975	0.067612612	0.023532767	4.166158515	6.499870564	25.66848801	0.327037671	1.253683507	2.091834657	2.036906633	4.447844199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9891
H7301_802_0	2011	12																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	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	YES	262.2545969	6.54189054	26.10452441	0	8.142153938	7.744165942	8.691953328	21.53800309	75.0502131	14.84819275	37.61874148	0.343760171	0.137782472	21.2370154	33.04703904	130.5150872	1.914779417	6.374054283	10.74813324	10.35668267	23.49366157	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.5%	FFS Medicare 8.5%	FFS Medicare 18.6%		FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																				0.084551692	0.084551692	0.186254233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.061979121	0.061979121	0.136530368	0	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0	0	0	0	0	0	0	0	0												16.2543	0.405460626	3.564060335	0	1.390651601	1.322676634	1.484555427	3.678616091	12.81831562	2.53601973	6.425150333	0.058713043	0.023532767	3.627208439	5.644319442	22.29152341	0.327037671	1.088666324	1.835743811	1.768885414	4.012635764	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5581	0	32.98092476	16.2543	0.405460626	3.564060335	0	1.390651601	1.322676634	1.484555427	3.678616091	12.81831562	2.53601973	6.425150333	0.058713043	0.023532767	3.627208439	5.644319442	22.29152341	0.327037671	1.088666324	1.835743811	1.768885414	4.012635764	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5581	YES	FFS Medicare 8.5%	FFS Medicare 8.5%	FFS Medicare 18.6%		FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																			10000	2.426	0	0.5402	0	0.2108	0.2757	0.225	0.5576	1.943	0.3844	0.9636	0.0089	0	0.539	0.8556	3.377	0	0.165	0.2561	0.268	0.4352	0	0	0	0	0	0	0	0	0											13.431	0	0	18.6804	0.405460626	4.104291243	0	1.60144292	1.598359323	1.709580441	4.23621106	14.76128225	2.920422942	7.38874975	0.067612612	0.023532767	4.166158515	6.499870564	25.66848801	0.327037671	1.253683507	2.091834657	2.036906633	4.447844199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9891
H7301_803_0	2011	5																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	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	YES	262.2545969	6.54189054	26.10452441	0	8.142153938	7.744165942	8.691953328	21.53800309	75.0502131	14.84819275	37.61874148	0.343760171	0.137782472	21.2370154	33.04703904	130.5150872	1.914779417	6.374054283	10.74813324	10.35668267	23.49366157	0	0	0	0	0	0	0	0	0											6700	FFS Medicare 8.5%	FFS Medicare 8.5%	FFS Medicare 18.6%		FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																				0.084551692	0.084551692	0.186254233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.061979121	0.061979121	0.136530368	0	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0.170796525	0	0	0	0	0	0	0	0	0												16.2543	0.405460626	3.564060335	0	1.390651601	1.322676634	1.484555427	3.678616091	12.81831562	2.53601973	6.425150333	0.058713043	0.023532767	3.627208439	5.644319442	22.29152341	0.327037671	1.088666324	1.835743811	1.768885414	4.012635764	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5581	0	32.98092476	16.2543	0.405460626	3.564060335	0	1.390651601	1.322676634	1.484555427	3.678616091	12.81831562	2.53601973	6.425150333	0.058713043	0.023532767	3.627208439	5.644319442	22.29152341	0.327037671	1.088666324	1.835743811	1.768885414	4.012635764	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5581	YES	FFS Medicare 8.5%	FFS Medicare 8.5%	FFS Medicare 18.6%		FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																			10000	2.426	0	0.5402	0	0.2108	0.2757	0.225	0.5576	1.943	0.3844	0.9636	0.0089	0	0.539	0.8556	3.377	0	0.165	0.2561	0.268	0.4352	0	0	0	0	0	0	0	0	0											13.431	0	0	18.6804	0.405460626	4.104291243	0	1.60144292	1.598359323	1.709580441	4.23621106	14.76128225	2.920422942	7.38874975	0.067612612	0.023532767	4.166158515	6.499870564	25.66848801	0.327037671	1.253683507	2.091834657	2.036906633	4.447844199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9891
H7306_001_0	2011	10																															COIN	D	D	V	COIN	COIN	COIN	V	V	O	COIN	O	COIN	COIN	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	190.3367155	68.59403398	246.6912233	0	1.605917758	7.706597593	3.231521641	349.1657778	197.3167395	0	9.328166495	11.77449603	0.219453348	10.17722561	21.13644534	83.22203129	227.2521681	280.9327444	1597.206519	1342.321311	12.45213383	0	0	0	0	0	0	0	0	0											6700	1a: Days 1 - 6: $160/day then $0	1b: Days 1 - 7: $200/day then $0	"2: Days 1 - 4: $0/day, then $50/day"	6: $0/visit	10a: 20%	11a: 20%	11b: 20%;11c: 20%	4a: $50/visit;4a1: $50/visit;4b: $30/visit	9a: $245/visit;9b: $245/visit	8a: $0/visit	8b: $0/visit;8b: $250/visit;8b: 20%	9a: $245/visit	12a: 20%	3: 20%;5: 20%;9a: $245/visit;9c: $30;9d: 20%;7i: $30/visit;7e: $30/visit;7c: $30/visit	7a: $15/visit;14c: $0/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: $15/visit;7d: $30/visit	7c: $30/visit;7i: $30/visit;7a: $15/visit;7d: $30/visit	14h: $0/visit;7a: $15/visit;7d: $30/visit	7g: $30/visit;14b: $0/visit;14i: 0%;14j: 0%; 17b: $0/visit7a: $15/visit;7d: $30/visit;8a: $0/visit;12a: 20%	15: 20%	13a: $0/visit							14a: $0/visit													0.053515083	146.0337289	37.37086477	0	0.2	0.2	0.2	49.65964995	245	0	0.405748309	245	0.021059452	0.155534683	0.145316944	0.072656052	30	30	0.005499158	28.60770284	0.2	0	0	0	0	0	0	0	0	0											NO	0.051512201	140.5681991	35.9722045	0	0.192514702	0.192514702	0.192514702	47.80106358	235.8305101	0	0.390562575	235.8305101	0.02027127	0.149713566	0.139878241	0.069936791	28.87720532	28.87720532	0.005293344	27.53701695	0.192514702	0	0	0	0	0	0	0	0	0												9.8047	0.803511652	0.739502261	0	0.309162779	1.48363334	0.622115426	1.390874629	3.87777561	0	3.643232723	0.231398784	0.004448598	1.523668739	2.956528798	5.82028181	0.546867293	0.676046045	0.000704547	3.080293724	2.397218835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9119	0	1.551843429	9.8047	0.803511652	0.739502261	0	0.309162779	1.48363334	0.622115426	1.390874629	3.87777561	0	3.643232723	0.231398784	0.004448598	1.523668739	2.956528798	5.82028181	0.546867293	0.676046045	0.000704547	3.080293724	2.397218835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9119	YES	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%	OON: 30%	OON: 30%	"OON: 30%; flu, pneumonia $0"	OON: 30%	OON: 30%							OON: $50/visit; 30%												10000	20.5087	0.0528	1.2492	1.241	1.446	0.9643	1.0825	0.1309	5.4529	0.8362	1.7691	0.0775	0.0057	2.0848	4.5865	19.8638	0.0021	0.7203	2.2788	1.4681	2.1111	0	0	0	0	0	0	0	0.8667	0											68.7991	0	8.440397883	30.3133	0.856344867	1.988728396	1.24100107	1.755118857	2.447940429	1.704640148	1.521819743	9.330698304	0.836191229	5.412292129	0.308922002	0.010159883	3.608509108	7.54305819	25.68408159	0.548957054	1.396327538	2.279490611	4.548383399	4.508359763	0	0	0	0	0	0	0	0.866666667	0	0	0	0	0	0	0	0	0	0	0	108.711
H7306_801_0	2011	4																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	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	YES	364.1925495	5.694488547	18.11359652	0	8.265740081	12.64034922	8.861276563	20.58186742	54.04888132	8.298211912	19.54878121	0.846558734	0.295058066	22.03860289	47.08122806	193.7294379	4.472235268	6.171490824	22.97779115	14.35650603	24.78939376	0	0	0	0	0	0	0	0	0											6700	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS																					0.073889322	0.073889322	0.18681722	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.062311955	0.062311955	0.157545717	0	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0	0	0	0	0	0	0	0	0												22.6935	0.354834715	2.853719552	0	1.624154579	2.483731749	1.741172934	4.044179214	10.62019096	1.630535045	3.841185691	0.166342303	0.057976649	4.330416569	9.251100494	38.06634986	0.878759956	1.21265065	4.514959864	2.82094341	4.870925894	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.0577	0	21.93474903	22.6935	0.354834715	2.853719552	0	1.624154579	2.483731749	1.741172934	4.044179214	10.62019096	1.630535045	3.841185691	0.166342303	0.057976649	4.330416569	9.251100494	38.06634986	0.878759956	1.21265065	4.514959864	2.82094341	4.870925894	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.0577	YES	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS																				10000	2.846	0.0445	0.3579	0	0.2037	0.3115	0.2184	0.5072	1.3319	0.2045	0.4817	0.0209	0.0073	0.5431	1.1602	4.774	0.1102	0.1521	0.5662	0.3538	0.6109	0	0	0	0	0	0	0	0	0											14.8058	0	0.748875673	25.5396	0.399335213	3.21160996	0	1.827842901	2.795221281	1.95953675	4.551367438	11.95208935	1.835023553	4.32291611	0.187203609	0.065247611	4.873502364	10.41129864	42.84032335	0.988966917	1.364731479	5.081189586	3.1747233	5.481797994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.8635
H7306_803_0	2011	4																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	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	YES	364.1925495	5.694488547	18.11359652	0	8.265740081	12.64034922	8.861276563	20.58186742	54.04888132	8.298211912	19.54878121	0.846558734	0.295058066	22.03860289	47.08122806	193.7294379	4.472235268	6.171490824	22.97779115	14.35650603	24.78939376	0	0	0	0	0	0	0	0	0											6700	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS																					0.073889322	0.073889322	0.18681722	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.062311955	0.062311955	0.157545717	0	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0	0	0	0	0	0	0	0	0												22.6935	0.354834715	2.853719552	0	1.624154579	2.483731749	1.741172934	4.044179214	10.62019096	1.630535045	3.841185691	0.166342303	0.057976649	4.330416569	9.251100494	38.06634986	0.878759956	1.21265065	4.514959864	2.82094341	4.870925894	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.0577	0	21.93474903	22.6935	0.354834715	2.853719552	0	1.624154579	2.483731749	1.741172934	4.044179214	10.62019096	1.630535045	3.841185691	0.166342303	0.057976649	4.330416569	9.251100494	38.06634986	0.878759956	1.21265065	4.514959864	2.82094341	4.870925894	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.0577	YES	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS																				10000	2.846	0.0445	0.3579	0	0.2037	0.3115	0.2184	0.5072	1.3319	0.2045	0.4817	0.0209	0.0073	0.5431	1.1602	4.774	0.1102	0.1521	0.5662	0.3538	0.6109	0	0	0	0	0	0	0	0	0											14.8058	0	0.748875673	25.5396	0.399335213	3.21160996	0	1.827842901	2.795221281	1.95953675	4.551367438	11.95208935	1.835023553	4.32291611	0.187203609	0.065247611	4.873502364	10.41129864	42.84032335	0.988966917	1.364731479	5.081189586	3.1747233	5.481797994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.8635
H7306_804_0	2011	5																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	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	YES	364.1925495	5.694488547	18.11359652	0	8.265740081	12.64034922	8.861276563	20.58186742	54.04888132	8.298211912	19.54878121	0.846558734	0.295058066	22.03860289	47.08122806	193.7294379	4.472235268	6.171490824	22.97779115	14.35650603	24.78939376	0	0	0	0	0	0	0	0	0											6700	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS																				0.073889322	0.073889322	0.18681722	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.062311955	0.062311955	0.157545717	0	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0.196492336	0	0	0	0	0	0	0	0	0												22.6935	0.354834715	2.853719552	0	1.624154579	2.483731749	1.741172934	4.044179214	10.62019096	1.630535045	3.841185691	0.166342303	0.057976649	4.330416569	9.251100494	38.06634986	0.878759956	1.21265065	4.514959864	2.82094341	4.870925894	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.0577	0	21.93474903	22.6935	0.354834715	2.853719552	0	1.624154579	2.483731749	1.741172934	4.044179214	10.62019096	1.630535045	3.841185691	0.166342303	0.057976649	4.330416569	9.251100494	38.06634986	0.878759956	1.21265065	4.514959864	2.82094341	4.870925894	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.0577	YES	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS																			10000	2.846	0.0445	0.3579	0	0.2037	0.3115	0.2184	0.5072	1.3319	0.2045	0.4817	0.0209	0.0073	0.5431	1.1602	4.774	0.1102	0.1521	0.5662	0.3538	0.6109	0	0	0	0	0	0	0	0	0											14.8058	0	0.748875673	25.5396	0.399335213	3.21160996	0	1.827842901	2.795221281	1.95953675	4.551367438	11.95208935	1.835023553	4.32291611	0.187203609	0.065247611	4.873502364	10.41129864	42.84032335	0.988966917	1.364731479	5.081189586	3.1747233	5.481797994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.8635
H7341_001_1	2011	6																															D	D	D	V	T	Coin	Coin	V	V	P	Coin		Coin	Coin	V	V	Coin	V	Coin	P	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	1082.450508	52.75526388	1239.774108	482.8753244	373.3973221	27.12350826	2.898881752	457.9977467	344.7752269	2437.222988	20.72989046	0	0.084084094	15.48729049	4381.433672	4797.422367	1.865728872	659.244297	16.81595832	2933.458414	1317.822382	6.39451215	0	0	0	0	0	0	0	0											3400	$275/Days 1-6 for IP Medical; $275/Days 1-6 for IP Surgical; PBP 1a	$275/Days 1-6 for IP Psych; $275/Days 1-6 for IP Substance Abuse; PBP 1b	$100/Days 1-100 for SNF; PBP 2	$21/Visit for Home Health; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 10% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $50/Visit for Urgent Care; PBP 4a, 4b"	"$350/Visit for OP Fac - Surgery; $150/Visit for Ambulatory Surgical Center Services; PBP 9a, 9b"	$30/Service for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"20% Coinsurance for OP Fac - Other/CORF/Partial Hospitalization; $40-$50/Visit for OP Fac - PT/OT/ST; PBP 3, 5, 9a, 9c, 9d, 13a"	"$25/Visit for PCP Office Visits; $25/Visit for PCP Consults; $15/Visit for Routine Physicals; PBP 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $50/Visit for Cardio; 50% Coinsurance for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"45% coinsurance for OP Psych and Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $40/Visit for PT/ST; 20% Coinsurance for Prof - CORF; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology; PBP 7d, 14g-h"	"$25-$50/Visit for Other Prof Services (Allergy Testing, etc.); PBP 7g, 14f, 14i"	$25-$50/Visit for Tx Injections; 20% for Part B drugs; PBP 15	"20% Coinsurance for Renal Dialysis - Prof; PBP 7g, 12, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	275	275	100	21	100	0.2	0.193235922	50	350	24.81077606	0.2	0	0.2	0.220388154	24.97091824	45.91342638	0.45	48.33097236	0.2	28.27446571	52.48474334	0.2	0	0	0	0	0	0	0	0											NO	172.9144158	172.9144158	62.8779694	13.20437357	100	0.2	0.193235922	50	220.0728929	24.81077606	0.2	0	0.2	0.220388154	24.97091824	45.91342638	0.45	48.33097236	0.2	28.27446571	33.00134086	0.2	0	0	0	0	0	0	0	0												15.5976	0.760178803	6.496206536	0.531338848	3.111644351	5.424701651	0.560168087	1.908323944	6.322973466	5.039116148	4.145978092	0	0.016816819	3.413215356	9.1173685	18.35550822	0.839577992	2.655159824	3.363191664	6.911830777	3.624158802	1.27890243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.474	0	19.678892	15.5976	0.760178803	6.496206536	0.531338848	3.111644351	5.424701651	0.560168087	1.908323944	6.322973466	5.039116148	4.145978092	0	0.016816819	3.413215356	9.1173685	18.35550822	0.839577992	2.655159824	3.363191664	6.911830777	3.624158802	1.27890243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.474	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.5976	0.760178803	6.496206536	0.531338848	3.111644351	5.424701651	0.560168087	1.908323944	6.322973466	5.039116148	4.145978092	0	0.016816819	3.413215356	9.1173685	18.35550822	0.839577992	2.655159824	3.363191664	6.911830777	3.624158802	1.27890243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.474
H7341_001_2	2011	5																															D	D	D	V	T	Coin	Coin	V	V	P	Coin		Coin	Coin	V	V	Coin	V	Coin	P	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	1229.152965	59.90954439	1348.711778	565.9051889	423.6008362	31.70956774	3.314317165	536.7765001	429.3753407	2839.843963	25.69396759	0	0.148040965	20.73526218	4938.630259	5409.875159	2.697671067	748.6110584	19.78242364	3263.407249	1522.279355	7.537528881	0	0	0	0	0	0	0	0											3400	$275/Days 1-6 for IP Medical; $275/Days 1-6 for IP Surgical; PBP 1a	$275/Days 1-6 for IP Psych; $275/Days 1-6 for IP Substance Abuse; PBP 1b	$100/Days 1-100 for SNF; PBP 2	$21/Visit for Home Health; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 10% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $50/Visit for Urgent Care; PBP 4a, 4b"	"$350/Visit for OP Fac - Surgery; $150/Visit for Ambulatory Surgical Center Services; PBP 9a, 9b"	$30/Service for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"20% Coinsurance for OP Fac - Other/CORF/Partial Hospitalization; $40-$50/Visit for OP Fac - PT/OT/ST; PBP 3, 5, 9a, 9c, 9d, 13a"	"$25/Visit for PCP Office Visits; $25/Visit for PCP Consults; $15/Visit for Routine Physicals; PBP 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $50/Visit for Cardio; 50% Coinsurance for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"45% coinsurance for OP Psych and Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $40/Visit for PT/ST; 20% Coinsurance for Prof - CORF; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology; PBP 7d, 14g-h"	"$25-$50/Visit for Other Prof Services (Allergy Testing, etc.); PBP 7g, 14f, 14i"	$25-$50/Visit for Tx Injections; 20% for Part B drugs; PBP 15	"20% Coinsurance for Renal Dialysis - Prof; PBP 7g, 12, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	275	275	100	21	100	0.2	0.193280693	50	350	25.6216176	0.2	0	0.2	0.218806129	24.97149895	45.95559695	0.45	48.35544193	0.2	28.86646933	52.94846536	0.2	0	0	0	0	0	0	0	0											NO	159.3834629	159.3834629	57.95762289	12.17110081	100	0.2	0.193280693	50	202.8516801	25.6216176	0.2	0	0.2	0.218806129	24.97149895	45.95559695	0.45	48.35544193	0.2	28.86646933	30.68767188	0.2	0	0	0	0	0	0	0	0												16.3256	0.795715887	6.514010719	0.573974092	3.530006969	6.341913548	0.640593517	2.236568751	7.258292438	6.063449671	5.138793519	0	0.029608193	4.537002442	10.27708336	20.71783686	1.21395198	3.016618214	3.956484727	7.850253771	3.892934113	1.507505776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.4182	0	25.65044323	16.3256	0.795715887	6.514010719	0.573974092	3.530006969	6.341913548	0.640593517	2.236568751	7.258292438	6.063449671	5.138793519	0	0.029608193	4.537002442	10.27708336	20.71783686	1.21395198	3.016618214	3.956484727	7.850253771	3.892934113	1.507505776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.4182	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.3256	0.795715887	6.514010719	0.573974092	3.530006969	6.341913548	0.640593517	2.236568751	7.258292438	6.063449671	5.138793519	0	0.029608193	4.537002442	10.27708336	20.71783686	1.21395198	3.016618214	3.956484727	7.850253771	3.892934113	1.507505776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.4182
H7341_002_1	2011	3																															D	D	D	V	T	Coin	Coin	V	V	P	Coin		Coin	Coin	V	V	Coin	V	Coin	P	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	890.846543	23.37840487	1298.152695	1669.173655	315.8447104	12.15761116	7.721193993	290.263487	385.1877084	1132.250799	21.68909334	0	0.283145598	18.07921535	4059.690874	5021.547361	1.096687004	483.5729234	18.56173975	5743.535265	811.1913228	9.32972752	0	0	0	0	0	0	0	0											3400	$275/Days 1-6 for IP Medical; $275/Days 1-6 for IP Surgical; PBP 1a	$275/Days 1-6 for IP Psych; $275/Days 1-6 for IP Substance Abuse; PBP 1b	$100/Days 1-100 for SNF; PBP 2	$21/Visit for Home Health; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 10% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $50/Visit for Urgent Care; PBP 4a, 4b"	"$350/Visit for OP Fac - Surgery; $150/Visit for Ambulatory Surgical Center Services; PBP 9a, 9b"	$30/Service for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"20% Coinsurance for OP Fac - Other/CORF/Partial Hospitalization; $40-$50/Visit for OP Fac - PT/OT/ST; PBP 3, 5, 9a, 9c, 9d, 13a"	"$25/Visit for PCP Office Visits; $25/Visit for PCP Consults; $15/Visit for Routine Physicals; PBP 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $50/Visit for Cardio; 50% Coinsurance for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"45% coinsurance for OP Psych and Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $40/Visit for PT/ST; 20% Coinsurance for Prof - CORF; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology; PBP 7d, 14g-h"	"$25-$50/Visit for Other Prof Services (Allergy Testing, etc.); PBP 7g, 14f, 14i"	$25-$50/Visit for Tx Injections; 20% for Part B drugs; PBP 15	"20% Coinsurance for Renal Dialysis - Prof; PBP 7g, 12, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	275	275	100	21	100	0.2	0.191489179	50	350	30	0.2	0	0.2	0.191639096	24.89537398	45.50897933	0.45	42.42775476	0.2	26.81941412	56.888864	0.2	0	0	0	0	0	0	0	0											NO	171.2520985	171.2520985	62.27349035	13.07743297	100	0.2	0.191489179	50	217.9572162	30	0.2	0	0.2	0.191639096	24.89537398	45.50897933	0.45	42.42775476	0.2	26.81941412	35.42668123	0.2	0	0	0	0	0	0	0	0												12.7133	0.333633408	6.736708276	1.819042217	2.632039254	2.431522231	1.478525101	1.209431196	6.996203387	2.830626998	4.337818668	0	0.05662912	3.464684486	8.422293547	19.04379125	0.493509152	1.709742783	3.71234795	12.8365209	2.394818034	1.865945504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5191	0	18.77658533	12.7133	0.333633408	6.736708276	1.819042217	2.632039254	2.431522231	1.478525101	1.209431196	6.996203387	2.830626998	4.337818668	0	0.05662912	3.464684486	8.422293547	19.04379125	0.493509152	1.709742783	3.71234795	12.8365209	2.394818034	1.865945504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5191	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.7133	0.333633408	6.736708276	1.819042217	2.632039254	2.431522231	1.478525101	1.209431196	6.996203387	2.830626998	4.337818668	0	0.05662912	3.464684486	8.422293547	19.04379125	0.493509152	1.709742783	3.71234795	12.8365209	2.394818034	1.865945504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5191
H7341_002_2	2011	3																															D	D	D	V	T	Coin	Coin	V	V	P	Coin		Coin	Coin	V	V	Coin	V	Coin	P	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	926.5431965	24.30366583	1122.817742	1819.581015	329.0217272	12.72466745	8.079056211	352.1935277	515.451955	1394.256571	27.43744368	0	0.455611871	27.24845079	4132.900492	5135.943577	1.19687257	505.6133737	20.20030023	5801.858047	925.1027508	10.18582182	0	0	0	0	0	0	0	0											3400	$275/Days 1-6 for IP Medical; $275/Days 1-6 for IP Surgical; PBP 1a	$275/Days 1-6 for IP Psych; $275/Days 1-6 for IP Substance Abuse; PBP 1b	$100/Days 1-100 for SNF; PBP 2	$21/Visit for Home Health; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 10% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $50/Visit for Urgent Care; PBP 4a, 4b"	"$350/Visit for OP Fac - Surgery; $150/Visit for Ambulatory Surgical Center Services; PBP 9a, 9b"	$30/Service for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"20% Coinsurance for OP Fac - Other/CORF/Partial Hospitalization; $40-$50/Visit for OP Fac - PT/OT/ST; PBP 3, 5, 9a, 9c, 9d, 13a"	"$25/Visit for PCP Office Visits; $25/Visit for PCP Consults; $15/Visit for Routine Physicals; PBP 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $50/Visit for Cardio; 50% Coinsurance for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"45% coinsurance for OP Psych and Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $40/Visit for PT/ST; 20% Coinsurance for Prof - CORF; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology; PBP 7d, 14g-h"	"$25-$50/Visit for Other Prof Services (Allergy Testing, etc.); PBP 7g, 14f, 14i"	$25-$50/Visit for Tx Injections; 20% for Part B drugs; PBP 15	"20% Coinsurance for Renal Dialysis - Prof; PBP 7g, 12, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	275	275	100	21	100	0.2	0.191486022	50	350	30	0.2	0	0.2	0.198465048	24.89536767	45.54672305	0.45	42.53244224	0.2	27.73427327	56.67584485	0.2	0	0	0	0	0	0	0	0											NO	163.143923	163.143923	59.3250629	12.45826321	100	0.2	0.191486022	50	207.6377202	30	0.2	0	0.2	0.198465048	24.89536767	45.54672305	0.45	42.53244224	0.2	27.73427327	33.62298061	0.2	0	0	0	0	0	0	0	0												12.5967	0.330416282	5.550936096	1.889068268	2.741847727	2.54493349	1.547026339	1.467473032	8.918939066	3.485641426	5.487488737	0	0.091122374	5.4078651	8.574173107	19.49378331	0.538592657	1.792080967	4.040060046	13.40919305	2.592059321	2.037164363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.5365	0	21.85650888	12.5967	0.330416282	5.550936096	1.889068268	2.741847727	2.54493349	1.547026339	1.467473032	8.918939066	3.485641426	5.487488737	0	0.091122374	5.4078651	8.574173107	19.49378331	0.538592657	1.792080967	4.040060046	13.40919305	2.592059321	2.037164363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.5365	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.5967	0.330416282	5.550936096	1.889068268	2.741847727	2.54493349	1.547026339	1.467473032	8.918939066	3.485641426	5.487488737	0	0.091122374	5.4078651	8.574173107	19.49378331	0.538592657	1.792080967	4.040060046	13.40919305	2.592059321	2.037164363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.5365
H7352_002_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	395.2384619	32.54701076	30.5197282		33.58814176	19.20913181	19.0409455	36.98640475	38.24098986	8.341136465	13.02399328	12.10188019		55.36734158	42.20606333	82.66971429	4.042765898	3.239839851	30.05848661	63.24723666	45.66044695	6.821962958																			6700	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share		Preventive Dental - 1 cleaning/x-ray per year	Routine Exam 1/yr	$100 Eyewear																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																			NO	0.055555543	0.055555543	0.115449578		0.181184277	0.181184277	0.181184277	0.181184277	0.181184277	0.181184277	0.181184277	0.181184277		0.181184277	0.181184277	0.181184277	0.181184277	0.181184277	0.181184277	0.181184277	0.181184277	0.181184277																				21.9577	1.80816686	3.523489726	0	6.085643182	3.480392659	3.449919946	6.701355005	6.928666103	1.51128278	2.359742806	2.192670414	0	10.03169176	7.647075072	14.97845242	0.732485617	0.587008041	5.446125167	11.45940485	8.272955071	1.236032427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.3902	0	34.42963044	21.9577	1.80816686	3.523489726	0	6.085643182	3.480392659	3.449919946	6.701355005	6.928666103	1.51128278	2.359742806	2.192670414	0	10.03169176	7.647075072	14.97845242	0.732485617	0.587008041	5.446125167	11.45940485	8.272955071	1.236032427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.3902	NO																																																																																		0	0	0	21.9577	1.80816686	3.523489726	0	6.085643182	3.480392659	3.449919946	6.701355005	6.928666103	1.51128278	2.359742806	2.192670414	0	10.03169176	7.647075072	14.97845242	0.732485617	0.587008041	5.446125167	11.45940485	8.272955071	1.236032427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.3902
H7352_003_0	2011	5																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	335.2013405	32.26287622	36.69694171		25.29330986	12.04578434	14.00729216	34.05210801	14.23953501	8.734072902	11.53970531	5.803644226		69.6379986	40.11451896	82.34779551	2.670029092	5.709363816	31.46579488	64.96635322	20.58035305	6.562727604																			6700	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share		Preventive Benefits - 1 Cleaning/x-ray per yr	Routine Exam - 1/yr	$75 Eyewear																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																			NO	0.063445364	0.063445364	0.106658647		0.18726364	0.18726364	0.18726364	0.18726364	0.18726364	0.18726364	0.18726364	0.18726364		0.18726364	0.18726364	0.18726364	0.18726364	0.18726364	0.18726364	0.18726364	0.18726364	0.18726364																				21.267	2.046929929	3.91404616	0	4.736517272	2.255737422	2.623056517	6.376721696	2.666547158	1.635574284	2.16096722	1.086811543	0	13.0406651	7.511990838	15.42074793	0.499999367	1.06915625	5.892399285	12.16583578	3.853951824	1.228960259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.4536	0	27.22088162	21.267	2.046929929	3.91404616	0	4.736517272	2.255737422	2.623056517	6.376721696	2.666547158	1.635574284	2.16096722	1.086811543	0	13.0406651	7.511990838	15.42074793	0.499999367	1.06915625	5.892399285	12.16583578	3.853951824	1.228960259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.4536	NO																																																																																		0	0	0	21.267	2.046929929	3.91404616	0	4.736517272	2.255737422	2.623056517	6.376721696	2.666547158	1.635574284	2.16096722	1.086811543	0	13.0406651	7.511990838	15.42074793	0.499999367	1.06915625	5.892399285	12.16583578	3.853951824	1.228960259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.4536
H7352_004_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	328.6348487	38.17455547	32.84447974		38.25923921	17.1309178	21.94327476	30.68411527	30.25650028	3.605129743	8.365939319	6.169524312		61.05652175	45.02501864	66.07515448	5.779644336	3.780344472	25.71891634	51.16705091	14.57925055	3.191727625																			6700	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share		"Preventive Dental - Cleanings 2/yr, X-ray 1/yr"	Routine Exam - 1/yr	$100 Eyewear																0.07295657	0.07295657	0.1450671		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.07295657	0.07295657	0.1450671		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				23.9761	2.785084631	4.76465341	0	8.914402737	3.991503847	5.112783019	7.149398858	7.049764565	0.83999523	1.949263861	1.437499165	0	14.22616957	10.49082934	15.39551099	1.34665713	0.880820262	5.992507506	11.92192286	3.396965379	0.743672537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.3655	0	3.17E-17	23.9761	2.785084631	4.76465341	0	8.914402737	3.991503847	5.112783019	7.149398858	7.049764565	0.83999523	1.949263861	1.437499165	0	14.22616957	10.49082934	15.39551099	1.34665713	0.880820262	5.992507506	11.92192286	3.396965379	0.743672537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.3655	NO																																																																																		0	0	0	23.9761	2.785084631	4.76465341	0	8.914402737	3.991503847	5.112783019	7.149398858	7.049764565	0.83999523	1.949263861	1.437499165	0	14.22616957	10.49082934	15.39551099	1.34665713	0.880820262	5.992507506	11.92192286	3.396965379	0.743672537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.3655
H7475_001_0	2011	8																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	531.8455424		361.644082		81.28445428	38.93190415		31.9128791	20.59006247	202.7353448					343.0109834						49.34405015	7.140621303																			6700	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																				0.082236859		0.149739575		0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																			NO	0.082236859		0.149739575		0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																				43.7373	0	54.15243106	0	18.93927785	9.071133667	0	7.43570083	4.797484556	47.23733534	0	0	0	0	79.92155913	0	0	0	0	0	11.49716369	1.663764764	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	278.4532	0	0	43.7373	0	54.15243106	0	18.93927785	9.071133667	0	7.43570083	4.797484556	47.23733534	0	0	0	0	79.92155913	0	0	0	0	0	11.49716369	1.663764764	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	278.4532	NO																																																																																		0	0	0	43.7373	0	54.15243106	0	18.93927785	9.071133667	0	7.43570083	4.797484556	47.23733534	0	0	0	0	79.92155913	0	0	0	0	0	11.49716369	1.663764764	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	278.4532
H7526_001_0	2011	5																															A	A			T	Coin	Coin	V	V	V	V			V		V	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	YES	452.7031704	23.39844181	0	0	803.4782894	29.84630534	0.70900226	615.7395881	354.8332977	1444.879651	856.1531091	0	0	1030.809613	0	3702.695398	664.853177	752.952044	0	419.7160821	17.33940858	0	0	0	0	0	0	0	0	0											3000	$100/Admit for Inpatient Facility; PBP 1a	$100/Admit for Inpatient Psychiatric; $100/Admit for Inpatient Psychiatric; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Supplies; PBP 11b, 11c"	"$50/Case for OP Facility - Emergency; $50/Visit for Urgent Care; PBP 4a, 4b"	"$25/Case for OP Facility - Surgery; PBP 9a, 9b"	$25/Case for OP Facility - Pathology Diagnostic Procedures/Tests; $0/Case for OP Facility - Pathology Lab Services PBP; 8a	$25/Case for OP Facility - Radiology X-Rays; $25/Case for OP Facility - Diagnostic Radiological Services; $10/Case for OP Facility - Therapeutic Radiological Services; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$10/Case for OP Facility - Other; $10/Visit for Professional - Substance Abuse; $10/Visit for Cardiac Rehabilitation Services; PBP 3, 5, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$10/Visit for SCP Office Visits; $10/Consult for Consults; PBP 7d, 7f, 7g, 14d-j, 17a, 18a"	"$10/Visit for Professional - Psychiatric Services; PBP 7e, 7h"	"$10/Visit for Professional - Physical Therapy; PBP 7c, 7i"	$25 for X-Ray Services; $25 for Diagnostic Radiological Services; $10 for Therapeutic Radiological Services; PBP 8b	"$10/Visit for SCP Services; 20% Coinsurance for Medicare-Covered Glasses; PBP 7b, 7d, 7g, 17b"	20% Coinsurance for Part B Rx; PBP 15	No Cost Sharing; PBP 13a	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	$125 maximum for Non-Medicare covered eye weare every two years; PBP 17b	$0 for Routine Hearing Exams - Limit 1 per year; $450 per year combined maximum for Fitting/Evaluation for Hearing Aids and the purchase of a Hearing Aid; PBP 18a	$450 per year combined maximum for Fitting/Evaluation for Hearing Aids and the purchase of a Hearing Aid; PBP 18b	No Cost Sharing; PBP 14a	PBP 13b											0	100	100	0	0	50	0.2	0.2	50	25	25	21.27596672	0	0	10	0	10	10	10	0	10.24715564	0.2	0	0	0	0	0	0	0	0	0											NO	94.38092688	94.38092688	0	0	47.19046344	0.188761854	0.188761854	47.19046344	23.59523172	23.59523172	20.08045459	0	0	9.438092688	0	9.438092688	9.438092688	9.438092688	0	9.671360469	0.188761854	0	0	0	0	0	0	0	0	0												3.5605	0.184030552	0	0	3.159709403	5.633843925	0.133832581	2.42141971	0.697697823	2.841022515	1.432661969	0	0	0.810739723	0	2.91219853	0.522912159	0.592202598	0	0.338268794	3.273018908	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.5141	0	1.69761883	3.5605	0.184030552	0	0	3.159709403	5.633843925	0.133832581	2.42141971	0.697697823	2.841022515	1.432661969	0	0	0.810739723	0	2.91219853	0.522912159	0.592202598	0	0.338268794	3.273018908	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.5141	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.5605	0.184030552	0	0	3.159709403	5.633843925	0.133832581	2.42141971	0.697697823	2.841022515	1.432661969	0	0	0.810739723	0	2.91219853	0.522912159	0.592202598	0	0.338268794	3.273018908	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.5141
H7526_003_0	2011	4																															A	A			T	Coin	Coin	V	V	V	V			V		V	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	YES	390.867744	5.767025538	0	0	400.9722707	54.43882409	1.21729458	470.265528	413.6029794	1027.882136	998.7469007	0	0	457.2815015	0	4352.331963	200.7074575	583.5479512	0	499.7302286	33.43610679	0	0	0	0	0	0	0	0	0											3000	$100/Admit for Inpatient Facility; PBP 1a	$100/Admit for Inpatient Psychiatric; $100/Admit for Inpatient Psychiatric; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics/Supplies; PBP 11b, 11c"	"$50/Case for OP Facility - Emergency; $50/Visit for Urgent Care; PBP 4a, 4b"	"$25/Case for OP Facility - Surgery; PBP 9a, 9b"	$25/Case for OP Facility - Pathology Diagnostic Procedures/Tests; $0/Case for OP Facility - Pathology Lab Services; PBP 8a	$10/Case for OP Facility - Radiology X-Rays; $10/Case for OP Facility - Diagnostic Radiological Services; $10/Case for OP Facility - Therapeutic Radiological Services; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$10/Case for OP Facility - Other; $10/Case for Partial Hospitalization; $10/Visit for Professional - Substance Abuse; $10/Visit for Cardiac Rehabilitation Services; PBP 3, 5, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$10/Visit for SCP Office Visits; $10/Consult for Consults; PBP 7d, 7f, 7g, 14d-j, 17a, 18a"	"$10/Visit for Professional - Psychiatric Services; PBP 7e, 7h"	"$10/Visit for Professional - Physical Therapy; PBP 7c, 7i"	$10 for X-Ray Services; $10 for Diagnostic Radiological Services; $10 for Therapeutic Radiological Services; PBP 8b	"$10/Visit for SCP Services; 20% Coinsurance for Medicare-Covered Glasses; PBP 7b, 7d, 7g, 17b"	20% Coinsurance for Part B Rx; PBP 15	No Cost Sharing; PBP 13a	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	$125 maximum for Non-Medicare covered eye weare every two years; PBP 17b	$0 for Routine Hearing Exams - Limit 1 per year; $450 per year combined maximum for Fitting/Evaluation for Hearing Aids and the purchase of a Hearing Aid; PBP 18a	$450 per year combined maximum for Fitting/Evaluation for Hearing Aids and the purchase of a Hearing Aid; PBP 18b	No Cost Sharing; PBP 14a	PBP 13b											0	100	100	0	0	50	0.2	0.2	50	25	10	10	0	0	10	0	10	10	10	0	10	0.2	0	0	0	0	0	0	0	0	0											NO	93.61208716	93.61208716	0	0	46.80604358	0.187224174	0.187224174	46.80604358	23.40302179	9.361208716	9.361208716	0	0	9.361208716	0	9.361208716	9.361208716	9.361208716	0	9.361208716	0.187224174	0	0	0	0	0	0	0	0	0												3.0492	0.044988608	0	0	1.563993798	10.19226389	0.227906973	1.8342724	0.806629962	0.801851601	0.779123183	0	0	0.356725631	0	3.395257326	0.156572033	0.455226181	0	0.389839914	6.260047487	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.3139	0	2.068560891	3.0492	0.044988608	0	0	1.563993798	10.19226389	0.227906973	1.8342724	0.806629962	0.801851601	0.779123183	0	0	0.356725631	0	3.395257326	0.156572033	0.455226181	0	0.389839914	6.260047487	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.3139	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.0492	0.044988608	0	0	1.563993798	10.19226389	0.227906973	1.8342724	0.806629962	0.801851601	0.779123183	0	0	0.356725631	0	3.395257326	0.156572033	0.455226181	0	0.389839914	6.260047487	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.3139
H7526_004_0	2011	5																															A	A			T	Coin	Coin	V	V	V	V			V		V	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	YES	318.3480856	4.459521153	0	0	328.7059385	32.32604575	1.705111181	421.4102771	429.3402481	1059.204504	814.7129915	0	0	484.9216392	0	4380.032343	180.8586352	681.4598454	0	588.7786374	24.74577589	0	0	0	0	0	0	0	0	0											3000	$100/Admit for Inpatient Facility; PBP 1a	$100/Admit for Inpatient Psychiatric; $100/Admit for Inpatient Psychiatric; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; 5% Coinsurance for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$50/Case for OP Facility - Emergency; $50/Visit for Urgent Care; PBP 4a, 4b"	"$25/Case for OP Facility - Surgery; PBP 9a, 9b"	$25/Case for OP Facility - Pathology Diagnostic Procedures/Tests; $0/Case for OP Facility - Pathology Lab Services; PBP 8a	$25/Case for OP Facility - Radiology X-Rays; $25/Case for OP Facility - Diagnostic Radiological Services; $10/Case for OP Facility - Therapeutic Radiological Services; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"$10/Case for OP Facility - Other; $10/Case for Partial Hospitalization; $10/Visit for Professional - Substance Abuse; $10/Visit for Cardiac Rehabilitation Services; PBP 3, 5, 9c, 9d"	"No Cost Sharing; PBP 7a, 14b-c"	"$10/Visit for SCP Office Visits; $10/Consult for Consults; PBP 7d, 7f, 7g, 14d-j, 17a, 18a"	"$10/Visit for Professional - Psychiatric Services; PBP 7e, 7h"	"$10/Visit for Professional - Physical Therapy; PBP 7c, 7i"	$25 for X-Ray Services; $25 for Diagnostic Radiological Services; $10 for Therapeutic Radiological Services; PBP 8b	"$10/Visit for SCP Services; 20% Coinsurance for Medicare-Covered Glasses; PBP 7b, 7d, 7g, 17b"	20% Coinsurance for Part B Rx; PBP 15	No Cost Sharing; PBP 13a	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	$125 maximum for Non-Medicare covered eye weare every two years; PBP 17b	$0 for Routine Hearing Exams - Limit 1 per year; $450 per year combined maximum for Fitting/Evaluation for Hearing Aids and the purchase of a Hearing Aid; PBP 18a	$450 per year combined maximum for Fitting/Evaluation for Hearing Aids and the purchase of a Hearing Aid; PBP 18b	No Cost Sharing; PBP 14a	PBP 13b											0	100	100	0	0	50	0.2	0.2	50	25	25	21.40879056	0	0	10	0	10	10	10	0	10	0.2	0	0	0	0	0	0	0	0	0											NO	95.45332047	95.45332047	0	0	47.72666023	0.190906641	0.190906641	47.72666023	23.86333012	23.86333012	20.43540146	0	0	9.545332047	0	9.545332047	9.545332047	9.545332047	0	9.545332047	0.190906641	0	0	0	0	0	0	0	0	0												2.5323	0.035473008	0	0	1.307336387	6.171256808	0.325517048	1.676042093	0.853790673	2.106345561	1.387415588	0	0	0.385728172	0	3.484071924	0.143862977	0.542063375	0	0.468340633	4.724132952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.1437	0	1.245287632	2.5323	0.035473008	0	0	1.307336387	6.171256808	0.325517048	1.676042093	0.853790673	2.106345561	1.387415588	0	0	0.385728172	0	3.484071924	0.143862977	0.542063375	0	0.468340633	4.724132952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.1437	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.5323	0.035473008	0	0	1.307336387	6.171256808	0.325517048	1.676042093	0.853790673	2.106345561	1.387415588	0	0	0.385728172	0	3.484071924	0.143862977	0.542063375	0	0.468340633	4.724132952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.1437
H7678_001_0	2011	8																																																																							0	0	0	0	0	0	0	0	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											6700	No Cost-Sharing; PBP 1a	No Cost-Sharing; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	No Cost-Sharing; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"No Cost-Sharing; PBP 4a, 4b"	"No Cost-Sharing; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b, 14c"	"No Cost-Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	No Cost-Sharing; PBP 8b	"No Cost-Sharing; PBP 7d, 7g, 14d-j"	No Cost-Sharing; PBP 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	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
H7678_002_0	2011	9																															D	D	D		T	Coin	Coin	V	V		Coin		Coin	V	V	V	V	V	Coin	V	Coin			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	868.6558572	21.59567467	465.0479647	0	234.7021182	11.5136735	7.589157532	245.8545029	325.2678179	0	23.06476138	0	0.359933861	929.2138508	4741.10517	5156.606049	123.3997681	477.4790771	23.69570168	102.0311813	8.702519421	0	0	2225.980239	0	0	0	0	0	0											3200	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical; PBP 1a	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse; PBP 1b	$125 /Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$75/Run for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for ER - Facility; $25/Visit for PCP Urgent Care; PBP 4a, 4b"	"$150/Case for OP Hospital Services; $50/Case for Ambulatory Surgery Center Services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	20% Coinsurance for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET; PBP 8b		20% Coinsurance for Renal Dialysis - Fac; PBP 12	"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; $150/Case for OP Fac - Other; $20/Visit for Prof - CORF; $25/Visit for OP Substance Abuse; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"$5/Visit for Prof - Asst Surgeon (OP); $5/Visit for PCP Office Visits; $5/Consult for PCP Consults; PBP 7a, 14b, 14c"	"$20/Visit for Prof - Asst Surgeon (OP); $20/Visit for Speclst Office Visits; $20/Consult for Speclst Consults; $15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; PBP 7e, 7h"	"$20/Visit for Occ Therapy; $20/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); $33/Procedure for Prof Radiology (Office); PBP 8b	"$5/Visit for Allergy Testing; $5/Visit for Allergy Tx; PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; PBP 15			"$10/Procedure for Dental: Preventive Services; PBP 16a, 16b"																	0	250	250	125	0	75	0.2	0.2	47.82363874	150	0	0.181578726	0	0.2	83.66869048	5	18.96127967	20	20	0.172726803	5	0.2	0	0	10	0	0	0	0	0	0											NO	239.4266035	239.4266035	119.7133018	0	71.82798105	0.191541283	0.191541283	45.80100557	143.6559621	0	0.17389911	0	0.191541283	80.13004153	4.80215354	18.15933916	19.15412828	19.15412828	0.165421568	4.78853207	0.191541283	0	0	10	0	0	0	0	0	0												17.3316	0.430881586	4.639368944	0	1.404848275	2.205343792	1.453636969	0.938365288	3.893888444	0	4.010941484	0	0.068942194	6.204828705	1.897292915	7.803379846	0.196967916	0.762141291	3.919780115	0.040714965	1.666891734	0	0	1.854983533	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7248	0	2.594150164	17.3316	0.430881586	4.639368944	0	1.404848275	2.205343792	1.453636969	0.938365288	3.893888444	0	4.010941484	0	0.068942194	6.204828705	1.897292915	7.803379846	0.196967916	0.762141291	3.919780115	0.040714965	1.666891734	0	0	1.854983533	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7248	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.3316	0.430881586	4.639368944	0	1.404848275	2.205343792	1.453636969	0.938365288	3.893888444	0	4.010941484	0	0.068942194	6.204828705	1.897292915	7.803379846	0.196967916	0.762141291	3.919780115	0.040714965	1.666891734	0	0	1.854983533	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7248
H7731_001_0	2011	4																																A	D		T	Coin	Coin	V			V		Coin			V	V				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	YES	0	34.08216022	384.9008954	0	270.7361139	16.25557876	0.931575877	323.1892952	0	0	221.2738362	0	0.245359918	0	0	3505.253678	133.1865348	0	0	0	8.824357186	0	0	1138.694089	0	0	0	0	0	0.862050502											3400	No Cost Sharing; PBP 1a	$250/Admit for IP S/A; $250/Admit for IP Psych; PBP 1b	$75/Days Custom for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance on DME items > $150; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $25/Visit for Urgent Care PCP; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$100/Visit for Diagnostic Radiology; $55/Visit for Therapeutic Radiology; PBP 8b	No Cost Sharing;	20% Coinsurance for Dialysis; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-c"	"$5/Visit for Specialist Office Visit; $5/Visit for Specialist Consult; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$5/Visit for OP Psych non-physician; $5/Visit for OP Psych; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	No Cost Sharing; PBP 14g-h	"No Cost Sharing; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"$15/visit for Dental; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	PBP 18a	PBP 18b	PBP 14a	$50/Other for Worldwide ER; PBP 13b											0	0	250	75	0	100	0.07	0.2	48.24995403	0	0	91.5	0	0.2	0	0	5	7.545653232	0	0	0	0.2	0	0	15	0	0	0	0	0	50											NO	0	249.1069898	74.73209693	0	99.6427959	0.069749957	0.199285592	48.07760322	0	0	91.17315825	0	0.199285592	0	0	4.982139795	7.518699849	0	0	0	0.199285592	0	0	14.94641939	0	0	0	0	0	49.82139795												0	0.707508695	2.397037585	0	2.248075279	1.133825922	0.18564965	1.294847225	0	0	1.681186207	0	0.048896697	0	0	1.45530532	0.083449132	0	0	0	1.758567244	0	0	1.418283284	0	0	0	0	0	0.003579047	0	0	0	0	0	0	0	0	0	0	14.4162	0	0.0516799	0	0.707508695	2.397037585	0	2.248075279	1.133825922	0.18564965	1.294847225	0	0	1.681186207	0	0.048896697	0	0	1.45530532	0.083449132	0	0	0	1.758567244	0	0	1.418283284	0	0	0	0	0	0.003579047	0	0	0	0	0	0	0	0	0	0	14.4162	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.707508695	2.397037585	0	2.248075279	1.133825922	0.18564965	1.294847225	0	0	1.681186207	0	0.048896697	0	0	1.45530532	0.083449132	0	0	0	1.758567244	0	0	1.418283284	0	0	0	0	0	0.003579047	0	0	0	0	0	0	0	0	0	0	14.4162
H7731_007_0	2011	3																																A	D		T	Coin	Coin	V			V		Coin				V				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	YES	0	5.173157466	386.720802	0	135.8869136	7.894796588	3.764170718	147.7037945	0	0	116.1836416	0	0.205179556	0	0	0	8.258996345	0	0	0	6.33762531	0	0	1139.539733	0	0	0	0	0	0.846040182											3400	No Cost Sharing; PBP 1a	$250/Admit for IP S/A; $250/Admit for IP Psych; PBP 1b	$75/Days Custom for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance on DME items > $150; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $25/Visit for Urgent Care PCP; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$100/Visit for Diagnostic Radiology; $55/Visit for Therapeutic Radiology; PBP 8b	No Cost Sharing;	20% Coinsurance for Dialysis; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-c"	"No Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for OP Substance Abuse; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	No Cost Sharing; PBP 14g-h	"No Cost Sharing; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"$15/visit for Dental; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14a	$50/Other for Worldwide ER; PBP 13b											0	0	250	75	0	100	0.07	0.104122978	47.36061373	0	0	91.5	0	0.2	0	0	0	30	0	0	0	0.2	0	0	15	0	0	0	0	0	50											NO	0	249.9057425	74.97172276	0	99.96229702	0.069973608	0.104083721	47.34275736	0	0	91.46550177	0	0.199924594	0	0	0	29.9886891	0	0	0	0.199924594	0	0	14.99947901	0	0	0	0	0	49.99682016												0	0.10773348	2.41609373	0	1.131964002	0.552427401	0.391788893	0.582725409	0	0	0.885566256	0	0.041020439	0	0	0	0.020639706	0	0	0	1.267047167	0	0	1.424375192	0	0	0	0	0	0.003524943	0	0	0	0	0	0	0	0	0	0	8.8249	0	0.002839642	0	0.10773348	2.41609373	0	1.131964002	0.552427401	0.391788893	0.582725409	0	0	0.885566256	0	0.041020439	0	0	0	0.020639706	0	0	0	1.267047167	0	0	1.424375192	0	0	0	0	0	0.003524943	0	0	0	0	0	0	0	0	0	0	8.8249	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.10773348	2.41609373	0	1.131964002	0.552427401	0.391788893	0.582725409	0	0	0.885566256	0	0.041020439	0	0	0	0.020639706	0	0	0	1.267047167	0	0	1.424375192	0	0	0	0	0	0.003524943	0	0	0	0	0	0	0	0	0	0	8.8249
H7731_008_0	2011	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	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	No Cost Sharing; PBP 1a	No Cost Sharing; PBP 1b	No Cost Sharing; PBP 2	No Cost Sharing; PBP 6	No Cost Sharing; PBP 10a	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"No Cost Sharing; PBP 4a, 4b"	"No Cost Sharing; PBP 9a, 9b"	No Cost Sharing; PBP 8a	No Cost Sharing; PBP 8b	No Cost Sharing;	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost Sharing; PBP 4b, 7a, 14b-c"	"No Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"No Cost Sharing; PBP 7e, 7h"	"No Cost Sharing; PBP 7c, 7i"	No Cost Sharing; PBP 14g-h	"No Cost Sharing; PBP 7g, 14f, 14i"	No Cost Sharing; PBP 15	"No Cost Sharing; PBP 7g, 14a, 14j"	No Cost Sharing; PBP 10b	"No Cost Sharing; PBP 16a, 16b"	No Cost Sharing; PBP 17a	No Cost Sharing; PBP 17b	No Cost Sharing; PBP 18a	No Cost Sharing; PBP 18b	PBP 14a	No Cost Sharing; PBP 13b											0	0	0	0	0	0	0	0	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
H7787_001_0	2011	6																															A	D	D	V	T	Coin	Coin	V	P	P	Coin	V	Coin	Coin	V	V	Coin	V	P	P	Coin																																																												0	YES	216.8584066	14.40858295	373.2490362	0	310.260105	8.340910661	7.742357411	226.2082038	270.9012828	0	10.32593707	49.06281428	0.076649497	10.2827144	1866.502581	3398.933299	2.143438338	118.4031199	0	0	44.05094163																				3400	"1a. $350 per admit(Acute), $500 per admit (Rehab/LTAC)"	1b. $150/day for days 1-7	2. $100/day for days 21-100	No cost sharing	10a. $50 per trip	"11a, b, c. 20% Coinsurance for DME, Prosthetics, Supplies; 0% coinsurance for Diabetes Monitoring Supplies"	"11a, b, c. 20% Coinsurance for DME, Prosthetics, Supplies; 0% coinsurance for Diabetes Monitoring Supplies"	4a-b. $50 per ER visit; $25 per UC visit	9a-b. $150 Amb. Surg and $250 OP Hosp Surg per visit	No cost sharing	"8a-b. $0 for X-rays/Ultrasounds; 20% coinsurance for Radiation Therapy; 15% coinsurance for MRI, CT, PET, CNM, Other Imaging"	1a. $100 per visit	12. 20% Coinsurance	"3, 5, 7c, 7i, 9c, 9d, 13a. $30 per CORF/Therapy visit; $30 per Cardiac Rehab session; $30 per CORF visit; 20% coinsurance for all OP MH, Substance Abuse or Partial Hosp visits"	7a. $0 per visit; $0 per routine physical exam	"7b, 7d, 7f. $30 per visit"	"7e, 7h. 20% Coinsurance"	"7c, 7i. $30 per visit"	No cost sharing	No cost sharing	15. 20% Coinsurance																				0	359.8765432	150	100	0	50	0.2	0.2	48.81600935	237.0203069	0	0.2	100	0.2	0.19041883	0	30	0.2	30	0	0	0.2																				NO	350.1598765	145.95	97.3	0	48.65	0.1946	0.1946	47.49797709	230.6207586	0	0.1946	97.3	0.1946	0.185277522	0	29.19	0.1946	29.19	0	0	0.1946																					6.3279	0.17524439	3.026427602	0	1.257846176	1.623141215	1.506662752	0.89536934	5.206288278	0	2.009427353	0.397817652	0.014915992	1.905155838	0	8.26790525	0.417113101	0.288015589	0	0	8.572313242	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8916	0	1.158430156	6.3279	0.17524439	3.026427602	0	1.257846176	1.623141215	1.506662752	0.89536934	5.206288278	0	2.009427353	0.397817652	0.014915992	1.905155838	0	8.26790525	0.417113101	0.288015589	0	0	8.572313242	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8916	YES	1a. 30% Coinsurance	1b. 30% Coinsurance	2. 30% Coinsurance	6. $40 per visit	10a. $50 per trip	"11a, b, c. 30% Coinsurance"	"11a, b, c. 30% Coinsurance"	4a-b. $50 per ER visit; $25 per UC visit	9a-b. 30% Coinsurance	8a. 30% Coinsurance	"8a-b. 30% coinsurance for X-rays/Ultrasounds/Radiation Therapy, MRI, CT, PET, CNM, Other Imaging"	1a. 30% Coinsurance	12. 30% Coinsurance	"3, 5, 7c, 7i, 9c, 9d, 13a. 30% Coinsurance"	7a. $40 per visit	"7b, 7d, 7f. $60 per visit"	"7e, 7h. 30% Coinsurance"	"7c, 7i. $60 per visit"	30% Coinsurance	7g. 30% Lab/Path	15. 30% Coinsurance																				5100	11.0058	0.2757	1.781	0.1095	0.1974	0.5737	0.43	0.1405	1.7314	0.2045	0.5735	0.257	0.0043	0.4174	0.9503	2.5956	0.119	0.0904	0.0952	0.2267	2.4466																				24.2254	1000	5.13463077	17.3337	0.450903483	4.807442527	0.109455181	1.455292062	2.196792065	1.936668162	1.035916728	6.937728693	0.204481018	2.582923069	0.654770073	0.019173054	2.322555077	0.950256257	10.86355473	0.536158248	0.378436015	0.095161643	0.226690333	11.01887341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.1169
H7787_002_0	2011	5																															A	D	D	V	T	Coin	Coin	V	P	P	Coin	V	Coin	Coin	V	V	Coin	V	P	P	Coin																																																												0	YES	181.0906644	14.04240639	362.8131294	0	261.8703012	5.978101353	5.99275186	178.3513529	120.4735426	0	7.064055431	11.53365814	0.062858806	7.137450159	1429.168124	3440.275064	1.136637677	132.8498081	0	0	15.79126765																				3400	"1a. $375 per admit(Acute), $500 per admit (Rehab/LTAC)"	1b. $150/day for days 1-7	2. $100/day for days 21-100	No cost sharing	10a. $50 per trip	"11a, b, c. 20% Coinsurance for DME, Prosthetics, Supplies; 0% coinsurance for Diabetes Monitoring Supplies"	"11a, b, c. 20% Coinsurance for DME, Prosthetics, Supplies; 0% coinsurance for Diabetes Monitoring Supplies"	4a-b. $50 per ER visit; $25 per UC visit	9a-b. $150 Amb. Surg and $250 OP Hosp Surg per visit	No cost sharing	"8a-b. $0 for X-rays/Ultrasounds; 20% coinsurance for Radiation Therapy; 15% coinsurance for MRI, CT, PET, CNM, Other Imaging"	1a. $100 per visit	12. 20% Coinsurance	"3, 5, 7c, 7i, 9c, 9d, 13a. $35 per CORF/Therapy visit; $35 per Cardiac Rehab session; $35 per CORF visit; 20% coinsurance for all OP MH, Substance Abuse or Partial Hosp visits"	7a. $10 per visit; $0 per routine physical exam	"7b, 7d, 7f. $35 per visit"	"7e, 7h. 20% Coinsurance"	"7c, 7i. $35 per visit"	No cost sharing	No cost sharing	15. 20% Coinsurance																				0	382.656325	150	100	0	50	0.2	0.2	48.81600935	236.9431124	0	0.2	100	0.2	0.183436708	10	35	0.2	35	0	0	0.2																				NO	374.6205421	146.85	97.9	0	48.95	0.1958	0.1958	47.79087315	231.967307	0	0.1958	97.9	0.1958	0.179584537	9.79	34.265	0.1958	34.265	0	0	0.1958																					5.6534	0.171843948	2.959950447	0	1.068212603	1.170512245	1.173380814	0.71029724	2.328826937	0	1.383142053	0.094095428	0.012307754	1.281775682	1.165962994	9.823418756	0.222553657	0.379341556	0	0	3.091930206	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.6909	0	0.699090773	5.6534	0.171843948	2.959950447	0	1.068212603	1.170512245	1.173380814	0.71029724	2.328826937	0	1.383142053	0.094095428	0.012307754	1.281775682	1.165962994	9.823418756	0.222553657	0.379341556	0	0	3.091930206	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.6909	YES	1a. 30% Coinsurance	1b. 30% Coinsurance	2. 30% Coinsurance	6. $40 per visit	10a. $50 per trip	"11a, b, c. 30% Coinsurance"	"11a, b, c. 30% Coinsurance"	4a-b. $50 per ER visit; $25 per UC visit	9a-b. 30% Coinsurance	8a. 30% Coinsurance	"8a-b. 30% coinsurance for X-rays/Ultrasounds/Radiation Therapy, MRI, CT, PET, CNM, Other Imaging"	1a. 30% Coinsurance	12. 30% Coinsurance	"3, 5, 7c, 7i, 9c, 9d, 13a. 30% Coinsurance"	7a. $40 per visit	"7b, 7d, 7f. $60 per visit"	"7e, 7h. 30% Coinsurance"	"7c, 7i. $60 per visit"	30% Coinsurance	7g. 30% Lab/Path	15. 30% Coinsurance																				5100	10.09	0.2359	1.7708	0.0938	0.1667	0.4142	0.3328	0.1108	1.1041	0.0996	0.3923	0.0404	0.0035	0.3156	0.7276	2.6272	0.0631	0.1015	0.0615	0.1638	0.877																				19.7922	1000	4.197793904	15.7434	0.40776648	4.73074848	0.093775637	1.234863788	1.584704917	1.506214289	0.821110271	3.432930507	0.09956056	1.77547502	0.134451564	0.015798891	1.597397282	1.893567642	12.45063953	0.285681762	0.480794425	0.061475501	0.163811527	3.968966768	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.4831
H7787_004_0	2011	7																															A	D	D	V	T	Coin	Coin	V	P	P	Coin	V	Coin	Coin	V	V	Coin	V	P	P	Coin																																																												0	YES	235.2782153	10.27453007	286.0715372	0	301.1143182	8.111895065	9.727229103	323.9233529	332.9570589	0	11.30505112	55.23858525	0	8.504483078	1134.39127	3155.754418	58.60467599	141.9388571	0	0	19.80702974																				3400	"1a. $350 per admit(Acute), $500 per admit (Rehab/LTAC)"	1b. $150/day for days 1-7	2. $100/day for days 21-100	No cost sharing	10a. $50 per trip	"11a, b, c. 20% Coinsurance for DME, Prosthetics, Supplies; 0% coinsurance for Diabetes Monitoring Supplies"	"11a, b, c. 20% Coinsurance for DME, Prosthetics, Supplies; 0% coinsurance for Diabetes Monitoring Supplies"	4a-b. $50 per ER visit; $25 per UC visit	9a-b. $200 Amb. Surg and $300 OP Hosp Surg per visit	No cost sharing	"8a-b. $0 for X-rays/Ultrasounds; 20% coinsurance for Radiation Therapy; 15% coinsurance for MRI, CT, PET, CNM, Other Imaging"	1a. $100 per visit	12. 20% Coinsurance	"3, 5, 7c, 7i, 9c, 9d, 13a. $35 per CORF/Therapy visit; $35 per Cardiac Rehab session; 20% coinsurance for all OP MH, Substance Abuse or Partial Hosp visits"	7a. $5 per visit; $0 per routine physical exam	"7b, 7d, 7f. $35 per visit"	"7e, 7h. 20% Coinsurance"	"7c, 7i. $35 per visit"	No cost sharing	No cost sharing	15. 20% Coinsurance																				0	357.2432763	150	100	0	50	0.2	0.2	48.81600935	286.7258652	0	0.2	100	0.2	0.150070924	5	35	0.2	35	0	0	0.2																				NO	345.0970049	144.9	96.6	0	48.3	0.1932	0.1932	47.15626503	276.9771858	0	0.1932	96.6	0.1932	0.144968512	4.83	33.81	0.1932	33.81	0	0	0.1932																					6.7662	0.124064951	2.302875874	0	1.211985131	1.567218127	1.879300663	1.272917956	7.685125763	0	2.184135877	0.444670611	0	1.232882261	0.456592486	8.891338072	11.3224234	0.39991273	0	0	3.826718146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5683	0	1.811687334	6.7662	0.124064951	2.302875874	0	1.211985131	1.567218127	1.879300663	1.272917956	7.685125763	0	2.184135877	0.444670611	0	1.232882261	0.456592486	8.891338072	11.3224234	0.39991273	0	0	3.826718146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5683	YES	1a. 30% Coinsurance	1b. 30% Coinsurance	2. 30% Coinsurance	6. $40 per visit	10a. $50 per trip	"11a, b, c. 30% Coinsurance"	"11a, b, c. 30% Coinsurance"	4a-b. $50 per ER visit; $25 per UC visit	9a-b. 30% Coinsurance	8a. 30% Coinsurance	"8a-b. 30% coinsurance for X-rays/Ultrasounds/Radiation Therapy, MRI, CT, PET, CNM, Other Imaging"	1a. 30% Coinsurance	12. 30% Coinsurance	"3, 5, 7c, 7i, 9c, 9d, 13a. 30% Coinsurance"	7a. $40 per visit	"7b, 7d, 7f. $60 per visit"	"7e, 7h. 30% Coinsurance"	"7c, 7i. $60 per visit"	30% Coinsurance	7g. 30% Lab/Path	15. 30% Coinsurance																				5100	12.0536	0.2164	1.2861	0.1276	0.1916	0.573	0.5402	0.2013	2.0508	0.2033	0.6279	0.3567	0	0.4255	0.5775	2.4099	3.2549	0.1084	0.0745	0.2081	1.1001																				26.5872	1000	5.642785284	18.8197	0.340417179	3.588982225	0.127556733	1.403610746	2.140202523	2.419544534	1.474177593	9.73593566	0.203266636	2.81201094	0.801344761	0	1.658428166	1.034123111	11.30128013	14.57728835	0.508306596	0.074473303	0.20806624	4.926787478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.1555
H7908_001_0	2011	3																															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	1416.849774	154.1678061	619.4633928	789.9805285	199.0760762	13.80444248	0	349.3344928	392.0228763	2235.926544	2594.820996	85.35468987	1.043829277	34.85356119	3641.61295	4976.401537	279.7970593	665.9316009	0	0	252.8003191	0	0	0	972.7196287	0	53.43004488	0	0	0											3400	$225/day 1-7	$225/day 1-7	"$0/d 1-20, $130/d 21-100"	$0 per visit	$175 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$25 per visit	$50 X-ray; $250 Complex Radiology	$50 per visit	$25 per visit	$50 per visit	"$25 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$50 per visit; Chiropractic Visits $11 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$40 per visit	$50 per visit	$50 per visit	$50 per visit	$50 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											0	162.6423925	162.6423925	52.43074037	0	175	0.05	0.05	48.5	250	3.75	30	50	25	50	25	50	40	37.5	50	50	$50 	0	0	0	0	0	0	0	0	0											NO	131.3348114	131.3348114	42.33817083	0	141.3136615	0.040375332	0.040375332	39.16407189	201.8766592	3.028149889	24.22519911	40.37533185	20.18766592	40.37533185	20.18766592	40.37533185	32.30026548	30.28149889	40.37533185	40.37533185	40.37533185	0	0	0	0	0	0	0	0	0												15.5068	1.687299979	2.185578912	0	2.344347437	0.557358946	0	1.140113433	6.595022384	0.564226726	5.23833794	0.287185327	0.00175604	0.117268675	6.126305472	16.74365529	0.753126608	1.680450586	0	0	0.850574731	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3794	0	14.87	15.5068	1.687299979	2.185578912	0	2.344347437	0.557358946	0	1.140113433	6.595022384	0.564226726	5.23833794	0.287185327	0.00175604	0.117268675	6.126305472	16.74365529	0.753126608	1.680450586	0	0	0.850574731	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3794	NO																																																																																		0			15.5068	1.687299979	2.185578912	0	2.344347437	0.557358946	0	1.140113433	6.595022384	0.564226726	5.23833794	0.287185327	0.00175604	0.117268675	6.126305472	16.74365529	0.753126608	1.680450586	0	0	0.850574731	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3794
H7908_801_0	2011	1																															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	YES	338.7673202	6.915857654	43.27666886	8.596316228	10.07574155	13.02943673	0	16.15149287	44.57632954	19.97037697	64.52869255	1.142582136	0.097980152	29.71755305	30.3444639	145.2093422	3.926595757	9.24928402	0	0	77.1434654	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.069723925	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	0.058657686	0.058657686	0.12206879	0	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0	0	0	0	0	0	0	0												19.8713	0.405668206	5.28273059	0	1.975040633	2.554022137	0	3.166005653	8.737824576	3.914580955	12.64887444	0.223968244	0.019206009	5.825216387	5.948103066	28.46384554	0.769688874	1.813038939	0	0	15.12161443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7407	0	22.02406969	19.8713	0.405668206	5.28273059	0	1.975040633	2.554022137	0	3.166005653	8.737824576	3.914580955	12.64887444	0.223968244	0.019206009	5.825216387	5.948103066	28.46384554	0.769688874	1.813038939	0	0	15.12161443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7407	NO																																																																																		0			19.8713	0.405668206	5.28273059	0	1.975040633	2.554022137	0	3.166005653	8.737824576	3.914580955	12.64887444	0.223968244	0.019206009	5.825216387	5.948103066	28.46384554	0.769688874	1.813038939	0	0	15.12161443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7407
H7908_802_0	2011	1																															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	YES	338.7647313	6.915804804	43.27633814	8.596250535	10.07566455	13.02933715	0	16.15136944	44.57598889	19.97022435	64.52819942	1.142573404	0.097979403	29.71732595	30.34423201	145.2082325	3.92656575	9.249213337	0	0	77.14287588	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.069723925	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	0.058657686	0.058657686	0.12206879	0	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0.196019382	0	0	0	0	0	0	0	0												19.8712	0.405665105	5.28269022	0	1.97502554	2.554002619	0	3.165981458	8.737757801	3.914551039	12.64877778	0.223966533	0.019205862	5.825171871	5.948057611	28.46362802	0.769682992	1.813025084	0	0	15.12149887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7398	0	22.02390139	19.8712	0.405665105	5.28269022	0	1.97502554	2.554002619	0	3.165981458	8.737757801	3.914551039	12.64877778	0.223966533	0.019205862	5.825171871	5.948057611	28.46362802	0.769682992	1.813025084	0	0	15.12149887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7398	NO																																																																																		0			19.8712	0.405665105	5.28269022	0	1.97502554	2.554002619	0	3.165981458	8.737757801	3.914551039	12.64877778	0.223966533	0.019205862	5.825171871	5.948057611	28.46362802	0.769682992	1.813025084	0	0	15.12149887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7398
H7917_008_0	2011	7																															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	1125.642763	19.62389894	783.9752684	24.04446962	185.5938484	30.0433649	8.742212803	252.4508356	455.0116344	10.03247497	16.73936671	0	0.051117074	315.8712447	3715.349979	4596.517459	203.1091291	115.6401913	26.9444158	33.13294855	13.50717122	0	4	984.1425502	202.3561773	0	30.24846324	0	360	0											4400	1a:  Acute - $150/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $150/$0/day for 1-3/4-190	2:  Skilled Nursing Services - $48/day for 1-100	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 - $30/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 - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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/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			17a:  Routine Eye Exams - $30/visit	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year	18a:  Routine Hearing Test - $30/visit		14c:  Routine Exams - $0/visit/												0	150	150	48.19629245	0	150	0.2	0.050542148	36.61295192	150	0	0.15419121	0	0.2	20	15.00118184	28.83951494	30	20	0	0.002017945	0.2	0	0	0	30	0	30	0	0	0											NO	131.930685	131.930685	42.39046584	0	131.930685	0.17590758	0.044453734	32.22121944	131.930685	0	0.135617013	0	0.17590758	17.59075799	13.19410797	25.36544639	26.38613699	17.59075799	0	0.001774859	0.17590758	0	0	0	30	0	30	0	0	0												12.3756	0.215749536	2.769423069	0	2.040460296	5.284855613	0.388624006	0.677856148	5.002499716	0	2.270142918	0	0.008991881	0.463034552	4.08506073	9.716059768	0.446605442	0.169516552	0	0.058806306	2.376013801	0	0	0	0.505890443	0	0.075621158	0	0	0	0	0	0	0	0	0	0	0	0	0	48.9308	0	6.6215	12.3756	0.215749536	2.769423069	0	2.040460296	5.284855613	0.388624006	0.677856148	5.002499716	0	2.270142918	0	0.008991881	0.463034552	4.08506073	9.716059768	0.446605442	0.169516552	0	0.058806306	2.376013801	0	0	0	0.505890443	0	0.075621158	0	0	0	0	0	0	0	0	0	0	0	0	0	48.9308	YES	1a:  Acute - $250/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $250/$0/day for 1-3/4-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $98/day for 1-100/2:  Non-Medicare Covered Stay - $98/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/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 - 25.0%/8b:  Outpatient Therapeutic Radiological Services - 25.0%/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $45/visit/3:  Rehab Services (CORF) - $45/day/5:  Partial Hospitalization - $45/day	7a:  Primary Care - $25/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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 - $25/visit/18a:  Hearing Exams - $30/visit	15:  Medicare Part B Rx Drugs - Chemo - 25.0%/Medicare Part B Rx Drugs - Non-Chemo - 25.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $30/visit	17b:  Eye Glasses & Contact Lenses - $100/Every Other Year	18a:  Routine Hearing Test - $30/visit		14c:  Routine Exams - $0/visit/												5900	2.987	0.0521	0.8462	0	0.2932	1.2202	0.0868	0.1192	2.3996	0.6097	0.655	0	0.0018	0.1634	1.141	2.5308	0.1127	0.0627	0	0.0131	0.818	0	0	0	0.0962	0	0.0144	0	0	0	0	0	0	0	0	0	0	0	0	0	14.2233	0	3.1335	15.3626	0.267823609	3.615658528	0	2.333671951	6.505058941	0.475419212	0.797103705	7.402134115	0.609746663	2.925149934	0	0.01074218	0.626455607	5.226040548	12.24689705	0.559308911	0.232258327	0	0.071875497	3.194062567	0	0	0	0.602133395	0	0.090007679	0	0	0	0	0	0	0	0	0	0	0	0	0	63.1541
H7917_009_0	2011	7																															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	730.4852586	38.66319916	662.0216445	21.92261018	179.8710106	26.88825003	7.81680018	239.9969538	534.1725232	14.98976469	20.56723108	0	0.05864841	482.9243691	3887.060953	4710.862122	361.4834743	125.0370595	28.22783486	34.77533918	10.52795531	0	4	1101.95984	193.7181147	0	35.75346996	0	360	0											4400	1a:  Acute - $150/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $150/$0/day for 1-3/4-190	2:  Skilled Nursing Services - $48/day for 1-100	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 - $30/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 - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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/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			17a:  Routine Eye Exams - $30/visit	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year	18a:  Routine Hearing Test - $30/visit		14c:  Routine Exams - $0/visit/												0	150	150	48.19629245	0	150	0.2	0.060721933	36.61033149	150	0	0.151876638	0	0.2	20	15.00107413	28.75904729	30	20	0	0.004332869	0.2	0	0	0	30	0	30	0	0	0											NO	133.9002024	133.9002024	43.02328875	0	133.9002024	0.178533603	0.054204527	32.69652267	133.9002024	0	0.135575417	0	0.178533603	17.85336031	13.39097908	25.67228168	26.78004047	17.85336031	0	0.003867814	0.178533603	0	0	0	30	0	30	0	0	0												8.151	0.431417516	2.373529031	0	2.007063726	4.80045616	0.423705958	0.653922153	5.960484078	0	2.788410922	0	0.010470712	0.71848523	4.337629324	10.07821494	0.806711839	0.18602764	0	0.134504543	1.879593795	0	0	0	0.484295287	0	0.089383675	0	0	0	0	0	0	0	0	0	0	0	0	0	46.3153	0	5.4995	8.151	0.431417516	2.373529031	0	2.007063726	4.80045616	0.423705958	0.653922153	5.960484078	0	2.788410922	0	0.010470712	0.71848523	4.337629324	10.07821494	0.806711839	0.18602764	0	0.134504543	1.879593795	0	0	0	0.484295287	0	0.089383675	0	0	0	0	0	0	0	0	0	0	0	0	0	46.3153	YES	1a:  Acute - $250/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $250/$0/day for 1-3/4-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $98/day for 1-100/2:  Non-Medicare Covered Stay - $98/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/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 - 25.0%/8b:  Outpatient Therapeutic Radiological Services - 25.0%/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $45/visit/3:  Rehab Services (CORF) - $45/day/5:  Partial Hospitalization - $45/day	7a:  Primary Care - $25/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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 - $25/visit/18a:  Hearing Exams - $30/visit	15:  Medicare Part B Rx Drugs - Chemo - 25.0%/Medicare Part B Rx Drugs - Non-Chemo - 25.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $30/visit	17b:  Eye Glasses & Contact Lenses - $100/Every Other Year	18a:  Routine Hearing Test - $30/visit		14c:  Routine Exams - $0/visit/												5900	2.2116	0.1171	0.6387	0	0.3139	1.2098	0.1033	0.1076	2.6103	0.5712	0.6947	0	0.0021	0.2182	1.1819	2.6484	0.2209	0.0747	0	0.0344	0.4991	0	0	0	0.0895	0	0.0165	0	0	0	0	0	0	0	0	0	0	0	0	0	13.5638	0	2.6745	10.3626	0.548471484	3.01221404	0	2.320934394	6.010277913	0.526998862	0.76150682	8.570804448	0.571218955	3.483065314	0	0.012585482	0.936683177	5.519567763	12.7266012	1.027661344	0.260755664	0	0.168868687	2.378656459	0	0	0	0.573780474	0	0.105899456	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8791
H7917_010_0	2011	7																															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	993.9552976	32.60927415	674.4846736	30.5857165	216.7663332	31.83885708	9.862440194	283.7544443	491.3378623	11.18741231	19.40752793	0	0.062727595	420.6791129	4195.160377	5020.401592	296.6921101	126.7198125	27.0503687	39.60225351	9.81360722	0	4	845.7674708	208.8233296	0	30.55386082	0	360	0											4400	1a:  Acute - $150/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $150/$0/day for 1-3/4-190	2:  Skilled Nursing Services - $48/day for 1-100	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 - $30/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 - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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/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			17a:  Routine Eye Exams - $30/visit	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year	18a:  Routine Hearing Test - $30/visit		14c:  Routine Exams - $0/visit/												0	150	150	48.19629245	0	150	0.2	0.035547774	36.60774466	150	0	0.156190577	0	0.2	20	15.00107233	28.83814422	30	20	0	0.001278372	0.2	0	0	0	30	0	30	0	0	0											NO	131.4420689	131.4420689	42.2334693	0	131.4420689	0.175256092	0.031149819	32.09549997	131.4420689	0	0.136866751	0	0.175256092	17.52560919	13.14514656	25.27030227	26.28841379	17.52560919	0	0.001120213	0.175256092	0	0	0	30	0	30	0	0	0												10.8873	0.357185872	2.37381898	0	2.374351275	5.579953662	0.307213232	0.75893673	5.381872096	0	2.656245291	0	0.010993393	0.614388144	4.595499832	10.57225548	0.649963747	0.185070159	0	0.044362939	1.719894449	0	0	0	0.522058324	0	0.076384652	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6677	0	6.9275	10.8873	0.357185872	2.37381898	0	2.374351275	5.579953662	0.307213232	0.75893673	5.381872096	0	2.656245291	0	0.010993393	0.614388144	4.595499832	10.57225548	0.649963747	0.185070159	0	0.044362939	1.719894449	0	0	0	0.522058324	0	0.076384652	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6677	YES	1a:  Acute - $250/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $250/$0/day for 1-3/4-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $98/day for 1-100/2:  Non-Medicare Covered Stay - $98/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/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 - 25.0%/8b:  Outpatient Therapeutic Radiological Services - 25.0%/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $45/visit/3:  Rehab Services (CORF) - $45/day/5:  Partial Hospitalization - $45/day	7a:  Primary Care - $25/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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 - $25/visit/18a:  Hearing Exams - $30/visit	15:  Medicare Part B Rx Drugs - Chemo - 25.0%/Medicare Part B Rx Drugs - Non-Chemo - 25.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $30/visit	17b:  Eye Glasses & Contact Lenses - $100/Every Other Year	18a:  Routine Hearing Test - $30/visit		14c:  Routine Exams - $0/visit/												5900	2.8569	0.0937	0.69	0	0.3236	1.2438	0.0665	0.1161	2.3992	0.3974	0.7171	0	0.0022	0.1733	1.2933	2.8051	0.1747	0.0733	0	0.0102	0.4644	0	0	0	0.0946	0	0.0138	0	0	0	0	0	0	0	0	0	0	0	0	0	14.0093	0	2.958	13.7442	0.450883405	3.063786828	0	2.697937489	6.82372722	0.373755862	0.87501095	7.781103957	0.397378025	3.37339052	0	0.013147286	0.787701515	5.888805858	13.37737294	0.82463325	0.258406311	0	0.054554518	2.184309683	0	0	0	0.616684528	0	0.09022787	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6771
H7917_011_0	2011	6																															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	786.5107801	7.978713725	250.9583028	13.25200566	132.7232722	22.59883373	10.54203215	232.252485	392.9097955	8.746944177	18.45530338	0	0.046531569	333.7627623	3675.640957	4492.795241	361.071007	101.5121261	25.01949623	31.47620607	1.270322729	0	4	1577.449317	208.9686661	0	27.60714019	0	360	0											4400	1a:  Acute - $150/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $150/$0/day for 1-3/4-190	2:  Skilled Nursing Services - $48/day for 1-100	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 - $30/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 - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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/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			17a:  Routine Eye Exams - $30/visit	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year	18a:  Routine Hearing Test - $30/visit		14c:  Routine Exams - $0/visit/												0	150	150	48.19629245	0	150	0.2	0.069543255	36.60698488	150	0	0.146419998	0	0.2	20	15.00122939	28.70405365	30	20	0	0.000719562	0.2	0	0	0	30	0	30	0	0	0											NO	138.0504671	138.0504671	44.35680458	0	138.0504671	0.18406729	0.064003192	33.70136598	138.0504671	0	0.134755661	0	0.18406729	18.40672895	13.80617817	26.41738676	27.61009343	18.40672895	0	0.000662239	0.18406729	0	0	0	30	0	30	0	0	0												9.0482	0.091788763	0.927642366	0	1.52687581	4.159706071	0.67472371	0.652268833	4.520115067	0	2.486956611	0	0.00856494	0.511956725	4.228879494	9.890659126	0.83076702	0.155708849	0	0.020844778	0.233824861	0	0	0	0.522421665	0	0.06901785	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5609	0	3.4595	9.0482	0.091788763	0.927642366	0	1.52687581	4.159706071	0.67472371	0.652268833	4.520115067	0	2.486956611	0	0.00856494	0.511956725	4.228879494	9.890659126	0.83076702	0.155708849	0	0.020844778	0.233824861	0	0	0	0.522421665	0	0.06901785	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5609	YES	1a:  Acute - $250/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $250/$0/day for 1-3/4-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $98/day for 1-100/2:  Non-Medicare Covered Stay - $98/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/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 - 25.0%/8b:  Outpatient Therapeutic Radiological Services - 25.0%/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $45/visit/3:  Rehab Services (CORF) - $45/day/5:  Partial Hospitalization - $45/day	7a:  Primary Care - $25/visit/17a:  Vision Exams - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $30/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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 - $25/visit/18a:  Hearing Exams - $30/visit	15:  Medicare Part B Rx Drugs - Chemo - 25.0%/Medicare Part B Rx Drugs - Non-Chemo - 25.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $30/visit	17b:  Eye Glasses & Contact Lenses - $100/Every Other Year	18a:  Routine Hearing Test - $30/visit		14c:  Routine Exams - $0/visit/												5900	2.4843	0.0252	0.2318	0	0.1918	0.7842	0.123	0.096	2.5154	0.4591	0.6828	0	0.0018	0.2322	1.3149	2.9077	0.2495	0.0686	0	0.0039	0.1212	0	0	0	0.1016	0	0.0134	0	0	0	0	0	0	0	0	0	0	0	0	0	12.6083	0	2.1105	11.5325	0.116990693	1.159428165	0	1.71867494	4.943861097	0.797759734	0.748262735	7.035504911	0.459060351	3.169739536	0	0.010335604	0.744173867	5.543731754	12.79834033	1.080282762	0.224299263	0	0.024766506	0.355016607	0	0	0	0.624032585	0	0.08244181	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1692
H7917_012_0	2011	7																															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	1269.029775	75.66969773	562.5059737	18.50638875	173.3211858	22.88273959	6.920081477	197.2719393	350.7213287	7.656865972	12.90196598	0	0.037759222	264.901783	2780.649965	3535.260907	146.6759704	83.50997	20.62223801	25.51259936	9.815587695	0	4	0	151.5899362	0	21.90885216	0	360	0											4900	1a:  Acute - $175/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-6/7-190	2:  Skilled Nursing Services - $56/day for 1-100	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 - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $225/visit/9b:  Ambulatory Surgical Center Services - $225/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%	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $35/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7i:  Physical/Speech Therapy - $20/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/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 - $35/visit	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year	18a:  Routine Hearing Test - $35/visit		14c:  Routine Exams - $0/visit/												0	175	175	56.39187372	0	150	0.2	0.048652948	40.01390566	225	0	0.156415926	0	0.2	20	20.00118989	33.26582914	35	20	0	0.002202105	0.2	0	0	0	35	0	35	0	0	0											NO	156.023687	163.9115845	50.12353354	0	135.5638671	0.177780647	0.043354628	35.81493632	201.0664536	0	0.139391473	0	0.178031963	17.9710516	17.85995833	29.69609617	31.10951203	17.77686402	0	0.001957326	0.177902179	0	0	0	35	0	35	0	0	0												16.4999	1.033595004	2.349565586	0	1.958007516	4.06810825	0.30001756	0.588773495	5.876524478	0	1.798424043	0	0.006722348	0.396713634	4.138524374	8.748620655	0.380251489	0.123712115	0	0.049936475	1.746214434	0	0	0	0.442137314	0	0.063900819	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5696	0	5.991955423	16.4999	1.033595004	2.349565586	0	1.958007516	4.06810825	0.30001756	0.588773495	5.876524478	0	1.798424043	0	0.006722348	0.396713634	4.138524374	8.748620655	0.380251489	0.123712115	0	0.049936475	1.746214434	0	0	0	0.442137314	0	0.063900819	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5696	YES	1a:  Acute - $275/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$0/day for 1-6/7-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$106/day for 1--1/-100/2:  Non-Medicare Covered Stay - $0/$106/day for 1--1/-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/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 - $35/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 - 20.0%	9d:  Cardiac Rehabilitation Services - $45/visit/3:  Rehab Services (CORF) - $45/day/5:  Partial Hospitalization - $45/day	7a:  Primary Care - $30/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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/18a:  Hearing Exams - $35/visit	15:  Medicare Part B Rx Drugs - Chemo - 25.0%/Medicare Part B Rx Drugs - Non-Chemo - 25.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $100/Every Other Year	18a:  Routine Hearing Test - $35/visit		14c:  Routine Exams - $0/visit/												5900	3.8235	0.2577	0.7044	0	0.281	0.8997	0.0663	0.1032	1.9197	0.4693	0.5168	0	0.0013	0.1428	1.0834	2.0144	0.083	0.0462	0	0.0101	0.6091	0	0	0	0.0839	0	0.0121	0	0	0	0	0	0	0	0	0	0	0	0	0	13.1279	0	2.487691923	20.3234	1.291252279	3.053998924	0	2.238999057	4.9678539	0.366283503	0.691961451	7.796244435	0.469285756	2.315196772	0	0.008043362	0.539495211	5.221876699	10.76306149	0.463278375	0.169933001	0	0.060012286	2.355306354	0	0	0	0.526006325	0	0.076018182	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6975
H7917_013_0	2011	7																															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	941.0871206	52.55976727	518.4186835	18.28757546	154.2115537	22.50822571	6.586012072	197.4671211	420.6880712	12.43326799	17.12775819	0	0.046092424	412.0105849	3085.080598	3847.753239	307.1297962	100.627761	22.62001014	27.4943556	7.205947389	0	4	0	161.5094161	0	28.72869742	0	360	0											4900	1a:  Acute - $175/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-6/7-190	2:  Skilled Nursing Services - $56/day for 1-100	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 - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $225/visit/9b:  Ambulatory Surgical Center Services - $225/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%	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $35/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7i:  Physical/Speech Therapy - $20/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/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 - $35/visit	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year	18a:  Routine Hearing Test - $35/visit		14c:  Routine Exams - $0/visit/												0	175	175	56.39187372	0	150	0.2	0.068842619	40.03086431	225	0	0.153718617	0	0.2	20	20.00112929	33.23164417	35	20	0	0.004622132	0.2	0	0	0	35	0	35	0	0	0											NO	157.1427411	156.4075887	50.40066851	0	135.1928527	0.178781669	0.061528617	35.90284065	201.4129716	0	0.13738719	0	0.17933158	18.01445973	17.93479126	29.7969395	31.28151773	17.87515299	0	0.004131066	0.17875153	0	0	0	35	0	35	0	0	0												12.3238	0.685062205	2.177387351	0	1.737358322	4.024058158	0.405228216	0.590802549	7.061002877	0	2.353134564	0	0.008265827	0.618512341	4.610856378	9.55427254	0.800623847	0.149894719	0	0.113581001	1.28807412	0	0	0	0.47106913	0	0.083792034	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0567	0	5.612582371	12.3238	0.685062205	2.177387351	0	1.737358322	4.024058158	0.405228216	0.590802549	7.061002877	0	2.353134564	0	0.008265827	0.618512341	4.610856378	9.55427254	0.800623847	0.149894719	0	0.113581001	1.28807412	0	0	0	0.47106913	0	0.083792034	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0567	YES	1a:  Acute - $275/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$0/day for 1-6/7-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$106/day for 1--1/-100/2:  Non-Medicare Covered Stay - $0/$106/day for 1--1/-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/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 - $35/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 - 20.0%	9d:  Cardiac Rehabilitation Services - $45/visit/3:  Rehab Services (CORF) - $45/day/5:  Partial Hospitalization - $45/day	7a:  Primary Care - $30/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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/18a:  Hearing Exams - $35/visit	15:  Medicare Part B Rx Drugs - Chemo - 25.0%/Medicare Part B Rx Drugs - Non-Chemo - 25.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $100/Every Other Year	18a:  Routine Hearing Test - $35/visit		14c:  Routine Exams - $0/visit/												5900	3.1744	0.1761	0.574	0	0.2705	0.9575	0.0964	0.0973	2.0957	0.4743	0.5724	0	0.0017	0.1908	1.178	2.2063	0.1887	0.0604	0	0.0254	0.3455	0	0	0	0.0872	0	0.0155	0	0	0	0	0	0	0	0	0	0	0	0	0	12.7883	0	2.3776054	15.4981	0.861131872	2.751404898	0	2.007857539	4.981592689	0.501663749	0.68812726	9.156657499	0.474338525	2.925554548	0	0.009949972	0.809309775	5.788887042	11.7605432	0.989313565	0.210343041	0	0.138965955	1.633607853	0	0	0	0.55831101	0	0.099302428	0	0	0	0	0	0	0	0	0	0	0	0	0	61.845
H7917_014_0	2011	7																															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	859.9124707	44.58985562	411.9263817	20.41124894	153.0417857	22.57191143	7.621858683	261.1572783	347.3228651	8.50260867	14.00872615	0	0.042936234	251.0452349	3043.392119	3734.337857	266.7418444	71.5427407	17.75601061	27.11403311	6.09202156	0	4	0	148.8240816	0	23.30956475	0	360	0											4900	1a:  Acute - $175/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-6/7-190	2:  Skilled Nursing Services - $56/day for 1-100	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 - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $225/visit/9b:  Ambulatory Surgical Center Services - $225/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%	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $35/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7i:  Physical/Speech Therapy - $20/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/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 - $35/visit	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year	18a:  Routine Hearing Test - $35/visit		14c:  Routine Exams - $0/visit/												0	175	175	56.39187372	0	150	0.2	0.030387253	39.86283024	225	0	0.153786802	0	0.2	20	20.00105164	33.33434043	35	20	0	0.000979981	0.2	0	0	0	35	0	35	0	0	0											NO	159.9240903	161.6640985	51.39248503	0	138.1099751	0.183785069	0.027800918	36.81149964	206.1948809	0	0.140779468	0	0.183205091	18.22373616	18.33833355	30.5505076	32.1828272	18.26765644	0	0.000895374	0.182735248	0	0	0	35	0	35	0	0	0												11.4601	0.600714901	1.764160034	0	1.7613831	4.14838029	0.211894671	0.801132588	5.968016402	0	1.972141014	0	0.007866137	0.38124851	4.650894984	9.507159757	0.715375557	0.108909851	0	0.024277203	1.11322707	0	0	0	0.434070238	0	0.067986231	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6989	0	4.138071321	11.4601	0.600714901	1.764160034	0	1.7613831	4.14838029	0.211894671	0.801132588	5.968016402	0	1.972141014	0	0.007866137	0.38124851	4.650894984	9.507159757	0.715375557	0.108909851	0	0.024277203	1.11322707	0	0	0	0.434070238	0	0.067986231	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6989	YES	1a:  Acute - $275/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$0/day for 1-6/7-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$106/day for 1--1/-100/2:  Non-Medicare Covered Stay - $0/$106/day for 1--1/-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/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 - $35/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 - 20.0%	9d:  Cardiac Rehabilitation Services - $45/visit/3:  Rehab Services (CORF) - $45/day/5:  Partial Hospitalization - $45/day	7a:  Primary Care - $30/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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/18a:  Hearing Exams - $35/visit	15:  Medicare Part B Rx Drugs - Chemo - 25.0%/Medicare Part B Rx Drugs - Non-Chemo - 25.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $100/Every Other Year	18a:  Routine Hearing Test - $35/visit		14c:  Routine Exams - $0/visit/												5900	2.9591	0.1537	0.5001	0	0.2474	0.9015	0.0462	0.1259	1.8176	0.3475	0.5345	0	0.0015	0.1134	1.1854	2.1449	0.1589	0.0408	0	0.0045	0.3077	0	0	0	0.079	0	0.0124	0	0	0	0	0	0	0	0	0	0	0	0	0	11.682	0	1.700784175	14.4192	0.754431157	2.264235642	0	2.008797289	5.049867488	0.258068184	0.927039178	7.78559817	0.347535673	2.506671254	0	0.00938852	0.494674231	5.836264296	11.65207569	0.874316043	0.149696008	0	0.028811837	1.420906333	0	0	0	0.513021914	0	0.080361797	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3809
H7917_015_0	2011	7																															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	762.066527	32.47863453	331.069046	10.89012706	114.4711561	18.57158857	5.744341982	208.4034091	303.9549458	8.013321713	16.3480684	0	0.038738739	163.9813905	2825.509582	3420.620896	262.3110374	74.66937581	16.62915336	26.15990995	2.095340024	0	4	0	146.4525447	0	17.4736982	0	360	0											4900	1a:  Acute - $175/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-6/7-190	2:  Skilled Nursing Services - $56/day for 1-100	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 - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $225/visit/9b:  Ambulatory Surgical Center Services - $225/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%	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $35/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7i:  Physical/Speech Therapy - $20/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/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 - $35/visit	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year	18a:  Routine Hearing Test - $35/visit		14c:  Routine Exams - $0/visit/												0	175	175	56.39187372	0	150	0.2	0.029487273	39.90748828	225	0	0.140726349	0	0.2	20	20.00112108	33.54641052	35	20	0	0.001480474	0.2	0	0	0	35	0	35	0	0	0											NO	163.3020441	163.1606843	52.73666448	0	140.0042979	0.187017122	0.027603749	37.36727129	210.4434077	0	0.131283256	0	0.186250318	18.68033245	18.71204006	31.36943164	32.88236069	18.68402214	0	0.001374739	0.185214247	0	0	0	35	0	35	0	0	0												10.3706	0.441603019	1.454956433	0	1.33553782	3.473205039	0.158565374	0.648955561	5.330442881	0	2.146227649	0	0.007215103	0.255268907	4.405920708	8.941911116	0.718783846	0.116260356	0	0.035963058	0.388086824	0	0	0	0.427153255	0	0.050964953	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7076	0	2.821130454	10.3706	0.441603019	1.454956433	0	1.33553782	3.473205039	0.158565374	0.648955561	5.330442881	0	2.146227649	0	0.007215103	0.255268907	4.405920708	8.941911116	0.718783846	0.116260356	0	0.035963058	0.388086824	0	0	0	0.427153255	0	0.050964953	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7076	YES	1a:  Acute - $275/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$0/day for 1-6/7-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$106/day for 1--1/-100/2:  Non-Medicare Covered Stay - $0/$106/day for 1--1/-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/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 - $35/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 - 20.0%	9d:  Cardiac Rehabilitation Services - $45/visit/3:  Rehab Services (CORF) - $45/day/5:  Partial Hospitalization - $45/day	7a:  Primary Care - $30/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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/18a:  Hearing Exams - $35/visit	15:  Medicare Part B Rx Drugs - Chemo - 25.0%/Medicare Part B Rx Drugs - Non-Chemo - 25.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $100/Every Other Year	18a:  Routine Hearing Test - $35/visit		14c:  Routine Exams - $0/visit/												5900	2.8336	0.1208	0.3983	0	0.1763	0.66	0.03	0.0953	1.915	0.4198	0.5506	0	0.0015	0.1252	1.2058	2.1549	0.1751	0.0478	0	0.0073	0.17	0	0	0	0.084	0	0.01	0	0	0	0	0	0	0	0	0	0	0	0	0	11.1813	0	1.427437649	13.2042	0.562421922	1.853227917	0	1.51187713	4.133157691	0.188611019	0.74422557	7.245401864	0.419827171	2.696843091	0	0.008670676	0.380501319	5.611689422	11.09683257	0.893865518	0.164092319	0	0.043228222	0.558108506	0	0	0	0.511170934	0	0.060970618	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8889
H7917_026_0	2011	5																															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	1185.226464	52.40717976	615.2692944	20.36449496	163.8710416	25.28571553	7.579884271	217.8383041	457.8564665	11.85582416	17.70023036	0	0.050500565	395.0771593	3394.497975	4277.230376	311.8458537	113.9685944	25.39741112	30.98267374	9.193723822	0	4	1104.538233	182.2091196	0	31.5922652	0	360	0											4900	1a:  Acute - $175/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-6/7-190	2:  Skilled Nursing Services - $56/day for 1-100	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 - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $225/visit/9b:  Ambulatory Surgical Center Services - $225/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%	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $35/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7i:  Physical/Speech Therapy - $20/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/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 - $35/visit	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year	18a:  Routine Hearing Test - $35/visit		14c:  Routine Exams - $0/visit/												0	175	175	56.39187372	0	150	0.2	0.063329721	40.04185753	225	0	0.153373895	0	0.2	20	20.00115822	33.18807638	35	20	0	0.004101795	0.2	0	0	0	35	0	35	0	0	0											NO	153.6400962	153.6400962	49.50887375	0	131.6915111	0.175588681	0.055599911	35.17326773	197.5372666	0	0.1346536	0	0.175588681	17.55886814	17.55988499	29.13725285	30.72801925	17.55886814	0	0.003601144	0.175588681	0	0	0	35	0	35	0	0	0												15.1749	0.670987012	2.538440818	0	1.798368758	4.439885449	0.421440889	0.638507082	7.53697624	0	2.383399731	0	0.008867328	0.578092312	4.967249504	10.38556191	0.798533783	0.166763293	0	0.111573062	1.614313843	0	0	0	0.531443266	0	0.092144107	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8574	0	7.539500004	15.1749	0.670987012	2.538440818	0	1.798368758	4.439885449	0.421440889	0.638507082	7.53697624	0	2.383399731	0	0.008867328	0.578092312	4.967249504	10.38556191	0.798533783	0.166763293	0	0.111573062	1.614313843	0	0	0	0.531443266	0	0.092144107	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8574	YES	1a:  Acute - $275/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$0/day for 1-6/7-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$106/day for 1--1/-100/2:  Non-Medicare Covered Stay - $0/$106/day for 1--1/-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/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 - $35/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 - 20.0%	9d:  Cardiac Rehabilitation Services - $45/visit/3:  Rehab Services (CORF) - $45/day/5:  Partial Hospitalization - $45/day	7a:  Primary Care - $30/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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/18a:  Hearing Exams - $35/visit	15:  Medicare Part B Rx Drugs - Chemo - 25.0%/Medicare Part B Rx Drugs - Non-Chemo - 25.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $100/Every Other Year	18a:  Routine Hearing Test - $35/visit		14c:  Routine Exams - $0/visit/												5900	3.7005	0.1636	0.6997	0	0.2752	1.0379	0.0985	0.1087	2.2829	0.5206	0.6012	0	0.0018	0.1847	1.268	2.3764	0.1816	0.0649	0	0.0241	0.4494	0	0	0	0.099	0	0.0172	0	0	0	0	0	0	0	0	0	0	0	0	0	14.156	0	3.075	18.8754	0.834613058	3.238102705	0	2.073587915	5.477747306	0.519956363	0.747211238	9.819897008	0.520588657	2.984631238	0	0.01062663	0.762832096	6.235291354	12.76194842	0.980157678	0.231665336	0	0.135698542	2.063746048	0	0	0	0.630420731	0	0.10930528	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0134
H7917_027_0	2011	5																															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	1115.812147	37.98754548	561.0419169	19.35194375	149.8630298	22.89724979	7.334005638	223.720396	398.1203126	9.885307268	17.585583	0	0.051666715	331.863286	3471.253599	4346.827196	263.9855945	94.18843997	20.9851726	32.706464	7.191928742	0	4	1128.733638	186.1941264	0	25.82173086	0	360	0											4900	1a:  Acute - $175/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-6/7-190	2:  Skilled Nursing Services - $56/day for 1-100	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 - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $225/visit/9b:  Ambulatory Surgical Center Services - $225/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%	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $35/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $20/visit/7i:  Physical/Speech Therapy - $20/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/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 - $35/visit	17b:  Eye Glasses & Contact Lenses - $100 Every Other Year	18a:  Routine Hearing Test - $35/visit		14c:  Routine Exams - $0/visit/												0	175	175	56.39187372	0	150	0.2	0.037261689	40.03877156	225	0	0.148894321	0	0.2	20	20.00115644	33.16011234	35	20	0	0.001228129	0.2	0	0	0	35	0	35	0	0	0											NO	155.795578	155.795578	50.20345464	0	133.5390669	0.178052089	0.033172607	35.66012695	200.3086003	0	0.132554724	0	0.178052089	17.80520892	17.80623845	29.52113639	31.15911561	17.80520892	0	0.001093354	0.178052089	0	0	0	35	0	35	0	0	0												14.4865	0.493190967	2.347186869	0	1.667714096	4.076903162	0.24328809	0.66482481	6.645576881	0	2.331052104	0	0.009199367	0.492407928	5.150830775	10.69360655	0.685463138	0.139753738	0	0.035759755	1.280537938	0	0	0	0.543066202	0	0.075313382	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0622	0	6.341000003	14.4865	0.493190967	2.347186869	0	1.667714096	4.076903162	0.24328809	0.66482481	6.645576881	0	2.331052104	0	0.009199367	0.492407928	5.150830775	10.69360655	0.685463138	0.139753738	0	0.035759755	1.280537938	0	0	0	0.543066202	0	0.075313382	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0622	YES	1a:  Acute - $275/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$0/day for 1-6/7-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$106/day for 1--1/-100/2:  Non-Medicare Covered Stay - $0/$106/day for 1--1/-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/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 - $35/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 - 20.0%	9d:  Cardiac Rehabilitation Services - $45/visit/3:  Rehab Services (CORF) - $45/day/5:  Partial Hospitalization - $45/day	7a:  Primary Care - $30/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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/18a:  Hearing Exams - $35/visit	15:  Medicare Part B Rx Drugs - Chemo - 25.0%/Medicare Part B Rx Drugs - Non-Chemo - 25.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit	17b:  Eye Glasses & Contact Lenses - $100/Every Other Year	18a:  Routine Hearing Test - $35/visit		14c:  Routine Exams - $0/visit/												5900	3.7704	0.1284	0.659	0	0.2308	0.8592	0.0513	0.1027	2.0775	0.4015	0.6085	0	0.0018	0.1573	1.3133	2.425	0.1509	0.0526	0	0.0069	0.3682	0	0	0	0.1005	0	0.0139	0	0	0	0	0	0	0	0	0	0	0	0	0	13.4795	0	2.6205	18.2569	0.621552202	3.006195995	0	1.898488743	4.936056377	0.294557825	0.767498517	8.723033082	0.401463752	2.939594164	0	0.010975736	0.649675402	6.464107886	13.11858011	0.836331253	0.192386359	0	0.042697532	1.64876177	0	0	0	0.643575962	0	0.089252253	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5417
H7917_801_0	2011	3																															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	YES	250.6240505	4.539039228	42.36967223	34.21984587	9.011652839	29.04463569	9.565507046	15.04325953	49.74788954	13.32341835	20.55160926	0	0.045095007	12.95155664	50.94250823	130.9809657	1.906795653	2.902482012	27.7352669	30.51908148	4.99965642	0.533670286	0	0	0	0	0	0	0	0											6700	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												0.082257364	0.082257364	0.188673552	0	0.233	0.233	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	0.066055392	0.066055392	0.15151112	0	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0	0	0	0	0	0	0	0												16.5551	0.299828014	6.419476514	0	1.686140878	5.434446754	1.789770727	2.814695071	9.308164844	2.492901215	3.845344367	0	0.008437579	2.423323388	9.531686039	24.50741994	0.356774296	0.543073913	5.189455044	5.710325483	0.935469355	0.099853301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9517	0	24.51599999	16.5551	0.299828014	6.419476514	0	1.686140878	5.434446754	1.789770727	2.814695071	9.308164844	2.492901215	3.845344367	0	0.008437579	2.423323388	9.531686039	24.50741994	0.356774296	0.543073913	5.189455044	5.710325483	0.935469355	0.099853301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9517	YES	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											10000	2.0111	0.0364	0.7008	0	0.1877	0.605	0.1992	0.323	1.1428	0.4714	0.4698	0	0.0011	0.3249	1.2285	3.231	0.0483	0.0735	0.7742	0.7154	0.1456	0.0156	0	0	0	0	0	0	0	0											12.7053	0	1.673999998	18.5662	0.336250918	7.120246671	0	1.873853807	6.039447159	1.98902045	3.137676656	10.45092775	2.964323396	4.315116586	0	0.009582257	2.748215346	10.76018964	27.73840956	0.405077053	0.616599297	5.963671279	6.425708251	1.081075453	0.115409388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.657
H7917_802_0	2011	3																															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	YES	250.6240505	4.539039228	42.36967223	34.21984587	9.011652839	29.04463569	9.565507046	15.04325953	49.74788954	13.32341835	20.55160926	0	0.045095007	12.95155664	50.94250823	130.9809657	1.906795653	2.902482012	27.7352669	30.51908148	4.99965642	0.533670286	0	0	0	0	0	0	0	0											6700	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												0.082257364	0.082257364	0.188673552	0	0.233	0.233	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	0.066055392	0.066055392	0.15151112	0	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0	0	0	0	0	0	0	0												16.5551	0.299828014	6.419476514	0	1.686140878	5.434446754	1.789770727	2.814695071	9.308164844	2.492901215	3.845344367	0	0.008437579	2.423323388	9.531686039	24.50741994	0.356774296	0.543073913	5.189455044	5.710325483	0.935469355	0.099853301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9517	0	24.51599999	16.5551	0.299828014	6.419476514	0	1.686140878	5.434446754	1.789770727	2.814695071	9.308164844	2.492901215	3.845344367	0	0.008437579	2.423323388	9.531686039	24.50741994	0.356774296	0.543073913	5.189455044	5.710325483	0.935469355	0.099853301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9517	YES	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											10000	2.0111	0.0364	0.7008	0	0.1877	0.605	0.1992	0.323	1.1428	0.4714	0.4698	0	0.0011	0.3249	1.2285	3.231	0.0483	0.0735	0.7742	0.7154	0.1456	0.0156	0	0	0	0	0	0	0	0											12.7053	0	1.673999998	18.5662	0.336250918	7.120246671	0	1.873853807	6.039447159	1.98902045	3.137676656	10.45092775	2.964323396	4.315116586	0	0.009582257	2.748215346	10.76018964	27.73840956	0.405077053	0.616599297	5.963671279	6.425708251	1.081075453	0.115409388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.657
H7917_803_0	2011	3																															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	YES	250.6240505	4.539039228	42.36967223	34.21984587	9.011652839	29.04463569	9.565507046	15.04325953	49.74788954	13.32341835	20.55160926	0	0.045095007	12.95155664	50.94250823	130.9809657	1.906795653	2.902482012	27.7352669	30.51908148	4.99965642	0.533670286	0	0	0	0	0	0	0	0											6700	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												0.082257364	0.082257364	0.188673552	0	0.233	0.233	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	0.066055392	0.066055392	0.15151112	0	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0.187106728	0	0	0	0	0	0	0	0												16.5551	0.299828014	6.419476514	0	1.686140878	5.434446754	1.789770727	2.814695071	9.308164844	2.492901215	3.845344367	0	0.008437579	2.423323388	9.531686039	24.50741994	0.356774296	0.543073913	5.189455044	5.710325483	0.935469355	0.099853301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9517	0	24.51599999	16.5551	0.299828014	6.419476514	0	1.686140878	5.434446754	1.789770727	2.814695071	9.308164844	2.492901215	3.845344367	0	0.008437579	2.423323388	9.531686039	24.50741994	0.356774296	0.543073913	5.189455044	5.710325483	0.935469355	0.099853301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9517	YES	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											10000	2.0111	0.0364	0.7008	0	0.1877	0.605	0.1992	0.323	1.1428	0.4714	0.4698	0	0.0011	0.3249	1.2285	3.231	0.0483	0.0735	0.7742	0.7154	0.1456	0.0156	0	0	0	0	0	0	0	0											12.7053	0	1.673999998	18.5662	0.336250918	7.120246671	0	1.873853807	6.039447159	1.98902045	3.137676656	10.45092775	2.964323396	4.315116586	0	0.009582257	2.748215346	10.76018964	27.73840956	0.405077053	0.616599297	5.963671279	6.425708251	1.081075453	0.115409388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.657
H7949_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1003.711056	70.54727768	2395.667689	2328.390717	323.3622661	13.71401062	24.84641902	233.3487553	172.0920625	5.009345354	13.98728867	0	4.112546946	281.9960268	5033.72956	121.1829848	492.583894	290.1829048	0	0	14.24086253	1922.64469	0	0	0	0	17.46434425	6	210.4196854	0											3350	"$125 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-44 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$125 (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $125 (9a); $40/$30 (9c)"	"$0 (7a, 14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $0/$30 (17a)"	$0 n/c (10b)	"$0 n/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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												93.12452764	62.29135204	60.01863838	0	200	0.2	0.102213706	49.77493171	125	0.142824165	0.167787804	0	0.2	46.65520148	0.049332705	0.123897464	38.5	30	0	0	0.2	27.91004288	0	0	0	0	0	0	0	0											NO	73.61229337	49.23954405	47.44302847	0	158.0943179	0.158094318	0.080797031	39.36937385	98.80894867	0.112898445	0.132631492	0	0.158094318	36.87961126	0.048503566	0.12182857	37.85292722	29.49578745	0	0	0.158094318	22.06209595	0	0	0	0	0	0	0	0												6.1571	0.289476316	9.471477531	0	4.26014474	2.168107154	2.007516887	0.765566199	1.417019647	0.565547301	1.855154968	0	0.650170304	0.866658654	0.020346153	14.7635497	1.553811857	0.71326444	0	0	2.251399447	3.534797636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3111	0	9.90062733	6.1571	0.289476316	9.471477531	0	4.26014474	2.168107154	2.007516887	0.765566199	1.417019647	0.565547301	1.855154968	0	0.650170304	0.866658654	0.020346153	14.7635497	1.553811857	0.71326444	0	0	2.251399447	3.534797636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3111	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.1571	0.289476316	9.471477531	0	4.26014474	2.168107154	2.007516887	0.765566199	1.417019647	0.565547301	1.855154968	0	0.650170304	0.866658654	0.020346153	14.7635497	1.553811857	0.71326444	0	0	2.251399447	3.534797636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3111
H7949_801_0	2011	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	395.7631652	3.413981875	24.77384664	432.1157393	13.35746779	7.638703971	8.491333192	13.81030705	27.24471021	36.23371356	74.23663951	0	0.268755442	13.59141176	31.08092125	154.4642167	0.854346646	5.968017593	0	0	27.66463687	15.14685267	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.069821157	0.069821157	0.145276672	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.054812364	0.054812364	0.114047922	0	0.182914197	0.182914197	0.182914197	0.182914197	0.182914197	0.182914197	0.182914197	0	0.182914197	0.182914197	0.182914197	0.182914197	0.182914197	0.182914197	0	0	0.182914197	0.182914197	0	0	0	0	0	0	0	0												21.6927	0.187128418	2.825405733	0	2.443270501	1.397227406	1.553185396	2.52610123	4.983444302	6.627660635	13.57893534	0	0.049159186	2.486062173	5.685141766	28.25369823	0.156272131	1.091635148	0	0	5.060254851	2.770574399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.3679	0	28.30432455	21.6927	0.187128418	2.825405733	0	2.443270501	1.397227406	1.553185396	2.52610123	4.983444302	6.627660635	13.57893534	0	0.049159186	2.486062173	5.685141766	28.25369823	0.156272131	1.091635148	0	0	5.060254851	2.770574399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.3679	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.6927	0.187128418	2.825405733	0	2.443270501	1.397227406	1.553185396	2.52610123	4.983444302	6.627660635	13.57893534	0	0.049159186	2.486062173	5.685141766	28.25369823	0.156272131	1.091635148	0	0	5.060254851	2.770574399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.3679
H7949_803_0	2011	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	396.1542341	3.386564256	25.31657865	431.05134	13.38753161	8.120343061	9.342302543	13.35245011	27.31574734	37.62746217	78.47536656	0	0.19733214	15.21551891	31.73262913	160.6455529	0.97666689	6.123007439	0	0	29.76106554	15.44987189	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.069818666	0.069818666	0.145272119	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.054361451	0.054361451	0.113110198	0	0.181415927	0.181415927	0.181415927	0.181415927	0.181415927	0.181415927	0.181415927	0	0.181415927	0.181415927	0.181415927	0.181415927	0.181415927	0.181415927	0	0	0.181415927	0.181415927	0	0	0	0	0	0	0	0												21.5355	0.184098546	2.863563215	0	2.428711452	1.473159561	1.694842473	2.42234711	4.955511617	6.826220918	14.23668135	0	0.035799193	2.760337462	5.756804318	29.14366185	0.177182929	1.110811069	0	0	5.399131284	2.802852826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8072	0	30.08538625	21.5355	0.184098546	2.863563215	0	2.428711452	1.473159561	1.694842473	2.42234711	4.955511617	6.826220918	14.23668135	0	0.035799193	2.760337462	5.756804318	29.14366185	0.177182929	1.110811069	0	0	5.399131284	2.802852826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8072	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.5355	0.184098546	2.863563215	0	2.428711452	1.473159561	1.694842473	2.42234711	4.955511617	6.826220918	14.23668135	0	0.035799193	2.760337462	5.756804318	29.14366185	0.177182929	1.110811069	0	0	5.399131284	2.802852826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8072
H7949_804_0	2011	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	388.2029194	3.677573852	23.66457941	421.9843478	14.04370232	8.49965688	9.502616771	14.60146719	30.12613293	34.98478161	74.31074753	0	0.170921889	14.17449609	31.62039144	150.3858564	1.035323925	6.060944216	0	0	34.62694503	15.36983351	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.054512883	0.054512883	0.113443304	0	0.182168484	0.182168484	0.182168484	0.182168484	0.182168484	0.182168484	0.182168484	0	0.182168484	0.182168484	0.182168484	0.182168484	0.182168484	0.182168484	0	0	0.182168484	0.182168484	0	0	0	0	0	0	0	0												21.1621	0.200475155	2.684588081	0	2.558319963	1.548369609	1.731077292	2.659927143	5.488031968	6.373124633	13.53707623	0	0.031136581	2.582146465	5.760238775	27.39556349	0.18860339	1.10411302	0	0	6.307938085	2.799899271	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1127	0	29.05116032	21.1621	0.200475155	2.684588081	0	2.558319963	1.548369609	1.731077292	2.659927143	5.488031968	6.373124633	13.53707623	0	0.031136581	2.582146465	5.760238775	27.39556349	0.18860339	1.10411302	0	0	6.307938085	2.799899271	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1127	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.1621	0.200475155	2.684588081	0	2.558319963	1.548369609	1.731077292	2.659927143	5.488031968	6.373124633	13.53707623	0	0.031136581	2.582146465	5.760238775	27.39556349	0.18860339	1.10411302	0	0	6.307938085	2.799899271	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1127
H8050_001_0	2011	9																															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	756.6642677	20.77428959	602.6802738	22.24377871	213.3695695	11.05470121	3.012607931	239.4338182	31.87702955	433.199589	727.7508446	0	0.01727981	927.6614951	0.426420349	4266.359706	99.45689521	137.5452519	10.52491444	19.65499737	5.397258381	0	0	0	305.5585542	0	0	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 1-5/6-90	2:  Skilled Nursing Services - $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 - $15/visit/8b:  Outpatient Therapeutic Radiological Services - $15/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $15/visit/3:  Rehab Services (CORF) - $15/day/5:  Partial Hospitalization - $15/day	7a:  Primary Care - $0/visit/17a:  Vision Exams - $15/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/7f:  Podiatry Services - $15/visit/17a:  Vision Exams - $15/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $15/visit/9c:  Outpatient Substance Abuse Svcs - Group - $15/visit/7g:  Other Health Care Professional Services - $15/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 - $15/visit	17b:  Eye Glasses & Contact Lenses - $100 Per Year			14c:  Routine Exams - $0/visit/													100	100	75	0	100	0.2	0.052463811	43.41947792	0.2	10	15	0	0.2	22.04698554	15	15	15	15	0	0.002410162	0.2	0	0	0	15	0	0	0	0	0											NO	92.77193178	92.77193178	69.57894883	0	92.77193178	0.185543864	0.048671691	40.28108843	0.185543864	9.277193178	13.91578977	0	0.185543864	20.45341438	13.91578977	13.91578977	13.91578977	13.91578977	0	0.002235954	0.185543864	0	0	0	13.91578977	0	0	0	0	0												5.8498	0.160605915	3.494488328	0	1.649558929	2.051131974	0.146628723	0.803721234	5.914587223	0.334906356	0.843935646	0	0.003206163	1.581153747	0.000494498	4.947480395	0.115335104	0.159504234	0	0.04394767	1.001428173	0	0	0	0.354340717	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.4562	0	2.295	5.8498	0.160605915	3.494488328	0	1.649558929	2.051131974	0.146628723	0.803721234	5.914587223	0.334906356	0.843935646	0	0.003206163	1.581153747	0.000494498	4.947480395	0.115335104	0.159504234	0	0.04394767	1.001428173	0	0	0	0.354340717	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.4562	YES	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%	4a:  Emergency Care / Post Stabilization Care - 30.0%/4b:  Urgently Needed Care / Urgent Care Centers - 30.0%/4a:  Worldwide Coverage - 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%	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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - $8/visit/14e:  Prostate Cancer Screening - $8/visit/14f:  Colorectal Screening - $8/visit/14g:  Bone Mass Measurement - $8/visit/14h:  Mammography - $8/visit/14i:  Diabetes Monitoring - $8/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $8/visit	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - $8/visit/14e:  Prostate Cancer Screening - $8/visit/14f:  Colorectal Screening - $8/visit/14g:  Bone Mass Measurement - $8/visit/14h:  Mammography - $8/visit/14i:  Diabetes Monitoring - $8/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $8/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 - 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%/18a:  Hearing Exams - 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%	17b:  Eye Glasses & Contact Lenses - $100/Per Year			14c:  Routine Exams - 30.0%/												5000	6.3555	0.0729	1.3915	0.8512	0.203	0.3287	0.083	0.2349	1.0185	0.1483	0.5254	0	0.0006	0.5209	0.8624	2.2908	0.028	0.1106	0.4475	0.5117	0.2082	0.0213	0	0	0.0851	0.011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.3111	500	9.47	12.2053	0.233500159	4.886005049	0.851240397	1.852542714	2.37984477	0.229600798	1.038635687	6.93312544	0.483199031	1.369333723	0	0.003806306	2.102064133	0.86291781	7.238312083	0.143286878	0.270083907	0.44745409	0.555637142	1.20962332	0.021340959	0	0	0.43948039	0.010975412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7673
H8050_005_0	2011	7																															D	D	D	coin	T	coin	coin	V	coin	P	coin	O	coin	coin	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	977.9236063	26.84898582	590.1235982	22.76516447	214.932928	11.34783867	3.09249324	236.0925899	32.26991697	497.3597027	19.36768833	0	0.017518468	14.06612621	3192.259596	3984.842037	92.50851838	127.9359006	10.45354703	18.92547227	5.397980771	0	0	0	0	0	0	0	0	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 1-10/11-90	2:  Skilled Nursing Services - $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 - $15/visit/8a:  Outpatient Lab Services - $15/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%	9d:  Cardiac Rehabilitation Services - 20.0%/3:  Rehab Services (CORF) - $45/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $45/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $15/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $45/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $45/visit/7i:  Physical/Speech Therapy - $45/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/18a:  Hearing Exams - $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							14c:  Routine Exams - $0/visit/													175	175	110	0	200	0.2	0.052463811	46.73919532	0.2	15	0.2	0	0.2	0.19182025	20.00307686	42.08044295	40	45	0	0.006919917	0.2	0	0	0	0	0	0	0	0	0											NO	159.5173936	159.5173936	100.268076	0	182.3055927	0.182305593	0.047822231	42.60408352	0.182305593	13.67291945	0.182305593	0	0.182305593	0.174849522	18.23336391	38.35750047	36.46111854	41.01875836	0	0.006307698	0.182305593	0	0	0	0	0	0	0	0	0												12.9997	0.356906687	4.930879815	0	3.265289568	2.068774454	0.147889926	0.838209035	5.882986339	0.566696596	3.530837899	0	0.003193715	2.459455445	4.850469242	12.73738169	0.281080338	0.437314316	0	0.119376165	0.984082084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.4605	0	5.48	12.9997	0.356906687	4.930879815	0	3.265289568	2.068774454	0.147889926	0.838209035	5.882986339	0.566696596	3.530837899	0	0.003193715	2.459455445	4.850469242	12.73738169	0.281080338	0.437314316	0	0.119376165	0.984082084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.4605	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.9997	0.356906687	4.930879815	0	3.265289568	2.068774454	0.147889926	0.838209035	5.882986339	0.566696596	3.530837899	0	0.003193715	2.459455445	4.850469242	12.73738169	0.281080338	0.437314316	0	0.119376165	0.984082084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.4605
H8050_006_0	2011	5																															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	817.5207877	22.44511115	567.1875973	20.44598761	197.9460565	10.30392912	2.808008827	220.992816	29.86957318	413.2202617	657.4616408	0	0.016162511	861.0289405	3102.838618	3821.90594	88.44815586	122.3205676	9.652805325	17.61388512	4.936561694	0	0	0	0	0	0	0	0	0											3200	1a:  Acute - $175/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-7/8-90	2:  Skilled Nursing Services - $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 - $15/visit/8a:  Outpatient Lab Services - $15/visit	8b:  Outpatient Diagnostic Radiological Services - $35/visit/8b:  Outpatient Therapeutic Radiological Services - $35/visit/8b:  Outpatient X-Ray Services - $35/visit		12:  Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $35/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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 - $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 - $35/visit/9c:  Outpatient Substance Abuse Svcs - Group - $35/visit/7g:  Other Health Care Professional Services - $35/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							14c:  Routine Exams - $0/visit/													175	175	110	0	150	0.2	0.052463811	43.41982774	0.2	15	35	0	0.2	30.45055073	15.00243856	33.10381958	35	35	0	0.005567833	0.2	0	0	0	0	0	0	0	0	0											NO	148.0042904	148.0042904	93.03126822	0	126.8608203	0.16914776	0.044370681	36.7218331	0.16914776	12.68608203	29.60085807	0	0.16914776	25.7532123	12.68814442	27.99718471	29.60085807	29.60085807	0	0.004708933	0.16914776	0	0	0	0	0	0	0	0	0												10.083	0.276831062	4.397181791	0	2.092633259	1.742886534	0.124593263	0.676271775	5.052371407	0.436845511	1.621785726	0	0.002733853	1.847855092	3.280772041	8.916883879	0.218178442	0.301732813	0	0.082942598	0.835008355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9906	0	7.659	10.083	0.276831062	4.397181791	0	2.092633259	1.742886534	0.124593263	0.676271775	5.052371407	0.436845511	1.621785726	0	0.002733853	1.847855092	3.280772041	8.916883879	0.218178442	0.301732813	0	0.082942598	0.835008355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9906	YES	1a:  Acute - 30.0% for 1-7/8-90/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-7/8-190/1b:  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%	4a:  Emergency Care / Post Stabilization Care - 30.0%/4b:  Urgently Needed Care / Urgent Care Centers - 30.0%/4a:  Worldwide Coverage - 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%	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%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - $8/visit/14e:  Prostate Cancer Screening - $8/visit/14f:  Colorectal Screening - $8/visit/14g:  Bone Mass Measurement - $8/visit/14h:  Mammography - $8/visit/14i:  Diabetes Monitoring - $8/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $8/visit	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14c:  Physical Exams (Initial Exam) - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - $8/visit/14e:  Prostate Cancer Screening - $8/visit/14f:  Colorectal Screening - $8/visit/14g:  Bone Mass Measurement - $8/visit/14h:  Mammography - $8/visit/14i:  Diabetes Monitoring - $8/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $8/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 - 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%/18a:  Hearing Exams - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%							14c:  Routine Exams - 30.0%/												5000	7.9472	0.0912	1.74	1.0644	0.2538	0.411	0.1038	0.2939	1.2736	0.1854	0.657	0	0.0008	0.6514	1.1501	3.0338	0.035	0.1383	0.5747	0.6439	0.2603	0.0267	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.5363	1500	8.366	18.0302	0.367989548	6.137186618	1.064422998	2.346463261	2.153921374	0.228344666	0.970207407	6.325989889	0.622276248	2.278763235	0	0.003484295	2.49926116	4.430910217	11.95072753	0.253130392	0.440005794	0.574658599	0.726855721	1.095356439	0.026685537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.5268
H8050_007_0	2011	7																															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	YES	235.6718661	2.696522483	63.75580388	25.60015857	244.0765724	13.14580782	3.440778854	91.88970364	37.03847273	2.67538675	22.89905153	0	0.020390047	16.54199957	0	0	1.085517461	4.294402346	12.78736637	22.37044094	6.118417021	0.661057135	0	0	0	0	0	0	0	0											3200	1a:  Acute - 0/day for 1-100/1a:  Additional Days - $0/day for 91-999	1b:  Psych - 0/day for 1-100	2:  Skilled Nursing Services - 0/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $50/trip	11a:  Durable Medical Equipment - 10.0%	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 - $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	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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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/14b:  Immunizations (Hepatitis B) - $0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14h:  Mammography - $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	"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 - $0/visit/9c:  Outpatient Substance Abuse Svcs - Group - $0/visit/7g:  Other Health Care Professional Services - $0/visit/18a:  Hearing Exams - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 10.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $0/visit	17b:  Eye Glasses & Contact Lenses - $200 Per Year	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14c:  Routine Exams - $0/visit/													-1.77E-19	0	0	0	50	0.1	0	50	0	0	0	0	0	0	0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	50	0.1	0	50	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	1.016985718	1.314580782	0	0.382873765	0	0	0	0	0	0	0	0	0	0	0	0	0.611841702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.3263	0	0	0	0	0	0	1.016985718	1.314580782	0	0.382873765	0	0	0	0	0	0	0	0	0	0	0	0	0.611841702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.3263	YES	1a:  Acute - 20.0% for 1-100/1a:  Additional Days - 20.0% for 91-999	1b:  Psych - 20.0% for 1-100/1b:  Non-Medicare Covered Stay - 20.0%	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 - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - 20.0%/4b:  Urgently Needed Care / Urgent Care Centers - 20.0%/4a:  Worldwide Coverage - 20.0%	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%	9d:  Cardiac Rehabilitation Services - 20.0%/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%	7a:  Primary Care - 20.0%/17a:  Vision Exams - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14c:  Physical Exams (Initial Exam) - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - $6/visit/14e:  Prostate Cancer Screening - $6/visit/14f:  Colorectal Screening - $6/visit/14g:  Bone Mass Measurement - $6/visit/14h:  Mammography - $6/visit/14i:  Diabetes Monitoring - $6/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $6/visit	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14c:  Physical Exams (Initial Exam) - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - $6/visit/14e:  Prostate Cancer Screening - $6/visit/14f:  Colorectal Screening - $6/visit/14g:  Bone Mass Measurement - $6/visit/14h:  Mammography - $6/visit/14i:  Diabetes Monitoring - $6/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $6/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - 20.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 20.0%/7h:  Psychiatric Services - Individual - 20.0%/7h:  Psychiatric Services - Group - 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%"	9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - 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%							14c:  Routine Exams - 20.0%/												5000	5.4515	0.0635	1.1936	0.7302	0.1756	0.282	0.0712	0.2074	0.8737	0.1285	0.4554	0	0.0005	0.4511	0.7706	2.0178	0.0243	0.0965	0.3938	0.447	0.1799	0.0183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.0323	500	4.875	5.4515	0.063453044	1.19359962	0.730167449	1.192610903	1.596540361	0.071170857	0.590262255	0.873692289	0.128539785	0.45541397	0	0.000520203	0.451066891	0.770560085	2.017834375	0.024272131	0.096468769	0.393816837	0.446995415	0.791709776	0.018317029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.3586
H8091_001_0	2011	5	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							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	NO	1039.714161	31.20631224	334.9062221	0	243.5847836	18.50845828	1.049397649	273.6054592	507.3647859	0	278.6538819	0	0	1828.817011	3593.530686	3533.614869	90.21019047	140.8223031	141.7444661	0	30.66175782	0	0	0	0	0	0	0	0	0	4.655044523	6.215703748										"$265 copay per day for days 1-6, $0 after day 6, unlimited coverage"	"$265 copay per day for days 1-6, $0 after day 6, 190 day per lifetime limit"	"$0 copay for days 1-20, $137.5 copay per day for days 21-100*"	No cost sharing	"$250 copay ground, $500 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $50 copay, (4b) $20 to $40 copay"	"(9a) $280 copay, (9b) $280 copay"	No cost sharing	"$0 to $280 copay for diag rad, 20% therapeutic rad"	$280 copay	20% coinsurance	"(3) $280 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) $20 copay, (7c) $40 copay, (7f) $20 copay, (7g) $40 copay"	"(7e) $40 copay, (7h) $40 copay"	"(7c) $40 copay, (7i) $40 copay"	"$0 to $280 copay for diag rad, 20% for therapeutic rad"	No cost sharing	20% coinsurance	20% coinsurance	Not covered	"(16a) not covered, (16b) $40 copay Medicare covered only"	(17a) $0 - $40 copay Medicare covered only  (17b) $40 copay Medicare covered only	(17a) $0 - $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									25	265	265	137.5	0	250	0.2	0.2	48.55161577	280	0	280	0	0	135.6103446	20	37.86463053	40	40	280	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									NO	228.2167314	228.2167314	118.4143418	0	215.2988032	0.172239043	0.172239043	41.81241908	241.1346596	0	241.1346596	0	0	116.7869796	17.22390426	32.60883856	34.44780852	34.44780852	241.1346596	0	0.172239043	0.172239043	0	0	0	0	0	0	0	0	0.172239043	0.172239043										19.7733	0.593483548	3.304808321	0	4.370292701	3.187879134	0.180747246	0.953342177	10.19526958	0	5.599425747	0	0	17.79850124	5.157885707	9.602256399	0.258961947	0.404251644	2.848291966	0	5.28115181	0	0	0	0	0	0	0	0	0	0.801780412	1.070586863	0	0	0	0	0	0	0	0	91.3823	0	14.72871129	19.7733	0.593483548	3.304808321	0	4.370292701	3.187879134	0.180747246	0.953342177	10.19526958	0	5.599425747	0	0	17.79850124	5.157885707	9.602256399	0.258961947	0.404251644	2.848291966	0	5.28115181	0	0	0	0	0	0	0	0	0	0.801780412	1.070586863	0	0	0	0	0	0	0	0	91.3823	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$250 copay ground, $500 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	Not covered	"(16a) not covered, (16b) 30% coinsurance Medicare covered only"	(17a) 30% coinsurance Medicare covered only  (17b) 30% coinsurance Medicare covered only	(17a) 30% coinsurance Medicare covered only  (17b) 30% coinsurance Medicare covered only	(18a) 30% coinsurance Medicare covered only	Not covered	50% coinsurance	n/a	30% coinsurance	30% coinsurance									6700	3.4708	0.0437	0.3831	0.3153	0.1966	0.2491	0.0141	0.0737	0.6583	0.0422	0.2167	0	0	0.3861	0.2851	0.3722	0.0169	0.0671	0.1939	1.1687	0.4126	0.1359	0	0	0	0	0	0	0.0302	0	0.0817	0.0974									8.9113	500	4.437571443	23.2442	0.6371995	3.687915041	0.315254377	4.566896737	3.43694331	0.194868755	1.027066373	10.85361693	0.042239635	5.816154386	0	0	18.1845842	5.442953649	9.974424247	0.275824023	0.471335402	3.042148908	1.16872984	5.693760215	0.135855681	0	0	0	0	0	0	0.030210402	0	0.883456509	1.167960994	0	0	0	0	0	0	0	0	100.2936
H8098_001_0	2011	15																															D	D	D		T	Coin	Coin	V	Coin	Coin	P		Coin	Coin	V	V	V	V	P	Coin	O	Coin		V		V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	944.6154882	28.26873759	1289.178298	0	264.2910234	8.926074742	5.920688852	277.2011414	48.61575642	3.406150857	200.8038357	0	0.237859635	17.64746165	4411.054272	5499.857643	156.4276729	655.8627804	169.4835031	33.98799789	948.7932602	10.93176256	0	2925	0	31.77142857	167.8159533	0	0	0												$268/Days 1-6 for IP Medical; $268/Days 1-6 for IP Surgical; PBP 1a	$299/Days 1-6 for IP Psych; $299/Days 1-6 for IP Substance Abuse; PBP 1b	"$50 days 1-20, $128 days 21-100 for SNF; PBP 2"	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; $0 (Mail Order) or 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; 10% Coinsurance for ASC; PBP 9a, 9b"	5% Coinsurance for OP Fac - Pathology; PBP 8a	$0-50/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40/Visit for OP Fac - Cardiovascular; $40/Visit for OP Fac - Occ Therapy; $40/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $269/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; PBP 7a, 14b-c"	"$40/Visit for Speclst Office Visits; $40/Visit for Speclst Consults; $40/Visit for Cardio; $20/Visit for Chiropractor; $40/Exam for Vision Exams; $40/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$40/Visit for Occ Therapy; $40/Visit for PT/ST; PBP 7c, 7i"	"$0-50/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $15-40/Visit for Allergy Testing; $15-40/Visit for Allergy Tx; 5% Coinsurance for Prof Path (OP); 5% Coinsurance for Prof Path (Office); PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $15-40/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride;  $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$40/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	268	299	80.73	0	125	0.2	0.177458657	46.84308015	0.25	0.05	50	0	0.2	0.208682056	15	35.86452388	40	38.37302621	50	0.163799992	45.30207096	0.200607623	0	4	0	50	40	0	0	0											NO	254.8815175	284.3640811	76.7783019	0	118.8813048	0.190210088	0.168772134	44.55013192	0.23776261	0.047552522	47.55252193	0	0.190210088	0.198467161	14.28815051	34.10897116	38.04201754	36.49468341	47.55252193	0.155782054	43.08455445	0.190787968	0	4	0	50	40	0	0	0												20.0638	0.669884466	8.248410045	0	2.618271809	1.697829459	0.999247292	1.029112285	11.55900912	0.161971063	0.7957274	0	0.045243302	3.502441608	5.252150611	15.63287381	0.495902023	1.994625377	0.671614	5.29472013	3.406527906	2.085648768	0	0.975	0	0.132380952	0.559386511	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8917	0	4.429252348	20.0638	0.669884466	8.248410045	0	2.618271809	1.697829459	0.999247292	1.029112285	11.55900912	0.161971063	0.7957274	0	0.045243302	3.502441608	5.252150611	15.63287381	0.495902023	1.994625377	0.671614	5.29472013	3.406527906	2.085648768	0	0.975	0	0.132380952	0.559386511	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8917	YES																																									6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.0638	0.669884466	8.248410045	0	2.618271809	1.697829459	0.999247292	1.029112285	11.55900912	0.161971063	0.7957274	0	0.045243302	3.502441608	5.252150611	15.63287381	0.495902023	1.994625377	0.671614	5.29472013	3.406527906	2.085648768	0	0.975	0	0.132380952	0.559386511	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8917
H8098_003_0	2011	12																															D	D	D		T	Coin	Coin	V	Coin	Coin	P		Coin	Coin	V	V	V	V	P	Coin	O	Coin		V		V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	1482.123949	44.35431507	2059.638932	0	432.4439791	15.1034248	10.01814139	407.8749036	78.57799686	6.190288222	317.9026708	0	0.462669082	33.71269494	6720.396624	8438.048311	246.7941912	1034.747379	258.5919576	53.88176878	1497.236418	17.86087158	0	2925	0	31.77142857	259.5880744	0	0	0												$268/Days 1-6 for IP Medical; $268/Days 1-6 for IP Surgical; PBP 1a	$299/Days 1-6 for IP Psych; $299/Days 1-6 for IP Substance Abuse; PBP 1b	"$50 days 1-20, $128 days 21-100 for SNF; PBP 2"	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; $0 (Mail Order) or 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; 10% Coinsurance for ASC; PBP 9a, 9b"	5% Coinsurance for OP Fac - Pathology; PBP 8a	$0-50/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40/Visit for OP Fac - Cardiovascular; $40/Visit for OP Fac - Occ Therapy; $40/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $269/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; PBP 7a, 14b-c"	"$40/Visit for Speclst Office Visits; $40/Visit for Speclst Consults; $40/Visit for Cardio; $20/Visit for Chiropractor; $40/Exam for Vision Exams; $40/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$40/Visit for Occ Therapy; $40/Visit for PT/ST; PBP 7c, 7i"	"$0-50/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $15-40/Visit for Allergy Testing; $15-40/Visit for Allergy Tx; 5% Coinsurance for Prof Path (OP); 5% Coinsurance for Prof Path (Office); PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $15-40/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride;  $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$40/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	268	299	80.73	0	125	0.2	0.177458657	46.73123207	0.25	0.05	50	0	0.2	0.203961369	15	35.81346784	40	38.47077302	50	0.166733692	46.48400529	0.200569936	0	4	0	50	40	0	0	0											NO	241.3566657	269.2747874	72.70419261	0	112.5730717	0.180116915	0.159816529	42.08542669	0.225146143	0.045029229	45.02922867	0	0.180116915	0.183684462	13.5548569	32.25305666	36.02338293	34.64618471	45.02922867	0.150157791	41.86277807	0.18063019	0	4	0	50	40	0	0	0												29.81	0.995291563	12.4786988	0	4.056795588	2.720382276	1.601064587	1.43046578	17.69153294	0.278743904	1.192909338	0	0.083334528	6.192498238	7.591167881	22.67940419	0.740863471	2.987504067	0.970349699	8.090767374	5.223206323	3.226212626	0	0.975	0	0.132380952	0.865293581	0	0	0	0	0	0	0	0	0	0	0	0	0	132.0139	0	14.32657654	29.81	0.995291563	12.4786988	0	4.056795588	2.720382276	1.601064587	1.43046578	17.69153294	0.278743904	1.192909338	0	0.083334528	6.192498238	7.591167881	22.67940419	0.740863471	2.987504067	0.970349699	8.090767374	5.223206323	3.226212626	0	0.975	0	0.132380952	0.865293581	0	0	0	0	0	0	0	0	0	0	0	0	0	132.0139	YES																																									6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	29.81	0.995291563	12.4786988	0	4.056795588	2.720382276	1.601064587	1.43046578	17.69153294	0.278743904	1.192909338	0	0.083334528	6.192498238	7.591167881	22.67940419	0.740863471	2.987504067	0.970349699	8.090767374	5.223206323	3.226212626	0	0.975	0	0.132380952	0.865293581	0	0	0	0	0	0	0	0	0	0	0	0	0	132.0139
H8098_005_0	2011	14																															D	D	D		T	Coin	Coin	V	Coin	Coin	P		Coin	Coin	V	V	V	V	P	Coin	O	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	NO	1121.3188	33.55679354	1610.980889	0	281.2690102	9.731031198	6.454618586	290.1199464	51.46071411	4.2990602	232.6413788	0	0.260477049	19.80876125	4869.390718	6031.979165	174.6142954	732.1148182	187.4743655	37.75463302	1058.050082	12.44462649	0	0	0	31.77142857	189.1866812	0	0	0												$268/Days 1-6 for IP Medical; $268/Days 1-6 for IP Surgical; PBP 1a	$299/Days 1-6 for IP Psych; $299/Days 1-6 for IP Substance Abuse; PBP 1b	"$50 days 1-20, $128 days 21-100 for SNF; PBP 2"	No Cost-Sharing; PBP 6	$125/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; $0 (Mail Order) or 20% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; PBP 4a, 4b"	"30% Coinsurance for OP Fac - Surgery; 15% Coinsurance for ASC; PBP 9a, 9b"	5% Coinsurance for OP Fac - Pathology; PBP 8a	$0-50/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$40/Visit for OP Fac - Cardiovascular; $40/Visit for OP Fac - Occ Therapy; $40/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 30% Coinsurance for OP Fac - Other; $269/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; PBP 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $40/Visit for Speclst Consults; $40/Visit for Cardio; $20/Visit for Chiropractor; $40/Exam for Vision Exams; $40/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$40/Visit for Occ Therapy; $40/Visit for PT/ST; PBP 7c, 7i"	"$0-50/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $15-40/Visit for Allergy Testing; $15-40/Visit for Allergy Tx; 5% Coinsurance for Prof Path (OP); 5% Coinsurance for Prof Path (Office); PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $15-40/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$40/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	268	299	80.73	0	125	0.2	0.182167134	46.67023792	0.3	0.05	50	0	0.2	0.226390861	15	43.360259	40	38.42746184	50	0.19049859	51.82002682	0.20058631	0	0	0	50	40	0	0	0											NO	249.6202617	278.4942472	75.19344674	0	116.4273609	0.186283777	0.169673909	43.46954105	0.279425666	0.046570944	46.57094434	0	0.186283777	0.210864723	14.00296977	40.38656417	37.25675548	35.79206373	46.57094434	0.177433984	48.2661517	0.186829878	0	0	0	50	40	0	0	0												23.3253	0.778781163	10.09460048	0	2.728950712	1.812733249	1.095180365	1.05094841	14.37944432	0.200211293	0.902860725	0	0.048522649	4.176968964	5.682160917	20.30090947	0.542130176	2.183658353	0.72757152	6.698954961	4.255667148	2.325028048	0	0	0	0.132380952	0.630622271	0	0	0	0	0	0	0	0	0	0	0	0	0	104.0736	0	7.593037601	23.3253	0.778781163	10.09460048	0	2.728950712	1.812733249	1.095180365	1.05094841	14.37944432	0.200211293	0.902860725	0	0.048522649	4.176968964	5.682160917	20.30090947	0.542130176	2.183658353	0.72757152	6.698954961	4.255667148	2.325028048	0	0	0	0.132380952	0.630622271	0	0	0	0	0	0	0	0	0	0	0	0	0	104.0736	YES																																									6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.3253	0.778781163	10.09460048	0	2.728950712	1.812733249	1.095180365	1.05094841	14.37944432	0.200211293	0.902860725	0	0.048522649	4.176968964	5.682160917	20.30090947	0.542130176	2.183658353	0.72757152	6.698954961	4.255667148	2.325028048	0	0	0	0.132380952	0.630622271	0	0	0	0	0	0	0	0	0	0	0	0	0	104.0736
H8098_009_0	2011	12																															A	A	D		T	Coin	Coin	V	Coin	Coin	P		Coin	Coin	V	V	V	V	P	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	0	0	0	0	0	0	0	0											0	NO	337.7555396	5.672961676	1881.743714	0	332.7030856	12.22811298	8.110939502	342.4164614	64.54433829	5.390979684	277.722512	0	0.326577496	24.9134294	5922.337287	7275.48599	209.0199133	874.9064354	224.0697552	47.47221363	58.26368241	15.64321386	0	2925	0	31.77142857	211.6006036	0	0	0												$1000/Admit for IP Medical; $1000/Admit for IP Surgical; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse; PBP 1b	"$50 days 1-20, $128 days 21-100 for SNF; PBP 2"	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; $0 (Mail Order) or 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $10/Visit for PCP Urgent Care; PBP 4a, 4b"	"25% Coinsurance for OP Fac - Surgery; 10% Coinsurance for ASC; PBP 9a, 9b"	5% Coinsurance for OP Fac - Pathology; PBP 8a	$0-50/Service for OP Fac - Radiology; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$30/Visit for OP Fac - Cardiovascular; $30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $269/Day for Partial Hospitalization; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"$10/Visit for PCP Office Visits; $10/Visit for PCP Consults; PBP 7a, 14b-c"	"$30/Visit for Speclst Office Visits; $30/Visit for Speclst Consults; $30/Visit for Cardio; $20/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	"$0-50/Service for Prof Radiology (Office); PBP 7d, 8a, 8b, 14g-h"	"25% Coinsurance for Prof - Primary Surgeon (OP); 25% Coinsurance for Prof - Anesthesia (OP); $10-30/Visit for Allergy Testing; $10-30/Visit for Allergy Tx; 5% Coinsurance for Prof Path (OP); 5% Coinsurance for Prof Path (Office); PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $10-30/Other for Tx Injections; PBP 15	"Varies; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$0 Copay for Oral Exams, Routine Cleanings, and Fluoride;  $0-75 Copay for Dental X-Rays; PBP 16a, 16b"	"$0/Visit for Routine Eye Exam, 1 per year, $100 vision credit; PBP 17a"	$10 Copay for Lenses and Contacts; $50/Visit for Progressive lenses; $50/Visit for Photochromic lenses; PBP 17b	$30/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	1000	1000	80.73	0	100	0.2	0.177458657	46.07725538	0.25	0.05	50	0	0.2	0.17828747	10	27.61887626	30	29.71048774	50	0.161496386	0.073278309	0.200271272	0	4	0	50	30	0	0	0											NO	930.6011993	930.6011993	75.12743482	0	93.06011993	0.18612024	0.165143239	42.87954912	0.2326503	0.04653006	46.53005996	0	0.18612024	0.165914534	9.324254768	25.70215937	27.91803598	27.64861552	46.53005996	0.150288731	0.068192882	0.186372686	0	4	0	50	30	0	0	0												26.193	0.439938745	11.78088152	0	2.580115754	2.275899322	1.339466824	1.223555289	15.01625965	0.250842608	1.076870428	0	0.060782682	4.133500023	4.601781807	15.58297504	0.486285455	2.015829304	0.868831595	7.134538733	3.973168409	2.915467789	0	0.975	0	0.132380952	0.529001509	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5863	0	7.742306496	26.193	0.439938745	11.78088152	0	2.580115754	2.275899322	1.339466824	1.223555289	15.01625965	0.250842608	1.076870428	0	0.060782682	4.133500023	4.601781807	15.58297504	0.486285455	2.015829304	0.868831595	7.134538733	3.973168409	2.915467789	0	0.975	0	0.132380952	0.529001509	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5863	YES																																									6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	26.193	0.439938745	11.78088152	0	2.580115754	2.275899322	1.339466824	1.223555289	15.01625965	0.250842608	1.076870428	0	0.060782682	4.133500023	4.601781807	15.58297504	0.486285455	2.015829304	0.868831595	7.134538733	3.973168409	2.915467789	0	0.975	0	0.132380952	0.529001509	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5863
H8098_801_0	2011	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	0	0	0	0	0	0	0	0	0											0	YES	321.332303	4.048410889	64.90081612	0	11.42661755	12.45699084	8.101373585	15.2916624	59.63370358	4.776008213	30.07543244	0	0.316099057	23.85428909	36.90669795	63.71297501	2.083729656	8.224528798	38.59476425	128.6512317	56.40171327	14.97877823	0	0	0	0	0	0	0	0											6700	8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical; PBP 1a	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse; PBP 1b	16% Coinsurance for SNF; PBP 2	No Cost-Sharing; PBP 6	23% Coinsurance for Ambulance; PBP 10a	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for DME / Medical Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics; PBP 11b, 11c"	"23% Coinsurance for ER - Facility; 23% Coinsurance for PCP Urgent Care; PBP 4a, 4b"	"23% Coinsurance for OP Fac - Surgery; PBP 9a, 9b"	23% Coinsurance for OP Fac - Pathology; PBP 8a	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	23% Coinsurance for Renal Dialysis - Fac; PBP 12	"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; PBP 3, 5, 8a, 9a, 9c, 9d, 13a"	"23% Coinsurance for PCP Office Visits; 23% Coinsurance for PCP Consults; 23% Coinsurance for Medical Nutrition Therapy; 23% Coinsurance for Hepatitis B (HBV) Vaccine; PBP 7a, 14b-c"	"23% Coinsurance for Speclst Office Visits; 23% Coinsurance for Speclst Consults; 23% Coinsurance for Cardio; 23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Diabetes Self-Management Training; 23% Coinsurance for Prostate Cancer Screening; 23% Coinsurance for Pneumococcal Vaccine; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"23% Coinsurance for Occ Therapy; 23% Coinsurance for PT/ST; 23% Coinsurance for Prof - CORF; PBP 7c, 7i"	"23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office); 23% Coinsurance for Prof Radiology (Office); 23% Coinsurance for Initial Preventive Physical Examination (IPPE); 23% Coinsurance for Glaucoma Screening; PBP 7d, 8a, 8b, 14g-h"	"23% Coinsurance for Prof - Primary Surgeon (IP); 23% Coinsurance for Prof - Asst Surgeon (IP); 23% Coinsurance for Prof - Anesthesia (IP); 23% Coinsurance for Prof - Primary Surgeon (OP); 23% Coinsurance for Prof - Asst Surgeon (OP); 23% Coinsurance for Prof - Asst Surgeon (OP); 23% Coinsurance for Prof - Anesthesia (OP); 23% Coinsurance for Prof - IP Visits; 23% Coinsurance for Allergy Testing; 23% Coinsurance for Allergy Tx; 23% Coinsurance for Prof - ER Visits; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for PCP Immunizations; 23% Coinsurance for Speclst Immunizations; 23% Coinsurance for Cardio Screenings; 23% Coinsurance for Diabetes Screening Tests; 23% Coinsurance for Pelvic Tests; 23% Coinsurance for Colorectal Cancer Screening; 23% Coinsurance for Influenza Virus Vaccine; PBP 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"23% Coinsurance for Renal Dialysis - Prof; 23% Coinsurance for Bone Mass Measurements; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	0.078199625	0.078199625	0.162732508	0	0.233	0.233	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	0.2	0.233	0	0	0	0	0	0	0	0											NO	0.069785696	0.069785696	0.145223221	0	0.207930245	0.207930245	0.207930245	0.207930245	0.207930245	0.207930245	0.207930245	0	0.207930245	0.207930245	0.207930245	0.207930245	0.207930245	0.207930245	0.207930245	0.207930245	0.178480897	0.207930245	0	0	0	0	0	0	0	0												22.4244	0.282521173	9.42510554	0	2.375939392	2.590185162	1.684520598	3.179599116	12.39965062	0.99307656	6.253592047	0	0.065726554	4.960028185	7.674018762	13.24785453	0.433270419	1.710128291	8.025018802	26.75048218	10.0666284	3.114541032	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.6563	0	16.59695682	22.4244	0.282521173	9.42510554	0	2.375939392	2.590185162	1.684520598	3.179599116	12.39965062	0.99307656	6.253592047	0	0.065726554	4.960028185	7.674018762	13.24785453	0.433270419	1.710128291	8.025018802	26.75048218	10.0666284	3.114541032	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.6563	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	22.4244	0.282521173	9.42510554	0	2.375939392	2.590185162	1.684520598	3.179599116	12.39965062	0.99307656	6.253592047	0	0.065726554	4.960028185	7.674018762	13.24785453	0.433270419	1.710128291	8.025018802	26.75048218	10.0666284	3.114541032	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.6563
H8130_001_0	2011	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	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											6700	No Cost-Sharing; PBP 1a	No Cost-Sharing; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	No Cost-Sharing; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"No Cost-Sharing; PBP 4a, 4b"	"No Cost-Sharing; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b, 14c"	"No Cost-Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	No Cost-Sharing; PBP 8b	"No Cost-Sharing; PBP 7d, 7g, 14d-j"	No Cost-Sharing; PBP 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	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
H8130_002_0	2011	8																																	D		T		Coin	V	V		Coin		Coin	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	0	0	0	0	0	0	0											0	YES	0	0	765.8271732	0	207.4242394	0	1.844324437	241.9797696	291.4545344	0	46.23338198	0	0.880337662	1038.61661	0	24.89875029	119.6742877	0	24.80951832	0	20.50559288	0	0	0	0	0	185.3250282	0	0	0											3400	No Cost-Sharing; PBP 1a	No Cost-Sharing; PBP 1b	$50 /Days 11-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$75/Run for Ambulance; PBP 10a	No Cost-Sharing; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for ER - Facility; $15/Visit for PCP Urgent Care; PBP 4a, 4b"	"$50/Case for OP Hospital Services; $50/Case for Ambulatory Surgery Center Services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	20% Coinsurance for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET; PBP 8b		20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$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; $50/Case for OP Fac - Other; $10/Visit for Prof - CORF; $15/Visit for OP Substance Abuse; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b, 14c"	"$10/Exam for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); $33/Procedure for Prof Radiology (Office); PBP 8b	"No Cost-Sharing; PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; PBP 15						$10/Exam for Hearing Exam; PBP 18a														0	0	0	50	0	75	0	0.2	46.71305204	50	0	0.151866482	0	0.2	31.68510626	0	10	12	0	0.171803485	0	0.2	0	0	0	0	0	10	0	0	0											NO	0	0	49.63365834	0	74.45048752	0	0.198534633	46.37079331	49.63365834	0	0.150753782	0	0.198534633	31.45295477	0	9.928773882	11.912078	0	0.170544709	0	0.198534633	0	0	0	0	0	10	0	0	0												0	0	3.167567022	0	1.286902979	0	0.366162276	0.935066157	1.205496232	0	6.96985717	0	0.174777515	2.722296771	0	0.020601172	0.118797454	0	4.231132094	0	4.071070365	0	0	0	0	0	0.154437524	0	0	0	0	0	0	0	0	0	0	0	0	0	25.4242	0	0.18650936	0	0	3.167567022	0	1.286902979	0	0.366162276	0.935066157	1.205496232	0	6.96985717	0	0.174777515	2.722296771	0	0.020601172	0.118797454	0	4.231132094	0	4.071070365	0	0	0	0	0	0.154437524	0	0	0	0	0	0	0	0	0	0	0	0	0	25.4242	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	3.167567022	0	1.286902979	0	0.366162276	0.935066157	1.205496232	0	6.96985717	0	0.174777515	2.722296771	0	0.020601172	0.118797454	0	4.231132094	0	4.071070365	0	0	0	0	0	0.154437524	0	0	0	0	0	0	0	0	0	0	0	0	0	25.4242
H8130_004_0	2011	8																															D	D	D		T	Coin	Coin	V	V		Coin		Coin	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	0	0	0	0	0	0	0											0	YES	725.2189816	13.10079095	738.8855247	0	177.0696688	0.620619907	1.255264815	222.291868	278.0930131	0	22.52400954	0	0.347922917	866.4217772	0	3975.446959	108.9494541	0	19.18668876	0	9.404142322	0	0	0	0	0	185.3250282	0	0	0											3400	$150 Days(1-7 for IP Medical; $150 /Days 1-7 for IP Surgical; PBP 1a	$150 /Days 1-7 for IP Psych; $150 /Days 1-7 for IP Substance Abuse; PBP 1b	$50 /Days 11-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$50/Run for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for ER - Facility; $15/Visit for PCP Urgent Care; PBP 4a, 4b"	"$50/Case for OP Hospital Services; $50/Case for Ambulatory Surgery Center Services; $100/Case for Hospital Facility PBP 9a, 9b"	No Cost-Sharing; PBP 8a	20% Coinsurance for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET; PBP 8b		20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$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; $50/Case for OP Fac - Other; $10/Visit for Prof - CORF; $15/Visit for OP Substance Abuse; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b, 14c"	"$15/Visit for Prof - Asst Surgeon (OP); $15/Visit for Speclst Office Visits; $15/Consult for Speclst Consults; $10/Exam for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); $8/Procedure for Prof Radiology (Office); PBP 8b	"No Cost-Sharing; PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; PBP 15						$10/Exam for Hearing Exam; PBP 18a														0	150	150	50	0	50	0.2	0.2	46.73064523	50	0	0.176338165	0	0.2	30.8697958	0	14.97143077	12	0	0.158552751	0	0.2	0	0	0	0	0	10	0	0	0											NO	148.2045569	148.2045569	49.40151896	0	49.40151896	0.197606076	0.197606076	46.17129713	49.40151896	0	0.174227464	0	0.197606076	30.50029605	0	14.79903012	11.85636455	0	0.156654935	0	0.197606076	0	0	0	0	0	10	0	0	0												8.9567	0.161799743	3.041838938	0	0.728959217	0.122638264	0.248047954	0.855291991	1.144851438	0	3.924301064	0	0.068751682	2.202176726	0	4.90272994	0.10764537	0	3.005689481	0	1.858315661	0	0	0	0	0	0.154437524	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4842	0	0.37726787	8.9567	0.161799743	3.041838938	0	0.728959217	0.122638264	0.248047954	0.855291991	1.144851438	0	3.924301064	0	0.068751682	2.202176726	0	4.90272994	0.10764537	0	3.005689481	0	1.858315661	0	0	0	0	0	0.154437524	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4842	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.9567	0.161799743	3.041838938	0	0.728959217	0.122638264	0.248047954	0.855291991	1.144851438	0	3.924301064	0	0.068751682	2.202176726	0	4.90272994	0.10764537	0	3.005689481	0	1.858315661	0	0	0	0	0	0.154437524	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4842
H8145_001_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1279.036959	79.40181	356.344177	1810.634567	2.287422	12.148086	3.518557	341.916734	34.870418	6.209387	11.354322	5.879287	0.30606	16.337099	2913.582336	2340.287863	83.277558	1.381073		1018.319217	19.846967	0							3.69	0.93	1148.51372	559.802883	248.262574	0	257.353498							$250/Day(Days 1-7):1a.IP Acute	$250/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							179.655	153.80975	46.371	0	0.2	0.2	0.2	50	0.243468	0.25	0.24281	0.25	0.2	0.229425	15	34.095191	35	0.25		0	0.2	0							0	0	0	0	22.083087	0	35						NO	123.526107	105.755585	22.308856	0	0.152855	0.152855	0.152855	38.2137	0.186076	0.191069	0.185574	0.191069	0.152855	0.175343	11.46411	26.058068	26.74959	0.191069		0	0.152855	0							0	0	0	0	16.877529	0	26.74959							13.1662	0.699765406	0.662469244	0	0.34964389	1.856895686	0.53782903	1.088825292	6.4885479	1.186421365	2.107066951	1.123349488	0.046782801	2.86459595	2.783469033	5.081948356	0.185636711	0.263880237	0	0	3.033708141	0	0	0	0	0	0	0	0	0	0	0	0.349171566	0	0.573675046	0	0	0	0	0	44.4499	0	16.24378181	13.1662	0.699765406	0.662469244	0	0.34964389	1.856895686	0.53782903	1.088825292	6.4885479	1.186421365	2.107066951	1.123349488	0.046782801	2.86459595	2.783469033	5.081948356	0.185636711	0.263880237	0	0	3.033708141	0	0	0	0	0	0	0	0	0	0	0	0.349171566	0	0.573675046	0	0	0	0	0	44.4499	YES	$250/Day(Days 1-7)	$250/Day(Days 1-7)	$0/Day(Days 1-14) $100(Days 15-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									20% Coins	$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit						3400	5.8293	0.3098	0.2943	0	1.8527	2.2654	0.6562	0.48	2.9192	0.5338	0.948	0.5054	0.021	1.2888	1.322	2.4137	0.0882	0.1187		0	1.4781	0									0.457	0	0.1658	0	0.2725						24.2198	0	8.248501386	18.9955	1.009582385	0.956763939	0	2.202293957	4.122305806	1.19397986	1.568814126	9.407711846	1.72018505	3.055023801	1.628737501	0.067830158	4.153432576	4.105483024	7.495629566	0.273805225	0.382598094	0	0	4.511814927	0	0	0	0	0	0	0	0	0	0.457034941	0	0.515011277	0	0.846143116	0	0	0	0	0	68.6696
H8145_003_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1228.24934	57.578802	553.330355	439.007519	38.860787	9.585023	2.894176	381.592078	31.943464	8.969854	11.261327	3.088151	0.21285	19.651991	3019.855524	2506.963843	140.996209	1.585997		1486.316349	17.977545	0							3.72	0.56	1626.607804	394.197591	225.810845	0	316.13847							$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.243802	0.25	0.245634	0.25	0.2	0.22903	15	34.277044	35	0.25		0	0.2	0							0	0	0	0	30.404068	0	35						NO	144.540147	126.410127	23.066222	0	130.977	0.174636	0.174636	43.659	0.212883	0.218295	0.214483	0.218295	0.174636	0.199985	13.0977	29.930029	30.5613	0.218295		0	0.174636	0							0	0	0	0	26.548224	0	30.5613							14.7943	0.606545306	1.063603401	0	0.424155775	1.673890077	0.50542732	1.388327378	6.800220447	1.958074279	2.415363199	0.674127923	0.037171273	3.93010342	3.296096808	6.25279171	0.35908562	0.346215215	0	0	3.139526549	0	0	0	0	0	0	0	0	0	0	0	0.499573075	0	0.805133552	0	0	0	0	0	50.9697	0	7.728115962	14.7943	0.606545306	1.063603401	0	0.424155775	1.673890077	0.50542732	1.388327378	6.800220447	1.958074279	2.415363199	0.674127923	0.037171273	3.93010342	3.296096808	6.25279171	0.35908562	0.346215215	0	0	3.139526549	0	0	0	0	0	0	0	0	0	0	0	0.499573075	0	0.805133552	0	0	0	0	0	50.9697	YES	$220/Day(Days 1-8)	$220/Day(Days 1-8)	$0/Day(Days 1-8) $50(Days 9-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$35/Visit						5000	6.4501	0.2644	0.4631	0	2.223	2.02	0.6099	0.6054	3.0261	0.8714	1.0748	0.3	0.0165	1.749	1.5485	2.9375	0.1687	0.1541		0	1.513	0									0	0	0.2347	0	0.3782						26.6086	0	4.06015411	21.2444	0.870992332	1.526690396	0	2.647199242	3.693843875	1.115347616	1.993695431	9.826359337	2.829429086	3.490212099	0.974118683	0.053712652	5.679119652	4.844572137	9.190294532	0.527780672	0.500283178	0	0	4.652569886	0	0	0	0	0	0	0	0	0	0	0	0.734267817	0	1.183377733	0	0	0	0	0	77.5783
H8145_004_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1004.527756	47.091012	452.543048	359.043741	31.782422	8.439338	2.548239	312.086334	28.125306	7.897699	9.915277	2.719028	0.187409	17.303015	2469.798757	2050.328612	115.314212	1.396425		1215.588707	15.828715	0							3.72	0.56	1330.326534	322.395794	184.680142	0	258.554886							$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.243802	0.25	0.245634	0.25	0.2	0.22903	15	34.277044	35	0.25		0	0.2	0							0	0	0	0	30.404068	0	35						NO	158.185408	138.34383	29.403742	0	141.72015	0.18896	0.18896	47.24005	0.230344	0.2362	0.232075	0.2362	0.18896	0.216388	14.172015	32.384985	33.068035	0.2362		0	0.18896	0							0	0	0	0	28.725794	0	33.068035							13.2418	0.542895913	1.108871586	0	0.375350801	1.594697308	0.481515241	1.228581169	6.478495485	1.865436504	2.30108791	0.642234414	0.035412805	3.74416481	2.916835419	5.533321779	0.317767867	0.329835585	0	0	2.990993986	0	0	0	0	0	0	0	0	0	0	0	0.44209031	0	0.712491835	0	0	0	0	0	46.8839	0	2.662694163	13.2418	0.542895913	1.108871586	0	0.375350801	1.594697308	0.481515241	1.228581169	6.478495485	1.865436504	2.30108791	0.642234414	0.035412805	3.74416481	2.916835419	5.533321779	0.317767867	0.329835585	0	0	2.990993986	0	0	0	0	0	0	0	0	0	0	0	0.44209031	0	0.712491835	0	0	0	0	0	46.8839	YES	$220/Day(Days 1-8)	$220/Day(Days 1-8)	$0/Day(Days 1-8) $50(Days 9-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$35/Visit						6700	5.7808	0.237	0.4838	0	1.9692	1.9263	0.5816	0.5362	2.8859	0.831	1.025	0.2861	0.0158	1.6679	1.3717	2.6021	0.1494	0.1469		0	1.4429	0									0	0	0.2079	0	0.3351						24.4828	0	1.414004289	19.0226	0.779901735	1.592678889	0	2.344576377	3.521018943	1.06316356	1.764830805	9.364361527	2.696400878	3.326113752	0.928319621	0.051187407	5.412107484	4.288512252	8.135432703	0.467202018	0.476761933	0	0	4.433902106	0	0	0	0	0	0	0	0	0	0	0	0.64998858	0	1.047549663	0	0	0	0	0	71.3666
H8145_005_0	2011	6	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	O							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1169.095875	65.846262	498.970955	487.571543	1.988548	11.624884	3.906063	412.684691	43.050018	16.564601	15.95548	4.230267	0.136832	25.348181	2994.603381	2936.614297	123.322991	3.329731		1373.070189	20.536833	0							3.7	0.6	1275.558658	296.783831	348.789335	0	485.764885							$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$20/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$20-$40/Visit:7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$40/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $40 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$40/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	45.243839	0	0.2	0.2	0.2	50	0.242436	0.25	0.247531	0.25	0.2	0.236436	20	38.427079	40	0.25		0	0.2	0							0	0	0	0	6.927162	0	40						NO	143.923704	123.218775	33.570838	0	0.176072	0.176072	0.176072	44.018	0.213431	0.22009	0.217916	0.22009	0.176072	0.208149	17.6072	33.829663	35.2144	0.22009		0	0.176072	0							0	0	0	0	6.098396	0	35.2144							14.0217	0.676124645	1.395906091	0	0.350127623	2.046816576	0.687748325	1.513796227	9.188208392	3.645703034	3.47695438	0.931039464	0.024092284	5.276198527	4.393881721	8.278722669	0.361895428	0.732840496	0	0	3.61596126	0	0	0	0	0	0	0	0	0	0	0	0.177254624	0	1.425493247	0	0	0	0	0	62.2205	0	8.56823638	14.0217	0.676124645	1.395906091	0	0.350127623	2.046816576	0.687748325	1.513796227	9.188208392	3.645703034	3.47695438	0.931039464	0.024092284	5.276198527	4.393881721	8.278722669	0.361895428	0.732840496	0	0	3.61596126	0	0	0	0	0	0	0	0	0	0	0	0.177254624	0	1.425493247	0	0	0	0	0	62.2205	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	$0/Day(Days 1-20) $137(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$20/Visit	$20-$40/Visit	$40/Visit	25% Coins		$0/Visit	20% Coins	$0/Service									20% Coins	$0/Visit	$0-$40/Visit	$0/Visit	$40/Visit						5000	2.1137	0.1019	0.2119	0	1.4129	1.3615	0.4575	0.2282	1.4136	0.5609	0.5349	0.1432	0.0037	0.8118	0.7823	1.4739	0.0644	0.1127		0	0.6604	0									0.3432	0	0.0316	0	0.2538						13.0779	0	1.66216919	16.1354	0.778045515	1.607824858	0	1.76303393	3.408310605	1.145222275	1.741997739	10.60178961	4.2065839	4.01187403	1.074277066	0.027798898	6.087991481	5.176135539	9.752604515	0.426324582	0.845585619	0	0	4.276359291	0	0	0	0	0	0	0	0	0	0.343151025	0	0.208811709	0	1.679277397	0	0	0	0	0	75.2984
H8145_006_0	2011	6	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	O							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	957.576308	43.865604	573.778013	168.849805	1.434627	6.425641	2.013609	287.636953	45.033123	15.047099	17.707717	4.778055	0.182418	23.098926	2455.658267	2854.201539	84.210671	2.843465		1682.10936	20.367815	0							6.04	0.6	481.175054	592.184717	285.850199	0	377.566383							$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	45.243839	0	0.2	0.2	0.2	50	0.244449	0.25	0.247976	0.25	0.2	0.235083	15	32.82716	35	0.25		0	0.2	0							0	0	0	0	19.83222	0	35						NO	152.309569	130.398245	38.647875	0	0.186136	0.186136	0.186136	46.534	0.227504	0.23267	0.230786	0.23267	0.186136	0.218787	13.9602	30.551581	32.5738	0.23267		0	0.186136	0							0	0	0	0	18.45745	0	32.5738							12.154	0.476666481	1.847941744	0	0.267035731	1.196043113	0.374805125	1.115408164	10.24521561	3.501008524	4.086693176	1.111710057	0.033954557	5.053744723	2.856790045	7.266697459	0.228588463	0.661589002	0	0	3.791183613	0	0	0	0	0	0	0	0	0	0	0	0.439672146	0	1.024897654	0	0	0	0	0	57.7336	0	4.315012405	12.154	0.476666481	1.847941744	0	0.267035731	1.196043113	0.374805125	1.115408164	10.24521561	3.501008524	4.086693176	1.111710057	0.033954557	5.053744723	2.856790045	7.266697459	0.228588463	0.661589002	0	0	3.791183613	0	0	0	0	0	0	0	0	0	0	0	0.439672146	0	1.024897654	0	0	0	0	0	57.7336	YES	$250/Day(Days 1-7)	$250/Day(Days 1-7)	$0/Day(Days 1-20) $137(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	$0/Service									20% Coins	$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit						6000	2.0142	0.079	0.274	0	1.0673	0.788	0.2469	0.1665	1.5612	0.5335	0.6227	0.1694	0.0052	0.7701	0.5038	1.2814	0.0403	0.1008		0	0.6858	0									0.1357	0	0.0775	0	0.1807						11.3043	0	0.8550558	14.1682	0.55566092	2.121955912	0	1.334384819	1.984056727	0.621745582	1.281954426	11.80642074	4.034506138	4.709440064	1.281116903	0.039128638	5.823894616	3.360554616	8.548102348	0.268897608	0.762404583	0	0	4.476998614	0	0	0	0	0	0	0	0	0	0.135719287	0	0.517203659	0	1.205627464	0	0	0	0	0	69.038
H8145_007_0	2011	6	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	O							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	981.706948	44.971004	588.237049	173.10477	1.38477	6.202332	1.943631	294.885319	43.468093	14.52417	17.092323	4.612004	0.176079	22.296172	2517.540128	2926.126573	86.332755	2.744646		1724.498017	19.659975	0							4.51	0.6	493.300523	607.107597	293.053539	0	387.080944							$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	45.243839	0	0.2	0.2	0.2	50	0.244449	0.25	0.247976	0.25	0.2	0.235083	15	32.82716	35	0.25		0	0.2	0							0	0	0	0	19.83222	0	35						NO	148.175007	126.858483	35.024477	0	0.181145	0.181145	0.181145	45.28615	0.221403	0.226431	0.224597	0.226431	0.181145	0.21292	13.585845	29.732314	31.700305	0.226431		0	0.181145	0							0	0	0	0	17.962498	0	31.700305							12.122	0.475412779	1.716891249	0	0.250844162	1.12352143	0.352079037	1.112851732	9.623966194	3.288722337	3.838884469	1.044300678	0.03189583	4.747300942	2.850242497	7.250042839	0.228064555	0.621472938	0	0	3.561306171	0	0	0	0	0	0	0	0	0	0	0	0.438664467	0	1.022548665	0	0	0	0	0	55.701	0	5.957872835	12.122	0.475412779	1.716891249	0	0.250844162	1.12352143	0.352079037	1.112851732	9.623966194	3.288722337	3.838884469	1.044300678	0.03189583	4.747300942	2.850242497	7.250042839	0.228064555	0.621472938	0	0	3.561306171	0	0	0	0	0	0	0	0	0	0	0	0.438664467	0	1.022548665	0	0	0	0	0	55.701	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	$0/Day(Days 1-20) $137(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	$0/Service									20% Coins	$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit						5000	1.8152	0.0712	0.2578	0	1.0059	0.7427	0.2327	0.1667	1.4714	0.5028	0.5869	0.1597	0.0049	0.7258	0.5043	1.2827	0.0403	0.095		0	0.6464	0									0.1279	0	0.0776	0	0.1809						10.6989	0	1.107607804	13.9373	0.546603713	1.97473069	0	1.256781153	1.866194994	0.584811207	1.279564584	11.09534419	3.79152389	4.425800257	1.203960194	0.036772347	5.473138475	3.354510967	8.532729478	0.268414022	0.716487782	0	0	4.207661451	0	0	0	0	0	0	0	0	0	0.127910491	0	0.516273531	0	1.203459256	0	0	0	0	0	66.3999
H8145_008_0	2011	3	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	O							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1483.767126	74.821891	754.197306	432.583058	2.488413	13.280652	3.285604	447.064023	49.111337	16.13539	18.945864	5.448151	0.384204	24.857278	3751.546124	3701.319071	115.994832	3.415221		1472.331868	24.964219	0							4.51	0.6	1393.459938	655.608847	338.079119	0	464.053481							$225/Day(Days 1-9):1a.IP Acute	$225/Day(Days 1-9):1b.IP Psych	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							176.2695	156.803175	57.868692	0	0.2	0.2	0.2	50	0.242176	0.25	0.245335	0.25	0.2	0.235121	15	33.334786	35	0.25		0	0.2	0							0	0	0	0	15.338091	0	35						NO	119.433339	106.243716	21.779635	0	0.150429	0.150429	0.150429	37.6073	0.182152	0.188037	0.184528	0.188037	0.150429	0.176845	11.28219	25.072626	26.32511	0.188037		0	0.150429	0							0	0	0	0	11.536483	0	26.32511							14.7676	0.662446311	1.36884517	0	0.374329479	1.9977952	0.494250124	1.401072569	8.945728257	3.034050329	3.496042392	1.02445397	0.057795424	4.395885328	3.527138014	7.733482398	0.254464726	0.642187911	0	0	3.7553425	0	0	0	0	0	0	0	0	0	0	0	0.325020334	0	1.018021578	0	0	0	0	0	59.276	0	23.60849454	14.7676	0.662446311	1.36884517	0	0.374329479	1.9977952	0.494250124	1.401072569	8.945728257	3.034050329	3.496042392	1.02445397	0.057795424	4.395885328	3.527138014	7.733482398	0.254464726	0.642187911	0	0	3.7553425	0	0	0	0	0	0	0	0	0	0	0	0.325020334	0	1.018021578	0	0	0	0	0	59.276	YES	$225/Day(Days 1-9)	$225/Day(Days 1-9)	$0/Day(Days 1-7) $84(Days 8-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	$0/Service									20% Coins	$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit						3400	2.2084	0.0991	0.2047	0	1.4981	1.3179	0.3261	0.2095	1.3649	0.4629	0.5334	0.1563	0.0088	0.6708	0.6228	1.3655	0.0449	0.098		0	0.6802	0									0.3009	0	0.0574	0	0.1797						12.4103	0	4.688799749	16.976	0.761510705	1.573582526	0	1.8724515	3.31573035	0.820304621	1.610540413	10.31065738	3.496981599	4.02946504	1.180763665	0.066613943	5.066657462	4.149907635	9.098945801	0.299394328	0.740172049	0	0	4.43554475	0	0	0	0	0	0	0	0	0	0.30090145	0	0.382407599	0	1.197768702	0	0	0	0	0	71.6863
H8145_009_0	2011	3	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	O							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1246.954299	57.678956	604.405337	355.941703	2.130326	11.449838	2.498626	374.589249	41.061181	14.507308	16.072386	4.516004	0.346882	21.341001	3165.192353	3085.499886	96.399475	3.082556		1237.148923	21.814293	0							4.51	0.6	1174.313834	408.323439	289.119883	0	360.380542							$225/Day(Days 1-9):1a.IP Acute	$225/Day(Days 1-9):1b.IP Psych	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							176.2695	156.803175	57.868692	0	0.2	0.2	0.2	50	0.241781	0.25	0.246114	0.25	0.2	0.235809	15	33.341004	35	0.25		0	0.2	0							0	0	0	0	15.386725	0	35						NO	133.011026	118.321951	26.961255	0	0.159248	0.159248	0.159248	39.812	0.192516	0.19906	0.195966	0.19906	0.159248	0.187761	11.9436	26.547441	27.8684	0.19906		0	0.159248	0							0	0	0	0	12.251526	0	27.8684							13.8216	0.568723884	1.357960535	0	0.339250155	1.823363802	0.397901193	1.242762265	7.904934321	2.88782473	3.149641195	0.898955756	0.055240265	4.007007689	3.150315949	6.826010515	0.223874927	0.613613597	0	0	3.473882532	0	0	0	0	0	0	0	0	0	0	0	0.29517998	0	0.836935758	0	0	0	0	0	53.8749	0	15.99351512	13.8216	0.568723884	1.357960535	0	0.339250155	1.823363802	0.397901193	1.242762265	7.904934321	2.88782473	3.149641195	0.898955756	0.055240265	4.007007689	3.150315949	6.826010515	0.223874927	0.613613597	0	0	3.473882532	0	0	0	0	0	0	0	0	0	0	0	0.29517998	0	0.836935758	0	0	0	0	0	53.8749	YES	$225/Day(Days 1-9)	$225/Day(Days 1-9)	$0/Day(Days 1-7) $84(Days 8-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	$0/Service									20% Coins	$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit						3400	2.0638	0.0849	0.2027	0	1.3563	1.2016	0.2622	0.1856	1.2048	0.4402	0.4801	0.137	0.0084	0.6108	0.5556	1.204	0.0395	0.0935		0	0.6285	0									0.2676	0	0.0521	0	0.1476						11.2268	0	3.210843259	15.8854	0.653644455	1.560674707	0	1.695529872	3.024943061	0.660114141	1.42836372	9.109774003	3.327976192	3.629698541	1.03597137	0.06365969	4.617782354	3.705958717	8.029960686	0.263361279	0.70713821	0	0	4.10243185	0	0	0	0	0	0	0	0	0	0.267628005	0	0.34724289	0	0.984551841	0	0	0	0	0	65.1018
H8145_010_0	2011	2																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	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	NO	258.668892	6.101931	33.466757	422.285809	1.683334	12.893965	6.629139	22.731631	64.717949	13.326896	30.094259	7.28807	0.147091	26.15229	37.139121	79.150553	0.570031	5.274807		5.851977	20.961218	0		3.19					4.63	0.58												Medicare FFS Cost Sharing:1a.IP Acute	Medicare FFS Cost Sharing:1b.IP Psych	Medicare FFS Cost Sharing:2.SNF	$0/Visit:6.Home Health	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		"DEN762: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d												0.085423	0.085423	0.16904	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0		0					0	0											NO	0.073245	0.073245	0.097001	0	0.199911	0.199911	0.199911	0.199911	0.199911	0.199911	0.199911	0.199911	0.199911	0.199911	0.199911	0.199911	0.199911	0.199911		0.199911	0.199911	0		0					0	0												18.9462	0.446935936	3.246308896	0	0.336516983	2.577645437	1.325237807	4.544303085	12.9378299	2.664193106	6.016173411	1.456965362	0.029405109	5.228130446	7.424518818	15.8230662	0.113955467	1.054491942	0	1.169874574	4.190378052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.5321	0	16.70712541	18.9462	0.446935936	3.246308896	0	0.336516983	2.577645437	1.325237807	4.544303085	12.9378299	2.664193106	6.016173411	1.456965362	0.029405109	5.228130446	7.424518818	15.8230662	0.113955467	1.054491942	0	1.169874574	4.190378052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.5321	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		0.5																	6700	2.91	0.0686	0.4973	0	1.3549	1.7107	0.8795	0.6975	2.0985	0.4089	0.9849	0.2236	0.0045	0.8026	1.3529	2.8832	0.0208	0.1805		0.2132	0.7636	0		0																	18.0557	0	3.145038926	21.8562	0.515580971	3.74359295	0	1.691402922	4.28832593	2.204745359	5.241837132	15.03633646	3.073137081	7.001094232	1.680604422	0.03391869	6.030683571	8.77739919	18.70631263	0.134720232	1.234970378	0	1.383046739	4.953939642	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.5878
H8145_011_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1029.814632	52.142892	712.150838	322.194861	32.96902	9.371029	2.588994	309.340437	36.807304	10.744302	12.937931	6.208424	0.219977	17.85904	2475.616071	2460.982049	81.71893	1.901396		1085.506297	21.342911	0							4.9	0.56	884.862829	908.19267	264.918547	0	213.754708							$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.241444	0.25	0.246097	0.25	0.2	0.230302	15	33.94477	35	0.25		0	0.2	0							0	0	0	0	34.198391	0	35						NO	155.074702	135.623307	27.119328	0	138.75735	0.18501	0.18501	46.25245	0.223348	0.231262	0.227652	0.231262	0.18501	0.213041	13.875735	31.400576	32.376715	0.231262		0	0.18501	0							0	0	0	0	31.635187	0	32.376715							13.3082	0.589315954	1.609421013	0	0.381224487	1.733734075	0.47898978	1.192312758	8.220837734	2.484748769	2.945345868	1.435772551	0.040697945	3.804707741	2.862582714	6.439687822	0.220482542	0.439720642	0	0	3.948651964	0	0	0	0	0	0	0	0	0	0	0	0.698395648	0	0.576722938	0	0	0	0	0	53.4115	0	4.366919841	13.3082	0.589315954	1.609421013	0	0.381224487	1.733734075	0.47898978	1.192312758	8.220837734	2.484748769	2.945345868	1.435772551	0.040697945	3.804707741	2.862582714	6.439687822	0.220482542	0.439720642	0	0	3.948651964	0	0	0	0	0	0	0	0	0	0	0	0.698395648	0	0.576722938	0	0	0	0	0	53.4115	YES	$220/Day(Days 1-8)	$220/Day(Days 1-8)	$0/Day(Days 1-8) $50(Days 9-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$35/Visit						6700	5.8015	0.2569	0.6999	0	1.997	2.0911	0.5777	0.5196	3.6564	1.1051	1.31	0.6386	0.0181	1.6923	1.3441	3.0237	0.1035	0.1956		0	1.902	0									0	0	0.3279	0	0.2708						27.5317	0	2.314069728	19.1097	0.846217918	2.309316558	0	2.37819821	3.824789703	1.056699005	1.711933876	11.87720747	3.589889692	4.255343591	2.074360719	0.058799255	5.497020335	4.206682054	9.463383872	0.324008091	0.6352953	0	0	5.850626075	0	0	0	0	0	0	0	0	0	0	0	1.026320888	0	0.847517881	0	0	0	0	0	80.9433
H8145_012_0	2011	3	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1506.623104	76.285268	1041.879646	471.372427	48.233813	15.058918	4.160423	452.566351	55.741424	16.2713	19.593362	9.402112	0.333139	27.046262	3621.836643	3600.427008	119.555136	2.879496		1588.100242	32.348032	0							4.9	0.56	1294.558012	1328.689667	387.576939	0	312.72403							$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.241444	0.25	0.246097	0.25	0.2	0.230302	15	33.94477	35	0.25		0	0.2	0							0	0	0	0	34.198391	0	35						NO	150.417105	131.549924	24.670748	0	134.6952	0.179594	0.179594	44.8984	0.216809	0.224492	0.220987	0.224492	0.179594	0.206804	13.46952	30.481317	31.42888	0.224492		0	0.179594	0							0	0	0	0	30.709061	0	31.42888							18.8852	0.836276767	2.141995849	0	0.541405257	2.704491319	0.747187008	1.693292088	12.0852424	3.65277668	4.329878288	2.110698927	0.059829766	5.593275167	4.065366758	9.145479747	0.313123669	0.646423816	0	0	5.809512459	0	0	0	0	0	0	0	0	0	0	0	0.991843655	0	0.819047168	0	0	0	0	0	77.1723	0	9.003431381	18.8852	0.836276767	2.141995849	0	0.541405257	2.704491319	0.747187008	1.693292088	12.0852424	3.65277668	4.329878288	2.110698927	0.059829766	5.593275167	4.065366758	9.145479747	0.313123669	0.646423816	0	0	5.809512459	0	0	0	0	0	0	0	0	0	0	0	0.991843655	0	0.819047168	0	0	0	0	0	77.1723	YES	$220/Day(Days 1-8)	$220/Day(Days 1-8)	$0/Day(Days 1-8) $50(Days 9-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$35/Visit						6700	2.8239	0.125	0.3205	0	2.1673	1.7845	0.493	0.2532	1.8444	0.5575	0.6608	0.3221	0.0091	0.8537	0.718	1.6151	0.0553	0.0987		0	1.0525	0									0	0	0.1752	0	0.1446						16.0744	0	1.847890722	21.709	0.9613234	2.462545094	0	2.708675917	4.489026553	1.240212298	1.946505472	13.92961401	4.210239721	4.99067629	2.432820287	0.068960429	6.4469322	4.783330893	10.76061729	0.368422877	0.745076934	0	0	6.862018714	0	0	0	0	0	0	0	0	0	0	0	1.167008207	0	0.963694999	0	0	0	0	0	93.2467
H8145_014_0	2011	5	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin		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	NO	214.398429	3.490992	51.399231	324.99409	1.596194	9.452444	2.611488	312.027987	48.5417	12.063406	21.040629	6.262364	0.221889	18.014196	21.066288	33.140194	0.644003	3.652136		1094.937176	21.528339	0		3.22	1.82				4.9	0.56	892.550517											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit:14b-j.Preventive Services	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											0.0811	0.0811	0.1879	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0		0	0				0	0	0										NO	0.070056	0.070056	0.079387	0	0.204897	0.204897	0.204897	43.9694	0.204897	0.204897	0.204897	0.204897	0.204897	0.204897	0.204897	0.204897	0.204897	0.204897		0	0.204897	0		0	0				0	0	0											15.0199	0.244564936	4.080430751	0	0.327055362	1.936777418	0.535086057	1.143306948	9.946048705	2.471755699	4.31116176	1.283139597	0.04546439	3.691054718	4.316419212	6.79032633	0.131954283	0.74831171	0	0	4.411092076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4338	0	13.7564569	15.0199	0.244564936	4.080430751	0	0.327055362	1.936777418	0.535086057	1.143306948	9.946048705	2.471755699	4.31116176	1.283139597	0.04546439	3.691054718	4.316419212	6.79032633	0.131954283	0.74831171	0	0	4.411092076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4338	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	$50/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		0.5							$0/Service										6700	6.6789	0.1088	1.7823	0	1.712	2.3343	0.6449	0.4979	4.5069	1.0986	1.9678	0.5703	0.0202	1.6406	2.0777	3.2685	0.0635	0.3457		0	2.1232	0		0							0										31.4422	0	6.843689827	21.6988	0.353316368	5.862725661	0	2.039080326	4.271097233	1.180003273	1.641222409	14.45292183	3.57034991	6.279001164	1.853442557	0.065671746	5.331688028	6.394090437	10.05879162	0.195469213	1.094011096	0	0	6.534333071	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.8761
H8145_020_0	2011	4	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1528.721958	86.051281	507.523212	752.608653	50.197351	13.041443	3.038277	385.044893	43.8513	9.599335	15.01379	8.711474	0.289937	18.884043	3196.740883	2920.741205	102.117193	1.96968		1281.062177	20.498732	0							4.85	0.56	1278.624822	980.041848	275.492505	0	231.704502							$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.24363	0.25	0.243536	0.25	0.2	0.232584	15	34.355662	35	0.25		0	0.2	0							0	0	0	0	42.960868	0	35						NO	148.654184	130.00813	25.382655	0	133.70655	0.178275	0.178275	44.56885	0.217166	0.222844	0.217082	0.222844	0.178275	0.20732	13.370655	30.623847	31.198195	0.222844		0	0.178275	0							0	0	0	0	38.29433	0	31.198195							18.9376	0.932280511	1.073523883	0	0.559309552	2.324963251	0.541648832	1.430084007	9.523011416	2.139154209	3.259223561	1.941299712	0.051688519	3.915039795	3.561876623	7.453694316	0.265489342	0.43893137	0	0	3.654411447	0	0	0	0	0	0	0	0	0	0	0	0.879150075	0	0.602396853	0	0	0	0	0	63.4848	0	7.79627758	18.9376	0.932280511	1.073523883	0	0.559309552	2.324963251	0.541648832	1.430084007	9.523011416	2.139154209	3.259223561	1.941299712	0.051688519	3.915039795	3.561876623	7.453694316	0.265489342	0.43893137	0	0	3.654411447	0	0	0	0	0	0	0	0	0	0	0	0.879150075	0	0.602396853	0	0	0	0	0	63.4848	YES	$220/Day(Days 1-8)	$220/Day(Days 1-8)	$0/Day(Days 1-8) $50(Days 9-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$35/Visit						6700	8.2813	0.4077	0.4699	0	2.9397	2.8136	0.6555	0.6253	4.2498	0.9546	1.4545	0.8663	0.0231	1.7472	1.6781	3.5116	0.1251	0.1959		0	1.7662	0									0	0	0.4142	0	0.2838						33.4632	0	4.060792911	27.2189	1.339963438	1.543398357	0	3.49899209	5.138530246	1.19712802	2.055421959	13.77278103	3.093781684	4.71369804	2.807631888	0.074755497	5.662287035	5.239941814	10.96526596	0.390566225	0.634810561	0	0	5.420576227	0	0	0	0	0	0	0	0	0	0	0	1.293333741	0	0.886197024	0	0	0	0	0	96.948
H8145_021_0	2011	3	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1451.197948	85.260674	497.994283	736.227155	48.690282	12.20364	2.475389	368.597325	40.492583	8.328109	13.826352	5.582928	0.327936	16.527723	3039.983068	2867.234288	91.026558	1.863184		1236.207986	19.800127	0							4.85	0.56	1253.562302	1002.4028	259.9837	0	208.104518							$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.243243	0.25	0.242947	0.25	0.2	0.233885	15	33.599579	35	0.25		0	0.2	0							0	0	0	0	42.624296	0	35						NO	151.145171	132.186667	26.233353	0	135.64755	0.180863	0.180863	45.21585	0.219969	0.226079	0.219701	0.226079	0.180863	0.211506	13.564755	30.38467	31.651095	0.226079		0	0.180863	0							0	0	0	0	38.545876	0	31.651095							18.2785	0.939193694	1.088671651	0	0.550393122	2.207186941	0.447706281	1.388870113	8.90711299	1.882810555	3.037663361	1.262182779	0.059311489	3.495712581	3.43638546	7.259997304	0.240090853	0.421226776	0	0	3.58111037	0	0	0	0	0	0	0	0	0	0	0	0.835108289	0	0.548894656	0	0	0	0	0	59.8681	0	6.327818288	18.2785	0.939193694	1.088671651	0	0.550393122	2.207186941	0.447706281	1.388870113	8.90711299	1.882810555	3.037663361	1.262182779	0.059311489	3.495712581	3.43638546	7.259997304	0.240090853	0.421226776	0	0	3.58111037	0	0	0	0	0	0	0	0	0	0	0	0.835108289	0	0.548894656	0	0	0	0	0	59.8681	YES	$220/Day(Days 1-8)	$220/Day(Days 1-8)	$0/Day(Days 1-8) $50(Days 9-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$35/Visit						6700	7.991	0.4106	0.4764	0	2.8924	2.6706	0.5417	0.6072	3.9743	0.8401	1.3554	0.5632	0.0265	1.5599	1.6187	3.4198	0.1131	0.188		0	1.7305	0									0	0	0.3934	0	0.2586						31.6312	0	3.309912899	26.2695	1.349792245	1.565032431	0	3.442778444	4.877826019	0.989419419	1.99609537	12.88143962	2.72291536	4.393057113	1.825365406	0.085775916	5.055587211	5.055087032	10.6798026	0.353185103	0.609177072	0	0	5.3115899	0	0	0	0	0	0	0	0	0	0	0	1.228484153	0	0.807450238	0	0	0	0	0	91.4993
H8145_024_0	2011	5	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin		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	NO	311.641208	6.248035	36.344507	760.377832	2.956237	13.17607	3.069641	389.019712	57.348763	12.327925	25.065254	8.801403	0.292931	19.078983	28.123049	44.898645	0.639945	3.830103		1294.286582	20.71034	0		3.23	1.82				4.85	0.56	1291.824066											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit:14b-j.Preventive Services	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											0.08	0.08	0.1863	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0		0	0				0	0	0										NO	0.065309	0.065309	0.083651	0	0.196049	0.196049	0.196049	42.0705	0.196049	0.196049	0.196049	0.196049	0.196049	0.196049	0.196049	0.196049	0.196049	0.196049		0	0.196049	0		0	0				0	0	0											20.353	0.408052918	3.040254355	0	0.579567308	2.583155347	0.601800048	1.363854483	11.24316764	2.416877368	4.914017981	1.725506257	0.05742883	3.740415538	5.513495633	8.802334454	0.125460577	0.750887863	0	0	4.060241447	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2795	0	17.53802623	20.353	0.408052918	3.040254355	0	0.579567308	2.583155347	0.601800048	1.363854483	11.24316764	2.416877368	4.914017981	1.725506257	0.05742883	3.740415538	5.513495633	8.802334454	0.125460577	0.750887863	0	0	4.060241447	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2795	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	$50/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		0.5							$0/Service										6700	9.0586	0.1816	1.3371	0	3.0403	3.12	0.7269	0.5952	5.1023	1.0765	2.2512	0.7685	0.0256	1.6661	2.6595	4.2459	0.0605	0.3478		0	1.9585	0		0							0										38.2221	0	9.035551425	29.4116	0.589667607	4.377375471	0	3.619847774	5.703138285	1.328665128	1.959083149	16.34542962	3.493360933	7.165219285	2.494051511	0.083007918	5.406526687	8.173004246	13.04825801	0.185978242	1.098668692	0	0	6.018753203	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.5016
H8145_025_0	2011	4	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin		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	NO	281.420131	5.958349	33.496329	736.227155	2.758579	12.20364	2.475389	368.597325	52.367656	10.727697	22.887765	5.582928	0.327936	16.527723	25.678903	41.177421	0.554472	3.446774		1236.207986	19.800127	0		3.23	1.82				4.85	0.56	1253.562302											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit:14b-j.Preventive Services	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											0.0804	0.0804	0.1787	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0		0	0				0	0	0										NO	0.06816	0.06816	0.090161	0	0.201068	0.201068	0.201068	43.1476	0.201068	0.201068	0.201068	0.201068	0.201068	0.201068	0.201068	0.201068	0.201068	0.201068		0	0.201068	0		0	0				0	0	0											19.1816	0.406121068	3.020062519	0	0.554661962	2.453761488	0.497721515	1.325340828	10.52945986	2.15699658	4.601997133	1.122548167	0.065937436	3.323196208	5.163205668	8.279461686	0.111486576	0.693035955	0	0	3.981171936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.4678	0	13.60752359	19.1816	0.406121068	3.020062519	0	0.554661962	2.453761488	0.497721515	1.325340828	10.52945986	2.15699658	4.601997133	1.122548167	0.065937436	3.323196208	5.163205668	8.279461686	0.111486576	0.693035955	0	0	3.981171936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.4678	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	$50/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		0.5							$0/Service										6700	8.5457	0.1809	1.3306	0	2.9111	2.9652	0.6015	0.5787	4.7805	0.9612	2.1093	0.5002	0.0294	1.481	2.4918	3.9957	0.0538	0.3206		0	1.9213	0		0							0										35.7585	0	7.020708237	27.7273	0.587054824	4.35063608	0	3.4657438	5.418936534	1.099178407	1.904048233	15.30994193	3.11820752	6.711338192	1.622783511	0.095320537	4.80420543	7.654987954	12.27516047	0.165290335	1.013644427	0	0	5.902500341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.2263
H8145_032_0	2011	7	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	Lab	Radiology	Radiology		Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	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	1559.837563	63.924162	1062.073732	790.649416	64.799512	12.802092	4.608161	431.232078	44.380065	13.923097	17.763609	6.025641	0.474764	23.156494	3687.14966	3268.115272	80.045697	2.544011		1273.794526	23.652722	0							4.53	0.56	1262.635845	848.837982	143.534883	154.48282	0	334.114906						$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	$0/Visit:14h.SMAM -- OP	"$0-$75/Visit:14h. $0 SMAM -- FSR,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.241564	0.25	0.244784	0.25	0.2	0.229821	15	34.010236	35	0.25		0	0.2	0							0	0	0	0	0	57.930272	0	35					NO	152.480345	133.354367	25.29308	0	136.89765	0.18253	0.18253	45.63255	0.220464	0.228163	0.223402	0.228163	0.18253	0.209746	13.689765	31.039476	31.942785	0.228163		0	0.18253	0							0	0	0	0	0	52.87012	0	31.942785						19.8204	0.710380513	2.238592989	0	0.739241743	2.336765853	0.841127627	1.639851613	9.78420665	3.176735581	3.968425778	1.374828327	0.086658673	4.856981991	4.20635103	8.453382129	0.213073541	0.580449182	0	0	4.317331347	0	0	0	0	0	0	0	0	0	0	0	0	0.680627103	0	0.889380051	0	0	0	0	70.9148	0	7.062094471	19.8204	0.710380513	2.238592989	0	0.739241743	2.336765853	0.841127627	1.639851613	9.78420665	3.176735581	3.968425778	1.374828327	0.086658673	4.856981991	4.20635103	8.453382129	0.213073541	0.580449182	0	0	4.317331347	0	0	0	0	0	0	0	0	0	0	0	0	0.680627103	0	0.889380051	0	0	0	0	70.9148	YES	30% Coins	30% Coins	$0/Day(Days 1-8) $50(Days 9-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-30% Coins	30% Coins	20%-30% Coins	30% Coins	20% Coins	20%-30% Coins	$15/Visit	$15-$35/Visit	$35/Visit	30% Coins		$0/Visit	20% Coins	0% Coins									$0/Service	$0/Visit	30% Coins	$0-$75/Visit	$0/Visit	$35/Visit					6700	7.863	0.1201	0.1702	0	2.4034	1.2523	0.4508	0.1992	1.4214	0.4725	0.5819	0.2045	0.0107	0.771	0.6033	1.2125	0.0306	0.0863		0	0.6353	0									0	0	0.0524	0.0976	0	0.1276					18.7666	0	11.07462651	27.6833	0.830512751	2.408749762	0	3.142688033	3.589080593	1.29190331	1.839018258	11.2056402	3.64924689	4.55030807	1.579321755	0.09740023	5.627995863	4.809696139	9.665907365	0.243636106	0.666785851	0	0	4.952602298	0	0	0	0	0	0	0	0	0	0	0	0.052374605	0.778254009	0	1.01694979	0	0	0	0	89.6814
H8145_033_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1135.763589	46.545061	773.327109	575.695084	47.182429	8.361442	3.009733	313.992754	30.757467	9.64936	12.311014	4.176051	0.329034	16.048293	2684.722071	2379.610812	58.283625	1.763119		927.487244	16.379236	0							4.53	0.56	919.36228	618.06389	216.995452	0	243.278886							$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.241564	0.25	0.244784	0.25	0.2	0.229821	15	34.010236	35	0.25		0	0.2	0							0	0	0	0	30.029195	0	35						NO	155.381492	135.891616	26.864903	0	139.46805	0.185957	0.185957	46.48935	0.224603	0.232447	0.227597	0.232447	0.185957	0.213685	13.946805	31.622276	32.542545	0.232447		0	0.185957	0							0	0	0	0	27.920755	0	32.542545							14.7064	0.527090296	1.731279814	0	0.548370114	1.55486867	0.559680919	1.216443253	6.908219361	2.242964784	2.801949853	0.970710527	0.061186176	3.42927949	3.1202746	6.270725822	0.158058124	0.409831722	0	0	3.045833589	0	0	0	0	0	0	0	0	0	0	0	0.504889738	0	0.659742841	0	0	0	0	0	51.4278	0	4.003692388	14.7064	0.527090296	1.731279814	0	0.548370114	1.55486867	0.559680919	1.216443253	6.908219361	2.242964784	2.801949853	0.970710527	0.061186176	3.42927949	3.1202746	6.270725822	0.158058124	0.409831722	0	0	3.045833589	0	0	0	0	0	0	0	0	0	0	0	0.504889738	0	0.659742841	0	0	0	0	0	51.4278	YES	$220/Day(Days 1-8)	$220/Day(Days 1-8)	$0/Day(Days 1-8) $50(Days 9-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$35/Visit						6700	6.4095	0.2297	0.7527	0	2.8715	1.8746	0.6748	0.5299	3.0714	0.9972	1.2458	0.4316	0.0272	1.5248	1.4646	2.9433	0.0742	0.1822		0	1.4666	0									0	0	0.237	0	0.3097						27.3183	0	2.190399006	21.1159	0.756813607	2.483936545	0	3.419857252	3.429516538	1.234467661	1.746387259	9.979666429	3.240201621	4.047713088	1.402294629	0.088390097	4.954071451	4.584836287	9.21401314	0.232245784	0.592045698	0	0	4.512410771	0	0	0	0	0	0	0	0	0	0	0	0.741869576	0	0.969406001	0	0	0	0	0	78.7461
H8145_040_0	2011	6	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	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	NO	266.857848	4.077121	61.373664	662.34942	2.430383	9.919014	3.570388	361.255331	48.424538	13.247668	22.44259	4.953967	0.390327	19.037777	26.195928	40.230889	0.666743	4.374703		1067.09377	19.430366	0							4.53	0.56	1057.745827											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"$0/Visit:14b-j, 17a.Preventive Services"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											0.081384	0.081384	0.174903	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0							0	0	0										NO	0.067711	0.067711	0.064087	0	0.199705	0.199705	0.199705	42.85525	0.199705	0.199705	0.199705	0.199705	0.199705	0.199705	0.199705	0.199705	0.199705	0.199705		0	0.199705	0							0	0	0											18.0692	0.27606594	3.933254005	0	0.485359637	1.980876691	0.713024336	1.290140627	9.670622361	2.645625538	4.481897436	0.98933198	0.077950254	3.801939256	5.231457801	8.034309688	0.133151911	0.873650063	0	0	3.880341242	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.5682	0	17.88952945	18.0692	0.27606594	3.933254005	0	0.485359637	1.980876691	0.713024336	1.290140627	9.670622361	2.645625538	4.481897436	0.98933198	0.077950254	3.801939256	5.231457801	8.034309688	0.133151911	0.873650063	0	0	3.880341242	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.5682	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	$50/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible									$0/Service										6700	8.0451	0.1229	1.7238	0	2.5459	2.3924	0.8611	0.563	4.3951	1.1783	2.0438	0.4406	0.0347	1.6934	2.5233	3.8752	0.0642	0.406		0	1.8716	0									0										34.7806	0	8.918769212	26.1143	0.398981548	5.65707873	0	3.031280534	4.373258744	1.574171382	1.853158549	14.06576911	3.823916822	6.525671778	1.429954093	0.112667083	5.495366175	7.754755454	11.9095115	0.197375212	1.279602236	0	0	5.751952699	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.3488
H8145_041_0	2011	6	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	Lab	Radiology	Radiology		Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	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	1387.102593	65.025645	624.894266	495.785708	43.886772	11.744143	3.546118	430.944552	36.88483	10.35741	13.003354	3.56586	0.245776	22.692243	3410.422699	2831.197164	159.23168	1.831336		1678.5462	20.775249	0							3.72	0.56	1836.98198	445.180374	112.688032	142.327623	0	357.025628						$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$0/Visit:14h.SMAM -- OP	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.243802	0.25	0.245634	0.25	0.2	0.22903	15	34.277044	35	0.25		0	0.2	0							0	0	0	0	68.805117	0	0	35					NO	143.925406	125.872494	22.878864	0	130.4889	0.173985	0.173985	43.4963	0.21209	0.217482	0.213683	0.217482	0.173985	0.199239	13.04889	29.818491	30.44741	0.217482		0	0.173985	0							0	0	0	0	59.855361	0	0	30.44741						16.6366	0.682078343	1.191405911	0	0.47722805	2.04330472	0.61697134	1.562041126	7.822903595	2.252550242	2.778595693	0.775510365	0.042761337	4.521179803	3.708519221	7.035168929	0.40401602	0.398282616	0	0	3.614581697	0	0	0	0	0	0	0	0	0	0	0	0.562081903	0	0	0.905875473	0	0	0	0	58.0317	0	9.061056686	16.6366	0.682078343	1.191405911	0	0.47722805	2.04330472	0.61697134	1.562041126	7.822903595	2.252550242	2.778595693	0.775510365	0.042761337	4.521179803	3.708519221	7.035168929	0.40401602	0.398282616	0	0	3.614581697	0	0	0	0	0	0	0	0	0	0	0	0.562081903	0	0	0.905875473	0	0	0	0	58.0317	YES	$1100/Admit	$1100/Admit	$0/Day(Days 1-8) $50(Days 9-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									$0/Service	$0/Visit	$0-$75/Visit	25% Coins	$0/Visit	$35/Visit					4500	3.0152	0.1016	0.1669	0	1.8753	1.3235	0.3996	0.2293	1.172	0.3375	0.4163	0.1162	0.0064	0.7329	0.6429	1.2197	0.07	0.0597		0	0.6428	0									0	0	0.0974	0.0504	0	0.157					12.8328	0	2.32522359	19.6518	0.783648296	1.358258745	0	2.352564666	3.366843827	1.016611083	1.791344186	8.994890982	2.590015374	3.194871736	0.891693428	0.049167777	5.254102571	4.351452861	8.254832778	0.474058936	0.457951465	0	0	4.257427717	0	0	0	0	0	0	0	0	0	0	0	0.659528168	0.050441036	0	1.062924089	0	0	0	0	70.8645
H8145_042_0	2011	3	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin		V					O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0					0	0	0	0	0	0	0						0	NO	1233.162338	57.809117	555.543676	440.763549	39.01623	9.623363	2.905751	383.118447	32.071237	9.005734	11.306372	3.100503	0.213701	19.730599	3031.934946	2516.991699	141.560193	1.592342		1492.261615	18.049454	0		3.4					3.72	0.56	1633.114235	395.774382	226.714089	0	317.403024							$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist"							165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.243802	0.25	0.245634	0.25	0.2	0.22903	15	34.277044	35	0.25		0	0.2	0		0					0	0	0	0	30.404068	0	35						NO	144.35979	126.252392	22.999545	0	130.85655	0.174475	0.174475	43.61885	0.212687	0.218094	0.214285	0.218094	0.174475	0.199801	13.085655	29.902504	30.533195	0.218094		0	0.174475	0		0					0	0	0	0	26.52381	0	30.533195							14.8349	0.608211608	1.064770981	0	0.425460771	1.679036259	0.506980906	1.392598839	6.821135184	1.964096551	2.422785924	0.676201101	0.037285482	3.942193411	3.30623789	6.272029529	0.360190415	0.347280236	0	0	3.149178487	0	0	0	0	0	0	0	0	0	0	0	0.501110118	0	0.807610702	0	0	0	0	0	51.1193	0	7.813268073	14.8349	0.608211608	1.064770981	0	0.425460771	1.679036259	0.506980906	1.392598839	6.821135184	1.964096551	2.422785924	0.676201101	0.037285482	3.942193411	3.30623789	6.272029529	0.360190415	0.347280236	0	0	3.149178487	0	0	0	0	0	0	0	0	0	0	0	0.501110118	0	0.807610702	0	0	0	0	0	51.1193	YES	$220/Day(Days 1-8)	$220/Day(Days 1-8)	$0/Day(Days 1-8) $50(Days 9-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins		0.5							20% Coins	$0/Visit	$0-$75/Visit	$0/Visit	$35/Visit						5000	6.4288	0.2636	0.4588	0	2.2175	2.015	0.6084	0.6039	3.0186	0.8692	1.0722	0.2992	0.0165	1.7447	1.5446	2.9302	0.1683	0.1537		0	1.5093	0		0							0.705	0	0.2341	0	0.3773						27.239	0	4.366476631	21.2637	0.87178334	1.523551302	0	2.643001612	3.693990284	1.11539152	1.996468448	9.839783625	2.83329438	3.494974422	0.975449454	0.053785827	5.686879784	4.850880333	9.202261256	0.528467903	0.50096686	0	0	4.658476508	0	0	0	0	0	0	0	0	0	0.705035126	0	0.735223928	0	1.184918628	0	0	0	0	0	78.3583
H8145_044_0	2011	4	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	Lab	Radiology	Radiology		Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin		V					O	O	O	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	1392.651003	65.285747	627.393843	497.76885	44.062319	11.791119	3.560303	432.66833	37.032369	10.398841	13.055367	3.580123	0.24676	22.78301	3424.064389	2842.521953	159.868607	1.838662		1685.260384	20.85835	0		3.4					3.72	0.56	1844.329908	446.961096	113.138784	142.896934	0	358.45373						$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$0/Visit:14h.SMAM -- OP	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist"						165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.243802	0.25	0.245634	0.25	0.2	0.22903	15	34.277044	35	0.25		0	0.2	0		0					0	0	0	0	68.805118	0	0	35					NO	148.296953	129.695708	24.537689	0	133.45575	0.177941	0.177941	44.48525	0.216912	0.222426	0.218542	0.222426	0.177941	0.203769	13.345575	30.496457	31.139675	0.222426		0	0.177941	0		0					0	0	0	0	61.216257	0	0	31.139675						17.2105	0.705606765	1.282899583	0	0.490030819	2.098123506	0.633523876	1.603946569	8.032765225	2.312972608	2.853146015	0.796312438	0.043908721	4.642471165	3.808009009	7.223904043	0.414854705	0.408966234	0	0	3.711555657	0	0	0	0	0	0	0	0	0	0	0	0.577161073	0	0	0.930177721	0	0	0	0	59.7808	0	7.580262967	17.2105	0.705606765	1.282899583	0	0.490030819	2.098123506	0.633523876	1.603946569	8.032765225	2.312972608	2.853146015	0.796312438	0.043908721	4.642471165	3.808009009	7.223904043	0.414854705	0.408966234	0	0	3.711555657	0	0	0	0	0	0	0	0	0	0	0	0.577161073	0	0	0.930177721	0	0	0	0	59.7808	YES	$1100/Admit	$1100/Admit	$0/Day(Days 1-8) $50(Days 9-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins		0.5							20% Coins	$0/Visit	$0-$75/Visit	25% Coins	$0/Visit	$35/Visit					5000	3.1264	0.1053	0.1791	0	1.9192	1.3545	0.409	0.2347	1.1994	0.3454	0.426	0.1189	0.0066	0.7501	0.658	1.2482	0.0717	0.0611		0	0.6579	0		0							0.4739	0	0.0997	0.0516	0	0.1607					13.6572	0	2.1055169	20.3368	0.810920781	1.462042973	0	2.409215784	3.452609138	1.042507936	1.838611098	9.232155465	2.658328015	3.279155477	0.915212017	0.050464967	5.392531283	4.46597546	8.472085575	0.486535336	0.470029996	0	0	4.369432625	0	0	0	0	0	0	0	0	0	0.473936385	0	0.676885786	0.051620353	0	1.090898383	0	0	0	0	73.438
H8145_049_0	2011	5	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	Lab	Radiology	Radiology		Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	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	1365.867789	100.488315	513.582315	396.005732	63.240248	13.619986	2.654247	466.294501	45.363729	11.926822	16.411647	5.057802	0.187469	26.187689	3078.970083	2388.979102	150.310632	1.912604		1044.957176	12.08962	0							3	0.56	1556.465061	440.248936	122.617195	129.37979	0	348.403792						$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$0/Visit:14h.SMAM -- OP	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						161.6895	138.428775	32.5726	0	150	0.2	0.2	50	0.246396	0.25	0.24774	0.25	0.2	0.233272	15	34.295047	35	0.25		0	0.2	0							0	0	0	0	45.670446	0	0	35					NO	144.556719	123.760724	25.126015	0	133.1799	0.177573	0.177573	44.3933	0.218766	0.221967	0.21996	0.221967	0.177573	0.207114	13.31799	30.449406	31.07531	0.221967		0	0.177573	0							0	0	0	0	40.549237	0	0	31.07531						16.4538	1.036375551	1.075356413	0	0.701860825	2.418541774	0.471322603	1.725029306	9.924041538	2.647360899	3.609905874	1.122665137	0.033289433	5.42383702	3.417141065	6.061916217	0.38924579	0.424534972	0	0	2.146790092	0	0	0	0	0	0	0	0	0	0	0	0.414336142	0	0	0.902229653	0	0	0	0	60.3996	0	7.67510328	16.4538	1.036375551	1.075356413	0	0.701860825	2.418541774	0.471322603	1.725029306	9.924041538	2.647360899	3.609905874	1.122665137	0.033289433	5.42383702	3.417141065	6.061916217	0.38924579	0.424534972	0	0	2.146790092	0	0	0	0	0	0	0	0	0	0	0	0.414336142	0	0	0.902229653	0	0	0	0	60.3996	YES	$1100/Admit	$1100/Admit	$0/Day(Days 1-8) $50(Days 9-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									$0/Service	$0/Visit	$0-$75/Visit	25% Coins	$0/Visit	$35/Visit					5000	2.9355	0.1136	0.1517	0	2.7531	1.5638	0.3048	0.2528	1.4841	0.3959	0.5399	0.1679	0.005	0.8626	0.5914	1.0491	0.0674	0.0635		0	0.3811	0									0	0	0.0717	0.0405	0	0.1561					13.9515	0	2.120303061	19.3893	1.150024587	1.227056917	0	3.455006017	3.982344941	0.776074732	1.977806975	11.40816371	3.04326742	4.149759358	1.290556925	0.038267887	6.286455115	4.008503001	7.110976363	0.4566077	0.488023149	0	0	2.527911489	0	0	0	0	0	0	0	0	0	0	0	0.486040127	0.04054909	0	1.058367274	0	0	0	0	74.3511
H8145_050_0	2011	4	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin		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	NO	264.980962	6.645668	31.63365	397.177909	2.966074	13.660301	2.662104	467.674733	58.052424	14.146458	23.830917	5.072773	0.188024	26.265206	28.579559	31.577419	0.998907	4.516053		1048.050249	12.125404	0		2.88	1.82				3	0.56	1561.072197											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit:14b-j.Preventive Services	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											0.0807	0.0807	0.1853	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0		0	0				0	0	0										NO	0.066927	0.066927	0.088214	0	0.197491	0.197491	0.197491	42.38005	0.197491	0.197491	0.197491	0.197491	0.197491	0.197491	0.197491	0.197491	0.197491	0.197491		0	0.197491	0		0	0				0	0	0											17.7344	0.444774622	2.790530801	0	0.58577292	2.697786505	0.525741581	1.651673214	11.46483127	2.793798137	4.706391629	1.001827013	0.037133048	5.187141798	5.644205686	6.236256056	0.197275142	0.891879823	0	0	2.394658161	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9861	0	15.08596314	17.7344	0.444774622	2.790530801	0	0.58577292	2.697786505	0.525741581	1.651673214	11.46483127	2.793798137	4.706391629	1.001827013	0.037133048	5.187141798	5.644205686	6.236256056	0.197275142	0.891879823	0	0	2.394658161	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9861	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	$50/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		0.5							$0/Service										5000	2.6995	0.0677	0.4198	0	2.3402	1.7766	0.3462	0.2465	1.8169	0.4255	0.7509	0.1526	0.0057	0.7901	1.0205	1.1276	0.0357	0.1505		0	0.433	0		0							0										14.6054	0	3.12557027	20.4339	0.512477741	3.210360736	0	2.925989643	4.474364635	0.871959229	1.898172137	13.28170415	3.219322194	5.457270534	1.154415658	0.04278876	5.977242426	6.664733445	7.363832466	0.232944416	1.042343706	0	0	2.827636247	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.5914
H8145_051_0	2011	6	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin		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	NO	211.17536	5.296236	25.210292	317.742328	2.372858	10.262216	1.999888	374.139786	46.26877	11.276934	18.993075	4.043791	0.149884	20.937252	22.764005	25.151842	0.795644	3.59833		838.440199	9.65805	0		2.88	1.82				3	0.56	1248.857758											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"$0/Visit:14b-j, 17a.Preventive Services"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"DEN767: Dental 16a, 16b"	"VIS742: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											0.0807	0.0807	0.1853	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0		0	0				0	0	0										NO	0.072758	0.072758	0.116891	0	0.210428	0.210428	0.210428	45.15625	0.210428	0.210428	0.210428	0.210428	0.210428	0.210428	0.210428	0.210428	0.210428	0.210428		0	0.210428	0		0	0				0	0	0											15.3647	0.385343539	2.946856242	0	0.499315763	2.159457588	0.420832432	1.407895809	9.736244734	2.372982668	3.996674786	0.850926853	0.03153979	4.405784064	4.790184044	5.292651808	0.167425776	0.757189385	0	0	2.032324145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6183	0	7.618779726	15.3647	0.385343539	2.946856242	0	0.499315763	2.159457588	0.420832432	1.407895809	9.736244734	2.372982668	3.996674786	0.850926853	0.03153979	4.405784064	4.790184044	5.292651808	0.167425776	0.757189385	0	0	2.032324145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6183	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	$50/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		0.5							$0/Service										6700	6.8262	0.1712	1.2911	0	2.6103	2.5993	0.5065	0.6123	4.3991	1.0533	1.8113	0.3777	0.014	1.9557	2.3027	2.5442	0.0805	0.3521		0	0.9769	0		0							0										30.4846	0	4.081382608	22.1909	0.556544382	4.237966196	0	3.10960036	4.758714147	0.927372695	2.020228892	14.13537624	3.426277996	5.808022406	1.228627584	0.045539455	6.361491894	7.092841245	7.83684654	0.247907973	1.109320557	0	0	3.009269098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1029
H8145_052_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1096.983304	64.548255	474.572237	287.321746	32.359345	6.419002	2.261369	244.957239	30.567313	12.75153	13.484572	2.022501	0.159178	19.326464	2973.448695	2295.13077	88.662025	1.852813		1052.668932	14.839537	0							4.1	0.56	771.776428	395.426581	227.52228	0	424.845429							$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.237931	0.25	0.245496	0.25	0.2	0.226751	15	33.63343	35	0.25		0	0.2	0							0	0	0	0	30.2314	0	35						NO	151.637793	132.617498	26.129512	0	135.85875	0.181145	0.181145	45.28625	0.2155	0.226431	0.222352	0.226431	0.181145	0.205374	13.585875	30.462638	31.700375	0.226431		0	0.181145	0							0	0	0	0	27.381334	0	31.700375							13.862	0.71335234	1.033361747	0	0.366358347	1.162770117	0.409635688	0.924432897	6.587255952	2.887341689	2.998321553	0.457956924	0.028834299	3.969153218	3.366408524	5.826311484	0.234218287	0.4195343	0	0	2.68810793	0	0	0	0	0	0	0	0	0	0	0	0.519155295	0	1.122313285	0	0	0	0	0	49.5768	0	5.163470866	13.862	0.71335234	1.033361747	0	0.366358347	1.162770117	0.409635688	0.924432897	6.587255952	2.887341689	2.998321553	0.457956924	0.028834299	3.969153218	3.366408524	5.826311484	0.234218287	0.4195343	0	0	2.68810793	0	0	0	0	0	0	0	0	0	0	0	0.519155295	0	1.122313285	0	0	0	0	0	49.5768	YES	$220/Day(Days 1-8)	$220/Day(Days 1-8)	$0/Day(Days 1-8) $50(Days 9-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$35/Visit						5500	6.038	0.3107	0.4489	0	1.9177	1.4014	0.4937	0.4026	2.9276	1.2833	1.3326	0.2035	0.0128	1.7642	1.5795	2.7337	0.1099	0.1865		0	1.2938	0									0	0	0.2436	0	0.5266						25.2105	0	2.707969588	19.9	1.024074078	1.482216984	0	2.284042151	2.564153136	0.903333084	1.327012095	9.514899377	4.170596204	4.330896068	0.66149198	0.041649548	5.733327761	4.945907969	8.559983215	0.344112155	0.605992607	0	0	3.981952734	0	0	0	0	0	0	0	0	0	0	0	0.762739965	0	1.648896197	0	0	0	0	0	74.7873
H8145_053_0	2011	6	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	Lab	Radiology	Radiology		Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	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	1767.507864	86.41111858	881.3320098	504.3847245	54.34214899	11.72596705	3.785264932	323.5688457	42.80217367	12.88465907	20.27512406	3.18671076	0.041533832	21.48171448	3500.384144	3336.848452	125.0515224	1.656088581		1292.347348	19.31534235	0							4.1	0.56	1079.698992	897.9123264	108.396052	139.5769363	0	708.2300139						$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$0/Visit:14h.SMAM -- OP	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.238834	0.25	0.239259	0.25	0.2	0.225253	15	33.616508	35	0.25		0	0.2	0							0	0	0	0	54.688789	0	0	35					NO	152.582056	133.44332	25.841472	0	137.23455	0.182979	0.182979	45.74485	0.218509	0.228724	0.218897	0.228724	0.182979	0.206083	13.723455	30.755642	32.021395	0.228724		0	0.182979	0							0	0	0	0	50.034609	0	0	32.021395						22.4742	0.960915546	1.897909705	0	0.621468364	2.145605725	0.692623992	1.233467359	9.352660165	2.94703076	4.438163831	0.728877232	0.007599819	4.427016164	4.00311369	8.552243034	0.333693683	0.378787205	0	0	3.534302028	0	0	0	0	0	0	0	0	0	0	0	0.45196284	0	0	1.889876085	0	0	0	0	71.0715	0	6.797808277	22.4742	0.960915546	1.897909705	0	0.621468364	2.145605725	0.692623992	1.233467359	9.352660165	2.94703076	4.438163831	0.728877232	0.007599819	4.427016164	4.00311369	8.552243034	0.333693683	0.378787205	0	0	3.534302028	0	0	0	0	0	0	0	0	0	0	0	0.45196284	0	0	1.889876085	0	0	0	0	71.0715	YES	$1100/Admit	$1100/Admit	$0/Day(Days 1-8) $50(Days 9-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									$0/Service	$0/Visit	$0-$75/Visit	25% Coins	$0/Visit	$35/Visit					6700	4.0019	0.1092	0.2723	0	2.4601	1.4	0.4519	0.1824	1.4115	0.4448	0.6698	0.11	0.0011	0.7315	0.6991	1.4936	0.0583	0.0572		0	0.6332	0									0	0	0.0789	0.0667	0	0.3301					15.6637	0	1.697190045	26.4761	1.070086579	2.170244514	0	3.081597229	3.54564292	1.144570638	1.415869782	10.76414288	3.391791268	5.107962915	0.838878152	0.008746806	5.158503863	4.702229458	10.0458324	0.391970947	0.435953135	0	0	4.167498742	0	0	0	0	0	0	0	0	0	0	0	0.530894983	0.066722117	0	2.219929708	0	0	0	0	86.7351
H8145_054_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1479.963984	72.46470882	737.2163336	422.0677805	45.48766172	9.0040803	2.908838376	271.3792788	34.94250681	10.5604516	16.54033945	2.598561096	0.035430822	17.58366191	2939.090317	2796.282761	104.8203121	1.35986952		1084.656989	15.76823443	0							4.1	0.56	905.0858815	750.1881807	208.3819545	0	592.8630195							$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.238825	0.25	0.239318	0.25	0.2	0.225273	15	33.61665	35	0.25		0	0.2	0							0	0	0	0	23.976385	0	35						NO	151.487468	132.486029	25.254677	0	136.4481	0.181931	0.181931	45.4827	0.217248	0.227414	0.217697	0.227414	0.181931	0.20492	13.64481	30.57952	31.83789	0.227414		0	0.181931	0							0	0	0	0	21.810214	0	31.83789							18.683	0.800046793	1.551513365	0	0.517225418	1.638121333	0.529207875	1.028588527	7.591189719	2.401594539	3.600782277	0.590949173	0.006445965	3.603243998	3.341944079	7.125748719	0.278104797	0.309253367	0	0	2.868730657	0	0	0	0	0	0	0	0	0	0	0	0.378737919	0	1.572958967	0	0	0	0	0	58.4174	0	6.018852753	18.683	0.800046793	1.551513365	0	0.517225418	1.638121333	0.529207875	1.028588527	7.591189719	2.401594539	3.600782277	0.590949173	0.006445965	3.603243998	3.341944079	7.125748719	0.278104797	0.309253367	0	0	2.868730657	0	0	0	0	0	0	0	0	0	0	0	0.378737919	0	1.572958967	0	0	0	0	0	58.4174	YES	$220/Day(Days 1-8)	$220/Day(Days 1-8)	$0/Day(Days 1-8) $50(Days 9-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									$0/Service	$0/Visit	$0-$75/Visit	$0/Visit	$35/Visit						6700	8.1447	0.3488	0.6751	0	2.7101	1.9763	0.6384	0.4484	3.3772	1.0684	1.6019	0.2629	0.0029	1.6032	1.5696	3.3467	0.1306	0.1376		0	1.3822	0									0	0	0.1779	0	0.7388						30.3417	0	3.174712799	26.8277	1.148822712	2.226573365	0	3.227342354	3.614388966	1.167656753	1.476977463	10.96842393	3.470034238	5.2027298	0.853855234	0.009313709	5.206433914	4.911544517	10.47247684	0.408721408	0.446836528	0	0	4.250902739	0	0	0	0	0	0	0	0	0	0	0	0.556618579	0	2.31172569	0	0	0	0	0	88.7591
H8145_055_0	2011	3	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin		V					O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0					0	0	0	0	0	0	0						0	NO	1103.169193	64.912243	477.24835	288.941954	32.54182	6.455199	2.27412	246.338553	30.739683	12.823435	13.560613	2.033906	0.160077	19.435447	2990.215973	2308.073012	89.16199	1.86326		1058.604932	14.923218	0		3.43					4.1	0.56	776.128476	397.656392	228.805278	0	427.241132							$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist"							165.92202	145.11002	32.5726	0	150	0.2	0.2	50	0.237931	0.25	0.245496	0.25	0.2	0.226751	15	33.63343	35	0.25		0	0.2	0		0					0	0	0	0	30.2314	0	35						NO	148.056864	129.485734	24.620749	0	133.1991	0.177599	0.177599	44.3997	0.211281	0.221999	0.217999	0.221999	0.177599	0.201353	13.31991	29.866284	31.07979	0.221999		0	0.177599	0		0					0	0	0	0	26.845302	0	31.07979							13.611	0.700434119	0.97918432	0	0.361211761	1.146436887	0.403881438	0.911446488	6.494710964	2.846789747	2.956200073	0.451525098	0.028429515	3.91338556	3.319117303	5.744463672	0.230927994	0.413641857	0	0	2.650348594	0	0	0	0	0	0	0	0	0	0	0	0.511862232	0	1.106547055	0	0	0	0	0	48.7815	0	6.26745978	13.611	0.700434119	0.97918432	0	0.361211761	1.146436887	0.403881438	0.911446488	6.494710964	2.846789747	2.956200073	0.451525098	0.028429515	3.91338556	3.319117303	5.744463672	0.230927994	0.413641857	0	0	2.650348594	0	0	0	0	0	0	0	0	0	0	0	0.511862232	0	1.106547055	0	0	0	0	0	48.7815	YES	$220/Day(Days 1-8)	$220/Day(Days 1-8)	$0/Day(Days 1-8) $50(Days 9-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins		0.5							20% Coins	$0/Visit	$0-$75/Visit	$0/Visit	$35/Visit						5000	5.9062	0.3039	0.4229	0	1.8845	1.3772	0.4852	0.3956	2.877	1.2611	1.3095	0.2	0.0126	1.7337	1.5522	2.6864	0.108	0.1832		0	1.2715	0		0							0.3541	0	0.2394	0	0.5175						25.0818	0	3.395358139	19.5172	1.004375107	1.402040767	0	2.245751076	2.523598724	0.889045904	1.307067668	9.371754057	4.107865028	4.265742772	0.651542366	0.04102325	5.647069121	4.871317307	8.430887706	0.338922501	0.596877642	0	0	3.921831143	0	0	0	0	0	0	0	0	0	0.354142397	0	0.751236879	0	1.624028718	0	0	0	0	0	73.8633
H8145_061_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1375.718974	97.814008	516.250021	422.017405	35.090071	12.88577	3.935909	357.553757	45.079141	9.665932	17.758055	7.283438	0.146998	26.135665	3433.446053	4237.615664	68.255537	2.030956		1409.509724	20.947894	0							4.63	0.58	1276.663233	712.210301	362.441639	0	389.31426							$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$30/Visit:7b. $25 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"20% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$75/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	34.44565	0	150	0.2	0.2	50	0.232468	0.25	0.231555	0.25	0.2	0.223921	10	29.86442	30	0.25		0	0.2	0							0	0	0	0	40.179917	0	30						NO	150.478273	128.830401	29.385687	0	137.9481	0.183931	0.183931	45.9827	0.21379	0.229914	0.21295	0.229914	0.183931	0.20593	9.19654	27.464933	27.58962	0.229914		0	0.183931	0							0	0	0	0	36.951621	0	27.58962							17.2513	1.050118156	1.264196794	0	0.403384052	2.370092562	0.723935678	1.370107262	9.637469554	2.22233309	3.781577812	1.674564364	0.027037489	5.382117493	2.631318664	9.698819191	0.156928694	0.466945218	0	0	3.852967091	0	0	0	0	0	0	0	0	0	0	0	1.116067173	0	0.895086041	0	0	0	0	0	65.9764	0	5.63590825	17.2513	1.050118156	1.264196794	0	0.403384052	2.370092562	0.723935678	1.370107262	9.637469554	2.22233309	3.781577812	1.674564364	0.027037489	5.382117493	2.631318664	9.698819191	0.156928694	0.466945218	0	0	3.852967091	0	0	0	0	0	0	0	0	0	0	0	1.116067173	0	0.895086041	0	0	0	0	0	65.9764	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	$0/Day(Days 1-7) $50(Days 8-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$10/Visit	$25-$30/Visit	$30/Visit	25% Coins		$0/Visit	20% Coins	20% Coins									40% Coins	$0/Visit	$0-$75/Visit	$0/Visit	$30/Visit						6300	2.5593	0.1558	0.186	0	1.5997	1.5493	0.4732	0.203	1.4571	0.336	0.5717	0.2532	0.0041	0.8138	0.4604	1.6969	0.0275	0.0706		0	0.6915	0									0.6466	0	0.1953	0	0.1566						14.1076	0	1.343080395	19.8106	1.205904404	1.450245085	0	2.003105276	3.919409562	1.197168646	1.57308306	11.09457546	2.558330402	4.353321497	1.927744016	0.031125364	6.195895686	3.091693288	11.39572132	0.184384884	0.537543203	0	0	4.544504262	0	0	0	0	0	0	0	0	0	0.646626352	0	1.31133391	0	1.051689991	0	0	0	0	0	80.084
H8145_063_0	2011	6	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	1217.551737	76.287568	532.971618	422.774085	1.943057	13.712886	4.010808	376.333948	36.632412	8.463052	12.439224	7.506222	0.178118	17.038569	3604.082492	2930.027969	76.933733	2.192371		1726.555376	17.301199	0							4.38	0.41	1990.30588	458.601452	338.834467	0	0	273.18614						$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						147.067245	128.620245	34.44565	0	0.2	0.2	0.2	50	0.244028	0.25	0.246224	0.25	0.2	0.229323	15	35	35	0.25		0	0.2	0							0	0	0	0	20.370758	0	0	15					NO	137.109763	119.911754	29.235022	0	0.184171	0.184171	0.184171	46.04265	0.224714	0.230213	0.226736	0.230213	0.184171	0.211173	13.812795	32.229855	32.229855	0.230213		0	0.184171	0							0	0	0	0	18.758474	0	0	13.812795						13.9115	0.762314674	1.298453081	0	0.357854751	2.525515928	0.73867452	1.443951021	8.23181583	1.94830459	2.820419893	1.728029885	0.03280417	3.598085731	4.148537719	7.869531382	0.206630255	0.504712305	0	0	3.186379121	0	0	0	0	0	0	0	0	0	0	0	0.529668128	0	0	0.314455346	0	0	0	0	56.1577	0	4.751018214	13.9115	0.762314674	1.298453081	0	0.357854751	2.525515928	0.73867452	1.443951021	8.23181583	1.94830459	2.820419893	1.728029885	0.03280417	3.598085731	4.148537719	7.869531382	0.206630255	0.504712305	0	0	3.186379121	0	0	0	0	0	0	0	0	0	0	0	0.529668128	0	0	0.314455346	0	0	0	0	56.1577	YES	$195/Day(Days 1-8)	$195/Day(Days 1-8)	$0/Day(Days 1-7) $50(Days 8-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins										20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					5500	2.0759	0.1138	0.1934	0	1.429	1.6623	0.4862	0.2154	1.2532	0.2966	0.4294	0.2631	0.005	0.5478	0.7308	1.3864	0.0364	0.0768		0	0.5759										0.5353	0	0.0933	0	0	0.0554					12.4613	0	1.082366624	15.9874	0.876066762	1.491895299	0	1.786826053	4.187843333	1.224879874	1.65934525	9.485001124	2.244908673	3.249791128	1.991100013	0.037798251	4.145890199	4.879382046	9.255899968	0.243032129	0.581548255	0	0	3.762229167	0	0	0	0	0	0	0	0	0	0.535264753	0	0.622979303	0	0	0.369852673	0	0	0	0	68.6189
H8145_069_0	2011	3	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	1440.757498	88.28585	455.791135	469.087907	2.013339	12.715797	4.093071	378.998081	41.875961	8.771044	13.684206	2.789253	0.174345	20.236603	3531.077518	3422.931955	146.791163	1.733599		1727.202922	21.212051	0							3.83	0.41	1708.430101	450.397715	456.185139	0	0	410.306887						$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						147.067245	128.620245	34.44565	0	0.2	0.2	0.2	50	0.239127	0.25	0.241241	0.25	0.2	0.229612	15	35	35	0.25		0	0.2	0							0	0	0	0	15.842559	0	0	15					NO	132.444055	115.831277	27.120748	0	0.178422	0.178422	0.178422	44.60555	0.213327	0.223028	0.215213	0.223028	0.178422	0.204839	13.381665	31.223885	31.223885	0.223028		0	0.178422	0							0	0	0	0	14.133321	0	0	13.381665						15.9016	0.852188562	1.030116376	0	0.359223971	2.268777932	0.730293914	1.408784821	8.933273132	1.956188401	2.945019026	0.622081518	0.031106984	4.145245522	3.93764137	8.906436144	0.381949199	0.386641118	0	0	3.784696564	0	0	0	0	0	0	0	0	0	0	0	0.53728425	0	0	0.457549109	0	0	0	0	59.5761	0	7.182230665	15.9016	0.852188562	1.030116376	0	0.359223971	2.268777932	0.730293914	1.408784821	8.933273132	1.956188401	2.945019026	0.622081518	0.031106984	4.145245522	3.93764137	8.906436144	0.381949199	0.386641118	0	0	3.784696564	0	0	0	0	0	0	0	0	0	0	0	0.53728425	0	0	0.457549109	0	0	0	0	59.5761	YES	$195/Day(Days 1-8)	$195/Day(Days 1-8)	$0/Day(Days 1-7) $50(Days 8-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins										20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					5000	2.3783	0.1275	0.1542	0	1.4382	1.4972	0.4819	0.2107	1.3635	0.2986	0.4495	0.095	0.0047	0.6327	0.6955	1.5731	0.0675	0.059		0	0.6858										0.4484	0	0.0949	0	0	0.0808					12.837	0	1.536028858	18.2799	0.979642035	1.184285011	0	1.797412149	3.766020274	1.212239237	1.619481906	10.29679949	2.254769468	3.394530526	0.717032218	0.035855132	4.777984172	4.633143169	10.47957137	0.449412519	0.445655904	0	0	4.470463694	0	0	0	0	0	0	0	0	0	0.44838094	0	0.63218425	0	0	0.538365566	0	0	0	0	72.4131
H8145_071_0	2011	3	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	1367.486002	86.14182	446.450982	435.92613	1.965684	12.728312	4.000437	364.403492	40.695616	8.698472	13.188288	2.815962	0.188241	20.035667	3346.612378	3230.872315	143.479828	1.601893		1647.461833	20.335399	0							3.83	0.41	1644.788353	419.117755	430.695486	0	0	386.477712						$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						147.067245	128.620245	34.44565	0	0.2	0.2	0.2	50	0.238967	0.25	0.241387	0.25	0.2	0.229838	15	35	35	0.25		0	0.2	0							0	0	0	0	15.749291	0	0	15					NO	133.669566	116.903069	27.675254	0	0.179778	0.179778	0.179778	44.94455	0.214806	0.224723	0.21698	0.224723	0.179778	0.2066	13.483365	31.461185	31.461185	0.224723		0	0.179778	0							0	0	0	0	14.156896	0	0	13.483365						15.2326	0.839186927	1.029637027	0	0.353386738	2.288270475	0.719190563	1.364829247	8.74166249	1.954746723	2.86159473	0.632811429	0.03384159	4.139368802	3.760299684	8.470589301	0.376170451	0.359982201	0	0	3.655857361	0	0	0	0	0	0	0	0	0	0	0	0.508109267	0	0	0.434251671	0	0	0	0	57.7564	0	6.435708299	15.2326	0.839186927	1.029637027	0	0.353386738	2.288270475	0.719190563	1.364829247	8.74166249	1.954746723	2.86159473	0.632811429	0.03384159	4.139368802	3.760299684	8.470589301	0.376170451	0.359982201	0	0	3.655857361	0	0	0	0	0	0	0	0	0	0	0	0.508109267	0	0	0.434251671	0	0	0	0	57.7564	YES	$195/Day(Days 1-8)	$195/Day(Days 1-8)	$0/Day(Days 1-7) $50(Days 8-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins										20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					5000	2.2761	0.1254	0.1538	0	1.4135	1.5087	0.4742	0.2039	1.333	0.2981	0.4364	0.0965	0.0052	0.6313	0.6636	1.4948	0.0664	0.0549		0	0.6618										0.4526	0	0.0897	0	0	0.0766					12.5164	0	1.399141778	17.5087	0.964579638	1.183482985	0	1.766896983	3.796981701	1.193370051	1.568763803	10.07470544	2.252831919	3.297969221	0.729310644	0.039002345	4.770622198	4.423864264	9.965359267	0.4425517	0.414876907	0	0	4.317667606	0	0	0	0	0	0	0	0	0	0.45256713	0	0.597773214	0	0	0.510882274	0	0	0	0	70.2727
H8145_073_0	2011	3																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin							O	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0											0	NO	270.3498603	3.901541223	18.11204019	7.486290031	3.38050413	4.871379122	4.008798299	25.4223115	40.20697126	9.001118453	17.53033514	3.948432378	0.053014688	22.6063153	41.56391209	35.49410725	0.627361147	4.753194214		4.373082342	11.82965488	0							1.42	0.51												Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0% Coins:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d												0.072698	0.072698	0.142396	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0							0	0											NO	0.067266	0.067266	0.114673	0	0.213489	0.213489	0.213489	0.213489	0.213489	0.213489	0.213489	0.213489	0.213489	0.213489	0.213489	0.213489	0.213489	0.213489		0.213489	0.213489	0							0	0												18.1854	0.262441072	2.076961984	0	0.721700446	1.039985857	0.85583434	5.427383859	8.583746087	1.921639777	3.742533718	0.84294688	0.011318053	4.826199648	8.873438028	7.577601462	0.133934704	1.014754679	0	0.933604976	2.525501191	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.5569	0	6.473123058	18.1854	0.262441072	2.076961984	0	0.721700446	1.039985857	0.85583434	5.427383859	8.583746087	1.921639777	3.742533718	0.84294688	0.011318053	4.826199648	8.873438028	7.577601462	0.133934704	1.014754679	0	0.933604976	2.525501191	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.5569	YES	7% Coins	7% Coins	14% Coins(Days 1-7) 14%(Days 8-100)	0% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins		23% Coins	23% Coins	23% Coins																			6700	2.7777	0.0401	0.3161	0	2.8897	0.6864	0.5648	0.8285	1.3739	0.2933	0.6083	0.1287	0.0017	0.7368	1.608	1.3731	0.0243	0.1742		0.1692	0.4576	0																			15.0523	0	1.38134242	20.9631	0.302528024	2.393073888	0	3.611350506	1.726367432	1.420677526	6.255862125	9.957626548	2.214973912	4.350807679	0.971621057	0.013045806	5.562968717	10.48139897	8.950743236	0.158205062	1.188926756	0	1.102784098	2.983148501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.6092
H8145_075_0	2011	4	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	1450.290946	119.293397	454.384242	564.356446	2.118465	13.87346	5.100629	391.787519	43.667073	9.078148	11.18104	2.878763	0.401134	14.234492	3353.342034	2901.435298	67.426946	1.461579		1261.6093	18.041474	0							3.62	0.58	2040.631322	479.292199	291.825097	0	0	336.944856						$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						147.067245	128.620245	34.44565	0	0.2	0.2	0.2	50	0.243991	0.25	0.244601	0.25	0.2	0.229404	15	35	35	0.25		0	0.2	0							0	0	0	0	19.27942	0	0	15					NO	133.400874	116.66808	27.465549	0	0.179878	0.179878	0.179878	44.96945	0.219443	0.224847	0.219991	0.224847	0.179878	0.206324	13.490835	31.478615	31.478615	0.224847		0	0.179878	0							0	0	0	0	17.339698	0	0	13.490835						16.1225	1.159810965	1.039992722	0	0.381065247	2.495530238	0.917490943	1.468205771	9.5824335	2.041194343	2.459728171	0.647281224	0.072155182	2.936917327	3.769948673	7.611097058	0.176875573	0.328631653	0	0	3.24526426	0	0	0	0	0	0	0	0	0	0	0	0.421679921	0	0	0.378805621	0	0	0	0	57.2566	0	6.390228108	16.1225	1.159810965	1.039992722	0	0.381065247	2.495530238	0.917490943	1.468205771	9.5824335	2.041194343	2.459728171	0.647281224	0.072155182	2.936917327	3.769948673	7.611097058	0.176875573	0.328631653	0	0	3.24526426	0	0	0	0	0	0	0	0	0	0	0	0.421679921	0	0	0.378805621	0	0	0	0	57.2566	YES	$195/Day(Days 1-8)	$195/Day(Days 1-8)	$0/Day(Days 1-7) $50(Days 8-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins										20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					5000	2.411	0.1734	0.1556	0	1.5255	1.6468	0.6054	0.2196	1.4625	0.3115	0.3754	0.0988	0.011	0.4483	0.6658	1.3442	0.0312	0.0502		0	0.588										0.5396	0	0.0745	0	0	0.0669					12.8053	0	1.418544782	18.5335	1.333251894	1.19563229	0	1.906578853	4.142286899	1.52292689	1.687773345	11.04493074	2.352727415	2.835139527	0.746071282	0.0831679	3.385195656	4.435781118	8.955336939	0.208114591	0.378788417	0	0	3.833243465	0	0	0	0	0	0	0	0	0	0.539604832	0	0.49615525	0	0	0.445708674	0	0	0	0	70.0619
H8145_078_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	875.415939	17.717445	268.241803	485.711388	2.321324	12.33894	2.450642	283.446269	24.729194	8.306044	10.837848	4.00816	0.149323	13.771391	2445.359437	2178.324886	79.936074	0.945997		825.497024	16.289847	0							4.14	1.48	914.910633	646.716933	241.508169	0	432.2663							$175/Day(Days 1-7):1a.IP Acute	$175/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $100(Days 21-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							125.7585	107.666825	33.0247	0	0.2	0.2	0.2	50	0.239787	0.25	0.235697	0.25	0.2	0.232821	15	34.272929	35	0.25		0	0.2	0							0	0	0	0	19.450202	0	35						NO	117.611739	100.69206	29.069464	0	0.183705	0.183705	0.183705	45.9263	0.220251	0.229632	0.216494	0.229632	0.183705	0.213852	13.77789	31.480576	32.14841	0.229632		0	0.183705	0							0	0	0	0	17.865516	0	32.14841							8.5799	0.14866717	0.649803786	0	0.426438825	2.266724973	0.450195189	1.084803199	5.446629708	1.907333496	2.346329065	0.920401797	0.027431382	2.945039508	2.807657778	5.714576844	0.214151473	0.217231183	0	0	2.992526343	0	0	0	0	0	0	0	0	0	0	0	0.359555671	0	1.158056187	0	0	0	0	0	40.6635	0	3.468040007	8.5799	0.14866717	0.649803786	0	0.426438825	2.266724973	0.450195189	1.084803199	5.446629708	1.907333496	2.346329065	0.920401797	0.027431382	2.945039508	2.807657778	5.714576844	0.214151473	0.217231183	0	0	2.992526343	0	0	0	0	0	0	0	0	0	0	0	0.359555671	0	1.158056187	0	0	0	0	0	40.6635	YES	$175/Day(Days 1-7)	$175/Day(Days 1-7)	$0/Day(Days 1-20) $100(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									20% Coins	$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit						5000	3.7327	0.0647	0.2816	0	2.2277	2.7264	0.5415	0.4715	2.4159	0.846	1.0407	0.4082	0.0122	1.3064	1.3147	2.6759	0.1003	0.0964		0	1.4375	0									0.4284	0	0.1684	0	0.5423						22.8394	0	2.085591738	12.3127	0.21334543	0.931399359	0	2.654172033	4.993173187	0.991696299	1.556281779	7.862515866	2.753342438	3.387059114	1.328651269	0.039598872	4.251466792	4.122373634	8.39048875	0.314430197	0.313585327	0	0	4.430030214	0	0	0	0	0	0	0	0	0	0.428368843	0	0.527921468	0	1.700328411	0	0	0	0	0	63.5029
H8145_079_0	2011	4	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	1345.917682	82.501007	441.732895	549.284996	2.136971	13.631361	4.50106	374.113144	42.99541	10.750032	14.413594	6.310052	0.637494	21.959592	3262.179333	3579.850898	68.096201	2.11511		1468.317216	26.051867	0							3.9	0.41	1464.856739	595.442132	342.681266	0	0	401.05304						$195/Day(Days 1-9):1a.IP Acute	$195/Day(Days 1-9):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						152.7669	135.896085	34.44565	0	0.2	0.2	0.2	50	0.240934	0.25	0.239874	0.25	0.2	0.228328	15	35	35	0.25		0	0.2	0							0	0	0	0	19.418269	0	0	15					NO	141.276996	125.675069	29.177877	0	0.182357	0.182357	0.182357	45.58935	0.219681	0.227947	0.218714	0.227947	0.182357	0.208187	13.676805	31.912545	31.912545	0.227947		0	0.182357	0							0	0	0	0	17.705325	0	0	13.676805						15.8456	0.864026646	1.074069006	0	0.389691621	2.485774098	0.820799798	1.421297922	9.445274664	2.450437544	3.152454798	1.438357423	0.116251493	4.57170158	3.718015884	9.520179406	0.18109359	0.482132979	0	0	4.750740311	0	0	0	0	0	0	0	0	0	0	0	0.505606932	0	0	0.457093685	0	0	0	0	63.6906	0	5.994259849	15.8456	0.864026646	1.074069006	0	0.389691621	2.485774098	0.820799798	1.421297922	9.445274664	2.450437544	3.152454798	1.438357423	0.116251493	4.57170158	3.718015884	9.520179406	0.18109359	0.482132979	0	0	4.750740311	0	0	0	0	0	0	0	0	0	0	0	0.505606932	0	0	0.457093685	0	0	0	0	63.6906	YES	$195/Day(Days 1-9)	$195/Day(Days 1-9)	$0/Day(Days 1-7) $50(Days 8-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins										20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					5900	2.3747	0.1295	0.1615	0	1.5641	1.6446	0.543	0.2131	1.4453	0.375	0.4824	0.2201	0.0178	0.6996	0.6584	1.6858	0.0321	0.0738		0	0.863										0.3905	0	0.0895	0	0	0.0809					13.7444	0	1.254287381	18.2203	0.993515347	1.235541628	0	1.953769758	4.130330893	1.363830834	1.634399004	10.89055604	2.825395052	3.634833755	1.65844979	0.134039921	5.271300005	4.376370688	11.20593225	0.213160112	0.555907354	0	0	5.6137067	0	0	0	0	0	0	0	0	0	0.390469867	0	0.595135531	0	0	0.538031969	0	0	0	0	77.435
H8145_080_0	2011	4	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	1363.597452	89.961493	537.484342	882.908846	2.534582	15.921192	4.062058	385.308611	37.27395	7.103883	13.344697	4.111608	0.165078	17.941096	3802.03	3041.505118	146.293506	1.985297		1808.426671	22.076917	0							4.23	0.58	1217.538254	410.149201	352.653545	0	0	321.795143						$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						147.067245	128.620245	34.44565	0	0.2	0.2	0.2	50	0.237864	0.25	0.243794	0.25	0.2	0.230283	15	35	35	0.25		0	0.2	0							0	0	0	0	20.381807	0	0	15					NO	133.033059	116.346401	26.938875	0	0.179095	0.179095	0.179095	44.77385	0.213002	0.223869	0.218312	0.223869	0.179095	0.206213	13.432155	31.341695	31.341695	0.223869		0	0.179095	0							0	0	0	0	18.25144	0	0	13.432155						15.117	0.872224662	1.206601959	0	0.453930963	2.851405881	0.727494278	1.437645829	7.939425898	1.590339183	2.913307491	0.920461571	0.029564644	3.699687229	4.255788023	7.943827146	0.382090537	0.444446454	0	0	3.95386545	0	0	0	0	0	0	0	0	0	0	0	0.536369585	0	0	0.360200187	0	0	0	0	57.6356	0	6.743267096	15.117	0.872224662	1.206601959	0	0.453930963	2.851405881	0.727494278	1.437645829	7.939425898	1.590339183	2.913307491	0.920461571	0.029564644	3.699687229	4.255788023	7.943827146	0.382090537	0.444446454	0	0	3.95386545	0	0	0	0	0	0	0	0	0	0	0	0.536369585	0	0	0.360200187	0	0	0	0	57.6356	YES	$195/Day(Days 1-8)	$195/Day(Days 1-8)	$0/Day(Days 1-7) $50(Days 8-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins										20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					5000	2.2721	0.1311	0.1825	0	1.827	1.8917	0.4826	0.2162	1.2183	0.244	0.447	0.1412	0.0045	0.5677	0.7557	1.4106	0.0678	0.0682		0	0.7202										0.3224	0	0.0952	0	0	0.064					13.1301	0	1.444285663	17.389	1.003318843	1.389092605	0	2.280927511	4.743124782	1.210138546	1.653799565	9.157679415	1.834366897	3.360336228	1.061700678	0.03410099	4.267428528	5.01147	9.354378372	0.449936711	0.512644141	0	0	4.674084813	0	0	0	0	0	0	0	0	0	0.322382937	0	0.631610421	0	0	0.424159384	0	0	0	0	70.7657
H8145_084_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1304.806969	57.575604	338.904862	1165.575659	1.729746	9.967308	3.707869	273.460912	35.440351	6.894913	13.341319	5.412632	0.16949	13.359813	2787.175966	2905.936945	80.223118	1.857683		1196.287553	22.748124	0							4.14	1.48	1027.4108	1477.23638	315.030933	0	330.658965							$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $100(Days 21-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	33.0247	0	0.2	0.2	0.2	50	0.240164	0.25	0.234659	0.25	0.2	0.229966	10	34.247657	35	0.25		0	0.2	0							0	0	0	0	21.019218	0	35						NO	135.391026	115.913612	22.976308	0	0.169792	0.169792	0.169792	42.44805	0.20389	0.21224	0.199216	0.21224	0.169792	0.195232	8.48961	29.074925	29.713635	0.21224		0	0.169792	0							0	0	0	0	17.844496	0	29.713635							14.7216	0.556149685	0.648898541	0	0.293697033	1.69236916	0.629566493	0.967323539	7.225933165	1.463376335	2.657804206	1.148777016	0.028778046	2.608263012	1.971836413	7.040824894	0.198643371	0.39427464	0	0	3.86244947	0	0	0	0	0	0	0	0	0	0	0	0.468464019	0	0.81875665	0	0	0	0	0	49.3978	0	9.206216182	14.7216	0.556149685	0.648898541	0	0.293697033	1.69236916	0.629566493	0.967323539	7.225933165	1.463376335	2.657804206	1.148777016	0.028778046	2.608263012	1.971836413	7.040824894	0.198643371	0.39427464	0	0	3.86244947	0	0	0	0	0	0	0	0	0	0	0	0.468464019	0	0.81875665	0	0	0	0	0	49.3978	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	$0/Day(Days 1-20) $100(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$10/Visit	$10-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									20% Coins	$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit						4500	6.4603	0.2441	0.2854	0	1.5478	2.0536	0.7639	0.4241	3.2334	0.6548	1.1893	0.5141	0.0129	1.1672	0.9315	3.3261	0.0938	0.1764		0	1.8718	0									0.4397	0	0.2213	0	0.3868						25.9985	0	4.682791662	21.1819	0.800206893	0.934299646	0	1.841542955	3.745967314	1.393511216	1.391459081	10.45937381	2.11820481	3.847113638	1.662829191	0.041655567	3.775499414	2.903331388	10.3669086	0.292482442	0.57070394	0	0	5.734233942	0	0	0	0	0	0	0	0	0	0.439722211	0	0.689766294	0	1.205537065	0	0	0	0	0	75.3963
H8145_087_0	2011	6	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	1397.458879	81.756146	420.055287	1288.552471	1.671289	14.261949	4.893199	401.00416	39.688423	8.681368	15.691927	7.746105	0.062625	27.645402	2957.486393	2811.878485	58.123649	3.369742		1743.192381	16.560502	0							3.85	0.73	2174.282735	409.03203	306.524387	0	0	395.027739						$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						161.6895	138.428775	66.51235	0	0.2	0.2	0.2	50	0.237343	0.25	0.240552	0.25	0.2	0.225056	15	35	35	0.25		0	0.2	0							0	0	0	0	18.997885	0	0	15					NO	151.687226	129.865433	55.945932	0	0.185998	0.185998	0.185998	46.49955	0.220727	0.232498	0.223711	0.232498	0.185998	0.2093	13.949865	32.549685	32.549685	0.232498		0	0.185998	0							0	0	0	0	17.667862	0	0	13.949865						17.6647	0.884774775	1.958365377	0	0.310856411	2.65269399	0.910125228	1.553876082	8.760306544	2.018400697	3.510456681	1.80095392	0.011648125	5.786182639	3.43804466	7.627146579	0.157658872	0.783458276	0	0	3.080220251	0	0	0	0	0	0	0	0	0	0	0	0.451302547	0	0	0.459215303	0	0	0	0	63.8204	0	4.853564712	17.6647	0.884774775	1.958365377	0	0.310856411	2.65269399	0.910125228	1.553876082	8.760306544	2.018400697	3.510456681	1.80095392	0.011648125	5.786182639	3.43804466	7.627146579	0.157658872	0.783458276	0	0	3.080220251	0	0	0	0	0	0	0	0	0	0	0	0.451302547	0	0	0.459215303	0	0	0	0	63.8204	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins										20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					6700	2.6601	0.1332	0.2979	0	1.2554	1.7659	0.6059	0.2344	1.3488	0.3108	0.5405	0.2773	0.0018	0.8909	0.6126	1.3589	0.0281	0.1206		0	0.563										0.6445	0	0.0804	0	0	0.0818					13.8129	0	0.908206115	20.3248	1.018009558	2.256312646	0	1.566273116	4.418589296	1.515994825	1.78830323	10.10911192	2.329169035	4.050953816	2.078242302	0.013441535	6.677087585	4.050608376	8.986091477	0.185749287	0.904085506	0	0	3.6432159	0	0	0	0	0	0	0	0	0	0.644525184	0	0.53171208	0	0	0.541034667	0	0	0	0	77.6333
H8145_089_0	2011	6	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	Coin							O		O	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	NO	905.881452	55.272225	545.844964	181.581984	1.636388	6.462318	2.294737	305.541589	37.851122	13.310692	14.247642	3.749254	0.12698	23.279251	2758.101303	2384.163663	70.796811	2.904573		2129.869381	16.971552	0							3.45		601.898488	139.977933	346.976357	119.755297	0	280.964746						$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $50(Days 15-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,7h. 25% Psych -- OP,8b. 20% Rad therapy,3, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Membership in health club/fitness class 14a		$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	$35/Visit:5.Partial Hospitalization	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						161.6895	138.428775	23.1855	0	0.2	0.2	0.2	50	0.243232	0.25	0.247484	0.25	0.2	0.23758	15	32.528228	35	0.25		0	0.2	0							0		0	0	21.854724	35	0	35					NO	151.321323	129.552168	20.258702	0	0.184292	0.184292	0.184292	46.073	0.224128	0.230365	0.228047	0.230365	0.184292	0.218921	13.8219	29.973461	32.2511	0.230365		0	0.184292	0							0		0	0	20.138254	32.2511	0	32.2511						11.4233	0.596719715	0.921509205	0	0.301573217	1.190953509	0.422901671	1.173101469	8.483496272	3.066317563	3.249132015	0.863696898	0.023401398	5.096316908	3.176850033	5.955136381	0.190272919	0.669111959	0	0	3.127721261	0	0	0	0	0	0	0	0	0	0	0	0.582291501	0.321853338	0	0.75511851	0	0	0	0	51.5907	0	4.250953603	11.4233	0.596719715	0.921509205	0	0.301573217	1.190953509	0.422901671	1.173101469	8.483496272	3.066317563	3.249132015	0.863696898	0.023401398	5.096316908	3.176850033	5.955136381	0.190272919	0.669111959	0	0	3.127721261	0	0	0	0	0	0	0	0	0	0	0	0.582291501	0.321853338	0	0.75511851	0	0	0	0	51.5907	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	$0/Day(Days 1-14) $50(Days 15-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									20% Coins	$0/Visit	$0-$35/Visit	$35/Visit	$0/Visit	$35/Visit					5000	1.708	0.0892	0.1379	0	1.2073	0.7859	0.2791	0.1754	1.2947	0.468	0.4959	0.1318	0.0036	0.7778	0.5611	1.0517	0.0336	0.1021		0	0.5667	0									0.1541	0	0.1028	0.0481	0	0.1334					10.3082	0	0.848105629	13.1313	0.685940655	1.059371449	0	1.508826789	1.97682289	0.701960158	1.348532124	9.778238342	3.534295513	3.745010115	0.995513233	0.026972687	5.874109345	3.737917197	7.006879905	0.22387724	0.771231112	0	0	3.694389924	0	0	0	0	0	0	0	0	0	0.15414694	0	0.685130674	0.369984676	0	0.888480864	0	0	0	0	61.8989
H8145_091_0	2011	4	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	1098.423435	51.492725	480.690922	397.254768	1.745137	9.867623	2.979507	344.42009	30.794457	8.645161	10.853899	2.976365	0.205172	18.92655	2720.462663	2259.231964	127.586462	1.528586		1338.960788	17.340762	0							3.72	0.58	1471.905785	356.25722	203.823567	0	0	286.071443						$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						147.067245	128.620245	34.44565	0	0.2	0.2	0.2	50	0.243792	0.25	0.245633	0.25	0.2	0.229053	15	35	35	0.25		0	0.2	0							0	0	0	0	14.187896	0	0	15					NO	138.249828	120.908818	29.778264	0	0.185891	0.185891	0.185891	46.47265	0.226593	0.232363	0.228304	0.232363	0.185891	0.212894	13.941795	32.530855	32.530855	0.232363		0	0.185891	0							0	0	0	0	13.186983	0	0	13.941795						12.6547	0.518827043	1.192845098	0	0.324405262	1.834302307	0.553863536	1.333842858	6.977808395	2.008815545	2.477988557	0.6915971	0.038139628	4.029348936	3.160677729	6.124562286	0.345874725	0.355186829	0	0	3.223491589	0	0	0	0	0	0	0	0	0	0	0	0.223984826	0	0	0.332362451	0	0	0	0	48.4027	0	3.610565768	12.6547	0.518827043	1.192845098	0	0.324405262	1.834302307	0.553863536	1.333842858	6.977808395	2.008815545	2.477988557	0.6915971	0.038139628	4.029348936	3.160677729	6.124562286	0.345874725	0.355186829	0	0	3.223491589	0	0	0	0	0	0	0	0	0	0	0	0.223984826	0	0	0.332362451	0	0	0	0	48.4027	YES	$195/Day(Days 1-8)	$195/Day(Days 1-8)	$0/Day(Days 1-7) $50(Days 8-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins										20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					5000	1.8924	0.0776	0.1785	0	1.2988	1.2106	0.3655	0.1995	1.0651	0.3066	0.3782	0.1056	0.0058	0.6151	0.5583	1.0818	0.0611	0.0542		0	0.5841										0.4236	0	0.0396	0	0	0.0587					10.5608	0	0.781632383	14.5471	0.59641197	1.371374559	0	1.623253119	3.044876166	0.919393439	1.53334163	8.042913741	2.315445259	2.856234033	0.797164193	0.043961472	4.64443191	3.718973078	7.206391858	0.406969296	0.409403438	0	0	3.807598442	0	0	0	0	0	0	0	0	0	0.423581442	0	0.263549024	0	0	0.391070243	0	0	0	0	58.9635
H8145_093_0	2011	4	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery						Prosthetics/Supplies	Lab	Radiology	Other							D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	961.0066727	74.36821256	305.9555293	332.080145	42.39410781	15.25374139	7.065527057	426.3851491	0	601.7729928	0	112.5802039	0.087026698	7.358646361	3353.307125	2818.015853	60.85096132	610.3122129		1075.396377	11.80879498	0							3.68	0.49	1070.125951	1707.495659	961.3387031	1272.681975	261.8500607							$250/Day(Days 1-7):1a.IP Acute	$250/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	$0/Visit:8a.Lab -- FSL	$0/Visit:8b.Radiology OP -- Physician	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$125/Visit:7c, 7d, 7i. $125 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$100/Visit:8a.Lab -- OP	"$0-$125/Visit:8b, 9a. $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,8b, 9a. $125 Advanced Imaging -- OP,8b. $125 Radiology OP -- Facility"	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,3, 7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- CORF"	"$75-$125/Visit:9b. $75 Surgery ASC -- Facility,9a. $125 Surgery OP -- Facility"							179.655	153.80975	42.271616	0	100	0.2	0.2	50	0	0	0	125	0.2	0.2	15	34.087827	35	69.732788		0	0.2	0							0	0	0	100	87.182513	109.92285	104.443586						NO	133.071177	113.927497	24.047139	0	76.7678	0.153536	0.153536	38.3839	0	0	0	95.95975	0.153536	0.153536	11.51517	26.168475	26.86873	53.532327		0	0.153536	0							0	0	0	76.7678	66.928097	84.385354	80.179043							10.6569	0.706048693	0.613112929	0	0.271208532	2.341998438	1.084812762	1.36386041	0	0	0	0.900264018	0.013361731	1.129817128	3.217825134	6.145264783	0.136249004	2.722619413	0	0	1.813075145	0	0	0	0	0	0	0	0	0	0	10.92339043	5.361714164	8.949643249	1.74957394	0	0	0	0	0	60.1007	0	19.00637635	10.6569	0.706048693	0.613112929	0	0.271208532	2.341998438	1.084812762	1.36386041	0	0	0	0.900264018	0.013361731	1.129817128	3.217825134	6.145264783	0.136249004	2.722619413	0	0	1.813075145	0	0	0	0	0	0	0	0	0	0	10.92339043	5.361714164	8.949643249	1.74957394	0	0	0	0	0	60.1007	YES	$250/Day(Days 1-7)	$250/Day(Days 1-7)	$0/Day(Days 1-20) $128(Days 21-100)	40% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	20% Coins	30% Coins	$125/Visit	20% Coins	20% Coins	$15/Visit	$15-$35/Visit	$35/Visit	$35-$125/Visit		$0/Visit	20% Coins	$0/Service									40% Coins	$100/Visit	$0-$125/Visit	$50-$125/Visit	$75-$125/Visit						3400	1.383	0.0916	0.0759	2.6356	0.9836	2.8001	1.297	0.1848	0.4833	0.0466	0.1448	0.122	0.0018	0.1562	0.5149	0.9832	0.0218	0.3894		0	0.2976	0									0.4674	1.4799	0.734	1.2125	0.237						16.7441	0	7.537985668	12.0398	0.797675994	0.689050478	2.635611433	1.254798455	5.142114905	2.381825487	1.54863607	0.483253641	0.046622936	0.144770515	1.022231691	0.015209179	1.286031184	3.732680815	7.128514117	0.158049	3.11205676	0	0	2.110666665	0	0	0	0	0	0	0	0	0	0.46737449	12.40329017	6.095702074	10.16213992	1.986606024	0	0	0	0	0	76.8448
H8145_095_0	2011	3	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	Lab	Radiology	Radiology		Therapy (PT/OT/ST)					D	D	D	V	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	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	902.95039	58.824472	361.632983	240.232417	1.483882	10.936792	4.193422	279.526101	0	148.587711	20.143421	7.801872	0.03647	30.38713	2362.734986	2374.276287	29.056126	3.128345		1045.520268	16.775884	0							5.21	1.29	603.687992	1675.057987	0	302.082064	244.42519	511.749549						$250/Day(Days 1-7):1a.IP Acute	$250/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	$0/Visit:8a.Lab -- FSL	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$100/Visit:8a.Lab -- OP	$0/Visit:8b.Radiology OP -- Physician	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office"	"$125/Visit:9a.Surgery OP -- Facility, 9b.Surgery ASC -- Facility"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						179.655	153.80975	43.922851	0	0.2	0.2	0.2	50	0	0	0.24235	0.25	0.2	0.235264	15	32.975853	35	0.25		0	0.2	0							0	0	0	100	0	11.532675	125	35					NO	144.632336	123.825462	27.356645	0	0.163056	0.163056	0.163056	40.76405	0	0	0.197583	0.20382	0.163056	0.191806	12.229215	26.884586	28.534835	0.20382		0	0.163056	0							0	0	0	81.5281	0	9.402371	101.910125	28.534835						10.883	0.606997285	0.824422095	0	0.241955863	1.783309556	0.683762618	0.94955133	0	0	3.979997551	1.590177551	0.005946652	5.828433857	2.407866178	5.319286252	0.069092647	0.637619278	0	0	2.735408542	0	0	0	0	0	0	0	0	0	0	11.38035792	0	0.236690637	2.075783472	1.216890745	0	0	0	0	53.4565	0	12.60315001	10.883	0.606997285	0.824422095	0	0.241955863	1.783309556	0.683762618	0.94955133	0	0	3.979997551	1.590177551	0.005946652	5.828433857	2.407866178	5.319286252	0.069092647	0.637619278	0	0	2.735408542	0	0	0	0	0	0	0	0	0	0	11.38035792	0	0.236690637	2.075783472	1.216890745	0	0	0	0	53.4565	YES	$250/Day(Days 1-7)	$250/Day(Days 1-7)	$0/Day(Days 1-20) $133(Days 21-100)	25% Coins	20% Coins	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									40% Coins	$100/Visit	30% Coins	$0-$35/Visit	$125/Visit	$35/Visit					3400	1.5055	0.084	0.1099	1.0624	0.9123	1.6626	0.6375	0.1338	0.4678	0.0246	0.5721	0.2286	0.0009	0.8379	0.4006	0.8849	0.0115	0.0917		0	0.4668	0									0.2936	1.603	0.1457	0.0394	0.2924	0.2024					12.6717	0	3.935635434	12.3885	0.690966581	0.934285393	1.062371634	1.15429266	3.445906575	1.321241048	1.083303592	0.46781822	0.024634595	4.552139984	1.818772752	0.006801421	6.666336729	2.808422204	6.204166063	0.080586424	0.72927985	0	0	3.202214673	0	0	0	0	0	0	0	0	0	0.293579746	12.9833767	0.145670727	0.276064859	2.368174967	1.419324305	0	0	0	0	66.1282
H8145_096_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Radiology									Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin							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	NO	207.042469	4.802659	23.80617	240.232417	1.483882	10.936792	4.193422	279.526101	51.068574	17.007628	25.780876	7.801872	0.03647	30.38713	22.093177	30.143688	0.253649	6.94954		1045.520268	16.775884	0							5.21	0.49	603.687992	202.544516										Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"0%-20% Coins:8a. 0% Lab -- FSL,8a. 20% Lab -- OP"	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"20% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"										0.091519	0.091519	0.146056	0	0.2	0.2	0.2	50	0.2	0.191761	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0							0	0	0	0									NO	0.084135	0.084135	0.107592	0	0.183246	0.183246	0.183246	45.8116	0.183246	0.175697	0.183246	0.183246	0.183246	0.183246	0.183246	0.183246	0.183246	0.183246		0	0.183246	0							0	0	0	0										17.4195	0.404071715	2.561353443	0	0.271915441	2.004123387	0.768427808	1.067128161	9.358111911	2.988189217	4.724242403	1.429661837	0.006682982	5.568320024	4.048486313	5.523710251	0.046480165	1.273475407	0	0	3.074113639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.538	0	6.333891091	17.4195	0.404071715	2.561353443	0	0.271915441	2.004123387	0.768427808	1.067128161	9.358111911	2.988189217	4.724242403	1.429661837	0.006682982	5.568320024	4.048486313	5.523710251	0.046480165	1.273475407	0	0	3.074113639	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.538	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	0%-20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		$0/Visit	20% Coins	20% Coins									$0/Service	$0/Visit									6000	2.6541	0.0616	0.3867	0	1.0857	1.319	0.5057	0.1592	1.483	0.4549	0.7485	0.2176	0.001	0.8477	0.7316	0.9981	0.0084	0.2138		0	0.5555	0									0	0									12.432	0	1.261352226	20.0736	0.465636563	2.948030989	0	1.357595743	3.323116431	1.274160469	1.226293281	10.84109873	3.443050154	5.47278845	1.64728437	0.007700156	6.415975582	4.78005646	6.521856456	0.054879127	1.48726721	0	0	3.629612686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.97
H8145_097_0	2011	2	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Radiology									Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin							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	NO	216.470032	5.185899	26.835854	379.858394	1.645594	13.324678	3.929004	331.848757	54.495404	15.411974	23.582891	6.43185	0.130346	25.91853	23.80088	34.039611	0.511411	6.406036		1042.366981	15.735473	0							5.05	0.49	716.737675	182.946527										Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"0%-20% Coins:8a. 0% Lab -- FSL,8a. 20% Lab -- OP"	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"20% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"										0.079379	0.079379	0.14941	0	0.2	0.2	0.2	50	0.2	0.185251	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0							0	0	0	0									NO	0.060942	0.060942	0.063106	0	0.160907	0.160907	0.160907	40.22665	0.160907	0.14904	0.160907	0.160907	0.160907	0.160907	0.160907	0.160907	0.160907	0.160907		0	0.160907	0							0	0	0	0										13.1921	0.316039057	1.693503403	0	0.264787594	2.144033963	0.632204247	1.112430317	8.768691971	2.297000605	3.794652242	1.034929688	0.020973584	4.170472907	3.829728198	5.477211687	0.08228961	1.030776035	0	0	2.531947754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3938	0	15.43874501	13.1921	0.316039057	1.693503403	0	0.264787594	2.144033963	0.632204247	1.112430317	8.768691971	2.297000605	3.794652242	1.034929688	0.020973584	4.170472907	3.829728198	5.477211687	0.08228961	1.030776035	0	0	2.531947754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3938	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	0%-20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		$0/Visit	20% Coins	20% Coins									$0/Service	$0/Visit									3400	2.0099	0.0481	0.2554	0	1.0592	1.4137	0.4168	0.1662	1.3943	0.3503	0.6097	0.1578	0.0032	0.636	0.6933	0.9916	0.0149	0.1754		0	0.4584	0									0	0									10.8542	0	3.061073575	15.202	0.36418867	1.948874637	0	1.323951455	3.557700143	1.049047378	1.278658016	10.16299404	2.647292901	4.404358649	1.192755511	0.024172294	4.806512715	4.523040025	6.468774138	0.097186887	1.206223002	0	0	2.990317154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.248
H8145_099_0	2011	4	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Surgery	Professional							Prosthetics/Supplies	Radiology		Therapy (PT/OT/ST)							D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	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	1264.009418	47.480879	296.540645	165.170875	2.093281	21.087261	3.223308	359.257389	41.747972	13.105128	18.585344	7.709091	0	18.995786	2744.572216	3000.498315	64.704703	1.820151		910.993721	19.388986	0							3.43	0.49	893.397975	349.085479	0	731.371999								$250/Day(Days 1-7):1a.IP Acute	$250/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	"0%-25% Coins:8a. 0% Lab -- FSL,8a. 25% Lab -- OP"	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 20% Psych -- OP,8b. 20% Rad therapy,3, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								179.655	153.80975	43.922851	0	0.2	0.2	0.2	50	0.239219	0.241812	0.241496	0.25	0	0.230692	15	33.867628	35	0.25		0	0.2	0							0	0	0	14.435066	0	35							NO	136.185137	116.593481	25.818555	0	0.158972	0.158972	0.158972	39.74305	0.190146	0.192207	0.191955	0.198715	0	0.183368	11.922915	26.920056	27.820135	0.198715		0	0.158972	0							0	0	0	11.473871	0	27.820135								14.3449	0.46133008	0.638020913	0	0.332773067	3.352284056	0.512415719	1.189832031	7.938209884	2.518897337	3.567549708	1.531912018	0	3.483219287	2.72694177	6.731131889	0.150007798	0.361691306	0	0	3.082305882	0	0	0	0	0	0	0	0	0	0	0.333780146	0	1.695572312	0	0	0	0	0	0	54.9528	0	15.36992785	14.3449	0.46133008	0.638020913	0	0.332773067	3.352284056	0.512415719	1.189832031	7.938209884	2.518897337	3.567549708	1.531912018	0	3.483219287	2.72694177	6.731131889	0.150007798	0.361691306	0	0	3.082305882	0	0	0	0	0	0	0	0	0	0	0.333780146	0	1.695572312	0	0	0	0	0	0	54.9528	YES	30% Coins	30% Coins	$0/Day(Days 1-20) $137(Days 21-100)	25% Coins	20% Coins	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	20%-30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	$0/Service									40% Coins	30% Coins	30% Coins	30% Coins							3400	3.1595	0.0363	0.0313	0.7399	0.9308	3.0911	0.4725	0.1243	1.0616	0.3332	0.4726	0.196	0	0.4368	0.6834	1.1091	0.0193	0.0463		0.0968	0.4264	0									0.3023	0.2431	0.4472	0.1612							14.6212	0	20.54077828	17.5045	0.497634902	0.669342502	0.739904254	1.263542706	6.443396464	0.984910101	1.314152707	8.999768037	2.85213169	4.040133519	1.727937051	0	3.920055473	3.410380517	7.840225632	0.169293057	0.40797366	0	0.096781791	3.508748903	0	0	0	0	0	0	0	0	0	0.302327315	0.576872557	0.447242635	1.856767359	0	0	0	0	0	0	69.574
H8145_100_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Radiology									Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin							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	NO	312.766618	3.593862	20.64129	165.170875	2.093281	21.087261	3.223308	359.257389	56.564345	13.105128	25.503377	7.709091	0	18.995786	22.641145	36.742357	0.638887	7.160262		910.993721	19.388986	0							3.43	0.49	893.397975	205.112										Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"0%-20% Coins:8a. 0% Lab -- FSL,8a. 20% Lab -- OP"	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"20% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"										0.078539	0.078539	0.158536	0	0.2	0.2	0.2	50	0.2	0.19345	0.2	0.2	0	0.2	0.2	0.2	0.2	0.2		0	0.2	0							0	0	0	0									NO	0.070559	0.070559	0.111142	0	0.179951	0.179951	0.179951	44.9877	0.179951	0.174057	0.179951	0.179951	0	0.179951	0.179951	0.179951	0.179951	0.179951		0	0.179951	0							0	0	0	0										22.0685	0.253579309	2.294114253	0	0.376688009	3.794673704	0.580037498	1.34684697	10.17881045	2.281039264	4.589358195	1.387258635	0	3.418310686	4.074296684	6.611823885	0.114968355	1.288496307	0	0	3.48906742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1479	0	8.35292312	22.0685	0.253579309	2.294114253	0	0.376688009	3.794673704	0.580037498	1.34684697	10.17881045	2.281039264	4.589358195	1.387258635	0	3.418310686	4.074296684	6.611823885	0.114968355	1.288496307	0	0	3.48906742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1479	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	0%-20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		$0/Visit	20% Coins	20% Coins									$0/Service	$0/Visit									6000	3.3412	0.0384	0.3424	0	1.4955	2.4833	0.3796	0.1998	1.6162	0.3453	0.7299	0.21	0	0.5175	0.7321	1.188	0.0207	0.2222		0	0.6269	0									0	0									14.4889	0	1.861995459	25.4097	0.291971199	2.636530687	0	1.87220798	6.278005856	0.959629158	1.546599999	11.79499388	2.626299123	5.319264186	1.597234938	0	3.935782349	4.806376354	7.799852783	0.135626162	1.510740054	0	0	4.115991938	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.6368
H8145_103_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Radiology	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1281.390989	104.384332	437.316131	342.014118	2.800441	12.732135	4.678742	372.773049	45.326388	14.831332	21.193848	4.58235	0.213904	13.160652	3526.194169	4510.95977	101.051263	1.816247		1484.98026	32.687391	0							4.86	0.51	547.679498	208.906869	209.568023	0	759.425064							$225/Day(Days 1-5):1a.IP Acute	$225/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	"0%-25% Coins:8a. 0% Lab -- FSL,8a. 25% Lab -- OP"	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$20/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$20-$40/Visit:7b. $20 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$40/Visit:8b.Advanced Imaging -- Office	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$40/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							139.3002	112.142475	45.243839	0	0.2	0.2	0.2	50	0.23625	0.124828	0.220191	0.25	0.2	0.232647	20	38.957707	40	0.25		0	0.2	0							0	0	0	40	0	0	40						NO	130.01417	104.666833	39.048645	0	0.183558	0.183558	0.183558	45.8896	0.216828	0.114567	0.202089	0.229448	0.183558	0.213522	18.35584	35.755072	36.71168	0.229448		0	0.183558	0							0	0	0	36.71168	0	0	36.71168							13.8832	0.910464787	1.423050196	0	0.514043349	2.337085236	0.858820524	1.425533842	9.828030057	1.699181213	4.283043548	1.051411043	0.03926379	2.810088736	5.393854665	13.44080761	0.309146803	0.416734242	0	0	6.000032117	0	0	0	0	0	0	0	0	0	0	0.639110177	0	0	2.323314161	0	0	0	0	0	69.5863	0	6.06277495	13.8832	0.910464787	1.423050196	0	0.514043349	2.337085236	0.858820524	1.425533842	9.828030057	1.699181213	4.283043548	1.051411043	0.03926379	2.810088736	5.393854665	13.44080761	0.309146803	0.416734242	0	0	6.000032117	0	0	0	0	0	0	0	0	0	0	0.639110177	0	0	2.323314161	0	0	0	0	0	69.5863	YES	$1200/Admit	$1200/Admit	40% Coins(Days 1-20) 40%(Days 21-100)	$0/Visit	20% Coins	35% Coins	35% Coins	$50/Visit	25% Coins	0%-25% Coins	25% Coins	25% Coins	20% Coins	20%-25% Coins	25% Coins	25% Coins	25% Coins	25% Coins		$0/Visit	20% Coins	$0/Service									35% Coins	25% Coins	$0/Visit	$0/Visit	25% Coins						6700	3.2061	0.1304	0.6666	0	1.885	2.4722	0.9085	0.1953	1.454	0.2376	0.6799	0.147	0.0055	0.405	1.3632	3.2058	0.0377	0.0583		0	0.9958	0									0.2445	0.2589	0	0	0.2895						18.8465	0	4.569472633	17.0894	1.040835663	2.089646187	0	2.399080339	4.809280182	1.767290467	1.620815253	11.2820049	1.936733609	4.962897627	1.198403131	0.044753097	3.215075755	6.757101547	16.64656943	0.346826257	0.474995651	0	0	6.995824653	0	0	0	0	0	0	0	0	0	0.244505027	0.897967713	0	0	2.61279326	0	0	0	0	0	88.4328
H8145_104_0	2011	4	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	755.777455	106.260255	456.649949	312.612552	1.324613	11.792021	2.816766	343.015283	45.332387	12.976217	14.589983	4.613029	0.090757	27.141551	2240.802554	2558.895093	76.337795	2.044902		943.719906	10.121684	0							5.38	0.49	742.168873	264.834009	289.388218	0	525.793551							$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	43.922851	0	0.2	0.2	0.2	50	0.238918	0.25	0.242513	0.25	0.2	0.235271	15	32.91598	35	0.25		0	0.2	0							0	0	0	0	13.41331	0	35						NO	137.750723	117.933841	28.711885	0	0.16942	0.16942	0.16942	42.3551	0.202388	0.211776	0.205434	0.211776	0.16942	0.199299	12.70653	27.883193	29.64857	0.211776		0	0.16942	0							0	0	0	0	11.362442	0	29.64857							8.6757	1.044306668	1.092606735	0	0.224415934	1.997804198	0.477216496	1.210703884	9.17473114	2.748051331	2.997278568	0.97692883	0.015376051	5.409283973	2.372735406	5.945847145	0.188608872	0.433061166	0	0	1.714815703	0	0	0	0	0	0	0	0	0	0	0	0.27401307	0	1.299085575	0	0	0	0	0	48.2726	0	9.029371006	8.6757	1.044306668	1.092606735	0	0.224415934	1.997804198	0.477216496	1.210703884	9.17473114	2.748051331	2.997278568	0.97692883	0.015376051	5.409283973	2.372735406	5.945847145	0.188608872	0.433061166	0	0	1.714815703	0	0	0	0	0	0	0	0	0	0	0	0.27401307	0	1.299085575	0	0	0	0	0	48.2726	YES	$275/Day(Days 1-7)	$275/Day(Days 1-7)	$0/Day(Days 1-20) $137(Days 21-100)	25% Coins	20% Coins	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	20%-30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	$0/Service									40% Coins	30% Coins	30% Coins	30% Coins	30% Coins						3400	1.2959	0.156	0.1238	1.5477	0.7762	2.278	0.5441	0.1564	1.5191	0.4348	0.4889	0.1546	0.002	0.8325	0.8447	1.3102	0.028	0.0685		0.1257	0.3204	0									0.3342	0.0348	0.3064	0.5038	0.1605						14.3471	0	5.42990498	9.9716	1.200292332	1.216426206	1.547676431	1.000609007	4.275776995	1.021356896	1.367132702	10.69381747	3.182883986	3.486188457	1.131511341	0.017403531	6.241779455	3.217396792	7.256008721	0.216584796	0.501585732	0	0.125708944	2.035231846	0	0	0	0	0	0	0	0	0	0.334171729	0.034790761	0.580412428	0.503760007	1.459544188	0	0	0	0	0	62.6197
H8145_107_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Radiology									Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin							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	NO	229.920825	3.41246	37.31625	1122.453165	2.013337	23.133328	4.097635	360.879334	59.548295	14.690261	21.129259	3.117168	0.707194	18.437833	27.310114	39.672976	0.648559	5.986322		1128.388497	22.578384	0							5.05	0.49	705.746641	145.280759										Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"0%-20% Coins:8a. 0% Lab -- FSL,8a. 20% Lab -- OP"	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"20% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"										0.082768	0.082768	0.163926	0	0.2	0.2	0.2	50	0.2	0.187001	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0	0.2	0							0	0	0	0									NO	0.059479	0.059479	0.051664	0	0.155168	0.155168	0.155168	38.79205	0.155168	0.145083	0.155168	0.155168	0.155168	0.155168	0.155168	0.155168	0.155168	0.155168		0	0.155168	0							0	0	0	0										13.6755	0.202969708	1.92790674	0	0.312405476	3.589552239	0.635821828	1.166604097	9.239989839	2.131307137	3.278584861	0.483684724	0.109733879	2.860961671	4.237655769	6.15597634	0.100635603	0.928885612	0	0	3.503442689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5416	0	20.81489711	13.6755	0.202969708	1.92790674	0	0.312405476	3.589552239	0.635821828	1.166604097	9.239989839	2.131307137	3.278584861	0.483684724	0.109733879	2.860961671	4.237655769	6.15597634	0.100635603	0.928885612	0	0	3.503442689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5416	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	0%-20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		$0/Visit	20% Coins	20% Coins									$0/Service	$0/Visit									3400	2.1096	0.0313	0.2946	0	1.2614	2.3891	0.4232	0.176	1.4885	0.3281	0.5379	0.0745	0.0169	0.4405	0.7744	1.125	0.0184	0.1596		0	0.6402	0									0	0									12.2892	0	4.176158979	15.7851	0.234280842	2.222514497	0	1.573847926	5.978678154	1.059010721	1.342572994	10.72848089	2.459400086	3.816498513	0.558143118	0.126626423	3.301424203	5.012063634	7.280946717	0.119026212	1.088477443	0	0	4.143677267	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.8308
H8145_108_0	2011	1	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	1102.817129	51.698696	482.613686	398.843787	1.752117	9.907094	2.991425	345.797771	30.917634	8.679742	10.897314	2.98827	0.205992	19.002257	2731.344514	2268.268891	128.096808	1.534701		1344.316631	17.410124	0							3.72	0.58	1477.793408	357.682249	204.638861	0	0	287.215729						$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist"						147.067245	128.620245	34.44565	0	0.2	0.2	0.2	50	0.243792	0.25	0.245633	0.25	0.2	0.229053	15	35	35	0.25		0	0.2	0							0	0	0	0	14.187896	0	0	15					NO	135.910136	118.862599	28.304163	0	0.182774	0.182774	0.182774	45.69345	0.222794	0.228467	0.224476	0.228467	0.182774	0.209325	13.708035	31.985415	31.985415	0.228467		0	0.182774	0							0	0	0	0	12.965878	0	0	13.708035						12.4903	0.512086781	1.13833137	0	0.320241433	1.810759199	0.546754713	1.31672443	6.888263349	1.983034616	2.446185457	0.682721082	0.037649982	3.977647447	3.12011385	6.045960151	0.341435797	0.350628533	0	0	3.182118004	0	0	0	0	0	0	0	0	0	0	0	0.221110209	0	0	0.328096939	0	0	0	0	47.7402	0	4.481093214	12.4903	0.512086781	1.13833137	0	0.320241433	1.810759199	0.546754713	1.31672443	6.888263349	1.983034616	2.446185457	0.682721082	0.037649982	3.977647447	3.12011385	6.045960151	0.341435797	0.350628533	0	0	3.182118004	0	0	0	0	0	0	0	0	0	0	0	0.221110209	0	0	0.328096939	0	0	0	0	47.7402	YES	$195/Day(Days 1-8)	$195/Day(Days 1-8)	$0/Day(Days 1-7) $50(Days 8-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins										20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					4500	1.8681	0.0766	0.1705	0	1.2824	1.1952	0.3609	0.197	1.0516	0.3027	0.3734	0.1042	0.0057	0.6073	0.5512	1.0681	0.0603	0.0535		0	0.5767										0.4182	0	0.0391	0	0	0.058					10.4207	0	0.967103548	14.3584	0.588674804	1.308783942	0	1.602613061	3.005976732	0.907647959	1.513692512	7.939857349	2.285774554	2.819632682	0.786948903	0.043397946	4.58492761	3.671327088	7.114066458	0.401755369	0.404157295	0	0	3.758815336	0	0	0	0	0	0	0	0	0	0.418208393	0	0.260172527	0	0	0.386060009	0	0	0	0	58.1609
H8145_109_0	2011	4	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery						Prosthetics/Supplies	Lab	Radiology	Other							D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	866.815549	76.309411	416.194328	210.483126	37.600175	9.275616	4.942702	417.695032	0	904.354583	0	319.254717	0.005261	7.407762	3597.291156	3163.07784	84.310339	866.321469		1404.520395	20.565948	0							4.39	0.49	908.908181	1006.310596	1034.628238	1323.646771	325.995481							$250/Day(Days 1-7):1a.IP Acute	$250/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	$0/Visit:8a.Lab -- FSL	$0/Visit:8b.Radiology OP -- Physician	$125/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$125/Visit:7c, 7d, 7i. $125 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$100/Visit:8a.Lab -- OP	"$0-$125/Visit:8b, 9a. $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,8b, 9a. $125 Advanced Imaging -- OP,8b. $125 Radiology OP -- Facility"	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,3, 7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- CORF"	"$75-$125/Visit:9b. $75 Surgery ASC -- Facility,9a. $125 Surgery OP -- Facility"							179.655	153.80975	42.271616	0	100	0.2	0.2	50	0	0	0	125	0.2	0.2	15	32.69879	35	62.961809		0	0.2	0							0	0	0	100	72.024934	112.452815	103.026071						NO	136.422282	116.79651	23.684956	0	77.8775	0.155755	0.155755	38.93875	0	0	0	97.346875	0.155755	0.155755	11.681625	25.465	27.257125	49.033083		0	0.155755	0							0	0	0	77.8775	56.091218	87.575441	80.234129							9.8544	0.74272274	0.821462029	0	0.244017302	1.44472357	0.76985055	1.355376869	0	0	0	2.589870752	0.000819427	1.15379597	3.501850525	6.712314766	0.191504787	3.539867708	0	0	3.203249231	0	0	0	0	0	0	0	0	0	0	6.53074612	4.836129837	9.659912475	2.179663623	0	0	0	0	0	59.3323	0	17.61365307	9.8544	0.74272274	0.821462029	0	0.244017302	1.44472357	0.76985055	1.355376869	0	0	0	2.589870752	0.000819427	1.15379597	3.501850525	6.712314766	0.191504787	3.539867708	0	0	3.203249231	0	0	0	0	0	0	0	0	0	0	6.53074612	4.836129837	9.659912475	2.179663623	0	0	0	0	0	59.3323	YES	$250/Day(Days 1-7)	$250/Day(Days 1-7)	$0/Day(Days 1-20) $128(Days 21-100)	40% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	20% Coins	30% Coins	$125/Visit	20% Coins	20% Coins	$15/Visit	$15-$35/Visit	$35/Visit	$35-$125/Visit		$0/Visit	20% Coins	$0/Service									40% Coins	$100/Visit	$0-$125/Visit	$50-$125/Visit	$75-$125/Visit						3400	1.2985	0.0979	0.1034	2.1287	0.8923	1.7415	0.928	0.1851	0.5253	0.0798	0.1545	0.3538	0.0001	0.1608	0.5649	1.0828	0.0309	0.5171		0	0.5301	0									0.3994	0.8921	0.6746	1.3195	0.2977						14.9588	0	6.251282907	11.1529	0.840587597	0.924862276	2.128702166	1.136275716	3.186268447	1.697867981	1.54051429	0.525287434	0.079805832	0.154536066	2.943633611	0.000933617	1.314638803	4.066761458	7.795130835	0.222397924	4.056930042	0	0	3.73334665	0	0	0	0	0	0	0	0	0	0.399387533	7.422812028	5.510759101	10.97940621	2.477394319	0	0	0	0	0	74.2911
H8145_110_0	2011	6	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	O							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1167.74387	53.333938	707.630173	208.891139	1.918609	8.445962	2.667509	338.231403	58.135034	19.662581	23.004677	6.379426	0.260822	30.179408	2893.273258	3304.775288	102.434357	3.669478		1911.713032	27.172389	0							6.04	0.6	591.396455	748.534491	329.877427	0	444.987525							$250/Day(Days 1-7):1a.IP Acute	$250/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							179.655	153.80975	45.243839	0	0.2	0.2	0.2	50	0.244473	0.25	0.247921	0.25	0.2	0.234736	15	32.92021	35	0.25		0	0.2	0							0	0	0	0	19.522212	0	35						NO	165.750242	141.905337	36.162812	0	0.182299	0.182299	0.182299	45.57485	0.222837	0.227874	0.225979	0.227874	0.182299	0.213961	13.672455	30.006673	31.902395	0.227874		0	0.182299	0							0	0	0	0	17.794438	0	31.902395							16.1295	0.630697537	2.132491409	0	0.349760502	1.539690427	0.486284223	1.284570455	12.95463657	4.480590983	5.198573904	1.45370532	0.04754759	6.457216315	3.296512369	8.26377595	0.27232511	0.83617863	0	0	4.953499342	0	0	0	0	0	0	0	0	0	0	0	0.489165285	0	1.183013983	0	0	0	0	0	72.4397	0	7.140731749	16.1295	0.630697537	2.132491409	0	0.349760502	1.539690427	0.486284223	1.284570455	12.95463657	4.480590983	5.198573904	1.45370532	0.04754759	6.457216315	3.296512369	8.26377595	0.27232511	0.83617863	0	0	4.953499342	0	0	0	0	0	0	0	0	0	0	0	0.489165285	0	1.183013983	0	0	0	0	0	72.4397	YES	$250/Day(Days 1-7)	$250/Day(Days 1-7)	$0/Day(Days 1-20) $137(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	$0/Service									20% Coins	$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit						6700	2.4151	0.0944	0.3202	0	1.4025	1.0177	0.3214	0.1924	1.9804	0.6849	0.7947	0.2222	0.0073	0.9872	0.5832	1.4619	0.0482	0.1278		0	0.8989	0									0.1834	0	0.0865	0	0.2093						14.0394	0	1.342025743	18.5446	0.725132451	2.452648503	0	1.752212116	2.557345842	0.807692767	1.476985264	14.9349923	5.165534033	5.993273554	1.675931574	0.054816026	7.444380263	3.879666699	9.725641137	0.320499528	0.964004212	0	0	5.852426919	0	0	0	0	0	0	0	0	0	0.183416809	0	0.575698817	0	1.392289622	0	0	0	0	0	86.4792
H8145_111_0	2011	1	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	NO	254.038319	6.526507	457.726693	568.507852	2.134048	13.975513	5.138148	394.669508	56.551236	9.144927	20.896914	2.899938	0.404085	14.339201	33.13928	43.998543	0.49625	4.418924		1270.889698	18.174186	0							3.62	0.58	2055.642206	482.817873	132.04019									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	20% Coins:8a.Lab -- OP	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"									0.08994	0.08994	45.408962	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	0.2	0							0	0	0	0	0								NO	0.083977	0.083977	38.593895	0	0.18525	0.18525	0.18525	46.31245	0.18525	0.18525	0.18525	0.18525	0.18525	0.18525	0.18525	0.18525	0.18525	0.18525		0	0.18525	0							0	0	0	0	0									21.3334	0.548076478	1.472121327	0	0.395332392	2.588963783	0.951841917	1.523175988	10.47611647	1.694097727	3.871153319	0.537213515	0.074856746	2.656336985	6.13905162	8.150730091	0.091930313	0.818605671	0	0	3.366767957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6897	0	5.264319403	21.3334	0.548076478	1.472121327	0	0.395332392	2.588963783	0.951841917	1.523175988	10.47611647	1.694097727	3.871153319	0.537213515	0.074856746	2.656336985	6.13905162	8.150730091	0.091930313	0.818605671	0	0	3.366767957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6897	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Day(Days 1-20) $137(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		$0/Visit	20% Coins	$0/Service									$0/Service	$0/Visit	$0/Visit								6700	3.2723	0.0841	0.2218	0	1.5903	1.7167	0.6311	0.2289	1.6734	0.2598	0.6449	0.0824	0.0115	0.4074	1.1176	1.4839	0.0167	0.1412		0	0.6129	0									0	0	0								14.1969	0	1.040822066	24.6057	0.632146188	1.693961093	0	1.985596497	4.305617091	1.582975676	1.752063111	12.14950556	1.95390268	4.516040424	0.619600019	0.086336715	3.063749951	7.256695037	9.634608778	0.10866664	0.959810111	0	0	3.979704077	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.8867
H8145_112_0	2011	3	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	NO	268.785657	6.222187	422.037948	1294.634439	1.679178	14.329266	4.916295	402.8969	54.178968	8.722345	24.077654	7.782666	0.06292	27.775889	28.126529	40.431512	0.466177	6.743923		1751.420249	16.638667	0							3.85	0.73	2184.54535	410.962661	140.805437									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	20% Coins:8a.Lab -- OP	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"									0.086682	0.086682	45.408962	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	0.2	0							0	0	0	0	0								NO	0.080555	0.080555	38.380382	0	0.184211	0.184211	0.184211	46.0527	0.184211	0.184211	0.184211	0.184211	0.184211	0.184211	0.184211	0.184211	0.184211	0.184211		0	0.184211	0							0	0	0	0	0									21.652	0.501228274	1.349831472	0	0.309323059	2.639608419	0.905635618	1.546207506	9.980361874	1.606751895	4.435368721	1.433652687	0.011590556	5.116624289	5.181216034	7.447929257	0.085874931	1.2423048	0	0	3.065025487	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5106	0	5.789763179	21.652	0.501228274	1.349831472	0	0.309323059	2.639608419	0.905635618	1.546207506	9.980361874	1.606751895	4.435368721	1.433652687	0.011590556	5.116624289	5.181216034	7.447929257	0.085874931	1.2423048	0	0	3.065025487	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5106	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Day(Days 1-20) $137(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		$0/Visit	20% Coins	$0/Service									$0/Service	$0/Visit	$0/Visit								6700	3.3467	0.0775	0.2067	0	1.2555	1.766	0.6059	0.2344	1.6207	0.2486	0.7307	0.2218	0.0018	0.7918	0.9518	1.3681	0.0158	0.2101		0	0.563	0									0	0	0								14.217	0	0.989168059	24.9988	0.578702421	1.556577336	0	1.564813739	4.405607685	1.511540899	1.780648465	11.6010152	1.855381074	5.166030845	1.655496546	0.013384244	5.908392186	6.132977513	8.816073124	0.101649705	1.452451368	0	0	3.628054218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.7275
H8145_113_0	2011	1	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	NO	247.960202	5.504543	540.803308	888.360808	2.550234	16.019506	4.087142	387.687892	51.897836	7.14775	22.596151	4.136996	0.166098	18.051882	35.852354	44.949753	1.067781	4.971102		1819.593706	22.213242	0							4.23	0.58	1225.056553	412.681872	148.19973									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	20% Coins:8a.Lab -- OP	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"									0.08803	0.08803	45.408963	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	0.2	0							0	0	0	0	0								NO	0.081868	0.081868	37.786251	0	0.184413	0.184413	0.184413	46.10335	0.184413	0.184413	0.184413	0.184413	0.184413	0.184413	0.184413	0.184413	0.184413	0.184413		0	0.184413	0							0	0	0	0	0									20.3	0.450645926	1.702910795	0	0.470296303	2.95420516	0.753722118	1.489475881	9.57063563	1.318138021	4.167023994	0.762915843	0.03063063	3.329001715	6.611640158	8.2893188	0.196912698	0.916735833	0	0	4.096410597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.4106	0	5.705069804	20.3	0.450645926	1.702910795	0	0.470296303	2.95420516	0.753722118	1.489475881	9.57063563	1.318138021	4.167023994	0.762915843	0.03063063	3.329001715	6.611640158	8.2893188	0.196912698	0.916735833	0	0	4.096410597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.4106	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Day(Days 1-20) $137(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		$0/Visit	20% Coins	$0/Service									$0/Service	$0/Visit	$0/Visit								6700	3.12	0.0693	0.2579	0	1.8963	1.9634	0.5009	0.2243	1.5475	0.2026	0.6892	0.1173	0.0047	0.5118	1.2065	1.5127	0.0359	0.1567		0	0.7475	0									0	0	0								14.7646	0	1.125282609	23.42	0.519908588	1.960819264	0	2.366556828	4.917641787	1.254663992	1.713824289	11.11817673	1.520761409	4.856211347	0.880190817	0.035339059	3.84078251	7.81814971	9.801975628	0.232845761	1.073428393	0	0	4.8439342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.1753
H8145_114_0	2011	2	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	NO	237.672687	5.126445	532.971618	422.774085	1.943057	13.712886	4.010808	376.333948	48.560939	8.463052	20.826589	7.506222	0.178118	17.038569	35.084181	46.192558	0.637016	4.530076		1726.555376	17.301199	0							4.38	0.41	1990.30588	458.601452	141.625469									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	20% Coins:8a.Lab -- OP	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"									0.080846	0.080846	45.408962	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	0.2	0							0	0	0	0	0								NO	0.076102	0.076102	39.049664	0	0.186501	0.186501	0.186501	46.62515	0.186501	0.186501	0.186501	0.186501	0.186501	0.186501	0.186501	0.186501	0.186501	0.186501		0	0.186501	0							0	0	0	0	0									18.0874	0.390132717	1.73436355	0	0.362382074	2.557466952	0.748019703	1.462218898	9.056663684	1.578367661	3.884179675	1.399917909	0.033219185	3.177710157	6.543234841	8.61495826	0.118804121	0.844863704	0	0	3.226690915	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8206	0	4.590700002	18.0874	0.390132717	1.73436355	0	0.362382074	2.557466952	0.748019703	1.462218898	9.056663684	1.578367661	3.884179675	1.399917909	0.033219185	3.177710157	6.543234841	8.61495826	0.118804121	0.844863704	0	0	3.226690915	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8206	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Day(Days 1-20) $137(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		$0/Visit	20% Coins	$0/Service									$0/Service	$0/Visit	$0/Visit								6700	2.769	0.0597	0.2603	0	1.4546	1.6921	0.4949	0.2192	1.4496	0.2415	0.6392	0.2142	0.0051	0.4863	1.1886	1.565	0.0216	0.1418		0	0.5862	0									0	0	0								13.4889	0	0.924459922	20.8564	0.449858442	1.994683075	0	1.816933343	4.249551623	1.242928602	1.681468892	10.50626641	1.819898527	4.523349122	1.614141379	0.038302665	3.664026567	7.731873519	10.17994472	0.140386123	0.986633322	0	0	3.812849233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3095
H8145_115_0	2011	3	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	O							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	NO	259.552903	5.6286	455.791135	469.087907	2.013339	12.715797	4.093071	378.998081	54.907699	8.771044	23.303119	2.789253	0.174345	20.236603	34.104321	52.565334	1.105895	5.491292		1727.202922	21.212051	0							3.83	0.41	1708.430101	450.397715	249.695424									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	20% Coins:8a.Lab -- OP	"20% Coins:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins:7e, 7h.Psych -- Other Provider"	"20% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"									0.080069	0.080069	45.408962	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	0.2	0							0	0	0	0	0								NO	0.074755	0.074755	38.74942	0	0.18478	0.18478	0.18478	46.195	0.18478	0.18478	0.18478	0.18478	0.18478	0.18478	0.18478	0.18478	0.18478	0.18478		0	0.18478	0							0	0	0	0	0									19.4029	0.420765993	1.47180351	0	0.37202478	2.34962497	0.756317659	1.458984696	10.14584462	1.62071351	4.305950329	0.515398169	0.032215469	3.739319502	6.301796434	9.713022417	0.204347278	1.014680936	0	0	3.919562784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7453	0	5.488156523	19.4029	0.420765993	1.47180351	0	0.37202478	2.34962497	0.756317659	1.458984696	10.14584462	1.62071351	4.305950329	0.515398169	0.032215469	3.739319502	6.301796434	9.713022417	0.204347278	1.014680936	0	0	3.919562784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7453	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Day(Days 1-20) $137(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		$0/Visit	20% Coins	$0/Service									$0/Service	$0/Visit	$0/Visit								6700	2.9736	0.0645	0.2213	0	1.495	1.5564	0.501	0.219	1.6234	0.2483	0.7106	0.079	0.0049	0.5729	1.1461	1.7665	0.0372	0.1754		0	0.7129	0									0	0	0								14.108	0	1.080524298	22.3764	0.485249968	1.693143836	0	1.867024574	3.906011698	1.257300889	1.678004782	11.76926331	1.869014054	5.016592875	0.594359339	0.03715118	4.312232908	7.447912654	11.47954295	0.241512137	1.190039397	0	0	4.632419234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8532
H8145_117_0	2011	2	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Lab	Radiology								Coin	Coin	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	O							O	O	O	V	V								0.300343987	0.006132279	0.021652616	0	0.018755352	0.11963708	0.039504029	0.068405071	0.501144733	0.094348784	0.203156652	0.05538084	0.00559504	0.19273067	0.28838175	0.493645305	0.004968652	0.050982575		0	0.228646944	0							0	0	0	0	0								2.6934	NO	276.317156	5.641711	447.908321	556.964	2.166846	13.821928	4.563985	379.343246	57.898324	10.900317	23.471123	6.398267	0.646407	22.266587	33.317361	57.031899	0.574039	5.890126		1488.844291	26.416071	0							3.9	0.41	1485.335436	603.766413	154.691843									Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	20% Coins after payment of $50 Part B deductible:10a.Ambulance Emergency	20% Coins after payment of $50 Part B deductible:11a.DME	"20% Coins after payment of $50 Part B deductible:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20% Coins after payment of $50 Part B deductible:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	20% Coins after payment of $50 Part B deductible:8a.Lab -- OP	"20% Coins after payment of $50 Part B deductible:8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	20% Coins after payment of $50 Part B deductible:9a.Observation	"20% Coins after payment of $50 Part B deductible:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"20% Coins after payment of $50 Part B deductible:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"20% Coins after payment of $50 Part B deductible:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"20% Coins after payment of $50 Part B deductible:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"20% Coins after payment of $50 Part B deductible:7e, 7h.Psych -- Other Provider"	"20% Coins after payment of $50 Part B deductible:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		$0/Visit:14b-j.Preventive Services	"20% Coins after payment of $50 Part B deductible:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"									0.079976	0.079976	45.408963	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	0.2	0							0	0	0	0	0								NO	0.07369	0.07369	37.598167	0	0.182346	0.182346	0.182346	45.5864	0.182346	0.182346	0.182346	0.182346	0.182346	0.182346	0.182346	0.182346	0.182346	0.182346		0	0.182346	0							0	0	0	0	0									20.3618	0.415737684	1.403377654	0	0.395115701	2.520373283	0.832224409	1.441074412	10.55752779	1.987629204	4.279865395	1.166698394	0.117869731	4.060223073	6.075287509	10.39953866	0.104673715	1.074040916	0	0	4.816864883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.0099	50	6.888298218	20.6622	0.421869963	1.42503027	0	0.413871053	2.640010363	0.871728437	1.509479483	11.05867252	2.081977987	4.483022047	1.222079234	0.123464771	4.252953744	6.363669259	10.89318396	0.109642367	1.12502349	0	0	5.045511827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.7033	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Day(Days 1-20) $137(Days 21-100)	$0/Visit	20% Coins after payment of $50 Part B deductible	20% Coins after payment of $50 Part B deductible	20% Coins after payment of $50 Part B deductible	$50/Visit	20% Coins after payment of $50 Part B deductible	20% Coins after payment of $50 Part B deductible	20% Coins after payment of $50 Part B deductible	20% Coins after payment of $50 Part B deductible	20% Coins after payment of $50 Part B deductible	20% Coins after payment of $50 Part B deductible	20% Coins after payment of $50 Part B deductible	20% Coins after payment of $50 Part B deductible	20% Coins after payment of $50 Part B deductible	20% Coins after payment of $50 Part B deductible		$0/Visit	20% Coins after payment of $50 Part B deductible	$0/Service									$0/Service	$0/Visit	$0/Visit								6700	3.1713	0.0647	0.2151	0	1.6732	1.7593	0.5809	0.228	1.7833	0.3209	0.7398	0.1884	0.019	0.6556	1.1644	1.9932	0.0201	0.194		0	0.9232	0									0	0	0								15.6944	50	1.33538671	23.8334	0.486619854	1.640103884	0	2.087113194	4.399347963	1.452659948	1.737453799	12.84196362	2.402879876	5.222788863	1.410442177	0.142494907	4.908531666	7.528053905	12.88635096	0.129704165	1.319059026	0	0	5.968708376	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3977
H8145_120_0	2011	5	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	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	NO	196.255752	3.511337	21.172634	12.318082	1.657008	10.432161	3.056265	288.665737	43.457485	8.795892	19.600495	4.580194	0.185809	16.859989	21.761557	31.044575	0.518335	4.361848		4.352471	16.52953	0							1.42	0.93	917.547212											Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies											0.08202	0.08202	0.17478	0	0.233	0.233	0.233	50	0.233	0.210624	0.219977	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0							0	0	0										NO	0.069363	0.069363	0.094315	0	0.19938	0.19938	0.19938	42.7855	0.19938	0.180233	0.188236	0.19938	0.19938	0.19938	0.19938	0.19938	0.19938	0.19938		0	0.19938	0							0	0	0											13.6129	0.243556868	1.996896976	0	0.330374255	2.07996426	0.609358116	1.029225658	8.664553359	1.585310003	3.689518777	0.91319908	0.037046598	3.361544607	4.338819235	6.189667364	0.103345632	0.869665254	0	0	3.295657691	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9506	0	10.4875421	13.6129	0.243556868	1.996896976	0	0.330374255	2.07996426	0.609358116	1.029225658	8.664553359	1.585310003	3.689518777	0.91319908	0.037046598	3.361544607	4.338819235	6.189667364	0.103345632	0.869665254	0	0	3.295657691	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9506	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	Medicare FFS Cost Sharing									20% Coins										5000	6.0198	0.1077	0.87	0	1.7226	2.4971	0.7316	0.4465	3.9149	0.7019	1.6834	0.4043	0.0164	1.4883	2.0803	2.9677	0.0496	0.4035		0	1.5801	0									0.3961										28.0817	0	5.693795785	19.6327	0.351260424	2.866877923	0	2.05301038	4.577059076	1.340921478	1.475705506	12.57949026	2.287160041	5.372966313	1.317491527	0.053448016	4.84988623	6.419106728	9.157361088	0.152895825	1.273119284	0	0	4.875791369	0	0	0	0	0	0	0	0	0	0.396076387	0	0	0	0	0	0	0	0	0	81.0323
H8145_121_0	2011	2	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Radiology									Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin							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	NO	251.661048	3.978822	41.867494	299.074751	1.745442	8.813688	2.68885	344.192147	57.017275	16.606986	24.297516	4.712987	0.210135	23.504373	25.820524	41.224521	0.779658	6.202181		1514.677261	21.000441	0							4.51	0.6	848.243491	175.481984										Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	20% Coins after payment of Original Medicare Part B deductible:10a.Ambulance Emergency	20% Coins after payment of Original Medicare Part B deductible:11a.DME	"20% Coins after payment of Original Medicare Part B deductible:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"15%-20% Coins after payment of Original Medicare Part B deductible:9b. 15% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 15% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	"0%-20% Coins after payment of Original Medicare Part B deductible:8a. 0% Lab -- FSL,8a. 20% Lab -- OP"	"15%-20% Coins after payment of Original Medicare Part B deductible:8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 15% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 15% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	20% Coins after payment of Original Medicare Part B deductible:9a.Observation	"20% Coins after payment of Original Medicare Part B deductible:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"15%-20% Coins after payment of Original Medicare Part B deductible:9d. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a. 15% OP Other,5. 20% Partial Hospitalization,7h. 20% Psych -- OP,8b. 20% Rad therapy,3, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"15% Coins after payment of Original Medicare Part B deductible:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"15% Coins after payment of Original Medicare Part B deductible:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"15% Coins after payment of Original Medicare Part B deductible:7e, 7h.Psych -- Other Provider"	"15%-20% Coins after payment of Original Medicare Part B deductible:7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. 15% Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"20% Coins after payment of Original Medicare Part B deductible:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"20% Coins after payment of Original Medicare Part B deductible:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"										0.076993	0.076993	0.163937	0	0.233	0.233	0.233	50	0.221577	0.214743	0.218091	0.233	0.233	0.209233	0.183	0.183	0.183	0.207046		0	0.233	0							0	0	0	0									NO	0.065265	0.065265	0.075871	0	0.200993	0.200993	0.200993	43.1315	0.191139	0.185244	0.188132	0.200993	0.200993	0.180491	0.157861	0.157861	0.157861	0.178604		0	0.200993	0							0	0	0	0										16.4247	0.259677818	3.176528637	0	0.350821624	1.771489592	0.540440028	1.237126966	10.89822493	3.076344515	4.57114028	0.947277396	0.042235664	4.242327787	4.076053739	6.50774411	0.123077592	1.107734335	0	0	4.220941638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.5738	0	13.64635336	16.4247	0.259677818	3.176528637	0	0.350821624	1.771489592	0.540440028	1.237126966	10.89822493	3.076344515	4.57114028	0.947277396	0.042235664	4.242327787	4.076053739	6.50774411	0.123077592	1.107734335	0	0	4.220941638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.5738	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	20% Coins after payment of Original Medicare Part B deductible	20% Coins after payment of Original Medicare Part B deductible	20% Coins after payment of Original Medicare Part B deductible	$50/Visit	15%-20% Coins after payment of Original Medicare Part B deductible	0%-20% Coins after payment of Original Medicare Part B deductible	15%-20% Coins after payment of Original Medicare Part B deductible	20% Coins after payment of Original Medicare Part B deductible	20% Coins after payment of Original Medicare Part B deductible	15%-20% Coins after payment of Original Medicare Part B deductible	15% Coins after payment of Original Medicare Part B deductible	15% Coins after payment of Original Medicare Part B deductible	15% Coins after payment of Original Medicare Part B deductible	15%-20% Coins after payment of Original Medicare Part B deductible		$0/Visit	20% Coins after payment of Original Medicare Part B deductible	20% Coins after payment of Original Medicare Part B deductible									$0/Service	$0/Visit									5000	2.5054	0.0396	0.4788	0	1.4039	1.1685	0.3565	0.1849	1.7213	0.4693	0.73	0.1445	0.0064	0.6473	0.7382	1.1786	0.0223	0.1835		0	0.7644	0									0	0									12.7435	0	2.573694553	18.9301	0.299289581	3.655305248	0	1.754676419	2.939977421	0.896918291	1.422060023	12.61954943	3.54566811	5.301158309	1.091793144	0.048679292	4.889590622	4.814250315	7.686333815	0.145367648	1.291237344	0	0	4.98537601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3173
H8145_122_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1199.60699	82.406467	319.836661	617.577819	1.742659	11.962391	3.603409	317.023519	32.456221	6.823432	10.144881	4.089222	0.099674	15.470446	2506.972701	2039.472143	56.940883	1.552674		1283.398147	15.278356	0							4.64	0.93	1292.939363	596.670901	303.982203	0	230.776157							$250/Day(Days 1-7):1a.IP Acute	$250/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $125(Days 21-100):2. $0 SNF 1,2. $125 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							179.655	153.80975	41.280875	0	0.2	0.2	0.2	50	0.240393	0.25	0.24132	0.25	0.2	0.23246	15	34.028473	35	0.25		0	0.2	0							0	0	0	0	23.934036	0	35						NO	158.415288	135.625592	30.976921	0	0.176893	0.176893	0.176893	44.22315	0.212619	0.221116	0.213438	0.221116	0.176893	0.205602	13.266945	30.096925	30.956205	0.221116		0	0.176893	0							0	0	0	0	21.168769	0	30.956205							15.8363	0.931368823	0.825629582	0	0.308264178	2.116063231	0.637417828	1.168314886	6.900809253	1.50876999	2.165303111	0.904192412	0.017631633	3.180754638	2.771655745	5.115153344	0.146889471	0.343321064	0	0	2.702634228	0	0	0	0	0	0	0	0	0	0	0	0.536244086	0	0.595329502	0	0	0	0	0	48.7121	0	6.587806698	15.8363	0.931368823	0.825629582	0	0.308264178	2.116063231	0.637417828	1.168314886	6.900809253	1.50876999	2.165303111	0.904192412	0.017631633	3.180754638	2.771655745	5.115153344	0.146889471	0.343321064	0	0	2.702634228	0	0	0	0	0	0	0	0	0	0	0	0.536244086	0	0.595329502	0	0	0	0	0	48.7121	YES	$250/Day(Days 1-7)	$250/Day(Days 1-7)	$0/Day(Days 1-20) $125(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									20% Coins	$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit						5000	6.8825	0.4048	0.3576	0	1.611	2.5462	0.767	0.508	3.062	0.6695	0.9608	0.4012	0.0078	1.4115	1.2983	2.3961	0.0688	0.1523		0	1.2987	0									0.5744	0	0.2512	0	0.2789						25.9087	0	3.622093467	22.7189	1.336145048	1.183217458	0	1.919247645	4.662240966	1.40439801	1.676280123	9.96285481	2.17824566	3.126100007	1.305403312	0.025455212	4.592204829	4.070000686	7.511278282	0.21569787	0.495660404	0	0	4.001367412	0	0	0	0	0	0	0	0	0	0.574434835	0	0.787440436	0	0.87420362	0	0	0	0	0	74.6207
H8145_123_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O		O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0		0	0	0	0	0						0	NO	775.173964	42.170136	353.783527	268.851965	1.327385	12.115548	2.431546	258.156636	32.386923	9.149469	13.228165	3.206017	0.146638	12.979058	2507.189039	2460.561663	49.699807	1.749781		821.026283	15.774709	0							5.55		525.585865	413.062507	239.288373	0	559.538135							$250/Day(Days 1-7):1a.IP Acute	$250/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a		$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							179.655	153.80975	46.371	0	0.2	0.2	0.2	50	0.234624	0.25	0.237443	0.25	0.2	0.231749	15	33.480368	35	0.25		0	0.2	0							0		0	0	11.678474	0	35						NO	145.673616	124.716943	27.798533	0	0.164866	0.164866	0.164866	41.21645	0.193407	0.206082	0.195731	0.206082	0.164866	0.191037	12.364935	27.598838	28.851515	0.206082		0	0.164866	0							0		0	0	9.626905	0	28.851515							9.4102	0.438277537	0.819555254	0	0.218840655	1.997441937	0.400879263	0.886691673	6.263857617	1.88554087	2.589161964	0.660702395	0.024175621	2.479480303	2.583435792	5.659053561	0.119492894	0.360598368	0	0	2.600713174	0	0	0	0	0	0	0	0	0	0	0	0.191967203	0	1.345293575	0	0	0	0	0	40.9354	0	9.295122634	9.4102	0.438277537	0.819555254	0	0.218840655	1.997441937	0.400879263	0.886691673	6.263857617	1.88554087	2.589161964	0.660702395	0.024175621	2.479480303	2.583435792	5.659053561	0.119492894	0.360598368	0	0	2.600713174	0	0	0	0	0	0	0	0	0	0	0	0.191967203	0	1.345293575	0	0	0	0	0	40.9354	YES	$250/Day(Days 1-7)	$250/Day(Days 1-7)	$0/Day(Days 1-14) $100(Days 15-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									20% Coins	$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit						3400	4.0696	0.1895	0.3525	0	1.1398	2.3953	0.4807	0.3842	2.77	0.8338	1.145	0.2922	0.0107	1.0966	1.2061	2.6419	0.0558	0.1595		0	1.2455	0									0.2226	0	0.0896	0	0.628						21.4088	0	5.033623247	13.4798	0.627816162	1.172047456	0	1.358614142	4.392723602	0.881603753	1.270901645	9.033839714	2.719357762	3.734129079	0.952875976	0.034866517	3.576103355	3.789499907	8.300954501	0.175277554	0.520061046	0	0	3.846224253	0	0	0	0	0	0	0	0	0	0.222603099	0	0.281586134	0	1.973337169	0	0	0	0	0	62.3442
H8145_124_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	1029.478793	55.771429	441.9978	392.803558	1.319502	7.946133	3.821559	273.784577	31.75561	5.469394	10.86182	8.357086	0.154728	13.909032	2504.566061	2336.138987	128.494096	2.229696		1356.781023	30.74425	0							5.91	0.93	905.48765	239.281988	354.122519	0	336.580639							$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $125(Days 21-100):2. $0 SNF 1,2. $125 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	41.280875	0	0.2	0.2	0.2	50	0.239515	0.25	0.243773	0.25	0.2	0.233885	15	32.085451	35	0.25		0	0.2	0							0	0	0	0	25.852746	0	35						NO	144.620586	123.815403	30.771755	0	0.177519	0.177519	0.177519	44.37975	0.212592	0.221899	0.216372	0.221899	0.177519	0.207595	13.313925	28.478886	31.065825	0.221899		0	0.177519	0							0	0	0	0	22.946768	0	31.065825							12.407	0.57544683	1.133420668	0	0.234236676	1.410589584	0.678399332	1.012540923	6.750988641	1.213653059	2.350193717	1.854429026	0.02746716	2.887445498	2.778800391	5.544219658	0.332647925	0.494767313	0	0	5.457688516	0	0	0	0	0	0	0	0	0	0	0	0.677163941	0	0.871346269	0	0	0	0	0	48.6924	0	6.298118683	12.407	0.57544683	1.133420668	0	0.234236676	1.410589584	0.678399332	1.012540923	6.750988641	1.213653059	2.350193717	1.854429026	0.02746716	2.887445498	2.778800391	5.544219658	0.332647925	0.494767313	0	0	5.457688516	0	0	0	0	0	0	0	0	0	0	0	0.677163941	0	0.871346269	0	0	0	0	0	48.6924	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	$0/Day(Days 1-20) $125(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									20% Coins	$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit						5000	5.3948	0.2502	0.491	0	1.2244	1.6976	0.8165	0.4403	2.9962	0.5386	1.043	0.823	0.0122	1.2816	1.3019	2.5976	0.1559	0.2196		0	2.6232	0									0.4131	0	0.3173	0	0.4083						25.0461	0	3.356365246	17.8018	0.825661196	1.624412177	0	1.4585957	3.108232573	1.494852068	1.452863912	9.747150895	1.752283636	3.393230147	2.67744202	0.039657395	4.169045315	4.08074602	8.141841484	0.488502773	0.714349779	0	0	8.080862563	0	0	0	0	0	0	0	0	0	0.413050535	0	0.994434168	0	1.279596344	0	0	0	0	0	73.7386
H8145_125_0	2011	5	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional						Prosthetics/Supplies	Lab	Radiology		Therapy (PT/OT/ST)						D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin		V	Coin	Coin							O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0	0	0						0	NO	823.083102	22.198685	318.725098	203.024751	1.664449	7.71531	2.351371	254.029185	30.078358	8.824349	11.241629	3.593102	0.262067	20.696159	1986.346529	1654.913329	35.993867	1.944474		1037.870275	9.767135	0							4.56	0.93	751.500374	659.151036	236.552834	0	155.794493							$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $125(Days 21-100):2. $0 SNF 1,2. $125 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							161.6895	138.428775	41.280875	0	0.2	0.2	0.2	50	0.242152	0.25	0.247158	0.25	0.2	0.233574	15	33.636804	35	0.25		0	0.2	0							0	0	0	0	17.616991	0	35						NO	150.841913	129.141727	35.134029	0	0.184265	0.184265	0.184265	46.0662	0.223101	0.230331	0.227713	0.230331	0.184265	0.215198	13.81986	30.990395	32.24634	0.230331		0	0.184265	0							0	0	0	0	16.230957	0	32.24634							10.3463	0.238898043	0.933174736	0	0.306699695	1.421661597	0.433275377	0.975179937	6.710511748	2.03252113	2.559865064	0.827602777	0.048289776	4.453772024	2.287585912	4.273868146	0.096722539	0.447872641	0	0	1.799741131	0	0	0	0	0	0	0	0	0	0	0	0.319956573	0	0.418650183	0	0	0	0	0	40.9321	0	3.4362539	10.3463	0.238898043	0.933174736	0	0.306699695	1.421661597	0.433275377	0.975179937	6.710511748	2.03252113	2.559865064	0.827602777	0.048289776	4.453772024	2.287585912	4.273868146	0.096722539	0.447872641	0	0	1.799741131	0	0	0	0	0	0	0	0	0	0	0	0.319956573	0	0.418650183	0	0	0	0	0	40.9321	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	$0/Day(Days 1-20) $125(Days 21-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$15-$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	0% Coins									20% Coins	$0/Visit	$0-$35/Visit	$0/Visit	$35/Visit						5000	4.5044	0.104	0.4048	0	1.6037	1.7116	0.5216	0.4242	2.9792	0.9024	1.1365	0.3674	0.0214	1.9774	1.0722	2.0031	0.0453	0.1988		0	0.8653	0									0.3463	0	0.15	0	0.1962						21.5357	0	1.905255708	14.8507	0.342904846	1.337952822	0	1.910373458	3.133217013	0.954900437	1.399401716	9.68972251	2.934884317	3.696348404	1.19502736	0.069728722	6.431143767	3.359752673	6.276983902	0.142055349	0.646711438	0	0	2.665062491	0	0	0	0	0	0	0	0	0	0.346272205	0	0.469916755	0	0.614866991	0	0	0	0	0	62.4679
H8145_126_0	2011	2	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin							O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0									0	NO	1317.44272	58.133167	342.186817	1176.863094	36.458406	10.063832	3.743776	276.109107	242.778111	2051.602576	862.069532	79.888875	0.171131	708.709798	2814.166978	2934.078039	80.999998	549.000295		1207.872401	22.968417	0							4.14	1.48	1037.360246	0										$200/Day(Days 1-5):1a.IP Acute	$200/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-20) $100(Days 21-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	15% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:9a, 12.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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$30-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										123.8224	99.6822	33.0247	0	100	0.15	0.2	50	86.165538	13.649345	38.198893	50	0.2	46.938077	10	29.398125	30	37.83749		0	0.2	0							0	0	0	0									NO	114.998197	92.578348	27.913005	0	92.005	0.138008	0.18401	46.0025	79.276603	12.55808	35.144892	46.0025	0.18401	43.185378	9.2005	27.047745	27.6015	34.812383		0	0.18401	0							0	0	0	0										12.6253	0.44848938	0.795955194	0	0.279529637	1.388889327	0.688892222	1.058475766	1.603885327	2.147015773	2.524778383	0.306257331	0.031489815	2.55049171	2.157645273	6.613349551	0.18631012	1.592667378	0	0	4.226418412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2258	0	3.526133466	12.6253	0.44848938	0.795955194	0	0.279529637	1.388889327	0.688892222	1.058475766	1.603885327	2.147015773	2.524778383	0.306257331	0.031489815	2.55049171	2.157645273	6.613349551	0.18631012	1.592667378	0	0	4.226418412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2258	YES	$200/Day(Days 1-5)	$200/Day(Days 1-5)	$0/Day(Days 1-20) $100(Days 21-100)	$0/Visit	$100/Trip	15% Coins	20% Coins	$50/Visit	$0-$95/Visit	$0-$50/Visit	$0-$50/Visit	$50/Visit	20% Coins	$30-$50/Visit	$10/Visit	$10-$30/Visit	$30/Visit	$30-$50/Visit		$0/Visit	20% Coins	0% Coins									15% Coins	$0/Proc									5000	5.5151	0.1959	0.3477	0	1.4677	1.6791	0.8328	0.4624	0.7006	0.9379	1.1178	0.1338	0.014	1.1141	1.0155	3.1125	0.0877	0.7217		0	2.0406	0									0.3595	0									21.8565	0	1.871878383	18.1404	0.644401752	1.143694401	0	1.747237279	3.067962911	1.521719637	1.520854292	2.304517456	3.084905925	3.64254388	0.440041042	0.045528528	3.664633981	3.173130255	9.725889532	0.273996049	2.314363119	0	0	6.266975727	0	0	0	0	0	0	0	0	0	0.359527928	0	0	0	0	0	0	0	0	0	63.0823
H8145_801_0	2011	3																															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	288.712882	2.575873	60.435517	20.871753	2.370548	10.549886	4.30124	19.701059	62.87204	16.249509	28.58977	6.188991	0.396011	21.775325	34.995376	68.124111	0.613628	10.362968		7.120305	28.869298	0																				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.081349	0.081349	0.171808	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.068063	0.068063	0.07344	0	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115		0.198115	0.198115	0																				19.6507	0.175321644	4.438384368	0	0.469641117	2.090090665	0.852140163	3.903075304	12.4558942	3.219271476	5.664062284	1.226131952	0.078455719	4.314018512	6.933108916	13.49640825	0.121568911	2.053059405	0	1.410639225	5.719440973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2714	0	21.08582189	19.6507	0.175321644	4.438384368	0	0.469641117	2.090090665	0.852140163	3.903075304	12.4558942	3.219271476	5.664062284	1.226131952	0.078455719	4.314018512	6.933108916	13.49640825	0.121568911	2.053059405	0	1.410639225	5.719440973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2714	YES	8% Coins	8% Coins	17% Coins	0% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins		23% Coins	23% Coins	23% Coins																			6700	3.0316	0.027	0.6826	0	1.8996	1.3935	0.5681	0.6019	2.0131	0.4964	0.9285	0.1891	0.0121	0.6653	1.2691	2.4706	0.0223	0.3555		0.2582	1.047	0																			17.9314	0	3.777772518	22.6822	0.202368993	5.121004723	0	2.369203722	3.483576032	1.420271046	4.504936857	14.4690432	3.715689027	6.592540353	1.415203678	0.090553814	4.979287338	8.202252205	15.9669991	0.143822707	2.408521157	0	1.668864273	6.766415709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.2028
H8145_802_0	2011	3																															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	288.712882	2.575873	60.435517	20.871753	2.370548	10.549886	4.30124	19.701059	62.87204	16.249509	28.58977	6.188991	0.396011	21.775325	34.995376	68.124111	0.613628	10.362968		7.120305	28.869298	0																				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.081349	0.081349	0.171808	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.068063	0.068063	0.07344	0	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115		0.198115	0.198115	0																				19.6507	0.175321644	4.438384368	0	0.469641117	2.090090665	0.852140163	3.903075304	12.4558942	3.219271476	5.664062284	1.226131952	0.078455719	4.314018512	6.933108916	13.49640825	0.121568911	2.053059405	0	1.410639225	5.719440973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2714	0	21.08582189	19.6507	0.175321644	4.438384368	0	0.469641117	2.090090665	0.852140163	3.903075304	12.4558942	3.219271476	5.664062284	1.226131952	0.078455719	4.314018512	6.933108916	13.49640825	0.121568911	2.053059405	0	1.410639225	5.719440973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2714	YES	8% Coins	8% Coins	17% Coins	0% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins		23% Coins	23% Coins	23% Coins																			6700	3.0316	0.027	0.6826	0	1.8996	1.3935	0.5681	0.6019	2.0131	0.4964	0.9285	0.1891	0.0121	0.6653	1.2691	2.4706	0.0223	0.3555		0.2582	1.047	0																			17.9314	0	3.777772518	22.6822	0.202368993	5.121004723	0	2.369203722	3.483576032	1.420271046	4.504936857	14.4690432	3.715689027	6.592540353	1.415203678	0.090553814	4.979287338	8.202252205	15.9669991	0.143822707	2.408521157	0	1.668864273	6.766415709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.2028
H8145_803_0	2011	3																															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	288.712882	2.575873	60.435517	20.871753	2.370548	10.549886	4.30124	19.701059	62.87204	16.249509	28.58977	6.188991	0.396011	21.775325	34.995376	68.124111	0.613628	10.362968		7.120305	28.869298	0																				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.081349	0.081349	0.171808	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.068063	0.068063	0.07344	0	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115	0.198115		0.198115	0.198115	0																				19.6507	0.175321644	4.438384368	0	0.469641117	2.090090665	0.852140163	3.903075304	12.4558942	3.219271476	5.664062284	1.226131952	0.078455719	4.314018512	6.933108916	13.49640825	0.121568911	2.053059405	0	1.410639225	5.719440973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2714	0	21.08582189	19.6507	0.175321644	4.438384368	0	0.469641117	2.090090665	0.852140163	3.903075304	12.4558942	3.219271476	5.664062284	1.226131952	0.078455719	4.314018512	6.933108916	13.49640825	0.121568911	2.053059405	0	1.410639225	5.719440973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2714	YES	8% Coins	8% Coins	17% Coins	0% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins		23% Coins	23% Coins	23% Coins																			6700	3.0316	0.027	0.6826	0	1.8996	1.3935	0.5681	0.6019	2.0131	0.4964	0.9285	0.1891	0.0121	0.6653	1.2691	2.4706	0.0223	0.3555		0.2582	1.047	0																			17.9314	0	3.777772518	22.6822	0.202368993	5.121004723	0	2.369203722	3.483576032	1.420271046	4.504936857	14.4690432	3.715689027	6.592540353	1.415203678	0.090553814	4.979287338	8.202252205	15.9669991	0.143822707	2.408521157	0	1.668864273	6.766415709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.2028
H8189_001_0	2011	3																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	176.2735896	8.591545578	34.14888159	0	8.50349937	9.962001722	8.57349584	13.96642312	17.57704971	4.277388359	12.30439073	0	3.220308997	27.54384486	23.38620286	27.34362467	3.781448366	2.255236218	6.852549085	32.76032891	22.83674944	22.30130373	0	0	0	0	0	0	0	0											3400	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a; No Cost-Sharing PBP; 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, No Cost-Sharing PBP; 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, No Cost-Sharing PBP; 14a"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b-f											0	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	0.076347652	0.076347652	0.153340445	0	0.232507503	0.232507503	0.232507503	0.232507503	0.232507503	0.232507503	0.232507503	0	0.232507503	0.232507503	0.232537158	0.232507503	0.232507503	0.232507503	0.232507503	0.232507503	0.232507503	0.232507503	0	0	0	0	0	0	0	0												13.4581	0.655944335	5.236404707	0	1.977127404	2.316240144	1.993402109	3.247298164	4.086795936	0.994524886	2.860863164	0	0.748746004	6.404150589	5.438161155	6.357597891	0.879215117	0.524359341	1.593269076	7.617022269	5.309715585	5.185220442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8841	0	0.162160885	13.4581	0.655944335	5.236404707	0	1.977127404	2.316240144	1.993402109	3.247298164	4.086795936	0.994524886	2.860863164	0	0.748746004	6.404150589	5.438161155	6.357597891	0.879215117	0.524359341	1.593269076	7.617022269	5.309715585	5.185220442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8841	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.4581	0.655944335	5.236404707	0	1.977127404	2.316240144	1.993402109	3.247298164	4.086795936	0.994524886	2.860863164	0	0.748746004	6.404150589	5.438161155	6.357597891	0.879215117	0.524359341	1.593269076	7.617022269	5.309715585	5.185220442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8841
H8393_001_0	2011	10																															D	D	D	COIN	T	COIN	COIN	V	V	O	COIN	COIN	COIN	COIN	P	COIN	P	P	COIN	COIN	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	831.8030848	23.65553978	505.9520138	0	104.4630436	6.06994227	5.796288788	249.875327	330.2604428	1331.509483	19.1363528	0.708843518	0.136180665	10.63011427	3108.328827	91.00717025	274.437579	871.6016822	6.526746125	7.459269156	22.71957991	0	0	0	0	0	0	0	0	0											6700	1a $175 days 1-9	1b $175 days 1-9	2 $50 days 1-50	6 $0	"10a $150,"	11a 20%	11b 20%	"4a $50, 4b $40"	"9a $300, 9b $300"	"8a $0 -20%, 8b 20%, 11c $0, 11c 20%"	8b 20%/$300 Adv. Imaging; 14h $0	5 20%	12 20%	"3 20%, 9d 20%, 13a $0 , 9a 20%, 9b 20%"	"7a $15, 14c $0"	"17a $0 - 20%, 18a 20%, 7b $30,7d $45,7f $45, 14d - 14g $0, 14i - 14j $0, 17b 20%"	"7e $40, 7h $40, 9c $40"	"7c $45,7i $45"	"8b 20% Ther., $300 Adv. Imaging, 14h $0"	"7g $45, 14b $0, 14a $0"	"15 20%, 11c 20%"	15 20%							14a $0													156.4797723	110.6321839	48.82880638	0	150	0.2	0.2	49.3384923	300	6.489688274	0.502553511	0.2	0.2	0.184659038	14.56585983	0.156003728	39.49329568	45	0.267663434	0.000250446	0.217393651	0	0	0	0	0	0	0	0	0											NO	138.7515799	98.09824029	43.29680399	0	133.0059258	0.177341234	0.177341234	43.74874564	266.0118516	5.754446647	0.4456173	0.177341234	0.177341234	0.163738308	12.91563782	0.138329468	35.01894903	39.90177774	0.237338819	0.000222072	0.192764292	0	0	0	0	0	0	0	0	0												9.6178	0.193380569	1.825508764	0	1.157850319	1.076451055	1.027921008	0.910977677	7.321099324	0.638508357	8.527489864	0.125707184	0.024150447	1.740556928	3.345504111	12.58897347	0.800876299	2.898204717	1.549050218	0.001656493	4.379523745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.7512	0	7.634372045	9.6178	0.193380569	1.825508764	0	1.157850319	1.076451055	1.027921008	0.910977677	7.321099324	0.638508357	8.527489864	0.125707184	0.024150447	1.740556928	3.345504111	12.58897347	0.800876299	2.898204717	1.549050218	0.001656493	4.379523745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.7512	YES	0.2	0.2	0.2	0.2	150	0.2	0.2	$50/$40	0.2	0.2	"20%, 14h $0"	0.2	0.2	0.2	"20%, 14c $0"	"20%, 14d-14g $0, 14i-14j $0"	0.2	0.2	"20%, 14h $0"	"20% , 14a-14b $0"	0.2	0.2							14a $50												10000	5.8803	0.0383	0.6006	0.3481	0.2304	0.2142	0.2046	0.1813	1.682	0.3581	0.6304	0.025	0.0048	0.3464	0.7651	3.1824	0.011	0.1963	0.2233	0.256	0.8716	0	0	0	0	0	0	0	0.8667	0											17.117	0	0	15.4982	0.23163258	2.426151367	0.348057286	1.388283504	1.290684311	1.232495907	1.092278734	9.003134779	0.996651954	9.157894405	0.150725191	0.028956824	2.086959282	4.110561671	15.77139594	0.811851598	3.094511941	1.772358735	0.257661313	5.251128292	0	0	0	0	0	0	0	0.866666667	0	0	0	0	0	0	0	0	0	0	0	76.8682
H8393_801_0	2011	7																															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	YES	194.3645013	3.622469062	21.44748506	0	5.069628208	7.018120735	5.3564015	14.7731837	57.04610742	10.50661072	22.55379415	1.079736595	0.132817192	11.70895044	26.82214411	108.2688139	1.259080995	5.845700415	9.408855619	7.390715369	16.943643	0	0	0	0	0	0	0	0	0											6700	FFS Medicare  7.3%	FFS Medicare  7.3%	FFS Medicare  15.0%		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%																				0.081003486	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	0.066962351	0.066962351	0.132792154	0	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0	0	0	0	0	0	0	0	0												13.0151	0.242569046	2.848057737	0	0.976470252	1.351772919	1.031706174	2.845489613	10.98775385	2.02369728	4.344127054	0.207970017	0.025582159	2.255282107	5.166261655	20.85385194	0.242513866	1.125950922	1.812256686	1.423539045	3.263545703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0435	0	15.94533404	13.0151	0.242569046	2.848057737	0	0.976470252	1.351772919	1.031706174	2.845489613	10.98775385	2.02369728	4.344127054	0.207970017	0.025582159	2.255282107	5.166261655	20.85385194	0.242513866	1.125950922	1.812256686	1.423539045	3.263545703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0435	YES	FFS Medicare  7.3%	FFS Medicare  7.3%	FFS Medicare  15.0%		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%																			10000	2.7784	0.0411	0.608	0	0.2085	0.2886	0.2202	0.6074	2.3456	0.432	0.9274	0.0444	0.0055	0.4814	1.1029	4.4518	0.0234	0.2404	0.3869	0.3039	0.8094	0	0	0	0	0	0	0	0	0											16.307	0	0	15.7935	0.283676	3.456044518	0	1.184921435	1.640341531	1.2519488	3.452928166	13.33335556	2.455704391	5.271486002	0.252366245	0.03104329	2.736726599	6.26912511	25.30561082	0.265904824	1.366312369	2.199126691	1.727427871	4.072961906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.3505
H8393_802_0	2011	5																															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	YES	194.3645013	3.622469062	21.44748506	0	5.069628208	7.018120735	5.3564015	14.7731837	57.04610742	10.50661072	22.55379415	1.079736595	0.132817192	11.70895044	26.82214411	108.2688139	1.259080995	5.845700415	9.408855619	7.390715369	16.943643	0	0	0	0	0	0	0	0	0											6700	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	0.066962351	0.066962351	0.132792154	0	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0	0	0	0	0	0	0	0	0												13.0151	0.242569046	2.848057737	0	0.976470252	1.351772919	1.031706174	2.845489613	10.98775385	2.02369728	4.344127054	0.207970017	0.025582159	2.255282107	5.166261655	20.85385194	0.242513866	1.125950922	1.812256686	1.423539045	3.263545703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0435	0	15.94533404	13.0151	0.242569046	2.848057737	0	0.976470252	1.351772919	1.031706174	2.845489613	10.98775385	2.02369728	4.344127054	0.207970017	0.025582159	2.255282107	5.166261655	20.85385194	0.242513866	1.125950922	1.812256686	1.423539045	3.263545703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0435	YES	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%																			10000	2.7784	0.0411	0.608	0	0.2085	0.2886	0.2202	0.6074	2.3456	0.432	0.9274	0.0444	0.0055	0.4814	1.1029	4.4518	0.0234	0.2404	0.3869	0.3039	0.8094	0	0	0	0	0	0	0	0	0											16.307	0	0	15.7935	0.283676	3.456044518	0	1.184921435	1.640341531	1.2519488	3.452928166	13.33335556	2.455704391	5.271486002	0.252366245	0.03104329	2.736726599	6.26912511	25.30561082	0.265904824	1.366312369	2.199126691	1.727427871	4.072961906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.3505
H8393_803_0	2011	5																															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	YES	194.3645013	3.622469062	21.44748506	0	5.069628208	7.018120735	5.3564015	14.7731837	57.04610742	10.50661072	22.55379415	1.079736595	0.132817192	11.70895044	26.82214411	108.2688139	1.259080995	5.845700415	9.408855619	7.390715369	16.943643	0	0	0	0	0	0	0	0	0											6700	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	0.066962351	0.066962351	0.132792154	0	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0.192611807	0	0	0	0	0	0	0	0	0												13.0151	0.242569046	2.848057737	0	0.976470252	1.351772919	1.031706174	2.845489613	10.98775385	2.02369728	4.344127054	0.207970017	0.025582159	2.255282107	5.166261655	20.85385194	0.242513866	1.125950922	1.812256686	1.423539045	3.263545703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0435	0	15.94533404	13.0151	0.242569046	2.848057737	0	0.976470252	1.351772919	1.031706174	2.845489613	10.98775385	2.02369728	4.344127054	0.207970017	0.025582159	2.255282107	5.166261655	20.85385194	0.242513866	1.125950922	1.812256686	1.423539045	3.263545703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0435	YES	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%																			10000	2.7784	0.0411	0.608	0	0.2085	0.2886	0.2202	0.6074	2.3456	0.432	0.9274	0.0444	0.0055	0.4814	1.1029	4.4518	0.0234	0.2404	0.3869	0.3039	0.8094	0	0	0	0	0	0	0	0	0											16.307	0	0	15.7935	0.283676	3.456044518	0	1.184921435	1.640341531	1.2519488	3.452928166	13.33335556	2.455704391	5.271486002	0.252366245	0.03104329	2.736726599	6.26912511	25.30561082	0.265904824	1.366312369	2.199126691	1.727427871	4.072961906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.3505
H8558_001_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			2.110548067	0.063419114	0.264959032	0	0.57332577	0.514081797	0.510715171	0.300877959	2.859584811	0	1.147478091	0.000775802	0.002367455	0.000742429	1.349735244	1.087476655	0.134645657	0.279595194	0	7.25E-05	0.542782535	0.014354424																			11.7575	NO	696.0434026	20.91516239	349.5262466	27.74140967	252.1048924	14.1283698	14.03584574	396.9094499	78.58918944	28.79919699	31.53582741	0.010660576	0.065064119	0.010201981	4451.328668	1793.209458	1.850214938	7.684038452	0	0.263774834	14.91714437	0.394498708																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	184.5941799	184.5941799	46.14854497	0	138.4456349	0.18459418	0.18459418	46.14854497	0.18459418	0	0.18459418	0.36918836	0.18459418	0.36918836	18.45941799	36.91883597	0.36918836	0.18459418	36.91883597	16.73225221	0.18459418	0.18459418																				10.7071	0.321734771	1.344177309	0	2.908568491	2.608014837	2.590935434	1.526399466	14.50710697	0	5.821330197	0.003935761	0.012010458	0.003766453	6.847411373	5.516933821	0.683077818	1.418428776	0	0.000367796	2.753618032	0.072822165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6478	200	8.383541535	12.8177	0.385153884	1.609136341	0	3.481894262	3.122096633	3.101650604	1.827277425	17.36669178	0	6.968808288	0.004711563	0.014377913	0.004508881	8.197146617	6.604410475	0.817723475	1.69802397	0	0.000440294	3.296400567	0.087176589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.4053	YES	$300 - days 1-5	$300 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	2.8842	0.0867	0.3643	0	0.7075	0.6429	0.6387	0.2588	3.5761	0	1.435	0.001	0.0028	0.0009	1.7838	1.3536	0.1684	0.3497	0	0.0001	0.4669	0.018																			14.7391	200	0	15.7018	0.471818808	1.973392429	0	4.189375716	3.764988075	3.74033187	2.086095603	20.94278145	0	8.403801414	0.005681751	0.017153735	0.005437335	9.980943934	7.957985868	0.986106292	2.047675248	0	0.000530532	3.763307439	0.105127694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.1444
H8558_002_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			4.753872248	0.07453921	0.761461754	0.551597195	0.223770034	0.280921887	0.279082182	0.221855874	1.562630629	0.572629742	0.627304515	0.000220681	0.001293704	0.000202851	0.61570413	0.715286057	0.036788807	0.152785821	0	0.000202032	0.296605511	0.007844028																			11.7366	NO	668.5680051	20.08956388	335.7291579	26.64635403	242.1533835	13.57067099	13.4817992	381.2419716	75.48698459	27.66238658	30.29099211	0.010660576	0.062495798	0.009799271	4275.618326	1722.424874	1.777180138	7.380721145	0	0.274614896	14.32830973	0.378926391																				$250 - days 1-5	$250 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				250	250	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	230.596919	230.596919	46.1193838	0	138.3581514	0.184477535	0.184477535	46.1193838	0.184477535	0	0.184477535	0.36895507	0.184477535	0.36895507	18.44775352	36.89550704	0.36895507	0.184477535	36.89550704	15.42760182	0.184477535	0.184477535																				12.8475	0.386049295	1.290301824	0	2.791991208	2.503483936	2.487089087	1.465220401	13.92565286	0	5.588007564	0.003933274	0.011529071	0.003615491	6.572962751	5.295811589	0.655699623	1.361577245	0	0.000353054	2.643251262	0.069903407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9039	200	8.466895426	17.6013	0.460588505	2.051763578	0.551597195	3.015761242	2.784405823	2.766171268	1.687076275	15.48828349	0.572629742	6.215312079	0.004153955	0.012822775	0.003818342	7.188666882	6.011097646	0.69248843	1.514363066	0	0.000555086	2.939856773	0.077747434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.6405	YES	$375 - days 1-5	$375 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	3.4623	0.104	0.3499	0	0.6767	0.6074	0.6034	0.2431	3.3786	0	1.3557	0.001	0.0026	0.0009	1.7109	1.2952	0.1591	0.3303	0	0.0001	0.4385	0.017																			14.7368	200	0	21.0637	0.564627186	2.40166466	0.551597195	3.692483584	3.391793066	3.369580845	1.930173999	18.86688072	0.572629742	7.571056551	0.005108233	0.015443055	0.004695521	8.899607098	7.306285937	0.851572169	1.84470457	0	0.000641432	3.378404015	0.094707174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3773
H8558_003_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			4.473236444	0.070239703	0.703626176	0.451668523	0.31962083	0.401253398	0.398625665	0.299051987	1.626387619	0.332268904	0.364114146	0.000177799	0.001691924	0.00021113	0.513746012	0.596837573	0.030696729	0.127485106	0	0.000168576	0.387904648	0.010258524																			11.1093	NO	751.8763818	22.59286787	385.0518958	27.08144803	429.2991223	24.05862376	23.90106832	613.8339846	97.51605332	19.92240457	21.81552189	0.010660576	0.101445526	0.01265905	4428.04105	1783.828085	1.840535334	7.643838556	0	0.258199504	23.25825033	0.615087544																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	180.2611368	180.2611368	45.06528421	0	135.1958526	0.180261137	0.180261137	45.06528421	0.180261137	0	0.180261137	0.360522274	0.180261137	0.360522274	18.02611368	36.05222737	0.360522274	0.180261137	36.05222737	16.60498299	0.180261137	0.180261137																				11.2945	0.339384671	1.446039427	0	4.836621739	4.33683487	4.308433747	2.305216915	17.57835463	0	3.932490776	0.003843375	0.018286686	0.00456387	6.651697614	5.359247974	0.663553983	1.377887028	0	0.000357283	4.192558645	0.11087638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.7608	200	11.58314286	15.7677	0.409624374	2.149665603	0.451668523	5.156242569	4.738088268	4.707059412	2.604268902	19.20474225	0.332268904	4.296604922	0.004021174	0.01997861	0.004774999	7.165443626	5.956085548	0.694250713	1.505372134	0	0.00052586	4.580463293	0.121134904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.87	YES	$300 - days 1-5	$300 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	2.7968	0.084	0.3576	0	0.9628	1.0077	1.0011	0.3603	4.0844	0	0.9137	0.0009	0.004	0.0011	1.6408	1.2412	0.1542	0.3202	0	0.0001	0.6552	0.0258																			15.6117	200	0	18.5646	0.49366548	2.507279393	0.451668523	6.119014088	5.745765693	5.708137745	2.964532828	23.28912906	0.332268904	5.210331705	0.004914194	0.023949362	0.005835429	8.806203584	7.197306372	0.848429599	1.825528583	0	0.000608608	5.235684773	0.146897385	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.4817
H8558_004_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			4.431721673	0.069587829	0.697096032	0.447476722	0.316654525	0.397529486	0.394926139	0.296276575	1.611293601	0.329185215	0.360734911	0.000179161	0.001676222	0.00020917	0.508978089	0.591298502	0.030411842	0.126301955	0	0.000167012	0.384304621	0.010163318																			11.0062	NO	739.234843	22.21300673	378.5778948	26.62611896	422.0811784	23.6541184	23.49921199	603.5133969	95.87648464	19.58744279	21.44873052	0.010660576	0.09973989	0.01244621	4353.590975	1753.836011	1.809589823	7.515320246	0	0.262614934	22.8672019	0.60474588																				$250 - days 1-5	$250 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				250	250	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	224.4513543	224.4513543	44.89027086	0	134.6708126	0.179561083	0.179561083	44.89027086	0.179561083	0	0.179561083	0.359122167	0.179561083	0.359122167	17.95610834	35.91221669	0.359122167	0.179561083	35.91221669	15.98897113	0.179561083	0.179561083																				13.8269	0.415478287	1.416205353	0	4.736834606	4.247359128	4.219543965	2.257656655	17.21568546	0	3.85135729	0.003828449	0.017909403	0.00446971	6.514462604	5.248678238	0.649863819	1.349459046	0	0.000349912	4.106059549	0.108588825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1906	200	12.14643356	18.2586	0.485066116	2.113301385	0.447476722	5.053489131	4.644888614	4.614470105	2.55393323	18.82697906	0.329185215	4.212092201	0.00400761	0.019585624	0.00467888	7.023440692	5.83997674	0.680275661	1.475761001	0	0.000516924	4.49036417	0.118752143	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1968	YES	$375 - days 1-5	$375 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	3.386	0.1017	0.3463	0	0.9268	0.9688	0.9625	0.3438	3.927	0	0.8785	0.0009	0.0038	0.001	1.5889	1.2001	0.1482	0.3078	0	0.0001	0.6253	0.0248																			15.7424	200	0	21.6445	0.586809714	2.459643617	0.447476722	5.980267905	5.613729648	5.576966379	2.897764013	22.75395156	0.329185215	5.090603499	0.004880896	0.023399298	0.00569844	8.612383182	7.040039223	0.828512415	1.78357846	0	0.000596928	5.11569826	0.143521725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.9392
H8558_005_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			5.554492545	0.087240251	0.690538418	0.751725824	0.144522692	0.181434425	0.180246244	0.262841011	1.495002408	0.402273151	0.440748577	0.000198839	0.00147593	0.000194072	0.533767688	0.635524483	0.032048382	0.1298665	0	0.000171725	0.338384076	0.008948903																			11.8716	NO	829.0608278	24.91215603	337.9025971	40.30305176	173.5750802	9.727430902	9.663727771	479.0376065	80.15310574	21.56748529	23.61692564	0.010660576	0.07913056	0.010405007	4033.441223	1624.864279	1.718242939	6.962666601	0	0.288375016	18.14213442	0.479786775																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	185.4198565	185.4198565	46.35496414	0	139.0648924	0.185419857	0.185419857	46.35496414	0.185419857	0	0.185419857	0.370839713	0.185419857	0.370839713	18.54198565	37.08397131	0.370839713	0.185419857	37.08397131	13.93010651	0.185419857	0.185419857																				12.8104	0.384934033	1.305288564	0	2.011516654	1.803658842	1.791847017	1.850480922	14.86197737	0	4.379046965	0.003953365	0.014672377	0.00385859	6.232334107	5.02136836	0.637192718	1.291016642	0	0.000334758	3.363911962	0.088961995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8567	200	7.840817397	18.3649	0.472174284	1.995826982	0.751725824	2.156039346	1.985093267	1.972093261	2.113321933	16.35697978	0.402273151	4.819795542	0.004152204	0.016148307	0.004052662	6.766101795	5.656892843	0.6692411	1.420883143	0	0.000506483	3.702296038	0.097910898	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.7284	YES	$300 - days 1-5	$300 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	3.3843	0.1017	0.3727	0	0.5785	0.464	0.461	0.3325	3.8237	0	1.1266	0.001	0.0035	0.001	1.7507	1.3258	0.1639	0.3322	0	0.0001	0.6044	0.0229																			14.8506	200	0	21.7492	0.573869144	2.368477948	0.751725824	2.73456951	2.449139155	2.433100199	2.445798589	20.18067377	0.402273151	5.946438058	0.005169327	0.019695476	0.005045402	8.516801841	6.982701808	0.833178234	1.753036292	0	0.000594871	4.306691462	0.120799067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.579
H8558_006_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			5.523422214	0.086752252	0.686675732	0.747520872	0.143714271	0.180419529	0.179237996	0.261370749	1.486639768	0.400022944	0.438283148	0.000204679	0.001467674	0.000192987	0.530781936	0.631969531	0.031869112	0.129140062	0	0.000170765	0.336491247	0.008898845																			11.8052	NO	800.90346	24.06606523	326.4264214	38.93424044	167.679955	9.397058461	9.335518878	462.7680667	77.43086824	20.83498944	22.81482471	0.010660576	0.076443051	0.010051623	3896.45358	1569.679063	1.659886306	6.726193766	0	0.298318982	17.52597366	0.463491791																				$250 - days 1-5	$250 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				250	250	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	231.1533003	231.1533003	46.23066006	0	138.6919802	0.18492264	0.18492264	46.23066006	0.18492264	0	0.18492264	0.36984528	0.18492264	0.36984528	18.49226402	36.98452805	0.36984528	0.18492264	36.98452805	12.97354908	0.18492264	0.18492264																				15.4276	0.4635792	1.257575744	0	1.93798875	1.737728861	1.726348799	1.782839432	14.31872059	0	4.218977622	0.003942764	0.014136051	0.003717545	6.004520697	4.837819945	0.613901116	1.24382551	0	0.000322521	3.240949322	0.085710126	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9202	200	8.161725286	20.951	0.550331453	1.944251476	0.747520872	2.081703021	1.918148391	1.905586794	2.044210181	15.80536036	0.400022944	4.657260771	0.004147442	0.015603725	0.003910532	6.535302633	5.469789476	0.645770228	1.372965572	0	0.000493286	3.577440569	0.094608971	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.7255	YES	$375 - days 1-5	$375 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	4.0262	0.121	0.3558	0	0.5525	0.4364	0.4336	0.3101	3.5961	0	1.0596	0.001	0.0033	0.0009	1.6704	1.2618	0.1542	0.3124	0	0.0001	0.5636	0.0215																			14.8805	200	0	24.9773	0.671314108	2.300047284	0.747520872	2.634226393	2.354569493	2.339149856	2.354269827	19.40142874	0.400022944	5.716833932	0.005137646	0.018935568	0.004844173	8.205740511	6.731571062	0.799948137	1.685345548	0	0.000577405	4.141085047	0.116134601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.606
H8558_007_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			5.065002156	0.079552192	0.734755771	0.521285621	0.140212708	0.184384775	0.183177273	0.304229369	1.586278365	0.509594262	0.558283067	0.000185177	0.001792326	0.000205923	0.522762275	0.596409127	0.030448735	0.122865523	0	0.000162468	0.392289846	0.010374495																			11.5443	NO	811.7784621	24.39284432	386.066904	30.010283	180.8233832	10.61498543	10.54546987	595.3789821	91.32164932	29.33721439	32.12496967	0.010660576	0.103183749	0.01185491	4097.552341	1650.691324	1.752926058	7.073337446	0	0.281899614	22.58402843	0.597257076																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	183.2213979	183.2213979	45.80534947	0	137.4160484	0.183221398	0.183221398	45.80534947	0.183221398	0	0.183221398	0.366442796	0.183221398	0.366442796	18.32213979	36.64427958	0.366442796	0.183221398	36.64427958	14.30494909	0.183221398	0.183221398																				12.3946	0.37244092	1.473660788	0	2.070669566	1.944892469	1.932155731	2.272628528	16.73208025	0	5.885981849	0.003906491	0.018905471	0.004344146	6.256327233	5.040699532	0.642347125	1.295986775	0	0.000336047	4.13787726	0.109430276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.5893	200	9.350404793	17.4596	0.451993112	2.208416559	0.521285621	2.210882273	2.129277243	2.115333004	2.576857898	18.31835861	0.509594262	6.444264917	0.004091668	0.020697796	0.004550069	6.779089508	5.637108659	0.67279586	1.418852297	0	0.000498514	4.530167105	0.119804771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.1335	YES	$300 - days 1-5	$300 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	3.1654	0.0951	0.3856	0	0.5643	0.4799	0.4768	0.3859	4.1287	0	1.4524	0.001	0.0044	0.0011	1.6805	1.271	0.1585	0.3198	0	0.0001	0.7026	0.027																			15.2999	200	0	20.625	0.547109611	2.593982276	0.521285621	2.775216604	2.609185143	2.592098076	2.962734006	22.4470483	0.509594262	7.896648135	0.005055606	0.025071783	0.005622	8.459602262	6.908073513	0.83129689	1.73864082	0	0.000583245	5.23274914	0.146807012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4334
H8558_008_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			5.049763545	0.079312851	0.732545178	0.519717276	0.139790863	0.183830033	0.182626164	0.303314062	1.581505874	0.508061092	0.556603412	0.000191888	0.001786933	0.000205303	0.521189488	0.594614765	0.030357126	0.122495868	0	0.000161979	0.391109599	0.010343282																			11.5095	NO	781.0292779	23.46887295	371.4431576	28.87352985	173.9740127	10.21290265	10.14602025	572.8267479	87.86249594	28.22595627	30.90811475	0.010660576	0.099275273	0.011405861	3942.342025	1588.165138	1.686527343	6.805407997	0	0.292998024	21.72857281	0.574633702																				$250 - days 1-5	$250 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																			400	250	250	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	228.660719	228.660719	45.73214379	0	137.1964314	0.182928575	0.182928575	45.73214379	0.182928575	0	0.182928575	0.36585715	0.182928575	0.36585715	18.29285752	36.58571504	0.36585715	0.182928575	36.58571504	13.22060274	0.182928575	0.182928575																				14.8826	0.44720078	1.415574325	0	1.989051141	1.86823173	1.855997029	2.1830496	16.07256119	0	5.653977394	0.003900248	0.018160284	0.004172916	6.00972508	4.842013096	0.617028088	1.244903588	0	0.000322801	3.974776865	0.105116924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.1883	200	9.550399711	19.9323	0.526513631	2.148119503	0.519717276	2.128842004	2.052061763	2.038623193	2.486363662	17.65406707	0.508061092	6.210580806	0.004092136	0.019947218	0.004378219	6.530914568	5.436627862	0.647385214	1.367399457	0	0.00048478	4.365886464	0.115460206	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.6978	YES	$375 - days 1-5	$375 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	3.7803	0.1136	0.3687	0	0.5406	0.4522	0.4492	0.361	3.8904	0	1.3686	0.0009	0.0041	0.001	1.6088	1.2137	0.1494	0.3013	0	0.0001	0.6574	0.0254																			15.2868	200	0	23.7127	0.640107757	2.516854406	0.519717276	2.66940602	2.504272835	2.48787282	2.847403065	21.54447853	0.508061092	7.579142929	0.005036203	0.024064499	0.005388285	8.139739358	6.650279125	0.796738707	1.66873209	0	0.00056569	5.023247188	0.140904072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9847
H8558_009_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			4.613759941	0.072464869	0.680616599	0.620288777	0.151544389	0.199286345	0.197981256	0.288849262	1.608371957	0.590573568	0.646961083	0.000177333	0.001701538	0.00020879	0.535087264	0.606610242	0.031566845	0.124871769	0	0.000165121	0.372418872	0.009848987																			11.3534	NO	772.164576	23.20250065	373.4385028	37.28938824	204.0817011	11.98033266	11.90187569	590.2834617	96.689169	35.5030236	38.87668206	0.010660576	0.102289936	0.012551677	4348.662783	1751.850697	1.897677955	7.506813028	0	0.254995971	22.38839787	0.592083432																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	181.9716968	181.9716968	45.49292421	0	136.4787726	0.181971697	0.181971697	45.49292421	0.181971697	0	0.181971697	0.363943394	0.181971697	0.363943394	18.19716968	36.39433937	0.363943394	0.181971697	36.39433937	16.66887745	0.181971697	0.181971697																				11.7093	0.351849868	1.415734125	0	2.321068341	2.180081463	2.165804516	2.237810065	17.59469215	0	7.074455802	0.003879846	0.018613873	0.0045681	6.594446213	5.313120734	0.690647355	1.366027505	0	0.000354208	4.074054749	0.107742427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2243	200	10.27155636	16.3231	0.424314737	2.096350724	0.620288777	2.47261273	2.379367807	2.363785771	2.526659328	19.20306411	0.590573568	7.721416885	0.004057179	0.020315411	0.00477689	7.129533477	5.919730976	0.7222142	1.490899273	0	0.000519329	4.446473622	0.117591414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5776	YES	$300 - days 1-5	$300 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	2.9906	0.0899	0.3686	0	0.5952	0.5285	0.525	0.3709	4.2654	0	1.715	0.0009	0.0042	0.0011	1.7048	1.2914	0.1674	0.3312	0	0.0001	0.6752	0.0261																			15.6516	200	0	19.3137	0.514178732	2.464941454	0.620288777	3.067851973	2.907873032	2.888829914	2.897535301	23.46844909	0.590573568	9.436438512	0.004997749	0.02454236	0.00588431	8.834326521	7.211110862	0.889644061	1.82205785	0	0.000605421	5.121673471	0.143710821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2292
H8558_010_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			4.604120058	0.072313463	0.679194534	0.61899276	0.151227756	0.198869961	0.197567598	0.288245748	1.605011462	0.589339638	0.645609338	0.000183929	0.001697983	0.000208354	0.533969265	0.605342805	0.03150089	0.124610865	0	0.000164776	0.371640749	0.009828409																			11.3296	NO	742.9159178	22.32361805	359.2931049	35.87691142	196.3513337	11.52653218	11.45104707	567.9242396	93.02670048	34.1582121	37.40408047	0.010660576	0.098415317	0.012076234	4183.940708	1685.492717	1.825796215	7.22246405	0	0.265035182	21.54035249	0.569656029																				$250 - days 1-5	$250 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				250	250	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	227.2369922	227.2369922	45.44739844	0	136.3421953	0.181789594	0.181789594	45.44739844	0.181789594	0	0.181789594	0.363579188	0.181789594	0.363579188	18.17895938	36.35791875	0.363579188	0.181789594	36.35791875	15.41455911	0.181789594	0.181789594																				14.0682	0.422729318	1.360744741	0	2.230914324	2.095403602	2.081681195	2.150889933	16.91128609	0	6.799672593	0.003875964	0.01789088	0.004390667	6.338307346	5.106750604	0.663821504	1.312968806	0	0.00034045	3.915811929	0.103557538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5892	200	10.40363472	18.6723	0.495042781	2.039939275	0.61899276	2.38214208	2.294273563	2.279248793	2.439135681	18.51629755	0.589339638	7.445281931	0.004059893	0.019588863	0.004599022	6.872276611	5.712093408	0.695322394	1.43757967	0	0.000505226	4.287452678	0.113385947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.9188	YES	$375 - days 1-5	$375 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	3.5859	0.1078	0.3538	0	0.5711	0.4996	0.4963	0.3484	4.0322	0	1.6213	0.0009	0.004	0.001	1.636	1.2363	0.1583	0.3131	0	0.0001	0.6343	0.0247																			15.6252	200	0	22.2582	0.602793353	2.393759588	0.61899276	2.953203632	2.793891828	2.775595152	2.787555571	22.54854576	0.589339638	9.066564162	0.00498406	0.023581142	0.005645912	8.508320385	6.948428043	0.853600899	1.750637831	0	0.000587648	4.921770009	0.138077724	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.544
H8558_011_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			4.694399562	0.073823601	0.65236712	0.55310899	0.19043403	0.259512353	0.257812855	0.25839793	1.47761543	0.647857351	0.709666399	0.000177476	0.001520399	0.000191815	0.521087221	0.593469617	0.030497097	0.122247652	0	0.000161651	0.321123288	0.008492424																			11.374	NO	758.4908841	22.79162471	357.6491453	33.22390096	256.2461406	15.58827077	15.48618609	509.5352743	88.75673618	38.9152027	42.61310191	0.010660576	0.091326622	0.011521886	4253.834276	1713.64921	1.831885872	7.343116759	0	0.264312767	19.28908861	0.510119118																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	182.1094048	182.1094048	45.52735119	0	136.5820536	0.182109405	0.182109405	45.52735119	0.182109405	0	0.182109405	0.36421881	0.182109405	0.36421881	18.21094048	36.42188095	0.36421881	0.182109405	36.42188095	15.74254325	0.182109405	0.182109405																				11.5107	0.345880767	1.35690152	0	2.916552009	2.838770711	2.820180131	1.933149281	16.16343639	0	7.760246623	0.003882782	0.016631437	0.004196488	6.455526899	5.20119396	0.667207291	1.337250622	0	0.000346746	3.512724445	0.092897489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.9377	200	10.1685809	16.2051	0.419704369	2.00926864	0.55310899	3.106986039	3.098283063	3.077992985	2.191547211	17.64105182	0.647857351	8.469913022	0.004060259	0.018151835	0.004388303	6.97661412	5.794663577	0.697704389	1.459498274	0	0.000508397	3.833847733	0.101389913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3116	YES	$300 - days 1-5	$300 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	2.9741	0.0894	0.3608	0	0.698	0.692	0.6875	0.3228	3.9401	0	1.8917	0.0009	0.0038	0.001	1.691	1.2801	0.1626	0.326	0	0.0001	0.5866	0.0226																			15.7312	200	0	19.1792	0.509072438	2.370063051	0.55310899	3.804973819	3.790279056	3.765457226	2.514364566	21.58114927	0.647857351	10.36159788	0.00500675	0.021950638	0.005411265	8.667633867	7.074795402	0.860346891	1.785474609	0	0.000593739	4.420438962	0.12403517	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.0428
H8558_012_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			4.684612465	0.073669691	0.651007035	0.551955843	0.190037005	0.258971309	0.257275355	0.25785921	1.474534831	0.646506669	0.708186854	0.000184079	0.001517229	0.000191416	0.520000835	0.592232325	0.030433516	0.121992785	0	0.000161314	0.320453796	0.008474719																			11.3503	NO	729.7601688	21.92830559	344.1018292	31.96541987	246.5398474	14.99780597	14.89958813	490.2346957	85.3947386	37.441142	40.99896926	0.010660576	0.08786728	0.011085451	4092.704189	1648.738255	1.762496255	7.064968397	0	0.274718782	18.55844131	0.490796424																				$250 - days 1-5	$250 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				250	250	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	227.4347278	227.4347278	45.48694557	0	136.4608367	0.181947782	0.181947782	45.48694557	0.181947782	0	0.181947782	0.363895565	0.181947782	0.363895565	18.19477823	36.38955646	0.363895565	0.181947782	36.38955646	14.55958065	0.181947782	0.181947782																				13.8311	0.415604851	1.304345098	0	2.803586155	2.728817535	2.710947017	1.858273243	15.53738331	0	7.459671532	0.003879336	0.015987257	0.004033947	6.20548709	4.999737818	0.64136457	1.285455332	0	0.000333316	3.37666724	0.089299321	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2719	200	10.28880255	18.5157	0.489274542	1.955352133	0.551955843	2.99362316	2.987788844	2.968222372	2.116132454	17.01191814	0.646506669	8.167858387	0.004063416	0.017504486	0.004225362	6.725487925	5.591970143	0.671798086	1.407448117	0	0.00049463	3.697121036	0.09777404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6222	YES	$375 - days 1-5	$375 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	3.5677	0.1072	0.3466	0	0.6678	0.6544	0.6501	0.3034	3.7258	0	1.7888	0.0009	0.0036	0.001	1.6236	1.2262	0.1538	0.3082	0	0.0001	0.5513	0.0214																			15.7018	200	0	22.0833	0.596478039	2.301961345	0.551955843	3.661437106	3.642142268	3.618290558	2.419520245	20.73768574	0.646506669	9.956641091	0.004993656	0.021093428	0.005192677	8.349124785	6.81814755	0.825593309	1.715692287	0	0.000576375	4.248406816	0.11918746	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.324
H8558_801_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			4.719121877	0.074116974	0.679420171	0.560691697	0.185783099	0.239776798	0.238206544	0.265888516	1.509929875	0.494425835	0.541660847	0.000165186	0.00154114	0.000196265	0.520964754	0.601291846	0.030839116	0.125029255	0	0.000165329	0.342336972	0.009053441																			11.1406	NO	848.7215607	25.50293445	400.1943868	36.18524017	268.5878766	15.47442396	15.37308484	583.4904701	97.44602157	31.90865441	34.94075958	0.010660576	0.099460193	0.012666325	4674.327232	1883.044014	1.99025742	8.068986333	0	0.244628192	22.09332801	0.584280016																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	180.4808246	180.4808246	45.12020616	0	135.3606185	0.180480825	0.180480825	45.12020616	0.180480825	0	0.180480825	0.360961649	0.180480825	0.360961649	18.04808246	36.09616493	0.360961649	0.180480825	36.09616493	18.52353066	0.180480825	0.180480825																				12.7648	0.383565887	1.50473777	0	3.029685091	2.792836797	2.77454703	2.193934192	17.58713833	0	6.306137103	0.003848059	0.017950658	0.004572058	7.030220279	5.664222274	0.718406601	1.456297307	0	0.000377615	3.987422059	0.105451339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3262	200	11.41194576	17.484	0.457682861	2.184157941	0.560691697	3.21546819	3.032613595	3.012753574	2.459822708	19.09706821	0.494425835	6.84779795	0.004013245	0.019491797	0.004768323	7.551185033	6.26551412	0.749245717	1.581326563	0	0.000542944	4.329759031	0.114504781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.4668	YES	$300 - days 1-5	$300 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	3.123	0.0938	0.3782	0	0.703	0.6697	0.6653	0.3582	4.217	0	1.5121	0.0009	0.004	0.0011	1.7532	1.3313	0.1723	0.3492	0	0.0001	0.6509	0.0253																			16.0084	200	0	20.607	0.551524797	2.56237922	0.560691697	3.918448241	3.70226864	3.678023173	2.817974903	23.31404068	0.494425835	8.359857849	0.004935917	0.023521182	0.005864592	9.304421976	7.596771972	0.921502329	1.930511607	0	0.000631694	4.980691938	0.139789474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.4752
H8558_802_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			4.6349557	0.072795088	0.667302621	0.550691684	0.182469632	0.235500346	0.233958099	0.261146359	1.483000071	0.485607683	0.532000252	0.00016224	0.001513653	0.000192765	0.511673278	0.590567724	0.030289096	0.122799342	0	0.00016238	0.336231346	0.008891972																			10.9419	NO	848.7215607	25.50293445	400.1943868	36.18524017	268.5878766	15.47442396	15.37308484	583.4904701	97.44602157	31.90865441	34.94075958	0.010660576	0.099460193	0.012666325	4674.327232	1883.044014	1.99025742	8.068986333	0	0.244628192	22.09332801	0.584280016																				$250 - days 1-5	$250 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				250	250	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	223.9270145	223.9270145	44.7854029	0	134.3562087	0.179141612	0.179141612	44.7854029	0.179141612	0	0.179141612	0.358283223	0.179141612	0.358283223	17.91416116	35.82832232	0.358283223	0.179141612	35.82832232	18.38608142	0.179141612	0.179141612																				15.8376	0.475899664	1.493572238	0	3.007204067	2.772113247	2.753959194	2.177654649	17.45663735	0	6.259343982	0.003819506	0.017817459	0.004538132	6.978054279	5.622192323	0.713075844	1.445491216	0	0.000374813	3.957834386	0.104668864	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.0819	200	12.49753143	20.4726	0.548694752	2.160874858	0.550691684	3.189673699	3.007613593	2.987917292	2.438801008	18.93963742	0.485607683	6.791344235	0.003981746	0.019331112	0.004730896	7.489727556	6.212760047	0.74336494	1.568290558	0	0.000537193	4.294065732	0.113560836	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.0238	YES	$375 - days 1-5	$375 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	3.7794	0.1136	0.3664	0	0.6798	0.6481	0.6438	0.3432	4.081	0	1.4633	0.0009	0.0039	0.0011	1.6981	1.2878	0.1667	0.3379	0	0.0001	0.6238	0.0245																			16.2634	200	0	24.252	0.662261747	2.527249656	0.550691684	3.869517138	3.655676393	3.63173605	2.782043195	23.02063855	0.485607683	8.254649528	0.004874667	0.023225073	0.005791818	9.187786138	7.50055471	0.910067338	1.906216537	0	0.000623046	4.917900062	0.138030254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2872
H8578_001_0	2011	6																															A	A	D		T			V	V		V			V	V	V	V	V							V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	199.4226716	1.92709674	450.6408911	0	172.1880253	0	0	274.3705524	201.6709163	0	406.1576396	0	0	1276.213125	4211.122711	4271.416687	366.0138804	527.7703335	0	0	0	0	0	0	123.2346653	0	52.81485656	0	0	0											3400	$300/Admit for IP Medical; $300/Admit for IP Surgical; PBP 1a	$300/Admit for IP Psych; $300/Admit for IP Substance Abuse; PBP 1b	$75/Days Custom for SNF; PBP 2	No Cost-Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; $50/Visit for Foreign Travel; PBP 4a, 4b"	"$150/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$50/Case for OP Fac - Radiology; $50/Case for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"$15/Visit for OP Fac - Occ Therapy; $15/Visit for OP Fac - Physical/Speech Therapy; $15/Visit for OP Fac - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; PBP 4b, 7a, 14b-j"	"$15/Visit for Speclst Office Visits; $15/Visit for Speclst Consults; $15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse; PBP 7e, 7h"	"$15/Visit for Occ Therapy; $15/Visit for PT/ST; PBP 7c, 7i"	No Cost-Sharing; PBP 7d	"No Cost-Sharing; PBP 7d, 7g"	No Cost-Sharing; PBP 15	No Cost-Sharing; PBP 7g	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$15/Exam for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	$15/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	300	300	75	0	50	0	0	48.99196438	150	0	50	0	0	15	15	15	15	15	0	0	0	0	0	0	15	0	15	0	0	0											NO	294.8280344	294.8280344	73.70700859	0	49.13800573	0	0	48.15132763	147.4140172	0	49.13800573	0	0	14.74140172	14.742483	14.74140172	14.74140172	14.74140172	0	0	0	0	0	0	15	0	15	0	0	0												4.8996	0.047346845	2.767949336	0	0.705081348	0	0	1.100942197	2.47742666	0	1.663148035	0	0	1.567764197	5.173533747	5.247222441	0.449629804	0.648339542	0	0	0	0	0	0	0.154043332	0	0.066018571	0	0	0	0	0	0	0	0	0	0	0	0	0	26.9681	0	0.46874311	4.8996	0.047346845	2.767949336	0	0.705081348	0	0	1.100942197	2.47742666	0	1.663148035	0	0	1.567764197	5.173533747	5.247222441	0.449629804	0.648339542	0	0	0	0	0	0	0.154043332	0	0.066018571	0	0	0	0	0	0	0	0	0	0	0	0	0	26.9681	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.8996	0.047346845	2.767949336	0	0.705081348	0	0	1.100942197	2.47742666	0	1.663148035	0	0	1.567764197	5.173533747	5.247222441	0.449629804	0.648339542	0	0	0	0	0	0	0.154043332	0	0.066018571	0	0	0	0	0	0	0	0	0	0	0	0	0	26.9681
H8578_003_0	2011	3																															A	A	D		T			V	V		V			V	V	V	V	V							V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	187.9002741	2.235958145	510.9268072	0	162.3893906	0	0	245.1140978	199.1210443	0	455.0533195	0	0	1047.320545	3929.923353	4028.357433	294.9718366	473.6909213	0	0	0	0	0	0	144.5493315	0	61.94971349	0	0	0											3400	$300/Admit for IP Medical; $300/Admit for IP Surgical; PBP 1a	$300/Admit for IP Psych; $300/Admit for IP Substance Abuse; PBP 1b	$75/Days Custom for SNF; PBP 2	No Cost-Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; $50/Visit for Foreign Travel; PBP 4a, 4b"	"$150/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$50/Case for OP Fac - Radiology; $50/Case for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"$15/Visit for OP Fac - Occ Therapy; $15/Visit for OP Fac - Physical/Speech Therapy; $15/Visit for OP Fac - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; PBP 4b, 7a, 14b-j"	"$15/Visit for Speclst Office Visits; $15/Visit for Speclst Consults; $15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse; PBP 7e, 7h"	"$15/Visit for Occ Therapy; $15/Visit for PT/ST; PBP 7c, 7i"	No Cost-Sharing; PBP 7d	"No Cost-Sharing; PBP 7d, 7g"	No Cost-Sharing; PBP 15	No Cost-Sharing; PBP 7g	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$15/Exam for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	$15/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	300	300	75	0	50	0	0	48.67648678	150	0	50	0	0	15	15	15	15	15	0	0	0	0	0	0	15	0	15	0	0	0											NO	295.2548975	295.2548975	73.81372436	0	49.20914958	0	0	47.91132514	147.6274487	0	49.20914958	0	0	14.76274487	14.76406148	14.76274487	14.76274487	14.76274487	0	0	0	0	0	0	15	0	15	0	0	0												4.6232	0.055014799	3.142784209	0	0.665920318	0	0	0.978645103	2.449644313	0	1.866065572	0	0	1.288443833	4.835135833	4.955801087	0.362882831	0.582748185	0	0	0	0	0	0	0.180686664	0	0.077437142	0	0	0	0	0	0	0	0	0	0	0	0	0	26.0644	0	0.414201473	4.6232	0.055014799	3.142784209	0	0.665920318	0	0	0.978645103	2.449644313	0	1.866065572	0	0	1.288443833	4.835135833	4.955801087	0.362882831	0.582748185	0	0	0	0	0	0	0.180686664	0	0.077437142	0	0	0	0	0	0	0	0	0	0	0	0	0	26.0644	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.6232	0.055014799	3.142784209	0	0.665920318	0	0	0.978645103	2.449644313	0	1.866065572	0	0	1.288443833	4.835135833	4.955801087	0.362882831	0.582748185	0	0	0	0	0	0	0.180686664	0	0.077437142	0	0	0	0	0	0	0	0	0	0	0	0	0	26.0644
H8578_004_0	2011	6																															A	A	D		T	Coin	Coin	V	V		V			V	V	V	V	V							V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	181.8968748	2.163858034	496.2518531	0	157.9470022	3.356061591	3.807945767	238.1650706	190.1718212	0	423.7050923	0	0	1017.187774	3700.347024	3793.023611	278.3802044	446.0112328	0	0	0	0	0	0	135.8274779	0	58.21177624	0	0	0											3400	$600/Admit for IP Medical; $600/Admit for IP Surgical; PBP 1a	$600/Admit for IP Psych; $600/Admit for IP Substance Abuse; PBP 1b	$75/Days Custom for SNF; PBP 2	No Cost-Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	15% Coinsurance for DME; PBP 11a	"15% Coinsurance for DME / Medical Supplies; 15% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $20/Visit for PCP Urgent Care; $50/Visit for Foreign Travel; PBP 4a, 4b"	"$300/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$100/Case for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"$20/Visit for OP Fac - Occ Therapy; $20/Visit for OP Fac - Physical/Speech Therapy; $20/Visit for OP Fac - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$20/Visit for PCP Office Visits; $20/Visit for PCP Consults; PBP 4b, 7a, 14b-j"	"$20/Visit for Speclst Office Visits; $20/Visit for Speclst Consults; $20/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse; PBP 7e, 7h"	"$20/Visit for Occ Therapy; $20/Visit for PT/ST; PBP 7c, 7i"	No Cost-Sharing; PBP 7d	"No Cost-Sharing; PBP 7d, 7g"	No Cost-Sharing; PBP 15	No Cost-Sharing; PBP 7g	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$20/Exam for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	$20/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	600	600	75	0	50	0.15	0.15	48.90290745	300	0	100	0	0	20	20	20	20	20	0	0	0	0	0	0	20	0	20	0	0	0											NO	578.4661106	578.4661106	72.30826382	0	48.20550922	0.144616528	0.144616528	47.15861095	289.2330553	0	96.41101843	0	0	19.28220369	19.28629877	19.28220369	19.28220369	19.28220369	0	0	0	0	0	0	20	0	20	0	0	0												8.7684	0.104309878	2.99025916	0	0.634492972	0.485341974	0.550691894	0.935961159	4.583664741	0	3.404153289	0	0	1.634468487	5.947166521	6.094821155	0.447315317	0.716673286	0	0	0	0	0	0	0.22637913	0	0.097019627	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6212	0	1.386907774	8.7684	0.104309878	2.99025916	0	0.634492972	0.485341974	0.550691894	0.935961159	4.583664741	0	3.404153289	0	0	1.634468487	5.947166521	6.094821155	0.447315317	0.716673286	0	0	0	0	0	0	0.22637913	0	0.097019627	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6212	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.7684	0.104309878	2.99025916	0	0.634492972	0.485341974	0.550691894	0.935961159	4.583664741	0	3.404153289	0	0	1.634468487	5.947166521	6.094821155	0.447315317	0.716673286	0	0	0	0	0	0	0.22637913	0	0.097019627	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6212
H8578_007_0	2011	6																															A	A	D		T	Coin	Coin	V	V		V			V	V	V	V	V							V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	175.6408069	2.08951295	474.383951	0	152.1947366	3.172712615	3.644376651	230.3636458	184.2207552	0	393.511915	0	0	979.1778028	3477.191283	3539.210888	259.8421959	415.8298092	0	0	0	0	0	0	126.8731573	0	54.37421028	0	0	0											3400	$800/Admit for IP Medical; $800/Admit for IP Surgical; PBP 1a	$800/Admit for IP Psych; $800/Admit for IP Substance Abuse; PBP 1b	$100/Days Custom for SNF; PBP 2	No Cost-Sharing; PBP 6	$75/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $30/Visit for PCP Urgent Care; $50/Visit for Foreign Travel; PBP 4a, 4b"	"$400/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$150/Case for OP Fac - Radiology; $150/Case for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"$30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; $30/Visit for OP Fac - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$30/Visit for PCP Office Visits; $30/Visit for PCP Consults; PBP 4b, 7a, 14b-j"	"$35/Visit for Speclst Office Visits; $35/Visit for Speclst Consults; $35/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse; PBP 7e, 7h"	"$35/Visit for Occ Therapy; $35/Visit for PT/ST; PBP 7c, 7i"	No Cost-Sharing; PBP 7d	"No Cost-Sharing; PBP 7d, 7g"	No Cost-Sharing; PBP 15	No Cost-Sharing; PBP 7g	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$35/Exam for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	$35/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	800	800	100	0	75	0.2	0.2	49.28825212	400	0	150	0	0	30	30	35	35	35	0	0	0	0	0	0	35	0	35	0	0	0											NO	749.4745806	749.4745806	93.68432257	0	70.26324193	0.187368645	0.187368645	46.19459114	374.7372903	0	140.5264839	0	0	28.10529677	28.11643022	32.7895129	32.7895129	32.7895129	0	0	0	0	0	0	35	0	35	0	0	0												10.9699	0.13050307	3.703528258	0	0.8911413	0.594466864	0.682841915	0.886796203	5.752865552	0	4.608237148	0	0	2.293340228	8.147183841	9.670750088	0.710008253	1.136238075	0	0	0	0	0	0	0.370046709	0	0.158591447	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7064	0	3.378868789	10.9699	0.13050307	3.703528258	0	0.8911413	0.594466864	0.682841915	0.886796203	5.752865552	0	4.608237148	0	0	2.293340228	8.147183841	9.670750088	0.710008253	1.136238075	0	0	0	0	0	0	0.370046709	0	0.158591447	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7064	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.9699	0.13050307	3.703528258	0	0.8911413	0.594466864	0.682841915	0.886796203	5.752865552	0	4.608237148	0	0	2.293340228	8.147183841	9.670750088	0.710008253	1.136238075	0	0	0	0	0	0	0.370046709	0	0.158591447	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7064
H8578_009_0	2011	3																															A	A	D		T	Coin	Coin	V	V		V			V	V	V	V	V							V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	175.6744798	2.089881056	474.4127836	0	152.225958	3.172883859	3.645115762	230.4156339	184.2535922	0	393.5349967	0	0	979.4858802	3477.971466	3539.927113	259.9235319	415.9286182	0	0	0	0	0	0	126.8769602	0	54.37584007	0	0	0											3400	$800/Admit for IP Medical; $800/Admit for IP Surgical; PBP 1a	$800/Admit for IP Psych; $800/Admit for IP Substance Abuse; PBP 1b	$100/Days Custom for SNF; PBP 2	No Cost-Sharing; PBP 6	$75/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $30/Visit for PCP Urgent Care; $50/Visit for Foreign Travel; PBP 4a, 4b"	"$400/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$150/Case for OP Fac - Radiology; $150/Case for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"$30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; $30/Visit for OP Fac - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$30/Visit for PCP Office Visits; $30/Visit for PCP Consults; PBP 4b, 7a, 14b-j"	"$35/Visit for Speclst Office Visits; $35/Visit for Speclst Consults; $35/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse; PBP 7e, 7h"	"$35/Visit for Occ Therapy; $35/Visit for PT/ST; PBP 7c, 7i"	No Cost-Sharing; PBP 7d	"No Cost-Sharing; PBP 7d, 7g"	No Cost-Sharing; PBP 15	No Cost-Sharing; PBP 7g	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$35/Exam for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	$35/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	800	800	100	0	75	0.2	0.2	49.28839138	400	0	150	0	0	30	30	35	35	35	0	0	0	0	0	0	35	0	35	0	0	0											NO	749.4618844	749.4618844	93.68273554	0	70.26205166	0.187365471	0.187365471	46.19393993	374.7309422	0	140.5241033	0	0	28.10482066	28.11595412	32.78895744	32.78895744	32.78895744	0	0	0	0	0	0	35	0	35	0	0	0												10.9718	0.13052385	3.703690612	0	0.89130901	0.594488879	0.682968832	0.886983829	5.753793517	0	4.608429377	0	0	2.294022917	8.148873849	9.672543288	0.710218469	1.136488813	0	0	0	0	0	0	0.3700578	0	0.1585962	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7148	0	3.380338361	10.9718	0.13052385	3.703690612	0	0.89130901	0.594488879	0.682968832	0.886983829	5.753793517	0	4.608429377	0	0	2.294022917	8.148873849	9.672543288	0.710218469	1.136488813	0	0	0	0	0	0	0.3700578	0	0.1585962	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7148	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.9718	0.13052385	3.703690612	0	0.89130901	0.594488879	0.682968832	0.886983829	5.753793517	0	4.608429377	0	0	2.294022917	8.148873849	9.672543288	0.710218469	1.136488813	0	0	0	0	0	0	0.3700578	0	0.1585962	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7148
H8578_010_0	2011	4																															A	A	D		T			V	V		V			V	V	V	V	V							V		V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	150.5462895	1.954262932	721.4555794	0	120.2448584	0	0	158.7554012	171.6575468	0	649.264436	0	0	241.1296126	2557.004459	3032.179856	68.78034679	279.0541151	0	0	0	0	0	0	300.0066579	0	128.574282	0	0	0												$300/Admit for IP Medical; $300/Admit for IP Surgical; PBP 1a	$300/Admit for IP Psych; $300/Admit for IP Substance Abuse; PBP 1b	$75/Days Custom for SNF; PBP 2	No Cost-Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; $50/Visit for Foreign Travel; PBP 4a, 4b"	"$150/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$50/Case for OP Fac - Radiology; $50/Case for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"$15/Visit for OP Fac - Occ Therapy; $15/Visit for OP Fac - Physical/Speech Therapy; $15/Visit for OP Fac - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$15/Visit for PCP Office Visits; $15/Visit for PCP Consults; PBP 4b, 7a, 14b-j"	"$15/Visit for Speclst Office Visits; $15/Visit for Speclst Consults; $15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse; PBP 7e, 7h"	"$15/Visit for Occ Therapy; $15/Visit for PT/ST; PBP 7c, 7i"	No Cost-Sharing; PBP 7d	"No Cost-Sharing; PBP 7d, 7g"	No Cost-Sharing; PBP 15	No Cost-Sharing; PBP 7g	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$15/Exam for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	$15/Exam for Routine Hearing Exams; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	300	300	75	0	50	0	0	46.8191431	150	0	50	0	0	15	15	15	15	15	0	0	0	0	0	0	15	0	15	0	0	0											NO	289.5590025	289.5590025	72.38975063	0	48.25983375	0	0	45.22056519	144.7795013	0	48.25983375	0	0	14.47795013	14.49200184	14.47795013	14.47795013	14.47795013	0	0	0	0	0	0	15	0	15	0	0	0												3.6327	0.047156202	4.35216579	0	0.483583073	0	0	0.598250747	2.071041168	0	2.611116145	0	0	0.290921875	3.088009444	3.658312393	0.082983203	0.33667763	0	0	0	0	0	0	0.375008322	0	0.160717852	0	0	0	0	0	0	0	0	0	0	0	0	0	21.7886	0	0.762816928	3.6327	0.047156202	4.35216579	0	0.483583073	0	0	0.598250747	2.071041168	0	2.611116145	0	0	0.290921875	3.088009444	3.658312393	0.082983203	0.33667763	0	0	0	0	0	0	0.375008322	0	0.160717852	0	0	0	0	0	0	0	0	0	0	0	0	0	21.7886	YES	$600/Admit for IP Medical; $600/Admit for IP Surgical; PBP 1a	$600/Admit for IP Psych; $600/Admit for IP Substance Abuse; PBP 1b	$100/Day for SNF; PBP 2	No Cost-Sharing; PBP 6	$50/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $30/Visit for PCP Urgent Care; PBP 4a, 4b"	"$300/Case for OP Fac - Surgery; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	$100/Case for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	No Cost-Sharing; PBP 12	"$30/Visit for OP Fac - Occ Therapy; $30/Visit for OP Fac - Physical/Speech Therapy; $30/Visit for OP Fac - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$30/Visit for PCP Office Visits; $30/Visit for PCP Consults; PBP 4b, 7a, 14b-j"	"$30/Visit for Speclst Office Visits; $30/Visit for Speclst Consults; $30/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse; PBP 7e, 7h"	"$30/Visit for Occ Therapy; $30/Visit for PT/ST; PBP 7c, 7i"	No Cost-Sharing; PBP 7d	"No Cost-Sharing; PBP 7d, 7g"	No Cost-Sharing; PBP 15	No Cost-Sharing; PBP 7g	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	$30/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											3400	2.7494	0.0455	3.5816	0	0.1612	0.4357	0.2514	0.2031	1.7871	0	1.6432	0	0	0.1925	1.9341	2.2942	0.0564	0.2108	0	0	0	0	0	0	0.1761	0	0	0	0	0											15.7223	0	0.558749579	6.3821	0.092646612	7.933762901	0	0.644777431	0.435738966	0.251411097	0.801321535	3.858135963	0	4.254331791	0	0	0.483404191	5.022090178	5.952542441	0.139424827	0.547453112	0	0	0	0	0	0	0.551087499	0	0.160717852	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5109
H8578_801_0	2011	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	198.2173525	1.662051356	31.11950913	0	6.817867194	3.286457865	6.368768903	11.70596756	33.65130863	17.16111565	22.15098005	0	0.149498548	31.06988332	52.43471123	39.76340664	2.565758176	2.973509626	28.82994276	45.6289234	26.39386479	2.818480768	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.076488794	0.076488794	0.168490153	0	0.233	0.233	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	0.067430746	0.067430746	0.148537009	0	0.205407393	0.205407393	0.205407393	0.205407393	0.205407393	0.205407393	0.205407393	0	0.205407393	0.205407393	0.205407393	0.205407393	0.205407393	0.205407393	0.205407393	0.205407393	0.205407393	0.205407393	0	0	0	0	0	0	0	0												13.3659	0.112073362	4.622398819	0	1.400440329	0.675062744	1.30819222	2.404492284	6.91222759	3.525020033	4.549975074	0	0.030708107	6.381983746	10.77047736	8.167697709	0.527025699	0.610780861	5.921883394	9.372518219	5.421494968	0.578936788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6593	0	11.64104588	13.3659	0.112073362	4.622398819	0	1.400440329	0.675062744	1.30819222	2.404492284	6.91222759	3.525020033	4.549975074	0	0.030708107	6.381983746	10.77047736	8.167697709	0.527025699	0.610780861	5.921883394	9.372518219	5.421494968	0.578936788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6593	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b												0.5106	0.0064	0.2826	0	0.0355	0.0483	0.0302	0.0499	0.1625	0.0578	0.1199	0	0.0019	0.1129	0.1184	0.2446	0.0048	0.0172	0.0758	0.2523	0.1499	0.0352	0	0	0	0	0	0	0	0											2.3167	0	8.88E-16	13.8765	0.118506393	4.904951544	0	1.435891346	0.723372424	1.33843082	2.454415923	7.074690899	3.582867113	4.669914859	0	0.032616602	6.494928874	10.8888355	8.412260654	0.531856941	0.627942983	5.997677359	9.624774034	5.571428985	0.614110029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.976
H8578_802_0	2011	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	201.3208966	1.55835214	31.62050129	0	6.205108305	3.770875563	6.375443907	11.69307879	32.13676954	16.47137063	21.87377234	0	0.18146672	30.55749235	50.22927988	41.06224053	2.450504038	3.151611963	27.1446641	45.4939004	27.14518278	3.421173424	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.076488794	0.076488794	0.168490153	0	0.233	0.233	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	0.067463236	0.067463236	0.148608581	0	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0	0	0	0	0	0	0	0												13.5818	0.105131479	4.699077812	0	1.275189265	0.774938937	1.310194316	2.403002141	6.604310756	3.384971538	4.495199487	0	0.037292566	6.279759238	10.32243683	8.438551873	0.503594182	0.647676325	5.578401304	9.349286194	5.578507895	0.703072921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0724	0	11.5151747	13.5818	0.105131479	4.699077812	0	1.275189265	0.774938937	1.310194316	2.403002141	6.604310756	3.384971538	4.495199487	0	0.037292566	6.279759238	10.32243683	8.438551873	0.503594182	0.647676325	5.578401304	9.349286194	5.578507895	0.703072921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0724	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b												0.607	0.0076	0.3359	0	0.0421	0.0574	0.0359	0.0593	0.1931	0.0688	0.1426	0	0.0023	0.1343	0.1407	0.2907	0.0057	0.0204	0.0901	0.2999	0.1782	0.0418	0	0	0	0	0	0	0	0											2.7539	0	0	14.1887	0.112778514	5.034952222	0	1.317330389	0.832365336	1.346139366	2.462347075	6.797433182	3.453735178	4.637773601	0	0.039561221	6.414018704	10.46313082	8.729267294	0.509337148	0.668077181	5.668498659	9.649146238	5.756736576	0.744883849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.8262
H8578_803_0	2011	1																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	201.3208966	1.55835214	31.62050129	0	6.205108305	3.770875563	6.375443907	11.69307879	32.13676954	16.47137063	21.87377234	0	0.18146672	30.55749235	50.22927988	41.06224053	2.450504038	3.151611963	27.1446641	45.4939004	27.14518278	3.421173424	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.076488794	0.076488794	0.168490153	0	0.233	0.233	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	0.067463236	0.067463236	0.148608581	0	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0.205506367	0	0	0	0	0	0	0	0												13.5818	0.105131479	4.699077812	0	1.275189265	0.774938937	1.310194316	2.403002141	6.604310756	3.384971538	4.495199487	0	0.037292566	6.279759238	10.32243683	8.438551873	0.503594182	0.647676325	5.578401304	9.349286194	5.578507895	0.703072921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0724	0	11.5151747	13.5818	0.105131479	4.699077812	0	1.275189265	0.774938937	1.310194316	2.403002141	6.604310756	3.384971538	4.495199487	0	0.037292566	6.279759238	10.32243683	8.438551873	0.503594182	0.647676325	5.578401304	9.349286194	5.578507895	0.703072921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0724	NO	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-j"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g"	Medicare-FFS Cost Sharing; PBP 15	Medicare-FFS Cost Sharing; PBP 7g	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b												0.607	0.0076	0.3359	0	0.0421	0.0574	0.0359	0.0593	0.1931	0.0688	0.1426	0	0.0023	0.1343	0.1407	0.2907	0.0057	0.0204	0.0901	0.2999	0.1782	0.0418	0	0	0	0	0	0	0	0											2.7539	0	0	14.1887	0.112778514	5.034952222	0	1.317330389	0.832365336	1.346139366	2.462347075	6.797433182	3.453735178	4.637773601	0	0.039561221	6.414018704	10.46313082	8.729267294	0.509337148	0.668077181	5.668498659	9.649146238	5.756736576	0.744883849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.8262
H8604_001_0	2011	5																															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	1011.18	19.95	1140.76	263.53	234.6	6.813040764	0	306.2	338.105	5891.52	892.145	129.2	83.9	3808.455	2841.83	2726.69	208.81	178.41	831.725	0	11.34981124	0	0	0.19	168.2	142	0	0	0	0												$175 / days 1-12	$175 / days 1-12	$100 / days 11-100	$0.00 	125	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$250.00 	$10.00 	"$25 X-Rays, $125 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	$0.00 	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												126.6715116	126.6715116	43.0432551	$0.00 	125	20%	20%	$50.00 	$250.00 	$10.00 	51.37419558	$0.00 	13.60710984	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	100.9571948	100.9571948	34.30547431	0	99.625	0.1594	0.1594	39.85	199.25	7.97	40.94523387	0	10.84486654	0	0	27.895	27.895	27.895	0	0	0.15143	0	0	0	27.895	11.955	0	0	0	0												8.5072	0.167841336	3.26119274	0	1.94766875	1.085998698	0	1.016839167	5.613951771	3.9129512	3.044090473	0	0.075823692	0	0	6.338418129	0.485396246	0.414728913	0	0	1.718701916	0	0	0	0.390994917	0.1414675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1232		9.710181133	8.5072	0.167841336	3.26119274	0	1.94766875	1.085998698	0	1.016839167	5.613951771	3.9129512	3.044090473	0	0.075823692	0	0	6.338418129	0.485396246	0.414728913	0	0	1.718701916	0	0	0	0.390994917	0.1414675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1232	YES	20%	20%	20%	20%	0	30%	30%	0	20%	20%	20%	20%	0	20%	$20.00 	$45.00 	$45.00 	$45.00 	$45.00 	$45.00 	20%	20%	0	0	0	0	0	0	0	0											3400	1.6192	0.0319	0.3041	0.0203	0	0.0947	0	0	0.3803	0.4279	0.0648	0.0094	0	0.2766	0.1987	0.4289	0.0328	0.0281	0.1308	0	0.1102	0	0	0	0	0	0	0	0	0											4.1587	250	1.059231595	10.1264	0.199787093	3.565291824	0.020257322	1.94766875	1.180699964	0	1.016839167	5.994269002	4.340832477	3.108883963	0.009383361	0.075823692	0.276595274	0.198678817	6.767333642	0.518242608	0.442793275	0.130832531	0	1.82885482	0	0	0	0.390994917	0.1414675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2819
H8604_002_0	2011	5																															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	1062.955	24.415	1346.15	274.265	246.3	7.203972582	0	328.7	367.84	6325.575	805.315	134.71	103	3722.29	2940.725	2498.5	118.085	210.71	679.345	0	11.73501515	0	0	0.19	149	104.2	0	0	0	0												$175 / days 1-12	$175 / days 1-12	$100 / days 11-100	$0.00 	$125.00 	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$250.00 	$10.00 	"$25 X-Rays, $125 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	$0.00 	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												126.6715116	126.6715116	43.0432551	$0.00 	$125.00 	20%	20%	$50.00 	$250.00 	$10.00 	51.37419558	$0.00 	13.60710984	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	100.9571948	100.9571948	34.30547431	0	99.625	0.1594	0.1594	39.85	199.25	7.97	40.94523387	0	10.84486654	0	0	27.895	27.895	27.895	0	0	0.15143	0	0	0	27.895	11.955	0	0	0	0												8.9427	0.205405826	3.848359521	0	2.044803125	1.14831323	0	1.091557917	6.107676667	4.201236063	2.747817585	0	0.093085104	0	0	5.807971458	0.274498423	0.489812954	0	0	1.777033344	0	0	0	0.346362917	0.10380925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2305		9.992207522	8.9427	0.205405826	3.848359521	0	2.044803125	1.14831323	0	1.091557917	6.107676667	4.201236063	2.747817585	0	0.093085104	0	0	5.807971458	0.274498423	0.489812954	0	0	1.777033344	0	0	0	0.346362917	0.10380925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2305	YES	20%	20%	20%	20%	0	30%	30%	0	20%	20%	20%	20%	0	20%	$20.00 	$45.00 	$45.00 	$45.00 	$45.00 	$45.00 	20%	20%	0	0	0	0	0	0	0	0											3400	1.6762	0.0385	0.3337	0.0214	0	0.1001	0	0	0.3547	0.4573	0.0582	0.0097	0	0.2691	0.2056	0.393	0.0186	0.0331	0.1069	0	0.1139	0	0	0	0	0	0	0	0	0											4.1901	250	1.067237473	10.6189	0.243906522	4.182087856	0.02136755	2.044803125	1.248448448	0	1.091557917	6.462360221	4.658551417	2.80603884	0.009739028	0.093085104	0.26910761	0.205592792	6.200992083	0.293073504	0.522958192	0.106862756	0	1.890924754	0	0	0	0.346362917	0.10380925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.4206
H8604_003_0	2011	5																															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	1707.245	53.01	2402.835	2173.41	369	13.81360227	0	373	314.83	12909.835	976.79	241.49	39.1	5669.315	3164.925	3066.22	212.99	33.44	860.605	0	19.12509042	0	0	0.38	180.8	152.4	0	0	0	0												$175 / days 1-12	$175 / days 1-12	$100 / days 11-100	$0.00 	125	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$250.00 	$10.00 	"$25 X-Rays, $125 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	$0.00 	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												126.6715116	126.6715116	43.0432551	$0.00 	125	20%	20%	$50.00 	$250.00 	$10.00 	56.42380972	$0.00 	41.62096591	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	100.9571948	100.9571948	34.30547431	0	99.625	0.1594	0.1594	39.85	199.25	7.97	44.96977635	0	33.17190983	0	0	27.895	27.895	27.895	0	0	0.15143	0	0	0	27.895	11.955	0	0	0	0												14.3632	0.445978408	6.869199531	0	3.06346875	2.201888202	0	1.238670833	5.227489792	8.574282079	3.66050232	0	0.10808514	0	0	7.127683908	0.495113004	0.077734067	0	0	2.896112442	0	0	0	0.420284667	0.1518285	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.9215		14.49821003	14.3632	0.445978408	6.869199531	0	3.06346875	2.201888202	0	1.238670833	5.227489792	8.574282079	3.66050232	0	0.10808514	0	0	7.127683908	0.495113004	0.077734067	0	0	2.896112442	0	0	0	0.420284667	0.1518285	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.9215	YES	20%	20%	20%	20%	0	30%	30%	0	20%	20%	20%	20%	0	20%	$20.00 	$45.00 	$45.00 	$45.00 	$45.00 	$45.00 	20%	20%	0	0	0	0	0	0	0	0											3400	2.043	0.0634	0.7026	0.1626	0	0.192	0	0	0.5615	0.7672	0.058	0.0144	0	0.3369	0.2213	0.4823	0.0335	0.0053	0.1354	0	0.1856	0	0	0	0	0	0	0	0	0											5.965	250	1.519325456	16.4063	0.509414873	7.57184309	0.162574149	3.06346875	2.393897274	0	1.238670833	5.789027052	9.341441045	3.718547462	0.014350394	0.10808514	0.33689554	0.221267125	7.610008383	0.528616892	0.082994267	0.135375431	0	3.081726478	0	0	0	0.420284667	0.1518285	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8866
H8604_004_0	2011	5																															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	1613.48	33.155	2343.27	1743.345	305.7	11.96773661	0	339.3	259.16	11379.1	865.735	172.615	44.3	4658.04	2878.595	2585.045	145.445	35.815	660.25	0	19.19377837	0	0	0.475	155.5	127.5	0	0	0	0												$175 / days 1-12	$175 / days 1-12	$100 / days 11-100	$0.00 	$125.00 	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$250.00 	$10.00 	"$25 X-Rays, $125 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	$0.00 	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												126.6715116	126.6715116	43.0432551	$0.00 	$125.00 	20%	20%	$50.00 	$250.00 	$10.00 	56.42380972	$0.00 	41.62096591	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	100.9571948	100.9571948	34.30547431	0	99.625	0.1594	0.1594	39.85	199.25	7.97	44.96977635	0	33.17190983	0	0	27.895	27.895	27.895	0	0	0.15143	0	0	0	27.895	11.955	0	0	0	0												13.5744	0.278936316	6.698915733	0	2.537946875	1.907657215	0	1.12675875	4.303135833	7.557618917	3.244325777	0	0.122459634	0	0	6.009152523	0.338099023	0.083254952	0	0	2.906513859	0	0	0	0.361472708	0.127021875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1776		13.03520764	13.5744	0.278936316	6.698915733	0	2.537946875	1.907657215	0	1.12675875	4.303135833	7.557618917	3.244325777	0	0.122459634	0	0	6.009152523	0.338099023	0.083254952	0	0	2.906513859	0	0	0	0.361472708	0.127021875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1776	YES	20%	20%	20%	20%	0	30%	30%	0	20%	20%	20%	20%	0	20%	$20.00 	$45.00 	$45.00 	$45.00 	$45.00 	$45.00 	20%	20%	0	0	0	0	0	0	0	0											3400	1.8704	0.0384	0.6928	0.1325	0	0.1664	0	0	0.4575	0.6598	0.0502	0.01	0	0.2701	0.2012	0.4066	0.0229	0.0056	0.1039	0	0.1863	0	0	0	0	0	0	0	0	0											5.2747	250	1.343485987	15.4447	0.317370265	7.391737985	0.132528666	2.537946875	2.074008754	0	1.12675875	4.760607002	8.217454037	3.294526791	0.010009354	0.122459634	0.27010382	0.201249142	6.415786904	0.360977904	0.088888746	0.103859063	0	3.092794529	0	0	0	0.361472708	0.127021875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.4523
H8604_005_0	2011	6																															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	1138.48	26.695	1473.45	298.395	267.9	7.777176983	0	309.7	335.16	5948.71	838.185	146.585	112.1	3753.735	2991.36	2599.865	131.86	235.125	726.655	0	12.7024729	0	0	0.19	162.2	113.4	0	0	0	0												$100 / days 1-12	$100 / days 1-12	$75 / days 11-100	$0.00 	125	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$175.00 	$5.00 	"$20 X-Rays, $100 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	$0.00 	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												72.38372093	72.38372093	32.28244132	$0.00 	125	20%	20%	$50.00 	$175.00 	$5.00 	44.87419558	$0.00 	13.60710984	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	61.81569767	61.81569767	27.56920489	0	106.75	0.1708	0.1708	42.7	149.45	4.27	38.32256302	0	11.6204718	0	0	29.89	29.89	29.89	0	0	0.16226	0	0	0	29.89	12.81	0	0	0	0												5.8647	0.137514171	3.385153745	0	2.38319375	1.328341829	0	1.102015833	4.1741385	2.116749308	2.676783124	0	0.108554574	0	0	6.475830404	0.328441283	0.585657188	0	0	2.061103252	0	0	0	0.404013167	0.1210545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2532		5.684974314	5.8647	0.137514171	3.385153745	0	2.38319375	1.328341829	0	1.102015833	4.1741385	2.116749308	2.676783124	0	0.108554574	0	0	6.475830404	0.328441283	0.585657188	0	0	2.061103252	0	0	0	0.404013167	0.1210545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2532	YES	20%	20%	20%	20%	0	30%	30%	0	20%	20%	20%	20%	0	20%	$20.00 	$45.00 	$45.00 	$45.00 	$45.00 	$45.00 	20%	20%	0	0	0	0	0	0	0	0											3400	1.8432	0.0432	0.3879	0.0247	0	0.1151	0	0	0.3972	0.4786	0.0674	0.0118	0	0.302	0.2241	0.4382	0.0222	0.0396	0.1225	0	0.1309	0	0	0	0	0	0	0	0	0											4.6487	250	0.794747269	7.7079	0.180733778	3.773035461	0.024683998	2.38319375	1.443444048	0	1.102015833	4.5713219	2.595385157	2.744223861	0.011794294	0.108554574	0.302027185	0.2240896	6.914044492	0.350666633	0.625288125	0.122479613	0	2.192005578	0	0	0	0.404013167	0.1210545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9019
H8604_006_0	2011	6																															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	1684.065	39.805	2487.67	2039.365	365.7	13.16685142	0	358.5	304.76	12749.475	1005.67	206.53	53	5219.585	3175.755	2924.195	159.03	42.94	784.7	0	22.81974694	0	0	0.57	178	144.5	0	0	0	0												$100 / days 1-12	$100 / days 1-12	$75 / days 11-100	$0.00 	125	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$175.00 	$5.00 	"$20 X-Rays, $100 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	$0.00 	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												72.38372093	72.38372093	32.28244132	$0.00 	125	20%	20%	$50.00 	$175.00 	$5.00 	49.92380972	$0.00 	41.62096591	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	61.81569767	61.81569767	27.56920489	0	106.75	0.1708	0.1708	42.7	149.45	4.27	42.6349335	0	35.54430489	0	0	29.89	29.89	29.89	0	0	0.16226	0	0	0	29.89	12.81	0	0	0	0												8.6751	0.20504782	5.715256994	0	3.25320625	2.248898222	0	1.2756625	3.795531833	4.536688188	3.573056131	0	0.156987347	0	0	7.283682379	0.396117225	0.106956383	0	0	3.702732139	0	0	0	0.443368333	0.15425375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5226		7.782549359	8.6751	0.20504782	5.715256994	0	3.25320625	2.248898222	0	1.2756625	3.795531833	4.536688188	3.573056131	0	0.156987347	0	0	7.283682379	0.396117225	0.106956383	0	0	3.702732139	0	0	0	0.443368333	0.15425375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5226	YES	20%	20%	20%	20%	0	30%	30%	0	20%	20%	20%	20%	0	20%	$20.00 	$45.00 	$45.00 	$45.00 	$45.00 	$45.00 	20%	20%	0	0	0	0	0	0	0	0											3400	2.0327	0.048	0.7644	0.164	0	0.1949	0	0	0.5625	0.8001	0.0631	0.013	0	0.3276	0.2379	0.4929	0.0268	0.0072	0.1323	0	0.2352	0	0	0	0	0	0	0	0	0											6.1026	250	1.043297873	10.7078	0.253092485	6.479689017	0.164035398	3.25320625	2.443767623	0	1.2756625	4.358020804	5.336825823	3.636170449	0.012961508	0.156987347	0.327573206	0.23790305	7.776563142	0.42292215	0.114194033	0.13226325	0	3.937895636	0	0	0	0.443368333	0.15425375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6252
H8604_801_0	2011	5																															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	1396.785	31.54	1868.555	1085.375	307	13.08369708	0	363	386.745	9977.565	959.12	186.485	80.5	4650.725	3371.93	3062.42	142.785	192.85	831.725	0	17.85205405	0	0	0.38	182.4	147.5	0	0	0	0												$175 / days 1-12	$175 / days 1-12	$100 / days 11-100	$0.00 	125	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$250.00 	$10.00 	"$25 X-Rays, $125 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	$0.00 	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												126.6715116	126.6715116	43.0432551	$0.00 	125	20%	20%	$50.00 	$250.00 	$10.00 	54.52685124	$0.00 	23.01631888	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	100.9571948	100.9571948	34.30547431	0	99.625	0.1594	0.1594	39.85	199.25	7.97	43.45790044	0	18.34400615	0	0	27.895	27.895	27.895	0	0	0.15143	0	0	0	27.895	11.955	0	0	0	0												11.7513	0.26534916	5.341805463	0	2.548739583	2.085541315	0	1.2054625	6.421578438	6.626766088	3.473445122	0	0.123057708	0	0	7.118850492	0.331915631	0.448295896	0	0	2.703336545	0	0	0	0.424004	0.146946875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0164		12.99413598	11.7513	0.26534916	5.341805463	0	2.548739583	2.085541315	0	1.2054625	6.421578438	6.626766088	3.473445122	0	0.123057708	0	0	7.118850492	0.331915631	0.448295896	0	0	2.703336545	0	0	0	0.424004	0.146946875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0164	YES	20%	20%	20%	20%	0	30%	30%	0	20%	20%	20%	20%	0	20%	$20.00 	$45.00 	$45.00 	$45.00 	$45.00 	$45.00 	20%	20%	0	0	0	0	0	0	0	0											3400	1.9755	0.0446	0.5103	0.0825	0	0.1819	0	0	0.6151	0.6275	0.0603	0.0117	0	0.2925	0.2357	0.4817	0.0225	0.0303	0.1308	0	0.1733	0	0	0	0	0	0	0	0	0											5.4763	250	1.394843936	13.7268	0.309957235	5.852077209	0.082531149	2.548739583	2.267404704	0	1.2054625	7.0367244	7.25425167	3.533763845	0.011727977	0.123057708	0.292482473	0.235739317	7.600577217	0.354376088	0.478631708	0.130832531	0	2.876595427	0	0	0	0.424004	0.146946875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.4927
H8604_802_0	2011	5																															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	1506.985	35.53	2104.63	1222.46	340.2	11.19595354	0	360.1	344.28	9947.355	992.94	189.43	90.7	4816.595	3329.845	2978.82	156.655	154.945	815.765	0	18.96806808	0	0	0.38	183.5	138.7	0	0	0	0												$175 / days 1-12	$175 / days 1-12	$100 / days 11-100	$0.00 	$125.00 	20%	20%	"$50.00 ER, $35.00 Urgent Care"	$250.00 	$10.00 	"$25 X-Rays, $125 Scans, 20% Rad Ther, $35 CORF"	$0.00 	20%	"20% Rad Ther, CORF"	$0.00 	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"$7.50 copayment diabetic supplies, 10% coinsurance Chemotherapy, 20% coinsurance All other"	$0.00 	$0.00 	$0.00 	$35.00 	"$15.00 copayment Contacts/Frmaes/Lenses, $100.00/year benefit maximum"	$0.00 	$0.00 	$0.00 	$0.00 												126.6715116	126.6715116	43.0432551	$0.00 	$125.00 	20%	20%	$50.00 	$250.00 	$10.00 	54.52685124	$0.00 	23.01631888	0	0	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.19	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	100.9571948	100.9571948	34.30547431	0	99.625	0.1594	0.1594	39.85	199.25	7.97	43.45790044	0	18.34400615	0	0	27.895	27.895	27.895	0	0	0.15143	0	0	0	27.895	11.955	0	0	0	0												12.6784	0.298917428	6.0166942	0	2.82436875	1.784634994	0	1.195832083	5.7164825	6.606701613	3.595923972	0	0.138650113	0	0	6.924515325	0.364157602	0.360182565	0	0	2.872334549	0	0	0	0.426561042	0.138179875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9426		13.23003506	12.6784	0.298917428	6.0166942	0	2.82436875	1.784634994	0	1.195832083	5.7164825	6.606701613	3.595923972	0	0.138650113	0	0	6.924515325	0.364157602	0.360182565	0	0	2.872334549	0	0	0	0.426561042	0.138179875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.9426	YES	20%	20%	20%	20%	0	30%	30%	0	20%	20%	20%	20%	0	20%	$20.00 	$45.00 	$45.00 	$45.00 	$45.00 	$45.00 	20%	20%	0	0	0	0	0	0	0	0											3400	1.9613	0.0462	0.5747	0.093	0	0.1556	0	0	0.4816	0.6507	0.065	0.0124	0	0.3151	0.2328	0.4686	0.0246	0.0244	0.1283	0	0.1841	0	0	0	0	0	0	0	0	0											5.4183	250	1.380078674	14.6397	0.345158172	6.591438108	0.092958851	2.82436875	1.940258748	0	1.195832083	6.198061945	7.257399806	3.66087634	0.01239141	0.138650113	0.315073672	0.232797058	7.39309155	0.388799846	0.384555821	0.128321981	0	3.056424641	0	0	0	0.426561042	0.138179875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3609
H8644_003_0	2011	6	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	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	YES	1300.603832	60.301574	308.944017	1013.766321	36.006362	10.966026	2.89094	361.546337	306.751008	930.426159	857.342652	113.077559	0.089286	701.454733	3528.946831	2787.469514	75.721393	600.142994		1305.217129	16.157788	0		3.1					3.69	0.93	930.118613										3400	$250/Day(Days 1-8):1a.IP Acute	$250/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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.Lab -- FSL, 8a.Lab -- OP"	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $35 Radiology OP -- Facility"	$50/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% 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, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies											188.54775	164.89775	46.371	0	150	0.2	0.2	50	193.636187	0	50.183506	50	0.2	44.205675	10	32.647879	35	38.903259		0	0.2	0		0					0	0	0										NO	157.823328	138.027167	31.484796	0	129.60495	0.172807	0.172807	43.20165	167.308056	0	43.360205	43.20165	0.172807	38.195162	8.64033	28.208845	30.241155	33.6137		0	0.172807	0		0					0	0	0											17.1055	0.693604619	0.810586613	0	0.388883562	1.895006055	0.499574669	1.301616526	4.276826235	0	3.097879429	0.407094761	0.015429246	2.23268143	2.540938764	6.552607955	0.190825199	1.681085546	0	0	2.792178871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4823	0	8.234427668	17.1055	0.693604619	0.810586613	0	0.388883562	1.895006055	0.499574669	1.301616526	4.276826235	0	3.097879429	0.407094761	0.015429246	2.23268143	2.540938764	6.552607955	0.190825199	1.681085546	0	0	2.792178871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4823	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	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins										5100	3.0196	0.1313	0.3236	4.176	1.8357	2.2118	0.5831	0.2295	2.6093	0.3283	1.2502	0.2389	0.0028	0.7791	1.6488	1.9989	0.03	0.2613		0.2733	0.8168	0		0					0	0	0.2959										23.0441	500	5.829176055	20.1251	0.824857401	1.13418123	4.176025823	2.224599529	4.10675908	1.082652273	1.531143147	6.8861468	0.32833045	4.348075077	0.646037051	0.018205785	3.01175775	4.189697346	8.551490427	0.220827427	1.942372506	0	0.273291033	3.608969225	0	0	0	0	0	0	0	0	0	0.295862985	0	0	0	0	0	0	0	0	0	69.5264
H8649_003_0	2011	8																															D	D	D	V	T	COIN	COIN	V	V	O	O	O	COIN	COIN	P	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	640.8853125	14.61590554	383.1138876	0	3.891425111	12.21142475	11.13692538	304.9945766	409.4025008	1231.807776	1003.447587	44.23192847	0.102290117	12.70469899	3103.897954	91.65069005	25.29426322	851.249243	1200.991075	1475.336545	9.125342084	0	0	0	0	0	0	0	0	0											3400	1a: $200/d (1-10) then $0;1a1: $200/d (1-10) then $0	1b: $200/d (1-10) then $0	"2: $0 (1-22),$100/d (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: $0-$45/visit	"8b: $75/visit for X-rays,MRI, CT, PET Scans; 8b: $45/visit for chemotherapy, radiation therapy, nuclear medicine, and all other therapeutic radiology"	9a: $300/visit	12: 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: $10/visit;14b: $0/visit;14c: $0/visit;14d: $0/visit;14d1: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit	7b: $40/visit;7d: $45/visit;7f: $45/visit;16b: 20%;17a: $45/visit;18a: $45/visit	7e: $40/visit;7h: $40/visit;7a: $10/visit;7d: $40/visit	7c: $45/visit;7i: $45/visit;7a: $10/visit;7d: $45/visit	14h: $0/visit;7a: $10/visit;7d: $45/visit	7g: $45/visit;14b: $0/visit;14i: 0%;14j: 0%;7a: $10/visit;7d: $45/visit;8a: $45/visit;12: 20%	15: 20%	13a: 20%;17b: 20%		16a:	17a1:		18a:		14a: $0													177.1584368	156.1403509	19.33904529	0	150	0.2	0.135071404	47.97639123	300	45	46.52229626	253.7036126	0.2	0.123860761	9.763359975	0.197823961	42.40384615	45	39.80060125	0.014836795	0.235924104	0	0	0	0	0	0	0	0	0											NO	145.9603945	128.6436459	15.93339121	0	123.5846261	0.164779502	0.111284993	39.52762916	247.1692523	37.07538784	38.32960393	209.025774	0.164779502	0.102048572	8.044007948	0.162986669	34.93642316	37.07538784	32.79161617	0.012223999	0.194377282	0	0	0	0	0	0	0	0	0												7.7953	0.156686948	0.508691954	0	0.040076693	2.012192483	1.239372665	1.00464271	8.432642499	3.805812585	3.205145713	0.770467757	0.016855314	1.296496395	2.080648318	14.93784064	0.073640924	2.630032986	3.281869862	0.001502876	1.773759187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0637	0	11.7694919	7.7953	0.156686948	0.508691954	0	0.040076693	2.012192483	1.239372665	1.00464271	8.432642499	3.805812585	3.205145713	0.770467757	0.016855314	1.296496395	2.080648318	14.93784064	0.073640924	2.630032986	3.281869862	0.001502876	1.773759187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0637	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%																				0.3743	0	0.5108	0.4129	0.8512	0.8602	0.3789	0.0349	0.2447	0.0608	0.068	0.0031	0	0.3357	0.2563	2.5287	0.0004	0.0221	0.1327	0.1216	0.5729	0	0	0	0	0	0	0	0	0											7.7702	500	0	8.1696	0.156686948	1.019531402	0.41285795	0.891325936	2.872394079	1.618237295	1.039537404	8.677296547	3.866623271	3.273128347	0.773524405	0.016855314	1.63217551	2.336976054	17.46656504	0.074073701	2.652091289	3.414616474	0.123087536	2.346655569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8339
H8649_801_0	2011	4																															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	YES	202.9332389	3.982863762	24.38020335	0	1.307364101	18.246641	15.68528544	22.38194155	60.51442081	16.72101145	31.31081807	1.394155779	0.061058165	17.16771561	28.82958492	125.8337481	0.514966186	9.381180169	7.701424807	9.732642359	21.94316308	0	0	0	0	0	0	0	0	0											6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.083293685	0.083293685	0.159956713	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.072990374	0.072990374	0.140170294	0	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0	0	0	0	0	0	0	0	0												14.8122	0.290710715	3.417380274	0	0.266935288	3.72556686	3.202593815	4.569905206	12.35572732	3.414066519	6.392987409	0.284656259	0.012466748	3.505273784	5.886373617	25.69251195	0.105144884	1.915432761	1.572463284	1.987193688	4.480316194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8899	0	13.81812162	14.8122	0.290710715	3.417380274	0	0.266935288	3.72556686	3.202593815	4.569905206	12.35572732	3.414066519	6.392987409	0.284656259	0.012466748	3.505273784	5.886373617	25.69251195	0.105144884	1.915432761	1.572463284	1.987193688	4.480316194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8899	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																				0.1863	0	0.3287	0	0.9995	1.0296	0.4207	0.2577	0.2601	0.0444	0.0677	0.0013	0	0.4117	0.1871	2.4543	0.0009	0.044	0.1139	0.106	0.4021	0	0	0	0	0	0	0	0	0											7.3158	0	0	14.9985	0.290710715	3.746048232	0	1.266407158	4.755203332	3.623332436	4.827578673	12.61586956	3.458421883	6.460666568	0.28592541	0.012466748	3.916975735	6.07352107	28.14676643	0.106017682	1.959395623	1.686315871	2.093146431	4.88244292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.2057
H8649_802_0	2011	4																															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	YES	202.9332389	3.982863762	24.38020335	0	1.307364101	18.246641	15.68528544	22.38194155	60.51442081	16.72101145	31.31081807	1.394155779	0.061058165	17.16771561	28.82958492	125.8337481	0.514966186	9.381180169	7.701424807	9.732642359	21.94316308	0	0	0	0	0	0	0	0	0											6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.083293685	0.083293685	0.159956713	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.072990374	0.072990374	0.140170294	0	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0	0	0	0	0	0	0	0	0												14.8122	0.290710715	3.417380274	0	0.266935288	3.72556686	3.202593815	4.569905206	12.35572732	3.414066519	6.392987409	0.284656259	0.012466748	3.505273784	5.886373617	25.69251195	0.105144884	1.915432761	1.572463284	1.987193688	4.480316194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8899	0	13.81812162	14.8122	0.290710715	3.417380274	0	0.266935288	3.72556686	3.202593815	4.569905206	12.35572732	3.414066519	6.392987409	0.284656259	0.012466748	3.505273784	5.886373617	25.69251195	0.105144884	1.915432761	1.572463284	1.987193688	4.480316194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8899	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																				0.1863	0	0.3287	0	0.9995	1.0296	0.4207	0.2577	0.2601	0.0444	0.0677	0.0013	0	0.4117	0.1871	2.4543	0.0009	0.044	0.1139	0.106	0.4021	0	0	0	0	0	0	0	0	0											7.3158	0	0	14.9985	0.290710715	3.746048232	0	1.266407158	4.755203332	3.623332436	4.827578673	12.61586956	3.458421883	6.460666568	0.28592541	0.012466748	3.916975735	6.07352107	28.14676643	0.106017682	1.959395623	1.686315871	2.093146431	4.88244292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.2057
H8649_803_0	2011	4																															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	YES	202.9332389	3.982863762	24.38020335	0	1.307364101	18.246641	15.68528544	22.38194155	60.51442081	16.72101145	31.31081807	1.394155779	0.061058165	17.16771561	28.82958492	125.8337481	0.514966186	9.381180169	7.701424807	9.732642359	21.94316308	0	0	0	0	0	0	0	0	0											6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.083293685	0.083293685	0.159956713	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.072990374	0.072990374	0.140170294	0	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0.20417823	0	0	0	0	0	0	0	0	0												14.8122	0.290710715	3.417380274	0	0.266935288	3.72556686	3.202593815	4.569905206	12.35572732	3.414066519	6.392987409	0.284656259	0.012466748	3.505273784	5.886373617	25.69251195	0.105144884	1.915432761	1.572463284	1.987193688	4.480316194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8899	0	13.81812162	14.8122	0.290710715	3.417380274	0	0.266935288	3.72556686	3.202593815	4.569905206	12.35572732	3.414066519	6.392987409	0.284656259	0.012466748	3.505273784	5.886373617	25.69251195	0.105144884	1.915432761	1.572463284	1.987193688	4.480316194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8899	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																				0.1863	0	0.3287	0	0.9995	1.0296	0.4207	0.2577	0.2601	0.0444	0.0677	0.0013	0	0.4117	0.1871	2.4543	0.0009	0.044	0.1139	0.106	0.4021	0	0	0	0	0	0	0	0	0											7.3158	0	0	14.9985	0.290710715	3.746048232	0	1.266407158	4.755203332	3.623332436	4.827578673	12.61586956	3.458421883	6.460666568	0.28592541	0.012466748	3.916975735	6.07352107	28.14676643	0.106017682	1.959395623	1.686315871	2.093146431	4.88244292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.2057
H8684_001_0	2011	4																															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	1337.39159	89.07773256	949.0231773	737.2065234	199.9120139	10.65564856	0	240.5564883	344	2563.915709	2225.88435	55.47068102	2.238204586	0	2903.014245	4793.717294	251.1402652	630.7823411	0	0	239.08	0	0	0	1097.616127	86.43844963	53.46360728	12.41192719	3.523340232	0											6700	$150/day 1-10	$175/day 1-10	"$0/d 1-4, $50/d 5-20, $125/d 21-100"	$0 per visit	$200 per trip	0.2	"20% for all items except Diabetes Monitoring Supplies, which have no cost share."	$50 Emer Rm; $35 Urgent Care Ctr	$300 per procedure	$0 per visit	$45 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	"$10 PCP visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	"$30 per visit; Chiropractic Visits $12 per visit; Preventive Services as described in the PBP lines 14b, c, d, e, f, g, h, I, j $0 per visit"	$30 per visit	$30 per visit	$45 per visit	$30 per visit	$50 per script	0	Not Covered	0	$0 per visit	$75.00 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											0	122.9471107	143.4382958	71.93854446	0	200	0.05	0.05	48.5	300	0	25.75	30	25	30	10	30	30	22.5	45	30	$50 	0	0	0	0	0	0	0	0	0											NO	109.6615875	127.9385188	64.16494822	0	178.3882304	0.044597058	0	43.25914588	267.5823456	0	22.96748467	26.75823456	22.2985288	26.75823456	8.919411521	26.75823456	26.75823456	20.06867592	40.13735184	26.75823456	44.5970576	0	0	0	0	0	0	0	0	0												12.2217	0.949706097	5.07450192	0	2.9718292	0.475210573	0	0.867189018	7.670693908	0	4.260247056	0.123691458	0.004159056	0	2.157764892	10.68928432	0.560005844	1.054913865	0	0	0.888522044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9694	0	6.053805935	12.2217	0.949706097	5.07450192	0	2.9718292	0.475210573	0	0.867189018	7.670693908	0	4.260247056	0.123691458	0.004159056	0	2.157764892	10.68928432	0.560005844	1.054913865	0	0	0.888522044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9694	YES	$500 ded; 20% coinsurance; $10000 max OOP	$500 ded; 20% coinsurance; $10000 max OOP	$500 ded; 20% coinsurance; $10000 max OOP	$500 ded; 20% coinsurance; $10000 max OOP	$200 per trip	$500 ded; 20% coinsurance; $10000 max OOP	$500 ded; 20% coinsurance; $10000 max OOP	$50 Emer Rm; $35 Urgent Care Ctr	$500 ded; 20% coinsurance; $10000 max OOP	$500 ded; 20% coinsurance; $10000 max OOP	$500 ded; 20% coinsurance; $10000 max OOP	$500 ded; 20% coinsurance; $10000 max OOP	$25 per visit	$500 ded; 20% coinsurance; $10000 max OOP	$500 ded; 20% coinsurance; $10000 max OOP	$500 ded; 20% coinsurance; $10000 max OOP	$500 ded; 20% coinsurance; $10000 max OOP	$500 ded; 20% coinsurance; $10000 max OOP	$500 ded; 20% coinsurance; $10000 max OOP	$500 ded; 20% coinsurance; $10000 max OOP	$500 ded; 20% coinsurance; $10000 max OOP		Not Covered	0	$500 ded; 20% coinsurance; $10000 max OOP	$75.00 Every 2 Years	$500 ded; 20% coinsurance; $10000 max OOP	Not Covered	Not Covered	0	0	0	0	0	0	0	0	0	0	0	10000	8.3058	0.1696	1.0611	0.2107	0.4511	0.3194	0	0.1973	1.0929	0.4896	1.5821	0.028	0.001	0.7286	0.7437	3.5587	0.0962	0.2267	0	0	1.8906	0	0	0	0.2324	0	0.0156	0	0	0	0	0	0	0	0	0	0	0	0	0	21.4011	500	2.68206869	20.5276	1.119263699	6.135566282	0.210673092	3.42296969	0.794657351	0	1.064452052	8.763607451	0.48960396	5.842349106	0.151703749	0.005183847	0.728609029	2.901427859	14.24798321	0.656236374	1.281589479	0	0	2.7791054	0	0	0	0.232363742	0	0.015590473	0	0	0	0	0	0	0	0	0	0	0	0	0	71.3705
H8684_801_0	2011	2																															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	YES	238.6143246	4.871257069	30.48237683	6.054905738	7.096954521	9.177420781	0	11.37647386	31.3978065	14.06634503	45.45146321	0.804789743	0.06901335	20.93187101	21.37344227	102.2797273	2.765739016	6.514830469	0	0	54.33681113	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.071036927	0.071036927	0.151138785	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.059769744	0.059769744	0.127166629	0	0.196043818	0.196043818	0.196043818	0.196043818	0.196043818	0.196043818	0.196043818	0.196043818	0.196043818	0.196043818	0.196043818	0.196043818	0.196043818	0.196043818	0.196043818	0.196043818	0.196043818	0.196043818	0	0	0	0	0	0	0	0												14.2619	0.291153789	3.876341094	0	1.391314064	1.799176613	0	2.230287375	6.155345877	2.757619992	8.910478402	0.157774054	0.013529641	4.10356392	4.190131235	20.05130828	0.542206037	1.277192242	0	0	10.65239594	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.6617	0	15.58254749	14.2619	0.291153789	3.876341094	0	1.391314064	1.799176613	0	2.230287375	6.155345877	2.757619992	8.910478402	0.157774054	0.013529641	4.10356392	4.190131235	20.05130828	0.542206037	1.277192242	0	0	10.65239594	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.6617	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	2.5132	0.0513	0.6831	0	0.2452	0.3171	0	0.393	1.0847	0.4859	1.5702	0.0278	0.0024	0.7231	0.7384	3.5335	0.0955	0.2251	0	0	1.8772	0	0	0	0	0	0	0	0	0											14.5667	0	1.426544675	16.7752	0.34246112	4.55943272	0	1.636492432	2.116228815	0	2.623310226	7.24004537	3.243569778	10.48068934	0.185577112	0.015913844	4.826696916	4.928519186	23.5847643	0.637753977	1.50225998	0	0	12.52956884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2284
H8684_802_0	2011	2																															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	YES	250.4690313	5.113268205	31.99678565	6.355722262	7.449541544	9.633368394	0	11.94167362	32.95769519	14.76518151	47.70955801	0.844772868	0.072442034	21.97179681	22.43530597	107.3611329	2.903144952	6.838496722	0	0	57.03634294	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.072478698	0.072478698	0.150272564	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.061020699	0.061020699	0.126516301	0	0.196165537	0.196165537	0.196165537	0.196165537	0.196165537	0.196165537	0.196165537	0.196165537	0.196165537	0.196165537	0.196165537	0.196165537	0.196165537	0.196165537	0.196165537	0.196165537	0.196165537	0.196165537	0	0	0	0	0	0	0	0												15.2838	0.312015199	4.048114978	0	1.461343318	1.889734885	0	2.342544821	6.46516398	2.896419763	9.358971073	0.165715323	0.014210631	4.310109323	4.401033845	21.0605543	0.569496989	1.341477383	0	0	11.18856485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1093	0	16.35668421	15.2838	0.312015199	4.048114978	0	1.461343318	1.889734885	0	2.342544821	6.46516398	2.896419763	9.358971073	0.165715323	0.014210631	4.310109323	4.401033845	21.0605543	0.569496989	1.341477383	0	0	11.18856485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1093	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	2.6925	0.055	0.7131	0	0.2574	0.3329	0	0.4127	1.139	0.5103	1.6488	0.0292	0.0025	0.7593	0.7753	3.7102	0.1003	0.2363	0	0	1.9711	0	0	0	0	0	0	0	0	0											15.3459	0	1.497415026	17.9763	0.36698235	4.761264038	0	1.718785516	2.222646046	0	2.755226686	7.604120171	3.40667677	11.007724	0.194909091	0.016714091	5.069413451	5.176355981	24.77075388	0.669824239	1.577803016	0	0	13.15963399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.4551
H8684_805_0	2011	2																															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	YES	244.1746838	4.984770536	31.19269867	6.196001421	7.26233276	9.391279511	0	11.64157647	32.12946032	14.39412893	46.51060525	0.823543521	0.070621548	21.41964023	21.87150129	104.6631216	2.830188216	6.666643642	0	0	55.60300582	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0	0	0	0	0	0	0	0												0	0	0	0	1.346730062	1.74152285	0	2.158818871	5.958100729	2.669253364	8.624946335	0.152718259	0.01309609	3.972067155	4.055860461	19.40877359	0.524831301	1.23626522	0	0	10.31104495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.174	0	15.945663	0	0	0	0	1.346730062	1.74152285	0	2.158818871	5.958100729	2.669253364	8.624946335	0.152718259	0.01309609	3.972067155	4.055860461	19.40877359	0.524831301	1.23626522	0	0	10.31104495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.174	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	0	0	0	0	0.2438	0.3153	0	0.3909	1.0788	0.4833	1.5617	0.0277	0.0024	0.7192	0.7344	3.5142	0.095	0.2238	0	0	1.8669	0	0	0	0	0	0	0	0	0											11.2574	0	1.459787025	0	0	0	0	1.590572093	2.056846967	0	2.549699562	7.036888097	3.152554493	10.18659888	0.180369777	0.015467298	4.691258734	4.790223849	22.9229706	0.619858459	1.460106233	0	0	12.17798637	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.4314
H8684_806_0	2011	2																															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	YES	244.1744629	4.984766025	31.19267044	6.195995814	7.262326188	9.391271013	0	11.64156594	32.12943125	14.3941159	46.51056316	0.823542776	0.070621484	21.41962085	21.8714815	104.6630269	2.830185655	6.666637609	0	0	55.6029555	0																			6700	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0.185440423	0	0	0	0	0	0	0	0												0	0	0	0	1.346728844	1.741521274	0	2.158816918	5.958095337	2.669250948	8.62493853	0.152718121	0.013096078	3.972063561	4.055856791	19.40875603	0.524830826	1.236264102	0	0	10.31103562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.174	0	15.94564857	0	0	0	0	1.346728844	1.741521274	0	2.158816918	5.958095337	2.669250948	8.62493853	0.152718121	0.013096078	3.972063561	4.055856791	19.40875603	0.524830826	1.236264102	0	0	10.31103562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.174	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											10000	0	0	0	0	0.2438	0.3153	0	0.3909	1.0788	0.4833	1.5617	0.0277	0.0024	0.7192	0.7344	3.5142	0.095	0.2238	0	0	1.8669	0	0	0	0	0	0	0	0	0											11.2574	0	1.459785704	0	0	0	0	1.590570654	2.056845105	0	2.549697255	7.03688173	3.15255164	10.18658966	0.180369614	0.015467284	4.691254489	4.790219514	22.92294986	0.619857898	1.460104912	0	0	12.17797535	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.4313
H8707_001_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O		V	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	YES	1090.967325	71.38551232	236.1260998	524.6182658	42.65857545	10.04029722	2.560070305	488.7567551	374.5717982	1103.626323	1053.507382	49.51831504	0.255669101	4.036453685	3415.237613	3887.789164	112.7976881	615.075023		1854.409003	25.90700696	0		4.32	3.1				3.83	0.41	1190.952186	762.3744181									4900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN814: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	34.44565	0	100	0.2	0.2	50	175	62.303632	92.16834	50	0.2	0.2	15	35	35	15		0	0.2	0		0	0				0	0	0	66.80254									NO	128.88021	110.339445	29.544551	0	90.2837	0.180567	0.180567	45.14185	157.996475	56.250025	83.212988	45.14185	0.180567	0.180567	13.542555	31.599295	31.599295	13.542555		0	0.180567	0		0	0				0	0	0	60.311805										11.717	0.656386484	0.5813533	0	0.320947836	1.812946348	0.462264215	1.838615344	4.931751979	5.17325069	7.305458093	0.186279029	0.046165403	0.728850333	3.854253601	10.23761639	0.297027285	0.694140611	0	0	4.677950526	0	0	0	0	0	0	0	0	0	0	3.831681437	0	0	0	0	0	0	0	0	59.3539	0	6.170051377	11.717	0.656386484	0.5813533	0	0.320947836	1.812946348	0.462264215	1.838615344	4.931751979	5.17325069	7.305458093	0.186279029	0.046165403	0.728850333	3.854253601	10.23761639	0.297027285	0.694140611	0	0	4.677950526	0	0	0	0	0	0	0	0	0	0	3.831681437	0	0	0	0	0	0	0	0	59.3539	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		30% Coins	20%-30% Coins	$0/Service		0.5	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									7300	6.6021	0.1281	0.2701	1.9494	1.0841	2.0189	0.5148	0.232	2.3247	0.279	0.9764	0.1004	0.0059	0.1408	1.448	2.4274	0.0472	0.219		0.307	1.0257	0		0	0				0	0	0.4229	0.3929									22.9168	0	8.985013164	18.3191	0.784462491	0.851469747	1.949375911	1.405091361	3.831861672	0.977046443	2.070625671	7.256413469	5.452219033	8.281833441	0.286698151	0.052110687	0.869644586	5.302280586	12.665045	0.344233639	0.913124018	0	0.307029086	5.703634812	0	0	0	0	0	0	0	0	0	0.422889259	4.224561544	0	0	0	0	0	0	0	0	82.2707
H8707_003_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	996.60016	56.34448	279.682167	476.721132	39.653633	10.040192	4.511272	366.142804	296.174466	917.25106	867.056024	60.037746	0.547918	3.569931	3878.221695	3268.341833	144.84153	560.627283		1854.16976	13.755234	0							3.83	0.41	1815.398905	536.074189									3900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$10/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$10-$100/Visit:9d. $10 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $10 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	34.44565	0	100	0.2	0.2	50	175	62.427226	69.312546	50	0.2	0.2	10	35	35	10		0	0.2	0							0	0	0	68.404322									NO	126.951869	108.688515	28.027013	0	89.1189	0.178238	0.178238	44.55945	155.958075	55.634457	61.770579	44.55945	0.178238	0.178238	8.91189	31.191615	31.191615	8.91189		0	0.178238	0							0	0	0	60.96118										10.5434	0.510333155	0.653221311	0	0.294490679	1.789543742	0.804080099	1.359593497	3.849233298	4.252563721	4.463212719	0.222937412	0.097659808	0.636297362	2.880190428	8.495405012	0.37648677	0.416354056	0	0	2.451705398	0	0	0	0	0	0	0	0	0	0	2.723309594	0	0	0	0	0	0	0	0	46.82	0	5.584274298	10.5434	0.510333155	0.653221311	0	0.294490679	1.789543742	0.804080099	1.359593497	3.849233298	4.252563721	4.463212719	0.222937412	0.097659808	0.636297362	2.880190428	8.495405012	0.37648677	0.416354056	0	0	2.451705398	0	0	0	0	0	0	0	0	0	0	2.723309594	0	0	0	0	0	0	0	0	46.82	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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	40% Coins	30% Coins									5800	5.4816	0.1012	0.2696	2.1857	0.9488	1.9008	0.8541	0.1636	1.8652	0.2341	0.7677	0.0498	0.012	0.1172	1.4148	1.9675	0.0487	0.1756		0.2717	0.4941	0							0	0	0.5655	0.2576									20.1469	0	10.73671226	16.025	0.611529781	0.922812015	2.185684741	1.243302989	3.690317639	1.658137947	1.523230661	5.71441937	4.486620827	5.230915143	0.272723385	0.109655526	0.753533402	4.29498431	10.46291991	0.425214095	0.591933118	0	0.271692527	2.94584493	0	0	0	0	0	0	0	0	0	0.565500525	2.980909996	0	0	0	0	0	0	0	0	66.9669
H8707_005_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1318.635167	93.18969421	379.6349089	582.7238848	38.29092903	10.52098853	2.66592403	338.63367	361.6034057	957.8375591	1167.63568	50.15736554	0.233609999	3.058852899	3322.962437	3778.805504	87.79210262	795.3410919		1957.15691	26.44306952	0							3.83	0.41	1271.02373	926.594005									4900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$195/Visit:9b. $0 Surgery ASC -- Physician,9b. $195 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $195 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$150/Visit:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	34.44565	0	150	0.2	0.2	50	195	59.187271	87.728511	50	0.2	0.2	15	35	35	15		0	0.2	0							0	0	0	71.275894									NO	126.804031	108.561945	27.907039	0	134.02785	0.178704	0.178704	44.67595	174.236205	52.884951	78.387091	44.67595	0.178704	0.178704	13.402785	31.273165	31.273165	13.402785		0	0.178704	0							0	0	0	63.686365										13.934	0.843071205	0.882873851	0	0.427670908	1.880142735	0.476411288	1.260731742	5.250367094	4.221266032	7.627297024	0.186735663	0.041747041	0.546629248	3.711412593	9.847934003	0.228794743	0.888315471	0	0	4.725482296	0	0	0	0	0	0	0	0	0	0	4.917617001	0	0	0	0	0	0	0	0	61.8985	0	7.270167354	13.934	0.843071205	0.882873851	0	0.427670908	1.880142735	0.476411288	1.260731742	5.250367094	4.221266032	7.627297024	0.186735663	0.041747041	0.546629248	3.711412593	9.847934003	0.228794743	0.888315471	0	0	4.725482296	0	0	0	0	0	0	0	0	0	0	4.917617001	0	0	0	0	0	0	0	0	61.8985	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	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		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									7300	6.7756	0.1423	0.397	3.3098	1.8188	1.977	0.501	0.2003	2.6974	0.2921	1.1489	0.1358	0.0068	0.1329	1.7607	3.138	0.0449	0.3278		0.416	1.3084	0							0	0	0.4185	0.4133									27.3634	500	10.78651852	20.7096	0.98540463	1.279915261	3.309791056	2.246516836	3.857192732	0.977378568	1.461028077	7.94780541	4.513389691	8.776175216	0.322540883	0.048515907	0.679574207	5.472104328	12.98590001	0.273663595	1.216110167	0	0.416002086	6.033882487	0	0	0	0	0	0	0	0	0	0.418491231	5.330934265	0	0	0	0	0	0	0	0	89.2619
H8707_006_0	2011	5	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	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	YES	1025.659644	64.317537	309.88681	531.223094	34.945568	8.472953	2.974673	309.445761	325.155502	948.620847	873.91701	68.926937	0.393586	5.153561	3186.851649	3358.917725	79.773028	652.104483		1716.739395	19.714815	0			1.82				3.83	0.41	1142.795606	593.66667									4900	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$195/Visit:9b. $0 Surgery ASC -- Physician,9b. $195 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $195 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$150/Visit:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $75 Radiology OP -- Facility"	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"			"VIS742: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	34.44565	0	150	0.2	0.2	50	195	56.988071	94.655292	50	0.2	0.2	15	35	35	15		0	0.2	0			0				0	0	0	68.698733									NO	130.166752	111.440904	29.862174	0	136.85535	0.182474	0.182474	45.61845	177.911955	51.994149	86.360554	45.61845	0.182474	0.182474	13.685535	31.932915	31.932915	13.685535		0	0.182474	0			0				0	0	0	62.678594										11.1256	0.597300372	0.77115782	0	0.398540662	1.546093626	0.542800481	1.176369665	4.820754253	4.110227805	6.289329761	0.262028336	0.071819212	0.94039089	3.634480815	8.938336184	0.21228211	0.743699894	0	0	3.597441152	0	0	0	0	0	0	0	0	0	0	3.100849348	0	0	0	0	0	0	0	0	52.8795	0	4.894668866	11.1256	0.597300372	0.77115782	0	0.398540662	1.546093626	0.542800481	1.176369665	4.820754253	4.110227805	6.289329761	0.262028336	0.071819212	0.94039089	3.634480815	8.938336184	0.21228211	0.743699894	0	0	3.597441152	0	0	0	0	0	0	0	0	0	0	3.100849348	0	0	0	0	0	0	0	0	52.8795	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	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		30% Coins	20%-30% Coins	$0/Service			"VIS742: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins									7300	6.4983	0.1316	0.3592	3.148	1.7629	1.691	0.5937	0.1944	2.6957	0.3195	1.1125	0.1885	0.0121	0.2379	1.6881	2.8421	0.039	0.3086		0.3883	1.0086	0			0				0	0	0.389	0.4379									26.0472	500	7.815999347	17.6239	0.728889343	1.130404762	3.148016902	2.161485185	3.237089263	1.136472948	1.370759669	7.516489029	4.429765017	7.40183222	0.450544754	0.083931041	1.178276317	5.322616942	11.78048535	0.251259778	1.052332403	0	0.388311966	4.606022131	0	0	0	0	0	0	0	0	0	0.389035698	3.538741299	0	0	0	0	0	0	0	0	78.9266
H8707_007_0	2011	5																															A	A	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V		V	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	YES	216.469559	9.198023	356.171705	610.566919	40.165061	9.003504	10255.65398	355.66478	373.720938	1090.307472	1004.44582	79.221909	0.418231	780.000369	3662.841874	3860.60785	91.68798	749.503231		1973.152702	20.949299	0							3.83	0.41											3400	$0/Admit:1a.IP Acute	$0/Admit:1b.IP Psych	$0/Day(Days 1-20) $0(Days 21-100):2.SNF	$0/Visit:6.Home Health	$0/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"$0/Service:11b.Prosthetics, 11b.Supplies, 11c.Diabetic Monitoring Supplies"	"$0/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Facility, 9a.Surgery OP -- Physician, 9b.Surgery ASC -- Facility, 9b.Surgery ASC -- Physician"	"$0/Visit:8a.Lab -- FSL, 8a.Lab -- OP"	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP, 8b.Advanced Imaging -- FSR, 8b.Advanced Imaging -- Office, 8b.Radiology -- FSR, 8b.Radiology OP -- Facility, 8b.Radiology OP -- Physician, 8b, 9a.Advanced Imaging -- OP, 8b, 9a.DMAM -- OP"	$0/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$0/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization, 7h.Psych -- OP, 8b.Nuclear Medicine, 8b.Rad therapy, 9a.OP Other, 9d.Cardiac Rehab"	"$0/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$0/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$0/Visit:7e, 7h.Psych -- Other Provider"	"$0/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d												0	0	0	0	0	0.2	0	0	0	0	0	0	0.2	0	0	0	0	0		0	0.2	0							0	0											NO	0	0	0	0	0	0.199535	0	0	0	0	0	0	0.199535	0	0	0	0	0		0	0.199535	0							0	0												0	0	0	0	0	1.796514171	0	0	0	0	0	0	0.083451723	0	0	0	0	0	0	0	4.180118376	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.0601	0	0.014110382	0	0	0	0	0	1.796514171	0	0	0	0	0	0	0.083451723	0	0	0	0	0	0	0	4.180118376	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.0601	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		30% Coins	20%-30% Coins	30% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d											5100	4.905	0.0993	0.239	3.0919	0	1.6609	0.9652	0	2.6477	0.3138	1.0927	0.1852	0.0119	0.6637	1.6581	2.7915	0.0383	0.3031		0.3814	0.9906	0							0	0											22.0393	500	11.79916141	4.905	0.099324217	0.238954801	3.091941793	0	3.457388105	0.965203762	0	2.647715532	0.313845283	1.092685109	0.185158648	0.095347743	0.663739544	1.658065232	2.79152171	0.038283573	0.303135059	0	0.381395149	5.170733541	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.0994
H8742_001_0	2011	10																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	P	V	V	V	Coin	V	Coin	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	YES	1985.407384	140.1633478	1191.69106		146.6134617	9.15286424	0.148562301	514.8362112	356.7369023	18.95409029	40.39150368		0.687652557	55.03137958		3177.771979	2.773533779	533.4026359		480.5056722	16.20088192	552.8762788			115.2145767																6700	(1a/1a1) $265/Day Days 1 - 6	(1b) $265/Day Days 1 - 6	(2a/2a2) $135/Day Days 21-100	(6a) 0%	(10a) $150	(11a) 20%	(11b) 20% (11c) 20%	(4a) $50 (4a1) $250/ 20% (4b) $35 (4b1) n/c	(9b) $175	(8a) 20%	(8b1) 20% (8b2) 20% (8b3) 20%	(9a) $0	(12) $25	(3) $45 (5) $265 (9a) $325 (9c) 45% for days 1 and beyond (9d) $45	(7a) $25 (14b) $0 (14c) $0 (14d) $0 (14d1) n/c (14d2) n/c (14e) $0 (14f) $0 (14g) $0 (14h) $0 (14i) $0 (14j) $0	(7b) 50% (7d) $50 (7f) $50	(7e) 45% for days 1 and beyond (7h) 45% for days 1 and beyond	(7c) $45 (7i) $45		(7d) $50 (7g) $50	(15) 20%	(13a) $0 (16b) $0 (17a) $0/$20 (17b) $20 (18a) $20	(10b) n/c	(16a) n/c	(17a1) $20	(17b1) n/c	(18a1) n/c	(18b) n/c	(14a) $0  (14a6) n/c	(13b) n/c  (13c) n/c												189.0044712	130.976253	42.11106467		150	0.2	0.2	49.16079	175	0.2	0.2		25	78.7864242		49.60935387	0.45	45		49.94366072	0.2	20			20																NO	171.3565554	118.7466064	38.17902793		135.9940489	0.181325399	0.181325399	44.5704992	158.6597238	0.181325399	0.181325399		22.66567482	72.66794432		44.97717932	0.407982147	40.79821468		45.2893735	0.181325399	18.13253986			18.13253986																	28.351	1.386993491	3.79146719	0	1.661546524	1.659646756	0.026938118	1.912208912	4.716648198	3.436857977	7.324005504	0	0.001298842	0.333251436	0	11.91060168	1.131552266	1.813489604	0	1.813483405	2.937631371	0.83542093	0	0	0.174094409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2182	0	7.740014356	28.351	1.386993491	3.79146719	0	1.661546524	1.659646756	0.026938118	1.912208912	4.716648198	3.436857977	7.324005504	0	0.001298842	0.333251436	0	11.91060168	1.131552266	1.813489604	0	1.813483405	2.937631371	0.83542093	0	0	0.174094409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2182	NO																																																																																		0	0	0	28.351	1.386993491	3.79146719	0	1.661546524	1.659646756	0.026938118	1.912208912	4.716648198	3.436857977	7.324005504	0	0.001298842	0.333251436	0	11.91060168	1.131552266	1.813489604	0	1.813483405	2.937631371	0.83542093	0	0	0.174094409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2182
H8742_003_0	2011	7																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	P	V	V	V	Coin	V	Coin	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	YES	1875.057711	115.0079674	1123.367279		117.4757915	8.379849535	0.078037017	376.1205963	323.0085333	14.2162603	31.70864566		0.308302743	29.25016569	3258.850424	2410.504083	2.510366004	375.4958735		379.6426897	9.455008111	468.5838911			107.0984278																6700	(1a/1a1) $265/Day Days 1 - 6	(1b) $265/Day Days 1 - 6	(2a/2a2) $135/Day Days 21-100	(6a) 0%	(10a) $150	(11a) 20%	(11b) 20% (11c) 20%	(4a) $50 (4a1) 20% (4b) $35 (4b1) n/c	(9b) $163	(8a) 20%	(8b1) 20% (8b2) 20% (8b3) 20%	(9a) $0	(12) $25	(3) $45 (5) $265 (9a) $325 (9c) 45% for days 1 and beyond (9d) $45	(7a) $25 (14b) $0 (14c) $0 (14d) $0 (14d1) n/c (14d2) n/c (14e) $0 (14f) $0 (14g) $0 (14h) $0 (14i) $0 (14j) $0	(7b) 50% (7d) $50 (7f) $50	(7e) 45% for days 1 and beyond (7h) 45% for days 1 and beyond	(7c) $45 (7i) $45		(7d) $50 (7g) $50	(15) 20%	(13a) $0 (16b) $0 (17a) $0/$20 (17b) $20 (18a) $20	(10b) n/c	(16a) n/c	(17a1) $20	(17b1) n/c	(18a1) n/c	(18b) n/c	(14a) $0  (14a6) n/c	(13b) n/c  (13c) n/c												189.0044712	147.6966257	42.11106467		150	0.2	0.2	48.97824152	163	0.2	0.2		25	92.30268653	25	49.75031947	0.45	45		49.91276139	0.2	20			20																NO	173.2420603	135.3791662	38.59912708		137.490446	0.183320595	0.183320595	44.89360179	149.4062846	0.183320595	0.183320595		22.91507433	85.7093436	22.91507433	45.60129074	0.412471338	41.24713379		45.7627501	0.183320595	18.33205946			18.33205946																	27.0699	1.297473561	3.613416363	0	1.345983247	1.536199	0.014305792	1.407117357	4.021625405	2.606133292	5.812847777	0	0.000588732	0.208917708	6.223066641	9.160174795	1.035454024	1.290677378	0	1.447791128	1.733297709	0.715842313	0	0	0.163611229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.7044	0	6.429664468	27.0699	1.297473561	3.613416363	0	1.345983247	1.536199	0.014305792	1.407117357	4.021625405	2.606133292	5.812847777	0	0.000588732	0.208917708	6.223066641	9.160174795	1.035454024	1.290677378	0	1.447791128	1.733297709	0.715842313	0	0	0.163611229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.7044	NO																																																																																		0	0	0	27.0699	1.297473561	3.613416363	0	1.345983247	1.536199	0.014305792	1.407117357	4.021625405	2.606133292	5.812847777	0	0.000588732	0.208917708	6.223066641	9.160174795	1.035454024	1.290677378	0	1.447791128	1.733297709	0.715842313	0	0	0.163611229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.7044
H8742_008_0	2011	10																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	P	V	V	V	Coin	V	Coin	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	YES	2324.520714	188.1375425	1481.047459	18.03152596	160.8449453	12.40575058	0.109150484	500.9287848	387.9502993		46.46435179		9.666289349	89.11696215	4580.323149	3637.955339	2.818144583	586.2788699		544.9492189	27.94931982	619.0023846		1877.325022	118.0397802																3250	(1a/1a1) $250/Day Days 1 - 6	(1b) $250/Day Days 1 - 6	(2a/2a2) $100/Day Days 21-100	(6a) 15%	(10a) $150	(11a) 20%	(11b) 20% (11c) 20%	(4a) $50 (4a1) $250/ 20% (4b) $35 (4b1) n/c	(9b) $123	(8a) $0	(8b1) 20% (8b2) 20% (8b3) 20%	(9a) $0	(12) $50	(3) $30 (5) $250 (9a) $245 (9c) 45% (9d) $30	(7a) $15 (14b) $0 (14c) $0 (14d) $0 (14d1) n/c (14d2) n/c (14e) $0 (14f) $0 (14g) $0 (14h) $0 (14i) $0 (14j) $0	(7b) 50% (7d) $40 (7f) $40	(7e) 45% (7h) 45%	(7c) $30 (7i) $30		(7d) $40 (7g) $40	(15) 20%	(13a) $0 (16b) $0 (17a) $0/$20 (17b) $0 (18a) $20	(10b) n/c	(16a) $15	(17a1) $20	(17b1) n/c	(18a1) n/c	(18b) n/c	(14a) $0  (14a6) n/c	(13b) n/c  (13c) n/c												178.3061049	139.3364393	31.19338124	0.15	150	0.2	0.2	48.83968915	123		0.2		50	69.06977009	15	39.77307635	0.45	30		39.95316292	0.2	20		15	20																NO	128.2479556	100.2187418	22.43606506	0.107888585	107.8885849	0.143851447	0.143851447	35.12829966	88.46863961		0.143851447		35.96286163	49.67893169	10.78885849	28.60707283	0.323665755	21.57771698		28.77028931	0.143851447	14.38514465		10.78885849	14.38514465																	24.8429	1.571242316	2.769073096	1.945395819	1.446111128	1.784585166	0.015701455	1.466398038	2.860119602	0	6.683964217	0	0.028968952	0.36893629	4.118038191	8.672604444	0.912136893	1.054213294	0	1.30652889	4.020550086	0.74203657	0	1.6878495	0.141501609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4389	0	26.71115193	24.8429	1.571242316	2.769073096	1.945395819	1.446111128	1.784585166	0.015701455	1.466398038	2.860119602	0	6.683964217	0	0.028968952	0.36893629	4.118038191	8.672604444	0.912136893	1.054213294	0	1.30652889	4.020550086	0.74203657	0	1.6878495	0.141501609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4389	NO																																																																																		0	0	0	24.8429	1.571242316	2.769073096	1.945395819	1.446111128	1.784585166	0.015701455	1.466398038	2.860119602	0	6.683964217	0	0.028968952	0.36893629	4.118038191	8.672604444	0.912136893	1.054213294	0	1.30652889	4.020550086	0.74203657	0	1.6878495	0.141501609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4389
H8742_801_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	339.4886798	16.9059364	29.48834148		10.64043076	9.543496358	0.154902743	22.00278025	56.20875243	19.76302575	42.11535954	1.394341796	0.014628315	11.92469416	38.75239272	108.7391226	2.891904526	6.212518542		7.472676026	16.89231409	3.74699631																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0.065024084	0.065024084	0.129767801		0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771		0.196920771	0.196920771	0.196920771																				22.0749	1.099293025	3.826637236	0	2.095321828	1.879312661	0.030503568	4.332804451	11.06867087	3.891750269	8.293389072	0.274574862	0.002880619	2.348219969	7.631151054	21.41299186	0.569476069	1.223373941	0	1.471525125	3.326447515	0.737861402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5911	0	17.88035134	22.0749	1.099293025	3.826637236	0	2.095321828	1.879312661	0.030503568	4.332804451	11.06867087	3.891750269	8.293389072	0.274574862	0.002880619	2.348219969	7.631151054	21.41299186	0.569476069	1.223373941	0	1.471525125	3.326447515	0.737861402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5911	NO																																																																																		0	0	0	22.0749	1.099293025	3.826637236	0	2.095321828	1.879312661	0.030503568	4.332804451	11.06867087	3.891750269	8.293389072	0.274574862	0.002880619	2.348219969	7.631151054	21.41299186	0.569476069	1.223373941	0	1.471525125	3.326447515	0.737861402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5911
H8742_802_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	339.4886798	16.9059364	29.48834148		10.64043076	9.543496358	0.154902743	22.00278025	56.20875243	19.76302575	42.11535954	1.394341796	0.014628315	11.92469416	38.75239272	108.7391226	2.891904526	6.212518542		7.472676026	16.89231409	3.74699631																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0.065024084	0.065024084	0.129767801		0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771		0.196920771	0.196920771	0.196920771																				22.0749	1.099293025	3.826637236	0	2.095321828	1.879312661	0.030503568	4.332804451	11.06867087	3.891750269	8.293389072	0.274574862	0.002880619	2.348219969	7.631151054	21.41299186	0.569476069	1.223373941	0	1.471525125	3.326447515	0.737861402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5911	0	17.88035134	22.0749	1.099293025	3.826637236	0	2.095321828	1.879312661	0.030503568	4.332804451	11.06867087	3.891750269	8.293389072	0.274574862	0.002880619	2.348219969	7.631151054	21.41299186	0.569476069	1.223373941	0	1.471525125	3.326447515	0.737861402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5911	NO																																																																																		0	0	0	22.0749	1.099293025	3.826637236	0	2.095321828	1.879312661	0.030503568	4.332804451	11.06867087	3.891750269	8.293389072	0.274574862	0.002880619	2.348219969	7.631151054	21.41299186	0.569476069	1.223373941	0	1.471525125	3.326447515	0.737861402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5911
H8742_803_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES	339.4886798	16.9059364	29.48834148		10.64043076	9.543496358	0.154902743	22.00278025	56.20875243	19.76302575	42.11535954	1.394341796	0.014628315	11.92469416	38.75239272	108.7391226	2.891904526	6.212518542		7.472676026	16.89231409	3.74699631																			6700	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0.065024084	0.065024084	0.129767801		0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771	0.196920771		0.196920771	0.196920771	0.196920771																				22.0749	1.099293025	3.826637236	0	2.095321828	1.879312661	0.030503568	4.332804451	11.06867087	3.891750269	8.293389072	0.274574862	0.002880619	2.348219969	7.631151054	21.41299186	0.569476069	1.223373941	0	1.471525125	3.326447515	0.737861402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5911	0	17.88035134	22.0749	1.099293025	3.826637236	0	2.095321828	1.879312661	0.030503568	4.332804451	11.06867087	3.891750269	8.293389072	0.274574862	0.002880619	2.348219969	7.631151054	21.41299186	0.569476069	1.223373941	0	1.471525125	3.326447515	0.737861402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5911	NO																																																																																		0	0	0	22.0749	1.099293025	3.826637236	0	2.095321828	1.879312661	0.030503568	4.332804451	11.06867087	3.891750269	8.293389072	0.274574862	0.002880619	2.348219969	7.631151054	21.41299186	0.569476069	1.223373941	0	1.471525125	3.326447515	0.737861402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5911
H8748_001_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1260.31915	95.70072217	797.0681339	1264.731887	152.5130695	10.72186098	11.10808645	352.3026399	35.92208366	15.87954667	35.87978721	0	0.124930661	21.15520494	6213.348222	103.6632976	481.8861935	337.4954444	0	0	18.78007041	1405.376688	0	0	103.1690287	0	14.93201433	6	598.5575223	0											4750	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-58 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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, 18a); $0/$40 (17a)"	$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												187.4696942	115.9014585	65.83311266	0	200	0.2	0.114663452	48.92757555	0.2	0.145559564	0.165191153	0	0.2	0.159996568	13.08614661	0.132365276	38.5	40	0	0	0.2	39.71861734	0	0	40	0	0	0	0	0											YES	145.1015273	89.70771906	50.9548236	0	154.799983	0.154799983	0.088749502	37.88433408	0.154799983	0.11266309	0.127857938	0	0.154799983	0.12383733	12.58517698	0.127333437	37.02612603	38.46870237	0	0	0.154799983	30.74220645	0	0	40	0	0	0	0	0											7500	15.2395	0.715424458	3.384538846	0	1.96741838	1.659743897	0.985837141	1.112229242	5.560737939	1.789038802	4.587515614	0	0.019339264	2.619804089	6.516340582	13.19980395	1.486864911	1.08191765	0	0	2.90715458	3.600365024	0	0	0.343896762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.7775	0	14.35765661	15.2395	0.715424458	3.384538846	0	1.96741838	1.659743897	0.985837141	1.112229242	5.560737939	1.789038802	4.587515614	0	0.019339264	2.619804089	6.516340582	13.19980395	1.486864911	1.08191765	0	0	2.90715458	3.600365024	0	0	0.343896762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.7775	NO	"$350 Days 1-22 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$350 Days 1-22 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-43 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.5457	0.1031	0.7609	0.4334	0.3433	0.4344	0.4501	0.1941	1.4554	0.3122	1.1768	0	0.0034	0.6829	1.5538	2.5068	0.2844	0.2061	0	0	0.7312	0.6782	0	0	0.0656	0	0	0	0	0											13.9219	0	3.041371351	16.7853	0.818557727	4.145410236	0.433378702	2.310705917	2.094147732	1.435889176	1.306301708	7.016146747	2.101201547	5.764324705	0	0.022713701	3.302741166	8.07018658	15.70662745	1.771301079	1.287995591	0	0	3.638378263	4.278608331	0	0	0.409508645	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.6994
H8748_002_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1103.437581	91.03447271	644.1218831	1022.047489	143.4682037	9.395867267	11.30400372	361.268614	255.4543121	15.0950792	32.62557162	0	0.09750323	492.2283196	6045.523953	93.38348463	481.1077046	389.2571139	0	0	16.77029395	1277.940565	0	0	141.5687323	164.4466912	14.89673961	6	176.0673931	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); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$150 (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$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, 18a); $0/$25 (17a)"	$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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												159.3767773	111.9031178	72.11322603	0	200	0.2	0.109618804	49.07010465	150	0.147795217	0.166337407	0	0.2	59.10022221	6.802155288	0.086987732	38.5	25	0	0	0.2	24.84370969	0	0	25	30	0	0	0	0											YES	114.2501018	80.21835308	51.69475473	0	143.3710779	0.143371078	0.07858083	35.19357894	107.5283084	0.105947798	0.119239866	0	0.143371078	42.36631281	6.47011427	0.082777654	36.62065755	23.77964776	0	0	0.143371078	17.80934719	0	0	25	30	0	0	0	0											9500	10.5057	0.608552956	2.77481023	0	1.714099251	1.347095618	0.888277995	1.059527957	2.289047504	1.599290401	3.890268802	0	0.013979143	1.737824913	3.259602567	7.730065784	1.468206708	0.771366421	0	0	2.40437512	1.896607267	0	0	0.294934859	0.411116728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6647	0	13.60214572	10.5057	0.608552956	2.77481023	0	1.714099251	1.347095618	0.888277995	1.059527957	2.289047504	1.599290401	3.890268802	0	0.013979143	1.737824913	3.259602567	7.730065784	1.468206708	0.771366421	0	0	2.40437512	1.896607267	0	0	0.294934859	0.411116728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6647	NO	"$275 Days 1-35 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-35 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-55 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.2313	0.0958	0.7411	0.3792	0.3621	0.4268	0.5135	0.2237	1.4504	0.3378	1.2075	0	0.003	0.6494	1.0089	1.8706	0.289	0.1881	0	0	0.7321	0.5393	0	0	0.07	0	0.0074	0	0	0											12.327	0	1.549281361	11.7369	0.70440008	3.515937484	0.379243259	2.076181286	1.773931277	1.401796518	1.283275632	3.739469153	1.937120502	5.097741056	0	0.016932062	2.387226423	4.268453194	9.600633664	1.757158849	0.95947082	0	0	3.136514978	2.435859318	0	0	0.364960328	0.411116728	0.007368514	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9917
H8748_003_0	2011	6																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1184.698234	93.32268901	671.2434511	1065.082094	143.6790141	10.24627045	11.60445522	317.2641341	34.90404775	18.44597132	40.44342429	0	0.105300188	18.78025178	6196.652195	104.2084646	481.0568917	490.752563	0	0	20.94334473	1314.511658	0	0	127.983732	158.6323694	15.02955094	6	177.0437839	0											3380	"$295 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-34 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												219.7738852	147.0075908	76.12584214	0	200	0.2	0.115810967	48.9971263	0.2	0.126712969	0.163195304	0	0.2	0.159907907	6.9169334	0.120170537	38.5	35	0	0	0.2	34.73361571	0	0	35	30	0	0	0	0											NO	154.8268765	103.5642887	53.62933064	0	140.8965185	0.140896519	0.081586811	34.53835176	0.140896519	0.089267081	0.114968251	0	0.140896519	0.112652337	6.563383268	0.114075229	36.53212214	33.21102013	0	0	0.140896519	24.46922765	0	0	35	30	0	0	0	0												15.2853	0.805408159	2.999861415	0	1.686989406	1.443663834	0.94677049	0.913148355	4.917858811	1.646618014	4.649709744	0	0.01483643	2.115639256	3.389250278	11.88760442	1.464502427	1.358199437	0	0	2.950844359	2.680423751	0	0	0.373285885	0.396580923	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9265	0	19.03065253	15.2853	0.805408159	2.999861415	0	1.686989406	1.443663834	0.94677049	0.913148355	4.917858811	1.646618014	4.649709744	0	0.01483643	2.115639256	3.389250278	11.88760442	1.464502427	1.358199437	0	0	2.950844359	2.680423751	0	0	0.373285885	0.396580923	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9265	NO	"$325 Days 1-Unlimited (1a); $325 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-40 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$15 (7a, 14c); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$15 (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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.8674	0.1463	0.8	0.4773	0.4226	0.5424	0.6144	0.2286	1.8479	0.4125	1.7168	0	0.0037	0.792	1.0825	2.4143	0.2957	0.2774	0	0	1.0655	0.7377	0	0	0.0723	0	0.0085	0	0	0											15.8259	0	0	17.1527	0.951661559	3.799898611	0.477306977	2.109574741	1.986113446	1.561124001	1.14175175	6.765720163	2.059090448	6.366488008	0	0.018552907	2.907634547	4.471739719	14.30187557	1.760239887	1.635622914	0	0	4.01638295	3.418154604	0	0	0.445635363	0.396580923	0.008496237	0	0	0	0	0	0	0	0	0	0	0	0	0	77.7523
H8748_004_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1234.004492	95.30605435	666.7402439	1063.887532	135.5931842	9.859534738	11.57098855	536.7150639	42.98740197	17.22115492	44.25123761	0	0.10672872	23.0195674	6206.876619	112.8545671	479.9385853	416.2733345	0	0	16.88882987	1396.417049	0	0	142.2657369	159.4444548	14.92515139	6	172.3506203	0											3600	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-46 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$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)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	61.50490018	0	200	0.2	0.111519196	49.29912214	0.2	0.129786495	0.163144804	0	0.2	0.159693327	10.09308109	0.096204132	38.5	30	0	0	0.2	29.82233683	0	0	30	30	0	0	0	0											YES	135.0614537	90.34312197	44.60125295	0	145.0331691	0.145033169	0.080869912	35.76165245	0.145033169	0.094116733	0.11830704	0	0.145033169	0.115804147	9.615921667	0.091690759	36.67987812	28.58172321	0	0	0.145033169	21.62614011	0	0	30	30	0	0	0	0											3900	13.8889	0.717520541	2.478120856	0	1.638792435	1.429959569	0.935744831	1.599484798	6.234599141	1.620798845	5.235232927	0	0.015479204	2.665761364	4.973736614	10.34772092	1.467007401	0.991484102	0	0	2.449440519	2.516592563	0	0	0.355664342	0.398611137	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9606	0	17.33582214	13.8889	0.717520541	2.478120856	0	1.638792435	1.429959569	0.935744831	1.599484798	6.234599141	1.620798845	5.235232927	0	0.015479204	2.665761364	4.973736614	10.34772092	1.467007401	0.991484102	0	0	2.449440519	2.516592563	0	0	0.355664342	0.398611137	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9606	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); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.9679	0.0592	0.3409	0.3025	0.248	0.3246	0.3809	0.2421	1.4151	0.2452	1.1672	0	0.0023	0.6038	1.5217	2.2765	0.2754	0.2197	0	0	0.5343	0.4879	0	0	0.0804	0	0	0	0	0											11.6955	0	4.757321997	14.8568	0.776683557	2.819057177	0.302467264	1.886764964	1.754519304	1.316642821	1.841557067	7.649674004	1.866048689	6.402430856	0	0.017821428	3.269543865	6.495482008	12.62419001	1.74242305	1.211144756	0	0	2.98371857	3.004505383	0	0	0.436087468	0.398611137	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6561
H8748_801_0	2011	1																															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	224.4762104	4.9987665	23.80983428	1321.436872	6.230921701	11.14748194	11.54903923	16.35698002	37.19926961	16.44413346	37.15546934	0	0.129372488	21.89568417	37.16717114	110.4306978	2.1632355	4.17094435	0	0	19.70751753	9.344586655	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.080134647	0.080134647	0.182977965	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064421125	0.064421125	0.147098001	0	0.187311266	0.187311266	0.187311266	0.187311266	0.187311266	0.187311266	0.187311266	0	0.187311266	0.187311266	0.187311266	0.187311266	0.187311266	0.187311266	0	0	0.187311266	0.187311266	0	0	0	0	0	0	0	0												14.461	0.322026164	3.502379035	0	1.167121832	2.088048955	2.16326516	3.063846634	6.967842285	3.080171457	6.959638001	0	0.024232925	4.101308322	6.961829879	20.6849138	0.40519838	0.781264867	0	0	3.691440059	1.750346356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.1759	0	20.04424079	14.461	0.322026164	3.502379035	0	1.167121832	2.088048955	2.16326516	3.063846634	6.967842285	3.080171457	6.959638001	0	0.024232925	4.101308322	6.961829879	20.6849138	0.40519838	0.781264867	0	0	3.691440059	1.750346356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.1759	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0469	0.0233	0.4309	0	0.2562	0.4584	0.4749	0.6726	1.5295	0.6761	1.5277	0	0.0053	0.9003	1.4686	4.3636	0.0855	0.1648	0	0	0.7787	0.3692	0	0	0	0	0	0	0	0											15.2327	0	0	15.5079	0.345340017	3.933258983	0	1.423322671	2.546407183	2.638134479	3.736407166	8.497388724	3.756315533	8.487383475	0	0.029552417	5.001607336	8.430476519	25.04854084	0.490677809	0.946078147	0	0	4.470175123	2.119594146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4086
H8748_802_0	2011	1																															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	224.4762104	4.9987665	23.80983428	1321.436872	6.230921701	11.14748194	11.54903923	16.35698002	37.19926961	16.44413346	37.15546934	0	0.129372488	21.89568417	37.16717114	110.4306978	2.1632355	4.17094435	0	0	19.70751753	9.344586655	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.080134647	0.080134647	0.182977965	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064421125	0.064421125	0.147098001	0	0.187311266	0.187311266	0.187311266	0.187311266	0.187311266	0.187311266	0.187311266	0	0.187311266	0.187311266	0.187311266	0.187311266	0.187311266	0.187311266	0	0	0.187311266	0.187311266	0	0	0	0	0	0	0	0												14.461	0.322026164	3.502379035	0	1.167121832	2.088048955	2.16326516	3.063846634	6.967842285	3.080171457	6.959638001	0	0.024232925	4.101308322	6.961829879	20.6849138	0.40519838	0.781264867	0	0	3.691440059	1.750346356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.1759	0	20.04424079	14.461	0.322026164	3.502379035	0	1.167121832	2.088048955	2.16326516	3.063846634	6.967842285	3.080171457	6.959638001	0	0.024232925	4.101308322	6.961829879	20.6849138	0.40519838	0.781264867	0	0	3.691440059	1.750346356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.1759	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0469	0.0233	0.4309	0	0.2562	0.4584	0.4749	0.6726	1.5295	0.6761	1.5277	0	0.0053	0.9003	1.4686	4.3636	0.0855	0.1648	0	0	0.7787	0.3692	0	0	0	0	0	0	0	0											15.2327	0	0	15.5079	0.345340017	3.933258983	0	1.423322671	2.546407183	2.638134479	3.736407166	8.497388724	3.756315533	8.487383475	0	0.029552417	5.001607336	8.430476519	25.04854084	0.490677809	0.946078147	0	0	4.470175123	2.119594146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4086
H8748_803_0	2011	1																															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	224.4762104	4.9987665	23.80983428	1321.436872	6.230921701	11.14748194	11.54903923	16.35698002	37.19926961	16.44413346	37.15546934	0	0.129372488	21.89568417	37.16717114	110.4306978	2.1632355	4.17094435	0	0	19.70751753	9.344586655	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.080134647	0.080134647	0.182977965	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064421125	0.064421125	0.147098001	0	0.187311266	0.187311266	0.187311266	0.187311266	0.187311266	0.187311266	0.187311266	0	0.187311266	0.187311266	0.187311266	0.187311266	0.187311266	0.187311266	0	0	0.187311266	0.187311266	0	0	0	0	0	0	0	0												14.461	0.322026164	3.502379035	0	1.167121832	2.088048955	2.16326516	3.063846634	6.967842285	3.080171457	6.959638001	0	0.024232925	4.101308322	6.961829879	20.6849138	0.40519838	0.781264867	0	0	3.691440059	1.750346356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.1759	0	20.04424079	14.461	0.322026164	3.502379035	0	1.167121832	2.088048955	2.16326516	3.063846634	6.967842285	3.080171457	6.959638001	0	0.024232925	4.101308322	6.961829879	20.6849138	0.40519838	0.781264867	0	0	3.691440059	1.750346356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.1759	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.0469	0.0233	0.4309	0	0.2562	0.4584	0.4749	0.6726	1.5295	0.6761	1.5277	0	0.0053	0.9003	1.4686	4.3636	0.0855	0.1648	0	0	0.7787	0.3692	0	0	0	0	0	0	0	0											15.2327	0	0	15.5079	0.345340017	3.933258983	0	1.423322671	2.546407183	2.638134479	3.736407166	8.497388724	3.756315533	8.487383475	0	0.029552417	5.001607336	8.430476519	25.04854084	0.490677809	0.946078147	0	0	4.470175123	2.119594146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4086
H8822_001_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	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	274.9658091	2.84905714	70.49048769	17.68623202	7.345024263	16.54255728	0.939819645	9.127812314	22.31738511	9.407703787	39.33855624	0	0	70.25714152	26.66735451	23.85659513	1.744384197	0	42.90436679	87.98272086	48.32166039	3.479880084	0.840858778	0	0	0	0	0	0	0											3400	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"$0 copay, limited to 6 trips per year"	Medicare FFS Cost Sharing	Medicare 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	0.233	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	0.073464884	0.073464884	0.181740437	0	0.22937984	0.22937984	0.22937984	0.22937984	0.22937984	0.22937984	0.22937984	0	0	0.22937984	0.22937984	0.22937984	0.22937984	0	0.22937984	0.22937984	0.22937984	0.22937984	0	0	0	0	0	0	0	0												20.2003	0.209305651	12.810972	0	1.684800491	3.794529143	0.21557568	2.093736129	5.119158227	2.15793759	9.02347174	0	0	16.11557189	6.116953513	5.472221977	0.400126568	0	9.841396793	20.18146244	11.08401473	0.798214337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.3198		1.970766153	20.2003	0.209305651	12.810972	0	1.684800491	3.794529143	0.21557568	2.093736129	5.119158227	2.15793759	9.02347174	0	0	16.11557189	6.116953513	5.472221977	0.400126568	0	9.841396793	20.18146244	11.08401473	0.798214337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.3198	NO	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-																																																				0			20.2003	0.209305651	12.810972	0	1.684800491	3.794529143	0.21557568	2.093736129	5.119158227	2.15793759	9.02347174	0	0	16.11557189	6.116953513	5.472221977	0.400126568	0	9.841396793	20.18146244	11.08401473	0.798214337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.3198
H8822_004_0	2011	7																															A	A	A	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	YES	246.1060625	5.676626312	98.71839824	107.8351663	185.8234087	13.64869394	0.585662803	387.2322159	312.6708492	2471.405586	1384.637265	0	0	1099.189343	3902.361031	3216.384188	201.4474849	0	8716.884999	7069.685598	35.4520428	396.945416	0	369.5093604	311.8789161	4.604847601	0	0	0	0.246638319											3400	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	"$0 copay for x-rays, $50 for all other"	-	-	-	$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	$0 copay	-	$10 copay	$20 copay	-	-	-	-	-												346.070133	353.3333333	0	0	50	0.2	0.2	49.87343835	100	0	6	0	0	41.20372719	8.243671729	25	25	0	0.764096476	0	0.2	0	0	10	20	0	0	0	0	0											NO	323.589845	330.3812368	0	0	46.75206181	0.187008247	0.187008247	46.63372145	93.50412361	0	5.610247417	0	0	38.52718401	7.708173004	23.3760309	23.3760309	0	0.714461713	0	0.187008247	0	0	9.350412361	18.70082472	0	0	0	0	0												6.6365	0.156287568	0	0	0.723968957	2.55241833	0.109523774	1.504839941	2.436334478	0	0.64734647	0	0	3.529055838	2.506672829	6.265524682	0.392420219	0	0.518990049	0	6.629824384	0	0	0.287922074	0.486032745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3836		2.494662378	6.6365	0.156287568	0	0	0.723968957	2.55241833	0.109523774	1.504839941	2.436334478	0	0.64734647	0	0	3.529055838	2.506672829	6.265524682	0.392420219	0	0.518990049	0	6.629824384	0	0	0.287922074	0.486032745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3836	NO	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			6.6365	0.156287568	0	0	0.723968957	2.55241833	0.109523774	1.504839941	2.436334478	0	0.64734647	0	0	3.529055838	2.506672829	6.265524682	0.392420219	0	0.518990049	0	6.629824384	0	0	0.287922074	0.486032745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3836
H8822_801_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	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	269.6850522	2.988620715	63.65367225	17.19292801	7.140635784	16.08115261	0.913606215	8.939544663	22.86618903	9.145304309	38.25913022	0	0	63.76107262	25.92354596	21.29628877	1.593102657	0	41.70781544	85.5287069	46.97387364	3.110379134	0	0	0	0	0	0	0	0											3400	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												0.078178457	0.078178457	0.183397922	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	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074416715	0.074416715	0.174573297	0	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0	0	0.221788653	0.221788653	0.221788653	0.221788653	0	0.221788653	0.221788653	0.221788653	0.221788653	0	0	0	0	0	0	0	0												20.0691	0.222403336	11.1122314	0	1.583711993	3.56661718	0.202627492	1.982689571	5.071461269	2.028324726	8.485440963	0	0	14.14148242	5.749548345	4.723275203	0.353332093	0	9.250320213	18.96929671	10.41827217	0.689846799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.62		5.996201629	20.0691	0.222403336	11.1122314	0	1.583711993	3.56661718	0.202627492	1.982689571	5.071461269	2.028324726	8.485440963	0	0	14.14148242	5.749548345	4.723275203	0.353332093	0	9.250320213	18.96929671	10.41827217	0.689846799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.62	NO																																																																																		0		0	20.0691	0.222403336	11.1122314	0	1.583711993	3.56661718	0.202627492	1.982689571	5.071461269	2.028324726	8.485440963	0	0	14.14148242	5.749548345	4.723275203	0.353332093	0	9.250320213	18.96929671	10.41827217	0.689846799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.62
H8822_802_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	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	269.6850522	2.988620715	63.65367225	17.19292801	7.140635784	16.08115261	0.913606215	8.939544663	22.86618903	9.145304309	38.25913022	0	0	63.76107262	25.92354596	21.29628877	1.593102657	0	41.70781544	85.5287069	46.97387364	3.110379134	0	0	0	0	0	0	0	0											3400	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												0.078178457	0.078178457	0.183397922	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	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074416715	0.074416715	0.174573297	0	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0	0	0.221788653	0.221788653	0.221788653	0.221788653	0	0.221788653	0.221788653	0.221788653	0.221788653	0	0	0	0	0	0	0	0												20.0691	0.222403336	11.1122314	0	1.583711993	3.56661718	0.202627492	1.982689571	5.071461269	2.028324726	8.485440963	0	0	14.14148242	5.749548345	4.723275203	0.353332093	0	9.250320213	18.96929671	10.41827217	0.689846799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.62		5.996201629	20.0691	0.222403336	11.1122314	0	1.583711993	3.56661718	0.202627492	1.982689571	5.071461269	2.028324726	8.485440963	0	0	14.14148242	5.749548345	4.723275203	0.353332093	0	9.250320213	18.96929671	10.41827217	0.689846799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.62	NO																																																																																		0		0	20.0691	0.222403336	11.1122314	0	1.583711993	3.56661718	0.202627492	1.982689571	5.071461269	2.028324726	8.485440963	0	0	14.14148242	5.749548345	4.723275203	0.353332093	0	9.250320213	18.96929671	10.41827217	0.689846799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.62
H8822_803_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	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	269.6850522	2.988620715	63.65367225	17.19292801	7.140635784	16.08115261	0.913606215	8.939544663	22.86618903	9.145304309	38.25913022	0	0	63.76107262	25.92354596	21.29628877	1.593102657	0	41.70781544	85.5287069	46.97387364	3.110379134	0	0	0	0	0	0	0	0											3400	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												0.078178457	0.078178457	0.183397922	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	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074416715	0.074416715	0.174573297	0	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0	0	0.221788653	0.221788653	0.221788653	0.221788653	0	0.221788653	0.221788653	0.221788653	0.221788653	0	0	0	0	0	0	0	0												20.0691	0.222403336	11.1122314	0	1.583711993	3.56661718	0.202627492	1.982689571	5.071461269	2.028324726	8.485440963	0	0	14.14148242	5.749548345	4.723275203	0.353332093	0	9.250320213	18.96929671	10.41827217	0.689846799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.62		5.996201629	20.0691	0.222403336	11.1122314	0	1.583711993	3.56661718	0.202627492	1.982689571	5.071461269	2.028324726	8.485440963	0	0	14.14148242	5.749548345	4.723275203	0.353332093	0	9.250320213	18.96929671	10.41827217	0.689846799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.62	NO																																																																																		0		0	20.0691	0.222403336	11.1122314	0	1.583711993	3.56661718	0.202627492	1.982689571	5.071461269	2.028324726	8.485440963	0	0	14.14148242	5.749548345	4.723275203	0.353332093	0	9.250320213	18.96929671	10.41827217	0.689846799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.62
H8822_804_0	2011	4																															Coin	Coin	Coin	Coin	Coin	Coin	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	269.6850522	2.988620715	63.65367225	17.19292801	7.140635784	16.08115261	0.913606215	8.939544663	22.86618903	9.145304309	38.25913022	0	0	63.76107262	25.92354596	21.29628877	1.593102657	0	41.70781544	85.5287069	46.97387364	3.110379134	0	0	0	0	0	0	0	0											3400	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												0.078178457	0.078178457	0.183397922	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	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074416715	0.074416715	0.174573297	0	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0.221788653	0	0	0.221788653	0.221788653	0.221788653	0.221788653	0	0.221788653	0.221788653	0.221788653	0.221788653	0	0	0	0	0	0	0	0												20.0691	0.222403336	11.1122314	0	1.583711993	3.56661718	0.202627492	1.982689571	5.071461269	2.028324726	8.485440963	0	0	14.14148242	5.749548345	4.723275203	0.353332093	0	9.250320213	18.96929671	10.41827217	0.689846799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.62		5.996201629	20.0691	0.222403336	11.1122314	0	1.583711993	3.56661718	0.202627492	1.982689571	5.071461269	2.028324726	8.485440963	0	0	14.14148242	5.749548345	4.723275203	0.353332093	0	9.250320213	18.96929671	10.41827217	0.689846799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.62	NO																																																																																		0		0	20.0691	0.222403336	11.1122314	0	1.583711993	3.56661718	0.202627492	1.982689571	5.071461269	2.028324726	8.485440963	0	0	14.14148242	5.749548345	4.723275203	0.353332093	0	9.250320213	18.96929671	10.41827217	0.689846799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.62
H8953_001_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V	V		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	1676.634179	71.36019	696.463797	1729.966414	233.468043	10.155634	3.089602	405.864337	338.14842	1564.5534	1567.407137	79.378815	0.561999	3.474184	4846.513079	5024.903238	76.481298	755.081884		1913.933635	34.424695	0		2.48	1.65		0.28		4.46	0.2	395.862274	586.774667									3750	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $150 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$40/Visit:7b. $5 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"	"VIS734: Vision 17a, 17b"		"HER814: Hearing 18a, 18b"		$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$40-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"										140.1309	119.971605	32.5726	0	100	0.2	0.2	50	178.964225	10.377806	74.77137	150	0.186153	0.2	5	39.248977	40	63.622327		0	0.2	0		0	0		0		0	0	0	133.600739									NO	116.091724	99.390716	21.206619	0	84.2154	0.168431	0.168431	42.1077	150.715438	8.739711	62.969009	126.3231	0.156769	0.168431	4.21077	33.053683	33.68616	53.579797		0	0.168431	0		0	0		0		0	0	0	112.512396										16.2203	0.591045031	1.230803533	0	1.638467052	1.71052359	0.520384754	1.424167812	4.247015602	1.139478713	8.22483951	0.835614832	0.088104021	0.585160285	1.700629323	13.84096323	0.21469677	3.371427839	0	0	5.798185804	0	0	0	0	0	0	0	0	0	0	5.501618641	0	0	0	0	0	0	0	0	68.8834	0	13.6700399	16.2203	0.591045031	1.230803533	0	1.638467052	1.71052359	0.520384754	1.424167812	4.247015602	1.139478713	8.22483951	0.835614832	0.088104021	0.585160285	1.700629323	13.84096323	0.21469677	3.371427839	0	0	5.798185804	0	0	0	0	0	0	0	0	0	0	5.501618641	0	0	0	0	0	0	0	0	68.8834	NO																																																																																		0	0	0	16.2203	0.591045031	1.230803533	0	1.638467052	1.71052359	0.520384754	1.424167812	4.247015602	1.139478713	8.22483951	0.835614832	0.088104021	0.585160285	1.700629323	13.84096323	0.21469677	3.371427839	0	0	5.798185804	0	0	0	0	0	0	0	0	0	0	5.501618641	0	0	0	0	0	0	0	0	68.8834
H8953_002_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							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	YES	1829.305432	77.858119	759.882521	1887.494003	254.727218	11.776267	3.582639	442.821604	368.9396	1707.018782	1710.132375	86.606905	0.651683	4.028593	5287.827729	5482.461771	83.445546	823.838265		2088.212944	39.918177	0							3.22		431.908771	640.205298									5000	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $150 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$40/Visit:7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a		$0/Service:11c.Diabetic Monitoring Supplies	"$40-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"										165.92202	145.11002	32.5726	0	100	0.2	0.2	50	178.964225	10.377806	74.77137	150	0.186153	0.2	10	39.356266	40	63.622327		0	0.2	0							0		0	133.600739									NO	143.118195	125.166534	23.198597	0	86.7977	0.173595	0.173595	43.39885	155.336831	9.007697	64.89983	130.19655	0.161576	0.173595	8.67977	34.160334	34.71908	55.222717		0	0.173595	0							0		0	115.962368										21.8172	0.812102575	1.469017364	0	1.842478054	2.04430107	0.621928217	1.601495697	4.775825691	1.281358997	9.248941701	0.93966002	0.105296332	0.699343602	3.824760707	15.60689377	0.241429382	3.791215613	0	0	6.929595936	0	0	0	0	0	0	0	0	0	0	6.18664353	0	0	0	0	0	0	0	0	83.8395	0	13.28614521	21.8172	0.812102575	1.469017364	0	1.842478054	2.04430107	0.621928217	1.601495697	4.775825691	1.281358997	9.248941701	0.93966002	0.105296332	0.699343602	3.824760707	15.60689377	0.241429382	3.791215613	0	0	6.929595936	0	0	0	0	0	0	0	0	0	0	6.18664353	0	0	0	0	0	0	0	0	83.8395	NO																																																																																		0	0	0	21.8172	0.812102575	1.469017364	0	1.842478054	2.04430107	0.621928217	1.601495697	4.775825691	1.281358997	9.248941701	0.93966002	0.105296332	0.699343602	3.824760707	15.60689377	0.241429382	3.791215613	0	0	6.929595936	0	0	0	0	0	0	0	0	0	0	6.18664353	0	0	0	0	0	0	0	0	83.8395
H8953_003_0	2011	4	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V					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	YES	1717.383485	73.094544	713.390814	1772.011918	239.142305	10.300987	3.133822	415.728558	346.366858	1602.578668	1605.501764	81.308056	0.570043	3.523908	4964.303856	5147.02965	78.340117	773.43357		1960.450321	34.917398	0		2.48					3.22		405.483402	601.035773									3900	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $150 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$40/Visit:7b. $5 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN756: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a		$0/Service:11c.Diabetic Monitoring Supplies	"$40-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"										165.92202	145.11002	32.5726	0	100	0.2	0.2	50	178.964225	10.377806	74.771371	150	0.186153	0.2	5	39.248977	40	63.622327		0	0.2	0		0					0		0	133.600739									NO	134.222286	117.38646	20.514973	0	83.4387	0.166877	0.166877	41.71935	149.325423	8.659106	62.38826	125.15805	0.155324	0.166877	4.171935	32.748836	33.37548	53.085643		0	0.166877	0		0					0		0	111.474719										19.2093	0.715025814	1.219599441	0	1.662810254	1.718997808	0.522962814	1.445327101	4.310114799	1.156408213	8.347038457	0.848029812	0.088541359	0.588059195	1.725896084	14.04660249	0.217886584	3.421518198	0	0	5.826910626	0	0	0	0	0	0	0	0	0	0	5.583357825	0	0	0	0	0	0	0	0	72.6543	0	15.64644273	19.2093	0.715025814	1.219599441	0	1.662810254	1.718997808	0.522962814	1.445327101	4.310114799	1.156408213	8.347038457	0.848029812	0.088541359	0.588059195	1.725896084	14.04660249	0.217886584	3.421518198	0	0	5.826910626	0	0	0	0	0	0	0	0	0	0	5.583357825	0	0	0	0	0	0	0	0	72.6543	NO																																																																																		0	0	0	19.2093	0.715025814	1.219599441	0	1.662810254	1.718997808	0.522962814	1.445327101	4.310114799	1.156408213	8.347038457	0.848029812	0.088541359	0.588059195	1.725896084	14.04660249	0.217886584	3.421518198	0	0	5.826910626	0	0	0	0	0	0	0	0	0	0	5.583357825	0	0	0	0	0	0	0	0	72.6543
H8953_004_0	2011	2	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							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	YES	1829.305432	77.858119	759.882521	1887.494003	254.727218	11.776267	3.582639	442.821604	368.9396	1707.018782	1710.132375	86.606905	0.651683	4.028593	5287.827729	5482.461771	83.445546	823.838265		2088.212944	39.918177	0							4.53	0.56	431.908771	640.205298									5000	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $150 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$40/Visit:7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$40-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"										165.92202	145.11002	32.5726	0	100	0.2	0.2	50	178.964225	10.377806	74.77137	150	0.186153	0.2	10	39.356266	40	63.622327		0	0.2	0							0	0	0	133.600739									NO	143.118195	125.166534	23.198597	0	86.7977	0.173595	0.173595	43.39885	155.336831	9.007697	64.89983	130.19655	0.161576	0.173595	8.67977	34.160334	34.71908	55.222717		0	0.173595	0							0	0	0	115.962368										21.8172	0.812102575	1.469017364	0	1.842478054	2.04430107	0.621928217	1.601495697	4.775825691	1.281358997	9.248941701	0.93966002	0.105296332	0.699343602	3.824760707	15.60689377	0.241429382	3.791215613	0	0	6.929595936	0	0	0	0	0	0	0	0	0	0	6.18664353	0	0	0	0	0	0	0	0	83.8395	0	13.28614521	21.8172	0.812102575	1.469017364	0	1.842478054	2.04430107	0.621928217	1.601495697	4.775825691	1.281358997	9.248941701	0.93966002	0.105296332	0.699343602	3.824760707	15.60689377	0.241429382	3.791215613	0	0	6.929595936	0	0	0	0	0	0	0	0	0	0	6.18664353	0	0	0	0	0	0	0	0	83.8395	NO																																																																																		0	0	0	21.8172	0.812102575	1.469017364	0	1.842478054	2.04430107	0.621928217	1.601495697	4.775825691	1.281358997	9.248941701	0.93966002	0.105296332	0.699343602	3.824760707	15.60689377	0.241429382	3.791215613	0	0	6.929595936	0	0	0	0	0	0	0	0	0	0	6.18664353	0	0	0	0	0	0	0	0	83.8395
H8953_801_0	2011	4																															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	YES	336.45464	4.719713	34.579053	18.685392	8.456336	10.769554	3.802195	30.661357	56.872012	6.141595	33.286659	5.902091	0.595974	11.439972	44.365053	80.3557	0.553446	6.138102		8.728353	36.505704	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07937	0.07937	0.16821	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.07082	0.07082	0.110866	0	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827		0.207827	0.207827	0																				23.8277	0.334250075	3.83364129	0	1.757454942	2.238204099	0.79019878	6.372257841	11.81953964	1.276389264	6.91786648	1.226613866	0.123859488	2.377535061	9.22025587	16.70008406	0.115021022	1.275663324	0	1.813987419	7.586870945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6074	0	13.57407203	23.8277	0.334250075	3.83364129	0	1.757454942	2.238204099	0.79019878	6.372257841	11.81953964	1.276389264	6.91786648	1.226613866	0.123859488	2.377535061	9.22025587	16.70008406	0.115021022	1.275663324	0	1.813987419	7.586870945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6074	NO																																																																																		0	0	0	23.8277	0.334250075	3.83364129	0	1.757454942	2.238204099	0.79019878	6.372257841	11.81953964	1.276389264	6.91786648	1.226613866	0.123859488	2.377535061	9.22025587	16.70008406	0.115021022	1.275663324	0	1.813987419	7.586870945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6074
H8953_802_0	2011	4																															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	YES	336.45464	4.719713	34.579053	18.685392	8.456336	10.769554	3.802195	30.661357	56.872012	6.141595	33.286659	5.902091	0.595974	11.439972	44.365053	80.3557	0.553446	6.138102		8.728353	36.505704	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07937	0.07937	0.16821	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.07082	0.07082	0.110866	0	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827		0.207827	0.207827	0																				23.8277	0.334250075	3.83364129	0	1.757454942	2.238204099	0.79019878	6.372257841	11.81953964	1.276389264	6.91786648	1.226613866	0.123859488	2.377535061	9.22025587	16.70008406	0.115021022	1.275663324	0	1.813987419	7.586870945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6074	0	13.57407203	23.8277	0.334250075	3.83364129	0	1.757454942	2.238204099	0.79019878	6.372257841	11.81953964	1.276389264	6.91786648	1.226613866	0.123859488	2.377535061	9.22025587	16.70008406	0.115021022	1.275663324	0	1.813987419	7.586870945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6074	NO																																																																																		0	0	0	23.8277	0.334250075	3.83364129	0	1.757454942	2.238204099	0.79019878	6.372257841	11.81953964	1.276389264	6.91786648	1.226613866	0.123859488	2.377535061	9.22025587	16.70008406	0.115021022	1.275663324	0	1.813987419	7.586870945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6074
H8953_803_0	2011	4																															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	YES	336.45464	4.719713	34.579053	18.685392	8.456336	10.769554	3.802195	30.661357	56.872012	6.141595	33.286659	5.902091	0.595974	11.439972	44.365053	80.3557	0.553446	6.138102		8.728353	36.505704	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07937	0.07937	0.16821	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.07082	0.07082	0.110866	0	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827	0.207827		0.207827	0.207827	0																				23.8277	0.334250075	3.83364129	0	1.757454942	2.238204099	0.79019878	6.372257841	11.81953964	1.276389264	6.91786648	1.226613866	0.123859488	2.377535061	9.22025587	16.70008406	0.115021022	1.275663324	0	1.813987419	7.586870945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6074	0	13.57407203	23.8277	0.334250075	3.83364129	0	1.757454942	2.238204099	0.79019878	6.372257841	11.81953964	1.276389264	6.91786648	1.226613866	0.123859488	2.377535061	9.22025587	16.70008406	0.115021022	1.275663324	0	1.813987419	7.586870945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6074	NO																																																																																		0	0	0	23.8277	0.334250075	3.83364129	0	1.757454942	2.238204099	0.79019878	6.372257841	11.81953964	1.276389264	6.91786648	1.226613866	0.123859488	2.377535061	9.22025587	16.70008406	0.115021022	1.275663324	0	1.813987419	7.586870945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6074
H8980_002_0	2011	12																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	COIN	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	YES	1811.510471	40.07113232	1034.207032	0	178.5786309	12.49281391	8.030298563	130.2918192	749.8289692	1419.203864	31.27323646	0	0	554.147113	34.18176806	16254.71892	145.6180235	1581.802717	32.40102608	1472.630741	26.73783025	0	0	0	0	0	0	0	0	94.12644347											6700	1a $195 days 1-7	1b $195 days 1-7	"2 $50 days 1-20, $70 days 21-100"	6 $0	10a $100	11a 20%	11b 20%	4a $50	"9a $165, 9b $165"	8a $15	8b $105 ($20 x-ray) 15B Outpatient Chemotherapy Drugs 15% 8B Radiation Therapy $55	5 $0	12 $0	4b $50 3 $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 $105 ($20 x-ray) 15B Physician Chemotherapy Drugs 15% 8B Radiation Therapy $55	7g $40	"11c 20%, 15A 20% coinsurance, 15B Physician Chemotherapy Drugs 15%"				17a $25 Medicare covered only	17b 1 pair of glasses or contacts after cataract surgery	18a $25 Medicare covered only		14a $0	"14c $15, 7f $40"												148.5366348	109.5735981	57.65389521	0	98.45060739	0.198935607	0.2	60.92293758	163.16219	15	0.072592397	0	0	0.785842159	0.126343832	11.48068645	38.35081048	24.98521366	0.351706806	2.586150328	0.216770245	0	0	0	0	0	0	0	0	19.23783124											NO	142.7071077	105.2732296	55.39118778	0	94.58677616	0.191128102	0.192150721	58.53193203	156.7586626	14.41130411	0.069743407	0	0	0.69550932	0.121385293	11.03011092	36.8456795	24.00463414	0.337903582	2.484653256	0.208262795	0	0	0	0	0	0	0	0	18.48281575												21.543	0.351534793	4.773829661	0	1.407598082	2.387727816	1.543027662	0.635519325	9.795182198	1.70438154	2.181102056	0	0	0.032117873	4.149163915	14.94094606	0.447116252	3.164216292	10.94842278	0.30491473	5.568495251	0	0	0	0	0	0	0	0	0.144976809	0	0	0	0	0	0	0	0	0	0	86.0232	0	3.516873116	21.543	0.351534793	4.773829661	0	1.407598082	2.387727816	1.543027662	0.635519325	9.795182198	1.70438154	2.181102056	0	0	0.032117873	4.149163915	14.94094606	0.447116252	3.164216292	10.94842278	0.30491473	5.568495251	0	0	0	0	0	0	0	0	0.144976809	0	0	0	0	0	0	0	0	0	0	86.0232	YES	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			14a OON:  $50/visit	0.2											10000	2.5135	0.0028	1.6549	0	0.7584	0.6483	0.1631	0.0227	0.1835	0.0552	0.0698	0.0016	0	0.0608	0.6475	2.0082	0	0.2004	0.5911	0.3845	0.1072	0	0	0	0	0	0	0	0.8667	0.0003											10.9406	1500	0	24.0565	0.354341566	6.428722834	0	2.166041638	3.036022262	1.706174196	0.658227447	9.978700529	1.759617681	2.25090984	0.001614107	0	0.092949909	4.796669093	16.94910877	0.447116252	3.364593698	11.5395331	0.689367787	5.675702876	0	0	0	0	0	0	0	0.866666667	0.145239728	0	0	0	0	0	0	0	0	0	0	96.9638
H8980_003_0	2011	6																															D	D	D	V	T	O	O	COIN	V	O	COIN	O	O	O	P	P	P	P	COIN	P	COIN	V	T	V	V	V	V	V	P	O											10.11581776	0.178615421	1.621820947	0	2.988877393	2.354271279	1.373847806	0	14.6950298	3.563153067	8.841239136	0.928255444	0	1.56287905	0.002811786	0.307131443	0.487851107	3.705118236	0.123966719	0	0	0	0	0	0	0	0	0	0	0.12025188											52.9709	YES	1572.162462	64.45872354	1256.263419	0	0	0	0	5.27089261	0	0	32.96410065	0	0	0	5942.246805	17646.41338	0	0	44.78927473	1804.048317	40.55206446	0	0	0	177.932311	0	0	0	0	0											3400	1a $125 days 1-4	1b $125 days 1-4	2 $60 days 1-100	6 $0	10a $0	11a 0%	11b 0%	4a $50	"9a $0, 9b $0"	8a $0	8b $95 $25 X-Ray 8b Radiation Therapy $55	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 $95 $25 X-Ray 8b Radiation Therapy $55	7g $0	15 $0				17a $30	"17b 1 pair of glasses after cataract surgery - Medicare Covered Only, $150 Allowance every two years Non-Medicare Covered"	18a $0 Medicare covered only		14a $0	"14c $10, 7f $0"												72.49488291	49.2114486	60	0	0	0	0	0.119600342	0	0	0.025771454	0	0	0	5.499419059	8.425041029	0	0	0.30955778	1.814067873	0.157376225	0	0	0	19.73776397	0	0	0	0	0											NO	57.50164801	39.03364323	47.59092976	0	0	0	0	0.094864858	0	0	0.020441458	0	0	0	4.362041103	6.682592264	0	0	0.24553571	1.438886278	0.124828014	0	0	0	15.65564231	0	0	0	0	0												7.5335	0.209671568	4.982228677	0	0	0	0	0.50002248	0	0	0.673834275	0	0	0	2.160027067	9.826982127	0	0	10.99736635	0.216318364	5.062033681	0	0	0	0.232137051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3941	1300	11.05402996	17.6493	0.38828699	6.604049624	0	2.988877393	2.354271279	1.373847806	0.50002248	14.6950298	3.563153067	9.515073411	0.928255444	0	1.56287905	2.162838853	10.13411357	0.487851107	3.705118236	11.12133307	0.216318364	5.062033681	0	0	0	0.232137051	0	0	0	0	0.12025188	0	0	0	0	0	0	0	0	0	0	95.3651	YES	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			14a OON:  $50/visit	0.3											5100	0.329	0.0067	0.0833	0	0	0.0381	0.0158	0.0028	0.0572	0.0087	0.064	0.0039	0	0.006	0.0194	0.1537	0	0.007	0.0425	0.0146	0.1474	0	0	0	0.0002	0	0	0	0.8667	0.0006											1.8675	2000	0	17.9783	0.394945553	6.687321825	0	2.988877393	2.392413254	1.389600051	0.502853142	14.75221139	3.571867958	9.579034009	0.932177678	0	1.568832564	2.182232465	10.28782629	0.487851107	3.712136426	11.16382791	0.230912544	5.209483066	0	0	0	0.232292953	0	0	0	0.866666667	0.120889092	0	0	0	0	0	0	0	0	0	0	97.2326
H8980_801_0	2011	4																															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	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	294.6009451	4.582243433	66.01940696	0	14.64841982	17.38753981	8.967987735	5.29971277	73.32627837	15.28054545	44.38002831	4.150647605	0.12433051	8.038665121	43.8903579	140.6642678	2.419288884	18.38553566	60.86773773	11.22622201	48.47545408	0	0	0	0	0	0	0	0	0											6700	FFS 8.2%	FFS 8.2%	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%												0.08159693	0.08159693	0.175759887	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.232753505	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.074340084	0.074340084	0.160128633	0	0.212278081	0.21236314	0.212278081	0.212278081	0.212278081	0.212278081	0.212278081	0.212278081	0.212278081	0.212278081	0.212278081	0.212053599	0.2122809	0.212278081	0.212279808	0.212321447	0.212278081	0	0	0	0	0	0	0	0	0												21.9007	0.340644364	10.5715974	0	3.109538443	3.692472544	1.903707223	1.125012854	15.56556163	3.243724859	9.420907225	0.881091507	0.026392642	1.706432402	9.316960931	29.8283643	0.513568821	3.90284622	12.92099167	2.383567704	10.29027635	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.6443	0	13.92219555	21.9007	0.340644364	10.5715974	0	3.109538443	3.692472544	1.903707223	1.125012854	15.56556163	3.243724859	9.420907225	0.881091507	0.026392642	1.706432402	9.316960931	29.8283643	0.513568821	3.90284622	12.92099167	2.383567704	10.29027635	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.6443	YES	FFS 8.2%	FFS 8.2%	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%											10000	0.0997	0	0.0131	0	0.2041	0.0058	0.0166	0.0099	0.1638	0.0225	0.0049	0	0	0.0039	0.0307	0.2314	0	0.0282	0.0232	0.0134	0.0423	0	0	0	0	0	0	0	0	0											0.9136	0	0	22.0004	0.340644364	10.58471731	0	3.313646094	3.698255988	1.9203077	1.134946292	15.72940365	3.266181657	9.425854164	0.881091507	0.026392642	1.710344799	9.347614271	30.05981393	0.513568821	3.931048258	12.94415219	2.396993956	10.33257661	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.558
H8980_802_0	2011	5																															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	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	281.1321581	3.150540237	49.24880435	0	12.7089458	13.62308515	8.825052709	4.872595953	77.06437143	11.39562861	44.85105725	6.27804696	0.081421078	6.962581077	40.85221382	131.1804236	2.486409446	15.36972213	64.08168055	9.366467794	34.13987725	0	0	0	0	0	0	0	0	0											6700	FFS 8.4%	FFS 8.4%	FFS 18.5%	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%												0.083576798	0.083576798	0.184676816	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.232817742	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.077749769	0.077749769	0.171801027	0	0.216755087	0.216838792	0.216755087	0.216755087	0.216755087	0.216755087	0.216755087	0.216755087	0.216755087	0.216755087	0.216755087	0.216585587	0.216756495	0.216755087	0.216755929	0.216793378	0.216755087	0	0	0	0	0	0	0	0	0												21.858	0.244953775	8.460995159	0	2.754728655	2.954013333	1.912875069	1.05615996	16.70409455	2.470060474	9.721694824	1.360798616	0.017648433	1.509174868	8.854925167	28.411789	0.538945398	3.33146546	13.89008423	2.030588197	7.399992069	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.4829	0	10.15221608	21.858	0.244953775	8.460995159	0	2.754728655	2.954013333	1.912875069	1.05615996	16.70409455	2.470060474	9.721694824	1.360798616	0.017648433	1.509174868	8.854925167	28.411789	0.538945398	3.33146546	13.89008423	2.030588197	7.399992069	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.4829	YES	FFS 8.4%	FFS 8.4%	FFS 18.5%	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%											10000	0.1311	0	0.009	0	0.37	0.0135	0.0471	0.0124	0.1073	0.0548	0.0055	0	0	0.0054	0.1859	0.7052	0	0.0328	0.1499	0.0992	0.0282	0	0	0	0	0	0	0	0	0											1.9573	0	0	21.9891	0.244953775	8.470022977	0	3.124706207	2.967492689	1.95998441	1.068533362	16.81139077	2.524899416	9.727215564	1.360798616	0.017648433	1.514526398	9.040865871	29.11694332	0.538945398	3.364248009	14.03993801	2.129794577	7.428223319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.4402
H8980_803_0	2011	5																															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	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	294.6009451	4.582243433	66.01940696	0	14.64841982	17.38753981	8.967987735	5.29971277	73.32627837	15.28054545	44.38002831	4.150647605	0.12433051	8.038665121	43.8903579	140.6642678	2.419288884	18.38553566	60.86773773	11.22622201	48.47545408	0	0	0	0	0	0	0	0	0											6700	FFS 8.2%	FFS 8.2%	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%												0.08159693	0.08159693	0.175759887	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.232753505	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.074340084	0.074340084	0.160128633	0	0.212278081	0.21236314	0.212278081	0.212278081	0.212278081	0.212278081	0.212278081	0.212278081	0.212278081	0.212278081	0.212278081	0.212053599	0.2122809	0.212278081	0.212279808	0.212321447	0.212278081	0	0	0	0	0	0	0	0	0												21.9007	0.340644364	10.5715974	0	3.109538443	3.692472544	1.903707223	1.125012854	15.56556163	3.243724859	9.420907225	0.881091507	0.026392642	1.706432402	9.316960931	29.8283643	0.513568821	3.90284622	12.92099167	2.383567704	10.29027635	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.6443	0	13.92219555	21.9007	0.340644364	10.5715974	0	3.109538443	3.692472544	1.903707223	1.125012854	15.56556163	3.243724859	9.420907225	0.881091507	0.026392642	1.706432402	9.316960931	29.8283643	0.513568821	3.90284622	12.92099167	2.383567704	10.29027635	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.6443	YES	FFS 8.2%	FFS 8.2%	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%											10000	0.0997	0	0.0131	0	0.2041	0.0058	0.0166	0.0099	0.1638	0.0225	0.0049	0	0	0.0039	0.0307	0.2314	0	0.0282	0.0232	0.0134	0.0423	0	0	0	0	0	0	0	0	0											0.9136	0	0	22.0004	0.340644364	10.58471731	0	3.313646094	3.698255988	1.9203077	1.134946292	15.72940365	3.266181657	9.425854164	0.881091507	0.026392642	1.710344799	9.347614271	30.05981393	0.513568821	3.931048258	12.94415219	2.396993956	10.33257661	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.558
H8991_017_0	2011	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											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											6700	No Cost-Sharing; PBP 1a	No Cost-Sharing; PBP 1b	No Cost-Sharing; PBP 2	No Cost-Sharing; PBP 6	No Cost-Sharing; PBP 10a	No Cost-Sharing; PBP 11a	"No Cost-Sharing; PBP 11b, 11c"	"No Cost-Sharing; PBP 4a, 4b"	No Cost-Sharing; PBP 9b	No Cost-Sharing; PBP 8a	No Cost-Sharing; PBP 8b	No Cost-Sharing; PBP 9a	No Cost-Sharing; PBP 12	"No Cost-Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"No Cost-Sharing; PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"No Cost-Sharing; PBP 7e, 7h"	"No Cost-Sharing; PBP 7c, 7i"	"No Cost-Sharing; PBP 7d, 14g-h"	"No Cost-Sharing; PBP 7d, 7g, 14f, 14i"	No Cost-Sharing; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	PBP 14a	"No Cost-Sharing; PBP 13b-f, 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	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	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	2011	5																															D	D	D		T	Coin	Coin	V	V	V	V	V	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	0	0	0	0	0	0	0											0	YES	1052.172693	91.5557375	254.6483017	0	261.0773865	3.300830711	1.567036304	309.1694099	220.1407522	1471.734986	471.2166955	54.00867637	0.143679593	740.5990495	5365.318419	5388.30949	312.0850332	461.6194861	701.3741929	0	36.43016361	2.483740272	0	0	0	0	0	0	0	0											6700	$175/Days 1-7 for IP Medical; $175/Days 1-7 for IP Surgical; PBP 1a	$175/Days 1-7 for IP Psych; $175/Days 1-7 for IP Substance Abuse; PBP 1b	$50/$100 per day for SNF days 11-20/21-100; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $25/Visit for PCP Urgent Care; PBP 4a, 4b"	$100/Visit for OP Fac - Surgery; PBP 9b	$150/Visit for OP Fac - Pathology; PBP 8a	$50/Visit for OP Fac - Radiology; $100/Visit for OP Fac - CT/MRI/PET; PBP 8b	$150/Visit for OP Fac - Observation; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$150/Visit for OP Fac - Cardiovascular; $25/Visit for OP Fac - Occ Therapy; $25/Visit for OP Fac - Physical/Speech Therapy; $25/Visit for OP Fac - CORF; $150/Visit for OP Fac - Other; $25/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$5/Visit for PCP Office Visits; $5/Visit for PCP Consults; PBP 7a, 14b-c"	"$25/Visit for Speclst Office Visits; $25/Visit for Speclst Consults; $25/Visit for Chiropractor; $25/Visit for Vision Exams; $25/Visit for Hearing/Speech Exams; $25/Visit for Podiatrist (Routine); PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse; PBP 7e, 7h"	"$25/Visit for Occ Therapy; $25/Visit for PT/ST; PBP 7c, 7i"	"$50/Visit for Prof Radiology (Office); $100/Visit for Prof Radiology (Office); PBP 7d, 14g-h"	"No Cost-Sharing; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"$25/Visit for Bone Mass Measurements; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	PBP 14a	"No Cost-Sharing; PBP 13b-f, 14a"											0	175	175	81.55299825	0	100	0.2	0.2	48.72263714	100	43.31335549	62.61579771	103.8893743	0.2	64.46973287	5	24.98313561	25	25	57.85332841	0	0.2	25	0	0	0	0	0	0	0	0											NO	161.0938986	161.0938986	78.58339418	0	99.9851511	0.199970302	0.199970302	48.71542746	99.9851511	43.30692393	62.60649995	103.8739478	0.199970302	64.46015983	4.999265028	24.97943745	24.99628778	24.99628778	57.84473782	0	0.199970302	24.99628778	0	0	0	0	0	0	0	0												14.1249	1.229089225	1.66759399	0	2.175321828	0.660068115	0.313360723	1.255109997	1.834233864	5.311359589	2.458435668	0.467507869	0.028731652	3.978261091	2.235220728	11.21641165	0.650080608	0.96156446	3.380900526	0	7.284950827	0.005173691	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.2383	0	1.394974835	14.1249	1.229089225	1.66759399	0	2.175321828	0.660068115	0.313360723	1.255109997	1.834233864	5.311359589	2.458435668	0.467507869	0.028731652	3.978261091	2.235220728	11.21641165	0.650080608	0.96156446	3.380900526	0	7.284950827	0.005173691	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.2383	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.1249	1.229089225	1.66759399	0	2.175321828	0.660068115	0.313360723	1.255109997	1.834233864	5.311359589	2.458435668	0.467507869	0.028731652	3.978261091	2.235220728	11.21641165	0.650080608	0.96156446	3.380900526	0	7.284950827	0.005173691	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.2383
H8991_022_0	2011	5																															D	D	D		T	Coin	Coin	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0											0	YES	816.3767404	15.29254666	162.0621222	0	178.1246976	3.500255224	1.934942418	205.4999597	196.215882	946.4178973	830.0120778	72.55899988	0.257702847	1078.697906	0	5471.814895	183.4262249	585.7534521	845.4475296	0	45.07727745	3.454503713	0	0	0	0	0	0	0	0											6700	$50/Days 1-10 for IP Medical; $50/Days 1-10 for IP Surgical; PBP 1a	$50/Days 1-10 for IP Psych; $50/Days 1-10 for IP Substance Abuse; PBP 1b	$50/$100 per day for SNF days 11-20/21-100; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $15/Visit for PCP Urgent Care; PBP 4a, 4b"	$75/Visit for OP Fac - Surgery; PBP 9b	$150/Visit for OP Fac - Pathology; PBP 8a	$25/Visit for OP Fac - Radiology; $75/Visit for OP Fac - CT/MRI/PET; PBP 8b	$150/Visit for OP Fac - Observation; PBP 9a	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$150/Visit for OP Fac - Cardiovascular; $15/Visit for OP Fac - Occ Therapy; $15/Visit for OP Fac - Physical/Speech Therapy; $15/Visit for OP Fac - CORF; $150/Visit for OP Fac - Other; $15/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"No Cost-Sharing; PBP 7a, 14b-c"	"$15/Visit for Speclst Office Visits; $15/Visit for Speclst Consults; $15/Visit for Chiropractor; $15/Visit for Vision Exams; $15/Visit for Hearing/Speech Exams; $15/Visit for Podiatrist (Routine); PBP 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse; PBP 7e, 7h"	"$15/Visit for Occ Therapy; $15/Visit for PT/ST; PBP 7c, 7i"	"$25/Visit for Prof Radiology (Office); $75/Visit for Prof Radiology (Office); PBP 7d, 14g-h"	"No Cost-Sharing; PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; 20% Coinsurance for Tx Injections; PBP 15	"$15/Visit for Bone Mass Measurements; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	PBP 14a	"No Cost-Sharing; PBP 13b-f, 14a"											0	50	50	81.55299825	0	100	0.2	0.2	46.16197502	75	36.22036717	37.67691262	97.37959249	0.2	56.94035793	0	15	15	15	32.81798137	0	0.2	15	0	0	0	0	0	0	0	0											NO	46.47086123	46.47086123	78.58339418	0	99.99183856	0.199983677	0.199983677	46.15824576	74.99387892	36.21741107	37.67383765	97.37164491	0.199983677	56.93571078	0	14.99878348	14.99877578	14.99877578	32.81530295	0	0.199983677	14.99877578	0	0	0	0	0	0	0	0												3.1615	0.059221484	1.061282636	0	1.484251334	0.699993911	0.3869569	0.790459804	1.226249175	2.856400503	2.605811689	0.588765764	0.051536363	5.118035998	0	6.839213904	0.229264068	0.732132058	2.311968068	0	9.0147197	0.004317777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2221	0	0.287542404	3.1615	0.059221484	1.061282636	0	1.484251334	0.699993911	0.3869569	0.790459804	1.226249175	2.856400503	2.605811689	0.588765764	0.051536363	5.118035998	0	6.839213904	0.229264068	0.732132058	2.311968068	0	9.0147197	0.004317777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2221	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.1615	0.059221484	1.061282636	0	1.484251334	0.699993911	0.3869569	0.790459804	1.226249175	2.856400503	2.605811689	0.588765764	0.051536363	5.118035998	0	6.839213904	0.229264068	0.732132058	2.311968068	0	9.0147197	0.004317777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2221
H9001_001_0	2011	5																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S			V	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	256.2813104	3.204987609	1767.01057	0	469.8739182	12.77770099	1.922907586	1213.716144	963.1484767	0	2742.770043	64.96856376	0	0	6495.912282	4765.583023	142.7823937	402.3201663	0	36.38486327	75.38337369	0	0	1118.55236	157.8137652	0	0	0	115.9538548	0											3400	"$400/Admit for IP Acute, Annual Limit of 3 Admits; PBP 1a"	"$400/Admit for IP Psych, Annual Limit of 3 Admits; PBP 1b"	"$35/Days 1-20 for SNF, $0/Days 21-100; PBP 2"	No Cost Sharing; PBP 6	"$75/Trip for Ambulance, Annual Limit of 4 Trips; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies, No Cost Sharing for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$50/Visit for ER; $15/Visit for Urgent Care; PBP 4a, 4b"	$125/Visit for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$100/Visit for OP diagnostic radiology; no cost sharing for OP X-rays or OP therapeutic radiology; PBP 8b	$125/Visit for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"$15/Visit for Bone Mass Measurement; $15/Visit for Colorectal Screening; $15/Visit for Diabetes Monitoring; $15/Visit for Mammography; $15/Visit for PCP; $15/Visit for Pelvic Exams & Pap Smears; $15/Visit for Prostate Screening; $15/Visit for Nutritional Therapy; No Cost Sharing for Immunizations; No Cost Sharing for Routine Physical Exams; PBP 7a, 14b-j"	"$25/Visit for Chiropractic; $25/Visit for Podiatry; $25/Visit for Physician Specialist; $20/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$25/Visit for Mental Health; $25/Visit for Psychiatric; $25/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$25/Visit for Occupational Therapy; $25/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$25/Visit for Medicare Covered Hearing Exams; $15/Visit for Other Health Care; PBP 7g, 18a-b"	$5-50/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a		"$29/Procedure for Non-Medicare Covered Comprehensive Dental Services; $25/Visit for Non-Medicare Covered Preventive Dental Services; PBP 16a, 16b"	$25/Exam for Non-Medicare Covered Eye Exams; PBP 17a	"No Cost Sharing, One Pair of Glasses/2 Years; PBP 17b"			$15/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											0	400	400	35	0	75	0.1	0.1	47.7971702	125	0	100	125	0	0	15	23.63462194	25	24.46069652	0	25	4.85	0	0	25.84799667	25	0	0	0	15	0											NO	378.4889578	378.4889578	33.11778381	0	70.96667959	0.094622239	0.094622239	45.22675284	118.2777993	0	94.62223945	118.2777993	0	0	14.19333592	22.36360857	23.65555986	23.14525883	0	23.65555986	4.589178613	0	0	24.4579533	23.65555986	0	0	0	14.19333592	0												8.0833	0.101087702	4.876622836	0	2.77878265	1.209054683	0.181949822	4.574370007	9.493256853	0	21.62725365	0.640361562	0	0	7.683222092	8.881302776	0.281466455	0.775983699	0	0.071725359	0.028828981	0	0	2.279791783	0.311097748	0	0	0	0.137147668	0	0	0	0	0	0	0	0	0	0	0	74.0166	0	4.208171084	8.0833	0.101087702	4.876622836	0	2.77878265	1.209054683	0.181949822	4.574370007	9.493256853	0	21.62725365	0.640361562	0	0	7.683222092	8.881302776	0.281466455	0.775983699	0	0.071725359	0.028828981	0	0	2.279791783	0.311097748	0	0	0	0.137147668	0	0	0	0	0	0	0	0	0	0	0	74.0166	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.0833	0.101087702	4.876622836	0	2.77878265	1.209054683	0.181949822	4.574370007	9.493256853	0	21.62725365	0.640361562	0	0	7.683222092	8.881302776	0.281466455	0.775983699	0	0.071725359	0.028828981	0	0	2.279791783	0.311097748	0	0	0	0.137147668	0	0	0	0	0	0	0	0	0	0	0	74.0166
H9001_010_0	2011	8																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S				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	190.3452285	0.905811002	819.3928317	0	275.3601725	8.471347428	0.969187876	880.3390263	825.5527238	0	2133.464251	49.82327625	0	0	5916.366676	3922.236915	220.0831896	364.0017415	0	39.196448	56.49220976	0	0	0	143.1831082	0	0	0	185.37753	0											3400	"$500/Admit for IP Acute, Annual Limit of 3 Admits; PBP 1a"	"$500/Admit for IP Psych, Annual Limit of 3 Admits; PBP 1b"	"$50/Days 1-20 for SNF, $0/Days 21-100; PBP 2"	No Cost Sharing; PBP 6	"$75/Trip for Ambulance, Annual Limit of 4 Trips; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies, No Cost Sharing for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$150/Visit for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$125/Visit for OP diagnostic radiology; no cost sharing for OP X-rays or OP therapeutic radiology; PBP 8b	$150/Visit for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"$25/Visit for Bone Mass Measurement; $25/Visit for Colorectal Screening; $25/Visit for Diabetes Monitoring; $25/Visit for Mammography; $25/Visit for PCP; $25/Visit for Pelvic Exams & Pap Smears; $25/Visit for Prostate Screening; $25/Visit for Nutritional Therapy; No Cost Sharing for Immunizations; No Cost Sharing for Routine Physical Exams; PBP 7a, 14b-j"	"$30/Visit for Chiropractic; $30/Visit for Podiatry; $30/Visit for Physician Specialist; $28/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$30/Visit for Mental Health; $30/Visit for Psychiatric; $30/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$30/Visit for Occupational Therapy; $30/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$30/Visit for Medicare Covered Hearing Exams; $25/Visit for Other Health Care; PBP 7g, 18a-b"	$5-55/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a		"Not Covered; PBP 16a, 16b"	$30/Exam for Non-Medicare Covered Eye Exams; PBP 17a	"No Cost Sharing, One Pair of Glasses/2 Years; PBP 17b"			$25/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											0	500	500	50	0	75	0.1	0.1	48.16737349	150	0	125	150	0	0	25	29.2687821	30	29.42921626	0	30	9.740534236	0	0	0	30	0	0	0	25	0											NO	474.4185541	474.4185541	47.44185541	0	71.16278311	0.094883711	0.094883711	45.70299137	142.3255662	0	118.6046385	142.3255662	0	0	23.7209277	27.77130657	28.46511325	27.92353245	0	28.46511325	9.242180337	0	0	0	28.46511325	0	0	0	23.7209277	0												7.5253	0.035811129	3.239459687	0	1.632949686	0.80379288	0.091960142	3.35284391	9.791438239	0	21.08656302	0.590927167	0	0	11.69514218	9.077136985	0.522057743	0.84701787	0	0.092977611	0.043509266	0	0	0	0.339643616	0	0	0	0.366443916	0	0	0	0	0	0	0	0	0	0	0	71.135	0	3.835716116	7.5253	0.035811129	3.239459687	0	1.632949686	0.80379288	0.091960142	3.35284391	9.791438239	0	21.08656302	0.590927167	0	0	11.69514218	9.077136985	0.522057743	0.84701787	0	0.092977611	0.043509266	0	0	0	0.339643616	0	0	0	0.366443916	0	0	0	0	0	0	0	0	0	0	0	71.135	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.5253	0.035811129	3.239459687	0	1.632949686	0.80379288	0.091960142	3.35284391	9.791438239	0	21.08656302	0.590927167	0	0	11.69514218	9.077136985	0.522057743	0.84701787	0	0.092977611	0.043509266	0	0	0	0.339643616	0	0	0	0.366443916	0	0	0	0	0	0	0	0	0	0	0	71.135
H9001_011_0	2011	7																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S				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	237.695801	1.883535859	1204.536859	0	449.4532015	12.74200498	2.250610179	1312.837363	869.3598185	0	2706.074514	61.26108492	0	0	6901.983197	4495.453676	574.8855558	467.4986348	0	58.65946757	212.7617874	0	0	0	149.473417	0	0	0	107.9998042	0											3400	"$500/Admit for IP Acute, Annual Limit of 3 Admits; PBP 1a"	"$500/Admit for IP Psych, Annual Limit of 3 Admits; PBP 1b"	"$50/Days 1-20 for SNF, $0/Days 21-100; PBP 2"	No Cost Sharing; PBP 6	"$75/Trip for Ambulance, Annual Limit of 4 Trips; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies, No Cost Sharing for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$150/Visit for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$140/Visit for OP diagnostic radiology; no cost sharing for OP X-rays or OP therapeutic radiology; PBP 8b	$150/Visit for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"$25/Visit for Bone Mass Measurement; $25/Visit for Colorectal Screening; $25/Visit for Diabetes Monitoring; $25/Visit for Mammography; $25/Visit for PCP; $25/Visit for Pelvic Exams & Pap Smears; $25/Visit for Prostate Screening; $25/Visit for Nutritional Therapy; No Cost Sharing for Immunizations; No Cost Sharing for Routine Physical Exams; PBP 7a, 14b-j"	"$30/Visit for Chiropractic; $30/Visit for Podiatry; $30/Visit for Physician Specialist; $28/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$30/Visit for Mental Health; $30/Visit for Psychiatric; $30/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$30/Visit for Occupational Therapy; $30/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$30/Visit for Medicare Covered Hearing Exams; $25/Visit for Other Health Care; PBP 7g, 18a-b"	$5-55/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a		"Not Covered; PBP 16a, 16b"	$30/Exam for Non-Medicare Covered Eye Exams; PBP 17a	"No Cost Sharing, One Pair of Glasses/2 Years; PBP 17b"			$25/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											0	500	500	50	0	75	0.1	0.1	48.39576793	150	0	140	150	0	0	25	29.26474494	30	30	0	30	9.740534236	0	0	0	30	0	0	0	25	0											NO	467.2598129	467.2598129	46.72598129	0	70.08897194	0.093451963	0.093451963	45.22679494	140.1779439	0	130.8327476	140.1779439	0	0	23.36299065	27.34847849	28.03558878	28.03558878	0	28.03558878	9.10272041	0	0	0	28.03558878	0	0	0	23.36299065	0												9.2555	0.073341718	4.690263897	0	2.625142735	1.190765373	0.210323938	4.947952185	10.15542265	0	29.503597	0.715621077	0	0	13.43758074	10.24531818	1.343104586	1.092216623	0	0.137046059	0.161392589	0	0	0	0.349214604	0	0	0	0.210266535	0	0	0	0	0	0	0	0	0	0	0	90.344	0	6.108776881	9.2555	0.073341718	4.690263897	0	2.625142735	1.190765373	0.210323938	4.947952185	10.15542265	0	29.503597	0.715621077	0	0	13.43758074	10.24531818	1.343104586	1.092216623	0	0.137046059	0.161392589	0	0	0	0.349214604	0	0	0	0.210266535	0	0	0	0	0	0	0	0	0	0	0	90.344	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.2555	0.073341718	4.690263897	0	2.625142735	1.190765373	0.210323938	4.947952185	10.15542265	0	29.503597	0.715621077	0	0	13.43758074	10.24531818	1.343104586	1.092216623	0	0.137046059	0.161392589	0	0	0	0.349214604	0	0	0	0.210266535	0	0	0	0	0	0	0	0	0	0	0	90.344
H9001_013_0	2011	7																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S				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	189.1298755	0.531724933	723.1673505	0	298.9084115	10.34195787	1.647905582	1056.904023	904.4131428	0	2598.757789	57.75539729	0	0	7107.179749	4573.951014	393.5238505	500.5267378	0	41.65283785	171.5467752	0	0	0	161.2367917	0	0	0	74.83232795	0											3400	"$500/Admit for IP Acute, Annual Limit of 3 Admits; PBP 1a"	"$500/Admit for IP Psych, Annual Limit of 3 Admits; PBP 1b"	"$50/Days 1-20 for SNF, $0/Days 21-100; PBP 2"	No Cost Sharing; PBP 6	"$75/Trip for Ambulance, Annual Limit of 4 Trips; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies, No Cost Sharing for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$150/Visit for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$125/Visit for OP diagnostic radiology; no cost sharing for OP X-rays or OP therapeutic radiology; PBP 8b	$150/Visit for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"$25/Visit for Bone Mass Measurement; $25/Visit for Colorectal Screening; $25/Visit for Diabetes Monitoring; $25/Visit for Mammography; $25/Visit for PCP; $25/Visit for Pelvic Exams & Pap Smears; $25/Visit for Prostate Screening; $25/Visit for Nutritional Therapy; No Cost Sharing for Immunizations; No Cost Sharing for Routine Physical Exams; PBP 7a, 14b-j"	"$30/Visit for Chiropractic; $30/Visit for Podiatry; $30/Visit for Physician Specialist; $28/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$30/Visit for Mental Health; $30/Visit for Psychiatric; $30/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$30/Visit for Occupational Therapy; $30/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$30/Visit for Medicare Covered Hearing Exams; $25/Visit for Other Health Care; PBP 7g, 18a-b"	$3-50/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a		"Not Covered; PBP 16a, 16b"	$30/Exam for Non-Medicare Covered Eye Exams; PBP 17a	"No Cost Sharing, One Pair of Glasses/2 Years; PBP 17b"			$25/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											0	500	500	50	0	75	0.1	0.1	47.8388544	150	0	125	150	0	0	25	29.26396282	30	30	0	30	9.740534236	0	0	0	30	0	0	0	25	0											NO	469.8313308	469.8313308	46.98313308	0	70.47469963	0.093966266	0.093966266	44.95238526	140.9493993	0	117.4578327	140.9493993	0	0	23.49156654	27.4982532	28.18987985	28.18987985	0	28.18987985	9.152816327	0	0	0	28.18987985	0	0	0	23.49156654	0												7.4049	0.020818419	2.831388989	0	1.75545671	0.971795166	0.154847535	3.959196401	10.62304076	0	25.43703814	0.678382379	0	0	13.91323217	10.48130526	0.924449172	1.175815717	0	0.097849041	0.130844677	0	0	0	0.378770482	0	0	0	0.146494051	0	0	0	0	0	0	0	0	0	0	0	81.0857	0	5.206647775	7.4049	0.020818419	2.831388989	0	1.75545671	0.971795166	0.154847535	3.959196401	10.62304076	0	25.43703814	0.678382379	0	0	13.91323217	10.48130526	0.924449172	1.175815717	0	0.097849041	0.130844677	0	0	0	0.378770482	0	0	0	0.146494051	0	0	0	0	0	0	0	0	0	0	0	81.0857	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.4049	0.020818419	2.831388989	0	1.75545671	0.971795166	0.154847535	3.959196401	10.62304076	0	25.43703814	0.678382379	0	0	13.91323217	10.48130526	0.924449172	1.175815717	0	0.097849041	0.130844677	0	0	0	0.378770482	0	0	0	0.146494051	0	0	0	0	0	0	0	0	0	0	0	81.0857
H9001_015_0	2011	6																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S			V	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	263.5565021	0.503178136	1758.477868	0	509.6035348	15.16419352	2.229750005	1275.762467	961.6633169	0	2927.408104	64.14804501	0	0	7762.575496	5103.658138	397.3508046	466.0572969	0	54.71122456	232.9412238	0	0	1205.071332	177.7087301	0	0	0	52.37050353	0											3400	"$400/Admit for IP Acute, Annual Limit of 3 Admits; PBP 1a"	"$400/Admit for IP Psych, Annual Limit of 3 Admits; PBP 1b"	"$35/Days 1-20 for SNF, $0/Days 21-100; PBP 2"	No Cost Sharing; PBP 6	"$75/Trip for Ambulance, Annual Limit of 4 Trips; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies, No Cost Sharing for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$50/Visit for ER; $15/Visit for Urgent Care; PBP 4a, 4b"	$125/Visit for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$100/Visit for OP diagnostic radiology; no cost sharing for OP X-rays or OP therapeutic radiology; PBP 8b	$125/Visit for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"$15/Visit for Bone Mass Measurement; $15/Visit for Colorectal Screening; $15/Visit for Diabetes Monitoring; $15/Visit for Mammography; $15/Visit for PCP; $15/Visit for Pelvic Exams & Pap Smears; $15/Visit for Prostate Screening; $15/Visit for Nutritional Therapy; No Cost Sharing for Immunizations; No Cost Sharing for Routine Physical Exams; PBP 7a, 14b-j"	"$25/Visit for Chiropractic; $25/Visit for Podiatry; $25/Visit for Physician Specialist; $20/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$25/Visit for Mental Health; $25/Visit for Psychiatric; $25/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$25/Visit for Occupational Therapy; $25/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$25/Visit for Medicare Covered Hearing Exams; $15/Visit for Other Health Care; PBP 7g, 18a-b"	$3-50/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a		"$29/Procedure for Non-Medicare Covered Comprehensive Dental Services; $25/Visit for Non-Medicare Covered Preventive Dental Services; PBP 16a, 16b"	$25/Exam for Non-Medicare Covered Eye Exams; PBP 17a	"No Cost Sharing, One Pair of Glasses/2 Years; PBP 17b"			$15/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											0	400	400	35	0	75	0.1	0.1	47.6564467	125	0	100	125	0	0	15	23.50639202	25	25	0	25	9.322423652	0	0	25.84799667	25	0	0	0	15	0											NO	376.6345011	376.6345011	32.95551885	0	70.61896896	0.094158625	0.094158625	44.87265507	117.6982816	0	94.15862528	117.6982816	0	0	14.12379379	22.13329558	23.53965632	23.53965632	0	23.53965632	8.777865954	0	0	24.33811833	23.53965632	0	0	0	14.12379379	0												8.272	0.015792854	4.829295878	0	2.998973018	1.427839615	0.209950195	4.770570762	9.432176656	0	22.97006023	0.629176222	0	0	9.136417967	9.413397844	0.779458448	0.914235716	0	0.107323619	0.170393903	0	0	2.444097389	0.348600203	0	0	0	0.061639183	0	0	0	0	0	0	0	0	0	0	0	78.9314	0	4.896716692	8.272	0.015792854	4.829295878	0	2.998973018	1.427839615	0.209950195	4.770570762	9.432176656	0	22.97006023	0.629176222	0	0	9.136417967	9.413397844	0.779458448	0.914235716	0	0.107323619	0.170393903	0	0	2.444097389	0.348600203	0	0	0	0.061639183	0	0	0	0	0	0	0	0	0	0	0	78.9314	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.272	0.015792854	4.829295878	0	2.998973018	1.427839615	0.209950195	4.770570762	9.432176656	0	22.97006023	0.629176222	0	0	9.136417967	9.413397844	0.779458448	0.914235716	0	0.107323619	0.170393903	0	0	2.444097389	0.348600203	0	0	0	0.061639183	0	0	0	0	0	0	0	0	0	0	0	78.9314
H9001_017_0	2011	6																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S			V	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	280.160595	0.145268651	2333.658666	0	663.7259774	17.54493833	2.085692222	1542.620463	951.5910309	0	3149.860707	70.57590179	0	0	8064.001802	5586.248785	492.530513	583.5413761	0	58.7508411	263.4812717	0	0	1373.665574	179.586247	0	0	0	48.5994722	0											3400	"$150/Admit for IP Acute, Annual Limit of 2 Admits; PBP 1a"	"$150/Admit for IP Psych, Annual Limit of 2 Admits; PBP 1b"	"$20/Days 1-20 for SNF, $0/Days 21-100; PBP 2"	No Cost Sharing; PBP 6	"$50/Trip for Ambulance, Annual Limit of 4 Trips; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies, No Cost Sharing for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$50/Visit for ER; $10/Visit for Urgent Care; PBP 4a, 4b"	$50/Visit for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$75/Visit for OP diagnostic radiology; no cost sharing for OP X-rays or OP therapeutic radiology; PBP 8b	$50/Visit for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"$10/Visit for Bone Mass Measurement; $10/Visit for Colorectal Screening; $10/Visit for Diabetes Monitoring; $10/Visit for Mammography; $10/Visit for PCP; $10/Visit for Pelvic Exams & Pap Smears; $10/Visit for Prostate Screening; $10/Visit for Nutritional Therapy; No Cost Sharing for Immunizations; No Cost Sharing for Routine Physical Exams; PBP 7a, 14b-j"	"$15/Visit for Chiropractic; $15/Visit for Podiatry; $15/Visit for Physician Specialist; $13/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$15/Visit for Mental Health; $15/Visit for Psychiatric; $15/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$15/Visit for Occupational Therapy; $15/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$15/Visit for Medicare Covered Hearing Exams; $10/Visit for Other Health Care; PBP 7g, 18a-b"	$3-50/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a		"$29/Procedure for Non-Medicare Covered Comprehensive Dental Services; $25/Visit for Non-Medicare Covered Preventive Dental Services; PBP 16a, 16b"	$15/Exam for Non-Medicare Covered Eye Exams; PBP 17a	"No Cost Sharing, One Pair of Glasses/2 Years; PBP 17b"			$10/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											0	150	150	20	0	50	0.1	0.1	47.03899188	50	0	75	50	0	0	10	14.25536009	15	14.97237652	0	15	9.853551575	0	0	25.84799667	15	0	0	0	10	0											NO	144.2735364	144.2735364	19.23647152	0	48.0911788	0.096182358	0.096182358	45.24321138	48.0911788	0	72.1367682	48.0911788	0	0	9.61823576	13.71114142	14.42735364	14.40078472	0	14.42735364	9.477378212	0	0	24.86121259	14.42735364	0	0	0	9.61823576	0												3.3683	0.001746535	3.740946538	0	2.659947054	1.687513532	0.200606795	5.816091975	3.813594534	0	18.9350643	0.282839859	0	0	6.463455875	6.382820592	0.592159324	0.700287811	0	0.07063493	0.208092639	0	0	2.845915988	0.215912858	0	0	0	0.038953432	0	0	0	0	0	0	0	0	0	0	0	58.0249	0	2.303107515	3.3683	0.001746535	3.740946538	0	2.659947054	1.687513532	0.200606795	5.816091975	3.813594534	0	18.9350643	0.282839859	0	0	6.463455875	6.382820592	0.592159324	0.700287811	0	0.07063493	0.208092639	0	0	2.845915988	0.215912858	0	0	0	0.038953432	0	0	0	0	0	0	0	0	0	0	0	58.0249	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	3.3683	0.001746535	3.740946538	0	2.659947054	1.687513532	0.200606795	5.816091975	3.813594534	0	18.9350643	0.282839859	0	0	6.463455875	6.382820592	0.592159324	0.700287811	0	0.07063493	0.208092639	0	0	2.845915988	0.215912858	0	0	0	0.038953432	0	0	0	0	0	0	0	0	0	0	0	58.0249
H9001_019_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	500.1098433	20.42884007	429.0386535	0	68.11618752	36.81862445	17.63059218	52.97564166	47.20083341	49.86546301	49.31965109	49.49826855	12.42780212	38.54417549	53.27879112	53.95719329	7.8193184	3.916633118	0	39.06355048	30.75660489	20.68618149	0	0	0	0	0	0	0	0											3400	7% Coinsurance for IP Acute; PBP 1a	7% Coinsurance for IP Psych; PBP 1b	15% Coinsurance for SNF; PBP 2	No Cost Sharing; PBP 6	"23% Coinsurance for Ambulance; PBP 10a, 10b"	23% Coinsurance for DME; PBP 11a	"23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics / Medical Supplies; PBP 11b, 11c"	"23% Coinsurance for ER; 23% Coinsurance for Urgent Care; PBP 4a, 4b"	23% Coinsurance for ASC Services; PBP 9b	23% Coinsurance for OP C/D/T; PBP 8a	23% Coinsurance for OP X-Ray; PBP 8b	23% Coinsurance for OP Hospital; PBP 9a	23% Coinsurance for Renal Dialysis; PBP 12	"23% Coinsurance for Cardiac Rehab; 23% Coinsurance for CORF; PBP 3, 5, 9d"	"23% Coinsurance for Bone Mass Measurement; 23% Coinsurance for Colorectal Screening; 23% Coinsurance for Diabetes Monitoring; 23% Coinsurance for Immunizations; 23% Coinsurance for Mammography; 23% Coinsurance for Pap Smears; 23% Coinsurance for PCP; 23% Coinsurance for Pelvic Exams & Pap Smears; 23% Coinsurance for Prostate Screening; 23% Coinsurance for Routine Physical Exams; 23% Coinsurance for Nutritional Therapy; PBP 7a, 14b-j"	"23% Coinsurance for Chiropractic; 23% Coinsurance for Podiatry; 23% Coinsurance for Physician Specialist; 23% Coinsurance for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"23% Coinsurance for Mental Health; 23% Coinsurance for Psychiatric; 23% Coinsurance for OP Substance Abuse; PBP 7e, 7h, 9c"	"23% Coinsurance for Occupational Therapy; 23% Coinsurance for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"23% Coinsurance for Medicare Covered Hearing Exams; 23% Coinsurance for Other Health Care; PBP 7g, 18a-b"	23% Coinsurance for Part B Drugs; PBP 15	23% Coinsurance for Blood; PBP 13a		"PBP 16a, 16b"	PBP 17a	PBP 17b			PBP 14a	PBP 13b											0	0.067402283	0.067402283	0.149796681	0	0.233	0.233	0.233	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											NO	0.067402283	0.067402283	0.149796681	0	0.233	0.233	0.233	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												33.7085	1.376950454	64.26856629	0	15.87107169	8.578739497	4.107927977	12.34332451	10.99779418	11.61865288	11.4914787	11.53309657	2.895677893	8.98079289	12.41395833	12.57202604	1.821901187	0.912575517	0	9.101807261	7.166288939	4.819880287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	246.5811	0	0	33.7085	1.376950454	64.26856629	0	15.87107169	8.578739497	4.107927977	12.34332451	10.99779418	11.61865288	11.4914787	11.53309657	2.895677893	8.98079289	12.41395833	12.57202604	1.821901187	0.912575517	0	9.101807261	7.166288939	4.819880287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	246.5811	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	33.7085	1.376950454	64.26856629	0	15.87107169	8.578739497	4.107927977	12.34332451	10.99779418	11.61865288	11.4914787	11.53309657	2.895677893	8.98079289	12.41395833	12.57202604	1.821901187	0.912575517	0	9.101807261	7.166288939	4.819880287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	246.5811
H9001_020_0	2011	6																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S				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	197.6344887	1.566084235	1001.523903	0	441.1814737	12.4997695	2.20782432	1226.412586	812.1294025	0	2527.9322	57.22823535	0	0	6774.959235	4412.719437	564.3053735	458.8947992	0	57.5798999	208.8461237	0	0	0	146.7225112	0	0	0	106.012178	0											3400	"$500/Admit for IP Acute, Annual Limit of 3 Admits; PBP 1a"	"$500/Admit for IP Psych, Annual Limit of 3 Admits; PBP 1b"	"$50/Days 1-20 for SNF, $0/Days 21-100; PBP 2"	No Cost Sharing; PBP 6	"$75/Trip for Ambulance, Annual Limit of 4 Trips; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies, No Cost Sharing for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$150/Visit for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$140/Visit for OP diagnostic radiology; no cost sharing for OP X-rays or OP therapeutic radiology; PBP 8b	$150/Visit for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"$25/Visit for Bone Mass Measurement; $25/Visit for Colorectal Screening; $25/Visit for Diabetes Monitoring; $25/Visit for Mammography; $25/Visit for PCP; $25/Visit for Pelvic Exams & Pap Smears; $25/Visit for Prostate Screening; $25/Visit for Nutritional Therapy; No Cost Sharing for Immunizations; No Cost Sharing for Routine Physical Exams; PBP 7a, 14b-j"	"$30/Visit for Chiropractic; $30/Visit for Podiatry; $30/Visit for Physician Specialist; $28/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$30/Visit for Mental Health; $30/Visit for Psychiatric; $30/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$30/Visit for Occupational Therapy; $30/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$30/Visit for Medicare Covered Hearing Exams; $25/Visit for Other Health Care; PBP 7g, 18a-b"	$5-50/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a		"Not Covered; PBP 16a, 16b"	$30/Exam for Non-Medicare Covered Eye Exams; PBP 17a	"No Cost Sharing, One Pair of Glasses/2 Years; PBP 17b"			$25/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											0	500	500	50	0	75	0.1	0.1	48.39576793	150	0	140	150	0	0	25	29.26474494	30	30	0	30	9.740534236	0	0	0	30	0	0	0	25	0											NO	469.4974479	469.4974479	46.94974479	0	70.42461719	0.09389949	0.09389949	45.44337906	140.8492344	0	131.4592854	140.8492344	0	0	23.4748724	27.47944612	28.16984687	28.16984687	0	28.16984687	9.14631193	0	0	0	28.16984687	0	0	0	23.4748724	0												7.7324	0.061272713	3.918440971	0	2.589169699	1.173721976	0.207313577	4.644361004	9.532317047	0	27.69334672	0.671712761	0	0	13.25344196	10.10492383	1.324699664	1.077249685	0	0.13516808	0.159180983	0	0	0	0.344429223	0	0	0	0.207385196	0	0	0	0	0	0	0	0	0	0	0	84.8305	0	5.318543429	7.7324	0.061272713	3.918440971	0	2.589169699	1.173721976	0.207313577	4.644361004	9.532317047	0	27.69334672	0.671712761	0	0	13.25344196	10.10492383	1.324699664	1.077249685	0	0.13516808	0.159180983	0	0	0	0.344429223	0	0	0	0.207385196	0	0	0	0	0	0	0	0	0	0	0	84.8305	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.7324	0.061272713	3.918440971	0	2.589169699	1.173721976	0.207313577	4.644361004	9.532317047	0	27.69334672	0.671712761	0	0	13.25344196	10.10492383	1.324699664	1.077249685	0	0.13516808	0.159180983	0	0	0	0.344429223	0	0	0	0.207385196	0	0	0	0	0	0	0	0	0	0	0	84.8305
H9001_021_0	2011	6																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S				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	158.7567631	0.446333129	607.0310544	0	296.5252608	10.25434149	1.633944635	996.7634294	852.9496778	0	2450.881698	54.46896466	0	0	7050.5153	4537.483607	390.3863455	496.5361153	0	41.32074619	170.1790592	0	0	0	159.9512756	0	0	0	74.23570134	0											3400	"$500/Admit for IP Acute, Annual Limit of 3 Admits; PBP 1a"	"$500/Admit for IP Psych, Annual Limit of 3 Admits; PBP 1b"	"$50/Days 1-20 for SNF, $0/Days 21-100; PBP 2"	No Cost Sharing; PBP 6	"$75/Trip for Ambulance, Annual Limit of 4 Trips; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies, No Cost Sharing for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$150/Visit for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$125/Visit for OP diagnostic radiology; no cost sharing for OP X-rays or OP therapeutic radiology; PBP 8b	$150/Visit for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"$25/Visit for Bone Mass Measurement; $25/Visit for Colorectal Screening; $25/Visit for Diabetes Monitoring; $25/Visit for Mammography; $25/Visit for PCP; $25/Visit for Pelvic Exams & Pap Smears; $25/Visit for Prostate Screening; $25/Visit for Nutritional Therapy; No Cost Sharing for Immunizations; No Cost Sharing for Routine Physical Exams; PBP 7a, 14b-j"	"$30/Visit for Chiropractic; $30/Visit for Podiatry; $30/Visit for Physician Specialist; $28/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$30/Visit for Mental Health; $30/Visit for Psychiatric; $30/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$30/Visit for Occupational Therapy; $30/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$30/Visit for Medicare Covered Hearing Exams; $25/Visit for Other Health Care; PBP 7g, 18a-b"	$3-50/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a		"Not Covered; PBP 16a, 16b"	$30/Exam for Non-Medicare Covered Eye Exams; PBP 17a	"No Cost Sharing, One Pair of Glasses/2 Years; PBP 17b"			$25/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											0	500	500	50	0	75	0.1	0.1	47.8388544	150	0	125	150	0	0	25	29.26396282	30	30	0	30	9.740534236	0	0	0	30	0	0	0	25	0											NO	471.6204017	471.6204017	47.16204017	0	70.74306025	0.09432408	0.09432408	45.12355946	141.4861205	0	117.9051004	141.4861205	0	0	23.58102008	27.6029638	28.2972241	28.2972241	0	28.2972241	9.187669338	0	0	0	28.2972241	0	0	0	23.58102008	0												6.2394	0.017541651	2.385735248	0	1.748092033	0.967231331	0.154120325	3.748126156	10.05671174	0	24.0809544	0.642216875	0	0	13.85486191	10.43733298	0.920570825	1.170882811	0	0.097438535	0.130295744	0	0	0	0.377181424	0	0	0	0.145879464	0	0	0	0	0	0	0	0	0	0	0	77.1746	0	4.643954523	6.2394	0.017541651	2.385735248	0	1.748092033	0.967231331	0.154120325	3.748126156	10.05671174	0	24.0809544	0.642216875	0	0	13.85486191	10.43733298	0.920570825	1.170882811	0	0.097438535	0.130295744	0	0	0	0.377181424	0	0	0	0.145879464	0	0	0	0	0	0	0	0	0	0	0	77.1746	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.2394	0.017541651	2.385735248	0	1.748092033	0.967231331	0.154120325	3.748126156	10.05671174	0	24.0809544	0.642216875	0	0	13.85486191	10.43733298	0.920570825	1.170882811	0	0.097438535	0.130295744	0	0	0	0.377181424	0	0	0	0.145879464	0	0	0	0	0	0	0	0	0	0	0	77.1746
H9001_022_0	2011	5																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S			V	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	218.0022416	2.726279501	1503.083719	0	470.7226379	12.79470021	1.925465787	1159.966904	920.4955881	0	2621.306875	62.09144047	0	0	6507.645661	4774.190958	143.0402974	403.0468657	0	36.4505842	75.5195365	0	0	1120.572769	158.0988197	0	0	0	116.1632989	0											3400	"$400/Admit for IP Acute, Annual Limit of 3 Admits; PBP 1a"	"$400/Admit for IP Psych, Annual Limit of 3 Admits; PBP 1b"	"$35/Days 1-20 for SNF, $0/Days 21-100; PBP 2"	No Cost Sharing; PBP 6	"$75/Trip for Ambulance, Annual Limit of 4 Trips; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies, No Cost Sharing for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$50/Visit for ER; $15/Visit for Urgent Care; PBP 4a, 4b"	$125/Visit for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$100/Visit for OP diagnostic radiology; no cost sharing for OP X-rays or OP therapeutic radiology; PBP 8b	$125/Visit for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"$15/Visit for Bone Mass Measurement; $15/Visit for Colorectal Screening; $15/Visit for Diabetes Monitoring; $15/Visit for Mammography; $15/Visit for PCP; $15/Visit for Pelvic Exams & Pap Smears; $15/Visit for Prostate Screening; $15/Visit for Nutritional Therapy; No Cost Sharing for Immunizations; No Cost Sharing for Routine Physical Exams; PBP 7a, 14b-j"	"$25/Visit for Chiropractic; $25/Visit for Podiatry; $25/Visit for Physician Specialist; $20/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$25/Visit for Mental Health; $25/Visit for Psychiatric; $25/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$25/Visit for Occupational Therapy; $25/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$25/Visit for Medicare Covered Hearing Exams; $15/Visit for Other Health Care; PBP 7g, 18a-b"	$5-50/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a		"$29/Procedure for Non-Medicare Covered Comprehensive Dental Services; $25/Visit for Non-Medicare Covered Preventive Dental Services; PBP 16a, 16b"	$25/Exam for Non-Medicare Covered Eye Exams; PBP 17a	"No Cost Sharing, One Pair of Glasses/2 Years; PBP 17b"			$15/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											0	400	400	35	0	75	0.1	0.1	47.7971702	125	0	100	125	0	0	15	23.63462194	25	24.37130142	0	25	4.661211826	0	0	25.84799667	25	0	0	0	15	0											NO	379.6913981	379.6913981	33.22299733	0	71.19213714	0.09492285	0.09492285	45.37043594	118.6535619	0	94.92284951	118.6535619	0	0	14.23842743	22.43465662	23.73071238	23.13393377	0	23.73071238	4.424555087	0	0	24.53565498	23.73071238	0	0	0	14.23842743	0												6.8978	0.086262073	4.161412199	0	2.792645882	1.214509403	0.182770699	4.385683675	9.101673353	0	20.73515984	0.613947548	0	0	7.721553372	8.925611231	0.28287068	0.777004958	0	0.072083194	0.027845029	0	0	2.291165571	0.312649801	0	0	0	0.137831892	0	0	0	0	0	0	0	0	0	0	0	70.7205	0	3.782635193	6.8978	0.086262073	4.161412199	0	2.792645882	1.214509403	0.182770699	4.385683675	9.101673353	0	20.73515984	0.613947548	0	0	7.721553372	8.925611231	0.28287068	0.777004958	0	0.072083194	0.027845029	0	0	2.291165571	0.312649801	0	0	0	0.137831892	0	0	0	0	0	0	0	0	0	0	0	70.7205	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.8978	0.086262073	4.161412199	0	2.792645882	1.214509403	0.182770699	4.385683675	9.101673353	0	20.73515984	0.613947548	0	0	7.721553372	8.925611231	0.28287068	0.777004958	0	0.072083194	0.027845029	0	0	2.291165571	0.312649801	0	0	0	0.137831892	0	0	0	0	0	0	0	0	0	0	0	70.7205
H9001_024_0	2011	6																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S			V	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	221.1014586	0.422123601	1475.213165	0	504.4649932	15.00839967	2.206842006	1202.464156	906.4114195	0	2759.215297	60.46245033	0	0	7684.30226	5052.195857	393.3441533	461.3578498	0	54.15954882	230.5923817	0	0	1192.920103	175.91682	0	0	0	51.84243024	0											3400	"$400/Admit for IP Acute, Annual Limit of 3 Admits; PBP 1a"	"$400/Admit for IP Psych, Annual Limit of 3 Admits; PBP 1b"	"$35/Days 1-20 for SNF, $0/Days 21-100; PBP 2"	No Cost Sharing; PBP 6	"$75/Trip for Ambulance, Annual Limit of 4 Trips; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies, No Cost Sharing for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$50/Visit for ER; $15/Visit for Urgent Care; PBP 4a, 4b"	$125/Visit for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$100/Visit for OP diagnostic radiology; no cost sharing for OP X-rays or OP therapeutic radiology; PBP 8b	$125/Visit for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"$15/Visit for Bone Mass Measurement; $15/Visit for Colorectal Screening; $15/Visit for Diabetes Monitoring; $15/Visit for Mammography; $15/Visit for PCP; $15/Visit for Pelvic Exams & Pap Smears; $15/Visit for Prostate Screening; $15/Visit for Nutritional Therapy; No Cost Sharing for Immunizations; No Cost Sharing for Routine Physical Exams; PBP 7a, 14b-j"	"$25/Visit for Chiropractic; $25/Visit for Podiatry; $25/Visit for Physician Specialist; $20/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$25/Visit for Mental Health; $25/Visit for Psychiatric; $25/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$25/Visit for Occupational Therapy; $25/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$25/Visit for Medicare Covered Hearing Exams; $15/Visit for Other Health Care; PBP 7g, 18a-b"	$3-50/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a		"$29/Procedure for Non-Medicare Covered Comprehensive Dental Services; $25/Visit for Non-Medicare Covered Preventive Dental Services; PBP 16a, 16b"	$25/Exam for Non-Medicare Covered Eye Exams; PBP 17a	"No Cost Sharing, One Pair of Glasses/2 Years; PBP 17b"			$15/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											0	400	400	35	0	75	0.1	0.1	47.6564467	125	0	100	125	0	0	15	23.50639202	25	25	0	25	9.322423652	0	0	25.84799667	25	0	0	0	15	0											NO	378.2693161	378.2693161	33.09856516	0	70.92549678	0.094567329	0.094567329	45.06742876	118.2091613	0	94.56732904	118.2091613	0	0	14.18509936	22.22936709	23.64183226	23.64183226	0	23.64183226	8.815967049	0	0	24.44376006	23.64183226	0	0	0	14.18509936	0												6.9697	0.013306367	4.068953255	0	2.981619187	1.41930427	0.208695154	4.515997307	8.928844474	0	21.74430174	0.595601295	0	0	9.083549253	9.358926361	0.774948041	0.908945408	0	0.106702581	0.169407903	0	0	2.429954398	0.346582996	0	0	0	0.061282502	0	0	0	0	0	0	0	0	0	0	0	74.6866	0	4.290568656	6.9697	0.013306367	4.068953255	0	2.981619187	1.41930427	0.208695154	4.515997307	8.928844474	0	21.74430174	0.595601295	0	0	9.083549253	9.358926361	0.774948041	0.908945408	0	0.106702581	0.169407903	0	0	2.429954398	0.346582996	0	0	0	0.061282502	0	0	0	0	0	0	0	0	0	0	0	74.6866	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.9697	0.013306367	4.068953255	0	2.981619187	1.41930427	0.208695154	4.515997307	8.928844474	0	21.74430174	0.595601295	0	0	9.083549253	9.358926361	0.774948041	0.908945408	0	0.106702581	0.169407903	0	0	2.429954398	0.346582996	0	0	0	0.061282502	0	0	0	0	0	0	0	0	0	0	0	74.6866
H9001_025_0	2011	6																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S			V	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	233.6029729	0.12112763	1945.846817	0	654.4782121	17.29878656	2.056430402	1445.156393	891.4687016	0	2950.849833	66.11685639	0	0	7951.645199	5508.414981	485.6680325	575.4108315	0	57.93225933	259.8101588	0	0	1354.526144	177.0840526	0	0	0	47.92233053	0											3400	"$150/Admit for IP Acute, Annual Limit of 2 Admits; PBP 1a"	"$150/Admit for IP Psych, Annual Limit of 2 Admits; PBP 1b"	"$20/Days 1-20 for SNF, $0/Days 21-100; PBP 2"	No Cost Sharing; PBP 6	"$50/Trip for Ambulance, Annual Limit of 4 Trips; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies, No Cost Sharing for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$50/Visit for ER; $10/Visit for Urgent Care; PBP 4a, 4b"	$50/Visit for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$75/Visit for OP diagnostic radiology; no cost sharing for OP X-rays or OP therapeutic radiology; PBP 8b	$50/Visit for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"$10/Visit for Bone Mass Measurement; $10/Visit for Colorectal Screening; $10/Visit for Diabetes Monitoring; $10/Visit for Mammography; $10/Visit for PCP; $10/Visit for Pelvic Exams & Pap Smears; $10/Visit for Prostate Screening; $10/Visit for Nutritional Therapy; No Cost Sharing for Immunizations; No Cost Sharing for Routine Physical Exams; PBP 7a, 14b-j"	"$15/Visit for Chiropractic; $15/Visit for Podiatry; $15/Visit for Physician Specialist; $13/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$15/Visit for Mental Health; $15/Visit for Psychiatric; $15/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$15/Visit for Occupational Therapy; $15/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$15/Visit for Medicare Covered Hearing Exams; $10/Visit for Other Health Care; PBP 7g, 18a-b"	$3-50/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a		"$29/Procedure for Non-Medicare Covered Comprehensive Dental Services; $25/Visit for Non-Medicare Covered Preventive Dental Services; PBP 16a, 16b"	$15/Exam for Non-Medicare Covered Eye Exams; PBP 17a	"No Cost Sharing, One Pair of Glasses/2 Years; PBP 17b"			$10/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											0	150	150	20	0	50	0.1	0.1	47.03899188	50	0	75	50	0	0	10	14.25536009	15	14.91780001	0	15	9.853551575	0	0	25.84799667	15	0	0	0	10	0											NO	144.764418	144.764418	19.3019224	0	48.254806	0.096509612	0.096509612	45.39714856	48.254806	0	72.382209	48.254806	0	0	9.650961201	13.75779272	14.4764418	14.39711091	0	14.4764418	9.509624394	0	0	24.9458013	14.4764418	0	0	0	9.650961201	0												2.8181	0.001461248	3.129882022	0	2.63180993	1.669499179	0.1984653	5.467164953	3.584804104	0	17.79908578	0.26587134	0	0	6.395084941	6.315302626	0.585895417	0.690354463	0	0.069887748	0.205891419	0	0	2.81581167	0.213628915	0	0	0	0.038541379	0	0	0	0	0	0	0	0	0	0	0	54.8966	0	1.985401105	2.8181	0.001461248	3.129882022	0	2.63180993	1.669499179	0.1984653	5.467164953	3.584804104	0	17.79908578	0.26587134	0	0	6.395084941	6.315302626	0.585895417	0.690354463	0	0.069887748	0.205891419	0	0	2.81581167	0.213628915	0	0	0	0.038541379	0	0	0	0	0	0	0	0	0	0	0	54.8966	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.8181	0.001461248	3.129882022	0	2.63180993	1.669499179	0.1984653	5.467164953	3.584804104	0	17.79908578	0.26587134	0	0	6.395084941	6.315302626	0.585895417	0.690354463	0	0.069887748	0.205891419	0	0	2.81581167	0.213628915	0	0	0	0.038541379	0	0	0	0	0	0	0	0	0	0	0	54.8966
H9001_026_0	2011	5																															A	A	D		T	Coin	Coin	V	V		V	V			V	V	V	V		V	S				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	160.7796128	0.824966415	705.7182592	0	317.9052119	9.935072421	1.581444823	973.0300894	771.1093616	0	2234.443328	50.41396856	0	0	6283.843439	4081.396914	387.4061034	427.2485094	0	43.23311575	150.0889292	0	0	0	142.0133282	0	0	0	99.4302352	0											3400	"$500/Admit for IP Acute, Annual Limit of 3 Admits; PBP 1a"	"$500/Admit for IP Psych, Annual Limit of 3 Admits; PBP 1b"	"$50/Days 1-20 for SNF, $0/Days 21-100; PBP 2"	No Cost Sharing; PBP 6	"$75/Trip for Ambulance, Annual Limit of 4 Trips; PBP 10a, 10b"	10% Coinsurance for DME; PBP 11a	"10% Coinsurance for Prosthetics / Medical Supplies, No Cost Sharing for Diabetes Monitoring Supplies; PBP 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$150/Visit for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$125/Visit for OP diagnostic radiology; no cost sharing for OP X-rays or OP therapeutic radiology; PBP 8b	$150/Visit for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"$25/Visit for Bone Mass Measurement; $25/Visit for Colorectal Screening; $25/Visit for Diabetes Monitoring; $25/Visit for Mammography; $25/Visit for PCP; $25/Visit for Pelvic Exams & Pap Smears; $25/Visit for Prostate Screening; $25/Visit for Nutritional Therapy; No Cost Sharing for Immunizations; No Cost Sharing for Routine Physical Exams; PBP 7a, 14b-j"	"$30/Visit for Chiropractic; $30/Visit for Podiatry; $30/Visit for Physician Specialist; $28/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$30/Visit for Mental Health; $30/Visit for Psychiatric; $30/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$30/Visit for Occupational Therapy; $30/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$30/Visit for Medicare Covered Hearing Exams; $25/Visit for Other Health Care; PBP 7g, 18a-b"	$5-50/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a		"Not Covered; PBP 16a, 16b"	$30/Exam for Non-Medicare Covered Eye Exams; PBP 17a	"No Cost Sharing, One Pair of Glasses/2 Years; PBP 17b"			$25/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											0	500	500	50	0	75	0.1	0.1	48.10977785	150	0	125	150	0	0	25	29.26507118	30	30	0	30	9.740534236	0	0	0	30	0	0	0	25	0											NO	473.9430052	473.9430052	47.39430052	0	71.09145078	0.094788601	0.094788601	45.60258539	142.1829016	0	118.4857513	142.1829016	0	0	23.69715026	27.73995157	28.43658031	28.43658031	0	28.43658031	9.232916137	0	0	0	28.43658031	0	0	0	23.69715026	0												6.35	0.032582255	2.787251938	0	1.883361894	0.941731616	0.149902942	3.697723978	9.136547205	0	22.06247471	0.597333694	0	0	12.40909852	9.434812727	0.918042064	1.012457212	0	0.102450164	0.115479875	0	0	0	0.336531118	0	0	0	0.196351102	0	0	0	0	0	0	0	0	0	0	0	72.1642	0	3.967526109	6.35	0.032582255	2.787251938	0	1.883361894	0.941731616	0.149902942	3.697723978	9.136547205	0	22.06247471	0.597333694	0	0	12.40909852	9.434812727	0.918042064	1.012457212	0	0.102450164	0.115479875	0	0	0	0.336531118	0	0	0	0.196351102	0	0	0	0	0	0	0	0	0	0	0	72.1642	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.35	0.032582255	2.787251938	0	1.883361894	0.941731616	0.149902942	3.697723978	9.136547205	0	22.06247471	0.597333694	0	0	12.40909852	9.434812727	0.918042064	1.012457212	0	0.102450164	0.115479875	0	0	0	0.336531118	0	0	0	0.196351102	0	0	0	0	0	0	0	0	0	0	0	72.1642
H9001_801_0	2011	3																															A	A	D		T			V	V		V	V			V	V	V	V		V	S				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	244.6681658	0.07584078	1559.813491	0	584.1129378	0	0	1148.095866	922.2549131	0	2850.907631	49.89380194	0	0	7316.694944	5130.129368	342.6212997	615.7474974	0	61.72133971	211.0665778	0	0	0	133.6806929	0	0	0	186.3448837	0											3400	$450/Admit for IP Acute; PBP 1a	$450/Admit for IP Psych; PBP 1b	$100/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$50/Trip for Ambulance; PBP 10a, 10b"	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$225/Visit for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$75/Visit for OP X-Ray; PBP 8b	$225/Visit for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"$25/Visit for Bone Mass Measurement; $25/Visit for Colorectal Screening; $25/Visit for Diabetes Monitoring; $25/Visit for Mammography; $25/Visit for PCP; $25/Visit for Pelvic Exams & Pap Smears; $25/Visit for Prostate Screening; $25/Visit for Nutritional Therapy; PBP 7a, 14b-j"	"$35/Visit for Chiropractic; $35/Visit for Podiatry; $35/Visit for Physician Specialist; $30/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$35/Visit for Mental Health; $35/Visit for Psychiatric; $35/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$35/Visit for Occupational Therapy; $35/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$35/Visit for Medicare Covered Hearing Exams; $25/Visit for Other Health Care; PBP 7g, 18a-b"	$10-50/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a		"PBP 16a, 16b"	$35/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			$25/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											0	450	450	100	0	50	0	0	47.74011793	225	0	75	225	0	0	25	33.5573371	35	34.6461465	0	35	12.13324943	0	0	0	35	0	0	0	25	0											NO	418.7087915	418.7087915	93.04639812	0	46.52319906	0	0	44.42046019	209.3543958	0	69.78479859	209.3543958	0	0	23.26159953	31.22389348	32.56623934	32.2369914	0	32.56623934	11.28955157	0	0	0	32.56623934	0	0	0	23.26159953	0												8.5371	0.002646267	12.09458559	0	2.264566873	0	0	4.249912227	16.08984334	0	16.5791679	0.87045723	0	0	14.18316897	13.34855108	0.929823938	1.654153898	0	0.16750266	0.198570585	0	0	0	0.362789787	0	0	0	0.361223338	0	0	0	0	0	0	0	0	0	0	0	91.894	0	6.867481862	8.5371	0.002646267	12.09458559	0	2.264566873	0	0	4.249912227	16.08984334	0	16.5791679	0.87045723	0	0	14.18316897	13.34855108	0.929823938	1.654153898	0	0.16750266	0.198570585	0	0	0	0.362789787	0	0	0	0.361223338	0	0	0	0	0	0	0	0	0	0	0	91.894	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.5371	0.002646267	12.09458559	0	2.264566873	0	0	4.249912227	16.08984334	0	16.5791679	0.87045723	0	0	14.18316897	13.34855108	0.929823938	1.654153898	0	0.16750266	0.198570585	0	0	0	0.362789787	0	0	0	0.361223338	0	0	0	0	0	0	0	0	0	0	0	91.894
H9001_803_0	2011	3																															A	A	D		T			V	V		V	V			V	V	V	V		V	S				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	226.0218209	0.364376809	1332.009961	0	512.4650442	0	0	1216.811182	890.6370833	0	2866.119579	59.3085673	0	0	7144.779997	5144.631001	373.2012721	688.9196596	0	56.89938773	184.437309	0	0	0	150.119176	0	0	0	56.62364128	0											3400	$450/Admit for IP Acute; PBP 1a	$450/Admit for IP Psych; PBP 1b	$100/Days 1-20 for SNF; PBP 2	No Cost Sharing; PBP 6	"$50/Trip for Ambulance; PBP 10a, 10b"	No Cost Sharing; PBP 11a	"No Cost Sharing; PBP 11b, 11c"	"$50/Visit for ER; $25/Visit for Urgent Care; PBP 4a, 4b"	$225/Visit for ASC Services; PBP 9b	No Cost Sharing; PBP 8a	$75/Visit for OP X-Ray; PBP 8b	$225/Visit for OP Hospital; PBP 9a	No Cost Sharing; PBP 12	"No Cost Sharing; PBP 3, 5, 9d"	"$25/Visit for Bone Mass Measurement; $25/Visit for Colorectal Screening; $25/Visit for Diabetes Monitoring; $25/Visit for Mammography; $25/Visit for PCP; $25/Visit for Pelvic Exams & Pap Smears; $25/Visit for Prostate Screening; $25/Visit for Nutritional Therapy; PBP 7a, 14b-j"	"$35/Visit for Chiropractic; $35/Visit for Podiatry; $35/Visit for Physician Specialist; $30/Visit for Medicare Covered Eye Exams; PBP 7b, 7d, 7f"	"$35/Visit for Mental Health; $35/Visit for Psychiatric; $35/Visit for OP Substance Abuse; PBP 7e, 7h, 9c"	"$35/Visit for Occupational Therapy; $35/Visit for Physical and Speech Therapy; PBP 7c, 7i"	No Cost Sharing;	"$35/Visit for Medicare Covered Hearing Exams; $25/Visit for Other Health Care; PBP 7g, 18a-b"	$10-50/Script for Part B Drugs; PBP 15	No Cost Sharing; PBP 13a		"PBP 16a, 16b"	$35/Exam for Non-Medicare Covered Eye Exams; PBP 17a	No Cost Sharing; PBP 17b			$25/Service for Health Education / Wellness Programs; PBP 14a	No Cost Sharing; PBP 13b											0	450	450	100	0	50	0	0	47.5611108	225	0	75	225	0	0	25	33.61093857	35	35	0	35	12.13324943	0	0	0	35	0	0	0	25	0											NO	419.74726	419.74726	93.27716889	0	46.63858444	0	0	44.36365764	209.87363	0	69.95787667	209.87363	0	0	23.31929222	31.35133194	32.64700911	32.64700911	0	32.64700911	11.31755156	0	0	0	32.64700911	0	0	0	23.31929222	0												7.906	0.012745514	10.35384317	0	1.991720353	0	0	4.498516223	15.57676981	0	16.70897	1.037275359	0	0	13.88426772	13.44091952	1.015325444	1.874263867	0	0.154799569	0.17394823	0	0	0	0.408411842	0	0	0	0.11003527	0	0	0	0	0	0	0	0	0	0	0	89.1478	0	6.425213295	7.906	0.012745514	10.35384317	0	1.991720353	0	0	4.498516223	15.57676981	0	16.70897	1.037275359	0	0	13.88426772	13.44091952	1.015325444	1.874263867	0	0.154799569	0.17394823	0	0	0	0.408411842	0	0	0	0.11003527	0	0	0	0	0	0	0	0	0	0	0	89.1478	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.906	0.012745514	10.35384317	0	1.991720353	0	0	4.498516223	15.57676981	0	16.70897	1.037275359	0	0	13.88426772	13.44091952	1.015325444	1.874263867	0	0.154799569	0.17394823	0	0	0	0.408411842	0	0	0	0.11003527	0	0	0	0	0	0	0	0	0	0	0	89.1478
H9003_001_0	2011	8	q.		q.								Other Non-Covered		Other Non-Covered								Other - Residential Treatment Facility		Other - Travel Benefit								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		V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1027.335467	37.25785472	634.9682616	1089.95912	400.4339485	13.16606588	0.683269234	337.9059941	162.7834987	0.083540579	46.55886059	1.197938488	17.20473114	317.0413969	6220.750008	5135.679093	387.4381988	510.000109	3240.026376	6217.48101	1251.551975	0.049370561	0	0	404.1162419	0	50.29074512	0	21.74276318	4.554218573	37.06505832	0	0.002111708	0	0	0	0	0	0	0	2500	$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, $100/day (days 1 - 4)"	$20 per visit	$0-$50 per visit	$0 - $20 per visit	$0 or $10 generic/$45 brand per script	$0 copay			$20 per visit		$20 per visit		$0-$120 per class	$0 copay	$100/day $400max/admit		$800/year plan benefit coverage amount with 20% coinsurance									114.8845415	114.8845415	0	0	100	0.135649002	0.163784065	47.49605115	150	0	0	0	0	16.64881528	17.38474609	14.99391682	17.89507222	20	7.638407367	0	5.041047804	0	0	0	20	0	20	0	15	0	57.44227076	0	0.02	0	0	0	0	0	0	0	NO	102.0830062	102.0830062	0	0	95.25678523	0.129214878	0.156015435	45.24321144	142.8851778	0	0	0	0	15.85912622	16.56015025	14.28272314	17.04627051	19.05135705	7.276101301	0	4.80194008	0	0	0	19.05135705	0	19.05135705	0	15	0	51.04150308	0	0.02	0	0	0	0	0	0	0		8.7395	0.316949484	0	0	3.178670886	1.7012516	0.106600547	1.273996028	1.938279097	0	0	0	0	0.418999961	8.5847129	6.112623552	0.550364695	0.809682848	1.964563344	0	0.500823133	0	0	0	0.641580234	0	0.079842245	0	0.027178454	0	0.157654691	0	3.52E-09	0	0	0	0	0	0	0	37.1032	0	2.54283234	8.7395	0.316949484	0	0	3.178670886	1.7012516	0.106600547	1.273996028	1.938279097	0	0	0	0	0.418999961	8.5847129	6.112623552	0.550364695	0.809682848	1.964563344	0	0.500823133	0	0	0	0.641580234	0	0.079842245	0	0.027178454	0	0.157654691	0	3.52E-09	0	0	0	0	0	0	0	37.1032	NO																																																																																		0	0	0	8.7395	0.316949484	0	0	3.178670886	1.7012516	0.106600547	1.273996028	1.938279097	0	0	0	0	0.418999961	8.5847129	6.112623552	0.550364695	0.809682848	1.964563344	0	0.500823133	0	0	0	0.641580234	0	0.079842245	0	0.027178454	0	0.157654691	0	3.52E-09	0	0	0	0	0	0	0	37.1032
H9003_006_0	2011	5	q.										Other Non-Covered										Other - 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	0	0	0	0	0	0	0	0	0	YES	653.9481157	59.73740696	387.2074867	519.1948567	247.3685378	8.888123131	0.707955988	264.835477	130.1101865	0.486872164	22.94501923	0.997698439	0.486872164	245.273365	5264.397038	3826.386123	661.1518215	414.9450935	2646.67258	4583.747174	1125.535174	0.049663064	0	0	319.908494	0	40.94267273	0	20.18152491	0.49271301	28.15391866	0	0	0	0	0	0	0	0	0	3400	$275/day $1100max/admit	$275/day $1100max/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, $137/Day (days 1-4)"	$30 per visit	$0-$125 copay	$0 - $30 copay	$0 or $10 generic/$45 brand per script	$0 copay			$30 per visit		$30 per visit		$0-$120 per class	$0 copay	$137/day $548max/admit											157.9662446	157.9662446	0	0	150	0.135649002	0.163784065	47.45733453	200	0	0	0	0	24.74386286	24.95130368	22.19577332	23.54443771	30	17.7324348	0	4.080460781	0	0	0	30	0	30	0	15	0	78.69591094	0	0	0	0	0	0	0	0	0	NO	140.435306	140.435306	0	0	142.7366454	0.129080556	0.155853253	45.15933822	190.3155272	0	0	0	0	23.54570653	23.74310257	21.12100151	22.40436038	28.54732909	16.87378839	0	3.882875225	0	0	0	28.54732909	0	28.54732909	0	15	0	69.9623161	0	0	0	0	0	0	0	0	0		7.6531	0.699103419	0	0	2.942379606	1.147283879	0.110337244	0.996649573	2.063499062	0	0	0	0	0.481261223	10.41609324	6.734758925	1.234390306	0.987131178	3.721616087	0	0.36419272	0	0	0	0.761044421	0	0.097400329	0	0.025226906	0	0.16414278	0	0	0	0	0	0	0	0	0	40.5996	0	2.54283234	7.6531	0.699103419	0	0	2.942379606	1.147283879	0.110337244	0.996649573	2.063499062	0	0	0	0	0.481261223	10.41609324	6.734758925	1.234390306	0.987131178	3.721616087	0	0.36419272	0	0	0	0.761044421	0	0.097400329	0	0.025226906	0	0.16414278	0	0	0	0	0	0	0	0	0	40.5996	NO																																																																																		0	0	0	7.6531	0.699103419	0	0	2.942379606	1.147283879	0.110337244	0.996649573	2.063499062	0	0	0	0	0.481261223	10.41609324	6.734758925	1.234390306	0.987131178	3.721616087	0	0.36419272	0	0	0	0.761044421	0	0.097400329	0	0.025226906	0	0.16414278	0	0	0	0	0	0	0	0	0	40.5996
H9003_801_0	2011	4																															A	A	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	891.0005388	20.40610786	524.8257829	864.2698333	277.4771152	11.57298069	0.662395538	284.9085411	161.0383907	0.050403594	41.4666642	1.032326099	4.699560585	282.66984	5412.453315	4873.092323	359.8419303	601.0516461	3076.472935	6043.593535	8.985927231	0.09534081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2500	"$1,000/admit"	"$1,000/admit"	$0 per day	$0 copay	$150 copay	0-20% Coinsurance	0-20% Coinsurance	$0-$50/copay waived if admitted	$250 per visit	$0 copay	$0 per visit	$0 copay	$0 copay	$0-$40 per visit	$0-$45 per visit	$0-$250 per visit	"$20-$40 per visit, $500/admit"	$40 per visit	$0-$150 copay	$0-$40 per visit	0 or 20% Coin	$0 copay																				196.1365996	196.1365996	0	0	150	0.135649002	0.163784065	47.83421947	250	0	0	0	0	33.12408359	35.42812251	35.23614993	30.23943301	40	21.89289779	0	0.072830809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	143.3806167	143.3806167	0	0	133.3086993	0.120554613	0.145558938	42.51145053	222.1811655	0	0	0	0	29.43818999	31.48584621	31.31523544	26.87452988	35.54898648	19.45675819	0	0.064726536	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		10.646	0.243820027	0	0	3.082509443	1.39517621	0.096417591	1.009322946	2.981641445	0	0	0	0	0.693440705	14.20130606	12.71683612	0.805881892	1.780564737	4.988182497	0	0.581627947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2227	0	2.54283234	10.646	0.243820027	0	0	3.082509443	1.39517621	0.096417591	1.009322946	2.981641445	0	0	0	0	0.693440705	14.20130606	12.71683612	0.805881892	1.780564737	4.988182497	0	0.581627947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2227	NO																																																																																		0	0	0	10.646	0.243820027	0	0	3.082509443	1.39517621	0.096417591	1.009322946	2.981641445	0	0	0	0	0.693440705	14.20130606	12.71683612	0.805881892	1.780564737	4.988182497	0	0.581627947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2227
H9003_802_0	2011	4																															A	A	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	935.9655079	16.36439448	366.6287065	1174.762208	295.2493857	12.21393818	0.798088851	276.2073362	149.8149307	0.332628736	39.19091643	2.04407011	19.76706138	283.6868323	5733.735602	5088.071561	310.7783286	579.1316573	3196.160821	6508.98954	6.508396707	0.066006777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2500	"$1,000/admit"	"$1,000/admit"	$0 per day	$0 copay	$150 copay	0-20% Coinsurance	0-20% Coinsurance	$0-$50/copay waived if admitted	$250 per visit	$0 copay	$0 per visit	$0 copay	$0 copay	$0-$40 per visit	$0-$45 per visit	$0-$250 per visit	"$20-$40 per visit, $500/admit"	$40 per visit	$0-$150 copay	$0-$40 per visit	0 or 20% Coin	$0 copay																				196.1365996	196.1365996	0	0	150	0.135649002	0.163784065	47.77931056	250	0	0	0	0	33.11807475	35.72056008	35.42340434	31.40545831	40	22.73419301	0	0.059207195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	143.3806167	143.3806167	0	0	133.3086993	0.120554613	0.145558938	42.46265163	222.1811655	0	0	0	0	29.43284979	31.74574268	31.48165305	27.91080532	35.54898648	20.204438	0	0.052618894	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		11.1833	0.195528081	0	0	3.279942632	1.472446593	0.116168966	0.977374658	2.773837993	0	0	0	0	0.695809327	15.16847459	13.34840863	0.722839452	1.715628621	5.381386095	0	0.34246464	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3736	0	2.54283234	11.1833	0.195528081	0	0	3.279942632	1.472446593	0.116168966	0.977374658	2.773837993	0	0	0	0	0.695809327	15.16847459	13.34840863	0.722839452	1.715628621	5.381386095	0	0.34246464	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3736	NO																																																																																		0	0	0	11.1833	0.195528081	0	0	3.279942632	1.472446593	0.116168966	0.977374658	2.773837993	0	0	0	0	0.695809327	15.16847459	13.34840863	0.722839452	1.715628621	5.381386095	0	0.34246464	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3736
H9003_805_0	2011	3																															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	970.9655921	5.483248738	651.5498565	1423.515056	352.5987249	13.65562006	0.952384061	336.5902509	164.7086421	0.383151358	38.85844442	0.784693981	25.91007417	297.0797771	6771.693555	5605.412524	475.2867184	748.8728732	3322.571115	6588.760894	1234.256469	0.05766968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	750	$100/admit	$100/admit	$0 per day	$0 copay	$125 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-$5 per visit	"$2-$5 per visit, $50/admit"	$5 per visit	$0 - $5 copay	$0 - $5 copay	$0 or $20 generic/$40 brand per script	$0 copay																				19.61365996	19.61365996	0	0	125	0.135649002	0.163784065	48.5421841	50	0	0	0	0	4.293022792	4.670530133	3.843168756	3.458689622	5	0	0	5.124854727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	15.89906056	15.89906056	0	0	112.4956158	0.122079344	0.147399914	43.68626313	44.9982463	0	0	0	0	3.863569939	4.203313306	3.458717085	3.11269935	4.49982463	0	0	4.612189505	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		1.2865	0.007264875	0	0	3.305484223	1.667069136	0.140381329	1.225364189	0.617633337	0	0	0	0	0.095649041	2.371962469	1.615628005	0.123285388	0.280816383	0	0	0.474385395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.2114	0	2.54283234	1.2865	0.007264875	0	0	3.305484223	1.667069136	0.140381329	1.225364189	0.617633337	0	0	0	0	0.095649041	2.371962469	1.615628005	0.123285388	0.280816383	0	0	0.474385395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.2114	NO																																																																																		0	0	0	1.2865	0.007264875	0	0	3.305484223	1.667069136	0.140381329	1.225364189	0.617633337	0	0	0	0	0.095649041	2.371962469	1.615628005	0.123285388	0.280816383	0	0	0.474385395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.2114
H9011_003_0	2011	5																															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	1747.34878	30.90983417	453.9000457	3193.552461	182.416052	10.18982845	15.62646268	317.7536237	390.4090479	16576.97912	6052.941874	0	0.129557921	986.5651206	5659.704704	7728.776058	107.003791	870.8922942	0	0	35.18676381	1858.420575	721.1726127	275.4786516	254.3188914	315.5259267	18.05491726	6	555.9291951	0											2950	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-12 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$100 Days 21-50 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$0 (9b)	$0 (8a1a); $0/$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, 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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0	116.8098224	31.92081548	0	200	0.2	0.116428168	49.43646133	0	2.5	2.260301498	0	0.2	0.023158617	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	95.67175436	26.1443803	0	163.8077217	0.163807722	0.095359165	40.50641461	0	2.047596521	1.851274193	0	0.163807722	0.018967801	0	0	0	0	0	0	0.163807722	0	0	0	0	0	0	0	0	0												0	0.246433172	0.988911284	0	2.49009649	1.669172583	1.49012643	1.072588335	0	2.828580399	0.933804591	0	0.021222588	0.001559414	0	0	0	0	0	0	5.763863614	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.5064	0	3.867400381	0	0.246433172	0.988911284	0	2.49009649	1.669172583	1.49012643	1.072588335	0	2.828580399	0.933804591	0	0.021222588	0.001559414	0	0	0	0	0	0	5.763863614	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.5064	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.246433172	0.988911284	0	2.49009649	1.669172583	1.49012643	1.072588335	0	2.828580399	0.933804591	0	0.021222588	0.001559414	0	0	0	0	0	0	5.763863614	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.5064
H9011_011_0	2011	5																															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	1712.457021	324.8470346	1335.880699	3139.638489	240.5448667	17.13046295	15.30656383	348.7179282	553.1728995	17039.65236	7007.866875	0	0.412959184	385.5413423	8722.962842	8300.56904	1301.188613	748.692089	0	0	44.65418701	3177.805799	0	1611.168082	120.6655306	206.2668939	0	0	132	0											6700	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	$0 (4a); $50 (4a1); $40 (4b)	$0 (9b)	"$0 (8a1a, 8a2)"	"$15 (8b1); $0 (8b2, 8b3)"	Included in h.5.	20% (12)	"$0 (3, 5, 9a, 9c, 9d)"	"$0 (7a, 7a1, 14b, 14c, 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 n/c (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 (14a1); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0	0	0	0	150	0.2	0.130123278	3.26881351	0	0	2.137733265	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	136.4790345	0.181972046	0.118393996	2.980987351	0	0	1.945038481	0	0.181972046	0	0	0	0	0	0	0	0.181972046	0	0	0	0	0	0	0	0	0												0	0	0	0	2.735777597	3.117265393	1.812205259	0.086626978	0	0	1.135880895	0	0.075147028	0	0	0	0	0	0	0	8.125813774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.0887	0	1.692759677	0	0	0	0	2.735777597	3.117265393	1.812205259	0.086626978	0	0	1.135880895	0	0.075147028	0	0	0	0	0	0	0	8.125813774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.0887	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	2.735777597	3.117265393	1.812205259	0.086626978	0	0	1.135880895	0	0.075147028	0	0	0	0	0	0	0	8.125813774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.0887
H9011_016_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	O	V	Coin	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	1362.126752	49.39084729	956.6180344	2312.271419	180.4139558	11.79168801	13.27707209	291.7128761	413.6134752	25.43468906	66.3365174	0	0.234710268	445.8437099	6920.280988	165.0630427	221.3159778	885.0604691	0	0	36.49410951	2329.615746	0	212.8423131	90.73147674	0	15.01661789	6	585.0597949	0											3400	"$175 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-12 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-44 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$175 (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												163.4770469	116.8098224	60.71758667	0	200	0.2	0.129776748	49.32545204	175	0.116449466	0.159003963	0	0.2	68.9864572	3.750564638	0.103242501	38.5	30	0	0	0.2	29.80851675	0	0	30	0	0	0	0	0											YES	111.3920012	79.59331365	41.3724961	0	136.2784602	0.13627846	0.088428877	33.63490988	119.2436527	0.07934777	0.108344077	0	0.13627846	47.00684082	3.54276044	0.097543217	36.36686476	28.3378167	0	0	0.13627846	20.31129382	0	0	30	0	0	0	0	0											7200	12.6442	0.327598433	3.298139658	0	2.048878008	1.606953085	1.174076577	0.817644691	4.110065133	2.018185847	7.18716872	0	0.031985954	1.746475358	2.04307481	16.10078011	0.67071402	2.090056778	0	0	4.973361052	3.943125826	0	0	0.226828692	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0593	0	22.69671385	12.6442	0.327598433	3.298139658	0	2.048878008	1.606953085	1.174076577	0.817644691	4.110065133	2.018185847	7.18716872	0	0.031985954	1.746475358	2.04307481	16.10078011	0.67071402	2.090056778	0	0	4.973361052	3.943125826	0	0	0.226828692	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0593	NO	"$375 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-20 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-42 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												1.5863	0.0495	0.7827	0.9156	0.3642	0.4285	0.4824	0.1453	1.8279	0.3587	1.8922	0	0.0057	0.5909	2.8027	3.6235	0.1286	0.4731	0	0	1.2743	0.8981	0	0.0373	0.0513	0	0.0085	0	0	0											18.7273	0	5.705706509	14.2304	0.377086417	4.080875248	0.915553513	2.41307098	2.035412723	1.656508736	0.962980555	5.937934979	2.376923214	9.079381729	0	0.037671534	2.337326235	4.845799026	19.72424549	0.799358834	2.563124365	0	0	6.24770383	4.841236941	0	0.037340757	0.27811939	0	0.008488926	0	0	0	0	0	0	0	0	0	0	0	0	0	85.7866
H9011_018_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1445.152465	68.8854376	1127.357511	2649.559227	202.9972155	12.71850669	11.36435337	294.3675085	54.66950163	24.05263416	63.8418658	0	0.325944604	14.312614	7419.198257	158.4356173	363.8645145	631.8256193	0	0	33.15348672	2681.768843	0	180.6029118	120.6655306	0	17.46434425	6	598.5575223	0											3400	"$150 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-44 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$20 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$5 (7a); $20 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $20 (7d, 7f, 7f1)"	"$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, 18a); $0/$20 (17a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												105.2526427	67.8284715	60.22946106	0	200	0.2	0.130123278	49.20194611	0.2	0.124552037	0.160542502	0	0.2	0.158214497	3.622139284	0.073884204	38.5	20	0	0	0.2	19.91668184	0	0	20	0	0	0	0	0											NO	77.33010866	49.83421733	44.25115273	0	146.9418851	0.146941885	0.095602799	36.17292523	0.146941885	0.091509556	0.11795209	0	0.146941885	0.116241682	3.45728953	0.070540195	36.74779915	19.08976579	0	0	0.146941885	14.63297387	0	0	20	0	0	0	0	0												9.3128	0.286070989	4.157239117	0	2.485732793	1.868881348	1.086463993	0.887344489	8.033239626	2.20104586	7.530281477	0	0.047894914	1.663722328	2.137526371	11.17607933	1.114268341	1.005116924	0	0	4.871635836	3.270187783	0	0	0.201109218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.3367	0	17.95654232	9.3128	0.286070989	4.157239117	0	2.485732793	1.868881348	1.086463993	0.887344489	8.033239626	2.20104586	7.530281477	0	0.047894914	1.663722328	2.137526371	11.17607933	1.114268341	1.005116924	0	0	4.871635836	3.270187783	0	0	0.201109218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.3367	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.3128	0.286070989	4.157239117	0	2.485732793	1.868881348	1.086463993	0.887344489	8.033239626	2.20104586	7.530281477	0	0.047894914	1.663722328	2.137526371	11.17607933	1.114268341	1.005116924	0	0	4.871635836	3.270187783	0	0	0.201109218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.3367
H9011_019_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1365.66908	69.34094273	1025.895335	2252.125343	172.5476332	10.81073068	9.659700368	250.2123822	46.46907638	20.44473903	54.26558593	0	0.277052913	12.1661469	6381.439139	135.4624528	315.7401697	540.2109045	0	0	28.34623115	2292.91236	0	189.6330574	103.1690287	0	14.93201433	6	598.5575223	0											4200	"$250 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$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, 18a); $0/$25 (17a)"	$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												175.4210712	113.0474525	65.27382542	0	200	0.2	0.130123278	49.20194611	0.2	0.124552037	0.160542502	0	0.2	0.15853761	7.102195896	0.091921931	38.5	25	0	0	0.2	24.8958523	0	0	25	0	0	0	0	0											NO	131.8641623	84.97786228	49.06638783	0	150.3401632	0.150340163	0.097813775	37.00741089	0.150340163	0.093625868	0.12067993	0	0.150340163	0.11917285	6.803658987	0.088079502	36.88167362	23.94913871	0	0	0.150340163	18.71423248	0	0	25	0	0	0	0	0												15.0069	0.49103709	4.194748198	0	2.161736611	1.625287015	0.944851754	0.771642703	6.986168526	1.914156434	6.548767109	0	0.04165218	1.449874405	3.618094646	11.93146538	0.970418824	1.078132157	0	0	4.261577016	3.575841248	0	0	0.214935476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7873	0	17.27584974	15.0069	0.49103709	4.194748198	0	2.161736611	1.625287015	0.944851754	0.771642703	6.986168526	1.914156434	6.548767109	0	0.04165218	1.449874405	3.618094646	11.93146538	0.970418824	1.078132157	0	0	4.261577016	3.575841248	0	0	0.214935476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7873	YES	"$375 Days 1-26 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-26 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-55 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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)	"$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											9500	1.7886	0.0821	1.021	0.9397	0.3815	0.4302	0.3844	0.1362	1.8493	0.3378	1.7097	0	0.0074	0.3834	1.9677	3.2122	0.1859	0.2925	0	0	1.0841	0.9703	0	0.0333	0.0583	0	0.0084	0	0	0											17.2641	0	4.047639954	16.7955	0.573157723	5.215720718	0.939701344	2.543219542	2.055510048	1.329268471	0.907814945	8.83544843	2.251948746	8.25850582	0	0.049002565	1.833295764	5.585836246	15.14362618	1.156366017	1.370677959	0	0	5.345662397	4.546142142	0	0.033268957	0.27325715	0	0.0084411	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0514
H9011_020_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1367.411681	70.82500385	1066.712244	2507.028375	192.0771478	11.38694852	10.17456767	278.5606539	46.33648039	20.38640151	54.11074318	0	0.276262364	12.13488508	7020.088609	141.8600205	365.6032225	597.8370815	0	0	29.6824978	2537.505301	0	180.6029118	120.6655306	0	17.46434425	6	598.5575223	0											3900	"$225 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-49 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$20 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$5 (7a); $20 (7a1); $0 (14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $20 (7d, 7f, 7f1)"	"$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, 18a); $0/$20 (17a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												145.4506248	89.92354543	62.34408604	0	200	0.2	0.130123278	49.20202748	0.2	0.139046008	0.162590888	0	0.2	0.15847833	3.622139284	0.078004244	38.5	20	0	0	0.2	19.91668184	0	0	20	0	0	0	0	0											NO	112.5800634	69.60161542	48.25487117	0	154.8017598	0.15480176	0.100716563	38.10421951	0.15480176	0.107622833	0.125846778	0	0.15480176	0.122663622	3.483480803	0.075035638	37.02618822	19.23438349	0	0	0.15480176	15.41568699	0	0	20	0	0	0	0	0												12.8286	0.410794557	4.289505158	0	2.477823375	1.762719671	1.02474748	0.884528025	7.172968709	2.194042296	6.809662696	0	0.0427659	1.488508953	2.037861992	10.64455708	1.128074478	0.958252308	0	0	4.594902896	3.259782288	0	0	0.201109218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2112	0	14.96189063	12.8286	0.410794557	4.289505158	0	2.477823375	1.762719671	1.02474748	0.884528025	7.172968709	2.194042296	6.809662696	0	0.0427659	1.488508953	2.037861992	10.64455708	1.128074478	0.958252308	0	0	4.594902896	3.259782288	0	0	0.201109218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2112	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	12.8286	0.410794557	4.289505158	0	2.477823375	1.762719671	1.02474748	0.884528025	7.172968709	2.194042296	6.809662696	0	0.0427659	1.488508953	2.037861992	10.64455708	1.128074478	0.958252308	0	0	4.594902896	3.259782288	0	0	0.201109218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2112
H9011_021_0	2011	5																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1292.204038	69.34822767	970.7081418	2130.974119	163.2655756	9.678906246	8.648382515	236.7765558	39.38600833	17.32844129	45.99413171	0	0.234823009	10.31482232	6038.154886	121.2903176	316.5162762	511.1507046	0	0	25.37853562	2169.567032	0	189.6330574	103.1690287	0	14.93201433	6	598.5575223	0											4200	"$275 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $25 (7d, 7f, 7f1)"	"$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, 18a); $0/$25 (17a)"	$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 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												177.7729858	109.9065555	63.91205466	0	200	0.2	0.130123278	49.20202748	0.2	0.139046008	0.162590888	0	0.2	0.158830508	7.102195896	0.097072016	38.5	25	0	0	0.2	24.8958523	0	0	25	0	0	0	0	0											NO	137.122129	84.77452754	49.29746194	0	154.2665533	0.154266553	0.100368348	37.97280689	0.154266553	0.107250742	0.12541168	0	0.154266553	0.122511175	6.829281309	0.093363759	37.0205686	24.03933026	0	0	0.154266553	19.20298663	0	0	25	0	0	0	0	0												14.7658	0.489913603	3.987787307	0	2.098868136	1.493131507	0.868023869	0.749255869	6.075943755	1.858488183	5.768201314	0	0.036225336	1.263681006	3.436354859	11.32412003	0.97646771	1.023976717	0	0	3.915059218	3.471847226	0	0	0.214935476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8181	0	14.55321326	14.7658	0.489913603	3.987787307	0	2.098868136	1.493131507	0.868023869	0.749255869	6.075943755	1.858488183	5.768201314	0	0.036225336	1.263681006	3.436354859	11.32412003	0.97646771	1.023976717	0	0	3.915059218	3.471847226	0	0	0.214935476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8181	YES	"$375 Days 1-26 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-26 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-55 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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)	"$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											9500	1.7366	0.0843	0.9992	0.8633	0.3704	0.3952	0.3532	0.1322	1.6083	0.328	1.5038	0	0.0064	0.3341	1.8588	3.0497	0.1871	0.2779	0	0	0.9959	0.9421	0	0.0333	0.0583	0	0.0084	0	0	0											16.1265	0	3.371877942	16.5024	0.57418781	4.986969662	0.863292249	2.46925663	1.888372199	1.221182854	0.881477493	7.684281807	2.186456686	7.27201062	0	0.042618043	1.597805967	5.295182827	14.3737997	1.163573963	1.301827709	0	0	4.910995335	4.413928708	0	0.033268957	0.27325715	0	0.0084411	0	0	0	0	0	0	0	0	0	0	0	0	0	79.9446
H9011_801_0	2011	1																															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	261.8945614	4.4299	27.48302657	2688.857696	7.241698924	12.82132082	15.29797608	18.87430575	45.83509357	24.02426257	66.94386976	0	0.164897039	20.28743445	83.6309433	186.9564744	2.086	10.77181584	0	0	39.23675931	13.13823825	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.057087597	0.057087597	0.119726403	0	0.174866105	0.174866105	0.174866105	0.174866105	0.174866105	0.174866105	0.174866105	0	0.174866105	0.174866105	0.174866105	0.174866105	0.174866105	0.174866105	0	0	0.174866105	0.174866105	0	0	0	0	0	0	0	0												14.9509	0.252892345	3.290443903	0	1.266327682	2.242014427	2.675097485	3.300476324	8.015004267	4.201029212	11.70621373	0	0.028834903	3.547584636	14.62421728	32.69235042	0.364770694	1.883625476	0	0	6.861179258	2.297432544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2004	0	37.96570877	14.9509	0.252892345	3.290443903	0	1.266327682	2.242014427	2.675097485	3.300476324	8.015004267	4.201029212	11.70621373	0	0.028834903	3.547584636	14.62421728	32.69235042	0.364770694	1.883625476	0	0	6.861179258	2.297432544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2004	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.9509	0.252892345	3.290443903	0	1.266327682	2.242014427	2.675097485	3.300476324	8.015004267	4.201029212	11.70621373	0	0.028834903	3.547584636	14.62421728	32.69235042	0.364770694	1.883625476	0	0	6.861179258	2.297432544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2004
H9011_802_0	2011	1																															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	261.9310389	4.43	27.4868545	2689.232247	7.242707572	12.82310661	15.30010683	18.87693463	45.84147763	24.02760875	66.95319392	0	0.164920007	20.28925784	83.6425917	186.9825143	2.0846	10.77331617	0	0	39.24222433	13.14006818	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.057085134	0.057085134	0.119721237	0	0.17485856	0.17485856	0.17485856	0.17485856	0.17485856	0.17485856	0.17485856	0	0.17485856	0.17485856	0.17485856	0.17485856	0.17485856	0.17485856	0	0	0.17485856	0.17485856	0	0	0	0	0	0	0	0												14.9524	0.252887143	3.290760223	0	1.266449417	2.242229959	2.67535465	3.300793608	8.015774772	4.201433069	11.70733908	0	0.028837675	3.547750412	14.62562315	32.69549322	0.364510154	1.883806554	0	0	6.861838843	2.297653402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2109	0	37.97575818	14.9524	0.252887143	3.290760223	0	1.266449417	2.242229959	2.67535465	3.300793608	8.015774772	4.201433069	11.70733908	0	0.028837675	3.547750412	14.62562315	32.69549322	0.364510154	1.883806554	0	0	6.861838843	2.297653402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2109	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.9524	0.252887143	3.290760223	0	1.266449417	2.242229959	2.67535465	3.300793608	8.015774772	4.201433069	11.70733908	0	0.028837675	3.547750412	14.62562315	32.69549322	0.364510154	1.883806554	0	0	6.861838843	2.297653402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2109
H9011_803_0	2011	1																															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	261.9310389	4.43	27.4868545	2689.232247	7.242707572	12.82310661	15.30010683	18.87693463	45.84147763	24.02760875	66.95319392	0	0.164920007	20.28925784	83.6425917	186.9825143	2.0846	10.77331617	0	0	39.24222433	13.14006818	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.057085134	0.057085134	0.119721237	0	0.17485856	0.17485856	0.17485856	0.17485856	0.17485856	0.17485856	0.17485856	0	0.17485856	0.17485856	0.17485856	0.17485856	0.17485856	0.17485856	0	0	0.17485856	0.17485856	0	0	0	0	0	0	0	0												14.9524	0.252887143	3.290760223	0	1.266449417	2.242229959	2.67535465	3.300793608	8.015774772	4.201433069	11.70733908	0	0.028837675	3.547750412	14.62562315	32.69549322	0.364510154	1.883806554	0	0	6.861838843	2.297653402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2109	0	37.97575818	14.9524	0.252887143	3.290760223	0	1.266449417	2.242229959	2.67535465	3.300793608	8.015774772	4.201433069	11.70733908	0	0.028837675	3.547750412	14.62562315	32.69549322	0.364510154	1.883806554	0	0	6.861838843	2.297653402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2109	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.9524	0.252887143	3.290760223	0	1.266449417	2.242229959	2.67535465	3.300793608	8.015774772	4.201433069	11.70733908	0	0.028837675	3.547750412	14.62562315	32.69549322	0.364510154	1.883806554	0	0	6.861838843	2.297653402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2109
H9011_805_0	2011	1																															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	261.9310389	4.43	27.4868545	2689.232247	7.242707572	12.82310661	15.30010683	18.87693463	45.84147763	24.02760875	66.95319392	0	0.164920007	20.28925784	83.6425917	186.9825143	2.0846	10.77331617	0	0	39.24222433	13.14006818	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												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	0.057085134	0.057085134	0.119721237	0	0.17485856	0.17485856	0.17485856	0.17485856	0.17485856	0.17485856	0.17485856	0	0.17485856	0.17485856	0.17485856	0.17485856	0.17485856	0.17485856	0	0	0.17485856	0.17485856	0	0	0	0	0	0	0	0												14.9524	0.252887143	3.290760223	0	1.266449417	2.242229959	2.67535465	3.300793608	8.015774772	4.201433069	11.70733908	0	0.028837675	3.547750412	14.62562315	32.69549322	0.364510154	1.883806554	0	0	6.861838843	2.297653402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2109	0	37.97575818	14.9524	0.252887143	3.290760223	0	1.266449417	2.242229959	2.67535465	3.300793608	8.015774772	4.201433069	11.70733908	0	0.028837675	3.547750412	14.62562315	32.69549322	0.364510154	1.883806554	0	0	6.861838843	2.297653402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2109	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.9524	0.252887143	3.290760223	0	1.266449417	2.242229959	2.67535465	3.300793608	8.015774772	4.201433069	11.70733908	0	0.028837675	3.547750412	14.62562315	32.69549322	0.364510154	1.883806554	0	0	6.861838843	2.297653402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2109
H9047_001_0	2011	8																															D				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	747.0969233	0	0	0	303.9635189	17.46578028	0	423.4691716	426.4165991	0	22.46985364	0	0	419.6487009	10704.76579	0	0	0	14.15287309	0	32.94795064	0	0	0	131.941323	0	0	0	51.931512	0	0	0	0	0	0	0	0	0	0	0	2500	$100/day for 6 days	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		100	0	0	0	100	0.1	0	45.86282267	100	0	0.1	0	0	15	15	0	0	0	0.1	0	0.1	0	0	0	15	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0	NO	95.4	0	0	0	95.4	0.0954	0	43.75313283	95.4	0	0.0954	0	0	14.31	14.31	0	0	0	0.0954	0	0.0954	0	0	0	15	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0		5.9394	0	0	0	2.416509975	1.666235438	0	1.544008576	3.390011963	0	2.143624037	0	0	0.500431076	12.7654332	0	0	0	1.350184093	0	3.143234491	0	0	0	0.164926654	0	0	0	0.06491439	0	0	0	0	0	0	0	0	0	0	0	35.0889	0	1.680836788	5.9394	0	0	0	2.416509975	1.666235438	0	1.544008576	3.390011963	0	2.143624037	0	0	0.500431076	12.7654332	0	0	0	1.350184093	0	3.143234491	0	0	0	0.164926654	0	0	0	0.06491439	0	0	0	0	0	0	0	0	0	0	0	35.0889	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	5.9394	0	0	0	2.416509975	1.666235438	0	1.544008576	3.390011963	0	2.143624037	0	0	0.500431076	12.7654332	0	0	0	1.350184093	0	3.143234491	0	0	0	0.164926654	0	0	0	0.06491439	0	0	0	0	0	0	0	0	0	0	0	35.0889
H9047_013_0	2011	8																															D				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	753.7924594	0	0	0	341.0510539	21.84150114	0	493.6768854	418.0135988	0	22.51458636	0	0	442.014236	10787.00527	0	0	0	13.72507153	0	31.03102555	0	0	0	138.5496158	0	0	0	45.80126298	0	0	0	0	0	0	0	0	0	0	0	2500	$100/day for 6 days	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		100	0	0	0	100	0.1	0	45.86282267	100	0	0.1	0	0	15	15	0	0	0	0.1	0	0.1	0	0	0	15	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0	NO	95.4	0	0	0	95.4	0.0954	0	43.75313283	95.4	0	0.0954	0	0	14.31	14.31	0	0	0	0.0954	0	0.0954	0	0	0	15	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0		5.9927	0	0	0	2.711355878	2.083679209	0	1.799992528	3.323208111	0	2.147891539	0	0	0.527101976	12.86350379	0	0	0	1.309371824	0	2.960359838	0	0	0	0.17318702	0	0	0	0.057251579	0	0	0	0	0	0	0	0	0	0	0	35.9496	0	1.722305323	5.9927	0	0	0	2.711355878	2.083679209	0	1.799992528	3.323208111	0	2.147891539	0	0	0.527101976	12.86350379	0	0	0	1.309371824	0	2.960359838	0	0	0	0.17318702	0	0	0	0.057251579	0	0	0	0	0	0	0	0	0	0	0	35.9496	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	5.9927	0	0	0	2.711355878	2.083679209	0	1.799992528	3.323208111	0	2.147891539	0	0	0.527101976	12.86350379	0	0	0	1.309371824	0	2.960359838	0	0	0	0.17318702	0	0	0	0.057251579	0	0	0	0	0	0	0	0	0	0	0	35.9496
H9047_024_0	2011	11																															D		D	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	468.3139477	0	504.657649	11.941777	134.8289307	11.29015549	0	289.8221375	388.8402514	0	20.64580913	0	0	1500.427367	10195.17865	0	0	0	14.83013338	0	23.65329616	0	0	0	155.1365361	0	0	0	40.9102176	0	0	0	0	0	0	0	0	0	0	0		$200/day for 6 days	covered under a.1.	"Days 1-20 $0, Days 21-100 $50"	10% coins.	$150/trip	15% coins. for non-diabetic DME/Pros./Supplies	covered under e.1.	$50/ER visit; $25/urgent care visit	$200/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		200	0	11.76637275	0.1	150	0.15	0	43.11836846	200	0	0.1	0	0	20	20	0	0	0	0.1	0	0.1	0	0	0	20	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0	NO	187.8	0	11.04862402	0.0939	140.85	0.14085	0	40.48814798	187.8	0	0.0939	0	0	18.78	18.78	0	0	0	0.0939	0	0.0939	0	0	0	20	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0		7.3291	0	0.464647718	1.12133286	1.582554575	1.590218401	0	0.977863466	6.085349934	0	1.938641477	0	0	2.348168829	15.95545459	0	0	0	1.392549525	0	2.22104451	0	0	0	0.258560894	0	0	0	0.051137772	0	0	0	0	0	0	0	0	0	0	0	43.3166	0	2.793848018	7.3291	0	0.464647718	1.12133286	1.582554575	1.590218401	0	0.977863466	6.085349934	0	1.938641477	0	0	2.348168829	15.95545459	0	0	0	1.392549525	0	2.22104451	0	0	0	0.258560894	0	0	0	0.051137772	0	0	0	0	0	0	0	0	0	0	0	43.3166	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	0.19	0	0.0125	0.0005	0	0.1747	0	0.1166	0	0	0	0	0	0.0381	0.8454	0	0	0	0	0	0.1342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.512	0	0.167816041	7.5191	0	0.477170578	1.121834575	1.582554575	1.764904485	0	1.09442377	6.085349934	0	1.938641477	0	0	2.386288712	16.80089267	0	0	0	1.392549525	0	2.355197666	0	0	0	0.258560894	0	0	0	0.051137772	0	0	0	0	0	0	0	0	0	0	0	44.8286
H9047_033_0	2011	6																															D				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	629.5890701	0	0	0	261.1069444	12.43520655	0	344.3849029	365.6950492	0	20.91020124	0	0	349.9329877	8830.229156	0	0	0	12.50272461	0	24.97839823	0	0	0	152.1423331	0	0	0	45.04137488	0	0	0	0	0	0	0	0	0	0	0	2500	$100/day for 6 days	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		100	0	0	0	100	0.1	0	45.20275811	100	0	0.1	0	0	15	15	0	0	0	0.1	0	0.1	0	0	0	15	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0	NO	95.4	0	0	0	95.4	0.0954	0	43.12343124	95.4	0	0.0954	0	0	14.31	14.31	0	0	0	0.0954	0	0.0954	0	0	0	15	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0		5.0052	0	0	0	2.075800208	1.186318705	0	1.237588223	2.907275641	0	1.994833198	0	0	0.417295088	10.53004827	0	0	0	1.192759928	0	2.382939191	0	0	0	0.190177916	0	0	0	0.056301719	0	0	0	0	0	0	0	0	0	0	0	29.1766	0	1.394952004	5.0052	0	0	0	2.075800208	1.186318705	0	1.237588223	2.907275641	0	1.994833198	0	0	0.417295088	10.53004827	0	0	0	1.192759928	0	2.382939191	0	0	0	0.190177916	0	0	0	0.056301719	0	0	0	0	0	0	0	0	0	0	0	29.1766	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	5.0052	0	0	0	2.075800208	1.186318705	0	1.237588223	2.907275641	0	1.994833198	0	0	0.417295088	10.53004827	0	0	0	1.192759928	0	2.382939191	0	0	0	0.190177916	0	0	0	0.056301719	0	0	0	0	0	0	0	0	0	0	0	29.1766
H9047_035_0	2011	7																															D		D	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	436.6542619	0	567.4377406	8.045194456	123.9583985	8.696609467	0	245.0529577	364.0923319	0	15.47907309	0	0	1155.412954	8253.210908	0	0	0	12.44095018	0	20.28367621	0	0	0	135.5898569	0	0	0	24.96372164	0	0	0	0	0	0	0	0	0	0	0		$225/day for 6 days	covered under a.1.	"Days 1-20 $0, Days 21-100 $50"	10% coins.	$150/trip	15% coins. for non-diabetic DME/Pros./Supplies	covered under e.1.	$50/ER visit; $25/urgent care visit	$200/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		225	0	11.76637275	0.1	150	0.15	0	43.11836846	200	0	0.1	0	0	20	20	0	0	0	0.1	0	0.1	0	0	0	20	0	0	0	20	0	0	0	0	0	0	0	0	0	0	0	NO	209.025	0	10.93096029	0.0929	139.35	0.13935	0	40.0569643	185.8	0	0.0929	0	0	18.58	18.58	0	0	0	0.0929	0	0.0929	0	0	0	20	0	0	0	20	0	0	0	0	0	0	0	0	0	0	0		7.606	0	0.516886617	0.747398565	1.439466903	1.211872529	0	0.818006465	5.637362939	0	1.43800589	0	0	1.788964391	12.77872156	0	0	0	1.155764272	0	1.88435352	0	0	0	0.225983095	0	0	0	0.041606203	0	0	0	0	0	0	0	0	0	0	0	37.2904	0	2.829512411	7.606	0	0.516886617	0.747398565	1.439466903	1.211872529	0	0.818006465	5.637362939	0	1.43800589	0	0	1.788964391	12.77872156	0	0	0	1.155764272	0	1.88435352	0	0	0	0.225983095	0	0	0	0.041606203	0	0	0	0	0	0	0	0	0	0	0	37.2904	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	0.1535	0	0.0219	0	0	0.0642	0	0.116	0	0	0	0	0	0.0272	1.258	0	0	0	0	0	0.1903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.8311	0	0.382062687	7.7594	0	0.538792486	0.747398565	1.439466903	1.276100067	0	0.933983157	5.637362939	0	1.43800589	0	0	1.816157774	14.03671005	0	0	0	1.155764272	0	2.0746799	0	0	0	0.225983095	0	0	0	0.041606203	0	0	0	0	0	0	0	0	0	0	0	39.1215
H9047_801_0	2011	7																															Coin		Coin		Coin	Coin		Coin	Coin					Coin	Coin						Coin	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	205.314874	0	31.51328661	25.78548223	9.587661583	24.74532715	0	21.51334312	75.51209365	0	0	0	0	85.4788228	238.5835718	0	0	0	0	0	47.86294763	0.002296163																			6700	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing																				0.083110471	0	0.127726125	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																			NO	0.083110471	0	0.127726125	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																				17.0638	0	4.025069991	0	2.233925149	5.765661227	0	5.012608946	17.59431782	0	0	0	0	19.91656571	55.58997223	0	0	0	0	0	11.1520668	0.000535006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.3545	0	0	17.0638	0	4.025069991	0	2.233925149	5.765661227	0	5.012608946	17.59431782	0	0	0	0	19.91656571	55.58997223	0	0	0	0	0	11.1520668	0.000535006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.3545	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	17.0638	0	4.025069991	0	2.233925149	5.765661227	0	5.012608946	17.59431782	0	0	0	0	19.91656571	55.58997223	0	0	0	0	0	11.1520668	0.000535006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.3545
H9047_804_0	2011	7																															A				T			V						V	V										V				O												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	164.6386543	0	0	0	185.3849525	0.000128353	0	345.8301066	0	0	0.001041535	0	0	121.1929444	10281.58998	0	0	0	0.001278322	0	2.34E-06	0	0	0	141.4412923	0	0	0	45.25545807	0	0	0	0	0	0	0	0	0	0	0	2500	$250 per stay	covered under a.1.	$0 with 100 day limit	no cost sharing	$50/trip	no cost sharing	covered under e.1.	$50/ER visit; $25/urgent care visit	no cost sharing	no cost sharing	no cost sharing	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.	no cost sharing	covered under i.1.	no cost sharing	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		250	0	0	0	50	0	0	40.47533608	0	0	0	0	0	15	15	0	0	0	0	0	0	0	0	0	15	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0	NO	250	0	0	0	50	0	0	40.47533608	0	0	0	0	0	15	15	0	0	0	0	0	0	0	0	0	15	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0		3.43	0	0	0	0.772437302	0	0	1.166465816	0	0	0	0	0	0.15149118	12.85198748	0	0	0	0	0	0	0	0	0	0.176801615	0	0	0	0.056569323	0	0	0	0	0	0	0	0	0	0	0	18.6057	0	0	3.43	0	0	0	0.772437302	0	0	1.166465816	0	0	0	0	0	0.15149118	12.85198748	0	0	0	0	0	0	0	0	0	0.176801615	0	0	0	0.056569323	0	0	0	0	0	0	0	0	0	0	0	18.6057	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	3.43	0	0	0	0.772437302	0	0	1.166465816	0	0	0	0	0	0.15149118	12.85198748	0	0	0	0	0	0	0	0	0	0.176801615	0	0	0	0.056569323	0	0	0	0	0	0	0	0	0	0	0	18.6057
H9047_805_0	2011	7																															A		D	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	169.0862458	0	0	26.37179427	221.3178677	24.40637855	0	586.0578945	430.6874178	0	33.30140457	0	0	139.3308898	11668.70566	0	0	0	30.50934839	0	48.55902675	0	0	0	164.9236672	0	0	0	35.44283993	0	0	0	0	0	0	0	0	0	0	0		$350/admit	covered under a.1.	"Days 1-20 $0, Days 21-100 $50"	10% coins.	$50/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	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		350	0	0	0.1	50	0.1	0	28.515	100	0	0.1	0	0.1	20	20	0	0	0	0.1	0	0.1	0.1	0	0	20	0	0	0	20	0	0	0	0	0	0	0	0	0	0	0	NO	328.65	0	0	0.0939	46.95	0.0939	0	26.775585	93.9	0	0.0939	0	0.0939	18.78	18.78	0	0	0	0.0939	0	0.0939	0.0939	0	0	20	0	0	0	20	0	0	0	0	0	0	0	0	0	0	0		4.6308	0	0	2.476311482	0.865906158	2.291758946	0	1.307670247	3.370129044	0	3.127001889	0	0	0.218052843	18.26152435	0	0	0	2.864827814	0	4.559692612	0	0	0	0.274872779	0	0	0	0.0590714	0	0	0	0	0	0	0	0	0	0	0	44.3077	0	2.856665825	4.6308	0	0	2.476311482	0.865906158	2.291758946	0	1.307670247	3.370129044	0	3.127001889	0	0	0.218052843	18.26152435	0	0	0	2.864827814	0	4.559692612	0	0	0	0.274872779	0	0	0	0.0590714	0	0	0	0	0	0	0	0	0	0	0	44.3077	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.	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	0.226	0	0.0244	0.0009	0	0.2203	0	0.1382	0.1543	0	0	0	0	0.1777	0.8185	0	0	0	0	0	0.0501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.8103	0	0.110429103	4.8568	0	0.024392161	2.477187613	0.865906158	2.512073752	0	1.445902382	3.524428273	0	3.127001889	0	0	0.395754281	19.07997722	0	0	0	2.864827814	0	4.609783927	0	0	0	0.274872779	0	0	0	0.0590714	0	0	0	0	0	0	0	0	0	0	0	46.118
H9047_806_0	2011	9																															Coin		Coin		Coin	Coin		Coin	Coin					Coin	Coin						Coin	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	204.5345373	0	5.003960249	7.081276073	4.651189515	22.20351756	0	15.39499642	125.5996285	0	0	0	0	76.88809984	318.5621792	0	0	0	0	0	18.10885412	0																				Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing																				0.08323532	0	0.128172031	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																			NO	0.08323532	0	0.128172031	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																				17.0245	0	0.641367751	0	1.083727157	5.173419591	0	3.587034165	29.26471344	0	0	0	0	17.91492726	74.22498775	0	0	0	0	0	4.219363009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.134	0	0	17.0245	0	0.641367751	0	1.083727157	5.173419591	0	3.587034165	29.26471344	0	0	0	0	17.91492726	74.22498775	0	0	0	0	0	4.219363009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.134	YES	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	6700	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.0245	0	0.641367751	0	1.083727157	5.173419591	0	3.587034165	29.26471344	0	0	0	0	17.91492726	74.22498775	0	0	0	0	0	4.219363009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.134
H9082_002_0	2011	9																															D	D	D		T	Coin	Coin	V	V		Coin		Coin	V	V	V	V	V	Coin	V	Coin			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	692.3227567	7.350807107	320.8230248	0	162.9233371	13.42025307	4.335748045	330.7040714	221.7515619	0	11.86701352	0	0.304629087	1411.566538	3620.931161	3472.74032	222.9120551	248.5202505	11.4144985	44.77484539	12.09505967	0	0	1908.183869	350.7327675	0	280.0652363	0	0	0											2800	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical; PBP 1a	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse; PBP 1b	$125/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$125/Run for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for ER - Facility; $35/Visit for PCP Urgent Care; PBP 4a, 4b"	"$125/Case for OP Hospital Services; $100/Case for Ambulatory Surgery Center Services; PBP 9a, 9b"	No Cost-Sharing; PBP 8a	20% Coinsurance for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET; PBP 8b		20% Coinsurance for Renal Dialysis - Fac; PBP 12	"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; $125/Case for OP Fac - Other; $20/Visit for Prof - CORF; $20/Visit for OP Substance Abuse; PBP 3, 5, 7c, 7i, 9a, 9c, 9d, 13a"	"$5/Visit for Prof - Asst Surgeon (OP); $5/Visit for PCP Office Visits; $5/Consult for PCP Consults; PBP 7a, 14b, 14c"	"$20/Visit for Prof - Asst Surgeon (OP); $20/Visit for Speclst Office Visits; $20/Consult for Speclst Consults; $20/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; PBP 7e, 7h"	"$20/Visit for Occ Therapy; $20/Visit for PT/ST; PBP 7c, 7i"	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); $33/Procedure for Prof Radiology (Office); PBP 8b	"$5/Visit for Allergy Testing; $5/Visit for Allergy Tx; PBP 7d, 7g, 14d-j"	20% Coinsurance for Part B Rx; PBP 15			"$5/Procedure for Dental: Preventive Services; $5/Procedure for Dental: Comprehensive Services; PBP 16a, 16b"	$15/Exam for Vision Exams (Refractions); PBP 17a		$15/Exam for Hearing Exam; PBP 18a														0	250	250	125	0	125	0.2	0.2	47.71780967	123.667722	0	0.203983404	0	0.2	99.68020616	5	20	20	20	0.23748067	5.192127372	0.2	0	0	5	15	0	15	0	0	0											NO	239.2063596	239.2063596	119.6031798	0	119.6031798	0.191365088	0.191365088	45.65761417	118.3284224	0	0.19517651	0	0.191365088	95.37655697	4.792864235	19.13650877	19.13650877	19.13650877	0.227227546	4.96795955	0.191365088	0	0	4.919168346	14.75395977	0	14.77908165	0	0	0												13.8007	0.146529984	3.197621161	0	1.623845765	2.568167906	0.829710805	1.258263242	2.18662604	0	2.316162286	0	0.058295372	11.21919636	1.446219288	5.538010467	0.355479875	0.396317496	2.593688484	0.018536635	2.314572154	0	0	0.78222314	0.431224762	0	0.344925583	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4263	0	2.363759812	13.8007	0.146529984	3.197621161	0	1.623845765	2.568167906	0.829710805	1.258263242	2.18662604	0	2.316162286	0	0.058295372	11.21919636	1.446219288	5.538010467	0.355479875	0.396317496	2.593688484	0.018536635	2.314572154	0	0	0.78222314	0.431224762	0	0.344925583	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4263	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.8007	0.146529984	3.197621161	0	1.623845765	2.568167906	0.829710805	1.258263242	2.18662604	0	2.316162286	0	0.058295372	11.21919636	1.446219288	5.538010467	0.355479875	0.396317496	2.593688484	0.018536635	2.314572154	0	0	0.78222314	0.431224762	0	0.344925583	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4263
H9104_006_0	2011	9																															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	835.2243974	8.675876742	438.3021597	0	318.2434031	7.55300135	0.694997413	901.1825515	200.7280523	0	27.00314547	0	0	136.5376933	0	6937.373516	347.2310038	2981.355593	105.2793689	600	0.534539851	0	0	0	279.96875	111.9875	0	0	0	0											6700	"$50/day (1-8), $0/day (9-90)"	"$50/day (1-8), $0/day (9-90)"	"$0/day (1-20), $20/day (21-100)"	$0 Copay	$100/run	0% - 20%	0% - 20%	$50 ER ($0 if admitted immed.) Worldwide coverage; $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	$0 Copay	$5/visit	$25/visit	$10/visit PT/OT/ST; $10/visit CORF	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0/visit for hearing/vision/dental; $10/visit for chiropractic/podiatry	20% coinsurance	$0 Copay	$0 Copay (unlimited trips)	Not Covered	$15/visit for routine vision	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$0 Copay												50	50	20	0	100	0.06	0.055702532	46.25	66.5	0	0.045	0	0	10	0	5	25	10	0.098	10	0.2	0	0	0	15	25	0	0	0	0											NO	49	49	19.6	0	98	0.0588	0.054588481	45.325	65.17	0	0.0441	0	0	9.8	0	4.9	24.5	9.8	0.09604	9.8	0.196	0	0	0	14.7	24.5	0	0	0	0												3.4105	0.035426497	0.715893528	0	2.598987792	0.444116479	0.037938853	3.403841595	1.090120598	0	1.190838715	0	0	0.111505783	0	2.832760852	0.708929966	2.434773734	10.11103059	0.49	0.104769811	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.293		0.618225251	3.4105	0.035426497	0.715893528	0	2.598987792	0.444116479	0.037938853	3.403841595	1.090120598	0	1.190838715	0	0	0.111505783	0	2.832760852	0.708929966	2.434773734	10.11103059	0.49	0.104769811	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.293	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			3.4105	0.035426497	0.715893528	0	2.598987792	0.444116479	0.037938853	3.403841595	1.090120598	0	1.190838715	0	0	0.111505783	0	2.832760852	0.708929966	2.434773734	10.11103059	0.49	0.104769811	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.293
H9104_007_0	2011	11																															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	1020.084283	12.06931123	348.4665986	0	237.2978478	6.559831474	0.458149948	669.179177	186.0293883	0	17.80077085	0	0	0	0	4138.348966	216.6982766	1862.881343	97.21069258	600	0.212918385	0	0	0	279.96875	111.9875	0	0	0	0											6700	"$50/day (1-8), $0/day (9-90)"	"$50/day (1-8), $0/day (9-90)"	"$0/day (1-20), $20/day (21-100)"	$0 Copay	$100/run	0% - 20%	0% - 20%	$50 ER ($0 if admitted immed.) Worldwide coverage; $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	$0 Copay	$5/visit	$25/visit	$10/visit PT/OT/ST; $10/visit CORF	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0/visit for hearing/vision/dental; $10/visit for chiropractic/podiatry	20% coinsurance	$0 Copay	$0 Copay (unlimited trips)	Not Covered	$15/visit for routine vision	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$0 Copay												50	50	20	0	100	0.06	0.055702532	46.25	66.5	0	0.045	0	0	10	0	5	25	10	0.098	10	0.2	0	0	0	15	25	0	0	0	0											NO	49	49	19.6	0	98	0.0588	0.054588481	45.325	65.17	0	0.0441	0	0	9.8	0	4.9	24.5	9.8	0.09604	9.8	0.196	0	0	0	14.7	24.5	0	0	0	0												4.1653	0.049283021	0.569162111	0	1.937932423	0.385718091	0.02500971	2.527545516	1.010294603	0	0.785013994	0	0	0	0	1.689825828	0.442425648	1.521353097	9.336114915	0.49	0.041732003	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.5484		0.521395061	4.1653	0.049283021	0.569162111	0	1.937932423	0.385718091	0.02500971	2.527545516	1.010294603	0	0.785013994	0	0	0	0	1.689825828	0.442425648	1.521353097	9.336114915	0.49	0.041732003	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.5484	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			4.1653	0.049283021	0.569162111	0	1.937932423	0.385718091	0.02500971	2.527545516	1.010294603	0	0.785013994	0	0	0	0	1.689825828	0.442425648	1.521353097	9.336114915	0.49	0.041732003	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.5484
H9104_008_0	2011	8																															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	913.7303956	11.85135474	352.6940718	0	210.2522006	8.041325167	0.509603572	954.3560597	217.7720587	0	19.79992894	0	0	0	0	4656.319475	247.4096831	2009.828647	103.6776097	600	0.116594086	0	0	0	279.96875	111.9875	0	0	0	0											6700	"$50/day (1-8), $0/day (9-90)"	"$50/day (1-8), $0/day (9-90)"	"$0/day (1-20), $20/day (21-100)"	$0 Copay	$100/run	0% - 20%	0% - 20%	$50 ER ($0 if admitted immed.) Worldwide coverage; $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	$0 Copay	$5/visit	$25/visit	$10/visit PT/OT/ST; $10/visit CORF	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0/visit for hearing/vision/dental; $10/visit for chiropractic/podiatry	20% coinsurance	$0 Copay	$0 Copay (unlimited trips)	Not Covered	$15/visit for routine vision	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$0 Copay												50	50	20	0	100	0.06	0.055692475	46.25	66.5	0	0.075	0	0	10	0	5	25	10	0.098	10	0.2	0	0	0	15	25	0	0	0	0											NO	49	49	19.6	0	98	0.0588	0.054578626	45.325	65.17	0	0.0735	0	0	9.8	0	4.9	24.5	9.8	0.09604	9.8	0.196	0	0	0	14.7	24.5	0	0	0	0												3.7311	0.048393032	0.576066984	0	1.717059638	0.47282992	0.027813463	3.604682367	1.182683755	0	1.455294777	0	0	0	0	1.901330452	0.505128103	1.641360062	9.957197639	0.49	0.022852441	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.9054		0.569497169	3.7311	0.048393032	0.576066984	0	1.717059638	0.47282992	0.027813463	3.604682367	1.182683755	0	1.455294777	0	0	0	0	1.901330452	0.505128103	1.641360062	9.957197639	0.49	0.022852441	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.9054	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			3.7311	0.048393032	0.576066984	0	1.717059638	0.47282992	0.027813463	3.604682367	1.182683755	0	1.455294777	0	0	0	0	1.901330452	0.505128103	1.641360062	9.957197639	0.49	0.022852441	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.9054
H9104_009_0	2011	8																															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	877.1775836	13.26130705	420.7387325	0	293.0792381	11.27216618	0.499282041	1829.874033	158.2943048	0	19.39890039	0	0	0	0	4337.512701	241.3424731	1960.541763	129.369303	600	0.157886104	0	0	0	279.96875	111.9875	0	0	0	0											6700	"$50/day (1-8), $0/day (9-90)"	"$50/day (1-8), $0/day (9-90)"	"$0/day (1-20), $20/day (21-100)"	$0 Copay	$100/run	0% - 20%	0% - 20%	$50 ER ($0 if admitted immed.) Worldwide coverage; $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	$0 Copay	$5/visit	$25/visit	$10/visit PT/OT/ST; $10/visit CORF	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0/visit for hearing/vision/dental; $10/visit for chiropractic/podiatry	20% coinsurance	$0 Copay	$0 Copay (unlimited trips)	Not Covered	$15/visit for routine vision	$25 (1 pair every 2 years)	Not Covered	Not Covered	$0 Copay	$0 Copay												50	50	20	0	100	0.06	0.055692475	46.25	66.5	0	0.075	0	0	10	0	5	25	10	0.098	10	0.2	0	0	0	15	25	0	0	0	0											NO	49	49	19.6	0	98	0.0588	0.054578626	45.325	65.17	0	0.0735	0	0	9.8	0	4.9	24.5	9.8	0.09604	9.8	0.196	0	0	0	14.7	24.5	0	0	0	0												3.5818	0.054150337	0.687206596	0	2.393480445	0.662803371	0.027250128	6.911586712	0.859669987	0	1.425819179	0	0	0	0	1.77115102	0.492740883	1.601109106	12.42462786	0.49	0.030945676	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.986		0.69359087	3.5818	0.054150337	0.687206596	0	2.393480445	0.662803371	0.027250128	6.911586712	0.859669987	0	1.425819179	0	0	0	0	1.77115102	0.492740883	1.601109106	12.42462786	0.49	0.030945676	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.986	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			3.5818	0.054150337	0.687206596	0	2.393480445	0.662803371	0.027250128	6.911586712	0.859669987	0	1.425819179	0	0	0	0	1.77115102	0.492740883	1.601109106	12.42462786	0.49	0.030945676	0	0	0	0.342961719	0.228641146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.986
H9184_002_0	2011	4																															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	1235.763919	12.6780661	1200.98902	6.21496484	201.0032	8.228079435	3.698230694	360.685251	170.7696159	5.431236004	19.5850835	0	0.030275479	886.2348874	0	2749.558144	216.2633122	134.0847399	29.08859594	26.12518004	7.080112562	0.166213678	0	0	0	0	0	0	0	0												1a:  Acute - $250/$0/day for 1-7/8-90	"1b:  Psych - Days 1-60, initial deductible of $1100; days 61-90, $275/day; days 91-150, $550/day"	2:  Skilled Nursing Services - $0/$50/$110/day for 1-10/11-20/21-100 /2:  Non-Medicare Covered Stay - $0/$50/$110/day for 1-10/11-20/21-100	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 - 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 - $0/visit/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $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/17a:  Vision Exams - $0/visit"	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $40/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/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 - $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 - $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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/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 - Non-Routine 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:  Eye Glasses & Contact Lenses - $0/service			14a:  Written health education materials - $0/service/14c:  Routine Exams - $0/visit													250	0.061610448	46	0	150	0.2	0.2	43.42014043	249.580843	0	0.2	0	0.2	61.80100367	0	39.75729014	20	40	0	39.99433749	0.2	0	0	0	0	0	0	0	0	0											NO	235.0516166	0.057926542	43.24949745	0	141.03097	0.188041293	0.188041293	40.83401997	234.6575225	0	0.188041293	0	0.188041293	58.10570328	0	37.38006127	18.80412933	37.60825865	0	37.60293473	0.188041293	0	0	0	0	0	0	0	0	0												24.2057	0.734396528	4.328514297	0	2.362306355	1.547218698	0.695420082	1.227352395	3.339364581	0	3.68280443	0	0.00569304	4.291275117	0	8.564887658	0.338886941	0.420224465	0	0.081865287	1.331353523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1573	0	3.634659127	24.2057	0.734396528	4.328514297	0	2.362306355	1.547218698	0.695420082	1.227352395	3.339364581	0	3.68280443	0	0.00569304	4.291275117	0	8.564887658	0.338886941	0.420224465	0	0.081865287	1.331353523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1573	YES	1a:  Acute - 20.0%	1b:  Psych - 30.0%	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 - $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 - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	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%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/14c:  Routine Exams - 20.0%/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/Vision Exams:   - /visit"	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/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/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 - 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:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%/7a:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7a:  Phys Svcs (Surgery, Misc. Med, 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%		"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 - Non-Routine 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:  Eye Glasses & Contact Lenses - $0/service			14c:  Routine Exams - 20.0%												6700	5.9291	0	0.9219	0.1514	0.1453	0.3222	0.1448	0.146	0.5104	0.1203	0.5	0	0.0005	0.3117	0.3907	0.9955	0	0.0236	0.3528	0.2122	0.1502	0.0037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.3323	0	2.963647793	30.1348	0.734396528	5.250411513	0.151427451	2.507612261	1.869417398	0.840237003	1.373354952	3.849744837	0.120286085	4.182825198	0	0.006202645	4.602987477	0.390664712	9.56035599	0.338886941	0.443788906	0.352810161	0.294101628	1.481542314	0.003736276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4896
H9302_001_0	2011	5																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	V		Coin					V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	934.6683254	28.69562531	432.1636882	0	160.7902294	12.19093637	1.059446488	351.1591407	558.960675	0	130.283796	0	0	147.0151801	5164.99232	4274.277031	140.0152721	432.1076989	284.205988	0	44.00021942	0	0	0	0	60.30710532	30.76353484	0	0	0											1200	$125/Days 1-5 for IP Med/Surg; $125/Days 1-5 for IP Additional Non-Medicare Covered Days; PBP 1a	$125/Days 1-5 for IP MH/SA; PBP 1b	$100/Days 11-22 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for OP ER; $50/Case for Worldwide OP ER; $15/Case for Urgent Care; PBP 4a, 4b, 7a"	"$50/Case for OP Surg; $50/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$15/Case for Therapeutic Radiology; $130/Case for OP Rad - PET/CAT/MRI; PBP 8b	$15/Visit for OP Clinic Services; PBP 9a	20% Coinsurance for Renal Dialysis; PBP 12	"$15/Case for CORF; $50/Day for Partial Hosp; $15/Case for OP - PT/OT/ST; $15/Case for OP Substance Abuse; $15/Case for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$5/Visit for PCP OV; PBP 7a, 7g, 14b, 14c"	"$15/Visit for Chiro - cvd; $15/Visit for SCP OV; $15/Visit for SCP - Office Surg; $5/Visit for Diabetic Foot Care, $15/Visit for all other covered Podiatry Services; $15/Visit for Vision Exams; $15/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$15/Visit for Psych Services; $15/Visit for MH Services; PBP 7e, 7h"	"$15/Visit for OP PT/OT/ST; $15/Visit for PT/ST; PBP 7c, 7i"	"$15/Visit for Therapeutic Radiology; $130/Visit for Office Rad - PET/CAT/MRI; PBP 7d, 8b"	"No Cost Sharing; PBP 7d, 7g, 14d-j"	20% Coinsurance for Medicare Part B Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	$15/Visit for Glasses/Contacts (non-cvd) - ($120 allowance for hardware every 12 months); PBP 17b	$15/Visit for Routine Hearing Test (non-cvd); PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b-f											0	125	125	100	0	100	0.2	0.2	44.43360255	50	0	108.2545349	0	0	15.05073243	5	14.92563457	15	15	104.7658157	0	0.2	0	0	0	0	15	15	0	0	0											NO	87.9664258	87.9664258	70.37314064	0	70.37314064	0.140746281	0.140746281	31.26932162	35.18657032	0	76.1821161	0	0	10.5916731	3.518657032	10.50363781	10.5559711	10.5559711	73.72699485	0	0.140746281	0	0	0	0	10.5559711	10.5559711	0	0	0												6.8516	0.2103543	2.534393001	0	0.942942786	1.715828959	0.149113153	0.915042342	1.638992425	0	0.827107939	0	0	0.129761394	1.514486379	3.741288152	0.12316643	0.380109698	1.746137785	0	6.192867259	0	0	0	0	0.053050005	0.027061582	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6933	0	12.5007907	6.8516	0.2103543	2.534393001	0	0.942942786	1.715828959	0.149113153	0.915042342	1.638992425	0	0.827107939	0	0	0.129761394	1.514486379	3.741288152	0.12316643	0.380109698	1.746137785	0	6.192867259	0	0	0	0	0.053050005	0.027061582	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6933	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.8516	0.2103543	2.534393001	0	0.942942786	1.715828959	0.149113153	0.915042342	1.638992425	0	0.827107939	0	0	0.129761394	1.514486379	3.741288152	0.12316643	0.380109698	1.746137785	0	6.192867259	0	0	0	0	0.053050005	0.027061582	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6933
H9302_003_0	2011	5																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	V		Coin					V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	696.3605528	8.77356609	479.0011734	0	97.26329451	8.358683434	0.746548404	282.6206124	376.0242057	0	114.971419	0	0	82.45932764	4122.5934	3014.702806	46.68800388	270.8406749	201.5804472	0	30.86780924	0	0	0	0	64.47477442	5.614015185	0	0	0											2250	$200/Days 1-5 for IP Med/Surg; $200/Days 1-5 for Additional Non-Medicare Covered Days; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	$100/Days 11-33 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for OP ER; $50/Case for Worldwide OP ER; $30/Case for Urgent Care; PBP 4a, 4b, 7a"	"$150/Case for OP Surg; $150/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$30/Case for Therapeutic Radiology; $130/Case for OP Rad - PET/CAT/MRI; PBP 8b	$15/Visit for OP Clinic Services; PBP 9a	20% Coinsurance for Renal Dialysis; PBP 12	"$30/Case for CORF; $150/Day for Partial Hosp; $30/Case for OP - PT/OT/ST; $30/Case for OP Substance Abuse; $30/Case for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$10/Visit for PCP OV; PBP 7a, 7g, 14b, 14c"	"$15/Visit for Chiro - cvd; $30/Visit for SCP OV; $30/Visit for SCP - Office Surg; $10/Visit for Diabetic Foot Care, $30/Visit for all other covered Podiatry Services; $30/Visit for Vision Exams; $30/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$30/Visit for Psych Services; $30/Visit for MH Services; PBP 7e, 7h"	"$30/Visit for OP PT/OT/ST; $30/Visit for PT/ST; PBP 7c, 7i"	"$30/Visit for Therapeutic Radiology; $130/Visit for Office Rad - PET/CAT/MRI; PBP 7d, 8b"	"No Cost Sharing; PBP 14d-j, 8b"	20% Coinsurance for Medicare Part B Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	$15/Visit for Glasses/Contacts (non-cvd) - ($120 allowance for hardware every 12 months); PBP 17b	$30/Visit for Routine Hearing Test (non-cvd); PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b-f											0	200	200	100	0	150	0.2	0.2	47.83980462	150	0	110.0027156	0	0	30.49232774	10	28.20929294	30	30	105.473364	0	0.2	0	0	0	0	15	30	0	0	0											NO	164.8277363	164.8277363	82.41386816	0	123.6208022	0.164827736	0.164827736	39.42663351	123.6208022	0	90.65749303	0	0	25.12990679	8.241386816	23.24836949	24.72416045	24.72416045	86.92467912	0	0.164827736	0	0	0	0	12.36208022	24.72416045	0	0	0												9.565	0.120510587	3.289694963	0	1.001980541	1.377742869	0.123051883	0.928564942	3.873701165	0	0.868585051	0	0	0.172682935	2.831323908	5.840577061	0.096193475	0.558025692	1.460192974	0	5.087871123	0	0	0	0	0.066420194	0.011566818	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2736	0	7.953749659	9.565	0.120510587	3.289694963	0	1.001980541	1.377742869	0.123051883	0.928564942	3.873701165	0	0.868585051	0	0	0.172682935	2.831323908	5.840577061	0.096193475	0.558025692	1.460192974	0	5.087871123	0	0	0	0	0.066420194	0.011566818	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2736	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.565	0.120510587	3.289694963	0	1.001980541	1.377742869	0.123051883	0.928564942	3.873701165	0	0.868585051	0	0	0.172682935	2.831323908	5.840577061	0.096193475	0.558025692	1.460192974	0	5.087871123	0	0	0	0	0.066420194	0.011566818	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2736
H9302_004_0	2011	4																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	V		Coin					V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	718.8150086	8.505947883	478.5449339	0	117.770089	4.89717741	0.77450778	246.8264448	361.9960022	0	103.0063464	0	0	70.73810441	3561.199192	2858.998837	37.43573276	272.0532723	183.4812548	0	20.72276399	0	0	0	0	64.47477442	13.77615649	0	0	0											2250	$200/Days 1-5 for IP Med/Surg; $200/Days 1-5 for Additional Non-Medicare Covered Days; PBP 1a	$200/Days 1-5 for IP MH/SA; PBP 1b	$100/Days 11-33 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for OP ER; $50/Case for Worldwide OP ER; $30/Case for Urgent Care; PBP 4a, 4b, 7a"	"$150/Case for OP Surg; $150/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$30/Case for Therapeutic Radiology; $130/Case for OP Rad - PET/CAT/MRI; PBP 8b	$15/Visit for OP Clinic Services; PBP 9a	20% Coinsurance for Renal Dialysis; PBP 12	"$30/Case for CORF; $150/Day for Partial Hosp; $30/Case for OP - PT/OT/ST; $30/Case for OP Substance Abuse; $30/Case for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$10/Visit for PCP OV; PBP 7a, 7g, 14b, 14c"	"$15/Visit for Chiro - cvd; $30/Visit for SCP OV; $30/Visit for SCP - Office Surg; $10/Visit for Diabetic Foot Care, $30/Visit for all other covered Podiatry Services; $30/Visit for Vision Exams; $30/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$30/Visit for Psych Services; $30/Visit for MH Services; PBP 7e, 7h"	"$30/Visit for OP PT/OT/ST; $30/Visit for PT/ST; PBP 7c, 7i"	"$30/Visit for Therapeutic Radiology; $130/Visit for Office Rad - PET/CAT/MRI; PBP 7d, 8b"	"No Cost Sharing; PBP 14d-j, 8b"	20% Coinsurance for Medicare Part B Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	$15/Visit for Glasses/Contacts (non-cvd) - ($120 allowance for hardware every 12 months); PBP 17b	$30/Visit for Routine Hearing Test (non-cvd); PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b-f											0	200	200	100	0	150	0.2	0.2	47.52801585	150	0	111.5459064	0	0	30.39617875	10	28.13146787	30	30	104.8094886	0	0.2	0	0	0	0	15	30	0	0	0											NO	169.5161609	169.5161609	84.75808045	0	127.1371207	0.169516161	0.169516161	40.28383391	127.1371207	0	94.54416912	0	0	25.76321764	8.475808045	23.84369217	25.42742414	25.42742414	88.83451066	0	0.169516161	0	0	0	0	12.71371207	25.42742414	0	0	0												10.1542	0.120157969	3.380045834	0	1.247745835	0.830150714	0.131291585	0.828592959	3.835260784	0	0.811554119	0	0	0.151870098	2.51533673	5.68075735	0.079324521	0.576467829	1.358288957	0	3.512843395	0	0	0	0	0.068309476	0.029191014	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3114	0	6.35	10.1542	0.120157969	3.380045834	0	1.247745835	0.830150714	0.131291585	0.828592959	3.835260784	0	0.811554119	0	0	0.151870098	2.51533673	5.68075735	0.079324521	0.576467829	1.358288957	0	3.512843395	0	0	0	0	0.068309476	0.029191014	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3114	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.1542	0.120157969	3.380045834	0	1.247745835	0.830150714	0.131291585	0.828592959	3.835260784	0	0.811554119	0	0	0.151870098	2.51533673	5.68075735	0.079324521	0.576467829	1.358288957	0	3.512843395	0	0	0	0	0.068309476	0.029191014	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3114
H9302_005_0	2011	5																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	V		Coin					V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	920.018815	35.66723281	358.471092	0	147.2655772	7.71121806	2.502036572	389.1546677	598.9559567	0	213.9706598	0	0	83.84673371	5162.658858	3915.385485	44.10078568	446.7841337	170.1084747	0	40.68834721	0	0	0	0	60.30710532	8.233981139	0	0	0											1200	$125/Days 1-5 for IP Med/Surg; $125/Days 1-5 for Additional Non-Medicare Covered Days; PBP 1a	$125/Days 1-5 for IP MH/SA; PBP 1b	$100/Days 11-22 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for OP ER; $50/Case for Worldwide OP ER; $15/Case for Urgent Care; PBP 4a, 4b, 7a"	"$50/Case for OP Surg; $50/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$15/Case for Therapeutic Radiology; $130/Case for OP Rad - PET/CAT/MRI; PBP 8b	$15/Visit for OP Clinic Services; PBP 9a	20% Coinsurance for Renal Dialysis; PBP 12	"$15/Case for CORF; $50/Day for Partial Hosp; $15/Case for OP - PT/OT/ST; $15/Case for OP Substance Abuse; $15/Case for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$5/Visit for PCP OV; PBP 7a, 7g, 14b, 14c"	"$15/Visit for Chiro - cvd; $15/Visit for SCP OV; $15/Visit for SCP - Office Surg; $5/Visit for Diabetic Foot Care, $15/Visit for all other covered Podiatry Services; $15/Visit for Vision Exams; $15/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$15/Visit for Psych Services; $15/Visit for MH Services; PBP 7e, 7h"	"$15/Visit for OP PT/OT/ST; $15/Visit for PT/ST; PBP 7c, 7i"	"$15/Visit for Therapeutic Radiology; $130/Visit for Office Rad - PET/CAT/MRI; PBP 7d, 8b"	"No Cost Sharing; PBP 7d, 7g, 14d-j"	20% Coinsurance for Medicare Part B Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	$15/Visit for Glasses/Contacts (non-cvd) - ($120 allowance for hardware every 12 months); PBP 17b	$15/Visit for Routine Hearing Test (non-cvd); PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b-f											0	125	125	100	0	100	0.2	0.2	48.02072293	50	0	113.328134	0	0	15.54631833	5	14.93104077	15	15	91.69674259	0	0.2	0	0	0	0	15	15	0	0	0											NO	88.15760271	88.15760271	70.52608217	0	70.52608217	0.141052164	0.141052164	33.86713451	35.26304108	0	79.9258929	0	0	10.96420924	3.526304108	10.53027808	10.57891232	10.57891232	64.67012002	0	0.141052164	0	0	0	0	10.57891232	10.57891232	0	0	0												6.7589	0.262028145	2.106796807	0	0.86550535	1.087683997	0.352917674	1.098296123	1.760084042	0	1.42514967	0	0	0.076609428	1.517092095	3.435841497	0.038878195	0.393874182	0.916744623	0	5.739179437	0	0	0	0	0.053165298	0.00725888	0	0	0	0	0	0	0	0	0	0	0	0	0	27.896	0	11.65815804	6.7589	0.262028145	2.106796807	0	0.86550535	1.087683997	0.352917674	1.098296123	1.760084042	0	1.42514967	0	0	0.076609428	1.517092095	3.435841497	0.038878195	0.393874182	0.916744623	0	5.739179437	0	0	0	0	0.053165298	0.00725888	0	0	0	0	0	0	0	0	0	0	0	0	0	27.896	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.7589	0.262028145	2.106796807	0	0.86550535	1.087683997	0.352917674	1.098296123	1.760084042	0	1.42514967	0	0	0.076609428	1.517092095	3.435841497	0.038878195	0.393874182	0.916744623	0	5.739179437	0	0	0	0	0.053165298	0.00725888	0	0	0	0	0	0	0	0	0	0	0	0	0	27.896
H9302_007_0	2011	5																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	V		Coin					V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	587.225154	32.14747469	535.3530997	0	75.00810599	5.546901804	0.76885434	228.0463851	320.3923199	0	106.0332804	0	0	91.1606127	3122.382179	2508.888113	49.30063606	227.5571549	155.1558765	0	27.24396195	0	0	0	0	67.58869513	15.10455232	0	0	0											3400	$275/Days 1-8 for IP Med/Surg; $275/Days 1-8 for non-covered additional days IP Med/Surg; PBP 1a	$300/Days 1-7 for IP MH/SA; PBP 1b	$100/Days 1-30 for SNF; PBP 2	No Cost Sharing; PBP 6	$200/Trip for Ambulance; PBP 10a	25% Coinsurance for DME; PBP 11a	"25% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for OP ER; $50/Case for Worldwide OP ER; $40/Case for Urgent Care; PBP 4a, 4b, 7a"	"$300/Case for OP Surg; $300/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$40/Case for Therapeautic Rad; $250/Case for OP Rad - PET/CAT/MRI; PBP 8b	$40/Visit for OP Clinic Services; PBP 9a	23% Coinsurance for Renal Dialysis; PBP 12	"$40/Case for CORF; $275/Day for Partial Hosp; $40/Case for OP - PT/OT/ST; $40/Case for OP Substance Abuse; $40/Case for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$15/Visit for PCP OV; PBP 7a, 7g, 14b, 14c"	"$15/Visit for Chiro - cvd; $40/Visit for SCP OV; $40/Visit for SCP - Office Surg; $15/Visit for Diabetic Foot Care, $40/Visit for all other covered Podiatry Services; $40/Visit for Vision Exams; $40/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$40/Visit for Psych Services; $40/Visit for MH Services; PBP 7e, 7h"	"$40/Visit for OP PT/OT/ST; $40/Visit for PT/ST; PBP 7c, 7i"	"$40/Visit for Office Therapeautic Rad; $250/Visit for Office Rad - PET/CAT/MRI; PBP 7d, 8b"	"No Cost Sharing; PBP 7d, 7g, 14d-j"	20% Coinsurance for Medicare Part B Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	$15/Visit for Glasses/Contacts (non-cvd) - ($120 allowance for hardware every 12 months); PBP 17b	$40/Visit for Routine Hearing Test (non-cvd); PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b-f											0	275	300	100	0	200	0.25	0.25	48.75663457	300	0	204.1652572	0	0	40.68909809	15	36.5261387	40	40	195.0444911	0	0.2	0	0	0	0	15	40	0	0	0											NO	232.5188952	253.6569766	84.55232554	0	169.1046511	0.211380814	0.211380814	41.22486839	253.6569766	0	172.6264729	0	0	34.40357868	12.68284883	30.8836997	33.82093022	33.82093022	164.914653	0	0.169104651	0	0	0	0	12.68284883	33.82093022	0	0	0												11.3784	0.679535936	3.772112464	0	1.057018299	1.172508618	0.162521056	0.783431851	6.772478933	0	1.525345933	0	0	0.261354276	3.300058431	6.456978921	0.138949448	0.641349555	2.132289795	0	4.607080679	0	0	0	0	0.071434767	0.042570834	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9554	0	8.21333856	11.3784	0.679535936	3.772112464	0	1.057018299	1.172508618	0.162521056	0.783431851	6.772478933	0	1.525345933	0	0	0.261354276	3.300058431	6.456978921	0.138949448	0.641349555	2.132289795	0	4.607080679	0	0	0	0	0.071434767	0.042570834	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9554	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.3784	0.679535936	3.772112464	0	1.057018299	1.172508618	0.162521056	0.783431851	6.772478933	0	1.525345933	0	0	0.261354276	3.300058431	6.456978921	0.138949448	0.641349555	2.132289795	0	4.607080679	0	0	0	0	0.071434767	0.042570834	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9554
H9302_008_0	2011	5																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	V		Coin					V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1028.069799	29.33902214	444.5925551	0	160.9159712	10.77503417	1.698616785	400.7498996	595.0852268	0	178.8892105	0	0	122.6671784	5753.590525	4228.291241	86.2666064	433.4582581	264.5584727	0	43.7296812	0	0	0	0	60.30710532	19.25828837	0	0	0											1200	$125/Days 1-5 for IP Med/Surg; $125/Days 1-5 for Additional Non-Medicare Covered Days; PBP 1a	$125/Days 1-5 for IP MH/SA; PBP 1b	$100/Days 11-22 for SNF; PBP 2	No Cost Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Case for OP ER; $50/Case for Worldwide OP ER; $15/Case for Urgent Care; PBP 4a, 4b, 7a"	"$50/Case for OP Surg; $50/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$15/Case for Therapeutic Radiology; $130/Case for OP Rad - PET/CAT/MRI; PBP 8b	$15/Visit for OP Clinic Services; PBP 9a	20% Coinsurance for Renal Dialysis; PBP 12	"$15/Case for CORF; $50/Day for Partial Hosp; $15/Case for OP - PT/OT/ST; $15/Case for OP Substance Abuse; $15/Case for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$5/Visit for PCP OV; PBP 7a, 7g, 14b, 14c"	"$15/Visit for Chiro - cvd; $15/Visit for SCP OV; $15/Visit for SCP - Office Surg; $5/Visit for Diabetic Foot Care, $15/Visit for all other covered Podiatry Services; $15/Visit for Vision Exams; $15/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$15/Visit for Psych Services; $15/Visit for MH Services; PBP 7e, 7h"	"$15/Visit for OP PT/OT/ST; $15/Visit for PT/ST; PBP 7c, 7i"	"$15/Visit for Therapeutic Radiology; $130/Visit for Office Rad - PET/CAT/MRI; PBP 7d, 8b"	"No Cost Sharing; PBP 7d, 7g, 14d-j"	20% Coinsurance for Medicare Part B Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	No Cost Sharing; PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	$15/Visit for Glasses/Contacts (non-cvd) - ($120 allowance for hardware every 12 months); PBP 17b	$15/Visit for Routine Hearing Test (non-cvd); PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b-f											0	125	125	100	0	100	0.2	0.2	46.06210675	50	0	109.7180904	0	0	15.18753638	5	14.92889254	15	15	100.7330635	0	0.2	0	0	0	0	15	15	0	0	0											NO	86.51755851	86.51755851	69.21404681	0	69.21404681	0.138428094	0.138428094	31.88144812	34.6070234	0	75.94033042	0	0	10.51190854	3.46070234	10.33289067	10.38210702	10.38210702	69.7214297	0	0.138428094	0	0	0	0	10.38210702	10.38210702	0	0	0												7.4122	0.21152838	2.564337494	0	0.92813713	1.491567439	0.235136283	1.064707261	1.716177364	0	1.132075479	0	0	0.107455513	1.659288683	3.640872593	0.074635762	0.375017502	1.537116246	0	6.053416403	0	0	0	0	0.052176235	0.016661801	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2725	0	13.46500091	7.4122	0.21152838	2.564337494	0	0.92813713	1.491567439	0.235136283	1.064707261	1.716177364	0	1.132075479	0	0	0.107455513	1.659288683	3.640872593	0.074635762	0.375017502	1.537116246	0	6.053416403	0	0	0	0	0.052176235	0.016661801	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2725	NO	PBP 1a	PBP 1b	PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	"PBP 4a, 4b, 7a"	"PBP 9a, 9b"	PBP 8a	PBP 8b	PBP 9a	PBP 12	"$50/Visit for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"PBP 7a, 7g, 14b, 14c"	"$50/Visit for SCP OV; $50/Visit for SCP - IP Visit; $50/Visit for SCP - Office Surg; $50/Visit for Podiatry; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$50/Visit for Psych Services; $50/Visit for MH Services; PBP 7e, 7h"	"$50/Visit for OP PT/OT/ST; $50/Visit for PT/ST; PBP 7c, 7i"	"PBP 7d, 8b"	"PBP 7d, 7g, 14d-j"	PBP 15	"PBP 13a, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f												0	0	0	0	0	0	0	0	0	0	0	0	0	0.0103	0	0.9978	0.0185	0.093	0	0	0	0	0	0	0	0	0	0	0	0											1.1196	0	0	7.4122	0.21152838	2.564337494	0	0.92813713	1.491567439	0.235136283	1.064707261	1.716177364	0	1.132075479	0	0	0.117777278	1.659288683	4.638697883	0.093140162	0.467995368	1.537116246	0	6.053416403	0	0	0	0	0.052176235	0.016661801	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3921
H9302_009_0	2011	4																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	V		Coin					V	V														0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	729.8986738	21.09261947	739.2699397	0	102.1028666	6.722032152	1.059686351	254.0710309	368.0086332	0	111.6710785	0	0	76.41103466	3531.713242	2819.304107	53.6920346	269.7829063	165.5269025	0	27.28087155	0	0	0	0	67.58869513	11.38697686	0	0	0											3400	$275/Days 1-8 for IP Med/Surg; $275/Days 1-8 for non-covered additional days IP Med/Surg; PBP 1a	$300/Days 1-7 for IP MH/SA; PBP 1b	$100/Days 1-30 for SNF; PBP 2	No Cost Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	25% Coinsurance for DME; PBP 11a	"25% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for OP ER; $50/Visit for Worldwide OP ER; $40/Visit for Urgent Care; PBP 4a, 4b, 7a"	"$250/Case for OP Surg; $250/Case for ASC services; PBP 9a, 9b"	No Cost Sharing; PBP 8a	$40/Case for OP Therapeautic Rad; $200/Case for OP Rad - PET/CAT/MRI; PBP 8b	$40 for OP Clinic Services; PBP 9a	23% Coinsurance for Renal Dialysis; PBP 12	"$40/Visit for CORF; $250/Day for Partial Hosp; $40/Case for OP - PT/OT/ST; $40/Case for OP Substance Abuse; $40/Case for Cardiac Rehab; PBP 3, 5, 9a, 9c, 9d"	"$10/Visit for PCP OV; PBP 7a, 7g, 14b, 14c"	"$15/Visit for Chiro - cvd; $40/Visit for SCP OV; $40/Visit for SCP - Office Surg; $10/Visit for Diabetic Foot Care, $40/Visit for all other covered Podiatry Services; $40/Visit for Vision Exams; $40/Visit for Hearing Exams; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"$40/Visit for Psych Services; $40/Visit for MH Services; PBP 7e, 7h"	"$40/Visit for OP PT/OT/ST; $40/Visit for PT/ST; PBP 7c, 7i"	"$40/Visit for Office Therapeautic Rad; $200/Visit for Office Rad - PET/CAT/MRI; PBP 7d, 8b"	"No Cost Sharing; PBP 7d, 7g, 14d-j"	20% Coinsurance for Medicare Part B Drugs; PBP 15	"No Cost Sharing; PBP 13a, 14a"	PBP 10b	"PBP 16a, 16b"	No Cost Sharing; PBP 17a	$15/Visit for Glasses/Contacts (non-cvd) - ($120 allowance for hardware every 12 months); PBP 17b	$40/Visit for Routine Hearing Test (non-cvd); PBP 18a	PBP 18b	No Cost Sharing; PBP 14a	PBP 13b-f											0	275	300	100	0	150	0.25	0.25	48.95068732	250	0	171.1025742	0	0	41.15500619	10	36.85332807	40	40	158.3957949	0	0.2	0	0	0	0	15	40	0	0	0											NO	236.2044707	257.6776043	85.89253478	0	128.8388022	0.214731337	0.214731337	42.04498613	214.731337	0	146.9643381	0	0	35.34907801	8.589253478	31.65425763	34.35701391	34.35701391	136.0501633	0	0.17178507	0	0	0	0	12.88388022	34.35701391	0	0	0												14.3671	0.452924638	5.291480751	0	1.096234252	1.443430951	0.227547867	0.890201081	6.585248819	0	1.367638844	0	0	0.225088302	2.527898354	7.436914879	0.153724832	0.772411255	1.876663509	0	4.686446416	0	0	0	0	0.072567054	0.032601877	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5061	0	8.131161484	14.3671	0.452924638	5.291480751	0	1.096234252	1.443430951	0.227547867	0.890201081	6.585248819	0	1.367638844	0	0	0.225088302	2.527898354	7.436914879	0.153724832	0.772411255	1.876663509	0	4.686446416	0	0	0	0	0.072567054	0.032601877	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5061	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	14.3671	0.452924638	5.291480751	0	1.096234252	1.443430951	0.227547867	0.890201081	6.585248819	0	1.367638844	0	0	0.225088302	2.527898354	7.436914879	0.153724832	0.772411255	1.876663509	0	4.686446416	0	0	0	0	0.072567054	0.032601877	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5061
H9302_801_0	2011	4																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	291.0536617	4.500929016	52.86058748	0	8.441684068	10.05536006	1.844407928	20.24234733	81.20851614	9.270962503	20.77723472	0	0	14.98392161	62.04540033	70.77424348	0.899416838	5.302996592	33.71189912	87.9814702	40.80893257	0.050917089	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9a	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d"	"Medicare-FFS Cost Sharing; PBP 7a, 14b, 14c"	"Medicare-FFS Cost Sharing; PBP 7b, 7d, 7f, 7g, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	Medicare-FFS Cost Sharing; PBP 7d	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14d-j"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 13a, 14a"	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-f											0	0.072140506	0.072140506	0.142892862	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	0.066809732	0.066809732	0.132333889	0	0.21578262	0.21578262	0.21578262	0.21578262	0.21578262	0.21578262	0.21578262	0	0	0.21578262	0.21578262	0.21578262	0.21578262	0.21578262	0.21578262	0.21578262	0.21578262	0.21578262	0	0	0	0	0	0	0	0												19.4452	0.30070586	6.9952471	0	1.821568706	2.169771939	0.397991175	4.367946742	17.52338638	2.000512579	4.483366146	0	0	3.233269864	13.38831905	15.27185169	0.194078522	1.144294499	7.274441919	18.98487216	8.805858392	0.010987023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8137	0	10.19830423	19.4452	0.30070586	6.9952471	0	1.821568706	2.169771939	0.397991175	4.367946742	17.52338638	2.000512579	4.483366146	0	0	3.233269864	13.38831905	15.27185169	0.194078522	1.144294499	7.274441919	18.98487216	8.805858392	0.010987023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8137	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.4452	0.30070586	6.9952471	0	1.821568706	2.169771939	0.397991175	4.367946742	17.52338638	2.000512579	4.483366146	0	0	3.233269864	13.38831905	15.27185169	0.194078522	1.144294499	7.274441919	18.98487216	8.805858392	0.010987023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8137
H9385_001_0	2011	6																															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	V	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	YES	720.8848676	19.1894489	188.5043719	67.29423093	54.96493392	76.1216023	23.92945647	37.5130018	13.76788671	6.620845156	12.80400377	0	1.770967977	71.82502644	163.5641846	166.675665	17.30949816	20.39077008	169.2282874	55.43912205	1.437020541	0.231536663	0	11.0075	0.566182696	0.365760417	0	0	0	0.712141884											5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0 cost sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	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	$0 cost sharing	$25/visit for routine vision	$0 cost sharing	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	25	0	0	0	0	0.2											NO	0.077362132	0.077362132	0.130054267	0	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0	0	24.5	0	0	0	0	0.196												55.7692	1.484536679	24.51579798	0	12.55069301	17.38160667	5.46405209	8.565718831	3.143759252	1.511803783	2.923666221	0	0.404382828	16.40052654	37.34824591	38.05872136	3.952450809	4.65602844	38.64158714	12.65896913	0.32812927	0.052869082	0	0	0.001155956	0	0	0	0	0.139579809	0	0	0	0	0	0	0	0	0	0	285.9535		5.716254707	55.7692	1.484536679	24.51579798	0	12.55069301	17.38160667	5.46405209	8.565718831	3.143759252	1.511803783	2.923666221	0	0.404382828	16.40052654	37.34824591	38.05872136	3.952450809	4.65602844	38.64158714	12.65896913	0.32812927	0.052869082	0	0	0.001155956	0	0	0	0	0.139579809	0	0	0	0	0	0	0	0	0	0	285.9535	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			55.7692	1.484536679	24.51579798	0	12.55069301	17.38160667	5.46405209	8.565718831	3.143759252	1.511803783	2.923666221	0	0.404382828	16.40052654	37.34824591	38.05872136	3.952450809	4.65602844	38.64158714	12.65896913	0.32812927	0.052869082	0	0	0.001155956	0	0	0	0	0.139579809	0	0	0	0	0	0	0	0	0	0	285.9535
H9385_002_0	2011	7																															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	YES	600.989801	18.00584882	256.7691087	0	145.9378535	9.657699655	6.054101941	205.3072838	334.103489	0	4.557442933	0	34.60491264	357.4564573	3819.531	3338.153778	164.6579392	477.0779965	10.32015448	952.0956739	4.812531374	0	0	0	357.934172	0	0	0	0	0											5000	$150/day (1-5); $0/day (6-90)	$200/day (1-7); $0/day (8-90)	$0/day (1-20); $100/day (21-100)	$0 Copay	$150/run	0.2	0.2	$50 ER ($0 if admitted immed.) Worldwide coverage; $30 Urgent care	$150/OP hospital and $150/ASC visits	$0 Copay	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	25	$30/visit cardiac rehab	$10/visit	$35/visit	$30/visit	$30/visit PT/OT/ST; $30/visit CORF	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$30/visit for dental/chiropractic/podiatry; $10/visit for hearing/vision	20% coinsurance	$0 Copay	Not Covered	Not Covered	$5/visit for routine vision	Not Covered	Not Covered	Not Covered	$0 Copay	Silver Sneakers												150	200	100	0	150	0.233	0.233	42	150	0	0.233	0	25	30	10	35	30	30	0.233	16.91862033	0.233	0	0	0	5	0	0	0	0	0											NO	147	196	98	0	147	0.22834	0.22834	41.16	147	0	0.22834	0	24.5	29.4	9.8	34.3	29.4	29.4	0.22834	16.58024792	0.22834	0	0	0	4.9	0	0	0	0	0												7.3621	0.294095531	2.096947721	0	1.787738705	2.205239139	1.382393637	0.704203983	4.09276774	0	1.040646519	0	0.070651697	0.87576832	3.11928365	9.541556214	0.403411951	1.168841091	2.356504073	1.315498527	1.098893414	0	0	0	0.146156454	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0627		0.748171238	7.3621	0.294095531	2.096947721	0	1.787738705	2.205239139	1.382393637	0.704203983	4.09276774	0	1.040646519	0	0.070651697	0.87576832	3.11928365	9.541556214	0.403411951	1.168841091	2.356504073	1.315498527	1.098893414	0	0	0	0.146156454	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0627	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			7.3621	0.294095531	2.096947721	0	1.787738705	2.205239139	1.382393637	0.704203983	4.09276774	0	1.040646519	0	0.070651697	0.87576832	3.11928365	9.541556214	0.403411951	1.168841091	2.356504073	1.315498527	1.098893414	0	0	0	0.146156454	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0627
H9385_805_0	2011	4																															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	YES	183.3043686	0.469702081	30.99158909	42.12790415	7.788123953	12.52365789	5.2532122	11.01168349	41.18283396	2.77933051	4.446928817	0	0.521124471	28.85407426	77.47200346	82.72434268	4.09244764	3.42277439	49.44639679	27.69307206	6.755732736	0.753311375	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	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												0.078940951	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	0.077362132	0.077362132	0.130054267	0	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0	0	0	0	0	0	0	0												14.1808	0.036337154	4.030588414	0	1.778340223	2.859652042	1.199518474	2.514407807	9.403688306	0.634632329	1.015411726	0	0.118993562	6.588539316	17.68995727	18.88927641	0.934469494	0.781556304	11.29059024	6.323436075	1.542604013	0.172011119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9848		2.039696541	14.1808	0.036337154	4.030588414	0	1.778340223	2.859652042	1.199518474	2.514407807	9.403688306	0.634632329	1.015411726	0	0.118993562	6.588539316	17.68995727	18.88927641	0.934469494	0.781556304	11.29059024	6.323436075	1.542604013	0.172011119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9848	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			14.1808	0.036337154	4.030588414	0	1.778340223	2.859652042	1.199518474	2.514407807	9.403688306	0.634632329	1.015411726	0	0.118993562	6.588539316	17.68995727	18.88927641	0.934469494	0.781556304	11.29059024	6.323436075	1.542604013	0.172011119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9848
H9385_807_0	2011	5																															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	YES	183.3043686	0.469702081	30.99158909	42.12790415	7.788123953	12.52365789	5.2532122	11.01168349	41.18283396	2.77933051	4.446928817	0	0.521124471	28.85407426	77.47200346	82.72434268	4.09244764	3.42277439	49.44639679	27.69307206	6.755732736	0.753311375	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	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												0.078940951	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	0.077362132	0.077362132	0.130054267	0	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0	0	0	0	0	0	0	0												14.1808	0.036337154	4.030588414	0	1.778340223	2.859652042	1.199518474	2.514407807	9.403688306	0.634632329	1.015411726	0	0.118993562	6.588539316	17.68995727	18.88927641	0.934469494	0.781556304	11.29059024	6.323436075	1.542604013	0.172011119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9848		2.039696541	14.1808	0.036337154	4.030588414	0	1.778340223	2.859652042	1.199518474	2.514407807	9.403688306	0.634632329	1.015411726	0	0.118993562	6.588539316	17.68995727	18.88927641	0.934469494	0.781556304	11.29059024	6.323436075	1.542604013	0.172011119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9848	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			14.1808	0.036337154	4.030588414	0	1.778340223	2.859652042	1.199518474	2.514407807	9.403688306	0.634632329	1.015411726	0	0.118993562	6.588539316	17.68995727	18.88927641	0.934469494	0.781556304	11.29059024	6.323436075	1.542604013	0.172011119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9848
H9385_808_0	2011	4																															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	YES	183.3043686	0.469702081	30.99158909	42.12790415	7.788123953	12.52365789	5.2532122	11.01168349	41.18283396	2.77933051	4.446928817	0	0.521124471	28.85407426	77.47200346	82.72434268	4.09244764	3.42277439	49.44639679	27.69307206	6.755732736	0.753311375	0	0	0	0	0	0	0	0											6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	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												0.078940951	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	0.077362132	0.077362132	0.130054267	0	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0.22834	0	0	0	0	0	0	0	0												14.1808	0.036337154	4.030588414	0	1.778340223	2.859652042	1.199518474	2.514407807	9.403688306	0.634632329	1.015411726	0	0.118993562	6.588539316	17.68995727	18.88927641	0.934469494	0.781556304	11.29059024	6.323436075	1.542604013	0.172011119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9848		2.039696541	14.1808	0.036337154	4.030588414	0	1.778340223	2.859652042	1.199518474	2.514407807	9.403688306	0.634632329	1.015411726	0	0.118993562	6.588539316	17.68995727	18.88927641	0.934469494	0.781556304	11.29059024	6.323436075	1.542604013	0.172011119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9848	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			14.1808	0.036337154	4.030588414	0	1.778340223	2.859652042	1.199518474	2.514407807	9.403688306	0.634632329	1.015411726	0	0.118993562	6.588539316	17.68995727	18.88927641	0.934469494	0.781556304	11.29059024	6.323436075	1.542604013	0.172011119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9848
H9503_001_0	2011	3	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O		V					O	O	O	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	YES	1395.462302	36.09715224	379.8623731	528.0838729	32.24150817	10.31417116	3.597603581	276.0750367	387.6730681	1413.030998	1390.654814	26.74139875	0.31499752	3.616534289	4095.537722	5470.745876	73.68911077	858.3716015		1221.961944	35.04584475	0		4					4.74	0.15	570.6117559	0.544570697	633.6255079								6000	$195/Day(Days 1-7):1a.IP Acute	$195/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $150 DMAM -- OP,8b. $35 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$35/Visit:7b. $10 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center	"$40-$150/Visit:9d. $50 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- CORF"									140.1309	119.971605	45.243839	0	100	0.2	0.2	50	150	34.528419	60.091258	100	0.2	0.2	10	33.825572	35	36.79147		0	0.2	0		0					0	0	0	0	129.144952								NO	128.953499	110.40219	37.800051	0	90.5204	0.181041	0.181041	45.2602	135.7806	31.255263	54.394847	90.5204	0.181041	0.181041	9.05204	30.619043	31.68214	33.303786		0	0.181041	0		0					0	0	0	0	116.902527									14.9958	0.332100388	1.19656809	0	0.243209518	1.867287861	0.65131375	1.041267615	4.386540149	3.680387955	6.303704653	0.201720176	0.057027466	0.654740984	3.089414273	13.9590836	0.194552394	2.38225201	0	0	6.344734779	0	0	0	0	0	0	0	0	0	0	0	6.17270192	0	0	0	0	0	0	0	67.7544	0	6.929193791	14.9958	0.332100388	1.19656809	0	0.243209518	1.867287861	0.65131375	1.041267615	4.386540149	3.680387955	6.303704653	0.201720176	0.057027466	0.654740984	3.089414273	13.9590836	0.194552394	2.38225201	0	0	6.344734779	0	0	0	0	0	0	0	0	0	0	0	6.17270192	0	0	0	0	0	0	0	67.7544	YES	$250/Day(Days 1-7)	$250/Day(Days 1-7)	40% Coins(Days 1-20) 40%(Days 21-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	$0/Service		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Nutritional benefit 13d	30% Coins	$0/Proc	30% Coins								7500	2.8978	0.0642	0.6692	3.5491	1.0631	2.0181	0.7039	0.17	3.7663	0.463	1.8356	0.0889	0.0095	0.1091	2.5751	4.8084	0.0377	0.4594		0.3488	1.383	0		0					0	0	0.1979	0	0.4132								27.6314	500	6.305204826	17.8936	0.396275127	1.865787707	3.549119776	1.306323801	3.885427612	1.355245222	1.211297734	8.152828033	4.14340856	8.139277519	0.290611652	0.066530909	0.763852599	5.664471345	18.76750742	0.232222684	2.841625699	0	0.348836611	7.727756595	0	0	0	0	0	0	0	0	0	0.197905843	0	6.585913205	0	0	0	0	0	0	0	95.3858
H9503_003_0	2011	3	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Renal Dialysis	Other								A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	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	YES	185.3301	5.984174	427.762201	489.440954	26.838394	9.321716	2.110718	270.50565	333.705429	1252.851474	983.69685	39.283422	0.251312	5.343018	3166.208601	3190.924389	76.685344	801.921947		1371.949024	19.786642	0							4.74	0.15	568.56411	1.956453	786.968296								3400	$550/Admit:1a.IP Acute	$550/Admit:1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $150 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$25/Visit:7b. $10 Chiropractic,7f. $25 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $25 Spec Cap"	"$25/Visit:7e, 7h.Psych -- Other Provider"	"$25-$50/Visit:7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $25 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center	"$40-$150/Visit:9d. $50 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $50 Therapy (AT,PT,ST,OT) -- CORF"									550	550	42.271616	0	100	0.2	0.2	50	150	89.717513	81.146202	100	0.2	0.2	10	23.352568	25	31.596025		0	0.2	0							0	0	0	0	120.997653								NO	478.9356	478.9356	29.900024	0	85.8399	0.17168	0.17168	42.91995	128.75985	77.013424	69.655819	85.8399	0.17168	0.17168	8.58399	20.045821	21.459975	27.121996		0	0.17168	0							0	0	0	0	103.864264									7.3968	0.238836164	1.065841673	0	0.191983755	1.600352203	0.362368066	0.967507414	3.580655082	8.040531815	5.710017478	0.281007085	0.043145244	0.91728933	2.264891914	5.330391594	0.137138797	1.812476987	0	0	3.396970699	0	0	0	0	0	0	0	0	0	0	0	6.811490238	0	0	0	0	0	0	0	50.1497	0	8.41125045	7.3968	0.238836164	1.065841673	0	0.191983755	1.600352203	0.362368066	0.967507414	3.580655082	8.040531815	5.710017478	0.281007085	0.043145244	0.91728933	2.264891914	5.330391594	0.137138797	1.812476987	0	0	3.396970699	0	0	0	0	0	0	0	0	0	0	0	6.811490238	0	0	0	0	0	0	0	50.1497	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	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Nutritional benefit 13d	40% Coins	$0/Proc	30% Coins								5000	1.4511	0.0469	0.4801	2.4493	0.7137	1.9613	0.4441	0.1344	2.2625	0.3586	1.0032	0.1015	0.0061	0.13	1.3199	2.0301	0.0304	0.3046		0.2346	0.6536	0							0	0	0.188	0	0.4259								16.7299	0	4.995558698	8.8478	0.285690609	1.545911447	2.449339964	0.905690911	3.561681285	0.806472163	1.101868648	5.843190088	8.399163196	6.713224415	0.382509494	0.049260091	1.04729541	3.584820537	7.360478801	0.167502498	2.117096943	0	0.234565434	4.050618324	0	0	0	0	0	0	0	0	0	0.187955441	0	7.237404403	0	0	0	0	0	0	0	66.8796
H9572_001_1	2011	12																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	Coin	V	V	V	V	O	O																																																			0	YES	516.5399412	12.07548004	148.7977883	299.8116987	216.4129449	18.33936614	0.462922121	168.12538	192.980996	1041.99104	677.5920712	0	0	1714.849047	3553.732819	1537.325854	241.5022112	404.8574733	354.8490303	1855.205578	6.577569024	553.8075955	0	1319.42	441	330.75	39	108.4	600	0											4000	$150 copay per day (1-5)	$150 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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	"$150 copay (PBP Section B-09,#9a); $75 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest (PBP Section B-8, #8a)"	"$0 copay therapeutic, $35 low-tech, $100 high-tech (PBP Section B-8, #8b)"	"$35 copay (PBP Section B-05,#5)"	"$27 copay (PBP Section B-12, #12)"	"$35 copay (PBP Sections B-03, #3 & B-09, #9c); $100 copay (PBP Section B-09, # 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)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												150	150	130	0	50	0.18	0.2	47.91543954	121.5	0	45.30156454	0	0	81	25	35	35	35	28.00457246	35	0.15	0	0	0	10	10	25	0	0	0											YES	136.731156	136.731156	118.5003352	0	45.577052	0.151239331	0.168043701	43.67688959	110.7522363	0	41.29423525	0	0	73.83482423	22.788526	31.9039364	31.9039364	31.9039364	25.5273171	31.9039364	0.136731156	0	0	0	9.5	9.5	23.75	0	0	0											5000	5.8856	0.137591195	1.469382316	0	0.821955337	2.773633466	0.077791147	0.611932805	1.78108974	0	2.331720533	0	0	10.55129816	6.748694394	4.087228855	0.642072599	1.076378923	0.754861977	4.932363397	0.899358616	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2711	0	1.952230754	5.8856	0.137591195	1.469382316	0	0.821955337	2.773633466	0.077791147	0.611932805	1.78108974	0	2.331720533	0	0	10.55129816	6.748694394	4.087228855	0.642072599	1.076378923	0.754861977	4.932363397	0.899358616	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2711	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40%coinsurance after deductible ($50 emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	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	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"50% coinsurance, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												1.9851	0.0234	0.0839	0.1987	0.0522	0.2233	0.0056	0.0193	0.1345	0.0636	0.0414	0	0	0.1047	0.2892	0.1251	0.0197	0.0329	0.0289	0.151	0.03	0	0	0.2208	0.0184	0.0138	0.0037	0.0103	0.0594	0											3.939	500	2.632428777	7.8707	0.160988909	1.553322456	0.198733699	0.874114138	2.996953069	0.083428178	0.631238186	1.915580816	0.063636865	2.373102688	0	0	10.65602806	7.037914459	4.212343912	0.661727224	1.109328194	0.783741317	5.083349052	0.929394416	0	0	0.2208	0.3675	0.275625	0.080891706	0.010295794	0.0594	0	0	0	0	0	0	0	0	0	0	0	50.2101
H9572_001_2	2011	13																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	Coin	V	V	V	V	O	O																																																			0	YES	653.6115902	15.27989045	129.8046951	165.1321841	227.9273079	14.1195825	0.356406379	137.4999109	294.1167774	1053.027204	684.7687329	0	0	1733.011732	3739.465988	1617.673032	254.1241424	426.0170442	373.3949476	1952.1665	10.89674638	546.1793331	0	1319.42	441	330.75	39	108.4	600	0											4000	$150 copay per day (1-5)	$150 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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	"$150 copay (PBP Section B-09,#9a); $75 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest (PBP Section B-8, #8a)"	"$0 copay therapeutic, $35 low-tech, $100 high-tech (PBP Section B-8, #8b)"	"$35 copay (PBP Section B-05,#5)"	"$27 copay (PBP Section B-12, #12)"	"$35 copay (PBP Sections B-03, #3 & B-09, #9c); $100 copay (PBP Section B-09, # 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)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												150	150	130	0	50	0.18	0.2	47.91543954	121.5	0	45.30156454	0	0	81	25	35	35	35	28.00457246	35	0.15	0	0	0	10	10	25	0	0	0											YES	136.731156	136.731156	118.5003352	0	45.577052	0.151239331	0.168043701	43.67688959	110.7522363	0	41.29423525	0	0	73.83482423	22.788526	31.9039364	31.9039364	31.9039364	25.5273171	31.9039364	0.136731156	0	0	0	9.5	9.5	23.75	0	0	0											5000	7.4474	0.17410309	1.28182499	0	0.865687897	2.135436211	0.059891847	0.500464035	2.71450757	0	2.356416763	0	0	10.66305139	7.101409824	4.300844793	0.67563004	1.132635057	0.794314269	5.190149655	1.489924729	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5719	0	2.091493982	7.4474	0.17410309	1.28182499	0	0.865687897	2.135436211	0.059891847	0.500464035	2.71450757	0	2.356416763	0	0	10.66305139	7.101409824	4.300844793	0.67563004	1.132635057	0.794314269	5.190149655	1.489924729	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5719	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40%coinsurance after deductible ($50 emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	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	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"50% coinsurance, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												1.9814	0.0234	0.0757	0.1619	0.056	0.1719	0.0043	0.0158	0.136	0.0598	0.0389	0	0	0.0985	0.3078	0.1332	0.0209	0.0351	0.0307	0.1607	0.0498	0	0	0.2208	0.0184	0.0138	0.0037	0.0103	0.0594	0											3.8883	500	2.598506927	9.4289	0.19745734	1.357568483	0.161949655	0.921735133	2.307371245	0.06423183	0.516252777	2.850482801	0.059837048	2.395327951	0	0	10.76152777	7.409222275	4.434002817	0.696548153	1.167702457	0.825050106	5.350841357	1.539683613	0	0	0.2208	0.3675	0.275625	0.080891706	0.010295794	0.0594	0	0	0	0	0	0	0	0	0	0	0	53.4602
H9572_001_3	2011	12																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	Coin	V	V	V	V	O	O																																																			0	YES	584.0849135	13.65452147	118.4692672	204.2031286	158.0663923	11.7109361	0.295607348	161.0040975	296.5616345	1216.365416	790.9852675	0	0	2001.824386	3173.29888	1372.752162	215.6489346	361.5167015	316.8617586	1656.60225	10.82437872	578.9043323	0	1319.42	441	330.75	39	108.4	600	0											4000	$150 copay per day (1-5)	$150 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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	"$150 copay (PBP Section B-09,#9a); $75 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest (PBP Section B-8, #8a)"	"$0 copay therapeutic, $35 low-tech, $100 high-tech (PBP Section B-8, #8b)"	"$35 copay (PBP Section B-05,#5)"	"$27 copay (PBP Section B-12, #12)"	"$35 copay (PBP Sections B-03, #3 & B-09, #9c); $100 copay (PBP Section B-09, # 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)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												150	150	130	0	50	0.18	0.2	47.91543954	121.5	0	45.30156454	0	0	81	25	35	35	35	28.00457246	35	0.15	0	0	0	10	10	25	0	0	0											YES	136.731156	136.731156	118.5003352	0	45.577052	0.151239331	0.168043701	43.67688959	110.7522363	0	41.29423525	0	0	73.83482423	22.788526	31.9039364	31.9039364	31.9039364	25.5273171	31.9039364	0.136731156	0	0	0	9.5	9.5	23.75	0	0	0											5000	6.6552	0.155583209	1.169887323	0	0.600350015	1.771154141	0.049674953	0.586013182	2.73707202	0	2.721927643	0	0	12.31702931	6.026233669	3.649683139	0.573337491	0.961150488	0.674052549	4.404344401	1.480029815	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2209	0	1.992303695	6.6552	0.155583209	1.169887323	0	0.600350015	1.771154141	0.049674953	0.586013182	2.73707202	0	2.721927643	0	0	12.31702931	6.026233669	3.649683139	0.573337491	0.961150488	0.674052549	4.404344401	1.480029815	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2209	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40%coinsurance after deductible ($50 emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	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	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"50% coinsurance, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												1.899	0.0224	0.0576	0.1168	0.053	0.1426	0.0036	0.0185	0.1566	0.0792	0.0515	0	0	0.1304	0.2575	0.1114	0.0175	0.0293	0.0257	0.1344	0.0494	0	0	0.2208	0.0184	0.0138	0.0037	0.0103	0.0594	0											3.6831	500	2.461359696	8.5542	0.177965792	1.227503825	0.116836161	0.65339111	1.913758938	0.053274582	0.604500846	2.893703257	0.079235682	2.773453489	0	0	12.44743085	6.283760959	3.76108807	0.590838359	0.990489173	0.699767287	4.538785027	1.52945824	0	0	0.2208	0.3675	0.275625	0.080891706	0.010295794	0.0594	0	0	0	0	0	0	0	0	0	0	0	50.904
H9572_001_4	2011	12																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	Coin	V	V	V	V	O	O																																																			0	YES	610.7186415	14.27715493	188.6227799	131.523255	223.3556501	13.66330278	0.34488897	127.2016222	349.0034993	1271.44258	826.8011699	0	0	2092.467221	3673.211555	1589.011718	249.6216677	418.4690366	366.7792783	1917.578758	10.68575384	675.6532206	0	1319.42	441	330.75	39	108.4	600	0											4000	$150 copay per day (1-5)	$150 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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	"$150 copay (PBP Section B-09,#9a); $75 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest (PBP Section B-8, #8a)"	"$0 copay therapeutic, $35 low-tech, $100 high-tech (PBP Section B-8, #8b)"	"$35 copay (PBP Section B-05,#5)"	"$27 copay (PBP Section B-12, #12)"	"$35 copay (PBP Sections B-03, #3 & B-09, #9c); $100 copay (PBP Section B-09, # 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)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												150	150	130	0	50	0.18	0.2	47.91543954	121.5	0	45.30156454	0	0	81	25	35	35	35	28.00457246	35	0.15	0	0	0	10	10	25	0	0	0											YES	136.731156	136.731156	118.5003352	0	45.577052	0.151239331	0.168043701	43.67688959	110.7522363	0	41.29423525	0	0	73.83482423	22.788526	31.9039364	31.9039364	31.9039364	25.5273171	31.9039364	0.136731156	0	0	0	9.5	9.5	23.75	0	0	0											5000	6.9587	0.162677658	1.86265522	0	0.84832434	2.066428771	0.057956419	0.462980934	3.221076503	0	2.845176835	0	0	12.87474579	6.975589752	4.224644064	0.663659484	1.112567461	0.780240912	5.098192562	1.461075475	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3648	0	2.209332436	6.9587	0.162677658	1.86265522	0	0.84832434	2.066428771	0.057956419	0.462980934	3.221076503	0	2.845176835	0	0	12.87474579	6.975589752	4.224644064	0.663659484	1.112567461	0.780240912	5.098192562	1.461075475	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3648	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40%coinsurance after deductible ($50 emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	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	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"50% coinsurance, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												1.9713	0.0232	0.0963	0.1423	0.0525	0.1664	0.0042	0.0146	0.1916	0.0748	0.0486	0	0	0.1231	0.3054	0.1321	0.0208	0.0348	0.0305	0.1594	0.0488	0	0	0.2208	0.0184	0.0138	0.0037	0.0103	0.0594	0											3.9672	500	2.651221737	8.93	0.185912451	1.959000298	0.142293302	0.900859781	2.232807659	0.062156154	0.477587151	3.4127214	0.074797667	2.893816703	0	0	12.9978435	7.280971101	4.356750406	0.684412387	1.147357899	0.810733997	5.257615122	1.509870884	0	0	0.2208	0.3675	0.275625	0.080891706	0.010295794	0.0594	0	0	0	0	0	0	0	0	0	0	0	56.332
H9572_001_5	2011	12																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	Coin	V	V	V	V	O	O																																																			0	YES	860.948041	20.12692545	194.1502541	184.8466895	237.8043911	18.26411407	0.461022609	171.7240704	259.7441054	1085.986384	706.2016229	0	0	1787.25406	4212.788959	1822.430023	286.28991	479.9401588	420.6574194	2199.262008	7.450870465	644.6562916	0	1319.42	441	330.75	39	108.4	600	0											4000	$150 copay per day (1-5)	$150 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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	"$150 copay (PBP Section B-09,#9a); $75 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest (PBP Section B-8, #8a)"	"$0 copay therapeutic, $35 low-tech, $100 high-tech (PBP Section B-8, #8b)"	"$35 copay (PBP Section B-05,#5)"	"$27 copay (PBP Section B-12, #12)"	"$35 copay (PBP Sections B-03, #3 & B-09, #9c); $100 copay (PBP Section B-09, # 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)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												150	150	130	0	50	0.18	0.2	47.91543954	121.5	0	45.30156454	0	0	81	25	35	35	35	28.00457246	35	0.15	0	0	0	10	10	25	0	0	0											YES	136.731156	136.731156	118.5003352	0	45.577052	0.151239331	0.168043701	43.67688959	110.7522363	0	41.29423525	0	0	73.83482423	22.788526	31.9039364	31.9039364	31.9039364	25.5273171	31.9039364	0.136731156	0	0	0	9.5	9.5	23.75	0	0	0											5000	9.8099	0.229331482	1.917239182	0	0.903201925	2.762252393	0.077471946	0.625031105	2.397270046	0	2.430171329	0	0	10.99679911	8.000270892	4.845224295	0.761147923	1.275998358	0.894854611	5.847092935	1.018766132	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4801	0	2.340770976	9.8099	0.229331482	1.917239182	0	0.903201925	2.762252393	0.077471946	0.625031105	2.397270046	0	2.430171329	0	0	10.99679911	8.000270892	4.845224295	0.761147923	1.275998358	0.894854611	5.847092935	1.018766132	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4801	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40%coinsurance after deductible ($50 emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	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	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"50% coinsurance, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												2.2859	0.0269	0.0998	0.199	0.0615	0.2224	0.0056	0.0197	0.1374	0.0642	0.0417	0	0	0.1056	0.3255	0.1408	0.0221	0.0371	0.0325	0.1699	0.034	0	0	0.2208	0.0184	0.0138	0.0037	0.0103	0.0594	0											4.3582	500	2.912519157	12.0958	0.256274721	2.017086951	0.198957803	0.964733079	2.984655646	0.083085847	0.644749714	2.534629052	0.06418209	2.471908037	0	0	11.10242631	8.325767251	4.986032283	0.783267788	1.31308039	0.92735623	6.017016419	1.052789774	0	0	0.2208	0.3675	0.275625	0.080891706	0.010295794	0.0594	0	0	0	0	0	0	0	0	0	0	0	59.8383
H9572_001_6	2011	12																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	Coin	V	V	V	V	O	O																																																			0	YES	1026.493426	23.99698433	273.215397	255.634249	302.2257465	15.94234975	0.402416654	141.0807911	277.2922117	1182.517959	768.974744	0	0	1946.120185	5550.72413	2401.213639	377.2124185	632.3638441	554.2535625	2897.723294	11.82365306	949.8211845	0	1319.42	441	330.75	39	108.4	600	0											4000	$150 copay per day (1-5)	$150 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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	"$150 copay (PBP Section B-09,#9a); $75 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest (PBP Section B-8, #8a)"	"$0 copay therapeutic, $35 low-tech, $100 high-tech (PBP Section B-8, #8b)"	"$35 copay (PBP Section B-05,#5)"	"$27 copay (PBP Section B-12, #12)"	"$35 copay (PBP Sections B-03, #3 & B-09, #9c); $100 copay (PBP Section B-09, # 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)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												150	150	130	0	50	0.18	0.2	47.91543954	121.5	0	45.30156454	0	0	81	25	35	35	35	28.00457246	35	0.15	0	0	0	10	10	25	0	0	0											YES	136.731156	136.731156	118.5003352	0	45.577052	0.151239331	0.168043701	43.67688959	110.7522363	0	41.29423525	0	0	73.83482423	22.788526	31.9039364	31.9039364	31.9039364	25.5273171	31.9039364	0.136731156	0	0	0	9.5	9.5	23.75	0	0	0											5000	11.6961	0.273427951	2.698009677	0	1.14787988	2.411110311	0.067623584	0.513497511	2.559227714	0	2.646185332	0	0	11.97428682	10.54106843	6.384013934	1.002880084	1.681241322	1.179050537	7.704064971	1.616661751	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7845	0	2.817715449	11.6961	0.273427951	2.698009677	0	1.14787988	2.411110311	0.067623584	0.513497511	2.559227714	0	2.646185332	0	0	11.97428682	10.54106843	6.384013934	1.002880084	1.681241322	1.179050537	7.704064971	1.616661751	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7845	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40%coinsurance after deductible ($50 emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	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	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"50% coinsurance, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												2.6191	0.0309	0.1418	0.3101	0.0676	0.1941	0.0049	0.0162	0.1615	0.0675	0.0439	0	0	0.111	0.4442	0.1922	0.0302	0.0506	0.0444	0.2319	0.054	0	0	0.2208	0.0184	0.0138	0.0037	0.0103	0.0594	0											5.1423	500	3.436564003	14.3153	0.304298455	2.839766407	0.310094108	1.215451999	2.605241296	0.072523837	0.529697436	2.720712864	0.067476622	2.690064427	0	0	12.08533597	10.98528224	6.576178459	1.033067671	1.731848188	1.223406388	7.935964213	1.67065326	0	0	0.2208	0.3675	0.275625	0.080891706	0.010295794	0.0594	0	0	0	0	0	0	0	0	0	0	0	71.9268
H9572_002_1	2011	11																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	Coin	V	V	V	V	V	O																																																			0	YES	617.352782	15.54379926	172.4293577	270.3996537	186.9008627	18.89851254	0.5067216	141.2687618	260.550766	1068.938099	679.0441416	0	0	1711.630366	3787.95904	1626.761918	256.6397746	437.1415742	369.2143739	2089.14597	7.369580208	565.9616383	0	1244.55	441	330.75	39	108.4	600	0											4500	$200 copay per day (1-7)	$200 copay per day (1-7)	"$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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a); no cost-sharing for diabetes monitoring supplies"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $35 copay (PBP Section B-04, #4b)"	"$175 copay (PBP Section B-09,#9a); $100 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest; $30 copay other (PBP Section B-8, #8a)"	"$0 copay therapeutic, $40 low-tech, $150 high-tech (PBP Section B-8, #8b)"	"$40 copay (PBP Section B-05,#5)"	"$27 copay (PBP Section B-12, #12)"	"$40 copay (PBP Sections B-03, #3 & B-09, #9c); $100 copay (PBP Section B-09, # 9d)"	"$25 copay (PBP Section B-07, #7a and PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b-#14j)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing after 3-pint deductible (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												200	200	130	0	50	0.18	0.2	47.91543954	146.5	0	57.18862139	0	27	106	25	40	40	40	35.33490258	40	0.15	0	0	0	10	10	25	0	0	0											YES	184.7775623	184.7775623	120.1054155	0	46.19439057	0.151239331	0.168043701	44.26849057	135.3495644	0	52.83587026	0	24.94	97.93210802	23.09719529	36.95551246	36.95551246	36.95551246	32.64548582	36.95551246	0.138583172	0	0	0	9.5	9.5	23.75	0	0	0											4500	9.5061	0.239345445	1.725808304	0	0.719480954	2.858198394	0.085151373	0.521146238	2.938786057	0	2.989824014	0	0	13.96863082	7.290935808	5.009818361	0.790354532	1.346232574	1.004431884	6.433788326	1.0212998	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	59.1375	0	1.671424479	9.5061	0.239345445	1.725808304	0	0.719480954	2.858198394	0.085151373	0.521146238	2.938786057	0	2.989824014	0	0	13.96863082	7.290935808	5.009818361	0.790354532	1.346232574	1.004431884	6.433788326	1.0212998	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	59.1375	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40%coinsurance after deductible ($50 emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $35 copay (PBP Section B-04, #4b)"	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	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"50% coinsurance, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												1.927	0.0282	0.0874	0.265	0.0456	0.2407	0.0065	0.0172	0.1301	0.0622	0.0395	0	0	0.0996	0.2954	0.1268	0.02	0.0341	0.0288	0.1629	0.0352	0	0	0.208	0.0184	0.0138	0.0037	0.0103	0.0594	0											3.9658	500	2.358512497	11.4331	0.267552112	1.813249966	0.265033269	0.765083536	3.098944905	0.091606456	0.538346066	3.068892611	0.062186287	3.029327923	0	0	14.06820622	7.586288562	5.136659388	0.810365114	1.380317148	1.033220073	6.596682119	1.056504965	0	0	0.208	0.3675	0.275625	0.080891706	0.010295794	0.0594	0	0	0	0	0	0	0	0	0	0	0	63.1033
H9572_002_2	2011	11																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	Coin	V	V	V	V	V	O																																																			0	YES	619.9851746	15.61007803	85.03731473	175.9696699	195.4311017	11.60652993	0.311203297	133.0651563	319.5387606	1078.155882	684.8997484	0	0	1726.390282	3858.922364	1657.237547	261.4476437	445.3309497	376.1312066	2128.283864	8.942609467	588.4380837	0	1244.55	441	330.75	39	108.4	600	0											4500	$200 copay per day (1-7)	$200 copay per day (1-7)	"$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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $35 copay (PBP Section B-04, #4b)"	"$175 copay (PBP Section B-09,#9a); $100 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest (PBP Section B-8, #8a)"	"$0 copay therapeutic, $40 low-tech, $150 high-tech (PBP Section B-8, #8b)"	"$40 copay (PBP Section B-05,#5)"	"$27 copay (PBP Section B-12, #12)"	"$40 copay (PBP Sections B-03, #3 & B-09, #9c); $100 copay (PBP Section B-09, # 9d)"	"$25 copay (PBP Section B-07, #7a and PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b-#14j)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												200	200	130	0	50	0.18	0.2	47.91543954	146.5	0	57.18862139	0	27	106	25	40	40	40	35.33490258	40	0.15	0	0	0	10	10	25	0	0	0											YES	184.7775623	184.7775623	120.1054155	0	46.19439057	0.151239331	0.168043701	44.26849057	135.3495644	0	52.83587026	0	24.94497091	97.93210802	23.09719529	36.95551246	36.95551246	36.95551246	32.64548582	36.95551246	0.138583172	0	0	0	9.5	9.5	23.75	0	0	0											4500	9.5466	0.240366014	0.851120168	0	0.752318387	1.755363822	0.052295754	0.490882801	3.604119337	0	3.015606187	0	0	14.08908663	7.42752362	5.1036719	0.805160971	1.371452788	1.023248831	6.554318405	1.239295183	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6106	0	1.656533406	9.5466	0.240366014	0.851120168	0	0.752318387	1.755363822	0.052295754	0.490882801	3.604119337	0	3.015606187	0	0	14.08908663	7.42752362	5.1036719	0.805160971	1.371452788	1.023248831	6.554318405	1.239295183	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6106	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	$50 copay per trip (40% non-emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $35 copay (PBP Section B-04, #4b)"	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	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"no copay, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												1.8066	0.0264	0.0559	0.1736	0.0475	0.1479	0.004	0.0162	0.1476	0.0559	0.0355	0	0	0.0895	0.3263	0.1401	0.0221	0.0377	0.0318	0.1799	0.0427	0	0	0.208	0.0184	0.0138	0.0037	0.0103	0.0594	0											3.7007	500	2.20087361	11.3532	0.266810345	0.907007533	0.17363882	0.799856103	1.903218399	0.056260146	0.50708382	3.75172875	0.055878009	3.051102756	0	0	14.17856094	7.753778318	5.243783954	0.827265205	1.409103537	1.055049049	6.734255326	1.282014856	0	0	0.208	0.3675	0.275625	0.080891706	0.010295794	0.0594	0	0	0	0	0	0	0	0	0	0	0	62.3113
H9572_002_3	2011	11																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	Coin	V	V	V	V	V	O																																																			0	YES	657.7977104	16.56212763	105.109036	167.933745	218.8083651	13.01563498	0.348985317	166.7946477	338.5859332	1133.786086	720.2388991	0	0	1815.467795	3391.486057	1456.494198	229.7781491	391.3874301	330.5699422	1870.48206	14.20202275	625.1150683	0	1244.55	441	330.75	39	108.4	600	0											4500	$200 copay per day (1-7)	$200 copay per day (1-7)	"$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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $35 copay (PBP Section B-04, #4b)"	"$175 copay (PBP Section B-09,#9a); $100 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest (PBP Section B-8, #8a)"	"$0 copay therapeutic, $40 low-tech, $150 high-tech (PBP Section B-8, #8b)"	"$40 copay (PBP Section B-05,#5)"	"$27 copay (PBP Section B-12, #12)"	"$40 copay (PBP Sections B-03, #3 & B-09, #9c); $100 copay (PBP Section B-09, # 9d)"	"$25 copay (PBP Section B-07, #7a and PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b-#14j)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												200	200	130	0	50	0.18	0.2	47.91543954	146.5	0	57.18862139	0	27	106	25	40	40	40	35.33490258	40	0.15	0	0	0	10	10	25	0	0	0											YES	184.7775623	184.7775623	120.1054155	0	46.19439057	0.151239331	0.168043701	44.26849057	135.3495644	0	52.83587026	0	24.94497091	97.93210802	23.09719529	36.95551246	36.95551246	36.95551246	32.64548582	36.95551246	0.138583172	0	0	0	9.5	9.5	23.75	0	0	0											4500	10.1289	0.255025797	1.052013703	0	0.842309923	1.968475927	0.058644784	0.615312274	3.81895488	0	3.171204086	0	0	14.81604902	6.527817982	4.485457457	0.707630771	1.205326921	0.899301363	5.760385255	1.968161358	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9691	0	1.666665347	10.1289	0.255025797	1.052013703	0	0.842309923	1.968475927	0.058644784	0.615312274	3.81895488	0	3.171204086	0	0	14.81604902	6.527817982	4.485457457	0.707630771	1.205326921	0.899301363	5.760385255	1.968161358	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9691	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	$50 copay per trip (40% non-emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $35 copay (PBP Section B-04, #4b)"	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	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"no copay, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												1.7711	0.0259	0.0587	0.1638	0.0736	0.1658	0.0044	0.0203	0.1944	0.0692	0.044	0	0	0.1108	0.2634	0.1131	0.0178	0.0304	0.0257	0.1453	0.0678	0	0	0.208	0.0184	0.0138	0.0037	0.0103	0.0594	0											3.6792	500	2.188072437	11.9	0.280950257	1.110753407	0.163789857	0.915941681	2.134280971	0.063090478	0.635619943	4.013329429	0.069197763	3.215162043	0	0	14.9268515	6.791230758	4.598581667	0.725477373	1.235725527	0.924976346	5.905663421	2.036005734	0	0	0.208	0.3675	0.275625	0.080891706	0.010295794	0.0594	0	0	0	0	0	0	0	0	0	0	0	62.6483
H9572_002_4	2011	11																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	Coin	V	V	V	V	V	O																																																			0	YES	665.7988897	16.7635825	186.7327494	138.491375	247.8182779	16.35948969	0.438643347	136.7515719	329.9314981	1237.114987	785.8787006	0	0	1980.922543	3941.960292	1692.898687	267.073585	454.91377	384.2249574	2174.081179	6.163846772	717.313478	0	1244.55	441	330.75	39	108.4	600	0											4500	$200 copay per day (1-7)	$200 copay per day (1-7)	"$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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $35 copay (PBP Section B-04, #4b)"	"$175 copay (PBP Section B-09,#9a); $100 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest (PBP Section B-8, #8a)"	"$0 copay therapeutic, $40 low-tech, $150 high-tech (PBP Section B-8, #8b)"	"$40 copay (PBP Section B-05,#5)"	"$27 copay (PBP Section B-12, #12)"	"$40 copay (PBP Sections B-03, #3 & B-09, #9c); $100 copay (PBP Section B-09, # 9d)"	"$25 copay (PBP Section B-07, #7a and PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b-#14j)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												200	200	130	0	50	0.18	0.2	47.91543954	146.5	0	57.18862139	0	27	106	25	40	40	40	35.33490258	40	0.15	0	0	0	10	10	25	0	0	0											YES	184.7775623	184.7775623	120.1054155	0	46.19439057	0.151239331	0.168043701	44.26849057	135.3495644	0	52.83587026	0	24.94497091	97.93210802	23.09719529	36.95551246	36.95551246	36.95551246	32.64548582	36.95551246	0.138583172	0	0	0	9.5	9.5	23.75	0	0	0											4500	10.2521	0.258127826	1.868967871	0	0.953984527	2.474198276	0.073711251	0.504482139	3.721340378	0	3.460215422	0	0	16.16632671	7.587352224	5.213494877	0.822486767	1.400964291	1.045267533	6.695357008	0.854205436	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0407	0	1.810006286	10.2521	0.258127826	1.868967871	0	0.953984527	2.474198276	0.073711251	0.504482139	3.721340378	0	3.460215422	0	0	16.16632671	7.587352224	5.213494877	0.822486767	1.400964291	1.045267533	6.695357008	0.854205436	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0407	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	$50 copay per trip (40% non-emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $35 copay (PBP Section B-04, #4b)"	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	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"no copay, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												1.9781	0.029	0.1087	0.2296	0.0595	0.2084	0.0056	0.0166	0.1922	0.0702	0.0446	0	0	0.1124	0.328	0.1409	0.0222	0.0379	0.032	0.1809	0.0294	0	0	0.208	0.0184	0.0138	0.0037	0.0103	0.0594	0											4.1397	500	2.461920223	12.2302	0.287081989	1.977675639	0.229595199	1.013509805	2.682600395	0.079299091	0.521131988	3.913519954	0.070184396	3.504800139	0	0	16.27870903	7.915370295	5.354364222	0.844710471	1.438818538	1.077239628	6.87626647	0.883650702	0	0	0.208	0.3675	0.275625	0.080891706	0.010295794	0.0594	0	0	0	0	0	0	0	0	0	0	0	68.1804
H9572_002_5	2011	11																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	Coin	V	V	V	V	V	O																																																			0	YES	775.6954065	19.53057318	168.3566808	148.8087529	203.0037769	18.53404367	0.496949178	149.113599	277.658294	1026.910345	652.3459631	0	0	1644.333691	4441.979115	1907.634794	300.9505928	512.6174074	432.9620569	2449.852985	5.078400418	679.2488788	0	1244.55	441	330.75	39	108.4	600	0											4500	$200 copay per day (1-7)	$200 copay per day (1-7)	"$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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $35 copay (PBP Section B-04, #4b)"	"$175 copay (PBP Section B-09,#9a); $100 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest (PBP Section B-8, #8a)"	"$0 copay therapeutic, $40 low-tech, $150 high-tech (PBP Section B-8, #8b)"	"$40 copay (PBP Section B-05,#5)"	"$27 copay (PBP Section B-12, #12)"	"$40 copay (PBP Sections B-03, #3 & B-09, #9c); $100 copay (PBP Section B-09, # 9d)"	"$25 copay (PBP Section B-07, #7a and PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b-#14j)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												200	200	130	0	50	0.18	0.2	47.91543954	146.5	0	57.18862139	0	27	106	25	40	40	40	35.33490258	40	0.15	0	0	0	10	10	25	0	0	0											YES	184.7775623	184.7775623	120.1054155	0	46.19439057	0.151239331	0.168043701	44.26849057	135.3495644	0	52.83587026	0	24.94497091	97.93210802	23.09719529	36.95551246	36.95551246	36.95551246	32.64548582	36.95551246	0.138583172	0	0	0	9.5	9.5	23.75	0	0	0											4500	11.9443	0.300734309	1.685045758	0	0.781469646	2.803076366	0.083509179	0.550086163	3.131744095	0	2.872272223	0	0	13.41942205	8.549771589	5.874801784	0.926815282	1.578669916	1.177854724	7.544631044	0.703780837	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	64.6161	0	1.826269126	11.9443	0.300734309	1.685045758	0	0.781469646	2.803076366	0.083509179	0.550086163	3.131744095	0	2.872272223	0	0	13.41942205	8.549771589	5.874801784	0.926815282	1.578669916	1.177854724	7.544631044	0.703780837	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	64.6161	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	$50 copay per trip (40% non-emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $35 copay (PBP Section B-04, #4b)"	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	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"no copay, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												2.1191	0.031	0.085	0.1779	0.0533	0.2361	0.0063	0.0182	0.1442	0.067	0.0425	0	0	0.1073	0.3449	0.1481	0.0234	0.0398	0.0336	0.1902	0.0243	0	0	0.208	0.0184	0.0138	0.0037	0.0103	0.0594	0											4.2057	500	2.501154071	14.0634	0.331752751	1.77002478	0.177923448	0.834744957	3.039179939	0.089839771	0.568241119	3.2759639	0.06697985	2.914821248	0	0	13.52667311	8.894634867	6.022905404	0.950180274	1.618468148	1.21146873	7.734831022	0.728040826	0	0	0.208	0.3675	0.275625	0.080891706	0.010295794	0.0594	0	0	0	0	0	0	0	0	0	0	0	68.8218
H9572_002_6	2011	11																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	Coin	V	V	V	V	V	O																																																			0	YES	970.7970813	24.44287188	220.1756434	283.0820726	285.195296	15.396903	0.412833725	135.7179369	264.3082194	1119.380707	711.0878653	0	0	1792.401272	5576.344894	2394.795039	377.8055363	643.5265427	543.5292902	3075.481634	7.821904399	979.2015017	0	1244.55	441	330.75	39	108.4	600	0											4500	$225 copay per day (1-7)	$225 copay per day (1-7)	"$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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $35 copay (PBP Section B-04, #4b)"	"$175 copay (PBP Section B-09,#9a); $100 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest (PBP Section B-8, #8a)"	"$0 copay therapeutic, $40 low-tech, $150 high-tech (PBP Section B-8, #8b)"	"$40 copay (PBP Section B-05,#5)"	"$27 copay (PBP Section B-12, #12)"	"$40 copay (PBP Sections B-03, #3 & B-09, #9c); $100 copay (PBP Section B-09, # 9d)"	"$25 copay (PBP Section B-07, #7a and PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b-#14j)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"$40 copay (PBP Section B-07,#7b, #7d & #7f)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												200	200	130	0	50	0.18	0.2	47.91543954	146.5	0	57.18862139	0	27	106	25	40	40	40	35.33490258	40	0.15	0	0	0	10	10	25	0	0	0											YES	184.7775623	184.7775623	120.1054155	0	46.19439057	0.151239331	0.168043701	44.26849057	135.3495644	0	52.83587026	0	24.94497091	97.93210802	23.09719529	36.95551246	36.95551246	36.95551246	32.64548582	36.95551246	0.138583172	0	0	0	9.5	9.5	23.75	0	0	0											4500	14.9485	0.376374523	2.203690594	0	1.097868574	2.32861731	0.069374107	0.500669018	2.981166863	0	3.130912182	0	0	14.62780291	10.73316058	7.375073157	1.163499767	1.981821097	1.478648144	9.471333321	1.08398432	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2406	0	2.154817093	14.9485	0.376374523	2.203690594	0	1.097868574	2.32861731	0.069374107	0.500669018	2.981166863	0	3.130912182	0	0	14.62780291	10.73316058	7.375073157	1.163499767	1.981821097	1.478648144	9.471333321	1.08398432	0	0	0	0.349125	0.26184375	0.0771875	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2406	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	$50 copay per trip (40% non-emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $35 copay (PBP Section B-04, #4b)"	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	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"no copay, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												2.4327	0.0356	0.1138	0.3406	0.0672	0.1961	0.0053	0.0165	0.1616	0.0646	0.041	0	0	0.1035	0.4551	0.1955	0.0308	0.0525	0.0444	0.251	0.0374	0	0	0.208	0.0184	0.0138	0.0037	0.0103	0.0594	0											4.959	500	2.949146191	17.3812	0.411983578	2.317518214	0.340615869	1.165106203	2.52475712	0.07463316	0.517193019	3.142800131	0.064613634	3.171958067	0	0	14.73126509	11.18829234	7.570532242	1.19433561	2.034344636	1.523010078	9.722348884	1.121350281	0	0	0.208	0.3675	0.275625	0.080891706	0.010295794	0.0594	0	0	0	0	0	0	0	0	0	0	0	81.1996
H9572_003_1	2011	10																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	V	V	V	V	V	O	O																																																			0	YES	996.3809149	21.29587849	506.2062363	497.561467	394.9883078	21.33024533	0.443625423	253.335019	204.4583333	1084.051202	777.2235096	0	0	1941.466537	3931.116314	1654.112577	273.0627413	487.3609106	407.7030564	2160.066033	9.750141709	722.1074439	0	1138.86	441	330.75	39	108.4	0	0											3000	$75 copay per day (1-5)	$75 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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	"$100 copay (PBP Section B-09,#9a); $50 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest (PBP Section B-8, #8a)"	"$0 copay therapeutic, $20 low-tech, $50 high-tech (PBP Section B-8, #8b)"	"$30 copay (PBP Section B-05,#5)"	"$50 copay (PBP Section B-12, #12)"	"$30 copay (PBP Sections B-03, #3 & B-09, #9c); $50 copay (PBP Section B-09, # 9d)"	"$15 copay (PBP Section B-07, #7a and PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b-#14j)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												75	75	130	0	50	0.18	0.2	47.92	81	0	25.2475444	0	0	39.75	15	30	30	30	14.7479489	30	0.15	0	0	0	10	10	25	0	0	0											YES	70.644375	70.644375	122.45025	0	47.09625	0.151239331	0.168043701	45.137046	76.295925	0	23.78129326	0	0	37.44151875	14.128875	28.25775	28.25775	28.25775	13.89146177	28.25775	0.14128875	0	0	0	9.41925	9.41925	23.548125	0	0	0											4000	5.8657	0.125369502	5.165423349	0	1.550205674	3.225972034	0.074548458	0.952899534	1.299944805	0	1.540281684	0	0	6.057621313	4.628520918	3.895124972	0.643011557	1.147643564	0.471965952	5.086550496	1.377585334	0	0	0	0.346157438	0.259618078	0.076531406	0	0	0	0	0	0	0	0	0	0	0	0	0	43.7907	0	0.375411966	5.8657	0.125369502	5.165423349	0	1.550205674	3.225972034	0.074548458	0.952899534	1.299944805	0	1.540281684	0	0	6.057621313	4.628520918	3.895124972	0.643011557	1.147643564	0.471965952	5.086550496	1.377585334	0	0	0	0.346157438	0.259618078	0.076531406	0	0	0	0	0	0	0	0	0	0	0	0	0	43.7907	NO	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	$50 copay per trip (30% non-emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	40% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"no copay, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												2.1992	0.0237	0.1848	0.2587	0.0681	0.2494	0.0052	0.0293	0.0997	0.0429	0.0308	0	0	0.0769	0.2381	0.1002	0.0165	0.0295	0.0247	0.1308	0.0427	0	0	0.1892	0.0182	0.0137	0.0037	0.0103	0	0											4.0864	0	2.903694442	8.0649	0.149068219	5.350192828	0.258739757	1.618315562	3.475365263	0.079735326	0.982218748	1.399615634	0.04291661	1.571051262	0	0	6.134482224	4.866651201	3.995324067	0.659552534	1.177165813	0.496662866	5.217398096	1.420334831	0	0	0.1892	0.36437625	0.273282188	0.080235612	0.010295794	0	0	0	0	0	0	0	0	0	0	0	0	47.8771
H9572_003_2	2011	10																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	V	V	V	V	V	O	O																																																			0	YES	1016.017836	21.71558292	376.6541962	253.0551242	391.8024698	22.85979448	0.475436913	194.0966176	328.8572901	1215.56181	871.5116172	0	0	2176.993646	3944.842664	1659.888271	274.0161994	489.0626374	409.1266405	2167.608375	25.18443309	731.724015	0	1138.86	441	330.75	39	108.4	0	0											3000	$75 copay per day (1-5)	$75 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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	"$100 copay (PBP Section B-09,#9a); $50 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest (PBP Section B-8, #8a)"	"$0 copay therapeutic, $20 low-tech, $50 high-tech (PBP Section B-8, #8b)"	"$30 copay (PBP Section B-05,#5)"	"$50 copay (PBP Section B-12, #12)"	"$30 copay (PBP Sections B-03, #3 & B-09, #9c); $50 copay (PBP Section B-09, # 9d)"	"$15 copay (PBP Section B-07, #7a and PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b-#14j)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												75	75	130	0	50	0.18	0.2	47.92	81	0	25.2475444	0	0	39.75	15	30	30	30	14.7479489	30	0.15	0	0	0	10	10	25	0	0	0											YES	70.644375	70.644375	122.45025	0	47.09625	0.151239331	0.168043701	45.137046	76.295925	0	23.78129326	0	0	37.44151875	14.128875	28.25775	28.25775	28.25775	13.89146177	28.25775	0.14128875	0	0	0	9.41925	9.41925	23.548125	0	0	0											4000	5.9813	0.127840315	3.843450041	0	1.537702256	3.457300023	0.079894178	0.730078996	2.090872595	0	1.727139445	0	0	6.7924957	4.644682408	3.90872565	0.645256772	1.151650812	0.473613924	5.104311296	3.558277071	0	0	0	0.346157438	0.259618078	0.076531406	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5369	0	0.398954998	5.9813	0.127840315	3.843450041	0	1.537702256	3.457300023	0.079894178	0.730078996	2.090872595	0	1.727139445	0	0	6.7924957	4.644682408	3.90872565	0.645256772	1.151650812	0.473613924	5.104311296	3.558277071	0	0	0	0.346157438	0.259618078	0.076531406	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5369	NO	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	$50 copay per trip (30% non-emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	40% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"no copay, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												2.2683	0.0244	0.1407	0.2158	0.0644	0.2673	0.0056	0.0225	0.1081	0.0491	0.0352	0	0	0.0878	0.2325	0.0978	0.0162	0.0288	0.0241	0.1278	0.1104	0	0	0.1892	0.0182	0.0137	0.0037	0.0103	0	0											4.1618	0	2.957273307	8.2496	0.152283436	3.984160466	0.215773631	1.602086502	3.72457674	0.085452987	0.752542374	2.199014406	0.049052116	1.762307948	0	0	6.880344909	4.877195691	4.006561256	0.661407582	1.180476691	0.497728289	5.232072472	3.668698218	0	0	0.1892	0.36437625	0.273282188	0.080235612	0.010295794	0	0	0	0	0	0	0	0	0	0	0	0	50.6988
H9572_003_3	2011	10																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	V	V	V	V	V	O	O																																																			0	YES	1233.202832	26.35752779	316.1966176	304.7323008	324.4645725	20.67199998	0.429935267	218.8132996	348.0079664	1450.750705	1040.133116	0	0	2598.201951	3593.299602	1511.967998	249.5973564	445.4800179	372.667485	1974.442829	30.00740373	726.9412692	0	1138.86	441	330.75	39	108.4	0	0											3000	$75 copay per day (1-5)	$75 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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	"$100 copay (PBP Section B-09,#9a); $50 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest (PBP Section B-8, #8a)"	"$0 copay therapeutic, $20 low-tech, $50 high-tech (PBP Section B-8, #8b)"	"$30 copay (PBP Section B-05,#5)"	"$50 copay (PBP Section B-12, #12)"	"$30 copay (PBP Sections B-03, #3 & B-09, #9c); $50 copay (PBP Section B-09, # 9d)"	"$15 copay (PBP Section B-07, #7a and PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b-#14j)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												75	75	130	0	50	0.18	0.2	47.92	81	0	25.2475444	0	0	39.75	15	30	30	30	14.7479489	30	0.15	0	0	0	10	10	25	0	0	0											YES	70.644375	70.644375	122.45025	0	47.09625	0.151239331	0.168043701	45.137046	76.295925	0	23.78129326	0	0	37.44151875	14.128875	28.25775	28.25775	28.25775	13.89146177	28.25775	0.14128875	0	0	0	9.41925	9.41925	23.548125	0	0	0											4000	7.2599	0.15516759	3.226529573	0	1.273422052	3.126419447	0.072247914	0.823048831	2.212632475	0	2.061309221	0	0	8.106718921	4.230773409	3.560401141	0.587754975	1.049021915	0.43140801	4.649442654	4.239708564	0	0	0	0.346157438	0.259618078	0.076531406	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7482	0	0.40933923	7.2599	0.15516759	3.226529573	0	1.273422052	3.126419447	0.072247914	0.823048831	2.212632475	0	2.061309221	0	0	8.106718921	4.230773409	3.560401141	0.587754975	1.049021915	0.43140801	4.649442654	4.239708564	0	0	0	0.346157438	0.259618078	0.076531406	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7482	NO	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	$50 copay per trip (30% non-emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	40% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"no copay, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												2.4856	0.0268	0.1157	0.1587	0.0734	0.2417	0.005	0.0253	0.118	0.071	0.0509	0	0	0.1271	0.2153	0.0906	0.015	0.0267	0.0223	0.1183	0.1316	0	0	0.1892	0.0182	0.0137	0.0037	0.0103	0	0											4.3539	0	3.093765274	9.7455	0.181951905	3.342245385	0.158690546	1.346798522	3.368116471	0.077274717	0.848372744	2.330586154	0.070992192	2.112207925	0	0	8.233861407	4.446042656	3.6509809	0.602707982	1.075709961	0.453733966	4.767728594	4.371276025	0	0	0.1892	0.36437625	0.273282188	0.080235612	0.010295794	0	0	0	0	0	0	0	0	0	0	0	0	52.1021
H9572_003_4	2011	10																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	V	V	V	V	V	O	O																																																			0	YES	1074.595755	22.96758227	426.1342482	225.1004364	392.7855764	24.40457175	0.507565117	166.1255984	375.022131	1377.823082	987.8467816	0	0	2467.59323	3951.965522	1662.885387	274.5109665	489.9456951	409.8653647	2171.522236	18.92063531	779.1961966	0	1138.86	441	330.75	39	108.4	0	0											3000	$75 copay per day (1-5)	$75 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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	"$100 copay (PBP Section B-09,#9a); $50 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest (PBP Section B-8, #8a)"	"$0 copay therapeutic, $20 low-tech, $50 high-tech (PBP Section B-8, #8b)"	"$30 copay (PBP Section B-05,#5)"	"$50 copay (PBP Section B-12, #12)"	"$30 copay (PBP Sections B-03, #3 & B-09, #9c); $50 copay (PBP Section B-09, # 9d)"	"$15 copay (PBP Section B-07, #7a and PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b-#14j)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												75	75	130	0	50	0.18	0.2	47.92	81	0	25.2475444	0	0	39.75	15	30	30	30	14.7479489	30	0.15	0	0	0	10	10	25	0	0	0											YES	70.644375	70.644375	122.45025	0	47.09625	0.151239331	0.168043701	45.137046	76.295925	0	23.78129326	0	0	37.44151875	14.128875	28.25775	28.25775	28.25775	13.89146177	28.25775	0.14128875	0	0	0	9.41925	9.41925	23.548125	0	0	0											4000	6.3262	0.135210875	4.348353769	0	1.541560642	3.690931105	0.085293121	0.624868231	2.384388365	0	1.957689501	0	0	7.699203182	4.653068905	3.915783294	0.646421855	1.153730247	0.474469087	5.113527705	2.673272912	0	0	0	0.346157438	0.259618078	0.076531406	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1063	0	0.412408671	6.3262	0.135210875	4.348353769	0	1.541560642	3.690931105	0.085293121	0.624868231	2.384388365	0	1.957689501	0	0	7.699203182	4.653068905	3.915783294	0.646421855	1.153730247	0.474469087	5.113527705	2.673272912	0	0	0	0.346157438	0.259618078	0.076531406	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1063	NO	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	$50 copay per trip (30% non-emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	40% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"no copay, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												2.2118	0.0238	0.1555	0.2251	0.0709	0.2853	0.0059	0.0192	0.1453	0.0574	0.0412	0	0	0.1029	0.2304	0.097	0.016	0.0286	0.0239	0.1266	0.083	0	0	0.1892	0.0182	0.0137	0.0037	0.0103	0	0											4.185	0	2.973741338	8.538	0.159045655	4.503893402	0.225051457	1.612465248	3.976269358	0.091227572	0.64409444	2.529716048	0.057437333	1.998869885	0	0	7.802069781	4.883497599	4.012741759	0.662427866	1.182297689	0.498367256	5.240143443	2.756230438	0	0	0.1892	0.36437625	0.273282188	0.080235612	0.010295794	0	0	0	0	0	0	0	0	0	0	0	0	52.2913
H9572_003_5	2011	10																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	V	V	V	V	V	O	O																																																			0	YES	1625.174654	34.73523172	376.2362526	273.8347947	409.4208223	24.56582579	0.510918871	218.7094383	350.8868279	1229.377447	881.4169035	0	0	2201.736569	4519.986671	1901.894068	313.9667851	560.3662277	468.7758471	2483.637954	25.28318427	867.4463259	0	1138.86	441	330.75	39	108.4	0	0											3000	$75 copay per day (1-5)	$75 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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	"$100 copay (PBP Section B-09,#9a); $50 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest (PBP Section B-8, #8a)"	"$0 copay therapeutic, $20 low-tech, $50 high-tech (PBP Section B-8, #8b)"	"$30 copay (PBP Section B-05,#5)"	"$50 copay (PBP Section B-12, #12)"	"$30 copay (PBP Sections B-03, #3 & B-09, #9c); $50 copay (PBP Section B-09, # 9d)"	"$15 copay (PBP Section B-07, #7a and PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b-#14j)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												75	75	130	0	50	0.18	0.2	47.92	81	0	25.2475444	0	0	39.75	15	30	30	30	14.7479489	30	0.15	0	0	0	10	10	25	0	0	0											YES	70.644375	70.644375	122.45025	0	47.09625	0.151239331	0.168043701	45.137046	76.295925	0	23.78129326	0	0	37.44151875	14.128875	28.25775	28.25775	28.25775	13.89146177	28.25775	0.14128875	0	0	0	9.41925	9.41925	23.548125	0	0	0											4000	9.5675	0.204487395	3.839185266	0	1.606848784	3.715319058	0.085856698	0.822658165	2.230936259	0	1.746769489	0	0	6.869696753	5.321860556	4.478603925	0.73933291	1.319557398	0.542665147	5.848501699	3.572229502	0	0	0	0.346157438	0.259618078	0.076531406	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1943	0	0.456027528	9.5675	0.204487395	3.839185266	0	1.606848784	3.715319058	0.085856698	0.822658165	2.230936259	0	1.746769489	0	0	6.869696753	5.321860556	4.478603925	0.73933291	1.319557398	0.542665147	5.848501699	3.572229502	0	0	0	0.346157438	0.259618078	0.076531406	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1943	NO	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	$50 copay per trip (30% non-emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	40% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"no copay, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												2.8137	0.0303	0.1468	0.2468	0.0749	0.2872	0.006	0.0253	0.1392	0.0555	0.0398	0	0	0.0995	0.2606	0.1096	0.0181	0.0323	0.027	0.1432	0.1109	0	0	0.1892	0.0182	0.0137	0.0037	0.0103	0	0											4.9018	0	3.483061188	12.3811	0.23480744	3.98597742	0.246829762	1.681698937	4.002542693	0.091830361	0.847970058	2.370179339	0.055542784	1.786591553	0	0	6.969170334	5.582416612	4.588239208	0.757431624	1.351859885	0.569687878	5.991671791	3.683083623	0	0	0.1892	0.36437625	0.273282188	0.080235612	0.010295794	0	0	0	0	0	0	0	0	0	0	0	0	58.096
H9572_003_6	2011	11																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	V	V	V	V	V	O	O																																																			0	YES	1768.629138	37.80131741	589.5104963	377.2526586	593.7701633	20.06563464	0.41732411	170.0520098	329.1720437	1218.048594	873.2945466	0	0	2181.447316	5840.49196	2457.52871	405.691569	724.0761281	605.7277965	3209.227937	26.43346174	1066.350162	0	1138.86	441	330.75	39	108.4	0	0											3000	$75 copay per day (1-5)	$75 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 (PBP Section B-11, #11a)"	"20% on contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	"$100 copay (PBP Section B-09,#9a); $50 copay ASC (PBP Section B-09, #9b)"	"$0 copay JVHL & Quest (PBP Section B-8, #8a)"	"$0 copay therapeutic, $20 low-tech, $50 high-tech (PBP Section B-8, #8b)"	"$30 copay (PBP Section B-05,#5)"	"$50 copay (PBP Section B-12, #12)"	"$30 copay (PBP Sections B-03, #3 & B-09, #9c); $50 copay (PBP Section B-09, # 9d)"	"$15 copay (PBP Section B-07, #7a and PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b-#14j)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"15% cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	"$25 copay (PBP B-18, #18a)"	"no copay, but benefit max (PBP B-18, #18b)"	"no copay (PBP Section B-14, #14a)"	not covered												75	75	130	0	50	0.18	0.2	47.92	81	0	25.2475444	0	0	39.75	15	30	30	30	14.7479489	30	0.15	0	0	0	10	10	25	0	0	0											YES	70.644375	70.644375	122.45025	0	47.09625	0.151239331	0.168043701	45.137046	76.295925	0	23.78129326	0	0	37.44151875	14.128875	28.25775	28.25775	28.25775	13.89146177	28.25775	0.14128875	0	0	0	9.41925	9.41925	23.548125	0	0	0											4000	10.412	0.222537537	6.015475637	0	2.330362338	3.034713158	0.070128688	0.639637116	2.092873796	0	1.730672809	0	0	6.806391717	6.876631737	5.787019326	0.955327578	1.705063517	0.701203711	7.557130062	3.734750768	0	0	0	0.346157438	0.259618078	0.076531406	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3542	0	0.525981555	10.412	0.222537537	6.015475637	0	2.330362338	3.034713158	0.070128688	0.639637116	2.092873796	0	1.730672809	0	0	6.806391717	6.876631737	5.787019326	0.955327578	1.705063517	0.701203711	7.557130062	3.734750768	0	0	0	0.346157438	0.259618078	0.076531406	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3542	NO	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	$50 copay per trip (30% non-emergency)	40% coinsurance	40% coinsurance	"$50 copay, waived if admitted (PBP Section B-04, #4a); $30 copay (PBP Section B-04, #4b)"	40% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	30% coinsurance after deductible	15% coinsurance after deductible	"no cost sharing (PBP B-13, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"$10 copay (PBP Section B-17, #17a)"	"$10 copay (PBP Section B-17, #17b)"	50% coinsurance	"no copay, but benefit max (PBP B-18, #18b)"	40% coinsurance	not covered												2.9212	0.0315	0.2046	0.3669	0.0935	0.2346	0.0049	0.0197	0.1246	0.0497	0.0357	0	0	0.0891	0.3373	0.1419	0.0234	0.0418	0.035	0.1854	0.1159	0	0	0.1892	0.0182	0.0137	0.0037	0.0103	0	0											5.2916	0	3.760028533	13.3332	0.254016082	6.220027587	0.366852724	2.423820831	3.269320558	0.075008042	0.65931774	2.217458512	0.049726382	1.766324735	0	0	6.895448494	7.213964708	5.928960358	0.978759361	1.746884438	0.736189112	7.74248746	3.850648281	0	0	0.1892	0.36437625	0.273282188	0.080235612	0.010295794	0	0	0	0	0	0	0	0	0	0	0	0	66.6458
H9572_801_0	2011	13																															Coin	Coin	Coin	Coin	Coin	Coin	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	304.246327	5.706535761	100.7584653	24.96088212	10.29616273	22.92242097	0.20278501	16.37194285	42.91422973	40.00477952	6.570763288	0	0	18.74832482	43.47165795	19.94464656	2.091814705	11.1419826	25.86848279	118.2868312	8.144945506	29.17469933	0	0	0	0	0	0	0	0											6700	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	0.076410293	0.076410293	0.172802074	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											YES	0.066752498	0.066752498	0.150960944	0	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0	0	0	0	0	0	0	0											3300	20.3092	0.380925515	15.21059308	0	2.09578618	4.66586381	0.041276933	3.332512554	8.735200862	8.142981635	1.337480307	0	0	3.816225623	8.848665497	4.059737177	0.425789341	2.267952999	5.265535338	24.0773104	1.657905442	5.93851644	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.6095	0	10.4	20.3092	0.380925515	15.21059308	0	2.09578618	4.66586381	0.041276933	3.332512554	8.735200862	8.142981635	1.337480307	0	0	3.816225623	8.848665497	4.059737177	0.425789341	2.267952999	5.265535338	24.0773104	1.657905442	5.93851644	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.6095	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												0.6525	0.0122	0.488	0	0.0694	0.1545	0.0014	0.1103	0.2892	0.2696	0.0443	0	0	0.1264	0.293	0.1344	0.0141	0.0751	0.1743	0.7972	0.0549	0.1966	0	0	0	0	0	0	0	0											3.9575	0	3	20.9617	0.393164113	15.698544	0	2.165180816	4.820357587	0.042643675	3.442857063	9.024436516	8.412608018	1.381766293	0	0	3.9425866	9.141658136	4.194161188	0.439887868	2.343048338	5.439885142	24.8745464	1.712801188	6.135149662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.567
H9572_802_0	2011	12																															Coin	Coin	Coin	Coin	Coin	Coin	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	304.246327	5.706535761	100.7584653	24.96088212	10.29616273	22.92242097	0.20278501	16.37194285	42.91422973	40.00477952	6.570763288	0	0	18.74832482	43.47165795	19.94464656	2.091814705	11.1419826	25.86848279	118.2868312	8.144945506	29.17469933	0	0	0	0	0	0	0	0											6700	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	0.076410293	0.076410293	0.172802074	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											YES	0.066752498	0.066752498	0.150960944	0	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0	0	0	0	0	0	0	0											3300	20.3092	0.380925515	15.21059308	0	2.09578618	4.66586381	0.041276933	3.332512554	8.735200862	8.142981635	1.337480307	0	0	3.816225623	8.848665497	4.059737177	0.425789341	2.267952999	5.265535338	24.0773104	1.657905442	5.93851644	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.6095	0	10.5	20.3092	0.380925515	15.21059308	0	2.09578618	4.66586381	0.041276933	3.332512554	8.735200862	8.142981635	1.337480307	0	0	3.816225623	8.848665497	4.059737177	0.425789341	2.267952999	5.265535338	24.0773104	1.657905442	5.93851644	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.6095	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												0.6525	0.0122	0.488	0	0.0694	0.1545	0.0014	0.1103	0.2892	0.2696	0.0443	0	0	0.1264	0.293	0.1344	0.0141	0.0751	0.1743	0.7972	0.0549	0.1966	0	0	0	0	0	0	0	0											3.9575	0	3	20.9617	0.393164113	15.698544	0	2.165180816	4.820357587	0.042643675	3.442857063	9.024436516	8.412608018	1.381766293	0	0	3.9425866	9.141658136	4.194161188	0.439887868	2.343048338	5.439885142	24.8745464	1.712801188	6.135149662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.567
H9572_803_0	2011	13																															Coin	Coin	Coin	Coin	Coin	Coin	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	304.246327	5.706535761	100.7584653	24.96088212	10.29616273	22.92242097	0.20278501	16.37194285	42.91422973	40.00477952	6.570763288	0	0	18.74832482	43.47165795	19.94464656	2.091814705	11.1419826	25.86848279	118.2868312	8.144945506	29.17469933	0	0	0	0	0	0	0	0											6700	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	0.076410293	0.076410293	0.172802074	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											YES	0.066752498	0.066752498	0.150960944	0	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0.203550219	0	0	0	0	0	0	0	0											3300	20.3092	0.380925515	15.21059308	0	2.09578618	4.66586381	0.041276933	3.332512554	8.735200862	8.142981635	1.337480307	0	0	3.816225623	8.848665497	4.059737177	0.425789341	2.267952999	5.265535338	24.0773104	1.657905442	5.93851644	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.6095	0	10.4	20.3092	0.380925515	15.21059308	0	2.09578618	4.66586381	0.041276933	3.332512554	8.735200862	8.142981635	1.337480307	0	0	3.816225623	8.848665497	4.059737177	0.425789341	2.267952999	5.265535338	24.0773104	1.657905442	5.93851644	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.6095	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												0.6525	0.0122	0.488	0	0.0694	0.1545	0.0014	0.1103	0.2892	0.2696	0.0443	0	0	0.1264	0.293	0.1344	0.0141	0.0751	0.1743	0.7972	0.0549	0.1966	0	0	0	0	0	0	0	0											3.9575	0	3	20.9617	0.393164113	15.698544	0	2.165180816	4.820357587	0.042643675	3.442857063	9.024436516	8.412608018	1.381766293	0	0	3.9425866	9.141658136	4.194161188	0.439887868	2.343048338	5.439885142	24.8745464	1.712801188	6.135149662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.567
H9615_002_0	2011	6																															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	Coin																																																			0	NO			705.6808508		129.9080251	7.666521492	2.381766688	236.5983523			771.5212218	46.33042517		226.8286394	3545.523355	6003.861236	160.6228831	1016.348213	2619.284639	14.8907131	1270.827959				211.3767372		1.332570547			0.056656855												$0 Copay	$0 (190 day limit)	$0 days 1-20; $105/day days 21-100	$0 Copay	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	$0 for OP Surgery;$0 for ASC	$0 Copay	"$15 Copay for MRI, CT, Other Imaging, and Diag Rad.;$15 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$15 Copay	$0 Copay	"$15 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$15 Copay for Chemotherapy;$15 Copay for Clinic"	$10 Copay for Office Visits;$0 Copay for Preventive Services;$15 Copay for PCP Ophthalmology Services	$15 Copay for Office Visits;$15 Copay for Chiro Visits;$0 Copay for Preventive Services	$15 Copay	$15 Copay	$15 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$15 	$100 allowance	$15 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture											0			26.76		34.93516294	0.2	0.2	49.38796249			15	15		15	10.00219634	15	15	15	14.89317363	41.62727451	19.49695149				15		8.085			0.5											NO			25.70851231		33.56252282	0.192141348	0.192141348	47.44734834			14.41060107	14.41060107		14.41060107	9.609177416	14.41060107	14.41060107	14.41060107	14.30797225	39.9916031	18.73085266				14.41060107		8.085			0.5												0	0	1.511833736	0	0.363336755	1.473055771	0.457635861	0.935497037	0	0	0.926507045	0.05563744	0	0.272394753	2.839130246	7.209937429	0.192889358	1.220515721	3.123054328	0.049625291	1.983640939	0	0	0	0.25383882	0	0.000897819	0	0	0.028328428	0	0	0	0	0	0	0	0	0	0	22.8978	0	0.935330523	0	0	1.511833736	0	0.363336755	1.473055771	0.457635861	0.935497037	0	0	0.926507045	0.05563744	0	0.272394753	2.839130246	7.209937429	0.192889358	1.220515721	3.123054328	0.049625291	1.983640939	0	0	0	0.25383882	0	0.000897819	0	0	0.028328428	0	0	0	0	0	0	0	0	0	0	22.8978	NO	20.00%	20.00%	20.00%	20.00%	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	20% for OP Surgery;$0 for ASC	20.00%	"$0 Copay for MRI, CT, Other Imaging, and Diag Rad.;$25 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$25 Copay	$0 Copay	"$25 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$25 Copay for Chemotherapy; 20% Copay for Clinic"	$25 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	2500.00%	$25 Copay	$25 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 	$100 allowance	$25 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture												0.5011	0.0014	1.0572	0.0046	0.081	0.0548	0.1672	0.0698	0.1961	0.4167	0.2337	0.0026		0.0575	0.2004	0.6954	0.1483	0.0992	0.2484	0.0004	0.0744				0.0209		0.0014			0.0784											4.4108	0	0.177139374	0.5011	0.001426136	2.568985275	0.004558848	0.444290421	1.527869005	0.624819116	1.005260613	0.196116584	0.416738004	1.160196827	0.058254086	0	0.329882473	3.039546558	7.905315711	0.341185734	1.319740534	3.37148077	0.050062625	2.058021422	0	0	0	0.274694886	0	0.0023193	0	0	0.106699345	0	0	0	0	0	0	0	0	0	0	27.3085
H9615_004_0	2011	6																															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	Coin																																																			0	NO			702.7542245		164.8126587	7.275277421	3.124413805	253.7456703			772.6398967	28.88373445		192.9020837	3733.331545	6055.756956	161.9190176	1007.779879	2750.580157	13.28042416	1386.892288				189.0624487		2.551450049			0.13317644												$0 Copay	$0 (190 day limit)	$0 days 1-20; $105/day days 21-100	$0 Copay	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	$0 for OP Surgery;$0 for ASC	$0 Copay	"$15 Copay for MRI, CT, Other Imaging, and Diag Rad.;$15 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$15 Copay	$0 Copay	"$15 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$15 Copay for Chemotherapy;$15 Copay for Clinic"	$10 Copay for Office Visits;$0 Copay for Preventive Services;$15 Copay for PCP Ophthalmology Services	$15 Copay for Office Visits;$15 Copay for Chiro Visits;$0 Copay for Preventive Services	$15 Copay	$15 Copay	$15 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$15 	$100 allowance	$15 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture											0			26.76		34.90008532	0.2	0.2	49.42149414			15	15		15	10.00136818	15	15	15	14.9090065	45.48347228	20.69385371				15		8.085			0.5											NO			25.38412308		33.10585363	0.189716914	0.189716914	46.88769218			14.22876854	14.22876854		14.22876854	9.487143526	14.22876854	14.22876854	14.22876854	14.14245351	43.14491997	19.62987031				14.22876854		8.085			0.5												0	0	1.486566644	0	0.454688646	1.38024318	0.592754145	0.991462407	0	0	0.916142855	0.034248331	0	0.228729925	2.951554349	7.180497007	0.191992352	1.194955554	3.241662667	0.04774857	2.268709646	0	0	0	0.224177152	0	0.001719039	0	0	0.06658822	0	0	0	0	0	0	0	0	0	0	23.4544	0	1.267417813	0	0	1.486566644	0	0.454688646	1.38024318	0.592754145	0.991462407	0	0	0.916142855	0.034248331	0	0.228729925	2.951554349	7.180497007	0.191992352	1.194955554	3.241662667	0.04774857	2.268709646	0	0	0	0.224177152	0	0.001719039	0	0	0.06658822	0	0	0	0	0	0	0	0	0	0	23.4544	NO	20.00%	20.00%	20.00%	20.00%	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	20% for OP Surgery;$0 for ASC	20.00%	"$0 Copay for MRI, CT, Other Imaging, and Diag Rad.;$25 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$25 Copay	$0 Copay	"$25 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$25 Copay for Chemotherapy; 20% Copay for Clinic"	$25 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	2500.00%	$25 Copay	$25 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 	$100 allowance	$25 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture												0.8128	0.0033	0.0731	0.0025	0.0074	0.0291	0.0125	0.0161	0.2118	0.0752	0.0882	0.0009		0.0064	0.1356	0.1946	0.0052	0.0324	0.0884	0.001	0.0533				0.0061					0.0014											1.8572	0	0.100589965	0.8128	0.003279252	1.5596702	0.002512661	0.462082177	1.409299616	0.605232615	1.00758515	0.211767455	0.075229085	1.00437987	0.03517647	0	0.235174463	3.087112541	7.375051029	0.197195397	1.227339173	3.330048774	0.048753757	2.321982923	0	0	0	0.230252413	0	0.001719039	0	0	0.067990014	0	0	0	0	0	0	0	0	0	0	25.3117
H9615_802_0	2011	4																															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	Coin																																																			0	NO					166.4836526	8.74330194	2.797060488	232.9716486			816.2997451	64.45507323		365.9394528	3732.660738	6607.431582	100.4538258	822.1770979	2572.144397	18.77696744	1222.941931				172.8660443		2.994481219			0.067174994												$0 Copay	$0 (190 day limit)	$0(day 1-100)	$0 Copay	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	$0 for OP Surgery;$0 for ASC	$0 Copay	"$15 Copay for MRI, CT, Other Imaging, and Diag Rad.;$15 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$15 Copay	$0 Copay	"$15 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$15 Copay for Chemotherapy;$15 Copay for Clinic"	$10 Copay for Office Visits;$0 Copay for Preventive Services;$15 Copay for PCP Ophthalmology Services	$15 Copay for Office Visits;$15 Copay for Chiro Visits;$0 Copay for Preventive Services	$15 Copay	$15 Copay	$15 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$15 	$100 allowance	$15 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture											0					35	0.2	0.2	49.11085826			15	15		15	10	15	15	15	14.92336748	37.9608405	19.09618675				14.98444682		15			0.5											NO					33.82827122	0.193304407	0.193304407	47.46672666			14.49783052	14.49783052		14.49783052	9.665220349	14.49783052	14.49783052	14.49783052	14.4237635	36.68998881	18.45688528				14.48289869		15			0.5												0	0	0	0	0.46932118	1.690118797	0.540684119	0.921533464	0	0	0.986214613	0.077871561	0	0.442110681	3.00641571	7.982785273	0.121363545	0.993315352	3.091666873	0.05741056	1.88097491	0	0	0	0.208633451	0	0.003743102	0	0	0.033587497	0	0	0	0	0	0	0	0	0	0	22.5078	0	0.778319026	0	0	0	0	0.46932118	1.690118797	0.540684119	0.921533464	0	0	0.986214613	0.077871561	0	0.442110681	3.00641571	7.982785273	0.121363545	0.993315352	3.091666873	0.05741056	1.88097491	0	0	0	0.208633451	0	0.003743102	0	0	0.033587497	0	0	0	0	0	0	0	0	0	0	22.5078	YES	20.00%	20.00%	20.00%	20.00%	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	20% for OP Surgery;$0 for ASC	20.00%	"$0 Copay for MRI, CT, Other Imaging, and Diag Rad.;$25 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$25 Copay	$0 Copay	"$25 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$25 Copay for Chemotherapy; 20% Copay for Clinic"	$25 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	2500.00%	$25 Copay	$25 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 	$100 allowance	$25 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture											4000	0.5369	0.0026	0.0818	0.004	0.1157	0.0481	0.0879	0.0315	0.3405	0.2917	0.0489	0.0008		0.0056	0.205	0.5826	0.0066	0.0671	0.2866	0.001	0.0634				0.0257		0.0066			0.0007											2.8412	0	0.097829633	0.5369	0.002555257	0.081848391	0.004038411	0.585029729	1.738176747	0.628586155	0.953073342	0.340469405	0.291687048	1.035087336	0.078658834	0	0.447731121	3.21136847	8.565338299	0.127953318	1.060379947	3.378302235	0.058414705	1.944395275	0	0	0	0.234289442	0	0.010326073	0	0	0.03429457	0	0	0	0	0	0	0	0	0	0	25.3489
H9615_804_0	2011	5																															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	Coin																																																			0	NO			826.8740285		170.5137832	7.333738155	3.099891884	208.4070569			691.1630203	43.83666867		188.8127365	3305.227016	6153.301724	110.4071512	984.5663131	2443.730277	17.7635268	1205.423975				154.9445251		3.18964693			0.08467249												$0 Copay	$0 (190 day limit)	$0 days 1-20; $105/day days 21-100	$0 Copay	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	$0 for OP Surgery;$0 for ASC	$0 Copay	"$15 Copay for MRI, CT, Other Imaging, and Diag Rad.;$15 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$15 Copay	$0 Copay	"$15 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$15 Copay for Chemotherapy;$15 Copay for Clinic"	$10 Copay for Office Visits;$0 Copay for Preventive Services;$15 Copay for PCP Ophthalmology Services	$15 Copay for Office Visits;$15 Copay for Chiro Visits;$0 Copay for Preventive Services	$15 Copay	$15 Copay	$15 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$15 	$100 allowance	$15 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture											0			26.76		35	0.2	0.2	49.53208853			15	15		15	10	15	15	15	14.92712296	42.0227632	20.20662824				14.98151695		15			0.5											NO			24.76899825		32.39592446	0.185119568	0.185119568	45.84679424			13.88396763	13.88396763		13.88396763	9.255978418	13.88396763	13.88396763	13.88396763	13.8165128	38.89617892	18.70321149				13.8671256		15			0.5												0	0	1.70673678	0	0.460329303	1.357618442	0.573850648	0.796232955	0	0	0.79967375	0.050718907	0	0.218455827	2.549425828	7.119353494	0.127740776	1.139140568	2.813652554	0.057577776	1.878774961	0	0	0	0.179052933	0	0.003987059	0	0	0.042336245	0	0	0	0	0	0	0	0	0	0	21.8747	0	1.754619302	0	0	1.70673678	0	0.460329303	1.357618442	0.573850648	0.796232955	0	0	0.79967375	0.050718907	0	0.218455827	2.549425828	7.119353494	0.127740776	1.139140568	2.813652554	0.057577776	1.878774961	0	0	0	0.179052933	0	0.003987059	0	0	0.042336245	0	0	0	0	0	0	0	0	0	0	21.8747	YES	20.00%	20.00%	20.00%	20.00%	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	20% for OP Surgery;$0 for ASC	20.00%	"$0 Copay for MRI, CT, Other Imaging, and Diag Rad.;$25 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$25 Copay	$0 Copay	"$25 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$25 Copay for Chemotherapy; 20% Copay for Clinic"	$25 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	2500.00%	$25 Copay	$25 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 	$100 allowance	$25 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture											4000	1.1222	0.0031	0.0869	0.0049	0.029	0.0281	0.0684	0.0885	2.2424	0.4749	0.1521	0.0009		0.0327	0.327	0.7441	0.011	0.0621	0.2793	0.0012	0.0639				0.0109		0.0001			0.0009											5.8346	0	0.468919987	1.1222	0.003055861	1.79363781	0.004874789	0.489377788	1.38572954	0.642208171	0.884689493	2.242410797	0.474883553	0.95179531	0.05159251	0	0.251183521	2.876399395	7.86344526	0.138756431	1.201270995	3.092939717	0.058789885	1.942675666	0	0	0	0.189967816	0	0.004095109	0	0	0.043227494	0	0	0	0	0	0	0	0	0	0	27.7092
H9615_807_0	2011	4																															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	Coin																																																			0	NO	258.520227	3.759716533	1418.102068		264.8761424	12.6354682	3.557889617	255.2721801			416.1527549	50.12245389		689.7236087	2756.371854	6678.112088	117.5568906	847.9257563	2785.914364	9.420158612	1275.430598				215.9887337		0.800143492			0.055510238												$100 Copay	$100 (190 day limit)	$0 days 1-20; $105/day days 21-100	$0 Copay	$35 Copay	20.00%	20.00%	$50 ER Copay;$20 UC Copay	$0 for OP Surgery;$0 for ASC	$0 Copay	"$20 Copay for MRI, CT, Other Imaging, and Diag Rad.;$20 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$20 Copay	$0 Copay	"$20 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$20 Copay for Chemotherapy;$20 Copay for Clinic"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$20 Copay for PCP Ophthalmology Services	$20 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$20 Copay	$20 Copay	$20 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No Coverage	No coverage	$20 	Rider??	$20 Copay	No Coverage	No Cost Sharing	50.0% for Accupuncture											0	100	100	26.76		35	0.2	0.2	49.21861086			20	20		20	15.0033367	20	20	20	19.70838335	26.27293344	21.57178988				20		20			0.5											NO	94.6595228	94.6595228	25.3308883		33.13083298	0.189319046	0.189319046	46.59010217			18.93190456	18.93190456		18.93190456	14.20208693	18.93190456	18.93190456	18.93190456	18.65586163	24.86983342	20.41975336				18.93190456		20			0.5												2.0393	0.029657748	2.99348209	0	0.731297269	2.39213478	0.673576267	0.991096413	0	0	0.65654702	0.079076126	0	1.088148461	3.262186057	10.53578172	0.185464653	1.337737458	4.331136074	0.019523148	2.17033152	0	0	0	0.340756508	0	0.001333572	0	0	0.027755119	0	0	0	0	0	0	0	0	0	0	33.8863	0	1.910147958	2.0393	0.029657748	2.99348209	0	0.731297269	2.39213478	0.673576267	0.991096413	0	0	0.65654702	0.079076126	0	1.088148461	3.262186057	10.53578172	0.185464653	1.337737458	4.331136074	0.019523148	2.17033152	0	0	0	0.340756508	0	0.001333572	0	0	0.027755119	0	0	0	0	0	0	0	0	0	0	33.8863	YES	10000.00%	$100 (190 day limit)	$0 days 1-20; $105/day days 21-100	0.00%	$35 Copay	20.00%	20.00%	$50 ER Copay;$20 UC Copay	$0 for OP Surgery;$0 for ASC	0.00%	"$20 Copay for MRI, CT, Other Imaging, and Diag Rad.;$20 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$20 Copay	$0 Copay	"$20 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$20 Copay for Chemotherapy;$20 Copay for Clinic"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$20 Copay for PCP Ophthalmology Services	$20 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	2000.00%	$20 Copay	$20 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No Coverage	No coverage	$20 	Rider??	$20 Copay	No Coverage	No Cost Sharing	50.0% for Accupuncture											4000	0.0336	0.0005	0.0493		0.012	0.0394	0.0111	0.0163			0.0108	0.0013		0.0179	0.0537	0.1734	0.0031	0.022	0.0713	0.0003	0.0357				0.0056					0.0005											0.5576	0	0.03143459	2.0728	0.030145814	3.042744703	0	0.743331955	2.431501246	0.684661059	1.007406515	0	0	0.667351568	0.080377452	0	1.106055713	3.315870631	10.70916514	0.188516775	1.359752102	4.402411958	0.019844433	2.206047853	0	0	0	0.34636421	0	0.001333572	0	0	0.028211875	0	0	0	0	0	0	0	0	0	0	34.4439
H9670_003_0	2011	6																															A	A	D		T	coin	coin	V	V		P	V		V	V	V	V	V			S	P	T	V																	5.423578476	0.098209413	0.401046701	1.404290245	2.975185166	4.23680243	0	0	8.591009634	0	26.75691643	1.632363762	0.011747084	0	2.411627325	7.87735955	0.032383597	1.344553058	0	0	0.183073046	1.256949202	0	0	0	0	0.000349076	0	0	0.052135159											64.6896	YES	306.7535952	4.870591435	1509.227688	0	308.0187558	21.61177496	0	1403.774993	1492.276157	0	10321.2795	1837.122194	0	110.9638773	40259.64247	6790.391569	53.89123145	824.2755436	0	0	338.9195026	471.033295	0	0	0	0	0	0	0	0											3400	1a $0/stay	1b $0/stay	2 $0/days 1-100	6 $0/vst	10a $0/trip	11a $0/item	"11b $0/item, 11c $0/item"	"4a $50/vst, 4b $50/vst"	"9a $0/vst, 9b $0/vst"	8a $0/vst	8b $0/all x-rays	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $25/vst, 9d $0/vst"	"7a $15/PCP; $25/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $25/vst, 7d $25/vst, 7f $25/vst, 7g $25/vst, 16b $25/vst, 17a $0/vst, 18a $25/vst"	"7e $25/vst, 7h $25/vst"	"7c $0/vst, 7i $0/vst"	0	0	15 $0/vst	13a $0/vst	10b not covrd	"16a not covrd, 16b not covrd"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	18a not covrd	18b not covrd	14a $0/vst	13b not covrd											1200	0	0	0	0	0	0	0	22.07300487	0	0	0	0	0	25.71542828	1.386630698	13.01840175	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	21.43994538	0	0	0	0	0	24.97790315	1.346861771	12.64503063	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	2.508071598	0	0	0	0	0	0.230970415	4.518681113	7.155392446	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.4131	1200	0.425577556	5.4236	0.098209413	0.401046701	1.404290245	2.975185166	4.23680243	0	2.508071598	8.591009634	0	26.75691643	1.632363762	0.011747084	0.230970415	6.930308438	15.032752	0.032383597	1.344553058	0	0	0.183073046	1.256949202	0	0	0	0	0.000349076	0	0	0.052135159	0	0	0	0	0	0	0	0	0	0	79.1027	YES	1a 30% coin	1b 30% coin	2 30% coin	6 30% coin	10a 30% coin	11a 50% coin	"11b 50% coin, 11c 30% coin"	refer to In Network	"9a 30% coin, 9b 30% coin"	8a 30% coin	8b 30% coin	5 30% coin	12 30% coin	"3 30% coin, 9c $50/vst, 9d 30% coin"	"7a $30/vst, 14b $0/vst, 14c 30% coin, 14d 30% coin, 14e 30% coin, 14f 30% coin, 14g 30% coin, 14h 30% coin, 14i 30% coin, 14j 30% coin"	"7b $50/vst, 7d $50/vst, 7f $50/vst, 7g $50/vst, 16b $50/vst, 17a $50/vst, 18a $50/vst"	"7e $50/vst, 7h $50/vst"	"7c 30% coin, 7i 30% coin"	0	0	15 30% coin	13a 30% coin	10b not covrd	"16a not covrd, 16b not covrd"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	18a not covrd	18b not covrd	14a 50% coin	13b not covrd											5100	4.2641	0.0466	0.79	0.4526	0.2988	0.7912	0	0.1359	1.0186	0	2.1733	0.1983	0.0074	0.025	1.0727	1.8467	0.0081	0.1446	0	0	0.1234	0.1849	0	0	0	0	0.002	0.0006	0	0.0032											13.588	1200	0.29	9.6876	0.144829477	1.191022276	1.856878352	3.274032106	5.028006044	0	2.643973055	9.609609355	0	28.93022152	1.830651763	0.019106363	0.256000973	8.003023064	16.87948868	0.04048099	1.489165954	0	0	0.30642477	1.441824169	0	0	0	0	0.002394884	0.000636082	0	0.055299014	0	0	0	0	0	0	0	0	0	0	92.6907
H9670_004_0	2011	6																															A	A	D		T	coin	coin	V	V		P	V		V	V	V	V	V			S	P	T	V																	5.423578476	0.098209413	0.401046701	1.404290245	2.975185166	4.23680243	0	0	8.591009634	0	26.75691643	1.632363762	0.011747084	0	2.411627325	7.87735955	0.032383597	1.344553058	0	0	0.183073046	1.256949202	0	0	0	0	0.000349076	0	0	0.052135159											64.6896	YES	306.7535952	4.870591435	1509.227688	0	308.0187558	21.61177496	0	1403.774993	1492.276157	0	10321.2795	1837.122194	0	110.9638773	40259.64247	6790.391569	53.89123145	824.2755436	0	0	338.9195026	471.033295	0	0	0	0	0	0	0	0											3400	1a $0/stay	1b $0/stay	2 $0/days 1-100	6 $0/vst	10a $0/trip	11a $0/item	"11b $0/item, 11c $0/item"	"4a $50/vst, 4b $50/vst"	"9a $0/vst, 9b $0/vst"	8a $0/vst	8b $0/all x-rays	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $25/vst, 9d $0/vst"	"7a $15/PCP; $25/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $25/vst, 7d $25/vst, 7f $25/vst, 7g $25/vst, 16b $25/vst, 17a $0/vst, 18a $25/vst"	"7e $25/vst, 7h $25/vst"	"7c $0/vst, 7i $0/vst"	0	0	15 $0/vst	13a $0/vst	10b not covrd	"16a not covrd, 16b not covrd"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	18a not covrd	18b not covrd	14a $0/vst	13b not covrd											1200	0	0	0	0	0	0	0	22.07300487	0	0	0	0	0	25.71542828	1.386630698	13.01840175	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	21.43994538	0	0	0	0	0	24.97790315	1.346861771	12.64503063	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	2.508071598	0	0	0	0	0	0.230970415	4.518681113	7.155392446	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.4131	1200	0.425577556	5.4236	0.098209413	0.401046701	1.404290245	2.975185166	4.23680243	0	2.508071598	8.591009634	0	26.75691643	1.632363762	0.011747084	0.230970415	6.930308438	15.032752	0.032383597	1.344553058	0	0	0.183073046	1.256949202	0	0	0	0	0.000349076	0	0	0.052135159	0	0	0	0	0	0	0	0	0	0	79.1027	YES	1a 30% coin	1b 30% coin	2 30% coin	6 30% coin	10a 30% coin	11a 50% coin	"11b 50% coin, 11c 30% coin"	refer to In Network	"9a 30% coin, 9b 30% coin"	8a 30% coin	8b 30% coin	5 30% coin	12 30% coin	"3 30% coin, 9c $50/vst, 9d 30% coin"	"7a $30/vst, 14b $0/vst, 14c 30% coin, 14d 30% coin, 14e 30% coin, 14f 30% coin, 14g 30% coin, 14h 30% coin, 14i 30% coin, 14j 30% coin"	"7b $50/vst, 7d $50/vst, 7f $50/vst, 7g $50/vst, 16b $50/vst, 17a $50/vst, 18a $50/vst"	"7e $50/vst, 7h $50/vst"	"7c 30% coin, 7i 30% coin"	0	0	15 30% coin	13a 30% coin	10b not covrd	"16a not covrd, 16b not covrd"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	18a not covrd	18b not covrd	14a 50% coin	13b not covrd											5100	4.2641	0.0466	0.79	0.4526	0.2988	0.7912	0	0.1359	1.0186	0	2.1733	0.1983	0.0074	0.025	1.0727	1.8467	0.0081	0.1446	0	0	0.1234	0.1849	0	0	0	0	0.002	0.0006	0	0.0032											13.588	1200	0.29	9.6876	0.144829477	1.191022276	1.856878352	3.274032106	5.028006044	0	2.643973055	9.609609355	0	28.93022152	1.830651763	0.019106363	0.256000973	8.003023064	16.87948868	0.04048099	1.489165954	0	0	0.30642477	1.441824169	0	0	0	0	0.002394884	0.000636082	0	0.055299014	0	0	0	0	0	0	0	0	0	0	92.6907
H9670_801_0	2011	5																															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	299.6134964	9.321308776	1371.147861		189.174909	32.7295482	0	1368.192268	1797.852055		11028.97261	2431.657042		469.4851756	450908.655	10121.54805	89.75451886	2038.117997			687.1147667	1009.254936	0	695.3353768																	3400	1a $150/stay	1b $150/stay	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/vst	10a $75/trp	11a 20% coin	"11b 20% coin, 11c $25-$50/item"	"4a $50/vst, 4b $50 vst"	"9a $100/vst, 9b $100/vst"	8a $0/vst	8b $25/x-ray; $75/diag x-ray; $0/thera x-ray	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $25/vst, 9d $0/vst"	"7a $15/PCP; $25/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $25/vst, 7d $25/vst, 7f $25/vst, 7g $25/vst, 16b $25/vst, 17a $25/vst, 18a $25/vst"	"7e $25/vst, 7h $25/vst"	"7c $25/vst, 7i $25/vst"	0	0	15 20% coin	13a $0/vst	10b not covrd	"16a $25/vst-6 mo; $25/x-ray-1yr, 16b 20% coin"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	"18a $25/vst - 1 yr, $25/fitting - 3yr"	"18b $1,000 max-3 yr"	14a $0/vst	13b not covrd												27.33333333	150	48.03515459		75	0.120079671	0	11.30306022	2.011710189		0.977097336	1.132572402		25	0.118375022	14.57835721	20.38461538	22.56097561			162.6691178	51.95979933	0	0	0	0	0	0	0												NO	26.60754067	146.0169915	46.75965839		73.00849573	0.116891149	0	11.00292565	1.958292464		0.951152089	1.102498765		24.33616524	0.115231764	14.1912524	19.84333474	21.96190522			158.3497012	50.5800905	0	0	0	0	0	0	0													0.6643	0.113422455	5.342867132	0	1.150947961	3.825794486	0	1.254509817	0.293393344	0	0.874185862	0.22340824	0	0.952122401	4.329916637	11.96978692	0.14841908	3.730079524	0	0	9.067034834	4.254017167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1942	0	1.669549146	0.6643	0.113422455	5.342867132	0	1.150947961	3.825794486	0	1.254509817	0.293393344	0	0.874185862	0.22340824	0	0.952122401	4.329916637	11.96978692	0.14841908	3.730079524	0	0	9.067034834	4.254017167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1942	YES	1a 20% coin	1b 20% coin	2 20% coin	6 20% coin	10a 20% coin	11a 50% coin	"11b 50% coin, 11c 50% coin"	Refer to In Network	"9a 20% coin, 9b 20% coin"	8a 20% coin	8b 20% coin	5 20% coin	12 20% coin	"3 20% coin, 9c 20% coin, 9d 20% coin"	"7a 20% coin, 14b $0/vst, 14c 20% coin, 14d 20% coin, 14e 20% coin, 14f 20% coin, 14g 20% coin, 14h 20% coin, 14i 20% coin, 14j 20% coin"	"7b 20% coin, 7d 20% coin, 7f 20% coin, 7g 20% coin, 17a 20% coin, 18a 20% coin"	"7e 20% coin, 7h 20% coin"	"7c 20% coin, 7i 20% coin"	0	0	15 20% coin	13a 20% coin	10b not covrd	"16a 50% coin, 16b 50% coin"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	18a 20% coin	18b 50% coin	14a 50% coin	13b not covrd											5100	0.0294	0	0	0	0.4023	0.7155	0	0.1082	0.2448	0	1.1064	0	0	0.2301	0.3053	0.6588	0	0.8284	0	0	0	0	0	0	0	0	0	0	0												4.6291	500	0.05	0.6938	0.113422455	5.342867132	0	1.553199999	4.541319077	0	1.362723878	0.538152958	0	1.98055916	0.22340824	0	1.182219572	4.635218502	12.62860982	0.14841908	4.558447014	0	0	9.067034834	4.254017167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8234
H9670_802_0	2011	5																															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	299.6134964	9.321308776	1371.147861		189.174909	32.7295482	0	1368.192268	1797.852055		11028.97261	2431.657042		469.4851756	450908.655	10121.54805	89.75451886	2038.117997			687.1147667	1009.254936	0	695.3353768																	3400	1a $150/stay	1b $150/stay	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/vst	10a $75/trp	11a 20% coin	"11b 20% coin, 11c $25-$50/item"	"4a $50/vst, 4b $50 vst"	"9a $100/vst, 9b $100/vst"	8a $0/vst	8b $25/x-ray; $75/diag x-ray; $0/thera x-ray	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $25/vst, 9d $0/vst"	"7a $15/PCP; $25/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $25/vst, 7d $25/vst, 7f $25/vst, 7g $25/vst, 16b $25/vst, 17a $25/vst, 18a $25/vst"	"7e $25/vst, 7h $25/vst"	"7c $25/vst, 7i $25/vst"	0	0	15 20% coin	13a $0/vst	10b not covrd	"16a $25/vst-6 mo; $25/x-ray-1yr, 16b 20% coin"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	"18a $25/vst - 1 yr, $25/fitting - 3yr"	"18b $1,000 max-3 yr"	14a $0/vst	13b not covrd												27.33333333	150	48.03515459		75	0.120079671	0	11.30306022	2.011710189		0.977097336	1.132572402		25	0.118375022	14.57835721	20.38461538	22.56097561			162.6691178	51.95979933	0	0	0	0	0	0	0												NO	26.60754067	146.0169915	46.75965839		73.00849573	0.116891149	0	11.00292565	1.958292464		0.951152089	1.102498765		24.33616524	0.115231764	14.1912524	19.84333474	21.96190522			158.3497012	50.5800905	0	0	0	0	0	0	0													0.6643	0.113422455	5.342867132	0	1.150947961	3.825794486	0	1.254509817	0.293393344	0	0.874185862	0.22340824	0	0.952122401	4.329916637	11.96978692	0.14841908	3.730079524	0	0	9.067034834	4.254017167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1942	0	1.669549146	0.6643	0.113422455	5.342867132	0	1.150947961	3.825794486	0	1.254509817	0.293393344	0	0.874185862	0.22340824	0	0.952122401	4.329916637	11.96978692	0.14841908	3.730079524	0	0	9.067034834	4.254017167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1942	YES	1a 20% coin	1b 20% coin	2 20% coin	6 20% coin	10a 20% coin	11a 50% coin	"11b 50% coin, 11c 50% coin"	Refer to In Network	"9a 20% coin, 9b 20% coin"	8a 20% coin	8b 20% coin	5 20% coin	12 20% coin	"3 20% coin, 9c 20% coin, 9d 20% coin"	"7a 20% coin, 14b $0/vst, 14c 20% coin, 14d 20% coin, 14e 20% coin, 14f 20% coin, 14g 20% coin, 14h 20% coin, 14i 20% coin, 14j 20% coin"	"7b 20% coin, 7d 20% coin, 7f 20% coin, 7g 20% coin, 17a 20% coin, 18a 20% coin"	"7e 20% coin, 7h 20% coin"	"7c 20% coin, 7i 20% coin"	0	0	15 20% coin	13a 20% coin	10b not covrd	"16a 50% coin, 16b 50% coin"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	18a 20% coin	18b 50% coin	14a 50% coin	13b not covrd											5100	0.0294	0	0	0	0.4023	0.7155	0	0.1082	0.2448	0	1.1064	0	0	0.2301	0.3053	0.6588	0	0.8284	0	0	0	0	0	0	0	0	0	0	0												4.6291	500	0.05	0.6938	0.113422455	5.342867132	0	1.553199999	4.541319077	0	1.362723878	0.538152958	0	1.98055916	0.22340824	0	1.182219572	4.635218502	12.62860982	0.14841908	4.558447014	0	0	9.067034834	4.254017167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8234
H9670_803_0	2011	5																															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	299.6134964	9.321308776	1371.147861		189.174909	32.7295482	0	1368.192268	1797.852055		11028.97261	2431.657042		469.4851756	450908.655	10121.54805	89.75451886	2038.117997			687.1147667	1009.254936	0	695.3353768																	3400	1a $150/stay	1b $150/stay	2 $0/days 1-10; $70/days 11-50; $0/days 51-100	6 $0/vst	10a $75/trp	11a 20% coin	"11b 20% coin, 11c $25-$50/item"	"4a $50/vst, 4b $50 vst"	"9a $100/vst, 9b $100/vst"	8a $0/vst	8b $25/x-ray; $75/diag x-ray; $0/thera x-ray	5 $0/vst	12 $0/vst	"3 $0/vst, 9c $25/vst, 9d $0/vst"	"7a $15/PCP; $25/IN Urgt, 14b $0/vst, 14c $0/vst, 14d $0/vst, 14e $0/vst, 14f $0/vst, 14g $0/vst, 14h $0/vst, 14i $0/vst, 14j $0/vst"	"7b $25/vst, 7d $25/vst, 7f $25/vst, 7g $25/vst, 16b $25/vst, 17a $25/vst, 18a $25/vst"	"7e $25/vst, 7h $25/vst"	"7c $25/vst, 7i $25/vst"	0	0	15 20% coin	13a $0/vst	10b not covrd	"16a $25/vst-6 mo; $25/x-ray-1yr, 16b 20% coin"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	"18a $25/vst - 1 yr, $25/fitting - 3yr"	"18b $1,000 max-3 yr"	14a $0/vst	13b not covrd												27.33333333	150	48.03515459		75	0.120079671	0	11.30306022	2.011710189		0.977097336	1.132572402		25	0.118375022	14.57835721	20.38461538	22.56097561			162.6691178	51.95979933	0	0	0	0	0	0	0												NO	26.60754067	146.0169915	46.75965839		73.00849573	0.116891149	0	11.00292565	1.958292464		0.951152089	1.102498765		24.33616524	0.115231764	14.1912524	19.84333474	21.96190522			158.3497012	50.5800905	0	0	0	0	0	0	0													0.6643	0.113422455	5.342867132	0	1.150947961	3.825794486	0	1.254509817	0.293393344	0	0.874185862	0.22340824	0	0.952122401	4.329916637	11.96978692	0.14841908	3.730079524	0	0	9.067034834	4.254017167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1942	0	1.669549146	0.6643	0.113422455	5.342867132	0	1.150947961	3.825794486	0	1.254509817	0.293393344	0	0.874185862	0.22340824	0	0.952122401	4.329916637	11.96978692	0.14841908	3.730079524	0	0	9.067034834	4.254017167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1942	YES	1a 20% coin	1b 20% coin	2 20% coin	6 20% coin	10a 20% coin	11a 50% coin	"11b 50% coin, 11c 50% coin"	Refer to In Network	"9a 20% coin, 9b 20% coin"	8a 20% coin	8b 20% coin	5 20% coin	12 20% coin	"3 20% coin, 9c 20% coin, 9d 20% coin"	"7a 20% coin, 14b $0/vst, 14c 20% coin, 14d 20% coin, 14e 20% coin, 14f 20% coin, 14g 20% coin, 14h 20% coin, 14i 20% coin, 14j 20% coin"	"7b 20% coin, 7d 20% coin, 7f 20% coin, 7g 20% coin, 17a 20% coin, 18a 20% coin"	"7e 20% coin, 7h 20% coin"	"7c 20% coin, 7i 20% coin"	0	0	15 20% coin	13a 20% coin	10b not covrd	"16a 50% coin, 16b 50% coin"	17a $200 combined max INN/OON-2yr (17a/17b)	17b $200 combined max INN/OON-2yr (17a/17b)	18a 20% coin	18b 50% coin	14a 50% coin	13b not covrd											5100	0.0294	0	0	0	0.4023	0.7155	0	0.1082	0.2448	0	1.1064	0	0	0.2301	0.3053	0.6588	0	0.8284	0	0	0	0	0	0	0	0	0	0	0												4.6291	500	0.05	0.6938	0.113422455	5.342867132	0	1.553199999	4.541319077	0	1.362723878	0.538152958	0	1.98055916	0.22340824	0	1.182219572	4.635218502	12.62860982	0.14841908	4.558447014	0	0	9.067034834	4.254017167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8234
H9720_038_0	2011	4																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	O	V	V	V	V	P	P	Coin	O	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	1169.119114	16.37297776	449.264704	81.6752288	319.9793976	7.969143832	11.54921803	290.4387315	332.8479268	902.5876214	16.37325404	45.83620099	0.182403522	339.2735625	3809.634417	9210.859767	213.2060341	1368.645187	0	0	25.57558269	9.585688089	4.108152038	425	362.430302	24.64891223	29.66998694	0	0	0											3400	1a1: $187.8	1b1: $131.37	21: $40.74	6: $10	10a: $100	11a: 20.0%	"11b: 20.0%,11c: 20.0%"	"4a1: $50,4a2: $500,4b: $22.5"	"9a1: $250,9b: $100"	"8a1: $15,8a2: $15"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: $250,9a2: $250"	12: 20.0%	"3: $35,9a3: $250,9c: $35,9d1: $35"	7a: $10	"7b1: $35,7d1: $35,7f1: $35,7g: $35,17b1: $10"	"7e: $35,7h: $35"	"7c: $35,7i: $35"	7d2: $35	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16a1: $1.225	$0 	17b2: $10	$0 	$0 	$0 	$0 												187.8	131.37	40.74	10	100	0.2	0.2	48.58038348	155.7915058	15	0.2	250	0.2	128.2971357	6.346703893	31.75573691	35	35	0	0	0.2	0	0	1.225	0	10	0	0	0	0											NO	165.0963482	115.4883241	35.81483081	8.791072854	87.91072854	0.175821457	0.175821457	42.70736905	136.9574477	13.18660928	0.175821457	219.7768214	0.175821457	112.7869467	5.579433631	27.91669967	30.76875499	30.76875499	0	0	0.175821457	0	0	1.076906425	0	8.791072854	0	0	0	0												16.0848	0.15757398	1.340861613	0.059834407	2.344135164	1.40114648	2.030600342	1.033656174	3.798833546	0.991839192	2.878769382	0.83947788	0.032070453	3.188802434	1.771300199	21.42806715	0.546673685	3.509292368	0	0	4.496736214	0	0	0.038140436	0	0.018057532	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.9906		9.349909362	16.0848	0.15757398	1.340861613	0.059834407	2.344135164	1.40114648	2.030600342	1.033656174	3.798833546	0.991839192	2.878769382	0.83947788	0.032070453	3.188802434	1.771300199	21.42806715	0.546673685	3.509292368	0	0	4.496736214	0	0	0.038140436	0	0.018057532	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.9906	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		16.0848	0.15757398	1.340861613	0.059834407	2.344135164	1.40114648	2.030600342	1.033656174	3.798833546	0.991839192	2.878769382	0.83947788	0.032070453	3.188802434	1.771300199	21.42806715	0.546673685	3.509292368	0	0	4.496736214	0	0	0.038140436	0	0.018057532	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.9906
H9720_039_0	2011	5																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	O	V	V	V	V	P	P	Coin	O	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	1234.397649	17.28717374	474.3496943	86.23561894	337.8456578	8.41410622	12.19407622	306.6555692	351.4327098	952.9841951	17.16720974	48.39549543	0.192588142	358.2171251	4022.347861	9725.154182	225.1105333	1445.064391	0	0	27.00361217	10.12091129	4.33753341	0	382.6668364	26.02520046	31.32663018	0	0	0											3400	1a1: $221.61	1b1: $155.01	21: $40.74	6: $10	10a: $100	11a: 20.0%	"11b: 20.0%,11c: 20.0%"	"4a1: $50,4a2: $500,4b: $22.5"	"9a1: $250,9b: $100"	"8a1: $15,8a2: $15"	"8b1: 20.0%,8b2: 20.0%,8b3: 20.0%,8b4: 20.0%,8b5: 20.0%,8b6: 20.0%"	"5: $295,9a2: $250"	12: 20.0%	"3: $35,9a3: $250,9c: $35,9d1: $35"	7a: $10	"7b1: $35,7d1: $35,7f1: $35,7g: $35,17b1: $10"	"7e: $35,7h: $35"	"7c: $35,7i: $35"	7d2: $35	$0 	"151: 20.0%,152: 20.0%,153: 20.0%"	$0 	$0 	16a1: $1.225	$0 	17b2: $10	$0 	$0 	$0 	$0 												221.61	155.01	40.74	10	100	0.2	0.2	48.58038348	155.7915058	15	0.2	250	0.2	127.412663	6.346703893	31.74383844	35	35	0	0	0.2	0	0	0	0	10	0	0	0	0											NO	191.735182	134.1133999	35.24791893	8.651919226	86.51919226	0.173038385	0.173038385	42.03135539	134.7895524	12.97787884	0.173038385	216.2979807	0.173038385	110.2364069	5.491116944	27.46451261	30.28171729	30.28171729	0	0	0.173038385	0	0	0	0	8.651919226	0	0	0	0												19.7231	0.19320347	1.393319964	0.062175301	2.435844452	1.455963348	2.110043249	1.074095767	3.947454805	1.030642785	2.97058624	0.872320661	0.033325141	3.290714063	1.840598541	22.25805164	0.568061127	3.646585946	0	0	4.672661426	0	0	0	0	0.018763994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5975		11.46744638	19.7231	0.19320347	1.393319964	0.062175301	2.435844452	1.455963348	2.110043249	1.074095767	3.947454805	1.030642785	2.97058624	0.872320661	0.033325141	3.290714063	1.840598541	22.25805164	0.568061127	3.646585946	0	0	4.672661426	0	0	0	0	0.018763994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5975	NO	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 	$0 												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0		19.7231	0.19320347	1.393319964	0.062175301	2.435844452	1.455963348	2.110043249	1.074095767	3.947454805	1.030642785	2.97058624	0.872320661	0.033325141	3.290714063	1.840598541	22.25805164	0.568061127	3.646585946	0	0	4.672661426	0	0	0	0	0.018763994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5975
H9779_001_0	2011	6																															D	D	D	V	T	Coin	Coin	V	V	P	Coin		Coin	Coin	V	V	Coin	V	Coin	P	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	869.3262491	20.86096977	1102.769438	1676.055135	289.9409929	11.17091735	7.20943051	280.2009112	338.698403	1048.549623	19.53746555	0	0.293698554	18.05468931	4084.34749	4921.741437	1.063858181	449.7644503	19.23252556	5407.079376	785.0632199	9.152434754	0	0	0	0	0	0	0	0											3400	$280/Days 1-6 for IP Medical; $280/Days 1-6 for IP Surgical; PBP 1a	$280/Days 1-6 for IP Psych; $280/Days 1-6 for IP Substance Abuse; PBP 1b	$100/Days 1-100 for SNF; PBP 2	$21/Visit for Home Health; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 10% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $50/Visit for Urgent Care; PBP 4a, 4b"	"$350/Visit for OP Fac - Surgery; $150/Visit for Ambulatory Surgical Center Services; PBP 9a, 9b"	$30/Service for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"20% Coinsurance for OP Fac - Other/CORF/Partial Hospitalization; $40-$50/Visit for OP Fac - PT/OT/ST; PBP 3, 5, 9a, 9c, 9d, 13a"	"$25/Visit for PCP Office Visits; $25/Visit for PCP Consults; $15/Visit for Routine Physicals; PBP 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $50/Visit for Cardio; 50% Coinsurance for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"45% coinsurance for OP Psych and Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $40/Visit for PT/ST; 20% Coinsurance for Prof - CORF; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology; PBP 7d, 14g-h"	"$25-$50/Visit for Other Prof Services (Allergy Testing, etc.); PBP 7g, 14f, 14i"	$25-$50/Visit for Tx Injections; 20% for Part B drugs; PBP 15	"20% Coinsurance for Renal Dialysis - Prof; PBP 7g, 12, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											0	280	280	100	21	100	0.2	0.191668179	50	350	30	0.2	0	0.2	0.190887089	24.88621814	45.94869028	0.45	42.51115292	0.2	26.82005717	56.37743407	0.2	0	0	0	0	0	0	0	0											NO	249.8785503	249.8785503	89.24233941	18.74089128	89.24233941	0.178484679	0.171049167	44.6211697	312.3481879	26.77270182	0.178484679	0	0.178484679	0.170352104	22.28555556	41.00568613	0.401590527	37.93794738	0.178484679	23.93484645	50.31254106	0.178484679	0	0	0	0	0	0	0	0												18.1022	0.434392407	8.201143703	2.617563921	2.156251041	1.993837595	1.233167081	1.041907701	8.815986035	2.339375533	3.487138263	0	0.052420692	3.075654305	7.585162744	16.81828205	0.427235368	1.421928337	3.432711147	10.78480122	3.291543791	1.633569377	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9462	0	11.89822967	18.1022	0.434392407	8.201143703	2.617563921	2.156251041	1.993837595	1.233167081	1.041907701	8.815986035	2.339375533	3.487138263	0	0.052420692	3.075654305	7.585162744	16.81828205	0.427235368	1.421928337	3.432711147	10.78480122	3.291543791	1.633569377	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9462	YES	$280/Days Custom for IP Medical; $280/Days Custom for IP Surgical; PBP 1a	$280/Days Custom for IP Psych; $280/Days Custom for IP Substance Abuse; PBP 1b	$100/Days Custom for SNF; PBP 2	$21/Visit for Home Health; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"20% Coinsurance for DME / Medical Supplies; 10% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $50/Visit for ER - Worldwide; $50/Visit for PCP Urgent Care; $50/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$350/Visit for OP Fac - Surgery; PBP 9a, 9b"	$30/Service for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	No Cost-Sharing;	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"20% Coinsurance for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $40/Visit for OP Fac - Physical/Speech Therapy; 20% Coinsurance for OP Fac - CORF; 20% Coinsurance for OP Fac - Other; PBP 3, 5, 9a, 9c, 9d, 13a"	"$25/Visit for PCP Office Visits; $25/Visit for PCP Consults; $15/Visit for Routine Physicals; PBP 4b, 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $50/Visit for Cardio; 50% Coinsurance for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"45% Coinsurance for OP Psych - Non-Physician; 45% Coinsurance for OP Psych - Psychiatrist; 45% Coinsurance for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $40/Visit for PT/ST; 20% Coinsurance for Prof - CORF; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"$48/Visit for Allergy Testing; $45/Visit for Allergy Tx; $30/Service for Prof Path (OP); $30/Service for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; $43/Visit for Tx Injections; PBP 15	"20% Coinsurance for Renal Dialysis - Prof; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"No Cost-Sharing; PBP 16a, 16b"	No Cost-Sharing; PBP 17a	No Cost-Sharing; PBP 17b	No Cost-Sharing; PBP 18a	No Cost-Sharing; PBP 18b	No Cost-Sharing; PBP 14a	No Cost-Sharing; PBP 13b											5100	1.1728	0.0328	0.4805	0.1345	0.1414	0.1348	0.0809	0.0624	0.577	0.1413	0.2032	0	0.0027	0.1649	0.4115	0.9426	0.025	0.0898	0.2053	0.6228	0.1845	0.0934	0	0	0	0	0	0	0	0											5.9039	0	0.7104084	19.275	0.467216856	8.681601717	2.752037036	2.297642768	2.128667662	1.314059934	1.104271306	9.39297332	2.480640859	3.690313576	0	0.055087383	3.240515895	7.996654232	17.76090445	0.452219059	1.511728747	3.638060829	11.40755417	3.476011482	1.726997669	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.8502
H9779_003_0	2011	5																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	255.2618983	19.00336291	234.1573744	0	12.11774666	15.70502052	12.13084525	23.35430034	33.76870931	6.819358588	21.3927809	0	4.280645169	37.16858041	24.26648237	30.95960979	4.953131548	3.53627518	11.26862215	48.94167432	28.43788477	28.17949126	0	0	0	0	0	0	0	0											3400	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 12, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	0.080262788	0.080262788	0.184649638	0	0.233	0.233	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	0.067969275	0.067969275	0.15636763	0	0.19731237	0.19731237	0.19731237	0.19731237	0.19731237	0.19731237	0.19731237	0	0.19731237	0.19731237	0.19731237	0.19731237	0.19731237	0.19731237	0.19731237	0.19731237	0.19731237	0.19731237	0	0	0	0	0	0	0	0												17.35	1.29164479	36.61463359	0	2.390981315	3.098794823	2.393565829	4.608092355	6.662984073	1.345543806	4.221060304	0	0.844624244	7.333820698	4.788077152	6.108713989	0.977314126	0.697750837	2.223438546	9.656797762	5.611146448	5.560162211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.7791	0	22.38776593	17.35	1.29164479	36.61463359	0	2.390981315	3.098794823	2.393565829	4.608092355	6.662984073	1.345543806	4.221060304	0	0.844624244	7.333820698	4.788077152	6.108713989	0.977314126	0.697750837	2.223438546	9.656797762	5.611146448	5.560162211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.7791	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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;	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											5100	2.2523	0.2052	4.3361	0	0.3423	0.4653	0.3414	0.5553	0.9039	0.1659	0.5477	0	0.0987	0.8718	0.5811	0.7674	0.1269	0.0939	0.291	1.2339	0.6633	0.6887	0	0	0	0	0	0	0	0											15.5321	0	2.809277524	19.6023	1.496837673	40.95075912	0	2.733256874	3.564117363	2.73496398	5.163347504	7.566896945	1.511488237	4.768807785	0	0.943311692	8.205581971	5.36916222	6.876122007	1.104250315	0.791602884	2.514401168	10.89072086	6.274476954	6.24886939	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.3113
H9847_001_0	2011	13																															D	D	D	V	T	COIN	COIN	V	COIN	O	COIN	COIN	COIN	COIN	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	999.3128257	38.40433598	435.6536332	0	193.4447215	2.50972324	4.569209582	410.0175884	39.56811978	1230.471578	20.38463018	1.014856898	0.014501591	14.8803288	3382.673878	8511.321709	263.9449808	599.4001694	1140.547641	1484.439428	21.05206604	0	0	0	0	0	0	0	0	0											3400	1a $223 days 1-10	1b $215 days 1-10	2 $100 days 13-100	6 $0	10a $100	11a 20%	11b 20%	"4a $50, 4b $25"	"9a 20%, 9b 20%"	8a $35	"8b1 20%, 9a 20%, 14h $0"	9a 20%	12 20%	"9a 20%, 9d $35, 13a $0"	7a $15	"7b $35, 7d $35, 7f $35, 7g $35, 14d $0, 14e $0, 17a $35 ,17b $0"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	"7d $35, 8b2 $35, 14h $0"	"7d $35, 14b $0"	15 20%								14a $0	"14c $0, 7f $35"												200.7594407	191.8670886	49.17647059	0	100	0.2	0.2	41.16828396	0.2	33.48240936	0.194440476	0.2	0.2	0.208892344	14.67755344	16.61026428	30.86564507	30.22672799	3.571654472	2.074424899	0.2	0	0	0	0	0	0	0	0	0											NO	182.2266183	174.1562105	44.63708614	0	90.76919431	0.181538389	0.181538389	37.36811966	0.181538389	30.39171321	0.176492054	0.181538389	0.181538389	0.189535458	13.32269701	15.07700306	28.01649734	27.43655746	3.241961988	1.882938767	0.181538389	0	0	0	0	0	0	0	0	0												15.1751	0.557362802	1.62052573	0	1.463235126	0.455611113	0.829486945	1.276798859	7.183132705	3.116344942	3.597725247	0.184235486	0.002632595	2.82034993	3.755528262	10.69376862	0.616234488	1.370456433	0.308134342	0.232925712	3.821758146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.0814	0	6.009622481	15.1751	0.557362802	1.62052573	0	1.463235126	0.455611113	0.829486945	1.276798859	7.183132705	3.116344942	3.597725247	0.184235486	0.002632595	2.82034993	3.755528262	10.69376862	0.616234488	1.370456433	0.308134342	0.232925712	3.821758146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.0814	YES	0.2	0.2	0.2	30	100	0.2	0.25	"4a $50, 4b $25"	0.2	0.2	"8b1 20%, 9a 20%, 14h $0"	0.2	0.2	0.2	0.2	"7b 20% ,7d 20% ,7f 20% ,7g 20% ,14d $0 ,14e $0 17a 20% ,17b 20%"	0.2	0.2	"7d 20% ,8b2 20% ,14h $0"	"7d 20% ,14b $0"	0.2								50	"14c $0 ,7f 20%"											5100	2.99	0.2262	1.2552	0.0361	0.3581	1.3631	1.7236	0.1917	0.875	0.1303	0.2165	0.0005	0	0.4836	1.4949	6.314	0.2704	0.2645	0.6789	0.4639	0.2887	0	0	0	0	0	0	0	0.8667	0											20.4919	0	1.778890622	18.1651	0.783611742	2.875722438	0.036115187	1.821300224	1.818758794	2.55310078	1.468465291	8.05810145	3.246671371	3.81418387	0.184755473	0.002632595	3.303950456	5.250475735	17.00780411	0.88663105	1.63494172	0.987032802	0.696840305	4.110425213	0	0	0	0	0	0	0	0.866666667	0	0	0	0	0	0	0	0	0	0	0	79.5733
H9847_004_0	2011	10																															D	D	D	V	T	COIN	COIN	V	COIN	O	COIN	COIN	COIN	COIN	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	992.8327982	38.15530369	444.9228595	0	193.4447215	2.50972324	4.569209582	410.0175884	39.56811978	1230.471578	20.38463018	1.014856898	0.014501591	14.8803288	3305.794927	8317.882579	257.9462312	585.7774383	1114.626104	1450.702168	21.05206604	0	0	0	0	0	0	0	0	0											6700	1a $265 days 1-6	1b $265 days 1-6	2 $50 days 1-100	6 $0	10a $125	11a 20%	11b 20%	"4a $50, 4b $25"	"9a 20%, 9b 20%"	8a $50	"8b1 20%, 9a 20%, 14h $0"	9a 20%	12 20%	"9a 20%, 9d $50, 13a $0"	7a $35	"7b $35, 7d $50, 7f $50, 7g $50, 14d $0, 14e $0, 17a $50 ,17b $0"	"7e $40, 7h $40, 9c $40"	"7c $50, 7i $50"	"7d $50, 8b2 $50, 14h $0"	"7d $50, 14b $0"	15 20%								14a $0	"14c $0, 7f $50"												210.3652719	189.5253165	50	0	125	0.2	0.2	41.16828396	0.2	47.83201337	0.194440476	0.2	0.2	0.218356232	34.2476247	23.57051535	35.27502293	43.18103999	5.102363532	2.963464141	0.2	0	0	0	0	0	0	0	0	0											NO	208.0189738	187.4115772	49.44235965	0	123.6058991	0.197769439	0.197769439	40.70914204	0.197769439	47.29855215	0.192271919	0.197769439	0.197769439	0.215911953	33.86566755	23.30763794	34.88160741	42.69945018	5.045457856	2.930413197	0.197769439	0	0	0	0	0	0	0	0	0												17.2107	0.59589547	1.833169669	0	1.992575728	0.496346556	0.903650014	1.390955353	7.825364835	4.849960341	3.919391969	0.200707679	0.002867972	3.21284085	9.329412665	16.15584963	0.749798264	2.084364545	0.468649919	0.354263065	4.163455282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.7402	0	0.876946761	17.2107	0.59589547	1.833169669	0	1.992575728	0.496346556	0.903650014	1.390955353	7.825364835	4.849960341	3.919391969	0.200707679	0.002867972	3.21284085	9.329412665	16.15584963	0.749798264	2.084364545	0.468649919	0.354263065	4.163455282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.7402	YES	0.2	0.2	0.2	30	125	0.25	0.25	"4a $50, 4b $25"	0.2	0.2	"8b1 20%, 9a 20%, 14h $0"	0.2	0.2	0.2	0.2	"7b 20% ,7d 20% ,7f 20% ,7g 20% ,14d $0 ,14e $0 17a 20% ,17b 20%"	0.2	0.2	"7d 20% ,8b2 20% ,14h $0"	"7d 20% ,14b $0"	0.2									"14c $0 ,7f 20%"											10000	3.1531	0.2386	1.3237	0.0385	0.4766	1.7969	1.8176	0.2041	0.9227	0.1374	0.2283	0.0005	0	0.51	1.5765	6.6585	0.2851	0.2789	0.7159	0.4892	0.3044	0	0	0	0	0	0	0	0	0											21.1567	0	0.459240219	20.3638	0.834487813	3.156845807	0.038458653	2.469200062	2.293242259	2.721298585	1.595058767	8.748069014	4.987396954	4.147659867	0.201256034	0.002867972	3.72282504	10.90591958	22.81435826	1.034946779	2.363279285	1.184586861	0.843487322	4.467871081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.8969
H9847_801_0	2011	3																															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	YES	203.8505327	3.798521772	20.00291226	0	7.029303896	2.636737824	4.569209582	12.63619731	39.56811978	8.171378556	20.38463018	1.014856898	0.014501591	14.8803288	25.27450887	91.2392729	6.958293068	3.891823058	5.884457976	5.757401678	21.05206604	0	0	0	0	0	0	0	0	0											6700	FFS Medicare	FFS Medicare	FFS Medicare		FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				0.080705016	0.080705016	0.181384006	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.079341166	0.079341166	0.178318764	0	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0	0	0	0	0	0	0	0	0												16.1737	0.301379148	3.566894581	0	1.610149844	0.603977728	1.046634518	2.894478804	9.063571992	1.871756309	4.669354122	0.232465647	0.003321771	3.408525149	5.789441903	20.89949492	1.593883928	0.891470675	1.347908589	1.318804757	4.82223864	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.1095	0	1.411436027	16.1737	0.301379148	3.566894581	0	1.610149844	0.603977728	1.046634518	2.894478804	9.063571992	1.871756309	4.669354122	0.232465647	0.003321771	3.408525149	5.789441903	20.89949492	1.593883928	0.891470675	1.347908589	1.318804757	4.82223864	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.1095	YES	FFS Medicare	FFS Medicare	FFS Medicare		FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			10000	1.3	0.0984	1.2265	0	0.408	1.7111	1.7308	0.3319	1.0983	0.1636	0.2899	0.0007	0	0.607	1.8765	8.2252	0.3394	0.332	0.9254	0.602	0.3623	0	0	0	0	0	0	0	0	0											21.6288	0	0	17.4737	0.399747008	4.793421051	0	2.018105019	2.315036683	2.777454988	3.226407264	10.16185586	2.035345483	4.959207544	0.233118348	0.003321771	4.015553296	7.665939435	29.12464829	1.93329283	1.22345959	2.273313568	1.920770432	5.184581164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7383
H9847_802_0	2011	2																															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	YES	203.8505327	3.798521772	20.00291226	0	7.029303896	2.636737824	4.569209582	12.63619731	39.56811978	8.171378556	20.38463018	1.014856898	0.014501591	14.8803288	25.27450887	91.2392729	6.958293068	3.891823058	5.884457976	5.757401678	21.05206604	0	0	0	0	0	0	0	0	0											6700	FFS Medicare	FFS Medicare	FFS Medicare		FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				0.080705016	0.080705016	0.181384006	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.079341166	0.079341166	0.178318764	0	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0	0	0	0	0	0	0	0	0												16.1737	0.301379148	3.566894581	0	1.610149844	0.603977728	1.046634518	2.894478804	9.063571992	1.871756309	4.669354122	0.232465647	0.003321771	3.408525149	5.789441903	20.89949492	1.593883928	0.891470675	1.347908589	1.318804757	4.82223864	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.1095	0	1.411436027	16.1737	0.301379148	3.566894581	0	1.610149844	0.603977728	1.046634518	2.894478804	9.063571992	1.871756309	4.669354122	0.232465647	0.003321771	3.408525149	5.789441903	20.89949492	1.593883928	0.891470675	1.347908589	1.318804757	4.82223864	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.1095	YES	FFS Medicare	FFS Medicare	FFS Medicare		FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			10000	1.3	0.0984	1.2265	0	0.408	1.7111	1.7308	0.3319	1.0983	0.1636	0.2899	0.0007	0	0.607	1.8765	8.2252	0.3394	0.332	0.9254	0.602	0.3623	0	0	0	0	0	0	0	0	0											21.6288	0	0	17.4737	0.399747008	4.793421051	0	2.018105019	2.315036683	2.777454988	3.226407264	10.16185586	2.035345483	4.959207544	0.233118348	0.003321771	4.015553296	7.665939435	29.12464829	1.93329283	1.22345959	2.273313568	1.920770432	5.184581164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7383
H9847_803_0	2011	2																															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	YES	203.8505327	3.798521772	20.00291226	0	7.029303896	2.636737824	4.569209582	12.63619731	39.56811978	8.171378556	20.38463018	1.014856898	0.014501591	14.8803288	25.27450887	91.2392729	6.958293068	3.891823058	5.884457976	5.757401678	21.05206604	0	0	0	0	0	0	0	0	0											6700	FFS Medicare	FFS Medicare	FFS Medicare		FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				0.080705016	0.080705016	0.181384006	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	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	0.079341166	0.079341166	0.178318764	0	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0.229062489	0	0	0	0	0	0	0	0	0												16.1737	0.301379148	3.566894581	0	1.610149844	0.603977728	1.046634518	2.894478804	9.063571992	1.871756309	4.669354122	0.232465647	0.003321771	3.408525149	5.789441903	20.89949492	1.593883928	0.891470675	1.347908589	1.318804757	4.82223864	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.1095	0	1.411436027	16.1737	0.301379148	3.566894581	0	1.610149844	0.603977728	1.046634518	2.894478804	9.063571992	1.871756309	4.669354122	0.232465647	0.003321771	3.408525149	5.789441903	20.89949492	1.593883928	0.891470675	1.347908589	1.318804757	4.82223864	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.1095	YES	FFS Medicare	FFS Medicare	FFS Medicare		FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			10000	1.3	0.0984	1.2265	0	0.408	1.7111	1.7308	0.3319	1.0983	0.1636	0.2899	0.0007	0	0.607	1.8765	8.2252	0.3394	0.332	0.9254	0.602	0.3623	0	0	0	0	0	0	0	0	0											21.6288	0	0	17.4737	0.399747008	4.793421051	0	2.018105019	2.315036683	2.777454988	3.226407264	10.16185586	2.035345483	4.959207544	0.233118348	0.003321771	4.015553296	7.665939435	29.12464829	1.93329283	1.22345959	2.273313568	1.920770432	5.184581164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7383
H9859_001_0	2011	5																															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	Coin																																																			0	YES	287.3724396	4.564885227	1222.903075		244.4149529	6.614716317	1.482289529	271.0284953	270.7765803		556.7565488	27.17692603		308.2829984	3352.692808	5149.979664	77.99307887	728.7582672	2339.337228	5.428051459	889.0948798				141.0202253		2.528442947			0.164610619											3400	$300 per stay/$900 max	$300 per stay/$900 max	$0 days 1-20; $105/day days 21-100	$0 Copay	$50 Copay	20.00%	20.00%	$50 ER Copay;$25 UC Copay	$150 for OP Surgery;$75 for ASC	$0 Copay	"$40 Copay for MRI, CT, Other Imaging, and Diag Rad.;$25 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$25 Copay	$0 Copay	"$25 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$25 Copay for Chemotherapy;$40 Copay for Clinic"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$25 Copay	$25 Copay	$25 Copay	20% of the cost for diabetic related shoe inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 	$100 allowance	$25 exam Copay	No coverage	No Cost Sharing	50.0% for Accupuncture												280.2132935	294.5619335	26.76		50	0.2	0.2	48.57478897	133.4047676		36.15811289	25		38.15343436	15.00216255	24.90828731	25	25	24.88049292	25.58680004	25.36270073				25		25			0.5											NO	253.713603	266.7052963	24.22931451		45.2715144	0.181086058	0.181086058	43.98108517	120.7887171		32.73865057	22.6357572		34.54527507	13.58605748	22.55271776	22.6357572	22.6357572	22.52755187	23.16706373	22.96415743				22.6357572		22.6357572			0.5												6.0759	0.101456589	2.469175268	0	0.922086255	1.1978329	0.268421967	0.993343945	2.72556298	0	1.518954842	0.051264192	0	0.887476748	3.795823099	9.678836484	0.147119366	1.374666266	4.391628396	0.010479335	1.701442899	0	0	0	0.266008298	0	0.004769435	0	0	0.08230531	0	0	0	0	0	0	0	0	0	0	38.6645	0	4.028989598	6.0759	0.101456589	2.469175268	0	0.922086255	1.1978329	0.268421967	0.993343945	2.72556298	0	1.518954842	0.051264192	0	0.887476748	3.795823099	9.678836484	0.147119366	1.374666266	4.391628396	0.010479335	1.701442899	0	0	0	0.266008298	0	0.004769435	0	0	0.08230531	0	0	0	0	0	0	0	0	0	0	38.6645	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	No Cost Sharing																																									0.0927											0.0927	0	0	6.0759	0.101456589	2.469175268	0	0.922086255	1.1978329	0.268421967	0.993343945	2.72556298	0	1.518954842	0.051264192	0	0.887476748	3.795823099	9.678836484	0.147119366	1.374666266	4.391628396	0.010479335	1.701442899	0	0	0	0.266008298	0	0.004769435	0	0	0.175035039	0	0	0	0	0	0	0	0	0	0	38.7572
H9859_002_0	2011	6																															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	Coin																																																			0	NO	328.091804	2.013955252	719.9229547		182.6164097	7.296723317	3.13362388	265.0168124	343.146469		806.9598282	30.16672255		201.4706113	3861.942779	6264.374479	167.4970394	1042.497346	2845.336142	13.73792752	1420.774944				214.6138471		2.89627324			0.123492062												$300 per stay/$900 max	$300 per stay/$900 max	$0 days 1-20; $105/day days 21-100	$0 Copay	$50 Copay	20.00%	20.00%	$50 ER Copay;$25 UC Copay	$150 for OP Surgery;$75 for ASC	$0 Copay	"$40 Copay for MRI, CT, Other Imaging, and Diag Rad.;$25 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$25 Copay	$0 Copay	"$25 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$25 Copay for Chemotherapy;$40 Copay for Clinic"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$25 Copay	$25 Copay	$25 Copay	20% of the cost for diabetic related shoe inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 	$100 allowance	$25 exam Copay	No coverage	No Cost Sharing	50.0% for Accupuncture												280.2132935	294.5619335	26.76		49.85552172	0.2	0.2	49.4686775	137.5196232		36.15487316	25		37.67379679	15.00273635	24.99493917	25	25	24.818013	41.17017351	25.06245929				25		8.109218726			0.5											NO	245.858388	258.4478461	23.47915183		43.74346987	0.175479461	0.175479461	43.41931184	120.6593466		31.72218821	21.93493258		33.0548877	13.16336041	21.93049222	21.93493258	21.93493258	21.77525767	36.1225992	21.98973419				21.93493258		8.109218726			0.5												6.722	0.0433752	1.408598363	0	0.665689618	1.280425072	0.549886628	0.958903968	3.45031906	0	2.133210962	0.055142085	0	0.554965703	4.236345392	11.44840132	0.306169689	1.905592417	5.163160639	0.041354137	2.603538613	0	0	0	0.392295022	0	0.001957209	0	0	0.061746031	0	0	0	0	0	0	0	0	0	0	43.9831	0	6.136654575	6.722	0.0433752	1.408598363	0	0.665689618	1.280425072	0.549886628	0.958903968	3.45031906	0	2.133210962	0.055142085	0	0.554965703	4.236345392	11.44840132	0.306169689	1.905592417	5.163160639	0.041354137	2.603538613	0	0	0	0.392295022	0	0.001957209	0	0	0.061746031	0	0	0	0	0	0	0	0	0	0	43.9831	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	No Cost Sharing																																									0.3639											0.3639	0	0	6.722	0.0433752	1.408598363	0	0.665689618	1.280425072	0.549886628	0.958903968	3.45031906	0	2.133210962	0.055142085	0	0.554965703	4.236345392	11.44840132	0.306169689	1.905592417	5.163160639	0.041354137	2.603538613	0	0	0	0.392295022	0	0.001957209	0	0	0.425639244	0	0	0	0	0	0	0	0	0	0	44.347
H9859_003_0	2011	5																															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	Coin																																																			0	YES	228.3864664	6.12975963	1110.566687		203.0294386	4.388550322	1.798100267	233.1174947	221.7272446		368.4235843	38.47001379		429.9229914	2961.370651	4337.291467	101.9985116	585.384982	1968.243004	5.974319871	764.8984531				29.23917278		1.843114218			0.141563141											3400	$500 per stay/$1500 max per yr	$500 per stay	$0 days 1-20; $105/day days 21-100	$0 Copay	$100 Copay	20.00%	20.00%	$50 ER Copay;$30 UC Copay	$250 for OP Surgery;$100 for ASC	$0 Copay	"$40 Copay for MRI, CT, Other Imaging, and Diag Rad.;$30 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$30 Copay	$0 Copay	"$30 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$30 Copay for Chemotherapy;$40 Copay for Clinic"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$30 Copay for PCP Ophthalmology Services	$30 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$30 Copay	$30 Copay	$30 Copay	20% of the cost for diabetic related shoe inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No Coverage	No coverage	$30 	$100 allowance	$30 exam Copay	No Coverage	No Cost Sharing	50.0% for Accupuncture												467.0221558	500	26.76		100	0.2	0.2	47.55020225	198.6845572		38.17833569	30		39.04633719	15	29.54683783	30	30	29.93506986	27.13764727	27.0622149				30		30			0.5											NO	419.4316584	449.048994	24.03310216		89.80979879	0.179619598	0.179619598	42.70474097	178.4382011		34.28788646	26.94293964		35.06743686	13.47146982	26.5359556	26.94293964	26.94293964	26.88462601	24.37226641	24.30452075				26.94293964		26.94293964			0.5												7.9827	0.2293802	2.224196887	0	1.519502752	0.788269643	0.322974046	0.829601852	3.297050888	0	1.052705502	0.086374605	0	1.256358113	3.324501279	9.591181151	0.229011645	1.314332686	4.409623088	0.012133976	1.549207527	0	0	0	0.065649106	0	0.004138243	0	0	0.070781571	0	0	0	0	0	0	0	0	0	0	40.1597	0	4.548657167	7.9827	0.2293802	2.224196887	0	1.519502752	0.788269643	0.322974046	0.829601852	3.297050888	0	1.052705502	0.086374605	0	1.256358113	3.324501279	9.591181151	0.229011645	1.314332686	4.409623088	0.012133976	1.549207527	0	0	0	0.065649106	0	0.004138243	0	0	0.070781571	0	0	0	0	0	0	0	0	0	0	40.1597	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	No Cost Sharing																																									0.2804											0.2804	0	0	7.9827	0.2293802	2.224196887	0	1.519502752	0.788269643	0.322974046	0.829601852	3.297050888	0	1.052705502	0.086374605	0	1.256358113	3.324501279	9.591181151	0.229011645	1.314332686	4.409623088	0.012133976	1.549207527	0	0	0	0.065649106	0	0.004138243	0	0	0.35113493	0	0	0	0	0	0	0	0	0	0	40.44
H9859_004_0	2011	6																															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	Coin																																																			0	NO	303.5743286	3.704454817	817.6036304		149.9395119	6.057062064	2.619748859	241.3938065	322.2718819		650.4126983	25.04699622		140.1875207	3921.102035	6214.246386	241.6128763	939.6329094	2710.602205	9.684564823	1485.195595				218.8188566		3.966172288			0.687157277												$500 per stay/$1500 max per yr	$500 per stay	$0 days 1-20; $105/day days 21-100	$0 Copay	$100 Copay	20.00%	20.00%	$50 ER Copay;$30 UC Copay	$250 for OP Surgery;$100 for ASC	$0 Copay	"$40 Copay for MRI, CT, Other Imaging, and Diag Rad.;$30 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$30 Copay	$0 Copay	"$30 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$30 Copay for Chemotherapy;$40 Copay for Clinic"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$30 Copay for PCP Ophthalmology Services	$30 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$30 Copay	$30 Copay	$30 Copay	20% of the cost for diabetic related shoe inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No Coverage	No coverage	$30 	$100 allowance	$30 exam Copay	No Coverage	No Cost Sharing	50.0% for Accupuncture												410.1004611	500	26.76		99.78326744	0.2	0.2	49.33108169	217.7087656		37.20179546	30		38.35595664	14.99795022	29.99377494	30	30	29.76027953	43.91099695	27.7609812				30		30			0.364198249											NO	361.6762845	422.2367991	22.59811349		84.26471759	0.16889472	0.16889472	41.70584054	183.8493046		31.41593407	25.33420794		32.39059272	12.66918678	25.32895104	25.33420794	25.33420794	25.13177034	37.08167759	23.44341568				25.33420794		25.33420794			0.307555805												9.1496	0.130346429	1.539691635	0	1.052884219	1.023005799	0.442461749	0.838960967	4.937455117	0	1.702776871	0.052878818	0	0.378396407	4.139764507	13.1166952	0.510089237	1.98373796	5.676852674	0.029926659	2.901504808	0	0	0	0.461966868	0	0.008373319	0	0	0.21133921	0	0	0	0	0	0	0	0	0	0	50.2887	0	8.799001026	9.1496	0.130346429	1.539691635	0	1.052884219	1.023005799	0.442461749	0.838960967	4.937455117	0	1.702776871	0.052878818	0	0.378396407	4.139764507	13.1166952	0.510089237	1.98373796	5.676852674	0.029926659	2.901504808	0	0	0	0.461966868	0	0.008373319	0	0	0.21133921	0	0	0	0	0	0	0	0	0	0	50.2887	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	No Cost Sharing																																									0.4711											0.4711	0	0	9.1496	0.130346429	1.539691635	0	1.052884219	1.023005799	0.442461749	0.838960967	4.937455117	0	1.702776871	0.052878818	0	0.378396407	4.139764507	13.1166952	0.510089237	1.98373796	5.676852674	0.029926659	2.901504808	0	0	0	0.461966868	0	0.008373319	0	0	0.682401142	0	0	0	0	0	0	0	0	0	0	50.7598
H9859_013_0	2011	6																															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	Coin																																																			0	NO	311.5330232	1.912311007	683.5884706		160.3178315	6.416156794	2.755459029	246.8254315	319.5920837	7069.156137	751.5681968	28.09600736		187.641192	3631.514848	5890.602278	157.5031067	980.2953612	2675.565393	12.91823588	1349.068487				202.8441079		2.737437354			0.117449943												$500 per stay/$1500 max per yr	$500 per stay/$1500 max	$0 days 1-20; $105/day days 21-100	$0 Copay	$75 Copay	20.00%	20.00%	$50 ER Copay;$40 UC Copay	$250 for OP Surgery;$150 for ASC	$10 Copay	"$50 Copay for MRI, CT, Other Imaging, and Diag Rad.;$40 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$40 Copay	$0 Copay	"$40 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$40 Copay for Chemotherapy;$50 Copay for Clinic"	$20 Copay for Office Visits;$0 Copay for Preventive Services;$40 Copay for PCP Ophthalmology Services	$40 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$40 Copay	$40 Copay	$40 Copay	20% of the cost for diabetic related shoe inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$40 	No coverage	$40 Copay	No coverage	No Cost Sharing	50.0% for Accupuncture												424.6645852	490.9365559	26.76		74.78178031	0.2	0.2	49.55925707	233.3594976	10	47.43658211	40		48.44919786	20.0054727	39.9797567	40	40	39.636026	41.23706597	33.39459807				40		8.085			0.5											NO	379.7332542	416.8690895	22.72272598		63.4999287	0.169826054	0.169826054	42.10152719	198.1526129	8.491302684	40.2798377	33.96521074		41.13968038	16.98725241	33.94802153	33.96521074	33.96521074	33.65614939	35.0156409	28.35636402				33.96521074		8.085			0.5												9.8583	0.066431946	1.294416125	0	0.848347572	1.089630588	0.467948733	0.865977301	5.277333869	5.002195373	2.522753749	0.079523901	0	0.643291555	5.140788279	16.66452442	0.445802184	2.774661544	7.504102381	0.037695026	3.187889758	0	0	0	0.574136906	0	0.001844348	0	0	0.058724971	0	0	0	0	0	0	0	0	0	0	64.4063	0	10.84708305	9.8583	0.066431946	1.294416125	0	0.848347572	1.089630588	0.467948733	0.865977301	5.277333869	5.002195373	2.522753749	0.079523901	0	0.643291555	5.140788279	16.66452442	0.445802184	2.774661544	7.504102381	0.037695026	3.187889758	0	0	0	0.574136906	0	0.001844348	0	0	0.058724971	0	0	0	0	0	0	0	0	0	0	64.4063	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	No Cost Sharing																																									0.3461											0.3461	0	0	9.8583	0.066431946	1.294416125	0	0.848347572	1.089630588	0.467948733	0.865977301	5.277333869	5.002195373	2.522753749	0.079523901	0	0.643291555	5.140788279	16.66452442	0.445802184	2.774661544	7.504102381	0.037695026	3.187889758	0	0	0	0.574136906	0	0.001844348	0	0	0.404813914	0	0	0	0	0	0	0	0	0	0	64.7524
H9859_802_0	2011	3																															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	Coin																																																			0	YES			912.8910592		231.4856218	8.799155388	3.622432287	250.3978458			781.0748512	37.824448		180.422617	3827.663935	7295.292242	149.8862295	1054.768689	2934.653652	24.11535871	1502.211189				193.0774051		4.733316881			0.10902446											4000	$0 Copay	$0 Copay	$0 days 1-20; $105/day days 21-100	$0 Copay	$50 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	$0 for OP Surgery;$0 for ASC	$0 Copay	"$15 Copay for MRI, CT, Other Imaging, and Diag Rad.;$15 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$15 Copay	$0 Copay	"$15 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$15 Copay for Chemotherapy;$15 Copay for Clinic"	$10 Copay for Office Visits;$0 Copay for Preventive Services;$15 Copay for PCP Ophthalmology Services	$15 Copay for Office Visits;$15 Copay for Chiro Visits;$0 Copay for Preventive Services	$15 Copay	$15 Copay	$15 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No Coverage	No coverage	$15 	No Coverage	$15 exam Copay	No Coverage	No Cost Sharing	50.0% for Accupuncture														26.76		50	0.2	0.2	49.47129909			15	15		15	10	15	15	15	14.92667509	37.75915861	19.20086566				14.97791314		15			0.489474432											NO			25.86014225		48.31865144	0.193274606	0.193274606	47.80772915			14.49559543	14.49559543		14.49559543	9.663730289	14.49559543	14.49559543	14.49559543	14.42473622	36.48943247	18.5551987				14.47439183		15			0.488943518												0	0	1.967291054	0	0.932089423	1.700653289	0.700124172	0.997579366	0	0	0.943512087	0.045690658	0	0.217944439	3.082459325	8.812467076	0.181057512	1.274125016	3.527633736	0.073329646	2.322818925	0	0	0	0.232889835	0	0.005916646	0	0	0.053306803	0	0	0	0	0	0	0	0	0	0	27.0709	0	0.939982952	0	0	1.967291054	0	0.932089423	1.700653289	0.700124172	0.997579366	0	0	0.943512087	0.045690658	0	0.217944439	3.082459325	8.812467076	0.181057512	1.274125016	3.527633736	0.073329646	2.322818925	0	0	0	0.232889835	0	0.005916646	0	0	0.053306803	0	0	0	0	0	0	0	0	0	0	27.0709	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	No Cost Sharing																																									0.2796											0.2796	0	0	0	0	1.967291054	0	0.932089423	1.700653289	0.700124172	0.997579366	0	0	0.943512087	0.045690658	0	0.217944439	3.082459325	8.812467076	0.181057512	1.274125016	3.527633736	0.073329646	2.322818925	0	0	0	0.232889835	0	0.005916646	0	0	0.332925408	0	0	0	0	0	0	0	0	0	0	27.3505
H9859_804_0	2011	4																															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	Coin																																																			0	YES	358.5527191	0.895924048	946.1708858		241.9686945	10.88183515	3.360640328	262.7337547			752.9009187	71.767253		134.1219424	4527.198855	7673.979693	115.6836255	1366.924862	3276.042062	22.64706522	1702.539356				189.498067		3.859552381			0.098039721											4000	$100 per stay/$300 max ($0 w/rider)	$100 per stay/$300 max ($0 w/rider)	$0 days 1-20; $105/day days 21-100	$0 Copay	$50 Copay	20.00%	20.00%	$50 ER Copay;$20 UC Copay	$0 for OP Surgery;$0 for ASC	$0 Copay	"$20 Copay for MRI, CT, Other Imaging, and Diag Rad.;$20 Copay for X-Rays;$0 Copay for Nuclear Med. and Radiation Therapy"	$20 Copay	$0 Copay	"$20 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$20 Copay for Chemotherapy;$20 Copay for Clinic"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$20 Copay for PCP Ophthalmology Services	$20 Copay for Office Visits;$20 Copay for Chiro Visits;$0 Copay for Preventive Services	$20 Copay	$20 Copay	$20 Copay	20% of the cost for diabetic related shoe inserts Copay for foot inserts	Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No Coverage	No coverage	$20 	Rider	$20 exam Copay	No Coverage	No Cost Sharing	50.0% for Accupuncture												93.40443115	100	26.76		50	0.2	0.2	49.58333563			20	20		20	15	20	20	20	19.93587797	42.11030574	21.71254771				19.8799004		20			0.491755702											NO	87.04839571	93.19514571	24.93902099		46.59757286	0.186390291	0.186390291	46.20926189			18.63902914	18.63902914		18.63902914	13.97927186	18.63902914	18.63902914	18.63902914	18.57927052	39.2447608	20.23504047				18.52844358		20			0.490914183												2.601	0.006957981	1.966381299	0	0.939596156	2.028268425	0.62639073	1.01172774	0	0	1.16944518	0.11147266	0	0.208325233	5.273911962	11.91962759	0.179685872	2.123179361	5.072205976	0.074064888	2.870912731	0	0	0	0.29259202	0	0.006432587	0	0	0.048129089	0	0	0	0	0	0	0	0	0	0	38.5303	0	2.809449936	2.601	0.006957981	1.966381299	0	0.939596156	2.028268425	0.62639073	1.01172774	0	0	1.16944518	0.11147266	0	0.208325233	5.273911962	11.91962759	0.179685872	2.123179361	5.072205976	0.074064888	2.870912731	0	0	0	0.29259202	0	0.006432587	0	0	0.048129089	0	0	0	0	0	0	0	0	0	0	38.5303	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	No Cost Sharing																																									0.9982											0.9982	0	0	2.601	0.006957981	1.966381299	0	0.939596156	2.028268425	0.62639073	1.01172774	0	0	1.16944518	0.11147266	0	0.208325233	5.273911962	11.91962759	0.179685872	2.123179361	5.072205976	0.074064888	2.870912731	0	0	0	0.29259202	0	0.006432587	0	0	1.046351582	0	0	0	0	0	0	0	0	0	0	39.5285
H9988_001_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			4.053441834	0.06366978	0.741037181	0.571712745	0.193347557	0.242729376	0.241139786	0.304327275	1.686528734	0.629594418	0.689702921	0.000183116	0.001705237	0.000218936	0.586773489	0.686015667	0.035283364	0.146533636	0	0.000193765	0.390957016	0.010339247																			11.2754	NO	655.4550868	19.69553842	393.7486243	33.28370798	252.1537245	14.13110643	14.03856445	600.8684803	98.18554921	36.65343643	40.13641234	0.010660576	0.099274726	0.012745916	4706.54255	1896.021895	2.054110532	8.530827413	0	0.231037996	22.76055457	0.601925486																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	181.3821899	181.3821899	45.34554748	0	136.0366424	0.18138219	0.18138219	45.34554748	0.18138219	0	0.18138219	0.36276438	0.18138219	0.36276438	18.13821899	36.27643798	0.36276438	0.18138219	36.27643798	19.84692906	0.18138219	0.18138219																				9.9073	0.297701658	1.487895578	0	2.858512172	2.563131031	2.546345563	2.270559183	17.80910993	0	7.280030365	0.003867277	0.018006667	0.004623764	7.114024955	5.73174339	0.745158133	1.547340158	0	0.000382116	4.128359231	0.109178563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.4233	200	10.70553235	13.9608	0.361371438	2.22893276	0.571712745	3.051859729	2.805860406	2.78748535	2.574886458	19.49563867	0.629594418	7.969733286	0.004050394	0.019711905	0.0048427	7.700798444	6.417759057	0.780441497	1.693873794	0	0.000575881	4.519316247	0.11951781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6987	YES	$300 - days 1-5	$300 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	2.6266	0.0789	0.3709	0	0.6662	0.6057	0.6017	0.3633	4.2086	0	1.7204	0.0009	0.004	0.0011	1.7451	1.3246	0.1761	0.3657	0	0.0001	0.6605	0.0258																			15.5462	200	0	16.5874	0.440297876	2.599862763	0.571712745	3.718069343	3.411566053	3.389224343	2.938173694	23.70419388	0.629594418	9.690111779	0.004964288	0.023692307	0.005935364	9.445938471	7.742315287	0.956533349	2.059533084	0	0.000664185	5.179849664	0.145318313	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.2449
H9988_002_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			4.029489776	0.063293551	0.736658343	0.568334457	0.192205054	0.241295071	0.239714875	0.302528985	1.676562924	0.625874103	0.68562742	0.000185656	0.001695161	0.000217642	0.583306205	0.681961955	0.035074872	0.145667759	0	0.00019262	0.388646824	0.010278152																			11.2088	NO	642.6691356	19.31133789	386.0677766	32.63444326	247.2349661	13.85545118	13.76471441	589.1473491	96.27024538	35.93843847	39.35347203	0.010660576	0.097338176	0.012497281	4614.732105	1859.036228	2.014041033	8.364416709	0	0.235634514	22.31656482	0.590183735																				$250 - days 1-5	$250 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				250	250	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	226.122053	226.122053	45.22441059	0	135.6732318	0.180897642	0.180897642	45.22441059	0.180897642	0	0.180897642	0.361795285	0.180897642	0.361795285	18.08976424	36.17952847	0.361795285	0.180897642	36.17952847	19.02920274	0.180897642	0.180897642																				12.1101	0.363893281	1.454973971	0	2.795263905	2.506418452	2.490004385	2.220320134	17.41506042	0	7.118950309	0.003856946	0.017608246	0.004521457	6.956617983	5.604921179	0.728670549	1.513103262	0	0.000373661	4.037013961	0.106762846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.4485	200	11.07659469	16.1396	0.427186832	2.191632314	0.568334457	2.987468959	2.747713524	2.72971926	2.522849119	19.09162334	0.625874103	7.804577729	0.004042602	0.019303408	0.0047391	7.539924188	6.286883133	0.763745421	1.658771022	0	0.000566281	4.425660786	0.117040998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.6573	YES	$375 - days 1-5	$375 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	3.1885	0.0958	0.3597	0	0.6449	0.5827	0.5789	0.3473	4.0488	0	1.6551	0.0009	0.0038	0.0011	1.6915	1.2818	0.1694	0.3518	0	0.0001	0.6314	0.0248																			15.6583	200	0	19.3281	0.522996832	2.551310308	0.568334457	3.632328608	3.330433644	3.308623255	2.870132619	23.14047085	0.625874103	9.459670707	0.004939308	0.023129243	0.005790299	9.231428686	7.568694503	0.933154878	2.010554146	0	0.000651735	5.057096009	0.141862415	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.3156
H9988_003_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			4.432573649	0.069552222	0.714769554	0.626184651	0.202384348	0.254074203	0.252410318	0.345138485	1.567268667	0.510539679	0.559315147	0.000182124	0.001993602	0.000203454	0.526614993	0.621172098	0.03194831	0.131412389	0	0.00017545	0.457069878	0.012087667																			11.3171	NO	741.0878935	22.26868839	381.8608115	36.65356677	265.3772052	14.87217188	14.7747768	704.8722587	91.73969156	29.88431636	32.72405975	0.010660576	0.116695009	0.011909149	4388.998049	1768.099684	1.870086567	7.692192353	0	0.245089326	26.75447452	0.707548668																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	181.6940383	181.6940383	45.42350958	0	136.2705287	0.181694038	0.181694038	45.42350958	0.181694038	0	0.181694038	0.363388077	0.181694038	0.363388077	18.16940383	36.33880767	0.363388077	0.181694038	36.33880767	17.47679384	0.181694038	0.181694038																				11.2209	0.337173994	1.445454853	0	3.013591006	2.702184968	2.684488862	2.66814765	16.66855503	0	5.945766566	0.003873926	0.021202787	0.004327643	6.645456498	5.35421953	0.679567161	1.397625492	0	0.000356948	4.861128518	0.128557375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7826	200	10.47364062	15.6535	0.406726215	2.160224406	0.626184651	3.215975354	2.95625917	2.93689918	3.013286135	18.2358237	0.510539679	6.505081713	0.00405605	0.023196389	0.004531097	7.17207149	5.975391628	0.711515471	1.529037881	0	0.000532398	5.318198396	0.140645042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.0997	YES	$300 - days 1-5	$300 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	2.8559	0.0858	0.3666	0	0.6959	0.6427	0.6385	0.4307	3.9644	0	1.4141	0.0009	0.0047	0.001	1.6815	1.273	0.1616	0.3324	0	0.0001	0.7847	0.0306																			15.3652	200	0	18.5094	0.492542452	2.526821973	0.626184651	3.91192082	3.598940929	3.575372136	3.444000061	22.20023635	0.510539679	7.91920982	0.004977416	0.027915194	0.005560374	8.853530134	7.248399317	0.873142237	1.861446069	0	0.000617265	6.10292099	0.171220847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.4649
H9988_004_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			4.410075438	0.069199199	0.711141631	0.623006354	0.201357115	0.25278461	0.251129171	0.343386682	1.559313753	0.507948356	0.556476257	0.000186211	0.001983483	0.000202422	0.523942077	0.618019243	0.031786151	0.130745385	0	0.000174559	0.454749949	0.012026314																			11.2596	NO	721.1418436	21.66933658	371.5831981	35.66705238	258.2346961	14.47189401	14.37712028	685.9009364	89.27055869	29.07999332	31.84330628	0.010660576	0.113554215	0.011588619	4270.870125	1720.51207	1.819754022	7.485160428	0	0.251868248	26.03438977	0.688505311																				$250 - days 1-5	$250 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				250	250	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	226.5821102	226.5821102	45.31642205	0	135.9492661	0.181265688	0.181265688	45.31642205	0.181265688	0	0.181265688	0.362531376	0.181265688	0.362531376	18.12656882	36.25313764	0.362531376	0.181265688	36.25313764	16.50967956	0.181265688	0.181265688																				13.6165	0.409157001	1.403235086	0	2.925568119	2.623257827	2.606078601	2.590214693	16.18168926	0	5.772098827	0.003864793	0.020583483	0.004201238	6.451351769	5.197830074	0.65971793	1.356802756	0	0.000346522	4.719141579	0.124802389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6664	200	10.79353489	18.0266	0.4783562	2.114376717	0.623006354	3.126925235	2.876042437	2.857207772	2.933601375	17.74100301	0.507948356	6.328575084	0.004051005	0.022566966	0.00440366	6.975293847	5.815849317	0.691504081	1.487548141	0	0.000521081	5.173891528	0.136828703	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9261	YES	$375 - days 1-5	$375 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	3.4435	0.1035	0.3536	0	0.6692	0.6131	0.6091	0.4081	3.7817	0	1.349	0.0009	0.0045	0.001	1.6216	1.2253	0.1542	0.3171	0	0.0001	0.7435	0.0292																			15.428	200	0	21.4701	0.5818291	2.467958189	0.623006354	3.796122717	3.489108557	3.466259036	3.341688481	21.5227302	0.507948356	7.677538268	0.004954223	0.027063905	0.005385506	8.596933768	7.041126298	0.845682869	1.804638514	0	0.000602766	5.917390063	0.165995534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.354
H9988_005_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	604.6336064	18.16842171	322.185564	24.91358744	194.2806713	10.88780604	11.0588058	556.313643	91.75398192	25.79445944	28.24556606	0.010660576	0.095522961	0.011911057	3938.734063	1586.711677	1.660669672	6.799179806	0	0.285147581	21.05807067	0.556901607																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	114.7496961	114.7496961	45.89987846	0	91.79975691	0.183599514	0.183599514	45.89987846	0.091799757	0	0.091799757	0.367199028	0.091799757	0.367199028	9.179975691	22.94993923	0.367199028	0.091799757	22.94993923	8.513705164	0.183599514	0.091799757																				5.7818	0.173735073	1.232356519	0	1.4862432	1.998995895	2.030391369	2.12789405	8.422993236	0	2.592936098	0.003914553	0.008768985	0.004373728	3.013123579	3.034578046	0.609796289	0.624163053	0	0.000202305	3.866251538	0.051123432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0636		3.310801932	5.7818	0.173735073	1.232356519	0	1.4862432	1.998995895	2.030391369	2.12789405	8.422993236	0	2.592936098	0.003914553	0.008768985	0.004373728	3.013123579	3.034578046	0.609796289	0.624163053	0	0.000202305	3.866251538	0.051123432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0636	YES	$200 - days 1-5	$200 - days 1-5	$75 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	50% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																			3000	0.6493	0.0195	0.1251	0	0.1477	0.146	0.1483	0.0145	0.9499	0	0.2924	0.0003	0.001	0.0003	0.3759	0.307	0.0445	0.0704	0	0	0.0263	0.0058																			3.3241		0	6.4311	0.193244536	1.357460233	0	1.633954669	2.144985866	2.178674204	2.142353366	9.372884208	0	2.885350745	0.00420044	0.009757894	0.004693149	3.389056247	3.341589666	0.654330719	0.694552146	0	0.000222773	3.892523219	0.056888804	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3878
H9988_006_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	579.4405395	17.41140414	308.7611655	23.87552129	186.1856433	10.43414745	10.59802223	533.1339079	87.93089934	24.7196903	27.06866747	0.010660576	0.091542838	0.011414763	3774.620143	1520.59869	1.591475102	6.515880647	0	0	20.18065106	0.533697373																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	133.6874778	133.6874778	44.5624926	0	133.6874778	0.17824997	0.17824997	44.5624926	0.133687478	0	0.133687478	0.356499941	0.133687478	0.356499941	13.36874778	26.73749556	0.356499941	0.133687478	26.73749556	9.109425332	0.17824997	0.133687478																				6.4553	0.193973892	1.146597263	0	2.074224088	1.859886474	1.889097148	1.979814652	11.75526015	0	3.618741882	0.003800495	0.012238131	0.004069362	4.205162056	3.388083394	0.56736078	0.871091649	0	0	3.597200455	0.071348656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.6933		5.331473695	6.4553	0.193973892	1.146597263	0	2.074224088	1.859886474	1.889097148	1.979814652	11.75526015	0	3.618741882	0.003800495	0.012238131	0.004069362	4.205162056	3.388083394	0.56736078	0.871091649	0	0	3.597200455	0.071348656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.6933	YES	$225 - days 1-5	$225 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$25 Copay	"$45 Copay, Chiropractor $25 Copay"	50% Coinsurance	20% Coinsurance	$45 Copay	$45 Copay	20% Coinsurance	20% Coinsurance																			3000	0.72	0.0216	0.1229	0	0.1954	0.1386	0.1408	0.0162	0.9279	0	0.2856	0.0003	0.001	0.0003	0.4664	0.341	0.0423	0.0688	0	0	0.0294	0.0056																			3.5239		0	7.1753	0.215607893	1.269464026	0	2.269578807	1.998467211	2.029854381	1.99601453	12.68312838	0	3.904377043	0.004083671	0.013204113	0.004372572	4.671541726	3.729040027	0.609635013	0.939848806	0	2.27E-05	3.626634628	0.07698036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2172
H9988_007_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	623.5146472	18.73577144	332.246531	25.69157009	200.3475211	11.2278022	11.40414182	573.6857845	94.61920584	26.5999493	29.12759722	0.010660576	0.09850588	0.012283006	4061.741125	1636.264843	1.712037626	7.011518879	0	0.276504981	21.71565617	0.574292109																				$125 - days 1-5	$125 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	10% Coinsurance	0% Coinsurance	10% Coinsurance	40% Coinsurance	10% Coinsurance	"40% Coinsurance, CORF 10% Coinsurance"	$10 Copay	"$25 Copay, Chiropractor $10 Copay"	40% Coinsurance	10% Coinsurance	$25 Copay	$25 Copay	20% Coinsurance	10% Coinsurance																				125	125	50	0	100	0.2	0.2	50	0.1	0	0.1	0.4	0.1	0.4	10	25	0.4	0.1	25	25	0.2	0.1																			NO	114.2581542	114.2581542	45.70326167	0	91.40652334	0.182813047	0.182813047	45.70326167	0.091406523	0	0.091406523	0.365626093	0.091406523	0.365626093	9.140652334	22.85163083	0.365626093	0.091406523	22.85163083	9.015225214	0.182813047	0.091406523																				5.9368	0.178392888	1.265395845	0	1.526089197	2.052588728	2.084825911	2.184942627	8.648812647	0	2.662452395	0.003897785	0.00900408	0.004490988	3.093913625	3.115943344	0.625965629	0.640898564	0	0.00020773	3.969905265	0.052494045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.057		3.577886302	5.9368	0.178392888	1.265395845	0	1.526089197	2.052588728	2.084825911	2.184942627	8.648812647	0	2.662452395	0.003897785	0.00900408	0.004490988	3.093913625	3.115943344	0.625965629	0.640898564	0	0.00020773	3.969905265	0.052494045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.057	YES	$200 - days 1-5	$200 - days 1-5	$75 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	50% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																			3000	0.6494	0.0195	0.1252	0	0.1478	0.1505	0.1528	0.0154	0.9778	0	0.301	0.0003	0.001	0.0003	0.3758	0.3072	0.0459	0.0725	0	0	0.028	0.0059																			3.3764		0	6.5862	0.197906012	1.390579048	0	1.673909287	2.203055099	2.23765545	2.200351332	9.626627696	0	2.963463196	0.004183515	0.010022061	0.004820202	3.469758438	3.423154975	0.671852452	0.713357095	0	0.00022821	3.997901926	0.058428902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4334
H9988_008_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	617.2301399	18.5469305	328.8977632	25.43262051	198.3281853	11.11463533	11.28919759	567.9035106	93.66552321	26.33184401	28.83401535	0.010660576	0.097513023	0.012159204	4020.802165	1619.772659	1.694781715	6.94084862	0	0.279320296	21.49678048	0.568503724																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	15% Coinsurance	0% Coinsurance	15% Coinsurance	40% Coinsurance	15% Coinsurance	"40% Coinsurance, CORF 15% Coinsurance"	$15 Copay	"$30 Copay, Chiropractor $15 Copay"	40% Coinsurance	15% Coinsurance	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance																				150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.4	0.15	0.4	15	30	0.4	0.15	30	30	0.2	0.15																			NO	132.2078037	132.2078037	44.06926788	0	132.2078037	0.176277072	0.176277072	44.06926788	0.132207804	0	0.132207804	0.352554143	0.132207804	0.352554143	13.22078037	26.44156073	0.352554143	0.132207804	26.44156073	10.22227115	0.176277072	0.132207804																				6.8002	0.204337412	1.207856969	0	2.185044482	1.959255367	1.990026691	2.085590995	12.3833131	0	3.81208184	0.00375843	0.012891983	0.004286778	4.429845193	3.56910976	0.597502315	0.917634352	0	0.000237941	3.78938951	0.075160629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.0275		6.194272008	6.8002	0.204337412	1.207856969	0	2.185044482	1.959255367	1.990026691	2.085590995	12.3833131	0	3.81208184	0.00375843	0.012891983	0.004286778	4.429845193	3.56910976	0.597502315	0.917634352	0	0.000237941	3.78938951	0.075160629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.0275	YES	$225 - days 1-5	$225 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	"50% Coinsurance, CORF 20% Coinsurance"	$25 Copay	"$45 Copay, Chiropractor $25 Copay"	50% Coinsurance	20% Coinsurance	$45 Copay	$45 Copay	20% Coinsurance	20% Coinsurance																			3000	0.7196	0.0216	0.1229	0	0.1956	0.1472	0.1495	0.0182	0.9849	0	0.3032	0.0003	0.001	0.0003	0.4662	0.3411	0.0449	0.073	0	0	0.0331	0.006																			3.6285		0	7.5198	0.225959944	1.330708673	0	2.380655045	2.106411076	2.139493572	2.103825918	13.36818636	0	4.115265441	0.004040718	0.013917311	0.004608749	4.89600393	3.910254457	0.642379506	0.990615914	0	0.000260684	3.822521234	0.081138326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6561
H9988_009_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			3.772572243	0.059476721	0.721423689	0.582075286	0.143292295	0.210650931	0.209271417	0.24714255	1.398170629	0.931886806	1.020672358	0.000145401	0.001455969	0.000181502	0.474839867	0.551807159	0.028372056	0.13644639	0	0.00015581	0.285062109	0.007538751																			10.7826	NO	691.430387	20.77654752	412.2607696	42.67685862	235.3471762	15.44460006	15.34345626	552.2428323	102.5117055	68.32449763	74.81700153	0.010660576	0.106749422	0.013307423	5004.62541	2016.104019	2.080195237	10.00403803	0	0.226440602	20.90031241	0.552729533																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	177.8940788	177.8940788	44.47351971	0	133.4205591	0.177894079	0.177894079	44.47351971	0.177894079	0	0.177894079	0.355788158	0.177894079	0.355788158	17.78940788	35.57881576	0.355788158	0.177894079	35.57881576	21.11829562	0.177894079	0.177894079																				10.2501	0.308002065	1.527890622	0	2.616679319	2.747502901	2.729510017	2.046681874	18.23622541	0	13.30950157	0.003792907	0.01899009	0.004734623	7.419110226	5.977549455	0.740108831	1.779659131	0	0.000398503	3.718041823	0.098327311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5328	200	13.51788917	14.0227	0.367478786	2.249314311	0.582075286	2.759971614	2.958153832	2.938781434	2.293824423	19.63439604	0.931886806	14.33017393	0.003938308	0.020446059	0.004916125	7.893950093	6.529356614	0.768480887	1.916105521	0	0.000554313	4.003103932	0.105866062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.3155	YES	$300 - days 1-5	$300 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	2.6657	0.0801	0.3754	0	0.6246	0.6504	0.6461	0.3283	4.3169	0	3.1507	0.0009	0.0042	0.0011	1.7853	1.3585	0.1752	0.4213	0	0.0001	0.5963	0.0233																			17.2043	200	0	16.6884	0.447579462	2.624716046	0.582075286	3.384540843	3.608549914	3.584918193	2.622074775	23.95132308	0.931886806	17.48083399	0.004836175	0.024651499	0.006036917	9.679267944	7.887824836	0.943681388	2.33739109	0	0.000644878	4.599409861	0.12914236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5198
H9988_010_0	2011	5																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			3.766882146	0.059387013	0.72033558	0.581197353	0.14307617	0.21033321	0.208955777	0.24676979	1.396061795	0.93048126	1.019132897	0.000149872	0.001453773	0.000181228	0.474123675	0.550974879	0.028329263	0.136240591	0	0.000155575	0.284632155	0.00752738																			10.7664	NO	669.7937899	20.12639705	399.3600925	41.34139229	227.9825707	14.96129965	14.86332089	534.961764	99.30385618	66.18645213	72.47578924	0.010660576	0.103408963	0.012891	4848.018084	1953.01505	2.015100692	9.690986504	0	0.233755396	20.24628903	0.535433235																				$250 - days 1-5	$250 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				250	250	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	222.236503	222.236503	44.44730059	0	133.3419018	0.177789202	0.177789202	44.44730059	0.177789202	0	0.177789202	0.355578405	0.177789202	0.355578405	17.77892024	35.55784048	0.355578405	0.177789202	35.55784048	19.80560269	0.177789202	0.177789202																				12.4044	0.372735008	1.479206506	0	2.533302462	2.659957532	2.642537966	1.981467194	17.65515338	0	12.88541276	0.003790671	0.018384997	0.004583761	7.182710569	5.787083133	0.71652629	1.722952761	0	0.000385806	3.599571577	0.095194248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7453	200	13.60946412	16.1713	0.432122021	2.199542087	0.581197353	2.676378632	2.870290742	2.851493744	2.228236984	19.05121518	0.93048126	13.90454566	0.003940542	0.019838771	0.004764989	7.656834244	6.338058011	0.744855553	1.859193351	0	0.000541381	3.884203732	0.102721628	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5117	YES	$375 - days 1-5	$375 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	3.2272	0.097	0.363	0	0.6033	0.6215	0.6175	0.3121	4.1254	0	3.0109	0.0009	0.004	0.0011	1.725	1.3101	0.1674	0.4026	0	0.0001	0.567	0.0222																			17.1782	200	0	19.3984	0.529094184	2.562495515	0.581197353	3.279684907	3.491833896	3.468966527	2.540346427	23.17663431	0.93048126	16.91543586	0.004826295	0.023854718	0.005836061	9.381820664	7.648162022	0.912283793	2.261789814	0	0.000628721	4.451187775	0.124965341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.69
H9988_801_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			4.362497641	0.06849759	0.727247248	0.589269173	0.18733145	0.239510858	0.238893012	0.313618421	1.627459274	0.583707732	0.639445281	0.00018252	0.001823988	0.0002107	0.536215349	0.627998882	0.03223395	0.134898427	0	0.000176305	0.40800989	0.010790227																			11.33	NO	715.2117133	21.49114419	379.7716633	34.4179269	245.1063424	13.9893067	13.95321965	628.7500301	95.05634587	34.09309527	37.33277593	0.010660576	0.106535171	0.012306552	4415.752492	1778.877662	1.882714701	7.879122821	0	0.248281806	23.83096761	0.630233622																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				200	200	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	181.7924745	181.7924745	45.44811861	0	136.3443558	0.181792474	0.181792474	45.44811861	0.181792474	0	0.181792474	0.363584949	0.181792474	0.363584949	18.17924745	36.35849489	0.363584949	0.181792474	36.35849489	17.36664089	0.181792474	0.181792474																				10.835	0.325577357	1.438325633	0	2.784905531	2.543150682	2.536590328	2.381292162	17.28052833	0	6.786817715	0.003876025	0.019367292	0.004474477	6.689588101	5.389776199	0.684526729	1.432365234	0	0.000359318	4.332290571	0.11457173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5834	200	10.40153179	15.1975	0.394074947	2.165572881	0.589269173	2.972236981	2.782661539	2.775483339	2.694910583	18.9079876	0.583707732	7.426262996	0.004058545	0.02119128	0.004685177	7.22580345	6.01777508	0.716760679	1.567263661	0	0.000535623	4.740300461	0.125361957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.9134	YES	$300 - days 1-5	$300 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	2.804	0.0843	0.3668	0	0.6616	0.6071	0.6056	0.3864	4.1253	0	1.6202	0.0009	0.0043	0.0011	1.6949	1.2838	0.1634	0.3419	0	0.0001	0.703	0.0274																			15.482	200	0	18.0015	0.478330131	2.532386584	0.589269173	3.633851804	3.389778564	3.381034234	3.081303193	23.03330468	0.583707732	9.04645507	0.004983854	0.025518581	0.005753353	8.920730013	7.301530836	0.880175231	1.909206954	0	0.000621207	5.443265468	0.152713245	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.3954
H9988_802_0	2011	3																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																			4.300777353	0.067528491	0.716958209	0.580932237	0.184681099	0.236122276	0.235513171	0.309181371	1.604434103	0.575449479	0.630398457	0.000179937	0.001798183	0.000207719	0.528629014	0.619114001	0.031777907	0.132989894	0	0.00017381	0.402237397	0.010637568																			11.1697	NO	715.2117133	21.49114419	379.7716633	34.4179269	245.1063424	13.9893067	13.95321965	628.7500301	95.05634587	34.09309527	37.33277593	0.010660576	0.106535171	0.012306552	4415.752492	1778.877662	1.882714701	7.879122821	0	0.248281806	23.83096761	0.630233622																				$250 - days 1-5	$250 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	20% Coinsurance	0% Coinsurance	20% Coinsurance	40% Coinsurance	20% Coinsurance	"40% Coinsurance, CORF 20% Coinsurance"	$20 Copay	"$40 Copay, Chiropractor $20 Copay"	40% Coinsurance	20% Coinsurance	$40 Copay	$40 Copay	20% Coinsurance	20% Coinsurance																				250	250	50	0	150	0.2	0.2	50	0.2	0	0.2	0.4	0.2	0.4	20	40	0.4	0.2	40	40	0.2	0.2																			NO	225.8334604	225.8334604	45.16669207	0	135.5000762	0.180666768	0.180666768	45.16669207	0.180666768	0	0.180666768	0.361333537	0.180666768	0.361333537	18.06667683	36.13335366	0.361333537	0.180666768	36.13335366	17.25910215	0.180666768	0.180666768																				13.4599	0.404451622	1.429419148	0	2.767660673	2.527402833	2.520883102	2.366546583	17.17352281	0	6.744791979	0.003852024	0.019247365	0.00444677	6.648164436	5.356401306	0.680287961	1.423495657	0	0.000357093	4.305463904	0.113862272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.9502	200	11.26466338	17.7607	0.471980113	2.146377356	0.580932237	2.952341772	2.763525109	2.756396273	2.675727955	18.77795692	0.575449479	7.375190436	0.004031961	0.021045548	0.004654489	7.176793451	5.975515307	0.712065868	1.556485551	0	0.000530904	4.707701301	0.12449984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.1199	YES	$375 - days 1-5	$375 - days 1-5	$75 - days 11-100	0% Coinsurance	$200 Copay	25% Coinsurance	25% Coinsurance	"$50 Copay, Urgent Care $35 Copay"	25% Coinsurance	0% Coinsurance	25% Coinsurance	50% Coinsurance	25% Coinsurance	"50% Coinsurance, CORF 25% Coinsurance"	$30 Copay	"$50 Copay, Chiropractor $30 Copay"	50% Coinsurance	25% Coinsurance	$50 Copay	$50 Copay	25% Coinsurance	25% Coinsurance																			5000	3.4093	0.1024	0.3567	0	0.6426	0.5897	0.5882	0.372	4.0069	0	1.5737	0.0009	0.0042	0.001	1.6481	1.2469	0.1587	0.3321	0	0.0001	0.6768	0.0266																			15.7369	200	0	21.17	0.57442529	2.503091344	0.580932237	3.594913252	3.353221008	3.344570983	3.047725362	22.78489869	0.575449479	8.94889136	0.004930719	0.025243296	0.005692014	8.824863641	7.222380749	0.870791266	1.888616836	0	0.000614028	5.38447708	0.151066287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.8568
R3175_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	921.7319144	90.1040682	363.7295002	68.70148941	108.2214585	2.817060806	6.800850913	354.682866	24.40888136	18.60298949	28.47267128	0	1.162810193	10.83777503	6394.540391	72.38119901	457.4578162	701.4804358	0	0	8.927398471	1749.390724	0	0	182.0370504	176.4285714	15.26372304	10.45	83.70916219	0											4200	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$0 n/c (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 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												206.8631108	127.8912646	63.66408384	0	200	0.2	0.094403557	49.81021202	0.2	0.132390741	0.160780255	0	0.2	0.162141201	7.050923363	0.130972703	38.5	35	0	0	0.2	34.90388388	0	0	35	0	35	0	0	0											NO	171.3512758	105.9363908	52.7349799	0	165.6663435	0.165666343	0.07819746	41.27134537	0.165666343	0.10966345	0.133179385	0	0.165666343	0.1343067	6.857553041	0.127415234	37.44414433	34.04013121	0	0	0.165666343	28.91199408	0	0	35	0	35	0	0	0												13.1617	0.795441649	1.59843899	0	1.494054443	0.466692163	0.53180927	1.219853255	4.043730124	2.04006801	3.791972843	0	0.192638513	1.455585798	3.654241658	9.222467428	1.427426375	1.98987384	0	0	1.478969461	4.214864521	0	0	0.530941397	0	0.044519192	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3553	0	8.017996619	13.1617	0.795441649	1.59843899	0	1.494054443	0.466692163	0.53180927	1.219853255	4.043730124	2.04006801	3.791972843	0	0.192638513	1.455585798	3.654241658	9.222467428	1.427426375	1.98987384	0	0	1.478969461	4.214864521	0	0	0.530941397	0	0.044519192	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3553	YES	"$425 Days 1-24 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$425 Days 1-24 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-58 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$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 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.5255	0.0459	0.1495	0.1081	0.2952	0.1383	0.334	0.241	1.1986	0.4031	1.1008	0	0.0381	0.4295	2.8353	2.7616	0.3783	0.6001	0	0	0.5204	1.2697	0	0	0.1481	0	0.0134	0	0	0											13.5346	0	1.5930565	13.6872	0.841325131	1.747923279	0.108127253	1.789286759	0.605023074	0.865762977	1.460902102	5.242320789	2.443195221	4.892793521	0	0.230704806	1.885045416	6.489565473	11.98409665	1.805738993	2.589994522	0	0	1.999347605	5.484553843	0	0	0.67902254	0	0.057945615	0	0	0	0	0	0	0	0	0	0	0	0	0	66.8898
R3175_002_0	2011	2																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	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	1034.598692	92.48316426	377.0262848	76.80517365	86.44952361	3.167289201	5.716282998	336.2947713	21.92297109	18.17697623	29.20326423	0	0.377483282	14.17144597	6454.189758	4343.122685	453.308028	783.4991578	0	0	9.177262558	1827.618117	0	0	124.7848951	176.4285714	14.57218171	10.45	162.6400338	599.0553959											4200	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$10 (7b, 7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$0 n/c (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 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$10 (13b); $0 n/c (13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												206.8631108	127.8912646	63.97621646	0	200	0.2	0.105567913	49.98516564	0.2	0.135156015	0.16207817	0	0.2	0.161946597	6.998991659	31.00458445	38.5	35	0	0	0.2	34.90262069	0	0	35	0	35	0	0	10											NO	169.2728322	104.6514117	52.3507324	0	163.6568566	0.163656857	0.086384564	40.9145079	0.163656857	0.110596043	0.132626019	0	0.163656857	0.132518355	6.794108251	30.14470661	37.37297891	33.97543537	0	0	0.163656857	28.56026594	0	0	35	0	35	0	0	10												14.5941	0.806541142	1.644800178	0	1.179004774	0.518348594	0.493798616	1.146611256	3.587844535	2.010301638	3.873112686	0	0.061777727	1.877976708	3.654205324	10.91017993	1.411789281	2.218310417	0	0	1.501921942	4.349771621	0	0	0.363955944	0	0.042502197	0	0	0.49921283	0	0	0	0	0	0	0	0	0	0	56.7461	0	8.890454134	14.5941	0.806541142	1.644800178	0	1.179004774	0.518348594	0.493798616	1.146611256	3.587844535	2.010301638	3.873112686	0	0.061777727	1.877976708	3.654205324	10.91017993	1.411789281	2.218310417	0	0	1.501921942	4.349771621	0	0	0.363955944	0	0.042502197	0	0	0.49921283	0	0	0	0	0	0	0	0	0	0	56.7461	YES	"$425 Days 1-24 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$425 Days 1-24 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-58 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b, 7b1); $45 (7d, 7f, 7f1)"	"$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 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"50% (13b); $0 n/c (13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.5827	0.0465	0.1528	0.0738	0.233	0.1536	0.2773	0.2266	1.0635	0.3972	1.124	0	0.0122	0.5544	2.8472	3.3458	0.3742	0.669	0	0	0.5285	1.3089	0	0	0.1098	0	0.0128	0	0	0.201											14.2948	0	1.706577463	15.1768	0.853064876	1.797638632	0.073803458	1.411981765	0.671990842	0.771090178	1.373187134	4.651307437	2.407546872	4.997100929	0	0.073985302	2.432403942	6.501372491	14.25597956	1.78595758	2.887324669	0	0	2.030375959	5.658632683	0	0	0.473720435	0	0.055320319	0	0	0.700262483	0	0	0	0	0	0	0	0	0	0	71.0409
R3175_003_0	2011	4																															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	327.8135238	22.531113	27.10703696	1421.112398	16.8457581	12.47961076	14.67283387	29.75661516	32.50294606	29.72985724	46.39350759	0	0.115505465	39.48072922	34.31935307	96.99307703	9.804986	3.672482032	0	3.458647138	16.02442268	7.663935639	0	330.3192395	0	0	0	0	210.4196854	0											3400	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.071720922	0.0725915	0.142548892	0	0.233	0.233	0.233	0.09332304	0.233	0.233	0.233	0	0.233	0.233	0.228362427	0.232778985	0.240320157	0.233	0	0.233	0.233	0.228772936	0	0	0	0	0	0	0	0											NO	0.047908312	0.048489843	0.095220147	0	0.155639894	0.155639894	0.155639894	0.062361116	0.155639894	0.155639894	0.155639894	0	0.155639894	0.155639894	0.150930504	0.153849519	0.15883367	0.153995593	0	0.153995593	0.155639894	0.156850335	0	0	0	0	0	0	0	0												15.705	1.092530128	2.581136053	0	2.621872	1.942325292	2.283678303	1.855655717	5.05875507	4.62715182	7.22068059	0	0.017977258	6.1447765	5.179837242	14.9223382	1.557361908	0.565546048	0	0.532616417	2.494039442	1.202090876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6054	0	38.88986545	15.705	1.092530128	2.581136053	0	2.621872	1.942325292	2.283678303	1.855655717	5.05875507	4.62715182	7.22068059	0	0.017977258	6.1447765	5.179837242	14.9223382	1.557361908	0.565546048	0	0.532616417	2.494039442	1.202090876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.6054	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											7500	0.6556	0.0456	0.4404	0.7347	1.1346	0.8405	0.8741	0.3662	2.1891	0	2.6983	0	0.0063	2.3495	2.2945	7.2047	0.7284	0.2728	0	0	1.1989	0.5531	0	0.0711	0	0	0	0	0	0											24.6583	475	8.544084306	16.3606	1.13813736	3.021577152	0.734729699	3.756422835	2.782818947	3.157808565	2.221808804	7.247807314	4.62715182	9.918956665	0	0.024231844	8.494318357	7.474303447	22.12706352	2.285762763	0.83837041	0	0.532616417	3.692922921	1.75514194	0	0.071089824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.2636
R3175_801_0	2011	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	221.9174416	4.516036	13.71019782	72.55381183	11.78925634	2.98967262	7.217564394	15.56467156	25.89086576	19.73246936	30.20138854	0	1.233410174	11.47980318	36.91525048	76.33812354	1.804356	9.101238269	0	0	9.427277061	12.16939905	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.072737478	0.072737478	0.142339169	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.062564825	0.062564825	0.122432416	0	0.200413936	0.200413936	0.200413936	0.200413936	0.200413936	0.200413936	0.200413936	0	0.200413936	0.200413936	0.200634707	0.200634707	0.200634707	0.200634707	0	0	0.200413936	0.200413936	0	0	0	0	0	0	0	0												13.8842	0.282545004	1.678572648	0	2.362731263	0.599172056	1.446500487	3.119377085	5.188890306	3.954661846	6.052779142	0	0.247192587	2.300712537	7.40648045	15.31607702	0.362016437	1.82602427	0	0	1.889357699	2.438917159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3562	0	11.40762026	13.8842	0.282545004	1.678572648	0	2.362731263	0.599172056	1.446500487	3.119377085	5.188890306	3.954661846	6.052779142	0	0.247192587	2.300712537	7.40648045	15.31607702	0.362016437	1.82602427	0	0	1.889357699	2.438917159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3562	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.2834	0.0058	0.0609	0	0.4669	0.1184	0.2858	0.6164	1.0253	0.7815	1.1961	0	0.0488	0.4546	1.7373	3.5927	0.0849	0.4283	0	0	0.4432	0.5721	0	0	0	0	0	0	0	0											12.2024	0	1.976554901	14.1676	0.288311228	1.739453522	0	2.829618279	0.717571325	1.732335912	3.73578094	6.214239888	4.736121971	7.248837295	0	0.296039027	2.755344356	9.143803024	18.90873706	0.446933872	2.25435095	0	0	2.332540369	3.011008838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5586
R3175_802_0	2011	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	221.9174416	4.516036	13.71019782	72.55381183	11.78925634	2.98967262	7.217564394	15.56467156	25.89086576	19.73246936	30.20138854	0	1.233410174	11.47980318	36.91525048	76.33812354	1.804356	9.101238269	0	0	9.427277061	12.16939905	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.072737478	0.072737478	0.142339169	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.062564825	0.062564825	0.122432416	0	0.200413936	0.200413936	0.200413936	0.200413936	0.200413936	0.200413936	0.200413936	0	0.200413936	0.200413936	0.200634707	0.200634707	0.200634707	0.200634707	0	0	0.200413936	0.200413936	0	0	0	0	0	0	0	0												13.8842	0.282545004	1.678572648	0	2.362731263	0.599172056	1.446500487	3.119377085	5.188890306	3.954661846	6.052779142	0	0.247192587	2.300712537	7.40648045	15.31607702	0.362016437	1.82602427	0	0	1.889357699	2.438917159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3562	0	11.40762026	13.8842	0.282545004	1.678572648	0	2.362731263	0.599172056	1.446500487	3.119377085	5.188890306	3.954661846	6.052779142	0	0.247192587	2.300712537	7.40648045	15.31607702	0.362016437	1.82602427	0	0	1.889357699	2.438917159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3562	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.2834	0.0058	0.0609	0	0.4669	0.1184	0.2858	0.6164	1.0253	0.7815	1.1961	0	0.0488	0.4546	1.7373	3.5927	0.0849	0.4283	0	0	0.4432	0.5721	0	0	0	0	0	0	0	0											12.2024	0	1.976554901	14.1676	0.288311228	1.739453522	0	2.829618279	0.717571325	1.732335912	3.73578094	6.214239888	4.736121971	7.248837295	0	0.296039027	2.755344356	9.143803024	18.90873706	0.446933872	2.25435095	0	0	2.332540369	3.011008838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5586
R3175_803_0	2011	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	221.9174416	4.516036	13.71019782	72.55381183	11.78925634	2.98967262	7.217564394	15.56467156	25.89086576	19.73246936	30.20138854	0	1.233410174	11.47980318	36.91525048	76.33812354	1.804356	9.101238269	0	0	9.427277061	12.16939905	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.072737478	0.072737478	0.142339169	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.062564825	0.062564825	0.122432416	0	0.200413936	0.200413936	0.200413936	0.200413936	0.200413936	0.200413936	0.200413936	0	0.200413936	0.200413936	0.200634707	0.200634707	0.200634707	0.200634707	0	0	0.200413936	0.200413936	0	0	0	0	0	0	0	0												13.8842	0.282545004	1.678572648	0	2.362731263	0.599172056	1.446500487	3.119377085	5.188890306	3.954661846	6.052779142	0	0.247192587	2.300712537	7.40648045	15.31607702	0.362016437	1.82602427	0	0	1.889357699	2.438917159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3562	0	11.40762026	13.8842	0.282545004	1.678572648	0	2.362731263	0.599172056	1.446500487	3.119377085	5.188890306	3.954661846	6.052779142	0	0.247192587	2.300712537	7.40648045	15.31607702	0.362016437	1.82602427	0	0	1.889357699	2.438917159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3562	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.2834	0.0058	0.0609	0	0.4669	0.1184	0.2858	0.6164	1.0253	0.7815	1.1961	0	0.0488	0.4546	1.7373	3.5927	0.0849	0.4283	0	0	0.4432	0.5721	0	0	0	0	0	0	0	0											12.2024	0	1.976554901	14.1676	0.288311228	1.739453522	0	2.829618279	0.717571325	1.732335912	3.73578094	6.214239888	4.736121971	7.248837295	0	0.296039027	2.755344356	9.143803024	18.90873706	0.446933872	2.25435095	0	0	2.332540369	3.011008838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5586
R3332_001_0	2011	10	g.2.	h.6.	h.7.	h.8.	h.9.	f.2.	i.7.	i.8.	i.9.	e.3.	OP Facility - Surgery	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Emergency	Professional	Professional	Professional	DME/Prosthetics/Supplies	ASC	AIXIDTF	IDTF	MH/SA	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine	DME Scooter	D	D	D		T	O	O	V	Coin	V	Coin		V	Coin	V	V	V	V			Coin									O	V	V	V	V	V	V	V	O	O	Coin																																									0	YES	1034.074399	31.32162709	485.4852199	596.1845117	22.50002959	804.2521589	63.73356399	159.7103226	40.73977657	67.99568413	1.189246374	0	13.38107486	23.12573036	5217.847324	13101.30891	213.5024834	1625.841319	0	0	48.4238755	0	0	0	0	0	0	0	0	193.1051016	220.3416994	10.11014545	648.0404998	1.189428877	135.4957729	59.05401334	586.4875554	98.82171585	0	0.554822977	4500	300 Copay for 5 days (#1A)	300 Copay for 5 days (#1B)	50 Copay for days 7 to 25 (#2)	0 Copay (#6)	150 Copay (#10A)	0 Copay (#11A)	0 Copay (#11A)	50 Copay (#4A)	0.2 Coins (#9A)	15 Copay (#8A)	0.2 Coins (#9A)		25 Copay (#9A)	0.2 Coins (#9A)	15 Copay PCP/0 Copay Immunizations (#7A)	50 Copay (multiple)/40 Spec Chiro	40 Copay (#7H)	50 Copay (#7I)			0.2 Coins (#15)									(multiple)	200 Copay (#9B)	100 Copay (#8B)	75 Copay (#8B)	40 Copay (#7E)	50 Copay (#3)	25 Copay (#4B)	100 Copay (#8B)	5 Copay (#7G)	5 Copay (#7G)	0.2 Coins (#11A)		181.0979815	177.5316456	23.12383709	0	135.4625551	0	0	47.27866093	0.196817293	6.017144845	0.120364072	0	15.97251254	0.179417461	11.42261738	29.15895744	32.3845077	32.64882971	0	0	0.179430411	0	0	0	0	0	0	0	0	37.96765838	192.8749628	95.14563107	48.9808713	16.66666667	47.40668463	21.0585321	42.47234269	4.934804413	0	0.158853479	YES	160.4576853	174.2565541	19.86617029	0	135.4625551	0	0	47.27866093	0.166463152	5.142166152	0.038634391	0	15.97251254	0.124549967	10.99673802	26.6731359	31.32081333	31.54142379	0	0	0.091447902	0	0	0	0	0	0	0	0	36.70539257	190.8109448	82.9547602	47.5308325	16.66666667	45.80162795	20.70727514	35.86402529	4.929789368	0	0.131317269	10000	13.8271	0.454833234	0.803727671	0	0.253992625	0	0	0.629240849	6.781671617	0.029137092	0.045945809	0	0.017810782	2.88030896	4.781608339	29.12108274	0.557255952	4.273445837	0	0	4.428261821	0	0	0	0	0	0	0	0	0.590666547	3.503633987	0.069890391	2.56682537	0.001651985	0.517160582	0.101903975	1.752817043	0.04059752	0	0.072857838	78.1034	0	12.46789549	13.8271	0.454833234	0.803727671	0	0.253992625	0	0	0.629240849	6.781671617	0.029137092	0.045945809	0	0.017810782	2.88030896	4.781608339	29.12108274	0.557255952	4.273445837	0	0	4.428261821	0	0	0	0	0	0	0	0	0.590666547	3.503633987	0.069890391	2.56682537	0.001651985	0.517160582	0.101903975	1.752817043	0.04059752	0	0.072857838	78.1034	YES	325 Copay for 30 days 1500 Ded	325 Copay for 30 days 1500 Ded	0.3 Coins 1500 Ded	0 Copay	150 Copay	0.3 Coins 1500 Ded	0.3 Coins 1500 Ded	50 Copay	0.3 Coins 1500 Ded	0.3 Coins 1500 Ded	0.3 Coins 1500 Ded		25 Copay	0.3 Coins 1500 Ded	0.3 Coins 1500 Ded	0.3 Coins 1500 Ded	0.3 Coins 1500 Ded	0.3 Coins 1500 Ded			0.3 Coins 1500 Ded									(multiple)	0.3 Coins 1500 Ded	0.3 Coins 1500 Ded	0.3 Coins 1500 Ded	0.3 Coins 1500 Ded	0.3 Coins 1500 Ded	25 Copay 1500 Ded	0.3 Coins 1500 Ded	0.3 Coins 1500 Ded	0.3 Coins 1500 Ded	0.3 Coins 1500 Ded	10000	8.5037	0.6958	0.9718	0	1.7494	3.0133	0.427	0.2431	3.5551	0.0724	0.0991	0	0.0036	1.6283	5.5857	13.7476	0.8584	2.3225	0	0	0.8776	0	0	0	0	0	0	0	0	0.0029	8.5455	0.2382	4.1274	0.0163	0.1682	0.0716	0.4712	0.0155	0	0	58.0108	1500	1.155471769	22.3308	1.150656939	1.775494099	0	2.003348631	3.013326594	0.426951443	0.872344366	10.3367447	0.101544876	0.145059365	0	0.021382823	4.508590769	10.36728256	42.86864794	1.415664564	6.595911018	0	0	5.305863359	0	0	0	0	0	0	0	0	0.593521525	12.04912021	0.308091498	6.694260482	0.017931785	0.685313613	0.173545285	2.223969709	0.056081874	0	0.072857838	136.1143
R3444_008_0	2011	6																															A	A	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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	479.977612	25.01929989	189.8484327	19.67149002	17.60714177	36.64633191	37.39479363	30.49383054	35.27897089	14.62964976	13.69420859	0	0.006428939	3887.492602	50.87334088	103.388247	0.892679849	1.056364046	26.78830158	37.24486522	1.779271073	38.26214609	1320	403.3286825	304.3651585	0	0	0	0	12000											6700	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: $0, 9D Cardiac Rehab: 20%"	"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: 20%, 14J Nutrition Therapy: 20%"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: $0, MH (Group): $0, 7H Psychiatric: $0, Psychiatric (Group): $0, 9C OP Substance Abuse: $0, OP Substance Abuse (Group): $0"	"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: $20, 13D Meal Benefit: not covered"											0	773.4006114	501.6385806	410.7594438	0	0.233	0.233	0.233	0.233983806	0.233	0.233	0.233	0	0.233	21.6074889	0.231467974	0.233	0.233	0.233	0.233	0.228978252	0.233	0.233	0	15	22.82784283	0	0	0	0	0											YES	632.1806966	410.0413455	381.895793	0	0.220476687	0.220476687	0.220476687	0.232967475	0.220476687	0.220476687	0.220476687	0	0.220476687	20.44612691	0.219936121	0.221495358	0.220476687	0.220476687	0.220476687	0.2166711	0.220476687	0.220476687	0	15	22.82784283	0	0	0	0	0											6700	25.286	0.854912282	6.041859815	0	3.881964287	8.079661856	8.244680215	7.104070692	7.778190627	3.225496714	3.019253743	0	0.001417431	6.623680593	11.18888527	22.90001678	0.196815096	0.232903645	5.906195988	8.06988593	0.392287792	8.435911214	0	0.504160853	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.5473	0	11.38443996	25.286	0.854912282	6.041859815	0	3.881964287	8.079661856	8.244680215	7.104070692	7.778190627	3.225496714	3.019253743	0	0.001417431	6.623680593	11.18888527	22.90001678	0.196815096	0.232903645	5.906195988	8.06988593	0.392287792	8.435911214	0	0.504160853	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.5473	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: $0, 9C OP Substance Abuse: $0, OP Substance Abuse (Group): $0, 9D Cardiac Rehab: 20%"	"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: 20%, 14J Nutrition Therapy: 20%"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: $0, MH (Group): $0, 7H Psychiatric: $0, Psychiatric (Group): $0, 9C OP Substance Abuse: $0, OP Substance Abuse (Group): $0"	"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: $20, 13D Meal Benefit: not covered"											6700	0	0	0	0	0	4.3506	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											4.3806	0	0.576216662	25.286	0.854912282	6.041859815	0	3.881964287	12.43024901	8.244680215	7.134070692	7.778190627	3.225496714	3.019253743	0	0.001417431	6.623680593	11.18888527	22.90001678	0.196815096	0.232903645	5.906195988	8.06988593	0.392287792	8.435911214	0	0.504160853	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.9279
R3444_009_0	2011	6																															D	A	D	Coin	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	Coin	Coin	Coin	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	1994.826432	6.232586493	115.0053876	19.50100699	214.9179918	28.76454306	31.71951577	399.8133552	250.7250464	9.544363032	15.72638637	0	0.003770891	2017.664902	4506.666693	3844.887324	189.0357933	285.2540889	26.60165955	41.23709951	5.848292893	15.68811269	660	125.0832628	299.8541775	0	0	0	0	12000											3400	1A IP Acute: $220 Per Day for days 0	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: $150, 9B ASC Services: $150"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $50, 5 Partial Hosp: $40, 9D Cardiac Rehab: $50"	"7A PCP: $35, 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): $50	"7E Mental Health: $40, MH (Group): $35, 7H Psychiatric: $40, Psychiatric (Group): $35, 9C OP Substance Abuse: $40, OP Substance Abuse (Group): $35"	"7C Occupational Therapy: $50, 7I Physical and Speech Therapy: $50"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $40, 7F Podiatry: $50, 7G Other Health Care: $50, 18A Hearing Exams (Medicare Covered): $50"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $50"	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): $50	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	220	1000	130	0	150	0.084	0.221971602	49.32278684	150	0.18	0.2	0	0	42.23214171	34.12012842	50	39.75	43.480171	0.12	0.154450877	0.12	0.157727979	0	10	30	0	0	0	0	0											YES	204.9491837	911.3088774	103.5444996	0	145.3518456	0.079175798	0.216256461	48.41211353	137.7217276	0.173976548	0.194123462	0	0	41.29043565	33.85047662	49.07958338	39.48061212	43.16471564	0.113535808	0.148359132	0.113535808	0.151562998	0	10	30	0	0	0	0	0											3400	34.0698	0.473317617	0.992347942	0	2.60322723	2.277455637	6.859550212	1.612984129	2.877523879	1.660495337	3.052860565	0	0	6.9425219	12.71273463	15.72545567	0.621937403	1.026075969	3.020240913	6.117900301	0.66399066	2.377737398	0	0.104236052	0.749635444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5421	0	4.689509686	34.0698	0.473317617	0.992347942	0	2.60322723	2.277455637	6.859550212	1.612984129	2.877523879	1.660495337	3.052860565	0	0	6.9425219	12.71273463	15.72545567	0.621937403	1.026075969	3.020240913	6.117900301	0.66399066	2.377737398	0	0.104236052	0.749635444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5421	YES	1A IP Acute: $220 Per Day for days 0	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: $150, 9B ASC Services: $150"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $50, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, OP Substance Abuse (Group): $35, 9D Cardiac Rehab: $50"	"7A PCP: $35, 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): $50	"7E Mental Health: $40, MH (Group): $35, 7H Psychiatric: $40, Psychiatric (Group): $35, 9C OP Substance Abuse: $40, OP Substance Abuse (Group): $35"	"7C Occupational Therapy: $50, 7I Physical and Speech Therapy: $50"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $40, 7F Podiatry: $50, 7G Other Health Care: $50, 18A Hearing Exams (Medicare Covered): $50"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $50"	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): $50	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	3.1502	0	2.4526	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											5.6328	0	0.19554477	34.0698	0.473317617	0.992347942	3.150162667	2.60322723	4.73010017	6.859550212	1.642984129	2.877523879	1.660495337	3.052860565	0	0	6.9425219	12.71273463	15.72545567	0.621937403	1.026075969	3.020240913	6.117900301	0.66399066	2.377737398	0	0.104236052	0.749635444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.1749
R3444_011_0	2011	4																															A	A	D	V	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	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	2079.988853	58.34580912	2058.595634	0	13.3833335	14.86037098	9.01279259	19.48801266	49.18683665	6.313552477	26.12444414	16.58030793	0.537739717	15.14877476	23.91511293	55.56053162	1.291739268	4.480485139	20.32277704	74.975038	39.70658421	9.333660783	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9c	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	164.8685968	76.12201263	83.6002835	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											YES	164.8685968	76.12201263	83.6002835	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											6700	28.5771	0.370116702	14.34159822	0	3.118316706	3.462466438	2.099980673	4.54070695	11.46053294	1.471057727	6.086995485	3.863211749	0.125293354	3.529664519	5.572221313	12.94560387	0.300975249	1.043953037	4.735207051	17.46918385	9.25163412	2.174742963	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5405	0	0	28.5771	0.370116702	14.34159822	0	3.118316706	3.462466438	2.099980673	4.54070695	11.46053294	1.471057727	6.086995485	3.863211749	0.125293354	3.529664519	5.572221313	12.94560387	0.300975249	1.043953037	4.735207051	17.46918385	9.25163412	2.174742963	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5405	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9c	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.0304	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.0304	0	0	28.5771	0.370116702	14.34159822	0	3.118316706	3.462466438	2.099980673	4.571078993	11.46053294	1.471057727	6.086995485	3.863211749	0.125293354	3.529664519	5.572221313	12.94560387	0.300975249	1.043953037	4.735207051	17.46918385	9.25163412	2.174742963	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5709
R3444_012_0	2011	5																															D	A	D	Coin	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	Coin	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	1145.350859	3.87640846	368.3185647	0	296.6570813	7.197525177	6.248187557	294.9110385	335.481215	4.668076426	18.36498945	1308.391889	0.433742506	577.1479769	2432.895684	2951.082962	96.53506463	340.7802822	13.77651643	9.522007885	8.389192234	0	0	240	294.2275045	0	0	0	0	0											3400	$220/Days 1-15 for IP Medical; $220/Days 1-15 for IP Surgical; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse; PBP 1b	$130/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"35% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 35% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $40/Visit for PCP Urgent Care; $40/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$175/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$50/Visit for OP Fac - Other; PBP 9c	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$50/Visit for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $50/Visit for OP Fac - Physical/Speech Therapy; $50/Visit for OP Fac - CORF; $50/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35/Visit for PCP Office Visits; $35/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $15/Visit for Chiropractor; $50/Visit for Vision Exams; $50/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $50/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$10/Visit for Dental - Preventive; PBP 16a, 16b"	$30/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	Not Covered; PBP 18a	Not Covered; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											0	220	1000	130	0	150	0.2	0.244830269	49.51767548	175	0.2	0.2	50	0.2	50	35	45.70674616	39.75	50	0.2	0.2	0.2	0	0	10	30	0	0	0	0	0											YES	200.2729672	910.331669	118.343117	0	136.5497503	0.182066334	0.222876747	45.07750816	159.3080421	0.182066334	0.182066334	45.51658345	0.182066334	45.51658345	31.9405778	41.67014833	36.18568384	45.51658345	0.182066334	0.182066334	0.182066334	0	0	10	30	0	0	0	0	0											3400	19.1152	0.294068115	3.632330582	0	3.375704199	1.310427021	1.392575717	1.107821229	4.453737959	0.849899561	3.3436463	4.962794051	0.078969908	2.189150338	6.475674489	10.24767206	0.291098944	1.292596179	2.508239839	1.733637066	1.527389474	0	0	0.2	0.735568761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.1182	0	6.878747828	19.1152	0.294068115	3.632330582	0	3.375704199	1.310427021	1.392575717	1.107821229	4.453737959	0.849899561	3.3436463	4.962794051	0.078969908	2.189150338	6.475674489	10.24767206	0.291098944	1.292596179	2.508239839	1.733637066	1.527389474	0	0	0.2	0.735568761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.1182	YES	$220/Days 1-15 for IP Medical; $220/Days 1-15 for IP Surgical; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse; PBP 1b	$130/Days 21-100 for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$150/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; PBP 11a	"35% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 35% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Worldwide; ; PBP 4a, 4b"	"$175/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$50/Visit for OP Fac - Other; PBP 9c	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$50/Visit for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $50/Visit for OP Fac - Physical/Speech Therapy; $50/Visit for OP Fac - CORF; $50/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35/Visit for PCP Office Visits; $35/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $15/Visit for Chiropractor; $50/Visit for Vision Exams; $50/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $50/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$10/Visit for Dental - Preventive; PBP 16a, 16b"	$30/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	Not Covered; PBP 18a	Not Covered; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											3400	0	0	0	2.1541	0	1.4112	0	0.0038	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											3.5691	0	0.351182838	19.1152	0.294068115	3.632330582	2.154052594	3.375704199	2.721656121	1.392575717	1.111669189	4.453737959	0.849899561	3.3436463	4.962794051	0.078969908	2.189150338	6.475674489	10.24767206	0.291098944	1.292596179	2.508239839	1.733637066	1.527389474	0	0	0.2	0.735568761	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.6874
R5287_001_0	2011	6																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	999.070632	80.97704708	533.5433662	1268.966051	116.3886577	9.140146463	10.65480552	257.6778991	44.08667407	21.24346104	52.54369005	0	0.105059532	13.07060173	5975.64001	126.7490279	399.3721058	630.7051663	0	0	25.61356266	1743.186051	0	325.5364496	203.7459415	0	16.06449828	0	606.6598307	0											4750	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-58 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$20 (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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												187.4696942	115.9014585	64.4538838	0	200	0.2	0.12968714	48.84170472	0.2	0.231350697	0.160386928	0	0.2	0.160106739	7.162355599	0.107912164	38.5	30	0	0	0.2	29.86723815	0	0	30	0	30	0	0	0											NO	150.8713712	93.27487336	51.8710284	0	160.9554781	0.160955478	0.104369278	39.32554576	0.160955478	0.18618581	0.129075774	0	0.160955478	0.128850283	6.931369808	0.104435189	37.25837595	29.03250074	0	0	0.160955478	24.03647797	0	0	30	0	30	0	0	0												12.5609	0.629426984	2.306286925	0	1.561116003	1.471156644	1.112034359	0.844443668	7.095991702	3.955231009	6.782117449	0	0.016909907	1.684150734	3.451614229	13.23705866	1.239996339	1.525912351	0	0	4.122643223	3.491671093	0	0	0.509364854	0	0.040161246	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6382	0	12.20246253	12.5609	0.629426984	2.306286925	0	1.561116003	1.471156644	1.112034359	0.844443668	7.095991702	3.955231009	6.782117449	0	0.016909907	1.684150734	3.451614229	13.23705866	1.239996339	1.525912351	0	0	4.122643223	3.491671093	0	0	0.509364854	0	0.040161246	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6382	YES	"$375 Days 1-27 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-27 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-58 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $20 (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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	1.1385	0.0841	0.3439	0.2566	0.1266	0.1789	0.2086	0.0685	0.863	0.3207	0.8141	0	0.0014	0.2041	1.4987	1.8417	0.1471	0.2136	0	0	0.6491	0.4888	0	0.0571	0.0674	0	0.0056	0	0	0											9.5781	0	1.517085525	13.6994	0.713551536	2.650143994	0.256634599	1.687692976	1.6500811	1.320609275	0.912912073	7.95901772	4.275925415	7.596236759	0	0.018280981	1.888253152	4.950302261	15.07880428	1.387066292	1.739483877	0	0	4.771788703	3.980465725	0	0.057111658	0.576792688	0	0.045782341	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2164
R5287_002_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	873.8230694	80.05225292	471.0857323	927.8496968	98.83607417	5.416171732	8.024631002	211.9384825	37.89539394	16.92903927	43.88443582	0	0.051378776	8.908237627	4835.587482	109.6238953	398.8214802	547.607131	0	0	18.45579341	1428.820052	0	324.4068858	174.8622254	0	16.03965852	0	526.0085797	0											3400	"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-44 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$18 (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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $30 (7d, 7f, 7f1)"	"$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, 18a); $0/$30 (17a)"	$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 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 (14a1, 14a6, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												187.4696942	115.9014585	58.33727874	0	200	0.2	0.147704679	48.93164226	0.2	0.201504469	0.160678298	0	0.2	0.161100425	7.168342885	0.107197862	38.5	30	0	0	0.2	29.88229305	0	0	30	0	30	0	0	0											NO	146.7901322	90.75168386	45.67851297	0	156.6014526	0.156601453	0.115653837	38.34017244	0.156601453	0.157779463	0.125812274	0	0.156601453	0.126142803	6.912646716	0.103378986	37.1266976	28.92989423	0	0	0.156601453	23.3980525	0	0	30	0	30	0	0	0												10.6891	0.605406396	1.793207978	0	1.289822732	0.848180361	0.928079363	0.677146497	5.93447374	2.671054718	5.521200683	0	0.008045991	1.123710065	2.785558994	11.33280712	1.233910374	1.320184698	0	0	2.890204057	2.785967215	0	0	0.437155564	0	0.040099146	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9153	0	11.08142497	10.6891	0.605406396	1.793207978	0	1.289822732	0.848180361	0.928079363	0.677146497	5.93447374	2.671054718	5.521200683	0	0.008045991	1.123710065	2.785558994	11.33280712	1.233910374	1.320184698	0	0	2.890204057	2.785967215	0	0	0.437155564	0	0.040099146	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9153	YES	"$375 Days 1-27 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-27 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-58 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $18 (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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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 (14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.9688	0.0809	0.2954	0.1653	0.1046	0.1032	0.1528	0.0549	0.7218	0.2166	0.6626	0	0.0007	0.1361	1.2121	1.578	0.1463	0.1848	0	0	0.4551	0.39	0	0.0569	0.0596	0	0.0056	0	0	0											7.752	0	1.364597177	11.6579	0.686320533	2.088610081	0.165312071	1.394402954	0.951337432	1.080917469	0.732050267	6.65623406	2.887626723	6.18382001	0	0.008698369	1.259820974	3.997631391	12.91078362	1.380258501	1.50496193	0	0	3.345291436	3.175921667	0	0.056913489	0.49677368	0	0.04571155	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6673
R5287_003_0	2011	4																															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	YES	417.1290715	22.349867	48.21336176	2900.174193	14.71644038	29.70094653	26.80233163	37.73230613	65.25088467	25.31900057	73.4908428	0	0.216601484	25.89049901	38.67007092	184.4850056	9.4707375	7.137657397	0	0	53.46025379	9.66022664	890.526671	284.2322995	0	0	0	0	210.4196854	0											3900	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/20% (8a1a); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 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, 18a); $0/20% (17a); $0 (17b)"	$0 (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.083711143	0.084727378	0.16037461	0	0.2	0.2	0.2	0.075429924	0.2	0	0.153708328	0	0.2	0.160675875	0.172134216	0.199968258	0.2	0.2	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.056557367	0.057243961	0.108353146	0	0.135125062	0.135125062	0.135125062	0.050980372	0.135125062	0	0.103849237	0	0.135125062	0.108556687	0.116037048	0.134800198	0.134821595	0.134821595	0	0	0.135125062	0.136821841	0	0	0	0	0	0	0	0												23.5917	1.279394909	5.224069409	0	1.988559914	4.013342233	3.621666715	1.923606985	8.817029816	0	7.631967932	0	0.029268289	2.810586807	4.487160874	24.8686153	1.27685994	0.962310358	0	0	7.223820092	1.321729991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.0717	0	48.60556629	23.5917	1.279394909	5.224069409	0	1.988559914	4.013342233	3.621666715	1.923606985	8.817029816	0	7.631967932	0	0.029268289	2.810586807	4.487160874	24.8686153	1.27685994	0.962310358	0	0	7.223820092	1.321729991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.0717	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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)	"$40 (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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											7500	2.5835	0.1401	0.4605	0.5701	0.2594	0.5235	0.4724	0.1673	1.15	0	0.9955	0	0.0025	0.3666	1.056	5.3302	0.2736	0.2062	0	0	1.548	0.2832	0	0.0499	0	0	0	0	0	0											16.4385	0	7.885314924	26.1752	1.419499262	5.684541933	0.570062971	2.247937295	4.536821654	4.094058025	2.090877158	9.967077184	0	8.62744201	0	0.031813357	3.177185087	5.543186997	30.19885912	1.550472785	1.168519721	0	0	8.77178154	1.604957847	0	0.049865316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5102
R5287_801_0	2011	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	174.3804497	4.273816	18.92676202	1549.181718	5.161657761	8.970383461	11.7230335	15.19281395	57.50349285	23.51135883	61.85469375	0	0.05583217	12.55201202	34.02084155	149.5753418	1.909188	9.031708197	0	0	41.75491896	11.16350795	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.084555111	0.084555111	0.157898352	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.066688374	0.066688374	0.124533978	0	0.183766433	0.183766433	0.183766433	0.183766433	0.183766433	0.183766433	0.183766433	0	0.183766433	0.183766433	0.184132817	0.184132817	0.184132817	0.184132817	0	0	0.183766433	0.183766433	0	0	0	0	0	0	0	0												11.6291	0.285013839	2.357024962	0	0.948539434	1.64845537	2.154300049	2.791929224	10.56721176	4.320598545	11.36681643	0	0.010260079	2.306638473	6.264353385	27.54172902	0.351544164	1.663033871	0	0	7.673152512	2.051478034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9312	0	25.61093085	11.6291	0.285013839	2.357024962	0	0.948539434	1.64845537	2.154300049	2.791929224	10.56721176	4.320598545	11.36681643	0	0.010260079	2.306638473	6.264353385	27.54172902	0.351544164	1.663033871	0	0	7.673152512	2.051478034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9312	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.548	0.0134	0.1372	0	0.0769	0.1337	0.1747	0.2264	0.8568	0.3503	0.9216	0	0.0008	0.187	0.6576	2.8911	0.0369	0.1746	0	0	0.8055	0.2153	0	0	0	0	0	0	0	0											8.4078	0	2.243079907	12.1771	0.298443811	2.49420631	0	1.025448037	1.782113914	2.328973026	3.018301864	11.42401271	4.670917346	12.28845019	0	0.011091977	2.493663215	6.921937442	30.43284974	0.38844659	1.837606487	0	0	8.47862156	2.266826557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.339
R5287_802_0	2011	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	183.8007024	4.26312	19.94920967	1590.710149	5.440497051	9.454974937	12.35632662	16.013549	60.60990436	24.78147221	65.19616264	0	0.058848294	13.22832811	35.8586905	157.6555912	1.902491	9.519612512	0	0	44.01057256	11.76657479	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.082606461	0.082606461	0.159241443	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064281074	0.064281074	0.123915379	0	0.181311364	0.181311364	0.181311364	0.181311364	0.181311364	0.181311364	0.181311364	0	0.181311364	0.181311364	0.181685202	0.181685202	0.181685202	0.181685202	0	0	0.181311364	0.181311364	0	0	0	0	0	0	0	0												11.8149	0.27403793	2.472013869	0	0.986423942	1.714294405	2.240342436	2.903438415	10.98926445	4.493162536	11.82080519	0	0.010669865	2.398446216	6.514993415	28.64368789	0.345654461	1.729572719	0	0	7.979616953	2.133413727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4647	0	28.25717067	11.8149	0.27403793	2.472013869	0	0.986423942	1.714294405	2.240342436	2.903438415	10.98926445	4.493162536	11.82080519	0	0.010669865	2.398446216	6.514993415	28.64368789	0.345654461	1.729572719	0	0	7.979616953	2.133413727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4647	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.5567	0.0129	0.1439	0	0.08	0.139	0.1816	0.2354	0.891	0.3643	0.9584	0	0.0009	0.1945	0.6839	3.0068	0.0363	0.1816	0	0	0.8376	0.2239	0	0	0	0	0	0	0	0											8.7288	0	2.478084661	12.3716	0.286950712	2.615887692	0	1.066404262	1.853291248	2.421991823	3.138852341	11.88028589	4.857473011	12.77924886	0	0.011534989	2.592914828	7.198887752	31.65048386	0.381938631	1.911130077	0	0	8.817256302	2.357363234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1935
R5287_805_0	2011	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	183.8007024	4.26312	19.94920967	1590.710149	5.440497051	9.454974937	12.35632662	16.013549	60.60990436	24.78147221	65.19616264	0	0.058848294	13.22832811	35.8586905	157.6555912	1.902491	9.519612512	0	0	44.01057256	11.76657479	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.082606461	0.082606461	0.159241443	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.064281074	0.064281074	0.123915379	0	0.181311364	0.181311364	0.181311364	0.181311364	0.181311364	0.181311364	0.181311364	0	0.181311364	0.181311364	0.181685202	0.181685202	0.181685202	0.181685202	0	0	0.181311364	0.181311364	0	0	0	0	0	0	0	0												11.8149	0.27403793	2.472013869	0	0.986423942	1.714294405	2.240342436	2.903438415	10.98926445	4.493162536	11.82080519	0	0.010669865	2.398446216	6.514993415	28.64368789	0.345654461	1.729572719	0	0	7.979616953	2.133413727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4647	0	28.25717067	11.8149	0.27403793	2.472013869	0	0.986423942	1.714294405	2.240342436	2.903438415	10.98926445	4.493162536	11.82080519	0	0.010669865	2.398446216	6.514993415	28.64368789	0.345654461	1.729572719	0	0	7.979616953	2.133413727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4647	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.5567	0.0129	0.1439	0	0.08	0.139	0.1816	0.2354	0.891	0.3643	0.9584	0	0.0009	0.1945	0.6839	3.0068	0.0363	0.1816	0	0	0.8376	0.2239	0	0	0	0	0	0	0	0											8.7288	0	2.478084661	12.3716	0.286950712	2.615887692	0	1.066404262	1.853291248	2.421991823	3.138852341	11.88028589	4.857473011	12.77924886	0	0.011534989	2.592914828	7.198887752	31.65048386	0.381938631	1.911130077	0	0	8.817256302	2.357363234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1935
R5342_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1245.97921	111.3543757	691.1824801	231.2614756	133.6169835	6.85145003	8.97937268	431.7073146	22.35120398	16.8389914	35.90993745	0	0.031956323	11.91069996	4750.697694	85.74812828	491.7852054	896.1538576	0	0	14.95454148	1178.073461	0	0	114.6707247	0	13.64295203	10.45	0	0											4400	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$75 Days 21-66 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	56.33057436	0	200	0.2	0.098300585	49.88644281	0.2	0.120910832	0.163518959	0	0.2	0.161327671	10.02040544	0.139855562	38.5	35	0	0	0.2	34.74713295	0	0	33.42961846	0	35	0	0	0											NO	145.4072409	97.26345853	43.97806681	0	156.1427957	0.156142796	0.076744641	38.95867428	0.156142796	0.094396777	0.127661537	0	0.156142796	0.125950768	9.65636075	0.134779154	37.10128207	33.72843825	0	0	0.156142796	27.1275724	0	0	33.42961846	0	35	0	0	0												15.0979	0.902559309	2.53307244	0	1.738610779	1.069804562	0.689118729	1.401562054	3.489979476	1.58954651	4.584317795	0	0.00498975	1.500161806	3.822870895	11.55706019	1.520488469	2.518822504	0	0	2.335043915	2.663189425	0	0	0.319449881	0	0.039791943	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3783	0	11.85391232	15.0979	0.902559309	2.53307244	0	1.738610779	1.069804562	0.689118729	1.401562054	3.489979476	1.58954651	4.584317795	0	0.00498975	1.500161806	3.822870895	11.55706019	1.520488469	2.518822504	0	0	2.335043915	2.663189425	0	0	0.319449881	0	0.039791943	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3783	YES	"$295 Days 1-30 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-30 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-40 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											8800	1.0911	0.0903	0.5489	0.4565	0.6109	0.5638	0.7389	0.4924	1.8393	0.5585	2.3762	0	0.0018	0.7857	2.441	5.243	0.6848	1.1474	0	0	1.3961	1.2137	0	0	0.1273	0	0.0181	0	0	0											22.426	0	3.942625392	16.189	0.992897271	3.08199566	0.456462679	2.349474026	1.63362048	1.428044537	1.894002776	5.329292984	2.148035824	6.960557092	0	0.006742905	2.285903815	6.263902314	16.80006585	2.205267537	3.66625813	0	0	3.73117157	3.87690274	0	0	0.446783051	0	0.057918943	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8043
R5342_002_0	2011	2																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1333.332961	111.4804113	775.1650488	256.4100825	140.2246034	6.140784117	7.341478694	423.9400593	19.98611177	15.62960259	33.50631853	0	0.021997887	11.28803532	4282.496532	81.87821287	477.6498921	797.1287335	0	0	10.1914373	1164.116052	0	0	107.4515707	0	13.57356475	10.42912864	0	0											3400	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$75 Days 21-52 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												186.2490553	124.5827041	53.76091999	0	200	0.2	0.102144888	49.87945256	0.2	0.116690907	0.164173179	0	0.2	0.161516454	10.17328765	0.139084618	38.5	35	0	0	0.2	34.79819972	0	0	32.90327794	0	35	0	0	0											NO	137.1145963	91.7164769	39.57822406	0	147.2378972	0.147237897	0.075197993	36.73501831	0.147237897	0.085906619	0.120862568	0	0.147237897	0.118906715	9.721859821	0.13292198	36.79160721	33.44691565	0	0	0.147237897	25.61806877	0	0	32.90327794	0	35	0	0	0												15.235	0.852049214	2.556637999	0	1.720531312	0.904156141	0.552064462	1.297787154	2.94271307	1.342686312	4.049659718	0	0.003238923	1.342223201	3.469485914	10.88341415	1.464458935	2.221791459	0	0	1.500565797	2.485200424	0	0	0.294625741	0	0.039589564	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1578	0	14.01773534	15.235	0.852049214	2.556637999	0	1.720531312	0.904156141	0.552064462	1.297787154	2.94271307	1.342686312	4.049659718	0	0.003238923	1.342223201	3.469485914	10.88341415	1.464458935	2.221791459	0	0	1.500565797	2.485200424	0	0	0.294625741	0	0.039589564	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1578	YES	"$295 Days 1-24 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-24 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-40 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $40 (7d, 7f, 7f1)"	"$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											6800	1.0809	0.0804	0.5801	0.4026	0.6045	0.4765	0.5697	0.456	1.5509	0.4718	2.0982	0	0.0011	0.703	2.2081	4.936	0.6595	1.0121	0	0	0.8972	1.1324	0	0	0.1174	0	0.018	0	0	0											20.0566	0	4.387170999	16.3158	0.932487995	3.136736882	0.402642158	2.325042313	1.380670864	1.121751105	1.753766424	4.493602391	1.814440963	6.147819006	0	0.004376922	2.045249205	5.677600875	15.81945131	2.124004104	3.23391624	0	0	2.397757235	3.617619752	0	0	0.412063974	0	0.05762437	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2144
R5342_003_0	2011	4																															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	YES	265.298973	21.3200805	23.52016323	346.0135746	11.28245821	14.33278558	12.65620544	19.67051815	19.94689743	14.70464436	24.25750898	0	0.007093774	14.42513695	21.0821274	80.02903731	8.657077	3.660852052	0	0	10.19232158	4.030421253	789.0942281	451.5072796	148.066782	194.566213	0	0	210.4196854	0											3400	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); FFS (4b)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 7a1, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1); FFS (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e, 13e1, 13e2, 13f); $0 (13c1)"												0.087296184	0.088355807	0.177527804	0	0.233	0.233	0.233	0.140934426	0.233	0.233	0.233	0	0.233	0.233	0.220211392	0.232972607	0.234648313	0.233	0	0	0.233	0.23067165	0	0	0	0	0	0	0	0											NO	0.053794637	0.05444761	0.109398181	0	0.143581882	0.143581882	0.143581882	0.086872706	0.143581882	0.143581882	0.143581882	0	0.143581882	0.143581882	0.135308311	0.143149406	0.144179039	0.143166238	0	0	0.143581882	0.143910702	0	0	0	0	0	0	0	0												14.2717	1.160827418	2.57306307	0	1.619956578	2.057928321	1.81720179	1.708831145	2.864013064	2.111320505	3.482938781	0	0.001018537	2.071188305	2.852587059	11.45610919	1.248169046	0.524110416	0	0	1.46343271	0.580020751	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8644	0	33.60842466	14.2717	1.160827418	2.57306307	0	1.619956578	2.057928321	1.81720179	1.708831145	2.864013064	2.111320505	3.482938781	0	0.001018537	2.071188305	2.852587059	11.45610919	1.248169046	0.524110416	0	0	1.46343271	0.580020751	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8644	YES	"30% (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	30% (9b)	30% (8a1a); $0 (8a2)	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b)"	"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)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											7500	5.0867	0.4137	0.9223	0.8153	1.4784	1.8781	1.4365	0.7321	2.6137	0	2.7188	0	0.0007	1.6666	2.2203	9.7341	1.053	0.4453	0	0	1.2421	0.4846	0	0.1	0.1063	0	0	0	0	0											35.1487	480	16.28702018	19.3584	1.574568685	3.495399591	0.815276977	3.098336565	3.936003378	3.253710667	2.440976699	5.477724847	2.111320505	6.201694427	0	0.001760713	3.737782614	5.072868305	21.19021091	2.301149789	0.969388507	0	0	2.705574183	1.064638968	0	0.1	0.106344674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.0131
R5342_801_0	2011	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	205.3191042	7.0667135	16.45026914	207.2443201	5.590592106	7.073506243	8.271869278	11.8968776	23.23477662	16.24550544	35.87878533	0	0.023762523	16.51053352	24.22375175	86.02524263	2.5193025	6.044183364	0	0	17.53189721	7.37239326	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	$0 n/c (8a1a); FFS (8a2)	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.085862503	0.085862503	0.177709253	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.072594643	0.072594643	0.150248819	0	0.196995791	0.196995791	0.196995791	0.196995791	0.196995791	0.196995791	0.196995791	0	0.196995791	0.196995791	0.197511183	0.197511183	0.197511183	0.197511183	0	0	0.196995791	0.196995791	0	0	0	0	0	0	0	0												14.9051	0.513005542	2.471633515	0	1.101323112	1.393450955	1.629523429	2.34363481	4.577153192	3.200296189	7.067969686	0	0.004681117	3.252505605	4.784461859	16.99094742	0.497590416	1.193793805	0	0	3.453709953	1.452330439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8331	0	12.87347919	14.9051	0.513005542	2.471633515	0	1.101323112	1.393450955	1.629523429	2.34363481	4.577153192	3.200296189	7.067969686	0	0.004681117	3.252505605	4.784461859	16.99094742	0.497590416	1.193793805	0	0	3.453709953	1.452330439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8331	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	$0 n/c (8a1a); FFS (8a2)	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.7023	0.0242	0.2296	0	0.387	0.4896	0.5725	0.8234	1.6082	1.1244	2.4833	0	0.0016	1.1428	1.9071	6.7726	0.1983	0.4758	0	0	1.3767	0.5789	0	0	0	0	0	0	0	0											20.8985	0	3.790665653	15.6074	0.537178578	2.701238815	0	1.488274476	1.883041831	2.202058688	3.167074068	6.185342151	4.32472458	9.551310386	0	0.006325834	4.395277844	6.691555047	23.76356282	0.695930652	1.669641685	0	0	4.830363571	2.031231384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7315
R5342_802_0	2011	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	205.2765335	7.067764	16.44685835	207.2013108	5.589432956	7.072039626	8.270154194	11.89441091	23.22995913	16.24213711	35.87134625	0	0.023757596	16.50674447	24.21872921	86.0074062	2.5190165	6.042930167	0	0	17.52826216	7.370864672	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	$0 n/c (8a1a); FFS (8a2)	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.085862482	0.085862482	0.177709252	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.072598946	0.072598946	0.150257762	0	0.197007517	0.197007517	0.197007517	0.197007517	0.197007517	0.197007517	0.197007517	0	0.197007517	0.197007517	0.197522633	0.197522633	0.197522633	0.197522633	0	0	0.197007517	0.197007517	0	0	0	0	0	0	0	0												14.9029	0.513112217	2.471268127	0	1.101160308	1.393244967	1.629282543	2.34328836	4.576476569	3.199823102	7.066924856	0	0.004680425	3.251952741	4.783747168	16.98840935	0.497562772	1.193615479	0	0	3.453199405	1.452115747	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8227	0	12.86665879	14.9029	0.513112217	2.471268127	0	1.101160308	1.393244967	1.629282543	2.34328836	4.576476569	3.199823102	7.066924856	0	0.004680425	3.251952741	4.783747168	16.98840935	0.497562772	1.193615479	0	0	3.453199405	1.452115747	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8227	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	$0 n/c (8a1a); FFS (8a2)	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.7022	0.0242	0.2296	0	0.3869	0.4895	0.5725	0.8233	1.608	1.1243	2.483	0	0.0016	1.1426	1.9068	6.7716	0.1983	0.4758	0	0	1.3765	0.5788	0	0	0	0	0	0	0	0											20.8954	0	3.788650729	15.6051	0.53729028	2.700839483	0	1.48805447	1.882763469	2.201733166	3.166605892	6.184427796	4.324085273	9.549898453	0	0.006324899	4.394530731	6.690555479	23.76001308	0.695891989	1.669392278	0	0	4.829649517	2.030931115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7181
R5342_803_0	2011	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	205.2764566	7.0667135	16.44685219	207.201272	5.589430863	7.072036978	8.270151098	11.89440646	23.22995044	16.24213103	35.87133282	0	0.023757587	16.50710829	24.21872015	86.00737401	2.5193025	6.042927905	0	0	17.5282556	7.370861913	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	$0 n/c (8a1a); FFS (8a2)	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.085862503	0.085862503	0.177709253	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.072598949	0.072598949	0.150257733	0	0.197007478	0.197007478	0.197007478	0.197007478	0.197007478	0.197007478	0.197007478	0	0.197007478	0.197007478	0.197522599	0.197522599	0.197522599	0.197522599	0	0	0.197007478	0.197007478	0	0	0	0	0	0	0	0												14.9029	0.513035976	2.471266732	0	1.101159679	1.393244171	1.629281613	2.343287022	4.576473957	3.199821276	7.066920821	0	0.004680422	3.252023779	4.783744541	16.98840002	0.497619177	1.193614824	0	0	3.453197434	1.452114918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8227	0	12.86667767	14.9029	0.513035976	2.471266732	0	1.101159679	1.393244171	1.629281613	2.343287022	4.576473957	3.199821276	7.066920821	0	0.004680422	3.252023779	4.783744541	16.98840002	0.497619177	1.193614824	0	0	3.453197434	1.452114918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8227	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	$0 n/c (8a1a); FFS (8a2)	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.7022	0.0242	0.2296	0	0.3869	0.4895	0.5725	0.8233	1.608	1.1243	2.483	0	0.0016	1.1426	1.9068	6.7716	0.1984	0.4758	0	0	1.3764	0.5788	0	0	0	0	0	0	0	0											20.8954	0	3.788661328	15.6051	0.537210446	2.700837959	0	1.488053621	1.882762394	2.201731909	3.166604084	6.184424266	4.324082805	9.549893002	0	0.006324895	4.394626728	6.690551806	23.76000003	0.695970877	1.669391362	0	0	4.82964676	2.030929956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7181
R5566_005_0	2011	9																															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	197.6269255		876.3544605		3.013499721	5.447171832	2.191866714	203.6042778	256.2163076		24.13245303			706.8404812	4650.657036	1855.471656	178.0762896	257.2430803			18.50879198	30.61834416			384.5664026		20.82047403														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) $0 (14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i)"	"20% (7b) $35 (7d, 7f)"	"$35 (7e, 7h)"	"$35 (7c, 7i)"	$0 (8b)	$35 (7g)	20% (15)	"$35 (16b) 20% (17b) $0 (13a, 14a, 14j, 17a)"	$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)												633.7672612		33.0924368		0.2	0.2	0.2	49.81486345	150		0.2			35	20.15495302	16.57857574	35	35			0.2	11.21002225			35		35														NO	542.1937647		28.31088633		0.171101853	0.171101853	0.171101853	42.61707728	128.32639		0.171101853			29.94282432	17.24274907	14.18312516	29.94282432	29.94282432			0.171101853	9.590277914			29.94282432		29.94282432															8.9293	0	2.067530959	0	0.515615387	0.932021195	0.375032457	0.723084937	2.739942816	0	4.129107437	0	0	1.763733363	6.682509357	2.193032228	0.444342255	0.64188203	0	0	3.166888609	0.024469869	0	0	0.959583686	0	0.051951983	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3401		6.137634572	8.9293	0	2.067530959	0	0.515615387	0.932021195	0.375032457	0.723084937	2.739942816	0	4.129107437	0	0	1.763733363	6.682509357	2.193032228	0.444342255	0.64188203	0	0	3.166888609	0.024469869	0	0	0.959583686	0	0.051951983	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3401	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) $0 (14b, 14c, 14d, 14e, 14f, 14g, 14h, 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 (16b) 20% (17b) $0 (13a, 14a, 14j, 17a)"	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)											5100	3.8284		0.5206	0.3076	0.4437	0.3481	0.3156	0.0494	0.3857	0.6402	0.2157	0.1007	0.0012	0.262	1.2666	0.5246	0.1494	0.1178	0.4234		0.3305	0.0271			0.0162		0.0036														10.278		3.936465967	12.7577	0	2.5881225	0.307622164	0.959334139	1.280164279	0.69062647	0.772442066	3.125601591	0.640164362	4.344791012	0.100719692	0.001191256	2.025728738	7.949092762	2.71766574	0.593729503	0.759721308	0.423405257	0	3.497339502	0.05154681	0	0	0.975786781	0	0.055537931	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6181
R5566_805_0	2011	7																															Coin		Coin		Coin	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin																																																											0	YES	259.661614		47.18578723		4.37318444	13.11327507	3.232663361	295.8925829	54.94515811		24.61013545	6.039302036	0	30.35532832	75.90932644	25.56027722	0.71262863	3.980056411	16.47223035		37.29727518	2.681372177																			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																				0.088882097		0.111487895		0.233	0.233	0.233	50	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233																			NO	0.065245558		0.081839766		0.171037989	0.171037989	0.171037989	36.70343119	0.171037989		0.171037989	0.171037989	0.171037989	0.171037989	0.171037989	0.171037989	0.171037989	0.171037989	0.171037989		0.171037989	0.171037989																				16.9418	0	3.861673778	0	0.747980674	2.242868202	0.552908241	0.905022755	9.397709369	0	4.209268086	1.032950077	0	5.191914323	12.98337857	4.371778423	0.121886568	0.680740846	2.81737716	0	6.379250955	0.458616506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.8971		26.4084627	16.9418	0	3.861673778	0	0.747980674	2.242868202	0.552908241	0.905022755	9.397709369	0	4.209268086	1.032950077	0	5.191914323	12.98337857	4.371778423	0.121886568	0.680740846	2.81737716	0	6.379250955	0.458616506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.8971	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																			5100	6.2083		0.7142	0.3873	0.7203	0.8845	0.5905	0.0514	0.4894	0	0.254	0.0792	0	0.5535	1.6489	1.1122	0.403	0.1223	0.2473		0.1539	0.1866																			14.8069		6.616200777	23.1501	0	4.575882013	0.38732168	1.468324822	3.127378109	1.143425032	0.956431993	9.887143379	0	4.463271112	1.11210586	0	5.745423426	14.63224106	5.48401747	0.524896535	0.803028829	3.064725281	0	6.533124859	0.645176404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.704
R5674_001_0	2011	3																															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	YES	901.6300967	60.03515419	532.3958957	365.6591574	153.2814563	12.71112871	8.909346826	283.9742287	426.5621546	9495.994423	44.41369891	0	0.364920301	1029.199543	4245.119955	5468.866406	136.3643739	669.5662801	0	0	13.94633171	4.632735425	0	0	0	0	0	0	12.09729314	0											4250	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	$225 Days 1-7 (1b); $0 (1b1); $0 n/c (1b2)	"$50 Days 1-20/$100 Days 21-53 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$150/30% (10a)	20% (11a)	"20% (11b, 11b1); $0/20% (11c)"	"$50 (4a, 4a1); $40 (4b)"	$125 (9b)	$0/$15 (8a1a); $0/$10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$0 (3, 5); $175 (9a); $35 (9c, 9d)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$17 (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $35 (16b, 18a); $0/$35 (17a); 20% (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 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												167.6241497	112.1244337	64.56021956	0	183.5720734	0.2	0.177147444	49.13157002	125	2.325	0.156138633	0	0.2	68.82880378	11.42949425	34.25825905	35	35	0	0	0.2	0.48455638	0	0	0	0	0	0	0	0											NO	134.8501713	90.20179436	51.9373651	0	147.679947	0.160895875	0.142511465	39.54263677	100.5599219	1.870414548	0.12561031	0	0.160895875	55.37135307	11.06957647	33.1860085	33.8978408	33.8978408	0	0	0.160895875	0.389815614	0	0	0	0	0	0	0	0												10.1321	0.451273219	2.304270001	0	1.886383112	2.045168176	1.269684066	0.935757481	3.574588079	1.480120509	5.578818502	0	0.058714171	4.749014273	3.915973329	15.12415392	0.38520482	1.891404264	0	0	2.243907245	1.805912603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8324	0	10.05035567	10.1321	0.451273219	2.304270001	0	1.886383112	2.045168176	1.269684066	0.935757481	3.574588079	1.480120509	5.578818502	0	0.058714171	4.749014273	3.915973329	15.12415392	0.38520482	1.891404264	0	0	2.243907245	1.805912603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8324	YES	"$350 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$350 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"40% (2a); $0 n/c (2a1, 2a2)"	40% (6a); $0 n/c (6a2)	$150/30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	"30% (8a1a, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$0 (3, 5); 20% (9a); $45 (9c, 9d)"	"$40 (7a, 14c); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b); 30% (14d, 14e, 14f, 14g, 14h, 14i, 14j)"	"$40 (7b); $0 n/c (7b1); $45 (7d, 7f, 7f1)"	"$45 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$40/$45 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 40% (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 (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	2.8911	0.1288	0.3355	0.2185	0.1752	0.285	0.1997	0.0869	0.6888	0.1335	0.7648	0	0.0055	0.24	2.0294	3.6045	0.0908	0.4461	0	0	0.4116	0.4266	0	0	0	0	0	0	0	0											13.1625	0	1.899270958	13.0232	0.580038885	2.639770502	0.218527598	2.061620887	2.330150627	1.469430882	1.022685772	4.263425902	1.613665298	6.343614626	0	0.064168493	4.989063327	5.945409997	18.72867371	0.476051941	2.337475092	0	0	2.655511533	2.232483559	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9949
R5674_801_0	2011	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	224.9570966	6.8128778	101.1943353	2237.001338	14.07548138	14.24204239	25.85379698	20.46819914	10.29686406	5.224324993	14.37498674	0	4.289870808	4.429827932	51.641802	117.3756964	3.334534391	2.254766304	0	0	13.21226764	10.36609098	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.069723926	0.069723926	0.145098041	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.056723013	0.056723013	0.118042665	0	0.189554185	0.189554185	0.189554185	0.189554185	0.189554185	0.189554185	0.189554185	0	0.189554185	0.189554185	0.190582135	0.190582135	0.190582135	0.190582135	0	0	0.189554185	0.189554185	0	0	0	0	0	0	0	0												12.7602	0.386446956	11.945249	0	2.668066402	2.699638739	4.900695417	3.879832809	1.951813676	0.990292667	2.724838897	0	0.813162965	0.839692424	9.842004874	22.3697108	0.635502683	0.429718176	0	0	2.504440625	1.964935929	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.3063	0	19.1023737	12.7602	0.386446956	11.945249	0	2.668066402	2.699638739	4.900695417	3.879832809	1.951813676	0.990292667	2.724838897	0	0.813162965	0.839692424	9.842004874	22.3697108	0.635502683	0.429718176	0	0	2.504440625	1.964935929	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.3063	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	2.3406	0.0709	0.7625	0	0.2479	0.2508	0.4553	0.3604	0.1813	0.092	0.2531	0	0.0755	0.078	1.8053	4.1033	0.1166	0.0788	0	0	0.4594	0.3604	0	0	0	0	0	0	0	0											12.0922	0	2.731053983	15.1009	0.457333676	12.7077117	0	2.915919565	2.950424852	5.355951276	4.240254436	2.1331297	1.082287067	2.977966008	0	0.888702694	0.917696638	11.64734305	26.47303053	0.752074181	0.50854222	0	0	2.963835059	2.325367963	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3985
R5674_802_0	2011	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	211.3339024	6.400296206	95.06609977	2168.208193	13.22308321	13.37955744	24.28811489	19.22866389	9.673295472	4.907944691	13.50445081	0	4.03008019	4.16156164	48.51442212	110.2675325	3.132598065	2.118219737	0	0	12.4121449	9.738330078	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.070875102	0.070875102	0.147104013	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.058562963	0.058562963	0.121549693	0	0.192524173	0.192524173	0.192524173	0.192524173	0.192524173	0.192524173	0.192524173	0	0.192524173	0.192524173	0.193504651	0.193504651	0.193504651	0.193504651	0	0	0.192524173	0.192524173	0	0	0	0	0	0	0	0												12.3763	0.374820312	11.55525523	0	2.545763165	2.575888237	4.676049241	3.70198262	1.862343214	0.944897995	2.599933228	0	0.775887857	0.801201215	9.387766339	21.33728044	0.606172297	0.409885372	0	0	2.389637936	1.874863948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.796	0	16.79171002	12.3763	0.374820312	11.55525523	0	2.545763165	2.575888237	4.676049241	3.70198262	1.862343214	0.944897995	2.599933228	0	0.775887857	0.801201215	9.387766339	21.33728044	0.606172297	0.409885372	0	0	2.389637936	1.874863948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.796	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	2.2702	0.0688	0.7376	0	0.2365	0.2393	0.4344	0.3439	0.173	0.0878	0.2415	0	0.0721	0.0744	1.722	3.9139	0.1112	0.0752	0	0	0.4383	0.3439	0	0	0	0	0	0	0	0											11.584	0	2.399688684	14.6466	0.443574334	12.29282471	0	2.782254825	2.815178401	5.110436329	4.045882645	2.035347775	1.032675404	2.84145708	0	0.847964871	0.875629743	11.10978265	25.25121945	0.717363665	0.485071446	0	0	2.827973889	2.218773903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.38
R5674_803_0	2011	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	211.3339024	6.400296206	95.06609977	2168.208193	13.22308321	13.37955744	24.28811489	19.22866389	9.673295472	4.907944691	13.50445081	0	4.03008019	4.16156164	48.51442212	110.2675325	3.132598065	2.118219737	0	0	12.4121449	9.738330078	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.070875102	0.070875102	0.147104013	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.058562963	0.058562963	0.121549693	0	0.192524173	0.192524173	0.192524173	0.192524173	0.192524173	0.192524173	0.192524173	0	0.192524173	0.192524173	0.193504651	0.193504651	0.193504651	0.193504651	0	0	0.192524173	0.192524173	0	0	0	0	0	0	0	0												12.3763	0.374820312	11.55525523	0	2.545763165	2.575888237	4.676049241	3.70198262	1.862343214	0.944897995	2.599933228	0	0.775887857	0.801201215	9.387766339	21.33728044	0.606172297	0.409885372	0	0	2.389637936	1.874863948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.796	0	16.79171002	12.3763	0.374820312	11.55525523	0	2.545763165	2.575888237	4.676049241	3.70198262	1.862343214	0.944897995	2.599933228	0	0.775887857	0.801201215	9.387766339	21.33728044	0.606172297	0.409885372	0	0	2.389637936	1.874863948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.796	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	2.2702	0.0688	0.7376	0	0.2365	0.2393	0.4344	0.3439	0.173	0.0878	0.2415	0	0.0721	0.0744	1.722	3.9139	0.1112	0.0752	0	0	0.4383	0.3439	0	0	0	0	0	0	0	0											11.584	0	2.399688684	14.6466	0.443574334	12.29282471	0	2.782254825	2.815178401	5.110436329	4.045882645	2.035347775	1.032675404	2.84145708	0	0.847964871	0.875629743	11.10978265	25.25121945	0.717363665	0.485071446	0	0	2.827973889	2.218773903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.38
R5826_001_0	2011	7	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	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	1326.661463	73.365504	345.876759	723.830746	10.097047	9.662128	3.15703	346.199246	284.210099	944.24898	753.718168	56.365668	0	568.828654	3592.541544	2853.253984	78.069681	464.931963		1542.794455	18.612019	0							3.62	0.58	1281.164709										3900	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$150/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											161.6895	138.428775	34.44565	0	100	0.2	0.2	50	240.836745	40.555611	88.900015	150	0	53.110058	15	35	35	15		0	0.2	0							0	0	0										NO	133.414049	114.221043	23.255843	0	84.0853	0.168171	0.168171	42.04265	202.5083	34.101307	74.751844	126.12795	0	44.657752	12.612795	29.429855	29.429855	12.612795		0	0.168171	0							0	0	0											14.7496	0.698323699	0.670304634	0	0.070751102	1.624889728	0.530920892	1.212927811	4.796241999	2.683343696	4.69515191	0.592440513	0	2.11688408	3.775999169	6.997570919	0.191464949	0.488674295	0	0	3.130001847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0255	0	9.824827982	14.7496	0.698323699	0.670304634	0	0.070751102	1.624889728	0.530920892	1.212927811	4.796241999	2.683343696	4.69515191	0.592440513	0	2.11688408	3.775999169	6.997570919	0.191464949	0.488674295	0	0	3.130001847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0255	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		30% Coins	20%-30% Coins	30% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins										5800	8.9439	0.1934	0.3763	3.1899	1.1011	2.0477	0.6691	0.4258	4.248	0.6009	1.7045	0.3831	0	1.1476	1.9735	2.2071	0.03	0.2704		0.3411	0.9623	0							0	0	0.4044										31.2199	0	20.85497688	23.6935	0.891724203	1.046611749	3.18988632	1.171867971	3.67254164	1.199976281	1.638726917	9.044277153	3.284225473	6.399660385	0.975572964	0	3.264463732	5.749451182	9.204687527	0.22145609	0.759027238	0	0.341056087	4.092320268	0	0	0	0	0	0	0	0	0	0.404371062	0	0	0	0	0	0	0	0	0	80.2454
R5826_002_0	2011	7	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		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	YES	1563.714457	129.323113	391.743246	481.231233	14.586839	9.469793	2.647595	391.927712	251.604365	1261.44462	848.317844	52.831833	0.197594	14.175854	3080.126023	2741.953907	196.255135	581.107672		1122.88674	22.876683	0		3.39					4	0.56	1020.623585	931.171814									5000	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$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$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										161.6895	138.428775	32.5726	0	150	0.2	0.2	50	190.34344	44.394241	117.212563	150	0.2	0.2	15	34.083071	35	63.090048		0	0.2	0		0					0	0	0	128.175495									NO	132.478513	113.420094	22.205425	0	124.7955	0.166394	0.166394	41.5985	158.360032	36.934677	97.517336	124.7955	0.166394	0.166394	12.47955	28.356092	29.11895	52.489027		0	0.166394	0		0					0	0	0	106.638167										17.2632	1.222319969	0.724902106	0	0.151697656	1.575716736	0.440543922	1.358633744	3.320339608	3.882587466	6.893808019	0.549431251	0.032878456	2.35877705	3.203215559	6.479258104	0.476228622	2.54181469	0	0	3.806542791	0	0	0	0	0	0	0	0	0	0	8.274871284	0	0	0	0	0	0	0	0	64.5568	0	13.57286495	17.2632	1.222319969	0.724902106	0	0.151697656	1.575716736	0.440543922	1.358633744	3.320339608	3.882587466	6.893808019	0.549431251	0.032878456	2.35877705	3.203215559	6.479258104	0.476228622	2.54181469	0	0	3.806542791	0	0	0	0	0	0	0	0	0	0	8.274871284	0	0	0	0	0	0	0	0	64.5568	YES	20% Coins	20% Coins	20% Coins(Days 1-8) 20%(Days 9-100)	20% Coins	$150/Trip	20% Coins	20% Coins	$50/Visit	20% Coins	20% Coins	20% Coins	20% Coins	0%-20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		20% Coins	20% Coins	20% Coins		0.5					$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$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	20% Coins									7500	11.2978	0.3065	0.4958	1.3938	2.8277	1.5855	0.4433	0.5713	2.8307	0.7029	1.5089	0.1553	0.0142	1.0157	1.2547	1.6368	0.0602	0.2711		0.1756	1.0275	0		0					0	0	0.2463	0.9815									30.8029	0	9.253444571	28.561	1.528791563	1.220671269	1.393781076	2.979406467	3.161251429	0.883832945	1.92988588	6.151086265	4.585513906	8.402706041	0.70476948	0.047035715	3.374445813	4.457954502	8.116019568	0.536387669	2.812936884	0	0.175557428	4.834034736	0	0	0	0	0	0	0	0	0	0.246305852	9.256351646	0	0	0	0	0	0	0	0	95.3597
R5826_003_0	2011	7	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	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	YES	850.573012	62.853739	260.975734	326.62326	7.418673	6.119756	1.532826	267.469979	176.834864	752.492833	565.206348	73.554132	0.650846	569.906022	2733.996099	2157.87934	91.187674	355.847114		1249.110922	12.229659	0		3.36					3.62	0.41	1017.618514										5900	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$150/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											161.6895	138.428775	34.44565	0	150	0.2	0.2	50	244.255984	39.037795	84.005783	150	0.2	49.067916	15	35	35	15		0	0.2	0		0					0	0	0										NO	153.191747	131.153512	31.043832	0	140.47335	0.187298	0.187298	46.82445	228.743042	36.558466	78.670492	140.47335	0.187298	45.951564	14.047335	32.777115	32.777115	14.047335		0	0.187298	0		0					0	0	0											10.8584	0.686957384	0.67514057	0	0.086843821	1.146218059	0.287095244	1.043677888	3.37081206	2.292498638	3.70542179	0.861032944	0.121902154	2.18233942	3.200446591	5.894088274	0.249072406	0.416558635	0	0	2.290590671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3691	0	2.555587946	10.8584	0.686957384	0.67514057	0	0.086843821	1.146218059	0.287095244	1.043677888	3.37081206	2.292498638	3.70542179	0.861032944	0.121902154	2.18233942	3.200446591	5.894088274	0.249072406	0.416558635	0	0	2.290590671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3691	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	$0/Day(Days 1-7) $50(Days 8-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	$0-$250/Visit	$0-$50/Visit	$0-$150/Visit	$150/Visit	20% Coins	$15-$150/Visit	$15/Visit	$35/Visit	$35/Visit	$15/Visit		$0/Visit	20% Coins	$0/Service		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins										5900	6.0657	0.3837	0.3747	0	2.066	1.8936	0.4743	0.8129	2.6253	1.7855	2.6511	0.6706	0.0972	1.6265	1.8472	3.402	0.1438	0.2662		0	1.3684	0		0					0	0	0.5453										29.1001	0	2.172476568	16.9241	1.070702768	1.049837075	0	2.152856641	3.039862442	0.761400194	1.856534596	5.996130877	4.077985227	6.356545664	1.531638703	0.219131668	3.808812611	5.047690263	9.29605639	0.392832788	0.682804132	0	0	3.658993498	0	0	0	0	0	0	0	0	0	0.545266435	0	0	0	0	0	0	0	0	0	68.4692
R5826_004_0	2011	8	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	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	1076.124011	53.829089	237.438297	374.249742	8.662113	7.535592	2.624787	285.510539	308.519673	760.250257	881.778648	60.980588	0.098762	628.559975	3483.050161	3706.906728	63.634697	636.408442		1727.085609	21.62953	0							3.83	0.41	1088.669854										5900	$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$150/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											147.067245	128.620245	34.44565	0	100	0.2	0.2	50	240.59536	38.821982	87.159457	150	0.2	51.846574	15	35	35	15		0	0.2	0							0	0	0										NO	138.369541	121.013515	31.002187	0	92.5595	0.185119	0.185119	46.27975	222.693863	35.933432	80.674358	138.83925	0.185119	47.98893	13.883925	32.395825	32.395825	13.883925		0	0.185119	0							0	0	0											12.4086	0.542837272	0.61342554	0	0.066813404	1.394981255	0.485897945	1.101113031	5.725453149	2.276533409	5.928077194	0.705541592	0.018282723	2.513660053	4.029867267	10.00735847	0.171791542	0.73632059	0	0	4.004036964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.7306	0	4.030621457	12.4086	0.542837272	0.61342554	0	0.066813404	1.394981255	0.485897945	1.101113031	5.725453149	2.276533409	5.928077194	0.705541592	0.018282723	2.513660053	4.029867267	10.00735847	0.171791542	0.73632059	0	0	4.004036964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.7306	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		30% Coins	20%-30% Coins	30% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins										8800	12.5969	0.2041	0.5079	2.8073	1.402	1.9752	0.688	0.5212	6.8741	0.8836	2.6173	0.5717	0.0089	1.9155	2.8844	4.5304	0.0479	0.5551		0.5879	1.6967	0							0	0	0.4289										44.3049	500	12.04496619	25.0055	0.746940745	1.121341616	2.807326396	1.468816825	3.37015645	1.173888209	1.622292128	12.59952964	3.16016707	8.545407098	1.277227574	0.02714493	4.429114352	6.914291004	14.53777915	0.219648935	1.29142359	0	0.587851277	5.700702871	0	0	0	0	0	0	0	0	0	0.428945193	0	0	0	0	0	0	0	0	0	97.0355
R5826_005_0	2011	9	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							Prosthetics/Supplies	Radiology	Other	Therapy (PT/OT/ST)							D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V					O	O	O	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	1289.371542	37.937318	486.969436	716.296065	10.094604	6.716612	2.059794	243.314945	314.572691	446.699833	211.564243	88.437879	0.393346	5.70062	3949.52485	4889.427979	74.316716	100.814741		1511.61466	28.07545	0		3.22					4.63	0.58	494.711799	937.451281	476.29973	612.554966							6000	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$35/Visit:7b. $25 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$100/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN762: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$150/Visit:8b, 9a. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								161.6895	138.428775	34.44565	0	150	0.2	0.2	50	123.176457	104.859644	75	150	0.18039	0.2	15	34.580754	35	100		0	0.2	0		0					0	0	0	91.925809	118.687171	35							NO	146.431347	125.365667	27.571263	0	133.91925	0.178559	0.178559	44.63975	109.971325	93.618166	66.959625	133.91925	0.161052	0.178559	13.391925	30.873525	31.247825	89.2795		0	0.178559	0		0					0	0	0	82.070903	105.963313	31.247825								15.7337	0.396336431	1.118863533	0	0.11265515	1.199311522	0.367794757	0.905126526	2.882831303	3.484934926	1.180521865	0.986961202	0.06334916	1.017897007	4.407645048	12.57948975	0.193519645	0.750057472	0	0	5.013124277	0	0	0	0	0	0	0	0	0	0	6.411456096	4.205858114	1.595084198	0	0	0	0	0	0	64.6065	0	7.646324674	15.7337	0.396336431	1.118863533	0	0.11265515	1.199311522	0.367794757	0.905126526	2.882831303	3.484934926	1.180521865	0.986961202	0.06334916	1.017897007	4.407645048	12.57948975	0.193519645	0.750057472	0	0	5.013124277	0	0	0	0	0	0	0	0	0	0	6.411456096	4.205858114	1.595084198	0	0	0	0	0	0	64.6065	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$150/Trip	35% Coins	35% Coins	$50/Visit	30% Coins	30% Coins	$100/Visit	30% Coins	0%-20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins		$40/Visit	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	35% Coins	30% Coins	30% Coins	$40/Visit							7500	3.6427	0.0918	0.9374	2.3788	2.0046	2.016	0.6183	0.3633	5.7484	0.5886	0.3919	0.9886	0.026	0.6276	2.9262	3.6225	0.0551	0.1384		1.1199	1.7748	0		0					0	0	0.1995	2.3853	0.8192	0.4538							33.9187	0	7.350922677	19.3764	0.48809804	2.056255904	2.378755598	2.117284093	3.215331255	0.986050918	1.268423548	8.631209511	4.073521438	1.572384903	1.975575141	0.089388524	1.645503181	7.333797015	16.2020038	0.248579939	0.888489306	0	1.119935783	6.787927628	0	0	0	0	0	0	0	0	0	0.199494217	8.796784287	5.025082155	2.048918264	0	0	0	0	0	0	98.5252
R5826_006_0	2011	12	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V					O	O	O	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	YES	1337.664643	88.218692	442.10127	596.9406	11.334543	7.273056	2.17161	297.46968	285.832091	1696.289931	770.386818	40.984713	0.082092	7.036026	3180.898781	2913.208195	123.214697	803.827904		1359.754815	18.848719	0		4.02					3.7	0.6	989.119185	0	905.71621								4000	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$5/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$5-$35/Visit:7b. $5 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center	"$35-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $35 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"									161.6895	138.428775	45.243839	0	100	0.2	0.2	50	138.651446	95.484215	70.91761	100	0.2	0.2	5	32.260373	35	56.345052		0	0.2	0		0					0	0	0	0	84.576156								NO	125.79912	107.701601	26.010276	0	80.5246	0.161049	0.161049	40.2623	111.648522	76.888282	57.106122	80.5246	0.161049	0.161049	4.02623	25.977537	28.18361	45.371627		0	0.161049	0		0					0	0	0	0	68.104611									14.0231	0.791774531	0.958264671	0	0.076059128	1.171318396	0.349735619	0.998067791	2.659394208	10.86873488	3.666150301	0.275023135	0.013220835	1.133144951	1.067252508	6.306497806	0.289386247	3.039248319	0	0	3.035567346	0	0	0	0	0	0	0	0	0	0	0	5.140287513	0	0	0	0	0	0	0	55.8622	0	14.63107501	14.0231	0.791774531	0.958264671	0	0.076059128	1.171318396	0.349735619	0.998067791	2.659394208	10.86873488	3.666150301	0.275023135	0.013220835	1.133144951	1.067252508	6.306497806	0.289386247	3.039248319	0	0	3.035567346	0	0	0	0	0	0	0	0	0	0	0	5.140287513	0	0	0	0	0	0	0	55.8622	YES	$250/Day(Days 1-7)	$250/Day(Days 1-7)	30% Coins(Days 1-20) 30%(Days 21-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	$0/Proc	30% Coins								5000	3.5811	0.2022	0.6101	3.0782	1.3637	1.7004	0.5077	0.4036	4.7766	1.1981	1.9632	0.3032	0.0055	0.4693	2.0964	2.9756	0.0642	0.5213		0.3605	1.0934	0		0					0	0	0.3343	0	1.394								29.0027	0	10.50050983	17.6042	0.993970015	1.568405006	3.078245351	1.439718759	2.871765462	0.857460199	1.401698558	7.436013139	12.06682482	5.629339566	0.578254404	0.018696183	1.602444449	3.163650994	9.282115816	0.353563356	3.560500943	0	0.360506785	4.129002424	0	0	0	0	0	0	0	0	0	0.3343338	0	6.534270211	0	0	0	0	0	0	0	84.8649
R5826_007_0	2011	8	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		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	YES	1265.123069	65.725338	744.963821	521.903834	12.876725	7.862147	2.420783	361.94985	298.733121	1852.246598	869.101433	131.729684	0.227576	6.610375	3365.854074	2924.975362	94.030665	461.051854		1101.938547	18.25473	0		3.22					4.53	0.56	877.190226	822.072738									5000	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										165.92202	145.11002	32.5726	0	150	0.2	0.2	50	185.953685	39.964525	110.505861	150	0.175694	0.2	15	33.562951	35	84.90326		0	0.2	0		0					0	0	0	126.206887									NO	140.037355	122.472131	21.380166	0	126.86595	0.169155	0.169155	42.28865	157.274606	33.800917	93.462874	126.86595	0.148597	0.169155	12.686595	28.386638	29.602055	71.808885		0	0.169155	0		0					0	0	0	106.742378										14.7637	0.670793517	1.327287513	0	0.136134829	1.329921476	0.409487548	1.275530877	3.915261159	5.217302794	6.76905981	1.392667625	0.033817111	1.118177983	3.558435622	6.91918473	0.23195841	2.758968297	0	0	3.087878853	0	0	0	0	0	0	0	0	0	0	7.312499912	0	0	0	0	0	0	0	0	62.2281	0	11.83855127	14.7637	0.670793517	1.327287513	0	0.136134829	1.329921476	0.409487548	1.275530877	3.915261159	5.217302794	6.76905981	1.392667625	0.033817111	1.118177983	3.558435622	6.91918473	0.23195841	2.758968297	0	0	3.087878853	0	0	0	0	0	0	0	0	0	0	7.312499912	0	0	0	0	0	0	0	0	62.2281	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	20% Coins	$150/Trip	20% Coins	20% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	30% Coins									7500	11.4295	0.1897	0.7882	1.1818	2.2812	1.203	0.3704	0.4821	4.874	1.351	2.0962	0.6115	0.0131	0.6492	1.7894	2.4331	0.045	0.3089		0.2547	1.0319	0		0					0	0	0.2028	1.3018									34.8886	0	18.14852929	26.1932	0.860538058	2.115526481	1.181766874	2.417323774	2.532902464	0.779889789	1.757648076	8.789242299	6.568344128	8.865233602	2.004208049	0.046906963	1.767413921	5.347875623	9.35228887	0.276961554	3.067855708	0	0.254736081	4.11973535	0	0	0	0	0	0	0	0	0	0.202797149	8.61432082	0	0	0	0	0	0	0	0	97.1167
R5826_008_0	2011	7	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		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	YES	1216.685815	44.304367	327.679089	494.34969	9.075056	9.521504	2.892401	320.761327	319.342785	1317.31331	919.084869	97.359646	0.235145	7.275428	3510.372831	3077.351503	90.080312	454.738929		1447.601577	20.19825	0		3.21					4.9	0.56	1106.804922	670.752396									5500	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$150/Visit:7c, 7d, 7i. $150 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"										161.6895	138.428775	32.5726	0	150	0.2	0.2	50	187.5888	37.220531	106.248697	150	0.161985	0.2	15	33.806511	35	80.998401		0	0.2	0		0					0	0	0	130.024288									NO	144.494307	123.70729	26.072966	0	132.0552	0.176074	0.176074	44.0184	165.147177	32.767764	93.537953	132.0552	0.142607	0.176074	13.20552	29.762171	30.81288	71.3084		0	0.176074	0		0					0	0	0	114.469222										14.6503	0.456731098	0.711963812	0	0.099867361	1.676489295	0.509276614	1.1766167	4.394879953	3.597117638	7.164109773	1.07140396	0.033533323	1.28101371	3.863024886	7.632388472	0.23130282	2.702225454	0	0	3.556386671	0	0	0	0	0	0	0	0	0	0	6.39837541	0	0	0	0	0	0	0	0	61.2071	0	8.142976519	14.6503	0.456731098	0.711963812	0	0.099867361	1.676489295	0.509276614	1.1766167	4.394879953	3.597117638	7.164109773	1.07140396	0.033533323	1.28101371	3.863024886	7.632388472	0.23130282	2.702225454	0	0	3.556386671	0	0	0	0	0	0	0	0	0	0	6.39837541	0	0	0	0	0	0	0	0	61.2071	YES	20% Coins	20% Coins	20% Coins(Days 1-8) 20%(Days 9-100)	20% Coins	$150/Trip	20% Coins	20% Coins	$50/Visit	20% Coins	20% Coins	20% Coins	20% Coins	0%-20% Coins	20% Coins	20% Coins	20% Coins	20% Coins	20% Coins		20% Coins	20% Coins	20% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	20% Coins									8000	10.67	0.1331	0.5536	1.2414	1.854	1.6801	0.5104	0.4927	3.9424	0.7483	1.7064	0.5358	0.0144	0.5494	1.4183	1.8101	0.0296	0.2003		0.2516	0.9561	0		0					0	0	0.2756	0.8943									30.4679	0	5.918304664	25.3204	0.589858872	1.265578286	1.241396033	1.953893626	3.356584533	1.019648437	1.669333019	8.337287429	4.345377643	8.870525109	1.607182514	0.047913748	1.830370459	5.281298059	9.442533416	0.260934199	2.902507622	0	0.251573731	4.512462192	0	0	0	0	0	0	0	0	0	0.275642151	7.292652629	0	0	0	0	0	0	0	0	91.6749
R5826_009_0	2011	7	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Radiology									Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin		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	YES	298.851431	3.905902	37.904117	684.382861	0.554961	8.153808	3.01003	293.607886	51.752211	9.174344	21.159861	6.727257	1.388404	21.088284	29.330748	42.34055	1.466698	8.211331		1106.258714	25.065248	0		3.59					4.51	0.6	688.918373	132.519883									5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	"15%-20% coinsurance after $155 plan year deductible:9b. 15% Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. 15% Surgery OP -- Physician,9a. 20% Surgery OP -- Facility"	"0%-20% coinsurance after $155 plan year deductible:8a. 0% Lab -- FSL,8a. 20% Lab -- OP"	"15%-20% coinsurance after $155 plan year deductible:8b, 9a. 20% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b. 15% Advanced Imaging -- Office,8b, 9a. 20% Advanced Imaging -- OP,8b. 15% Radiology OP -- Physician,8b. 20% Radiology OP -- Facility"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"15%-20% coinsurance after $155 plan year deductible:9d. 20% Cardiac Rehab,8b. 20% Nuclear Medicine,9a. 15% OP Other,5. 20% Partial Hospitalization,7h. 20% Psych -- OP,8b. 20% Rad therapy,3, 7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- CORF"	"15% coinsurance after $155 plan year deductible:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"15% coinsurance after $155 plan year deductible:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"15% coinsurance after $155 plan year deductible:7e, 7h.Psych -- Other Provider"	"15%-20% coinsurance after $155 plan year deductible:7c, 7d, 7i. 20% Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. 15% Therapy (AT,PT,ST,OT) - Specialist"		$0/Visit:14b-j.Preventive Services	20% coinsurance after $155 plan year deductible	"20% coinsurance after $155 plan year deductible:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"										0.076993	0.076993	0.163937	0	0.233	0.233	0.233	50	0.220845	0.218337	0.215287	0.233	0.233	0.214741	0.183	0.183	0.183	0.200493		0	0.233	0		0					0	0	0	0									NO	0.061593	0.061593	0.069143	0	0.193814	0.193814	0.193814	41.59095	0.183703	0.181617	0.17908	0.193814	0.193814	0.178626	0.152223	0.152223	0.152223	0.166774		0	0.193814	0		0					0	0	0	0										18.4072	0.240576222	2.620804362	0	0.107559211	1.580322144	0.583385954	1.017619242	9.507036417	1.666216834	3.789307908	1.303836588	0.269092133	3.766915818	4.464814453	6.445205543	0.22326517	1.369436516	0	0	4.857995976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2205	0	16.53545694	18.4072	0.240576222	2.620804362	0	0.107559211	1.580322144	0.583385954	1.017619242	9.507036417	1.666216834	3.789307908	1.303836588	0.269092133	3.766915818	4.464814453	6.445205543	0.22326517	1.369436516	0	0	4.857995976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2205	YES	7% Coins	7% Coins	16% Coins(Days 1-7) 16%(Days 8-100)	$0/Visit	23% Coins	23% Coins	23% Coins	$50/Visit	18%-23% Coins	0%-23% Coins	18%-23% Coins	23% Coins	23% Coins	18%-23% Coins	18% Coins	18% Coins	18% Coins	18%-23% Coins		$0/Visit	23% Coins	23% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service	$0/Visit									5000	4.6298	0.0605	0.6466	0	2.0187	1.6011	0.591	0.4308	3.8119	0.7224	1.4582	0.5653	0.1167	1.5547	1.2134	1.7517	0.0607	0.4622		0	1.3203	0		0					0	0	0	0									23.0159	0	6.056828784	23.037	0.3010867	3.267425972	0	2.126236662	3.181380283	1.174426493	1.448418558	13.31891003	2.388588717	5.247541267	1.869101692	0.385754335	5.321567571	5.678245185	8.196859837	0.283943262	1.83168575	0	0	6.178284449	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.2364
R5826_010_0	2011	8	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O		V					O		O	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	YES	1423.870971	83.501497	341.863614	539.197765	0.655292	10.176572	3.132445	352.060586	46.157678	8.891542	14.090292	4.225747	0.937225	17.251255	3550.202651	2685.72974	83.705891	1.507058		1768.885908	16.942406	0		3.1					3.77		1221.456591	413.215638	329.145671	101.165894	0	261.119617					6700	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $125(Days 21-100):2. $0 SNF 1,2. $125 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	20% Coins:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,7h. 25% Psych -- OP,8b. 20% Rad therapy"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a		$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$35/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						161.6895	138.428775	41.280875	0	0.2	0.2	0.2	50	0.242821	0.25	0.243374	0.2	0.15202	0.230934	15	34.085755	35	0.25		0	0.2	0		0					0		0	0	21.29826	35	0	35					NO	151.120504	129.38024	35.903917	0	0.184833	0.184833	0.184833	46.20835	0.224407	0.231042	0.224918	0.184833	0.140492	0.213422	13.862505	31.50093	32.345845	0.231042		0	0.184833	0		0					0		0	0	19.683149	32.345845	0	32.345845						17.9313	0.900286977	1.022853569	0	0.121119586	1.880966332	0.578979207	1.355678232	10.35810605	2.054319647	3.169160296	0.781057495	0.131672615	3.681797345	4.101225167	7.050248712	0.225628148	0.348193694	0	0	3.131515728	0	0	0	0	0	0	0	0	0	0	0	0.539885274	0.272691361	0	0.703844555	0	0	0	0	60.3406	0	4.792327862	17.9313	0.900286977	1.022853569	0	0.121119586	1.880966332	0.578979207	1.355678232	10.35810605	2.054319647	3.169160296	0.781057495	0.131672615	3.681797345	4.101225167	7.050248712	0.225628148	0.348193694	0	0	3.131515728	0	0	0	0	0	0	0	0	0	0	0	0.539885274	0.272691361	0	0.703844555	0	0	0	0	60.3406	YES	30% Coins	30% Coins	30% Coins(Days 1-20) 30%(Days 20-100)	30% Coins	20% Coins	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	30% Coins		0.5					$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a		30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins					8000	12.1527	0.2536	0.5366	1.872	1.8875	2.3735	0.7306	0.4765	4.6069	0.8874	1.4063	0.4218	0.0474	1.7218	1.9484	2.4911	0.0359	0.1504		0.4171	0.9452	0		0					0		0.4127	0.0252	0.7418	0.0388	1.0289	0.1281					37.7383	0	16.5891593	30.0841	1.153855144	1.559431279	1.871961584	2.00865328	4.254500171	1.309575234	1.832226182	14.96497039	2.941758852	4.57547153	1.202817015	0.179073353	5.403594612	6.049585239	9.541319822	0.261546414	0.498608838	0	0.417115699	4.076744556	0	0	0	0	0	0	0	0	0	0.412731119	0.025244595	1.281693238	0.311442855	1.028934192	0.83192474	0	0	0	0	98.0788
R5826_011_0	2011	7	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	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	1532.731649	49.523153	228.850211	1557.109546	7.53853	8.993464	4.26485	308.864763	351.044068	1080.472451	933.268632	99.95572	0.200078	705.229859	3422.241312	3123.054028	56.196775	615.804073		1486.132868	19.221598	0							4.21	0.73	1229.285603										5500	$195/Day(Days 1-8):1a.IP Acute	$195/Day(Days 1-8):1b.IP Psych	"$50/Day(Days 1-20) $100(Days 21-100):2. $50 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$150/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											147.067245	128.620245	66.51235	0	100	0.2	0.2	50	140.282987	35.703914	95.266863	150	0.2	50.317731	15	35	35	15		0	0.2	0							0	0	0										NO	133.841782	117.053684	53.542708	0	90.2373	0.180475	0.180475	45.11865	126.587579	32.218248	85.966245	135.35595	0.180475	45.405362	13.535595	31.583055	31.583055	13.535595		0	0.180475	0							0	0	0											17.0953	0.483072292	1.021105002	0	0.056688049	1.623095415	0.769698804	1.161296762	3.703151558	2.900910782	6.685799989	1.127466787	0.036109077	2.668434753	3.860172699	8.219632261	0.147905486	0.694606211	0	0	3.469017899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7235	0	6.000746114	17.0953	0.483072292	1.021105002	0	0.056688049	1.623095415	0.769698804	1.161296762	3.703151558	2.900910782	6.685799989	1.127466787	0.036109077	2.668434753	3.860172699	8.219632261	0.147905486	0.694606211	0	0	3.469017899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7235	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 7-100)	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		30% Coins	20%-30% Coins	30% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins										8200	12.7081	0.1568	0.3602	3.8133	0.901	2.0888	0.9905	0.4163	5.5105	0.7251	2.1855	0.5339	0.0133	1.9005	1.9153	2.4957	0.0315	0.3993		0.3502	1.1077	0							0	0	0.4622										39.0658	0	17.15288332	29.8034	0.639892569	1.381334352	3.813283876	0.957649972	3.711867183	1.760229441	1.577617228	9.213693381	3.626000995	8.871263057	1.661377059	0.049365802	4.568963159	5.775503111	10.71532651	0.179386301	1.093929319	0	0.350242974	4.576710972	0	0	0	0	0	0	0	0	0	0.462228579	0	0	0	0	0	0	0	0	0	94.7893
R5826_012_0	2011	7	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	Coin							O	O	O	P									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0									0	YES	1250.781281	60.74033	258.02264	1058.664918	9.281921	7.92516	2.697579	282.003212	273.472394	1141.345067	974.884279	64.270112	0.162853	573.842725	3377.147928	3515.270137	83.906034	522.554952		1506.751236	21.061614	0							4.14	1.48	885.169561	0.923367									5000	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $100(Days 21-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	15% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $50 Rad therapy,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$40/Visit:7b. $15 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Proc:12.Dialysis -- Dialysis Center										161.6895	138.428775	33.0247	0	100	0.15	0.2	50	130.105795	36.394406	85.495709	100	0.2	85.749681	15	38.559164	40	56.341644		0	0.2	0							0	0	0	0									NO	144.855198	124.016263	26.660015	0	88.6523	0.132978	0.177305	44.32615	115.34178	32.264478	75.793913	88.6523	0.177305	76.019064	13.297845	34.183586	35.46092	49.948164		0	0.177305	0							0	0	0	0										15.0985	0.627732395	0.573240621	0	0.06857197	1.053871926	0.478294245	1.04167639	2.628566059	3.0687419	6.157524519	0.474807771	0.028874651	3.635248903	3.742399141	10.01371159	0.247948763	2.175055037	0	0	3.73432947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8491	0	6.898913944	15.0985	0.627732395	0.573240621	0	0.06857197	1.053871926	0.478294245	1.04167639	2.628566059	3.0687419	6.157524519	0.474807771	0.028874651	3.635248903	3.742399141	10.01371159	0.247948763	2.175055037	0	0	3.73432947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8491	YES	$240/Day(Days 1-7)	$240/Day(Days 1-7)	30% Coins(Days 1-20) 30%(Days 20-100)	20% Coins	$100/Trip	25% 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		30% Coins	20%-30% Coins	30% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	25% Coins	$0/Proc									7500	4.568	0.1899	0.6876	2.9771	1.6118	2.2286	0.9103	0.5523	6.9852	0.859	3.2551	0.8391	0.0157	1.7914	3.0623	5.0414	0.062	0.4588		0.633	1.7739	0							0	0	0.3463	0									38.8487	500	5.195943494	19.6665	0.817651058	1.260861665	2.97707224	1.680351221	3.282506107	1.388597445	1.593959032	9.613812183	3.927780507	9.412591666	1.313927438	0.044552249	5.426629498	6.804664403	15.05511157	0.309901103	2.633832555	0	0.632951191	5.50819327	0	0	0	0	0	0	0	0	0	0.346322748	0	0	0	0	0	0	0	0	0	93.6978
R5826_013_0	2011	9	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O		V					O	O	O	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	1488.449609	66.59750226	402.1157361	1179.006478	0.624867486	11.70548174	8.085668658	327.2595618	43.27155354	11.34916876	16.51000811	11.11219127	0.027265928	16.25864128	3704.869104	3354.626137	96.34465571	1.76650346		1405.505385	27.64331623	0		3.13					5.91	0.93	952.9039581	211.131045	304.6791129	163.3135948	0	278.4657661					3400	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	20% Coins:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,7h. 25% Psych -- OP,8b. 20% Rad therapy"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$35/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						161.6895	138.428775	46.371	0	0.2	0.2	0.2	50	0.241392	0.25	0.245042	0.2	0.192837	0.236843	15	33.838082	35	0.25		0	0.2	0		0					0	0	0	0	18.144679	35	0	35					NO	110.207887	94.35333	22.052888	0	0.150102	0.150102	0.150102	37.52545	0.181167	0.187627	0.183906	0.150102	0.144726	0.177753	11.257635	25.395785	26.267815	0.187627		0	0.150102	0		0					0	0	0	0	13.617745	26.267815	0	26.267815						13.6699	0.523641342	0.738984441	0	0.093793859	1.75701622	1.213675037	1.023380194	7.839377541	2.129410487	3.036289551	1.667962134	0.003946089	2.890022263	3.475672008	7.099447012	0.210896966	0.331443745	0	0	4.149317053	0	0	0	0	0	0	0	0	0	0	0	0.345753539	0.357490941	0	0.609557269	0	0	0	0	53.167	0	20.15538569	13.6699	0.523641342	0.738984441	0	0.093793859	1.75701622	1.213675037	1.023380194	7.839377541	2.129410487	3.036289551	1.667962134	0.003946089	2.890022263	3.475672008	7.099447012	0.210896966	0.331443745	0	0	4.149317053	0	0	0	0	0	0	0	0	0	0	0	0.345753539	0.357490941	0	0.609557269	0	0	0	0	53.167	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	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	30% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins					5100	7.6481	0.1196	0.3001	2.3978	1.4512	2.2013	1.5205	0.3572	3.4822	0.9133	1.3286	0.8942	0.0014	1.3084	1.6772	2.0716	0.0359	0.1422		0.2744	1.2958	0		0					0	0	0.2486	0.0461	0.5841	0.0563	0.7985	0.1212					31.2757	0	32.39585357	21.318	0.643205536	1.039051819	2.397798832	1.545021246	3.9582699	2.73421111	1.380544853	11.32155452	3.042708252	4.364893978	2.562189599	0.005356436	4.198398723	5.152893179	9.17108298	0.246836913	0.47359911	0	0.274354915	5.445134389	0	0	0	0	0	0	0	0	0	0.248607278	0.046063912	0.92988637	0.41382928	0.798454226	0.730749248	0	0	0	0	84.4427
R5826_014_0	2011	6	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery						Prosthetics/Supplies	Lab	Other	Other							D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O		V					O	O	O	V	V	V	V						0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0					0	0	0	0	0	0	0						0	YES	999.662641	20.959849	271.031971	170.77492	8.604902	7.416902	2.090421	262.928644	0	343.461277	902.667956	48.272081	0.028197	3.166358	3246.689214	3535.340401	45.579508	656.101867		1303.085573	20.507018	0		3.28					4.86	0.51	564.241058	653.759306	0	350.075935	249.975713						5000	$255/Day(Days 1-7):1a.IP Acute	$255/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	$100/Visit:8a.Lab -- OP	"$0-$100/Visit:8b, 9a. $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,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$35-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$35/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP"	"$100-$150/Visit:9b. $100 Surgery ASC -- Facility,9a. $150 Surgery OP -- Facility"							183.2481	156.885945	45.243839	0	100	0.2	0.2	50	0	100	64.494643	100	0.2	0.2	15	33.910686	35	41.238975		0	0.2	0		0					0	0	0	0	0	89.571222	126.268217						NO	168.32071	144.106016	37.596997	0	90.7394	0.181479	0.181479	45.3697	0	90.7394	58.522052	90.7394	0.181479	0.181479	13.61091	30.770353	31.75879	37.419998		0	0.181479	0		0					0	0	0	0	0	81.27639	114.575023							14.022	0.251703361	0.849165683	0	0.06506697	1.346011958	0.379367513	0.994082808	0	2.597122517	4.402165088	0.365014972	0.005117163	0.574627483	3.682532891	9.065306009	0.120629169	2.045944213	0	0	3.72159312	0	0	0	0	0	0	0	0	0	0	0	0	2.371075685	2.386747756	0	0	0	0	0	49.2453	0	4.920996242	14.022	0.251703361	0.849165683	0	0.06506697	1.346011958	0.379367513	0.994082808	0	2.597122517	4.402165088	0.365014972	0.005117163	0.574627483	3.682532891	9.065306009	0.120629169	2.045944213	0	0	3.72159312	0	0	0	0	0	0	0	0	0	0	0	0	2.371075685	2.386747756	0	0	0	0	0	49.2453	YES	$255/Day(Days 1-7)	$255/Day(Days 1-7)	30% Coins(Days 1-20) 30%(Days 21-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	$0/Visit	$100/Visit	$0-$100/Visit	$100/Visit	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	$40-$100/Visit		$0/Visit	20%-30% Coins	$0/Service		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	25% Coins	30% Coins	30% Coins	$40-$100/Visit	30% Coins						7500	3.5055	0.0629	0.8251	1.2186	1.2404	1.7314	0.488	0.4274	0	1.1167	1.8477	0.157	0.0023	0.253	2.619	2.8519	0.0368	0.6832		0	1.1874	0		0					0	0	0.1863	0.2475	0	0.9866	4.1821						25.8566	0	2.744384971	17.5275	0.314629267	1.674261872	1.218609956	1.305428098	3.077373402	0.867344695	1.421527315	0	3.713856191	6.249842877	0.521967336	0.007370573	0.827663762	6.301569268	11.91719128	0.157397206	2.729165908	0	0	4.908984629	0	0	0	0	0	0	0	0	0	0.186261582	0.247463933	0	3.357638243	6.5688584	0	0	0	0	0	75.1019
R5826_018_0	2011	9	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							Prosthetics/Supplies	Radiology	Other	Therapy (PT/OT/ST)							D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							O	O	O	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	864.03962	24.262507	388.296549	423.004504	7.378616	3.916209	1.146108	179.949927	223.23904	277.846569	152.173051	52.906867	0.005664	5.202836	2506.267165	3308.602073	19.078062	71.524598		966.41052	12.307452	0							1.42	1.09	242.806746	571.084139	236.168663	415.847977							4000	$150/Day(Days 1-10):1a.IP Acute	$150/Day(Days 1-10):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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/Visit:8b.Advanced Imaging -- Office	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$30/Visit:7b. $25 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$100/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$125/Visit:8b, 9a. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b, 9a. $125 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	"$30-$125/Visit:9d. $100 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $100 OP Other,5. $30 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								121.20465	109.29915	34.44565	0	150	0.2	0.2	50	85.53462	65.633242	50	100	0.2	0.2	10	29.773934	30	100		0	0.2	0							0	0	0	70.659747	92.376097	30							NO	114.265441	103.041555	29.884185	0	139.7016	0.186269	0.186269	46.5672	79.662155	61.127126	46.5672	93.1344	0.186269	0.186269	9.31344	27.729775	27.94032	93.1344		0	0.186269	0							0	0	0	65.808532	86.033924	27.94032								8.2275	0.208337204	0.966993825	0	0.085900372	0.729468334	0.213484391	0.698313687	1.481975251	1.415330186	0.590522742	0.410620776	0.001055028	0.969127059	1.945164072	7.645565921	0.044420596	0.55511671	0	0	2.292496777	0	0	0	0	0	0	0	0	0	0	3.131850736	1.693209734	0.968243796	0	0	0	0	0	0	34.2747	0	2.493380183	8.2275	0.208337204	0.966993825	0	0.085900372	0.729468334	0.213484391	0.698313687	1.481975251	1.415330186	0.590522742	0.410620776	0.001055028	0.969127059	1.945164072	7.645565921	0.044420596	0.55511671	0	0	2.292496777	0	0	0	0	0	0	0	0	0	0	3.131850736	1.693209734	0.968243796	0	0	0	0	0	0	34.2747	YES	$150/Day(Days 1-10)	$150/Day(Days 1-10)	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$75/Visit	30% Coins	0%-20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins		$35/Visit	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins	30% Coins	30% Coins	$35/Visit							6000	1.941	0.0491	0.8841	2.2895	1.5461	1.0631	0.3111	0.2835	4.2538	0.306	0.2231	0.4976	0.0004	0.6044	1.7144	2.2632	0.013	0.1059		0.6611	0.8963	0							0	0	0.0969	1.5261	0.4931	0.2845							22.3071	0	3.494002469	10.1684	0.257486209	1.85110288	2.289456121	1.631986386	1.792576991	0.524610999	0.981817405	5.735819813	1.72135329	0.813574207	0.908231193	0.001493686	1.573520128	3.659521916	9.908743605	0.057470533	0.660979874	0	0.661052214	3.18874849	0	0	0	0	0	0	0	0	0	0.096926342	4.657940781	2.186260293	1.252695612	0	0	0	0	0	0	56.5818
R5826_021_0	2011	8	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Radiology	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V					O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0					0	0	0	0	0								0	YES	1050.55807	23.451949	619.188201	366.115277	9.897549	3.738497	1.475675	250.978501	207.998854	1053.877472	51.564199	67.550113	0	3.795478	2049.736054	2028.704606	20.851422	322.119464		646.191318	3.852097	0		3.22					4.53	0.56	415.908275	449.581783	393.881506								5000	$220/Day(Days 1-8):1a.IP Acute	$220/Day(Days 1-8):1b.IP Psych	"$0/Day(Days 1-8) $50(Days 9-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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"	$75/Visit:8b.Advanced Imaging -- Office	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$40/Visit:7b. $10 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$100/Visit:7c, 7d, 7i. $100 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$150/Visit:8b, 9a. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	"$40-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"									165.92202	145.11002	32.5726	0	150	0.2	0.2	50	135.107041	37.192713	75	150	0	0.2	10	37.113586	40	65.153139		0	0.2	0		0					0	0	0	123.389956	96.387971								NO	155.886227	136.33304	27.221248	0	140.08395	0.186779	0.186779	46.69465	126.17552	34.734015	70.041975	140.08395	0	0.186779	9.33893	34.660118	37.35572	60.846061		0	0.186779	0		0					0	0	0	115.233016	90.016052									13.6473	0.266439625	1.404589632	0	0.115540647	0.698272731	0.275625101	0.976612772	2.187030297	3.05044966	0.300971528	0.788557221	0	0.708915585	1.595195127	5.859595086	0.06490999	1.63330838	0	0	0.719490826	0	0	0	0	0	0	0	0	0	0	4.317222066	2.954638177	0	0	0	0	0	0	0	41.5647	0	3.029761638	13.6473	0.266439625	1.404589632	0	0.115540647	0.698272731	0.275625101	0.976612772	2.187030297	3.05044966	0.300971528	0.788557221	0	0.708915585	1.595195127	5.859595086	0.06490999	1.63330838	0	0	0.719490826	0	0	0	0	0	0	0	0	0	0	4.317222066	2.954638177	0	0	0	0	0	0	0	41.5647	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	20% Coins	$150/Trip	20% Coins	20% Coins	$50/Visit	30% Coins	30% Coins	$75/Visit	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	30% Coins	30% Coins								7500	12.1787	0.0926	0.8769	2.381	2.7705	0.9038	0.3568	0.5282	5.3994	1.0412	0.101	0.3931	0	0.589	1.7639	2.1178	0.0182	0.2911		0.2244	0.3747	0		0					0	0	0.142	1.8265	0.9243								35.2951	500	11.17261343	25.826	0.359049597	2.281513132	2.381013779	2.88606109	1.602115032	0.632393648	1.50483736	7.586388383	4.09164552	0.401941124	1.181663375	0	1.297923693	3.359050994	7.977393193	0.083070367	1.924442965	0	0.224421605	1.094234	0	0	0	0	0	0	0	0	0	0.142002704	6.143737791	3.878904846	0	0	0	0	0	0	0	76.8598
R5826_023_0	2011	8	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Radiology	Renal Dialysis	Other	Therapy (PT/OT/ST)						A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V					O	O	O	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	YES	172.122641	4.132861	455.100544	240.042527	7.509457	3.26625	0.730209	196.648229	212.093723	800.07281	75.976858	46.508914	0.040219	3.794003	1978.203296	1988.509084	34.708773	199.744602		860.081782	7.541657	0		3.74					4.51	0.6	237.479202	471.593164	0	549.36397	351.814634						3400	$550/Admit:1a.IP Acute	$550/Admit:1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							550	550	46.371	0	100	0.2	0.2	50	91.26706	38.32423	30	50	0.2	0.2	10	27.636034	30	50		0	0.2	0		0					0	0	0	41.308108	0	47.450437	30						NO	515.6899	515.6899	36.391543	0	93.3163	0.186633	0.186633	46.65815	85.167044	35.762754	27.99489	46.65815	0.186633	0.186633	9.33163	25.788925	27.99489	46.65815		0	0.186633	0		0					0	0	0	38.547198	0	44.278993	27.99489							7.3968	0.177606223	1.380150918	0	0.058396229	0.609590036	0.136281096	0.764603547	1.505282953	2.384400591	0.177246982	0.18083499	0.007506193	0.708086162	1.538321769	4.273459302	0.080972357	0.7766428	0	0	1.407522071	0	0	0	0	0	0	0	0	0	0	1.514882922	0	2.027106949	0.820750998	0	0	0	0	0	27.9265	0	2.241261431	7.3968	0.177606223	1.380150918	0	0.058396229	0.609590036	0.136281096	0.764603547	1.505282953	2.384400591	0.177246982	0.18083499	0.007506193	0.708086162	1.538321769	4.273459302	0.080972357	0.7766428	0	0	1.407522071	0	0	0	0	0	0	0	0	0	0	1.514882922	0	2.027106949	0.820750998	0	0	0	0	0	27.9265	YES	$800/Admit	$800/Admit	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	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins		$35/Visit	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	30% Coins	$0/Proc	30% Coins	$35/Visit						5100	2.5089	0.0602	0.8486	0.828	1.0458	0.884	0.1976	0.3089	4.0967	0.7985	0.0518	0.4558	0.0031	0.2929	1.349	1.356	0.0237	0.1857		0.5865	0.4113	0		0					0	0	0.0598	1.5825	0	1.0789	0.2399						19.2541	0	3.4491273	9.9057	0.237846584	2.22878184	0.827958492	1.104187053	1.493545085	0.333899611	1.073466628	5.601990667	3.182885392	0.229058262	0.636603925	0.010611205	1.001010131	2.887327864	5.62949328	0.104641483	0.962390726	0	0.586519882	1.818861327	0	0	0	0	0	0	0	0	0	0.0598338	3.097335876	0	3.105972708	1.060665717	0	0	0	0	0	47.1806
R5826_026_0	2011	6	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							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		V	Coin	Coin							O	O	O	V	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	YES	1122.037971	31.655587	190.949534	815.179143	8.64848	4.517597	1.791663	203.906791	196.531861	628.683027	138.733714	38.917388	0.061635	326.489523	2003.311777	2274.687339	26.629184	132.055812		801.731712	12.752883	0							4.14	3.18	481.326913	441.51032	0.490619	223.136658							3400	$200/Day(Days 1-5):1a.IP Acute	$200/Day(Days 1-5):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	15% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								123.8224	99.6822	46.371	0	100	0.15	0.2	50	87.332753	18.884382	30	50	0.2	48.08049	10	28.624487	30	50		0	0.2	0							0	0	0	43.852068	0	30							NO	116.340555	93.659003	40.050169	0	93.4395	0.140159	0.186879	46.71975	81.603288	17.645472	28.03185	46.71975	0.186879	44.926169	9.34395	26.746578	28.03185	46.71975		0	0.186879	0							0	0	0	40.975153	0	28.03185								10.8782	0.247069226	0.637296759	0	0.067342471	0.633181878	0.33482419	0.793872858	1.336470505	0.924450729	0.324080222	0.151517553	0.011518287	1.222326957	1.559903757	5.070008528	0.062205441	0.514134544	0	0	2.383246022	0	0	0	0	0	0	0	0	0	0	1.507579409	0	0.521244444	0	0	0	0	0	0	29.1805	0	2.038977511	10.8782	0.247069226	0.637296759	0	0.067342471	0.633181878	0.33482419	0.793872858	1.336470505	0.924450729	0.324080222	0.151517553	0.011518287	1.222326957	1.559903757	5.070008528	0.062205441	0.514134544	0	0	2.383246022	0	0	0	0	0	0	0	0	0	0	1.507579409	0	0.521244444	0	0	0	0	0	0	29.1805	YES	$250/Day(Days 1-5)	$250/Day(Days 1-5)	30% Coins(Days 1-14) 30%(Days 15-100)	20% Coins	$100/Trip	20% 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		$35/Visit	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: Nutritional benefit 13d$0: OTC items 13c	20% Coins	30% Coins	$0/Proc	$35/Visit							5000	3.8617	0.0877	0.4591	2.089	1.7038	1.1531	0.6859	0.4531	5.7373	0.7092	0.1338	0.6432	0.0067	1.1826	1.9326	2.1944	0.0257	0.2379		0.7734	1.3098	0							0	0	0.1668	2.0324	0	0.2153							27.7947	500	3.316954448	14.7399	0.334777133	1.096392	2.089023809	1.771185498	1.786237627	1.020770885	1.246938456	7.073771785	1.633667912	0.457917912	0.79467216	0.01825008	2.40497649	3.492517075	7.264420351	0.087894861	0.752079194	0	0.773437964	3.693008631	0	0	0	0	0	0	0	0	0	0.166824831	3.539976873	0	0.736506433	0	0	0	0	0	0	56.9751
R5826_053_0	2011	11	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Prosthetics/Supplies	Radiology	Renal Dialysis	Other	Therapy (PT/OT/ST)						A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V					O	O	O	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	YES	180.1856115	6.213774611	237.6852333	355.99015	7.303249197	4.083970915	1.082680718	238.9698309	212.1067023	940.4263156	77.63884776	40.70421109	0.066771417	3.081053294	2004.663881	1839.346863	27.99594516	146.9653958		825.498255	13.90619119	0		3.93					3.7	0.6	565.4368724	413.3715143	0.350582979	521.841081	276.3758025						3400	$550/Admit:1a.IP Acute	$550/Admit:1b.IP Psych	"$0/Day(Days 1-15) $100(Days 16-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:9a, 12.Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$0/Proc:12.Dialysis -- Dialysis Center	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"							550	550	43.8157	0	100	0.2	0.2	50	89.580693	44.514481	30	50	0.2	0.2	10	28.30506	30	50		0	0.2	0		0					0	0	0	41.075255	0	46.361472	30						NO	517.8646	517.8646	38.028654	0	93.0985	0.186197	0.186197	46.54925	83.398281	41.442314	27.92955	46.54925	0.186197	0.186197	9.30985	26.351586	27.92955	46.54925		0	0.186197	0		0					0	0	0	38.240446	0	43.161835	27.92955							7.776	0.268157825	0.753237458	0	0.056660129	0.760423132	0.201591902	0.926988867	1.474111197	3.247786889	0.180701507	0.157895875	0.012432638	0.57368288	1.555260003	4.039142253	0.065159513	0.570094079	0	0	2.589291081	0	0	0	0	0	0	0	0	0	0	1.317292589	0	1.87696822	0.643254316	0	0	0	0	0	29.0461	0	2.114855276	7.776	0.268157825	0.753237458	0	0.056660129	0.760423132	0.201591902	0.926988867	1.474111197	3.247786889	0.180701507	0.157895875	0.012432638	0.57368288	1.555260003	4.039142253	0.065159513	0.570094079	0	0	2.589291081	0	0	0	0	0	0	0	0	0	0	1.317292589	0	1.87696822	0.643254316	0	0	0	0	0	29.0461	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	20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins		$35/Visit	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$0/Proc	30% Coins	$35/Visit						5100	2.651	0.0914	0.5786	2.0045	1.0124	1.1001	0.2917	0.3736	4.5567	0.8223	0.0527	0.2456	0.0051	0.2368	1.3607	1.2485	0.019	0.1316		0.5603	0.9843	0		0					0	0	0.2368	1.3048	0	0.8223	0.1876						20.8785	0	3.210344064	10.4269	0.359577582	1.331884386	2.004498801	1.069019487	1.860557092	0.493242919	1.300584059	6.030842956	4.070071268	0.233400742	0.403511273	0.017563906	0.810459329	2.915973825	5.287643172	0.084162433	0.701685606	0	0.560326794	3.573636167	0	0	0	0	0	0	0	0	0	0.236788936	2.622114143	0	2.699238382	0.830851039	0	0	0	0	0	49.9246
R5826_062_0	2011	7	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							Prosthetics/Supplies	Radiology	Other	Therapy (PT/OT/ST)							D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V					O	O	O	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	1056.744624	40.93300183	245.9415171	384.045567	9.64738903	4.847481101	2.069995522	232.5471804	199.6246997	784.4333937	78.73853502	56.53096095	0.020785734	7.251556121	2142.528644	2035.607321	50.82737134	100.1153028		736.5450603	15.13602397	0		3.39					4	0.82	607.9316877	451.5185662	430.9707104	349.5089934							3400	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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"	$75/Visit:8b.Advanced Imaging -- Office	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$150/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$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$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$150/Visit:8b, 9a. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	"$30-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								161.6895	138.428775	46.371	0	150	0.2	0.2	50	135.175755	42.259886	75	150	0.088794	0.2	10	28.707069	30	150		0	0.2	0		0					0	0	0	119.265122	136.145429	30							NO	138.14088	118.26787	32.696795	0	129.01965	0.172026	0.172026	43.00655	116.268857	36.349038	64.509825	129.01965	0.076375	0.172026	8.60131	24.69184	25.80393	129.01965		0	0.172026	0		0					0	0	0	102.583628	117.102904	25.80393								12.165	0.403421578	0.670124947	0	0.10372523	0.833892784	0.35609305	0.833420995	1.934177971	2.376116603	0.423284093	0.6078004	0.00158751	1.247456193	1.535712754	4.18857419	0.109295494	1.076403443	0	0	2.603789659	0	0	0	0	0	0	0	0	0	0	3.859867719	4.205660143	0.7515588	0	0	0	0	0	0	40.2869	0	6.821206405	12.165	0.403421578	0.670124947	0	0.10372523	0.833892784	0.35609305	0.833420995	1.934177971	2.376116603	0.423284093	0.6078004	0.00158751	1.247456193	1.535712754	4.18857419	0.109295494	1.076403443	0	0	2.603789659	0	0	0	0	0	0	0	0	0	0	3.859867719	4.205660143	0.7515588	0	0	0	0	0	0	40.2869	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 14-100)	20% Coins	$150/Trip	20% Coins	20% Coins	$50/Visit	30% Coins	30% Coins	$75/Visit	30% Coins	0%-20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5					$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$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	30% Coins	30% Coins	$35/Visit							5100	8.4934	0.1088	0.327	1.6215	2.4437	1.0605	0.4529	0.4429	4.6554	0.7634	0.1395	0.313	0.0009	1.0183	1.7716	1.6832	0.042	0.1808		0.2346	1.3324	0		0					0	0	0.1897	1.6474	1.0389	0.289							30.2508	500	14.11624498	20.6584	0.512216812	0.997133762	1.621523655	2.547410411	1.894399635	0.808955781	1.276310008	6.589556339	3.139480758	0.562802466	0.920755469	0.002451419	2.265783446	3.307360979	5.871809605	0.15132444	1.257174067	0	0.234602704	3.936237668	0	0	0	0	0	0	0	0	0	0.189655443	5.507314078	5.24454898	1.040566365	0	0	0	0	0	0	70.5377
R5826_063_0	2011	6	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	Professional								Prosthetics/Supplies	Radiology	Therapy (PT/OT/ST)								A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O		V	V				O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0				0	0	0	0	0								0	YES	171.3072285	3.771928527	315.5343643	353.3691869	7.980060065	3.785515524	2.861606206	236.1171116	163.7272896	526.0633106	84.52590189	52.77623494	0.014684866	377.3460157	1987.50245	1863.09534	36.29822829	119.0747942		841.5185188	8.770140523	0		5.13	2.01				4.38	0.41	553.332814	378.5953293	165.0402535								3400	$550/Admit:1a.IP Acute	$550/Admit:1b.IP Psych	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$30/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN750: Dental 16a, 16b"	"VIS751: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"									550	550	68.8913	0	100	0.2	0.2	50	88.379215	36.804571	30	50	0.2	47.603836	10	30	30	50		0	0.2	0		0	0				0	0	0	41.956143	30								NO	520.02225	520.02225	55.00991	0	94.3753	0.188751	0.188751	47.18765	83.40815	34.734424	28.31259	47.18765	0.188751	44.926263	9.43753	28.31259	28.31259	47.18765		0	0.188751	0		0	0				0	0	0	39.596236	28.31259									7.4236	0.16345723	1.446459748	0	0.062760047	0.714519841	0.540131033	0.928484302	1.138015861	1.52270884	0.199428934	0.207532209	0.002771783	1.412728862	1.563092833	4.395754541	0.085641405	0.468238309	0	0	1.655372794	0	0	0	0	0	0	0	0	0	0	1.249245834	0.389393086	0	0	0	0	0	0	0	25.5694	0	1.787900545	7.4236	0.16345723	1.446459748	0	0.062760047	0.714519841	0.540131033	0.928484302	1.138015861	1.52270884	0.199428934	0.207532209	0.002771783	1.412728862	1.563092833	4.395754541	0.085641405	0.468238309	0	0	1.655372794	0	0	0	0	0	0	0	0	0	0	1.249245834	0.389393086	0	0	0	0	0	0	0	25.5694	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		$35/Visit	20%-30% Coins	$0/Service		50%-55%	"VIS751: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$35/Visit								5100	2.5509	0.0562	0.7267	1.994	1.1272	1.0391	0.7855	0.3761	3.4	0.485	0.0585	0.2606	0.0011	0.8201	1.3747	1.2886	0.0251	0.1025		0.582	0.6458	0		0	0				0	0	0.2144	1.1718	0.1142								19.2001	0	2.746017349	9.9745	0.219624695	2.173123816	1.9939672	1.189943237	1.75362038	1.325624222	1.304629402	4.538025831	2.007724748	0.25789243	0.468168586	0.00392174	2.232850354	2.937776106	5.684389933	0.110747571	0.570709687	0	0.582047801	2.301159731	0	0	0	0	0	0	0	0	0	0.214410544	2.421058611	0.503545436	0	0	0	0	0	0	0	44.7695
R5826_064_0	2011	5	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	Professional								Prosthetics/Supplies	Radiology	Therapy (PT/OT/ST)								A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O		V	V				O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0				0	0	0	0	0								0	YES	155.8273964	6.178529328	215.1904845	344.6724948	8.663879245	3.800784847	0.783223556	223.5385498	189.092021	435.7231063	135.1194307	19.49049352	0.013265889	447.2469297	1916.127027	2349.460373	20.50532548	114.8758842		990.56087	10.99465515	0		3.1	2.01				3.14	0.41	498.2808388	361.9249695	268.3541116								3400	$550/Admit:1a.IP Acute	$550/Admit:1b.IP Psych	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$30/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS751: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"									550	550	68.8913	0	100	0.2	0.2	50	86.21508	39.422637	30	50	0.2	47.55447	10	30	30	50		0	0.2	0		0	0				0	0	0	40.755543	30								NO	522.81185	522.81185	59.464215	0	94.3816	0.188763	0.188763	47.1908	81.371172	37.207716	28.31448	47.1908	0.188763	44.88267	9.43816	28.31448	28.31448	47.1908		0	0.188763	0		0	0				0	0	0	38.465734	28.31448									6.789	0.269184029	1.066344436	0	0.068142565	0.71744755	0.147843628	0.87908025	1.282219947	1.351021799	0.318819702	0.076647665	0.002504109	1.672803029	1.507059455	5.543645728	0.048383136	0.451757073	0	0	2.07538409	0	0	0	0	0	0	0	0	0	0	1.160142467	0.633192261	0	0	0	0	0	0	0	26.0607	0	1.60381496	6.789	0.269184029	1.066344436	0	0.068142565	0.71744755	0.147843628	0.87908025	1.282219947	1.351021799	0.318819702	0.076647665	0.002504109	1.672803029	1.507059455	5.543645728	0.048383136	0.451757073	0	0	2.07538409	0	0	0	0	0	0	0	0	0	0	1.160142467	0.633192261	0	0	0	0	0	0	0	26.0607	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		$35/Visit	20%-30% Coins	$0/Service		0.5	"VIS751: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$35/Visit								5100	2.3326	0.0925	0.5965	2.1637	1.2207	1.0406	0.2144	0.3552	3.8498	0.3987	0.0932	0.2126	0.001	0.9631	1.3219	1.6209	0.0141	0.1635		0.6834	0.8075	0		0	0				0	0	0.2118	0.9913	0.1851								19.5343	0	2.631851968	9.1216	0.361671466	1.662893566	2.163737275	1.288798426	1.7580826	0.362285856	1.234280211	5.131999531	1.74973387	0.412038891	0.289209037	0.003540353	2.635861857	2.828999644	7.164543531	0.062529806	0.615219859	0	0.683390092	2.882910295	0	0	0	0	0	0	0	0	0	0.211812792	2.151441703	0.818330344	0	0	0	0	0	0	0	45.595
R5826_065_0	2011	5	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	Professional								Prosthetics/Supplies	Radiology	Therapy (PT/OT/ST)								A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O		V	V				O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0				0	0	0	0	0								0	YES	170.1898657	4.244589493	221.6245412	413.1598118	7.100737422	5.515009432	1.376194366	253.1734551	200.0956993	532.5935587	109.9636465	29.96012245	0.018538796	370.0835079	2108.026582	2128.844182	19.45978134	117.7014923		928.685186	14.53063644	0		4.54	2.01				2.79	0.36	561.9838488	376.2991117	213.1089108								3400	$550/Admit:1a.IP Acute	$550/Admit:1b.IP Psych	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$30/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN750: Dental 16a, 16b"	"VIS751: Vision 17a, 17b"				$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"									550	550	68.8913	0	100	0.2	0.2	50	87.25008	40.465228	30	50	0.2	46.933642	10	30	30	50		0	0.2	0		0	0				0	0	0	42.0256	30								NO	519.9249	519.9249	58.205433	0	93.8216	0.187643	0.187643	46.9108	81.859421	37.965124	28.14648	46.9108	0.187643	44.033894	9.38216	28.14648	28.14648	46.9108		0	0.187643	0		0	0				0	0	0	39.42909	28.14648									7.3738	0.183905647	1.074979365	0	0.055516879	1.034852915	0.258233239	0.98971411	1.364976507	1.684998375	0.257924131	0.117121109	0.003478675	1.358018163	1.648153556	4.993289183	0.045643696	0.460122597	0	0	2.726572214	0	0	0	0	0	0	0	0	0	0	1.236427629	0.499855475	0	0	0	0	0	0	0	27.3676	0	1.868274808	7.3738	0.183905647	1.074979365	0	0.055516879	1.034852915	0.258233239	0.98971411	1.364976507	1.684998375	0.257924131	0.117121109	0.003478675	1.358018163	1.648153556	4.993289183	0.045643696	0.460122597	0	0	2.726572214	0	0	0	0	0	0	0	0	0	0	1.236427629	0.499855475	0	0	0	0	0	0	0	27.3676	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		$35/Visit	20%-30% Coins	$0/Service		50%-55%	"VIS751: Vision 17a, 17b"				$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	30% Coins	$35/Visit								5100	2.5326	0.0632	0.5584	2.0893	0.994	1.5002	0.3744	0.3997	3.7467	0.4152	0.0754	0.1892	0.0014	0.9308	1.4449	1.4592	0.0133	0.1779		0.6366	1.0603	0		0	0				0	0	0.2252	1.0809	0.1461								20.1148	0	2.824588049	9.9065	0.247070099	1.633330854	2.089334356	1.049469951	2.535066094	0.632590685	1.389401304	5.11172225	2.100206591	0.333297551	0.306333709	0.004917383	2.288854485	3.09307813	6.452482963	0.058982197	0.637996827	0	0.63655746	3.78690323	0	0	0	0	0	0	0	0	0	0.225193035	2.317278344	0.645928729	0	0	0	0	0	0	0	47.4824
R5826_066_0	2011	6	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							Prosthetics/Supplies	Radiology	Other	Therapy (PT/OT/ST)							D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin		V					O	O	O	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	960.692747	8.133504	383.494995	186.75513	7.645764	3.917699	0.959833	229.32708	232.751483	727.73716	116.531568	35.270181	0.02284	2.988183	2036.756104	2020.142641	29.787666	135.320125		867.050581	6.358084	0		3.22					4.9	0.56	474.117021	412.851973	334.004242	199.171598							3400	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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"	$75/Visit:8b.Advanced Imaging -- Office	$150/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$100/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$150/Visit:8b, 9a. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $150 Radiology OP -- Facility"	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $150 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								161.6895	138.428775	46.371	0	150	0.2	0.2	50	137.050397	35.395569	75	150	0.2	0.2	10	28.246716	30	100		0	0.2	0		0					0	0	0	120.34002	130.380617	30							NO	143.944077	123.236217	32.86795	0	133.57035	0.178094	0.178094	44.52345	122.03913	31.518657	66.785175	133.57035	0.178094	0.178094	8.90469	25.152825	26.71407	89.0469		0	0.178094	0		0					0	0	0	107.159057	116.099897	26.71407								11.5238	0.083528522	1.050391193	0	0.085103948	0.697718686	0.170940498	0.850869398	2.367065708	1.911441494	0.64854843	0.392587535	0.004067667	0.532177463	1.511390143	4.23435786	0.066312483	1.004153137	0	0	1.132336612	0	0	0	0	0	0	0	0	0	0	3.686735676	3.231488174	0.443390334	0	0	0	0	0	0	35.6284	0	4.687964364	11.5238	0.083528522	1.050391193	0	0.085103948	0.697718686	0.170940498	0.850869398	2.367065708	1.911441494	0.64854843	0.392587535	0.004067667	0.532177463	1.511390143	4.23435786	0.066312483	1.004153137	0	0	1.132336612	0	0	0	0	0	0	0	0	0	0	3.686735676	3.231488174	0.443390334	0	0	0	0	0	0	35.6284	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 14-100)	20% Coins	$150/Trip	20% Coins	20% Coins	$50/Visit	30% Coins	30% Coins	$75/Visit	30% Coins	0%-20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins		30% Coins	20%-30% Coins	0% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	30% Coins	30% Coins	$35/Visit							5100	8.7521	0.0269	0.452	0.8479	2.0319	0.8992	0.2203	0.4582	5.7742	0.6402	0.2166	0.54	0.0022	0.4403	1.767	1.7526	0.0258	0.1599		0.2953	0.5872	0		0					0	0	0.1702	1.5604	0.8879	0.1728							28.6812	500	13.81848626	20.276	0.110382776	1.502356224	0.847914378	2.117032011	1.596968469	0.391255915	1.309107492	8.14125847	2.551597806	0.86518895	0.93257072	0.00631123	0.972443732	3.278411931	5.986966364	0.092155272	1.16402529	0	0.295277498	1.719578296	0	0	0	0	0	0	0	0	0	0.170175534	5.247112426	4.119398957	0.616184983	0	0	0	0	0	0	64.3096
R5826_067_0	2011	7	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O		V	V				O	O	O	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	YES	856.8959415	22.84334919	158.7376395	386.8269379	0.527405675	3.474798077	1.919810998	192.7339499	23.48061968	2.94140539	6.405232839	2.185358944	0.005106063	6.355678038	1645.877405	1742.503236	19.33275787	0.87473904		807.2965409	8.300657492	0		3.1	3.1				4.56	0.93	418.866282	351.3435074	119.9992674	43.36790952	0	203.7745321					3400	$225/Day(Days 1-9):1a.IP Acute	$225/Day(Days 1-9):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	20% Coins:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,7h. 25% Psych -- OP,8b. 20% Rad therapy"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$35/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						176.2695	156.803175	46.371	0	0.2	0.2	0.2	50	0.240517	0.25	0.2442	0.2	0.088794	0.243893	15	32.141724	35	0.25		0	0.2	0		0	0				0	0	0	0	22.709345	35	0	35					NO	162.431815	144.493655	38.797456	0	0.183136	0.183136	0.183136	45.7839	0.220236	0.22892	0.223609	0.183136	0.081306	0.223328	13.73517	29.43147	32.04873	0.22892		0	0.183136	0		0	0				0	0	0	0	20.794447	32.04873	0	32.04873						11.5989	0.275059918	0.513218049	0	0.096586966	0.636360621	0.351586507	0.735342658	5.171277756	0.673346522	1.43226771	0.400217895	0.000415154	1.419400865	1.883867163	4.273702644	0.051632528	0.200245261	0	0	1.52014921	0	0	0	0	0	0	0	0	0	0	0	0.2079432	0.115823869	0	0.544226247	0	0	0	0	32.1016	0	2.927175907	11.5989	0.275059918	0.513218049	0	0.096586966	0.636360621	0.351586507	0.735342658	5.171277756	0.673346522	1.43226771	0.400217895	0.000415154	1.419400865	1.883867163	4.273702644	0.051632528	0.200245261	0	0	1.52014921	0	0	0	0	0	0	0	0	0	0	0	0.2079432	0.115823869	0	0.544226247	0	0	0	0	32.1016	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	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	30% Coins		0.5	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins					5100	8.739	0.065	0.2615	1.3749	1.5366	0.8198	0.4529	0.2639	2.3705	0.2969	0.6466	0.2206	0.0002	0.6416	0.941	1.4469	0.0101	0.0883		0.2001	0.5253	0		0	0				0	0	0.147	0.0316	0.2898	0.0158	0.6251	0.1052					22.1163	0	10.23778471	20.338	0.340010355	0.774669935	1.374927097	1.633222243	1.456124092	0.804502589	0.999226409	7.541757291	0.970295295	2.078906263	0.620840234	0.000567724	2.061036366	2.824905441	5.720577203	0.061771522	0.288554276	0	0.200146064	2.045466639	0	0	0	0	0	0	0	0	0	0.146965355	0.031586079	0.497754341	0.131574729	0.625145099	0.649445569	0	0	0	0	54.2179
R5826_068_0	2011	5	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	Professional								Prosthetics/Supplies	Radiology	Therapy (PT/OT/ST)								A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	Coin	O		V	V				O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0		0	0				0	0	0	0	0								0	YES	185.3403402	5.231463079	238.9538902	855.2506381	7.108817604	4.1944035	1.241368326	232.5899029	235.0650248	669.3798055	116.7298706	44.78503662	0.015248525	441.3234393	2191.191361	2492.021014	18.39947492	143.277415		916.9448178	5.049243973	0		4.47	3.1				3.45	0.73	494.525364	431.2464259	382.5094274								3400	$550/Admit:1a.IP Acute	$550/Admit:1b.IP Psych	"$0/Day(Days 1-7) $50/Day(Days 8-20)$100(Days 21-100):2. $0 SNF 12. $50 SNF 2,2. $100 SNF 3"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.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, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$30/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN750: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"									550	550	66.51235	0	100	0.2	0.2	50	86.604198	39.683578	30	50	0.2	47.597585	10	30	30	50		0	0.2	0		0	0				0	0	0	42.18771	30								NO	516.59575	516.59575	54.854398	0	93.2584	0.186517	0.186517	46.6292	80.765689	37.00827	27.97752	46.6292	0.186517	44.388747	9.32584	27.97752	27.97752	46.6292		0	0.186517	0		0	0				0	0	0	39.343583	27.97752									7.9788	0.225212633	1.092305983	0	0.055246413	0.782327558	0.231536296	0.903790092	1.582099057	2.064382381	0.272151024	0.174024202	0.002844109	1.632482874	1.70289167	5.810047314	0.04289764	0.556742603	0	0	0.941769838	0	0	0	0	0	0	0	0	0	0	1.413898296	0.89180543	0	0	0	0	0	0	0	28.3573	0	2.1405399	7.9788	0.225212633	1.092305983	0	0.055246413	0.782327558	0.231536296	0.903790092	1.582099057	2.064382381	0.272151024	0.174024202	0.002844109	1.632482874	1.70289167	5.810047314	0.04289764	0.556742603	0	0	0.941769838	0	0	0	0	0	0	0	0	0	0	1.413898296	0.89180543	0	0	0	0	0	0	0	28.3573	YES	$800/Admit	$800/Admit	30% Coins(Days 1-7) 30%(Days 7-100)	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		$35/Visit	20%-30% Coins	$0/Service		50%-55%	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	$35/Visit								5100	2.7114	0.0765	0.5315	2.65	0.9785	1.1219	0.332	0.3611	4.7099	0.5423	0.0787	0.3442	0.0012	1.3624	1.4768	1.6796	0.0124	0.2324		0.618	0.3623	0		0	0				0	0	0.2203	1.2967	0.2578								21.9579	0	3.496817164	10.6902	0.30174508	1.623820878	2.649994068	1.033697089	1.904232073	0.563573448	1.264843965	6.292046996	2.606715648	0.350824835	0.518225435	0.004007759	2.994904867	3.17971481	7.48962417	0.055298551	0.789148246	0	0.618004136	1.30406438	0	0	0	0	0	0	0	0	0	0.220256225	2.710637116	1.14960983	0	0	0	0	0	0	0	50.3152
R5826_069_0	2011	6	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O		V	V				O	O	O	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	YES	1070.592044	27.97643283	175.0289703	580.0608908	0.52999105	5.642551861	1.451282673	244.4704549	30.87606225	4.423899101	8.299176365	2.870620994	0.019322129	7.995502916	1931.63565	1966.043981	34.91045582	1.002860933		795.758337	6.635959898	0		3.11	3.1				5.91	0.93	391.089061	154.5580527	161.0901405	64.50875735	0	187.0597088					3400	$225/Day(Days 1-9):1a.IP Acute	$225/Day(Days 1-9):1b.IP Psych	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	20% Coins:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,7h. 25% Psych -- OP,8b. 20% Rad therapy"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN767: Dental 16a, 16b"	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$35/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF, 5.Partial Hospitalization"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						176.2695	156.803175	46.371	0	0.2	0.2	0.2	50	0.242676	0.25	0.241907	0.2	0.088796	0.241138	15	32.49592	35	0.25		0	0.2	0		0	0				0	0	0	0	25.064003	35	0	35					NO	153.791085	136.807164	34.864871	0	0.175792	0.175792	0.175792	43.948	0.213302	0.21974	0.212627	0.175792	0.078048	0.21195	13.1844	28.562614	30.7636	0.21974		0	0.175792	0		0	0				0	0	0	0	22.030256	30.7636	0	30.7636						13.7206	0.318948036	0.508530206	0	0.093168187	0.991915477	0.255123884	0.895332296	6.585925831	0.972107588	1.764628973	0.504632206	0.001508054	1.694646843	2.122288089	4.679612944	0.089497608	0.220368661	0	0	1.166548662	0	0	0	0	0	0	0	0	0	0	0	0.295738086	0.165376801	0	0.479552505	0	0	0	0	37.5261	0	5.384133678	13.7206	0.318948036	0.508530206	0	0.093168187	0.991915477	0.255123884	0.895332296	6.585925831	0.972107588	1.764628973	0.504632206	0.001508054	1.694646843	2.122288089	4.679612944	0.089497608	0.220368661	0	0	1.166548662	0	0	0	0	0	0	0	0	0	0	0	0.295738086	0.165376801	0	0.479552505	0	0	0	0	37.5261	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	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	30% Coins		0.5	"VIS752: Vision 17a, 17b"				$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d$0: OTC items 13c	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins					5100	8.5788	0.0672	0.3017	1.4815	1.4922	1.2864	0.3309	0.3235	3.0121	0.4316	0.8096	0.28	0.0006	0.78	1.075	1.4642	0.0248	0.0978		0.1963	0.4058	0		0	0				0	0	0.1277	0.0318	0.3534	0.0265	0.6413	0.0909					23.7116	0	12.66870112	22.2995	0.386119564	0.81021717	1.481524723	1.585353373	2.278274875	0.585979681	1.218783298	9.598073788	1.40368572	2.574264219	0.784678799	0.002065997	2.474656524	3.197316146	6.143832327	0.114285459	0.318203778	0	0.196340885	1.572375406	0	0	0	0	0	0	0	0	0	0.127711247	0.031801796	0.649121927	0.191840612	0.641325648	0.570435943	0	0	0	0	61.2377
R5826_070_0	2011	5	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							Prosthetics/Supplies	Radiology	Other	Therapy (PT/OT/ST)							A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O		V					O	O	O	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	170.4178997	2.313840727	323.637962	272.7638718	7.724936501	3.791389818	1.721237258	204.6054408	199.3172432	518.9960399	87.39018398	28.49431101	0.049786787	2.553532791	1745.061519	2179.494669	13.37367608	60.30190807		765.5802555	8.195735325	0		5.05					4.86	0.51	478.2852818	432.1098814	223.1650057	302.4867367							5000	$600/Admit:1a.IP Acute	$600/Admit:1b.IP Psych	"$0/Day(Days 1-20) $137(Days 21-100):2. $0 SNF 1,2. $137 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$50/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$10/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$10-$30/Visit:7b. $10 Chiropractic,7f. $30 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $30 Spec Cap"	"$30/Visit:7e, 7h.Psych -- Other Provider"	"$50/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"		"DEN750: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$50/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b, 9a. $50 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,3, 7c, 7d, 7i. $30 Therapy (AT,PT,ST,OT) -- CORF"	"$30/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								600	600	45.243839	0	100	0.2	0.2	50	150	25.459198	30	50	0.169061	0.2	10	28.175961	30	50		0	0.2	0		0					0	0	0	43.406539	47.733787	30							NO	586.1346	586.1346	43.352285	0	97.6052	0.19521	0.19521	48.8026	146.4078	24.849501	29.28156	48.8026	0.165013	0.19521	9.76052	27.501203	29.28156	48.8026		0	0.19521	0		0					0	0	0	42.367039	46.590658	29.28156								8.324	0.113018509	1.169203764	0	0.062832831	0.740117206	0.336002725	0.832106457	2.431799924	1.074732718	0.21324341	0.115883039	0.008215467	0.498475136	1.419392321	4.994893778	0.032633508	0.245240825	0	0	1.599889493	0	0	0	0	0	0	0	0	0	0	1.52560135	0.866450372	0.738106961	0	0	0	0	0	0	27.3418	0	0.685751578	8.324	0.113018509	1.169203764	0	0.062832831	0.740117206	0.336002725	0.832106457	2.431799924	1.074732718	0.21324341	0.115883039	0.008215467	0.498475136	1.419392321	4.994893778	0.032633508	0.245240825	0	0	1.599889493	0	0	0	0	0	0	0	0	0	0	1.52560135	0.866450372	0.738106961	0	0	0	0	0	0	27.3418	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%-20% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins		$35/Visit	20%-30% Coins	$0/Service		50%-55%					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	30% Coins	$35/Visit							7500	2.7071	0.0368	0.911	0.9742	1.164	1.1102	0.504	0.3477	4.2173	0.3772	0.0645	0.3117	0.0035	0.2133	1.2876	1.6081	0.0099	0.0737		0.5649	0.4774	0		0					0	0	0.1765	1.1963	0.5982	0.2232							19.158	0	1.137905131	11.0311	0.149773625	2.080190953	0.974158222	1.226815041	1.850299479	0.840009702	1.179809289	6.649110433	1.451955042	0.277722771	0.427602906	0.011730965	0.711786309	2.706956308	6.602996884	0.042501049	0.318934914	0	0.564870382	2.077251814	0	0	0	0	0	0	0	0	0	0.176455832	2.721938008	1.464638115	0.961291658	0	0	0	0	0	0	46.4999
R5826_072_0	2011	9	r.	s.									DME/Prosthetics/Supplies	OP Facility - Other									Prosthetics/Supplies	Radiology									Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	Coin	Coin		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	YES	287.4319814	4.789757604	21.54342496	595.1198711	0.641413395	8.990898786	4.427755371	390.4996585	62.05606931	9.985727746	22.28542304	3.54437212	0.149365163	20.15258058	35.09545439	47.15451347	0.993299244	6.526749564		1345.031853	22.71484852	0		4.02					3.7	0.6	949.588029	151.2348552									6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $155 plan year deductible	"0%-20% coinsurance after $155 plan year deductible:8a. 0% Lab -- FSL,8a. 20% Lab -- OP"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"15% coinsurance after $155 plan year deductible:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit:14b-j.Preventive Services	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0/Visit:14h.SMAM -- FSR, 14h.SMAM -- OP"										0.073129	0.073129	0.167227	0	0.233	0.233	0.233	50	0.233	0.218874	0.233	0.233	0.233	0.233	0.183	0.231269	0.233	0.233		0	0.233	0		0					0	0	0	0									NO	0.065759	0.065759	0.118623	0	0.208651	0.208651	0.208651	44.77485	0.208651	0.196001	0.208651	0.208651	0.208651	0.208651	0.163876	0.2071	0.208651	0.208651		0	0.208651	0		0					0	0	0	0										18.9012	0.31496967	2.555545699	0	0.133831546	1.875960023	0.923855586	1.45704697	12.94806092	1.957212624	4.649875802	0.739536787	0.031165191	4.204856091	5.751302684	9.76569974	0.207252881	1.361812823	0	0	4.739475858	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5187	0	9.122893826	18.9012	0.31496967	2.555545699	0	0.133831546	1.875960023	0.923855586	1.45704697	12.94806092	1.957212624	4.649875802	0.739536787	0.031165191	4.204856091	5.751302684	9.76569974	0.207252881	1.361812823	0	0	4.739475858	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5187	YES	7% Coins	7% Coins	16% Coins(Days 1-20) 16%(Days 21-100)	$0/Visit	23% Coins	23% Coins	23% Coins	$50/Visit	23% Coins	0%-23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins	23% Coins		$0/Visit	23% Coins	23% Coins		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service	$0/Visit									10000	5.0895	0.0848	0.784	0	2.6633	2.0152	0.9924	0.654	5.3642	0.8997	1.8516	0.34	0.0143	1.8644	2.1102	2.8353	0.0597	0.4704		0	1.3658	0		0					0	0	0	0									29.4588	0	1.988738313	23.9907	0.399780839	3.339583558	0	2.797109348	3.891182494	1.916294022	2.111082297	18.31222733	2.856930546	6.501482318	1.079495956	0.045491626	6.069223111	7.861489072	12.60096186	0.26697703	1.83216684	0	0	6.105252652	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9775
R5826_074_0	2011	7	r.	s.	t.								DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other								Prosthetics/Supplies	Radiology	Other								D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	Coin							O	O	O	V	V								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0							0	0	0	0	0								0	YES	1363.478923	63.066714	411.526988	746.05851	10.8657	8.89179	2.949259	324.623117	321.609353	1155.55467	191.501322	86.564648	0.293768	6.54699	3794.043613	3839.270153	95.355749	644.982469		1594.142934	24.051284	0							1.42	0.58	990.517048	823.394176	672.780846								4500	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$0-$250/Visit:9b. $0 Surgery ASC -- Physician,9b. $200 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $250 Surgery OP -- Facility"	"$0-$250/Visit:8a. $0 Lab -- FSL,8a. $250 Lab -- OP"	$75/Visit:8b.Advanced Imaging -- Office	$250/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$25-$40/Visit:7b. $25 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$40-$250/Visit:7c, 7d, 7i. $250 Therapy (AT,PT,ST,OT) -- OP,7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) - Specialist"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"0% Coins:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$250/Visit:8b, 9a. $250 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b, 9a. $250 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $250 Radiology OP -- Facility"	"$40-$250/Visit:9d. $250 Cardiac Rehab,8b. $250 Nuclear Medicine,9a. $250 OP Other,5. $40 Partial Hospitalization,7h. $250 Psych -- OP,3, 7c, 7d, 7i. $40 Therapy (AT,PT,ST,OT) -- CORF"									161.6895	138.428775	34.44565	0	150	0.2	0.2	50	231.664301	171.964375	75	250	0.168946	0.2	15	39.191158	40	98.561062		0	0.2	0							0	0	0	158.377021	206.86744								NO	115.022677	98.475462	18.823997	0	112.04295	0.149391	0.149391	37.34765	173.042344	128.449306	56.021475	186.73825	0.126194	0.149391	11.204295	29.273953	29.87812	73.620481		0	0.149391	0							0	0	0	118.300191	154.520255									13.0692	0.51754365	0.645548566	0	0.10145209	1.3283534	0.440592751	1.01032588	4.637669691	12.36918295	0.894015544	1.347077573	0.037071759	0.978061383	3.542465324	9.365884501	0.237420876	3.9569933	0	0	3.593045368	0	0	0	0	0	0	0	0	0	0	8.117307357	8.66318899	0	0	0	0	0	0	0	74.8525	0	26.58454967	13.0692	0.51754365	0.645548566	0	0.10145209	1.3283534	0.440592751	1.01032588	4.637669691	12.36918295	0.894015544	1.347077573	0.037071759	0.978061383	3.542465324	9.365884501	0.237420876	3.9569933	0	0	3.593045368	0	0	0	0	0	0	0	0	0	0	8.117307357	8.66318899	0	0	0	0	0	0	0	74.8525	YES	20% Coins	20% Coins	30% Coins(Days 1-7) 30%(Days 7-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$100/Visit	30% Coins	0%-20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins		30% Coins	20%-30% Coins	0% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	30% Coins								6700	8.8693	0.1362	0.5521	3.1564	2.338	2.4787	0.8222	0.5252	6.5685	1.0468	0.3843	0.7753	0.0197	0.781	2.8372	4.5154	0.0581	0.4921		0.5123	1.6556	0							0	0	0.4073	2.4754	1.3093								42.7164	500	18.00430838	21.9385	0.653736614	1.197608951	3.156390668	2.439445517	3.807075124	1.262743882	1.535512172	11.20620545	13.41595399	1.278345912	2.1224034	0.056806874	1.759056061	6.379640985	13.88125676	0.295520826	4.449138032	0	0.512259817	5.248669024	0	0	0	0	0	0	0	0	0	0.407320159	10.59272486	9.972531097	0	0	0	0	0	0	0	117.5689
R5826_076_0	2011	5	r.	s.	t.	u.							DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Professional							Prosthetics/Supplies	Radiology	Other	Therapy (PT/OT/ST)							A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V		V	Coin	O							O	O	O	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	216.797388	7.408989	344.890348	625.252746	9.106268	6.954569	2.306715	272.058414	269.532655	968.441108	160.492408	72.54764	0.229767	5.120623	3179.69188	3217.595097	79.915239	150.737143		1336.010827	18.811323	0							4.86	0.51	830.127256	690.065809	563.840591	389.806333							6000	$800/Admit:1a.IP Acute	$800/Admit:1b.IP Psych	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b.Advanced Imaging -- Office	$100/Visit:9a.Observation	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,9a, 12. 20% Dialysis -- OP Hosp"	20% Coins:8b.Rad therapy	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$15-$35/Visit:7b. $15 Chiropractic,7f. $35 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $35 Spec Cap"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"$100/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	"$0-$100/Visit:8b, 9a. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b, 9a. $100 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $100 Radiology OP -- Facility"	"$35-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $35 Partial Hospitalization,7h. $100 Psych -- OP,3, 7c, 7d, 7i. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$35/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"								800	800	42.271616	0	100	0.2	0.2	50	131.664301	68.78575	35	100	0.168945	0.2	15	33.921544	35	100		0	0.2	0							0	0	0	72.593797	86.649446	35							NO	750.564	750.564	36.98386	0	92.5525	0.185105	0.185105	46.27625	121.858602	63.662931	32.393375	92.5525	0.156363	0.185105	13.882875	31.395237	32.393375	92.5525		0	0.185105	0							0	0	0	67.187374	80.196228	32.393375								13.56	0.463410035	1.062948029	0	0.070233989	1.287325495	0.42698448	1.049153598	2.737072711	5.13781662	0.433240896	0.559538788	0.035927057	0.94785292	3.678605409	8.41809672	0.215727025	1.162591619	0	0	3.482069944	0	0	0	0	0	0	0	0	0	0	3.863642466	3.768157383	1.052261894	0	0	0	0	0	0	53.4127	0	4.159664823	13.56	0.463410035	1.062948029	0	0.070233989	1.287325495	0.42698448	1.049153598	2.737072711	5.13781662	0.433240896	0.559538788	0.035927057	0.94785292	3.678605409	8.41809672	0.215727025	1.162591619	0	0	3.482069944	0	0	0	0	0	0	0	0	0	0	3.863642466	3.768157383	1.052261894	0	0	0	0	0	0	53.4127	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	0%-20% Coins	20% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins		$40/Visit	20% Coins	$0/Service							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins	30% Coins	30% Coins	$40/Visit							9000	3.9572	0.1352	0.9624	2.4882	1.3166	1.954	0.6481	0.4436	5.178	0.8252	0.1299	0.6112	0.0156	0.4104	2.5727	2.6034	0.0647	0.1567		1.081	0.9452	0							0	0	0.3211	1.9514	1.0321	0.3154							30.1189	0	3.067347528	17.5172	0.598645143	2.025325947	2.488170203	1.386801135	3.241291823	1.075082802	1.492766704	7.9150229	5.962982115	0.563095	1.170725127	0.051484151	1.358289459	6.251288071	11.0214468	0.280386292	1.319300305	0	1.080963822	4.427272843	0	0	0	0	0	0	0	0	0	0.321088992	5.815004471	4.800306765	1.367653458	0	0	0	0	0	0	83.5316
R5826_077_0	2011	6	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Professional					Prosthetics/Supplies	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		V	Coin	O							O	O	O	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	YES	863.466503	43.191691	190.517092	300.292636	0.341589	5.741223	1.999773	229.089569	33.173829	4.92321	9.961168	3.396657	0.078979	11.642893	2794.749592	2974.368898	51.05957	1.396701		1385.78877	17.260389	0							3	0.41	873.533107	136.374936	295.544994	0	0	363.42184					5900	$195/Day(Days 1-9):1a.IP Acute	$195/Day(Days 1-9):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	20% Coins:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a.Lab -- OP	"20%-25% Coins:8b, 9a. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,8b, 9a. 25% Advanced Imaging -- OP,8b. 25% Radiology OP -- Facility"	25% Coins:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"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"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35/Visit:4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Physician Services Spec, 4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a.Spec Cap, 7b.Chiropractic, 7f.Podiatry"	"$35/Visit:7e, 7h.Psych -- Other Provider"	"25% Coins:7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies	$0/Visit:8a.Lab -- FSL	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8b. $0 Radiology OP -- Physician"	"$15/Visit:3, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- CORF"	"$0/Visit:9a.Surgery OP -- Physician, 9b.Surgery ASC -- Physician"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist"						152.7669	135.896085	34.44565	0	0.2	0.2	0.2	50	0.24103	0.25	0.237749	0.25	0.2	0.230158	15	35	35	0.25		0	0.2	0							0	0	0	0	18.099195	0	0	15					NO	143.153432	127.34428	30.736198	0	0.184325	0.184325	0.184325	46.0812	0.222139	0.230406	0.219115	0.230406	0.184325	0.212119	13.82436	32.25684	32.25684	0.230406		0	0.184325	0							0	0	0	0	16.680653	0	0	13.82436						10.3007	0.458351233	0.487980922	0	0.062963392	1.058250929	0.368608158	0.879726854	7.3692012	1.134337123	2.182641326	0.782610153	0.014557804	2.46967882	3.219635372	7.995311804	0.137251698	0.321808291	0	0	3.181521202	0	0	0	0	0	0	0	0	0	0	0	0.410823624	0	0	0.418672862	0	0	0	0	43.2546	0	3.503378773	10.3007	0.458351233	0.487980922	0	0.062963392	1.058250929	0.368608158	0.879726854	7.3692012	1.134337123	2.182641326	0.782610153	0.014557804	2.46967882	3.219635372	7.995311804	0.137251698	0.321808291	0	0	3.181521202	0	0	0	0	0	0	0	0	0	0	0	0.410823624	0	0	0.418672862	0	0	0	0	43.2546	YES	$195/Day(Days 1-9)	$195/Day(Days 1-9)	$0/Day(Days 1-7) $50(Days 8-100)	$0/Visit	20% Coins	20% Coins	20% Coins	$50/Visit	20%-25% Coins	25% Coins	20%-25% Coins	25% Coins	20% Coins	20%-25% Coins	$15/Visit	$35/Visit	$35/Visit	25% Coins		$0/Visit	20% Coins	$0/Service							$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	20% Coins	$0/Visit	$0-$35/Visit	$15/Visit	$0/Visit	$15/Visit					5900	5.756	0.2561	0.2711	0	1.4987	1.7492	0.6093	0.6855	5.8807	0.9052	1.7418	0.6245	0.0116	1.9445	1.8593	4.6171	0.0793	0.2568		0	1.9016	0							0	0	0.3799	0	0.2372	0	0	0.2418					31.5074	0	2.855193835	16.0567	0.714477582	0.75905903	0	1.561634573	2.807471078	0.977894029	1.565246844	13.24994233	2.039557398	3.924424727	1.407146282	0.026175334	4.414193513	5.078916475	12.61245953	0.216512065	0.578616778	0	0	5.083151434	0	0	0	0	0	0	0	0	0	0.379874807	0	0.648066822	0	0	0.660448856	0	0	0	0	74.762
R5826_078_0	2011	5	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	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	1540.387651	49.770521	229.993319	1564.887316	7.576185	9.038386	4.286155	310.407544	352.797535	1085.869417	937.930314	100.455	0.201076	708.752485	3439.335425	3138.6537	56.477478	618.880017		1493.55611	19.31761	0							3.38	0.73	1235.425891										5900	$255/Day(Days 1-7):1a.IP Acute	$255/Day(Days 1-7):1b.IP Psych	"$50/Day(Days 1-20) $100(Days 21-100):2. $50 SNF 1,2. $100 SNF 2"	$0/Visit:6.Home Health	$150/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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-$200/Visit:8b, 9a. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $200 Advanced Imaging -- FSR,8b. $200 Advanced Imaging -- Office,8b, 9a. $200 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$150/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$15-$200/Visit:9d. $15 Cardiac Rehab,8b. $200 Nuclear Medicine,9a. $50 OP Other,5. $40 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35-$40/Visit:7b. $35 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											183.2481	156.885945	66.51235	0	150	0.2	0.2	50	240.282987	35.703914	121.362005	150	0.2	53.781463	15	39.81916	40	15		0	0.2	0							0	0	0										NO	162.270591	138.92627	51.106759	0	132.63195	0.176843	0.176843	44.21065	212.46134	31.569865	107.309863	132.63195	0.176843	47.554268	13.263195	35.208619	35.36852	13.263195		0	0.176843	0							0	0	0											20.83	0.576202737	0.97951776	0	0.083737016	1.598375295	0.757976509	1.14360994	6.246319753	2.856729242	8.387431125	1.110295211	0.035558883	2.808683801	3.801381368	9.208971858	0.166460401	0.684027196	0	0	3.416184105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.6914	0	8.602447195	20.83	0.576202737	0.97951776	0	0.083737016	1.598375295	0.757976509	1.14360994	6.246319753	2.856729242	8.387431125	1.110295211	0.035558883	2.808683801	3.801381368	9.208971858	0.166460401	0.684027196	0	0	3.416184105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.6914	YES	30% Coins	30% Coins	30% Coins(Days 1-20) 30%(Days 21-100)	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		30% Coins	20%-30% Coins	30% Coins							$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins										8800	13.4309	0.1657	0.3855	3.9073	1.3848	2.1403	1.015	0.4266	5.6465	0.743	2.2394	0.5471	0.0136	1.9474	1.9626	2.5572	0.0323	0.4092		0.3589	1.135	0							0	0	0.4736										40.9217	0	16.17762893	34.2608	0.741941699	1.365011821	3.907335313	1.468512072	3.738664757	1.772937918	1.570198592	11.8927746	3.599702929	10.6267965	1.657373914	0.049142631	4.756086876	5.763951642	11.76622021	0.198717569	1.093199196	0	0.358881488	4.551197419	0	0	0	0	0	0	0	0	0	0.473629079	0	0	0	0	0	0	0	0	0	105.6131
R5826_079_0	2011	5	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V		V	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	1058.988766	78.25478	324.922571	406.655699	9.236469	8.024354	2.009876	333.0081	220.164678	936.876018	703.698761	91.577089	0.813036	709.549995	3403.906675	2686.624129	113.531373	443.040269		1555.180348	15.309953	0							3.62	0.41	1266.965396										5900	$225/Day(Days 1-7):1a.IP Acute	$225/Day(Days 1-7):1b.IP Psych	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6.Home Health	$100/Trip:10a.Ambulance Emergency	20% Coins:11a.DME	"20% Coins:11b.Prosthetics, 11b.Supplies"	"$50/Visit:4a, 4b.Emergency Room"	"$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:8b, 9a. $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,8b, 9a. $150 Advanced Imaging -- OP,8b. $0 Radiology OP -- Physician,8b. $50 Radiology OP -- Facility"	$150/Visit:9a.Observation	"20% Coins:12.Dialysis -- Dialysis Center, 9a, 12.Dialysis -- OP Hosp"	"$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, 7c, 7d, 7i. $15 Therapy (AT,PT,ST,OT) -- CORF"	"$15/Visit:4b, 7a, 8a, 8b.PCP Cap, 4b, 7a, 8a, 8b.Physician Services PCP"	"$35-$40/Visit:7b. $35 Chiropractic,7f. $40 Podiatry,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Physician Services Spec,4b, 7d, 8a, 8b, 9d, 16b, 17a, 18a. $40 Spec Cap"	"$40/Visit:7e, 7h.Psych -- Other Provider"	"$15/Visit:7c, 7d, 7i.Therapy (AT,PT,ST,OT) - Specialist, 7c, 7d, 7i.Therapy (AT,PT,ST,OT) -- OP"		"$0/Visit:14b-j, 17a.Preventive Services"	"20% Coins:15.Part B Rx, 15.Part B Rx - Chemo, 15.Part B Rx at Pharmacy"	"$0/Service:7g, 13a.Other Part B"							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											161.6895	138.428775	34.44565	0	100	0.2	0.2	50	244.255983	39.037795	84.005783	150	0.2	50.130799	15	39.78161	40	15		0	0.2	0							0	0	0										NO	152.858181	130.867934	30.916383	0	93.368	0.186736	0.186736	46.684	228.056927	36.448808	78.434519	140.052	0.186736	46.806124	14.0052	37.143294	37.3472	14.0052		0	0.186736	0							0	0	0											13.4896	0.853420115	0.837119221	0	0.071865886	1.498435769	0.375316205	1.295512512	4.184173325	2.845667842	4.59952282	1.068796206	0.15182309	2.767607088	3.97269948	8.315839158	0.353339908	0.517072298	0	0	2.858919383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0567	0	3.401533917	13.4896	0.853420115	0.837119221	0	0.071865886	1.498435769	0.375316205	1.295512512	4.184173325	2.845667842	4.59952282	1.068796206	0.15182309	2.767607088	3.97269948	8.315839158	0.353339908	0.517072298	0	0	2.858919383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0567	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		30% Coins	20%-30% Coins	30% Coins							$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	30% Coins										8800	12.8702	0.3067	0.6598	2.1365	1.1898	2.0087	0.5031	0.4838	4.2485	0.8522	1.7557	0.5087	0.0581	1.6162	2.1943	2.4933	0.0615	0.2707		0.4599	0.9263	0							0	0	0.4627										36.0666	0	10.93178403	26.3598	1.160083772	1.496869905	2.136450702	1.261649298	3.507141768	0.878440909	1.779301925	8.432710153	3.697858843	6.355205476	1.577490053	0.209885078	4.383778278	6.167032862	10.80912679	0.414833085	0.787766164	0	0.459921007	3.785242542	0	0	0	0	0	0	0	0	0	0.46271827	0	0	0	0	0	0	0	0	0	86.1233
R5826_080_0	2011	8	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		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	YES	248.504545	3.81594	18.823029	696.49279	0.500576	7.731472	2.5644	303.056204	53.378768	7.629896	24.538322	5.651334	0.255434	15.608169	32.989103	52.502246	0.675556	4.859921		1488.233221	20.912756	0		3.22					4.53	0.56	924.710291										8500	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"$0/Visit:14b-j, 17a.Preventive Services"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											0.079876	0.079876	0.172273	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0		0					0	0	0										NO	0.07539	0.07539	0.145258	0	0.218083	0.218083	0.218083	46.7989	0.218083	0.218083	0.218083	0.218083	0.218083	0.218083	0.218083	0.218083	0.218083	0.218083		0	0.218083	0		0					0	0	0											18.7348	0.287683717	2.734195546	0	0.109167116	1.686102608	0.559252045	1.181891415	11.64100186	1.663950609	5.351390877	1.232459873	0.055705813	3.40387632	7.19436255	11.44984731	0.147327279	1.059866151	0	0	4.560716567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0536	0	5.149065961	18.7348	0.287683717	2.734195546	0	0.109167116	1.686102608	0.559252045	1.181891415	11.64100186	1.663950609	5.351390877	1.232459873	0.055705813	3.40387632	7.19436255	11.44984731	0.147327279	1.059866151	0	0	4.560716567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0536	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	$50/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service										12000	4.92	0.0756	0.7737	0	2.1359	1.7808	0.5907	0.5216	4.7192	0.7521	2.0953	0.557	0.0252	1.5018	2.0384	3.2441	0.0417	0.3536		0	1.2922	0		0					0	0	0										27.4188	0	1.031182654	23.6548	0.363233961	3.507907123	0	2.245109303	3.466936233	1.149925109	1.703500388	16.36015592	2.41600154	7.446686147	1.789491709	0.080882948	4.905675591	9.232726805	14.69390951	0.189069234	1.413446689	0	0	5.852895177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4724
R5826_081_0	2011	7	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		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	YES	266.49	4.092117	20.185341	14.618435	0.536805	8.291035	2.749998	316.368937	57.242042	8.182108	26.314276	6.060348	0.27392	16.737808	35.376681	56.302082	0.724449	5.211658		1553.608722	22.426311	0		3.39					4	0.56	965.331209										7500	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0% Coins:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"$0/Visit:14b-j, 17a.Preventive Services"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"DEN767: Dental 16a, 16b"					$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$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											0.078008	0.078008	0.164772	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0		0					0	0	0										NO	0.071008	0.071008	0.123397	0	0.2102	0.2102	0.2102	45.1073	0.2102	0.2102	0.2102	0.2102	0.2102	0.2102	0.2102	0.2102	0.2102	0.2102		0	0.2102	0		0					0	0	0											18.9229	0.290573044	2.490810523	0	0.112836411	1.742775557	0.57804958	1.189212379	12.03227723	1.719879102	5.531260815	1.27388515	0.057577984	3.518287242	7.436178346	11.83469764	0.15227918	1.095490512	0	0	4.714010572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.693	0	8.476743493	18.9229	0.290573044	2.490810523	0	0.112836411	1.742775557	0.57804958	1.189212379	12.03227723	1.719879102	5.531260815	1.27388515	0.057577984	3.518287242	7.436178346	11.83469764	0.15227918	1.095490512	0	0	4.714010572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.693	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0% Coins	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	$50/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		0.5					$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$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service										10000	5.0463	0.0775	0.7358	0	2.234	1.8626	0.6178	0.5311	4.9358	0.7866	2.1915	0.5826	0.0263	1.5708	2.132	3.393	0.0437	0.3698		0	1.3515	0		0					0	0	0										28.4886	0	1.836892596	23.9692	0.368061988	3.226642556	0	2.346845661	3.605372255	1.19584193	1.720298088	16.96810082	2.506458979	7.722756348	1.856491838	0.083911102	5.089038482	9.568129487	15.2277036	0.195937577	1.46530498	0	0	6.065517022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.1816
R5826_082_0	2011	8	r.										DME/Prosthetics/Supplies										Prosthetics/Supplies										Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		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	YES	242.034642	3.71659	18.332965	13.276924	0.487543	7.53018	2.497635	297.951622	51.98903	7.431249	23.899455	5.5042	0.248783	15.201805	32.13022	51.135331	0.657968	4.733391		1463.165894	20.368285	0		3.21					4.9	0.56	909.134765										7500	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0% Coins:6.Home Health	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	"$50/Visit:4a, 4b.Emergency Room"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"$0/Visit:14b-j, 17a.Preventive Services"	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		"DEN767: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service:11c.Diabetic Monitoring Supplies											0.080041	0.080041	0.188556	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0.233	0		0					0	0	0										NO	0.073808	0.073808	0.144849	0	0.213147	0.213147	0.213147	45.73975	0.213147	0.213147	0.213147	0.213147	0.213147	0.213147	0.213147	0.213147	0.213147	0.213147		0	0.213147	0		0					0	0	0											17.8641	0.274314075	2.655511647	0	0.103918328	1.605035276	0.532363407	1.135686059	11.08130578	1.583948431	5.094097135	1.173203717	0.05302735	3.24021913	6.848460002	10.8993424	0.140243905	1.008908091	0	0	4.341438843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.6351	0	6.882190115	17.8641	0.274314075	2.655511647	0	0.103918328	1.605035276	0.532363407	1.135686059	11.08130578	1.583948431	5.094097135	1.173203717	0.05302735	3.24021913	6.848460002	10.8993424	0.140243905	1.008908091	0	0	4.341438843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.6351	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	0% Coins	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	$50/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		$0/Visit	20% coinsurance after $155 plan year deductible	20% coinsurance after $155 plan year deductible		0.5					$0: Additional Smoking Cessation 14a$0: Health Education Materials 14a$0: Membership in health club/fitness class 14a$0: Nurse hotline 14a	$0: Member Incentive Program 14a$0: Nutritional benefit 13d	$0/Service										10000	4.7351	0.0727	0.7769	0	2.0477	1.7073	0.5663	0.5048	4.5242	0.721	2.0087	0.534	0.0241	1.4398	1.9541	3.11	0.04	0.339		0	1.2388	0		0					0	0	0										26.3444	0	1.456628732	22.5991	0.347023781	3.432409923	0	2.151611827	3.31229213	1.09863221	1.640463458	15.60548332	2.304927964	7.102823481	1.707221204	0.077164221	4.679970091	8.802607267	14.00937276	0.180261285	1.347879813	0	0	5.580229963	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9795
R5826_801_0	2011	4																															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	YES	221.9810154	2.131693222	26.44364827	13.62963165	0.547123709	7.385368856	2.413833558	17.3384006	53.95888807	8.414526029	22.64184585	5.60418846	1.024774024	14.52326531	32.41747201	59.82873117	0.441292127	5.935324769		5.206068059	21.22014451	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.087876	0.087876	0.194696	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.078219	0.078219	0.124713	0	0.207007	0.207007	0.207007	0.207007	0.207007	0.207007	0.207007	0.207007	0.207007	0.207007	0.207007	0.207007	0.207007	0.207007		0.207007	0.207007	0																				17.3631	0.166738912	3.297866706	0	0.113258438	1.528823051	0.499680443	3.589170293	11.16986754	1.74186579	4.687020583	1.16010624	0.212135396	3.006417583	6.710643628	12.38496615	0.091350559	1.228653774	0	1.077692531	4.392718456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4221	0	10.74428447	17.3631	0.166738912	3.297866706	0	0.113258438	1.528823051	0.499680443	3.589170293	11.16986754	1.74186579	4.687020583	1.16010624	0.212135396	3.006417583	6.710643628	12.38496615	0.091350559	1.228653774	0	1.077692531	4.392718456	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4221	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	Medicare FFS Cost Sharing																			10000	4.6971	0.0451	1.0463	0	2.2649	1.6504	0.5394	1.658	4.5713	0.8047	1.8836	0.5359	0.098	1.3674	1.9433	3.5865	0.0265	0.4378		0.3121	1.2721	0																			28.7403	0	2.162849011	22.0603	0.211845811	4.344139092	0	2.378189509	3.179200863	1.0390897	5.247183079	15.74120736	2.54651849	6.57060812	1.69601587	0.31013099	4.373807396	8.653946337	15.97146829	0.117804322	1.66643912	0	1.389776301	5.66478458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.1624
R5826_802_0	2011	5																															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	YES	256.988243	2.182852	36.028218	16.292826	0.50022	7.304001	2.952427	19.00197	53.964575	10.301098	26.311302	6.591671	0.884813	17.825033	33.866102	68.641766	0.494103	6.855406		6.062426	23.751923	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082511	0.082511	0.176005	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.071515	0.071515	0.100877	0	0.202948	0.202948	0.202948	0.202948	0.202948	0.202948	0.202948	0.202948	0.202948	0.202948	0.202948	0.202948	0.202948	0.202948		0.202948	0.202948	0																				18.3785	0.156106661	3.634418547	0	0.101518649	1.482332395	0.599189155	3.856411808	10.95200257	2.090587237	5.339826118	1.337766446	0.179571029	3.617554797	6.873057669	13.93070913	0.100277216	1.391290937	0	1.230357232	4.820405269	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.0719	0	14.13086475	18.3785	0.156106661	3.634418547	0	0.101518649	1.482332395	0.599189155	3.856411808	10.95200257	2.090587237	5.339826118	1.337766446	0.179571029	3.617554797	6.873057669	13.93070913	0.100277216	1.391290937	0	1.230357232	4.820405269	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.0719	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	Medicare FFS Cost Sharing																			10000	5.029	0.0427	1.1783	0	2.0423	1.6098	0.6507	1.7921	4.5008	0.9715	2.1622	0.6217	0.0834	1.6565	2.0023	4.0583	0.0292	0.4916		0.3584	1.4043	0																			30.6851	0	2.906281855	23.4075	0.198822448	4.812698341	0	2.143831022	3.092103127	1.249891538	5.64854179	15.4527925	3.062113381	7.502024614	1.959445697	0.263020456	5.274045803	8.875308867	17.98898757	0.129490092	1.88291674	0	1.588783443	6.224679989	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.757
R5826_803_0	2011	5																															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	YES	224.496856	1.90687	31.473119	14.2329	0.436976	6.380545	2.579148	16.599525	47.141758	8.998717	22.984727	5.758276	0.772945	15.571387	29.584363	59.963289	0.431633	5.988668		5.295945	20.748934	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.080236	0.080236	0.179236	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.071895	0.071895	0.113862	0	0.208416	0.208416	0.208416	0.208416	0.208416	0.208416	0.208416	0.208416	0.208416	0.208416	0.208416	0.208416	0.208416	0.208416		0.208416	0.208416	0																				16.1402	0.137094419	3.583592276	0	0.09107279	1.329807667	0.53753571	3.459606602	9.825096635	1.875476602	4.790384862	1.200116851	0.161094105	3.245326193	6.165854599	12.49730884	0.089959223	1.24813423	0	1.103759673	4.324409829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.8058	0	10.07320032	16.1402	0.137094419	3.583592276	0	0.09107279	1.329807667	0.53753571	3.459606602	9.825096635	1.875476602	4.790384862	1.200116851	0.161094105	3.245326193	6.165854599	12.49730884	0.089959223	1.24813423	0	1.103759673	4.324409829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.8058	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	Medicare FFS Cost Sharing																			10000	4.3495	0.0369	1.1374	0	1.8173	1.4324	0.579	1.5947	4.0049	0.8645	1.924	0.5532	0.0743	1.474	1.7816	3.6111	0.026	0.4375		0.3189	1.2495	0																			27.2667	0	1.971848594	20.4897	0.174039374	4.721030433	0	1.908355064	2.762207557	1.116540851	5.054272648	13.82997168	2.739956219	6.714344791	1.753296918	0.23534869	4.719298661	7.947489883	16.10842976	0.115953275	1.685590665	0	1.422693189	5.573956128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.0725
R5826_804_0	2011	5																															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	YES	251.4042279	3.516237685	34.45480893	14.38674629	0.455058646	7.773184158	3.34303371	17.64349214	48.29146199	6.236659626	20.77002936	4.146821255	2.124753193	12.13272984	30.49978011	55.2891039	0.291018434	6.522073103		6.546491698	14.02029398	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.08092	0.08092	0.182118	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.072155	0.072155	0.110524	0	0.208412	0.208412	0.208412	0.208412	0.208412	0.208412	0.208412	0.208412	0.208412	0.208412	0.208412	0.208412	0.208412	0.208412		0.208412	0.208412	0																				18.1401	0.25371413	3.808083302	0	0.094839683	1.620024857	0.696728341	3.677115484	10.06452018	1.299794706	4.32872336	0.864247311	0.442824063	2.528606491	6.356520172	11.52291272	0.060651734	1.359278299	0	1.364367428	2.921997508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.405	0	10.50611848	18.1401	0.25371413	3.808083302	0	0.094839683	1.620024857	0.696728341	3.677115484	10.06452018	1.299794706	4.32872336	0.864247311	0.442824063	2.528606491	6.356520172	11.52291272	0.060651734	1.359278299	0	1.364367428	2.921997508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.405	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	Medicare FFS Cost Sharing																			10000	4.8966	0.0685	1.2182	0	1.8917	1.7444	0.7502	1.6943	4.1397	0.5989	1.7183	0.3982	0.204	1.1373	1.836	3.3283	0.0175	0.4781		0.3941	0.844	0																			27.3584	0	2.077230769	23.0366	0.322199391	5.026252285	0	1.986586218	3.364383258	1.446929141	5.371410191	14.20425915	1.89869775	6.047041738	1.262464113	0.646863119	3.665857868	8.19256624	14.85124319	0.078170601	1.837360505	0	1.758457647	3.766000579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.7634
R5826_805_0	2011	5																															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	YES	218.6079549	1.860919323	26.51713636	12.74780967	0.371800143	7.195374692	2.290527433	19.22397502	58.65651617	4.365515912	33.36179364	9.117213208	0.032648796	18.76143636	43.49389393	106.2083197	0.678760453	9.488612755		8.156629407	30.69981585	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.083043	0.083043	0.160213	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.071414	0.071414	0.101437	0	0.199351	0.199351	0.199351	0.199351	0.199351	0.199351	0.199351	0.199351	0.199351	0.199351	0.199351	0.199351	0.199351	0.199351		0.199351	0.199351	0																				15.6117	0.132895693	2.689818761	0	0.07411873	1.43440514	0.456618934	3.832318645	11.69323515	0.870269963	6.650706925	1.81752557	0.00650857	3.7401111	8.67055125	21.17273473	0.135311575	1.891564441	0	1.626032229	6.12003899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.6264	0	15.97041884	15.6117	0.132895693	2.689818761	0	0.07411873	1.43440514	0.456618934	3.832318645	11.69323515	0.870269963	6.650706925	1.81752557	0.00650857	3.7401111	8.67055125	21.17273473	0.135311575	1.891564441	0	1.626032229	6.12003899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.6264	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	Medicare FFS Cost Sharing																			10000	4.2897	0.0365	0.8557	0	1.4968	1.5637	0.4978	1.7878	4.7593	0.406	2.6599	0.8479	0.003	1.7086	2.5356	6.1918	0.0396	0.6498		0.4755	1.7898	0																			32.5948	0	3.322530157	19.9013	0.169411877	3.545516802	0	1.570955828	2.998132615	0.95440582	5.620116684	16.45257049	1.276255893	9.310586627	2.665411543	0.00954481	5.448685166	11.20618224	27.36452604	0.174882098	2.541413667	0	2.101551905	7.909793708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.2213
R5826_806_0	2011	5																															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	YES	263.549321	1.596342283	30.50287538	14.588073	0.477098009	7.303384378	3.416494491	19.80847888	59.77275192	10.99276606	26.17903895	5.505927914	0.647073756	18.16205987	38.63753246	71.15734377	0.482545999	6.4651066		6.210411956	20.08543538	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.074941	0.074941	0.169155	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.065455	0.065455	0.104595	0	0.203248	0.203248	0.203248	0.203248	0.203248	0.203248	0.203248	0.203248	0.203248	0.203248	0.203248	0.203248	0.203248	0.203248		0.203248	0.203248	0																				17.2506	0.104488584	3.190448251	0	0.096969216	1.484398268	0.694395672	4.026033715	12.14869228	2.234257716	5.320837308	1.119068837	0.131516447	3.691402344	7.853001197	14.46258781	0.098076509	1.314019986	0	1.262253809	4.08232457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5654	0	13.27050811	17.2506	0.104488584	3.190448251	0	0.096969216	1.484398268	0.694395672	4.026033715	12.14869228	2.234257716	5.320837308	1.119068837	0.131516447	3.691402344	7.853001197	14.46258781	0.098076509	1.314019986	0	1.262253809	4.08232457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5654	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	Medicare FFS Cost Sharing																			10000	4.7072	0.0285	1.0206	0	1.9496	1.611	0.7536	1.8698	5.013	1.0376	2.154	0.5197	0.0611	1.6855	2.2863	4.2106	0.0286	0.4611		0.3675	1.1885	0																			30.9539	0	2.750767495	21.9578	0.133000503	4.211074846	0	2.046552688	3.095415563	1.44802292	5.895832027	17.16165094	3.271907062	7.474788332	1.638794502	0.192596254	5.376928433	10.13931325	18.67320639	0.126630399	1.775120634	0	1.629744807	5.27084716	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5192
R5826_807_0	2011	5																															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	YES	280.532441	2.071617	58.396441	22.625659	0.652054	6.654043	2.918617	20.36627	45.673882	16.049371	22.486875	6.725382	0.224471	22.031463	27.467917	53.889162	0.439234	4.414368		3.90703	22.756671	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.080201	0.080201	0.169274	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.068835	0.068835	0.081011	0	0.203277	0.203277	0.203277	0.203277	0.203277	0.203277	0.203277	0.203277	0.203277	0.203277	0.203277	0.203277	0.203277	0.203277		0.203277	0.203277	0																				19.3105	0.142599756	4.730754082	0	0.132547581	1.352613899	0.593287708	4.139994267	9.284449711	3.262467989	4.571064489	1.367115477	0.045629791	4.478489704	5.583595764	10.95442718	0.08928617	0.897339484	0	0.794209337	4.625907811	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3562	0	15.99486734	19.3105	0.142599756	4.730754082	0	0.132547581	1.352613899	0.593287708	4.139994267	9.284449711	3.262467989	4.571064489	1.367115477	0.045629791	4.478489704	5.583595764	10.95442718	0.08928617	0.897339484	0	0.794209337	4.625907811	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3562	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	Medicare FFS Cost Sharing																			10000	5.2865	0.039	1.5603	0	2.6641	1.4676	0.6437	1.9222	3.7863	1.5147	1.9137	0.6347	0.0212	2.0677	1.6251	3.1883	0.026	0.32		0.2312	1.3464	0																			30.2588	0	3.397635872	24.5969	0.18163818	6.291051782	0	2.79667428	2.820184452	1.236998344	6.062167632	13.07075192	4.777211526	6.484794761	2.001858754	0.066815476	6.546156166	7.208730221	14.1427699	0.115273255	1.217372558	0	1.025368121	5.972302141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.615
R5826_808_0	2011	5																															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	YES	256.9929632	1.25771238	39.49082485	12.53774517	0.608686102	6.770130512	2.994849809	16.84397683	46.68642507	9.022114046	21.89910607	5.618902086	0.509810457	14.77864837	27.82602314	54.91029914	0.322696566	5.606362128		5.164103248	17.94155857	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.079741	0.079741	0.187341	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.070585	0.070585	0.106185	0	0.207535	0.207535	0.207535	0.207535	0.207535	0.207535	0.207535	0.207535	0.207535	0.207535	0.207535	0.207535	0.207535	0.207535		0.207535	0.207535	0																				18.1398	0.088775628	4.193333236	0	0.12632367	1.405039036	0.621536155	3.495714731	9.689067226	1.872404439	4.544830978	1.166118844	0.105803513	3.067086789	5.774873713	11.39580893	0.066970832	1.163516364	0	1.071732168	3.723501358	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7123	0	11.61756041	18.1398	0.088775628	4.193333236	0	0.12632367	1.405039036	0.621536155	3.495714731	9.689067226	1.872404439	4.544830978	1.166118844	0.105803513	3.067086789	5.774873713	11.39580893	0.066970832	1.163516364	0	1.071732168	3.723501358	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7123	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	Medicare FFS Cost Sharing																			10000	4.9028	0.024	1.3523	0	2.5204	1.5133	0.6694	1.6111	3.9332	0.863	1.8238	0.5374	0.0488	1.3966	1.6685	3.2925	0.0193	0.427		0.3096	1.0758	0																			27.9889	0	2.386323705	23.0427	0.112769955	5.545675359	0	2.646714332	2.918297736	1.290944677	5.10683659	13.62224274	2.735367127	6.368664095	1.703565359	0.154566751	4.463677087	7.4433398	14.68826567	0.086320015	1.590545782	0	1.381375159	4.799288952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.7011
R5826_809_0	2011	5																															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	YES	241.3011878	0.97586171	25.3425785	12.82899908	0.389066394	7.692946268	2.494278588	16.14088818	50.64233275	11.2900623	25.65095693	4.028990366	3.213884614	18.13018529	29.59049767	54.22617996	0.330773401	9.173098678		5.321679609	27.03068668	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.077191	0.077191	0.15703	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.069251	0.069251	0.108949	0	0.207589	0.207589	0.207589	0.207589	0.207589	0.207589	0.207589	0.207589	0.207589	0.207589	0.207589	0.207589	0.207589	0.207589		0.207589	0.207589	0																				16.7103	0.067579399	2.761048585	0	0.080765904	1.596971023	0.517784798	3.350670837	10.51279121	2.343692743	5.324856498	0.836374081	0.667167093	3.763627033	6.14266182	11.25675847	0.06866492	1.904234382	0	1.104722148	5.611273218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.622	0	9.884718473	16.7103	0.067579399	2.761048585	0	0.080765904	1.596971023	0.517784798	3.350670837	10.51279121	2.343692743	5.324856498	0.836374081	0.667167093	3.763627033	6.14266182	11.25675847	0.06866492	1.904234382	0	1.104722148	5.611273218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.622	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	Medicare FFS Cost Sharing																			10000	4.508	0.0182	0.8577	0	1.6137	1.7224	0.5585	1.5465	4.3548	1.0817	2.1603	0.386	0.3079	1.7117	1.7772	3.2569	0.0199	0.678		0.3196	1.6235	0																			28.5025	0	1.978518516	21.2183	0.085810366	3.618737484	0	1.694472449	3.319378091	1.07623974	4.89712904	14.86756848	3.425393475	7.485157892	1.22239157	0.975089356	5.475350107	7.919899479	14.51364224	0.088531456	2.582264873	0	1.424348178	7.234765848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.1245
R5826_810_0	2011	5																															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	YES	239.5598451	1.83774447	24.70005365	12.59248697	0.366533581	6.248123114	4.448718031	16.56490288	55.57486071	7.957548196	27.22331197	4.250514886	0.542532253	15.84583675	31.8100507	57.62466484	0.365040676	6.197957187		6.191029654	22.54493823	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.083679	0.083679	0.178938	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.07458	0.07458	0.119427	0	0.206985	0.206985	0.206985	0.206985	0.206985	0.206985	0.206985	0.206985	0.206985	0.206985	0.206985	0.206985	0.206985	0.206985		0.206985	0.206985	0																				17.8664	0.137058983	2.949853307	0	0.075866953	1.293267763	0.920817902	3.428686423	11.50316254	1.647093113	5.634817228	0.879792824	0.112296038	3.279850519	6.584203345	11.92744125	0.075557944	1.282884168	0	1.281450273	4.666464039	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5469	0	10.52808057	17.8664	0.137058983	2.949853307	0	0.075866953	1.293267763	0.920817902	3.428686423	11.50316254	1.647093113	5.634817228	0.879792824	0.112296038	3.279850519	6.584203345	11.92744125	0.075557944	1.282884168	0	1.281450273	4.666464039	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5469	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	Medicare FFS Cost Sharing																			10000	4.8364	0.0371	0.9274	0	1.5177	1.3966	0.9944	1.5845	4.6761	0.7612	2.1731	0.4066	0.0519	1.4993	1.9074	3.4553	0.0219	0.4525		0.3712	1.3518	0																			28.4223	0	2.064095793	22.7028	0.174160754	3.877222199	0	1.593608446	2.689880278	1.915218377	5.013152196	16.17922126	2.408248505	7.807920677	1.286363046	0.164190371	4.779192618	8.491599159	15.38273438	0.097446628	1.735347578	0	1.652677086	6.018305034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.9693
R5826_811_0	2011	5																															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	YES	273.4588288	3.480172103	24.87696729	13.44342828	0.455444876	7.21779702	2.948383617	17.63793752	54.78163576	11.10163913	29.94205357	8.537741064	0.593293407	18.71928286	30.00822515	62.85224001	0.634879538	6.399365573		6.137574191	20.40774012	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.080188	0.080188	0.208855	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.069984	0.069984	0.12842	0	0.203912	0.203912	0.203912	0.203912	0.203912	0.203912	0.203912	0.203912	0.203912	0.203912	0.203912	0.203912	0.203912	0.203912		0.203912	0.203912	0																				19.1377	0.243556364	3.194700139	0	0.092870675	1.471795426	0.6012108	3.596587115	11.17063291	2.263757438	6.105544027	1.740947856	0.120979645	3.817086407	6.119037206	12.81632596	0.129459556	1.304907433	0	1.251525028	4.161383104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.34	0	12.92443094	19.1377	0.243556364	3.194700139	0	0.092870675	1.471795426	0.6012108	3.596587115	11.17063291	2.263757438	6.105544027	1.740947856	0.120979645	3.817086407	6.119037206	12.81632596	0.129459556	1.304907433	0	1.251525028	4.161383104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.34	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	Medicare FFS Cost Sharing																			10000	5.2304	0.0666	1.0245	0	1.8665	1.5967	0.6522	1.6697	4.6303	1.0509	2.4777	0.8082	0.0562	1.738	1.7808	3.7299	0.0377	0.4491		0.3642	1.2111	0																			30.4406	0	2.628250628	24.3681	0.310120848	4.219160071	0	1.95932129	3.068509649	1.253449164	5.266285067	15.80089807	3.314695792	8.583256602	2.549174273	0.177144117	5.555121869	7.899828073	16.54619315	0.167135507	1.754038432	0	1.615749773	5.372448174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.7807
R5826_812_0	2011	5																															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	YES	259.6575429	3.124233113	27.31856832	21.04785006	0.452628849	7.43635667	2.586881983	20.21684944	60.58587074	8.369528921	26.09394287	7.234482114	1.096578666	12.89716173	37.69819688	74.27996506	0.776236997	7.317690935		7.182025456	28.22016117	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.075451	0.075451	0.188048	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.065678	0.065678	0.11571	0	0.20257	0.20257	0.20257	0.20257	0.20257	0.20257	0.20257	0.20257	0.20257	0.20257	0.20257	0.20257	0.20257	0.20257		0.20257	0.20257	0																				17.0538	0.205193382	3.16103154	0	0.091689026	1.506382771	0.524024683	4.095327191	12.27287984	1.695415474	5.285850008	1.465489042	0.22213394	2.612578051	7.636523742	15.04689252	0.157242329	1.482344653	0	1.454862897	5.716558048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6862	0	13.74788783	17.0538	0.205193382	3.16103154	0	0.091689026	1.506382771	0.524024683	4.095327191	12.27287984	1.695415474	5.285850008	1.465489042	0.22213394	2.612578051	7.636523742	15.04689252	0.157242329	1.482344653	0	1.454862897	5.716558048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6862	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	Medicare FFS Cost Sharing																			10000	4.6678	0.0562	1.0163	0	1.8487	1.6396	0.5704	1.9075	5.0976	0.7897	2.1242	0.6826	0.1035	1.1844	2.2297	4.3933	0.0459	0.5464		0.4248	1.6691	0																			30.9976	0	2.767750309	21.7216	0.261357328	4.177379969	0	1.94041879	3.14596407	1.094384768	6.002780094	17.37051077	2.485077728	7.41002147	2.148059812	0.325595788	3.796980706	9.866208286	19.44022996	0.203153374	2.028735	0	1.879648517	7.385657656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.6838
R5826_813_0	2011	5																															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	YES	228.382705	1.939876	32.017892	14.47926	0.44454	6.490988	2.62379	16.886849	47.95774	9.154476	23.382575	5.857947	0.786325	15.840915	30.096443	61.001203	0.439105	6.092327		5.387613	21.108081	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.086536	0.086536	0.142981	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.077479	0.077479	0.095442	0	0.207949	0.207949	0.207949	0.207949	0.207949	0.207949	0.207949	0.207949	0.207949	0.207949	0.207949	0.207949	0.207949	0.207949		0.207949	0.207949	0																				17.6949	0.150299653	3.055851648	0	0.092441648	1.349794464	0.545614507	3.511603363	9.972764075	1.90366413	4.862383089	1.218154221	0.163515497	3.294102433	6.258525225	12.68513916	0.091311446	1.266893307	0	1.120348736	4.389404336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6267	0	9.959848162	17.6949	0.150299653	3.055851648	0	0.092441648	1.349794464	0.545614507	3.511603363	9.972764075	1.90366413	4.862383089	1.218154221	0.163515497	3.294102433	6.258525225	12.68513916	0.091311446	1.266893307	0	1.120348736	4.389404336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6267	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	Medicare FFS Cost Sharing																			10000	4.7793	0.0406	0.9617	0	1.8475	1.4562	0.5886	1.6211	4.0714	0.8788	1.9559	0.5624	0.0755	1.4984	1.8112	3.6711	0.0264	0.4447		0.3242	1.2703	0																			27.8853	0	1.93363871	22.4741	0.190894711	4.017525159	0	1.939894441	2.805974914	1.134232617	5.132743923	14.04412805	2.782495459	6.818284154	1.780518342	0.239002852	4.792545968	8.069738988	16.3562121	0.117736919	1.7116122	0	1.444577373	5.659695678	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.512
R5826_814_0	2011	5																															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	YES	234.451045	1.991421	32.868638	14.863987	0.456351	6.663459	2.693508	17.335547	49.232023	9.397719	24.003869	6.013598	0.807219	16.261822	30.896134	62.622061	0.450772	6.254205		5.530768	21.668942	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.077486	0.077486	0.135477	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.069541	0.069541	0.091743	0	0.207916	0.207916	0.207916	0.207916	0.207916	0.207916	0.207916	0.207916	0.207916	0.207916	0.207916	0.207916	0.207916	0.207916		0.207916	0.207916	0																				16.304	0.138485408	3.015467456	0	0.094882675	1.385439741	0.560023409	3.60433759	10.23612529	1.953936144	4.990788427	1.250323242	0.167833746	3.381092983	6.423800597	13.02012843	0.093722711	1.300349287	0	1.149935159	4.505319745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.576	0	9.845169857	16.304	0.138485408	3.015467456	0	0.094882675	1.385439741	0.560023409	3.60433759	10.23612529	1.953936144	4.990788427	1.250323242	0.167833746	3.381092983	6.423800597	13.02012843	0.093722711	1.300349287	0	1.149935159	4.505319745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.576	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	Medicare FFS Cost Sharing																			10000	4.3966	0.0373	0.9443	0	1.8957	1.4942	0.604	1.6635	4.1778	0.9018	2.007	0.5771	0.0775	1.5376	1.8586	3.767	0.0271	0.4563		0.3327	1.3035	0																			28.0598	0	1.940587928	20.7006	0.175830358	3.959761257	0	1.990630068	2.879686691	1.164028432	5.267856676	14.413919	2.85574144	6.997819259	1.827388027	0.245294416	4.918707378	8.282361682	16.78716716	0.120839171	1.756693964	0	1.48263937	5.808818105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.6358
R5826_815_0	2011	5																															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	YES	249.02951	2.11525	34.912451	15.788249	0.484728	7.077802	2.860993	18.413494	52.293333	9.982081	25.49646	6.387532	0.857412	17.273004	32.817294	66.51598	0.478802	6.643099		5.874677	23.016345	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082566	0.082566	0.199403	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.071852	0.071852	0.11176	0	0.203846	0.203846	0.203846	0.203846	0.203846	0.203846	0.203846	0.203846	0.203846	0.203846	0.203846	0.203846	0.203846	0.203846		0.203846	0.203846	0																				17.8933	0.151984943	3.901815524	0	0.098809864	1.442781626	0.583201979	3.753517098	10.65978676	2.034807284	5.197351385	1.302072848	0.174780007	3.521032773	6.689674113	13.55901646	0.097601872	1.354169159	0	1.197529408	4.691789863	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.305	0	13.81084647	17.8933	0.151984943	3.901815524	0	0.098809864	1.442781626	0.583201979	3.753517098	10.65978676	2.034807284	5.197351385	1.302072848	0.174780007	3.521032773	6.689674113	13.55901646	0.097601872	1.354169159	0	1.197529408	4.691789863	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.305	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	Medicare FFS Cost Sharing																			10000	4.881	0.0415	1.2659	0	1.9843	1.564	0.6322	1.7412	4.3729	0.9439	2.1008	0.604	0.0811	1.6094	1.9454	3.943	0.0284	0.4777		0.3482	1.3644	0																			29.9293	0	2.834318005	22.7743	0.193444091	5.167694832	0	2.083107201	3.006824405	1.215419917	5.494738828	15.03272492	2.978735478	7.298129925	1.90609236	0.255858857	5.130468729	8.635048362	17.50201302	0.125984727	1.831829541	0	1.545774012	6.056174281	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.2343
R5826_816_0	2011	5																															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	YES	254.416073	2.161003	35.667615	16.129752	0.495213	7.230896	2.922876	18.811782	53.424448	10.197996	26.047955	6.525696	0.875957	17.646622	33.527139	67.954736	0.489158	6.78679		6.001749	23.514193	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082409	0.082409	0.188329	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.071463	0.071463	0.106083	0	0.203164	0.203164	0.203164	0.203164	0.203164	0.203164	0.203164	0.203164	0.203164	0.203164	0.203164	0.203164	0.203164	0.203164		0.203164	0.203164	0																				18.1813	0.154431757	3.783727602	0	0.100609454	1.469057755	0.59382318	3.821876878	10.85392455	2.071865659	5.29200673	1.325786502	0.177962928	3.585158312	6.811507668	13.80595598	0.099379296	1.378831404	0	1.219339334	4.777237507	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.5038	0	14.16933871	18.1813	0.154431757	3.783727602	0	0.100609454	1.469057755	0.59382318	3.821876878	10.85392455	2.071865659	5.29200673	1.325786502	0.177962928	3.585158312	6.811507668	13.80595598	0.099379296	1.378831404	0	1.219339334	4.777237507	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.5038	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	Medicare FFS Cost Sharing																			10000	4.9702	0.0422	1.2285	0	2.0228	1.5944	0.6445	1.775	4.4578	0.9622	2.1415	0.6157	0.0827	1.6407	1.9831	4.0195	0.0289	0.4869		0.355	1.3909	0																			30.4424	0	2.918495479	23.1515	0.196648209	5.012238983	0	2.123401362	3.063442318	1.238305738	5.596877667	15.31169519	3.034105796	7.433539748	1.941523585	0.260614717	5.225816836	8.794621317	17.82544464	0.128312883	1.865758183	0	1.574339836	6.168090298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9463
R5826_817_0	2011	5																															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	YES	229.013659	1.945236	32.106349	14.519261	0.445768	6.50892	2.631039	16.933502	48.090234	9.179767	23.447173	5.874132	0.788497	15.88468	30.17959	61.169729	0.440317	6.109157		5.402498	21.166397	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.08114	0.08114	0.178192	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.072404	0.072404	0.111614	0	0.207659	0.207659	0.207659	0.207659	0.207659	0.207659	0.207659	0.207659	0.207659	0.207659	0.207659	0.207659	0.207659	0.207659		0.207659	0.207659	0																				16.5815	0.140842867	3.583518037	0	0.092567737	1.351635818	0.546358928	3.516394092	9.986369902	1.906261235	4.869016498	1.219816377	0.163738499	3.298596764	6.26706348	12.70244475	0.091435788	1.268621433	0	1.121877332	4.395392835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1035	0	10.59812923	16.5815	0.140842867	3.583518037	0	0.092567737	1.351635818	0.546358928	3.516394092	9.986369902	1.906261235	4.869016498	1.219816377	0.163738499	3.298596764	6.26706348	12.70244475	0.091435788	1.268621433	0	1.121877332	4.395392835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1035	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	Medicare FFS Cost Sharing																			10000	4.477	0.038	1.1419	0	1.8493	1.4577	0.5892	1.6228	4.0755	0.8797	1.9579	0.5629	0.0756	1.5	1.8131	3.6748	0.0265	0.4452		0.3246	1.2716	0																			27.7832	0	2.088505804	21.0585	0.1788701	4.725401675	0	1.941905746	2.809302413	1.135577587	5.139189237	14.06188872	2.785989806	6.826913064	1.782754387	0.239303007	4.798569178	8.080125633	16.37726359	0.11788806	1.713794362	0	1.446436798	5.666980381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.8866
R5826_818_0	2011	5																															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	YES	242.030891	2.055804	33.931287	15.344543	0.471105	6.87889	2.780588	17.896009	50.823703	9.70155	24.77992	6.208019	0.833315	16.787569	31.895011	64.646645	0.465345	6.456405		5.709578	22.369503	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.08023	0.08023	0.181937	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.070717	0.070717	0.108659	0	0.205566	0.205566	0.205566	0.205566	0.205566	0.205566	0.205566	0.205566	0.205566	0.205566	0.205566	0.205566	0.205566	0.205566		0.205566	0.205566	0																				17.1157	0.145380291	3.686939714	0	0.09684317	1.414065902	0.571594353	3.678810986	10.44762533	1.994308827	5.093909035	1.276157634	0.171301231	3.450953409	6.556529831	13.28915223	0.09565911	1.32721735	0	1.173695111	4.598409254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.1843	0	12.17988913	17.1157	0.145380291	3.686939714	0	0.09684317	1.414065902	0.571594353	3.678810986	10.44762533	1.994308827	5.093909035	1.276157634	0.171301231	3.450953409	6.556529831	13.28915223	0.09565911	1.32721735	0	1.173695111	4.598409254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.1843	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	Medicare FFS Cost Sharing																			10000	4.6457	0.0395	1.1845	0	1.9406	1.5296	0.6183	1.7029	4.2766	0.9231	2.0545	0.5907	0.0793	1.574	1.9025	3.8561	0.0278	0.4671		0.3406	1.3343	0																			29.0878	0	2.457480607	21.7614	0.184841156	4.871450027	0	2.03743357	2.943658348	1.189886939	5.381679763	14.72424295	2.917445609	7.148414464	1.866872869	0.250593949	5.024939189	8.459054245	17.14529854	0.123416841	1.794356669	0	1.514269257	5.932741061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.272
R5826_819_0	2011	5																															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	YES	297.977391	2.531012	41.774652	18.891501	0.580004	8.468976	3.423333	22.03275	62.571824	11.944105	30.507906	7.64303	1.02594	20.668088	39.267683	79.589998	0.572912	7.948832		7.029372	27.54031	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.084065	0.084065	0.158206	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.069521	0.069521	0.082933	0	0.196278	0.196278	0.196278	0.196278	0.196278	0.196278	0.196278	0.196278	0.196278	0.196278	0.196278	0.196278	0.196278	0.196278		0.196278	0.196278	0																				20.7157	0.175958485	3.464497214	0	0.113842025	1.662273671	0.671924955	4.324544105	12.28147247	2.344365041	5.988030774	1.500158642	0.201369451	4.056690976	7.707382284	15.62176563	0.112450022	1.560180847	0	1.379711077	5.405556966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2879	0	19.66313733	20.7157	0.175958485	3.464497214	0	0.113842025	1.662273671	0.671924955	4.324544105	12.28147247	2.344365041	5.988030774	1.500158642	0.201369451	4.056690976	7.707382284	15.62176563	0.112450022	1.560180847	0	1.379711077	5.405556966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2879	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	Medicare FFS Cost Sharing																			10000	5.8074	0.0493	1.141	0	2.3146	1.8244	0.7374	2.031	5.1008	1.101	2.4504	0.7046	0.0946	1.8773	2.2692	4.5993	0.0331	0.5572		0.4062	1.5915	0																			34.6902	0	4.188077847	26.5231	0.225286326	4.605524542	0	2.428409643	3.486638725	1.409370498	6.35557815	17.38225079	3.445402904	8.438466848	2.20471233	0.295943302	5.934004683	9.976548119	20.22104208	0.14555695	2.117343932	0	1.785918265	6.997032419	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.9781
R5826_820_0	2011	5																															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	YES	317.339083	2.69547	44.489045	20.119014	0.61769	9.019264	3.645772	23.464373	66.637557	12.720198	32.490219	8.139652	1.092603	22.011044	41.819181	84.761523	0.610139	8.465323		7.48612	29.329799	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.07344	0.07344	0.167295	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.060219	0.060219	0.083297	0	0.194581	0.194581	0.194581	0.194581	0.194581	0.194581	0.194581	0.194581	0.194581	0.194581	0.194581	0.194581	0.194581	0.194581		0.194581	0.194581	0																				19.1098	0.162318508	3.705803981	0	0.120190738	1.754977408	0.709397962	4.565721163	12.96640248	2.475108847	6.321979303	1.583821626	0.212599784	4.282930953	8.137218058	16.49298191	0.118721457	1.647191015	0	1.456656716	5.707021619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5309	0	21.50369656	19.1098	0.162318508	3.705803981	0	0.120190738	1.754977408	0.709397962	4.565721163	12.96640248	2.475108847	6.321979303	1.583821626	0.212599784	4.282930953	8.137218058	16.49298191	0.118721457	1.647191015	0	1.456656716	5.707021619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5309	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	Medicare FFS Cost Sharing																			10000	5.3637	0.0456	1.224	0	2.4461	1.928	0.7793	2.1464	5.3905	1.1636	2.5896	0.7446	0.0999	1.984	2.3981	4.8606	0.035	0.5888		0.4293	1.6819	0																			35.8989	0	4.738782264	24.4735	0.207877334	4.929812229	0	2.566245552	3.682982079	1.48873663	6.712135476	18.35694858	3.638694671	8.911621015	2.328400038	0.312546021	6.266892093	10.53529205	21.353537	0.153709101	2.236005737	0	1.88594012	7.388906025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.4298
R5826_821_0	2011	5																															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	YES	266.283291	2.261803	37.331328	16.882123	0.518312	7.568181	3.059213	19.689256	55.916429	10.673681	27.26296	6.830086	0.916816	18.469747	35.09101	71.124479	0.511975	7.10336		6.2817	24.611011	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.079584	0.079584	0.168847	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.068613	0.068613	0.096041	0	0.20191	0.20191	0.20191	0.20191	0.20191	0.20191	0.20191	0.20191	0.20191	0.20191	0.20191	0.20191	0.20191	0.20191		0.20191	0.20191	0																				18.2705	0.155189089	3.585338072	0	0.104652376	1.528091426	0.617685697	3.975457679	11.29008618	2.155122931	5.504664254	1.379062664	0.185114319	3.729226617	7.085225829	14.36074355	0.103372872	1.434239418	0	1.268338047	4.969209231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.7013	0	14.85536907	18.2705	0.155189089	3.585338072	0	0.104652376	1.528091426	0.617685697	3.975457679	11.29008618	2.155122931	5.504664254	1.379062664	0.185114319	3.729226617	7.085225829	14.36074355	0.103372872	1.434239418	0	1.268338047	4.969209231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.7013	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	Medicare FFS Cost Sharing																			10000	5.0114	0.0426	1.1644	0	2.1085	1.662	0.6718	1.8502	4.6467	1.003	2.2323	0.6418	0.0862	1.7102	2.0672	4.1899	0.0302	0.5076		0.37	1.4498	0																			31.4458	0	3.090927397	23.2819	0.197756229	4.749751337	0	2.213183401	3.190056471	1.289485842	5.825694601	15.93680645	3.158148934	7.736968943	2.020898889	0.271269449	5.439427008	9.152396765	18.55060455	0.133532703	1.941805496	0	1.638385945	6.419015323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1471
R5826_822_0	2011	5																															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	YES	237.909934	2.020801	33.353553	15.083278	0.463084	6.761766	2.733244	17.591302	49.95835	9.536365	24.358002	6.102318	0.819126	16.501738	31.351948	63.545932	0.457422	6.346474		5.612364	21.988626	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.079467	0.079467	0.185475	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.070344	0.070344	0.111655	0	0.206273	0.206273	0.206273	0.206273	0.206273	0.206273	0.206273	0.206273	0.206273	0.206273	0.206273	0.206273	0.206273	0.206273		0.206273	0.206273	0																				16.7355	0.142151226	3.72409096	0	0.095521726	1.394769758	0.56379444	3.628610637	10.30505873	1.967094618	5.024398147	1.258743441	0.168963577	3.403863002	6.46706037	13.10781003	0.094353808	1.309106231	0	1.157679159	4.535659851	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0843	0	11.71040848	16.7355	0.142151226	3.72409096	0	0.095521726	1.394769758	0.56379444	3.628610637	10.30505873	1.967094618	5.024398147	1.258743441	0.168963577	3.403863002	6.46706037	13.10781003	0.094353808	1.309106231	0	1.157679159	4.535659851	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0843	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	Medicare FFS Cost Sharing																			10000	4.5313	0.0385	1.1938	0	1.9116	1.5067	0.609	1.6774	4.2127	0.9093	2.0238	0.5819	0.0781	1.5504	1.8741	3.7985	0.0273	0.4602		0.3355	1.3144	0																			28.6344	0	2.357116933	21.2668	0.180639653	4.917904424	0	2.007088657	2.901485648	1.172840026	5.306011407	14.51771521	2.876424944	7.04817669	1.840623732	0.247070672	4.954307941	8.341130733	16.90628358	0.121696386	1.76925879	0	1.493159487	5.850035447	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.7186
R5826_823_0	2011	5																															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	YES	248.857065	2.113785	34.888275	15.777316	0.484392	7.0729	2.85901	18.400744	52.257121	9.975169	25.478806	6.383109	0.856818	17.26104	32.794569	66.469921	0.47847	6.6385		5.870609	23.000406	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.077046	0.077046	0.161891	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.067898	0.067898	0.099288	0	0.205127	0.205127	0.205127	0.205127	0.205127	0.205127	0.205127	0.205127	0.205127	0.205127	0.205127	0.205127	0.205127	0.205127		0.205127	0.205127	0																				16.8969	0.143521774	3.463987048	0	0.099361878	1.450842758	0.586460144	3.774489414	10.71934646	2.046176491	5.226391038	1.309348	0.175756506	3.540705352	6.727051555	13.63477548	0.098147116	1.36173559	0	1.204220412	4.718004282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.1772	0	12.18076598	16.8969	0.143521774	3.463987048	0	0.099361878	1.450842758	0.586460144	3.774489414	10.71934646	2.046176491	5.226391038	1.309348	0.175756506	3.540705352	6.727051555	13.63477548	0.098147116	1.36173559	0	1.204220412	4.718004282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.1772	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	Medicare FFS Cost Sharing																			10000	4.5906	0.039	1.1092	0	1.9929	1.5708	0.635	1.7488	4.3919	0.948	2.1099	0.6066	0.0814	1.6164	1.9538	3.9601	0.0285	0.4797		0.3498	1.3703	0																			29.5827	0	2.468741397	21.4875	0.182514404	4.573158272	0	2.092258678	3.021663763	1.221418415	5.523257328	15.11123558	2.99419566	7.336274145	1.915985069	0.257186647	5.157116669	8.680856561	17.5948602	0.126653025	1.841466104	0	1.553974515	6.088301709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7599
R5826_824_0	2011	5																															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	YES	268.457958	2.280275	37.636204	17.019995	0.522546	7.629988	3.084197	19.850053	56.373083	10.760849	27.485609	6.885866	0.924305	18.620585	35.37759	71.705336	0.516155	7.161371		6.333	24.812002	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082157	0.082157	0.186591	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.070219	0.070219	0.100871	0	0.200961	0.200961	0.200961	0.200961	0.200961	0.200961	0.200961	0.200961	0.200961	0.200961	0.200961	0.200961	0.200961	0.200961		0.200961	0.200961	0																				18.8508	0.16011863	3.796401534	0	0.105011367	1.533330018	0.619803313	3.989086501	11.32879113	2.162510976	5.52353547	1.383790517	0.185749257	3.742011382	7.109515864	14.40997603	0.103727025	1.439156278	0	1.272686013	4.986244734	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.7023	0	16.00743067	18.8508	0.16011863	3.796401534	0	0.105011367	1.533330018	0.619803313	3.989086501	11.32879113	2.162510976	5.52353547	1.383790517	0.185749257	3.742011382	7.109515864	14.40997603	0.103727025	1.439156278	0	1.272686013	4.986244734	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.7023	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	Medicare FFS Cost Sharing																			10000	5.1878	0.0441	1.2407	0	2.1182	1.6696	0.6749	1.8587	4.6681	1.0076	2.2426	0.6448	0.0866	1.7181	2.0767	4.2091	0.0303	0.5099		0.3717	1.4565	0																			31.816	0	3.352053923	24.0386	0.204183639	5.037100079	0	2.22323924	3.202938262	1.294692923	5.847832417	15.99688139	3.170150167	7.766106426	2.028578386	0.27230035	5.460076836	9.186193563	18.61910595	0.134025476	1.9490566	0	1.64443558	6.442718186	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.5183
R5826_825_0	2011	5																															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	YES	304.438772	2.585895	42.680499	19.301147	0.592581	8.652618	3.497566	22.510511	63.92864	12.203101	31.169443	7.808762	1.048186	21.11626	40.119168	81.315839	0.585336	8.121195		7.181798	28.137499	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.081886	0.081886	0.197876	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.066882	0.066882	0.093455	0	0.194887	0.194887	0.194887	0.194887	0.194887	0.194887	0.194887	0.194887	0.194887	0.194887	0.194887	0.194887	0.194887	0.194887		0.194887	0.194887	0																				20.3615	0.172949829	3.988706034	0	0.115486333	1.686282764	0.681630145	4.387005957	12.45886086	2.378225745	6.074519238	1.5218262	0.204277825	4.115284563	7.818704294	15.84739992	0.114074377	1.58271533	0	1.399639067	5.483632768	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3927	0	21.94511513	20.3615	0.172949829	3.988706034	0	0.115486333	1.686282764	0.681630145	4.387005957	12.45886086	2.378225745	6.074519238	1.5218262	0.204277825	4.115284563	7.818704294	15.84739992	0.114074377	1.58271533	0	1.399639067	5.483632768	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3927	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	Medicare FFS Cost Sharing																			10000	5.7217	0.0486	1.3224	0	2.3494	1.8518	0.7485	2.0616	5.1775	1.1176	2.4873	0.7152	0.096	1.9055	2.3033	4.6684	0.0336	0.5655		0.4123	1.6154	0																			35.2016	0	4.781858835	26.0831	0.221549431	5.311085998	0	2.464865311	3.538086596	1.430167061	6.448586907	17.63635517	3.495823019	8.561809867	2.236976318	0.300273866	6.020833082	10.12199872	20.51584973	0.147679231	2.148258267	0	1.811955716	7.099043694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.5943
R5826_826_0	2011	5																															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	YES	329.581171	2.799453	46.205313	20.895153	0.641519	9.367204	3.786416	24.369566	69.208255	13.210909	33.743605	8.453657	1.134752	22.860168	43.432452	88.031395	0.633676	8.791892		7.774915	30.461264	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.074746	0.074746	0.188998	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.060015	0.060015	0.086136	0	0.192174	0.192174	0.192174	0.192174	0.192174	0.192174	0.192174	0.192174	0.192174	0.192174	0.192174	0.192174	0.192174	0.192174		0.192174	0.192174	0																				19.7798	0.168009172	3.979940841	0	0.123283272	1.800133061	0.727650708	4.683196976	13.3000272	2.538793226	6.484643547	1.62457308	0.218069831	4.393129925	8.346588031	16.9173453	0.121776052	1.689573053	0	1.494136515	5.853862948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2445	0	24.58733283	19.7798	0.168009172	3.979940841	0	0.123283272	1.800133061	0.727650708	4.683196976	13.3000272	2.538793226	6.484643547	1.62457308	0.218069831	4.393129925	8.346588031	16.9173453	0.121776052	1.689573053	0	1.494136515	5.853862948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2445	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	Medicare FFS Cost Sharing																			10000	5.5967	0.0475	1.3219	0	2.5159	1.983	0.8016	2.2077	5.5444	1.1968	2.6636	0.7658	0.1028	2.0406	2.4665	4.9993	0.036	0.6056		0.4415	1.7299	0																			37.0674	0	5.505786188	25.3765	0.215547368	5.3018866	0	2.63917117	3.783180972	1.529239495	6.890889732	18.84446963	3.735598832	9.14821786	2.390408588	0.320869591	6.433731789	10.81312527	21.9166654	0.157762779	2.295198095	0	1.935675562	7.583764282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.3119
R5826_827_0	2011	5																															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	YES	250.048008	2.123901	35.055238	15.852821	0.486711	7.106749	2.872693	18.488802	52.507205	10.022907	25.600738	6.413656	0.860919	17.343646	32.951513	66.788023	0.48076	6.670268		5.898704	23.110479	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.084874	0.084874	0.167157	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.074069	0.074069	0.099367	0	0.203999	0.203999	0.203999	0.203999	0.203999	0.203999	0.203999	0.203999	0.203999	0.203999	0.203999	0.203999	0.203999	0.203999		0.203999	0.203999	0																				18.5208	0.157315223	3.483333834	0	0.099288557	1.449769689	0.586026499	3.771697119	10.71141731	2.044663005	5.222524951	1.30837941	0.175626615	3.53808644	6.7220757	13.6246899	0.098074559	1.360728002	0	1.203329717	4.714514606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.7923	0	13.15184296	18.5208	0.157315223	3.483333834	0	0.099288557	1.449769689	0.586026499	3.771697119	10.71141731	2.044663005	5.222524951	1.30837941	0.175626615	3.53808644	6.7220757	13.6246899	0.098074559	1.360728002	0	1.203329717	4.714514606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.7923	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	Medicare FFS Cost Sharing																			10000	5.0566	0.043	1.123	0	1.9952	1.5727	0.6357	1.7508	4.397	0.9491	2.1124	0.6073	0.0815	1.6183	1.9561	3.9647	0.0285	0.4803		0.3502	1.3719	0																			30.0943	0	2.663001053	23.5774	0.200265681	4.606296073	0	2.094519712	3.022430719	1.221728044	5.52251332	15.10845101	2.993792588	7.334878469	1.915726995	0.257152206	5.156390625	8.678169048	17.58941304	0.126613856	1.84102033	0	1.553493303	6.086416912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.8867
R5826_828_0	2011	5																															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	YES	250.157583	2.124832	35.0706	15.859768	0.486923	7.109862	2.873953	18.496905	52.530214	10.0273	25.611957	6.416467	0.861296	17.351248	32.965953	66.817289	0.48097	6.673192		5.901289	23.120605	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.076441	0.076441	0.137412	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.067634	0.067634	0.088646	0	0.205439	0.205439	0.205439	0.205439	0.205439	0.205439	0.205439	0.205439	0.205439	0.205439	0.205439	0.205439	0.205439	0.205439		0.205439	0.205439	0																				16.9192	0.143710887	3.108868408	0	0.100032974	1.460642939	0.59042203	3.799985666	10.79175463	2.059998485	5.261694834	1.318192564	0.176943789	3.564623038	6.772492418	13.72687703	0.098809996	1.370933891	0	1.212354911	4.749873971	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2274	0	11.58636654	16.9192	0.143710887	3.108868408	0	0.100032974	1.460642939	0.59042203	3.799985666	10.79175463	2.059998485	5.261694834	1.318192564	0.176943789	3.564623038	6.772492418	13.72687703	0.098809996	1.370933891	0	1.212354911	4.749873971	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2274	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	Medicare FFS Cost Sharing																			10000	4.5945	0.039	0.9864	0	2.0064	1.5815	0.6393	1.7606	4.4217	0.9545	2.1242	0.6108	0.082	1.6274	1.9671	3.987	0.0287	0.483		0.3521	1.3796	0																			29.6257	0	2.334432634	21.5136	0.182736405	4.09527402	0	2.106459455	3.042128274	1.229690738	5.560625633	15.21345991	3.014453341	7.385901755	1.928948126	0.258926918	5.192007699	8.73956181	17.71384645	0.127509437	1.853921507	0	1.564483468	6.129473836	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8531
R5826_831_0	2011	5																															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	YES	249.098861	2.115839	34.922173	15.792646	0.484863	7.079772	2.861789	18.418622	52.307895	9.984861	25.503561	6.389311	0.85765	17.277813	32.826433	66.534504	0.478935	6.644949		5.876314	23.022755	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.080364	0.080364	0.171629	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.070449	0.070449	0.102319	0	0.204554	0.204554	0.204554	0.204554	0.204554	0.204554	0.204554	0.204554	0.204554	0.204554	0.204554	0.204554	0.204554	0.204554		0.204554	0.204554	0																				17.5488	0.149058742	3.573201819	0	0.099180666	1.448195682	0.585390387	3.767602805	10.69978915	2.042443257	5.216855417	1.306959122	0.175435738	3.53424576	6.714778176	13.60989893	0.09796807	1.359250898	0	1.202023534	4.709396626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8404	0	12.77806094	17.5488	0.149058742	3.573201819	0	0.099180666	1.448195682	0.585390387	3.767602805	10.69978915	2.042443257	5.216855417	1.306959122	0.175435738	3.53424576	6.714778176	13.60989893	0.09796807	1.359250898	0	1.202023534	4.709396626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8404	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	Medicare FFS Cost Sharing																			10000	4.7781	0.0406	1.1499	0	1.9908	1.5692	0.6343	1.747	4.3874	0.947	2.1077	0.606	0.0813	1.6147	1.9518	3.956	0.0285	0.4792		0.3494	1.3689	0																			29.7879	0	2.595022676	22.3269	0.189644219	4.723086798	0	2.090023641	3.017397633	1.219693999	5.514568164	15.08715226	2.989485384	7.32456371	1.912971171	0.256782303	5.148990698	8.666569518	17.56590192	0.126444619	1.83848685	0	1.551417081	6.078281619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.6284
R5826_832_0	2011	5																															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	YES	213.774266	1.815793	29.969876	13.553098	0.416105	6.075793	2.45596	15.806686	44.890138	8.568913	21.886912	5.483246	0.736027	14.827655	28.171332	57.099277	0.411017	5.702633		5.042996	19.75791	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.080665	0.080665	0.178088	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.072946	0.072946	0.117384	0	0.210122	0.210122	0.210122	0.210122	0.210122	0.210122	0.210122	0.210122	0.210122	0.210122	0.210122	0.210122	0.210122	0.210122		0.210122	0.210122	0																				15.594	0.132454836	3.517983924	0	0.087432815	1.276657777	0.516051227	3.321332476	9.432405577	1.800517137	4.598921723	1.152150616	0.154655465	3.115616524	5.919416623	11.99781428	0.086363714	1.198248651	0	1.059644406	4.151571565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1132	0	8.913147232	15.594	0.132454836	3.517983924	0	0.087432815	1.276657777	0.516051227	3.321332476	9.432405577	1.800517137	4.598921723	1.152150616	0.154655465	3.115616524	5.919416623	11.99781428	0.086363714	1.198248651	0	1.059644406	4.151571565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.1132	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	Medicare FFS Cost Sharing																			10000	4.1863	0.0356	1.1065	0	1.7405	1.3718	0.5545	1.5272	3.8356	0.8279	1.8426	0.5298	0.0711	1.4117	1.7063	3.4585	0.0249	0.419		0.3054	1.1967	0																			26.1519	0	1.705010327	19.7803	0.168013407	4.624461588	0	1.827884368	2.648498759	1.070577433	4.848579433	13.26796305	2.628448324	6.441540018	1.681943282	0.225770775	4.527272622	7.625728134	15.45626453	0.111258838	1.617210397	0	1.365094105	5.348289658	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2651
R5826_833_0	2011	5																															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	YES	260.955753	2.216551	36.584439	16.544362	0.507942	7.416764	2.998008	19.295333	54.797707	10.460132	26.717507	6.693437	0.898474	18.100222	34.388944	69.70149	0.501732	6.961243		6.156021	24.118617	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.081143	0.081143	0.186963	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.069983	0.069983	0.103668	0	0.202262	0.202262	0.202262	0.202262	0.202262	0.202262	0.202262	0.202262	0.202262	0.202262	0.202262	0.202262	0.202262	0.202262		0.202262	0.202262	0																				18.2625	0.155120889	3.792635622	0	0.102737365	1.50012952	0.606383094	3.902712643	11.08349381	2.115687219	5.403936401	1.353827954	0.181727148	3.660987102	6.955576591	14.09796277	0.101481318	1.407994932	0	1.24512912	4.878279712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.8083	0	14.88963414	18.2625	0.155120889	3.792635622	0	0.102737365	1.50012952	0.606383094	3.902712643	11.08349381	2.115687219	5.403936401	1.353827954	0.181727148	3.660987102	6.955576591	14.09796277	0.101481318	1.407994932	0	1.24512912	4.878279712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.8083	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	Medicare FFS Cost Sharing																			10000	5.0041	0.0425	1.2342	0	2.0682	1.6301	0.6589	1.8148	4.5578	0.9838	2.1896	0.6295	0.0845	1.6775	2.0276	4.1096	0.0296	0.4978		0.363	1.422	0																			31.0252	0	3.095201958	23.2666	0.197625622	5.026836901	0	2.170899828	3.130275755	1.265321432	5.717526168	15.64125135	3.099510156	7.593503226	1.983376058	0.26623294	5.338444615	8.983170857	18.20760747	0.131063777	1.905843401	0	1.60809221	6.300329103	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.8335
R5826_834_0	2011	5																															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	YES	309.756082	2.63106	43.425954	19.638259	0.602931	8.803744	3.558655	22.903678	65.045215	12.41624	31.713847	7.945151	1.066493	21.485074	40.819887	82.736096	0.595559	8.263038		7.307235	28.628947	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082283	0.082283	0.159436	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.067233	0.067233	0.080881	0	0.194618	0.194618	0.194618	0.194618	0.194618	0.194618	0.194618	0.194618	0.194618	0.194618	0.194618	0.194618	0.194618	0.194618		0.194618	0.194618	0																				20.8258	0.176894057	3.512334585	0	0.117341225	1.71336705	0.692578319	4.457468005	12.65896965	2.416423796	6.172085475	1.546269397	0.207558735	4.181382132	7.944284768	16.10193353	0.115906501	1.608135929	0	1.422119461	5.571708407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.4426	0	21.31194147	20.8258	0.176894057	3.512334585	0	0.117341225	1.71336705	0.692578319	4.457468005	12.65896965	2.416423796	6.172085475	1.546269397	0.207558735	4.181382132	7.944284768	16.10193353	0.115906501	1.608135929	0	1.422119461	5.571708407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.4426	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	Medicare FFS Cost Sharing																			10000	5.8695	0.0499	1.1611	0	2.3909	1.8846	0.7618	2.0981	5.2691	1.1374	2.5313	0.7278	0.0977	1.9393	2.344	4.7511	0.0342	0.5755		0.4196	1.644	0																			35.6869	0	4.599415595	26.6954	0.226749844	4.673472638	0	2.508290703	3.597937017	1.45436015	6.555527173	17.92807595	3.553796381	8.70338694	2.274073585	0.30525333	6.120648057	10.28833434	20.85298825	0.150106007	2.183685645	0	1.841731754	7.215703026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.1295
R5826_835_0	2011	5																															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	YES	233.981967	1.987437	32.802875	14.834248	0.455439	6.650127	2.688117	17.300863	49.133521	9.378917	23.955846	6.001567	0.805603	16.229287	30.834318	62.496769	0.44987	6.241691		5.519702	21.625587	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.086518	0.086518	0.189963	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.076365	0.076365	0.113274	0	0.206151	0.206151	0.206151	0.206151	0.206151	0.206151	0.206151	0.206151	0.206151	0.206151	0.206151	0.206151	0.206151	0.206151		0.206151	0.206151	0																				17.868	0.151770627	3.715712863	0	0.093889205	1.370930331	0.554158008	3.566590208	10.12892449	1.933473118	4.938521609	1.237229039	0.166075864	3.345683744	6.35652549	12.88377143	0.09274115	1.286730841	0	1.137892087	4.458136386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2868	0	11.8858891	17.868	0.151770627	3.715712863	0	0.093889205	1.370930331	0.554158008	3.566590208	10.12892449	1.933473118	4.938521609	1.237229039	0.166075864	3.345683744	6.35652549	12.88377143	0.09274115	1.286730841	0	1.137892087	4.458136386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2868	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	Medicare FFS Cost Sharing																			10000	4.8478	0.0412	1.1945	0	1.8802	1.482	0.599	1.6499	4.1435	0.8944	1.9906	0.5723	0.0768	1.525	1.8433	3.7361	0.0269	0.4526		0.33	1.2928	0																			28.5789	0	2.364488351	22.7158	0.192947874	4.910257901	0	1.974072921	2.852909807	1.153204118	5.216452135	14.27242007	2.827874881	6.92907501	1.809556404	0.242900782	4.87067438	8.199828344	16.61988384	0.119634804	1.739329031	0	1.467864994	5.750932942	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.8657
R5826_836_0	2011	5																															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	YES	260.786203	2.215111	36.560669	16.533612	0.507612	7.411945	2.99606	19.282796	54.762103	10.453336	26.700151	6.689087	0.897891	18.088461	34.3666	69.656202	0.501406	6.956721		6.152021	24.102946	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.073876	0.073876	0.167599	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.064454	0.064454	0.098474	0	0.203437	0.203437	0.203437	0.203437	0.203437	0.203437	0.203437	0.203437	0.203437	0.203437	0.203437	0.203437	0.203437	0.203437		0.203437	0.203437	0																				16.8087	0.142772764	3.600275319	0	0.103267062	1.507863855	0.609509458	3.92283417	11.14063795	2.126595316	5.431798619	1.360807792	0.182664251	3.67986224	6.991438004	14.17064877	0.102004532	1.41525445	0	1.251548696	4.903431025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.4519	0	13.56439904	16.8087	0.142772764	3.600275319	0	0.103267062	1.507863855	0.609509458	3.92283417	11.14063795	2.126595316	5.431798619	1.360807792	0.182664251	3.67986224	6.991438004	14.17064877	0.102004532	1.41525445	0	1.251548696	4.903431025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.4519	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	Medicare FFS Cost Sharing																			10000	4.5826	0.0389	1.1607	0	2.0752	1.6357	0.6612	1.821	4.5733	0.9872	2.197	0.6317	0.0848	1.6832	2.0345	4.1237	0.0297	0.4995		0.3642	1.4269	0																			30.611	0	2.816833631	21.3913	0.181696875	4.760961833	0	2.178488159	3.143573577	1.270696469	5.743841418	15.71395081	3.11377596	7.628838444	1.992504453	0.267458288	5.363045236	9.025952447	18.29431948	0.131687889	1.914801927	0	1.615750447	6.330333694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.0629
R5826_837_0	2011	5																															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	YES	244.723997	2.078679	34.308844	15.515283	0.476347	6.955432	2.811528	18.09514	51.389224	9.8095	25.055652	6.277097	0.842587	16.974368	32.24991	65.365976	0.470524	6.528245		5.773109	22.618411	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.079682	0.079682	0.169461	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.070242	0.070242	0.103068	0	0.205399	0.205399	0.205399	0.205399	0.205399	0.205399	0.205399	0.205399	0.205399	0.205399	0.205399	0.205399	0.205399	0.205399		0.205399	0.205399	0																				17.1899	0.14601057	3.536143933	0	0.097841197	1.428638777	0.57748504	3.716723661	10.55529522	2.014861491	5.146405865	1.289309447	0.173066527	3.486518213	6.624099264	13.4261061	0.096645159	1.340894995	0	1.185790815	4.645799001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6775	0	12.10678991	17.1899	0.14601057	3.536143933	0	0.097841197	1.428638777	0.57748504	3.716723661	10.55529522	2.014861491	5.146405865	1.289309447	0.173066527	3.486518213	6.624099264	13.4261061	0.096645159	1.340894995	0	1.185790815	4.645799001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6775	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	Medicare FFS Cost Sharing																			10000	4.6689	0.0397	1.1336	0	1.9616	1.5461	0.625	1.7213	4.3229	0.9331	2.0767	0.5971	0.0802	1.591	1.9231	3.8979	0.0281	0.4722		0.3443	1.3488	0																			29.3113	0	2.440780138	21.8588	0.185667805	4.669730486	0	2.059421466	2.974775835	1.202465226	5.438011211	14.87817031	2.947983204	7.223133614	1.886413861	0.253216983	5.077528464	8.547202181	17.32396156	0.124703205	1.813086728	0	1.530048586	5.994563104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9889
R5826_838_0	2011	5																															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	YES	232.126093	1.971673	32.542693	14.716588	0.451826	6.597381	2.666797	17.163638	48.743809	9.304526	23.765831	5.953964	0.799213	16.100561	30.58975	62.001065	0.446301	6.192184		5.475921	21.45406	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.079318	0.079318	0.18628	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.070578	0.070578	0.114101	0	0.207187	0.207187	0.207187	0.207187	0.207187	0.207187	0.207187	0.207187	0.207187	0.207187	0.207187	0.207187	0.207187	0.207187		0.207187	0.207187	0																				16.383	0.139156737	3.713153814	0	0.093612473	1.366891577	0.55252567	3.556082666	10.09908356	1.927776828	4.923971227	1.233583939	0.165586544	3.335826932	6.337798533	12.84581465	0.092467765	1.282940026	0	1.134539644	4.445002329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6288	0	11.04723928	16.383	0.139156737	3.713153814	0	0.093612473	1.366891577	0.55252567	3.556082666	10.09908356	1.927776828	4.923971227	1.233583939	0.165586544	3.335826932	6.337798533	12.84581465	0.092467765	1.282940026	0	1.134539644	4.445002329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6288	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	Medicare FFS Cost Sharing																			10000	4.4259	0.0376	1.1868	0	1.871	1.4748	0.5961	1.6418	4.1233	0.89	1.9809	0.5695	0.0765	1.5176	1.8343	3.7179	0.0268	0.4504		0.3284	1.2865	0																			28.0361	0	2.199763085	20.8089	0.176750091	4.899961817	0	1.964639733	2.841653969	1.148654905	5.197910042	14.22240063	2.817822891	6.904830465	1.803124034	0.242036997	4.853390828	8.172124685	16.5637324	0.119230393	1.733333869	0	1.462905512	5.731503312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.6649
R5826_839_0	2011	5																															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	YES	236.084013	2.005292	33.09757	14.967516	0.459531	6.70987	2.712267	17.45629	49.574926	9.463175	24.171057	6.055484	0.81284	16.375088	31.111327	63.058229	0.453912	6.297766		5.56929	21.819867	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.077615	0.077615	0.164359	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.069177	0.069177	0.104152	0	0.207106	0.207106	0.207106	0.207106	0.207106	0.207106	0.207106	0.207106	0.207106	0.207106	0.207106	0.207106	0.207106	0.207106		0.207106	0.207106	0																				16.3316	0.138720085	3.447178111	0	0.095171627	1.389654336	0.561726769	3.615302397	10.26726462	1.959880322	5.005970931	1.254127069	0.168344041	3.391378975	6.44334249	13.05973758	0.094007899	1.304305125	0	1.153433375	4.519025375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2002	0	10.7885687	16.3316	0.138720085	3.447178111	0	0.095171627	1.389654336	0.561726769	3.615302397	10.26726462	1.959880322	5.005970931	1.254127069	0.168344041	3.391378975	6.44334249	13.05973758	0.094007899	1.304305125	0	1.153433375	4.519025375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2002	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	Medicare FFS Cost Sharing																			10000	4.4125	0.0375	1.096	0	1.9029	1.4999	0.6063	1.6698	4.1935	0.9052	2.0146	0.5792	0.0778	1.5434	1.8656	3.7812	0.0272	0.4581		0.334	1.3084	0																			28.313	0	2.148950004	20.7441	0.176199544	4.543187566	0	1.998060722	2.889530321	1.168007317	5.285088328	14.46079698	2.865082828	7.020562452	1.833365939	0.246096603	4.934785881	8.308905325	16.84096759	0.12122633	1.762368829	0	1.487390997	5.827434308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5131
R5826_840_0	2011	5																															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	YES	226.574736	1.92452	31.764426	14.364636	0.441021	6.439602	2.60302	16.753166	47.578088	9.082006	23.197469	5.811574	0.780099	15.715511	29.858187	60.518292	0.435628	6.044097		5.344963	20.940981	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.082417	0.082417	0.18496	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.073553	0.073553	0.115003	0	0.207823	0.207823	0.207823	0.207823	0.207823	0.207823	0.207823	0.207823	0.207823	0.207823	0.207823	0.207823	0.207823	0.207823		0.207823	0.207823	0																				16.6653	0.14155422	3.653004283	0	0.091654307	1.338297406	0.540967425	3.481693218	9.887820982	1.887449733	4.8209676	1.207778743	0.162122514	3.266044643	6.205217997	12.577093	0.090533518	1.256102371	0	1.110806246	4.352017494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7364	0	10.58070876	16.6653	0.14155422	3.653004283	0	0.091654307	1.338297406	0.540967425	3.481693218	9.887820982	1.887449733	4.8209676	1.207778743	0.162122514	3.266044643	6.205217997	12.577093	0.090533518	1.256102371	0	1.110806246	4.352017494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7364	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	Medicare FFS Cost Sharing																			10000	4.4987	0.0382	1.1656	0	1.8305	1.4428	0.5832	1.6063	4.0341	0.8708	1.938	0.5572	0.0748	1.4847	1.7946	3.6375	0.0262	0.4406		0.3213	1.2587	0																			27.6038	0	2.079416105	21.164	0.179766254	4.818565104	0	1.922191967	2.781145199	1.124196033	5.087990592	13.92190717	2.758234695	6.758959924	1.76499392	0.236918939	4.750768253	7.999848305	16.21455355	0.116717127	1.696749728	0	1.432066157	5.610678231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3402
R5826_841_0	2011	5																															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	YES	262.98477	2.233785	36.868895	16.672999	0.511892	7.474432	3.021318	19.44536	55.223776	10.541463	26.925248	6.74548	0.905459	18.240957	34.656329	70.243441	0.505633	7.015371		6.203887	24.306147	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.080998	0.080998	0.20393	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.069499	0.069499	0.108505	0	0.201668	0.201668	0.201668	0.201668	0.201668	0.201668	0.201668	0.201668	0.201668	0.201668	0.201668	0.201668	0.201668	0.201668		0.201668	0.201668	0																				18.2772	0.155245824	4.000459452	0	0.103232236	1.507353753	0.609303158	3.92150686	11.13686846	2.12587576	5.429960914	1.360347461	0.182602106	3.678617316	6.989072557	14.16585426	0.101969996	1.414775839	0	1.251125484	4.901772053	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.3131	0	15.7158969	18.2772	0.155245824	4.000459452	0	0.103232236	1.507353753	0.609303158	3.92150686	11.13686846	2.12587576	5.429960914	1.360347461	0.182602106	3.678617316	6.989072557	14.16585426	0.101969996	1.414775839	0	1.251125484	4.901772053	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.3131	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	Medicare FFS Cost Sharing																			10000	5.0147	0.0426	1.3073	0	2.0791	1.6387	0.6624	1.8244	4.5818	0.989	2.2011	0.6329	0.085	1.6863	2.0383	4.1313	0.0297	0.5005		0.3649	1.4295	0																			31.2395	0	3.296468553	23.2919	0.197840409	5.307794057	0	2.182301748	3.146096929	1.271716551	5.745891164	15.71866269	3.114887175	7.631074856	1.993215485	0.267553324	5.364921794	9.027359909	18.29717278	0.131708395	1.915249983	0	1.616002686	6.331320791	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.5526
R5826_842_0	2011	5																															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	YES	272.661821	2.315982	38.22556	17.286516	0.530727	7.749468	3.132493	20.160891	57.255846	10.929357	27.916015	6.993693	0.938779	18.91217	35.931577	72.82819	0.524239	7.273514		6.432171	25.200541	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.074653	0.074653	0.190218	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.064012	0.064012	0.10237	0	0.201083	0.201083	0.201083	0.201083	0.201083	0.201083	0.201083	0.201083	0.201083	0.201083	0.201083	0.201083	0.201083	0.201083		0.201083	0.201083	0																				17.4536	0.14825064	3.913150577	0	0.106720177	1.558286274	0.62989109	4.054012445	11.51317728	2.197707894	5.613436044	1.40631277	0.188772498	3.80291588	7.225229298	14.64451093	0.105415551	1.462580016	0	1.293400241	5.067400386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.3848	0	15.94570822	17.4536	0.14825064	3.913150577	0	0.106720177	1.558286274	0.62989109	4.054012445	11.51317728	2.197707894	5.613436044	1.40631277	0.188772498	3.80291588	7.225229298	14.64451093	0.105415551	1.462580016	0	1.293400241	5.067400386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.3848	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	Medicare FFS Cost Sharing																			10000	4.7892	0.0407	1.2768	0	2.1506	1.6952	0.6852	1.8872	4.7395	1.0231	2.2769	0.6547	0.0879	1.7443	2.1084	4.2735	0.0308	0.5177		0.3774	1.4788	0																			31.8377	0	3.388318843	22.2428	0.18892977	5.189924058	0	2.257354613	3.253437569	1.315105981	5.941194974	16.2526834	3.220762454	7.890315782	2.060965052	0.276648024	5.547265595	9.333677603	18.91803563	0.136177786	1.980281199	0	1.670837088	6.546156481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2225
R5826_843_0	2011	5																															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	YES	234.266961	1.989857	32.842829	14.852316	0.455994	6.658227	2.69139	17.321936	49.193367	9.39034	23.985023	6.008877	0.806584	16.249053	30.871875	62.572891	0.450418	6.249294		5.526425	21.651927	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.084294	0.084294	0.167173	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.074829	0.074829	0.104654	0	0.206722	0.206722	0.206722	0.206722	0.206722	0.206722	0.206722	0.206722	0.206722	0.206722	0.206722	0.206722	0.206722	0.206722		0.206722	0.206722	0																				17.53	0.148899009	3.437133426	0	0.094263992	1.376402002	0.556369524	3.580825254	10.16935121	1.941189865	4.958231925	1.242167071	0.166738658	3.359036734	6.381895744	12.93519317	0.09311131	1.291866554	0	1.142433629	4.475929653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.881	0	11.12385001	17.53	0.148899009	3.437133426	0	0.094263992	1.376402002	0.556369524	3.580825254	10.16935121	1.941189865	4.958231925	1.242167071	0.166738658	3.359036734	6.381895744	12.93519317	0.09311131	1.291866554	0	1.142433629	4.475929653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.881	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	Medicare FFS Cost Sharing																			10000	4.7481	0.0403	1.0967	0	1.8867	1.4871	0.6011	1.6556	4.1578	0.8975	1.9974	0.5743	0.0771	1.5303	1.8497	3.749	0.027	0.4542		0.3311	1.2973	0																			28.4581	0	2.196854561	22.2781	0.189229643	4.533863254	0	1.980932646	2.863492811	1.157482204	5.236377747	14.32713774	2.8386761	6.955651002	1.816468369	0.243828189	4.889287681	8.231556275	16.68419158	0.120097774	1.746025757	0	1.473544476	5.773185365	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.3391
R5826_844_0	2011	5																															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	YES	220.239432	1.870708	30.876254	13.962984	0.428689	6.259543	2.530236	16.284727	46.247747	8.828061	22.548837	5.649075	0.758287	15.276087	29.023316	58.826127	0.423448	5.875097		5.195512	20.355445	0																			6700	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.075348	0.075348	0.139696	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0																			NO	0.06844	0.06844	0.098193	0	0.210215	0.210215	0.210215	0.210215	0.210215	0.210215	0.210215	0.210215	0.210215	0.210215	0.210215	0.210215	0.210215	0.210215		0.210215	0.210215	0																				15.0732	0.128031256	3.031832009	0	0.090116858	1.315849832	0.531893561	3.423293886	9.721970136	1.855790843	4.74010377	1.187520301	0.159403302	3.211262629	6.101136373	12.36613429	0.089015121	1.235033516	0	1.092174555	4.279019871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.6328	0	8.386803387	15.0732	0.128031256	3.031832009	0	0.090116858	1.315849832	0.531893561	3.423293886	9.721970136	1.855790843	4.74010377	1.187520301	0.159403302	3.211262629	6.101136373	12.36613429	0.089015121	1.235033516	0	1.092174555	4.279019871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.6328	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	Medicare FFS Cost Sharing																			10000	4.0423	0.0343	0.9384	0	1.794	1.4141	0.5716	1.5742	3.9536	0.8534	1.8993	0.5461	0.0733	1.4551	1.7588	3.5649	0.0257	0.4319		0.3148	1.2335	0																			26.4793	0	1.614371243	19.1155	0.162366598	3.970185651	0	1.884127228	2.729906452	1.103484148	4.997538456	13.67555879	2.709199882	6.639425174	1.733616415	0.232706878	4.666359208	7.859955916	15.93101113	0.114676329	1.666888073	0	1.407023777	5.51256437	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.1121
R5941_003_0	2011	12	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	996.9979228	77.40401439	344.9513254	365.0508507	29.77365255	11.2365317	2.310740223	274.6930251	324.8362407	5550.428878	610.0313141	75.60451463	0.008571718	97.58833496	2921.854648	2721.47778	7.044823005	910.6904562	452.646507	989.803058	27.39916082	1.238919274	0	745.9758882	302.4	239.2	129.6	0	4545.850315	0	3.566323267	3.245456753	0.354418451	0	0	0	0	0	0	0	3300	1A: $170/day (days1-9) w/$1530 yrly max	1B: $170/day (days1-9) w/$1530 yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $150 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $30 copay	9A: $30-$200 copay; 9B: $200 copay	8A: $0-$150 copay	8B: $95-$150 copay	9A: $200 copay	12: 20% coin	3: $30 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $20 copay; 7G: $20 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $30 copay; 7F: $30 copay; 7G: $30 copay	7E: $40 copay; 7H: $40 copay	7C: $30-$50 copay; 7I: $30-$50 copay	8B: $95-$150 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$30; 17B: $0; 18A: $30	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $30 copay	17B: $30 copay	18A: $30 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 0% coin; 14J: 0% coin									170	170	128	0	150	0.2	0.053619939	49.92239038	164.3772475	20.45924027	116.4191115	200	0.2	9.580193757	17.7140642	27.76996967	40	44.44970378	109.8264917	15.55830408	0.2	0	0	0	30	30	30	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	97.04440375	73.93562495	110.6019881	0	129.6117048	0.172815606	0.046331811	43.13684083	142.0347685	17.67838007	100.5951967	172.8156064	0.172815606	8.278034968	15.30633373	23.99542074	34.56312128	38.40801256	94.89865886	13.44358877	0.172815606	0	0	0	30	30	30	0	0	0	0.172815606	0.172815606	0	0	0	0	0	0	0	0		8.0628	0.476909515	3.179358533	0	0.321584489	1.941848039	0.10706078	0.987449109	3.844836688	8.176882606	5.113851672	1.088803337	0.001481327	0.067319971	3.726906862	5.441917029	0.020290923	2.91481754	3.579628871	1.10887544	4.735002592	0	0	0	0.756	0.598	0.324	0	0	0	0.616316318	0.560865577	0	0	0	0	0	0	0	0	57.7528		8.820722031	8.0628	0.476909515	3.179358533	0	0.321584489	1.941848039	0.10706078	0.987449109	3.844836688	8.176882606	5.113851672	1.088803337	0.001481327	0.067319971	3.726906862	5.441917029	0.020290923	2.91481754	3.579628871	1.10887544	4.735002592	0	0	0	0.756	0.598	0.324	0	0	0	0.616316318	0.560865577	0	0	0	0	0	0	0	0	57.7528	YES	1A: 25% coin	1B: 25% coin	2: 25% coin (for days 1-100)	6: $0 copay	10A: $150 copay	11A: 25% coin	11B: 25% coin; 11C: 25% coin	4A: $50 copay; 4B: $30 copay	9A: $40-$275 copay; 9B: $275 copay	8A: 0% - 25%	8B: 25% coin	9A: $275 copay	12: 20% coin	3: $40 copay; 5: $50 copay; 9C: $50 copay; 9D: $0 copay	7A: $30 copay; 7G: $30 copay; 14B: $0 copay; 14C: $0 copay	7B: $40 copay; 7D: $40 copay; 7F: $40 copay; 7G: $40 copay	7E: $50 copay; 7H: $50 copay	7C: $40-$80 copay; 7I: $40-$80 copay	8B: 25% coin	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $40; 17B: $0; 18A: $40	15: 20% coinsurance	13A: $0 copay	10B: Not covered	$16A: 20% coinsurance	17A: $40 copay	17B: $40 copay	18A: $40 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin								3300	21.5537	0.3542	1.5085	0	1.6986	0.7674	0.5738	0.4948	3.6068	1.4003	1.6075	0.7979	0.0281	0.0392	2.6971	3.0604	0.0043	1.5841	2.4287	0.3987	2.3651	0	0	0.1734	0.252	0.1993	0.108	0	0	0	0.3417	0.4292	0.0499	0	0	0	0	0	0	0	48.5227		7.517489413	29.6164	0.831073657	4.687866403	0	2.020146456	2.70927446	0.680827442	1.482293483	7.451614569	9.57720034	6.721393706	1.886685708	0.029626532	0.106471263	6.424029199	8.502319891	0.024544027	4.498889649	6.008352904	1.507527838	7.100095984	0	0	0.173441296	1.008	0.797333333	0.432	0	0	0	0.958048595	0.99003306	0.04992946	0	0	0	0	0	0	0	106.2754
R5941_007_0	2011	4	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	960.0586783	36.07913331	472.189092	496.6984876	100.8504201	8.485753022	1.467912086	268.7406635	605.6666017	6485.882291	669.1556902	90.72149295	0.116724722	129.3043073	3249.552263	3268.617749	10.30053863	1285.381644	541.7955181	1270.25931	28.94934588	2.920916597	0	2131.35968	302.4	239.2	129.6	0	5796.697699	0	3.46653668	6.864142448	0.227827932	0	0	0	0	0	0	0	5000	1A: $240/day (days1-7) w/$1680 yrly max	1B: $240/day (days1-7) w/$1680 yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $25 copay	9A: $25-$225 copay; 9B: $225 copay	8A: $0-$125 copay	8B: $75-$125 copay	9A: $225 copay	12: 20% coin	3: $25 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $5 copay; 7G: $5 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: $75-$125 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$25; 17B: $0; 18A: $25	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $25 copay	17B: $25 copay	18A: $25 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 0% coin; 14J: 0% coin									240	240	128	0	125	0.2	0.063722235	49.58178438	153.1500481	18.48163543	94.88652685	225	0.2	5.216072782	4.345744883	23.93201864	40	42.22380691	89.47933884	12.77719784	0.2	0	0	0	25	25	25	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	132.4755024	113.3696813	115.3463834	0	112.6429526	0.180228724	0.057422886	44.68030869	138.0101888	16.65460786	85.50638834	202.7573146	0.180228724	4.700430711	3.916140277	21.56618592	36.04574482	38.04971423	80.63373535	11.51409032	0.180228724	0	0	0	25	25	25	0	0	0	0.180228724	0.180228724	0	0	0	0	0	0	0	0		10.5987	0.340856654	4.538775337	0	0.946674091	1.52937644	0.084291748	1.000617984	6.96568017	9.001652181	4.768090525	1.532870524	0.021037148	0.050648828	1.060475208	5.874301507	0.030940882	4.075700351	3.640583035	1.218823369	5.217503671	0	0	0	0.63	0.498333333	0.27	0	0	0	0.624769483	1.237115635	0	0	0	0	0	0	0	0	65.7578		7.060300181	10.5987	0.340856654	4.538775337	0	0.946674091	1.52937644	0.084291748	1.000617984	6.96568017	9.001652181	4.768090525	1.532870524	0.021037148	0.050648828	1.060475208	5.874301507	0.030940882	4.075700351	3.640583035	1.218823369	5.217503671	0	0	0	0.63	0.498333333	0.27	0	0	0	0.624769483	1.237115635	0	0	0	0	0	0	0	0	65.7578	YES	1A: 20% coin	1B: 20% coin	2: 30% coin (for days 1-100)	6: $0 copay	10A: $125 copay	11A: 30% coin	11B: 30% coin; 11C: 30% coin	4A: $50 copay; 4B: $25 copay	9A: $45-$300 copay; 9B: $300 copay	8A: 0% - 30%	8B: 30% coin	9A: $300 copay	12: 20% coin	3: $45 copay; 5: $50 copay; 9C: $50 copay; 9D: $0 copay	7A: $30 copay; 7G: $30 copay; 14B: $0 copay; 14C: $0 copay	7B: $45 copay; 7D: $45 copay; 7F: $45 copay; 7G: $45 copay	7E: $50 copay; 7H: $50 copay	7C: $45-$90 copay; 7I: $45-$90 copay	8B: 30% coin	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $45; 17B: $0; 18A: $45	15: 20% coinsurance	13A: $0 copay	10B: Not covered	$16A: 20% coinsurance	17A: $45 copay	17B: $45 copay	18A: $45 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin								5000	14.3224	0.2662	1.5391	0	1.2566	0.5983	0.5025	0.4638	1.7579	1.1634	1.5268	0.7114	0.0014	0.0243	1.9473	2.7012	0.0326	1.3564	1.8924	0.342	1.2066	0	0	0	0.2835	0.2243	0.1215	0	0	0	0.3609	0.1589	0.0284	0	0	0	0	0	0	0	34.7901		3.747477684	24.9211	0.607007618	6.077885143	0	2.203277639	2.127668555	0.586823475	1.464454392	8.723597882	10.1650201	6.294872521	2.24430339	0.022443711	0.074980106	3.007785062	8.575482866	0.063501389	5.432082071	5.532991927	1.560776027	6.424116657	0	0	0	0.9135	0.722583333	0.3915	0	0	0	0.985691302	1.396002732	0.028425789	0	0	0	0	0	0	0	100.5479
R5941_008_0	2011	7	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	960.0586783	36.07913331	472.189092	496.6984876	100.8504201	8.485753023	1.467912086	268.7406635	605.6666017	6485.882291	669.1556902	90.72149296	0.116724722	129.3043073	3249.552263	3268.61775	10.30053863	1285.381644	541.7955182	1270.259311	28.94934588	2.920916597	0	745.9758882	302.4	239.2	129.6	0	5794.639381	0	3.466536681	6.864142449	0.227827932	0	0	0	0	0	0	0	4800	1A: $270/day (days1-5) w/$1350 yrly max	1B: $270/day (days1-5) w/$1350 yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $35 copay	9A: $35-$250 copay; 9B: $250 copay	8A: $0-$125 copay	8B: $75-$125 copay	9A: $250 copay	12: 20% coin	3: $35 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $20 copay; 7G: $20 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $35 copay; 7F: $35 copay; 7G: $35 copay	7E: $40 copay; 7H: $40 copay	7C: $35-$50 copay; 7I: $35-$50 copay	8B: $75-$125 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$35; 17B: $0; 18A: $35	15: 20% coinsurance	13A: $0 copay	10B: Not covered	16A: $0 Co-Pay	17A: $35 copay	17B: $35 copay	18A: $35 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 0% coin; 14J: 0% coin									270	270	128	0	125	0.2	0.063722235	49.74907063	172.7613017	18.48163543	94.88652686	250	0.2	5.216072782	17.38297953	33.22003106	40	45.33428415	89.47933884	17.88807698	0.2	0	0	0	35	35	35	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	123.6326676	96.22358042	113.8896844	0	111.220395	0.177952632	0.056697697	44.26489028	153.7166417	16.44427833	84.42653595	222.4407899	0.177952632	4.6410694	15.46673479	29.55795981	35.59052639	40.33677591	79.61541926	15.91615189	0.177952632	0	0	0	35	35	35	0	0	0	0.177952632	0.177952632	0	0	0	0	0	0	0	0		9.8912	0.289305282	4.481455557	0	0.93471863	1.510062084	0.083227235	0.991314665	7.758419666	8.887971136	4.707874745	1.681680046	0.020771472	0.050009189	4.188330255	8.051139339	0.030550133	4.320679276	3.594606444	1.684803344	5.151612293	0	0	0	0.882	0.697666667	0.378	0	0	0	0.616879326	1.221492215	0	0	0	0	0	0	0	0	72.1058		8.690972478	9.8912	0.289305282	4.481455557	0	0.93471863	1.510062084	0.083227235	0.991314665	7.758419666	8.887971136	4.707874745	1.681680046	0.020771472	0.050009189	4.188330255	8.051139339	0.030550133	4.320679276	3.594606444	1.684803344	5.151612293	0	0	0	0.882	0.697666667	0.378	0	0	0	0.616879326	1.221492215	0	0	0	0	0	0	0	0	72.1058	YES	1A: 25% coin	1B: 25% coin	2: 25% coin (for days 1-100)	6: $0 copay	10A: $125 copay	11A: 30% coin	11B: 30% coin; 11C: 30% coin	4A: $50 copay; 4B: $35 copay	9A: $45-$300 copay; 9B: $300 copay	8A: 0% - 30%	8B: 30% coin	9A: $300 copay	12: 20% coin	3: $45 copay; 5: $50 copay; 9C: $50 copay; 9D: $0 copay	7A: $30 copay; 7G: $30 copay; 14B: $0 copay; 14C: $0 copay	7B: $45 copay; 7D: $45 copay; 7F: $45 copay; 7G: $45 copay	7E: $50 copay; 7H: $50 copay	7C: $45-$90 copay; 7I: $45-$90 copay	8B: 30% coin	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $45; 17B: $0; 18A: $45	15: 20% coinsurance	13A: $0 copay	10B: Not covered	$16A: 20% coinsurance	17A: $45 copay	17B: $45 copay	18A: $45 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin								4800	17.6769	0.3285	1.2664	0	1.2407	0.5907	0.4962	0.4617	1.7357	1.1487	1.5075	0.7024	0.0014	0.024	1.9227	2.6671	0.0321	1.3393	1.8685	0.3376	1.1914	0	0	0.1807	0.2835	0.2243	0.1215	0	0	0	0.3564	0.1569	0.0281	0	0	0	0	0	0	0	37.8909		4.594127675	27.5681	0.617792493	5.74784933	0	2.175452646	2.100798423	0.579412534	1.453015354	9.494136795	10.03664699	6.21537515	2.384128291	0.022160272	0.074033189	6.11104771	10.71820772	0.062699436	5.659931375	5.463116276	2.022437513	6.342987073	0	0	0.180728745	1.1655	0.921916667	0.4995	0	0	0	0.973243097	1.378372741	0.028066802	0	0	0	0	0	0	0	109.9967
R5941_009_0	2011	10	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								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		Coin	Coin	Coin								0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	996.9979226	77.40401437	344.9513254	365.0508506	29.77365255	11.23653169	2.310740223	274.3143676	324.8362406	5550.428877	610.031314	75.60451461	0.008571718	97.58833494	2921.854647	2721.477779	7.044823004	910.690456	452.6465069	989.8030578	27.39916081	1.238919274	0	0	0	0	129.6	0	4550.441646	0	3.566323266	3.245456752	0.354418451	0	0	0	0	0	0	0	3900	1A: $210/day (days1-7) no yrly max	1B: $210/day (days1-7) no yrly max	2: $128/day (for days 21-100)	6: $0 copay	10A: $125 copay	11A: 20% coin	11B: 20% coin; 11C: 0% coin	4A: $50 copay; 4B: $35 copay	9A: $40-$250 copay; 9B: $250 copay	8A: $0-$170 copay	8B: $95-$170 copay	9A: $250 copay	12: 20% coin	3: $35 copay; 5: $40 copay; 9C: $40 copay; 9D: $0 copay	7A: $25 copay; 7G: $25 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $40 copay; 7F: $40 copay; 7G: $40 copay	7E: $40 copay; 7H: $40 copay	7C: $40-$60 copay; 7I: $40-$60 copay	8B: $95-$170 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0-$40; 17B: $0; 18A: $40	15: 20% coinsurance	13A: $0 copay	10B: Not covered	-	17A: OSB	17B: OSB	18A: $35 copay	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 0% coin; 14J: 0% coin									210	210	128	0	125	0.2	0.053619939	49.94179277	205.9954233	20.70591866	124.2078793	250	0.2	9.677072119	22.14258024	36.65495449	40	54.44970377	115.2179433	20.74440544	0.2	0	0	0	0	0	30	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	146.3351153	112.4171364	111.3835754	0	108.7730229	0.174036837	0.046659223	43.45855815	179.2539592	18.01796292	108.083732	217.5460458	0.174036837	8.420835097	19.2681231	31.89656163	34.80736733	47.381271	100.2608319	18.0514535	0.174036837	0	0	0	0	0	30	0	0	0	0.174036837	0.174036837	0	0	0	0	0	0	0	0		12.158	0.725128137	3.201825998	0	0.269880849	1.955570431	0.107817342	0.993442241	4.852348518	8.333951806	5.494538419	1.370621933	0.001491795	0.068481273	4.691554585	7.233815309	0.020434312	3.595805941	3.781892943	1.488948656	4.768463274	0	0	0	0	0	0.324	0	0	0	0.62067162	0.564829027	0	0	0	0	0	0	0	0	66.6235		9.890691746	12.158	0.725128137	3.201825998	0	0.269880849	1.955570431	0.107817342	0.993442241	4.852348518	8.333951806	5.494538419	1.370621933	0.001491795	0.068481273	4.691554585	7.233815309	0.020434312	3.595805941	3.781892943	1.488948656	4.768463274	0	0	0	0	0	0.324	0	0	0	0.62067162	0.564829027	0	0	0	0	0	0	0	0	66.6235	YES	1A: 20% coin	1B: 20% coin	2: 30% coin (for days 1-100)	6: $0 copay	10A: $125 copay	11A: 30% coin	11B: 30% coin; 11C: 30% coin	4A: $50 copay; 4B: $35 copay	9A: $45-$350 copay; 9B: $350 copay	8A: 0% - 30%	8B: 30% coin	9A: $350 copay	12: 20% coin	3: $45 copay; 5: $50 copay; 9C: $50 copay; 9D: $0 copay	7A: $35 copay; 7G: $35 copay; 14B: $0 copay; 14C: $0 copay	7B: $45 copay; 7D: $45 copay; 7F: $45 copay; 7G: $45 copay	7E: $50 copay; 7H: $50 copay	7C: $45-$100 copay; 7I: $45-$100 copay	8B: 30% coin	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $35; 17B: $0; 18A: $35	15: 20% coinsurance	13A: $0 copay	10B: Not covered		17A: Not covered	17B: Not covered	18A: $45 copay 1/yr $75 limit	18B: Not covered	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: 20% coin; 14J: 20% coin								3900	17.3648	0.2853	1.823	0	1.4255	0.9274	0.6934	0.4989	4.598	1.6923	1.9427	1.0227	0.0283	0.0394	3.1689	3.4673	0.0043	1.9553	2.9351	0.3515	2.3818	0	0	0	0	0	0.108	0	0	0	0.3441	0.4322	0.0503	0	0	0	0	0	0	0	47.5404		7.076057327	29.5228	1.010461659	5.024827588	0	1.695351797	2.882989911	0.801202879	1.492346772	9.450352933	10.02620778	7.437220815	2.393284692	0.029835892	0.107909235	7.860433584	10.70109873	0.024717471	5.551076699	6.71695736	1.840437022	7.150269991	0	0	0	0	0	0.432	0	0	0	0.964818804	0.997029293	0.050282295	0	0	0	0	0	0	0	114.1639
R5941_801_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	277.9655212	3.328166081	34.38670944	4.650865888	9.691904328	9.049158307	2.284144259	18.56195349	52.69294778	6.790663249	28.35312178	0	0.024932994	34.68893672	43.8564415	120.7566916	1.168082248	4.644751156	18.25195689	22.03730572	43.01395473	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.057959721	0.057959721	0.121648837	0	0.171875477	0.171875477	0.171875477	0.171875477	0.171875477	0.171875477	0.171875477	0.171875477	0.171875477	0.171875477	0.171875477	0.171875477	0.171875477	0.171875477	0.171875477	0.171875477	0.171875477	0.171875477																			NO	0.047340404	0.047340404	0.09936047	0	0.14038464	0.14038464	0.14038464	0.14038464	0.14038464	0.14038464	0.14038464	0.14038464	0.14038464	0.14038464	0.14038464	0.14038464	0.14038464	0.14038464	0.14038464	0.14038464	0.14038464	0.14038464																				13.159	0.157556728	3.416679609	0	1.3605945	1.270362831	0.320658769	2.605813159	7.397280505	0.953304816	3.980342793	0	0.003500209	4.869793893	6.156770751	16.95238468	0.163980806	0.652051719	2.562294397	3.093699229	6.038498549	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1146		16.84956868	13.159	0.157556728	3.416679609	0	1.3605945	1.270362831	0.320658769	2.605813159	7.397280505	0.953304816	3.980342793	0	0.003500209	4.869793893	6.156770751	16.95238468	0.163980806	0.652051719	2.562294397	3.093699229	6.038498549	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1146	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	3.0967	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			3.0967		5.992255921	16.2557	0.157556728	3.416679609	0	1.3605945	1.270362831	0.320658769	2.605813159	7.397280505	0.953304816	3.980342793	0	0.003500209	4.869793893	6.156770751	16.95238468	0.163980806	0.652051719	2.562294397	3.093699229	6.038498549	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.2113
R5941_802_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	317.1151142	3.796916114	61.28284971	5.826769952	7.089709688	14.83027476	3.743385383	19.43590369	53.38098313	8.458437953	35.31659759	0	0.031056492	43.20847731	42.37028325	116.6646233	1.128499578	4.487355002	17.6334549	21.29053004	62.48276345	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.059123645	0.059123645	0.138200124	0	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174																			NO	0.046329396	0.046329396	0.10829387	0	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184																				14.6918	0.175908832	6.636556942	0	0.956587475	2.000992383	0.505080706	2.622412321	7.20249236	1.141264757	4.765133751	0	0.004190334	5.829954966	5.716860641	15.74111245	0.152264142	0.605461687	2.379214783	2.872649978	8.430560849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4305		22.76385553	14.6918	0.175908832	6.636556942	0	0.956587475	2.000992383	0.505080706	2.622412321	7.20249236	1.141264757	4.765133751	0	0.004190334	5.829954966	5.716860641	15.74111245	0.152264142	0.605461687	2.379214783	2.872649978	8.430560849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4305	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	3.5007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			3.5007		8.03970684	18.1925	0.175908832	6.636556942	0	0.956587475	2.000992383	0.505080706	2.622412321	7.20249236	1.141264757	4.765133751	0	0.004190334	5.829954966	5.716860641	15.74111245	0.152264142	0.605461687	2.379214783	2.872649978	8.430560849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.9312
R5941_805_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	248.81693	2.979161096	37.44725413	5.899519041	8.802331508	8.378666498	2.114901997	17.6693158	45.8601551	6.828326617	28.510378	0	0.025071281	34.88133356	41.72133047	114.8777617	1.111215224	4.418625664	17.36337694	20.9644395	32.33683788	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.057915506	0.057915506	0.121556036	0	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436																			NO	0.0482552	0.0482552	0.101280489	0	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401																				12.0067	0.143760013	3.792676211	0	1.25959076	1.198965398	0.302636979	2.528433165	6.562468997	0.977115791	4.079760989	0	0.003587635	4.991428171	5.97021395	16.43870912	0.15901201	0.632293848	2.48465411	2.999956803	4.627317452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.1593		14.24552312	12.0067	0.143760013	3.792676211	0	1.25959076	1.198965398	0.302636979	2.528433165	6.562468997	0.977115791	4.079760989	0	0.003587635	4.991428171	5.97021395	16.43870912	0.15901201	0.632293848	2.48465411	2.999956803	4.627317452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.1593	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	2.8462	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			2.8462		5.08091582	14.853	0.143760013	3.792676211	0	1.25959076	1.198965398	0.302636979	2.528433165	6.562468997	0.977115791	4.079760989	0	0.003587635	4.991428171	5.97021395	16.43870912	0.15901201	0.632293848	2.48465411	2.999956803	4.627317452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0055
R5941_806_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	317.1151142	3.796916114	61.28284971	5.826769952	7.089709688	14.83027476	3.743385383	19.43590369	53.38098313	8.458437953	35.31659759	0	0.031056492	43.20847731	42.37028325	116.6646233	1.128499578	4.487355002	17.6334549	21.29053004	62.48276345	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.059123645	0.059123645	0.138200124	0	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174																			NO	0.046329396	0.046329396	0.10829387	0	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184																				14.6918	0.175908832	6.636556942	0	0.956587475	2.000992383	0.505080706	2.622412321	7.20249236	1.141264757	4.765133751	0	0.004190334	5.829954966	5.716860641	15.74111245	0.152264142	0.605461687	2.379214783	2.872649978	8.430560849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4305		22.76385553	14.6918	0.175908832	6.636556942	0	0.956587475	2.000992383	0.505080706	2.622412321	7.20249236	1.141264757	4.765133751	0	0.004190334	5.829954966	5.716860641	15.74111245	0.152264142	0.605461687	2.379214783	2.872649978	8.430560849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4305	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	3.5007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			3.5007		8.03970684	18.1925	0.175908832	6.636556942	0	0.956587475	2.000992383	0.505080706	2.622412321	7.20249236	1.141264757	4.765133751	0	0.004190334	5.829954966	5.716860641	15.74111245	0.152264142	0.605461687	2.379214783	2.872649978	8.430560849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.9312
R5941_807_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	248.81693	2.979161096	37.44725413	5.899519041	8.802331508	8.378666498	2.114901997	17.6693158	45.8601551	6.828326617	28.510378	0	0.025071281	34.88133356	41.72133047	114.8777617	1.111215224	4.418625664	17.36337694	20.9644395	32.33683788	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.057915506	0.057915506	0.121556036	0	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436	0.17174436																			NO	0.0482552	0.0482552	0.101280489	0	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401	0.143097401																				12.0067	0.143760013	3.792676211	0	1.25959076	1.198965398	0.302636979	2.528433165	6.562468997	0.977115791	4.079760989	0	0.003587635	4.991428171	5.97021395	16.43870912	0.15901201	0.632293848	2.48465411	2.999956803	4.627317452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.1593		14.24552312	12.0067	0.143760013	3.792676211	0	1.25959076	1.198965398	0.302636979	2.528433165	6.562468997	0.977115791	4.079760989	0	0.003587635	4.991428171	5.97021395	16.43870912	0.15901201	0.632293848	2.48465411	2.999956803	4.627317452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.1593	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	2.8462	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			2.8462		5.08091582	14.853	0.143760013	3.792676211	0	1.25959076	1.198965398	0.302636979	2.528433165	6.562468997	0.977115791	4.079760989	0	0.003587635	4.991428171	5.97021395	16.43870912	0.15901201	0.632293848	2.48465411	2.999956803	4.627317452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0055
R5941_808_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	317.1151142	3.796916114	61.28284971	5.826769952	7.089709688	14.83027476	3.743385383	19.43590369	53.38098313	8.458437953	35.31659759	0	0.031056492	43.20847731	42.37028325	116.6646233	1.128499578	4.487355002	17.6334549	21.29053004	62.48276345	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.059123645	0.059123645	0.138200124	0	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174	0.172187174																			NO	0.046329396	0.046329396	0.10829387	0	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184	0.134926184																				14.6918	0.175908832	6.636556942	0	0.956587475	2.000992383	0.505080706	2.622412321	7.20249236	1.141264757	4.765133751	0	0.004190334	5.829954966	5.716860641	15.74111245	0.152264142	0.605461687	2.379214783	2.872649978	8.430560849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4305		22.76385553	14.6918	0.175908832	6.636556942	0	0.956587475	2.000992383	0.505080706	2.622412321	7.20249236	1.141264757	4.765133751	0	0.004190334	5.829954966	5.716860641	15.74111245	0.152264142	0.605461687	2.379214783	2.872649978	8.430560849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.4305	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	3.5007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			3.5007		8.03970684	18.1925	0.175908832	6.636556942	0	0.956587475	2.000992383	0.505080706	2.622412321	7.20249236	1.141264757	4.765133751	0	0.004190334	5.829954966	5.716860641	15.74111245	0.152264142	0.605461687	2.379214783	2.872649978	8.430560849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.9312
R6801_008_0	2011	6																															A	A	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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	464.159108	3.878486387	217.5246182	119.5332523	14.04162753	38.212998	46.12723442	33.00704419	27.50817456	12.68314418	14.39098624	0	0.004344689	3188.494094	63.43149944	116.7011576	0.895686743	3.029238076	44.91199654	66.25977692	3.303973331	29.77344785	1320	288.9306514	336.2670487	0	0	0	0	12000											6700	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: $0, 9D Cardiac Rehab: 20%"	"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: 20%, 14J Nutrition Therapy: 20%"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: $0, MH (Group): $0, 7H Psychiatric: $0, Psychiatric (Group): $0, 9C OP Substance Abuse: $0, OP Substance Abuse (Group): $0"	"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"											0	802.1056762	859.8711668	357.6601034	0	0.233	0.233	0.233	0.233908897	0.233	0.233	0.233	0	0.233	24.10373159	0.23113012	0.233	0.233	0.233	0.233	0.228732028	0.233	0.233	0	15	20.6621494	0	0	0	0	0											YES	645.5502701	692.041062	334.3631198	0	0.221003041	0.221003041	0.221003041	0.232961453	0.221003041	0.221003041	0.221003041	0	0.221003041	22.86265229	0.21992083	0.22191917	0.221003041	0.221003041	0.221003041	0.216954823	0.221003041	0.221003041	0	15	20.6621494	0	0	0	0	0											6700	24.9698	0.223672653	6.061017497	0	3.103242386	8.445188768	10.19425908	7.68936896	6.079390234	2.803013435	3.180451725	0	0.000960189	6.074785983	13.94990801	25.89822406	0.197949494	0.669470827	9.925687817	14.3753782	0.730188154	6.58002252	0	0.361163314	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.0922	0	11.70830877	24.9698	0.223672653	6.061017497	0	3.103242386	8.445188768	10.19425908	7.68936896	6.079390234	2.803013435	3.180451725	0	0.000960189	6.074785983	13.94990801	25.89822406	0.197949494	0.669470827	9.925687817	14.3753782	0.730188154	6.58002252	0	0.361163314	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.0922	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: $0, 9C OP Substance Abuse: $0, OP Substance Abuse (Group): $0, 9D Cardiac Rehab: 20%"	"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: 20%, 14J Nutrition Therapy: 20%"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: $0, MH (Group): $0, 7H Psychiatric: $0, Psychiatric (Group): $0, 9C OP Substance Abuse: $0, OP Substance Abuse (Group): $0"	"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"											6700	0	0	0	0	0	4.5474	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											4.5774	0	1.004083837	24.9698	0.223672653	6.061017497	0	3.103242386	12.9925981	10.19425908	7.71936896	6.079390234	2.803013435	3.180451725	0	0.000960189	6.074785983	13.94990801	25.89822406	0.197949494	0.669470827	9.925687817	14.3753782	0.730188154	6.58002252	0	0.361163314	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	156.6696
R6801_009_0	2011	6																															D	A	D	Coin	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	Coin	Coin	Coin	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	2557.53027	9.185254142	82.4274416	76.28643115	257.1535314	25.79456633	32.04682553	515.0142539	211.7424805	13.4945288	16.98614957	0	0.003266421	1917.79665	5937.204726	4887.902742	140.5824407	310.9573421	39.40718659	58.08944005	5.503247035	14.89478157	660	105.370137	254.5225416	0	0	0	0	12000											3400	1A IP Acute: $215 Per Day for days 0	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: $50, 5 Partial Hosp: $40, 9D Cardiac Rehab: $50"	"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): $50	"7E Mental Health: $40, MH (Group): $25, 7H Psychiatric: $40, Psychiatric (Group): $25, 9C OP Substance Abuse: $40, OP Substance Abuse (Group): $25"	"7C Occupational Therapy: $50, 7I Physical and Speech Therapy: $50"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $40, 7F Podiatry: $50, 7G Other Health Care: $50, 18A Hearing Exams (Medicare Covered): $50"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $50"	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): $50	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	215	1000	130	0	150	0.084	0.236363305	49.14269179	175	0.18	0.2	0	3.32E-17	37.98133641	24.14071045	50	39.25	41.53972399	0.12	0.144154115	0.12	0.189455273	0	10	10	0	0	0	0	0											YES	198.7139737	960.0995894	99.88142975	0	146.0893534	0.078898499	0.230431447	48.43079459	159.4341885	0.173630317	0.193785675	0	3.32E-17	36.63133001	23.76547781	49.02598515	38.92288985	41.20565565	0.113164242	0.137652118	0.113164242	0.183165476	0	10	10	0	0	0	0	0											3400	42.3514	0.734896561	0.686080893	0	3.130616092	2.035152573	7.38459637	2.078545795	2.813249213	2.343059308	3.291672455	0	1.08E-19	5.854286832	11.7583756	19.9695206	0.455989571	1.067766764	4.459484409	7.996134463	0.622770781	2.72820976	0	0.087808447	0.212102118	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.0617	0	5.959685129	42.3514	0.734896561	0.686080893	0	3.130616092	2.035152573	7.38459637	2.078545795	2.813249213	2.343059308	3.291672455	0	1.08E-19	5.854286832	11.7583756	19.9695206	0.455989571	1.067766764	4.459484409	7.996134463	0.622770781	2.72820976	0	0.087808447	0.212102118	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.0617	YES	1A IP Acute: $215 Per Day for days 0	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: $50, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, OP Substance Abuse (Group): $25, 9D Cardiac Rehab: $50"	"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): $50	"7E Mental Health: $40, MH (Group): $25, 7H Psychiatric: $40, Psychiatric (Group): $25, 9C OP Substance Abuse: $40, OP Substance Abuse (Group): $25"	"7C Occupational Therapy: $50, 7I Physical and Speech Therapy: $50"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $40, 7F Podiatry: $50, 7G Other Health Care: $50, 18A Hearing Exams (Medicare Covered): $50"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $50"	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): $50	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	12.3232	0	2.1917	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											14.5449	0	0.351687715	42.3514	0.734896561	0.686080893	12.32319272	3.130616092	4.226855344	7.38459637	2.108545795	2.813249213	2.343059308	3.291672455	0	1.08E-19	5.854286832	11.7583756	19.9695206	0.455989571	1.067766764	4.459484409	7.996134463	0.622770781	2.72820976	0	0.087808447	0.212102118	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.6066
R6801_011_0	2011	4																															A	A	D	V	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	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	1856.118884	52.06602813	1744.890299	0	14.01038643	15.55662793	9.435071384	17.35292403	42.83657928	4.342460852	24.06565407	11.82794922	0.383609164	10.922074	26.57238459	61.20980745	1.492974759	5.178484069	25.82017345	80.44343751	40.46456409	10.78771878	0	0	0	0	0	0	0	0											6700	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9c	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											0	157.1464158	72.5565795	88.90827087	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											YES	157.1464158	72.5565795	88.90827087	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											6700	24.3069	0.314811076	12.92793161	0	3.264420037	3.624694308	2.198371632	4.043231299	9.980922972	1.011793379	5.607297397	2.755912168	0.089380935	2.544843243	6.191365609	14.26188514	0.347863119	1.206586788	6.016100414	18.74332094	9.428243433	2.513538476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.3794	0	0	24.3069	0.314811076	12.92793161	0	3.264420037	3.624694308	2.198371632	4.043231299	9.980922972	1.011793379	5.607297397	2.755912168	0.089380935	2.544843243	6.191365609	14.26188514	0.347863119	1.206586788	6.016100414	18.74332094	9.428243433	2.513538476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.3794	YES	Medicare-FFS Cost Sharing; PBP 1a	Medicare-FFS Cost Sharing; PBP 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	"Medicare-FFS Cost Sharing; PBP 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 9c	Medicare-FFS Cost Sharing; PBP 12	"Medicare-FFS Cost Sharing; PBP 3, 5, 9a, 9c, 9d, 13a"	"Medicare-FFS Cost Sharing; PBP 4b, 7a, 14b-c"	"Medicare-FFS Cost Sharing; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"Medicare-FFS Cost Sharing; PBP 7e, 7h"	"Medicare-FFS Cost Sharing; PBP 7c, 7i"	"Medicare-FFS Cost Sharing; PBP 7d, 14g-h"	"Medicare-FFS Cost Sharing; PBP 7d, 7g, 14f, 14i"	Medicare-FFS Cost Sharing; PBP 15	"Medicare-FFS Cost Sharing; PBP 7g, 14a, 14j"	Medicare-FFS Cost Sharing; PBP 10b	"Medicare-FFS Cost Sharing; PBP 16a, 16b"	Medicare-FFS Cost Sharing; PBP 17a	Medicare-FFS Cost Sharing; PBP 17b	Medicare-FFS Cost Sharing; PBP 18a	Medicare-FFS Cost Sharing; PBP 18b	Medicare-FFS Cost Sharing; PBP 14a	Medicare-FFS Cost Sharing; PBP 13b											6700	0	0	0	0	0	0	0	0.027	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.027	0	0	24.3069	0.314811076	12.92793161	0	3.264420037	3.624694308	2.198371632	4.070229856	9.980922972	1.011793379	5.607297397	2.755912168	0.089380935	2.544843243	6.191365609	14.26188514	0.347863119	1.206586788	6.016100414	18.74332094	9.428243433	2.513538476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.4064
R6801_012_0	2011	5																															D	A	D	Coin	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	Coin	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	1192.952099	3.714007593	354.5460555	0	317.8608355	7.53590929	6.541939555	289.7631583	292.5472033	4.316809558	19.35538979	932.5720461	0.343315906	468.7591281	2671.356158	3250.827822	108.7955206	384.0611527	16.84074054	11.20190751	6.772538967	0	0	241.8461538	278.6707454	0	0	0	0	0											3400	$220/Days 1-15 for IP Medical; $220/Days 1-15 for IP Surgical; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse; PBP 1b	$130/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$150/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"35% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 35% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $35/Visit for PCP Urgent Care; $35/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$150/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$50/Visit for OP Fac - Other; PBP 9c	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$50/Visit for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $50/Visit for OP Fac - Physical/Speech Therapy; $50/Visit for OP Fac - CORF; $50/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35/Visit for PCP Office Visits; $35/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $15/Visit for Chiropractor; $50/Visit for Vision Exams; $50/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $50/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$10/Visit for Dental - Preventive; PBP 16a, 16b"	$10/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	Not Covered; PBP 18a	Not Covered; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											0	220	1000	130	0	150	0.2	0.244830269	49.1852199	150	0.2	0.2	50	0.2	50	35	45.60761965	39.75	50	0.2	0.2	0.2	0	0	10	10	0	0	0	0	0											YES	199.118132	905.0824181	117.6607144	0	135.7623627	0.181016484	0.221591572	44.51667777	135.7623627	0.181016484	0.181016484	45.25412091	0.181016484	45.25412091	31.77092626	41.35163737	35.97702612	45.25412091	0.181016484	0.181016484	0.181016484	0	0	10	10	0	0	0	0	0											3400	19.7949	0.280123581	3.476345181	0	3.59612817	1.364123801	1.449638667	1.074941096	3.309741627	0.781413687	3.5036446	3.516894011	0.062145838	1.767773522	7.072621625	11.20225444	0.326178274	1.448362487	3.048451635	2.027729907	1.225941189	0	0	0.201538462	0.232225621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.7631	0	7.33083015	19.7949	0.280123581	3.476345181	0	3.59612817	1.364123801	1.449638667	1.074941096	3.309741627	0.781413687	3.5036446	3.516894011	0.062145838	1.767773522	7.072621625	11.20225444	0.326178274	1.448362487	3.048451635	2.027729907	1.225941189	0	0	0.201538462	0.232225621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.7631	YES	$220/Days 1-15 for IP Medical; $220/Days 1-15 for IP Surgical; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse; PBP 1b	$130/Days 21-100 for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$150/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; PBP 11a	"35% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 35% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Worldwide; ; PBP 4a, 4b"	"$150/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$50/Visit for OP Fac - Other; PBP 9c	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$50/Visit for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $50/Visit for OP Fac - Physical/Speech Therapy; $50/Visit for OP Fac - CORF; $50/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35/Visit for PCP Office Visits; $35/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $15/Visit for Chiropractor; $50/Visit for Vision Exams; $50/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $50/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$10/Visit for Dental - Preventive; PBP 16a, 16b"	$10/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	Not Covered; PBP 18a	Not Covered; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											3400	0	0	0	5.1522	0	1.4691	0	0.0038	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											6.625	0	0.694380669	19.7949	0.280123581	3.476345181	5.152179866	3.59612817	2.833180201	1.449638667	1.07869771	3.309741627	0.781413687	3.5036446	3.516894011	0.062145838	1.767773522	7.072621625	11.20225444	0.326178274	1.448362487	3.048451635	2.027729907	1.225941189	0	0	0.201538462	0.232225621	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3881
R7439_001_0	2011	10																															D	D	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	1066.16277	47.73841725	537.4996895		91.74361707	4.770277278	6.463881004	256.7306217	256.0095738	2175.208154	20.6192476	6.579497324	0.040671715	1385.462608	4266.338167	6090.538468	332.3237	758.2471013	3069.326927	11568.06736	13.93734682																				3400	$220/day days 1-11	$235/day days 1-9	"$100/day days 1-26, $0/day days 27-100"	$0 copay	$150 copay/trip	20% coinsurance	20% coinsurance	"$50 copay ER, $40 copay Urgent Care,10% coinsurance for ER worldwide coverage"	20% coinsurance	$10 copay	20% coinsurance	20% coinsurance	20% coinsurance	"$35 Copay for OP PT/OT/ST,$40 Copay for OP Partial Hospitalization"	"$19 copay, $35 copay for medicare covered eye exam, services"	"$19 copay, $35 copay for medicare covered eye exam, services, chiro and podiatry"	$40 copay	$35 copay	20% coins	"$35 copay for chiro and podiatry, 20% coins for chemotherapy"	20% coinsurance	"$35  copay for Medicare covered Dental, hearing screening"	N/A	N/A	N/A	N/A	N/A	N/A	$0 copay	N/A												144.2265695	150.487239	66.11078385		150	0.2	0.2	48	309.1590892	10	0.2	532.4238527	0.2	26.35846877	19.19418892	25.33477849	40	35	14.89527767	9.947572376	0.2																				NO	112.6015787	117.4894525	51.61447478		117.1090519	0.156145403	0.156145403	37.47489661	241.3688521	7.807270127	0.156145403	415.677684	0.156145403	20.57876858	14.98542178	19.77954592	31.22908051	27.32544544	11.62914564	7.807270127	0.156145403																					10.0043	0.467396709	2.311897014	0	0.895334001	0.744856866	1.009305301	0.801746125	5.149394747	1.415203137	3.219600716	0.227912517	0.006350701	2.375926198	5.32773974	10.03900711	0.864846965	1.726619983	2.97447082	7.526252224	2.17625263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2644	0	16.59431098	10.0043	0.467396709	2.311897014	0	0.895334001	0.744856866	1.009305301	0.801746125	5.149394747	1.415203137	3.219600716	0.227912517	0.006350701	2.375926198	5.32773974	10.03900711	0.864846965	1.726619983	2.97447082	7.526252224	2.17625263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2644	YES	$375/day days 1-21	$375/day days 1-21	"$150/day days 1-52, $0/day days 53-100"	$0 copay	$150 copay/trip	30% coinsurance	30% coinsurance	"$50 copay ER, $40 copay Urgent Care"	30% coinsurance	$10 copay	30% coinsurance	30% coinsurance	20% coinsurance	"$37 Copay for OP PT/OT/ST,$45 Copay for OP Partial Hospitalization"	$37 copay	$37 copay	$45 copay	$37 copay	30% coinsurance	"$37 copay for chiro and podiatry, 30% coins for chemotherapy"	30% coinsurance	"$37  copay for Medicare covered Dental, hearing screening"	N/A	N/A	N/A	N/A	N/A	N/A	$0 copay	N/A											5100	0.2743	0.013	0.0589		0.0115	0.0143	0.023	0.0103	0.099	0.0181	0.0619	0.0044	0.0001	0.0443	0.1367	0.1977	0.0125	0.0234	0.0572	0.0964	0.0418																				1.1987	0	1.280168433	10.2786	0.480415523	2.370773496	0	0.906807304	0.759174374	1.032324703	0.812020141	5.248375513	1.433338328	3.281487318	0.232293412	0.006432083	2.420222671	5.464458019	10.2367184	0.877314918	1.750010176	3.031645578	7.622697761	2.218084177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4631
R7439_003_0	2011	10																															A	A	A	V	T	Coin	Coin	V	P	P	P	P	Coin	P	P	P	P	P	P	P	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	YES	251.7400783	1.869249416	102.9718161					281.3361123	170.7853658	460.9757542	651.9812219	3.064941759		1561.502689	4854.693255	6385.214482	309.9620878	1660.934907	3112.54886	14840.66149																					3400	$200 per admission	$200 per admission	$100 per admission	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$50 copay for both ER and Urgent Care	$15 copay	$15 copay	$15 copay	$15 copay	No cost sharing	$15 copay	$15 copay	$15 copay	$15 copay	$15 copay	$15 copay	$15 copay	No cost sharing	"$15  copay for Medicare covered Dental, hearing screening"	N/A	N/A	N/A	N/A	N/A	N/A	$0 copay	N/A												200	200	100					50	15	15	15	15		15	15	15	15	15	15	14.79777628																					NO	176.1618055	176.1618055	88.08090276					44.04045138	13.21213541	13.21213541	13.21213541	13.21213541		13.21213541	13.21213541	13.21213541	13.21213541	13.21213541	13.21213541	13.06488125																						3.6956	0.027440863	0.755820877	0	0	0	0	1.032514114	0.188036615	0.507539507	0.717838683	0.003374535	0	1.719232081	5.345072056	7.030193198	0.341271756	1.828708075	3.426951419	16.15762334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7772	0	5.745266895	3.6956	0.027440863	0.755820877	0	0	0	0	1.032514114	0.188036615	0.507539507	0.717838683	0.003374535	0	1.719232081	5.345072056	7.030193198	0.341271756	1.828708075	3.426951419	16.15762334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7772	YES	$400 per admission	$400 per admission	$200 per admission	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$50 copay for both ER and Urgent Care	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	No cost sharing	$30 copay	N/A	N/A	$30 copay	N/A	N/A	N/A	$0 copay	N/A											5100	0.0246		0.0013					0.0028	0.0008	0.001	0.0031	0.0003		0.0033	0.1168	0.0271	0.0059	0.0145	0.0022	0.0586		0.0147			0.0344																0.3116	0	0.085482733	3.7202	0.027440863	0.757087878	0	0	0	0	1.035322619	0.188849075	0.508562605	0.720938068	0.003675447	0	1.722572195	5.461904251	7.057336991	0.347175071	1.843227039	3.429185105	16.21620975	0	0.014730834	0	0	0.034398775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.0888
R7439_006_0	2011	10																															A	A	A	V	T	Coin	Coin	V	P	P	P	P	Coin	P	P	P	P	P	P	P	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	YES	251.7400783	1.869249416	102.9718161					281.3361123	170.7853658	460.9757542	651.9812219	3.064941759		1561.502689	4854.693255	6385.214482	309.9620878	1660.934907	3112.54886	14840.66149																					3400	$200 per admission	$200 per admission	$100 per admission	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$50 copay for both ER and Urgent Care	$15 copay	$15 copay	$15 copay	$15 copay	No cost sharing	$15 copay	$15 copay	$15 copay	$15 copay	$15 copay	$15 copay	$15 copay	No cost sharing	"$15  copay for Medicare covered Dental, hearing screening"	N/A	N/A	N/A	N/A	N/A	N/A	$0 copay	N/A												200	200	100					50	15	15	15	15		15	15	15	15	15	15	14.79777628																					NO	176.1618055	176.1618055	88.08090276					44.04045138	13.21213541	13.21213541	13.21213541	13.21213541		13.21213541	13.21213541	13.21213541	13.21213541	13.21213541	13.21213541	13.06488125																						3.6956	0.027440863	0.755820877	0	0	0	0	1.032514114	0.188036615	0.507539507	0.717838683	0.003374535	0	1.719232081	5.345072056	7.030193198	0.341271756	1.828708075	3.426951419	16.15762334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7772	0	5.745266895	3.6956	0.027440863	0.755820877	0	0	0	0	1.032514114	0.188036615	0.507539507	0.717838683	0.003374535	0	1.719232081	5.345072056	7.030193198	0.341271756	1.828708075	3.426951419	16.15762334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7772	YES	$400 per admission	$400 per admission	$200 per admission	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$50 copay for both ER and Urgent Care	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	$30 copay	No cost sharing	$30 copay	N/A	N/A	$30 copay	N/A	N/A	N/A	$0 copay	N/A											5100	0.0246		0.0013					0.0028	0.0008	0.001	0.0031	0.0003		0.0033	0.1168	0.0271	0.0059	0.0145	0.0022	0.0586		0.0147			0.0344																0.3116	0	0.085482733	3.7202	0.027440863	0.757087878	0	0	0	0	1.035322619	0.188849075	0.508562605	0.720938068	0.003675447	0	1.722572195	5.461904251	7.057336991	0.347175071	1.843227039	3.429185105	16.21620975	0	0.014730834	0	0	0.034398775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.0888
R7439_801_0	2011	5																															A	A	A	V	T	Coin	Coin	V	P	P	P	P	Coin	P	P	P	P	P	P	P	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	YES	251.7891112	1.869613501	102.9918725		83.21191668	4.2359033	1.498752583	281.3909097	170.8186306	461.0655412	720.1461412	3.065538735	1.129538412	1597.01795	8405.171855	10545.24799	310.0224609	1661.258417	3113.15511	20641.65731	30.18738659	1.126353895																				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	Woldwide ER coverage $50 copay											0	986.1523918	504.9065029	1246.795822		115.5521411	0.233	0.233	148.7899237	481.352134	16.44174836	73.73799962	400.4641042	0.233	43.77236892	16.92614063	18.63940582	23.0367891	13.76605288	18.22810569	8.187082849	0.233	0.233																			YES	905.8720089	463.8032335	1145.297061		106.1453088	0.214032009	0.214032009	136.6772805	442.1663713	15.10326369	67.73515979	367.8632487	0.214032009	40.20896172	15.54822271	17.13475509	21.16141744	12.64539038	16.74419781	7.520591389	0.214032009	0.214042443																				19.0074	0.072261066	9.829690737	0	0.736046216	0.906618895	0.320781027	3.204978691	6.294187838	0.580299537	4.064934496	0.09397492	0.241757376	5.351202802	10.89045699	15.05752014	0.546709559	1.750605101	4.343940415	12.93645586	6.461067012	0.241087539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.932	0	9.109858294	19.0074	0.072261066	9.829690737	0	0.736046216	0.906618895	0.320781027	3.204978691	6.294187838	0.580299537	4.064934496	0.09397492	0.241757376	5.351202802	10.89045699	15.05752014	0.546709559	1.750605101	4.343940415	12.93645586	6.461067012	0.241087539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.932	YES	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	N/A											10000	0.2119		0.0114		0.5574	0.03	0.0493	0.0751	0.1079	0.008	0.0619	0.0279	0.0001	0.0476	0.1668	0.0226	0.0053	0.0079	0.0008	0.0524	0.0499	0.0117																			1.5059	0	0.132846465	19.2193	0.072261066	9.841138866	0	1.293429283	0.936614807	0.370043127	3.280044814	6.402053839	0.588339689	4.126826428	0.121886212	0.241903187	5.398792634	11.0573	15.08007421	0.552006402	1.758502267	4.344755542	12.98883652	6.510972756	0.252747901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.4379
R7439_802_0	2011	5																															A	A	A	V	T	Coin	Coin	V	P	P	P	P	Coin	P	P	P	P	P	P	P	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	YES	251.7891112	1.869613501	102.9918725		83.21191668	4.2359033	1.498752583	281.3909097	170.8186306	461.0655412	720.1461412	3.065538735	1.129538412	1597.01795	8405.171855	10545.24799	310.0224609	1661.258417	3113.15511	20641.65731	30.18738659	1.126353895																				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	Woldwide ER coverage $50 copay											0	986.1523918	504.9065029	1246.795822		115.5521411	0.233	0.233	148.7899237	481.352134	16.44174836	73.73799962	400.4641042	0.233	43.77236892	16.92614063	18.63940582	23.0367891	13.76605288	18.22810569	8.187082849	0.233	0.233																			YES	905.873142	463.8038137	1145.298493		106.1454416	0.214032277	0.214032277	136.6774514	442.1669244	15.10328258	67.73524452	367.8637088	0.214032277	40.20901201	15.54824216	17.13477633	21.16144391	12.6454062	16.74421876	7.520600797	0.214032277	0.214042711																				19.0074	0.072261156	9.829703032	0	0.736047137	0.906620029	0.320781428	3.2049827	6.294195711	0.580300263	4.06493958	0.093975037	0.241757678	5.351209495	10.89047062	15.0575388	0.546710243	1.75060729	4.343945848	12.93647204	6.461075093	0.241087841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9321	0	9.109729714	19.0074	0.072261156	9.829703032	0	0.736047137	0.906620029	0.320781428	3.2049827	6.294195711	0.580300263	4.06493958	0.093975037	0.241757678	5.351209495	10.89047062	15.0575388	0.546710243	1.75060729	4.343945848	12.93647204	6.461075093	0.241087841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9321	YES	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	N/A											10000	0.2119		0.0114		0.5574	0.03	0.0493	0.0751	0.1079	0.008	0.0619	0.0279	0.0001	0.0476	0.1668	0.0226	0.0053	0.0079	0.0008	0.0524	0.0499	0.0117																			1.506	0	0.132770886	19.2193	0.072261156	9.841151175	0	1.293430901	0.936615978	0.37004359	3.280048917	6.402061847	0.588340425	4.12683159	0.121886364	0.241903489	5.398799387	11.05731383	15.08016661	0.552007092	1.758504467	4.344760977	12.98885277	6.510980901	0.252748208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.4381
R7439_805_0	2011	5																															A	A	A	V	T	Coin	Coin	V	P	P	P	P	Coin	P	P	P	P	P	P	P	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	YES	251.7891112	1.869613501	102.9918725		83.21191668	4.2359033	1.498752583	281.3909097	170.8186306	461.0655412	720.1461412	3.065538735	1.129538412	1597.01795	8405.171855	10545.24799	310.0224609	1661.258417	3113.15511	20641.65731	30.18738659	1.126353895																				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	Woldwide ER coverage $50 copay											0	986.1523918	504.9065029	1246.795822		115.5521411	0.233	0.233	148.7899237	481.352134	16.44174836	73.73799962	400.4641042	0.233	43.77236892	16.92614063	18.63940582	23.0367891	13.76605288	18.22810569	8.187082849	0.233	0.233																			YES	905.873142	463.8038137	1145.298493		106.1454416	0.214032277	0.214032277	136.6774514	442.1669244	15.10328258	67.73524452	367.8637088	0.214032277	40.20901201	15.54824216	17.13477633	21.16144391	12.6454062	16.74421876	7.520600797	0.214032277	0.214042711																				19.0074	0.072261156	9.829703032	0	0.736047137	0.906620029	0.320781428	3.2049827	6.294195711	0.580300263	4.06493958	0.093975037	0.241757678	5.351209495	10.89047062	15.0575388	0.546710243	1.75060729	4.343945848	12.93647204	6.461075093	0.241087841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9321	0	9.109729714	19.0074	0.072261156	9.829703032	0	0.736047137	0.906620029	0.320781428	3.2049827	6.294195711	0.580300263	4.06493958	0.093975037	0.241757678	5.351209495	10.89047062	15.0575388	0.546710243	1.75060729	4.343945848	12.93647204	6.461075093	0.241087841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9321	YES	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	N/A											10000	0.2119		0.0114		0.5574	0.03	0.0493	0.0751	0.1079	0.008	0.0619	0.0279	0.0001	0.0476	0.1668	0.0226	0.0053	0.0079	0.0008	0.0524	0.0499	0.0117																			1.506	0	0.132770886	19.2193	0.072261156	9.841151175	0	1.293430901	0.936615978	0.37004359	3.280048917	6.402061847	0.588340425	4.12683159	0.121886364	0.241903489	5.398799387	11.05731383	15.08016661	0.552007092	1.758504467	4.344760977	12.98885277	6.510980901	0.252748208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.4381
R7439_806_0	2011	5																															A	A	A	V	T	Coin	Coin	V	P	P	P	P	Coin	P	P	P	P	P	P	P	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	YES	251.7891112	1.869613501	102.9918725		83.21191668	4.2359033	1.498752583	281.3909097	170.8186306	461.0655412	720.1461412	3.065538735	1.129538412	1597.01795	8405.171855	10545.24799	310.0224609	1661.258417	3113.15511	20641.65731	30.18738659	1.126353895																				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	Woldwide ER coverage $50 copay											0	986.1523918	504.9065029	1246.795822		115.5521411	0.233	0.233	148.7899237	481.352134	16.44174836	73.73799962	400.4641042	0.233	43.77236892	16.92614063	18.63940582	23.0367891	13.76605288	18.22810569	8.187082849	0.233	0.233																			YES	905.873142	463.8038137	1145.298493		106.1454416	0.214032277	0.214032277	136.6774514	442.1669244	15.10328258	67.73524452	367.8637088	0.214032277	40.20901201	15.54824216	17.13477633	21.16144391	12.6454062	16.74421876	7.520600797	0.214032277	0.214042711																				19.0074	0.072261156	9.829703032	0	0.736047137	0.906620029	0.320781428	3.2049827	6.294195711	0.580300263	4.06493958	0.093975037	0.241757678	5.351209495	10.89047062	15.0575388	0.546710243	1.75060729	4.343945848	12.93647204	6.461075093	0.241087841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9321	0	9.109729714	19.0074	0.072261156	9.829703032	0	0.736047137	0.906620029	0.320781428	3.2049827	6.294195711	0.580300263	4.06493958	0.093975037	0.241757678	5.351209495	10.89047062	15.0575388	0.546710243	1.75060729	4.343945848	12.93647204	6.461075093	0.241087841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9321	YES	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	N/A											10000	0.2119		0.0114		0.5574	0.03	0.0493	0.0751	0.1079	0.008	0.0619	0.0279	0.0001	0.0476	0.1668	0.0226	0.0053	0.0079	0.0008	0.0524	0.0499	0.0117																			1.506	0	0.132770886	19.2193	0.072261156	9.841151175	0	1.293430901	0.936615978	0.37004359	3.280048917	6.402061847	0.588340425	4.12683159	0.121886364	0.241903489	5.398799387	11.05731383	15.08016661	0.552007092	1.758504467	4.344760977	12.98885277	6.510980901	0.252748208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.4381
R7444_001_0	2011	4																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	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	1086.455191	120.6643587	786.9997831	808.8141001	186.2583441	4.726818976	8.470343666	316.0753019	25.4486949	17.48103347	34.48206392	0	0.008084821	20.51926122	5260.824519	86.81414181	594.7825117	764.1405984	0	0	10.65376507	1391.76911	0	0	217.4674933	0	16.10439487	10.45	3.037608514	0											4400	"$320 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$320 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$50 Days 1-20/$100 Days 21-54 (2a); $0 n/c (2a1, 2a2)"	$0 (6a); $0 n/c (6a2)	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/20% (8a1a); $0/$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, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"50% (7b); $0 n/c (7b1); $35 (7d, 7f, 7f1)"	"$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, 18a); $0/$35 (17a)"	$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 (14a1, 14a7); $0 n/c (14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												206.8631108	127.8912646	60.84968972	0	200	0.2	0.091473716	48.67746843	0.2	0.102478515	0.162596943	0	0.2	0.160114054	9.596334413	0.141856062	38.5	35	0	0	0.2	34.82682989	0	0	35	0	35	0	0	0											NO	163.9352337	101.3514893	48.22226674	0	158.4963439	0.158496344	0.072491247	38.59201632	0.158496344	0.08121235	0.128855105	0	0.158496344	0.126887461	9.2640975	0.136972303	37.1670826	33.78825691	0	0	0.158496344	27.59962603	0	0	35	0	35	0	0	0												14.8424	1.019126038	3.162576122	0	2.460105547	0.749183526	0.614025778	1.016498601	4.033525099	1.419675802	4.443189955	0	0.001281415	2.603636956	4.061399273	11.89113295	1.842194228	2.151581571	0	0	1.688582812	3.20102558	0	0	0.634280189	0	0.046971152	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8823	0	11.5152569	14.8424	1.019126038	3.162576122	0	2.460105547	0.749183526	0.614025778	1.016498601	4.033525099	1.419675802	4.443189955	0	0.001281415	2.603636956	4.061399273	11.89113295	1.842194228	2.151581571	0	0	1.688582812	3.20102558	0	0	0.634280189	0	0.046971152	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8823	YES	"$425 Days 1-21 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$425 Days 1-21 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-51 (2a); $0 n/c (2a1, 2a2)"	30% (6a); $0 n/c (6a2)	$200 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30% (8a1a); $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); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"50% (7b); $0 n/c (7b1); $50 (7d, 7f, 7f1)"	"$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 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											8800	1.0405	0.1009	0.0426	0.4625	0.5584	0.2551	0.4571	0.2307	1.3734	0.3223	1.4841	0	0.0003	0.8843	1.8111	3.4394	0.4263	0.6296	0	0	0.5188	0.9329	0	0	0.1477	0	0.0137	0	0	0											15.1315	0	2.493833065	15.8828	1.120021904	3.205147122	0.462545805	3.018534413	1.004273622	1.071140974	1.247237547	5.406903277	1.741933499	5.927286498	0	0.001572288	3.487891403	5.872450909	15.33050318	2.268513312	2.781132117	0	0	2.207364278	4.133893925	0	0	0.781975439	0	0.060714862	0	0	0	0	0	0	0	0	0	0	0	0	0	77.0139
R7444_801_0	2011	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	230.6184957	7.7600475	21.13716531	876.9968908	8.958738406	5.288502496	9.476866757	12.55220455	25.36469965	17.42333606	34.36825339	0	0.008058137	20.43780681	30.69923951	97.05421118	3.220483	8.247256014	0	0	11.9197421	8.994647002	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.071931035	0.071931035	0.15517664	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.060700334	0.060700334	0.130948676	0	0.196621357	0.196621357	0.196621357	0.196621357	0.196621357	0.196621357	0.196621357	0	0.196621357	0.196621357	0.196799288	0.196799288	0.196799288	0.196799288	0	0	0.196621357	0.196621357	0	0	0	0	0	0	0	0												13.9986	0.471037474	2.767883811	0	1.761479303	1.039832538	1.863354402	2.468031492	4.987241666	3.42579998	6.75753262	0	0.001584402	4.018509309	6.041588463	19.10019961	0.63378876	1.623054108	0	0	2.343675868	1.7685397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0718	0	13.86032902	13.9986	0.471037474	2.767883811	0	1.761479303	1.039832538	1.863354402	2.468031492	4.987241666	3.42579998	6.75753262	0	0.001584402	4.018509309	6.041588463	19.10019961	0.63378876	1.623054108	0	0	2.343675868	1.7685397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0718	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.5077	0.0171	0.0139	0	0.3998	0.236	0.423	0.5602	1.1321	0.7776	1.5339	0	0.0004	0.9122	1.2374	3.9121	0.1298	0.3324	0	0	0.48	0.3622	0	0	0	0	0	0	0	0											12.968	0	2.393308547	14.5063	0.488121735	2.781792775	0	2.161324298	1.275868144	2.28632442	3.028259499	6.119314928	4.203435558	8.291451068	0	0.001944051	4.930686269	7.279022245	23.01228869	0.763600916	1.955486877	0	0	2.823705864	2.130770722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0397
R7444_802_0	2011	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	230.6184957	7.7600475	21.13716531	876.9968908	8.958738406	5.288502496	9.476866757	12.55220455	25.36469965	17.42333606	34.36825339	0	0.008058137	20.43780681	30.69923951	97.05421118	3.220483	8.247256014	0	0	11.9197421	8.994647002	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.071931035	0.071931035	0.15517664	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.060700334	0.060700334	0.130948676	0	0.196621357	0.196621357	0.196621357	0.196621357	0.196621357	0.196621357	0.196621357	0	0.196621357	0.196621357	0.196799288	0.196799288	0.196799288	0.196799288	0	0	0.196621357	0.196621357	0	0	0	0	0	0	0	0												13.9986	0.471037474	2.767883811	0	1.761479303	1.039832538	1.863354402	2.468031492	4.987241666	3.42579998	6.75753262	0	0.001584402	4.018509309	6.041588463	19.10019961	0.63378876	1.623054108	0	0	2.343675868	1.7685397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0718	0	13.86032902	13.9986	0.471037474	2.767883811	0	1.761479303	1.039832538	1.863354402	2.468031492	4.987241666	3.42579998	6.75753262	0	0.001584402	4.018509309	6.041588463	19.10019961	0.63378876	1.623054108	0	0	2.343675868	1.7685397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0718	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.5077	0.0171	0.0139	0	0.3998	0.236	0.423	0.5602	1.1321	0.7776	1.5339	0	0.0004	0.9122	1.2374	3.9121	0.1298	0.3324	0	0	0.48	0.3622	0	0	0	0	0	0	0	0											12.968	0	2.393308547	14.5063	0.488121735	2.781792775	0	2.161324298	1.275868144	2.28632442	3.028259499	6.119314928	4.203435558	8.291451068	0	0.001944051	4.930686269	7.279022245	23.01228869	0.763600916	1.955486877	0	0	2.823705864	2.130770722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0397
R7444_803_0	2011	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	230.6184957	7.7600475	21.13716531	876.9968908	8.958738406	5.288502496	9.476866757	12.55220455	25.36469965	17.42333606	34.36825339	0	0.008058137	20.43780681	30.69923951	97.05421118	3.220483	8.247256014	0	0	11.9197421	8.994647002	0	0	0	0	0	0	0	0											6700	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"												0.071931035	0.071931035	0.15517664	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	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	0.060700334	0.060700334	0.130948676	0	0.196621357	0.196621357	0.196621357	0.196621357	0.196621357	0.196621357	0.196621357	0	0.196621357	0.196621357	0.196799288	0.196799288	0.196799288	0.196799288	0	0	0.196621357	0.196621357	0	0	0	0	0	0	0	0												13.9986	0.471037474	2.767883811	0	1.761479303	1.039832538	1.863354402	2.468031492	4.987241666	3.42579998	6.75753262	0	0.001584402	4.018509309	6.041588463	19.10019961	0.63378876	1.623054108	0	0	2.343675868	1.7685397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0718	0	13.86032902	13.9986	0.471037474	2.767883811	0	1.761479303	1.039832538	1.863354402	2.468031492	4.987241666	3.42579998	6.75753262	0	0.001584402	4.018509309	6.041588463	19.10019961	0.63378876	1.623054108	0	0	2.343675868	1.7685397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0718	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a); $0 n/c (2a1, 2a2)"	FFS (6a); $0 n/c (6a2)	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1a, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10, 14a11, 14a12, 14a13); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13c1, 13d, 13e, 13e1, 13e2, 13f)"											10000	0.5077	0.0171	0.0139	0	0.3998	0.236	0.423	0.5602	1.1321	0.7776	1.5339	0	0.0004	0.9122	1.2374	3.9121	0.1298	0.3324	0	0	0.48	0.3622	0	0	0	0	0	0	0	0											12.968	0	2.393308547	14.5063	0.488121735	2.781792775	0	2.161324298	1.275868144	2.28632442	3.028259499	6.119314928	4.203435558	8.291451068	0	0.001944051	4.930686269	7.279022245	23.01228869	0.763600916	1.955486877	0	0	2.823705864	2.130770722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0397
R9896_008_0	2011	6																															A	A	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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	479.7395766	3.994898964	150.1110333	36.43468434	18.30768703	33.23011884	38.06330235	39.14348085	43.25738347	12.36948664	15.98092828	0	0.006951829	3206.183699	62.23079782	111.9757304	0.940610907	5.125440338	31.66498172	52.34171697	2.305656161	15.77733573	1320	439.2094991	447.4518178	0	0	0	0	12000											6700	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: $0, 9D Cardiac Rehab: 20%"	"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: 20%, 14J Nutrition Therapy: 20%"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: $0, MH (Group): $0, 7H Psychiatric: $0, Psychiatric (Group): $0, 9C OP Substance Abuse: $0, OP Substance Abuse (Group): $0"	"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: $9, 13D Meal Benefit: not covered"											0	906.9729091	495.9116026	368.220772	0	0.233	0.233	0.233	0.233766411	0.233	0.233	0.233	0	0.233	28.03792514	0.231432093	0.233	0.233	0.233	0.233	0.22711614	0.233	0.233	0	15	15.52792887	0	0	0	0	0											YES	743.1273249	406.3246641	342.8076135	0	0.220845649	0.220845649	0.220845649	0.232968664	0.220845649	0.220845649	0.220845649	0	0.220845649	26.57533805	0.22018623	0.221939575	0.220845649	0.220845649	0.220845649	0.215268718	0.220845649	0.220845649	0	15	15.52792887	0	0	0	0	0											6700	29.709	0.135268832	4.28826709	0	4.043173018	7.33872715	8.406114698	9.119204446	9.553204911	2.731747301	3.529318472	0	0.001535281	7.100451304	13.70236476	24.85184605	0.207729826	1.131931196	6.993073428	11.2675343	0.50919413	3.484355944	0	0.549011874	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.232	0	12.00948971	29.709	0.135268832	4.28826709	0	4.043173018	7.33872715	8.406114698	9.119204446	9.553204911	2.731747301	3.529318472	0	0.001535281	7.100451304	13.70236476	24.85184605	0.207729826	1.131931196	6.993073428	11.2675343	0.50919413	3.484355944	0	0.549011874	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.232	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: $0, 9C OP Substance Abuse: $0, OP Substance Abuse (Group): $0, 9D Cardiac Rehab: 20%"	"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: 20%, 14J Nutrition Therapy: 20%"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: $0, MH (Group): $0, 7H Psychiatric: $0, Psychiatric (Group): $0, 9C OP Substance Abuse: $0, OP Substance Abuse (Group): $0"	"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: $9, 13D Meal Benefit: not covered"											6700	0	0	0	0	0	3.9516	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											3.9816	0	0.694294761	29.709	0.135268832	4.28826709	0	4.043173018	11.29034946	8.406114698	9.149204446	9.553204911	2.731747301	3.529318472	0	0.001535281	7.100451304	13.70236476	24.85184605	0.207729826	1.131931196	6.993073428	11.2675343	0.50919413	3.484355944	0	0.549011874	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.2136
R9896_009_0	2011	6																															D	A	D	Coin	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	Coin	Coin	Coin	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	2193.9702	4.371964377	93.32945629	31.14387868	273.1894423	27.87875176	32.7840192	616.0149734	215.3406177	9.946211525	17.87357982	0	0.003625803	1675.52862	5594.703532	4533.686131	157.7087096	311.5471329	34.99081665	53.01148071	5.182956445	18.49504759	660	127.5795694	233.2691705	0	0	0	0	12000											3400	1A IP Acute: $220 Per Day for days 0	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: $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: $50, 5 Partial Hosp: $40, 9D Cardiac Rehab: $50"	"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): $50	"7E Mental Health: $40, MH (Group): $30, 7H Psychiatric: $40, Psychiatric (Group): $30, 9C OP Substance Abuse: $40, OP Substance Abuse (Group): $30"	"7C Occupational Therapy: $50, 7I Physical and Speech Therapy: $50"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $15, 7F Podiatry: $50, 7G Other Health Care: $50, 18A Hearing Exams (Medicare Covered): $50"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $50"	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): $50	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	220	1000	130	0	150	0.084	0.229943271	49.46180125	175	0.18	0.2	0	8.97E-17	39.19239361	28.82304198	50	39.5	46.78430731	0.12	0.140782181	0.12	0.148815379	0	10	25	0	0	0	0	0											YES	205.08717	897.8655823	101.6662936	0	146.9034611	0.079024451	0.224109226	48.86839222	158.3625306	0.173787579	0.193939102	0	8.97E-17	38.0138546	28.49059231	49.14011064	39.19611259	46.43402737	0.113333012	0.134421618	0.113333012	0.142377763	0	10	25	0	0	0	0	0											3400	37.4963	0.327119695	0.790704992	0	3.344372884	2.203103066	7.347201172	2.508638444	2.841823762	1.728528024	3.466386016	0	3.25E-19	5.307775112	13.28303479	18.56548651	0.515130695	1.205532341	3.965614641	7.125889026	0.587400065	2.633283495	0	0.106316308	0.485977439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.8356	0	5.150823773	37.4963	0.327119695	0.790704992	0	3.344372884	2.203103066	7.347201172	2.508638444	2.841823762	1.728528024	3.466386016	0	3.25E-19	5.307775112	13.28303479	18.56548651	0.515130695	1.205532341	3.965614641	7.125889026	0.587400065	2.633283495	0	0.106316308	0.485977439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.8356	YES	1A IP Acute: $220 Per Day for days 0	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: $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: $50, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, OP Substance Abuse (Group): $30, 9D Cardiac Rehab: $50"	"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): $50	"7E Mental Health: $40, MH (Group): $30, 7H Psychiatric: $40, Psychiatric (Group): $30, 9C OP Substance Abuse: $40, OP Substance Abuse (Group): $30"	"7C Occupational Therapy: $50, 7I Physical and Speech Therapy: $50"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $15, 7F Podiatry: $50, 7G Other Health Care: $50, 18A Hearing Exams (Medicare Covered): $50"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $50"	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): $50	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	5.0309	0	2.3726	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											7.4335	0	0.23386989	37.4963	0.327119695	0.790704992	5.030934248	3.344372884	4.5756756	7.347201172	2.538638444	2.841823762	1.728528024	3.466386016	0	3.25E-19	5.307775112	13.28303479	18.56548651	0.515130695	1.205532341	3.965614641	7.125889026	0.587400065	2.633283495	0	0.106316308	0.485977439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.2691
R9896_012_0	2011	5																															D	A	D	Coin	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	Coin	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	1028.871186	3.376282951	253.8355399	0	293.0329361	6.885887439	5.977654146	307.9948305	359.1778512	4.89309868	20.46690258	803.4070554	0.284475884	477.2822387	2880.379149	3418.29133	94.1339051	332.3039029	16.02566003	11.4153323	7.08812959	0	0	254.7692308	284.1103472	0	0	0	0	0											3400	$220/Days 1-15 for IP Medical; $220/Days 1-15 for IP Surgical; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse; PBP 1b	$130/Days 21-100 for SNF; PBP 2	No Cost-Sharing; PBP 6	$100/Trip for Ambulance; PBP 10a	20% Coinsurance for DME; PBP 11a	"35% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 35% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Facility; $35/Visit for PCP Urgent Care; $35/Visit for Urgent Care - Worldwide; PBP 4a, 4b"	"$150/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$50/Visit for OP Fac - Other; PBP 9c	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$50/Visit for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $50/Visit for OP Fac - Physical/Speech Therapy; $50/Visit for OP Fac - CORF; $50/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35/Visit for PCP Office Visits; $35/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $15/Visit for Chiropractor; $50/Visit for Vision Exams; $50/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $50/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$10/Visit for Dental - Preventive; PBP 16a, 16b"	$25/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	Not Covered; PBP 18a	Not Covered; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											0	220	1000	130	0	100	0.2	0.244830269	49.17347115	150	0.2	0.2	50	0.2	50	35	46.3857358	39.75	50	0.2	0.2	0.2	0	0	10	25	0	0	0	0	0											YES	201.2601482	914.8188554	118.9264512	0	91.48188554	0.182963771	0.223975346	44.9848186	137.2228283	0.182963771	0.182963771	45.74094277	0.182963771	45.74094277	32.10061595	42.50356368	36.3640495	45.74094277	0.182963771	0.182963771	0.182963771	0	0	10	25	0	0	0	0	0											3400	17.2559	0.257390609	2.515646663	0	2.233933793	1.259867933	1.338847156	1.154590965	4.107283384	0.895259787	3.744701679	3.062383012	0.052048781	1.819278297	7.705162071	12.1074636	0.285257499	1.266657817	2.932115192	2.088592246	1.29687092	0	0	0.212307692	0.591896557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1835	0	6.230861085	17.2559	0.257390609	2.515646663	0	2.233933793	1.259867933	1.338847156	1.154590965	4.107283384	0.895259787	3.744701679	3.062383012	0.052048781	1.819278297	7.705162071	12.1074636	0.285257499	1.266657817	2.932115192	2.088592246	1.29687092	0	0	0.212307692	0.591896557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1835	YES	$220/Days 1-15 for IP Medical; $220/Days 1-15 for IP Surgical; PBP 1a	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse; PBP 1b	$130/Days 21-100 for SNF; PBP 2	30% Coinsurance for Home Health; PBP 6	$100/Trip for Ambulance; PBP 10a	40% Coinsurance for DME; PBP 11a	"35% Coinsurance for DME / Medical Supplies; 0% Coinsurance for Diabetes Monitoring Supplies; 35% Coinsurance for Prosthetics; PBP 11b, 11c"	"$50/Visit for ER - Worldwide; ; PBP 4a, 4b"	"$150/Visit for OP Fac - Surgery; PBP 9a, 9b"	20% Coinsurance for OP Fac - Pathology; PBP 8a	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET; PBP 8b	$50/Visit for OP Fac - Other; PBP 9c	20% Coinsurance for Renal Dialysis - Fac; PBP 12	"$50/Visit for OP Fac - Cardiovascular; $50/Visit for OP Fac - Occ Therapy; $50/Visit for OP Fac - Physical/Speech Therapy; $50/Visit for OP Fac - CORF; $50/Visit for Prof - CORF; PBP 3, 5, 9a, 9c, 9d, 13a"	"$35/Visit for PCP Office Visits; $35/Visit for PCP Consults; PBP 4b, 7a, 14b-c"	"$50/Visit for Speclst Office Visits; $50/Visit for Speclst Consults; $15/Visit for Chiropractor; $50/Visit for Vision Exams; $50/Visit for Hearing/Speech Exams; PBP 4b, 7b, 7d, 7f, 7g, 14d-e, 17a, 18a"	"$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse; PBP 7e, 7h"	"$50/Visit for Occ Therapy; $50/Visit for PT/ST; PBP 7c, 7i"	"20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office); 20% Coinsurance for Prof Radiology (Office); PBP 7d, 14g-h"	"20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); PBP 7d, 7g, 14f, 14i"	20% Coinsurance for Part B Rx; PBP 15	"No Cost-Sharing; PBP 7g, 14a, 14j"	No Cost-Sharing; PBP 10b	"$10/Visit for Dental - Preventive; PBP 16a, 16b"	$25/Visit for Vision (Refractions); PBP 17a	No Cost-Sharing; PBP 17b	Not Covered; PBP 18a	Not Covered; PBP 18b	No Cost-Sharing; PBP 14a	Not Covered; PBP 13b											3400	0	0	0	2.2487	0	1.3568	0	0.004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											3.6095	0	0.335714547	17.2559	0.257390609	2.515646663	2.248688402	2.233933793	2.616648784	1.338847156	1.158580636	4.107283384	0.895259787	3.744701679	3.062383012	0.052048781	1.819278297	7.705162071	12.1074636	0.285257499	1.266657817	2.932115192	2.088592246	1.29687092	0	0	0.212307692	0.591896557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7929
R9943_001_0	2011	10	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	V		V	V	V	V	V		Coin	Coin	V								1.946859482	0.065007088	0.256822204	0	0.312787248	0.225502548	0.127855662	0	0.831446183	0	0	0.232124424	0.010553757	0.047999047	0	0	0.007798113	0.657509622	1.348987326	0	0.985006988	0.011299895	0	0	0	0	0	0	0	0	0.196533294	0.34956201	0	0	0	0	0	0	0	0	7.6137	YES	145.7478441	4.866629092	136.1876675	218.4343031	113.7358685	5.978974085	3.389964752	232.929946	464.9772633	16481.70275	516.2538351	59.0836461	0.559644594	100.8272688	3540.498477	3248.994494	12.40554979	1320.736887	974.6265581	978.1083872	26.11647316	0.599210806	0	0	0	0	0	0	5820.75581	0	5.210883348	9.268286391	118.6644845	0	0	0	0	0	0	0	3300	1A: $850/admit no yrly max	1B: $850/admit no yrly max	2: $120/day (for days 21-100)	6: $0 copay	10A: $175 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $35 copay	9A: $25-$250 copay; 9B: $100 copay	8A: $0 - $185 copay	8B: $40 - $185 copay	9A: $250 copay	12: 10% coin	3: $25 copay; 5: $25 copay; 9C: $40 copay; 9D: $25 copay	7A: $15 copay; 7G: $15 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $25 copay; 7F: $25 copay; 7G: $25 copay	7E: $40 copay; 7H: $40 copay	7C: $25-$50 copay; 7I: $25-$50 copay	8B: $40 - $185 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0; 18A: $25	15: 20% coinsurance	13A: 10% coin	10B: Not covered	-	17A: $0 copay	-	18A: Not Covered	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay; 17B: $0 copay								300	850	850	120	0	175	0.2	0.2	49.59399606	113.7860143	6.888993144	78.75412453	250	0.1	30.29291553	13.48319237	22.35775893	40	31.67905835	88.07569656	0.832444465	0.2	0.1	0	0	0	0	25	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0	NO	736.0118152	736.0118152	103.9075504	0	151.5318443	0.173179251	0.173179251	42.94325537	98.52688346	5.965153351	68.19290135	216.4740633	0.086589625	26.23052206	11.67504575	19.35949968	34.63585013	27.43077793	76.26441565	0.720810543	0.173179251	0.086589625	0	0	0	0	25	0	0	0	0.173179251	0.173179251	0	0	0	0	0	0	0	0		8.9393	0.298491376	1.17924391	0	1.43621716	1.035434252	0.587071555	0.83356418	3.817730052	8.192990367	2.933737237	1.065839745	0.048459416	0.220395992	3.444623476	5.241575657	0.035806397	3.019070019	6.194110411	0.05875257	4.522831251	0.051885439	0	0	0	0	0	0	0	0	0.902416873	1.605074892	0	0	0	0	0	0	0	0	55.6647		8.62094086	10.8862	0.363498464	1.436066114	0	1.749004408	1.2609368	0.714927218	0.83356418	4.649176235	8.192990367	2.933737237	1.297964169	0.059013173	0.268395039	3.444623476	5.241575657	0.04360451	3.676579641	7.543097737	0.05875257	5.507838239	0.063185335	0	0	0	0	0	0	0	0	1.098950168	1.954636902	0	0	0	0	0	0	0	0	63.2783	YES	1A: 15% coin	1B: 15% coin	2: 25% coin (for days 1-100)	6: 30% coin	10A: $175 copay	11A: 25% coin	11B: 25% coin; 11C: 25% coin	4A: $50 copay; 4B: $35 copay	9A: 30% coin	8A: 30% coin	8B: 30% coin	9A: 30% coin	12: 10% coin	3: 30% coin; 5: 30% coin; 9C: 30% coin; 9D: 30% coin	7A: $30 copay; 7G: $30 copay; 14B: $0 copay; 14C: $30 copay	7B: $40 copay; 7D: $40 copay; 7F: $40 copay; 7G: $40 copay	7E: 30% coin; 7H: 30% coin	7C: 30% coin; 7I: 30% coin	8B: 30% coin	14D: 30%; 14E: 30%; 14F: 30%; 14G: 30%; 14H: 30%; 17A: 0%; 18A: 30%	15: 25% coinsurance	13A: 30% coin	10B: Not covered	-	17A: $0 copay	-	18A: Not Covered	-	14A: $0 copay or not covd;  Silver Sneakers		8B: 30% coinsurance	8B: 30% coinsurance	14I: 30% coin; 14J: 30% coin; 17B: 0% coin								3300	11.9716	0.2539	1.5564	0.5516	0.6972	0.6283	0.3562	0.3253	4.2471	4.6029	0.7572	0.181	0.0235	0.1458	2.836	3.7379	0.0196	1.7472	3.3658	0.9311	2.7443	0.0756	0	0	0	0	0	0	0	0	0.6571	1.1687	0.0153	0	0	0	0	0	0	0	43.5965		5.910172235	22.8578	0.61736748	2.992433807	0.551609365	2.446160011	1.889200765	1.071140954	1.158839914	8.896315867	12.79593964	3.690929464	1.478952962	0.082535906	0.414207196	6.280651709	8.979516289	0.063248541	5.42376587	10.90889101	0.989825546	8.25212827	0.138742623	0	0	0	0	0	0	0	0	1.756014778	3.123318407	0.015279439	0	0	0	0	0	0	0	106.8748
R9943_004_0	2011	8	H.6	I.7	I.8								OP Facility - Other	Professional	Professional								Radiology	Radiology	Other								A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	V	V	V	V	V	V	V	V	Coin	Coin	V								1.569635571	0.052411301	0.19555693	0	0.285805726	0.210874728	0.119561966	0	0.678062822	0	0	0.169680804	0.009643374	0.048543265	0	0	0.007125436	0.670282959	0.837463506	0	0.900038732	0.010325149	0	0	0	0	0	0	0	0	0.179580023	0.31940824	0	0	0	0	0	0	0	0	6.264	YES	145.7478441	4.866629092	136.1876675	218.4343031	113.7358685	6.118963517	3.469336102	232.6482042	464.9772633	16481.70275	516.2538351	59.0836461	0.559644594	100.8272688	3540.498477	3248.994494	12.40554979	1320.736887	974.6265581	978.1083872	26.11647316	0.599210806	0	745.9758882	302.4	143.52	129.6	12.6	5822.615019	784.7	5.210883348	9.268286391	118.6644845	0	0	0	0	0	0	0	3300	1A: $750/admit no yrly max	1B: $750/admit no yrly max	2: $100/day (for days 21-100)	6: $0 copay	10A: $175 copay	11A: 20% coin	11B: 20% coin; 11C: 20% coin	4A: $50 copay; 4B: $35 copay	9A: $30-$200 copay; 9B: $100 copay	8A: $0 - $120 copay	8B: $30 - $120 copay	9A: $200 copay	12: 10% coin	3: $30 copay; 5: $30 copay; 9C: $40 copay; 9D: $30 copay	7A: $15 copay; 7G: $15 copay; 14B: $0 copay; 14C: $0 copay	7B: $10 copay; 7D: $30 copay; 7F: $30 copay; 7G: $30 copay	7E: $40 copay; 7H: $40 copay	7C: $30-$50 copay; 7I: $30-$50 copay	8B: $30 - $120 copay	14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 17A: $0; 18A: $30	15: 20% coinsurance	13A: 10% coin	10B: Not covered	16A: $0 Co-Pay	17A: $0 copay	17B: $0 copay	18A: $0 copay	18B: $0 copay	14A: $0 copay or not covd;  Silver Sneakers	7B: Routine/ $30 copay; 13B: $30 copay	8B: 20% coinsurance	8B: 20% coinsurance	14I: $0 copay; 14J: $0 copay; 17B: $0 copay								250	750	750	100	0	175	0.2	0.2	49.59399606	101.5553452	5.08452967	54.05428419	200	0.1	33.52861035	13.48319237	26.4770119	40	35.34324668	59.84008752	0.998933358	0.2	0.1	0	20	0	0	0	0	0	30	0.2	0.2	0	0	0	0	0	0	0	0	NO	652.9953675	652.9953675	87.066049	0	152.3655858	0.174132098	0.174132098	43.17953291	88.42022662	4.426899094	47.06292956	174.132098	0.087066049	29.19203632	11.73928288	23.05248816	34.8264196	30.77196847	52.10039992	0.869731807	0.174132098	0.087066049	0	20	0	0	0	0	0	30	0.174132098	0.174132098	0	0	0	0	0	0	0	0		7.9311	0.264823854	0.988110177	0	1.444119352	1.065507955	0.604122774	0.837136733	3.426116249	6.080236249	2.02470149	0.857363271	0.048726044	0.245279441	3.463576095	6.241450592	0.036003407	3.386806153	4.231536121	0.070890998	4.547716264	0.052170917	0	1.243293147	0	0	0	0	0	1.96175	0.90738205	1.613906154	0	0	0	0	0	0	0	0	53.5738		7.482443451	9.5007	0.317235155	1.183667107	0	1.729925079	1.276382683	0.72368474	0.837136733	4.104179072	6.080236249	2.02470149	1.027044075	0.058369417	0.293822706	3.463576095	6.241450592	0.043128843	4.057089112	5.068999627	0.070890998	5.447754996	0.062496066	0	1.243293147	0	0	0	0	0	1.96175	1.086962072	1.933314394	0	0	0	0	0	0	0	0	59.8378	YES	1A: 15% coin	1B: 15% coin	2: 20% coin (for days 1-100)	6: 30% coin	10A: $175 copay	11A: 25% coin	11B: 25% coin; 11C: 25% coin	4A: $50 copay; 4B: $35 copay	9A: 30% coin	8A: 30% coin	8B: 30% coin	9A: 30% coin	12: 10% coin	3: 30% coin; 5: 30% coin; 9C: 30% coin; 9D: 30% coin	7A: $30 copay; 7G: $30 copay; 14B: $0 copay; 14C: $30 copay	7B: $45 copay; 7D: $45 copay; 7F: $45 copay; 7G: $45 copay	7E: 30% coin; 7H: 30% coin	7C: 30% coin; 7I: 30% coin	8B: 30% coin	14D: 30%; 14E: 30%; 14F: 30%; 14G: 30%; 14H: 30%; 17A: 0%; 18A: 30%	15: 25% coinsurance	13A: 30% coin	10B: Not covered	$16A: 20% coinsurance	17A: $0 copay	17B: $0 copay	18A: 30% coinsurance	18B: $0 copay	14A: $0 copay or not covd;  Silver Sneakers	7B: Routine/ $45 copay; 13B: $45 copay	8B: 30% coinsurance	8B: 30% coinsurance	14I: 30% coin; 14J: 30% coin; 17B: 0% coin								3300	11.841	0.2511	1.2315	0.5456	0.6896	0.636	0.3606	0.3271	4.2008	4.6283	0.7614	0.179	0.0233	0.1442	2.8516	4.2283	0.0194	1.7281	3.3291	0.9362	2.7144	0.0747	0	0.827	0	0	0.0673	0	0	1.1981	0.6499	1.1559	0.0154	0	0	0	0	0	0	0	45.6146		5.734644045	21.3417	0.568334795	2.415178929	0.545592035	2.419475635	1.912342586	1.084261926	1.164202162	8.304988018	10.70851135	2.786059855	1.206058519	0.081635548	0.438044245	6.315208403	10.46977109	0.062558583	5.785215845	8.398076539	1.007086819	8.162108446	0.137229124	0	2.070264222	0	0	0.067268144	0	0	3.15981875	1.736858976	3.089247127	0.015363508	0	0	0	0	0	0	0	105.4524
R9943_805_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	300.9469576	3.603329837	34.14683813	7.696949074	9.744147465	9.571415143	2.415969774	13.7022187	55.44297794	6.425374441	26.82792789	0	0.023591778	32.82292159	63.56662547	175.0277753	1.693047685	6.732218735	26.45484376	31.94142322	60.30512661	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.047754759	0.047754759	0.102495828	0	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805																			NO	0.037368392	0.037368392	0.080203616	0	0.154975342	0.154975342	0.154975342	0.154975342	0.154975342	0.154975342	0.154975342	0.154975342	0.154975342	0.154975342	0.154975342	0.154975342	0.154975342	0.154975342	0.154975342	0.154975342	0.154975342	0.154975342																				11.2459	0.134650642	2.738699876	0	1.510102586	1.483333335	0.374415742	2.12350603	8.592294469	0.995774602	4.157667301	0	0.003656144	5.0867435	9.851259523	27.12498934	0.262380644	1.043327901	4.099848459	4.950132988	9.345807622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1245		26.43940007	11.2459	0.134650642	2.738699876	0	1.510102586	1.483333335	0.374415742	2.12350603	8.592294469	0.995774602	4.157667301	0	0.003656144	5.0867435	9.851259523	27.12498934	0.262380644	1.043327901	4.099848459	4.950132988	9.345807622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1245	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.9846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.9846		4.665776483	13.2305	0.134650642	2.738699876	0	1.510102586	1.483333335	0.374415742	2.12350603	8.592294469	0.995774602	4.157667301	0	0.003656144	5.0867435	9.851259523	27.12498934	0.262380644	1.043327901	4.099848459	4.950132988	9.345807622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1091
R9943_806_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	274.8891788	3.291332094	21.24837922	6.174690696	8.412069451	9.279402472	2.342261364	10.66762029	44.94153768	4.75948943	19.87234213	0	0.017475218	24.31303417	57.13513969	157.3189754	1.521750058	6.051072478	23.77821982	28.70968317	34.28443068	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.047754759	0.047754759	0.102495828	0	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805																			NO	0.039489873	0.039489873	0.08475694	0	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611																				10.8553	0.129974285	1.800947599	0	1.377674991	1.519721252	0.383600602	1.747074698	7.360237915	0.779478771	3.254565233	0	0.00286198	3.981833404	9.357228149	25.7646967	0.249222502	0.991005991	3.894244926	4.701888487	5.614885018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7665		17.53159414	10.8553	0.129974285	1.800947599	0	1.377674991	1.519721252	0.383600602	1.747074698	7.360237915	0.779478771	3.254565233	0	0.00286198	3.981833404	9.357228149	25.7646967	0.249222502	0.991005991	3.894244926	4.701888487	5.614885018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7665	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.9156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.9156		3.093810731	12.771	0.129974285	1.800947599	0	1.377674991	1.519721252	0.383600602	1.747074698	7.360237915	0.779478771	3.254565233	0	0.00286198	3.981833404	9.357228149	25.7646967	0.249222502	0.991005991	3.894244926	4.701888487	5.614885018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6821
R9943_807_0	2011	6																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	274.8891788	3.291332094	21.24837922	6.174690696	8.412069451	9.279402472	2.342261364	10.66762029	44.94153768	4.75948943	19.87234213	0	0.017475218	24.31303417	57.13513969	157.3189754	1.521750058	6.051072478	23.77821982	28.70968317	34.28443068	0																				Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing																				0.047754759	0.047754759	0.102495828	0	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805	0.19805																			NO	0.039489873	0.039489873	0.08475694	0	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611	0.163773611																				10.8553	0.129974285	1.800947599	0	1.377674991	1.519721252	0.383600602	1.747074698	7.360237915	0.779478771	3.254565233	0	0.00286198	3.981833404	9.357228149	25.7646967	0.249222502	0.991005991	3.894244926	4.701888487	5.614885018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7665		17.53159414	10.8553	0.129974285	1.800947599	0	1.377674991	1.519721252	0.383600602	1.747074698	7.360237915	0.779478771	3.254565233	0	0.00286198	3.981833404	9.357228149	25.7646967	0.249222502	0.991005991	3.894244926	4.701888487	5.614885018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7665	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	Medicare FFS cost sharing	Medicare FFS cost sharing																			6700	1.9156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			1.9156		3.093810731	12.771	0.129974285	1.800947599	0	1.377674991	1.519721252	0.383600602	1.747074698	7.360237915	0.779478771	3.254565233	0	0.00286198	3.981833404	9.357228149	25.7646967	0.249222502	0.991005991	3.894244926	4.701888487	5.614885018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6821
